Analysis of the efficacy of cytokine therapy in the treatment of chronic endometritis in women with reproductive losses

Abstract

Aim: to evaluate the efficacy of using cytokine as an adjuvant therapeutic agent for the treatment of chronic endometritis (CE) in women with reproductive losses Patients and Methods: this prospective cohort study included 60 women with reproductive losses in the medical history who were examined at the preconception stage to identify potential causes of pregnancy losses and to prepare for future pregnancy. The diagnosis of moderate/ severe CE was established by histological and immunohistochemical methods in all patients. All patients received a two-stage treatment course. At the first stage, patients received standard treatment — antibacterial and enzymatic therapy. The study group patients (n=30, mean age 32.9±7.1 years) additionally received adjuvant cytokine therapy in rectal suppositories for 20 days, and the comparison group patients (n=30,mean age 33.5±7.5 years) — only standard therapy. One month after the end of treatment, a control examination of the endometrium was performed on days 21–23 of the ovarian cycle to assess histopathological findings in the endometrium and to measure immunohistochemical markers CD16, CD20, HLA-DR and CD138. Results: immunohistochemical tests showed that in the study group 16 (53.3%) patients had signs of moderate CR and 14 (46.7%) — severe CR, while in the comparison group 21 (70.0%) and 9 (30%) had moderate and severe CE, respectively. After the treatment these indicators in the study group amounted to 6 (20%) and 1 (10%), in the comparison group — 7 (23.3%) and 9 (30%). The combination therapy administered to both groups led to a statistically significant decrease in all evaluated (CD16+, CD20+, HLA-DR+, CD138+) indicators of local immunity. A decline in CD20 and CD138 markers after the treatment was more pronounced in the study group than in the comparison group (p=0.005 and p<0.001 respectively). Conclusion: topical cytokine therapy in patients with recurrent pregnancy loss has demonstrated its effectiveness for the correction of immune imbalance as it improves the morphological and functional characteristics of the endometrium. KEYWORDS: chronic endometritis, recurrent pregnancy loss, cytokines, cytokine therapy, preconception preparation. FOR CITATION: Pluzhnikova T.A., Alyabeva E.A., Samarskaya I.V. Analysis of the efficacy of cytokine therapy in the treatment of chronic endometritis in women with reproductive losses. Russian Journal of Woman and Child Health. 2023;6(2):88–94 (in Russ.). DOI: 10.32364/2618- 8430-2023-6-2-88-94.