卷 70, 编号 4 (2021)

目标是开发一种有效的方法，用于在缺乏分娩生理准备的背景下为有过成熟倾向的孕妇准备软产道，并减少准备软产道所需的时间用于分娩，以便进行后续的分娩激发。

材料与方法。根据准备分娩宫颈的方法将患者分为三组：第一组（n=50）仅使用海带，第二组 （n=50）- 组合使用双向弗雷氏导尿管与米非司酮，第3组（n=50）- 仅药物米非司酮。纳入标准：孕周41周-41周和4天（含）、宫颈未成熟（基线比肖普评分0-2）、单胎妊娠、头先露、胎儿全膀胱、阴道清洁I-II、胎儿状况满意（正常曲线类型）根据胎心监护和多普勒数据显示没有胎儿血流动力学紊乱）。所得数据采用Statistica 6.0软件包进行统计处理。

结果。这三组患者的年龄、妊娠期和出生体重指数没有差异。使用米非司酮和弗雷氏导尿管联合准备分娩宫颈时，根据比肖普量表，宫颈成熟的动态更加明显，并且该过程比仅使用海带或仅使用抗孕激素准备分娩时发生得更快。当米非司酮和弗雷氏导尿管联合使用时，与单独使用米非司酮或仅在海带的帮助下进行预引产相比，可以缩短从预引产开始到产程发展的时间间隔，并且还可以减少与仅使用米非司酮或单独使用海带的引产前相比，由于引产缺乏效果而导致剖宫产的频率。这种为分娩准备宫颈的组合方法的无疑优点是其有效性、子宫过度刺激、胎儿窘迫综合征的风险低，以及发生感染并发症的风险低。

结论。有过成熟倾向的子宫颈准备分娩的组合方法是有效、安全的，并且可以让您在缺乏分娩生物准备的背景下缩短软产道准备分娩的时间。

AIM: The aim of this study was to analyze the association between the vitamin D receptor gene polymorphism and the risk of developing genital endometriosis and type 1 diabetes mellitus.

MATERIALS AND METHODS: The frequency of allelic variants of the VDR gene was studied by PCR-RFLP analysis in 282 women, including 129 patients with genital endometriosis (stages I–IV), 71 patients with type 1 diabetes mellitus, and 82 women of the control group represented by the population sample.

RESULTS: It was found that the frequency of the allele G polymorphic variant of rs1544410 (BsmI) in the VDR gene was significantly higher in the group of patients with genital endometriosis compared to the population sample (p = 0.048). Significant differences for the G / G genotype in patients with genital endometriosis relative to the control group (p < 0.05) and the group of patients with type 1 diabetes mellitus (p < 0.05) were revealed. According to the odds ratio, the risk of developing genital endometriosis was 1.9 times higher for this genotype (OR = 1.93 CI = 1.082–3.450; OR = 1.892 CI = 1.022–3.430). The combination of the A / A and G / A genotypes was significantly more common in patients with type 1 diabetes mellitus (p = 0.040) and in the population (p = 0.025), when compared to the patients with genital endometriosis. A significant increase in the t allele of the rs731236 polymorphism (TaqI) of the VDR gene was found in the group of patients with type 1 diabetes mellitus (p < 0.05). The combination of the T / t and t / t genotypes of the rs731236 polymorphism (TaqI) of the VDR gene in patients with type 1 diabetes mellitus were significantly more common than in the group of patients with genital endometriosis (p = 0.017).

CONCLUSIONS: The data obtained may be important for risk assessment of genital endometriosis and type 1 diabetes mellitus development and for developing new strategies for the prevention and treatment of these diseases.

AIM: The aim of this study was to evaluate soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) levels in the blood of women with various types of diabetes mellitus, depending on the correction method applied, and to determine the prognostic significance of the sFlt-1 / PlGF ratio for predicting the development of preeclampsia in this patient population.

MATERIALS AND METHODS: We examined 140 pregnant women who were included in six main study groups: type 1 diabetes mellitus (with or without pregravid preparation), type 2 diabetes mellitus (diet therapy or insulin therapy), and gestational diabetes mellitus (diet therapy or insulin therapy). The comparison groups consisted of pregnant women with preeclampsia and patients without complications of pregnancy. Using electrochemiluminescence analysis, PlGF and sFlt-1 levels in the blood serum were determined twice, at 11⁺⁰–13⁺⁶ and 30⁺⁰–33⁺⁶ weeks of gestation. Statistical data processing was performed using the IBM SPSS Statistics version 23 and GraphPad Prism version 8.0 software packages.

RESULTS: In the blood serum of pregnant women with diabetes mellitus in the first and third trimesters of pregnancy, we found an increase in sFlt-1 level and a decrease in PlGF level, as well as an increase in the sFlt-1 / PlGF ratio. These changes were most pronounced in individuals with type 1 diabetes mellitus without pregravid preparation and with type 2 diabetes mellitus on insulin therapy. In patients with pregestational types of diabetes mellitus, the sFlt-1 / PlGF ratio was a predictor of preeclampsia already in the early stages of pregnancy. Analysis of the ROC curve showed that the threshold sFlt-1 / PlGF ratio for predicting preeclampsia in pregnant women with diabetes mellitus in the first trimester was 32.5 (sensitivity 92.9%, specificity 50.0%) and in the third trimester 71.8 (sensitivity 85.7%, specificity 82.3%) with AUC 0.78 (95% CI 0.68–0.88) and 0.89 (95% CI 0.83–0.95), respectively. In the first trimester, the positive and negative predictive values of the sFlt-1 / PlGF ratio as a predictor of preeclampsia in pregnant women with diabetes mellitus were 63.3% and 97.6%, respectively; in the third trimester, 38.9% and 93.6%, respectively.

CONCLUSIONS: Blood level alterations of PlGF and sFlt-1 are characteristic of patients with diabetes mellitus in the first and third trimesters of pregnancy. An increase in the sFlt-1 / PlGF ratio is associated with a higher incidence of unfavorable perinatal outcomes in women with impaired carbohydrate metabolism. Determination of the sFlt-1 / PlGF ratio is a valid method for predicting the development or absence of preeclampsia in women with diabetes mellitus.

组链球菌B或Streptococcus agalactiae是新生儿和成人严重疾病的病原体。组链球菌B的移动遗传元件中发现了分别含有sspB1和sspB1a基因的致病岛PAI-A和PAI-A1。SspB基因的存在与泌尿生殖道感染相关。本研究的目的是确定与来自圣彼得堡的菌株相比，在莫斯科流通的具有致病性岛PAI-A和PAI-A1的组链球菌菌株B的出现频率。莫斯科菌株的基因组中未检测到sspB1基因以及PAI-A致病岛。临床菌株基因组中sspB1a基因和PAI-A1致病岛的出现频率是定植菌株基因组的3倍。因此，可以假设sspB家族的基因更具有定植孕妇和新生儿的B组链球菌的特征。

Polycystic ovary syndrome occupies a leading place in the structure of endocrine infertility. This article presents the endocrine and metabolic features of the polycystic ovary syndrome phenotypes, as well as modern concepts of efficiency and complications of the use of assisted reproductive technologies, depending on the specific phenotype. The issues of polycystic ovary syndrome influence on selecting the method of assisted reproductive technologies, as well as possible complications that occur during in vitro fertilization and the features of the pregnancy course remain unresolved. The individualization of the approach seems to be promising when taking into account the differences in the hormonal profile and the features of metabolic disorders in each polycystic ovary syndrome phenotype. That may allow us to take one more step towards improving the effectiveness of in vitro fertilization and reducing the frequency of complications in patients with polycystic ovary syndrome.

BACKGROUND: The high prevalence, the lack of reliable data on the etiology, as well as the complexity of diagnosis and treatment of genital endometriosis indicate the urgency of the problem.

AIM: The aim of this study was to analyze and summarize scientific publications devoted to the study of single-nucleotide polymorphisms involved in apoptosis and their association with endometriosis.

MATERIALS AND METHODS: Based on keyword searches for “gene,” “SNP,” “apoptosis,” and “endometriosis,” a selection of papers published in open sources (PubMed and Google Scholar) in the period from 2010 to 2020 was performed.

RESULTS AND CONCLUSIONS: An analysis of the main and auxiliary apoptotic pathways was performed, with the protein regulators and their genes detailed in accordance with the implementation of the programmed cell death cascade in genital endometriosis. The review identified the significance of a number of proteins (TNF-á, FADD, CASP3, CASP7, CASP10) in the pathogenesis of hyperproliferative diseases. However, many apoptotic regulators (BCL2, BIK, BMF, HRK, BAD, Survivin) in genital endometriosis were found to have been understudied, which makes future research in this direction promising.

AIM: The aim of this study was to determine the 25(OH)D status in patients with genital endometriosis compared to the control group and to analyze the clinical efficacy of cholecalciferol implication as a combined targeted therapy of the disease.

MATERIALS AND METHODS: The main group included 440 patients with genital endometriosis (mean age 33.7±5.8 years) with various degrees of disease prevalence. The control group consisted of 30 women with the normal ovulatory menstrual cycle (mean age 26.3±3.1 years) in whom gynecological pathology was not revealed. Peripheral blood (PB) 25(OH)D level was assessed in all the participants included into the study. In 49 women from the main group, the level of 25(OH)D in the peritoneal fluid (PF) was determined. Comparative evaluation of the clinical efficacy of cholecalciferol intake in combination with gonadotropin-releasing hormone agonist (aGnRH) 3.75 mg injections or with dienogest 2 mg oral administration, as well as monotherapy in comparison with standard hormone-modulating treatment was carried out. Prior to the start of treatment, the patients had pain syndrome of varying severity, which was evaluated using the McGill Pain Questionnaire with the Visual Analogue Scale for pain. The psycho-emotional status was assessed using the Hospital Anxiety and Depression Scale. The Excel, Statistica 10, and Jamovi software programs were used to process the obtained data.

RESULTS: The level of 25(OH)D in PB of patients with endometriosis was significantly lower compared to the control group (p < 0.001). Women with Grades III and IV genital endometriosis were characterized by lower PB 25(OH)D levels compared to the patients with Grades I and II of the disease, but the difference was not statistically significant. Relationships were revealed between 25(OH)D levels in the PB and PF (p < 0.001), as well as PF 25(OH)D level and the disease prevalence (p = 0.004). Significantly more pronounced pain reduction and stabilization of the psycho-emotional status were observed in patients receiving combined therapy with cholecalciferol.

CONCLUSIONS: Insufficient level of vitamin D and vitamin D deficiency can be considered as factors that play a role in the progression of genital endometriosis. The use of cholecalciferol in combination with aGnRH 3.75 mg or dienogest 2 mg may more effectively reduce the severity of pain and stabilize the psycho-emotional status in patients with genital endometriosis compared to standard hormone-modulating therapy.

BACKGROUND: Glucocorticoid-induced osteoporosis is one of the most serious complications of prolonged (more than three months) systemic glucocorticoid therapy. Rapid bone loss occurs in the first months of treatment, which is a significant risk factor, especially during pregnancy and lactation. When taking systemic glucocorticoid therapy in a daily dose of 5 mg or more (in prednisone equivalent), the relative risk of vertebral fractures increases by 2.9 times.

RESULTS: This article examines a clinical case of pregnancy and childbirth of 32-year-old woman diagnosed with secondary complicated osteoporosis during treatment with systemic glucocorticosteroids, who has a history of spine compression fractures during lactation after a previous pregnancy. Vitamin D deficiency was diagnosed and corrected during this pregnancy, which minimized the risk of fractures. A baby was delivered through the birth canal. Bisphosphonate therapy was started six months after birth. No new fractures were diagnosed within two years of observation.

CONCLUSIONS: The approach to the management, diagnosis and delivery of pregnant patients with secondary osteoporosis treated long-term with glucocorticosteroids should be multidisciplinary. It is imperative to prescribe vitamin D and calcium preparations throughout pregnancy and lactation.