PREDICTING THE COURSE OF ULCERATIVE COLITIS IN CHILDREN AT THE STAGE OF HOSPITAL TREATMENT

PUMTS. 2021; 42(2): 69-74.
https://doi.org/10.31071/promedosvity2021.02.069

The problem of predicting the course of ulcerative colitis (UC), its complications, the effectiveness of the therapy is an urgent task of practical health care, and its solution will improve the efficiency of diagnosis and treatment of this complex pathology of childhood. The aim of the work — to develop a model for predicting a continuously recurrent course of UC in children. Clinical and statistical analysis of 52 case histories of children with UC in the dynamics of treatment was carried out. The patients were divided into 2 groups: group I — 24 (46 %) children within 6 months achieved clinical remission (clinical activity index (PUCAI) less than 10 points after the course of treatment), which corresponded to the minimum degree of activity; group II — 28 (54 %) patients, within 6 months did not achieve clinical remission (PUCAI ≥ 20 points after the course of treatment), which indicated a chronic continuously recurrent course of ulcerative colitis. Based on the analysis of anamnestic, clinical, laboratory, endoscopic, morphological and histochemical criteria in children with ulcerative colitis, predictors of its continuous recurrent course in the acute stage were established: anamnestic — intolerance to dairy products (RR = 2,1 ± 0,4, p < 0,05); clinical — PUCAI ≥ 55 points (RR = 10,7 ± 1,0, p < 0,05); endoscopic — Rachmilewitz index ≥ 6 points (RR = 3,6 ± 0,5, p < 0,05); laboratory — platelets ≥ 450 × 109/l (RR = 6,4 ± 0,7, p < 0,05), hemoglobin ≤ 90 g/l (RR = 5,6 ± 0,7, p < 0,05), ERS ≥ 22 mm/hr (RR = 5,6 ± 0,7, p < 0,05), fibrinogen ≥ 4 g/l (RR = 4,3 ± 0,7, p < 0,05), leukocyte ≥ 13 × 109/l (RR = 3,4 ± 0,7, p < 0,05); morphological — high histological activity (RR = 4,9 ± 0,6, p < 0,05), total form (RR = 2,0 ± 0,4, p < 0,05), the presence of cryptitis (RR = 2,8 ± 0,5, p < 0,05), decrease in the number of goblet cells (RR = 1,7 ± 0,3, p < 0,05), stromal fibrosis (RR = 1,5 ± 0,2, p < 0,05); histochemical and immunohistochemical — absence (0 points) of MUC2 expression (RR = 5,5 ± 0,7, p < 0,05), staining of neutrophils with the presence of glycogen (RR = 3,6 ± 0,6, p < 0,05), low (1–2 points) level of TFF3 expression (RR = 2,5 ± 0,4, p < 0,05). A mathematical model of individual prognosis of chronic continuous-recurrent course was created, the diagnostic efficiency of which was: sensitivity — 93 %, specificity — 86 %, accuracy — 89 %.

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