INTRODUCTION

Theme urgency

JUvenilnyj a chronic arthritis (JUHA) - one of the most frequent and most invalidizirujushchih the rheumatic diseases meeting at children. The case rate makes from 2 to 16 persons on 100 000 children's population aged till 16 years.

Now the case rate a chronic gastritis (HG) at children sick JUHA, makes 91-93 % [Zholobova E. S, Gesheva Z. V, 2010]. Feature HG at children with JUHA is disharmony of complaints and an endoscopic picture of a mucosa of a stomach (SOZH). ErozivnoYOjazvennye lesions SOZH meet at 18,1-30 % at children with JUHA and authentically are more often taped at system form JUHA [by Gesheva Z. V, 2012; Abdulganieva D. I, 2012]. Frequency helikobakterioza at JUHA at children makes 85,7 %. Role H. Pylori (NR) in a genesis of an immune inflammation at JUHA it is ambiguous. In a number of works the interrelation between a current of a pseudorheumatism and persistirovaniem H is described. Pylori [Zholobova E. S, Gesheva Z. V, 2010; Adams J., 2002; Zentilin P., Bilardi C., 2004]; at the same time there are data that eradikatsija H. Pyloriне influences level From reactive fiber, a marker of the inflammation typical for a chronic arthritis [Steen K. S., Lems W. F. 2009]. However the large-scale

randomizirovannyh researches for an estimation of interrelation of infection H.
Pyloriи JUHA by present time it was not spent also a true role helikobakterioza in a genesis of a chronic gastritis at children sick JUHA, it is not clear.

The role of virus agents - viruses of a hepatitis, a rubella, Koksaki, Epstein-Barr (veb) - in development of chronic arthritises [Vorontsov I. M, Ivanov R. S, 2012] is studied. It is proved, that veb promotes formation of the rhematoid factor [Aghighi Y., 2007; Toussirot E., Roudier J., 2007; Us T., Cetin E., 2011]. Also last years the question on value veb in formation of a chronic gastritis at persons of different age is activly discussed. Possibility long persistentsii veb in SOZH is established, that Levit R. M, 2011] is accompanied by disturbance of local and general mechanisms of nonspecific protection and immunity [.

In a number of works role veb as trigger factor in formation of an autoimmune gastritis [Volynets G. V, 2005 is described; Novikova V. P, 2009]. Now the publications describing a role of virus veb in formation of a gastritis at children with JUHA, by us it is not taped.

There are the numerous publications devoted NPVP - to gastropathies in which it is proved gastrotoksicheskoe influence NPVP on SOZH [Yoshikawa T., Naito Y., 2011; Roth S. H., 2011; Schellack N., 2012]. Data about influence on condition SOZH of other groups of the medicinal preparations used in therapy JUHA are inconsistent: gljukokortikosteroidov, antitsitokinovyh preparations, Methotrexatum and basic agents [Nasonov E. L, 2007].

There are the individual publications devoted to research of clinico-morphological features HG at children, sick JUHA.

At etiological heterogeneity of a gastritis children with JUHA and ambiguities of a pathogenetic role of some infectious agents in its development still have undeveloped its therapy. In connection with the above-stated studying etiopatogeneticheskih and morfofunktsionalnyh features of a chronic gastritis at children sick JUHA that will help differentsirovanno to approach to treatment tactics is represented to the most actual.

Dissertational work is surveyed at session of ethical committee at SZGMU of I.I.Mechnikova, the report № 4 from April, 9th, 2014.

Research objective: perfection of methods of diagnostics of a chronic gastritis at children sick juvenilnym of a chronic arthritis, on the basis of its studying etiopatogeneticheskih and morfofunktsionalnyh features.

Research problems

1. To tap clinico-functional and morphological features of a chronic gastritis at children sick JUHA.

2. To estimate frequency of detection and the importance of various etiological factors at a chronic gastritis at children sick JUHA.

3. To carry out the analysis tsitokinovogo a profile (TNF-a, IL-6, IL-8, IL-10, IL-1fi, IFN - Y) in blood serum at children sick JUHA.

4. To estimate possibilities of not morphological diagnostics of condition SOZH at children sick JUHA.

5. To develop a non-invasive way of definition of erosive lesions of a mucosa of a stomach at children sick JUHA.

Scientific novelty of research

For the first time role NR, veb and their combinations in a genesis of a chronic gastritis at children with JUHA is shown.

It is established, that at children sick JUHA, in 25,7 % of cases rising of level of autoantibodies to Н⁺К ⁺/АТФ-азе parietal cells of a stomach that is accompanied by depression of level IL-8 in blood serum and occurrence of a destruction of fundal glands of a mucosa of a stomach is diagnosed.

For the first time the likelihood non-invasive way of definition of erosive lesions of a mucosa of a stomach at children sick JUHA, including an estimation of anamnestic, clinical and laboratory signs (the demand for invention MPK G 01 N33/48 is developed and introduced in practical public health services; G 01 N33/52).

On the basis of studying tsitokinovogo the status at children sick JUHA, the generality of pathogenetic mechanisms of development of a chronic gastritis and juvenilnogo a chronic arthritis is proved.

It is established, that possibilities «Biohit Gastropanel» for revealing of an atrophic gastritis at children with JUHA are limited, at the same time indicators «Biohit Gastropanel» vysokoinformativny as a part of complex non-invasive diagnostics of an erosive gastritis.

The practical importance of the received results

The algorithm of early non-invasive diagnostics of an erosive gastritis at children sick JUHA and receiving complex antiinflammatory therapy is developed and introduced in practical public health services. The algorithm includes following methods: «Biohit Gastropanel», definition of autoantibodies to Н⁺К ⁺/АТФ-азе parietal cells of a stomach, the test «Colon View Hbи Hb/Hp».

For non-invasive diagnostics of an erosive gastritis at children sick JUHA, it is expedient to apply the developed likelihood
Diagnostic method (the demand for invention MPK G 01 N33/48; G 01 N33/52).

For the decision of a question on carrying out effective personified etiopatogeneticheskoj at children sick JUHA, definition of autoantibodies to Н⁺К ⁺/АТФ-азе parietal cells of a stomach, level IL-8 and immunohistochemical revealing of antigens to veb in SOZH is recommended to therapy of a chronic gastritis.

The substantive provisions which are taken out on protection

1. The chronic gastritis at JUHA is polyetiological disease. Gistomorfologichesky and functional characteristics of a chronic gastritis depend on separate etiological factors and their combinations.

2. An immune inflammation at JUHA and inflammatory changes in SOZH have some general pathogenetic mechanisms.

3. Absence of a painful syndrome at an erosive gastritis at children with JUHA demands early complex non-invasive diagnostics for the purpose of preventive maintenance of gastric bleedings.

The personal contribution of the author

The author personally participated in research planning, drawing up of design of research, clinical inspection of patients, working out of a computer database, the collecting and processing of the medical information, the analysis of the received results and interpreting of the received data, their statistical processing. The author personally spent questionnaire of parents and children. The author personally spent immunohromatografichesky the express test «Colon View Hbи Hb/Hp».

Approbation

On dissertation materials 15 works, including 3 articles in the magazines reviewed VAK are published. Substantive provisions
Dissertational work are reported at 15th International Slavjanoyobaltijsky scientific forum «St.-Petersburg - Гастро-2013», 13th Russian scientific conference «Pressing questions of children's gastroenterology and a food» (on May, 15th, 2013, St.-Petersburg), at scientifically-practical conference of pediatrists and the children's gastroenterologists, devoted to the 90 anniversary from the date of a birth of the professor. G.Apostolova (on September, 26th, 2013, St.-Petersburg), at conference of pediatrists «Novyeaspekty dieto - and pharmacotherapies at a pathology of organs of digestion udetej» (on February, 26th, 2013, St.-Petersburg), at 16th International Slavjano-Baltic scientific forum «St.-Petersburg - Гастро-2014» (on May, 21st, 2014, St.-Petersburg), IV Conferences «Modern problems of children's gastroenterology. Apostolovsky readings» (on September, 25th, 2014, St.-Petersburg), 20th Incorporated Russian gastroenterologicheskoj to week (on October, 8th, 2014, Moscow).

Introduction of results in practice

The received results are used in medical-diagnostic work of somatic unit of a day hospital of the St.-Petersburg state budgetary establishment of public health services «the Children's city out-patient department № 8» Ministry of Health of Russia, in work

kardiorevmatologicheskogo units of the St.-Petersburg budgetary establishment of public health services «the Children's municipal hospital № 2 Sacred Marias Magdaliny» Ministry of Health of Russia and in work kardiorevmatologicheskogo units of the State budgetary establishment of public health services «Children's republican hospital» of Ministry of Health of Russia of of Petrozavodsk. Results of dissertational research are used in educational process on chair of pediatrics and children's cardiology of the State budgetary educational institution of the higher vocational training «Northwest state medical university
I.I.Mechnikova's name »Ministries of Health of the Russian Federation.

On materials of dissertational work the patent for the invention «the Way of definition of erosive lesions of a mucosa of a stomach at children with juvenilnym an arthritis» (the demand for invention MPK G 01 N33/48 is issued; G 01 N33/52).

Volume and dissertation structure

The dissertation consists of following sections: Introduction, Chapters 1-7, Conclusions, Practical references, the literature and Appendix List. Work is stated on 115 pages of the typewritten text, illustrated by 24 tables and 15 drawing. The literature list includes 95 domestic and 108 foreign publications. The dissertation is performed according to the plan of research work of the State budgetary educational institution of the higher vocational training «Northwest state medical university of a name of I.I.Mechnikova» of Ministry of Health of the Russian Federation.