Гормонально-метаболічні порушення у дівчат-підлітків з ювенільними матковими кровотечами та їх корекція

Ключевые слова: ювенильные маточные кровотечения, девочки-подростки, гиперандрогения, гиперинсулинемия, инсулиновая резистентность, функция в-клеток, коррекция.

SUMMARY

Marchuk N. Yu. Hormonal-metabolic disorders in teenage girls with juvenile uterine bleeding and their correction. - Manuscript.

The dissertation for attaining the level of candidate of medical sciences, specializing in 14.01.01. - obstetrics and gynecology. - at the A. A. Bogomolets National Medical University, the Ukrainian Ministry of Health, Kyiv 2006.

This dissertation deals with the study of the origin and formation of juvenile uterine bleeding (JUB), which is a factor of the risk of development of the disorders of menstrual and reproductive functions, hormonally determined pathology in reproductive age. In this work the author for the first time has established the relationship between hyperandrogyny and hyperinsulinemia in patients with JUB on the basis of clinical, hormonal and biochemical investigations, and proceeding from these studies has elaborated the new criteria for diagnostics and treatment of teenage girls with this pathology. These has been detected a reduction of peripheral sensitivity to insulin and dysfunction of в-cells in patients with JUB (by indices of insulin resistance, insulin sensitivity, в-cells function and indices of insulin response), which with the increase of indices of body weight is accompanied by prevalence of insulin resistance, and with their physiological values manifestations of dysfunction of в-cells are caused not only by the reduced sensitivity to insulin, but also by their insufficient secretory abilities. There have been found differences in hormonal status of patients with JUB depending on the time of appearance of bleeding: teenage girls with JUB appearing with the menarche have a latent hyperinsulinism and immaturity of central regulating mechanism, determining disturbance of the process of follicle genesis and development of scleropolycystic degeneration of the ovaries, and JUB taking place are of the type of occurrence of JUB against the background of a regular menstrual cycle characteristic is the increase of extraglandular of estrone (E1) formation from androgens and the development of apparent hyperinsulinism and insulin resistance; bleeding occurs after a prolonged amenorrhea and terminates with the commencement of the new cycle (after appearance and development of the new follicle). It has been established, that the factors of the risk of occurrence of JUB in the patients in question are: infectious pathology (71,8%), concomitant somatic pathology (84,0%), peculiarities of the course of antenatal period (73,4%) and aggravated heredity. There have been found the most widespread morhotypes among patients with JUB: intersexual (41,7% and 58,3%), infantile (16,7% and 4,2%), forestalling the norm (8,3% and 16,7%) and normoskelia (33,4% and 20,8%). It has been established, that 85,7% of patients with JUB have no physiological variation of the levels of hormones of thyrotropic hormone of hypophysis (TSH) and total thyroxin (T4). Simultaneously with the disorder TSH secretion there has been detected a reduction of hormones of thyroid gland against the background of absence of clinical manifestations of its dysfunction. These changes, detected both, in vascular- thrombocyte (increase of its activity) and in coagulation (increase of retraction of the blood clot, general fibrinolythic activity and activated time of recalcification) chains of hemostasis, may testify to the presence in patients with JUB of chronic disseminated coagulation syndrome. Medicaments correction of hormonal- metabolic disorders with administering of preparation Humodarum R to patients with JUB facilitated improvement of temporary and quantitative indices of insulin secretion, reduction of integral production of the hormone during stimulation with glucose; improvement of indices of metabolism of androgens: reduction of the level testosterone (T) with simultaneous increase of sex hormone-binding globulin (SHBG), which permitted to increase effectiveness of treatment of JUB up to 93,3% reduce the number of recurrences of the disease and facilitate restoration of menstrual function.

Key words: juvenile uterine bleeding, teenage girls, hyperandrogyny, hyperinsulinemia, insulin resistance.

ПЕРЕЛІК УМОВНИХ СКОРОЧЕНЬ

АКТГ - кортикотропін

ДГЕА - дегідроепіандростерон

ДГЕА-С - дегідроепіандростерон-сульфат

Е1 - естрон

Е2 - естрадіол

ІМТ - індекс маси тіла

ІРМА - імунорадіометричний метод

ІРІ - імунореактивний інсулін

ІПФР-1 - інсуліноподібний фактор росту-1

К - кортизол

КОК - комбіновані оральні контрацептиви

ЛГ - лютеїнізуючий гормон

П - прогестерон

ПІ - пульсаційний індекс

Прл - пролактин

РІА - радіоімунний метод

СГТТ - стандартний глюкозотолерантний тест

СЗГ - сексстероїд-зв'язувальний глобулін

Т - тестостерон

Т3 - тироксин

Т4 - трийодтиронін

ТТГ - тиреотропний гормон (тиреотропін)

УЗД - ультразвукове дослідження

ФСГ - фолікулостимулюючий гормон (фолітропін)

ЮМК - ювенільні маткові кровотечі

Підписано до друку 18. 05. 2006. Формат 60х84/16

Папір офсетний. Умовн. друк. арк. 2,79. Умовн. фарбовідб. 3, 25

Зам. 375. Наклад 100.

Віддруковано в НВЕД УАД

79008, м. Львів, пл. Митна, 1 тел. 76-65-89

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