Obstetrics and GynecologyObstetrics and GynecologyАкушерство и гинекология0300-90922412-5679Bionika Media46278310.18565/aig.2023.9Original ArticlesОригинальные статьиResearch ArticlePrinciples of early diagnosis of endometriosis based on the assessment of comorbidity and clinical manifestationsОптимизация принципов ранней диагностики эндометриоза на основе оценки коморбидности и клинической манифестацииhttps://orcid.org/0000-0003-4566-4065ProninaVeronika A.ПронинаВероника Алексеевна
Russian Federation

obstetrician-gynecologist, PhD student

врач акушер-гинеколог, аспирант

ver22595@yandex.ruhttps://orcid.org/0000-0001-7286-6047DumanovskayaMadina R.ДумановскаяМадина Равилевна
Russian Federation

PhD, Researcher at the Department of Gynecological Endocrinology

к.м.н., н.с. отделения гинекологической эндокринологии

dumanovskaya@gmail.comhttps://orcid.org/0000-0002-9065-5689ChernukhaGalina E.ЧернухаГалина Евгеньевна
Russian Federation

Dr. Med. Sci., Professor, Chief Researcher at the Department of Gynecological Endocrinology

д.м.н., профессор, главный н.с. отделения гинекологической эндокринологии

c-galina1@yandex.ruAcademician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of RussiaФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. Кулакова» Министерства здравоохранения Российской Федерации30052023487962805202328052023Copyright ©; 2023, Bionika MediaCopyright ©; 2023, ООО «Бионика Медиа»2023Bionika MediaООО «Бионика Медиа»https://journals.eco-vector.com/0300-9092/article/view/462783

Objective: To analyze the clinical characteristics and concomitant diseases in patients with endometriosis.

Materials and methods: The cross-sectional study was conducted at the National Medical Research Center for Obstetrics, Gynecology and Perinatology in Moscow, Russia in the period from 2021 to 2022. The main group included 110 patients (mean age 29 (25; 36) years) with extragenital endometriosis confirmed by ultrasound and MRI assessment; the control group consisted of 110 women who were comparable in age to the patients of the main group (mean age 27 (26; 32) years) without echographic signs of endometriosis. The patients of both study groups were interviewed and surveyed for a comprehensive analysis of clinical and anamnestic data; the presence of comorbid conditions was determined on the basis of laboratory and instrumental studies which were carried out in accordance with the clinical recommendations of the Ministry of Health of the Russian Federation.

Results: Not only the severity of dysmenorrhea, dyspareunia and chronic pelvic pain, assessed by the visual analog scale (VAS), are significant, but also the combination of the symptoms is of importance, as it demonstrates a two-fold increase in the risk of endometriosis. It was found that lower body mass index (BMI) is characteristic of the patients of the main group (p=0.001). Every fifth patient with endometriosis had a body weight deficit (BMI<18.5 kg/m2), every second patient had a BMI<21 kg/m2. The patients with endometriosis, in comparison with the patients of the control group, had a higher incidence of acne (39.5 and 13.6%), fibrocystic disease (29.5 and 12%), human papillomavirus (41.7% and 22.7%), endometrial polyps (20.9 and 5.5%), uterine fibroids (23.6 and 8.2%, respectively). The presence of recurrent functional cysts (OR 2.11, 95% CI 1.66–2.69) and ovarian apoplexy (OR 1.99, 95% CI 1.62–2.45) had the greatest diagnostic significance. The combination of several comorbid conditions greatly increased the likelihood of endometriosis.

Conclusion: At the initial stage of the examination of a patient with suspected endometriosis, it is advisable to listen to the patient’s complaints and also to conduct a cumulative assessment of their severity counting the points according to the VAS score. Thus, precise anamnesis and clinical examination can be considered effective and available methods of identifying women at risk for the development of endometriosis.

Цель: Провести анализ значимости клинических характеристик и сопутствующих заболеваний у пациенток с эндометриозом.

Материалы и методы: Проведено одномоментное исследование на базе ФГБУ «НМИЦ АГП им. академика В.И. Кулакова» МЗ РФ в период с 2021 по 2022 гг. В основную группу были включены 110 пациенток (средний возраст 29 (25; 36) лет) с наличием наружного генитального эндометриоза по данным экспертного УЗИ и МРТ, в группу сравнения – 110 женщин, сопоставимых по возрасту с основной группой (средний возраст 27 (26; 32) лет), с отсутствием эхографических признаков эндометриоза. Выполнен комплексный анализ клинико-анамнестических данных пациенток обеих исследуемых групп путем опроса и анкетирования; наличие коморбидных состояний определялось на основании лабораторного и инструментального обследования в необходимом объеме согласно клиническим рекомендациям МЗ РФ.

Результаты: Значимость имеет не только степень выраженности дисменореи, диспареунии и хронической тазовой боли, оцененная по визуальной аналоговой шкале (ВАШ), но и их сочетание, повышающее риск наличия эндометриоза в 2 раза. Установлено, что для пациенток основной группы характерны более низкие значения индекса массы тела (ИМТ) (р=0,001). Каждая 5-я пациентка с эндометриозом имела дефицит массы тела (ИМТ<18,5 кг/м2), каждая 2-я – ИМТ<21 кг/м2. У женщин с эндометриозом, в отличие от группы сравнения, была установлена более высокая частота встречаемости акне (39,5 и 13,6%), фиброзно-кистозной болезни (29,5 и 12%), вируса папилломы человека (41,7 и 22,7%), полипов эндометрия (20,9 и 5,5%), миомы матки (23,6 и 8,2%). Наибольшей диагностической значимостью обладало наличие у пациенток рецидивирующих функциональных кист (ОР 2,11 [95%, ДИ 1,66; 2,69]) и апоплексии яичников (ОР 1,99 [95%, ДИ 1,62; 2,45]). Сочетание нескольких коморбидных состояний многократно повышало вероятность наличия эндометриоза.

Заключение: На начальном этапе обследования пациенток с подозрением на эндометриоз целесообразно проводить не только сбор жалоб, но также совокупную оценку их выраженности с расчетом баллов по ВАШ. Анализ коморбидности значительно повышает шансы на раннюю диагностику эндометриоза. Таким образом, прицельное клинико-анамнестическое обследование может рассматриваться как эффективный и доступный метод выявления женщин группы риска по развитию эндометриоза.

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