Actualization of differential diagnosis of chronic pelvic pain syndrome in women of reproductive age

Abstract

The objective: to study the significance of the levels of tumor necrosis factor α (TNF-α) and brain-derived neurotrophic factor (BDNF) in the blood of patients with chronic pelvic pain syndrome (CPPS).Materials and methods. The examined cohort included 150 patients with CPPS, who according to the clinical manifestations were divided into groups A and B: group A (n=74) included the patients with CPPS and suspicion of endometriosis and group B (n=76) – patients with CPPS and suspicion for benign proliferative diseases of reproductive organs. The control group included healthy women (n=50).Serum TNF-α and plasma BDNF levels were investigated by enzyme-linked immunosorbent assay. A visual analog scale (VAS) was used to study pain intensity.Results. The mean concentration of TNF-α in blood serum was significantly higher in women of group A (10.76±0.55 pg/ml) and group B (14.65±0.95 pg/ml) than in the control one (5.02±0.31 pg/ml). The mean concentration of BDNF in blood plasma was higher in women in group A (1473.88±53.02 pg/ml; p<0.001) and in group B (1711.65±66.79 pg/ml; p<0.01) compared to the control group (1082.91±56.24 pg/ml). The levels of TNF-α (p<0.001) and BDNF (p<0.01) are significantly higher in the blood of patients with CPPS and suspected combined benign proliferative diseases of the reproductive organs (group B) than in patients with CPPS and suspected endometriosis (group A).Between the intensity of pain according to VAS and the level of TNF-α in the blood a direct correlation of medium strength was found (r=0.56) in patients of group A and group B (r=0.62). A strong direct correlation between the intensity of pain according to VAS and the level of BDNF in the blood was established in women of group A (r=0.74) and group B (r=0.83).Between the disease duration and the level of TNF-α in the blood of patients a direct correlation of medium strength (r=0.65) in group A and a direct strong correlation (r=0.72) in group B were determined. Between the duration of the disease and the level of BDNF in the blood of patients a direct correlation of average strength was also establishe, a strong correlation (r=0.67) was determined in group A and a direct strong correlation (r=0.78) – group B.Conclusions. Women with CPPS and suspicion of benign proliferative diseases of the organs of the reproductive system have significantly higher concentrations of TNF-α and BDNF in the blood compared to healthy women (p<0.001).The existence of a direct correlation between the intensity of pain, the duration of the disease, and the levels of TNF-α and BDNF suggest the possibility of their use as objective markers of the effectiveness of diagnostic and therapeutic measures.