EFFICIENCY OF REHABILITATION MEASURES AFTER DESTRUCTIVE THERAPIES IN PATIENTS WITH UTERINE CERVICAL PATHOLOGY ASSOCIATED WITH PAPILLOMAVIRUS INFECTION

Objective. To study the clinical efficacy of a combined drug containing dexpanthenol (D-panthenol), 0.1 g; chlorhexidine bigluconate (chlorhexidine), 0.016 g; a polyethylene oxide base (macrogol 1500, macrogol 400), the amount sufficient to prepare a 3.0-g suppository, after destructive therapies in the rehabilitation stage for uterine cervical pathology associated with papillomavirus infection. Subjects and methods. All the patients (n=95) underwent microscopic and bacteriological tests of the contents of the vagina and cervix uteri before and after treatment, expanded colposcopy, a cytological study of ecto- and endocervical smears, a histological study of biopsy specimens from the cervix uteri; secretory immunoglobulin A (sIgA) levels, interferon status, and proinflammatory cytokines were determined. Sixty patients with grade 1 cervical intraepithelial neoplasia were treated with spray argon plasma ablation of the cervix uteri (APACU) by a FOTEK EA140 apparatus, 60-80 watt, without electrode-tissue contact. After APACU, the cervix uteri was once treated with an aqueous chlorhexidine solution in all the patients. Further, the latter were randomized into 2 groups. Group 1 included 30 patients who used for 10 days a vaginal depanthol suppository twice/day on day 7 after destruction. Group 2 comprised 30 patients who did not use depanthol. A control group consisted of 20 patients with the visually unaltered cervix uteri and without virus infection as evidenced by polymerase chain reaction. The efficiency of using depanthol after destructive treatments for pathology of the cervix uteri was evaluated by the following criteria: the time of termination of epithelization and its adequacy; a change in local immunity parameters; a bacterioscopic study of the contents of the vagina and cervical canal; recurrence rates. Results. After destruction of the cervix uteri, there were significantly reduced sIgA and interferon status parameters, which could be indicative of an immune deficiency state. After depanthol therapy, the parameters of nonspecific resistance and interferon status were significantly increased as compared to those obtained in Group 2, which contributed to the acceleration of reparative processes and the values of proinflammatory cytokines were considerably decreased, which was suggestive of the anti-inflammatory effect of one of the depanthol components — chlorhexidine and the normalization of vaginal microbiocenosis. Conclusion. The use of the combined drug depanthol in the rehabilitation stage after APACU was ascertained to normalize local immunity parameters, to assist in significantly reducing the time of epithelization and decreasing the number of recurrencies.

pathology of the cervix uteri, depanthol, local immunity