Current approaches to the treatment of endometrial hyperplasia in women with uterine leiomyoma

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7. Nojima M, Suzuki H, Toyota M. et al. Frequent epigenetic inactivation of SFRP genes and constitutive activation of Wnt signaling in gastric cancer. Oncogene. 2007;26:4699–713.

8. Suzuki H, Toyota M, Caraway H. et al. Frequent epigenetic inactivation of Wnt antagonist genes in breast cancer. Br. J. Cancer. 2008;98:1147–56.

9. Yau TO, Chan CY, Chan KL, Lee MF, Wong CM, Fan ST, Ng IO. HDPR1, a novel inhibitor of the WNT/beta-catenin signaling, is frequently downregulated in hepatocellular carcinoma: involvement of methylation-mediated gene silencing. Oncogene. 2005;24:1607–14.

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13. Kawano Y, Kypta R. Secreted antagonists of the Wnt signaling pathway. J. Cell Sci. 2003;116:2627–34.

14. Gandhirajan RK, Staib PA, Minke K, Gehrke I, Plickert G, Schlösser A, Schmitt EK, Hallek M, Kreuzer KA. Small molecule inhibitors of Wnt/beta-catenin/lef-1 signaling induces apoptosis in chronic lymphocytic leuke-mia cells in vitro and in vivo. Neoplasia. 2010;12:326–35.

ɍȾɄ 618.14:616-006.36-089:612.6

ȼ.Ɉ.ɉɨɬɚɩɨɜ, ɘ.ȼ.Ⱦɨɧɫɶɤɚ, Ɇ.ȼ.Ɇɟɞɜɟɞɽɜ

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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, Dnɿpropetrovsk, 49044, Ukraine e-mail: medvedev.mv@gmail.com

Ʉɥɸɱɨɜɿ ɫɥɨɜɚ:ɥɟɣɨɦɿɨɦɚ ɦɚɬɤɢ,ɝɿɩɟɪɩɥɚɡɿɹ ɟɧɞɨɦɟɬɪɿɹ,ɤɨɧɫɟɪɜɚɬɢɜɧɚ ɦɿɨɦɟɤɬɨɦɿɹ,ɨɪɝɚɧɨɡɛɟɪɿɝɚɸɱɟ ɥɿɤɭɜɚɧɧɹ,ɚɝɨɧɿɫɬɢ ȽɧɊȽ,ɄɈɄ

Key words: uterine leiomyoma, endometrial hyperplasia, myomectomy, conservative treatment, GnRH agonists, OCPs

Ɋɟɮɟɪɚɬ. ɋɨɜɪɟɦɟɧɧɵɟ ɩɨɞɯɨɞɵ ɤ ɥɟɱɟɧɢɸ ɝɢɩɟɪɩɥɚɡɢɢ ɷɧɞɨɦɟɬɪɢɹ ɭ ɠɟɧɳɢɧ ɫ ɥɟɣɨɦɢɨɦɨɣ ɦɚɬɤɢ.

(2)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

Abstract. Current approaches to the treatment of endometrial hyperplasia in women with uterine leiomyoma. Potapov V.A., Donskaya Yu.V., Medvediev M.V. The study involved 155 women, of which 30 healthy women were in the control group. 125 women with uterine leiomyomas and endometrial hyperplasia constituted the main groups. In all women with uterine leiomyoma myomectomy was performed. Further treatment included randomized study of a new regimen of GnRH agonists together with COCs after myomectomy using comparison techniques: monotherapy with a-GnRH, progestins (dydrogesterone) or COCs. The treatment using different medication regimens of endometrial hyperplasia after myomectomy convincingly demonstrated significantly greater efficacy of GnRH-a and COCs com-bination in reducing frequency of symptoms of these diseases, volume of menstrual blood loss and improvement quality of life through the entire observation period. Greater efficacy of COCs and a-GnRH combination, to our opinion, is associated with a greater degree of suppression of cell proliferation and angiogenesis as a result of local (COCs), and systemic effects (a-GnRH).Thus, the proposed method of adjuvant therapy after myomectomy for women with as-sociated endometrial hyperplasia has significant clinical benefits with minimal impact on bone mineral density and other menopausal signs caused by a-GnRH monotherapy.

Ɋɟɩɪɨɞɭɤɬɢɜɧɟ ɡɞɨɪɨɜ’ɹ ɠɿɧɨɤ ɽ ɨɞɧɢɦ ɿɡ

ɩɪɿɨɪɢɬɟɬɧɢɯ ɧɚɩɪɹɦɤɿɜ ɫɭɱɚɫɧɨʀ ɦɟɞɢɰɢɧɢ. Ɉɞ

-ɧɢɦ ɿɡ ɮɚɤɬɨɪɿɜ, ɳɨ ɧɟɝɚɬɢɜɧɨ ɜɩɥɢɜɚɸɬɶ ɧɚ

ɠɿɧɨɱɭ ɪɟɩɪɨɞɭɤɬɢɜɧɭ ɮɭɧɤɰɿɸ, ɽ ɥɟɣɨɦɿɨɦɚ

ɦɚɬɤɢ (ɅɆ) – ɧɚɣɛɿɥɶɲ ɩɨɲɢɪɟɧɚ ɩɭɯɥɢɧɚ ɠɿɧɨ

-ɱɨʀ ɪɟɩɪɨɞɭɤɬɢɜɧɨʀ ɫɢɫɬɟɦɢ, ɹɤɚ ɡɧɢɠɭɽ ɪɟɩɪɨ

-ɞɭɤɬɢɜɧɢɣ ɩɨɬɟɧɰɿɚɥ, ɩɪɚɰɟɡɞɚɬɧɿɫɬɶ ɬɚ ɹɤɿɫɬɶ

ɠɢɬɬɹ ɠɿɧɨɤ [1, 3].

ɍ ɤɨɠɧɨʀ ɞɪɭɝɨʀ ɯɜɨɪɨʀ ɡ ɅɆ ɫɩɨɫɬɟɪɿɝɚɸɬɶɫɹ ɝɿɩɟɪɩɥɚɫɬɢɱɧɿ ɩɪɨɰɟɫɢ ɟɧɞɨɦɟɬɪɿɹ (Ƚȿ).ɇɚ ɫɶɨ

-ɝɨɞɧɿ ɡɨɥɨɬɢɦ ɫɬɚɧɞɚɪɬɨɦ ɬɟɪɚɩɿʀ ɝɿɩɟɪɩɥɚɫɬɢɱ

-ɧɢɯ ɩɪɨɰɟɫɿɜ ɟɧɞɨɦɟɬɪɿɹ ɜɜɚɠɚɽɬɶɫɹ ɩɪɢɡɧɚɱɟɧɧɹ ɩɪɟɩɚɪɚɬɿɜ ɝɪɭɩɢ ɝɟɫɬɚɝɟɧɿɜ.Ɉɞɧɚɤ ɡɚɫɬɨɫɭɜɚɧɧɹ

ɝɟɫɬɚɝɟɧɿɜ, ɧɟɨɛɯɿɞɧɟ ɞɥɹ ɞɨɫɹɝɧɟɧɧɹ ɬɚ ɩɿɞ

-ɬɪɢɦɤɢ ɥɿɤɭɜɚɥɶɧɨɝɨ ɟɮɟɤɬɭ Ƚȿ, ɱɚɫɬɨ ɨɛɦɟɠɟɧɟ

ɡ ɭɪɚɯɭɜɚɧɧɹɦ ɫɭɱɚɫɧɨʀ ɤɨɧɰɟɩɰɿʀ ɩɚɬɨɝɟɧɟɡɭ ɅɆ ɹɤ ɝɨɪɦɨɧɨɡɚɥɟɠɧɨɝɨ ɡɚɯɜɨɪɸɜɚɧɧɹ ɡ ɞɨɦɿɧɭɸ

-ɱɢɦ ɧɟɝɚɬɢɜɧɢɦ ɜɩɥɢɜɨɦ ɩɪɨɝɟɫɬɟɪɨɧɭ,ɭ ɡɜ’ɹɡɤɭ

ɡ ɱɢɦ ɞɨɜɨɞɢɬɶɫɹ ɡɿɲɬɨɜɯɭɜɚɬɢɫɹ ɡ ɪɟɰɢɞɢɜɚɦɢ ɥɟɣɨɦɿɨɦɢ.ɐɢɦ ɦɨɠɧɚ ɩɨɹɫɧɢɬɢ ɜɿɞɫɭɬɧɿɫɬɶ ɨɛ

-ʉɪɭɧɬɨɜɚɧɢɯ ɪɟɤɨɦɟɧɞɚɰɿɣ ɳɨɞɨ ɜɢɛɨɪɭ ɥɿɤɭ

-ɜɚɥɶɧɨɝɨ ɡɚɫɨɛɭ, ɞɨɡɭɜɚɧɧɹ, ɨɩɬɢɦɚɥɶɧɨʀ ɬɪɢɜɚ

-ɥɨɫɬɿ ɣɨɝɨ ɡɚɫɬɨɫɭɜɚɧɧɹ ɩɪɢ ɥɿɤɭɜɚɧɧɿ ɝɿɩɟɪ

-ɩɥɚɫɬɢɱɧɢɯ ɩɪɨɰɟɫɿɜ ɟɧɞɨɦɟɬɪɿɹ ɭ ɠɿɧɨɤ ɡ ɥɟɣɨ

-ɦɿɨɦɨɸ ɦɚɬɤɢ, ɹɤɿ ɛɚɠɚɸɬɶ ɡɛɟɪɟɝɬɢ ɪɟɩɪɨɞɭɤ

-ɬɢɜɧɭ ɮɭɧɤɰɿɸ [4, 6].

Ɇɟɬɨɸ ɞɨɫɥɿɞɠɟɧɧɹ ɛɭɥɨ ɭɞɨɫɤɨɧɚɥɟɧɧɹ ɬɟ

-ɪɚɩɿʀ ɝɿɩɟɪɩɥɚɡɿʀ ɟɧɞɨɦɟɬɪɿɹ ɭ ɠɿɧɨɤ ɡ ɥɟɣɨɦɿɨ

-ɦɨɸ ɦɚɬɤɢ.

ɆȺɌȿɊȱȺɅɂ ɌȺ ɆȿɌɈȾɂ ȾɈɋɅȱȾɀȿɇɖ

ɍ ɤɥɿɧɿɱɧɨɦɭ ɞɨɫɥɿɞɠɟɧɧɿ ɛɪɚɥɨ ɭɱɚɫɬɶ 155

ɫɨɦɚɬɢɱɧɨ ɡɞɨɪɨɜɢɯ ɠɿɧɨɤ ɪɟɩɪɨɞɭɤɬɢɜɧɨɝɨ ɜɿɤɭ.Ʉɨɧɬɪɨɥɶɧɭ ɝɪɭɩɭ (ɄȽ)ɫɤɥɚɥɢ 30 ɡɞɨɪɨɜɢɯ

ɠɿɧɨɤ ɪɟɩɪɨɞɭɤɬɢɜɧɨɝɨ ɜɿɤɭ. Ⱦɨ ɨɫɧɨɜɧɢɯ ɝɪɭɩ

ɭɜɿɣɲɥɢ 125 ɠɿɧɨɤ ɿɡ ɫɢɦɩɬɨɦɧɨɸ ɅɆ ɬɚ Ƚȿ (ɩɪɨɫɬɚ ɚɛɨ ɤɨɦɩɥɟɤɫɧɚ ɛɟɡ ɚɬɢɩɿʀ).ȼɫɿɦ ɠɿɧɤɚɦ

ɨɫɧɨɜɧɢɯ ɝɪɭɩ ɧɚ ɩɟɪɲɨɦɭ ɟɬɚɩɿ ɛɭɥɚ ɜɢɤɨɧɚɧɚ ɤɨɧɫɟɪɜɚɬɢɜɧɚ ɦɿɨɦɟɤɬɨɦɿɹ. Ƚɪɭɩɭ ȱ ɫɤɥɚɥɢ 30

ɠɿɧɨɤ ɡ ɅɆ ɬɚ Ƚȿ, ɹɤɿ ɨɬɪɢɦɭɜɚɥɢ ɬɪɚɞɢɰɿɣɧɟ

ɥɿɤɭɜɚɧɧɹ ɜ ɩɿɫɥɹɨɩɟɪɚɰɿɣɧɨɦɭ ɩɟɪɿɨɞɿ ɡɝɿɞɧɨ ɡ ɤɥɿɧɿɱɧɢɦ ɩɪɨɬɨɤɨɥɨɦ «Ƚɿɩɟɪɩɥɚɡɿɹ ɟɧɞɨɦɟɬɪɿɹ»,

ɚ ɫɚɦɟ ɞɿɞɪɨɝɟɫɬɟɪɨɧ 10 ɦɝ ɯ 2 ɪɚɡɢ ɧɚ ɞɨɛɭ ɡ 5

ɩɨ 25 ɞɟɧɶ ɦɟɧɫɬɪɭɚɥɶɧɨɝɨ ɰɢɤɥɭ (ɬɚɛɥ. 1).

Ɍ ɚ ɛ ɥ ɢ ɰ ɹ 1

Ɋɨɡɩɨɞɿɥ ɠɿɧɨɤ ɧɚ ɝɪɭɩɢ

Ƚɪɭɩɢ Ʉɿɥɶɤɿɫɬɶ ɯɜɨɪɢɯ ɏɚɪɚɤɬɟɪɢɫɬɢɤɚ ɝɪɭɩ

ɄȽ 30 Ɂɞɨɪɨɜɿ ɠɿɧɤɢ

Ƚɪɭɩɚ ȱ 30 ɀɿɧɤɢ ɡ ɅɆ ɬɚ Ƚȿ,ɝɟɫɬɚɝɟɧ

Ƚɪɭɩɚ ȱȱ 30 ɀɿɧɤɢ ɡ ɅɆ ɬɚ Ƚȿ,ɚ-ȽɧɊȽ

Ƚɪɭɩɚ ȱȱȱ 30 ɀɿɧɤɢ ɡ ɅɆ ɬɚ Ƚȿ,ɄɈɄ

Ƚɪɭɩɚ ȱV 35 ɀɿɧɤɢ ɡ ɅɆ ɬɚ Ƚȿ,ɚ-ȽɧɊȽ+ɄɈɄ

Ƚɪɭɩɭ ȱȱ ɫɤɥɚɥɢ 30 ɠɿɧɨɤ ɡ Ƚȿ ɬɚ ɅɆ, ɹɤɿ ɨɬ

-ɪɢɦɭɜɚɥɢ ɚɝɨɧɿɫɬ ɝɨɧɚɞɨɬɪɨɩɿɧ-ɪɟɥɿɡɢɧɝ ɝɨɪɦɨɧɭ (ɚ-ȽɧɊȽ), ɚ ɫɚɦɟ ɥɟɣɩɪɨɥɿɞɭ ɚɰɟɬɚɬ 3,75 ɦɝ ɩ/ɲ

ɱɟɪɟɡ ɤɨɠɧɿ 28 ɞɿɛ. Ƚɪɭɩɭ ȱȱȱ ɫɤɥɚɥɢ 30 ɠɿɧɨɤ ɡ

Ƚȿ ɬɚ ɅɆ,ɹɤɿ ɨɬɪɢɦɭɜɚɥɢ ɦɿɤɪɨɞɨɡɨɜɚɧɢɣ ɨɪɚɥɶ

-ɧɢɣ ɤɨɧɬɪɚɰɟɩɬɢɜ (ɄɈɄ),ɳɨ ɦɿɫɬɢɬɶ 20 ɦɤɝ ɟɬɢ

-ɧɿɥɟɫɬɪɚɞɿɨɥɭ ɬɚ 75 ɦɤɝ ɝɟɫɬɨɞɟɧɭ ɭ ɤɨɠɧɿɣ ɤɚɩ

-ɫɭɥɿ ɜ ɛɟɡɩɟɪɟɪɜɧɨɦɭ ɪɟɠɢɦɿ.Ƚɪɭɩɭ ȱVɫɤɥɚɥɢ 35

(3)

Ɍɪɢɜɚɥɿɫɬɶ ɥɿɤɭɜɚɧɧɹ ɫɬɚɧɨɜɢɥɚ 6 ɦɿɫɹɰɿɜ,

ɩɿɫɥɹ ɱɨɝɨ ɩɪɨɜɨɞɢɥɨɫɶ ɭɥɶɬɪɚɡɜɭɤɨɜɟ ɞɨɫɥɿɞ

-ɠɟɧɧɹ (ɍɁȾ) ɬɚ ɛɿɨɩɫɿɹ ɟɧɞɨɦɟɬɪɿɹ. ɉɨɞɚɥɶɲɟ

ɫɩɨɫɬɟɪɟɠɟɧɧɹ ɡ ɍɁȾ ɩɪɨɜɨɞɢɥɨɫɶ ɱɟɪɟɡ 12

ɦɿɫɹɰɿɜ ɩɿɫɥɹ ɨɩɟɪɚɬɢɜɧɨɝɨ ɥɿɤɭɜɚɧɧɹ ɿ ɧɚɞɚɥɿ ɳɨɪɿɱɧɨ.

ɉɨ ɡɚɜɟɪɲɟɧɧɿ 6-ɦɿɫɹɱɧɨɝɨ ɤɭɪɫɭ ɥɿɤɭɜɚɧɧɹ

ɪɟɤɨɦɟɧɞɭɜɚɜɫɹ ɩɨɞɚɥɶɲɢɣ ɩɪɢɣɨɦ ɄɈɄ ɡ ɦɟ

-ɬɨɸ ɩɪɨɮɿɥɚɤɬɢɤɢ ɪɟɰɢɞɢɜɭɜɚɧɧɹ Ƚȿ ɬɚ ɅɆ.

Ɍɪɢɜɚɥɿɫɬɶ ɡɚɫɬɨɫɭɜɚɧɧɹ ɄɈɄ ɫɬɚɧɨɜɢɥɚ 3 ɦɿɫɹɰɿ

ɬɚ ɞɨɜɲɟ ɩɪɢ ɛɚɠɚɧɧɿ ɩɚɰɿɽɧɬɤɢ ɦɚɬɢ ɤɨɧ

-ɬɪɚɰɟɩɰɿɸ.

ȼɫɿ ɩɚɰɿɽɧɬɤɢ ɛɭɥɢ ɨɝɥɹɧɭɬɿ ɧɚɩɟɪɟɞɨɞɧɿ ɜɬɪɭɱɚɧɧɹ, ɛɭɜ ɪɟɬɟɥɶɧɨ ɡɿɛɪɚɧɢɣ ɚɧɚɦɧɟɡ, ɜɢ

-ɤɨɧɚɧɨ ɍɁȾ ɨɪɝɚɧɿɜ ɦɚɥɨɝɨ ɬɚɡɭ.ɉɨɜɬɨɪɧɟ ɍɁȾ,

ɨɝɥɹɞ ɝɿɧɟɤɨɥɨɝɚ ɬɚ ɚɧɤɟɬɭɜɚɧɧɹ ɛɭɥɢ ɜɢɤɨɧɚɧɿ ɱɟɪɟɡ 1, 3, 6, 12 ɦɿɫɹɰɿɜ ɩɿɫɥɹ ɨɩɟɪɚɰɿʀ.ɉɨɞɚɥɶɲɟ

ɨɛɫɬɟɠɟɧɧɹ ɩɪɨɜɨɞɢɥɨɫɶ ɳɨɪɿɱɧɨ. ɍ ɪɚɡɿ ɧɚɫ

-ɬɚɧɧɹ ɜɚɝɿɬɧɨɫɬɿ ɜɿɞɫɬɟɠɭɜɚɜɫɹ ʀʀ ɩɟɪɟɛɿɝ ɬɚ ɧɚɫɥɿɞɤɢ.

Ɂ ɦɟɬɨɸ ɨɰɿɧɤɢ ɹɤɨɫɬɿ ɠɢɬɬɹ ɜɢɤɨɪɢɫɬɨɜɭɜɚɥɢ ɲɤɚɥɭ UFS-QOL, ɹɤɚ ɛɭɥɚ ɪɨɡɪɨɛɥɟɧɚ ɞɥɹ ɰɿɽʀ

ɤɚɬɟɝɨɪɿʀ ɠɿɧɨɤ Spies J.B. et al. (2002) [7] ɿ ɩɟɪɟ

-ɤɥɚɞɟɧɚ ɭɤɪɚʀɧɫɶɤɨɸ ɦɨɜɨɸ ɬɚ ɚɞɚɩɬɨɜɚɧɚ ɚɜ

-ɬɨɪɚɦɢ. Ɂ ɦɟɬɨɸ ɨɰɿɧɤɢ ɫɬɭɩɟɧɹ ɤɪɨɜɨɜɬɪɚɬɢ

ɛɭɥɚ ɜɢɤɨɪɢɫɬɚɧɚ ɦɨɞɢɮɿɤɨɜɚɧɚ ɜɿɡɭɚɥɶɧɚ ɲɤɚɥɚ ɨɰɿɧɤɢ ɤɪɨɜɨɜɬɪɚɬɢ PBAC, ɡɚɩɪɨɩɨɧɨɜɚɧɚ

Higham et al. (1990) [5]. Ɉɛ’ɽɦ ɤɪɨɜɨɜɬɪɚɬɢ, ɜɿɞ

-ɩɨɜɿɞɧɢɣ ɞɿɚɝɧɨɡɭ ɦɟɧɨɪɚɝɿɹ, ɜɫɬɚɧɨɜɥɟɧɨ 100

ɛɚɥɿɜ, ɳɨ ɞɥɹ ɡɪɭɱɧɨɫɬɿ ɩɪɢɪɿɜɧɸɜɚɥɨɫɶ 100 ɦɥ.

ɉɚɰɿɽɧɬɤɢ ɡɚɩɨɜɧɸɜɚɥɢ ɚɧɤɟɬɢ ɧɚɩɟɪɟɞɨɞɧɿ

Ɉɬɪɢɦɚɧɿ ɞɚɧɿ ɨɛɪɨɛɥɹɥɢɫɹ ɡɚ ɞɨɩɨɦɨɝɨɸ ɩɪɨɝɪɚɦɢ Statistica (ɜɟɪɫɿɹ 6.1;Statsoft, ɋɒȺ). ɍ

ɞɨɫɥɿɞɠɟɧɧɿ ɛɭɥɨ ɩɪɢɣɧɹɬɨ ɪɿɜɟɧɶ ɫɬɚɬɢɫɬɢɱɧɨʀ ɡɧɚɱɭɳɨɫɬɿ p<0,05. Ⱦɥɹ ɩɨɪɿɜɧɹɧɧɹ ɞɨɫɥɿɞɠɭ

-ɜɚɧɢɯ ɝɪɭɩ ɜɢɤɨɪɢɫɬɨɜɭɜɚɥɢɫɹ ɩɚɪɚɦɟɬɪɢɱɧɿ ɬɚ ɧɟɩɚɪɚɦɟɬɪɢɱɧɿ ɤɪɢɬɟɪɿʀ ɡɚɥɟɠɧɨ ɜɿɞ ɧɨɪɦɚɥɶ

-ɧɨɫɬɿ ɪɨɡɩɨɞɿɥɭ [2].

ɊȿɁɍɅɖɌȺɌɂ ɌȺ Ȳɏ ɈȻȽɈȼɈɊȿɇɇə

ɋɟɪɟɞɧɿɣ ɩɟɪɿɨɞ ɫɩɨɫɬɟɪɟɠɟɧɧɹ ɡɚ ɠɿɧɤɚɦɢ ɫɬɚɧɨɜɢɜ 29,7±4,3 ɦɿɫɹɰɹ. Ɇɿɧɿɦɚɥɶɧɢɣ ɬɟɪɦɿɧ – 12 ɦɿɫɹɰɿɜ, ɦɚɤɫɢɦɚɥɶɧɢɣ – 36 ɦɿɫɹɰɿɜ. Ʉɥɿɧɿɱɧɿ

ɝɪɭɩɢ, ɳɨ ɞɨɫɥɿɞɠɭɜɚɥɢɫɶ, ɧɟ ɜɿɞɪɿɡɧɹɥɢɫɹ ɜɿɪɨ

-ɝɿɞɧɨ ɦɿɠ ɫɨɛɨɸ ɡɚ ɜɿɤɨɦ, ɿɧɞɟɤɫɨɦ ɦɚɫɢ ɬɿɥɚ ɬɚ

ɬɪɢɜɚɥɿɫɬɸ ɩɟɪɿɨɞɭ ɫɩɨɫɬɟɪɟɠɟɧɧɹ (p>0,05).

ɉɪɢ ɨɰɿɧɰɿ ɪɟɡɭɥɶɬɚɬɿɜ ɦɿɨɦɟɤɬɨɦɿʀ ɡɚ ɨɫ

-ɧɨɜɧɢɦɢ ɿɧɬɪɚɨɩɟɪɚɰɿɣɧɢɦɢ ɯɚɪɚɤɬɟɪɢɫɬɢɤɚɦɢ:

ɬɪɢɜɚɥɿɫɬɶ ɜɬɪɭɱɚɧɧɹ, ɫɟɪɟɞɧɹ ɦɚɫɚ ɜɢɞɚɥɟɧɢɯ

ɜɭɡɥɿɜ, ɫɟɪɟɞɧɿɣ ɞɿɚɦɟɬɪ ɞɨɦɿɧɚɧɬɧɨɝɨ ɜɭɡɥɚ ɬɚ

ɿɧɬɪɚɨɩɟɪɚɰɿɣɧɨɸ ɤɪɨɜɨɜɬɪɚɬɨɸ (ɬɚɛɥ. 2) ɧɟ

ɛɭɥɨ ɡɧɚɣɞɟɧɨ ɫɬɚɬɢɫɬɢɱɧɨ ɡɧɚɱɭɳɨʀ ɪɿɡɧɢɰɿ ɦɿɠ ɿɧɬɪɚɨɩɟɪɚɰɿɣɧɢɦɢ ɩɨɤɚɡɧɢɤɚɦɢ ɝɪɭɩ, ɳɨ ɞɨ

-ɫɥɿɞɠɭɜɚɥɢɫɶ (p>0,05). Ʉɪɿɦ ɬɨɝɨ, ɧɟ ɛɭɥɨ ɜɿɪɨ

-ɝɿɞɧɨʀ ɪɿɡɧɢɰɿ ɡɚ ɬɚɤɢɦɢ ɩɚɪɚɦɟɬɪɚɦɢ, ɳɨ ɧɟ

ɜɤɚɡɚɧɿ ɜ ɬɚɛɥɢɰɿ ɱɟɪɟɡ ɧɟɜɟɥɢɤɭ ɱɚɫɬɨɬɭ: ɤɿɥɶ

-ɤɿɫɬɶ ɝɟɦɨɬɪɚɧɫɮɭɡɿɣ, ɬɪɨɦɛɨɟɦɛɨɥɿɱɧɢɯ, ɫɟɩ

-ɬɢɱɧɢɯ ɬɚ ɿɧɲɢɯ ɡɚɝɚɥɶɧɨɯɿɪɭɪɝɿɱɧɢɯ ɭɫɤɥɚɞ

-ɧɟɧɶ. Ɉɬɠɟ, ɭɫɿ ɜɿɞɦɿɧɧɨɫɬɿ ɩɨɦɿɠ ɝɪɭɩɚɦɢ, ɹɤɿ

ɛɭɞɭɬɶ ɜɢɫɜɿɬɥɟɧɿ ɭ ɩɨɞɚɥɶɲɨɦɭ,ɛɭɥɢ ɡɚ ɪɚɯɭɧɨɤ

ɩɿɫɥɹɨɩɟɪɚɰɿɣɧɨɝɨ ɦɟɞɢɤɚɦɟɧɬɨɡɧɨɝɨ ɥɿɤɭɜɚɧɧɹ.

ɏɚɪɚɤɬɟɪɢɫɬɢɤɢ ɞɨɫɥɿɞɠɭɜɚɧɢɯ ɝɪɭɩ ɩɿɞ ɱɚɫ ɜɢɤɨɧɚɧɧɹ ɦɿɨɦɟɤɬɨɦɿʀ

ɉɚɪɚɦɟɬɪ _(n=30)ɄȽ _(n=30)ȱ _(n=30)ȱȱ _(n=30)ȱȱȱ _(n=35)ȱV

Ɍɪɢɜɚɥɿɫɬɶ ɜɬɪɭɱɚɧɧɹ,ɯɜ. (M±m) - 53,2±2,3 55,1±2,4 52,1±4,2 54,0±4,6

ɋɟɪɟɞɧɹ ɦɚɫɚ ɜɢɞɚɥɟɧɢɯ ɜɭɡɥɿɜ,ɝ(M±m) - 101±5,3 96±5,3 102±6,9 107±5,9

ɋɟɪɟɞɧɹ ɤɿɥɶɤɿɫɬɶ ɜɢɞɚɥɟɧɢɯ ɜɭɡɥɿɜ ɭ ɨɞɧɿɽʀ ɠɿɧɤɢ (M±m) - 2,7±0,5 3,1±0,2 3,2±0,2 3,3±0,2

ɋɟɪɟɞɧɿɣ ɞɿɚɦɟɬɪ ɞɨɦɿɧɚɧɬɧɨɝɨ ɜɭɡɥɚ,ɫɦ (Ɇ±m) - 4,2±0,4 4,2±0,3 4,0±0,5 3,9±0,6

Ʉɪɨɜɨɜɬɪɚɬɚ,ɦɥ (Ɇ±m) - 79,5±8,4 83,4±6,7 84,3±9,5 84,8±9,3

ɉ ɪ ɢ ɦ ɿ ɬ ɤ ɚ. ȼɿɪɨɝɿɞɧɨʀ ɪɿɡɧɢɰɿ ɩɨɦɿɠ ɝɪɭɩɚɦɢ ɩɪɢ ɪ<0,05 ɧɟ ɜɢɹɜɥɟɧɨ.

ɇɚɩɟɪɟɞɨɞɧɿ ɿɧɜɚɡɢɜɧɨɝɨ ɥɿɤɭɜɚɧɧɹ ɛɭɥɨ ɩɪɨ

-ɜɟɞɟɧɨ ɚɧɚɥɿɡ ɪɨɡɩɨɜɫɸɞɠɟɧɨɫɬɿ ɨɫɧɨɜɧɢɯ ɫɢɦ

-ɩɬɨɦɿɜ ɥɟɣɨɦɿɨɦɢ ɦɚɬɤɢ ɬɚ ɝɿɩɟɪɩɥɚɡɿʀ ɟɧɞɨ

-ɦɟɬɪɿɹ.Ȼɭɥɨ ɜɫɬɚɧɨɜɥɟɧɨ,ɳɨ ɩɨɲɢɪɟɧɿɫɬɶ ɝɟɦɨ

-ɪɚɝɿɱɧɨɝɨ, ɛɨɥɶɨɜɨɝɨ ɬɚ ɫɢɦɩɬɨɦɿɜ ɫɬɢɫɧɟɧɧɹ

ɫɭɦɿɠɧɢɯ ɨɪɝɚɧɿɜ ɩɟɪɟɜɢɳɭɜɚɥɚ ɜ ɨɫɧɨɜɧɢɯ ɝɪɭɩɚɯ ɩɨɤɚɡɧɢɤ ɤɨɧɬɪɨɥɶɧɨʀ ɝɪɭɩɢ ɜ 3,6 ɪɚɡɭ (p<0,05).

ɋɬɚɬɢɫɬɢɱɧɨ ɡɧɚɱɭɳɨʀ ɪɿɡɧɢɰɿ ɩɨɦɿɠ ɨɫɧɨɜɧɢɦɢ ɝɪɭɩɚɦɢ, ɳɨ ɞɨɫɥɿɞɠɭɜɚɥɢɫɶ, ɜɢɹɜɥɟɧɨ ɧɟ ɛɭɥɨ

(4)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

ɉɪɢ ɨɰɿɧɰɿ ɤɨɪɨɬɤɨɬɪɢɜɚɥɢɯ ɪɟɡɭɥɶɬɚɬɿɜ ɥɿɤɭ

-ɜɚɧɧɹ ɩɨɽɞɧɚɧɧɹ ɅɆ ɡ Ƚȿ (ɬɚɛɥ. 3) ɛɭɥɨ ɜɢɹɜ

-ɥɟɧɨ ɜɿɞɦɿɧɧɨɫɬɿ ɩɨɦɿɠ ɝɪɭɩɚɦɢ, ɳɨ ɞɨɫɥɿɞ

-ɠɭɜɚɥɢɫɶ. Ɍɚɤ, ɝɪɭɩɢ, ɞɟ ɜɢɤɨɪɢɫɬɨɜɭɜɚɥɢɫɶ ɚ

-ȽɧɊȽ ɬɚ ɤɨɦɛɿɧɚɰɿɹ ɚ-ȽɧɊȽ ɡ ɄɈɄ ɜ ɰɿɥɨɦɭ,ɦɚɥɢ

ɦɟɧɲɭ ɤɿɥɶɤɿɫɬɶ ɠɿɧɨɤ ɡ ɨɫɧɨɜɧɢɦɢ ɫɢɦɩɬɨɦɚɦɢ ɝɿɩɟɪɩɪɨɥɿɮɟɪɚɬɢɜɧɢɯ ɡɚɯɜɨɪɸɜɚɧɶ, ɚɥɟ ɰɿ ɜɿɞ

-ɦɿɧɧɨɫɬɿ ɧɟ ɛɭɥɢ ɜɿɪɨɝɿɞɧɢɦɢ (p>0,05).

Ʉɥɿɧɿɱɧɿ ɫɢɦɩɬɨɦɢ ɥɟɣɨɦɿɨɦɢ ɦɚɬɤɢ ɬɚ ɝɿɩɟɪɩɥɚɡɿʀ ɟɧɞɨɦɟɬɪɿɹ ɱɟɪɟɡ ɬɪɢ ɦɿɫɹɰɿ ɩɿɫɥɹ ɿɧɜɚɡɢɜɧɨɝɨ ɥɿɤɭɜɚɧɧɹ,ɚɛɫ.ɱ. (%)

ɋɢɦɩɬɨɦ _(n=30)ɄȽ _(n=30)ȱ _(n=30)ȱȱ _(n=30)ȱȱȱ _(n=35)ȱV

Ƚɟɦɨɪɚɝɿɱɧɢɣ ɫɢɧɞɪɨɦ - 2

(6,7)

-2

(6,7)

-Ȼɨɥɶɨɜɢɣ ɫɢɧɞɪɨɦ - 5

(16,7)

2 (6,7)

4

(13,3)

-ɋɬɢɫɧɟɧɧɹ ɫɭɦɿɠɧɢɯ ɨɪɝɚɧɿɜ - 1

(3,3)

1

(3,3) - -

Ȼɟɡɫɢɦɩɬɨɦɧɢɣ ɩɟɪɟɛɿɝ 30 (100,0) 25 (83,3)

28 (93,3)

26 (86,7)

35 (100,0)

ɉ ɪ ɢ ɦ ɿ ɬ ɤ ɚ.ȼɿɪɨɝɿɞɧɨʀ ɪɿɡɧɢɰɿ ɩɨɦɿɠ ɝɪɭɩɚɦɢ ɩɪɢ ɪ<0,05 ɧɟ ɜɢɹɜɥɟɧɨ.

ɉɪɢ ɨɰɿɧɰɿ ɞɨɜɝɨɬɪɢɜɚɥɢɯ ɪɟɡɭɥɶɬɚɬɿɜ ɥɿɤɭ

-ɜɚɧɧɹ ɩɨɽɞɧɚɧɧɹ ɅɆ ɡ Ƚȿ (ɬɚɛɥ. 4) ɛɭɥɨ

ɜɢɹɜɥɟɧɨ ɫɬɚɬɢɫɬɢɱɧɨ ɡɧɚɱɭɳɿ ɜɿɞɦɿɧɧɨɫɬɿ ɩɨɦɿɠ ɝɪɭɩɚɦɢ ɡɚɥɟɠɧɨ ɜɿɞ ɩɿɫɥɹɨɩɟɪɚɰɿɣɧɨɝɨ ɥɿɤɭɜɚɧ

-ɧɹ, ɳɨ ɡɚɫɬɨɫɨɜɭɜɚɥɨɫɶ. Ɍɚɤ, ɝɪɭɩɢ, ɞɟ ɜɢɤɨ

-ɪɢɫɬɨɜɭɜɚɥɢɫɶ ɚ-ȽɧɊȽ ɬɚ ɤɨɦɛɿɧɚɰɿɹ ɚ-ȽɧɊȽ ɡ

ɄɈɄ, ɦɚɥɢ ɜɿɪɨɝɿɞɧɨ ɦɟɧɲɭ ɤɿɥɶɤɿɫɬɶ ɠɿɧɨɤ ɡ

ɨɫɧɨɜɧɢɦɢ ɫɢɦɩɬɨɦɚɦɢ ɝɿɩɟɪɩɪɨɥɿɮɟɪɚɬɢɜɧɢɯ ɡɚɯɜɨɪɸɜɚɧɶ, ɬɚɤɢɦɢ ɹɤ: ɛɨɥɶɨɜɢɣ ɬɚ ɝɟɦɨ

-ɪɚɝɿɱɧɢɣ ɫɢɧɞɪɨɦ (p<0,05). Ɍɚɤɨɠ ɭ ɠɿɧɨɤ, ɭ

ɥɿɤɭɜɚɧɧɿ ɹɤɢɯ ɜɢɤɨɪɢɫɬɨɜɭɜɚɜɫɹ ɝɨɡɟɪɟɥɿɧ, ɛɭɥɚ

ɜɿɪɨɝɿɞɧɨ ɛɿɥɶɲɚ ɱɚɫɬɨɬɚ ɛɟɡɫɢɦɩɬɨɦɧɢɯ ɠɿɧɨɤ

(p<0,05). ɉɪɢɱɨɦɭ ɝɪɭɩɚ ȱV, ɞɟ ɜɢɤɨɪɢɫɬɨɜɭ

-ɜɚɥɚɫɶ ɤɨɦɛɿɧɚɰɿɹ ɚ-ȽɧɊȽ ɬɚ ɄɈɄ, ɡɚ ɱɚɫɬɨɬɨɸ

ɨɫɧɨɜɧɢɯ ɫɢɦɩɬɨɦɿɜ ɧɟ ɜɿɞɪɿɡɧɹɥɚɫɹ ɜɿɞ ɤɨɧɬɪɨɥɶɧɨʀ ɝɪɭɩɢ, ɳɨ ɫɜɿɞɱɢɬɶ ɩɪɨ ɧɚɣɜɢɳɭ

ɟɮɟɤɬɢɜɧɿɫɬɶ ɡɚɩɪɨɩɨɧɨɜɚɧɨʀ ɫɯɟɦɢ ɥɿɤɭɜɚɧɧɹ ɩɨɪɿɜɧɹɧɨ ɡ ɿɧɲɢɦɢ ɦɟɬɨɞɢɤɚɦɢ.

Ʉɥɿɧɿɱɧɿ ɫɢɦɩɬɨɦɢ ɥɟɣɨɦɿɨɦɢ ɦɚɬɤɢ ɬɚ ɝɿɩɟɪɩɥɚɡɿʀ ɟɧɞɨɦɟɬɪɿɹ ɱɟɪɟɡ ɞɜɚ ɪɨɤɢ ɬɚ ɛɿɥɶɲɟ ɩɿɫɥɹ ɿɧɜɚɡɢɜɧɨɝɨ ɥɿɤɭɜɚɧɧɹ,ɚɛɫ.ɱ. (%)

ɋɢɦɩɬɨɦ _(n=30)ɄȽ _(n=30)ȱ _(n=30)ȱȱ _(n=30)ȱȱȱ _(n=35)ȱV

Ƚɟɦɨɪɚɝɿɱɧɢɣ ɫɢɧɞɪɨɦ 1* (3,3)

8 (26,7)

4† (13,3)

9 (30,0)

2* (5,7)

Ȼɨɥɶɨɜɢɣ ɫɢɧɞɪɨɦ _(6,7)2* _(23,3)7 4†(13,3) 6 (20,0)

2* (5,7)

ɋɬɢɫɧɟɧɧɹ ɫɭɦɿɠɧɢɯ ɨɪɝɚɧɿɜ - 5

(16,7)

3 (10,0)

5 (16,7)

2* (5,7)

Ȼɟɡɫɢɦɩɬɨɦɧɢɣ ɩɟɪɟɛɿɝ 28* (93,3)

17 (56,7)

23† (76,7)

16 (53,3)

32* (91,4)

(5)

ɧɚɩɟɪɟɞɨɞɧɿ ɿɧɜɚɡɢɜɧɨɝɨ ɬɚ ɦɟɞɢɤɚɦɟɧɬɨɡɧɨɝɨ ɥɿɤɭɜɚɧɧɹ (ɪɢɫ. 1). Ⱥɥɟ ɧɚɩɪɢɤɿɧɰɿ ɫɩɨɫɬɟɪɟɠɟɧ

-ɧɹ ɪɿɡɧɢɰɹ ɩɨɦɿɠ ɝɪɭɩɚɦɢ ɧɚɛɭɥɚ ɿɫɬɨɬɧɨʀ ɜɿɞ

-ɦɿɧɧɨɫɬɿ. ɇɚɣɝɿɪɲɿ ɩɨɤɚɡɧɢɤɢ ɛɭɥɢ ɭ ɝɪɭɩɚɯ ȱ ɬɚ

ȱȱȱ,ɹɤɿ ɛɭɥɢ ɜɿɪɨɝɿɞɧɨ ɛɿɥɶɲɢɦɢ, ɧɿɠ ɭ ɝɪɭɩɚɯ ȱȱ,

ȱV ɬɚ ɤɨɧɬɪɨɥɶɧɿɣ ɝɪɭɩɿ (p<0,05). ɇɚɣɧɢɠɱɢɣ

ɩɪɢɡɧɚɱɚɥɨɫɹ ɤɨɦɛɿɧɨɜɚɧɟ ɥɿɤɭɜɚɧɧɹ. ɉɪɢɱɨɦɭ

ɰɟɣ ɩɨɤɚɡɧɢɤ ɞɨɪɿɜɧɸɜɚɜ ɩɨɤɚɡɧɢɤɭ ɤɨɧɬɪɨɥɶɧɨʀ ɝɪɭɩɢ, ɳɨ ɫɜɿɞɱɢɬɶ ɩɪɨ ɜɢɫɨɤɭ ɤɨɪɨɬɤɨɬɪɢɜɚɥɭ

ɬɚ ɞɨɜɝɨɬɪɢɜɚɥɭ ɟɮɟɤɬɢɜɧɿɫɬɶ ɤɨɦɛɿɧɚɰɿʀ ɄɈɄ ɬɚ ɚ-ȽɧɊȽ.

35,6±1,7

235±6,3 247,9±7,2 241,2±6,3 241,2±6,4

44,5±2,2

95,8±4,1

57,4±2,2*

88,3±5,2

35,3±1,2**

0 50 100 150 200 250 300

ɄȽ Ƚɪɭɩɚ ȱ Ƚɪɭɩɚ ȱȱ Ƚɪɭɩɚ ȱȱȱ Ƚɪɭɩɚ ȱV

ɦɥ

Ⱦɨ ɥɿɤɭɜɚɧɧɹ ɉɿɫɥɹ ɥɿɤɭɜɚɧɧɹ

ɉ ɪ ɢ ɦ ɿ ɬ ɤ ɢ: * – ɜɿɞɦɿɧɧɿɫɬɶ ɡ ɝɪɭɩɚɦɢ ȱ ɬɚ ȱȱȱ ɜɿɪɨɝɿɞɧɚ ɩɪɢ ɪ<0,05; ** – ɜɿɞɦɿɧɧɿɫɬɶ ɡ ɝɪɭɩɚɦɢ ȱ,ȱȱ ɬɚ ȱȱȱ ɜɿɪɨɝɿɞɧɚ ɩɪɢ ɪ<0,05.

Ɋɢɫ. 1. Ɇɟɧɫɬɪɭɚɥɶɧɚ ɤɪɨɜɨɜɬɪɚɬɚ ɡɚ ɞɚɧɢɦɢ ɚɧɤɟɬɭɜɚɧɧɹ PBAC ɭ ɩɟɪɿɨɞ ɫɩɨɫɬɟɪɟɠɟɧɧɹ

ȼɫɿ ɞɨɫɥɿɞɠɭɜɚɧɿ ɝɪɭɩɢ ɧɚɩɟɪɟɞɨɞɧɿ ɥɿɤɭ

-ɜɚɧɧɹ ɯɚɪɚɤɬɟɪɢɡɭɜɚɥɢɫɹ ɧɢɡɶɤɢɦ ɩɨɤɚɡɧɢɤɨɦ ɹɤɨɫɬɿ ɠɢɬɬɹ, ɹɤɢɣ ɛɭɜ ɜɿɪɨɝɿɞɧɨ ɧɢɠɱɢɦ, ɧɿɠ ɭ

ɤɨɧɬɪɨɥɶɧɿɣ ɝɪɭɩɿ (p<0,05). ȼɿɪɨɝɿɞɧɨʀ ɪɿɡɧɢɰɿ

ɩɨɦɿɠ ɨɫɧɨɜɧɢɦɢ ɝɪɭɩɚɦɢ, ɳɨ ɜɢɜɱɚɥɢɫɹ, ɜɢɹɜ

-ɥɟɧɨ ɧɟ ɛɭɥɨ (ɪɢɫ. 2).

ɇɚɩɪɢɤɿɧɰɿ ɩɟɪɿɨɞɭ ɫɩɨɫɬɟɪɟɠɟɧɧɹ ɜ ɭɫɿɯ ɝɪɭɩɚɯ ɜɿɞɡɧɚɱɟɧɨ ɩɨɤɪɚɳɟɧɧɹ ɹɤɨɫɬɿ ɠɢɬɬɹ ɡɚ ɲɤɚɥɨɸ UFS-QOL. Ⱥɥɟ ɽɞɢɧɚ ɝɪɭɩɚ, ɳɨ ɧɟ ɜɿɞ

-ɪɿɡɧɹɥɚɫɹ ɫɬɚɬɢɫɬɢɱɧɨ ɡɧɚɱɭɳɨ (p<0,05) ɜɿɞ ɄȽ

ɬɚ ɝɪɭɩɢ ȱȱȱ ɬɚ ɜɿɪɨɝɿɞɧɨ ɩɟɪɟɜɢɳɭɜɚɥɚ ɩɨɤɚɡɧɢɤɢ ɪɟɲɬɢ ɨɫɧɨɜɧɢɯ ɝɪɭɩ, ɛɭɥɚ ɝɪɭɩɚ ȱV. ɐɟ ɜɤɚɡɭɽ

ɧɚ ɧɚɣɤɪɚɳɭ ɞɨɜɝɨɬɪɢɜɚɥɭ ɟɮɟɤɬɢɜɧɿɫɬɶ ɤɨɦɛɿ

-ɧɨɜɚɧɨʀ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨʀ ɬɟɪɚɩɿʀ ɄɈɄ ɡ ɚ-ȽɧɊȽ.

Ɉɬɠɟ, ɞɨ ɥɿɤɭɜɚɧɧɹ ɜɫɿ ɨɫɧɨɜɧɿ ɝɪɭɩɢ ɯɚɪɚɤ

-ɬɟɪɢɡɭɜɚɥɢɫɹ ɞɨɫɢɬɶ ɜɢɫɨɤɨɸ ɩɨɲɢɪɟɧɿɫɬɸ ɫɢɦɩɬɨɦɿɜ ɅɆ ɬɚ Ƚȿ, ɩɟɪɲ ɡɚ ɜɫɟ ɝɟɦɨɪɚɝɿɱɧɨɝɨ

ɬɚ ɛɨɥɶɨɜɨɝɨ,ɩɟɪɟɜɢɳɭɸɱɢ ʀɯ ɩɨɲɢɪɟɧɿɫɬɶ ɭ ɄȽ

ɜ 3,6 ɪɚɡɭ; ɜɢɫɨɤɢɦ ɪɿɜɧɟɦ ɦɟɧɫɬɪɭɚɥɶɧɨʀ ɤɪɨ

-ɜɨɜɬɪɚɬɢ (ɜ ɫɟɪɟɞɧɶɨɦɭ 241,3±11,2 ɦɥ) ɬɚ ɧɢɡɶ

-ɤɨɸ ɹɤɿɫɬɸ ɠɢɬɬɹ – ɭ ɫɟɪɟɞɧɶɨɦɭ 53,5±2,6 ɛɚɥɚ,

ɳɨ ɛɭɥɨ ɜ 1,6 ɪɚɡɭ ɦɟɧɲɟ,ɧɿɠ ɭ ɡɞɨɪɨɜɢɯ ɠɿɧɨɤ (p<0,05).

ɉɪɨɜɟɞɟɧɟ ɥɿɤɭɜɚɧɧɹ ɡ ɜɢɤɨɪɢɫɬɚɧɧɹɦ ɪɿɡɧɢɯ ɦɟɞɢɤɚɦɟɧɬɨɡɧɢɯ ɫɯɟɦ ɬɟɪɚɩɿʀ ɝɿɩɟɪɩɥɚɡɿʀ ɟɧɞɨ

-ɦɟɬɪɿɹ ɩɿɫɥɹ ɦɿɨɦɟɤɬɨɦɿʀ ɩɟɪɟɤɨɧɥɢɜɨ ɩɪɨɞɟ

-ɦɨɧɫɬɪɭɜɚɥɨ ɜɿɪɨɝɿɞɧɨ ɛɿɥɶɲɭ ɟɮɟɤɬɢɜɧɿɫɬɶ ɤɨɦ

-ɛɿɧɚɰɿʀ ɚ-ȽɧɊȽ ɡ ɄɈɄ ɭ ɜɿɞɧɨɲɟɧɧɿ ɡɧɢɠɟɧɧɹ

ɱɚɫɬɨɬɢ ɫɢɦɩɬɨɦɿɜ ɰɢɯ ɡɚɯɜɨɪɸɜɚɧɶ, ɜɢɪɚɡɧɨɫɬɿ

ɦɟɧɫɬɪɭɚɥɶɧɨʀ ɤɪɨɜɨɜɬɪɚɬɢ ɬɚ ɩɿɞɜɢɳɟɧɧɹ ɹɤɨɫɬɿ ɠɢɬɬɹ ɭ ɜɟɫɶ ɩɟɪɿɨɞ ɫɩɨɫɬɟɪɟɠɟɧɧɹ.Ɍɚɤ,ɜɿɞɫɨɬɨɤ

ɛɟɡɫɢɦɩɬɨɦɧɢɯ ɠɿɧɨɤ ɭ ɝɪɭɩɿ ȱV ɧɚɩɪɢɤɿɧɰɿ

ɩɟɪɿɨɞɭ ɫɩɨɫɬɟɪɟɠɟɧɧɹ ɩɟɪɟɜɢɳɭɜɚɜ ɜɿɞɫɨɬɨɤ ɭ ɝɪɭɩɿ ȱ ɜ 1,6 ɪɚɡɭ, ɭ ɝɪɭɩɿ ȱȱ – ɜ 1,2 ɪɚɡɭ,ɭ ɝɪɭɩɿ

ȱȱȱ – ɜ 1,7 ɪɚɡɭ (p<0,05). ɋɟɪɟɞɧɹ ɦɟɧɫɬɪɭɚɥɶɧɚ

ɤɪɨɜɨɜɬɪɚɬɚ ɧɚɩɪɢɤɿɧɰɿ ɩɟɪɿɨɞɭ ɫɩɨɫɬɟɪɟɠɟɧɧɹ ɛɭɥɚ ɦɟɧɲɨɸ ɭ ɠɿɧɨɤ ȱVɝɪɭɩɢ ɭ 2,7, ɧɿɠ ɭ ɝɪɭɩɿ

ȱ;ɭ 1,6 ɪɚɡɭ,ɧɿɠ ɭ ɝɪɭɩɿ ȱȱ,ɬɚ 2,5 ɪɚɡɭ,ɧɿɠ ɭ ɝɪɭɩɿ

ȱȱȱ (p<0,05). Ɉɰɿɧɤɚ ɹɤɨɫɬɿ ɠɢɬɬɹ ɡɚ ɲɤɚɥɨɸ

(6)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

ɠɿɧɨɤ ȱV ɝɪɭɩɢ ɩɨɪɿɜɧɹɧɨ ɡ ɞɚɧɢɦɢ ɿɧɲɢɯ

ɨɫɧɨɜɧɢɯ ɝɪɭɩ ɬɚ ɧɟ ɜɿɞɪɿɡɧɹɥɚɫɹ ɫɬɚɬɢɫɬɢɱɧɨ ɡɧɚɱɭɳɨ ɜɿɞ ɩɨɤɚɡɧɢɤɚ ɄȽ (p>0,05). Ɍɚɤ, ɹɤɿɫɬɶ

ɠɢɬɬɹ ɜ ȱV ɝɪɭɩɿ ɛɭɥɚ ɜɢɳɨɸ ɜ 1,14 ɪɚɡɭ, ɧɿɠ ɭ

ɝɪɭɩɿ ȱȱȱ (p>0,05); ɜ 1,17 ɪɚɡɭ ɜɢɳɨɸ,ɧɿɠ ɭ ɝɪɭɩɿ

ȱȱ (p<0,05), ɬɚ ɜ 1,28 ɪɚɡɭ ɜɢɳɨɸ, ɧɿɠ ɭ ɝɪɭɩɿ ȱ

(p<0,05).

49,3±3,2 56,3±2,9

54,2±2,4 54,2±2,8

85,9±2,5*

81,3±5,2**

71,5±4,3 69,4±3,7

63,4±3,3 83,4±3,4

0 10 20 30 40 50 60 70 80 90 100

ɄȽ Ƚɪɭɩɚ ȱ Ƚɪɭɩɚ ȱȱ Ƚɪɭɩɚ ȱȱȱ Ƚɪɭɩɚ ȱV

ɛɚɥɢ

Ⱦɨ ɥɿɤɭɜɚɧɧɹ ɉɿɫɥɹ ɥɿɤɭɜɚɧɧɹ

ɉ ɪ ɢ ɦ ɿ ɬ ɤ ɢ: * - ɜɿɞɦɿɧɧɿɫɬɶ ɡ ɿɧɲɢɦɢ ɝɪɭɩɚɦɢ «ɞɨ ɥɿɤɭɜɚɧɧɹ»ɜɿɪɨɝɿɞɧɚ ɩɪɢ ɪ<0,05; ** - ɜɿɞɦɿɧɧɿɫɬɶ ɡ ɿɧɲɢɦɢ ɝɪɭɩɚɦɢ «ɧɚɩɪɢɤɿɧɰɿ

ɫɩɨɫɬɟɪɟɠɟɧɧɹ»,ɨɤɪɿɦ ɝɪɭɩɢ ȱȱȱ ɬɚ ɄȽ,ɜɿɪɨɝɿɞɧɚ ɩɪɢ ɪ<0,05.

Ɋɢɫ. 2. əɤɿɫɬɶ ɠɢɬɬɹ ɭ ɠɿɧɨɤ ɞɨ ɥɿɤɭɜɚɧɧɹ ɬɚ ɧɚɩɪɢɤɿɧɰɿ ɩɟɪɿɨɞɭ ɫɩɨɫɬɟɪɟɠɟɧɧɹ

Ȼɿɥɶɲɚ ɟɮɟɤɬɢɜɧɿɫɬɶ ɡɚɫɬɨɫɭɜɚɧɧɹ ɤɨɦɛɿɧɚɰɿʀ ɄɈɄ ɬɚ ɚ-ȽɧɊȽ,ɧɚ ɧɚɲɭ ɞɭɦɤɭ,ɩɨɜ'ɹɡɚɧɚ ɡ ɛɿɥɶ

-ɲɢɦ ɫɬɭɩɟɧɟɦ ɫɭɩɪɟɫɿʀ ɩɪɨɰɟɫɿɜ ɩɪɨɥɿɮɟɪɚɰɿʀ ɬɚ ɚɧɝɿɨɝɟɧɟɡɭ ɹɤ ɡɚ ɪɚɯɭɧɨɤ ɥɨɤɚɥɶɧɨɝɨ ɜɩɥɢɜɭ

(ɄɈɄ),ɬɚɤ ɿ ɧɚ ɫɢɫɬɟɦɧɨɦɭ ɪɿɜɧɿ (ɚ-ȽɧɊȽ). ɉȱȾɋɍɆɈɄ

Ʌɟɣɨɦɿɨɦɚ ɦɚɬɤɢ ɬɚ ɝɿɩɟɪɩɥɚɡɿɹ ɟɧɞɨɦɟɬɪɿɹ ɽ ɝɨɪɦɨɧɨɡɚɥɟɠɧɢɦɢ ɡɚɯɜɨɪɸɜɚɧɧɹɦɢ ɦɚɬɤɢ, ɹɤɿ

ɞɭɠɟ ɱɚɫɬɨ ɜɢɹɜɥɹɸɬɶɫɹ ɪɚɡɨɦ ɭ ɜɢɩɚɞɤɚɯ, ɤɨɥɢ

ɩɥɚɧɭɽɬɶɫɹ ɿɧɜɚɡɢɜɧɟ ɨɪɝɚɧɨɡɛɟɪɿɝɚɸɱɟ ɥɿɤɭ

-ɜɚɧɧɹ ɅɆ. Ɉɞɧɿɽɸ ɡ ɩɪɨɛɥɟɦ, ɡ ɹɤɨɸ ɡɿɲɬɨɜ

-ɯɭɸɬɶɫɹ ɥɿɤɚɪɿ ɚɤɭɲɟɪɢ-ɝɿɧɟɤɨɥɨɝɢ, ɽ ɜɢɫɨɤɚ

ɱɚɫɬɨɬɚ ɪɟɰɢɞɢɜɿɜ ɹɤ ɅɆ,ɬɚɤ ɿ Ƚȿ ɬɚ ɩɨɜɟɪɧɟɧɧɹ

ɫɢɦɩɬɨɦɿɜ ɰɢɯ ɡɚɯɜɨɪɸɜɚɧɶ ɩɿɫɥɹ ɤɨɧɫɟɪɜɚ

-ɬɢɜɧɨʀ ɦɿɨɦɟɤɬɨɦɿʀ. Ɍɚɤɢɦ ɱɢɧɨɦ, ɡɚɩɪɨɩɨɧɨ

-ɜɚɧɢɣ ɦɟɬɨɞ ɚɞ'ɸɜɚɧɬɧɨʀ ɬɟɪɚɩɿʀ ɩɿɫɥɹ ɦɿɨɦɟɤ

-ɬɨɦɿʀ ɠɿɧɤɚɦ ɡ ɩɨɽɞɧɚɧɢɦɢ ɝɿɩɟɪɩɥɚɫɬɢɱɧɢɦɢ ɩɪɨɰɟɫɚɦɢ ɟɧɞɨɦɟɬɪɿɹ ɦɚɽ ɫɭɬɬɽɜɿ ɤɥɿɧɿɱɧɿ ɩɟ

-ɪɟɜɚɝɢ ɩɪɢ ɦɿɧɿɦɚɥɶɧɨɦɭ ɜɩɥɢɜɿ ɧɚ ɦɿɧɟɪɚɥɶɧɭ ɳɿɥɶɧɿɫɬɶ ɤɿɫɬɨɤ ɬɚ ɿɧɲɿ ɦɟɧɨɩɚɭɡɚɥɶɧɿ ɩɪɨɹɜɢ ɝɿɩɨɝɨɪɦɨɧɟɦɿʀ, ɡɭɦɨɜɥɟɧɨʀ ɦɨɧɨɬɟɪɚɩɿɽɸ ɚ

-ȽɧɊȽ. ȿɮɟɤɬɢɜɧɿɫɬɶ ɡɚɩɪɨɩɨɧɨɜɚɧɨɝɨ ɦɟɬɨɞɭ

ɥɿɤɭɜɚɧɧɹ, ɧɚ ɞɭɦɤɭ ɚɜɬɨɪɿɜ, ɩɨɜ'ɹɡɚɧɢɣ ɿɡ ɜɩɥɢ

-ɜɨɦ ɹɤ ɧɚ ɰɟɧɬɪɚɥɶɧɭ,ɬɚɤ ɿ ɧɚ ɩɟɪɢɮɟɪɿɣɧɭ ɥɚɧɤɢ

ɩɚɬɨɝɟɧɟɡɭ ɰɢɯ ɡɚɯɜɨɪɸɜɚɧɶ, ɳɨ ɡɧɚɣɲɥɨ ɫɜɨɽ

ɜɿɞɨɛɪɚɠɟɧɧɹ ɭ ɞɨɜɝɨɬɪɢɜɚɥɨɦɭ ɤɨɧɬɪɨɥɿ ɫɢɦɩɬɨɦɿɜ ɅɆ ɬɚ Ƚȿ.

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1. Ʉɚɦɿɧɫɶɤɢɣ ȼ.ȼ.Ɂɛɟɪɟɠɟɧɧɹ ɪɟɩɪɨɞɭɤɬɢɜɧɨɝɨ ɡɞɨɪɨɜ’ɹ ɠɿɧɤɢ – ɨɫɧɨɜɚ ɮɨɪɦɭɜɚɧɧɹ ɡɞɨɪɨɜɨʀ ɧɚɰɿʀ / ȼ.ȼ.Ʉɚɦɿɧɫɶɤɢɣ, Ʌ.Ȼ.Ɇɚɪɤɿɧ, ɋ.ȱ.ɀɭɤ // Ɂɞɨɪɨɜ'ɹ ɍɤɪɚʀɧɢ. — 2008. - ʋ 9. — C. 58-59, 61.

2. Ɋɟɛɪɨɜɚ Ɉ.ɘ. ɋɬɚɬɢɫɬɢɱɟɫɤɢɣ ɚɧɚɥɢɡ ɦɟɞɢ -ɰɢɧɫɤɢɯ ɞɚɧɧɵɯ / Ɉ.ɘ.Ɋɟɛɪɨɜɚ. – Ɇ.:Ɇɟɞɢɚ ɋɮɟɪɚ, 2002. – 312 c.

3. ɋɨɜɪɟɦɟɧɧɵɟ ɚɫɩɟɤɬɵ ɨɪɝɚɧɨɫɨɯɪɚɧɹɸɳɟɣ ɬɟ -ɪɚɩɢɢ ɥɟɣɨɦɢɨɦɵ ɦɚɬɤɢ / Ɍ.Ɏ.Ɍɚɬɚɪɱɭɤ,ɇ.ȼ.Ʉɨɫɟɣ, Ⱦ.Ɇ.Ɇɨɝɢɥɟɜɫɤɢɣ [ɢ ɞɪ.] // Ɋɟɩɪɨɞɭɤɬɢɜɧɨɟ ɡɞɨɪɨɜɶɟ ɠɟɧɳɢɧɵ. — 2006. — Ɍ. 25, ʋ 1. — C. 123-129.

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using a pictorial chart / J.M. Higham, P.M.S. O'brien, R.W. Shaw // Obstetrics & Gynaecology. — 1990. — Vol. 97, N 8. – P. 734.

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7. The UFS-QOL, a New Disease-Specific Symptom and Health-Related Quality of Life Questionnaire for Leiomyomata / J.B. Spies, K. Coyne, N.G. Guaou, [et al.] // Obstetrics& Gynecology. – 2002. – Vol. 99, N 2. – P. 290–300.

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5. Higham JM, O'brien, PMS, Shaw, RW. Asses-sment of menstrual blood loss using a pictorial chart. BJOG: An International Journal of Obstetrics & Gy-naecology. 1990;97(8):734.

6. Rodriguez MI, Warden M, Darney PD. Intrau-terine progestins, progesterone antagonists, and receptor modulators: a review of gynecologic applications. Ame-rican journal of obstetrics and gynecology; 2009. Epub 2009/12/25. doi: S0002-9378(09)02001-8[pii]0.1016/ j.ajog.2009. 10.863. PubMed PMID: 20031112.

7. Spies JB, Coyne K, Guaou NG, Boyle D Skyr-narz-Murphy K, Gonzalves SM. The UFS-QOL, a New Disease-Specific Symptom and Health-Related Quality of Life Questionnaire for Leiomyomata. Obstetrics & Gy-necology. 2002;99(2):290–300.

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Ɇ.ɏ.ȿɥɶ ɏɚɠɠ, ȱ.Ɇ.Ȼɨɧɞɚɪɟɧɤɨ, Ɉ.ȱ.Ⱥɫɽɽɜ,

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ȾɁ «Ⱦɧɿɩɪɨɩɟɬɪɨɜɫɶɤɚ ɦɟɞɢɱɧɚ ɚɤɚɞɟɦɿɹ ɆɈɁ ɍɤɪɚʀɧɢ» ɤɚɮɟɞɪɚ ɨɧɤɨɥɨɝɿʀ ɬɚ ɦɟɞɢɱɧɨʀ ɪɚɞɿɨɥɨɝɿʀ

(ɡɚɜ. – ɞ.ɦɟɞ.ɧ.,ɩɪɨɮ.ȱ.Ɇ.Ȼɨɧɞɚɪɟɧɤɨ)

ɜɭɥ.Ⱦɡɟɪɠɢɧɫɶɤɨɝɨ, 9, 49044, Ⱦɧɿɩɪɨɩɟɬɪɨɜɫɶɤ,ɍɤɪɚʀɧɚ

SE "Dnipropetrovsk medical academy of Health Ministry of Ukraine" Department of oncology and medical radiology

Dzerzhinsky str., 9, Dnipropetrovsk, 49044, Ukraine e-mail: emh2@rambler.ru

Ʉɥɸɱɨɜɿ ɫɥɨɜɚ:ɪɚɤ ɦɨɥɨɱɧɨʀ ɡɚɥɨɡɢ,ɿɦɭɧɨɝɿɫɬɨɯɿɦɿɱɧɢɣ ɩɿɞɬɢɩ,ɞɿɚɝɧɨɫɬɢɤɚ,ɤɥɿɧɿɱɧɢɣ ɩɟɪɟɛɿɝ,ɡɚɝɚɥɶɧɚ ɜɢɠɢɜɚɧɿɫɬɶ