ПАТОГЕНЕТИЧЕСКИЕ БИОХИМИЧЕСКИЕ АСПЕКТЫ ПРИ ИСТИННОЙ И ИНФИЦИРОВАННОЙ СУБИНВОЛЮЦИИ

Abstract

The aim of the study was to analyze the activity of cholinesterase, the content of norepinephrine, monoamine oxidase, TNF-α, procalcitonin, highly sensitive CRP in the blood serum of puerperas with various types of postpartum uterine subinvolution. A survey of 111 puerperas (mean age 25.1±2.3) who were hospitalized in the physiological department of the 3rd City Clinical Hospital named after E.V. Klumova, Minsk. All patients were divided into the following groups: 1st – 34 puerperas with infected subinvolution (mean age 22.6±2.0); 2nd – 45 puerperas with true true (mean age 23.0±2.1). The control group consisted of 32 puerperas with a physiological postpartum period (mean age 25.4±1.9). The obtained results demonstrated that an important link in the pathogenesis of postpartum subinvolution of the uterus is a decrease in the content of norepinephrine and an increase in the activity of cholinesterase in the blood serum. The threshold level of HoA concentration was 57.8 ng/ml (ROC-curve area 0.98±0.02; CI 0.95-1.0; p < 0.001), PN was 97.0%, DS 94.0%. The threshold level of ChE activity was 4124 U/l (ROC-curve area 0.94±0.03; CI 0.88-1.0; p < 0.001), PM was 93.0%, DS 88.0%. The conducted ROC-analysis allows us to regard the studied parameters as predictors of the development of SCI, which makes it possible to conduct a reliable and timely differential diagnosis of the normal and complicated course of puerperia. A significant increase in the level of C-reactive protein up to 17.4±1.2 mg/l (p = 0.001) and procalcitonin up to 0.8±0.03 mg/l (p = 0.001), as well as an increase in the concentration TNF-α up to 336.0±96.0 (p = 0.007) compared with normal data. Therefore, the treatment of postpartum subinvolution of the uterus, accompanied by hypotension and congestion in the uterine cavity, should be aimed at stimulating the adreno- and cholinergic parts of the ANS.