Remote clinical prognosis in patients with coronary X syndrome

(1)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

ɍȾɄ 616.132.2-008.6-036-037

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Ɉɞɟɫɶɤɢɣ ɧɚɰɿɨɧɚɥɶɧɢɣ ɦɟɞɢɱɧɢɣ ɭɧɿɜɟɪɫɢɬɟɬ ɩɪɨɜ.ȼɚɥɿɯɨɜɫɶɤɢɣ, 2, Ɉɞɟɫɚ, 65082, ɍɤɪɚʀɧɚ Odessa National Medical University

Valɿhovsky lane, 2, Odesa, 65082, Ukraine e-mail: seboff@mail.ru

Ʉɥɸɱɨɜɿ ɫɥɨɜɚ:ɤɨɪɨɧɚɪɧɢɣ ɫɢɧɞɪɨɦ ɏ,ɜɢɪɚɠɟɧɚ ɡɜɢɬɿɫɬɶ ɤɨɪɨɧɚɪɧɢɯ ɚɪɬɟɪɿɣ,ɫɟɪɣɨɡɧɿ ɤɚɪɞɿɨɜɚɫɤɭɥɹɪɧɿ

ɩɨɞɿʀ

Key words: coronary X syndrome, severe coronary tortuosity, major acute cardiovascular events

Ɋɟɮɟɪɚɬ.Ɉɬɞɚɥɟɧɧɵɣ ɤɥɢɧɢɱɟɫɤɢɣ ɩɪɨɝɧɨɡ ɩɚɰɢɟɧɬɨɜ ɫ ɤɨɪɨɧɚɪɧɵɦ ɫɢɧɞɪɨɦɨɦ ɏ.ɋɟɛɨɜ Ⱦ.Ɇ.ȼ ɫɬɚɬɶɟ ɩɪɨɚɧɚɥɢɡɢɪɨɜɚɧɵ ɞɚɧɧɵɟ 3234 ɤɨɪɨɧɚɪɧɵɯ ɚɧɝɢɨɝɪɚɮɢɣ, ɜ 217 ɫɥɭɱɚɹɯ ɭɫɬɚɧɨɜɥɟɧ ɤɨɪɨɧɚɪɧɵɣ ɫɢɧɞɪɨɦ ɏ (Ʉɋɏ), ɩɪɢ ɤɨɬɨɪɨɦ ɜɵɪɚɠɟɧɧɚɹ ɢɡɜɢɬɨɫɬɶ ɤɨɪɨɧɚɪɧɵɯ ɚɪɬɟɪɢɣ (ȼɂɄȺ)ɭɫɬɚɧɨɜɥɟɧɚ ɜ 148 (ɛɨɥɟɟ 2/3) ɫɥɭ

-ɱɚɹɯ.ɉɪɨɢɡɜɟɞɟɧ 5-ɥɟɬɧɢɣ ɚɧɚɥɢɡ ɤɚɪɞɢɨɜɚɫɤɭɥɹɪɧɵɯ ɫɨɛɵɬɢɣ ɭ ɩɚɰɢɟɧɬɨɜ ɫ Ʉɋɏ ɜ ɫɪɚɜɧɟɧɢɢ ɫ ɝɪɭɩɩɨɣ ɩɚ

-ɰɢɟɧɬɨɜ ɫ ɂȻɋ ɢ ɧɚɱɚɥɶɧɵɦ ɚɬɟɪɨɫɤɥɟɪɨɡɨɦ ɤɨɪɨɧɚɪɧɵɯ ɚɪɬɟɪɢɣ. Ⱦɨɤɚɡɚɧɨ ɨɬɫɭɬɫɬɜɢɟ ɞɨɫɬɨɜɟɪɧɨɝɨ ɨɬ

-ɥɢɱɢɹ ɜɨɡɧɢɤɧɨɜɟɧɢɹ ɫɟɪɶɟɡɧɵɯ ɤɚɪɞɢɨɜɚɫɤɭɥɹɪɧɵɯ ɫɨɛɵɬɢɣ (ɋɄȼɋ) ɦɟɠɞɭ ɩɚɰɢɟɧɬɚɦɢ ɫ ɧɚɱɚɥɶɧɵɦ ɚɬɟ

-ɪɨɫɤɥɟɪɨɡɨɦ ɢ Ʉɋɏ (ɪ>0,05). ɉɪɢ ɷɬɨɦ ɪɢɫɤ ɜɨɡɧɢɤɧɨɜɟɧɢɹ ɋɄȼɋ ɛɵɥ ɡɧɚɱɢɦɨ ɜɵɲɟ ɭ ɩɚɰɢɟɧɬɨɜ ɫ ȼɂɄȺ, OR=4,93; 95% (0,62; 39,29), ɱɬɨ ɨɩɪɟɞɟɥɹɟɬ ɟɟ ɤɚɤ ɞɨɩɨɥɧɢɬɟɥɶɧɵɣ ɮɚɤɬɨɪ ɪɢɫɤɚ ɪɚɡɜɢɬɢɹ ɋɄȼɋ.Ɍɚɤɠɟ ɭ

ɩɚɰɢɟɧɬɨɜ ɫ Ʉɋɏ ɨɫɬɚɜɚɥɫɹ ɛɨɥɟɟ ɜɵɫɨɤɢɦ ɪɢɫɤ ɜɨɡɧɢɤɧɨɜɟɧɢɹ ɫɟɪɶɟɡɧɵɯ ɚɪɢɬɦɢɣ ɜ ɫɪɚɜɧɟɧɢɢ ɫ ɩɚɰɢɟɧɬɚɦɢ,

ɛɨɥɶɧɵɦɢ ɂȻɋ ɫ ɧɚɱɚɥɶɧɵɦ ɚɬɟɪɨɫɤɥɟɪɨɡɨɦ: OR=2,36 (1,01; 5,56), ɩɪɢ ɷɬɨɦ ɞɨɫɬɨɜɟɪɧɨɝɨ ɪɚɡɥɢɱɢɹ ɦɟɠɞɭ

ɫɦɟɪɬɧɨɫɬɶɸ ɩɨ ɥɸɛɨɣ ɩɪɢɱɢɧɟ ɢ ɤɨɥɢɱɟɫɬɜɨɦ ɤɨɪɨɧɚɪɧɵɯ ɢɧɬɟɪɜɟɧɰɢɣ ɜ ɝɪɭɩɩɚɯ ɩɚɰɢɟɧɬɨɜ ɧɟ ɧɚɛɥɸɞɚɥɨɫɶ.

Abstract. Remote clinical prognosis in patients with coronary X syndrome. Sebov D.M. The article analyzes data of 3234 coronary angiographies with established coronary X syndrome (CXS) in 217 cases, herewith expressed tortuosity of coronary arteries (ETCA) was found out in 148 (more than 2/3) of cases. A 5-years’ analysis of cardio-vascular events (CVE) in patients with CXS in comparison with the group of IHD patients and initial atherosclerosis of coronary arteries was made. Absence of reliable difference of developing severe cardio-vascular events (SCVE) bet-ween patients with initial atherosclerosis and CXS was proved. Risk of CVE development was significantey higher in patients with ETCA, OR=4,93; 95% (0,62; 3929). Patients with CXS had higher risk of severe arrhythmias development as compared with IHD patients with initial atherosclerosis: OR=2,36 (1,01; 5,56). There was no reliable difference between lethality of any causes and number of coronary interventions in all groups.

ȼ ɟɩɨɯɭ ɜɩɪɨɜɚɞɠɟɧɧɹ ɜ ɪɭɬɢɧɧɭ ɩɪɚɤɬɢɤɭ ɿɧɬɟɪɜɟɧɰɿɣɧɢɯ ɦɟɬɨɞɿɜ ɜɟɪɢɮɿɤɚɰɿʀ ɤɨɪɨɧɚɪɧɨʀ ɚɧɚɬɨɦɿʀ ɫɭɱɚɫɧɟ ɩɿɡɧɚɧɧɹ ɫɭɬɧɨɫɬɿ ɪɨɡɜɢɬɤɭ ɫɬɚɛɿɥɶɧɨʀ ȱɏɋ ɿɫɬɨɬɧɨ ɩɟɪɟɝɥɹɧɭɬɨ. ɍ ɤɥɿɧɿɱɧɿɣ

ɩɪɚɤɬɢɰɿ ɡɭɫɬɪɿɱɚɸɬɶɫɹ ɩɚɰɿɽɧɬɢ ɡ ɚɧɝɿɧɨɡɧɢɦɢ ɫɤɚɪɝɚɦɢ ɬɚ ɨɛ'ɽɤɬɢɜɧɢɦɢ ɤɥɿɧɿɱɧɢɦɢ ɞɨɤɚɡɚɦɢ

ɿɲɟɦɿʀ ɦɿɨɤɚɪɞɚ ɩɪɢ ɿɧɬɚɤɬɧɢɯ ɤɨɪɨɧɚɪɧɢɯ ɚɪɬɟɪɿɹɯ ɡɚ ɞɚɧɢɦɢ ɤɨɪɨɧɚɪɧɢɯ ɚɧɝɿɨɝɪɚɮɿɣ

(ɄȺȽ), ɚɛɨ ɬɚɤ ɡɜɚɧɢɣ ɤɨɪɨɧɚɪɧɢɣ ɫɢɧɞɪɨɦ ɏ (Ʉɋɏ). ɑɢɫɥɟɧɧɿ ɞɨɫɥɿɞɠɟɧɧɹ ɬɚɤɨʀ ɤɚɬɟɝɨɪɿʀ

ɩɚɰɿɽɧɬɿɜ ɞɨɜɨɞɢɥɢ ɚɫɨɰɿɚɰɿɸ ɩɿɞɜɢɳɟɧɨɝɨ ɪɢ

-ɡɢɤɭ ɫɟɪɣɨɡɧɢɯ ɤɚɪɞɿɨɜɚɫɤɭɥɹɪɧɢɯ ɩɨɞɿɣ (ɋɄȼɉ) [1, 3, 4, 5, 6, 9, 8].

ɉɪɢ 7-ɪɿɱɧɨɦɭ ɫɩɨɫɬɟɪɟɠɟɧɧɿ ɬɚɤɨɠ ɜɿɞɡɧɚ

-ɱɟɧɨ ɜɡɚɽɦɨɡɜ'ɹɡɨɤ ɩɿɞɜɢɳɟɧɨɝɨ ɪɢɡɢɤɭ ɋɄȼɉ

ɩɪɢ ɫɬɚɛɿɥɶɧɿɣ ɫɬɟɧɨɤɚɪɞɿʀ ɧɚɜɿɬɶ ɩɪɢ ɿɧɬɚɤɬɧɢɯ

("ɧɨɪɦɚɥɶɧɢɯ") ɤɨɪɨɧɚɪɧɢɯ ɚɪɬɟɪɿɹɯ [9]. ɉɨɤɚ

-ɡɚɧɨ, ɳɨ ɭ ɜɢɩɚɞɤɚɯ ɫɬɚɛɿɥɶɧɨʀ ɫɬɟɧɨɤɚɪɞɿʀ ɄȺȽ

ɜɢɹɜɥɹɥɚ ɧɟɨɛɫɬɪɭɤɬɢɜɧɭ ɮɨɪɦɭ ȱɏɋ ɭ 2/3 ɜɢ

-ɩɚɞɤɚɯ ɭ ɠɿɧɨɤ ɿ ɜ 1/3 ɜɢɩɚɞɤɿɜ ɭ ɱɨɥɨɜɿɤɿɜ. ɉɪɢ

ɰɶɨɦɭ ɹɤ ɿɧɬɚɤɬɧɿ ɤɨɪɨɧɚɪɧɿ ɚɪɬɟɪɿʀ,ɬɚɤ ɿ ɞɢɮɭɡɧɿ

ɧɟɨɛɫɬɪɭɤɬɢɜɧɿ ɚɬɟɪɨɫɤɥɟɪɨɬɢɱɧɿ ɡɦɿɧɢ ɩɨɽɞɧɭ

-ɜɚɥɢɫɹ ɡ ɞɨɫɬɨɜɿɪɧɨ ɩɿɞɜɢɳɟɧɢɦ ɪɢɡɢɤɨɦ ɋɄȼɉ ɿ ɡɚɝɚɥɶɧɨɸ ɫɦɟɪɬɧɿɫɬɸ ɜ ɦɚɣɛɭɬɧɶɨɦɭ ɩɨɪɿɜɧɹɧɨ ɡ ɧɨɪɦɚɥɶɧɨɸ ɩɨɩɭɥɹɰɿɽɸ ɛɟɡ ȱɏɋ, ɧɚɜɿɬɶ ɩɿɫɥɹ

ɪɚɧɠɭɜɚɧɧɹ ɡɚ ɬɪɚɞɢɰɿɣɧɢɦɢ ɮɚɤɬɨɪɚɦɢ ɫɟɪ

-ɰɟɜɨ-ɫɭɞɢɧɧɨɝɨ ɪɢɡɢɤɭ [8]. Ɉɞɧɚɤ ɭ ɞɨɫɥɿɞɠɟɧɧɿ

ɧɟ ɛɭɥɨ ɿɧɮɨɪɦɚɰɿʀ ɩɪɨ ɩɪɨɜɟɞɟɧɧɹ ɚɧɚɬɨɦɿɱɧɨɝɨ ɚɧɚɥɿɡɭ ɬɚɤ ɡɜɚɧɢɯ "ɧɨɪɦɚɥɶɧɢɯ" ɚɪɬɟɪɿɨɝɪɚɦ ɡɚ

ɧɚɹɜɧɿɫɬɸ ɚɧɚɬɨɦɿɱɧɢɯ ɨɫɨɛɥɢɜɨɫɬɟɣ, ɡɨɤɪɟɦɚ

(2)

ɚɧɚɬɨɦɿʀ, ɳɨ ɜɢɹɜɥɹɽɬɶɫɹ ɞɚɧɢɦɢ ɄȺȽ. ȼɁɄȺ

ɜɢɡɧɚɱɚɽɬɶɫɹ ɹɤ ɞɜɚ ɚɛɨ ɛɿɥɶɲɟ ɩɨɫɥɿɞɨɜɧɢɯ

180-ɝɪɚɞɭɫɧɢɯ ɩɨɜɟɪɬɿɜ ɭ ɤɪɭɩɧɿɣ ɟɩɿɤɚɪɞɿɚɥɶɧɿɣ ɚɪɬɟɪɿʀ ɿ ɪɨɡɩɿɡɧɚɽɬɶɫɹ ɹɤ ɮɚɤɬɨɪ ɪɢɡɢɤɭ ɪɨɡɜɢɬɤɭ ɩɨɞɚɥɶɲɢɯ ɚɬɟɪɨɫɤɥɟɪɨɬɢɱɧɢɯ ɭɪɚɠɟɧɶ ɭ ɦɿɫɰɿ ɡɜɢɬɨɫɬɿ ɡɚ ɪɚɯɭɧɨɤ ɬɭɪɛɭɥɟɧɰɿɣ ɤɪɨɜɨɬɨɤɭ, ɪɨɡ

-ɝɨɣɞɭɜɚɧɧɹ ɚɪɬɟɪɿʀ ɬɚ ɡɦɿɧɢ ʀʀ ɫɬɿɧɤɢ ɭ ɡɜ'ɹɡɤɭ ɡ

ɩɨɫɬɿɣɧɢɦ ɩɭɥɶɫɨɜɢɦ ɭɞɚɪɨɦ ɤɪɨɜɿ ɧɚ ɡɜɢɬɭ ɞɿɥɹɧɤɭ ɚɪɬɟɪɿʀ [2, 7, 10]. Ⱥɫɨɰɿɚɰɿɹ ɪɢɡɢɤɭ ɋɄȼɉ

ɡɚɥɟɠɧɨ ɜɿɞ ɧɚɹɜɧɨɫɬɿ ɚɛɨ ɜɿɞɫɭɬɧɨɫɬɿ ȼɁɄȺ ɭ ɩɚɰɿɽɧɬɿɜ ɡ ȱɏɋ ɬɚ Ʉɋɏ ɞɨ ɬɟɩɟɪɿɲɧɶɨɝɨ ɱɚɫɭ ɜɢɜɱɟɧɚ ɧɟ ɛɭɥɨ.

Ɇɟɬɚ ɞɨɫɥɿɞɠɟɧɧɹ - ɜɢɜɱɢɬɢ ɩɪɨɝɧɨɫɬɢɱɧɿ ɧɚ

-ɫɥɿɞɤɢ ɤɚɪɞɿɚɥɶɧɢɯ ɚɧɝɿɧɨɡɧɢɯ ɫɢɦɩɬɨɦɿɜ ɭ ɩɚɰɿɽɧɬɿɜ ɡ ȱɏɋ ɬɚ ɿɧɬɚɤɬɧɢɦɢ ɤɨɪɨɧɚɪɧɢɦɢ ɚɪ

-ɬɟɪɿɹɦɢ ɡɚ ɞɚɧɢɦɢ ɄȺȽ ɡɚɥɟɠɧɨ ɜɿɞ ɧɚɹɜɧɨɫɬɿ ɚɛɨ ɜɿɞɫɭɬɧɨɫɬɿ ȼɁɄȺ.

ɆȺɌȿɊȱȺɅɂ ɌȺ ɆȿɌɈȾɂ ȾɈɋɅȱȾɀȿɇɖ

Ⱦɨɫɥɿɞɠɟɧɧɹ ɨɪɝɚɧɿɡɨɜɚɧɨ ɹɤ ɱɚɫɬɤɨɜɨ ɪɟɬɪɨ

-ɫɩɟɤɬɢɜɧɟ ɭ ɜɫɿɯ ɩɚɰɿɽɧɬɿɜ, ɹɤɢɦ ɩɪɨɜɨɞɢɥɚɫɶ

ɄȺȽ ɜ ɆɄɅ ʋ9ɿɦɟɧɿ ɩɪɨɮɟɫɨɪɚ Ɉ.ȱ.Ɇɿɧɚɤɨɜɚ ɿ

ɥɿɤɭɜɚɥɶɧɨ-ɞɿɚɝɧɨɫɬɢɱɧɨɦɭ ɰɟɧɬɪɿ ɌɈȼ "ɋɜɹɬɚ

Ʉɚɬɟɪɢɧɚ – Ɉɞɟɫɚ" ɡɚ 2008-2011ɪɪ. (ɪɢɫ. 1). ȼɿɞ 3234 ɤɥɿɧɿɱɧɢɯ ɜɢɩɚɞɤɿɜ ɿɞɟɧɬɢɮɿɤɨɜɚɧɿ ɞɚɧɿ 217

ɩɚɰɿɽɧɬɿɜ, ɯɜɨɪɢɯ ɧɚ ȱɏɋ, ɭ ɹɤɢɯ ɩɪɢ ɬɢɩɨɜɢɯ

ɚɧɝɿɧɨɡɧɢɯ ɧɚɩɚɞɚɯ ɿ ɨɛ'ɽɤɬɢɜɧɢɯ ɞɨɤɚɡɚɯ ɿɲɟɦɿʀ

ɦɿɨɤɚɪɞɚ ɛɭɥɢ ɜɢɡɧɚɱɟɧɿ ɿɧɬɚɤɬɧɿ ɤɨɪɨɧɚɪɧɿ ɚɪɬɟɪɿʀ (Ʉɋɏ). ɍ ɞɨɫɥɿɞɠɟɧɧɹ ɭɜɿɣɲɥɢ 100 (46,1%) ɱɨɥɨɜɿɤɿɜ ɿ 117 (53,9%) ɠɿɧɨɤ. Ʉɪɢɬɟɪɿʀ

ȼɁɄȺ ɜɢɡɧɚɱɟɧɿ ɭ 148 ɩɚɰɿɽɧɬɿɜ (68,2%), ɳɨ

ɞɨɡɜɨɥɹɽ ɡɪɨɛɢɬɢ ɜɢɫɧɨɜɨɤ, ɳɨ ȼɁɄȺ ɩɪɢɫɭɬɧɹ

ɞɨɫɢɬɶ ɱɚɫɬɨ, ɩɪɚɤɬɢɱɧɨ ɦɚɣɠɟ ɭ 2/3 ɜɿɞ ɭɫɿɯ

ɜɢɩɚɞɤɿɜ ȱɏɋ ɡ Ʉɋɏ.

Ʉɪɢɬɟɪɿɹɦɢ ɜɢɤɥɸɱɟɧɧɹ ɛɭɥɢ ɿɧɲɿ ɦɨɠɥɢɜɿ ɡɚɯɜɨɪɸɜɚɧɧɹ, ɹɤɿ ɜɢɤɥɢɤɚɸɬɶ ɫɢɦɩɬɨɦɚɬɢɱɧɭ

ɫɬɟɧɨɤɚɪɞɿɸ (ɝɿɩɟɪɬɪɨɮɿɱɧɚ ɤɚɪɞɿɨɦɿɨɩɚɬɿɹ,ɚɪɬɟ

-ɪɿɚɥɶɧɚ ɝɿɩɟɪɬɟɧɡɿɹ ɡ ɨɪɝɚɧɿɱɧɢɦ ɭɪɚɠɟɧɧɹɦ ɨɪ

-ɝɚɧɿɜ-ɦɿɲɟɧɟɣ,ɚɨɪɬɚɥɶɧɚ ɧɟɞɨɫɬɚɬɧɿɫɬɶ,ɚɨɪɬɚɥɶ

-ɧɢɣ ɫɬɟɧɨɡ,ɚɧɨɦɚɥɿʀ ɤɨɪɨɧɚɪɧɢɯ ɚɪɬɟɪɿɣ ɬɚ ɿɧ.)

Ʉɥɿɧɿɱɧɟ ɞɨɫɥɿɞɠɟɧɧɹ ɫɤɥɚɞɚɥɨɫɶ ɿɡ 5-ɪɿɱɧɨɝɨ

ɫɩɨɫɬɟɪɟɠɟɧɧɹ ɡɚ ɯɜɨɪɢɦɢ ɧɚ ɪɿɡɧɿ ɮɨɪɦɢ ȱɏɋ –

ɡ ɩɨɱɚɬɤɨɜɢɦ ɚɬɟɪɨɫɤɥɟɪɨɡɨɦ (ɝɪɭɩɚ "Ʉ", n=217)

ɬɚ ɤɨɪɨɧɚɪɧɢɦ ɫɢɧɞɪɨɦɨɦ ɏ (ɝɪɭɩɚ "ɏ", n=217).

Ɂɚɥɟɠɧɨ ɜɿɞ ɧɚɹɜɧɨɫɬɿ ȼɁɄȺ ɬɚɤɨɠ ɩɪɨɜɨɞɢɥɨɫɶ ɫɩɨɫɬɟɪɟɠɟɧɧɹ ɡɚ ɝɪɭɩɚɦɢ "ɏ+" (n=148) ɬɚ "ɏ-" (ɛɟɡ ȼɁɄȺ, n=69). Ɂɚɝɚɥɶɧɚ ɬɪɢɜɚɥɿɫɬɶ ɫɩɨɫɬɟ

-ɪɟɠɟɧɧɹ ɫɬɚɧɨɜɢɥɚ 5,01 ɪɨɤɭ, ɱɚɫɬɤɨɜɨ ɪɟɬɪɨ

-ɫɩɟɤɬɢɜɧɟ (ɜ ɞɨɫɥɿɞɠɟɧɧɹ ɭɜɿɣɲɥɨ 34 ɩɚɰɿɽɧɬɢ ɡ

Ʉɋɏ, ɞɿɚɝɧɨɡ ɹɤɢɦ ɜɫɬɚɧɨɜɥɟɧɨ ɩɨɩɟɪɟɞɧɶɨ).

ɬɢɣ ɭ ɞɨɫɥɿɞɠɟɧɧɹ - 30.12.2011 ɪ., ɚɛɫɨɥɸɬɧɚ

ɬɪɢɜɚɥɿɫɬɶ ɞɨɫɥɿɞɠɟɧɧɹ ɫɬɚɧɨɜɢɥɚ 5,01 ɪɨɤɭ,

ɦɟɞɿɚɧɚ ɞɨɫɥɿɞɠɟɧɧɹ ɫɬɚɧɨɜɢɥɚ 3,45 ɪɨɤɭ.

Ⱥɧɚɥɿɡ ɛɭɞɭɜɚɜɫɹ ɧɚ ɬɥɿ ɦɨɞɟɥɿ ɨɰɿɧɤɢ ɩɟɪɜɢɧɧɨʀ ɬɚ ɜɬɨɪɢɧɧɢɯ ɤɿɧɰɟɜɢɯ ɬɨɱɨɤ ɞɨɫɥɿɞ

-ɠɟɧɧɹ.Ʉɭɦɭɥɹɬɢɜɧɨɸ ɩɟɪɜɢɧɧɨɸ ɤɿɧɰɟɜɨɸ ɬɨɱ

-ɤɨɸ ɭɜɚɠɚɥɚɫɶ ɤɭɦɭɥɹɬɢɜɧɚ ɱɚɫɬɤɚ ɩɚɰɿɽɧɬɿɜ ɡɿ ɋɄȼɉ, ɡɨɤɪɟɦɚ ɫɦɟɪɬɶ ɱɟɪɟɡ ɤɚɪɞɿɨɜɚɫɤɭɥɹɪɧɿ

ɨɛɫɬɚɜɢɧɢ, ɜɢɩɚɞɤɢ ȽɄɋ, ɡɨɤɪɟɦɚ ɝɨɫɬɪɢɣ

ɿɧɮɚɪɤɬ ɦɿɨɤɚɪɞɚ (ȽȱɆ) ɚɛɨ ɧɟɫɬɚɛɿɥɶɧɚ ɫɬɟɧɨ

-ɤɚɪɞɿɹ (ɇɋ), ɝɨɫɬɪɟ ɩɨɪɭɲɟɧɧɹ ɦɨɡɤɨɜɨɝɨ

ɤɪɨɜɨɨɛɿɝɭ (ȽɉɆɄ).

ȼɪɚɯɨɜɭɜɚɥɢɫɶ ɬɚɤɿ ɜɬɨɪɢɧɧɿ ɤɿɧɰɟɜɿ ɬɨɱɤɢ: 1 – ɤɭɦɭɥɹɬɢɜɧɚ ɱɚɫɬɤɚ ɫɦɟɪɬɟɣ ɱɟɪɟɡ ɛɭɞɶ-ɹɤɿ

ɨɛɫɬɚɜɢɧɢ; 2 – ɫɟɪɣɨɡɧɿ ɜɢɞɢ ɚɪɢɬɦɿɣ: ɫɢɧɞɪɨɦ

ɫɥɚɛɤɨɫɬɿ ɫɢɧɭɫɨɜɨɝɨ ɜɭɡɥɚ, ɜɟɪɢɮɿɤɨɜɚɧɿ ɚɬɪɿɨ

-ɜɟɧɬɪɢɤɭɥɹɪɧɿ ɛɥɨɤɚɞɢ II-III ɫɬɭɩɟɧɿɜ, ɡɨɤɪɟɦɚ

ɿɦɩɥɚɧɬɚɰɿɹ ɟɥɟɤɬɪɨɤɚɪɞɿɨɫɬɢɦɭɥɹɬɨɪɚ (ȿɄɋ),

ɩɚɪɨɤɫɢɡɦɚɥɶɧɿ ɬɚ ɩɟɪɫɢɫɬɭɸɱɿ ɮɿɛɪɢɥɹɰɿɹ

-ɬɪɿɩɨɬɿɧɧɹ ɩɟɪɟɞɫɟɪɞɶ, ɩɚɪɨɤɫɢɡɦɚɥɶɧɚ ɲɥɭ

-ɧɨɱɤɨɜɚ ɬɚɯɿɤɚɪɞɿɹ ɬɨɳɨ; 3 – ɤɿɥɶɤɿɫɬɶ ɪɟɜɚɫɤɭ

-ɥɹɪɢɡɚɰɿɣɧɢɯ ɜɬɪɭɱɚɧɶ ɤɨɪɨɧɚɪɧɢɯ ɚɪɬɟɪɿɣ ɡɚ ɩɥɚɧɨɜɢɦɢ ɚɛɨ ɭɪɝɟɧɬɧɢɦɢ ɩɨɤɚɡɚɧɧɹɦɢ.

ɊȿɁɍɅɖɌȺɌɂ ɌȺ Ȳɏ ɈȻȽɈȼɈɊȿɇɇə

Ɂɚ ɩɟɪɜɢɧɧɨɸ ɤɭɦɭɥɹɬɢɜɧɨɸ ɤɿɧɰɟɜɨɸ ɬɨɱɤɨɸ ɞɨɫɥɿɞɠɟɧɧɹ ɜɫɬɚɧɨɜɥɟɧɨ ɜɫɶɨɝɨ 14 ɩɨɞɿɣ

ɭ ɤɨɧɬɪɨɥɶɧɿɣ ɝɪɭɩɿ "K" ɬɚ 11 – ɜ ɨɫɧɨɜɧɿɣ "ɏ".

ɋɥɿɞ ɜɿɞɡɧɚɱɢɬɢ, ɳɨ ɫɟɪɟɞ ɩɨɞɿɣ ɝɪɭɩɢ "Ʉ"

ɡɭɫɬɪɿɱɚɥɨɫɶ 2 ɜɢɩɚɞɤɢ Ʉȼɋ, 8 - ȽɄɋ, ɡɨɤɪɟɦɚ

ȽȱɆ ɬɚ ɇɋ, ɬɚ 4 - ȽɉɆɄ. ȼ ɨɫɧɨɜɧɿɣ ɝɪɭɩɿ "ɏ"

Ʉȼɋ ɡɚɪɟɽɫɬɪɨɜɚɧɨ ɧɟ ɛɭɥɨ, ɚɥɟ ɜɿɞɛɭɥɨɫɶ 6 ɩɨ

-ɞɿɣ ȽɄɋ ɬɚ 5 ɜɢɩɚɞɤɿɜ ȽɉɆɄ. Ɍɚɤɢɦ ɱɢɧɨɦ,

ɤɭɦɭɥɹɬɢɜɧɚ ɱɚɫɬɨɬɚ ɯɜɨɪɢɯ ɛɟɡ ɩɨɞɿɣ ɭ ɝɪɭɩɚɯ ɫɬɚɧɨɜɢɥɚ 0,913 ɬɚ 0,912 ɜɿɞɩɨɜɿɞɧɨ (p>0,5), ɳɨ

ɞɨɜɨɞɢɬɶ ɜɿɞɫɭɬɧɿɫɬɶ ɜɿɞɦɿɧɧɨɫɬɿ ɡɚ ɩɟɪɜɢɧɧɨɸ ɤɭɦɭɥɹɬɢɜɧɨɸ ɤɿɧɰɟɜɨɸ ɬɨɱɤɨɸ ɞɨɫɥɿɞɠɟɧɧɹ ɭ ɯɜɨɪɢɯ ɡ Ʉɋɏ ɬɚ ɩɨɱɚɬɤɨɜɢɦ ɚɬɟɪɨɫɤɥɟɪɨɡɨɦ ɤɨɪɨɧɚɪɧɢɯ ɚɪɬɟɪɿɣ (ɪɢɫ. 2).

ȼɪɚɯɨɜɭɸɱɢ ɪɟɡɭɥɶɬɚɬɢ ɩɨɩɟɪɟɞɧɿɯ ɞɨɫɥɿɞ

-ɠɟɧɶ, ɛɭɥɨ ɩɪɢɣɧɹɬɨ ɪɿɲɟɧɧɹ ɩɪɨɚɧɚɥɿɡɭɜɚɬɢ

ɞɚɧɿ ɩɚɰɿɽɧɬɿɜ ɡ Ʉɋɏ ɝɪɭɩɢ "ɏ",ɪɨɡɩɨɞɿɥɹɸɱɢ ʀɯ

ɧɚ ɝɪɭɩɢ "ɏ+"ɬɚ "ɏ-" (148 ɯɜɨɪɢɯ ɡ ȼɁɄȺ ɬɚ 69 -

ɛɟɡ ȼɁɄȺ). Ɂ 11 ɋɄȼɉ ɭ ɯɜɨɪɢɯ ɝɪɭɩɢ "ɏ" 10

ɜɿɞɛɭɥɨɫɹ ɭ ɝɪɭɩɿ "ɏ+" ɬɚ ɥɢɲɟ 1 - ɭ ɝɪɭɩɿ "ɏ-" (ɤɭɦɭɥɹɬɢɜɧɚ ɱɚɫɬɨɬɚ ɛɟɡ ɩɨɞɿɣ - 0,88 ɬɚ 0,93

ɜɿɞɩɨɜɿɞɧɨ, t=2,11; ɪ<0,05). Ɍɚɤɢɦ ɱɢɧɨɦ, ɨɬɪɢ

-ɦɚɧɿ ɞɚɧɿ ɞɨɡɜɨɥɹɸɬɶ ɡɪɨɛɢɬɢ ɜɢɫɧɨɜɨɤ, ɳɨ

(3)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

Ɋɢɫ. 1. Ⱦɢɮɟɪɟɧɰɿɸɜɚɧɧɹ ɜɢɛɿɪɤɢ ɬɚ ɫɬɪɭɤɬɭɪɚ ɨɛ`ɽɤɬɚ ɞɨɫɥɿɞɠɟɧɧɹ ȱɏɋ – ɿɲɟɦɿɱɧɚ ɯɜɨɪɨɛɚ ɫɟɪɰɹ;Ʉɋɏ –ɤɨɪɨɧɚɪɧɢɣ ɫɢɧɞɪɨɦ ɏ;ɄȺȽ – ɤɨɪɨɧɚɪɧɚ ɚɧɝɿɨɝɪɚɮɿɹ;ȽɄɋ – ɝɨɫɬɪɢɣ ɤɨɪɨɧɚɪɧɢɣ ɫɢɧɞɪɨɦ;ȼɁɄȺ –

ɜɢɪɚɠɟɧɚ ɡɜɢɬɿɫɬɶ ɤɨɪɨɧɚɪɧɢɯ ɚɪɬɟɪɿɣ

3234 ɩɚɰɿɽɧɬɢ ɩɨɤɚɡɚɧɧɹ ɞɨ ɩɪɨɜɟɞɟɧɧɹ ɄȺȽ

768

ɭɪɝɟɧɬɧɢɯ ɄȺȽ ɧɚ ȽɄɋ _{ɩɥɚɧɨɜɢɯ ɄȺȽ}2466

89ɚɧɨɦɚɥɿʀ

ɤɨɪɨɧɚɪɧɢɯ ɚɪɬɟɪɿɣ ɤɥɚɩɚɧɧɿ ɩɚɬɨɥɨɝɿʀ377

207 ɢɧɬɚɤɬɧɿ ɤɨɪɨɧɚɪɧɿ

ɚɪɬɟɪɿʀ ɛɟɡ ɞɨɜɟɞɟɧɨʀ ȱɏɋ _{ɄȺȽ ɧɚ ɫɬɚɛɢɥɶɧɿɣ}1793

ȱɏɋ

185ɩɿɫɥɹɿɧɮɚɪɤɬɧɢɣ

ɤɚɪɞɿɨɫɤɥɟɪɨɡ

133ɤɨɪɨɧɚɪɨɲɭɧɬɨ

-ɝɪɚɮɿʀ

217ɤɨɪɨɧɚɪɧɢɣ

ɫɢɧɞɪɨɦ ɏ

308ɞɢɮɭɡɧɢɣ

ɧɟɨɛɫɬɪɭɤɬɢɜɧɢɣ ɚɬɟɪɨɫɤɥɟɪɨɡ

301ɨɞɧɨɫɭɞɢɧɧɟ

ɭɪɚɠɟɧɧɹ

183ɞɜɨɫɭɞɢɧɧɟ

ɭɪɚɠɟɧɧɹ

466ɬɪɢ-,ɛɚɝɚɬɨɫɭɞɢɧɧɟ

ɭɪɚɠɟɧɧɹ

424

ɩɚɰɿɽɧɬɢ ɡ ɿɧɬɚɤɬɧɢɦɢ ɤɨɪɨɧɚɪɧɢɦɢ ɚɪɬɟɪɿɹɦɢ

217

ɡ ɨɛ`ɽɤɬɢɜɧɢɦɢ ɨɡɧɚɤɚɦɢ

ɿɲɟɦɿʀ ɦɿɨɤɚɪɞɚ (Ʉɋɏ)

ɈȻ`ȿɄɌ ȾɈɋɅȱȾɀȿɇɇə 185

ɛɟɡ ɨɛ`ɽɤɬɢɜɧɢɯ ɨɡɧɚɤ ɿɲɟɦɿʀ

ɦɿɨɤɚɪɞɚ

22ɜɢɤɥɸɱɟɧɿ (ɧɟɞɨɫɬɚɬɧɶɨ ɞɚɧɢɯ ɚɛɨ

ɜɿɞɦɨɜɢɥɢɫɶ ɜɿɞ ɩɨɞɚɥɶɲɨʀ ɭɱɚɫɬɿ ɭ ɪɨɛɨɬɿ)

148ɩɚɰɿɽɧɬɿɜ

(4)

0,88 0,93

0 12 24 36 48 60

Ɇɿɫɹɰɿ

Ʉɭ

ɦ

ɭɥɹ

ɬɢ

ɜɧ

ɚ

ɱɚ

ɫɬ

ɤɚ

ɯɜ

ɨɪɢ

ɯ

ɛɟ

ɡ

ɩɨɞɿ

ɉɨɱɚɬɤɨɜɢɣ ɚɬɟɪɨɫɤɥɟɪɨɡ ɝɪɭɩɚ "Ʉ"

Ʉɨɪɨɧɚɪɧɢɣ ɫɢɧɞɪɨɦ ɏ ɝɪɭɩɚ "ɏ"

Ʉɋɏ Ɂ ȼɁɄȺ "ɏ+"

Ʉɋɏ ɛɟɡ ȼɁɄȺ "ɏ-"

Ɋɢɫ. 2. Ɋɟɡɭɥɶɬɚɬ ɬɪɢɜɚɥɨɝɨ 5-ɪɿɱɧɨɝɨ ɫɩɨɫɬɟɪɟɠɟɧɧɹ ɡɚ ɤɭɦɭɥɹɬɢɜɧɨɸ ɩɟɪɜɢɧɧɨɸ ɬɨɱɤɨɸ ɯɜɨɪɢɯ ɧɚ ȱɏɋ ɡ ɩɨɱɚɬɤɨɜɢɦ ɚɬɟɪɨɫɤɥɟɪɨɡɨɦ,Ʉɋɏ ɬɚ ɡɚ ɪɨɡɤɥɚɞɨɦ ɜɿɞ ɩɪɢɫɭɬɧɨɫɬɿ ȼɁɄȺ

ɋɩɨɫɬɟɪɟɠɟɧɧɹ ɡɚ ɜɬɨɪɢɧɧɢɦɢ ɤɿɧɰɟɜɢɦɢ ɬɨɱɤɚɦɢ ɧɟ ɜɢɹɜɢɥɢ ɜɿɞɦɿɧɧɨɫɬɟɣ ɭ ɝɪɭɩɚɯ "Ʉ"ɬɚ "ɏ"ɡɚ ɤɿɥɶɤɿɫɬɸ ɫɦɟɪɬɟɣ ɱɟɪɟɡ ɛɭɞɶ-ɹɤɿ ɨɛɫɬɚɜɢ

-ɧɢ (OR=0,66; 95%; Ⱦȱ=0,11-4,01ɛ ɪ>0,5). ɉɪɨɬɟ

ɜɢɹɜɢɥɚɫɶ ɞɭɠɟ ɜɢɪɚɠɟɧɚ ɜɿɞɦɿɧɧɿɫɬɶ ɡɚ ɤɿɥɶ

-ɤɿɫɬɸ ɫɟɪɣɨɡɧɢɯ ɚɪɢɬɦɿɣ - ɭ ɝɪɭɩɿ Ʉɋɏ ɤɭɦɭɥɹ

-ɬɢɜɧɚ ɱɚɫɬɨɬɚ ɯɜɨɪɢɯ ɛɟɡ ɰɿɽʀ ɜɬɨɪɢɧɧɨʀ ɤɿɧɰɟɜɨʀ ɬɨɱɤɢ ɛɭɥɚ ɡɧɚɱɧɨ ɦɟɧɲɨɸ (0,88 ɩɨɪɿɜɧɹɧɨ ɡ 0,94

ɭ ɝɪɭɩɿ "Ʉ", t=2,07, ɪ=0,04), ɩɪɢ ɰɶɨɦɭ ɪɢɡɢɤ

ɚɪɢɬɦɿɱɧɢɯ ɩɨɞɿɣ ɭ ɝɪɭɩɿ "ɏ"ɛɭɜ ɡɧɚɱɧɨ ɜɢɳɢɣ (OR=2,36; 95%; Ⱦȱ=1,01-5,56, p<0,05) (ɪɢɫ. 3).

ȼɿɞɦɿɧɧɨɫɬɿ ɡɚ ɤɿɥɶɤɿɫɬɸ ɭɪɝɟɧɬɧɢɯ ɬɚ ɩɥɚɧɨɜɢɯ

ɤɨɪɨɧɚɪɧɢɯ ɜɬɪɭɱɚɧɶ ɧɟ ɫɩɨɫɬɟɪɿɝɚɥɨɫɶ

(OR=0,74; 95%; Ⱦȱ=0,31-1,79; ɪ>0,05), ɳɨ ɜɿɞɛɭ

-ɥɨɫɹ ɡɚ ɡɧɚɱɧɨɸ ɤɿɥɶɤɿɫɬɸ ɩɨɜɬɨɪɧɢɯ ɄȺȽ ɭ ɝɪɭɩɿ "ɏ" ɛɟɡ ɩɨɞɚɥɶɲɨɝɨ ɤɨɪɨɧɚɪɧɨɝɨ ɜɬɪɭ

-ɱɚɧɧɹ, ɚ ɜ ɝɪɭɩɿ "Ʉ" ɛɭɥɚ ɡɧɚɱɧɨ ɛɿɥɶɲɨɸ

ɤɿɥɶɤɿɫɬɶ ɫɬɟɧɬɭɜɚɧɶ. ȼɂɋɇɈȼɄɂ

1. Ⱥɧɚɥɿɡ ɤɨɦɛɿɧɨɜɚɧɨʀ ɩɟɪɜɢɧɧɨʀ ɤɿɧɰɟɜɨʀ

ɬɨɱɤɢ 5-ɪɿɱɧɨɝɨ ɫɩɨɫɬɟɪɟɠɟɧɧɹ ɞɨɜɿɜ ɜɿɞɫɭɬɧɿɫɬɶ

ɞɨɫɬɨɜɿɪɧɨʀ ɜɿɞɦɿɧɧɨɫɬɿ ɭ ɜɢɧɢɤɧɟɧɧɿ ɫɟɪɣɨɡɧɢɯ ɤɚɪɞɿɨɜɚɫɤɭɥɹɪɧɢɯ ɩɨɞɿɣ ɦɿɠ ɩɚɰɿɽɧɬɚɦɢ ɡ ɩɨ

-ɱɚɬɤɨɜɢɦ ɚɬɟɪɨɫɤɥɟɪɨɡɨɦ ɬɚ ɤɨɪɨɧɚɪɧɢɦ ɫɢɧɞɪɨ

-ɦɨɦ ɏ (ɪ>0,05). ɉɪɨɬɟ ɪɨɡɪɚɯɭɧɨɤ ɡɚ ɜɿɞɧɨɲɟɧ

-ɧɹɦ ɲɚɧɫɿɜ ɩɪɨɞɟɦɨɧɫɬɪɭɜɚɜ, ɳɨ ɪɢɡɢɤ ɜɢɧɢɤ

-ɧɟɧɧɹ ɋɄȼɉ ɛɭɜ ɡɧɚɱɧɨ ɜɢɳɢɣ ɭ ɯɜɨɪɢɯ ɡ ȼɁɄȺ, OR=4,93; 95% (0,62, 39,29), ɳɨ ɞɨɡɜɨɥɹɽ ɜɜɚɠɚɬɢ

ɜɢɪɚɠɟɧɭ ɡɜɢɬɿɫɬɶ ɤɨɪɨɧɚɪɧɢɯ ɚɪɬɟɪɿɣ ɞɨɞɚɬɤɨ

-ɜɢɦ ɮɚɤɬɨɪɨɦ ɪɢɡɢɤɭ ɭ ɪɨɡɜɢɬɤɭ ɤɚɪɞɿɨɜɚɫɤɭ

-ɥɹɪɧɢɯ ɭɫɤɥɚɞɧɟɧɶ.

2. Ⱥɧɚɥɿɡ ɜɬɨɪɢɧɧɢɯ ɤɿɧɰɟɜɢɯ ɬɨɱɨɤ ɩɪɨɞɟ

-ɦɨɧɫɬɪɭɜɚɜ ɜɿɞɫɭɬɧɿɫɬɶ ɜɿɞɦɿɧɧɨɫɬɿ ɭ ɩɚɰɿɽɧɬɿɜ ɡ ɪɿɡɧɢɦɢ ɮɨɪɦɚɦɢ ȱɏɋ ɡɚ ɫɦɟɪɬɧɿɫɬɸ ɱɟɪɟɡ ɛɭɞɶ

-ɹɤɿ ɨɛɫɬɚɜɢɧɢ ɬɚ ɤɿɥɶɤɿɫɬɸ ɧɚɫɬɭɩɧɢɯ ɪɟɜɚɫɤɭɥɹ

-ɪɢɡɚɰɿɣɧɢɯ ɜɬɪɭɱɚɧɶ ɧɚ ɤɨɪɨɧɚɪɧɢɯ ɚɪɬɟɪɿɹɯ.

ɉɪɨɬɟ ɭ ɯɜɨɪɢɯ ɧɚ ȱɏɋ ɡ Ʉɋɏ ɡɚɥɢɲɚɜɫɹ ɛɿɥɶɲ ɜɢɫɨɤɢɣ ɪɢɡɢɤ ɜɢɧɢɤɧɟɧɧɹ ɫɟɪɣɨɡɧɢɯ ɚɪɢɬɦɿɣ ɩɨɪɿɜɧɹɧɨ ɡ ɯɜɨɪɢɦɢ ɧɚ ȱɏɋ ɡ ɩɨɱɚɬɤɨɜɢɦ ɚɬɟ

(5)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

ɈɁɇȺɄɂ

ɉɨɪɿɜɧɹɧɧɹ

ʋ

Odds ratio (OR) CI=95%

ɉɟɪɜɢɧɧɚ ɤɭɦɭɥɹɬɢɜɧɚ

ɤɿɧɰɟɜɚ ɬɨɱɤɚ:

(

Ʉȼɋ

+

ȽȱɆ

+

ɇɋ

+

ȽɉɆɄ

)

Ƚɪɭɩɚ "Ʉ" vs

Ƚɪɭɩɚ "ɏ"

14

11 0,77

Ʉȼɋ

Ƚɪɭɩɚ "Ʉ" vs _{Ƚɪɭɩɚ "ɏ"}

2 ₀

ȽɄɋ

(

ȽȱɆ

+

ɇɋ

)

8

6

0.55 ȽɉɆɄ

4 ₅

0.68 ȼɬɨɪɢɧɧɿ ɤɿɧɰɟɜɿ ɬɨɱɤɢ

:

ɋɦɟɪɬɶ ɡ ɛɭɞɶ

-

ɹɤɢɯ ɨɛɫɬɚɜɢɧ

3

2

0.66 ɋɟɪɣɨɡɧɿ ɚɪɢɬɦɿʀ

(

ɋɋɋȼ

,

ɛɥɨɤɚɞɢ,

ȿɄɋ +ɩɚɪɨɤɫɢɡɦɢ

Ɏɉ

,

ɒɌ

)

Ƚɪɭɩɚ "ɏ"

18

8

2.36 ɋɋɋȼ

,

ɛɥɨɤɚɞɢ

,

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1

4 4,06

ɉɚɪɨɤɫɢɡɦɢ Ɏɉ

,

ɒɌ

Ƚɪɭɩɚ "ɏ"

14

7

1.97 Ʉɿɥɶɤɿɫɬɶ ɭɪɝɟɧɬɧɢɯ ɬɚ

ɩɥɚɧɨɜɢɯ ɤɨɪɨɧɚɪɧɢɯ

ɜɬɪɭɱɚɧɶ

Ƚɪɭɩɚ "ɏ"

12

9

0.74 ɊɟɄȺȽ

6 ₈

1.35 ɋɬɟɧɬɭɜɚɧɶ

,

ȺɄɒ

Ƚɪɭɩɚ "Ʉ" vs Ƚɪɭɩɚ "ɏ"

6

1

0.16 0,5 1 2 4

Ɋɢɫ. 3. Ɋɢɡɢɤ ɜɢɧɢɤɧɟɧɧɹ ɩɟɪɜɢɧɧɢɯ,ɜɬɨɪɢɧɧɢɯ ɤɿɧɰɟɜɢɯ ɬɨɱɨɤ ɬɚ ʀɯ ɫɤɥɚɞɨɜɢɯ ɭ ɯɜɨɪɢɯ ɧɚ ȱɏɋ ɡ ɤɨɪɨɧɚɪɧɢɦ ɫɢɧɞɪɨɦɨɦ ɏ

ɋ

ɋɉ

ɉ

ɂɋ

ɂ

ɋɈ

ɈɄ

Ʉ

Ʌȱ

Ʌ

ȱɌ

Ɍȿ

ȿɊ

ɊȺ

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1. Ⱦɡɹɤ Ƚ.ȼ. ɉɨɤɚɡɚɬɟɥɢ ɥɢɩɢɞɧɨɝɨ ɩɪɨɮɢɥɹ ɢ

ɪɢɫɤ ɪɚɡɜɢɬɢɹ ɨɫɥɨɠɧɟɧɢɣ ɭ ɩɚɰɢɟɧɬɨɜ ɫ ɪɚɡɥɢɱɧɵɦɢ ɮɨɪɦɚɦɢ ɂȻɋ / Ƚ.ȼ.Ⱦɡɹɤ,Ʌ.ɂ.ȼɚɫɢɥɶɟɜɚ,ɇ.Ⱥ. ɉɟɬ-ɪɢɤ // ɋɭɱɚɫɧɿ ɦɟɞɢɱɧɿ ɬɟɯɧɨɥɨɝɿʀ. – 2010. – ʋ 3. – ɋ. 17-21.

2. Ʉɧɵɲɨɜ Ƚ.ȼ. ɂɡɜɢɬɨɫɬɶ ɜɟɧɟɱɧɵɯ ɚɪɬɟɪɢɣ ɢ ɟɟ ɪɨɥɶ ɜ ɪɚɡɜɢɬɢɢ ɢɲɟɦɢɢ ɦɢɨɤɚɪɞɚ / Ƚ.ȼ.Ʉɧɵɲɨɜ, ȿ.Ɉ.Ʌɟɛɟɞɟɜɚ, ȿ.Ⱥ ɇaɫɬɟɧɤɨ [ɬɚ ɿɧ.] // ɍɤɪ. ɤɚɪɞɿɨɥ. ɠɭɪɧɚɥ. – 2012. – ʋ 5. – ɋ. 28-35.

3. Ʌɭɩɚɧɨɜ ȼ.ɉ.Ⱦɢɚɝɧɨɫɬɢɤɚ ɢ ɥɟɱɟɧɢɟ ɛɨɥɶɧɵɯ ɫ ɤɚɪɞɢɚɥɶɧɵɦ ɫɢɧɞɪɨɦɨɦ X / ȼ.ɉ.Ʌɭɩɚɧɨɜ, ɘ.ȼ.Ⱦɨɰɟɧɤɨ // Ɋɭɫ. ɦɟɞ.ɠɭɪɧɚɥ. – 2009. – ʋ 14. -ɋ. 903-909.

4. Ɇɚɤɨɥɤɢɧ ȼ.ɂ. Ʉɥɢɧɢɱɟɫɤɢɟ ɨɫɨɛɟɧɧɨɫɬɢ ɢ ɞɢɚɝɧɨɫɬɢɤɚ ɫɬɟɧɨɤɚɪɞɢɢ ɭ ɥɢɰ ɫ ɧɨɪɦɚɥɶɧɵɦɢ ɤɨɪɨ-ɧɚɪɧɵɦɢ ɫɨɫɭɞɚɦɢ / ȼ.ɂ.Ɇɚɤɨɥɤɢɧ,ɋ.Ⱥ.Ⱥɛɛɚɤɭɦɨɜ, ɂ.Ƚ.Ⱥɥɥɢɥɭɟɜ [ɢ ɞɪ.] // Ʉɚɪɞɢɨɥɨɝɢɹ. – 1989. – Ɍ. 2. – ɋ. 34-37.

5. Angina pectoris with angiographically normal coronary arteries: a clinical, hemodynamic, and metabolic study / J. Berland, A. Gribier, J.L. Cazor [et al.] // Clin. Cardiol. – 1984. – Vol. 7. – P. 485-492.

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8. Kubler W. Syndrom X: diagnostic criteria and long term prognosis / W. Kubler, D. Opherk, H. Tillmanns // Can. J. Cardial. – 1986. – N 7. – P. 219-220.

9. Persistence of multiple cardiovascular risk clustering related to syndrome X from childhood to young

10. Severe coronary tortuosity and the relationship to significant coronary artery disease / S.S. Groves, A.C. Jain, B.E. Warden [et al.] // W.V.Med.J, 2009. –Vol. 105, N 4. – P. 14-17.

R

E

F

E

R

E

N

C

E

S

1. Dzyak GV. [Indexes of lipid profile and risk of complications in patients with different formes of coronary artery disease]. Suchasni medychni tehnologiyi. 2010;3:17-21. Russian.

2. Knyshov GV, Lebedeva EO, Nastenko EA. [Tor-tuosity of the coronary arteries and its role in the deve-lopment of myocardial ischemia]. Ukraʀns'kiy kardɿ o-logɿchniy zhurnal. 2012;5:28-35. Russian.

3. Lupanov VP, Dotsenko YuV. [Diagnosis and treatment of patients with cardiac syndrome X]. Rus. med. zhurnal. 2009;14:903-9. Russian.

4. Makolkin VI, Abbakumov SA, Alliluev IG. [Clinical features and diagnosis of angina pectoris in patients with normal coronary vessels]. Kardiologiya. 1989;2:34-37. Russian.

5. Berland J, Gribier A, Cazor JL. Angina pectoris with angiographically normal coronary arteries: a clinical,

hemodynamic, and metabolic study. Clin. Cardiol. 1984;7:485-92.

6. Asbury EA, Collins P. Cardiac syndrome X. Int.J. Clin. Pract. 2005;59(9):1063-9.

7. Dobrin PB, Schwarcz TH, Baker WH. Mecha-nisms of arterial and aneurysmal tortuosity. Surgery. 1988;104(3):568-71.

8. Kubler W, Opherk D, Tillmanns H. Syndrom X: diagnostic criteria and long term prognosis. Can. J. Cardial, 1986;219-20.

9. Bao WH, Srinivasan SR, Wattingney WA. Persis-tence of multiple cardiovascular risk clustering related to syndrome X from childhood to young adulthood. The Bo-galusa Heart Study. Arch. Intern. Med. 1994;54:1842-47.

10. Groves SS, Jain AC, Warden BE. Severe coronary tortuosity and the relationship to significant coronary artery disease. W.V.Med.J. 2009;105(4):14-17.

ɋɬɚɬɬɹ ɧɚɞɿɣɲɥɚ ɞɨ ɪɟɞɚɤɰɿʀ 08.07.2015

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ȾɁ «Ⱦɧɿɩɪɨɩɟɬɪɨɜɫɶɤɚ ɦɟɞɢɱɧɚ ɚɤɚɞɟɦɿɹ ɆɈɁ ɍɤɪɚʀɧɢ»

ɤɚɮɟɞɪɚ ɚɤɭɲɟɪɫɬɜɚ ɿ ɝɿɧɟɤɨɥɨɝɿʀ

(ɡɚɜ. – ɞ.ɦɟɞ.ɧ.,ɩɪɨɮ.ȼ.Ɉ.ɉɨɬɚɩɨɜ)

ɜɭɥ.Ⱦɡɟɪɠɢɧɫɶɤɨɝɨ, 9, Ⱦɧɿɩɪɨɩɟɬɪɨɜɫɶɤ, 49044, ɍɤɪɚʀɧɚ

SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine» Department of Obstetrics and Gynecology

Dzerzhinsky str., 9, Dnipropetrovsk, 49044, Ukraine e-mail: medvedev.mv@gmail.com

Ʉɥɸɱɨɜɿ ɫɥɨɜɚ:ɥɟɣɨɦɿɨɦɚ ɦɚɬɤɢ,ȿɆȺ,ɥɟɣɨɦɿɨɦɚ ɜɢɝɧɚɧɧɹ,ɪɟɡɭɥɶɬɚɬɢ ɜɚɝɿɬɧɨɫɬɿ