ЗНАЧЕННЯ ОКРЕМИХ ПАТОГЕНЕТИЧНИХ ФАКТОРІВ РОЗВИТКУ ЗАПАЛЬНИХ ЗАХВОРЮВАНЬ ВЕРХНІХ ВІДДІЛІВ ШЛУНКОВО-КИШКОВОГО ТРАКТУ У ДІТЕЙ

The significant prevalence of gastrointestinal diseases, including Helicobacter pylori (Hp)-associated conditions, presents challenges characterized by variable clinical progression, diagnostic difficulties, and and heterogeneous therapeutic responses, thereby compromising treatment efficacy. A 2022 meta-analysis estimated the global prevalence of Hp infection in the pediatric population at approximately 32%, underscoring the necessity of investigating Hp-associated pathologies. To identify key drivers in the development of chronic inflammatory processes in the gastrointestinal tract, factor analysis was conducted to elucidate latent relationships among the evaluated parameters. Objectives of the study. To determine the role of individual pathogenetic factors in the development of inflammatory diseases of the upper gastrointestinal tract in children utilizing factor and cluster analyses. Material and Methods. The study cohort comprised 60 patients aged 10 to 17 years diagnosed with inflammatory diseases of the upper gastrointestinal tract. Participants were stratified into two subgroups: 30 children with Hp-associated gastroduodenal diseases (Subgroup 1) and 30 children with Hp-negative gastroduodenal diseases (Subgroup 2). The control group comprised 20 apparently healthy children matched for age and sex. Prior to enrollment, all patients had remained free of any therapeutic interventions for a minimum of 4 weeks. Invasive diagnostic evaluation was performed via esophagogastroduodenoscopy (EGD) using an MTW-Endoskopie W. Haag KG endoscope, with biopsy specimens obtained during the procedure. Serum levels of antimicrobial peptides were quantified via enzyme-linked immunosorbent assay (ELISA) utilizing commercial kits (Human SP-D, Human BPI, and Human LTF/LF [Lactoferrin]; Elabscience Biotechnology, USA). Systemic inflammatory response index (SIRI index) calculated from complete blood count (CBC) parameters using the following formula: ; Statistical analysis was performed using licensed software (Statistica for Windows, version 13.0, serial number JPZ8041382130ARCN10-J). For variables exhibiting a normal distribution, the arithmetic mean (M), standard deviation (σ), and standard error of the mean (m) were calculated. Factor analysis was performed using principal component analysis with subsequent orthogonal VARIMAX rotation of the factor axes, the scree plot method, and the Kaiser criterion. Hierarchical cluster analysis was additionally conducted utilizing the between-group linkage method, culminating in dendrogram construction. The patient examination protocol was formulated in strict adherence to bioethical norms and scientific research principles, receiving formal approval from the Bioethics Commission of Zaporizhzhia State Medical and Pharmaceutical University (Protocol No. 3, October 28, 2024). This study was conducted as part of the departmental research project "Predicting the course of the most common inflammatory diseases of childhood" (registration number 00121U107520, 2020–2026). Results. Five factors underlying chronic upper gastrointestinal inflammation in children were identified: immune, functional disorders and allergies, adaptive immune defense, predisposition, and anemia. These extracted factors explained 73.72% of the total variance in the evaluated variables. The primary determinants of the inflammatory process included functional gastrointestinal disorders (impaired motility manifesting as gastroesophageal and duodenogastric reflux), antimicrobial peptide levels, and the systemic inflammatory response index (SIRI). Disease duration and Hp infection status were significantly associated with these factors. Hierarchical cluster analysis identified a distinct primary cluster comprising biliary tract pathology, gastrointestinal motility disorders, and allergies, potentially contributing to the pathogenesis of subsequent pathological changes. Conclusions. Evaluating the pathogenetic roles of various factors in pediatric upper gastrointestinal inflammatory diseases enabled the identification of key drivers underlying the development and progression of chronic gastroduodenal inflammation. The pivotal role of Hp in this inflammatory process was demonstrated. Factor analysis yielded a factor loading matrix, identifying several variables that contributed most significantly (> 0.7) to each respective factor.