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THE CONCLUSION

The anaemia is frequent complication of chronic arthritises, both at children [136,169], and at adults [185]. JUvenilnyj the pseudorheumatism is the most widespread chronic rheumatic disease at children and is one of principal causes of an invalidism [29].

The anaemia at a pseudorheumatism is a typical example of an anaemia at chronic illnesses, and is caused by negative effects of proinflammatory cytokines [149]. The anaemia is one of independent factors of an invalidism at patients with chronic arthritises. Possibly, improvement on an anaemia after effective therapy of a basic disease can play an independent role in improvement of a physical condition of the patient [19]. Besides, the anaemia at chronic arthritises associates with more poor quality of a life, both at children, and at adults [63,244]. If arthritis treatment effectively concerning an anaemia, most likely, dynamics from a lesion of joints will be positive [185]. Thus, the anaemia is prognostically adverse factor at children with a chronic arthritis, and more often assotsiirovana with a serious current of an arthritis and the bad answer to spent therapy. It demands understanding of the mechanisms underlying development of an anaemia, and ways of its correction from children with chronic arthritises.

System studying "gepsidin-interlejkin-6" as factor of management of a current of an anaemia at children with chronic arthritises is the most perspective and actual for today. A system choice gepsidin - interlejkin-6 as object of research, it is based on data available in the literature on the leading part gepsidina and ИЛ-6 in anaemia development at chronic illnesses including at a pseudorheumatism. It is considered, that production rising gepsidina the hepatocytes, caused by hyperproduction ИЛ-6 leads to disturbance of an absorption of iron and its redistribution from circulation in storehouse in cells of reticuloendothelial system with
The subsequent restriction of availability of iron for erythroidal cells - of precursors and, as consequence, to an iron deficiency erythrogenesis [43,97,245].

Potential possibility of use gepsidina as one of laboratory indicators for differential diagnostics of anemias at children with chronic arthritises, and also possibility of management of an anaemia current at juvenilnom a pseudorheumatism, by use of inhibitors both ИЛ-6, and gepsidina do necessary system studying gepsidin-interlejkin - 6 as factor of management by a current of an anaemia at children with chronic arthritises [48,70,72,91,202].

In this connection an objective of this research was the estimation of a role of a link "gepsidin-interlejkin-6" in management of an anaemia current at chronic arthritises at children, and working out of references to destination biological therapy at children with an anaemia in structure of chronic arthritises.

Inspection of children with a chronic arthritis included clinical and laboratory parts. In a clinical part the estimation of the general condition of the child has been spent, character of a lesion of joints and quantity of the joints involved in inflammatory process is defined, the answer to spent therapy of an arthritis is estimated. The laboratory part included carrying out of the clinical analysis of blood with definition of concentration of haemoglobin, quantity of erythrocytes, leucocytes and thrombocytes, definition of erythrocyte indexes (average volume of an erythrocyte, an average haemoglobin content in an erythrocyte and average concentration of haemoglobin in an erythrocyte); definition of the indicators characterising a metabolism of iron in an organism - a ferritin, Serum iron, OZHSS, LZHSS, KNT, and also level definition gepsidina Serums - a key regulator of a metabolism of iron in an organism; definition of indicators characterising inflammatory activity of an arthritis - an ESR, level S-rb. Diagnostics of an anaemia and degree of its gravity was carried out on the basis of criteria the CART for various age and gender groups [83].

Research has met with approval of ethical committee at GOU VPO the St.-Petersburg state pediatric medical academy of Ministry of Health of the Russian Federation (the report № 7/6 from January, 28th, 2010)

254 children with juvenilnym a pseudorheumatism have been surveyed. From them 159 girls (62,2 %) and 96 boys (37,8 %). Middle age at the moment of including in research has made 9,5 years (SD=4,0 year). Depending on character of therapy all children have been parted on 2 groups: group of the patients receiving standard therapy JURA, and group of the patients receiving biological therapy JURA. Besides, depending on a clinical variant of current JURA all children have been parted on 3 subgroups: children with oligoartikuljarnoj form JURA, children with polyarticulary form JURA, and children with system form JURA.

It has been shown, that an anaemia widespread among children suffering JURA (40,9 %). It corresponds to the data received by the European and American researchers at patients with a pseudorheumatism [185]. However prevalence of an anaemia strongly varies, depending on clinical variant JURA that proves to be true also literary data [136,169]. The comparative analysis of prevalence of an anaemia in various subgroups has shown, that prevalence of an anaemia significantly above at patients with the system form, than at children with oligoartikuljarnoj and polyarticulary forms JURA (х2=44,2909, df=1, p

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Scientific source EGOROV Andrey Sergeevich. THE GEPSIDIN-INTERLEUKIN-6 SYSTEM AS A FACTOR FOR MANAGING THE COURSE OF ANEMIA IN CHRONIC ARTHRITIS IN CHILDREN DISSERTATION for the degree of candidate of medical sciences. St. Petersburg - 2016. 2016

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