COPD exacerbation: anthropometric characteristics of patients and the frequency of hospital admissions

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R, Fagard R, Germano G, et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007 Jun;25(6):1105–87.

13. London GM, Asmar RG, O’Rourke MF, Safar ME, REASON Project Investigators. Mechanism(s) of selective systolic blood pressure reduction after a low-dose combination of perindopril/indapamide in hyper-tensive subjects: comparison with atenolol. J Am Coll Cardiol. 2004 Jan 7;43(1):92–9.

14. Nichols WW, Edwards DG. Arterial elastance and wave reflection augmentation of systolic blood pressure: deleterious effects and implications for therapy. J Car-diovasc Pharmacol Ther. 2001 Jan;6(1):5–21.

15. McEniery CM, Yasmin, Hall IR, Qasem A, Wil-kinson IB, Cockcroft JR. Normal Vascular Aging: Dif-ferential Effects on Wave Reflection and Aortic Pulse Wave VelocityThe Anglo-Cardiff Collaborative Trial (ACCT). J Am Coll Cardiol. 2005 Nov 1;46(9):1753–60.

arterial function in young otherwise healthy men. Am J Hypertens. 2014 Apr;27(4):628–34.

17. Boutouyrie P, Laurent S, Benetos A, Girerd XJ, Hoeks AP, Safar ME. Opposing effects of ageing on distal and proximal large arteries in hypertensives. J Hypertens Suppl Off J Int Soc Hypertens. 1992 Aug;10(6):S87–91.

18. Vlachopoulos C, Aznaouridis K, O’Rourke MF, Safar ME, Baou K, Stefanadis C. Prediction of cardiovas-cular events and all-cause mortality with central haemo-dynamics: a systematic review and meta-analysis. Eur Heart J. 2010 Aug 1;31(15):1865–71.

19. Hansen TW, Staessen JA, Torp-Pedersen C, Rasmussen S, Thijs L, Ibsen H, et al. Prognostic Value of Aortic Pulse Wave Velocity as Index of Arterial Stiffness in the General Population. Circulation. 2006 Feb 7;113(5):664–70.

20. Hawkins M, Gabriel KP, Cooper J, Storti KL, Sutton-Tyrrell K, Kriska A. The impact of change in physical activity on change in arterial stiffness in over-weight or obese sedentary young adults. Vasc Med. 2014 Aug 1;19(4):257–63.

ɋɬɚɬɬɹ ɧɚɞɿɣɲɥɚ ɞɨ ɪɟɞɚɤɰɿʀ 10.09.2014

ɍȾɄ 616.24-007.272-036.1-002.1-071.3:615.859

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ȾɁ «Ⱦɧɿɩɪɨɩɟɬɪɨɜɫɶɤɚ ɦɟɞɢɱɧɚ ɚɤɚɞɟɦɿɹ ɆɈɁ ɍɤɪɚʀɧɢ»

ɤɚɮɟɞɪɚ ɮɚɤɭɥɶɬɟɬɫɶɤɨʀ ɬɟɪɚɩɿʀ ɬɚ ɟɧɞɨɤɪɢɧɨɥɨɝɿʀ

(ɡɚɜ. – ɱɥɟɧ-ɤɨɪ.ɇȺɆɇ ɍɤɪɚʀɧɢ,ɞ.ɦɟɞ.ɧ., ɩɪɨɮ.Ɍ.Ɉ.ɉɟɪɰɟɜɚ)

ɜɭɥ.Ⱦɡɟɪɠɢɧɫɶɤɨɝɨ, 9, Ⱦɧɿɩɪɨɩɟɬɪɨɜcɶɤ, 49044, ɍɤɪɚʀɧɚ

SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine» Department of faculty therapy and endocrinology

Dzerzhinsky str., 9, Dnepropetrovsk, 49044, Ukraine Dzerginsky e-mail: gashynova@mail.ru

Ʉɥɸɱɨɜɿ ɫɥɨɜɚ:ɏɈɁɅ,ɡɚɝɨɫɬɪɟɧɧɹ,ɚɧɬɪɨɩɨɦɟɬɪɢɱɧɿ ɩɨɤɚɡɧɢɤɢ

Key words: COPD, exacerbation, anthropometric parameters

Ɋɟɮɟɪɚɬ. Ɉɛɨɫɬɪɟɧɢɟ ɏɈȻɅ: ɚɧɬɪɨɩɨɦɟɬɪɢɱɟɫɤɢɟ ɯɚɪɚɤɬɟɪɢɫɬɢɤɢ ɛɨɥɶɧɵɯ ɢ ɱɚɫɬɨɬɚ ɝɨɫɩɢɬɚɥɢɡɚɰɢɣ.

Ƚɚɲɢɧɨɜɚ ȿ.ɘ. ɂɫɤɥɸɱɢɬɟɥɶɧɚɹ ɡɧɚɱɢɦɨɫɬɶ ɨɛɨɫɬɪɟɧɢɣ ɞɥɹ ɩɪɨɝɧɨɡɢɪɨɜɚɧɢɹ ɬɟɱɟɧɢɹ ɏɈȻɅ ɛɵɥɚ ɨɬɪɚɠɟɧɚ ɜ ɪɟɞɚɤɰɢɢ GOLD, 2011, ɝɞɟ ɤɨɥɢɱɟɫɬɜɨ ɨɛɨɫɬɪɟɧɢɣ ɜ ɬɟɱɟɧɢɟ ɩɪɨɲɥɨɝɨ ɝɨɞɚ ɛɵɥɨ ɩɪɢɡɧɚɧɨ ɨɞɧɢɦ

ɢɡ ɝɥɚɜɧɵɯ ɤɪɢɬɟɪɢɟɜ ɛɭɞɭɳɢɯ ɪɢɫɤɨɜ ɞɥɹ ɩɚɰɢɟɧɬɨɜ.ɐɟɥɶɸ ɪɚɛɨɬɵ ɛɵɥɨ ɨɩɪɟɞɟɥɟɧɢɟ ɚɧɬɪɨɩɨɦɟɬɪɢɱɟɫɤɢɯ

ɩɨɤɚɡɚɬɟɥɟɣ, ɩɨɜɵɲɚɸɳɢɯ ɪɢɫɤ ɩɨɜɬɨɪɧɨɣ ɝɨɫɩɢɬɚɥɢɡɚɰɢɢ ɜ ɫɜɹɡɢ ɫ ɨɛɨɫɬɪɟɧɢɟɦ ɏɈȻɅ. ɉɪɨɜɟɞɟɧ ɪɟɬɪɨ

(2)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

ɏɈȻɅ» ɜ ɬɟɪɚɩɟɜɬɢɱɟɫɤɨɟ ɨɬɞɟɥɟɧɢɟ Ʉɍ «Ⱦɧɟɩɪɨɩɟɬɪɨɜɫɤɚɹ ɲɟɫɬɚɹ ɝɨɪɨɞɫɤɚɹ ɤɥɢɧɢɱɟɫɤɚɹ ɛɨɥɶɧɢɰɚ»

Ⱦɧɟɩɪɨɩɟɬɪɨɜɫɤɨɝɨ ɨɛɥɚɫɬɧɨɝɨ ɫɨɜɟɬɚ»ɧɚ ɩɪɨɬɹɠɟɧɢɢ ɬɪɟɯ ɥɟɬ.ɍɫɬɚɧɨɜɥɟɧɨ,ɱɬɨ ɧɢ ɩɨɥ,ɧɢ ɪɨɫɬ,ɧɢ ɜɟɫ

ɧɟ ɜɥɢɹɸɬ ɧɚ ɱɚɫɬɨɬɭ ɝɨɫɩɢɬɚɥɢɡɚɰɢɣ ɜɫɥɟɞɫɬɜɢɟ ɨɛɨɫɬɪɟɧɢɹ ɏɈȻɅ.ɉɨɠɢɥɨɣ ɜɨɡɪɚɫɬ ɬɚɤɠɟ ɧɟ ɹɜɥɹɟɬɫɹ

ɮɚɤɬɨɪɨɦ,ɩɨɜɵɲɚɸɳɢɦ ɪɢɫɤ ɝɨɫɩɢɬɚɥɢɡɚɰɢɣ ɢɡ-ɡɚ ɨɛɨɫɬɪɟɧɢɹ ɏɈȻɅ (ɧɟɫɦɨɬɪɹ ɧɚ ɬɨ, ɱɬɨ ɛɨɥɶɲɢɧɫɬɜɨ

ɩɚɰɢɟɧɬɨɜ ɫɬɚɰɢɨɧɚɪɚ ɫɨɫɬɚɜɥɹɥɢ ɩɨɠɢɥɵɟ ɛɨɥɶɧɵɟ, 37% ɢɡ ɧɢɯ ɛɵɥɢ ɥɢɰɚɦɢ ɩɨɬɟɧɰɢɚɥɶɧɨ ɬɪɭɞɨɫɩɨɫɨɛɧɨɝɨ

ɜɨɡɪɚɫɬɚ). Ɍɹɠɟɥɨɟ ɨɛɨɫɬɪɟɧɢɟ ɏɈȻɅ ɦɨɠɟɬ ɜɨɡɧɢɤɧɭɬɶ ɩɪɢ ɥɸɛɨɦ,ɜ ɬɨɦ ɱɢɫɥɟ ɦɟɧɟɟ ɨɞɧɨɝɨ ɝɨɞɚ,ɫɬɚɠɟ

ɡɚɛɨɥɟɜɚɧɢɹ. ɋɪɟɞɢ ɚɧɬɪɨɩɨɦɟɬɪɢɱɟɫɤɢɯ ɩɨɤɚɡɚɬɟɥɟɣ ɧɚɢɛɨɥɟɟ ɜɚɠɧɵɦ ɩɪɟɞɢɤɬɨɪɨɦ ɩɨɜɬɨɪɧɨɣ ɝɨɫɩɢ

-ɬɚɥɢɡɚɰɢɢ ɜɫɥɟɞɫɬɜɢɟ ɨɛɨɫɬɪɟɧɢɹ ɏɈȻɅ ɹɜɥɹɟɬɫɹ ɫɧɢɠɟɧɢɟ ɂɆɌ <18,5, ɩɨɷɬɨɦɭ ɟɝɨ ɩɨɞɫɱɟɬ ɰɟɥɟɫɨɨɛɪɚɡɟɧ

ɩɪɢ ɞɥɢɬɟɥɶɧɨɦ ɧɚɛɥɸɞɟɧɢɢ ɛɨɥɶɧɵɯ.

Abstract. COPD exacerbation: anthropometric characteristics of patients and the frequency of hospital admissions. Gashynova K.Y.Exceptional importance of exacerbations for COPD course prognosing was reflected in the GOLD, 2011, where the number of exacerbations during the past year has been recognized as one of the main criteria of the future risks for patients. The aim of study was to determine the anthropometric indicators that increase the risk of re-hospitalization due to acute exacerbation of COPD. A retrospective analysis of medical records of inpatients who were hospitalized with COPD exacerbation to therapeutic department of CI "Dnipropetrovs’k sixth municipal clinical hospital" of Dnipropetrovsk regional council" during three years was done. It was established that neither sex, nor height, nor weight affect the rate of hospitalization due to COPD exacerbations. Older age is not a factor that increases the risk of hospitalization due to COPD exacerbation (despite the fact that the majority of hospitalized patients were elderly patients, 37% of them were persons of potentially working age). Severe exacerbation of COPD may occur in any patients with, even one year, experience of the disease. Among anthropometric indices, the most important predictor of re-hospitalization due to exacerbation of COPD is BMI<18.5, so its calculation is advisable in long-term observation of patients.

ɏɪɨɧɿɱɧɟ ɨɛɫɬɪɭɤɬɢɜɧɟ ɡɚɯɜɨɪɸɜɚɧɧɹ ɥɟɝɟɧɶ

(ɏɈɁɅ) ɽ ɨɞɧɢɦ ɡ ɨɫɧɨɜɧɢɯ ɱɢɧɧɢɤɿɜ ɫɦɟɪɬɧɨɫɬɿ

ɭ ɜɫɶɨɦɭ ɫɜɿɬɿ ɿ ɡɚ ɞɚɧɢɦɢ ȼɫɟɫɜɿɬɧɶɨʀ ɨɪɝɚɧɿɡɚɰɿʀ ɨɯɨɪɨɧɢ ɡɞɨɪɨɜ'ɹ ɜɢɤɥɢɤɚɽ ɩɪɢɛɥɢɡɧɨ ɬɪɢ

ɦɿɥɶɣɨɧɢ ɫɦɟɪɬɟɣ ɳɨɪɨɤɭ [11]. ɍ ɫɭɱɚɫɧɿɣ ɩɭɥɶ

-ɦɨɧɨɥɨɝɿʀ ɡɚɝɨɫɬɪɟɧɧɹ ɜɢɡɧɚɽɬɶɫɹ ɧɚɣɛɿɥɶɲ ɜɚɠɥɢɜɢɦ ɮɚɤɬɨɪɨɦ ɡɧɚɱɧɨʀ ɿɧɜɚɥɿɞɢɡɚɰɿʀ ɬɚ ɫɦɟɪɬɧɨɫɬɿ ɩɪɢ ɏɈɁɅ [12]. ɇɚ ɧɟɜɟɥɢɤɭ ɱɚɫɬɢɧɭ

ɩɚɰɿɽɧɬɿɜ, ɹɤɿ ɫɬɪɚɠɞɚɸɬɶ ɜɿɞ ɱɚɫɬɢɯ ɡɚɝɨɫɬɪɟɧɶ (ɩɪɢɛɥɢɡɧɨ 10%), ɩɪɢɩɚɞɚɽ ɛɿɥɶɲɟ ɧɿɠ 70%

ɡɚɝɚɥɶɧɢɯ ɜɢɬɪɚɬ ɧɚ ɥɿɤɭɜɚɧɧɹ ɱɟɪɟɡ ɧɟɨɛɯɿɞɧɿɫɬɶ ɩɟɪɟɛɭɜɚɧɧɹ ɭ ɫɬɚɰɿɨɧɚɪɿ ɬɚ ɧɚɞɚɧɧɹ ɧɟɜɿɞɤɥɚɞ

-ɧɨʀ ɞɨɩɨɦɨɝɢ [14]. Ɂɚ ɞɚɧɢɦɢ ɇɚɰɿɨɧɚɥɶɧɨɝɨ

ɪɟɽɫɬɪɭ ɜɢɩɢɫɨɤ ɡɿ ɫɬɚɰɿɨɧɚɪɭ (NHDS), ɭ ɋɒȺ

ɤɿɥɶɤɿɫɬɶ ɝɨɫɩɿɬɚɥɿɡɚɰɿɣ ɱɟɪɟɡ ɏɈɁɅ ɡɛɿɥɶɲɢɥɚɫɶ ɡ 15,9 ɭ 1990 ɪɨɰɿ ɞɨ 23,6 ɧɚ 10000 ɨɫɿɛ ɭ 2005

ɪɨɰɿ [18]. Ɉɫɨɛɥɢɜɨʀ ɭɜɚɝɢ ɩɪɢ ɏɈɁɅ ɩɨɬɪɟ

-ɛɭɸɬɶ ɩɨɜɬɨɪɧɿ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ. ȼɫɬɚɧɨɜɥɟɧɨ, ɳɨ

ɩɪɢ ɧɢɯ ɜɢɬɪɚɬɢ ɡɚɡɜɢɱɚɣ ɡɧɚɱɧɨ ɜɢɳɟ, ɧɿɠ ɩɪɢ

ɩɨɱɚɬɤɨɜɨɦɭ ɩɟɪɟɛɭɜɚɧɧɿ ɭ ɫɬɚɰɿɨɧɚɪɿ [9].

ȼɢɤɥɸɱɧɚ ɡɧɚɱɭɳɿɫɬɶ ɡɚɝɨɫɬɪɟɧɶ ɞɥɹ ɩɪɨɝɧɨ

-ɡɭɜɚɧɧɹ ɩɟɪɟɛɿɝɭ ɏɈɁɅ ɛɭɥɚ ɜɿɞɨɛɪɚɠɟɧɚ ɜ ɧɨɜɿɣ ɪɟɞɚɤɰɿʀ GOLD, 2011. ɍ ɰɶɨɦɭ ɞɨɤɭɦɟɧɬɿ,ɧɚɜɿɬɶ

ɭ ɜɢɡɧɚɱɟɧɧɿ ɩɨɧɹɬɬɹ ɏɈɁɅ, ɩɿɞɤɪɟɫɥɟɧɨ, ɳɨ

ɡɚɝɨɫɬɪɟɧɧɹ ɬɚ ɫɭɩɭɬɧɹ ɩɚɬɨɥɨɝɿɹ ɫɭɬɬɽɜɨ ɜɩɥɢ

-ɜɚɸɬɶ ɧɚ ɬɹɠɤɿɫɬɶ ɩɟɪɟɛɿɝɭ ɜ ɨɤɪɟɦɢɯ ɿɧɞɢɜɿ

-ɞɭɭɦɿɜ. Ʉɪɿɦ ɬɨɝɨ, ɜ GOLD, 2011 ɤɿɥɶɤɿɫɬɶ ɡɚ

-ɝɨɫɬɪɟɧɶ ɩɪɨɬɹɝɨɦ ɦɢɧɭɥɨɝɨ ɪɨɤɭ ɛɭɥɚ ɜɢɡɧɚɧɚ ɨɞɧɢɦ ɡ ɝɨɥɨɜɧɢɯ ɤɪɢɬɟɪɿʀɜ ɦɚɣɛɭɬɧɿɯ ɪɢɡɢɤɿɜ ɞɥɹ ɩɚɰɿɽɧɬɿɜ [6, 10]. Ⱥɧɚɥɨɝɿɱɧɢɣ ɩɿɞɯɿɞ ɛɭɜ ɡɚ

-ɫɬɨɫɨɜɚɧɢɣ ɿ ɜ ɇɚɤɚɡɿ ʋ 555 Ɇɿɧɿɫɬɟɪɫɬɜɚ ɨɯɨ

-ɪɨɧɢ ɡɞɨɪɨɜ'ɹ ɍɤɪɚʀɧɢ ɜɿɞ 27 ɱɟɪɜɧɹ 2013 ɪɨɤɭ

[4], ɹɤɢɣ ɧɢɧɿ ɪɟɝɥɚɦɟɧɬɭɽ ɧɚɞɚɧɧɹ ɦɟɞɢɱɧɨʀ

ɞɨɩɨɦɨɝɢ ɯɜɨɪɢɦ ɧɚ ɏɈɁɅ ɭ ɧɚɲɿɣ ɤɪɚʀɧɿ.

Ɂɝɿɞɧɨ ɿɡ ɫɭɱɚɫɧɢɦɢ ɞɚɧɢɦɢ, ɩɪɨɛɥɟɦɚ ɚɞɟɤ

-ɜɚɬɧɨɫɬɿ ɞɿɚɝɧɨɡɭ ɡɚɝɨɫɬɪɟɧɧɹ ɏɈɁɅ ɩɪɢ ɝɨɫɩɿɬɚ

-ɥɿɡɚɰɿʀ ɿɫɧɭɽ ɿ ɽ ɞɭɠɟ ɚɤɬɭɚɥɶɧɨɸ [7, 8, 17]. Ɂɧɚɧ

-ɧɹ ɜɿɞɧɨɫɧɨ ɱɢɧɧɢɤɿɜ, ɳɨ ɜɢɤɥɢɤɚɸɬɶ ɚɛɨ

ɩɟɪɟɞɭɸɬɶ ɡɚɝɨɫɬɪɟɧɧɸ ɬɚ ɩɪɢɡɜɨɞɹɬɶ ɞɨ ɜɢɧɢɤ

-ɧɟɧɧɹ ɩɨɬɪɟɛɢ ɭ ɫɬɚɰɿɨɧɚɪɧɨɦɭ ɥɿɤɭɜɚɧɧɿ, ɨɛɦɟ

-ɠɟɧɿ ɬɚ ɞɭɠɟ ɫɭɩɟɪɟɱɥɢɜɿ [9, 14, 15]. ȼɬɿɦ,

ɨɫɤɿɥɶɤɢ ɜ ɨɤɪɟɦɢɯ ɜɢɩɚɞɤɚɯ ɩɨɜɬɨɪɧɨʀ ɝɨɫɩɿ

-ɬɚɥɿɡɚɰɿʀ ɦɨɠɧɚ ɡɚɩɨɛɿɝɬɢ,ɜɢɤɥɸɱɧɨ ɜɚɠɥɢɜɢɦ ɽ

ɜɢɡɧɚɱɟɧɧɹ ɩɪɟɞɢɤɬɨɪɿɜ ɩɨɜɟɪɧɟɧɧɹ ɞɨ ɥɿɤɚɪɧɿ ɜɧɚɫɥɿɞɨɤ ɡɚɝɨɫɬɪɟɧɧɹ ɏɈɁɅ.

Ɇɟɬɨɸ ɰɿɽʀ ɪɨɛɨɬɢ ɛɭɥɨ ɜɢɡɧɚɱɟɧɧɹ ɚɧɬɪɨɩɨ

-ɦɟɬɪɢɱɧɢɯ ɩɨɤɚɡɧɢɤɿɜ, ɹɤɿ ɩɿɞɜɢɳɭɸɬɶ ɪɢɡɢɤ

ɩɨɜɬɨɪɧɨʀ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ ɭ ɡɜ’ɹɡɤɭ ɿɡ ɡɚɝɨɫɬɪɟɧɧɹɦ

ɏɈɁɅ.

ɆȺɌȿɊȱȺɅɂ ɌȺ ɆȿɌɈȾɂ ȾɈɋɅȱȾɀȿɇɖ

ɉɪɨɜɟɞɟɧɢɣ ɪɟɬɪɨɫɩɟɤɬɢɜɧɢɣ ɚɧɚɥɿɡ ɜɫɿɯ ɿɫɬɨɪɿɣ ɯɜɨɪɨɛ ɫɬɚɰɿɨɧɚɪɧɢɯ ɯɜɨɪɢɯ, ɹɤɿ ɛɭɥɢ

ɝɨɫɩɿɬɚɥɿɡɨɜɚɧɿ ɡ ɞɿɚɝɧɨɡɨɦ «ɡɚɝɨɫɬɪɟɧɧɹ ɏɈɁɅ»

ɭ ɬɟɪɚɩɟɜɬɢɱɧɟ ɜɿɞɞɿɥɟɧɧɹ ɡ ɩɭɥɶɦɨɧɨɥɨɝɿɱɧɢɦɢ ɥɿɠɤɚɦɢ ɤɨɦɭɧɚɥɶɧɨɝɨ ɡɚɤɥɚɞɭ «Ⱦɧɿɩɪɨɩɟɬ

-ɪɨɜɫɶɤɚ ɲɨɫɬɚ ɦɿɫɶɤɚ ɤɥɿɧɿɱɧɚ ɥɿɤɚɪɧɹ» Ⱦɧɿɩɪɨ

-ɩɟɬɪɨɜɫɶɤɨʀ ɨɛɥɚɫɧɨʀ ɪɚɞɢ» ɜɩɪɨɞɨɜɠ ɬɪɶɨɯ

ɪɨɤɿɜ. Ʉɪɢɬɟɪɿɽɦ ɜɢɤɥɸɱɟɧɧɹ ɿɫɬɨɪɿɣ ɯɜɨɪɨɛ ɡ

ɚɧɚɥɿɡɭ ɛɭɥɚ ɧɚɹɜɧɿɫɬɶ ɤɥɿɧɿɤɨ-ɪɟɧɬɝɟɧɨɥɨɝɿɱɧɢɯ

ɨɡɧɚɤ ɥɟɝɟɧɟɜɨʀ ɿɧɮɿɥɶɬɪɚɰɿʀ, ɚɬɟɥɟɤɬɚɡɭ ɥɟɝɟɧɶ

(3)

Ⱦɿɚɝɧɨɡ ɏɈɁɅ ɜɟɪɢɮɿɤɭɜɚɜɫɹ ɡɚ ɤɪɢɬɟɪɿɹɦɢ, ɳɨ

ɛɭɥɢ ɜɢɤɥɚɞɟɧɿ ɜ ɇɚɤɚɡɿ ʋ128ɆɈɁ ɍɤɪɚʀɧɢ ɜɿɞ 19.03.2007 ɪ. [3], ɡ ɭɪɚɯɭɜɚɧɧɹɦ ɞɚɧɢɯ ɩɨɫɬ

-ɛɪɨɧɯɨɞɿɥɹɬɚɰɿɣɧɨɝɨ ɫɩɿɪɨɦɟɬɪɢɱɧɨɝɨ ɨɛɫɬɟɠɟɧ

-ɧɹ ɡɚ ɭɦɨɜɢ ɜɿɞɩɨɜɿɞɧɨɫɬɿ ɬɟɫɬɿɜ ɦɿɠɧɚɪɨɞɧɢɦ ɫɬɚɧɞɚɪɬɚɦ ɹɤɨɫɬɿ ɬɚ ɪɟɤɨɦɟɧɞɚɰɿɹɦ ɜɿɬɱɢɡɧɹɧɢɯ ɜɱɟɧɢɯ [1, 16].

ɇɚ ɞɪɭɝɨɦɭ ɟɬɚɩɿ ɚɧɚɥɿɡɭɜɚɥɢɫɶ ɩɟɪɫɨɧɚɥɶɧɿ ɞɚɧɿ ɝɨɫɩɿɬɚɥɿɡɨɜɚɧɢɯ ɡ ɩɿɞɬɜɟɪɞɠɟɧɢɦ ɞɿɚɝɧɨɡɨɦ ɡɚɝɨɫɬɪɟɧɧɹ ɏɈɁɅ ɞɥɹ ɜɿɞɨɤɪɟɦɥɟɧɧɹ ɨɫɿɛ, ɹɤɿ

ɩɨɬɪɚɩɥɹɥɢ ɭ ɫɬɚɰɿɨɧɚɪ ɥɢɲɟ ɨɞɧɨɪɚɡɨɜɨ, ɜɿɞ

ɬɢɯ, ɹɤɿ ɛɭɥɢ ɝɨɫɩɿɬɚɥɿɡɨɜɚɧɿ ɞɟɤɿɥɶɤɚ ɪɚɡɿɜ ɩɪɨ

-ɬɹɝɨɦ ɬɪɶɨɯ ɪɨɤɿɜ.

ȼ ɭɫɿɯ ɯɜɨɪɢɯ ɬɚɤɨɠ ɜɢɜɱɚɥɢɫɹ ɚɧɬɪɨɩɨ

-ɦɟɬɪɢɱɧɿ ɩɨɤɚɡɧɢɤɢ (ɫɬɚɬɶ,ɜɿɤ,ɡɪɿɫɬ,ɜɚɝɚ,ȱɆɌ).

Ɉɬɪɢɦɚɧɿ ɪɟɡɭɥɶɬɚɬɢ ɛɭɥɢ ɨɛɪɨɛɥɟɧɿ ɿɡ ɡɚɫɬɨɫɭɜɚɧɧɹɦ ɨɩɢɫɨɜɨʀ ɬɚ ɚɧɚɥɿɬɢɱɧɨʀ ɫɬɚ

-ɬɢɫɬɢɤɢ ɡɚ ɞɨɩɨɦɨɝɨɸ ɩɪɨɝɪɚɦɢ «STATISTICA 6.1» (StatSoft Inc., USA, ɫɟɪɿɣɧɢɣ ʋ AGAR909 E415822FA) [2, 5].

Ⱦɥɹ ɜɫɿɯ ɩɨɤɚɡɧɢɤɿɜ ɩɿɞɪɚɯɨɜɭɜɚɥɚɫɶ ɤɿɥɶɤɿɫɬɶ ɫɩɨɫɬɟɪɟɠɟɧɶ (n). Ⱦɥɹ ɤɿɥɶɤɿɫɧɢɯ ɨɡɧɚɤ ɜɢɡɧɚ

-ɱɚɥɢɫɶ ɫɟɪɟɞɧɿ ɜɟɥɢɱɢɧɢ (Ɇ) ɬɚ ɫɟɪɟɞɧɶɨɤɜɚɞ

-ɪɚɬɢɱɧɿ ɜɿɞɯɢɥɟɧɧɹ (± SD) ɡɚ ɭɦɨɜɢ ɧɨɪɦɚɥɶɧɨɝɨ

ɪɨɡɩɨɞɿɥɭ ɚɛɨ ɦɟɞɿɚɧɢ (Ɇɟ) ɬɚ ɜɟɪɯɧɿ ɣ ɧɢɠɧɿ

ɤɜɚɪɬɢɥɿ ([25%-75%]) ɡɚ ɭɦɨɜɢ ɧɟɧɨɪɦɚɥɶɧɨɝɨ

ɪɨɡɩɨɞɿɥɭ ɞɚɧɢɯ. ɇɨɪɦɚɥɶɧɿɫɬɶ ɪɨɡɩɨɞɿɥɟɧɧɹ

ɤɿɥɶɤɿɫɧɢɯ ɨɡɧɚɤ ɩɟɪɟɜɿɪɹɥɚɫɶ ɡɚ ɦɟɬɨɞɨɦ ɧɚ

-ɝɥɹɞɧɨʀ ɨɰɿɧɤɢ ɜɿɞɩɨɜɿɞɧɢɯ ɝɿɫɬɨɝɪɚɦ ɡ ɩɨɞɚɥɶ

-ɲɢɦ ɜɢɤɨɪɢɫɬɚɧɧɹɦ ɤɪɢɬɟɪɿɸ Ʌɿɥɥɿɽɮɨɪɫɚ.

Ɋɨɡɩɨɞɿɥɟɧɧɹ ɜɜɚɠɚɥɨɫɶ ɧɨɪɦɚɥɶɧɢɦ ɩɪɢ

ɪ > 0,05. Ⱦɥɹ ɚɧɚɥɿɡɭ ɧɨɪɦɚɥɶɧɨ ɪɨɡɩɨɞɿɥɟɧɢɯ

ɡɧɚɱɟɧɶ ɜɢɤɨɪɢɫɬɨɜɭɜɚɥɢɫɶ ɩɚɪɚɦɟɬɪɢɱɧɿ, ɚ ɞɥɹ

ɧɟɧɨɪɦɚɥɶɧɨ ɪɨɡɩɨɞɿɥɟɧɢɯ – ɧɟɩɚɪɚɦɟɬɪɢɱɧɿ ɦɟ

-ɬɨɞɢ ɫɬɚɬɢɫɬɢɤɢ. Ⱦɥɹ ɩɨɪɿɜɧɹɧɧɹ ɩɨɤɚɡɧɢɤɿɜ

ɞɜɨɯ ɧɟɡɚɥɟɠɧɢɯ ɝɪɭɩ ɜɢɤɨɪɢɫɬɨɜɭɜɚɜɫɹ t-ɬɟɫɬ

ɋɬ’ɸɞɟɧɬɚ ɡɚ ɭɦɨɜ ɧɨɪɦɚɥɶɧɨɝɨ ɪɨɡɩɨɞɿɥɭ ɚɛɨ

ɬɟɫɬ Ɇɚɧɧɚ-ɍɿɬɧɿ ɡɚ ɭɦɨɜ ɧɟɧɨɪɦɚɥɶɧɨɝɨ ɪɨɡ

-ɩɨɞɿɥɭ ɞɚɧɢɯ. əɤɿɫɧɿ ɨɡɧɚɤɢ ɛɭɥɢ ɩɪɟɞɫɬɚɜɥɟɧɿ ɭ

ɜɢɝɥɹɞɿ ɚɛɫɨɥɸɬɧɢɯ ɡɧɚɱɟɧɶ (n) ɬɚ ɜɿɞɧɨɫɧɢɯ

ɱɚɫɬɨɬ (P), ɳɨ ɛɭɥɢ ɜɢɪɚɠɟɧɿ ɭ ɱɚɫɬɤɚɯ ɨɞɢɧɢɰɿ

ɚɛɨ ɜɿɞɫɨɬɤɚɯ (%), ɿɡ ɡɚɡɧɚɱɟɧɧɹɦ ɩɨɦɢɥɤɢ (± m)

ɚɛɨ ɜɢɡɧɚɱɟɧɧɹɦ 95 % ɞɨɜɿɪɱɨɝɨ ɿɧɬɟɪɜɚɥɭ ([95% ɋȱ]), ɳɨ ɪɨɡɪɚɯɨɜɭɜɚɜɫɹ ɡɚ ɤɨɪɟɤɬɨɜɚɧɨɸ

ɮɨɪɦɭɥɨɸ ȼɿɥɫɨɧɚ [13].

Ⱦɥɹ ɧɨɦɿɧɚɥɶɧɢɯ ɬɚ ɩɨɪɹɞɤɨɜɢɯ ɨɡɧɚɤ ɬɚɤɨɠ ɨɛɱɢɫɥɸɜɚɥɢɫɶ Ɇɟ [25%-75%]. ȼɿɪɨɝɿɞɧɿɫɬɶ ɜɿɞ

-ɦɿɧɧɨɫɬɟɣ ɹɤɿɫɧɢɯ ɨɡɧɚɤ ɩɪɨɜɨɞɢɥɚɫɶ ɩɟɪɟɜɚɠɧɨ ɡɚ ɤɪɢɬɟɪɿɽɦ ɏɿ-ɤɜɚɞɪɚɬ (Ȥ2), ɚ ɩɪɢ n < 5 ɡɚ

ɬɨɱɧɢɦ ɤɪɢɬɟɪɿɽɦ Ɏɿɲɟɪɚ ɞɥɹ ɱɚɫɬɨɬ.Ⱦɥɹ ɨɰɿɧɤɢ

ɜɿɪɨɝɿɞɧɨɫɬɿ ɜɿɞɦɿɧɧɨɫɬɟɣ ɦɿɠ ɛɿɧɚɪɧɢɦɢ ɧɨɦɿ

-ɧɚɥɶɧɢɦɢ ɨɡɧɚɤɚɦɢ ɭɫɟɪɟɞɢɧɿ ɨɞɧɿɽʀ ɚɛɨ ɜ ɞɜɨɯ ɝɪɭɩɚɯ ɩɨɪɿɜɧɸɜɚɥɢɫɶ [95% ɋȱ] ɬɚ ɜɢɤɨɪɢɫɬɨ

-ɠɚɥɢɫɶ ɜɿɞɦɿɧɧɨɫɬɿ ɦɿɠ ɝɪɭɩɚɦɢ ɩɪɢ ɪ < 0,05.

ɊȿɁɍɅɖɌȺɌɂ ɌȺ Ȳɏ ɈȻȽɈȼɈɊȿɇɇə

ɍ ɯɨɞɿ ɩɪɨɜɟɞɟɧɨɝɨ ɪɟɬɪɨɫɩɟɤɬɢɜɧɨɝɨ ɚɧɚɥɿɡɭ ɛɭɥɨ ɜɢɹɜɥɟɧɨ 536 ɿɫɬɨɪɿɣ ɫɬɚɰɿɨɧɚɪɧɢɯ ɯɜɨɪɢɯ,

ɹɤɿ ɛɭɥɢ ɝɨɫɩɿɬɚɥɿɡɨɜɚɧɿ ɩɪɨɬɹɝɨɦ ɬɪɶɨɯ ɪɨɤɿɜ ɡ ɞɿɚɝɧɨɡɨɦ «ɡɚɝɨɫɬɪɟɧɧɹ ɏɈɁɅ» ɭ ɬɟɪɚɩɟɜɬɢɱɧɟ

ɜɿɞɞɿɥɟɧɧɹ ɡ ɩɭɥɶɦɨɧɨɥɨɝɿɱɧɢɦɢ ɥɿɠɤɚɦɢ ɤɨɦɭ

-ɧɚɥɶɧɨɝɨ ɡɚɤɥɚɞɭ «Ⱦɧɿɩɪɨɩɟɬɪɨɜɫɶɤɚ ɲɨɫɬɚ

ɦɿɫɶɤɚ ɤɥɿɧɿɱɧɚ ɥɿɤɚɪɧɹ» Ⱦɧɿɩɪɨɩɟɬɪɨɜɫɶɤɨʀ ɨɛ

-ɥɚɫɧɨʀ ɪɚɞɢ». Ⱦɨ ɨɫɬɚɬɨɱɧɨɝɨ ɚɧɚɥɿɡɭ ɛɭɥɢ ɜɿɞɿ

-ɛɪɚɧɿ 162 ɿɫɬɨɪɿʀ ɯɜɨɪɨɛɢ, ɜ ɹɤɢɯ ɞɿɚɝɧɨɡ ɡɚ

-ɝɨɫɬɪɟɧɧɹ ɏɈɁɅ,ɳɨ ɩɨɬɪɟɛɭɽ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ, ɛɭɜ

ɩɿɞɬɜɟɪɞɠɟɧɢɣ ɹɤ ɤɥɿɧɿɤɨ-ɚɧɚɦɧɟɫɬɢɱɧɢɦɢ, ɬɚɤ ɿ

ɫɩɿɪɨɦɟɬɪɢɱɧɢɦɢ ɩɨɤɚɡɧɢɤɚɦɢ, ɬɚ ɜ ɹɤɢɯ ɛɭɥɢ

ɜɿɞɫɭɬɧɿ ɨɡɧɚɤɢ ɤɪɢɬɟɪɿʀɜ ɜɢɤɥɸɱɟɧɧɹ.

Ɂɚ ɞɚɧɢɦɢ ɩɪɨɜɟɞɟɧɨɝɨ ɞɨɫɥɿɞɠɟɧɧɹ, ɩɪɨ

-ɬɹɝɨɦ ɬɪɶɨɯ ɪɨɤɿɜ ɭ ɬɟɪɚɩɟɜɬɢɱɧɟ ɜɿɞɞɿɥɟɧɧɹ ɡ ɩɭɥɶɦɨɧɨɥɨɝɿɱɧɢɦɢ ɥɿɠɤɚɦɢ ɿɡ ɡɚɝɨɫɬɪɟɧɧɹɦ ɛɭɥɢ ɝɨɫɩɿɬɚɥɿɡɨɜɚɧɿ ɯɜɨɪɿ ɧɚ ɏɈɁɅ ɭɫɿɯ ɫɬɭɩɟɧɿɜ ɬɹɠɤɨɫɬɿ ɩɟɪɟɛɿɝɭ (ɪɢɫ. 1): ɥɟɝɤɨɝɨ (ȱ ɫɬɚɞɿɹ) – 14

ɜɢɩɚɞɤɿɜ, ɩɨɦɿɪɧɨɝɨ (ȱȱ ɫɬɚɞɿɹ) – 44, ɬɹɠɤɨɝɨ (ȱȱȱ

ɫɬɚɞɿɹ) – 85 ɬɚ ɞɭɠɟ ɬɹɠɤɨɝɨ (ȱV ɫɬɚɞɿɹ) – 19

ɜɢɩɚɞɤɿɜ, ɬɨɛɬɨ ɤɨɧɬɢɧɝɟɧɬ ɝɨɫɩɿɬɚɥɿɡɨɜɚɧɢɯ ɛɭɜ

ɞɨɫɢɬɶ ɧɟɨɞɧɨɪɿɞɧɢɣ.

Ɉɱɿɤɭɜɚɧɢɦ ɜɢɹɜɢɜɫɹ ɮɚɤɬ, ɳɨ ɭ ɜɿɪɨɝɿɞɧɿɣ (ɪ < 0,001) ɛɿɥɶɲɨɫɬɿ ɜɢɩɚɞɤɿɜ ɝɨɫɩɿɬɚɥɿɡɚɰɿɣ

ɯɜɨɪɿ ɦɚɥɢ ɬɹɠɤɢɣ ɿ ɞɭɠɟ ɬɹɠɤɢɣ ɩɟɪɟɛɿɝ ɡɚɯɜɨ

-ɪɸɜɚɧɧɹ. Ɉɞɧɚɤ ɜɟɥɶɦɢ ɧɟɫɩɨɞɿɜɚɧɢɦ ɛɭɥɨ ɬɟ,

ɳɨ ɞɨɫɢɬɶ ɜɟɥɢɤɭ ɤɿɥɶɤɿɫɬɶ (ɛɿɥɶɲɟ ɬɪɟɬɶɨʀ ɱɚɫ

-ɬɢɧɢ) ɝɨɫɩɿɬɚɥɿɡɨɜɚɧɢɯ ɜɧɚɫɥɿɞɨɤ ɡɚɝɨɫɬɪɟɧɧɹ

ɫɤɥɚɞɚɥɢ ɯɜɨɪɿ ɡ ɥɟɝɤɢɦ ɬɚ ɩɨɦɿɪɧɢɦ ɏɈɁɅ. ɐɹ

ɡɧɚɯɿɞɤɚ ɩɿɞɬɜɟɪɞɠɭɽ ɬɨɱɤɭ ɡɨɪɭ, ɳɨ ɧɚɜɿɬɶ ɩɪɢ

ɧɟɡɧɚɱɧɿɣ ɨɛɫɬɪɭɤɰɿʀ ɞɢɯɚɥɶɧɢɯ ɲɥɹɯɿɜ ɭ ɯɜɨɪɢɯ ɧɚ ɏɈɁɅ ɦɨɠɥɢɜɿ ɬɹɠɤɿ ɡɚɝɨɫɬɪɟɧɧɹ, ɤɨɬɪɿ

ɩɨɬɪɟɛɭɸɬɶ ɧɚɞɚɧɧɹ ɫɬɚɰɿɨɧɚɪɧɨʀ ɞɨɩɨɦɨɝɢ.

Ɇɚɣɠɟ ɭɫɿ ɝɨɫɩɿɬɚɥɿɡɨɜɚɧɿ ɯɜɨɪɿ ɧɚɥɟɠɚɥɢ ɞɨ ɫɬɚɪɲɢɯ ɜɿɤɨɜɢɯ ɝɪɭɩ: ɜɿɤ ɩɚɰɿɽɧɬɿɜ ɩɿɞ ɱɚɫ

ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ ɫɬɚɧɨɜɢɜ 63,00 [55,00-70,00] ɪɨɤɢ,

ɚ ɧɚɣɫɬɚɪɿɲɨɦɭ ɩɚɰɿɽɧɬɭ ɜɢɩɨɜɧɢɥɨɫɹ 90. ȼɬɿɦ,

ɹɤ ɩɨɤɚɡɚɥɢ ɪɟɡɭɥɶɬɚɬɢ ɚɧɚɥɿɡɭ, ɧɚ ɜɿɞɦɿɧɭ ɜɿɞ

ɡɚɝɚɥɶɧɨɩɪɢɣɧɹɬɢɯ ɭɹɜɥɟɧɶ, ɬɹɠɤɟ ɡɚɝɨɫɬɪɟɧɧɹ

ɏɈɁɅ, ɳɨ ɩɨɬɪɟɛɭɽ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ, ɦɨɠɟ ɜɢ

-ɧɢɤɧɭɬɢ ɣ ɞɨ 40 ɪɨɤɿɜ (3 ɨɫɨɛɢ (1,85 ± 1,06%)).

ɉɪɢɬɨɦɭ ɦɨɥɨɞɲɨɦɭ ɯɜɨɪɨɦɭ ɛɭɥɨ ɥɢɲɟ 33. ɍ 60 ɜɢɩɚɞɤɚɯ (37,0 ± 3,79%) ɝɨɫɩɿɬɚɥɿɡɨɜɚɧɢɦ

ɯɜɨɪɢɦ ɳɟ ɧɟ ɜɢɩɨɜɧɢɥɨɫɹ 60 ɪɨɤɿɜ, ɬɨɛɬɨ ɜɨɧɢ

ɡɧɚɯɨɞɢɥɢɫɶ ɭ ɩɨɬɟɧɰɿɣɧɨ ɩɪɚɰɟɡɞɚɬɧɨɦɭ ɜɿɰɿ.

Ⱥɥɟ ɜɫɟ ɠ ɬɚɤɢ ɭ ɩɟɪɟɜɚɠɚɸɱɿɣ (ɪ < 0,001)

ɛɿɥɶɲɨɫɬɿ ɜɢɩɚɞɤɿɜ (131 (80,86 ± 3,09 %)) ɝɨɫɩɿ

(4)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

8,64

27,16

52,47

11,73

ɋɬɚɞɿɹ ȱ ɋɬɚɞɿɹ ȱȱ ɋɬɚɞɿɹ ȱȱȱ ɋɬɚɞɿɹ ȱV

Ɋɢɫ. 1. ȼɿɞɫɨɬɤɨɜɢɣ ɪɨɡɩɨɞɿɥ ɡɚ ɫɬɭɩɟɧɟɦ ɬɹɠɤɨɫɬɿ ɩɟɪɟɛɿɝɭ ɏɈɁɅ ɯɜɨɪɢɯ,

ɝɨɫɩɿɬɚɥɿɡɨɜɚɧɢɯ ɿɡ ɡɚɝɨɫɬɪɟɧɧɹɦ

ɋɟɪɟɞ ɝɨɫɩɿɬɚɥɿɡɨɜɚɧɢɯ ɿɡ ɡɚɝɨɫɬɪɟɧɧɹɦ ɛɭɥɚ ɩɟɪɟɜɚɠɧɚ ɛɿɥɶɲɿɫɬɶ (ɪ < 0,001) ɱɨɥɨɜɿɤɿɜ – 120

ɨɫɿɛ (74,07 ± 3,44%). ɇɟɡɜɚɠɚɸɱɢ ɧɚ ɬɟ, ɳɨ ɨɱɿ

-ɤɭɜɚɧɨ (ɩɟɪɲ ɡɚ ɜɫɟ, ɜɪɚɯɨɜɭɸɱɢ ɧɚɹɜɧɿɫɬɶ ɜ

ɚɧɚɦɧɟɡɿ ɬɪɚɞɢɰɿɣɧɨʀ ɩɪɢɯɢɥɶɧɨɫɬɿ ɞɨ ɬɸɬɸɧɨ

-ɩɚɥɿɧɧɹ) ɫɟɪɟɞ ɯɜɨɪɢɯ ɩɪɟɜɚɥɸɜɚɥɢ ɨɫɨɛɢ ɱɨɥɨ

-ɜɿɱɨʀ ɫɬɚɬɿ,ɭɜɚɝɭ ɩɪɢɜɟɪɧɭɜ ɿ ɬɨɣ ɮɚɤɬ,ɳɨ ɠɿɧɤɢ

ɫɤɥɚɥɢ ɛɿɥɶɲɟ ɱɜɟɪɬɿ ɬɢɯ, ɯɬɨ ɩɨɬɪɚɩɢɜ ɞɨ

ɫɬɚɰɿɨɧɚɪɭ ɱɟɪɟɡ ɏɈɁɅ.

Ɍɪɢɜɚɥɿɫɬɶ ɡɚɯɜɨɪɸɜɚɧɧɹ ɧɚ ɦɨɦɟɧɬ ɧɚɞɯɨɞ

-ɠɟɧɧɹ ɞɨ ɥɿɤɚɪɧɿ ɧɟ ɛɭɥɚ ɜɟɥɢɤɨɸ ɣ ɫɬɚɧɨɜɢɥɚ

6,00 [4,00-8,00] ɪɨɤɿɜ. ɐɟ ɦɨɠɟ ɫɜɿɞɱɢɬɢ ɩɪɨ ɬɟ,

ɳɨ ɧɚɜɿɬɶ ɩɪɢ ɦɚɥɨɦɭ ɫɬɚɠɿ ɧɟɞɭɝɭ (6 ɨɫɿɛ (3,70 ± 1,48 %) ɯɜɨɪɿɥɢ ɥɢɲɟ ɩɪɨɬɹɝɨɦ ɨɞɧɨɝɨ

ɪɨɤɭ ɧɚ ɦɨɦɟɧɬ ɩɨɬɪɚɩɥɹɧɧɹ ɞɨ ɫɬɚɰɿɨɧɚɪɭ), ɭ

ɩɚɰɿɽɧɬɿɜ ɡ ɏɈɁɅ ɦɨɠɟ ɜɢɧɢɤɧɭɬɢ ɡɚɝɨɫɬɪɟɧɧɹ,

ɹɤɟ ɩɨɬɪɟɛɭɜɚɬɢɦɟ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ. ɉɪɨɬɟ ɧɟ ɦɨɠ

-ɧɚ ɿɝɧɨɪɭɜɚɬɢ ɣ ɩɪɢɩɭɳɟɧɧɹ,ɳɨ ɛɿɥɶɲɿɫɬɶ ɨɫɿɛ ɡ

ɏɈɁɅ ɡɜɟɪɬɚɸɬɶɫɹ ɡɚ ɦɟɞɢɱɧɨɸ ɞɨɩɨɦɨɝɨɸ ɥɢɲɟ ɩɪɢ ɡɧɚɱɧɢɯ ɤɥɿɧɿɱɧɢɯ ɫɢɦɩɬɨɦɚɯ, ɬɨɛɬɨ

ɪɟɚɥɶɧɚ ɬɪɢɜɚɥɿɫɬɶ ɡɚɯɜɨɪɸɜɚɧɧɹ ɦɨɝɥɚ ɫɭɬɬɽɜɨ ɜɿɞɪɿɡɧɹɬɢɫɹ ɜɿɞ ɡɚɞɨɤɭɦɟɧɬɨɜɚɧɨʀ.

ɍ 130 ɜɢɩɚɞɤɚɯ (80,25 ± 3,13%) ɯɜɨɪɿ ɛɭɥɢ

ɤɭɪɰɹɦɢ,ɬɚɤɢɦ ɱɢɧɨɦ ɬɢɯ, ɯɬɨ ɤɭɪɢɜ,ɛɭɥɨ ɜɿɪɨ

-ɝɿɞɧɨ ɛɿɥɶɲɟ (ɪ < 0,001), ɧɿɠ ɬɢɯ,ɯɬɨ ɧɟ ɤɭɪɢɜ ɧɚ

ɦɨɦɟɧɬ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ. Ⱦɨɫɬɨɜɿɪɧɢɯ ɜɿɤɨɜɢɯ ɬɚ

ɫɬɚɬɟɜɢɯ ɜɿɞɡɧɚɤ ɡɝɿɞɧɨ ɡ ɧɚɹɜɧɿɫɬɸ ɚɛɨ ɜɿɞ

-ɫɭɬɧɿɫɬɸ ɩɚɥɿɧɧɹ ɧɚɦɢ ɧɟ ɛɭɥɨ ɜɫɬɚɧɨɜɥɟɧɨ.

ɋɬɚɠ ɤɭɪɿɧɧɹ, ɩɚɫɢɜɧɟ ɤɭɪɿɧɧɹ ɬɚ ɤɿɥɶɤɿɫɬɶ ɟɤɫ

-ɤɭɪɰɿɜ ɭ ɯɨɞɿ ɪɟɬɪɨɫɩɟɤɬɢɜɧɨɝɨ ɞɨɫɥɿɞɠɟɧɧɹ ɨɰɿɧɢɬɢ ɛɭɥɨ ɧɟɦɨɠɥɢɜɨ ɱɟɪɟɡ ɜɿɞɫɭɬɧɿɫɬɶ ɜ ɿɫɬɨɪɿɹɯ ɯɜɨɪɨɛɢ ɜɿɞɩɨɜɿɞɧɨʀ ɿɧɮɨɪɦɚɰɿʀ.

ɉɪɢ ɞɟɬɚɥɶɧɨɦɭ ɚɧɚɥɿɡɿ ɜɫɿɯ ɡɚɝɨɫɬɪɟɧɶ ɏɈɁɅ, ɳɨ ɩɨɬɪɟɛɭɜɚɥɢ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ, ɡ’ɹɫɨɜɚɧɨ,

ɳɨ ɭ 112 ɜɢɩɚɞɤɚɯ (69,14 ± 3,63%) ɯɜɨɪɿ ɛɭɥɢ

ɝɨɫɩɿɬɚɥɿɡɨɜɚɧɿ ɥɢɲɟ ɨɞɧɨɤɪɚɬɧɨ ɩɪɨɬɹɝɨɦ ɬɪɶɨɯ ɪɨɤɿɜ.Ɉɞɧɚɤ ɦɚɣɠɟ ɬɪɟɬɹ ɱɚɫɬɢɧɚ ɟɩɿɡɨɞɿɜ ɩɟɪɟ

-ɛɭɜɚɧɧɹ ɭ ɫɬɚɰɿɨɧɚɪɿ ɱɟɪɟɡ ɡɚɝɨɫɬɪɟɧɧɹ ɏɈɁɅ – 50 (30,86 ± 3,63%) – ɛɭɥɚ ɡɭɦɨɜɥɟɧɚ ɝɨɫɩɿɬɚɥɿɡɚ

-ɰɿɽɸ ɨɞɧɢɯ ɿ ɬɢɯ ɫɚɦɢɯ ɩɚɰɿɽɧɬɿɜ.

Ɍɚɤɢɦ ɱɢɧɨɦ,ɞɥɹ ɞɪɭɝɨɝɨ ɟɬɚɩɭ ɚɧɚɥɿɡɭ ɧɚɦɢ

ɛɭɥɨ ɜɢɞɿɥɟɧɨ ɞɜɿ ɝɪɭɩɢ ɯɜɨɪɢɯ: ɝɪɭɩɚ ȱ (112

ɨɫɿɛ) – ɬɿ,ɳɨ ɛɭɥɢ ɝɨɫɩɿɬɚɥɿɡɨɜɚɧɿ ɨɞɧɨɪɚɡɨɜɨ,ɬɚ

ɝɪɭɩɚ ȱȱ (19 ɨɫɿɛ) – ɬɿ, ɳɨ ɛɭɥɢ ɝɨɫɩɿɬɚɥɿɡɨɜɚɧɿ

ɜɧɚɫɥɿɞɨɤ ɡɚɝɨɫɬɪɟɧɧɹ ɏɈɁɅ ɞɜɚ ɿ ɛɿɥɶɲɟ ɪɚɡɿɜ ɩɪɨɬɹɝɨɦ ɬɪɶɨɯ ɪɨɤɿɜ. Ⱦɟɬɚɥɶɧɿ ɚɧɬɪɨɩɨɦɟɬɪɢɱɧɿ

ɞɚɧɿ ɯɜɨɪɢɯ ɝɪɭɩɢ ȱ ɬɚ ɝɪɭɩɢ ȱȱ ɧɚɜɟɞɟɧɿ ɭ ɬɚɛɥɢɰɿ.

Ɉɛɢɞɜɿ ɝɪɭɩɢ ɛɭɥɢ ɩɨɪɿɜɧɹɧɿ ɡɚ ɫɬɚɬɬɸ – ɜ ɧɢɯ

ɡɭɫɬɪɿɱɚɥɢɫɶ ɹɤ ɠɿɧɤɢ, ɬɚɤ ɿ ɱɨɥɨɜɿɤɢ, ɩɪɢɬɨɦɭ

ɨɫɬɚɧɧɿ ɫɬɚɧɨɜɢɥɢ ɩɟɪɟɜɚɠɧɭ (ɪ < 0,001) ɛɿɥɶ

-ɲɿɫɬɶ ɜ ɨɛɨɯ ɜɢɩɚɞɤɚɯ.ɋɬɚɬɢɫɬɢɱɧɿ ɜɿɞɦɿɧɧɨɫɬɿ ɡɚ

ɜɿɤɨɦ ɦɿɠ ɩɚɰɿɽɧɬɚɦɢ ɨɛɨɯ ɝɪɭɩ ɬɚɤɨɠ ɧɟ ɛɭɥɢ ɜɿɪɨɝɿɞɧɢɦɢ. ɉɪɢ ɩɨɝɥɢɛɥɟɧɨɦɭ ɚɧɚɥɿɡɿ ɜɫɬɚɧɨɜ

-ɥɟɧɨ, ɳɨ ɜ ɨɛɨɯ ɝɪɭɩɚɯ ɜɿɤ ɩɚɰɿɽɧɬɿɜ ɤɨɥɢɜɚɜɫɹ ɜ

ɞɨɫɢɬɶ ɲɢɪɨɤɢɯ ɦɟɠɚɯ – ɜɿɞ 33 ɞɨ 90 ɪɨɤɿɜ ɭ ɝɪɭɩɿ

ȱ (ɪɢɫ. 2) ɬɚ ɜɿɞ 47 ɞɨ 81 ɪɨɤɭ ɭ ɝɪɭɩɿ ȱȱ (ɪɢɫ. 3).

Ɋɿɡɧɢɰɹ ɦɿɠ ɧɚɣɦɨɥɨɞɲɿɦ ɬɚ ɫɚɦɢɦ ɫɬɚɪɢɦ ɩɚɰɿɽɧɬɨɦ ɝɪɭɩɢ ȱ ɫɬɚɧɨɜɢɥɚ ɦɚɣɠɟ 60 ɪɨɤɿɜ, ɭ

ɬɨɣ ɱɚɫ ɹɤ ɭ ɝɪɭɩɿ ȱȱ ɰɹ ɪɿɡɧɢɰɹ ɞɨɪɿɜɧɸɜɚɥɚ ɥɢɲɟ 34 ɪɨɤɚɦ.Ɍɚɤɨɠ,ɧɚ ɜɿɞɦɿɧɭ ɜɿɞ ɝɪɭɩɢ ȱȱ,ɞɟ

ɛɭɜ ɥɢɲɟ ɨɞɢɧ ɯɜɨɪɢɣ ɭ ɜɿɰɿ 65-70 ɪɨɤɿɜ (5,26 ± 5,12%), ɭ ɝɪɭɩɿ ȱ ɰɹ ɜɿɤɨɜɚ ɤɚɬɟɝɨɪɿɹ ɛɭɥɚ

(5)

20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100

ȼɿɤɨɜɿ ɤɚɬɟɝɨɪɿʀ (ɜɟɪɯɧɿɣ ɥɿɦɿɬ),ɪɨɤɢ 0

5 10 15 20 25 30 35 40

Ʉɿɥɶ

ɤɿɫ

ɬɶ

ɫɩɨ

ɫɬɟ

ɪɟ

ɠ

ɟɧ

ɶ

, n

Ɋɢɫ. 2. Ɋɨɡɩɨɞɿɥ ɡɚ ɜɿɤɨɦ ɩɚɰɿɽɧɬɿɜ ɝɪɭɩɢ ȱ

ɉɚɰɿɽɧɬɢ ɝɪɭɩɢ ȱ ɬɚ ɝɪɭɩɢ ȱȱ ɫɭɬɬɽɜɨ ɧɟ ɜɿɞɪɿɡɧɹɥɢɫɶ ɡɚ ɡɪɨɫɬɨɦ ɬɚ ɡɚɝɚɥɶɧɨɸ ɜɚɝɨɸ

(ɬɚɛɥ.). Ⱥɥɟ ɞɥɹ ɛɿɥɶɲ ɬɨɱɧɨʀ ɚɧɬɪɨɩɨɦɟɬɪɢɱɧɨʀ

ɯɚɪɚɤɬɟɪɢɫɬɢɤɢ ɞɨɰɿɥɶɧɢɦ ɜɜɚɠɚɜɫɹ ɩɿɞɪɚɯɭɧɨɤ ɭ ɤɨɠɧɨɝɨ ɡ ɧɢɯ ȱɆɌ.

ɉɪɢ ɚɧɚɥɿɡɿ ȱɆɌ, ɡɝɿɞɧɨ ɡ ɪɟɤɨɦɟɧɞɚɰɿɹɦɢ

ȼɫɟɫɜɿɬɧɶɨʀ ɨɪɝɚɧɿɡɚɰɿʀ ɨɯɨɪɨɧɢ ɡɞɨɪɨɜ’ɹ (ȼɈɈɁ) [19], ɯɜɨɪɢɦɢ ɡɿ ɡɧɢɠɟɧɨɸ ɜɚɝɨɸ ɜɜɚɠɚɥɢɫɶ ɬɿ,

ɯɬɨ ɦɚɥɢ ȱɆɌ < 18,5; ɡ ɧɨɪɦɚɥɶɧɨɸ – ɩɪɢ 18,5 ȱɆɌ < 25; ɡ ɩɿɞɜɢɳɟɧɨɸ ɜɚɝɨɸ – ɩɪɢ

ȱɆɌ 25. ɍ ɯɨɞɿ ɩɨɪɿɜɧɹɧɧɹ ɛɭɥɨ ɜɫɬɚɧɨɜɥɟɧɨ,

ɳɨ ɜ ɝɪɭɩɿ ȱ ɰɟɣ ɩɨɤɚɡɧɢɤ ɤɨɥɢɜɚɜɫɹ ɜ ɞɭɠɟ ɲɢɪɨɤɢɯ ɦɟɠɚɯ (ɜɿɞ 16,96 ɞɨ 54,77). ɍ ɝɪɭɩɿ ȱȱ

ɦɿɧɿɦɚɥɶɧɟ ɡɧɚɱɟɧɧɹ ȱɆɌ ɫɬɚɧɨɜɢɥɨ 15,53, ɚ

ɦɚɤɫɢɦɚɥɶɧɟ – 38,06. Ɍɨɛɬɨ ɧɚ ɜɿɞɦɿɧɭ ɜɿɞ ɝɪɭɩɢ

ȱ, ɫɟɪɟɞ ɯɜɨɪɢɯ ɡ ɛɚɝɚɬɨɤɪɚɬɧɨɸ ɝɨɫɩɿɬɚɥɿɡɚɰɿɽɸ

ɛɭɥɢ ɩɪɢɫɭɬɧɿ ɨɫɨɛɢ ɡ ɬɹɠɤɢɦ (ȱɆɌ < 16) ɡɧɢ

-ɠɟɧɧɹɦ ɦɚɫɢ ɿ, ɧɚɜɩɚɤɢ, ɧɟ ɡɭɫɬɪɿɱɚɥɢɫɶ ɯɜɨɪɿ ɡ

ɬɹɠɤɢɦ (ȱɆɌ > 40) ɡɛɿɥɶɲɟɧɧɹɦ ɜɚɝɢ.

35 40 45 50 55 60 65 70 75 80 85

ȼɿɤɨɜɿ ɤɚɬɟɝɨɪɿʀ (ɜɟɪɯɧɿɣ ɥɿɦɿɬ), ɪɨɤɢ 0,0

0,5 1,0 1,5 2,0 2,5 3,0 3,5 4,0 4,5 5,0 5,5 6,0 6,5 7,0 7,5 8,0 8,5 9,0 9,5 10,0

Ʉɿ

ɥɶ

ɤɿ

ɫɬ

ɶ

ɫɩ

ɨɫɬ

ɟɪ

ɟɠ

ɟɧ

ɶ

, n

(6)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

Ⱥɧɬɪɨɩɨɦɟɬɪɢɱɧɿ ɞɚɧɿ ɯɜɨɪɢɯ,ɳɨ ɛɭɥɢ ɝɨɫɩɿɬɚɥɿɡɨɜɚɧɿ ɜɧɚɫɥɿɞɨɤ ɡɚɝɨɫɬɪɟɧɧɹ ɏɈɁɅ

ɉɨɤɚɡɧɢɤɢ _{(n = 112)}Ƚɪɭɩɚ ȱ Ƚɪɭɩɚ ȱ_{(n = 19)}I* ɪ

ɋɬɚɬɶ:

1) ɱɨɥɨɜɿɤɢ, n

(Ɋ [95 % CI])

2) ɠɿɧɤɢ, n

(Ɋ [95 % CI])

79 (0,71 [0,62-0,78])

33 (0,29 [0,22-0,38])

16 (0,84 [0,60-0,96])

3 (0,16 [0,05-0,40])

0,239

ȼɿɤ Med [25 %-75 %], ɪɨɤɢ 65,00 [55,00-69,00] 59,00 [53,00-73,00] 0,882

Ɂɪɿɫɬ M ± SD, ɫɦ 169,45 ± 8,46 171,26 ± 8,01 0,387

ȼɚɝɚ Med [25 %-75 %], ɤɝ 75,00 [69,00-85,00] 70,00 [60,00-90,00] 0,253

ȱɆɌ Med [25 %-75 %], ɤɝ/ɦ2 _{26,12 [23,62-29,73]} _{25,71 [20,78-28,38]} _0,137

ȱɆɌ:

ȱɆɌ < 18,5, n (Ɋ ± m, %) 18,5 ȱɆɌ < 25, n (Ɋ ± m, %)

ȱɆɌ 25, n (Ɋ ± m, %)

3 (2,68 ± 1,53) 40 (35,71± 4,53) 69 (61,61 ± 4,60)

3 (15,79 ± 8,37) 6 (31,58 ± 10,66) 10 (52,63 ± 11,45)

0,039 0,727 0,460

ɉ ɪ ɢ ɦ ɿ ɬ ɤ ɚ. * – ɞɚɧɿ ɝɪɭɩɢ ȱȱ ɧɚɜɟɞɟɧɿ ɞɥɹ ɩɟɪɲɨʀ ɡɚɪɟɽɫɬɪɨɜɚɧɨʀ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ.

ɍ ɰɿɥɨɦɭ, ɜɿɞɫɨɬɨɤ ɯɜɨɪɢɯ ɡ ɧɨɪɦɚɥɶɧɨɸ ɚɛɨ

ɩɿɞɜɢɳɟɧɨɸ ɜɚɝɨɸ ɜɿɪɨɝɿɞɧɨ ɧɟ ɜɿɞɪɿɡɧɹɜɫɹ ɜ ɝɪɭɩɿ ȱ ɬɚ ɝɪɭɩɿ ȱȱ. Ⱥɥɟ ɜɿɞɫɨɬɨɤ ɯɜɨɪɢɯ ɡ

ȱɆɌ < 18,5 ɫɟɪɟɞ ɬɢɯ, ɯɬɨ ɦɚɜ ɞɜɿ ɬɚ ɛɿɥɶɲɟ

ɝɨɫɩɿɬɚɥɿɡɚɰɿɣ ɩɪɨɬɹɝɨɦ ɬɪɶɨɯ ɪɨɤɿɜ,ɛɭɜ ɦɚɣɠɟ ɜ

ɲɿɫɬɶ ɪɚɡɿɜ ɜɢɳɟ, ɧɿɠ ɭ ɯɜɨɪɢɯ, ɹɤɿ ɛɭɥɢ ɝɨɫɩɿ

-ɬɚɥɿɡɨɜɚɧɿ ɿɡ ɡɚɝɨɫɬɪɟɧɧɹɦ ɏɈɁɅ ɨɞɧɨɪɚɡɨɜɨ.

ȼɂɋɇɈȼɄɂ

1. Ⱥɧɿ ɫɬɚɬɶ, ɚɧɿ ɡɪɿɫɬ, ɚɧɿ ɜɚɝɚ ɧɟ ɜɩɥɢɜɚɸɬɶ

ɧɚ ɱɚɫɬɨɬɭ ɝɨɫɩɿɬɚɥɿɡɚɰɿɣ ɜɧɚɫɥɿɞɨɤ ɡɚɝɨɫɬɪɟɧɧɹ ɏɈɁɅ.

2. ɉɨɯɢɥɢɣ ɜɿɤ ɧɟ ɽ ɮɚɤɬɨɪɨɦ, ɳɨ ɩɿɞɜɢɳɭɽ

ɪɢɡɢɤ ɝɨɫɩɿɬɚɥɿɡɚɰɿɣ ɱɟɪɟɡ ɡɚɝɨɫɬɪɟɧɧɹ ɏɈɁɅ.

ɇɟɡɜɚɠɚɸɱɢ ɧɚ ɬɟ, ɳɨ ɛɿɥɶɲɿɫɬɶ ɩɚɰɿɽɧɬɿɜ ɫɬɚ

-ɰɿɨɧɚɪɭ ɫɤɥɚɞɚɥɢ ɥɿɬɧɿ ɯɜɨɪɿ, 37 % ɡ ɧɢɯ ɛɭɥɢ

ɨɫɨɛɚɦɢ ɩɨɬɟɧɰɿɣɧɨ ɩɪɚɰɟɡɞɚɬɧɨɝɨ ɜɿɤɭ.

3. Ɍɹɠɤɟ ɡɚɝɨɫɬɪɟɧɧɹ ɏɈɁɅ ɦɨɠɟ ɜɢɧɢɤɧɭɬɢ

ɩɪɢ ɛɭɞɶ-ɹɤɨɦɭ (ɧɚɜɿɬɶ ɦɟɧɲɟ ɨɞɧɨɝɨ ɪɨɤɭ) ɫɬɚ

-ɠɿ ɡɚɯɜɨɪɸɜɚɧɧɹ.

4. ɋɟɪɟɞ ɚɧɬɪɨɩɨɦɟɬɪɢɱɧɢɯ ɩɨɤɚɡɧɢɤɿɜ ɧɚɣ

-ɛɿɥɶɲ ɜɚɠɥɢɜɢɦ ɩɪɟɞɢɤɬɨɪɨɦ ɩɨɜɬɨɪɧɨʀ ɝɨɫɩɿ

-ɬɚɥɿɡɚɰɿʀ ɱɟɪɟɡ ɡɚɝɨɫɬɪɟɧɧɹ ɏɈɁɅ ɽ ɡɧɢɠɟɧɧɹ ȱɆɌ < 18,5, ɬɨɦɭ ɣɨɝɨ ɩɿɞɪɚɯɭɜɚɧɧɹ ɽ ɞɨɰɿɥɶɧɢɦ

ɩɪɢ ɬɪɢɜɚɥɨɦɭ ɫɩɨɫɬɟɪɟɠɟɧɧɿ ɯɜɨɪɢɯ.

ɋ

ɉ

ɂ

ɋ

Ɉ

Ʉ

Ʌ

ȱ

Ɍ

ȿ

Ɋ

Ⱥ

Ɍ

ɍ

Ɋ

ɂ

1. ȱɧɫɬɪɭɦɟɧɬɚɥɶɧɿ ɦɟɬɨɞɢ ɞɨɫɥɿɞɠɟɧɧɹ ɮɭɧɤɰɿʀ

ɡɨɜɧɿɲɧɶɨɝɨ ɞɢɯɚɧɧɹ ɩɪɢ ɡɚɯɜɨɪɸɜɚɧɧɹɯ ɛɪɨɧɯɨ -ɥɟɝɟɧɟɜɨʀ ɫɢɫɬɟɦɢ: ɦɟɬɨɞ. ɪɟɤɨɦɟɧɞɚɰɿʀ / ɘ.Ɇ.Ɇɨɫ -ɬɨɜɢɣ, Ɍ.ȼ.Ʉɨɧɫɬɚɧɬɢɧɨɜɢɱ-ɑɿɱɟɪɟɥɶɨ,Ɉ.Ɇ.Ʉɨɥɨɲ -ɤɨ,Ʌ.ȼ.Ɋɚɫɩɭɬɿɧɚ. – ȼɿɧɧɢɰɹ, 2000. – 36 ɫ.

2. Ʌɚɩɚɱ ɋ.ɇ.ɋɬɚɬɢɫɬɢɱɟɫɤɢɟ ɦɟɬɨɞɵ ɜ ɦɟɞɢɤɨ -ɛɢɨɥɨɝɢɱɟɫɤɢɯ ɢɫɫɥɟɞɨɜɚɧɢɹɯ ɫ ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ Exel /ɋ.ɇ.Ʌɚɩɚɱ,Ⱥ.ȼ.Ƚɭɛɟɧɤɨ,ɉ.ɇ.Ȼɚɛɢɱ. – Ʉ. : Ɇɨɪɢɨɧ, 2000. – 320 ɫ.

3. ɉɪɨ ɡɚɬɜɟɪɞɠɟɧɧɹ ɤɥɿɧɿɱɧɢɯ ɩɪɨɬɨɤɨɥɿɜ ɧɚ -ɞɚɧɧɹ ɦɟɞɢɱɧɨʀ ɞɨɩɨɦɨɝɢ ɡɚ ɫɩɟɰɿɚɥɶɧɿɫɬɸ "ɉɭɥɶ -ɦɨɧɨɥɨɝɿɹ":ɧɚɤɚɡ ɆɈɁ ɍɤɪɚʀɧɢ ʋ128ɜɿɞ 19.03.2007ɪ. /ɆɈɁ ɍɤɪɚɿɧɢ. – Ɉɮɿɰ.ɜɢɞ. – Ʉ., 2007. – 146 ɫ.

4. ɉɪɨ ɡɚɬɜɟɪɞɠɟɧɧɹ ɬɚ ɜɩɪɨɜɚɞɠɟɧɧɹ ɦɟɞɢɤɨ -ɬɟɯɧɨɥɨɝɿɱɧɢɯ ɞɨɤɭɦɟɧɬɿɜ ɡɿ ɫɬɚɧɞɚɪɬɢɡɚɰɿʀ ɦɟɞɢɱɧɨʀ ɞɨɩɨɦɨɝɢ ɩɪɢ ɯɪɨɧɿɱɧɨɦɭ ɨɛɫɬɪɭɤɬɢɜɧɨɦɭ ɡɚɯɜɨɪɸ -ɜɚɧɧɿ ɥɟɝɟɧɶ:ɧɚɤɚɡ ɆɈɁ ɍɤɪɚʀɧɢ ʋ 555 ɜɿɞ 27.06.2013 /ɆɈɁ ɍɤɪɚɿɧɢ. – Ɉɮɿɰ.ɜɢɞ. – Ʉ., 2013. – 3 ɫ.

5. Ɋɟɛɪɨɜɚ Ɉ.ɘ. ɋɬɚɬɢɫɬɢɱɟɫɤɢɣ ɚɧɚɥɢɡ ɦɟɞɢ -ɰɢɧɫɤɢɯ ɞɚɧɧɵɯ. ɉɪɢɦɟɧɟɧɢɟ ɩɚɤɟɬɚ ɩɪɢɤɥɚɞɧɵɯ ɩɪɨɝɪɚɦɦ STATISTICA / Ɉ.ɘ.Ɋɟɛɪɨɜɚ. – Ɇ.: Ɇɟ -ɞɢɚɫɮɟɪɚ, 2002. – 312 ɫ.

6. Ɏɟɳɟɧɤɨ ɘ.ɂ. ɇɨɜɚɹ ɪɟɞɚɤɰɢɹ ɝɥɨɛɚɥɶɧɨɣ ɢɧɢɰɢɚɬɢɜɵ ɩɨ ɏɈɁɅ / ɘ.ɂ. Ɏɟɳɟɧɤɨ // ɍɤɪ. ɩɭɥɶɦɨɧɨɥ.ɠɭɪɧɚɥ. – 2012. – ʋ 2. – ɋ. 6–8.

7. Acute exacerbations of COPD in the United States: inpatient burden and predictors of costs and morta-lity / P.N. Perera, E.P. Armstrong, D.L. Sherrill G.H. Skrepnek // COPD. – 2012. – Vol. 9. – P.131–141.

8. Baker Christine L Risk assessment of readmis-sions following an initial COPD-related hospitalization / L. Christine Baker, H. Kelly Zou, Jun Su R // Inter. J. COPD. – 2013. – Vol. 8. – P. 551–559.

9. Elixhauser A. Readmissions for Chronic Obstruc-tive Pulmonary Disease, 2008 [Electronic Resource] / A. Elixhauser, D. Au, J. Podulka. – HCUP Statistical Brief # 121. September 2011. Agency for Healthcare Re-search and Quality, Rockville, MD. Ɋɟɠɢɦ ɞɨɫɬɭɩɭ : http://www.hcup-us.ahrq.gov/reports/statbriefs/sb121.pdf

(7)

burden and future projections / A.D. Lopez, K. Shibuya, C. Rao [et al.] // Eur. Resp. J. – 2006. – Vol. 27. – P. 397– 412.

12. Natural history of chronic bronchitis and em-physema / C. M. Fletcher, R. Peto, C. M. Tinker, F.E. Spei-zer. – Oxford : Oxford University Press, 1976. – 272 p.

13. Newcombe R.G. Two-Sided Confidence Intervals for the Single Proportion: Comparison of Seven Methods / R.G. Newcombe // Statistics in Medicine. – 1998. – Vol. 17. – P. 857–872.

14. Oostenbrink J.B. Resource use and risk factors in high-cost exacerbations of COPD / J.B. Oostenbrink, M. P. Rutten-van Molken // Resp. Medicine. – 2004. – Vol. 98. – P. 883–91.

15. Prediction model for COPD readmissions: cat-ching up, catcat-ching our breath, and improving a national

16. Series ATS/ERS task force: Standardisation of lung function testing [Text] / V. Brusasco [et al.] // Eur. Resp. J. – 2005. – Vol. 26. – P. 319–338.

17. Stein B.D. Hospitalizations for acute exacer-bations of chronic obstructive pulmonary disease: how you count matters / B.D. Stein, J.T. Charbeneau, T.A. Lee [et al.] // COPD. – 2010. – Vol. 7. – P. 164–171.

18. Trends in hospitalization with chronic obstructive pulmonary disease – United States, 1990-2005 / D.W. Brown, J. B. Croft, K. J. Greenlund, W. H. Giles // COPD. – 2010. – Vol. 7. – P. 59–62.

19. WHO. Physical status: the use and interpretation of anthropometry / Report of a WHO Expert Committee. WHO Technical Report Series 854. – Geneva: World Health Organization, 1995. – 36 ɪ.

R

E

F

E

R

E

N

C

E

S

1. Mostoviy YuM, Konstantinovich-Chɿcherel'o TV, Koloshko OM, Rasputɿna LV. [Instrumental methods of respiratory function testing in patients with broncho-pulmonary diseases]. Vɿnnitsya; 2000. Russian.

2. Lapach SN, Gubenko AV, Babich PN. [Statistic methods in medical-biological investigations by means of Exel] Kiev: Morion; 2000. Russian.

3. [On approval of clinical protocols of care in "Pulmonology" specialty]. Order N 128 of MOH of Uk-raine. March 19; 2007. Ukrainian.

4. [On approval and implementation of medical and technological documents on standardization of medical care in chronic obstructive pulmonary disease]: Order N 555 MoH of Ukraine. June 27; 2013. Ukrainian.

5. Rebrova ɈYu. [Statistical analysis of medical data. Application of software package STATISTICA] Ɇoscow. Mediasphera; 2002. Russian.

6. FeshchenkoYuI. [New edition of Global Initiative for Chronic Obstructive Pulmonary Diseases]. Uk-raʀns'kiy pul'monologɿchniy zhurnal. 2012;2:6-8. Russian. 7. Perera PN, Armstrong EP, Sherrill DL, Skrepnek GH. Acute exacerbations of COPD in the United States: inpatient burden and predictors of costs and mortality. COPD. 2012;9:131-41.

8. Baker CL, Zou KH, R JunSu. Risk assessment of readmissions following an initial COPD-related hospi-talization. International Journal of COPD. 2013;8:551-9.

9. Elixhauser A, Au D, Podulka J. Readmissions for Chronic Obstructive Pulmonary Disease, 2008. HCUP Statistical Brief N 121. September 2011. Agency for Healthcare Research and Quality, Rockville, MD. [cited 2014 Aug 15]; [about 2 p.]. Available from: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb121.pdf

10. Global Initiative for Chronic Obstructive Lung Diseases (GOLD). Global strategy for diagnosis, mana-gement, and prevention of chronic obstructive pulmonary

disease. NHLBI/WHO workshop report WHO, 2011. [cited 2014 Aug 15]; Available from: http://www.goldcopd.com/.

11. Lopez A, Shibuya K, Rao C. et al. Chronic ob-structive pulmonary disease: current burden and future projections. European Respiratory Journal. 2006;27:397-412.

12. Fletcher CM, Peto R, Tinker CM, Speizer FE. Na-tural history of chronic bronchitis and emphysema. Oxfor: Oxford University Press; 1976.

13. Newcombe RG. Two-Sided Confidence Intervals for the Single Proportion: Comparison of Seven Methods. Statistics in Medicine. 1998;17:857-72.

14. Oostenbrink JB, Rutten-van Molken MP. Re-source use and risk factors in high-cost exacerbations of COPD. Respiratory Medicine. 2004;98:883–91.

15. Bravein AA, Lukasz K, Arvin P. et al. Prediction model for COPD readmissions: catching up, catching our breath, and improving a national problem. Journal of Community Hospital Internal Medicine Perspectives. 2012;2(1):302-4.

16. Brusasco V. et al. Series ATS/ERS task force: Standardisation of lung function testing. European Respiratory Journal. 2005;26:319-38.

17. Stein BD, Charbeneau JT, Lee TA. et al. Hospi-talizations for acute exacerbations of chronic obstructive pulmonary disease: how you count matters. COPD. 2010;7:164-71.

18. Brown DW, Croft JB, Greenlund KJ, Giles WH. Trends in hospitalization with chronic obstructive pulmonary disease. United States, 1990-2005. COPD. 2010;7:59-62.

19. WHO. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. WHO Technical Report Series 854. Geneva: World Health Organization, 1995;36.