Change in endothelial function state under the influence of antihypertensive therapy in patients with arterial hypertension and high cardiovascular risk

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ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

8. Torchins'kiy VP. [Total hip arthroplasty with useage of bone cement [dissertation PhD: 14.01.21]]. Travmatologɿya ɿ ortopedɿya. 2001:14. Ukrainian.

9. Porter M, Borroff M, Gregg P. Annual Report National Joint Registry for England, Wales and Northern Ireland [E-resource]. 10th Annual Report National Joint Registry for England, Wales and Northern Ireland, 2013. access mode: http://www.njrcentre.org.uk/njrcentre/ Portals/0/Documents/England/Reports/10th_annual_repor t/NJR 2010th Online Appendices 2013.pdf.

10. Barrack RL, Mulroy RD, Harris WH. Improved cementing techniques and femoral component loosening in young patients with hip arthroplasty. J. Bone Joint Surg. 1992;74-B:385–9.

11. Breusch SJ, Malchau H. The well-cemented total hip arthroplasty. Heidelberg: Springer; 2005:378.

12. Charnley J. Low friction arthroplasty of the hip : Theory and practice. Berlin, Heidelberg, New York, To-kyo: Springer; 1979:211.

13. Furnes O, Havelin LI, Espehaug B. The Norwegian Arthroplasty Register. Annually report. 2010:214.

14. Lübbeke A, Garavaglia G, Barea C. Why do we need hospital-based registries? The Geneva Hip Arthroplasty Registry. Geneva: Division of Orthopaedics and Trauma Surgery., Geneva University Hospitals, Geneva, Switzerland. 2010:22.

ɋɬɚɬɬɹ ɧɚɞɿɣɲɥɚ ɞɨ ɪɟɞɚɤɰɿʀ 06.12.2013

ɍȾɄ 616.12-008.331-037-08:615.224:611.018.74

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Ƚɍ «Ⱦɧɟɩɪɨɩɟɬɪɨɜɫɤɚɹ ɦɟɞɢɰɢɧɫɤɚɹ ɚɤɚɞɟɦɢɹ ɆɁ ɍɤɪɚɢɧɵ»

ɤɚɮɟɞɪɚ ɮɚɤɭɥɶɬɟɬɫɤɨɣ ɬɟɪɚɩɢɢ ɢ ɷɧɞɨɤɪɢɧɨɥɨɝɢɢ

(ɡɚɜ. – ɱɥ.-ɤɨɪ.ɇȺɆɇ ɍɤɪɚɢɧɵ,ɞ.ɦɟɞ.ɧ., ɩɪɨɮ.Ɍ.Ⱥ.ɉɟɪɰɟɜɚ)

ɩɪ.ȼɨɪɨɧɰɨɜɚ, 29, Ⱦɧɟɩɪɨɩɟɬɪɨɜɫɤ, 49023, ɍɤɪɚɢɧɚ

SE «Dnepropetrovsk medical academy of Health Ministry of Ukraine» Department of Faculty Therapy and Endocrinology

Vorontsov av., 29, Dnepropetrovsk, 49023, Ukraine e-mail: turlyunt@gmail.com

Ʉɥɸɱɟɜɵɟ ɫɥɨɜɚ:ɚɪɬɟɪɢɚɥɶɧɚɹ ɝɢɩɟɪɬɟɧɡɢɹ,ɫɚɯɚɪɧɵɣ ɞɢɚɛɟɬ 2-ɝɨ ɬɢɩɚ,ɷɧɞɨɬɟɥɢɚɥɶɧɚɹ ɞɢɫɮɭɧɤɰɢɹ,

ɷɧɞɨɬɟɥɢɧ-1, ɥɨɡɚɪɬɚɧ ɤɚɥɢɹ

Key words: arterial hypertension, diabetes mellitus type 2, endothelial dysfunction, endothelin-1, losartan potassium

Ɋɟɮɟɪɚɬ. Ɂɦɿɧɚ ɮɭɧɤɰɿɨɧɚɥɶɧɨɝɨ ɫɬɚɧɭ ɟɧɞɨɬɟɥɿɸ ɩɿɞ ɜɩɥɢɜɨɦ ɩɪɨɜɟɞɟɧɨʀ ɚɧɬɢɝɿɩɟɪɬɟɧɡɢɜɧɨʀ ɬɟɪɚɩɿʀ ɭ ɩɚɰɿɽɧɬɿɜ ɡ ɚɪɬɟɪɿɚɥɶɧɨɸ ɝɿɩɟɪɬɟɧɡɿɽɸ ɿ ɜɢɫɨɤɢɦ ɤɚɪɞɿɨɜɚɫɤɭɥɹɪɧɢɦ ɪɢɡɢɤɨɦ. Ɍɭɪɥɸɧ Ɍ.ɋ. ɍ ɫɬɚɬɬɿ

ɩɪɨɚɧɚɥɿɡɨɜɚɧɨ ɩɨɤɚɡɧɢɤɢ,ɳɨ ɯɚɪɚɤɬɟɪɢɡɭɸɬɶ ɮɭɧɤɰɿɸ ɟɧɞɨɬɟɥɿɸ ɭ ɩɚɰɿɽɧɬɿɜ ɜɢɞɿɥɟɧɢɯ ɝɪɭɩ ɧɚ ɩɨɱɚɬɤɨɜɨɦɭ

ɟɬɚɩɿ ɞɨɫɥɿɞɠɟɧɧɹ (1 ɜɿɡɢɬ)ɿ ɜ ɞɢɧɚɦɿɰɿ ɥɿɤɭɜɚɧɧɹ (2 ɜɿɡɢɬ). ɇɚ ɩɨɱɚɬɤɭ ɞɨɫɥɿɞɠɟɧɧɹ ɪɿɜɟɧɶ ɟɧɞɨɬɟɥɿɧɭ-1 ɭ

ɤɪɨɜɿ ɩɚɰɿɽɧɬɿɜ ɜɫɿɯ ɝɪɭɩ ɿɫɬɨɬɧɨ ɧɟ ɜɿɞɪɿɡɧɹɜɫɹ ɦɿɠ ɜɢɞɿɥɟɧɢɦɢ ɝɪɭɩɚɦɢ.ɉɿɫɥɹ ɥɿɤɭɜɚɧɧɹ ɞɢɧɚɦɿɤɚ ɩɨɤɚɡɧɢɤɚ ɭ

ɜɫɿɯ ɝɪɭɩɚɯ ɛɭɥɚ ɩɨɡɢɬɢɜɧɨɸ ɿ ɫɬɚɬɢɫɬɢɱɧɨ ɡɧɚɱɭɳɨɸ (ɪ<0,05): ɪɿɜɟɧɶ ȿɌ -1 ɜ ɝɪɭɩɿ ɡ Ƚɏ ɡɧɢɡɢɜɫɹ ɧɚ 7,7%,

ɛɿɥɶɲ ɜɢɪɚɠɟɧɿ ɡɦɿɧɢ ɜɿɞɡɧɚɱɚɥɢɫɹ ɜ ɝɪɭɩɿ ɯɜɨɪɢɯ Ƚɏ ɡ ɐȾ 2-ɝɨ ɬɢɩɭ - ɩɨɤɚɡɧɢɤ ɡɧɢɡɢɜɫɹ ɧɚ 21,7 % (ɪ<0,05), ɳɨ

ɫɜɿɞɱɢɬɶ ɩɪɨ ɡɧɢɠɟɧɧɹ ɭɬɜɨɪɟɧɧɹ ɟɧɞɨɬɟɥɿɧɭ-1 ɿ ɧɚɞɯɨɞɠɟɧɧɹ ɣɨɝɨ ɜ ɤɪɨɜ.ɉɪɢ ɩɨɪɿɜɧɹɧɧɿ ɞɨɫɥɿɞɠɭɜɚɧɢɯ ɝɪɭɩ

(2)

ɪɿɜɧɹ ȿɌ - 1 ɿ ɜ ɝɪɭɩɿ ɡ ɐȾ 2-ɝɨ ɬɢɩɭ,ɚɥɟ ɫɬɚɬɢɫɬɢɱɧɨ ɧɟɞɨɫɬɨɜɿɪɧɨ (ɪ<0,233). ɉɿɞ ɜɩɥɢɜɨɦ ɩɪɢɣɨɦɭ ɥɨɡɚɪɬɚɧɭ

ɤɚɥɿɸ ɡ ɝɿɞɪɨɯɥɨɪɬɿɚɡɢɞɨɦ ɫɟɪɟɞɧɿɣ ɩɨɤɚɡɧɢɤ ɚɥɶɛɭɦɿɧɭɪɿʀ ɡɧɢɡɢɜɫɹ ɜ ɝɪɭɩɚɯ ɯɜɨɪɢɯ ɡ Ƚɏ ɿ Ƚɏ ɡ ɐȾ 2-ɝɨ ɬɢɩɭ (ɪ<0,05). ɍ ɝɪɭɩɿ ɯɜɨɪɢɯ ɡ ɐȾ 2-ɝɨ ɬɢɩɭ,ɹɤɿ ɧɟ ɩɪɢɣɦɚɥɢ ɚɧɬɢɝɿɩɟɪɬɟɧɡɢɜɧɿ ɩɪɟɩɚɪɚɬɢ,ɩɨɤɚɡɧɢɤ ɧɟ ɡɦɿɧɢɜɫɹ (ɪ>0,60).

Abstract. Change in endothelial function state under the influence of antihypertensive therapy in patients with arterial hypertension and high cardiovascular risk. Turlyun T.S.The article analyzes the indicators characterizing endothelial function in patients of distinguished groups at the initial stage of the study (visit 1) and during the treatment (visit 2). At baseline levels of endothelin-1 in the blood of patients of all groups did not differ significantly between the groups distinguished. After treatment, the dynamics of the indicator in all groups was positive and statistically significant (p<0,05): the level of ET-1 in the group with HD decreased by 7,7%, more pronounced changes were observed in hypertensive patients with type 2 diabetes - indicator decreased by 21,7% (p<0,05), testifying to reducing of endothelin-1 formation and its entering to the blood. When comparing control and treatment groups (0,37±0,06 fmol/ml) a twofold excess of endothelin-1 in hypertensive groups (p<0,01) and in patients with hypertension and diabetes mellitus type 2 (p<0,01) was observed. After the treatment with losartan potassium and hydrochlorothiazide, a statistically significant reduction of ET-1 in the group without hypertension comorbidity (p<0,004) and in the group of hypertensive type 2 diabetic (p<0,004) was noted. Dynamics of ET-1 decrease in the group with type 2 diabetes, but statistically unreliable (p<0,233) was noted. Under the influence of losartan potassium and hydrochlorothiazide average albuminuria level decreased in groups of patients with hypertension and hypertension with type 2 diabetes (p<0,05). In patients with type 2 diabetes who were not taking antihypertensive drugs, the rate did not change (p>0,60).

Ⱥɪɬɟɪɢɚɥɶɧɚɹ ɝɢɩɟɪɬɟɧɡɢɹ (ȺȽ)ɹɜɥɹɟɬɫɹ ɧɚɢ

-ɛɨɥɟɟ ɪɚɫɩɪɨɫɬɪɚɧɟɧɧɵɦ ɢ ɫɨɰɢɚɥɶɧɨ ɡɧɚɱɢɦɵɦ ɡɚɛɨɥɟɜɚɧɢɟɦ ɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɨɣ ɫɢɫɬɟɦɵ,

ɨɫɧɨɜɧɵɦ ɮɚɤɬɨɪɨɦ ɪɢɫɤɚ ɪɚɡɜɢɬɢɹ ɫɟɪɶɟɡɧɵɯ ɨɫɥɨɠɧɟɧɢɣ ɢ ɫɦɟɪɬɧɨɫɬɢ [1, 2]. Ʉ ɪɚɧɧɢɦ ɦɚɪ

-ɤɟɪɚɦ ɫɨɫɭɞɢɫɬɵɯ ɧɚɪɭɲɟɧɢɣ ɩɪɢ ȺȽ ɨɬɧɨɫɢɬɫɹ ɷɧɞɨɬɟɥɢɚɥɶɧɚɹ ɞɢɫɮɭɧɤɰɢɹ (ɗȾ), ɤɨɬɨɪɚɹ ɧɟ

ɬɨɥɶɤɨ ɫɨɩɪɨɜɨɠɞɚɟɬ ȺȽ, ɧɨ ɢ ɪɚɫɫɦɚɬɪɢɜɚɟɬɫɹ

ɤɚɤ ɪɚɧɧɢɣ ɮɚɤɬɨɪ ɪɢɫɤɚ ɚɬɟɪɨɫɤɥɟɪɨɡɚ ɢ ɚɬɟɪɨ

-ɬɪɨɦɛɨɡɚ [4, 5, 6].

ɇɚɪɹɞɭ ɫ ɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɨɣ ɩɚɬɨɥɨɝɢɟɣ

ɫɟɪɶɟɡɧɭɸ ɦɟɞɢɤɨ-ɫɨɰɢɚɥɶɧɭɸ ɩɪɨɛɥɟɦɭ ɩɪɟɞ

-ɫɬɚɜɥɹɟɬ ɫɚɯɚɪɧɵɣ ɞɢɚɛɟɬ (ɋȾ),ɱɬɨ ɨɛɭɫɥɨɜɥɟɧɨ

ɟɝɨ ɜɵɫɨɤɨɣ ɪɚɫɩɪɨɫɬɪɚɧɟɧɧɨɫɬɶɸ, ɫɨɯɪɚɧɹɸ

-ɳɟɣɫɹ ɬɟɧɞɟɧɰɢɟɣ ɤ ɪɨɫɬɭ ɡɚɛɨɥɟɜɚɟɦɨɫɬɢ,

ɯɪɨɧɢɱɟɫɤɢɦ ɬɟɱɟɧɢɟɦ, ɨɩɪɟɞɟɥɹɸɳɢɦ ɤɭɦɭɥɹ

-ɬɢɜɧɵɣ ɯɚɪɚɤɬɟɪ ɡɚɛɨɥɟɜɚɧɢɹ, ɜɵɫɨɤɨɣ ɢɧɜɚɥɢ

-ɞɢɡɚɰɢɟɣ ɛɨɥɶɧɵɯ ɬɪɭɞɨɫɩɨɫɨɛɧɨɝɨ ɜɨɡɪɚɫɬɚ. ȼ

ɧɚɫɬɨɹɳɟɟ ɜɪɟɦɹ ɜ ɫɬɪɭɤɬɭɪɟ ɢɧɜɚɥɢɞɢɡɚɰɢɢ ɢ ɫɦɟɪɬɧɨɫɬɢ ɛɨɥɶɧɵɯ ɋȾ 2 ɬɢɩɚ ɜɟɞɭɳɟɟ ɦɟɫɬɨ

ɡɚɧɢɦɚɟɬ ɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɚɹ ɩɚɬɨɥɨɝɢɹ – ɨɫɥɨ

-ɠɧɟɧɢɹ ɤɨɪɨɧɚɪɧɨɝɨ ɚɬɟɪɨɫɤɥɟɪɨɡɚ, ɢɲɟɦɢɱɟɫ

-ɤɚɹ ɛɨɥɟɡɧɶ ɫɟɪɞɰɚ, ȺȽ. ɗɬɨ ɨɩɪɟɞɟɥɹɟɬ ɧɟɨɛɯɨ

-ɞɢɦɨɫɬɶ ɛɨɥɟɟ ɞɟɬɚɥɶɧɨɝɨ ɢɡɭɱɟɧɢɹ ɩɚɬɨɝɟɧɟɡɚ ɞɢɚɛɟɬɢɱɟɫɤɨɣ ɦɚɤɪɨɚɧɝɢɨɩɚɬɢɢ, ɮɭɧɤɰɢɢ ɷɧɞɨ

-ɬɟɥɢɹ ɢ ɟɟ ɪɨɥɢ ɜ ɮɨɪɦɢɪɨɜɚɧɢɢ ȺȽ ɭ ɛɨɥɶɧɵɯ ɋȾ 2-ɝɨ ɬɢɩɚ [10, 11, 12].

ȺȽ ɡɧɚɱɢɬɟɥɶɧɨ ɱɚɳɟ ɨɬɦɟɱɚɟɬɫɹ ɭ ɛɨɥɶɧɵɯ ɋȾ ɩɨ ɫɪɚɜɧɟɧɢɸ ɫ ɩɨɤɚɡɚɬɟɥɟɦ ɪɚɫɩɪɨɫɬɪɚ

-ɧɟɧɧɨɫɬɢ ɝɢɩɟɪɬɟɧɡɢɢ ɜ ɨɛɳɟɣ ɩɨɩɭɥɹɰɢɢ. ɍɫ

-ɬɚɧɨɜɥɟɧɨ,ɱɬɨ ɩɨɜɵɲɟɧɢɟ ȺȾ ɹɜɥɹɟɬɫɹ ɨɞɧɢɦ ɢɡ

ɜɚɠɧɟɣɲɢɯ ɮɚɤɬɨɪɨɜ ɪɢɫɤɚ ɪɚɡɜɢɬɢɹ ɢ ɩɪɨɝɪɟɫ

-ɫɢɪɨɜɚɧɢɹ ɞɢɚɛɟɬɢɱɟɫɤɢɯ ɦɢɤɪɨ- ɢ ɦɚɤɪɨ

-ɚɧɝɢɨɩɚɬɢɣ,ɚ ɫɧɢɠɟɧɢɟ ȺȾ,ɧɚɩɪɨɬɢɜ, ɩɪɢɜɨɞɢɬ

ɤ ɡɧɚɱɢɬɟɥɶɧɨɦɭ ɫɧɢɠɟɧɢɸ ɪɢɫɤɚ ɮɨɪɦɢɪɨɜɚɧɢɹ ɭɤɚɡɚɧɧɵɯ ɨɫɥɨɠɧɟɧɢɣ ɋȾ. Ɍɚɤ, ɜ ɢɫɫɥɟɞɨɜɚɧɢɢ UK Prospective Diabetes Study (UKPDS) [4],

ɹɜɢɜɲɟɦɫɹ ɧɚɢɛɨɥɟɟ ɤɪɭɩɧɵɦ ɢ ɜɚɠɧɵɦ ɢɫ

-ɫɥɟɞɨɜɚɧɢɟɦ ɜ ɨɛɥɚɫɬɢ ɋȾ 2-ɝɨ ɬɢɩɚ, ɛɵɥɨ ɭɫɬɚ

-ɧɨɜɥɟɧɨ, ɱɬɨ ɫɧɢɠɟɧɢɟ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɫɢɫɬɨɥɢ

-ɱɟɫɤɨɝɨ ɞɚɜɥɟɧɢɹ ɧɚ 10 ɦɦ ɪɬ.ɫɬ. ɩɪɢɜɨɞɢɬ ɤ

ɫɧɢɠɟɧɢɸ ɪɢɫɤɚ ɪɚɡɜɢɬɢɹ ɨɫɥɨɠɧɟɧɢɣ ɋȾ ɧɚ

12%, ɫɦɟɪɬɧɨɫɬɢ, ɧɟɩɨɫɪɟɞɫɬɜɟɧɧɨ ɨɛɭɫɥɨɜɥɟɧ

-ɧɨɣ ɞɢɚɛɟɬɨɦ, — ɧɚ 15%, ɢɧɮɚɪɤɬɚ ɦɢɨɤɚɪɞɚ —

ɧɚ 11%, ɦɢɤɪɨɫɨɫɭɞɢɫɬɵɯ ɨɫɥɨɠɧɟɧɢɣ — ɧɚ 13%. Ɍɚɤɢɦ ɨɛɪɚɡɨɦ, ɫɜɨɟɜɪɟɦɟɧɧɨɟ ɜɵɹɜɥɟɧɢɟ

ȺȽ ɢ ɧɚɡɧɚɱɟɧɢɟ ɚɞɟɤɜɚɬɧɨɣ ɬɟɪɚɩɢɢ ɪɚɫɫɦɚɬɪɢ

-ɜɚɟɬɫɹ ɜ ɧɚɫɬɨɹɳɟɟ ɜɪɟɦɹ ɤɚɤ ɨɞɧɨ ɢɡ ɜɚɠɧɟɣɲɢɯ ɧɚɩɪɚɜɥɟɧɢɣ ɩɪɨɮɢɥɚɤɬɢɤɢ ɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫ

-ɬɵɯ ɢ ɦɢɤɪɨɫɨɫɭɞɢɫ-ɬɵɯ ɨɫɥɨɠɧɟɧɢɣ ɭ ɩɚɰɢɟɧ

-ɬɨɜ,ɫɬɪɚɞɚɸɳɢɯ ɋȾ [3, 4, 11].

ȼɡɚɢɦɨɫɜɹɡɶ ɦɟɠɞɭ ɩɨɜɵɲɟɧɧɵɦ ɭɪɨɜɧɟɦ ɢɧɫɭɥɢɧɚ ɢ ɪɢɫɤɨɦ ɤɚɪɞɢɨɜɚɫɤɭɥɹɪɧɵɯ ɫɨɛɵɬɢɣ ɛɵɥɚ ɩɨɤɚɡɚɧɚ ɫɪɚɜɧɢɬɟɥɶɧɨ ɧɟɞɚɜɧɨ. Ⱦɨɤɚɡɚɧɨ

ɩɪɨɚɬɟɪɨɝɟɧɧɨɟ ɜɥɢɹɧɢɟ ɢɧɫɭɥɢɧɚ, ɤɨɬɨɪɨɟ ɩɪɨ

-ɹɜɥɹɟɬɫɹ ɩɨɬɟɧɰɢɚɰɢɟɣ ɚɬɟɪɨɝɟɧɟɡɚ ɢ ɫɬɢɦɭ

-ɥɹɰɢɟɣ ɥɨɤɚɥɶɧɨɣ ɩɪɨɞɭɤɰɢɢ ɚɧɝɢɨɬɟɧɡɢɧɚ ȱȱ.

ɉɨɷɬɨɦɭ ɜ ɪɟɤɨɦɟɧɞɚɰɢɹɯ ȿɜɪɨɩɟɣɫɤɨɝɨ ɨɛ

-ɳɟɫɬɜɚ ɩɨ ȺȽ 2007 ɝɨɞɚ ɩɪɟɩɚɪɚɬɚɦɢ ɜɵɛɨɪɚ ɜ

ɥɟɱɟɧɢɢ ɩɚɰɢɟɧɬɨɜ ɫ ɋȾ 2-ɝɨ ɬɢɩɚ ɢ ɦɟɬɚ

-ɛɨɥɢɱɟɫɤɢɦ ɫɢɧɞɪɨɦɨɦ ɛɵɥɢ ɛɥɨɤɚɬɨɪɵ ɪɟɧɢɧ

-ɚɧɝɢɨɬɟɧɡɢɧ-ɚɥɶɞɨɫɬɟɪɨɧɨɜɨɣ ɫɢɫɬɟɦɵ — ɫɚɪ

-ɬɚɧɵ ɢ ɢɧɝɢɛɢɬɨɪɵ ȺɉɎ [7, 8]. Ⱦɨɤɚɡɚɧɧɵɦ

(3)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

ɫɩɨɫɨɛɫɬɜɭɟɬ ɫɧɢɠɟɧɢɸ ɭɪɨɜɧɹ ɢɧɫɭɥɢɧɚ ɧɚɬɨ

-ɳɚɤ ɭ ɩɚɰɢɟɧɬɨɜ ɫ ȽȻ ɧɚ ɮɨɧɟ ɋȾ 2-ɝɨ ɬɢɩɚ,

ɩɨɜɵɲɚɟɬ ɱɭɜɫɬɜɢɬɟɥɶɧɨɫɬɶ ɤ ɢɧɫɭɥɢɧɭ ɢ ɨɤɚɡɵ

-ɜɚɟɬ ɩɨɥɨɠɢɬɟɥɶɧɨɟ ɜɥɢɹɧɢɟ ɧɚ ɥɢɩɢɞɧɵɣ ɨɛɦɟɧ

[9, 11].

ɗȾ ɯɚɪɚɤɬɟɪɢɡɭɟɬɫɹ ɫɞɜɢɝɨɦ ɜ ɪɚɛɨɬɟ ɷɧɞɨ

-ɬɟɥɢɹ ɜ ɫɬɨɪɨɧɭ ɭɦɟɧɶɲɟɧɢɹ ɜɚɡɨɞɢɥɚɬɚɰɢɢ,

ɩɪɨɜɨɫɩɚɥɢɬɟɥɶɧɨɝɨ ɫɨɫɬɨɹɧɢɹ ɢ ɩɪɨɬɪɨɦɛɨɬɢ

-ɱɟɫɤɢɯ ɫɜɨɣɫɬɜ. ɉɨɷɬɨɦɭ ɤɥɢɧɢɱɟɫɤɚɹ ɨɰɟɧɤɚ

ɫɨɫɬɨɹɧɢɹ ɷɧɞɨɬɟɥɢɹ ɧɟɨɛɯɨɞɢɦɚ ɞɥɹ ɛɨɥɟɟ ɪɚɧɧɟɝɨ ɜɵɹɜɥɟɧɢɹ ɩɪɢɡɧɚɤɨɜ ɷɧɞɨɬɟɥɢɚɥɶɧɨɣ ɞɢɫɮɭɧɤɰɢɢ ɫ ɰɟɥɶɸ ɞɚɥɶɧɟɣɲɟɝɨ ɜɨɡɞɟɣɫɬɜɢɹ ɧɚ ɷɧɞɨɬɟɥɢɣ ɡɚɜɢɫɢɦɵɟ ɦɟɯɚɧɢɡɦɵ ɮɨɪɦɢɪɨ

-ɜɚɧɢɹ ȺȽ, ɫɧɢɠɟɧɢɟ ɪɚɡɧɵɯ ɤɚɪɞɢɨɜɚɫɤɭɥɹɪɧɵɯ

ɪɢɫɤɨɜ, ɱɬɨ ɦɨɠɟɬ ɫɩɨɫɨɛɫɬɜɨɜɚɬɶ ɫɨɯɪɚɧɟɧɢɸ

ɮɭɧɤɰɢɢ ɨɪɝɚɧɨɜ-ɦɢɲɟɧɟɣ ɢ ɡɚɦɟɞɥɢɬɶ ɩɪɨɝɪɟɫ

-ɫɢɪɨɜɚɧɢɟ ɪɟɦɨɞɟɥɢɪɭɸɳɢɯ ɩɪɨɰɟɫɫɨɜ [4, 7, 8].

Ɉɞɧɢɦɢ ɢɡ ɧɚɢɛɨɥɟɟ ɦɨɳɧɵɯ ɫɨɫɭɞɨɫɭɠɢ

-ɜɚɸɳɢɯ ɜɟɳɟɫɬɜ ɹɜɥɹɸɬɫɹ ɷɧɞɨɬɟɥɢɧɵ. ɂɯ ɫɟ

-ɦɟɣɫɬɜɨ ɫɨɫɬɨɢɬ ɢɡ ɬɪɟɯ ɫɯɨɞɧɵɯ ɩɨ ɫɬɪɭɤɬɭɪɟ ɩɟɩɬɢɞɨɜ - ɷɧɞɨɬɟɥɢɧɚ-1 (ɗɌ-1), ɷɧɞɨɬɟɥɢɧɚ-2 ɢ

ɷɧɞɨɬɟɥɢɧɚ-3, ɩɪɢ ɷɬɨɦ ɬɨɥɶɤɨ ɩɟɪɜɵɣ ɬɢɩ

ɫɢɧɬɟɡɢɪɭɟɬɫɹ ɷɧɞɨɬɟɥɢɚɥɶɧɵɦɢ ɤɥɟɬɤɚɦɢ. ȼ

ɮɢɡɢɨɥɨɝɢɱɟɫɤɢɯ ɤɨɧɰɟɧɬɪɚɰɢɹɯ ɨɧ ɞɟɣɫɬɜɭɟɬ ɧɚ ɷɧɞɨɬɟɥɢɚɥɶɧɵɟ ɪɟɰɟɩɬɨɪɵ, ɜɵɡɵɜɚɹ ɜɵɫɜɨɛɨɠ

-ɞɟɧɢɟ ɮɚɤɬɨɪɨɜ ɪɟɥɚɤɫɚɰɢɢ, ɚ ɜ ɛɨɥɟɟ ɜɵɫɨɤɢɯ -

ɚɤɬɢɜɢɪɭɟɬ ɪɟɰɟɩɬɨɪɵ ɧɚ ɝɥɚɞɤɨɦɵɲɟɱɧɵɯ ɤɥɟɬ

-ɤɚɯ, ɫɬɢɦɭɥɢɪɭɹ ɫɬɨɣɤɭɸ ɜɚɡɨɤɨɧɫɬɪɢɤɰɢɸ. ɂɡ

-ɜɟɫɬɧɨ, ɱɬɨ ɫɢɧɬɟɡ ɷɧɞɨɬɟɥɢɧɚ-1 ɜɨ ɦɧɨɝɨɦ

ɨɩɪɟɞɟɥɹɟɬ ɞɢɫɮɭɧɤɰɢɸ ɷɧɞɨɬɟɥɢɹ, ɤɨɬɨɪɚɹ ɹɜ

-ɥɹɟɬɫɹ ɩɭɫɤɨɜɵɦ ɦɟɯɚɧɢɡɦɨɦ ɜ ɩɚɬɨɝɟɧɟɡɟ ɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɨɣ ɩɚɬɨɥɨɝɢɢ (ɚɬɟɪɨɫɤɥɟɪɨɡ,

ȺȽ,ɬɪɨɦɛɨɨɛɪɚɡɨɜɚɧɢɟ) [5].

ɐɟɥɶ ɢɫɫɥɟɞɨɜɚɧɢɹ: ɨɰɟɧɢɬɶ ɜɥɢɹɧɢɟ ɩɪɨɜɨ

-ɞɢɦɨɣ ɬɟɪɚɩɢɢ ɧɚ ɭɪɨɜɟɧɶ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɞɚɜ

-ɥɟɧɢɹ ɢ ɜɵɪɚɠɟɧɧɨɫɬɶ ɧɚɪɭɲɟɧɢɣ ɮɭɧɤɰɢɨ

-ɧɚɥɶɧɨɝɨ ɫɨɫɬɨɹɧɢɹ ɷɧɞɨɬɟɥɢɹ ɭ ɩɚɰɢɟɧɬɨɜ ɫ ȽȻ

II ɫɬɚɞɢɢ, 2 ɫɬɟɩɟɧɢ ɢ ɜɵɫɨɤɢɦ ɤɚɪɞɢɨɜɚɫɤɭ

-ɥɹɪɧɵɦ ɪɢɫɤɨɦ.

ɆȺɌȿɊɂȺɅɕ ɂ ɆȿɌɈȾɕ ɂɋɋɅȿȾɈȼȺɇɂɃ ɋ ɰɟɥɶɸ ɤɨɦɩɥɟɤɫɧɨɝɨ ɢɫɫɥɟɞɨɜɚɧɢɹ ɮɭɧɤɰɢɢ ɷɧɞɨɬɟɥɢɹ ɧɚɦɢ ɛɵɥ ɨɛɫɥɟɞɨɜɚɧ 51 ɩɚɰɢɟɧɬ ɜ

ɜɨɡɪɚɫɬɟ ɨɬ 42 ɞɨ 77 ɥɟɬ, ɢɡ ɧɢɯ 38 ɠɟɧɳɢɧ (74,5%) ɢ 13 ɦɭɠɱɢɧ (25,5%). ɋɪɟɞɧɢɣ ɜɨɡɪɚɫɬ

ɩɚɰɢɟɧɬɨɜ ɫɨɫɬɚɜɢɥ – 61,8±0,9 (SD=6,7) ɝɨɞɚ.

ȼɵɞɟɥɟɧɵ ɬɪɢ ɝɪɭɩɩɵ ɩɚɰɢɟɧɬɨɜ: ɚɪɬɟɪɢɚɥɶɧɚɹ

ɝɢɩɟɪɬɟɧɡɢɹ (ȽȻ II ɫɬɚɞɢɢ, 2 ɫɬɟɩɟɧɢ) – ɭ 17 (33,3%) ɱɟɥɨɜɟɤ,ɫɚɯɚɪɧɵɣ ɞɢɚɛɟɬ (ɋȾ) 2-ɝɨ ɬɢɩɚ – ɭ 7 (13,7%), ȺȽ ɫ ɋȾ 2-ɝɨ ɬɢɩɚ – ɭ 27 (53,0%)

ɩɚɰɢɟɧɬɨɜ.ȼ ɫɪɟɞɧɟɦ ɞɥɢɬɟɥɶɧɨɫɬɶ ɋȾ 2-ɝɨ ɬɢɩɚ

ɫɨɫɬɚɜɢɥɚ 6,6±0,6 (SD=3,5) ɝɨɞɚ, ɞɥɢɬɟɥɶɧɨɫɬɶ

ȽȻ II ɫɬɚɞɢɢ, 2 ɫɬɟɩɟɧɢ – 12,3±1,3 (SD=8,9) ɝɨɞɚ.

Ƚɪɭɩɩɭ ɤɨɧɬɪɨɥɹ ɫɨɫɬɚɜɢɥɢ 15 ɫɨɩɨɫɬɚɜɢɦɵɯ ɩɨ

ɜɨɡɪɚɫɬɭ (ɫɪɟɞɧɢɣ ɜɨɡɪɚɫɬ 63,0±1,2 ɝɨɞɚ;ɪ>0,50)

ɢ ɩɨɥɭ (6 ɦɭɠɱɢɧ ɢ 9 ɠɟɧɳɢɧ; ɪ>0,20) ɤɥɢɧɢ

-ɱɟɫɤɢ ɡɞɨɪɨɜɵɯ ɥɢɰ.

Ⱦɢɚɝɧɨɡ ȽȻ II ɫɬɚɞɢɢ, 2 ɫɬɟɩɟɧɢ ɭ ɩɚɰɢɟɧɬɨɜ

ɞɥɹ ɜɤɥɸɱɟɧɢɹ ɜ ɧɚɛɥɸɞɟɧɢɟ ɛɵɥ ɩɨɫɬɚɜɥɟɧ ɫɨɝɥɚɫɧɨ ɪɟɤɨɦɟɧɞɚɰɢɹɦ ȼɈɁ, ȿɜɪɨɩɟɣɫɤɨɝɨ

ɨɛɳɟɫɬɜɚ ɝɢɩɟɪɬɟɧɡɢɢ ɢ ȿɜɪɨɩɟɣɫɤɨɝɨ ɨɛɳɟɫɬɜɚ ɤɚɪɞɢɨɥɨɝɨɜ (2007) [7] ɢ ɩɨɞɬɜɟɪɠɞɟɧ ɜɵɩɢɫɤɨɣ

ɢɡ ɚɦɛɭɥɚɬɨɪɧɨɣ ɤɚɪɬɵ. Ⱦɢɚɝɧɨɡ ɋȾ 2-ɝɨ ɬɢɩɚ

ɛɵɥ ɩɨɫɬɚɜɥɟɧ ɧɚ ɨɫɧɨɜɚɧɢɢ ɪɟɤɨɦɟɧɞɚɰɢɣ ȼɈɁ

(2011ɝɝ) [5]. Ȼɨɥɶɧɵɟ ɋȾ 2-ɝɨ ɬɢɩɚ ɩɪɢɧɢɦɚɥɢ

ɩɨɫɬɨɹɧɧɭɸ ɩɟɪɨɪɚɥɶɧɭɸ ɫɚɯɚɪɨɫɧɢɠɚɸɳɭɸ ɬɟ

-ɪɚɩɢɸ ɢ ɧɚɯɨɞɢɥɢɫɶ ɜ ɫɨɫɬɨɹɧɢɢ ɫɭɛɤɨɦɩɟɧ

-ɫɚɰɢɢ ɭɝɥɟɜɨɞɧɨɝɨ ɨɛɦɟɧɚ.

ȼɫɟ ɜɵɞɟɥɟɧɧɵɟ ɝɪɭɩɩɵ ɩɚɰɢɟɧɬɨɜ ɛɵɥɢ ɫɨɩɨɫɬɚɜɢɦɵɦɢ ɩɨ ɩɨɥɭ, ɜɨɡɪɚɫɬɭ ɢ ɞɥɢɬɟɥɶ

-ɧɨɫɬɢ ɨɫɧɨɜɧɨɝɨ ɡɚɛɨɥɟɜɚɧɢɹ – ɩɪɢ ɜɫɟɯ ɫɪɚɜ

-ɧɟɧɢɹɯ ɪ>0,10 (ɬɚɛɥ. 1).

Ɍ ɚ ɛ ɥ ɢ ɰ ɚ 1 Ɉɫɧɨɜɧɵɟ ɯɚɪɚɤɬɟɪɢɫɬɢɤɢ ɩɚɰɢɟɧɬɨɜ ɢɫɫɥɟɞɨɜɚɧɢɹ

ɉɨɤɚɡɚɬɟɥɶ ȼɫɟ ɩɚɰɢɟɧɬɵ_(n=51) Ƚɢɩɟɪɬɨɧɢɱɟɫɤɚɹ_{ɛɨɥɟɡɧɶ (n=17)}

Ƚɢɩɟɪɬɨɧɢɱɟɫɤɚɹ ɛɨɥɟɡɧɶ ɢ ɫɚɯɚɪɧɵɣ ɞɢɚɛɟɬ

2-ɝɨ ɬɢɩɚ (n=27)

ɋɚɯɚɪɧɵɣ ɞɢɚɛɟɬ

2-ɝɨ ɬɢɩɚ (n=7) Ƚɪɭɩɩɚ ɤɨɧɬɪɨɥɹ(n=15)

Ɇɭɠɱɢɧɵ(ɚɛɫ., %) 13 (25,5) 6 (35,3) 5 (18,5) 2 (28,6) 6 (40,0)

ɀɟɧɳɢɧɵ (ɚɛɫ., %) 38 (74,5) 11 (64,7) 22 (81,5) 5 (71,4) 9 (60,0)

ȼɨɡɪɚɫɬ,ɥɟɬ (M±m, SD) 61,8±0,9 (6,7) 59,3±2,1 (8,5) 63,4±1,1 (5,7) 62,0±1,4 (3,8) 63,0±1,2 (4,5)

Ⱦɥɢɬɟɥɶɧɨɫɬɶ ȽȻ,ɥɟɬ

(M±m, SD) 12,3±1,3 (8,9) 10,4±1,6 (6,5) 13,5±1,9 (10,0) - -

Ⱦɥɢɬɟɥɶɧɨɫɬɶ ɋȾ 2-ɝɨ ɬɢɩɚ,

(4)

(ɪɨɫɬ,ɦɚɫɫɚ ɬɟɥɚ,ɨɤɪɭɠɧɨɫɬɶ ɬɚɥɢɢ ɢ ɛɟɞɟɪ,ɭɪɨ

-ɜɟɧɶ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɞɚɜɥɟɧɢɹ) ɢ ɥɚɛɨɪɚɬɨɪɧɵɟ

ɩɨɤɚɡɚɬɟɥɢ (ɭɪɨɜɟɧɶ ɚɥɶɛɭɦɢɧɭɪɢɢ,ɗɌ-1) [3, 7].

ɋ ɩɨɦɨɳɶɸ ɬɟɫɬ-ɩɨɥɨɫɨɤ Ɇɭɥɶɬɢɫɬɢɤɫ (Multistix 8 SG) (ɩɪɨɢɡɜɨɞɢɬɟɥɶ ɤɨɦɩɚɧɢɹ Siemens (Bayer Diagnostics)) ɨɩɪɟɞɟɥɹɥɫɹ ɭɪɨɜɟɧɶ

ɚɥɶɛɭɦɢɧɭɪɢɢ ɜ ɭɬɪɟɧɧɟɣ ɩɨɪɰɢɢ ɦɨɱɢ. Ʉɨɧɬ

-ɪɨɥɶ ɥɚɛɨɪɚɬɨɪɧɵɯ ɞɚɧɧɵɯ ɨɫɭɳɟɫɬɜɥɹɥɫɹ ɩɟɪɟɞ ɧɚɡɧɚɱɟɧɢɟɦ ɬɟɪɚɩɢɢ ɢ ɱɟɪɟɡ 6 ɦɟɫɹɰɟɜ.

Ɏɭɧɤɰɢɹ ɷɧɞɨɬɟɥɢɹ ɨɰɟɧɢɜɚɥɚɫɶ ɧɟ ɬɨɥɶɤɨ ɩɨ ɭɪɨɜɧɸ ɚɥɶɛɭɦɢɧɭɪɢɢ [3], ɧɨ ɢ ɩɭɬɟɦ ɨɩɪɟ

-ɞɟɥɟɧɢɹ ɭɪɨɜɧɹ ɷɧɞɨɬɟɥɢɧɚ-1 ɦɟɬɨɞɨɦ ɢɦɦɭɧɨ

-ɮɟɪɦɟɧɬɧɨɝɨ ɚɧɚɥɢɡɚ ɩɥɚɡɦɵ ɜɟɧɨɡɧɨɣ ɤɪɨɜɢ [2, 7]. Ⱦɥɹ ɨɩɪɟɞɟɥɟɧɢɹ ɩɨɤɚɡɚɬɟɥɹ ɧɨɪɦɵ ɗɌ-1 ɢ

ɩɨɫɥɟɞɭɸɳɟɝɨ ɫɪɚɜɧɟɧɢɹ ɦɟɠɞɭ ɜɵɞɟɥɟɧɧɵɦɢ ɝɪɭɩɩɚɦɢ ɧɚɦɢ ɛɵɥɨ ɩɪɨɜɟɞɟɧɨ ɨɛɫɥɟɞɨɜɚɧɢɟ ɝɪɭɩɩɵ ɩɪɚɤɬɢɱɟɫɤɢ ɡɞɨɪɨɜɵɯ ɞɨɛɪɨɜɨɥɶɰɟɜ.

ɍɪɨɜɟɧɶ ɗɌ–1 ɜ ɤɪɨɜɢ ɩɪɚɤɬɢɱɟɫɤɢ ɡɞɨɪɨɜɵɯ

ɥɸɞɟɣ ɫɨɫɬɚɜɢɥ 0,37±0,06 ɮɦɨɥɶ/ɦɥ.

ȼ ɤɚɱɟɫɬɜɟ ɩɪɟɩɚɪɚɬɨɜ ɜɵɛɨɪɚ ɞɥɹ ɥɟɱɟɧɢɹ ɚɪɬɟɪɢɚɥɶɧɨɣ ɝɢɩɟɪɬɟɧɡɢɢ (ȺȽ) ɛɵɥɢ ɜɵɛɪɚɧɵ

ɛɥɨɤɚɬɨɪɵ ɪɟɰɟɩɬɨɪɨɜ ɤ ɚɧɝɢɨɬɟɧɡɢɧɭ II (ȻɊȺ,

ɫɚɪɬɚɧɵ) - ɥɨɡɚɪɬɚɧ ɤɚɥɢɹ, ɜ ɫɨɱɟɬɚɧɢɢ ɫ ɝɢɞɪɨ

-ɯɥɨɪɬɢɚɡɢɞɨɦ ( Ʌɨɡɚɩ ɩɥɸɫ®, Zentiva) ɜ ɞɨɡɟ ɨɬ 50-150 ɦɝ/ɫɭɬ.

Ɉɫɧɨɜɧɵɟ ɫɬɚɬɢɫɬɢɱɟɫɤɢɟ ɯɚɪɚɤɬɟɪɢɫɬɢɤɢ ɜɤɥɸɱɚɥɢ: ɱɢɫɥɨ ɧɚɛɥɸɞɟɧɢɣ (n), ɫɪɟɞɧɸɸ ɚɪɢ

-ɮɦɟɬɢɱɟɫɤɭɸ (M), ɫɬɚɧɞɚɪɬɧɭɸ ɨɲɢɛɤɭ ɫɪɟɞɧɟɣ (m), ɫɬɚɧɞɚɪɬɧɨɟ ɨɬɤɥɨɧɟɧɢɟ (SD), 95% ɞɨɜɟ

-ɪɢɬɟɥɶɧɵɣ ɢɧɬɟɪɜɚɥ ɞɥɹ ɫɪɟɞɧɟɣ (95% CI), ɦɟ

-ɞɢɚɧɭ (Ɇɟ), ɢɧɬɟɪɤɜɚɪɬɢɥɶɧɵɣ ɪɚɡɦɚɯ [25%; 75%], ɨɬɧɨɫɢɬɟɥɶɧɵɟ ɩɨɤɚɡɚɬɟɥɢ (ɚɛɫ., %), ɭɪɨ

-ɤɨɥɢɱɟɫɬɜɟɧɧɵɯ ɞɚɧɧɵɯ ɩɪɨɜɨɞɢɥɚɫɶ ɩɨ ɤɪɢ

-ɬɟɪɢɸ Ʉɨɥɦɨɝɨɪɨɜɚ-ɋɦɢɪɧɨɜɚ. ɋɪɚɜɧɟɧɢɟ ɫɬɚ

-ɬɢɫɬɢɱɟɫɤɢɯ ɯɚɪɚɤɬɟɪɢɫɬɢɤ ɜ ɪɚɡɧɵɯ ɝɪɭɩɩɚɯ ɢ ɜ ɞɢɧɚɦɢɤɟ ɩɪɨɜɨɞɢɥɨɫɶ ɫ ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ Ɍ

-ɤɪɢɬɟɪɢɹ ȼɢɥɤɨɤɫɨɧɚ (ɞɥɹ ɫɜɹɡɚɧɧɵɯ ɜɵɛɨɪɨɤ),

ɨɞɧɨɮɚɤɬɨɪɧɨɝɨ ɞɢɫɩɟɪɫɢɨɧɧɨɝɨ ɚɧɚɥɢɡɚ Ʉɪɭɫ

-ɤɚɥɚ-ɍɨɥɥɢɫɚ (ɇ) ɫ ɩɨɫɥɟɞɭɸɳɟɣ ɩɪɨɜɟɪɤɨɣ ɩɨ

ɤɪɢɬɟɪɢɹɦ Ⱦɭɧɤɚɧɚ ɢ Ⱦɚɧɧɟɬɬɚ (ɩɪɢ ɦɧɨɠɟɫɬ

-ɜɟɧɧɵɯ ɫɪɚɜɧɟɧɢɹɯ), ɬɨɱɧɨɝɨ ɤɪɢɬɟɪɢɹ Ɏɢɲɟɪɚ (ɞɥɹ ɨɬɧɨɫɢɬɟɥɶɧɵɯ ɜɟɥɢɱɢɧ). Ɉɰɟɧɤɚ ɜɡɚɢɦɨ

-ɫɜɹɡɢ ɦɟɠɞɭ ɮɚɤɬɨɪɚɦɢ ɩɪɨɜɨɞɢɥɚɫɶ ɩɨ ɤɨɷɮ

-ɮɢɰɢɟɧɬɚɦ ɪɚɧɝɨɜɨɣ ɤɨɪɪɟɥɹɰɢɢ ɋɩɢɪɦɟɧɚ (r).

ɉɪɢ ɩɪɨɜɟɞɟɧɢɢ ɫɬɚɬɢɫɬɢɱɟɫɤɨɣ ɨɛɪɚɛɨɬɤɢ ɩɨɥɭ

-ɱɟɧɧɵɯ ɪɟɡɭɥɶɬɚɬɨɜ ɜɫɟ ɧɟɨɛɯɨɞɢɦɵɟ ɪɚɫɱɟɬɵ ɩɪɨɢɡɜɨɞɢɥɢɫɶ ɫ ɩɨɦɨɳɶɸ ɥɢɰɟɧɡɢɨɧɧɨɣ ɩɪɨ

-ɝɪɚɦɦɵ Statistica (ɜɟɪɫɢɹ 6.1; ɫɟɪɢɣɧɵɣ ɧɨɦɟɪ AGAR 909 E415822FA).

ɊȿɁɍɅɖɌȺɌɕ ɂ ɂɏ ɈȻɋɍɀȾȿɇɂȿ

Ɉɰɟɧɤɭ ɫɬɟɩɟɧɢ ɨɠɢɪɟɧɢɹ ɩɚɰɢɟɧɬɨɜ ɦɵ ɩɪɨ

-ɜɨɞɢɥɢ ɫ ɩɨɦɨɳɶɸ ɢɧɞɟɤɫɚ ɦɚɫɫɵ ɬɟɥɚ (ɂɆɌ) ɜ

ɫɨɨɬɜɟɬɫɬɜɢɢ ɫ ɪɟɤɨɦɟɧɞɚɰɢɹɦɢ ȼɈɁ [6, 7],

ɩɨɫɤɨɥɶɤɭ ɨɧ ɨɞɢɧɚɤɨɜ ɞɥɹ ɨɛɨɢɯ ɩɨɥɨɜ ɢ ɞɥɹ ɜɫɟɯ ɜɨɡɪɚɫɬɧɵɯ ɤɚɬɟɝɨɪɢɣ ɜɡɪɨɫɥɵɯ. ɍ ɛɨɥɶ

-ɲɢɧɫɬɜɚ ɩɚɰɢɟɧɬɨɜ ɜɫɟɯ ɝɪɭɩɩ ɨɬɦɟɱɚɥɚɫɶ ɢɡ

-ɛɵɬɨɱɧɚɹ ɦɚɫɫɚ ɬɟɥɚ (37,3%) ɢɥɢ ɨɠɢɪɟɧɢɟ (49,0%), ɱɬɨ ɫɜɢɞɟɬɟɥɶɫɬɜɭɟɬ ɨ ɜɵɫɨɤɨɦ ɤɚɪɞɢɨ

-ɜɚɫɤɭɥɹɪɧɨɦ ɪɢɫɤɟ. ɉɪɢ ɷɬɨɦ, ɂɆɌ ɜ ɩɪɟɞɟɥɚɯ

ɧɨɪɦɵ ɢɦɟɥɢ 42,9% (3 ɢɡ 7) ɩɚɰɢɟɧɬɨɜ ɫ ɋȾ 2

ɬɢɩɚ ɢ 17,6% (3 ɢɡ 17) ɩɚɰɢɟɧɬɨɜ ɫ ȽȻ ɛɟɡ

ɫɨɩɭɬɫɬɜɭɸɳɟɣ ɩɚɬɨɥɨɝɢɢ ɢ ɬɨɥɶɤɨ ɨɞɢɧ ɩɚ

-ɰɢɟɧɬ ɢɡ 27 (3,7%) ɫ ȺȽ ɢ ɋȾ 2-ɝɨ ɬɢɩɚ (ɬɚɛɥ. 2).

Ɍ ɚ ɛ ɥ ɢ ɰ ɚ 2 Ɋɚɫɩɪɟɞɟɥɟɧɢɟ ɩɚɰɢɟɧɬɨɜ ɩɨ ɜɟɥɢɱɢɧɟ ɢɧɞɟɤɫɚ ɦɚɫɫɵ ɬɟɥɚ (ɚɛɫ., %)

ɂɧɞɟɤɫ ɦɚɫɫɵ ɬɟɥɚ ȼɫɟ ɩɚɰɢɟɧɬɵ (n=51) Ƚɢɩɟɪɬɨɧɢɱɟɫɤɚɹ_{ɛɨɥɟɡɧɶ (n=17)} Ƚɢɩɟɪɬɨɧɢɱɟɫɤɚɹ ɛɨɥɟɡɧɶɢ ɫɚɯɚɪɧɵɣ ɞɢɚɛɟɬ 2-ɝɨ ɬɢɩɚ (n=27)

ɋɚɯɚɪɧɵɣ ɞɢɚɛɟɬ 2-ɝɨ ɬɢɩɚ (n=7)

ɇɨɪɦɚ 7 (13,7) 3 (17,6) 1 (3,7) _{3 (42,9)*}

ɂɡɛɵɬɨɱɧɚɹ ɦɚɫɫɚ ɬɟɥɚ 19 (37,3) 8 (47,1) 9 (33,3) 2 (28,6)

Ɉɠɢɪɟɧɢɟ,ɜ ɬ.ɱ. 25 (49,0) 6 (35,3) 17 (63,0) 2 (28,6)

ȱ ɫɬɟɩɟɧɶ 10 (19,6) 4 (23,5) 5 (18,5) 1 (14,3)

ȱȱ ɫɬɟɩɟɧɶ 13 (25,5) 2 (11,8) 10 (37,) 1 (14,3)

ȱȱȱ ɫɬɟɩɟɧɶ 2 (3,9) - 2 (7,4) -

ɋɪɟɞɧɢɣ ɭɪɨɜɟɧɶ (M±m, SD) 30,2±0,7 (5,3) 27,9±1,0 (4,1) # 32,3±1,0 (5,4) 28,0±1,8 (4,7) #

ɉ ɪ ɢ ɦ ɟ ɱ ɚ ɧ ɢ ɹ: * – p<0,05 ɩɨ ɫɪɚɜɧɟɧɢɸ ɫ ɝɪɭɩɩɨɣ ȽȻ ɫ ɋȾ 2-ɝɨ ɬɢɩɚ ɩɨ ɬɨɱɧɨɦɭ ɤɪɢɬɟɪɢɸ Ɏɢɲɟɪɚ; # – p<0,05 ɩɨ ɫɪɚɜɧɟɧɢɸ ɫ

(5)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

ɉɨ ɞɚɧɧɵɦ ɤɨɪɪɟɥɹɰɢɨɧɧɨɝɨ ɚɧɚɥɢɡɚ ɭɫɬɚ

-ɧɨɜɥɟɧɨ ɧɚɥɢɱɢɟ ɩɪɹɦɨɣ ɞɨɫɬɨɜɟɪɧɨɣ ɫɜɹɡɢ ɦɟɠɞɭ ɂɆɌ ɢ ȽȻ ɫ ɋȾ 2-ɝɨ ɬɢɩɚ (r=0,41, p<0,01),

ɬ.ɟ. ɷɬɨɬ ɮɚɤɬɨɪ ɪɢɫɤɚ ɧɚɢɛɨɥɟɟ ɩɨɜɵɲɟɧ ɩɪɢ

ɫɨɱɟɬɚɧɢɢ ȽȻ ɢ ɋȾ 2-ɝɨ ɬɢɩɚ (ɬɚɛɥ. 2), ɜ ɬɨ ɜɪɟɦɹ

ɤɚɤ ɭ ɩɚɰɢɟɧɬɨɜ ɫ ȽȻ ɛɟɡ ɫɨɩɭɬɫɬɜɭɸɳɟɣ ɩɚɬɨ

-ɥɨɝɢɢ ɂɆɌ ɧɢɠɟ (ɪ<0,05).

ɇɚɪɹɞɭ ɫ ɂɆɌ, ɧɚɦɢ ɛɵɥɨ ɩɪɨɚɧɚɥɢɡɢɪɨɜɚɧɨ

ɫɨɨɬɧɨɲɟɧɢɟ ɈɌ/ɈȻ ɜ ɫɜɹɡɢ ɫ ɬɟɦ,ɱɬɨ ɰɟɧɬɪɚɥɶ

-ɧɨɟ ɨɠɢɪɟɧɢɟ (ɢɡɛɵɬɨɤ ɠɢɪɨɜɵɯ ɨɬɥɨɠɟɧɢɣ ɜ

ɪɚɣɨɧɟ ɠɢɜɨɬɚ) ɫɱɢɬɚɟɬɫɹ ɧɚɢɛɨɥɟɟ ɨɩɚɫɧɵɦ

ɜɢɞɨɦ ɨɠɢɪɟɧɢɹ ɢ, ɩɨ ɫɬɚɬɢɫɬɢɤɟ, ɹɜɥɹɟɬɫɹ

ɮɚɤɬɨɪɨɦ ɪɢɫɤɚ ɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɵɯ ɫɨɛɵɬɢɣ.

ɉɚɰɢɟɧɬ ɫɬɪɚɞɚɟɬ ɰɟɧɬɪɚɥɶɧɵɦ ɨɠɢɪɟɧɢɟɦ,ɟɫɥɢ

ɨɬɧɨɲɟɧɢɟ ɨɛɴɺɦɚ ɬɚɥɢɢ ɤ ɨɛɴɺɦɭ ɛɺɞɟɪ ɩɪɟ

-ɜɵɲɚɟɬ 0,8 ɞɥɹ ɠɟɧɳɢɧ ɢɥɢ 0,95 ɞɥɹ ɦɭɠɱɢɧ [8, 10]. ȼ ɝɪɭɩɩɚɯ ɢɫɫɥɟɞɨɜɚɧɢɹ ɨɬɤɥɨɧɟɧɢɟ ɨɬ

ɧɨɪɦɵ ɫɨɨɬɧɨɲɟɧɢɹ ɈɌ/ɈȻ ɧɚɛɥɸɞɚɥɨɫɶ ɭ 4 (23,5%) ɩɚɰɢɟɧɬɨɜ ɫ ȺȽ ɢ ɭ ɨɞɧɨɝɨ ɩɚɰɢɟɧɬɚ ɫ

ɋȾ 2-ɝɨ ɬɢɩɚ,ɜ ɬɨ ɜɪɟɦɹ ɤɚɤ ɫɪɟɞɢ ɛɨɥɶɧɵɯ ȺȽ ɫ

ɋȾ 2-ɝɨ ɬɢɩɚ ɬɚɤɨɟ ɩɨɜɵɲɟɧɢɟ ɧɚɛɥɸɞɚɥɨɫɶ ɭ 17 (63,0%) ɱɟɥɨɜɟɤ (ɪ<0,05 ɩɨ ɫɪɚɜɧɟɧɢɸ ɫ ɜɵɲɟ

-ɩɟɪɟɱɢɫɥɟɧɧɵɦɢ ɝɪɭɩɩɚɦɢ), ɱɬɨ ɦɨɠɟɬ ɫɜɢɞɟ

-ɬɟɥɶɫɬɜɨɜɚɬɶ ɨ ɩɨɜɵɲɟɧɧɨɦ ɪɢɫɤɟ ɪɚɡɜɢɬɢɹ ɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɵɯ ɫɨɛɵɬɢɣ ɩɪɢ ɫɨɱɟɬɚɧɢɢ

ɷɬɢɯ ɩɚɬɨɥɨɝɢɣ.ɉɪɢ ɷɬɨɦ ɞɨɫɬɨɜɟɪɧɵɟ ɨɬɥɢɱɢɹ ɜ

ɩɨɤɚɡɚɬɟɥɹɯ ɨɬɦɟɱɟɧɵ ɬɨɥɶɤɨ ɜ ɩɨɞɝɪɭɩɩɚɯ ɠɟɧɳɢɧ (ɪɢɫ. 1). Ɉɬɫɭɬɫɬɜɢɟ ɞɨɫɬɨɜɟɪɧɵɯ ɪɚɡ

-ɥɢɱɢɣ ɫɨɨɬɧɨɲɟɧɢɹ ɈɌ/ɈȻ ɫɪɟɞɢ ɩɨɞɝɪɭɩɩ ɦɭɠ

-ɱɢɧ ɦɨɠɧɨ ɨɛɴɹɫɧɢɬɶ ɡɧɚɱɢɬɟɥɶɧɨɣ ɟɝɨ ɜɚɪɢɚ

-ɛɟɥɶɧɨɫɬɶɸ ɭ ɦɭɠɱɢɧ,ɫɬɪɚɞɚɸɳɢɯ ȺȽ ɢ ɋȾ 2-ɝɨ

ɬɢɩɚ: 95% CI 0,75-1,32, ɤɨɷɮɮɢɰɢɟɧɬ ɜɚɪɢɚɰɢɢ

ɋ=17,4%.

0,94

1,04

0,93

0,83* 0,89 0,83*

0 0,2 0,4 0,6 0,8 1 1,2 1,4

ȺȽ ȺȽ ɢ ɋȾ 2 ɬɢɩɚ ɋȾ 2 ɬɢɩɚ

ɝɪɭɩɩɵ ɩɚɰɢɟɧɬɨɜ

ɋ

ɨɨɬɧ

ɨɲɟɧɢɟ

ɈɌ

/

ɈȻ

Ɇɭɠɱɢɧɵ ɀɟɧɳɢɧɵ

Ɋɢɫ. 1. ɋɪɟɞɧɢɟ ɭɪɨɜɧɢ ɫɨɨɬɧɨɲɟɧɢɹ ɨɛɴɟɦɚ ɬɚɥɢɢ ɤ ɨɛɴɟɦɭ ɛɟɞɟɪ (Ɇ, 95% CI) ɭ ɩɚɰɢɟɧɬɨɜ ɪɚɡɧɵɯ ɩɨɥɨɜɵɯ ɝɪɭɩɩ (*-p<0,05– ɫɬɚɬɢɫɬɢɱɟɫɤɚɹ ɞɨɫɬɨɜɟɪɧɨɫɬɶ)

ɉɪɢ ɚɧɚɥɢɡɟ ɭɪɨɜɧɹ ɰɢɮɪ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɞɚɜɥɟɧɢɹ ɞɨɫɬɨɜɟɪɧɵɯ ɪɚɡɥɢɱɢɣ ɦɟɠɞɭ ɝɪɭɩɩɚɦɢ ɨɬɦɟɱɟɧɨ ɧɟ ɛɵɥɨ, ɱɬɨ ɦɨɠɟɬ ɛɵɬɶ ɫɜɹɡɚɧɨ ɫ

ɚɞɟɤɜɚɬɧɨɫɬɶɸ ɚɧɬɢɝɢɩɟɪɬɟɧɡɢɜɧɨɣ ɬɟɪɚɩɢɢ,

ɩɪɨɜɨɞɢɦɨɣ ɧɚ ɩɪɨɬɹɠɟɧɢɢ ɜɫɟɝɨ ɧɚɛɥɸɞɟɧɢɹ.ɍ

ɜɫɟɯ ɩɚɰɢɟɧɬɨɜ ɜ ɝɪɭɩɩɚɯ ɫ ȺȽ ɢ ɝɪɭɩɩɟ ȺȽ ɢ ɋȾ

2-ɝɨ ɬɢɩɚ ɧɚɛɥɸɞɚɥɢɫɶ ɪɟɤɨɦɟɧɞɨɜɚɧɧɵɟ ɰɢɮɪɵ

ȺȾ,ɯɚɪɚɤɬɟɪɧɵɟ ɞɥɹ ȺȽ II ɫɬɚɞɢɢ, 2 ɫɬɟɩɟɧɢ.

ɇɚɦɢ ɩɪɨɚɧɚɥɢɡɢɪɨɜɚɧɵ ɩɨɤɚɡɚɬɟɥɢ, ɯɚɪɚɤ

-ɬɟɪɢɡɭɸɳɢɟ ɮɭɧɤɰɢɸ ɷɧɞɨɬɟɥɢɹ, ɭ ɩɚɰɢɟɧɬɨɜ

ɜɵɞɟɥɟɧɧɵɯ ɝɪɭɩɩ ɧɚ ɧɚɱɚɥɶɧɨɦ ɷɬɚɩɟ ɢɫɫɥɟ

-ɞɨɜɚɧɢɹ (1 ɜɢɡɢɬ) ɢ ɜ ɞɢɧɚɦɢɤɟ ɥɟɱɟɧɢɹ (2 ɜɢ

-ɡɢɬ).Ɋɟɡɭɥɶɬɚɬɵ ɩɪɟɞɫɬɚɜɥɟɧɵ ɜ ɬɚɛɥɢɰɟ 3.

ȼ ɧɚɱɚɥɟ ɢɫɫɥɟɞɨɜɚɧɢɹ ɭɪɨɜɟɧɶ ɷɧɞɨɬɟɥɢɧɚ-1

ɜ ɤɪɨɜɢ ɩɚɰɢɟɧɬɨɜ ɜɫɟɯ ɝɪɭɩɩ ɫɭɳɟɫɬɜɟɧɧɨ ɧɟ ɪɚɡɥɢɱɚɥɫɹ ɦɟɠɞɭ ɜɵɞɟɥɟɧɧɵɦɢ ɝɪɭɩɩɚɦɢ

(ɇ=2,46, ɪɧ=0,293; p>0,20 ɩɪɢ ɜɫɟɯ ɩɨɩɚɪɧɵɯ

ɫɪɚɜɧɟɧɢɹɯ ɦɟɠɞɭ ɝɪɭɩɩɚɦɢ ɩɨ ɤɪɢɬɟɪɢɸ Ⱦɭɧɤɚɧɚ). ɉɨɫɥɟ ɥɟɱɟɧɢɹ ɞɢɧɚɦɢɤɚ ɩɨɤɚɡɚɬɟɥɹ

ɜɨ ɜɫɟɯ ɝɪɭɩɩɚɯ ɛɵɥɚ ɩɨɥɨɠɢɬɟɥɶɧɨɣ ɢ ɫɬɚ

-ɬɢɫɬɢɱɟɫɤɢ ɡɧɚɱɢɦɨɣ (ɪ<0,05): ɭɪɨɜɟɧɶ ɗɌ-1 ɜ

ɝɪɭɩɩɟ ɫ ȽȻ ɫɧɢɡɢɥɫɹ ɧɚ 7,7%, ɛɨɥɟɟ ɜɵɪɚɠɟɧɧɵɟ

ɢɡɦɟɧɟɧɢɹ ɨɬɦɟɱɚɥɢɫɶ ɜ ɝɪɭɩɩɟ ɛɨɥɶɧɵɯ ȽȻ ɫ ɋȾ

2 ɬɢɩɚ – ɩɨɤɚɡɚɬɟɥɶ ɫɧɢɡɢɥɫɹ ɧɚ 14,5% (ɪ<0,05),

(6)

ɜ ɞɢɧɚɦɢɤɟ ɥɟɱɟɧɢɹ [M±m (SD)]

ɉɟɪɢɨɞ ɧɚɛɥɸɞɟɧɢɹ Ƚɪɭɩɩɚ

1ɜɢɡɢɬ 2 ɜɢɡɢɬ

¨, % ɪ

ȽȻ (n=17) 0,78±0,09 (0,37) 0,72±0,09 (0,37) -7,7 <0,05

ȽȻ ɫ ɋȾ 2-ɝɨ ɬɢɩɚ (n=27) 0,76±0,09 (0,49) 0,65±0,06 (0,32) -14,5 <0,05

ɋȾ 2-ɝɨ ɬɢɩɚ (n=7) 0,55±0,07 (0,18) 0,48±0,04 (0,11) -12,7 <0,07

ɉ ɪ ɢ ɦ ɟ ɱ ɚ ɧ ɢ ɟ:ɪ – ɫɬɚɬɢɫɬɢɱɟɫɤɚɹ ɞɨɫɬɨɜɟɪɧɨɫɬɶ ɦɟɠɞɭ ɩɟɪɢɨɞɚɦɢ ɧɚɛɥɸɞɟɧɢɹ ɜ ɝɪɭɩɩɟ ɩɨ ɤɪɢɬɟɪɢɸ ȼɢɥɤɨɤɫɨɧɚ.

ɉɪɢ ɫɪɚɜɧɟɧɢɢ ɢɫɫɥɟɞɭɟɦɵɯ ɝɪɭɩɩ ɫ ɤɨɧɬ

-ɪɨɥɶɧɨɣ (0,37±0,06 ɮɦɨɥɶ/ɦɥ) ɜ ɧɚɱɚɥɟ ɢɫɫɥɟ

-ɞɨɜɚɧɢɹ ɩɨ ɤɪɢɬɟɪɢɸ Ⱦɚɧɧɟɬɬɚ ɧɚɛɥɸɞɚɥɨɫɶ ɞɜɭɯɤɪɚɬɧɨɟ ɩɪɟɜɵɲɟɧɢɟ ɭɪɨɜɧɹ ɷɧɞɨɬɟɥɢɧɚ-1 ɜ

ɝɪɭɩɩɚɯ ɫ ɫɚɦɵɦ ɜɵɫɨɤɢɦ ɤɚɪɞɢɨɜɚɫɤɭɥɹɪɧɵɦ ɪɢɫɤɨɦ, ɚ ɢɦɟɧɧɨ: ɜ ɝɪɭɩɩɟ ɫ ȺȽ (ɪ<0,01) ɢ ɭ

ɩɚɰɢɟɧɬɨɜ ɫ ȺȽ ɢ ɋȾ 2-ɝɨ ɬɢɩɚ (ɪ<0,01) (ɪɢɫ. 2).

ɉɨɫɥɟ ɥɟɱɟɧɢɹ ɥɨɡɚɪɬɚɧɨɦ ɤɚɥɢɹ ɫ ɝɢɞɪɨɯɥɨɪ

-ɬɢɚɡɢɞɨɦ ɧɚɛɥɸɞɚɥɨɫɶ ɫɬɚɬɢɫɬɢɱɟɫɤɢ ɡɧɚɱɢɦɨɟ ɫɧɢɠɟɧɢɟ ɭɪɨɜɧɹ ɗɌ-1 ɤɚɤ ɜ ɝɪɭɩɩɟ ȺȽ ɛɟɡ ɫɨ

-ɩɭɬɫɬɜɭɸɳɟɣ ɩɚɬɨɥɨɝɢɢ (ɪ<0,004), ɬɚɤ ɢ ɜ ɝɪɭɩɩɟ

ȺȽ ɫ ɋȾ 2 ɬɢɩɚ (ɪ<0,004). Ɉɬɦɟɱɚɟɬɫɹ ɞɢɧɚɦɢɤɚ

ɫɧɢɠɟɧɢɹ ɭɪɨɜɧɹ ɗɌ-1ɢ ɜ ɝɪɭɩɩɟ ɫ ɋȾ 2 ɬɢɩɚ,ɧɨ

ɫɬɚɬɢɫɬɢɱɟɫɤɢ ɧɟɞɨɫɬɨɜɟɪɧɨ (ɪ<0,233). ɂɡ

-ɦɟɧɟɧɢɹ ɭɪɨɜɧɹ ɗɌ-1ɨɬɨɛɪɚɠɟɧɵ ɧɚ ɪɢɫɭɧɤɟ 2.

0,78* 0,76*

0,55

0,37 0,72*

0,65*

0,48

0 0,2 0,4 0,6 0,8 1 1,2

ȺȽ ȺȽ ɢ ɋȾ 2 ɬɢɩɚ ɋȾ 2 ɬɢɩɚ Ʉɨɧɬɪɨɥɶɧɚɹ

ɝɪɭɩɩɚ ɝɪɭɩɩɵ ɩɚɰɢɟɧɬɨɜ

ɗɌ

-1,

ɮɦ

ɨɥ

ɶ

/

ɦɥ

1ɜɢɡɢɬ 2ɜɢɡɢɬ

Ɋɢɫ. 2. ɋɪɟɞɧɢɟ ɭɪɨɜɧɢ ɷɧɞɨɬɟɥɢɧɚ-1 (Ɇ, 95% CI) ɭ ɩɚɰɢɟɧɬɨɜ ɪɚɡɧɵɯ ɝɪɭɩɩ ɜ ɞɢɧɚɦɢɤɟ ɥɟɱɟɧɢɹ: ɫɬɚɬɢɫɬɢɱɟɫɤɚɹ ɞɨɫɬɨɜɟɪɧɨɫɬɶ (p<0,05) ɩɨ ɫɪɚɜɧɟɧɢɸ ɫ ɤɨɧɬɪɨɥɶɧɨɣ ɝɪɭɩɩɨɣ

ɋɪɟɞɧɢɣ ɭɪɨɜɟɧɶ Ɇɟ [25%; 75%] ɩɨɤɚɡɚɬɟɥɹ

ɚɥɶɛɭɦɢɧɭɪɢɢ ɜ ɧɚɱɚɥɟ ɢɫɫɥɟɞɨɜɚɧɢɹ ɛɵɥ

15ɦɝ/ɥ,ɫɨɫɬɚɜɥɹɹ 15,0 [3,0; 15,0] ɦɝ/ɥ ɭ ɛɨɥɶɧɵɯ

ɫ ȺȽ ɢ ɭ ɩɚɰɢɟɧɬɨɜ ɫ ȺȽ ɢ ɋȾ 2 ɬɢɩɚ, 6,0 [3,0; 15,0] ɦɝ/ɥ – ɭ ɛɨɥɶɧɵɯ ɫ ɋȾ 2 ɬɢɩɚ.

ɉɨɞ ɜɥɢɹɧɢɟɦ ɩɪɢɟɦɚ ɥɨɡɚɪɬɚɧɚ ɤɚɥɢɹ ɫ ɝɢɞɪɨɯɥɨɪɬɢɚɡɢɞɨɦ ɫɪɟɞɧɢɣ ɩɨɤɚɡɚɬɟɥɶ ɚɥɶɛɭɦɢ

-ɧɭɪɢɢ ɫɧɢɡɢɥɫɹ ɜ ɝɪɭɩɩɚɯ ɛɨɥɶɧɵɯ ȺȽ ɢ ȺȽ ɫ ɋȾ 2 ɬɢɩɚ (ɪ<0,05).ȼ ɝɪɭɩɩɟ ɛɨɥɶɧɵɯ ɫ ɋȾ 2 ɬɢ

-ɩɚ, ɧɟ ɩɪɢɧɢɦɚɜɲɢɯ ɚɧɬɢɝɢɩɟɪɬɟɧɡɢɜɧɵɟ ɩɪɟ

-ɩɚɪɚɬɵ, ɩɨɤɚɡɚɬɟɥɶ ɧɟ ɢɡɦɟɧɢɥɫɹ (ɪ>0,60). ɋɥɟ

-ɞɭɟɬ ɨɬɦɟɬɢɬɶ, ɱɬɨ ɛɥɨɤɚɬɨɪɵ ɪɟɰɟɩɬɨɪɨɜ ɤ ɚɧ

-ɝɢɨɬɟɧɡɢɧɭ II ɫɩɨɫɨɛɫɬɜɭɸɬ ɫɧɢɠɟɧɢɸ ɷɤɫɤɪɟ

-ɰɢɢ ɚɥɶɛɭɦɢɧɨɜ ɫ ɦɨɱɨɣ. ɉɪɢ ȺȽ ɫɧɢɠɟɧɢɟ ȺȾ

ɩɪɢ ɨɞɧɨɜɪɟɦɟɧɧɨɦ ɭɦɟɧɶɲɟɧɢɢ ɚɥɶɛɭɦɢɧɭɪɢɢ ɪɚɫɰɟɧɢɜɚɸɬ ɤɚɤ ɛɨɥɟɟ ɧɚɞɟɠɧɵɣ ɩɨɤɚɡɚɬɟɥɶ ɷɮɮɟɤɬɢɜɧɨɫɬɢ ɬɟɪɚɩɢɢ, ɱɟɦ ɫɧɢɠɟɧɢɟ ɤɚɠɞɨɝɨ

ɢɡ ɷɬɢɯ ɩɨɤɚɡɚɬɟɥɟɣ ɜ ɨɬɞɟɥɶɧɨɫɬɢ. Ɍɨ ɠɟ ɨɬ

-ɧɨɫɢɬɫɹ ɤ ɋȾ: ɧɨɪɦɚɥɢɡɚɰɢɹ ɭɪɨɜɧɹ ɫɚɯɚɪɚ ɜ

(7)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

ɫɜɢɞɟɬɟɥɶɫɬɜɭɸɬ ɨ ɜɵɫɨɤɨɣ ɷɮɮɟɤɬɢɜɧɨɫɬɢ ɬɟ

-ɪɚɩɢɢ, ɬɨɝɞɚ ɤɚɤ ɩɨɥɨɠɢɬɟɥɶɧɚɹ ɞɢɧɚɦɢɤɚ ɤɚɠ

-ɞɨɝɨ ɢɡ ɷɬɢɯ ɩɨɤɚɡɚɬɟɥɟɣ ɜ ɨɬɞɟɥɶɧɨɫɬɢ ɦɨɠɟɬ ɛɵɬɶ ɜɪɟɦɟɧɧɨɣ ɢ ɫɥɭɱɚɣɧɨɣ.

ȼɕȼɈȾɕ

1. ɉɨɜɵɲɟɧɧɵɣ ɭɪɨɜɟɧɶ ɢɧɞɟɤɫɚ ɦɚɫɫɵ ɬɟɥɚ ɜ

ɝɪɭɩɩɟ ɩɚɰɢɟɧɬɨɜ ɫ ɝɢɩɟɪɬɨɧɢɱɟɫɤɨɣ ɛɨɥɟɡɧɶɸ II

ɫɬɚɞɢɢ, 2 ɫɬɟɩɟɧɢ ɧɚɛɥɸɞɚɟɬɫɹ ɭ 14 ɱɟɥɨɜɟɤ (82,4%), ɜ ɝɪɭɩɩɟ ɫ ɝɢɩɟɪɬɨɧɢɱɟɫɤɨɣ ɛɨɥɟɡɧɶɸ ɢ

ɫɚɯɚɪɧɵɦ ɞɢɚɛɟɬɨɦ 2-ɝɨ ɬɢɩɚ - ɭ 26 ɱɟɥɨɜɟɤ (96,3 %), ɜ ɝɪɭɩɩɟ ɫ ɫɚɯɚɪɧɵɦ ɞɢɚɛɟɬɨɦ 2-ɝɨ ɬɢɩɚ - ɭ 4 ɩɚɰɢɟɧɬɨɜ (57,1%). ɇɚɢɛɨɥɟɟ ɜɵɪɚɠɟɧɨ

ɩɨɜɵɲɟɧɢɟ ɷɬɨɝɨ ɩɨɤɚɡɚɬɟɥɹ ɜ ɝɪɭɩɩɟ ɩɚɰɢɟɧɬɨɜ ɫ ɝɢɩɟɪɬɨɧɢɱɟɫɤɨɣ ɛɨɥɟɡɧɶɸ ɢ ɫɚɯɚɪɧɵɦ ɞɢɚ

-ɛɟɬɨɦ 2-ɝɨ ɬɢɩɚ, ɱɬɨ ɫɜɢɞɟɬɟɥɶɫɬɜɭɟɬ ɨ ɩɨɜɵ

-ɲɟɧɧɨɦ ɪɢɫɤɟ ɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɵɯ ɡɚɛɨɥɟ

-ɜɚɧɢɣ.

2. ɉɨɞ ɜɥɢɹɧɢɟɦ ɥɟɱɟɧɢɹ ɥɨɡɚɪɬɚɧɨɦ ɤɚɥɢɹ ɫ

ɝɢɞɪɨɯɥɨɪɬɢɚɡɢɞɨɦ ɨɬɦɟɱɟɧɚ ɬɟɧɞɟɧɰɢɹ ɤ ɫɧɢ

-ɠɟɧɢɸ ɭɪɨɜɧɹ ɚɥɶɛɭɦɢɧɭɪɢɢ ɜ ɝɪɭɩɩɟ ɩɚɰɢɟɧɬɨɜ ɫ ɚɪɬɟɪɢɚɥɶɧɨɣ ɝɢɩɟɪɬɟɧɡɢɟɣ ɢ ɭ ɛɨɥɶɧɵɯ ɫ ɚɪɬɟ

-ɪɢɚɥɶɧɨɣ ɝɢɩɟɪɬɟɧɡɢɟɣ ɢ ɫɚɯɚɪɧɵɦ ɞɢɚɛɟɬɨɦ

2-ɝɨ ɬɢɩɚ ɧɚ 80%. ȼ ɝɪɭɩɩɟ ɩɚɰɢɟɧɬɨɜ ɫ ɫɚɯɚɪɧɵɦ

ɞɢɚɛɟɬɨɦ 2-ɝɨ ɬɢɩɚ, ɤɨɬɨɪɵɟ ɩɪɢɧɢɦɚɥɢ ɬɨɥɶɤɨ

ɫɚɯɚɪɨɫɧɢɠɚɸɳɢɟ ɩɪɟɩɚɪɚɬɵ, ɷɬɨɬ ɩɨɤɚɡɚɬɟɥɶ

ɜɵɪɨɫ ɧɚ 16,5%.

3. ɉɪɢɟɦ ɤɨɦɛɢɧɢɪɨɜɚɧɧɵɯ ɩɪɟɩɚɪɚɬɨɜ, ɚ

ɢɦɟɧɧɨ ɛɥɨɤɚɬɨɪɚ ɪɟɰɟɩɬɨɪɨɜ ɤ ɚɧɝɢɨɬɟɧɡɢɧɭ II

ɥɨɡɚɪɬɚɧɚ ɤɚɥɢɹ ɫ ɝɢɞɪɨɯɥɨɬɢɚɡɢɞɨɦ, ɩɪɢɜɟɥ ɤ

ɞɨɫɬɨɜɟɪɧɨɦɭ ɫɧɢɠɟɧɢɸ ɭɪɨɜɧɹ ɚɪɬɟɪɢɚɥɶɧɨɣ ɝɢɩɟɪɬɟɧɡɢɢ ɜ ɝɪɭɩɩɚɯ ɫ ɝɢɩɟɪɬɨɧɢɱɟɫɤɨɣ ɛɨ

-ɥɟɡɧɶɸ ɢ ɝɢɩɟɪɬɨɧɢɱɟɫɤɨɣ ɛɨ-ɥɟɡɧɶɸ ɫ ɫɚɯɚɪɧɵɦ ɞɢɚɛɟɬɨɦ 2-ɝɨ ɬɢɩɚ ɞɨ ɜɟɥɢɱɢɧ, ɪɟɤɨɦɟɧɞɨɜɚɧ

-ɧɵɯ ɞɥɹ ɞɚɧɧɨɣ ɤɚɬɟɝɨɪɢɢ ɩɚɰɢɟɧɬɨɜ.

4. ɉɪɢ ɥɟɱɟɧɢɢ ɥɨɡɚɪɬɚɧɨɦ ɤɚɥɢɹ ɫ ɝɢɞɪɨ

-ɯɥɨɪɬɢɚɡɢɞɨɦ ɧɚɛɥɸɞɚɟɬɫɹ ɞɨɫɬɨɜɟɪɧɨɟ ɫɧɢɠɟ

-ɧɢɟ ɦɚɪɤɟɪɚ ɷɧɞɨɬɟɥɢɚɥɶɧɨɣ ɞɢɫɮɭɧɤɰɢɢ ɷɧɞɨ

-ɬɟɥɢɧɚ-1ɧɚ 7,7% ɜ ɝɪɭɩɩɟ ɫ ɚɪɬɟɪɢɚɥɶɧɨɣ ɝɢɩɟɪ

-ɬɟɧɡɢɟɣ ɢ ɧɚ 14,5% ɜ ɝɪɭɩɩɟ ɫ ɚɪɬɟɪɢɚɥɶɧɨɣ

ɝɢɩɟɪɬɟɧɡɢɟɣ ɢ ɫɚɯɚɪɧɵɦ ɞɢɚɛɟɬɨɦ 2-ɝɨ ɬɢɩɚ ɩɨ

ɫɪɚɜɧɟɧɢɸ ɫ ɢɫɯɨɞɧɵɦɢ ɩɨɤɚɡɚɬɟɥɹɦɢ.

5. ȼ ɝɪɭɩɩɟ ɩɚɰɢɟɧɬɨɜ ɫ ɫɚɯɚɪɧɵɦ ɞɢɚɛɟɬɨɦ 2-ɝɨ ɬɢɩɚ ɛɟɡ ɝɢɩɟɪɬɨɧɢɱɟɫɤɨɣ ɛɨɥɟɡɧɢ, ɧɟ ɩɪɢ

-ɧɢɦɚɜɲɢɯ ɚɧɬɢɝɢɩɟɪɬɟɧɡɢɜɧɵɟ ɩɪɟɩɚɪɚɬɵ, ɬɚɤ

-ɠɟ ɧɚɛɥɸɞɚɟɬɫɹ ɫɧɢ-ɠɟɧɢɟ ɭɪɨɜɧɹ ɷɧɞɨɬɟɥɢɧɚ-1,

ɧɨ ɫɬɚɬɢɫɬɢɱɟɫɤɢ ɧɟɞɨɫɬɨɜɟɪɧɨɟ.

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1. Ⱥɛɪɚɝɚɦɨɜɢɱ Ɉ.Ɉ. Ɇɟɯɚɧɿɡɦɢ ɪɨɡɜɢɬɤɭ ɞɢɫ-ɮɭɧɤɰɿʀ ɟɧɞɨɬɟɥɿɸ ɬɚ ʀʀ ɪɨɥɶ ɭ ɩɚɬɨɝɟɧɟɡɿ ɿɲɟɦɿɱɧɨʀ ɯɜɨ -ɪɨɛɢ ɫɟɪɰɹ / Ɉ.Ɉ.Ⱥɛɪɚɝɚɦɨɜɢɱ,Ⱥ.Ɏ.Ɏɚɣɧɢɤ,Ɉ.ȼ. ɇɟ-ɱɚɣ // ɍɤɪ.ɤɚɪɞɿɨɥ.ɠɭɪɧɚɥ. – 2007. - ʋ 4. – ɋ. 81-87.

2. ȼɚɬɭɬɢɧ ɇ.Ɍ. ɗɧɞɨɬɟɥɢɧɵ ɢ ɫɟɪɞɟɱɧɨ-ɫɨɫɭ-ɞɢɫɬɚɹ ɩɚɬɨɥɨɝɢɹ / ɇ.Ɍ. ȼɚɬɭɬɢɧ, ɇ.ȼ. Ʉɚɥɢɧɤɢɧɚ, Ⱥ.Ʌ.Ⱦɟɦɢɞɨɜɚ // ɍɤɪ.ɤɚɪɞɿɨɥ.ɠɭɪɧɚɥ. – 2006. – ʋ 1. –ɋ. 101-106.

3. ɂɜɚɧɨɜ Ⱦ.Ⱦ.Ɇɢɤɪɨɚɥɶɛɭɦɢɧɭɪɢɹ:ɜɡɝɥɹɞ ɧɟɮ-ɪɨɥɨɝɚ / Ⱦ.Ⱦ.ɂɜɚɧɨɜ // Ɂɞɨɪɨɜɶɟ ɍɤɪɚɢɧɵ. — 2008. — Ɍ. 21, ʋ 1. — ɋ. 18-19.

4. Ɇɟɥɶɧɢɤɨɜɚ Ɉ.Ƚ. Ȼɪɢɬɚɧɫɤɨɟ ɩɪɨɫɩɟɤɬɢɜɧɨɟ ɢɫɫɥɟɞɨɜɚɧɢɟ ɫɚɯɚɪɧɨɝɨ ɞɢɚɛɟɬɚ (UKPDS) – ɪɟɡɭɥɶ-ɬɚɬɵ 30-ɥɟɬɧɟɝɨ ɧɚɛɥɸɞɟɧɢɹ ɛɨɥɶɧɵɯ ɋȾ 2 ɬɢɩɚ / Ɉ.Ƚ.Ɇɟɥɶɧɢɤɨɜɚ // ɋɚɯɚɪɧɵɣ ɞɢɚɛɟɬ. – 2008. – ʋ 4. – ɋ. 90-91.

5. ɉɨɥɢɜɨɞɚ ɋ.ɇ. ɉɨɪɚɠɟɧɢɟ ɨɪɝɚɧɨɜ-ɦɢɲɟɧɟɣ ɩɪɢ ɝɢɩɟɪɬɨɧɢɱɟɫɤɨɣ ɛɨɥɟɡɧɢ: ɩɪɚɤɬ. ɪɭɤɨɜɨɞɫɬɜɨ / ɋ.ɇ. ɉɨɥɢɜɨɞɚ, ɘ.Ɇ. Ʉɨɥɟɫɧɢɤ, Ⱥ.Ⱥ. ɑɟɪɟɩɨɤ. – Ʉ.: ɑɟɬɜɟɪɬɚ ɯɜɢɥɹ, 2005. – 800 ɫ.

6. Ɍɢɯɨɧɨɜɚ ɋ.Ⱥ. XVII ɤɨɧɝɪɟɫɫ ȿɜɪɨɩɟɣɫɤɨɝɨ ɨɛɳɟɫɬɜɚ ɝɢɩɟɪɬɟɧɡɢɢ ɢ ɤɚɪɞɢɨɥɨɝɨɜ:ɧɨɜɵɟ

ɪɟɤɨɦɟɧ-ɞɚɰɢɢ ɩɨ ɚɪɬɟɪɢɚɥɶɧɨɣ ɝɢɩɟɪɬɟɧɡɢɢ / ɋ.Ⱥ.Ɍɢɯɨɧɨɜɚ // Ɂɞɨɪɨɜɶɟ ɍɤɪɚɢɧɵ.- 2007. – Ɍ. 12, ʋ 1. – ɋ. 10-13.

7. ɘɳɭɤ ȿ.ɇ. ɗɧɞɨɬɟɥɢɚɥɶɧɚɹ ɞɢɫɮɭɧɤɰɢɹ ɩɪɢ ɡɚɛɨɥɟɜɚɧɢɹɯ ɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɨɣ ɫɢɫɬɟɦɵ ɢ ɦɟɬɨɞɵ ɟɟ ɤɨɪɪɟɤɰɢɢ / ȿ.ɇ. ɘɳɭɤ, ɘ.Ⱥ. ȼɚɫɸɤ, Ⱥ.Ȼ. ɏɚɞ-ɡɟɝɨɜɚ // Ʉɥɢɧɢɱ. ɮɚɪɦɚɤɨɥɨɝɢɹ ɢ ɬɟɪɚɩɢɹ. – 2005. – Ɍ. 14, ʋ 3. – ɋ. 85-88.

8. American Diabetes Association. Standards of Medical Care in Diabetes // Diabetes Care. – 2011. – Vol. 34. – P. 11-61.

9. Initial monotherapy and combination therapy and hypertension control the first year / B.M. Egan, D. Ban-dyopadhyay, S.R. Shaftman [et al.] // Hypertension. – 2012. – Vol. 59. – P. 1124-1131.

10. Gupta A.K. Compliance, safety, and effectiveness offixed_dose combinations of antihypertensive agents: a metaanalysis / A.K. Gupta, S. Arshad, N.R. Poulter // Hy-pertension. – 2010. – Vol. 55. – P. 399-407.

11. Risk prediction is improved by adding markers of subclinical organ damage to SCORE / T. Sehestedt, J.J eppesen, T.W. Hansen [et al.] // Eur. Heart J. – 2010. – Vol. 31. – P. 883-891.

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1. Abragamovich OO, Faynik AF, Nechay OV. [Mechanisms of development of epithelial dysfunction and their role in pathogenesis of ischemic heart disease]. Ukr. kardiologichnyi zhurnal. 2007;4:81-87. Ukrainian.

2. Vatutin NT, Kalinkina NV, Demidova AL. [Endothelins and cardio-vascular pathology]. Ukr. kardio-logichnyi zhurnal. 2006;1:101-6. Russian.

3. Ivanov DD. [Microalbuminuria: view of nephro-logist]. Zdorov'e Ukrainy. 2008;21(1):18-19. Russian.

4. Mel'nikova OG. [Britain prospective investigation of diabetes melitus]. Sakharnyy diabet. 2008;4:90-91. Russian.

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2007;12(1):10-13. Russian.

7. Yushchuk EN, Vasyuk YuA, Khadzegova AB. [Endothelial dysfunction in cardio-vascular diseases and methods of its correction]. Klinichna farmakologya i terapya. 2005;14(3):85-88. Russian.

8. American Diabetes Association. Standards of Medical Care in Diabetes. Diabetes Care. 2011;34:11-61.

10. Gupta AK, Arshad S, Poulter NR. Compliance, safety, and effectiveness offixed_dose combinations of antihypertensive agents: a metaanalysis. Hypertension. 2010;55:399-407.

11. Sehestedt T, Jeppesen J, Hansen TW. Risk pre-diction is improved by adding markers of subclinical organ damage to SCORE. Eur. Heart J. 2010;31:883-91.

ɋɬɚɬɬɹ ɧɚɞɿɣɲɥɚ ɞɨ ɪɟɞɚɤɰɿʀ 12.01.2014

ɍȾɄ 616.831-006:616.89-008.454-036

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Ƚɍ «Ⱦɧɟɩɪɨɩɟɬɪɨɜɫɤɚɹ ɦɟɞɢɰɢɧɫɤɚɹ ɚɤɚɞɟɦɢɹ ɆɁ ɍɤɪɚɢɧɵ»

ɤɚɮɟɞɪɚ ɩɫɢɯɢɚɬɪɢɢ ɎɉɈ

(ɡɚɜ. – ɞ.ɦɟɞ.ɧɚɭɤ,ɩɪɨɮ.Ʌ.ɇ.ɘɪɶɟɜɚ)

ɭɥ.Ⱦɡɟɪɠɢɧɫɤɨɝɨ, 9, Ⱦɧɟɩɪɨɩɟɬɪɨɜɫɤ, 49044, ɍɤɪɚɢɧɚ

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

e-mail: kafpsydnep@i.ua

Ʉɥɸɱɟɜɵɟ ɫɥɨɜɚ: ɨɩɭɯɨɥɢ ɝɨɥɨɜɧɨɝɨ ɦɨɡɝɚ, ɩɫɢɯɨɩɚɬɨɥɨɝɢɱɟɫɤɢɟ ɧɚɪɭɲɟɧɢɹ, ɧɟɩɫɢɯɨɬɢɱɟɫɤɢɟ ɩɫɢɯɢɱɟɫɤɢɟ

ɪɚɫɫɬɪɨɣɫɬɜɚ,ɞɟɩɪɟɫɫɢɜɧɵɟ ɪɚɫɫɬɪɨɣɫɬɜɚ,ɚɫɬɟɧɢɱɟɫɤɢɟ ɫɨɫɬɨɹɧɢɹ,ɬɪɟɜɨɠɧɵɟ ɪɚɫɫɬɪɨɣɫɬɜɚ

Key words: brain tumor, psychiatric disorders, non-psychotic mental disorders, depressive disorders, asthenia, anxiety disorders

Ɋɟɮɟɪɚɬ. Ʉɥɿɧɿɱɧɿ ɨɫɨɛɥɢɜɨɫɬɿ ɞɟɩɪɟɫɢɜɧɢɯ ɪɨɡɥɚɞɿɜ ɭ ɯɜɨɪɢɯ ɡ ɨɧɤɨɩɚɬɨɥɨɝɿɽɸ ɝɨɥɨɜɧɨɝɨ ɦɨɡɤɭ. Ɉɝɨɪɟɧɤɨ ȼ.ȼ. Ɇɟɬɨɸ ɞɨɫɥɿɞɠɟɧɧɹ ɛɭɥɨ ɜɢɜɱɢɬɢ ɩɫɢɯɨɩɚɬɨɥɨɝɿɱɧɭ ɫɬɪɭɤɬɭɪɭ ɬɚ ɤɥɿɧɿɱɧɿ ɨɫɨɛɥɢɜɨɫɬɿ ɞɟ

-ɩɪɟɫɢɜɧɢɯ ɪɨɡɥɚɞɿɜ ɭ ɯɜɨɪɢɯ ɧɚ ɨɧɤɨɩɚɬɨɥɨɝɿɸ ɝɨɥɨɜɧɨɝɨ ɦɨɡɤɭ. ɉɨɥɿɦɨɪɮɧɿ ɩɫɢɯɿɱɧɿ ɩɨɪɭɲɟɧɧɹ ɪɿɡɧɨɝɨ

ɤɥɿɧɿɱɧɨɝɨ ɡɦɿɫɬɭ ɿ ɫɬɭɩɟɧɹ ɜɢɪɚɠɟɧɨɫɬɿ ɧɟ ɬɿɥɶɤɢ ɜ ɛɿɥɶɲɨɫɬɿ ɜɢɩɚɞɤɿɜ ɤɨɦɨɪɛɿɞɧɿ ɨɧɤɨɥɨɝɿɱɧɿɣ ɩɚɬɨɥɨɝɿʀ ɝɨɥɨɜɧɨɝɨ ɦɨɡɤɭ, ɚɥɟ ɣ ɱɚɫɬɨ ɽ ɩɟɪɲɢɦɢ ɧɚɣɛɿɥɶɲ ɪɚɧɧɿɦɢ ɤɥɿɧɿɱɧɢɦɢ ɩɪɨɹɜɚɦɢ ɧɨɜɨɭɬɜɨɪɟɧɶ. Ⱦɨɫɥɿɞɠɟɧɧɹ

ɩɪɨɜɨɞɢɥɨɫɶ ɡɚ ɞɨɩɨɦɨɝɨɸ ɬɚɤɢɯ ɦɟɬɨɞɿɜ: ɤɥɿɧɿɱɧɨɝɨ ɩɫɢɯɿɚɬɪɢɱɧɨɝɨ, ɨɩɢɬɭɜɚɥɶɧɢɤɚ Simptom Check List-90-Revised-SCL-90-R, ɬɟɫɬɚ Ʌɸɲɟɪɚ ɬɚ ɦɟɬɨɞɿɜ ɦɚɬɟɦɚɬɢɱɧɨʀ ɨɛɪɨɛɤɢ.ȼɢɛɿɪɤɭ ɫɤɥɚɥɢ 175 ɯɜɨɪɢɯ ɧɚ ɩɭɯɥɢɧɢ ɝɨ

-ɥɨɜɧɨɝɨ ɦɨɡɤɭ ɡ ɧɟɩɫɢɯɨɬɢɱɧɢɦ ɪɿɜɧɟɦ ɩɫɢɯɿɱɧɢɯ ɩɨɪɭɲɟɧɶ. Ɋɨɡɝɥɹɧɭɬɨ ɨɫɨɛɥɢɜɨɫɬɿ ɩɫɢɯɿɱɧɢɯ ɩɨɪɭɲɟɧɶ ɿ

ɩɫɢɯɨɩɚɬɨɥɨɝɿɱɧɚ ɫɬɪɭɤɬɭɪɚ ɞɟɩɪɟɫɢɜɧɢɯ ɪɨɡɥɚɞɿɜ ɧɟɩɫɢɯɨɬɢɱɧɨɝɨ ɪɿɜɧɹ,ɳɨ ɛɭɥɢ ɤɥɿɧɿɱɧɢɦ ɜɚɪɿɚɧɬɨɦ ɞɟɛɸɬɭ

ɩɭɯɥɢɧɧɨɝɨ ɩɪɨɰɟɫɭ. ȼɢɹɜɥɟɧɨ, ɳɨ ɞɥɹ ɞɟɩɪɟɫɢɜɧɢɯ ɫɬɚɧɿɜ ɧɟɩɫɢɯɨɬɢɱɧɨɝɨ ɪɿɜɧɹ ɯɚɪɚɤɬɟɪɧɿ ɩɨɥɿɦɨɪɮɿɡɦ ɿ

ɫɢɧɞɪɨɦɚɥɶɧɚ ɧɟɡɚɜɟɪɲɟɧɿɫɬɶ,ɳɨ ɡɭɦɨɜɥɸɽ ɧɟɨɞɧɨɡɧɚɱɧɿɫɬɶ ɬɪɚɤɬɭɜɚɧɧɹ ɞɿɚɝɧɨɡɿɜ ɧɚ ɟɬɚɩɿ ɞɿɚɝɧɨɫɬɢɱɧɨɝɨ

ɩɟɪɿɨɞɭ. ȼɢɡɧɚɱɟɧɿ ɨɫɨɛɥɢɜɨɫɬɿ ɞɟɩɪɟɫɢɜɧɢɯ ɫɢɦɩɬɨɦɨɤɨɦɩɥɟɤɫɿɜ ɡɚɥɟɠɧɨ ɜɿɞ ɨɡɧɚɤɢ ɡɥɨɹɤɿɫɧɨɫɬɿ/ɞɨɛɪɨ