Гинекология (Dec 2020)
The value of azoximer bromide for optimization of therapy for HPV-associated cervical precancerous diseases
Abstract
A significant increase in human papillomavirus-associated cervical oncological diseases, a high rate of recurrence of the process (4862.4%) after surgical treatment, changes in the local immune microenvironment in cervical biopsy specimens with (HSIL) created the prerequisites for studying the clinical efficacy of local immunocorrection in complex HSIL therapy. Aim. To study the clinical efficacy of local immunocorrection of azoximer with bromide in the complex therapy of cervical intraepithelial neoplasias. Materials and methods. Examination and treatment of 40 patients with HSIL was carried out. The study of the effectiveness of azoximer bromide in complex therapy in patients with cervical intraepithelial neoplasias of a high degree of oncogenic risk was carried out on the basis of an immunohistochemical study of cervicobioptates to markers CD3, CD56, CD20, CD138, M-CSF. Results and discussion. It was revealed that cervical intraepithelial neoplasias of a high degree of oncogenic risk are accompanied by changes in the local immune microenvironment in the epithelium and stroma of neoplastic altered tissues, which may contribute to the development of neoplasia progression. The inclusion of a local immunomodulator azoximer bromide in the complex therapy helped to reduce the recurrence of the process by 2 times, the elimination of the human papillomavirus by 3.5 times relative to the comparison group. Conclusion. 1. In cervico-biopsy specimens of patients with HSIL, there is an increase in the proportion of cells with expression of receptors CD20, CD3, CD138 (in stromal cells) and a decrease in epithelial infiltration with M-CSF, which indicates significant changes in immune homeostasis in cells of the affected epithelium. Based on the results obtained, at the stage of preparation for surgical treatment of patients with HSIL, it is advisable to include local immunocorrection to improve the outcome of therapy. 2. The inclusion of a local immunomodulator azoximer bromide in the complex therapy helped to reduce the recurrence of the process by 2 times, the elimination of the human papillomavirus by 3.5 times, which dictates the need for complex immunomodulation in the treatment of HSIL at the stage of preparation for surgery.
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