Russian MedicineRussian MedicineРоссийский медицинский журнал0869-21062412-9100Eco-Vector62684110.17816/medjrf626841ReviewsНаучные обзорыReview ArticleCurrent understanding of the connection between endometriosis and intestinal microbiocenosis: a literature reviewСовременные представления о взаимосвязи эндометриоза и кишечного микробиоценоза: обзор литературыhttps://orcid.org/0009-0008-3448-8143ShelekhovaMarina S.ШелеховаМарина Сергеевна
Russian Federation
marina.shelehova.01@mail.ruhttps://orcid.org/0009-0004-5817-1301ModorskayaAnna N.МодорскаяАнна Николаевна
Russian Federation
annamoo@bk.ruhttps://orcid.org/0009-0002-0079-7374Fil'chakovaAngelina N.ФильчаковаАнгелина Николаевна
Russian Federation
ange.fil4akova@mail.ruhttps://orcid.org/0009-0008-0727-3913GrudkovaYuliya V.ГрудковаЮлия Викторовна
Russian Federation
jeemba@yandex.ruhttps://orcid.org/0000-0002-9939-34439133-3802RayevskiyKirill P.РаевскийКирилл Павлович
Russian Federation
sicarius001@gmail.comAcademician I.P. Pavlov First St. Petersburg State Medical UniversityПервый Санкт-Петербургский государственный медицинский университет имени И.П. ПавловаMilitary Medical Academy named after S.M. KirovВоенно-медицинская академия имени С.М. Кирова22042024170520243021811901302202421032024Copyright ©; 2024, Eco-VectorCopyright ©; 2024, Эко-Вектор2024Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0/https://medjrf.com/0869-2106/article/view/626841

Endometriosis is a complex condition that affects at least 10% of women in their reproductive years worldwide. It is characterized by persistent pelvic pain, dysmenorrhea, impaired pelvic organ function, infertility, and psychological distress. Alarmingly, about 30% of patients experience a recurrence of the disease even after receiving full treatment. Given the urgent nature of this problem, extensive studies are regularly conducted to investigate the various factors that contribute to the development of endometriosis. One area of particular interest is the relationship between the condition and changes in the intestinal microflora.

Research suggests that endometriosis is primarily associated with a decrease in the number of Lactobacillus bacteria and an increase in the presence of potentially harmful flora, including Enterobacteriaceae, Bifidobacterium, Parabacteroides, Proteobacteria, Actinobacteria, Cyanobacteria, Saccharibacteria, Fusobacteria etc. Furthermore, there is a focus on the ratio of Firmicutes to Bacteroidetes. Such dysbiosis leads to abnormal cytokine expression and immune cell dysfunction, ultimately resulting in chronic inflammation. A correlation has been found between changes in the intestinal microflora in endometriosis and an increase in the levels of TNF-α, NF-κB, and IL-8. Additionally, the condition has been linked to factors related to apoptosis (Fas and Bax), proliferation (epidermal growth factor), and angiogenesis (VEGF).

Another significant aspect is the role of the intestinal microbiota in the breakdown of estrogen. Enzymes such as β-glucuronidase and β-glucosidase, secreted by the microbiota, contribute to the breakdown of estrogen and subsequently increase the levels of free estrogen in the bloodstream. This increase in free estrogen is believed to play a role in the development of endometriosis by promoting the proliferative activity of endometrial cells. It further confirms the significance of intestinal dysbiosis in the pathogenesis of the disease.

However, despite these findings, additional research is still required to fully understand the mechanisms behind the development of endometriosis.

Эндометриоз — мультифакториальное заболевание, встречающееся не менее чем у 10% женщин репродуктивного возраста по всему миру. Оно становится причиной длительных тазовых болей, дисменореи, дисфункции органов малого таза, бесплодия и психологического дискомфорта, а почти 30% пациенток сталкиваются с рецидивом заболевания даже после завершения полного курса лечения. Вследствие актуальности проблемы проводятся многочисленные исследования факторов, влияющих на развитие данной патологии, в частности изучается связь развития эндометриоза и изменений кишечной микрофлоры.

Преимущественно развитие эндометриоза связывают со снижением числа бактерий рода Lactobacillus и повышением количества условно патогенной флоры, в частности Enterobacteriaceae, Bifidobacterium, Parabacteroides, а также Proteobacteria, Actinobacteria, Cyanobacteria, Saccharibacteria, Fusobacteria и др. Особое внимание уделяется повышению соотношения Firmicutes/Bacteroidetes.

Дисбактериоз становится причиной аномальной экспрессии цитокинов и дисфункции иммунных клеток, следствием чего становится хроническое воспаление. Обнаружена корреляция изменений кишечной микрофлоры при эндометриозе с увеличением TNF-α, NF-kβ и IL-8, описана взаимосвязь с факторами апоптоза (Fas и Bax), пролиферации (эпидермальный фактор роста) и ангиогенеза (VEGF).

Кишечная микробиота также секретирует ферменты β-глюкуронидазу и β-глюкозидазу, что приводит к распаду эстрогена и увеличению циркулирующего в крови свободного эстрогена. Это служит одним из факторов развития эндометриоза за счёт увеличения пролиферативной активности клеток эндометрия и доказывает роль дисбактериоза кишечника в патогенезе развития заболевания.

Тем не менее механизмы развития эндометриоза требуют дополнительных исследований.

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