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Development of complications of gestation in pregnant women with preeclampsia associated with thrombophilia

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ȾɁ «ȾɧɿɩɪɨɩɟɬɪɨɜɫɶɤɚɦɟɞɢɱɧɚɚɤɚɞɟɦɿɹɆɈɁɍɤɪɚʀɧɢ»

ɤɚɮɟɞɪɚɚɤɭɲɟɪɫɬɜɚɬɚɝɿɧɟɤɨɥɨɝɿʀ (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: loskutovata@gmail.com

Ʉɥɸɱɨɜɿɫɥɨɜɚɜɚɝɿɬɧɿɫɬɶ, ɩɪɟɟɤɥɚɦɩɫɿɹ, ɚɤɭɲɟɪɫɶɤɿɬɚɩɟɪɢɧɚɬɚɥɶɧɿɭɫɤɥɚɞɧɟɧɧɹ, ɩɨɥɿɦɨɪɮɿɡɦɝɟɧɿɜ, ɚɧɬɢɮɨɫɮɨɥɿɩɿɞɧɿɚɧɬɢɬɟɥɚ, ɝɨɦɨɰɢɫɬɟʀɧ

.H\ZRUGVpregnancy, pre-eclampsia, obstetric and perinatal complications, gene polymorphism, antiphospholipid antibodies, homocysteine

Ɋɟɮɟɪɚɬ Ɋɚɡɜɢɬɢɟ ɨɫɥɨɠɧɟɧɢɣ ɝɟɫɬɚɰɢɢ ɭ ɛɟɪɟɦɟɧɧɵɯ ɫ ɩɪɟɷɤɥɚɦɩɫɢɟɣ ɚɫɫɨɰɢɢɪɨɜɚɧɧɨɣ ɫ ɬɪɨɦɛɨɮɢɥɢɟɣɅɨɫɤɭɬɨɜɚɌȺɋɰɟɥɶɸɨɩɪɟɞɟɥɟɧɢɹɜɥɢɹɧɢɹɩɪɢɨɛɪɟɬɟɧɧɵɯ, ɧɚɫɥɟɞɫɬɜɟɧɧɵɯ, ɦɭɥɶɬɢɝɟɧɧɵɯ ɢ ɤɨɦɛɢɧɢɪɨɜɚɧɧɵɯ ɮɨɪɦ ɬɪɨɦɛɨɮɢɥɢɢ ɧɚ ɪɚɡɜɢɬɢɟ ɚɤɭɲɟɪɫɤɢɯ ɢ ɩɟɪɢɧɚɬɚɥɶɧɵɯ ɨɫɥɨɠɧɟɧɢɣ ɩɪɢ ɩɪɟɷɤɥɚɦɩɫɢɢ ɛɵɥɨ ɨɛɫɥɟɞɨɜɚɧɨ 133 ɠɟɧɳɢɧɵ ɜɨ ɜɬɨɪɨɦ ɢ ɬɪɟɬɶɟɦ ɬɪɢɦɟɫɬɪɚɯ ɛɟɪɟɦɟɧɧɨɫɬɢ. 46 ɛɟɪɟɦɟɧɧɵɯɫɩɪɟɷɤɥɚɦɩɫɢɟɣɢɚɤɭɲɟɪɫɤɢɦɢɢ/ɢɥɢɩɟɪɢɧɚɬɚɥɶɧɵɦɢɨɫɥɨɠɧɟɧɢɹɦɢɫɨɫɬɚɜɢɥɢɨɫɧɨɜɧɭɸɝɪɭɩɩɭ. Ʉɚɤɨɫɥɨɠɧɟɧɢɹ ɪɚɫɫɦɚɬɪɢɜɚɥɢɫɶ: ɩɪɟɠɞɟɜɪɟɦɟɧɧɚɹ ɨɬɫɥɨɣɤɚɧɨɪɦɚɥɶɧɨ ɪɚɫɩɨɥɨɠɟɧɧɨɣɩɥɚɰɟɧɬɵ – 8,7%, ɷɤɥɚɦɩɫɢɹ – 2,17%, HELLP- ɫɢɧɞɪɨɦ – 2,17%, ɁɊɉ – 50,0%, ɚɧɬɟɧɚɬɚɥɶɧɚɹ ɝɢɛɟɥɶɩɥɨɞɚ – 13,04%, ɞɢɫɬɪɟɫɫ ɩɥɨɞɚɜɨɜɪɟɦɹɛɟɪɟɦɟɧɧɨɫɬɢ – 45,65%. Ƚɪɭɩɩɭɫɪɚɜɧɟɧɢɹɫɮɨɪɦɢɪɨɜɚɥɢ 87 ɛɟɪɟɦɟɧɧɵɯɫɩɪɟɷɤɥɚɦɩɫɢɟɣ, ɧɨɛɟɡ ɜɵɲɟɩɟɪɟɱɢɫɥɟɧɧɵɯ ɨɫɥɨɠɧɟɧɢɣ. Ɇɟɬɨɞɨɦ ɚɥɥɟɥɶ ɫɩɟɰɢɮɢɱɟɫɤɨɣ ɩɨɥɢɦɟɪɚɡɧɨɣ ɰɟɩɧɨɣ ɪɟɚɤɰɢɢ ɩɪɨɜɨɞɢɥɢ ɨɩɪɟɞɟɥɟɧɢɟ ɩɨɥɢɦɨɪɮɢɡɦɨɜɜɝɟɧɚɯɮɚɤɬɨɪɚ V Leiden 1691 G ĺ A, ɩɪɨɬɪɨɦɛɢɧɚ 20210 G ĺ A, ɢɧɝɢɛɢɬɨɪɚ ɚɤɬɢɜɚɬɨɪɚ ɩɥɚɡɦɢɧɨɝɟɧɚ-1 ɬɢɩɚ 5G / 4G, ɮɢɛɪɢɧɨɝɟɧɚ ȕ 455 G ĺ A, ɩɚɪɚɨɤɫɨɧɚɡɵ-1 192 QĺR, ɦɟ -ɬɢɥɟɧɬɟɬɪɚɝɢɞɪɨɮɨɥɚɬɪɟɞɭɤɬɚɡɵ 677 C ĺ T ɢ ɚɧɝɢɨɬɟɧɡɢɧɨɝɟɧɚ 235 M ĺ T. Ⱦɥɹ ɨɩɪɟɞɟɥɟɧɢɹ ɩɪɢɨɛɪɟ -ɬɟɧɧɵɯɩɪɢɱɢɧɬɪɨɦɛɨɮɢɥɢɢɢɡɭɱɚɥɢɭɪɨɜɟɧɶɚɧɬɢɮɨɫɮɨɥɢɩɢɞɧɵɯɚɧɬɢɬɟɥɢɤɨɧɰɟɧɬɪɚɰɢɸɝɨɦɨɰɢɫɬɟɢɧɚɜ ɩɥɚɡɦɟɤɪɨɜɢ (ɂɎȺ). Ȼɵɥɨɨɩɪɟɞɟɥɟɧɨ, ɱɬɨɮɚɤɬɨɪɚɦɢ, ɤɨɬɨɪɵɟɭɜɟɥɢɱɢɜɚɸɬɨɬɧɨɫɢɬɟɥɶɧɵɣɪɢɫɤɪɚɡɜɢɬɢɹ ɚɤɭɲɟɪɫɤɢɯɢɩɟɪɢɧɚɬɚɥɶɧɵɯ ɨɫɥɨɠɧɟɧɢɣ ɭɛɟɪɟɦɟɧɧɵɯ ɫɩɪɟɷɤɥɚɦɩɫɢɟɣ, ɹɜɥɹɸɬɫɹ: ɩɟɪɜɵɟɪɨɞɵ, ɩɨɹɜɥɟɧɢɟ ɫɢɦɩɬɨɦɨɜɩɪɟɷɤɥɚɦɩɫɢɢɜɫɪɨɤɟ ɦɟɧɟɟ 28 ɧɟɞɟɥɶɛɟɪɟɦɟɧɧɨɫɬɢ, ɩɪɟɷɤɥɚɦɩɫɢɹɬɹɠɟɥɨɣɢɥɢɫɪɟɞɧɟɣɫɬɟɩɟɧɢ ɬɹɠɟɫɬɢ, ɞɥɢɬɟɥɶɧɨɫɬɶ ɩɪɟɷɤɥɚɦɩɫɢɢ ɛɨɥɟɟ 5 ɧɟɞɟɥɶ. Ɇɚɪɤɟɪɚɦɢ ɩɪɟɞɪɚɫɩɨɥɨɠɟɧɧɨɫɬɢ ɤ ɪɚɡɜɢɬɢɸ ɚɤɭ -ɲɟɪɫɤɢɯɢɩɟɪɢɧɚɬɚɥɶɧɵɯɨɫɥɨɠɧɟɧɢɣɭɛɟɪɟɦɟɧɧɵɯɫɩɪɟɷɤɥɚɦɩɫɢɟɣɟɫɬɶɬɚɤɢɟɝɟɧɨɬɢɩɵ: 1691 GȺɮɚɤɬɨɪɚ V Leiden - ɩɨɜɵɲɚɟɬɪɢɫɤɜ 2,9 ɪɚɡɚ (95% Ⱦɂ 1,94-4,33); 20210 GA ɩɪɨɬɪɨɦɛɢɧɚ – ɜ 2,36 ɪɚɡɚ (95% Ⱦɂ 1,54-3,6); 20210 ȺȺ ɩɪɨɬɪɨɦɛɢɧɚ – ɜ 3,12 ɪɚɡɚ (95% Ⱦɂ 2,4-4,0), ɤɨɦɛɢɧɚɰɢɹ ɢɡ ɬɪɟɯ ɢ ɛɨɥɟɟ ɩɚɬɨɥɨɝɢɱɟɫɤɢɯ ɩɨɥɢɦɨɪɮɢɡɦɨɜ - ɜ 2,58 ɪɚɡɚ (95% Ⱦɂ 1,64-4,05); ɩɚɬɨɥɨɝɢɱɟɫɤɢɣɭɪɨɜɟɧɶȺɎȺ – ɜ 1,7 ɪɚɡɚ (95% Ⱦɂ 1,08-2,67); ɤɨɦɛɢɧɢɪɨɜɚɧɧɵɟɬɪɨɦɛɨɮɢɥɢɢ - ɜ 1,76 ɪɚɡɚ (95% Ⱦɂ 1,12-2,76); ɤɨɧɰɟɧɬɪɚɰɢɹɝɨɦɨɰɢɫɬɟɢɧɚɛɨɥɟɟ 15 ɦɤɦɨɥɶ / ɥ - ɜ 2,31 ɪɚɡɚ (95% Ⱦɂ 1,5-3,5).

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GA of Factor V Leiden – increases the risk by in 2.9 times (95% CI 1,94-4,33); prothrombin 20210 GA – by 2.36 times (95% CI: 1,54-3,6); prothrombin 20210 AA – by 3.12 times (95% CI 2,4-4,0) a combination of three or more pathologic polymorphisms – by 2.58 times (95% CI 1,64-4,05); pathological level of AFA – by 1.7 times (95% CI 1,08-2,67); combined thrombophilia – by 1.76 times (95% CI 1,12-2,76); homocysteine concentration of more than 15

μmol/l – by 2.31 times (95% CI 1.5-3.5) are markers of predisposition to the development of obstetric and perinatal complications in pregnant women with pre-eclampsia

ɉɪɟɟɤɥɚɦɩɫɿɹ ɽ ɨɞɧɿɽɸ ɡ ɧɚɣɜɚɠɥɢɜɿɲɢɯ ɩɪɨɛɥɟɦɫɭɱɚɫɧɨɝɨɚɤɭɲɟɪɫɬɜɚȱɫɧɭɽɞɭɦɤɚɳɨ ɩɪɢɪɨɞɚɩɪɟɟɤɥɚɦɩɫɿʀɉȿɪɿɡɧɚɜɪɚɡɿʀʀɩɨɱɚɬɤɭ ɞɨɚɛɨɩɿɫɥɹɬɢɠɧɹɜɚɝɿɬɧɨɫɬɿɊɚɧɧɿɣɩɨɱɚɬɨɤ ɉȿ ɤɨɪɟɥɸɽ ɡ ɜɢɫɨɤɨɸ ɧɟɨɧɚɬɚɥɶɧɨɸ ɡɚɯɜɨɪɸ ɜɚɧɿɫɬɸɿɫɦɟɪɬɧɿɫɬɸɦɚɬɟɪɢɧɫɶɤɢɦɢɭɫɤɥɚɞɧɟɧ ɧɹɦɢ ɉɪɟɟɤɥɚɦɩɫɿɹ ɛɭɞɭɱɢ ɦɭɥɶɬɢɮɚɤɬɨ ɪɿɚɥɶɧɢɦ ɡɚɯɜɨɪɸɜɚɧɧɹɦ ɦɚɽ ɰɿɥɢɣ ɪɹɞ ɝɟɧɿɜ ɫɯɢɥɶɧɨɫɬɿ ɹɤɿ ɡɚɥɭɱɟɧɿ ɭ ɫɤɥɚɞɧɢɣ ɩɪɨɰɟɫ ɪɟɝɭɥɸɜɚɧɧɹ ɪɿɡɧɨɦɚɧɿɬɧɢɯ ɮɭɧɤɰɿɣ ɟɧɞɨɬɟɥɿɸ >@ȱɫɧɭɜɚɧɧɹɝɟɧɟɬɢɱɧɨʀɫɯɢɥɶɧɨɫɬɿɞɨɟɧɞɨ

ɬɟɥɿɨɩɚɬɿʀ ɩɿɞɜɢɳɟɧɨɝɨ ɬɪɨɦɛɨɭɬɜɨɪɟɧɧɹ

ɚɪɬɟɪɿɚɥɶɧɨʀ ɝɿɩɟɪɬɟɧɡɿʀ ɽ ɩɪɢɱɢɧɨɸ ɩɨɪɭɲɟɧɨʀ ɿɧɜɚɡɿʀ ɬɪɨɮɨɛɥɚɫɬɚ ɳɨ ɩɪɢɡɜɨɞɢɬɶ ɞɨ ɪɨɡɜɢɬɤɭ ɫɚɦɨɝɨɡɚɯɜɨɪɸɜɚɧɧɹɚɬɚɤɨɠɩɨɜ¶ɹɡɚɧɢɯɡɧɢɦ ɭɫɤɥɚɞɧɟɧɶ ɹɤ ɡ ɛɨɤɭ ɩɥɨɞɚ ɡɚɬɪɢɦɤɚ ɪɨɡɜɢɬɤɭ ɩɥɨɞɚ ɁɊɉ ɞɢɫɬɪɟɫ ɚɧɬɟɧɚɬɚɥɶɧɚ ɡɚɝɢɛɟɥɶ ɬɚɤ ɿ ɡ ɛɨɤɭ ɦɚɬɟɪɿ ɩɟɪɟɞɱɚɫɧɟ ɜɿɞɲɚɪɭɜɚɧɧɹ ɧɨɪɦɚɥɶɧɨ ɪɨɡɬɚɲɨɜɚɧɨʀ ɩɥɚɰɟɧɬɢ +(//3 ɫɢɧɞɪɨɦɟɤɥɚɦɩɫɿɹɍɪɨɡɜɢɧɟɧɢɯɤɪɚʀɧɚɯɭ ɉȿ ɽ ɞɪɭɝɨɸ ɛɟɡɩɨɫɟɪɟɞɧɶɨɸ ɩɪɢɱɢɧɨɸ ɚɧɬɟ ɿ ɩɨɫɬɧɚɬɚɥɶɧɨʀ ɫɦɟɪɬɧɨɫɬɿ ɜɩɥɢɜɚɸɱɢ ɧɚ ɩɟɪɢɧɚɬɚɥɶɧɭɫɦɟɪɬɧɿɫɬɶɭɜɢɩɚɞɤɚɯ>@ ɉɪɟɟɤɥɚɦɩɫɿɹ ɡɚ ɤɨɪɞɨɧɨɦ ɪɨɡɩɨɞɿɥɹɽɬɶɫɹ ɧɚ ɥɟɝɤɭ ɿ ɬɹɠɤɨɝɨ ɫɬɭɩɟɧɹ ɍ ɛɿɥɶɲɨɫɬɿ ɪɟɤɨ ɦɟɧɞɚɰɿɣɬɹɠɤɚɩɪɟɟɤɥɚɦɩɫɿɹɜɢɡɧɚɱɚɽɬɶɫɹɤɨɥɢ ɩɪɢɫɭɬɧɹ ɛɭɞɶɹɤɚ ɡ ɬɚɤɢɯ ɭɦɨɜ ɬɹɠɤɚ ɝɿɩɟɪ ɬɟɧɡɿɹ ɬɹɠɤɚ ɩɪɨɬɟʀɧɭɪɿɹ ɨɪɝɚɧɧɚ ɞɢɫɮɭɧɤɰɿɹ >@Ɋɚɧɧɿɣɩɨɱɚɬɨɤɞɨɬɢɠɧɿɜɜɚɝɿɬɧɨɫɬɿɿ ɡɚɯɜɨɪɸɜɚɧɿɫɬɶ ɩɥɨɞɚ ɬɚɤɨɠ ɜɢɤɨɪɢɫɬɨɜɭɸɬɶɫɹ ɹɤ ɧɟɡɚɥɟɠɧɿ ɤɪɢɬɟɪɿʀ ɞɥɹ ɜɢɡɧɚɱɟɧɧɹ ɬɹɠɤɨʀ ɩɪɟɟɤɥɚɦɩɫɿʀɜɞɟɹɤɢɯɱɚɫɬɢɧɚɯɫɜɿɬɭȱɫɧɭɸɱɿɜ ɍɤɪɚʀɧɿ ɧɚɫɬɚɧɨɜɢ ɳɨɞɨ ɜɟɞɟɧɧɹ ɜɚɝɿɬɧɢɯ ɡ ɝɿɩɟɪɬɟɧɡɢɜɧɢɦɢ ɪɨɡɥɚɞɚɦɢ ɧɟ ɜɪɚɯɨɜɭɸɬɶ ɪɨɡ ɜɢɬɨɤ ɭɫɤɥɚɞɧɟɧɶ ɡ ɛɨɤɭ ɦɚɬɟɪɿ ɬɚ ɩɥɨɞɚ ɹɤ ɞɨɞɚɬɤɨɜɢɣ ɨɛɬɹɠɭɸɱɢɣ ɮɚɤɬɨɪ ɹɤɢɣ ɩɿɞɜɢɳɭɽ ɬɹɠɤɿɫɬɶɩɪɟɟɤɥɚɦɩɫɿʀɏɨɱɚɫɚɦɟɪɨɡɜɢɬɨɤɬɚɤɢɯ ɭɫɤɥɚɞɧɟɧɶ ɜɢɦɚɝɚɽ ɩɟɪɟɝɥɹɞɭ ɬɚɤɬɢɤɢ ɜɟɞɟɧɧɹ ɬɚɫɩɨɫɨɛɭɪɨɡɪɨɞɠɟɧɧɹ

Ɇɟɬɚɞɨɫɥɿɞɠɟɧɧɹɜɢɡɧɚɱɢɬɢɜɩɥɢɜɧɚɛɭɬɢɯ ɝɟɧɟɬɢɱɧɢɯ ɦɭɥɶɬɢɝɟɧɧɢɯ ɬɚ ɤɨɦɛɿɧɨɜɚɧɢɯ ɬɪɨɦɛɨɮɿɥɿɣ ɧɚ ɪɨɡɜɢɬɨɤ ɚɤɭɲɟɪɫɶɤɢɯ ɿ ɩɟɪɢ ɧɚɬɚɥɶɧɢɯɭɫɤɥɚɞɧɟɧɶɩɪɢɩɪɟɟɤɥɚɦɩɫɿʀ

ɆȺɌȿɊȱȺɅɂɌȺɆȿɌɈȾɂȾɈɋɅȱȾɀȿɇɖ

Ɉɛɫɬɟɠɟɧɨ ɠɿɧɤɢ ɜ ɞɪɭɝɨɦɭ ɿ ɬɪɟɬɶɨɦɭ ɬɪɢɦɟɫɬɪɚɯ ɜɚɝɿɬɧɨɫɬɿ ɜɚɝɿɬɧɢɯ ɡ ɩɪɟɟɤ ɥɚɦɩɫɿɽɸ ɬɚ ɿɫɬɨɬɧɢɦɢ ɚɤɭɲɟɪɫɶɤɢɦɢ ɣ ɩɟɪɢɧɚ ɬɚɥɶɧɢɦɢ ɭɫɤɥɚɞɧɟɧɧɹɦɢ ɫɤɥɚɥɢ ɨɫɧɨɜɧɭ ɝɪɭɩɭ

Ɉ əɤ ɭɫɤɥɚɞɧɟɧɧɹ ɪɨɡɝɥɹɞɚɥɢɫɶ ɩɟɪɟɞɱɚɫɧɟ ɜɿɞɲɚɪɭɜɚɧɧɹɧɨɪɦɚɥɶɧɨɪɨɡɬɚɲɨɜɚɧɨʀɩɥɚɰɟɧɬɢ ± ɟɤɥɚɦɩɫɿɹ ± +(//3 ɫɢɧɞɪɨɦ ± ɁɊɉ ± ɚɧɬɟɧɚɬɚɥɶɧɚ ɡɚɝɢɛɟɥɶ ɩɥɨɞɚ±ɞɢɫɬɪɟɫɩɥɨɞɚɩɿɞɱɚɫɜɚɝɿɬɧɨɫɬɿ ± Ƚɪɭɩɭ ɩɨɪɿɜɧɹɧɧɹ ɉ ɫɮɨɪɦɭɜɚɥɢ ɜɚɝɿɬɧɢɯ ɡ ɩɪɟɟɤɥɚɦɩɫɿɽɸ ɚɥɟ ɛɟɡ ɜɢɳɟɩɟɪɟ ɪɚɯɨɜɚɧɢɯɭɫɤɥɚɞɧɟɧɶȽɿɩɟɪɬɟɧɡɢɜɧɿɪɨɡɥɚɞɢɬɚ ɫɬɭɩɿɧɶ ɬɹɠɤɨɫɬɿ ɩɪɟɟɤɥɚɦɩɫɿʀ ɛɭɥɨ ɞɿɚɝɧɨɫɬɨ ɜɚɧɨ ɧɚ ɩɿɞɫɬɚɜɿ ɜɟɥɢɱɢɧɢ ɚɪɬɟɪɿɚɥɶɧɨɝɨ ɬɢɫɤɭ ɪɿɜɧɹ ɩɪɨɬɟʀɧɭɪɿʀ ɞɨɞɚɬɤɨɜɢɯ ɭɫɤɥɚɞɧɟɧɶ ɿ

ɜɿɞɩɨɜɿɞɧɨ ɞɨ ɤɥɿɧɿɱɧɨɝɨ ɩɪɨɬɨɤɨɥɭ

ɆɈɁɍɤɪɚʀɧɢʋ>@

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ɄɅȱɇȱɑɇȺ

ɆȿȾɂɐɂɇȺ

ɲɜɢɞɤɨɫɬɿ ɤɪɨɜɨɬɨɤɭ ɜ ɚɪɬɟɪɿʀ ɩɭɩɨɜɢɧɢ Ⱦɨ ɫɥɿɞɠɟɧɧɹ ɩɪɨɜɨɞɢɥɢɫɶ ɜɿɞɩɨɜɿɞɧɨ ɞɨ ɧɚɤɚɡɿɜ ɆɈɁɍɤɪɚʀɧɢʋɜɿɞɬɚʋɜɿɞ

ɋɬɚɬɢɫɬɢɱɧɢɣɚɧɚɥɿɡɩɪɨɜɨɞɢɥɢɡɚɞɨɩɨɦɨɝɨɸ ɩɪɨɝɪɚɦɧɨɝɨɡɚɛɟɡɩɟɱɟɧɧɹ0LFURVRIW([FHOɿ *UDI3DG 3ULVP ɞɥɹ :LQGRZV Ⱦɥɹ ɩɨɪɿɜɧɹɧɧɹ ɹɤɿɫɧɢɯɩɨɤɚɡɧɢɤɿɜɜɢɤɨɪɢɫɬɨɜɭɜɚɥɢɤɪɢɬɟɪɿɣȤ Ⱦɥɹɩɨɪɿɜɧɹɧɧɹɤɿɥɶɤɿɫɧɢɯ±ɧɟɩɚɪɧɢɣɤɪɢɬɟɪɿɣ W Ⱦɥɹ ɨɰɿɧɤɢ ɫɢɥɢ ɡɜ¶ɹɡɤɭ ɦɿɠ ɹɜɢɳɚɦɢ ɪɨɡ ɪɚɯɨɜɭɜɚɥɢ ɤɨɟɮɿɰɿɽɧɬ ɤɨɪɟɥɹɰɿʀ ɋɩɿɪɦɟɧɚ U Ⱦɥɹ ɨɰɿɧɤɢ ɪɢɡɢɤɭ ɜɩɥɢɜɭ ɩɪɟɟɤɥɚɦɩɫɿʀ ɧɚ ɪɨɡ ɜɢɬɨɤ ɭɫɤɥɚɞɧɟɧɶ ɪɨɡɪɚɯɨɜɭɜɚɥɢ ɩɨɤɚɡɧɢɤ ɜɿɞ ɧɨɫɧɨɝɨ ɪɢɡɢɤɭ 55 ± UHODWLYH ULVN ɿɡ ɡɧɚɱɟɧɧɹɦ ɞɨɜɿɪɱɨɝɨ ɿɧɬɟɪɜɚɥɭ Ⱦȱ əɤ ɡɧɚɱɭɳɢɣ ɛɪɚɥɢɪɿɜɟɧɶɞɨɫɬɨɜɿɪɧɨɫɬɿɪ>@

ɊȿɁɍɅɖɌȺɌɂɌȺȲɏɈȻȽɈȼɈɊȿɇɇə

ɍɈɝɪɭɩɿɩɪɟɟɤɥɚɦɩɫɿɸɥɟɝɤɨɝɨɫɬɭɩɟɧɹɦɚɥɢ ɠɿɧɨɤ ɳɨ ɩɟɪɟɜɚɠɧɨ ɦɟɧɲɟ ɧɿɠ ɭ ɝɪɭɩɿɩɨɪɿɜɧɹɧɧɹɪ25 Ⱦȱɍɝɪɭɩɿɡɭɫɤɥɚɞɧɟɧɧɹɦɢɩɪɟ ɟɤɥɚɦɩɫɿɸɫɟɪɟɞɧɶɨɝɨɚɛɨɬɹɠɤɨɝɨɫɬɭɩɟɧɹɦɚɥɢ ɠɿɧɨɤɳɨɛɿɥɶɲɟɧɿɠɭɝɪɭɩɿɉ± ɪ 25 Ⱦȱ 55 Ⱦȱ ɋɟɪɟɞɧɿɣ ɫɬɪɨɤ ɩɨɱɚɬɤɭ ɡɚɯɜɨɪɸɜɚɧɧɹ ɫɬɚɧɨɜɢɜ ɭ Ɉ ɝɪɭɩɿ “ ɬɢɠɧɹ ɳɨ ɜ ɪɚɡɭ ɦɟɧɲɟ ɧɿɠ ɭ ɝɪɭɩɿ ɩɨɪɿɜɧɹɧɧɹ “ ɬɢɠɧɹ ɪ Ɍɪɢɜɚɥɿɫɬɶ ɿɫɧɭɜɚɧɧɹ ɉȿ ɜ ɝɪɭɩɿ ɡ ɭɫɤɥɚɞɧɟɧ ɧɹɦɢ “ ɬɢɠɧɹ ɛɭɥɚ ɛɿɥɶɲɟ ɜ ɪɚɡɭ ɧɿɠɭɉɝɪɭɩɿ“ɬɢɠɧɹɪȾɟɛɸɬ ɩɪɟɟɤɥɚɦɩɫɿʀɜɬɟɪɦɿɧɬɢɠɧɿɜɝɟɫɬɚɰɿʀɚɛɨɪɚ ɧɿɲɟɡɛɿɥɶɲɭɽɜɿɞɧɨɫɧɢɣɪɢɡɢɤɪɨɡɜɢɬɤɭɭɫɤɥɚɞ ɧɟɧɶ ɭ ɪɚɡɭ ɪ 55 Ⱦȱ ɚ ɬɪɢɜɚɥɿɫɬɶ ɿɫɧɭɜɚɧɧɹ ɉȿ ɛɿɥɶɲɚ ɧɿɠɬɢɠɧɿɜɡɛɿɥɶɲɭɽɜɿɞɧɨɫɧɢɣɪɢɡɢɤɪɨɡɜɢɬɤɭ ɭɫɤɥɚɞɧɟɧɶɭɪɚɡɭȾȱ

Ⱥɧɚɥɿɡ ɪɟɡɭɥɶɬɚɬɿɜ ɬɟɫɬɭɜɚɧɧɹ ɝɟɧɿɜɪɟɝɭɥɹ ɬɨɪɿɜ ɫɢɫɬɟɦɢ ɝɟɦɨɫɬɚɡɭ ©ɟɧɞɨɬɟɥɿɚɥɶɧɨʀ ɫɢɫɬɟ ɦɢªɿɝɟɧɿɜ ɳɨɪɟɝɭɥɸɸɬɶɪɿɜɟɧɶɚɪɬɟɪɿɚɥɶɧɨɝɨ ɬɢɫɤɭ ɩɨɤɚɡɚɜ ɳɨ ɯɨɱɚ ɱɚɫɬɨɬɚ ɝɟɧɟɬɢɱɧɢɯ ɩɨɥɿɦɨɪɮɿɡɦɿɜɿɦɭɬɚɰɿɣɝɟɧɿɜɪɟɝɭɥɹɬɨɪɿɜɫɢɫɬɟ ɦɢ ɝɟɦɨɫɬɚɡɭ ©ɟɧɞɨɬɟɥɿɚɥɶɧɨʀ ɫɢɫɬɟɦɢª ɿ ɝɟɧɿɜ ɳɨ ɪɟɝɭɥɸɸɬɶ ɪɿɜɟɧɶ ɚɪɬɟɪɿɚɥɶɧɨɝɨ ɬɢɫɤɭ ɭ ɜɚɝɿɬɧɢɯ ɡ ɧɚɹɜɧɿɫɬɸ ɿ ɛɟɡ ɭɫɤɥɚɞɧɟɧɶ ɛɭɥɚ ɨɞɧɚɤɨɜɨ ɜɢɫɨɤɨɸ ɬɚ ɪ! ɜɿɞɩɨɜɿɞɧɨ ɦɿɠ ɰɢɦɢ ɝɪɭɩɚɦɢ ɡɧɚɣɞɟɧɨ ɜɿɞ ɦɿɧɧɨɫɬɿ ɭ ɫɤɥɚɞɿ ɬɚ ɤɿɥɶɤɨɫɬɿ ɩɚɬɨɥɨɝɿɱɧɢɯ ɩɨɥɿɦɨɪɮɿɡɦɿɜɍɝɪɭɩɿɜɚɝɿɬɧɢɯɡɩɪɟɟɤɥɚɦɩɫɿɽɸ ɬɚ ɭɫɤɥɚɞɧɟɧɧɹɦɢ ɩɨɪɿɜɧɹɧɨ ɡ ɝɪɭɩɨɸ ɛɟɡ ɭɫɤɥɚɞɧɟɧɶɪɜɫɬɚɧɨɜɥɟɧɨɜɪɚɡɭɡɧɢ ɠɟɧɨ ɱɚɫɬɨɬɭ ɧɨɪɦɚɥɶɧɨɝɨ ɝɟɧɨɬɢɩɭ ** ɭ ɝɟɧɿ ɮɚɤɬɨɪɚ9/HLGHQɩɪɨɬɢɭ ɪɚɡɭɩɿɞɜɢɳɟɧɨɱɚɫɬɨɬɭɝɟɧɨɬɢɩɭ*Ⱥɜɝɟɧɿ

ɮɚɤɬɨɪɚ 9 /HLGHQ ɩɪɨɬɢ ɭ ɪɚɡɭ±ɤɿɥɶɤɿɫɬɶɧɨɫɿʀɜɝɟɬɟɪɨɡɢɝɨɬɧɢɯɮɨɪɦ *Ⱥɩɪɨɬɢɿɡɧɢɠɟɧɨɜɪɚɡɭ ɤɿɥɶɤɿɫɬɶ ɧɨɪɦɚɥɶɧɢɯ ɝɨɦɨɡɢɝɨɬ ** ɩɪɨɬɢ ɭ ɝɟɧɿ ɩɪɨɬɪɨɦɛɿɧɭ ɜ ɪɚɡɢɡɧɢɠɟɧɚɱɚɫɬɨɬɚɧɨɪɦɚɥɶɧɨɝɨɝɟɧɨɬɢɩɭɋɋ ɭ ɝɟɧɿ 07+)5 ɩɪɨɬɢ Ⱥɥɟɥɶɧɿ ɩɨɥɿɦɨɪɮɿɡɦɢ ɚɧɝɿɨɬɟɧɡɢɧɨɝɟɧɭ ȱȱ ɆĺɌ 3$, ** ɮɿɛɪɢɧɨɝɟɧɭ ȕ *ĺ$ ɩɚɪɚɨɤɫɨɧɚɡɢ 4ĺ5 ɨɞɧɚɤɨɜɨ ɱɚɫɬɨ ɡɭɫɬɪɿɱɚɥɢɫɶ ɧɟɡɚɥɟɠɧɨ ɜɿɞ ɧɚɹɜɧɨɫɬɿ ɭɫɤɥɚɞ ɧɟɧɶɌɨɛɬɨɫɚɦɟɧɚɹɜɧɿɫɬɶɧɚɣɛɿɥɶɲɩɚɬɨɝɟɧɧɢɯ ɩɨɥɿɦɨɪɮɿɡɦɿɜɬɚʀɯɩɨɽɞɧɚɧɚɞɿɹɜɿɞɿɝɪɚɸɬɶɪɨɥɶ ɭ ɜɢɧɢɤɧɟɧɧɿ ɭɫɤɥɚɞɧɟɧɶ ɩɪɢ ɉȿ ɐɟ ɩɿɞ ɬɜɟɪɞɠɭɽɬɶɫɹɞɨɫɥɿɞɠɟɧɧɹɦ0.XSIHUPLQFɟWDO ɜ ɹɤɨɦɭ ɩɨɪɿɜɧɸɸɱɢ ɝɪɭɩɭ ɡ ɚɤɭ ɲɟɪɫɶɤɢɦɢ ɭɫɤɥɚɞɧɟɧɧɹɦɢ ɿ ɦɧɨɠɢɧɧɢɦɢ ɫɩɚɞ ɤɨɜɢɦɢ ɬɚ ɧɚɛɭɬɢɦɢ ɬɪɨɦɛɨɮɿɥɿɹɦɢ ɡ ɝɪɭɩɨɸ ɡ ɬɚɤɢɦɢɠɭɫɤɥɚɞɧɟɧɧɹɦɢɣɨɞɢɧɢɱɧɢɦɢɬɪɨɦɛɨ ɮɿɥɿɹɦɢ ɩɨɤɚɡɚɧɨ ɳɨ ɜ ɝɪɭɩɿ ɡ ɦɧɨɠɢɧɧɢɦɢ ɬɪɨɦɛɨɮɿɥɿɹɦɢ ɭɫɤɥɚɞɧɟɧɧɹ ɜɢɧɢɤɚɸɬɶ ɪɚɧɿɲɟ ɿ ɱɢɧɹɬɶ ɛɿɥɶɲ ɜɢɪɚɠɟɧɢɣ ɟɮɟɤɬ ɧɚ ɩɟɪɢɧɚɬɚɥɶɧɿ ɧɚɫɥɿɞɤɢ >@ ɉɨɞɿɛɧɿ ɞɚɧɿ ɦɿɫɬɹɬɶɫɹ ɿ ɜ ɿɧɲɢɯ ɞɨɫɥɿɞɠɟɧɧɹɯ > @ ȱɫɧɭɜɚɧɧɹ ɫɩɚɞɤɨɜɢɯ ɮɨɪɦ ɬɪɨɦɛɨɮɿɥɿʀ ɦɭɬɚɰɿɹ ɩɪɨɬɪɨɦɛɿɧɭ ɮɚɤɬɨɪɚ 9 /HLGHQ 07+)5 ɽ ɞɨɞɚɬɤɨɜɢɦ ɱɢɧɧɢɤɨɦ ɳɨ ɩɿɞɬɪɢɦɭɽ ɬɚ ɩɨɫɢɥɸɽ ɡɧɢɠɟɧɭ ɩɟɪɮɭɡɿɸ ɩɥɚ ɰɟɧɬɢ ɜɧɚɫɥɿɞɨɤ ʀʀ ɬɪɨɦɛɭɜɚɧɧɹ ɳɨ ɧɚ ɪɚɧɧɿɯ ɟɬɚɩɚɯ ɜɟɞɟ ɞɨ ɪɨɡɜɢɬɤɭ ɞɢɫɬɪɟɫɭ ɩɥɨɞɚ ɁɊɉ ɚ ɩɨɬɿɦɿɞɨɉȼɇɊɉȺɁɉȽɟɧɟɪɚɥɿɡɨɜɚɧɚɛɥɨɤɚɞɚ ɦɿɤɪɨɰɢɪɤɭɥɹɰɿʀ ɩɪɢɡɜɨɞɢɬɶ ɞɨ +((/3ɫɢɧɞɪɨ ɦɭɟɤɥɚɦɩɫɿʀɩɨɥɿɨɪɝɚɧɧɨʀɧɟɞɨɫɬɚɬɧɨɫɬɿ>@

Ɇɿɠ ɧɟɫɩɪɢɹɬɥɢɜɢɦɢ ɝɟɧɨɬɢɩɚɦɢ ɝɨɦɨ ɿ ɝɟɬɟɪɨɡɢɝɨɬɧɿ ɦɭɬɚɰɿʀ ɜ ɝɟɧɿ ɩɪɨɬɪɨɦɛɿɧɭ *$ȺȺɜɝɟɧɿ)9/HLGHQ*$ȺȺɝɨɦɨɿ ɝɟɬɟɪɨɡɢɝɨɬɧɿ ɩɨɥɿɦɨɪɮɿɡɦɢ ɜ ɝɟɧɿ 3$, ** ** ɭ ɝɟɧɿ )*% *$ $$ ɦɨɧɨɡɢɝɨɬɧɿ ɩɨɥɿɦɨɪɮɿɡɦɢ 321 55 $1* 77 07+)5 77 ɦɭɬɚɰɿɹɦɢ ɜ ɝɟɧɿ ɩɪɨɬɪɨɦɛɿɧɭ *ĺ$ ɮɚɤɬɨɪɚ 9 /HLGHQ 07+)5 ɋĺ7 ɪɨɡɜɢɬɤɨɦ ɭɫɤɥɚɞɧɟɧɶ ɤɿɥɶɤɿɫɧɢɦɢ ɯɚ ɪɚɤɬɟɪɢɫɬɢɤɚɦɢ ɫɬɚɧɭ ɩɥɨɞɚ ɛɭɜ ɜɢɡɧɚɱɟɧɢɣ ɤɨɪɟɥɹɰɿɣɧɢɣɡɜɹɡɨɤɬɚɛɥɬɚɜɫɬɚɧɨɜɥɟɧɨɳɨ ɧɚɣɛɿɥɶɲɟ ɡɧɚɱɟɧɧɹ ɞɥɹ ɪɨɡɜɢɬɤɭ ɭɫɤɥɚɞɧɟɧɶ ɦɚɸɬɶ ɩɨɥɿɦɨɪɮɿɡɦɢ )9 /HLGHQ *ĺ$ ɩɪɨɬɪɨɦɛɿɧɭ *ĺ$ 07+)5 ɋĺ7 ɇɟɫɩɪɢɹɬɥɢɜɢɣ ɜɩɥɢɜ ɩɚɬɨɥɨɝɿɱɧɢɯ ɩɨɥɿɦɨɪ ɮɿɡɦɿɜ ɧɚ ɪɨɡɜɢɬɨɤ ɩɟɪɢɧɚɬɚɥɶɧɢɯ ɭɫɤɥɚɞɧɟɧɶ ɩɨɹɫɧɸɽɦɨ ɩɨɪɭɲɟɧɧɹɦɢ ɜ ɫɢɫɬɟɦɿ ɝɟɦɨɫɬɚɡɭ ɩɿɞɜɢɳɟɧɧɹ ɚɝɪɟɝɚɰɿʀ ɚɞɝɟɡɿʀ ɬɪɨɦɛɨɰɢɬɿɜ ɡɝɨɪ ɬɚɸɱɢɯ ɜɥɚɫɬɢɜɨɫɬɟɣ ɤɪɨɜɿ ɳɨ ɩɪɢɡɜɨɞɢɬɶ ɞɨ

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ɉ ɪ ɢ ɦ ɿ ɬ ɤ ɚ ɨɰɿɧɤɚɫɬɚɬɢɫɬɢɱɧɨʀɡɧɚɱɭɳɨɫɬɿɤɨɟɮɿɰɿɽɧɬɚɤɨɪɟɥɹɰɿʀɪ

Ⱦɨɜɟɞɟɧɨ ɳɨ ɞɥɹ ɜɢɧɢɤɧɟɧɧɹ ɭɫɤɥɚɞɧɟɧɶ ɭ ɜɚɝɿɬɧɢɯɡɩɪɟɟɤɥɚɦɩɫɿɽɸɜɚɠɥɢɜɢɦɽɿɫɧɭɜɚɧɧɹ ɞɟɤɿɥɶɤɨɯɩɚɬɨɥɨɝɿɱɧɢɯɝɟɧɿɜɚɛɨɩɨɥɿɦɨɪɮɿɡɦɿɜ ʀɯ ɩɚɬɨɥɨɝɿɱɧɢɣ ɟɮɟɤɬ ɩɿɞɫɭɦɨɜɭɽɬɶɫɹ Ɍɪɢ ɿ ɛɿɥɶɲɟ ɩɨɽɞɧɚɧɢɯ ɩɨɥɿɦɨɪɮɿɡɦɢ ɡɞɟɛɿɥɶɲɨɝɨ ɜ ɪɚɡɭ ɜɢɡɧɚɱɟɧɨ ɡɚ ɧɚɹɜɧɨɫɬɿ ɭɫɤɥɚɞɧɟɧɶ ɧɿɠ ɭ ɝɪɭɩɿ ɛɟɡ ɭɫɤɥɚɞɧɟɧɶ ± ɪ

ȼɫɬɚɧɨɜɥɟɧɨ ɳɨ ɝɟɧɟɬɢɱɧɢɦɢ ɦɚɪɤɟɪɚɦɢ ɫɯɢɥɶɧɨɫɬɿ ɞɨ ɪɨɡɜɢɬɤɭ ɚɤɭɲɟɪɫɶɤɢɯ ɿ ɩɟɪɢɧɚ ɬɚɥɶɧɢɯɭɫɤɥɚɞɧɟɧɶɭɜɚɝɿɬɧɢɯɡɩɪɟɟɤɥɚɦɩɫɿɽɸɽ ɩɨɥɿɦɨɪɮɿɡɦɢ *Ⱥ ɡɚ ɝɟɧɨɦ ɮɚɤɬɨɪɚ 9 /HLGHQ±ɩɿɞɜɢɳɭɽɪɢɡɢɤɭɪɚɡɭȾȱ *$ ɡɚ ɝɟɧɨɦ ɩɪɨɬɪɨɦɛɿɧɭ ± ɭ ɪɚɡɭ Ⱦȱ Ⱥ$ ɩɿɞɜɢɳɭɽ ɪɢɡɢɤɭɪɚɡɭȾȱɤɨɦɛɿɧɚɰɿɹɡ ɬɪɶɨɯ ɿ ɛɿɥɶɲɟ ɩɚɬɨɥɨɝɿɱɧɢɯ ɩɨɥɿɦɨɪɮɿɡɦɿɜ ± ɭ ɪɚɡɭȾȱ

Ⱥɧɚɥɿɡɭɸɱɢ ɧɚɛɭɬɿ ɮɨɪɦɢ ɬɪɨɦɛɨɮɿɥɿʀ ɞɨɜɟ ɞɟɧɨ ɳɨ ɞɥɹ ɪɨɡɜɢɬɤɭ ɭɫɤɥɚɞɧɟɧɶ ɩɿɞ ɱɚɫ ɉȿ ɩɪɢɬɚɦɚɧɧɟ ɪ ɩɿɞɜɢɳɟɧɧɹ ɤɿɥɶɤɨɫɬɿ ɚɧɬɢɬɿɥ ɞɨ ɩɪɨɬɪɨɦɛɿɧɭ ɜ ɪɚɡɭ “ ɩɪɨɬɢ “ Ɉɞɦɥ ɬɚ ɪɿɜɧɹ ɝɨɦɨɰɢɫɬɟʀɧɭ ɜ

ɪɚɡɭ “ɦɤɦɨɥɶɥ ɩɪɨɬɢ

“ɦɤɦɨɥɶɥ

ɇɚɹɜɧɿɫɬɶɩɚɬɨɥɨɝɿɱɧɨɝɨɪɿɜɧɹȺɎȺɩɿɞɜɢɳɭɽ ɪɢɡɢɤɪɨɡɜɢɬɤɭɭɫɤɥɚɞɧɟɧɶɩɿɞɱɚɫɉȿɜɪɚɡɭ Ⱦȱɤɨɦɛɿɧɨɜɚɧɢɯɬɪɨɦɛɨɮɿɥɿɣ± ɜ ɪɚɡɭ Ⱦȱ ɤɨɧɰɟɧɬɪɚɰɿʀ ɝɨ

ɦɨɰɢɫɬɟʀɧɭɛɿɥɶɲɟɧɿɠɦɤɦɨɥɶɥ±ɭɪɚɡɭ Ⱦȱ

Ɋɟɡɭɥɶɬɚɬɢ ɜɚɝɿɬɧɨɫɬɿ ɠɿɧɨɤ ɡ ɭɫɤɥɚɞɧɟɧɧɹɦɢ ɩɪɢɉȿɜɿɞɪɿɡɧɹɥɢɫɶɜɿɞɝɪɭɩɢɩɨɪɿɜɧɹɧɧɹɬɚɤɢɦ ɪ ɫɟɪɟɞɧɿɣ ɫɬɪɨɤ ɪɨɡɪɨɞɠɟɧɧɹ ɜ ɪɚɡɭ ɦɟɧɲɟ “ ɩɪɨɬɢ “ ɬɢɠɧɹ ɤɿɥɶɤɿɫɬɶ ɩɟɪɟɞɱɚɫɧɢɯ ɩɨɥɨɝɿɜ ɜ ɪɚɡɭ ɛɿɥɶɲɚ ɩɪɨɬɢɤɿɥɶɤɿɫɬɶɩɨɥɨɝɿɜɭɫɬɪɨɤ ɦɟɧɲɚ ɜ ɪɚɡɭ ɩɪɨɬɢ ɤɿɥɶ ɤɿɫɬɶ ɨɩɟɪɚɬɢɜɧɨɝɨ ɪɨɡɪɨɞɠɟɧɧɹ ɛɿɥɶɲɚ ɜ ɪɚɡɭ ɩɪɨɬɢ ɤɿɥɶɤɿɫɬɶ ɩɨɥɨɝɿɜ ɩɪɢɪɨɞɧɢɦ ɲɥɹɯɨɦ ɜ ɪɚɡɢ ɦɟɧɲɚ ɩɪɨɬɢ ɤɿɥɶɤɿɫɬɶ ɞɨɫɬɪɨɤɨɜɢɯ ɩɨɥɨɝɿɜ ɲɥɹɯɨɦ ɤɟɫɚɪɟɜɨɝɨ ɪɨɡɬɢɧɭ ɛɿɥɶɲɚ ɜ ɪɚɡɭ ɩɪɨɬɢ ɉɨɥɨɝɢ ɜ Ɉ ɝɪɭɩɿ ɩɨ ɪɿɜɧɹɧɨ ɡ ɉ ɝɪɭɩɨɸ ɜ ɪɚɡɭ ɱɚɫɬɿɲɟ ɛɭɥɢ ɭɫɤɥɚɞɧɟɧɿɞɢɫɬɪɟɫɨɦɩɥɨɞɚɩɪɨɬɢ ɪɬɚɩɟɪɟɞɱɚɫɧɢɦɜɿɞɲɚɪɭɜɚɧɧɹɦɧɨɪɦɚɥɶ ɧɨ ɪɨɡɬɚɲɨɜɚɧɨʀ ɩɥɚɰɟɧɬɢ ɩɪɨɬɢ ɪ

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ɧɟɞɨɧɨɲɟɧɿɫɬɶȱȱȱɫɬɭɩɟɧɹɩɨɪɿɜɧɹɧɨɡɝɪɭɩɨɸɉ ɩɪɨɬɢɪɬɚɧɟɞɨɧɨɲɟɧɿɫɬɶ ȱ9 ɫɬɭɩɟɧɹ ɩɪɨɬɢ ɪ ɇɨɜɨ ɧɚɪɨɞɠɟɧɿ ɨɫɧɨɜɧɨʀ ɝɪɭɩɢ ɭ ɡɜ¶ɹɡɤɭ ɡ ʀɯ ɦɨɪɮɨ ɮɭɧɤɰɿɨɧɚɥɶɧɨɸ ɧɟɡɪɿɥɿɫɬɸ ɜ ɪɚɡɭ ɛɿɥɶɲɟ ɩɨɬɪɟɛɭɜɚɥɢ ɥɿɤɭɜɚɧɧɹ ɭ ɜɿɞɞɿɥɟɧɧɿ ɿɧɬɟɧɫɢɜɧɨʀ ɬɟɪɚɩɿʀ ɬɚ ɜ ɪɚɡɭ ɱɚɫɬɿɲɟ ɧɚ ɧɚɫɬɭɩɧɨɦɭ ɟɬɚɩɿɧɚɞɚɧɧɹɦɟɞɢɱɧɨʀɞɨɩɨɦɨɝɢɪ

ɉɿɞɫɭɦɨɜɭɸɱɢɜɢɳɟɡɚɡɧɚɱɟɧɟɫɥɿɞɩɪɢɩɭɫɬɢ ɬɢ ɳɨ ɧɟɨɛɯɿɞɧɨ ɜɢɞɿɥɹɬɢ ɞɜɚ ɜɢɞɢ ɝɿɩɟɪɬɟɧ ɡɢɜɧɢɯɪɨɡɥɚɞɿɜɩɿɞɱɚɫ ɜɚɝɿɬɧɨɫɬɿɩɟɪɲɢɣ±ɰɟ ɉȿ ɫɟɪɟɞɧɶɨɝɨ ɚɛɨ ɬɹɠɤɨɝɨ ɫɬɭɩɟɧɹ ɹɤɚ ɪɚɧɨ ɪɨɡɩɨɱɢɧɚɽɬɶɫɹ ɬɚ ɫɭɩɪɨɜɨɞɠɭɽɬɶɫɹ ɡɚɝɪɨɡɥɢ ɜɢɦɢɞɥɹɠɢɬɬɹɦɚɬɟɪɿɬɚɞɢɬɢɧɢɭɫɤɥɚɞɧɟɧɧɹɦɢ ɿɞɪɭɝɢɣ±ɰɟɥɟɝɤɚɉȿɭɩɿɡɧɿɬɟɪɦɿɧɢɜɚɝɿɬɧɨɫɬɿ ɬɚ ɛɟɡ ɫɭɩɭɬɧɿɯ ɭɫɤɥɚɞɧɟɧɶ ɍ ɪɨɡɜɢɬɤɭ ɰɢɯ ɪɿɡɧɢɯ ɡɚ ɬɟɪɦɿɧɨɦ ɿ ɩɟɪɟɛɿɝɨɦ ɜɢɞɿɜ ɝɿɩɟɪ ɬɟɧɡɢɜɧɢɯ ɪɨɡɥɚɞɿɜ ɥɟɠɚɬɶ ɪɿɡɧɿ ɟɬɿɨɥɨɝɿɱɧɿ ɬɚ ɩɚɬɨɮɿɡɿɨɥɨɝɿɱɧɿ ɡɦɿɧɢ Ɋɨɡɜɢɬɨɤ ɉȿ ɧɚ ɮɨɧɿ ɿɫɧɭɜɚɧɧɹ ɧɚɛɭɬɢɯ ɬɚ ɫɩɚɞɤɨɜɢɯ ɜɢɞɿɜ ɌɎ ɩɨ ɜɹɡɚɧɢɣ ɡ ɛɿɥɶɲ ɬɹɠɤɢɦ ɩɟɪɟɛɿɝɨɦ ɪɚɧɧɿɦ ɩɨɱɚɬɤɨɦ ɬɚ ɪɨɡɜɢɬɤɨɦ ɡɚɝɪɨɡɥɢɜɢɯ ɞɥɹ ɠɢɬɬɹ ɦɚɬɟɪɿ ɬɚ ɩɥɨɞɚ ɭɫɤɥɚɞɧɟɧɶ ɇɚɲɚ ɞɭɦɤɚ ɭɡ ɝɨɞɠɭɽɬɶɫɹɡɪɨɛɨɬɚɦɢ*0HOORHWDO>@

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Ʉɥɿɧɿɤɨɚɧɚɦɧɟɫɬɢɱɧɢɦɢ ɱɢɧɧɢɤɚɦɢ ɳɨ

ɡɛɿɥɶɲɭɸɬɶɜɿɞɧɨɫɧɢɣɪɢɡɢɤɪɨɡɜɢɬɤɭɚɤɭɲɟɪɫɶ ɤɢɯɿɩɟɪɢɧɚɬɚɥɶɧɢɯɭɫɤɥɚɞɧɟɧɶɭɜɚɝɿɬɧɢɯɡɩɪɟ ɟɤɥɚɦɩɫɿɽɸ ɽ ɩɟɪɲɿ ɩɨɥɨɝɢ ɩɨɹɜɚ ɫɢɦɩɬɨɦɿɜ ɩɪɟɟɤɥɚɦɩɫɿʀɜɬɟɪɦɿɧɿɦɟɧɲɟɧɿɠɬɢɠɧɿɜɜɚ ɝɿɬɧɨɫɬɿ ɩɪɟɟɤɥɚɦɩɫɿɹ ɬɹɠɤɨɝɨ ɚɛɨ ɫɟɪɟɞɧɶɨɝɨ ɫɬɭɩɟɧɹ ɬɹɠɤɨɫɬɿ ɬɪɢɜɚɥɿɫɬɶ ɩɪɟɟɤɥɚɦɩɫɿʀ ɛɿɥɶ ɲɟɧɿɠɬɢɠɧɿɜ

Ɇɚɪɤɟɪɚɦɢ ɫɯɢɥɶɧɨɫɬɿ ɞɨ ɪɨɡɜɢɬɤɭ ɚɤɭ

ɲɟɪɫɶɤɢɯɿɩɟɪɢɧɚɬɚɥɶɧɢɯɭɫɤɥɚɞɧɟɧɶɭɜɚɝɿɬɧɢɯ ɡɩɪɟɟɤɥɚɦɩɫɿɽɸɽɬɚɤɿɝɟɧɨɬɢɩɢ*Ⱥɮɚɤɬɨ ɪɚ9/HLGHQ±ɩɿɞɜɢɳɭɽɪɢɡɢɤɭɪɚɡɭȾȱ *$ ɩɪɨɬɪɨɦɛɿɧɭ ± ɜ ɪɚɡɭ Ⱦȱ Ⱥ$ ɩɪɨɬɪɨɦɛɿɧɚ ± ɜ ɪɚɡɭ Ⱦȱ ɤɨɦɛɿɧɚɰɿɹ ɡ ɬɪɶɨɯ ɿ ɛɿɥɶɲɟɩɚɬɨɥɨɝɿɱɧɢɯɩɨɥɿɦɨɪɮɿɡɦɿɜ±ɭɪɚɡɭ ȾȱɩɚɬɨɥɨɝɿɱɧɢɣɪɿɜɟɧɶȺɎȺ±ɜ ɪɚɡɭ Ⱦȱ ɤɨɦɛɿɧɨɜɚɧɿ ɬɪɨɦ ɛɨɮɿɥɿʀ ± ɜ ɪɚɡɭ Ⱦȱ ɤɨɧ ɰɟɧɬɪɚɰɿɹ ɝɨɦɨɰɢɫɬɟʀɧɭ ɛɿɥɶɲɟ ɧɿɠ ɦɤɦɨɥɶɥ ±ɜɪɚɡɭȾȱ

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ɉɪɨɮɢɥɚɤɬɢɤɚ ɩɨɜɬɨɪɧɵɯ ɨɫɥɨɠɧɟɧɢɣ ɛɟɪɟ ɦɟɧɧɨɫɬɢ ɜ ɭɫɥɨɜɢɹɯ ɬɪɨɦɛɨɮɢɥɢɢ Ɋɭɤɨɜɨɞɫɬɜɨ ɞɥɹ ɜɪɚɱɟɣ ȺȾ Ɇɚɤɚɰɚɪɢɹ ȼɈ Ȼɢɰɚɞɡɟ ɋɆ Ȼɚɣɦɭ ɪɚɞɨɜɚ ȿȻ ɉɟɪɟɞɟɪɹɟɜɚ >ɢ ɞɪ@ ± Ɇɨɫɤɜɚ Ɍɪɢɚɞɚ ± ɏ±ɫ

ɉɪɨ ɡɚɬɜɟɪɞɠɟɧɧɹ ɤɥɿɧɿɱɧɢɯ ɩɪɨɬɨɤɨɥɿɜ ɡ ɚɤɭ ɲɟɪɫɶɤɨʀ ɬɚ ɝɿɧɟɤɨɥɨɝɿɱɧɨʀ ɞɨɩɨɦɨɝɢ ɇɚɤɚɡ ɜɿɞ ɪʋɆɿɧɿɫɬɟɪɫɬɜɨɨɯɨɪɨɧɢɡɞɨɪɨɜ¶ɹ ɍɤɪɚʀɧɢ±Ʉɢʀɜ

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ȾɁ «ȾɧɿɩɪɨɩɟɬɪɨɜɫɶɤɚɦɟɞɢɱɧɚɚɤɚɞɟɦɿɹɆɈɁɍɤɪɚʀɧɢ»

ɤɚɮɟɞɪɚɜɧɭɬɪɿɲɧɶɨʀɦɟɞɢɰɢɧɢʋ 2 ɬɚɩɪɨɮɩɚɬɨɥɨɝɿʀ (ɡɚɜ. – ɞ. ɦɟɞ. ɧ., ɩɪɨɮ. Ɉ.ȼ. Ʉɭɪɹɬɚ)

ɩɥ. ɀɨɜɬɧɟɜɚ, 14, Ⱦɧɿɩɪɨɩɟɬɪɨɜɫɶɤ, 49005, ɍɤɪɚʀɧɚ

SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine» Department of Internal Medicine N 2 and occupational disease Oktyabrskay Sq., 14, Dnipropetrovsk, 49005, Ukraine

e-mail: Filippova-dma@i.ua

Ʉɥɸɱɨɜɿɫɥɨɜɚɫɬɟɚɬɨɡɩɟɱɿɧɤɢ, ɧɟɚɥɤɨɝɨɥɶɧɢɣɫɬɟɚɬɨɝɟɩɚɬɢɬ, ɨɠɢɪɿɧɧɹ, ɿɧɞɟɤɫɦɚɫɢɬɿɥɚ, ɛɿɥɿɚɪɧɢɣ ɬɪɚɤɬ, ɤɥɿɧɿɤɚ, ɞɿɚɝɧɨɫɬɢɤɚ

.H\ZRUGVsteatosis, non-alcoholic steatohepatitis, obesity, body mass index, biliary tract, clinical findings, diagnostics

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