A.V. ZATVORNITSKAYA^1, 2, E.A. KAZACHKOVA¹, E.L. KAZACHKOV¹, L.R. PYKHOVA¹

¹South Ural State Medical University, Chelyabinsk

²Ural Research Institute for Maternity and Child Care, Yekaterinburg

Contact details:

Zatvornitskaya A.V. — PhD (Medicine), Associate Professor of the Department of Pathological Anatomy and Forensic Medicine named after Prof. V.L. Kovalenko, Head of the 1^st Obstetrics Department of Pregnancy Pathology

Address: 64 Vorovskogo St., 454141 Chelyabinsk, Russian Federation, tel.: +7-919-400-75-35, e-mail: monostyle@list.ru

ORCID: https://orcid.org/0000-0002-9245-3749

 The contribution of stress reactions to the genesis of endometrial hyperplasia (EH), especially in terms of the relationship between chronic stress and hypoxic damage in this pathology, is relevant and requires a detailed study.

The purpose — to investigate the features of hypoxic damage to the uterine mucosa under chronic stress in patients with endometrial hyperplasia without atypia.

Material and methods. We conducted a clinical, prospective, non-randomized study of 30 patients with endometrial hyperplasia without atypia (EHWA). TOBOL questionnaire was used to subjectively assess anxiety and stress levels in patients. To objectively analyze stress levels, salivary cortisol was measured using a competitive enzyme-linked immunosorbent assay (ELISA). The morphological study included histological and immunohistochemical (IHC) analysis of endometrial biopsies using ready-to-use mouse polyclonal antibodies to HIF-1-alpha. The results were processed using nonparametric statistical analysis.

Results. Patients with EHWA exhibit ergopathic and sensitive attitudes toward illness. Elevated salivary cortisol levels were noted in every second case. IGCh-analysis of HIF-1-alpha expression in endometrial biopsies revealed that 21.5% [18.6, 25.4%] of cells were immunopositive. We also analyzed HIF-1-alpha expression levels in EHWA, depending on salivary cortisol levels, as well as in patients with a predominantly sensitive attitude toward the disease.

Conclusion. The relationship between chronic stress and hypoxic damage to the uterine mucosa in EHWA demonstrates that chronic stress correlates with increased HIF-1-alpha expression in endometrial biopsies. This requires further research for practical application within the individualized approach to the treatment of patients with this nosology.

Key words: endometrial hyperplasia without atypia, hypoxia, stress, cortisol, HIF-1-alpha, attitude toward illness

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