Національна медична академія післядипломної освіти імені П.Л. Шупика, м. Київ Мета дослідження: вивчення сучасних імунологічних аспектів доброякісної дисплазії грудних залоз (ддГЗ) у жінок репродуктивного віку. Матеріали та методи. Обстежено 90 пацієнток віком від 22 до 45 років, яких було розподілено на три групи по 30 жінок: 1-а група (група контролю)-жінки без патології ГЗ. до 2-ї групи увійшли пацієнтки з дифузною формою ддГЗ. У 3-ю групу увійшли пацієнтки з вузловою формою ддГЗ. до комплексу проведених досліджень було включено клінічні імунологічні та статистичні методи. Результати. Результати проведених досліджень свідчать, що до чинників ризику розвитку ддГЗ можна віднести наявність хронічних екстрагенітальних захворювань, куріння, раннє менархе, порушення менструального циклу, міому матки і аденоміоз, штучне або мимовільне переривання вагітності. Проведене дослідження довело, що імунологічні детермінанти відіграють істотну роль, є чинниками ризику та ініціальною ланкою патогенезу доброякісної патології ГЗ. Заключення. Отримані результати слід враховувати під час розроблення алгоритму діагностичних та лікувально-профілактичних заходів. Ключові слова: доброякісна дисплазія грудних залоз, клініка, імунологія. Imunological aspects of good-quality dysplasia of mammary glands at women of reproductive age S.E. Gladenko The objective: to study modern imunonologic aspects of good-quality dysplasia of mammary glands at women of reproductive age. Materials and methods. Were surveyed 90 patients aged from 22 till 45 years which are divided into 3 groups on 30 women: 1 group (group of control)-the woman without pathology in mammary glands. The 2nd group included patients with diffuse form of good-quality dysplasia of mammary glands. The 3rd group was made by patients with a nodal form of a good-quality dysplasia of mammary glands. The complex the researches included clinical, imunologic and statistical methods. Results. Results of the conducted researches testify that it is possible to refer existence of chronic extragenital diseases, smoking, an early menarche to risk factors of development of a good-quality dysplasia of mammary glands, disturbances of a menstrual cycle, hysteromyoma and an adenomyosis, an artificial or spontaneous abortion. The research conducted by us proved that immunologic determinants play an essential role and are risk factors and an initial link of pathogenesis of benign pathology of mammary glands. Conclusion. The received results needs to be considered when developing algorithm of diagnostic and treatment-and-prophylactic actions.

The objective: to study the effect of stimulating hormone therapy on the condition of the mammary glands depending on the initial endocrine status of women with menstrual disorders in the background and after ovulation stimulation.Materials and methods. The study selected a group of 130 patients (n=130) of reproductive age (mean age 27±2,3 years), which by the nature of menstrual disorders are divided into 2 subgroups: 1 subgroup (n=57) – women with regular menstrual rhythm and insufficiency of the luteal phase (ILP), 2 subgroup (n=73) – women with secondary amenorrhea and oligomenorrhea on the background of chronic anovulation. All patients complained of no pregnancy for an average of 4±1,2 years. After a comprehensive assessment of the reproductive system and hormone-dependent organs, women received the proposed treatment with estrogen-progestogen drug, bromocriptine and ovulation stimulation with clomifene citrate.Results. During the preparatory (diagnostic) phase of the study it was found that in 1 subgroup in 89,5% of patients with concomitant diseases of the pelvic organs and only endocrine disorders of the ILP type in 10,5%. In women of 2 subgroup, the frequency of combined pathology was 23,3%, and endocrine disorders – 76,7%. These results confirmed the need for laparoscopic and hysteroscopic examination of all patients with infertility in addressing the issue of ovulation stimulation. After short cycles (3 months) of monophasic estrogen-progestogen therapy, 31,6% of patients with ILP and 17,1% with anovulation had a positive effect on reducing the incidence of pain in the mammary glands, with the most sensitive to therapy were patients with diffuse forms of fibrocystic disease with a predominance of cystic and glandular components. When resuming biphasic ovulatory cycles with clomifene citrate stimulation, only 5,7% of women complained of breast pain during the first 1–2 cycles. No additional foci in the subgroups were detected, and previously diagnosed fibroadenomas did not increase.Conclusion. Analyzing the obtained data, a positive effect of different types of hormone therapy on the condition of the mammary glands in patients with menstrual and reproductive dysfunction, in particular with diffuse forms of fibrocystic disease with a predominance of cystic and glandular components, is structures most sensitive to normal progesterone levels. Despite the lack of negative dynamics on the background of ovulation stimulation and restoration of normal mammary gland structure after therapy in women with menstrual disorders of endocrine origin, menstrual cycle regulation and dynamic monitoring of the mammary glands are shown to prevent the development of hyperplastic processes.

Diffuse benign dysplasia of the mammary glands is one of the frequent pathologies that practitioners almost daily encounter. Studying the mechanisms of development of pathological gynecological conditions, the researchers concluded that there is a pathogenetic connection between cyclic changes in the reproductive system and the physiological processes occurring in the mammary glands. This makes it possible to assume a high probability of occurrence of pathological changes in the mammary glands in various gynecological diseases, developing as a result of disorders of the hypothalamic-pituitary-ovarian system. The general inhibition and unity of the reaction of the reproductive organs to hormonal imbalance is the main prerequisite for the development of benign hyperplastic and the risk of malignant processes. The relevance of studying the reproductive health of patients with dyshormonal non-inflammatory pathology of the genital organs is due to the steady increase in the proportion of this pathology in recent years in the structure of gynecological morbidity, the rejuvenation of the patient population, and the lack of a single algorithm for rehabilitation measures. On the one hand, effective treatment reduces symptoms, guarantees quality of life, on the other hand, mastopathy is a risk factor for the development of a malignant tumor in the future. Therefore, timely correction of dysplasia can be considered as a variant of primary prevention of breast cancer. The choice of an adequate tactic to manage such patients from the existing variety of dosage forms is the key to the success of treatment.