Grek L. Р.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The comorbid diseases represent a practically important and not enough studied problem in patients with CPP with a genital endometriosis in a combination with benign hormonal pathology of the genitals. Interaction of gynecological diseases of the reproductive system and somatic diseases with CPP, changes the clinical picture of the main nosology, the nature and severity of complications, restricts diagnosis and treatment, negatively affects the quality of life of a woman. The aim of our study to determine an influence of the clinic comorbid extra genital pathology to the course of chronic pelvic pain syndrome in patients with genital endometriosis in a combination with benign hormonal pathology of the genitals. Object and methods. We examined 120 patients with a genital endometriosis in a combination with benign hormonal pathology of the genitals. There were 120 women in research were divided into several groups, depending on visual analogue scale (VAS) and durations of disease: of 1 group (n=44) VAS are 7-10 points; 2 group (n=41) VAS 4-6 point; 3 group (n=35) VAS 0-3 points. The Teilor’s Manifest Anxiety Scale determination of level of personality anxiety. The level of depression was determined by Hamilton Rating Scale for Depression (HDRS). McGill Pain Questionnaire, (MPQ) measured sensory, emotional and quantitative description of pain. The result of the study with the determination of cytokine levels of pro- inflammatory (IL-6, TNF-α) and anti-inflammatory cytokines ( IL-10) by immunoassay method (ELISA) using the sets of CJSC Vector-Best. The statistical processing was carried out using STATISTICA 6.1 software (StatSoftInc., Serial No. AGAR909E415822FA) and the MedCalc Statistical Software trial version 17.4 software package. (MedCalc Software bvba, Ostend, Belgium; https://www.medcalc.org; 2017). Study results and their discussion. The frequency of extra genital pathology, was statistically meaningful (р<0,05) for the patients of a 1 group by comparison to the patients of 3 group. A disease of gastrointestinal tract is in 1-б groups (75 % (95 % ДІ 53,13 – 88,81) comparatively with 37,14 % (95 % ДІ 23,17 – 53,66)); with 2 groups. Chronic gastritis met for 50% women 1th groups and in 60% womens of 1-б group, chronic cholecystitis in 35,7% and accordingly in 46,6%. Irritable bowel syndrome, constipation, diarrhea in 14,2% and accordingly in 26,7%. The disease of the urogenital system, dysuria, was observed accordingly in «pain groups» 1th – 37,7% and 1-б – 35,0%. During the progress of СРР, the level of cytokines ІL-10 was low, and increased of ІL-6, TNF -α comparatively with 3th a group (р<0,05). The level of cytokines of ІL-6, TNF-α correlated with the higher points of intensity of pain syndrome in a 1-th group, with pain anamnesis duration, and enhance able level of anxiety and depression. Сomorbid pathology in research marked as a “visceral syndrome”(VS). A VS correlates with the diseases of gastrointestinal tract (ρ=0,33; р<0,001), urogenital system (ρ=0,26; р=0,004), iron-deficient states (ρ=0,29; р=0,001). Marked middle force direct cross-correlation. Copulas connection of VS with duration of CPP (ρ=0,35; р<0,001) and force of pain for VAS (ρ=0,63; р<0,001), and also related to the enhance able level of anxiety(ρ=0,50; р<0,001) and depression(ρ=0,52; р<0,001). Conclusion. Influence of extra genital comorbid pathology, genesis of that has multifactorial reasons, chronic inflammation, pathological pain sensitiveness results in violation of the nociceptive system and assists progress of СРР, that is confirmed statistically by meaningful associative connections.

«proliferative diseases» of genitalia, chronic pelvic pain, comorbid diseases

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«Bulletin of problems biology and medicine» Issue 2 (144), 2018 year, 154-160 pages, index UDK 618.14 – 002.092 – 006.03:618 – 071.4 – 008.6:612.017:159.92

10.29254/2077-4214-2018-2-144-154-160