• O. O. Pryimak Ivano-Frankivsk National Medical University, Department of Obstetrics and Gynecology named after I.D. Lanovyi, Ivano-Frankivsk, Ukraine
  • N. I. Henyk Ivano-Frankivsk National Medical University, Department of Obstetrics and Gynecology named after I.D. Lanovyi, Ivano-Frankivsk, Ukraine
Ключові слова: bacterial vaginosis, microbiota, local immunity, cytokines, secretory immunoglobulin A


According to scientific reports, the frequency of bacterial vaginosis (BV) is quite variable and ranges from 30% to 80%, and in 24-50% of cases, it is asymptomatic. In the general population, BV is diagnosed in 20% of women, in 87% - with pathological secretions, in the structure of patients who turned to the primary outpatient appointment - 41%

The purpose of the study: to establish the nature of immunological violations of the parameters of local anti-infective protection, which underlie the development and progression of bacterial vaginosis in women of reproductive age.

Research materials and methods: to assess the state of local immune protection, a study of women of reproductive age with bacterial vaginosis was conducted. 30 patients under the age of 35 belonged to group I; group 2 consisted of 30 women over the age of 35. The control group included 30 patients of reproductive age with normobiocenosis of the vaginal mucosa (including: 10 women under 35 years of age and 20 women over 35 years of age) without acute gynecological pathology, infertility, endometriosis and background processes of the cervix. Methods of measuring the vagina pH, Gram microscopy, Amsel’s diagnostic criteria, dysbiosis according to the Real-Time PCR "Femoflor" were used; PCR test for antigens of TORCH infections and statistical methods were also applied.

Research results and their discussion. In patients of the older age category, women presented clinical complaints in the form of increased secretion and discomfort 1.7 times more often, which accounted for 63.3% of observations. Severe dysbiosis was diagnosed 1.6 times more often in patients of the older age category compared to the data of women of group I with significant statistical differences in the control. A decrease in the level of lactoferrin was revealed in the samples of women of group 2 (by 3.8 times). Indicators of local immune protection were characterized by an increase in the concentration of IgM by 3.4 times, depression of sIg A synthesis (by 2.7 times) in a third of observations (36.7%), a decrease in the level of IL-1β (by 1.7 times), an increase in levels of TNF-α (by 3.8 times), low levels of IFN-γ – by 1.9 times (p<0.05), which demonstrates reduced opportunities to eliminate pathogens and an imbalance of cytokine synthesis. Low indicators of the level of IFN-γ, as well as a decrease in the level of the anti-inflammatory cytokine IL-4 (by 2.5 times compared to control data, p<0.05), as a marker of the immunopathological process, demonstrate the depression of interferonogenesis processes, reduced opportunities for the elimination of pathogens and imbalance cytokine synthesis.

Conclusions. In patients with bacterial vaginosis and in those who are older than 35 years, a characteristic feature of local immunity is a pronounced dysbiosis caused by hormonal imbalance and hypoestrogenemia, a decrease in the level of lactoferrin, depression of sIg A synthesis., interferon deficiency and imbalance of pro-inflammatory cytokine synthesis. Clinical assessment of inflammation from the standpoint of the immune response prevents a one-sided stencil approach to the correction of violations of the vaginal micro ecosystem, helps to improve the diagnosis of the phase of immune inflammation, and optimize the use of antibacterial agents.

Further studies of the level of parameters of local immune protection, taking into account the comorbidity of gynecological pathology and the violation of the micro ecosystem of the vaginal mucosa, are promising.

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