[POPULATION AND CLUSTER APPROACH TO ASSESSMENT OF REPRODUCTIVE HEALTH OF WOMEN].

The purpose of this study was to explore the possibility of using a population approach to assessing the risk of reproductive health disorders in women of childbearing age. We observed 240 clinically healthy women aged 20 to 43 years, half of them lived in the Middle Black Earth region of Russia, and 120 women lived in Tajikistan. The study identified population differences in women with different ethnic backgrounds and regions of residence according to a set of genetic, hormonal, and immune signs. All women underwent venous blood sampling for the purpose of HLA typing by molecular genetic analysis and determining the range of normative values ​​of hormonal and immune status parameters. DNA samples were obtained from peripheral blood lymphocytes using reagent kits and a protocol for isolating DNA from various biological materials from DLAtomTM DNAPrep 100 (Russia). Hormonal status was studied in terms of follicle-stimulating hormone, luteinizing hormone, prolactin, estradiol, progesterone, 17-OH-progesterone; Thyroid hormones - thyroid-stimulating hormone, total triiodothyronine, total thyroxine; Androgens - testosterone, dihydroepiandrosterone; Steroid hormone-cortisol. In order to exclude the variability of the data, the examination was carried out on the 3-5th days of the menstrual cycle: luteinizing hormone, follicle-stimulating hormone, estradiol, prolactin, testosterone and on the 20-22nd Day of the progesterone cycle. Statistical data processing was carried out on the basis of SPSS programs and included descriptive and comparative nonparametric statistics, discriminant, regression analysis, one - factorial analysis of variance, calculation of 95% confidence intervals, construction of ROC curves. The study included the determination of allelic variants at the three loci of the HLA-D genes (HLA-DRB1, HLA-DQA1, HLA-DQB1) controlling the immune response. Population differences in the locus of the HLA-DRB1 gene were determined. The HLA-DRB1 * 08 and HLA-DRB1 * 12 alleles are found in the Russian women's population, and the HLA-DRB1 * 04 and HLA-DRB1 * 17 alleles are more reliably detected in the Tajik women's population, while the HLA-DRB1 * 04 allele Is associated with a higher incidence of miscarriage. The population characteristics of the HLA-DQA1 gene locus were also established. In the group of women of the Russian population, the incidence of HLA-DQA1 * 0101 and HLA-DQA1 * 0103 alleles is significantly higher, of which the former is associated with protective properties for reproductive pathology, and the latter, on the contrary, with miscarriage. At the same time, the alleles HLA-DQA1 * 0201 and HLA-DQA1 * 0301 were significantly more often detected in the compared with the population of Tajik women. As in the previous case, for the HLA-DQA1 * 0201 allele reproductive health disorders are not characteristic, and in the case of the HLA-DQA1 * 0301 allele they accompany it. Our studies have revealed that there are differences between the populations of Russian and Tajik women in a number of parameters of the hormonal and immune status, as well as at the level of allelic variants of genes that control the immune response. The population approach, based on the use of discriminant analysis, is a highly effective way of grouping women according to their reproductive health status and the risk factors that caused reproductive damage. The risk factors that caused the reproductive failure are different in combination and manifestation in the populations of Russian and Tajik women, except for the adverse allelic variants of the HLA-DRB1 * 04 and HLA-DQA1 * 0103 genes, which are the same in both populations. The obtained data also show that in different populations in the evaluation of reproductive health a differentiated approach is needed both to establish physiological norms in these categories of parameters and to assess the reproductive health of women.