Hemodynamics, functional state of endothelium and renal function, platelets depending on the body mass index in patients with chronic heart failure and preserved systolic function

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ȾɁ «Ⱦɧɿɩɪɨɩɟɬɪɨɜɫɶɤɚ ɦɟɞɢɱɧɚ ɚɤɚɞɟɦɿɹ ɆɈɁ ɍɤɪɚʀɧɢ»

ɤɚɮɟɞɪɚ ɝɨɫɩɿɬɚɥɶɧɨʀ ɬɟɪɚɩɿʀ ʋ 1 ɬɚ ɩɪɨɮɩɚɬɨɥɨɝɿʀ (ɡɚɜ. – ɞ.ɦɟɞ.ɧ.,ɩɪɨɮ.Ɉ.ȼ.Ʉɭɪɹɬɚ)

ɩɥ.ɀɨɜɬɧɟɜɚ, 14, Ⱦɧɿɩɪɨɩɟɬɪɨɜɫɶɤ, 49005, ɍɤɪɚʀɧɚ

SE "Dnipropetrovsk medical academy of Health Ministry of Ukraine" Chair of Hospital therapy ʋ1 and occupational disease

Oktyabrskay Sq., 14, Dnipropetrovsk, 49005, Ukraine e-mail: 101182mir@mail.ru

Ʉɥɸɱɨɜɿ ɫɥɨɜɚ:ɯɪɨɧɿɱɧɚ ɫɟɪɰɟɜɚ ɧɟɞɨɫɬɚɬɧɿɫɬɶ,ɝɟɦɨɞɢɧɚɦɿɤɚ,ɟɧɞɨɬɟɥɿɣ,ɬɪɨɦɛɨɰɢɬɢ,ɿɧɞɟɤɫ ɦɚɫɢ ɬɿɥɚ Key words:chronic heart failure, hemodynamics, endothelium, platelets, body mass index

Ɋɟɮɟɪɚɬ. Ƚɟɦɨɞɢɧɚɦɢɤɚ, ɮɭɧɤɰɢɨɧɚɥɶɧɨɟ ɫɨɫɬɨɹɧɢɟ ɷɧɞɨɬɟɥɢɹ ɫɨɫɭɞɨɜ, ɩɨɱɟɤ ɢ ɬɪɨɦɛɨɰɢɬɨɜ ɜ ɡɚɜɢ -ɫɢɦɨɫɬɢ ɨɬ ɢɧɞɟɤɫɚ ɦɚɫɫɵ ɬɟɥɚ ɩɪɢ ɯɪɨɧɢɱɟɫɤɨɣ ɫɟɪɞɟɱɧɨɣ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɢ ɫ ɫɨɯɪɚɧɟɧɧɨɣ ɫɢɫɬɨɥɢ-ɱɟɫɤɨɣ ɮɭɧɤɰɢɟɣ.Ʉɭɲɧɢɪ ɘ.ɋ.ɐɟɥɶɸ ɪɚɛɨɬɵ ɛɵɥɨ ɨɰɟɧɢɬɶ ɫɨɫɬɨɹɧɢɟ ɝɟɦɨɞɢɧɚɦɢɤɢ,ɮɭɧɤɰɢɢ ɷɧɞɨɬɟɥɢɹ,

ɩɨɱɟɤ ɢ ɬɪɨɦɛɨɰɢɬɨɜ ɭ ɛɨɥɶɧɵɯ ɫ ɯɪɨɧɢɱɟɫɤɨɣ ɫɟɪɞɟɱɧɨɣ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɶɸ (ɏɋɇ)ɫ ɫɨɯɪɚɧɟɧɧɨɣ ɫɢɫɬɨɥɢ

-ɱɟɫɤɨɣ ɮɭɧɤɰɢɟɣ ɜ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɢɧɞɟɤɫɚ ɦɚɫɫɵ ɬɟɥɚ (ɂɆɌ). Ɉɛɫɥɟɞɨɜɚɧɨ 42 ɛɨɥɶɧɵɯ ɫ ɏɋɇ ȱȱ-ȱȱȱ ɮɭɧɤ

-ɰɢɨɧɚɥɶɧɨɝɨ ɤɥɚɫɫɚ (NYHA) ɫ ɫɨɯɪɚɧɟɧɧɨɣ ɫɢɫɬɨɥɢɱɟɫɤɨɣ ɮɭɧɤɰɢɟɣ ɥɟɜɨɝɨ ɠɟɥɭɞɨɱɤɚ (ɮɪɚɤɰɢɹ ɜɵɛɪɨɫɚ

ɛɨɥɶɲɟ 45%) ɜ ɜɨɡɪɚɫɬɟ ɨɬ 51 ɞɨ 75 ɥɟɬ (ɫɪɟɞɧɢɣ ɜɨɡɪɚɫɬ – 67,8±1,2 ɝɨɞɚ). ɉɚɰɢɟɧɬɚɦ ɩɪɨɜɨɞɢɥɚɫɶ ɷɯɨɤɚɪɞɢɨ

-ɝɪɚɮɢɹ, ɨɩɪɟɞɟɥɹɥɢɫɶ ɮɭɧɤɰɢɹ ɷɧɞɨɬɟɥɢɹ, ɭɪɨɜɟɧɶ ɤɪɟɚɬɢɧɢɧɚ, ɦɢɤɪɨɚɥɶɛɭɦɢɧɭɪɢɢ. ɋɤɨɪɨɫɬɶ ɤɥɭɛɨɱɤɨɜɨɣ

ɮɢɥɶɬɪɚɰɢɢ ɢ ɂɆɌ ɪɚɫɫɱɢɬɵɜɚɥɢɫɶ ɩɨ ɮɨɪɦɭɥɚɦ. Ⱦɥɹ ɨɰɟɧɤɢ ɦɨɪɮɨɮɭɧɤɰɢɨɧɚɥɶɧɨɝɨ ɫɨɫɬɨɹɧɢɹ ɬɪɨɦɛɨ

-ɰɢɬɨɜ ɩɪɨɜɨɞɢɥɢ ɷɥɟɤɬɪɨɧɧɭɸ ɦɢɤɪɨɫɤɨɩɢɸ.ɍɫɬɚɧɨɜɥɟɧɨ,ɱɬɨ ɩɨɜɵɲɟɧɢɟ ɢɧɞɟɤɫɚ ɦɚɫɫɵ ɬɟɥɚ ɭ ɩɚɰɢɟɧɬɨɜ ɫ

ɏɋɇ ɫ ɫɨɯɪɚɧɟɧɧɨɣ ɫɢɫɬɨɥɢɱɟɫɤɨɣ ɮɭɧɤɰɢɟɣ ɨɛɭɫɥɚɜɥɢɜɚɟɬ ɫɬɪɭɤɬɭɪɧɨ-ɮɭɧɤɰɢɨɧɚɥɶɧɵɟ ɢɡɦɟɧɟɧɢɹ ɦɢɨɤɚɪɞɚ,

ɚ ɬɚɤɠɟ ɜɟɞɟɬ ɤ ɮɭɧɤɰɢɨɧɚɥɶɧɵɦ ɢɡɦɟɧɟɧɢɹɦ ɫɨ ɫɬɨɪɨɧɵ ɷɧɞɨɬɟɥɢɹ ɫɨɫɭɞɨɜ ɢ ɩɨɱɟɤ.ȼɵɹɜɥɟɧ ɩɨɜɵɲɟɧɧɵɣ

ɪɢɫɤ ɬɪɨɦɛɨɨɛɪɚɡɨɜɚɧɢɹ ɭ ɞɚɧɧɨɣ ɤɚɬɟɝɨɪɢɢ ɩɚɰɢɟɧɬɨɜ ɫ ɩɨɜɵɲɟɧɧɵɦ ɂɆɌ ɢ ɨɠɢɪɟɧɢɟɦ.

Abstract. Hemodynamics, functional state of endothelium and renal function, platelets depending on the body mass index in patients with chronic heart failure and preserved systolic function. Kushnir Yu. The aim of the study was to evaluate hemodynamics, endothelium function of kidneys and platelets depending on the body mass index (BMI) in patients with chronic heart failure (CHF) and preserved systolic function. 42 patients (mean age - 76,69r0,83 years) with CHF II-III FC NYHA with preserved systolic function (LVEF>45%) were enrolled. Echocardiography was performed, endothelial function, serum creatinine levels and microalbuminuria were determined in patients. BMI and glomerulation filtration rate were calculated by formulas. The morphological and functional status of platelets was estimated by electronic microscopy. It was defined that increased BMI in patients with CHF and preserved systolic function determines the structural and functional changes of the myocardium and leads to the endothelial and renal functional changes. An increased risk of thrombogenesis was established in patients with overweight and obesity.

ɋɟɪɰɟɜɚ ɧɟɞɨɫɬɚɬɧɿɫɬɶ ɽ ɧɚɣɛɿɥɶɲ ɩɨɲɢɪɟɧɢɦ ɬɚ ɩɪɨɝɧɨɫɬɢɱɧɨ ɧɟɫɩɪɢɹɬɥɢɜɢɦ ɭɫɤɥɚɞɧɟɧɧɹɦ ɡɚɯɜɨɪɸɜɚɧɶ ɫɟɪɰɟɜɨ-ɫɭɞɢɧɧɨʀ ɫɢɫɬɟɦɢ. Ɂɝɿɞɧɨ ɡ

ɥɿɬɟɪɚɬɭɪɧɢɦɢ ɞɚɧɢɦɢ, ɩɨɲɢɪɟɧɧɹ ɯɪɨɧɿɱɧɨʀ

ɫɟɪɰɟɜɨʀ ɧɟɞɨɫɬɚɬɧɨɫɬɿ (ɏɋɇ) ɫɟɪɟɞ ɨɫɿɛ ɫɬɚɪɲɟ 65 ɪɨɤɿɜ ɫɹɝɚɽ 6-17% [7,9] ɿ ɡɚɥɢɲɚɽɬɶɫɹ ɝɨɥɨɜ

-ɧɢɦ ɱɢɧɧɢɤɨɦ ɫɦɟɪɬɧɨɫɬɿ ɜ ɰɿɣ ɜɿɤɨɜɿɣ ɝɪɭɩɿ. ɇɚ

ɫɶɨɝɨɞɧɿ ɩɪɢɛɥɢɡɧɨ 47% ɝɨɫɩɿɬɚɥɿɡɨɜɚɧɢɯ ɯɜɨɪɢɯ

ɩɨɯɢɥɨɝɨ ɜɿɤɭ ɦɚɸɬɶ ɡɛɟɪɟɠɟɧɭ ɫɢɫɬɨɥɿɱɧɭ ɮɭɧɤɰɿɸ, ɚɥɟ ɩɪɢ ɰɶɨɦɭ ɫɩɨɫɬɟɪɿɝɚɽɬɶɫɹ ɜɢɫɨɤɚ

ɫɦɟɪɬɧɿɫɬɶ ɩɨɪɿɜɧɹɧɨ ɡ ɯɜɨɪɢɦɢ ɛɟɡ ɫɟɪɰɟɜɨʀ ɧɟɞɨɫɬɚɬɧɨɫɬɿ ɜ ɩɨɩɭɥɹɰɿʀ [13].

ɍ ɡɜ’ɹɡɤɭ ɡ ɧɟɞɨɫɬɚɬɧɶɨɸ ɟɮɟɤɬɢɜɧɿɫɬɸ ɬɚ

ɜɿɞɫɭɬɧɿɫɬɸ ɽɞɢɧɨɝɨ ɩɪɨɬɨɤɨɥɭ ɥɿɤɭɜɚɧɧɹ ɏɋɇ ɡ ɮɪɚɤɰɿɽɸ ɜɢɤɢɞɭ (Ɏȼ) >45% ɩɟɜɧɭ ɡɚɰɿɤɚɜ

-ɥɟɧɿɫɬɶ ɫɬɚɧɨɜɥɹɬɶ ɧɨɜɿ ɦɿɲɟɧɿ – ɟɧɞɨɬɟɥɿɣ, ɧɢɪ

-ɤɢ, ɬɪɨɦɛɨɰɢɬɢ, ɦɚɫɚ ɬɿɥɚ – ʀɯ ɭɱɚɫɬɶ ɭ ɩɪɨ

-ɝɪɟɫɭɜɚɧɧɿ ɡɚɯɜɨɪɸɜɚɧɧɹ ɬɚ ɦɨɠɥɢɜɿɫɬɶ ɤɨɪɟɤɰɿʀ.

ȼɿɞɨɦɨ, ɳɨ ɿɧɞɟɤɫ ɦɚɫɢ ɬɿɥɚ (ȱɆɌ) ɽ ɜɚɠ

-ɥɢɜɢɦ ɩɪɨɝɧɨɫɬɢɱɧɢɦ ɮɚɤɬɨɪɨɦ ɜɢɠɢɜɚɧɧɹ ɩɚ

-ɰɿɽɧɬɿɜ ɡ ɫɟɪɰɟɜɨ-ɫɭɞɢɧɧɨɸ ɩɚɬɨɥɨɝɿɽɸ [10,14].

Ʉɪɿɦ ɰɶɨɝɨ, ɭ ɪɟɤɨɦɟɧɞɚɰɿɹɯ ȯɜɪɨɩɟɣɫɶɤɨɝɨ

ɬɨɜɚɪɢɫɬɜɚ ɤɚɪɞɿɨɥɨɝɿɜ ɡ ɞɿɚɝɧɨɫɬɢɤɢ ɬɚ ɥɿɤɭ

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ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

ɏɋɇ ɭ ɯɜɨɪɢɯ ɡ ɧɢɡɶɤɨɸ ɦɚɫɨɸ ɬɿɥɚ, ɚɥɟ ɡɨɜɫɿɦ

ɧɟ ɜɿɞɨɛɪɚɠɟɧɨ ɩɪɢ ɧɚɞɥɢɲɤɨɜɿɣ ɦɚɫɿ ɬɿɥɚ ɬɚ ɨɠɢɪɿɧɧɿ [15].

Ɂɚ ɥɿɬɟɪɚɬɭɪɧɢɦɢ ɞɚɧɢɦɢ ɜɜɚɠɚɽɬɶɫɹ, ɳɨ

ɨɠɢɪɿɧɧɹ ɽ ɧɟɡɚɥɟɠɧɢɦ ɮɚɤɬɨɪɨɦ ɪɢɡɢɤɭ ɜ ɪɨɡ

-ɜɢɬɤɭ ɏɋɇ, ɩɪɨɬɟ ɣɨɝɨ ɪɨɥɶ ɜ ʀʀ ɩɪɨɝɪɟɫɭɜɚɧɧɿ

ɧɟɞɨɫɬɚɬɧɶɨ ɜɢɜɱɟɧɚ [14]. Ʉɪɿɦ ɰɶɨɝɨ, ɫɟɪɰɟɜɚ

ɧɟɞɨɫɬɚɬɧɿɫɬɶ ɽ ɩɪɨɜɿɞɧɨɸ ɩɪɢɱɢɧɨɸ ɫɦɟɪɬɧɨɫɬɿ ɭ ɯɜɨɪɢɯ ɡ ɪɿɡɤɨ ɜɢɪɚɠɟɧɢɦ ɨɠɢɪɿɧɧɹɦ [10]. Ⱥɥɟ

ɪɟɡɭɥɶɬɚɬɢ ɞɨɫɥɿɞɠɟɧɶ ɧɟ ɽ ɨɞɧɨɡɧɚɱɧɢɦɢ. Ȼɚ

-ɝɚɬɨ ɞɨɫɥɿɞɠɟɧɶ ɫɜɿɞɱɚɬɶ ɩɪɨ ɬɟ, ɳɨ ɯɜɨɪɿ ɡ

ɧɚɞɥɢɲɤɨɜɨɸ ɦɚɫɨɸ ɬɿɥɚ ɬɚ ɨɠɢɪɿɧɧɹɦ ɦɚɸɬɶ ɧɢɠɱɭ ɫɦɟɪɬɧɿɫɬɶ, ɧɿɠ ɯɜɨɪɿ ɡ ɧɨɪɦɚɥɶɧɨɸ ɦɚ

-ɫɨɸ ɬɿɥɚ. ɍ ɥɿɬɟɪɚɬɭɪɿ ɰɟ ɨɬɪɢɦɚɥɨ ɧɚɡɜɭ «ɩɚ

-ɪɚɞɨɤɫ ɨɠɢɪɿɧɧɹ» [12].

Ɍɚɤɢɦ ɱɢɧɨɦ, ɭ ɩɪɨɬɨɤɨɥɿ ɜɿɞɫɭɬɧɹ ɫɬɪɚɬɟɝɿɹ

ɥɿɤɭɜɚɧɧɹ ɯɜɨɪɢɯ ɡ ɏɋɇ ɩɪɢ ȱɆɌ ɜɢɳɟ 25, ɚ ɪɨɥɶ

ȱɆɌ ɭ ɩɪɨɝɪɟɫɭɜɚɧɧɿ ɏɋɇ ɽ ɫɭɩɟɪɟɱɥɢɜɨɸ ɬɚ ɧɟ

-ɞɨɫɬɚɬɧɶɨ ɜɢɜɱɟɧɨɸ, ɳɨ ɣ ɡɭɦɨɜɢɥɨ ɜɢɛɿɪ

ɧɚɩɪɹɦɤɭ ɞɨɫɥɿɞɠɟɧɧɹ.

Ɇɟɬɚ ɪɨɛɨɬɢ – ɨɰɿɧɢɬɢ ɫɬɚɧ ɩɨɤɚɡɧɢɤɿɜ

ɝɟɦɨɞɢɧɚɦɿɤɢ, ɮɭɧɤɰɿɨɧɚɥɶɧɢɣ ɫɬɚɧ ɟɧɞɨɬɟɥɿɸ

ɫɭɞɢɧ, ɧɢɪɨɤ ɬɚ ɬɪɨɦɛɨɰɢɬɿɜ ɭ ɯɜɨɪɢɯ ɧɚ ɯɪɨ

-ɧɿɱɧɭ ɫɟɪɰɟɜɭ ɧɟɞɨɫɬɚɬɧɿɫɬɶ ɡɿ ɡɛɟɪɟɠɟɧɨɸ ɫɢɫɬɨɥɿɱɧɨɸ ɮɭɧɤɰɿɽɸ ɡɚɥɟɠɧɨ ɜɿɞ ɿɧɞɟɤɫɭ ɦɚɫɢ ɬɿɥɚ.

ɆȺɌȿɊȱȺɅɂ ɌȺ ɆȿɌɈȾɂ ȾɈɋɅȱȾɀȿɇɖ

Ɉɛɫɬɟɠɟɧɨ 42 ɯɜɨɪɢɯ ɡ ɏɋɇ ȱȱ-ȱȱȱ ɮɭɧɤ

-ɰɿɨɧɚɥɶɧɨɝɨ ɤɥɚɫɭ (ɎɄ) (ɡɝɿɞɧɨ ɡ ɤɥɚɫɢɮɿɤɚɰɿɽɸ

ɇɶɸ-Ƀɨɪɤɫɶɤɨʀ ɚɫɨɰɿɚɰɿʀ ɤɚɪɞɿɨɥɨɝɿɜ (NYHA)) [15] ɡɿ ɡɛɟɪɟɠɟɧɨɸ ɫɢɫɬɨɥɿɱɧɨɸ ɮɭɧɤɰɿɽɸ ɥɿɜɨɝɨ

ɲɥɭɧɨɱɤɚ (Ʌɒ) (Ɏȼ ɛɿɥɶɲɟ 45%, ɫɟɪɟɞɧɹ M±m – 59,6±0,6%) ɭ ɜɿɰɿ ɜɿɞ 51 ɞɨ 75 ɪɨɤɿɜ (ɫɟɪɟɞɧɿɣ ɜɿɤ – 67,8±1,2 ɪɨɤɭ). ɑɨɥɨɜɿɤɢ ɫɤɥɚɥɢ 69,0% (29

ɨɫɿɛ),ɠɿɧɤɢ – 31,0% (13 ɨɫɿɛ).ɍ ɜɫɿɯ ɯɜɨɪɢɯ ɞɿɚɝ

-ɧɨɫɬɨɜɚɧɨ ɿɲɟɦɿɱɧɭ ɯɜɨɪɨɛɭ ɫɟɪɰɹ (ȱɏɋ). Ⱥɪɬɟ

-ɪɿɚɥɶɧɭ ɝɿɩɟɪɬɟɧɡɿɸ (ȺȽ) - ɭ 39 ɯɜɨɪɢɯ (92,9%), ɿɡ

ɧɢɯ ɭ 26 ɯɜɨɪɢɯ (65,0%) – ȱȱ ɫɬɚɞɿʀ,ɭ 14 (35,0%) –

ȱȱȱ ɫɬɚɞɿʀ. 12 ɩɚɰɿɽɧɬɿɜ (28,6%) ɦɚɥɢ ɜ ɚɧɚɦɧɟɡɿ (ɛɿɥɶɲɟ ɩɿɜɪɨɤɭ) ɿɧɮɚɪɤɬ ɦɿɨɤɚɪɞɚ, 2 (4,8%) –

ɩɨɪɭɲɟɧɧɹ ɦɨɡɤɨɜɨɝɨ ɤɪɨɜɨɨɛɿɝɭ.

ɉɪɢ ɩɪɨɜɟɞɟɧɧɿ ɤɥɿɧɿɤɨ-ɞɿɚɝɧɨɫɬɢɱɧɢɯ ɬɚ

ɥɿɤɭɜɚɥɶɧɢɯ ɡɚɯɨɞɿɜ ɫɩɢɪɚɥɢɫɹ ɧɚ ɇɚɤɚɡ ɆɈɁ ɍɤɪɚʀɧɢ ʋ 436 ɜɿɞ 03.07.06 ɪ., ɪɟɤɨɦɟɧɞɚɰɿʀ ɍɤ

-ɪɚʀɧɫɶɤɨʀ ɚɫɨɰɿɚɰɿʀ ɤɚɪɞɿɨɥɨɝɿɜ ɬɚ ȯɜɪɨɩɟɣɫɶɤɨɝɨ ɬɨɜɚɪɢɫɬɜɚ ɤɚɪɞɿɨɥɨɝɿɜ [6, 9, 15]. ɏɋɇ ɜɢɡɧɚɱɚɥɢ

ɩɪɢ ɧɚɹɜɧɨɫɬɿ ɨɛ’ɽɤɬɢɜɧɢɯ ɬɚ ɫɭɛ’ɽɤɬɢɜɧɢɯ ɨɡ

-ɧɚɤ, ɩɪɢɬɚɦɚɧɧɢɯ ɰɶɨɦɭ ɤɥɿɧɿɱɧɨɦɭ ɫɢɧɞɪɨɦɭ,

ɩɪɨɜɨɞɢɥɢ ɡɛɿɪ ɚɧɚɦɧɟɫɬɢɱɧɢɯ ɞɚɧɢɯ, ɮɿɡɢ

-ɤɚɥɶɧɟ ɨɛɫɬɟɠɟɧɧɹ ɬɚ ɫɬɚɧɞɚɪɬɧɿ ɥɚɛɨɪɚɬɨɪɧɨ

-ɿɧɫɬɪɭɦɟɧɬɚɥɶɧɿ ɞɨɫɥɿɞɠɟɧɧɹ.

ɇɚɣɩɨɲɢɪɟɧɿɲɢɦɢ ɫɤɚɪɝɚɦɢ ɫɟɪɟɞ ɯɜɨɪɢɯ ɡ ɏɋɇ ɛɭɥɢ ɡɚɝɚɥɶɧɚ ɫɥɚɛɤɿɫɬɶ ɭ 30 (71,4%) ɨɫɿɛ,

ɡɚɞɢɲɤɚ ɭ 27 (64,3%), ɧɚɛɪɹɤɢ ɤɿɧɰɿɜɨɤ ɭ 22 (52,4%), ɛɨɥɿ ɜ ɞɿɥɹɧɰɿ ɫɟɪɰɹ ɭ 15 (35,7%) ɯɜɨɪɢɯ.

Ʉɪɢɬɟɪɿɹɦɢ ɜɤɥɸɱɟɧɧɹ ɛɭɥɢ ɧɚɹɜɧɿɫɬɶ ɏɋɇ ȱȱ-ȱȱȱ ɮɭɧɤɰɿɨɧɚɥɶɧɨɝɨ ɤɥɚɫɭ, ɡɭɦɨɜɥɟɧɚ ȱɏɋ;

Ɏȼ 45%; ɿɧɮɨɪɦɨɜɚɧɚ ɡɝɨɞɚ ɯɜɨɪɨɝɨ.

Ʉɪɢɬɟɪɿʀ ɜɢɤɥɸɱɟɧɧɹ: ɝɨɫɬɪɚ ɫɟɪɰɟɜɚ ɧɟɞɨ

-ɫɬɚɬɧɿɫɬɶ,ɿɧɮɚɪɤɬ ɦɿɨɤɚɪɞɚ ɬɚ ɩɨɪɭɲɟɧɧɹ ɦɨɡɤɨ

-ɜɨɝɨ ɤɪɨɜɨɨɛɿɝɭ ɜ ɚɧɚɦɧɟɡɿ ɞɨ 6 ɦɿɫɹɰɿɜ, ɝɨɫɬɪɿ

ɩɨɪɭɲɟɧɧɹ ɪɢɬɦɭ, ɹɤɿ ɡɭɦɨɜɥɸɸɬɶ ɩɨɪɭɲɟɧɧɹ

ɝɟɦɨɞɢɧɚɦɿɤɢ,ɮɪɚɤɰɿɹ ɜɢɤɢɞɭ ɦɟɧɲɟ 45%, ɏɋɇ

ȱ,ȱVɮɭɧɤɰɿɨɧɚɥɶɧɨɝɨ ɤɥɚɫɭ,ɨɠɢɪɿɧɧɹ ȱȱȱ-ȱVɫɬɭ

-ɩɟɧɹ, ɝɿɩɨɬɢɪɟɨɡ, ɯɪɨɧɿɱɧɚ ɧɢɪɤɨɜɚ ɧɟɞɨɫɬɚɬ

-ɧɿɫɬɶ,ɡɚɯɜɨɪɸɜɚɧɧɹ ɤɪɨɜɿ.

ȼɫɿ ɩɚɰɿɽɧɬɢ ɨɬɪɢɦɭɜɚɥɢ ɛɚɡɢɫɧɭ ɬɟɪɚɩɿɸ,

ɜɿɞɩɨɜɿɞɧɨ ɞɨ ɫɬɚɧɞɚɪɬɿɜ ɥɿɤɭɜɚɧɧɹ ɯɜɨɪɢɯ ɡ ɏɋɇ (ɇɚɤɚɡ ɆɈɁ ɍɤɪɚʀɧɢ ɜɿɞ 03.07.2006 ʋ 436): 39ɯɜɨɪɢɯ (92,9%) – ɿɧɝɿɛɿɬɨɪɢ ȺɉɎ, 27 (64,3%) – E-ɚɞɪɟɧɨɛɥɨɤɚɬɨɪɢ, 30 (71,4%) – ɫɬɚɬɢɧɢ, 15 (35,7%) – ɧɿɬɪɚɬɢ, 4 (9,5%) – ɚɧɬɚɝɨɧɿɫɬɢ ɤɚɥɶ

-ɰɿɸ.

ȱɧɞɟɤɫ ɦɚɫɢ ɬɿɥɚ (ȱɆɌ) ɜɢɡɧɚɱɚɜɫɹ ɡɚ ɫɬɚɧ

-ɞɚɪɬɧɨɸ ɮɨɪɦɭɥɨɸ [14].

ɉɚɰɿɽɧɬɢ ɛɭɥɢ ɪɨɡɩɨɞɿɥɟɧɿ ɧɚ ɬɪɢ ɝɪɭɩɢ ɡ

ɭɪɚɯɭɜɚɧɧɹɦ ɧɚɹɜɧɨɫɬɿ ɩɨɪɭɲɟɧɶ ɠɢɪɨɜɨɝɨ ɨɛ

-ɦɿɧɭ: ȱ ɝɪɭɩɚ – 12 ɯɜɨɪɢɯ ɡ ɧɨɪɦɚɥɶɧɨɸ ɦɚɫɨɸ

ɬɿɥɚ (ȱɆɌ 18,5–24,9); ȱȱ ɝɪɭɩɚ – 14 ɯɜɨɪɢɯ ɡ

ɧɚɞɥɢɲɤɨɜɨɸ ɦɚɫɨɸ ɬɿɥɚ (ȱɆɌ 25,0–29,9); ȱȱȱ

ɝɪɭɩɚ – 16 ɯɜɨɪɢɯ ɡ ɨɠɢɪɿɧɧɹɦ ȱ-ȱȱ ɫɬɭɩɟɧɹ (ȱɆɌ 30,0–39,9).

ɍɫɿɦ ɯɜɨɪɢɦ ɜɢɡɧɚɱɚɥɢ ɮɭɧɤɰɿɨɧɚɥɶɧɢɣ ɫɬɚɧ ɟɧɞɨɬɟɥɿɸ ɫɭɞɢɧ ɡɚ ɞɨɩɨɦɨɝɨɸ ɟɯɨɞɨɩɥɟɪɚ ɲɥɹ

-ɯɨɦ ɜɢɦɿɪɸɜɚɧɧɹ ɟɧɞɨɬɟɥɿɣɡɚɥɟɠɧɨʀ ɜɚɡɨɞɢɥɚ

-ɬɚɰɿʀ (ȿɁȼȾ)ɡɚ ɪɟɡɭɥɶɬɚɬɚɦɢ ɩɪɨɛɢ ɡ ɪɟɚɤɬɢɜɧɨɸ

ɝɿɩɟɪɟɦɿɽɸ ɡɚ ɦɟɬɨɞɢɤɨɸ, ɨɩɢɫɚɧɨɸ D. Celer-majer [11]. ɇɨɪɦɨɸ ɜɜɚɠɚɜɫɹ ɩɪɢɪɿɫɬ ɞɿɚɦɟɬɪɚ

ɚɪɬɟɪɿʀ ɧɚ 10% ɿ ɛɿɥɶɲɟ.

Ⱦɥɹ ɤɥɿɧɿɱɧɨʀ ɨɰɿɧɤɢ ɮɭɧɤɰɿʀ ɧɢɪɨɤ ɜɢɡɧɚɱɚɥɢ ɪɿɜɟɧɶ ɤɪɟɚɬɢɧɿɧɭ ɜ ɫɢɪɨɜɚɬɰɿ ɤɪɨɜɿ ɡɚ ɞɨɩɨ

-ɦɨɝɨɸ ɤɨɥɨɪɢɦɟɬɪɢɱɧɢɯ ɦɟɬɨɞɿɜ ɬɚ ɨɛɱɢɫɥɸ

-ɜɚɥɢ ɲɜɢɞɤɿɫɬɶ ɤɥɭɛɨɱɤɨɜɨʀ ɮɿɥɶɬɪɚɰɿʀ (ɒɄɎ)ɡɚ

ɮɨɪɦɭɥɨɸ Cocroft-Gault ɚɛɨ MDRD (ɩɪɢ ɧɚɹɜ

-ɧɨɫɬɿ ɨɠɢɪɿɧɧɹ).ȼɢɡɧɚɱɟɧɧɹ ɒɄɎ ɡɚ ɮɨɪɦɭɥɨɸ

Cocroft-Gaultɩɪɨɜɨɞɢɥɨɫɶ ɡɝɿɞɧɨ ɡ ɪɟɤɨɦɟɧɞɚɰɿɹ

-ɦɢ Ⱥɦɟɪɢɤɚɧɫɶɤɨʀ ɇɚɰɿɨɧɚɥɶɧɨʀ Ɏɟɞɟɪɚɰɿʀ ɇɢ

-ɪɨɤ [1,3]. ȼɢɡɧɚɱɟɧɧɹ ɦɿɤɪɨɚɥɶɛɭɦɿɧɭɪɿʀ (ɆȺɍ)

ɩɪɨɜɨɞɢɥɨɫɹ ɿɦɭɧɨɬɭɪɛɨɞɿɦɟɬɪɢɱɧɢɦ ɦɟɬɨɞɨɦ.

ȼɦɿɫɬ ɚɥɶɛɭɦɿɧɭ ɨɰɿɧɸɜɚɜɫɹ ɜ ɩɟɪɲɿɣ ɩɨɪɰɿʀ ɪɚɧɤɨɜɨʀ ɫɟɱɿ.

Ⱦɥɹ ɨɰɿɧɤɢ ɦɨɪɮɨɮɭɧɤɰɿɨɧɚɥɶɧɨɝɨ ɫɬɚɧɭ ɬɪɨɦɛɨɰɢɬɿɜ ɩɪɨɜɨɞɢɥɢ ɟɥɟɤɬɪɨɧɧɭ ɦɿɤɪɨɫɤɨɩɿɸ

12 ɯɜɨɪɢɦ. Ⱦɥɹ ɰɶɨɝɨ ɜ ɨɞɧɚɤɨɜɢɯ ɭɦɨɜɚɯ

ɧɚɛɢɪɚɥɢ 5 ɦɥ ɜɟɧɨɡɧɨʀ ɤɪɨɜɿ ɬɚ ɰɟɧɬɪɢɮɭɝɭɜɚɥɢ

ɭ ɝɟɩɚɪɢɧɿɡɨɜɚɧɿɣ ɩɪɨɛɿɪɰɿ ɜ ɪɟɠɢɦɿ 900 ɨɛ./ɯɜ.

ɩɪɨɬɹɝɨɦ 15 ɯɜɢɥɢɧ ɩɪɢ ɬɟɦɩɟɪɚɬɭɪɿ 22±2°ɋ.

Ɏɪɚɤɰɿɸ, ɡɛɚɝɚɱɟɧɭ ɬɪɨɦɛɨɰɢɬɚɦɢ ɩɥɚɡɦɢ, ɩɟɪɟ

-ɧɨɫɢɥɢ ɭ ɩɪɟɮɿɤɫɚɰɿɣɧɢɣ ɪɨɡɱɢɧ (ɫɩɿɜɜɿɞɧɨɲɟɧ

(3)

30 ɯɜɢɥɢɧ ɫɭɫɩɟɧɡɿɸ ɰɟɧɬɪɢɮɭɝɭɜɚɥɢ ɩɪɢ 3000

ɨɛ./ɯɜ.ɩɪɨɬɹɝɨɦ 10 ɯɜɢɥɢɧ [5].

ȿɥɟɤɬɪɨɧɧɨ-ɦɿɤɪɨɫɤɨɩɿɱɧɟ ɞɨɫɥɿɞɠɟɧɧɹ ɨɫɚɞɭ

ɡ ɬɪɨɦɛɨɰɢɬɚɦɢ ɩɪɨɜɨɞɢɥɢ ɡɚ ɫɬɚɧɞɚɪɬɧɨɸ ɫɯɟ

-ɦɨɸ (Ⱥ.Ⱥ.Ɇɢɪɨɧɨɜ ɢ ɫɨɚɜɬ., 1994) [4]. Ⱦɨɫɥɿɞ

-ɠɟɧɧɹ ɩɪɨɜɨɞɢɥɢ ɡɚ ɞɨɩɨɦɨɝɨɸ ɬɪɚɧɫɦɿɫɿɣɧɨɝɨ ɟɥɟɤɬɪɨɧɧɨɝɨ ɦɿɤɪɨɫɤɨɩɚ ɉɗɆ-100-01 (“SELMI”,

ɍɤɪɚʀɧɚ) ɩɪɢ ɧɚɩɪɭɡɿ ɩɪɢɫɤɨɪɟɧɧɹ 65-90 ɤȼ ɿ

ɩɟɪɜɢɧɧɢɯ ɡɛɿɥɶɲɟɧɧɹɯ ɜɿɞ 2000 ɞɨ 80000.

Ʉɿɥɶɤɿɫɧɭ ɨɰɿɧɤɭ ɭɥɶɬɪɚɫɬɪɭɤɬɭɪɧɢɯ ɡɦɿɧ ɩɪɨ

-ɜɨɞɢɥɢ ɲɥɹɯɨɦ ɩɿɞɪɚɯɭɧɤɭ ɜɿɞɧɨɫɧɨɝɨ ɜɦɿɫɬɭ ɧɟɚɤɬɢɜɨɜɚɧɢɯ, ɚɝɪɟɝɨɜɚɧɢɯ, ɞɟɝɪɚɧɭɥɶɨɜɚɧɢɯ ɿ

ɚɤɬɢɜɨɜɚɧɢɯ ɬɪɨɦɛɨɰɢɬɿɜ, ɚ ɬɚɤɨɠ ɳɿɥɶɧɨɫɬɿ

ɭɩɚɤɭɜɚɧɧɹ ɚɥɶɮɚ - ɝɪɚɧɭɥ [2].

Ⱦɥɹ ɫɬɚɬɢɫɬɢɱɧɨɝɨ ɚɧɚɥɿɡɭ ɞɚɧɢɯ ɜɢɤɨɪɢɫ

-ɬɨɜɭɜɚɥɢ ɥɿɰɟɧɡɿɣɧɭ ɩɪɨɝɪɚɦɭ STATISTICA 6.1.

ȼɪɚɯɨɜɭɸɱɢ ɧɟɜɟɥɢɤɭ ɱɢɫɟɥɶɧɿɫɬɶ ɜɢɛɿɪɨɤ, ɡɚɫ

-ɬɨɫɨɜɭɜɚɥɢ ɦɟɬɨɞɢ ɧɟɩɚɪɚɦɟɬɪɢɱɧɨʀ ɫɬɚɬɢɫɬɢɤɢ

–ɩɪɢ ɨɩɢɫɚɧɧɿ ɤɿɥɶɤɿɫɧɢɯ ɨɡɧɚɤ ɞɚɧɿ ɛɭɥɢ ɩɪɟɞ

-ɫɬɚɜɥɟɧɿ ɭ ɜɢɝɥɹɞɿ ɦɟɞɿɚɧɢ (Ɇɟ) ɬɚ ɦɟɠ

ɪɚɤɬɟɪɢɫɬɢɤ ɭ ɜɫɿɯ 3 ɝɪɭɩɚɯ ɜɢɤɨɪɢɫɬɨɜɭɜɚɥɢ

ɦɧɨɠɢɧɧɟ ɩɨɪɿɜɧɹɧɧɹ ɫɟɪɟɞɧɿɯ ɩɨɤɚɡɧɢɤɿɜ ɡɚ

ɨɞɧɨɮɚɤɬɨɪɧɢɦ ɞɢɫɩɟɪɫɿɣɧɢɦ ɚɧɚɥɿɡɨɦ Ʉɪɭɫ

-ɤɚɥɚ-ɍɨɥɥɿɫɚ (Kruskal-Wallis ANOVA) ɡ ɩɨɩɚɪ

-ɧɢɦ ɡɿɫɬɚɜɥɟɧɧɹɦ ɡɚ ɤɪɢɬɟɪɿɽɦ Ɇɚɧɧɚ-ɍʀɬɧɿ

(Mann-Whitney U Test), ɜɿɞɧɨɫɧɢɯ ɩɨɤɚɡɧɢɤɿɜ –

ɡɚ ɤɪɢɬɟɪɿɽɦ ɏɿ-ɤɜɚɞɪɚɬ ɉɿɪɫɨɧɚ (F2). Ⱦɥɹ ɨɰɿɧɤɢ

ɜɡɚɽɦɨɡɜ’ɹɡɤɭ ɦɿɠ ɨɡɧɚɤɚɦɢ ɜɢɤɨɧɭɜɚɜɫɹ ɤɨɪɟ

-ɥɹɰɿɣɧɢɣ ɚɧɚɥɿɡ ɡ ɪɨɡɪɚɯɭɧɤɨɦ ɤɨɟɮɿɰɿɽɧɬɿɜ ɪɚɧ

-ɝɨɜɨʀ ɤɨɪɟɥɹɰɿʀ ɋɩɿɪɦɟɧɚ (r) [8].

ɊȿɁɍɅɖɌȺɌɂ ɌȺ Ȳɏ ɈȻȽɈȼɈɊȿɇɇə

Ɂɚ ɨɫɧɨɜɧɢɦɢ ɤɥɿɧɿɱɧɢɦɢ ɯɚɪɚɤɬɟɪɢɫɬɢɤɚɦɢ ɯɜɨɪɢɯ ɡ ɏɋɇ, ɩɪɟɞɫɬɚɜɥɟɧɢɯ ɭ ɬɚɛɥɢɰɿ 1, ɜɢ

-ɞɿɥɟɧɿ ɡɚ ɜɟɥɢɱɢɧɨɸ ȱɆɌ ɝɪɭɩɢ ɞɨɫɥɿɞɠɟɧɧɹ ɫɭɬɬɽɜɨ ɧɟ ɜɿɞɪɿɡɧɹɥɢɫɶ ɦɿɠ ɫɨɛɨɸ (ɩɪɢ ɜɫɿɯ

ɩɨɪɿɜɧɹɧɧɹɯ ɪ>0,05). ȼɨɞɧɨɱɚɫ ɜɿɞɡɧɚɱɟɧɚ ɬɟɧ

-ɞɟɧɰɿɹ ɞɨ ɡɛɿɥɶɲɟɧɧɹ ɱɚɫɬɨɬɢ ɪɟɽɫɬɪɚɰɿʀ ȱȱȱ ɎɄ ɏɋɇ ɬɚ ɡɚɯɜɨɪɸɜɚɧɨɫɬɿ ɧɚ ɰɭɤɪɨɜɢɣ ɞɿɚɛɟɬ ɭ ɯɜɨɪɢɯ ɡ ɧɚɞɦɿɪɧɨɸ ɦɚɫɨɸ ɬɿɥɚ ɬɚ ɨɠɢɪɿɧɧɹɦ.

Ɍ ɚ ɛ ɥ ɢ ɰ ɹ 1

ɏɚɪɚɤɬɟɪɢɫɬɢɤɚ ɯɜɨɪɢɯ ɡ ɏɋɇ (ɚɛɫ., %)

ɉɨɤɚɡɧɢɤ ȱ ɝɪɭɩɚ_n=12 , ȱȱ ɝɪɭɩɚ_N=14 , ȱȱȱ ɝɪɭɩɚ_n=16 , Ɋ

ɋɟɪɟɞɧɿɣ ɜɿɤ, ɪɨɤɢ

(Ɇɟ [25%; 75%])

66,0 [63,0; 71,5]

74,0 [72,0; 75,0]

70,5 [61,0; 73,5]

0,166*

ȱɆɌ,ɤɝ/ɦ² (Ɇɟ [25%; 75%]) 24,3 [23,7; 24,5]

26,9 [26,2; 28,4]

33,6 [31,0; 35,7]

<0,001*

ɋɬɟɧɨɤɚɪɞɿɹ:ɎɄ ȱȱ

ɎɄ ȱȱȱ 4 (33,3%) 2 (16,7%)

5 (35,7%) 4 (28,6%)

6 (37,5%) 5 (31,3%)

0,861

ȱɧɮɚɪɤɬ ɦɿɨɤɚɪɞɚ ɜ ɚɧɚɦɧɟɡɿ 5 (41,7%) 4 (28,6%) 3 (18,8%) 0,414

ɇɚɹɜɧɿɫɬɶ ȺȽ 12 (100%) 12 (85,7%) 15 (93,8%) 0,364

ɋɬɚɞɿɹ ȺȽ:ȱȱ

ȱȱȱ 6 (50,0%) 6 (50,0%)

8 (66,7%) 4 (33,3%)

12 (75,0%) 4 (25,0%)

0,386

ɋɬɭɩɿɧɶ ȺȽ: 1

2 3

2 (16,7%) 6 (50,0%) 4 (33,3%)

1 (8,3%) 7 (58,4%) 4 (33,3%)

0 9 (56,3%) 7 (43,7%)

0,572

ɇɚɹɜɧɿɫɬɶ ɰɭɤɪɨɜɨɝɨ ɞɿɚɛɟɬɭ 1 (8,3%) 5 (35,7%) 6 (37,5%) 0,184

ɏɋɇ: ɎɄ ȱȱ

ɎɄ ȱȱȱ 7 (58,3%) 5 (41,7%)

3 (21,4%) 11 (78,6%)

5 (31,3%) 11 (68,7%)

0,132

ɉ ɪ ɢ ɦ ɿ ɬ ɤ ɚ: * ɩɨɪɿɜɧɹɧɧɹ ɭɫɿɯ ɝɪɭɩ ɡɚ ɤɪɢɬɟɪɿɽɦ Ʉɪɭɫɤɚɥɚ-ɍɨɥɥɿɫɚ,ɜ ɿɧɲɢɯ ɜɢɩɚɞɤɚɯ – ɡɚ ɤɪɢɬɟɪɿɽɦF2_.

Ɂɚ ɪɟɡɭɥɶɬɚɬɚɦɢ ɬɟɫɬɭ ɡ 6-ɯɜɢɥɢɧɧɨɸ ɯɨɞɨɸ

ɜɢɹɜɥɟɧɨ, ɳɨ ɧɚɣɛɿɥɶɲɭ ɞɢɫɬɚɧɰɿɸ ɩɪɨɯɨɞɢɥɢ

ɯɜɨɪɿ ɡ ɏɋɇ ɬɚ ɧɨɪɦɚɥɶɧɢɦ ȱɆɌ. Ɍɚɤ, ɭ ȱ ɝɪɭɩɿ

ɜɨɧɚ ɫɬɚɧɨɜɢɥɚ 345,0 [267,5; 375,0] ɦ;ɜ ȱȱ – 265,0 [240,0; 300,0] ɦ; ɜ ȱȱȱ – 280,0 [227,5; 335,0] ɦ.

ɉɪɨɬɟ ɞɨɫɬɨɜɿɪɧɨʀ ɪɿɡɧɢɰɿ ɦɿɠ ɝɪɭɩɚɦɢ ɡɚ ɰɢɦ

ɩɨɤɚɡɧɢɤɨɦ ɧɚɦɢ ɧɟ ɜɢɹɜɥɟɧɨ (ɡɚ ɤɪɢɬɟɪɿɽɦ

Ʉɪɭɫɤɚɥɚ-ɍɨɥɥɿɫɚ ɪɧ=0,276), ɳɨ, ɦɨɠɥɢɜɨ, ɩɨ

-ɬɪɟɛɭɽ ɛɿɥɶɲɨʀ ɤɿɥɶɤɨɫɬɿ ɞɨɫɥɿɞɠɟɧɶ.

Ⱥɧɚɥɿɡ ɩɨɤɚɡɧɢɤɿɜ ɝɟɦɨɞɢɧɚɦɿɤɢ ɡɚɥɟɠɧɨ ɜɿɞ ȱɆɌ ɩɨɤɚɡɚɜ ɧɚɹɜɧɿɫɬɶ ɩɪɹɦɨʀ ɤɨɪɟɥɹɰɿʀ ɦɿɠ ȱɆɌ

ɿ ɫɢɫɬɨɥɿɱɧɢɦ ɚɪɬɟɪɿɚɥɶɧɢɦ ɬɢɫɤɨɦ (ɋȺɌ)

(r=0,30; ɪ=0,05) ɬɚ ɞɿɚɫɬɨɥɿɱɧɢɦ (ȾȺɌ) (r=0,36;

(4)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

ɩɿɞɜɢɳɭɜɚɥɢɫɶ ɭ ɯɜɨɪɢɯ ɡ ɨɠɢɪɿɧɧɹɦ ɩɨɪɿɜɧɹɧɨ ɡ ɯɜɨɪɢɦɢ ɡ ɧɨɪɦɚɥɶɧɨɸ ɦɚɫɨɸ ɬɿɥɚ (ɪ=0,028 ɿ

ɪ=0,024 ɜɿɞɩɨɜɿɞɧɨ). ɋɬɚɬɢɫɬɢɱɧɨ ɡɧɚɱɭɳɿ ɜɿɞ

-ɦɿɧɧɨɫɬɿ ɜɢɹɜɥɟɧɿ ɬɚɤɨɠ ɦɿɠ ɪɿɜɧɹɦɢ ȾȺɌ ɭ ɯɜɨɪɢɯ ɡ ɧɚɞɥɢɲɤɨɜɨɸ ɜɚɝɨɸ ɬɚ ɨɠɢɪɿɧɧɹɦ

(ɪ=0,043).

ɍɫɿɦ ɯɜɨɪɢɦ ɩɪɨɜɨɞɢɥɨɫɶ ɟɯɨɤɚɪɞɿɨɝɪɚɮɿɱɧɟ

ɞɨɫɥɿɞɠɟɧɧɹ. Ⱥɧɚɥɿɡ ɩɨɤɚɡɧɢɤɿɜ ɰɟɧɬɪɚɥɶɧɨʀ

ɝɟɦɨɞɢɧɚɦɿɤɢ ɜ ɨɛɫɬɟɠɟɧɢɯ ɯɜɨɪɢɯ ɡɞɿɣɫɧɸɜɚɥɢ ɜɿɞɩɨɜɿɞɧɨ ɞɨ ɪɨɡɩɨɞɿɥɭ ɧɚ ɝɪɭɩɢ ɡɚɥɟɠɧɨ ɜɿɞ ȱɆɌ (ɬɚɛɥɢɰɹ 2).

ɉɪɢ ɧɚɹɜɧɨɫɬɿ ɨɠɢɪɿɧɧɹ ɭ ɯɜɨɪɢɯ ɡ ɏɋɇ ɜɢɹɜɥɟɧɿ ɫɭɬɬɽɜɿ ɫɬɪɭɤɬɭɪɧɨ-ɮɭɧɤɰɿɨɧɚɥɶɧɿ ɡɦɿɧɢ

ɨɫɧɨɜɧɢɯ ɩɨɤɚɡɧɢɤɿɜ ɤɚɪɞɿɨɝɟɦɨɞɢɧɚɦɿɤɢ ɩɨɪɿɜ

-ɧɹɧɨ ɡ ɯɜɨɪɢɦɢ ɡ ɧɨɪɦɚɥɶɧɢɦɢ ɡɧɚɱɟɧɧɹɦɢ ȱɆɌ

(ɬɚɛɥɢɰɹ 2). Ⱦɨɫɬɨɜɿɪɧɨ ɩɿɞɜɢɳɭɜɚɥɢɫɹ ɡɚɥɟɠɧɨ

ɜɿɞ ȱɆɌ ɤɿɧɰɟɜɨ-ɫɢɫɬɨɥɿɱɧɢɣ ɨɛ’ɽɦ (ɄɋɈ) ɬɚ

ɤɿɧɰɟɜɨ-ɞɿɚɫɬɨɥɿɱɧɢɣ ɪɨɡɦɿɪ (ɄȾɊ) (ɪ<0,05).Ɍɚɤ,

ɧɚɣɧɢɠɱɿ ɄɋɈ ɿ ɄȾɊ ɜɢɹɜɥɟɧɿ ɜ ȱ ɝɪɭɩɿ, ɚ

ɧɚɣɜɢɳɿ – ɭ ȱȱȱ ɝɪɭɩɿ. Ɍɚɤɨɠ ɞɨɫɬɨɜɿɪɧɨ ɜɿɞɪɿɡ

-ɧɹɥɢɫɹ ɜ ɝɪɭɩɿ ɡ ɨɠɢɪɿɧɧɹɦ ɩɨɪɿɜɧɹɧɨ ɡ ɧɨɪ

-ɦɚɥɶɧɨɸ ɦɚɫɨɸ ɬɿɥɚ ɤɿɧɰɟɜɨ-ɫɢɫɬɨɥɿɱɧɢɣ (ɄɋɊ)

ɬɚ ɤɿɧɰɟɜɨ-ɞɿɚɫɬɨɥɿɱɧɢɣ ɨɛ’ɽɦ (ɄȾɈ) (ɪ<0,05).

Ⱦɨɫɬɨɜɿɪɧɨ ɡɛɿɥɶɲɭɜɚɥɚɫɹ ɩɪɨɩɨɪɰɿɣɧɨ ɩɿɞɜɢ

-ɳɟɧɧɸ ɦɚɫɢ ɬɿɥɚ ɬɨɜɳɢɧɚ ɡɚɞɧɶɨʀ ɫɬɿɧɤɢ ɥɿɜɨɝɨ ɲɥɭɧɨɱɤɚ (ɌɁɋɅɒ) (ɪ<0,05) ɭ ɜɫɿɯ ɝɪɭɩɚɯ ɯɜɨ

-ɪɢɯ. Ɍɨɜɳɢɧɚ ɦɿɠɲɥɭɧɨɱɤɨɜɨʀ ɩɟɪɟɬɢɧɤɢ

(ɌɆɒɉ) ɞɨɫɬɨɜɿɪɧɨ ɡɛɿɥɶɲɭɜɚɥɚɫɶ ɭ ȱȱ ɿ ȱȱȱ

ɝɪɭɩɚɯ. Ɂɚ ɜɫɿɦɚ ɜɢɳɟɡɝɚɞɚɧɢɦɢ ɩɨɤɚɡɧɢɤɚɦɢ

ɜɿɞɡɧɚɱɟɧɨ ɩɨɡɢɬɢɜɧɢɣ ɤɨɪɟɥɹɰɿɣɧɢɣ ɡɜ’ɹɡɨɤ

(r<0,30;ɪ<0,05).

ȼɨɞɧɨɱɚɫ ɜɫɬɚɧɨɜɥɟɧɨ, ɳɨ ɡɛɿɥɶɲɟɧɧɹ ȱɆɌ ɭ

ɯɜɨɪɢɯ ɡ ɏɋɇ ɩɪɢɡɜɨɞɢɬɶ ɞɨ ɞɨɫɬɨɜɿɪɧɨɝɨ ɡɧɢɠɟɧɧɹ ɩɨɤɚɡɧɢɤɿɜ ɮɪɚɤɰɿʀ ɜɢɤɢɞɭ (Ɏȼ)ɥɿɜɨɝɨ

ɲɥɭɧɨɱɤɚ (r=-0,67, p<0,001) – ɡ 63,5% ɩɪɢ ɧɨɪ

-ɦɚɥɶɧɨɦɭ ȱɆɌ ɞɨ 59,5% (ɪ<0,01) ɿ 57,0%

(ɪ<0,001) ɩɪɢ ɧɚɞɥɢɲɤɨɜɿɣ ɦɚɫɿ ɬɿɥɚ ɿ ɨɠɢɪɿɧɧɿ

ɜɿɞɩɨɜɿɞɧɨ.

ɉɨɤɚɡɧɢɤɢ ɤɚɪɞɿɨɝɟɦɨɞɢɧɚɦɢɤɢ ɭ ɯɜɨɪɢɯ ɡ ɏɋɇ ɡɚɥɟɠɧɨ ɜɿɞ ȱɆɌ (Ɇɟ [25%; 75%])

ɉɨɤɚɡɧɢɤ ȱ ɝɪɭɩɚ, n=12 ȱȱ ɝɪɭɩɚ, n=14 ȱȱȱ ɝɪɭɩɚ, n=16 ɪɧ

ɑɋɋ,ɡɚ 1 ɯɜɢɥɢɧɭ 78,0 [72,5; 86,0] 79,0 [68,0; 90,0] 78,0 [70,0; 84,0] 0,923

ɋȺɌ,ɦɦ ɪɬ.ɫɬ. 150,0 [137,5; 160,0]

ɪȱȱȱ

150,0 [130,0;160,0] 160,0 [155,0; 175,0]

ɪȱ

0,079

ȾȺɌ,ɦɦ ɪɬ.ɫɬ. 87,5 [80,0; 95,0]

ɪȱȱȱ

90,0 [80,0; 100,0]

Ɋȱȱȱ

100,0 [92,5; 100,0]

ɪȱ,ȱȱ

0,040

ɄɋɊ,ɫɦ 3,40 [3,20; 3,83]

ɪȱȱȱ

3,79 [3,68; 3,82] 4,01 [3,66; 4,02]

ɪȱ

0,016

ɄȾɊ,ɫɦ 4,53 [3,95; 5,20]

ɪȱȱȱ

4,90 [4,60; 5,76]

Ɋȱȱȱ

5,66 [5,18; 6,15]

ɪȱ,ȱȱ

<0,001

ɄɋɈ,ɦɥ 37,5 [35,5; 38,0]

Ɋȱȱ,ȱȱȱ

53,5 [47,0; 68,0]

Ɋȱ

67,0 [48,0; 79,0]

ɪȱ

0,001

ɄȾɈ,ɦɥ 112,0 [107,5; 127,5]

ɪȱȱȱ

143,5 [112,0; 150,0] 148,5 [130,5; 195,0]

ɪȱ

0,012

ɌɆɒɉ,ɫɦ 1,19 [1,11; 1,30]

ɪȱȱȱ

1,24 [1,20; 1,27] 1,32 [1,21; 1,45]

ɪȱ

0,045

ɌɁɋɅɒ,ɫɦ 1,11 [1,03; 1,12]

Ɋȱȱ,ȱȱȱ

1,20 [1,15; 1,26]

Ɋȱ

1,23 [1,17; 1,41]

ɪȱ

0,002

Ɏȼ, % 63,5 [61,0; 65,0]

Ɋȱȱ,ȱȱȱ

59,5 [58,0; 62,0]

ɪȱ,ȱȱȱ

57,0 [55,5; 57,5]

ɪȱ,ȱȱ

<0,001

Ɇɚɫɚ ɦɿɨɤɚɪɞɭ Ʌɒ,ɝ 225,0 [169,8; 260,7]

ɪȱȱȱ

285,2 [213,0; 315,0] 304,0 [270,0; 413,0]

ɪȱ

0,018

ȱɧɞɟɤɫ ɦɚɫɢ ɦɿɨɤɚɪɞɚ Ʌɒ,ɝ/ɦ2 _{128,5 [96,5; 148,8]}

ɪȱȱȱ

151,0 [130,7; 167,8] 152,0 [120,0; 215,0]

ɪȱ

0,189

(5)

Ɋɢɫ. 1. Ʉɨɪɟɥɹɰɿɣɧɿ ɡɜ’ɹɡɤɢ ɩɨɤɚɡɧɢɤɿɜ ɤɚɪɞɿɨɝɟɦɨɞɢɧɚɦɿɤɢ ɡ ȱɆɌ ɭ ɯɜɨɪɢɯ ɡ ɏɋɇ: r –ɤɨɟɮɿɰɿɽɧɬ ɤɨɪɟɥɹɰɿʀ ɋɩɿɪɦɟɧɚ, * – p<0,05, ** – p<0,001

ɍ 40 ɯɜɨɪɢɯ (95,2%) ɡ ɏɋɇ ɜɿɞɡɧɚɱɟɧɨ ɩɨɝɿɪ

-ɲɟɧɧɹ ɫɬɚɧɭ ɟɧɞɨɬɟɥɿɚɥɶɧɨʀ ɮɭɧɤɰɿʀ ɫɭɞɢɧ, ɩɪɨ

ɳɨ ɫɜɿɞɱɢɬɶ ɧɢɡɶɤɢɣ ɩɪɢɪɿɫɬ (<10%) ɞɿɚɦɟɬɪɚ

ɫɭɞɢɧ ɩɥɟɱɨɜɨʀ ɚɪɬɟɪɿʀ ɡɚ ɪɟɡɭɥɶɬɚɬɚɦɢ ɩɪɨɛɢ ɡ ɪɟɚɤɬɢɜɧɨɸ ɝɿɩɟɪɟɦɿɽɸ. ɉɪɢɱɨɦɭ ɜɿɞɫɨɬɨɤ ɜɚɡɨ

-ɞɢɥɚɬɚɰɿʀ ɩɥɟɱɨɜɨʀ ɚɪɬɟɪɿʀ ɡɦɟɧɲɭɜɚɜɫɹ ɩɪɨɩɨɪ

-ɰɿɣɧɨ ɡɛɿɥɶɲɟɧɧɸ ȱɆɌ (r=-0,66, p<0,001). ɉɪɢ

ɧɚɞɥɢɲɤɭ ɦɚɫɢ ɬɿɥɚ ɜɿɞɫɨɬɨɤ ɜɚɡɨɞɢɥɹɬɚɰɿʀ ɡɦɟɧ

-ɲɢɜɫɹ ɜ 1,4 ɪɚɡɭ ɩɨɪɿɜɧɹɧɨ ɡ ɯɜɨɪɢɦɢ ɡ ɧɨɪɦɚɥɶ

-ɧɢɦ ȱɆɌ (p<0,001), ɚ ɩɪɢ ɨɠɢɪɿɧɧɿ ȱ-ȱȱ ɫɬɭɩɟɧɹ –

ɭ 2,1 ɪɚɡɭ ɡ p<0,001 (ɬɚɛɥ. 3).

ɋɬɚɧ ɮɭɧɤɰɿʀ ɟɧɞɨɬɟɥɿɸ ɫɭɞɢɧ ɭ ɯɜɨɪɢɯ ɡ ɏɋɇ ɡɚɥɟɠɧɨ ɜɿɞ ȱɆɌ (Ɇɟ [25%; 75%])

ȼɿɞɫɨɬɨɤ ɡɛɿɥɶɲɟɧɧɹ ɞɿɚɦɟɬɪɚ ɩɥɟɱɨɜɨʀ ɚɪɬɟɪɿʀ ɩɿɫɥɹ ɩɪɨɛɢ ɡ ɪɟɚɤɬɢɜɧɨɸ ɝɿɩɟɪɟɦɿɽɸ

8,80 [8,40; 9,65]

ɪȱȱ,ȱȱȱ

6,35 [5,90; 6,90]

ɪȱ,ȱȱȱ

4,10 [3,60; 5,43]

ɪȱ,ȱȱ

<0,001

ɉ ɪ ɢ ɦ ɿ ɬ ɤ ɢ: ɪɧ – ɦɿɠ ɜɫɿɦɚ ɝɪɭɩɚɦɢ ɡɚ ɤɪɢɬɟɪɿɽɦ Ʉɪɭɫɤɚɥɚ-ɍɨɥɥɿɫɚ;ɪ_ȱ_,_ȱȱ_,_ȱȱȱ– p<0,002 ɡ ɜɿɞɩɨɜɿɞɧɨɸ ɝɪɭɩɨɸ ɡɚ ɤɪɢɬɟɪɿɽɦ Ɇɚɧɧɚ-ɍʀɬɧɿ.

Ɂ ɦɟɬɨɸ ɨɰɿɧɤɢ ɮɭɧɤɰɿɨɧɚɥɶɧɨɝɨ ɫɬɚɧɭ ɧɢɪɨɤ ɭ ɩɚɰɿɽɧɬɿɜ ɡ ɏɋɇ ɡɿ ɡɛɟɪɟɠɟɧɨɸ Ɏȼ ɧɚɦɢ ɛɭɥɨ ɜɢɡɧɚɱɟɧɨ ɪɿɜɟɧɶ ɤɪɟɚɬɢɧɿɧɭ, ɦɿɤɪɨɚɥɶɛɭɦɿɧɭɪɿʀ

(ɆȺɍ) ɬɚ ɨɛɱɢɫɥɟɧɚ ɲɜɢɞɤɿɫɬɶ ɤɥɭɛɨɱɤɨɜɨʀ

ɮɿɥɶɬɪɚɰɿʀ (ɒɄɎ)ɭ ɰɿɽʀ ɤɚɬɟɝɨɪɿʀ ɯɜɨɪɢɯ.

ȼɿɞɩɨɜɿɞɧɨ ɞɨ ɫɭɱɚɫɧɢɯ ɫɬɚɧɞɚɪɬɿɜ ɞɿɚɝɧɨɫ

-ɬɢɤɢ ɫɟɪɰɟɜɨ-ɫɭɞɢɧɧɢɯ ɡɚɯɜɨɪɸɜɚɧɶ ɆȺɍ ɪɨɡ

-ɝɥɹɞɚɽɬɶɫɹ ɹɤ ɧɟɡɚɥɟɠɧɢɣ ɮɚɤɬɨɪ ɩɨɝɿɪɲɟɧɧɹ ɩɪɨɝɧɨɡɭ ɭ ɯɜɨɪɢɯ ɬɚ ɩɿɞɜɢɳɟɧɧɹ ɪɢɡɢɤɭ ɤɚɪ

-ɞɿɨɜɚɫɤɭɥɹɪɧɢɯ ɭɫɤɥɚɞɧɟɧɶ [1, 3]. Ɉɫɬɚɧɧɿɦɢ

ɪɨɤɚɦɢ ɜɟɞɟɬɶɫɹ ɞɢɫɤɭɫɿɹ, ɳɨ ɜɢɹɜɥɟɧɧɹ ɆȺɍ ɭ

ɯɜɨɪɢɯ ɡ ɫɟɪɰɟɜɨ-ɫɭɞɢɧɧɨɸ ɩɚɬɨɥɨɝɿɽɸ ɦɨɠɟ

ɛɭɬɢ ɹɤ ɩɪɨɹɜɨɦ ɭɲɤɨɞɠɟɧɧɹ ɧɢɪɨɤ, ɬɚɤ ɿ ɩɨ

-ɪɭɲɟɧɧɹɦ ɟɧɞɨɬɟɥɿɚɥɶɧɨʀ ɮɭɧɤɰɿʀ, ɡ ɹɤɨʀ ɩɨɱɢ

-ɧɚɽɬɶɫɹ ɤɚɪɞɿɨɥɨɝɿɱɧɢɣ ɤɨɧɬɢɧɭɭɦ [3].

Ɂɚ ɧɚɲɢɦɢ ɞɚɧɢɦɢ, ɪɿɜɟɧɶ ɆȺɍ ɞɨɫɬɨɜɿɪɧɨ

ɡɛɿɥɶɲɭɜɚɜɫɹ ɡ ɩɿɞɜɢɳɟɧɧɹɦ ȱɆɌ (r=0,48,

p<0,001), ɚ ɒɄɎ,ɧɚɜɩɚɤɢ,ɡɧɢɠɭɜɚɥɚɫɶ (r=-0,60, p<0,001) (ɬɚɛɥ. 4). ȼɢɹɜɥɟɧɨ, ɳɨ ɩɪɢ ɨɠɢɪɿɧɧɿ

ɛɿɥɶɲɟ ɫɬɪɚɠɞɚɽ ɹɤ ɆȺɍ,ɬɚɤ ɿ ɒɄɎ.

ȱɆɌ

Ɏȼ r=-0,67**

ɄȾɈ r=0,49**

ɌɁɋɅɒ r=0,49**

ɌɆɒɉ r=0,33*

ɄɋɈ r=0,56**

(6)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

ɉɨɤɚɡɧɢɤɢ ɮɭɧɤɰɿɨɧɚɥɶɧɨɝɨ ɫɬɚɧɭ ɧɢɪɨɤ ɭ ɯɜɨɪɢɯ ɡ ɏɋɇ

Ʉɪɟɚɬɢɧɿɧ,ɦɤɦɨɥɶ/ɥ 76,0 [69,0; 79,5]

ɪȱȱȱ

70,0 [60,0; 84,0]

ɪȱȱȱ

83,0 [78,0; 93,0]

ɪȱ,ȱȱ

0,014

ɒɄɎ,ɦɥ/ɯɜ./1,73ɦ2 _{93,5 [91,0; 102,5]}

ɪȱȱȱ

91,0 [84,0; 94,0]

ɪȱ

ȱȱ

82,5 [71,0; 86,5]

ɪȱ,ȱȱ

<0,001

ɆȺɍ,ɦɝ/ɥ 12,5 [7,5; 15,5]

Ɋȱȱ,ȱȱȱ

26,0 [24,0; 29,0]

Ɋȱ

29,5 [15,5; 32,0]

Ɋȱ

0,002

ɉ ɪ ɢ ɦ ɿ ɬ ɤ ɢ: ɪɧ – ɦɿɠ ɜɫɿɦɚ ɝɪɭɩɚɦɢ ɡɚ ɤɪɢɬɟɪɿɽɦ Ʉɪɭɫɤɚɥɚ-ɍɨɥɥɿɫɚ;ɪȱ,ȱȱ,ȱȱȱ– p<0,05 ɡ ɜɿɞɩɨɜɿɞɧɨɸ ɝɪɭɩɨɸ ɡɚ ɤɪɢɬɟɪɿɽɦ Ɇɚɧɧɚ-ɍʀɬɧɿ.

ɍ ɞɨɫɥɿɞɠɟɧɧɹ ɮɭɧɤɰɿɨɧɚɥɶɧɨɝɨ ɫɬɚɧɭ ɬɪɨɦ

-ɛɨɰɢɬɿɜ ɡɚ ɞɨɩɨɦɨɝɨɸ ɟɥɟɤɬɪɨɧɧɨʀ ɦɿɤɪɨɫɤɨɩɿʀ

ɛɭɥɢ ɜɤɥɸɱɟɧɿ ɬɿɥɶɤɢ ɯɜɨɪɿ, ɹɤɿ ɩɪɢɣɦɚɸɬɶ

ɚɫɩɿɪɢɧ, ɳɨ ɞɨɡɜɨɥɢɥɨ ɜɫɬɚɧɨɜɢɬɢ ɬɚɤɿ ɡɚɤɨ

-ɧɨɦɿɪɧɨɫɬɿ (ɬɚɛɥɢɰɹ 5). ȼɢɹɜɥɟɧɨ, ɳɨ ɩɿɞɜɢ

-ɳɟɧɧɹ ȱɆɌ ɩɪɢɡɜɨɞɢɬɶ ɞɨ ɫɭɬɬɽɜɨɝɨ ɡɧɢɠɟɧɧɹ ɧɟɚɤɬɢɜɨɜɚɧɢɯ ɮɨɪɦ ɬɪɨɦɛɨɰɢɬɿɜ (ɪ_ɧ=0,004) ɿ

ɡɛɿɥɶɲɟɧɧɹ ʀɯ ɚɤɬɢɜɨɜɚɧɢɯ ɮɨɪɦ (ɪɧ=0,035), ɳɨ

ɫɜɿɞɱɢɬɶ ɩɪɨ ɩɿɞɜɢɳɟɧɢɣ ɪɢɡɢɤ ɬɪɨɦɛɨɭɬɜɨɪɟɧɧɹ

ɭ ɯɜɨɪɢɯ ɡ ɧɚɞɥɢɲɤɨɜɨɸ ɦɚɫɨɸ ɬɿɥɚ ɣ ɨɠɢ

-ɪɿɧɧɹɦ (ɪɢɫ. 2). ɉɪɢɜɟɪɬɚɽ ɬɚɤɨɠ ɭɜɚɝɭ, ɳɨ

ɳɿɥɶɧɿɫɬɶ ɦɿɬɨɯɨɧɞɪɿɣ ɞɨɫɬɨɜɿɪɧɨ ɡɧɢɠɭɽɬɶɫɹ ɡɿ ɡɛɿɥɶɲɟɧɧɹɦ ȱɆɌ (ɪ=0,017).

Ɇɨɪɮɨɮɭɧɤɰɿɨɧɚɥɶɧɿ ɯɚɪɚɤɬɟɪɢɫɬɢɤɢ ɬɪɨɦɛɨɰɢɬɿɜ ɭ ɯɜɨɪɢɯ

ɡ ɏɋɇ ɡɚɥɟɠɧɨ ɜɿɞ ȱɆɌ (Me [25%; 75%])

ɇɟɚɤɬɢɜɨɜɚɧɿ

ɬɪɨɦɛɨɰɢɬɢ, %

68,5 [62,5; 71,5] 39,5 [37,5; 42,5]

ɪȱ=0,007

49,5 [40,0; 62,0]

ɪȱ=0,021

0,004

Ⱥɤɬɢɜɨɜɚɧɿ ɬɪɨɦɛɨɰɢɬɢ, % 39,0 [32,5; 47,5] 59,0 [55,0; 62,5]

ɪȱ=0,017

50,5 [38,0; 59,5]

ɪȱ=0,203

0,035

Ⱥɝɪɟɝɨɜɚɧɿ ɬɪɨɦɛɨɰɢɬɢ, % 14,5 [11,5; 17,0] 19,0 [17,0; 22,0]

ɪȱ=0,0401

17,0 [12,5; 20,5]

ɪȱ=0,330

0,145

Ⱦɟɝɪɚɧɭɥɶɨɜɚɧɿ

ɬɪɨɦɛɨɰɢɬɢ, %

11,0 [9,0; 13,0] 14,5 [12,0; 15,0]

ɪȱ=0,141

13,0 [10,0; 15,5]

ɪȱ=0,271

0,368

ɓɿɥɶɧɿɫɬɶ ɚɥɶɮɚ-ɝɪɚɧɭɥ,

ɦɤɦ3_/_ɦɤɦ3

0,064 [0,054; 0,073] 0,066 [0,060; 0,076]

ɪȱ=0,734

0,079 [0,063; 0,083]

ɪȱ=0,114

0,099

ɓɿɥɶɧɿɫɬɶ ɞɟɥɶɬɚ-ɝɪɚɧɭɥ,

ɦɤɦ3

/ɦɤɦ3

0,027 [0,023; 0,030] 0,024 [0,023; 0,026]

ɪȱ=0,607

0,026 [0,024; 0,028]

ɪȱ=0,669

0,569

ɓɿɥɶɧɿɫɬɶ ɥɹɦɛɞɚ-ɝɪɚɧɭɥ,

0,089 [0,083; 0,092] 0,074 [0,068; 0,079]

ɪȱ=0,027

0,093 [0,085; 0,102]

ɪȱ=0,332

0,004

ɓɿɥɶɧɿɫɬɶ ɦɿɬɨɯɨɧɞɪɿɣ,

0,020 [0,019; 0,023] 0,016 [0,015; 0,018]

ɪȱ=0,010

0,017 [0,016; 0,019]

ɪȱ=0,019

0,017

(7)

ɚ) ɛ)

Ɋɢɫ. 2. Ʉɿɥɶɤɿɫɬɶ ɧɟɚɤɬɢɜɨɜɚɧɢɯ (ɚ)ɬɚ ɚɤɬɢɜɨɜɚɧɢɯ (ɛ)ɮɨɪɦ ɬɪɨɦɛɨɰɢɬɿɜ ɡɚɥɟɠɧɨ ɜɿɞ ɦɚɫɢ ɬɿɥɚ

Ʉɿɥɶɤɿɫɬɶ ɚɝɪɟɝɨɜɚɧɢɯ ɬɪɨɦɛɨɰɢɬɿɜ ɡɛɿɥɶ

-ɲɭɽɬɶɫɹ ɩɪɢ ɩɿɞɜɢɳɟɧɧɿ ȱɆɌ, ɚɥɟ ɞɨɫɬɨɜɿɪɧɿ

ɜɿɞɦɿɧɧɨɫɬɿ ɜɿɞɡɧɚɱɟɧɨ ɬɿɥɶɤɢ ɜ ȱȱ ɝɪɭɩɿ, ɳɨ,

ɣɦɨɜɿɪɧɨ, ɩɨɜ’ɹɡɚɧɨ ɡ ɛɿɥɶɲɨɸ ɜɚɪɿɚɛɟɥɶɧɿɫɬɸ

ɞɚɧɢɯ ɩɪɢ ɨɠɢɪɿɧɧɿ ɬɚ ɧɟɜɟɥɢɤɨɸ ɤɿɥɶɤɿɫɬɸ

ɫɩɨɫɬɟɪɟɠɟɧɶ. Ɉɬɪɢɦɚɧɿ ɧɚɣɝɿɪɲɿ ɩɨɤɚɡɧɢɤɢ

ɫɬɚɧɭ ɬɪɨɦɛɨɰɢɬɚɪɧɨʀ ɥɚɧɤɢ ɫɚɦɟ ɜ ɝɪɭɩɿ ɯɜɨɪɢɯ ɡ ɧɚɞɥɢɲɤɨɜɨɸ ɜɚɝɨɸ ɬɿɥɚ,ɚ ɧɟ ɡ ɨɠɢɪɿɧɧɹɦ,ɳɨ,

ɡ ɨɞɧɨɝɨ ɛɨɤɭ, ɩɨɬɪɟɛɭɽ ɩɨɞɚɥɶɲɨɝɨ ɞɨɫɥɿɞ

-ɠɟɧɧɹ, ɚɥɟ, ɡ ɿɧɲɨɝɨ ɛɨɤɭ, ɜɿɞɩɨɜɿɞɚɽ ɞɚɧɢɦ

ɥɿɬɟɪɚɬɭɪɢ ɩɪɨ ɛɿɥɶɲɢɣ ɪɢɡɢɤ ɫɦɟɪɬɧɨɫɬɿ ɭ ɯɜɨ

-ɪɢɯ ɡ ɧɚɞɥɢɲɤɨɜɨɸ ɜɚɝɨɸ. Ɍɚɤɨɠ ɜɢɹɜɥɟɧɿ

ɞɨɫɬɨɜɿɪɧɿ ɡɦɿɧɢ ɳɨɞɨ ɡɧɢɠɟɧɧɹ ɳɿɥɶɧɨɫɬɿ ɥɹɦɛ

-ɞɚ-ɝɪɚɧɭɥ ɬɚ ɦɿɬɨɯɨɧɞɪɿɣ ɡɿ ɡɛɿɥɶɲɟɧɧɹɦ ȱɆɌ,

ɳɨ ɩɨɬɪɟɛɭɽ ɩɨɞɚɥɶɲɨɝɨ ɜɢɜɱɟɧɧɹ.

ȼɂɋɇɈȼɄɂ

1. ɉɿɞɜɢɳɟɧɧɹ ɿɧɞɟɤɫɭ ɦɚɫɢ ɬɿɥɚ ɭ ɯɜɨɪɢɯ ɧɚ

ɏɋɇ ɡɿ ɡɛɟɪɟɠɟɧɨɸ ɮɪɚɤɰɿɽɸ ɜɢɤɢɞɭ ɚɫɨɰɿɸɜɚ

-ɥɨɫɶ ɡ ɪɨɡɜɢɬɤɨɦ ɫɬɪɭɤɬɭɪɧɨ-ɮɭɧɤɰɿɨɧɚɥɶɧɢɯ

ɡɦɿɧ ɦɿɨɤɚɪɞɚ ɡɚ ɪɚɯɭɧɨɤ ɡɛɿɥɶɲɟɧɧɹ ɩɨɤɚɡɧɢɤɿɜ ɤɿɧɰɟɜɨ-ɫɢɫɬɨɥɿɱɧɨɝɨ ɨɛ’ɽɦɭ ɬɚ ɤɿɧɰɟɜɨ-ɞɿɚɫɬɨ

-ɥɿɱɧɨɝɨ ɪɨɡɦɿɪɭ ɧɚ ɬɥɿ ɡɧɢɠɟɧɧɹ ɮɪɚɤɰɿʀ ɜɢɤɢɞɭ,

ɚ ɬɚɤɨɠ ɮɨɪɦɭɜɚɧɧɹɦ ɩɨɪɭɲɟɧɧɹ ɮɭɧɤɰɿɨɧɚɥɶ

-ɧɨɝɨ ɫɬɚɧɭ ɟɧɞɨɬɟɥɿɸ ɡ ɧɚɣɫɭɬɬɽɜɿɲɢɦɢ ɡɦɿɧɚɦɢ ɩɪɢ ȱɆɌ ɭ ɞɿɚɩɚɡɨɧɿ 30-39,9.

2. ɉɿɞɜɢɳɟɧɧɹ ȱɆɌ ɭ ɰɿɽʀ ɤɚɬɟɝɨɪɿʀ ɯɜɨɪɢɯ

ɡɭɦɨɜɥɸɜɚɥɨ ɪɨɡɜɢɬɨɤ ɮɭɧɤɰɿɨɧɚɥɶɧɢɯ ɡɦɿɧ ɡ ɛɨɤɭ ɧɢɪɨɤ (ɭ ɝɪɭɩɿ ɡ ɧɨɪɦɚɥɶɧɨɸ ɦɚɫɨɸ ɬɿɥɚ

ɒɄɎ ɫɬɚɧɨɜɢɥɚ 93,5 [91,0; 102,5], ɭ ɝɪɭɩɿ ɡ

ɨɠɢɪɿɧɧɹɦ – 82,5 [71,0; 86,5]) ɡɚ ɭɦɨɜɢ ɪɟɽɫɬɪɚɰɿʀ

ɦɿɤɪɨɚɥɶɛɭɦɿɧɭɪɿʀ ɭ 56,2% ɯɜɨɪɢɯ ɧɚ ɬɥɿ ɨɠɢ

-ɪɿɧɧɹ ɬɚ ɭ 8,3% ɧɚ ɬɥɿ ɧɨɪɦɚɥɶɧɨɝɨ ȱɆɌ.

3. ɉɪɢ ɏɋɇ ɡɿ ɡɛɟɪɟɠɟɧɨɸ ɫɢɫɬɨɥɿɱɧɨɸ ɮɭɧɤ

-ɰɿɽɸ ɜɢɹɜɥɟɧɿ ɩɨɪɭɲɟɧɧɹ ɮɭɧɤɰɿɨɧɚɥɶɧɨɝɨ ɫɬɚɧɭ ɬɪɨɦɛɨɰɢɬɿɜ ɡɚ ɪɚɯɭɧɨɤ ɡɛɿɥɶɲɟɧɧɹ ɚɝɪɟɝɨɜɚɧɢɯ ɮɨɪɦ.

ɋ

ɋɉ

ɉɂ

ɂɋ

ɋɈ

Ɉ

Ʉ

Ʌȱ

Ʌ

ȱɌ

Ɍȿ

ȿɊ

ɊȺ

ȺɌ

Ɍɍ

ɍɊ

Ɋɂ

ɂ

1. Ȼɢɥɶɱɟɧɤɨ Ⱥ.ȼ. Ⱥɪɬɟɪɢɚɥɶɧɚɹ ɝɢɩɟɪɬɟɧɡɢɹ ɜ ɪɚɡɥɢɱɧɵɯ ɤɥɢɧɢɱɟɫɤɢɯ ɫɢɬɭɚɰɢɹɯ / Ⱥ.ȼ.Ȼɢɥɶɱɟɧɤɨ, Ƚ.ȼ.Ⱦɡɹɤ – ɏɚɪɶɤɨɜ:ɑɉɂ «ɇɨɜɨɟ ɫɥɨɜɨ», 2012. – 196 ɫ.

2. Ʉɨɪɤɭɲɤɨ Ɉ.ȼ. Ɍɪɨɦɛɨɰɢɬɵ: ɮɢɡɢɨɥɨɝɢɹ, ɦɨɪɮɨɥɨɝɢɹ, ɜɨɡɪɚɫɬɧɵɟ ɢ ɩɚɬɨɥɨɝɢɱɟɫɤɢɟ ɨɫɨɛɟɧ -ɧɨɫɬɢ,ɚɧɬɢɬɪɨɦɛɨɰɢɬɚɪɧɚɹ ɬɟɪɚɩɢɹ / Ɉ.ȼ.Ʉɨɪɤɭɲɤɨ, ȼ.ɘ.Ʌɢɲɧɟɜɫɤɚɹ. – Ʉ.:Ɇɟɞɤɧɢɝɚ, 2011. – 240 ɫ.

3. Ʉɭɪɹɬɚ Ɉ.ȼ.Ʌɿɩɿɞɧɢɣ ɨɛɦɿɧ ɿ ɤɚɪɞɿɨɜɚɫɤɭɥɹɪ -ɧɢɣ ɪɢɡɢɤ ɭ ɯɜɨɪɢɯ ɧɚ ɯɪɨɧɿɱɧɭ ɯɜɨɪɨɛɭ ɧɢɪɨɤ: ɦɨ -ɧɨɝɪɚɮɿɹ / Ɉ.ȼ. Ʉɭɪɹɬɚ, ȯ.Ɉ. Ɏɪɨɥɨɜɚ; Ⱦɧɿɩɪɨɩɟɬɪ. ɦɟɞ. ɚɤɚɞ. ɆɈɁ ɍɤɪɚʀɧɢ. – Ⱦɧɿɩɪɨɩɟɬɪɨɜɫɶɤ : Ƚɟɪɞɚ, 2013. – 112ɫ.

4. Ʉɭɪɹɬɚ Ɉ.ȼ.ɏɪɨɧɿɱɧɚ ɫɟɪɰɟɜɚ ɧɟɞɨɫɬɚɬɧɿɫɬɶ ɡɿ ɡɛɟɪɟɠɟɧɨɸ ɫɢɫɬɨɥɿɱɧɨɸ ɮɭɧɤɰɿɽɸ:ɨɫɨɛɥɢɜɨɫɬɿ ɦɨɪ -ɮɨɮɭɧɤɰɿɨɧɚɥɶɧɨɝɨ ɫɬɚɧɭ ɬɪɨɦɛɨɰɢɬɿɜ ɬɚ ʀɯ ɡɦɿɧɢ ɩɿɞ ɜɩɥɢɜɨɦ ɥɿɤɭɜɚɧɧɹ / Ɉ.ȼ.Ʉɭɪɹɬɚ,ɘ.ɋ.Ʉɭɲɧɿɪ // Ɇɟ

-ɞɢɰɢɧɚ ɧɟɨɬɥɨɠɧɵɯ ɫɨɫɬɨɹɧɢɣ. – 2013. – ʋ 6 (53). – ɋ. 113-118.

5. ɉɟɪɰɟɜɚ ɇ.Ɉ. Ʉɿɥɶɤɿɫɧɚ ɭɥɶɬɪɚɫɬɪɭɤɬɭɪɧɚ ɯɚ -ɪɚɤɬɟɪɢɫɬɢɤɚ ɬɪɨɦɛɨɰɢɬɿɜ ɭ ɯɜɨɪɢɯ ɧɚ ɰɭɤɪɨɜɢɣ ɞɿɚɛɟɬ 2-ɝɨ ɬɢɩɭ ɭ ɮɚɡɿ ɤɨɦɩɟɧɫɚɰɿʀ ɡ ɚɪɬɟɪɿɚɥɶɧɨɸ ɝɿ -ɩɟɪɬɨɧɿɽɸ ɡɚ ɭɦɨɜ ɤɨɪɟɤɰɿʀ ɚɪɬɟɪɿɚɥɶɧɨɝɨ ɬɢɫɤɭ ɥɨɡɚɪ -ɬɚɧɨɦ / ɇ.Ɉ. ɉɟɪɰɟɜɚ // Ɇɨɪɮɨɥɨɝɿɹ. – 2011. – T.V, ʋ 4. – ɋ. 37-44.

6. ɉɪɨ ɡɚɬɜɟɪɞɠɟɧɧɹ ɩɪɨɬɨɤɨɥɿɜ ɧɚɞɚɧɧɹ ɦɟɞɢɱ -ɧɨʀ ɞɨɩɨɦɨɝɢ ɡɚ ɫɩɟɰɿɚɥɶɧɿɫɬɸ «Ʉɚɪɞɿɨɥɨɝɿɹ»: ɇɚɤɚɡ ɆɈɁ ɍɤɪɚʀɧɢ ɜɿɞ 03.07.2006 ʋ 436. – Ɋɟɠɢɦ ɞɨɫɬɭɩɭ: www.moz.gov.ua.

7. Ɋɚɬɦɚɧɨɜɚ Ⱥ.ɋɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɚɹ ɡɚɛɨɥɟɜɚɟ -ɦɨɫɬɶ ɢ ɫɦɟɪɬɧɨɫɬɶ - ɫɬɚɬɢɫɬɢɤɚ ɩɨ ɟɜɪɨɩɟɣɫɤɢɦ ɫɬɪɚ -ɧɚɦ (2008) / Ⱥ.Ɋɚɬɦɚɧɨɜɚ // Medicine rewiew. – 2009. – ʋ 1 (6). – ɋ. 6–12.

Median 25%-75%

ɧɨɪɦɚ

ɧɚɞɥɢɲɨɤɨɠɢɪɿɧɧɹ ȱ

-ȱȱ ɫɬ.

ȱɆɌ

0 10 20 30 40 50

ɇɟɚɤɬɢɜɨɜɚɧɿ

ɬɪɨɦɛɨɰɢɬɢ

KW-H = 11,1, p = 0,004

Median 25%-75%

ɧɨɪɦɚ

ɧɚɞɥɢɲɨɤɨɠɢɪɿɧɧɹ ȱ

-ȱȱ ɫɬ.

ȱɆɌ

0 10 20 30 40 50

Ⱥɤ

ɬɢɜɨɜɚ

ɧɿ

ɬɪɨɦ

ɛɨɰɢɬɢ

(8)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

8. Ɋɟɛɪɨɜɚ Ɉ.ɘ. ɋɬɚɬɢɫɬɢɱɟɫɤɢɣ ɚɧɚɥɢɡ ɦɟɞɢ -ɰɢɧɫɤɢɯ ɞɚɧɧɵɯ. ɉɪɢɦɟɧɟɧɢɟ ɩɚɤɟɬɚ ɩɪɢɤɥɚɞɧɵɯ ɩɪɨɝɪɚɦɦ STATISTICA / Ɉ.ɘ.Ɋɟɛɪɨɜɚ. – Ɇ.: Ɇɟɞɢɚ ɋɮɟɪɚ, 2002. – 312 ɫ.

9. Ɋɟɤɨɦɟɧɞɚɰɿʀ Ⱥɫɨɰɿɚɰɿʀ ɤɚɪɞɿɨɥɨɝɿɜ ɍɤɪɚʀɧɢ ɡ ɥɿɤɭɜɚɧɧɹ ɯɪɨɧɿɱɧɨʀ ɫɟɪɰɟɜɨʀ ɧɟɞɨɫɬɚɬɧɨɫɬɿ ɭ ɞɨɪɨɫ -ɥɢɯ (ɩɟɪɟɝɥɹɞ 2011) / Ʌ.Ƚ. ȼɨɪɨɧɤɨɜ, Ʉ.Ɇ. Ⱥɦɨɫɨɜɚ, Ⱥ.ȿ.Ȼɚɝɪɿɣ [ɬɚ ɿɧ.] // ɋɟɪɰɟɜɚ ɧɟɞɨɫɬɚɬɧɿɫɬɶ. – 2011. – ʋ 1. – ɋ. 101-116.

10. Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies / A. Romero-Corral, V. Montori [et al.] // Lancet.–2006. – Vol. 368. – P. 666-678. 11. Celermajer D. S. Endothelial dysfunction: does it matter? It is relevant? / D. S. Celermajer // J. Am. Coll. Cardiology. – 1997. – Vol. 30. – P. 325–333.

12. Doehner W. The obesity paradox: weighing the benefit / W. Doehner, A. Clark, S. Anker // Eur. Heart J. – 2010. – Vol. 31, N 2. – P. 146-148.

13. Prognosis of heart failure with preserved ejection fraction: a 5 year prospective population-based study / C. Tribouilloy, D. Rusinaru [et al.] // Eur. Heart J. – 2008. – Vol. 28, N 3. – P. 339-347.

14. The influence of body mass index on mortality and bleeding among patients with or at high-risk of athe-rothrombotic disease / K. Mak, D. Bhatt [et al.] // Eur. Heart J. – 2009. – Vol. 30, N 7. – P. 857-865.

15. The Task Force for the diagnosis and treatment of Chronic Heart Failure of the European Society of Car-diology. Guidelines for the diagnosis and treatment of Chronic Heart Failure: full text (update 2005) // Eur. Heart J. – 2005. – Vol. 7. – P. 1–45.

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2. Korkushko OV, Lishnevskaya VYu. [Platelets: physiology, morphology, age and pathological features, antiplatelet therapy]. Kiev: Medkniga; 2011. Russian.

3. Kuryata OV, Frolova ȯO. [Lipid metabolism and cardiovascular risk in patients with chronic kidney di-sease]. Dnɿpropetrovs'k: Gerda; 2013. Ukrainian.

4. Kuryata OV, Kushnɿr YuS. [Chronic heart failure with preserved systolic function: the feartures of mor-phological and functional status of platelets and their changes under the influence of the treatment]. Meditsina neotlozhnykh sostoyaniy. 2013;6(53):113-8. Ukrainian.

5. Pertseva NO. [Quantitative ultrastructural cha-racteristics of platelets in the patients with diabetes mellitus type 2 in a compensation with arterial hyper-tension under correction of arterial blood pressure with losartan]. Morphologɿya. 2011;5(4):37-44. Ukrainian.

6. [On approval of the protocols of medical care in Cardiology. Order of HM of Ukraine from 03.07.2006 N 436]. Available from: http://www.moz.gov.ua. Ukrainian.

7. Ratmanova A. [Cardiovascular morbidity and mortality - statistics of the European countries (2008)]. Medicine rewiew. 2009;1(6):6–12. Russian.

8. Rebrova OYu. [Statistical analysis of medical data. The use of the application package STATISTICA]. Media Sfera; 2002. Russian.

9. Voronkov LG, Amosova KM, Bagriy AE. [Re-commendations of the Association of Cardiologists of Ukraine for the treatment of chronic heart failure in adults (view 2011)]. Sertseva nedostatnɿst'. 2011;1:101-16. Ukrainian.

10. Romero-Corral A, Montori A. Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet. 2006;368:666-78.

11. Celermajer DS. Endothelial dysfunction: does it matter? It is relevant? J. Am. Coll. Cardiology. 1997;30:325–33.

12. Doehner W, Clark A, Anker S. The obesity para-dox: weighing the benefit. Eur. Heart J. 2010;31(2):146-8.

13. Tribouilloy C, Rusinaru D. Prognosis of heart failure with preserved ejection fraction: a 5 year prospec-tive population-based study. Eur. Heart J. 2008;28(3):339-47.

14. Mak K, Bhatt D. The influence of body mass index on mortality and bleeding among patients with or at high-risk of atherothrombotic disease. Eur. Heart J. 2009;30(7):857-65.

15. The Task Force for the diagnosis and treatment of Chronic Heart Failure of the European Society of Car-diology. Guidelines for the diagnosis and treatment of Chronic Heart Failure: full text (update 2005). Eur. Heart J. 2005;7:1–45.