COPD exacerbation: factors influencing hospitalization duration

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10. Cao Y, Zhang Z, Zheng Y, Yuan W, Wang J, Liang H, Chen J, Du J. The association of idiopathic recurrent early pregnancy loss with polymorphisms in

inherited thrombophilias and adverse pregnancy out-comes: fashion or science? J. Obstet. Gynaecol. Res. 2010;36(5):996-1002.

ɋɬɚɬɬɹ ɧɚɞɿɣɲɥɚ ɞɨ ɪɟɞɚɤɰɿʀ 23.12.2014

ɍȾɄ 616.24-007.272-036.1-002.1:615.859

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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, Dnipropetrovsk, 49044, Ukraine e-mail: gashynova@mail.ru

Ʉɥɸɱɨɜɿ ɫɥɨɜɚ:ɏɈɁɅ,ɡɚɝɨɫɬɪɟɧɧɹ,ɝɨɫɩɿɬɚɥɿɡɚɰɿɹ Key words: COPD, exacerbation, hospitalisation

Ɋɟɮɟɪɚɬ. Ɉɛɨɫɬɪɟɧɢɟ ɏɈȻɅ: ɮɚɤɬɨɪɵ, ɜɥɢɹɸɳɢɟ ɧɚ ɞɥɢɬɟɥɶɧɨɫɬɶ ɝɨɫɩɢɬɚɥɢɡɚɰɢɣ. Ƚɚɲɢɧɨɜɚ ȿ.ɘ.

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ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

Abstract. COPD exacerbation: factors influencing hospitalization duration. Gashynova K.Yu. Studying the causes of hospitalization prolongation terms in COPD exacerbation may help optimize treatment, reduce expenditures on the patient and avoid episodes relapses. The aim of the work was to determine the factors affecting the length of hospitalization due to COPD exacerbation. A retrospective analysis of medical records of inpatients hospitalized with COPD exacerbation to therapeutic department of CI "Dnipropetrovsk municipal clinical hospital N 6" of “Dnipropetrovsk regional council" during three years was done. It was found that age, height, number of comorbidities, presence of any symptoms or changes in laboratory analyses do not affect the duration of hospitalizations due to COPD exacerbations. Regardless of the frequency of hospital admissions, length of hospitalization moderately positively and reliably correlates with the disease stage (R = 0,516, p <0,001). Decrease of respiratory function indices, especially FEV1, significantly increases the length of stay in the hospital both in case of one (R = -0,457, p <0.001) or multiple hospitalization during three years (R = -0,512, p <0.001). Reduced body weight and low body mass index during hospitalization are prognostically unfavorable factors, because these parameters, though weakly, but reliably negatively correlate with the number of days spent in the hospital (R = -0,195, p = 0,028 and R = -0,246, respectively, p = 0,005). In the population of patients hospitalized due to COPD exacerbation, moderately positive reliable correlation (R = 0,392, p <0,001) between the length of hospital stay and number of hospitalizations during three years was established. The dependence of hospitalization duration in COPD exacerbations on patient’s gender requires further investigation.

Ɂɚɝɨɫɬɪɟɧɧɹ ɽ ɩɨɞɿɽɸ ɜɟɥɢɤɨɝɨ ɡɧɚɱɟɧɧɹ ɜ ɩɟɪɟɛɿɝɭ ɯɪɨɧɿɱɧɨɝɨ ɨɛɫɬɪɭɤɬɢɜɧɨɝɨ ɡɚɯɜɨɪɸ

-ɜɚɧɧɹ ɥɟɝɟɧɶ (ɏɈɁɅ), ɨɫɤɿɥɶɤɢ ɜɨɧɨ ɜɿɞɿɝɪɚɽ

ɜɚɠɥɢɜɭ ɪɨɥɶ ɭ ɡɛɿɥɶɲɟɧɧɿ ɫɦɟɪɬɧɨɫɬɿ, ɩɨ

-ɝɿɪɲɟɧɧɿ ɹɤɨɫɬɿ ɠɢɬɬɹ ɩɚɰɿɽɧɬɿɜ ɿ ɡɪɨɫɬɚɧɧɿ ɫɨɰɿɚɥɶɧɨʀ ɬɚ ɟɤɨɧɨɦɿɱɧɨʀ ɜɚɪɬɨɫɬɿ ɯɜɨɪɨɛɢ [5, 6, 9, 10]. ɋɟɪɟɞ ɩɨɯɢɥɢɯ ɨɫɿɛ ɞɟɫɬɚɛɿɥɿɡɚɰɿɹ ɩɟɪɟ

-ɛɿɝɭ ɏɈɁɅ – ɨɞɢɧ ɡ ɩɨɲɢɪɟɧɢɯ ɮɚɤɬɨɪɿɜ, ɹɤɢɣ

ɩɪɢɡɜɨɞɢɬɶ ɞɨ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ [14]. ɇɚ ɩɨɦɿɪɧɿ ɚɛɨ

ɬɹɠɤɿ ɡɚɝɨɫɬɪɟɧɧɹ ɩɪɢɩɚɞɚɽ ɩɨɧɚɞ 40% ɤɨɲɬɿɜ

ɫɢɫɬɟɦɢ ɨɯɨɪɨɧɢ ɡɞɨɪɨɜ'ɹ, ɳɨ ɩɪɢɡɧɚɱɟɧɿ ɧɚ

ɜɟɞɟɧɧɹ ɯɜɨɪɢɯ ɡ ɏɈɁɅ [12]. ɇɟɟɮɟɤɬɢɜɧɟ ɥɿɤɭ

-ɜɚɧɧɹ ɿ ɧɚɞɦɿɪɧɨ ɬɪɢɜɚɥɟ ɩɟɪɟɛɭ-ɜɚɧɧɹ ɭ ɲɩɢɬɚɥɿ ɽ ɱɢɧɧɢɤɚɦɢ ɧɚɣɛɿɥɶɲɨʀ ɱɚɫɬɤɢ ɜɢɬɪɚɬ ɜɧɚɫɥɿɞɨɤ ɡɚɝɨɫɬɪɟɧɶ [6]. Ɉɫɨɛɥɢɜɨʀ ɭɜɚɝɢ ɩɨɬɪɟɛɭɸɬɶ ɩɨɜ

-ɬɨɪɧɿ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ. ȼɫɬɚɧɨɜɥɟɧɨ, ɳɨ ɩɪɢ ɧɢɯ

ɜɢɬɪɚɬɢ ɡɚɡɜɢɱɚɣ ɡɧɚɱɧɨ ɜɢɳɿ, ɧɿɠ ɩɪɢ

ɩɨɱɚɬɤɨɜɨɦɭ ɩɟɪɟɛɭɜɚɧɧɿ ɭ ɫɬɚɰɿɨɧɚɪɿ [8]. ɇɟɡɜɚ

-ɠɚɸɱɢ ɧɚ ɬɟ, ɳɨ ɜ ɨɫɬɚɧɧɿ ɪɨɤɢ ɡ’ɹɜɢɥɨɫɶ

ɞɟɤɿɥɶɤɚ ɩɭɛɥɿɤɚɰɿɣ ɫɬɨɫɨɜɧɨ ɣɦɨɜɿɪɧɢɯ ɱɢɧ

-ɧɢɤɿɜ ɜɢɧɢɤɧɟɧɧɹ ɬɹɠɤɢɯ ɡɚɝɨɫɬɪɟɧɶ ɏɈɁɅ,ɞɚɧɿ

ɩɪɨ ɮɚɤɬɨɪɢ, ɳɨ ɜɩɥɢɜɚɸɬɶ ɧɚ ɬɪɢɜɚɥɿɫɬɶ

ɩɟɪɟɛɭɜɚɧɧɹ ɭ ɫɬɚɰɿɨɧɚɪɿ, ɩɪɚɤɬɢɱɧɨ ɜɿɞɫɭɬɧɿ [7, 8, 11, 14]. Ɇɿɠ ɬɢɦ, ɪɨɡɭɦɿɧɧɹ ɩɪɟɞɢɤɬɨɪɿɜ ɩɨ

-ɞɨɜɠɟɧɧɹ ɫɬɪɨɤɿɜ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ ɩɪɢ ɡɚɝɨɫɬɪɟɧɧɿ ɏɈɁɅ ɦɨɠɟ ɞɨɩɨɦɨɝɬɢ ɨɩɬɢɦɿɡɭɜɚɬɢ ɥɿɤɭɜɚɧɧɹ,

ɡɦɟɧɲɢɬɢ ɜɢɬɪɚɬɢ ɧɚ ɯɜɨɪɨɝɨ ɬɚ ɭɧɢɤɧɭɬɢ ɩɨɜɬɨɪɟɧɧɹ ɩɨɞɿɛɧɢɯ ɟɩɿɡɨɞɿɜ.

Ɇɟɬɨɸ ɞɨɫɥɿɞɠɟɧɧɹ ɛɭɥɨ ɜɫɬɚɧɨɜɥɟɧɧɹ ɩɨɤɚɡ

-ɧɢɤɿɜ, ɳɨ ɜɩɥɢɜɚɥɢ ɧɚ ɬɪɢɜɚɥɿɫɬɶ ɩɟɪɟɛɭɜɚɧɧɹ ɭ

ɫɬɚɰɿɨɧɚɪɿ ɯɜɨɪɢɯ ɧɚ ɏɈɁɅ ɜɧɚɫɥɿɞɨɤ ɡɚ

-ɝɨɫɬɪɟɧɧɹ.

ɆȺɌȿɊȱȺɅɂ ɌȺ ɆȿɌɈȾɂ ȾɈɋɅȱȾɀȿɇɖ

ɉɪɨɜɟɞɟɧɢɣ ɪɟɬɪɨɫɩɟɤɬɢɜɧɢɣ ɚɧɚɥɿɡ ɿɫɬɨɪɿɣ ɯɜɨɪɨɛ ɫɬɚɰɿɨɧɚɪɧɢɯ ɯɜɨɪɢɯ, ɹɤɿ ɛɭɥɢ ɝɨɫɩɿɬɚɥɿ

-ɡɨɜɚɧɿ ɜ ɬɟɪɚɩɟɜɬɢɱɧɟ ɜɿɞɞɿɥɟɧɧɹ ɡ ɩɭɥɶɦɨɧɨɥɨ

-ɝɿɱɧɢɦɢ ɥɿɠɤɚɦɢ ɤɨɦɭɧɚɥɶɧɨɝɨ ɡɚɤɥɚɞɭ «Ⱦɧɿɩɪɨ

-ɩɟɬɪɨɜɫɶɤɚ ɲɨɫɬɚ ɦɿɫɶɤɚ ɤɥɿɧɿɱɧɚ ɥɿɤɚɪɧɹ»

Ⱦɧɿɩɪɨɩɟɬɪɨɜɫɶɤɨʀ ɨɛɥɚɫɧɨʀ ɪɚɞɢ» ɜɩɪɨɞɨɜɠ

ɬɪɶɨɯ ɪɨɤɿɜ.

Ʉɪɢɬɟɪɿɽɦ ɜɿɞɛɨɪɭ ɿɫɬɨɪɿɣ ɞɨ ɚɧɚɥɿɡɭ ɛɭɜ ɜɟɪɢɮɿɤɨɜɚɧɢɣ ɞɿɚɝɧɨɡ «ɡɚɝɨɫɬɪɟɧɧɹ ɏɈɁɅ»

ɜɿɞɩɨɜɿɞɧɨ ɞɨ ɇɚɤɚɡɭ ʋ128 ɆɈɁ ɍɤɪɚʀɧɢ ɜɿɞ 19.03.2007 ɪ. [3] ɡ ɭɪɚɯɭɜɚɧɧɹɦ ɞɚɧɢɯ ɩɨɫɬ

-ɛɪɨɧɯɨɞɿɥɹɬɚɰɿɣɧɨɝɨ ɫɩɿɪɨɦɟɬɪɢɱɧɨɝɨ ɨɛɫɬɟɠɟɧ

-ɧɹ ɡɚ ɭɦɨɜɢ ɜɢɤɨɧɚɧ-ɧɹ ɬɟɫɬɿɜ ɡɚ ɦɿɠɧɚɪɨɞɧɢɦɢ ɫɬɚɧɞɚɪɬɚɦɢ ɹɤɨɫɬɿ ɬɚ ɪɟɤɨɦɟɧɞɚɰɿɹɦɢ ɜɿɬ

-ɱɢɡɧɹɧɢɯ ɜɱɟɧɢɯ [1, 13].

Ʉɪɢɬɟɪɿɹɦɢ ɜɢɤɥɸɱɟɧɧɹ ɿɫɬɨɪɿɣ ɯɜɨɪɨɛ ɿɡ ɪɨɡɛɨɪɭ ɛɭɥɚ ɧɚɹɜɧɿɫɬɶ ɤɥɿɧɿɤɨ-ɪɟɧɬɝɟɧɨɥɨɝɿɱɧɢɯ

ɨɡɧɚɤ ɥɟɝɟɧɟɜɨʀ ɿɧɮɿɥɶɬɪɚɰɿʀ, ɚɬɟɥɟɤɬɚɡɭ ɥɟɝɟɧɶ

ɚɛɨ ɟɤɫɭɞɚɬɭ ɭ ɩɥɟɜɪɚɥɶɧɿɣ ɩɨɪɨɠɧɢɧɿ ɩɿɞ ɱɚɫ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ.

ɍ ɜɫɿɯ ɯɜɨɪɢɯ ɜɢɜɱɚɥɢɫɹ ɚɧɬɪɨɩɨɦɟɬɪɢɱɧɿ ɞɚɧɿ (ɫɬɚɬɶ, ɜɿɤ, ɡɪɿɫɬ, ɜɚɝɚ, ɿɧɞɟɤɫ ɦɚɫɢ ɬɿɥɚ (ȱɆɌ)), ɦɟɞɢɱɧɢɣ ɚɧɚɦɧɟɡ (ɬɪɢɜɚɥɿɫɬɶ ɡɚɯɜɨ

-ɪɸɜɚɧɧɹ, ɫɬɚɬɭɫ ɩɚɥɿɧɧɹ, ɧɚɹɜɧɿɫɬɶ ɡɚɞɨɤɭ

-ɦɟɧɬɨɜɚɧɨʀ ɫɭɩɭɬɧɶɨʀ ɩɚɬɨɥɨɝɿʀ),ɫɤɚɪɝɢ (ɤɚɲɟɥɶ,

ɯɚɪɚɤɬɟɪ ɦɨɤɪɨɬɢɧɧɹ,ɡɚɞɢɲɤɚ),ɪɟɡɭɥɶɬɚɬɢ ɮɿɡɢ

-ɤɚɥɶɧɨɝɨ ɨɝɥɹɞɭ (ɰɿɚɧɨɡ,ɨɡɧɚɤɢ ɟɦɮɿɡɟɦɢ,ɭɱɚɫɬɶ

ɞɨɞɚɬɤɨɜɨʀ ɦɭɫɤɭɥɚɬɭɪɢ ɜ ɞɢɯɚɧɧɿ, ɞɚɧɿ

ɚɭɫɤɭɥɶɬɚɰɿʀ), ɪɟɧɬɝɟɧɨɝɪɚɮɿʀ ɨɪɝɚɧɿɜ ɝɪɭɞɧɨʀ

ɤɥɿɬɤɢ, ȿɄȽ, ɫɩɿɪɨɝɪɚɮɿɱɧɨɝɨ ɞɨɫɥɿɞɠɟɧɧɹ ɡ

ɨɰɿɧɤɨɸ ɩɨɤɚɡɧɢɤɿɜ ɩɿɫɥɹ ɩɪɨɛɢ ɡ ɛɪɨɧɯɨ

-ɞɿɥɹɬɚɬɨɪɚɦɢ (ɪɿɜɟɧɶ ɨɛ’ɽɦɭ ɮɨɪɫɨɜɚɧɨɝɨ ɜɢɞɢɯɭ

ɡɚ ɩɟɪɲɭ ɫɟɤɭɧɞɭ (ɈɎȼ1), ɮɨɪɫɨɜɚɧɨʀ ɠɢɬɬɽɜɨʀ ɽɦɧɨɫɬɿ ɥɟɝɟɧɶ (ɎɀȯɅ) ɬɚ ɫɩɿɜɜɿɞɧɨɲɟɧɧɹ

ɈɎȼ1/ɎɀȯɅ), ɞɚɧɿ ɡɚɝɚɥɶɧɨɝɨ ɚɧɚɥɿɡɭ ɤɪɨɜɿ, ɡɚɝɚɥɶɧɨɝɨ ɚɧɚɥɿɡɭ ɫɟɱɿ, ɪɿɜɟɧɶ ɡɚɝɚɥɶɧɨɝɨ ɬɚ ɋ

-ɪɟɚɤɬɢɜɧɨɝɨ ɛɿɥɤɿɜ ɭ ɫɢɪɨɜɚɬɰɿ ɤɪɨɜɿ ɩɪɢ ɧɚɞ

-ɯɨɞɠɟɧɧɿ ɞɨ ɜɿɞɞɿɥɟɧɧɹ. Ʉɥɸɱɨɜɢɦɢ ɬɨɱɤɚɦɢ

ɰɶɨɝɨ ɟɬɚɩɭ ɞɨɫɥɿɞɠɟɧɧɹ ɛɭɥɢ ɧɚɹɜɧɿɫɬɶ ɚɛɨ ɜɿɞɫɭɬɧɿɫɬɶ ɩɨɜɬɨɪɧɨʀ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ ɬɚ ɬɪɢɜɚɥɿɫɬɶ ɩɟɪɟɛɭɜɚɧɧɹ ɭ ɫɬɚɰɿɨɧɚɪɿ ɭ ɡɜ’ɹɡɤɭ ɿɡ ɡɚ

-ɝɨɫɬɪɟɧɧɹɦ ɏɈɁɅ.

Ɂɚ ɞɚɧɢɦɢ, ɳɨ ɨɬɪɢɦɭɜɚɥɢɫɶ ɭ ɯɨɞɿ ɩɪɨɜɟɞɟ

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ɏɈɁɅ. Ɉɬɪɢɦɚɧɿ ɪɟɡɭɥɶɬɚɬɢ ɛɭɥɢ ɨɛɪɨɛɥɟɧɿ ɿɡ

ɡɚɫɬɨɫɭɜɚɧɧɹɦ ɨɩɢɫɨɜɨʀ ɬɚ ɚɧɚɥɿɬɢɱɧɨʀ ɫɬɚɬɢɫ

-ɬɢɤɢ ɡɚ ɞɨɩɨɦɨɝɨɸ ɩɪɨɝɪɚɦɢ «STATISTICA 6.1» (StatSoft Inc., USA, ɫɟɪɿɣɧɢɣ ʋ AGAR909 E415822FA) [2, 4]. Ɂɚɥɟɠɧɿɫɬɶ ɦɿɠ ɩɨɤɚɡɧɢɤɚɦɢ (ɤɿɥɶɤɿɫɧɢɦɢ, ɹɤɿɫɧɢɦɢ) ɨɰɿɧɸɜɚɥɚɫɶ ɡɚ ɞɨɩɨ

-ɦɨɝɨɸ ɤɨɟɮɿɰɿɽɧɬɚ ɤɨɪɟɥɹɰɿʀ ɋɩɿɪɦɟɧɚ (R)

ɧɟɡɚɥɟɠɧɨ ɜɿɞ ʀɯ ɪɨɡɩɨɞɿɥɭ. Ⱦɥɹ ɨɰɿɧɤɢ ɜɿɪɨ

-ɝɿɞɧɨɫɬɿ ɜɿɞɦɿɧɧɨɫɬɟɣ ɦɿɠ ɤɨɟɮɿɰɿɽɧɬɚɦɢ ɤɨɪɟ

-ɥɹɰɿʀ ɜ ɞɜɨɯ ɝɪɭɩɚɯ ɜɢɤɨɪɢɫɬɨɜɭɜɚɥɚɫɶ ɨɩɰɿɹ

«ɬɟɫɬ ɜɿɞɡɧɚɤ ɞɥɹ ɤɨɟɮɿɰɿɽɧɬɿɜ ɤɨɪɟɥɹɰɿɣ». ɉɪɢ

ɚɧɚɥɿɡɿ ɜɫɿɯ ɬɢɩɿɜ ɞɚɧɢɯ ɡɧɚɱɭɳɢɦɢ ɜɜɚɠɚɥɢɫɶ ɜɿɞɦɿɧɧɨɫɬɿ ɦɿɠ ɝɪɭɩɚɦɢ ɩɪɢ ɪ < 0,05.

ɊȿɁɍɅɖɌȺɌɂ ɌȺ Ȳɏ ɈȻȽɈȼɈɊȿɇɇə

Ⱦɨ ɨɫɬɚɬɨɱɧɨɝɨ ɚɧɚɥɿɡɭ ɛɭɥɢ ɜɿɞɿɛɪɚɧɿ 162

ɿɫɬɨɪɿʀ ɯɜɨɪɨɛɢ, ɜ ɹɤɢɯ ɞɿɚɝɧɨɡ ɡɚɝɨɫɬɪɟɧɧɹ

ɏɈɁɅ, ɳɨ ɩɨɬɪɟɛɭɽ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ, ɛɭɜ ɩɿɞɬɜɟɪɞ

-ɜɿɞɫɭɬɧɿ ɨɡɧɚɤɢ ɤɪɢɬɟɪɿʀɜ ɜɢɤɥɸɱɟɧɧɹ.

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

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

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

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

-ɡɚɰɿɽɸ ɨɞɧɢɯ ɿ ɬɢɯ ɩɚɰɿɽɧɬɿɜ.

Ɍɚɤɢɦ ɱɢɧɨɦ, ɞɥɹ ɧɚɫɬɭɩɧɨɝɨ ɟɬɚɩɭ ɚɧɚɥɿɡɭ

ɧɚɦɢ ɛɭɥɨ ɜɢɞɿɥɟɧɨ ɞɜɿ ɝɪɭɩɢ ɯɜɨɪɢɯ: ɝɪɭɩɚ ȱ (112ɨɫɿɛ) – ɬɿ, ɹɤɿ ɛɭɥɢ ɝɨɫɩɿɬɚɥɿɡɨɜɚɧɿ ɨɞɧɨ

-ɪɚɡɨɜɨ, ɬɚ ɝɪɭɩɚ ȱȱ (19 ɨɫɿɛ) – ɬɿ, ɹɤɿ ɛɭɥɢ

ɝɨɫɩɿɬɚɥɿɡɨɜɚɧɿ ɜɧɚɫɥɿɞɨɤ ɡɚɝɨɫɬɪɟɧɧɹ ɏɈɁɅ ɞɜɚ ɿ ɛɿɥɶɲɟ ɪɚɡɿɜ ɩɪɨɬɹɝɨɦ ɬɪɶɨɯ ɪɨɤɿɜ. Ɉɛɢɞɜɿ

ɝɪɭɩɢ ɛɭɥɢ ɩɨɪɿɜɧɹɧɿ ɡɚ ɫɬɚɬɬɸ, ɜɿɤɨɦ ɬɚ

ɚɧɬɪɨɩɨɦɟɬɪɢɱɧɢɦɢ ɞɚɧɢɦɢ (ɬɚɛɥ. 1).

Ɍ ɚ ɛ ɥ ɢ ɰ ɹ 1

Ⱥɧɬɪɨɩɨɦɟɬɪɢɱɧɿ ɞɚɧɿ ɯɜɨɪɢɯ

,

ɹɤɿ ɛɭɥɢ ɝɨɫɩɿɬɚɥɿɡɨɜɚɧɿ ɜɧɚɫɥɿɞɨɤ ɡɚɝɨɫɬɪɟɧɧɹ ɏɈɁɅ

ɉɨɤɚɡɧɢɤɢ _{(n = 112)}Ƚɪɭɩɚ ȱ Ƚɪɭɩɚ ȱI*

(n = 19) 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 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

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

ɉɪɢ ɩɪɨɜɟɞɟɧɧɿ ɤɨɪɟɥɹɰɿɣɧɨɝɨ ɚɧɚɥɿɡɭ, ɩɨ

-ɩɟɪɲɟ, ɨɰɿɧɸɜɚɥɢɫɶ ɩɨɤɚɡɧɢɤɢ ɡ ɭɫɿɯ ɿɫɬɨɪɿɣ

ɯɜɨɪɨɛ ɭ ɰɿɥɨɦɭ, ɩɨ-ɞɪɭɝɟ, – ɨɤɪɟɦɨ ɭ ɝɪɭɩɚɯ

ɩɨɪɿɜɧɹɧɧɹ.

Ⱦɥɹ ɜɫɿɯ ɜɢɩɚɞɤɿɜ ɧɚɞɯɨɞɠɟɧɧɹ ɞɨ ɬɟɪɚ

-ɩɟɜɬɢɱɧɨɝɨ ɜɿɞɞɿɥɟɧɧɹ ɜɫɬɚɧɨɜɥɟɧɨ ɩɨɡɢɬɢɜɧɢɣ ɩɨɦɿɪɧɢɣ (R = 0,516) ɞɨɫɬɨɜɿɪɧɢɣ (p < 0,001) ɤɨ

-ɪɟɥɹɰɿɣɧɢɣ ɡɜ'ɹɡɨɤ ɦɿɠ ɫɬɚɞɿɽɸ ɡɚɯɜɨɪɸɜɚɧɧɹ ɬɚ

ɬɪɢɜɚɥɿɫɬɸ ɩɟɪɟɛɭɜɚɧɧɹ ɭ ɫɬɚɰɿɨɧɚɪɿ (ɪɢɫ. 1).

Ⱥɧɚɥɨɝɿɱɧɿ ɞɚɧɿ ɛɭɥɢ ɨɬɪɢɦɚɧɿ ɩɪɢ ɩɪɨɜɟɞɟɧɧɿ ɚɧɚɥɿɡɭ ɨɤɪɟɦɨ ɩɨ ɝɪɭɩɚɯ. Ɍɚɤ, ɫɟɪɟɞ ɝɨɫɩɿɬɚ

-ɥɿɡɨɜɚɧɢɯ ɨɞɧɨɪɚɡɨɜɨ R = 0,472 (p < 0,001), ɚ ɜ

ɬɢɯ, ɯɬɨ ɩɨɬɪɚɩɥɹɜ ɞɨ ɫɬɚɰɿɨɧɚɪɭ ɛɚɝɚɬɨɪɚɡɨɜɨ – R = 0,696 (p = 0,001). ɏɨɱɚ ɧɚ ɩɟɪɲɢɣ ɩɨɝɥɹɞ

ɡɜ'ɹɡɨɤ ɭ ɝɪɭɩɿ ȱȱ ɡɞɚɜɚɜɫɹ ɫɢɥɶɧɿɲɢɦ, ɩɪɢ ɫɬɚ

-ɬɢɫɬɢɱɧɿɣ ɨɛɪɨɛɰɿ ɞɚɧɢɯ ɛɭɥɨ ɜɫɬɚɧɨɜɥɟɧɨ, ɳɨ

ɤɨɟɮɿɰɿɽɧɬɢ ɤɨɪɟɥɹɰɿʀ ɋɩɿɪɦɟɧɚ ɞɨɫɬɨɜɿɪɧɨ ɧɟ ɜɿɞɪɿɡɧɹɥɢɫɶ ɦɿɠ ɝɪɭɩɚɦɢ (p = 0,198).

Ɉɫɤɿɥɶɤɢ ɛɭɥɨ ɜɢɹɜɥɟɧɿ, ɳɨ ɫɬɚɞɿɹ ɡɚɯɜɨ

-ɪɸɜɚɧɧɹ ɜɩɥɢɜɚɬɢɦɟ ɧɚ ɫɬɪɨɤɢ ɩɟɪɟɛɭɜɚɧɧɹ ɭ ɫɬɚɰɿɨɧɚɪɿ ɩɪɢ ɡɚɝɨɫɬɪɟɧɧɿ ɏɈɁɅ, ɧɚɫɬɭɩɧɢɦɢ

ɜɚɝɨɦɢɦɢ ɮɚɤɬɨɪɚɦɢ, ɹɤɿ ɦɨɝɥɢ ɛ ɡɭɦɨɜɢɬɢ

ɬɪɢɜɚɥɿɫɬɶ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ, ɨɱɿɤɭɜɚɧɨ ɛɭɥɢ ɡɧɚ

(4)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

2 4 6 8 10 12 14 16 18

Ɍɪɢɜɚɥɿɫɬɶ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ,ɞɧɿ 0

1 2 3 4

ɏɈ

ɁɅ

,

ɫɬ

ɭɩ

ɟɧ

ɶ

Ɋɢɫ. 1. Ⱦɚɧɿ ɚɧɚɥɿɡɭ ɤɨɪɟɥɹɰɿɣɧɨɝɨ ɡɜ'ɹɡɤɭ ɦɿɠ ɫɬɭɩɟɧɟɦ ɬɹɠɤɨɫɬɿ ɡɚɯɜɨɪɸɜɚɧɧɹ

ɬɚ ɬɪɢɜɚɥɿɫɬɸ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ ɭ ɯɜɨɪɢɯ ɿɡ ɡɚɝɨɫɬɪɟɧɧɹɦ ɏɈɁɅ

ɍ ɰɿɥɨɦɭ ɜ ɩɨɩɭɥɹɰɿʀ ɝɨɫɩɿɬɚɥɿɡɨɜɚɧɢɯ ɱɟɪɟɡ ɡɚɝɨɫɬɪɟɧɧɹ ɏɈɁɅ ɡɦɟɧɲɟɧɧɹ ɡɧɚɱɟɧɶ ɨɫɧɨɜɧɢɯ ɩɨɤɚɡɧɢɤɿɜ ɮɭɧɤɰɿʀ ɡɨɜɧɿɲɧɶɨɝɨ ɞɢɯɚɧɧɹ ɩɪɢɡɜɨ

-ɞɢɥɨ ɞɨ ɛɿɥɶɲ ɞɨɜɝɨʀ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ. Ⱦɥɹ ɈɎȼ1 –

R = -0,512 (p < 0,001); ɞɥɹ ɎɀȯɅ – R = -0,421 (p < 0,001); ɞɥɹ ɈɎȼ1/ɎɀȯɅ – R = -0,354

(p < 0,001). ɉɪɢɬɨɦɭ ɞɟɳɨ ɜɚɝɨɦɿɲɢɦ ɜɢɝɥɹɞɚɽ

ɡɜ'ɹɡɨɤ ɦɿɠ ɡɧɢɠɟɧɧɹɦ ɈɎȼ1 ɿ ɩɪɨɥɨɧɝɚɰɿɽɸ ɩɟɪɟɛɭɜɚɧɧɹ ɜ ɥɿɤɚɪɧɿ.

ɉɪɢ ɪɨɡɝɥɹɞɿ ɤɨɪɟɥɹɰɿɣɧɢɯ ɜɿɞɧɨɫɢɧ ɦɿɠ ɩɨɤɚɡɧɢɤɚɦɢ ɮɭɧɤɰɿʀ ɡɨɜɧɿɲɧɶɨɝɨ ɞɢɯɚɧɧɹ ɬɚ ɬɪɢɜɚɥɿɫɬɸ ɩɟɪɟɛɭɜɚɧɧɹ ɭ ɫɬɚɰɿɨɧɚɪɿ ɜ ɝɪɭɩɚɯ ɡ ɪɿɡɧɨɸ ɱɚɫɬɨɬɨɸ ɝɨɫɩɿɬɚɥɿɡɚɰɿɣ ɨɞɟɪɠɚɧɿ ɪɟɡɭɥɶ

-ɬɚɬɢ ɛɭɥɢ ɿɞɟɧɬɢɱɧɿ ɞɚɧɢɦ ɭ ɰɿɥɨʀ ɩɨɩɭɥɹɰɿʀ

(ɬɚɛɥ. 2). ȼɿɪɨɝɿɞɧɢɯ ɜɿɞɦɿɧɧɨɫɬɟɣ ɦɿɠ ɝɪɭɩɚɦɢ

ɡɚ ɫɢɥɨɸ ɤɨɪɟɥɹɰɿɣɧɨɝɨ ɡɜ’ɹɡɤɭ ɜɫɬɚɧɨɜɥɟɧɨ ɧɟ

ɛɭɥɨ.

Ɍ ɚ ɛ ɥ ɢ ɰ ɹ 2

Ⱦɚɧɿ ɚɧɚɥɿɡɭ ɤɨɪɟɥɹɰɿɣɧɨɝɨ ɡɜ

'

ɹɡɤɭ ɦɿɠ ɬɪɢɜɚɥɿɫɬɸ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ

ɬɚ ɩɨɤɚɡɧɢɤɚɦɢ ɮɭɧɤɰɿʀ ɡɨɜɧɿɲɧɶɨɝɨ ɞɢɯɚɧɧɹ ɭ ɝɪɭɩɚɯ ɯɜɨɪɢɯ ɿɡ ɡɚɝɨɫɬɪɟɧɧɹɦ ɏɈɁɅ

Ɍɪɢɜɚɥɿɫɬɶ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ ɭ ɝɪɭɩɿ ȱ

(n = 112)

Ɍɪɢɜɚɥɿɫɬɶ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ ɭ ɝɪɭɩɿ ȱI*

(n = 19)

ɉɨɤɚɡɧɢɤɢ

R p R p

ɪ

ɈɎȼ1 -0,457 < 0,001 -0,512 < 0,001 0,771

ɎɀȿɅ -0,383 < 0,001 -0,421 < 0,001 0,859

ɈɎȼ1/ɎɀȿɅ -0,279 0,003 -0,354 < 0,001 0,772

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

ɓɟ ɨɞɧɢɦɢ ɮɚɤɬɨɪɚɦɢ ɩɨɞɨɜɠɟɧɧɹ ɫɬɪɨɤɿɜ ɩɟɪɟɛɭɜɚɧɧɹ ɭ ɜɿɞɞɿɥɟɧɧɿ ɜɢɹɜɢɥɢɫɶ ɡɧɢɠɟɧɧɹ ɡɚɝɚɥɶɧɨʀ ɜɚɝɢ ɬɚ ȱɆɌ. Ɍɚɤ, ɞɥɹ ɭɫɿɯ ɯɜɨɪɢɯ, ɳɨ

ɛɭɥɢ ɝɨɫɩɿɬɚɥɿɡɨɜɚɧɿ ɱɟɪɟɡ ɡɚɝɨɫɬɪɟɧɧɹ ɏɈɁɅ,

ɜɫɬɚɧɨɜɥɟɧɢɣ ɫɥɚɛɤɢɣ, ɚɥɟ ɞɨɫɬɨɜɿɪɧɢɣ ɧɟɝɚ

-ɬɢɜɧɢɣ ɤɨɪɟɥɹɰɿɣɧɢɣ ɡɜ'ɹɡɨɤ ɦɿɠ ɬɪɢɜɚɥɿɫɬɸ

ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ ɬɚ ɜɚɝɨɸ (R = -0,195, p = 0,028).

(5)

2 4 6 8 10 12 14 16 18 Ɍɪɢɜɚɥɿɫɬɶ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ,ɞɧɿ

10 15 20 25 30 35 40 45 50

ȱɆɌ

Ɋɢɫ. 2. Ⱦɚɧɿ ɚɧɚɥɿɡɭ ɤɨɪɟɥɹɰɿɣɧɨɝɨ ɡɜ'ɹɡɤɭ ɦɿɠ ɬɪɢɜɚɥɿɫɬɸ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ

ɬɚ ȱɆɌ ɭ ɯɜɨɪɢɯ ɿɡ ɡɚɝɨɫɬɪɟɧɧɹɦ ɏɈɁɅ

ɉɪɢɛɥɢɡɧɨ ɬɚɤɿ ɠ ɫɚɦɿ ɞɚɧɿ ɛɭɥɢ ɨɬɪɢɦɚɧɿ ɩɪɢ ɩɪɨɜɟɞɟɧɧɿ ɤɨɪɟɥɹɰɿɣɧɨɝɨ ɚɧɚɥɿɡɭ ɩɨ ɝɪɭɩɚɯ.

ɉɪɨɬɟ ɥɢɲɟ ɞɥɹ ɯɜɨɪɢɯ, ɹɤɿ ɛɭɥɢ ɝɨɫɩɿɬɚɥɿɡɨɜɚɧɿ

ɨɞɧɨɪɚɡɨɜɨ, ɜɫɬɚɧɨɜɥɟɧɢɣ ɡɜ'ɹɡɨɤ ɛɭɜ ɞɨɫɬɨ

-ɜɿɪɧɢɦ (ɞɥɹ ɜɚɝɢ – R = -0,219, p = 0,023, ɞɥɹ ȱɆɌ – R = -0,242, p = 0,011).

Ɂɝɿɞɧɨ ɡ ɨɬɪɢɦɚɧɢɦɢ ɪɟɡɭɥɶɬɚɬɚɦɢ ɤɨɪɟɥɹɰɿɣ

-ɧɨɝɨ ɚɧɚɥɿɡɭ, ɜ ɰɿɥɨɦɭ ɭ ɩɨɩɭɥɹɰɿʀ ɯɜɨɪɢɯ, ɹɤɿ

ɛɭɥɢ ɝɨɫɩɿɬɚɥɿɡɨɜɚɧɿ, ɜɫɬɚɧɨɜɥɟɧɢɣ ɩɨɦɿɪɧɢɣ

ɩɨɡɢɬɢɜɧɢɣ ɜɿɪɨɝɿɞɧɢɣ ɡɜ'ɹɡɨɤ (R = 0,392, p < 0,001) ɦɿɠ ɬɪɢɜɚɥɿɫɬɸ ɩɟɪɟɛɭɜɚɧɧɹ ɭ ɫɬɚ

-ɰɿɨɧɚɪɿ ɬɚ ɤɿɥɶɤɿɫɬɸ ɝɨɫɩɿɬɚɥɿɡɚɰɿɣ ɱɟɪɟɡ ɡɚ

-ɝɨɫɬɪɟɧɧɹ ɏɈɁɅ ɩɪɨɬɹɝɨɦ ɬɪɶɨɯ ɪɨɤɿɜ.ɉɪɢɬɨɦɭ

ɫɥɿɞ ɡɚɡɧɚɱɢɬɢ, ɳɨ ɨɤɪɟɦɨ ɜ ɝɪɭɩɿ ȱȱ ɬɚɤɨɝɨ

ɡɜ’ɹɡɤɭ ɜɫɬɚɧɨɜɥɟɧɨ ɧɟ ɛɭɥɨ (p = 0,795). ȼɨɱɟ

-ɜɢɞɶ, ɬɪɢɜɚɥɿɫɬɶ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ ɜɧɚɫɥɿɞɨɤ ɡɚ

-ɝɨɫɬɪɟɧɧɹ ɏɈɁɅ ɡɛɿɥɶɲɭɽɬɶɫɹ ɩɪɢ ɧɚɹɜɧɨɫɬɿ ɫɚɦɨɝɨ ɮɚɤɬɭ ɛɚɝɚɬɨɪɚɡɨɜɨɝɨ ɩɨɬɪɚɩɥɹɧɧɹ ɞɨ ɫɬɚɰɿɨɧɚɪɭ ɧɟɡɚɥɟɠɧɨ ɜɿɞ ɤɿɥɶɤɨɫɬɿ ɩɨɜɬɨɪɧɢɯ ɝɨɫɩɿɬɚɥɿɡɚɰɿɣ.

ɇɚɦɢ ɧɟ ɛɭɥɨ ɜɫɬɚɧɨɜɥɟɧɨ ɞɨɫɬɨɜɿɪɧɨɝɨ ɜɚɝɨ

-ɦɨɝɨ ɜɩɥɢɜɭ ɜɿɤɭ, ɡɪɨɫɬɭ, ɤɿɥɶɤɨɫɬɿ ɫɭɩɭɬɧɿɯ

ɡɚɯɜɨɪɸɜɚɧɶ, ɤɥɿɧɿɱɧɢɯ ɫɢɦɩɬɨɦɿɜ, ɩɨɤɚɡɧɢɤɿɜ

ɡɚɝɚɥɶɧɨɝɨ ɬɚ ɛɿɨɯɿɦɿɱɧɨɝɨ ɚɧɚɥɿɡɭ ɤɪɨɜɿ ɧɚ ɬɪɢ

-ɜɚɥɿɫɬɶ ɝɨɫɩɿɬɚɥɿɡɚɰɿɣ ɩɪɢ ɡɚɝɨɫɬɪɟɧɧɿ ɏɈɁɅ ɚɧɿ ɜ ɰɿɥɨɦɭ ɭ ɩɨɩɭɥɹɰɿʀ ɯɜɨɪɢɯ, ɚɧɿ ɨɤɪɟɦɨ ɩɨ

ɝɪɭɩɚɯ (ɪ > 0,05).

ɍ ɯɨɞɿ ɩɨɪɿɜɧɹɧɧɹ ɬɪɢɜɚɥɨɫɬɿ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ ɜ ɨɫɿɛ ɪɿɡɧɨʀ ɫɬɚɬɿ ɜɢɹɜɥɟɧɨ, ɳɨ ɜ ɰɿɥɨɦɭ ɫɟɪɟɞ

ɯɜɨɪɢɯ, ɝɨɫɩɿɬɚɥɿɡɨɜɚɧɢɯ ɱɟɪɟɡ ɡɚɝɨɫɬɪɟɧɧɹ

ɏɈɁɅ, ɱɨɥɨɜɿɤɢ ɡɧɚɯɨɞɢɥɢɫɶ ɭ ɫɬɚɰɿɨɧɚɪɿ ɜɿɪɨ

-ɝɿɞɧɨ ɞɨɜɲɟ (ɪ = 0,039), ɧɿɠ ɠɿɧɤɢ – 8,00 [7,00-12,00] ɬɚ 7,00 [5,00-10,00] ɞɿɛ ɜɿɞɩɨɜɿɞɧɨ.Ɍɚɤɚ ɠ

ɬɟɧɞɟɧɰɿɹ ɡɛɟɪɿɝɚɥɚɫɹ ɣ ɩɪɢ ɨɤɪɟɦɨɦɭ ɚɧɚɥɿɡɿ ɜ ɝɪɭɩɚɯ 1 ɬɚ 2, ɩɪɨɬɟ ɡɚɡɧɚɱɟɧɿ ɜɿɞɦɿɧɧɨɫɬɿ ɛɭɥɢ

ɧɟɜɿɪɨɝɿɞɧɢɦɢ (ɪ = 0,492 ɬɚ ɪ = 0,128 ɜɿɞɩɨɜɿɞɧɨ),

ɧɚɣɿɦɨɜɿɪɧɿɲɟ, ɱɟɪɟɡ ɦɚɥɭ ɡɚɝɚɥɶɧɭ ɤɿɥɶɤɿɫɬɶ

ɠɿɧɨɤ.

ȼɂɋɇɈȼɄɂ

1. ȼɿɤ, ɡɪɿɫɬ, ɤɿɥɶɤɿɫɬɶ ɫɭɩɭɬɧɿɯ ɡɚɯɜɨɪɸɜɚɧɶ,

ɧɚɹɜɧɿɫɬɶ ɛɭɞɶ-ɹɤɢɯ ɤɥɿɧɿɱɧɢɯ ɫɢɦɩɬɨɦɿɜ ɱɢ ɡɦɿɧ

ɩɨɤɚɡɧɢɤɿɜ ɡɚɝɚɥɶɧɨɝɨ ɬɚ ɛɿɨɯɿɦɿɱɧɨɝɨ ɚɧɚɥɿɡɭ ɤɪɨɜɿ ɧɟ ɜɩɥɢɜɚɸɬɶ ɧɚ ɬɪɢɜɚɥɿɫɬɶ ɝɨɫɩɿɬɚɥɿɡɚɰɿɣ ɩɪɢ ɡɚɝɨɫɬɪɟɧɧɿ ɏɈɁɅ ɚɧɿ ɜ ɰɿɥɨɦɭ ɭ ɩɨɩɭɥɹɰɿʀ,

ɚɧɿ ɨɤɪɟɦɨ ɩɨ ɝɪɭɩɚɯ ɡ ɪɿɡɧɨɸ ɤɿɥɶɤɿɫɬɸ ɝɨɫɩɿ

-ɬɚɥɿɡɚɰɿɣ ɩɪɨɬɹɝɨɦ ɦɢɧɭɥɢɯ ɬɪɶɨɯ ɪɨɤɿɜ.

2. ɇɟɡɚɥɟɠɧɨ ɜɿɞ ɱɚɫɬɨɬɢ ɧɚɞɯɨɞɠɟɧɧɹ ɞɨ

ɫɬɚɰɿɨɧɚɪɭ ɜɧɚɫɥɿɞɨɤ ɡɚɝɨɫɬɪɟɧɧɹ ɏɈɁɅ, ɬɪɢɜɚ

-ɥɿɫɬɶ ɩɟɪɟɛɭɜɚɧɧɹ ɜ ɥɿɤɚɪɧɿ ɩɨɦɿɪɧɨ ɩɨɡɢɬɢɜɧɨ ɣ ɞɨɫɬɨɜɿɪɧɨ ɤɨɪɟɥɸɽ ɡɿ ɫɬɚɞɿɽɸ ɡɚɯɜɨɪɸɜɚɧɧɹ

(R = 0,516, p < 0,001).

3. Ɂɧɢɠɟɧɧɹ ɩɨɤɚɡɧɢɤɿɜ ɮɭɧɤɰɿʀ ɡɨɜɧɿɲɧɶɨɝɨ

ɞɢɯɚɧɧɹ, ɨɫɨɛɥɢɜɨ ɈɎȼ1, ɜɿɪɨɝɿɞɧɨ ɡɛɿɥɶɲɭɽ

ɫɬɪɨɤɢ ɩɟɪɟɛɭɜɚɧɧɹ ɭ ɫɬɚɰɿɨɧɚɪɿ ɹɤ ɩɪɢ ɨɞɧɨ

-ɪɚɡɨɜɿɣ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ (R = -0,457, ɪ < 0,001), ɬɚɤ ɿ

ɩɪɢ ɩɨɬɪɚɩɥɹɧɧɿ ɞɨ ɫɬɚɰɿɨɧɚɪɭ ɞɟɤɿɥɶɤɚ ɪɚɡɿɜ

(R = -0,512, ɪ < 0,001).

4. Ɂɧɢɠɟɧɚ ɡɚɝɚɥɶɧɚ ɜɚɝɚ ɬɚ ȱɆɌ ɩɪɢ ɩɨɬɪɚɩ

-ɥɹɧɧɿ ɞɨ ɫɬɚɰɿɨɧɚɪɭ ɽ ɩɪɨɝɧɨɫɬɢɱɧɨ ɧɟɫɩɪɢɹɬ

-ɥɢɜɢɦɢ ɮɚɤɬɨɪɚɦɢ ɜ ɚɫɩɟɤɬɿ ɬɪɢɜɚɥɨɝɨ ɩɟɪɟɛɭ

(6)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

ɜɿɪɨɝɿɞɧɨ ɧɟɝɚɬɢɜɧɨ ɤɨɪɟɥɸɸɬɶ ɡ ɤɿɥɶɤɿɫɬɸ ɞɧɿɜ,

ɩɪɨɜɟɞɟɧɢɯ ɭ ɫɬɚɰɿɨɧɚɪɿ (R = -0,195, p = 0,028 ɬɚ R = -0,246, p = 0,005 ɜɿɞɩɨɜɿɞɧɨ).

5. ɍ ɩɨɩɭɥɹɰɿʀ ɯɜɨɪɢɯ, ɳɨ ɛɭɥɢ ɝɨɫɩɿɬɚ

-ɥɿɡɨɜɚɧɿ ɱɟɪɟɡ ɡɚɝɨɫɬɪɟɧɧɹ ɏɈɁɅ, ɜɫɬɚɧɨɜɥɟɧɢɣ

ɩɨɦɿɪɧɢɣ ɩɨɡɢɬɢɜɧɢɣ ɜɿɪɨɝɿɞɧɢɣ ɡɜ'ɹɡɨɤ

(R = 0,392, p < 0,001) ɦɿɠ ɬɪɢɜɚɥɿɫɬɸ ɩɟɪɟɛɭɜɚɧ

-ɧɹ ɭ ɫɬɚɰɿɨɧɚɪɿ ɬɚ ɤɿɥɶɤɿɫɬɸ ɝɨɫɩɿɬɚɥɿɡɚɰɿɣ ɩɪɨ

-ɬɹɝɨɦ ɬɪɶɨɯ ɪɨɤɿɜ.

6. ȼɩɥɢɜ ɫɬɚɬɿ ɧɚ ɬɪɢɜɚɥɿɫɬɶ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ ɩɪɢ

ɡɚɝɨɫɬɪɟɧɧɿ ɏɈɁɅ ɩɨɬɪɟɛɭɽ ɩɨɞɚɥɶɲɨɝɨ ɜɢɜɱɟɧɧɹ.

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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 ɧɚɞɚɧɧɹ ɦɟɞɢɱɧɨʀ ɞɨɩɨɦɨɝɢ ɡɚ ɫɩɟɰɿɚɥɶɧɿɫɬɸ "ɉɭɥɶ -ɦɨɧɨɥɨɝɿɹ": ɧɚɤɚɡ ɆɈɁ ɍɤɪɚʀɧɢ ʋ 128 ɜɿɞ 19.03.2007 ɪ. / Ɇɿɧɿɫɬɟɪɫɬɜɨ ɨɯɨɪɨɧɢ ɡɞɨɪɨɜ’ɹ ɍɤɪɚɿ -ɧɢ.Ɉɮɿɰ.ɜɢɞ. – Ʉ., 2007. – 146 ɫ.

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

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

6. 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. – N 9. – P.131–141.

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

8. 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 Research and Quality, Rockville, MD. Ɋɟɠɢɦ ɞɨɫɬɭɩɭ: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb121.pdf 9. 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 [Electronic Resource] / WHO, 2011. – Ɋɟɠɢɦ ɞɨɫɬɭɩɭ: http://www.goldcopd.com/.

10. Natural history of chronic bronchitis and emphy-sema / C.M. Fletcher, R. Peto, C.M. Tinker, F.E. Speizer. – Oxford: Oxford University Press, 1976. – 272 p.

11. Prediction model for COPD readmissions: cat-ching up, catcat-ching our breath, and improving a national problem / A. Bravein, K. Lukasz, P. Arvin [et al.] // J. Community Hospital Inter. Med. Perspect. – 2012. – Vol. 2, N 1. – P. 302–304.

12. Risk Factors of Readmission in Acute Exa-cerbation of Moderate-to-Severe Chronic Obstructive Pul-monary Disease / C. González, E. Servera, G. Ferris, M.L. Blasco [et al.] // Arch. Bronconeumologia. – 2004. – Vol. 40, Issue 11. – P. 502-507.

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

14. 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. – N 7. – P. 59–62.

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FE

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RE

EN

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CE

ES

S

1. Mostoviy YuM, Konstantinovich-Chɿcherel'o TV, Koloshko OM, Rasputɿna LV. [Respiratory function tes-ting in patients with broncho-pulmonary diseases]. Vɿ n-nitsya; 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 the specialty "Pulmonology"]: Order ʋ128 MoH of Ukraine (March 19, 2007). Ukrainian.

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

5. FeshchenkoYuI. [New edition of Global Initiative for Chronic Obstructive Lung Diseases]. Ukraʀns'kiy

ɿ

6. 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.

7. 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.

8. Elixhauser A, Au D, Podulka J. Readmissions for Chronic Obstructive Pulmonary Disease, 2008. HCUP Statistical Brief # 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

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10. Fletcher CM, Peto R, Tinker CM, Speizer FE. Natural history of chronic bronchitis and emphysema. Oxfor: Oxford University Press; 1976.

11. 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.

monary Disease. Archivos de Bronconeumologia. 2004;40(11):502-7.

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

14. 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.

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Ƚɍ «Ⱦɧɟɩɪɨɩɟɬɪɨɜɫɤɚɹ ɦɟɞɢɰɢɧɫɤɚɹ ɚɤɚɞɟɦɢɹ ɆɁ ɍɤɪɚɢɧɵ»1 ɤɚɮɟɞɪɚ ɩɫɢɯɢɚɬɪɢɢ,ɨɛɳɟɣ ɢ ɦɟɞɢɰɢɧɫɤɨɣ ɩɫɢɯɨɥɨɝɢɢ (ɡɚɜ. – ɞ.ɦɟɞ.ɧ.,ɩɪɨɮ.ɂ.Ⱦ.ɋɩɢɪɢɧɚ)

ɭɥ.Ⱦɡɟɪɠɢɧɫɤɨɝɨ, 9, Ⱦɧɟɩɪɨɩɟɬɪɨɜɫɤ, 49044, ɍɤɪɚɢɧɚ

Ʉɍ «Ⱦɧɟɩɪɨɩɟɬɪɨɜɫɤɚɹ ɤɥɢɧɢɱɟɫɤɚɹ ɩɫɢɯɢɚɬɪɢɱɟɫɤɚɹ ɛɨɥɶɧɢɰɚ»Ⱦɧɟɩɪɨɩɟɬɪɨɜɫɤɨɝɨ ɨɛɥɚɫɬɧɨɝɨ ɫɨɜɟɬɚ»2 (ɝɥ.ɜɪɚɱ – ɤ.ɦɟɞ.ɧ.ɘ.ɇ.Ɂɚɜɚɥɤɨ)

ɭɥ.Ȼɟɯɬɟɪɟɜɚ, 1, Ⱦɧɟɩɪɨɩɟɬɪɨɜɫɤ, 49115, ɍɤɪɚɢɧɚ

SE "Dnipropetrovsk medical academy of Health Ministry of Ukraine" 1 Department of Psychiatry, General and Medical Psychology

Dzerzhinsky str., 9, Dnɟpropetrovsk, 49044, Ukraine e-mail: kpomp@yandex.ru

CI «Dnipropetrovsk clinical psychiatric hospital of Dnipropetrovsk regional council» 2 Bekhterev str., 1, Dnɟpropetrovsk, 49115, Ukraine

e-mail: dkpl@i.ua

Ʉɥɸɱɟɜɵɟ ɫɥɨɜɚ:ɞɟɩɪɟɫɫɢɹ,ɨɪɝɚɧɢɱɟɫɤɨɟ ɪɚɫɫɬɪɨɣɫɬɜɨ,ɡɥɨɭɩɨɬɪɟɛɥɟɧɢɟ ɚɥɤɨɝɨɥɟɦ Key words: depression, organic disorder, abusing alcohol

Ɋɟɮɟɪɚɬ.Ʉɥɿɧɿɤɨ-ɩɫɢɯɨɩɚɬɨɥɨɝɿɱɧɿ ɨɫɨɛɥɢɜɨɫɬɿ ɨɪɝɚɧɿɱɧɨɝɨ ɞɟɩɪɟɫɢɜɧɨɝɨ ɪɨɡɥɚɞɭ ɜ ɨɫɨɛɢ,ɹɤɚ ɡɥɨɜɠɢɜɚɽ

ɚɥɤɨɝɨɥɟɦ (ɤɥɿɧɿɱɧɢɣ ɜɢɩɚɞɨɤ).ɋɩɿɪɿɧɚ ȱ.Ⱦ.,Ʌɟɨɧɨɜ ɋ.Ɏ.,ɒɭɫɬɟɪɦɚɧ Ɍ.Ƀ.,ȼɚɪɲɚɜɫɶɤɢɣ ə.ɋ.ɍ ɫɬɚɬɬɿ