Primary dyslipidemia and cardiometabolic risk: potential of pitavastatin

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Ɇɟɞɢɰɢɧɫɤɢɣ ɭɧɢɜɟɪɫɢɬɟɬ,ɝ.Ɂɚɩɨɪɨɠɶɟ1

ɤɚɮɟɞɪɚ ɜɧɭɬɪɟɧɧɢɯ ɛɨɥɟɡɧɟɣ ʋ 2

ɩɪ.Ɇɚɹɤɨɜɫɤɨɝɨ, 26, Ɂɚɩɨɪɨɠɶɟ, 69035, ɍɤɪɚɢɧɚ Ʉɉ «Ƚɨɪɨɞɫɤɚɹ ɛɨɥɶɧɢɰɚ ʋ 7» 2

ɭɥ.Ʌɭɧɚɱɚɪɨɜɚ, 9, Ɂɚɩɨɪɨɠɶɟ, 69600, ɍɤɪɚɢɧɚ ɈɈɈ «ȼɢɬɚ ɰɟɧɬɪ»3

ɭɥ.ɋɟɞɨɜɚ, 3, Ɂɚɩɨɪɨɠɶɟ, 69035, ɍɤɪɚɢɧɚ Ƚɍ «ɋɆɋɑ ʋ 6 ɆɁ ɍɤɪɚɢɧɵ»4

ɭɥ.Ɍɢɬɨɜɚ, 29, Ⱦɧɟɩɪɨɩɟɬɪɨɜɫɤ, 49089, ɍɤɪɚɢɧɚ State Medical University 1

Internal Medicine Department N 2

Mayakovsky av., 26, Zaporizhzhya, 69035, Ukraine City hospital N 7 2

Lunacharova st., 9, Zaporozhye, 69600, Ukraine Vita Center LTD 3

Sedov st., 3, Zaporozhye, 69035, Ukraine SI «SɆSD N 6, HM of Ukraine» 4

Titov st., 29, Dnepropetrovsk, 49089, Ukraine e-mail: dr_berezin@mail.ru

Ʉɥɸɱɟɜɵɟ ɫɥɨɜɚ:ɞɢɫɥɢɩɢɞɟɦɢɹ,ɤɚɪɞɢɨɦɟɬɚɛɨɥɢɱɟɫɤɢɣ ɪɢɫɤ,ɫɬɚɬɢɧɵ,ɩɢɬɚɜɚɫɬɚɬɢɧ Key words: dyslipidemia, cardiometabolic risk, statins, pitavastatin

Ɋɟɮɟɪɚɬ. ɉɟɪɜɢɧɧɚ ɞɢɫɥɿɩɿɞɟɦɿɹ ɿ ɤɚɪɞɿɨɦɟɬɚɛɨɥɿɱɧɢɣ ɪɢɡɢɤ: ɩɨɬɟɧɰɿɣɧɿ ɦɨɠɥɢɜɨɫɬɿ ɩɿɬɚɜɚɫɬɚɬɢɧɭ.

Ȼɟɪɟɡɿɧ Ɉ.ȯ.,ɒɟɣɱɟɧɤɨ Ɍ.ȼ.,Ȼɟɪɟɡɿɧɚ Ɍ.Ɉ.,ȼɢɲɧɟɜɚ ɇ.ȼ.Ʉɨɜɚɥɟɧɤɨ ɇ.ȼ., Ʉɭɥɿɤ Ɂ.ȱ.,Ɇɨɿɫɟɟɧɤɨ ȱ.Ɉ.ȼ ɨɝ -ɥɹɞɿ ɪɨɡɝɥɹɞɚɸɬɶɫɹ ɧɚɣɛɿɥɶɲ ɜɚɠɥɢɜɿ ɚɫɩɟɤɬɢ ɥɿɤɭɜɚɧɧɹ ɩɟɪɜɢɧɧɨʀ ɡɦɿɲɚɧɨʀ ɞɢɫɥɿɩɿɞɟɦɿʀ ɜ ɩɚɰɿɽɧɬɿɜ ɡ ɫɭɩɭɬɧɿɦɢ ɦɟɬɚɛɨɥɿɱɧɢɦɢ ɤɨɦɨɪɛɿɞɧɢɦɢ ɫɬɚɧɚɦɢ. ɇɚɜɨɞɹɬɶɫɹ ɜɿɞɨɦɨɫɬɿ ɳɨɞɨ ɧɨɜɿɬɧɿɯ ɫɭɱɚɫɧɢɯ ɩɪɨɝɪɚɦ ɩɟɪɜɢɧɧɨʀ ɩɪɨɮɿɥɚɤɬɢɤɢ ɤɚɪɞɿɨɜɚɫɤɭɥɹɪɧɢɯ ɡɚɯɜɨɪɸɜɚɧɶ ɭ ɩɚɰɿɽɧɬɿɜ ɡ ɞɨɤɭɦɟɧɬɨɜɚɧɨɸ ɞɢɫɥɿɩɿɞɟɦɿɽɸ. Ɉɛɝɨɜɨɪɸɽɬɶɫɹ ɝɿɩɨɥɿɩɿɞɟɦɿɱɧɢɣ ɩɨɬɟɧɰɿɚɥ ɫɬɚɬɢɧɿɜ,ɚ ɬɚɤɨɠ ʀɯ ɪɨɥɶ ɭ ɡɧɢɠɟɧɧɿ ɜɟɥɢɱɢɧɢ ɤɚɪɞɿɨɜɚɫɤɭɥɹɪɧɨɝɨ ɪɢɡɢɤɭ. ɇɚɜɨɞɹɬɶɫɹ ɫɭɱɚɫɧɿ ɜɿɞɨɦɨɫɬɿ ɩɪɨ ɦɟɬɨɞɢ ɦɿɧɿɦɿɡɚɰɿʀ ɪɟɡɢɞɭɚɥɶɧɨɝɨ ɤɚɪɞɿɨɜɚɫɤɭɥɹɪɧɨɝɨ ɪɢɡɢɤɭ ɡɚ ɞɨɩɨɦɨɝɨɸ ɤɨɦɛɿɧɨɜɚɧɨʀ ɝɿɩɨɥɿɩɿɞɟɦɿɱɧɨʀ ɫɬɪɚɬɟɝɿʀ ɿ ɧɨɜɢɯ ɩɪɟɞɫɬɚɜɧɢɤɿɜ ɤɥɚɫɭ ɫɬɚɬɢɧɿɜ. Ɉɛɝɨɜɨɪɸɸɬɶɫɹ ɪɿɡɧɿ ɡɚ cɜɨɽɸ ɟɮɟɤɬɢɜɧɿɫɬɸ ɫɬɪɚɬɟɝɿʀ ɩɪɢɡɧɚɱɟɧɧɹ ɫɬɚɬɢɧɿɜ ɯɜɨɪɢɦ ɧɚ ɞɢɫɥɿɩɿɞɟɦɿɸ ɪɿɡɧɨɝɨ ɜɿɤɭ ɬɚ ɡɚ ɧɚɹɜɧɿɫɬɸ ɫɭɩɭɬɧɿɯ ɤɨɦɨɪɛɿɞɧɢɯ ɫɬɚɧɿɜ, ɡɨɤɪɟɦɚ ɨɠɢɪɿɧɧɹ, ɰɭɤɪɨɜɨɝɨ ɞɿɚɛɟɬɭ, ɦɟɬɚɛɨɥɿɱɧɨɝɨ ɫɢɧɞɪɨɦɭ. ɇɚɜɨɞɹɬɫɹ ɞɚɧɿ ɡ ɨɛɫɬɟɠɟɧɧɹ ɬɚ ɫɬɪɚɬɟɝɿʀ ɥɿɤɭɜɚɧɧɹ ɯɜɨɪɨʀ ɧɚ ɨɠɢɪɿɧɧɹ, ɦɟɬɚɛɨɥɿɱɧɢɣ ɫɢɧɞɪɨɦ ɬɚ ɫɭɛ-ɤɥɿɧɿɱɧɢɣ ɚɬɟɪɨɫɤɥɟɪɨɡ ɡɚ ɞɨɩɨɦɨɝɨɸ ɫɬɚɬɢɧɿɜ. Ɉɛɝɨɜɨɪɸɽɬɶɫɹ ɪɨɥɶ ɩɿɬɚɜɚɫɬɚɬɢɧɭ ɭ ɩɪɨɝɪɚɦɿ ɩɟɪɜɢɧɧɨʀ ɩɪɟɜɟɧɰɿʀ ɤɚɪɞɿɨɜɚɫɤɭɥɹɪɧɢɯ ɩɨɞɿɣ.

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ɨɤɚɡɵɜɚɸɳɢɯ ɧɟɩɨɫɪɟɞɫɬɜɟɧɧɨɟ ɜɥɢɹɧɢɟ ɧɚ ɮɨɪ

-ɦɢɪɨɜɚɧɢɟ ɜɟɥɢɱɢɧɵ ɝɥɨɛɚɥɶɧɨɝɨ ɤɚɪɞɢɨɜɚɫɤɭ

-ɥɹɪɧɨɝɨ ɪɢɫɤɚ ɢ ɨɩɪɟɞɟɥɹɸɳɚɹ ɭɪɨɜɟɧɶ ɡɞɨɪɨɜɶɹ ɧɚɫɟɥɟɧɢɹ ɜ ɰɟɥɨɦ [19]. ȼ ɧɚɫɬɨɹɳɟɟ ɜɪɟɦɹ

ɥɟɱɟɧɢɟ ɫɦɟɲɚɧɧɨɣ ɞɢɫɥɢɩɢɞɟɦɢɢ ɡɚɧɢɦɚɟɬ ɰɟɧɬɪɚɥɶɧɨɟ ɦɟɫɬɨ ɜ ɫɬɪɚɬɟɝɢɢ ɩɟɪɜɢɱɧɨɣ ɩɪɟ

-ɜɟɧɰɢɢ ɤɚɪɞɢɨɜɚɫɤɭɥɹɪɧɵɯ ɫɨɛɵɬɢɣ ɭ ɩɚɰɢɟɧɬɨɜ ɜɵɫɨɤɨɝɨ ɪɢɫɤɚ, ɨɞɨɛɪɟɧɧɵɯ ɜɟɞɭɳɢɦɢ ɦɟɞɢ

-ɰɢɧɫɤɢɦɢ ɚɫɫɨɰɢɚɰɢɹɦɢ ɫ ɜɵɫɨɤɢɦ ɭɪɨɜɧɟɦ ɧɚɭɱɧɨɣ ɪɟɩɭɬɚɰɢɢ, ɬɚɤɢɦɢ ɤɚɤ ȿɜɪɨɩɟɣɫɤɨɟ

ɨɛɳɟɫɬɜɨ ɤɚɪɞɢɨɥɨɝɨɜ / ȿɜɪɨɩɟɣɫɤɨɟ ɨɛɳɟɫɬɜɨ

ɚɬɟɪɨɫɤɥɟɪɨɡɚ (2011), Ⱥɦɟɪɢɤɚɧɫɤɢɣ ɤɨɥɥɟɞɠ

ɜɪɚɱɟɣ ɨɛɳɟɣ ɩɪɚɤɬɢɤɢ (2012), Ʉɚɧɚɞɫɤɨɟ

ɤɚɪɞɢɨɜɚɫɤɭɥɹɪɧɨɟ ɨɛɳɟɫɬɜɨ (2012) ɢ Ⱥɦɟɪɢ

-ɤɚɧɫɤɚɹ ɫɟɪɞɟɱɧɚɹ ɚɫɫɨɰɢɚɰɢɹ / Ⱥɦɟɪɢɤɚɧɫɤɢɣ

ɤɨɥɥɟɞɠ ɤɚɪɞɢɨɥɨɝɨɜ (ATP IV, ɋɒȺ, 2013).

ɋɨɜɪɟɦɟɧɧɚɹ ɫɬɪɚɬɟɝɢɹ ɩɟɪɜɢɱɧɨɣ ɩɪɨɮɢ

-ɥɚɤɬɢɤɢ ɤɚɪɞɢɨɜɚɫɤɭɥɹɪɧɵɯ ɡɚɛɨɥɟɜɚɧɢɣ ɢɫɯɨ

-ɞɢɬ ɢɡ ɫɭɳɟɫɬɜɨɜɚɧɢɹ ɬɟɫɧɨɣ ɚɫɫɨɰɢɚɰɢɢ ɦɟɠɞɭ ɭɪɨɜɧɟɦ ɯɨɥɟɫɬɟɪɢɧɚ (ɏɋ) ɥɢɩɨɩɪɨɬɟɢɞɨɜ ɧɢɡ

-ɤɨɣ ɩɥɨɬɧɨɫɬɢ (Ʌɉɇɉ) ɢɥɢ ɏɋ ɥɢɩɨɩɪɨɬɟɢɞɨɜ

ɧɟɜɵɫɨɤɨɣ ɩɥɨɬɧɨɫɬɢ (ɏɋ ɧɟ-Ʌɉȼɉ) ɫ ɨɞɧɨɣ

ɫɬɨɪɨɧɵ ɢ ɱɚɫɬɨɬɨɣ ɨɠɢɞɚɟɦɵɯ ɤɚɪɞɢɨɜɚɫɤɭ

-ɥɹɪɧɵɯ ɫɨɛɵɬɢɣ [16]. ɉɪɢ ɷɬɨɦ ɛɥɚɝɨɩɪɢɹɬɧɵɟ

ɷɮɮɟɤɬɵ ɪɚɡɥɢɱɧɵɯ ɥɟɤɚɪɫɬɜɟɧɧɵɯ ɫɪɟɞɫɬɜ,

ɢɫɩɨɥɶɡɭɸɳɢɯɫɹ ɜ ɥɟɱɟɧɢɢ ɛɨɥɶɧɵɯ ɫ ɞɢɫɥɢ

-ɩɢɞɟɦɢɹɦɢ, ɪɚɫɫɦɚɬɪɢɜɚɸɬɫɹ ɜ ɨɫɧɨɜɧɨɦ ɤɚɤ

ɚɬɪɢɛɭɬ ɢɯ ɝɢɩɨɥɢɩɢɞɟɦɢɱɟɫɤɨɝɨ ɩɨɬɟɧɰɢɚɥɚ,

ɯɨɬɹ ɬɚɤɠɟ ɧɟɥɶɡɹ ɢɫɤɥɸɱɢɬɶ ɜɤɥɚɞ ɢɯ ɩɥɟɣ

-ɨɬɪɨɩɧɵɯ ɤɚɱɟɫɬɜ ɜ ɪɟɚɥɢɡɚɰɢɸ ɨɛɳɟɝɨ ɬɟɪɚɩɟɜɬɢɱɟɫɤɨɝɨ ɷɮɮɟɤɬɚ [13, 17]. ɇɟɨɛɯɨɞɢɦɨ

ɨɬɦɟɬɢɬɶ, ɱɬɨ ɛɨɥɶɲɨɟ ɡɧɚɱɟɧɢɟ ɢɦɟɟɬ ɞɨɫɬɢ

-ɠɟɧɢɟ ɢ ɭɞɟɪɠɢɜɚɧɢɟ ɰɟɥɟɜɨɝɨ ɭɪɨɜɧɹ ɏɋ Ʌɉɇɉ ɤɚɤ ɩɟɪɜɢɱɧɨɣ ɰɟɥɢ ɬɟɪɚɩɢɢ ɢ ɭɪɨɜɧɟɣ ɚɩɨ-ɥɢɩɨɩɪɨɬɟɢɧɚ ȼ ɢ / ɢɥɢ ɏɋ ɧɟ-Ʌɉȼɉ ɜ ɤɚ

-ɱɟɫɬɜɟ ɚɥɶɬɟɪɧɚɬɢɜɧɨɣ ɫɬɪɚɬɟɝɢɢ [1, 16]. ȿɫɥɢ ɞɨ

ɧɟɞɚɜɧɟɝɨ ɜɪɟɦɟɧɢ ɞɢɫɤɭɫɫɢɹ ɜɨɤɪɭɝ ɷɮ

-ɮɟɤɬɢɜɧɨɣ ɝɢɩɨɥɢɩɢɞɟɦɢɱɟɫɤɨɣ ɬɟɪɚɩɢɢ ɡɚɬɪɚ

-ɝɢɜɚɥɚ ɜ ɨɫɧɨɜɧɨɦ ɱɚɫɬɨɬɭ ɞɨɫɬɢɠɟɧɢɹ ɰɟɥɟɜɨɝɨ ɭɪɨɜɧɹ ɏɋ Ʌɉɇɉ, ɬɨ ɫ ɩɨɡɢɰɢɢ ɫɟɝɨɞɧɹɲɧɟɝɨ

ɞɧɹ ɧɚɢɛɨɥɟɟ ɨɩɬɢɦɚɥɶɧɵɦ ɹɜɥɹɟɬɫɹ ɩɨɞɞɟɪɠɚ

-ɧɢɟ ɫɧɢɠɟɧɧɨɣ ɤɨɧɰɟɧɬɪɚɰɢɢ ɏɋ Ʌɉɇɉ [19].

Ȼɨɥɶɲɢɧɫɬɜɨ ɷɤɫɩɟɪɬɨɜ ɫɯɨɞɹɬɫɹ ɜɨ ɦɧɟɧɢɢ ɨ ɬɨɦ, ɱɬɨ ɮɚɪɦɚɤɨɬɟɪɚɩɢɹ ɭ ɩɚɰɢɟɧɬɨɜ ɫ ɞɢɫɥɢ

-ɩɢɞɟɦɢɹɦɢ ɞɨɥɠɧɚ ɧɚɡɧɚɱɚɬɶɫɹ ɩɪɢ ɢɫɯɨɞɧɨɦ ɭɪɨɜɧɟ ɏɋ Ʌɉɇɉ ɩɪɟɜɵɲɚɸɳɟɦ 5 ɦɦɨɥɶ/ɥ ɢɥɢ

ɩɪɢ ɥɸɛɨɦ ɢɧɨɦ ɭɪɨɜɧɟ ɏɋ Ʌɉɇɉ ɭ ɩɚɰɢɟɧɬɨɜ ɫ ɜɵɫɨɤɢɦ ɢ ɨɱɟɧɶ ɜɵɫɨɤɢɦ ɤɚɪɞɢɨɜɚɫɤɭɥɹɪɧɵɦ ɪɢɫɤɨɦ [16]. ɉɪɢ ɷɬɨɦ ɜ ɤɚɱɟɫɬɜɟ ɩɟɪɜɨɣ ɩɪɨ

-ɦɟɠɭɬɨɱɧɨɣ ɬɨɱɤɢ ɥɟɱɟɧɢɹ ɪɚɫɫɦɚɬɪɢɜɚɟɬɫɹ ɫɧɢɠɟɧɢɟ ɫɨɞɟɪɠɚɧɢɹ ɏɋ Ʌɉɇɉ ɛɨɥɟɟ ɱɟɦ ɧɚ

50% ɨɬ ɢɫɯɨɞɧɨɝɨ, ɚ ɜ ɤɚɱɟɫɬɜɟ ɚɥɶɬɟɪɧɚɬɢɜɧɨɣ

ɰɟɥɢ ɬɟɪɚɩɢɢ – ɭɪɨɜɟɧɶ ɏɋ Ʌɉɇɉ ɦɟɧɟɟ

Ɍɟɦ ɧɟ ɦɟɧɟɟ, ɰɟɥɟɜɵɟ ɭɪɨɜɧɢ ɏɋ Ʌɉɇɉ ɞɥɹ

ɩɚɰɢɟɧɬɨɜ ɜɵɫɨɤɨɝɨ ɢ ɨɱɟɧɶ ɜɵɫɨɤɨɝɨ ɤɚɪɞɢɨɜɚɫ

-ɤɭɥɹɪɧɨɝɨ ɪɢɫɤɚ ɭɫɬɚɧɨɜɥɟɧɵ ɤɚɤ < 2,5 ɦɦɨɥɶ/ɥ ɢ < 1,8 ɦɦɨɥɶ/ɥ ɫɨɨɬɜɟɬɫɬɜɟɧɧɨ [16]. ɂɡɜɟɫɬɧɨ,ɱɬɨ

ɫɧɢɠɟɧɢɟ ɭɪɨɜɧɹ ɏɋ Ʌɉɇɉ ɧɚ ɤɚɠɞɵɟ

1ɦɦɨɥɶ/ɥ ɚɫɫɨɰɢɢɪɭɟɬɫɹ ɫ 50% ɫɧɢɠɟɧɢɟɦ ɪɢɫɤɚ

ɛɨɥɶɲɢɯ ɚɬɟɪɨɬɪɨɦɛɨɬɢɱɟɫɤɢɯ ɜɚɫɤɭɥɹɪɧɵɯ ɫɨ

-ɛɵɬɢɣ. ɉɪɢ ɷɬɨɦ, ɧɟɫɦɨɬɪɹ ɧɚ ɤɥɢɧɢɱɟɫɤɭɸ

ɭɫɩɟɲɧɨɫɬɶ ɩɪɢɦɟɧɟɧɢɹ ɪɚɡɥɢɱɧɵɯ ɤɥɚɫɫɨɜ ɝɢɩɨɥɢɩɢɞɟɦɢɱɟɫɤɢɯ ɥɟɤɚɪɫɬɜɟɧɧɵɯ ɫɪɟɞɫɬɜ,

ɜɤɥɸɱɚɹ ɫɬɚɬɢɧɵ,ɫɭɳɟɫɬɜɭɸɬ ɫɟɪɶɟɡɧɵɟ ɨɝɪɚɧɢ

-ɱɟɧɢɹ ɞɥɹ ɪɟɚɥɢɡɚɰɢɢ ɢɯ ɩɪɟɜɟɧɬɢɜɧɨɝɨ ɩɨɬɟɧ

-ɰɢɚɥɚ. Ʉ ɩɨɫɥɟɞɧɢɦ ɨɬɧɨɫɹɬɫɹ ɧɟɠɟɥɚɬɟɥɶɧɵɟ

ɩɨɛɨɱɧɵɟ ɷɮɮɟɤɬɵ, ɨɬɤɚɡɵ ɨɬ ɥɟɱɟɧɢɹ, ɧɟɞɨɫ

-ɬɚɬɨɱɧɵɣ ɤɨɦɩɥɚɣɟɧɫ ɩɚɰɢɟɧɬɨɜ, ɧɟɠɟɥɚɬɟɥɶɧɨɟ

ɥɟɤɚɪɫɬɜɟɧɧɨɟ ɜɡɚɢɦɨɞɟɣɫɬɜɢɟ, ɚ ɬɚɤɠɟ ɫɭ

-ɳɟɫɬɜɭɸɳɢɟ ɞɨɩɨɥɧɢɬɟɥɶɧɵɟ (ɨɬɥɢɱɧɵɟ ɨɬ ɏɋ

Ʌɉɇɉ,ɏɋ Ʌɉȼɉ,ɏɋ ɧɟ-Ʌɉȼɉ)ɮɚɤɬɨɪɵ ɪɢɫɤɚ,

ɮɨɪɦɢɪɭɸɳɢɟ ɜɦɟɫɬɟ ɫ ɜɵɲɟɭɤɚɡɚɧɧɵɦɢ ɮɚɤɬɨɪɚɦɢ ɬɚɤ ɧɚɡɵɜɚɟɦɵɣ ɪɟɡɢɞɭɚɥɶɧɵɣ (ɨɫɬɚ

-ɬɨɱɧɵɣ)ɤɚɪɞɢɨɜɚɫɤɭɥɹɪɧɵɣ ɪɢɫɤ (ɄȼɊ).

ȼ ɷɬɨɦ ɤɨɧɬɟɤɫɬɟ ɢɧɬɟɪɟɫ ɩɪɟɞɫɬɚɜɥɹɟɬ ɧɨɜɚɹ ɪɟɞɚɤɰɢɹ ATP (Expert Panel on Detection, Eva-luation, and Treatment of High Blood Cholesterol in Adults) ȱV, ɤɨɬɨɪɚɹ ɜ ɨɬɥɢɱɢɟ ɨɬ ATP ȱȱI

ɝɚɪɦɨɧɢɡɢɪɨɜɚɧɚ ɫ ɚɧɚɥɨɝɢɱɧɵɦɢ ɤɥɢɧɢɱɟɫɤɢɦɢ ɫɨɝɥɚɲɟɧɢɹɦɢ ɦɧɨɝɢɯ ɜɟɞɭɳɢɯ ɦɟɞɢɰɢɧɫɤɢɯ ɚɫɫɨɰɢɚɰɢɣ, ɬɚɤɢɯ ɤɚɤ ȿɜɪɨɩɟɣɫɤɨɟ ɨɛɳɟɫɬɜɨ

ɤɚɪɞɢɨɥɨɝɨɜ / ȿɜɪɨɩɟɣɫɤɨɟ ɨɛɳɟɫɬɜɨ ɚɬɟɪɨɫɤɥɟ

-ɪɨɡɚ (2013), Ʉɚɧɚɞɫɤɨɟ ɤɚɪɞɢɨɜɚɫɤɭɥɹɪɧɨɟ ɨɛ

-ɳɟɫɬɜɨ (2012), ɚ ɬɚɤɠɟ ɫ ɪɟɤɨɦɟɧɞɚɰɢɹɦɢ ɩɨ

ɩɪɨɮɢɥɚɤɬɢɤɟ ɢ ɥɟɱɟɧɢɸ ɞɢɫɥɢɩɢɞɟɦɢɢ NICE [11, 12, 15, 19]. ɗɤɫɩɟɪɬɵ ATP IV ɩɨɥɚɝɚɸɬ,ɱɬɨ ɫ

ɩɪɚɤɬɢɱɟɫɤɨɣ ɬɨɱɤɢ ɡɪɟɧɢɹ ɛɵɥɨ ɛɵ ɪɚɰɢɨ

-ɧɚɥɶɧɵɦ ɜɵɞɟɥɟɧɢɟ ɱɟɬɵɪɟɯ ɝɪɭɩɩ ɩɚɰɢɟɧɬɨɜ,

ɧɚɡɧɚɱɟɧɢɟ ɫɬɚɬɢɧɨɜ ɜ ɤɨɬɨɪɵɯ ɨɛɥɚɞɚɟɬ ɪɚɡ

-ɥɢɱɧɨɣ ɭɫɩɟɲɧɨɫɬɶɸ. ɉɪɢ ɷɬɨɦ ɫɥɟɞɭɟɬ ɜɵɞɟ

-ɥɢɬɶ ɬɚɤ ɧɚɡɵɜɚɟɦɵɟ ɜɵɫɨɤɨɢɧɬɟɧɫɢɜɧɵɟ,

ɫɪɟɞɧɟɢɧɬɟɧɫɢɜɧɵɟ ɢ ɧɢɡɤɨɢɧɬɟɧɫɢɜɧɵɟ ɫɬɪɚɬɟ

-ɝɢɢ ɥɟɱɟɧɢɹ ɫɬɚɬɢɧɚɦɢ (ɬɚɛɥ.).

ɉɪɢ ɨɛɫɭɠɞɟɧɢɢ ɩɪɨɝɪɚɦɦ ɩɟɪɜɢɱɧɨɣ ɩɪɨɮɢ

-ɥɚɤɬɢɤɢ ɤɚɪɞɢɨɜɚɫɤɭɥɹɪɧɨɝɨ ɡɚɛɨɥɟɜɚɧɢɹ (ɄȼɁ)

ɭ ɩɚɰɢɟɧɬɨɜ ɫɬɚɪɲɟ 21 ɝɨɞɚ ɢ ɧɚɥɢɱɢɢ ɞɨɤɭɦɟɧ

-ɬɢɪɨɜɚɧɧɨɣ ɝɢɩɟɪɥɢɩɢɞɟɦɢɢ (ɏɋ Ʌɉɇɉ ɛɨɥɟɟ 190ɦɝ/ɞɥ [4,92 ɦɦɨɥɶ/ɥ]ɢɥɢ ɌȽ ɛɨɥɟɟ 500 ɦɝ/ɞɥ)

ɫɬɚɬɢɧɵ ɜ ɤɚɱɟɫɬɜɟ ɜɵɫɨɤɨɢɧɬɟɧɫɢɜɧɨɣ ɫɬɪɚɬɟ

-ɝɢɢ ɥɟɱɟɧɢɹ ɹɜɥɹɸɬɫɹ ɧɚɢɛɨɥɟɟ ɨɩɬɢɦɚɥɶɧɵɦɢ ɥɟɤɚɪɫɬɜɟɧɧɵɦɢ ɫɪɟɞɫɬɜɚɦɢ. ɉɪɢ ɷɬɨɦ ɩɪɟɞ

-ɜɚɪɢɬɟɥɶɧɵɣ ɪɚɫɱɟɬ 10-ɥɟɬɧɟɣ ɜɟɥɢɱɢɧɵ ɄȼɊ ɧɟ

ɹɜɥɹɟɬɫɹ ɛɟɡɭɫɥɨɜɧɨ ɧɟɨɛɯɨɞɢɦɵɦ. ɉɟɪɜɢɱɧɨɣ

ɤɨɧɟɱɧɨɣ ɬɨɱɤɨɣ ɥɟɱɟɧɢɹ ɹɜɥɹɟɬɫɹ ɫɧɢɠɟɧɢɟ ɢɫɯɨɞɧɨɣ ɤɨɧɰɟɧɬɪɚɰɢɢ ɏɋ Ʌɉɇɉ ɛɨɥɟɟ ɱɟɦ ɧɚ

(3)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

ɧɟɜɨɡɦɨɠɧɨɫɬɢ ɞɨɫɬɢɠɟɧɢɹ ɪɟɤɨɦɟɧɞɨɜɚɧɧɨɝɨ ɰɟɥɟɜɨɝɨ ɭɪɨɜɧɹ ɏɋ Ʌɉɇɉ ɩɪɢ ɢɫɩɨɥɶɡɨɜɚɧɢɢ ɦɚɤɫɢɦɚɥɶɧɨ ɪɚɡɪɟɲɟɧɧɵɯ ɞɨɡ ɫɬɚɬɢɧɨɜ ɜ ɭɫɥɨ

-ɜɢɹɯ ɢɯ ɭɞɨɜɥɟɬɜɨɪɢɬɟɥɶɧɨɣ ɩɟɪɟɧɨɫɢɦɨɫɬɢ,

ɫɥɟɞɭɟɬ ɪɚɫɫɦɨɬɪɟɬɶ ɜɨɡɦɨɠɧɨɫɬɶ ɩɪɢɦɟɧɟɧɢɹ ɤɨɦɛɢɧɚɰɢɢ ɝɢɩɨɥɢɩɢɞɟɦɢɱɟɫɤɢɯ ɥɟɤɚɪɫɬɜɟɧ

-ɧɵɯ ɫɪɟɞɫɬɜ [19].

ɋɬɪɚɬɟɝɢɹ ɧɚɡɧɚɱɟɧɢɹ ɫɬɚɬɢɧɨɜ ɫ ɪɚɡɥɢɱɧɨɣ ɷɮɮɟɤɬɢɜɧɨɫɬɶɸ ɢɫɩɨɥɶɡɨɜɚɧɧɵɯ

ɫɭɬɨɱɧɵɯ ɞɨɡ ɜ ɫɨɨɬɜɟɬɫɬɜɢɢ ɫ ɪɟɤɨɦɟɧɞɚɰɢɹɦɢ

Expert Panel on Detection, Evaluation,

and Treatment of High Blood Cholesterol in Adults - ATP IV (2013).

Ɇɨɞɢɮɢɰɢɪɨɜɚɧɚ ɢɡ ɪɚɛɨɬɵ

Stone N.J., Robinson J., Lichtenstein A.H. et al. (2013) [19]

ɋɬɪɚɬɟɝɢɢ ɧɚɡɧɚɱɟɧɢɹ ɫɬɚɬɢɧɨɜ

ɜɵɫɨɤɨɢɧɬɟɧɫɢɜɧɚɹ cɬɪɚɬɟɝɢɹ ɫɪɟɞɧɟɢɧɬɟɧɫɢɜɧɚɹ cɬɪɚɬɟɝɢɹ ɧɢɡɤɨɢɧɬɟɧɫɢɜɧɚɹ cɬɪɚɬɟɝɢɹ

ɫɭɬɨɱɧɚɹ ɞɨɡɚ ɫɬɚɬɢɧɨɜ ɫɧɢɠɚɟɬ ɭɪɨɜɟɧɶ ɏɋ Ʌɉɇɉ ɛɨɥɟɟ ɱɟɦ ɧɚ 50% ɨɬ ɢɫɯɨɞɧɨɝɨ

ɫɭɬɨɱɧɚɹ ɞɨɡɚ ɫɬɚɬɢɧɨɜ ɫɧɢɠɚɟɬ ɭɪɨɜɟɧɶ ɏɋ Ʌɉɇɉ ɧɚ 30-50% ɨɬ ɢɫɯɨɞɧɨɝɨ

ɫɭɬɨɱɧɚɹ ɞɨɡɚ ɫɬɚɬɢɧɨɜ ɫɧɢɠɚɟɬ

ɭɪɨɜɟɧɶ ɏɋ Ʌɉɇɉ ɦɟɧɟɟ ɱɟɦ ɧɚ 30% ɨɬ ɢɫɯɨɞɧɨɝɨ

ɉɪɟɞɫɬɚɜɢɬɟɥɢ ɤɥɚɫɫɚ ɫɬɚɬɢɧɨɜ ɢ ɢɯ ɞɨɡɵ

ɚɬɨɪɜɚɫɬɚɬɢɧ 40-80 ɦɝ/ɫɭɬ ɪɨɡɭɜɚɫɬɚɬɢɧ 20-40 ɦɝ/ɫɭɬ.

ɚɬɨɪɜɚɫɬɚɬɢɧ 10-20 ɦɝ/ɫɭɬ ɪɨɡɭɜɚɫɬɚɬɢɧ 5-10 ɦɝ/ɫɭɬ. ɫɢɦɜɚɫɬɚɬɢɧ 20-40 ɦɝ/ɫɭɬ. ɩɪɚɜɚɫɬɚɬɢɧ 40-80 ɦɝ/ɫɭɬ. ɥɨɜɚɫɬɚɬɢɧ 40 ɦɝ/ɫɭɬ. ɮɥɭɜɚɫɬɚɬɢɧ 40-80 ɦɝ/ɫɭɬ. ɩɢɬɚɜɚɫɬɚɬɢɧ 2-4 ɦɝ/ɫɭɬ.

ɫɢɦɜɚɫɬɚɬɢɧ 10 ɦɝ/ɫɭɬ ɩɪɚɜɚɫɬɚɬɢɧ 10-20ɦɝ/ɫɭɬ.

ɥɨɜɚɫɬɚɬɢɧ 20 ɦɝ/ɫɭɬ. ɮɥɭɜɚɫɬɚɬɢɧ 20-40 ɦɝ/ɫɭɬ. ɩɢɬɚɜɚɫɬɚɬɢɧ 1 ɦɝ/ɫɭɬ.

ɉɚɰɢɟɧɬɚɦ ɫ ɫɚɯɚɪɧɵɦ ɞɢɚɛɟɬɨɦ ɜ ɜɨɡɪɚɫɬɟ

40-75 ɥɟɬ ɫ ɭɪɨɜɧɟɦ ɏɋ Ʌɉɇɉ 1,9-4,9 ɦɦɨɥɶ/ɥ (70-189 ɦɝ/ɞɥ) ɜ ɤɚɱɟɫɬɜɟ ɩɪɨɝɪɚɦɦɵ ɩɟɪɜɢɱɧɨɣ

ɩɪɨɮɢɥɚɤɬɢɤɢ ɄȼɁ ɪɟɤɨɦɟɧɞɨɜɚɧɨ ɩɪɨɜɟɞɟɧɢɟ ɭɦɟɪɟɧɧɨ ɢɧɬɟɧɫɢɜɧɨɣ ɫɬɪɚɬɟɝɢɢ ɩɪɢɦɟɧɟɧɢɹ ɫɬɚɬɢɧɨɜ.ȼɵɫɨɤɨɢɧɬɟɧɫɢɜɧɚɹ ɫɬɪɚɬɟɝɢɹ ɥɟɱɟɧɢɹ

ɪɚɰɢɨɧɚɥɶɧɚ ɞɥɹ ɥɢɰ ɫ ɫɚɯɚɪɧɵɦ ɞɢɚɛɟɬɨɦ ɜ ɜɨɡɪɚɫɬɟ 40-75 ɥɟɬ ɩɪɢ ɭɫɥɨɜɢɢ, ɱɬɨ ɪɚɫɫɱɢɬɚɧ

-ɧɚɹ ɜɟɥɢɱɢɧɚ ɄȼɊ ɩɪɟɜɵɲɚɟɬ 7,5% (Framingham risk Score). ɍ ɛɨɥɶɧɵɯ ɫ ɫɚɯɚɪɧɵɦ ɞɢɚɛɟɬɨɦ

ɦɨɥɨɠɟ 40 ɥɟɬ ɢɥɢ ɫɬɚɪɲɟ 75-ɥɟɬɧɟɝɨ ɜɨɡɪɚɫɬɚ,ɚ

ɬɚɤɠɟ ɭ ɥɢɰ ɫ ɭɪɨɜɧɟɦ ɏɋ Ʌɉɇɉ 1,9-4,9 ɦɦɨɥɶ/ɥ

ɩɪɢ ɨɬɫɭɬɫɬɜɢɢ ɤɥɢɧɢɱɟɫɤɢɯ ɩɪɢɡɧɚɤɨɜ ɄȼɁ ɩɪɢ ɜɵɛɨɪɟ ɧɚɢɛɨɥɟɟ ɨɩɬɢɦɚɥɶɧɨɣ ɫɬɪɚɬɟɝɢɢ ɧɚɡɧɚ

-ɱɟɧɢɹ ɫɬɚɬɢɧɨɜ ɧɟɨɛɯɨɞɢɦɨ ɢɫɯɨɞɢɬɶ ɢɡ ɫɨɨɬɧɨ

-ɲɟɧɢɹ ɪɢɫɤ / ɩɨɥɶɡɚ.ȼɨ ɦɧɨɝɢɯ ɫɥɭɱɚɹɯ, ɤɨɝɞɚ ɭ

ɚɫɢɦɩɬɨɦɧɨɝɨ ɩɚɰɢɟɧɬɚ ɪɚɫɫɱɢɬɚɧɧɚɹ ɜɟɥɢɱɢɧɚ ɄȼɊ ɩɨ ɫɢɫɬɟɦɟ Framingham risk Score ɦɟɧɟɟ 7,5% ɡɚ 10 ɥɟɬ, ɭɦɟɪɟɧɧɨ ɢɧɬɟɧɫɢɜɧɚɹ ɫɬɪɚɬɟɝɢɹ

ɥɟɱɟɧɢɹ ɜɩɨɥɧɟ ɦɨɠɟɬ ɨɛɫɭɠɞɚɬɶɫɹ [19].

ɉɢɬɚɜɚɫɬɚɬɢɧ (ɥɢɜɚɡɨ, «Recordati group», ɂɬɚ

-ɥɢɹ) ɨɬɧɨɫɢɬɫɹ ɤ ɩɨɥɧɨɫɬɶɸ ɫɢɧɬɟɬɢɱɟɫɤɢɦ

ɩɪɟɞɫɬɚɜɢɬɟɥɹɦ ɢɧɝɢɛɢɬɨɪɨɜ 3-ɝɢɞɪɨɤɫɢ-ɦɟɬɢɥ

-ɝɥɭɬɚɪɢɥ-ɄɨȺ-ɪɟɞɭɤɬɚɡɵ,ɨɬɥɢɱɢɬɟɥɶɧɨɣ ɨɫɨɛɟɧ

-ɧɨɫɬɶɸ ɤɨɬɨɪɨɝɨ ɹɜɥɹɟɬɫɹ ɞɨɩɨɥɧɢɬɟɥɶɧɚɹ ɫɩɨ

-ɫɨɛɧɨɫɬɶ ɤ ɩɨɜɵɲɟɧɢɸ ɷɤɫɩɪɟɫɫɢɢ ɥɢɩɨɩɪɨɬɟɢɧ ɥɢɩɚɡɵ ɜ ɚɞɢɩɨɰɢɬɚɯ ɢ ɢɧɞɭɤɰɢɹ ɫɢɧɬɟɡɚ ɚɩɨ-Ⱥ-1

ɥɢɩɢɞɟɦɢɱɟɫɤɚɹ ɚɤɬɢɜɧɨɫɬɶ ɩɢɬɚɜɚɫɬɚɬɢɧɚ ɩɪɨɹɜɥɹɟɬɫɹ ɧɟ ɬɨɥɶɤɨ ɜ ɜɵɪɚɠɟɧɧɨɦ ɫɧɢɠɟɧɢɢ ɰɢɪɤɭɥɢɪɭɸɳɟɝɨ ɭɪɨɜɧɹ ɏɋ Ʌɉɇɉ, ɧɨ ɢ ɜ

ɫɭɳɟɫɬɜɟɧɧɨɦ ɩɨɜɵɲɟɧɢɢ ɤɨɧɰɟɧɬɪɚɰɢɢ ɏɋ Ʌɉȼɉ ɧɚ ɮɨɧɟ ɪɟɞɭɤɰɢɢ ɭɪɨɜɧɹ ɬɪɢɝɥɢɰɟɪɢɞɨɜ.

ɉɢɬɚɜɚɫɬɚɬɢɧ ɨɛɥɚɞɚɟɬ ɛɥɚɝɨɩɪɢɹɬɧɵɦ ɮɚɪɦɚ

-ɤɨɤɢɧɟɬɢɱɟɫɤɢɦ ɩɪɨɮɢɥɟɦ. ȼɫɚɫɵɜɚɧɢɟ ɧɟ ɡɚ

-ɜɢɫɢɬ ɨɬ ɩɪɢɟɦɚ ɩɢɳɢ [18]. ɉɪɟɩɚɪɚɬ ɜ ɧɟɢɡɦɟ

-ɧɟɧɧɨɦ ɜɢɞɟ ɩɪɨɯɨɞɢɬ ɷɧɬɟɪɨɝɟɩɚɬɢɱɟɫɤɭɸ ɰɢɪ

-ɤɭɥɹɰɢɸ ɢ ɯɨɪɨɲɨ ɜɫɚɫɵɜɚɟɬɫɹ ɜ ɬɨɧɤɨɦ ɤɢ

-ɲɟɱɧɢɤɟ. Ⱥɛɫɨɥɸɬɧɚɹ ɛɢɨɞɨɫɬɭɩɧɨɫɬɶ ɩɢɬɚ

-ɜɚɫɬɚɬɢɧɚ ɫɨɫɬɚɜɥɹɟɬ 51% [18]. ɍɫɬɚɧɨɜɥɟɧɨ,ɱɬɨ

ɩɢɬɚɜɚɫɬɚɬɢɧ ɩɨɞɜɟɪɝɚɟɬɫɹ ɱɚɫɬɢɱɧɨɣ ɛɢɨɬɪɚɧɫ

-ɮɨɪɦɚɰɢɢ ɜ ɝɟɩɚɬɨɰɢɬɚɯ ɩɪɢ ɭɱɚɫɬɢɢ ɫɢɫɬɟɦɵ ɰɢɬɨɯɪɨɦɨɜ CYP2C9 ɢ CYP2C8, ɩɪɢɱɟɦ ɰɢɤɥɨ

-ɩɪɨɩɢɥɶɧɚɹ ɝɪɭɩɩɚ ɦɨɥɟɤɭɥɵ ɩɪɟɩɚɪɚɬɚ ɡɚɳɢ

-ɳɚɟɬ ɟɝɨ ɨɬ ɛɢɨɬɪɚɧɫɮɨɪɦɚɰɢɢ ɰɢɬɨɯɪɨɦɚɦɢ

CYP3A4.ɗɬɨ ɦɨɠɟɬ ɢɦɟɬɶ ɫɭɳɟɫɬɜɟɧɧɨɟ ɤɥɢɧɢ

-ɱɟɫɤɨɟ ɡɧɚɱɟɧɢɟ, ɩɨɫɤɨɥɶɤɭ ɨɛɟɫɩɟɱɢɜɚɟɬ ɜɨɡ

-ɦɨɠɧɨɫɬɶ ɜ ɫɥɭɱɚɟ ɧɟɨɛɯɨɞɢɦɨɫɬɢ ɢɫɩɨɥɶɡɨ

-ɜɚɧɢɹ ɩɢɬɚɜɚɫɬɚɬɢɧɚ ɫ ɩɨɬɟɧɰɢɚɥɶɧɵɦɢ ɛɥɨɤɚ

-ɬɨɪɚɦɢ CYP3A4, ɤɨɬɨɪɵɟ ɬɚɤ ɲɢɪɨɤɨ ɩɪɟɞ

-ɫɬɚɜɥɟɧɵ ɫɪɟɞɢ ɫɨɜɪɟɦɟɧɧɵɯ ɤɚɪɞɢɨɜɚɫɤɭ

-ɥɹɪɧɵɯ ɥɟɤɚɪɫɬɜɟɧɧɵɯ ɫɪɟɞɫɬɜ (ɚɦɢɨɞɚɪɨɧ,

ɜɚɪɮɚɪɢɧ ɢ ɬ.ɩ.). ɇɟɨɛɯɨɞɢɦɨ ɨɬɦɟɬɢɬɶ, ɱɬɨ

ɱɚɫɬɶ ɩɢɬɚɜɚɫɬɚɬɢɧɚ, ɧɟ ɩɨɞɜɟɪɝɚɸɳɚɹɫɹ ɛɢɨ

(4)

15/

Ɍɨɦ

XX / 2

ɰɢɪɤɭɥɢɪɭɸɳɢɣ ɭɪɨɜɟɧɶ ɏɋ Ʌɉɇɉ (ɩɪɢɛɥɢ

-ɡɢɬɟɥɶɧɨ ɧɚ 30%), ɧɟ ɭɫɬɭɩɚɟɬ ɚɬɨɪɜɚɫɬɚɬɢɧɭ ɢ

ɪɨɡɭɜɚɫɬɚɬɢɧɭ. ɉɪɢ ɷɬɨɦ ɩɢɬɚɜɚɫɬɚɬɢɧ ɫɩɨɫɨɛɟɧ

ɩɨɞɞɟɪɠɢɜɚɬɶ ɞɨɫɬɢɝɧɭɬɵɣ ɭɫɩɟɯ ɧɚ ɩɪɨɬɹɠɟɧɢɢ ɤɚɤ ɦɢɧɢɦɭɦ 52 ɧɟɞɟɥɶ ɥɟɱɟɧɢɹ, ɞɨɩɨɥɧɢɬɟɥɶɧɨ

ɫɩɨɫɨɛɫɬɜɭɹ ɞɨɫɬɨɜɟɪɧɨɦɭ ɢ ɫɭɳɟɫɬɜɟɧɧɨɦɭ ɩɨɜɵɲɟɧɢɸ ɭɪɨɜɧɹ ɏɋ Ʌɉȼɉ (ɧɚ 14% ɱɟɪɟɡ 12

ɧɟɞɟɥɶ ɬɟɪɚɩɢɢ ɢ ɧɚ 24,9% ɱɟɪɟɡ 2 ɝɨɞɚ

ɧɚɛɥɸɞɟɧɢɹ)ɢ ɪɟɞɭɤɰɢɢ ɨɛɴɟɦɚ ɚɬɟɪɨɦɵ [9, 18].

ɇɟɫɦɨɬɪɹ ɧɚ ɬɨ, ɱɬɨ ɩɟɪɜɨɟ ɩɨɤɨɥɟɧɢɟ ɫɟ

-ɥɟɤɬɢɜɧɵɯ ɢɧɝɢɛɢɬɨɪɨɜ CEPT (Cholesteryl ester transfer protein), ɫɩɨɫɨɛɫɬɜɭɸɳɢɯ ɫɭɳɟɫɬɜɟɧɧɨɦɭ

ɩɨɜɵɲɟɧɢɸ ɭɪɨɜɧɹ ɰɢɪɤɭɥɢɪɭɸɳɟɝɨ ɏɋ Ʌɉȼɉ,

ɧɟ ɩɪɢɜɟɥɨ ɤ ɫɧɢɠɟɧɢɸ ɤɚɪɞɢɨɜɚɫɤɭɥɹɪɧɨɣ ɫɦɟɪɬɧɨɫɬɢ, ɩɪɨɬɟɤɬɢɜɧɚɹ ɪɨɥɶ ɩɨɫɥɟɞɧɟɝɨ ɩɪɨ

-ɞɨɥɠɚɟɬ ɪɚɫɫɦɚɬɪɢɜɚɬɶɫɹ ɤɚɤ ɨɞɧɚ ɢɡ ɨɩɪɟ

-ɞɟɥɹɸɳɢɯ ɫɨɫɬɚɜɥɹɸɳɢɯ ɩɪɨɝɪɚɦɦ ɩɟɪɜɢɱɧɨɣ ɩɪɟɜɟɧɰɢɢ ɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɵɯ ɫɨɛɵɬɢɣ [3].

ɉɪɢ ɷɬɨɦ ɛɨɥɶɲɨɟ ɡɧɚɱɟɧɢɟ ɢɦɟɟɬ ɫɨɱɟɬɚɧɢɟ ɫɧɢɠɟɧɢɹ ɏɋ Ʌɉɇɉ ɫ ɩɨɜɵɲɟɧɢɟɦ ɰɢɪɤɭ

-ɥɢɪɭɸɳɟɝɨ ɭɪɨɜɧɹ ɏɋ Ʌɉȼɉ ɧɚ ɮɨɧɟ ɜɨɫ

-ɫɬɚɧɨɜɥɟɧɢɹ ɫɨɨɬɧɨɲɟɧɢɹ ɚɩɨ-Ⱥ-1 / ɚɩɨ-ȼ ɥɢɩɨ

-ɩɪɨɬɟɢɧɨɜ [4, 16, 22]. Ɍɚɤ, ɩɨ ɞɚɧɧɵɦ ɢɫɫɥɟ

-ɞɨɜɚɧɢɹ LIVES extension, ɫɩɨɫɨɛɧɨɫɬɶ ɩɢɬɚ

-ɜɚɫɬɚɬɢɧɚ ɤ ɩɨɜɵɲɟɧɢɸ ɰɢɪɤɭɥɢɪɭɸɳɟɝɨ ɭɪɨɜ

-ɧɹ ɏɋ Ʌɉȼɉ ɨɛɟɫɩɟɱɢɜɚɟɬ ɞɨɩɨɥɧɢɬɟɥɶɧɨ 59%

ɫɧɢɠɟɧɢɟ ɜɟɥɢɱɢɧɵ ɝɥɨɛɚɥɶɧɨɝɨ ɤɚɪɞɢɨɜɚɫɤɭ

-ɥɹɪɧɨɝɨ ɪɢɫɤɚ [5, 6]. Ȼɨɥɟɟ ɬɨɝɨ, ɩɢɬɚɜɚɫɬɚɬɢɧ,

ɫɬɢɦɭɥɢɪɭɹ ɩɪɨɞɭɤɰɢɸ ɚɩɨ-Ⱥ-1 ɥɢɩɨɩɪɨɬɟɢɧɚ,

ɫɩɨɫɨɛɫɬɜɭɟɬ ɢɧɬɟɧɫɢɮɢɤɚɰɢɢ ɨɛɪɚɬɧɨɝɨ ɬɪɚɧɫɩɨɪɬɚ ɏɋ ɢ ɩɟɪɢɮɟɪɢɱɟɫɤɢɯ ɬɤɚɧɟɣ ɡɚ ɫɱɟɬ ɩɨɜɵɲɟɧɢɹ ɦɨɳɧɨɫɬɢ ɚɩɨ-Ⱥ-1-ɫɨɞɟɪɠɚɳɢɯ ɥɢ

-ɩɨɩɪɨɬɟɢɧɨɜ [22]. ȼ ɪɟɡɭɥɶɬɚɬɟ ɢɦɟɟɬ ɦɟɫɬɨ

ɞɨɫɬɚɬɨɱɧɨ ɡɧɚɱɢɬɟɥɶɧɚɹ ɪɟɜɟɪɫɢɹ ɨɛɴɟɦɚ ɥɢ

-ɩɢɞɧɨɝɨ ɹɞɪɚ, ɱɬɨ, ɜɟɪɨɹɬɧɨ, ɦɨɠɟɬ ɛɵɬɶ ɪɚɫ

-ɫɦɨɬɪɟɧɨ ɤɚɤ ɩɨɡɢɬɢɜɧɚɹ ɫɨɫɬɚɜɥɹɸɳɚɹ ɜ ɫɩɨ

-ɫɨɛɧɨɫɬɢ ɩɢɬɚɜɚɫɬɚɬɢɧɚ ɤ ɨɝɪɚɧɢɱɟɧɢɸ ɜɚɫɤɭ

-ɥɹɪɧɨɝɨ ɪɟɦɨɞɟɥɢɪɨɜɚɧɢɹ [18]. Ɍɚɤ, ɜ ɢɫɫɥɟɞɨ

-ɜɚɧɢɢ Japan ACS ɭ ɩɚɰɢɟɧɬɨɜ ɫ ɨɫɬɪɵɦ ɤɨɪɨ

-ɧɚɪɧɵɦ ɫɢɧɞɪɨɦɨɦ ɩɪɢɦɟɧɟɧɢɟ ɩɢɬɚɜɚɫɬɚɬɢɧɚ ɜ ɫɭɬɨɱɧɨɣ ɞɨɡɟ 4 ɦɝ ɫɩɨɫɨɛɫɬɜɨɜɚɥɨ ɨɬɱɟɬɥɢɜɨɣ

ɪɟɜɟɪɫɢɢ ɨɛɴɟɦɚ ɥɢɩɢɞɧɨɝɨ ɹɞɪɚ ɛɨɥɟɟ ɱɟɦ ɧɚ

30% ɨɬ ɢɫɯɨɞɧɨɝɨ ɜ ɫɨɱɟɬɚɧɢɢ ɫ ɞɨɫɬɨɜɟɪɧɵɦ

ɭɦɟɧɶɲɟɧɢɟɦ ɰɢɪɤɭɥɢɪɭɸɳɟɝɨ ɭɪɨɜɧɹ ɞɪɭɝɢɯ ɛɢɨɦɚɤɟɪɨɜ ɜɚɫɤɭɥɹɪɧɨɝɨ ɪɟɦɨɞɟɥɢɪɨɜɚɧɢɹ,

ɬɚɤɢɯ ɤɚɤ ɦɚɬɪɢɤɫɧɵɟ ɩɪɨɬɟɢɧɚɡɵ -6 ɢ -9, ɩɨ

ɫɪɚɜɧɟɧɢɸ ɫ ɷɮɮɟɤɬɨɦ, ɤɨɬɨɪɵɣ ɨɤɚɡɵɜɚɥ ɚɬɨɪ

-ɜɚɫɬɚɬɢɧ ɜ ɞɨɡɟ 20 ɦɝ/ɫɭɬ. [2, 8].

ɂɧɬɟɪɟɫɧɨ,ɱɬɨ ɜ ɢɫɫɥɟɞɨɜɚɧɢɢ LIVES (Livalo Effectiveness and Safety) ɛɵɥɢ ɩɨɥɭɱɟɧɵ ɭɛɟɞɢ

-ɬɟɥɶɧɵɟ ɞɚɧɧɵɟ ɨ ɛɥɚɝɨɩɪɢɹɬɧɨɦ ɜɥɢɹɧɢɢ ɩɢɬɚ

-ɜɚɫɬɚɬɢɧɚ ɧɚ ɤɚɱɟɫɬɜɨ ɤɨɧɬɪɨɥɹ ɝɥɢɤɟɦɢɢ ɧɚ

-ɬɨɳɚɤ ɭ 1200 ɩɚɰɢɟɧɬɨɜ. Ȼɥɢɡɤɢɟ ɪɟɡɭɥɶɬɚɬɵ

ɦɨɦ [5, 20]. ɇɟɨɛɯɨɞɢɦɨ ɨɬɦɟɬɢɬɶ, ɱɬɨ ɩɢɬɚ

-ɜɚɫɬɚɬɢɧ ɜ ɞɨɡɟ 4 ɦɝ/ɫɭɬ ɩɪɟɜɨɫɯɨɞɢɥ ɚɬɨɪɜɚɫ

-ɬɚɬɢɧ ɜ ɞɨɡɟ 20 ɦɝ/ɫɭɬ ɩɨ ɫɩɨɫɨɛɧɨɫɬɢ ɫɭɩɪɟɫ

-ɫɢɪɨɜɚɬɶ ɢɡɛɵɬɨɱɧɭɸ ɩɪɨɞɭɤɰɢɸ ɤɨɧɟɱɧɵɯ ɤɨɦɩɨɧɟɧɬɨɜ ɝɥɢɤɢɪɨɜɚɧɢɹ, ɱɬɨ, ɜ ɤɨɧɟɱɧɨɦ

ɢɬɨɝɟ, ɨɤɚɡɵɜɚɥɨ ɛɥɚɝɨɩɪɢɹɬɧɨɟ ɜɥɢɹɧɢɟ ɜ

ɨɬɧɨɲɟɧɢɢ ɭɥɭɱɲɟɧɢɹ ɦɟɯɚɧɢɱɟɫɤɢɯ ɤɚɱɟɫɬɜ ɷɧɞɨɬɟɥɢɹ ɫɨɫɭɞɨɜ [8]. ɗɬɢ ɞɚɧɧɵɟ ɨɫɨɛɟɧɧɨ

ɢɧɬɟɪɟɫɧɵ ɜ ɫɜɟɬɟ ɩɨɹɜɥɹɸɳɢɯɫɹ ɩɭɛɥɢɤɚɰɢɣ ɨ ɧɟɝɚɬɢɜɧɨɦ ɜɥɢɹɧɢɢ ɬɟɪɚɩɢɢ ɫɬɚɬɢɧɨɜ ɧɚ ɪɢɫɤ ɜɨɡɧɢɤɧɨɜɟɧɢɹ ɧɨɜɵɯ ɫɥɭɱɚɟɜ ɫɚɯɚɪɧɨɝɨ ɞɢɚɛɟɬɚ ɭ ɩɚɰɢɟɧɬɨɜ ɜɵɫɨɤɨɝɨ ɪɢɫɤɚ ɜ ɩɪɨɝɪɚɦɦɚɯ ɩɟɪɜɢɱɧɨɣ ɩɪɟɜɟɧɰɢɢ. Ɍɚɤ, ɩɨ ɞɚɧɧɵɦ ɦɟɬɚ

-ɚɧɚɥɢɡɚ ɩɹɬɢ ɪɚɧɞɨɦɢɡɢɪɨɜɚɧɧɵɯ ɤɥɢɧɢɱɟɫɤɢɯ ɢɫɫɥɟɞɨɜɚɧɢɣ PROVE-IT, A to Z, TNT, IDEAL, and SEARCH (n=32752), ɜɵɫɨɤɢɟ ɞɨɡɵ ɫɬɚɬɢɧɨɜ

ɫɩɨɫɨɛɫɬɜɨɜɚɥɢ 12% (95% Ⱦɂ = 4-22%) ɩɨɜɵ

-ɲɟɧɢɸ ɨɞɧɨɝɨɞɢɱɧɨɝɨ ɪɢɫɤɚ ɦɚɧɢɮɟɫɬɚɰɢɢ ɫɚ

-ɯɚɪɧɨɝɨ ɞɢɚɛɟɬɚ ɩɨ ɫɪɚɜɧɟɧɢɸ ɫ ɧɢɡɤɢɦɢ ɞɨɡɚɦɢ ɩɪɟɩɚɪɚɬɨɜ [14]. ȼ ɫɜɹɡɢ ɫ ɷɬɢɦ ɩɢɬɚɜɚɫɬɚɬɢɧ

ɜɵɝɨɞɧɨ ɨɬɥɢɱɚɟɬɫɹ ɨɬ ɢɧɵɯ ɩɪɟɞɫɬɚɜɢɬɟɥɟɣ ɤɥɚɫɫɚ ɫɬɚɬɢɧɨɜ ɨɬɫɭɬɫɬɜɢɟɦ ɞɨɤɚɡɚɧɧɨɝɨ ɧɟɝɚ

-ɬɢɜɧɨɝɨ ɜɥɢɹɧɢɹ ɜ ɨɬɧɨɲɟɧɢɢ ɪɢɫɤɚ ɦɚɧɢ

-ɮɟɫɬɚɰɢɢ ɧɚɪɭɲɟɧɢɣ ɤɨɧɰɟɧɬɪɚɰɢɢ ɝɥɸɤɨɡɵ ɧɚɬɨɳɚɤ ɢ ɫɚɯɚɪɧɨɝɨ ɞɢɚɛɟɬɚ [7, 10].

ɇɚɪɹɞɭ ɫ ɜɵɫɨɤɨɣ ɝɢɩɨɥɢɩɢɞɟɦɢɱɟɫɤɨɣ ɚɤɬɢɜɧɨɫɬɶɸ, ɩɢɬɚɜɚɫɬɚɬɢɧ ɞɟɦɨɧɫɬɪɢɪɭɟɬ ɞɨ

-ɫɬɚɬɨɱɧɨ ɛɥɚɝɨɩɪɢɹɬɧɵɣ ɩɪɨɮɢɥɶ ɛɟɡɨɩɚɫɧɨɫɬɢ.

Ɍɚɤ, ɨɠɢɞɚɟɦɚɹ ɱɚɫɬɨɬɚ ɜɨɡɧɢɤɧɨɜɟɧɢɹ

ɚɫɢɦɩɬɨɦɧɨɣ ɷɥɟɜɚɰɢɢ ɤɪɟɚɬɢɧɢɧɮɨɫɮɨɤɢɧɚɡɵ ɢ ɬɪɚɧɫɚɦɧɚɡ ɨɛɵɱɧɨ ɧɟ ɩɪɟɜɵɲɚɟɬ 5%, ɚ ɜɟ

-ɪɨɹɬɧɨɫɬɶ ɦɚɧɢɮɟɫɬɚɰɢɢ ɦɢɨɩɚɬɢɢ ɢ ɪɚɛɞɨ

-ɦɢɨɥɢɡɚ ɷɤɫɬɪɟɦɚɥɶɧɨ ɧɢɡɤɚ [7]. Ʉɪɨɦɟ ɬɨɝɨ,

ɧɟɨɛɯɨɞɢɦɨ ɨɬɦɟɬɢɬɶ,ɱɬɨ ɜ ɰɟɥɨɦ ɞɥɹ ɩɚɰɢɟɧɬɨɜ

ɩɨɠɢɥɨɝɨ ɜɨɡɪɚɫɬɚ ɤɥɢɧɢɱɟɫɤɚɹ ɷɮɮɟɤɬɢɜɧɨɫɬɶ ɢ ɛɟɡɨɩɚɫɧɨɫɬɶ ɩɢɬɚɜɚɫɬɚɬɢɧɚ ɨɞɧɚ ɢɡ ɫɚɦɵɯ ɜɵɫɨɤɢɯ ɜ ɤɥɚɫɫɟ [5].

Ɍɚɤɢɦ ɨɛɪɚɡɨɦ, ɩɢɬɚɜɚɫɬɚɬɢɧ ɹɜɥɹɟɬɫɹ ɜɵɫɨ

-ɤɨɷɮɮɟɤɬɢɜɧɵɦ ɝɢɩɨɥɢɩɢɞɟɦɢɱɟɫɤɢɦ ɥɟ

-ɤɚɪɫɬɜɟɧɧɵɦ ɫɪɟɞɫɬɜɨɦ ɫ ɛɥɚɝɨɩɪɢɹɬɧɵɦ ɩɪɨɮɢ

-ɥɟɦ ɛɟɡɨɩɚɫɧɨɫɬɢ ɢ ɞɨɤɚɡɚɧɧɵɦ ɚɧɝɢɨɩɨɷɬɢ

-ɱɟɫɤɢɦ ɢ ɦɟɬɚɛɨɥɢ-ɱɟɫɤɢɦ ɷɮɮɟɤɬɨɦ [21].

Ɍɟɨɪɟɬɢɱɟɫɤɢ, ɩɚɰɢɟɧɬɵ ɫ ɞɢɫɥɢɩɢɞɟɦɢɟɣ ɜɵ

-ɫɨɤɨɝɨ ɤɚɪɞɢɨɜɚɫɤɭɥɹɪɧɨɝɨ ɪɢɫɤɚ, ɧɟ ɨɬɜɟ

-ɱɚɸɳɢɟ ɧɚ ɫɬɚɧɞɚɪɬɧɭɸ ɬɟɪɚɩɢɸ ɫɬɚɬɢɧɚɦɢ,

ɦɨɝɭɬ ɢɡɜɥɟɤɚɬɶ ɞɨɩɨɥɧɢɬɟɥɶɧɭɸ ɜɵɝɨɞɭ ɩɨɫɥɟ ɧɚɡɧɚɱɟɧɢɹ ɩɢɬɚɜɚɫɬɚɬɢɧɚ ɢɥɢ ɢɫɩɨɥɶɡɨɜɚɧɢɹ ɝɢɛɪɢɞɧɨɣ ɝɢɩɨɥɢɩɢɞɟɦɢɱɟɫɤɨɣ ɬɟɪɚɩɢɢ. Ⱦɥɹ

ɢɥɥɸɫɬɪɚɰɢɢ ɨɞɧɨɝɨ ɢɡ ɜɨɡɦɨɠɧɵɯ ɪɟɲɟɧɢɣ ɨɩɢɫɚɧɧɨɣ ɜɵɲɟ ɩɪɨɛɥɟɦɵ ɩɪɢɜɨɞɢɬɫɹ ɫɥɟɞɭɸ

-ɳɢɣ ɤɥɢɧɢɱɟɫɤɢɣ ɫɥɭɱɚɣ.

ɉɚɰɢɟɧɬɤɚ Ɇ. 47 ɥɟɬ,ɨɛɪɚɬɢɥɚɫɶ ɤ ɫɟɦɟɣɧɨɦɭ

(5)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

ɫɥɚɛɨɫɬɶ ɢ ɫɧɢɠɟɧɢɟ ɩɟɪɟɧɨɫɢɦɨɫɬɢ ɮɢɡɢɱɟɫɤɨɣ ɧɚɝɪɭɡɤɢ, ɤɨɬɨɪɵɟ ɩɨɹɜɢɥɢɫɶ ɜ ɬɟɱɟɧɢɟ ɩɨɫɥɟɞ

-ɧɢɯ 3 ɦɟɫɹɰɟɜ. ɉɚɰɢɟɧɬɤɚ ɧɟ ɢɦɟɥɚ ɨɬɹɝɨɳɟɧ

-ɧɨɝɨ ɫɟɦɟɣ-ɧɨɝɨ ɚɧɚɦɧɟɡɚ ɩɨ ɩɪɟɠɞɟɜɪɟɦɟɧɧɨɣ ɂȻɋ. Ɉɛɳɟɟ ɫɨɫɬɨɹɧɢɟ ɭɞɨɜɥɟɬɜɨɪɢɬɟɥɶɧɨɟ.

Ɋɨɫɬ = 166 ɫɦ, ɜɟɫ = 72 ɤɝ, ɢɧɞɟɤɫ ɦɚɫɫɵ ɬɟɥɚ = 26,1ɤɝ/ɫɦ2, ɨɤɪɭɠɧɨɫɬɶ ɬɚɥɢɢ = 89 ɫɦ, ɨɤɪɭɠ

-ɧɨɫɬɶ ɛɟɞɟɪ 99 ɫɦ, ɨɬɧɨɲɟɧɢɟ ɨɤɪɭɠɧɨɫɬɶ ɬɚɥɢɢ /ɨɤɪɭɠɧɨɫɬɶ ɛɟɞɟɪ = 0,9 ɟɞ.ȼɢɞɢɦɵɟ ɫɥɢɡɢɫɬɵɟ

ɨɛɵɱɧɨɣ ɨɤɪɚɫɤɢ. ɉɟɪɢɮɟɪɢɱɟɫɤɢɟ ɥɢɦɮɨɭɡɥɵ

ɧɟ ɭɜɟɥɢɱɟɧɵ.ɇɚɞ ɥɟɝɤɢɦɢ ɹɫɧɵɣ ɥɟɝɨɱɧɨɣ ɡɜɭɤ,

ɜ ɥɟɝɤɢɯ ɜɟɡɢɤɭɥɹɪɧɨɟ ɞɵɯɚɧɢɟ. Ⱦɟɹɬɟɥɶɧɨɫɬɶ

ɫɟɪɞɰɚ ɪɢɬɦɢɱɧɚɹ, ɱɚɫɬɨɬɚ ɫɟɪɞɟɱɧɵɯ ɫɨɤɪɚɳɟ

-ɧɢɣ (ɑɋɋ) = 64 ɜ 1 ɦɢɧ.ȺȾ = 128 / 76 ɦɦ ɪɬ.ɫɬ.

ɀɢɜɨɬ ɦɹɝɤɢɣ,ɭɱɚɫɬɜɭɟɬ ɜ ɚɤɬɟ ɞɵɯɚɧɢɹ, ɞɨɫɬɭ

-ɩɟɧ ɩɚɥɶɩɚɰɢɢ. ɉɟɱɟɧɶ ɢ ɫɟɥɟɡɟɧɤɚ ɧɟ ɭɜɟɥɢ

-ɱɟɧɵ. ɉɟɪɢɮɟɪɢɱɟɫɤɢɯ ɨɬɟɤɨɜ ɧɟɬ. Ɇɟɧɫɬɪɭɚɥɶ

-ɧɚɹ ɮɭɧɤɰɢɹ ɫɨɯɪɚɧɟɧɚ.

ɇɚ ɷɥɟɤɬɪɨɤɚɪɞɢɨɝɪɚɦɦɟ: ɜɨɥɶɬɚɠ ɧɨɪɦɚɥɶ

-ɧɵɣ, ɷɥɟɤɬɪɢɱɟɫɤɚɹ ɨɫɶ ɫɟɪɞɰɚ ɧɟ ɨɬɤɥɨɧɟɧɚ,

ɩɪɢɡɧɚɤɢ ɧɟɩɨɥɧɨɣ ɛɥɨɤɚɞɵ ɩɪɚɜɨɣ ɧɨɠɤɢ ɩɭɱɤɚ Ƚɢɫɚ.

ɗɯɨɤɚɪɞɢɨɝɪɚɮɢɹ: Ƚɥɨɛɚɥɶɧɚɹ ɫɨɤɪɚɬɢɬɟɥɶ

-ɧɚɹ ɮɭɧɤɰɢɹ ɧɟ ɧɚɪɭɲɟɧɚ: ɮɪɚɤɰɢɹ ɜɵɛɪɨɫɚ

ɥɟɜɨɝɨ ɠɟɥɭɞɨɱɤɚ = 66%, ɪɚɡɦɟɪɵ ɤɚɦɟɪ ɫɟɪɞɰɚ

ɧɟ ɢɡɦɟɧɟɧɵ, ɤɨɧɰɟɧɬɪɢɱɟɫɤɚɹ ɝɢɩɟɪɬɪɨɮɢɹ ɥɟ

-ɜɨɝɨ ɠɟɥɭɞɨɱɤɚ. ɂɧɞɟɤɫ ɦɚɫɫɵ ɦɢɨɤɚɪɞɚ (ɂɆɆ) = 152 ɝ/ɦ2. ɉɢɤɨɜɚɹ ɫɤɨɪɨɫɬɶ ɪɚɧɧɟɝɨ ɞɢɚɫɬɨɥɢ

-ɱɟɫɤɨɝɨ ɪɚɫɫɥɚɛɥɟɧɢɹ = 57 ɫɦ/ɫ, ɩɢɤɨɜɚɹ ɫɤɨ

-ɪɨɫɬɶ ɜ ɮɚɡɭ ɫɢɫɬɨɥɵ ɩɪɟɞɫɟɪɞɢɣ = 59 ɫɦ/ɫ, ɩɪɨ

-ɞɨɥɠɢɬɟɥɶɧɨɫɬɶ ɮɚɡɵ ɢɡɨɜɨɥɸɦɢɱɟɫɤɨɝɨ ɪɚɫ

-ɫɥɚɛɥɟɧɢɹ = 98 ɦɫ.Ⱦɢɚɫɬɨɥɢɱɟɫɤɚɹ ɞɢɫɮɭɧɤɰɢɹ I

ɬɢɩɚ ɩɨ ɤɥɚɫɫɢɮɢɤɚɰɢɢ Appleton C. et al. TDI:

ɮɨɪɦɵ ɤɪɢɜɵɯ ɞɜɢɠɟɧɢɹ ɦɢɨɤɚɪɞɚ ɧɨɪɦɚɥɶɧɵɟ,

ɩɢɤɨɜɚɹ ɫɢɫɬɨɥɢɱɟɫɤɚɹ ɦɢɨɤɚɪɞɢɚɥɶɧɚɹ ɫɤɨ

-ɪɨɫɬɶ = 6,8 ɫɦ/ɫ, ɚɦɩɥɢɬɭɞɨɣ ɫɢɫɬɨɥɢɱɟɫɤɨɝɨ

ɫɦɟɳɟɧɢɹ ɦɢɨɤɚɪɞɚ = 0,98 ɫɦ.

ȼ-ɦɨɞɚɥɶɧɚɹ ɥɨɤɚɰɢɹ ɫɨɧɧɵɯ ɚɪɬɟɪɢɣ: Ɍɨɥ

-ɳɢɧɚ ɢɧɬɢɦɨ-ɦɟɞɢɚɥɶɧɨɝɨ ɫɟɝɦɟɧɬɚ ɨɛɳɟɣ ɫɨɧ

-ɧɨɣ ɚɪɬɟɪɢɢ = 1 ɦɦ.

ȼ ɚɧɚɥɢɡɟ ɤɪɨɜɢ: ɷɪɢɬɪɨɰɢɬɵ = 5,23×1012,

ɥɟɣɤɨɰɢɬɵ = 4,46×1012,ɷɨɡɢɧɨɮɢɥɵ=0%, ɛɚɡɨɮɢ

-ɥɵ = 0%, ɩɚɥɨɱɤɨɹɞɟɪɧɵɟ = 3%, ɫɟɝɦɟɧɬɨɹɞɟɪ

-ɧɵɟ = 57%, ɥɢɦɮɨɰɢɬɵ = 29%, ɦɨɧɨɰɢɬɵ = 11%.

ɋɤɨɪɨɫɬɶ ɨɫɟɞɚɧɢɹ ɷɪɢɬɪɨɰɢɬɨɜ = 6 ɦɦ/ɱ. Ʉɪɟɚ

-ɬɢɧɢɧ ɤɪɨɜɢ = 67 ɦɤɦɨɥɶ/ɥ, ɦɨɱɟɜɢɧɚ 6.6 ɦɦɨɥɶ/ɥ,

ɜɵɫɨɤɨɱɭɜɫɬɜɢɬɟɥɶɧɵɣ ɋ-Ɋɉ = 4,11 ɦɝ/ɥ, NT-

pro-Ɇɇɍɉ = 73 ɧɝ/ɦɥ, ɛɢɥɢɪɭɛɢɧ ɨɛɳ. = 16,4 ɦɤɦɨɥɶ/ɥ, ɛɢɥɢɪɭɛɢɧ ɩɪɹɦɨɣ = 4,7 ɦɤɦɨɥɶ/ɥ.

ȺɥȺɌ = 0,67 ɦɤɦɨɥɶ/ɥ×ɱ,ȺɫȺɌ = 0,33 ɦɤɦɨɥɶ/ɥ×ɱ.

ɏɨɥɟɫɬɟɪɢɧ ɨɛɳɢɣ = 6,6 ɦɦɨɥɶ/ɥ, ɏɋ Ʌɉɇɉ = 4,09ɦɦɨɥɶ/ɥ, ɏɋ Ʌɉȼɉ = 1,02 ɦɦɨɥɶ/ɥ, ɌȽ = 3,27ɦɦɨɥɶ/ɥ, ɝɥɸɤɨɡɚ ɧɚɬɨɳɚɤ = 4,52 ɦɦɨɥɶ/ɥ.

ɂɧɫɭɥɢɧ = 15,12 ɦɤȿɞ/ɦɥ, ɢɧɞɟɤɫ ɢɧɫɭɥɢɧɨɪɟɡɢɫ

-ɬɟɧɬɧɨɫɬɢ (HOMA-IR) = 3,03 ɦɦɨɥɶ/ɥ × ɦɤȿɞ/ɦɥ,

ɝɥɢɤɨɡɢɥɢɪɨɜɚɧɧɵɣ ɝɟɦɨɝɥɨɛɢɧ (HbA1c) =5,1%.

ȼ ɚɧɚɥɢɡɟ ɦɨɱɢ – ɭɞɟɥɶɧɵɣ ɜɟɫ 1020, ɥ = 2-3 ɜ

ɩɨɥɟ ɡɪ., ɷɪɢɬɪɨɰɢɬɵ = 0, ɷɩɢɬɟɥɢɣ ɟɞɢɧɢɱɧɵɣ.

ɋɭɬɨɱɧɚɹ ɷɤɫɤɪɟɰɢɹ ɚɥɶɛɭɦɢɧɚ ɫ ɦɨɱɨɣ = 32ɦɝ/ɫɭɬ.

ȼɟɪɢɮɢɰɢɪɨɜɚɧ ɞɢɚɝɧɨɡ: Ɉɠɢɪɟɧɢɟ, I ɫɬ.,

ɚɧɞɪɨɢɞɧɨɝɨ ɬɢɩɚ, ɫɦɟɲɚɧɧɚɹ ɞɢɫɥɢɩɢɞɟɦɢɹ.

ɍɱɢɬɵɜɚɹ ɧɚɥɢɱɢɟ ɚɧɞɪɨɢɞɧɨɝɨ ɬɢɩɚ ɨɠɢɪɟɧɢɹ,

ɫɦɟɲɚɧɧɭɸ ɞɢɫɥɢɩɢɞɟɦɢɸ ɢ ɪɚɫɫɱɢɬɚɧɧɭɸ ɜɟɥɢ

-ɱɢɧɭ ɢɧɞɟɤɫɚ HOMA-IR = 3,03 ɦɦɨɥɶ/ɥ × ɦɤȿɞ/ɦɥ (ɪɟɮɟɪɟɧɫɧɵɟ ɡɧɚɱɟɧɢɹ ɦɟɧɟɟ 2,7 ɦɦɨɥɶ/ɥ ×

ɦɤȿɞ/ɦɥ), ɫɜɢɞɟɬɟɥɶɫɬɜɭɸɳɭɸ ɨ ɧɚɥɢɱɢɢ ɢɧɫɭ

-ɥɢɧɨɪɟɡɢɫɬɟɧɬɧɨɫɬɢ, ɦɨɠɧɨ ɪɚɫɫɦɨɬɪɟɬɶ ɧɚɥɢ

-ɱɢɟ ɦɟɬɚɛɨɥɢɱɟɫɤɨɝɨ ɫɢɧɞɪɨɦɚ ɤɚɤ ɞɢɚɝɧɨɡɚ,

ɨɩɪɟɞɟɥɹɸɳɟɝɨ ɬɚɤɬɢɤɭ ɞɚɥɶɧɟɣɲɟɝɨ ɥɟɱɟɧɢɹ ɩɚɰɢɟɧɬɚ ɜɵɫɨɤɨɝɨ ɤɚɪɞɢɨɜɚɫɤɭɥɹɪɧɨɝɨ ɪɢɫɤɚ.

ȼɪɚɱɨɦ ɪɟɤɨɦɟɧɞɨɜɚɧɨ ɫɨɛɥɸɞɟɧɢɟ ɞɢɟɬɢɱɟɫɤɢɯ ɨɝɪɚɧɢɱɟɧɢɣ, ɪɚɫɲɢɪɟɧɢɟ ɮɢɡɢɱɟɫɤɨɣ ɚɤɬɢɜ

-ɧɨɫɬɢ ɢ ɟɠɟɞɧɟɜɧɵɣ ɩɪɢɟɦ ɚɬɨɪɜɚɫɬɚɬɢɧɚ ɜ ɫɭɬɨɱɧɨɣ ɞɨɡɟ 20 ɦɝ ɧɚ ɧɨɱɶ ɫ ɩɨɫɥɟɞɭɸɳɟɣ

ɨɰɟɧɤɨɣ ɞɢɧɚɦɢɤɢ ɥɢɩɢɞɧɨɝɨ ɩɪɨɮɢɥɹ ɩɥɚɡɦɵ ɤɪɨɜɢ ɢ ɭɪɨɜɧɹ ɩɟɱɟɧɨɱɧɵɯ ɬɪɚɧɫɚɦɢɧɚɡ ɱɟɪɟɡ 6

ɧɟɞɟɥɶ.

ɉɨɜɬɨɪɧɵɣ ɚɧɚɥɢɡ ɥɢɩɢɞɧɨɝɨ ɩɪɨɮɢɥɹ ɩɥɚɡ

-ɦɵ ɤɪɨɜɢ ɱɟɪɟɡ 6 ɧɟɞɟɥɶ ɬɟɪɚɩɢɢ ɚɬɨɪɜɚɫɬɚ

-ɬɢɧɨɦ: ɯɨɥɟɫɬɟɪɢɧ ɨɛɳɢɣ = 5,9 ɦɦɨɥɶ/ɥ,

ɏɋ Ʌɉɇɉ = 3,51 ɦɦɨɥɶ/ɥ, ɏɋ Ʌɉȼɉ = 0,98ɦɦɨɥɶ/ɥ,ɬɪɢɝɥɢɰɟɪɢɞɵ (ɌȽ) = 3,11 ɦɦɨɥɶ/ɥ.

Ƚɥɸɤɨɡɚ ɧɚɬɨɳɚɤ = 4,46 ɦɦɨɥɶ/ɥ, HbA1c = 5,1%, ɛɢɥɢɪɭɛɢɧ ɨɛɳɢɣ = 15,9 ɦɤɦɨɥɶ/ɥ, ɛɢɥɢ

-ɪɭɛɢɧ ɩɪɹɦɨɣ = 4,3 ɦɤɦɨɥɶ/ɥ. Ⱥɥɚɧɢɧɚɦɢɧɨ

-ɬɪɚɧɫɮɟɪɚɡɚ (ȺɥȺɌ) = 0,56 ɦɤɦɨɥɶ/ɥ×ɱ, ɚɫɩɚɪɬɚ

-ɬɚɦɢɧɨɬɪɚɧɫɮɟɪɚɡɚ (ȺɫȺɌ) = 0,31 ɦɤɦɨɥɶ/ɥ×ɱ.

ɍɱɢɬɵɜɚɹ ɜɵɫɨɤɭɸ ɩɪɟɬɟɫɬɨɜɭɸ ɜɟɪɨɹɬɧɨɫɬɶ ɚɫɢɦɩɬɨɦɧɨɝɨ ɚɬɟɪɨɫɤɥɟɪɨɡɚ ɭ ɩɚɰɢɟɧɬɤɢ ɫ ɦɟɬɚ

-ɛɨɥɢɱɟɫɤɢɦ ɫɢɧɞɪɨɦɨɦ ɟɣ ɩɪɟɞɥɨɠɟɧɚ ɤɨɧɬɪɚɫɬɧɚɹ ɦɭɥɶɬɫɩɢɪɚɥɶɧɚɹ ɤɨɦɩɶɸɬɟɪɧɚɹ ɬɨ

-ɦɨɝɪɚɮɢɹ ɚɧɝɢɨɝɪɚɮɢɹ ɤɨɪɨɧɚɪɧɵɯ ɚɪɬɟɪɢɣ.

ɉɨɫɥɟɞɧɹɹ ɜɵɩɨɥɧɟɧɚ ɧɚ ɫɤɚɧɟɪɟ "Somatom Volum Zoom" (Siemens, ɗɪɥɚɧɝɟɧ, Ƚɟɪɦɚɧɢɹ) ɫ 2

ɪɹɞɚɦɢ ɞɟɬɟɤɬɨɪɨɜ ɜɨ ɜɪɟɦɹ ɡɚɞɟɪɠɤɢ ɞɵɯɚɧɢɹ ɜ ɤɨɧɰɟ ɜɵɞɨɯɚ. ɉɨɫɥɟ ɩɪɟɞɜɚɪɢɬɟɥɶɧɨɝɨ ɧɚɬɢɜ

-ɧɨɝɨ ɫɤɚɧɢɪɨɜɚɧɢɹ ɩɪɨɢɡɜɨɞɢɥɨɫɶ ɜɜɟɞɟɧɢɟ ɧɟɢɨɧɧɨɝɨ ɤɨɧɬɪɚɫɬɚ ɨɦɧɢɩɚɤ («Amersham Health, ɂɪɥɚɧɞɢɹ»), ɤɨɬɨɪɵɣ ɢɫɩɨɥɶɡɨɜɚɥɫɹ ɞɥɹ

ɩɨɥɭɱɟɧɢɹ ɨɩɬɢɦɚɥɶɧɨɝɨ ɢɡɨɛɪɚɠɟɧɢɹ ɤɨɪɨ

-ɧɚɪɧɵɯ ɚɪɬɟɪɢɣ. Ⱦɥɹ ɩɪɨɜɟɞɟɧɢɹ ɪɟɤɨɧɫɬɪɭɤɰɢɢ

ɢɡɨɛɪɚɠɟɧɢɹ ɢɫɩɨɥɶɡɨɜɚɥɢɫɶ ɚɤɫɢɚɥɶɧɵɟ ɬɨɦɨ

-ɝɪɚɮɢɱɟɫɤɢɟ ɫɪɟɡɵ ɲɢɪɢɧɨɣ 0,6ɦɦ. Ⱥɧɚɥɢɡ

ɩɨɥɭɱɟɧɧɵɯ ɞɚɧɧɵɯ ɩɨɡɜɨɥɢɥ ɜɵɹɜɢɬɶ ɚɬɟ

-ɪɨɫɤɥɟɪɨɬɢɱɟɫɤɨɟ ɩɨɪɚɠɟɧɢɟ ɩɪɚɜɨɣ ɤɨɪɨɧɚɪɧɨɣ ɚɪɬɟɪɢɢ (44% ɫɬɟɧɨɡ ɩɪɨɬɹɠɟɧɧɨɫɬɶɸ 7,4 ɦɦ) (ɪɢɫ.). Ɋɟɤɨɦɟɧɞɨɜɚɧɨ ɩɪɨɜɟɞɟɧɢɟ ɪɟɧɬɝɟɧ

-ɤɨɧɬɪɚɫɬɧɨɣ ɚɧɝɢɨɝɪɚɮɢɢ ɫ ɩɨɫɥɟɞɭɸɳɟɣ ɤɨɧ

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Ȼ.ɋɬɪɭɤɬɭɪɧɨɟ ɪɟɦɨɞɟɥɢɪɨɜɚɧɢɟ ɩɪɚɜɨɣ ɤɨɪɨɧɚɪɧɨɣ ɚɪɬɟɪɢɢ ɷɤɫɰɟɧɬɪɢɱɧɨ ɪɚɫɩɨɥɨɠɟɧɧɨɣ ɚɬɟɪɨɦɨɣ

ɋɬɟɧɨɬɢɱɟɫɤɨɟ ɩɨɪɚɠɟɧɢɟ ɩɪɚɜɨɣ ɤɨɪɨɧɚɪɧɨɣ ɚɪɬɟɪɢɢ.

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ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

ɉɨɫɤɨɥɶɤɭ ɰɟɥɟɜɨɣ ɭɪɨɜɟɧɶ ɏɋ Ʌɉɇɉ (ɦɟɧɟɟ 2,5ɦɦɨɥɶ/ɥ) ɧɟ ɛɵɥ ɞɨɫɬɢɝɧɭɬ,ɚ ɬɚɤɠɟ ɭɱɢɬɵɜɚɹ

ɜɵɫɨɤɢɣ ɪɢɫɤ ɜɨɡɧɢɤɧɨɜɟɧɢɹ ɫɚɯɚɪɧɨɝɨ ɞɢɚɛɟɬɚ ɜ ɤɪɚɬɤɨɫɪɨɱɧɨɣ ɩɟɪɫɩɟɤɬɢɜɟ, ɩɪɢɧɹɬɨ ɪɟɲɟɧɢɟ

ɨ ɩɟɪɟɫɦɨɬɪɟ ɬɚɤɬɢɤɢ ɥɟɱɟɧɢɹ. Ⱥɬɨɪɜɚɫɬɚɬɢɧ ɜ

ɞɨɡɟ 20 ɦɝ/ɫɭɬ ɡɚɦɟɧɟɧ ɩɢɬɚɜɚɫɬɚɬɢɧɨɦ ɜ

ɫɭɬɨɱɧɨɣ ɞɨɡɟ 4 ɦɝ. Ⱦɨɛɚɜɥɟɧɚ ɚɰɟɬɢɥɫɚɥɢɰɢ

-ɥɨɜɚɹ ɤɢɫɥɨɬɚ ɜ ɮɨɪɦɟ ɤɢɲɟɱɧɨɝɨ ɜɵɫɜɨɛɨɠ

-ɞɟɧɢɹ ɜ ɫɭɬɨɱɧɨɣ ɞɨɡɟ 100 ɦɝ.

ɑɟɪɟɡ 6 ɧɟɞɟɥɶ ɬɟɪɚɩɢɢ ɩɪɢ ɩɨɜɬɨɪɧɨɦ ɢɡɦɟ

-ɪɟɧɢɢ ɥɢɩɢɞɧɨɝɨ ɩɪɨɮɢɥɹ ɩɥɚɡɦɵ ɤɪɨɜɢ ɛɵɥɨ ɭɫɬɚɧɨɜɥɟɧɨ ɫɭɳɟɫɬɜɟɧɧɨɟ ɫɧɢɠɟɧɢɟ ɨɛɳɟɝɨ ɯɨɥɟɫ

-ɬɟɪɢɧɚ ɞɨ 4,7 ɦɦɨɥɶ/ɥ, ɏɋ Ʌɉɇɉ = 2,38 ɦɦɨɥɶ/ɥ,

ɌȽ = 2,73 ɦɦɨɥɶ/ɥ ɧɚ ɮɨɧɟ ɭɦɟɪɟɧɧɨɝɨ ɩɨɜɵɲɟ

-ɧɢɹ ɏɋ Ʌɉȼɉ ɞɨ 1,08 ɦɦɨɥɶ/ɥ.Ƚɥɸɤɨɡɚ ɧɚɬɨɳɚɤ = 4,44 ɦɦɨɥɶ/ɥ, HbA1c = 5,0%, ɛɢɥɢɪɭɛɢɧ ɨɛɳ. = 12,5 ɦɤɦɨɥɶ/ɥ, ɛɢɥɢɪɭɛɢɧ ɩɪɹɦɨɣ = 4,1 ɦɤɦɨɥɶ/ɥ,

ȺɥȺɌ = 0,35 ɦɤɦɨɥɶ/ɥ×ɱ,ȺɫȺɌ = 0,33 ɦɤɦɨɥɶ/ɥ×ɱ.

ɇɟɠɟɥɚɬɟɥɶɧɵɯ ɩɨɛɨɱɧɵɯ ɷɮɮɟɤɬɨɜ ɧɟ ɛɵɥɨ ɡɚ

-ɪɟɝɢɫɬɪɢɪɨɜɚɧɨ, ɩɚɰɢɟɧɬɤɚ ɯɨɪɨɲɨ ɩɟɪɟɧɨɫɢɥɚ

ɬɟɪɚɩɢɸ.

Ɍɚɤɢɦ ɨɛɪɚɡɨɦ, ɭ ɩɚɰɢɟɧɬɤɢ ɜɵɫɨɤɨɝɨ

ɤɚɪɞɢɨɜɚɫɤɭɥɹɪɧɨɝɨ ɪɢɫɤɚ, ɨɛɭɫɥɨɜɥɟɧɧɨɝɨ ɫɭɛ

-ɤɥɢɧɢɱɟɫɤɢɦ ɚɬɟɪɨɫɤɥɟɪɨɡɨɦ ɢ ɦɟɬɚɛɨɥɢɱɟɫɤɢɦ ɫɢɧɞɪɨɦɨɦ, ɢɡɦɟɧɟɧɢɟ ɪɟɠɢɦɚ ɝɢɩɨɥɢɩɢɞɟɦɢ

-ɱɟɫɤɨɣ ɬɟɪɚɩɢɢ ɫ ɚɬɨɪɜɚɫɬɚɬɢɧɚ 20 ɦɝ/ɫɭɬ ɧɚ

ɩɢɬɚɜɚɫɬɚɬɢɧ 4 ɦɝ/ɫɭɬ ɫɩɨɫɨɛɫɬɜɨɜɚɥɨ ɞɨɫɬɢɠɟ

-ɧɢɸ ɰɟɥɟɜɨɝɨ ɭɪɨɜɧɹ ɏɋ Ʌɉɇɉ ɭɠɟ ɱɟɪɟɡ 6

ɧɟɞɟɥɶ ɩɨɫɬɨɹɧɧɨɝɨ ɩɪɢɟɦɚ ɩɪɟɩɚɪɚɬɚ, ɱɬɨ

ɚɫɫɨɰɢɢɪɨɜɚɥɨɫɶ ɫ ɩɪɢɟɦɥɟɦɵɦ ɩɪɨɮɢɥɟɦ ɛɟɡɨɩɚɫɧɨɫɬɢ.

ɁȺɄɅɘɑȿɇɂȿ

ɉɢɬɚɜɚɫɬɚɬɢɧ ɩɨɡɜɨɥɹɟɬ ɫɨɯɪɚɧɢɬɶ ɜɵɫɨɤɭɸ ɛɟɡɨɩɚɫɧɨɫɬɶ, ɜ ɬɨɦ ɱɢɫɥɟ ɢ ɜ ɨɬɧɨɲɟɧɢɢ ɪɢɫɤɚ

ɦɚɧɢɮɟɫɬɚɰɢɢ ɫɚɯɚɪɧɨɝɨ ɞɢɚɛɟɬɚ 2 ɬɢɩɚ,ɧɚ ɮɨɧɟ

ɜɵɫɨɤɨɣ ɝɢɩɨɥɢɩɢɞɟɦɢɱɟɫɤɨɣ ɷɮɮɟɤɬɢɜɧɨɫɬɢ.

ɉɪɟɩɚɪɚɬ ɨɬɥɢɱɚɟɬ ɤɨɦɮɨɪɬɧɵɣ ɞɥɹ ɜɪɚɱɚ ɩɪɨ

-ɮɢɥɶ ɦɟɠɥɟɤɚɪɫɬɜɟɧɧɨɝɨ ɜɡɚɢɦɨɞɟɣɫɬɜɢɹ ɢ ɞɨ

-ɤɚɡɚɧɧɚɹ ɚɧɝɢɨɩɨɷɬɢɱɟɫɤɚɹ ɷɮɮɟɤɬɢɜɧɨɫɬɶ. ȼ

ɫɜɹɡɢ ɫ ɷɬɢɦ ɦɨɠɧɨ ɩɪɟɞɩɨɥɚɝɚɬɶ, ɱɬɨ ɩɢɬɚ

-ɜɚɫɬɚɬɢɧ ɡɚɣɦɟɬ ɧɚɞɥɟɠɚɳɟɟ ɟɦɭ ɦɟɫɬɨ ɫɪɟɞɢ ɩɪɟɩɚɪɚɬɨɜ ɚɧɚɥɨɝɢɱɧɨɝɨ ɤɥɚɫɫɚ ɢ ɜ ɩɪɨɝɪɚɦɦɚɯ ɜɬɨɪɢɱɧɨɣ ɩɪɟɜɟɧɰɢɢ, ɩɨɫɤɨɥɶɤɭ ɩɟɪɜɵɟ ɨɛɧɚ

-ɞɟɠɢɜɚɸɳɢɟ ɪɟɡɭɥɶɬɚɬɵ ɜ ɷɬɨɦ ɨɬɧɨɲɟɧɢɢ ɭɠɟ ɩɨɥɭɱɟɧɵ.

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2. 2013 ACC/AHA Cholesterol Guideline Panel. Treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease risk in adults: synopsis of the 2013 American College of Cardiology/American Heart As-sociation cholesterol guideline / N.J. Stone, J.G. Robin-son, A.H. Lichtenstein [et al.] // Ann. Inter. Med.-2014. – Vol. 160, N 5. – P. 339-343.

3. Are all statins the same? Focus on the efficacy and tolerability of pitavastatin / P.M. da Silva [et al.]// Am. J. Cardiovasc. Drugs. – 2011. – Vol. 11, N 2. – P. 93-107.

4. Chapman M.J. Pitavastatin: novel effects on lipid parameters/ M. J. Chapman // Atheroscler. – 2011. – Vol. 12, N 3, Suppl. – P. 277-284.

5. Clinical implications of discordance between low-density lipoprotein cholesterol and particle number / J.D. Otvos, S. Mora, I. Shalaurova [et al.] // J. Clin. Lipidol. – 2011. – Vol. 5, N 2. – P. 105-113.

6. ESC/EAS guidelines for the management of lipidaemias. The Task Force on the management of dys-lipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) /A. Catapano, Z. Reiner, G. de Backer [et al.] // Athero-sclerosis. – 2011. – doi:10.1016/j.atheroAthero-sclerosis. 2011.06.012 [Epub ahead of print].

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dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) / Z. Reiner, Ⱥ.L. Catapano, G. De Backer [et al.] // Eur. Heart J. – 2011. – Vol. 32. – P. 1769-1818.

8. European Atherosclerosis Society Consensus Panel. Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for mana-gement / M.J. Chapman, H.N. Ginsberg, P. Amarenco [et al.] // Eur. Heart. J. – 2011. – Vol. 32. – P. 1345-1361.

9. HDL cholesterol, very low levels of LDL cho-lesterol, and cardiovascular events / P. Barter, A.M. Got-to, J.C. LaRosa [et al] // N. Engl. J. Med. – 2007. – Vol. 357. – P. 1301-1310.

10. JAPAN-ACS Investigators. Clinically evident polyvascular disease and regression of coronary athe-rosclerosis after intensive statin therapy in patients with acute coronary syndrome: serial intravascular ultrasound from the Japanese assessment of pitavastatin and atorvastatin in acute coronary syndrome (JAPAN-ACS) trial / K. Hibi, T. Kimura, K. Kimura [et al.]// Athero-sclerosis.-2011. - Vol. 219, N 2. - P. 743-749.

11. JAPAN-ACS Investigators. Clustering of me-tabolic syndrome components attenuates coronary plaque regression during intensive statin therapy in patients with acute coronary syndrome: the JAPAN-ACS subanalysis study / H.Takashima, Y. Ozaki, T. Morimoto [et al.] // Circ J. – 2012. – Vol. 76, N 12. – P. 2840-2847.

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1. Anderson TJ, Grégoire J, Hegele RA. 2012 up-date of the Canadian Cardiovascular Society guidelines for the diagnosis and treatment of dyslipidemia for the prevention of cardiovascular disease in the adult. Can. J. Cardiol. 2013;29(2):151-67.

2. Stone NJ, Robinson JG, Lichtenstein AH. 2013 ACC/AHA Cholesterol Guideline Panel. Treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease risk in adults: synopsis of the 2013 American College of Cardiology/American Heart Association cho-lesterol guideline. Ann. Intern. Med. 2014;160(5):339-43. 3. da Silva PM. Are all statins the same? Focus on the efficacy and tolerability of pitavastatin. Am J Car-diovasc Drugs. 2011;11(2):93-107.

4. Chapman MJ. Pitavastatin: novel effects on lipid parameters. Atheroscler Suppl. 2011;12(3):277-84.

5. Otvos JD, Mora S, Shalaurova I. Clinical im-plications of discordance between low-density lipoprotein cholesterol and particle number. J. Clin. Lipidol. 2011;5(2):105-13.

6. Catapano A, Reiner Z, de Backer G. ESC/EAS guidelines for the management of dyslipidaemias. The Task Force on the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Atherosclerosis; 2011. doi:10.1016/j.atherosclerosis.2011.06.012 [Epub ahead of print].

7. Reiner Z, Catapano ȺL, De Backer G. ESC/EAS Guidelines for the management of dyslipidaemias. The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur. Heart J. 2011;32:1769-818.

8. Chapman MJ, Ginsberg HN, Amarenco P. Euro-pean Atherosclerosis Society Consensus Panel.

Triglyceride-rich lipoproteins and high-density lipo-protein cholesterol in patients at high risk of cardio-vascular disease: evidence and guidance for management. Eur. Heart. J. 2011;32:1345-61.

9. Barter P, Gotto AM, LaRosa JC. HDL choles-terol, very low levels of LDL cholescholes-terol, and cardio-vascular events. N. Engl. J. Med. 2007;357:1301-10.

10. Hibi K, Kimura T, Kimura K. JAPAN-ACS In-vestigators. Clinically evident polyvascular disease and regression of coronary atherosclerosis after intensive statin therapy in patients with acute coronary syndrome: serial intravascular ultrasound from the Japanese assessment of pitavastatin and atorvastatin in acute coronary syndrome (JAPAN-ACS) trial. Atherosclerosis. 2011;219(2):743-9.

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ɋɬɚɬɬɹ ɧɚɞɿɣɲɥɚ ɞɨ ɪɟɞɚɤɰɿʀ 08.12.2014

ɍȾɄ 616.831-005.1:616.13-007.64-089-092-001.18

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Ⱦɧɿɩɪɨɩɟɬɪɨɜɫɶɤɚ ɨɛɥɚɫɧɚ ɤɥɿɧɿɱɧɚ ɥɿɤɚɪɧɹ ɿɦ.ȱ.ȱ.Ɇɟɱɧɢɤɨɜɚ ɜɿɞɞɿɥɟɧɧɹ ɧɟɣɪɨɪɟɚɧɿɦɚɰɿʀ

ɩɥ.ɀɨɜɬɧɟɜɚ, 14, Ⱦɧɿɩɪɨɩɟɬɪɨɜɫɶɤ, 49000, ɍɤɪɚʀɧɚ Dnipropetrovsk Mechnikov Regional Clinical Hospital Intensive neurocare unit

October sq. 14, Dnipropetrovsk, 49000, Ukraine e-mail: dudukina@ukr.net

Ʉɥɸɱɨɜɿ ɫɥɨɜɚ:ɿɧɬɪɚɤɪɚɧɿɚɥɶɧɿ ɚɧɟɜɪɢɡɦɚɬɢɱɧɿ ɤɪɨɜɨɜɢɥɢɜɢ,ɮɚɤɬɨɪɢ ɪɢɡɢɤɭ,ɬɟɪɚɩɟɜɬɢɱɧɚ ɝɿɩɨɬɟɪɦɿɹ,

ɩɪɚɜɢɥɚ ɩɪɨɝɧɨɡɭɜɚɧɧɹ

Key words: intracranial aneurism hemorrhage, risk factors, therapeutic hypothermia, rules of prognosis

Ɋɟɮɟɪɚɬ. Ɉɬɞɚɥɟɧɧɵɟ ɪɟɡɭɥɶɬɚɬɵ ɥɟɱɟɧɢɹ ɛɨɥɶɧɵɯ ɫ ɢɧɬɪɚɤɪɚɧɢɚɥɶɧɵɦɢ ɚɧɟɜɪɢɡɦɚɬɢɱɟɫɤɢɦɢ

ɤɪɨɜɨɢɡɥɢɹɧɢɹɦɢ ɢ ɢɯ ɩɪɨɝɧɨɡɢɪɨɜɚɧɢɟ. Ⱦɭɞɭɤɢɧɚ ɋ.Ⱥ. Ɉɰɟɧɟɧɵ ɪɟɡɭɥɶɬɚɬɵ ɥɟɱɟɧɢɹ 260 ɩɚɰɢɟɧɬɨɜ ɫ