Determining level of endogenous serum erythropoietin for differential diagnosis of polycythemia vera and symptomatic polycythemia

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ɍȾɄ 616.155.191-079.4

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Ⱦɇɍ «ɇɚɭɤɨɜɨ-ɩɪɚɤɬɢɱɧɢɣ ɰɟɧɬɪ ɩɪɨɮɿɥɚɤɬɢɱɧɨʀ ɬɚ ɤɥɿɧɿɱɧɨʀ ɦɟɞɢɰɢɧɢ»Ⱦɟɪɠɚɜɧɨɝɨ ɭɩɪɚɜɥɿɧɧɹ ɫɩɪɚɜɚɦɢ ɧɚɭɤɨɜɢɣ ɜɿɞɞɿɥ ɜɧɭɬɪɿɲɧɶɨʀ ɦɟɞɢɰɢɧɢ

(ɡɚɜ. – ɞ.ɦɟɞ.ɧ.Ⱥ.Ɇ.Ʉɪɚɜɱɟɧɤɨ) Ʉɢʀɜ, 01133 , ɍɤɪɚʀɧɚ

SRI "Scientific and practical center of preventive and clinical medicine" the State Administration research department of internal medicine

Kyiv, 01133, Ukraine e-mail: oksakost@gmail.com

Ʉɥɸɱɨɜɿ ɫɥɨɜɚ:ɟɪɢɬɪɨɩɨɟɬɢɧ,ɫɩɪɚɜɠɧɹ ɩɨɥɿɰɢɬɟɦɿɹ,ɫɢɦɩɬɨɦɚɬɢɱɧɢɣ ɟɪɢɬɪɨɰɢɬɨɡ Key words: erythropoietin, polycythemia vera, secondary erythrocytosis

Ɋɟɮɟɪɚɬ. Ɉɩɪɟɞɟɥɟɧɢɟ ɭɪɨɜɧɹ ɷɧɞɨɝɟɧɧɨɝɨ ɷɪɢɬɪɨɩɨɷɬɢɧɚ ɫɵɜɨɪɨɬɤɢ ɞɥɹ ɞɢɮɮɟɪɟɧɰɢɚɥɶɧɨɣ

ɞɢɚɝɧɨɫɬɢɤɢ ɢɫɬɢɧɧɨɣ ɩɨɥɢɰɢɬɟɦɢɢ ɢ ɫɢɦɩɬɨɦɚɬɢɱɟɫɤɢɯ ɷɪɢɬɪɨɰɢɬɨɡɨɜ. Ʉɨɫɬɸɤɟɜɢɱ Ɉ.Ɇ. ȼ

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Abstract. Determining level of endogenous serum erythropoietin for differential diagnosis of polycythemia vera and symptomatic polycythemia. Kostyukevych O.M. The article deals with determining possibility of the assessment of the level of endogenous serum erythropoietin (EPO) for differential diagnosis of polycythemia vera (PV) and secondary erythrocytosis (SE). The determination of subnormal level of this cytokine for the diagnosis of PV has been detected. The relation between the level of endogenous erythropoietin and iron metabolism also has been analyzed. The study involved 88 patients with PV and 119 patients with SE. Statistically significant decrease in EPO concentration level has been detected in PV patients. The mean EPO level was equal to 6.38 ± 0.84 mIU/mL and 17.98 ±2.48 mIU/mL in PV and SE patients respectively. In control group of individuals EPO concentration was equal to 9,81 ±0,58 mIU/mL, the significant difference was found between all studied groups (ɪ<0.01). According to our data, EPO was increased in 28 SE patients (23.53%), it was not observed in control group and in group of PV patients (ĳ*emp = 4.355, ɪ<0.01). The decrease of EPO level in PV patients has been detected more often than in SE patients (84.09% versus 11.76% , ĳ*emp = 5.218, ɪ<0.01), it has not been observed in control group. Only 14 (15.91%) PV patients had normal EPO level, in contrast 77 (64.71%) SE patients demonstrated normal EPO level (ĳ*emp = 4.578, ɪ<0.01). The average level of ferritin was equal to 57.41 ± 9.74 ng/mL in PV patients and 199.77 ± 14.32 ng/mL in SE patients (ɪ<0.01). Significantly more patients with PV demonstrated decrease of ferritin level (31.81% versus 7.56%, ĳ*emp = 4.438, ɪ<0.01). Patients with SE more often had raised level of EPO than PV patients (15.12% versus 4.54%, ĳ*emp = 2.453, ɪ<0.01). The sensitivity of test with detecting of the reduced level of EPO for the diagnosis of PV was 84.1%, specificity - 87.4%, positive predictive value - 83.1%, negative predictive value - 88.1%. Normal range of EPO significantly (rs = 0,5494) correlated with decreased levels of serum ferritin in patients with polycythemia vera, which

was caused by iron deficiency in a certain number of patients with PV.

ȿɪɢɬɪɨɩɨɟɬɢɧ (ȿɉɈ) ɜɿɞɿɝɪɚɽ ɜɢɪɿɲɚɥɶɧɭ

ɪɨɥɶ ɭ ɪɟɝɭɥɹɰɿʀ ɟɪɢɬɪɨɩɨɟɡɭ,ɫɚɦɟ ɜɿɞ ɣɨɝɨ ɪɿɜɧɹ

ɜ ɤɪɨɜɿ ɡɚɥɟɠɢɬɶ ɿɧɬɟɧɫɢɜɧɿɫɬɶ ɩɪɨɥɿɮɟɪɚɰɿʀ ɤɥɿ

-ɬɢɧ ɟɪɢɬɪɨʀɞɧɨɝɨ ɩɚɪɨɫɬɤɚ ɬɚ ʀɯ ɞɢɮɟɪɟɧɰɿɸ

-ɜɚɧɧɹ. ȿɪɢɬɪɨɩɨɟɬɢɧ – ɰɟ ɝɥɿɤɨɩɪɨɬɟʀɞɝɥɸɤɨ

-ɩɪɨɬɟʀɞ, ɳɨ ɫɤɥɚɞɚɽɬɶɫɹ ɡ 193 ɚɦɿɧɨɤɢɫɥɨɬɧɢɯ

ɡɚɥɢɲɤɿɜ. Ƚɟɧ ɰɶɨɝɨ ɛɿɥɤɚ ɪɨɡɬɚɲɨɜɚɧɢɣ ɧɚ

ɯɪɨɦɨɫɨɦɿ 7. ȿɪɢɬɪɨɩɨɟɬɢɧ ɧɚɥɟɠɢɬɶ ɞɨ ɝɪɭɩɢ

ɰɢɬɨɤɿɧɿɜ (ɝɟɦɨɩɨɟɬɢɱɧɢɯ ɮɚɤɬɨɪɿɜ ɪɨɫɬɭ),ɜɢɪɨ

-ɛɥɹɽɬɶɫɹ ɩɟɪɟɜɚɠɧɨ ɤɨɪɬɢɤɚɥɶɧɢɦɢ ɿɧɬɟɪɫɬɢ

-ɰɿɚɥɶɧɢɦɢ ɤɥɿɬɢɧɚɦɢ ɧɢɪɨɤ (90%) ɬɚ ɜ ɡɧɚɱɧɨ

ɦɟɧɲɨɦɭ ɨɛɫɹɡɿ ɤɥɿɬɢɧɚɦɢ ɩɟɱɿɧɤɢ (10%). ȱɧɬɟɪ

-ɫɬɢɰɿɚɥɶɧɿ ɤɥɿɬɢɧɢ ɩɪɨɞɭɤɭɸɬɶ ɟɪɢɬɪɨɩɨɟɬɢɧ ɡɚ

ɩɪɢɧɰɢɩɨɦ «ɜɫɟ ɚɛɨ ɧɿɱɨɝɨ», ɬɨɛɬɨ ɩɿɞɜɢɳɟɧɧɹ

ɩɪɨɞɭɤɰɿʀ ɞɨɫɹɝɚɽɬɶɫɹ ɡɛɿɥɶɲɟɧɧɹɦ ɱɢɫɥɚ ɤɥɿɬɢɧ,

ɳɨ ɩɪɨɞɭɤɭɸɬɶ ɰɢɬɨɤɿɧ.ȼɢɪɨɛɤɚ ɟɪɢɬɪɨɩɨɟɬɢɧɭ

ɪɟɝɭɥɸɽɬɶɫɹ ɧɚ ɪɿɜɧɿ ɬɪɚɧɫɤɪɢɩɰɿʀ ɣɨɝɨ ɝɟɧɚ.

ȯɞɢɧɢɦ ɮɿɡɿɨɥɨɝɿɱɧɢɦ ɫɬɢɦɭɥɨɦ, ɹɤɢɣ ɡɛɿɥɶɲɭɽ

ɤɿɥɶɤɿɫɬɶ ɤɥɿɬɢɧ, ɳɨ ɫɢɧɬɟɡɭɸɬɶ ȿɉɈ, ɽ ɝɿɩɨɤɫɿɹ

(ɡɚɝɚɥɶɧɚ ɚɛɨ ɥɨɤɚɥɶɧɚ ɧɢɪɤɨɜɚ). ȼɦɿɫɬ ɟɪɢ

-ɬɪɨɩɨɟɬɢɧɭ ɜ ɤɪɨɜɿ ɥɸɞɢɧɢ ɦɨɠɟ ɡɛɿɥɶɲɭɜɚɬɢɫɹ

ɩɪɢ ɝɿɩɨɤɫɿʀ ɜ 10-100 ɪɚɡɿɜ. Ɍɚɤɢɦ ɱɢɧɨɦ, ɩɪɨ

-ɞɭɤɰɿɹ ɬɚ ɦɟɬɚɛɨɥɿɡɦ ɟɪɢɬɪɨɩɨɟɬɢɧɭ ɜɿɞ ɣɨɝɨ

ɤɨɧɰɟɧɬɪɚɰɿʀ ɜ ɫɢɪɨɜɚɬɰɿ ɧɟ ɡɚɥɟɠɚɬɶ. Ɂɛɿɥɶ

-ɲɟɧɧɹ ɦɚɫɢ ɰɢɪɤɭɥɸɸɱɢɯ ɟɪɢɬɪɨɰɢɬɿɜ ɦɨɠɟ ɛɭ

-ɬɢ ɧɚɫɥɿɞɤɨɦ ɩɿɞɜɢɳɟɧɧɹ ɩɪɨɞɭɤɰɿʀ ɟɪɢɬɪɨɩɨ

-ɟɬɢɧɭ ɩɪɢ ɯɪɨɧɿɱɧɿɣ ɝɿɩɨɤɫɿʀ ɚɛɨ ɧɚɫɥɿɞɤɨɦ

ɧɟɚɞɟɤɜɚɬɧɨʀ, ɛɟɡ ɧɚɹɜɧɨɫɬɿ ɝɿɩɨɤɫɿʀ, ɩɪɨɞɭɤɰɿʀ

ɰɶɨɝɨ ɰɢɬɨɤɿɧɭ,ɳɨ ɦɚɽ ɦɿɫɰɟ,ɡɨɤɪɟɦɚ, ɩɪɢ ɟɪɢ

-ɬɪɨɩɨɟɬɢɧɩɪɨɞɭɤɭɸɱɢɯ ɩɭɯɥɢɧɚɯ.

Ɉɤɪɿɦ ɜɩɥɢɜɭ ɧɚ ɩɪɨɥɿɮɟɪɚɰɿɸ ɟɪɢɬɪɨɤɚɪɿɨ

-ɰɢɬɿɜ, ɟɪɢɬɪɨɩɨɟɬɢɧ ɬɚɤɨɠ ɫɬɢɦɭɥɸɽ ɜɤɥɸɱɟɧɧɹ

ɡɚɥɿɡɚ ɞɨ ɤɥɿɬɢɧ ɤɿɫɬɤɨɜɨɝɨ ɦɨɡɤɭ. ɉɿɞɜɢɳɟɧɢɣ

ɜɦɿɫɬ ɡɚɥɿɡɚ ɜ ɟɪɢɬɪɨʀɞɧɢɯ ɤɥɿɬɢɧɚɯ-ɩɨɩɟ

-ɪɟɞɧɢɤɚɯ ɽ ɧɟɨɛɯɿɞɧɢɦ ɞɥɹ ʀɯ ɩɨɞɚɥɶɲɨɝɨ ɞɨɡɪɿ

-ɜɚɧɧɹ ɬɚ, ɜ ɩɟɪɲɭ ɱɟɪɝɭ, ɹɤ ɫɭɛɫɬɪɚɬɭ ɞɥɹ

ɫɢɧɬɟɡɭ ɝɟɦɚɝɟɦɚ [1]. Ɍɚɤɢɦ ɱɢɧɨɦ, ɦɚɽ ɦɿɫɰɟ

ɩɟɜɧɢɣ ɡɜ’ɹɡɨɤ ɦɿɠ ɟɮɟɤɬɚɦɢ ɟɪɢɬɪɨɩɨɟɬɢɧɭ ɬɚ

ɮɟɪɨɤɿɧɟɬɢɤɨɸ.

Ʉɨɧɰɟɧɬɪɚɰɿɹ ɟɪɢɬɪɨɩɨɟɬɢɧɭ ɜ ɤɪɨɜɿ ɤɨɥɢ

-ɜɚɽɬɶɫɹ ɜ ɲɢɪɨɤɢɯ ɦɟɠɚɯ ɩɪɢ ɪɿɡɧɢɯ ɜɢɞɚɯ

ɟɪɢɬɪɨɰɢɬɨɡɿɜ.ȼɦɿɫɬ ɟɪɢɬɪɨɩɨɟɬɢɧɭ ɩɪɢ ɫɩɪɚɜɠ

-ɧɿɣ ɩɨɥɿɰɢɬɟɦɿʀ ɡɧɢɠɟɧɢɣ, ɭ ɛɿɥɶɲɨɫɬɿ ɜɢɩɚɞɤɿɜ

ɡɧɚɱɧɨ, ɬɨɞɿ ɹɤ ɩɪɢ ɫɢɦɩɬɨɦɚɬɢɱɧɨɦɭ ɟɪɢɬɪɨ

-ɰɢɬɨɡɿ ɩɿɞɜɢɳɟɧɢɣ, ɧɟɡɚɥɟɠɧɨ ɜɿɞ ɣɨɝɨ ɩɚɬɨ

-ɝɟɧɟɡɭ. Ɉɞɧɚɤ ɩɪɢ ɝɿɩɨɤɫɢɱɧɢɯ ɟɪɢɬɪɨɰɢɬɨɡɚɯ

ɦɨɠɟ ɫɩɨɫɬɟɪɿɝɚɬɢɫɹ ɹɤ ɩɿɞɜɢɳɟɧɢɣ, ɬɚɤ ɿ ɧɨɪ

-ɦɚɥɶɧɢɣ ɪɿɜɟɧɶ ɰɶɨɝɨ ɰɢɬɨɤɿɧɭ.

ȿɪɢɬɪɨɩɨɟɬɢɧ – ɧɚɞɡɜɢɱɚɣɧɨ ɚɤɬɢɜɧɢɣ ɝɨɪ

-ɦɨɧ, ɧɚɜɿɬɶ ɧɟɜɟɥɢɤɿ ɤɨɥɢɜɚɧɧɹ ɣɨɝɨ ɤɨɧɰɟɧ

-ɬɪɚɰɿʀ ɩɪɢɡɜɨɞɹɬɶ ɞɨ ɡɧɚɱɧɢɯ ɡɦɿɧ ɚɤɬɢɜɧɨɫɬɿ

ɟɪɢɬɪɨɩɨɟɡɭ. ɇɨɪɦɚɥɶɧɢɣ ɞɿɚɩɚɡɨɧ ɤɨɧɰɟɧɬɪɚɰɿʀ

ɰɶɨɝɨ ɰɢɬɨɤɿɧɭ ɞɨɫɬɚɬɧɶɨ ɲɢɪɨɤɢɣ

(4-29ɦɆɈ/ɦɥ). Ɍɨɦɭ ɜ ɞɟɹɤɢɯ ɜɢɩɚɞɤɚɯ ɡɚɮɿɤ

-ɫɭɜɚɬɢ ɩɿɞɜɢɳɟɧɧɹ ɤɨɧɰɟɧɬɪɚɰɿʀ ȿɉɈ ɧɟɦɨɠ

-ɥɢɜɨ, ɹɤɳɨ ɧɟ ɡɧɚɬɢ ʀʀ ɜɢɯɿɞɧɿ ɡɧɚɱɟɧɧɹ. Ʉɪɿɦ

ɬɨɝɨ, ɩɿɞɜɢɳɟɧɧɹ ɦɚɫɢ ɰɢɪɤɭɥɸɸɱɢɯ ɟɪɢɬɪɨ

-ɰɢɬɿɜ ɩɪɢ ɩɨɤɪɚɳɚɧɧɿ ɬɤɚɧɟɜɨʀ ɨɤɫɢɝɿɧɚɰɿʀ ɱɢ

ɩɿɞɜɢɳɟɧɧɿ ɜ’ɹɡɤɨɫɬɿ ɤɪɨɜɿ ɦɨɠɟ ɩɪɢɡɜɨɞɢɬɢ ɞɨ

ɡɧɢɠɟɧɧɹ ɩɪɨɞɭɤɰɿʀ ɟɪɢɬɪɨɩɨɟɬɢɧɭ. Ɍɚɤɢɦ ɱɢ

-ɧɨɦ, ɩɿɞɜɢɳɟɧɢɣ ɪɿɜɟɧɶ ɟɪɢɬɪɨɩɨɟɬɢɧɭ ɫɢɪɨ

-ɜɚɬɤɢ ɩɟɪɟɞɛɚɱɚɽ ɧɚɹɜɧɿɫɬɶ ɬɤɚɧɟɜɨʀ ɝɿɩɨɤɫɿʀ ɹɤ

ɩɪɢɱɢɧɢ ɟɪɢɬɪɨɰɢɬɨɡɭ, ɬɨɞɿ ɹɤ ɧɨɪɦɚɥɶɧɢɣ ɪɿ

(3)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

ɍ ɬɨɣ ɠɟ ɱɚɫ ɧɨɪɦɚɥɶɧɢɣ ɪɿɜɟɧɶ ȿɉɈ ɧɟ

ɜɢɤɥɸɱɚɽ ɬɚɤɨɠ ɿ ɧɚɹɜɧɨɫɬɿ ɫɩɪɚɜɠɧɶɨʀ ɩɨɥɿ

-ɰɢɬɟɦɿʀ.

Ɂɭɫɬɪɿɱɚɸɬɶɫɹ ɬɚɤɨɠ ɟɪɢɬɪɨɰɢɬɨɡɢ ɿɡ ɫɭɛ

-ɧɨɪɦɚɥɶɧɢɦ ɪɿɜɧɟɦ ȿɉɈ, ɳɨ ɦɨɠɥɢɜɨ ɩɪɢ

ɧɚɹɜɧɨɫɬɿ ɦɭɬɚɰɿʀ ɭ ɝɟɧɿ ɪɟɰɟɩɬɨɪɚ ɞɨ ɟɪɢɬɪɨ

-ɩɨɟɬɢɧɭ.

Ⱦɨɫɥɿɞɠɟɧɧɹ ɤɨɧɰɟɧɬɪɚɰɿʀ ɟɪɢɬɪɨɩɨɟɬɢɧɭ ɫɢ

-ɪɨɜɚɬɤɢ ɤɪɨɜɿ ɽ ɨɞɧɢɦ ɡ ɞɿɚɝɧɨɫɬɢɱɧɢɯ ɤɪɢɬɟɪɿʀɜ ɞɢɮɟɪɟɧɰɿɚɰɿʀ ɫɢɦɩɬɨɦɚɬɢɱɧɢɯ ɟɪɢɬɪɨɰɢɬɨɡɿɜ

(ɋȿ)ɬɚ ɟɪɢɬɪɨɰɢɬɨɡɿɜ ɩɪɢ ɫɩɪɚɜɠɧɿɣ ɩɨɥɿɰɢɬɟɦɿʀ

(ɋɉ) [6,8]. Ɉɞɧɚɤ ɪɟɡɭɥɶɬɚɬɢ ɞɨɫɥɿɞɠɟɧɶ ɪɿɡɧɢɯ

ɚɜɬɨɪɿɜ ɡɚɫɜɿɞɱɭɸɬɶ ɬɟ, ɳɨ ɞɿɚɝɧɨɫɬɢɱɧɚ ɡɧɚ

-ɱɭɳɿɫɬɶ ɩɨɤɚɡɧɢɤɚ ɽ ɫɭɩɟɪɟɱɥɢɜɨɸ. Ɍɚɤ,

M.Mes-sinezy et al. ɜɢɹɜɢɥɢ ɩɨɦɿɪɧɭ ɱɭɬɥɢɜɿɫɬɶ (ɬɿɥɶɤɢ 64%) ɧɢɡɶɤɨɝɨ ɪɿɜɧɹ ȿɊɈ ɩɪɢ ɞɿɚɝɧɨɫɬɢɰɿ ɋɉ [9]. ɉɪɨɬɢɥɟɠɧɨʀ ɞɭɦɤɢ ɞɨɬɪɢɦɭɸɬɶɫɹ P. Mossur et al. [4], M. McMullin et al. [5], A. Teffery et al. [7,12], ɹɤɿ ɜɜɚɠɚɸɬɶ ɜɢɡɧɚɱɟɧɧɹ ɪɿɜɧɹ ɫɢɪɨ

-ɜɚɬɤɨɜɨɝɨ ɟɪɢɬɪɨɩɨɟɬɢɧɭ ɩɟɪɲɢɦ ɬɚ ɜɚɠɥɢɜɢɦ

ɞɿɚɝɧɨɫɬɢɱɧɢɦ ɬɟɫɬɨɦ ɩɪɢ ɩɪɨɜɟɞɟɧɧɿ ɞɢɮɟ

-ɪɟɧɰɿɣɧɨʀ ɞɿɚɝɧɨɫɬɢɤɢ ɋɉ, ɳɨ ɞɟɦɨɧɫɬɪɭɽ ɱɭɬ

-ɥɢɜɿɫɬɶ ɧɚ ɪɿɜɧɿ 85-87%. ȼɿɞɩɨɜɿɞɧɨ ɞɨ ɤɥɚɫɢ

-ɮɿɤɚɰɿʀ ɯɪɨɧɿɱɧɢɯ ɦɿɽɥɨɩɪɨɥɿɮɟɪɚɬɢɜɧɢɯ ɡɚɯɜɨ

-ɪɸɜɚɧɶ ȼɈɈɁ 2008 ɪ. ɡɚɩɪɨɩɨɧɨɜɚɧɿ ɨɧɨɜɥɟɧɿ

ɞɿɚɝɧɨɫɬɢɱɧɿ ɤɪɢɬɟɪɿʀ ɞɥɹ ɫɩɪɚɜɠɧɶɨʀ ɩɨɥɿɰɢɬɟɦɿʀ,

ɨɞɧɢɦ ɡ ɹɤɢɯ ɽ ɧɚɹɜɧɿɫɬɶ ɫɭɛɩɨɪɨɝɨɜɨɝɨ ɪɿɜɧɹ

ɟɪɢɬɪɨɩɨɟɬɢɧɭ ɫɢɪɨɜɚɬɤɢ [11,13].

ɇɚɦɢ ɭ ɞɨɫɬɭɩɧɿɣ ɥɿɬɟɪɚɬɭɪɿ ɧɟ ɡɧɚɣɞɟɧɨ ɚɧɚɥɿɡɭ ɩɪɢɱɢɧ ɜɢɹɜɥɟɧɧɹ ɧɨɪɦɚɥɶɧɨɝɨ ɪɿɜɧɹ

ɟɪɢɬɪɨɩɨɟɬɢɧɭ ɩɪɢ ɜɟɪɢɮɿɤɨɜɚɧɨɦɭ ɞɿɚɝɧɨɡɿ ɋɉ,

ɣɨɝɨ ɿɦɨɜɿɪɧɨɝɨ ɡɜ’ɹɡɤɭ ɡ ɨɛɦɿɧɨɦ ɡɚɥɿɡɚ ɬɚ

ɪɿɜɧɟɦ ɮɟɪɢɬɢɧɭ.

Ɇɟɬɚ ɪɨɛɨɬɢ – ɜɢɡɧɚɱɢɬɢ ɱɭɬɥɢɜɿɫɬɶ ɬɚ ɫɩɟɰɢ

-ɮɿɱɧɿɫɬɶ ɜɢɡɧɚɱɟɧɧɹ ɡɧɢɠɟɧɨɝɨ ɪɿɜɧɹ ɟɧɞɨɝɟɧ

-ɧɨɝɨ ɟɪɢɬɪɨɩɨɟɬɢɧɭ ɹɤ ɦɚɪɤɟɪɭ ɫɩɪɚɜɠɧɶɨʀ ɩɨɥɿ

-ɰɢɬɟɦɿʀ, ɨɰɿɧɢɬɢ ɦɨɠɥɢɜɿɫɬɶ ɜɢɤɨɪɢɫɬɚɧɧɹ ɬɟɫɬɭ

ɞɥɹ ɞɢɮɟɪɟɧɰɿɣɧɨʀ ɞɿɚɝɧɨɫɬɢɤɢ ɫɩɪɚɜɠɧɶɨʀ ɩɨ

-ɥɿɰɢɬɟɦɿʀ ɬɚ ɜɬɨɪɢɧɧɢɯ ɫɢɦɩɬɨɦɚɬɢɱɧɢɯ ɟɪɢɬɪɨ

-ɰɢɬɨɡɿɜ, ɩɪɨɚɧɚɥɿɡɭɜɚɬɢ ɡɜ'ɹɡɨɤ ɪɿɜɧɹ ɟɧɞɨɝɟɧ

-ɧɨɝɨ ɟɪɢɬɪɨɩɨɟɬɢɧɭ ɬɚ ɩɨɤɚɡɧɢɤɿɜ ɨɛɦɿɧɭ ɡɚɥɿɡɚ.

ɆȺɌȿɊȱȺɅɂ ɌȺ ɆȿɌɈȾɂ ȾɈɋɅȱȾɀȿɇɖ

ɉɪɨɜɟɞɟɧɨ ɨɛɫɬɟɠɟɧɧɹ 88 ɩɚɰɿɽɧɬɿɜ ɡɿ ɫɩɪɚɜ

-ɠɧɶɨɸ ɩɨɥɿɰɢɬɟɦɿɽɸ – 49 ɱɨɥɨɜɿɤɿɜ (55,7%) ɬɚ 39

ɠɿɧɨɤ (44,3%). ȼɿɤ ɨɛɫɬɟɠɟɧɢɯ ɛɭɜ ɜɿɞ 22 ɞɨ 80

ɪɨɤɿɜ, ɭ ɫɟɪɟɞɧɶɨɦɭ – 56,69±1,48 ɪɨɤɭ. ȼɫɿɦ ɩɚ

-ɰɿɽɧɬɚɦ ɡɿ ɋɉ ɞɿɚɝɧɨɡ ɛɭɥɨ ɜɫɬɚɧɨɜɥɟɧɨ ɡɝɿɞɧɨ ɡ

ɤɪɢɬɟɪɿɹɦɢ ȼɈɈɁ 2001 ɪɨɤɭ. Ɍɪɢɜɚɥɿɫɬɶ ɡɚɯɜɨ

-ɪɸɜɚɧɧɹ ɧɚ ɦɨɦɟɧɬ ɨɛɫɬɟɠɟɧɧɹ ɫɬɚɧɨɜɢɥɚ ɜɿɞ 1

ɞɨ 264 ɦɿɫɹɰɿɜ,ɭ ɫɟɪɟɞɧɶɨɦɭ – 37,79±6,07 ɦɿɫ.ɇɚ

ɦɨɦɟɧɬ ɩɪɨɜɟɞɟɧɧɹ ɨɛɫɬɟɠɟɧɧɹ ɭ 45 ɩɚɰɿɽɧɬɿɜ

(51,1%) ɞɿɚɝɧɨɫɬɨɜɚɧɨ I ɫɬɚɞɿɸ ɡɚɯɜɨɪɸɜɚɧɧɹ.

ɉɨɥɿɰɢɬɟɦɿɹ ɫɩɪɚɜɠɧɹ ɧɚ ɫɬɚɞɿʀ IIȺ ɜɢɡɧɚɱɟɧɚ ɭ

30 (34,1%) ɯɜɨɪɢɯ, ɧɚ ɫɬɚɞɿʀ II B - ɭ 10 (11,4%)

ɯɜɨɪɢɯ. ɍ 3 ɩɚɰɿɽɧɬɿɜ (3,4%) ɧɚ ɦɨɦɟɧɬ ɨɛɫɬɟ

-ɠɟɧɧɹ ɛɭɥɚ III ɫɬɚɞɿɹ ɡɚɯɜɨɪɸɜɚɧɧɹ.

Ɉɛɫɬɟɠɟɧɨ 119 ɩɚɰɿɽɧɬɿɜ ɿɡ ɫɢɦɩɬɨɦɚɬɢɱɧɢɦɢ

ɟɪɢɬɪɨɰɢɬɨɡɚɦɢ.ɋɟɪɟɞ ɨɛɫɬɟɠɟɧɢɯ ɛɭɥɨ 107 ɱɨ

-ɥɨɜɿɤɿɜ (89,9%) ɬɚ 12 ɠɿɧɨɤ (10,1%). ȼɿɤ ɨɛɫɬɟ

-ɠɟɧɢɯ ɤɨɥɢɜɚɜɫɹ ɜɿɞ 21 ɞɨ 82 ɪɨɤɿɜ,ɭ ɫɟɪɟɞɧɶɨɦɭ

– 48,82±1,38 ɪɨɤɭ. Ɍɪɢɜɚɥɿɫɬɶ ɡɚɯɜɨɪɸɜɚɧɧɹ ɧɚ

ɦɨɦɟɧɬ ɨɛɫɬɟɠɟɧɧɹ ɫɬɚɧɨɜɢɥɚ ɜɿɞ 3 ɞɨ 120

ɦɿɫɹɰɿɜ,ɭ ɫɟɪɟɞɧɶɨɦɭ – 13,57±2,08 ɦɿɫ.

Ʉɨɧɬɪɨɥɶɧɭ ɝɪɭɩɭ ɫɤɥɚɥɢ 30 ɨɫɿɛ, ɳɨ ɛɭɥɢ

ɩɨɪɿɜɧɸɜɚɧɢɦɢ ɡ ɩɚɰɿɽɧɬɚɦɢ ɞɨɫɥɿɞɠɭɜɚɧɢɯ

ɝɪɭɩ ɡɚ ɜɿɤɨɦ,ɫɬɚɬɬɸ ɬɚ ɫɭɩɭɬɧɶɨɸ ɩɚɬɨɥɨɝɿɽɸ.

Ⱦɨɫɥɿɞɠɟɧɧɹ ɩɟɪɢɮɟɪɢɱɧɨʀ ɤɪɨɜɿ ɜɢɤɨɧɭɜɚɥɢ

ɧɚ ɝɟɦɚɬɨɥɨɝɿɱɧɨɦɭ ɚɧɚɥɿɡɚɬɨɪɿ «Micros» (Ɏɪɚɧ

-ɰɿɹ).

Ʉɿɥɶɤɿɫɧɭ ɨɰɿɧɤɭ ɪɿɜɧɹ ɟɪɢɪɨɩɨɟɬɢɧɭ ɬɚ ɮɟ

-ɪɢɬɢɧɭ ɜ ɫɢɪɨɜɚɬɰɿ ɤɪɨɜɿ ɩɪɨɜɨɞɢɥɢ ɦɟɬɨɞɨɦ ɬɜɟɪɞɨɮɚɡɧɨɝɨ ɿɦɭɧɨɮɟɪɦɟɧɬɧɨɝɨ ɚɧɚɥɿɡɭ ɧɚ

ɚɩɚɪɚɬɿ «Humareader» (Human, ɇɿɦɟɱɱɢɧɚ) ɡ

ɜɢɤɨɪɢɫɬɚɧɧɹɦ ɬɟɫɬ-ɫɢɫɬɟɦ ɬɚ ɤɨɧɬɪɨɥɶɧɢɯ

ɫɢɪɨɜɚɬɨɤ ɮɿɪɦɢ «ȼɟɤɬɨɪ ȻȿɋɌ» (ɇɨɜɨɫɢɛɿɪɫɶɤ,

Ɋɨɫɿɹ)ɬɚ «Ⱥɥɤɨɪ Ȼɢɨ» (ɋɚɧɤɬ-ɉɟɬɟɪɛɭɪɝ,Ɋɨɫɿɹ).

ɋɬɚɬɢɫɬɢɱɧɢɣ ɚɧɚɥɿɡ ɩɪɨɜɨɞɢɥɢ ɡ ɜɢɤɨɪɢɫ

-ɬɚɧɧɹɦ ɩɪɨɝɪɚɦɢ ɫɬɚɬɢɫɬɢɱɧɨʀ ɨɛɪɨɛɤɢ ɞɚɧɢɯ

STATISTICA 6.0. Ⱦɨɫɬɨɜɿɪɧɿɫɬɶ ɦɿɠɝɪɭɩɨɜɢɯ

ɜɿɞɦɿɧɧɨɫɬɟɣ ɤɿɥɶɤɿɫɧɢɯ ɩɨɤɚɡɧɢɤɿɜ ɜɢɡɧɚɱɚɥɢ ɡɚ

ɞɨɩɨɦɨɝɨɸ ɤɪɢɬɟɪɿɸ ɋɬɶɸɞɟɧɬɚ (t-ɬɟɫɬɭ ɜ ɞɜɨ

-ɛɿɱɧɨɦɭ ɜɚɪɿɚɧɬɿ). Ⱦɨɫɬɨɜɿɪɧɿɫɬɶ ɦɿɠɝɪɭɩɨɜɢɯ

ɜɿɞɦɿɧɧɨɫɬɟɣ ɹɤɿɫɧɢɯ ɩɨɤɚɡɧɢɤɿɜ ɜɢɡɧɚɱɚɥɢ ɡɚ

ɞɨɩɨɦɨɝɨɸ ɬɨɱɧɨɝɨ ɤɪɢɬɟɪɿɸ Ɏɿɲɟɪɚ. Ⱦɥɹ ɜɢɹɜ

-ɥɟɧɧɹ ɡɜ’ɹɡɤɿɜ ɦɿɠ ɨɤɪɟɦɢɦɢ ɩɨɤɚɡɧɢɤɚɦɢ ɜɢ

-ɤɨɪɢɫɬɨɜɭɜɚɥɢ ɤɨɪɟɥɹɰɿɣɧɢɣ ɚɧɚɥɿɡ ɡ ɜɢɪɚ

-ɯɭɜɚɧɧɹɦ ɤɨɟɮɿɰɿɽɧɬɭ ɤɨɪɟɥɹɰɿʀ ɋɩɿɪɦɟɧɚ.

Ɂɝɿɞɧɨ ɡ ɫɭɱɚɫɧɢɦɢ ɜɢɦɨɝɚɦɢ ɞɨɤɚɡɨɜɨʀ ɦɟ

-ɞɢɰɢɧɢ ɚɧɚɥɿɡ ɟɮɟɤɬɢɜɧɨɫɬɿ ɞɿɚɝɧɨɫɬɢɱɧɢɯ ɤɪɢ

-ɬɟɪɿʀɜ ɩɨɜɢɧɟɧ ɜɪɚɯɨɜɭɜɚɬɢ ʀɯ ɨɩɟɪɚɰɿɣɧɿ ɯɚ

-ɪɚɤɬɟɪɢɫɬɢɤɢ – ɱɭɬɥɢɜɿɫɬɶ ɬɚ ɫɩɟɰɢɮɿɱɧɿɫɬɶ, ɚ

ɬɚɤɨɠ ʀɯ ɿɧɬɟɝɪɚɥɶɧɿ ɤɪɢɬɟɪɿʀ – ɩɪɨɝɧɨɫɬɢɱɧɭ

ɰɿɧɧɿɫɬɶ ɩɨɡɢɬɢɜɧɨɝɨ (ɉɐɉɊ) ɬɚ ɧɟɝɚɬɢɜɧɨɝɨ

ɪɟɡɭɥɶɬɚɬɿɜ (ɉɐɇɊ) [2,3].

ɑɭɬɥɢɜɿɫɬɶ ɜɢɡɧɚɱɚɽɬɶɫɹ ɹɤ ɱɚɫɬɤɚ ɫɩɨɫɬɟ

-ɪɟɠɟɧɶ ɡ ɧɚɹɜɧɿɫɬɸ ɞɨɫɥɿɞɠɭɜɚɧɨɝɨ ɤɪɢɬɟɪɿɸ

(ɩɨɡɢɬɢɜɧɢɣ ɪɟɡɭɥɶɬɚɬ ɬɟɫɬɭ) ɭ ɝɪɭɩɿ, ɞɥɹ ɹɤɨʀ

ɫɬɜɟɪɞɠɭɽɬɶɫɹ ɣɨɝɨ ɯɚɪɚɤɬɟɪɧɿɫɬɶ, ɚ ɫɩɟɰɢ

-ɮɿɱɧɿɫɬɶ – ɹɤ ɱɚɫɬɤɚ ɫɩɨɫɬɟɪɟɠɟɧɶ ɡ ɜɿɞɫɭɬɧɿɫɬɸ

ɞɨɫɥɿɞɠɭɜɚɧɨɝɨ ɤɪɢɬɟɪɿɸ (ɧɟɝɚɬɢɜɧɢɣ ɪɟɡɭɥɶɬɚɬ

ɬɟɫɬɭ) ɜ ɝɪɭɩɿ, ɞɥɹ ɹɤɨʀ ɞɟɤɥɚɪɭɽɬɶɫɹ ɣɨɝɨ

ɧɟɬɢɩɨɜɿɫɬɶ. ɍ ɪɚɡɿ ɞɿɚɝɧɨɫɬɢɤɢ ɫɩɪɚɜɠɧɶɨʀ

ɩɨɥɿɰɢɬɟɦɿʀ ɩɨɡɢɬɢɜɧɢɦ ɪɟɡɭɥɶɬɚɬɨɦ ɜɜɚɠɚɽɬɶɫɹ

ɧɚɹɜɧɿɫɬɶ ɡɧɢɠɟɧɨɝɨ ɪɿɜɧɹ ɟɪɢɬɪɨɩɨɟɬɢɧɭ, ɧɟ

-ɝɚɬɢɜɧɢɦɢ – ɧɨɪɦɚɥɶɧɢɣ ɚɛɨ ɩɿɞɜɢɳɟɧɢɣ ɪɿɜɟɧɶ

ɟɪɢɬɪɨɩɨɟɬɢɧɭ. ɍ ɪɚɡɿ ɞɿɚɝɧɨɫɬɢɤɢ ɜɬɨɪɢɧɧɨɝɨ

ɫɢɦɩɬɨɦɚɬɢɱɧɨɝɨ ɟɪɢɬɪɨɰɢɬɨɡɭ, ɧɚɜɩɚɤɢ, ɩɨɡɢ

(4)

ɉɪɢ ɩɪɨɜɟɞɟɧɧɿ ɛɭɞɶ-ɹɤɨɝɨ ɞɿɚɝɧɨɫɬɢɱɧɨɝɨ

ɬɟɫɬɭ ɧɟɨɛɯɿɞɧɨ ɜɿɞɩɨɜɿɫɬɢ ɧɚ ɨɫɧɨɜɧɟ ɩɢɬɚɧɧɹ –

ɱɢ ɽ ɜɿɞɩɨɜɿɞɧɚ ɩɚɬɨɥɨɝɿɹ (ɯɜɨɪɨɛɚ) ɭ ɞɨɫɥɿɞ

-ɠɭɜɚɧɨɝɨ. ɍ ɰɶɨɦɭ ɧɚɦ ɞɨɩɨɦɚɝɚɽ ɩɨɧɹɬɬɹ ɩɪɨ

ɩɪɨɝɧɨɫɬɢɱɧɭ ɰɿɧɧɿɫɬɶ ɬɟɫɬɭ. ɉɪɨɝɧɨɫɬɢɱɧɚ ɰɿɧ

-ɧɿɫɬɶ ɩɨɡɢɬɢɜɧɨɝɨ ɪɟɡɭɥɶɬɚɬɭ – ɜɿɪɨɝɿɞɧɿɫɬɶ

ɧɚɹɜɧɨɫɬɿ ɡɚɯɜɨɪɸɜɚɧɧɹ ɩɪɢ ɩɨɡɢɬɢɜɧɨɦɭ ɪɟ

-ɡɭɥɶɬɚɬɿ ɬɟɫɬɭ. ɉɪɨɝɧɨɫɬɢɱɧɚ ɰɿɧɧɿɫɬɶ ɧɟɝɚ

-ɬɢɜɧɨɝɨ ɪɟɡɭɥɶɬɚɬɭ – ɜɿɪɨɝɿɞɧɿɫɬɶ ɜɿɞɫɭɬɧɨɫɬɿ

ɡɚɯɜɨɪɸɜɚɧɧɹ ɩɪɢ ɧɟɝɚɬɢɜɧɨɦɭ ɪɟɡɭɥɶɬɚɬɿ ɬɟɫɬɭ.

ɉɪɨɝɧɨɫɬɢɱɧɚ ɰɿɧɧɿɫɬɶ ɡɚɥɟɠɢɬɶ ɜɿɞ ɱɭɬɥɢɜɨɫɬɿ,

ɫɩɟɰɢɮɿɱɧɨɫɬɿ ɬɟɫɬɭ ɬɚ ɪɨɡɩɨɜɫɸɞɠɟɧɨɫɬɿ ɞɨ

-ɫɥɿɞɠɭɜɚɧɨɝɨ ɤɪɢɬɟɪɿɸ ɜ ɝɪɭɩɿ, ɳɨ ɞɨɫɥɿɞ

-ɠɭɽɬɶɫɹ. ɑɢɦ ɛɿɥɶɲ ɱɭɬɥɢɜɢɦ ɽ ɬɟɫɬ, ɬɢɦ ɜɢɳɟ

ɩɪɨɝɧɨɫɬɢɱɧɚ ɰɿɧɧɿɫɬɶ ɣɨɝɨ ɧɟɝɚɬɢɜɧɨɝɨ ɪɟ

-ɡɭɥɶɬɚɬɭ, ɬɨɛɬɨ ɜɢɳɟ ɜɿɪɨɝɿɞɧɿɫɬɶ ɬɨɝɨ, ɳɨ

ɧɟɝɚɬɢɜɧɢɣ ɪɟɡɭɥɶɬɚɬ ɬɟɫɬɭ ɫɩɪɨɫɬɨɜɭɽ ɧɚɹɜɧɿɫɬɶ

ɡɚɯɜɨɪɸɜɚɧɧɹ. ɑɢɦ ɛɿɥɶɲ ɫɩɟɰɢɮɿɱɧɢɦ ɽ ɬɟɫɬ,

ɬɢɦ ɜɢɳɟ ɩɪɨɝɧɨɫɬɢɱɧɚ ɰɿɧɧɿɫɬɶ ɣɨɝɨ ɩɨɡɢ

-ɬɢɜɧɨɝɨ ɪɟɡɭɥɶɬɚɬɭ, ɬɨɛɬɨ ɜɢɳɟ ɜɿɪɨɝɿɞɧɿɫɬɶ

ɬɨɝɨ, ɳɨ ɩɨɡɢɬɢɜɧɢɣ ɪɟɡɭɥɶɬɚɬ ɬɟɫɬɭ ɩɿɞ

-ɬɜɟɪɞɠɭɽ ɩɟɪɟɞɛɚɱɭɜɚɧɢɣ ɞɿɚɝɧɨɡ.

ɫɩɪɚɜɠɧɶɨʀ ɩɨɥɿɰɢɬɟɦɿʀ ɬɚ ɫɢɦɩɬɨɦɚɬɢɱɧɨɝɨ

ɟɪɢɬɪɨɰɢɬɨɡɭ ɪɨɡɪɚɯɨɜɭɜɚɥɢ ɡɚ ɦɟɬɨɞɨɦ ɥɚɬɢɧɫɶ

-ɤɨɝɨ ɤɜɚɞɪɚɬɭ (ɱɨɬɢɪɶɨɯɩɿɥɶɧɨʀ ɬɚɛɥɢɰɿ) [2,3].

ɊȿɁɍɅɖɌȺɌɂ ɌȺ Ȳɏ ɈȻȽɈȼɈɊȿɇɇə

ɉɪɢ ɚɧɚɥɿɡɿ ɩɨɤɚɡɧɢɤɿɜ ɩɟɪɢɮɟɪɢɱɧɨʀ ɤɪɨɜɿ

ɞɨɫɬɨɜɿɪɧɨʀ ɪɿɡɧɢɰɿ ɦɿɠ ɫɟɪɟɞɧɿɦ ɱɢɫɥɨɦ ɟɪɢ

-ɬɪɨɰɢɬɿɜ ɬɚ ɫɟɪɟɞɧɿɦ ɪɿɜɧɟɦ ɝɟɦɨɝɥɨɛɿɧɭ ɜ ɨɛɨɯ

ɞɨɫɥɿɞɠɭɜɚɧɢɯ ɝɪɭɩɚɯ ɜɢɹɜɥɟɧɨ ɧɟ ɛɭɥɨ. ȼɫɿ

ɜɢɳɟɡɚɡɧɚɱɟɧɿ ɩɨɤɚɡɧɢɤɢ ɫɬɚɬɢɫɬɢɱɧɨ ɞɨɫɬɨ

-ɜɿɪɧɨ ɩɟɪɟɜɢɳɭɜɚɥɢ ɡɧɚɱɟɧɧɹ ɜ ɨɫɿɛ ɤɨɧɬɪɨɥɶɧɨʀ

ɝɪɭɩɢ.

ɋɟɪɟɞɧɽ ɱɢɫɥɨ ɬɪɨɦɛɨɰɢɬɿɜ ɛɭɥɨ ɞɨɫɬɨɜɿɪɧɨ

ɜɢɳɢɦ ɭ ɝɪɭɩɿ ɯɜɨɪɢɯ ɧɚ ɋɉ (522,67 ± 27,38)

ɩɨɪɿɜɧɹɧɨ ɡ ɝɪɭɩɨɸ ɩɚɰɿɽɧɬɿɜ ɡ ɋȿ (235,68 ± 7,67,

ɪ<0,01) ɬɚ ɤɨɧɬɪɨɥɶɧɨɸ ɝɪɭɩɨɸ (217,29±7,97,

ɪ<0,01).Ⱦɨɫɬɨɜɿɪɧɨ ɜɢɳɢɦ ɜ ɝɪɭɩɿ ɯɜɨɪɢɯ ɧɚ ɋɉ

ɛɭɥɨ ɬɚɤɨɠ ɫɟɪɟɞɧɽ ɱɢɫɥɨ ɥɟɣɤɨɰɢɬɿɜ

(11,74 ± 0,55 ɩɪɨɬɢ 7,48 ± 0,22 ɭ ɝɪɭɩɿ ɋȿ ɬɚ 6,29 ± 0,30 ɭ ɝɪɭɩɿ ɤɨɧɬɪɨɥɸ,ɪ<0,01).

Ɉɫɧɨɜɧɿ ɩɨɤɚɡɧɢɤɢ ɩɟɪɢɮɟɪɢɱɧɨʀ ɤɪɨɜɿ ɩɪɟɞ

-ɫɬɚɜɥɟɧɿ ɭ ɬɚɛɥɢɰɿ 1.

Ɍ ɚ ɛ ɥ ɢ ɰ ɹ 1

ɉɨɤɚɡɧɢɤɢ ɩɟɪɢɮɟɪɢɱɧɨʀ ɤɪɨɜɿ ɜ ɨɛɫɬɟɠɟɧɢɯ ɨɫɿɛ (M±m)

ɉɨɤɚɡɧɢɤɢ ɋɉ (n=88) ɋȿ (n=119)

Ʉɨɧɬɪɨɥɶ

(n=30)

ȿɪɢɬɪɨɰɢɬɢ,Ɍ/ɥ 6,64 ± 0,10** 6,13 ± 0,38** 4,97±0,08

Ƚɟɦɨɝɥɨɛɿɧ,ɝ/ɥ 184,74 ± 2,42** 182,07 ± 1,44** 153,14±1,94

ɋɟɪɟɞɧɿɣ ɨɛ’ɽɦ ɟɪɢɬɪɨɰɢɬɿɜ, MCV 81,11±0,78*,_{** 87,05±0,64*}_88,96±0,65

Ƚɟɦɚɬɨɤɪɢɬ, % 57,97±0,01*,_{** 52,89±0,01*},_{** 44,25±0,005}

Ɍɪɨɦɛɨɰɢɬɢ,Ƚ/ɥ 522,67 ± 27,38*,_** _{235,68 ± 7,67*} _217,29±7,97

Ʌɟɣɤɨɰɢɬɢ,Ƚ/ɥ 11,74 ± 0,55*,_** _{7,48 ± 0,22*} _6,29±0,30

ɒɈȿ,ɦɦ/ɝɨɞ 1,41±0,17** 1,84±0,08** 7,25±0,96

ɉ ɪ ɢ ɦ ɿ ɬ ɤ ɢ: * - ɞɨɫɬɨɜɿɪɧɚ ɪɿɡɧɢɰɹ (p<0.05) ɦɿɠ ɩɨɤɚɡɧɢɤɚɦɢ ɨɛɨɯ ɞɨɫɥɿɞɠɭɜɚɧɢɯ ɝɪɭɩ, ** - ɞɨɫɬɨɜɿɪɧɚ ɪɿɡɧɢɰɹ (p<0.05) ɩɨ ɜɿɞɧɨɲɟɧɧɸ

ɞɨ ɤɨɧɬɪɨɥɶɧɨʀ ɝɪɭɩɢ

ɉɪɢ ɞɨɫɥɿɞɠɟɧɧɿ ɪɿɜɧɹ ɟɪɢɬɪɨɩɨɟɬɢɧɭ ɫɢɪɨ

-ɜɚɬɤɢ ɤɪɨɜɿ ɜɢɹɜɥɟɧɨ ɞɨɫɬɨɜɿɪɧɟ ɡɧɢɠɟɧɧɹ ɣɨɝɨ

ɤɨɧɰɟɧɬɪɚɰɿʀ ɭ ɝɪɭɩɿ ɯɜɨɪɢɯ ɧɚ ɋɉ:

6,38 ± 0,84 ɦɆɨ/ɦɥ ɩɪɨɬɢ 17,98 ± 2,48 ɦɆɈ/ɦɥ ɭ

ɩɚɰɿɽɧɬɿɜ ɡ ɋȿ (ɪ<0,01) ɬɚ 9,81 ± 0,58 ɜ ɨɫɿɛ

ɤɨɧɬɪɨɥɶɧɨʀ ɝɪɭɩɢ (ɪ<0,01). ɉɿɞɜɢɳɟɧɧɹ ɪɿɜɧɹ

ɟɪɢɬɪɨɩɨɟɬɢɧɭ ȿɊɈ ɜɢɳɟ ɧɨɪɦɢ ɡɚɮɿɤɫɨɜɚɧɟ ɭ

28 (23,53%) ɩɚɰɿɽɧɬɿɜ ɡ ɋȿ (23,53%), ɭ ɝɪɭɩɿ

ɯɜɨɪɢɯ ɧɚ ɋɉ ɬɚ ɫɟɪɟɞ ɨɫɿɛ ɤɨɧɬɪɨɥɶɧɨʀ ɝɪɭɩɢ -

ɧɟ ɫɩɨɫɬɟɪɿɝɚɥɨɫɶ ɭ ɠɨɞɧɨɝɨ. Ɋɿɡɧɢɰɹ ɫɬɚɬɢɫ

-ɬɢɱɧɨ ɞɨɫɬɨɜɿɪɧɚ, ĳ*ɟɦɩ = 4,355, ɪ<0,01. Ɂɧɢ

-ɠɟɧɧɹ ɪɿɜɧɹ ɟɪɢɬɪɨɩɨɟɬɢɧɭ ȿɊɈ ɞɨɫɬɨɜɿɪɧɨ

ɱɚɫɬɿɲɟ ɫɩɨɫɬɟɪɿɝɚɥɨɫɶ ɩɪɢ ɋɉ (ɭ 84,09% ɯɜɨ

-ɪɢɯ), ɧɿɠ ɩɪɢ ɋȿ (ɩɪɨɬɢ 11,76% ɩɪɢ ɋȿ ɩɚɰɿ

-ɽɧɬɿɜ), (ĳ*ɟɦɩ = 5,218, ɪ<0,01). ɍ ɤɨɧɬɪɨɥɶɧɿɣ

ɝɪɭɩɿ ɡɧɢɠɟɧɧɹ ɤɨɧɰɟɧɬɪɚɰɿʀ ȿɊɈ ɧɢɠɱɟ ɪɟ

-ɮɟɪɟɧɬɧɢɯ ɡɧɚɱɟɧɶ ɧɟ ɫɩɨɫɬɟɪɿɝɚɥɨɫɶ. ɇɨɪɦɚɥɶ

(5)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

ɫɬɚɬɢɫɬɢɱɧɨ ɞɨɫɬɨɜɿɪɧɚ, ĳ*ɟɦɩ = 4,578, ɪ<0,01).

ɍ ɜɫɿɯ ɨɫɿɛ ɤɨɧɬɪɨɥɶɧɨʀ ɝɪɭɩɢ ɪɿɜɟɧɶ ɟɪɢɬɪɨɩɨ

-ɟɬɢɧɭ ȿɊɈ ɛɭɜ ɭ ɧɨɪɦɿ.

Ɋɟɡɭɥɶɬɚɬɢ ɞɨɫɥɿɞɠɟɧɧɹ ɪɿɜɧɹ ɟɪɢɬɪɨɩɨɟɬɢɧɭ

ɫɢɪɨɜɚɬɤɢ ɩɪɟɞɫɬɚɜɥɟɧɿ ɭ ɬɚɛɥɢɰɿ 2.

ɉɨɤɚɡɧɢɤɢ ɪɿɜɧɹ ɟɪɢɬɪɨɩɨɟɬɢɧɭ ɜ ɨɛɫɬɟɠɟɧɢɯ ɨɫɿɛ

ɉɨɤɚɡɧɢɤɢ ɋɉ (n=88) _(n=119)ɋȿ Ʉɨɧɬɪɨɥɶ_(n=30)

Ɋɿɜɟɧɶ ɟɪɢɬɪɨɩɨɟɬɢɧɭ ɫɢɪɨɜɚɬɤɢ,ɦɆɈ/ɦɥ,

(M±m) 6,38 ± 0,84*

,_** _{17,98 ±2,48*} _{9,81 ±0,58}

ɉɿɞɜɢɳɟɧɧɹ ɪɿɜɧɹ ɟɪɢɬɪɨɩɨɟɬɢɧɭ, n, % _ 28 (23,53%) _

ɇɨɪɦɚɥɶɧɢɣ ɪɿɜɟɧɶ ɟɪɢɬɪɨɩɨɟɬɢɧɭ, n, % 14 (15,91%)*,_{** 77}_(64,71%)*,_{** 30(100%)}

Ɂɧɢɠɟɧɧɹ ɪɿɜɧɹ ɟɪɢɬɪɨɩɨɟɬɢɧɭ, n, % 74 (84,09%)* 14 (11,76%)* _

Ⱦɨɫɥɿɞɠɟɧɧɹ ɪɿɜɧɹ ɮɟɪɢɬɢɧɭ ɫɢɪɨɜɚɬɤɢ ɩɨ

-ɤɚɡɚɥɨ,ɳɨ ɩɪɢ ɫɩɪɚɜɠɧɿɣ ɩɨɥɿɰɢɬɟɦɿʀ,ɩɨɪɿɜɧɹɧɨ

ɡ ɝɪɭɩɨɸ ɨɫɿɛ ɿɡ ɋȿ, ɫɟɪɟɞɧɿɣ ɪɿɜɟɧɶ ɮɟɪɢɬɢɧɭ

ɫɬɚɧɨɜɢɬɶ 57,41 ± 9,74 ɧɝ/ɦɥ ɩɪɨɬɢ

199,77 ± 14,32 ɧɝ/ɦɥ (ɪ<0,01). Ɍɚɤɨɠ ɞɨɫɬɨɜɿɪɧɨ

ɛɿɥɶɲɨɸ ɽ ɤɿɥɶɤɿɫɬɶ ɯɜɨɪɢɯ ɧɚ ɋɉ ɡɿ ɡɧɢɠɟɧɢɦ

ɪɿɜɧɟɦ ɮɟɪɢɬɢɧɭ ɫɢɪɨɜɚɬɤɢ (31,81% ɩɪɨɬɢ

7,56%, ĳ*ɟɦɩ = 4,438, ɪ<0,01).ɉɿɞɜɢɳɟɧɧɹ ɪɿɜɧɹ

ɮɟɪɢɬɢɧɭ ɱɚɫɬɿɲɟ ɫɩɨɫɬɟɪɿɝɚɥɨɫɶ ɭ ɩɚɰɿɽɧɬɿɜ ɿɡ ɋȿ (15,12%), ɧɿɠ ɭ ɯɜɨɪɢɯ ɧɚ ɋɉ (ɩɪɨɬɢ 4,54%)

ɩɪɢ ɋɉ (ĳ*ɟɦɩ =2,453, ɪ<0,01). ɍ ɤɨɧɬɪɨɥɶɧɿɣ

ɝɪɭɩɿ ɜɢɹɜɥɟɧɨ ɬɿɥɶɤɢ ɜ ɨɞɧɿɽʀ ɨɫɨɛɢ (3,33%).

Ɋɟɡɭɥɶɬɚɬɢ ɞɨɫɥɿɞɠɟɧɧɹ ɪɿɜɧɹ ɮɟɪɢɬɢɧɭ ɫɢɪɨ

-ɜɚɬɤɢ ɜɿɞɨɛɪɚɠɟɧɿ ɜ ɬɚɛɥɢɰɿ 3.

ɉɨɤɚɡɧɢɤɢ ɪɿɜɧɹ ɮɟɪɢɬɢɧɭ ɜ ɨɛɫɬɟɠɟɧɢɯ ɨɫɿɛ

ɉɨɤɚɡɧɢɤɢ ɋɉ (n=88) ɋȿ (n=119) (n=119)

Ʉɨɧɬɪɨɥɶ

(n=30)

Ɋɿɜɟɧɶ ɮɟɪɢɬɢɧɭ ɫɢɪɨɜɚɬɤɢ,ɧɝ/ɦɥ 57,41 ± 9,74*,_** _{199,77 ± 14,32} _{158,99 ±17,25}

ɉɿɞɜɢɳɟɧɧɹ ɪɿɜɧɹ ɮɟɪɢɬɢɧɭ, n, % 4 (4,54%)* 18 (15.12%) 1(3,33%)

ɇɨɪɦɚɥɶɧɢɣ ɪɿɜɟɧɶ ɮɟɪɢɬɢɧɭ, n, % 56 (63,65%)** 92(77,32%)** 29(96,67%)

Ɂɧɢɠɟɧɧɹ ɪɿɜɧɹ ɮɟɪɢɬɢɧɭ, n, % 28 (31,81%)*,_{** 9}_{(7,56%) _}

ɇɚɦɢ ɩɪɨɚɧɚɥɿɡɨɜɚɧɚ ɝɪɭɩɚ ɡ 14 ɯɜɨɪɢɯ ɧɚ

ɋɉ, ɳɨ ɞɟɦɨɧɫɬɪɭɜɚɥɚ ɧɨɪɦɚɥɶɧɢɣ ɪɿɜɟɧɶ ɟɪɢ

-ɬɪɨɩɨɟɬɢɧɭ ɫɢɪɨɜɚɬɤɢ. ɍ 11 ɡ ɧɢɯ (78,57%) ɦɚɜ

ɦɿɫɰɟ ɞɟɮɿɰɢɬ ɡɚɥɿɡɚ, ɳɨ ɩɿɞɬɜɟɪɞɠɭɜɚɥɨɫɶ ɡɧɢ

-ɠɟɧɢɦ ɪɿɜɧɟɦ ɮɟɪɢɬɢɧɭ ɫɢɪɨɜɚɬɤɢ. Ʉɪɿɦ ɬɨɝɨ,

ɫɟɪɟɞɧɿɣ ɪɿɜɟɧɶ ɝɟɦɨɝɥɨɛɿɧɭ ɜ ɰɿɣ ɝɪɭɩɿ ɛɭɜ ɧɢɠ

-ɱɢɦ (150,28 ± 3,18), ɧɿɠ ɭ ɝɪɭɩɿ ɯɜɨɪɢɯ ɧɚ ɋɉ ɜ

ɰɿɥɨɦɭ (184,74 ± 2,42), ɩɪɢ ɰɶɨɦɭ ɫɟɪɟɞɧɽ ɱɢɫɥɨ

ɟɪɢɬɪɨɰɢɬɿɜ ɩɪɚɤɬɢɱɧɨ ɧɟ ɜɿɞɪɿɡɧɹɥɨɫɶ ɜɿɞ ɫɟ

-ɪɟɞɧɶɨɝɨ ɩɨ ɝɪɭɩɿ (6,12 ± 0,21 ɬɚ 6,64 ± 0,10 ɜɿɞ

-ɩɨɜɿɞɧɨ).

ɉɪɨɜɟɞɟɧɢɣ ɤɨɪɟɥɹɰɿɣɧɢɣ ɚɧɚɥɿɡ ɦɿɠ ɤɨɧ

-ɰɟɧɬɪɚɰɿɽɸ ɟɪɢɬɪɨɩɨɟɬɢɧɭ ɫɢɪɨɜɚɬɤɢ ɤɪɨɜɿ ɯɜɨ

-ɪɢɯ ɧɚ ɫɩɪɚɜɠɧɸ ɩɨɥɿɰɢɬɟɦɿɸ ɬɚ ɪɿɜɧɟɦ ɝɟɦɨ

-ɝɥɨɛɿɧɭ (ɪɢɫ. 1), ɬɚ ɤɨɧɰɟɧɬɪɚɰɿɽɸ ɮɟɪɢɬɢɧɭ

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ȼɢɹɜɥɟɧɨ, ɳɨ ɦɿɠ ɪɿɜɧɟɦ ɝɟɦɨɝɥɨɛɿɧɭ ɬɚ

ɤɨɧɰɟɧɬɪɚɰɿɽɸ ɟɪɢɬɪɨɩɨɟɬɢɧɭ ɫɢɪɨɜɚɬɤɢ ɿɫɧɭɽ

ɡɜɨɪɨɬɧɚ ɤɨɪɟɥɹɰɿɣɧɚ ɡɚɥɟɠɧɿɫɬɶ (rs= -0,2286).

Ɍɚɤɨɠ ɡɜɨɪɨɬɧɚ ɤɨɪɟɥɹɰɿɣɧɚ ɡɚɥɟɠɧɿɫɬɶ ɜɢɡɧɚ

-ɱɟɧɚ ɦɿɠ ɤɨɧɰɟɧɬɪɚɰɿɽɸ ɟɪɢɬɪɨɩɨɟɬɢɧɭ ɫɢɪɨ

-ɜɚɬɤɢ ɤɪɨɜɿ ɯɜɨɪɢɯ ɧɚ ɋɉ ɬɚ ɤɨɧɰɟɧɬɪɚɰɿɽɸ

ɮɟɪɢɬɢɧɭ (rs= -0,2298).

ȼɫɬɚɧɨɜɥɟɧɨ, ɳɨ ɿɫɧɭɽ ɩɪɹɦɚ ɤɨɪɟɥɹɰɿɣɧɚ

ɡɚɥɟɠɧɿɫɬɶ ɦɿɠ ɤɿɥɶɤɿɫɬɸ ɩɚɰɿɽɧɬɿɜ ɡ ɧɨɪɦɚɥɶɧɢɦ

ɪɿɜɧɟɦ ɟɪɢɬɪɨɩɨɟɬɢɧɭ ɬɚ ɡɧɢɠɟɧɢɦ ɪɿɜɧɟɦ ɡɚɥɿɡɚ

ɬɚ ɮɟɪɢɬɢɧɭ ɫɢɪɨɜɚɬɤɢ (rs = 0,5041 ɬɚ 0,5494

ɜɿɞɩɨɜɿɞɧɨ).

Ɍɚɤɢɦ ɱɢɧɨɦ, ɧɨɪɦɚɥɶɧɚ ɤɨɧɰɟɧɬɪɚɰɿɹ ɟɪɢ

-ɬɪɨɩɨɟɬɢɧɭ ɧɚɣɱɚɫɬɿɲɟ ɫɩɨɫɬɟɪɿɝɚɥɚɫɶ ɭ ɜɢɩɚɞ

-ɤɚɯ ɬɚɤ ɡɜɚɧɢɯ «ɡɚɥɿɡɨɞɟɮɿɰɢɬɧɢɯ» ɋɉ, ɤɨɥɢ

ɪɿɜɟɧɶ ɝɟɦɨɝɥɨɛɿɧɭ ɬɚ ɮɟɪɢɬɢɧɭ ɡɧɚɱɧɨ ɧɢɠɱɟ,

ɧɿɠ ɩɪɢ ɰɿɣ ɩɚɬɨɥɨɝɿʀ ɛɟɡ ɞɟɮɿɰɢɬɭ ɡɚɥɿɡɚ.

Ɋɢɫ. 2. Ɂɚɥɟɠɧɿɫɬɶ ɦɿɠ ɪɿɜɧɟɦ ɮɟɪɢɬɢɧɭ ɫɢɪɨɜɚɬɤɢ ɤɪɨɜɿ ɬɚ ɤɨɧɰɟɧɬɪɚɰɿɽɸ ɟɪɢɬɪɨɩɨɟɬɢɧɭ

(7)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

ɑɭɬɥɢɜɿɫɬɶ ɬɟɫɬɭ ɡɧɢɠɟɧɧɹ ɪɿɜɧɹ ɟɪɢɬɪɨ

-ɩɨɟɬɢɧɭ ɩɪɢ ɞɿɚɝɧɨɫɬɢɰɿ ɫɩɪɚɜɠɧɶɨʀ ɩɨɥɿɰɢɬɟɦɿʀ

ɫɬɚɧɨɜɢɥɚ 84,1%, ɫɩɟɰɢɮɿɱɧɿɫɬɶ – 88,2%. ɉɪɨ

-ɝɧɨɫɬɢɱɧɚ ɰɿɧɧɿɫɬɶ ɩɨɡɢɬɢɜɧɨɝɨ ɪɟɡɭɥɶɬɚɬɭ (ɜɿɪɨ

-ɝɿɞɧɿɫɬɶ ɧɚɹɜɧɨɫɬɿ ɫɩɪɚɜɠɧɶɨʀ ɩɨɥɿɰɢɬɟɦɿʀ ɩɪɢ

ɜɢɹɜɥɟɧɧɿ ɡɧɢɠɟɧɨɝɨ ɪɿɜɧɹ ɟɪɢɬɪɨɩɨɟɬɢɧɭ) ɫɬɚ

-ɧɨɜɢɬɶ 84,1%. ɉɪɨɝɧɨɫɬɢɱɧɚ ɰɿɧɧɿɫɬɶ ɧɟɝɚɬɢɜ

-ɧɨɝɨ ɪɟɡɭɥɶɬɚɬɭ (ɜɿɪɨɝɿɞɧɿɫɬɶ ɜɿɞɫɭɬɧɨɫɬɿ ɫɩɪɚɜɠ

-ɧɶɨʀ ɩɨɥɿɰɢɬɟɦɿʀ, ɹɤɳɨ ɪɿɜɟɧɶ ɟɪɢɬɪɨɩɨɟɬɢɧɭ ɜ

ɧɨɪɦɿ ɚɛɨ ɩɿɞɜɢɳɟɧɢɣ) - 88,2%.

ȼɂɋɇɈȼɄɂ

1. ɏɜɨɪɿ ɧɚ ɋɉ ɱɚɫɬɿɲɟ ɯɚɪɚɤɬɟɪɢɡɭɸɬɶɫɹ ɡɧɢ

-ɠɟɧɢɦ ɪɿɜɧɟɦ ɟɧɞɨɝɟɧɧɨɝɨ ɟɪɢɬɪɨɩɨɟɬɢɧɭ ɩɨɪɿɜ

-ɧɹɧɨ ɡ ɩɚɰɿɽɧɬɚɦɢ ɡ ɋȿ (84,09% ɩɪɨɬɢ 11,76%

ɜɿɞɩɨɜɿɞɧɨ).

2. ɍ ɯɜɨɪɢɯ ɧɚ ɋɉ ɧɨɪɦɚɥɶɧɢɣ ɪɿɜɟɧɶ ɟɪɢ

-ɬɪɨɩɨɟɬɢɧɭ ɫɬɚɬɢɫɬɢɱɧɨ ɡɧɚɱɭɳɟ ɤɨɪɟɥɸɜɚɜ ɡɿ

ɡɧɢɠɟɧɢɦ ɪɿɜɧɟɦ ɮɟɪɢɬɢɧɭ ɫɢɪɨɜɚɬɤɢ, ɡɭɦɨɜ

-ɥɟɧɢɦ ɞɟɮɿɰɢɬɨɦ ɡɚɥɿɡɚ ɭ ɩɟɜɧɨʀ ɤɿɥɶɤɨɫɬɿ ɯɜɨɪɢɯ

ɧɚ ɋɉ.

3. ɑɭɬɥɢɜɿɫɬɶ ɬɟɫɬɭ ɡ ɜɢɡɧɚɱɟɧɧɹ ɡɧɢɠɟɧɨɝɨ

ɪɿɜɧɹ ɟɪɢɬɪɨɩɨɟɬɢɧɭ ɞɥɹ ɞɿɚɝɧɨɫɬɢɤɢ ɋɉ ɫɬɚ

-ɧɨɜɢɥɚ 84,1%, ɫɩɟɰɢɮɿɱɧɿɫɬɶ – 87,4%, ɉɐɉɊ –

83,1%, ɉɐɇɊ – 88,1%.

ɋ

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ɂ

1. Ɋɭɦɹɧɰɟɜ Ⱥ.Ƚ. ɗɪɢɬɪɨɩɨɷɬɢɧ. Ȼɢɨɥɨɝɢɱɟɫɤɢɟ

ɫɜɨɣɫɬɜɚ. ȼɨɡɪɚɫɬɧɚɹ ɪɟɝɭɥɹɰɢɹ ɷɪɢɬɪɨɩɨɷɡɚ. Ʉɥɢɧɢ-ɱɟɫɤɨɟ ɩɪɢɦɟɧɟɧɢɟ / Ⱥ.Ƚ.Ɋɭɦɹɧɰɟɜ,ȿ.Ɏ.Ɇɨɪɳɚɤɨɜɚ, Ⱥ.Ⱦ.ɉɚɜɥɨɜ. - Ɇ.:Ƚɷɨɬɚɪ -ɦɟɞ, 2002. – 399 ɫ.

2. Ɍɚɧɚɫɢɣɱɭɤ ɂ.ɋ.Ⱥɥɝɨɪɢɬɦ ɨɰɟɧɤɢ ɷɮɮɟɤɬɢɜ-ɧɨɫɬɢ ɞɢɚɝɷɮɮɟɤɬɢɜ-ɧɨɫɬɢɱɟɫɤɢɯ ɤɪɢɬɟɪɢɟɜ / ɂ.ɋ.Ɍɚɧɚɫɢɣɱɭɤ // ɍɤɪ.ɠɭɪɧɚɥ ɝɟɦɚɬɨɥɨɝɿʀ ɬɚ ɬɪɚɧɫɮɭɡɿɨɥɨɝɿʀ . – 2010. - ʋ 4. – ɋ. 35-39.

3. Alman, D.G. Diagnostic test.1: sensitivity and specificity / D.G. Alman, J.M. Bland // BMJ. – 1994. – Vol.308. – P. 1552.

4. Diagnostic value of serum erythropoetin level in patient with absolute erythrocytosis / P. Mossuz, F. Giro-don, M. Donnard [ et al.] // Haematologica. – 2004. - Vol. 89, N 10. – P. 1194-1198.

5. McMullin M.F. The classification and diagnosis of erythrocytosis / M.F.McMullin // Int. Jnl. Lab. Hem. – 2008. – Vol. 30, N 6. – P. 447-459.

6. Mesa R. A. Navigating the evolving paradigms in the diagnosis and treatment of myeloproliferative disor-ders / R. A. Mesa // Hematol. – 2007. – Vol. 93. – P. 355– 362.

7. Patnaik M.M. The complete evaluation of ery-throcytosis: congenital and acquired / M.M. Patnaik, A. Teffery // Leukemia. – 2009. – Vol. 23, N 5. – P. 834-844.

8. Philadelphia-negative classical myeloproliferative neoplasms: critical concepts and management recom-mendations from European Leukemia Net / T. Barbui, G. Barosi, G. Birgegard [et al.] // J. Clin. Oncol. – 2011. – Vol. 29, N 6. – P. 761 - 770.

9. Serum erythropoetin values in erythrocytosis and primary thrombocytaemia / M. Messinezy [ et al.] // Br. J. Haematol. – 2002. – Vol. 117, N 1. – P. 47-53.

10. Spivak J.L. Polycythemia vera: myths, mecha-nisms and management / J.L. Spivak // Blood. – 2002. – Vol. 100, N 13. – P. 4272-4290.

11. Tefferi A. Classification and diagnosis of myelo-proliferative neoplasms: The 2008 World Health Orga-nization criteria and point-of-care diagnostic algorithms / A. Tefferi, J. W. Vardiman // Leukemia. – 2008. – Vol. 22. – P. 14–22.

12. Tefferi A. Myeloproliferative Neoplasms: Mole-cular Pathophysiology, Essential Clinical Understanding, and Treatment Strategies / A.Tefferi, W.Vainchenker // J. Clin. Oncol. – 2011. – Vol. 29, N 2. – P. 573-582.

13. Thiele J. The 2008 WHO Diagnostic Criteria for Polycythemia Vera, Essential Thrombocythemia, and Pri-mary Myelofibrosis / J.Thiele, H.M. Kvasnicka // Current Hematologic Malignancy Reports. – 2009. – Vol. 4. – Ɋ. 33-40.

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1. Rumjancev AG, Morshhakova EF, Pavlov AD. Jeritropojetin. Biologicheskie svojstva. Vozrastnaja reguljacija jeritropojeza. Klinicheskoe primenenie. M: Gjeotar –med. 2002;399.

2. Tanasijchuk IS. Algoritm ocenki jeffektivnosti diagnosticheskih kriteriev. Ukr zhurnal gematologɿʀ ta transfuzɿologɿʀ.2010;4:35-39.

3. Alman DG, Bland JM. Diagnostic test.1: sensitivity and specificity. BMJ. 1994;308;1552.

4. Mossuz P, Girodon F, Donnard M. Diagnostic value of serum erythropoetin level in patient with absolute erythrocytosis. Haematologica.2004;89(10):1194-8.

5. McMullin MF. The classification and diagnosis of erythrocytosis. Int Jnl Lab Hem. 2008;30(6):447-59.

6. Mesa RA. Navigating the evolving paradigms in the diagnosis and treatment of myeloproliferative disorders. Hematol. 2007;93:355–62.

7. Patnaik MM, Teffery A. The complete evaluation of erythrocytosis: congenital and acquired. Leukemia. 2009;23(5):834-44.

8. Barbui T, Barosi G, Birgegard G. Philadelphia-negative classical myeloproliferative neoplasms: critical concepts and management recommendations from European Leukemia Net. J Clin Oncol. 2011;29(6):761-70.

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nosis of myeloproliferative neoplasms: The 2008 World Health Organization criteria and point-of-care diagnostic algorithms. Leukemia. 2008;22:14–22.

12. Tefferi A, Vainchenker W. Myeloproliferative Neoplasms: Molecular Pathophysiology, Essential

Clini-nostic Criteria for Polycythemia Vera, Essential Throm-bocythemia, and Primary Myelofibrosis. Current Hema-tologic Malignancy Reports. 2009;4:33-40.

ɍȾɄ575.224: 612.398.192:616.71-001.59

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ɇȾȱ ɪɟɚɛɿɥɿɬɚɰɿʀ ɿɧɜɚɥɿɞɿɜ ȼɿɧɧɢɰɶɤɨɝɨ ɧɚɰɿɨɧɚɥɶɧɨɝɨ ɦɟɞɢɱɧɨɝɨ ɭɧɿɜɟɪɫɢɬɟɬɭ ɿɦ.Ɇ.ȱ.ɉɢɪɨɝɨɜɚ

(ɞɢɪɟɤɬɨɪ – ɞ.ɦɟɞ.ɧ., ɩɪɨɮ.ȼ.ȱ.ɒɟɜɱɭɤ) ȼɿɧɧɢɰɹ, 21029, ɍɤɪɚʀɧɚ

Institute of Rehabilitation, Vinnitsa national medical university M.I. Pirogov Vinnitsa, 21029, Ukraine

e-mail: bess_mert_niy@mail.ru

Ʉɥɸɱɨɜɿ ɫɥɨɜɚ:ɦɭɬɚɰɿɹ eNOS Ɍ786ɋ,ɯɢɛɧɢɣ ɫɭɝɥɨɛ,ɥɿɩɿɞɢ,ɟɧɞɨɬɟɥɿɚɥɶɧɚ ɮɭɧɤɰɿɹ

Key words: mutation eNOS T786ɋ, pseudoarthrosis, lipids, endothelial function

Ɋɟɮɟɪɚɬ.Ɇɭɬɚɰɢɹ ɩɪɨɦɨɬɨɪɚ ɝɟɧɚ ɫɢɧɬɚɡɵ ɨɤɫɢɞɚ ɚɡɨɬɚ eNOS Ɍ786ɋ ɭ ɛɨɥɶɧɵɯ ɫ ɥɨɠɧɵɦɢ ɫɭɫɬɚɜɚɦɢ

ɞɥɢɧɧɵɯ ɤɨɫɬɟɣ: ɜɡɚɢɦɨɫɜɹɡɶ ɫ ɭɪɨɜɧɟɦ ɥɢɩɢɞɨɜ ɢ ɷɧɞɨɬɟɥɢɚɥɶɧɨɣ ɮɭɧɤɰɢɟɣ ɫɨɫɭɞɨɜ.

Ȼɟɫɫɦɟɪɬɧɵɣ ɘ.Ⱥ.ɐɟɥɶ ɪɚɛɨɬɵ:ɢɡɭɱɢɬɶ ɪɚɫɩɪɨɫɬɪɚɧɟɧɧɨɫɬɶ ɩɨɥɢɦɨɪɮɢɡɦɚ ɩɪɨɦɨɬɨɪɚ ɝɟɧɚ eNOS Ɍ786ɋ ɭ ɥɢɰ ɫ ɥɨɠɧɵɦɢ ɫɭɫɬɚɜɚɦɢ ɞɥɢɧɧɵɯ ɤɨɫɬɟɣ ɢ ɨɰɟɧɢɬɶ ɟɝɨ ɫɜɹɡɶ ɫ ɭɪɨɜɧɟɦ ɥɢɩɢɞɨɜ ɢ ɷɧɞɨɬɟɥɢɚɥɶɧɨɣ ɮɭɧɤɰɢɟɣ ɫɨɫɭɞɨɜ.Ɇɚɬɟɪɢɚɥɵ ɢ ɦɟɬɨɞɵ ɢɫɫɥɟɞɨɜɚɧɢɹ.ɍ 118 ɛɨɥɶɧɵɯ ɫ ɥɨɠɧɵɦɢ ɫɭɫɬɚɜɚɦɢ ɞɥɢɧɧɵɯ ɤɨɫɬɟɣ ɢɡɭɱɟɧɚ ɱɚɫɬɨɬɚ ɦɭɬɚɰɢɢ ɩɪɨɦɨɬɨɪɚ ɝɟɧɚ eNOS Ɍ786ɋ ɢ ɨɩɪɟɞɟɥɟɧɚ ɟɟ ɜɡɚɢɦɨɫɜɹɡɶ ɫ ɭɪɨɜɧɟɦ ɥɢɩɢɞɨɜ ɢ ɷɧɞɨɬɟɥɢɚɥɶɧɨɣ ɮɭɧɤɰɢɟɣ ɫɨɫɭɞɨɜ. Ƚɪɭɩɩɭ ɤɨɧɬɪɨɥɹ ɫɨɫɬɚɜɢɥɢ 48 ɛɨɥɶɧɵɯ ɫ ɤɨɧɫɨɥɢɞɢɪɨɜɚɧɧɵɦɢ ɞɢɚɮɢ -ɡɚɪɧɵɦɢ ɩɟɪɟɥɨɦɚɦɢ, ɪɟɩɪɟɡɟɧɬɚɬɢɜɧɵɟ ɩɨ ɜɨɡɪɚɫɬɭ, ɩɨɥɭ ɢ ɥɨɤɚɥɢɡɚɰɢɢ ɩɨɜɪɟɠɞɟɧɢɹ. Ɋɟɡɭɥɶɬɚɬɵ ɢ ɢɯ ɨɛɫɭɠɞɟɧɢɟ.ɉɚɬɨɥɨɝɢɱɟɫɤɢɟ ɝɨɦɨɡɢɝɨɬɵ eNOS 786-ɋɋ ɧɚɤɚɩɥɢɜɚɸɬɫɹ ɩɪɟɢɦɭɳɟɫɬɜɟɧɧɨ ɜ ɝɪɭɩɩɚɯ ɛɨɥɶɧɵɯ ɫ ɝɢɩɨɩɥɚɫɬɢɱɟɫɤɢɦ ɢ ɚɬɪɨɮɢɱɟɫɤɢɦ ɬɢɩɨɦ ɥɨɠɧɵɯ ɫɭɫɬɚɜɨɜ, ɜ ɬɨ ɜɪɟɦɹ ɤɚɤ ɱɚɫɬɨɬɚ ɪɚɫɩɪɟɞɟɥɟɧɢɹ ɝɟ-ɧɨɬɢɩɨɜ ɫɪɟɞɢ ɛɨɥɶɧɵɯ ɫ ɧɨɪɦɨɩɥɚɫɬɢɱɧɢɦ ɬɢɩɨɦ ɫɨɨɬɜɟɬɫɬɜɭɟɬ ɬɚɤɨɦɭ ɭ ɥɢɰ ɫ ɤɨɧɫɨɥɢɞɢɪɨɜɚɧɧɵɦɢ ɩɟɪɟɥɨɦɚɦɢ.ɋɪɟɞɢ ɛɨɥɶɧɵɯ ɫ ɝɟɧɨɬɢɩɨɦ eNOS 786-ɋɋ ɱɚɳɟ ɜɵɹɜɥɹɸɬɫɹ ɥɢɰɚ ɫ ɚɛɟɪɪɚɧɬɧɵɦɢ ɭɪɨɜɧɹɦɢ ɥɢɩɢ -ɞɨɜ ɢ ɫɬɪɭɤɬɭɪɧɨ-ɮɭɧɤɰɢɨɧɚɥɶɧɵɦɢ ɢɡɦɟɧɟɧɢɹɦɢ ɨɛɳɟɣ ɫɨɧɧɨɣ, ɩɥɟɱɟɜɨɣ ɢ ɛɟɞɪɟɧɧɨɣ ɚɪɬɟɪɢɣ. ȼɵɜɨɞɵ. ɍ ɛɨɥɶɧɵɯ ɫ ɥɨɠɧɵɦɢ ɫɭɫɬɚɜɚɦɢ ɞɥɢɧɧɵɯ ɤɨɫɬɟɣ ɨɬɦɟɱɚɟɬɫɹ ɬɟɧɞɟɧɰɢɹ ɤ ɭɦɟɧɶɲɟɧɢɸ ɞɨɥɢ ɧɨɪɦɚɥɶɧɵɯ ɝɨ-ɦɨɡɢɝɨɬ (786-ɌɌ), ɭɜɟɥɢɱɟɧɢɸ ɝɟɬɟɪɨɡɢɝɨɬ (786-ɋɌ)ɢ ɞɨɥɢ ɥɢɰ ɫ ɩɚɬɨɥɨɝɢɱɟɫɤɢɦ ɝɟɧɨɬɢɩɨɦ 786-ɋɋ.Ɇɭɬɚɰɢɹ ɝɟɧɚ eNOS Ɍ786ɋ ɚɫɫɨɰɢɢɪɨɜɚɥɚɫɶ ɫ ɪɚɡɜɢɬɢɟɦ ɝɢɩɨɩɥɚɫɬɢɱɟɫɤɢɯ ɢ ɚɩɥɚɫɬɢɱɟɫɤɢɯ ɬɢɩɨɜ ɥɨɠɧɵɯ ɫɭɫɬɚɜɨɜ, ɭɜɟɥɢɱɟɧɢɟɦ ɞɨɥɢ ɥɢɰ ɫ ɚɛɟɪɪɚɧɬɧɵɦɢ ɭɪɨɜɧɹɦɢ ɥɢɩɢɞɨɜ, ɷɧɞɨɬɟɥɢɚɥɶɧɨɣ ɞɢɫɮɭɧɤɰɢɟɣ ɰɟɧɬɪɚɥɶɧɵɯ ɢ ɩɟɪɢ-ɮɟɪɢɱɟɫɤɢɯ ɫɨɫɭɞɨɜ.