medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-479medsovet-8025Research ArticleГИНЕКОЛОГИЯGYNECOLOGYИзменения липидома влагалищного секрета в результате терапии у пациенток с вульвовагинальной атрофиейChanges in vaginal secretion lipidom as a result of therapy in patients with vulvovaginal atrophyhttps://orcid.org/0000-0003-1273-213XКазаковаС. Н.KazakovaS. N.

Казакова Светлана Николаевна - аспирант кафедры акушерства, гинекологии, перинатологии и репродуктологии.

117997, Москва, ул. Академика Опарина, д. 4

Svetlana N. Kazakova - Postgraduate student of the Department of Obstetrics, Gynecology, Perinatology and Reproductology.

4, Academician Oparin St., Moscow, 117997

s-juice@mail.ruhttps://orcid.org/0000-0001-5918-9045ТокареваА. О.TokarevaA. O.

Токарева Алиса Олеговна - к.ф.-м.н., специалист лаборатории метаболомики и биоинформатики.

117997, Москва, ул. Академика Опарина, д. 4

Alisa O. Tokareva - Cand. Sci. (Phys.-Math.), Specialist of the Laboratory of Metabolomics and Bioinformatics.

4, Academician Oparin St., Moscow, 117997

alisa.tokareva@phystech.eduhttps://orcid.org/0000-0002-4023-5256НовоселоваА. В.NovoselovaA. V.

Новоселова Анастасия Викторовна - научный сотрудник лаборатории метаболомики и биоинформатики.

117997, Москва, ул. Академика Опарина, д. 4

Anastasia V. Novoselova - Researcher at the Laboratory of Metabolomics and Bioinformatics.

4, Academician Oparin St., Moscow, 117997

aequus@ro.ruhttps://orcid.org/0000-0002-5120-376XЧаговецВ. В.ChagovetsV. V.

Чаговец Виталий Викторович - к.ф.-м.н., заведующий лабораторией метаболомики и биоинформатики.

117997, Москва, ул. Академика Опарина, д. 4

Vitaliy V. Chagovets - Cand. Sci. (Phys.-Math.), Head of the Laboratory of Metabolomics and Bioinformatics.

4, Academician Oparin St., Moscow, 117997

v_chagovets@oparina4.ruhttps://orcid.org/0000-0002-4581-6295АполихинаИ. А.ApolikhinaI. A.

Аполихина Инна Анатольевна - д.м.н., профессор, руководитель отделения эстетической гинекологии и реабилитации.

117997, Москва, ул. Академика Опарина, д. 4; 119991, Москва, ул. Трубецкая, д. 8, стр. 2

Inna A. Apolikhina - Dr. Sci. (Med.), Professor, Head of the Department of Aesthetic Gynecology and Rehabilitation, Kulakov NMRCOGP; Professor of the Department of Obstetrics, Gynecology, Perinatology and Reproductology at the Institute of Professional Education, Sechenov FMSMU (Sechenov University);

4, Academician Oparin St., Moscow, 117997; 8, Bldg. 2, Trubetskaya St., Moscow, 119991

i_apolikhina@oparina4.ruhttps://orcid.org/0000-0002-9780-4579ФранкевичВ. Е.FrankevichV. E.

Франкевич Владимир Евгеньевич - д.ф-м.н., заместитель директора по науке, заведующий отделом системной биологии в репродукции Института трансляционной медицины.

117997, Россия, Москва, ул. Академика Опарина, д. 4

Vladimir E. Frankevich - Dr. Sci. (Phys.-Math.), Deputy Director of Science, Head of the Department of Systems Biology in Reproduction at the Institute of Translational Medicine.

4, Academician Oparin St., Moscow, 117997

vfrankevich@gmail.comНациональный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. КулаковаРоссияKulakov National Medical Research Center of Obstetrics, Gynecology and PerinatologyRussian FederationНациональный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. Кулакова; Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияKulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology; Sechenov First Moscow State Medical University (Sechenov University)Russian Federation202320012024023250258Copyright © Казакова С.Н., Токарева А.О., Новоселова А.В., Чаговец В.В., Аполихина И.А., Франкевич В.Е., 20242024Казакова С.Н., Токарева А.О., Новоселова А.В., Чаговец В.В., Аполихина И.А., Франкевич В.Е.Kazakova S.N., Tokareva A.O., Novoselova A.V., Chagovets V.V., Apolikhina I.A., Frankevich V.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/8025Введение

Введение. Вульвовагинальная атрофия – хроническое прогрессирующее заболевание, включающее физиологические и анатомические изменения в результате снижения уровня половых гормонов. ВВА оказывает пагубное влияние на межличностные отношения, сексуальное здоровье и общее качество жизни. Динамическая квадриполярная радиочастота (ДКРЧ) – неинвазивная процедура, которая может применяться в качестве средства для лечения заболеваний вульвы.

Цель

Цель. Изучить метаболиты вагинальных смывов у женщин в постменопаузе при лечении ДКРЧ.

Материалы и методы

Материалы и методы. Было исследовано 180 женщин, разбитых на 3 группы: лечение ДРКЧ; лечение комбинацией ДРКЧ и эстрадиола; лечение эстрадиолом. Перед началом лечения и спустя месяц после лечения осуществлялся забор смывов из влагалища и в 6 временных точках производилась оценка клинических параметров. Из смывов липиды экстрагировались с последующим жидкостным хромато-масс-спектрометрическим анализом. Также был проведен сравнительный и корреляционный анализ клинических данных и клинических показателей каждой группы и уровней липидов до и после лечения.

Результаты

Результаты. Было отмечено статистически значимое снижение степени тяжести симптомов ВВА через 1 мес. после лечения во всех группах. Наиболее выраженный эффект наблюдался после применения ДКРЧ с сохранением эффекта до 12 мес. В первой и второй группах было обнаружено статистически значимое различие в уровнях 2 липидов, в третьей – у 4. В первой группе была выявлена корреляция с липидами, связанными с болью и любрикацией, во второй – с pH влагалища, в третьей – с ИВЗ, ИЖСФ, оргазмом, удовлетворением и болью.

Выводы

Выводы. При терапии ВВА путем ДКРЧ и гормонального лечения происходит запуск воспалительного каскада в тканях. Применение стратегии лечения физическими методами воздействия имеет схожий с местным применением эстрогенов механизм влияния при ВВА. Терапия ДКРЧ приводит к нормализации микробиоты влагалища и может конкурировать по терапевтическому эффекту с применением эстрогенов.

Introduction

Introduction. Vulvovaginal atrophy is a chronic progressive disease that includes physiological and anatomical changes as a result of a decrease in the level of sex hormones. VVA affects approximately 50% of middle-aged and older women and has a detrimental effect on interpersonal relationships, sexual health, and overall quality of life. Dynamic quadripolar radiofrequency (DRF) is a non-invasive procedure that may be a potential treatment for vulvar diseases.

Aim

Aim. To study the metabolites of vaginal swabs in postmenopausal women treated with DRF.

Materials and methods

Materials and methods. The study included 180 women divided into 3 groups: treatment with DRF; treatment with a combination of DRF and estradiol, and estradiol treatment. In all patients, vaginal swabs were taken before the start of treatment and a month after treatment, and clinical parameters were assessed at 6 time points. Lipids were extracted from the cervico-vaginal fluid by the Folch method followed by liquid chromatography-mass spectrometric analysis. A comparative analysis of the clinical data of each of the groups and lipid profiles after treatment with a zero time point and their changes and a correlation analysis of changes in lipid levels and changes in clinical parameters before treatment and after 1 month was carried out.

Results

Results. There was a statistically significant reduction in the severity of VVA symptoms one month after treatment in all groups. The most pronounced effect of the therapy was observed in groups with the use of DRF with the preservation of the effect up to 12 months. In the first and second groups, a statistically significant difference was found in the levels of 2 lipids, in the third – in 4. In the first group, a correlation was found with lipids related with pain and lubrication, in the second – with vaginal pH, in the third – with the index of vaginal health, orgasm, satisfaction and pain.

Conclusions

Conclusions. VVA therapy by DRF and local hormonal treatment triggers an inflammatory cascade in tissues. The use of the strategy of treatment with physical methods of influence has a mechanism of influence similar to the local application of estrogen in VVA. DRF therapy leads to the normalization of the vaginal microbiota and can compete with the use of estrogen in this therapeutic effect.

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The authors declare that there are no conflicts of interest present.