Прогнозування хронічного тазового болю тяжкого ступеня при гінекологічній патології

Abstract

. Враховуючи доведену патофізіологічну роль цитокінів, на підставі рівняння логістичної регресії, у роботі розроблено модель прогнозування хронічного тазового болю важкого ступеня (7 балів та вище за ВАШ) при запальних захворюваннях органів малого таза та геніальному ендометріозі у поєднанні з доброякісними гормонозалежними захворюваннями геніталій. Визначено, що до найбільш прогностично здатних функціональних показників про- і протизапальних інтерлейкінів (IL – 10, IL – 6, TNF -α) відноситься прозапальний індекс TNF-α/ІЛ-10. Згідно логістичної прогностичної моделі, на кожну одиницю його збільшення шанс розвитку високого ступеню больового синдрому зростає у 9,96 разів (95 % ДІ 4,85 – 20,46).

The relevance of the study is due to the pathophysiological role of cytokines in the activation mechanisms of the local inflammatory response, peripheral sensitization, emotional and behavioral manifestations of chronic pelvic pain caused by inflammatory diseases of the pelvic organs, genital endometriosis. This requires the development of new algorithms for the prediction and monitoring of chronic pelvic pain of severe degree chronic in these diseases. The aim of our study: based on the pathophysiological role of cytokines, to develop a model of prediction of chronic pelvic pain of severe degree (7 points and above VAS) in inflammatory diseases of the pelvic organs and genital endometriosis in combined with benign genital diseases. Object and methods: 210 women with gynecological pathology were examined: 90 patients with inflammatory diseases of the pelvic organs (group I); 120 patients with genital endometriosis in combined with benign genital diseases (group II). Clinical, instrumental, laboratory, psychological and mathematical-statistical methods of research were used. The severity of pelvic pain was determined by a 10-point visual analog scale. Statistical processing was performed using relevant statistical methods (ANOVA, correlation, simple and multiple logistic regression and ROC analyzes) using the STATISTICA 6.1 program (StatSoftInc., Serial No. AGAR909E415822FA) and the MedCalc Statistical Software trial version 18.11.3 (MedCalc Software bvba, Ostend, Belgium; https://www. medcalc.org; 2018). Research results and their discussion. It was determined that the pro-inflammatory index TNF-α / IL-10 (PI) is one of the most prognostically significant functional indicators of pro- and anti-inflammatory interleukins (IL-10, IL-6, TNF-α). The best prognostic characteristics were determined for the pro-inflammatory index TNF-α / IL-10. A logistic regression equation of using pro-inflammatory index for predicting a high degree of CPP for VAS (7-10 points) in the surveyed women with gynecologic pathology: y = exp (-2.270+ (2.299) × x) / (1 + exp (-2.270+ (2.299) × x)), where y is the result: theoretical probability of a high level of CPP for VAS (7 points and above) in the examined women (1 – severe pain syndrome in 7-10 points in VAS, 0 – absence / low level of pain syndrome – up to 4 points in VAS); x – specific value of TNF-α / IL-10. The logistic regression equation has excellent operational characteristics; evaluation of the logistic regression equation showed its adequacy: χ2 = 86,94 (p <0,001). Conclusions. The study established the pathophysiological role of interleukins in the process of enhancing and chronic pelvic pain in patients with pelvic inflammatory diseases and with genital endometriosis. According to the logistic prognostic model, for each unit of its increase the chance of developing a high degree of CPP increases by 9.96 times (95% CI 4.85–20.46), which proves the expediency of determining the cytokine status in patients with pelvic pain.