Manhattan Family Study. Stroke. 2004;35:2243–7. 17. Joseph L, Izzo Jr. Hypertension primer. The es-sentials of high blood pressure. Basic science, population science, and clinical managemen. 2012.
18. Nilsson Peter. Early vascular aging as a clinical model for understanding cardiovascular risk. Internal Me-dicine. 2008;5–6(11–12):112–7.
20. Stein JH, Korcarz CE, Hurst RT. Use of Carotid Ultrasound to Identify Subclinical Vascular Disease and Evaluate Cardiovascular Disease Risk: A Consensus Sta-tement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force Endorsed by the Society for Vascular Medicine .Journal of the American Society of Echocardiography. 2008;48:93–111.
ɍȾɄ 616.12-005.4:612.115:615.225 Ɍ.Ⱥ.ɏɨɦɚɡɸɤ,
Ʌ.ɂ.ɇɨɜɨɠɟɧɢɧɚ,
Ⱥ.ɗ.Ʌɟɜɵɯ,
ɋ.ɂ.Ʉɪɵɠɚɧɨɜɫɤɚɹ,
ȼ.ɂ.Ƚɪɢɰɟɧɤɨ
ɂ
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Ƚɍ «Ⱦɧɟɩɪɨɩɟɬɪɨɜɫɤɚɹ ɦɟɞɢɰɢɧɫɤɚɹ ɚɤɚɞɟɦɢɹ»ɆɁ ɍɤɪɚɢɧɵ
ɤɚɮɟɞɪɚ ɩɪɨɩɟɞɟɜɬɢɤɢ ɜɧɭɬɪɟɧɧɟɣ ɦɟɞɢɰɢɧɵ
(ɡɚɜ. – ɞ.ɦɟɞ.ɧɚɭɤ,ɩɪɨɮ.Ɍ.Ⱥ.ɏɨɦɚɡɸɤ)
ɤɚɮɟɞɪɚ ɮɚɪɦɚɤɨɥɨɝɢɢ,ɤɥɢɧɢɱɟɫɤɨɣ ɮɚɪɦɚɤɨɥɨɝɢɢ ɢ ɮɚɪɦɚɤɨɷɤɨɧɨɦɢɤɢ (ɡɚɜ. – ɞ.ɦɟɞ.ɧɚɭɤ,ɩɪɨɮ.ȼ.ɂ.Ɇɚɦɱɭɪ)
ɭɥ.Ⱦɡɟɪɠɢɧɫɤɨɝɨ, 9, Ⱦɧɟɩɪɨɩɟɬɪɨɜɫɤ, 49044, ɍɤɪɚɢɧɚ
SE "Dnipropetrovsk medical academy Ministry of Health of Ukraine" Dzerzhinsky Str., 9, Dnipropetrovsk, 49044, Ukraine
e-mail: m.mila.5@mail.ru
Ʉɥɸɱɟɜɵɟ ɫɥɨɜɚ:ɢɲɟɦɢɱɟɫɤɚɹ ɛɨɥɟɡɧɶ ɫɟɪɞɰɚ,ɚɧɬɢɬɪɨɦɛɨɰɢɬɚɪɧɨɟ ɫɪɟɞɫɬɜɨ,ɥɨɫɩɢɪɢɧ Key words: coronary artery disease, antithrombotic agent, lospirin
Ɋɟɮɟɪɚɬ. Ⱦɨɫɥɿɞɠɟɧɧɹ ɚɧɬɢɬɪɨɦɛɨɬɢɱɧɨʀ ɟɮɟɤɬɢɜɧɨɫɬɿ, ɛɟɡɩɟɤɢ ɬɚ ɩɟɪɟɧɨɫɢɦɨɫɬɿ ɝɟɧɟɪɢɤɿɜ ɚɰɟɬɢɥ -ɫɚɥɿɰɢɥɨɜɨʀ ɤɢɫɥɨɬɢ ɭ ɯɜɨɪɢɯ ɡ ɿɲɟɦɿɱɧɨɸ ɯɜɨɪɨɛɨɸ ɫɟɪɰɹ. Ɍ.Ⱥ.ɏɨɦɚɡɸɤ, Ʌ.ȱ.ɇɨɜɨɠɟɧɿɧɚ, Ⱥ.ȿ.Ʌɟɜɢɯ, ɋ.Ƀ.Ʉɪɢɠɚɧɿɜɫɶɤɚ, ȼ.ȱ.Ƚɪɢɰɟɧɤɨ. Ɇɟɬɨɸ ɞɨɫɥɿɞɠɟɧɧɹ ɛɭɥɨ ɜɢɜɱɟɧɧɹ ɚɧɬɢɬɪɨɦɛɨɬɢɱɧɨʀ ɟɮɟɤɬɢɜɧɨɫɬɿ,
ɛɟɡɩɟɤɢ ɬɚ ɩɟɪɟɧɨɫɢɦɨɫɬɿ ɩɪɟɩɚɪɚɬɭ Ʌɨɫɩɿɪɢɧɬɦɭ ɩɚɰɿɽɧɬɿɜ ɡ ȱɏɋ.ɍ ɞɨɫɥɿɞɠɟɧɧɿ ɜɡɹɥɢ ɭɱɚɫɬɶ 50 ɩɚɰɿɽɧɬɿɜ
(32 ɱɨɥɨɜɿɤɢ ɿ 18 ɠɿɧɨɤ)ɜɿɤɨɦ 40-65 ɪɨɤɿɜ ɿ ɬɪɢɜɚɥɿɫɬɸ ɡɚɯɜɨɪɸɜɚɧɧɹ ɜɿɞ 3 ɞɨ 27 ɪɨɤɿɜ,ɹɤɿ ɜɩɪɨɞɨɜɠ 28 ɞɧɿɜ,
ɨɤɪɿɦ ɛɚɡɢɫɧɨʀ ɬɟɪɚɩɿʀ, ɹɤ ɚɧɬɢɬɪɨɦɛɨɰɢɬɚɪɧɢɣ ɡɚɫɿɛ ɩɪɢɣɦɚɥɢ 1 ɬɚɛɥɟɬɤɭ Ʌɨɫɩɿɪɢɧɭɬɦ (75 ɦɝ) ɧɚ ɞɨɛɭ.
Ɉɰɿɧɸɜɚɥɢɫɹ ɡɚɝɚɥɶɧɨɤɥɿɧɿɱɧɿ ɞɚɧɿ, ɝɟɦɨɞɢɧɚɦɿɱɧɿ ɩɚɪɚɦɟɬɪɢ, ɥɚɛɨɪɚɬɨɪɧɿ ɩɨɤɚɡɧɢɤɢ ɚɧɚɥɿɡɿɜ ɤɪɨɜɿ, ɫɟɱɿ ɣ
ɚɝɪɟɝɚɧɬɧɨɝɨ ɫɬɚɧɭ ɩɥɚɡɦɢ ɤɪɨɜɿ. Ɂɚ ɩɟɪɿɨɞ ɡɚɫɬɨɫɭɜɚɧɧɹ ɞɨɫɥɿɞɠɭɜɚɧɨɝɨ ɩɪɟɩɚɪɚɬɭ ɩɨɛɿɱɧɢɯ ɹɜɢɳ/ɪɟɚɤɰɿɣ
ɡɚɪɟɽɫɬɪɨɜɚɧɨ ɧɟ ɛɭɥɨ. ɉɟɪɟɧɨɫɢɦɿɫɬɶ ɩɪɟɩɚɪɚɬɭ Ʌɨɫɩɿɪɢɧɬɦ ɛɭɥɚ ɡɚɞɨɜɿɥɶɧɨɸ ɭ 100% ɩɚɰɿɽɧɬɿɜ. ɉɪɢɣɨɦ
ɩɪɟɩɚɪɚɬɭ ɩɪɨɬɹɝɨɦ 28 ɞɧɿɜ ɩɨɤɚɡɚɜ ɝɚɪɧɿ ɚɧɬɢɚɝɪɟɝɚɧɬɧɿ ɜɥɚɫɬɢɜɨɫɬɿ ɭ 90% ɯɜɨɪɢɯ ɧɚ ȱɏɋ.
ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ
ȼ ɫɨɜɪɟɦɟɧɧɨɣ ɤɚɪɞɢɨɥɨɝɢɢ ɚɰɟɬɢɥɫɚɥɢɰɢɥɨ -ɜɚɹ ɤɢɫɥɨɬɚ (ȺɋɄ) ɹɜɥɹɟɬɫɹ ɡɨɥɨɬɵɦ ɫɬɚɧɞɚɪɬɨɦ ɚɧɬɢɬɪɨɦɛɨɰɢɬɚɪɧɨɣ ɬɟɪɚɩɢɢ, ɞɨɤɚɡɚɜ ɧɟɨɫɩɨ -ɪɢɦɵɟ ɩɪɟɢɦɭɳɟɫɬɜɚ ɜ ɤɚɱɟɫɬɜɟ ɷɮɮɟɤɬɢɜɧɨɝɨ ɫɪɟɞɫɬɜɚ ɞɥɹ ɫɧɢɠɟɧɢɹ ɪɢɫɤɚ ɫɟɪɞɟɱɧɨ-ɫɨɫɭ -ɞɢɫɬɵɯ ɨɫɥɨɠɧɟɧɢɣ ɢ ɨɛɭɫɥɨɜɥɟɧɧɨɣ ɢɦɢ ɫɦɟɪɬɢ.
ɇɚ ɨɫɧɨɜɚɧɢɢ ɪɟɡɭɥɶɬɚɬɨɜ ɤɪɭɩɧɟɣɲɟɝɨ ɦɟɬɚ-ɚɧɚɥɢɡɚ ȺɌɌɋ (Antithrombotic Trialists’
Collabo-ration, 2009), ɜɤɥɸɱɢɜɲɟɝɨ 16 ɢɫɫɥɟɞɨɜɚɧɢɣ ɩɨ
ɜɬɨɪɢɱɧɨɣ ɩɪɨɮɢɥɚɤɬɢɤɟ ɫ ɭɱɚɫɬɢɟɦ ɨɤɨɥɨ 17 ɬɵɫɹɱ ɛɨɥɶɧɵɯ ɫ ɢɧɮɚɪɤɬɨɦ ɦɢɨɤɚɪɞɚ, ɢɧɫɭɥɶ -ɬɨɦ ɢ ɬɪɚɧɡɢɬɨɪɧɨɣ ɢɲɟɦɢɱɟɫɤɨɣ ɚɬɚɤɨɣ ɜ ɚɧɚɦ -ɧɟɡɟ, ɩɨɤɚɡɚɧɨ, ɱɬɨ ɥɟɱɟɧɢɟ ɧɢɡɤɢɦɢ ɞɨɡɚɦɢ ɚɫ -ɩɢɪɢɧɚ ɫɬɚɬɢɫɬɢɱɟɫɤɢ ɞɨɫɬɨɜɟɪɧɨ ɫɧɢɠɚɟɬ ɪɢɫɤ ɤɪɭɩɧɵɯ ɤɨɪɨɧɚɪɧɵɯ ɫɨɛɵɬɢɣ (ɢɧɮɚɪɤɬɚ ɦɢɨ -ɤɚɪɞɚ, ɜɧɟɡɚɩɧɨɣ ɤɨɪɨɧɚɪɧɨɣ ɫɦɟɪɬɢ) ɧɚ 20%, ɧɟɮɚɬɚɥɶɧɨɝɨ ɢɧɮɚɪɤɬɚ ɦɢɨɤɚɪɞɚ – ɧɚ 31%, ɫɦɟɪɬɢ,ɫɜɹɡɚɧɧɨɣ ɫ ɤɨɪɨɧɚɪɧɨɣ ɩɚɬɨɥɨɝɢɟɣ, – ɧɚ
13%, ɢɲɟɦɢɱɟɫɤɨɝɨ ɢɧɫɭɥɶɬɚ – ɧɚ 22%, ɫɨɫɭ
-ɞɢɫɬɨɣ ɫɦɟɪɬɢ ɧɚ 9% ɢ ɬɹɠɟɥɵɯ ɫɨɫɭɞɢɫɬɵɯ ɫɨɛɵɬɢɣ – ɧɚ 19% [14].
ɉɪɢɦɟɧɟɧɢɟ ȺɋɄ ɨɛɭɫɥɨɜɥɢɜɚɟɬ ɧɟ ɬɨɥɶɤɨ ɫɭɳɟɫɬɜɟɧɧɨɟ ɫɧɢɠɟɧɢɟ ɪɢɫɤɚ ɤɚɪɞɢɨɜɚɫɤɭɥɹɪ-ɧɵɯ ɫɨɛɵɬɢɣ, ɧɨ ɢ ɞɨɫɬɨɜɟɪɧɨɟ ɭɦɟɧɶɲɟɧɢɟ ɫɦɟɪɬɧɨɫɬɢ ɨɬ ɥɸɛɵɯ ɩɪɢɱɢɧ (ɧɚ 18%) [4].
ȼ ɨɬɧɨɲɟɧɢɢ ɛɟɡɨɩɚɫɧɨɫɬɢ ɩɪɢɦɟɧɟɧɢɹ ȺɋɄ ɜ ɢɡɜɟɫɬɧɨɦ ɢɫɫɥɟɞɨɜɚɧɢɢ CAPRIE (1996), ɨɯɜɚ -ɬɢɜɲɟɦ ɨɤɨɥɨ 20 ɬɵɫ. ɩɚɰɢɟɧɬɨɜ,ɧɟ ɛɵɥɨ ɜɵɹɜ -ɥɟɧɨ ɞɨɫɬɨɜɟɪɧɨɣ ɪɚɡɧɢɰɵ ɦɟɠɞɭ ɪɢɫɤɨɦ ɩɨɛɨɱ -ɧɵɯ ɹɜɥɟɧɢɣ, ɜɵɡɜɚɧɧɵɦ ɩɪɢɟɦɨɦ ȺɋɄ (325ɦɝ/ɫɭɬ) ɢ ɤɥɨɩɢɞɨɝɪɟɥɹ,ɜ ɬɨ ɜɪɟɦɹ ɤɚɤ ɷɤɨ -ɧɨɦɢɱɟɫɤɚɹ ɞɨɫɬɭɩɧɨɫɬɶ ɥɟɱɟɧɢɹ ȺɋɄ ɨɫɬɚɟɬɫɹ ɧɚ ɩɨɪɹɞɨɤ ɜɵɲɟ [15].
ɋɨɜɪɟɦɟɧɧɵɟ ɦɟɠɞɭɧɚɪɨɞɧɵɟ ɪɟɤɨɦɟɧɞɚɰɢɢ ɭɛɟɞɢɬɟɥɶɧɨ ɚɪɝɭɦɟɧɬɢɪɭɸɬ (ɤɥɚɫɫ ɞɨɤɚɡɚɬɟɥɶ -ɧɨɫɬɢ IA) ɧɚɡɧɚɱɟɧɢɟ ȺɋɄ ɤɚɪɞɢɨɥɨɝɢɱɟɫɤɢɦ ɩɚɰɢɟɧɬɚɦ ɜɵɫɨɤɨɝɨ ɪɢɫɤɚ ɤɚɤ ɩɪɟɩɚɪɚɬɚ ɩɟɪɜɨɣ ɥɢɧɢɢ ɞɥɹ ɜɬɨɪɢɱɧɨɣ ɩɪɨɮɢɥɚɤɬɢɤɢ ɤɚɪɞɢɨɜɚɫ -ɤɭɥɹɪɧɵɯ ɫɨɛɵɬɢɣ ɢ ɫɦɟɪɬɢ.
Ⱦɥɹ ɷɮɮɟɤɬɢɜɧɨɣ ɢ ɛɟɡɨɩɚɫɧɨɣ ɚɧɬɢɬɪɨɦɛɨɰɢ -ɬɚɪɧɨɣ ɬɟɪɚɩɢɢ ɩɪɟɞɩɨɱɬɢɬɟɥɟɧ ɥɢɛɨ ɨɪɢɝɢ-ɧɚɥɶɧɵɣ ɩɪɟɩɚɪɚɬ ȺɋɄ,ɥɢɛɨ ɝɟɧɟɪɢɤ,ɞɨɤɚɡɚɜɲɢɣ ɫɜɨɸ ɛɢɨ- ɢ ɬɟɪɚɩɟɜɬɢɱɟɫɤɭɸ ɷɤɜɢɜɚɥɟɧɬɧɨɫɬɶ ɨɪɢɝɢɧɚɥɶɧɨɦɭ ɩɪɟɩɚɪɚɬɭ. ɇɚ ɮɚɪɦɚɰɟɜɬɢɱɟɫɤɨɦ ɪɵɧɤɟ ɍɤɪɚɢɧɵ ɫɟɝɨɞɧɹ ɩɪɟɞɫɬɚɜɥɟɧɨ ɛɨɥɟɟ 15 ɩɪɟɩɚɪɚɬɨɜ ȺɋɄ ɫ ɧɟ ɜɫɟɝɞɚ ɭɛɟɞɢɬɟɥɶɧɨɣ «ɤɥɢ -ɧɢɱɟɫɤɨɣ ɪɟɩɭɬɚɰɢɟɣ». Ɍɚɤɨɟ «ɪɚɡɧɨɨɛɪɚɡɢɟ» ɡɚ -ɬɪɭɞɧɹɟɬ ɜɵɛɨɪ ɢ ɜɪɚɱɚ, ɨɪɢɟɧɬɢɪɨɜɚɧɧɵɣ, ɜ ɩɟɪ -ɜɭɸ ɨɱɟɪɟɞɶ,ɧɚ ɛɟɡɨɩɚɫɧɨɫɬɶ ɥɟɤɚɪɫɬɜɟɧɧɨɝɨ ɩɪɟ -ɩɚɪɚɬɚ, ɢ ɩɚɰɢɟɧɬɚ, ɱɚɳɟ ɨɫɧɨɜɵɜɚɸɳɢɣɫɹ ɧɚ ɮɢɧɚɧɫɨɜɨɣ ɫɨɫɬɚɜɥɹɸɳɟɣ ɧɚɡɧɚɱɟɧɢɣ ɥɟɱɚɳɟɝɨ ɜɪɚɱɚ, ɚ ɬɚɤɠɟ «ɩɨɞɫɤɚɡɤɚɯ» (ɧɟ ɜɫɟɝɞɚ ɨɛɨɫɧɨ -ɜɚɧɧɵɯ)ɤɥɢɧɢɱɟɫɤɨɝɨ ɮɚɪɦɚɰɟɜɬɚ ɜ ɚɩɬɟɤɟ.
ɐɟɥɶɸ ɞɚɧɧɨɝɨ ɢɫɫɥɟɞɨɜɚɧɢɹ ɹɜɢɥɚɫɶ ɨɰɟɧɤɚ ɚɧɬɢɬɪɨɦɛɨɬɢɱɟɫɤɨɣ ɷɮɮɟɤɬɢɜɧɨɫɬɢ, ɛɟɡɨɩɚɫ -ɧɨɫɬɢ ɢ ɩɟɪɟɧɨɫɢɦɨɫɬɢ ɩɪɟɩɚɪɚɬɚ Ʌɨɫɩɢɪɢɧɬɦ, (ɤɢɲɟɱɧɨɪɚɫɬɜɨɪɢɦɵɟ ɬɚɛɥɟɬɤɢ, ɩɨɤɪɵɬɵɟ ɨɛɨ -ɥɨɱɤɨɣ, ɩɪɨɢɡɜɨɞɫɬɜɚ ɮɚɪɦɚɰɟɜɬɢɱɟɫɤɨɣ ɤɨɦ -ɩɚɧɢɢ «Ʉɭɫɭɦ», ɫɨɞɟɪɠɚɳɢɟ 75 ɦɝ ȺɋɄ ɜ 1 ɬɚɛ -ɥɟɬɤɟ) ɭ ɩɚɰɢɟɧɬɨɜ ɫ ɢɲɟɦɢɱɟɫɤɨɣ ɛɨɥɟɡɧɶɸ ɫɟɪɞɰɚ ɢ ɚɪɬɟɪɢɚɥɶɧɨɣ ɝɢɩɟɪɬɟɧɡɢɟɣ.
Ⱦɚɧɧɨɟ ɤɥɢɧɢɱɟɫɤɨɟ ɢɫɫɥɟɞɨɜɚɧɢɟ ɩɪɨɜɨɞɢ -ɥɨɫɶ ɤɚɤ ɨɬɤɪɵɬɨɟ,ɩɪɨɫɩɟɤɬɢɜɧɨɟ,ɧɟɫɪɚɜɧɢɬɟɥɶ -ɧɨɟ ɜ ɫɨɨɬɜɟɬɫɬɜɢɢ ɫ ɬɪɟɛɨɜɚɧɢɹɦɢ Ƚɨɫɭɞɚɪ -ɫɬɜɟɧɧɨɝɨ ɷɤɫɩɟɪɬɧɨɝɨ ɰɟɧɬɪɚ ɆɁ ɍɤɪɚɢɧɵ [1].
ɆȺɌȿɊɂȺɅɕ ɂ ɆȿɌɈȾɕ ɂɋɋɅȿȾɈȼȺɇɂə
ȼ ɢɫɫɥɟɞɨɜɚɧɢɢ ɩɪɢɧɹɥɢ ɭɱɚɫɬɢɟ 50 ɚɦɛɭɥɚ -ɬɨɪɧɵɯ ɩɚɰɢɟɧɬɨɜ (32 ɦɭɠɱɢɧɵ ɢ 18 ɠɟɧɳɢɧ) ɜ ɜɨɡɪɚɫɬɟ 40-65 ɥɟɬ ɫ ɞɢɚɝɧɨɡɨɦ ɂȻɋ ɢ ɞɥɢɬɟɥɶ -ɧɨɫɬɶɸ ɡɚɛɨɥɟɜɚɧɢɹ ɨɬ 3 ɞɨ 27 ɥɟɬ,ɭ 26 (52%) – ɜ ɫɨɱɟɬɚɧɢɢ ɫ ɚɪɬɟɪɢɚɥɶɧɨɣ ɝɢɩɟɪɬɟɧɡɢɟɣ (ȺȽ) ɢ ɤɨɧɬɪɨɥɢɪɭɟɦɵɦ ɚɧɬɢɝɢɩɟɪɬɟɧɡɢɜɧɵɦɢ ɩɪɟɩɚɪɚ -ɬɚɦɢ ȺȾ. ȼɫɟ ɨɧɢ ɫɨɫɬɨɹɥɢ ɧɚ ɞɢɫɩɚɧɫɟɪɧɨɦ ɭɱɟɬɟ ɩɨ ɩɨɜɨɞɭ ɯɪɨɧɢɱɟɫɤɨɝɨ ɬɟɱɟɧɢɹ ɂȻɋ: ɫɬɚɛɢɥɶɧɨɣ ɫɬɟɧɨɤɚɪɞɢɢ ɧɚɩɪɹɠɟɧɢɹ III ɎɄ ɢ ȺȽ II ɫɬɚɞɢɢ, 1-2 ɫɬɟɩɟɧɢ (ɭ 18-ɬɢ ɩɚɰɢɟɧɬɨɜ – 1ɫɬɟɩɟɧɢ (36%) ɢ ɭ 8-ɦɢ (16%) – 2 ɫɬɟɩɟɧɢ).ɍ
4-ɯ (8%) ɩɚɰɢɟɧɬɨɜ ɩɨɞɬɜɟɪɠɞɟɧ ɩɟɪɟɧɟɫɟɧɧɵɣ ɢɧ
-ɮɚɪɤɬ ɦɢɨɤɚɪɞɚ. Ⱦɢɚɝɧɨɡ ɭɫɬɚɧɨɜɥɟɧ ɜ ɫɨɨɬɜɟɬ -ɫɬɜɢɢ ɫ ɪɟɤɨɦɟɧɞɚɰɢɹɦɢ ɍȺɄ (2008) ɢ ɤɪɢɬɟ -ɪɢɹɦɢ ɩɪɢɤɚɡɚ ʋ436 ɆɁ ɍɤɪɚɢɧɵ. Ʉɪɢɬɟɪɢɟɦ ɜɤɥɸɱɟɧɢɹ ɜ ɢɫɫɥɟɞɨɜɚɧɢɟ ɛɵɥɨ ɨɬɫɭɬɫɬɜɢɟ ɜ ɩɪɨɝɪɚɦɦɟ ɥɟɱɟɧɢɹ ɚɧɬɢɚɝɪɟɝɚɧɬɧɵɯ ɩɪɟɩɚɪɚɬɨɜ (ɩɨ ɪɚɡɥɢɱɧɵɦ ɩɪɢɱɢɧɚɦ:ɧɟɠɟɥɚɧɢɟ/ɧɟɨɫɜɟɞɨɦ -ɥɟɧɧɨɫɬɶ ɩɚɰɢɟɧɬɚ, ɨɛɨɫɬɪɟɧɢɟ ɬɟɱɟɧɢɹ ȺȽ, ɨɬ -ɫɭɬɫɬɜɢɟ ɧɚɡɧɚɱɟɧɢɣ) ɜ ɬɟɱɟɧɢɟ ɧɟ ɦɟɧɟɟ 2-ɯ ɧɟɞɟɥɶ.
ɇɟ ɜɤɥɸɱɚɥɢ ɜ ɢɫɫɥɟɞɨɜɚɧɢɟ ɩɚɰɢɟɧɬɨɜ ɫ ɫɟɪɞɟɱɧɨɣ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɶɸ ȱȱȱ-IV ɎɄ ɩɨ
NYHA, ɬɹɠɟɥɵɦɢ ɧɚɪɭɲɟɧɢɹɦɢ ɪɢɬɦɚ ɫɟɪɞɰɚ,
ɩɨɜɵɲɟɧɧɨɣ ɱɭɜɫɬɜɢɬɟɥɶɧɨɫɬɶɸ ɤ ȺɋɄ ɢ ɞɪɭɝɢɦ ɫɚɥɢɰɢɥɚɬɚɦ,ɝɟɦɨɪɪɚɝɢɱɟɫɤɢɦ ɞɢɚɬɟɡɨɦ ɢ ɬɪɨɦ -ɛɨɰɢɬɨɩɟɧɢɟɣ, ɩɟɱɟɧɨɱɧɨɣ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɶɸ, ɛɪɨɧɯɢɚɥɶɧɨɣ ɚɫɬɦɨɣ,ɞɪɭɝɢɦɢ ɫɨɩɭɬɫɬɜɭɸɳɢɦɢ ɡɚɛɨɥɟɜɚɧɢɹɦɢ ɢɥɢ ɨɫɬɪɵɦɢ ɫɨɫɬɨɹɧɢɹɦɢ, ɧɚɥɢ -ɱɢɟ ɤɨɬɨɪɵɯ ɦɨɝɥɨ ɩɨɜɥɢɹɬɶ ɧɚ ɪɟɡɭɥɶɬɚɬɵ ɢɫ -ɫɥɟɞɨɜɚɧɢɹ. ȼ ɯɨɞɟ ɢɫɫɥɟɞɨɜɚɧɢɹ ɧɟ ɧɚɡɧɚɱɚɥɢ ɞɪɭɝɢɟ ɚɧɬɢɚɝɪɟɝɚɧɬɧɵɟ ɩɪɟɩɚɪɚɬɵ, ɝɥɸɤɨɤɨɪ-ɬɢɤɨɫɬɟɪɨɢɞɵ, ɇɉȼɋ, ɚɧɬɚɰɢɞɵ ɢ ɩɪɨɱɢɟ ɫɪɟɞ-ɫɬɜɚ, ɤɨɬɨɪɵɟ ɦɨɝɥɢ ɩɨɜɥɢɹɬɶ ɧɚ ɩɚɪɚɦɟɬɪɵ ɚɧɬɢɬɪɨɦɛɨɰɢɬɚɪɧɨɣ ɚɤɬɢɜɧɨɫɬɢ ɢɡɭɱɚɟɦɨɝɨ ɝɟ -ɧɟɪɢɤɚ ȺɋɄ.
ɇɚ ɷɬɚɩɟ ɫɤɪɢɧɢɧɝɚ ɩɚɰɢɟɧɬɚɦ ɩɪɨɜɨɞɢɥɢ ɎɗȽȾɋ ɞɥɹ ɢɫɤɥɸɱɟɧɢɹ ɬɟɯ,ɭ ɤɨɝɨ ɢɦɟɥɢ ɦɟɫɬɨ ɩɪɢɡɧɚɤɢ ɷɪɨɡɢɜɧɨ-ɹɡɜɟɧɧɨɝɨ ɩɨɪɚɠɟɧɢɹ ɜɟɪɯɧɢɯ ɨɬɞɟɥɨɜ ɠɟɥɭɞɨɱɧɨ-ɤɢɲɟɱɧɨɝɨ ɬɪɚɤɬɚ.
ɹɜɥɹɟɬɫɹ ɩɪɨɬɢɜɨɩɨɤɚɡɚɧɢɟɦ ɞɥɹ ɩɪɢɟɦɚ ɩɪɟɩɚɪɚɬɚ ȺɋɄ.
ȼɫɟ ɩɚɰɢɟɧɬɵ ɩɨɥɭɱɚɥɢ ɛɚɡɢɫɧɭɸ ɬɟɪɚɩɢɸ ɤɚɤ ɂȻɋ, ɬɚɤ ɢ ȺȽ ɫɨɝɥɚɫɧɨ ɦɟɠɞɭɧɚɪɨɞɧɵɦ ɫɬɚɧɞɚɪɬɚɦ ɢ ɩɪɢɤɚɡɭ ʋ436 ɆɁɍ (ɢȺɉɎ/ɛɥɨɤɚ-ɬɨɪɵ ȺII, ȻɄɄ, ȕ-ɚɞɪɟɧɨɛɥɨɤɚɬɨɪɵ, ɧɢɬɪɚɬɵ, ɫɬɚɬɢɧɵ ɢ ɞɪ.). Ʉɨɪɪɟɤɰɢɸ ɛɚɡɢɫɧɨɝɨ ɦɟɞɢɤɚ -ɦɟɧɬɨɡɧɨɝɨ ɥɟɱɟɧɢɹ ɩɪɨɜɨɞɢɥɢ ɬɨɥɶɤɨ ɜɨ ɜɪɟɦɹ ɜɜɨɞɧɨɝɨ ɩɟɪɢɨɞɚ ɜ ɬɟɱɟɧɢɟ 2-ɯ ɧɟɞɟɥɶ. ȼ ɫɨɨɬɜɟɬɫɬɜɢɢ ɫ ɞɢɡɚɣɧɨɦ ɢɫɫɥɟɞɨɜɚɧɢɹ ɜɨ ɜɪɟɦɹ ȼɢɡɢɬɚ-1 ɩɪɨɜɨɞɢɥɢ ɡɚɛɨɪ ɤɪɨɜɢ ɞɥɹ ɛɢɨɯɢɦɢ -ɱɟɫɤɨɝɨ ɢɫɫɥɟɞɨɜɚɧɢɹ ɚɝɪɟɝɚɰɢɨɧɧɵɯ ɫɜɨɣɫɬɜ ɤɪɨɜɢ ɢ ɧɚɡɧɚɱɚɥɢ ɩɪɟɩɚɪɚɬ ȺɋɄ - Ʌɨɫɩɢɪɢɧɬɦ ɜ ɞɨɡɟ 1 ɬɚɛɥɟɬɤɚ ɜ ɫɭɬɤɢ,ɩɨɫɥɟ ɭɠɢɧɚ,ɧɚ 28 ɞɧɟɣ. Ɍɚɛɥɟɬɤɭ ɛɨɥɶɧɵɟ ɩɪɢɧɢɦɚɥɢ ɰɟɥɢɤɨɦ, ɧɟ ɪɚɡ -ɠɟɜɵɜɚɹ, ɡɚɩɢɜɚɹ ɞɨɫɬɚɬɨɱɧɵɦ ɤɨɥɢɱɟɫɬɜɨɦ ɜɨɞɵ.Ɇɨɧɢɬɨɪɢɧɝ ɮɢɡɢɤɚɥɶɧɵɯ ɞɚɧɧɵɯ,ɚ ɬɚɤɠɟ ɪɟɡɭɥɶɬɚɬɨɜ ɢɧɫɬɪɭɦɟɧɬɚɥɶɧɵɯ ɢ ɥɚɛɨɪɚɬɨɪɧɵɯ ɦɟɬɨɞɨɜ ɢɫɫɥɟɞɨɜɚɧɢɹ ɩɪɨɜɨɞɢɥɢ ɧɚ 7-ɣ (ȼɢɡɢɬ -2) ɢ 28-ɣ ɞɟɧɶ (ȼɢɡɢɬ-3) ɩɪɢɟɦɚ ɢɡɭɱɚɟɦɨɝɨ ɩɪɟɩɚɪɚɬɚ.
ȼ ɯɨɞɟ ɢɫɫɥɟɞɨɜɚɧɢɹ ɚɧɚɥɢɡɢɪɨɜɚɥɢ ɞɢɧɚ-ɦɢɤɭ ɨɛɳɟɝɨ ɫɨɫɬɨɹɧɢɹ ɛɨɥɶɧɨɝɨ, ɞɚɧɧɵɯ ɨɮɢɫ-ɧɨɝɨ ɚɪɬɟɪɢɚɥɶɨɮɢɫ-ɧɨɝɨ ɞɚɜɥɟɧɢɹ (ȺȾ), ɱɢɫɥɚ ɫɟɪɞɟɱ -ɧɵɯ ɫɨɤɪɚɳɟɧɢɣ (ɑɋɋ),ɧɚɪɭɠɧɨɣ ɝɪɚɮɢɤɢ ɗɄȽ, ɨɛɳɟɤɥɢɧɢɱɟɫɤɨɝɨ ɚɧɚɥɢɡɚ ɤɪɨɜɢ ɢ ɦɨɱɢ,ɩɨɤɚɡɚ -ɬɟɥɟɣ ɚɝɪɟɝɚɧɬɧɨɝɨ ɫɨɫɬɨɹɧɢɹ ɩɥɚɡɦɵ ɤɪɨɜɢ (ɫɨ -ɞɟɪɠɚɧɢɟ ɬɪɨɦɛɨɰɢɬɨɜ ɜ ɤɪɨɜɢ;ɫɬɟɩɟɧɶ,ɜɪɟɦɹ ɢ ɫɤɨɪɨɫɬɶ ɚɝɪɟɝɚɰɢɢ ɬɪɨɦɛɨɰɢɬɨɜ, ɢɧɞɭɰɢɪɨɜɚɧ -ɧɨɣ ɤɨɥɥɚɝɟɧɨɦ ɢ ȺȾɎ [8]; ɮɚɤɬɨɪ ȼɢɥɥɟɛɪɚɧɞɚ; ɜɪɟɦɹ ɤɪɨɜɨɬɟɱɟɧɢɹ ɩɨ Ⱦɶɸɤɟ), ɫɨɞɟɪɠɚɧɢɟ ɨɫ -ɧɨɜɧɨɝɨ ɦɟɬɚɛɨɥɢɬɚ ɬɪɨɦɛɨɤɫɚɧɚ Ⱥ2 (11-ɞɟɝɢɞ
-ɨɬɞɟɥɨɜ ɠɟɥɭɞɨɱɧɨ-ɤɢɲɟɱɧɨɝɨ ɬɪɚɤɬɚ ɩɨ ɞɚɧɧɵɦ ɎɗȽȾɋ.
ɋɬɚɬɢɫɬɢɱɟɫɤɭɸ ɨɛɪɚɛɨɬɤɭ ɩɪɨɜɨɞɢɥɢ ɫ ɩɨ -ɦɨɳɶɸ ɤɨɦɩɶɸɬɟɪɧɨɣ ɩɪɨɝɪɚɦɦɵ «StatPlus 2006
Professional» ɢ ɫ ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ t-ɤɪɢɬɟɪɢɹ
ɋɬɶɸɞɟɧɬɚ [9].
ɊȿɁɍɅɖɌȺɌɕ ɂ ɂɏ ɈȻɋɍɀȾȿɇɂȿ
ɏɚɪɚɤɬɟɪ ɨɫɧɨɜɧɵɯ ɠɚɥɨɛ ɭ ɨɛɫɥɟɞɭɟɦɵɯ ɛɨɥɶɧɵɯ ɫɨɨɬɜɟɬɫɬɜɨɜɚɥ ɤɥɢɧɢɱɟɫɤɨɣ ɫɢɦɩɬɨ -ɦɚɬɢɤɟ ɂȻɋ: ɫɬɚɛɢɥɶɧɨɣ ɫɬɟɧɨɤɚɪɞɢɢ ɧɚɩɪɹɠɟ
-ɧɢɹ III ɎɄ ɢ ɤɨɧɬɪɨɥɢɪɭɟɦɨɣ ɤɨɦɩɥɟɤɫɧɨɣ ɬɟɪɚ
-ɩɢɟɣ ɚɧɬɢɝɢɩɟɪɬɟɧɡɢɜɧɵɦɢ ɩɪɟɩɚɪɚɬɚɦɢ ȺȽ 1-2 ɫɬɟɩɟɧɢ ɜ ɩɪɟɞɟɥɚɯ ɰɟɥɟɜɵɯ ɡɧɚɱɟɧɢɣ ȺȾ. Ɍɢ -ɩɢɱɧɵɣ ɫɬɟɧɨɤɚɪɞɢɬɢɱɟɫɤɢɣ ɫɢɧɞɪɨɦ ɨɬɦɟɱɚɥɢ 38ɩɚɰɢɟɧɬɨɜ,ɚɬɢɩɢɱɧɵɣ - 7, ɭ 5 – ɷɤɜɢɜɚɥɟɧɬɨɦ ɛɵɥɚ ɨɞɵɲɤɚ.
ɉɨ ɞɚɧɧɵɦ ɗɄȽ-ɢɫɫɥɟɞɨɜɚɧɢɹ ɩɪɢɡɧɚɤɢ ɯɪɨ -ɧɢɱɟɫɤɨɣ ɤɨɪɨɧɚɪɧɨɣ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɢ ɜɵɹɜɢɥɢ
ɭ 22-ɯ (44%) ɛɨɥɶɧɵɯ,ɪɭɛɰɨɜɵɟ ɢɡɦɟɧɟɧɢɹ ɩɨɫ
-ɥɟ ɩɟɪɟɧɟɫɟɧɧɨɝɨ ɢɧɮɚɪɤɬɚ ɦɢɨɤɚɪɞɚ ɭ 4-ɯ (8%) ɛɨɥɶɧɵɯ, ɭ 11 ɩɚɰɢɟɧɬɨɜ - ɷɩɢɡɨɞɵ ɛɟɡɛɨɥɟɜɨɣ ɢɲɟɦɢɢ ɦɢɨɤɚɪɞɚ. Ⱥɪɢɬɦɢɢ – ɪɟɝɢɫɬɪɢɪɨɜɚɥɢ ɭ 27ɩɚɰɢɟɧɬɨɜ, ɜ ɨɫɧɨɜɧɨɦ – ɷɩɢɡɨɞɢɱɟɫɤɢɟ ɩɪɟɞ -ɫɟɪɞɧɵɟ ɢ ɱɚɳɟ ɠɟɥɭɞɨɱɤɨɜɵɟ ɷɤɫɬɪɚɫɢɫɬɨɥɵ.
Ʉɥɢɧɢɱɟɫɤɢ ɡɧɚɱɢɦɵɟ ɨɬɤɥɨɧɟɧɢɹ ɥɚɛɨɪɚɬɨɪ -ɧɵɯ ɩɨɤɚɡɚɬɟɥɟɣ ɨɛɳɟɤɥɢɧɢɱɟɫɤɨɣ ɢ ɛɢɨɯɢɦɢ -ɱɟɫɤɨɣ ɩɚɧɟɥɟɣ ɨɬɫɭɬɫɬɜɨɜɚɥɢ. ȼ ɫɨɨɬɜɟɬɫɬɜɢɢ ɫ ɰɟɥɶɸ ɪɚɛɨɬɵ ɢɡɭɱɚɥɢ ɩɨɤɚɡɚɬɟɥɢ ɢɫɯɨɞɧɨɝɨ ɚɝ -ɪɟɝɚɧɬɧɨɝɨ ɫɨɫɬɨɹɧɢɹ ɤɪɨɜɢ ɭ ɜɫɟɯ ɨɛɫɥɟɞɨɜɚɧɵɯ ɩɚɰɢɟɧɬɨɜ (ɬɚɛɥ.1).
Ɍ ɚ ɛ ɥ ɢ ɰ ɚ 1
ɉɨɤɚɡɚɬɟɥɢ ɚɝɪɟɝɚɧɬɧɨɝɨ ɫɨɫɬɨɹɧɢɹ ɤɪɨɜɢ ɭ ɨɛɫɥɟɞɨɜɚɧɧɵɯ ɞɨ ɥɟɱɟɧɢɹ (M±m)
ɉɨɤɚɡɚɬɟɥɢ Ɂɧɚɱɟɧɢɹ (n=50)
ɉɪɨɛɚ Ⱦɶɸɤɟ,ɦɢɧ,ɫ,Ɇ±m 2,43r0,07
ɋɬɟɩɟɧɶ ɚɝɪɟɝɚɰɢɢ, %, Ɋ±m 84,18r14,59
ȼɪɟɦɹ ɚɝɪɟɝɚɰɢɢ,ɦɢɧ.,Ɇ±m 8,53r0,20
ɋɤɨɪɨɫɬɶ ɚɝɪɟɝɚɰɢɢ ɡɚ 30 ɫ, %/ɦɢɧ.,Ɋ±m 8,89r1,90
Ʉɨɥɢɱɟɫɬɜɨ ɬɪɨɦɛɨɰɢɬɨɜ,ɬɵɫ./ɦɤɥ,Ɇ±m 182,7r14,98
Ɏɚɤɬɨɪ ȼɢɥɥɟɛɪɚɧɞɚ, %, Ɋ±m 184,94r8,05
Ʉɪɟɚɬɢɧɢɧ ɫɭɬɨɱɧɨɣ ɦɨɱɢ ɫɨɫɬɚɜɢɥ
179,9 r 6,95 ɦɤɦɨɥɶ/ɤɝ/ɫɭɬ. ɉɪɢ ɩɪɨɜɟɞɟɧɢɢ ɂɎȺ
ɭɪɨɜɟɧɶ 11-ɞɟɝɢɞɪɨ-ɬɪɨɦɛɨɤɫɚɧ ȼ2ɜ ɫɭɬɨɱɧɨɣ ɦɨ -ɱɟ ɪɚɜɧɹɥɫɹ 659,2 r 54,28 ɩɝ/ɦɝ.
ȼ ɩɪɨɰɟɫɫɟ ɥɟɱɟɧɢɹ ɨɬɦɟɱɟɧɚ ɩɨɥɨɠɢɬɟɥɶɧɚɹ ɞɢɧɚɦɢɤɚ ɩɨ ɭɦɟɧɶɲɟɧɢɸ ɢɧɬɟɧɫɢɜɧɨɫɬɢ ɫɭɛɴɟ -ɤɬɢɜɧɵɯ ɫɢɦɩɬɨɦɨɜ ɭ ɩɚɰɢɟɧɬɨɜ ɫɨ ɫɬɚɛɢɥɶɧɨɣ
ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ
*
0 0,5 1 1,5 2 2,5 3 3,5
ɞɨ ɥɟɱɟɧɢɹ ɱɟɪɟɡ 7 ɞɧɟɣ ɱɟɪɟɡ 28 ɞɧɟɣ
Ɋɢɫ. 1. Ⱦɢɧɚɦɢɤɚ ɤɨɥɢɱɟɫɬɜɚ ɩɪɢɧɢɦɚɟɦɵɯ ɬɚɛɥɟɬɨɤ ɧɢɬɪɨɝɥɢɰɟɪɢɧɚ ɜ ɫɭɬɤɢ ɭ ɛɨɥɶɧɵɯ ɫɨ ɫɬɚɛɢɥɶɧɨɣ ɫɬɟɧɨɤɚɪɞɢɟɣ ɧɚɩɪɹɠɟɧɢɹ III ɎɄ
ɉ ɪ ɢ ɦ ɟ ɱ ɚ ɧ ɢ ɟ: * – p<0,05 ɨɬɧɨɫɢɬɟɥɶɧɨ ɩɨɤɚɡɚɬɟɥɟɣ ɞɨ ɧɚɱɚɥɚ ɥɟɱɟɧɢɹ
ɉɚɪɚɦɟɬɪɵ ɨɫɧɨɜɧɵɯ ɝɟɦɨɞɢɧɚɦɢɱɟɫɤɢɯ ɩɨ -ɤɚɡɚɬɟɥɟɣ ɭ ɨɛɫɥɟɞɭɟɦɵɯ ɩɚɰɢɟɧɬɨɜ ɢɦɟɥɢ ɫɬɚ -ɛɢɥɶɧɭɸ ɞɢɧɚɦɢɤɭ ɢ ɞɚɠɟ ɬɟɧɞɟɧɰɢɸ ɤ ɫɧɢ -ɠɟɧɢɸ ɜ ɩɪɟɞɟɥɚɯ ɜɵɫɨɤɨɝɨ ɧɨɪɦɚɥɶɧɨɝɨ ȺȾ (ɜ ɫɪɟɞɧɟɦ ɫɢɫɬɨɥɢɱɟɫɤɨɟ ȺȾ ɫɧɢɡɢɥɨɫɶ ɧɚ
4,6 ɦɦ ɪɬ.ɫɬ.,ɞɢɚɫɬɨɥɢɱɟɫɤɨɟ ȺȾ ɧɚ 2,6 ɦɦ ɪɬ.ɫɬ).
ɉɪɢ ɞɢɧɚɦɢɱɟɫɤɨɣ ɨɰɟɧɤɟ ɗɄȽ-ɞɚɧɧɵɯ ɭ 8-ɦɢ ɩɚɰɢɟɧɬɨɜ (16%) ɪɟɝɢɫɬɪɢɪɨɜɚɥɢ ɧɨɪɦɚɥɢ -ɡɚɰɢɸ ɝɪɚɮɢɤɢ ɮɚɡɵ ɪɟɩɨɥɹɪɢɡɚɰɢɢ.
Ɂɚ ɜɪɟɦɹ ɧɚɛɥɸɞɟɧɢɹ ɫɬɚɬɢɫɬɢɱɟɫɤɢ ɡɧɚɱɢ -ɦɵɯ ɢɡɦɟɧɟɧɢɣ ɫɨ ɫɬɨɪɨɧɵ ɩɨɤɚɡɚɬɟɥɟɣ ɝɟɦɨ -ɝɪɚɦɦɵ ɩɟɪɢɮɟɪɢɱɟɫɤɨɣ ɤɪɨɜɢ ɢ ɨɛɳɟɝɨ ɚɧɚɥɢɡɚ
ɦɨɱɢ ɭ ɨɛɫɥɟɞɭɟɦɵɯ ɩɚɰɢɟɧɬɨɜ ɩɨɫɥɟ 28-ɞɧɟɜ -ɧɨɝɨ ɩɪɢɟɦɚ ɩɪɟɩɚɪɚɬɚ Ʌɨɫɩɢɪɢɧɬɦ ɜɵɹɜɥɟɧɨ ɧɟ ɛɵɥɨ.
ɍ ɜɫɟɯ ɩɚɰɢɟɧɬɨɜ ɪɟɝɢɫɬɪɢɪɨɜɚɥɢ ɧɨɪɦɚɥɶ-ɧɵɟ ɩɨɤɚɡɚɬɟɥɢ ɤɪɟɚɬɢɧɢɧɚ ɜ ɫɭɬɨɱɧɨɣ ɦɨɱɟ ɫ ɬɟɧɞɟɧɰɢɟɣ ɤ ɟɝɨ ɫɧɢɠɟɧɢɸ (ɬɚɛɥ. 2). Ʉɥɢɧɢɱɟɫɤɢ ɡɧɚɱɢɦɵɟ ɩɨɛɨɱɧɵɟ ɷɮɮɟɤɬɵ ɢ ɧɟɛɥɚɝɨɩɪɢɹɬɧɵɟ ɢɡɦɟɧɟɧɢɹ ɥɚɛɨɪɚɬɨɪɧɵɯ ɩɨɤɚɡɚɬɟɥɟɣ ɤɪɨɜɢ ɢ ɦɨɱɢ ɜ ɞɢɧɚɦɢɤɟ ɧɚɛɥɸɞɟɧɢɹ ɨɬɫɭɬɫɬɜɨɜɚɥɢ, ɱɬɨ ɫɜɢɞɟɬɟɥɶɫɬɜɨɜɚɥɨ ɨ ɯɨɪɨɲɟɣ ɩɟɪɟɧɨɫɢɦɨɫɬɢ ɢ ɛɟ -ɡɨɩɚɫɧɨɫɬɢ 28-ɞɧɟɜɧɨɝɨ ɩɪɢɦɟɧɟɧɢɹ ɢɫɫɥɟɞɭɟɦɨɝɨ ɩɪɟɩɚɪɚɬɚ Ʌɨɫɩɢɪɢɧɬɦ.
Ɍ ɚ ɛ ɥ ɢ ɰ ɚ 2
Ⱦɢɧɚɦɢɤɚ ɩɨɤɚɡɚɬɟɥɟɣ ɤɪɟɚɬɢɧɢɧɚ ɜ ɫɭɬɨɱɧɨɣ ɦɨɱɟ ɭ ɨɛɫɥɟɞɨɜɚɧɧɵɯ ɛɨɥɶɧɵɯ (n=50)
ɉɨɤɚɡɚɬɟɥɢ Ʉɪɟɚɬɢɧɢɧ,ɦɤɦɨɥɶ/ɤɝ/ɫɭɬ
Ⱦɨ ɥɟɱɟɧɢɹ
ɋɪɟɞɧɟɟ ɡɧɚɱɟɧɢɟ,Ɇ±m 179,9r6,95
ɑɟɪɟɡ 28 ɞɧɟɣ
ɋɪɟɞɧɟɟ ɡɧɚɱɟɧɢɟ,Ɇ±m 147,6r3,98
%ɨɬɤɥɨɧɟɧɢɹ ɨɬ ɢɫɯɨɞɧɨɝɨ ɭɪɨɜɧɹ -17,92
ɍɪɨɜɟɧɶ ɡɧɚɱɢɦɨɫɬɢ,ɪ 0,00023
Ⱦɥɹ ɨɰɟɧɤɢ ɚɧɬɢɚɝɪɟɝɚɧɬɧɨɣ ɷɮɮɟɤɬɢɜɧɨɫɬɢ ɩɪɟɩɚɪɚɬɚ Ʌɨɫɩɢɪɢɧɬɦ ɢɡɭɱɚɥɢɫɶ ɜɪɟɦɹ ɤɪɨɜɨ -ɬɟɱɟɧɢɹ ɩɨ Ⱦɶɸɤɟ, ɩɨɤɚɡɚɬɟɥɢ ɨɩɬɢɱɟɫɤɨɣ ɚɝɪɟ -ɝɨɦɟɬɪɢɢ, ɤɨɥɢɱɟɫɬɜɟɧɧɨɟ ɨɩɪɟɞɟɥɟɧɢɟ
ɭ ɨɛɫɥɟɞɨɜɚɧɧɵɯ ɛɨɥɶɧɵɯ (n=50)
ɉɨɤɚɡɚɬɟɥɢ ȼɪɟɦɹ ɤɪɨɜɨɬɟɱɟɧɢɹ,ɦɢɧ.
Ⱦɨ ɥɟɱɟɧɢɹ
ɋɪɟɞɧɟɟ ɡɧɚɱɟɧɢɟ,Ɇ±m 2,43r0,07
ɑɟɪɟɡ 28 ɞɧɟɣ
ɋɪɟɞɧɟɟ ɡɧɚɱɟɧɢɟ,Ɇ±m 4,00r0,24
%ɨɬɤɥɨɧɟɧɢɹ ɨɬ ɢɫɯɨɞɧɨɝɨ ɭɪɨɜɧɹ +64,83
ɍɪɨɜɟɧɶ ɡɧɚɱɢɦɨɫɬɢ,ɪ 0,0000006
ɋɨɝɥɚɫɧɨ ɩɨɥɭɱɟɧɧɵɦ ɞɚɧɧɵɦ,ɩɪɟɩɚɪɚɬ Ʌɨɫ-ɩɢɪɢɧɬɦ ɜ ɞɨɡɟ 1 ɬɚɛɥ. (75 ɦɝ) ɜ ɫɭɬɤɢ ɜ ɬɟɱɟɧɢɟ 28 ɞɧɟɣ ɭɜɟɥɢɱɢɜɚɟɬ ɜɪɟɦɹ ɤɪɨɜɨɬɟɱɟɧɢɹ ɩɨ Ⱦɶɸɤɟ ɜ 1,65 ɪɚɡɚ, ɩɪɢɱɟɦ ɫɪɟɞɧɢɟ ɡɧɚɱɟɧɢɹ
ɷɬɨɝɨ ɩɨɤɚɡɚɬɟɥɹ ɨɫɬɚɸɬɫɹ ɜ ɩɪɟɞɟɥɚɯ ɧɨɪɦɵ,ɱɬɨ ɭɤɚɡɵɜɚɟɬ ɧɚ ɷɮɮɟɤɬɢɜɧɨɫɬɶ ɩɪɟɩɚɪɚɬɚ ɢ ɟɝɨ ɛɟɡɨɩɚɫɧɨɫɬɶ.
Ɍ ɚ ɛ ɥ ɢ ɰ ɚ 4
Ⱦɢɧɚɦɢɤɚ ɨɫɧɨɜɧɵɯ ɩɨɤɚɡɚɬɟɥɟɣ,ɩɨɥɭɱɟɧɧɵɯ ɩɪɢ ɩɪɨɜɟɞɟɧɢɢ
ɨɩɬɢɱɟɫɤɨɣ ɚɝɪɟɝɨɦɟɬɪɢɢ ɭ ɨɛɫɥɟɞɨɜɚɧɧɵɯ ɛɨɥɶɧɵɯ(n=50)
Ⱦɨ ɥɟɱɟɧɢɹ ɑɟɪɟɡ 7 ɞɧɟɣ ɑɟɪɟɡ 28 ɞɧɟɣ
ɉɨɤɚɡɚɬɟɥɢ
Ɇ±m Ɇ±m ɨɬɤɥ%
. ɪ Ɇ±m
%
ɨɬɤɥ. ɪ
ȱ 84,18r14,59 32,55r5,72 -61,3 0,001 25,35r10,44 -69,9 0,001
ɋɬɟɩɟɧɶ ɚɝɪɟɝɚɰɢɢ ɬɪɨɦɛɨɰɢɬɨɜ, %
ȱȱ 75,94r17,21 43,25r5,72 -43,0 0,02 38,16r2,15 -49,7 0,007
ȱ 28,89r3,9 9,89r1,41 -65,8 0,003 7,16r1,65 -75,2 0,001
ɋɤɨɪɨɫɬɶ ɚɝɪɟɝɚɰɢɢ ɬɪɨɦɛɨɰɢɬɨɜ, %/ɦɢɧ
ȱȱ 46,18r4,79 27,22r2,38 -41,1 0,03 23,37r2,9 -49,4 0,01
ȱ 8,53r0,21 8,24r0,43 -3,41 0,55 8,33r0,49 -2,34 0,68
ȼɪɟɦɹ ɚɝɪɟɝɚɰɢɢ ɬɪɨɦɛɨɰɢɬɨɜ,ɦɢɧ
ȱȱ 5,08r0,71 6,06r0,49 +19,2 0,27 7,47r0,49 +46,9 0,009
ɋɩɨɧɬɚɧɧɚɹ ɚɝɪɟɝɚɰɢɹ ɬɪɨɦɛɨɰɢɬɨɜ, %
2,08r0,32 1,86r0,43 -10,7 0,68 0,71r0,15 -65,8 0,001
Ʉɨɥɢɱɟɫɬɜɨ ɬɪɨɦɛɨɰɢɬɨɜ ɬɵɫ/ɦɤɥ
182,7r14,98 194,7r11,04 +6,59 0,52 164,49r8,88 -9,98 0,31
Ɏɚɤɬɨɪ ȼɢɥɥɟɛɪɚɧɞɚ, % 184,9r8,05 188,1r8,29 +1,74 0,79 189,47r16,22 +2,45 0,81
ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ
ɉɪɢ ɚɧɚɥɢɡɟ ɞɚɧɧɵɯ ɚɝɪɟɝɚɬɨɝɪɚɦɦ ɜ ɞɢɧɚ -ɦɢɤɟ ɩɪɨɫɥɟɠɢɜɚɥɨɫɶ ɫɧɢɠɟɧɢɟ ɫɬɟɩɟɧɢ ɢ ɫɤɨ -ɪɨɫɬɢ ɢɧɞɭɰɢɪɨɜɚɧɧɨɣ ɚɝɪɟɝɚɰɢɢ ɬɪɨɦɛɨɰɢɬɨɜ. ɉɪɢɱɟɦ, ɟɫɥɢ ɞɥɹ ɤɨɥɥɚɝɟɧ-ɢɧɞɭɰɢɪɨɜɚɧɧɨɣ ɚɝɪɟɝɚɰɢɢ ɛɵɥɨ ɯɚɪɚɤɬɟɪɧɨ ɩɪɚɤɬɢɱɟɫɤɢ ɩɨɥɧɨɟ ɭɝɧɟɬɟɧɢɟ ɩɪɨɰɟɫɫɚ ɚɝɪɟɝɚɰɢɢ ɬɪɨɦɛɨɰɢɬɨɜ (ɞɨ
-75%) ɧɚ ɮɨɧɟ 28-ɞɧɟɜɧɨɝɨ ɥɟɱɟɧɢɹ ɩɪɟɩɚɪɚɬɨɦ
Ʌɨɫɩɢɪɢɧɬɦ, ɬɨ ɞɥɹ ȺȾɎ-ɢɧɞɭɰɢɪɨɜɚɧɧɨɣ ɚɝɪɟ-ɝɚɰɢɢ ɛɵɥɨ ɨɬɦɟɱɟɧɨ ɦɟɧɟɟ ɜɵɪɚɠɟɧɧɨɟ ɢɡɦɟ -ɧɟɧɢɟ ɢɫɫɥɟɞɭɟɦɵɯ ɩɨɤɚɡɚɬɟɥɟɣ (ɞɨ -50%), ɱɬɨ ɫɜɢɞɟɬɟɥɶɫɬɜɨɜɚɥɨ ɨ ɧɚɪɭɲɟɧɢɢ ɜɬɨɪɢɱɧɨɣ ɜɨɥ -ɧɵ ɚɝɪɟɝɚɰɢɢ, ɤɨɬɨɪɚɹ, ɜ ɫɜɨɸ ɨɱɟɪɟɞɶ, ɨɬɨɛɪɚ -ɠɚɥɚ ɩɪɨɰɟɫɫ ɜɵɫɜɨɛɨɠɞɟɧɢɹ ɫɨɞɟɪɠɢɦɨɝɨ ɝɪɚ -ɧɭɥ ɬɪɨɦɛɨɰɢɬɨɜ. Ɍɚɤɠɟ ɧɚɛɥɸɞɚɥɢ ɭɜɟɥɢɱɟɧɢɟ ɜɪɟɦɟɧɢ ɦɚɤɫɢɦɭɦɚ ɚɝɪɟɝɚɰɢɢ (ɩɪɢ ɢɫɩɨɥɶɡɨ -ɜɚɧɢɢ ɜ ɤɚɱɟɫɬɜɟ ɢɧɞɭɤɬɨɪɚ ȺȾɎ),ɱɬɨ ɭɤɚɡɵɜɚɥɨ ɧɚ ɡɚɦɟɞɥɟɧɢɟ ɩɪɨɰɟɫɫɚ ɚɤɬɢɜɚɰɢɢ ɬɪɨɦɛɨɰɢɬɨɜ, ɜɵɡɜɚɧɧɨɟ ɧɚɪɭɲɟɧɢɟɦ ɢɯ ɮɭɧɤɰɢɨɧɚɥɶɧɨɣ ɚɤ -ɬɢɜɧɨɫɬɢ. ɋɩɨɧɬɚɧɧɚɹ ɚɝɪɟɝɚɰɢɹ ɬɪɨɦɛɨɰɢɬɨɜ ɭɦɟɧɶɲɢɥɚɫɶ ɩɪɚɤɬɢɱɟɫɤɢ ɧɚ 65% ɩɨ ɫɪɚɜɧɟɧɢɸ ɫ ɩɨɤɚɡɚɬɟɥɹɦɢ ɞɨ ɧɚɱɚɥɚ ɥɟɱɟɧɢɹ ɩɪɟɩɚɪɚɬɨɦ Ʌɨɫɩɢɪɢɧɬɦ.
Ɍɚɤɢɦ ɨɛɪɚɡɨɦ, ɪɟɡɭɥɶɬɚɬɵ ɨɩɬɢɱɟɫɤɨɣ ɚɝɪɟ-ɝɨɦɟɬɪɢɢ ɢ ɨɩɪɟɞɟɥɟɧɢɟ ɫɬɚɛɢɥɶɧɵɯ ɦɟɬɚɛɨ-ɥɢɬɨɜ ɬɪɨɦɛɨɤɫɚɧɚ Ⱥ2 ɜ ɦɨɱɟ ɩɨɤɚɡɚɥɢ, ɱɬɨ ɩɪɢɦɟɧɟɧɢɟ ɩɪɟɩɚɪɚɬɚ Ʌɨɫɩɢɪɢɧɬɦ ɜ ɬɟɱɟɧɢɟ 4 ɧɟɞɟɥɶ ɭɝɧɟɬɚɟɬ ɮɭɧɤɰɢɨɧɚɥɶɧɭɸ ɚɤɬɢɜɧɨɫɬɶ ɬɪɨɦɛɨɰɢɬɨɜ ɧɚ 50-80%. ɍ 10% ɩɚɰɢɟɧɬɨɜ ɧɚɛ -ɥɸɞɚɥɨɫɶ ɨɬɫɭɬɫɬɜɢɟ ɚɧɬɢɚɝɪɟɝɚɧɬɧɨɝɨ ɷɮɮɟɤɬɚ, ɱɬɨ ɫɨɨɬɜɟɬɫɬɜɭɟɬ ɫɬɚɬɢɫɬɢɱɟɫɤɢɦ ɞɚɧɧɵɦ ɩɨ ɩɪɢɦɟɧɟɧɢɸ ȺɋɄ ɭ ɤɚɪɞɢɨɥɨɝɢɱɟɫɤɢɯ ɛɨɥɶɧɵɯ.
Ⱥɤɬɢɜɧɨɫɬɶ ɮɚɤɬɨɪɚ ȼɢɥɥɟɛɪɚɧɞɚ ɢ ɤɨɥɢ -ɱɟɫɬɜɨ ɬɪɨɦɛɨɰɢɬɨɜ ɜ ɩɟɪɢɮɟɪɢɱɟɫɤɨɣ ɤɪɨɜɢ ɞɨ -ɫɬɨɜɟɪɧɨ ɧɟ ɢɡɦɟɧɢɥɢɫɶ. ɗɬɨ ɫɜɢɞɟɬɟɥɶɫɬɜɨɜɚɥɨ ɨɛ ɨɬɫɭɬɫɬɜɢɢ ɜɥɢɹɧɢɹ ȺɋɄ ɧɚ ɞɚɧɧɵɟ ɡɜɟɧɶɹ ɫɨɫɭɞɢɫɬɨ-ɬɪɨɦɛɨɰɢɬɚɪɧɨɝɨ ɤɨɦɩɨɧɟɧɬɚ ɝɟɦɨ -ɫɬɚɡɚ.
Ɋɟɡɭɥɶɬɚɬɵ ɢɫɫɥɟɞɨɜɚɧɢɹ ɫɨɞɟɪɠɚɧɢɹ ɨɫɧɨɜ -ɧɨɝɨ ɦɟɬɚɛɨɥɢɬɚ ɬɪɨɦɛɨɤɫɚɧɚ Ⱥ2 ɜ ɦɨɱɟ – 11-ɞɟɝɢɞɪɨ-ɬɪɨɦɛɨɤɫɚɧɚ ȼ2 – ɩɨɤɚɡɚɥɢ (ɬɚɛɥ.5), ɱɬɨ ɩɪɟɩɚɪɚɬ Ʌɨɫɩɢɪɢɧɬɦ ɫɧɢɠɚɟɬ ɩɨɱɟɱɧɭɸ ɷɤɫɤɪɟ-ɰɢɸ ɞɚɧɧɨɝɨ ɜɟɳɟɫɬɜɚ ɛɨɥɟɟ ɱɟɦ ɧɚ 80%. ɗɬɨ ɫɜɢɞɟɬɟɥɶɫɬɜɭɟɬ ɨ ɫɭɳɟɫɬɜɟɧɧɨɦ ɭɝɧɟɬɟɧɢɢ ɷɧ -ɞɨɝɟɧɧɨɣ ɩɪɨɞɭɤɰɢɢ ɬɪɨɦɛɨɤɫɚɧɚ Ⱥ2 ɢ, ɫɨɨɬ -ɜɟɬɫɬɜɟɧɧɨ, ɭɦɟɧɶɲɟɧɢɢ ɟɝɨ ɚɤɬɢɜɢɪɭɸɳɟɝɨ ɜɥɢɹɧɢɹ ɧɚ ɬɪɨɦɛɨɰɢɬɵ, ɨɫɨɛɟɧɧɨ ɧɚ ɜɬɨɪɭɸ ɮɚɡɭ ɚɝɪɟɝɚɰɢɢ, ɤɨɬɨɪɚɹ ɯɚɪɚɤɬɟɪɢɡɭɟɬɫɹ ɜɵɫɜɨ -ɛɨɠɞɟɧɢɟɦ ɫɨɞɟɪɠɢɦɨɝɨ ɬɪɨɦɛɨɰɢɬɚɪɧɵɯ ɝɪɚ -ɧɭɥ (ɫɟɪɨɬɨɧɢɧ, ɚɞɟɧɨɡɢɧ ɞɢɮɨɫɮɚɬ, ɬɪɨɦɛɨɰɢ -ɬɚɪɧɵɟ ɮɚɤɬɨɪɵ), ɱɬɨ ɩɪɢɜɨɞɢɬ ɤ ɭɦɟɧɶɲɟɧɢɸ ɢɯ ɚɞɝɟɡɢɢ ɢ ɚɝɪɟɝɚɰɢɢ, ɭɦɟɧɶɲɟɧɢɸ ɚɭɬɨɤɚɬɚ -ɥɢɬɢɱɟɫɤɨɣ ɚɤɬɢɜɚɰɢɢ, ɬ.ɟ. ɮɨɪɦɢɪɨɜɚɧɢɸ ɚɧɬɢ -ɚɝɪɟɝɚɧɬɧɨɝɨ ɷɮɮɟɤɬɚ.
ɍ 5-ɬɢ ɩɚɰɢɟɧɬɨɜ (10%) ɧɟ ɛɵɥɨ ɨɬɦɟɱɟɧɨ ɫɭ -ɳɟɫɬɜɟɧɧɵɯ ɢɡɦɟɧɟɧɢɣ ɩɨɤɚɡɚɬɟɥɟɣ ɚɝɪɟɝɚɬɨ
-ɝɪɚɦɦ, ɱɬɨ, ɜɨɡɦɨɠɧɨ, ɭɤɚɡɵɜɚɟɬ ɧɚ ɚɫɩɢɪɢɧɨ -ɪɟɡɢɫɬɟɧɬɧɨɫɬɶ. ɉɨɥɭɱɟɧɧɵɟ ɪɟɡɭɥɶɬɚɬɵ ɫɨɝɥɚ -ɫɭɸɬɫɹ ɫ ɞɚɧɧɵɦɢ ɥɢɬɟɪɚɬɭɪɵ ɩɨ ɩɪɢɦɟɧɟɧɢɸ ȺɋɄ ɭ ɤɚɪɞɢɨɥɨɝɢɱɟɫɤɢɯ ɩɚɰɢɟɧɬɨɜ.
Ɍ ɚ ɛ ɥ ɢ ɰ ɚ 5
Ⱦɢɧɚɦɢɤɚ ɩɨɤɚɡɚɬɟɥɹ ɫɨɞɟɪɠɚɧɢɹ
11-ɞɟɝɢɞɪɨ-ɬɪɨɦɛɨɤɫɚɧɚ ȼ2ɜ ɫɭɬɨɱɧɨɣ ɦɨɱɟ ɭ
ɨɛɫɥɟɞɨɜɚɧɧɵɯ ɛɨɥɶɧɵɯ (n=50)
ɉɨɤɚɡɚɬɟɥɢ 11-ɞɟɝɢɞɪɨ-ɬɪɨɦɛɨɤɫɚɧ ȼ2,
ɩɝ/ɦɝ
Ⱦɨ ɥɟɱɟɧɢɹ
ɋɪɟɞɧɟɟ ɡɧɚɱɟɧɢɟ,Ɇ±m 659,2r54,28
ɑɟɪɟɡ 28 ɞɧɟɣ
ɋɪɟɞɧɟɟ ɡɧɚɱɟɧɢɟ,Ɇ±m 128,3r14,10
%ɨɬɤɥɨɧɟɧɢɹ ɨɬ ɢɫɯɨɞɧɨɝɨ
ɭɪɨɜɧɹ -80,54
ɍɪɨɜɟɧɶ ɡɧɚɱɢɦɨɫɬɢ,ɪ < 0,0001
Ɍɚɤɢɦ ɨɛɪɚɡɨɦ, ɜɤɥɸɱɟɧɢɟ ɩɪɟɩɚɪɚɬɚ Ʌɨɫɩɢ -ɪɢɧɬɦ ɜ ɩɪɨɝɪɚɦɦɭ ɤɨɦɩɥɟɤɫɧɨɣ ɬɟɪɚɩɢɢ ɜ ɬɟ -ɱɟɧɢɟ 28 ɞɧɟɣ ɫɜɢɞɟɬɟɥɶɫɬɜɨɜɚɥɨ ɨ ɟɝɨ ɭɞɨɜɥɟɬ -ɜɨɪɢɬɟɥɶɧɵɯ ɚɧɬɢɚɝɪɟɝɚɧɬɧɵɯ ɫɜɨɣɫɬɜɚɯ ɭ 90% ɩɚɰɢɟɧɬɨɜ ɫ ɂȻɋ.
ɉɨ ɪɟɡɭɥɶɬɚɬɚɦ ɤɨɧɬɪɨɥɶɧɨɣ ɎɗȽȾɋ ɭ 30
(60%) ɛɨɥɶɧɵɯ ɫ ɨɱɚɝɨɜɨɣ ɩɨɜɟɪɯɧɨɫɬɧɨɣ ɝɚɫɬɪɨ
-ɩɚɬɢɟɣ ɧɟ ɜɵɹɜɢɥɢ ɨɬɪɢɰɚɬɟɥɶɧɨɣ ɞɢɧɚɦɢɤɢ ɦɨɪɮɨɥɨɝɢɱɟɫɤɨɣ ɫɬɪɭɤɬɭɪɵ ɫɥɢɡɢɫɬɨɣ ɜɟɪɯɧɢɯ ɨɬɞɟɥɨɜ ɀɄɌ.
Ɂɚ ɩɟɪɢɨɞ ɢɫɫɥɟɞɨɜɚɧɢɹ ɩɨɛɨɱɧɵɯ ɹɜɥɟ -ɧɢɣ/ɪɟɚɤɰɢɣ ɢ ɩɪɟɠɞɟɜɪɟɦɟɧɧɨɝɨ ɜɵɯɨɞɚ ɩɚɰɢ -ɟɧɬɨɜ ɢɡ ɢɫɫɥɟɞɨɜɚɧɢɹ ɡɚɪɟɝɢɫɬɪɢɪɨɜɚɧɨ ɧɟ ɛɵɥɨ.
ȼɕȼɈȾɕ
1. Ɋɟɡɭɥɶɬɚɬɵ ɤɥɢɧɢɱɟɫɤɨɝɨ ɢɫɫɥɟɞɨɜɚɧɢɹ ɩɨɡɜɨɥɹɸɬ ɪɟɤɨɦɟɧɞɨɜɚɬɶ ɝɟɧɟɪɢɤ ȺɋɄ – ɩɪɟ -ɩɚɪɚɬ Ʌɨɫɩɢɪɢɧɬɦ ɤɚɤ ɷɮɮɟɤɬɢɜɧɨɟ ɚɧɬɢɚɝɪɟ-ɝɚɧɬɧɨɟ ɢ ɛɟɡɨɩɚɫɧɨɟ ɫɪɟɞɫɬɜɨ ɜ ɤɨɦɩɥɟɤɫɧɨɦ ɥɟɱɟɧɢɢ ɩɚɰɢɟɧɬɨɜ ɫ ɂȻɋ.
2. Ȼɥɚɝɨɞɚɪɹ ɤɢɫɥɨɬɨɭɫɬɨɣɱɢɜɨɣ ɤɢɲɟɱɧɨ -ɪɚɫɬɜɨɪɢɦɨɣ ɨɛɨɥɨɱɤɟ ɚɤɬɢɜɧɚɹ ɫɭɛɫɬɚɧɰɢɹ Ʌɨɫ -ɩɢɪɢɧɬɦ ɜɵɫɜɨɛɨɠɞɚɟɬɫɹ ɧɟ ɜ ɠɟɥɭɞɤɟ, ɚ ɜ ɳɟɥɨɱɧɨɣ ɫɪɟɞɟ ɬɨɧɤɨɝɨ ɤɢɲɟɱɧɢɤɚ,ɱɬɨ ɫɧɢɠɚɟɬ ɱɚɫɬɨɬɭ ɩɨɛɨɱɧɵɯ ɷɮɮɟɤɬɨɜ ɫɨ ɫɬɨɪɨɧɵ ɫɥɢ -ɡɢɫɬɨɣ ɨɛɨɥɨɱɤɢ ɠɟɥɭɞɤɚ.
Ⱥɥɹɛɶɟɜɚ ȼɆ Ɍɪɟɛɨɜɚɧɢɹ ɤ ɩɪɨɬɨɤɨɥɭ ɤɥɢ ɧɢɱɟɫɤɨɝɨ ɢɫɩɵɬɚɧɢɹ / ȼ.Ɇ. Ⱥɥɹɛɶɟɜɚ // Ɇɚɬɟɪɢɚɥɵ ɧɚɭɱ.-ɩɪɚɤɬ. ɫɟɦɢɧɚɪɚ «Ʉɥɢɧɢɱɟɫɤɢɟ ɢɫɩɵɬɚɧɢɹ ɥɟ -ɤɚɪɫɬɜɟɧɧɵɯ ɫɪɟɞɫɬɜ ɢ ɮɚɪɦɚɤɨɧɚɞɡɨɪ ɜ ɍɤɪɚɢɧɟ». – Ʉ.:Ⱥɜɢɰɟɧɧɚ, 2001. – ɋ. 17 – 29.
2. Ȼɚɪɤɚɝɚɧ Ɂ.ɋ. Ⱦɢɚɝɧɨɫɬɢɤɚ ɢ ɤɨɧɬɪɨɥɢɪɭɟɦɚɹ ɬɟɪɚɩɢɹ ɧɚɪɭɲɟɧɢɣ ɝɟɦɨɫɬɚɡɚ / Ɂ.ɋ.Ȼɚɪɤɚɝɚɧ,Ⱥ.ɉ.Ɇɨ -ɦɨɬ. – Ɇ.:ɇɶɸɞɢɚɦɟɞ, 2001. – 285 ɫ.
3. Ȼɪɚɬɭɫɶ ȼ.ȼ. Ⱥɬɟɪɨɫɤɥɟɪɨɡ, ɢɲɟɦɢɱɟɫɤɚɹ ɛɨ -ɥɟɡɧɶ ɫɟɪɞɰɚ,ɨɫɬɪɵɣ ɤɨɪɨɧɚɪɧɵɣ ɫɢɧɞɪɨɦ:ɩɚɬɨɝɟɧɟɡ, ɞɢɚɝɧɨɫɬɢɤɚ,ɤɥɢɧɢɤɚ,ɥɟɱɟɧɢɟ / ȼ.ȼ.Ȼɪɚɬɭɫɶ,ȼ.Ⱥ.ɒɭ -ɦɚɤɨɜ,Ɍ.ȼ.Ɍɚɥɚɟɜɚ. – Ʉ.:ɑɟɬɜɟɪɬɚ ɯɜɢɥɹ, 2004.–576 ɫ.
4. ȼɨɪɨɧɤɨɜ Ʌ.Ƚ. Ⱥɫɩɢɪɢɧ: ɜɵɫɨɤɢɟ ɫɬɚɧɞɚɪɬɵ ɚɧɬɢɬɪɨɦɛɨɰɢɬɚɪɧɨɣ ɬɟɪɚɩɢɢ / Ʌ.Ƚ. ȼɨɪɨɧɤɨɜ, ȿ.Ⱥ. Ʉɨɜɚɥɶ //Ɂɞɨɪɨɜ’ɹ ɍɤɪɚʀɧɢ. – 2007. – ʋ 7. – ɋ.48-49.
5. ȼɨɪɨɧɤɨɜ Ʌ.Ƚ.Ɍɪɨɦɛɨɷɦɛɨɥɢɱɟɫɤɢɟ ɨɫɥɨɠɧɟ -ɧɢɹ ɭ ɛɨɥɶɧɵɯ ɫ ɫɟɪɞɟɱɧɨɣ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɶɸ / Ʌ.Ƚ.ȼɨ -ɪɨɧɤɨɜ, ɇ.Ⱥ. Ɍɤɚɱ // ɍɤɪ. ɤɚɪɞɿɨɥ.ɠɭɪɧɚɥ. – 2002. – ʋ 5. – ɋ. 107-112.
6. Ƚɪɢɛɚɭɫɤɚɫ ɉ.ɋ. Ⱥɧɬɢɤɨɚɝɭɥɹɧɬɵ ɧɟɩɪɹɦɨɝɨ ɞɟɣɫɬɜɢɹ / ɉ.ɋ.Ƚɪɢɛɚɭɫɤɚɫ // ɍɤɪ.ɤɚɪɞɿɨɥ.ɠɭɪɧɚɥ. – 2002. – Ⱦɨɞɚɬɨɤ 2. – ɋ. 15-31.
7. ȿɮɪɟɦɨɜɚ Ɉ.Ⱥ.ɋɜɹɡɶ ɦɟɠɞɭ ɩɨɤɚɡɚɬɟɥɹɦɢ ɤɨ -ɚɝɭɥɨɝɪɚɦɦɵ ɢ ɷɧɞɨɬɟɥɢɚɥɶɧɨɣ ɞɢɫɮɭɧɤɰɢɢ ɩɪɢ ɨɫ -ɬɪɨɦ ɤɨɪɨɧɚɪɧɨɦ ɫɢɧɞɪɨɦɟ / Ɉ.Ⱥ.ȿɮɪɟɦɨɜɚ,ɂ.ɇ.Ƚɭɧɶ -ɤɨ // ɍɤɪ.ɬɟɪɚɩɟɜɬ.ɠɭɪɧɚɥ. – 2005. – ʋ 8. – ɋ. 65-67.
8. Ʌɚɛɨɪɚɬɨɪɧɵɟ ɦɟɬɨɞɵ ɢɫɫɥɟɞɨɜɚɧɢɹ ɫɢɫɬɟɦɵ ɝɟɦɨɫɬɚɡɚ / ȼ.ɉ.Ȼɚɥɭɞɚ,Ɂ.ɋ.Ȼɚɪɤɚɝɚɧ,ȿ.Ⱦ.Ƚɨɥɶɞɛɟɪɝ [ɢ ɞɪ.]. – Ɍɨɦɫɤ, 1980. – 308 ɫ.
ɉɟɪɟɝɭɞɨɜ Ɏɂ Ɉɫɧɨɜɵ ɫɢɫɬɟɦɧɨɝɨ ɚɧɚɥɢɡɚ ɭɱɟɛ. – 2-ɟ ɢɡɞ.,ɞɨɩ. / Ɏ.ɂ.ɉɟɪɟɝɭɞɨɜ,Ɏ.ɉ.Ɍɚɪɚɫɟɧ -ɤɨ. – Ɍɨɦɫɤ:ɂɡɞ-ɜɨ ɇɌɅ, 1997. - 396ɫ.
10. ɉɨɫɨɛɢɟ ɩɨ ɢɡɭɱɟɧɢɸ ɚɞɝɟɡɢɜɧɨ-ɚɝɪɟɝɚɰɢɨɧ -ɧɨɣ ɚɤɬɢɜɧɨɫɬɢ ɬɪɨɦɛɨɰɢɬɨɜ / Ⱥ.Ʌ.Ȼɟɪɤɨɜɫɤɢɣ,ɋ.Ⱥ.ȼɚ -ɫɢɥɶɟɜ,Ʌ.ȼ.ɀɟɪɞɟɜɚ [ɢ ɞɪ.]. – Ɇ., 2001. – 29 ɫ.
11. ɉɪɨɛɥɟɦɵ ɢ ɩɟɪɫɩɟɤɬɢɜɵ ɢɫɩɨɥɶɡɨɜɚɧɢɹ ɦɟ -ɬɨɞɨɜ ɬɪɨɦɛɨɰɢɬɚɪɧɨɣ ɚɝɪɟɝɚɬɨɦɟɬɪɢɢ ɜ ɤɥɢɧɢɱɟɫɤɨɣ ɩɪɚɤɬɢɤɟ: ɦɚɬɟɪɢɚɥɵ ɧɚɭɱ.-ɩɪɚɤɬ. ɤɨɧɮ. – Ɇɢɧɫɤ, 2000. – 47 ɫ.
12. ɋɬɟɮɚɧɨɜ Ⱥ.ȼ. Ɋɭɤɨɜɨɞɫɬɜɨ ɩɨ ɤɥɢɧɢɱɟɫɤɢɦ ɢɫɩɵɬɚɧɢɹɦ ɥɟɤɚɪɫɬɜɟɧɧɵɯ ɫɪɟɞɫɬɜ / Ⱥ.ȼ.ɋɬɟɮɚɧɨɜ, ȼ.ɂ.Ɇɚɥɶɰɟɜ,Ɍ.Ʉ.ȿɮɢɦɰɟɜɚ. – Ʉ.:Ⱥɜɢɰɟɧɧɚ, 2001. – 426 ɫ.
13. Ɍɟɪɟɳɟɧɤɨ Ⱥ.Ⱥɫɩɢɪɢɧ:ɧɨɜɨɫɬɢ ɤɨɧɝɪɟɫɫɚ ȿɜ -ɪɨɩɟɣɫɤɨɝɨ ɨɛɳɟɫɬɜɚ ɤɚɪɞɢɨɥɨɝɨɜ (ESC-2012) 25-29 ɚɜɝɭɫɬɚ, ɝ.Ɇɸɧɯɟɧ, Ƚɟɪɦɚɧɢɹ // Ɂɞɨɪɨɜ’ɹ ɍɤɪɚʀɧɢ. – 2012. – ʋ 6(26). – ɋ.6.
14. Antithrombotic Trialists' Collaboration. Collabo-rative meta_analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients // BMJ. – 2002. – Vol. 324. – P. 71-86.
15. CAPRIE steering committee. A randomised, blin-ded trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE) // Lancet. – 1996. – Vol. 348. – P. 1329–39.
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