Cytokine profile in patients with chronic endometritis and reproductive disorders

Abstract

Objective. To study the immune response in patients with chronic endometritis (CE) of viral and bacterial etiology based on the evaluation of cytokine status as well as the efficiency of local therapy using a complex of natural exogenous cytokines. Patients and methods. A prospective randomized clinical trial, which included 76 women with CE and infertility, who received etiotropic antibacterial therapy prior to inclusion in the study, is presented. In group I (n = 36), patients were treated with a daily intravaginal administration of Superlymph 25 U for 20 days; in group II (n = 40), patients were under observation. We used a vaginal wet mount test, real-time polymerase chain reaction (RT-PCR) (to estimate virus shedding), and an analysis of serum cytokine levels (interleukins IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, and tumor necrosis factor alpha (TNF-α)). Results. The herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) (80.6% and 80.0%, respectively) was predominantly detected in both groups of patients in combination with other types of herpesviruses (50.0% and 42.5%, respectively) and/or human papillomavirus (HPV) (50%). After treatment with Superlymph, virus shedding ceased in 66.7% of patients (p < 0.001). Before treatment, the levels of all cytokines were higher than the reference values (p < 0.001) in both groups (IL-1β – 1.8 times, IL-6 – 1.6 times, IL-2 and IL-8 – 1.2 times, TNF-α – 1.4 times). After treatment, their values decreased in group I (p < 0.001 for each indicator). In group II, the changes were insignificant. Pregnancy occurred within 12 months in 30 (83.3%) patients in group I and in 24 (60.0%) patients in group II, and this result was statistically significantly higher in group I (p = 0.047). Conclusion. The role of viral and bacterial infections accompanied by an imbalance of pro- and anti-inflammatory cytokines in patients with CE was revealed, which is the basis for prescribing not only antibacterial therapy, but also local immunomodulatory agents. Key words: infertility, immunity, Superlymph, chronic endometritis, cytokines