Хронический эндометрит у пациенток с повторными неудачами имплантации: эпидемиология, этиология, патогенез и преодоление бесплодия
DOI:
https://doi.org/10.37800/RM2021-2-3Ключевые слова:
хронический эндометрит, повторные неудачи имплантации, цитокинотерапия, репродуктивные исходыАннотация
Данные последних лет указывают на то, что качество эндометрия играет гораздо более важную роль в успешной имплантации и наступлении клинической беременности, чем многие другие признанные факторы. Хронический эндометрит (ХЭ) ассоциирован с отрицательными репродуктивными исходами, которые включают повторные неудачи имплантации. Streptococcusspp., Escherichiacoli, Enterococcusfaecalis, Klebsiellapneumoniae, Staphylococcusspp., Corynebacterium и Mycoplasma / Ureaplasmaspp в настоящее время считаются основными возбудителями ХЭ. Это заболевание нарушает архитектонику эндометрия на разных уровнях: прежде всего, ХЭ способствует изменениям в популяции иммунокомпетентных клеток и, следовательно, способствует нарушению локального иммунного ответа в эндометрии в момент имплантации. Лечение ХЭ антибиотиками улучшает частоту имплантации и снижает частоту абортов, хотя хорошо спланированные проспективные исследования, подтверждающие этот вывод, отсутствуют.
Учитывая недостаточную эффективность антибиотикотерапии ХЭ, особенно в случаях резистентности возбудителей, либо в случае вирусного хронического эндометрита, необходимо разработать схемы с дополнительным применением препаратов, влияющих на другие этиопатогенетические пути развития и поддержания ХЭ. Примером такого лечения может быть цитокинотерапия, требующая дальнейшего изучения в отношении эффективности и безопасности в терапии ХЭ.
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