Стан мікрофлори та ступінь вираженості місцевого імунного захисту в ендометрії жінок з безпліддям, що розвивається на тлі хронічного ендометриту поєднаного з бактеріальним вагінозом

Abstract

The purpose of the study was to evaluate the taxonomic profile of the microbiota and the state of local immunity in the endometrium of women with infertility under conditions of chronic endometritis combined with bacterial vaginosis. Materials and methods. Diagnosis of chronic form of endometritis was performed on clinical symptoms, medical history, scraping, endoscopic and ultrasound examinations. All women were divided into three groups: Group I – 12 healthy women, who had no signs of chronic endometritis and formed a control group; Group II – patients with severe chronic endometritis (n = 16); Group III – patients with chronic endometritis developed on the background of bacterial vaginosis (n = 12). Diagnosis of bacterial vaginosis in patients was performed by detecting an increase in the pH of vaginal secretions >4.5, the presence of homogeneous vaginal discharge with an unpleasant odor, detection of vaginal epitheliocytes with adherent gram-variable microorganisms, detection of "fishy" odor. The study was performed in the second phase of the menstrual cycle (day 18-23). Endometrial aspirate for the study of microflora was selected using a device for obtaining endometrial cytology Endobrash Standard for Endometrial Cytology. Results and discussion. It was found that the development of chronic endometritis on the background of bacterial vaginosis increases the frequency of detection of opportunistic anaerobic microflora in the endometrium compared to women without bacterial vaginosis. It has been shown that a decrease in the level of T-helpers and an increase in the level of T-suppressors / killers in the endometrium are exacerbated in patients with chronic endometritis developed against the background of bacterial vaginosis. Thus, the level of CD4 + cells decreased by 1.6 times, and the level of CD8 + cells increased by 1.9 times compared to healthy women. Against this background, the level of B-lymphocytes and IgA in the endometrium of women with chronic endometritis and bacterial vaginosis decreased. Conclusion. The development of chronic endometritis is associated with an increase in the frequency of detection and quantitative content in the endometrium of Streptococcus spp., Staphylococcus spp. The development of bacterial vaginosis is accompanied by the detection in the endometrium of new species of microorganisms – Prevotella spp., Mobiluncus spp. The imbalance of the endometrial microflora is accompanied by significant violations of local cellular and humoral immune defense, which is expressed by a decrease in the level of T-helpers, B-lymphocytes and IgA with a simultaneous increase in T-suppressors / killers in women with chronic endometritis. The established changes amplify at a bacterial vaginosis