Cardiovascular risk factors in patients with rheumatoid arthritis in combination with hypertension depending on body weight

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ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

ɍȾɄ 616.72 – 002.77: 616.12 – 008.331.1 – 06: 616.13/. 14

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ȾɁ «Ⱦɧɿɩɪɨɩɟɬɪɨɜɫɶɤɚ ɦɟɞɢɱɧɚ ɚɤɚɞɟɦɿɹ ɆɈɁ ɍɤɪɚʀɧɢ»

ɤɚɮɟɞɪɚ ɝɨɫɩɿɬɚɥɶɧɨʀ ɬɟɪɚɩɿʀ ʋ 1ɬɚ 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 ʋ 1 and occupational disease

Oktyabrskay Sq., 14, Dnipropetrovsk, 49005, Ukraine e-mail: oksanasirenko@i.ua

Ʉɥɸɱɨɜɿ ɫɥɨɜɚ:ɮɚɤɬɨɪɢ ɤɚɪɞɿɨɜɚɫɤɭɥɹɪɧɨɝɨ ɪɢɡɢɤɭ,ɚɪɬɟɪɿɚɥɶɧɚ ɝɿɩɟɪɬɟɧɡɿɹ,ɪɟɜɦɚɬɨʀɞɧɢɣ ɚɪɬɪɢɬ,ɿɧɞɟɤɫ

ɦɚɫɢ ɬɿɥɚ

Key words: cardiovascular risk factors, hypertension, rheumatoid arthritis, body mass index

Ɋɟɮɟɪɚɬ. Ɏɚɤɬɨɪɵ ɤɚɪɞɢɨɜɚɫɤɭɥɹɪɧɨɝɨ ɪɢɫɤɚ ɭ ɛɨɥɶɧɵɯ ɪɟɜɦɚɬɨɢɞɧɵɦ ɚɪɬɪɢɬɨɦ ɜ ɫɨɱɟɬɚɧɢɢ ɫ ɚɪɬɟɪɢɚɥɶɧɨɣ ɝɢɩɟɪɬɟɧɡɢɟɣ ɜ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɦɚɫɫɵ ɬɟɥɚ. ɋɢɪɟɧɤɨ Ɉ.ɘ. ɐɟɥɶɸ ɪɚɛɨɬɵ ɛɵɥɨ ɨɰɟɧɢɬɶ ɱɚɫɬɨɬɭ ɮɚɤɬɨɪɨɜ ɤɚɪɞɢɨɜɚɫɤɭɥɹɪɧɨɝɨ ɪɢɫɤɚ ɢ ɚɪɬɟɪɢɚɥɶɧɨɣ ɝɢɩɟɪɬɟɧɡɢɢ ɭ ɛɨɥɶɧɵɯ ɪɟɜɦɚɬɨɢɞɧɵɦ ɚɪɬɪɢ

-ɬɨɦ ɜ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɦɚɫɫɵ ɬɟɥɚ. Ɉɛɫɥɟɞɨɜɚɧɨ 100 ɛɨɥɶɧɵɯ ɫ ɪɟɜɦɚɬɨɢɞɧɵɦ ɚɪɬɪɢɬɨɦ ɢ ɫɬɚɛɢɥɶɧɨ

ɩɨɞɨɛɪɚɧɧɨɣ ɬɟɪɚɩɢɟɣ ɛɨɥɟɟ 6 ɦɟɫɹɰɟɜ ɜ ɜɨɡɪɚɫɬɟ ɨɬ 45 ɞɨ 65 ɥɟɬ (ɫɪɟɞɧɢɣ ɜɨɡɪɚɫɬ 53,19 ± 5,40 ɝɨɞɚ).

Ɉɰɟɧɢɜɚɥɢ ɬɪɚɞɢɰɢɨɧɧɵɣ ɤɚɪɞɢɨɜɚɫɤɭɥɹɪɧɵɣ ɪɢɫɤ ɫ ɭɱɟɬɨɦ ɮɚɤɬɨɪɨɜ ɪɢɫɤɚ ɩɨ ɲɤɚɥɟ SCORE ɢ ɫ ɭɱɟɬɨɦ ɩɨ

-ɩɪɚɜɨɤ ɞɥɹ ɩɚɰɢɟɧɬɨɜ ɫ ɪɟɜɦɚɬɨɢɞɧɵɦ ɚɪɬɪɢɬɨɦ.Ɉɩɪɟɞɟɥɹɥɢ ɭɪɨɜɟɧɶ ɨɛɳɟɝɨ ɯɨɥɟɫɬɟɪɢɧɚ,ɬɪɢɝɥɢɰɟɪɢɞɨɜ,ɋ

-ɪɟɚɤɬɢɜɧɨɝɨ ɛɟɥɤɚ,ɤɪɟɚɬɢɧɢɧɚ ɤɪɨɜɢ.ɋɤɨɪɨɫɬɶ ɤɥɭɛɨɱɤɨɜɨɣ ɮɢɥɶɬɪɚɰɢɢ,ɢɧɞɟɤɫ ɦɚɫɫɵ ɬɟɥɚ,ɢɧɞɟɤɫ ɩɥɨɳɚɞɢ

ɬɟɥɚ ɪɚɫɫɱɢɬɵɜɚɥɢɫɶ ɩɨ ɮɨɪɦɭɥɚɦ.Ⱥɪɬɟɪɢɚɥɶɧɚɹ ɝɢɩɟɪɬɟɧɡɢɹ ɜɵɹɜɥɟɧɚ ɭ 41 (41%) ɛɨɥɶɧɨɝɨ ɫ ɪɟɜɦɚɬɨɢɞɧɵɦ

ɚɪɬɪɢɬɨɦ ɢ ɚɫɫɨɰɢɢɪɨɜɚɥɚɫɶ ɫ ɬɪɚɞɢɰɢɨɧɧɵɦɢ ɮɚɤɬɨɪɚɦɢ ɪɢɫɤɚ (ɜɨɡɪɚɫɬ,ɨɠɢɪɟɧɢɟ), ɫɟɪɨɩɨɡɢɬɢɜɧɨɫɬɶɸ

ɩɨ ɪɟɜɦɚɬɨɢɞɧɨɦɭ ɮɚɤɬɨɪɭ,ɝɢɩɟɪɭɪɢɤɟɦɢɟɣ ɢ ɞɥɢɬɟɥɶɧɨɫɬɶɸ ɬɟɪɚɩɢɢ ɝɥɸɤɨɤɨɪɬɢɤɨɢɞɚɦɢ.Ɉɠɢɪɟɧɢɟ ɢ ɢɡ

-ɛɵɬɨɱɧɚɹ ɦɚɫɚ ɬɟɥɚ ɢɦɟɥɢ ɦɟɫɬɨ ɭ ɛɨɥɶɲɢɧɫɬɜɚ ɩɚɰɢɟɧɬɨɜ ɫ ɪɟɜɦɚɬɨɢɞɧɵɦ ɚɪɬɪɢɬɨɦ, ɩɪɢ ɷɬɨɦ ɧɚɢ

-ɛɨɥɶɲɢɣ ɭɪɨɜɟɧɶ ɩɨɤɚɡɚɬɟɥɟɣ ɜɨɫɩɚɥɟɧɢɹ ɢ ɪɢɫɤɚ ɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɵɯ ɨɫɥɨɠɧɟɧɢɣ ɭɫɬɚɧɨɜɥɟɧ ɫɪɟɞɢ ɛɨɥɶɧɵɯ

ɫ ɢɡɛɵɬɨɱɧɨɣ ɦɚɫɫɨɣ ɬɟɥɚ. Ɉɠɢɪɟɧɢɟ ɚɫɫɨɰɢɢɪɨɜɚɥɨɫɶ ɫ ɞɥɢɬɟɥɶɧɨɫɬɶɸ ɪɟɜɦɚɬɨɢɞɧɨɝɨ ɚɪɬɪɢɬɚ, ɚɤɬɢɜ

-ɧɨɫɬɶɸ ɜɨɫɩɚɥɢɬɟɥɶɧɨɝɨ ɩɪɨɰɟɫɫɚ, ɞɥɢɬɟɥɶɧɨɫɬɶɸ ɩɪɢɟɦɚ ɝɥɸɤɨɤɨɪɬɢɤɨɢɞɨɜ. ɍɫɬɚɧɨɜɥɟɧɨ, ɱɬɨ ɬɪɚɞɢ

-ɰɢɨɧɧɚɹ ɲɤɚɥɚ SCORE ɧɟ ɩɨɥɧɨɫɬɶɸ ɨɬɪɚɠɚɟɬ ɪɢɫɤ ɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɵɯ ɨɫɥɨɠɧɟɧɢɣ ɩɪɢ ɪɟɜɦɚɬɨɢɞɧɨɦ

ɚɪɬɪɢɬɟ. ȼɵɹɜɥɟɧɢɟ ɚɪɬɟɪɢɚɥɶɧɨɣ ɝɢɩɟɪɬɟɧɡɢɢ ɢ ɨɠɢɪɟɧɢɹ ɩɨɜɵɲɚɸɬ ɢɧɮɨɪɦɚɬɢɜɧɨɫɬɶ ɨɰɟɧɤɢ ɪɢɫɤɚ

ɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɵɯ ɨɫɥɨɠɧɟɧɢɣ ɩɪɢ ɪɟɜɦɚɬɨɢɞɧɨɦ ɚɪɬɪɢɬɟ.

Abstract. Cardiovascular risk factors in patients with rheumatoid arthritis in combination with hypertension depending on body weight. Sɿrenko O.Yu. The objective was to evaluate the frequency of cardiovascular risk factors and hypertension in patients with rheumatoid arthritis depending on body weight. The study involved 100 patients with rheumatoid arthritis and stably selected therapy for more than 6 months at the age from 45 to 65 years (mean age 53,19 ± 5,40 years). Traditional cardiovascular risk was assessed, taking into account risk factors by SCORE scale and amended for patients with RA. The levels of total cholesterol, triglycerides, C-reactive protein, serum creatinine, body mass index, body area index were determined. Arterial hypertension was diagnosed in 41 (41%) patients with rheuma-toid arthritis and was associated with traditional risk factors (age, obesity), rheumarheuma-toid factor, hyperuricemia and the duration of glucocorticoid therapy. Obesity and excess body mass occurred in the majority of patients with rheumatoid arthritis, herewith the highest level of inflammation indicators and risk of cardiovascular events was in overweight patients. Obesity was associated with duration of rheumatoid arthritis, the activity of the inflammatory process, the duration of glucocorticoids taking. It is found that the traditional SCORE scale does not fully reflect the risk of cardiovascular events in rheumatoid arthritis. Identification of hypertension and obesity increases the information content of the risk assessment of cardiovascular events in rheumatoid arthritis.

Ɋɚɡɨɦ ɿɡ ɩɨɞɨɜɠɟɧɧɹɦ ɬɪɢɜɚɥɨɫɬɿ ɠɢɬɬɹ ɯɜɨɪɢɯ ɧɚ ɊȺ ɜɿɞɛɭɥɚɫɹ ɣ ɡɦɿɧɚ ɫɬɪɭɤɬɭɪɢ ɫɦɟɪɬɧɨɫɬɿ ɰɢɯ ɩɚɰɿɽɧɬɿɜ. Ɍɚɤ, ɨɫɧɨɜɧɨɸ ɩɪɢ -ɱɢɧɨɸ ɩɟɪɟɞɱɚɫɧɨʀ ɥɟɬɚɥɶɧɨɫɬɿ ɩɪɢ ɊȺ (ɩɪɢ -ɛɥɢɡɧɨ ɜɢɩɚɞɤɿɜ ɽ ɡɚɯɜɨɪɸɜɚɧɧɹ ɫɟɪ

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ɩɪɢ ɪɟɜɦɚɬɢɱɧɢɯ ɡɚɩɚɥɶɧɢɯ ɚɪɬɪɢɬɚɯ — ɪɟɜɦɚ -ɬɨʀɞɧɨɦɭ ɚɪɬɪɢɬɿ (ɊȺ),ɚɧɤɿɥɨɡɢɜɧɨɦɭ ɫɩɨɧɞɢɥɨ -ɚɪɬɪɢɬɿ ɿ ɩɫɨɪɿɚɬɢɱɧɨɦɭ -ɚɪɬɪɢɬɿ, ɩɿɞɤɪɟɫɥɸɸɱɢ ɜɢɤɥɸɱɧɨ ɜɚɠɥɢɜɟ ɡɧɚɱɟɧɧɹ ɰɿɽʀ ɩɪɨɛɥɟɦɢ ɩɪɢ ɜɟɞɟɧɧɿ ɬɚɤɢɯ ɩɚɰɿɽɧɬɿɜ [11]. ɋɮɨɪɦɭɥɶɨɜɚɧɨ 10ɪɟɤɨɦɟɧɞɚɰɿɣ ɞɥɹ ɨɰɿɧɤɢ ɤɚɪɞɿɨɜɚɫɤɭɥɹɪɧɨɝɨ ɪɢɡɢɤɭ ɭ ɩɚɰɿɽɧɬɿɜ ɡ ɊȺ ɬɚ ɿɧɲɢɦɢ ɡɚɩɚɥɶɧɢɦɢ ɚɪɬɪɨɩɚɬɿɹɦɢ, ɹɤɿ ɩɟɪɟɞɛɚɱɚɸɬɶ ɧɚɭɤɨɜɨ ɨɛʉɪɭɧ -ɬɨɜɚɧɢɣ ɩɿɞɯɿɞ ɳɨɞɨ ɡɚɯɨɞɿɜ, ɡɞɚɬɧɢɯ ɡɧɢɡɢɬɢ ɤɚɪɞɿɨɜɚɫɤɭɥɹɪɧɢɣ ɪɢɡɢɤ ɭ ɩɚɰɿɽɧɬɿɜ ɿɡ ɡɚɩɚɥɶ -ɧɢɦ ɚɪɬɪɢɬɨɦ ɬɚ ɡɚɩɨɛɿɝɬɢ ɫɟɪɰɟɜɨ-ɫɭɞɢɧɧɿɣ ɫɦɟɪɬɧɨɫɬɿ.

ȼ ɨɫɬɚɧɧɿ ɪɨɤɢ ɜɫɟ ɛɿɥɶɲɟ ɭɜɚɝɢ ɩɪɢɜɟɪɬɚɽ ɩɨɽɞɧɚɧɧɹ ɚɪɬɟɪɿɚɥɶɧɨʀ ɝɿɩɟɪɬɟɧɡɿʀ (ȺȽ) ɡ ɊȺ ɱɟɪɟɡ ɜɢɫɨɤɢɣ ɪɿɜɟɧɶ ɧɟɩɪɚɰɟɡɞɚɬɧɨɫɬɿ ɬɚ ɫɦɟɪɬ -ɧɨɫɬɿ,ɚɞɠɟ ɧɚɹɜɧɿɫɬɶ ȺȽ ɭ ɯɜɨɪɢɯ ɧɚ ɊȺ ɽ ɨɞɧɢɦ ɡ ɱɢɧɧɢɤɿɜ ɫɟɪɰɟɜɨ-ɫɭɞɢɧɧɢɯ ɭɫɤɥɚɞɧɟɧɶ [9, 12]. ɑɚɫɬɨɬɚ ɪɨɡɜɢɬɤɭ ȺȽ ɩɪɢ ɊȺ ɦɨɠɟ ɤɨɥɢɜɚɬɢɫɹ ɜɿɞ 18 ɞɨ 70,5% ɡɚ ɪɿɡɧɢɦɢ ɞɚɧɢɦɢ [3, 8]. Ɍɚɤ, ɪɟɡɭɥɶɬɚɬɢ ɩɨɩɭɥɹɰɿɣɧɨɝɨ ɞɨɫɥɿɞɠɟɧɧɹ (280 ɬɢɫ. ɯɜɨɪɢɯ ɧɚ ɊȺ ɬɚ 113 ɬɢɫ. ɨɫɿɛ ɛɟɡ ɪɟɜɦɚɬɢɱɧɢɯ ɡɚɯɜɨɪɸɜɚɧɶ) ɫɜɿɞɱɚɬɶ ɩɪɨ ɞɨɫɬɨɜɿɪɧɟ ɩɿɞ -ɜɢɳɟɧɧɹ ɱɚɫɬɨɬɢ ɪɨɡɜɢɬɤɭ ȺȽ ɭ ɩɚɰɿɽɧɬɿɜ ɿɡ ɊȺ (34 ɬɚ 23% ɜɿɞɩɨɜɿɞɧɨ) [12]. ɋɥɿɞ ɡɚɡɧɚɱɢɬɢ, ɳɨ ɞɨɫɢɬɶ ɫɤɥɚɞɧɢɦ ɽ ɩɢɬɚɧɧɹ ɩɚɬɨɝɟɧɟɬɢɱɧɢɯ ɜɡɚ -ɽɦɨɜɿɞɧɨɫɢɧ ɦɿɠ ȺȽ ɬɚ ɊȺ. ɍ ɫɭɱɚɫɧɿɣ ɧɚɭɤɨɜɿɣ ɥɿɬɟɪɚɬɭɪɿ ɞɢɫɤɭɬɭɽɬɶɫɹ ɩɢɬɚɧɧɹ ɳɨɞɨ ɜɡɚ -ɽɦɨɡɜ’ɹɡɤɭ ɦɿɠ ɚɤɬɢɜɧɿɫɬɸ ɊȺ ɬɚ ɪɿɜɧɟɦ ɚɪɬɟ -ɪɿɚɥɶɧɨɝɨ ɬɢɫɤɭ (ȺɌ),ɚɥɟ ɪɟɡɭɥɶɬɚɬɢ ɞɨɫɥɿɞɠɟɧɶ ɡɚɥɢɲɚɸɬɶɫɹ ɞɨɫɢɬɶ ɫɭɩɟɪɟɱɥɢɜɢɦɢ [8]. Ⱦɨ ɦɨɠɥɢɜɢɯ ɩɪɢɱɢɧ ɩɿɞɜɢɳɟɧɧɹ ȺɌ ɩɪɢ ɊȺ ɜɿɞ -ɧɨɫɹɬɶ ɯɪɨɧɿɱɧɟ ɡɚɩɚɥɟɧɧɹ, ɚɭɬɨɿɦɭɧɧɿ ɬɚ ɦɟɬɚ -ɛɨɥɿɱɧɿ ɩɨɪɭɲɟɧɧɹ, ɡɚɫɬɨɫɭɜɚɧɧɹ ɩɪɨɬɢɪɟɜ -ɦɚɬɢɱɧɢɯ ɩɪɟɩɚɪɚɬɿɜ ɿɡ ɩɨɬɟɧɰɿɣɧɨ ɝɿɩɟɪɬɟɧɡɢɜ -ɧɢɦɢ ɟɮɟɤɬɚɦɢ (ɧɟɫɬɟɪɨʀɞɧɿ ɩɪɨɬɢɡɚɩɚɥɶɧɿ ɩɪɟ -ɩɚɪɚɬɢ (ɇɉɁɉ), ɝɥɸɤɨɤɨɪɬɢɤɨɫɬɟɪɨʀɞɢ (ȽɄɋ), ɛɚɡɢɫɧɿ ɩɪɨɬɢɡɚɩɚɥɶɧɿ ɩɪɟɩɚɪɚɬɢ).

Ɉɠɢɪɿɧɧɹ ɽ ɧɟɡɚɥɟɠɧɢɦ ɱɢɧɧɢɤɨɦ ɪɢɡɢɤɭ ɪɨɡɜɢɬɤɭ ɫɟɪɰɟɜɨ-ɫɭɞɢɧɧɢɯ ɡɚɯɜɨɪɸɜɚɧɶ ɫɟɪɟɞ ɧɚɫɟɥɟɧɧɹ ɜ ɰɿɥɨɦɭ. Ⱦɟɤɿɥɶɤɚ ɞɨɫɥɿɞɠɟɧɶ ɜɢ -ɜɱɚɥɢ ɜɩɥɢɜ ɨɠɢɪɿɧɧɹ ɧɚ ɪɢɡɢɤ ɫɟɪɰɟɜɨ -ɫɭɞɢɧɧɢɯ ɡɚɯɜɨɪɸɜɚɧɶ (ɋɋɁ) ɩɪɢ ɊȺ, ɚɥɟ ʀɯ ɪɟɡɭɥɶɬɚɬɢ ɫɭɩɟɪɟɱɥɢɜɿ. Ɉɠɢɪɿɧɧɹ ɧɟɡɚɥɟɠɧɨ ɚɫɨɰɿɸɽɬɶɫɹ ɡ ɤɥɚɫɢɱɧɢɦɢ ɮɚɤɬɨɪɚɦɢ ɪɢɡɢɤɭ ɋɋɁ ɩɪɢ ɊȺ, ɚ ɬɚɤɨɠ ɜɩɥɢɜɚɽ ɧɚ ɟɤɫɩɪɟɫɿɸ ɞɟɹɤɢɯ ɩɪɨɡɚɩɚɥɶɧɢɯ ɝɟɧɿɜ,ɹɤɿ ɩɨɜ’ɹɡɭɸɬɶ ɡ ɋɋɁ ɩɪɢ ɊȺ [7]. Ɍɨɦɭ ɛɭɥɨ ɛ ɥɨɝɿɱɧɢɦ ɨɱɿɤɭɜɚɬɢ, ɳɨ ɨɠɢɪɿɧɧɹ ɩɨɜ’ɹɡɚɧɨ ɡ ɝɿɪɲɢɦɢ ɫɟɪɰɟɜɨ -ɫɭɞɢɧɧɢɦɢ ɩɪɨɝɧɨɡɚɦɢ ɭ ɩɚɰɿɽɧɬɿɜ ɡ ɊȺ, ɹɤ ɿ ɜ ɡɚɝɚɥɶɧɿɣ ɩɨɩɭɥɹɰɿʀ.ɍ ɞɨɫɥɿɞɠɟɧɧɿ Kremers HM, Nicola PJ, et al. ɩɚɰɿɽɧɬɢ ɡ ɊȺ ɡ ȱɆɌ> 30 ɤɝ/ɦ2 ɦɚɥɢ ɛɿɥɶɲ ɧɢɡɶɤɭ ɡɚɝɚɥɶɧɭ ɫɦɟɪɬɧɿɫɬɶ,ɭ ɬɨɣ ɱɚɫ ɹɤ ɩɪɢ ɧɢɡɶɤɿɣ ȱɆɌ (<20 ɤɝ/ɦ2) ɚɫɨɰɿɸɜɚɜɫɹ ɡɿ

ɟɩɿɞɟɦɿɨɥɨɝɿɱɧɿ ɚɫɨɰɿɚɰɿʀ ɦɿɠ ɫɦɟɪɬɧɿɫɬɸ ɬɚ ɬɪɚɞɢɰɿɣɧɢɦɢ ɮɚɤɬɨɪɚɦɢ ɪɢɡɢɤɭ ɋɋɁ, ɬɚɤɢɦɢ ɹɤ ɨɠɢɪɿɧɧɹ. ȼɢɳɟɡɚɡɧɚɱɟɧɿ ɥɿɬɟɪɚɬɭɪɧɿ ɞɚɧɿ ɡɭɦɨɜɢɥɢ ɚɤɬɭɚɥɶɧɿɫɬɶ ɞɨɫɥɿɞɠɟɧɧɹ.

Ɇɟɬɚ ɞɨɫɥɿɞɠɟɧɧɹ – ɨɰɿɧɢɬɢ ɱɚɫɬɨɬɭ ɮɚɤɬɨɪɿɜ ɤɚɪɞɿɨɜɚɫɤɭɥɹɪɧɨɝɨ ɪɢɡɢɤɭ ɬɚ ɚɪɬɟɪɿɚɥɶɧɨʀ ɝɿɩɟɪ -ɬɟɧɡɿʀ ɭ ɯɜɨɪɢɯ ɧɚ ɪɟɜɦɚɬɨʀɞɧɢɣ ɚɪɬɪɢɬ ɡɚɥɟɠɧɨ ɜɿɞ ɦɚɫɢ ɬɿɥɚ.

ɆȺɌȿɊȱȺɅɂ ɌȺ ɆȿɌɈȾɂ ȾɈɋɅȱȾɀȿɇɖ

Ɉɛɫɬɟɠɟɧɨ 100 ɩɚɰɿɽɧɬɿɜ ɡ ɪɟɜɦɚɬɨʀɞɧɢɦ ɚɪɬɪɢɬɨɦ ɭ ɜɿɰɿ 45-65 ɪɨɤɿɜ (ɫɟɪɟɞɧɿɣ ɜɿɤ 53,19±5,40 ɪɨɤɭ). ɀɿɧɤɢ ɫɤɥɚɥɢ 92% (92 ɨɫɨɛɢ), ɱɨɥɨɜɿɤɢ – 8% (8 ɨɫɿɛ).Ɍɪɢɜɚɥɿɫɬɶ ɡɚɯɜɨɪɸɜɚɧɧɹ ɫɬɚɧɨɜɢɥɚ ɜɿɞ 1 ɞɨ 27 ɪɨɤɿɜ (ɭ ɫɟɪɟɞɧɶɨɦɭ – 10,23±6,8 ɪɨɤɭ). Ȼɚɡɢɫɧɭ ɬɟɪɚɩɿɸ ɨɬɪɢɦɭɜɚɥɢ 94 (94%) ɯɜɨɪɢɯ, ɡ ɧɢɯ 84 ɦɟɬɨɬɪɟɤɫɚɬ (89,36%), ɫɟɪɟɞɧɹ ɞɨɡɚ ɦɟɬɨɬɪɟɤɫɚɬɚ ɫɬɚɧɨɜɢɥɚ 12,53±3,15 ɦɝ ɧɚ ɬɢɠɞɟɧɶ, ɫɟɪɟɞɧɹ ɬɪɢɜɚɥɿɫɬɶ ɥɿɤɭɜɚɧɧɹ ɦɟɬɨɬɪɟɤɫɚɬɨɦ 55,08±51,43 ɦɿɫɹɰɹ. ȽɄɋ ɨɬɪɢɦɭ -ɜɚɜ 31 ɯɜɨɪɢɣ (26,27%), ɫɟɪɟɞɧɹ ɞɨɛɨɜɚ ɞɨɡɚ ɡɚ ɦɟɬɢɥɩɪɟɞɧɿɡɨɥɨɧɨɦ ɧɚ ɦɨɦɟɧɬ ɞɨɫɥɿɞɠɟɧɧɹ 8,09±3,32 ɦɝ, ɫɟɪɟɞɧɹ ɬɪɢɜɚɥɿɫɬɶ ɥɿɤɭɜɚɧɧɹ – 42,84±37,22 ɦɿɫɹɰɹ, 44 ɩɚɰɿɽɧɬɢ (37,29%) ɬɪɢɜɚɥɨ ɡɚɫɬɨɫɭɜɚɥɢ ɇɉɁɉ.

Ⱦɿɚɝɧɨɡ ɊȺ ɜɫɬɚɧɨɜɥɟɧɨ ɡɝɿɞɧɨ ɡ ɤɥɚɫɢɮɿ -ɤɚɰɿɽɸ Ⱥɫɨɰɿɚɰɿʀ ɪɟɜɦɚɬɨɥɨɝɿɜ ɍɤɪɚʀɧɢ (2002) ɬɚ ɞɿɚɝɧɨɫɬɢɱɧɢɦɢ ɤɪɢɬɟɪɿɹɦɢ Ⱥɦɟɪɢɤɚɧɫɶɤɨʀ ɪɟɜ -ɦɚɬɨɥɨɝɿɱɧɨʀ ɚɫɨɰɿɚɰɿʀ (1987) ɿ ɫɮɨɪɦɭɥɶɨɜɚɧɨ ɡɝɿɞɧɨ ɡ ɧɚɤɚɡɨɦ ɜɿɞ 12.10.2006 ʋ 676 “ɉɪɨ ɡɚɬɜɟɪɞɠɟɧɧɹ ɩɪɨɬɨɤɨɥɿɜ ɧɚɞɚɧɧɹ ɦɟɞɢɱɧɨʀ ɞɨ -ɩɨɦɨɝɢ ɡɚ ɫɩɟɰɿɚɥɶɧɿɫɬɸ «Ɋɟɜɦɚɬɨɥɨɝɿɹ» [1, 4].

Ⱦɿɚɝɧɨɡ «Ⱥɪɬɟɪɿɚɥɶɧɚ ɝɿɩɟɪɬɟɧɡɿɹ» ɜɫɬɚɧɨɜ -ɥɟɧɨ ɡɝɿɞɧɨ ɡ ɪɟɤɨɦɟɧɞɚɰɿɹɦɢ ɍɤɪɚʀɧɫɶɤɨʀ ɚɫɨ -ɰɿɚɰɿʀ ɤɚɪɞɿɨɥɨɝɿɜ (2012) ɬɚ ɫɮɨɪɦɭɥɶɨɜɚɧɨ ɡɝɿɞ -ɧɨ ɡ ɧɚɤɚɡɨɦ ɜɿɞ 24.05.2012 ɪ. ʋ 384 «ɉɪɨ ɡɚɬɜɟɪɞɠɟɧɧɹ ɬɚ ɜɩɪɨɜɚɞɠɟɧɧɹ ɦɟɞɢɤɨ-ɬɟɯɧɨɥɨ -ɝɿɱɧɢɯ ɞɨɤɭɦɟɧɬɿɜ ɡɿ ɫɬɚɧɞɚɪɬɢɡɚɰɿʀ ɦɟɞɢɱɧɨʀ ɞɨɩɨɦɨɝɢ ɩɪɢ ɚɪɬɟɪɿɚɥɶɧɿɣ ɝɿɩɟɪɬɟɧɡɿʀ» [5]. Ʉɚɪɞɿɨɜɚɫɤɭɥɹɪɧɢɣ ɪɢɡɢɤ ɨɰɿɧɸɜɚɥɢ ɡɝɿɞɧɨ ɡ ɪɟɤɨɦɟɧɞɚɰɿɹɦɢ ȯɜɪɨɩɟɣɫɶɤɨɝɨ ɬɨɜɚɪɢɫɬɜɚ ɤɚɪ -ɞɿɨɥɨɝɿɜ [14] ɡ ɭɪɚɯɭɜɚɧɧɹɦ ɮɚɤɬɨɪɿɜ ɪɢɡɢɤɭ ɡɚ ɲɤɚɥɨɸ SCORE. Ɂɝɿɞɧɨ ɡ ɪɟɤɨɦɟɧɞɚɰɿɹɦɢ ȯɜɪɨ -ɩɟɣɫɶɤɨʀ ɚɧɬɢɪɟɜɦɚɬɢɱɧɨʀ ɥɿɝɢ (EULAR) (2010) ɳɨɞɨ ɭɩɪɚɜɥɿɧɧɹ ɫɟɪɰɟɜɨ-ɫɭɞɢɧɧɢɦ ɪɢɡɢɤɨɦ, ɭ ɩɚɰɿɽɧɬɿɜ ɿɡ ɪɟɜɦɚɬɨʀɞɧɢɦ ɚɪɬɪɢɬɨɦ ɿ ɡɚɩɚɥɶɧɢɦɢ ɚɪɬɪɢɬɚɦɢ ɤɨɟɮɿɰɿɽɧɬ 1,5 ɜɪɚɯɨɜɭɜɚɥɢ ɩɪɢ ɧɚɹɜ -ɧɨɫɬɿ 2 ɿɡ 3 ɤɪɢɬɟɪɿʀɜ: ɬɪɢɜɚɥɿɫɬɶ ɊȺ>10ɪɨɤɿɜ; ɫɟɪɨɩɨɡɢɬɢɜɧɿɫɬɶ ɡɚ ɪɟɜɦɚɬɨʀɞɧɢɦ ɮɚɤɬɨɪɨɦ ɱɢ ɧɚɹɜɧɿɫɬɶ ɚɧɬɢɬɿɥ ɞɨ ɰɢɤɥɿɱɧɨɝɨ ɰɢɬɪɭɥɿɧɨɜɚɧɨɝɨ ɩɟɩɬɢɞɭ (ɚɧɬɢ-ɐɐɉ); ɧɚɹɜɧɿɫɬɶ ɩɨɡɚɫɭɝɥɨɛɨɜɢɯ ɩɪɨɹɜɿɜ ɊȺ [11].

(3)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

ɬɟɪɚɩɿɹ ɪɟɜɦɚɬɨʀɞɧɨɝɨ ɚɪɬɪɢɬɭ (ɬɪɢɜɚɥɿɫɬɶ ɛɿɥɶ -ɲɚ ɡɚ 6 ɦɿɫɹɰɿɜ), ɜɿɤ 40-65 ɪɨɤɿɜ, ɞɨɛɪɨɜɿɥɶɧɚ ɿɧɮɨɪɦɨɜɚɧɚ ɡɝɨɞɚ ɧɚ ɭɱɚɫɬɶ ɭ ɞɨɫɥɿɞɠɟɧɧɿ. Ʉɪɢɬɟɪɿʀ ɜɢɥɭɱɟɧɧɹ ɡ ɞɨɫɥɿɞɠɟɧɧɹ: ɜɿɤ ɫɬɚɪɲɢɣ ɡɚ 65 ɪɨɤɿɜ, ɜɫɬɚɧɨɜɥɟɧɢɣ ɬɚ ɜɟɪɢɮɿɤɨɜɚɧɢɣ ɞɿɚɝɧɨɡ ɿɲɟɦɿɱɧɨʀ ɯɜɨɪɨɛɢ ɫɟɪɰɹ, ɯɪɨɧɿɱɧɚ ɫɟɪɰɟɜɚ ɧɟɞɨɫɬɚɬɧɿɫɬɶ ȱȱȱ-IV ɮɭɧɤɰɿɨɧɚɥɶɧɨɝɨ ɤɥɚɫɭ (ɎɄ),ɚɪɢɬɦɿʀ,ɹɤɿ ɫɩɪɢɱɢɧɹɸɬɶ ɩɨɪɭɲɟɧɧɹ ɝɟɦɨɞɢɧɚɦɿɤɢ ɬɚ ɩɨɬɪɟɛɭɸɬɶ ɤɨɪɟɤɰɿʀ ɚɧɬɢɚɪɢɬ -ɦɿɱɧɢɦɢ ɡɚɫɨɛɚɦɢ, ɝɨɫɬɪɟ ɩɨɪɭɲɟɧɧɹ ɦɨɡɤɨɜɨɝɨ ɤɪɨɜɨɨɛɿɝɭ, ɞɟɤɨɦɩɟɧɫɨɜɚɧɢɣ ɰɭɤɪɨɜɢɣ ɞɿɚɛɟɬ (ɐȾ), ɝɿɩɟɪ- ɬɚ ɝɿɩɨɬɿɪɟɨɡ, ɯɪɨɧɿɱɧɚ ɧɢɪɤɨɜɚ ɧɟɞɨɫɬɚɬɧɿɫɬɶ (ɒɄɎ < 60 ɦɥ/ɯɜ./1,73ɦ2),ɨɠɢɪɿɧ -ɧɹ 3-4 ɫɬɭɩɟɧɹ.

ɉɪɢ ɤɥɿɧɿɱɧɨɦɭ ɬɚ ɿɧɫɬɪɭɦɟɧɬɚɥɶɧɨɦɭ ɨɛɫɬɟ -ɠɟɧɧɿ ɛɭɥɢ ɜɢɹɜɥɟɧɿ: ɦɿɨɤɚɪɞɢɬɢɱɧɢɣ ɤɚɪɞɿɨ -ɫɤɥɟɪɨɡ ɭ 42 ɯɜɨɪɢɯ (42%), ɩɨɥɿɚɪɬɪɢɬ ɭ 100 ɯɜɨɪɢɯ (100%), ɫɢɧɞɪɨɦ Ɋɟɣɧɨ – ɭ 10 ɯɜɨɪɢɯ (10%), ɚɭɬɨɿɦɭɧɧɚ ɚɧɟɦɿɹ - ɭ 39 (39%). ȱ ɫɬɭɩɿɧɶ ɚɤɬɢɜɧɨɫɬɿ ɛɭɜ ɜɫɬɚɧɨɜɥɟɧɢɣ ɭ 19 ɯɜɨɪɢɯ (19%), ȱȱ ɫɬɭɩɿɧɶ ɚɤɬɢɜɧɨɫɬɿ - ɭ 96 (96%), ȱȱȱ ɫɬɭɩɿɧɶ – ɭ 3 (3%), ɫɟɪɟɞɧɿɣ ɪɿɜɟɧɶ ɚɤɬɢɜɧɨɫɬɿ ɊȺ ɡɚ DAS28 – 6,33±0,94 ɛɚɥɚ. ɋɟɪɟɞ ɨɛɫɬɟɠɟɧɢɯ ɯɜɨɪɢɯ ɧɚ ɊȺ ɫɟɪɨɩɨɡɢɬɢɜɧɢɦɢ ɛɭɥɢ 89 (89%), ɫɟɪɨɧɟ -ɝɚɬɢɜɧɢɦɢ – 11 (11%).

ȼɫɿɦ ɩɚɰɿɽɧɬɚɦ ɜɢɦɿɪɸɜɚɥɢ ɡɪɿɫɬ ɬɚ ɦɚɫɭ ɬɿɥɚ, ɤɨɥɨ ɬɚɥɿʀ, ɪɨɡɪɚɯɨɜɭɜɚɥɢ ȱɆɌ ɡɚ ɫɬɚɧɞɚɪɬɧɨɸ ɮɨɪɦɭɥɨɸ,ɿɧɞɟɤɫ ɩɥɨɳɿ ɬɿɥɚ (BSA) ɡɚ ɮɨɪɦɭɥɨɸ Ɇɨɫɬɟɥɥɟɪɚ. ȼɦɿɫɬ Ɂɏɋ ɬɚ ɌȽ ɭ ɫɢɪɨɜɚɬɰɿ ɤɪɨɜɿ ɜɢɡɧɚɱɚɥɢ ɿɦɭɧɨɮɟɪɦɟɧɬɧɢɦ ɦɟɬɨɞɨɦ ɡɚ ɞɨɩɨ -ɦɨɝɨɸ ɤɨɥɨɪɢɦɟɬɪɢɱɧɨɝɨ ɬɟɫɬɭ ɧɚɛɨɪɿɜ ɮɿɪɦɢ «HUMAN» (ɇɿɦɟɱɱɢɧɚ) ɧɚ ɛɿɨɯɿɦɿɱɧɨɦɭ ɚɧɚɥɿɡɚɬɨɪɿ «Chemistry Analyzer RT-1904C». Ⱦɥɹ ɤɥɿɧɿɱɧɨʀ ɨɰɿɧɤɢ ɮɭɧɤɰɿʀ ɧɢɪɨɤ ɜɢɡɧɚɱɚɥɢ ɪɿɜɟɧɶ ɤɪɟɚɬɢɧɿɧɭ ɜ ɫɢɪɨɜɚɬɰɿ ɤɪɨɜɿ ɡɚ ɞɨɩɨɦɨɝɨɸ ɤɨɥɨ -ɪɢɦɟɬɪɢɱɧɢɯ ɦɟɬɨɞɿɜ ɬɚ ɨɛɱɢɫɥɸɜɚɥɢ ɲɜɢɞɤɿɫɬɶ ɤɥɭɛɨɱɤɨɜɨʀ ɮɿɥɶɬɪɚɰɿʀ (ɒɄɎ) ɡɚ ɮɨɪɦɭɥɨɸ ɋKD-EPI.

ɉɚɰɿɽɧɬɢ ɛɭɥɢ ɪɨɡɩɨɞɿɥɟɧɿ ɧɚ ɞɜɿ ɝɪɭɩɢ: ɩɟɪ -ɲɭ ɝɪɭɩɭ ɫɤɥɚɥɢ ɯɜɨɪɿ ɧɚ ɊȺ ɜ ɩɨɽɞɧɚɧɧɿ ɡ ȺȽ (n=41), ɞɪɭɝɭ ɝɪɭɩɭ – ɯɜɨɪɿ ɧɚ ɊȺ ɛɟɡ ɫɭɩɭɬɧɶɨʀ ȺȽ (n=59). Ɍɚɤɨɠ ɡɚɥɟɠɧɨ ɜɿɞ ɡɧɚɱɟɧɧɹ ȱɆɌ ɯɜɨɪɿ ɧɚ ɊȺ ɪɨɡɩɨɞɿɥɹɥɢɫɶ ɧɚ 3 ɝɪɭɩɢ:Ⱥ – ɯɜɨɪɿ ɡ ɧɨɪɦɚɥɶɧɢɦ ȱɆɌ (18,5-24,9 ɤɝ\ɦ2), Ȼ – ɡ ɩɿɞɜɢɳɟɧɨɸ ɜɚɝɨɸ ɬɿɥɚ (ȱɆɌ 25-29,9 ɤɝ\ɦ2),ȼ – ɡ ɨɠɢɪɿɧɧɹɦ 1-2-ɝɨ ɫɬɭɩɟɧɹ (ȱɆɌ 30-39,9 ɤɝ\ɦ2).

Ⱦɨɫɥɿɞɠɭɜɚɧɿ ɜɟɥɢɱɢɧɢ ɩɪɟɞɫɬɚɜɥɟɧɿ ɜ ɬɚɤɨɦɭ ɜɢɝɥɹɞɿ:ɜɢɛɿɪɤɨɜɟ ɫɟɪɟɞɧɽ ɡɧɚɱɟɧɧɹ ± ɫɬɚɧɞɚɪɬ -ɧɚ ɩɨɯɢɛɤɚ ɜɢɛɿɪɤɨɜɨɝɨ ɫɟɪɟɞɧɶɨɝɨ ɡ-ɧɚɱɟɧɧɹ. Ɉɰɿɧɤɭ ɪɿɡɧɢɰɿ ɫɭɤɭɩɧɨɫɬɟɣ ɜɢɛɿɪɤɢ ɩɪɨɜɨɞɢɥɢ, ɜɢɤɨɪɢɫɬɨɜɭɸɱɢ t-ɤɪɢɬɟɪɿɣ Student. Ɉɰɿɧɤɚ ɫɬɭ -ɩɟɧɹ ɜɡɚɽɦɨɡɜ’ɹɡɤɭ ɦɿɠ ɩɚɪɚɦɢ ɧɟɡɚɥɟɠɧɢɯ ɨɡɧɚɤ,ɜɢɪɚɠɟɧɢɯ ɭ ɤɿɥɶɤɿɫɧɿɣ ɲɤɚɥɿ,ɜɿɞɛɭɜɚɥɚɫɹ ɡɚ ɞɨɩɨɦɨɝɨɸ ɤɨɟɮɿɰɿɽɧɬɚ ɪɚɧɝɨɜɨʀ ɤɨɪɟɥɹɰɿʀ Spearman – r. Ⱦɥɹ ɩɨɪɿɜɧɹɧɧɹ ɫɟɪɟɞɧɿɯ ɡɧɚɱɟɧɶ

ɤɿɥɶɤɿɫɧɨɝɨ, ɧɨɪɦɚɥɶɧɨ ɪɨɡɩɨɞɿɥɟɧɨʀ ɨɡɧɚɤɢ ɭ ɝɪɭɩɚɯ, ɱɢɫɥɨ ɹɤɢɯ ɛɿɥɶɲɟ ɞɜɨɯ, ɤɨɪɢɫɬɭɜɚɥɢɫɹ ɩɚɪɚɦɟɬɪɢɱɧɢɦ ɨɞɧɨɮɚɤɬɨɪɧɢɦ ɚɧɚɥɿɡɨɦ ɜɚɪɿɚ -ɰɿɣ (ANOVA) [6]. ȼɫɿ ɫɬɚɬɢɫɬɢɱɧɿ ɩɪɨɰɟɞɭɪɢ ɩɪɨɜɨɞɢɥɢ ɡ ɜɢɤɨɪɢɫɬɚɧɧɹɦ ɩɚɤɟɬɿɜ ɩɪɢɤɥɚɞɧɢɯ ɩɪɨɝɪɚɦ «Microsoft® Excel 2013» (Microsoft®), «STATISTICA® for Windows 6.0» (StatSoft Inc.).

ɊȿɁɍɅɖɌȺɌɂ ɌȺ Ȳɏ ɈȻȽɈȼɈɊȿɇɇə

Ⱥɪɬɟɪɿɚɥɶɧɭ ɝɿɩɟɪɬɟɧɡɿɸ ɞɿɚɝɧɨɫɬɨɜɚɧɨ ɭ 41 ɯɜɨɪɨɝɨ ɧɚ ɊȺ (41%), ɡ ɧɢɯ ɭ 8 ɯɜɨɪɢɯ (19,51%) – ȱ ɫɬɚɞɿʀ, ɭ 33 (80,49%) – ȱȱ ɫɬɚɞɿʀ. ȱ ɫɬɭɩɿɧɶ ȺȽ ɜɫɬɚɧɨɜɥɟɧɢɣ ɭ 10 (24,39%) ɩɚɰɿɽɧɬɿɜ, ȱȱ ɫɬɭɩɿɧɶ –ɭ 26 (63,41%), ȱȱȱ ɫɬɭɩɿɧɶ – ɭ 5 (12,20%) ɯɜɨɪɢɯ. ɍ ɝɪɭɩɿ ɩɚɰɿɽɧɬɿɜ ɡ ɊȺ ɜ ɩɨɽɞɧɚɧɧɿ ɡ ȺȽ ɩɨɤɚɡɧɢɤ ɋȺɌ ɜ ɫɟɪɟɞɧɶɨɦɭ ɫɬɚɧɨɜɢɜ 142,8±16,5 ɦɦ ɪɬ.ɫɬ., ȾȺɌ – 85,73±9,25 ɦɦ ɪɬ.ɫɬ.,ɭ ɝɪɭɩɿ ɯɜɨɪɢɯ ɧɚ ɊȺ ɛɟɡ ɫɭɩɭɬɧɶɨʀ ȺȽ – 120,34±10,99 ɬɚ 74,4±7,2 ɦɦ ɪɬ.ɫɬ. ɜɿɞɩɨɜɿɞɧɨ.ɑɚɫɬɨɬɚ ɜɢɹɜɥɟɧ -ɧɹ ȺȽ ɧɟ ɡɚɥɟɠɚɥɚ ɜɿɞ ɬɪɢɜɚɥɨɫɬɿ ɊȺ (ɪ=0,23). Ʌɿɤɭɜɚɧɧɹ ɚɧɬɢɝɿɩɟɪɬɟɧɡɢɜɧɢɦɢ ɩɪɟɩɚɪɚɬɚɦɢ ɨɬɪɢɦɭɜɚɥɢ 22 (53,66%) ɯɜɨɪɢɯ ɧɚ ɊȺ ɿɡ ɫɭɩɭɬ -ɧɶɨɸ ȺȽ,ɡ ɧɢɯ 9 (40,91%) ɨɬɪɢɦɭɜɚɥɢ ɥɿɤɭɜɚɧɧɹ ɩɨɫɬɿɣɧɨ, 13 (59,09%) ɯɜɨɪɢɯ - ɟɩɿɡɨɞɢɱɧɨ. Ȼɿɥɶ -ɲɿɫɬɶ ɯɜɨɪɢɯ ɨɬɪɢɦɭɜɚɥɢ ɿȺɉɎ – 11 (50%), ɫɚɪɬɚɧɢ ɡɚɫɬɨɫɨɜɭɜɚɥɢ 6 (27,27%) ɯɜɨɪɢɯ, ɛ -ɛɥɨɤɚɬɨɪɢ – 3 (13,64%), ɞɿɭɪɟɬɢɤɢ – 8 (36,36%).

ɉɨɪɿɜɧɹɥɶɧɚ ɯɚɪɚɤɬɟɪɢɫɬɢɤɚ ɯɜɨɪɢɯ ɊȺ ɡɚ -ɥɟɠɧɨ ɜɿɞ ɫɭɩɭɬɧɶɨʀ ȺȽ ɧɚɜɟɞɟɧɚ ɜ ɬɚɛɥɢɰɿ 1. ɉɪɢ ɚɧɚɥɿɡɿ ɪɨɡɩɨɜɫɸɞɠɟɧɨɫɬɿ ɮɚɤɬɨɪɿɜ ɤɚɪɞɿɨ -ɜɚɫɤɭɥɹɪɧɨɝɨ ɪɢɡɢɤɭ ɭ ɯɜɨɪɢɯ ɧɚ ɊȺ ɡɚɥɟɠɧɨ ɜɿɞ ɧɚɹɜɧɨɫɬɿ ȺȽ ɜɫɬɚɧɨɜɥɟɧɿ ɞɨɫɬɨɜɿɪɧɿ ɜɿɞɦɿɧɧɨɫɬɿ ɦɿɠ ɝɪɭɩɚɦɢ ɡɚ ɜɿɤɨɦ (ɪ=0,01), ɪɿɜɧɟɦ ɪɟɜɦɚ -ɬɨʀɞɧɨɝɨ ɮɚɤɬɨɪɭ (ɪ=0,04) ɬɚ ɫɟɱɨɜɨʀ ɤɢɫɥɨɬɢ (ɪ=0,001). Ɂɚ ɪɨɡɩɨɜɫɸɞɠɟɧɿɫɬɸ ɬɚɤɢɯ ɬɪɚɞɢ -ɰɿɣɧɢɯ ɮɚɤɬɨɪɿɜ ɪɢɡɢɤɭ ɹɤ ɩɚɥɿɧɧɹ, ɝɿɩɟɪɯɨ -ɥɟɫɬɟɪɢɧɟɦɿɹ, ɨɛɬɹɠɟɧɢɣ ɫɟɪɰɟɜɨ-ɫɭɞɢɧɧɢɣ ɚɧɚɦɧɟɡ ɬɚ ɡɚ ɿɧɲɢɦɢ ɯɚɪɚɤɬɟɪɢɫɬɢɤɚɦɢ ɊȺ ɝɪɭɩɢ ɯɜɨɪɢɯ ɞɨɫɬɨɜɿɪɧɨ ɧɟ ɜɿɞɪɿɡɧɹɥɢɫɶ. ɋɟɪɟɞ ɩɚɰɿɽɧɬɿɜ 1-ʀ ɝɪɭɩɢ ɧɚɞɥɢɲɤɨɜɚ ɦɚɫɚ ɬɿɥɚ ɬɚ ɨɠɢɪɿɧɧɹ ɡɭɫɬɪɿɱɚɥɢɫɶ ɜ 1,77 ɪɚɡɭ ɱɚɫɬɿɲɟ, ɧɿɠ ɫɟɪɟɞ ɯɜɨɪɢɯ 2-ʀ ɝɪɭɩɢ – 37 (90,24%) ɬɚ 30 (50,85%) ɜɿɞɩɨɜɿɞɧɨ. Ɂɛɿɥɶɲɟɧɢɣ ɩɨɤɚɡɧɢɤ ɤɨɥɚ ɬɚɥɿʀ ɜɫɬɚɧɨɜɥɟɧɢɣ ɭ 38 (92,68%) ɩɚɰɿɽɧɬɿɜ ɡ ɊȺ ɜ ɩɨɽɞɧɚɧɧɿ ɡ ȺȽ ɬɚ ɭ 27 (45,76%) ɯɜɨɪɢɯ ɧɚ ɊȺ ɛɟɡ ɫɭɩɭɬɧɶɨʀ ȺȽ.

(4)

ɤɨɬɟɪɚɩɿʀ ɊȺ. ȼɫɬɚɧɨɜɥɟɧɢɣ ɩɪɹɦɢɣ ɞɨɫɬɨɜɿɪɧɢɣ ɤɨɪɟɥɹɰɿɣɧɢɣ ɡɜ'ɹɡɨɤ ɦɿɠ ɪɿɜɧɟɦ ɊɎ ɬɚ ɋȺɌ ɫɟɪɟɞ ɯɜɨɪɢɯ ɧɚ ɊȺ ɜ ɰɶɨɦɭ ɞɨɫɥɿɞɠɟɧɧɿ (r=0,45,

ɬɢɜɧɨɫɬɿ ɡɚ ɊɎ ɧɚ ɪɢɡɢɤ ɤɚɪɞɿɨɜɚɫɤɭɥɹɪɧɨʀ ɡɚɯɜɨɪɸɜɚɧɨɫɬɿ ɬɚ ɫɦɟɪɬɧɨɫɬɿ ɩɪɢ ɊȺ ɬɚ ɿɧɲɢɯ ɪɟɜɦɚɬɢɱɧɢɯ ɡɚɯɜɨɪɸɜɚɧɧɹɯ [8].

Ɍ ɚ ɛ ɥ ɢ ɰ ɹ 1

Ʉɥɿɧɿɱɧɚ ɯɚɪɚɤɬɟɪɢɫɬɢɤɚ ɨɛɫɬɟɠɟɧɢɯ ɯɜɨɪɢɯ ɡɚɥɟɠɧɨ ɜɿɞ ɧɚɹɜɧɨɫɬɿ ɚɪɬɟɪɿɚɥɶɧɨʀ ɝɿɩɟɪɬɟɧɡɿʀ (Ɇ±m)

ɉɨɤɚɡɧɢɤ ɍɫɿ ɯɜɨɪɿ_(n=100) ȱ ɝɪɭɩɚ_(n=41) ȱȱ ɝɪɭɩɚ_(n=59) Ɋɧ

ɋɟɪɟɞɧɿɣ ɜɿɤ,ɪɨɤɢ 53,19 ± 5,40 55,38 ± 5,44*#_51,93±5,14#_0,01

ȱɆɌ,ɤɝ/ɦ2 29,31±11,07 29,58 ± 11,22 27,68±13,34 0,43

ɋɬɚɬɶ,ɑ:ɀ 5:95 3:36 2:74

ȱɆɌ > 25 ɤɝ/ɦ2₆₇_(67%)× _{37 (90,24%)} _{30 (50,85%)}#_0,06

BSA 1,84±0,19 1,96±0,17#_{1,76±0,16 0,62}

Ɉɛɜɿɞ ɬɚɥɿʀ,ɫɦ 93,14±12,23×_{104,25±13,11*}#_94,51±9,97#_0,03

Ɂɛɿɥɶɲɟɧɢɣ ɨɛɜɿɞ ɬɚɥɿʀ 77 (77%) 38 (92,68%)* 27 (45,76%)#_0,02

ɋɩɚɞɤɨɜɢɣ ɚɧɚɦɧɟɡ 71 (71%) 22 (53,66%)#₄₉_{(83,05%) 0,12}

ɉɚɥɿɧɧɹ 18 (18%)* 8 (19,51%) 10 (5,9%) 0,18

Ɍɪɢɜɚɥɿɫɬɶ ɊȺ 10,23±6,8 10,32±6,86 9,5±5,95#_0,23

ɉɨɡɚɫɭɝɥɨɛɨɜɿ ɩɪɨɹɜɢ ɊȺ 76 (76%) 22 (53,66%)#₅₄_{(91,53%) 0,28}

ɋɟɪɨɩɨɡɢɬɢɜɧɿɫɬɶ 89 (89%) 36 (92,68%) 53 (91,53%) 0,16

DAS28 6,33 ± 0,94 6,25±0,82 6,38±0,96 0,49

ɒɄɎ ɦɥ/ɯɜ./1,73 ɦ2_99,86±24,94_107,7±24,97#_{94,91±21,87 0,26}

Ɇɟɬɨɬɪɟɤɫɚɬ 84 (84%) 33 (80,49%) 51 (86,44%) 0,41

Ɇɟɬɨɬɪɟɤɫɚɬ,ɫɟɪɟɞɧɹ ɞɨɡɚ 12,53 ± 3,15 12,35±3,19 12,65±3,18 0,68

ɋɟɪɟɞɧɹ ɬɪɢɜɚɥɿɫɬɶ,ɦɿɫ. 55,08 ± 21,43 46,62±21,98#_60,47±30,68#_0,24

ȽɄɋ 74 (74%) 29 (70,73%) 45 (76,27%) 0,34

Ⱦɨɡɚ ɦɟɬɢɥɩɪɟɞɧɿɡɨɥɨɧɭ,ɦɝ 8,09±3,32 7,79±3,4#_{8,29±3,68 0,52}

ɋɟɪɟɞɧɹ ɬɪɢɜɚɥɿɫɬɶ,ɦɿɫ. 42,84±17,22 44,38±16,98* 39,29±17,22#_0,04

ɉɨɫɬɿɣɧɟ ɡɚɫɬɨɫɭɜɚɧɧɹ ɇɉɁɉ 44 (44%) 19 (46,34%) 27 (45,77%) 0,14

ɉ ɪ ɢ ɦ ɿ ɬ ɤ ɢ: ɪɧ – ɦɿɠ ɜɫɿɦɚ ɝɪɭɩɚɦɢ ɡɚ ɤɪɢɬɟɪɿɽɦ Ɏɿɲɟɪɚ, × ɪ<0,05 – ɩɨɪɿɜɧɹɧɨ ɡ ɝɪɭɩɨɸ ɡ ȺȽ ɡɚ t-ɤɪɢɬɟɪɿɽɦ, * ɪ<0,05 – ɩɨɪɿɜɧɹɧɨ ɡ

(5)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

10-ɪɿɱɧɢɣ ɪɢɡɢɤ ɮɚɬɚɥɶɧɢɯ ɫɟɪɰɟɜɨ-ɫɭɞɢɧɧɢɯ ɩɨɞɿɣ ɡɚ ɲɤɚɥɨɸ SCORE ɜ ɨɛɫɬɟɠɟɧɢɯ ɯɜɨɪɢɯ ɫɬɚ -ɧɨɜɢɜ ɭ ɫɟɪɟɞɧɶɨɦɭ 1,48±1,94%, ɡ ɭɪɚɯɭɜɚɧɧɹɦ ɤɨɟɮɿɰɿɽɧɬɭ 1,5 - 1,98±2,53%, ɳɨ ɜɜɚɠɚɽɬɶɫɹ ɩɨ -ɦɿɪɧɢɦ ɪɿɜɧɟɦ ɪɢɡɢɤɭ. ɍ ɝɪɭɩɿ ɯɜɨɪɢɯ ɿɡ ɫɭɩɭɬ

-ɧɶɨɸ ȺȽ ɪɿɜɟɧɶ ɪɢɡɢɤɭ ɮɚɬɚɥɶɧɢɯ ɫɟɪɰɟɜɨ-ɫɭɞɢɧ -ɧɢɯ ɩɨɞɿɣ ɡɚ ɲɤɚɥɨɸ SCORE ɛɭɜ ɞɨɫɬɨɜɿɪɧɨ ɜɢɳɢɦ ɩɨɪɿɜɧɹɧɨ ɡ ɞɪɭɝɨɸ ɝɪɭɩɨɸ - 1,48±1,94% ɬɚ 2,22±1,96% (ɪ<0,05)ɜɿɞɩɨɜɿɞɧɨ (ɪɢɫ. 1).

0,96% 2,22%

1,09%

1,98%

1,67%

1,32%

2,93%

1,31%

2,73%

2,24%

ɬɪɚɞɢɰɿɣɧɢɣ ɪɢɡɢɤ ɡɚ SC OR E ɪɨɡɪɚɯɭɧɤɨɜɢɣ ɪɢɡɢɤ ɡɚ SCORE

ɊȺ (ɛɟɡ ɫɭɩɭɬɧɶɨʀ ȺȽ) ɊȺ + ȺȽ ɊȺ (ȱɆɌ < 25 ɤɝ/ɦ2)

ɊȺ (ȱɆɌ 25-29,9 ɤɝ/ɦ2) ɊȺ + ȺȽ + ɨɠɢɪɿɧɧɹ

* – ɞɨɫɬɨɜɿɪɧɿɫɬɶ ɜɿɞɦɿɧɧɨɫɬɟɣ (ɪ<0,05).

Ɋɢɫ. 1. Ɋɿɜɟɧɶ ɬɪɚɞɢɰɿɣɧɨɝɨ ɬɚ ɪɨɡɪɚɯɭɧɤɨɜɨɝɨ ɪɢɡɢɤɭ ɫɟɪɰɟɜɨ-ɫɭɞɢɧɧɢɯ ɭɫɤɥɚɞɧɟɧɶ ɩɪɢ ɊȺ ɡɚɥɟɠɧɨ ɜɿɞ ɧɚɹɜɧɨɫɬɿ ȺȽ ɬɚ ɡɧɚɱɟɧɧɹ ȱɆɌ

Ɂɝɿɞɧɨ ɿɡ ɫɭɱɚɫɧɢɦɢ ɥɿɬɟɪɚɬɭɪɧɢɦɢ ɞɚɧɢɦɢ, ɨɠɢɪɿɧɧɹ ɦɚɽ ɲɢɪɨɤɟ ɪɨɡɩɨɜɫɸɞɠɟɧɧɹ ɩɪɢ ɊȺ [12]. ɍ ɧɚɲɨɦɭ ɞɨɫɥɿɞɠɟɧɧɿ ȱɆɌ > 25 ɤɝ/ɦ2 ɬɚ ɨɠɢɪɿɧɧɹ ɛɭɥɨ ɜɫɬɚɧɨɜɥɟɧɨ ɭ 67 (67%) ɭɫɿɯ ɨɛ -ɫɬɟɠɟɧɢɯ ɯɜɨɪɢɯ, ɡ ɧɢɯ 33 (49,25%) ɨɫɨɛɢ ɦɚɥɢ ɧɚɞɥɢɲɤɨɜɭ ɦɚɫɭ ɬɿɥɚ, ɭ 34 (50,75%) ɯɜɨɪɢɯ ɜɫɬɚɧɨɜɥɟɧɨ ɨɠɢɪɿɧɧɹ:ɭ 23 (34,33%) - ȱ ɫɬɭɩɿɧɶ, 11 (16,42%) - ȱȱ ɫɬɭɩɿɧɶ. Ɂɛɿɥɶɲɟɧɢɣ ɩɨɤɚɡɧɢɤ ɤɨɥɚ ɬɚɥɿʀ ɜɿɞɦɿɱɚɜɫɹ ɜ 77 (77%) ɯɜɨɪɢɯ. ɋɥɿɞ ɡɚɡɧɚɱɢɬɢ, ɳɨ ɫɟɪɟɞ ɩɚɰɿɽɧɬɿɜ ɡ ɧɨɪɦɚɥɶɧɨɸ ɜɚɝɨɸ ɬɿɥɚ ɭ 20 (60,61%) ɨɫɿɛ ɬɚ ɫɟɪɟɞ ɭɫɿɯ ɯɜɨ -ɪɢɯ ɡ ȱɆɌ > 25 ɤɝ/ɦ2ɜɫɬɚɧɨɜɥɟɧɨ ɡɛɿɥɶɲɟɧɧɹ ɩɨ -ɤɚɡɧɢɤɚ ɤɨɥɚ ɬɚɥɿʀ.

ȱɆɌ ɚɫɨɰɿɸɜɚɜɫɹ ɡ ɬɪɢɜɚɥɿɫɬɸ ɊȺ (r=0,46, ɪ=0,04), ɚɤɬɢɜɧɿɫɬɸ ɊȺ ɡɚ ɲɤɚɥɨɸ DAS28

ɪ ɪɿɜɧɟɦ ɋɊɉ ɪ

ɬɪɢɜɚɥɿɫɬɸ ȽɄɋ ɬɟɪɚɩɿʀ (r=0,61, ɪ=0,01) (ɬɚɛɥ. 2). Ɂɚ ɿɧɲɢɦɢ ɯɚɪɚɤɬɟɪɢɫɬɢɤɚɦɢ ɮɚɪɦɚɤɨɬɟɪɚɩɿʀ ɝɪɭɩɢ ɯɜɨɪɢɯ ɡɚɥɟɠɧɨ ɜɿɞ ȱɆɌ ɞɨɫɬɨɜɿɪɧɨ ɧɟ ɜɿɞɪɿɡɧɹɥɢɫɶ.

Ƚɪɭɩɢ ɯɜɨɪɢɯ ɡɚɥɟɠɧɨ ɜɿɞ ȱɆɌ ɞɨɫɬɨɜɿɪɧɨ ɜɿɞɪɿɡɧɹɥɢɫɶ ɡɚ ɪɿɜɧɟɦ ɬɪɢɝɥɿɰɟɪɢɞɿɜ (ɪ=0,03), ɊɎ (ɪ=0,005) ɬɚ ɫɟɱɨɜɨʀ ɤɢɫɥɨɬɢ (ɪ=0,02) (ɪɢɫ. 2). Ɍɚɤ, ɧɚɣɜɢɳɿ ɜɤɚɡɚɧɿ ɩɨɤɚɡɧɢɤɢ ɜɢɹɜɥɟɧɿ ɫɟɪɟɞ ɩɚɰɿɽɧɬɿɜ ɡ ɧɚɞɥɢɲɤɨɜɨɸ ɦɚɫɨɸ ɬɿɥɚ ɩɨɪɿɜɧɹɧɨ ɡ ɿɧɲɢɦɢ ɝɪɭɩɚɦɢ.

Ⱥɧɚɥɿɡ ɪɿɜɧɹ ɋȺɌ ɬɚ ȾȺɌ ɡɚɥɟɠɧɨ ɜɿɞ ȱɆɌ ɩɨɤɚɡɚɜ ɧɚɹɜɧɿɫɬɶ ɩɪɹɦɨʀ ɤɨɪɟɥɹɰɿʀ: r=0,36, r=0,41 (ɪ<0,05) ɜɿɞɩɨɜɿɞɧɨ. Ɋɿɜɧɿ ɋȺɌ ɿ ȾȺɌ (ɬɚɛɥ. 2) ɞɨɫɬɨɜɿɪɧɨ ɡɛɿɥɶɲɭɜɚɥɢɫɶ ɭ ɯɜɨɪɢɯ ɧɚ ɊȺ ɡ ɨɠɢɪɿɧɧɹɦ ɩɨɪɿɜɧɹɧɨ ɡ ɯɜɨɪɢɦɢ ɡ ɧɨɪɦɚɥɶɧɨɸ ɦɚɫɨɸ ɬɿɥɚ ɋɬɚɬɢɫɬɢɱɧɨ ɡɧɚɱɭɳɿ

*

* *

(6)

Ɋɿɜɟɧɶ ɋɄɎ ɛɭɜ ɧɚɣɧɢɠɱɢɦ ɫɟɪɟɞ ɩɚɰɿɽɧɬɿɜ ɡ ɦɿɠ ɝɪɭɩɚɦɢ ɛɭɥɢ ɞɨɫɬɨɜɿɪɧɿ.

Ɍ ɚ ɛ ɥ ɢ ɰ ɹ 2

Ʉɥɿɧɿɱɧɚ ɯɚɪɚɤɬɟɪɢɫɬɢɤɚ ɨɛɫɬɟɠɟɧɢɯ ɯɜɨɪɢɯ ɧɚ ɪɟɜɦɚɬɨʀɞɧɢɣ ɚɪɬɪɢɬ ɡɚɥɟɠɧɨ ɜɿɞ ɿɧɞɟɤɫɭ ɦɚɫɢ ɬɿɥɚ

ɉɨɤɚɡɧɢɤ Ƚɪɭɩɚ Ⱥ_(n=33) Ƚɪɭɩɚ Ȼ_(n=33) Ƚɪɭɩɚ ȼ_(n=34) ɪ

ɋɟɪɟɞɧɿɣ ɜɿɤ,ɪɨɤɢ 51,76±5,97 53,76±5,35 53,85±5,31 0,55

ɋɬɚɬɶ,ɑ:ɀ 1:32 5:28 2:31

ȱɆɌ,ɤɝ/ɦ2

22,37±2,01*× 27,61±1,39*# 33,80±3,01*# 0,03

BSAɦ2_1,64±0,11*_1,88±0,11*#_{1,99±0,14* 0,02}

Ɉɛɜɿɞ ɬɚɥɿʀ,ɫɦ 82,10±4,99 96,42±8,89*#_{106,09±1,53* 0,06}

ȺȽ 2 ( 6,06%) 12 ( 36,36%)# _{27 ( 79,41%)}#_0,42

ɋȺɌ ɦɦ ɪɬ.ɫɬ. 116,03±13,72 130,03±12,81* 137,44±16,44* 0,04

ȾȺɌ ɦɦ ɪɬ.ɫɬ. 72,32±6,45 80,46±7,54* 86,45±7,54*#_0,11

ɋɩɚɞɤɨɜɢɣ ɚɧɚɦɧɟɡ 29 ( 87,88%) 30 ( 90,91%) 32 ( 94,12%) 0,71

ɉɚɥɿɧɧɹ 7 ( 21,21%) 8 ( 24,24%) 3 ( 8,82%)* 0,12

Ɍɪɢɜɚɥɿɫɬɶ ɊȺ,ɪɨɤɢ 9,14±7,45×_{11,91±7,82 9,76±5,48 0,18}

ɉɨɡɚɫɭɝɥɨɛɨɜɿ ɩɪɨɹɜɢ ɊȺ 27(81,82%) 27(81,82%) 24 (70,59%)#_0,23

ɋɟɪɨɩɨɡɢɬɢɜɧɿɫɬɶ 30(90,91%) 31 (93,94%) 29 (85,29%)* 0,28

DAS28,ɛɚɥɢ 6,19±0,78 6,43±0,82#_6,42±0,64*_0,16

ɋɄɎ 82,88±16,14×_{103,06±20,05* 113,96±27,43}#_0,49

Ɇɟɬɨɬɪɟɤɫɚɬ 30 (90,91%) 29 (87,88%) 27 (79,41%)#_0,26

Ɇɟɬɨɬɪɟɤɫɚɬ,ɦɝ/ɬɢɠɞɟɧɶ 12,31±3,23 12,76±3,36 12,69±3,24 0,29

ɋɟɪɟɞɧɹ ɬɪɢɜɚɥɿɫɬɶ,ɦɿɫ. 53,88±27,92×_{72±43,34 38,15±29,37}#_0,41

ȽɄɋ 29 (87,88%) 18 (54,55%)#₂₅_{(73,53%) 0,68}

Ⱦɨɡɚ ɦɟɬɢɥɩɪɟɞɧɿɡɨɥɨɧɚ,ɦɝ/ɞɨɛɚ 9,04±4,05×_{8,12±2,96 7,12±2,85*}#_0,24

Ɍɪɢɜɚɥɿɫɬɶ,ɦɿɫ. 32,96±23,35×_54,7±27,7*#_{45,53±25,63*}#_0,04

ɇɉɁɉ 11(33,33%) 16(48,48%) 14 (41,18%) 0,52

ɉɪɢɦɿɬɤɢ:ɪɧ – ɦɿɠ ɜɫɿɦɚ ɝɪɭɩɚɦɢ ɡɚ ɤɪɢɬɟɪɿɽɦ Ɏɿɲɟɪɚ,×ɪ<0,05 – ɩɨɪɿɜɧɹɧɨ ɡ ɝɪɭɩɨɸ Ȼ ɡɚ t-ɤɪɢɬɟɪɿɽɦ,*ɪ<0,05 – ɩɨɪɿɜɧɹɧɨ ɡ ɝɪɭɩɨɸ ȼ ɡɚ

(7)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

5,53 1,4 18,65 27,51 164,29 0,209 297,73

5,66 1,23 14,85 28,05 123,17 0,179 254,81

5,59 1,25 _13,63 29 _129,76 0,188 _248,37

5,52 _1,23

17,44 26,73 162,68

0,205

284,55

1,43 18,06 27,62 139,01 0,175

5,7 282,67

Ɂɏɋ,ɦɦɨɥɶ/ɥ ɌȽ,ɦɦɨɥɶ/ɥ ɋɊɉ,ɦɤɨɥɶ/ɥ COE ɦɦ/ɝɨɞ ɊɎ ɦɤɦɨɥɶ/ɥ ɐȱɄ ɋɟɱɨɜɚ ɤɢɫɥɨɬɚ ɦɦɨɥɶ/ɥ

ɊȺ+ȺȽ (n=41)

ɊȺ ɛɟɡ ȺȽ (n=59)

ȱɆɌ<25 ɤɝ\ɦ2 ȱɆɌ 25-29,9 ɤɝ\ɦ2 ȱɆɌ>30-39,9 ɤɝ\ɦ2

* – ɞɨɫɬɨɜɿɪɧɿɫɬɶ ɜɿɞɦɿɧɧɨɫɬɟɣ (ɪ<0,05)

Ɋɢɫ. 2. Ʌɿɩɿɞɧɢɣ ɩɪɨɮɿɥɶ,ɫɟɱɨɜɚ ɤɢɫɥɨɬɚ ɬɚ ɩɨɤɚɡɧɢɤɢ ɿɦɭɧɨ-ɡɚɩɚɥɶɧɨɝɨ ɩɪɨɰɟɫɭ ɫɟɪɟɞ ɯɜɨɪɢɯ ɧɚ ɪɟɜɦɚɬɨʀɞɧɢɣ ɚɪɬɪɢɬ ɡɚɥɟɠɧɨ ɜɿɞ ɿɧɞɟɤɫɭ ɦɚɫɢ ɬɿɥɚ ɬɚ ɧɚɹɜɧɨɫɬɿ ɚɪɬɟɪɿɚɥɶɧɨʀ ɝɿɩɟɪɬɟɧɡɿʀ

ɉɪɢ ɜɢɡɧɚɱɟɧɧɿ ɪɢɡɢɤɭ ɫɟɪɰɟɜɨ-ɫɭɞɢɧɧɢɯ ɭɫɤɥɚɞɧɟɧɶ ɫɟɪɟɞ ɯɜɨɪɢɯ ɧɚ ɊȺ ɜɫɬɚɧɨɜɥɟɧɢɣ ɞɨɫɬɨɜɿɪɧɨ ɜɢɳɢɣ ɪɿɜɟɧɶ ɪɢɡɢɤɭ ɡɚ ɭɦɨɜ ȱɆɌ > 25 ɤɝ/ɦ2ɩɨɪɿɜɧɹɧɨ ɡ ɩɚɰɿɽɧɬɚɦɢ ɡ ɧɨɪɦɚɥɶ -ɧɢɦ ɩɨɤɚɡɧɢɤɨɦ ȱɆɌ – 1,69±0,11% ɬɚ 1,09±0,09% (ɪ=0,02) ɜɿɞɩɨɜɿɞɧɨ (ɪɢɫ. 1). Ɍɚɤɢɦ ɱɢɧɨɦ, ɜɪɚ -ɯɭɜɚɧɧɹ ȱɆɌ ɬɚ ɛɿɥɶɲɨɸ ɦɿɪɨɸ ȺȽ ɩɿɞɜɢɳɭɽ ɿɧɮɨɪɦɚɬɢɜɧɿɫɬɶ ɨɰɿɧɤɢ ɪɢɡɢɤɭ ɫɟɪɰɟɜɨ-ɫɭɞɢɧ -ɧɢɯ ɭɫɤɥɚɞɧɟɧɶ ɩɪɢ ɊȺ, ɚɥɟ ɪɿɜɟɧɶ ɪɢɡɢɤɭ ɜɫɟ ɨɞɧɨ ɬɪɚɤɬɭɽɬɶɫɹ ɹɤ ɩɨɦɿɪɧɢɣ.ɉɪɨɬɟ, ɹɤ ɜɿɞɨɦɨ, ɊȺ ɚɫɨɰɿɸɽɬɶɫɹ ɡ ɜɢɫɨɤɢɦ ɪɢɡɢɤɨɦ ɫɟɪɰɟɜɨ -ɫɭɞɢɧɧɢɯ ɭɫɤɥɚɞɧɟɧɶ, ɨɬɠɟ ɜɢɤɨɪɢɫɬɚɧɧɹ ɬɪɚ -ɞɢɰɿɣɧɨʀ ɲɤɚɥɢ SCORE ɧɟ ɩɨɜɧɿɫɬɸ ɜɿɞɨɛɪɚɠɚɽ ɪɢɡɢɤ ɭ ɰɿɽʀ ɤɚɬɟɝɨɪɿʀ ɯɜɨɪɢɯ. Ɇɨɠɥɢɜɨ,ɳɨ ɫɚɦɟ ɦɟɬɨɞɢ ɜɿɡɭɚɥɿɡɚɰɿʀ ɽ ɜɚɠɥɢɜɢɦɢ ɩɪɢ ɨɰɿɧɰɿ ɪɢɡɢɤɭ ɋɋɁ ɩɪɢ ɊȺ,ɡɨɤɪɟɦɚ ɜ ɭɦɨɜɚɯ ɩɨɽɞɧɚɧɧɹ ɡ ȺȽ, ɨɠɢɪɿɧɧɹɦ. Ɍɚɤ, ɜ ȯɜɪɨɩɟɣɫɶɤɢɯ ɪɟɤɨɦɟɧ -ɞɚɰɿɹɯ ɡ ɩɪɨɮɿɥɚɤɬɢɤɢ ɫɟɪɰɟɜɨ-ɫɭɞɢɧɧɢɯ ɡɚɯɜɨ -ɪɸɜɚɧɶ (ɩɟɪɟɝɥɹɞɭ 2012 ɪ.) ɜɤɚɡɭɽɬɶɫɹ, ɳɨ ɭɥɶ -ɬɪɚɡɜɭɤɨɜɟ ɞɨɫɥɿɞɠɟɧɧɹ ɫɨɧɧɢɯ ɚɪɬɟɪɿɣ ɽ ɞɨ -ɰɿɥɶɧɢɦ ɞɥɹ ɨɰɿɧɤɢ ɪɢɡɢɤɭ ɛɟɡɫɢɦɩɬɨɦɧɢɯ ɨɫɿɛ ɡ ɩɨɦɿɪɧɢɦ ɪɢɡɢɤɨɦ [14], ɚɥɟ ɜɨɞɧɨɱɚɫ ɪɟɤɨɦɟɧ

-ɞɚɰɿɣ ɳɨɞɨ ɦɟɬɨɞɢɤɢ ɜɪɚɯɭɜɚɧɧɹ ɞɥɹ ɜɢɡɧɚɱɟɧɧɹ ɿɧɞɢɜɿɞɭɚɥɶɧɨɝɨ ɪɢɡɢɤɭ ɩɪɢ ɊȺ ɧɟ ɧɚɞɚɽɬɶɫɹ.

ɋɥɿɞ ɬɚɤɨɠ ɡɚɡɧɚɱɢɬɢ, ɳɨ ɬɪɚɞɢɰɿɣɧɢɣ ɬɚ ɪɨɡɪɚɯɭɧɤɨɜɢɣ ɪɿɜɧɿ ɪɢɡɢɤɭ ɡɚ SCORE ɛɭɥɢ ɞɨɫɬɨɜɿɪɧɨ ɜɢɳɢɦɢ ɫɚɦɟ ɫɟɪɟɞ ɩɚɰɿɽɧɬɿɜ ɡ ɧɚɞ -ɥɢɲɤɨɜɨɸ ɦɚɫɨɸ ɬɿɥɚ ɩɨɪɿɜɧɹɧɨ ɡ ɩɚɰɿɽɧɬɚɦɢ ɡ ɧɨɪɦɚɥɶɧɨɸ ɦɚɫɨɸ ɬɿɥɚ ɬɚ ɨɠɢɪɿɧɧɹɦ 1-2 ɫɬɭ -ɩɟɧɹ. ȼɫɬɚɧɨɜɥɟɧɨ ɩɪɹɦɢɣ ɤɨɪɟɥɹɰɿɣɧɢɣ ɡɜ'ɹɡɨɤ ɦɿɠ ɪɢɡɢɤɨɦ ɫɟɪɰɟɜɨ-ɫɭɞɢɧɧɢɯ ɭɫɤɥɚɞɧɟɧɶ ɡɚ SCORE ɬɚ ȱɆɌ (r=0,39, ɪ<0,05), ɡɛɿɥɶɲɟɧɧɹɦ ɤɨɥɚ ɬɚɥɿʀ (r=0,62, ɪ<0,05) ɬɚ ɩɨɤɚɡɧɢɤɨɦ BSA (r=0,57, ɪ<0,05). Ɂɚɡɧɚɱɟɧɿ ɪɟɡɭɥɶɬɚɬɢ ɦɨɠɥɢɜɨ ɡɭɦɨɜɥɟɧɿ ɡɦɿɧɨɸ ɫɨɦɚɬɨɬɢɩɨɥɨɝɿɱɧɢɯ ɩɨɤɚɡɧɢ -ɤɿɜ ɩɪɢ ɊȺ, ɩɨɜ’ɹɡɚɧɢɯ ɡɿ ɡɧɢɠɟɧɧɹɦ ɦ'ɹɡɨɜɨʀ ɦɚɫɢ ɧɚ ɬɥɿ ɩɿɞɜɢɳɟɧɨɝɨ ɧɚɤɨɩɢɱɟɧɧɹ ɠɢɪɨɜɨʀ ɬɤɚɧɢɧɢ, ɚɞɠɟ ɩɪɢ ɰɶɨɦɭ ɜɚɝɚ ɬɿɥɚ ɡɚɥɢɲɚɽɬɶɫɹ ɫɬɚɛɿɥɶɧɨɸ ɚɛɨ ɡɪɨɫɬɚɽ ɧɟɡɧɚɱɧɨ [7]. ɉɪɨɬɟ ȱɆɌ ɧɟ ɜɪɚɯɨɜɭɽ ɰɢɯ ɡɦɿɧ, ɬɨɦɭ ɭ ɡɜ’ɹɡɤɭ ɡɿ ɡɦɿɧɚɦɢ ɫɨɦɚɬɨɬɢɩɨɥɨɝɿɱɧɢɯ ɩɨɤɚɡɧɢɤɿɜ ɩɚɰɿɽɧɬɿɜ ɡ ɊȺ ɡɞɚɽɬɶɫɹ ɣɦɨɜɿɪɧɢɦ, ɳɨ ɦɟɬɨɞɢ ɨɰɿɧɤɢ ɨɠɢɪɿɧɧɹ ɫɟɪɟɞ ɧɚɫɟɥɟɧɧɹ ɜ ɰɿɥɨɦɭ ɧɟ ɦɨɠɭɬɶ ɛɭɬɢ ɩɪɢɣɧɹɬ -ɧɢɦɢ ɩɪɢ ɊȺ,ɳɨ ɩɨɬɪɟɛɭɽ ɩɨɞɚɥɶɲɨɝɨ ɜɢɜɱɟɧɧɹ.

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ɯɜɨɪɨɝɨ ɧɚ ɪɟɜɦɚɬɨʀɞɧɢɣ ɚɪɬɪɢɬ ɬɚ ɚɫɨɰɿɸ ɜɚɥɚɫɶ ɿɡ ɬɪɚɞɢɰɿɣɧɢɦɢ ɮɚɤɬɨɪɚɦɢ ɪɢɡɢɤɭ (ɜɿɤ, ɨɠɢɪɿɧɧɹ), ɫɟɪɨɩɨɡɢɬɢɜɧɿɫɬɸ ɡɚ ɪɟɜɦɚɬɨʀɞɧɢɦ ɮɚɤ -ɬɨɪɨɦ,ɝɿɩɟɪɭɪɿɤɟɦɿɽɸ ɬɚ ɬɪɢɜɚɥɿɫɬɸ ɩɪɢɣɨɦɭ ɝɥɸ -ɤɨɤɨɪɬɢɤɨʀɞɿɜ. 10-ɪɿɱɧɢɣ ɪɢɡɢɤ ɮɚɬɚɥɶɧɢɯ ɫɟɪɰɟɜɨ -ɫɭɞɢɧɧɢɯ ɩɨɞɿɣ ɡɚ ɲɤɚɥɨɸ SCORE ɭ ɯɜɨɪɢɯ ɧɚ ɪɟɜɦɚɬɨʀɞɧɢɣ ɚɪɬɪɢɬ ɫɬɚɧɨɜɢɜ 1,48±1,94%, ɡ ɭɪɚɯɭ -ɜɚɧɧɹɦ ɤɨɟɮɿɰɿɽɧɬɭ 1,5 – 1,98±2,53%, ɳɨ ɜɜɚ -ɠɚɽɬɶɫɹ ɫɟɪɟɞɧɿɦ ɪɿɜɧɟɦ ɪɢɡɢɤɭ.

ɜɫɬɚɧɨɜɥɟɧɿ ɭ ɯɜɨɪɢɯ ɧɚ ɪɟɜɦɚɬɨʀɞɧɢɣ ɚɪɬɪɢɬ. ȱɧɞɟɤɫ ɦɚɫɢ ɬɿɥɚ ɚɫɨɰɿɸɜɚɜɫɹ ɡ ɬɪɢɜɚɥɿɫɬɸ ɪɟɜɦɚɬɨʀɞɧɨɝɨ ɚɪɬɪɢɬɭ, ɚɤɬɢɜɧɿɫɬɸ ɡɚɩɚɥɶɧɨɝɨ ɩɪɨɰɟɫɭ, ɬɪɢɜɚɥɿɫɬɸ ɬɟɪɚɩɿʀ ɝɥɸɤɨɤɨɪɬɢɤɨʀɞɚɦɢ. ɉɚɰɿɽɧɬɢ ɡ ɧɚɞɥɢɲɤɨɜɨɸ ɦɚɫɨɸ ɬɿɥɚ ɦɚɥɢ ɧɚɣɛɿɥɶɲɢɣ ɪɿɜɟɧɶ ɩɨɤɚɡɧɢɤɿɜ ɡɚɩɚɥɟɧɧɹ,ɪɢɡɢɤ ɫɟɪɰɟɜɨ-ɫɭɞɢɧɧɢɯ ɭɫɤɥɚɞɧɟɧɶ.

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1. Ʉɨɜɚɥɟɧɤɨ ȼ.Ɇ. ɇɨɦɟɧɤɥɚɬɭɪɚ, ɤɥɚɫɢɮɿɤɚɰɿɹ, ɤɪɢɬɟɪɿʀ ɞɿɚɝɧɨɫɬɢɤɢ ɬɚ ɩɪɨɝɪɚɦɢ ɥɿɤɭɜɚɧɧɹ ɪɟɜɦɚ -ɬɢɱɧɢɯ ɯɜɨɪɨɛ / ȼ.Ɇ. Ʉɨɜɚɥɟɧɤɨ, ɇ.Ɇ. ɒɭɛɚ – Ʉ.: Ʉɚɬɪɚɧ ɝɪɭɩ, 2002. – 214 ɫ.

2. Ʉɭɪɹɬɚ Ɉ.ȼ. Ɏɚɤɬɨɪɢ ɪɢɡɢɤɭ ɬɚ ɫɭɛɤɥɿɧɿɱɧɿ ɩɪɨɹɜɢ ɚɬɟɪɨɫɤɥɟɪɨɡɭ ɭ ɯɜɨɪɢɯ ɧɚ ɫɢɫɬɟɦɧɢɣ ɱɟɪɜɨ -ɧɢɣ ɜɨɜɱɚɤ / Ɉ.ȼ.Ʉɭɪɹɬɚ,Ɉ.ɘ.ɇɨɞɚ,Ɍ.Ʉ.Ʌɢɫɭɧɟɰɶ // ɍɤɪ.ɪɟɜɦɚɬɨɥ.ɠɭɪɧɚɥ. – 2011. – ʋ3(45) – ɋ. 82-87.

3. ɉɨɩɤɨɜɚ Ɍ.ȼ. Ɏɚɤɬɨɪɵ ɪɢɫɤɚ ɤɚɪɞɢɨɜɚɫɤɭ -ɥɹɪɧɵɯ ɡɚɛɨɥɟɜɚɧɢɣ ɩɪɢ ɪɟɜɦɚɬɨɢɞɧɨɦ ɚɪɬɪɢɬɟ / Ɍ.ȼ. ɉɨɩɤɨɜɚ,Ⱦ.ɋ.ɇɨɜɢɤɨɜɚ,ȼ.ȼ.ɉɢɫɚɪɟɜ // ɇɚɭɱ.-ɩɪɚɤɬ. ɪɟɜɦɚɬɨɥɨɝɢɹ. – 2009. – ʋ 3 – ɋ. 4-11.

4. ɉɪɨ ɡɚɬɜɟɪɞɠɟɧɧɹ ɩɪɨɬɨɤɨɥɿɜ ɧɚɞɚɧɧɹ ɦɟɞɢɱ -ɧɨʀ ɞɨɩɨɦɨɝɢ ɡɚ ɫɩɟɰɿɚɥɶɧɿɫɬɸ «Ɋɟɜɦɚɬɨɥɨɝɿɹ»:ɧɚɤɚɡ ɆɈɁ ɍɤɪɚʀɧɢ ʋ 676 ɜɿɞ 12.10.2006 / Ɉɮɿɰɿɣɧɢɣ ɫɚɣɬ ɆɈɁ ɍɤɪɚʀɧɢ.Ɋɟɠɢɦ ɞɨɫɬɭɩɭ: (www.moz.gov.ua).

5. ɉɪɨ ɡɚɬɜɟɪɞɠɟɧɧɹ ɬɚ ɜɩɪɨɜɚɞɠɟɧɧɹ ɦɟɞɢɤɨ -ɬɟɯɧɨɥɨɝɿɱɧɢɯ ɞɨɤɭɦɟɧɬɿɜ ɡɿ ɫɬɚɧɞɚɪɬɢɡɚɰɿʀ ɦɟɞɢɱɧɨʀ ɞɨɩɨɦɨɝɢ ɩɪɢ ɚɪɬɟɪɿɚɥɶɧɿɣ ɝɿɩɟɪɬɟɧɡɿʀ: ɧɚɤɚɡ ɆɈɁ ɍɤɪɚʀɧɢ ʋ 384 ɜɿɞ 24.05.2012 ɪ. / Ɉɮɿɰɿɣɧɢɣ ɫɚɣɬ ɆɈɁ ɍɤɪɚʀɧɢ.Ɋɟɠɢɦ ɞɨɫɬɭɩɭ: (www.moz.gov.ua).

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

7. Associations of obesity with modifiable risk factors for the development of cardiovascular disease in patients with rheumatoid arthritis / A. Stavropoulos-Kalinoglou, G.S. Metsios, V.F. Panoulas [et al.] // Ann. Rheumatic Diseases. – 2009. – N 68 – Ɋ. 242-245.

8. Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis / C. Han, D.W. Robinson, M.V. Hackett [et al.] // Rheumatology. – 2006. – N 33 – Ɋ. 2167-72.

9. Cardiovascular disease in patients with rheuma-toid arthritis: results from the QUEST-RA study / A. Naranjo, T. Sokka, M.A. Descalzo [et al.] //Arthritis Research & Therapy. – 2008 – Vol. 10, N. 2: R30.

10. Meune C. Trends in cardiovascular mortality in patients with rheumatoid arthritis over 50 years: a syste-matic review and meta-analisis of cohort studies / C. Meune, E. Touze, L. Trinqurte // Rheumatology. – 2009. – Vol. 48, N 10. – Ɋ. 1309-1313.

11. Peters M.J. EULAR evidence-based recommen-dations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis / M.J. Peters, D.P. Symmons, D. McCarey // Ann. Rheumatic Diseases. – 2010. – Vol. 69 – Ɋ. 325-331.

12. Prevalence and associations of hypertension and its control in patients with rheumatoid arthritis / V.F. Pa-noulas, K.M. Douglas, H.J. Milionis, A. Stavropoulos-Kalinglou [et al.] // Rheumatology. – 2007. – Vol. 46, N 9 – P.1477-1482.

13. Prognostic importance of low body mass index in relation to cardiovascular mortality in rheumatoid arthritis / H.M. Kremers, P.J. Nicola, C.S. Crowson, K.V. Ballman [et al.] // Arthritis & Rheumatism. – 2004 – Vol. 50, N.11 –Ɋ. 3450-3457.

14. The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disea-se Prevention in Clinical Practice. European Guidelines on cardiovascular disease prevention in clinical practice: full text (update 2012) // Eur.Heart J.-2012.-Vol.33.-P.1635–1701.

15. Treatment to lipid targets in patients with inflam-matory joint diseases in a preventive cardio-rheuma clinic / Silvia Rollefstad, Tore K Kvien, Ingar Holme, Anne S Eirheim [et al.] // Ann. Rheumatic Diseases. – 2013. – Vol. 12, N 72 – Ɋ. 1968-1974.

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7. Stavropoulos-Kalinoglou A, Metsios GS, Pa-noulas VF et al. Associations of obesity with modifiable risk factors for the development of cardiovascular disease in patients with rheumatoid arthritis. J. Annals of the Rheumatic Diseases. 2009;68:242–45.

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ɋɬɚɬɬɹ ɧɚɞɿɣɲɥɚ ɞɨ ɪɟɞɚɤɰɿʀ 09.09.2014

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Ƚɍ «Ⱦɧɟɩɪɨɩɟɬɪɨɜɫɤɚɹ ɦɟɞɢɰɢɧɫɤɚɹ ɚɤɚɞɟɦɢɹ ɆɁ ɍɤɪɚɢɧɵ»

ɤɚɮɟɞɪɚ ɯɢɪɭɪɝɢɢ ʋ 2

(ɡɚɜ. – ɞ.ɦɟɞ.ɧ.,ɩɪɨɮ.Ⱥ.Ȼ.Ʉɭɬɨɜɨɣ)

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SE "Dnipropetrovsk medical academy of Health Ministry of Ukraine" Dzerzhinsky str., 9, Dnepropetrovsk, 49044, Ukraine

e-mail: korpus_i@hotmail.com

Ʉɥɸɱɨɜɿ ɫɥɨɜɚ:ɞɜɭɫɬɨɪɨɧɧɢɣ ɬɭɛɟɪɤɭɥɟɡ ɥɟɝɤɢɯ,ɜɢɞɟɨɚɫɫɢɫɬɢɪɨɜɚɧɧɚɹ ɬɨɪɚɤɨɩɥɚɫɬɢɤɚ,ɦɢɧɢɞɨɫɬɭɩ

Key words: bilateral pulmonary tuberculosis, video-assisted thoracoplastics, minimal surgical approach

Ɋɟɮɟɪɚɬ.ȿɬɚɩɧɟ ɤɨɥɚɩɫɨɯɿɪɭɪɝɿɱɧɟ ɥɿɤɭɜɚɧɧɹ ɯɜɨɪɢɯ ɧɚ ɞɜɨɛɿɱɧɢɣ ɞɟɫɬɪɭɤɬɢɜɧɢɣ ɬɭɛɟɪɤɭɥɶɨɡ ɥɟɝɟɧɿɜ. Ʉɨɪɩɭɫɟɧɤɨ ȱ.ȼ. ɍɡɚɝɚɥɶɧɟɧɨ ɞɨɫɜɿɞ ɯɿɪɭɪɝɿɱɧɨɝɨ ɥɿɤɭɜɚɧɧɹ 14 ɯɜɨɪɢɯ ɡ ɬɭɛɟɪɤɭɥɶɨɡɨɦ ɥɟɝɟɧɶ ɩɪɢ ɞɜɨɛɿɱɧɿɣ