Стан імунної системи у вагітних після органозберігаючого лікування пограничних пухлин і ранньої онкологічної патології яєчників

Анотація

Introduction. The efficiency of standard organ-sparing operations for borderline tumors and early oncological pathology of the ovaries is high both from an oncological point of view and in terms of preserving reproductive function and quality of life. The state of the immune system of the mother and fetus during pregnancy is the most important problem of modern obstetrics. The purpose of the study was to study the state of the immune system in pregnant women after organ-sparing treatment of borderline tumors and early oncological pathology of the ovaries. Materials and methods. The main group included 40 pregnant women who, 2 to 5 years ago, underwent organ-preserving treatment for borderline tumors and early oncological pathology of the ovaries (malignant ovarian tumors of stages Ia and Ic). The control group included 40 practically healthy pregnant women with an uncomplicated history and physiological course of this pregnancy. In the examined women, the immune status was established according to absolute and relative indicators of cellular and humoral links of systemic immunity - assessment of the concentration of immunoglobulins of class A, G and M in blood serum according to Manchini and in cervical mucus, as well as analysis of indicators of cellular immunity using the method of monoclonal antibodies. The concentration of secretory immunoglobulin A (sIg A) in biological fluid was studied by enzyme immunoassay. Results and discussion. The conducted studies showed that in pregnant women after organ-preserving treatment of borderline tumors and early oncological pathology of the ovaries, there is a decrease in the number of T-lymphocytes by 18.4%, as well as changes in the percentage of the subpopulation of T-helpers and T-suppressors with a noticeable increase in the level of CD4+ (T- helpers) by 17.8% and a sharp decrease in CD8+ (T-suppressors) by 26.7%, which indicates the blocking of the immune response and the possibility of allergic or autoimmune disorders in this category of women. Along with this, an increase in the level of CD56+ (natural natural killers) was noted by 31.4% in comparison with similar indicators of the control group. An increase in the immunoregulatory index was also noted, which may be evidence of the activation of autoimmune processes. The results of the study of the humoral link of systemic immunity in pregnant women of the main group allowed establishing the following violations: the concentration of immunoglobulin M and A increases, as well as the concentration of immunoglobulin G and circulating immune complexes (by 2.9 times compared to control indicators). During the evaluation of the concentration of class A, G and M immunoglobulins in the cervical mucus of pregnant women after organ-sparing treatment of borderline tumors and early oncological pathology of the ovaries, as the most informative indicators of local humoral immunity, an increase in the concentration of Ig G by 33.2% and a decrease in Ig A by 27 .1% compared to the control group. There was also a significant increase in Ig M indicators by 37.4% compared to the control group. The above indicates that a secondary immunodeficiency condition is formed in this category of women. Conclusions. 1. In pregnant women, after organ-preserving treatment of borderline tumors and early oncological pathology of the ovaries, there are changes in the cellular link of the immune system, which are manifested in a violation of autonomous immune self-regulation, first of all, in a decrease in the recognition function and weakening of suppressor mechanisms in the process of forming an immune response. 2. The obtained data indicate that in pregnant women of the main group, changes in the local immune system are accompanied by various disturbances, which is manifested by a decrease in the concentration of Ig A, sIg A and an increase in Ig G and Ig M.

Key words: pregnancy, immune system, borderline tumors, early oncological pathology of ovaries.