Клинические и фенотипические признаки недифференцированной дисплазии соединительной ткани при интрамуральной миоме матки как маркеры прогнозирования инфертильности

Abstract

Objective. To examine associations between clinical and phenotypic signs of undifferentiated connective tissue dysplasia (UCTD) and uterine leiomyoma, as well as fertility and infertility in case of intramural uterine leiomyoma. Patients and methods. In this retrospective cross-sectional study, 400 patients were included and divided into two groups. The study group consisted of 370 patients with intramural leiomyoma, including 240 infertile and 130 fertile patients (70 women in the first trimester of pregnancy and 60 women delivered less than 12 months ago, in whom leiomyoma was diagnosed before and/or during pregnancy). The control group consisted of 30 patients without leiomyoma and infertility who referred for a preventive examination. Results. The frequency of clinical and phenotypic signs of UCTD was significantly higher (2.5-fold) in patients with leiomyoma compared to healthy controls. A number of UCTD signs were significantly associated with infertility in intramural leiomyoma (De Quervain syndrome, mitral valve prolapse, hematomas due to minor trauma, hyperpigmentation, history of uterine appendage torsion, scoliosis, varicose veins, iron-deficiency anemia). Based on the findings, significant diagnostic coefficients and informativeness coefficients for several UCTD signs, expressed in rounded scores, were obtained using mathematical calculations, which allows their use as prognostic criteria for fertility/infertility in intramural leiomyoma. The identified clinical symptoms are apparently both systemic (manifested as UCTD signs) and localized (leiomyoma formation and infertility). Conclusion. A high frequency of the combination of clinical and phenotypic signs of UCTD with infertility in intramural uterine leiomyoma was established. The present study allowed us to determine significant signs of UCTD, the presence of which is associated with a high risk of infertility. The results of the study and the risk score can be used to assess potential fertility in intramural leiomyoma in patients of reproductive age and to choose treatment tactics. Key words: uterine leiomyoma, undifferentiated connective tissue dysplasia, infertility, infertility risk prediction