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The research objective was to study the spectrum of the vagina and endometrium microorganisms in women with chronic endometritis (CE) in order to take adequate therapeutic measures. Methods and Results: We did a cross-sectional study in 47 women (average age of 35.38±5.19 years) with histologically confirmed CE. The vaginal microbiota and endometrial biopsies were assessed using microbiological research methods in accordance with the medical technology "Integral assessment of the state of the vaginal microbiota." To identify the share of different types of microorganisms in the structure of the biocenosis, the coefficient of constancy of the species (C) was used. Only 19% of patients had a titer of Lactobacillus spp. within the age norm, while the deficit was observed in 80% of women. Among the representatives of Enterobacteriaecae, Escherichia coli and Klebsiella aerogenes were sown, which are considered to be random species (C=11% and C=2.1%, respectively). The average titer for E. coli was 3.6±1.3 lg CFU/swab and for K. aerogenes - 2.14 lg CFU/swab. An atypical variant of E. coli with hemolytic properties was found in only one sample. All isolates of the genus Staphylococcus were also random species (C did not exceed 25%). Coagulase-negative staphylococci (CoNS) were detected in 7 patients (C=15%), while the average titer was 2.1±0.4 lg CFU/swab. S. aureus was isolated from only one patient at a titer of 5 lg CFU/swab. Corynebacterium spp. were isolated in 11% of cases (C = 11% - random species), in a titer of 3.2±0.8 lg CFU/swab. Enterococcus spp. also belonged to random species (C=23.4%). At the same time, E. faecalis was inoculated in 19% of cases and E. faecium was sown in 4.3%, the average titer of which was 3.1±0.9 and 5 lg CFU/swab. Streptococcus spp. were recorded in only one case at a concentration of 5 lg CFU/swab. Fungi of the Candida were isolated as a random species in 8.5% of cases. The growth of microorganisms in endometrial samples was obtained only in 3 examined women with CE (6.4% of cases). The endometrial microbiota were represented only by random species, for which the C index ranged from 2.1% to 4.3%. Conclusion: The microbiological study of the microbiota of vaginal discharge showed the presence of dysbiotic disorders with a significant deficiency of lactobacilli (80%) without the dominance of representatives of the Lactobacillus spp. In the structure of opportunistic microflora, Escherichia coli, coagulase-negative staphylococcus, Enterococcus spp., and E. faecalis prevailed as random species. Representatives of the microbiota in endometrial biopsies were identified only in 6.4% of cases, and are represented by random species.

The purpose of this research was to study changes in endometrial cytokine concentrations in women suffering from reproductive disorders with and without chronic endometritis (CE) to justify pathogenetic treatment. Methods and Results: The study included 100 women of reproductive age with reproductive disorders. Group 1 included 50 patients with reproductive disorders and CE; Group 2 included 50 patients with reproductive disorders and without CE. Later on, all patients were divided into the following subgroups: Sub1A (n=31), and Sub2A (n=16) with an isolated bacterial flora, Sub1B (n=19) and Sub2B (n=34) with the absence of bacterial flora. The control group consisted of 31 fertile women. Endometrial aspiration pipe biopsy was performed on days 4-9 of the menstrual cycle (middle proliferative phase) using a disposable intrauterine probe (Taizhou Kechuang Medical Apparatus Co., Ltd, China) followed by histological examination of endometrial tissue. Laboratory diagnostics for sexually transmitted infections (STIs) was performed using the bacterial culture method. For the diagnosis of viral infection (HPV, HSV, CMV), cervical samples were studied using PCR. If STIs were detected, the patients were excluded from further research. Ultrasound examination of the pelvic organs was performed using the Aloka-5500 device with a 7MHz vaginal probe in two-dimensional visualization mode. The concentration of cytokines (IL-1β, INF-γ, TNF-α, ILs-4,6,8,10) in the endometrium was determined using the Protein Contour test systems (Saint Petersburg) and Multiskan EX ELISA Analyzer (Germany). In both groups, reproductive disorders were accompanied by hypoprogesteronemia and relative hyperestrogenemia, significantly apparent in CE. We found a 3-fold increase in the level of tissue pro- and anti-inflammatory cytokines (IL-1β, IL-4,6,10, INF-γ), and a 4-fold increase in the level of TNF-α and IL-8 in Group 1, compared to the CG. In Group 2, we found a 1.4-fold increase in the levels of IL-1β and INF-γ, compared to the CG. In Sub 1a, the levels of IL-6 and IL-8 were significantly higher than in the control group. In Sub1A, the isolated bacterial flora caused a cytokine inflammatory response characterized by a significant increase in the concentration of INF-γ and TNF-α, compared to Sub2A and Sub2B (P

The objective of our study was to investigate the specific features of immune status indicators in women of reproductive age with chronic endometritis (CE) and reproductive disorders. Methods and Results: The observational study involved 81 women of reproductive age with reproductive disorders. The main group (MG) included 50 women with CE (mean age of 29.2±5.34 years). The control group (CG) consisted of 31 fertile women also of reproductive age(mean age of 30.7 ± 5.9 years). MG was divided into the following subgroups: Subgroup A (SubA) included 31 patients with verified CE and an isolated infectious agent from endometrial tissue: Subgroup B (SubB) included 19 patients with verified CE and the absence of an infectious agent in the endometrial tissue. Endometrial aspiration pipe biopsy was performed on days 4-9 of the menstrual cycle (middle proliferative phase) using a disposable intrauterine probe (Taizhou Kechuang Medical Apparatus Co., Ltd, China) followed by histological examination of endometrial tissue. Laboratory diagnostics for sexually transmitted infections (STIs) was performed using the bacterial culture method. For the diagnosis of viral infection (HPV, HSV, CMV), cervical samples were studied using PCR. If STIs were detected, the patients were excluded from further research. Ultrasound examination of the pelvic organs was performed using the Aloka-5500 device with a 7MHz vaginal probe in two-dimensional visualization mode. The concentration of cytokines (IL-1β, INF-γ, TNF-α, ILs-4,6,8,10) in the endometrium was determined using the Protein Contour test systems (Saint Petersburg) and Multiskan EX ELISA Analyzer (Germany). The percentages and absolute counts of blood lymphocytes (CD3+, CD3+/CD8+/CD45+, CD19+/CD45+, and CD16+/CD56+/CD45+ cells) were determined by the method of indirect immunofluorescence with monoclonal antibodies using the BD FACSCalibur flow cytometer (USA). We found a significant increase in the blood concentrations of CD3+ cells, CD3+/CD8+/CD45+ cells, and CD19+/CD45+ cells and a decrease in the levels of CD16+/CD56+/CD45+ cells, microbicidal activity of oxygen-dependent function of neutrophils, and phagocytic activity of neutrophils, as well as a significant decrease in the levels of IgA, IgM, and IRI in MG, compared to CG. In SubA, compared to SubB, we found a significant decrease in CD3+ cells and CD19+/C45+ cells and a slight increase in immunoregulatory index. The concentrations of tissue cytokines in women of MG were characterized by a 3-fold increase in the level of pro- and anti-inflammatory cytokines (IL-1β, ILs - 4, 6, 10, and INF-γ), and a 4-fold increase in the levels of TNF-α and IL-8, compared to CG. In SubA, in comparison with SubB, a significant decrease in anti-inflammatory cytokines (ILs-4,10) and chemokine IL-8 was revealed against the background of a significant increase in the concentrations of INF–γ and TNF–α. Conclusion: The results obtained indicate changes in the reactivity of the immune system in women with reproductive disorders and chronic inflammation in the endometrium. The most pronounced changes in the local immunity indicators are observed when opportunistic pathogens are detected in the endometrial tissue.