High risks of somatic pathology in women with chronic endometritis

are given in scores as per 8 scales made up in such a way that a higher scor- ing means a better life quality [16, 17]. Pa- rameters as per 2 groups were assessed and represented by the median (Me) and a per- centile interval 25–75. We applied distribu- tion-free techniques (Mann-Whitney test for comparing two independent samplings) to compare both groups and examine pos- sible correlations. To analyze dependences between a frequency of a parameter occur- rence (somatic and gynecologic pathology) in a group, we applied chi-square criterion (χ2). We analyzed discrepancies between groups as per parameters occurrence fre- quencies also with χ2 criterion. We calcu- lated odds relation (OR) with 95%- confidence interval and applied relative risk with 95%-confidence interval as a way to assess risk factors and possibility of health disorders in female patients.

and discussion . Women from the first group were from 19 to 44 (average age was 30.90±7.09 ); from the second, from 21 to 44 (average age was 34.11±4.79). Reproductive case history analysis in the first group revealed the fol- lowing peculiarities: 11 women had child- birth in their case history (33.33±16.72%); 5 miscarriages which happened during first 5 gestation weeks were detected in 15.15±12.71% women, χ2=3.46; p=0.06; we didn't detect any frozen pregnancies in this group; medical abortions were made in 24.24±15.2% (8) cases, χ2=6.97; p=0.008, that is, frequency of this parameter occur- rence in this group was statistically signifi- cant; 96.97±6.08% women practiced birth control and used condoms to protect them- selves from unwanted pregnancies, and it proved that frequency of this parameter oc- currence was statistically significant for this category of the examined women (χ2=58.30; p<0.001). Our analysis of gynecological case his- tory which patients from the 1st group had revealed that 6.06±8.46% women suffered from such proliferative uterus diseases as leiomyoma, and we didn't detect adenomy- osis in this group. We analyzed frequency of chronic reproductive system inflamma- tions occurrence and revealed that women didn't have chronic salpiginitis, adnexitis, or cervicitis; chronic cervicitis led to sur- gery on the uterine neck in 2 patients (6.06±8.46%, χ2=0.52; p=0.473). Menstru- al cycle characteristics revealed that men- arche occurred timely in 87.88±11.57% (29) women and we didn't detect any other menstrual disorders in this group. Reproductive case history analysis performed on women suffering from chronic endometritis revealed the follow- ing: 57.14±15.42% (24) patients had pri- mary and secondary infertility, χ2=30.86; p<0.001; 14 patients (33.33±14.69%) had childbirth, 54.76±15.51% women had medical abortions (p<0.001), and it indi- cated that frequency of this parameter oc- currence in this patients' group was statisti- cally significant. Pregnancy had an unfa- vorable outcome, namely miscarriage or frozen pregnancy, in 26.19±13.7% (χ2=10.46; p<0.001) cases and it indicated that frequency of this parameter occurrence among these patients was also statistically significant. 14.29±10.9% (6) women suf- fered from proliferative uterus diseases (leiomyoma) and frequency of this parame- ters occurrence was also statistically signif- icant, χ2=4.49; p=0.034. Adenomyosis was detected in 9.52±9.15% (4), χ2=2.36; p=0.124, that is, the parameter was not sta- tistically significant in this group. Our analysis of chronic reproductive system inflammations revealed that 40.48±15.3%, (χ2=18.88; p<0.001) suffered from chronic salpiginitis and adnexitis; 47.62±15.56% (p<0.001), from chronic cervicitis; High risks of somatic pathology in women with chronic endometritis Health Risk Analysis. 2017. no. 4 61 52.38±15.56% (p<0.001) patients had sur- gery on the uterine neck in their case histo- ry. Women suffering from chronic endo- metritis had various menstrual function disorders in 69.05±14.41% cases (χ2=10.46; p<0.001), algomenorrhea (28.57±14.08%; p<0.001) and profuse menses (19.05±12.24% patients; p<0.001) were statistically significant. Comparative characteristics of all the above mentioned parameters is given in Table 1. Table 1 Comparative characteristics of the obstetric-gynecological case history between two groups Signs Groups 1(n=33) % Groups 2 (n=42) % Chi2 R OR CI 95% Child birth 33,33 ± 16,0 33,33 ± 14,6 0,061 0,805 1,000 0,38; 2,63 Infertility 0 57,14 ± 15,4 15,584 0,001* 416,00 25; 4195,12 Medical abortion 24,24 ± 15,0 54,76 ± 15,5 5,896 0,015* 3,783 1,39; 10 Miscarriage 15,15 ± 12,0 26,19 ± 13,7 0,765 0,382 1,987 0,61; 6,43 Frozen pregnancy 0 26,19 ± 13,7 4,252 0,039* – – Menstrual dysfunctions 0 69,05 ± 14,4 22,517 0,001* – – Leiomyoma 6,06 ± 8,4 14,29 ± 10,9 0,591 0,442 – – Adenomyosis 0 9,52 ± 9,2 0,799 0,371 – – Chronic salpiginitis 0 40,48 ± 15,3 8,527 0,003* – – Chronic adnexitis 0 40,48 ± 15,3 8,527 0,003* – – Chronic cervicitis 0 47,62 ± 15,5 11,234 0,001* – – Surgery on the uterine neck 6,06 ± 8,4 52,38 ± 15,5 16,155 0,001* 17,050 3,61; 80,56 Contraception 96,97 ± 6,08 61,9 ± 15,1 7,716 0,005* 0,000 – Note:* – means that statistically significant discrepancies in a parameter occurrence frequency were de- tected between healthy women and those suffering from chronic endometritis When we compared analyzed parame- ters in healthy women and in female pa- tients with chronic endometritis we re- vealed that there were statistically signifi- cant discrepancies in occurrence frequency of medical abortion (made to get rid of unwanted pregnancy, the parameter was higher in patients with chronic endometri- tis), chronic adnexitis and salpiginitis, chronic cervicitis, frozen pregnancy, and infertility. As per body mass index, healthy women from group I were divided into the following sub-groups: 23 (69.7±16.3%) out of 33 women had normal parameters (18.50–24.99); 10 (30.3±16.3%) women had excessive body weight and 1st degree obesity ( χ2=9.55; p=0.002). A share of women with normal body mass in group 2 amounted to 69.05±14.41% (29); 30.95±14.41% (13) had lipid metabolism disorders; χ2=13.11; p<0.001. We analyzed gastrointestinal tract disorders in the examined women and re- vealed that 4 women (12.5±11.92%, χ2=2.40; p=0.121) in the first group (n=33) suffered from chronic gastritis, and 3 (9.09±10.19%, χ2=1.40; p=0.237) had chronic pancreatitis; functional bowels dis- orders (notably, irritable bowels syndrome) were detected in 1 patient (3.03±6.08%), gall bladder disorders (including gall blad- der dyskinesia and biliary tracts dyskine- sia) were also detected in only 1 patient (3.03±6.08%). We didn't detect any urinary system disorders (chronic pyelonephritis, cystitis, or urethritis), or thyroid gland dis- orders (hypothyroidism or hyperthyroid- ism) in women from the first group. We detected 2 cases (6.06±8.46%, χ2=0.52; E.G. Kobaidze, M.M. Padrul Health Risk Analysis. 2017. no. 4 62 p=0.473) of chronic respiratory tracts dis- orders (chronic pharyngitis, rhinitis, or rhi- nopharyngitis). More than half of them had food allergy or household chemicals aller- gy, 6 (18.18±13.68%, χ2=4.52; p=0.003) women had broad spectrum antibiotics al- lergy. Gastrointestinal tract diseases analysis in the 2nd group (n=42) revealed that 57.14±15.42% had chronic gastritis, and 42.86±15.42% were healthy, χ2=30.86; p<0.001; chronic pancreatitis was detected in 23.81±13.27% (10 women), χ2=9,19; p=0.002; bowels functional disorders, in 64.29±14.93% (27 patients), χ2=36.90; p<0.001; gall bladder disorders were de- tected in 61.9±15.13% (26) cases, χ2=34.81; p<0.001. 21 patients (50±15.58%), had urinary system diseases χ2=25.40; p<0.001. Thyroid gland diseases were detected in 5 (11.9±10.09%) women; chronic respiratory tract diseases, in partic- ular, chronic rhinitis, in 19.05±12.24% pa- tients, χ2=6.77; p=0.009, and chronic rhi- nopharyngitis, in 28.57±14.08%, χ2=11.76, p<0.001. 15 patients (35.71±14.93%, χ2= 15.91; p<0.001) had broad spectrum antibiotics allergy. We applied Mann-Whitney criterion and revealed statistically significant dis- crepancies between 2 groups as per blood analysis. Notably, women from the groups 2 (patients with chronic endometritis) had greater quantities of stab neutrophils, lym- phocytes, and monocytes, as well as low erythrocytes sedimentation rates, which could possibly indicate their immune pro- tection was weaker, and their non-specific body reactivity, lower (Table 2). Comparison between patients from the 1st and 2nd group allowed to reveal statisti- cally significant discrepancies between oc- currence frequency of such diseases as chronic gastritis, bowels functional disor- ders, gall bladder diseases, urinary system diseases, and chronic rhinopharyngitis. the above-mentioned pathologies occurred more frequently in patients suffering from chronic endometritis. We also detected sta- tistically insignificant discrepancies be- tween occurrence frequency of such param- eters as body mass index deviations, chron- ic pancreatitis, chronic rhinitis, antibiotics allergy in groups of healthy and sick wom- en. Comparative characteristics of the above-mentioned pathologies is given in Table 3. Table 2 Comparative characteristics as per blood analysis between 2 groups Blood analysis parameters group1 (n=33) Me (25%-75%) group 2 (n=42) Me (25%-75%) p-level Leucocytes (10*9) 5,2 (4,7–5,5) 4,7 (4,1–5,3) 0,029* Stab neutrophils (%) 2 (1–2) 2 (2–3) 0,005* Monocytes (%) 9 (6–10) 11 (9–12) 0,003* Lymphocytes (%) 31 (27–35) 36 (33–40) 0,001* Thrombocytes (10*9) 244 (226–286) 221 (211–267) 0,024* Erythrocytes sedimentation rate (mm/h) 13 (11–15) 7 (5–12) 0,001* Hemoglobin g/l 127 (124–132) 124 (114–134) 0,246 Note:* – means Mann-Whitney criterion allowed to reveal statistically significant discrepancies between 2 groups. High risks of somatic pathology in women with chronic endometritis Health Risk Analysis. 2017. no. 4 63 Table 3 Comparative characteristics of somatic pathologies between groups Parameter Group 1(n=33) % Group 2 (n=42) % Chi2 Р OR CI 95% BMI 30,3 ± 16,3 30,95 ± 14,4 0,04 0,848 1,031 0,38; 2,77 Chronic gastritis 12,5 ± 11,9 57,14 ± 15,4 13,6 0,001* 9,333 2,78; 31,39 Chronic pancreatitis 9,09 ± 1,01 23,81 ± 13,2 1,9 0,172 3,125 0,78; 12,46 Bowels functional disorders 3,03 ± 6,0 64,29 ± 14,9 27,1 0,001* 57,60 7,14; 464,79 Gall bladder diseases 3,03 ± 6,0 61,9 ± 15,1 25,3 0,001* 52,00 6,46; 418,55 Urinary system diseases 0 50,0 ± 15,5 12,2 0,001* – – Thyroid gland diseases 0 11,9 ± 10,0 1, 1 0,300 – – Chronic rhinitis 6,06 ± 8,4 19,05 ± 12,2 1,4 0,229 3,412 0,67; 17,36 Chronic rhinopharyngitis 6,06 ± 8,4 28,27 ± 14,0 4,8 0,029* 6,200 1,28; 30,07 Antibiotics allergy 18,18 ± 13,0 35,71 ± 14,9 2,015 0,156 2,500 0,84; 7,41 Note: * – means that statistically significant discrepancies in a parameter occurrence frequency were de- tected between healthy women and those suffering from chronic endometritis. When we calculated relative health disorders risk in terms of a significant so- matic pathology in patients suffering from chronic endometritis, we obtained the fol- lowing results: chronic gastritis risk (RR) was equal to 2.190, OR 95% 1.48; 3.24; bowels functional disorders (RR), 3.021, OR 95% 1.98;4.62; gall bladder diseases (RR), 2.889, OR 95% 1.92;4.34; urinary system diseases (RR), 2.571, OR 95% 1.84;3.59; chronic rhinopharyngitis (RR) 1.743, OR 95% 1.25;2.43 (correlation was thought to be significant at p < 0.05), and it indicated that women from the 2nd group ran higher risks of somatic pathologies oc- currence. Bearing our research goals in mind, we analyzed women's questionnaires as per life quality and revealed statistically significant discrepancies between two groups as per two scales. We should high- light that patients suffering from chronic endometritis had lower Role-Emotional functioning capacities, greater anxiety, mental ill-being, lower health self-esteem and lower resistance to diseases, they as- sessed their treatment prospects skeptical- ly, and all this undoubtedly meant life quality of these women was rather poor (comparison results are given in Table 4). Table 4 Comparative characteristics of life quality between 2 groups Parameters Group 1 (n=33) Me (25%-75%) Group 2 (n=42) Me (25%-75%) p-level Physical functioning 65 (59–68) 44 (42–54) <0,001* Role physical functioning 68 (67–71) 47 (44–49) <0,001* Bodily pain 71 (69–74) 43,5 (38–47) <0,001* Vitality 71 (70–73) 48 (45–51) <0,001* Social functioning 72 (70–75) 55 (48–56) <0,001* Role emotional state 77 (74–79) 40,5 (37–45) <0,001* Mental health 80 (72–82) 42 (38–45) <0,001* General health 69 (60–72) 44,5 (43–55) <0,001* Note: p<0.001* – means Mann-Whitney criterion allowed to reveal statistically significant discrepancies between 2 groups. E.G. Kobaidze, M.M. Padrul Health Risk Analysis. 2017. no. 4 64 Conclusions. Health parameters of pa- tients suffering from chronic endometritis differ greatly from those of healthy women. High somatic pathology parameters and fer- tility issues can cause low scores of each life quality scale. Analysis of life quality which patients with this diseases have will allow to develop relevant recommendations aimed at its improvement and exerting positive influ- ence on efficiency of the basic pathology therapy. Allowing for poor health of women suffering from chronic endometritis, we as- sume that doctors with all specialties should pay greater attention to medical-preventive activities, and prescribe health-preserving treatment at all the stages when a woman applies for medical aid, and not only when she is getting ready for a pregnancy. It is necessary to apply individualized sets of pharmaceuticals, physiotherapeutic and bal- neal techniques, as well as diet therapy, for the recovery of basic metabolism types, anti- oxidant processes, immunologic protection factors and non-specific reactivity. Health- preserving treatment for not only gynecolog- ical but also concomitant somatic patholo- gies can stimulate adaptation reserves recov- ery in organs and systems, neuro-vegetative regulation, and, accordingly, hormonal ho- meostasis recovery which becomes truly vi- tal for maintaining proper reproductive sys- tem functioning.

1. Demin A.V. Populyatsionnye pokazateli kachestva zhizni zhenshchin 65-74 let, prozhivayushchikh na Evropeiskom Severe Rossii [Population parameters of life quality charac- teristic for women aged 65-74 living in the Northern European part of Russia]. Molodoi uchenyi, 2015, no. 21, pp. 261–269. Available at: https://moluch.ru/archive/101/22786/ (09.07.2017) (in Russian). 2. Dolgikh O.V., Zaitseva N.V., Dianova D.G. Analiz apoptoticheskoi aktivnosti limfotsitov u zhenshchin fertil'nogo vozrasta v usloviyakh vozdeistviya reprotoksikantov [In women of childbearing age under the conditions of reprotoxicants exposure]. Rossiiskii immuno- logicheskii zhurnal, 2015, vol. 9, no. 1, pp. 58 (in Russian). 3. Loranskaya I.D., Rakitskaya L.G., Malakhova E.V., Mamedova L.D. Lechenie khronicheskikh kholetsistitov [Chronic cholecystitis treatment]. Lechashchii vrach: meditsinskii nauchno-prakticheskii portal , 2006. Available at: https://www.lvrach.ru/2006/06/4534015/ (10.08.2017) (in Russian). 4. Minasyan A. M., Dubrovskaya M. V. Beremennost' na fone khronicheskogo pielonefrita (obzor) [Pregnancy of a woman suffering from chronic pyelonephritis (a review)]. Saratovskii nauchno-meditsinskii zhurnal, 2012, vol. 8, no. 4, pp. 920–925 (in Russian). 5. Orazmuradov A.A., Boltovskaya M.N., Shmel'kov A.V., Apresyan S.V., Nazimova S.V., Terent'eva S.L. Negativnoe vliyanie khronicheskogo pielonefrita na protsess gestatsii [Negative impact of chronic pyelonephritis on the gestation]. Vestnik Rossiiskogo universiteta druzhby narodov. Seriya: Meditsina, 2011, no. S5, pp. 14–18 (in Russian). 6. Ovchinnikov A.Yu., Slavskii A.N., Fetisov I.S. Khronicheskii tonzillit i sopryazhennye s nim zabolevaniya [Chronic tonsillitis and concomitant diseases]. Russkii meditsinskii zhurnal , 1999, no. 7, pp. 31–36 (in Russian). 7. Bubnova O.A., Dolgikh O.V., Sinitsyna O.O., Krivtsov A.V., Bezruchenko N.V., Ma- zunina A.A., Gusel'nikov M.A., Otavina E.A. Polimorfizm genov semeistva ppars, gena esr1 u zhenshchin s nevynashivaniem beremennosti v usloviyakh aerogennoi ekspozitsii fenolami [Polymorphism of ppars genes and esr1 gene in females with miscarriages under aerogenous exposure to phenols]. Okruzhayushchaya sreda i zdorov'e. Gigiena i ekologiya urbaniziro- High risks of somatic pathology in women with chronic endometritis Health Risk Analysis. 2017. no. 4 65 vannykh territorii: materialy VI Vserossiiskoi nauchno-prakticheskoi konferentsii s mezhdu- narodnym uchastiem molodykh uchenykh i spetsialistov, posvyashchennoi 85-letiyu FGBU NII ECh i GOS im. A.N. Sysina Minzdrava Rossii [Environment and health. Hygiene and ecology on urbanized territories: materials of the VI Russian theory and practical conference with interna- tional participation of young scientists and experts dedicated to 85-th anniversary of Sytin's Sci- entific Research Institute for Human Ecology and Environmental Hygiene of the RF Public Healthcare Ministry]. In: Yu.A. Rakhmanin, ed. 2016, pp. 93–98 (in Russian). 8. Amirdzhanova V.N., Goryachev D.V., Korshunov N.I., Rebrov A.P., Sorotskaya V.N. Populyatsionnye pokazateli kachestva zhizni po oprosniku SF-36 (rezul'taty mnogotsentrovogo issledovaniya kachestva zhizni «MIRAZh») [SF-36 questionnaire population quality of life in- dices Objective]. Nauchno-prakticheskaya revmatologiya, 2008, no. 1, pp. 36–48 (in Russian). 9. Radzinskii V.E. Reproduktivnaya infektologiya XXI veka [Reproductive infectology in the XXI century]. StatusPraesens, 2013, no.16-5, pp. 33–36 (in Russian). 10. Fen I., Sidorova I.S., Stanoevich I.V., Unanyan A.L., Kudrina E.A. Sochetanie giper- plasticheskikh protsessov endometriya s khronicheskim endometritom [Combination of endo- metrial hyperplastic processes with chronic endometritis]. Akusherstvo, ginekologiya i reproduk- tsiya, 2012, vol. 6, no. 1, pp. 31–33 (in Russian). 11. Motovilova T.M., Grechkanev G.O., Kachalina T.S., [et al.]. Sravnitel'naya kharakter- istika mikroflory polosti matki i nebnykh mindalin u patsientok s persistiruyushchim endometri- tom [Comparative characteristics of microflora of uterine cavity and palatal tonsils in the case of female patients having persistent endometritis]. Meditsinskii al'manakh , 2015, no. 4 (39), pp. 105–107 (in Russian). 12. Sukhikh G.T., Shurshalina A.V. Khronicheskii endometrit [Chronic endometritis]. Moscow, GEOTAR-Mediya, Publ., 2010, 64 p. (in Russian). 13. Styazhkina S.N., Chernenkova M.L., Krivenko P.A., Gailyamova L.I. Techenie i iskho- dy beremennosti u zhenshchin s khronicheskim pielonefritom [The course of pregnancy and outcome of labor in women with chronic pyelonephritis]. Sovremennye problem nauki i obra- zovaniya: elektronnyi nauchnyi zhurnal , 2015, no. 1–1. Available at: https://www.science- education.ru/ru/article/view?id=17394 (12.07.2017) (in Russian). 14. Tkachenko L.V., Sviridova N.I. Prognosticheskie faktory riska razvitiya giperplastich- eskikh protsessov endometriya v perimenopauzal'nom periode [Prognostic factors for the devel- opment of hyperplastic processes in perimenopause]. Volgogradskii nauchno-meditsinskii zhur- nal, 2013, no. 4, pp. 43–47 (in Russian). 15. Chereshnev V.A., Gusev E.Yu. Immunologiya vospaleniya: rol' tsitokinov [Immunolo- gy of Inflammation: The Role of Cytokines]. Meditsinskaya immunologiya, 2001, vol. 3, no. 3, pp. 361–368 (in Russian). 16. Ware J.E., Snow K.K., Kosinski M., Gandek B. SF-36 Health Survey. Manual and in- terpretation guide. Boston, Mass: The Health Institute, New England Medical Center, 1993. 17. Ware J.E., Kosinski M., Keller S.D. SF-36 Physical and Mental Health Summary Scales: A User`s Manual. Boston, Mass: The Health Institute, New England Medical Center, 1994. Kobaidze E.G., Padrul M.M. High risks of somatic pathology in women with chronic en- dometritis. Health Risk Analysis, 2017, no. 4, pp. 57–65. DOI: 10.21668/health.risk/2017.4.06.eng Received: 08.09.2017 Accepted: 11.12.2017 Published: 30.12.2017