ROLE OF COMORBID PATHOLOGY FOR PATIENTS WITH THE «PROLIFERATIVE» DISEASES OF GENITALIA AND СHRONIC PELVIC PAIN

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

1. Vortkin AL, Rumyantsev MA, Skotnikov AS. Komorbidnost’ v klinicheskoy praktike. Chast’ 1. Arkhiv vnutrenney meditsiny. 2011;1:16-20. DOI: 10.20514/2226-6704-2011-0-1-16-20 [in Russian].
2. Gubanova GV, Belyayeva YuN, Shemetova GN. Komorbidnyy patsiyent: etapy formirovaniya, faktory riska i taktika vedeniya. Sovremennyye problemy nauki i obrazovaniya. 2015;6. Dostupno: http://www.science-education.ru/ru/article/view?id=23986 [in Russian].
3. Dubossarskaya YuA, Dubossarskaya ZM. Sindrom khronicheskoy tazovoy boli na urovne mezhdistsiplinarnogo obshcheniya. Meditsinskiye aspekty zdorov’ya zhenshchiny. 2013;3(67):5-16. [in Russian].
4. Kharchenko YuA. Adekvatnaya otsenka boli – zalog yeyo uspeshnogo lecheniya. Universum: Meditsina i farmakologiya. 2014. Dostupno: http://7universum.com/ru/med/arhive/item/3966 [in Russian].
5. Minutko VP. Depressiya. M.: GEOTAR; 2006. 320 s. [in Russian].
6. Moskalenko VF, Gul’chíy OP, Golubchikov MV, Lêdoshchuk BA, Lêkhan VM, Ognêv VA, ta ín. Bíostatistika. K.: Kniga plyus; 2009. 184 s. [in Ukrainian].
7. Kuznetsova IV. Khronicheskaya tazovaya bol’. Akusherstvo i ginekologiya. 2013;5:91-7. [in Russian].
8. Tatarchuk TF, Zakharenko NF, Tutchenko TM. Novyye podkhody k problemnym voprosam lecheniya genital’nogo endometrioza. Reproduktivnaya endokrinologiya. 2013;3(11):36-42. [in Russian].
9. Yarmolinskaya MI, Denisova VM. Immunomoduliruyushchaya terapiya genital’nogo endometrioza: realii i perspektivy primeneniya. Farmateka. 2015;12:6-12. [in Russian].
10. Damirov MM. Genital’nyy endometrioz – bolezn’ aktivnykh i delovykh zhenshchin. M.: BINOM; 2010. 180 s. [in Russian].
11. Yarotskaya ML. Sovremennyye podkhody k lecheniyu bol’nykh s tazovymi bolyami v klinike operativnoy ginekologii [dissertatsiya]. Moskva: GU Nauch. tsentr. akush. gin. i perinat; 2004. 352 s. [in Russian].
12. Meurs-Szojda MM, Mijatovic V, Felt-Bersma RJ, Hompes PG. Irritable bowel syndrome and chronic constipation in patients with endometriosis. Colorectal Dis. 2011;13(1):67-71.
13. Marshall K. Interstitial cystitis: understanding the syndrome. Alternative Med. Rev Vol. 2003;8(4):426-37.
14. Christianson JA, Liang R, Ustinova EE, Davis BM, Fraser MO, Pezzone MA. Convergence of bladder and colon sensory innervation occurs at the primary afferent level. Pain. 2007;128(3):235-43.
15. Brumovsky P, Gebhart G. Visceral organ cross-sensitization—an integrated perspective. Auton Neurosci. 2010;153(1-2):106-15.
16. Hansen KE, Kesmodel US, Baldursson EB, Kold M, Forman A. Visceral syndrome in endometriosis patients. Eur J Obstet Gynecol Reprod Biol. 2014;179:198-203.
17. Gebhart GF. Visceral pain – peripheral sensitization. Gut. 2000;47(4):54-8.
18. Vincent K. Pelvic pain in women: clinical and scientific aspects. Curr Opin Support Palliat Care. 2011;5(2):143-9.
19. Vercellini P, Viganò P, Somigliana E, Fedele L. Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol. 2014;10:261.
20. Brawn J, Morotti М, Zondervan К, Becker С, Vincent К. Central changes associated with chronic pelvic pain and endometriosis. Hum Reprod Update. 2014;20(5):737-47.
21. Dowlati Y, Herrmann N, Swardfager W, Liu H, Sham L, Reim EK, et al. А meta-analysis of cytokines in major depression. Biol Psychiatry. 2010;67(5):446-57.
22. Graziottin A, Skaper SD, Fusco M. Inflammation and Chronic Pelvic Pain: a Biological Trigger for Depression in Women? J Depress Anxiety. 2013;3:142. DOI: 10.4172/2167-1044
23. Giamberardino MA. Women and visceral pain: are the reproductive organs the main protagonists? Mini-review at the occasion of the «European week against pain in women 2007». Eur. J. Pain. 2008;12(3):257-600.
24. Schwartz ES, Schwartz ES, Gebhart GF. Visceral pain. Curr Top Behav Neurosci. 2014;20:171-97.

«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