1. Introduction

Ulcerative colitis (ulcerative colitis) is the main form of inflammatory bowel disease. The exact cause of the UAC is unknown. However, genetically susceptible people appear to have an unregulated mucosal immune response to the commensal intestinal flora, which leads to intestinal inflammation [1,3,5,11].

Inflammation in UC is usually limited to the surface of the mucous membrane. The disease begins in the rectum and, as a rule, spreads proximally continuously through the entire colon. However, some patients with proctitis or left-sided colitis may have inflammation of the cecum. The spread of the disease is stratified by the degree of damage to the colon, from proctitis to left-sided colitis or extensive colitis or pancolitis [2,4,6,12].

UC is the most common disease among inflammatory pathologies of the large intestine. The countries of the northern hemisphere and the western region have the highest incidence rates of NC. It ranges from 9 to 20 cases per 100,000 people, and the prevalence rate ranges from 156 to 291 cases per 100,000 people. In contrast, low values of the NAC are observed in the countries of the southern hemisphere and the eastern region. It is interesting that in countries that are switching to an industrial lifestyle, there is an increase in the incidence of UC. This indicates environmental factors that may be crucial in the occurrence of NAC [7,9,13].

Improved sanitation in industrialized countries can reduce the susceptibility to intestinal infections in childhood, thereby limiting the maturation of the immune system of the mucous membranes, which can lead to an inadequate immune response when exposed to infectious microorganisms later in life [8,10,14,31,32,33]. The most effective surgical treatment methods in terms of radicality today are proctocolectomy with the use of an ilioanalytic anastomosis. However, the presence of background disorders of a systemic immunological nature, among which the most frequent is the development of a pelvic abscess [1,2,5,27,28,29,30].

There are empirical observations of an increase in postoperative complications from the formed sac from the ileum stump with prolonged use of corticosteroids and Infliximab in the preoperative period. Clinicians observed a significant increase in postoperative septic complications [3,7,15,17,18,19,20,21,22,23,24,25,26]. Clinicians associate this circumstance with a suppressive effect on the immune system.

The development of such complications in the early postoperative period, in the future from 15% to 30% of cases, leads to the development of anastomotic stricture and intestinal obstruction, chronic flatulence, sexual dysfunction, urinary disorders and female infertility with a threefold increased risk after the use of ilioanalytic anastomosis [5,8,16].

Thus, the high proportion of postoperative complications in patients with UC, despite the use of radical interventions, still creates an increased risk of their development. Given such high values of unsatisfactory treatment results, scientists are focusing on studying the features of immunological disorders that lead to the development of postoperative complications.

Improving the results of treatment of patients with inflammatory bowel diseases is one of the relevant areas of applied and fundamental medicine, due to the high medical and social significance of these pathologies.

All of the above has determined the main direction of this work.

The aim of the study is to improve the results of predicting the development of purulent-inflammatory complications of UC by developing and justifying the effectiveness of clinical and immunological monitoring methods in patients with this disease.

2. Materials and Methods

The study was conducted in 92 patients with UC who were under our supervision from 2015 to 2024. Male patients prevailed, mostly young (43.4%) and middle-aged (35.8%) according to WHO criteria. The ratio of male and female patients was 1.39 units. The control group consisted of 20 volunteers who were recognized as healthy by the medical commission. The results of the immunological studies of the control group were accepted by us as reference values.

The criteria for inclusion of patients in the study were: the presence of confirmed (endoscopically and morphologically) NAC; mandatory written consent of the patient to conduct the study; age of patients over 18 years old; absence of pregnancy and lactation at the time of treatment and examination; absence of complications of NAC in the form of intestinal malignancy, upon detection of which patients were excluded from the cohort; presence of NAC activity; absence of severe extra-intestinal somatic and mental pathology; absence of drug and alcohol dependence, as well as confirmed pathologies on the part of the immune system, including HIV infection; consent to additional laboratory and instrumental research methods. Any inconsistency with the above was determined by the criteria for excluding patients from the study.

The extent of the NAC lesion was identified according to the Montreal Classification (2005). The severity of the NAC attack was determined according to the criteria of S.P. Travis and L. Dinesen (2010). The activity of the NAC course was performed using an endoscopic pattern according to the criteria of K.W. Schroeder (1987).

Concomitant diseases, along with extra-intestinal lesions of the UC, were detected in 231 names according to medical history records, and there were an average of 2.5 names of diseases per 1 patient. The most frequent lesions (84.8% and 82.6% of cases) were noted from the musculoskeletal system and the skin surface.

The design of the study was to conduct a step-by-step prospective and retrospective study comparing the data obtained with reference values (control group).

The assessment of the state of the immune system of the patients was carried out by the expression of CD-differentiation and activation antigens. The following markers of immunocompetent cells were determined: CD3+, CD4+, CD8+, CD119+ lymphocytes. CD receptor expression was performed in the rosette formation reaction using LT series monoclonal antibodies manufactured by Sorbent LLC (RF) according to the method of Gharib F.Yu. et al. (1995).

Determination of the serum concentrations of the examined immunoglobulins of the main three classes M, A and G g/l was carried out by radial immunodiffusion according to Mancini (1963).

Interleukins (cytokines) were determined in the blood serum of the examined by solid-phase enzyme immunoassay. To implement this option, two monoclonal antibodies with different etiotropic specificity to interleukins IL-1a, IL-1b, IL-6, IL-8, TNF-α were used using special kits for enzyme immunoassay using a standard technique.

In accordance with the goals and objectives of the study, the calculation of elementary statistical indicators (averages, errors of averages, standard deviations, the range of data spread), the construction and visual analysis of data spread diagrams were performed. The indicators were compared using signs of nonparametric criteria. The reliability of the differences between the samples, which were close to the norm in terms of distribution, was determined by the Student's parametric criterion with a 95% reliable probability interval. The criterion of statistical reliability of the obtained conclusions was considered to be the generally accepted value in medicine, p<0.05.

3. The Results and Their Discussion

The development of methods for predicting purulent-inflammatory complications of ulcerative colitis (ulcerative colitis) was carried out based on the analysis of the results of treatment of patients and the frequency of purulent-inflammatory complications.

All the patients studied were operated on, and in more than half of the cases (53.3%), operations were performed in an emergency or urgent manner.

In the preoperative period, 49 (53.3%) patients were diagnosed with various types of UC complications, which in 46.8% of cases were purulent-inflammatory in nature. Among the preoperative complications of UC, the presence of toxic megacolon (26.1%), intestinal perforation (20.7%) and intestinal bleeding (6.5%) should be highlighted.

In total, preoperative complications were found in 45.3% of cases among patients with chronic recurrent disease, in 55.3% of cases with chronic continuous disease, and in 61.9% of cases with acute disease.

Such an impressive high incidence of complications of UC indicates the low prognostic significance of the known methods of diagnosing this disease at the stage of conservative therapy. All this requires more detailed methods for diagnosing and predicting complications of UC.

Of the total surgical procedures, coloprotectomy was performed in 26.1% of cases, colectomy in 18.5% of cases, hemicolectomy in 17.4% of cases, colon resection of various volumes in 15.2% of cases, and subtotal colectomy in 8.7% of cases. In 13 (14.1%) patients, relaparotomies, reconstructive surgeries and laparoscopies were performed, the indications for which were associated with the transfer of patients from other clinics after emergency palliative surgery.

The analysis of the distribution of surgical operations performed in the context of patients with UC, depending on the form of the disease course, showed the ambiguity of the volume of interventions performed. Thus, coloproctectomy was performed in 12 patients with chronic continuous form of UC, in 9 patients with chronic recurrent and in 3 patients with acute form of the disease. Colectomy was performed in 8 patients with chronic continuous UC, in 5 patients with chronic recurrent and in 4 patients with acute course of the disease.

Hemicolectomy was performed in 7 patients with chronic continuous UC, in 5 patients with chronic recurrent UC, and in 4 patients with acute UC. Other forms of colon resection were performed in 4 patients with chronic continuous UC, in 6 patients with chronic recurrent and in 4 patients with acute disease.

Subtotal colectomy was performed in 3 patients with chronic continuous UC, in 4 patients with chronic recurrent and in 1 patient with acute course of the disease. Reconstructive surgeries, laparoscopies and relaparotomies were performed in 4 patients with a chronic continuous form of the course of the disease, in 4 patients with a chronic recurrent and in 5 patients with an acute form of the course of the disease.

Purulent-inflammatory complications of UC in the postoperative period were noted in 45.7% of cases, that is, in 42 operated patients. Among them, they developed in 7 (16.7%) patients after subtotal colectomy, in 5 (11.9%) patients after colectomy, in 8 (19%) patients after coloprotectomy, in 5 (11.9%) patients after colon resection, in 9 (21.4%) patients after hemicolectomy and 8 (19%) of patients after relaparotomy and reconstructive surgery. Abdominal abscess was formed in 15 (11.3%) patients, peritonitis in the postoperative period developed in 7 (5.3%) patients, suppuration of the postoperative wound in 41 (30.8%) patients, which in 38 (28.6%) patients led to the failure of sutures with eventration, and in 32 (24.1%) patients in the postoperative period, parastomal phlegmons of the anterior abdominal wall of the abdomen developed.

It should be noted that a number of purulent-inflammatory complications were combined in the same patient, which determined the average burden of their development by an average of 3.2±0.27 units.

Mortality among patients with UC was noted in 23.9% of cases in the postoperative period due to the low effectiveness of treatment of patients with purulent-inflammatory complications. Peritonitis and abdominal abscesses triggered the development of death in 9.9% of cases. In 12 (13%) deceased patients, the severe course of the disease was on the background of suppuration and suture divergence of the postoperative laparotomy wound.

Thus, purulent-inflammatory complications of UC in patients with various forms of the disease develop in 46.7% of cases requiring the use of surgical treatment methods in an emergency or urgent manner. The most common purulent-inflammatory complications of UC develop in patients with an acute form (52.4%) of the disease course. In the postoperative period, purulent-inflammatory complications develop in 45.7% of cases and become the main cause of death in 29.3% of patients with UC. Such a high incidence of purulent-inflammatory complications and mortality among patients with UC indicates the need for early diagnosis and prediction of their development at the stage of conservative treatment of this disease.

Substantiation of the role and place of the clinical and immunological relationship in the pathogenesis of purulent-inflammatory complications of ulcerative colitis.

A comparative analysis of clinical and laboratory diagnostic data on the course of UC with changes in cellular and humoral immunity was carried out based on the determination of the cross- and linear correlation relationship of the studied parameters. At the same time, as a dividing gradation, we took into account the forms of manifestation and the course of the NAC.

At the first stage, we made numerical designations of the forms of the course of the UAC, which increased as the form of the course of the disease worsened, the possibility of complications and the onset of death. At the same time, the point randomization of the forms of the disease, complications and mortality of UAC was increasing in nature, the type of operation performed according to the severity of its implementation (radicality) or the repeated nature of the intervention due to the development of purulent-inflammatory complications in the postoperative period.

Linear correlation analysis of the frequency of clinical manifestations of UC showed that moderate degree of attack (R=0.997), moderate (R=0.959) and minimal (R=0.850) endoscopic activity, as well as left-sided intestinal lesion (R=0.899) had pronounced direct links, as purulent-inflammatory complications may develop.

We found a moderate direct correlation for only two classification clinical forms of UC – mild attack (R=0.739) and limited intestinal damage in the form of proctitis (R=0.712).

We found an inverse correlation with more severe forms of UC damage: severe attack (R=-0.313), pronounced activity (R=-0.692) and total colon damage (R=-0.767).

At the same time, within each form of lesion and manifestation of the NAC, the graphical characteristic of the cloud cover was completely different, having a direct correlation in only three parameters. Among them, the extent of the lesion (limited in the form of proctitis and left-sided colon lesion - = 0.345), the degree of manifestation of the endoscopic activity of the UC (minimal and moderate activity - = 0.667), as well as the degree of attack (mild and moderate degrees - = 0.787).

In other cases, all the analyzed parameters had a negative correlation.

Thus, linear correlation analysis allowed us to identify the maximum dependence of the pattern of clinical manifestations, course variants, and degree of damage to the large intestine in patients with UC. It may reflect the basis of a platform for building a relative correlation between the clinical manifestations of UC and changes in cellular and humoral immunity.

The studied forms of the disease had gradations from 1 to 3 points, despite the fact that the zero position was attributed to the normal (reference) value of the studied indicators of cellular-humoral immunity.

The ratios of absolute and relative values of CD3+CD8+ and the relative index CD4+/CD8+ were distinguished by a high direct correlation.

For the rest of the indicators, the correlation between absolute and relative values was inversely related, which indicated that the changes in the innate immune system were multidirectional.

A cross-correlation between the relative and absolute values of lymphocyte subpopulations revealed positive values of only relative CD3+CD8+cells to all absolute values of T-lymphocytes.

Of the 16 coefficients obtained, 25% had a direct correlation, 18.7% had a low feedback and 56.3% had a high feedback.

A comparative analysis of changes in the level of cellular immunity indicators among patients with varying severity of the NAC attack revealed the predominance of an inverse correlation among patients with mild and moderate degrees of attack and a mirror relationship with severe NAC attack. All this indicates fundamental changes in the indicators of cellular immunity in conditions of a more severe course of the pathological process, which may be the reason for such changes.

The correlational values of changes in cellular immunity indicators depending on the endoscopic activity of the UA manifestation revealed the maximum number of direct connections among patients with pronounced disease activity and averaged R=0.969±0.038. They occupied the lion's share of the values and accounted for 5 out of 8 values.

Accordingly, the obtained graphical curve of cloud coverage of changes in the level of cellular immunity indicators among patients with varying degrees of endoscopic manifestations of UC confirmed the similarity of changes between patients with minimal and moderate manifestations of activity and the exact opposite in patients with severe manifestations of pathology.

At the same time, an inverse correlation was noted with respect to the relative values of CD3+CD4+, CD3+CD19- and CD19+CD3-cells. The average level of correlation was R=-0.945±0.048. In patients with minimal activity of the endoscopic manifestation of UC, the mirror image was opposite with the average level of correlation R=-0.928±0.046 and R=0.887±0.026. In patients with a moderate degree of endoscopic UC, all correlation values were divided in the same proportion, equating on average to positive values of R=0.231±0.099 and negative values of R=-0.525±0.024.

A shift in correlation values among patients with an average degree of colon lesion may indicate borderline changes in the cellular immune system.

The analysis of changes in the correlation values of humoral immunity indicators depending on various forms of UC revealed the importance of the development of both preoperative and postoperative purulent-inflammatory complications of the disease.

It was found that the inverse correlation remains in priority in the correlation between IgM and IgG, whereas IgA has a low correlation in both directions. At the same time, circulating immune complexes had a direct correlation with changes in cytokines in the blood of patients with various forms of UC.

The highest direct correlation in the average statistical value was the level of circulating immune complexes (R=0.952±0.027). The mirror value was observed on average in relation to the IgG change (R=-0.936±0.049). A slightly smaller but homogeneous correlation value can be noted in relation to IgM changes in patients with various forms of UC (R=-0.707±0.067).

The average correlation of cytokines with immunoglobulins was not unambiguous, which is confirmed by the low rates of reverse and direct connections. A relatively close picture to the reliability of the correlation values was noted by us among patients with severe widespread intestinal damage.

The construction of a correlation curve of the significance of immunological markers for the development of purulent-inflammatory complications of UC made it possible to identify a certain sequence of growth or decrease in indicators.

According to this figure, it is possible to clearly trace the significance of changes in the marker of the immunological system in the development of purulent-inflammatory complications, which can be schematically depicted as follows. According to generally accepted data on the role of the immune system in the pathogenesis of UC development, the mechanisms of participation of both cellular and humoral system parameters are known. This mechanism is based on the primary exposure to an antigen, which is considered an unclassifiable antigen of the epithelial cells of the intestinal mucosa. Later, the cells of the plate itself begin to act as the antigen.

The primary contact of these antigens with lymphocytes at an early stage of the development of NAC leads to activation and an increase in the number of T-helper cells and macrophages. At this stage, the production of pro-inflammatory cytokines of the IL-1 group contributes to the production of appropriate growth factors and cell proliferation aimed at repairing damage and achieving recovery of the affected part of the intestine. However, at this level, an imbalance of IL-1a and IL-1b is in favor of the growth of the latter, which leads to the activation of the Th2 system of lymphocytes, which in turn activates B lymphocytes. They also act as co-factors of B-lymphocyte activation. At this stage of the immunological reaction, immunoglobulins are produced, a sufficient concentration of which can transform the inflammatory process in the intestine into a chronic recurrent ULCER with prolonged stages of remission. However, in the case of a low cellular immune response, there is an increase in the production and release into the systemic circulation of such pro-inflammatory cytokines as IL-6, IL-8 and TNF-α.

Local release of pro-inflammatory cytokines into the bloodstream should promote macrophage activation and neutrophil chemotaxis. This production also activates metabolic processes associated with the growth of connective tissue, stimulating the proliferation of fibroblasts and epithelial cells. This mechanism also helps to heal damage and restore the integrity of the mucous membrane of the large intestine.

However, unfortunately, as a result of an insufficient response of cellular immunity, an unregulated release of pro-inflammatory cytokines already occurs into the systemic bloodstream, which is accompanied by systemic inflammatory disorders. It is the insufficiency of Th1-lymphocytes at an early stage of the development of the above-described mechanisms that leads to the development of purulent-inflammatory complications of NAC, acquiring the reverse orientation of regenerative processes. The release of cytokines into the systemic bloodstream is manifested by fever, an increase in body temperature, adapting to a decrease in the ability of a number of bacteria to reproduce and stimulate processes associated with lymphocyte proliferation. Dysproteinemia develops, the number of white blood cells increases, the formation of nitrogenous components in the liver and acute phase proteins, components of the complement system, accelerates. This is also accompanied by a decrease in albumin synthesis and an imbalance of electrolytes in the blood.

In general, it can be summed up that hypercytokinemia is essentially a system of organizing the body's defensive response. However, such an effect of cytokines is possible only in the balance of activation of Th1-lymphocytes with the production of a sufficient amount of immunoglobulins that reduce the aggressive effects of antigens and the development of purulent-inflammatory complications of UC.

Thus, in the pathogenesis of the development of purulent-inflammatory complications of UC at different stages of treatment, there is a significant disruption in the immune system, which is characterized by a decrease in the expression of T-helper cells against the background of IgA formation and early immunosuppression, leading to increased apoptosis of lymphocytes. There is an increased production and release into the systemic circulation of pro-inflammatory cytokines IL-6, IL-8, IL-1b and TNF-α, which is accompanied by an increase in the number of circulating immune complexes. A vicious circle is forming in which increased activity of the Th2 cell pathway becomes the leading link in the immunological response, leading to the development of an acute or continuous form of the course of UC and its purulent-inflammatory complications both in the preoperative and postoperative periods.

As our research has shown, the possibility of developing purulent-inflammatory complications can be traced through the study of indicators of not only cellular, but also humoral immunity. Such an analysis was carried out by multidimensional logistic regression of the difference in significant independent variables identified during the construction of the matrix for predicting the development of purulent-inflammatory complications of UC.

The distribution parameters revealed high sensitivity of IL-6 and IL-1b, moderate sensitivity of TNF-α and the level of circulating immune complexes, and a relatively low sensitivity of IL-8. In this case, the confidence interval of the selected values in all cases has a reliable value (p<0.001). The choice of the above parameters allowed us to build a logarithmic program with carefully selected parameters for predicting the development of purulent-inflammatory complications of UC. It should be noted that the logarithmic program can only reflect the totality of the studied parameters, since their construction is based on the comparability of the clinical and immunological parameters studied.

As a result of the analysis of the dependence of these parameters, we have developed the platform of the computer calculator program "Program for predicting purulent-inflammatory complications of ulcerative colitis" (Program for predicting purulent-inflammatory complications of nonspecific ulcerative colitis – "PCNUC". The software product "PCNUC" developed by us is available for widespread implementation in practical healthcare, as it can function on any computer platform in various modes. This, in turn, minimizes the estimated time on the part of the medical staff.

When evaluating the effectiveness of the method we developed for predicting purulent-inflammatory complications of NAC, we conducted a retrospective comparison of the prototype method ("PCNUC") and the currently well-known "PKTA" method proposed by S.A. Sorogin and D.E. Dubrovina. This comparative method is based on the logistic regression of the most significant criteria of UA as the patient's gender, duration of the disease, endoscopic activity of inflammation, frequency of bowel movements, body mass index and serum IL-6 levels.

Based on the known results of treatment of patients with various forms of UC, the calculation of the comparative sensitivity and specificity of forecasting methods was based on an identical approach.

Of the total number of patients, we knew that purulent-inflammatory complications of UC were noted in 43 (46.7%) patients. The first stage of the comparative analysis showed that when assessing the total number of patients with UC, the prognostic sensitivity of the analog program was equal to Se=76.74% and the prognostic specificity was equal to Sp=65.52%. The expected predictive value was 52.4%. A detailed breakdown of the diagnostic and prognostic significance of the compared programs is presented in the. The application of the program developed by us allows us to increase the level of prognostic sensitivity to Se=95.35%, and prognostic specificity to Sp=95.74%. The expected predictive value of the program we developed turned out to be 38.7% higher than the analog one, and amounted to 91.1%.

These results were achieved by increasing the frequency of true positive results by 8.7% and true negative results by 28.3%. Against this background, thanks to the application of the clinical and immunological program developed by us for predicting the development of purulent-inflammatory complications of UAC, a 7.5-fold decrease in false-positive prediction results and a 5-fold decrease in false-negative prediction results was achieved. It should be noted that in the category of false positive results of predicting purulent-inflammatory complications of UC when using the prototype, patients with other types of complications turned out to be mostly patients, whereas when evaluating analog methods of such manifestation, there were no results.

Of the total number of patients, we also knew that postoperative purulent-inflammatory complications were noted in 42 (45.7%) patients. The first stage of the comparative analysis showed that when assessing the total number of patients with UC, the prognostic sensitivity of the analog program was equal to Se =50% and the prognostic specificity was equal to Sp=57.14%. The expected predictive value was 48.8%.

The application of the program developed by us makes it possible to increase the level of prognostic sensitivity of postoperative purulent-inflammatory complications to Se=73.81%, and prognostic specificity to Sp=80.36%. The expected predictive value of the program we developed turned out to be 37.3% higher than the analog one, and amounted to 86.1%. These results were achieved by increasing the frequency of true positive results by 10.9% and true negative results by 18.5%. Against this background, thanks to the application of the clinical and immunological program developed by us for predicting the development of purulent-inflammatory complications of UAC, a decrease in false-positive prediction results by 4.4 times and false-negative prediction results by 1.9 times was achieved.

Thus, a comparative assessment of the effectiveness of the PCNUC prognostic program developed by us in patients with UC showed that, compared with the traditional method of predicting purulent-inflammatory complications, an increase in true positive and true negative results was achieved by an average of 1.9 times, and the reliability of predicting the development of purulent-inflammatory complications was increased by an average of 1.8 times. This made it possible to reduce cases of false prediction results of purulent-inflammatory complications of UC by 2 times. All this indicates a significant increase in the reliability of predicting the development of purulent-inflammatory complications of UC in both the preoperative and postoperative periods of treatment.

4. Conclusions

1. The nature and analysis of changes in humoral immunity indicators in patients with various forms of UC showed an increase in immunoglobulins M, G and A in patients with remission of the disease. In patients with an exacerbation phase and the development of purulent-inflammatory complications of UC, a decrease in immunoglobulins below the reference value is accompanied by an increase in the proportion of circulating immune complexes in the blood. Significant changes in the system of proinflammatory cytokines were revealed in patients with UC. During the period of continuous and acute course of the disease, there is an increase in the level of cytokines IL-1, IL-6, IL-8 and TNF-α, which exceed the intensity of formation in patients with chronic recurrent UC by an average of 4.5 times. A separate analysis of IL-1 fractions revealed a relatively higher formation of IL-1b, the proportion of which was equal to 74%, which indicates the pronounced significance of this marker of the inflammatory process in conditions of exacerbation of UC and the possible development of its purulent-inflammatory complications.

2. Purulent-inflammatory complications of UC in patients with various forms of the disease develop in 46.7% of cases requiring the use of surgical treatment methods in an emergency or urgent manner. The most common purulent-inflammatory complications of UC develop in patients with an acute form (52.4%) of the disease course. In the postoperative period, purulent-inflammatory complications develop in 45.7% of cases and become the main cause of death in 29.3% of patients with UC.

3. In the pathogenesis of the development of purulent-inflammatory complications of UC at different stages of treatment, significant disorders in the immune system are noted, which are characterized by a decrease in the expression of T-helper cells against the background of IgA formation and early immunosuppression, leading to increased apoptosis of lymphocytes. There is an increased production and release into the systemic circulation of pro-inflammatory cytokines IL-6, IL-8, IL-1b and TNF-α, which is accompanied by an increase in the number of circulating immune complexes. A vicious circle is forming in which increased activity of the Th2 cell pathway becomes the leading link in the immunological response, leading to the development of an acute or continuous form of the course of UC and its purulent-inflammatory complications both in the preoperative and postoperative periods.

4. The main method of predicting purulent-inflammatory complications of UC is the corresponding program "PCNUC" developed by us. A comparative assessment of the effectiveness of the PCNUC prognostic program developed by us in patients with UC showed that, compared with the traditional method of predicting purulent-inflammatory complications, an increase in true positive and true negative results was achieved by an average of 1.9 times, and the reliability of predicting the development of purulent-inflammatory complications was increased by an average of 1.8 times. This made it possible to reduce cases of false prediction results of purulent-inflammatory complications of UC by 2 times. All this indicates a significant increase in the reliability of predicting the development of purulent-inflammatory complications of UC in both the preoperative and postoperative periods of treatment.