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12УДК: 618.175 -053.7-058
DOI: 10.24411/2181-0443/2020-10122
ЭФФЕКТИВНОСТЬ КОМПЛЕКСНОЙ ТЕРАПИИ НАРУШЕНИЙ МЕНСТРУАЛЬНОЙ ФУНКЦИИ У ПОДРОСТКОВ
Сулейманова Насибахон Адашевна
Андижанский государственный медицинский институт
Заболевания репродуктивной системы подростков, их хронизация ухудшают прогноз в отношении полноценного становления генеративной функции.
Сохранение репродуктивного потенциала девочек-подростков, т.е. возможность реализации детородной функции в фертильном возрасте, входит в число важнейших медико-социальных проблем во всех развитых странах мира.
В подростковый период у девушек происходит сложный процесс становления репродуктивной системы, завершается созревание гипоталамических структур, устанавливается стабильный ритм секреции гонадотропных гормонов.
Ключевые слова: нарушения менструальной функции, девочки - подростки, воспалительные заболевания органов малого таза, лечение.
УСМИР ЦИЗЛАРДА ХДЙЗ ЦИКЛИ БУЗИЛИШИНИНГ КОМПЛЕКС ДАВОЛАШ
САМАРАДОРЛИГИ
Усмирларнинг репродуктив тизимининг касалликлари, уларнинг сурункали х,олати генератив функтсияни тулик; шакллантириш учун прогнозни ёмонлаштиради.
Усмир кизларнинг репродуктив салох,иятини са;лаб ;олиш, яъни. тугиш ёшида репродуктив функтсияни амалга ошириш имконияти дунёнинг барча ривожланган мамлакатларидаги энг мух,им тиббий ва ижтимоий муаммолардан биридир.
Усмирлик даврида ;излар репродуктив тизимни шакллантиришнинг мураккаб жараёнини бошдан кечирадилар, гипоталамус тизимининг етилиш жараёни якунланади, гонадотропик гормонлар секретсиясининг баркарор ритми урнатилади.
EFFICIENCY OF COMPLEX THERAPY FOR DISORDERS OF MENSTRUAL FUNCTION IN ADOLESCENTS
Diseases of the reproductive system of adolescents, their chronicity worsen the prognosis regarding the full formation of the generative function.
Preserving the reproductive potential of adolescent girls, i.e. the possibility of realizing reproductive function at a fertile age is one of the most important medical and social problems in all developed countries of the world.
During adolescence, girls undergo a complex process of formation of the reproductive system, the maturation of hypothalamic structures is completed, a stable rhythm of secretion of gonadotropic hormones is established.
Key words: menstrual disorders, adolescent girls, inflammatory diseases of the pelvic organs, treatment.
Relevance: Menstrual
dysfunctions account for 21 to 63% in the structure of gynecological diseases in adolescent girls [1,2,9], which is due to the immaturity of the functional system of neuroendocrine regulation of menstrual function and high sensitivity to the effects of various adverse factors. In recent years, abnormal uterine bleeding (AMB) deserves special attention. In contrast to adults, adolescents are more difficult to tolerate blood loss and adapt worse even to minor anemia [3,5,7].
Modern schemes of hemostasis using low-dose oral contraceptives are often accompanied by relapses of AMC, which dictates the need to search for new means of rehabilitation for young patients [4,6].
Objective of the study: to study modern treatment of menstrual dysfunction in adolescent girls.
Materialsandmethodsofresearc
h: tosolvethesettasks, weexamined 256 patientsdiagnosedwithmenstrualdysfunct ioninadolescentgirls.
Results of the study: For the first time, on the basis of multivariate analysis, it was established that the greatest influence on the occurrence of gynecological pathology in adolescent girls is exerted by a combination of medical and biological factors. At the same time, the coefficient of multiple determination, reflecting what proportion of the causes contributing to the development of the studied diseases, the studied set of features has, is 26.3% (R2 = 0.224; p <0.001). The second place in terms of the power of influence on the occurrence of gynecological pathology in adolescent girls belongs to a set of environmental factors - 15.6% (R2 = 0.21; p <0.001), the third - social and hygienic -14.2% (R2 = 0.189; p <0.001). The conditions of educational and extracurricular activities take the fourth place - 12.3% (R2 = 0.163; p <0.001), the fifth and sixth place belongs to socio-psychological - 11.5% (R2 = 0.152; p <0.001) and sanitary and hygienic - 9.6%
(R2 = 0.124; p <0.001) factors. Medical-demographic (6.3%, R2 = 0.113; p <0.001) and medical (4.2%; R2 = 0.103; p <0.001) factors rank seventh and eighth, respectively.
In adolescent girls exposed to a complex of adverse factors, there is an imbalance between the processes of free radical oxidation and antioxidant protection, which is characterized by the activation of lipid peroxidation with the accumulation of primary and secondary products of intensification of lipid peroxidation (diene conjugates and malondialdehyde), against the background of a decrease in the activity of various mechanisms of antioxidant defense (a decrease in the level of supreoxide dismutase, reduced glutathione and an increase in oxidized glutathione).
It was shown for the first time that the likelihood of developing menstrual irregularities in adolescent girls at risk, formed using the developed computer program, increases when such laboratory signs as a combination of anemia with hyperethrocytosis, a decrease in the level of T- and B-lymphocytes, a significant increase in the number of undifferentiated lymphocytes, a decrease in the concentration of blood immunoglobulins [1,4,7].
It was established for the first time that the positive clinical effects of complex treatment of menstrual irregularities in adolescent girls exposed to a complex of unfavorable factors are accompanied by an increase in the nonspecific resistance of the organism [4,5.8,9]. This is confirmed by a significant increase in the frequency of detecting anti-stress reactions (calm and increased activation, training with a high level of reactivity - 32.2%; 26.3%; 14.7% versus 1.7%; 4.2%; 3.3% before treatment , p <0.001), a significant decrease in the level of stress reactions of reactivation (from 27.1% to 10.1% (p <0.05).
The developed computer program makes it possible, after calculating the probability of developing gynecological pathology in adolescent girls, to predict the development of states of polysystem maladjustment, determines the need for an integral assessment of a number of key indicators of universal regulation systems (immune, antioxidant) and types of adaptive reactions.
Conclusions: 1. Based on the multivariate analysis, it was found that the greatest influence on the occurrence of gynecological pathology in adolescent girls is exerted by a combination of biomedical factors, for which the multiple determination coefficient is 26.3% (R = 0.224; p <0.001). The second place in terms of influence on the occurrence of gynecological pathology in adolescents belongs to a set of environmental factors -15.6% (R2 = 0.21; p <0.001), the third -social and hygienic - 14.2% (R2 = 0.189; p <0.001 ). The conditions of educational and extracurricular activities take the fourth place - 12.3% (R ~ = 0.163; p <0.001), the fifth and sixth place belongs to socio-psychological - 11.5% (R ~ = 0.152; p <0.001) and sanitary hygienic -9.6% (R = 0.124; p <0.001) factors. Medical-demographic (6.3%, R2 = 0.113; p <0.001) and medical (4.2%; R2 = 0.103; p <0.001) factors rank seventh and eighth, respectively.
2. In adolescent girls with menstrual irregularities exposed to a complex of unfavorable factors, there is an imbalance between the processes of free radical oxidation and antioxidant protection, which is characterized by the activation of lipid peroxidation with the accumulation of primary and secondary products of intensification of lipid peroxidation (diene conjugates and malondialdehyde), on the background of a decrease in the activity of various
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mechanisms of antioxidant protection (a decrease in the level of superoxide dismutase and reduced glutathione, an increase in oxidized glutathione).
3. In adolescent girls exposed to a complex of unfavorable factors, an imbalance between the processes of free radical oxidation and antioxidant protection, the presence of changes in the cellular composition of blood and immunity indicators, characterized by a quantitative deficiency of T- and B-lymphocytes, tension of the humoral link of immunity, increased factors of nonspecific reactivity of the body - an increase in the phagocytic activity of neutrophils, the phagocytic index, an increase in the metabolic activity of phagocytes according to the NBT test are a manifestation of a polysystemic maladjustment syndrome.
4. Changes in the main parameters of universal regulation systems (immune, antioxidant), as well as types of adaptation reactions justify the need to expand the spectrum of basic pathogenetic therapy and develop a comprehensive rehabilitation program for adolescent girls with menstrual irregularities and exposed to a complex of adverse factors.
5. The inclusion of a complex of adaptogens, antioxidants and biostimulants in the basic therapy of menstrual irregularities in adolescent girls exposed to unfavorable factors has a positive effect on the quality and nature of adaptive adaptive reactions, which is characterized by a pronounced positive dynamics in the frequency of favorable reactions of high reactivity levels (with 28% to 72%), a significant reduction in the proportion of unfavorable adaptive reactions (low reactivity, overactivation reaction, stress) from 90.7% to 27.1% (p <0.001).
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