Assessment of immune-hormonal balance in women of reproductive age after urgent surgical interventions
Keywords:immune-hormonal balance, women, reproductive age, urgent surgical
The majority of urgent gynecological operations are performed on patients of
childbearing age, which requires the development of individualized rehabilitation
therapy in view of the heterogeneity of the «acute abdomen» symptom complex
The objective: work was to evaluate the immuno-hormonal homeostasis in women
of reproductive age who underwent urgent gynecological operations in the
dynamics of the six-month postoperative period.
Materials and methods. The studied cohort included 90 women aged 19 to 40 years.
The main group consisted of 60 women who were urgently operated on for ectopic
pregnancy, ovarian apoplexy, complicated ovarian neoplasm. The control group
consisted of 30 women of reproductive age without somatic and gynecological
pathology. The comprehensive examination included the determination of the level
of 25(OH)D, estradiol, free testosterone index, follicle-stimulating and luteinizing
hormone, prolactin, progesterone in blood, serum concentrations of TNFα, IL10,
IL8 and IL4. Examinations were carried out one and six months after surgery.
Results. Before this surgical intervention, premenstrual syndrome (15.0%),
dysmenorrhea (28.3%), abnormal uterine bleeding (23.3%), pelvic inflammatory
diseases (23.3%) were experienced by were observed in the patients of the main
group. In the postoperative period, the predominant violation of the menstrual
cycle was an increase in its duration in 56.7% patients. 63.3% patients after
urgent gynecological operations, normogonadotropic dysfunction of the ovaries
was observed, which was characterized by anovulation, insufficiency of the
luteal phase against the background of ovarian blood flow disorders. Transient
hyperprolactinemia (31.6±1.2 ng/m) was detected in 15.0% patients, which persisted
up to 3 months after surgery. An unfavorable prognostic factor was the detection
of an imbalance of pro- and anti-inflammatory cytokines in blood serum in 27.8%
operated patients one month after surgery, which correlated (r=0.876) with the
development of pain syndrome in half (56.0%) of this layer of women.
Conclusions. In the postoperative period, 56.7% of patients experience an increase
in the duration of the menstrual cycle, and 13.3% of women experience a delay in
menstruation of up to 3.4±1.5 months. An unfavorable prognostic factor was the
detection of an imbalance of pro- and anti-inflammatory cytokines in blood serum
in 25 (27.8%) operated patients one month after surgery, which correlated with the
development of pain syndrome in 56.0%.
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