Дискуссионные вопросы лечения хронического эндометрита

Распространенность хронического эндометрита (ХЭ) в общей популяции колеблется от 14,1 до 24,4% и в 2–3 раза выше у пациенток с нарушением репродуктивной функции. Лечение ХЭ представляет определенные трудности из-за различных подходов и противоречивых сведений об эффективности используемых методов. По данным исследований частота излечения ХЭ с помощью антибиотиков (АБ) составляет 82,3–87,9% с показателем живорождения – 56–62,4%. В программах ВРТ у пациенток, прошедших курс АБ-терапии, наблюдается увеличение частоты живорождений в 5 раз. Отмечена необходимость достичь консенсуса по диагностическим критериям ХЭ, чтобы исключить влияние гетерогенности исследований на результаты лечения. В последние годы широко обсуждается необходимость восстановления иммунной защиты при ХЭ. Из доступных в РФ иммуномодуляторов средством с доказанной эффективностью является комплекс экзогенных природных цитокинов и хемокинов, использование которого в комбинации с АБ позволяет добиться элиминации возбудителей у 86% пациенток с ХЭ вирусно-бактериальной этиологии (против 56% при лечении только АБ) и достичь наступления беременностей, завершившихся родами, в 60% наблюдений (против 29% соответственно). Иммунная функция может быть улучшена за счет устранения дефицита микронутриентов, в частности витаминно-минерального комплекса Прегнотон, что может способствовать повышению устойчивости к инфекциям, более быстрому выздоровлению и улучшению репродуктивной функции. Лечение ХЭ должно включать АБ-терапию препаратами широкого спектра действия и  противовирусную терапию, направленную на снижение активности вирусов. Комплекс экзогенных природных цитокинов и хемокинов для местного применения способствует увеличению показателей наступления беременности и  живорождений. Биологически активные добавки, в  т. ч. витаминно-минеральный комплекс Прегнотон, могут применяться в качестве дополнительных средств для улучшения функций врожденного и приобретенного иммунитета. 

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