The dissertation is devoted to the improvement of diagnostic and prognostic measures in children with ulcerative colitis based on the study of clinical features of various forms of the disease, risk factors, structural changes of the colonic mucosa and the state of its epithelial barrier, predictors of the disease.
Dissertation develops features of the current clinical course of ulcerative colitis in childhood, namely: confirmed family history of intestinal diseases (20 %, including ulcerative colitis, Crohn's disease, colorectal cancer); very early onset of the development of the disease (47 %, from 4–6 years); gradual development of the main clinical syndromes of the disease (88 %); prevalence of total forms (61 %), mainly in preschool children (68 %) and adolescents (66 %); the presence of different frequencies of the inflammatory process within the same form; presence of extraintestinal symptoms and concomitant diseases of the digestive system (43%); lack of correlation between clinical endoscopic and histological markers of disease activity.
Also, typical changes in the hemogram in the period of exacerbation of ulcerative colitis were established, namely: leukocytosis (56 %–34 %–4 %), thrombocytosis (41 %–7 %–0 %), increased ESR (43 %–24 %–0 %), respectively, the activity of the inflammatory process regardless of its location, which had significant differences among themselves (p <0,05).
Dissertation develops the peculiarities of disorders in the structure of the mucous membrane of the colon and its epithelial barrier in the pathogenesis of exacerbation of the disease in children with various forms of ulcerative colitis for the first time, as well as changes in the epithelial layer of the intestinal mucosa – dystrophy of the epithelium in combination with a violation of its histoarchitectonics (a decrease in the number of goblet cells) and stroma (diffuse inflammatory infiltration, crypt deformation, crypt abscesses, cryptitis, vascular dilation) that are simultaneously accompanied by disintegration of the inflammatory process, thick alteration colon and a variety of clinical symptoms of ulcerative colitis, the severity of which increased according to the number and magnitude of focal lesions of the mucous membrane and the activity of the inflammatory process.
Also, for the first time in children with different clinical forms of ulcerative colitis in the period of exacerbation, a decrease in mucus synthesis, changes in biochemical composition, low expression of secretory (MUC2) and membrane–associated (MUC4) mucins, mainly in active total forms of ulcerative colitis, insufficient expression of trefoyl factor (TFF3) were found.
For the first time in pediatric practice, taking into account the staged provision of medical care to children with ulcerative colitis, on the basis of mathematical analysis of the results obtained, an algorithm for individual prediction of the risk of ulcerative colitis has been developed (specificity – 67 %, sensitivity – 63 %, accuracy – 66 %), created a mathematical model for predicting chronic continuous recurrent course of ulcerative colitis (sensitivity – 93 %, specificity – 86 %, accuracy – 89 %).
