PARTICIPANTS OF THE FIBRINOLYSIS SYSTEM AS PREDICTORS OF MYOMATOUS NODES GROWTH RECURRENCE

Objective. To determine the role of participants in the fibrinolysis system in the recurrence of myomatous nodes growth after previous uterine artery embolization (UAE). Materials and Methods. A prospective cohort study that included 60 women with recurrent myomatous nodes growth that required medical care, including – main group (n=30) – patients with previously performed uterine artery embolization (UAE) and comparison group (n=30) – patients with previously performed conservative myomectomy. In all patients, the participants in the fibrinolysis system, namely tissue plasminogen activator (t-PA), type 1 plasminogen activator inhibitor (PAI-1) and urokinase plasminogen activator (u-PA), were studied. Peripheral blood and blood from the uterine vein obtained intraoperatively were studied. Results. At the preoperative stage in patients with recurrent growth of myomatous nodes after EMA in relation to patients with myomectomy in anamnesis a statistically significant higher activity of plasminogen activators was established both at the local level: t-PA 11.4 times (p = 0.0001), u-PA 23.7 (p<0.0001), and in the systemic bloodstream: t-PA 6.9 times (p = 0.0014), u-PA 23.6 (p<0.0001). The PAI-1 level in intraoperative blood plasma is 24 times lower in patients with recurrent growth of myomatous nodes after EMA (p=0.0001). A high degree of correlation (rs = 0.82, p = 0.0001) was established for t-PA activity in local and systemic blood flows. Conclusion. In case of recurrence of myomatous nodes growth after previously performed EMA, a statistically significant increase in plasminogen activator activity at the local level with peripheral blood is observed, in parallel with a pronounced decrease in the level of plasminogen activator inhibitor, suggesting different pathogenetic pathways of the disease recurrence.