Prediction of bladder tumor relapse based on the risk factors and characteristics of the treatment

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Ƚɍ «Ⱦɧɟɩɪɨɩɟɬɪɨɜɫɤɚɹ ɦɟɞɢɰɢɧɫɤɚɹ ɚɤɚɞɟɦɢɹ ɆɁ ɍɤɪɚɢɧɵ» 1 ɭɥ.Ⱦɡɟɪɠɢɧɫɤɨɝɨ, 9, Ⱦɧɟɩɪɨɩɟɬɪɨɜɫɤ, 49044, ɍɤɪɚɢɧɚ

ɍɧɢɜɟɪɫɢɬɟɬɫɤɢɣ ɤɨɥɥɟɞɠ Ʌɨɧɞɨɧɚ,ɂɧɫɬɢɬɭɬ ɠɟɧɫɤɨɝɨ ɡɞɨɪɨɜɶɹ,ɨɬɞɟɥ ɠɟɧɫɤɨɣ ɨɧɤɨɥɨɝɢɢ2

Ʌɨɧɞɨɧ,ȼɟɥɢɤɨɛɪɢɬɚɧɢɹ

SE «Dnipropetrovsk Medical Academy of Health Ministry of Ukraine» 1 Dzerzhinskogo Str., 9, Dnepropetrovsk, 49044, Ukraine

e-mail: rob_molch@yahoo.com

University ɋollege London, Institute for Women’s Health, Department of Women's Cancer 2

London, United Kingdom

Ʉɥɸɱɟɜɵɟ ɫɥɨɜɚ:ɨɩɭɯɨɥɶ,ɦɨɱɟɜɨɣ ɩɭɡɵɪɶ,ɩɪɨɝɧɨɡɢɪɨɜɚɧɢɟ,ɪɟɰɢɞɢɜ,ɩɪɨɛɢɨɬɢɤɢ Key words: tumors, urinary bladder, prognosis, recurrence, infection, probiotics

Ɋɟɮɟɪɚɬ. ɉɪɨɝɧɨɡɭɜɚɧɧɹ ɪɟɰɢɞɢɜɿɜ ɩɭɯɥɢɧ ɫɟɱɨɜɨɝɨ ɦɿɯɭɪɚ ɡ ɭɪɚɯɭɜɚɧɧɹɦ ɮɚɤɬɨɪɿɜ ɪɢɡɢɤɭ ɣ

ɨɫɨɛɥɢɜɨɫɬɟɣ ɥɿɤɭɜɚɧɧɹ.Ɇɨɥɱɚɧɨɜ Ɋ.Ɇ.,Ȼɥɸɫɫ Ɉ.Ȼ. Ɇɟɬɚ ɞɨɫɥɿɞɠɟɧɧɹ - ɜɢɜɱɢɬɢ ɦɨɠɥɢɜɨɫɬɿ

ɩɪɨɝɧɨɡɭ-ɜɚɧɧɹ ɪɟɰɢɞɢɜɭ ɩɭɯɥɢɧ ɫɟɱɨɜɨɝɨ ɦɿɯɭɪɚ ɡ ɭɪɚɯɭɩɪɨɝɧɨɡɭ-ɜɚɧɧɹɦ ɤɥɿɧɿɤɨ-ɦɨɪɮɨɥɨɝɿɱɧɢɯ ɨɫɨɛɥɢɜɨɫɬɟɣ ɡɚɯɜɨɪɸɩɪɨɝɧɨɡɭ-ɜɚɧɧɹ ɬɚ ɩɪɨɜɟɞɟɧɧɹ ɩɟɪɟɞɨɩɟɪɚɰɿɣɧɨʀ ɜɧɭɬɪɿɲɧɶɨɦɿɯɭɪɨɜɨʀ ɿɧɫɬɢɥɹɰɿʀ ɩɪɨɛɿɨɬɢɤɚ Aerococcus viridans 167. 190 ɩɚɰɿɽɧɬɿɜ,ɨɩɟɪɨɜɚɧɢɯ ɡ ɩɪɢɜɨɞɭ ɩɭɯɥɢɧ ɫɟɱɨɜɨɝɨ ɦɿɯɭɪɚ,ɫɩɨɫɬɟɪɿɝɚɥɢ ɩɪɨɬɹɝɨɦ ɜɿɞ 1 ɞɨ 73 ɦɿɫɹɰɿɜ (ɫɟɪɟɞɧɽ – 35,2 ɦɿɫ.). 51 ɩɚɰɿɽɧɬɭ ɞɨ ɫɬɚɧɞɚɪɬɧɨɝɨ ɥɿɤɭɜɚɧɧɹ ɞɨɞɚɧɚ ɨɞɧɨɪɚɡɨɜɚ ɩɟɪɟɞɨɩɟɪɚɰɿɣɧɚ ɜɧɭɬɪɿɲɧɶɨɦɿɯɭɪɨɜɚ ɿɧɫɬɢɥɹɰɿɹ ɩɪɨɛɿɨɬɢɤɚ Aerococcus viridans 167. ȼɢɹɜɥɟɧɿ ɜɢɩɚɞɤɢ ɪɟɰɢɞɢɜɭ ɩɭɯɥɢɧ ɩɨɤɥɚɞɟɧɿ ɜ ɨɫɧɨɜɭ ɪɨɡɪɨɛɤɢ ɦɚɬɟɦɚɬɢɱɧɢɯ ɩɪɚɜɢɥ ɩɪɨɝɧɨɡɭɜɚɧɧɹ ɪɟɰɢɞɢɜɭ, ɞɥɹ ɫɬɜɨɪɟɧɧɹ ɹɤɢɯ ɜɢɤɨɪɢɫɬɨɜɭɜɚɥɢɫɹ ɥɨɝɿɫɬɢɱɧɚ ɪɟɝɪɟɫɿɹ ɿ ɦɟɬɨɞ ɨɩɨɪɧɢɯ ɜɟɤɬɨɪɿɜ.Ɂɿ 190 ɩɚɰɿɽɧɬɿɜ ɭ 132 (69,5%) ɜɢɹɜɥɟɧɨ ɩɟɪɟɯɿɞɧɨɤɥɿɬɢɧɧɢɣ ɪɚɤ (ɉɄɊ)ɭ ɫɬɚɞɿʀ Ɍɚ-T1, ɭ 58 (30,5%) - ɩɟɪɟɯɿɞɧɨɤɥɿɬɢɧɧɚ ɩɚɩɿɥɨɦɚ ɫɟɱɨɜɨɝɨ ɦɿɯɭɪɚ (ɉɉ). Ɋɟɰɢɞɢɜɢ ɩɭɯɥɢɧɢ ɜɢɹɜɥɟɧɿ ɜ 52 (27,4%) ɯɜɨɪɢɯ, ɫɟɪɟɞɧɿɣ ɱɚɫ ɫɩɨɫɬɟɪɟɠɟɧɧɹ ɹɤɢɯ ɫɬɚɧɨɜɢɜ 14,7 (1-50 ɦɿɫ.) ɍ ɯɜɨɪɢɯ ɧɚ ɉɄɊ ɪɟɰɢɞɢɜɢ ɫɩɨɫɬɟɪɿɝɚɥɢɫɹ ɭ 36 (37%) ɡ 96 ɩɚɰɿɽɧɬɿɜ, ɹɤɿ ɧɟ ɨɬɪɢɦɭɜɚɥɢ ɿɧɫɬɢɥɹɰɿɸ ɩɪɨɛɿɨɬɢɤɚ ɿ ɜ 7 (19%) ɡ 36 ɩɿɫɥɹ ɣɨɝɨ ɜɢɤɨɪɢɫɬɚɧɧɹ (p<0,05). ɍ ɝɪɭɩɿ ɉɉ ɧɟ ɜɢɹɜɥɟɧɨ ɞɨɫɬɨɜɿɪɧɢɯ ɨɡɧɚɤ ɜɩɥɢɜɭ ɿɧɫɬɢɥɹɰɿʀ ɩɪɨɛɿɨɬɢɤɿɜ ɧɚ ɤɿɥɶɤɿɫɬɶ ɪɟɰɢɞɢɜɿɜ. Ɉɬɪɢɦɚɧɨ ɤɥɚɫɢɮɿɤɚɰɿɣɧɿ ɩɪɚɜɢɥɚ, ɹɤɿ ɞɨɡɜɨɥɹɸɬɶ ɩɪɨɝɧɨɡɭɜɚɬɢ ɪɢɡɢɤ ɪɟɰɢɞɢɜɭ ɩɭɯɥɢɧ ɫɟɱɨɜɨɝɨ ɦɿɯɭɪɚ ɡ ɭɪɚɯɭɜɚɧɧɹɦ ɝɿɫɬɨɥɨɝɿɱɧɢɯ ɯɚɪɚɤɬɟɪɢɫɬɢɤ ɿ ɡɚɫɬɨɫɭɜɚɧɧɹ ɩɪɨɛɿɨɬɢɤɚ.ɉɟɪɟɞɨɩɟɪɚɰɿɣɧɚ ɿɧɫɬɢɥɹɰɿɹ ɩɪɨɛɿɨɬɢɤɚ Aerococcus viridans 167 ɭ ɯɜɨɪɢɯ ɧɚ ɉɄɊ ɌɚɌ1 ɡɧɢɠɭɽ ɱɚɫɬɨɬɭ ɪɟɰɢɞɢɜɿɜ ɡ 37% ɞɨ 19% (p<0,05). Ɂɦɿɧɧɿ «Ʉɿɥɶɤɿɫɬɶ ɩɭɯɥɢɧ» ɿ «Ɇɚɤɫɢɦɚɥɶɧɢɣ ɪɨɡɦɿɪ ɩɭɯɥɢɧɢ», ɚ ɬɚɤɨɠ ʀɯ ɫɩɿɜɜɿɞɧɨɲɟɧɧɹ ɽ ɿɧɮɨɪɦɚɬɢɜɧɢɦɢ ɩɪɨɝɧɨɫɬɢɱɧɢɦɢ ɩɚɪɚɦɟɬɪɚɦɢ. Ɉɬɪɢɦɚɧɿ ɩɪɚɜɢɥɚ ɦɨɠɭɬɶ ɛɭɬɢ ɪɟɤɨɦɟɧɞɨɜɚɧɿ ɞɥɹ ɫɩɨɫɬɟɪɟɠɟɧɧɹ ɡɚ ɩɚɰɿɽɧɬɚɦɢ ɩɿɫɥɹ ɯɿɪɭɪɝɿɱɧɨɝɨ ɜɬɪɭɱɚɧɧɹ ɡ ɦɟɬɨɸ ɫɜɨɽɱɚɫɧɨɝɨ ɜɢɞɿɥɟɧɧɹ ɝɪɭɩɢ ɩɚɰɿɽɧɬɿɜ ɡ ɩɿɞɜɢɳɟɧɢɦ ɪɢɡɢɤɨɦ ɪɟɰɢɞɢɜɭ.

Abstract. Prediction of bladder tumor relapse based on the risk factors and characteristics of the treatment. Molchanov R.N. , Blyuss O.B. Objectives. To investigate the possibility of predicting recurrence of bladder tumors based on the clinical and morphological features of the disease and preoperative intravesical instillation of probiotic Aerococcus viridans 167. 190 patients operated for bladder tumors have been observed for a period from 1 to 73 months (mean 35.2 months). In 51 patients one single preoperative intravesical instillation of probiotic Aerococcus viridans 167 was added to a standard treatment. Reported cases of recurrence of tumors were used as a basis for the development of mathematical rules for predicting recurrences. These rules have been used to create a logistic regression and support vector machines. Of 190 patients, in 132 (69,5%) transitional cell carcinoma (TCC) in the stage Ta-T1, in 58 (30,5%) - transitional cell papilloma of the bladder (TCP) was identified. Recurrences were detected in 52

(2)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

Ɋɚɤ ɦɨɱɟɜɨɝɨ ɩɭɡɵɪɹ ɹɜɥɹɟɬɫɹ ɜɬɨɪɵɦ ɩɨ ɱɚɫɬɨɬɟ ɫɪɟɞɢ ɡɥɨɤɚɱɟɫɬɜɟɧɧɵɯ ɨɩɭɯɨɥɟɣ ɨɪɝɚ

-ɧɨɜ ɦɨɱɟɜɵɞɟɥɢɬɟɥɶɧɨɣ ɫɢɫɬɟɦɵ. Ⱦɨ 75%

ɨɩɭɯɨɥɟɣ ɦɨɱɟɜɨɝɨ ɩɭɡɵɪɹ ɹɜɥɹɸɬɫɹ ɧɟɦɵ

-ɲɟɱɧɨɢɧɜɚɡɢɜɧɵɦɢ ɢ ɨɬɥɢɱɚɸɬɫɹ ɫɤɥɨɧɧɨɫɬɶɸ ɤ ɱɚɫɬɵɦ ɪɟɰɢɞɢɜɚɦ, ɤɨɬɨɪɵɟ ɧɚɛɥɸɞɚɸɬɫɹ ɜ 30-80% ɜ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɝɢɫɬɨɩɚɬɨɥɨɝɢɱɟɫɤɢɯ

ɨɫɨɛɟɧɧɨɫɬɟɣ ɢ ɧɚɥɢɱɢɹ ɪɹɞɚ ɮɚɤɬɨɪɨɜ ɪɢɫɤɚ

[12]. ɇɟɨɛɯɨɞɢɦɨɫɬɶ ɩɪɨɝɧɨɡɢɪɨɜɚɧɢɹ ɪɢɫɤɚ

ɪɟɰɢɞɢɜɚ ɨɩɪɟɞɟɥɹɟɬɫɹ ɜɵɛɨɪɨɦ ɬɚɤɬɢɤɢ ɜɟɞɟɧɢɹ ɩɚɰɢɟɧɬɨɜ ɩɨɫɥɟ ɯɢɪɭɪɝɢɱɟɫɤɨɝɨ ɜɦɟɲɚɬɟɥɶɫɬɜɚ,

ɤɨɬɨɪɚɹ ɪɟɝɥɚɦɟɧɬɢɪɭɟɬ ɩɪɨɜɟɞɟɧɢɟ ɚɞɴɸɜɚɧɬ

-ɧɵɯ ɩɪɨɰɟɞɭɪ ɢ ɫɪɨɤɢ ɧɚɛɥɸɞɟɧɢɹ. ɋɭ

-ɳɟɫɬɜɭɸɳɢɟ ɩɪɨɝɧɨɫɬɢɱɟɫɤɢɟ ɫɢɫɬɟɦɵ ɢɫɩɨɥɶ

-ɡɭɸɬ ɪɹɞ ɤɥɢɧɢɤɨ-ɩɚɬɨɝɢɫɬɨɥɨɝɢɱɟɫɤɢɯ ɯɚɪɚɤɬɟ

-ɪɢɫɬɢɤ ɨɩɭɯɨɥɟɣ ɦɨɱɟɜɨɝɨ ɩɭɡɵɪɹ [6]. ȼ ɬɨ ɠɟ

ɜɪɟɦɹ ɨɧɢ ɧɟ ɭɱɢɬɵɜɚɸɬ ɜɥɢɹɧɢɹ ɚɞɴɸɜɚɧɬɧɵɯ ɦɟɬɨɞɨɜ ɥɟɱɟɧɢɹ (ɩɪɨɮɢɥɚɤɬɢɤɢ) ɧɚ ɪɢɫɤ ɪɚɡ

-ɜɢɬɢɹ ɪɟɰɢɞɢɜɚ ɨɩɭɯɨɥɢ.

Ɉɫɧɨɜɧɵɦ ɦɟɬɨɞɨɦ ɩɪɨɮɢɥɚɤɬɢɤɢ ɪɟɰɢɞɢɜɨɜ ɩɨɜɟɪɯɧɨɫɬɧɵɯ ɨɩɭɯɨɥɟɣ ɦɨɱɟɜɨɝɨ ɩɭɡɵɪɹ ɹɜɥɹɟɬɫɹ ɥɨɤɚɥɶɧɨɟ ɜɨɡɞɟɣɫɬɜɢɟ ɧɚ ɫɥɢɡɢɫɬɭɸ ɨɛɨɥɨɱɤɭ ɦɨɱɟɜɨɝɨ ɩɭɡɵɪɹ ɯɢɦɢɨɬɟɪɚɩɟɜ

-ɬɢɱɟɫɤɢɦɢ ɢ ɢɦɦɭɧɧɵɦɢ ɩɪɟɩɚɪɚɬɚɦɢ. Ⱥɞɴɸ

-ɜɚɧɬɧɵɟ ɢɧɫɬɢɥɥɹɰɢɢ ɜ ɦɨɱɟɜɨɣ ɩɭɡɵɪɶ ɯɢɦɢɨ

-ɩɪɟɩɚɪɚɬɨɜ, ɤɨɬɨɪɵɟ ɩɪɢɜɨɞɹɬ ɤ ɞɟɫɬɪɭɤɰɢɢ

ɮɥɨɬɢɪɭɸɳɢɯ ɨɩɭɯɨɥɟɜɵɯ ɤɥɟɬɨɤ ɢɥɢ ɪɟɡɢ

-ɞɭɚɥɶɧɵɯ ɨɩɭɯɨɥɟɣ ɫɧɢɠɚɸɬ ɱɚɫɬɨɬɭ ɪɟɰɢɞɢɜɨɜ ɩɨɜɟɪɯɧɨɫɬɧɵɯ ɨɩɭɯɨɥɟɣ ɧɢɡɤɨɣ ɝɪɚɞɚɰɢɢ [6]. ȼ

ɨɬɧɨɲɟɧɢɢ ɨɩɭɯɨɥɟɣ ɜɵɫɨɤɨɣ ɝɪɚɞɚɰɢɢ ɛɨɥɟɟ ɷɮɮɟɤɬɢɜɧɵ ɜɧɭɬɪɢɩɭɡɵɪɧɵɟ ɢɧɫɬɢɥɥɹɰɢɢ ɜɚɤ

-ɰɢɧɵ Ȼɐɀ, ɩɪɨɬɢɜɨɨɩɭɯɨɥɟɜɨɟ ɞɟɣɫɬɜɢɟ ɤɨɬɨ

-ɪɨɣ ɨɫɧɨɜɚɧɨ ɧɚ ɚɤɬɢɜɚɰɢɢ ɩɪɨɬɢɜɨɨɩɭɯɨɥɟɜɨɝɨ ɢɦɦɭɧɢɬɟɬɚ [4]. ɍɦɟɪɟɧɧɚɹ ɷɮɮɟɤɬɢɜɧɨɫɬɶ ɭɤɚ

-ɡɚɧɧɵɯ ɦɟɬɨɞɨɜ ɚɞɴɸɜɚɧɬɧɨɣ ɬɟɪɚɩɢɢ ɩɨɜɟɪɯ

-ɧɨɫɬɧɨɝɨ ɪɚɤɚ ɦɨɱɟɜɨɝɨ ɩɭɡɵɪɹ ɜ ɫɨɱɟɬɚɧɢɢ ɫ ɱɚɫɬɵɦɢ ɩɨɛɨɱɧɵɦɢ ɷɮɮɟɤɬɚɦɢ [7] ɫɬɢɦɭɥɢɪɭɟɬ

ɩɨɢɫɤ ɧɨɜɵɯ ɦɟɬɨɞɨɜ ɩɪɨɮɢɥɚɤɬɢɤɢ ɪɟɰɢɞɢɜɨɜ ɢ ɩɪɨɝɪɟɫɫɢɢ ɡɚɛɨɥɟɜɚɧɢɹ.

ɉɟɪɫɩɟɤɬɢɜɧɵɦ ɧɚɩɪɚɜɥɟɧɢɟɦ ɜ ɩɪɨɮɢɥɚɤ

-ɬɢɤɟ ɪɟɰɢɞɢɜɨɜ ɨɩɭɯɨɥɟɣ ɦɨɱɟɜɨɝɨ ɩɭɡɵɪɹ ɹɜɥɹɟɬɫɹ ɩɪɢɦɟɧɟɧɢɟ ɩɪɨɛɢɨɬɢɤɨɜ, ɭ ɤɨɬɨɪɵɯ

ɨɛɧɚɪɭɠɟɧɵ ɧɟ ɬɨɥɶɤɨ ɫɩɨɫɨɛɧɨɫɬɢ ɤ ɢɦɦɭɧɨɦɨ

-ɞɭɥɹɰɢɢ, ɚɧɬɚɝɨɧɢɫɬɢɱɟɫɤɨɦɭ ɞɟɣɫɬɜɢɸ ɩɨ

ɨɬɧɨɲɟɧɢɸ ɤ ɭɪɨɩɚɬɨɝɟɧɧɨɣ ɦɢɤɪɨɮɥɨɪɟ, ɧɨ ɢ ɤ

ɩɨɞɚɜɥɟɧɢɸ ɪɨɫɬɚ ɨɩɭɯɨɥɟɜɵɯ ɤɥɟɬɨɤ. ȼ

ɧɚɫɬɨɹɳɟɟ ɜɪɟɦɹ ɛɨɥɶɲɢɧɫɬɜɨ ɧɚɭɱɧɵɯ ɪɚɛɨɬ ɩɨɫɜɹɳɟɧɵ ɢɫɫɥɟɞɨɜɚɧɢɸ ɥɟɱɟɛɧɨ-ɩɪɨɮɢɥɚɤ

-ɬɢɱɟɫɤɨɝɨ ɩɪɨɬɢɜɨɨɩɭɯɨɥɟɜɨɝɨ ɷɮɮɟɤɬɚ ɩɪɨɛɢɨ

-ɬɢɤɨɜ ɩɪɢ ɩɟɪɨɪɚɥɶɧɨɦ ɩɪɢɟɦɟ, ɜ ɷɤɫɩɟɪɢɦɟɧɬɟ

ɧɚ ɠɢɜɨɬɧɵɯ ɢ ɧɚ ɤɭɥɶɬɭɪɚɯ ɤɥɟɬɨɤ. ȼ ɬɨ ɠɟ

ɜɪɟɦɹ ɢɯ ɤɥɢɧɢɱɟɫɤɢɣ ɷɮɮɟɤɬ ɩɪɢ ɧɟɩɨɫɪɟɞ

-ɫɬɜɟɧɧɨɦ ɜɨɡɞɟɣɫɬɜɢɢ ɧɚ ɨɩɭɯɨɥɢ ɦɨɱɟɜɨɝɨ ɩɭɡɵɪɹ ɹɜɥɹɟɬɫɹ ɦɚɥɨ ɢɡɭɱɟɧɧɵɦ [10, 11]. ɇɚɢ

-ɛɨɥɟɟ ɢɫɫɥɟɞɨɜɚɧɧɵɦɢ ɩɪɨɛɢɨɬɢɤɚɦɢ ɜ

ɧɚɫɬɨɹɳɟɟ ɜɪɟɦɹ ɹɜɥɹɸɬɫɹ ɛɚɤɬɟɪɢɢ

Lactobacillus. Ʉɪɨɦɟ ɬɨɝɨ, ɩɨɥɭɱɟɧɵ ɪɟɡɭɥɶɬɚɬɵ,

ɩɨɞɬɜɟɪɠɞɚɸɳɢɟ ɧɚɥɢɱɢɟ ɩɪɨɬɢɜɨɨɩɭɯɨɥɟɜɨɝɨ ɷɮɮɟɤɬɚ ɭ ɩɪɨɛɢɨɬɢɤɚȺerococcus viridans 167ɧɚ

ɤɭɥɶɬɭɪɚɯ ɤɥɟɬɨɤ ɜ ɷɤɫɩɟɪɢɦɟɧɬɟ ɧɚ ɠɢɜɨɬɧɵɯ,ɚ

ɬɚɤɠɟ ɩɨɥɭɱɟɧɵ ɞɚɧɧɵɟ ɩɨ ɜɥɢɹɧɢɸ ɧɚ ɫɨɫɬɨɹɧɢɟ ɦɟɫɬɧɨɝɨ ɢɦɦɭɧɢɬɟɬɚ ɭ ɛɨɥɶɧɵɯ ɫ ɨɩɭɯɨɥɹɦɢ ɦɨɱɟɜɨɝɨ ɩɭɡɵɪɹ ɩɪɢ ɨɝɪɚɧɢɱɟɧɧɨɦ ɤɥɢɧɢɱɟɫɤɨɦ ɢɫɩɨɥɶɡɨɜɚɧɢɢ [1, 2, 3].

ɉɪɟɞɫɬɚɜɥɹɟɬɫɹ ɰɟɥɟɫɨɨɛɪɚɡɧɵɦ ɭɱɟɬ ɩɪɨɮɢ

-ɥɚɤɬɢɱɟɫɤɨɝɨ ɷɮɮɟɤɬɚ ɚɞɴɸɜɚɧɬɧɨɣ ɬɟɪɚɩɢɢ ɫ ɰɟɥɶɸ ɭɬɨɱɧɟɧɢɹ ɩɪɨɝɧɨɡɢɪɨɜɚɧɢɹ ɪɟɰɢɞɢɜɚ ɨɩɭɯɨɥɢ ɦɨɱɟɜɨɝɨ ɩɭɡɵɪɹ, ɚ ɬɚɤɠɟ ɞɥɹ ɨɰɟɧɤɢ

ɷɮɮɟɤɬɢɜɧɨɫɬɢ ɢɡɛɪɚɧɧɨɝɨ ɦɟɬɨɞɚ ɥɟɱɟɧɢɹ.

ɐɟɥɶ ɪɚɛɨɬɵ – ɢɡɭɱɢɬɶ ɜɨɡɦɨɠɧɨɫɬɢ ɩɪɨɝɧɨ

-ɡɢɪɨɜɚɧɢɹ ɪɟɰɢɞɢɜɚ ɨɩɭɯɨɥɟɣ ɦɨɱɟɜɨɝɨ ɩɭɡɵɪɹ ɫ ɭɱɟɬɨɦ ɤɥɢɧɢɤɨ-ɦɨɪɮɨɥɨɝɢɱɟɫɤɢɯ ɨɫɨɛɟɧɧɨɫɬɟɣ

ɡɚɛɨɥɟɜɚɧɢɹ ɢ ɩɪɨɜɟɞɟɧɢɹ ɩɪɟɞɨɩɟɪɚɰɢɨɧɧɨɣ ɜɧɭɬɪɢɩɭɡɵɪɧɨɣ ɢɧɫɬɢɥɥɹɰɢɢ ɩɪɨɛɢɨɬɢɤɚ

Aerococcus viridans 167.

ɆȺɌȿɊɂȺɅɕ ɂ ɆȿɌɈȾɕ ɂɋɋɅȿȾɈȼȺɇɂɃ

ȼ ɢɫɫɥɟɞɨɜɚɧɢɟ ɜɤɥɸɱɟɧɵ 190 ɛɨɥɶɧɵɯ,

ɩɪɨɯɨɞɢɜɲɢɯ ɥɟɱɟɧɢɟ ɜ ɭɪɨɥɨɝɢɱɟɫɤɨɦ ɨɬɞɟ

-ɥɟɧɢɢ ʋ 2 Ʉɍ «Ɉɛɥɚɫɬɧɚɹ ɤɥɢɧɢɱɟɫɤɚɹ ɛɨɥɶɧɢɰɚ

ɢɦ.ɂ.ɂ.Ɇɟɱɧɢɤɨɜɚ»ɝ. Ⱦɧɟɩɪɨɩɟɬɪɨɜɫɤɚ ɜ ɬɟɱɟ

-ɧɢɟ ɫ ɹɧɜɚɪɹ 2007 ɩɨ ɞɟɤɚɛɪɶ 2009 ɝɨɞɚ. ɉɚ

-ɰɢɟɧɬɵ ɨɩɟɪɢɪɨɜɚɧɵ ɩɨ ɩɨɜɨɞɭ ɨɩɭɯɨɥɟɣ ɦɨ

-ɱɟɜɨɝɨ ɩɭɡɵɪɹ. ȼ ɩɪɟɞ- ɢ ɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɨɦ

ɩɟɪɢɨɞɟ ɩɚɰɢɟɧɬɵ ɩɨɥɭɱɚɥɢ ɫɬɚɧɞɚɪɬɧɨɟ ɥɟ

-ɱɟɧɢɟ. 51 ɩɚɰɢɟɧɬɭ ɩɪɨɜɨɞɢɥɢ ɢɧɫɬɢɥɥɹɰɢɸ 10ɦɥ ɩɪɨɛɢɨɬɢɱɟɫɤɨɝɨ ɩɪɟɩɚɪɚɬɚ ɚ-ɛɚɤɬɟɪɢɧ,ɫɨ

-ɞɟɪɠɚɳɟɝɨ 108 ɛɚɤɬɟɪɢɣ/ɦɥ Aerococcus viridans 167,ɤɨɬɨɪɭɸ ɨɫɭɳɟɫɬɜɥɹɥɢ ɩɨ ɤɚɬɟɬɟɪɭ,

ɜɜɟɞɟɧɧɨɦɭ ɜ ɦɨɱɟɜɨɣ ɩɭɡɵɪɶ ɨɞɧɨɤɪɚɬɧɨ ɡɚ 1-3

ɫɭɬɨɤ ɞɨ ɨɩɟɪɚɬɢɜɧɨɝɨ ɜɦɟɲɚɬɟɥɶɫɬɜɚ. ȼ ɞɚɥɶ

-ɧɟɣɲɟɦ ɩɚɰɢɟɧɬɵ ɩɨɥɭɱɚɥɢ ɫɬɚɧɞɚɪɬɧɭɸ ɬɟ

-ɪɚɩɢɸ, ɪɟɝɥɚɦɟɧɬɢɪɨɜɚɧɧɭɸ ɭɬɜɟɪɠɞɟɧɧɵɦɢ

ɩɪɨɬɨɤɨɥɚɦɢ ɥɟɱɟɧɢɹ ɩɚɰɢɟɧɬɨɜ, ɫɬɪɚɞɚɸɳɢɯ

ɨɩɭɯɨɥɹɦɢ ɦɨɱɟɜɨɝɨ ɩɭɡɵɪɹ. ɂɫɫɥɟɞɨɜɚɧɢɟ ɩɪɨ

-ɜɟɞɟɧɨ ɜ ɪɚɦɤɚɯ ɩɪɨɬɨɤɨɥɚ, ɪɚɡɪɚɛɨɬɚɧɧɨɝɨ ɜ

ɫɨɨɬɜɟɬɫɬɜɢɢ ɫ ɬɪɟɛɨɜɚɧɢɹɦɢ ɏɟɥɶɫɢɧɫɤɨɣ ɞɟɤɥɚɪɚɰɢɢ 1974 ɝ. ɢ ɭɬɜɟɪɠɞɟɧɧɨɝɨ ɷɬɢɱɟɫɤɢɦ

ɤɨɦɢɬɟɬɨɦ. ȼɫɟ ɛɨɥɶɧɵɟ ɧɚɛɥɸɞɚɥɢɫɶ ɞɨ ɢɸɧɹ

2012 ɝɨɞɚ, ɜ ɫɨɨɬɜɟɬɫɬɜɢɢ ɫɨ ɫɬɚɧɞɚɪɬɚɦɢ

ɧɚɛɥɸɞɟɧɢɹ ɡɚ ɩɚɰɢɟɧɬɚɦɢ ɫ ɨɩɭɯɨɥɹɦɢ ɦɨ

-ɱɟɜɨɝɨ ɩɭɡɵɪɹ.

ȼɵɹɜɥɟɧɧɵɟ ɫɥɭɱɚɢ ɪɟɰɢɞɢɜɚ ɨɩɭɯɨɥɟɣ ɩɨɥɨ

-ɠɟɧɵ ɜ ɨɫɧɨɜɭ ɪɚɡɪɚɛɨɬɤɢ ɦɚɬɟɦɚɬɢɱɟɫɤɢɯ ɩɪɚ

-ɜɢɥ ɩɪɨɝɧɨɡɢɪɨɜɚɧɢɹ ɪɟɰɢɞɢɜɚ,ɞɥɹ ɫɨɡɞɚɧɢɹ ɤɨ

-ɬɨɪɵɯ ɢɫɩɨɥɶɡɨɜɚɥɢɫɶ ɥɨɝɢɫɬɢɱɟɫɤɚɹ ɪɟɝɪɟɫɫɢɹ ɢ ɦɟɬɨɞ ɨɩɨɪɧɵɯ ɜɟɤɬɨɪɨɜ. Ɉɰɟɧɤɚ ɤɚɱɟɫɬɜɚ ɪɟɝ

-ɪɟɫɫɢɨɧɧɵɯ ɦɨɞɟɥɟɣ ɩɪɨɜɟɞɟɧɚ ɧɚ ɨɫɧɨɜɟ

(3)

84 ɝɨɞɚ (ɫɪɟɞɧɢɣ ɜɨɡɪɚɫɬ 63,1 ± 11,1 (M±ı)), ɢɡ

ɧɢɯ ɦɭɠɱɢɧ – 164, ɠɟɧɳɢɧ – 26. ɍ 145 (76,3%)

ɩɚɰɢɟɧɬɨɜ ɞɢɚɝɧɨɡ ɭɫɬɚɧɨɜɥɟɧ ɜɩɟɪɜɵɟ, ɜ ɬɨ

ɜɪɟɦɹ ɤɚɤ ɭ 41 (21,6%) – ɜɵɹɜɥɟɧ ɪɟɰɢɞɢɜ, ɭ 4 (2,1%) – ɨɩɭɯɨɥɢ ɪɟɰɢɞɢɜɢɪɨɜɚɥɢ 2 ɢ ɛɨɥɟɟ ɪɚɡ.

ɉɟɪɟɯɨɞɧɨɤɥɟɬɨɱɧɚɹ ɩɚɩɢɥɥɨɦɚ ɦɨɱɟɜɨɝɨ ɩɭɡɵɪɹ ɜɵɹɜɥɟɧɚ ɭ 58 (30,5%), ɧɟɦɵɲɟɱɧɨɢɧ

-ɜɚɡɢɜɧɵɣ ɩɟɪɟɯɨɞɧɨɤɥɟɬɨɱɧɵɣ ɪɚɤ – ɭ 132 (69,5%) ɩɚɰɢɟɧɬɨɜ:ɜ ɫɬɚɞɢɢ Ɍɚ ɭ 6 (3,2%), Ɍ1 –

126 (66,3%), ɫɨɝɥɚɫɧɨ ɤɥɚɫɫɢɮɢɤɚɰɢɢ ɌNM 2009

ɝ.,ɤɨɬɨɪɵɣ ɛɵɥ ɩɪɟɞɫɬɚɜɥɟɧ ɜɵɫɨɤɢɦ 59 (31,1%)

ɢ ɭɦɟɪɟɧɧɵɦ 73 (38,4%) ɭɪɨɜɧɟɦ ɞɢɮɮɟɪɟɧ

-ɰɢɪɨɜɤɢ. ɍ 138 (72,6%) ɩɚɰɢɟɧɬɨɜ ɜɵɹɜɥɟɧɚ 1

ɨɩɭɯɨɥɶ,ɭ 25 (13,2%) – 2, ɭ 14 (7,4%) – 3-7, ɛɨɥɟɟ 7 – ɭ 13 (6,8%) ɩɚɰɢɟɧɬɨɜ. Ɇɚɤɫɢɦɚɥɶɧɵɣ ɞɢɚ

-ɦɟɬɪ ɜɵɹɜɥɟɧɧɵɯ ɨɩɭɯɨɥɟɣ ɫɨɫɬɚɜɢɥ ɨɬ 2 ɞɨ 50

ɦɦ (ɫɪɟɞɧɢɣ ɞɢɚɦɟɬɪ 20,1±11,1 (M±ı)).

ɉɪɢɡɧɚɤɢ ɢɧɮɟɤɰɢɢ ɦɨɱɟɜɵɯ ɩɭɬɟɣ (ɂɆɉ),

ɯɚɪɚɤɬɟɪɢɡɭɸɳɢɟɫɹ ɧɚɥɢɱɢɟɦ ɥɟɣɤɨɰɢɬɭɪɢɢ ɛɨɥɟɟ 10 ɥɟɣɤɨɰɢɬɨɜ ɜ ɩɨɥɟ ɡɪɟɧɢɹ ɢɥɢ ɛɨɥɟɟ 4000 ɜ 1 ɦɥ, ɫɨɱɟɬɚɸɳɢɟɫɹ ɫ ɩɨɡɢɬɢɜɧɵɦ ɛɚɤɬɟ

-ɪɢɨɥɨɝɢɱɟɫɤɢɦ ɚɧɚɥɢɡɨɦ ɦɨɱɢ, ɜɵɹɜɥɟɧɵ ɭ 49 (25,7%) ɨɛɫɥɟɞɭɟɦɵɯ.

159 (83,6%) ɩɚɰɢɟɧɬɚɦ ɜɵɩɨɥɧɟɧɚ ɬɪɚɧɫ

-ɭɪɟɬɪɚɥɶɧɚɹ ɪɟɡɟɤɰɢɹ ɦɨɱɟɜɨɝɨ ɩɭɡɵɪɹ, 25

(13,2%) – ɨɬɤɪɵɬɚɹ ɪɟɡɟɤɰɢɹ ɦɨɱɟɜɨɝɨ ɩɭɡɵɪɹ, 6

(3,2%) – ɪɟɡɟɤɰɢɹ ɦɨɱɟɜɨɝɨ ɩɭɡɵɪɹ ɫ ɭɪɟɬɟ

-ɪɨɰɢɫɬɨɧɟɨɫɬɨɦɢɟɣ.

Ⱥɞɴɸɜɚɧɬɧɭɸ ɬɟɪɚɩɢɸ ɩɪɨɜɨɞɢɥɢ 24 (12,6%)

ɩɚɰɢɟɧɬɚɦ, ɢɡ ɧɢɯ 19 (10,0%) – ɨɞɧɨɤɪɚɬɧɭɸ

ɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɭɸ ɢɧɫɬɢɥɥɹɰɢɸ, 4 (2,1%) –

ɩɨɜɬɨɪɧɵɟ ɢɧɫɬɢɥɥɹɰɢɢ ɞɨɤɫɨɪɭɛɢɰɢɧɚ, 1 (0,5%) –ɫɢɫɬɟɦɧɭɸ ɯɢɦɢɨɬɟɪɚɩɢɸ.

Ɋɟɰɢɞɢɜɵ ɨɩɭɯɨɥɢ ɧɚɛɥɸɞɚɥɢ ɭ 52 (27,4%)

ɛɨɥɶɧɵɯ, ɫɪɟɞɧɟɟ ɜɪɟɦɹ ɧɚɛɥɸɞɟɧɢɹ ɤɨɬɨɪɵɯ

ɫɨɫɬɚɜɢɥɨ 14,7 (1-50 ɦɟɫ.), ɫɪɟɞɧɟɟ ɜɪɟɦɹ ɧɚɛɥɸ

-ɞɟɧɢɹ ɩɚɰɢɟɧɬɨɜ ɛɟɡ ɪɟɰɢɞɢɜɚ ɫɨɫɬɚɜɢɥɨ 43,7 (28-73 ɦɟɫ.). ȼ ɝɪɭɩɩɟ ɫ ɩɟɪɟɯɨɞɧɨɤɥɟɬɨɱɧɨɣ ɩɚ

-ɩɢɥɥɨɦɨɣ ɢɡ 43 ɛɨɥɶɧɵɯ,ɧɟ ɩɨɥɭɱɚɜɲɢɯ ɢɧɫɬɢɥ

-ɥɹɰɢɸ ɚ-ɛɚɤɬɟɪɢɧɚ, ɪɟɰɢɞɢɜ ɪɚɡɜɢɥɫɹ ɭ 7 (16%),

ɜ ɬɨ ɜɪɟɦɹ ɤɚɤ ɩɨɫɥɟ ɩɪɢɦɟɧɟɧɢɹ ɩɪɨɛɢɨɬɢɤɚ – ɭ 2 (13%) ɢɡ 15 (p>0,05). ȼ ɝɪɭɩɩɟ ɫ ɧɟɦɵɲɟɱɧɨ

-ɢɧɜɚɡɢɜɧɵɦ ɩɟɪɟɯɨɞɧɨɤɥɟɬɨɱɧɵɦ ɪɚɤɨɦ ɪɟɰɢ

-ɞɢɜɵ ɧɚɛɥɸɞɚɥɢɫɶ ɭ 36 (37%) ɢɡ 96 ɩɚɰɢɟɧɬɨɜ ɧɟ

ɩɨɥɭɱɚɜɲɢɯ ɢɧɫɬɢɥɥɹɰɢɸ ɩɪɨɛɢɨɬɢɤɚ ɢ ɭ 7 (19%) ɢɡ 36 ɩɨɫɥɟ ɟɝɨ ɢɫɩɨɥɶɡɨɜɚɧɢɹ (p<0,05).

Ⱦɥɹ ɩɪɨɝɧɨɡɢɪɨɜɚɧɢɹ ɪɟɰɢɞɢɜɚ ɧɟɦɵɲɟɱɧɨ

-ɢɧɜɚɡɢɜɧɨɝɨ ɩɟɪɟɯɨɞɧɨɤɥɟɬɨɱɧɨɝɨ ɪɚɤɚ ɦɨɱɟɜɨɝɨ ɩɭɡɵɪɹ ɢɫɩɨɥɶɡɨɜɚɥɢ ɥɨɝɢɫɬɢɱɟɫɤɭɸ ɪɟɝɪɟɫɫɢɸ ɤɚɤ ɨɞɢɧ ɢɡ ɧɚɢɛɨɥɟɟ ɪɚɫɩɪɨɫɬɪɚɧɟɧɧɵɯ ɦɟɬɨɞɨɜ ɩɪɨɝɧɨɡɚ ɪɟɚɥɢɡɚɰɢɢ ɧɟɤɨɬɨɪɨɝɨ ɫɨɛɵɬɢɹ ɩɨ ɡɧɚɱɟɧɢɹɦ ɦɧɨɠɟɫɬɜɚ ɩɪɢɡɧɚɤɨɜ.

ɱɟɧɢɹ»),ɩɪɢɧɢɦɚɸɳɚɹ ɨɞɧɨ ɢɡ ɞɜɭɯ ɜɨɡɦɨɠɧɵɯ

ɡɧɚɱɟɧɢɣ 0 ɢɥɢ 1, ɢ ɧɟɡɚɜɢɫɢɦɵɟ ɩɟɪɟɦɟɧɧɵɟ

5 2 1

,

x

,...,

x

, ɫɨɨɬɜɟɬɫɬɜɭɸɳɢɟ ɩɚɪɚɦɟɬɪɚɦ «Ʌɟɣ

-ɤɨɰɢɬɭɪɢɹ», «ɍɪɨɜɟɧɶ ɞɢɮɮɟɪɟɧɰɢɪɨɜɤɢ», «Ʉɨ

-ɥɢɱɟɫɬɜɨ ɪɟɰɢɞɢɜɨɜ ɞɨ ɨɩɟɪɚɰɢɢ», «Ʉɨɥɢɱɟɫɬɜɨ

ɨɩɭɯɨɥɟɣ», «Ɇɚɤɫɢɦɚɥɶɧɵɣ ɪɚɡɦɟɪ ɨɩɭɯɨɥɢ», (ɜ

ɫɨɨɬɜɟɬɫɬɜɢɢ ɫɨ ɫɬɚɞɢɟɣ Ɍ).Ⱦɚɧɧɵɟ ɧɟɡɚɜɢɫɢɦɵɟ

ɩɟɪɟɦɟɧɧɵɟ ɛɵɥɢ ɜɵɞɟɥɟɧɵ ɤɚɤ ɧɚɢɛɨɥɟɟ ɢɧ

-ɮɨɪɦɚɬɢɜɧɵɟ [6].

ɂɡɜɟɫɬɧɨ,ɱɬɨ,ɥɨɝɢɫɬɢɱɟɫɤɚɹ ɪɟɝɪɟɫɫɢɹ ɩɨɡɜɨ

-ɥɹɟɬ ɩɪɟɞɫɤɚɡɚɬɶ ɧɟɩɪɟɪɵɜɧɭɸ ɩɟɪɟɦɟɧɧɭɸ ɫɨ ɡɧɚɱɟɧɢɹɦɢ ɧɚ ɨɬɪɟɡɤɟ [12] ɩɪɢ ɩɪɨɢɡɜɨɥɶɧɵɯ

ɡɧɚɱɟɧɢɹɯ ɧɟɡɚɜɢɫɢɦɵɯ ɩɟɪɟɦɟɧɧɵɯ [9]. ɗɬɨ

ɞɨɫɬɢɝɚɟɬɫɹ ɩɪɢɦɟɧɟɧɢɟɦ ɫɥɟɞɭɸɳɟɝɨ ɩɪɟɨɛ

-ɪɚɡɨɜɚɧɢɹ:

)

exp(

1

1 X

Y

,

ɝɞɟ

Y

– ɪɟɡɭɥɶɬɚɬɢɜɧɵɣ ɩɪɢɡɧɚɤ,ɯɚɪɚɤɬɟɪɢɡɭɸɳɢɣ ɜɟɪɨɹɬɧɨɫɬɶ ɬɨɝɨ, ɱɬɨ ɩɪɨɢɡɨɣɞɟɬ ɢɧɬɟɪɟɫɭɸɳɟɟ ɫɨɛɵɬɢɟ (ɪɟɰɢɞɢɜ ɩɨɫɥɟ ɥɟɱɟɧɢɹ),

X

c

₀

c

₁

x

₁

c

₂

x

₂

c

₃

x

₃

c

₄

x

₄

c

₅

x

₅.

Ɂɞɟɫɶ

x

₁

,

x

₂

,...,

x

₅ - ɩɪɟɞɢɤɬɨɪɧɵɟ ɩɟɪɟɦɟɧɧɵɟ,

c

_i– ɤɨɷɮɮɢɰɢɟɧɬɵ ɪɟɝɪɟɫɫɢɢ.

Ⱦɥɹ ɤɚɠɞɨɣ ɢɡ ɪɚɫɫɦɚɬɪɢɜɚɟɦɵɯ ɡɚɞɚɱ ɫɪɟɞɢ ɜɫɟɯ ɧɟɡɚɜɢɫɢɦɵɯ ɩɟɪɟɦɟɧɧɵɯ ɛɵɥɢ ɜɵɛɪɚɧɵ ɬɚɤɢɟ, ɤɨɬɨɪɵɟ ɞɨɫɬɚɜɥɹɸɬ ɧɚɢɥɭɱɲɢɟ ɪɟɡɭɥɶ

-ɬɚɬɵ ɤɥɚɫɫɢɮɢɤɚɰɢɢ.

ɇɟɦɵɲɟɱɧɨɢɧɜɚɡɢɜɧɵɣ ɪɚɤ, ɛɟɡ ɩɪɢɦɟɧɟɧɢɹ

ɩɪɨɛɢɨɬɢɤɚ (96 ɛɨɥɶɧɵɯ):

Y

1

1 exp(

X

₎

,

ɝɞɟ

Y

– “ɇɚɥɢɱɢɟ ɪɟɰɢɞɢɜɚ”,

)

/

(

046 .

0

158 .

0

228 .

0 x

₄

x

₅

x

₄

X

,

x

4

,

x

5 –ɤɨɥɢɱɟɫɬɜɨ ɨɩɭɯɨɥɟɣ ɢ ɦɚɤɫɢɦɚɥɶɧɵɣ ɞɢɚɦɟɬɪ ɨɩɭɯɨɥɢ ɫɨɨɬɜɟɬɫɬɜɟɧɧɨ.

ɉɥɨɳɚɞɶ ɩɨɞ ROC-ɤɪɢɜɨɣ: AUC=0.732 (ɪɢɫ. 1).

(4)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

Ɋɢɫ. 1. ROC – ɤɪɢɜɚɹ ɞɥɹ ɩɪɨɝɧɨɡɢɪɨɜɚɧɢɹ ɪɟɰɢɞɢɜɚ ɜ ɝɪɭɩɩɟ ɛɨɥɶɧɵɯ

ɫ ɧɟɦɵɲɟɱɧɨɢɧɜɚɡɢɜɧɵɦ ɪɚɤɨɦ ɦɨɱɟɜɨɝɨ ɩɭɡɵɪɹ

ɇɟɦɵɲɟɱɧɨɢɧɜɚɡɢɜɧɵɣ ɪɚɤ, ɫ ɩɪɢɦɟɧɟɧɢɟɦ

ɩɪɨɛɢɨɬɢɤɚ (36 ɛɨɥɶɧɵɯ):

Y

1

1 exp(

X

₎

,

ɝɞɟ

Y

– “ɇɚɥɢɱɢɟ ɪɟɰɢɞɢɜɚ”,

5

112 ,

0

287 ,

4 x

X

,

x

5 –ɦɚɤɫɢɦɚɥɶɧɵɣ ɞɢɚɦɟɬɪ ɨɩɭɯɨɥɢ.

ɉɥɨɳɚɞɶ ɩɨɞ ROC-ɤɪɢɜɨɣ: AUC=0,8 (ɪɢɫ. 2).

Ɂɧɚɱɟɧɢɹ ɫɩɟɰɢɮɢɱɧɨɫɬɢ ɢ ɱɭɜɫɬɜɢɬɟɥɶɧɨɫɬɢ ɞɥɹ ɪɚɡɥɢɱɧɵɯ ɡɧɚɱɟɧɢɣ ɩɨɪɨɝɚ ɨɬɫɟɱɟɧɢɹ ɩɪɟɞ

-ɫɬɚɜɥɟɧɵ ɜ ɬɚɛɥɢɰɟ 2.

Ⱦɥɹ ɩɨɞɬɜɟɪɠɞɟɧɢɹ ɩɨɥɭɱɟɧɧɵɯ ɩɪɚɜɢɥ ɛɵɥɚ ɩɪɨɢɡɜɟɞɟɧɚ ɤɥɚɫɫɢɮɢɤɚɰɢɹ ɫ ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ ɦɟɬɨɞɚ ɨɩɨɪɧɵɯ ɜɟɤɬɨɪɨɜ – ɨɞɧɨɝɨ ɢɡ ɧɚɢɛɨɥɟɟ

ɪɚɫɩɪɨɫɬɪɚɧɟɧɧɵɯ ɫɪɟɞɢ ɢɫɩɨɥɶɡɭɸɳɢɯɫɹ ɞɥɹ ɪɟɲɟɧɢɹ ɡɚɞɚɱ ɤɥɚɫɫɢɮɢɤɚɰɢɢ [5]. ɗɬɨɬ ɦɟɬɨɞ

ɨɫɧɨɜɚɧ ɧɚ ɩɟɪɟɜɨɞɟ ɢɫɯɨɞɧɵɯ ɜɟɤɬɨɪɨɜ ɞɚɧɧɵɯ ɜ ɩɪɨɫɬɪɚɧɫɬɜɨ ɛɨɥɟɟ ɜɵɫɨɤɨɣ ɪɚɡɦɟɪɧɨɫɬɢ ɫ ɩɨɫɥɟɞɭɸɳɢɦ ɩɨɢɫɤɨɦ ɪɚɡɞɟɥɹɸɳɟɣ ɝɢɩɟɪ

-ɩɥɨɫɤɨɫɬɢ. ɉɪɢ ɷɬɨɦ ɢɡ ɜɫɟɯ ɜɨɡɦɨɠɧɵɯ

ɪɚɡɞɟɥɹɸɳɢɯ ɝɢɩɟɪɩɥɨɫɤɨɫɬɟɣ ɜɵɛɢɪɚɟɬɫɹ ɨɩɬɢ

-ɦɚɥɶɧɚɹ, ɪɚɫɫɬɨɹɧɢɟ ɨɬ ɤɨɬɨɪɨɣ ɞɨ ɤɚɠɞɨɝɨ ɢɡ

ɤɥɚɫɫɨɜ ɛɭɞɟɬ ɦɚɤɫɢɦɚɥɶɧɵɦ. ɉɨɞ ɤɥɚɫɫɚɦɢ ɜ

ɧɚɲɟɦ ɫɥɭɱɚɟ ɩɨɧɢɦɚɸɬɫɹ ɝɪɭɩɩɚ ɩɚɰɢɟɧɬɨɜ, ɭ

ɤɨɬɨɪɵɯ ɢɦɟɥ ɦɟɫɬɨ ɪɟɰɢɞɢɜ, ɢ ɝɪɭɩɩɚ ɩɚ

-ɰɢɟɧɬɨɜ ɛɟɡ ɪɟɰɢɞɢɜɚ. ɉɨɥɭɱɟɧɧɚɹ ɧɚ ɨɫɧɨɜɟ

ɦɟɬɨɞɚ ɨɩɨɪɧɵɯ ɜɟɤɬɨɪɨɜ ɤɥɚɫɫɢɮɢɤɚɰɢɹ ɭɪɨɥɨ

-ɝɢɱɟɫɤɢɯ ɩɚɰɢɟɧɬɨɜ ɫ ɭɱɟɬɨɦ ɜɨɡɦɨɠɧɨɝɨ ɪɟ

-ɰɢɞɢɜɚ ɫɨɜɩɚɥɚ ɩɨ ɫɜɨɢɦ ɯɚɪɚɤɬɟɪɢɫɬɢɤɚɦ ɢ ɧɚɛɨɪɭ ɧɟɡɚɜɢɫɢɦɵɯ ɩɟɪɟɦɟɧɧɵɯ ɫ ɪɟɡɭɥɶɬɚɬɚɦɢ ɥɨɝɢɫɬɢɱɟɫɤɨɣ ɪɟɝɪɟɫɫɢɢ, ɱɬɨ ɩɨɞɬɜɟɪɠɞɚɟɬ ɟɟ

ɞɨɫɬɨɜɟɪɧɨɫɬɶ.

Ɍ ɚ ɛ ɥ ɢ ɰ ɚ 1

Ɂɧɚɱɟɧɢɹ ɫɩɟɰɢɮɢɱɧɨɫɬɢ ɢ ɱɭɜɫɬɜɢɬɟɥɶɧɨɫɬɢ ɭ ɛɨɥɶɧɵɯ

ɫ ɧɟɦɵɲɟɱɧɨɢɧɜɚɡɢɜɧɵɦ ɪɚɤɨɦ ɦɨɱɟɜɨɝɨ ɩɭɡɵɪɹ

Ɂɧɚɱɟɧɢɟ ɩɨɪɨɝɚ ɉɨɤɚɡɚɬɟɥɢ

0,192 0,273 0,409

ɋɩɟɰɢɮɢɱɧɨɫɬɶ 6 ɢɡ 60 14 ɢɡ 60 49 ɢɡ 60

(5)

ɉɪɨɝɧɨɡɢɪɨɜɚɧɢɟ ɪɟɰɢɞɢɜɚ ɨɩɭɯɨɥɟɣ ɦɨɱɟ

-ɜɨɝɨ ɩɭɡɵɪɹ ɹɜɥɹɟɬɫɹ ɜɚɠɧɵɦ ɢɧɫɬɪɭɦɟɧɬɨɦ ɨɩɪɟɞɟɥɟɧɢɹ ɬɚɤɬɢɤɢ ɞɚɥɶɧɟɣɲɟɝɨ ɥɟɱɟɧɢɹ.ɋɨɜ

-ɪɟɦɟɧɧɵɟ ɫɢɫɬɟɦɵ ɩɪɨɝɧɨɡɢɪɨɜɚɧɢɹ ɩɪɟɞɩɨɥɚ

-ɝɚɸɬ ɪɚɡɞɟɥɟɧɢɟ ɩɚɰɢɟɧɬɨɜ ɫ ɧɟɦɵɲɟɱɧɨɢɧ

-ɜɚɡɢɜɧɵɦ ɪɚɤɨɦ ɧɚ ɝɪɭɩɩɵ ɪɢɫɤɚ ɧɚ ɨɫɧɨɜɚɧɢɢ

ɭɱɟɬɚ ɬɚɤɢɯ ɮɚɤɬɨɪɨɜ, ɤɚɤ ɜɨɡɪɚɫɬ, ɩɨɥ, ɤɨɥɢ

-ɱɟɫɬɜɨ ɨɩɭɯɨɥɟɣ, ɪɚɡɦɟɪ ɨɩɭɯɨɥɢ, ɱɚɫɬɨɬɚ ɪɟɰɢ

-ɞɢɜɨɜ, ɝɥɭɛɢɧɚ ɢɧɜɚɡɢɢ, ɧɚɥɢɱɢɟ ɫɨɩɭɬɫɬɜɭɸ

-ɳɟɝɨ ɪɚɤɚ in situ, ɭɪɨɜɧɹ ɞɢɮɮɟɪɟɧɰɢɪɨɜɤɢ

ɨɩɭɯɨɥɢ [6].

Ɍ ɚ ɛ ɥ ɢ ɰ ɚ 2

Ɂɧɚɱɟɧɢɹ ɫɩɟɰɢɮɢɱɧɨɫɬɢ ɢ ɱɭɜɫɬɜɢɬɟɥɶɧɨɫɬɢ ɭ ɛɨɥɶɧɵɯ ɫ ɧɟɦɵɲɟɱɧɨɢɧɜɚɡɢɜɧɵɦ

ɪɚɤɨɦ ɦɨɱɟɜɨɝɨ ɩɭɡɵɪɹ

Ɂɧɚɱɟɧɢɟ ɩɨɪɨɝɚ ɉɨɤɚɡɚɬɟɥɢ

0.114 0.183 0.408

ɋɩɟɰɢɮɢɱɧɨɫɬɶ 14 ɢɡ 29 23 ɢɡ 29 26 ɢɡ 29

ɑɭɜɫɬɜɢɬɟɥɶɧɨɫɬɶ 7 ɢɡ 7 5 ɢɡ 7 4 ɢɡ 7

ɉɪɢ ɪɚɡɪɚɛɨɬɤɟ ɦɚɬɟɦɚɬɢɱɟɫɤɢɯ ɩɪɚɜɢɥ ɧɚɦɢ ɭɱɬɟɧɵ ɞɚɧɧɵɟ ɧɟ ɬɨɥɶɤɨ ɩɚɰɢɟɧɬɨɜ ɫ ɧɟɦɵ

-ɲɟɱɧɨɢɧɜɚɡɢɜɧɵɦ ɪɚɤɨɦ, ɧɨ ɢ ɫ ɩɟɪɟɯɨɞɧɨɤɥɟ

-ɬɨɱɧɨɣ ɩɚɩɢɥɥɨɦɨɣ, ɩɨɫɤɨɥɶɤɭ ɜɨ ɜɫɟɯ ɫɥɭɱɚɹɯ

ɢɫɩɨɥɶɡɨɜɚɧɨ ɨɞɧɨɬɢɩɧɨɟ ɨɩɟɪɚɬɢɜɧɨɟ ɥɟɱɟɧɢɟ ɜ ɨɛɴɟɦɟ ɪɟɡɟɤɰɢɢ ɦɨɱɟɜɨɝɨ ɩɭɡɵɪɹ. Ⱦɚɧɧɵɟ ɩɚ

-ɰɢɟɧɬɵ ɧɟ ɧɭɠɞɚɥɢɫɶ ɜ ɥɭɱɟɜɨɣ ɢɥɢ ɫɢɫɬɟɦɧɨɣ ɯɢɦɢɨɬɟɪɚɩɢɢ ɢ ɩɨɞɥɟɠɚɥɢ ɧɚɛɥɸɞɟɧɢɸ ɩɭɬɟɦ ɩɪɨɜɟɞɟɧɢɹ ɪɟɝɭɥɹɪɧɵɯ ɰɢɫɬɨɫɤɨɩɢɣ ɜ ɫɨɨɬ

-ɜɟɬɫɬɜɢɢ ɫ ɫɨɜɪɟɦɟɧɧɵɦɢ ɫɬɚɧɞɚɪɬɚɦɢ. ɍɫɬɚ

-ɧɨɜɥɟɧɨ, ɱɬɨ ɩɪɨɝɧɨɫɬɢɱɟɫɤɢ ɡɧɚɱɢɦɵɦɢ ɩɚɪɚ

-ɦɟɬɪɚɦɢ ɹɜɥɹɸɬɫɹ ɤɚɤ ɪɚɡɦɟɪ ɨɩɭɯɨɥɢ ɢ ɤɨɥɢ

-ɱɟɫɬɜɨ ɨɩɭɯɨɥɟɣ, ɱɬɨ ɩɨɞɬɜɟɪɠɞɚɟɬɫɹ ɞɚɧɧɵɦɢ

ɞɪɭɝɢɯ ɢɫɫɥɟɞɨɜɚɬɟɥɟɣ [6], ɬɚɤ ɢ ɫɨɨɬɧɨɲɟɧɢɟ

ɷɬɢɯ ɩɚɪɚɦɟɬɪɨɜ.

Ⱥɧɚɥɢɡ ɩɨɥɭɱɟɧɧɵɯ ɞɚɧɧɵɯ ɩɨɡɜɨɥɹɟɬ ɨɬɦɟ

-ɬɢɬɶ ɪɚɡɥɢɱɢɟ ɩɪɨɝɧɨɫɬɢɱɟɫɤɢɯ ɩɪɚɜɢɥ ɩɪɢ ɢɫ

-ɩɨɥɶɡɨɜɚɧɢɢ ɜɧɭɬɪɢɩɭɡɵɪɧɵɯ ɢɧɫɬɢɥɥɹɰɢɣ

(6)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

ɧɟɨɛɯɨɞɢɦɨɫɬɢ ɭɱɟɬɚ ɨɫɨɛɟɧɧɨɫɬɟɣ ɩɪɨɜɟɞɟɧ

-ɧɨɝɨ ɥɟɱɟɧɢɹ ɩɪɢ ɩɪɨɝɧɨɡɢɪɨɜɚɧɢɢ.

ɉɪɢɧɢɦɚɹ ɜɨ ɜɧɢɦɚɧɢɟ ɮɚɤɬ,ɱɬɨ ɩɨɥɭɱɟɧɧɵɟ

ɞɚɧɧɵɟ ɨɫɧɨɜɚɧɵ ɧɚ ɚɧɚɥɢɡɟ ɪɟɡɭɥɶɬɚɬɨɜ ɧɚɛɥɸ

-ɞɟɧɢɹ ɨɬɧɨɫɢɬɟɥɶɧɨ ɧɟɛɨɥɶɲɨɝɨ ɤɨɥɢɱɟɫɬɜɚ ɫɥɭ

-ɱɚɟɜ, ɩɪɟɞɥɨɠɟɧɧɵɟ ɦɚɬɟɦɚɬɢɱɟɫɤɢɟ ɩɪɚɜɢɥɚ

ɦɨɝɭɬ ɫɨɜɟɪɲɟɧɫɬɜɨɜɚɬɶɫɹ ɩɨ ɦɟɪɟ ɪɚɫɲɢɪɟɧɢɹ ɛɚɡɵ ɞɚɧɧɵɯ ɩɚɰɢɟɧɬɨɜ ɫ ɨɩɭɯɨɥɹɦɢ ɦɨɱɟɜɨɝɨ ɩɭɡɵɪɹ ɢ ɭɜɟɥɢɱɟɧɢɹ ɞɥɢɬɟɥɶɧɨɫɬɢ ɧɚɛɥɸɞɟɧɢɹ.

ȼɕȼɈȾɕ

1. ɉɪɢ ɢɫɩɨɥɶɡɨɜɚɧɢɢ ɢɧɫɬɢɥɥɹɰɢɢ ɩɪɨɛɢɨ

-ɬɢɤɚ Aerococcus viridans 167 ɭ ɩɚɰɢɟɧɬɨɜ ɫ ɧɟ

-ɦɵɲɟɱɧɨɢɧɜɚɡɢɜɧɵɦ ɪɚɤɨɦ ɦɨɱɟɜɨɝɨ ɩɭɡɵɪɹ ɜɵɹɜɥɟɧɨ ɫɧɢɠɟɧɢɟ ɱɚɫɬɨɬɵ ɪɟɰɢɞɢɜɨɜ ɩɨɫɥɟ ɨɩɟɪɚɬɢɜɧɨɝɨ ɥɟɱɟɧɢɹ ɫ 37 % ɞɨ 19% (p<0,05).

2. ɉɟɪɟɦɟɧɧɵɟ «Ʉɨɥɢɱɟɫɬɜɨ ɨɩɭɯɨɥɟɣ» ɢ «Ɇɚɤɫɢɦɚɥɶɧɵɣ ɪɚɡɦɟɪ ɨɩɭɯɨɥɢ», ɚ ɬɚɤɠɟ ɢɯ

ɫɨɨɬɧɨɲɟɧɢɟ ɹɜɥɹɸɬɫɹ ɢɧɮɨɪɦɚɬɢɜɧɵɦ ɩɪɨɝɧɨ

-ɫɬɢɱɟɫɤɢɦ ɩɚɪɚɦɟɬɪɨɦ.

3. ɇɚ ɨɫɧɨɜɟ ɥɨɝɢɫɬɢɱɟɫɤɨɝɨ ɭɪɚɜɧɟɧɢɹ ɪɟ

-ɝɪɟɫɫɢɢ ɩɨɥɭɱɟɧɵ ɪɟɲɚɸɳɢɟ ɩɪɚɜɢɥɚ, ɩɨ

-ɡɜɨɥɹɸɳɢɟ ɩɪɢ ɡɚɞɚɧɧɨɦ ɩɨɪɨɝɟ ɞɨɫɬɨɜɟɪɧɨ ɜɵɞɟɥɢɬɶ ɩɚɰɢɟɧɬɨɜ ɫ ɜɨɡɦɨɠɧɵɦ ɪɟɰɢɞɢɜɨɦ ɫ ɭɱɟɬɨɦ ɩɪɢɦɟɧɟɧɢɹ ɩɪɨɛɢɨɬɢɤɚ.

4. ɉɨɥɭɱɟɧɧɵɟ ɩɪɚɜɢɥɚ ɦɨɝɭɬ ɛɵɬɶ ɪɟɤɨɦɟɧ

-ɞɨɜɚɧɵ ɞɥɹ ɧɚɛɥɸɞɟɧɢɹ ɡɚ ɩɚɰɢɟɧɬɚɦɢ ɩɨɫɥɟ ɯɢɪɭɪɝɢɱɟɫɤɨɝɨ ɜɦɟɲɚɬɟɥɶɫɬɜɚ ɫ ɰɟɥɶɸ ɫɜɨɟ

-ɜɪɟɦɟɧɧɨɝɨ ɜɵɞɟɥɟɧɢɹ ɝɪɭɩɩɵ ɩɚɰɢɟɧɬɨɜ ɫ ɜɨɡ

-ɦɨɠɧɵɦ ɪɟɰɢɞɢɜɧɵɦ ɬɟɱɟɧɢɟɦ ɡɚɛɨɥɟɜɚɧɢɹ.

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1. Ⱦɨɫɥɿɞɠɟɧɧɹ ɞɿʀ ɩɪɨɛɿɨɬɢɱɧɨɝɨ ɲɬɚɦɭ Ⱥ.

viri-dans 167 ɧɚ ɩɟɪɟɳɟɩɥɸɜɚɧɿ ɤɭɥɶɬɭɪɢ ɤɥɿɬɢɧ / ɋ.Ⱥ.Ɋɢ -ɠɟɧɤɨ,Ƚ.ɇ.Ʉɪɟɦɟɧɱɭɰɶɤɢɣ,Ɇ.Ɉ.Ȼɪɟɞɿɯɿɧɚ [ɬɚ ɿɧ.] // Ⱥɧɚɥɢ Ɇɟɱɧɿɤɨɜɫɶɤɨɝɨ ɿɧ-ɬɭ – 2007.– ʋ 1. – ɋ. 19-22.

2. Ɇɨɥɱɚɧɨɜ Ɋ.ɇ.ȼɥɢɹɧɢɟ Ⱥ-ɛɚɤɬɟɪɢɧɚ ɧɚ ɩɨɤɚ -ɡɚɬɟɥɢ ɦɟɫɬɧɨɝɨ ɢɦɦɭɧɢɬɟɬɚ ɭ ɛɨɥɶɧɵɯ ɫ ɩɨɜɟɪɯ -ɧɨɫɬɧɵɦ ɪɚɤɨɦ ɦɨɱɟɜɨɝɨ ɩɭɡɵɪɹ / Ɋ.ɇ. Ɇɨɥɱɚɧɨɜ, ɂ.ɋ. ɒɩɨɧɶɤɚ, ȼ.ɇ. ɋɥɸɫɚɪɟɜ // ɍɪɨɥɨɝɿɹ – 2012. – ʋ 3. – ɋ. 31-37.

3. Ɇɨɥɱɚɧɨɜ Ɋ.Ɇ.ȼɥɢɹɧɢɟ ɛɚɤɬɟɪɢɚɥɶɧɨɝɨ ɮɚɤ -ɬɨɪɚ ɧɚ ɪɚɡɜɢɬɢɟ ɪɚɤɚ ɦɨɱɟɜɨɝɨ ɩɭɡɵɪɹ ɜ ɷɤɫɩɟ -ɪɢɦɟɧɬɟ ɧɚ ɠɢɜɨɬɧɵɯ / Ɋ.Ɇ. Ɇɨɥɱɚɧɨɜ, Ⱥ.ɋ. Ʉɨɪɨ -ɥɟɧɤɨ // ɍɪɨɥɨɝɿɹ. – 2006. – ʋ 3. – ɋ. 35-37.

4. Bacillus Calmette-Guerin (BCG) immunotherapy for bladder cancer: current understanding and perspec-tives on engineered BCG vaccine / K. Kawai, J. Miya-zaki, A. Joraku [et al.] // Cancer Science. – 2013. – Vol. 104, N 1. – P. 22–27.

5. Cristianini N. An introduction to support vector machines: and other kernel-based learning methods / N.Cristianini, J.Shawe-Taylor. – Cambridge; New York: Cambridge University Press, 2000. – 189 p.

6. EAU guidelines on non-muscle-invasive uro-thelial carcinoma of the bladder: update 2013 / M. Ba-bjuk, M. Burger, R. Zigeuner [et al.] // Eur. Urology. – 2013. – Vol. 64, N 4. – P. 639–653.

7. Efficacy and safety of maintenance intravesical instillation therapy with bacillus Calmette-Guerin and epirubicin for non-muscle invasive bladder cancer / M. Ikeda, T. Motoshima, K. Kurosawa [et al.] // Hinyokika Kiyo – 2013. – Vol. 59, N 3. – P. 153-157.

8. Gray R. Construction of receiver operating characteristic curves when disease verification is subject to selection bias / R. Gray, C.B. Begg, R.A. Greenes // Medical Decision Making. – 1984. – Vol. 4, N 2. – P. 151-164.

9. Hosmer D.W. Applied logistic regression / D.W. Hosmer, S. Lemeshow. – 2nd ed. – New York: Wiley, 2000. – 373 p.

10. Lactobacillus rhamnosus GG induces tumor regression in mice bearing orthotopic bladder tumors / S.W. Seow, S. Cai, J.N. Rahmat [et al.] // Cancer Science. – 2010. – Vol.101, N 3. – P. 751-758.

11. Probiotics and its functionally valuable products-a review. Critical reviews in food science and nutrition / P. Kanmani, R.Satish-Kumar, N.Yuvaraj [et al.] // Crit. Rev. Food Sci. Nutr. – 2013. – Vol. 53, N 6. – P.641-658.

12. Recurrence and progression of disease in non-muscle-invasive bladder cancer: from epidemiology to treatment strategy / B.W. van Rhijn, M. Burge, Y. Lotan [et al.] // Eur. Urology. – 2009. – Vol. 56, N 3. – P. 430-442.

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1. Ryzhenko SA, Kremenchutsky GN, Bredykhyna MO, Kovalenko SM. [Investigation of probitic strain A. viridans 167 on inoculation on cell culture]. Annals of Mechnicov Institute.2007;1:19-22. Ukrainian.

2. Molchanov RM, Shpon’ka IS, Slyusarev VM. [Impact of A-bacterinum on indices of local immunity in patients with superficial cystic cancer]. Urologija. 2012;16(3):31-37. Russian.

3. Molchanov RM, Korolenko AS. [Impact of bacte-rial factor on development of cystic cancer in expe-riment]. Urologija. 2006;10(3):23-26. Ukrainian.

4. Kawai K, Miyazaki J, Joraku A, Nishiyama H, Akaza H. Bacillus Calmette-Guerin (BCG) immuno-therapy for bladder cancer: current understanding and per-spectives on engineered BCG vaccine. Cancer science. 2013;104(1):22-7. Epub 2012/11/28. doi: 10.1111/ cas.12075. PubMed PMID: 23181987.

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update 2013. European urology. 2013;64(4):639-53. Epub 2013/07/06. doi: 10.1016/j.eururo.2013.06.003. PubMed PMID: 23827737.

7. Ikeda M, Motoshima T, Kurosawa K, Fujii Y, Miyakawa J, Kamigaito T, et al. [Efficacy and safety of maintenance intravesical instillation therapy with bacillus Calmette-Guerin and epirubicin for non-muscle invasive bladder cancer]. Hinyokika Kiyo. 2013;59(3):153-7. Epub 2013/05/02. PubMed PMID: 23633629.

8. Gray R, Begg CB, Greenes RA. Construction of receiver operating characteristic curves when disease verification is subject to selection bias. Medical decision making: an international journal of the Society for Me-dical Decision Making. 1984;4(2):151-64. Epub 1984/01/01. PubMed PMID: 6472063.

9. Hosmer DW, Lemeshow S. Applied logistic regression. 2nd ed. New York: Wiley, 2000;xii:373.

tumors. Cancer science. 2010;101(3):751-8. Epub 2009/12/18. doi:10.1111/j.1349-7006.2009.01426.x. PubMed PMID: 20015287.

11. Kanmani P, Satish Kumar R, Yuvaraj N, Paari KA, Pattukumar V, Arul V. Probiotics and its functionally valuable products-a review. Critical reviews in food science and nutrition. 2013;53(6):641-58. Epub 2013/05/01. doi: 10.1080/10408398.2011.553752. PubMed PMID: 23627505.

12. van Rhijn BW, Burger M, Lotan Y, Solsona E, Stief CG, Sylvester RJ, et al. Recurrence and progression of disease in non-muscle-invasive bladder cancer: from epidemiology to treatment strategy. European urology. 2009;56(3):430-42. Epub 2009/07/07. doi: 10.1016/ j.eururo.2009.06.028. PubMed PMID: 19576682.

ɋɬɚɬɬɹ ɧɚɞɿɣɲɥɚ ɞɨ ɪɟɞɚɤɰɿʀ 27.11.2014

ɍȾɄ 618.2/.4:613.25:616.151.5

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ȾɁ «Ⱦɧɿɩɪɨɩɟɬɪɨɜɫɶɤɚ ɦɟɞɢɱɧɚ ɚɤɚɞɟɦɿɹ ɆɈɁ ɍɤɪɚʀɧɢ» ɤɚɮɟɞɪɚ ɚɤɭɲɟɪɫɬɜɚ,ɝɿɧɟɤɨɥɨɝɿʀ ɿ ɩɟɪɢɧɚɬɨɥɨɝɿʀ (ɡɚɜ. – ɞ.ɦɟɞ.ɧ.,ɩɪɨɮ.ɘ.Ɉ.Ⱦɭɛɨɫɫɚɪɫɶɤɚ)

ɜɭɥ.Ⱦɡɟɪɠɢɧɫɶɤɨɝɨ, 9, Ⱦɧɿɩɪɨɩɟɬɪɨɜɫɶɤ, 49044, ɍɤɪɚʀɧɚ

SE "Dnipropetrovsk medical academy of Health Ministry of Ukraine" Department of Obstetrics, Gynecology and Perinatology

Dzerzhinsky str., 9, Dnipropetrovsk, 49044, Ukraine e-mail: rduka@ukr.net

Ʉɥɸɱɨɜɿ ɫɥɨɜɚ:ɜɚɝɿɬɧɿɫɬɶ,ɨɠɢɪɿɧɧɹ,ɧɟɜɢɧɨɲɭɜɚɧɧɹ ɜɚɝɿɬɧɨɫɬɿ,ɝɿɩɟɪɤɨɚɝɭɥɹɰɿɹ Key words: pregnancy, obesity, pregnancy losses, hyper coagulation

Ɋɟɮɟɪɚɬ.Ⱥɧɚɥɢɡ ɬɟɱɟɧɢɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɢ ɪɨɞɨɜ ɭ ɛɟɪɟɦɟɧɧɵɯ ɠɟɧɳɢɧ ɫ ɢɡɛɵɬɨɱɧɵɦ ɜɟɫɨɦ.Ⱦɭɤɚ ɘ.Ɇ.