One of the most pressing problems of modern gynecology is the early detection of precancerous pathological processes of the cervix, that result in the malignancy in about 50% of all cases of cervical cancer [1].
It is known that the frequency and timing of malignancy vary widely (0.25-50%) and depend largely on the presence of human papilloma virus (HPV), dyshormonal, metabolic and immunological disorders, but the patterns of progression of pre-cancerous processes of the cervix are still insufficiently studied [2,3].
Existing clinical protocols include various clinical, instrumental and laboratory methods for diagnosing precancerous processes of the cervix uteri, but they do not pay enough attention to the study of local immunity in these diseases. The assessment of the functional state of antigen-presenting cells or dendritic cells (DC), as well as the activity of apoptosis, which plays an important role in the mechanisms of antitumor protection, seems promising [4,5].
The aim of the study was to assess the characteristics of the regulation of the proliferative response of cervical cells depending on the functional state of dendritic cells in women with risk factors for developing cervical cancer.
Material and methods.
The study was performed in the regional clinical hospital (Odessa, Ukraine). The total number of observations was 180 women of reproductive age, 4 clinical groups were formed:
The control group - 30 healthy women
Group I - 50 patients with CIN I.
Group II - 50 patients with CIN II with low and medium viral load of HPV.
Group III - 50 patients with CIN II with a high viral load of HPV.
In the distribution of patients into groups, histological verification was used according to the WHO Lyon Classification Review (2003), and the Classification of the European Expert Group was used additionally at the completion stage.
Criteria for inclusion in the study: 1) late reproductive age; 2) verified CIN, presence of HPV.
Exclusion criteria: 1) postmenopausal age;
2) cervical and endometrial cancer and other cancers; 3) fibroids, deforming the uterine cavity; 4) severe somatic diseases in the decompensation stage; 5) mental desease;
6) disagreement to participate in the study.
All patients underwent a comprehensive examination, which included clinical and paraclinical research methods, according to the orders of the Ministry of Health of Ukraine . All groups were comparable in age and medical-social characteristics. Selection of patients from clinical groups was carried out in compliance with the randomization procedure.
An immunological profile was determined with the establishment of expression of immunocompetent cell subpopulations and the functional state of the humoral and cellular immunity.
The qualitative composition of the cell population of immunocompetent cells (CD16 +; 56 +) of the peripheral blood was determined by flow cytometry in a commercial clinical laboratory using standard DAKO monoclonal antibody kits. Determination of CD receptor dendritic cells (CD1a, mature DCs - CD56, CD85) in biopsy specimens was determined by immunohistochemistry using monoclonal antibodies LIR, Dardilly (France) in CD56 (+), CD83 (+), CD1a (+). Material for research was obtained by performing a biopsy of the cervix.