Research Article
Open Access
Rehabilitation of Endometrial Receptivity in
Patients with Different Morphological Types of
Chronic Endometritis
Burova NA*, Zabolotneva KO and Zharkin NA
Volgograd state medical University, Ministry of health of Russia, Volgograd
*Corresponding author: Dr. Burova NA, Volgograd state medical University, Ministry of health of Russia, Volgograd, Tel: +79033715434;E-mail:
@
Received: December 20, 2018; Accepted: January 05, 2019; Published: January 21, 2019
Citation: Burova NA, Zabolotneva KO, Zharkin NA (2018) Rehabilitation of Endometrial Receptivity in Patients with Different Morphological Types of Chronic Endometritis. SOJ Gynecol Obstet Womens Health 4(2): 1-3. DOI: http://dx.doi.org/10.15226/2381-2915/4/2/00137
AbstractTop
A study of the local immune profile of 57 patients of reproductive
age with different morphological types of chronic endometritis
revealed a cellular and immune imbalance in the endometrium,
causing a decrease in its receptivity. The use of laser-magnetic
vaginal exposure contributed to a decrease in the expression of
estrogen receptors in the stromal and glandular components of the
endometrium. The best results of the regulation of the ratio of steroid
receptors of the endometrium were achieved in hyperplastic and
fibrous morphological type of chronic endometritis due to the relief
of tissue reception disorders and the regulation of the endometrial
gravidar transformation.
Keywords: Chronic Endometritis; Endometrial Receptivity; Vaginal Laser-Magnetopuncture.
Keywords: Chronic Endometritis; Endometrial Receptivity; Vaginal Laser-Magnetopuncture.
AbbreviationsTop
CE: Chronic Endometritis; IHCI: Immuno Histo Chemical Tests
Of The Endometrium; PID: Pelvic Inflammatory Disease
IntroductionTop
Currently, chronic endometritis (CE) acquires not only
medical, but also social significance, being the cause of
infertility and disrupting reproductive function in women [1].
The proportion of CE in comparison with pelvic inflammatory
disease (PID) ranges from 0.2 to 66.3% [2]. In most cases (76-
88%), CE occurs at fertile age, courses disorders not only in
the reproductive function, but also in the functions of the other
systems. As a result, there is a disbalance in the receptor profile
of the endometrium, namely, the number of functionally complete
receptors determines the normal endometrial transformation
necessary for successful implantation and pregnancy [3,4]. In
addition, chronic inflammation in the endometrium leads to
disadaptation of local immunity, activation of lymphocytes,
which causes perverted hormone perception in the form of “thin”
endometrium, fibrosis, polyposis and endometrial hyperplasia
[5].
The aim was to evaluate the effectiveness of preformed factors in the rehabilitation of endometrial receptivity in patients with different morphological types of chronic endometritis based on the study of local immune profile.
The objects included the analysis of data of histological and immunohistochemical tests of the endometrium, with the study of the morphological type of endometritis, as well as the identification of cellular and immune imbalance in the endometrium with the evaluation of the receptivity markers of endometrium stroma and glands, to determine the effectiveness of a complex method of rehabilitation vaginal laser-magnetopuncture.
The aim was to evaluate the effectiveness of preformed factors in the rehabilitation of endometrial receptivity in patients with different morphological types of chronic endometritis based on the study of local immune profile.
The objects included the analysis of data of histological and immunohistochemical tests of the endometrium, with the study of the morphological type of endometritis, as well as the identification of cellular and immune imbalance in the endometrium with the evaluation of the receptivity markers of endometrium stroma and glands, to determine the effectiveness of a complex method of rehabilitation vaginal laser-magnetopuncture.
Materials and MethodsTop
57 patients aged 18 to 44 years with CE and reproductive
dysfunction were examined. All patients underwent hysteroscopy
with endometrial biopsy on the 7th-10th day of the menstrual
cycle. The data of histological and immunohistochemical tests
of the endometrium (IHCE) were analyzed. The following
parameters were evaluated: morphological type of endometritis,
for which the biopsy materials were fixed in 10% neutral
formalin, enclosed in paraffin, made sections 5 microns thick
and stained with hematoxylin and eosin. Immunohistochemical
study of estrogen and progesterone receptor expression in the
stroma and epithelium of the endometrium was performed
in stepped paraffin sections with peroxidase-antiperoxidase
method. The following primary antibodies were used: on alphaestrogen
receptors (clone ID5), on progesterone receptors (clone
PgR 636) on plasma cells (CD138) (clone VS 38c), the PgR/ER
coefficient, the level of T-lymphocytes (CD3), NK-cells (CD56)
and the concentration of LIF were determined. All antibodies are
produced by “Dako”, Denmark, visualized system En Vision.
All women received vaginal laser-magnetopuncture on the unit KLM-01 “Androgin” in 2 days after operation (during postoperative period) “. In total, 7 procedures were performed.
Control pipel-endometrial biopsy followed by morphological and immunohistochemical tests was performed on the 7th-10th day of the next menstrual cycle.
All women received vaginal laser-magnetopuncture on the unit KLM-01 “Androgin” in 2 days after operation (during postoperative period) “. In total, 7 procedures were performed.
Control pipel-endometrial biopsy followed by morphological and immunohistochemical tests was performed on the 7th-10th day of the next menstrual cycle.
Results and DiscussionTop
Morphological study of 57 endometrial samples before
treatment revealed fibrous form of CE in 10 (17.5%) patients,
cystic - in 1 (1.8%), hyperplastic - in 30 (52.6%), hypoplastic -
in 16 (28.1%) patients. The results of IHCE in patients with
fibrous and cystic forms of CE showed a decrease in the PgR/
ER ratio to 1 in the epithelium of the glands and to 0.48 in the
endometrial stroma at a rate of 2.2 and 1.5 points. The study of
the material on plasmocytes (CD138) determined nonspecific
staining of epithelial and stromal components. T-lymphocytes
(CD3) up to 6% in the form of perivascular clusters were isolated
in the stroma in the superficial parts of the mucosa. There was a
decrease in LIF by 20% (8 points at a rate of 10 points), a clone
of CD56-positive lymphocytes (7-8% at a rate of 10% in the
field of view). The hyperplastic form of chronic endometritis
was characterized by a decrease in the PgR/ER ratio to 1 in the
epithelium of the glands and in the stroma of the endometrium,
nonspecific staining of epithelial and stromal cells in the study of
the material on CD138. CD3 was detected as uneven scattering
and perivascular clusters of up to 5% of stromal cells only.
There was a decrease in LIF in the stromal component by 30%
(7 points) and CD56 clone (6-7%). The hypoplastic form of
chronic endometritis was characterized by a decrease in the PgR/
ER coefficient to 0.97 in the epithelium of the glands and 0.41
in the stroma of the endometrium. Weak nonspecific staining
of epithelial and stromal components on CD138 was noted. In
the stroma in the superficial parts of the mucosa, an increased
amount of up to 8% CD3 was released. There was a 20% decrease
in LIF in the epithelial and stromal components. A clone of CD56
was determined above the norm (14-15%). Depending on the
morphological type of chronic endometritis, the features of
IHCE indices were revealed. The clone of CD56 was higher than
normal only in the hypoplastic type of CE, and in other variants of
CE its content was lower than normal. CD138 plasma cells were
determined in all morphological variants of CE, being less colored
in hypoplastic type. The level of T-lymphocytes was the highest in
the hypoplastic type, and the lowest – in the hyperplastic type, a
decrease in LIF by 20-30% and the PgR/ER coefficient to 0.41 -1
in any type of morphological variant of CE indicate the intensity
of the inflammatory process and the high activity of local immune
processes occurring in the endometrium, contributing to a
decrease in the receptivity of the endometrium with a violation
of implantation.
After the laser-magnetopuncture, the number of CD138 WAS not determined in the group with hypoplastic type of CE, and in the groups with hyperplastic and fibrous type decreased from 8.5±1.5 to 4.2±0.7 and 7.9±2.1 to 4.7±1.4, respectively (p< 0.05), which indicates a decrease in the adaptive imbalance in all morphological variants of CE. In addition, there was a decrease in the number of T-lymphocytes (CD3) in the stroma and mucosa in patients with hypoplastic type of CE by 1.6 times (from 8.2±1.4% to 5.1±1.6 %) (p< 0.05), clone of CD56 by 1.4 times (from 14.5±1.2 to 10.1±0.6) (p< 0.05). The number of CD3 cells in the groups of patients with hyperplastic and fibrous forms of CE did not change, and the number of CD56 increased from 6.2±1.1 to 9.8±1.3 and from 7.6±1.4 to 10.2±0.2, respectively (p< 0.05). LIF expression after treatment increased in all groups of CE from 8.1±1.0 to 10.0±1.0 in glands and stroma from 8.3±1.6 to 9.5±1.6 (p< 0.05).
The use of preformed factors in the treatment of patients with CE led to a decrease in the expression of estrogen receptors in the stromal and glandular components of the endometrium in all groups of the examined patients (Fig 1).
After the laser-magnetopuncture, the number of CD138 WAS not determined in the group with hypoplastic type of CE, and in the groups with hyperplastic and fibrous type decreased from 8.5±1.5 to 4.2±0.7 and 7.9±2.1 to 4.7±1.4, respectively (p< 0.05), which indicates a decrease in the adaptive imbalance in all morphological variants of CE. In addition, there was a decrease in the number of T-lymphocytes (CD3) in the stroma and mucosa in patients with hypoplastic type of CE by 1.6 times (from 8.2±1.4% to 5.1±1.6 %) (p< 0.05), clone of CD56 by 1.4 times (from 14.5±1.2 to 10.1±0.6) (p< 0.05). The number of CD3 cells in the groups of patients with hyperplastic and fibrous forms of CE did not change, and the number of CD56 increased from 6.2±1.1 to 9.8±1.3 and from 7.6±1.4 to 10.2±0.2, respectively (p< 0.05). LIF expression after treatment increased in all groups of CE from 8.1±1.0 to 10.0±1.0 in glands and stroma from 8.3±1.6 to 9.5±1.6 (p< 0.05).
The use of preformed factors in the treatment of patients with CE led to a decrease in the expression of estrogen receptors in the stromal and glandular components of the endometrium in all groups of the examined patients (Fig 1).
Figure 1: Changes In Endometrial Receptivity Parameters In The Dynamics Of Treatment
Thus, in women with fibrous form of CE, ER expression
in glands and stroma decreased by 1.2 times by 1.3 times,
which provided an increase in PgR/ER to 2 1 in epithelium and
stroma (p< 0.05). In the hyperplastic type of CE, er expression
decreased 1.3 times in both glands and stroma, which led to an
increase in PGR/e to 3 2 in the epithelium and stroma (p< 0.05).
In the hypoplastic type of CE, ER expression in the glands
and stroma decreased only by 1.1, and PgR/ER increased to
1.5 1 in the epithelium and stroma (p< 0.05). This indicates a
General normalization of immune processes occurring in the
endometrium against the background of CE.
ConclusionTop
The study revealed the features of local immune disorders
in various morphological types of CE, damaging the receptors of
the endometrium. “Adverse” morphotype CE according to IHCE
is hypoplastic type, in which the developing giperaktivnosti and
inhibition of cell-mediated reactions in the form of higher levels
of clone CD56-positive lymphocytes and T-lymphocytes (CD 3),
weak expression of plasma cells (CD138), a reduced expression of
the bodice in the epithelial and stromal components and reduce
the ratio of PgR/ER in 2 times in comparison with the norm.
The use of laser-magnetopuncture in the early rehabilitation of
patients with CE contributes to the restoration of the immune
profile of the endometrium. The best results were observed in
hyperplastic and fibrous morphotype of CE, with an increase
of 1.2 times factor (LIF), 1.4 times and NK-cells and CD56 on
the background of a stable number of T-lymphocytes (CD3),
reduction of plasma cells CD138 2.7 times. The PgR/ER ratio
increased to an average of 2.5, which corresponds to normal
values. Consequently, the use of preformed factors influences on
treatment and rehabilitation of patients with CE helps to regulate
the ratio of steroid receptors in the endometrium, the relief of
human tissue reception, which leads to normalization gravitinos
transformation of the endometrium.
ReferencesTop
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