Introduction. The problem of preventive management of uterine leiomyoma in general and its efficacy is widely discussed in the literature. Scientific researches confirm that great number of aetiological factors and pathogenetic mechanisms take part in formation of a benign tumour. Now there is no uniform algorithm of diagnostics, preventive management, therapeutic mode of conducting patients with uterine leiomyoma and concomitant pathology. The approach to a choice of preventive measures should be strictly individual and pathogenetically proved taking into account specific features of a woman’s organism at the molecular-genetic level, assessments of its reference state (hereditary predisposition, accompanying extragenital pathologies, characteristics of generative, reproductive functions). It is expedient to consider the age of a patient when the disease clinical form was diagnosed (a simple leiomyoma, uterine leiomyoma of proliferative type) at definition of complex stage of preventive management and the combined treatment of uterine leiomyoma.
The purpose of the work was carrying out pathogenetic substantiation of preventive management of the uterine leiomyoma of proliferative type in reproductive age women.
Materials and methods. 327 women of reproductive age have been observed. There were studied сliniсal-anamnestic data, family, somatic, obstetrics-gynecologic anamnesis, generative and reproductive function. There were carried out laboratory and instrumental investigation (level of sex hormones, diagnosis of sexually transmitted infections, there was made the method of polymerase chain reaction and IFA). The coagulating system of blood was investigated. There were made US of the small pelvis, dopplerometria of the uterus vessels, myomatous nodes. Quantitative definition of calcium, magnesium, manganese, zinc, iron level in blood was made with the atomic absorption method. Determination of alleles of genes of vascular-endothelial factor of growth, collagen type IV alpha 1, progesterone receptors was made with a method of polymerase chain reaction.
Results. The leiomyoma of uterus is met in relatives of I–II generations in 78.6% cases. Value of chance ratio of uterine leiomyoma development (odds ratio, ОR) in the presence of polymorphism of genes of collagen type IV alpha 1, GST m1, vascular-endotelial factor of growth, receptors of progesterone in women of reproductive age is in confidence interval limits (CI 0.53–2.69; p=0.95). Development of the leiomyoma in reproductive age women is accompanied with dismicroelementosis. It is evolved the periods of woman’s life: prenatal development, puberty, reproductive age for the purpose of individual preventive maintenance of occurrence of mutant forms of myocytes, leiomyoma development and its growth by proliferative type.
Conclusion. The problem of low efficacy of uterine leiomyoma prevention is associated with the absence of its aetiological orientation, insufficient understanding of key mechanisms of formation of tumoral process and its growth as multifactor pathology, in genesis of which there lies a complex of interrelations between genetical and ecological factors. Polymorphic alleles of genes are hereditary predisposition and risk factors of the uterine leiomyoma. The paramount mutation of a myocyte is a consequence of infringement of a tissue homeostasis which is sustained by the balanced metabolic process between cellular prolyferation and apoptosis, which take place with an active participation of calcium, magnesium, manganese, zinc, iron. The stage prevention of incidence and growth of leiomyoma, especially of proliferative type, depending on the period of woman’s life is expedient and pathogenetically proved.