PATHOGENETIC MECHANISMS OF DEVELOPMENT OF ADHESIVE PROCESS IN THE PELVIS AFTER GENICOLOGICAL INTERVENTIONS TAKING INTO ACCOUNT THE LEVEL OF MATRIX METAL PROTEINASE AND TUMOR NECROSIS FACTOR

The aim of this study was to evaluate the role of tumor necrosis factor α (TNFα) and matrix metalloproteinases (MMP-2 and MMP-9) in the development of adhesive disease during surgical interventions in gynecology.
Materials and methods. A comprehensive comparative immunological study of TNF-α and matrix metalloproteinases (MMP-2 and MMP-9) was conducted in 60 patients after gynecological operations in order to evaluate their role as predictors in the development of adhesive processes, of which 30 patients had an adhesive process in the small pelvis (N73.6 according to ICD-10; main group) and 30 women without an adhesive process (comparison group). The control group consisted of 20 women belonging to health group I.
Results. The average age of patients in the main group was 31.6±1.9, in the comparison group – 30.7±2.1 (p>0.05). Most women were in active reproductive age – 20 (66.7) and 21 (70.0%), respectively (p>0.05). When studying the somatic history, a statistically significant higher level of comorbidity was established in patients in the main group: extragenital pathology was recorded 1.6 times more often in relation to the comparison group (p=0.001). In 16.2% and 10% (p=0.048) of cases, respectively, combined damage to several organs and systems was observed. It should be noted that statistically significant higher proportion of cardiovascular (arterial hypertension, chronic venous diseases) and endocrine diseases (obesity, hyper- and hypothyroidism) was observed in patients of the main group 2.0 (p=0.038) times more often compared to the comparison group.
Conclusions. An increase in the content of matrix metalloproteinases-2 and 9 was established, which indicates a destructive effect on the extracellular matrix, creating conditions for the development of adhesions due to the growth of fibrous tissue. The range of MMP-2 levels >400 pg/ml and MMP-9 >350 pg/ml in determining the risk of developing adhesive processes after gynecological surgeries was established. A pathogenetic relationship between high TNF-α levels in the development of adhesive process in women who underwent gynecological surgeries was proven, a predictor content in the range of over 45 pg/ml in the development of adhesive disease was established.