RU2327164C1 - Method of hyperplastic endometrium processes diagnostics at hysteromyoma - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, specifically to obstetrics and gynecology, oncogynecology and can be applied for hyperplastic endometrium processes diagnostic at hysteromyoma. Substance of method: supernatant of uterine cavity lavage or menstrual blood are single-stage tested for catalase ratio, catalase number, malonic dialdehyde. If catalase number is lowered to 2.53±0,16 un., catalase ratio - to 0.71±0.05 un., and malonic dialdehyde is increased to 0.49±0.06 nmole normal condition of endometrium is diagnosed at hysteromyoma. If catalase number is lowered to 1.8±0.33 un., catalase ratio - to 0.44±0.09 un., and malonic dialdehyde is increased to 1.68±0.23 nmole endometrium hyperplasia is diagnosed at hysteromyoma. If catalase number is lowered to 0.68±0.2 un., catalase ratio - to 0.2±0.09 un., and malonic dialdehyde is increased to 3.01±0.85 nmole atypical endometrium hyperplasia is diagnosed at hysteromyoma. Application of method allows providing short-term diagnostics of endometrium diagnostic at hysteromyoma using low-sampled biological fluids.

EFFECT: provided short-term diagnostics of endometrium diagnostic at hysteromyoma using low-sampled biological fluids.

1 tbl, 6 ex

Description

The invention relates to medicine, namely to obstetrics and gynecology, gynecological oncology, and can be used to diagnose endometrial hyperplastic processes.

The successes of practical gynecology and oncogynecology are currently determined by the specific gravity of precancer and early stages of genital cancer in newly diagnosed patients. Clinical experience shows that the recognition and treatment of precancerous and early forms of tumor processes are not only a biomedical, but also an important social task.

Recent decades in many countries of the world are characterized by an increase in the incidence of hormone-dependent tumors (GZO) of the genitals, including uterine fibroids (MM), hyperplastic processes and endometrial cancer (RE), as well as their combinations (polyneoplasias). The increase in the incidence of precancer or atypical endometrial hyperplasia (AGE) and ER is associated with a progressive increase in “diseases of civilization and urbanization” - MM, genital endometriosis, inflammatory diseases of the uterus and appendages, infertility. An alarming fact is the "rejuvenation" of the contingent of patients with both benign and malignant uterine tumors. Over the past decade, the greatest increase in the incidence of AHE, RE has been noted in the age groups of women under 29 years old and 40-49 years old (L.V. Dikareva. Age-related aspects of the development of hormone-dependent uterine tumors in risk groups. Abstract for the degree of candidate of medical sciences, 2003, - 24 p.; Novikova, O.V. Chulkova, etc. // Precancer and initial endometrial cancer in women of reproductive age. - M. - 2005. - P.7-9; V.I. Chissov, V.V. Starinsky // Oncological care for the population of Russia in 2001. - M. - 2002, - 176 p.)

According to published data, the frequency of endometrial hyperplastic processes (GGE) in the structure of gynecological morbidity varies from 30% to 50%, and its combination with MM reaches 30-33%. At the same time, the risk of malignancy of GGE is from 1 to 5%, and the transformation of AGE in ER is from 23 to 57.1%, increasing to 81% with its complex form (G.E. Chernukha. Adenomatous and glandular endometrial hyperplasia in reproductive age. Abstract for the degree of Doctor of Medical Sciences. - M., 1999, - 42 pp .; EG Novikova, OV Chulkova and other Treatment of atypical endometrial hyperplasia. Practical oncology. - 2004. - No. 1. - P.52-59; T. Kaku, H. Tsukamoto et al. Endometrial carcinoma associated with hyperplasia // Gynecol. Oncol. - 1996. - Vol.60 (1). - P. 22-25).

He raises doubts about the polyetiology and diachronicity of the formation of GBD, but in recent years, the point of view on the pathogenesis of hyperplastic processes (GLP) of the myo-endometrium and RE has changed slightly. Along with the traditional concept of Y. V. Bokhman, E. M. Vikhlyaeva on two pathogenetic variants of the development of MM, GGE and RE (the first - hormone-dependent and the second - hormone-independent or autonomous), today reports about their “inflammatory” genesis are increasingly being discussed (Ya.V. Bohman. Guide to Oncogynecology, 1989, 463 p .; IS Sidorova. Uterine fibroids, 2003, 255 p .; VN Serov. Modern approaches to the treatment of inflammatory diseases of the female genital organs. - M., 2003. - P.3-7; L. M. Bershtein. Epidemiology, pathogenesis and ways of prevention of endometrial cancer: stable personality or evolution. // Practical Oncology. -2004. - No. 1. - P.5-7; A.A. Tikhomirov, L. M. Lubnin, 2006 // The new principle of treatment of uterine fibroids. - P.3-9 )

The causes of infection of the endometrium with its subsequent chronization may be septic complications of labor, manual control of the uterine cavity, abortion, diagnostic curettage of the uterine cavity, hysteroscopy, as well as an ascending infection with promiscuous sexual intercourse.

GGE can also be a consequence of the chronic inflammatory process in the uterine appendages. An infectious agent leads first to an inflammatory reaction of varying severity and oxidative stress, and then to a change in the receptor apparatus of the uterus (O.Yu. Romanovskiy. Hyperplastic processes of the endometrium in the reproductive period // Gynecology. - 2004. - No. 6. - P.296. -302).

At present, there is no doubt that the development of various pathological processes is associated with the onset of oxidative stress, which is either the direct cause of the disease or accompanies the development of this process.

As a rule, an antioxidant system (AOS) of the body is involved in the process, which regulates the processes of lipid peroxidation and proteins. This increases the production of reactive oxygen species (ROS). The increased content of ROS in the cell is accompanied by the destruction of the main antioxidant enzymes (AOD). Oxidative modification and inactivation of antioxidant enzymes leads to depletion of AOD activity and cell death.

Obviously, the most real way of preventing GBO of the uterus is the timely detection and correction of homeostatic disorders, aimed at increasing the antitumor resistance of the body.

The changed view of the pathogenesis of GP of myo-endometrium and RE (the role of infection, reactive oxygen species), as well as the real existence of two pathogenetic variants of these processes, sets important tasks for researchers, namely, the search for new approaches to mass screening.

As the test substrate, we chose endometrial secretion. This is due to the fact that when using immunofluorescence, histochemical methods for studying samples of normal, hyperplastic, and malignant endometrial tissue, the ability of a number of enzymes and their isoforms to accumulate in the apical portions of glandular cells and then to be secreted into the endometrial mucus was shown (EG Shvarev. Tumor markers in the diagnosis and assessment of the effectiveness of hormone therapy for endometrial cancer // Abstract for the degree of Doctor of Medical Sciences. - St. Petersburg. 1993. - 34 p.).

In our opinion, this phenomenon opens up prospects for the use of biochemical studies of biological fluids (menstrual blood, swabs from the uterine cavity) in screening and monitoring the state of the endometrium during HPE.

In the literature there are few data on the biochemical features of biological fluids (BF) flowing directly from a pathologically changed organ (I.Yu. Krasnoshchekova. Pathogenetic substantiation of the use of antioxidants in the complex treatment of women with inflammatory processes of the uterine appendages // Abstract for the degree of candidate of medical sciences . - Ivanovo. - 2001, - 24 pp .; RN Korotkina, G.N. Matskevich, A.Sh. Davlekanova, A.A. Vishnevsky, A.G. Kunitsyn, A.A. Karelin. "Comparative enzyme activity test the exchange of glutathione and antioxidant enzymes in malignant and benign tumors of the human lung. "// Bulletin of experimental biology and medicine. - 2002. - T.133. - No. 6. - P.697-700).

For the diagnosis of endometrial hyperplastic processes in GBW of the uterus, several methods are used in practical medicine.

A known method for the diagnosis of GGE in tumors of the female genitalia, based on a cytological study of aspirate from the uterine cavity (EG Shvarev. Tumor markers in the diagnosis and evaluation of the effectiveness of hormone therapy of endometrial cancer // Abstract for the degree of Doctor of Medical Sciences. - St. Petersburg, 1993 . - p. 34; I. D. Khokhlova, E. A. Kudrina. Diagnosis and treatment of endometrial hyperplastic processes // Obstetrics and Gynecology. - 1996. - No. 4. - P.50-55).

However, the method has significant disadvantages:

- the absence of generally accepted cytological criteria for the severity of endometrial hyperplastic processes;

- the complexity of the interpretation of the results;

- the need for special methods of staining drugs;

- the availability of specialized laboratories.

In the last decade, a method for the diagnosis of HPE in tumors of the female genitalia has become widespread, consisting in an echographic study of the genitals (L.A. Ashrafyan et al. Modern principles of primary and refinement diagnosis of endometrial cancer // Practical Oncology. - 2004. - No. 1. - C .16 -24; A.I. Gus et al. Modern principles of ultrasound, clinical and laboratory diagnosis of polycystic ovary syndrome // Gynecology. - 2002. - No. 2. - P.44-47; V.N. Demidov, A. I. Gus. Modern principles of ultrasound diagnostics of ge italnogo endometriosis Gynecology // -. 2002. - №2 -. S.48-52).

The disadvantages of these methods are:

- the need for the availability of appropriate equipment for ultrasound diagnostics and conditions for the study;

- the complexity of the interpretation of echo patterns in patients with volumetric processes of the internal genitalia.

The leading place in the diagnosis of intrauterine pathology is occupied by hysteroscopy (V.G. Breusenko. The place of hysteroscopy in the diagnosis and treatment of intrauterine pathology // Materials of the II Russian Forum "Mother and Child". - M., 2000. - P.11-15; L. A. Ashrafyan et al. Modern principles of primary and clarifying diagnosis of endometrial cancer // Practical Oncology, 2004. - No. 1. - P.16-24; V.N. Serov, I.N. Zvenigorsky. Diagnosis of gynecological diseases with a pathological course Anatomy. - M., 2003 .-- 139 p.).

However, to conduct this study, it is necessary to have the appropriate equipment, trained personnel, and operating room.

Among the additional methods for diagnosing HPE, the literature describes a ³² P radionuclide study based on the ability of radionuclides to accumulate in different concentrations in normal and hyperplastic endometrium. So in the secretory endometrium, the accumulation of ³² P is on average 175%, increasing to 250-300% with GPE, reaching a maximum level with AGE - 340% or more (I. D. Khokhlova, E. A. Kudrina. Diagnosis and treatment of hyperplastic processes endometrium // Obstetrics and gynecology. - 1996. - No. 4. - S.50-55).

The disadvantages of this method are:

- the presence of a special laboratory and related equipment, trained personnel;

- the inability to perform in conventional clinical laboratories;

- the high cost of research.

The most common is a method for the diagnosis of HPE in tumors of the female genitalia, based on a histological examination of scraping from the uterine cavity (Y. V. Bohman. Guide to Oncogynecology, 1989. - 463 p .; O.F. Chepik. Morphogenesis of endometrial hyperplastic processes // Practical oncology. - 2004. - No. 1. - S.9-15; K. Sylvia // Gynecology, Medpress. - 2004. - S.459-503). The disadvantages of this method are:

- the complexity of technical performance;

- the need for specially equipped premises and trained personnel;

- the need to use expensive equipment;

- the duration of the final conclusion (10-14 days).

Closest to the proposed method is the diagnosis of HPE by an immunochemical method based on the determination of certain tumor markers in the swabs from the uterine cavity: alpha ₂ microglobulin fertility, thermostable placental alkaline phosphatase type and non-specific tissue gamma esterase (L.A. Kostina. Thermostable alkaline phosphatase, nonspecific esterase and fertility protein in the diagnosis of hyperplastic processes and endometrial cancer // Abstract for the degree of candidate of medical sciences .-- 1987, - 23 p.).

The disadvantages of this method are:

- standard test systems are needed (monospecific antiserum, test antigen);

- to obtain antiserum, immunization of rabbits with semi-purified tissue extracts or protein fractions is required for a month, after the completion of which an interval of 7-8 days is still required before taking the rabbit blood;

- the complexity in the preparation of test systems, the duration of the study.

In addition, the insufficient reliability of the independent use of the method necessitates combining it at the first stage of selective screening with a cytological examination of endometrial swabs, and at the second stage with a histological examination of endometrial scraping.

The aim of the invention is to simplify the diagnosis of endometrial hyperplastic processes in uterine fibroids.

The goal of the invention is achieved by the fact that in the supernatant of the washout from the uterine cavity or menstrual blood, the catalase, catalase number, malondialdehyde indicators are simultaneously determined and, when the catalase number is reduced to 2.53 ± 0.16 units, the catalase index to 0.71 ± 0.05 units and increasing the value of malondialdehyde to 0.49 ± 0.06 nmol diagnose the normal structure of the endometrium in patients with uterine myoma; with a decrease in the catalase number to 1.8 ± 0.33 units, the catalase index to 0.44 ± 0.09 units. and increasing the value of malondialdehyde to 1.68 ± 0.23 nmol diagnose endometrial hyperplasia in patients with uterine myoma; with a decrease in the catalase number to 0.68 ± 0.2 units, and the catalase index to 0.2 ± 0.09 units and an increase in malondialdehyde to 3.01 ± 0.85 nmol, atypical endometrial hyperplasia is diagnosed in patients with uterine myoma.

The content of one of the enzymes AOD-catalase, a secondary product of lipid peroxidation, malondialdehyde (MDA), was studied in patients with GBO of the uterus in washes from the uterus and menstrual blood. The choice for the study of the enzyme catalase and MDA is associated with their physiological role, the presence in many tissues, body fluids, characterized by a high metabolism and lack of data on their significance in the pathogenesis of hormone-dependent uterine tumors.

The determination of lipid peroxidation rate in biological substrates was carried out according to the method of E.A. Stroev, E.G. Makarov, 1986, and the determination of the catalase number, catalase index, according to the method of Bach and Zubkova, 1976.

The determination of MDA, catalase index and catalase number was carried out simultaneously in blood serum and flushing from the uterine cavity or menstrual blood. The results of the study are shown in the table. It should be noted that changes in the studied parameters are more evident in flushing from the uterine cavity (menstrual blood) than in peripheral blood. This circumstance may be associated with the presence of concomitant extragenital pathology and its influence on their level.

Along with the traditional clinical and laboratory examination, all the subjects underwent ultrasound of the pelvic organs, mammary glands, according to indications - mammography, cytological examination of endo-exocervix. The results of catalase and MDA indicators were compared with a cytological examination of aspirates from the uterine cavity and histological findings of endometrial scrapings.

108 patients aged from 28 to 75 years were examined. All patients were divided according to the nosological basis (MM with normal endometrial structure, MM with endometrial hyperplasia, MM in combination with atypical endometrial hyperplasia - precancer). The control group consisted of 32 patients without hormone-dependent uterine tumors.

The proposed method was successfully tested in the gynecological departments of OOD, AMOKB No. 1 and Design Bureau No. 2, City Clinical Hospital No. 5, the hospital Clinical Hospital No. 2 of Astrakhan in 2004-2006.

Below are the results of testing.

Example 1

Patient Slashcheva L.A., 54 years old, was undergoing surgical treatment in the gynecological department of OOD (case history No. 6904) with a diagnosis of symptomatic uterine fibroids.

Menstrual and reproductive functions.

Menses from 12 years to 5 days, regular, heavy, 30 days cycle.

In the reproductive period of 4 pregnancies: 2 births, 2 abortions.

Uterine fibroids were detected in 2005.

Concomitant pathology: hypertension II Art.

Objectively.

The mammary glands - without features.

P.V. The external genitalia are developed correctly, the vaginal mucosa is not changed. The body of the uterus is enlarged to an 8-week pregnancy, tuberous. Appendages on both sides without features. Parametries are free. Allocations are white.

Ultrasound from 09/22/06 - the uterus is 77 × 58 × 83 mm in size, tuberous, increased to 8 weeks of pregnancy. The submucous node measuring 39 × 19 × 33 mm, the interstitial node measuring 20 × 15 × 17 mm, and many small nodes are determined by the posterior wall of the uterus. M - echo 5 mm. The right ovary is 30 × 27 × 31 mm, the follicles are d 1.3 mm, the left ovary is 24 × 20 x 24 mm. In the cervix, endocervix cysts.

Material sampling: after examining the woman on the mirrors, under aseptic conditions, with a sterile subclavian catheter with a diameter of 1.2 mm and a disposable syringe, sterile 0.9% saline solution with a volume of 4-5.0 ml is injected into the uterine cavity, then the contents of the uterus are sucked into the syringe. The resulting mixture was centrifuged for 15 minutes at a frequency of 3000 rpm. The supernatant (supernatant) is used for further work.

Cytological examination of the aspirate from 10/22/06 - blood, groups of prismatic epithelial cells.

On October 24, 2006, uterine extirpation with appendages was performed.

Histological examination of the removed preparation No. 22814 - 22 dated November 6, 2006. Micro: uterus - fibromyoma, endometrial atrophy. The cervix is a stratified squamous epithelium of normal structure, cysts, ovaries - white bodies, tubes - plethora.

Catalase number - 2.69 units.

The catalase index is 0.71 units.

MDA - 0.48 nmol

The indicated results of the catalase number, catalase index, and MDA correspond to the normal structure of the endometrium in a patient with MM.

Example 2

Patient Beloborodova L.N. 41 g. Was at the dispensary observation in the women's consultation at the place of residence with a diagnosis of uterine fibroids.

Menstrual and reproductive functions.

Menses from 14 years to 5-6 days, moderate, painful, 30 days cycle.

A history of 8 pregnancies, of which 2 ended in an urgent delivery, in 6 cases - termination of pregnancy at the request of the patient.

Concomitant pathology. NDC of mixed origin.

Uterine fibroids were first identified in 1997.

Ultrasound of the pelvic organs from 04.03.04: The uterus is 67 × 68 × 59 in size, the myometrium structure is diffusely heterogeneous due to single interstitial nodes d 10-12 mm. Endometrium 11 mm (phase II cycle). The cervix is not enlarged. The cervical canal is linear.

The left ovary is 43 × 30 mm, soldered to the uterus, with follicles d 4-5 mm, the right ovary is 39 × 14 mm with follicles d 4-9 mm. The structure of the ovaries is heterogeneous.

Conclusion: an ultrasound picture of uterine fibroids. Chronic adnexitis in senior remission.

Objectively.

The mammary glands - without features.

P.V. The external genitalia are developed correctly. The vaginal mucosa is not changed. The uterus is enlarged to a 6-7-week pregnancy. The appendages are heavy on both sides. Parametries are free. Allocations are white.

Material sampling was carried out similarly, see example 1.

Aspirate from the uterine cavity No. 28621-22 from 03/20/2004: blood, endometrial epithelial cells.

Histological result No. 15558 of a “column” of tissue from the uterine cavity from 03/31/2004 - micro: endometrium in the phase of secretion.

Catalase number - 2.62 units.

The catalase index is 0.68 units.

MDA - 0.47 nmol

The indicated results of the catalase number, catalase index, and MDA correspond to the normal structure of the endometrium in a patient with MM.

Example 3

Patient Tkacheva V.P., 46 years old, was undergoing surgical treatment in the gynecological department of the AIOCB (case history No. 17704) with a diagnosis of symptomatic uterine fibroids, endometrial hyperplastic process.

Menstrual and reproductive functions.

Menses from 13 years to 6-7 days, regular, heavy, 30 days cycle.

A history of 4 pregnancies: 2 births, 2 artificial abortions.

Uterine fibroids were first detected in 2001, with a size of 5-6 weeks.

During 2005, tumor growth was noted, with a control ultrasound from 08.16.06, the size of the uterus corresponds to a 9-week pregnancy.

The uterus with fuzzy contours, dimensions 111 × 68 × 98 mm, heterogeneous structure. On the posterior wall of the uterus, a node d 22 mm, deforming the uterine cavity. M - echo 18 mm. The cervix is 44 × 43 mm. Cervical canal up to 9 mm, filled with heterogeneous contents. The right ovary is 31 × 17 mm, the follicles are 2-3 mm, the left ovary is 34 × 20 mm, the follicle is 10-12 mm. Right fallopian tube with fluid area.

Conclusion: uterine fibroids, echographic signs of chronic adnexitis, hydrosalpinx of the right fallopian tube.

Objectively.

The mammary glands - without features.

P.V. The external genitalia are developed correctly. The vagina is capacious, giving birth to a woman, the mucous membrane is not changed. The body of the uterus is enlarged to a 9-week pregnancy, dense, painless. The appendages on both sides are thickened, more on the right. Parametries are free. The discharge is white.

Material sampling was carried out similarly, see example 1.

Cytological examination of aspirate from the uterine cavity No. 3187-88 from 09/18/06: blood, proliferation of prismatic epithelial cells.

09.21.2006 performed supravaginal amputation of the uterus with appendages.

Histological examination of the removed preparation No. 37390-404 of October 13, 2006 Micro: uterus - nodes of leiomyoma, foci of adenomyosis, endometrium - glandular hyperplasia; ovary cyst, corpus luteum, white bodies. Tubes with sections of desquamation of the mucosa.

Catalase number - 1.49 units.

The catalase index is 0.35 units.

MDA - 1.84 nmol

The indicated results of the catalase number, catalase index, and MDA correspond to endometrial hyperplasia in a patient with MM.

Example 4

Patient Petrichenko N.P., 49 years old. She was admitted to the gynecological department of the AIOCB for surgical treatment (medical history No. 1949) with a diagnosis of symptomatic uterine fibroids.

Uterine fibroids were first identified in 2005.

Menstrual and reproductive functions.

Menses from 14 years to 7 days after 28 days, regular, heavy. A history of 9 pregnancies: 2 births, 7 artificial abortions.

Concomitant pathology.

Diffuse mastopathy, mixed-type NCD, chronic spastic colitis, pancreatitis, cholecystitis, grade I obesity.

Objectively.

Mammary glands - nodular formations not detected.

P.V. The external genitalia are developed correctly. The vaginal mucosa is not changed. The cervix is cylindrical, clean, the external pharynx is slit-like. The body of the uterus is increased to 9 weeks of pregnancy. Appendages are not separately determined. Parametries are free. Spotting spotting spotting (menstruation).

Material fence: a sterile four-layer gauze napkin measuring 15 × 5 cm was offered to the patient in the form of a lining for 3 hours. Then, the used pad was placed in a Petri dish, 5 ml of 0.9% saline solution was added, a napkin was squeezed out, the resulting biological fluid was used for further work.

Cytological examination of endo-exocervix No. 291-292 - without features.

Cytological examination of aspirate from the uterine cavity No. 4887-88 - squamous epithelium, complexes and glandular structures of proliferating cubic epithelium.

Ultrasound of the pelvic organs from 11/18/05

The uterus is 87 × 68 × 71 mm in size. On the back wall of the interstitial myomatous node with centripetal growth of 33 × 26 mm in size; the cervix without pathology, M-echo - 14 mm. The ovaries on the right are 29 × 21 mm of a homogeneous structure, on the left - 24 × 14 mm.

12/07/05, performed supravaginal amputation of the uterus without appendages.

Histological examination No. 12485-500 of 17.12. 05 g. Micro: uterus - leiomyoma, adenomyosis, glandular endometrial hyperplasia. Tubes - plethora of blood vessels. The ovaries are a white body, a yellow body with hemorrhages, follicular cysts.

Catalase number - 2.12 units.

The rate of catalase is 0.4 units.

MDA - 1.53 nmol.

The indicated results of the catalase number, catalase index, and MDA of the menstrual blood correspond to endometrial hyperplasia in a patient with MM.

Example 5

Patient Agisheva A.Sh., 52 years old, was in the gynecological department of OOD (case history No. 6904) with a diagnosis of atypical endometrial hyperplasia, uterine fibroids. Menstrual and reproductive functions.

Menses from 14 years to 5-6 days, regular, painless, heavy, cycle 28 days.

The patient has a history of 6 pregnancies: 2 births, 4 artificial abortions.

Concomitant pathology: symptomatic hypertension Hk ₀ , anemia I Art.

Objectively.

The mammary glands - without features.

P.V. The external genitalia are developed correctly, the vaginal mucosa is not changed. The body of the uterus is enlarged to a 14-week pregnancy, tuberous, painless. Appendages on both sides without features. Parametries are free. Allocations are white.

Material sampling was carried out similarly, see example 1.

Ultrasound from 09/22/06 - uterus with dimensions 107 × 70 × 77 mm, tuberous, with nodes d 80 mm and 45 mm, the cavity expanded to 8 mm, with heterogeneous contents.

The right ovary is not located, the left ovary is 35 × 20 × 23 mm.

Cytological examination of aspirate from the uterine cavity No. 6495-96 from 09.10.06. - blood, pronounced proliferation of prismatic epithelium.

10.10.06, the extirpation of the uterus with appendages was performed.

Histological result No. 21476-98 of 10.23.06. Micro: uterus - fibromyoma, atypical endometrial hyperplasia. The cervix is a multilayered squamous epithelium edematous, cysts, tubes are plethora.

Catalase number - 0.8 units.

The catalase index is 0.13 units.

MDA - 3.85 nmol

The indicated results of the catalase number, catalase index, and MDA correspond to atypical endometrial hyperplasia in a patient with MM.

Example 6

Patient Smirnova L.A., 45 years old, was treated at the gynecological department of OOD (case history No. 1848) with a diagnosis of atypical endometrial hyperplasia, uterine fibroids.

Menstrual and reproductive functions.

Menses from 14 years to 5 days, heavy irregular.

A history of 3 pregnancies, of which 2 ended in an urgent delivery, in 1 case there was a correction of the menstrual cycle.

Concomitant pathology. NDC of mixed origin, chronic cystitis, chronic hepatitis, cholecystitis.

Uterine fibroids were first identified in 1996.

Ultrasound of the pelvic organs from 03/06/06: Uterus with dimensions of 77 × 68 × 59, endometrium 18 mm with uneven contours. In the area of the fundus of the uterus, a solid formation 43 × 31 mm in size. On the front wall of the uterus, a formation of 30 mm in size. The ovaries are not distinctly located.

Conclusion: suspected endometrial disease.

Objectively.

The mammary glands - without features.

P.V. The external genitalia are developed correctly. The vaginal mucosa is not changed. The uterus is enlarged to an 8-9 week pregnancy. Appendages are not separately determined. Parametries are free. Allocations are white.

Material sampling was carried out similarly, see example 1.

Aspirate from the uterine cavity No. 4437 dated 03.20.2006: pronounced proliferation of prismatic epithelium.

03/23/06, uterine extirpation with appendages was performed.

Histological result No. 5752-67 of 04/06/06. Micro: uterus - fibromyoma, atypical endometrial hyperplasia.

The cervix is a flat epithelium, edematous, with parakeratosis, cervical cysts. The ovaries are fibrosis of the body of the tissue, the tubes are plethora.

Catalase number - 0.51 units.

The catalase index is 0.11 units.

MDA - 2.26 nmol.

The indicated results of the catalase number, catalase index, and MDA correspond to atypical endometrial hyperplasia in a patient with MM.

The aim of the invention is to simplify the diagnosis of endometrial hyperplastic processes in uterine fibroids, which allows, in a short time, on small volumes of biological fluids, with minimal material costs, to evaluate pathological processes in women at the preclinical stage (screening test). It is important that this method can be used even in conditions of women's consultation, the method of sampling the material will depend on the age of the patient.

The results of biochemical studies can be compared with a cytological study of aspirate from the uterine cavity, as well as with the morphological picture of flushing or menstrual blood.

Table Study groups Indicator Control (n = 32) MM + NE (n = 39) MM + GGE (n = 26) MM + AGE (n = 11) Per. blood Flushing (menstru. Cr.) Per. blood Flushing (menstru. Cr.) Per. blood Flushing (menstru. Cr.) Per. blood Flushing (menstru. Cr.) Catalase number 4.4 ± 0.28 3.09 ± 0.18 3.37 ± 0.13 2.53 ± 0.16 3.07 ± 0.28 1.8 ± 0.33 5.24 ± 0.78 0.68 ± 0.2 Catalase index 1.12 ± 0.1 0.8 ± 0.08 1.01 ± 0.09 0.71 ± 0.05 0.94 ± 0.05 0.44 ± 0.09 1.35 ± 0.18 0.2 ± 0.09 MDA 0.71 ± 0.1 0.37 ± 0.1 0.85 ± 0.2 0.49 ± 0.06 1.9 ± 0.4 1.68 ± 0.23 1.29 ± 0.59 3.01 ± 0.85

Claims (1)

A method for the diagnosis of endometrial hyperplastic processes in patients with uterine myoma, based on a study of the biochemical characteristics of biological substrates, characterized in that the catalase, catalase number, malondialdehyde indicators are simultaneously determined in the supernatant of the uterine cavity or menstrual blood and the catalase number is reduced to 2, 53 ± 0.16 units, catalase up to 0.71 ± 0.05 units. and increasing the value of malondialdehyde to 0.49 ± 0.06 nmol diagnose the normal structure of the endometrium in patients with uterine myoma; with a decrease in the catalase number to 1.8 ± 0.33 units, the catalase index to 0.44 ± 0.09 units. and increasing the value of malondialdehyde to 1.68 ± 0.23 nmol diagnose endometrial hyperplasia in patients with uterine myoma; with a decrease in the catalase number to 0.68 ± 0.2 units, the catalase index to 0.2 ± 0.09 units and an increase in malondialdehyde to 3.01 ± 0.85 nmol, atypical endometrial hyperplasia is diagnosed in patients with uterine myoma.