The efficacy of the proteolytic medication longidaza in combined treatment of adhesions in patients with genital endometriosis
Genital endometriosis (GE) is a chronic progressive disease, which is characterized by ectopic expansion of endometrial tissue. This disease is one of the most common reasons of pain syndrome and infertility. GE is considered to be estrogen-dependent inflammatory response, which is the key factor in the development of adhesions. Actual direction of conservative treatment is medications which have a protective anti-adhesive effect, inhibit process of fibrosis and possess immunomodulatory action. Objective: to assess the effectiveness of the enzyme medication longidaza in combined treatment of GE. Materials and methods: the study included 50 patients with laparoscopically and histologically confirmed diagnosis of GE of II-III stages (R-AFS) in combination with adhesive disease of II-IIId degree. After surgery all the patients were administered aGnRH for 6 months. The patients were divided into 2 groups: the members of the first group received longidaza in combination with aGnRH (30 women), the patients of comparison group received aGnRH alone (20 women). Before surgery and during treatment we assessed pain syndrome, severity of adhesive process, peripheral blood and peritoneal fluid levels of IL-8, IP-10, MIG, MCP-1, RANTES. Determination of cytokine concentration was performed with the use of sets of fluorescent microparticles «Human IL-8, IP-10, MIG, MCP-1, RANTES Flex Set» and buffer solution kit «Human Soluble Protein Master Buffer Kit», «BD Bioscience» by running cytofluorimetry method. Results: Prior to surgery, in patients with GE we revealed reliable increase of IL-8, MIG, MCP-1, RANTES peritoneal fluid levels and reliable decrease of angiogenic chemokine IP-10 level compared to control group. In patients treated with longidaza, we noted a significant decrease of pelvic pain in relation to the comparison group (93,4% and 85%, respectively). In 6 months after combined treatment of GE we marked the increase of IL8 level in comparison group, it was 2 times higher in comparison group than in patients receiving longidaza. During treatment with Longidaza in patients with GE we marked reliable decrease of chemokines MIG, MCP-1 and RANTES levels in peripheral blood and increase of IP-10 level compared to control group. Conclusion: the use of proteolytic enzyme preparation longidaza in combined treatment of GE leads to significant reduction of pain syndrome and adhesive process, as well as more effective suppression of inflammatory reaction and processes of neoangiogenesis compared with standard therapy of GE. This medication has a protective effect against the development of fibrous tissue and adhesions.