Å˙Î„‡ ÒÍ‡ çÂ‚ ÓÎÓ„Ëﬂ Bulgarian Neurology · 2013-05-13 · ˆ‡ / ÓÚ-‰Ó/. è ËÏÂ : Binnie, C. , Jeavsons , .M. Photosensitive epilep-sies. In : Epileptic

Å˙Î„‡ÒÍ‡ çÂ‚ÓÎÓ„ËflBulgarian Neurology

àÁ‰‡ÌËÂ Ì‡ Å˙Î„‡ÒÍÓÚÓ ‰ÛÊÂÒÚ‚Ó ÔÓ ÌÂ‚ÓÎÓ„ËflOfficial Journal of The Bulgarian Society of Neurology

êÖÑÄäñàéççÄ äéãÖÉàü EDITORS

ÄÎÂÍÒËÂ‚ Ä. ëÓÙËfl Alexiev A. Sofia

Å‡ÈÍÛ¯Â‚ ë. èÎÓ‚‰Ë‚ Baykushev S. Plovdiv

ÅÂÎÓÔËÚÓ‚‡ ã. ëÓÙËfl Belopitova L. Sofia

ÅÓÊËÌÓ‚ ëÚ. èÎÂ‚ÂÌ Bojinov St. Pleven

Ç‡ÒËÎÂ‚‡ í. èÎÓ‚‰Ë‚ Vassileva T. Plovdiv

ÇÂÎÂ‚‡ ëÚ. ëÓÙËfl Veleva St. Sofia

É‡ÌÂ‚‡ É. ëÓÙËfl Ganeva G. Sofia

ÉÂÓ„ËÂ‚ Ñ. ëÓÙËfl Georgiev D. Sofia

ÉÂ‡ÒËÏÓ‚ Å. ëÓÙËfl Gerassimov B Sofia

ÉË„ÓÓ‚‡ é. ëÓÙËfl Grigorova O. Sofia

ÑÂÎÂ‚‡ ç. Ç‡Ì‡ Deleva N. Varna

ÑÂÌÒÍË Ç Ç‡Ì‡ Drensky V. Varna

á‡ı‡ËÂ‚ á. èÎÓ‚‰Ë‚ Zahariev Z. Plovdiv

à‚‡ÌÓ‚‡ ã. ëÓÙËfl Ivanova L. Sofia

à¯ÔÂÍÓ‚‡ Å. ëÓÙËfl Ishpekova B. Sofia

âÓÚÓ‚‡ ê. ëÓÙËfl Iotova R. Sofia

äÓÎÂ‚ é. ëÓÙËfl Kolev O. Sofia

ä˛˜ÛÍÓ‚ å. ëÓÙËfl Kyuchukov M. Sofia

å‡Ì˜Â‚ à. ëÚ.á‡„Ó‡ Manchev I. St. Zagora

åËÎ‡ÌÓ‚ à. ëÓÙËfl Milanov I. Sofia

åËÌ˜Â‚ Ñ. Ç‡Ì‡ Minchev D. Varna

çËÍÓÂ‚ÒÍË ç. ëÓÙËfl Nikoevsky N. Sofia

èÂÚÓ‚ à. ëÓÙËfl Petrov I. Sofia

èÓÔÓ‚‡ å. èÎÂ‚ÂÌ Popova M. PlÂven

ê‡¯Â‚‡ å. ëÓÙËfl Rasheva M. Sofia

ï‡‚ÂÁÓ‚‡ ã. Ç‡Ì‡ Havezova L. Varna

ï‡‰ÊËÂ‚ Ñ. ëÓÙËfl Hadjiev D. Sofia

ï‡‰ÊËÔÂÚÓ‚‡ Ö. èÎÓ‚‰Ë‚ Hadjipetrova E. Plovdiv

ñ‡ÌÍÓ‚‡ ñ. ëÓÙËfl Tzankova Tz. Sofia

ñ‚ÂÚ‡ÌÓ‚‡ Ö. ëÓÙËfl Tzvetanova E. Sofia

ó‡‚‰‡Ó‚ Ñ. ëÓÙËfl Chavdarov D. Sofia

ó‡ÎÏ‡ÌÓ‚ Ç. ëÓÙËfl Chalmanov D. Sofia

ó‡Î˙ÍÓ‚‡ ç. èÎÓ‚‰Ë‚ Chalakova N. Plovdiv

òÓÚÂÍÓ‚ è. ëÓÙËfl Shotekov P. Sofia

üÌ˜Â‚‡ ë. ëÓÙËfl Yancheva S. Sofia

ÉãÄÇçà êÖÑÄäíéêà EDITORS IN CHIEF

Ñ.ó‡Í˙Ó‚, è. ëÚ‡ÏÂÌÓ‚‡, à. ÇÂÎ˜Â‚‡ D. Chakarov, P. Stamenova, I. Velcheva

ëÖäêÖíÄê SECRETARY

å. Ñ‡ÒÍ‡ÎÓ‚ M. Daskalov

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ÌËˆËÚÂ Ì‡ ÍËËÎËˆ‡, ‡ ÒÎÂ‰ Úflı Ì‡ Î‡ÚËÌËˆ‡. á‡„Î‡‚ËflÚ‡ ‰‡ ÒÂ ÔÂ‰-

ÒÚ‡‚flÚ ËÁˆflÎÓ. Ç ÚÂÍÒÚ‡ ˆËÚË‡ÌËÚÂ ‡‚ÚÓË ‰‡ ÒÂ ÔÂ‰ÒÚ‡‚flÚ Ò

ÔÓÂ‰ÂÌ ÌÓÏÂ ÓÚ ÍÌË„ÓÔËÒ‡. Ñ‡ÌÌËÚÂ ‚ ÍÌË„ÓÔËÒ‡ ÒÂ ÔÂ‰ÒÚ‡‚flÚ

ÔÓ ÒÎÂ‰ÌËfl Ì‡˜ËÌ:

ëÚ‡ÚËfl ÓÚ ÒÔËÒ‡ÌËÂ : Ä‚ÚÓ /Ë/. á‡„Î‡‚ËÂ Ì‡ ÒÚ‡ÚËflÚ‡. á‡„-

Î‡‚ËÂ Ì‡ ÒÔËÒ‡ÌËÂÚÓ / Ò˙Í‡ÚÂÌÓ ÔÓ Index medicus/, ÚÓÏ, „Ó‰ËÌ‡ Ì‡

ËÁ‰‡‚‡ÌÂ, ÌÓÏÂ Ì‡ ÍÌËÊÍ‡Ú‡, ÒÚ‡ÌËˆ‡ / ÓÚ-‰Ó/. èËÏÂ :

Andersen, G., Vestergaard, K., Lauritzen, L. Effective treatment of post-

stroke depression with the selective serotonin reuptake inhibitor citalo-

pram. Stroke, 25, 1994, 6, 1099-1104.

äÌË„‡ : Ä‚ÚÓ /Ë/ . á‡„Î‡‚ËÂ. èÓ‰Á‡„Î‡‚ÌË ‰‡ÌÌË. åÂÒÚÓËÁ‰‡-

‚‡ÌÂ, ËÁ‰‡ÚÂÒÚ‚Ó, „Ó‰ËÌ‡ Ì‡ ËÁ‰‡‚‡ÌÂ, ÒÚ‡ÌËˆ‡ /ÓÚ-‰Ó/.èËÏÂ :

Calligaro,K., DeLaurentis, D., Baker, W. Management of Extracranial

Cerebrovascular Disease.Philadelphia-New York, Lippincott - Raven

Publishers, 1997, 217.

èÛ·ÎËÍ‡ˆËË ÓÚ Ò·ÓÌËÍ : Ä‚ÚÓ /Ë/. á‡„Î‡‚ËÂ: - Ç: á‡„Î‡‚ËÂ Ì‡

Ò·ÓÌËÍ‡. àÁ‰‡ÚÂÎ /Ë/. åÂÒÚÓËÁ‰‡‚‡ÌÂ, „Ó‰ËÌ‡ Ì‡ ËÁ‰‡‚‡ÌÂ, ÒÚ‡ÌË-

ˆ‡ / ÓÚ-‰Ó/. èËÏÂ : Binnie, C. , Jeavsons , .M. Photosensitive epilep-

sies. In : Epileptic syndromes in infancy, childhood and adolescence , eds.

J.Roger, M. Bureau, Ch.Dravet, F.E. Dreifuss, A.Perret , P.Wolf. London,

John Libbey & Company, Ltd, 1992, 299-305.

Ä‚ÚÓËÚÂ ÔÓ‰ÔËÒ‚‡Ú ‰ÂÍÎ‡‡ˆËfl, ˜Â ÔÂ‰ÓÒÚ‡‚ÂÌËfl Ï‡ÚÂË-

‡Î ÌÂ Â ÔÂ‰ÎÓÊÂÌ Á‡ ÔÂ˜‡Ú Ì‡ ‰Û„Ó ÏflÒÚÓ.

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·˙‰Â ÔÓ‰ÔËÒ‡Ì‡ ÓÚ ‚ÒË˜ÍË ‡‚ÚÓË.

ê˙ÍÓÔËÒËÚÂ ‚ ‰‚‡ ÂÍÁÂÏÔÎfl‡ (ËÎË Â‰ËÌ ÂÍÁÂÏÔÎfl Ë ‰ËÒÍÂÚ‡)

ËÁÔ‡˘‡ÈÚÂ Ì‡ ‡‰ÂÒ :

ëÓÙËfl 1504, ìÎ. 4 ÅflÎÓ ÏÓÂ " ‹ 8åÅÄã " ñ‡Ëˆ‡ âÓ‡ÌÌ‡" - ÖÄÑ äÎËÌËÍ‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl èÓÙ. è.ëÚ‡ÏÂÌÓ‚‡

INSTRUCTION FOR AUTHORS

Bulgarian Neurology is the official journal of the Bulgarian Society

of Neurology. It will consider for publication papers in neurology and

related areas in the following categories:

-Editorials, consisting of up to 3 pages, when approved by the

Editorial Board

-Original papers - up to 8 pages, including tables, figures and ref-

erences. An abstract in Bulgarian and English up to 40 rows on a sepa-

rate sheet is required. The abstract should contain title, authors, objec-

tive, background, methods, results and conclusions plus up to 6 keywords.

The original papers include short introduction, material, methods

results, discussion and references.

The title page should carry the full title, the short running title, the

authors with their initials, academic degrees, institutional affiliations,

address for correspondence, with telephone, fax and e-mail

-Short communications and case reports up to 3 pages

-Review articles up to 10 pages

-Book reviews and information. It includes information for new

books, congresses and conferences, new drugs, future events in neurolo-

gy

-Letters to the Editor with comments on previously published

papers, short case reports and discussion on current problems

-The manuscripts should be submitted on diskette / 3.5 inch/ using

Word 6/Windows 96 or Word7/Windows 98 with a printed copy.

The tables should be presented on separate sheets with a short

heading

The illustrations /figures, diagrams, formulas/ should be ready for

reproduction.

Explanatory legends should be provided on a separate sheet of paper

.

References should be presented in alphabetic order on a separate

sheet with all authors` names and full title of papers . In the text the

authors should be indicated by the number from the reference list .

The reference should be presented as follows:

Journal paper : (1) author(s), (2)title, (3) journal name ( as abbre-

viated in Index Medicus ). (4) volume, (5) year of publication, (6) jour-

nal number , (7) inclusive pages. Example: Andersen, G., Vestergaard, K.,

Lauritzen, L. Effective treatment of poststroke depression with the selec-

tive serotonin reuptake inhibitor citalopram. Stroke, 25, 1994, 6, 1099-

1104.

Book : (1) author(s), (2) title, (3) city of publication, (4) publisher,

(5) year of publication , (6) pages. Example : Calligaro,K., DeLaurentis,

D., Baker, W. Management of Extracranial Cerebrovascular

Disease.Philadelphia-New York, Lippincott - Raven Publishers, 1997,

217.

References to books : (1) authors(s), (2) chapter title, (3) title of

book, (4) editor(s), (5) city of publication, (6) publisher, (7) year of pub-

lication, (8) specific pages. Example : Binnie, C. , Jeavsons , .M.

Photosensitive epilepsies. In : Epileptic syndromes in infancy, childhood

and adolescence , eds. J.Roger, M. Bureau, Ch.Dravet, F.E. Dreifuss,

A.Perret , P.Wolf. London, John Libbey & Company, Ltd, 1992, 299-305.

The articles are considered for publication on the understanding

that the presented material has not been published or is being submitted

elsewhere before appearing in BULGARIAN NEUROLOGY.

Authors should indicate that ethical approval of the study was

granted and that informed consent was given.

All authors should approve and sign the final manuscript.

Manuscript with one copy (or a diskette and a copy) should be sent

to the following address:

Sofia 1504, Bulgaria, 8, Bialo more str.Department of Neurology University Hospital ◊ Queene Jovanna“: Prof. P. Stamenova

Å˙Î„‡ÒÍ‡ çÂ‚ÓÎÓ„Ëfl Bulgarian Neurology

Å˙Î„‡ÒÍ‡ çÂ‚ÓÎÓ„Ëfl Bulgarian Neurology

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ìÎÚ‡ÒÓÌÓ„‡ÙÒÍË ÓÒÓ·ÂÌÓÒÚË ÔË ËÁÒÎÂ‰‚‡ÌÂÚÓ Ì‡ ‚ÂÚÂ·Ó-·‡ÁËÎ‡Ì‡Ú‡ ÒËÒÚÂÏ‡à.ëÚ‡ÈÍÓ‚ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278

åÓÌËÚÓËÌ„ Ì‡ ‡ÌÌË Ë Í˙ÒÌË ÌÂ‚ÓÎÓ„Ë˜ÌËÛÒÎÓÊÌÂÌËfl ÔË Ô‡ˆËÂÌÚËÚÂ ‚ Í‡‰ËÓıËÛ„ËflÚ‡è. ÄÚ‡Ì‡ÒÓ‚‡ . . . . . . . . . . . . . . . . . . . . . . . . . . . 282

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ïÓÏÓˆËÒÚÂËÌ ÔË ·ÓÎÌË Ò ËÒıÂÏË˜ÂÌ ÏÓÁ˙˜ÂÌ ËÌÒÛÎÚÖ. Ç‡ÒËÎÂ‚‡, å. Ñ‡ÒÍ‡ÎÓ‚, ç. íÓÚÂ‚‡ . . . . . . . . . .287

àÌ‰ËÂÍÚÌË ÛÎÚ‡ÒÓÌÓ„‡ÙÒÍË ÍËÚÂËË Á‡ÓÔÂ‰ÂÎflÌÂ Ì‡ Í‡ÓÚË‰ÌË ÒÚÂÌÓÁËà. ëÚ‡ÈÍÓ‚ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .289

àÌÚËÏ‡-ÏÂ‰Ë‡ ÍÓÏÔÎÂÍÒ Ë Í‡ÓÚË‰Ì‡ ‡ÚÂÓÒÍÎÂÓÁ‡Ö. Ç‡ÒËÎÂ‚‡ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .294

ÇÎËflÌËÂ Ì‡ ‚˙Á‡ÒÚÚ‡ Ë ‰Û„Ë ËÒÍÓ‚Ë Ù‡ÍÚÓË Á‡ ÏÓÁ˙˜ÌÓÒ˙‰Ó‚Ë Á‡·ÓÎfl‚‡ÌËfl ‚˙ıÛ„ÓÎÂÏËÌ‡Ú‡ Ì‡ ËÌÚËÏ‡-ÏÂ‰Ëfl ÍÓÏÔÎÂÍÒÖ. Ç‡ÒËÎÂ‚‡ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .297

ë˙‰Ó‚Ë ÔÓÏÂÌË ÒÎÂ‰ Î˙˜ÂÚÂ‡ÔËfl ÔË ·ÓÎÌË Ò ÏÓÁ˙˜ÌÓÒ˙‰Ó‚‡ ·ÓÎÂÒÚû. èÂÚÓ‚‡, à. ëÚ‡ÈÍÓ‚, à. í˙ÌÂ‚ . . . . . . . . . .301

çÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌË ÔÓÛ˜‚‡ÌËfl ÔË Ò˙‰Ó‚ËÍÓ„ÌËÚË‚ÌË Ì‡Û¯ÂÌËflã. í‡ÈÍÓ‚, ë. ÅÓ‰ËÍ, î. ÅÓÎÂ, Ä. ëÏ‡„ . . . . . . .303

äÓÏ·ËÌË‡ÌÓ ËÁÒÎÂ‰‚‡ÌÂ Ì‡ ‰ÂÏ‡ÚÓÏÌË Ë ÚË·Ë‡ÎÌË ÒÓÏ‡ÚÓÒÂÌÁÓÌË Â‚ÓÍË‡ÌË ÔÓÚÂÌˆË‡ÎË ‚ ÓˆÂÌÍ‡Ú‡ Ì‡ ÎÛÏ·ÓÒ‡Í‡ÎÌ‡Ú‡ÒÔËÌ‡ÎÌ‡ ÒÚÂÌÓÁ‡.ä. äÓÒÚÓ‚, à. èÂÚÓ‚, à. à‚‡ÌÓ‚‡ . . . . . . . . . . .307

è˙‚ËÚÂ ·˙Î„‡ÒÍË ‰Âˆ‡ Ò GEFS+ ÒËÌ‰ÓÏ Ë ÒËÌ‰ÓÏ Ì‡ Dravet Ò ÏÛÚ‡ˆËË ‚ „ÂÌ SCN1A (SCN1A ÏÛÚ‡ˆËË ÔË GEFS+ Ë ÒËÌ‰ÓÏ Ì‡ Dravet)à. à‚‡ÌÓ‚, à. ãËÚ‚ËÌÂÌÍÓ, Ñ. ïËÒÚÓ‚‡, ã. äÎ‡ÂÒ, ä. äÎÂÈÒ, Ä. ëÛÎÒ, ã. ÑÂÔÂ, Ñ. ÄÛ‰ÂÌ‡ÂÚ, è. ÑÂ ûÌ„, Ä. âÓ‰‡ÌÓ‚‡ . . . . . . . . . . . . . . . . . . .311

éèàëÄçàÖ çÄ äãàçàóçà ëãìóÄà

ÄÚËÔË˜ÌË ‚‡Ë‡ÌÚË Ì‡ ÒËÌ‰ÓÏ‡ Ì‡ ÉËÎÂÌ-Å‡ÂÑ. ÄÚ‡Ì‡ÒÓ‚‡, å. Ñ‡ÒÍ‡ÎÓ‚ . . . . . . . . . . . . . . . . .316

ëÎÛ˜‡È Ì‡ ÓÔÚË˜Ì‡ ÂÚÓıË‡ÁÏ‡ÎÌ‡ ÎÂÁËfl Ò ‰ÂÏËÂÎËÌËÁË‡˘‡ ÂÚËÓÎÓ„ËflÄ. éÒÍ‡, ë. óÂÌËÌÍÓ‚‡, è. òÓÚÂÍÓ‚, ê. ä‡ÎÔ‡˜ÍË, Ä. ÅÓ˜Â‚‡, Å. åËÎÂ‚ . . . . . . . . . . . . .319

ÖÍÒÚ‡Í‡ÌË‡ÎÌ‡ ÔÓÒÚÓflÌÌÓ‚˙ÎÌÓ‚‡ ‰ÓÔÎÂÓ‚‡ÒÓÌÓ„‡ÙËfl ‚ ‰Ë‡„ÌÓÒÚËÍ‡Ú‡ Ì‡ ÓÒÚ‡ ‡ÓÚÌ‡‰ËÒÂÍ‡ˆËfl Ò˙Ò Á‡Òfl„‡ÌÂ Ò˙‰Ó‚ÂÚÂ ËÁıÓ‰fl˘Ë ÓÚ ÌÂflÖ. Ç‡ÒËÎÂ‚‡ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .323

ÄÚÂË‡ÎÌË Ë ‚ÂÌÓÁÌË ÚÓÏ·ÓÚË˜ÌË ËÌˆË‰ÂÌÚË ÔËıÓÏÓÁË„ÓÚ Á‡ Ù‡ÍÚÓ V Leidenñ. ñ‡ÌÍÓ‚‡, à. ëÚ‡ÈÍÓ‚, å. ê‡¯Â‚‡, Ö. Ç‡‚ÂÍ, Ä. ñÓÌ˜Â‚‡ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327

CONTENTS

REVIEWS

New horizons before statin treatment in neurologyM. Klissurski . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .275

Ultrasound peculiarities in the examination of the verte-bro-basilar systemI. Staikov . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .278

Monitoring of early and delayed neurological complica-tions in cardiac surgery patientsP. Atanassova . . . . . . . . . . . . . . . . . . . . . . . . . . . . .282

ORIGINAL PAPERS

Homocysteine in patients with ischemic stroke

E. Vassileva, M. Daskalov, N. Toteva . . . . . . . . . . . .287

Indirect ultrasound criteria for assesment of carotidstenosisI. Staikov . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .289

Intima-media thickness and carotid atherosclerosis

E. Vassileva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .294

The influence of the age and other risk factors for cerebrovascular diseases on the extent of intima-media thicknessE. Vassileva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .297

Vascular complications after radiotherapy in patients with cerebrovascular diseaseJ. Petrova, I. Staikov, I. Turnev . . . . . . . . . . . . . . . .301

Neuropsychological study in vascular cognitive impairmentL. Traykov, N. Raoux, A-S. Rigaud, F. Boller . . . . .303

Combined study on dermatome and tibial somatosensory evoked potentials in the assessmentof lumbosacral spinal stenosisK. Kostov, I. Petrov, I. Ivanova . . . . . . . . . . . . . . .307

The first bulgarian infants with gefs+ or dravet syndrome in which scn1a mutation was discovered

I. Ivanov, I. Litvinenko, D. Hristova, L. Claes, K. Claeys, A. Suls, L. Deprez, D. Audenaert, P.De Jonghe, A. Jordanova . . . . . . . . . . . . . . . . . . .311

CASE REPORT

Atypical variants of Guillain-Barre syndromeD. Atanasova, M. Daskalov . . . . . . . . . . . . . . . . . . .316

A case of optic retrochiasmal lesion with demyelinating etiologyA. Oscar, S.Cherninkova, P. Shotekov, R. Kalpachki, A. Bocheva, B. Milev . . . . . . . . . . . . .319

Extracranial continuous wave doppler sonography in acute aortic dissection

E. Vassileva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .323

Arterial and venous thrombotic incidences in a patienthomozygous for the factor v leidenTz. Tzankova, I. Staikov, M. Rascheva, E. Vavrek, A. Tzoncheva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .327

SUMMARY

NEW HORIZONS BEFORE STATIN TREATMENT IN NEUROLOGY

M. KlissurskiStatins are inhibitors of 3-hydroxy-3-methylglutaryl coen-

zyme A (HMG-CoA) reductase used as lipid lowering agents.They also have essential biological effects on endotheial func-tioning, immune regulation, chronic inflammation, thrombo-genesis, stability of atherosclerotic plaques and neuroprotec-tion. Estimating results from many trials, the greater benefitfor the patients at risk was achieved with atorvastatin, whichhave to be considered the gold standard for the prophylaxis ofcardiovascular disease and stroke.

Numerous experimental and clinical studies suggest thatstatins are especially perspective treatment modality forstroke, multiple sclerosis, Alzheimer disease and many otherneurological disorders.

Key words: statins, Òerebrovascular disorders, Alzheimerdisease, multiple sclerosis, treatment.

êÖáûåÖ

ëÚ‡ÚËÌËÚÂ Ò‡ ËÌıË·ËÚÓË Ì‡ 3-ıË‰ÓÍÒË-3-ÏÂÚËÎ-„ÎÛÚ‡ËÎ ÍÓÂÌÁËÏ Ä Â‰ÛÍÚ‡Á‡Ú‡ (HMG-CoA-R) Ë Ì‡Ï‡-Îfl‚‡Ú ÌË‚‡Ú‡ Ì‡ ıÓÎÂÒÚÂÓÎ‡ Ë ÌÂ„Ó‚ËÚÂ Ù‡ÍˆËË. íÂÔËÚÂÊ‡‚‡Ú Ò˙˘ÂÒÚ‚ÂÌË ·ËÓÎÓ„Ë˜ÌË ÂÙÂÍÚË ‚˙ıÛ ÂÌ-‰ÓÚÂÎÌ‡Ú‡ ÙÛÌÍˆËfl, ÔÓˆÂÒËÚÂ Ì‡ ËÏÛÌÌ‡ Â„ÛÎ‡ˆËfl,ıÓÌË˜ÌÓÚÓ ‚˙ÁÔ‡ÎÂÌËÂ, ÚÓÏ·Ó„ÂÌÂÁ‡Ú‡, ÒÚ‡·ËÎËÚÂÚ‡Ì‡ ‡ÚÂÓÒÍÎÂÓÚË˜ÌËÚÂ ÔÎ‡ÍË Ë ÌÂ‚ÓÔÓÚÂÍˆËflÚ‡. íÂ-ÁË ı‡‡ÍÚÂËÒÚËÍË ÒÂ ÔÓÛ˜‚‡Ú ËÌÚÂÌÁË‚ÌÓ Ë ‰‡‚‡Ú ÓÒ-ÌÓ‚‡ÌËÂ ‰‡ ÔËÂÏÂÏ, ˜Â Â ÒÚ‡ÚËÌËÚÂ ËÏ‡Ú ÓÒÓ·ÂÌÓ ÔÂÒ-ÔÂÍÚË‚ÌÓ ÏflÒÚÓ Á‡ ÍÎËÌË˜ÌÓ ÔËÎÓÊÂÌËÂ ÔË ËÒıÂÏË˜ÂÌÏÓÁ˙˜ÂÌ ËÌÒÛÎÚ (àåà), ÏÌÓÊÂÒÚ‚ÂÌ‡ ÒÍÎÂÓÁ‡ (åë), ·Ó-ÎÂÒÚ Ì‡ ÄÎˆı‡ÈÏÂ (ÅÄ) Ë ÏÌÓ„Ó ‰.

ëÎÂ‰ ÔÂÚ „Ó‰Ë¯ÌÓ ÎÂ˜ÂÌËÂ Â ÔÓÍ‡Á‡ÌÓ ˜Â ÏÓ·Ë‰ÌÓ-ÒÚÚ‡ ÓÚ àåà Â ÒÌËÊÂÌ‡ ‰Ó 41% ÔË ÎÂÍÛ‚‡ÌËÚÂ Ò ator-vastatin, 34% ÔË ÚÂÁË Ò˙Ò simvastatin, Ë ÔË·ÎËÁËÚÂÎÌÓ31% ÔË ÚÂÁË Ò pravastatin. èÂÁ Ô˙‚ËÚÂ 16 ÒÂ‰ÏËˆË Ì‡ÎÂ˜ÂÌËÂ Ò 80 Ï„ simvastatin ·ÓÎÌËÚÂ Ò ÓÒÚ˙ ÍÓÓÌ‡ÂÌÒËÌ‰ÓÏ, ËÒÍ˙Ú ÓÚ ÌÂÎÂÚ‡ÎÂÌ àåà Â ·ËÎ Ì‡Ï‡ÎÂÌ Ò59%, ÓÚÍÓÎÍÓÚÓ ÔË ÔÎ‡ˆÂ·Ó-„ÛÔ‡Ú‡, ‡ ÂÎ‡ÚË‚ÌËflÚËÒÍ Á‡ àåà Â ÒÌËÊÂÌ ‰Ó 50%. é·Ó·˘‡‚‡ÈÍË ÏÌÓ„Ó ÔÓ-Û˜‚‡ÌËfl, Ì‡È-„ÓÎflÏ‡ ÔÓÎÁ‡ Á‡ Ô‡ˆËÂÌÚËÚÂ ËÁÎÓÊÂÌË Ì‡ËÒÍ Á‡ ëëá Ë àåà, ÔÓfl‚fl‚‡ atorvastatin, ÍÓÈÚÓ Úfl·-‚‡ ‰‡ ÒÂ Ò˜ËÚ‡ Á‡ ÁÎ‡ÚÂÌ ÒÚ‡Ì‰‡Ú ‚ ÔÓÙËÎ‡ÍÚËÍ‡Ú‡Ì‡ Ò˙‰Â˜Ì‡ ËÒıÂÏËfl Ë àåà. ÅÓÎÌËÚÂ Ò ËÒÍ Á‡ Ò˙‰Ó‚ËÁ‡·ÓÎfl‚‡ÌËfl Úfl·‚‡ ‰‡ ·˙‰‡Ú ÎÂÍÛ‚‡ÌË Ò˙Ò ÒÚ‡ÚËÌ ÌÂ-Á‡‚ËÒËÏÓ ÓÚ ËÁıÓ‰Ì‡Ú‡ ÍÓÌˆÂÌÚ‡ˆËfl Ì‡ ıÓÎÂÒÚÂÓÎ,ÔÓÎ‡ Ë ‚˙Á‡ÒÚÚ‡.

ÖÊÂ‰ÌÂ‚Ì‡Ú‡ ÛÔÓÚÂ·‡ Ì‡ 80 Ï„ ‡torvastatin ÔË ·ÓÎ-ÌË Ò ÎÂÍ‡ ‰Ó ÛÏÂÂÌÓ ËÁ‡ÁÂÌ‡ ·ÓÎÂÒÚ Ì‡ ÄÎˆı‡ÈÏÂ Ì‡-Ï‡Îfl‚‡ ÍÓ„ÌËÚË‚ÌËfl ÛÔ‡‰˙Í Ë ÔÓ‰Ó·fl‚‡ ‰ÂÔÂÒË‚ÌËÚÂÒËÏÔÚÓÏË, ÒÔÓÂ‰ Â‰ÌÓ„Ó‰Ë¯ÌÓ ÔËÎÓÚÌÓ ÔÓÛ˜‚‡ÌÂ.

äÎ˛˜Ó‚Ë ‰ÛÏË: ÒÚ‡ÚËÌË, ÏÓÁ˙˜ÌÓÒ˙‰Ó‚Ë Á‡·ÓÎfl‚‡ÌËfl,·ÓÎÂÒÚ Ì‡ ÄÎˆı‡ÈÏÂ, ÏÌÓÊÂÒÚ‚ÂÌ‡ ÒÍÎÂÓÁ‡, ÎÂ˜ÂÌËÂ.

ÅÓflÚ Ì‡ ·ÓÎÌËÚÂ Ò ÏÓÁ˙˜ÌÓÒ˙‰Ó‚Ë Á‡·ÓÎfl‚‡ÌËfl(åëá), ‡‚ÚÓËÏÛÌÌË Ë ‰Â„ÂÌÂ‡ÚË‚ÌË Á‡·ÓÎfl‚‡ÌËfl Ì‡ÌÂ‚Ì‡Ú‡ ÒËÒÚÂÏ‡ ‚ Ò‚ÂÚÓ‚ÂÌ Ï‡˘‡· Â Ó„ÓÏÂÌ. ê‡Á‡-·ÓÚ‚‡ÌÂÚÓ Ì‡ ÌÓ‚Ë ÎÂÍ‡ÒÚ‚‡ ËÎË ÓÚÍË‚‡ÌÂÚÓ Ì‡ ÌÓ‚ËÒ‚ÓÈÒÚ‚‡ Ì‡ ÒÚ‡Ì‰‡ÚÌÓ ÔËÎ‡„‡ÌË ÏÂ‰ËÍ‡ÏÂÌÚË ÓÚÍ-Ë‚‡ ¯ËÓÍË ÔeÒÔeÍÚË‚Ë Á‡ ÚÂ‡ÔÂ‚ÚË˜Ì‡ Ì‡ÏÂÒ‡ ‚ Ô‡-ÚÓ„ÂÌÂÁ‡Ú‡ Ì‡ ÏÌÓ„Ó ·ÓÎÂÒÚÌË Ò˙ÒÚÓflÌËfl.

ëÚ‡ÚËÌËÚÂ, ÍÓËÚÓ Ò‡ ËÌıË·ËÚÓË Ì‡ 3-ıË‰ÓÍÒË-3-ÏÂÚËÎ-„ÎÛÚ‡ËÎ ÍÓÂÌÁËÏ Ä Â‰ÛÍÚ‡Á‡Ú‡ (HMG-CoA-R)Ë Ì‡Ï‡Îfl‚‡Ú ÌË‚‡Ú‡ Ì‡ ıÓÎÂÒÚÂÓÎ‡ Ë ÌÂ„Ó‚ËÚÂ ı‡ÍˆËË,ÔËÚÂÊ‡‚‡Ú ‰ÓÔ˙ÎÌËÚÂÎÌË Ò˙˘ÂÒÚ‚ÂÌË Ò‚ÓÈÒÚ‚‡, Ò‚˙-Á‡ÌË Ò ÂÙÂÍÚËÚÂ ËÏ ‚˙ıÛ ÂÌ‰ÓÚÂÎÌ‡Ú‡ ÙÛÌÍˆËfl, ÔÓˆÂ-ÒËÚÂ Ì‡ ËÏÛÌÌ‡ Â„ÛÎ‡ˆËfl, ıÓÌË˜ÌÓÚÓ ‚˙ÁÔ‡ÎÂÌËÂ,ÚÓÏ·Ó„ÂÌÂÁ‡Ú‡, ÒÚ‡·ËÎËÚÂÚ‡ Ì‡ ‡ÚÂÓÒÍÎÂÓÚË˜ÌË-ÚÂ ÔÎ‡ÍË Ë ÌÂ‚ÓÔÓÚÂÍˆËflÚ‡. íÂÁË ı‡‡ÍÚÂËÒÚËÍË ÒÂÔÓÛ˜‚‡Ú ËÌÚÂÌÁË‚ÌÓ Á‡ ÍÎËÌË˜ÌÓ ÔËÎÓÊÂÌËÂ ÔË ËÒıÂ-ÏË˜ÂÌ ÏÓÁ˙˜ÂÌ ËÌÒÛÎÚ (àåà), ÏÌÓÊÂÒÚ‚ÂÌ‡ ÒÍÎÂÓÁ‡(åë), ·ÓÎÂÒÚ Ì‡ ÄÎˆı‡ÈÏÂ (ÅÄ), ·ÓÎÂÒÚ Ì‡ è‡ÍËÌÒÓÌ(Åè), Â‚Ï‡ÚÓË‰ÂÌ ‡ÚËÚ, Á‡ı‡ÂÌ ‰Ë‡·ÂÚ Ë ÏÌÓ„Ó ‰.(1, 2, 3).

èÓ Ì‡‰ÓÎÛ Ò‡ ‡Á„ÎÂ‰‡ÌË „Î‡‚ÌËÚÂ ÏÂı‡ÌËÁÏË Ì‡‰ÂÈÒÚ‚ËÂ Ì‡ ÒÚ‡ÚËÌËÚÂ Ë ÔË˜ËÌËÚÂ Á‡ ·Î‡„ÓÔËflÚÌË-ÚÂ ËÏ ÂÙÂÍÚË ÔË ·ÓÎÌËÚÂ Ò àåà. é·Ó·˘ÂÌÓÚÓ‰ÂÈÒÚ‚ËÂ Ì‡ ÒÚ‡ÚËÌËÚÂ ÔÓ ‰‚‡Ú‡ ÓÒÌÓ‚ÌË Ô˙Úfl - ıÓÎÂÒ-ÚÂÓÎ-Á‡‚ËÒËÏ Ë ıÓÎÂÒÚÂÓÎ-ÌÂÁ‡‚ËÒËÏ Ô˙Ú Â ÔÂ‰ÒÚ‡-

Å˙Î„‡ÒÍ‡ çÂ‚ÓÎÓ„Ëfl Bulgarian Neurology 275ÓÍÚÓÏ‚Ë, 2005

é·ÁÓèÖêëèÖäíàÇà çÄ ëíÄíàçàíÖ Ç çÖÇêéãéÉàüíÄ

å. äÎËÒÛÒÍË

äÎËÌËÍ‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl, åÅÄã “ñ‡Ëˆ‡ âÓ‡ÌÌ‡”-ëÓÙËflä‡ÚÂ‰‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl, åì-ëÓÙËfl

îË„.2 ê‡ÁÔÂ‰ÂÎÂÌËÂ Ì‡ Û˜‡ÒÚÌËˆËÚÂ ‚ ÔÓÛ˜‚‡ÌÂÚÓ ÒÔÓÂ‰ ‚Ë‰‡ Ì‡ÔÎ‡ÍËÚÂ.

‚ÂÌÓ Ì‡ ÙË„Û‡ 1 (‡‰‡ÔÚË‡Ì‡ ÒÔÓÂ‰ 3).1. ëÚ‡ÚËÌËÚÂ ÔÓ‰Ó·fl‚‡Ú ÂÌ‰ÓÚÂÎÌ‡Ú‡ ÙÛÌÍˆËfl.

ïÓÌË˜ÌÓÚÓ ÔËÎÓÊÂÌËÂ Ì‡ ÒÚ‡ÚËÌË Â Ò‚˙Á‡ÌÓ Ò ÔÓ‚Ë-¯ÂÌËÂ Ì‡ ÂÌ‰ÓÚÂÎÌ‡Ú‡ ·ËÓÌ‡ÎË˜ÌÓÒÚ Ì‡ ‡ÁÓÚÂÌ ÓÍÒË‰(NO) (1-4). NO e ÏÓ‰ÛÎ‡ÚÓ Ì‡ ÂÌ‰ÓÚÂÎÌ‡Ú‡ ÙÛÌÍˆËfl,Í‡ÚÓ ÔÓÏÂÌfl Ò˙‰Ó‚Ëfl ÚÓÌÛÒ Ë ÔÓ‰˙Ê‡ ÚÓÏ·ÓÂÁËÒ-ÚÂÌÚÂÌ ËÌÚÂÙÈÒ ÏÂÊ‰Û Í˙‚ÌËfl ÚÓÍ Ë Ò˙‰Ó‚‡Ú‡ ÒÚÂ-Ì‡ (4). Ç ÚÓÏ·ÓˆËÚËÚÂ ÒÂ Û‚ÂÎË˜‡‚‡ ÂÍÒÔÂÒËflÚ‡ Ì‡ III-ÚË ÚËÔ ÒËÌÚ‡Á‡ Ì‡ ‡ÁÓÚÂÌ ÓÍÒË‰ (NOS), Ì‡Ï‡Îfl‚‡ ÒÂÚÓÏ·ÓˆËÚÌ‡Ú‡ ‡ÍÚË‚ÌÓÒÚ (5). Ätorvastatin, rosuvastatinË simvastatin Â‰ÛˆË‡Ú ‡ÁÏÂ‡ Ì‡ ÏÓÁ˙˜ÌËfl ËÌÙ‡ÍÚ/‰Ó ÓÍÓÎÓ Â‰Ì‡ ÚÂÚ‡/ ÔË ÏÓ‰ÂÎ Ì‡ àåà Ë ÂÔÂÙÛÁËflÔË ÌÓÏÓıÓÎÂÒÚÂÓÎÓ‚Ë ÏË¯ÍË (3). ì‚ÂÎË˜ÂÌËflÚ ÎÓÍ‡-ÎÂÌ Í˙‚ÓÚÓÍ ÔÓÚÂÍÚË‡ ÏÓÁ˙˜Ì‡Ú‡ Ú˙Í‡Ì, ÂÍÒÔÂË-ÏÂÌÚ‡ÎÌ‡Ú‡ ËÒıÂÏË˜Ì‡Ú‡ Û‚Â‰‡ ÒÂ Ó„‡ÌË˜‡‚‡ Ë Ò˙ÓÚ-‚ÂÚÌÓ ÔÓ„ÌÓÁ‡Ú‡ ÒÎÂ‰ ËÌˆË‰ÂÌÚ‡ Â ÔÓ-‰Ó·‡ (4, 5). íÂÁËÂÙÂÍÚË ‚˙ıÛ NOS Ë ‡ÁÏÂ‡ Ì‡ ËÌÙ‡ÍÚ‡ ‚˙ÁÌËÍ‚‡Ú ‡-ÌÓ, ÔÓfl‚fl‚‡Ú ÔË ‰ÓÁË ÔÓ-„ÓÎÂÏË ÓÚ ÍÎËÌË˜ÌËÚÂ ·ÂÁ‚˙ÁÍ‡ Ò ÌË‚‡Ú‡ Ì‡ ıÓÎÂÒÚÂÓÎ‡, ÌÓ ÒÂ ËÁ˜ÂÔ‚‡Ú ÔË ÔÂ-ÛÒÚ‡ÌÓ‚fl‚‡ÌÂ ÔËÎ‡„‡ÌÂÚÓ Ì‡ ÒÚ‡ÚËÌË (4).

2. ëÚ‡ÚËÌËÚÂ Â„ÂÒË‡Ú ‡ÚÂÓÒÍÎÂÓÁ‡Ú‡ Í‡ÚÓÒÚ‡·ËÎËÁË‡Ú ‡ÚÂÓÒÍÎÂÓÚË˜ÌËÚÂ ÔÎ‡ÍË ‚ Í‡ÓÚË‰ÌË-ÚÂ, ‡ÓÚÌË Ë ÍÓÓÌ‡ÌË ÁÓÌË Ë Ì‡Ï‡Îfl‚‡Ú ÚÓÏ·Ó„ÂÌÂÁ‡-Ú‡ (6). ëÚ‡ÚËÌËÚÂ Ì‡Ï‡Îfl‚‡Ú ·Ófl Ì‡ Ï‡ÍÓÙ‡„ËÚÂ, Â-‰ÛˆË‡Ú ÂÍÒÔÂÒËflÚ‡ Ì‡ Ú˙Í‡ÌÂÌ Ù‡ÍÚÓ, ‡‰ıÂÁËÓÌÌËÚÂÏÓÎÂÍÛÎË Ë Ï‡ÚËÍÒÌËÚÂ Ï‡Ú‡ÎÓÔÓÚÂËÌ‡ÁË ‚ ÔÎ‡ÍËÚÂ(6, 7). ëÚ‡·ËÎËÁË‡ÌÂÚÓ Ì‡ ‡ÚÂÓÒÍÎÂÓÚË˜ÌËÚÂ ÔÎ‡ÍËË Ì‡Ï‡ÎÂÌËÂÚÓ Ì‡ ÚÂıÌËÚÂ ‡ÁÏÂË, ÓÔÂ‰ÂÎÂÌË ÛÎÚ‡ÒÓ-ÌÓ„‡ÙÒÍË, ÒÂ ÓÒ˙˘ÂÒÚ‚fl‚‡ ˜ÂÁ ÔÓÚËÒÍ‡ÌÂ ‡ÍÚË‚‡ˆËfl-Ú‡ Ì‡ Ï‡ÍÓÙ‡„ËÚÂ Ë Ï‡ÚËÍÒËÌÚÂ ÏÂÚ‡ÎÓÔÓÚÂËÌ‡ÁË,ÍÓËÚÓ ‰ÂÒÚ‡·ËÎËÁË‡Ú ÙË·ÓÁÌËfl ÒÍÂÎÂÚ Ì‡ ÔÎ‡ÍËÚÂ ËÒ˙Á‰‡‚‡Ú ‚˙ÁÏÓÊÌÓÒÚ Á‡ ‡ÁÍ˙Ò‚‡ÌÂ (6). èÓˆÂÒ˙Ú Ì‡‡ÁˆÂÔ‚‡ÌÂÚÓ ËÎË ‡ÁÍ˙Ò‚‡ÌÂÚÓ Ì‡ ÔÎ‡ÍËÚÂ Â Ò‚˙Á‡Ì Ò‡Á‚ËÚËÂ Ì‡ ÚÓÏ·Ó„ÂÌÂÁ‡ Ë ÔÂ‰‡ÁÔÓÎ‡„‡ Í˙Ï ‡ÚÂËÓ-‡ÚÂË‡ÎÌË ÂÏ·ÓÎËÁ˙Ï Ë àåà. ç‡Ï‡ÎÂÌËÂÚÓ Ì‡ ‰Â·ÂÎË-Ì‡Ú‡ Ì‡ Í‡ÓÚË‰Ì‡Ú‡ ËÌÚËÏ‡Ú‡ Â ‰Û„ ÏÂı‡ÌËÁ˙Ï, ÍÓÈ-ÚÓ Ó·flÒÌfl‚‡ ÔÂ‚ÂÌˆËflÚ‡ Ì‡ ÌflÍÓË ÙÓÏË Ì‡ àåà ˜ÂÁÒÚ‡ÚËÌÓ‚Ó ÎÂ˜ÂÌËÂ. èËÎÓÊÂÌËÂÚÓ Ì‡ pravastatin Ì‡Ï‡-Îfl‚‡ ÔÓ„ÂÒËflÚ‡ ‚ ‰Â·ÂÎËÌ‡Ú‡ Ì‡ Í‡ÓÚË‰Ì‡Ú‡ ËÌÚËÏ‡(IMT) ÔË Â‰ÛˆË‡ÌÂ Ì‡ LDL-ıÓÎÂÒÚÂÓÎ‡ Ò 28% (8).

3. ëÚ‡ÚËÌËÚÂ ËÏ‡Ú ‡ÌÚËËÌÙÎ‡Ï‡ÚÓÌÓ‰ÂÈÒÚ‚ËÂ. ïÓÌË˜ÌÓÚÓ Ò˙‰Ó‚Ó ‚˙ÁÔ‡ÎÂÌËÂ ËÏ‡ ‚‡ÊÌ‡ Ó-Îfl ‚ Ô‡ÚÓÙËÁËÓÎÓ„ËflÚ‡ Ì‡ àåà (9). ëÚ‡ÚËÌËÚÂ Ì‡Ï‡-Îfl‚‡Ú Ì‡ÚÛÔ‚‡ÌÂÚÓ Ì‡ ÍÎÂÚÍË, Â‡ÎËÁË‡˘Ë ‚˙ÁÔ‡ÎË-ÚÂÎÌËÚÂ Â‡ÍˆËË, ‚ Ò˙‰Ó‚ËÚÂ ÔÎ‡ÍË, ÍÓÂÚÓ Â Â‰ËÌ ÓÚ ÏÂ-ı‡ÌËÁÏËÚÂ Á‡ ‡Á‚ËÚËÂ Ì‡ ‡ÚÂÓÒÍÎÂÓÚË˜ÌËÚÂ ÎÂÁËË(7). èÓ‚Ë¯ÂÌËÚÂ ÍÓÌˆÂÌÚ‡ˆËË Ì‡ ÌflÍÓË Ï‡ÍÂË Ì‡ ‚˙Á-Ô‡ÎÂÌËÂÚÓ, Í‡ÚÓ CRP (Ï‡ÍÂ Ì‡ ÓÒÚÓÙ‡ÁÓ‚Ó ‚˙ÁÔ‡ÎÂ-ÌËÂ, ÌÂÁ‡‚ËÒËÏ Ù‡ÍÚÓ Á‡ àåà), Ò‡ Ò‚˙Á‡ÌË Ò ËÒÍ ÓÚÒ˙‰Ó‚Ë ËÌˆË‰ÂÌÚË, ÓÒÓ·ÂÌÓ ÔË ïïÖ (10). ãÂ˜ÂÌËÂÚÓ Ò˙ÒÒÚ‡ÚËÌË Ì‡Ï‡Îfl‚‡ ÌË‚‡Ú‡ Ì‡ CRP, ÌÂÁ‡‚ËÒËÏÓ ÓÚ ÂÙÂÍ-ÚËÚÂ ‚˙ıÛ LDL-ıÓÎÂÒÚÂÓÎ‡ (10). Lovastatin ‚ ÔÓÛ˜‚‡-ÌÂÚÓ AFCAPS/TexCAPS ÂÙÂÍÚË‚ÌÓ Â‰ÛˆË‡ ËÒÍ‡ ÓÚÍÓÓÌ‡ÌË ËÌˆË‰ÂÌÚË ÔË ËÁÒÎÂ‰‚‡ÌËÚÂ Ò ÔÓ‚Ë¯ÂÌË ÌË‚‡Ì‡ CRP (10). Engstrom Ë Ò˙‡‚Ú. ‰ÂÏÓÌÒÚË‡Ú, ˜Â ·ÓÎÌË-ÚÂ Ò ïïÖ Ë ÔÓ‚Ë¯ÂÌË ËÌÙÎ‡Ï‡ÚÓÌËÚÂ Ï‡ÍÂË (ÙË·Ë-ÌÓ„ÂÌ Ë ı‡ÔÚÓ„ÎÓ·ËÌ) ËÏ‡Ú Á‡‚Ë¯ÂÌ ËÒÍ Á‡ àåà ‚ ‰˙Î-„ÓÒÓ˜ÂÌ ÔÎ‡Ì Ì‡ Ì‡·Î˛‰ÂÌËÂ, ÌÓ ÔË ÓÚÒ˙ÒÚ‚ËÂ Ì‡ ÚÂÁË‚˙ÁÔ‡ÎËÚÂÎÌË Ï‡ÍÂË, ıËÔÂÎËÔË‰ÂÏËflÚ‡ ÌÂ Â ËÒÍÓ‚Ù‡ÍÚÓ Á‡ àåà (11). èËÎÓÊÂÌËÂÚÓ Ì‡ ÒÚ‡ÚËÌË ÔÓ‰-ÚËÒÍ‡ í-ÍÎÂÚ˙˜Ì‡Ú‡ ‡ÍÚË‚‡ˆËfl Ë ÓÒ‚Ó·ÓÊ‰‡‚‡ÌÂÚÓ Ì‡ÔÓËÌÙÎ‡Ï‡ÚÓÌË ˆËÚÓÍËÌË, ÍÓËÚÓ Ò‡ ‚‡ÊÌË ÏÂ‰Ë‡ÚÓËÌ‡ ËÏÛÌÓÎÓ„Ë˜ÌËÚÂ Â‡ÍˆËË ‚ ÏÓÁ˙Í‡ Ë ÒÂ ÔÓ‰ÛˆË‡Ú ÓÚÌÂ‚ÓÌË, „ÎË‡ÎÌË Ë ÂÌ‰ÓÚÂÎÌË ÍÎÂÚÍË (12).

4. ëÚ‡ÚËÌËÚÂ ÔÓfl‚fl‚‡Ú Ë ‡ÌÚËÔÓÎËÙÂ‡ÚË‚ÌÓ‰ÂÈÒÚ‚ËÂ, Í‡ÚÓ ÒÏÛ˘‡‚‡Ú ÔÓÎËÙÂ‡ˆËflÚ‡, ÍÎÂÚ˙˜ÌËfl‡ÒÚÂÊ Ë ÏË„‡ˆËfl Ì‡ „Î‡‰ÍÓÏÛÒÍÛÎÌËÚÂ ÍÎÂÚÍË ‚ Ò˙‰Ó-

‚ËÚÂ ÒÚÂÌË (13). í‡Í‡ ‡ÁÏÂ˙Ú Ë ÙÓÏË‡ÌÂÚÓ Ì‡ ÌÓ‚ËÒ˙‰Ó‚Ë ÎÂÁËË Ì‡Ï‡Îfl‚‡ (13). íÓÁË ÂÙÂÍÚ Â ÏÂ‰ËË‡Ì ˜ÂÁÚ.Ì‡. 21 Ras ÔÓÚÂËÌ, Â„ÛÎ‡ÚÓ Ì‡ Ñçä ÂÔÎËÍ‡ˆËfl-Ú‡ Ë ÍÎÂÚ˙˜ÂÌ ‡ÒÚÂÊ (14).

5. ëÚ‡ÚËÌËÚÂ ËÏ‡Ú ÔÓÚÂÍÚË‚ÂÌ ÂÙÂÍÚ ÒÔflÏÓÚÓÏ·ÓÂÏ·ÓÎËÁ˙Ï ÓÚ Í‡‰ËÓ„ÂÌÂÌ Ë ‡ÚÂËÓ‡ÚÂË-‡ÎÂÌ ÚËÔ. ç‡Ï‡ÎÂÌËflÚ ËÒÍ ÓÚ àåà ÔË ÛÔÓÚÂ·‡ Ì‡ÒÚ‡ÚËÌ ÒÂ Ó·flÒÌfl‚‡ Ë Ò ÔÓ‰ÚËÒÍ‡ÌÂÚÓ Ì‡ ÚÓÏ·ÓˆËÚË-ÚÂ Ë ÚflıÌ‡Ú‡ ‡„Â„‡ˆËfl, Ë ÂÌ‰Ó„ÂÌÌËfl ·‡Î‡ÌÒ Ì‡ ÔÓˆÂÒË-ÚÂ Ì‡ ÚÓÏ·ÓÁ‡ / ÚÓÏ·ÓÎËÁ‡ (6). ç‡·Î˛‰‡‚‡ ÒÂ Ë Ì‡Ï‡-ÎÂÌËÂ ‚ ‡ÍÚË‚ÌÓÒÚÚ‡ Ì‡ ËÌıË·ËÚÓ‡ Ì‡ ÔÎ‡ÁÏËÌÓ„ÂÌ ‡Í-ÚË‚‡ÚÓ‡, ÍÓÂÚÓ ÛÒËÎ‚‡ ÙË·ËÌÓÎËÁ‡Ú‡ (15). ÇÒË˜ÍË ÚÂ-ÁË Ù‡ÍÚÓË ‰ÓÔËÌ‡ÒflÚ Á‡ Ì‡Ï‡ÎÂÌÓ ÙÓÏË‡ÌÂ Ì‡ ÚÓÏ-·Ë Ë ÍÎËÌË˜ÌË ÔÂÒÔÂÍÚË‚Ë, Ò‚˙Á‡ÌË Ò ÎÂ˜ÂÌËÂÚÓ Ì‡‡ÚÂÓÒÍÎÂÓÁ‡Ú‡ Ë ÌÂÈÌËÚÂ ÛÒÎÓÊÌÂÌËfl.

6. çÂ‚ÓÔÓÚÂÍÚË‚ÂÌ ÂÙÂÍÚ ÔË Ô‡ˆËÂÌÚË Â Ì‡·-Î˛‰‡‚‡Ì ÒÎÂ‰ ÔËÎÓÊÂÌËÂ Ì‡ ÒÚ‡ÚËÌË ÌÂÔÓÒÂ‰ÒÚ‚ÂÌÓÒÎÂ‰ ËÒıÂÏË˜ÌËfl ÏÓÁ˙˜ÂÌ ËÌˆË‰ÂÌÚ, ÍÓÂÚÓ Â Ò‚˙Á‡ÌÓ ÒÔÓ-ÎÂÍ ÌÂ‚ÓÎÓ„Ë˜ÂÌ ‰ÂÙËˆËÚ, ÓÚÍÓÎÍÓÚÓ ÔË ·ÓÎÌËÚÂ·ÂÁ Ú‡ÍÓ‚‡ ÎÂ˜ÂÌËÂ (3,4). Ätorvastatin Ë simvastatin ÔÓ‰Ó·-fl‚‡Ú ÙÛÌÍˆËÓÌ‡ÎÌÓÚÓ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂ, ‡ÍÓ ÒÂ ÔËÎÓ-Ê‡Ú ‰Ó 24 ˜ ÒÎÂ‰ ËÌ‰ÛÍˆËfl Ì‡ ÏÓÁ˙˜Ì‡ ËÒıÂÏËfl ÔË ÔÎ˙-ıÓ‚Â Ë ÔÓÏÓÚË‡Ú ‡Ì„ËÓ„ÂÌÂÁ‡Ú‡ ‚ ËÒıÂÏË˜ÌËÚÂ ÏÓÁ˙˜-ÌË ÁÓÌË (16).

7. ÖÙÂÍÚË Ì‡ ÒÚ‡ÚËÌËÚÂ ‚˙ıÛ ˆÂÚÓÍËÌË, ıÂÏÓÍË-ÌË Ë Ú˙Í‡ÌÌË Ù‡ÍÚÓË. ñËÚÓÍËÌËÚÂ Ë„‡flÚ ‚‡ÊÌ‡ Ó-Îfl ‚ ÔÓˆÂÒ‡ Ì‡ ‚˙ÁÔ‡ÎËÚÂÎÌË Â‡ÍˆËË ‚ ÏÓÁ˙˜Ì‡Ú‡ Ú˙-Í‡Ì ÒÎÂ‰ ËÌÙ‡ÍÚ (7); ÂÍÒÔÂÒËflÚ‡ Ì‡ ËÌÚÂÎÂ‚ÍËÌ IL-1beta ‰ÓÔËÌ‡Òfl Á‡ ÌÂ‚ÓÌ‡ÎÌ‡Ú‡ Û‚Â‰‡ ÔË ÂÍÒÔÂËÏÂÌ-ÚË Ò ÔÎ˙ıÓ‚Â (9). ëÎÂ‰ àåà ÌÂÛÚÓÙËÎËÚÂ ÏË„Ë‡Ú ‚ËÒıÂÏË˜Ì‡Ú‡ ÁÓÌ‡, Í˙‰ÂÚÓ ÓÒ‚Ó·ÓÊ‰‡‚‡Ú ÎËÚË˜ÌË ÂÌÁË-ÏË Ë ÒÛÔÂÓÍÒË‰, ÍÓËÚÓ ‰ÓÔ˙ÎÌËÚÂÎÌÓ Û‚ÂÊ‰‡Ú Ú˙Í‡-ÌËÚÂ (17). èÂ‰ÍÎËÌË˜ÌË ‰‡ÌÌË ‰ÂÏÓÌÒÚË‡Ú, ˜Â ÌÛÍÎÂ-‡ÌËflÚ Ù‡ÍÚÓ NFkB, ÍÓÈÚÓ Â„ÛÎË‡ ÂÍÒÔÂÒËflÚ‡ Ì‡ÔÓËÌÙÎ‡Ï‡ÚÓÌË ˆËÚÓÍËÌË Ë ÍÎÂÚ˙˜ÌË ‡‰ıÂÁËÓÌÌË ÏÓ-ÎÂÍÛÎË, Ò˙˘Ó Â ‡ÍÚË‚Ë‡Ì ÒÎÂ‰ ÏÓÁ˙˜Ì‡ ËÒıÂÏËfl Ë Á‡ÒËÎ-‚‡ ÍÎÂÚ˙˜Ì‡Ú‡ ÒÏ˙Ú (18). àÌÚ‡ˆÂÎÛÎ‡Ì‡Ú‡ ‡‰ıÂÁË-ÓÌÌ‡ ÏÓÎÂÍÛÎ‡ ICAM-1 Ë TNF alpha Ò‡ Ò‚˙Á‡ÌË Ò ‡ÌÌÓÚÓÌÂ‚ÓÎÓ„Ë˜ÌÓ ‚ÎÓ¯‡‚‡ÌÂ Ë ÎÓ¯‡ ÔÓ„ÌÓÁ‡ ÔË ·ÓÎÌË Ò Î‡-ÍÛÌ‡ÂÌ ÏÓÁ˙˜ÂÌ ËÌÙ‡ÍÚ. éÍ‡Á‚‡ ÒÂ, ˜Â ÒÚ‡ÚËÌËÚÂ ÓÒ˙-˘ÂÒÚ‚fl‚‡Ú ÌÂ‚ÓÔÓÚÂÍÚË‚ÌËÚÂ ÒË ÂÙÂÍÚË ˜ÂÁ ‚˙Á-‰ÂÈÒÚ‚ËÂ ‚˙ıÛ ‚ÒË˜ÍË ÚÂÁË Ù‡ÍÚÓË ‚ Ô‡ÚÓ„ÂÌÂÁ‡Ú‡ –Ì‡Ï‡Îfl‚‡Ú ‡ÍÚË‚ÌÓÒÚÚ‡ Ì‡ NFkB in vitro (19).Simvastatin Ë atorvastatin Â‰ÛˆË‡Ú ËÌ‰ÛÍˆËflÚ‡ Ì‡ ÔÓË-ÌÙÎ‡Ï‡ÚÓÌË ˆËÚÓÍËÌË IL-1 beta, TNF alpha ‚ ‡ÒÚÓˆË-ÚË Ë Ï‡ÍÓÙ‡„Ë, Ë Â‰ÛˆË‡Ú ÂÍÒÔÂÒËflÚ‡ Ì‡ ICAM-1 Ëê-selectin ÔË ÎËˆ‡ Ò àÅë ËÎË ïïÖ (20). Rosuvastatin Ësimvastatin ‰ÂÏÓÌÒÚË‡Ú Ì‡Ï‡ÎÂÌËÂ Ì‡ ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ë-flÚ‡ ÏÂÊ‰Û ÎÂ‚ÍÓˆËÚË Ë ÂÌ‰ÓÚÂÎÌË ÍÎÂÚÍË ÔË ÏÓ‰ÂÎË ÒÏÂÁÂÌÚÂË‡ÎÌË Ò˙‰Ó‚Â Ì‡ ÔÎ˙ıÓ‚Â, ‡ ÔËÎ‡„‡ÌÂÚÓ Ì‡pravastatin Ì‡Ï‡Îfl‚‡ „ÂÌÂË‡ÌÂÚÓ Ì‡ ÒÛÔÂÓÍÒË‰ ‚ ‡ÍÚË-‚Ë‡ÌËÚÂ ÌÂÛÚÓÙËÎË, ÍÓÂÚÓ ‚Ó‰Ë ‰Ó ÔÓ-Ï‡ÎÍË Ú˙Í‡ÌÌËÛ‚Â‰Ë ÓÚ ‚˙ÁÔ‡ÎËÚÂÎÂÌ ı‡‡ÍÚÂ ÔË ÏÓÁ˙˜Ì‡ ËÒıÂÏËfl.ÇÒË˜ÍÓ ÚÓ‚‡ ÔÓÍ‡Á‚‡, ˜Â ÒÚ‡ÚËÌËÚÂ ÓÒ˙˘ÂÒÚ‚fl‚‡Ú ÌÂ‚-ÓÔÓÚÂÍˆËfl ˜ÂÁ ‡ÌÚËËÌÙÎ‡Ï‡ÚÓÌË ÂÙÂÍÚË ÌÂ Ò‡ÏÓ ‚„ÓÎÂÏËÚÂ Ò˙‰Ó‚Â. Ñ‡ÎË Ó·‡˜Â ÚÂÁË ÂÙÂÍÚË ˘Â ·˙‰‡Ú ÍÎË-ÌË˜ÌÓ ÁÌ‡˜ËÏË ‚ÒÂ Ó˘Â Úfl·‚‡ ‰‡ ÒÂ ‰ÂÏÓÌÒÚË‡ ˜ÂÁ„ÓÎÂÏË ‡Ì‰ÓÏËÁË‡ÌË, ÔÎ‡ˆÂ·Ó-ÍÓÌÚÓÎË‡ÌË ÔÓÛ˜‚‡-ÌËfl (1-3).

êÓÎflÚ‡ Ì‡ ıËÔÂıÓÎÂÒÚÂÓÎÂÏËflÚ‡ (ïïÖ) ‚ Ô‡ÚÓ„ÂÌÂ-Á‡Ú‡ Ì‡ ÍÓÓÌ‡Ì‡Ú‡ ·ÓÎÂÒÚ Â ÚÓ˜ÌÓ ÛÒÚ‡ÌÓ‚ÂÌ‡. ÑÓÍ‡-Á‡ÌÓ Â Ì‡Ï‡ÎÂÌËÂ Ì‡ ˜ÂÒÚÓÚ‡Ú‡ Ì‡ àåà ÔË ·ÓÎÌË Ò ÍÓ-ÓÌ‡Ì‡ ·ÓÎÂÒÚ (äÅ, àÅë), ÎÂÍÛ‚‡ÌË Ò˙Ò ÒÚ‡ÚËÌË (8). êÂ-ÁÛÎÚ‡ÚËÚÂ Á‡ ÁÌ‡˜ÂÌËÂÚÓ Ì‡ ïïÖ Í‡ÚÓ ËÒÍÓ‚ Ù‡ÍÚÓÁ‡ àåà Ò‡ ÔÓÚË‚ÓÂ˜Ë‚Ë (21, 22). ëÂ‰ÌÓÚÓ Ì‡Ï‡ÎÂÌËÂÌ‡ ÍÓÌˆÂÌÚ‡ˆËflÚ‡ Ì‡ LDL-ıÓÎÂÒÚÂÓÎ‡ Ò 1,8 ÏÏÓÎ/Î ‚Ó-‰Ë ‰Ó Ì‡Ï‡ÎÂÌËÂ Ì‡ àåà Ò 17% (9-25%) (22). àÏ‡ ËÁÒÎÂ‰-


‚‡ÌËfl, ÍÓËÚÓ ÔÓÍ‡Á‚‡Ú, ˜Â ÔÓ-ÒÍÓÓ Ì‡ÎË˜ÌËflÚ ËÌÙÎ‡Ï‡-ÚÓÂÌ ÒÚ‡ÚÛÒ ÔÓ‚ÎËfl‚‡ ‚˙ÁÍ‡Ú‡ ÏÂÊ‰Û ïïÖ Ë Ë àåà(3, 6, 10). ê‡ÁÎË˜ËÂÚÓ ‚ ‰‡ÌÌËÚÂ ÏÂÊ‰Û ÂÔË‰ÂÏËÓÎÓ„Ë˜ÌË-ÚÂ Ë ÍÎËÌË˜ÌË ÔÓÛ˜‚‡ÌËfl ÔÓ‚Â‰ÂÌË ÔË Ì‡‰ 70 000 ËÁÒ-ÎÂ‰‚‡ÌË ÔÓÍ‡Á‚‡Ú, ˜Â ÓÎflÚ‡ Ì‡ ÒÚ‡ÚËÌËÚÂ ÔË àåà,ËÁ‚˙Ì ÂÙÂÍÚËÚÂ ‚˙ıÛ ÒÂÛÏÌËfl ıÓÎÂÒÚÂÓÎ, ËÁËÒÍ‚‡Á‡‰˙Î·Ó˜ÂÌÓ ËÁflÒÌfl‚‡ÌÂ Ì‡ ·ËÓÎÓ„Ë˜ÌËÚÂ ËÏ Ò‚ÓÈÒÚ‚‡,Í‡ÚÓ ÔÓÚÂÌˆË‡ÎÌË ËÏÛÌÓÏÓ‰ÛÎ‡ÚÓË, Á‡ ‰‡ ÒÂ ÓÚ„Ó‚ÓËÂ‰ÌÓÁÌ‡˜ÌÓ Ì‡ ‚˙ÔÓÒ‡ ‰‡ÎË Ò‡ ÔÓ-ÂÙÂÍÚË‚ÌË Á‡ ‚ÚÓË˜Ì‡ËÎË Á‡ Ô˙‚Ë˜Ì‡ ÔÓÙËÎ‡ÍÚËÍ‡ ÔË åëá.

Ç ÍÎËÌË˜Ì‡Ú‡ Ô‡ÍÚËÍ‡ Ò‡ ‚˙‚Â‰ÂÌË ÏÌÓ„Ó ÒÚ‡ÚËÌË –fluvastatin, lovastatin, pravastatin, simvastatin, atirvastatin,rosuvastatin Ë Ì‡ÒÍÓÓ pitavastatin (3). ÇÒË˜ÍË ÚÂ Ó·‡˜Â ÒÂ‡ÁÎË˜‡‚‡Ú ÔÓ Ù‡Ï‡ÍÓÍËÌÂÚË˜ÌË Ë ÔÎÂÈÓÚÓÔÌË Ò‚ÓÈ-ÒÚ‚‡, Í‡ÍÚÓ Ë ÔÓ ÒÔÓÒÓ·ÌÓÒÚÚ‡ ÒË ‰‡ Ì‡Ï‡Îfl‚‡Ú ÌËÒ-ÍÓÔÎ˙ÚÌÓÒÚÌËfl ıÓÎÂÒÚÂÓÎ. å‡ÍÒËÏ‡ÎÌÓ Ì‡Ï‡ÎÂÌËÂ ‰Ó55-60% Ì‡ LDL-ıÓÎÂÒÚÂÓÎ‡ ÒÂ ÔÓÎÛ˜‡‚‡ Ò Ì‡È-„ÓÎÂÏËÚÂ‰ÓÁË atorvastatin Ë rosuvastatin (22).

êÂÁÛÎÚ‡ÚËÚÂ ÓÚ ‡Ì‡ÎËÁ‡ Ì‡ 11 „ÓÎÂÏË ‡Ì‰ÓÏËÁË‡ÌË,ÔÎ‡ˆÂ·Ó ÍÓÌÚÓÎË‡ÌË ÔÓÛ˜‚‡ÌËfl (MIRACL,AFCAPS/TexCAPS, ASCOT, CARE, 4S, HPS, FLORIDA,PROSPER, LIPID, LIPS, WOSCOPS) ÓÚÌÓÒÌÓ Ò˙‰Â˜ÌÓ-Ò˙‰Ó‚ËÚÂ ÔÓÚÂÍÚË‚ÌË Ò‚ÓÈÒÚ‚‡ Ì‡ 5 ÒÚ‡ÚËÌ‡ (atorvas-tatin, fluvastatin, lovastatin, pravastatin, simvastatin) ÔÓÚ‚˙-Ê‰‡‚‡Ú ÒÎÂ‰ÌËÚÂ Ù‡ÍÚË (23, 24):

ëÚ‡ÚËÌËÚÂ ‰ÓÔËÌ‡ÒflÚ Ò˙˘ÂÒÚ‚ÂÌÓ Á‡ Ì‡Ï‡ÎÂÌËÂ Ì‡Ò˙‰Â˜ÌÓ-Ò˙‰Ó‚‡Ú‡ ·ÓÎÂÒÚÌÓÒÚ Ë ÒÏ˙ÚÌÓÒÚ;

● èÓÎÁ‡Ú‡ Â ÌÂÁ‡‚ËÒËÏ‡ ÓÚ Ì‡˜‡ÎÌËÚÂ ÍÓÌˆÂÌÚ‡ˆËËÌ‡ ıÓÎÂÒÚÂÓÎ‡ Ë LDL-Ù‡ÍˆËflÚ‡;

● ëÚ‡ÚËÌËÚÂ ËÏ‡Ú ‡ÁÎË˜ÌË ÂÙÂÍÚË, Í‡ÚÓ ÔÓÍ‡Á‚‡Ú‡ÁÎËÍ‡ Ë ‚˙‚ ‚ÂÏÂÚÓ ÓÚ Ì‡˜‡ÎÓÚÓ Ì‡ ÚÂ‡ÔËflÚ‡ ‰Ó ÔÓ-fl‚‡ Ì‡ ÍÎËÌË˜ÂÌ ÂÙÂÍÚ;

● éˆÂÌfl‚‡ÈÍË ÂÁÛÎÚ‡ÚËÚÂ Ì‡ ÔÂÚ „Ó‰Ë¯ÌÓ ÎÂ˜ÂÌËÂ,Â ÔÓÍ‡Á‡ÌÓ ˜Â ÏÓ·Ë‰ÌÓÒÚÚ‡ ÓÚ àåà Â ÒÌËÊÂÌ‡ ‰Ó 41%ÔË ÎÂÍÛ‚‡ÌËÚÂ Ò atorvastatin, 34% ÔË ÚÂÁË Ò˙Ò simvas-tatin, Ë ÔË·ÎËÁËÚÂÎÌÓ 31% ÔË ÚÂÁË Ò pravastatin. èÂÁÔ˙‚ËÚÂ 16 ÒÂ‰ÏËˆË Ì‡ ÎÂ˜ÂÌËÂ Ò 80 Ï„ simvastatin ·ÓÎÌË-ÚÂ Ò ÓÒÚ˙ ÍÓÓÌ‡ÂÌ ÒËÌ‰ÓÏ, ËÒÍ˙Ú ÓÚ ÌÂÎÂÚ‡ÎÂÌàåà Â ·ËÎ Ì‡Ï‡ÎÂÌ Ò 59%, ÓÚÍÓÎÍÓÚÓ ÔË ÔÎ‡ˆÂ·Ó-„Û-Ô‡Ú‡, ‡ ÂÎ‡ÚË‚ÌËflÚ ËÒÍ Á‡ àåà Â ÒÌËÊÂÌ ‰Ó 50%.

● ç‡È-„ÓÎflÏÓ Â Ì‡Ï‡ÎÂÌËÂÚÓ Ì‡ ÂÎ‡ÚË‚ÌËfl ËÒÍ ÓÚàåà ÔË ÎÂ˜ÂÌËÂ Ò atorvastatin 80 Ï„/‰ÌÂ‚ÌÓ, ‰ÓÍ‡ÚÓ ÔË-ÎÓÊÂÌËÂÚÓ Ì‡ 10 Ï„ atorvastatin ‰ÌÂ‚ÌÓ ÒÔÓÂ‰ ASCOT-LLA Â‰ÛˆË‡ Ò˙˘Ëfl ËÒÍ Ò 27%.

● äÎËÌË˜Ì‡ ÔÓÎÁ‡ Â ·ËÎ‡ ‰ÂÏÓÌÒÚË‡Ì‡ Ì‡È-·˙ÁÓ ÔË·ÓÎÌËÚÂ, ÔËÂÏ‡ÎË atorvastatin - ‚ ‡ÏÍËÚÂ Ì‡ ÌflÍÓÎÍÓÒÂ‰ÏËˆË, ÔÓÒÎÂ‰‚‡ÌË ÓÚ ·ÓÎÌËÚÂ ÎÂÍÛ‚‡ÌË Ò lovastatin(ÒÎÂ‰ 1 „Ó‰ËÌ‡) Ë Ò˙ÓÚ‚ÂÚÌÓ simvastatin (ÒÎÂ‰ 1,5 – 2 „Ó‰Ë-ÌË).

● é·Ó·˘‡‚‡ÈÍË ÚÂÁË 11 ÔÓÛ˜‚‡ÌËfl, ÒÂ ÓÍ‡Á‚‡, ˜Â Ì‡È-„ÓÎflÏ‡ ÔÓÎÁ‡ Á‡ Ô‡ˆËÂÌÚËÚÂ ËÁÎÓÊÂÌË Ì‡ ËÒÍ Á‡ ëëá Ëàåà, ÔÓfl‚fl‚‡ atorvastatin, ÍÓÈÚÓ Úfl·‚‡ ‰‡ ÒÂ Ò˜ËÚ‡ Á‡ÁÎ‡ÚÂÌ ÒÚ‡Ì‰‡Ú ‚ ÔÓÙËÎ‡ÍÚËÍ‡Ú‡ Ì‡ Ò˙‰Â˜Ì‡ ËÒıÂ-ÏËfl Ë àåà.

● Ä‚ÚÓËÚÂ Ì‡ ÚÓ‚‡ ÔÓÛ˜‚‡ÌÂ ÍÓÌÒÂÌÒÛÒÌÓ ÒÏflÚ‡Ú,˜Â ·ÓÎÌË Ò ËÒÍ Á‡ ëëá Úfl·‚‡ ‰‡ ·˙‰‡Ú ÎÂÍÛ‚‡ÌË Ò˙ÒÒÚ‡ÚËÌ ÌÂÁ‡‚ËÒËÏÓ ÓÚ ËÁıÓ‰Ì‡Ú‡ ÍÓÌˆÂÌÚ‡ˆËfl Ì‡ ıÓ-ÎÂÒÚÂÓÎ, ÔÓÎ‡ Ë ‚˙Á‡ÒÚÚ‡ (23).

Ç ÎËÚÂ‡ÚÛ‡Ú‡ (2, 3, 11, 12, 24, 25) ÔÓÌ‡ÒÚÓfl˘ÂÏ ÒÂÔÂÔÓ˙˜‚‡ ÔÂ‚ÂÌÚË‚ÌÓ ÎÂ˜ÂÌËÂ Ò˙Ò ÒÚ‡ÚËÌË ÔË ·ÓÎÌËÒ ïïÖ, ÓÒÓ·ÂÌÓ ‚ Ò˙˜ÂÚ‡ÌËÂ Ò ‰Ë‡·ÂÚ ËÎË ‡ÚÂË‡ÎÌ‡ ıË-ÔÂÚÓÌËfl, Í‡ÍÚÓ Ë ÔË ÚÂÁË Ò ÍÓÓÌ‡Ì‡ ·ÓÎÂÒÚ Ë ÏËÓ-Í‡‰ÂÌ ËÌÙ‡ÍÚ. è‡ˆËÂÌÚËÚÂ Ò Í‡ÓÚË‰Ì‡ ËÎË ‡ÓÚÌ‡‡ÚÂÓÒÍÎÂÓÁ‡, ÍÓflÚÓ Â ÛÒÚ‡ÌÓ‚ÂÌ‡ ˜ÂÁ ‡Ì„ËÓ„‡ÙËfl ËÎËÇ- ËÎË ‰ÛÔÎÂÍÒ ÂıÓ„‡ÙÒÍÓ ÒÍÂÌË‡ÌÂ, Ò˙˘Ó Úfl·‚‡ ‰‡ ·˙-‰‡Ú ÍÓÌÚËÌ„ÂÌÚ Á‡ ÒÚ‡ÚËÌÓ‚‡ ÚÂ‡ÔËfl. èÓÚÂÌˆË‡Î˙ÚÁ‡ ÔÂ‚ÂÌˆËfl Ë ÒÚ‡ÚËÌÓ‚‡ ÔÓÚÂÍˆËfl ÓÚ ÔÓ‚ÚÓÂÌ

àåà Â ÔÓ-„ÓÎflÏ‡ ÔË ·ÓÎÌËÚÂ ÔÓ‰ 75 „Ó‰ËÌË Ë ÌflÍÓË Ì‡‰75 „. Ò ‡Ì‡ÏÌÂÁ‡ Á‡ äÅ, åà Ë ÒËÒÚÂÏÌ‡ ‡ÚÂÓÒÍÎÂÓÁ‡,Í‡ÚÓ ‚ÂÓflÚÌ‡ ÔË˜ËÌ‡ Á‡ ÚÂıÌËfl ÔÂ‰¯ÂÒÚ‚‡˘ ÏÓÁ˙-˜ÂÌ ËÌÒÛÎÚ.

èËÎÓÊÂÌËÂÚÓ Ì‡ ÒÚ‡ÚËÌËÚÂ Í‡ÚÓ ËÏÛÌÓÏÓ‰ÛÎ‡ÚÓ-Ë ÔË ·ÓÎÌË Ò ÔËÒÚ˙ÔÌÓ-ÂÏËÚÂÌÚÌ‡ åë ÒÂ ÔÓÛ˜‚‡ËÌÚÂÌÁË‚ÌÓ (26-30) Ë ·Â¯Â Ó·Ó·˘ÂÌÓ ÔÓ-‡ÌÓ ‚ ·.1 Ì‡ ÒÔ.Å˙Î„‡ÒÍ‡ ÌÂ‚ÓÎÓ„Ëfl, 2005 „ (31).

ÖÊÂ‰ÌÂ‚Ì‡Ú‡ ÛÔÓÚÂ·‡ Ì‡ 80 Ï„ ‡torvastatin ÔË ·ÓÎÌËÒ ÎÂÍ‡ ‰Ó ÛÏÂ‡ÌÓ ËÁ‡ÁÂÌ‡ ·ÓÎÂÒÚ Ì‡ ÄÎˆı‡ÈÏÂ Ì‡Ï‡Îfl-‚‡ ÍÓ„ÌËÚË‚ÌËfl ÛÔ‡‰˙Í Ë ÔÓ‰Ó·fl‚‡ ‰ÂÔÂÒË‚ÌËÚÂ ÒËÏÔ-ÚÓÏË, ÒÔÓÂ‰ Â‰ÌÓ„Ó‰Ë¯ÌÓ ÔËÎÓÚÌÓ ÔÓÛ˜‚‡ÌÂ (32). ÑÓÒ-ÍÓÓ ÒÂ Â ÒÏflÚ‡ÎÓ, ˜Â ÒÚ‡ÚËÌËÚÂ Á‡ÒËÎ‚‡Ú ÌÂ‚ÓÌ‡ÎÌ‡-Ú‡ ‰Â„ÂÌÂ‡ˆËfl, Ò˙ÓÚ‚ÂÚÌÓ ÍÓ„ÌËÚË‚Ì‡Ú‡ ‰ÂÚÂËÓ‡-ˆËfl ÔË ·ÓÎÌË Ò ÅÄ, ÔÓ‡‰Ë ËÌıË·ËˆËfl Ì‡ ıÓÎÂÒÚÂÓÎÓ‚‡-Ú‡ ÒËÌÚÂÁ‡, ÌÂÓ·ıÓ‰ËÏ‡ Á‡ ÏÂÏ·‡ÌÌËfl ËÌÚÂ„ËÚÂÚ.èÓÛ˜‚‡ÌÂÚÓ ADCLT (Alzheimer’s Disease Cholesterol-Lowering Treatment Trial) ÔÓÔ‡‚Ë Ô˙Úfl Á‡ ÔÓ‚ÂÊ‰‡ÌÂ Ì‡ÌÓ‚Ë ÔÓ-„ÓÎÂÏË ÔÓÛ˜‚‡ÌËfl Á‡ ÓÎflÚ‡ Ì‡ ÒÚ‡ÚËÌËÚÂ ÔËÅÄ (33). àÁÔ˙ÎÌÂÌËÂÚÓ Ì‡ ADAS-cog ÚÂÒÚ‡ Ì‡ 3-fl Ë 6-ÏÂ-ÒÂˆ Â ·ËÎÓ Ò 3,5 ÚÓ˜ÍË ÔÓ-‰Ó·Ó ‚ „ÛÔ‡Ú‡ Ì‡ ÎÂ˜ÂÌËÂ Òatorvastatin, ÓÚÍÓÎÍÓÚÓ ‚ ‚ ÔÎ‡ˆÂ·Ó „ÛÔ‡Ú‡ (<.003 vsp=.055). ÉÎÓ·‡ÎÌÓÚÓ ÍÎËÌË˜ÌÓ ‚ÔÂ˜‡ÚÎÂÌËÂ Á‡ ÔÓÏflÌ‡(CGIC) Â ÔÓÍ‡Á‡ÎÓ ÚÂÌ‰ÂÌˆËfl ·Î‡„ÓÔËflÚÌ‡ Á‡ atorvas-tatin Ì‡ 9-fl (p=.058) Ë 12 ÏÂÒÂˆ (=.073).

èÓÌ‡ÒÚÓfl˘ÂÏ ÚË „ÓÎÂÏË ËÁÒÎÂ‰‚‡ÌËfl ÓÚ Ù‡Á‡ 3 ÓÚ-ÌÓÒÌÓ ÏflÒÚÓÚÓ Ì‡ ÒÚ‡ÚËÌËÚÂ ‚ ÎÂ˜ÂÌËÂÚÓ Ì‡ ÅÄ Ò‡ ‚ıÓ‰: 1) Û‰˙ÎÊÂÌ‡Ú‡ Ù‡Á‡ 3 Ì‡ ADCLT ÒÂ ÔÓ‚ÂÊ‰‡ ÓÚÍÓÏÔ‡ÌËfl Pfizer ‚ 40 ˆÂÌÚ˙‡ Ì‡ 14 ÒÚ‡ÌË, Á‡ ‰‡ ÒÂ ÔÓ-Û˜Ë ÂÙÂÍÚ‡ Ì‡ atorvastatin Á‡ Á‡·‡‚flÌÂ ÔÓ„ÂÒËflÚ‡ Ì‡ ÅÄ;2) ÔÓÛ˜‚‡ÌÂÚÓ LEAD ‡Ì‡ÎËÁË‡ ÂÙÂÍÚ‡ Ë ·ÂÁÓÔ‡ÒÌÓÒÚ-Ú‡ Ì‡ atorvastatin ‚ ÍÓÏ·ËÌ‡ˆËfl Ò donepezil ÔË ·ÓÎÌË Ò ÎÂ-Í‡ ‰Ó ÛÏÂÂÌ‡ ÅÄ; Ë 3) ÒÔÓÌÒÓË‡Ì‡Ú‡ ÓÚ ç‡ˆËÓÌ‡ÎÌËflËÌÒÚËÚÛÚ ÔÓ ÒÚ‡ÂÂÌÂ Ì‡ ëÄô ÔÓ„‡Ï‡ Á‡ ËÁÒÎÂ‰‚‡ÌÂÌ‡ ÂÙÂÍÚË‚ÌÓÒÚÚ‡ Ë ·ÂÁÓÔ‡ÒÌÓÒÚÚ‡ Ì‡ 20 Ï„ simvastatinÔË Á‡·‡‚flÌÂ ÔÓ„ÂÒËflÚ‡ Ì‡ ÅÄ, Í‡ÚÓ ÒÂ ÔÓÒÎÂ‰fl‚‡ ÔÒË-ıË˜ÌËfl ÒÚ‡ÚÛÒ, ÙÛÌÍˆËÓÌ‡ÎÌËÚÂ ‚˙ÁÏÓÊÌÓÒÚË, ÔÓ‚Â‰ÂÌ-˜ÂÒÍËÚÂ ÔÓÏÂÌË Ë Í‡˜ÂÒÚ‚Ó Ì‡ ÊË‚ÓÚ‡ Ì‡ ·ÓÎÌËÚÂ, Í‡Í-ÚÓ ÓˆÂÌÍ‡Ú‡ Ì‡ Ù‡Ï‡ÍÓËÍÓÌÓÏË˜ÂÒÍËÚÂ ‚˙ÔÓÒË Ì‡ ÎÂ-˜ÂÌËÂÚÓ.

åÌÓ„Ó·ÓÈÌËÚÂ ÂÍÒÔÂËÏÂÌÚ‡ÎÌË Ë ÍÎËÌË˜ÌË ÔÓÛ˜-‚‡ÌËfl ÌË ‰‡‚‡Ú ÓÒÌÓ‡ÌËÂ ‰‡ ÔËÂÏÂÏ, ˜Â Â ÒÚ‡ÚËÌËÚÂËÏ‡Ú ÓÒÓ·ÂÌÓ ÔÂÒÔÂÍÚË‚ÌÓ ÏflÒÚÓ ÔË ÎÂ˜ÂÌËÂÚÓ Ì‡àåà, åë, Ë ¯ËÓÍ ÒÔÂÍÚ˙ ‰Û„Ë ‚˙ÁÔ‡ÎËÚÂÎÌË Ë ‰Â„Â-ÌÂ‡ÚË‚ÌË ÌÂ‚ÓÎÓ„Ë˜ÌË Á‡·ÓÎfl‚‡ÌËfl.

ãàíÖêÄíìêÄ1. Cucchiara B, Kasner SE. Use of statins in CNS disorders. J Neurol Sci 2001;187:81–89.2. Trubelja N, Vaughan C, Coplan NL. Role of statins in preventing stroke. PrevCardiol. 2005; 8 (2): 98-101.3. Di Napoli å. Benefits of statins in cerebrovascular disease. Current opinion ininvestigational drugs. 2004, 5(3): 295-305. 4. Laufs U. Beyond lipid lowering: Effects of statins on endothelial nitic oxide.Eur J Clin Pharmacol. 2003; 58(11):719-731.5. Laufs U, Gertz K, Huang P et al. Atorvastatin upregulates type III nitric oxidesyntase in thrombocytes, decreases platelet activation, and protects from cerebralischemia in normocholesterolemic mice. Stroke 2000; 31:2437-2449.6. Libby P, Aikawa M. Mechanisms of plaque stabilization with statins. Am JC‡rdiol. 2003; 91(suppl):4B-9B.7. Libby P, Ridker PM, Maserl A. Inflammation and atherosclerosis. Circulation2002, 105(9):1135-1143.8. Crouse JR 3rd, Byigon RP, Bond MG et al. Pravastatin, Lipids andAtherosclerosis in the Carotid arteies (PLAC-III). Am J Cardiol. 1995;73(7):455-459.9. Becker KJ. Targeting the central nervous system inflammatory response inischemic stroke. Curr Opin Neurol. 2001;14(3): 349-353.10. Ridker PM, Rifai N, Clearfield M, et al. for the Air Force/Texas CoronaryAtherosclerosis Prevention Study Investigators. Measurement of C-reactive proteinfor the targeting of statin therapy in the primary prevention of acute coronary events.NEJM 2001, 344:1959-1965.11. Engstrom G, Lind P, Hablad P, et al. Effects of cholesterol and inflammation-sensitive plasma proteins on incidence of myocardial infarction and stroke in men.Circulation. 2002;105:2632-2637.12. Vaughan CJ. Prevention of stroke and dementia with statins: effects beyondlipid lowering. Am J Cardol. 2003; 91: 23B-29B.13. Roglaer G, Lackner KJ, Schmitz G. Effects of fluvastatin on growth of porcine


and human vascular smooth muscle cells in vitro. Am J Cardiol. 1995;76:114-116A.14. Bellosta S, Bemini F, Ferri N, et al. Direct vascular effects of HMG-coAreductase inhibitors. Atherosclerosis. 1998, 137 (suppl):S101-S109.15. Rosenson RS Tangney C. Antiatherothrombotic properties of statins: implica-tions for cardiovascular event reduction. JAMA. 1998;279:1643-1650.16. Chen J, Zhang ZG, Li Y, et al. Statins induce angiogenesis, neurogenesis andsynaptogenesis after stroke. Ann Neuro 2003; 53(6):743-751.17. Ambrosio G, Tritto I. Reperfusion injury :Experimental evidence and clinicalimplications. Am Heart J . 1999;138 (2 PL2):569-575.18. Tak PP, Firestein GB. NF-kB: A key role in inflammatory disease. J ClinInvest. 2001; 107(1):7-11.19. HMG-coA reductase inhibitors regulate inflammatory transcription factors inhuman endothelial and vascular smooth muscle cells. Atheroscler Thromb VascBiol. 2003;23(1):58-63.20. Reduced expression of endothelial cell markers after 1 year treatment withsimvastatin and atorvastatin in patients with coronary heart disease. Atherosclerosis.2002;162(1):179-185.21. Corvol J, Bouzamondo A, Siror M et al. Differential effects of lipid-loweringtherapies on stroke prevention. Arch Intern Med. 2003; 163:669-676.22. Law MR, Wald NJ, Rudnicka AR. Quantifying effect of statins on low densi-ty lipoprotein cholesterol, ischemic heart disease, and stroke: systematic review andmeta-anaysis. BMJ 2003;326:1-7.23. Gresser U, Gathof BS. Atorvastatin: Gold standard for prophylaxis of myocar-dial ischemia and stroke. Comparison of the clinical benefit of statins on the basisof randomized controlled endpoint studies. Eur J Med Res. 2004; 9:1-17.24. W‡ters DD, Schwartz GG, Olsson AG, et al; for the MIRACL StudyInvestigators. Effects of Atorvastatin on stroke in patients with unstable angina ornon-Q-wave myocardial infarction. A myocardial ischemia reduction with aggres-sive cholesterol lowering (MIRACL) substudy. Circulation. 2002; 106: 1690-1695.25. Hess DC, Demchuk AM, Brass LM, Yatsu FM. HMG-CoA reductaseinhibitors (statins). A promising approach to stroke prevention. Neurology2000;54:790–796.

26. Stuve O, Youssef S, Steinman L, Zamvil S. Statins as potential therapeuticagents in neuroinflammatory disorders. Current Opinion in Neurology. 16(3):393-401, June 2003.27. Neuhaus O., S. Strasser-Fuchs, F. Fazekas, B.C. Kieseier, G. Niederwieser,H.P. Hartung and J.J. Archelos. Statins as immunomodulators. Comparison withinterferon-beta1b in MS. Neurology 2002; 59:990–997.28. Vollmer T, et al. Oral simvastatin treatment in relapsing-remitting multiplesclerosis. Lancet 2004, 365; 9421:1607-1608.29. Zamvil S. Atorvastain therapy in patients with clinically isolated syndrome(CIS) at risk for multiple sclerosis. Immune íolerance Network.com30. Neuhaus O, Stuve O, Zamvil SS, Hartung HP. Are statins a treatment optionfor multiple sclerosis? Lancet Neurol. 2004 Jun; 3(6):369-71. 31. äÎËÒÛÒÍË å. ëÚ‡ÚËÌËÚÂ ÌÓ‚Ë ËÏÛÌÓÏÓ‰ÛÎ‡ÚÓË ‚ ÎÂ˜ÂÌËÂÚÓ Ì‡ ÏÌÓ-ÊÂÒÚ‚ÂÌ‡Ú‡ ÒÍÎÂÓÁ‡. Å˙Î„‡ÒÍ‡ ÌÂ‚ÓÎÓ„Ëfl, ÚÓÏ 5, ·. 1, ÙÂ‚Û‡Ë 2005;ÒÚ. 8-12.32. Sarks DL, Sabbagh MN, Connor DJ et al.Benefits of atorvastatin in subjectswith Alzheimer disease. Circulation. 2004; 111017: III-813. Abstract 3756.33. Brookes L. ADCLT: Alzheimer’s Disease Cholesterol-Lowering TreatmentTrial. Copyright Medscape 2004.

Ä‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËfl:Ñ- å. äÎËÒÛÒÍË, ‰Ï, „Î‡‚ÂÌ ‡ÒËÒÚÂÌÚ äÎËÌËÍ‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl, åÅÄã “ñ‡Ëˆ‡ âÓ‡ÌÌ‡”- ëÓ-ÙËfl, ÛÎ.” ÅflÎÓ ÏÓÂ” No 8, ëÓÙËfl 1527TÂÎ: (02) 9432-597 / 516 / 160e-mail: [email protected]


SUMMARY

ULTRASOUND PECULIARITIES IN THE EXAMINATION OF THE VERTEBRO-BASILAR

SYSTEMI. Staikov

Ultrasonography of the vertebral arteries has been neglectedfor a long time in comparison with that of carotid arteries. Thiswas related to the inconvenient anatomical position of the ves-sels which created technical problems with their imaging.

Vertebral arteries are situated deeper than carotid arteriesand their extracranial section is interrupted in the V2 segmentby the transverse processes of the cervical vertebrae whichhinders the delineation of its continuous course. The intro-duction of color-coded duplex ultrasonography has renderedsome of the methodological problems easier to solve.

In this revue are shown some ultrasound special features ofthe vertebro-basilar system and the difficulties connected withtheir overcome. Some anatomical particularities of all separatesegments of the vertebral arteries and the basilar artery, theaverage diameter of the normal vertebral arteries and theircongenital variations in relation to theirs Doppler and duplexultrasongraphy examination are shown. The Doppler andduplex ultrasongraphy characterization of all separate seg-ments of the vertebral arteries with their acoustic phenomenonand typical spectral analyses are presented. The most commonultrasound mistakes related to the false identification ofclosely adjacent to the vertebral and basilar artery vessels areemphasized.

Key words: vertebral arteries, ultrasound, basilar artery

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V0 Ë V1ÒÂ„ÏÂÌÚË: ÇÄ ËÁÎËÁ‡ ÓÚ ÏÂ‰ËÓ‰ÓÁ‡ÎÌ‡Ú‡˜‡ÒÚ Ì‡ ÔÓ‰ÍÎ˛˜Ë˜Ì‡Ú‡ ‡ÚÂËfl (èÄ) ‚ Ì‡‰ÍÎ˛˜Ë˜Ì‡Ú‡flÏÍ‡ Ë ÎÂÊË ÏÂÊ‰Û m. scalenus Ë m. longus coli. Ç ÓÍÓÎÓ 3%Úfl ËÁÎËÁ‡ ÓÚ Á‡‰Ì‡Ú‡ ËÎË Á‡‰ÌÓ-‰ÓÎÌ‡Ú‡ ÒÚ‡Ì‡ Ì‡ èÄ, ‚ÓÍÓÎÓ 4 ‰Ó 6% ÓÚ ÒÎÛ˜‡ËÚÂ ‰ËÂÍÚÌÓ ÓÚ ‡ÓÚÌ‡Ú‡ ‰˙„‡,‡ ‚ 6% ‚ Ó·˘ ÒÚ‚ÓÎ Ò truncus thyreocervicalis (2,23,24). ëÎÂ‰ËÁÎËÁ‡ÌÂÚÓ ÒË ÇÄ ÒÂ Ì‡ÒÓ˜‚‡ Í‡ÌË‡ÎÌÓ, Í‡ÚÓ ÒÂ ËÁ‚Ë‚‡ÔÓ‰ ÙÓÏ‡Ú‡ Ì‡ ·ÛÍ‚‡Ú‡ “S” Ë ÔÂÏËÌ‡‚‡ ÔÂ‰ m. scalenus(24). Ç Îfl‚‡Ú‡ ÒÚ‡Ì‡ ÇÄ ËÁÎËÁ‡ ÁÌ‡˜ËÚÂÎÌÓ ÔÓ-ÔÓÍÒË-Ï‡ÎÌÓ, Í‡ÍÚÓ Ë ÁÌ‡˜ËÚÂÎÌÓ ÔÓ-˜ÂÒÚÓ ÓÚ ‡ÓÚÌ‡Ú‡ ‰˙„‡ ‚Ò‡‚ÌÂÌËÂ Ò ‰flÒÌ‡Ú‡ ÒÚ‡Ì‡, ÍÓÂÚÓ Â ÓÚ ‚‡ÊÌÓ ÁÌ‡˜ÂÌËÂÁ‡ ÒÓÌÓ„‡ÙÒÍÓÚÓ È Ë‰ÂÌÚËÙËˆË‡ÌÂ (6).

V2 ÒÂ„ÏÂÌÚ: ë ËÁÍÎ˛˜ÂÌËÂ Ì‡ ÌÂÁÌ‡˜ËÚÂÎÌË ‚‡Ë‡ÌÚË‚ Ò‚ÓÂÚÓ ÔÓÚË˜‡ÌÂ ÇÄ ÔÓÍ‡Á‚‡ ÍÓÌÒÚ‡ÌÚÂÌ ıÓ‰. ëÎÂ‰Í‡fl Ì‡ V1 ÒÂ„ÏÂÌÚ ÇÄ ÒÂ ËÁ‚Ë‚‡ ‰˙„Ó‚Ë‰ÌÓ Ì‡Á‡‰ Ë Ì‡‚-ÎËÁ‡ ‚˙‚ ‚ÂÚÂ·‡ÎÌËfl ÍÓÒÚÂÌ Í‡Ì‡Î (foramen costotrans-versarium), Ó·‡ÁÛ‚‡Ì ÓÚ Ì‡ÔÂ˜ÌËÚÂ ËÁ‡ÒÚ˙ˆË Ì‡ 6-ÚË‰Ó 2-Ë ¯ËÂÌ ÔÂ¯ÎÂÌ. Ç ÓÍÓÎÓ 5% ÓÚ ÒÎÛ˜‡ËÚÂ ÇÄ ÎÂÊË‚˙‚ ‚ÂÚÂ·‡ÎÌËfl Í‡Ì‡Î, Ó·‡ÁÛ‚‡Ì ÏÂÊ‰Û 5-ÚË Ë 2-Ë¯ËÂÌ ÔÂ¯ÎÂÌ (24).

V3 ÒÂ„ÏÂÌÚ: ç‡‰ 2-Ë ¯ËÂÌ ÔÂ¯ÎÂÌ – Axis, ÇÄ ËÁÎË-Á‡ ÓÚ ‚ÂÚÂ·‡ÎÌËfl Í‡Ì‡Î, Ì‡ÒÓ˜‚‡ ÒÂ ÚËÎÌÓ Ë Î‡ÚÂ‡Î-ÌÓ Ë Ì‡‚ÎËÁ‡ ‚ ÓÚ‚Ó‡ Ì‡ Ì‡ÔÂ˜ÌËfl ËÁ‡ÒÚ˙Í Ì‡ 1-‚Ë ¯Ë-ÂÌ ÔÂ¯ÎÂÌ (Atlas). ëÎÂ‰‚‡ ‰˙„ÓÓ·‡ÁÌÓ ËÁ‚Ë‚‡ÌÂ Ì‡„ÓÂ Ë‰ÓÁ‡ÎÌÓ, ÔÂÏËÌ‡‚‡ÈÍË Ì‡ ÓÍÓÎÓ 1 ÒÏ. Ì‡‰ Massa lateralisÌ‡ Atlas.

ëÎÂ‰ ÚÓ‚‡ ÇÄ ÒÂ ‰‚ËÊË ÏÂ‰Ë‡ÎÌÓ ÔÓ Sulcus arteriae ver-tebralis Ì‡ Atlas, Í˙‰ÂÚÓ ÒÂ ‰Ó·ÎËÊ‡‚‡ ÌÂÔÓÒÂ‰ÒÚ‚ÂÌÓ ‰ÓÍÓÊ‡Ú‡. èÂ‰Ë Ì‡‚ÎËÁ‡ÌÂÚÓ ÒË ‚ ˜ÂÂÔÌ‡Ú‡ ÍÛıËÌ‡ ÔÂÁ„ÓÎÂÏËfl ÚËÎÂÌ ÓÚ‚Ó, ÇÄ Ó·‡ÁÛ‚‡ ·ËÏÍ‡ ÓÍÓÎÓ Atlas(atlas loop), ÍÓflÚÓ È ÔÓÁ‚ÓÎfl‚‡ ‰‡ ÒÂ ‰‚ËÊË Ò ‰‚ËÊÂÌËflÚ‡Ì‡ „Î‡‚‡Ú‡ Ë Ì‡ ¯ËÈÌËÚÂ ÔÂ¯ÎÂÌË. íÛÍ Rr. MuscularesÌ‡ ÇÄ Ó·‡ÁÛ‚‡Ú ‚‡ÊÌ‡ ‡Ì‡ÒÚÓÏÓÁ‡ Ò A. occipitalis (ÍÎÓÌÌ‡ A. carotis externa) – ÓÍˆËÔËÚÓ-‚ÂÚÂ·‡ÎÌ‡ ‡Ì‡ÒÚÓÏÓ-Á‡, ÍÓflÚÓ Â Ë Ì‡È-‚‡ÊÌ‡Ú‡ ÍÓÎ‡ÚÂ‡ÎÌ‡ ‚˙ÁÍ‡ ÏÂÊ‰Û Í‡-ÓÚË‰Ì‡Ú‡ Ë ‚ÂÂ·Ó-·‡ÁËÎ‡Ì‡ ÒËÒÚÂÏË (2,6).

V4 ÒÂ„ÏÂÌÚ Ë ÅÄ: Ç Ò‡„ËÚ‡ÎÌ‡ ÔÓÒÓÍ‡ ÇÄ Ì‡‚ÎËÁ‡ ÔÂÁMembrana atlantoocipitalis posterior, Dura mater ËArachnoidea ËÌÚ‡Í‡ÌË‡ÎÌÓ. ëÎÂ‰ ÚÓ‚‡ ÔÂÏËÌ‡‚‡ ‰Ó-Á‡ÎÌÓ ÏÂÊ‰Û Clivus Ë ÏÓÁ˙˜ÌËfl ÒÚ‚ÓÎ, Í˙‰ÂÚÓ Ì‡ ÌË‚ÓÚÓÌ‡ Í‡Û‰‡ÎÌ‡Ú‡ ˜‡ÒÚ Ì‡ ÏÓÒÚ‡ ÒÂ Ò‚˙Á‚‡ Ò ÔÓÚË‚ÓÔÓÎÓÊ-Ì‡Ú‡ ÇÄ, Á‡ ‰‡ Ó·‡ÁÛ‚‡ ·‡ÁËÎ‡Ì‡Ú‡ ‡ÚÂËfl (ÅÄ) (24).

éÒ‚ÂÌ ÓÍˆËÔËÚÓ-‚ÂÚÂ·‡ÎÌ‡Ú‡ ‡Ì‡ÒÚÓÏÓÁ‡, ÇÄ Ó·-‡ÁÛ‚‡ ‚‡ÊÌË ‡Ì‡ÒÚÓÏÓÁË Ë Ò ÍÎÓÌÓ‚Â Ì‡ truncus thyreo- Ëcostocervicalis. ÑÓÔÎÂ ÒÓÌÓ„‡ÙÒÍË ÇÄ Â ‰ÓÒÚ˙ÔÌ‡ Á‡ ËÁÒ-ÎÂ‰‚‡ÌÂ ‚ ÌÂÈÌËflÚ ÂÍÒÚ‡Í‡ÌË‡ÎÂÌ ÒÂ„ÏÂÌÚ- pars praev-ertebralis Ë pars atlantis, Í‡ÍÚÓ Ë ˜ÂÁ Ú‡ÌÒÓÍˆËÔËÚ‡ÎÂÌ‰ÓÒÚ˙Ô ‚ ÌÂÈÌËflÚ ËÌÚ‡Í‡ÌË‡ÎÂÌ ÒÂ„ÏÂÌÚ. ÑÛÔÎÂÍÒ ÒÓ-ÌÓ„‡ÙÒÍË ÇÄ Â ‰ÓÒÚ˙ÔÌ‡ Á‡ ÛÎÚ‡ÒÓÌÓ„‡ÙÒÍË ‡Ì‡ÎËÁ‚˙‚ ‚ÒË˜ÍËÚÂ ÒË ÒÂ„ÏÂÌÚË, Í‡ÚÓ pars transversaria Â Ì‡È-ÎÂÒÂÌ Á‡ ËÌÒÓÌË‡ÌÂ (6).

Ç Ò‚ÓÂÚÓ ÔÓÚË˜‡ÌÂ ÅÄ Ó·ËÍÌÓ‚ÂÌÓ Â Ô‡‚‡, ÌÓ ˜ÂÒÚÓÏÓÊÂ ‰‡ ·˙‰Â ËÁ‚ËÚ‡ Ë ‰‡ ÔÂÏËÌ‡‚‡ ‚ ‰˙„Ó‚Ë‰Ì‡ ÙÓÏ‡Ì‡ ‰flÒÌÓ ËÎË Ì‡ Îfl‚Ó ÏÂÊ‰Û clivus Ë ÏÓÁ˙˜ÌËfl ÒÚ‚ÓÎ, Í‡-ÚÓ ËÏ‡ ÒÂ‰Ì‡ ‰˙ÎÊËÌ‡ ÓÚ ÓÍÓÎÓ 30-40 ÏÏ. Ë ÒÂ‰Ì‡ ‰Â-·ÂÎËÌ‡ ÓÚ ÓÍÓÎÓ 3 ÏÏ. (6).

çéêåÄãçà êÄáåÖêà à äéçÉÖçàíÄãçàèêéåÖçà Ç êÄáÇàíàÖíé çÄ ÇÄ

Ç ÔÓ‚Â˜ÂÚÓ ÒÎÛ˜‡Ë ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡ ‰‚ÛÒÚ‡ÌÌ‡ ‡ÁÎËÍ‡‚ ÒÍÓÓÒÚÌËÚÂ ÍË‚Ë Ì‡ ‰‚ÂÚÂ ‚ÂÚÂ·‡ÎÌË ‡ÚÂËË,Í‡ÚÓ Îfl‚‡Ú‡ ÇÄ Â ‚ ÓÍÓÎÓ 62% ÓÚ ÒÎÛ˜‡ËÚÂ ÔÓ-¯ËÓÍ‡ÓÚ ‰flÒÌ‡Ú‡ ÇÄ (2).

Ç ÓÍÓÎÓ 25% ÓÚ ÒÎÛ˜‡ËÚÂ Îfl‚‡Ú‡ Ë ‰flÒÌ‡ ÇÄ Ò‡ Ò Â‰-Ì‡Í‚‡ ¯ËËÌ‡ (24). ëÂ‰Ì‡Ú‡ ¯ËËÌ‡ Ì‡ ÇÄ ‚ ÂÍÒÚ‡Í‡-ÌË‡ÎÌ‡Ú‡ È ˜‡ÒÚ Â ÓÍÓÎÓ 3.5 ÏÏ. (1,5 ‰Ó 5ÏÏ.), ‡ ‚ ËÌÚ-‡Í‡ÌË‡ÎÌËfl È ÒÂ„ÏÂÌÚ ÓÍÓÎÓ 2.1-2.3 ÏÏ. ‚ ‰Ë‡ÏÂÚ˙(24). ëÔÓÂ‰ ‰Û„Ë ‡‚ÚÓË ÒÂ‰ÌËflÚ ‰Ë‡ÏÂÚ˙ Ì‡ ÌÓ-Ï‡ÎÌ‡Ú‡ ÇÄ ‚ ‰flÒÌÓ Â 3.81 ± 0.46 ÏÏ., ÂÒÔÂÍÚË‚ÌÓ 3.88± 0.47 ÏÏ. ‚ Îfl‚Ó (8). ë‡ÏÓ ÍÓ„‡ÚÓ Â ËÁ‚ÂÒÚÂÌ ÚÓ˜ÌËflÚ‰Ë‡ÏÂÚ˙ Ì‡ ÇÄ, Â ‚˙ÁÏÓÊÌÓ ‰Ë‡„ÌÓÒÚËˆË‡ÌÂÚÓ Ì‡ ıË-ÔÓÔÎ‡ÁËfl ËÎË ÔÓÍÒËÏ‡ÎÌ‡ Ë ‰ËÒÚ‡ÎÌ‡ Ó·ÒÚÛÍˆËfl Ì‡ ÇÄ(26).

Ç ÎËÚÂ‡ÚÛ‡Ú‡ ÌÂ Ò˙˘ÂÒÚ‚Û‚‡ Â‰ËÌÌÓ ÏÌÂÌËÂ ÔÓÓÚÌÓ¯ÂÌËÂ Ì‡ ‰ÂÙËÌËˆËflÚ‡ Á‡ ıËÔÓÔÎ‡ÁËfl Ì‡ ÇÄ. çflÍÓË‡‚ÚÓË ‰ÂÙËÌË‡Ú ıËÔÓÔÎ‡ÒÚË˜Ì‡ ÇÄ, ÍÓ„‡ÚÓ ‰ÛÔÎÂÍÒÒÓÌÓ„‡ÙÒÍË Úfl Â ÔÓ-Ï‡ÎÍ‡ ÓÚ 2 ÏÏ., ‡ ‰Û„Ë ÍÓ„‡ÚÓ ÚflÂ ÔÓ-Ï‡ÎÍ‡ ÓÚ 3 ÏÏ. ‚ ‰Ë‡ÏÂÚ˙ (6,18,29). Ç 1,9% ‰Ó 6%ÓÚ ÒÎÛ˜‡ËÚÂ ÒÂ ÓÚÍË‚‡ ıËÔÓÔÎ‡ÁËfl Ì‡ ÇÄ, Í‡ÚÓ Úfl Â ÔÓ-˜ÂÒÚ‡ Á‡ ‰flÒÌ‡Ú‡ ÇÄ (6,18,29). Ç ÍÎËÌË˜Ì‡Ú‡ Ô‡ÍÚËÍ‡ÒÂ ÔËÂÏ‡, ˜Â ÇÄ Â ıËÔÓÔÎ‡ÒÚË˜Ì‡ ÍÓ„‡ÚÓ Â Ò ‰Ë‡ÏÂÚ˙ÔÓ-Ï‡Î˙Í ÓÚ 3 ÏÏ. Ë Â‰ÌÓ‚ÂÏÂÌÌÓ Ò ÚÓ‚‡ ÌÂÈÌ‡Ú‡ ÒËÒ-ÚÓÎË˜Ì‡ Ë ‰Ë‡ÒÚÓÎË˜Ì‡ ÒÍÓÓÒÚ Ò‡ ÒÌËÊÂÌË, ‡ ËÌ‰ÂÍÒËÚÂÌ‡ ÂÁËÒÚÂÌÚÌÓÒÚ Ò‡ ÔÓ‚Ë¯ÂÌË (10). ÑÓÔ˙ÎÌËÚÂÎÂÌ ÍË-ÚÂËÈ Á‡ ıËÔÓÔÎ‡ÁËfl Ì‡ ÇÄ Â ÍÓÏÔÂÌÒ‡ÚÓÌÓ ÔÓ-¯ËÓÍ‡-Ú‡ ÍÓÌÚ‡Î‡ÚÂ‡ÎÌ‡ ÇÄ (> 5 ÏÏ.).

ëéçéÉêÄîëäé àáëãÖÑÇÄçÖ à ÇöáåéÜçàÉêÖòäà èêà àçëéçàêÄçÖíé çÄ ÇÄ

ÇÂÚÂ·‡ÎÌËÚÂ ‡ÚÂËË ËÏ‡Ú ÌÂ·Î‡„ÓÔËflÚÌÓ ‡Ì‡-ÚÓÏË˜ÌÓ ÔÓÎÓÊÂÌËÂ, ÍÓÂÚÓ Ò˙Á‰‡‚‡ ËÁ‚ÂÒÚÌË ÚÂıÌË˜ÂÒ-ÍË Á‡ÚÛ‰ÌÂÌËfl ÔË ÚflıÌÓÚÓ ÒÓÌÓ„‡ÙÒÍÓ ËÁÒÎÂ‰‚‡ÌÂ(5,30). íÂ Ò‡ ‡ÁÔÓÎÓÊÂÌË Ì‡ ÔÓ-„ÓÎflÏ‡ ‰˙Î·Ó˜ËÌ‡ ‚ Ò‡‚-ÌÂÌËÂ Ò Í‡ÓÚË‰ÌËÚÂ ‡ÚÂËË Ë ÔÓ‡‰Ë ÚflıÌÓÚÓÔÂÍ˙Ò‚‡ÌÂ ‚ ars transversaria (‚ÂÚÂ·‡ÎÂÌ ÍÓÒÚÂÌ Í‡-Ì‡Î) ˜ÂÒÚÓ Â Á‡ÚÛ‰ÌÂÌ‡ ÓˆÂÌÍ‡Ú‡ Ì‡ ÔÓÚË˜‡ÌÂÚÓ ËÏ(8,15).

èÓ‰Ó·ÌÓ Ì‡ ÇëÄ, ÒÔÂÍÚ‡ÎÌ‡Ú‡ ‚˙ÎÌ‡ Ì‡ ÇÄ ÔÓÍ‡Á‚‡ÌÂÁÌ‡˜ËÚÂÎÌ‡ ÔÛÎÒ‡ÚË‚ÌÓÒÚ. ÄÍÛÒÚË˜ÌÓ ÇÄ ÒÂ ı‡‡ÍÚÂ-ËÁË‡ Ò ÏÂÍ ÌËÒÍÓ˜ÂÒÚÓÚÂÌ ÒË„Ì‡Î, ÍÓÈÚÓ ÔË ÌÓÏ‡ÎÌ‡Ì‡ıÓ‰Í‡ ÓÔÂ‰ÂÎÂÌÓ fl ÓÚÎË˜‡‚‡ ÓÚ ÒÔÂÍÚ‡ÎÌËfl ÒË„Ì‡ÎÌ‡ èÄ Ë ÓÍˆËÔËÚ‡ÎÌ‡Ú‡ ‡ÚÂËfl. ÑÓÔÎÂ ÒÓÌÓ„‡ÙÒÍÓÚÓÈ Ë‰ÂÌÚËÙËˆË‡ÌÂ Â ÁÌ‡˜ËÚÂÎÌÓ Á‡ÚÛ‰ÌÂÌÓ ÔË ıËÔÓÔÎ‡-ÁËfl ËÎË ÔË ‰ËÒÚ‡ÎÌË Ó·ÚÛ‡ˆËÓÌÌË ÔÓˆÂÒË (24).

● àÌÒÓÌË‡ÌÂ Ì‡ V1 ÒÂ„ÏÂÌÚ Ë ‚˙ÁÏÓÊÌË „Â¯ÍË(2,6,24): àÁÒÎÂ‰‚‡ ÒÂ ‚ Ì‡‰ÍÎ˛˜Ë˜Ì‡Ú‡ flÏÍ‡ Á‡‰ Î‡ÚÂ‡Î-ÌÓÚÓ Í‡˜Â Ì‡ m. sternocleidomastoideus Ì‡ 2 ÒÏ. Ì‡‰ ÍÎ˛-˜Ëˆ‡Ú‡, Í‡ÚÓ Ú‡ÌÒ‰˛ÒÂ‡ Â ‡ÁÔÓÎÓÊÂÌ ÏÂ‰ËÓÍ‡Û‰‡ÎÌÓ.èÓÁËˆËflÚ‡ Ì‡ ÒÓÌ‰‡Ú‡, ÔÓÒÓÍ‡Ú‡ Ì‡ Í˙‚ÌËfl ÚÓÍ, ÒÍÓÓ-ÒÚÌ‡Ú‡ ÍË‚‡, Í‡ÍÚÓ Ë ÒÔÂÍÚ‡ÎÌËfl ‡Ì‡ÎËÁ ÓÔÂ‰ÂÎflÚÑÓÔÎÂ ÒÓÌÓ„‡ÙÒÍ‡Ú‡ ı‡‡ÍÚÂËÒÚËÍ‡ Ì‡ ÇÄ ‚ ÚÓÁËÒÂ„ÏÂÌÚ. ÇÄ Â Ò˙Ò ÁÌ‡˜ËÚÂÎÌÓ ÔÓ-ÌËÒÍ‡ ÒËÒÚÓÎË˜Ì‡ ‡ÏÔ-ÎËÚÛ‰‡ ‚ Ò‡‚ÌÂÌËÂ Ò ‡ÏÔÎËÚÛ‰‡Ú‡ Ì‡ ‚˙ÚÂ¯Ì‡Ú‡ Ò˙Ì-Ì‡ ‡ÚÂËfl (ÇëÄ), Ò ‚ËÒÓÍ‡ Ë ‰Ó·Â ËÁ‡ÁÂÌ‡ ‰Ë‡ÒÚÓÎË˜-Ì‡ ‚˙ÎÌ‡, ·ÂÁ Ì‡ÎË˜ËÂ Ì‡ ‰Ë‡ÒÚÓÎË˜ÌÓ ÔÎ‡ÚÓ Ë Ò ‰Ó·Â ËÁ-‡ÁÂÌ ÒÔÂÍÚ‡ÎÂÌ ÔÓÁÓÂˆ. à‰ÂÌÚËÙËˆË‡ ÒÂ ˜ÂÁ ÂÔÂ-ÚËÚË‚Ì‡ ÍÓÏÔÂÒËfl ‚ Ó·Î‡ÒÚÚ‡ Ì‡ pars atlantis (23).äÓÏÔÂÒËflÚ‡ ÒÂ ÓÒ˙˘ÂÒÚ‚fl‚‡ Ì‡ ‚˙ÁÏÓÊÌÓ Ì‡È-Ï‡Î˙ÍÛ˜‡ÒÚ˙Í, ÏÂÊ‰Û Ï‡ÒÚÓË‰ÌËfl ËÁ‡ÒÚ˙Í Ë Ì‡ÔÂ˜ÌËfl ËÁ-‡ÒÚ˙Í Ì‡ Atlas. ÖÙÂÍÚ˙Ú Â ËÁ‡ÁÂÌ ÓÌ‰ÛÎË‡˘ ÒË„Ì‡Î‚˙‚ V1 ÒÂ„ÏÂÌÚ, ÒËÌıÓÌÂÌ Ò ÍÓÏÔÂÒËflÚ‡ ‚˙‚ V3. ëË„-Ì‡Î˙Ú Â ‰Ó·Â ËÁ‡ÁÂÌ ÔË ÒÎ‡·Ë ıÓ‡, ÌÓ ÔË Ô‡ˆËÂÌÚË ÒËÁ‡ÁÂÌ‡ ‚‡ÚÌ‡ ÏÛÒÍÛÎ‡ÚÛ‡ ËÎË ‰˙Î·ÓÍÓ ÎÂÊ‡˘‡ ÇÄÏÓÊÂ ‰‡ ·˙‰Â ÒÎ‡·Ó ËÁ‡ÁÂÌ.

éÚ ‡Ì‡ÚÓÏË˜Ì‡ „ÎÂ‰Ì‡ ÚÓ˜Í‡ Ì‡˜‡ÎÌËflÚ ÒÂ„ÏÂÌÚ Ì‡‰flÒÌ‡Ú‡ ‚ÂÚÂ·‡ÎÌ‡ ‡ÚÂËfl Â ÔÓ-ÎÂÒÂÌ Á‡ ‰ÛÔÎÂÍÒ ÒÓ-ÌÓ„‡ÙÒÍ‡ Ë‰ÂÌÚËÙËÍ‡ˆËfl ‚ Ò‡‚ÌÂÌËÂ Ò ÎÂ‚Ëfl V1 ÒÂ„-ÏÂÌÚ (4,17,20). àÁÎËÁ‡ÌÂÚÓ Ì‡ Îfl‚‡Ú‡ ÇÄ ÓÚ èÄ Â ÁÌ‡˜Ë-ÚÂÎÌÓ ÔÓ-ÔÓÍÒËÏ‡ÎÌÓ, ÂÒÔÂÍÚË‚ÌÓ ÔÓ- ‰˙Î·ÓÍÓ ‚ Ò‡‚-


ÌÂÌËÂ Ò ËÁÎËÁ‡ÌÂÚÓ È ÓÚ ‰flÒÌÓ.ç‡È-˜ÂÒÚËÚÂ ‚˙ÁÏÓÊÌË „Â¯ÍË ÔË ÑÓÔÎÂ ÒÓÌÓ„‡-

ÙÒÍÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ Ì‡ ÇÄ ‚˙‚ V1 ÒÂ„ÏÂÌÚ Ò‡ ÌÂÚÓ˜ÌÓÚÓÓˆÂÌfl‚‡ÌÂ Ì‡ ÇÄ Í‡ÚÓ Ó·˘‡ Ò˙ÌÌ‡ ‡ÚÂËfl (éëÄ), ‰ÓÎÌ‡ÚËÂÓË‰Ì‡ ‡ÚÂËfl ËÎË ÔÓ‰ÍÎ˛˜Ë˜Ì‡ ‡ÚÂËfl (ÔÓÍÒË-Ï‡ÎÂÌ ÒÂ„ÏÂÌÚ).

èË ËÌÒÓÌË‡ÌÂ Ì‡ Ó·˘‡Ú‡ Ò˙ÌÌ‡ ‡ÚÂËfl Ú‡ÌÒ‰˛-ÒÂ˙Ú Â Ì‡ÒÓ˜ÂÌ ‚ÂÌÚÓÏÂ‰Ë‡ÎÌÓ Ë Í‡Û‰‡ÎÌÓ (Á‡ V1 Â Ì‡-ÒÓ˜ÂÌ ÔÓ‚Â˜Â ‰ÓÁÓÏÂ‰Ë‡ÎÌÓ Ë Í‡Û‰‡ÎÌÓ). ÇÄ ÒÂ Ì‡ÏË‡Î‡ÚÂ‡ÎÌÓ ÓÚ éëÄ. èË ‚˙Á‡ÒÚÌË ıÓ‡ ‡ÁÒÚÓflÌËÂÚÓÏÂÊ‰Û ‰‚ÂÚÂ ‡ÚÂËË ÒÂ Û‚ÂÎË˜‡‚‡, ÍÓÂÚÓ Ó·ÎÂÍ˜‡‚‡ ËÁÒ-ÎÂ‰‚‡ÌÂÚÓ. ÇÄ Â Ò ÔÓ-ÌËÒÍ‡ ÒËÒÚÓÎË˜Ì‡ Ë ‰Ë‡ÒÚÓÎË˜Ì‡ÒÍÓÓÒÚ ‚ Ò‡‚ÌÂÌËÂ Ò éëÄ. á‡ ‡ÁÎËÍ‡ ÓÚ ÇÄ, Ó·˘‡Ú‡Ò˙ÌÌ‡ ‡ÚÂËfl ÒÂ ÔÓÒÎÂ‰fl‚‡ ÑÓÔÎÂ ÒÓÌÓ„‡ÙÒÍË ‰Ó·Â ‚Í‡ÌË‡ÎÌ‡ ÔÓÒÓÍ‡. ÇÄ ÏÓÊÂ ‰‡ ÒÂ ÔÓÒÎÂ‰Ë Í‡ÌË‡ÎÌÓ Ò‡-ÏÓ ˜‡ÒÚË˜ÌÓ. äÓÏÔÂÒËflÚ‡ ‚˙‚ V3 ÒÂ„ÏÂÌÚ ÔÂ‰ËÁ‚ËÍ‚‡ÓÌ‰ÛÎË‡˘ ÒË„Ì‡Î ‚˙‚ V1 ÒÂ„ÏÂÌÚ, ÌÓ Ï‡Í‡ Ë fl‰ÍÓ ·ËÏÓ„ÎÓ ‰‡ ÒÂ ÍÓÏÔÂÒË‡ a. occipitalis (ÍÎÓÌ Ì‡ a. carotisexterna ) Ë ‰‡ ÒÂ ÔÓÎÛ˜Ë ÌÂÁÌ‡˜ËÚÂÎÂÌ ÓÌ‰ÛÎË‡˘ ÒË„Ì‡Î Ë‚ éëÄ.

èË ÑÓÔÎÂ ÒÓÌÓ„‡ÙÒÍÓ ËÁÒÎÂ‰‚‡ÌÂ ‰ÓÎÌ‡Ú‡ ÚËÂÓË‰-Ì‡ ‡ÚÂËfl ÒÂ Ë‰ÂÌÚËÙËˆË‡ ÔÓ˜ÚË Ò˙Ò Ò˙˘ÓÚÓ Ì‡Ô‡‚-ÎÂÌËÂ Ì‡ ÒÓÌ‰‡Ú‡, Í‡ÍÚÓ Ë Ì‡˜‡ÎÌËfl ÒÂ„ÏÂÌÚ Ì‡ ÇÄ. íflËÁÎËÁ‡ ÓÚ truncus thyreocervicalis (Ì‡ÏË‡˘ ÒÂ Î‡ÚÂ‡ÎÌÓÓÚ ÇÄ) Ë Í‡ÚÓ ÒÂ Ì‡ÒÓ˜‚‡ ‚ Í‡Û‰‡ÎÌ‡ ÔÓÒÓÍ‡ ÔÓÚË˜‡ ÏÂ-‰Ë‡ÎÌÓ ÓÚ ÇÄ. ëÍÓÓÒÚÌ‡Ú‡ È ÍË‚‡ ÔËÎË˜‡ Ì‡ ÒÍÓÓ-ÒÚÌ‡Ú‡ ÍË‚‡Ú‡ Ì‡ ÇÄ, ÌÓ Â Ò ÔÓ-ÒÎ‡· ÔÛÎÒ‡ÚËÎËÚÂÚ. á‡‡ÁÎËÍ‡ ÓÚ ÇÄ, ÔË ÔËÚËÒÍ‡ÌÂ Ì‡ ˘ËÚÓ‚Ë‰Ì‡Ú‡ ÊÎÂÁ‡,Í˙‚ÌËfl ÚÓÍ ‚ ‰ÓÎÌ‡Ú‡ ÚËÂÓË‰Ì‡ ‡ÚÂËfl ÒËÎÌÓ Ì‡Ï‡-Îfl‚‡. ífl ÌÂ Â‡„Ë‡ ÔË ÍÓÏÔÂÒËfl ‚ Ó·Î‡ÒÚÚ‡ Ì‡ parsatlantis. èË Ô‡ˆËÂÌÚË Ò Û‚ÂÎË˜ÂÌ‡ ˘ËÚÓ‚Ë‰Ì‡ ÊÎÂÁ‡,Í˙‚ÌËfl ÚÓÍ ‚ ÚËÂÓË‰Ì‡Ú‡ ‡ÚÂËfl ÒÂ Û‚ÂÎË˜‡‚‡ ÁÌ‡˜Ë-ÚÂÎÌÓ Ë ÒË„Ì‡Î˙Ú È ÏÓÊÂ ‰‡ “ÒÍËÂ” ÒË„Ì‡Î‡, ÔÓÎÛ˜ÂÌ ÓÚÇÄ. V1 ÒÂ„ÏÂÌÚ.

èË Ë‰ÂÌÚËÙËˆË‡ÌÂÚÓ Ì‡ V1 ÒÂ„ÏÂÌÚ ˜ÂÒÚÓ ÒÂ ÔÓfl-‚fl‚‡ ÒÏÂÒÂÌ ÒË„Ì‡Î, Ë‰‚‡˘ ÓÚ ÇÄ Ë ÓÚ ÔÓÍÒËÏ‡ÎÌËfl ÒÂ„-ÏÂÌÚ Ì‡ èÄ. ë˙˘ÂÒÚ‚Û‚‡Ú ÌflÍÓÎÍÓ ÓÔÓÌË ÔÛÌÍÚ‡ Á‡ÚflıÌÓÚÓ ‡Á„‡ÌË˜‡‚‡ÌÂ. èÄ ËÏ‡ ÚËÔË˜Ì‡ ÑÓÔÎÂÓ‚‡ÍË‚‡ Ë ÒÔÂÍÚ‡ÎÂÌ ‡Ì‡ÎËÁ Í‡ÚÓ ‚ÒË˜ÍË ‡ÚÂËË, Í˙‚ÓÒ-Ì‡·‰fl‚‡˘Ë ÏÛÒÍÛÎËÚÂ Ì‡ Í‡ÈÌËˆËÚÂ: ÒÚ˙ÏÌÓ ÒËÒÚÓ-ÎË˜ÌÓ Ì‡‡ÒÚ‚‡ÌÂ, ·˙ÁÓ ÒÔ‡‰‡ÌÂ Ì‡ ÒËÒÚÓÎË˜Ì‡Ú‡ ‚˙ÎÌ‡‰Ó ÌÛÎÂ‚‡Ú‡ ÎËÌËfl Ò ÔÓÒÎÂ‰‚‡˘‡ ‡ÌÌÓ ‰Ë‡ÒÚÓÎË˜Ì‡ ËÌˆË-ÁÛ‡ Ë Ó·˙˘‡ÌÂ Ì‡ ÒÍÓÓÒÚÌ‡Ú‡ ÍË‚‡ ÔÓ‰ ÌÛÎÂ‚‡Ú‡ ÎË-ÌËfl. çÂ Â‡„Ë‡ ÔË ÍÓÏÔÂÒËfl ‚ ‰ËÒÚ‡ÎÌËfl ÒÂ„ÏÂÌÚ Ì‡ÇÄ. èË ÍÓÏÔÂÒËfl Ì‡ ıÓÏÓÎ‡ÚÂ‡ÎÌ‡Ú‡ ·‡ıË‡ÎÌ‡ ‡-ÚÂËfl ‚ èÄ ÒÂ Â„ËÒÚË‡ ‰Ó·Â ËÁ‡ÁÂÌ ÓÌ‰ÛÎË‡˘ ÒË„-Ì‡Î, ÒËÌıÓÌÂÌ Ò ÍÓÏÔÂÒËflÚ‡. èË Ë‰ÂÌÚËÙËˆË‡ÌÂÚÓÌ‡ ÇÄ Úfl Úfl·‚‡ ‰‡ ÒÂ ÔÓÒÎÂ‰Ë ‚ Í‡ÌË‡ÎÌ‡ ÔÓÒÓÍ‡ ‰ÓÌ‡‚ÎËÁ‡ÌÂÚÓ È ‚˙‚ ‚ÂÚÂ·‡ÎÌËfl Í‡Ì‡Î. Ç ÌflÍÓË ÒÎÛ˜‡Ë Ì‡ÔÓÍÒËÏ‡ÎÌÓ ËÎË Í‡Û‰‡ÎÌÓ ËÁÎËÁ‡ÌÂ Ì‡ ÇÄ, Úfl ÏÓÊÂ ‰‡ ·˙-‰Â Ï‡ÒÍË‡Ì‡ ÓÚ èÄ Ë ‰ÛÔÎÂÍÒ ÒÓÌÓ„‡ÙÒÍÓÚÓ È Ë‰ÂÌÚË-ÙËˆË‡ÌÂ Â ÁÌ‡˜ËÚÂÎÌÓ Á‡ÚÛ‰ÌÂÌÓ ËÎË ÌÂ‚˙ÁÏÓÊÌÓ.

èË Ú‡ÌÒ‰˛ÒÂ ÔÓÁËˆËÓÌË‡Ì Î‡ÚÂ‡ÎÌÓ ÓÚ V1 ÒÂ„-ÏÂÌÚ ·Ë ÏÓ„ÎÓ ‰‡ ÒÂ Ë‰ÂÌÚËÙËˆË‡Ú Ë ‰Û„Ë ˆÂ‚ËÍ‡ÎÌËÍÎÓÌÓ‚Â Ì‡ truncus thyreo- Ë costocervicalis, ÍÓÂÚÓ ËÏ‡ ÁÌ‡˜Â-ÌËÂ ÔÂ‰ËÏÌÓ ÔË Ó·ÚÛ‡ˆËfl Ì‡ ÇÄ. Truncus thyreocervicalisÍ˙‚ÓÒÌ‡·‰fl‚‡ ÏÛÒÍÛÎË Ë Ô‡ÂÌıËÏÂÌ Ó„‡Ì (˘ËÚÓ‚Ë‰Ì‡ÊÎÂÁ‡) Ë ËÏ‡ ÚËÔË˜ÂÌ ÒÔÂÍÚ˙ Ò ÔÓ-ÌËÒÍ‡ ‰Ë‡ÒÚÓÎË˜Ì‡ÍÓÏÔÓÌÂÌÚ‡ ‚ Ò‡‚ÌÂÌËÂ Ò ÇÄ. äÓÏÔÂÒËflÚ‡ Ì‡ ˘ËÚÓ‚Ë‰-Ì‡Ú‡ ÊÎÂÁ‡, Í‡ÍÚÓ Ë ÍÓÏÔÂÒËflÚ‡ ‚ pars atlantis ‰‡‚‡Ú ‚˙Á-ÏÓÊÌÓÒÚ Á‡ ‡ÁÎË˜‡‚‡ÌÂ Ì‡ ‰‚‡Ú‡ Í˙‚ÓÌÓÒÌË Ò˙‰‡.

● àÌÒÓÌË‡ÌÂ Ì‡ V2 ÒÂ„ÏÂÌÚ Ë ‚˙ÁÏÓÊÌË „Â¯ÍË(6): êars transversaria Â ‰ÓÒÚ˙ÔÌ‡ Â‰ËÌÒÚ‚ÂÌÓ Á‡ ‰ÛÔÎÂÍÒÒÓÌÓ„‡ÙÒÍÓ ËÁÒÎÂ‰‚‡ÌÂ. í‡ÌÒ‰˛ÒÂ˙Ú ÒÂ ‡ÁÔÓÎ‡„‡ ‚ÒÂ‰ÌËfl ¯ËÂÌ Â„ËÓÌ-Ô‡‡ÏÂ‰Ë‡ÌÌÓ, ÔÂÔÂÌ‰ËÍÛÎflÌÓ, ‚ÔÂ‰ÌÓ-Á‡‰Ì‡ ÔÓÒÓÍ‡ (‡ÌÚÂÓ-ÔÓÒÚÂËÓÌ‡ ÔÎÓÒÍÓÒÚ). ÇÂÁÛÎÚ‡Ú Ì‡ ‡ÍÛÒÚË˜ÌËÚÂ ÒÂÌÍË, Ó·‡ÁÛ‚‡ÌË ÓÚ Ì‡ÔÂ˜-

ÌËÚÂ ËÁ‡ÒÚ˙ˆË Ì‡ ë6 ‰Ó ë2 ÔÂ¯ÎÂÌË, ÚÓÁË ÒÂ„ÏÂÌÚ ÂÌ‡È-ÎÂÒÂÌ Á‡ ‰ÛÔÎÂÍÒ ÒÓÌÓ„‡ÙÒÍÓ Ë‰ÂÌÚËÙËˆË‡ÌÂ. Ç ÚÓ-ÁË ÒÂ„ÏÂÌÚ ÇÄ ÔÓÚË˜‡ ‚ Ô‡‚‡ ÔÓÒÓÍ‡, Í‡ÚÓ ‚ÂÌÚÓÎ‡-ÚÂ‡ÎÌÓ ÓÚ ÌÂfl Ó·ËÍÌÓ‚ÂÌÓ ÔÓÚË˜‡ ‚ÂÚÂ·‡ÎÌ‡Ú‡ ‚Â-Ì‡. é·ËÍÌÓ‚ÂÌÓ ËÁÒÎÂ‰‚‡˘ËflÚ Â ‡ÁÔÓÎÓÊÂÌ Á‡‰ „Î‡‚‡Ú‡Ì‡ Ô‡ˆËÂÌÚ‡ (7).

àÌÒÓÌË‡ÌÂÚÓ Ì‡ ÇÄ Â ‚˙ÁÏÓÊÌÓ Í‡ÍÚÓ ˜ÂÁ Ç-mode,Ú‡Í‡ Ë ˜ÂÁ ˆ‚ÂÚÌÓ-ÍÓ‰Ë‡Ì‡ ‰ÛÔÎÂÍÒ ÒÓÌÓ„‡ÙËfl. ÇÄ ÂÓˆ‚ÂÚÂÌ‡ Ó·ËÍÌÓ‚ÂÌÓ ‚ ˜Â‚ÂÌ ˆ‚flÚ, ‡ Ô‡‡ÎÂÎÌÓ ‰Ó ÌÂflÔÓÚË˜‡ ‚ ÒËÌ¸Ó Óˆ‚ÂÚÂÌ‡Ú‡ ‚ÂÌ‡. èË Ì‡ÍÎÓÌfl‚‡ÌÂ ËÎËËÁÍË‚fl‚‡ÌÂ Ì‡ ˆ‚ÂÚÌËfl ÔÓÁÓÂˆ ÔÂÁ ÍÓÈÚÓ ÒÂ ËÌÒÓÌË-‡ ÇÄ, ÎÂÒÌÓ ÒÂ ÔÓÎÛ˜‡‚‡ ‡‚ÚÓÏ‡ÚË˜Ì‡ ÒÏflÌ‡ Ì‡ ˆ‚ÂÚ‡-ÓÚ ˜Â‚ÂÌ ÇÄ ÏÓÊÂ ‰‡ ÒÂ Óˆ‚ÂÚË ‚ ÒËÌ ˆ‚flÚ. èÓ Ú‡ÁËÔË˜ËÌ‡ Ë Á‡ Ô‡‚ËÎÌÓÚÓ ÓÔÂ‰ÂÎflÌÂ ÔÓÒÓÍ‡Ú‡ Ì‡ ÔÓÚË-˜‡ÌÂ Ì‡ ÇÄ, ˆ‚ÂÚÌÓÚÓ ÍÓ‰Ë‡ÌÂ Ì‡ ËÔÒËÎ‡ÚÂ‡ÎÌ‡Ú‡ Í‡-ÓÚË‰Ì‡ ‡ÚÂËfl ÒÎÛÊË Á‡ ÓËÂÌÚË. ë‡‚Ìfl‚‡ÌÂÚÓ Ì‡ˆ‚ÂÚÌÓÚÓ ÍÓ‰Ë‡ÌÂ Ì‡ ÇÄ Ò ÍÓ‰Ë‡ÌÂÚÓ Ì‡ ËÔÒËÎ‡ÚÂ‡Î-Ì‡Ú‡ Í‡ÓÚË‰Ì‡ ‡ÚÂËfl Â ÓÚ Â¯‡‚‡˘Ó ÁÌ‡˜ÂÌËÂ Á‡ ÓÔ-Â‰ÂÎflÌÂ ÔÓÒÓÍ‡Ú‡ Ì‡ Í˙‚ÌËfl ÔÓÚÓÍ ‚˙‚ ÇÄ (9). éÚÓ„-‡‰ÌÓ ÔÓÚË˜‡˘‡Ú‡ ÇÄ Â ÍÓ‰Ë‡Ì‡ ‚ Ò˙˘Ëfl ˆ‚flÚ, Í‡ÍÚÓË ıÓÏÓÎ‡ÚÂ‡ÎÌÓ ÔÓÚË˜‡˘‡Ú‡ éëÄ.

ÑÓÔ˙ÎÌËÚÂÎÌ‡ ËÌÙÓÏ‡ˆËfl Á‡ ‰˙Î·Ó˜ËÌ‡Ú‡ Ì‡ ÍÓflÚÓ Â‡ÁÔÓÎÓÊÂÌ‡ ÇÄ, Í‡ÍÚÓ Ë Á‡ ÔÓÒÓÍ‡Ú‡ È Ì‡ ÔÓÚË˜‡ÌÂ ÒÂÔÓÎÛ˜‡‚‡ ÔË ËÌÒÓÌË‡ÌÂÚÓ È ‚ Ú‡ÌÒ‚ÂÁ‡ÎÂÌ ÔÎ‡Ì. èËÓÚÓ„‡‰ÌÓ ÔÓÚË˜‡ÌÂ ÇÄ Ë Ò˙ÌÌ‡Ú‡ ‡ÚÂËfl Ò‡ ÍÓ‰Ë‡-ÌË ‚ Â‰ËÌ Ë Ò˙˘Ë ˆ‚flÚ (˜Â‚ÂÌ), ‡ ˛„ÛÎ‡Ì‡Ú‡ ‚ÂÌ‡ Â ÍÓ-‰Ë‡Ì‡ ‚ ÒËÌ ˆ‚flÚ. Ç ÒÎÛ˜‡Ë Ì‡ subclavian steal ÙÂÌÓÏÂÌ,ÂÚÓ„‡‰ÌÓ ÔÓÚË˜‡˘‡Ú‡ ÇÄ, ·Ë ÏÓ„Î‡ ·˙ÁÓ ‰‡ ·˙‰ÂË‰ÂÌÚËÙËˆË‡Ì‡, ˜ÂÁ ˆ‚ÂÚÌÓ-ÍÓ‰Ë‡Ì‡ ‰ÛÔÎÂÍÒ ÒÓÌÓ„‡-ÙËfl. Ç ÚÓÁË ÒÎÛ˜‡È ˆ‚ÂÚÌÓÚÓ ÍÓ‰Ë‡ÌÂ Ì‡ ÇÄ ÍÓÌÚ‡Ò-ÚË‡ Ò ˆ‚ÂÚ‡ Ì‡ Í‡ÓÚË‰Ì‡Ú‡ ‡ÚÂËfl. Ç ÒÎÛ˜‡È, ˜Â Ò˙-˘ÂÒÚ‚Û‚‡Ú ÔÓ‰ÓÁÂÌËfl Á‡ ÂÚÓ„‡‰ÌÓ ÔÓÚË˜‡˘‡ ÇÄ ÂÓÚ ‚‡ÊÌÓ ÁÌ‡˜ÂÌËÂ, Úfl ‰‡ ·˙‰Â ËÁÒÎÂ‰‚‡Ì‡ ËÁˆflÎÓ ÔÓ ÌÂÈ-ÌÓÚÓ ÔÓÚÂÊÂÌËÂ ‚ ÎÓÌ„ËÚÛ‰ËÌ‡ÎÂÌ ÔÎ‡Ì, Á‡ ‰‡ ·˙‰‡ÚËÁÍÎ˛˜ÂÌË Ô‡ÚÓÎÓ„Ë˜ÌË ËÁ‚Ë‚ÍË, ‚Ó‰Â˘Ë ‰Ó Ó·˙˘‡ÌÂ Ì‡Í˙‚ÌËfl ÚÓÍ.

á‡ Ô˙ÎÌÓÚ‡ Ì‡ ‰ÛÔÎÂÍÒ ÒÓÌÓ„‡ÙÒÍÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ ÓÒ-‚ÂÌ ‚ ÔÂ‰ÌÓ-Á‡‰ÌÓ Ì‡Ô‡‚ÎÂÌËÂ, V2 ÒÂ„ÏÂÌÚ Ì‡ ÇÄ Â ÌÂ-Ó·ıÓ‰ËÏÓ ‰‡ ·˙‰Â ËÁÒÎÂ‰‚‡Ì Ë ‚ ÒÚ‡ÌË˜ÂÌ ÔÎ‡Ì. á‡ ÛÎÂÒ-Ìfl‚‡ÌÂ Ì‡ ËÁÒÎÂ‰‚‡ÌÂÚÓ Â ÌÂÓ·ıÓ‰ËÏÓ „Î‡‚‡Ú‡ Ì‡ ·ÓÎÌËfl‰‡ ·˙‰Â Ó·˙Ì‡Ú‡ Ì‡ ÔÓÚË‚ÓÔÓÎÓÊÌ‡Ú‡ ÒÚ‡Ì‡.

● àÌÒÓÌË‡ÌÂ Ì‡ V3 ÒÂ„ÏÂÌÚ Ë ‚˙ÁÏÓÊÌË „Â¯ÍË(2,6,24): àÌÒÓÌË‡ ÒÂ ÔÓ‰ Ï‡ÒÚÓË‰ÌËfl ËÁ‡ÒÚ˙Í Á‡‰ Á‡‰-ÌËfl ˙· Ì‡ m. sternocleidomastoideus. ÉÎ‡‚‡Ú‡ Ì‡ Ô‡ˆËÂÌÚ‡Â Ó·˙Ì‡Ú‡ Ì‡ ÔÓÚË‚ÓÔÓÎÓÊÌ‡Ú‡ Ì‡ ËÁÒÎÂ‰‚‡ÌÂÚÓÒÚ‡Ì‡. èË Ì‡ÒÓ˜‚‡ÌÂ Ì‡ Ú‡ÌÒ‰˛ÒÂ‡ ÏÂ‰ËÓ-Í‡ÌË‡ÎÌÓ‚ ÔÓÒÓÍ‡ ÏÂÊ‰Û ÍÓÌÚ‡Î‡ÚÂ‡ÎÌÓÚÓ ÛıÓ Ë ÓÍÓ Í˙‚ÌËflÚÓÍ Â Ò ÔÓÒÓÍ‡ ÓÚ ÒÓÌ‰‡Ú‡ Ì‡‚˙Ì Ë ÒÍÓÓÒÚÌ‡Ú‡ ÍË‚‡ ÂÌ‡‰ ÌÛÎÂ‚‡Ú‡ ÎËÌËfl.

èË ÔÂÏÂÒÚ‚‡ÌÂ Ì‡ Ú‡ÌÒ‰˛ÒÂ‡ ‚ ıÓËÁÓÌÚ‡ÎÌ‡ÔÎÓÒÍÓÒÚ ËÎË ‚ ÏÂ‰ËÓ-Í‡Û‰‡ÎÌ‡ ÔÓÒÓÍ‡, ‰ÓË ÎÂÍÓ ‰ÓÁ‡Î-ÌÓ, Í˙‚ÌËflÚ ÚÓÍ Â ‚ ÔÓÒÓÍ‡ Í˙Ï Ú‡ÌÒ‰˛ÒÂ‡, ‡ ÒÍÓÓ-ÒÚÌ‡Ú‡ ÍË‚‡ Â ÔÓ‰ ÌÛÎÂ‚‡Ú‡ ÎËÌËfl (ÍËÚÂËË Á‡ Ë‰ÂÌ-ÚËÙËÍ‡ˆËfl).

óÂÒÚÓ Ò ÔÓÏÓ˘Ú‡ Ì‡ ˆ‚ÂÚÌÓ-ÍÓ‰Ë‡Ì‡ ‰ÛÔÎÂÍÒ ÒÓÌÓ„-‡ÙËfl Â ‚˙ÁÏÓÊÌÓ Â‰ÌÓ‚ÂÏÂÌÌÓÚÓ Ë‰ÂÌÚËÙËˆË‡ÌÂ Ì‡‰‚ÂÚÂ ˜‡ÒÚË Ì‡ ·ËÏÍ‡Ú‡ Ì‡ ÇÄ ‚ Ú‡ÁË Ó·Î‡ÒÚ (atlasloop).

èË ËÌÒÓÌË‡ÌÂÚÓ ‚ ÚÓÁË ÒÂ„ÏÂÌÚ ÇëÄ Ë ÓÍˆËÔËÚ‡Î-Ì‡Ú‡ ‡ÚÂËfl ÏÓ„‡Ú ÔÓ„Â¯ÌÓ ‰‡ ·˙‰‡Ú ËÌÚÂÔÂÚË‡-ÌË Í‡ÚÓ ÇÄ.

èË ÌÂÁÌ‡˜ËÚÂÎÌÓ ÔÂÏÂÒÚ‚‡ÌÂ Ì‡ Ú‡ÌÒ‰˛ÒÂ‡ ‚˙‚‚ÂÌÚ‡ÎÌ‡ ÔÓÒÓÍ‡, ÏÂ‰Ë‡ÎÌÓ ‡ÁÔÓÎÓÊÂÌ‡ ÇëÄ ÏÓÊÂ ‰‡·˙‰Â ÔËÂÚ‡ Á‡ ÇÄ. Ñ‚ÂÚÂ ‡ÚÂËË ÒÂ ‡ÁÎË˜‡‚‡Ú ÔÓÑÓÔÎÂ ÒÓÌÓ„‡ÙÒÍ‡ ı‡‡ÍÚÂËÒÚËÍ‡, Í‡ÚÓ ÇëÄ ÏÓÊÂ‰‡ ÒÂ ÔÓÒÎÂ‰Ë Ë Í‡Û‰‡ÎÌÓ. êÂ„ËÒÚË‡ÌÂÚÓ Ì‡ Â‰ÌÓ Ë Ò˙-˘Ó ÏflÒÚÓ Ì‡ Í˙‚ÂÌ ÚÓÍ Ì‡ÒÓ˜ÂÌ Í˙Ï Ë Í˙‚ÂÌ ÚÓÍ Ì‡ÒÓ-


˜ÂÌ Ì‡‚˙Ì ÓÚ ÒÓÌ‰‡Ú‡ Â ‰ÓÔ˙ÎÌËÚÂÎÂÌ ÍËÚÂËÈ Á‡ Ë‰ÂÌ-ÚËÙËˆË‡ÌÂÚÓ Ì‡ ÇÄ È Á‡ ÌÂÈÌÓÚÓ ‰ËÙÂÂÌˆË‡ÌÂ ÓÚÇëÄ.

éÍˆËÔËÚ‡ÎÌ‡Ú‡ ‡ÚÂËfl ËÏ‡ ‡ÁÎË˜Ì‡ ÑÓÔÎÂ ÒÓÌÓ„-‡ÙÒÍ‡ ı‡‡ÍÚÂËÒÚËÍ‡ ‚ Ò‡‚ÌÂÌËÂ Ò ÇÄ. í‡ÁË ‡ÚÂËflËÏ‡ ÎËÔÒ‚‡˘‡ ËÎË ÒÎ‡·Ó ËÁ‡ÁÂÌ‡ ‰Ë‡ÒÚÓÎË˜Ì‡ ‚˙ÎÌ‡, ÚË-ÔË˜ÌÓ Á‡ ‡ÚÂËfl Í˙‚ÓÒÌ‡·‰fl‚‡˘‡ ÏÛÒÍÛÎË. ê‡ÁÔÓÎÓÊÂÌ‡Â ÔÓ‰ÍÓÊÌÓ Ë ÎÂÒÌÓ ÒÂ ÔËÚËÒÍ‡ Ò Ú‡ÌÒ‰˛ÒÂ‡ ËÎË ÒÔ˙ÒÚ Ì‡ ¯ËÓÍ‡ ÓÒÌÓ‚‡. êÂÁÛÎÚ‡Ú˙Ú Â Ì‡Ï‡Îfl‚‡ÌÂ ËÎËËÁ˜ÂÁ‚‡ÌÂ Ì‡ Í˙‚ÌËfl ÚÓÍ. éÍˆËÔËÚ‡ÎÌ‡Ú‡ ‡ÚÂËflÛ˜‡ÒÚ‚‡ ‚˙‚ ÙÓÏË‡ÌÂÚÓ Ì‡ ‡Ì‡ÒÚÓÏÓÁ‡ Ë ËÁÔ˙ÎÌfl‚‡‚‡ÊÌ‡ ÍÓÎ‡ÚÂ‡ÎÌ‡ ÙÛÌÍˆËfl.

● àÌÒÓÌË‡ÌÂ Ì‡ V4 ÒÂ„ÏÂÌÚ Ë ÅÄ Ë ‚˙ÁÏÓÊÌË„Â¯ÍË (6,24): ÑÓÔÎÂ ÒÓÌÓ„‡ÙÒÍÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ ÒÂ ÓÒ˙-˘ÂÒÚ‚fl‚‡ ˜ÂÁ ÒÛ·ÓÍˆËÔËÚ‡ÎÂÌ (Ú‡ÌÒÌÛı‡ÎÂÌ) ‰ÓÒÚ˙Ô(ÔÂÁ Foramen magnum) ÔË ÒÂ‰Ì‡ÎË Ô‡ˆËÂÌÚË Ò ÓÚÔÛÒÌ‡-Ú‡ Ë Ì‡‚Â‰ÂÌ‡ Ì‡ÔÂ‰ „Î‡‚‡. í‡ÌÒ‰˛ÒÂ˙Ú ÒÂ Ì‡ÒÓ˜‚‡ ÎÂÍÓÎ‡ÚÂ‡ÎÌÓ ÓÚ Ò‡„ËÚ‡ÎÌ‡Ú‡ ‡‚ÌËÌ‡ Í˙Ï ‚ÂÊ‰ËÚÂ Ì‡ Ô‡ˆË-ÂÌÚ‡, Ì‡Îfl‚Ó ËÎË Ì‡‰flÒÌÓ ÓÚ ÌÂfl ‰Ó ÔÓÎÛ˜‡‚‡ÌÂ Ì‡ ÓÔÚËÏ‡-ÎÂÌ ÒË„Ì‡Î ÓÚ ÇÄ. àÁÒÎÂ‰‚‡ÌÂÚÓ ÏÓÊÂ ‰‡ ÒÂ ÔÓ‚Â‰Â Ë ÔËÎÂ„Ì‡ÎË ÒÚ‡ÌË˜ÌÓ Ô‡ˆËÂÌÚË, ÔË ÒÚ‡·ËÎËÁË‡ÌÂ Ì‡ „Î‡‚‡-Ú‡ Ò ÓÔÓ‡. á‡ ÅÄ Ú‡ÌÒ‰˛ÒÂ˙Ú Â Ì‡ÒÓ˜ÂÌ ÔÓ ÔÓÒÓÍ‡ Ì‡‚ÂÊ‰ËÚÂ Ì‡ ËÁÒÎÂ‰‚‡ÌËfl ‚ Ò‡„ËÚ‡ÎÌ‡ ‡‚ÌËÌ‡.

ÑÛÔÎÂÍÒ ÒÓÌÓ„‡ÙÒÍË ÇÄ Ë ÅÄ ÒÂ ËÁÒÎÂ‰‚‡Ú ˜ÂÁÚ‡ÌÒÌÛı‡ÎÂÌ ‰ÓÒÚ˙Ô (3), ÔÓÒÂ‰ÒÚ‚ÓÏ 2-2.25 MHz ÒÂÍ-ÚÓÌË Ú‡ÌÒ‰˛ÒÂË ËÎË ÔÓÒÂ‰ÒÚ‚ÓÏ ÔÓÒÎÂ‰Ì‡ „ÂÌÂ‡-ˆËfl ÓÚ 3.5 MHz Phased array Ú‡ÌÒ‰˛ÒÂË. Ç 98%-99%ÓÚ ÒÎÛ˜‡ËÚÂ, ÇÄ Ë ÅÄ ÏÓ„‡Ú Ì‡‰ÂÊ‰ÌÓ ‰‡ ·˙‰‡Ú ËÁÒÎÂ‰-‚‡ÌË (13). è‡ˆËÂÌÚ˙Ú Â ÒÂ‰Ì‡Î ËÎË ÎÂ„Ì‡Î ‚ ÒÚ‡ÌË˜ÌÓÔÓÎÓÊÂÌËÂ Ò ÎÂÍÓ Ì‡‚Â‰ÂÌ‡ Ì‡ÔÂ‰ „Î‡‚‡. ëÓÌ‰‡Ú‡ ÒÂ ÔÓÒ-Ú‡‚fl ÒÛ·ÓÍˆËÔËÚ‡ÎÌÓ ÔÓ ÒÂ‰Ì‡ ÎËÌËfl. ä‡ÚÓ ÓËÂÌÚË ‚B-mode ÒÂ ËÁÔÓÎÁ‚‡ ıËÔÓÂıÓ„ÂÌÌ‡Ú‡ Ó‚‡ÎÌ‡ ÒÚÛÍÚÛ‡ Ì‡Foramen magnum (21,27). ëÎÂ‰ ÔÂ‚ÍÎ˛˜‚‡ÌÂÚÓ ‚ ÂÊËÏÌ‡ ˆ‚ÂÚÌÓ-ÍÓ‰Ë‡Ì‡ ‰ÛÔÎÂÍÒ ÒÓÌÓ„‡ÙËfl, ‰‚ÂÚÂ ‚ÂÚÂ·-‡ÎÌË ‡ÚÂËË ÒÂ Ë‰ÂÌÚËÙËˆË‡Ú ÒÚ‡ÌË˜ÌÓ ÓÚForamen magnum. ÅÄ Ë ‰‚ÂÚÂ ÇÄ Ò‡ ÍÓ‰Ë‡ÌË ÔÓ Ô‡‚ËÎÓ‚ ÒËÌ ˆ‚flÚ, Ó·ÓÁÌ‡˜‡‚‡˘Ó Í˙‚ÂÌ ÚÓÍ Ò ÔÓÒÓÍ‡ Ì‡‚˙Ì ÓÚÒÓÌ‰‡Ú‡. èË ÓÔÚËÏ‡ÎÌÓ ËÌÒÓÌË‡ÌÂ, ÍÓÌÙË„Û‡ˆËflÚ‡ÓÚ ÚËÚÂ Ò˙‰‡ ÒÂ ‚ËÁÛ‡ÎËÁË‡ Í‡ÚÓ ·ÛÍ‚‡Ú‡ Y. àÌÚ‡Í-‡ÌË‡ÎÌËfl ÒÂ„ÏÂÌÚ Ì‡ ÇÄ Ë Ì‡ ÅÄ ÏÓÊÂ ‰‡ ÒÂ ËÌÒÓÌË‡ÔÓ-ÎÂÒÌÓ ÔÓÒÂ‰ÒÚ‚ÓÏ Ú‡ÌÒÍ‡ÌË‡ÎÌ‡ ‰ÛÔÎÂÍÒ ÒÓÌÓ„‡-ÙËfl, ÓÚÍÓÎÍÓÚÓ Ò ÍÓÌ‚ÂÌˆËÓÌ‡ÎÌ‡ Ú‡ÌÒÍ‡ÌË‡ÎÌ‡ ÑÓÔ-ÎÂÓ‚‡ ÒÓÌÓ„‡ÙËfl.

Ñ˙Î·Ó˜ËÌ‡Ú‡ Ì‡ ËÌÒÓÌË‡ÌÂ Ì‡ ÛÒÚËÂÚÓ Ì‡ ÅÄ Â ‰ËÒÍÛ-ÚË‡Ì‡ ˜ÂÒÚÓ ‚ ÎËÚÂ‡ÚÛ‡Ú‡ (16,25). BA ÒÂ ËÌÒÓÌË‡Ì‡ ‰˙Î·Ó˜ËÌ‡ 55-80 ÏÏ, Í‡ÚÓ ÔÂ‰Ë 65-70 ÏÏ. ˜ÂÒÚÓ ÒÂ ÛÒ-Ú‡ÌÓ‚fl‚‡ ·Ë‰ËÂÍˆËÓÌ‡ÎÂÌ ÑÓÔÎÂÓ‚ ÒË„Ì‡Î (Í˙‚ÂÌ ÚÓÍÓÚ ıÓÏÓÎ‡ÚÂ‡ÎÌ‡Ú‡ Á‡‰ÌÓ- ‰ÓÎÌ‡ Ï‡ÎÍÓÏÓÁ˙˜Ì‡ ‡ÚÂ-Ëfl ËÎË ÓÚ ÂÒÚÂÒÚ‚ÂÌ‡ ËÁ‚Ë‚Í‡ Ì‡ ÇÄ) (1). ç‡È-˜ÂÒÚÓ‰˙Î·Ó˜ËÌ‡Ú‡ Ì‡ ÍÓflÚÓ ‰‚ÂÚÂ ÇÄ ÒÂ Ò‚˙Á‚‡Ú ‚ ÅÄ Â ÓÍÓ-ÎÓ 70-80 ÏÏ. é·ËÍÌÓ‚ÂÌÓ ÒÂ ËÁÒÎÂ‰‚‡Ú Ì‡È-‰ËÒÚ‡ÎÌËÚÂÒÂ„ÏÂÌÚË Ì‡ ÇÄ.

ÅÄ ÒÂ ËÌÒÓÌË‡ ÏÂÊ‰Û 85 Ë 120 ÏÏ, Í‡ÚÓ Ò Ú‡Í˙‚‰ÓÒÚ˙Ô Ë ‰˙Î·Ó˜ËÌ‡ ÏÓÊÂ ‰‡ ÒÂ Ë‰ÂÌÚËÙËˆË‡ Ò‡ÏÓ ÅÄ(1). Ç ÎÂ„Ì‡ÎÓ ÔÓÎÓÊÂÌËÂ Ë Ò ÔÓ-ÒËÎÂÌ Ì‡ÚËÒÍ ‚˙ıÛÚ‡ÌÒ‰˛ÒÂ‡, ‡ÚÂËËÚÂ ÏÓ„‡Ú ‰‡ ÒÂ ËÌÒÓÌË‡Ú Ë Ì‡ ÔÓ-ÌËÒÍ‡ ‰˙Î·Ó˜ËÌ‡ (Ò ÓÍÓÎÓ 10 ÏÏ. ÔÓ-ÌËÒÍ‡).

ÅÄ Â ˜ÂÒÚÓ ËÁ‚ËÚ‡ Ë Ì‡„˙Ì‡Ú‡, ÍÓÂÚÓ Á‡ÚÛ‰Ìfl‚‡ ÁÌ‡-˜ËÚÂÎÌÓ Ë‰ÂÌÚËÙËˆË‡ÌÂÚÓ È. Ç ÚÂÁË ÒÎÛ˜‡Ë Ú‡ÌÒ‰˛-ÒÂ˙Ú Úfl·‚‡ ‰‡ ÒÂ ÔÓÁËˆËÓÌË‡ ÒÔflÏÓ ‡Ì‡ÚÓÏË˜Ì‡Ú‡ÓÒÓ·ÂÌÓÒÚ Ì‡ ‡ÚÂËflÚ‡. èË ‰ÛÔÎÂÍÒ ÒÓÌÓ„‡ÙÒÍÓ ËÁÒ-ÎÂ‰‚‡ÌÂ Ì‡ ‰ËÒÚ‡ÎÌËfl ÒÂ„ÏÂÌÚ Ì‡ ÅÄ (top of the basilarartery) ÔÓ‡‰Ë „ÓÎflÏ‡Ú‡ ‰˙Î·Ó˜ËÌ‡ Ì‡ ËÌÒÓÌË‡ÌÂ (? 100ÏÏ.), ËÁÒÎÂ‰‚‡ÌÂÚÓ Â ÚÂıÌË˜ÂÒÍË ÎËÏËÚË‡ÌÓ. Ç Ú‡ÍË‚‡ÒÎÛ˜‡Ë ‰ËÒÚ‡ÎÌ‡Ú‡ ˜‡ÒÚ Ì‡ ÅÄ ÒÂ ËÌÒÓÌË‡ ÔÓ-‰Ó·Â ˜ÂÁÚ‡ÌÒÚÂÏÔÓ‡ÎÂÌ ‰ÓÒÚ˙Ô. ãËÏËÚË‡˘ Ù‡ÍÚÓ ÚÛÍ ÏÓ-ÊÂ ‰‡ ÒÂ fl‚Ë Á‡Ú‚‡flÌÂÚÓ Ì‡ ÚÂÏÔÓ‡ÎÌËfl ÔÓÁÓÂˆ. àÁ-

‚ÂÒÚÌÓ Â, ˜Â Ò Ì‡ÔÂ‰‚‡ÌÂ Ì‡ ‚˙Á‡ÒÚÚ‡ Ë ÓÒÓ·ÂÌÓ ÔË ÔÓ-‚˙Á‡ÒÚÌËÚÂ ÊÂÌË, ÚÂÏÔÓ‡ÎÌËflÚ ÔÓÁÓÂˆ ÒÂ Á‡Ú‚‡fl(12,19,28). Ç ÚÂÁË ÒÎÛ˜‡Ë ÒÂ ÔÂÔÓ˙˜‚‡ ÛÔÓÚÂ·‡Ú‡ Ì‡ÂıÓ-ÍÓÌÚ‡ÒÚÌË ‚Â˘ÂÒÚ‚‡, ÍÓËÚÓ ÛÒËÎ‚‡Ú Á‡ ËÁ‚ÂÒÚÌÓ‚ÂÏÂ ÛÎÚ‡Á‚ÛÍÓ‚Ëfl ÒË„Ì‡Î Ë Ô‡‚flÚ ‚˙ÁÏÓÊÂÌ Ú‡ÌÒ-ÚÂÏÔÓ‡ÎÌËfl ‰ÓÒÚ˙Ô Ë ÔË ‚˙Á‡ÒÚÌË Ô‡ˆËÂÌÚË(11,14,22).

● ïËÔÓÔÎ‡ÁËfl Ì‡ ÇÄ Ë ‚˙ÁÏÓÊÌË „Â¯ÍË. èË ıË-ÔÓÔÎ‡ÁËfl ÇÄ Â Ò Ì‡Ï‡ÎÂÌ Í˙‚ÂÌ ÚÓÍ, Û‚ÂÎË˜ÂÌÓ Ò˙‰Ó‚ÓÒ˙ÔÓÚË‚ÎÂÌËÂ Ë ÍÓÏÔÂÌÒ‡ÚÓÌÓ Û‚ÂÎË˜ÂÌ ‰Ë‡ÏÂÚ˙ Ì‡ÍÓÌÚ‡Î‡ÚÂ‡ÎÌ‡Ú‡ ÇÄ. ïËÔÓÔÎ‡ÒÚË˜Ì‡Ú‡ ÇÄ Ò˙Á‰‡‚‡‰ËÙÂÂÌˆË‡ÎÌÓ-‰Ë‡„ÌÓÒÚË˜ÌË ÚÛ‰ÌÓÒÚË ÔË ‡ÁÎË˜‡‚‡-ÌÂÚÓ È ÓÚ ÔÓÍÒËÏ‡ÎÌ‡ ÓÍÎÛÁËfl Ì‡ ÇÄ. Ç ÚÂÁË ÒÎÛ˜‡Ë ËÌ-ÒÓÌË‡ÌÂÚÓ Ì‡ ˆÂ‚ËÍ‡ÎÌÓ ‡Á‚ËÚ‡ ÍÓÎ‡ÚÂ‡ÎÌ‡ ÏÂÊ‡Ô‡‚Ë Ò˙˘ÂÒÚ‚Û‚‡ÌÂÚÓ Ì‡ ÔÓÍÒËÏ‡ÎÌ‡ ÓÍÎÛÁËfl ÏÌÓ„ÓÔÓ-‚ÂÓflÚÌÓ (23). ñflÎÓÒÚÌÓÚÓ ËÌÒÓÌË‡ÌÂ Ì‡ ÂÍÒÚ‡Í-‡ÌË‡ÎÌËfl ıÓ‰ Ì‡ ÇÄ ÒÔÓÏ‡„‡ Ò˙˘Ó Á‡ ÔÓÒÚ‡‚flÌÂ Ì‡ ‰Ë‡„-ÌÓÁ‡Ú‡.

åÌÓ„Ó ÚÛ‰ÌÓ Â ‡ÁÎË˜‡‚‡ÌÂÚÓ Ì‡ ıËÔÓÔÎ‡ÒÚË˜Ì‡ ÇÄÓÚ ‰ËÒÚ‡ÎÌ‡ ÒÚÂÌÓÁ‡ Ì‡ ÇÄ, Á‡˘ÓÚÓ Ë ‚ ‰‚‡Ú‡ ÒÎÛ˜‡fl ‰Ë-‡ÒÚÓÎË˜Ì‡Ú‡ ÍÓÏÔÓÌÂÌÚ‡ Â ÒÌËÊÂÌ‡. ÑÛÔÎÂÍÒ ÒÓÌÓ„‡ÙÒ-ÍÓÚÓ Ò‡‚ÌÂÌËÂ Ì‡ ‰Ë‡ÏÂÚ˙‡ Ì‡ ÇÄ ÓÚ ‰‚ÂÚÂ Ë ÒÚ‡ÌËÏÓÊÂ ‰‡ ·˙‰Â Â¯‡‚‡˘Ó Á‡ ‰Ë‡„ÌÓÁ‡Ú‡ (6).

ÑË‡„ÌÓÒÚË˜ÌË ÚÛ‰ÌÓÒÚË Ò˙˘ÂÒÚ‚Û‚‡Ú Ë ‚ ÒÎÛ˜‡Ë Ì‡ıËÔÓÔÎ‡ÒÚË˜Ì‡ ÇÄ, ÔÓ‰˙ÎÊ‡‚‡˘‡ ËÌÚ‡Í‡ÌË‡ÎÌÓ ‚‰ÓÎÌÓ- Á‡‰Ì‡ Ï‡ÎÍÓÏÓÁ˙˜Ì‡ ‡ÚÂËfl, ·ÂÁ Ò˙Â‰ËÌfl‚‡ÌÂ ÒÔÓÚË‚ÓÔÓÎÓÊÌ‡Ú‡ ÇÄ (10). Ç Ú‡ÍË‚‡ ÒÎÛ˜‡Ë ÒÔÂÍÚ‡Î-Ì‡Ú‡ ‚˙ÎÌ‡ ËÏ‡ ÚËÔË˜ÌË ·ÂÎÂÁË Ì‡ ‰ËÒÚ‡ÎÌ‡ Ó·ÒÚÛÍˆËfl(ÔÓ‚Ë¯ÂÌ ÔÛÎÒ‡ÚË‚ÂÌ ËÌ‰ÂÍÒ Ë Â‰ÛˆË‡Ì‡ ‰Ë‡ÒÚÓÎË˜Ì‡ÒÍÓÓÒÚ). ÑË‡ÒÚÓÎË˜Ì‡Ú‡ ‚˙ÎÌ‡ ÒÂ fl‚fl‚‡ Â¯‡‚‡˘ ‰Ë‡„-ÌÓÒÚË˜ÂÌ ÍËÚÂËÈ. èË ıËÔÓÔÎ‡ÁËfl Úfl Â ÒËÎÌÓ Â‰ÛˆË-‡Ì‡, ‰ÓÍ‡ÚÓ ÔË ‰ËÒÚ‡ÎÌ‡ ÓÍÎÛÁËfl Úfl ÎËÔÒ‚‡ (6).

Ç Á‡ÍÎ˛˜ÂÌËÂ Úfl·‚‡ ‰‡ ÒÂ ÓÚ·ÂÎÂÊË, ˜Â ˆflÎÓÒÚÌ‡Ú‡ÔÂˆÂÌÍ‡ Ì‡ ıÂÏÓ‰ËÌ‡ÏË˜ÌËÚÂ Ô‡‡ÏÂÚË Ì‡ ÇÄ, ‰‚ÛÒÚ-‡ÌÌÓÚÓ Ò‡‚Ìfl‚‡ÌÂ Ì‡ ‡ÚÂËflÚ‡, Í‡ÍÚÓ Ë ÓˆÂÌÍ‡Ú‡ Ì‡‰Ë‡ÏÂÚ˙‡ Ì‡ ÇÄ Ò‡ ÓÚ Â¯‡‚‡˘Ó ÁÌ‡˜ÂÌËÂ Á‡ ËÁ·fl„‚‡ÌÂ Ì‡ÛÎÚ‡ÒÓÌÓ„‡ÙÒÍË ‰Ë‡„ÌÓÒÚË˜ÌË „Â¯ÍË. í‚˙‰Â ‚‡ÊÌ‡ Â ËˆflÎÓÒÚÌ‡Ú‡ ıÂÏÓ‰ËÌ‡ÏË˜Ì‡ ÓˆÂÌÍ‡ Ì‡ ‚ÒË˜ÍË ËÌÒÓÌË‡ÌËÂÍÒÚ‡- Ë ËÌÚ‡Í‡ÌË‡ÎÌË ‡ÚÂËË (6).

ãàíÖêÄíìêÄ1. èÂÚÓ‚ Ç, òÓÚÂÍÓ‚ è. äËÚÂËË Á‡ Ë‰ÂÌÚËÙËÍ‡ˆËfl Ì‡ ·‡Á‡ÎÌËÚÂÏÓÁ˙˜ÌË ‡ÚÂËË ‚ ÍÌ. ìÎÚ‡Á‚ÛÍÓ‚‡ ‰Ë‡„ÌÓÁ‡ Ì‡ Ò˙‰Ó‚ÂÚÂ Ì‡ ÏÓÁ˙Í‡ Ë Í‡È-ÌËˆËÚÂ ÔÓ‰ Â‰. Ì‡ òÓÚÂÍÓ‚ è. ëÓÙËfl, ãË‰Â ÔÂÒ, 1998; 28-33.2. òÓÚÂÍÓ‚ è. ÑÓÔÎÂÓ‚‡ ÒÓÌÓ„‡ÙËfl Ì‡ ÂÍÒÚ‡Í‡ÌË‡ÎÌËÚÂ Ë ÔÂËÙÂÌË‡ÚÂËË Ë ‚ÂÌË. åà “ãË‰Â ÔÂÒ”, ëÓÙËfl, 1998.3. Aaslid R. Transcranial Doppler examination techniques. In: TranscranialDoppler Sonography. Aaslid R. Wien, Springer 1986, 39-59.4. Ackerstaff RGA, Eikelboom BC, Moll FL. Investigation of the vertebralartery in cerebral atherosclerosis. Eur J Vasc Surg 1991; 5:229-235. 5. Ackerstaff RGA, Grosveld WHJM, Eikelboom BC, et al. Ultrasonic duplexscanning of the prevertebral segment of the vertebral artery in patients with cere-bral atherosclerosis. Eur J Vasc Surg 1988; 2:387-393.6. Bartels E. Color-coded duplex ultrasonography of the cerebral vessels. Atlasand manual. Stuttgart; New York: Schattauer, 1999.7. Bartels E. Farbkodierte Dopplersonographie der Vertebralarterien. Vergleichmit der konventionellen Duplexsonographie. Ultraschall in Med 1992; 13:59-66.8. Bartels E. Duplexsonographie der Vertebralarterien, 1. Teil. PraktischeDurchfuerung, Moeglichkeiten und Grenzen der Methode, 2. Teil. KlinischeAnvendungen. Ultraschall in Med 1991; 12:54-69.9. Bartels E, Fluegel KA. Advantages of color Doppler imaging for the evalua-tion of vertebral arteries. J Neuroimaging 1993; 3:229-233.10. Bartels E. Vertebral sonography. In: Neurosonology. Tegeler CH, BabikianVL, Gomez CR (eds). St. Louis: Mosby 1995; 83-100.11. Baumgartner RW, Arnold M, Gonner F, Staikov IN, Herrmann C, Rivoir A,Muri RM. Contrast-enhanced transcranial color-coded duplex sonography inischemic cerebrovascular disease. Stroke 1997; 28:2473-2478.12. Baumgartner RW, Baumgartner I, Mattle HP, et al. Transcranial color-codedduplex sonography in the evaluation of collateral flow through the circle of Willis.AJNR Am J Neuroradiology 1997; 18:127-133.13. Baumgartner RW, Mattle HP, Schroth G, et al. Die transkranielle farbkodierteDuplexsonographie beim Erwachsenen. Schweiz Med Wochenschr 1993; 123:2102-2109.14. Becker G, Lindner A, Bogdahn U. Imaging of the vertebro-basilar system bytranscranial color-coded real-time sonography J Ultrasound Med 1993; 12:395-401.15. Bluth EI, Merritt CRB, Sullivan MA, et al. Usefulness of duplex ultrasoundin evaluating vertebral arteries. J Ultrasound Med 1989a; 8:229-235. 16. Buedingen HJ, Staudacher T. Die Identifiezierung der Arteria basilaris mi dertranskraniellen Doppler-Sonographie. Ultraschall in Med 1987; 8:95-101.


17. Davis PC, Nilsen B, Braun IF et al. A prospective comparison of duplexsonography vs angiography of the vertebral arteries. AJNR 1986; 7:1059-1064.18. Delcker A, Diener HC. Die verschiedene Ultraschallmethoden zurUntersuchung der Arteria vertebralis-eine vergleichende Wertung. Ultraschall inMed 1992; 13:213-220.19. Grolimud P, Seiler RW. Age dependence of the flow velocity in the basalcerebral arteries: a transcranial Doppler ultrasound study. Ultrasound Med Biol1988; 14:191-198.20. Jack JG, Hoeneveld H, van der Windt JM et al. A six year evaluation ofduplex scanning of the vertebral artery: a noninvasive technique compared withcontrast angiography. J Vasc Tech 1989; 1:26-30.21. Kaps M, Seidel G, Bauer T et al. Imaging of the intracranial vertebrobasilarsystem using color–coded ultrasound. Stroke 1992; 23:1577-1582.22. Otis S, Ruch M, Boyajian R. Contrast-enhanced transcranial imaging. Resultsof an American phase-two study. Stroke 1995; 26:203-209.23. v Reutern GM, Budingen HJ: Ultraschalldiagnostik der hirnversorgendenArterien. Stuttgart: Thieme 1993.24. v Reutern GM, Budingen HJ: Ultraschalldiagnostik der hirnversorgendenArterien. Georg Thieme Verlag, Stuttgart, New York 1989.25. Ringelstein EB, Kahlschauer B, Niggermeyer E, et al. Transcranial Dopplersonography: Anatomical landmarks and normal velocity values. Ultrasound MedBiol 1990; 16:745-761.26. Schreiner R, Bartels E, Nadjafi U et al. Quantification of obstructions in dis-tal vertebral arteries or basilar artery with extracranial duplex color-flow imaging.In: New Trends in Cerebral Hemodinamics and Neurosonology. Klingelhoefer J,

Bartels E, Ringelstein EB (eds). Amsterdam: Elsevier 1997; 73-78.27. SchoeningM, Walter J. Evaluation of the vertebrobasilar posterior system bytranscranial color duplex sonography in adults. Stroke 1992; 23:1280-1286. 28. Seidel G, Kaps M, Gerriets T. Potential and limitation of transcranial color-coded sonography in stroke patients. Stroke 1995; 26:2061-2066.29. Touboul PJ, Bousser MG, Laplane D et al. Duplex scanning of normal verte-bral arteries. Stroke 1986; 17:921-923.30. Visona A, Lusiani L, Castellani V, et al. The echo-Doppler (duplex) systemfor the detection of vertebral artery occlusive disease: Comparison with angiogra-phy. J Ultrasound Med 1986; 5:247-250.

Ä‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËfl:‰- à‚‡Ì ëÚ‡ÈÍÓ‚, ‰.Ï.ÉÎ‡‚ÂÌ ‡ÒËÒÚÂÌÚ Í˙Ï äÎËÌËÍ‡ ÔÓ çÂ‚ÓÎÓ„ËflìåÅÄã “ñ‡Ëˆ‡ âÓ‡ÌÌ‡”ÛÎ. ÅflÎÓ ÏÓÂ 81527 ëÓÙËflíÂÎ: 9432 571Ö-mail: [email protected]


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SUMMARY

MONITORING OF EARLY AND DELAYED NEURO-LOGICAL COMPLICATIONS IN CARDIAC SURGERY

PATIENTSP. Atanassova

Neurological complications after cardiac surgery remain arelatively ◊common” problem despite improvements in anes-thetic and surgical techniques as well as in perioperative mon-itoring and management. They are associated with signifi-cantly increased morbidity and mortality. The overall preva-lence of neurological complications after cadiac surgery isnearly 16% and suggests the need of systematic preoperativeevaluation of patients for identifying those with high risk andindividualization of the surgical strategy. Postoperative cogni-tive deficit occurs in up to 80% of patients after cardiac sur-gery. Stroke remains a devastating complication after cardiacsurgical procedures with an incidence between 0,8 % and 16,8%. Identification of predictors of cognitive impairment and ofstroke is important for understanding their pathogenesis andfor developing preventive strategies. Careful perioperativeneurological and neuropsychological monitoring should bemandatory for preventing and adequately treating neurologi-cal complications after cardiac surgery.

Key words: monitoring, cardiac surgery, neurologicalcomplications.

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ñÖã. àÌÙÓÏ‡ˆËÓÌÂÌ ‡Ì‡ÎËÁ Ì‡ Á‡·ÓÎÂ‚‡ÂÏÓÒÚÚ‡ ÓÚÔÂıÓ‰ÌË ËÎË ÔÂÏ‡ÌÂÌÚÌË ÌÂ‚ÓÎÓ„Ë˜ÌË ÛÒÎÓÊÌÂÌËfl ÔËÔ‡ˆËÂÌÚË, ÔÂÊË‚flÎË Í‡‰ËÓıËÛ„Ë˜Ì‡ ËÌÚÂ‚ÂÌˆËfl ËÌ‡ ËÒÍÓ‚ËÚÂ Ù‡ÍÚÓË Ò ÚflıÌ‡Ú‡ „ÂÌÂÁ‡, ÏÓÌËÚÓËÌ„ ËÁÌ‡˜ËÏÓÒÚ (‚ ÔÓ„ÌÓÒÚË˜ÌË ÏÓ‰ÂÎË) Á‡ ËÁıÓ‰ÌËfl ÌÂ‚ÓÎÓ-„Ë˜ÂÌ ‰ÂÙËˆËÚ.

Ç ÍÓÌÚÂÍÒÚ‡ Ì‡ Â‰Ëˆ‡Ú‡ ÔÓ·ÎÂÏË, Ò‚˙Á‡ÌË Ò ·ÓÎ-ÌËfl ‚ Í‡‰ËÓıËÛ„Ëfl, ÌÂ‚ÓÎÓ„Ë˜ÌÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ ÚÛ‰-ÌÓ ÒÂ ‚„‡Ê‰‡ Ë ‰ÓË ÒÂ ÍÓÌÙÓÌÚË‡ Ò ÔÂ‰- Ë ÔÓÒÚÓÔÂ-‡ÚË‚ÌÓÚÓ Ò˙ÒÚÓflÌËÂ Ì‡ Ô‡ˆËÂÌÚ‡. óÂÒÚÓ Ô‡ˆËÂÌÚËÚÂÔÂ‰ÓÔÂ‡ÚË‚ÌÓ Ò‡ ÚÂÊÍÓ ÙÛÌÍˆËÓÌ‡ÎÌÓ Ó·ÂÏÂÌÂÌË ËÓ„‡ÌË˜ÂÌË ‚˙‚ ‚˙ÁÏÓÊÌÓÒÚÚ‡ ‰‡ Ò˙‰ÂÈÒÚ‚‡Ú Á‡ Ó·ÒÚÓ-ÂÌ ÌÂ‚ÓÎÓ„Ë˜ÂÌ ÔÂ„ÎÂ‰. á‡·‡‚ÂÌÓÚÓ ÔÓÒÚÓÔÂ‡ÚË‚ÌÓ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂ Ò˙˘Ó ËÁËÒÍ‚‡ ‚ÂÏÂ Ë ËÌÚÂÌÁË‚ÌË „ËÊË‚ Â‡ÌËÏ‡ˆËfl Ë ÔÂÔflÚÒÚ‚‡ Ô˙ÎÌÓÚÓ ÌÂ‚ÓÎÓ„Ë˜ÌÓ ËÁÒ-ÎÂ‰‚‡ÌÂ Ì‡ Ô‡ˆËÂÌÚ‡. ëÎÂ‰ ·ÂÁÔÓ·ÎÂÏÌÓ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂÓÚ Í‡‰ËÓıËÛ„Ë˜Ì‡ Ì‡ÏÂÒ‡, ·ÓÎÍËÚÂ Ë ËÁÚÓ˘ÂÌËÂÚÓÒ˙˘Ó Â‰ÛˆË‡Ú ËÁÔ˙ÎÌÂÌËÂÚÓ Ì‡ ÌÂ‚ÓÎÓ„Ë˜ÌËÚÂ ÔÓ·ËË ÚÂÒÚÓ‚ÂÚÂ. åÌÓ„Ó ÓÚ Ô‡ˆËÂÌÚËÚÂ ‡Á‚Ë‚‡Ú ‰ÂÔÂ-ÒËfl, ÍÓflÚÓ Ì‡Î‡„‡ ÔËÂÏ‡ÌÂ Ì‡ ÏÂ‰ËÍ‡ÏÂÌÚË, ÍÓËÚÓ ÔÓ‚-ÎËfl‚‡Ú Ì‡ÒÚÓÂÌËÂÚÓ, ÒÚÂÔÂÌÚ‡ Ì‡ ‚ÌËÏ‡ÌËÂ Ë ÔÂÔflÚ-ÒÚ‚‡Ú ÌÂ‚ÓÎÓ„Ë˜ÌÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ (44).

çÂ‚ÓÎÓ„Ë˜ÌËflÚ ÔÂ„ÎÂ‰ Úfl·‚‡ ‰‡ ÒÂ ÔÓ‚ÂÊ‰‡ Í‡Í-ÚÓ ÔÂ‰ÓÔÂ‡ÚË‚ÌÓ, Ú‡Í‡ Ë ‰Ó 3-4 ‰ÂÌ ÒÎÂ‰ ËÌÚÂ‚ÂÌˆËfl.èÂÔÓ˙˜‚‡ ÒÂ ‰‡ ‚ÍÎ˛˜‚‡ 7 ÔÛÌÍÚ‡: ÔÒËıË˜ÂÌ ÒÚ‡ÚÛÒ,ËÁÒÎÂ‰‚‡ÌÂ Ì‡ ˜ÂÂÔÌÓÏÓÁ˙˜ÌË ÌÂ‚Ë, ÒÛıÓÊËÎÌË Ë Ì‡‰ÍÓ-ÒÚÌË ÂÙÎÂÍÒË (‚ÍÎ˛˜ËÚÂÎÌÓ Ó‡ÎÌË ‡‚ÚÓÏ‡ÚËÁÏË),‰‚Ë„‡ÚÂÎÌÓÒÚ, ÒÂÚË‚ÌÓÒÚ, ˆÂÂ·ÂÎ‡ÌË ÙÛÌÍˆËË, ÔÓÁ‡ ËÔÓıÓ‰Í‡ (15). ç‡ Ô‡ÍÚËÍ‡ ÒÎÂ‰ ÓÔÂ‡ˆËfl ËÁÒÎÂ‰‚‡ÌÂÚÓ ÒGlasgow Coma Score ‰‡‚‡ ‰Ó·‡ ËÌÙÓÏ‡ˆËfl, Á‡ ÒÚÂÔÂÌ-Ú‡ Ì‡ Ì‡Û¯ÂÌÓ Ò˙ÁÌ‡ÌËÂ, ÏÛÒÍÛÎÌ‡Ú‡ ÒËÎ‡ Ë Ò˙ÒÚÓflÌËÂ-ÚÓ Ì‡ ÒÛıÓÊËÎÌËÚÂ Ë Ì‡‰ÍÓÒÚÌË ÂÙÎÂÍÒË. éÒ‚ÂÌ Ú‡ÁËÔÓÔÛÎflÌ‡ ÒÍ‡Î‡ Ò‡ ËÁ‚ÂÒÚÌË Ë ‰Û„Ë, ÔÓ-ÔÂˆËÁÌË ÒÍ‡ÎË –NIH Scale, European Stroke Scale, Barthel Index. íÂ ÔÂ‰Ò-Ú‡‚Îfl‚‡Ú ÒÚ‡Ì‰‡ÚËÁË‡ÌË ÏÂÚÓ‰Ë Á‡ ÓÚ˜ËÚ‡ÌÂ Ì‡ Â-ÁÛÎÚ‡ÚË Ë ÔÓÁ‚ÓÎfl‚‡Ú Â‰Ëˆ‡ Ò˙ÔÓÒÚ‡‚ÍË. ëÍ‡Î‡Ú‡EuroSCORE ÍÎ‡ÒËÙËˆË‡ Ô‡ˆËÂÌÚËÚÂ Ì‡ ÌËÒÍÓ, ÒÂ‰ÌÓ Ë‚ËÒÓÍÓ ËÒÍÓ‚Ë Á‡ ÌÂ‚ÓÎÓ„Ë˜ÌÓ ÛÒÎÓÊÌÂÌËÂ (18). àÁÒÎÂ‰-‚‡ÌÂÚÓ Á‡ ÁËÚÂÎÂÌ ‰ÂÙËˆËÚ Â Á‡‰˙ÎÊËÚÂÎÌÓ. Shaw Ë Ò˙-‡‚Ú. (39) ÛÒÚ‡ÌÓ‚fl‚‡Ú ÌÂ‚ÓÓÙÚ‡ÎÏÓÎÓ„Ë˜ÂÌ ‰ÂÙÂÍÚÔË 25% ÓÚ Ô‡ˆËÂÌÚËÚÂ ÒÎÂ‰ Í‡‰ËÓÔÛÎÏÓÌ‡ÎÂÌ ·‡ÈÔ‡Ò.áËÚÂÎÌËÚÂ Ì‡Û¯ÂÌËfl ÔÓ‚ÎËfl‚‡Ú ÌÂ„‡ÚË‚ÌÓ ÔÓ‚ÂÊ‰‡-ÌÂÚÓ Ì‡ ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌË ÚÂÒÚÓ‚Â Ë ÓÚ˜ËÚ‡ÌÂÚÓ Ì‡ÍÓ„ÌËÚË‚ÌËfl ‰ÂÙËˆËÚ.

ç‡ÔÂ‰˙Í˙Ú Ì‡ ÓÔÂ‡ÚË‚ÌËÚÂ ÚÂıÌËÍË ‚ Í‡‰ËÓıË-Û„ËflÚ‡ ÔÂÁ ÔÓÒÎÂ‰ÌËÚÂ „Ó‰ËÌË, ÓÒÓ·ÂÌÓ off-pump coro-nary artery bypass (OPCAB), ÁÌ‡˜ËÚÂÎÌÓ Ó„‡ÌË˜Ë ÌÂ‚Ó-ÎÓ„Ë˜ÌËÚÂ ÛÒÎÓÊÌÂÌËfl. ÇÒÂ ÔÓ‚Â˜Â Ò‡ Ô‡ˆËÂÌÚËÚÂ Ò ÛÒ-ÔÂ¯ÌÓ ÔÓ‚Â‰ÂÌ‡ OPCAB ıËÛ„Ë˜Ì‡ Ì‡ÏÂÒ‡, ÌÓ Ò ÚÓ‚‡ÓÚÌÓÒËÚÂÎÌËfl ‰flÎ Ì‡ Ô‡ˆËÂÌÚËÚÂ ‚ Í˙ÒÌ‡ ‚˙Á‡ÒÚ Ò˙˘ÓÌ‡‡ÒÚÌ‡, ‡ ÚÂ Ò‡ ÌÓÒËÚÂÎË Ì‡ Ó˘Â ÏÌÓ„Ó ‰Û„Ë ÒÓÏ‡ÚË˜-ÌË Á‡·ÓÎfl‚‡ÌËfl (49).

àÁÒÎÂ‰Ó‚‡ÚÂÎËÚÂ Ë‰ÂÌÚËÙËˆË‡Ú Â‰Ëˆ‡ ÔÂ‰ÓÔÂ‡-ÚË‚ÌË Ë ËÌÚ‡ÓÔÂ‡ÚË‚ÌË Ù‡ÍÚÓË Á‡ ÏÓÁ˙˜Ì‡ Û‚Â‰‡ÔË Ô‡ˆËÂÌÚË, ÔÓ‰ÎÓÊÂÌË Ì‡ Í‡‰ËÓıËÛ„Ë˜Ì‡ ËÌÚÂ-‚ÂÌˆËfl. Ç˙Á‡ÒÚÚ‡, ÔÂ‰¯ÂÒÚ‚‡˘ÓÚÓ Ò˙‰Â˜ÌÓ Ë ÏÓÁ˙˜-ÌÓ-Ò˙‰Ó‚Ó Á‡·ÓÎfl‚‡ÌÂ, Á‡ı‡ÌËflÚ ‰Ë‡·ÂÚ ÒÂ Ò˜ËÚ‡Ú Á‡‚˙ÁÏÓÊÌË ÔÂ‰ÓÔÂ‡ÚË‚ÌË ËÒÍÓ‚Ë Ù‡ÍÚÓË Á‡ ÌÂ‚ÓÎÓ-„Ë˜ÌË ÛÒÎÓÊÌÂÌËfl. ä˙Ï ËÌÚ‡ÓÔÂ‡ÚË‚ÌËÚÂ ËÒÍÓ‚ËÙ‡ÍÚÓË ÒÂ ÓÚÌ‡ÒflÚ ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚÚ‡ Ì‡ ·‡ÈÔ‡Ò‡,ÔÂËÓÔÂ‡ÚË‚Ì‡Ú‡ ıËÔÓÚÓÌËfl, ‰ËÙÛÁÌ‡Ú‡ ÏÓÁ˙˜Ì‡ ıËÔÓ-

ÔÂÙÛÁËfl, ÎÓÍ‡ÎÌ‡Ú‡ ‰ËÒÂ„ÛÎ‡ˆËfl, ÔË˜ËÌÂÌ‡ ÓÚ ÏÌÓÊÂ-ÒÚ‚Ó ÂÏ·ÓÎË Ò ‡ÁÎË˜ÂÌ ı‡‡ÍÚÂ, ÒÌËÊÂÌÓÚÓ ÏÓÁ˙˜ÌÓÔÂÙÛÁËÓÌÌÓ Ì‡Îfl„‡ÌÂ, ÔÓÌËÊÂÌ‡Ú‡ ÚÂÏÔÂ‡ÚÛ‡, ÒÚÓÈ-ÌÓÒÚËÚÂ Ì‡ pH Ë Ú.Ì. (1, 14, 22, 23, 35, 38). àÁÎÓÊÂÌË ÒÂÂ‰Ëˆ‡ ıËÔÓÚÂÁË Á‡ ‚˙ÁÍ‡Ú‡ Ì‡ ÌÂ‚ÓÎÓ„Ë˜ÌËÚÂ ÛÒÎÓÊ-ÌÂÌËfl Ò Í‡˜ÂÒÚ‚ÓÚÓ Ë ‡ÁÏÂ‡ Ì‡ ÏÓÁ˙˜ÌËÚÂ ÂÏ·ÓÎË:Ï‡ÍÓÂÏ·ÓÎË Ò ‡ÁÏÂ Ì‡‰ 200 ªm ‚ ‰Ë‡ÏÂÚ˙ Ë ÏËÍÓ-ÂÏ·ÓÎË – Ò ‰Ë‡ÏÂÚ˙ ÔÓ‰ 40 ªm ‚ ‰Ë‡ÏÂÚ˙ (21, 30). èÓ-Û˜‚‡ÌËflÚ‡ Ò ‰ÓÔÎÂÓ‚‡ ÒÓÌÓ„‡ÙËfl Ì‡ÏË‡Ú ÔÓÎÓÊËÚÂÎ-Ì‡ ‚˙ÁÍ‡ ÏÂÊ‰Û ·Ófl Ì‡ ÏËÍÓÂÏ·ÓÎËÚÂ Ë ÓÚÍÎÓÌÂÌËfl-Ú‡ ‚ ÔÓÒÚÓÔÂ‡ÚË‚ÌËfl ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÂÌ ËÁıÓ‰ (4, 8).äÓ„ÌËÚË‚ÌËÚÂ Ì‡Û¯ÂÌËfl ÒÂ Ò‚˙Á‚‡Ú Ò ‚˙ÁÏÓÊÌËÚÂ‚˙Á‰Û¯ÌË ÂÏ·ÓÎËÁ‡ˆËË ÓÚ Í˙„‡ Ì‡ ·‡ÈÔ‡Ò‡. ìÒÔÂ¯Ì‡Ú‡‡ÚÂË‡ÎÌ‡ ÙËÎÚ‡ˆËfl ÁÌ‡˜ËÏÓ Â‰ÛˆË‡ ÏËÍÓÂÏ·ÓÎË-ÚÂ Ë ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌËÚÂ ÓÚÍÎÓÌÂÌËfl (32).

çÂ‚ÓÔÓ‚Â‰ÂÌ˜ÂÒÍËÚÂ Ì‡Û¯ÂÌËfl (ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÂÌË ÌÂ‚ÓÔÒËıË‡ÚË˜ÂÌ ‰ÂÙËˆËÚ) Ò‡ ˜ÂÒÚË Ë ‰Ó·Â ËÁ‚Â-ÒÚÌË ÛÒÎÓÊÌÂÌËfl ‚ Í‡‰ËÓıËÛ„ËflÚ‡. ÇÒÂ ÔÓ‚Â˜Â ‰‡ÌÌËÒÓ˜‡Ú, ˜Â ËÒÚÓËflÚ‡ Á‡ ÔÂ‰¯ÂÒÚ‚‡˘Ó Á‡·ÓÎfl‚‡ÌÂ Ì‡ˆÂÌÚ‡ÎÌ‡Ú‡ ÌÂ‚Ì‡ ÒËÒÚÂÏ‡, ıÓÌË˜Ì‡Ú‡ ‡ÎÍÓıÓÎÌ‡ ËÌ-ÚÓÍÒËÍ‡ˆËfl (35), Ì‡ÔÂ‰Ì‡Î‡Ú‡ ‚˙Á‡ÒÚ, ÔÓ-ÚÂÊÍ‡Ú‡‡ÚÂÓÒÍÎÂÓÁ‡, Ë ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚÚ‡ Ì‡ ÓÔÂ‡ˆËflÚ‡,Ò‡ Ù‡ÍÚÓË, ÍÓËÚÓ ÔË˜ËÌfl‚‡Ú ÁÌ‡˜ËÏ ÔÓÒÚÓÔÂ‡ÚË‚ÂÌÍÓ„ÌËÚË‚ÂÌ ÒÔ‡‰ (27). íÓÈ ÒÂ Ò‚˙Á‚‡ ÓÒÌÓ‚ÌÓ Ò ‰ËÒÙÛÌÍ-ˆËfl Ì‡ ÚÂÏÔÓ‡ÎÌËfl ‰flÎ Ì‡ ÏÓÁ˙Í‡, ÔË˜ËÌÂÌ‡ ÓÚ ÔÂıÓ‰-Ì‡ ıËÔÓÍÒËfl ÓÚ ÏËÍÓÂÏ·ÓÎËÁ‡ˆËfl ËÎË Ì‡Ï‡ÎÂÌ‡ ÓÍÒË„Â-Ì‡ˆËfl Ì‡ ÏÓÁ˙Í‡ (3, 29, 31).

çÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ Úfl·‚‡ ‰‡ Ë‰ÂÌÚË-ÙËˆË‡ Ë Í‚‡ÎËÙËˆË‡ ÍÓ„ÌËÚË‚ÌËÚÂ Û‚ÂÊ‰‡ÌËfl ÔË Ô‡-ˆËÂÌÚËÚÂ, ÔÓ‰ÎÂÊ‡˘Ë ËÎË ÔÂÚ˙ÔflÎË Í‡‰ËÓıËÛ„Ë˜-Ì‡ Ì‡ÏÂÒ‡. íÓ ÍÓÌÒÛÏË‡ ‰ÓÒÚ‡ ‚ÂÏÂ Ë Úfl·‚‡ ‰‡ ÒÂ ÔÓ-‚ÂÊ‰‡ ÓÚ ‰Ó·Â ÚÂÌË‡Ì ËÁÒÎÂ‰Ó‚‡ÚÂÎ Â‰ËÌ ‰ÂÌ ÔÂ‰ËËÌÚÂ‚ÂÌˆËflÚ‡, Ë Ì‡ 3 - 5 ‰ÂÌ (45), Ì‡ 7 ‰ÂÌ (43), Ì‡ 6 ÒÂ‰-ÏËˆ‡ (13), Ì‡ 3 Ë 12 ÏÂÒÂˆ ÒÎÂ‰ ÓÔÂ‡ˆËflÚ‡ (47). Ç Á‡‚ËÒË-ÏÓÒÚ ÓÚ ‰ËÁ‡ÈÌ‡ Ì‡ ‡ÁÎË˜ÌËÚÂ ÔÓÛ˜‚‡ÌËfl, ÔÓ‰·Ó‡ Ì‡ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌËÚÂ ÚÂÒÚÓ‚Â, ‚ÂÏÂÚÓ Ë ÏflÒÚÓÚÓ Ì‡ËÁÒÎÂ‰‚‡ÌÂ Ë ÎË˜ÌËÚÂ Í‡˜ÂÒÚ‚‡ Ì‡ ËÁÒÎÂ‰Ó‚‡ÚÂÎfl, Ò‡ ‰ÓÍ-Î‡‰‚‡ÌË ‡ÁÎË˜ÌË ÍÓ„ÌËÚË‚ÌË Ì‡Û¯ÂÌËfl (44). àÁ·‡Ì‡Ú‡ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜Ì‡ ·‡ÚÂËfl Úfl·‚‡ ‰‡ ËÁÚÂ„Îfl Ï‡ÍÒË-Ï‡ÎÌ‡ ËÌÙÓÏ‡ˆËfl ÔË ÏËÌËÏ‡ÎÌ‡ ÛÏÓ‡ Á‡ Ô‡ˆËÂÌÚ‡.àÁÔÓÎÁ‚‡ÌËÚÂ ÚÂÒÚÓ‚Â Úfl·‚‡ ‰‡ ·˙‰‡Ú Í‡ÚÍË, ·ÂÁËÁËÒÍ‚‡ÌËfl Á‡ Ó·ÂÏÂÌfl‚‡˘Ó Á‡Û˜‡‚‡ÌÂ. àÁÒÎÂ‰‚‡ÌÂÚÓÚfl·‚‡ ‰‡ ÒÂ ÔÓ‚ÂÊ‰‡ Ì‡ Â‰ÌÓ Ë Ò˙˘Ó ÏflÒÚÓ ÔÂ‰Ë ËÒÎÂ‰ ÓÔÂ‡ˆËflÚ‡, ÓÚ Â‰ËÌ Ë Ò˙˘ ËÁÒÎÂ‰Ó‚‡ÚÂÎ.

á‡ ÔÂ‰ËÍÚÓË Ì‡ ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜Ì‡ ‰ËÒÙÛÌÍˆËflSuksompong S Ë Ò˙‡‚Ú. (45) ÓÔÂ‰ÂÎflÚ ÔÓÏÂÌÎË‚ËÚÂ:Ì‡ÔÂ‰Ì‡Î‡ ‚˙Á‡ÒÚ, ÔÂ‰¯ÂÒÚ‚‡˘‡ ‡ÚÂË‡ÎÌ‡ ıËÔÂ-ÚÓÌËfl, ıËÔÂıÓÎÂÒÚÂÓÎÂÏËfl Ë ·˙·Â˜Ì‡ ÌÂ‰ÓÒÚ‡Ú˙˜-ÌÓÒÚ. èÂ‰Ë ÓÔÂ‡ˆËflÚ‡ Ë 6 ÏÂÒÂˆ‡ ÒÎÂ‰ ÓÔÂ‡ˆËflÚ‡‰‚‡Ï‡ ÌÂÁ‡‚ËÒËÏË ÌÂ‚ÓÔÒËıÓÎÓÁË ËÁÒÎÂ‰‚‡Ú Ô‡ˆËÂÌÚË-ÚÂ, Ë Ì‡ÏË‡Ú Ò ÏÛÎÚË‚‡Ë‡ÌÚÂÌ ‡Ì‡ÎËÁ, ˜Â ÊÂÌÒÍËfl ÔÓÎ,ËÁıÓ‰Ì‡Ú‡ ÛÔÓÚÂ·‡ Ì‡ ·ÂÚ‡-·ÎÓÍÂË Ë Ô‡ˆË‡ÎÌÓÚÓ Ì‡-Îfl„‡ÌÂ Ì‡ ÍËÒÎÓÓ‰‡ ÔË ÔÓÒÚ˙Ô‚‡ÌÂÚÓ ‚ Â‡ÌËÏ‡ˆËfl, Ò‡ÁÌ‡˜ËÏË ËÒÍÓ‚Ë Ù‡ÍÚÓË Á‡ Û‚ÂÊ‰‡ÌÂ Ì‡ ÍÓ„ÌËÚË‚ÌËÚÂÙÛÌÍˆËË (10). àÒÚÓËflÚ‡ Á‡ ‡ÚÂË‡ÎÌ‡ ıËÔÂÚÓÌËfl ÒÂfl‚fl‚‡ ÔÂ‰ËÍÚÓ Á‡ ÚÂÊ˙Í ÍÓ„ÌËÚË‚ÂÌ ÒÔ‡‰, ‡ ÔÓ-‚ËÒÓ-ÍÓÚÓ ÌË‚Ó Ì‡ Ó·‡ÁÓ‚‡ÌËÂ - ÔÓÚÂÍÚÓ.

Ç Í‡fl Ì‡ Ô˙‚Ëfl ÏÂÒÂˆ ÒÎÂ‰ Ò˙‰Â˜Ì‡ ÓÔÂ‡ˆËfl ÔË319 Ô‡ˆËÂÌÚË Smith MH Ë Ò˙‡‚Ú. (2000 „Ó‰.) ÓÚ˜ËÚ‡ÚÁ‡·ÓÎÂ‚‡ÂÏÓÒÚ ÓÚ ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÂÌ ‰ÂÙËˆËÚ ‚ 21,6%.èÓ-ÚÂÊ˙Í Â ÔË ÔÓ-‚˙Á‡ÒÚÌËÚÂ Ô‡ˆËÂÌÚË (41).

åÓÁ˙˜ÌËflÚ ËÌÒÛÎÚ Â Â‰ÌÓ ÓÚ Ì‡È-‡ÁÓ˜‡Ó‚‡˘ËÚÂÒÎÂ‰ÓÔÂ‡ÚË‚ÌË ÛÒÎÓÊÌÂÌËfl ‚ Í‡‰ËÓıËÛ„ËflÚ‡. á‡·Ó-ÎÂ‚‡ÂÏÓÒÚÚ‡ ÓÚ ËÌÒÛÎÚ ‚‡Ë‡ Í‡ÍÚÓ ÔË ‡ÁÎË˜ÌËÚÂÔ‡ˆËÂÌÚË, Ú‡Í‡ Ë ÏÂÊ‰Û ÓÚ‰ÂÎÌËÚÂ ÔËÎÓÊÂÌË ÓÔÂ‡-ÚË‚ÌË ÚÂıÌËÍË. åÌÓÊÂÒÚ‚Ó ÔÓÛ˜‚‡ÌËfl Ë‰ÂÌÚËÙËˆË-‡Ú ÌÂÁ‡‚ËÒËÏË ËÒÍÓ‚Ë Ù‡ÍÚÓË Á‡ ÔÓÒÚÓÔÂ‡ÚË‚ÂÌ ËÌ-


ÒÛÎÚ. äÓÏÔÎÂÍÒÌÓÚÓ ÓÚ˜ËÚ‡ÌÂ Ì‡ ÚÂÁË Ù‡ÍÚÓË Â ËÁÍ-Î˛˜ËÚÂÎÌÓ ‚‡ÊÌÓ Á‡ ‡Á‡·ÓÚ‚‡ÌÂ Ì‡ ÔÂ‚‡ÌÚË‚ÌË ÒÚ‡-ÚÂ„ËË.

å‡˘‡·ÌÓ ÔÓÛ˜‚‡ÌÂ, ÔÓ‚Â‰ÂÌÓ ÔË 16 184 Ô‡ˆËÂÌÚ‡,ÛÒÚ‡ÌÓ‚fl‚‡ 10 ÌÂÁ‡‚ËÒËÏË ÔÂ‰ËÍÚÓË Ì‡ ÏÓÁ˙˜ÂÌ ËÌ-ÒÛÎÚ: ËÒÚÓËfl Á‡ ÏÓÁ˙˜ÌÓÒ˙‰Ó‚‡ ·ÓÎÂÒÚ, ÔÂËÙÂÌ‡ Ò˙‰Ó-‚‡ ·ÓÎÂÒÚ, Á‡ı‡ÂÌ ‰Ë‡·ÂÚ, ‡ÚÂË‡ÎÌ‡ ıËÔÂÚÓÌËfl,ÔÂ‰¯ÂÒÚ‚‡˘‡ Ò˙‰Â˜Ì‡ ËÌÚÂ‚ÂÌˆËfl, Í‡‰ËÓÔÛÎÏÓÌ‡-ÎÂÌ ·‡ÈÔ‡Ò, ÔÓ‰˙ÎÊËÎ ÔÓ‚Â˜Â ÓÚ 2 ˜‡Ò‡, ÌÂÓ·ıÓ‰ËÏÓÒÚÓÚ ËÌÚ‡ÓÔÂ‡ÚË‚Ì‡ ıÂÏÓÙËÎÚ‡ˆËfl, ‚ËÒÓÍË Ú‡ÌÒÙÛ-ÁËÓÌÌË ËÁËÒÍ‚‡ÌËfl, ÔÂ‰ÓÔÂ‡ÚË‚Ì‡ ËÌÙÂÍˆËfl, ÓÔÂ‡ˆËflÔÓ ÒÔÂ¯ÌÓÒÚ. ÄÌ‡ÏÌÂÁ‡Ú‡ Á‡ ÔÂÊË‚flÌ‡ Ú‡ÌÁËÚÓÌ‡ËÒıÂÏË˜Ì‡ ‡Ú‡Í‡ (íàÄ), Ì‡ ÔÓÎÓÌ„Ë‡Ì Ë‚ÂÁË·ËÎÂÌÌÂ‚ÓÎÓ„Ë˜ÂÌ ‰ÂÙËˆËÚ ËÎË Ì‡ ËÌÒÛÎÚ, Ò‡ Ì‡È-ÁÌ‡˜ËÏËÚÂÔÓ„ÌÓÒÚË˜ÌË Ù‡ÍÚÓË Á‡ ÌÓ‚ ËÌÒÛÎÚ. ë‡Ï‡Ú‡ ‰Ë‡„ÌÓÁ‡ÏÓÁ˙˜ÌÓ-Ò˙‰Ó‚‡ ·ÓÎÂÒÚ ‚Ó‰Ë ‚ 16,8 % ‰Ó ÔÓÒÚÓÔÂ‡ÚË‚-Ì‡ Á‡·ÓÎÂ‚‡ÂÏÓÒÚ ÓÚ ËÌÒÛÎÚ. ç‡Î‡„‡ ÒÂ ÔÓ‚ÂÊ‰‡ÌÂÚÓ Ì‡ÔÂ‰ÓÔÂ‡ÚË‚ÂÌ ÒÍËÌËÌ„ Ò ‰ÛÔÎÂÍÒ Ì‡ ÍÓÓÚË‰ÌËÚÂ ‡-ÚÂËË Ë Ú‡ÌÒÂÁÓÙ‡„Â‡ÎÌ‡ ÂıÓÍ‡‰ËÓ„‡ÙËfl Á‡ Ë‰ÂÌÚË-ÙËˆË‡ÌÂ Ì‡ ‡ÚÂÓÒÍÎÂÓÚË˜ÌË ÎÂÁËË, ÍÓËÚÓ ·Ëı‡ ÔÓ‚ÎË-flÎË ËÌÚ‡ÓÔÂ‡ÚË‚ÌÓÚÓ ÔÓ‚Â‰ÂÌËÂ. ë ÔÓÏÂÌÎË‚ËÚÂ:‚˙Á‡ÒÚ, ÌÂÒÚ‡·ËÎÌ‡ ÒÚÂÌÓÍ‡‰Ëfl (‡Ì„ËÌ‡ ÔË ÔÓÍÓÈ ËÎËÒ ÍÂÒ˜ÂÌ‰Ó Ô‡ÚÂÌ), Á‡ı‡ÂÌ ‰Ë‡·ÂÚ, ËÒÚÓËfl Á‡ ÒËÏÔ-ÚÓÏÌÓ ÌÂ‚ÓÎÓ„Ë˜ÌÓ Á‡·ÓÎfl‚‡ÌÂ ÔÂ‰Ë CABG, ËÒÚÓËfl Á‡Ò˙‰Ó‚Ó Á‡·ÓÎfl‚‡ÌÂ Ë ËÒÚÓËfl Á‡ ·ÂÎÓ‰Ó·ÌÓ Á‡·ÓÎfl‚‡ÌÂ,Stroke Risk Index (SRI) ÓÔÂ‰ÂÎfl ‚ÂÓflÚÌÓÒÚÚ‡ ÓÚ Û‚Â-‰‡ Ì‡ ˆÂÌÚ‡ÎÌ‡Ú‡ ÌÂ‚Ì‡ ÒËÒÚÂÏ‡ ÔË Ô‡ˆËÂÌÚËÚÂ,ÔÓ‚ÂÊ‰‡˘Ë Í‡‰ËÓÔÛÎÏÓÌ‡ÎÂÌ ·‡ÈÔ‡Ò. ÇÒflÍ‡ ÓÚ ÚÂÁËÔÓÏÂÌÎË‚Ë ÒÂ ÚÓ˜ÍÛ‚‡ ÔÓ ÓÔÂ‰ÂÎÂÌ‡ ÒËÒÚÂÏ‡, ÒÎÂ‰ ÍÓÂ-ÚÓ ÒÂ ÓÙÓÏfl ÓÍÓÌ˜‡ÚÂÎÌËfl Ò·Ó. íÓÁË Ò·Ó ÒÂ Ò‡‚Ìfl‚‡Ò ‚ËÁÛ‡ÎÌ‡ ‡Ì‡ÎÓ„Ó‚‡ ÒÍ‡Î‡, ÍÓflÚÓ ‰‡‚‡ ‚ ÔÓˆÂÌÚ ËÒÍ‡Á‡ ÌÂ‚ÓÎÓ„Ë˜ÌË ÛÒÎÓÊÌÂÌËfl (28).

àÌÒÛÎÚËÚÂ, Ú‡ÁËÚÓÌËÚÂ ËÒıÂÏË˜ÌË ‡Ú‡ÍË, ÍÓÏË-ÚÂ, ÂÌˆÂÙ‡ÎÓÔ‡ÚËËÚÂ, ÂÔËÎÂÔÚË˜ÌËÚÂ ÔËÒÚ˙ÔË ÒÂ ÓÚ-Ì‡ÒflÚ Í˙Ï ÚÂÊÍËÚÂ ÌÂ‚ÓÎÓ„Ë˜ÌË ÛÒÎÓÊÌÂÌËfl ÒÎÂ‰ Í‡-‰ËÓıËÛ„Ë˜Ì‡ ËÌÚÂ‚ÂÌˆËfl (35). èÓÒÚÓÔÂ‡ÚË‚ÌËflÚËÌÒÛÎÚ ÓÒÚ‡‚‡ Ì‡È-ÓÔÛÒÚÓ¯ËÚÂÎÌ‡Ú‡ ÔÓÒÎÂ‰Ëˆ‡. á‡·Ó-ÎÂ‚‡ÂÏÓÒÚÚ‡ ‚‡Ë‡ ÓÚ 0,8% ‰Ó 13,8% (16, 38).

èÓ-ÌÓ‚Ë ÔÓÛ˜‚‡ÌËfl ÔÂ‰ÒÚ‡‚flÚ ‚‡ÊÌ‡ ËÌÙÓÏ‡ˆËflÁ‡ ÔÂ‰ËÍÚÓËÚÂ Ì‡ ËÌÒÛÎÚ ÒÎÂ‰ GABG ËÎË ‰Û„Ë Í‡‰Ë-ÓıËÛ„Ë˜ÌË ËÌÚÂ‚ÂÌˆËË, ÌÓ ‰‡ÌÌËÚÂ Ò‡ ÔÂ‰ËÏÌÓ Á‡Ï‡ÎÍË ÔÓÔÛÎ‡ˆËË Ô‡ˆËÂÌÚË ËÎË Ò‡ ÙÓÍÛÒË‡ÌË ‚˙ıÛ Â‰Ë-ÌË˜Ì‡ ıËÛ„Ë˜Ì‡ ÔÓˆÂ‰Û‡. òËÓÍÓÓ·ı‚‡ÚÌËÚÂ ÔÓÒ-ÔÂÍÚË‚ÌË ÔÓÛ˜‚‡ÌËfl, ÍÓËÚÓ ÏÓ„‡Ú ‰‡ ‡ÍˆÂÌÚË‡Ú ‚˙-ıÛ Á‡·ÓÎÂ‚‡ÂÏÓÒÚÚ‡ ÓÚ ËÌÒÛÎÚ Ë ÔË‰ÛÊ‡‚‡˘ËÚÂ „ÓËÒÍÓ‚Ë Ù‡ÍÚÓË Ò‡ Ï‡ÎÍÓ (1, 42, 48). ÇÌËÏ‡ÌËÂÚÓ Â Ì‡-ÒÓ˜ÂÌÓ Í˙Ï “ÏËÌËÏ‡ÎÌÓ ËÌ‚‡ÁË‚ÌËÚÂ ÚÂıÌËÍË”, ‚ÍÎ˛˜Ë-ÚÂÎÌÓ OPCAB, ÌÓ (Á‡ÒÂ„‡) ÔÓÎÛ˜ÂÌËÚÂ ÂÁÛÎÚ‡ÚË Ò‡ ÔÓ-ÚË‚ÓÂ˜Ë‚Ë.

ë˙Ò ÁÌ‡˜ËÚÂÎÂÌ ËÒÍ Á‡ ÔÓÒÚÓÔÂ‡ÚË‚ÂÌ ËÌÒÛÎÚ ÒÎÂ‰ÍÓÓÌ‡Ì‡ Â‚‡ÒÍÛÎ‡ËÁ‡ˆËfl Ò‡ Ô‡ˆËÂÌÚËÚÂ Ò: ‡ÚÂÓÒÍ-ÎÂÓÚË˜Ì‡ ‡ÒˆÂÌ‰Ë‡˘‡ ‡ÓÚ‡, Ì‡ÔÂ‰Ì‡Î‡ ‚˙Á‡ÒÚ,‡Ì‡ÏÌÂÁ‡ Á‡ ÔÂÊË‚flÌ ËÌÒÛÎÚ, ‰‡ÌÌË Á‡ ÏÓÁ˙˜ÌÓÒ˙‰Ó‚‡ ËÔÂËÙÂÌÓÒ˙‰Ó‚‡ (‚ÍÎ. Í‡ÓÚË‰Ì‡) ·ÓÎÂÒÚ, ıÓÌË˜Ì‡ ·˙·-Â˜Ì‡ ÌÂ‰ÓÒÚ‡Ú˙˜ÌÓÒÚ, ‡Ì‡ÏÌÂÁ‡ Á‡ ÒÍÓÓ¯ÌÓ Ú˛Ú˛ÌÓ-ÔÛ¯ÂÌÂ, Ë Á‡ı‡ÂÌ ‰Ë‡·ÂÚ (17). ÑÓÍ‡Á‡Ì‡ ÁÌ‡˜ËÏÓÒÚËÏ‡Ú Ó˘Â ÌÂÒÚ‡·ËÎÌ‡Ú‡ ‡Ì„ËÌ‡ ÔÂÍÚÓËÒ, ËÒÚÓËflÚ‡Á‡ ·ÂÎÓ‰Ó·ÌÓ Á‡·ÓÎfl‚‡ÌÂ (28), ÔÂËÓÔÂ‡ÚË‚ÌËflÚ ÏËÓ-Í‡‰ÂÌ ËÌÙ‡ÍÚ, ‚ÎÓ¯ÂÌ‡Ú‡ Îfl‚ÓÍ‡ÏÂÌ‡ ÙÛÌÍˆËfl (23).

Ç Â‰ÌÓ ÔÂÚ„Ó‰Ë¯ÌÓ ÒÎÂ‰ÓÔÂ‡ÚË‚ÌÓ ÔÓÒÎÂ‰fl‚‡ÌÂ Ì‡ 3282 Ô‡ˆËÂÌÚË (34) ÏÓÁ˙˜ÌÓÒ˙‰Ó‚Ë ÛÒÎÓÊÌÂÌËfl Ò‡ ‚˙ÁÌËÍ-Ì‡ÎË ‚ 3,3 %. éÚ Úflı 1,8 % Ò‡ ‡ÌÌË, 1 % - Ò‡ Í˙ÒÌË, ‡ ‚0,4 % – Ò ÌÂËÁ‚ÂÒÚÌÓ Ì‡˜‡ÎÓ. ëÂ‰ÌËflÚ ËÌÚÂ‚‡Î ÏÂÊ‰ÛÍ‡‰ËÓıËÛ„Ë˜Ì‡Ú‡ Ì‡ÏÂÒ‡ Ë Ì‡˜‡ÎÓÚÓ Ì‡ ÌÂ‚ÓÎÓ„Ë˜ÌË-ÚÂ ÛÒÎÓÊÌÂÌËfl Â 4±3,3 ‰ÌË (Ó·ı‚‡Ú ÓÚ 1 ‰Ó 16 ‰ÌË). ëÔÂÏ‡ÌÂÌÚÌË ÒËÏÔÚÓÏË Ò‡ 70,1 % ÓÚ Ô‡ˆËÂÌÚËÚÂ, ‡ ÒÔÂıÓ‰Ì‡ ÌÂ‚ÓÎÓ„Ë˜Ì‡ ÒËÏÔÚÓÏ‡ÚËÍ‡ - 29,9 %. éÚ ‡Ì-

ÌËÚÂ ÛÒÎÓÊÌÂÌËfl 78,3 % Ò‡ Ò ËÌ‚‡ÎË‰ËÁË‡˘ ËÌÒÛÎÚ, ‡21,7 % – Ò ÔÂıÓ‰ÌË ÌÂ‚ÓÎÓ„Ë˜ÌË ÒËÏÔÚÓÏË. éÚ Í˙ÒÌÓÔÓfl‚ËÎË ÒÂ ÛÒÎÓÊÌÂÌËfl 48,5 % Ò‡ Ò ËÌ‚‡ÎË‰ËÁË‡˘ ËÌ-ÒÛÎÚ, ‡ 51,5 % – ÔÂıÓ‰ÌË ÌÂ‚ÓÎÓ„Ë˜ÌË ÒËÏÔÚÓÏË. Ç „Û-Ô‡Ú‡ Ô‡ˆËÂÌÚË Ò ÌÂËÁ‚ÂÒÚÌÓ Ì‡˜‡ÎÓ Ì‡ ÌÂ‚ÓÎÓ„Ë˜Ì‡Ú‡ÒËÏÔÚÓÏ‡ÚËÍ‡ 85,7 % ‡Á‚Ë‚‡Ú ËÌ‚‡‰ËÁË‡˘ ËÌÒÛÎÚ, ‡14,3 % – ÔÂıÓ‰ÌË ÌÂ‚ÓÎÓ„Ë˜ÌË ÒËÏÔÚÓÏË. Ç 79,4 % ÓÚÔ‡ˆËÂÌÚËÚÂ Ò ÏÓÁ˙˜ÌË ÛÒÎÓÊÌÂÌËfl ÓÒ˙˘ÂÒÚ‚ÂÌ‡Ú‡ ÍÓÏ-Ô˛Ú˙Ì‡ ÚÓÏÓ„‡ÙËfl Ì‡ „Î‡‚Ó‚ ÏÓÁ˙Í Ì‡ÏË‡ ‡·ÌÓÏÌËÌ‡ıÓ‰ÍË: ıÂÏËÒÙÂÌË ÎÂÁËË ‚ 84 %, ˆÂÂ·ÂÎ‡ÌË ‚ 14 %, ËÎ‡ÍÛÌ‡ÌË ‚ 26 %. ë‡ÏÓ ‚ 11 ÒÎÛ˜‡fl ÍÓÏÔ˛Ú˙Ì‡Ú‡ ÚÓ-ÏÓ„‡ÙËfl Ì‡ „Î‡‚Ó‚Ëfl ÏÓÁ˙Í ÌÂ ÛÒÚ‡ÌÓ‚fl‚‡ ÎÂÁËfl. àÌÚ-‡ˆÂÂ·‡ÎÌ‡ ıÂÏÓ‡„Ëfl Â ÔÓÎÛ˜ËÎ Â‰ËÌ Ô‡ˆËÂÌÚ Ë Ó˘ÂÂ‰ËÌ - ıÂÏÓ‡„Ë˜ÂÌ ËÌÙ‡ÍÚ. ñflÎÓÒÚÌ‡Ú‡ ÒÏ˙ÚÌÓÒÚ(Á‡ ÔÂÚ„Ó‰Ë¯ÌËfl ÔÂËÓ‰ Ì‡ Ì‡·Î˛‰ÂÌËÂ) Â 5,2 % Á‡ Ô‡ˆË-ÂÌÚËÚÂ ·ÂÁ ÏÓÁ˙˜ÌË ÛÒÎÓÊÌÂÌËfl Ë 29 % - Á‡ ÚÂÁË Ò ÏÓÁ˙˜-ÌË ÍÓÏÔÎËÍ‡ˆËË. ëÏ˙ÚÌÓÒÚÚ‡ Â ÁÌ‡˜ËÏÓ ÔÓ-‚ËÒÓÍ‡ ÔËÔ‡ˆËÂÌÚËÚÂ Ò ‡ÌÌÓ Ì‡˜‡ÎÓ Ì‡ ÒËÏÔÚÓÏËÚÂ ‚ Ò‡‚ÌÂÌËÂÒ ÚÂÁË Ò ÔÓ-Í˙ÒÌÓ Ì‡˜‡ÎÓ (35 % ÒÂ˘Û 18,2 %).

á‡·ÓÎÂ‚‡ÂÏÓÒÚÚ‡ ÓÚ ÏÓÁ˙˜ÌÓ-Ò˙‰Ó‚Ë ÛÒÎÓÊÌÂÌËflÒÎÂ‰ ÓÔÂ‡ˆËË Ì‡ ‡ÒˆÂÌ‰Ë‡˘‡Ú‡ ‡ÓÚ‡ Ë Ì‡ ‰˙„‡Ú‡ Ì‡‡ÓÚ‡Ú‡ Â 25 %. ëÚÛÍÚÛË‡ÌË Ò‡ ÔÓ„ÌÓÒÚË˜ÌË ÏÓ‰Â-ÎË Á‡ ‡ÌÌÓ Ë ÔÓ-Í˙ÒÌÓ ÌÂ‚ÓÎÓ„Ë˜ÌÓ ÛÒÎÓÊÌÂÌËÂ ÒÎÂ‰ Í‡-‰ËÓıËÛ„Ë˜Ì‡ ÓÔÂ‡ˆËfl. èÓÏÂÌÎË‚ËÚÂ ‚ ÏÓ‰ÂÎ Á‡ ‡Ì-ÌÓ ÛÒÎÓÊÌÂÌËÂ Ò‡: ‚ÒÂÍË ‚˙Á‡ÒÚÂÌ Ô‡ˆËÂÌÚ Ò ÔÂ‰ÓÔÂ‡-ÚË‚Ì‡ ‡ÚÂË‡ÎÌ‡ ıËÔÂÚÓÌËfl, Ì‡ ÍÓÈÚÓ ÒÂ ÔÓ‚ÂÊ‰‡ÓÔÂ‡ˆËfl Ì‡ ‡ÓÚ‡Ú‡ ‚ ÛÒÎÓ‚Ëfl Ì‡ ÔÓ‰˙ÎÊËÚÂÎÂÌ Í‡‰Ë-ÓÔÛÎÏÓÌ‡ÎÂÌ ·‡ÈÔ‡Ò, Ò ËÌÚ‡ÓÔÂ‡ÚË‚Ì‡ ıËÔÓÚÓÌËfl, ÔÓÒ-ÚÓÔÂ‡ÚË‚Ì‡ ‡ËÚÏËfl ËÎË ÒÛÔ‡‚ÂÌÚËÍÛÎ‡Ì‡ Ú‡ıË‡-ËÚÏËfl ‚ ÔÂËÓ‰‡ Ì‡ ËÁÎËÁ‡ÌÂ ÓÚ ÓÔÂ‡ˆËflÚ‡. ë ‚ËÒÓÍËÒÍ Á‡ Á‡·‡‚ÂÌÓ ‚˙‚ ‚ÂÏÂÚÓ ÏÓÁ˙˜ÌÓ ÛÒÎÓÊÌÂÌËÂ, ÂÔÓ„ÌÓÒÚË˜ÌËflÚ ÏÓ‰ÂÎ Á‡ ÊÂÌ‡ Ò˙Ò Á‡ı‡ÂÌ ‰Ë‡·ÂÚ, ÔËÍÓflÚÓ ÒÂ ÔÓ‚ÂÊ‰‡ ÍÓÏ·ËÌË‡Ì‡ Í‡‰ËÓıËÛ„Ë˜Ì‡ ÔÓ-ˆÂ‰Û‡, Ì‡Î‡„‡˘‡ ÔÓ‰˙ÎÊËÚÂÎÌ‡ ‚ÂÌÚËÎ‡ˆËfl Ë Ò ÔÓÒÚÓ-ÔÂ‡ÚË‚Ì‡ ÒÛÔ‡‚ÂÌÚËÍÛÎ‡Ì‡ Ú‡ıË‡ËÚÏËfl.

Ç ÔÓÛ˜‚‡ÌÂÚÓ Ì‡ Puskas J Ë Ò˙‡‚Ú. (33) Á‡·ÓÎÂ‚‡ÂÏÓ-ÒÚÚ‡ ÓÚ ËÌÒÛÎÚ Â 2,2 % Á‡ 10 860 ÓÔÂË‡ÌË ·ÓÎÌË. á‡ ÌÂ-Á‡‚ËÒËÏË ÔÂ‰ËÍÚÓË Ì‡ ËÌÒÛÎÚ Ò‡ ÓÚ˜ÂÚÂÌË: Í˙ÒÌ‡ ‚˙Á-‡ÒÚ Ì‡ Ô‡ˆËÂÌÚ‡, ÔÂ‰¯ÂÒÚ‚‡˘‡ íàÄ Ë Ì‡ÎË˜ËÂ Ì‡ Í‡-ÓÚË‰ÌË ¯ÛÏÓ‚Â ÔË ‡ÛÒÍÛÎÚ‡ˆËfl.

ç‡ÔÂ‰Ì‡Î‡Ú‡ ‚˙Á‡ÒÚ ÒÂ Ò‚˙Á‚‡ Ò˙Ò Á‡·ÓÎfl‚‡ÌÂÚÓ‡ÚÂÓÒÍÎÂÓÁ‡ Ë ÂÒÔÂÍÚË‚ÌÓ – Ò ÔÓ‚Ë¯ÂÌ ËÒÍ Á‡ ÂÏ·Ó-ÎËÁ‡ˆËfl (9). è‡ˆËÂÌÚËÚÂ, ÔÓÎÛ˜ËÎË ÏÓÁ˙˜ÌÓ ÛÒÎÓÊÂÌËÂ Ò‡ÒÂ‰ÌÓ Ò 5 „Ó‰ËÌË ÔÓ-‚˙Á‡ÒÚÌË ÓÚ Ô‡ˆËÂÌÚËÚÂ ·ÂÁ ÛÒ-ÎÓÊÌÂÌËÂ (34).

ÇÒË˜ÍË ÔÓÛ˜‚‡ÌËfl Ì‡ Á‡·ÓÎÂ‚‡ÂÏÓÒÚÚ‡ Ë ÒÏ˙ÚÌÓ-ÒÚÚ‡ ÓÚ ÔÓÒÚÓÔÂ‡ÚË‚ÂÌ ËÌÒÛÎÚ, Á‡‰˙ÎÊËÚÂÎÌÓ Ë‰ÂÌ-ÚËÙËˆË‡Ú Ë ÔÂËÓÔÂ‡ÚË‚ÌËÚÂ ËÒÍÓ‚Ë Ù‡ÍÚÓË.

ÄÌ‡ÏÌÂÁ‡Ú‡ Á‡ ÔÂÊË‚flÌ ËÌÒÛÎÚ ËÎË ÏÓÁ˙˜ÌÓ-Ò˙‰Ó‚‡·ÓÎÂÒÚ Â ÒËÎÂÌ ÔÂ‰ËÍÚÓ Ì‡ ÌÓ‚ ËÌÒÛÎÚ (12, 28, 35). çÓ-‚ËflÚ ËÌÒÛÎÚ Â Ó·ËÍÌÓ‚ÂÌÓ ‚ ‰Û„‡ Ò˙‰Ó‚‡ ÚÂËÚÓËfl (‚Ò‡‚ÌÂÌËÂ Ò Ô˙‚Ëfl ËÌˆË‰ÂÌÚ) (36). á‡·ÓÎÂ‚‡ÂÏÓÒÚÚ‡ ÓÚÔÓÒÚÓÔÂ‡ÚË‚ÂÌ ËÌÒÛÎÚ Â 7 % ‰Ó 13 % Á‡ Ô‡ˆËÂÌÚË, ÍÓË-ÚÓ Ò‡ ÔÂÊË‚flÎË ‚ ÏËÌ‡ÎÓÚÓ ËÒıÂÏË˜ÌË Ì‡Û¯ÂÌËfl Ì‡ÏÓÁ˙˜ÌÓÚÓ Í˙‚ÓÓ·˙˘ÂÌËÂ (40).

è‡ˆËÂÌÚËÚÂ Ò ËÒÚÓËfl Á‡ ‡ÚÂË‡ÎÌ‡ ıËÔÂÚÓÌËfl ËÚÂÁË Ò˙Ò ÒËÒÚÓÎÌÓ ‡ÚÂË‡ÎÌÓ Ì‡Îfl„‡ÌÂ Ì‡‰ 120 mm HgÒ‡ Ò ÔÓ‚Ë¯ÂÌ ËÒÍ Á‡ ÔÓÒÚÓÔÂ‡ÚË‚ÂÌ ËÌÒÛÎÚ (7). ÇÌËÏ‡-ÚÂÎÌÓÚÓ ÎÂ˜ÂÌËÂ Ì‡ ‡ÚÂË‡ÎÌÓÚÓ Ì‡Îfl„‡ÌÂ ÔË Ô‡ˆËÂÌ-ÚËÚÂ Ò ÚÂÊÍ‡ ıËÔÂÚÓÌËfl Â Ì‡ÎÓÊËÚÂÎÌÓ, ÔÓ‡‰Ë ËÒÍ‡ÓÚ ËÌÒÛÎÚ ÔÓ ‚ÂÏÂ Ì‡ ‡„ÂÒË‚ÌÓÚÓ ÏÛ ÒÌËÊ‡‚‡ÌÂ ÔËÍ‡‰ËÓıËÛ„Ë˜Ì‡Ú‡ ËÌÚÂ‚ÂÌˆËfl (5).

ìÔÓÚÂ·‡Ú‡ Ì‡ ·ÓÌıÓ‰ËÎ‡Ú‡ÚÓË ‰Ó ‰‚Â ÒÂ‰ÏËˆËÔÂ‰Ë ËÌÚÂ‚ÂÌˆËflÚ‡ Ò˙˘Ó Â ÔÂ‰‚ÂÒÚÌËÍ Ì‡ ËÌÒÛÎÚ.íÂÁË ÏÂ‰ËÍ‡ÏÂÌÚË ÒÓ˜‡Ú ÁÌ‡˜ËÏÓ ·ÂÎÓ‰Ó·ÌÓ ÒÚ‡‰‡-ÌËÂ, ÔÓ-‚ËÒÓÍË ÒÚÓÈÌÓÒÚË Ì‡ ıÂÏÓ„ÎÓ·ËÌ‡, ıÂÏÓÍÓÌˆÂ-ÌÚ‡ˆËfl, Ì‡Û¯ÂÌË ıÂÏÓÂÓÎÓ„Ë˜ÌË Ò‚ÓÈÒÚ‚‡ Ì‡ Í˙‚Ú‡,


ÂÍÒˆÂÒË‚Ì‡ Á‡‰˙ÊÍ‡ Ì‡ ‚˙„ÎÂÓ‰ÂÌ ‰‚ÛÓÍËÒ, ÔÓÏÂÌË ‚ÏÓÁ˙˜Ì‡Ú‡ ‚‡ÁÓÂ‡ÍÚË‚ÌÓÒÚ – ÁÌ‡˜ËÏË ÔÂ‰ËÍÚÓË Ì‡ÏÓÁ˙˜ÂÌ ËÌÒÛÎÚ (28).

á‡ı‡ÌËflÚ ‰Ë‡·ÂÚ Ë ÔÂËÙÂÌ‡Ú‡ Ò˙‰Ó‚‡ ·ÓÎÂÒÚ Ò‡ÌÂÁ‡‚ËÒËÏË ÔÂ‰ËÍÚÓË Á‡ ÏÓÁ˙˜ÂÌ ËÌÒÛÎÚ. íÂ ÔÓÒÚ‡‚flÚÔ‡ˆËÂÌÚ‡ ‡‚ÚÓÏ‡ÚË˜ÌÓ ‚ Í‡ÚÂ„ÓËflÚ‡ Ò ÔÓ‚Ë¯ÂÌ ËÒÍÁ‡ ‡ÚÂÓÒÍÎÂÓÚË˜Ì‡ ÂÏ·ÓÎËÁ‡ˆËfl (6, 42).

àÒÚÓËflÚ‡ Á‡ ÔÂ‰¯ÂÒÚ‚‡˘‡ Ò˙‰Â˜Ì‡ ÓÔÂ‡ˆËfl Ò˙-˘Ó Â ËÒÍÓ‚ Ù‡ÍÚÓ Á‡ ÔÓÒÚÓÔÂ‡ÚË‚ÂÌ ËÌÒÛÎÚ, Ú˙È Í‡-ÚÓ ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚÚ‡ Ì‡ Í‡‰ËÓÔÛÎÏÓÌ‡ÎÌËfl ·‡ÈÔ‡Ò ÂÔÓ-„ÓÎflÏ‡ Ë ËÒÍ˙Ú Á‡ ˜‡ÒÚË˜Ì‡ ÂÏ·ÓÎËÁ‡ˆËfl ÒÂ ÔÓ‚Ë¯‡-‚‡. èË Â‰Ì‡ ÔÂ‰¯ÂÒÚ‚‡˘‡ ËÌÚÂ‚ÂÌˆËfl ÔÓ‰„ÓÚÓ‚Í‡Ú‡Ì‡ ÏÂ‰Ë‡ÒÚËÌÛÏ‡ Á‡ ÌÓ‚‡ (Í‡‰ËÓıËÛ„Ë˜Ì‡) Ì‡ÏÂÒ‡ÒÚ‡‚‡ ËÁÍÎ˛˜ËÚÂÎÌÓ ÚÛ‰Ì‡ Á‡‰‡˜‡. èË Ï‡ÌËÔÛÎË‡ÌÂ ‚ÚÂÁË ÒÎÛ˜‡Ë ÂÏ·ÓÎËÁ‡ˆËËÚÂ ÓÚ ‡ÓÚ‡Ú‡ Ò‡ ÔÓ-˜ÂÒÚË.è‡ˆËÂÌÚËÚÂ Ò‡ Ò ÔÓ‚Ë¯ÂÌ ËÒÍ Á‡ ÚÂÊÍË Í˙‚ÓËÁÎË‚Ë ËÔÓ‰˙ÎÊËÚÂÎÌ‡ ıËÔÓÚÓÌËfl ÓÚ ‡ÁÍ˙Ò‚‡ÌÂ Ì‡ Ò˙ˆÂÚÓ Ë„ÓÎÂÏËÚÂ Ò˙‰Ó‚Â ÔÓ ‚ÂÏÂ Ì‡ ıËÛ„Ë˜Ì‡Ú‡ ‰ËÒÂÍ‡ˆËfl.

çÂÁ‡‚ËÒËÏ ÔÂ‰‚ÂÒÚÌËÍ Ì‡ ËÌÒÛÎÚ Â ‚ÒflÍÓ ÌÂÒÚ‡·ËÎ-ÌÓÚÓ Ò˙‰Â˜ÌÓ Ò˙ÒÚÓflÌËÂ, ÍÓÂÚÓ Ì‡Î‡„‡ ÒÔÂ¯Ì‡ ËÌÚÂ-‚ÂÌˆËfl. ëÔÂ¯Ì‡Ú‡ Í‡‰ËÓıËÛ„Ë˜Ì‡ ËÌÚÂ‚ÂÌˆËfl Â ÔÓ-Í‡Á‡Ì‡ „Î‡‚ÌÓ ÔË ÌÂÒÚ‡·ËÎÌ‡ ‡Ì„ËÌ‡ ÔÂÍÚÓËÒ Ë ÔË Ô‡-ˆËÂÌÚË Ò ÂÌ‰ÓÍ‡‰ËÚ ÔÎ˛Ò ÍÎ‡ÔÌÓ Á‡·ÓÎfl‚‡ÌÂ. è‡ˆËÂÌ-ÚËÚÂ Ò ÌÂÒÚ‡·ËÎÌ‡ ÒÚÂÌÓÍ‡‰Ëfl Â ÔÓ-‚ÂÓflÚÌÓ ‰‡ ÒÚ‡-‰‡Ú ÓÚ ÔÂËÙÂÌ‡ Ò˙‰Ó‚‡ ·ÓÎÂÒÚ Ë ÚÂÊÍ‡ ‡ÚÂÓÒÍÎÂÓ-Á‡. íÂ ËÏ‡Ú Ò˙˘Ó ÔÓ‚Ë¯ÂÌ ËÒÍ ÓÚ ÔÂËÓÔÂ‡ÚË‚Ì‡ ıÂ-ÏÓ‰ËÌ‡ÏË˜Ì‡ ÌÂÒÚ‡·ËÎÌÓÒÚ Ë ÔÓ‚Ë¯ÂÌ‡ ÒÍÎÓÌÌÓÒÚ Í˙ÏÚÓÏ·ÓÓ·‡ÁÛ‚‡ÌÂ (25). è‡ˆËÂÌÚËÚÂ Ò ÂÌ‰ÓÍ‡‰ËÚ Ò‡ ÒÔÓ‚Ë¯ÂÌ‡ ÒÍÎÓÌÌÓÒÚ Í˙Ï ˜‡ÒÚË˜Ì‡ ÂÏ·ÓÎËÁ‡ˆËfl ÓÚÍÎ‡ÔÌËÚÂ ‚Â„ÂÚ‡ˆËË (6). ç‡ÎË˜ËÂÚÓ Ì‡ ÔÂ‰ÓÔÂ‡ÚË‚Ì‡ËÌÙÂÍˆËfl Ò˙˘Ó Â ‚‡ÊÂÌ ÔÂ‰‚ÂÒÚÌËÍ Ì‡ ËÌÒÛÎÚ.

ä‡‰ËÓÔÛÎÏÓÌ‡ÎÌËflÚ ·‡ÈÔ‡Ò, ÍÓÈÚÓ ÔÓ‰˙ÎÊ‡‚‡ ÔÓ-‚Â˜Â ÓÚ 2 ˜‡Ò‡ Â ËÒÍÓ‚ Ù‡ÍÚÓ Á‡ ËÌÒÛÎÚ. äÓÎÍÓÚÓ Â ÔÓ-„ÓÎflÏ‡ Â ÌÂ„Ó‚‡Ú‡ ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ, ÚÓÎÍÓ‚‡ Â ÔÓ-„ÓÎfl-Ï‡ ‚ÂÓflÚÌÓÒÚÚ‡ Á‡ ËÌÒÛÎÚ (46).

àÌÚ‡ÓÔÂ‡ÚË‚Ì‡Ú‡ ıÂÏÓÙËÎÚ‡ˆËfl Â ‰Û„ ÔÂ‰‚Â-ÒÚÌËÍ Ì‡ ËÌÒÛÎÚ. ífl ÒÂ ‰˙ÎÊË Ì‡ ÔÂ‰ÓÔÂ‡ÚË‚Ì‡ ·˙·Â˜-Ì‡ ÌÂ‰ÓÒÚ‡Ú˙˜ÌÓÒÚ ÔË ·˙·Â˜Ì‡ ‡ÚÂËÓÒÍÎÂÓÁ‡ (2).

èÓÒÚÓÔÂ‡ÚË‚ÌÓÚÓ ÔÂ‰Ò˙‰ÌÓ Ï˙Ê‰ÂÌÂ Â ÁÌ‡˜ËÏÓÒ‚˙Á‡ÌÓ Ò ËÌÒÛÎÚ ÔË ÛÌË‚‡Ë‡ÌÚÌËfl ‡Ì‡ÎËÁ. èÂ‰Ò˙-‰ÌÓ Ï˙Ê‰ÂÌÂ ËÁËÒÍ‚‡ ÌÂÁ‡·‡‚Ì‡ ÚÂ‡ÔÂ‚ÚË˜Ì‡ ËÌÚÂ-‚ÂÌˆËfl Á‡ ÌÂ„Ó‚ÓÚÓ Ó‚Î‡‰fl‚‡ÌÂ Ë ‚ÍÎ˛˜‚‡ÌÂ Ì‡ ‡ÌÚËÍÓ‡-„ÛÎ‡ÌÚ Á‡ ÔÓÙËÎ‡ÍÚËÍ‡ Ì‡ ÂÏ·ÓÎË˜ÂÌ ËÌÒÛÎÚ (1).

èË 13% ÓÚ Ô‡ˆËÂÌÚËÚÂ Ò ·‡ÈÔ‡Ò ÒÂ Ì‡ÏË‡Ú ÔÂË-ÙÂÌÓÌÂ‚ÌË Û‚Â‰Ë (19). èÓ‚Â˜ÂÚÓ Ò‡ Ú‡ÍˆËÓÌÌË Û‚Â-‰Ë Ì‡ ÏÂ‰Ë‡ÎÌËfl ÒÌÓÔ Ì‡ ·‡ıË‡ÎÌËfl ÔÎÂÍÒÛÒ, ÍÓËÚÓ ÒÂÎËÍ‚Ë‰Ë‡Ú Á‡ ÓÍÓÎÓ 3 ÏÂÒÂˆ‡. íÂÁË ÎÂÁËË Úfl·‚‡ Á‡‰˙Î-ÊËÚÂÎÌÓ ‰‡ ÒÂ ‰ËÙÂÂÌˆË‡Ú ÓÚ ‚˙ÁÏÓÊÌË ˆÂÌÚ‡ÎÌËÔ‡‡ÎËÁË (26, 37).

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çÂ‚ÓÎÓ„Ë˜ÌËÚÂ ÛÒÎÓÊÌÂÌËfl ‚ Í‡‰ËÓıËÛ„ËflÚ‡ Ò‡‰‚‡ ÓÒÌÓ‚ÌË ‚Ë‰‡: ÍÓ„ÌËÚË‚ÌË Ì‡Û¯ÂÌËfl Ë ÏÓÁ˙˜ÌË ËÌ-ÒÛÎÚË Ò ‡ÌÌÓ (‚ÍÎ. ËÌÚ‡ÓÔÂ‡ÚË‚ÌÓ) ËÎË ÔÓ-Í˙ÒÌÓ (ÔÓÒ-ÚÓÔÂ‡ÚË‚ÌÓ) Ì‡˜‡ÎÓ, Ò ÔÂıÓ‰ÂÌ ËÎË ÔÂÏ‡ÌÂÌÚÂÌ ı‡-‡ÍÚÂ. ç‡ ÚÂÚÓ ÏflÒÚÓ ÔÓ ˜ÂÒÚÓÚ‡ Ò‡ Ú‡ÍˆËÓÌÌËÚÂÔÂËÙÂÌÓÌÂ‚ÌË Û‚Â‰Ë.

áÌ‡˜ËÏ‡Ú‡ ËÌ‰Ë‚Ë‰Û‡ÎÌ‡ Ë ÒÓˆË‡ÎÌ‡ ˆÂÌ‡ Ì‡ ÚÂÁË ÛÒ-ÎÓÊÌÂÌËfl Ì‡Î‡„‡ ÌÂ‚ÓÎÓ„Ë˜ÂÌ ÏÓÌËÚÓËÌ„. èÂ‰ÓÔÂ‡-ÚË‚ÌËflÚ ÌÂ‚ÓÎÓ„Ë˜ÂÌ ÔÂ„ÎÂ‰ Ë Â„ËÒÚË‡ÌÂÚÓ Ì‡ ˆÂ-Â·Ó‚‡ÒÍÛÎ‡ÌË ËÒÍÓ‚Ë Ù‡ÍÚÓË ÔË Ô‡ˆËÂÌÚËÚÂ ‚Í‡‰ËÓıËÛ„Ëfl ÒÂ Ì‡Î‡„‡ ÌÂ ÚÓÎÍÓ‚‡ ÓÚ ÚflıÌ‡Ú‡ ˜ÂÒ-ÚÓÚ‡, ÍÓÎÍÓÚÓ ÓÚ ÁÌ‡˜ËÏÓÒÚÚ‡ Ì‡ ÍÓÏ·ËÌ‡ˆËflÚ‡ ËÏ Ò‰Û„Ë ÔÓÏÂÌÎË‚Ë: Ò˙‰Â˜ÂÌ ÒÚ‡ÚÛÒ Ì‡ Ô‡ˆËÂÌÚ‡, ÔÂËÓ-ÔÂ‡ÚË‚ÌË ÒËÚÛ‡ˆËË Ë ËÁ·‡ÌËfl ıËÛ„Ë˜ÂÌ ÏÂÚÓ‰, ÍÓË-ÚÓ ÒÚÛÍÚÛË‡Ú ÔÓ„ÌÓÒÚË˜ÂÌ ÏÓ‰ÂÎ. ç‡È-˜ÂÒÚÓ ÔÓ-

ÏÂÌÎË‚ËÚÂ ‚ ÚÓÁË ÏÓ‰ÂÎ Ò‡ Ò˙˘Ó ÌÂÁ‡‚ËÒËÏË ÔÂ‰ËÍÚÓ-Ë Á‡ ÌÂ‚ÓÎÓ„Ë˜ÌÓ ÛÒÎÓÊÌÂÌËÂ.

ä‡ÚÍÓÒÓ˜Ì‡Ú‡ ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜Ì‡ ‰ËÒÙÛÌÍˆËfl ÂÔÓ˜ÚË ÌÂËÁ·ÂÊÌ‡ ÒÎÂ‰ Í‡‰ËÓıËÛ„Ë˜Ì‡ ËÌÚÂ‚ÂÌˆËfl, ‡‰˙Î„ÓÒÓ˜Ì‡Ú‡ Â Ì‡È-˜ÂÒÚÓ ÔË Ô‡ˆËÂÌÚË Ò Ì‡ÎË˜ÂÌ ÔÂ-‰ÓÔÂ‡ÚË‚ÂÌ ÍÓ„ÌËÚË‚ÂÌ ‰ÂÙËˆËÚ, ÍÓÈÚÓ ÒÂ Á‡‰˙Î·Ó˜‡‚‡ÔË Ì‡ÔÂ‰Ì‡Î‡ ‚˙Á‡ÒÚ Ë ÌËÒ˙Í ÔÂÏÓ·Ë‰ÂÌ ËÌÚÂÎÂÍÚ.

ÑÓÍ‡Á‡ÌË Ò‡ ÔÂ‰ÓÔÂ‡ÚË‚ÌË, ËÌÚ‡ÓÔÂ‡ÚË‚ÌË Ë ÔÓÒ-ÚÓÔÂ‡ÚË‚ÌË Ù‡ÍÚÓË Á‡ ÔÂıÓ‰ÌË (ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜Ì‡‰ËÒÙÛÌÍˆËfl, íàÄ, Ï‡Î˙Í ËÌÒÛÎÚ) Ë ÔÂÏ‡ÌÂÌÚÌË (ËÌ‚‡-ÎË‰ËÁË‡˘Ë ÏÓÁ˙˜ÌË ËÌÒÛÎÚË) ÓÒÚË ÏÓÁ˙˜ÌÓ-Ò˙‰Ó‚Ë ËÌ-ˆË‰ÂÌÚË.

èÂ‰ÓÔÂ‡ÚË‚ÌËÚÂ ÔÂ‰ËÍÚÓË Ì‡ ËÌÒÛÎÚ Ò‡: ÌÂÒÚ‡-·ËÎÌÓ Ò˙‰Â˜ÌÓ Ò˙ÒÚÓflÌËÂ, Ì‡Î‡„‡˘Ó ÒÔÂ¯Ì‡ ËÌÚÂ‚ÂÌ-ˆËfl, ‡Ì‡ÏÌÂÁ‡ Á‡ ÏÓÁ˙˜ÌÓ-Ò˙‰Ó‚‡ ·ÓÎÂÒÚ, ‡ÚÂË‡ÎÌ‡ ıË-ÔÂÚÓÌËfl, Á‡ı‡ÂÌ ‰Ë‡·ÂÚ, ÔÂËÙÂÌ‡ Ò˙‰Ó‚‡ ·ÓÎÂÒÚ,ÔÂ‰¯ÂÒÚ‚‡˘‡ Ò˙‰Â˜Ì‡ ËÌÚÂ‚ÂÌˆËfl, Í‡‰ËÓ-ÔÛÎÏÓÌ‡-ÎÂÌ ·‡ÈÔ‡Ò, ÔÓ‰˙ÎÊËÎ ÔÓ‚Â˜Â ÓÚ 24 ˜‡Ò‡, ÌÂÓ·ıÓ‰ËÏÓÒÚÓÚ ËÌÚ‡ÓÔÂ‡ÚË‚Ì‡ ıÂÏÓÙËÎÚ‡ˆËfl, ÔÂ‰ÓÔÂ‡ÚË‚Ì‡ËÌÙÂÍˆËfl, ‚ËÒÓÍË Ú‡ÌÒÙÛÁËÓÌÌË ËÁÒËÍ‚‡ÌËfl, ÌÂÒÚ‡·ËÎ-Ì‡ ÒÚÂÌÓÍ‡‰Ëfl, ·ÂÎÓ‰Ó·ÌÓ Á‡·ÓÎfl‚‡ÌÂ, ÔÓÒÚÓÔÂ‡Ú‚Ë-ÌÓ ÔÂ‰Ò˙‰ÌÓ Ï˙Ê‰ÂÌÂ, ÔÂ‰ÓÔÂ‡ÚË‚Ì‡ ËÌÙÂÍˆËfl.

ë˙Ò ÁÌ‡˜ËÏ ÔÓÒÚÓÔÂ‡ÚË‚ÂÌ ËÒÍ Á‡ ËÌÒÛÎÚ ÒÎÂ‰ ÍÓÓ-Ì‡Ì‡ Â‚‡ÒÍÛÎ‡ËÁ‡ˆËfl Ò‡ Ô‡ˆËÂÌÚËÚÂ Ò ÏÓÁ˙˜ÌÓ-Ò˙‰Ó‚‡·ÓÎÂÒÚ, ‡ÚÂË‡ÎÌ‡ ıËÔÂÚÓÌËfl, Á‡ı‡ÂÌ ‰Ë‡·ÂÚ, ıÓ-ÌË˜Ì‡ ·˙·Â˜Ì‡ ÌÂ‰ÓÒÚ‡Ú˙˜ÌÓÒÚ ‚ Ì‡ÔÂ‰Ì‡Î‡ ‚˙Á‡ÒÚ,ÔÂÊË‚ÂÎË ËÌÒÛÎÚ ËÎË Ò ‡ÚÂÓÒÍÎÂÓÚË˜Ì‡ ‡ÒˆÂÌ‰Ë‡˘‡‡ÓÚ‡.

Ç ÔÓ„ÌÓÁÂÌ ÏÓ‰ÂÎ ÔÓÏÂÌÎË‚ËÚÂ Á‡ ‡ÌÌË ÌÂ‚ÓÎÓ-„Ë˜ÌË ÛÒÎÓÊÌÂÌËfl Ò‡: Ô‡ˆËÂÌÚ ‚ Í˙ÒÌ‡ ‚˙Á‡ÒÚ Ò ÔÂ‰ÓÔÂ-‡ÚË‚Ì‡ Äï, ÔË ÍÓÈÚÓ ÒÂ ÔÓ‚ÂÊ‰‡ ÓÔÂ‡ˆËfl Ì‡ ‡ÓÚ‡-Ú‡ ‚ ÛÒÎÓ‚ËflÚ‡ Ì‡ ÔÓ‰˙ÎÊËÚÂÎÂÌ Í‡‰ËÓÔÛÎÏÓÌ‡ÎÂÌ·‡ÈÔ‡Ò Ë ËÌÚ‡ÓÔÂ‡ÚË‚Ì‡ ıËÔÓÚÓÌËfl.

Ç ÔÓ„ÌÓÁÂÌ ÏÓ‰ÂÎ ÔÓÏÂÌÎË‚ËÚÂ Á‡ ÔÓ-Í˙ÒÌÓ ÏÓÁ˙˜ÌÓ-Ò˙‰Ó‚Ó ÛÒÎÓÊÌÂÌËÂ Ò‡: ÊÂÌ‡ Ò˙Ò Á‡ı‡ÂÌ ‰Ë‡·ÂÚ, ÔË ÍÓfl-ÚÓ ÒÂ ÔÓ‚ÂÊ‰‡ ÍÓÏ·ËÌË‡Ì‡ Í‡‰ËÓıËÛ„Ë˜Ì‡ ÔÓˆÂ‰Û-‡, Ò ÔÓ‰˙ÎÊËÚÂÎÌ‡ ‚ÂÌÚËÎ‡ˆËfl Ë ÔÓÒÚÓÔÂ‡ÚË‚Ì‡ ÒÛÔ-‡‚ÂÌÚËÍÛÎ‡Ì‡ Ú‡ıËÍ‡‰Ëfl.

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Ä‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËfl:Ñ- èÂÌÍ‡ ÄÚ‡Ì‡ÒÓ‚‡, ‰.Ï.äÎËÌËÍ‡ ÔÓ ÌÂ‚ÓÎÓ„ËflåÂ‰ËˆËÌÒÍË ÛÌË‚ÂÒËÚÂÚÅÛÎ. “Ç‡ÒËÎ ÄÔËÎÓ‚” ‹15 Ä, 4000 èÎÓ‚‰Ë‚íÂÎ.: 0888 83 73 52, 602 477Fax: + 359 32 62 32 54e-mail: [email protected]


SUMMARY

HOMOCYSTEINE IN STROKE PATIENTSE. Vassileva, M. Daskalov, N. Toteva, R. Mihailov

The level of total homocysteine of 35 patients withischemic stroke was evaluated.

All patients were classified in two groups: patients withstroke of large artery disease (n=20) and patients with strokeof undetermined etiology (n=15).

Ärterial lesions in the first group included: internal carotidartery pathology – atherosclerotic plaques (n=6), moderategrade stenosis (n=6), high-grade stenosis (n=14), carotidocclusion (n=4), vertebral artery pathology - (stenoses, sub-clavian steal phenomenon) (n=5) and middle cerebral arterystenoses (n=4).

In 20 patients with 39 arterial lesions hyperhomocysteine-mia (over 15 µmol/l) was found as following: in 3 of the arter-ies with plaques (3/6), in 2 with moderate grade stenoses(2/6), in 16 with high grade stenoses (16/23), in 2 with carotidocclusions (2/4). Progression in the atherosclerosis wasobserved in 2 patients with hyperhomocysteinemia.

In 4 out of 15 patients with undetermined etiology hyper-homocysteinemia was found in 4 cases. Severe hyperhomo-cysteinemia was not observed in any cases.

Key Words: Doppler sonography, stroke, homocysteine.

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ç‡ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡ÌÂ ËÏ‡ Á‡ ˆÂÎ ‰‡ ËÁÒÎÂ‰‚‡ ÌË‚Ó Ì‡ÚÓÚ‡ÎÌËfl ÔÎ‡ÁÏÂÌ ïˆ ‚ ‰‚Â „ÛÔË ·ÓÎÌË: Ò ËÒıÂÏË˜ÂÌ ËÌ-ÒÛÎÚ ÓÚ ÌÂflÒÌ‡ ÂÚËÓÎÓ„Ëfl Ë Ò ËÒıÂÏË˜ÂÌ ËÌÒÛÎÚ ÔË Ô‡-ÚÓÎÓ„Ëfl Ì‡ „ÓÎÂÏË ÏÓÁ˙˜ÌË ‡ÚÂËË, Ò ˆÂÎ ‰‡ ÒÂ ÔÓÒÎÂ‰ËÁÌ‡˜ÂÌËÂÚÓ Ì‡ ïïˆ ‚ Ô‡ÚÓ„ÂÌÂÁ‡Ú‡ Ì‡ ÏÓÁ˙˜ÌÓÒ˙‰Ó‚ËÚÂÁ‡·ÓÎfl‚‡ÌËfl.

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èÓÛ˜‚‡ÌÂÚÓ ‚ÍÎ˛˜‚‡ 35 ·ÓÎÌË, ÔÂÍ‡‡ÎË ËÒıÂÏË˜ÂÌÏÓÁ˙˜ÂÌ ËÌÒÛÎÚ, ÍÓËÚÓ ÒÏÂ ÍÎ‡ÒË‡ÎË ‚ ‰‚Â „ÛÔË Ò˙Ó·-‡ÁÌÓ ÂÚËÓÔ‡ÚÓ„ÂÌÂÚË˜Ì‡Ú‡ ÍÎ‡ÒËÙËÍ‡ˆËfl íéÄSí (7).è˙‚‡Ú‡ „ÛÔ‡ Ó·ı‚‡˘‡ ·ÓÎÌË Ò ÌÂflÒÌ‡ ÂÚËÓÎÓ„Ëfl Ì‡ÏÓÁ˙˜ÌËfl ËÌÒÛÎÚ, ‡ ‚ÚÓ‡Ú‡ „ÛÔ‡ – Ò ËÒıÂÏË˜ÂÌ ËÌÒÛÎÚÔË Ô‡ÚÓÎÓ„Ëfl Ì‡ „ÓÎÂÏË ÏÓÁ˙˜ÌË ‡ÚÂËË (>_50% ÒÚÂÌÓ-ÁË ËÎË ÚÓÏ·ÓÁË).

éÒÌÓ‚ÌË ËÁÍÎ˛˜‚‡˘Ë ÍËÚÂËË Ò‡: Ì‡ÎË˜ËÂ Ì‡ Í‡‰ËÓ-ÂÏ·ÓÎË˜ÂÌ ËÁÚÓ˜ÌËÍ, Ì‡ÎË˜ËÂ Ì‡ ÍÎËÌË˜ÌË Ë ÌÂ‚ÓËÁÓ·‡-Áfl‚‡˘Ë ‰‡ÌÌË Á‡ Î‡ÍÛÌ‡ÂÌ ËÌÒÛÎÚ, ıÓÌË˜Ì‡ ·˙·Â˜Ì‡ ÌÂ-‰ÓÒÚ‡Ú˙˜ÌÓÒÚ.

éÚ ‚ÒË˜ÍË ·ÓÎÌË, 7 Ò‡ ÊÂÌË Ë 28 - Ï˙ÊÂ, Ì‡ ‚˙Á‡ÒÚÓÚ 24 ‰Ó 74 „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ, ÒÂ‰Ì‡ ‚˙Á‡ÒÚ 50 „Ó‰.èÓ‚Â‰ÂÌË Ò‡ ÌÂÓ·ıÓ‰ËÏËÚÂ Ô‡‡ÍÎËÌË˜ÌË, ÌÂ‚ÓËÁÓ·-‡Áfl‚‡˘Ë (ÍÓÏÔ˛Ú˙Ì‡ ÚÓÏÓ„‡ÙËfl, Ï‡„ÌËÚÌÓÂÁÓÌ‡-ÌÒÌ‡ ÚÓÏÓ„‡ÙËfl, Ï‡„ÌËÚÌÓÂÁÓÌ‡ÌÒÌ‡ ‡Ì„ËÓ„‡ÙËfl) ËËÌÒÚÛÏÂÌÚ‡ÎÌË ËÁÒÎÂ‰‚‡ÌËfl (ÂÎÂÍÚÓÍ‡‰ËÓ„‡ÙËfl,ÂıÓÍ‡‰ËÓ„‡ÙËfl) Ò ˆÂÎ ÂÚËÓÔ‡ÚÓ„ÂÌÂÚË˜ÌÓ ÛÚÓ˜Ìfl-‚‡ÌÂ Ì‡ ÏÓÁ˙˜ÌËfl ËÌÒÛÎÚ. ÇÒË˜ÍË ·ÓÎÌË Ò‡ ËÁÒÎÂ‰‚‡ÌË ÒÔÓÒÚÓflÌÌÓ‚˙ÎÌÓ‚‡ ÂÍÒÚ‡Í‡ÌË‡ÎÌ‡, ˆ‚ÂÚÌ‡ ‰ÛÔÎÂÍÒ‰ÓÔÎÂÓ‚‡ Ë Ú‡ÌÒÍ‡ÌË‡ÎÌ‡ ‰ÓÔÎÂÓ‚‡ ÒÓÌÓ„‡ÙËfl.Ö‰Ì‡ „Ó‰ËÌ‡ ÔÓ-Í˙ÒÌÓ Â ÓÒ˙˘ÂÒÚ‚ÂÌ‡ ÍÓÌÚÓÎÌÓ ‰ÓÔ-ÎÂÒÓÌÓ„‡ÙÒÍÓ ËÁÒÎÂ‰‚‡ÌÂ Ì‡ ÚÂÁË ·ÓÎÌË, ÔË ÍÓËÚÓ ÂÛÒÚ‡ÌÓ‚ÂÌ‡ Ô‡ÚÓÎÓ„Ëfl Ì‡ Ï‡„ËÒÚ‡ÎÌË ÏÓÁ˙˜ÌË ‡ÚÂ-ËË.

àÁÒÎÂ‰‚‡ÌÓ Â ÔÎ‡ÁÏÂÌÓÚÓ ÌË‚Ó Ì‡ ÚÓÚ‡ÎÌËfl ïˆ Ì‡„Î‡‰ÌÓ > 12 ˜‡Ò‡ ÒÎÂ‰ Ì‡ı‡Ì‚‡ÌÂ, ÔÓÒÂ‰ÒÚ‚ÓÏ ÏÂÚÓ‰˙ÚÙÎÛÂÒˆÂÌÚÌÓ ÔÓÎflËÁ‡ˆËÓÌÂÌ ËÏÛÌÓ‡Ì‡ÎËÁ (FPIA). ë˙„-Î‡ÒÌÓ Ì‡È-˜ÂÒÚÓ ˆËÚË‡ÌËÚÂ ÂÙÂÂÌÚÌË ÒÚÓÈÌÓÒÚË,ÚÂÁË ÏÂÊ‰Û 5 Ë 15 µmol/l Ò‡ ÔËÂÚË Á‡ ÌÓÏ‡ÎÌË (8-11).Ä·ÌÓÏ‡ÎÌËÚÂ ÒÚÓÈÌÓÒÚË (11-14) Ò‡ ÍÎ‡ÒË‡ÌË Í‡ÚÓ


éË„ËÌ‡ÎÌË ÒÚ‡ÚËËïéåéñàëíÖàç

èêà Åéãçà ë àëïÖåàóÖç åéáöóÖç àçëìãíE. Ç‡ÒËÎÂ‚‡1, å. Ñ‡ÒÍ‡ÎÓ‚1, ç. íÓÚÂ‚‡1, ê. åËı‡ÈÎÓ‚2

1äÎËÌËÍ‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl2éÚ‰ÂÎÂÌËÂ ÔÓ ÍÎËÌË˜Ì‡ Î‡·Ó‡ÚÓÌ‡ ÏÂ‰ËˆËÌ‡

ìåÅÄã ñ‡Ëˆ‡ âÓ‡ÌÌ‡

1. ÎÂÍ‡ ïïˆ - 16-30 µmol/l2. ÛÏÂÂÌ‡ ïïˆ - 31-100 µmol/l 3. ÚÂÊÍ‡ ïïˆ – Ì‡‰ 100 µmol/l

êÖáìãíÄíà

è˙‚‡Ú‡ „ÛÔ‡ - Ò ËÒıÂÏË˜ÂÌ ËÌÒÛÎÚ ÔË Ô‡ÚÓÎÓ„Ëfl Ì‡„ÓÎÂÏË ÏÓÁ˙˜ÌË ‡ÚÂËË, ‚ÍÎ˛˜‚‡ 14 Ï˙ÊÂ Ë 6 ÊÂÌË, ÓÚ50 ‰Ó 74 „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ, ÒÂ‰Ì‡ ‚˙Á‡ÒÚ – 62 „Ó‰. èË12 ·ÓÎÌË Â Ì‡ÎËˆÂ ÍÓÏ·ËÌË‡Ì‡ ‡ÚÂË‡ÎÌ‡ ÏÓÁ˙˜ÌÓÒ˙‰Ó-‚‡ Ô‡ÚÓÎÓ„Ëfl, Í‡ÚÓ ÒÂ ÛÒÚ‡ÌÓ‚ÂÌË ÒÎÂ‰ÌËÚÂ ‡ÚÂË‡ÎÌËÎÂÁËË: ÌÂÒÚÂÌÓÁË‡˘Ë ‡ÚÂÓÒÍÎÂÓÚË˜ÌË ÔÎ‡ÍË Ì‡ ÇëÄ(n=6), ÛÏÂÂÌË Í‡ÓÚË‰ÌË ÒÚÂÌÓÁË – 50-75% (n=6), ‚ËÒÓ-ÍÓÒÚÂÔÂÌÌË Í‡ÓÚË‰ÌË ÒÚÂÌÓÁË – 75-99% (n=14), Í‡Ó-ÚË‰ÌË ÚÓÏ·ÓÁË (n=4), ÒÚÂÌÓÁË Ì‡ ‡ÚÂËfl ‚ÂÚÂ·‡ÎËÒË ‚ÂÚÂ·‡ÎÂÌ ÒÚËÎ ÙÂÌÓÏÂÌ (n=5), ÒÚÂÌÓÁË Ì‡ ÒÂ‰Ì‡ÏÓÁ˙˜Ì‡ ‡ÚÂËfl (n=4) (ÙË„.1).

êÂÁÛÎÚ‡ÚËÚÂ ÓÚ ËÁÒÎÂ‰‚‡ÌÂ ÔÎ‡ÁÏÂÌÓÚÓ ÌË‚Ó Ì‡ ïˆÔÓÍ‡Á‚‡Ú ÒÎÂ‰ÌÓÚÓ ‡ÁÔÂ‰ÂÎÂÌËÂ ÔÓ ÓÚÌÓ¯ÂÌËÂ ÒÚÂÔÂÌ-Ú‡ Ì‡ ÒÚÂÌÓÚË˜ÌËfl ÔÓˆÂÒ (ÙË„.2): ÔÓ‚Ë¯ÂÌË ÒÚÓÈÌÓÒÚË(Ì‡‰ 15 µmol/l ) ÔË 3 ÓÚ ‡ÚÂËËÚÂ Ò ÔÎ‡ÍË (3/6), ÔË 2ÓÚ ‡ÚÂËËÚÂ Ò ÛÏÂÂÌË ÒÚÂÌÓÁË (2/6), 16 ÓÚ ÚÂÁË Ò ‚Ë-ÒÓÍÓÒÚÂÔÂÌÌË ÒÚÂÌÓÁË (16/23), 2 ÓÚ ÚÂÁË Ò ‡ÚÂË‡ÎÌËÚÓÏ·ÓÁË (2/4).

äÓÌÚÓÎÌ‡Ú‡ ˆ‚ÂÚÌ‡ ‰ÛÔÎÂÍÒ ‰ÓÔÎÂÓ‚‡ ÒÓÌÓ„‡ÙËfl,ÔÓ‚Â‰ÂÌ‡ Â‰Ì‡ „Ó‰ËÌ‡ ÔÓ-Í˙ÒÌÓ ÔË ·ÓÎÌËÚÂ Ò˙Ò ÒÚÂÌÓÁËÌ‡ Ï‡„ËÒÚ‡ÎÌËÚÂ ÏÓÁ˙˜ÌË ‡ÚÂËË ÛÒÚ‡ÌÓ‚fl‚‡ ÔÓ„Â-ÒËfl ‚ ‡ÚÂÓÒÍÎÂÓÚË˜ÌËfl ÔÓˆÂÒ Ì‡ Í‡ÓÚË‰ÌËÚÂ ‡ÚÂ-ËË ÔË 2 ·ÓÎÌË. í‡ÁË ÔÓ„ÂÒËfl ÒÂ ËÁ‡Áfl‚‡ Â„ËÒÚË‡-ÌÂ Ì‡ ÌÓ‚‡ ÌÂÒÚÂÌÓÁË‡˘‡, ıËÔÓÂıÓ„ÂÌÌ‡ ÔÎ‡Í‡ ‚ Ó·˘‡Ú‡Ò˙ÌÌ‡ ‡ÚÂËfl, Í‡ÓÚË‰Ì‡Ú‡ ·ËÙÛÍ‡ˆËfl ËÎË ‚˙ÚÂ¯Ì‡-Ú‡ Ò˙ÌÌ‡ ‡ÚÂËfl. çË‚ÓÚÓ Ì‡ ÔÎ‡ÁÏÂÌËfl ïˆ ÔË ·ÓÎÌËÚÂÒ ÌÓ‚ÓÔÓfl‚ÂÌË ÔÎ‡ÍË Â Ò˙ÓÚ‚ÂÚÌÓ 24,4 µmol/l Ë 15,5µmol/l.

ÇÚÓ‡Ú‡ „ÛÔ‡ Ò‡ Ô‡ˆËÂÌÚËÚÂ Ò ËÒıÂÏË˜ÂÌ ËÌÒÛÎÚ ‚ÏÎ‡‰‡ ‚˙Á‡ÒÚ, ÔË ÍÓËÚÓ ËÌÒÚÛÏÂÌÚ‡ÎÌËÚÂ, Ô‡‡ÍÎË-ÌË˜ÌË Ë ÌÂ‚ÓËÁÓ·‡Áfl‚‡˘Ë ÏÂÚÓ‰Ë ÌÂ ‰Ó‚Â‰Óı‡ ‰Ó ËÁflÒ-Ìfl‚‡ÌÂ Ì‡ ÂÚËÓÔ‡ÚÓ„ÂÌÂÚË˜ÌËfl ÏÂı‡ÌËÁ˙Ï. ífl ‚ÍÎ˛˜‚‡10 Ï˙ÊÂ Ë 5 ÊÂÌË, ÓÚ 24 ‰Ó 48 „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ. ÄÚÂ-Ë‡ÎÌËflÚ ·‡ÒÂÈÌ Â ÒÂ‰Ì‡ ÏÓÁ˙˜Ì‡ ‡ÚÂËfl – ÔË 12 ·ÓÎ-ÌË Ë ‚ÂÚÂ·Ó·‡ÁËÎ‡Ì‡ ÒËÒÚÂÏ‡ – ÔË 3 ·ÓÎÌË. èË ÚÂ-ÁË Ô‡ˆËÂÌÚË ÎËÔÒ‚‡Ú ÍÓÌ‚ÂÌˆËÓÌ‡ÎÌËÚÂ ËÒÍÓ‚Ë Ù‡ÍÚÓ-Ë Á‡ ÏÓÁ˙˜ÂÌ ËÌÒÛÎÚ. èÎ‡ÁÏÂÌÓÚÓ ÌË‚Ó Ì‡ ïˆ Â ÔÓ‰ 15µmol/l ÔË 11 ·ÓÎÌË, ‡ ÔÓ‚Ë¯ÂÌÓ – ÔË 4 ·ÓÎÌË.

éÅëöÜÑÄçÖ

ç‡ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡ÌÂ ÔÂ‰ÒÚ‡‚fl Ï‡ÎÍ‡ „ÛÔ‡ ·ÓÎÌË(n=35), ÔÂÍ‡‡ÎË ËÒıÂÏË˜ÂÌ ËÌÒÛÎÚ, ÍÎ‡ÒË‡ÌË ÒÔÓÂ‰ÂÚËÓÔ‡ÚÓ„ÂÌÂÚË˜Ì‡Ú‡ ÍÎ‡ÒËÙËÍ‡ˆËfl íéÄSí ‚ ‰‚Â „Û-ÔË. ä‡Ò‡Â ÒÂ Á‡ ÔÓ‰·‡ÌË ·ÓÎÌË, ˜‡ÒÚ ÓÚ ÍÓËÚÓ Ò‡ Ò ‡Ì-Ì‡ ËÎË ËÁ‡ÁÂÌ‡ ‡ÚÂÓÒÍÎÂÓÁ‡, ‰Ó‚ÂÎ‡ ‰Ó ‚ËÒÓÍÓÒÚÂÔÂÌ-ÌË ÒÚÂÌÓÁË Ë ÚÓÏ·ÓÁË, ‡ ‰Û„‡Ú‡ ˜‡ÒÚ - ·ÓÎÌË ‚ ÏÎ‡‰‡‚˙Á‡ÒÚ, ·ÂÁ ËÒÍÓ‚Ë Ù‡ÍÚÓË Á‡ ÏÓÁ˙˜ÌÓÒ˙‰Ó‚Ë Á‡·ÓÎfl-‚‡ÌËfl, Ò ÌÂflÒÌ‡ „ÂÌÂÁ‡ Ì‡ ËÒıÂÏË˜ÌËfl ÏÓÁ˙˜ÂÌ ËÌÒÛÎÚ. è‡-ˆËÂÌÚËÚÂ Ò‡ ‚ÍÎ˛˜ÂÌË ÔÓ Ú‡Í˙‚ ÍËÚÂËÈ, Á‡˘ÓÚÓ ÓÚÂ‰Ì‡ ÒÚ‡Ì‡ ÔË ËÌÒÛÎÚË Ò ÌÂflÒÌ‡ ÂÚËÓÎÓ„Ëfl, ÓÒÓ·ÂÌÓ ‚ÏÎ‡‰‡ ‚˙Á‡ÒÚ ÒÂ Ó˜‡Í‚‡ ÓÚÍË‚‡ÌÂ Ì‡ ıËÔÂıÓÏÓˆËÒÚÂ-ËÌÂÏËfl, ‡ ÓÚ ‰Û„‡ ÒÚ‡Ì‡ - ÔÓ‚Ë¯ÂÌËÚÂ ïˆ ÍÓÌˆÂÌÚ‡-ˆËË Ò‡ Ò‚˙Á‡ÌË Ò Í‡ÓÚË‰Ì‡ ‡ÚÂÓÒÍÎÂÓÁ‡ (4,15,16). í‡-Í‡ Ì‡ÔËÏÂ ‰ÓÍ‡Á‡Ì‡ Â ÍÓÂÎ‡ˆËfl ÏÂÊ‰Û ÔÎ‡ÁÏÂÌ‡Ú‡ÍÓÌˆÂÌÚ‡ˆËfl Ì‡ ïˆ Ë ÒÚÂÔÂÌÚ‡ Ì‡ Í‡ÓÚË‰Ì‡ ‡ÚÂÓÒÍ-ÎÂÓÁ‡, ÓˆÂÌÂÌ‡ ˜ÂÁ ÒÛÏ‡Ì‡Ú‡ ‰Â·ÂÎËÌ‡ Ì‡ ‚ÒË˜ÍË ÔÎ‡ÍË,ÓÚÍËÚË ˜ÂÁ ‰ÛÔÎÂÍÒ ‰ÓÔÎÂÓ‚‡ ÒÓÌÓ„‡ÙËfl (17). ÑÛ„ÓÔÓÛ˜‚‡ÌÂ ËÁÒÎÂ‰‚‡ÎÓ ‚˙ÁÍ‡Ú‡ ÏÂÊ‰Û ÒÚÂÔÂÌÚ‡ Ì‡ Í‡-ÓÚË‰ÌËÚÂ ÒÚÂÌÓÁË, Í‡ÍÚÓ Ë ÚflıÌ‡Ú‡ ÍÎËÌË˜Ì‡ ËÁfl‚‡ ÒÔÎ‡ÁÏÂÌÓÚÓ ÌË‚Ó Ì‡ ïˆ ‰ÓÍ‡Á‚‡, ˜Â ÚÓÈ Â ËÒÍÓ‚ Ù‡ÍÚÓÁ‡ ‡Á‚ËÚËÂ Ì‡ ÏÓÁ˙˜ÂÌ ËÌÙ‡ÍÚ ÔË ·ÓÎÌË Ò Í‡ÓÚË‰ÌËÒÚÂÌÓÁË (18). ÄÌ‡ÎËÁË‡ÌË Ò‡ ·ÓÎÌË Ò Ì‡‰ 50% ÒÚÂÌÓÁË Ì‡‚˙ÚÂ¯Ì‡Ú‡ Ò˙ÌÌ‡ ‡ÚÂËfl, Ë Â ÛÒÚ‡ÌÓ‚ÂÌÓ ˜Â ÚÂÁË Ò˙ÒÒËÏÔÚÓÏ‡ÚË˜ÌË Í‡ÓÚË‰ÌË ÒÚÂÌÓÁË ÔÓÍ‡Á‚‡Ú ÒË„ÌËÙË-Í‡ÌÚÌÓ ÔÓ-‚ËÒÓÍË ÒÚÓÈÌÓÒÚË ‚ Ò‡‚ÌÂÌËÂ Ò Ô‡ˆËÂÌÚËÚÂÒ ‡ÒËÏÔÚÓÏ‡ÚË˜ÌË Í‡ÓÚË‰ÌË ÒÚÂÌÓÁË. ïïˆ ÒÂ Ò‚˙Á‚‡ÌÂ Ò‡ÏÓ Ò˙Ò ÒÚÂÔÂÌÚ‡ Ì‡ ‡ÚÂÓÒÍÎÂÓÚË˜ÌËfl ÔÓˆÂÒ, ÌÓË ÌÂ„Ó‚‡Ú‡ ÔÂÊ‰Â‚ÂÏÂÌÌ‡ ÔÓfl‚‡ (11,19,20).

å‡ÍÒËÏ‡ÎÌÓÚÓ Â„ËÒÚË‡ÌÓ ÔÎ‡ÁÏÂÌÓ ÌË‚Ó Ì‡ ıÓÏÓ-ˆËÒÚÂËÌ‡ ‚ ‰‚ÂÚÂ „ÛÔË Â 40 µmol/l. èË ÌËÚÓ Â‰ËÌ ÓÚÔ‡ˆËÂÌÚËÚÂ ÌÂ ÒÂ ÔÓ‰ÓÁË‡ Ì‡ÎË˜ËÂ Ì‡ ıÓÏÓÁË„ÓÚË Á‡ÚËÚÂ ‡‚ÚÓÁÓÏÌÓ-ÂˆÂÒË‚ÌË ‚Ó‰ÂÌË Ì‡Û¯ÂÌËfl Ì‡ ıÓ-ÏÓˆËÒÚÂËÌÓ‚Ëfl ÏÂÚ‡·ÓÎËÁ˙Ï, Ú˙È Í‡ÚÓ ÚÂÁË ·ÓÎÌËËÏ‡Ú ÍÓÌˆÂÌÚ‡ˆËË Ì‡ ıÓÏÓˆËÒÚÂËÌ‡ 10-50 Ô˙ÚË ÔÓ-‚Ë-ÒÓÍË ÓÚ Ó·˘‡Ú‡ ÔÓÔÛÎ‡ˆËfl. è‡‚Ë ‚ÔÂ˜‡ÚÎÂÌËÂ ˜ÂÒÚÓÛÒÚ‡ÌÓ‚fl‚‡ÌÂ Ì‡ ÒÚÓÈÌÓÒÚË ÏÂÊ‰Û 9 Ë 14,9 µmol/l – 40%ÓÚ ‚ÒË˜ÍË ÒÎÛ˜‡Ë, ÍÓÂÚÓ ÏÓÊÂ ‰‡ ÒÂ Ó·flÒÌË Ò˙Ò ÒÔÂˆËÙË˜-ÌËfl ÔÓ‰·Ó Ì‡ Ô‡ˆËÂÌÚË. ä‡ÍÚÓ Â ËÁ‚ÂÒÚÌÓ, Û‚ÂÎË˜ÂÌËÚÂÌ‡‰ 15 µmol/l ÒÚÓÈÌÓÒÚË Ì‡ ïˆ Ò‡ ÌÂÁ‡‚ËÒËÏ ËÒÍÓ‚ Ù‡Í-ÚÓ Á‡ ËÒıÂÏË˜ÌË ËÌÒÛÎÚË, ‡ ÒÚÓÈÌÓÒÚËÚÂ ÏÂÊ‰Û 10 Ë15 µmol/l ÌÂ Ò‡ ÒË„ÌËÙËÍ‡ÌÚÌÓ Ò‚˙Á‡ÌË Ò ËÒıÂÏË˜ÂÌ ËÌ-ÒÛÎÚ, ÌÓ Û‚ÂÎË˜‡‚‡Ú ËÒÍ‡ ÓÚ Ò˙‰Ó‚‡ ÒÏ˙Ú Ë ÍÓÏ·ËÌË-‡ÌË Ò˙‰Ó‚Ë Á‡·ÓÎfl‚‡ÌËfl (21). ë˙‰Ó‚ËÚÂ Û‚Â‰Ë Ó·ËÍÌÓ-‚ÂÌÓ Ò‡ ÂÁÛÎÚ‡Ú ÓÚ ÍÛÏÛÎ‡ÚË‚ÌÓ ‰ÂÈÒÚ‚ËÂ Ì‡ ÏÌÓ„ÓÙ‡ÍÚÓË, ÔÓ‡‰Ë ÍÓÂÚÓ „‡ÌË˜ÌËÚÂ ÒÚÓÈÌÓÒÚË ‚ ÓÔÂ-‰ÂÎÂÌ ÍÓÌÚËÌ„ÂÌÚ Ò˙˘Ó ·Ëı‡ ÓÍ‡Á‡ÎË ËÁ‚ÂÒÚÌÓ ‚ÎËflÌËÂ.

èÓ‡‰Ë Ï‡ÎÍËflÚ ·ÓÈ ËÁÒÎÂ‰‚‡ÌË ·ÓÎÌË ‚ „ÛÔ‡Ú‡ ·ÓÎ-ÌË Ò ‡ÚÂË‡ÎÌ‡ Ô‡ÚÓÎÓ„Ëfl, Ì‡ÒÚÓfl˘ËÚÂ ‰‡ÌÌË ÌÂ ÔÓÁ‚Ó-Îfl‚‡Ú ‰‡ ÒÂ Ì‡Ô‡‚Ë Á‡ÍÎ˛˜ÂÌËÂ Á‡ ‚˙ÁÍ‡ ÏÂÊ‰Û ÌË‚ÓÚÓÌ‡ ıÓÏÓˆËÒÚÂËÌ‡ Ë ÒÚÂÔÂÌÚ‡ Ì‡ ‡ÚÂÓÒÍÎÂÓÚË˜ÌËflÔÓˆÂÒ. êÂÁÛÎÚ‡ÚËÚÂ Ó·‡˜Â ÓÚ „ÓÎÂÏË ÔÓÛ˜‚‡ÌËfl ÔÓÍ‡Á-‚‡Ú, ˜Â Ô‡ˆËÂÌÚËÚÂ Ò ‰‚Â ËÎË ÚË ÒÚÂÌÓÁË Ì‡ ÂÍÒÚ‡- ËÚ‡ÌÒÍ‡ÌË‡ÎÌË Ò˙‰Ó‚Â ËÏ‡Ú ÔÓ-‚ËÒÓÍË ÌË‚‡ Ì‡ ıÓÏÓ-ˆËÒÚÂËÌ, ÓÚÍÓÎÍÓÚÓ ÚÂÁË Ò 1 ÒÚÂÌÓÁ‡ (22).


îË„. 1 ÄÚÂË‡ÎÌ‡ Ô‡ÚÓÎÓ„Ëfl ‚ ËÁÒÎÂ‰‚‡ÌËfl ÍÓÌÚËÌ„ÂÌÚ

îË„.2 èÎ‡ÁÏÂÌÓ ÌË‚Ó Ì‡ ïˆ Ë ÒÚÂÔÂÌ Ì‡ Ó·ÒÚÛÍÚË‚ÌËfl ÔÓˆÂÒ

éÚ ËÌÚÂÂÒ Ò‡ ‰‡ÌÌËÚÂ Á‡ ÔÓ„ÂÒËfl Ì‡ ‡ÚÂÓÒÍÎÂÓ-ÚË˜ÌËfl ÔÓˆÂÒ ÔË 2 ·ÓÎÌË Ò ïïˆ. Ç ÎËÚÂ‡ÚÛ‡Ú‡ ÌÂÒ˙˘ÂÒÚ‚Û‚‡Ú ‰ÓÒÚ‡Ú˙˜ÌÓ ‰‡ÌÌË Á‡ ‚ÎËflÌËÂÚÓ Ì‡ ıÓÏÓ-ˆËÒÚÂËÌ‡ ‚˙ıÛ ÒÍÓÓÒÚÚ‡ Ì‡ ‡Á‚ËÚËÂ Ì‡ ‡ÚÂÓÒÍÎÂÓ-Á‡. á‡ Ú‡ÁË ˆÂÎ Â ÌÂÓ·ıÓ‰ËÏÓ ‰‡ ÒÂ ÔÓ‚Â‰Â Ì‡·Î˛‰ÂÌËÂ‚˙ıÛ „ÓÎflÏ ÍÓÌÚËÌ„ÂÌÚ ÓÚ ·ÓÎÌË Á‡ ÔÓ-‰˙Î˙„ ÔÂËÓ‰.

Ç ÔÓÛ˜‚‡ÌÂÚÓ ÌÂ Ò‡ ‚ÍÎ˛˜ËÎË ·ÓÎÌË Ò Í‡‰ËÓÂÏ·ÓÎË˜-ÌË ËÌÒÛÎÚË Ë Î‡ÍÛÌ‡ÌË ÏÓÁ˙˜ÌË ËÌÙ‡ÍÚË Á‡˘ÓÚÓ ÔËËÁÒÎÂ‰‚‡ÌÂ Ì‡ ·ÓÎÌËÚÂ Ò ïïˆ, Ï‡„ÌËÚÌÓÂÁÓÌ‡ÌÒÌ‡Ú‡ÚÓÏÓ„‡ÙËfl Ë ÍÓÏÔ˛Ú˙Ì‡Ú‡ ÚÓÏÓ„‡ÙËfl ÔÂ‰ÒÚ‡‚flÚfl‰ÍÓ ‰‡ÌÌË Á‡ Î‡ÍÛÌ‡ÌË ËÌÒÛÎÚË (18).

àÁÒÎÂ‰‚‡ÌÂÚÓ Ì‡ ÔÎ‡ÁÏÂÌÓÚÓ ıÓÏÓˆËÒÚÂËÌÓ‚Ó ÌË‚ÓÔË ·ÓÎÌËÚÂ Ò ËÒıÂÏË˜ÂÌ ÏÓÁ˙˜ÂÌ ËÌÒÛÎÚ Ò ÌÂÛÚÓ˜ÌÂÌ‡ÂÚËÓÎÓ„Ëfl ÔÓÍ‡Á‚‡ ÔÓ‚Ë¯ÂÌË ÒÚÓÈÌÓÒÚË Ì‡‰ 15 µmol/lÔË 4 ·ÓÎÌË Ë ÌÓÏ‡ÎÌË ÒÚÓÈÌÓÒÚË ÔË 11 ·ÓÎÌË. ÇËÒÓÍËÒÚÓÈÌÓÒÚË – Ì‡‰ 40 µmol/l Ò‡ ÓÚÍËÚË ÔË ÚËÏ‡ ÓÚËÁÒÎÂ‰‚‡ÌËÚÂ ·ÓÎÌË. Ö‰ËÌ ÓÚ Úflı Â Ô‡ˆËÂÌÚ ‚ ÏÎ‡‰‡‚˙Á‡ÒÚ - 41 „Ó‰ Ò ÂˆË‰Ë‚Ë‡˘Ë ÔÂıÓ‰ÌË Ì‡Û¯ÂÌËfl Ì‡ÏÓÁ˙˜ÌÓÚÓ Í˙‚ÓÓ·‡˘ÂÌËÂ ‚˙‚ ‚ÂÚÂ·Ó·‡ÁËÎ‡Ì‡Ú‡ÒËÒÚÂÏ‡.

ç‡ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡ÌÂ ËÏ‡ Á‡ ˆÂÎ ‰‡ Ó·˙ÌÂ ‚ÌËÏ‡-ÌËÂ ‚˙ıÛ Â‰ËÌ ÌÓ‚, Ï‡ÎÍÓ ËÁÒÎÂ‰‚‡Ì ‚ Ì‡¯‡Ú‡ ÒÚ‡Ì‡ËÒÍÓ‚ Ù‡ÍÚÓ Á‡ ‡ÚÂÓÒÍÎÂÓÁ‡ Ë ËÒıÂÏË˜ÂÌ ÏÓÁ˙˜ÂÌ ËÌ-ÒÛÎÚ – ıËÔÂıÓÏÓˆËÒÚÂËÌÂÏËflÚ‡. çÂÈÌ‡Ú‡ ‡ÌÌ‡ ‰Ë‡„-ÌÓÒÚËÍ‡ Í‡ÍÚÓ Ë ‚˙ÁÏÓÊÌÓÒÚÚ‡ Á‡ Ò‡‚ÌËÚÂÎÌÓ ÎÂÒÌÓÔÓ‚ÂÊ‰‡ÌÂ Ì‡ ‚ÚÓË˜Ì‡ ÔÓÙËÎ‡ÍÚËÍ‡ Ò˙Á‰‡‚‡ ÔÓ-„ÓÎÂ-ÏË ‚˙ÁÏÓÊÌÓÒÚË Á‡ Ó„‡ÌË˜‡‚‡ÌÂ ÔÓ„ÂÒËflÚ‡ Ì‡ ‡ÚÂÓ-ÒÍÎÂÓÚË˜ÌËfl ÔÓˆÂÒ Ë Á‡ ÔÓ-ÛÒÔÂ¯Ì‡ ÔÂ‚ÂÌˆËfl Ì‡ ÌÓ‚ËÏÓÁ˙˜ÌÓ Ò˙‰Ó‚Ë ËÌˆË‰ÂÌÚË.

ãàíÖêÄíìêÄ1. Graham I, Daly E, Refsum H. Plasma homocysteine as a risk factor for vas-cular disease. The European Concentred Action project. JAMA, 1997; 277(22),1775-81.2. Bots M, Launewr L, Lindemabs J. Homocysteine and short-term risk ofmyocardial infarction and stroke in the elderly: the Rotterdame Stusy. Arch InternMad, 1999, 159 (1), 38-443. Kullo U, Gau G, Tajik A. Novel risk factors for atherosclerosis. Mayo ClinProc. 2000, 75, 369-380.4. Robinson K, Arheart K, Refsum H. Low circulating folate and vitamin B6concentration: risk factors for stroke, peripheral vascular disease and coronary dis-ease. European COMAC Group. Circulation, 1998, 97(5), 437-43.

5. Sacco R. Newer risk factors for stroke. Neurology. 2001, 57, 831-834.6. Spence J, Blake C, Landry A et al. Measurement of Carotid Plaque and Effectof Vitamin Therapy for Total homocysteine. Clin Chem Lab Med, 2003, 41, 1496-1504.7. Adams H, Bendixen B, Kappelle L et al. Classification of Subtype of AcuteIschemic Stroke. Definition for Use in a Multicenter Clinical Trial. Stroke, 1993,24, 35-41.8. Ueland P, Refsum H, Stabler S et al. Total homocysteine in plasma andserum: methods and clinical applications. Clin Chem 1993, 39, 1764-1779.9. Madonna P, de Stefano V, Coppola A et al. Hyperhomocysteinemia and otherinherited prothrombotic conditions in young adults with a history of ischemicstroke. Stroke, 2002, 33, 51-58.10. Sacco R, Anand K, Boden-Albala B et al. Homocysteine and the risk ofischemic stroke in a Triethnic Cohort. Stroke, 2004, 35, 2263-68.11. Welch G, Loscalzo J. Homocysteine and atherothrombosis. N Engl J Med1998, 338, 1042-1050.12. Korczyn, A. Homocysteine, Stroke and Dementia. Stroke. 2002, 33, 2343-7.13. Kang S, Wong P, Malinow M. Hyperhomocyst(e)inemia as a risk factor forocclusive disease. Ann Rev Nutr, 1992, 12, 279-98.14. Korn-Lubetzki I, Gillis S, Steiner I. Mutation in the MethylentetrahydrofolateReductase Gene Might Be a Risk Factor for Cerebrovascular Disease inPeripartum and Under Oral Contraceptive Use. Eur Neurol, 2001, 45, 171-173.15. Selhub J, Jaques P, Bostom A et al. Association between plasma homocysteineconcentration and external carotid artery disease. N Engl J Med, 1995, 332, 286-91.16. Malinow M, Nieto F, Szklo M et al. Carotid artery intimal-medial wall thick-ening and plasma homocysteine in asymptomatic adults. The atherosclerosis riskin Communities 1993, 87, 1107-13.17. Sasaki T, Watanale M, Nagai Y at al. Ässociation of plasma homocysteineconcentration with atherosclerotic carotid plaques and lacunar infarction. Stroke.2002, 33, 1493-1499.18. Streifler S, Rosenberg N, Chetrit T et al. Cerebrovascular events in patientswith significant stenosis of carotid artery are associated with hyperhomocysteine-mia and platelet antigen -1 (Leu 33 Pro) polymorphism. Stroke, 2001, 32, 2753-2759.19. Spence D, Malinow R, Barnett P et al. Plasma homocysteine concentratonbut not MTHFR genotype is associated with variation in carotid plaque area.Stroke, 1999, 30, 968-973.20. Eikeloom J, Hankey G Anand S et al. Association between high homocys-teine and ischemic stroke due to large and small artery disease but not other etsubtypes of ischemic stroke. Stroke, 2000, 31, 1069-1077.21. Yoo J, Chung C, Kang S. Relation of plasma homocysteine to cerebral infarc-tion and cerebral atherosclerosis. Stroke, 1998, (12), 2478-83.22. Van den Berg, M, Van der Knaap M, Boers J. Hyperhomocysteinemia withreference to its neuroradiological aspects. Neuroradiology, 1995, 37(5), 403-11.

Ä‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËfl Ñ- Ö. Ç‡ÒËÎÂ‚‡çÂ‚ÓÎÓ„Ë˜Ì‡ ÍÎËÌËÍ‡ìåÅÄã “ñ‡Ëˆ‡ âÓ‡ÌÌ‡”ìÎ. “ÅflÎÓ ÏÓÂ” 8ëÓÙËfl


éË„ËÌ‡ÎÌË ÒÚ‡ÚËËàçÑàêÖäíçà ìãíêÄëéçéÉêÄîëäà äêàíÖêàà áÄ éèêÖÑÖãüçÖ çÄ äÄêéíàÑçà ëíÖçéáà

à. ëÚ‡ÈÍÓ‚

äÎËÌËÍ‡ ÔÓ çÂ‚ÓÎÓ„Ëfl, ìåÅÄã “ñ‡Ëˆ‡ âÓ‡ÌÌ‡” , „.ëÓÙËfl

SUMMARY

INDIRECT ULTRASOUND CRITERIA FOR ASSESS-MENT OF CAROTID STENOSIS

I. StaikovPurpose: To determine the sensitivity, specificity, positive

and negative predictive values (ppv and npv) and accuracy ofsome indirect Doppler ultrasound criteria and the combinationof this ultrasound criteria for identifying unilateral severecarotid stenosis. To correlate those findings with angiograph-ic measurements obtained by the European Carotid SurgeryTrial (ECST) and North American Symptomatic CarotidEndarterectomy Trial (NASCET) methods.

Methods: From 84 patients with carotid stenosis andocclusions we analysed 43 patients with unilateral moderateand severe carotid stenosis. Doppler ultrasound examination,color-coded duplex sonography and digital subtractionangiography was performed in all of this patients. Usingreceiver operator characteristic (ROC) curves we determined

the sensitivity, specificity, npv, ppv and accuracy of sixDoppler ultrasound criteria for assessment of _> 70% carotidstenoses measured by ECST and NASCET angiographicmethods. The criteria were: on the unobstructed (contralater-al) side- increased peak velocity in the anterior cerebral arteryand on the obstructed (ipsilateral) side- reversed flow in theanterior cerebral artery, reversed flow in the ophthalmicartery, increased flow velocity in the posterior cerebral artery,decreased flow velocity in the common carotid artery(praestenotic region) and decreased flow velocity in the in theinternal carotid artery (poststenotic region).

Results: Five patients with thick bones preventingtranstemporal insonation were excluded. The single criteriawith high sensitivity and accuracy for assessing carotidstenoses of 70% or greater by using ECST and NASCETmethods were increased peak velocity in the anterior cerebralartery on the unobstructed side (sensitivity 59%-60%, accura-cy 53%-58%) and reversed flow in the anterior cerebral artery

on the obstructed side (sensitivity 46%-48%, accuracy 50%-55%). Sensitivity and accuracy of the combination of all sixfindings for identifying _>70% carotid stenoses by using ECSTmethod was 97%, respectively 89% and by using NASCETmethod was 96% respectively 68%.

Conclusion: The combination of routinely using Dopplerfindings is a high sensitive and accurate for evaluating severeinternal carotid stenoses.

Key words: carotid stenosis, Doppler ultrasound, angiog-raphy.

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ñÂÎ: Ñ‡ ÓÔÂ‰ÂÎËÏ ˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚÚ‡, ÒÔÂˆËÙË˜ÌÓÒÚ-Ú‡, ÔÓÁËÚË‚Ì‡Ú‡ Ë ÌÂ„‡ÚË‚Ì‡ ÔÂ‰ËÍÚË‚Ì‡ ÒÚÓÈÌÓÒÚ(ÔÔÒ Ë ÌÔÒ) Ë ÚÓ˜ÌÓÒÚÚ‡ Ì‡ ÌflÍÓË ËÌ‰ËÂÍÚÌË ÑÓÔÎÂÒÓ-ÌÓ„‡ÙÒÍË ÍËÚÂËË Ë Ì‡ ÍÓÏ·ËÌ‡ˆËflÚ‡ ÓÚ ÚÂÁË ÒÓÌÓ„‡-ÙÒÍË ÍËÚÂËË Á‡ ÛÒÚ‡ÌÓ‚fl‚‡ÌÂ Ì‡ Â‰ÌÓÒÚ‡ÌÌË ‚ËÒÓÍÓÒ-ÚÂÔÂÌÌË Í‡ÓÚË‰ÌË ÒÚÂÌÓÁË. Ñ‡ ÍÓÂÎË‡ÏÂ ÚÂÁË ÍËÚÂ-ËË Ò ‡Ì„ËÓ„‡ÙÒÍËÚÂ ËÁÏÂ‚‡ÌËfl, ÔÓÎÛ˜ÂÌË ˜ÂÁ EuropeanCarotid Surgery Trial (ECST) and North American SymptomaticCarotid Endarterectomy Trial (NASCET) ÏÂÚÓ‰Ë.

åÂÚÓ‰Ë: éÚ 84 Ô‡ˆËÂÌÚË Ò Í‡ÓÚË‰ÌË ÒÚÂÌÓÁË Ë ÓÍ-ÎÛÁËË ·flı‡ ‡Ì‡ÎËÁË‡ÌË 43 Ô‡ˆËÂÌÚË Ò Â‰ÌÓÒÚ‡ÌÌË ÒÂ‰-ÌÓÒÚÂÔÂÌÌË Ë ‚ËÒÓÍÓÒÚÂÔÂÌÌË Í‡ÓÚË‰ÌË ÒÚÂÌÓÁË. èË‚ÒË˜ÍË Ô‡ˆËÂÌÚË ·flı‡ ÔÓ‚Â‰ÂÌË ÑÓÔÎÂÓ‚‡ ÒÓÌÓ„‡ÙËfl,ˆ‚ÂÚÌÓ-ÍÓ‰Ë‡Ì ‰ÛÔÎÂÍÒÒÓÌÓ„‡ÙÒÍË ‡Ì‡ÎËÁ, Í‡ÍÚÓ Ë ‰Ë-„ËÚ‡ÎÌ‡ ÒÛ·Ú‡ÍˆËÓÌÌ‡ ‡Ì„ËÓ„‡ÙËfl. àÁÔÓÎÁ‚‡ÈÍËreceiver operator characteristic (ROC) „‡ÙËÍË, ·flı‡ ÓÔÂ‰Â-ÎÂÌË ˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚÚ‡, ÒÔÂˆËÙË˜ÌÓÒÚÚ‡, ÔÔÒ, ÌÔÒ ËÚÓ˜ÌÓÒÚÚ‡ Ì‡ ¯ÂÒÚ ÑÓÔÎÂÒÓÌÓ„‡ÙÒÍË ÍËÚÂËfl Á‡ ÓÔ-Â‰ÂÎflÌÂ Ì‡ _>70% Í‡ÓÚË‰Ì‡ ÒÚÂÌÓÁ‡ ËÁÏÂÂÌ‡ ˜ÂÁECST Ë NASCET ‡Ì„ËÓ„‡ÙÒÍËÚÂ ÏÂÚÓ‰Ë. íÂÁË ÍËÚÂËË·flı‡: ÍÓÌÚ‡Î‡ÚÂ‡ÎÌÓ Ì‡ ÒÚ‡Ì‡Ú‡ Ì‡ ÒÚÂÌÓÁË‡ÌÂÚÓ-ÛÒÍÓÂÌ‡ ÒÍÓÓÒÚ Ì‡ Í˙‚ÌËfl ÚÓÍ ‚ Ó·Î‡ÒÚÚ‡ Ì‡ ÔÂ‰Ì‡ÏÓÁ˙˜Ì‡ ‡ÚÂËfl Ë ËÔÒËÎ‡ÚÂ‡ÎÌÓ Ì‡ ÒÚ‡Ì‡Ú‡ Ì‡ ÒÚÂ-ÌÓÁË‡ÌÂÚÓ- ÂÚÓ„‡‰ÌÓ ÔÓÚË˜‡˘ Í˙‚ÓÚÓÍ ‚ Ó·Î‡-ÒÚÚ‡ Ì‡ ÔÂ‰Ì‡ ÏÓÁ˙˜Ì‡ ‡ÚÂËfl, ÂÚÓ„‡‰ÌÓ ÔÓÚË-˜‡˘ Í˙‚ÓÚÓÍ ‚ Ó·Î‡ÒÚÚ‡ Ì‡ ÓÙÚ‡ÎÏË˜Ì‡Ú‡ ‡ÚÂËfl,ÛÒÍÓÂÌ‡ ÒÍÓÓÒÚ Ì‡ Í˙‚ÌËfl ÚÓÍ ‚ Ó·Î‡ÒÚÚ‡ Ì‡ Á‡‰Ì‡ÏÓÁ˙˜Ì‡ ‡ÚÂËfl, Ì‡Ï‡ÎÂÌ‡ ÒÍÓÓÒÚ Ì‡ Í˙‚ÌËfl ÚÓÍ ‚ Ó·-Î‡ÒÚÚ‡ Ì‡ Ó·˘‡Ú‡ Ò˙ÌÌ‡ ‡ÚÂËfl (ÔÂ‰Ë ÒÚÂÌÓÁË‡ÌÂ-ÚÓ) Ë Ì‡Ï‡ÎÂÌ‡ ÒÍÓÓÒÚ Ì‡ Í˙‚ÌËfl ÚÓÍ ‚ Ó·Î‡ÒÚÚ‡ Ì‡‚˙ÚÂ¯Ì‡Ú‡ Ò˙ÌÌ‡ ‡ÚÂËfl (ÒÎÂ‰ ÒÚÂÌÓÁË‡ÌÂÚÓ).

êÂÁÛÎÚ‡ÚË: èÂÚËÏ‡ Ô‡ˆËÂÌÚË ·flı‡ ËÁÍÎ˛˜ÂÌË ÓÚËÁÒÎÂ‰‚‡ÌÂÚÓ ÔÓ‡‰Ë ÌÂ‰ÓÒÚ‡Ú˙˜ÂÌ ÚÂÏÔÓ‡ÎÂÌ ÔÓÁÓ-Âˆ. Ö‰ËÌË˜ÌËÚÂ ÍËÚÂËË Ò Ì‡È-‚ËÒÓÍ‡ ˜Û‚ÒÚ‚ËÚÂÎ-ÌÓÒÚ Ë ÚÓ˜ÌÓÒÚ Á‡ ÓˆÂÌÍ‡ Ì‡ 70% ËÎË ÔÓ-‚ËÒÓÍ‡ Í‡Ó-ÚË‰Ì‡ ÒÚÂÌÓÁ‡, ‰ÓÍ‡Á‡ÌË Ò ÔÓÏÓ˘Ú‡ Ì‡ ECST Ë NASCETÏÂÚÓ‰ËÚÂ ·flı‡ ÛÒÍÓÂÌ‡Ú‡ ÒÍÓÓÒÚ Ì‡ Í˙‚ÌËfl ÚÓÍ ‚Ó·Î‡ÒÚÚ‡ Ì‡ ÔÂ‰Ì‡ ÏÓÁ˙˜Ì‡ ‡ÚÂËfl (ÍÓÌÚ‡Î‡ÚÂ‡ÎÌÓÌ‡ ÒÚ‡Ì‡Ú‡ Ì‡ ÒÚÂÌÓÁË‡ÌÂÚÓ) (˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚ 59%-60%, ÚÓ˜ÌÓÒÚ 53%-58%) Ë ÂÚÓ„‡‰ÌÓ ÔÓÚË˜‡˘ËflÍ˙‚ÓÚÓÍ ‚ Ó·Î‡ÒÚÚ‡ Ì‡ ÔÂ‰Ì‡ ÏÓÁ˙˜Ì‡ ‡ÚÂËfl (ËÔÒË-Î‡ÚÂ‡ÎÌÓ Ì‡ ÒÚ‡Ì‡Ú‡ Ì‡ ÒÚÂÌÓÁË‡ÌÂÚÓ) (˜Û‚ÒÚ‚Ë-ÚÂÎÌÓÒÚ 46%-48%, ÚÓ˜ÌÓÒÚ 50%-55%).óÛ‚ÒÚ‚ËÚÂÎÌÓ-ÒÚÚ‡ Ë ÚÓ˜ÌÓÒÚÚ‡ Ì‡ ÍÓÏ·ËÌ‡ˆËflÚ‡ ÓÚ ¯ÂÒÚÚÂ ÍË-ÚÂËË Á‡ ÓÔÂ‰ÂÎflÌÂ Ì‡ Â‰Ì‡ _>70% Í‡ÓÚË‰Ì‡ ÒÚÂÌÓÁ‡,ËÁÔÓÎÁ‚‡ÈÍË ECST ÏÂÚÓ‰‡ ·flı‡ 97% Ò˙ÓÚ‚ÂÚÌÓ 89% Ë˜ÂÁ NASCET ÏÂÚÓ‰‡ ·flı‡ 96% Ò˙ÓÚ‚ÂÚÌÓ 68%.

á‡ÍÎ˛˜ÂÌËÂ: äÓÏ·ËÌ‡ˆËflÚ‡ ÓÚ ÛÚËÌÌÓ ËÁÔÓÎÁ‚‡ÌË‚ Ô‡ÍÚËÍ‡Ú‡ ËÌ‰ËÂÍÚÌË ÑÓÔÎÂÒÓÌÓ„‡ÙÒÍË ÍËÚÂËËÂ ‚ËÒÓÍÓ ˜Û‚ÒÚ‚ËÚÂÎÌ‡ Ë ÚÓ˜Ì‡ Á‡ ‰Ë‡„ÌÓÒÚËˆË‡ÌÂ Ì‡‚ËÒÓÍÓÒÚÂÔÂÌÌË Í‡ÓÚË‰ÌË ÒÚÂÌÓÁË.

äÎ˛˜Ó‚Ë ‰ÛÏË: Í‡ÓÚË‰ÌË ÒÚÂÌÓÁË, ÑÓÔÎÂÓ‚‡ ÒÓ-ÌÓ„‡ÙËfl, ‡Ì„ËÓ„‡ÙËfl

íË „ÓÎÂÏË ‡Ì‰ÓÏËÁË‡ÌË ÏÛÎÚËˆÂÌÚÓ‚Ë ÔÓÛ˜‚‡-

ÌËfl ‰ÂÏÓÌÒÚË‡ı‡ ÂÙËÍ‡ÒÌÓÒÚÚ‡ Ì‡ Í‡ÓÚË‰Ì‡Ú‡ ÂÌ-‰‡ÚÂÂÍÚÓÏËfl Á‡ ÔÂ‚ÂÌˆËfl ÓÚ ËÒıÂÏË˜ÂÌ ÏÓÁ˙˜ÂÌ ËÌ-ÒÛÎÚ ÔË Ô‡ˆËÂÌÚË Ò ıÂÏÓ‰ËÌ‡ÏË˜ÌÓ ÁÌ‡˜ËÏË Í‡ÓÚË‰ÌËÒÚÂÌÓÁË (9,10,11,15). íÂÁË ÔÓÛ˜‚‡ÌËfl ·flı‡ ÔÓ‚Â‰ÂÌË ÒÔÓÏÓ˘Ú‡ Ì‡ ‰‚‡ ‡ÁÎË˜ÌË ‡Ì„ËÓ„‡ÙÒÍË ÏÂÚÓ‰‡ Á‡ ËÁÏÂ-‚‡ÌÂ „ÓÎÂÏËÌ‡Ú‡ Ì‡ Í‡ÓÚË‰ÌËÚÂ ÒÚÂÌÓÁË. íÂÁË ÏÂÚÓ‰Ë- European Carotid Surgery Trial (ECST) Ë North AmericanSymptomatic Carotid Endarterectomy Trial (NASCET) ·flı‡¯ËÓÍÓ ‰ËÒÍÛÚË‡ÌË ‚ ÎËÚÂ‡ÚÛ‡Ú‡ (9,15,16). ëÎÂ‰ÔÛ·ÎËÍÛ‚‡ÌÂÚÓ Ì‡ ÚÂÁË ËÁÒÎÂ‰‚‡ÌËfl Ì‡‡ÒÌ‡ ËÌÚÂÂÒ‡ ËÌÛÊ‰‡Ú‡ Í˙Ï ÌÂËÌ‚‡ÁË‚ÌÓ ‰Ë‡„ÌÓÒÚËˆË‡ÌÂ Ì‡ ‚ËÒÓÍÓÒ-ÚÂÔÂÌÌË Í‡ÓÚË‰ÌË ÒÚÂÌÓÁË (Çäë) (7,17,21,24). ÄÌ‡ÎËÁË-‡ÌË ·flı‡ Â‰Ëˆ‡ ‰ËÂÍÚÌË Ë ËÌ‰ËÂÍÚÌË ÑÓÔÎÂÒÓÌÓ„-‡ÙÒÍË ÍËÚÂËË (7,17,21,24). á‡ ÒÓÌÓ„‡ÙÒÍÓ ‰ÓÍ‡Á‚‡ÌÂÌ‡ ıÂÏÓ‰ËÌ‡ÏË˜ÌÓ ËÁ‡ÁÂÌ‡ Í‡ÓÚË‰Ì‡ ÒÚÂÌÓÁ‡ ·flı‡ ËÁÒ-ÎÂ‰‚‡ÌË ËÌ‰ËÂÍÚÌË ÍËÚÂËË Í‡ÚÓ ÂÚÓ„‡‰ÌÓ ÔÓ-ÚË˜‡˘ Í˙‚ÂÌ ÚÓÍ ‚ Ó·Î‡ÒÚÚ‡ Ì‡ ÔÂ‰Ì‡ ÏÓÁ˙˜Ì‡ ‡ÚÂ-Ëfl (èåÄ), ÂÚÓ„‡‰ÌÓ ÔÓÚË˜‡˘ Í˙‚ÂÌ ÚÓÍ ‚ Ó·Î‡-ÒÚÚ‡ Ì‡ ÓÙÚ‡ÎÏË˜Ì‡Ú‡ ‡ÚÂËfl (éÄ), ÔÓ‚Ë¯ÂÌ Í˙‚ÂÌÚÓÍ ‚ Ó·Î‡ÒÚÚ‡ Ì‡ Á‡‰Ì‡ ÏÓÁ˙˜Ì‡ ‡ÚÂËfl (áåÄ) ËÎË ÔÓ-‚Ë¯ÂÌ Í˙‚ÂÌ ÚÓÍ ‚ èåÄ (3,24). Ç ÔÓ-Ï‡ÎÍ‡ ÒÚÂÔÂÌ ·flı‡ËÁÒÎÂ‰‚‡ÌË ˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚÚ‡ Ë ÒÔÂˆËÙË˜ÌÓÒÚÚ‡ Ì‡ÓÚ‰ÂÎÌËÚÂ ËÌ‰ËÂÍÚÌË ÑÓÔÎÂÒÓÌÓ„‡ÙÒÍË ÍËÚÂËË Á‡‰ÓÍ‡Á‚‡ÌÂ Ì‡ Çäë.

ñÂÎÚ‡ Ì‡ Ì‡ÒÚÓfl˘ÂÚÓ ÔÓÛ˜‚‡ÌÂ Â ËÁÒÎÂ‰‚‡ÌÂ Ì‡˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚÚ‡, ÒÔÂˆËÙË˜ÌÓÒÚÚ‡, ÌÂ„‡ÚË‚Ì‡Ú‡ ËÔÓÁËÚË‚Ì‡ ÔÂ‰ËÍÚË‚Ì‡ ÒÚÓÈÌÓÒÚ Ë ÚÓ˜ÌÓÒÚÚ‡ Ì‡ Â‰ËÌ‰ËÂÍÚÂÌ Ë ÔÂÚ ËÌ‰ËÂÍÚÌË ÂÍÒÚ‡- Ë Ú‡ÌÒÍ‡ÌË‡ÎÌËÑÓÔÎÂÒÓÌÓ„‡ÙÒÍË ÍËÚÂËË ÔË Ô‡ˆËÂÌÚË Ò Â‰ÌÓÒÚ-‡ÌÌË Í‡ÓÚË‰ÌË ÒÚÂÌÓÁË, Í‡ÍÚÓ Ë ÍÓÂÎË‡ÌÂ Ì‡ ÚÂÁËÍËÚÂËË Ò ECST Ë NASCET ‡Ì„ËÓ„‡ÙÒÍËÚÂ ÏÂÚÓ‰Ë.

äéçíàçÉÖçí à åÖíéÑà

äéçíàçÉÖçíÄÌ‡ÎËÁË‡ÌË ·flı‡ 168 Í‡ÓÚË‰ÌË ·ËÙÛÍ‡ˆËË ÔË 84

Ô‡ˆËÂÌÚË Ò˙Ò ÒÚÂÌÓÁ‡ Ì‡ ‚˙ÚÂ¯Ì‡Ú‡ Ò˙ÌÌ‡ ‡ÚÂËfl(ÇëÄ). èË ‚ÒË˜ÍË Ô‡ˆËÂÌÚË ·Â¯Â ÔÓ‚Â‰ÂÌÓ ÑÓÔÎÂ-,‰ÛÔÎÂÍÒÓÌÓ„‡ÙÒÍÓ Í‡ÍÚÓ Ë ÍÓÌ‚ÂÌˆËÓÌ‡ÎÌÓ ‡Ì„ËÓ„‡ÙÒ-ÍÓ ËÁÒÎÂ‰‚‡ÌÂ Ì‡ ÏÓÁ˙˜ÌËÚÂ ‡ÚÂËË. ÇÂÏÂÚÓ ÏÂÊ‰ÛÔÓ‚ÂÊ‰‡ÌÂ Ì‡ ÛÎÚ‡Á‚ÛÍÓ‚ÓÚÓ Ë ‡Ì„ËÓ„‡ÙÒÍÓÚÓ ËÁÒ-ÎÂ‰‚‡ÌÂ ·Â¯Â ÒÂ‰ÌÓ 10.5 ‰ÌË.

è‡ˆËÂÌÚËÚÂ ·flı‡ ‡Á‰ÂÎÂÌË ‚ ÚË „ÛÔË. è˙‚‡Ú‡„ÛÔ‡, Ò˙ÒÚÓfl˘‡ ÒÂ ÓÚ 43 ·ÓÎÌË Ó·ı‚‡˘‡ Ô‡ˆËÂÌÚË Ò Â‰-ÌÓÒÚ‡ÌÌË Í‡ÓÚË‰ÌË ÒÚÂÌÓÁË. ÇÚÓ‡Ú‡ „ÛÔ‡ ÒÂ Ò˙Ò-ÚÓË ÓÚ Ô‡ˆËÂÌÚË Ò ıÓÏÓÎ‡ÚÂ‡ÎÌ‡ Í‡ÓÚË‰Ì‡ ÒÚÂÌÓÁ‡ ËÍÓÌÚ‡Î‡ÚÂ‡ÎÌÓ Á‡ÔÛ¯‚‡ÌÂ, ‡ ÚÂÚ‡Ú‡ „ÛÔ‡ Â ÓÚ Ô‡-ˆËÂÌÚË Ò ‰‚ÛÒÚ‡ÌÌË Í‡ÓÚË‰ÌË ÒÚÂÌÓÁË. á‡ ‰‡ ÒÂ ËÁ·Â„-ÌÂ ‚ÎËflÌËÂÚÓ Ì‡ ÍÓÌÚ‡Î‡ÚÂ‡ÎÌ‡Ú‡ ÒÚÂÌÓÁ‡ ËÎË ÚÓÏ-·ÓÁ‡ ‚˙ıÛ ËÌ‰ËÂÍÚÌËÚÂ ÒÓÌÓ„‡ÙÒÍË ÍËÚÂËË, ·flı‡‡Ì‡ÎËÁË‡ÌË Ò‡ÏÓ Ô‡ˆËÂÌÚËÚÂ ÓÚ Ô˙‚‡ „ÛÔ‡. èË ÚÂÁË43 Ô‡ˆËÂÌÚË ·flı‡ ‰ÓÍ‡Á‡ÌË 43 Í‡ÓÚË‰ÌË ÒÚÂÌÓÁË. ä‡Í-ÚÓ ÑÓÔÎÂÒÓÌÓ„‡ÙÒÍË, Ú‡Í‡ Ë ‡Ì„ËÓ„‡ÙÒÍË ÔË ÚÂÁË·ÓÎÌË ÌÂ ·flı‡ Ë‰ÂÌÚËÙËˆË‡ÌË ‰Û„Ë ÂÍÒÚ‡- ËÎË ËÌÚ-‡Í‡ÌË‡ÎÌË ÒÚÂÌÓÁË ËÎË Ó·ÚÛ‡ˆËË. èË ÔÂÚ ÓÚ ÚÂÁË43 Ô‡ˆËÂÌÚË, ÔÓ‡‰Ë ËÌÒÛÙËˆËÂÌÚÂÌ ÚÂÏÔÓ‡ÎÂÌ ÔÓÁÓ-Âˆ ÌÂ ÏÓÊ‡ı‡ ‰‡ ÒÂ Ë‰ÂÌÚËÙËˆË‡Ú ·‡Á‡ÎÌËÚÂ ‡ÚÂËË.éÒÚ‡Ì‡Î‡Ú‡ „ÛÔ‡ ÓÚ Ô‡ˆËÂÌÚË ÒÂ Ò˙ÒÚÓË ÓÚ 30 Ï˙ÊÂ Ë8 ÊÂÌË Ì‡ ÒÂ‰Ì‡ ‚˙Á‡ÒÚ 68.26 ± 8.46 „Ó‰ËÌË. á‡ ÒÚ‡ÚËÒ-ÚË˜ÂÒÍÓ Ò‡‚Ìfl‚‡ÌÂ Ì‡ ÒÎÛ˜‡ËÚÂ ÒÂ ËÁÔÓÎÁ‚‡ ÍÓÌÚÓÎÌ‡„ÛÔ‡ ÓÚ Á‰‡‚Ë, ‡‰‡ÔÚË‡ÌË ÔÓˆÂÌÚÌÓ ÔÓ ‚˙Á‡ÒÚ ËÔÓÎ ÎËˆ‡ Ò ÑÓÔÎÂ- Ë ‰ÛÔÎÂÍÒÒÓÌÓ„‡ÙÒÍË ÛÒÚ‡ÌÓ‚ÂÌ‡ ËÌ-Ú‡ÍÚÌÓÒÚ Ì‡ ÂÍÒÚ‡- Ë ËÌÚ‡Í‡ÌË‡ÎÌËÚÂ ÏÓÁ˙˜ÌË Ò˙-‰Ó‚Â. ÇÍÎ˛˜‚‡ÌÂÚÓ ‚ ÍÓÌÚÓÎÌ‡Ú‡ „ÛÔ‡ ÒÚ‡‚‡ ÔÓ ÓÔËÒ‡-ÌË ‚Â˜Â ‚ ÎËÚÂ‡ÚÛ‡Ú‡ ÛÎÚ‡ÒÓÌÓ„‡ÙÒÍË ÍËÚÂËË Á‡ÌÓÏ‡ÎÌË ÏÓÁ˙˜ÌË ‡ÚÂËË (1,14,23).


ÄçÉàéÉêÄîëäà ÄçÄãàá

èË ‚ÒË˜ÍË Ô‡ˆËÂÌÚË ·Â¯Â ÔÓ‚Â‰ÂÌ‡ Ì‡È-Ï‡ÎÍÓ ‚ ‰‚ÂÔÓÂÍˆËË ‰Ë„ËÚ‡ÎÌ‡ ‡Ì„ËÓ„‡ÙËfl. ÄÌ„ËÓ„‡ÙËËÚÂ ·flı‡ËÁ‚˙¯ÂÌË ÔÓÒÂ‰ÒÚ‚ÓÏ ·ËÔÎ‡ÌÓ‚ ‡Ì„ËÓ„‡ÙÒÍË ‡Ô‡‡Ú(CAS 500, Toshiba Corporation, Tokyo, Japan). ÇÒË˜ÍË Í‡Ó-ÚË‰ÌË ÒÚÂÌÓÁË ·flı‡ ËÁÏÂÂÌË ÔÓ ECST Ë NASCET ÏÂÚÓ-‰ËÚÂ (18,19).

ìãíêÄëéçéÉêÄîëäà ÄçÄãàá

ÇÒË˜ÍË Ô‡ˆËÂÌÚË ·flı‡ ËÁÒÎÂ‰‚‡ÌË ÑÓÔÎÂÒÓÌÓ„‡ÙÒÍË,Í‡ÚÓ ‡ÚÂËËÚÂ Ò‡ Ë‰ÂÌÚËÙËˆË‡ÌË ÔÓ ÓÔËÒ‡ÌË ‚ ÎËÚÂ-‡ÚÛ‡Ú‡ ÍËÚÂËË (1,14,23). ëËÒÚÓÎË˜Ì‡Ú‡ Ë ‰Ë‡ÒÚÓ-ÎË˜Ì‡ ÒÍÓÓÒÚ Ì‡ Í˙‚ÌËfl ÚÓÍ ‚ ÔÂÒÚÂÌÓÚË˜ÌËfl Ë ‚ÔÓÒÚÒÚÂÌÓÚË˜ÌËfl ÒÂ„ÏÂÌÚ, Í‡ÍÚÓ Ë ‚ áåÄ Ë èåÄ ·flı‡Ò‡‚Ìfl‚‡ÌË Ò˙Ò ÒÍÓÓÒÚÚ‡ Ì‡ Í˙‚ÌËfl ÚÓÍ ‚ ÍÓÌÚ‡Î‡-ÚÂ‡ÎÌ‡Ú‡ ÒÚ‡Ì‡, Í‡ÍÚÓ Ë Ò Í˙‚ÌËfl ÚÓÍ Ì‡ Ò˙ÓÚ‚ÂÚ-Ì‡Ú‡ ‡ÚÂËfl ÓÚ ÍÓÌÚÓÎÌ‡Ú‡ „ÛÔ‡ Ô‡ˆËÂÌÚË. ëÍÓÓ-ÒÚÚ‡ Ì‡ Í˙‚ÌËfl ÚÓÍ ‚ ÍÓÌÚ‡Î‡ÚÂ‡ÎÌ‡Ú‡ Ì‡ ÒÚÂÌÓÁ‡-Ú‡ èåÄ ·Â¯Â ‰ÂÙËÌË‡Ì‡ Í‡ÚÓ Û‚ÂÎË˜ÂÌ‡, ÍÓ„‡ÚÓ ÔÂ-‚Ë¯‡‚‡¯Â 1.68 ÒÚ‡Ì‰‡ÚÌË ÓÚÍÎÓÌÂÌËfl ÒÂ‰Ì‡Ú‡ ÒÍÓ-ÓÒÚ Ì‡ Ò˙ÓÚ‚ÂÚÌ‡Ú‡ èåÄ ÓÚ ÍÓÌÚÓÎÌ‡Ú‡ „ÛÔ‡ (Ì‡‰94 ÒÏ./ÒÂÍ. ÒËÒÚÓÎË˜Ì‡ ÒÍÓÓÒÚ Ë Ì‡‰ 45 ÒÏ./ÒÂÍ ‰Ë‡ÒÚÓ-ÎË˜Ì‡ ÒÍÓÓÒÚ). èË ‚ÒË˜ÍË Ô‡ˆËÂÌÚË ·Â¯Â ÔÓ‚Â‰ÂÌ Ëˆ‚ÂÚÌÓ ÍÓ‰Ë‡Ì ‰ÛÔÎÂÍÒÒÓÌÓ„‡ÙÒÍË ‡Ì‡ÎËÁ Ò ÔÓÏÓ˘Ú‡Ì‡ ‰ÛÔÎÂÍÒÒÓÌÓ„‡ÙÒÍË ‡Ô‡‡Ú - Acuson 128 XP/5, ‡ Ò˙‰Ó-‚ÂÚÂ ·flı‡ Ë‰ÂÌÚËÙËˆË‡ÌË ÔÓ ÓÔËÒ‡ÌË ‚ ÎËÚÂ‡ÚÛ‡Ú‡ÍËÚÂËË (5,23).

ëíÄíàëíàäÄ (2)

ëÚ‡ÚËÒÚË˜ÂÒÍËflÚ ‡Ì‡ÎËÁ ÒÂ ËÁ‚˙¯Ë Ò ÔÓÏÓ˘Ú‡ Ì‡SPSS ÒÓÙÚÛÂÌ‡ ÔÓ„‡Ï‡. á‡ Ò‡‚Ìfl‚‡ÌÂ Ì‡ ÒÚÓÈÌÓÒÚË-ÚÂ Ì‡ Í˙‚ÌËfl ÚÓÍ ÓÚ áåÄ, èåÄ, Í‡ÍÚÓ Ë ÓÚ Ó·Î‡ÒÚ-Ú‡ Ì‡ ÒÚÂÌÓÁ‡Ú‡ Ò˙Ò ÒÚÓÈÌÓÒÚËÚÂ Ì‡ Í˙‚ÌËfl ÚÓÍ ÓÚÍÓÌÚ‡Î‡ÚÂ‡ÎÌ‡Ú‡ ÒÚ‡Ì‡, Í‡ÍÚÓ Ë Ò˙Ò ÒÚÓÈÌÓÒÚËÚÂÌ‡ Í˙‚ÌËfl ÚÓÍ Ì‡ Ò˙ÓÚ‚ÂÚÌ‡Ú‡ ‡ÚÂËfl ÓÚ ÍÓÌÚÓÎ-Ì‡Ú‡ „ÛÔ‡ Ô‡ˆËÂÌÚË ·Â¯Â ËÁÔÓÎÁ‚‡Ì í-ÚÂÒÚ (paired t-Test).

àÁ˜ËÒÎÂÌË ·flı‡ ˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚ, ÒÔÂˆËÙË˜ÌÓÒÚ, ÌÂ-„‡ÚË‚Ì‡ Ë ÔÓÁËÚË‚Ì‡ ÔÂ‰ËÍÚË‚Ì‡ ÒÚÓÈÌÓÒÚ (ÌÔÒ Ë ÔÔÒ)Ë ÚÓ˜ÌÓÒÚ Ì‡ ‚ÒÂÍË Â‰ËÌ ÍËÚÂËÈ, Í‡ÍÚÓ Ë Ì‡ ÍÓÏ·ËÌ‡-ˆËflÚ‡ ÓÚ ÚÂÁË ÍËÚÂËË ÒÔflÏÓ ECST Ë NASCET ‡Ì„Ë-Ó„‡ÙÒÍËÚÂ ÏÂÚÓ‰Ë. àÁÔÓÎÁ‚‡ÌË ·flı‡ receiver operatingcharacteristic (ROC)- „‡ÙËÍË. íÂÁË „‡ÙËÍË ÔÂ‰ÓÒÚ‡‚flÚÓÔÚËÏ‡ÎÌ‡ ‚˙ÁÏÓÊÌÓÒÚ ‚˙‚ ‚ÒflÍ‡ Â‰Ì‡ ÚÓ˜Í‡ ‰‡ ·˙‰‡ÚËÁ˜ËÒÎÂÌË ÒÂÌÁËÚË‚ÌÓÒÚÚ‡, ÒÔÂˆËÙË˜ÌÓÒÚÚ‡, ÌÔÒ, ÔÔÒ ËÚÓ˜ÌÓÒÚÚ‡, Ò˙ÓÚ‚ÂÚÌÓ ‚˙‚ ‚ÒflÍ‡ ÚÓ˜Í‡ ‰‡ ·˙‰‡Ú ÓÔÂ-‰ÂÎÂÌË ÍÓÎË˜ÂÒÚ‚ÓÚÓ Ì‡ Ù‡Î¯Ë‚Ó ÔÓÁËÚË‚ÌËÚÂ Ë Ù‡Î¯Ë-

‚Ó ÌÂ„‡ÚË‚ÌËÚÂ ÂÁÛÎÚ‡ÚË Ë ‰‡‚‡Ú ÚÓ˜Ì‡ ‚˙ÁÏÓÊÌÓÒÚÁ‡ ÔÓÎÛ˜‡‚‡ÌÂ Ì‡ ÓÔÚËÏ‡ÎÌË Ò˙ÓÚÌÓ¯ÂÌËfl ÏÂÊ‰Û ÚÂÁËÍËÚÂËË (22).

êÖáìãíÄíà

óÂÁ NASCET ÏÂÚÓ‰‡ ·flı‡ ‰Ë‡„ÌÓÒÚËˆË‡ÌË 10 (26%)ÒÂ‰ÌÓÒÚÂÔÂÌÌË ÒÚÂÌÓÁË (30%-69%) Ë 28 (74%) ‚ËÒÓÍÓÒ-ÚÂÔÂÌÌË ÒÚÂÌÓÁË (70%-99%). ë ÔÓÏÓ˘Ú‡ Ì‡ ECST ÏÂÚÓ-‰‡ ·flı‡ ‰Ë‡„ÌÓÒÚËˆË‡ÌË 3 (8%) ÒÂ‰ÌÓÒÚÂÔÂÌÌË ÒÚÂÌÓ-ÁË Ë 35 (92%) ‚ËÒÓÍÓÒÚÂÔÂÌÌË ÒÚÂÌÓÁË Ë ÒÂ ÛÒÚ‡ÌÓ‚Ëı‡ÚË Ù‡Î¯Ë‚Ó ÔÓÁËÚË‚ÌË (Ô‡ˆËÂÌÚË Ò 50%, 56% Ë 69% Í‡-ÓÚË‰ÌË ÒÚÂÌÓÁË ËÁÏÂÂÌË ÔÓ ECST ÏÂÚÓ‰‡ Ë ‡Á‚ËÚ‡ÍÓÎ‡ÚÂ‡ÎÌ‡ ÏÂÊ‡) Ë Â‰ËÌ Ù‡Î¯Ë‚Ó ÌÂ„‡ÚË‚ÂÌ ÂÁÛÎ-Ú‡Ú (Ô‡ˆËÂÌÚ Ò 90% ÒÚÂÌÓÁ‡ ËÁÏÂÂÌ‡ ÔÓ ECST ÏÂÚÓ‰‡,ÌÓ ·ÂÁ Ì‡ÎË˜ËÂ Ì‡ ÍÓÎ‡ÚÂ‡ÎËÁ‡ˆËfl). á‡ ÑÓÔÎÂÒÓÌÓ„‡ÙÒ-ÍÓ ÓÔÂ‰ÂÎflÌÂ Ì‡ Â‰Ì‡ _>70 NASCET Ë Ì‡ Â‰Ì‡ _>70 ECSTÍ‡ÓÚË‰Ì‡ ÒÚÂÌÓÁ‡ ·flı‡ ‡Ì‡ÎËÁË‡ÌË ÒÎÂ‰ÌËÚÂ ¯ÂÒÚÍËÚÂËfl:

1. äÓÌÚ‡Î‡ÚÂ‡ÎÌÓ Ì‡ ÒÚ‡Ì‡Ú‡ Ì‡ ÒÚÂÌÓÁË‡ÌÂÚÓ:● ÛÒÍÓÂÌ‡ ÒËÒÚÓÎË˜Ì‡ Ë ‰Ë‡ÒÚÓÎË˜Ì‡ ÒÍÓÓÒÚ Ì‡

Í˙‚ÌËfl ÚÓÍ ‚ Ó·Î‡ÒÚÚ‡ Ì‡ èåÄ.2. àÔÒËÎ‡ÚÂ‡ÎÌÓ Ì‡ ÒÚ‡Ì‡Ú‡ Ì‡ ÒÚÂÌÓÁË‡ÌÂÚÓ:● Ì‡Ï‡ÎÂÌ‡ ÔÂÒÚÂÌÓÚË˜Ì‡ ÒËÒÚÓÎË˜Ì‡ Ë ‰Ë‡ÒÚÓÎË˜Ì‡

ÒÍÓÓÒÚ Ì‡ Í˙‚ÌËfl ÚÓÍ ‚ Ó·Î‡ÒÚÚ‡ Ì‡ Ó·˘‡Ú‡ Ò˙ÌÌ‡‡ÚÂËfl (éëÄ) (ÔÂ‰Ë ÒÚÂÌÓÁË‡ÌÂÚÓ).

● Ì‡Ï‡ÎÂÌ‡ ÔÓÒÚÒÚÂÌÓÚË˜Ì‡ ÒËÒÚÓÎË˜Ì‡ Ë ‰Ë‡ÒÚÓ-ÎË˜Ì‡ ÒÍÓÓÒÚ Ì‡ Í˙‚ÌËfl ÚÓÍ ‚ Ó·Î‡ÒÚÚ‡ Ì‡ ÇëÄ (ÒÎÂ‰ÒÚÂÌÓÁË‡ÌÂÚÓ).

● ÛÒÍÓÂÌ‡ ÒËÒÚÓÎË˜Ì‡ Ë ‰Ë‡ÒÚÓÎË˜Ì‡ ÒÍÓÓÒÚ Ì‡Í˙‚ÌËfl ÚÓÍ ‚ Ó·Î‡ÒÚÚ‡ Ì‡ áåÄ.

● ÂÚÓ„‡‰ÌÓ ÔÓÚË˜‡˘ Í˙‚ÓÚÓÍ ‚ Ó·Î‡ÒÚÚ‡ Ì‡ éÄ.ÂÚÓ„‡‰ÌÓ ÔÓÚË˜‡˘ Í˙‚ÓÚÓÍ ‚ Ó·Î‡ÒÚÚ‡ Ì‡

èåÄ.

ìÒÚ‡ÌÓ‚Ë ÒÂ, ˜Â Ï‡ÍÒËÏ‡ÎÌ‡Ú‡ ÒËÒÚÓÎË˜Ì‡ ÒÍÓÓÒÚÔÓÒÚÒÚÂÌÓÚË˜ÌÓ, Í‡ÍÚÓ Ë ‚ Ó·Î‡ÒÚÚ‡ Ì‡ áåÄ Ë èåÄ ÂÔÓ-Ì‡‰ÂÊ‰ÂÌ ÍËÚÂËÈ (ÔÓ-‚ËÒÓÍ‡ ÒÂÁËÚË‚ÌÓÒÚ, ÒÔÂˆË-ÙË˜ÌÓÒÚ Ë ÚÓ˜ÌÓÒÚ) ‚ Ò‡‚ÌÂÌËÂ Ò Ï‡ÍÒËÏ‡ÎÌ‡Ú‡ ‰Ë‡Ò-ÚÓÎË˜Ì‡ ÒÍÓÓÒÚ Ì‡ Í˙‚ÌËfl ÚÓÍ ‚ ÚÂÁË ‡ÚÂËË. èÓ-ÚË‚ÓÔÓÎÓÊÌÓ Ì‡ ÚÓ‚‡ Á‡ÍÎ˛˜ÂÌËÂ, Ï‡ÍÒËÏ‡ÎÌ‡Ú‡ ‰Ë‡Ò-ÚÓÎË˜Ìa ÒÍÓÓÒÚ Ì‡ Í˙‚ÌËfl ÚÓÍ – ÔÂÒÚÂÌÓÚË˜ÌÓ Â ÔÓ-Ì‡‰ÂÊ‰ÂÌ ÔÓÍ‡Á‡ÚÂÎ ‚ Ò‡‚ÌÂÌËÂ Ò Ï‡ÍÒËÏ‡ÎÌ‡Ú‡ ÒËÒÚÓ-ÎË˜Ì‡Ú‡ ÒÍÓÓÒÚ ‚ Ú‡ÁË Ó·Î‡ÒÚ. í‡·ÎËˆË 1 Ë 2 ÔÓÍ‡Á‚‡Ú‡Ì‡ÎËÁË‡ÌËÚÂ ¯ÂÒÚ ÍËÚÂËfl Ò˙Ò Ò˙ÓÚ‚ÂÚÌËÚÂ˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚ, ÒÔÂˆËÙË˜ÌÓÒÚ, ÚÓ˜ÌÓÒÚ, ÌÔÒ Ë ÔÔÒ Á‡‚ÒÂÍË ÓÚ Úflı Ë ‚ ÍÓÏ·ËÌ‡ˆËfl. àÁ˜ËÒÎÂÌËflÚ‡ Ò‡ Ì‡Ô‡‚Â-ÌË Á‡ ‰‚‡Ú‡ ‡Ì„ËÓ„‡ÙÒÍË ÏÂÚÓ‰‡. éÚ‰ÂÎÌËÚÂ ÍËÚÂËË


í‡·ÎËˆ‡ 1: ÑÓÔÎÂÒÓÌÓ„‡ÙÒÍË ÍËÚÂËË Á‡ ÓÔÂ‰ÂÎflÌÂ Ì‡ Â‰Ì‡ _>70% NASCET ÒÚÂÌÓÁ‡.

ÒÂÌÁËÚË‚ÌÓÒÚ ÒÔÂˆËÙË˜ÌÓÒÚ ÌÔÒ ÔÔÒ ÚÓ˜ÌÓÒÚ(1) ìÒÍÓÂÌ‡ ÒÍÓÓÒÚ Ì‡ Í. ÚÓÍ 59% 36% 27% 70% 53%

‚ èåÄ (ÍÓÌÚ‡Î‡ÚÂ‡ÎÌÓ)

(2) êÂÚÓ„‡‰ÂÌ Í. ÚÓÍ ‚ èåÄ 48% 73% 36% 81% 55%

(ËÔÒËÎ‡ÚÂ‡ÎÌÓ)

(3) ç‡Ï‡ÎÂÌ‡ ÔÓÒÚÒÚÂÌÓÚË˜Ì‡ 33% 64% 28% 69% 42%

ÒÍÓÓÒÚ Ì‡ Í. ÚÓÍ ‚˙‚ ÇëÄ

(4) ç‡Ï‡ÎÂÌ‡ ÔÂÒÚÒÚÂÌÓÚË˜Ì‡ 26% 82% 31% 78% 42%

ÒÍÓÓÒÚ Ì‡ Í. ÚÓÍ ‚ éëÄ

(5) êÂÚÓ„‡‰ÂÌ Í. ÚÓÍ ‚ éÄ 26% 73% 29% 70% 39%


(6) ìÒÍÓÂÌ‡ ÒÍÓÓÒÚ Ì‡ Í. ÚÓÍ ‚ áåÄ 22% 82% 30% 75% 39%


äÓÏ·ËÌ‡ˆËfl ÓÚ (1)-(6) 96% - - 70% 68%

ÔÓÍ‡Á‚‡Ú ÓÚÌÓÒËÚÂÎÌÓ ÌËÒÍ‡ ˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚ Ë ÚÓ˜-ÌÓÒÚ Ë Á‡ ‰‚‡Ú‡ ‡Ì„ËÓ„‡ÙÒÍË ÏÂÚÓ‰‡, Í‡ÚÓ ÌflÏ‡ ‡ÁÎË-Í‡ ‚ ‡ÁÔÂ‰ÂÎÂÌËÂÚÓ ‚ Á‡‚ËÒËÏÓÒÚ ÓÚ ˜Û‚ÒÚ‚ËÚÂÎÌÓ-ÒÚÚ‡ Ë ÚÓ˜ÌÓÒÚÚ‡ Á‡ ECST Ë NASCET ÏÂÚÓ‰ËÚÂ. à Á‡‰‚‡Ú‡ ‡Ì„ËÓ„‡ÙÒÍË ÏÂÚÓ‰‡ ÍËÚÂËËÚÂ, ÍÓËÚÓ ÔÓÍ‡Á-‚‡Ú Ì‡È-‚ËÒÓÍÓ ÌË‚Ó Ì‡ ˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚ Ë ÚÓ˜ÌÓÒÚ Ò‡ÛÒÍÓÂÌ‡Ú‡ ÒËÒÚÓÎË˜Ì‡ ÒÍÓÓÒÚ Ì‡ Í˙‚ÌËfl ÚÓÍ ‚ Ó·Î‡-ÒÚÚ‡ Ì‡ èåÄ- ÍÓÌÚ‡Î‡ÚÂ‡ÎÌÓ Ì‡ ÒÚÂÌÓÁ‡Ú‡, ÂÚÓ„-‡‰ÌÓ ÔÓÚË˜‡˘Ëfl Í˙‚ÂÌ ÚÓÍ ‚ Ó·Î‡ÒÚÚ‡ Ì‡ èåÄ- ËÔ-ÒËÎ‡ÚÂ‡ÎÌÓ Ì‡ ÒÚÂÌÓÁ‡Ú‡ Ë Ì‡Ï‡ÎÂÌ‡Ú‡ ÔÓÒÚÒÚÂÌÓ-ÚË˜Ì‡ ÒËÒÚÓÎË˜Ì‡ ÒÍÓÓÒÚ Ì‡ Í˙‚ÌËfl ÚÓÍ ‚ Ó·Î‡ÒÚÚ‡Ì‡ ÇëÄ. äÓÏ·ËÌ‡ˆËflÚ‡ ÏÂÊ‰Û ¯ÂÒÚÚÂ ÍËÚÂËfl ‰‡‚‡ÏÌÓ„Ó ÔÓ-‚ËÒÓÍ‡ ˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚ (Á‡ NASCET – 96%, Á‡ECST – 97%) Ë ÔÓ-‚ËÒÓÍ‡ ÚÓ˜ÌÓÒÚ (Á‡ ECST – 89%, Á‡NASCET – 68%) ‚ Ò‡‚ÌÂÌËÂ Ò ‚ÒÂÍË ÓÚ‰ÂÎÂÌ ÍËÚÂËÈ.

Åflı‡ ‡Ì‡ÎËÁË‡ÌË Ó˘Â ÚË ËÌ‰ËÂÍÚÌË ÑÓÔÎÂÒÓÌÓ„-‡ÙÒÍË ÍËÚÂËfl Á‡ ‰ÓÍ‡Á‚‡ÌÂ Ì‡ Í‡ÓÚË‰ÌË ÒÚÂÌÓÁË: Ì‡-Ï‡ÎÂÌ ÔÛÎÒ‡ˆËÓÌÂÌ ËÌ‰ÂÍÒ ‚ ÒÂ‰Ì‡ ÏÓÁ˙˜Ì‡ ‡ÚÂËfl(ëåÄ), Â‰ÛˆË‡Ì‡ ÒËÒÚÓÎË˜Ì‡ Ë ‰Ë‡ÒÚÓÎË˜Ì‡ ÒÍÓÓÒÚÌ‡ Í˙‚ÌËfl ÚÓÍ ‚ ëåÄ Ë ÎËÔÒ‚‡˘ Í˙‚ÂÌ ÚÓÍ ‚ éÄ (ËÚËÚÂ ÍËÚÂËfl – ËÔÒËÎ‡ÚÂ‡ÎÌÓ Ì‡ ÒÚÂÌÓÁË‡ÌÂÚÓ). àÚËÚÂ ÍËÚÂËfl ÔÓÍ‡Á‡ı‡ ÏÌÓ„Ó ÌËÒÍ‡ ˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚË ÚÓ˜ÌÓÒÚ, Í‡ÍÚÓ Í‡ÚÓ Â‰ËÌË˜ÌË, Ú‡Í‡ Ë ‚ ÍÓÏ·ËÌ‡ˆËflÒ ÓÒÚ‡Ì‡ÎËÚÂ ¯ÂÒÚ ÍËÚÂËfl. èÓ Ú‡ÁË ÔË˜ËÌ‡ ÚÂ ·flı‡ËÁÍÎ˛˜ÂÌË ÓÚ ‡Ì‡ÎËÁ‡.

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Ç Ì‡ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡ÌÂ ÒÂ ËÁÒÎÂ‰‚‡Ú ˜Û‚ÒÚ‚ËÚÂÎ-ÌÓÒÚÚ‡, ÒÔÂˆËÙË˜ÌÓÒÚÚ‡, ÌÔÒ, ÔÔÒ Ë ÚÓ˜ÌÓÒÚÚ‡ Ì‡ ‡Á-ÎË˜ÌË ÛÚËÌÌÓ ËÁÔÓÎÁ‚‡ÌË ‚ Ô‡ÍÚËÍ‡Ú‡ ÍËÚÂËË ÔË‰Ë‡„ÌÓÒÚËÍ‡ Ì‡ ‚ËÒÓÍÓÒÚÂÔÂÌÌË Í‡ÓÚË‰ÌË ÒÚÂÌÓÁË(Çäë). ëÔÂˆËÙË˜ÌÓÒÚÚ‡ Ë ÌÔÒ ‚ ËÁÒÎÂ‰‚‡ÌËÚÂ ÍÓÏ·ËÌ‡-ˆËË ÓÚ ÍËÚÂËË ÌÂ ÏÓÊ‡ı‡ ‰‡ ·˙‰‡Ú ËÁ˜ËÒÎÂÌË ÔÓ‡‰ËÎËÔÒ‡Ú‡ Ì‡ ËÒÚËÌÒÍË ÌÂ„‡ÚË‚ÌË ÒÎÛ˜‡Ë. ÑÓÍ‡Á‡ ÒÂ, ˜Â ÓÚ-‰ÂÎÌËÚÂ ÍËÚÂËË ÔÓÍ‡Á‚‡Ú ÌËÒÍ‡ ˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚ ËÚÓ˜ÌÓÒÚ Ë Á‡ ‰‚‡Ú‡ ‡Ì„ËÓ„‡ÙÒÍË ÏÂÚÓ‰‡. äÓÏ·ËÌ‡ˆËfl-Ú‡ ÓÚ ¯ÂÒÚÚÂ ÍËÚÂËfl ‰‡‚‡ ÏÌÓ„Ó ‚ËÒÓÍ‡ ˜Û‚ÒÚ‚Ë-ÚÂÎÌÓÒÚ (Á‡ NASCET– 96%, Á‡ ECST– 97%), Ë ÔÓ-‚ËÒÓÍ‡ÚÓ˜ÌÓÒÚ (Á‡ ECST – 89% Ë NASCET – 68%), ‚ Ò‡‚ÌÂÌËÂÒ ‚ÒÂÍË ÓÚ‰ÂÎÂÌ ÍËÚÂËÈ Ë Â Ì‡‰ÂÊ‰ÂÌ Ô‡‡ÏÂÚ˙ Á‡ ‰Ë-‡„ÌÓÒÚËˆË‡ÌÂ Ì‡ Çäë. Wilterdink Ë Ò˙Ú. ‰ÓÍ‡Á‚‡Ú Ò˙-˘Ó, ˜Â ÍÓÏ·ËÌ‡ˆËflÚ‡ ÓÚ ËÌ‰ËÂÍÚÌË ÍËÚÂËË (ÔË ÚÂ-ÁË ‡‚ÚÓË ‡Ì‡ÎËÁ˙Ú Â Ò‡ÏÓ ‚˙ıÛ Ú‡ÌÒÍ‡ÌË‡ÎÌÓ ÓÚ˜Â-ÚÂÌË ÍËÚÂËË) ËÏ‡ ÏÌÓ„Ó ‚ËÒÓÍ‡ ÒÂÌÁËÚË‚ÌÓÒÚ (95%) ËÔÓÚ‚˙Ê‰‡‚‡Ú ‚ËÒÓÍ‡Ú‡ Ì‡‰ÂÊ‰ÌÓÒÚ Ì‡ ÚÂÁË ÍÓÏ·ËÌ‡-ˆËË ÔË ‰ÓÍ‡Á‚‡ÌÂ Ì‡ ‚ËÒÓÍÓÒÚÂÔÂÌÌË ÒÚÂÌÓÁË (24).

Ç ÚÓ‚‡ ÔÓÛ˜‚‡ÌÂ ÒÂ ‰ÓÍ‡Á‡, ˜Â Ë Á‡ ‰‚‡Ú‡ ‡Ì„ËÓ„‡ÙÒ-

ÍË ÏÂÚÓ‰‡ ÍËÚÂËËÚÂ, ÍÓËÚÓ ÔÓÍ‡Á‚‡Ú Ì‡È-‚ËÒÓÍÓ ÌË-‚Ó Ì‡ ÒÂÌÁËÚË‚ÌÓÒÚ Ë ÚÓ˜ÌÓÒÚ Ò‡ ÂÚÓ„‡‰ÌÓ ÔÓÚË˜‡-˘Ëfl Í˙‚ÂÌ ÚÓÍ ‚ Ó·Î‡ÒÚÚ‡ Ì‡ èåÄ (ËÔÒËÎ‡ÚÂ‡ÎÌÓ) ËÛÒÍÓÂÌ‡Ú‡ ÒËÒÚÓÎË˜Ì‡ ÒÍÓÓÒÚ Ì‡ Í˙‚ÌËfl ÚÓÍ ‚ Ó·Î‡-ÒÚÚ‡ Ì‡ èåÄ (ÍÓÌÚ‡Î‡ÚÂ‡ÎÌÓ). èÓÒÎÂ‰ÌËÚÂ ‰‚‡ ÍË-ÚÂËfl Ò‡ ËÁ‡Á Ë ÓÚ„Ó‚‡flÚ Ì‡ ÍÓÎ‡ÚÂ‡ÎÌ‡ ˆËÍÛÎ‡ˆËflÌ‡ Í˙‚ÌËfl ÚÓÍ ÔÂÁ ÔÂ‰Ì‡Ú‡ ÍÓÏÛÌËˆË‡˘‡ ‡ÚÂËfl(èäÓÄ). Ç ‰Û„Ë ËÁÒÎÂ‰‚‡ÌËfl Ò‡ Ì‡ÏÂÂÌË ÒıÓ‰ÌË Ò Ì‡¯Ë-ÚÂ ÂÁÛÎÚ‡ÚË. Baumgartner Ë Ò˙Ú. ÓÔËÒ‚‡Ú, ˜Â 82% ÓÚÔ‡ˆËÂÌÚËÚÂ Ò ‚ËÒÓÍÓÒÚÂÔÂÌÌË ÒÚÂÌÓÁË ËÎË Á‡ÔÛ¯‚‡ÌËflÌ‡ ÇëÄ ÔÓÍ‡Á‚‡Ú ÛÒÍÓÂÌ‡ ÒÍÓÓÒÚ Ì‡ Í˙‚ÌËfl ÚÓÍ ‚ÍÓÌÚ‡Î‡ÚÂ‡ÎÌ‡Ú‡ èåÄ, ‡ ÒÂÌÁËÚË‚ÌÓÒÚÚ‡ Ë ÒÔÂˆË-ÙË˜ÌÓÒÚÚ‡ Ì‡ ÂÚÓ„‡‰ÌÓ ÔÓÚË˜‡˘Ëfl Í˙‚ÂÌ ÚÓÍ ‚Ó·Î‡ÒÚÚ‡ Ì‡ ËÔÒËÎ‡ÚÂ‡ÎÌÚ‡ èåÄ, Í‡ÚÓ ·ÂÎÂ„ ÍÓÎ‡ÚÂ-‡ÎËÁ‡ˆËfl ÔÂÁ èäÓÄ ‰ÓÒÚË„‡Ú 100% (3,4). Messerli Ò˙-Ó·˘‡‚‡, ˜Â 97% ÓÚ Ô‡ˆËÂÌÚËÚÂ Ò ‚ËÒÓÍÓÒÚÂÔÂÌÌË ÎÂÁËËËÎË Ó·ÚÛ‡ˆËË Ì‡ ÇëÄ ÍÓÏÔÂÌÒË‡Ú ˜ÂÁ ÍÓÎ‡ÚÂ‡ÎÌ‡ˆËÍÛÎ‡ˆËfl ÔÂÁ èäÓÄ (13). çËÂ ÒÏflÚ‡ÏÂ, ˜Â ÛÒÍÓÂÌËflÚÍ˙‚ÂÌ ÚÓÍ ‚ ÍÓÌÚ‡Î‡ÚÂ‡ÎÌÓ ‡ÁÔÓÎÓÊÂÌ‡Ú‡ èåÄ ÂÌ‡È-‡ÌÌËflÚ ·ÂÎÂ„ Á‡ Ì‡˜‡ÎÌ‡ ÍÓÎ‡ÚÂ‡ÎËÁ‡ˆËfl ÔË Ô‡ˆË-ÂÌÚË Ò Í‡ÓÚË‰ÌË ÒÚÂÌÓÁË Ë ÙÛÌÍˆËÓÌË‡˘‡ èäÓÄ. íÓ-‚‡ ÒÂ ÔÓÚ‚˙Ê‰‡‚‡ Ë ÓÚ Ì‡¯ËÚÂ Ù‡Î¯Ë‚Ó ÔÓÁËÚË‚ÌË Â-ÁÛÎÚ‡ÚË (ÒÔflÏÓ ËÁÏÂ‚‡ÌËflÚ‡ ÔÓ ECST ÏÂÚÓ‰‡). Ñ‚‡ÓÚ Ì‡ÏÂÂÌËÚÂ ‚ ÚÓ‚‡ ÔÓÛ˜‚‡ÌÂ ÚË Ù‡Î¯Ë‚Ó ÔÓÁËÚË‚-ÌË ÒÎÛ˜‡fl ·flı‡ ÔË Ô‡ˆËÂÌÚË Ò 50%, ÂÒÔÂÍÚË‚ÌÓ Ò 56%Í‡ÓÚË‰ÌË ÒÚÂÌÓÁË Ë ÛÒÍÓÂÌ‡ ÒËÒÚÓÎË˜Ì‡ ÒÍÓÓÒÚ Ì‡Í˙‚ÌËfl ÚÓÍ ‚ Ó·Î‡ÒÚÚ‡ Ì‡ ÍÓÌÚ‡Î‡ÚÂ‡ÎÌ‡Ú‡ èåÄ.

Ç ÚÓ‚‡ ËÁÒÎÂ‰‚‡ÌÂ ÒÂ Ì‡ÏÂË, ˜Â ÍËÚÂËËÚÂ Ò Ì‡È-ÌËÒ-Í‡ ˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚ Á‡ ‰ÓÍ‡Á‚‡ÌÂ Ì‡ Çäë Ò‡ ÛÒÍÓÂÌ‡Ú‡ÒÍÓÓÒÚ Ì‡ Í˙‚ÌËfl ÚÓÍ ‚ Ó·Î‡ÒÚÚ‡ Ì‡ áåÄ Ë ÂÚÓ„‡‰-ÌÓ ÔÓÚË˜‡˘Ëfl Í˙‚ÓÚÓÍ ‚ Ó·Î‡ÒÚÚ‡ Ì‡ éÄ (˜Û‚ÒÚ‚Ë-ÚÂÎÌÓÒÚ 20%-26%). ÑÛ„Ë ÔÓÛ˜‚‡ÌËfl, ‚ ÍÓËÚÓ ÒÂ ‡Ì‡ÎË-ÁË‡Ú ÚÂÁË ÍËÚÂËË, ÔÓÍ‡Á‚‡Ú Ò˙˘Ó ÔÓ‰Ó·ÌË ÂÁÛÎÚ‡ÚËÓÒÓ·ÂÌÓ ÔÓ ÓÚÌÓ¯ÂÌËÂ Ì‡ ‚ÚÓËfl ÍËÚÂËÈ (4,24). Åflı‡‡Ì‡ÎËÁË‡ÌË Ó˘Â ÚË ËÌ‰ËÂÍÚÌË ÑÓÔÎÂÒÓÌÓ„‡ÙÒÍË ÍË-ÚÂËfl: ËÔÒËÎ‡ÚÂ‡ÎÌÓ Ì‡ ÒÚ‡Ì‡Ú‡ Ì‡ ÒÚÂÌÓÁË‡ÌÂÚÓ -Ì‡Ï‡ÎÂÌ ÔÛÎÒ‡ˆËÓÌÂÌ ËÌ‰ÂÍÒ ‚ ëåÄ, Â‰ÛˆË‡Ì‡ ÒËÒÚÓÎË˜-Ì‡ Ë ‰Ë‡ÒÚÓÎË˜Ì‡ ÒÍÓÓÒÚ Ì‡ Í˙‚ÌËfl ÚÓÍ ‚ ëåÄ Ë ÎËÔÒ-‚‡˘ Í˙‚ÂÌ ÚÓÍ ‚ éÄ. à ÚËÚÂ ÍËÚÂËfl ÔÓÍ‡Á‡ı‡ ÏÌÓ„ÓÌËÒÍ‡ ˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚ Ë ÚÓ˜ÌÓÒÚ, Í‡ÍÚÓ Í‡ÚÓ Â‰ËÌË˜ÌË,Ú‡Í‡ Ë ‚ ÍÓÏ·ËÌ‡ˆËfl Ò ÓÒÚ‡Ì‡ÎËÚÂ ¯ÂÒÚ ËÌ‰ËÂÍÚÌËÍËÚÂËfl Ë ·flı‡ ËÁÍÎ˛˜ÂÌË ÓÚ ‡Ì‡ÎËÁ‡. ÑÛ„Ó ÔÓÛ˜‚‡ÌÂÌ‡ÏË‡ Ò˙˘Ó, ˜Â ÎËÔÒ‚‡˘Ëfl Í˙‚ÂÌ ÚÓÍ ‚ éÄ, Í‡ÍÚÓ ËÒÌËÊÂÌËfl Í˙‚ÂÌ ÚÓÍ ‚ ëåÄ ËÔÒËÎ‡ÚÂ‡ÎÌÓ Ì‡ ÒÚÂÌÓÁ‡-Ú‡, ÌflÏ‡Ú ‰Ó·‡ ÍÓÂÎ‡ˆËfl Ò Çäë (24).

ìÎÚ‡Á‚ÛÍÓ‚‡Ú‡ ÒÓÌÓ„‡ÙËfl Â ¯ËÓÍÓ ‡ÁÔÓÒÚ‡ÌÂÌÌÂËÌ‚‡ÁË‚ÂÌ ÏÂÚÓ‰ Á‡ ‰Ë‡„ÌÓÒÚËˆË‡ÌÂ Ì‡ Çäë. Ç˙ÔÂÍË


í‡·ÎËˆ‡ 2: ÑÓÔÎÂÒÓÌÓ„‡ÙÒÍË ÍËÚÂËË Á‡ ÓÔÂ‰ÂÎflÌÂ Ì‡ Â‰Ì‡ _>70% ECST ÒÚÂÌÓÁ‡

ÒÂÌÁËÚË‚ÌÓÒÚ ÒÔÂˆËÙË˜ÌÓÒÚ ÌÔÒ ÔÔÒ ÚÓ˜ÌÓÒÚ(1) ìÒÍÓÂÌ‡ ÒÍÓÓÒÚ Ì‡ Í. ÚÓÍ 60% 33% 7% 91% 58%

‚ èåÄ (ÍÓÌÚ‡Î‡ÚÂ‡ÎÌÓ)

(2) êÂÚÓ„‡‰ÂÌ Í. ÚÓÍ ‚ èåÄ 46% 100% 14% 100% 50%


(3) ç‡Ï‡ÎÂÌ‡ ÔÓÒÚÒÚÂÌÓÚË˜Ì‡ ÒÍÓÓÒÚ 34% 67% 8% 92% 37%

Ì‡ Í. ÚÓÍ ‚˙‚ ÇëÄ

(4) ç‡Ï‡ÎÂÌ‡ ÔÂÒÚÒÚÂÌÓÚË˜Ì‡ ÒÍÓÓÒÚ 26% 100% 10% 100% 32%

Ì‡ Í. ÚÓÍ ‚ éëÄ

(5) ìÒÍÓÂÌ‡ ÒÍÓÓÒÚ Ì‡ Í. ÚÓÍ 20% 67% 7% 87% 32%

‚ áåÄ (ËÔÒËÎ‡ÚÂ‡ÎÌÓ)

(6) êÂÚÓ„‡‰ÂÌ Í. ÚÓÍ ‚ éÄ 26% 67% 7% 90% 29%


äÓÏ·ËÌ‡ˆËfl ÓÚ (1)-(6) 97% - - 92% 89%

ÏÌÓ„Ó·ÓÈÌËÚÂ ÒË ÔÂËÏÛ˘ÂÒÚ‚‡ (ÓÚÌÓÒËÚÂÎÌÓ Â‚ÚË-Ì‡, ÌÂËÌ‚‡ÁË‚ÂÌ‡, ·ÂÁÓÔ‡ÒÌ‡, ÚÓ˜Ì‡) Úfl ÔÓÍ‡Á‚‡ Ë ÌflÍÓËÌÂ‰ÓÒÚ‡Ú˙ˆË (Ì‡È-‚Â˜Â ÔË ‡Á„‡ÌË˜‡‚‡ÌÂÚÓ Ì‡ ‚ËÒÓ-ÍÓÒÚÂÔÂÌÌË ÒÚÂÌÓÁË ÓÚ Ó·ÚÛ‡ˆËË) Ë ÒÂ ËÁÔÓÎÁ‚‡ ‚ Ò‚Â-ÚÓ‚ÂÌ Ï‡˘‡· ‚ÒÂ Ó˘Â Í‡ÚÓ ÓÒÌÓ‚ÂÌ ÒÍËÌËÌ„ ÏÂÚÓ‰ Á‡‰Ë‡„ÌÓÒÚËÍ‡ Ì‡ Í‡ÓÚË‰ÌË ÒÚÂÌÓÁË, ÔÓÒÎÂ‰‚‡˘‡ ÒÂ ÓÚåê ‡Ì„ËÓ„‡ÙËfl ËÎË ÍÓÌ‚ÂÌˆËÓÌ‡ÎÌ‡ ‡Ì„ËÓ„‡ÙËfl. èÓ‡-‰Ë ÚÓ‚‡, ˜Â ËÒÍ˙Ú ÓÚ ÔÓÔÛÒÍ‡ÌÂ Ì‡ Çäë Â ÔÓ-‚ËÒÓÍ ‚Ò‡‚ÌÂÌËÂ Ò ËÒÍ‡ ÓÚ ÔÓ‚ÂÊ‰‡ÌÂ Ì‡ ÌÂÌÛÊÌÓ ‡Ì„ËÓ„‡ÙÒ-ÍÓ ËÁÒÎÂ‰‚‡ÌÂ, ‚ËÒÓÍ‡Ú‡ ˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚ Â ÔÓ-‚‡ÊÌ‡ ÓÚ‚ËÒÓÍ‡Ú‡ ÒÔÂˆËÙË˜ÌÓÒÚ (24). í‡Í˙‚ ·Â¯Â Ë ÏÂÚÓ‰˙Ú Ì‡ËÁ·Ó ‚ Ì‡ÒÚÓfl˘ÂÚÓ ÔÓÛ˜‚‡ÌÂ. éÚ‰ÂÎÌËÚÂ ÍËÚÂËË·flı‡ ÓÔÂ‰ÂÎflÌË ‚˙Á ÓÒÌÓ‚‡ Ì‡ ÚflıÌ‡Ú‡ ‚ËÒÓÍ‡ ˜Û‚ÒÚ‚Ë-ÚÂÎÌÓÒÚ Ë ÚÓ˜ÌÓÒÚ, ‡ ÌÂ ‚˙Á ÓÒÌÓ‚‡ Ì‡ ÚflıÌ‡Ú‡ ÒÔÂˆË-ÙË˜ÌÓÒÚ.

ìÎÚ‡ÒÓÌÓ„‡ÙÒÍË ÔÓÛ˜‚‡ÌËfl ÒÓ˜‡Ú, ˜Â Ó·ÚÛ‡ˆËfl-Ú‡ ËÎË ‚ËÒÓÍÓÒÚÂÔÂÌÌ‡Ú‡ ÒÚÂÌÓÁ‡ ‚ ÍÓÌÚ‡Î‡ÚÂ‡ÎÌ‡-Ú‡ Ì‡ ËÁÒÎÂ‰‚‡Ì‡Ú‡ ÒÚÂÌÓÁ‡ ÇëÄ, ÔÓÏÂÌflÚ ÒÚ‡ÚËÒÚË-˜ÂÒÍË ÁÌ‡˜ËÏÓ ÒÍÓÓÒÚÚ‡ Ì‡ Í˙‚ÌËfl ÚÓÍ ‚ Ó·Î‡ÒÚÚ‡ Ì‡ËÁÒÎÂ‰‚‡Ì‡Ú‡ ‡ÚÂËfl, ‡ ÔÓ ÚÓÁË Ì‡˜ËÌ Ë ËÁÒÎÂ‰‚‡ÌËÚÂÓÚ Ì‡Ò Ô‡‡ÏÂÚË (6,13,20). íÓ‚‡ ·Â¯Â ÓÒÌÓ‚‡ÌËÂÚÓ ‚˙ÁÓÒÌÓ‚‡ Ì‡ ÍÓÂÚÓ ËÁÍÎ˛˜ËıÏÂ ÓÚ ÚÓ‚‡ ÔÓÛ˜‚‡ÌÂ ‚ÒË˜ÍËÔ‡ˆËÂÌÚË Ò ‰‚ÛÒÚ‡ÌÌË ÒÚÂÌÓÁË ËÎË ÍÓÌÚ‡Î‡ÚÂ‡ÎÌËÁ‡ÔÛ¯‚‡ÌËfl. éÚ ‰Û„‡ ÒÚ‡Ì‡ ÎËÔÒ‡Ú‡ Ì‡ ÓÔÚËÏ‡ÎÂÌÚÂÏÔÓ‡ÎÂÌ ÔÓÁÓÂˆ ÏÓÊÂ ‰‡ Ì‡Ô‡‚Ë ÌÂ‚˙ÁÏÓÊÌÓ ÔÓ-‚ÂÊ‰‡ÌÂÚÓ Ì‡ Ú‡ÌÒÍ‡ÌË‡ÎÌ‡ ÑÓÔÎÂÓ‚‡ ÒÓÌÓ„‡ÙËfl ‚ÔÓ‚Â˜Â ÓÚ 30% ÓÚ Ô‡ˆËÂÌÚËÚÂ (8,12). èÓ Ú‡ÁË ÔË˜ËÌ‡ÓÚÔ‡‰Ì‡ı‡ 13% ÓÚ ËÁÒÎÂ‰‚‡ÌËÚÂ Ô‡ˆËÂÌÚË ‚ Ì‡ÒÚÓfl˘Â-ÚÓ ÔÓÛ˜‚‡ÌÂ.

Ç Á‡ÍÎ˛˜ÂÌËÂ ÚÓ‚‡ ÔÓÛ˜‚‡ÌÂ ‰ÓÍ‡Á‡, ˜Â ÍÓÏ·ËÌ‡ˆËfl-Ú‡ ÓÚ ÌflÍÓË ËÌ‰ËÂÍÚÌË ÑÓÔÎÂÒÓÌÓ„‡ÙÒÍË Ô‡‡ÏÂÚËËÏ‡ ÏÌÓ„Ó ‚ËÒÓÍ‡ ˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚ (96%-97%) ÔË ‰Ë‡„-ÌÓÒÚËˆË‡ÌÂ Ì‡ Çäë. êÂÚÓ„‡‰ÌÓ ÔÓÚË˜‡˘ËflÚ Í˙‚ÂÌÚÓÍ ‚ Ó·Î‡ÒÚÚ‡ Ì‡ èåÄ (ËÔÒËÎ‡ÚÂ‡ÎÌÓ Ì‡ ÒÚÂÌÓÁ‡Ú‡)Ë ÛÒÍÓÂÌ‡Ú‡ ÒËÒÚÓÎË˜Ì‡ ÒÍÓÓÒÚ Ì‡ Í˙‚ÌËfl ÚÓÍ ‚ Ó·-Î‡ÒÚÚ‡ Ì‡ èåÄ (ÍÓÌÚ‡Î‡ÚÂ‡ÎÌÓ Ì‡ ÒÚÂÌÓÁ‡Ú‡) Ò‡Â‰ËÌË˜ÌËÚÂ ÑÓÔÎÂÒÓÌÓ„‡ÙÒÍË ÍËÚÂËË Ò Ì‡È-‚ËÒÓÍ‡˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚ (46%-60%) Ë ÚÓ˜ÌÓÒÚ (50%-58%) ÔË‰ÓÍ‡Á‚‡ÌÂ Ì‡ Çäë. á‡ ‰Ë‡„ÌÓÒÚËˆË‡ÌÂ Ì‡ Í‡ÓÚË‰ÌËÒÚÂÌÓÁË ÑÓÔÎÂÒÓÌÓ„‡ÙÒÍËflÚ ÏÂÚÓ‰ Â ‚ËÒÓÍÓ Ì‡‰ÂÊ‰ÂÌË ÚÓ˜ÂÌ.

ãàíÖêÄíìêÄ1. Aaslid R, Markwalder TM, Nornes H. Noninvasive transcranial Dopplerultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg 1982,57: 769-774.2. Altman DG. Practical statistics for medical research. Chapman & Hall,London, New York, Tokyo 1 st ed. 1991.3. Baumgartner RW, Baumgartner I, Mattle HP, et al. Transcranial color-codedduplex sonography in unilateral flow-restrictive extracranial carotid artery disease.AJNR Am J Neuroradiol 1996; 17: 777-783.4. Baumgartner RW, Baumgartner I, Schroth G. Diagnostic criteria for transcra-nial color-coded duplex sonography evaluation of cross-flow through the circle of

Willis in unilateral obstructive carotid artery disease. J Neurol 1996; 243: 516-521.5. Baumgartner RW, Mattle HP, Schroth G, et al. Die transkranielle farbkodierteDuplexsonographie beim Erwachsenen. Schweiz Med Wochenschr 1993; 123:2102-2109.6. Bussutil SJ, Franklin DP, Youkey JR, et al. Carotid duplex overstimation ofstenosis due to severe contralateral disease. Am J Surg 1996; 172: 144-148.7. Carpenter JP, Lexa FJ, Davis JT. Determination of duplex doppler ultrasoundcriteria appropriate to the North American Symptomatic Carotid EndarterectomyTrial. Stroke 1996; 27: 695-699.8. Eden A. Transcranial Doppler ultrasonography and hyperostosis of the skull.Stroke 1988; 19: 1445-1446.9. European Carotid Surgery Trialists Collaborative Group. MRC EuropeanCarotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. Lancet 1991; 337: 1235-1243.10. European Carotid Surgery Trialists’ Collaborative Group: Randomised trial ofendarterectomy for recently symptomatic carotid stenosis: final results of the MRCEuropean Carotid Surgery Trial (ECST). Lancet 1998;351:1379-1387.11. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study:Endarterectomy for asymptomatic carotid artery stenosis. JAMA 1995;273:1421-1428.12. Halsey JH. Effect of emitted power on waveform intensity in transcranialDoppler. Stroke 1990; 21: 1573-1578.13. Messerli S. Extra- und transkranielle Dopplersonographische Befunde beimVerschluss der Arteria carotis interna und klinische Befunde. Inauguraldissertation,Medizinische Fakultat der Universitat, Bern 1992.14. Newell DW, Aaslid R. Transcranial Doppler. Raven Press, New York 1992.15. North American Symptomatic Carotid Endarterectomy Trial Colaborators:Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991; 325: 445-453.16. North American Symptomatic Carotid Endarterectomy Trial (NASCET)Steering Committee. North American Symptomatic Carotid Endarterectomy Trial:Methods, patients characteristics and progress. Stroke 1991; 22: 711-720. 17. Paivansalo M, Leinonen S, Turunen J et al. Quantification of carotid arterystenosis with various Doppler velocity parameters. Fortschr Rontgenstr 1996;164,2: 108-113.18. Rothwell PM, Gibson RJ, Slattery J, et al. for the European Carotid SurgeryTrialists’ Collaborative Group: Prognostic value and reproducibility of measur-ments of carotid stenosis: A comparison of three methods on 1001 angiograms.Stroke 1994; 25: 2440-2444.19. Rothwell PM, Gibson RJ, Slattery J, et al. for the European Carotid SurgeryTrialists’ Collaborative Group: Equivalence of measurments of carotid stenois: AComparison of three methods on 1001 Angiograms. Stroke 1994; 25: 2435-2439.20. Spadone DP, Barkmeier LD, Hodson KJ, et al. Contralateral internal carotidartery stenosis or occlusion: Pitfall of correct ipsilateral classification - A studyperformed with color-flow imaging. J Vasc Surg 1990; 11: 642-649.21. Suwanwela N, Can U, Furie KL, et al. Carotid Doppler ultrasound criteria forinternal carotid artery stenosis based on residual lumen diameter calculated fromen bloc carotid enderterectomy specimens. Stroke 1996; 27: 1965-1969.22. Swets JA. ROC analysis applied to the evaluation of medical imaging tech-niques. Investigative Radiology 1979; 2: 109-121.23. Von Reutern GM, Budingen HJ. Ultraschalldiagnostik der hirnversorgendenArterien. Georg Thieme Verlag, Stuttgart, New York 1989.24. Wilterdink JL, Feldmann E, Furie KL, et al. Transcranial Doppler ultrasoundbattery reliably identifies severe internal carotid artery stenosis. Stroke 1997; 28:133-136.

Ä‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËfl:‰- à‚‡Ì ëÚ‡ÈÍÓ‚, ‰.Ï.ÉÎ‡‚ÂÌ ‡ÒËÒÚÂÌÚ Í˙Ï äÎËÌËÍ‡ ÔÓ çÂ‚ÓÎÓ„ËflìåÅÄã “ñ‡Ëˆ‡ âÓ‡ÌÌ‡”ÛÎ. ÅflÎÓ ÏÓÂ 81527 ëÓÙËflíÂÎ: 9432 571Ö-mail: [email protected]


SUMMARY

COROTID ARTERY INTIMA - MEDIATHICKNESS AND CAROTID ATHEROSCLEROSIS

E. Vasileva101 patients were included. 202 internal carotid arteries

were examined by color coded duplex sonography. Intima-media thickness, the presence of plaques and carotid arterystenosis were measured. Mean IMT of common carotid arter-ies at plaque-free sites and prevalence of plaques, as well asthe grade of carotid stenosis were evaluated by B-mode ultra-sound

Mean IMT in subjects with plaques was significantlygreater than that in subjects free of plaques. This associationwas significant. There was no relationship between IMP andplaque ehogenicity (hyperehogenic or hypoehogenic).

When the percentage of carotid stenosis on the right sideincreases with 1%, ITM increases with 0,005. When the per-centage of carotid stenosis on the left side increases with 1%,ITM increases with 0,007. There was a linear increase inmean ITM with increasement of the percentage of carotidstenosis.

The results showed relationship between IMT and localatherosclerosis.

äey words: Intima-media thickness, atherosclerosis,Doppler sonography, carotid stenosis.

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ç‡ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡ÌÂ Â ÔÓÒÔÂÍÚË‚ÌÓ Ë ‚ÍÎ˛˜‚‡101 Ô‡ˆËÂÌÚ‡, ÔË ÍÓËÚÓ Ò ˆ‚ÂÚÌ‡ ‰ÛÔÎÂÍÒ ‰ÓÔÎÂÓ‚‡ ÒÓ-ÌÓ„‡ÙËfl Ò‡ ËÁÒÎÂ‰‚‡ÌË Ó·˘Ó 202 ‚˙ÚÂ¯ÌË Ò˙ÌÌË ‡ÚÂ-ËË. àÁÏÂÂÌ Â ËÌÚËÏ‡-ÏÂ‰Ëfl ÍÓÏÔÎÂÍÒ‡ (Iåí), ÓÚ·ÂÎfl-Á‡ÌÓ Â Ì‡ÎË˜ËÂÚÓ Ì‡ ‡ÚÂÓÒÍÎÂÓÚË˜ÌË ÔÎ‡ÍË Ë e ÓÔÂ‰Â-ÎÂÌ ÔÓˆÂÌÚ‡ Ì‡ ÒÚÂÌÓÁË‡ÌÂ Ì‡ ‚˙ÚÂ¯ÌËÚÂ Ò˙ÌÌË ‡-ÚÂËË. àÁ‚˙¯ÂÌ‡ Â ÍÓÂÎ‡ˆËfl ÏÂÊ‰Û Iåí Ë ‡Á‚ËÚËÂÚÓÌ‡ ‡ÚÂÓÒÍÎÂÓÚË˜ÌË ÔÎ‡ÍË, Í‡ÍÚÓ Ë ÏÂÊ‰Û Iåí Ë ÔÓ-ˆÂÌÚ‡ Ì‡ Í‡ÓÚË‰Ì‡Ú‡ ÒÚÂÌÓÁ‡.

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èË Û‚ÂÎË˜‡‚‡ÌÂÚÓ Ì‡ ÔÓˆÂÌÚ‡ Ì‡ ÒÚÂÌÓÁ‡Ú‡ Ò 1%,Iåí ‚ ‰flÒÌÓ ÒÂ Û‚ÂÎË˜‡‚‡ ÒÂ‰ÌÓÒÚ‡ÚËÒÚË˜ÂÒÍË Ò 0,005.èË Û‚ÂÎË˜‡‚‡ÌÂÚÓ Ì‡ ÔÓˆÂÌÚ‡ Ì‡ ÒÚÂÌÓÁË‡ÌÂ Ò 1%,Iåí ‚ Îfl‚Ó ÒÂ Û‚ÂÎË˜‡‚‡ ÒÂ‰ÌÓÒÚ‡ÚËÒÚË˜ÂÒÍË Ò 0,007.ç‡·Î˛‰‡‚‡ ÒÂ ÌÂÔÂÍ˙ÒÌ‡ÚÓ Û‚ÂÎË˜‡‚‡ÌÂ ÒÚÓÈÌÓÒÚËÚÂÌ‡ Iåí Ò Ì‡‡ÒÚ‚‡ÌÂ Ì‡ ÔÓˆÂÌÚ‡ Ì‡ ÒÚÂÌÓÁ‡Ú‡ ‰‚ÛÒÚ-‡ÌÌÓ.

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Ù‡Á‡. èÓÒÂ‰ÒÚ‚ÓÏ Ç-mode ËÁÓ·‡ÊÂÌËÂÚÓ ÒÂ ËÁÒÎÂ‰‚‡‡ÚÂË‡ÎÌ‡Ú‡ ÒÚÂÌ‡, Ò˙‰Ó‚ ‰Ë‡ÏÂÚ˙, ‚ËÁÛ‡ÎËÁË‡Ú ÒÂ‡ÚÂÓÒÍÎÂÓÚË˜ÌËÚÂ ÔÎ‡ÍË. àÁ‚˙¯‚‡ ÒÂ ÓˆÂÌÍ‡ Ì‡ÒÚÛÍÚÛ‡Ú‡ Ì‡ Í‡ÓÚË‰Ì‡Ú‡ ÔÎ‡Í‡, ı‡‡ÍÚÂËÁË‡ ÒÂÔÎ‡ÍÓ‚‡Ú‡ ÔÓ‚˙ıÌÓÒÚ, ÓÔÂ‰ÂÎfl ÒÂ ÌÂÈÌ‡Ú‡ „ÓÎÂÏËÌ‡.èÓÒÂ‰ÒÚ‚ÓÏ Ç-mode ÎÂÒÌÓ ÒÂ ‚ËÁÛ‡ÎËÁË‡ Á‡‰Â·ÂÎfl‚‡ÌÂ-ÚÓ Ì‡ ËÌÚËÏ‡-ÏÂ‰Ëfl ÍÓÏÔÎÂÍÒ (intima media thickness,IMT) Ë ÒÂ ËÁÏÂ‚‡ ÌÂ„Ó‚‡Ú‡ „ÓÎÂÏËÌ‡.

ì‚ÂÎË˜‡‚‡ÌÂÚÓ Ì‡ Iåí ÒÂ Ò‚˙Á‚‡ Ò Ì‡ÎË˜ËÂÚÓ Ì‡ ËÒ-ÍÓ‚Ë Ù‡ÍÚÓË Á‡ åëÅ (1-4), Ò˙‰Â˜ÌÓÒ˙‰Ó‚Ë Á‡·ÓÎfl‚‡ÌËfl(5-7) Ë ‡ÚÂÓÒÍÎÂÓÁ‡ Ò ‰Û„‡ ÎÓÍ‡ÎËÁ‡ˆËfl (8,9). Ç˙ÔÂÍËÚÓ‚‡ ‚ ÍÎËÌË˜Ì‡Ú‡ Ô‡ÍÚËÍ‡ ËÁÏÂ‚‡ÌÂÚÓ Ì‡ Iåí ‚ÒÂÓ˘Â ÌflÏ‡ ÛÚ‚˙‰ÂÌ‡ ÓÎfl Á‡ ‡ÌÌ‡ ‰Ë‡„ÌÓÒÚËÍ‡ Ì‡ ‡ÚÂ-ÓÒÍÎÂÓÚË˜ÌËfl ÔÓˆÂÒ (10).

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ç‡Ô‡‚ÂÌÓÚÓ ÔÓÒÔÂÍÚË‚ÌÓ ÍÎËÌËÍÓ-ÂÔË‰ÂÏËÓÎÓ„Ë˜-ÌÓ ÔÓÛ˜‚‡ÌÂ Ó·ı‚‡˘‡ 101 Ô‡ˆËÂÌÚË - 63 (62,38%) Ï˙ÊÂË 38 (37,62%) ÊÂÌË, ÍÓËÚÓ Ò‡ ËÁÒÎÂ‰‚‡ÌË ‚ ÔÂËÓ‰‡ ÒÂÔ-ÚÂÏ‚Ë 2004 – ˛ÌË 2005 „Ó‰. ëÂ‰Ì‡Ú‡ ‚˙Á‡ÒÚ Ì‡ ÍÓÌ-ÚËÌ„ÂÌÚ‡ Â 60,91±13,07 „. ‚ ‰Ë‡Ô‡ÁÓÌ‡ 20-80 „Ó‰ËÌË.

ÖÍÒÚ‡Í‡ÌË‡ÎÌËÚÂ ÏÓÁ˙˜ÌË ‡ÚÂËË Ì‡ ‚ÒË˜ÍË Ô‡ˆË-ÂÌÚË Ò‡ ËÁÒÎÂ‰‚‡ÌË Ò ˆ‚ÂÚÌ‡ ‰ÛÔÎÂÍÒ ‰ÓÔÎÂÓ‚‡ ÒÓÌÓ„‡-ÙËfl Ò 5 - 7 MHz Ú‡ÌÒ‰˛ÒÂ. Ç ÔÓÒÎÂ‰‚‡˘Ëfl ‡Ì‡ÎËÁ Ò‡‚ÍÎ˛˜ÂÌË ‰‡ÌÌËÚÂ ÓÚ 202 Ó·˘Ë Ë 202 ‚˙ÚÂ¯ÌË Ò˙ÌÌË‡ÚÂËË (ÇëÄ).

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2. éÚ·ÂÎflÁ‚‡ÌÂ Ì‡ÎË˜ËÂÚÓ Ì‡ ‡ÚÂÓÒÍÎÂÓÚË˜ÌË ÔÎ‡-ÍË Ò ÓÔÂ‰ÂÎflÌÂ Ì‡ ÚflıÌÓÚÓ ‡ÁÔÓÎÓÊÂÌËÂ, ·ÓÈ, „ÓÎÂÏË-Ì‡, ı‡‡ÍÚÂ (ıËÔÂÂıÓ„ÂÌÌË Ë ıËÔÓÂıÓÂÌÌË). á‡ ÔÎ‡ÍË Ò‡ÔËÂÚË ÎÓÍ‡ÎÌËÚÂ Á‡‰Â·ÂÎfl‚‡ÌËfl, ˜ËflÚÓ ¯ËËÌ‡ Â Ì‡‰ 2mm.

3. éÔÂ‰ÂÎflÌÂ ÔÓˆÂÌÚ‡ Ì‡ ÒÚÂÌÓÁË‡ÌÂ Ì‡ ÇëÄ ÔÓÒÂ-‰ÒÚ‚ÓÏ ËÁÏÂ‚‡ÌÂ ÒÍÓÓÒÚÌËÚÂ ÔÓÍ‡Á‡ÚÂÎË Ë Í‡ÓÚË‰-ÌÓÚÓ ÓÚÌÓ¯ÂÌËÂ.

Ñ‡ÌÌËÚÂ ·flı‡ ‚˙‚Â‰ÂÌË Ë Ó·‡·ÓÚÂÌË Ò˙Ò ÒÚ‡ÚËÒÚË-˜ÂÒÍËfl Ô‡ÍÂÚ SPSS 12.0.1. á‡ ÌË‚Ó Ì‡ ÁÌ‡˜ËÏÓÒÚ, ÔË ÍÓ-ÂÚÓ ÒÂ ÓÚı‚˙Îfl ÌÛÎÂ‚‡Ú‡ ıËÔÓÚÂÁ‡ ·Â ËÁ·‡ÌÓ p < 0,05.

Åflı‡ ÔËÎÓÊÂÌË ÒÎÂ‰ÌËÚÂ ÏÂÚÓ‰Ë: ‰ÂÒÍËÔÚË‚ÂÌ ‡Ì‡-ÎËÁ, ‚‡Ë‡ˆËÓÌÂÌ ‡Ì‡ÎËÁ, „‡ÙË˜ÂÌ ‡Ì‡ÎËÁ, Â‰ÌÓËÁ‚‡‰ÍÓ‚ÏÂÚÓ‰ Ì‡ äÓÎÏÓ„ÓÓ‚-ëÏËÌÓ‚, t-ÚÂÒÚ Ì‡ ëÚ˛‰ÂÌÚ, ÌÂ-ÎËÌÂÂÌ Â‰ÌÓÙ‡ÍÚÓÂÌ Â„ÂÒËÓÌÂÌ ‡Ì‡ÎËÁ.

1. ÑÂÒÍËÔÚË‚ÂÌ ‡Ì‡ÎËÁ – ‚ Ú‡·ÎË˜ÂÌ ‚Ë‰ Â ÔÂ‰ÒÚ‡‚Â-ÌÓ ˜ÂÒÚÓÚÌÓÚÓ ‡ÁÔÂ‰ÂÎÂÌËÂ Ì‡ ‡Á„ÎÂÊ‰‡ÌËÚÂ ÔËÁÌ‡-ˆË, ‡Á·ËÚË ÔÓ „ÛÔË Ì‡ ËÁÒÎÂ‰‚‡ÌÂ.

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3. É‡ÙË˜ÂÌ ‡Ì‡ÎËÁ – Á‡ ‚ËÁÛ‡ÎËÁ‡ˆËfl Ì‡ ÔÓÎÛ˜ÂÌËÚÂ


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Ç ËÁÒÎÂ‰‚‡ÌËfl ÍÓÌÚËÌ„ÂÌÚ ·ÓÎÌË, Ì‡È-‡ÌÌ‡Ú‡ ‚˙Á-‡ÒÚ, ‚ ÍÓflÚÓ Ò‡ Â„ËÒÚË‡ÌË ‡ÚÂÓÒÍÎÂÓÚË˜ÌË ÔÎ‡ÍËÂ 48 „Ó‰. ê‡ÌÌ‡ ‡ÚÂÓÒÍÎÂÓÁ‡ (ÔÓ‰ 55 „Ó‰) Â Ì‡·Î˛‰‡‚‡Ì‡ÔË 11 ·ÓÎÌË (11%). éÚ ‰Û„‡ ÒÚ‡Ì‡, ÔË 10 ·ÓÎÌË Ì‡‰ 70„Ó‰ËÌË ÌÂ Ò‡ Â„ËÒÚË‡ÌË ‡ÚÂÓÒÍÎÂÓÚË˜ÌË ÔÎ‡ÍË(10%).

ç‡ÎË˜ËÂÚÓ Ì‡ ‡ÚÂÓÒÍÎÂÓÚË˜ÌË ÔÎ‡ÍË Â Ò‚˙Á‡ÌÓ Ò˙ÒÒË„ÌËÙËÍ‡ÌÚÌÓ ÔÓ‚Ë¯ÂÌËÂ Ì‡ ÒÂ‰ÌËÚÂ ÒÚÓÈÌÓÒÚË Ì‡Iåí Í‡ÍÚÓ ‚Îfl‚Ó Ú‡Í‡ Ë ‚‰flÒÌÓ (í‡·Î.1 Ë í‡·Î.2).

ãËÔÒ‚‡ ÒÚ‡ÚËÒÚË˜ÂÒÍË ÁÌ‡˜ËÏ‡ ‡ÁÎËÍ‡ ÏÂÊ‰Û ‚Ë‰‡Ì‡ ‡ÚÂÓÒÍÎÂÓÚË˜ÌËÚÂ ÔÎ‡ÍË (ıËÔÂÂıÂ„ÂÌÌË ËÎË ıËÔÓ-ÂıÓ„ÂÌÌË) Ë ‰Â·ÂÎËÌ‡Ú‡ Ì‡ Iåí, Í‡ÚÓ ÒÂ‰Ì‡Ú‡ ‰Â·ÂÎËÌ‡Ì‡ Iåí ÔË Ô‡ˆËÂÌÚËÚÂ Ò ıËÔÓÂıÓ„ÂÌÌË ÔÎ‡ÍË Â 0,83, ‡ÒÂ‰Ì‡Ú‡ ‰Â·ÂÎËÌ‡ ÔË ÚÂÁË Ò ıËÔÂÂıÓ„ÂÌÌË ÔÎ‡ÍË Â 0,86(>0,05).

á‡‚ËÒËÏÓÒÚ Ì‡ Iåí -Îfl‚Ó ÓÚ ÒÚÂÔÂÌ Ì‡ ÒÚÂÌÓÁ‡Ú‡ Ì‡ÇëÄ-Îfl‚Ó

éÚ ‚„‡‰ÂÌËÚÂ ‚ SPSS 12.0.1. ÏÓ‰ÂÎË, Á‡‚ËÒËÏÓÒÚÚ‡Ì‡ ‰Â·ÂÎËÌ‡Ú‡ Ì‡ Iåí -Îfl‚Ó Ò˙Ò ÒÚÂÔÂÌÚ‡ Ì‡ ÒÚÂÌÓÁ‡Ú‡Ì‡ ÇëÄ - Îfl‚Ó ÒÂ ÓÔËÒ‚‡ Ì‡È-‰Ó·Â ÓÚ ÎËÌÂÈÌËfl ÏÓ‰ÂÎ(p<0.001, F=53.64, R2=0.351) Ò˙Ò ÒÎÂ‰ÌËÚÂ Ô‡‡ÏÂÚË:

Iåí_L = 0.610 + 0.007*VSA_L

Í˙‰ÂÚÓ Iåí _L Â Iåí -Îfl‚Ó, ‡ VSA_L Â ÒÚÂÔÂÌ Ì‡ ÒÚÂ-ÌÓÁ‡Ú‡ Ì‡ ÇëÄ-Îfl‚Ó. éÚ Û‡‚ÌÂÌËÂÚÓ ÒÂ ‚ËÊ‰‡, ˜Â ÔËÛ‚ÂÎË˜‡‚‡ÌÂÚÓ Ì‡ VSA_L Ò 1%, Iåí _L ÒÂ Û‚ÂÎË˜‡‚‡ ÒÂ‰-ÌÓÒÚ‡ÚËÒÚË˜ÂÒÍË Ò 0,007. ç‡ ÙË„Û‡ 1 ÒÂ Ì‡·Î˛‰‡‚‡ ÌÂÔ-ÂÍ˙ÒÌ‡ÚÓ Û‚ÂÎË˜‡‚‡ÌÂ ÒÚÓÈÌÓÒÚËÚÂ Ì‡ ITM_L Ò Ì‡‡-ÒÚ‚‡ÌÂ Ì‡ VSA_L.

á‡‚ËÒËÏÓÒÚ Ì‡ ‰Â·ÂÎËÌ‡Ú‡ Ì‡ Iåí - ‰flÒÌÓ ÓÚ ÒÚÂ-ÔÂÌÚ‡ Ì‡ ÒÚÂÌÓÁË‡ÌÂ Ì‡ ÇëÄ - ‰flÒÌÓ

éÚ ‚„‡‰ÂÌËÚÂ ‚ SPSS 12.0.1. ÏÓ‰ÂÎË, Á‡‚ËÒËÏÓÒÚÚ‡Ì‡ Iåí -‰flÒÌÓ Ò˙Ò ÒÚÂÔÂÌÚ‡ Ì‡ ÒÚÂÌÓÁË‡ÌÂ Ì‡ ÇëÄ-‰flÒ-ÌÓ ÒÂ ÓÔËÒ‚‡ Ì‡È-‰Ó·Â ÓÚ ÎËÌÂÈÌËfl ÏÓ‰ÂÎ (p<0.001,F=52.64, R2=0.349) Ò˙Ò ÒÎÂ‰ÌËÚÂ Ô‡‡ÏÂÚË:

Iåí_R = 0.583 + 0.005*VSA_R

Í˙‰ÂÚÓ Iåí_R Â Iåí-‰flÒÌÓ, ‡ VSA_R Â ÒÚÂÔÂÌ Ì‡ÒÚÂÌÓÁ‡Ú‡ Ì‡ ÇëÄ-‰flÒÌÓ. éÚ Û‡‚ÌÂÌËÂÚÓ ÒÂ ‚ËÊ‰‡, ˜ÂÔË Û‚ÂÎË˜‡‚‡ÌÂÚÓ Ì‡ VSA_R Ò 1%, Iåí_R ÒÂ Û‚ÂÎË˜‡‚‡ÒÂ‰ÌÓÒÚ‡ÚËÒÚË˜ÂÒÍË Ò 0,005. ç‡ ÙË„Û‡ 2 ÒÂ Ì‡·Î˛‰‡‚‡ÌÂÔÂÍ˙ÒÌ‡ÚÓ Û‚ÂÎË˜‡‚‡ÌÂ ÒÚÓÈÌÓÒÚËÚÂ Ì‡ Iåí_R Ò Ì‡-‡ÒÚ‚‡ÌÂ Ì‡ VSA_R.


í‡·ÎËˆ‡ 1: ë‡‚ÌËÚÂÎÂÌ ‡Ì‡ÎËÁ Ì‡ Iåí ÒÔÓÂ‰ Ì‡ÎË˜ËÂÚÓ Ì‡ ÔÎ‡ÍË (Îfl‚Ó)

èÎ‡ÍËèÓÍ‡Á‡ÚÂÎ çÂ Ñ‡

N X SD N X SD êIåí -Îfl‚Ó 49 0,59 0,17 52 0,89 0,22 <0,001

Iåí -‰flÒÌÓ 49 0,58 0,18 52 0,82 0,24 <0,001

í‡·ÎËˆ‡ 2 ë‡‚ÌËÚÂÎÂÌ ‡Ì‡ÎËÁ Ì‡ Iåí ÒÔÓÂ‰ Ì‡ÎË˜ËÂÚÓ Ì‡ ÔÎ‡ÍË (‰flÒÌÓ)

èÎ‡ÍËèÓÍ‡Á‡ÚÂÎ çÂ Ñ‡

N X SD N X SD êåí -Îfl‚Ó 48 0,60 0,19 53 0,87 0,23 <0,001

Iåí -‰flÒÌÓ 48 0,57 0,19 53 0,82 0,24 <0,001

îË„Û‡ 1 êÂ„ÂÒËÓÌÂÌ ÏÓ‰ÂÎ Ì‡ Á‡‚ËÒËÏÓÒÚÚ‡ ÏÂÊ‰Û Iåí -Îfl‚Ó Ë ÇëÄ-Îfl‚Ó

Ñ‡ÌÌËåÓ‰ÂÎ

0 20 40 60 80ÇëÄ-Îfl‚Ó

IMT-L

1,75

1,50

1,25

1

0,75

0,50

0,25

îË„Û‡ 2 êÂ„ÂÒËÓÌÂÌ ÏÓ‰ÂÎ Ì‡ Á‡‚ËÒËÏÓÒÚÚ‡ ÏÂÊ‰Û Iåí-‰flÒÌÓ Ë ÇëÄ-‰flÒÌÓ

0 20 40 60 80 100ÇëÄ-‰flÒÌÓ

IMT-R

1,75

1,50

1,25

1

0,75

0,50

0,25


éÅëöÜÑÄçÖ

ÉÓÎflÏ‡ ˜‡ÒÚ ÓÚ ÔÓÛ˜‚‡ÌËflÚ‡ ÔÂÁ ÔÓÒÎÂ‰ÌËÚÂ ‰ÂÒÂÚ„Ó‰ËÌË Ò‡ Ì‡ÒÓ˜ÂÌË Í˙Ï ËÁflÒÌfl‚‡ÌÂ ÍÎËÌË˜ÌÓÚÓ ÁÌ‡˜ÂÌËÂÌ‡ Iåí ÔÓ ÓÚÌÓ¯ÂÌËÂ ÔÂÍ‡‡ÌË Ë ·˙‰Â˘Ë Ò˙‰Â˜ÌÓÒ˙‰Ó-‚Ë Ë ÏÓÁ˙˜ÌÓÒ˙‰Ó‚Ë ËÌˆË‰ÂÌÚË, Í‡ÍÚÓ Ë Í˙Ï ËÁÒÎÂ‰‚‡ÌÂÙ‡ÍÚÓËÚÂ Ò ÍÓËÚÓ ÒÂ Ò‚˙Á‚‡ ÌÂÈÌÓÚÓ Ì‡‡ÒÚ‚‡ÌÂ.åÌÓ„Ó ÓÚ Úflı ‰ÓÍ‡Á‚‡Ú ˜Â Iåí Â Ï‡ÍÂ Á‡ ‡Á‚ËÚËÂ Ì‡‡ÚÂÓÒÍÎÂÓÚË˜ÂÌ ÔÓˆÂÒ Ò ‰Û„‡ ÎÓÍ‡ÎËÁ‡ˆËfl – ÍÓÓÌ‡-Ì‡, ÙÂÏÓ‡ÎÌ‡, ‡ÓÚÌ‡ Ë ‰. (5,11-13).

ÇÒÂ Ó˘Â Ó·‡˜Â Â Ó·ÂÍÚ Ì‡ ‰Â·‡ÚË ‰‡ÎË Û‚ÂÎË˜ÂÌËÂÚÓÌ‡ Iåí Â ËÁ‡Á Ì‡ ÎÓÍ‡ÎÌ‡ ‡ÚÂÓÒÍÎÂÓÁ‡. ä‡ÍÚÓ Â ËÁ‚Â-ÒÚÌÓ, Ó·˘‡Ú‡ Ò˙ÌÌ‡ ‡ÚÂËfl ÒÂ Á‡Òfl„‡ ÓÚ ‡ÚÂÓÒÍÎÂÓ-ÚË˜ÂÌ ÔÓˆÂÒ ÁÌ‡˜ËÚÂÎÌÓ ÔÓ-fl‰ÍÓ ÓÚÍÓÎÍÓÚÓ Í‡ÓÚË‰-Ì‡Ú‡ ·ËÙÛÍ‡ˆËfl Ë ÇëÄ. Iåí ÒÂ ËÁÏÂ‚‡ Ó·‡˜Â ‚˙ıÛ Ó·-˘‡Ú‡ Ò˙ÌÌ‡ ‡ÚÂËfl, Á‡˘ÓÚÓ ÌÂÈÌ‡Ú‡ ÒÚÂÌ‡ ÒÂ ËÁÓ·‡-Áfl‚‡ ÎÂÒÌÓ ˜ÂÁ ‰ÛÔÎÂÍÒ ‰ÓÔÎÂÓ‚‡ ÒÓÌÓ„‡ÙËfl Ë Â ‚˙Á-ÏÓÊÌÓ ÚÓ˜ÌÓ ËÁÏÂ‚‡ÌÂ. éÒ‚ÂÌ ÚÓ‚‡, ÔË ËÁÏÂ‚‡ÌÂ ÔÓ-ÏÂÌËÚÂ ‚ ËÌÚËÏ‡Ú‡ Ò˙˘ÂÒÚ‚Û‚‡Ú ËÁ‚ÂÒÚÌË ÏÂÚÓ‰ÓÎÓ-„Ë˜ÌË ÌÂÚÓ˜ÌÓÒÚË. ÄÚÂÓÒÍÎÂÓÁ‡Ú‡ Â Ô‡ÚÓÎÓ„Ë˜ÂÌÔÓˆÂÒ ÍÓÈÚÓ Ó·ı‚‡˘‡ ËÌÚËÏ‡Ú‡, ‡ ˜ÂÁ Ç-mode ÌÂ ÏÓ-ÊÂ ‰‡ ÒÂ Ì‡Ô‡‚Ë ‡Á„‡ÌË˜‡‚‡ÌÂ Ì‡ ‰‚‡Ú‡ ÒÎÓfl - ËÌÚËÏ‡ÓÚ ÏÂ‰Ëfl, ÔÓ‡‰Ë ÍÓÂÚÓ ÒÂ ËÁÏÂ‚‡ ˆÂÎËfl ÍÓÏÔÎÂÍÒ.

åÌÓ„Ó ‡‚ÚÓË ËÁÍ‡Á‚‡Ú Ò˙ÏÌÂÌËÂ ‰‡ÎË Û‚ÂÎË˜ÂÌËÂÚÓÌ‡ Iåí Â ËÁ‡Á Ì‡ ‡ÚÂÓÒÍÎÂÓÚË˜ÂÌ ÔÓˆÂÒ ËÎË Â ‡‰‡Ô-ÚË‚ÂÌ ÓÚ„Ó‚Ó Ì‡ Ò˙‰Ó‚‡Ú‡ ÒÚÂÌ‡ Í˙Ï ÔÓÏÂÌËÚÂ ‚ Ì‡-Îfl„‡ÌÂÚÓ ÍÓÂÚÓ Í˙‚ÌËflÚ Ó·ÂÏ ÛÔ‡ÊÌfl‚‡ ‚˙ıÛ ÂÌ‰Ó-ÚÂÎÌ‡Ú‡ ÔÓ‚˙ıÌÓÒÚ (14,15). í‡Í‡ Ì‡ÔËÏÂ Homma S etal. (16) ÒÚË„‡Ú ‰Ó Á‡ÍÎ˛˜ÂÌËÂ ˜Â Û‚ÂÎË˜ÂÌËÂÚÓ Ì‡ Iåí ÂÙËÁËÓÎÓ„Ë˜ÂÌ, ‚˙Á‡ÒÚÓ‚Ó Ó·ÛÒÎÓ‚ÂÌ ÔÓˆÂÒ, ‡ÁÎË˜ÂÌ ÓÚÙÓÏË‡ÌÂÚÓ Ì‡ ÔÎ‡ÍË, Ú˙È Í‡ÚÓ ‚ ËÁÒÎÂ‰‚‡ÌËfl ÓÚ ÚflıÍÓÌÚËÌ„ÂÌÚ Ì‡ÎË˜ËÂÚÓ Ì‡ ÔÎ‡ÍË Ë Iåí ÍÓÂÎË‡ Ò‡ÏÓ ‚ÒÂ‰ÏÓÚÓ Ë ÓÒÏÓÚÓ ‰ÂÒÂÚËÎÂÚËÂ, ÌÓ ÌÂ Ë ‚ ÔÓ-Í˙ÒÌ‡ ‚˙Á-‡ÒÚ.

ë ˆÂÎ ‰ÓÔËÌ‡ÒflÌÂ Á‡ ËÁflÒÌfl‚‡ÌÂÚÓ Ì‡ ÚÂÁË ‚˙ÔÓÒË, ‚Ì‡ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡ÌÂ Ò‡ ÔÓÒÎÂ‰ÂÌË ‰‚Â ÓÒÌÓ‚ÌË Á‡‚Ë-ÒËÏÓÒÚË – ÓÚ Â‰Ì‡ ÒÚ‡Ì‡ - ‰‡ÎË Â Ì‡ÎËˆÂ ‚˙ÁÍ‡ ÏÂÊ‰Û„ÓÎÂÏËÌ‡Ú‡ Ì‡ Iåí Ë ‡Á‚ËÚËÂÚÓ Ì‡ ‡ÚÂÓÒÍÎÂÓÚË˜ÌËÔÎ‡ÍË ‚ ËÔÒËÎ‡ÚÂ‡ÎÌ‡Ú‡ Ó·˘‡ Ë ‚˙ÚÂ¯Ì‡ Ò˙ÌÌ‡ ‡ÚÂ-Ëfl, ÛÒÚ‡ÌÓ‚ÂÌË ˜ÂÁ ˆ‚ÂÚÌ‡ ‰ÛÔÎÂÍÒ ‰ÓÔÎÂÓ‚‡ ÒÓÌÓ„‡-ÙËfl Ë ÓÚ ‰Û„‡ ÒÚ‡Ì‡ - ‰‡ÎË Ò˙˘ÂÒÚ‚Û‚‡ ‚˙ÁÍ‡ ÏÂÊ‰Û‰Â·ÂÎËÌ‡Ú‡ Ì‡ Iåí Ë ÒÚÂÔÂÌÚ‡ Ì‡ ‡ÚÂÓÒÍÎÂÓÚË˜ÌËflÔÓˆÂÒ, ËÁ‡ÁÂÌ‡ ˜ÂÁ ÔÓˆÂÌÚ‡ Ì‡ ÒÚÂÌÓÁË‡ÌÂ Ì‡ ÇëÄ.

êÂÁÛÎÚ‡ÚËÚÂ ÓÚ Ì‡ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡ÌÂ ÔÓÍ‡Á‚‡ÚÔÓÎÓÊËÚÂÎÌ‡ Á‡‚ËÒËÏÓÒÚ ÏÂÊ‰Û Iåí Ë ÔÓfl‚‡Ú‡ Ì‡ ÔÎ‡-ÍË ‚˙‚ ÇëÄ, ÍÓÂÚÓ Â ‚ Ò˙„Î‡ÒËÂ Ò ‰‡ÌÌËÚÂ ÓÚ ‰Û„ËÚÂÔÓÛ˜‚‡ÌËfl (17,18-21). íÂ ÔÓ‰Ó·ÌÓ Ì‡ Ì‡Ò ÔÓÚ‚˙Ê‰‡‚‡Ú,˜Â ÒÂ‰Ì‡Ú‡ ‰Â·ÂÎËÌ‡ Ì‡ Iåí ÔË Ô‡ˆËÂÌÚË Ò ‡ÚÂÓÒÍÎÂ-ÓÚË˜ÌË ÔÎ‡ÍË ‚ Ó·˘ËÚÂ Ò˙ÌÌË ‡ÚÂËË Â ÒË„ÌËÙËÍ‡ÌÚ-ÌÓ ÔÓ-„ÓÎflÏ‡ ÓÚÍÓÎÍÓÚÓ ÔË Á‰‡‚Ë. èÓ‚Â˜ÂÚÓ ÓÚ ÔÓ-‚Â‰ÂÌËÚÂ ‰Ó ÏÓÏÂÌÚ‡ ÔÓÛ˜‚‡ÌËfl Ó·‡˜Â ËÁÒÎÂ‰‚‡Ú Ó·˘‡-Ú‡ Á‡‚ËÒËÏÓÒÚ ÒÂ‰Ì‡ ‰Â·ÂÎËÌ‡ Ì‡ Iåí Ë Í‡ÓÚË‰Ì‡ ‡ÚÂ-ÓÒÍÎÂÓÁ‡. Ç Ì‡ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡ÌÂ Â Ì‡Ô‡‚ÂÌ‡ ‰ËÙÂ-ÂÌˆË‡ˆËfl ÔÓ ÓÚÌÓ¯ÂÌËÂ ÏflÒÚÓÚÓ Ì‡ ÔÓfl‚‡ Ì‡ ‡ÚÂÓÒÍ-ÎÂÓÚË˜ÌËÚÂ ÔÎ‡ÍË, ÍÓÂÚÓ ÔÓÍ‡Á‚‡ ˜Â Û‚ÂÎË˜ÂÌËÂÚÓ Ì‡ÍÓÏÔÎÂÍÒ‡ ËÌÚËÏ‡-ÏÂ‰Ëfl ËÏ‡ ÔflÍ‡ ‚˙ÁÍ‡ Ò ÎÓÍ‡ÎÌËfl‡ÚÂÓÒÍÎÂÓÚË˜ÂÌ ÔÓˆÂÒ.

á‡‚ËÒËÏÓÒÚÚ‡ ÏÂÊ‰Û ÚÂÊÂÒÚÚ‡ Ì‡ Í‡ÓÚË‰Ì‡Ú‡‡ÚÂÓÒÍÎÂÓÁ‡ Ë Iåí ÏÓÊÂ ‰‡ ÒÂ ÔÓÒÎÂ‰Ë ÔÓ ‡ÁÎË˜ÌË Ì‡-˜ËÌË. Bonithon-Kopp et al (21) Ì‡ÔËÏÂ ËÁÒÎÂ‰‚‡Ú Á‡‚ËÒË-ÏÓÒÚÚ‡ Iåí Ò ·Ófl Ë ‰Â·ÂÎËÌ‡Ú‡ Ì‡ Í‡ÓÚË‰ÌËÚÂ ‡ÚÂ-ÓÒÍÎÂÓÚË˜ÌË ÔÎ‡ÍË.

äÓÂÎ‡ˆËfl Ó·‡˜Â Ò ÔÓˆÂÌÚ‡ Ì‡ ÒÚÂÌÓÁ‡Ú‡ Â ÓÒ˙˘ÂÒÚ-‚ÂÌ‡ ‚ ÏÌÓ„Ó Ï‡ÎÍÓ ÔÓÛ˜‚‡ÌËfl (22). Homma S. et al. ÔÓ-‚Âfl‚‡Ú Ò‡ÏÓ ‰‡ÎË Ô‡ˆËÂÌÚËÚÂ Ò Í‡ÓÚË‰ÌË ÒÚÂÌÓÁËËÏ‡Ú ÔÓ-„ÓÎflÏ‡ Iåí ÓÚ ÚÂÁË ·ÂÁ Í‡ÓÚË‰ÌË ÒÚÂÌÓÁË(16).

ëÔÓÂ‰ ÂÁÛÎÚ‡ÚËÚÂ ÓÚ Ì‡¯ÂÚÓ ÔÓÛ˜‚‡ÌÂ, ÔË Û‚Â-ÎË˜‡‚‡ÌÂ ÔÓˆÂÌÚ‡ Ì‡ ÒÚÂÌÓÁ‡Ú‡ Ò 1%, Iåí ÒÂ Û‚ÂÎË˜‡‚‡ÒÂ‰ÌÓÒÚ‡ÚËÒÚË˜ÂÒÍË Ò 0,007 ‚ Îfl‚Ó Ë Ò 0,005 ‚ ‰flÒÌÓ.íÓ‚‡ ‰ÓÍ‡Á‚‡ Ì‡ÎË˜ËÂÚÓ Ì‡ ‚˙ÁÍ‡ ÏÂÊ‰Û ÚÓÁË ÔÓÍ‡Á‡ÚÂÎË ÚÂÊÂÒÚÚ‡ Ì‡ ‡ÚÂÓÒÍÎÂÓÚË˜ÂÌ ÔÓˆÂÒ ‚ Í‡ÓÚË‰ÌË-ÚÂ ‡ÚÂËË, ÍÓflÚÓ ÓÚ Ò‚Ófl ÒÚ‡Ì‡ ÓÚ‡Áfl‚‡ ÒÍÓÓÒÚÚ‡Ë ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚÚ‡ Ì‡ ÌÂ„Ó‚ÓÚÓ ‡Á‚ËÚËÂ.

éÚ „ÓÎflÏ ËÌÚÂÂÒ Â ÔÓÛ˜‚‡ÌÂÚÓ Ì‡Ô‡‚ÂÌÓ ÓÚ Zureiket al (23), ÍÓÂÚÓ ËÁÒÎÂ‰‚‡ ÔÂ‰ËÍÚË‚Ì‡Ú‡ ÒÚÓÈÌÓÒÚ Ì‡„ÓÎÂÏËÌ‡Ú‡ Ì‡ Iåí Á‡ ‚˙ÁÌËÍ‚‡ÌÂ Ì‡ ‡ÚÂÓÒÍÎÂÓÚË˜ÌËÔÎ‡ÍË ‚ ÂÍÒÚ‡Í‡ÌË‡ÎÌËÚÂ Í‡ÓÚË‰ÌË ‡ÚÂËË Á‡ 4 „Ó-‰Ë¯ÂÌ ÔÂËÓ‰ ÓÚ ‚ÂÏÂ ÔË 1010 Ô‡ˆËÂÌÚ‡. Ä‚ÚÓËÚÂ‰ÓÍ‡Á‚‡Ú ÔÓÎÓÊËÚÂÎÌ‡ Á‡‚ËÒËÏÓÒÚ, ÍÓÂÚÓ Â ‚ ÔÓ‰ÍÂÔ‡Ì‡ ÒÚ‡ÌÓ‚Ë˘ÂÚÓ ˜Â Iåí ÒÂ Û‚ÂÎË˜‡‚‡ ‚ ‡ÌÌ‡Ú‡ Ù‡Á‡ Ì‡‡ÚÂÓÒÍÎÂÓÚË˜ÌËfl ÔÓˆÂÒ Ë ÔÂ‰¯ÂÒÚ‚‡ Ó·‡ÁÛ‚‡ÌÂÚÓÌ‡ ÔÎ‡ÍË.

Ç Ì‡ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡ÌÂ ÌÂ ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡ ‚˙ÁÍ‡ÏÂÊ‰Û ÔÎ‡ÍÓ‚‡Ú‡ ÒÚÛÍÚÛ‡ Ë Iåí, ‚˙ÔÂÍË ˜Â ÔË Ô‡-ˆËÂÌÚËÚÂ Ò ‚ËÒÓÍÓÒÚÂÔÂÌÌË ÒÚÂÌÓÁË ÔÂ‚‡ÎË‡Ú ıËÔÂ-ÂıÓ„ÂÌÌËÚÂ ÔÎ‡ÍË, Í‡ÍÚÓ Ë ÚÂÁË Ò˙Ò ÒÏÂÒÂÌ‡ ÒÚÛÍÚÛ-‡. ëÂ‰Ì‡Ú‡ ‰Â·ÂÎËÌ‡ Ì‡ Iåí ÔË Ô‡ˆËÂÌÚËÚÂ Ò ıËÔÓÂ-ıÓ„ÂÌÌË ÔÎ‡ÍË Â 0,83, ‡ ÒÂ‰Ì‡Ú‡ ‰Â·ÂÎËÌ‡ ÔË ÚÂÁË Ò ıË-ÔÂÂıÓ„ÂÌÌË ÔÎ‡ÍË Â 0,86 (>0,05). Ç˙ÁÍ‡Ú‡ ÏÂÊ‰Û ÔÎ‡-ÍÓ‚‡ ÂıÓ„ÂÌÌÓÒÚ Ë Iåí Â ·ËÎ‡ Ó·ÂÍÚ Ì‡ ËÌÚÂÂÒ ‚ ÏÌÓ„ÓÏ‡ÎÍÓ ‰Û„Ë ÔÓÛ˜‚‡ÌËfl. Homma S. et al. (16) Ò˙˘Ó ÌÂ ÛÒ-Ú‡ÌÓ‚fl‚‡Ú ÒË„ÌËÙËÍ‡ÌÚÌ‡ Á‡‚ËÒËÏÓÒÚ, ÌÓ ‚˙ÔÂÍË ÚÓ-‚‡ ‚ ËÁÒÎÂ‰‚‡ÌËfl ÓÚ Úflı ÍÓÌÚËÌ„ÂÌÚ, ÔË Ô‡ˆËÂÌÚËÚÂ ÒıÂÚÂÓ„ÂÌÌË ÔÎ‡ÍË Ò‡ ÛÒÚ‡ÌÓ‚ÂÌË ÔÓ-‚ËÒÓÍË ÒÚÓÈÌÓÒÚËÌ‡ Iåí.

Ç Á‡ÍÎ˛˜ÂÌËÂ ‰‡ÌÌËÚÂ ÓÚ Ì‡ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡ÌÂ ‰Ó-Í‡Á‚‡Ú Ì‡ÎË˜ËÂÚÓ Ì‡ ‚˙ÁÍ‡ ÏÂÊ‰Û Á‡‰Â·ÂÎfl‚‡ÌÂÚÓ Ì‡ËÌÚËÏ‡-ÏÂ‰Ëfl ÍÓÏÔÎÂÍÒ‡ Ë ÎÓÍ‡ÎÌËfl ‡ÚÂÓÒÍÎÂÓÚË˜ÂÌÔÓˆÂÒ, Í‡ÚÓ ÔÓÍ‡Á‚‡Ú ÍÓÂÎ‡ˆËfl Í‡ÍÚÓ ÏÂÊ‰Û ÚÓÁËÙ‡ÍÚÓ Ë Ì‡ÎË˜ËÂÚÓ Ì‡ ÔÎ‡ÍË, Ú‡Í‡ Ë ÏÂÊ‰Û Iåí Ë ÒÚÂ-ÔÂÌÚ‡ Ì‡ Í‡ÓÚË‰Ì‡Ú‡ ÒÚÂÌÓÁ‡ ‚ ËÔÒËÎ‡ÚÂ‡ÎÌ‡Ú‡ÇëÄ.

ãàíÖêÄíìêÄ1. Homma S, Hirose N, Ishida H et al. Carotid Plaque and intima-Media thick-ness by b-Mode Ultrasonography in Subjects Ranging From young Adults toCentenarians. Stroke, 2001,2. Polak J, O’Leary D, Kronmal R et al. Sonographic evaluation of carotidartery atherosclerosis in the elderly: relationship of disease severity to stroke andtransient ischemic attack. Radiology, 1993,188,363-370.3. Touboul R-J. Clinical impact of intima media measurement. Eur J Ultrasound2002,16,105-113.4. Bots M, Witterman J, Grobbee D. Carotid intima-media wall thickness in eld-erly women with and without atherosclerosis of the abdominalaorta.Atherosclerosis,1993,102,99-105.5. Bots M, Hofman A, Grobbee D. Carotid intima-media thickness and lowerextremity arterial atherosclerosis: the Rotterdam study. ArteriosclerThromb,1994,14,1885-1891.6. Iglesias del Sol A., Bots M, Grobbee D et al. Carotid intima-media thicknessat different sites: relation to incident myocardial infarction. The Rotterdarm Study,European Heart Journal 2002, 23,934-940. 7. Kablak-Ziembicka A, Przewlocki T, Tracz W et al. Prognostic Value ofCarotid Intima-Media thickness in Detection of Coronary Atherosclerosis inPatients with Calcified Aortic valve Stenosis. J Ultrasound Med 2005,24,461-467.8. Rosfors S, Hallerstam S, Jensen-Urstad K et al. Relationship between intima-media thickness in the common carotid artery and atherosclerosis in the carotidbifurcation. Stroke 1998, 29, 1378-82.9. O’Leary D, Josef F, Polak J et al. Carotid artery intima media thickness as arisk factor for myocardial infarction and stroke in older adults. N Engl JMed,1999,340,14-22.10. Bots M, Hoes A, Koudstaal P et al. Common carotid intima-media thicknessand risk of stroke and myocardial infarction: the Rotterdam Study. Circulation,1997,96,1432-1437. 11. Zureik M, Ducimetiere P, Touboul P-J. Common Carotid Intima -MediaThickness Predicts Occurrence of Carotid Atherosclerotic Plaques.Arteriosclerosis, Thrombosis and Vascular Biology. 2000,20,1622.12. Persson J, Formgren J, Israelsson B et al. Ultrasound-determined intima-media thickness and atherosclerosis: direct and indirect validation. ArteriosclerThromb 1994,14,261-264.13 Suurkula M, Agewall S, Fagervberg B et al. Ultrasound evaluation of athero-sclerotic manifestations in the carotid artery in high-risk patients. ArteriosclerThromb 1994, 14,1297-1304.14. Ebrahim S, Papacosta O, Whincup P et al. Carotid plaque, intima mediathickness, cardiovascular risk factors and prevalent cardiovascular disease in menand women: the British Regional Heart Study.Stroke,1999,30,841-50.15. Bonithon-Kopp C, Touboul P-J, Berr C et al. Relation of intima media thick-


ening to atherosclerotic plaques in the carotid arteries: the vascular aging (EVA)study. Arterioscler Thromb Vasc Biol 1996,16,310-6.16. Bonithon-Kopp C, Scarabin P, Taquet A et al. Risk factor for early carotidatherosclerosis in middle aged French women. Atheroscler Thromb 1991,11,966-72.17. Bonithon-Kopp C, Jouven X, Taquet A et al. Early carotid atherosclerosis inhealthy middle-aged women: a follow-up study. Stroke,1993,24,1837-43.18. Magyar M, Paragh G, Katona E et al. Serum Cholesterol Have a MoreImportant Role than Triglycerides in Determining Intima-media thickness of theCommon carotid artery in Subjects Younger than 55 Year of Age. J UltrasoundMed 2004,23,1161-69.19. Solonen R, Salonen J. Determinants of carotid intima media thickness: apopulation based ultrasonographic study in Eastern Finnish men. J Int Med1991a,229,225-31.20. Solonen J, Salonen R. Ultrasound B-mode imaging in observational studiesof atherosclerotic progression. Circulation 1993,87,1156-1165. 21. Held C, Hjemdahl P, Eriksson S et al. Prognostic implications of intima-media thickness and plaques in the carotid and femoral arteries in patients withstable angina pectoris. European Heart Journal, 2001,22,62-72.

22. Kablak-Ziembicka A, Przewlocki T, Tracz W et al. Prognostic Value ofCarotid Intima-Media thickness in Detection of Coronary Atherosclerosis inPatients with Calcified Aortic valve Stenosis. J Ultrasound Med 2005,24,461-467.23. Geroulakos G, O’Gorman D, Kalodiki E et al. The carotid intima-mediathickness as a marker of the presence of severe symptomatic coronary artery dis-ease. Eur Heart Journal,1994, 15,781-785. 24. Irace C, Cortese C, Fiaschi E et al. Wall Shear Stress is associated with inti-ma-media thickness and carotid atherosclerosis in subjects at low coronary heartdisease risk. Stroke, 2004, 35, 464-470.

Ä‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËflÑ- Ö. Ç‡ÒËÎÂ‚‡äÎËÌËÍ‡ ÔÓ ÌÂ‚ÓÎÓ„ËflåÅÄã “ñ‡Ëˆ‡ âÓ‡ÌÌ‡”ìÎ. “ÅflÎÓ ÏÓÂ” 8ëÓÙËfl


éË„ËÌ‡ÎÌË ÒÚ‡ÚËËÇãàüçàÖíé çÄ ÇöáêÄëííÄ à ÑêìÉà êàëäéÇà îÄäíéêà áÄåéáöóçéëöÑéÇà áÄÅéãüÇÄçàü Çöêïì ÉéãÖåàçÄíÄ çÄ

àçíàåÄ-åÖÑàü äéåèãÖäëÖ. Ç‡ÒËÎÂ‚‡

äÎËÌËÍ‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl, ìåÅÄã “ñ‡Ëˆ‡ âÓ‡ÌÌ‡” ëÓÙËfl

SUMMARY

RELATIONSHIP BETWEEN CAROTID INTIMA-MEDIA THICKNESS AND

CEREBROVASCULAR RISK FACTORSE. Vasileva

101 patients were included. 202 internal carotid arterieswere examined by color coded duplex sonography. Intima-media thickness, the presence of risk factor (blood pressure,diabetes mellitus, hypercholestereolemia) were evaluated.Mean IMT of the common carotid arteries at plaque-free siteswas evaluated by B-mode ultrasound and correlate with themost common risk factors as well as with age.

With increasement of the age, IMT increases. There was anonlinear increase in mean ITM with increasement of the age.

The patients older than 55 had significantly higher IMT.IMT – in the left common carotid artery was higher than in theright common carotid artery. A significant correlation wasfound between IMT and the presence of diabetes mellitus,arterial hypertension, hypercholesterolemia. Current smokershave higher IMT value than never smokers but the differenceis not significant. There was not difference between IMT inthe group of man and in the woman’s group.

äey words : Intima-media thickness, Doppler sonography,carotid stenosis.

êÖáûåÖ

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êÂÁÛÎÚ‡ÚË ÔÓÍ‡Á‚‡Ú ˜Â Ò Û‚ÂÎË˜‡‚‡ÌÂ Ì‡ ‚˙Á‡ÒÚÚ‡ ÒÂÛ‚ÂÎË˜‡‚‡ Ë IMT. è‡ˆËÂÌÚËÚÂ Ò ‚˙Á‡ÒÚ Ì‡‰ 55 „Ó‰ËÌËËÏ‡Ú ÒË„ÌËÙËÍ‡ÌÚÌÓ ÔÓ-‚ËÒÓÍË ÒÚÓÈÌÓÒÚË Ì‡ IMT Í‡ÍÚÓ‚Îfl‚Ó Ú‡Í‡ Ë ‚ ‰flÒÌÓ. IMT -Îfl‚Ó ËÏ‡ ÒË„ÌËÙËÍ‡ÌÚÌÓ ÔÓ-‚ËÒÓÍ‡ ÒÂ‰Ì‡ ÒÚÓÈÌÓÒÚ ÓÚ IMT -‰flÒÌÓ. àÁÒÎÂ‰‚‡ÌËÚÂËÒÍÓ‚Ë Ù‡ÍÚÓË ‚Ó‰flÚ ‰Ó ÒË„ÌËÙËÍ‡ÌÚÌÓ Û‚ÂÎË˜‡‚‡ÌÂÒÚÓÈÌÓÒÚËÚÂ Ì‡ IMT Í‡ÍÚÓ ‚Îfl‚Ó Ú‡Í‡ Ë ‚‰flÒÌÓ. àÁÍÎ˛-˜ÂÌËÂ Ô‡‚Ë Ú˛Ú˛ÌÓÔÛ¯ÂÌÂÚÓ, ÌÓ Ï‡ÎÍËflÚ ‡ÁÏÂ Ì‡ ÔÓ-

ÎÛ˜ÂÌËÚÂ „ÛÔË ÌÂ ‰‡‚‡ ÓÒÌÓ‚‡ÌËÂ ‰‡ ÒÂ ÒÏflÚ‡, ˜Â ÂÁÛÎÚ‡-ÚËÚÂ ËÏ‡Ú ÒÚ‡ÚËÒÚË˜ÂÒÍ‡ ‰ÓÒÚÓ‚ÂÌÓÒÚ. Ñ‚‡Ú‡ ÔÓÎ‡ÌÂ ÒÂ ‡ÁÎË˜‡‚‡Ú ÒË„ÌËÙËÍ‡ÌÚÌÓ ÔÓ ÔÓÍ‡Á‡ÚÂÎfl IMT.

äÎ˛˜Ó‚Ë ‰ÛÏË ËÌÚËÏ‡-ÏÂ‰Ëfl ÍÓÏÔÎÂÍÒ, ‰ÓÔÎÂÓ‚‡ÒÓÌÓ„‡ÙËfl, Í‡ÓÚË‰ÌË ‡ÚÂËË.

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ëÚ‡ÂÂÌÂÚÓ Ì‡ Ó·˘ËÚÂ Ò˙ÌÌË ‡ÚÂËË Â Ò‚˙Á‡ÌÓ Ò ‡Á-ÎË˜ÌË ÒÚÛÍÚÛÌË, ÙÛÌÍˆËÓÌ‡ÎÌË Ë ıÂÏÓ‰ËÌ‡ÏË˜ÌË ÔÓÏÂ-ÌË: ‡ÚÂË‡ÎÌ‡ ‰ËÎ‡Ú‡ˆËfl (1,2), Ì‡Ï‡Îfl‚‡ÌÂ Ì‡ ÂÎ‡ÒÚË˜ÌË-ÚÂ Ò‚ÓÈÒÚ‚‡ Ì‡ Ò˙‰Ó‚‡Ú‡ ÒÚÂÌ‡, Û‚ÂÎË˜ÂÌ‡ Ò˙‰Ó‚‡ Ë„Ë‰-ÌÓÒÚ (3-5), Á‡‰Â·ÂÎfl‚‡ÌÂ Ì‡ ËÌÚËÏ‡Ú‡ Ë ‰. íÓÁË ÔÓˆÂÒ ÂÔÓ‰ ÌÂÔÂÍ˙ÒÌ‡ÚÓÚÓ ‚˙Á‰ÂÈÒÚ‚ËÂ Ì‡ ‡ÚÂÓÒÍÎÂÓÚË˜ÌËÚÂËÒÍÓ‚Ë Ù‡ÍÚÓË, Ú‡Í‡ ˜Â Â ÚÛ‰ÌÓ Ò ÚÓ˜ÌÓÒÚ ‰‡ ÒÂ ÔÂˆÂ-ÌË ‚˙Á‡ÒÚÓ‚ÓÚÓ ‚ÎËflÌËÂ. Ç˙ÔÂÍË Ò˙˘ÂÒÚ‚Û‚‡˘‡Ú‡ ÏÂÊ-‰Û Úflı ÚflÒÌ‡ ‚˙ÁÍ‡ Ë ÒıÓ‰ÒÚ‚Ó, ‡ÚÂÓÒÍÎÂÓÁ‡Ú‡ Ë ‚˙Á-‡ÒÚÓ‚Ó-Ó·ÛÒÎÓ‚ÂÌ‡Ú‡ “‡ÚÂËÓÔ‡ÚËfl” Ò‡ ‰‚‡ ‡ÁÎË˜ÌË ÙÂ-ÌÓÏÂÌ‡ (6). ç‡ÎË˜ËÂÚÓ Ì‡ ‚˙ÁÍ‡ ÏÂÊ‰Û „ÓÎÂÏËÌ‡Ú‡ Ì‡ ËÌ-ÚËÏ‡ - ÏÂ‰Ëfl ÍÓÏÔÎÂÍÒ (intima media thickness, IMT) Ë Í‡Ó-ÚË‰Ì‡Ú‡ ‡ÚÂÓÒÍÎÂÓÁ‡ ÌÂ ÓÁÌ‡˜‡‚‡ ˜Â ‚ÒË˜ÍË ÍÓÏÔÓÌÂÌÚËÌ‡ Û‚ÂÎË˜ÂÌËfl IMí Ò‡ ÂÁÛÎÚ‡Ú Ì‡ ‡ÚÂÓÒÍÎÂÓÚË˜ÌËfl ÔÓ-ˆÂÒ, ÍÓÈÚÓ Â ÏËÎÚËÙ‡ÍÚÓÌÓ Ó·ÛÒÎÓ‚ÂÌ.

ç‡ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡ÌÂ ËÏ‡ Á‡ ˆÂÎ ‰‡ ÔÓÒÎÂ‰Ë ‚ÎËfl-ÌËÂÚÓ Ì‡ ÌflÍÓË ÓÚ Ì‡È-ÔÓÔÛÎflÌËÚÂ ËÒÍÓ‚Ë Ù‡ÍÚÓË Á‡åëÅ – ‚˙Á‡ÒÚ, ÔÓÎ, ‡ÚÂË‡ÎÌ‡ ıËÔÂÚÓÌËfl, ıËÔÂıÓ-ÎÂÒÚÂÓÎÂÏËfl, Ú˛Ú˛ÌÓÔÛ¯ÂÌÂ Ë ‰Ë‡·ÂÚ ‚˙ıÛ „ÓÎÂÏË-Ì‡Ú‡ Ì‡ IMT, ËÁÏÂÂÌ Ì‡ Ó·˘‡Ú‡ Ò˙ÌÌ‡ ‡ÚÂËfl.


ç‡Ô‡‚ÂÌÓÚÓ ÔÓÒÔÂÍÚË‚ÌÓ ÍÎËÌËÍÓ-ÂÔË‰ÂÏËÓÎÓ„Ë˜-ÌÓ ÔÓÛ˜‚‡ÌÂ Ó·ı‚‡˘‡ 101 Ô‡ˆËÂÌÚË - 63 (62,38%) Ï˙ÊÂË 38 (37,62%) ÊÂÌË. ëÂ‰Ì‡Ú‡ ‚˙Á‡ÒÚ Ì‡ ËÁÒÎÂ‰‚‡ÌËflÍÓÌÚËÌ„ÂÌÚ Â 60,91±13,07 „. ‚ ‰Ë‡Ô‡ÁÓÌ‡ 20-80 „Ó‰ËÌË.

ÖÍÒÚ‡Í‡ÌË‡ÎÌËÚÂ ÏÓÁ˙˜ÌË ‡ÚÂËË Ì‡ ‚ÒË˜ÍË Ô‡ˆËÂÌ-ÚË Ò‡ ËÁÒÎÂ‰‚‡ÌË Ò ˆ‚ÂÚÌ‡ ‰ÛÔÎÂÍÒ ‰ÓÔÎÂÓ‚‡ ÒÓÌÓ„‡ÙËfl(Agilent tehnology) Ò 5 ËÎË 7 MHz Ú‡ÌÒ‰˛ÒÂ. Ç ÔÓÒÎÂ‰‚‡˘Ëfl‡Ì‡ÎËÁ Ò‡ ‚ÍÎ˛˜ÂÌË ‰‡ÌÌËÚÂ ÓÚ 202 Ó·˘Ë Ò˙ÌÌË ‡ÚÂËË.àÁÏÂÂÌ Â IMT Ì‡ Ó·˘‡Ú‡ Ò˙ÌÌ‡ ‡ÚÂËfl- ‡ÁÒÚÓflÌËÂÚÓÏÂÊ‰Û ÔÂ‰ÌËfl ˙· Ì‡ Ô˙‚‡Ú‡ Ò‚ÂÚÎ‡ ÎËÌËfl (ÎÛÏÂÌ – ËÌÚË-Ï‡ ÔÓ‚˙ıÌÓÒÚ) Ë ÔÂ‰ÌËfl ˙· Ì‡ ‚ÚÓ‡Ú‡ Ò‚ÂÚÎ‡ Ë‚Ëˆ‡ (ÏÂ-‰Ëfl-‡‰‚ÂÌÚËˆËfl „‡ÌËˆ‡). IMT Ì‡ Ó·˘‡Ú‡ Ò˙ÌÌ‡ ‡ÚÂËfl ÂËÁÏÂÂÌ ‚ Ò‚Ó·Ó‰ÌËÚÂ ÓÚ ÔÎ‡ÍË Û˜‡ÒÚ˙ˆË, ̃ ÂÁ ÔÓÁËˆËÓÌË‡-

ÌÂ Ì‡ ÍÛÒÓ‡. íÓ Â ÓÒ˙˘ÂÒÚ‚ÂÌÓ Ì‡ ÌflÍÓÎÍÓ ÏÂÒÚ‡ (Ì‡È-Ï‡Î-ÍÓ 5), Ì‡ 1 ÒÏ ÓÚ ·ËÙÛÍ‡ˆËflÚ‡, ÔÓ ‰‡ÎÂ˜Ì‡Ú‡ ÔÓ‚˙ıÌÓÒÚ,Í‡ÚÓ Á‡ ÓÍÓÌ˜‡ÚÂÎÌ‡ ÒÚÓÈÌÓÒÚ ÒÂ ÔËÂÏ‡ ÒÚÓÈÌÓÒÚÚ‡ ÍÓfl-ÚÓ Â ÒÂ‰ÌÓ ‡ËÚÏÂÚË˜ÌÓ Ì‡ ‚ÒË˜ÍË ËÁÏÂ‚‡ÌËfl.

Ñ‡ÌÌËÚÂ Ò‡ ‚˙‚Â‰ÂÌË Ë Ó·‡·ÓÚÂÌË Ò˙Ò ÒÚ‡ÚËÒÚË˜ÂÒ-ÍËfl Ô‡ÍÂÚ SPSS 12.0.1. á‡ ÌË‚Ó Ì‡ ÁÌ‡˜ËÏÓÒÚ, ÔË ÍÓÂÚÓÒÂ ÓÚı‚˙Îfl ÌÛÎÂ‚‡Ú‡ ıËÔÓÚÂÁ‡ Â ËÁ·‡ÌÓ p < 0,05. èË-ÎÓÊÂÌË Ò‡ ÒÎÂ‰ÌËÚÂ ÏÂÚÓ‰Ë: ‰ÂÒÍËÔÚË‚ÂÌ ‡Ì‡ÎËÁ, ‚‡Ë-‡ˆËÓÌÂÌ ‡Ì‡ÎËÁ, „‡ÙË˜ÂÌ ‡Ì‡ÎËÁ, Â‰ÌÓËÁ‚‡‰ÍÓ‚ ÏÂÚÓ‰ Ì‡äÓÎÏÓ„ÓÓ‚-ëÏËÌÓ‚, t-ÚÂÒÚ Ì‡ ëÚ˛‰ÂÌÚ, ÌÂÎËÌÂÂÌ Â‰-ÌÓÙ‡ÍÚÓÂÌ Â„ÂÒËÓÌÂÌ ‡Ì‡ÎËÁ.

ÑÂÒÍËÔÚË‚ÂÌ ‡Ì‡ÎËÁ – ‚ Ú‡·ÎË˜ÂÌ ‚Ë‰ Â ÔÂ‰ÒÚ‡‚Â-ÌÓ ˜ÂÒÚÓÚÌÓÚÓ ‡ÁÔÂ‰ÂÎÂÌËÂ Ì‡ ‡Á„ÎÂÊ‰‡ÌËÚÂ ÔËÁÌ‡-ˆË, ‡Á·ËÚË ÔÓ „ÛÔË Ì‡ ËÁÒÎÂ‰‚‡ÌÂ. Ç‡Ë‡ˆËÓÌÂÌ ‡Ì‡ÎËÁ– ËÁ˜ËÒÎfl‚‡ÌÂ ÓˆÂÌÍËÚÂ Ì‡ ˆÂÌÚ‡ÎÌ‡Ú‡ ÚÂÌ‰ÂÌˆËfl Ë‡ÁÒÂÈ‚‡ÌÂ. É‡ÙË˜ÂÌ ‡Ì‡ÎËÁ – Á‡ ‚ËÁÛ‡ÎËÁ‡ˆËfl Ì‡ ÔÓÎÛ-˜ÂÌËÚÂ ÂÁÛÎÚ‡ÚË. Ö‰ÌÓËÁ‚‡‰ÍÓ‚ ÏÂÚÓ‰ Ì‡ äÓÎÏÓ„Ó-Ó‚-ëÏËÌÓ‚ – Á‡ ÓÔÂ‰ÂÎflÌÂ ‚Ë‰‡ Ì‡ ‡ÁÔÂ‰ÂÎÂÌËÂÚÓ.è‡‡ÏÂÚË˜ÂÌ í-ÚÂÒÚ Ì‡ ëÚ˛‰ÂÌÚ Á‡ ÔÓ‚ÂÍ‡ Ì‡ıËÔÓÚÂÁË Á‡ ‡ÁÎË˜ËÂ ÏÂÊ‰Û ÒÂ‰ÌËÚÂ ‡ËÚÏÂÚË˜ÌË Ì‡‰‚Â ÌÂÁ‡‚ËÒËÏË ËÁ‚‡‰ÍË. çÂÎËÌÂÂÌ Â‰ÌÓÙ‡ÍÚÓÂÌ Â„Â-ÒËÓÌÂÌ ‡Ì‡ÎËÁ Á‡ ÔÓ‚ÂÍ‡ Ì‡ÎË˜ËÂÚÓ Ì‡ Á‡‚ËÒËÏÓÒÚÏÂÊ‰Û ‰‚‡ ÏÂÚË‡ÌË ÔËÁÌ‡Í‡.

êÖáìãíÄíàáÄÇàëàåéëí çÄ IMT - ãüÇé éí ÇöáêÄëííÄ

èÓ‚Â‰ÂÌËflÚ ÌÂÎËÌÂÂÌ Â„ÂÒËÓÌÂÌ ‡Ì‡ÎËÁ ÛÒÚ‡ÌÓ‚Ë,˜Â ÓÚ ‚„‡‰ÂÌËÚÂ ‚ SPSS 12.0.1. ÏÓ‰ÂÎË, Á‡‚ËÒËÏÓÒÚÚ‡Ì‡ IMT -Îfl‚Ó Ò ‚˙Á‡ÒÚÚ‡ ÒÂ ÓÔËÒ‚‡ Ì‡È-‰Ó·Â ÓÚ ÂÍÒÔÓ-

ÌÂÌˆË‡ÎÂÌ ÏÓ‰ÂÎ (p<0.001, F=50.17, R2=0.336) Ò˙Ò ÒÎÂ‰ÌË-ÚÂ Ô‡‡ÏÂÚË:

IMT-L = 0.288*e0.015AGE

Í˙‰ÂÚÓ IMT-L Â IMT -Îfl‚Ó, ‡ AGE Â ‚˙Á‡ÒÚÚ‡ Ì‡Û˜‡ÒÚÌËˆËÚÂ ‚ ËÁ‚‡‰Í‡Ú‡. éÚ ÙË„. 1 ÒÂ ‚ËÊ‰‡, ˜Â Ò Û‚Â-ÎË˜‡‚‡ÌÂ Ì‡ ‚˙Á‡ÒÚÚ‡ ÒÂ Û‚ÂÎË˜‡‚‡ Ë IMT -Îfl‚Ó. ä‡ÚÓÔÂÎÓÏÌ‡ ÚÓ˜Í‡ ÏÓÊÂ ‰‡ ÒÂ ÔËÂÏÂ ‚˙Á‡ÒÚÚ‡ 55 „Ó‰ËÌË,ÒÎÂ‰ ÍÓÂÚÓ ÍË‚‡Ú‡ Ì‡ IMT -Îfl‚Ó Ì‡‡ÒÚ‚‡ ÔÓ-ÒÚ˙ÏÌÓ.

áÄÇàëàåéëí çÄ IMT -Ñüëçé éí ÇöáêÄëííÄ

èÓ‚Â‰ÂÌËflÚ ÌÂÎËÌÂÂÌ Â„ÂÒËÓÌÂÌ ‡Ì‡ÎËÁ ÛÒÚ‡ÌÓ‚Ë,˜Â ÓÚ ‚„‡‰ÂÌËÚÂ ‚ SPSS 12.0.1. ÏÓ‰ÂÎË, Á‡‚ËÒËÏÓÒÚÚ‡Ì‡ IMT -‰flÒÌÓ Ò ‚˙Á‡ÒÚÚ‡ Ò˙˘Ó ÒÂ ÓÔËÒ‚‡ Ì‡È-‰Ó·Â ÓÚÂÍÒÔÓÌÂÌˆË‡ÎÂÌ ÏÓ‰ÂÎ (p<0.001, F=50.17, R2=0.336) Ò˙Ò ÒÎÂ‰ÌËÚÂ Ô‡‡ÏÂÚË:

IMT-L = 0.288*e0.015AGE

Í˙‰ÂÚÓ IMT-L Â IMT-Îfl‚Ó, ‡ AGE Â ‚˙Á‡ÒÚÚ‡ Ì‡Û˜‡ÒÚÌËˆËÚÂ ‚ ËÁ‚‡‰Í‡Ú‡. éÚ ÙË„. 2 ÒÂ ‚ËÊ‰‡, ˜Â ÒÛ‚ÂÎË˜‡‚‡ÌÂ Ì‡ ‚˙Á‡ÒÚÚ‡ ÒÂ Û‚ÂÎË˜‡‚‡ Ë IMT -‰flÒÌÓ.ä‡ÚÓ ÔÂÎÓÏÌ‡ ÚÓ˜Í‡ ÓÚÌÓ‚Ó ÏÓÊÂ ‰‡ ÒÂ ÔËÂÏÂ‚˙Á‡ÒÚÚ‡ 55 „Ó‰ËÌË, ÒÎÂ‰ ÍÓÂÚÓ ÍË‚‡Ú‡ Ì‡ IMT-‰flÒÌÓÌ‡‡ÒÚ‚‡ ÔÓ-ÒÚ˙ÏÌÓ.

Ç˙Á ÓÒÌÓ‚‡ Ì‡ ÔÓÎÛ˜ÂÌËÚÂ ÂÁÛÎÚ‡ÚË ÓÚ Â„ÂÒËÓÌÌËfl‡Ì‡ÎËÁ ‚˙Á‡ÒÚÚ‡ Ì‡ Ô‡ˆËÂÌÚËÚÂ ·Â ‡Á·ËÚ‡ Ì‡ ‰‚Â „ÛÔË– ‰Ó 55 Ë Ì‡‰ 55 „Ó‰ËÌË. éÚ Ú‡·Î. 2 ÒÂ ‚ËÊ‰‡, ˜Â Ô‡ˆËÂÌ-ÚËÚÂ Ò ‚˙Á‡ÒÚ Ì‡‰ 55 „Ó‰ËÌË ËÏ‡Ú ÒË„ÌËÙËÍ‡ÌÚÌÓ ÔÓ-‚ËÒÓÍË ÒÚÓÈÌÓÒÚË Ì‡ IMT Í‡ÍÚÓ ‚Îfl‚Ó Ú‡Í‡ Ë ‚ ‰flÒÌÓ.

éÚ Ú‡·Î. 3 ÒÂ ‚ËÊ‰‡, ˜Â IMT -Îfl‚Ó ËÏ‡ ÒË„ÌËÙËÍ‡ÌÚÌÓÔÓ-‚ËÒÓÍ‡ ÒÂ‰Ì‡ ÒÚÓÈÌÓÒÚ ÓÚ IMT -‰flÒÌÓ.


í‡·ÎËˆ‡ 1 ë‡‚ÌËÚÂÎÂÌ ‡Ì‡ÎËÁ Ì‡ IMT ÔË ‰‚ÂÚÂ ‚˙Á‡ÒÚÓ‚Ë „ÛÔË

Ç˙Á‡ÒÚèÓÍ‡Á‡ÚÂÎ ÑÓ 50„. ç‡‰ 50„.

N X SD N X SD êIMT -Îfl‚Ó 32 0,59 0,20 69 0,81 0,23 <0,001

IMT -‰flÒÌÓ 32 0,54 0,17 69 0,78 0,24 <0,001

í‡·ÎËˆ‡ 2 ë‡‚ÌËÚÂÎÂÌ ‡Ì‡ÎËÁ Ì‡ IMT -Îfl‚Ó Ë IMT -‰flÒÌÓ

èÓÍ‡Á‡ÚÂÎ ãfl‚Ó ÑflÒÌÓN X SD N X SD ê

IMT 101 0,74 0,25 101 0,70 0,25 0,003

îË„Û‡ 1 êÂ„ÂÒËÓÌÂÌ ÏÓ‰ÂÎ Ì‡ Á‡‚ËÒËÏÓÒÚÚ‡ ÏÂÊ‰Û IMT -Îfl‚Ó Ë‚˙Á‡ÒÚÚ‡

0 30 20 40 60 70 80Ç˙Á‡ÒÚ („Ó‰ËÌË)

IMT-L

1,75

1,50

1,25

1

0,75

0,50

0,25


îË„Û‡ 2 êÂ„ÂÒËÓÌÂÌ ÏÓ‰ÂÎ Ì‡ Á‡‚ËÒËÏÓÒÚÚ‡ ÏÂÊ‰Û IMT -‰flÒÌÓ Ë‚˙Á‡ÒÚÚ‡

0 30 20 40 60 70 80

IMT-R

1,75

1,50

1,25

1

0,75

0,50

0,25


éÚ Ú‡·Î. 1 ÒÂ ‚ËÊ‰‡, ̃ Â ‰‚‡Ú‡ ÔÓÎ‡ ÌÂ ÒÂ ‡ÁÎË˜‡‚‡Ú ÒË„-ÌËÙËÍ‡ÌÚÌÓ ÔÓ ÔÓÍ‡Á‡ÚÂÎfl IMT -Îfl‚Ó Ë IMT -‰flÒÌÓ. íÓ‚‡ÓÁÌ‡˜‡‚‡, ˜Â Ù‡ÍÚÓ˙Ú ÔÓÎ ÌÂ ÓÍ‡Á‚‡ ‚ÎËflÌËÂ ‚˙ıÛ IMT.

éÚ Ú‡·Î. 4 Ë 5 ÒÂ ‚ËÊ‰‡, ˜Â ËÁÒÎÂ‰‚‡ÌËÚÂ ËÒÍÓ‚ËÙ‡ÍÚÓË ‚Ó‰flÚ ‰Ó ÒË„ÌËÙËÍ‡ÌÚÌÓ Û‚ÂÎË˜‡‚‡ÌÂ ÒÚÓÈÌÓÒ-ÚËÚÂ Ì‡ IMT Í‡ÍÚÓ ‚Îfl‚Ó Ú‡Í‡ Ë ‚‰flÒÌÓ. àÁÍÎ˛˜ÂÌËÂÔ‡‚Ë Ú˛Ú˛ÌÓÔÛ¯ÂÌÂÚÓ, ÌÓ Ï‡ÎÍËflÚ ‡ÁÏÂ Ì‡ ÔÓÎÛ˜Â-ÌËÚÂ „ÛÔË ÌÂ ‰‡‚‡ ÓÒÌÓ‚‡ÌËÂ ‰‡ ÒÂ ÒÏflÚ‡, ˜Â ÂÁÛÎÚ‡ÚË-ÚÂ ËÏ‡Ú ÒÚ‡ÚËÒÚË˜ÂÒÍ‡ ‰ÓÒÚÓ‚ÂÌÓÒÚ.

éÅëöÜÑÄçÖ

Ñ‡ÌÌËÚÂ ÓÚ ÔÓ‚Â‰ÂÌÓÚÓ ÔÓÛ˜‚‡ÌÂ ÔÓÍ‡Á‚‡Ú ˜Â Ì‡-‡ÒÚ‚‡ÌÂÚÓ Ì‡ IMT Â ‚˙Á‡ÒÚÓ‚Ó Ó·ÛÒÎÓ‚ÂÌÓ. ÑÓÍ‡ÚÓÒÂ‰Ì‡Ú‡ ‰Â·ÂÎËÌ‡ Ì‡ IMT ‚˙‚ ‚˙Á‡ÒÚÓ‚‡Ú‡ „‡ÌËˆ‡ 20-40 „Ó‰ËÌË Â 0,35 mm, ÚÓ ÒÂ‰Ì‡Ú‡ IMT ‰Â·ÂÎËÌ‡ ÔË Ô‡-ˆËÂÌÚËÚÂ ÓÚ 70 ‰Ó 80 „Ó‰ËÌË Â 0,90 mm.

Schmidt-Trucksass Ä. et al (7) Ò˙Ó·˘‡‚‡Ú 40,4% ‡ÁÎË-Í‡ ÏÂÊ‰Û IMT ÔË 20 „Ó‰Ë¯ÌË (0,52 mm) Ë 60 „Ó‰Ë¯ÌË(0,73 mm). ëÔÓÂ‰ ‰‡ÌÌËÚÂ Ì‡ Howard G. et al (8) IMT ÔË60 „Ó‰Ë¯ÌË Â ÓÍÓÎÓ 0,73 mm, ‡ ÒÔÓÂ‰ Persson J. et al (9)Úfl Â 0,73 +0,13 mm. ëÂ‰Ì‡Ú‡ ‰Â·ÂÎËÌ‡ Ì‡ IMT ÔË Ô‡ˆË-ÂÌÚËÚÂ Ì‡ Ú‡ÁË ‚˙Á‡ÒÚ ‚ Ì‡ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡ÌÂ ÂÒ‡‚ÌËÏ‡ Ò ÚflıÌËÚÂ ‰‡ÌÌË - 0,7 mm.

ç‡·Î˛‰‡‚‡ ÒÂ ÌÂÎËÌÂÈÌÓ Ì‡‡ÒÚ‚‡ÌÂ Ì‡ IMT Ò Ì‡‡ÒÚ-‚‡ÌÂ Ì‡ ‚˙Á‡ÒÚÚ‡. ç‡ÎËˆÂ Â ‡ÁÎËÍ‡ ‚ ÒÍÓÓÒÚÚ‡ Ì‡ Ì‡-‡ÒÚ‚‡ÌÂ Ì‡ IMT, Í‡ÚÓ Úfl ÒÂ Û‚ÂÎË˜‡‚‡ Ò˙Ò ÁÌ‡˜ËÚÂÎÌÓÔÓ-„ÓÎflÏ‡ ÒÍÓÓÒÚ ÔË Ô‡ˆËÂÌÚËÚÂ Ì‡‰ 55 „Ó‰Ë¯Ì‡ ‚˙Á-‡ÒÚ. íÓÁË Ù‡ÍÚ ÏÓÊÂ ‰‡ ÒÂ Ó·flÒÌË Ò ÍÓÏ·ËÌË‡ÌÓÚÓ‚ÎËflÌËÂ Ì‡ ‡ÁÎË˜ÌË ËÒÍÓ‚Ë Ù‡ÍÚÓË ÒÎÂ‰ Ú‡ÁË „‡ÌË˜Ì‡‚˙Á‡ÒÚ Ë Â ËÌ‰ËÂÍÚÌÓ ‰ÓÍ‡Á‡ÚÂÎÒÚ‚Ó ˜Â Ì‡‡ÒÚ‚‡ÌÂ-ÚÓ Ì‡ IMT ÌÂ Â Ò‡ÏÓ ‚˙Á‡ÒÚÓ‚Ó Ó·ÛÒÎÓ‚ÂÌ ÔÓˆÂÒ. ÇÂÓ-flÚÌÓ ÚÓ Â Ò‚˙Á‡ÌÓ Ò ‚ÎËflÌËÂÚÓ Ì‡ ‡ÁÎË˜ÌË ‰Û„Ë Ù‡Í-ÚÓË ‚ÍÎ˛˜ËÚÂÎÌÓ ‡ÚÂÓÒÍÎÂÓÚË˜ÌËfl ÔÓˆÂÒ. èÓ ‡Û-ÚÓÔÒËÓÌÌË ‰‡ÌÌË ÒÂ‰ÌÓÚÓ ‡ÓÚÌÓ ËÌÚËÏ‡ÎÌÓ Á‡‰Â·ÂÎfl-‚‡ÌÂ Ò˙˘Ó ÒÂ Û‚ÂÎË˜‡‚‡ Ò ‚˙Á‡ÒÚÚ‡, ÓÒÓ·ÂÌÓ ‚ ¯ÂÒÚÓÚÓ‰ÂÒÂÚËÎÂÚËÂ, ÍÓ„‡ÚÓ Á‡ÔÓ˜‚‡Ú ‰‡ ÒÂ ÔÓfl‚fl‚‡Ú ÔÓ-ÁÌ‡˜Ë-

ÏË ÎÂÁËË Í‡ÚÓ ÔÂ‡ÚÂÓÏ‡ÚÓÁ‡ Ë ‡ÚÂÓÏ‡ÚÓÁ‡ (10). èÓ-‰Ó·ÌÓ Ì‡ Ì‡Ò ÌflÍÓÎÍÓ ‰Û„Ë ÔÓÛ˜‚‡ÌËfl ÛÒÚ‡ÌÓ‚fl‚‡Ú ÌÂ-ÎËÌÂÈÌÓ Ì‡‡ÒÚ‚‡ÌÂ Ì‡ IMT Ò ‚˙Á‡ÒÚÚ‡ (11-13). ï‡‡Í-ÚÂÌÓ Á‡ Úflı Â ˜Â ÚÂ ‚ÍÎ˛˜‚‡Ú Ë ÒÚÓÈÌÓÒÚË Ì‡ IMT, ËÁ-ÏÂÂÌË ‚ Û˜‡ÒÚ˙ˆË Ò ‡ÚÂÓÒÍÎÂÓÚË˜ÌË ÔÎ‡ÍË.

äÓ„‡ÚÓ Ó·‡˜Â ÒÂ Ì‡Ô‡‚Ë ÍÓÂÎ‡ˆËfl ÏÂÊ‰Û IMT Ë ‚˙Á-‡ÒÚÚ‡ ‚ ÍÓÌÚËÌ„ÂÌÚ Ò‡ÏÓ ÓÚ Á‰‡‚Ë Ô‡ˆËÂÌÚË ·ÂÁ‡ÚÂÓÒÍÎÂÓÚË˜ÌË ÔÎ‡ÍË Ë ·ÂÁ ËÒÍÓ‚Ë Ù‡ÍÚÓË ÒÂ ÛÒÚ‡-ÌÓ‚fl‚‡ ÎËÌÂÈÌÓ Ì‡‡ÒÚ‚‡ÌÂ Ì‡ IMT Ò ‚˙Á‡ÒÚÚ‡ (14).Homma et al (14) Ò˜ËÚ‡Ú ÎËÌÂÈÌÓÚÓ Ì‡‡ÒÚ‚‡ÌÂ Ì‡ IMTÒ ‚˙Á‡ÒÚÚ‡ Á‡ ÙËÁËÓÎÓ„Ë˜ÂÌ ÔÓˆÂÒ. ì‚ÂÎË˜‡‚‡ÌÂÚÓ Ì‡IMT Ò Ì‡ÔÂ‰‚‡ÌÂ Ì‡ ‚˙Á‡ÒÚÚ‡ ÔË Ô‡ˆËÂÌÚË ·ÂÁ ËÒÍÓ-‚Ë Ù‡ÍÚÓË Á‡ åëÅ Ë ·ÂÁ ÍÎËÌË˜ÌË ‰‡ÌÌË Á‡ ‡ÚÂÓÒÍÎÂ-ÓÁ‡ Ó·‡˜Â ÌÂ ËÁÍÎ˛˜‚‡ ‚˙ÁÏÓÊÌÓÒÚÚ‡ Á‡ Ò˙˘ÂÒÚ‚Û‚‡ÌÂ-ÚÓ Ì‡ ÒÛ·ÍÎËÌË˜Ì‡ ‡ÚÂÓÒÍÎÂÓÁ‡.

Ç˙Á‡ÒÚÓ‚Ó Ó·ÛÒÎÓ‚ÂÌ‡ Â Ë ÔÓfl‚‡Ú‡ Ì‡ ‡ÚÂÓÒÍÎÂÓ-ÚË˜ÌË ÔÎ‡ÍË. ÑÓÍ‡Á‡ÌÓ Â ˜Â Ë ‰‚‡Ú‡ ÔÓˆÂÒ‡ ÒÂ ÛÒÍÓfl‚‡ÚÓÚ ÒıÓ‰ÌË Ù‡ÍÚÓË, ‚˙ÔÂÍË ˜Â ÌÂ ‚ÒË˜ÍË Ù‡ÍÚÓË, ÓÚÍÓËÚÓ Á‡‚ËÒË ÔÓfl‚‡Ú‡ Ë ‡Á‚ËÚËÂÚÓ Ì‡ ‡ÚÂÓÒÍÎÂÓÁ‡‚ÎËflflÚ ‚˙ıÛ Û‚ÂÎË˜‡‚‡ÌÂÚÓ Ì‡ IMT.

Ç Ì‡ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡ÌÂ ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡ ÒË„ÌËÙËÍ‡-ÌÚÌ‡ ‡ÁÎËÍ‡ ÏÂÊ‰Û IMT ‚ Îfl‚‡ Ë ‰flÒÌ‡ Ó·˘‡ Ò˙ÌÌ‡ ‡-ÚÂËfl, ÍÓÂÚÓ ÔÓÒÚ‡‚fl ‚˙ÔÓÒ‡ Á‡ Ì‡ÎË˜ËÂ Ì‡ ÔÂ‰ËÎÂÍˆËfl‚ ‡Á‚ËÚËÂÚÓ Ì‡ ÚÓÁË ÔÓˆÂÒ. í‡Í‡‚‡ ‡ÁÎËÍ‡ Â Á‡·ÂÎflÁ‡-Ì‡ Ë ÓÚ ‰Û„Ë ‡‚ÚÓË (15), ‚˙ÔÂÍË ˜Â fl‰ÍÓ ÒÂ ‰ÓÍÎ‡‰‚‡ÓÚ‰ÂÎÌÓ Á‡ Îfl‚‡ Ë ‰flÒÌ‡ ÒÚ‡Ì‡ ÒÚÓÈÌÓÒÚËÚÂ Ì‡ IMT.é·ËÍÌÓ‚ÂÌÓ ÒÂ ËÁÔÓÎÁ‚‡ ÒÂ‰Ì‡Ú‡ ÒÚÓÈÌÓÒÚ. Ç˙ÔÂÍË ˜ÂÍÎËÌË˜ÌÓÚÓ ÁÌ‡˜ÂÌËÂ Ì‡ ÚÓÁË ÙÂÌÓÏÂÌ ÌÂ Â flÒÌÓ, ‡ÁÎËÍ‡-Ú‡ Úfl·‚‡ ‰‡ ÒÂ ËÏ‡ ÔÂ‰‚Ë‰ ÔË ÓˆÂÌÍ‡ ‚˙ÁÍ‡Ú‡ ÏÂÊ-‰Û IMT Ë Ò˙‰Â˜ÌÓÒ˙‰Ó‚Ë Á‡·ÓÎfl‚‡ÌËfl..

èË ¯ËÓÍÓ ÔÓÛ˜‚‡ÌÂ Ì‡ ‚˙ÁÍ‡Ú‡ ÏÂÊ‰Û IMT Ë ËÒ-ÍÓ‚ËÚÂ Ù‡ÍÚÓË Á‡ åëÅ, ÒÂ ÓÍ‡Á‡ ˜Â ÌflÍÓË ËÒÍÓ‚Ë Ù‡Í-ÚÓË ÒÂ Ò‚˙Á‚‡Ú Ò‡ÏÓ Ò˙Ò Á‡‰Â·ÂÎfl‚‡ÌÂ Ì‡ IMT, ‡ ‰Û„Ë– Ò‡ÏÓ Ò Ó·‡ÁÛ‚‡ÌÂ Ì‡ ‡ÚÂÓÒÍÎÂÓÚË˜ÌË ÔÎ‡ÍË. í‡Í‡Ì‡ÔËÏÂ Ì‡ÎË˜ËÂÚÓ Ì‡ Ù‡ÏËÎÌ‡ ‡Ì‡ÏÌÂÁ‡ Á‡ ÔÂÊ‰Â‚Â-ÏÂÌÌ‡ ÒÏ˙Ú ÓÚ Ò˙‰Â˜ÌÓÒ˙‰Ó‚Ë Á‡·ÓÎfl‚‡ÌËfl ÌflÏ‡ ‚˙Á-


í‡·ÎËˆ‡ 3 ë‡‚ÌËÚÂÎÂÌ ‡Ì‡ÎËÁ Ì‡ IMT ÔË ‰‚‡Ú‡ ÔÓÎ‡

èÓÎèÓÍ‡Á‡ÚÂÎ å˙ÊÂ ÜÂÌË

N X SD N X SD êIMT -Îfl‚Ó 63 0,74 0,24 38 0,76 0,26 n.s.

IMT -‰flÒÌÓ 63 0,71 0,23 38 0,69 0,27 n.s.

í‡·ÎËˆ‡ 4 ë‡‚ÌËÚÂÎÂÌ ‡Ì‡ÎËÁ Ì‡ IMT -Îfl‚Ó ÒÔÓÂ‰ Ì‡ÎË˜ËÂÚÓ ËÎË ÓÚÒ˙ÒÚ‚ËÂÚÓ Ì‡ ËÁÒÎÂ‰‚‡ÌËÚÂ ËÒÍÓ‚Ë Ù‡ÍÚÓË

èÓÍ‡Á‡ÚÂÎ çÂ Ñ‡N X SD N X SD ê

ËÔÂıÓÎÂÒÚÂÓÎÂÏËfl 59 0,64 0,19 42 0,89 0,25 <0,001

ÄÚÂË‡ÎÌ‡ ıËÔÂÚÓÌËfl 50 0,61 0,18 51 0,87 0,24 <0,001

ÑË‡·ÂÚ 84 0,69 0,21 17 1,00 0,25 <0,001

í˛Ú˛ÌÓÔÛ¯ÂÌÂ 94 0,74 0,25 7 0,84 0,24 n.s.

í‡·ÎËˆ‡ 5 ë‡‚ÌËÚÂÎÂÌ ‡Ì‡ÎËÁ Ì‡ IMT -‰flÒÌÓ ÒÔÓÂ‰ Ì‡ÎË˜ËÂÚÓ ËÎË ÓÚÒ˙ÒÚ‚ËÂÚÓ Ì‡ ËÁÒÎÂ‰‚‡ÌËÚÂ ËÒÍÓ‚Ë Ù‡ÍÚÓË

èÓÍ‡Á‡ÚÂÎ çÂ Ñ‡N X SD N X SD ê

ïËÔÂıÓÎÂÒÚÂÓÎÂÏËfl 59 0,62 0,19 42 0,82 0,27 <0,001

ÄÚÂË‡ÎÌ‡ ıËÔÂÚÓÌËfl 50 0,57 0,17 51 0,83 0,25 <0,001

ÑË‡·ÂÚ 84 0,65 0,21 17 0,96 0,26 <0,001

í˛Ú˛ÌÓÔÛ¯ÂÌÂ 94 0,70 0,24 7 0,74 0,30 n.s.

Í‡ Ò Û‚ÂÎË˜ÂÌËÂÚÓ Ì‡ IMT, ÌÓ ÍÓÂÎË‡ Ò Ì‡ÎË˜ËÂÚÓ Ì‡ Í‡-ÓÚË‰ÌË ÔÎ‡ÍË (16). íÓ‚‡ ÓÁÌ‡˜‡‚‡, ˜Â Ì‡È-‚ÂÓflÚÌÓ Ìfl-ÍÓË Ì‡ÒÎÂ‰ÒÚ‚ÂÌË Ù‡ÍÚÓË ÏÓ„‡Ú ‰‡ ·˙‰‡Ú Ò‚˙Á‡ÌË Ò‡-ÏÓ Ò ÔÎ‡ÍÓ‚‡Ú‡ ÙÓÏ‡ˆËfl, ÌÓ ÌÂ Ë Ò˙Ò Á‡‰Â·ÂÎfl‚‡ÌÂÚÓ Ì‡IMT. éÒ‚ÂÌ ÚÓ‚‡ „ÓÎÂÏËÌ‡Ú‡ Ì‡ ‡ÚÂÓÒÍÎÂÓÚË˜ÌËÚÂÔÎ‡ÍË ÍÓÂÎË‡ ÔÓ-‰Ó·Â Ò Ì‡ÎË˜ËÂÚÓ Ì‡ ‡ÁÎË˜ÌË ÍÎËÌË˜-ÌË ‡ÚÂÓÒÍÎÂÓÚË˜ÌË ÔÓfl‚Ë ÓÚÍÓÎÍÓÚÓ IMT.

Ç Ì‡ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡ÌÂ Â ËÁÒÎÂ‰‚‡ÌÓ ‚ÎËflÌËÂÚÓ Ì‡ÌflÍÓË ÓÚ Ì‡È-‡ÁÔÓÒÚ‡ÌÂÌËÚÂ ËÒÍÓ‚Ë Ù‡ÍÚÓË ‚˙ıÛIMT – ‡ÚÂË‡ÎÌ‡ ıËÔÂÚÓÌËfl, ıËÔÂıÓÎÂÒÚÂÓÎÂÏËfl,Á‡ı‡ÂÌ ‰Ë‡·ÂÚ, Ú˛Ú˛ÌÓÔÛ¯ÂÌÂ.

êÂÁÛÎÚ‡ÚËÚÂ ÔÓÍ‡Á‚‡Ú Á‡‚ËÒËÏÓÒÚ ÏÂÊ‰Û „ÓÎÂÏËÌ‡-Ú‡ Ì‡ IMT Ë Ì‡ÎË˜ËÂÚÓ Ì‡ ‡ÚÂË‡ÎÌ‡ ıËÔÂÚÓÌËfl.ëÂ‰Ì‡Ú‡ ÒÚÓÈÌÓÒÚ Ì‡ IMT ÔË Ô‡ˆËÂÌÚËÚÂ Ò ‡ÚÂË-‡ÎÌ‡ ıËÔÂÚÓÌËfl Â 0,83-0,87 mm ‰ÓÍ‡ÚÓ ÔË Á‰‡‚Ë Úfl Â0,57-0,61 (p<0,001).

Ç˙ÁÍ‡Ú‡ ÏÂÊ‰Û ‡ÚÂË‡ÎÌÓÚÓ Ì‡Îfl„‡ÌÂ Ë ÒÚÓÈÌÓÒ-ÚËÚÂ Ì‡ IMT Â ËÁÒÎÂ‰‚‡Ì‡ ÏÌÓ„ÓÍ‡ÚÌÓ ÓÚ ‰Û„Ë ‡‚ÚÓ-Ë, Í‡ÚÓ ‚ÒË˜ÍË ÔÓÛ˜‚‡ÌËfl ÔÓÚ‚˙Ê‰‡‚‡Ú, ˜Â IMT ÂÒË„ÌËÙËÍ‡ÌÚÌÓ ÔÓ-„ÓÎflÏ‡ ÔË Ô‡ˆËÌÚËÚÂ Ò ‡ÚÂË‡ÎÌ‡ıËÔÂÚÓÌËfl (17-22). ëÔÓÂ‰ Úflı ÒÂ‰Ì‡Ú‡ ‡ÁÎËÍ‡ ‚ IMTÏÂÊ‰Û ıËÔÂÚÓÌËˆË Ë Á‰‡‚Ë Â ÓÚ 0,06 ‰Ó 0,25 mm, ‡ ÒÔÓ-Â‰ Ì‡¯ËÚÂ ‰‡ÌÌË Ú‡ÁË ‡ÁÎËÍ‡ Â 0,26 mm. éÚ ‚ÒË˜ÍËËÒÍÓ‚Ë Ù‡ÍÚÓË Á‡ åëÅ, ‡ÚÂË‡ÎÌ‡Ú‡ ıËÔÂÚÓÌËflËÏ‡ Ì‡È-ÒËÎÌÓ ‚ÎËflÌËÂ ‚˙ıÛ IMT. ëËÒÚÓÎË˜ÌËÚÂ ÒÚÓÈ-ÌÓÒÚË Ì‡ Í˙‚ÌÓÚÓ Ì‡Îfl„‡ÌÂ ËÏ‡Ú ÔÓ-„ÓÎflÏÓ ÁÌ‡˜ÂÌËÂ Á‡‡ÚÂË‡ÎÌÓÚÓ Á‡‰Â·ÂÎfl‚‡ÌÂ, ‰ÓÍ‡ÚÓ ‚ÎËflÌËÂÚÓ Ì‡ ‰Ë‡Ò-ÚÓÎË˜ÌÓÚÓ Ì‡Îfl„‡ÌÂ Â ÔÓ-ÌÂÒË„ÛÌÓ (18-21).

ëÂ‰Ì‡Ú‡ ÒÚÓÈÌÓÒÚ Ì‡ IMT ÔË Ô‡ˆËÂÌÚËÚÂ Ò ıËÔÂ-ıÓÎÂÒÚÂÓÎÂÏËfl Â 0,82 mm, ‡ Ú‡ÁË ÔË Á‰‡‚Ë Â 0,62 mm(p<0,001). Ñ‚Â ÒÎÛ˜‡È-ÍÓÌÚÓÎ‡ ÔÓÛ˜‚‡ÌËfl - Poli et al (23)Ë Wendelhag et al (24) Ò˙Ó·˘‡‚‡Ú 0,13 mm ‡ÁÎËÍ‡ ÏÂÊ‰ÛIMT ÔË Á‰‡‚Ë Ë Ô‡ˆËÂÌÚË Ò ıËÔÂıÓÎÂÒÚÂÓÎÂÏËfl. ìÒÚ‡-ÌÓ‚ÂÌ‡Ú‡ ÓÚ Ì‡Ò ‡ÁÎËÍ‡ Â ÔÓ-„ÓÎflÏ‡ ‡ÁÎËÍ‡ – 0,20 mm.èÓ‚Â˜ÂÚÓ ÔÓÛ˜‚‡ÌËfl ÔÓÚ‚˙Ê‰‡‚‡Ú Ì‡ÎË˜ËÂÚÓ Ì‡ ‚˙Á-Í‡ ÏÂÊ‰Û IMT Ë ÚÓÚ‡ÎÌËfl ıÓÎÂÒÚÂÓÎ, Í‡ÚÓ ÒÂ ÔËÂÏ‡ ˜ÂıËÔÂıÓÎÂÒÚÂÓÎÂÏËflÚ‡ ËÏ‡ ÔÓ-‚‡ÊÌ‡ ÓÎfl Á‡ IMT ÓÚÍÓÎ-ÍÓÚÓ ıËÔÂÚË„ÎËˆÂË‰ÂÏËflÚ‡ (25). ì‚ÂÎË˜‡‚‡ÌÂ Ì‡ IMTÒÂ Ì‡·Î˛‰‡‚‡ ‰ÓË ÔË ‰Âˆ‡, Á‡ÒÂ„Ì‡ÚË ÓÚ Á‡·ÓÎfl‚‡ÌËfl Ì‡Ï‡ÒÚÌ‡Ú‡ Ó·ÏflÌ‡ (26). Ç˙ÁÍ‡Ú‡ ÏÂÊ‰Û IMT Ë ÚË„ÎËˆÂ-Ë‰Ë Â Ò ÔÓÚË‚ÓÂ˜Ë‚Ë ‰‡ÌÌË (25).

IMT ÔË ÔÛ¯‡˜ËÚÂ ÓÚ ËÁÒÎÂ‰‚‡ÌËfl ÍÓÌÚËÌ„ÂÌÚ Â ÒÔÓ-‚ËÒÓÍË ÒÚÓÈÌÓÒÚË – 0,74-0,84 mm ‚ Ò‡‚ÌÂÌËÂ Ò ÚÂÁËÔË ÌÂÔÛ¯‡˜Ë – 0,74 mm, ÌÓ ‡ÁÎËÍ‡Ú‡ Â ÌÂÒË„ÌËÙËÍ‡ÌÚ-Ì‡. ãËÔÒ‡Ú‡ Ì‡ ‡ÒÓˆË‡ˆËfl ÏÂÊ‰Û IMT Ë Ú˛Ú˛ÌÓÔÛ¯ÂÌÂ‚ Ì‡ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡ÌÂ ÒÂ Ó·flÒÌfl‚‡ Ò Ï‡ÎÍËfl ·ÓÈ‚ÍÎ˛˜ÂÌË Ô‡ˆËÂÌÚË Ò Ú˛Ú˛ÌÓÔÛ¯ÂÌÂ (n=7), ÔÓ‡‰Ë ÍÓÂ-ÚÓ ÚÂÁË ÂÁÛÎÚ‡ÚË ÌflÏ‡Ú ÒÚ‡ÚËÒÚË˜ÂÒÍ‡ ‰ÓÒÚÓ‚Â-ÌÓÒÚ. èÓÛ˜‚‡ÌËflÚ‡, ËÁÒÎÂ‰‚‡ÎË ÚÓÁË ‚˙ÔÓÒ ÔÓÍ‡Á‚‡Ú˜Â ÔÛ¯‡˜ËÚÂ ËÏ‡Ú ÒË„ÌËÙËÍ‡ÌÚÌÓ ÔÓ-‚ËÒÓÍË ÒÚÓÈÌÓÒ-ÚË Ì‡ IMT ‚ Ò‡‚ÌÂÌËÂ Ò ÌÂÔÛ¯‡˜ËÚÂ (17). éÚ ÁÌ‡˜ÂÌËÂÒ‡ ËÌÚÂÌÁË‚ÌÓÒÚÚ‡ Ë ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚÚ‡ Ì‡ Ú˛Ú˛ÌÓ-ÔÛ¯ÂÌÂÚÓ, Í‡ÚÓ ÚÓ‚‡ ÒÂ ÓÚ‡Áfl‚‡ ÌÂ Ò‡ÏÓ ‚˙ıÛ ÒÚÓÈ-ÌÓÒÚËÚÂ Ì‡ IMT, ÌÓ Ë ‚˙ıÛ ÒÚÂÔÂÌÚ‡ Ì‡ ÔÓ„ÂÒËfl. ìÒ-Ú‡ÌÓ‚ÂÌÓ Â Û‚ÂÎË˜ÂÌËÂ Ì‡ IMT ‰ÓË ÒÂ‰ Ô‡ÒË‚ÌËÚÂ ÔÛ-¯‡˜Ë (27).

ëÂ‰Ì‡Ú‡ ‰Â·ÂÎËÌ‡ Ì‡ IMT ÔË ·ÓÎÌËÚÂ Ò˙Ò Á‡ı‡ÂÌ‰Ë‡·ÂÚ Â 0,96-1,99 mm, ‡ ÔË Á‰‡‚Ë - 0,65-0,69 mm(p<0,001). èÓ‰Ó·ÌË ÂÁÛÎÚ‡ÚË Ò‡ ÔÓÎÛ˜ÂÌË Ë ÓÚ ‰Û„Ë ‡‚-ÚÓË (17,18,22,28). ëÂ‰Ì‡Ú‡ ‡ÁÎËÍ‡ ‚ ‰Â·ÂÎËÌ‡Ú‡ Ì‡ ËIMT ÏÂÊ‰Û ‰Ë‡·ÂÚËˆË Ë Á‰‡‚Ë Â ÓÚ 0,05 ‰Ó 0,08 mm ÔËÏ˙ÊÂ Ë ÔË ÊÂÌË. èÓ‰˙ÎÊËÚÂÎÌÓÒÚÚ‡ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓÒ˙˘Ó Â ÒË„ÌËÙËÍ‡ÌÚÌÓ Ò‚˙Á‡Ì‡ Ò ‰Â·ÂÎËÌ‡Ú‡ Ì‡ IMT.

Ñ‡ÌÌËÚÂ ÓÚ Ì‡ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡ÌÂ ÔÓÍ‡Á‚‡Ú ˜ÂÔÓÎ˙Ú ÌÂ ÓÍ‡Á‚‡ ‚ÎËflÌËÂ ‚˙ıÛ IMT, Í‡ÚÓ IMT ÔË ÊÂÌËÂ 0,71-0,74 mm, ‡ ÔË Ï˙ÊÂ - 0,69-0,76 mm. íÓÁË ÂÁÛÎÚ‡ÚÂ ‚ ÔÓÚË‚ÓÂ˜ËÂ Ò ‰‡ÌÌËÚÂ ÓÚ ‰Û„Ë ÔÓ‰Ó·ÌË ÔÓÛ˜‚‡-

ÌËfl, Í˙‰ÂÚÓ IMT Â Ò ÔÓ-„ÓÎÂÏË ÒÚÓÈÌÓÒÚË ÔË Ï˙ÊÂ (29). Ç Á‡ÍÎ˛˜ÂÌËÂ, ÂÁÛÎÚ‡ÚËÚÂ ÓÚ Ì‡ÒÚÓfl˘ÓÚÓ ÔÓÛ˜-

‚‡ÌÂ ÔÓÍ‡Á‚‡Ú ˜Â IMT Ì‡‡ÒÚ‚‡ ‚ ÛÏÂÂÌË „‡ÌËˆË Ò ‚˙Á-‡ÒÚÚ‡, ÌÓ Â‰ÌÓ‚ÂÏÂÌÌÓ Ò ÚÓ‚‡ ÏÌÓ„Ó ‰Û„Ë Ù‡ÍÚÓË,‚ÍÎ˛˜ËÚÂÎÌÓ ‡ÚÂÓÒÍÎÂÓÚË˜ÌËfl ÔÓˆÂÒ ‚ÎËflflÚ ‚˙ıÛÌÂÈÌÓÚÓ Û‚ÂÎË˜‡‚‡ÌÂ. ç‡ÎËˆÂ Â Á‡‚ËÒËÏÓÒÚ ÏÂÊ‰Û „ÓÎÂ-ÏËÌ‡Ú‡ Ì‡ IMT Ë Ì‡È-˜ÂÒÚÓ ÒÂ˘‡ÌËÚÂ ËÁÏÂÌflÂÏË ËÒ-ÍÓ‚Ë Ù‡ÍÚÓË Á‡ åëÅ – ‡ÚÂË‡ÎÌ‡ ıËÔÂÚÓÌËfl, Á‡ı‡ÂÌ‰Ë‡·ÂÚ Ë ıËÔÂıÓÎÂÒÚÂÓÎÂÏËfl.

èÓ‡‰Ë Ì‡·Î˛‰‡‚‡ÌÓÚÓ ‚˙Á‡ÒÚÓ‚Ó ‚ÎËflÌËÂ, ÌÂÓ·ıÓ-‰ËÏÓ Â ‚˙Á‡ÒÚÓ‚Ó ‡‰‡ÔÚË‡ÌÂ Ì‡ IMT ÒÚÓÈÌÓÒÚË, Á‡ ‰‡ÒÂ Ì‡Ô‡‚flÚ ÔÓ-ÚÓ˜ÌË ËÁ‚Ó‰Ë Á‡ ‚˙ÁÍ‡Ú‡ Ò ‡ÚÂÓÒÍÎÂ-ÓÚË˜ÌËfl ÔÓˆÂÒ Ë ‚ÎËflÌËÂÚÓ Ì‡ ‰Û„Ë Ù‡ÍÚÓË.

î‡ÍÚ˙Ú ˜Â Û‚ÂÎË˜ÂÌËÂÚÓ Ì‡ IMT Ë ‡ÚÂÓÒÍÎÂÓÚË˜-ÌËÚÂ ÔÎ‡ÍË ËÏ‡Ú ÒÎÂ‰ÌËÚÂ Ó·˘Ë ËÒÍÓ‚Ë Ù‡ÍÚÓË – ‡-ÚÂË‡ÎÌÓ Ì‡Îfl„‡ÌÂ, Á‡ı‡ÂÌ ‰Ë‡·ÂÚ, ıËÔÂıÓÎÂÒÚÂÓÎÂ-ÏËfl ÔÓ‰ÍÂÔfl Ú‚˙‰ÂÌËÂÚÓ, ˜Â ÚÂ ÔÓÌÂ ˜‡ÒÚË˜ÌÓ Ò‡ ËÁ-‡Á Ì‡ ÒıÓ‰ÂÌ Ô‡ÚÓÙËÁËÓÎÓ„Ë˜ÂÌ ÔÓˆÂÒ. ç‡È-‚ÂÓflÚÌÓÛ‚ÂÎË˜‡‚‡ÌÂÚÓ Ì‡ IMT Â ‡ÌÌ‡ ÌÂ„Ó‚‡ ÔÓfl‚‡.

ãàíÖêÄíìêÄ1. Crouse J, Goldbourt U, Evans G et al. Arterial enlargement in theAtherosclerosis Risk in Communities (ARIC) cohort. In vivo quantification ofcarotid arterial enlargement. The ARIC investigators. Stroke,1994,25,1354-1359.2. Ungern-Sternberg A, Traxel W, Schuster C et al. Transcutane Messung alters-bedingter Veranderungen der Gefaelastizitat der Arteria caritis communis desMensche. Z Kardiol, 1975, 64,879-888.3. Hasen F, Mangell P, Sonesson B et al. Diameter and compliance in thehuman common carotid artery-variations with age and sex. Ultrasound Med Biol,1995,21,1-9.4. Kelly R, Hayward C, Avolio A et al. Noninvasive determination of age-relat-ed changes in human arterial pulse. Circulation, 1989,80,1652-59.5. Van Merode T, Hick P, Hoekes A et al. carotid artery wall properties in nor-motensive and borderline hypertensive subjects of various ages. Ultrasound MedBiol, 1988,14,563-569.6. Bilato C, Crow M. Atherosclerosis and the vascular biology of aging. Aging(Milano),1996,4,221-34.7. Schmidt-Trucksass A, Grathwohl D, Schmid A et al. Structural, Functional andHemodynamic Changes of the Common Carotid Artery With Age in MaleSubjects. Arteriosclerosis, Thrombosis and Vascular Biology,1999,19,1091-1097.8. Howard G, Sharrett A, Heiss G et al. Carotid artery intimal-medial thicknessdistribution in general population as evaluated by B-mode ultrasound. ARIC inves-tigators, Stroke,1993,24,1297-1304.9. Persson J, Formgren J, Israelsson B et al. Ultrasound-determined intima-media thickness and atherosclerosis. Direct and indirect validation. ArteriosclerThromb Vasc Biol,1994,14,261-264. 10. Homma S, Ishii T, tsugane S et al. Different effect of hypertension andhypercholesterolemia on the natural history of aortic atherosclerosis by the stage ofintimal lesions. Atherosclerosis,1997,125,85-95.11. Salonen R, Salonen J. Progression of carotid atherosclerosis and its determi-nants: a population-based ultrasonography study. Atherosclerosis. 1990,81,33-40.12. O’Leary D, Polak J, Kronmal R et al. Distribution and correlates of sono-graphically detected carotid artery disease in the Cardiovascular Health Study.Stroke,1992,23,1752-1760.13. Allan P, Mowbray P, Lee A et al. Relationship between carotid intima-mediathickness and symptomatic and asymptomatic peripheral arterial disease: TheEdinburgh Artery Study. Stroke, 1997,28,348-353. 14. Homma S, Hirose N, Ishida h et al. Carotid Plaque and intima-Media thick-ness by b-Mode Ultrasonography in Subjects ranging From young Adults toCentenarians. Stroke, 2001,32,830-838.15. Hernandez S, Kroon A, Boxtel M et al. Is There a Side Predilection forCerebrovascular Disease? Hypertension 2003,42,56-60.16. Zureik M, Touboul P-J, Bonithon-Koop C et al. Differential association ofcommon carotid intima-media thickness and carotid atherosclerotic plaques withparental history of premature death from coronary heart disease: the EVA study.Arteriosclerosis, Thrombosis and Vascular Biology. 1999,19,366-371.17. O’Leary D, Josef F, Polak J et al. Carotid artery intima media thickness as arisk factor for myocardial infarction and stroke in older adults. N Engl JMed,1999,340,14-22.18. Solonen R, Salonen J. Determinants of carotid intima media thickness: a popu-lation based ultrasonographic study in Eastern Finnish men. J Int Med1991a,229,225-31.19. Bonithon-Kopp C, Scarabin P, Taquet A et al. Risk factor for early carotidatherosclerosis in middle aged French women. Atheroscler Thromb 1991,11,966-72.20. Bonithon-Kopp C, Jouven X, Taquet A et al. Early carotid atherosclerosis inhealthy middle-aged women: a follow-up study. Stroke,1993,24,1837-43.21. Tell G, Howard G, MacKinney W. Risk factors for site-specific extracranialcarotid artery plaque distribution as measured by B-mode ultrasound. J ClinEpidemiol 1989,42,551-9.22. Bonithon-Kopp C, Touboul P-J, Berr C et al. Relation of intima media thick-ening to atherosclerotic plaques in the carotid arteries: the vascular aging (EVA)study. Arterioscler Thromb Vasc Biol 1996,16,310-6.23. Poli A, Tremoli E, Colombo A et al. Ultrasonographic measurement of thecommon carotid artery wall thickness in hypercholesterolemic patients.Atherosclerosis 1988,970,253-61.24. Wendelhag I, Wiklund O, Wilkstrand J et al. Arterial wall thickness in famil-ial hypercholesterolemia. Atheroscler Thromb 1992,12,70-7.25. Magyar M, Paragh G, Katona E et al. Serum Cholesterol Have a MoreImportant Role than Triglicerides in Determining Intima-media thickness of the


Common carotid artery in Subjects Younger than 55 Year of Age. J UltrasoundMed 2004,23,1161-69.26. Pauciullo P, Ianuzzi A, Sartorio R et al. Increased intima media thickness ofthe carotid atery in hyperholesterolemic children.Arteioscler Thromb1994,14,1075-9.27. Atherosclerosis Risk in Communities (ARIC) Study Investigators,Folsom A, Eckffeldt J, Weitzman S et al. Relation of carotid artery wall thicknessto diabetes mellitus, fasting glucose and insulin, body size, and physical activity.Stroke,1994,25,66-73.28. Malinow M, Nieto J, Szklo M et al. Carotid artery intimal medial thickeningand plasma homocysteine in asymptomatic adults : the atherosclerosis risk in com-munities study. Circulation,1993,87,1107-13.1200. 29. Rosfors S, Hallerstam S, Jensen-Urstad K et al. Relationship between intima-

media thiscness in the common carotid artery and atherosclerosis in the carotidbifurcation. Stroke, 1998, 29, 1378-82.



éË„ËÌ‡ÎÌË ÒÚ‡ÚËËëöÑéÇà èêéåÖçà ëãÖÑ ãöóÖíÖêÄèàü èêà Åéãçà

ë åéáöóçéëöÑéÇÄ ÅéãÖëíû. èÂÚÓ‚‡1, à. ëÚ‡ÈÍÓ‚2, à. í˙ÌÂ‚1

1äÎËÌËÍ‡ ÔÓ çÂ‚ÓÎÓ„Ëfl, ìåÅÄã “ÄÎÂÍÒ‡Ì‰Ó‚ÒÍ‡ ÅÓÎÌËˆ‡” „.ëÓÙËfl, 2äÎËÌËÍ‡ ÔÓ çÂ‚ÓÎÓ„Ëfl, ìåÅÄã “ñ‡Ëˆ‡ âÓ‡ÌÌ‡” , „.ëÓÙËfl

SUMMARY

VASCULAR COMPLICATIONS AFTER RADIOTHERAPY IN PATIENTS WITH

CEREBROVASCULAR DISEASEJ. Petrova, I. Staikov, I. Turnev

Radiotherapy is often applied at treatment of cancer dis-eases as well as when there is a postoperative treatment on theoccasion of different histological structure of the tumors in thearea of the head and the neck. As a side effect of the radio-therapy are the vascular complications. This side effect isimportant when it concerns the life continuance of thepatients as well as worse quality of life they have.

Seven patients have been examined. All of them have acancer in the area of the head (5 of them men and 2 of themwomen). The average age of the patients is 56.6 (ranging from45 to 62). A radiotherapy had been applied following the frac-tion – like schema. The patients’ risk factors had been exam-ined. Doppler sonography, CT, MRI and conventional angiog-raphy had been applied. The patients had had transientischemic attacks and ischemic strokes. The pathogenesisobserved in these patients which concerns the available ves-sels changes is linked with the swollen intima-media thick-ness and the formation of the atherosclerotic plaques. Thisleads to occlusive changes of the vasa vasorum which causesischemia of arterial wall. These are prerequisites enough forcarotid arterial damages.

Key words: Radiotherapy, Doppler sonography, transientischemic attacks, ischemic stroke.

êÖáûåÖ

ã˙˜ÂÚÂ‡ÔËflÚ‡ Â ˜ÂÒÚÓ ËÁÔÓÎÁ‚‡Ì‡ ÔË ÎÂ˜ÂÌËÂ Ì‡ Ï‡-ÎË„ÌÂÌË Á‡·ÓÎfl‚‡ÌËfl, Í‡ÍÚÓ Ë ÔË ÔÓÒÚÓÔÂ‡ÚË‚ÌÓÔÓ‰˙ÎÊÂÌËÂ Ì‡ ÚÂ‡ÔËflÚ‡ ÔÓ ÔÓ‚Ó‰ ‡ÁÎË˜ÌË ÔÓ ıËÒÚÓ-ÎÓ„Ë˜ÂÌ ÒÚÓÂÊ ÚÛÏÓË ‚ Ó·Î‡ÒÚÚ‡ Ì‡ „Î‡‚‡Ú‡ Ë ‚‡Ú‡.ëÚ‡ÌË˜ÂÌ ÂÙÂÍÚ Ì‡ Î˙˜ÂÚÂ‡ÔËflÚ‡ Ò‡ Ò˙‰Ó‚ËÚÂ ÛÒ-ÎÓÊÌÂÌËfl. íÓÁË ÒÚ‡ÌË˜ÂÌ ÂÙÂÍÚ Â ‚‡ÊÂÌ ‚˙‚ ‚˙ÁÍ‡ ÒÔÂÊË‚flÂÏÓÒÚÚ‡ Ì‡ Ô‡ˆËÂÌÚËÚÂ, Í‡ÍÚÓ Ë ‚˙‚ ‚˙ÁÍ‡ Ò‚ÎÓ¯‡‚‡ÌÂÚÓ Í‡˜ÂÒÚ‚ÓÚÓ ËÏ Ì‡ ÊË‚ÓÚ.

àÁÒÎÂ‰‚‡ÌË Ò‡ 7 ·ÓÎÌË Ò Í‡ˆËÌÓÏ ‚ Ó·Î‡ÒÚÚ‡ Ì‡ „Î‡-‚‡Ú‡ (5 Ï˙ÊÂ Ë 2 ÊÂÌË). ëÂ‰Ì‡Ú‡ ‚˙Á‡ÒÚ Ì‡ Ô‡ˆËÂÌÚË-ÚÂ Â 56.6 „. (ÓÚ 45 „. ‰Ó 62 „.). èË Ô‡ˆËÂÌÚËÚÂ Â ÔÓ‚Â-

‰ÂÌ‡ Î˙˜ÂÚÂ‡ÔËfl ÔÓ Ù‡ÍˆËÓÌË‡Ì‡ ÒıÂÏ‡. àÁÒÎÂ‰‚‡ÌË Ò‡ËÒÍÓ‚ËÚÂ Ù‡ÍÚÓË. èÓ‚Â‰ÂÌË Ò‡ ÑÓÔÎÂÓ‚‡ ÒÓÌÓ„‡-ÙËfl, äí, åêí, Í‡ÍÚÓ Ë ÍÓÌ‚ÂÌˆËÓÌ‡ÎÌ‡ ‡Ì„ËÓ„‡ÙËfl. è‡-ˆËÂÌÚËÚÂ Ò‡ ËÏ‡ÎË Ú‡ÌÁËÚÓÌË ËÒıÂÏË˜ÌË ‡Ú‡ÍË ËÎËËÒıÂÏË˜ÌË ÏÓÁ˙˜ÌË ËÌÒÛÎÚË. è‡ÚÓ„ÂÌÂÁ‡Ú‡ Ì‡ Ì‡ÎË˜ÌË-ÚÂ Ò˙‰Ó‚Ë ÔÓÏÂÌË ÒÂ Ò‚˙Á‚‡ Ò Û‚ÂÎË˜ÂÌ‡Ú‡ ËÌÚËÏ‡-ÏÂ-‰Ëfl ‰Â·ÂÎËÌ‡, Í‡ÍÚÓ Ë Ò Ó·‡ÁÛ‚‡ÌÂÚÓ Ì‡ ‡ÚÂÓÒÍÎÂÓ-ÚË˜ÌË ÔÎ‡ÍË, ‚Ó‰Â˘Ë ‰Ó ÓÍÎÛÁË‚ÌË ÔÓÏÂÌË Ì‡ vasa vaso-rum Ë ‰Ó ËÒıÂÏËfl Ì‡ ‡ÚÂË‡ÎÌ‡Ú‡ ÒÚÂÌ‡. íÓ‚‡ Ò‡ ‰ÓÒ-Ú‡Ú˙˜ÌË ÔÂ‰ÔÓÒÚ‡‚ÍË Á‡ Û‚Â‰‡ Ì‡ Í‡ÓÚË‰Ì‡Ú‡ ‡ÚÂ-Ëfl.

äÎ˛˜Ó‚Ë ‰ÛÏË: ã˙˜ÂÚÂ‡ÔËfl, ÑÓÔÎÂ ÒÓÌÓ„‡ÙËfl,Ú‡ÌÁËÚÓÌ‡ ËÒıÂÏË˜Ì‡ ‡Ú‡Í‡, ËÒıÂÏË˜ÂÌ ËÌÒÛÎÚ.

ã˙˜ÂÚÂ‡ÔËflÚ‡ Â ˜ÂÒÚÓ ËÁÔÓÎÁ‚‡Ì‡ ÔË ÎÂ˜ÂÌËÂ Ì‡ Ï‡-ÎË„ÌÂÌË Á‡·ÓÎfl‚‡ÌËfl Í‡ÍÚÓ Ë ÔË ÔÓÒÚÓÔÂ‡ÚË‚ÌÓÔÓ‰˙ÎÊ‡‚‡ÌÂ Ì‡ ÚÂ‡ÔËflÚ‡ ÔÓ ÔÓ‚Ó‰ ‡ÁÎË˜ÌË ÔÓ ıËÒ-ÚÓÎÓ„Ë˜ÂÌ ÒÚÓÂÊ ÚÛÏÓË ‚ Ó·Î‡ÒÚÚ‡ Ì‡ „Î‡‚‡Ú‡ Ë ‚‡-Ú‡. ëÚ‡ÌË˜ÂÌ ÂÙÂÍÚ Ì‡ Î˙˜ÂÚÂ‡ÔËflÚ‡ Ò‡ Ò˙‰Ó‚ËÚÂÛÒÎÓÊÌÂÌËfl (5,9,17,19). íÂÁË ÒÚ‡ÌË˜ÌË ÂÙÂÍÚË Ò‡ ‚‡ÊÌËÁ‡ ÔÂÊË‚flÂÏÓÒÚÚ‡ Ì‡ ·ÓÎÌËÚÂ, Í‡ÍÚÓ Ë Á‡ ‚ÎÓ¯‡‚‡ÌÂ-ÚÓ Í‡˜ÂÒÚ‚Ó ËÏ Ì‡ ÊË‚ÓÚ. ÇÎËflÌËÂÚÓ Ì‡ ‡‰ËÓÚÂ‡ÔËfl-Ú‡ ‚˙ıÛ Ò˙‰Ó‚ÂÚÂ Â ÓÔËÒ‡ÌÓ Á‡ Ô˙‚Ë Ô˙Ú ÔÂÁ 1899 „.ÓÚ Gassmann (7).

äéçíàçÉÖçí à åÖíéÑà

àÁÒÎÂ‰‚‡ÌË Ò‡ 7 ·ÓÎÌË. éÚ Úflı 5 Ï˙ÊÂ Ë 2 ÊÂÌË. ëÂ‰-Ì‡Ú‡ ‚˙Á‡ÒÚ Ì‡ Ô‡ˆËÂÌÚËÚÂ Â 56.6 „. (ÓÚ 45 „. ‰Ó 62„.).ÅÓÎÌËÚÂ Ò‡ ·ËÎË ‰Ë‡„ÌÓÒÚËˆË‡ÌË ‚ ÛÌË‚ÂÒËÚÂÚÒÍË·ÓÎÌËˆË. óÂÚËËÏ‡ Ô‡ˆËÂÌÚË Ò‡ Ò ‡Í Ì‡ Î‡ËÌÍÒ‡, ‡ÚËÏ‡ Ò‡ Ò Í‡ˆËÌÓÏ Ì‡ Ì‡ÁÓÙ‡ËÌÍÒ‡. èË ‚ÒË˜ÍË Ô‡ˆË-ÂÌÚË Â ÔÓ‚Â‰ÂÌ‡ Î˙˜ÂÚÂ‡ÔËfl. ífl Â ·ËÎ‡ ÔÓ ÒÚ‡Ì‰‡ÚÌ‡Ù‡ÍˆËÓÌË‡Ì‡ ÒıÂÏ‡. è‡ˆËÂÌÚËÚÂ Ò‡ ÔÂÊË‚ÂÎË Ú‡Ì-ÁËÚÓÌË ËÒıÂÏË˜ÌË ‡Ú‡ÍË (íàÄ) ËÎË ËÒıÂÏË˜ÂÌ ÏÓÁ˙˜ÂÌËÌÒÛÎÚ (àåà) Ë Ò‡ ÎÂÍÛ‚‡ÌË ‚ ÌÂ‚ÓÎÓ„Ë˜ÌË ÓÚ‰ÂÎÂÌËfl.èÓ‚Â‰ÂÌË Ò‡ ÒÎÂ‰ÌËÚÂ ËÁÒÎÂ‰‚‡ÌËfl: ÍÎËÌË˜ÂÌ Ë ÌÂ‚ÓÎÓ-„Ë˜ÂÌ ÔÂ„ÎÂ‰, èää, Ï‡ÒÚÂÌ ÔÓÙËÎ, äí, åêí, åêÄ, ÑÓÔ-ÎÂÓ‚‡ ÒÓÌÓ„‡ÙËfl.

ÑÓÔÎÂÓ‚‡Ú‡ ÒÓÌÓ„‡ÙËfl Ë ÂıÓ„‡ÙËflÚ‡ Ì‡ Ò˙‰Ó‚Â ÒÂÔÓ‚Â‰ÂÌË ÔÓ ÒÚ‡Ì‰‡ÚËÁË‡Ì‡ ÏÂÚÓ‰ËÍ‡ (1,3,12,14).

ñÂÎÚ‡ Ì‡ Ì‡ÒÚÓfl˘ÂÚÓ ÔÓÛ˜‚‡ÌÂ ·Â¯Â ÓˆÂÌÍ‡ Ò˙ÒÚÓ-

flÌËÂÚÓ Ì‡ Í‡ÓÚË‰ÌËÚÂ ‡ÚÂËË ÔË ·ÓÎÌË ÔÂÊË‚ÂÎËíàÄ ËÎË àåà ÒÎÂ‰ Î˙˜ÂÚÂ‡ÔËfl. íÓ‚‡ Ô˙‚Ó ÔÓÛ˜‚‡ÌÂÔÓ ÚÓÁË ÔÓ·ÎÂÏ ‚ Ì‡¯‡Ú‡ ÒÚ‡Ì‡ ËÏ‡ Ë ÔËÎÓÚÂÌ ı‡‡Í-ÚÂ.

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èÓ‚Â‰ÂÌËÚÂ ÑÓÔÎÂÓ‚‡ ÒÓÌÓ„‡ÙËfl Ë ÂıÓ„‡ÙËfl Ì‡‰‚ÂÚÂ Í‡ÓÚË‰ÌË ‡ÚÂËË ÔÓÍ‡Á‡ı‡ ÒÚÂÌÓÁ‡ ÔË Â‰ËÌ ·Ó-ÎÂÌ, ÔÂÊË‚flÎ íàÄ Ë ÒÚÂÌÓÁ‡ Ë Ò˙ÓÚ‚ÂÚÌÓ ÚÓÏ·ÓÁ‡ÔË ÚËÏ‡ ·ÓÎÌË Ò àåà. èÓ‚Â‰ÂÌ‡Ú‡ åê ‡Ì„ËÓ„‡ÙËflÔÓÚ‚˙‰Ë ÂÁÛÎÚ‡ÚËÚÂ ÓÚ ÑÓÔÎÂÒÓÌÓ„‡ÙÒÍÓÚÓ ËÁÒ-ÎÂ‰‚‡ÌÂ, Í‡ÍÚÓ Ë ÓÚ ÍÓÌ‚ÂÌˆËÓÌ‡ÎÌ‡Ú‡ ‡Ì„ËÓ„‡ÙËfl. éÚËÁÒÎÂ‰‚‡ÌËÚÂ ËÒÍÓ‚Ë Ù‡ÍÚÓË Ì‡ÏÂËıÏÂ ÔÓÏÂÌË Ò‡ÏÓ‚ Ï‡ÒÚÌËfl ÔÓÙËÎ.

èË Ô‡ˆËÂÌÚ˙Ú Ò íàÄ Â ÔÓ‚Â‰ÂÌ‡ ÏÂ‰ËÍ‡ÏÂÌÚÓÁÌ‡ÚÂ‡ÔËfl ÒÎÂ‰ ÔÂÍ‡‡ÌËÚÂ ËÒıÂÏË˜ÌË ËÌˆË‰ÂÌÚË. è‡ˆË-ÂÌÚ˙Ú Ò íàÄ Â ÔÓÎÛ˜ËÎ ÚÓ‚‡ ÛÒÎÓÊÌÂÌËÂ Ì‡ ÚÂÚ‡Ú‡ „Ó-‰ËÌ‡, ‰ÓÍ‡ÚÓ ÔË ·ÓÎÌËÚÂ Ò àåà ÛÒÎÓÊÌÂÌËflÚ‡ Ò‡ Ì‡

˜ÂÚ‚˙Ú‡Ú‡ (Â‰ËÌ ·ÓÎÂÌ) Ë Ì‡ ÔÂÚ‡Ú‡ „Ó‰ËÌ‡ (‰‚‡Ï‡·ÓÎÌË). èË ‚ÒË˜ÍËÚÂ ·ÓÎÌË ‰Ë‡„ÌÓÒÚËˆË‡ÌËÚÂ ÒÚÂÌÓ-ÁË Ò‡ ‚ËÒÓÍÓÒÚÂÔÂÌÌË (Ú‡·ÎËˆ‡ 1).

éÅëöÜÑÄçÖ

Ñ˙Î„Ó ‚ÂÏÂ Ì‡ÎË˜ËÂÚÓ Ì‡ Ò˙‰Ó‚Ë ÔÓÏÂÌË ÔË Ô‡ˆËÂÌ-ÚË ÒÎÂ‰ Î˙˜ÂÚÂ‡ÔËfl ÌÂ Â ·ËÎÓ Ò‚˙Á‚‡ÌÓ Ò ‚˙ÁÏÓÊÌÓÒÚ-Ú‡ Á‡ ‚˙ÁÍ‡ ÏÂÊ‰Û Î˙˜ÂÚÂ‡ÔËflÚ‡ Ë Ì‡ÎË˜ÌËflÚ ËÌÒÛÎÚ.

çflÍÓË ÔÛ·ÎËÍ‡ˆËË ÔÓÍ‡Á‚‡Ú ˜ÂÁ ıËÒÚÓÎÓ„Ë˜ÌÓ ËÁÒ-ÎÂ‰‚‡ÌÂ ‚˙ÁÍ‡ ÏÂÊ‰Û Î˙˜ÂÚÂ‡ÔËflÚ‡ Ë Á‡·ÓÎfl‚‡ÌËflÚ‡Ì‡ „ÓÎÂÏËÚÂ Ò˙‰Ó‚Â. êËÒÍ˙Ú ÓÚ àåà ÔË Î˙˜ÂÚÂ‡ÔÂ‚-ÚË‡ÌË Ô‡ˆËÂÌÚË Â ÔÓÍ‡Á‡Ì Á‡ Ô˙‚Ë Ô˙Ú ‚ ÎËÚÂ‡ÚÛ‡-Ú‡ ÓÚ Ölerding Ë Ò˙Ú. íÓÈ ÌÂ ‰ÓÍ‡Á‚‡ Ó·‡˜Â ÒÚ‡ÚËÒÚË-˜ÂÒÍ‡ ÁÌ‡˜ËÏÓÒÚ ÔË ‚˙ÁÍ‡Ú‡ ÏÂÊ‰Û Î˙˜ÂÚÂ‡ÔËflÚ‡ Ëàåà (6). Ç ÔÛ·ÎËÍ‡ˆËË Ì‡ ‰Û„Ë ‡‚ÚÓË Ò ÔÓÒÎÂ‰fl‚‡ÌÂÌ‡ ÔÓ-ıÓÏÓ„ÂÌÌ‡ „ÛÔ‡ ·ÓÎÌË ÎÂÍÛ‚‡ÌË Ò˙Ò Ò˙˘ËÚÂ ‰ÓÁË Ì‡Î˙˜ÂÚÂ‡ÔËfl ÒÂ Ì‡ÏË‡ ÒÚ‡ÚËÒÚË˜ÂÒÍË ÔÓ‚Ë¯ÂÌ ËÒÍÓÚ àåà ËÁ‡ÁÂÌ ‚ „ÛÔ‡Ú‡ Ì‡‰ 60 „. (6,9,12).

è‡ÚÓ„ÂÌÂÁ‡Ú‡ ÔË ÚÂÁË Ô‡ˆËÂÌÚË ÒÂ Ò‚˙Á‚‡ Ò Û‚ÂÎË-˜ÂÌ‡Ú‡ ËÌÚËÏ‡-ÏÂ‰Ëfl ‰Â·ÂÎËÌ‡, Ò Ó·‡ÁÛ‚‡ÌÂÚÓ Ì‡ ‡ÚÂ-ÓÒÍÎÂÓÚË˜ÌË ÔÎ‡ÍË, ‚Ó‰Â˘Ë ‰Ó ÓÍÎÛÁË‚ÌË ÔÓÏÂÌË Ì‡vasa vasorum Ë ‰Ó ËÒıÂÏËfl Ì‡ ‡ÚÂË‡ÎÌ‡Ú‡ ÒÚÂÌ‡. íÂÁËÔÓÏÂÌË Ò‡ ÔÂ‰ÔÓÒÚ‡‚ÍË Á‡ Û‚Â‰‡ Ì‡ Í‡ÓÚË‰Ì‡Ú‡ ‡-ÚÂËfl (4,7,10,11,13). ÉÓ‰Ë¯ÌËfl ËÒÍ Â 14 Ì‡ 1000 Ô‡ˆËÂÌ-ÚË Ë Â Á‡ 10 „Ó‰Ë¯ÂÌ ÔÂËÓ‰ ÒÎÂ‰ Î˙˜ÂÚÂ‡ÔËflÚ‡. 90%ÓÚ àåà Ò‡ Ì‡ ÒÚ‡Ì‡Ú‡ Ì‡ ÔÓ‚Â‰ÂÌ‡Ú‡ Î˙˜ÂÚÂ‡ÔËfl-Ú‡ (2,3). ëÂ‰ÌËflÚ ËÌÚÂ‚‡Î Á‡ ÔÓÎÛ˜‡‚‡ÌÂ Ì‡ ÏÓÁ˙˜ÌËflËÌÒÛÎÚ Â 7 „Ó‰ËÌË. èË ÓÔËÒ‡ÌËÚÂ ÓÚ Ì‡Ò ·ÓÎÌË ÚÓ‚‡ Ò‡Ò˙ÓÚ‚ÂÚÌÓ 2, 4 Ë 5 „Ó‰ËÌË. íÓ‚‡ Â Â‰ÌÓ ÓÚ ÍÎËÌË˜ÌËÚÂ‰ÓÍ‡Á‡ÚÂÎÒÚ‚‡, ˜Â Î˙˜ÂÚÂ‡ÔËflÚ‡ Ë„‡Â ÓÎflÚ‡ Ì‡ Ô‡-ÚÓ„ÂÌÂÚË˜ÂÌ Ù‡ÍÚÓ ‚Ó‰Â˘ ‰Ó ‡Á‚ËÚËÂÚÓ Ì‡ ‡ÚÂÓÒÍ-ÎÂÓÁ‡ Ì‡ ‡ÚÂË‡ÎÌ‡Ú‡ Í‡ÓÚË‰Ì‡ ÒÚÂÌ‡. èËÎ‡„‡Ì‡Ú‡‰ÓÁ‡ Â ÓÚ 50 Ë 66 Gy. åËÌËÏ‡ÎÌ‡Ú‡ ‰ÓÁ‡ Á‡ Û‚Â‰‡ Ì‡ Í‡-ÓÚË‰ÌËÚÂ ‡ÚÂËË Â 40 Gy.

ÑÛ„ ËÒÍÓ‚ Ù‡ÍÚÓ ÔË àåà Â ‡ÚÂË‡ÎÌ‡Ú‡ ıËÔÂ-

ÚÓÌËfl. ífl Û‚ÂÎË˜‡‚‡ ËÒÍ‡ ÓÚ ËÌÒÛÎÚ ÒÎÂ‰ Î˙˜ÂÚÂ‡ÔËfl.çÂ Â ÛÒÚ‡ÌÓ‚ÂÌ‡ ÒÚ‡ÚËÒÚË˜ÂÒÍ‡ ‰ÓÒÚÓ‚ÂÌ‡ ‚˙ÁÍ‡ÏÂÊ‰Û ‡ÚÂË‡ÎÌ‡Ú‡ ıËÔÂÚÓÌËfl, ËÒıÂÏË˜ÌËflÚ ËÌÒÛÎÚË Ì‡ÎË˜ËÂÚÓ Ì‡ ÔÛ¯ÂÌÂ. èÓ‚Â˜ÂÚÓ ‡‚ÚÓË Ó·flÒÌfl‚‡ÚÚÓÁË Ù‡ÍÚ Ò ÌÂÚÓ˜Ì‡Ú‡ ÒÚ‡ÚËÒÚËÍ‡ Ì‡ ÛÔÓÚÂ·‡ Ì‡ ˆË-„‡Ë ÔË ÚÂÁË ·ÓÎÌË. èÓ‚Â˜ÂÚÓ ÓÚ Ô‡ˆËÂÌÚËÚÂ ÓÔÂË‡-ÌË Á‡ ‡Í Ì‡ Î‡ËÌÍÒ‡ Ò‡ ÒÔÂÎË Ú˛Ú˛ÌÓÔÛ¯ÂÌÂÚÓ. ïË-ÔÂıÓÎÂÒÚÂÓÎÂÏËflÚ‡ Ë„‡Â Ò˙˘Ó ÁÌ‡˜ËÚÂÎÌ‡ ÓÎfl ÔËÔÓfl‚‡Ú‡ Ì‡ ÒÚÂÌÓÚË˜ÌË ‡ÚÂË‡ÎÌË ÔÓÏÂÌË ÒÎÂ‰ Î˙˜Â-ÚÂ‡ÔËfl. Ç ÔÛ·ÎËÍ‡ˆËË Ì‡ Silverberg Ë Ò˙Ú. ÓÎflÚ‡ Ì‡ıËÔÂıÓÎÂÒÚÂÓÎÂÏËflÚ‡ Â ÔÓÍ‡Á‡Ì‡ Í‡ÚÓ ‚Ó‰Â˘ Ù‡ÍÚÓÁ‡ ÔÓfl‚‡Ú‡ Ì‡ Í‡ÓÚË‰ÌË ÒÚÂÌÓÁË (17). èË ‰‚‡Ï‡ ÓÚ Ì‡-¯ËÚÂ ·ÓÎÌË ·Â¯Â Ì‡ÏÂÂÌ‡ Ú‡Í‡‚‡.

ãÂ˜ÂÌËÂÚÓ Ì‡ Ï‡ÎË„ÌÂÌË Ó·‡ÁÓ‚‡ÌËfl ‚ Ó·Î‡ÒÚÚ‡ Ì‡„Î‡‚‡Ú‡ Â ÂÙÂÍÚË‚ÌÓ Ò Î˙˜ÂÚÂ‡ÔËfl. ã˙˜ÂÚÂ‡ÔËflÚ‡ ËÌ-‰ÛˆË‡ Í‡ÓÚË‰ÌË ‡ÚÂË‡ÎÌË ÔÓÏÂÌË, ÍÓÂÚÓ Â ‰ÓÍ‡Á‡-ÌÓ Ò ‡Ì„ËÓ„‡ÙÒÍË ËÁÒÎÂ‰‚‡ÌËfl. íÂÁË ÔÓÏÂÌË ÌÂ Ò‡ Â‰Ì‡Í-‚Ë ÔÓ ˆflÎÓÚÓ ÔÓÚÂÊÂÌËÂ Ì‡ Í‡ÓÚË‰ÌËÚÂ Ò˙‰Ó‚Â. ê‡Á-

ÔÓÎÓÊÂÌË Ò‡ „Î‡‚ÌÓ ‚ ‰ËÒÚ‡ÎÌËflÚ Û˜‡ÒÚ˙Í Ì‡ ‚˙ÚÂ¯Ì‡-Ú‡ Ò˙ÌÌ‡ ‡ÚÂËfl, Í‡ÍÚÓ Ë ‚ ˆÂ‚ËÍ‡ÎÌËÚÂ ‡ÚÂËË, ÍÓ-ÂÚÓ Â Ò‚˙Á‡ÌÓ Ò Ó·Î‡ÒÚÚ‡ Ì‡ ÚÂ‡ÔÂ‚ÚË˜Ì‡ ‡‰Ë‡ˆËfl(14). èË ·ÓÎÌË ÒÎÂ‰ Î˙˜ÂÚÂ‡ÔËfl ÔÓ ÔÓ‚Ó‰ Ì‡ Í‡ˆËÌÓÏ ‚Ó·Î‡ÒÚÚ‡ Ì‡ „Î‡‚‡Ú‡ Â ‚‡ÊÌÓ ËÒÍÓ‚ËÚÂ Ù‡ÍÚÓË ‰‡ ÒÂÒ‚Â‰‡Ú ‰Ó ÏËÌËÏÛÏ ËÎË ÓÚÒÚ‡ÌflÚ. íÓ‚‡ Ì‡Ï‡Îfl‚‡ ËÒ-Í‡, Í‡ÍÚÓ Ë ÔË ·ÓÎÌË ·ÂÁ ÔÓ‚Â‰ÂÌ‡ Î˙˜ÂÚÂ‡ÔËfl ÓÚíàÄ ËÎË àåà (9,11).

íÂ‡ÔÂ‚ÚË˜ÌÓÚÓ ÏÌÂÌËÂ Á‡ ÔÓ‚Â‰ÂÌËÂ ÔË ‚ËÒÓÍÓÒÚÂ-ÔÂÌÌËÚÂ Í‡ÓÚË‰ÌË ÒÚÂÌÓÁË, Í‡ÍÚÓ ÔË Ì‡¯ËÚÂ ·ÓÎÌËÚ‡Í‡ Ë ‚ ÎËÚÂ‡ÚÛ‡Ú‡ Â ÔÂÍÛÚ‡ÌÌ‡ Ú‡ÌÒÎÛÏËÌ‡ÎÌ‡‡Ì„ËÓÔÎ‡ÒÚËÍ‡, Í‡ÓÚË‰Ì‡ ÂÌ‰‡ÚÂÂÍÚÓÏËfl Ë ·‡È-Ô‡ÒıËÛ„Ëfl (12,16). íÂÁË ÚÂıÌËÍË ÔË Ô‡ˆËÂÌÚËÚÂ ÒÎÂ‰ Î˙-˜ÂÚÂ‡ÔËfl Ò‡ ÔÓ-ÚÛ‰ÌË ‚ Ò‡‚ÌÂÌËÂ Ò ·ÓÎÌËÚÂ ÓÚ ÓÒÚ‡-Ì‡Î‡Ú‡ ÔÓÔÛÎ‡ˆËfl ËÏ‡˘Ë ÔÓ‰Ó·ÌË Ò˙‰Ó‚Ë ÔÓÏÂÌË ÔÓ‡‰Ë‡ÚÂË‡ÎÌ‡ Ë ÔÂË‡ÚÂË‡ÎÌ‡ ÒÍÎÂÓÁ‡. Ç ÎËÚÂ‡ÚÛ‡-Ú‡ ÒÂ Ò˙Ó·˘‡‚‡Ú ‡ÁÎË˜ÌË ÛÒÎÓÊÌÂÌËfl: ËÌÙÂÍˆËË, ËÁÔÛÒ-Í‡ÌÂ Ì‡ ‡Ì‡ÒÚÓÏÓÁ‡, ÂÒÚÂÌÓÁ‡ Ë ‰. ç‡ ‰‚‡Ï‡ ÓÚ Ì‡¯Ë-ÚÂ Ô‡ˆËÂÌÚË ·Â¯Â ÔÓ‚Â‰ÂÌ‡ Í‡ÓÚË‰Ì‡ ÂÌ‰‡ÚÂÂÍÚÓ-ÏËfl ‚ çÂ‚ÓıËÛ„Ë˜Ì‡ ÍÎËÌËÍ‡ ÔË ÄÎÂÍÒ‡Ì‰Ó‚ÒÍ‡ ·ÓÎ-ÌËˆ‡. êÂÁÛÎÚ‡ÚËÚÂ ÓÚ ÔÓÒÚÓÔÂ‡ÚË‚ÌÓÚÓ Ì‡·Î˛‰ÂÌËÂÌÂ ÔÓÍ‡Áaıa ÛÒÎÓÊÌÂÌËfl.

ãàíÖêÄíìêÄ1. òÓÚÂÍÓ‚ è. ÑÓÔÎÂÓ‚‡ ÒÓÌÓ„‡ÙËfl Ì‡ ÂÍÒÚ‡Í‡ÌË‡ÎÌËÚÂ Ë ÔÂËÙÂÌË‡ÚÂËË Ë ‚ÂÌË. ãË‰Â ÔÂÒ 1998 „., ëÓÙËfl.2. Cestari D., Weine D., Panageas A. et all. Stroke in patients with cancer:Incidence and etiology. Neurology 2004; 62:2023-2030.3. Cheng. Duplex imaging and incidence of carotid radiation injury after high-dose radiotherapy for tumors of the head and neck. Arch Otolaryngol Head NeckSurg 2000; 126:517-521.4. Conomy J., Kellermeyer R. Delayed cerebrovascular consequences of thera-peutic radiatin: A clinicopathologic study of a stroke associated with radiation-related carotid arteriopathy. Cancer 1975; 36:1702-1708.5. Doll D., Ringenberg Q., Yarbro J. Vascular toxicity associated with antineo-plastic agents. J. Clin Oncol 1986; 4:1405-1417.6. Elerding S., Fernandez R., Grotta J. et all. Carotid artery diseases followingexternal cervical irradiation. Ann Surg 1981; 194:609-615.7. Gassmann A. Zur histology der roentgenulcera. Fortschr Geb Roentgenstr1999; 2:199-207.8. Graus F., Rogers L., Posner J. Cerebrovascular complications in patients withcancer. Medicine 1978; 137.


í‡·Î 1. àÁÒÎÂ‰‚‡ÌË Ô‡ˆËÂÌÚË Ë ÂÁÛÎÚ‡ÚË ÓÚ ÔÓ‚Â‰ÂÌËÚÂ ËÁÒÎÂ‰‚‡ÌËfl. Ö‰ËÌ Ô‡ˆËÂÌÚ Â Ò ÔÂÍ‡‡Ì àåà ·ÂÁ ÓÒÚ‡Ú˙˜Ì‡ ÒËÏÚÓÏ‡ÚËÍ‡ ÔÂ‰ËÎ˙˜ÂÚÂ‡ÔËflÚ‡.

ÅÓÎÌË èää å‡ÒÚÂÌ ÑÓÔÎÂÓ‚‡ äí åêí íÂ‡ÔËflÔÓÙËÎ ÒÓÌÓ„‡ÙËfl

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àåà- 3 ·ÂÁ ÔÓ‚Ë¯ÂÌ ‰‚Â ÒÚÂÌÓÁË Ñ‡ Ñ‡ Ñ‡

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9. Haynes J., Machtay M., Weber R. et all. Relative risk of stroke in head andneck carcinoma patients treated with external cervical irradiation. Laryngoscope2002; 112:1883-1887.10. Fonkalsrud E., Sanchez M., Zerubavel R. et all: Serial changes in arterial struc-ture following radiation therapy. Surg Gynecol Obstet 1977; 145:395-400.11. Kashyap V., Moore W., Quinones-Baldrich W. Carotid artery repair for radia-tion-associated atherosclerosis is a safe and durable procedure. J.Vasc.Surg 1999;29:90-96.12. Dorresteiju L., Kappelle A., Boogerd W., at all. Increased risk of ischemicstroke after radiotherapy on the neck in patients jounger than 60 years. J of ClinOncology 2002; 1:283-288.13. McCready R., Hyde G., Bivins B. et al. Radiation-induced arterial injuries.Surgery 1983; 93:306-312.14. Moritz MW., Higgins RF., Jacobs JR. Duplex imaging and incidence of carotidradiation injury after high-dose radiotherapy for tumors of the head and neck. ArchSurg 1990; 125:1181-1183.15. Murrors K., Toole J. The effect of radiation on carotid arteries: A review arti-cle. Arch Neurol 1989; 46:449-445.

16. Pettersson F., Swedenborg J. Atherosclerotic occlusive disease after radiationfor pelvic malignancies. Acta Chir Scand 1990; 156:367-371.17. Silverberg G., Britt R., Goffined. Radiation-induced carotid artery disease.Cancer 1978; 137:130-137.18. Taylor P., Cooper G., Sarkar T. Upper-limb arterial disease in women treatedfor breast cancer. Br. J. Surg 1995; 82:1089-1091.

Ä‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËfl:‰- ûÎËfl èÂÚÓ‚‡, ‰.Ï.ÉÎ‡‚ÂÌ ‡ÒËÒÚÂÌÚ Í˙Ï äÎËÌËÍ‡ ÔÓ çÂ‚ÓÎÓ„ËflìåÅÄã “ÄÎÂÍÒ‡Ì‰Ó‚ÒÍ‡ ÅÓÎÌËˆ‡”ÛÎ. ÉÂÓ„Ë ëÓÙËÈÒÍË 1ëÓÙËfl


éË„ËÌ‡ÎÌË ÒÚ‡ÚËËçÖÇêéèëàïéãéÉàóçà èêéìóÇÄçàü èêà ëöÑéÇà

äéÉçàíàÇçà çÄêìòÖçàüã. í‡ÈÍÓ‚1,2, ë. ÅÓ‰ËÍ2, î. ÅÓÎÂ2, Ä. ëÏ‡„3

1ä‡ÚÂ‰‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl - åì, ëÓÙËfl; 2àçëÖêå, è‡ËÊ, î‡ÌˆËfl;

3ÅÓÎÌËˆ‡ çÓÚ Ñ‡Ï ‰Â ÅÓÌ ëÂÍÛ, è‡ËÊ, î‡ÌˆËfl

SUMMARY

NEUROPSYCHOLOGICAL STUDY IN VASCULAR COGNITIVE IMPAIRMENT

L. Traykov, N. Raoux, A-S. Rigaud, F. BollerIn recent years, practical as well as theoretical considera-

tions have engendered a strong interest in recognizing vascu-lar dementia (VaD) at a very early stage. Recent study sug-gested that onset of VaD is preceded by a phase known as vas-cular cognitive impairment (VCI). Persons who experiencethis condition have a cognitive impairment related to cere-brovascular disease (CVD).

The objective of this study was to examine the pattern ofneuropsychological impairment in patients with VCI.

Study subjects were selected among patients who soughtconsultation at the Bon Secours Geriatric Day Care Hospitalin Paris, because of memory problems or other symptoms ofcognitive deterioration. We investigated 20 VCI subjects(MMSE=28.2±1.7) and 25 normal controls (NC)(MMSE=29.2±0.6). All subjects were assessed with detailedneuropsychological battery designed to measure memory, lan-guage, visuospatial functions and attention/executive func-tions.

VCI patients had a significantly worse scores on free recall(p < 0.05) and normal recognition of the Free and CuedSelective Reminding Test than NC. Furthermore, VCI hadlowest performance on Verbal fluency, TMT A and B,Similarities and on Modified Card Sorting Test (p<0.05 top<0.00001).

Despite the comparable global cognitive functioning, thefindings show more impaired retrieval from long term storagein VCI than in NC. Moreover, the data indicate that VCIpatients had additional problems with abstract thinking,response inhibition, switching and cognitive flexibility, whichencompass various aspects of executive function. This suggestthat VCI may be identified by using a more detailed procedurefor the assessment of executive functions and free recall.

Key words: dementia, early diagnosis, vascular cognitiveimpairment, neuropsychology.

êÖáûåÖ

Ç ÔÓÒÎÂ‰ÌËÚÂ „Ó‰ËÌË, Â‰Ëˆ‡ ÍÎËÌË˜ÌË Ë ÚÂÓÂÚË˜ÌËÔÂ‰ÔÓÒÚ‡‚ÍË ÔÂ‰ËÁ‚ËÍ‚‡Ú ÓÒÓ·ÂÌ ËÌÚÂÂÒ ÓÍÓÎÓ ‰Ë‡„-

ÌÓÁ‡Ú‡ Ì‡ Ò˙‰Ó‚‡Ú‡ ‰ÂÏÂÌˆËfl (ëÑ) ‚ Ì‡È-‡ÌÌËÚÂ È ÒÚ‡-‰ËË. çÂÓÚ‰‡‚Ì‡ ÒÂ ÔÂ‰ÎÓÊË ÔÓÌflÚËÂÚÓ ë˙‰Ó‚Ó äÓ„ÌË-ÚË‚ÌÓ ç‡Û¯ÂÌËÂ (ëäç), Á‡ ‡Á„‡ÌË˜‡‚‡ÌÂ Ì‡ ëÑ ‚ ÔÂ-‰ÂÏÂÌÚÌËfl ÒÚ‡‰ËÈ. íÂÁË ·ÓÎÌË ËÏ‡Ú ÍÓ„ÌËÚË‚ÌË Ì‡Û-¯ÂÌËfl ‚ ÂÁÛÎÚ‡Ú Ì‡ åëÅ.

ñÂÎÚ‡ Ì‡ Ì‡ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡ÌÂ Â ËÁflÒÌfl‚‡ÌÂ Ì‡ ÍÓ„-ÌËÚË‚ÌËfl ÔÓÙËÎ ÔË Ò˙‰Ó‚Ó ÍÓ„ÌËÚË‚ÌÓ Ì‡Û¯ÂÌËÂ(ëäç).

àÁÒÎÂ‰‚‡ÌËÚÂ ·ÓÎÌË Ò‡ ÔÓ‰·‡ÌË ÏÂÊ‰Û ÎËˆ‡Ú‡ ÍÓÌ-ÒÛÎÚË‡ÌË ‚ ·ÓÎÌËˆ‡Ú‡ çÓÚ Ñ‡Ï ‰Â ÅÓÌ ëÂÍÛ (è‡ËÊ)ÔÓ ÔÓ‚Ó‰ Ì‡ Ô‡ÏÂÚÓ‚Ë ÔÓ·ÎÂÏË ËÎË ‰Û„Ë ÒËÏÔÚÓÏË Ì‡ÍÓ„ÌËÚË‚ÌÓ Ì‡Û¯ÂÌËÂ. ÇÍÎ˛˜ÂÌË Ò‡ 20 ·ÓÎÌË ÒÚ‡‰‡˘ËÓÚ ëäç (MMSE=28.2±1.7) Ë 25 ÍÎËÌË˜ÌÓ Á‰‡‚Ë ÎËˆ‡(MMSE=29.2±0.6). ÇÒË˜ÍË ÎËˆ‡ Ò‡ ÓˆÂÌfl‚‡ÌË Ò ÔÓ‰Ó·Ì‡ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜Ì‡ ·‡ÚÂËfl Á‡ ËÁÒÎÂ‰‚‡ÌÂ Ì‡ Ô‡ÏÂÚ, Â˜,ÁËÚÂÎÌÓ ÔÓÒÚ‡ÌÒÚ‚ÂÌË ÙÛÌÍˆËË Ë ‚ÌËÏ‡ÌËÂ/ÂÍÁÂÍÛ-ÚË‚ÌË ÙÛÌÍˆËË.

ÄÌ‡ÎËÁ˙Ú ÔÓÍ‡Á‚‡, ˜Â ·ÓÎÌËÚÂ Ò˙Ò ëäç ËÏ‡Ú ÁÌ‡˜ËÏÓÔÓ-ÌËÒÍË ÒÚÓÈÌÓÒÚË ÔË Ò‚Ó·Ó‰ÌÓÚÓ ÔËÔÓÏÌflÌÂ Ì‡FCSRT (p<0.05) ‚ Ò‡‚ÌÂÌËÂ Ò ÍÓÌÚÓÎÌ‡Ú‡ „ÛÔ‡, ÔËÌÓÏ‡ÎÌÓ ‡ÁÔÓÁÌ‡‚‡ÌÂ. Ç ‰ÓÔ˙ÎÌÂÌËÂ, ·ÓÎÌËÚÂ ËÏ‡Ú ÔÓ-ÌËÒÍ‡ ÛÒÔÂ‚‡ÂÏÓÒÚ ÔË Verbal fluency, TMT A Ë B,Similarities Ë ÔË Modified Card Sorting Test (p<0.05 ‰Óp<0.00001).

Ç˙ÔÂÍË Â‰Ì‡Í‚‡Ú‡ ÛÒÔÂ‚‡ÂÏÓÒÚ ÔË Ó·˘‡Ú‡ ÍÓ„ÌË-ÚË‚Ì‡ ÓˆÂÌÍ‡, ÂÁÛÎÚ‡ÚËÚÂ ÔÓÍ‡Á‚‡Ú Ì‡Û¯ÂÌÓ ÔËÔÓÏ-ÌflÌÂ ÓÚ ‰˙Î„ÓÒÓ˜ÌËfl Ô‡ÏÂÚÓ‚ ÒÍÎ‡‰ ÔË ëäç ‚ Ò‡‚ÌÂ-ÌËÂ Ò ÍÓÌÚÓÎÌËÚÂ ÎËˆ‡. Ç ‰ÓÔ˙ÎÌÂÌËÂ, ‰‡ÌÌËÚÂ ÒÓ˜‡Ú ˜Â·ÓÎÌËÚÂ Ò˙Ò ëäç ËÏ‡Ú Ì‡Û¯ÂÌËfl ‚ ‡·ÒÚ‡ÍÚÌÓÚÓÏËÒÎÂÌÂ, ËÌıË·Ë‡ÌÂÚÓ Ì‡ ÌÂ‡‰ÂÍ‚‡ÚÌË ÓÚ„Ó‚ÓË, ÔÂ‚Í-Î˛˜‚‡ÂÏÓÒÚÚ‡ Ë ÍÓ„ÌËÚË‚Ì‡Ú‡ ÙÎÂÍÒË·ËÎÌÓÒÚ, ÍÓËÚÓÓÚ‡Áfl‚‡Ú ‡ÁÎË˜ÌË ‡ÒÔÂÍÚË Ì‡ ÂÍÁÂÍÛÚË‚ÌËÚÂ ÙÛÌÍ-ˆËË. íÓ‚‡ ÔÂ‰ÔÓÎ‡„‡, ˜Â ëäç ÏÓÊÂ ‰‡ ·˙‰Â ‰Ë‡„ÌÓÒÚËˆË-‡ÌÓ Ò ÔÓ-ÔÓ‰Ó·ÌÓ ËÁÒÎÂ‰‚‡ÌÂ ‚ÍÎ˛˜‚‡˘Ó ÓˆÂÌÍ‡ Ì‡ ÂÍÁÂ-ÍÛÚË‚ÌËÚÂ ÙÛÌÍˆËË Ë Ò‚Ó·Ó‰ÌÓÚÓ ÔËÔÓÏÌflÌÂ.

äÎ˛˜Ó‚Ë ‰ÛÏË: ÌÂ‚ÓÔÒËıÓÎÓ„Ëfl, ‡ÌÌ‡ ‰Ë‡„ÌÓÁ‡, Ò˙-‰Ó‚‡ ‰ÂÏÂÌˆËfl.

åÓÁ˙˜ÌÓÒ˙‰Ó‚‡Ú‡ ·ÓÎÂÒÚ (åëÅ) Â ‚ÚÓ‡Ú‡ ÔÓ ˜ÂÒÚÓ-Ú‡ ÔË˜ËÌ‡, ÒÎÂ‰ ·ÓÎÂÒÚÚ‡ Ì‡ ÄÎˆı‡ÈÏÂ (ÅÄ), Á‡ ‚˙ÁÌËÍ-‚‡ÌÂ Ì‡ ‰ÂÏÂÌˆËfl ÔË ÎËˆ‡Ú‡ ÓÚ ÚÂÚ‡Ú‡ ‚˙Á‡ÒÚ. ÇÔÓÒÎÂ‰ÌËÚÂ „Ó‰ËÌË Â‰Ëˆ‡ ÍÎËÌË˜ÌË Ë ÚÂÓÂÚË˜ÌË ÔÂ‰-

ÔÓÒÚ‡‚ÍË ÔÂ‰ËÁ‚ËÍ‡ı‡ ÓÒÓ·ÂÌ ËÌÚÂÂÒ ÓÍÓÎÓ ‡ÌÌ‡Ú‡‰Ë‡„ÌÓÁ‡ Ì‡ Ò˙‰Ó‚‡Ú‡ ‰ÂÏÂÌˆËfl (ëÑ).

äÓ„ÌËÚË‚ÌËÚÂ Ì‡Û¯ÂÌËfl ÔË åëÅ ÔÓ‰ÎÂÊ‡Ú Ì‡ ÎÂ-˜ÂÌËÂ ‚ ÌflÍÓË ÒÎÛ˜‡Ë, Í‡ÚÓ Ò‡ ‚˙ÁÏÓÊÌË Ë ÔÂ‚‡ÌÚË‚ÌËÏÂ‰ËÍ‡ÏÂÌÚÓÁÌË Ì‡ÏÂÒË (6). íÂÁË ‚˙ÁÏÓÊÌÓÒÚË ÔÓ‰˜Â-Ú‡‚‡Ú ÁÌ‡˜ÂÌËÂÚÓ Ì‡ ‡ÌÌ‡Ú‡ Ë ÔÂˆËÁÌ‡ ‰Ë‡„ÌÓÁ‡ Ì‡ëÑ. ÄÍÓ ˆÂÎÚ‡ ÌË Â ‰‡ ‡Á„‡ÌË˜ËÏ Ô‡ˆËÂÌÚËÚÂ Ò Ì‡˜‡Î-ÌË ÙÓÏË Ì‡ ëÑ, ÚÓ Ò˙˘ÂÒÚ‚Û‚‡˘ËÚÂ ‰Ë‡„ÌÓÒÚË˜ÌËÍËÚÂËË ËÏ‡Ú ÁÌ‡˜ËÚÂÎÌË ÌÂ‰ÓÒÚ‡Ú˙ˆË.

ç‡ Ô˙‚Ó ÏflÒÚÓ, Ì‡ÒÚÓfl˘ËÚÂ ÍËÚÂËË ËÁËÒÍ‚‡Ú“ÁÌ‡˜ËÏ ÔÓ Ò‚ÓflÚ‡ ÚflÊÂÒÚ ÍÓ„ÌËÚË‚ÂÌ ‰ÂÙËˆËÚ”, ÍÓÂ-ÚÓ ÓÁÌ‡˜‡‚‡, ˜Â Ò ÚflıÌ‡ ÔÓÏÓ˘ ·Ëı‡ ·ËÎË ‰Ë‡„ÌÓÒÚËˆË-‡ÌË Ò‡ÏÓ Ô‡ˆËÂÌÚË Ò ‚Â˜Â ÁÌ‡˜ËÏ‡ ÏÓÁ˙˜Ì‡ Û‚Â‰‡, ‡ ÌÂÚÂÁË Ò Ì‡˜‡ÎÌËÚÂ ÙÓÏË, ÔË ÍÓËÚÓ ·Ë ÏÓ„Î‡ ‰‡ ·˙‰Â ÓÒ˙-˘ÂÒÚ‚ÂÌ‡ ÂÙËÍ‡ÒÌ‡ ‚ÚÓË˜Ì‡ ÔÂ‚ÂÌˆËfl (1,12). ÇÚÓËÓÒÌÓ‚ÂÌ ÌÂ‰ÓÒÚ‡Ú˙Í Â ‚Ë‰‡ Ì‡ ÍÓ„ÌËÚË‚ÌÓÚÓ Ì‡Û¯ÂÌËÂ,Í‡ÚÓ Ô‡ÏÂÚÓ‚ËflÚ ‰ÂÙËˆËÚ Â ÔËÂÚ Á‡ Á‡‰˙ÎÊËÚÂÎÂÌ ·Â-ÎÂ„ ‚ Ô‡ÚÂÌ‡ Ì‡ ÍÓ„ÌËÚË‚Ì‡ Û‚Â‰‡. ë˙˘ÂÒÚ‚Û‚‡˘ËÚÂ‰‡ÌÌË Ó·‡˜Â ÒÓ˜‡Ú, ˜Â ÍÓ„ÌËÚË‚ÌËflÚ ÒËÌ‰ÓÏ ÔË åëÅ Â‰ÓÏËÌË‡Ì ÔÓ-ÒÍÓÓ ÓÚ Ì‡Û¯ÂÌËÂ ‚ ÂÍÁÂÍÛÚË‚ÌËÚÂÙÛÌÍˆËË (2,10). èÓ ÚÓÁË Ì‡˜ËÌ Ô‡ˆËÂÌÚËÚÂ Ò ÌÂÁÌ‡˜ËÏËÔ‡ÏÂÚÓ‚Ë Ì‡Û¯ÂÌËfl ˘Â ÓÒÚ‡Ì‡Ú ËÁ‚˙Ì ÍËÚÂËËÚÂ Á‡Ò˙‰Ó‚‡ ‰ÂÏÂÌˆËfl.

èÓ ‡Ì‡ÎÓ„Ëfl Ò ÔÓÛ˜‚‡ÌËflÚ‡ ÔÓÒ‚ÂÚÂÌË Ì‡ ÔÂıÓ‰‡ÏÂÊ‰Û ÌÓÏ‡ÎÌÓÚÓ ÒÚ‡ÂÂÌÂ Ë Ì‡È-‡ÌÌËÚÂ ÔËÁÌ‡ˆË Ì‡ÅÄ (9), ÌÂÓÚ‰‡‚Ì‡ ·Â¯Â ÔÂ‰ÎÓÊÂÌÓ ÔÓÌflÚËÂÚÓ ë˙‰Ó‚ÓäÓ„ÌËÚË‚ÌÓ ç‡Û¯ÂÌËÂ (Vascular Cognitive Impairment,VCI) (3), Á‡ ‡Á„‡ÌË˜‡‚‡ÌÂ Ì‡ ëÑ Ó˘Â ‚ ÔÂ‰ÂÏÂÌÚÌËflÒÚ‡‰ËÈ. çÂÓ·ıÓ‰ËÏË Ò‡ Â‰Ëˆ‡ ÔÓÛ˜‚‡ÌËfl Á‡ ÛÚÓ˜Ìfl‚‡-ÌÂ Ì‡ ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌËÚÂ Ì‡Û¯ÂÌËfl ‚ Ú‡ÁË Ù‡Á‡, Á‡ ‰‡ÏÓ„‡Ú ÔÓ-ÔÂˆËÁÌÓ ‰‡ ·˙‰‡Ú ‰ÂÙËÌË‡ÌË ‰Ë‡„ÌÓÒÚË˜ÌË-ÚÂ ÍËÚÂËË Á‡ Ú‡ÁË ÙÓÏ‡ Ì‡ åëÅ.

ñÂÎÚ‡ Ì‡ Ì‡ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡ÌÂ Â ËÁflÒÌfl‚‡ÌÂ Ì‡ ÍÓ„-ÌËÚË‚ÌËfl ÔÓÙËÎ ÔË Ò˙‰Ó‚Ó ÍÓ„ÌËÚË‚ÌÓ Ì‡Û¯ÂÌËÂ(ëäç). èÓÛ˜‚‡ÌÂÚÓ Â ÔÓ‚Â‰ÂÌÓ Ò ‰Ó·Â ‰Ë‡„ÌÓÒÚËˆË-‡ÌË ÌÂ‰ÂÏÂÌÚÌË ·ÓÎÌË Ò ÍÓ„ÌËÚË‚ÌË Ì‡Û¯ÂÌËfl ‚ ÂÁÛÎ-Ú‡Ú Ì‡ åëÅ. àÁÔÓÎÁ‚‡ÌË Ò‡ Á‡ Ô˙‚ Ô˙Ú, ÒÔÂˆË‡ÎÌÓ ÔÂ‰-ÎÓÊÂÌË Á‡ ˆÂÎÚ‡ Ì‡ ÚÓ‚‡ ÔÓÛ˜‚‡ÌÂ, ÍËÚÂËË.

äéçíàçÉÖçí à åÖíéÑàäÄ

èÓÛ˜‚‡ÌÂÚÓ Â ÔÓ‚Â‰ÂÌÓ ‚ ·ÓÎÌËˆ‡Ú‡ çÓÚ Ñ‡Ï ‰ÂÅÓÌ ëÂÍÛ (è‡ËÊ, î‡ÌˆËfl) ÔË 20 ·ÓÎÌË ÒÚ‡‰‡˘Ë ÓÚÒ˙‰Ó‚Ó ÍÓ„ÌËÚË‚ÌÓ Ì‡Û¯ÂÌËÂ (ëäç) Ë ÔË 25 ÍÎËÌË˜ÌÓÁ‰‡‚Ë ÎËˆ‡.

ÑË‡„ÌÓÁ‡Ú‡ Â ÔÓÒÚ‡‚flÌ‡ ‚˙Á ÓÒÌÓ‚‡ Ì‡ ÔÓ‰Ó·Ì‡ ‡Ì‡Ï-ÌÂÁ‡, ÒÓÏ‡ÚË˜ÂÌ Ë ÌÂ‚ÓÎÓ„Ë˜ÂÌ ÔÂ„ÎÂ‰, Î‡·Ó‡ÚÓÌËËÁÒÎÂ‰‚‡ÌËfl Ë ÍÓÏÔ˛Ú˙Ì‡ ÚÓÏÓ„‡ÙËfl (CT) Ë/ËÎË Ï‡„-ÌËÚÌÓ ÂÁÓÌ‡ÌÒÌ‡ ÚÓÏÓ„‡ÙËfl (åêí) Ì‡ ÏÓÁ˙Í‡. ëÍË-ÌËÌ„Ó‚‡Ú‡ ÒÍ‡Î‡ Mini Mental State (MMS) Â ËÁÔÓÎÁ‚‡Ì‡ Á‡ÓˆÂÌÍ‡ Ì‡ Ó·˘Ëfl ÍÓ„ÌËÚË‚ÂÌ Í‡Ô‡ˆËÚÂÚ. ã‡·Ó‡ÚÓÌË-ÚÂ ËÁÒÎÂ‰‚‡ÌËfl ‚ÍÎ˛˜‚‡Ú Ô˙ÎÌ‡ Í˙‚Ì‡ Í‡ÚËÌ‡, Í˙‚Ì‡Á‡ı‡, ÒÂÛÏÌË ÂÎÂÍÚÓÎËÚË, ˜ÂÌÓ‰Ó·ÌË Ë ·˙·Â˜ÌËÔÓ·Ë, ÚÂÒÚÓ‚Â Á‡ ÚËÂÓË‰Ì‡ ÙÛÌÍˆËfl, ÒÂÛÏÌÓ ÌË‚Ó Ì‡B12 Ë ÙÓÎ‡ÚË, VDRL Ë ÖäÉ. ÄÌ‡ÏÌÂÒÚË˜ÌËÚÂ ‰‡ÌÌË Á‡ÒÓÏ‡ÚË˜ÌË, ÌÂ‚ÓÎÓ„Ë˜ÌË Ë ÔÒËıË‡ÚË˜ÌË Á‡·ÓÎfl‚‡ÌËfl Ò‡ÔÓÎÛ˜‡‚‡ÌË Í‡ÍÚÓ ÓÚ Ò‡ÏËÚÂ ·ÓÎÌË, Ú‡Í‡ Ë ÓÚ ˜ÎÂÌÓ‚ÂÌ‡ ÒÂÏÂÈÒÚ‚‡Ú‡ ËÏ ËÎË ÓÚ ‰Û„Ë ÎËˆ‡, ÍÓËÚÓ ÒÂ „ËÊ‡ÚÁ‡ Úflı.

ÅÓÎÌËÚÂ ÒÚ‡‰‡˘Ë ÓÚ ëäç (10 Ï˙ÊÂ Ë 10 ÊÂÌË) Ò‡‰Ë‡„ÌÓÒÚËˆË‡ÌË ‚˙Á ÓÒÌÓ‚‡ Ì‡ ‰Ë‡„ÌÓÒÚË˜ÌË ÍËÚÂËË,ÔÂ‰ÎÓÊÂÌË ÒÔÂˆË‡ÎÌÓ Á‡ ˆÂÎÚ‡ Ì‡ ÚÓ‚‡ ÔÓÛ˜‚‡ÌÂ.

ÅÓÎÌËÚÂ Ò˙Ò ëäç ÓÚ„Ó‚‡flÚ Ì‡ ÍËÚÂËËÚÂ Á‡ ãäç,Í‡ÚÓ ‚ ÚÓ˜Í‡ “‡” Ì‡Û¯ÂÌËÂÚÓ ‚ Ô‡ÏÂÚÚ‡ Â Á‡ÏÂÒÚÂÌÓÒ Ì‡Û¯ÂÌËÂ ‚ ÍÓflÚÓ Ë ‰‡ Â ÍÓ„ÌËÚË‚Ì‡ Ó·Î‡ÒÚ. ë Ú‡ÁËÔÓÏflÌ‡ ÍËÚÂËËÚÂ ‰Ó·Ë‚‡Ú ÒÎÂ‰ÌËfl ‚Ë‰: (‡) ÒÛ·ÂÍ-ÚË‚ÌÓ Ë Ó·ÂÍÚË‚ÌÓ Ì‡Û¯ÂÌËÂ ‚ ÍÓflÚÓ Ë ‰‡ Â ÍÓ„ÌËÚË‚-

Ì‡ Ó·Î‡ÒÚ; (·) ÌÓÏ‡ÎÌË ÂÊÂ‰ÌÂ‚ÌË ‰ÂÈÌÓÒÚË; (‚) ÌÓÏ‡-ÎÂÌ Ó·˘ ÍÓ„ÌËÚË‚ÂÌ Í‡Ô‡ˆËÚÂÚ; („) ÎËÔÒ‡ Ì‡ ‰ÂÏÂÌˆËfl.éÒ‚ÂÌ ÚÓ‚‡, Í‡ÚÓ Ì‡È-‚ÂÓflÚÌ‡ ÔË˜ËÌ‡ Á‡ ÍÓ„ÌËÚË‚ÌËfl‰ÂÙËˆËÚ ÒÂ ÔËÂÏ‡ åëÅ. íÂÁË ÍËÚÂËË ÌflÏ‡Ú Á‡ ˆÂÎ ‰‡‚ÍÎ˛˜‡Ú ‚ÒË˜ÍË ·ÓÎÌË, ÔË ÍÓËÚÓ åëÅ ‚Ó‰Ë ‰Ó ÍÓ„ÌË-ÚË‚ÌË Ì‡Û¯ÂÌËfl. ‡ ÒÂ ÓÚÌ‡ÒflÚ Ò‡ÏÓ ‰Ó ·ÓÎÌË, ÔË ÍÓË-ÚÓ ÚÂ ÒÂ ‰˙ÎÊ‡Ú Ì‡ "Á‡·ÓÎfl‚‡ÌÂ Ì‡ Ï‡ÎÍËÚÂ Ò˙‰Ó‚Â".

ÉÎ‡‚ÌËÚÂ ‚ÍÎ˛˜‚‡˘Ë ÍËÚÂËË, ÍÓËÚÓ ÔÓÍ‡Á‚‡Ú Ì‡ÎË-˜ËÂÚÓ Ì‡ åëÅ Ò‡: ‡ÚÂË‡ÎÌ‡ ıËÔËÚÓÌËfl; ÌÂ‚ÓÎÓ„Ë˜ÌË·ÂÎÂÁË; Ì‡ÎË˜ËÂ Ì‡ ‰‡ÌÌË Á‡ åëÅ ÓÚ ÌÂ‚ÓËÁÓ·‡Áfl‚‡˘Ó-ÚÓ ËÁÒÎÂ‰‚‡ÌÂ (åêí ‰‡ÌÌË Á‡ Â‰ËÌË˜ÌË ËÎË ÏÌÓÊÂÒÚ‚ÂÌËÎ‡ÍÛÌ‡ÌË ÔÓ‰ÍÓÓ‚Ë ËÌÙ‡ÍÚË, ÌÂ ‚ÍÎ˛˜‚‡˘Ë ÚÂÁË ÒÔÂ‰Ì‡ Ú‡Î‡ÏË˜Ì‡ ÎÓÍ‡ÎËÁ‡ˆËfl). Ç ‰ÓÔ˙ÎÌÂÌËÂ, ‚ÍÎ˛˜‚‡-ÌÂÚÓ ‚ Ú‡ÁË „ÛÔ‡ ÒÂ ÔÓ‰ÍÂÔfl ÓÚ ÒÎÂ‰ÌËÚÂ ‚ÚÓÓÒÚÂ-ÔÂÌÌË ÍËÚÂËË: ‡Ì‡ÏÌÂÁ‡Ú‡ Á‡ Ò˙‰Â˜ÌÓ Á‡·ÓÎfl‚‡ÌÂË/ËÎË “Ï‡Î˙Í” ËÌÒÛÎÚ; ÓÒÚÓ Ì‡˜‡ÎÓ, ÒÚ˙Ô‡ÎÓ‚Ë‰Ì‡ Â‚Ó-Î˛ˆËfl, ËÎË ÙÎÛÍÚÛ‡ˆËfl Ì‡ ÍÓ„ÌËÚË‚ÌÓÚÓ Ì‡Û¯ÂÌËÂ;ÂÏÓˆËÓÌ‡ÎÌ‡ ËÌÍÓÌÚËÌÂÌÚÌÓÒÚ.

Ñ‡ÌÌËÚÂ ÓÚ ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌËÚÂ ÚÂÒÚÓ‚Â ‚ „ÛÔ‡Ú‡·ÓÎÌË Â Ò‡‚Ìfl‚‡Ì‡ Ò ÚÂÁË Ì‡ ÍÓÌÚÓÎÌ‡ „ÛÔ‡ Ò˙ÒÚ‡‚ÂÌ‡ÓÚ ÍÎËÌË˜ÌÓ Á‰‡‚Ë ÎËˆ‡ (19 Ï˙ÊÂ Ë 6 ÊÂÌË), ÍÓËÚÓ ÓÚ-„Ó‚‡flÚ ÔÓ ‚˙Á‡ÒÚ Ë Ó·‡ÁÓ‚‡ÚÂÎÂÌ ˆÂÌÁ Ì‡ Ô‡ˆËÂÌÚË-ÚÂ. íÂ ÌÂ Ò˙Ó·˘‡‚‡Ú ‰‡ÌÌË, ÌËÚÓ ËÏ‡Ú ÒËÏÔÚÓÏË Á‡Í‡Í‚ÓÚÓ Ë ‰‡ Â ÌÂ‚ÓÎÓ„Ë˜ÌÓ ËÎË ÔÒËıË‡ÚË˜ÌÓ Á‡·ÓÎfl‚‡-ÌÂ Ë ÒÍËÌËÌ„Ó‚ÓÚÓ ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌÓ ËÁÒÎÂ‰‚‡ÌÂ ÌÂ ÔÓ-Í‡Á‚‡ Ì‡Û¯ÂÌËÂ Ì‡ ÍÓ„ÌËÚË‚ÌËÚÂ ËÏ ÙÛÌÍˆËË. ÇÒË˜ÍËÎËˆ‡ Ò‡ ÓÚ ÙÂÌÒÍË ÔÓËÁıÓ‰.

äÓ„ÌËÚË‚ÌËÚÂ ÙÛÌÍˆËË ÔË ·ÓÎÌËÚÂ Ë ÔË „ÛÔ‡Ú‡ÓÚ Á‰‡‚Ë ÍÓÌÚÓÎË Ò‡ ÓˆÂÌfl‚‡ÌË Ò ·‡ÚÂËfl Ò˙ÒÚ‡‚ÂÌ‡ÓÚ ÒÛ·ÚÂÒÚÓ‚Â Ë Ò˙Í‡ÚÂÌË ‚ÂÒËË Ì‡ ¯ËÓÍÓ ËÁÔÓÎÁ‚‡-ÌË ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌË ÏÂÚÓ‰ËÍË. è‡ÏÂÚÚ‡ Â ËÁÒÎÂ‰‚‡Ì‡Ò: Digit Span (forward) ÓÚ Wechsler Adult Inteligence Scale(WAIS) Ë Corsi Block Tapping Test Á‡ ÓˆÂÌÍ‡ Ò˙ÓÚ‚ÂÚÌÓ Ì‡Í‡ÚÍÓÒÓ˜Ì‡ ‚Â·‡ÎÌ‡ Ë ÌÂ‚Â·‡ÎÌ‡ Ô‡ÏÂÚ, Í‡ÍÚÓ Ë ÒBuschke Free and Cued Selective Reminding Test (FCSRT) Á‡ÓˆÂÌÍ‡ Ì‡ ‚Â·‡ÎÌ‡ ÂÔËÁÓ‰Ë˜Ì‡ Ô‡ÏÂÚ ˜ÂÁ ËÁÒÎÂ‰‚‡ÌÂ Ì‡Ò‚Ó·Ó‰ÌÓÚÓ ÔËÔÓÏÌflÌÂ, Ó·˘ÓÚÓ (Ò‚Ó·Ó‰ÌÓ Ë ÛÎÂÒÌÂÌÓ)ÔËÔÓÏÌflÌÂ Ë ‡ÁÔÓÁÌ‡‚‡ÌÂÚÓ. ÖÍÁÂÍÛÚË‚ÌËÚÂ ÙÛÌÍˆËËÒ‡ ËÁÒÎÂ‰‚‡ÌË Ò: Trail Making Test – Ä (TMT-A) Ë Ç (TMT-B), ÔË ÍÓËÚÓ ÒÂ ÓˆÂÌfl‚‡ ·Ófl Ì‡ Ô‡‚ËÎÌÓ Ò‚˙Á‡ÌËÚÂÚÓ˜ÍË; Modified Card Sorting Test (MCST), ÔË ÍÓÈÚÓ ÒÂÓˆÂÌfl‚‡ ·ÓflÚ Ì‡ Á‡‚˙¯ÂÌËÚÂ Í‡ÚÂ„ÓËË Ë Ì‡ ÔÂÒÂ‚Â-‡ˆËËÚÂ; Verbal Fluency (Í‡ÚÂ„ÓËË ÊË‚ÓÚÌË, ÔÎÓ‰Ó‚Â,ÁÂÎÂÌ˜ÛˆË), ÔË ÍÓÈÚÓ ÒÂ ÓˆÂÌfl‚‡ Ó·˘ËflÚ ·ÓÈ ÂÎÂÏÂÌÚËË ÔÂÒÂ‚Â‡ˆËË ‚ ÚËÚÂ Í‡ÚÂ„ÓËË; Similarities ÒÛ·ÚÂÒÚÓÚ WAIS.

ï‡‡ÍÚÂËÒÚËÍËÚÂ Ì‡ ‚ÍÎ˛˜ÂÌËÚÂ „ÛÔË Ò‡ ÔÂ‰ÒÚ‡-‚ÂÌË Ì‡ Ú‡·ÎËˆ‡ 1. é·‡ÁÓ‚‡ÌËÂÚÓ Â ÓˆÂÌfl‚‡ÌÓ Í‡ÍÚÓ ‚ÔÂ‰Ë¯ÌËÚÂ ÔÓÛ˜‚‡ÌËfl Ò ÚËÒÚÂÔÂÌÌ‡ ÒÍ‡Î‡. ê‡ÁÎËÍË-ÚÂ ÏÂÊ‰Û ÚËÚÂ „ÛÔË ‚˙‚ ‚˙Á‡ÒÚÚ‡, Ó·‡ÁÓ‚‡ÌËÂÚÓ,ÂÁÛÎÚ‡ÚËÚÂ ÓÚ MMS Ë ÓÚ ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌËÚÂ ÚÂÒ-ÚÓ‚Â Ò‡ ÓˆÂÌfl‚‡ÌË Ò ÔÓÏÓ˘Ú‡ Ì‡ non paired t-test.


T‡·ÎËˆ‡ 1 ï‡‡ÍÚÂËÒÚËÍË Ì‡ ‚ÍÎ˛˜ÂÌËÚÂ „ÛÔË

ï‡‡ÍÚÂËÒÚËÍË ëäç äÓÌÚÓÎË (n=20) (n=25)

èÓÎ (Ü/M) 10/10 19/6

Ç˙Á‡ÒÚ 81.8 (5.6) 80.4 (5.8)

é·‡ÁÓ‚‡ÌËÂ/3 1.9 (0.7) 2.0 (0.8)

ÖàÑ/8 7.5 (0.5) 7.9 (0.2)

MMS/30 28.2 (1.7) 29.2 (0.6)

ëäç = Ò˙‰Ó‚Ó ÍÓ„ÌËÚË‚ÌÓ ÌÛ¯ÂÌËÂ;

ÖàÑ = ÂÊÂ‰ÌÂ‚ÌË ËÌÒÚÛÏÂÌÚ‡ÎÌË ‰ÂÈÌÓÒÚË; MMS = Mini

Mental State.

Ñ‡ÌÌËÚÂ Ò‡ ÒÂ‰ÌÓ ‡ËÚÏÂÚË˜ÌË (SD).

êÂÁÛÎÚ‡ÚËÚÂ ÓÚ ÔÓ‚Â‰ÂÌËfl ‡Ì‡ÎËÁ ÌÂ ÔÓÍ‡Á‚‡Ú ÁÌ‡-˜ËÏË ‡ÁÎËÍË ÏÂÊ‰Û „ÛÔËÚÂ ÔÓ ÓÚÌÓ¯ÂÌËÂ Ì‡ ‚˙Á‡ÒÚ-Ú‡, Ó·‡ÁÓ‚‡ÚÂÎÌËfl ˆÂÌÁ, ÂÁÛÎÚ‡ÚËÚÂ ÓÚ MMS Ë ÒÍ‡-Î‡Ú‡ Á‡ ËÁÔ˙ÎÌÂÌËÂ Ì‡ ÖàÑ.

êÖáìãíÄíà

êÂÁÛÎÚ‡ÚËÚÂ ÓÚ ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌÓÚÓ ËÁÒÎÂ‰‚‡ÌÂÔË ·ÓÎÌËÚÂ Ò ëäç Ë ÔË Á‰‡‚ËÚÂ ÍÓÌÚÓÎË Ò‡ ÔÂ‰ÒÚ‡-‚ÂÌË Ì‡ Ú‡·ÎËˆ‡ 2. ÄÌ‡ÎËÁË‡ÌÂÚÓ Ì‡ ‰‡ÌÌËÚÂ Ò t-test ÔÓ-Í‡Á‚‡ ÁÌ‡˜ËÏË ‡ÁÎËÍË ÔË ˜‡ÒÚ ÓÚ ÚÂÒÚÓ‚ÂÚÂ (p < 0.05‰Ó 0.0001, í‡·Î. 2).

èË Ô‡ÏÂÚÓ‚ËÚÂ ÚÂÒÚÓ‚Â, ‡Ì‡ÎËÁ˙Ú ÔÓÍ‡Á‚‡, ˜Â ·ÓÎ-ÌËÚÂ ËÏ‡Ú ÁÌ‡˜ËÏÓ ÔÓ-ÌËÒÍË ÒÚÓÈÌÓÒÚË ÔÂ‰ËÏÌÓ ÔËÒ‚Ó·Ó‰ÌÓÚÓ, Í‡ÍÚÓ ÌÂÔÓÒÂ‰ÒÚ‚ÂÌÓ, Ú‡Í‡ Ë ÓÚ‰‡ÎÂ˜ÂÌÓÔËÔÓÏÌflÌÂ Ì‡ FCSRT ‚ Ò‡‚ÌÂÌËÂ Ò ÍÓÌÚÓÎÌ‡Ú‡ „ÛÔ‡.ìÎÂÒÌÂÌÓÚÓ ÔËÔÓÏÌflÌÂ ÁÌ‡˜ËÏÓ ÔÓ‰Ó·fl‚‡ Ó·˘ÓÚÓ ÔË-ÔÓÏÌflÌÂ, Í‡ÚÓ ÚÓ ‰ÓÒÚË„‡ ÌÓÏ‡ÎÌË ÒÚÓÈÌÓÒÚË. ê‡ÁÔÓÁ-Ì‡‚‡ÌÂÚÓ ÔË ·ÓÎÌËÚÂ Ò˙Ò ëäç Â Ë‰ÂÌÚË˜ÌÓ Ò ÚÓ‚‡ Ì‡

Á‰‡‚ËÚÂ ÍÓÌÚÓÎË. ä‡ÚÍÓÒÓ˜Ì‡Ú‡ Ô‡ÏÂÚ ÓˆÂÌfl‚‡Ì‡ ÒCorsi test Â ÁÌ‡˜ËÏÓ Ì‡Û¯ÂÌ‡ ÔË ·ÓÎÌËÚÂ ‚ Ò‡‚ÌÂÌËÂ ÒÍÓÌÚÓÎËÚÂ, ‰ÓÍ‡ÚÓ ˆËÙÓ‚ËflÚ Ó·ı‚‡Ú Â ‚ ÌÓÏ‡ÎÌË„‡ÌËˆË.

èÓ ÓÚÌÓ¯ÂÌËÂ Ì‡ ÚÂÒÚÓ‚ÂÚÂ, ÍÓËÚÓ ËÁÒÎÂ‰‚‡Ú ‡Á-ÎË˜ÌË ‡ÒÔÂÍÚË Ì‡ ‚ÌËÏ‡ÌËÂÚÓ Ë ÂÍÁÂÍÛÚË‚ÌËÚÂ ÙÛÌÍ-ˆËË, Ò‡‚ÌÂÌËÂÚÓ ÔÓÍ‡Á‚‡ ÁÌ‡˜ËÏË ‡ÁÎËÍË ÏÂÊ‰Û ‰‚ÂÚÂ„ÛÔË ÔË TMT-Ä Ë B, Similarities ÒÛ·ÚÂÒÚ‡, Í‡ÍÚÓ Ë·Ófl Í‡ÚÂ„ÓËË ÔË MCST Ë Verbal Fluency. ôÓ ÒÂ ÓÚÌ‡-Òfl ‰Ó ‚Ë‰‡ Ë ÍÓÎË˜ÂÒÚ‚ÓÚÓ Ì‡ ÔÂÒÂ‚Â‡ˆËËÚÂ, ·ÓÎÌËÚÂÒ˙Ò ëäç ‰ÓÔÛÒÍ‡Ú ÁÌ‡˜ËÏÓ ÔÓ‚Â˜Â ÔÂÒÂ‚Â‡ˆËË ÔËMCST, ‰ÓÍ‡ÚÓ ÔË Í‡ÚÂ„ÓË‡ÎÌ‡Ú‡ ‚Â·‡ÎÌ‡ ÙÎÛË‰ÌÓÒÚ,·ÓflÚ Ì‡ ÔÂÒÂ‚Â‡ˆËËÚÂ Â ‚ ÌÓÏ‡.

èÓ ÓÚÌÓ¯ÂÌËÂ Ì‡ ÚÂÒÚÓ‚ÂÚÂ, ÓˆÂÌfl‚‡˘Ë Â˜Â-‚ËÚÂ ÒÔÓÒÓ·ÌÓÒÚË (BNT Ë Token test), ‡Ì‡ÎËÁ˙Ú Ì‡ ‰‡ÌÌË-ÚÂ ÔÓÍ‡Á‚‡ ÎËÔÒ‡ Ì‡ ÁÌ‡˜ËÏË ‡ÁÎËÍË ÏÂÊ‰Û ·ÓÎÌËÚÂ ËÁ‰‡‚ËÚÂ ÍÓÌÚÓÎË. íÂÒÚ˙Ú, ÓˆÂÌfl‚‡˘ Í‡ÚÂ„ÓË‡ÎÌ‡Ú‡‚Â·‡ÎÌ‡ ÙÎÛË‰ÌÓÒÚ, ÔÓÍ‡Á‚‡ ÁÌ‡˜ËÏÓ ÔÓ-ÌËÒ˙Í ÂÁÛÎÚ‡ÚÔË ·ÓÎÌËÚÂ, ÌÓ ·ÓflÚ Ì‡ ÔÂÒÂ‚Â‡ˆËËÚÂ Â ‚ ÌÓÏ‡ÎÌË„‡ÌËˆË. á‡‰‡˜ËÚÂ, ÓˆÂÌfl‚‡˘Ë ÍÓÌÒÚÛÍÚË‚ÌËfl Ô‡ÍÒËÒ,Ò˙˘Ó ÌÂ ÔÓÍ‡Á‚‡Ú ‡ÁÎË˜Ëfl ÏÂÊ‰Û ‰‚ÂÚÂ ËÁÒÎÂ‰‚‡ÌË „Û-ÔË.

éÅëöÜÑÄçÖ

êÂÁÛÎÚ‡ÚËÚÂ ÓÚ ÚÓ‚‡ ÔÓÛ˜‚‡ÌÂ ÔÓÍ‡Á‚‡Ú, ˜Â ·ÓÎÌË-ÚÂ Ò˙Ò ëäç ËÏ‡Ú ÁÌ‡˜ËÏÓ Ì‡Û¯ÂÌËÂ ‚ Ò‚Ó·Ó‰ÌÓÚÓ ÔË-ÔÓÏÌflÌÂ, ÁÌ‡˜ËÚÂÎÌÓ ÔÓ-‰Ó·Ó ÛÎÂÒÌÂÌÓ ÔËÔÓÏÌflÌÂ ËÔÓ˜ÚË ÌÓÏ‡ÎÌÓ ‡ÁÔÓÁÌ‡‚‡ÌÂ. ÅÓÎÌËÚÂ ÒÂ ‚˙ÁÔÓÎÁ‚‡ÚÓ˘Â ÔÓ-‰Ó·Â ÓÚ ÛÎÂÒÌÂÌÓÚÓ ÔËÔÓÏÌflÌÂ, ‰Ó ÒÚÂÔÂÌ, ˜ÂÓ·˘ÓÚÓ ÔËÔÓÏÌflÌÂ ÔË Úflı Â ‚ ÌÓÏ‡ÎÌË „‡ÌËˆË, ‡ ‡Á-ÔÓÁÌ‡‚‡ÌÂÚÓ Â Ë‰ÂÌÚË˜ÌÓ Ò ÚÓ‚‡ Ì‡ Á‰‡‚ËÚÂ ÍÓÌÚÓÎË.

äÓ„ÌËÚË‚ÌËflÚ ‰ÂÙËˆËÚ Â ‰ÓÏËÌË‡Ì ÔÂ‰ËÏÌÓ ÓÚÌ‡Û¯ÂÌËfl ‚ ÒËÒÚÂÏËÚÂ Ì‡ ‚ÌËÏ‡ÌËÂÚÓ (ÔÂ‰ËÏÌÓ ‡ÁÔ-Â‰ÂÎÂÌÓÚÓ ‚ÌËÏ‡ÌËÂ) Ë ÂÍÁÂÍÛÚË‚ÌËÚÂ ÙÛÌÍˆËË (ËÁ‡-·ÓÚ‚‡ÌÂ Ì‡ ÒÚ‡ÚÂ„ËË; ‚ÁËÏ‡ÌÂ Ì‡ Â¯ÂÌËÂ; ËÌıË·Ë‡ÌÂÌ‡ ÌÂ‡‰ÂÍ‚‡ÚÌËÚÂ Á‡ ÒÎÛ˜‡fl, ‡ÁÒÂÈ‚‡˘Ë Â¯ÂÌËfl; Í‡ÍÚÓË ÓˆÂÌÍ‡Ú‡ Ì‡ Ó·‡ÚÌ‡Ú‡ ‚˙ÁÍ‡ Á‡ Í‡˜ÂÒÚ‚ÓÚÓ Ë ÔÓÒÎÂ-‰Ó‚‡ÚÂÎÌÓÒÚÚ‡ Ì‡ ËÁ‚˙¯ÂÌËÚÂ ÓÔÂ‡ˆËË).

Ç ‰ÓÔ˙ÎÌÂÌËÂ Ì‡ Ô‡ÏÂÚÓ‚Ëfl ‰ÂÙËˆËÚ Ë ‰ËÒÂÍÁÂÍÛÚË‚-ÌËfl ÒËÌ‰ÓÏ, ÒÂ Ì‡·Î˛‰‡‚‡ ÒÔÂˆËÙË˜ÂÌ ÔÓÙËÎ Ì‡ ·Ófl Ë‚Ë‰‡ Ì‡ ÔÂÒÂ‚Â‡ˆËËÚÂ. ÅÓÎÌËÚÂ ‰ÓÔÛÒÍ‡Ú ÁÌ‡˜ËÏÓ ÔÓ-‚Â˜Â ÔÂÒÂ‚Â‡ˆËË ÔË ÚÂÒÚÓ‚ÂÚÂ Á‡ ÓˆÂÌÍ‡ Ì‡ ÂÍÁÂÍÛ-ÚË‚ÌË ÙÛÌÍˆËË, ÓÚÍÓÎÍÓÚÓ ÔË ÚÂÒÚÓ‚ÂÚÂ, ÓˆÂÌfl‚‡˘ËÒÂÏ‡ÌÚË˜ÌËÚÂ ÁÌ‡ÌËfl. ä‡ÚÍÓÒÓ˜Ì‡Ú‡ ÌÂ‚Â·‡ÎÌ‡ Ô‡-


T‡·ÎËˆ‡ 2: êÂÁÛÎÚ‡ÚË ÓÚ ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌËÚÂ ÚÂÒÚÓ‚Â

äÓÌÚÓÎË ëäç p <è‡ÏÂÚ Digit Span 5.9 ± 1.0 5.3 ± 0.: 0.064

Corsi Test 5.1 ± 0.7 4.2 ± 0.6 0.0001

ÖÍÁÂÍÛÚË‚ÌË ÙÛÌÍˆËËTrail Making Test A 25.0 ± 0 24.0 ± 1.6 0.002

åÂÌÚ‡ÎÂÌ ÍÓÌÚÓÎ 12.7 ± 0.7 12.6 ± 0.8 0.59

Trail Making Test B 23.9 ± 2.4 14.9 ± 6.9 0.00001

MCST (Í‡ÚÂ„ÓËË) 5.8 ± 0.4 2.5 ± 1.7 0.00001

Similarities 10.7 ± 1.2 8.7 ± 2.6 0.02

Verbal Fluency (Ó·˘ Ò·Ó) 48.6 ± 8.9 30.9 + 7.5 0.00001

êÂ˜BNT 14.0 + 1.15 13.65 + 1.0 0.29

Token test 33.0 + 2.84 31.95 + 2.4 0.21

äÓÌÒÚÛÍÚË‚ÂÌ Ô‡ÍÒËÒ 8.1 + 0.81 7.5 + 1.2 0.06

Ñ‡ÌÌËÚÂ Ò‡ ÒÂ‰ÌÓ ‡ËÚÏÂÚË˜ÌË + SD. (t-test; p<0.05).

MCST = Modified Card Sorting Test; BNT = Boston Naming test.

îË„Û‡ 1. êÂÁÛÎÚ‡ÚË ÓÚ ËÁÔ˙ÎÌÂÌËÂÚÓ Ì‡ FCSRT (Free and CuedSelective Reminding Test) ÔË Ô‡ˆËÂÌÚË Ò˙Ò Ò˙‰Ó‚Ó ÍÓ„ÌËÚË‚ÌÓ

Ì‡Û¯ÂÌËÂ (ëäç) ‚ Ò‡‚ÌÂÌËÂ Ò ÍÓÌÚÓÎÌ‡ „ÛÔ‡: ë‚è = Ò‚Ó·Ó‰ÌÓÔËÔÓÏÌflÌÂ, é·˘Óè = Ó·˘Ó ÔËÔÓÏÌflÌÂ (Ò‚Ó·Ó‰ÌÓ Ë ÛÎÂÒÌÂÌÓ),ë‚éÚ‰ = Ò‚Ó·Ó‰ÌÓ ÓÚ‰‡ÎÂ˜ÂÌÓ ÔËÔÓÏÌflÌÂ, é·˘ÓéÚ‰ = Ó·˘Ó

ÓÚ‰‡ÎÂ˜ÂÌÓ ÔËÔÓÏÌflÌÂ, ê‡ÁÔ = ‡ÁÔÓÁÌ‡‚‡ÌÂ.

ÏÂÚ Ë ‚Â·‡ÎÌ‡Ú‡ ÙÎÛË‰ÌÓÒÚ Ò‡ ÁÌ‡˜ËÏÓ Ì‡Û¯ÂÌË ÔË·ÓÎÌËÚÂ.

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Î‡ÒËÂ Ò ‰Û„Ë ‡‚ÚÓË (8,17).ÂÁÛÎÚ‡ÚËÚÂ ÌÂ ÔÓÍ‡Á‚‡ÚÁÌ‡˜ËÏË ‡ÁÎËÍË ÏÂÊ‰Û ·ÓÎÌËÚÂ Ë Á‰‡‚ËÚÂ ÍÓÌÚÓÎË.íÂÁË ‰‡ÌÌË Ò‡ ‚ Ò˙„Î‡ÒËÂ Ò Ì‡¯‡Ú‡ ıËÔÓÚÂÁ‡ Á‡ ÔÓ‰ÍÓÓ‚‡ÎÓÍ‡ÎËÁ‡ˆËfl Ì‡ ÎÂÁËËÚÂ, ÍÓflÚÓ ÌÂ ÔÂ‰ÔÓÎ‡„‡ Â˜Â‚Ë Ì‡-Û¯ÂÌËfl.

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ãàíÖêÄíìêÄ1. American Psychiatric Association. Diagnostic and Statistical Manual ofMental Disorders, ed 4, Washington, DC, American Psychiatric Association, 1994.2. Boller, F., Traykov, L. Classification and diagnosis of dementias. In:Dementias: Biological basis and clinical approach to treatment. Expert inNeuroscience Series (S. Govoni, C.L. Bolis, M. Trabucchi, eds), Milan, Springer-Verlag, 1999, 51-76.3. Bowler, J.V., Steenhuis, R., Hachinski, V. Conceptual background to vascularcognitive impairment. Alzheimer Dis. Assoc. Disord., 1999, Suppl 3, 30-37.4. Cummings, J.L. Anatomic and behavioral aspects of frontal-subcortical cir-cuits. Ann. N.Y. Acad. Sci., 1995, 769, 1-13.5. Erkinjuntti, T., Inzitari, D., Pantoni, L., Wallin, A., Scheltens, P., Rockwood,K., Roman, G.C., Chui, H., Desmond, D.W. Research criteria for subcortical vas-cular dementia in clinical trials. J. Neural. Transm., Suppl 2000, 59, 23-30.6. Inzitari, D., Erkinjuntti, T., Wallin, A., del Ser, T., Pantoni, L. Is subcorticalvascular dementia a clinical entity for clinical drug trials? Alzheimer Dis. Assoc.Disord., 1999, 13, S3, 66-68.7. Lafosse, J.M., Reed, B.R., Mungas, D., Sterling, S.B., Wahbeh, H., Jagust,W.J. Fluency and memory differences between ischemic vascular dementia andAlzheimer's disease. Neuropsychology, 1997, 11, 514-22.8. Looi, J.C., Sachdev, P.S. Differentiation of vascular dementia from AD onneuropsychological tests. Neurology, 1999, 53, 670-678.9. Petersen, R.C., Doody, R., Kurz, A., Mohs, R.C., Morris, J.C., Rabins, P.V.,Ritchie, K., Rossor, M., Thal, L., Winblad, B. Current concepts in mild cognitiveimpairment. Arch. Neurol., 2001, 58, 1985-1992.10. Ransmayr, G. Difficulties in the clinical diagnosis of vascular dementia anddementia of the Alzheimer. J. Neural. Transm., 1998, 53, 79-90. 11. Rao, R., Howard, R. Vascular dementia: dead or alive? Int. J. Geriatr.Psychiatry, 1998, 13, 277-284.12. Roman, G.C., Tatemichi, T.K., Erkinjuntti, T., Cummings, J.L., Masdeu, J.C.,Garcia, J.H., Amaducci, L., Orgogozo, J.M., Brun, A., Hofman, A., Moody, D.M.,O'Brien, M.D., Yamaguchi, T., Grafman, G., Drayer, B.P., Bennett, D.A., Fisher,M., Pajeau, A.K., Bell, M.A., DeCarli, C., Culebras, A., Korczyn, A.D.,Bogousslavsky, J., Hartmann, A., Scheinberg, P. Vascular dementia: diagnostic cri-teria for research studies (Report of the NINDS-AIREN International Workshop).Neurology, 1993, 43, 250-260.13. Schmidt, R., Fazekas, F., Offenbacher, H., Lytwyn, H., Blematl, B.,Niederkorn, K., Horner, S., Payer, F., Freidl, W. Magnetic resonance imagingwhite matter lesions and cognitive impairment in hypertensive individuals. Arch.Neurol., 1991, 48, 417-420.14. van Swieten, J.C., Geyskes, G.G., Derix, M.M., Peeck, B.M., Ramos, L.M.,van Latum, J.C., van Gijn, J. Hypertension in the elderly is associated with whitematter lesions and cognitive decline. Ann. Neurol., 1991, 30, 825-830.15. Tei, H., Miyazaki, A., Iwata, M., Osawa, M., Nagata, Y., Maruyama, S.Early-stage Alzheimer's disease and multiple subcortical infarction with mild cog-nitive impairment: neuropsychological comparison using an easily applicable testbattery. Dement. Geriatr. Cogn. Disord., 1997, 8, 355-358.16. Traykov, L. Boller, F. Patterns of cognitive dysfunction in dementia. In:Dementia: A multidisciplinary approach (C. Mangone R. Allegri R. Arizaga J.Ollari, eds), Buenos Aires, Ediciones Sagitario, 1997, 313-328.17. Traykov, L., Baudic, S., Thibaudet, M.C., Rigaud, A.S., Smagghe, A., Boller,F. Neuropsychological deficit in early subcortical vascular dementia: comparisonto Alzheimer’s disease. Dement. Geriatr. Cogn. Disord., 2002, 14, 26-32.

Ä‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËfl: ÑÓˆ. ‰- ã. í‡ÈÍÓ‚, ‰Ï, åÅÄã “ÄÎÂÍÒ‡Ì‰Ó‚ÒÍ‡”, çÂ‚ÓÎÓ„Ë˜Ì‡ ÍÎËÌËÍ‡, ÛÎ. “ë‚. ÉÂÓ„Ë ëÓÙËÈÒÍË” 1, ëÓ-ÙËfl 1431


SUMMARY

ATYPICAL VARIANTS OF GUILLAIN-BARRE SYNDROMESUMMARY

COMBINED STUDY ON DERMATOME AND TIBIALSOMATOSENSORY EVOKED POTENTIALS IN THE

ASSESSMENT OF LUMBOSACRAL SPINAL STENOSISK. Kostov, Iv. Petrov, Iv. Ivanova

Up to now lumbosacral spinal stenosis (LSSS) has beendiagnosed mainly clinically and through confirmation bynerve-imaging methods. As it is a neurocompressive diseaseof the nerve roots causing delayed nerve transfer similar tothat at other compressive tunnel syndromes, the neurophysio-logical approach to the diagnosis would be the most adequateone. The combined test of somatosensory evoked potentials(SEPs) of n. tibialis and lumbosacral dermatomes providesthis possibility. The method was implemented on 56 patients(39 men and 17 women), mean age 57 years (36 – 65 years)with clinical signs of bilateral root injury, but without pelvicreservoir disturbances and without classic symptoms of acute-ly developed syndrome of cauda equina. Twelve patients hadclinically expressed symptoms of LSSS. All patients under-went EMG and following nerve-imaging test. In 34 (91.8%)of 37 patients where the nerve-imaging test verified LSSS,electrophysiological data for multiple root injury were foundby dermatomal somatosensory evoked potentials (DSEPs),and in 31 (83.8%) of them DSEPs abnormalities were com-bined with bilateral abnormal tibial SEPs. EMG found abnor-mality for radiculopathy of more than two roots of thesepatients. The difference was statistically significant (χ2 = 5.1;0.05 > p(χ2) > 0.01).

Those results suggest that the combined testing of SEPs ofthe tibial nerve and DSEPs is valuable and reliable electro-physiological technique for diagnosis, functional assessmentand documentation of LSSS.

Key words: somatosensory evoked potentials (SEPs); der-matomal somatosensory evoked potentials (DSEPs); lum-bosacral spinal stenosis (LSSS).

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ÑÓ Ì‡ÒÚÓfl˘ËflÚ ÏÓÏÂÌÚ ÎÛÏ·ÓÒ‡Í‡ÎÌ‡Ú‡ ÒÔËÌ‡ÎÌ‡ÒÚÂÌÓÁ‡ (ãëëë) ÒÂ ‰Ë‡„ÌÓÒÚËˆË‡ ÓÒÌÓ‚ÌÓ ÍÎËÌË˜ÌÓ Ë ÒÔÓÚ‚˙Ê‰ÂÌËÂ ÓÚ ÌÂ‚ÓËÁÓ·‡Áfl‚‡˘ËÚÂ ÏÂÚÓ‰Ë. í˙ÈÍ‡ÚÓ Úfl Â ıÓÌË˜ÌÓ ÍÓÏÔÂÒË‚ÌÓ Á‡·ÓÎfl‚‡ÌÂ Ì‡ ÌÂ‚ÌË-ÚÂ ÍÓÂÌ˜ÂÚ‡ ‚Ó‰Â˘Ó ‰Ó Á‡·‡‚flÌÂ Ì‡ ÌÂ‚ÌÓÚÓ ÔÓ‚ÂÊ-‰‡ÌÂ, ‡Ì‡ÎÓ„Ë˜ÌÓ Ì‡ ÚÓ‚‡ ÔË ÓÒÚ‡Ì‡ÎËÚÂ ÍÓÏÔÂÒË‚ÌË“ÚÛÌÂÎ” ÒËÌ‰ÓÏË, ÌÂ‚ÓÙËÁËÓÎÓ„Ë˜ÌËflÚ ÔÓ‰ıÓ‰ Í˙Ï ‰Ë-‡„ÌÓÁ‡Ú‡ ·Ë ·ËÎ Ì‡È-ÔÓ‰ıÓ‰fl˘. äÓÏ·ËÌË‡ÌÓÚÓ ÚÂÒÚ‚‡-ÌÂ Ì‡ ëÖè ÓÚ n.tibialis Ë ÎÛÏ·ÓÒ‡Í‡ÎÌËÚÂ ‰ÂÏ‡ÚÓÏË‰ÓÒÚ‡‚fl Ú‡ÁË ‚˙ÁÏÓÊÌÓÒÚ. åÂÚÓ‰ËÍ‡Ú‡ Â ÔËÎÓÊÂÌ‡ÔË 56 Ô‡ˆËÂÌÚ‡ (39 Ï˙ÊÂ Ë 17 ÊÂÌË), Ì‡ ÒÂ‰Ì‡ ‚˙Á‡ÒÚ57„. (ÓÚ 36 ‰Ó 65 „.), Ò ÍÎËÌË˜ÌÓ ÔÓfl‚ÂÌË ÒËÏÔÚÓÏË Ì‡‰‚ÛÒÚ‡ÌÌ‡ ÍÓÂÌ˜Â‚‡ Û‚Â‰‡, ÌÓ ·ÂÁ Ú‡ÁÓ‚Ó ÂÁÂ‚Ó‡ÌËÌ‡Û¯ÂÌËfl Ë ·ÂÁ ÍÎ‡ÒË˜ÂÒÍË ÒËÏÔÚÓÏË Ì‡ ÓÒÚÓ ‡Á‚ËÎÒÂ ÒËÌ‰ÓÏ Ì‡ Í‡Û‰‡ ÂÍ‚ËÌ‡. Ñ‚‡Ì‡‰ÂÒÂÚ ÓÚ Ô‡ˆËÂÌÚËÚÂÒ‡ Ò ÍÎËÌË˜ÌÓ ÔÓfl‚ÂÌË ÒËÏÔÚÓÏË Ì‡ ãëëë. èË ‚ÒË˜ÍËÔ‡ˆËÂÌÚË Â ÓÒ˙˘ÂÒÚ‚ÂÌ‡ ÖåÉ Ë ‚ÔÓÒÎÂ‰ÒÚ‚ËÂ ÌÂ‚ÓË-ÁÓ·‡Áfl‚‡˘Ó ËÁÒÎÂ‰‚‡ÌÂ. èË 34 (91.8%) ÓÚ 37 Ô‡ˆËÂÌÚ‡

ÔË ÍÓËÚÓ ÌÂ‚ÓËÁÓ·‡Áfl‚‡˘ÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ ‚ÂËÙËˆË‡ãëëë, ˜ÂÁ ÑëÖè Ò‡ ÛÒÚ‡ÌÓ‚ÂÌË ÂÎÂÍÚÓÙËÁËÓÎÓ„Ë˜ÌË‰‡ÌÌË Á‡ ÏÌÓÊÂÒÚ‚ÂÌÓ ÍÓÂÌ˜Â‚Ó Á‡Òfl„‡ÌÂ, Í‡ÚÓ ÔË 31(83.8%) ÓÚ Úflı, ÑëÖè ‡·ÌÓÏÌÓÒÚËÚÂ Ò‡ Ò˙˜ÂÚ‡ÌË Ò‰‚ÛÒÚ‡ÌÌÓ ‡·ÌÓÏÌË ÚË·Ë‡ÎÌË ëÖè. ÖåÉ ÛÒÚ‡ÌÓ‚Ë‰‡ÌÌË Á‡ ‡‰ËÍÛÎÓÔ‡ÚËfl Ì‡ ÔÓ‚Â˜Â ÓÚ 2 ÍÓÂÌ˜Â ÔË 18 ÓÚÚÂÁË Ô‡ˆËÂÌÚË. ê‡ÁÎËÍ‡Ú‡ Â ÒÚ‡ÚËÒÚË˜ÂÒÍË ÁÌ‡˜ËÏ‡(χ2=5.1; 0.05>(χ2)>0.01).

íÂÁË ÂÁÛÎÚ‡ÚË ÔÂ‰ÔÓÎ‡„‡Ú, ˜Â ÍÓÏ·ËÌË‡ÌÓÚÓÚÂÒÚ‚‡ÌÂ Ì‡ ëÖè ÓÚ ÚË·Ë‡ÎÌËflÚ ÌÂ‚ Ë ÑëÖè Â ˆÂÌÌ‡Ë Ì‡‰ÂÊ‰Ì‡ ÂÎÂÍÚÓÙËÁËÓÎÓ„Ë˜Ì‡ ÚÂıÌËÍ‡ Á‡ ‰Ë‡„ÌÓÁ‡,ÙÛÌÍˆËÓÌ‡ÎÌ‡ ÓˆÂÌÍ‡ Ë ‰ÓÍÛÏÂÌÚË‡ÌÂ Ì‡ ãëëë.

äÎ˛˜Ó‚Ë ‰ÛÏË: ÒÓÏ‡ÚÓÒÂÌÁÓÌË Â‚ÓÍË‡ÌË ÔÓÚÂÌˆË-‡ÎË (ëÖè); ‰ÂÏ‡ÚÓÏÌË ÒÓÏ‡ÚÓÒÂÌÁÓÌË Â‚ÓÍË‡ÌË ÔÓ-ÚÂÌˆË‡ÎË (ÑëÖè); ÎÛÏ·ÓÒ‡Í‡ÎÌ‡ ÒÔËÌ‡ÎÌ‡ ÒÚÂÌÓÁ‡(ãëëë).

ìÇéÑ

äÓÏ·ËÌË‡ÌÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ Ì‡ ÒÓÏ‡ÚÓÒÂÌÁÓÌËÚÂ ÔÓ-ÚÂÌˆË‡ÎË (ëÖè) ÒÎÂ‰ ÒÚËÏÛÎ‡ˆËfl Ì‡ n.tibialis Ë ÓÚ‰ÂÎÌËÚÂÎÛÏ·ÓÒ‡Í‡ÎÌË ‰ÂÏ‡ÚÓÏË (ÑëÖè) ‰‡‚‡ ËÌÙÓÏ‡ˆËfl Á‡ ÛÒ-Ú‡ÌÓ‚fl‚‡ÌÂ Ë ÓˆÂÌÍ‡ Ì‡ ÎÛÏ·ÓÒ‡Í‡ÎÌ‡Ú‡ ÒÔËÌ‡ÎÌ‡ ÒÚÂÌÓ-Á‡ (ãëëë) Í‡ÍÚÓ ËÁÒÎÂ‰‚‡ÌÂÚÓ Ì‡ ÌÂ‚Ì‡Ú‡ ÔÓ‚Ó‰ËÏÓÒÚÔË ÔÂËÙÂÌÓ ÌÂ‚ÌËÚÂ “ÚÛÌÂÎ” ÒËÌ‰ÓÏË. èÂÁ 1956 „.Simpson ÓÔËÒ‚‡ ‡·ÌÓÏÌÓÒÚËÚÂ ‚ ÔÓ‚ÂÊ‰‡ÌÂÚÓ ÔÓ n.medianus ÔË Í‡Ô‡ÎÌËfl ÚÛÌÂÎ ÒËÌ‰ÓÏ (11). èÂ‰Ë ÚÓ‚‡“‡ÍÓÔ‡ÂÒÚÂÁËflÚ‡” Â ·ËÎ‡ ‰Ë‡„ÌÓÒÚËˆË‡Ì‡ ‚˙Á ÓÒÌÓ‚‡Ò‡ÏÓ Ì‡ ÍÎËÌË˜ÌËÚÂ ÒËÏÔÚÓÏË. ëÎÂ‰ ‰ÓÍ‡Á‚‡ÌÂÚÓ, ˜Â ÔÓ-‚Ó‰ËÏÓÒÚÚ‡ ÔÓ ÌÂ‚‡ ÔÂÁ Í‡Ô‡ÎÌËfl Í‡Ì‡Î Â Á‡·‡‚ÂÌ‡, ‰Ë-‡„ÌÓÒÚËˆË‡ÌÂÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ ÒÚ‡‚‡ ÂÎÂÍÚÓÙËÁËÓÎÓ-„Ë˜ÌÓ, ÁÌ‡˜ËÚÂÎÌÓ ÔÓ-‡ÌÓ ÓÚ ËÁfl‚‡Ú‡ Ì‡ ÚËÔË˜Ì‡Ú‡ ÍÎË-ÌË˜Ì‡ Í‡ÚËÌ‡ Ë ‚˙Á ÓÒÌÓ‚‡ Ì‡ ÂÁÛÎÚ‡ÚËÚÂ ÓÚ ÂÎÂÍÚÓ-ÏËÓ„‡ÙÒÍÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ ÒÂ ÔÂˆÂÌfl‚‡ ÍÓË Ô‡ˆËÂÌÚË Ò‡ÔÓ‰ıÓ‰fl˘Ë Á‡ ÓÔÂ‡ÚË‚Ì‡ ‰ÂÍÓÏÔÂÒËfl. èÓ‰Ó·ÌÓ Ì‡ ÚÓ‚‡‰Ó Ì‡ÒÚÓfl˘ËflÚ ÏÓÏÂÌÚ ãëëë, Ô˙‚ÓÌ‡˜‡ÎÌÓ ÔÓÁÌ‡Ú‡ Í‡-ÚÓ “ÔÒÂ‚‰ÓÍÎ‡Û‰ËÍ‡ˆËÓ”, ÒÂ ‰Ë‡„ÌÓÒÚËˆË‡ ÓÒÌÓ‚ÌÓ ÍÎË-ÌË˜ÌÓ Ë Ò ÔÓÚ‚˙Ê‰ÂÌËÂ ÓÚ ÌÂ‚ÓËÁÓ·‡Áfl‚‡˘ËÚÂ ÏÂÚÓ-‰Ë, ‚˙ÔÂÍË ˜Â Úfl Â ıÓÌË˜ÌÓ ÍÓÏÔÂÒË‚ÌÓ Á‡·ÓÎfl‚‡ÌÂ Ì‡ÌÂ‚ÌËÚÂ ÍÓÂÌ˜ÂÚ‡ Ë ÌÂ‚ÓÙËÁËÓÎÓ„Ë˜ÌËflÚ ÔÓ‰ıÓ‰ Í˙Ï‰Ë‡„ÌÓÁ‡Ú‡ Â ÔÓ-ÔÓ‰ıÓ‰fl˘.

äãàçàäÄ çÄ ãëëë

ëËÏÔÚÓÏËÚÂ Ë ÔËÁÌ‡ˆËÚÂ Ì‡ ãëëë Ò‡ ‡ÁÌÓÓ·‡ÁÌËË Ì‡È-˜ÂÒÚÓ ÒÂ ÔÓfl‚fl‚‡Ú ÔÂÁ 6-ÚÓ ‰ÂÒÂÚËÎÂÚËÂ. ç‡È-˜ÂÒÚÓÚÓ ÓÔÎ‡Í‚‡ÌÂ Ò‡ ·ÓÎÍËÚÂ ‚ Í˙ÒÚ‡ Ë Í‡Í‡Ú‡ ÍÓË-ÚÓ Ò‡ ‚ÎÓ¯‡‚‡Ú ÔË ıÓ‰ÂÌÂ. èÓ˜Ë‚Í‡Ú‡, Ì‡‚ÂÊ‰‡ÌÂÚÓ Ì‡ÚflÎÓÚÓ Ì‡ÔÂ‰ Ë Òfl‰‡ÌÂÚÓ, Ó·ÎÂÍ˜‡‚‡Ú ·ÓÎÍ‡Ú‡. ìÒÂ˘‡-ÌÂÚÓ Á‡ ÚÂÊÂÒÚ Ë ÒÎ‡·ÓÒÚ ‚ Í‡Í‡Ú‡ Â ˜ÂÒÚÓ ÓÔÎ‡Í‚‡ÌÂ.á‡ÒËÎ‚‡ÌÂÚÓ Ì‡ ÒËÏÔÚÓÏËÚÂ ˜ÂÒÚÓ Â Ò‚˙Á‡ÌÓ Ò ÂÍÒÚÂÌ-ÁËfl ‚ ÎÛÏ·‡ÎÌËfl ÓÚ‰ÂÎ Ì‡ „˙·Ì‡˜ÌËfl ÒÚ˙Î· ÍÓflÚÓ ‚Ó‰Ë‰Ó Ì‡Ï‡Îfl‚‡ÌÂ Ì‡ Ì‡ÔÂ˜ÌËfl ‰Ë‡ÏÂÚ˙ Ì‡ ÒÔËÌ‡ÎÌËfl Í‡-Ì‡Î (13). ëËÏÔÚÓÏËÚÂ Ì‡ ãëëë Ò‡ Ò‚˙Á‡ÌË Ò ‡Ì‡ÚÓÏË˜-Ì‡Ú‡ Ë ÎÓÍ‡ÎËÁ‡ˆËfl, ÒÚÂÔÂÌÚ‡ Ì‡ ËÁ‡ÁÂÌÓÒÚ Ë ÚËÔ‡ Ì‡Û‚Â‰ÂÌËÚÂ ÌÂ‚ÌË ‚Î‡ÍÌ‡: ÒÂÌÁÓÌË, ÏÓÚÓÌË ËÎË Ë ‰‚‡-Ú‡ ‚Ë‰‡. ç‡ÎËˆÂ Â ÔÂ‰ÂÎÂÍˆËÓÌÌÓ Á‡Òfl„‡ÌÂ Ì‡ ÒÂÚË‚ÌËÚÂ‚Î‡ÍÌ‡ ÔÓ‡‰Ë ÚflıÌÓÚÓ ÔÓ-ÔÂËÙÂÌÓ ‡ÁÔÓÎÓÊÂÌËÂ ‚ Í‡-Û‰‡ ÂÍ‚ËÌ‡ (16). óÂÒÚÓ Ó·‡˜Â, ‡Ì‡ÏÌÂÁ‡Ú‡ Ë ÍÎËÌË˜Ì‡Ú‡


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äÓÒÚÓ‚ ä., èÂÚÓ‚ à‚., à‚‡ÌÓ‚‡ à‚.

åÂ‰ËˆËÌÒÍË ËÌÒÚËÚÛÚ – åÇê, ëÓÙËfl

Ì‡ıÓ‰Í‡ Ò‡ Ò ÌËÒÍ‡ ‰Ë‡„ÌÓÒÚË˜Ì‡ ÒÚÓÈÌÓÒÚ Ë ÚÓ‚‡ Â ‚‡ÌÌËÚÂ ÒÚ‡‰ËË Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ, ÍÓ„‡ÚÓ Ô‡ˆËÂÌÚËÚÂÌÂ ÒÂ ÔÂ‰ÒÚ‡‚flÚ Ò ÍÎ‡ÒË˜ÂÒÍËÚÂ ÒËÏÔÚÓÏË.

ãëëë Ì‡È-˜ÂÒÚÓ Â Ì‡ ÌflÍÓÎÍÓ ÌË‚‡ Ë Â ˆÂÌÚ‡ÎÌ‡ ÔÓÎÓÍ‡ÎËÁ‡ˆËfl. Ç˙ÁÏÓÊÌ‡ Â Ë ãëëë Ì‡ Â‰ÌÓ ÌË‚Ó, ÍÓflÚÓ Ò˙-˘Ó ÏÓÊÂ ‰‡ ·˙‰Â ˆÂÌÚ‡ÎÌ‡, Î‡ÚÂ‡ÎÌÓ ÂˆÂÒÛÒÌ‡, ËÎËÙÓ‡ÏÂÌ‡ÎÌ‡ (7). ífl·‚‡ ‰‡ ÒÂ ÓÚ·ÂÎÂÊË, ˜Â ÏËÂÎÓ„‡ÙË-flÚ‡ Ò‡ÏÓÒÚÓflÚÂÎÌÓ ËÏ‡ ÔÓ-Ï‡ÎÍ‡ ‰Ë‡„ÌÓÒÚË˜Ì‡ ÒÚÓÈ-ÌÓÒÚ ÓÚ ÍÓÏÔ˛Ú˙Ì‡Ú‡ ÚÓÏÓ„‡ÙËfl (äí) Ë Ï‡„ÌËÚÌÓÂÁÓÌ‡ÌÒÌ‡Ú‡ ÚÓÏÓ„‡ÙËfl (åêí) Ë ˜ÂÒÚÓ ÔÓÔÛÒÍ‡ Î‡-ÚÂ‡ÎÌ‡Ú‡ ÂˆÂÒÛÒÌ‡ ÒÚÂÌÓÁ‡. äÓÂÍÚÌÓÚÓ ‰Ë‡„ÌÓÒÚË-ˆË‡ÌÂ Ì‡ ãëëë Ò‡ÏÓ ˜ÂÁ åêí Â ÚÛ‰ÌÓ Ë ÔÓÌflÍÓ„‡ÌÂ‚˙ÁÏÓÊÌÓ Á‡˘ÓÚÓ åêí ÏÓÊÂ ‰‡ ‰‡‰Â Ù‡Î¯Ë‚Ó ÔÓÎÓÊË-ÚÂÎÌË Ì‡ıÓ‰ÍË. Ç ÔÓÒÎÂ‰ÌË ÔÓÛ˜‚‡ÌËfl Ò‡ÏÓ 36% ÓÚ 98Á‰‡‚Ë ‰Ó·Ó‚ÓÎˆË, ÔÓ‰ÎÓÊÂÌË Ì‡ åêí, ËÏ‡Ú ÌÓÏ‡ÎÌ‡Ì‡ıÓ‰Í‡ Ì‡ ‚ÒË˜ÍË ÎÛÏ·ÓÒ‡Í‡ÎÌË ÌË‚‡, ‡ 38% ËÏ‡Ú ÏÌÓ-„ÓÂÚ‡ÊÌË ·˙Î‰ÊËÌ„ ‰ËÒÍÓ‚Â Ë/ËÎË ‰ËÒÍÓ‚Ë ÔÓÚÛÁËË (5).í‡Í‡ ÂÎÂÍÚÓ‰Ë‡„ÌÓÒÚË˜ÌËÚÂ ËÁÒÎÂ‰‚‡ÌËfl Í‡ÚÓ ÖåÉ ËÑëÖè, Ò ÔÓ-„ÓÎflÏ‡Ú‡ ÒÂÌÁËÚË‚ÌÓÒÚ Ì‡ ÑëÖè ÔÓ‡‰Ë ÔÓ-ÔÂËÙÂÌ‡Ú‡ ÎÓÍ‡ÎËÁ‡ˆËfl Ì‡ ‡ÙÂÂÌÚÌËÚÂ ‚Î‡ÍÌ‡, ÏÓ-„‡Ú ‰‡ ·˙‰‡Ú ÔÓÎÂÁÌË ÔË ÓÔÂ‰ÂÎflÌÂÚÓ ‰‡ÎË ‡Ì‡ÚÓÏË˜-ÌËÚÂ Ì‡ıÓ‰ÍË ÓÚ ÌÂ‚ÓËÁÓ·‡Áfl‚‡˘ËÚÂ ÏÂÚÓ‰Ë Ò‡ ÍÎË-ÌË˜ÌÓ ÁÌ‡˜ËÏË. óÂÁ ËÁÔÓÎÁ‚‡ÌÂ Ì‡ ëÖè Ë ÑëÖè ÚÂıÌËÍË-ÚÂ ÏÓÊÂ ‰‡ ÒÂ Ì‡Ô‡‚Ë ‡ÁÎËÍ‡ ÏÂÊ‰Û ·ÓÎÍ‡Ú‡ Ò‚˙Á‡Ì‡Ò ‰Â„ÂÌÂ‡ÚË‚ÌÓ Á‡·ÓÎfl‚‡ÌÂ Ì‡ ÎÛÏ·‡ÎÌËflÚ „˙·Ì‡Í Ë Ú‡-ÁË Ò‚˙Á‡Ì‡ Ò ãëëë.

äãàçàóÖç äéçíàçÉÖçí

ë ̂ ÂÎ ‰‡ ÒÂ ÛÒÚ‡ÌÓ‚Ë ÒÚÓÈÌÓÒÚÚ‡ Ì‡ ÑëÖè Ë ëÖè ‚ ‡Ì-Ì‡Ú‡ ‰Ë‡„ÌÓÁ‡ Ì‡ ãëëë ËÁÒÎÂ‰‚‡ıÏÂ 56 Ô‡ˆËÂÌÚ‡ (39 Ï˙ÊÂË 17 ÊÂÌË), Ì‡ ÒÂ‰Ì‡ ‚˙Á‡ÒÚ 57 „. (ÓÚ 36 ‰Ó 65 „.), Ò ÍÎËÌË˜-ÌÓ ÔÓfl‚ÂÌË ÒËÏÔÚÓÏË Ì‡ ‰‚ÛÒÚ‡ÌÌ‡ ÍÓÂÌ˜Â‚‡ Û‚Â‰‡, ÌÓ

·ÂÁ Ú‡ÁÓ‚Ó ÂÁÂ‚Ó‡ÌË Ì‡Û¯ÂÌËfl Ë ·ÂÁ ÍÎ‡ÒË˜ÂÒÍË ÒËÏÔ-ÚÓÏË Ì‡ ÓÒÚÓ ‡Á‚ËÎ ÒÂ ÒËÌ‰ÓÏ Ì‡ Í‡Û‰‡ ÂÍ‚ËÌ‡. Ñ‚‡Ì‡‰Â-ÒÂÚ ÓÚ Ô‡ˆËÂÌÚËÚÂ Ò‡ ÍÎËÌË˜ÌÓ ÔÓfl‚ÂÌË Ò ÚËÔË˜ÌË ÒËÏÔ-ÚÓÏË Ì‡ ãëëë. èË ‚ÒË˜ÍË Â ÓÒ˙˘ÂÒÚ‚ÂÌ‡ ÖåÉ Ë ‚ÔÓÒÎÂ‰-ÒÚ‚ËÂ ÌÂ‚ÓËÁÓ·‡Áfl‚‡˘Ó ËÁÒÎÂ‰‚‡ÌÂ (åÉ, äí Ë/ËÎË åêí).

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àÁÔÓÎÁ‚‡Ì Â ‡Ô‡‡Ú Nicolet CA-2000. á‡ÔËÒËÚÂ Ò‡ ÓÒ˙-˘ÂÒÚ‚ÂÌË ‚ ·Û‰ÌÓ Ò˙ÒÚÓflÌËÂ Ì‡ Ô‡ˆËÂÌÚ‡, Ï‡ÍÒËÏ‡ÎÌÓÓÚÔÛÒÌ‡Ú Ò ÓÚ‚ÓÂÌË Ó˜Ë. íÂÏÔÂ‡ÚÛ‡Ú‡ Ì‡ Í‡ÈÌËˆË-ÚÂ ·Â ‚ ‡ÏÍËÚÂ Ì‡ 29 – 33 Óë ÔÓ ‚ÂÏÂ Ì‡ ËÁÒÎÂ‰‚‡ÌÂÚÓ.ëÚËÏÛÎ‡ˆËflÚ‡ Â ÓÒ˙˘ÂÒÚ‚ÂÌ‡ Ò ÔÓ‚˙ıÌÓÒÚÂÌ ÒÚËÏÛÎË-‡˘ ÂÎÂÍÚÓ‰ Ò ‰Ë‡ÏÂÚ˙ Ì‡ ‰ËÒÍÓ‚ÂÚÂ 9 ÏÏ. Ë ‡ÁÒÚÓ-flÌËÂ ÏÂÊ‰Û Úflı 30 ÏÏ. ÄÌÓ‰‡ Â ÔÓÒÚ‡‚flÌ ‰ËÒÚ‡ÎÌÓ ÓÚÍ‡ÚÓ‰‡. èËÎ‡„‡ÌË Ò‡ ÔÓÒÚÓflÌÌÓÚÓÍÓ‚Ë Ô‡‚Ó˙„˙ÎÌËËÏÔÛÎÒË Ò ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ 0.1 ms. Ë ˜ÂÒÚÓÚ‡ 2.7 Hz Á‡n.tibialis Ë ÑëÖè. àÌÚÂÌÁËÚÂÚ‡ Ì‡ ÒÚËÏÛÎ‡ Â 2.5 Ô˙ÚËÌ‡‰ ÒÂÚË‚ÌËfl Ô‡„, ÌÓ ÌÂ ÔÓ‚Â˜Â ÓÚ 30 mA Á‡ ÑëÖè Ë ‰ÓÒ-Ú‡Ú˙˜ÂÌ ‰‡ ÔÂ‰ËÁ‚ËÍ‡ ‚Ë‰ËÏ‡, ÏËÌËÏ‡ÎÌ‡ ÏÛÒÍÛÎÌ‡ÍÓÌÚ‡ÍˆËfl Á‡ n.tibialis. åÂÒÚ‡Ú‡ Á‡ Ì‡Ì‡ÒflÌÂ Ì‡ ÒÚËÏÛ-Î‡ Á‡ ÓÚ‰ÂÎÌËÚÂ ‰ÂÏ‡ÚÓÏË Ò‡ ‰‡‰ÂÌË ‚ í‡·ÎËˆ‡ 1. á‡ëÖè, ÚË·Ë‡ÎÌËflÚ ÌÂ‚ Â ÒÚËÏÛÎË‡Ì ÌÂÔÓÒÂ‰ÒÚ‚ÂÌÓÁ‡‰ ÏÂ‰Ë‡ÎÌËfl Ï‡ÎÂÓÎ. Ñ‚‡ Ô˙ÚË ÔÓ 500 ÒÚËÏÛÎ‡ Ò‡ ÓÒ-Â‰Ìfl‚‡ÌË ÓÚ ‚ÒflÍ‡ ÒÚËÏÛÎË‡Ì‡ ÏÓ‰‡ÎÌÓÒÚ, Á‡ ÂÔÎËÍ‡-ˆËfl Ì‡ ‚˙ÎÌÓ‚ËÚÂ ÙÓÏË, Ò ˆÂÎ ‚ÂËÙËˆË‡ÌÂ Ì‡ ÚflıÌ‡Ú‡ÔÓÒÚÓflÌÌÓÒÚ. êÂ„ËÒÚ‡ˆËflÚ‡ Â ÓÒ˙˘ÂÒÚ‚fl‚‡Ì‡ Ò˙ÒÒÂ·˙ÌË, ˜‡¯ÍÓ‚Ë‰ÌË ÖÖÉ ÂÎÂÍÚÓ‰Ë Ò ‰Ë‡ÏÂÚ˙ 10ÏÏ., ÙËÍÒË‡ÌË Ò ÂÎÂÍÚÓ‰Ì‡ Ô‡ÒÚ‡ Í˙Ï ÔÓ˜ËÒÚÂÌ‡Ú‡ÍÓÊ‡. á‡ÔËÒ‚‡˘ËflÚ ÂÎÂÍÚÓ‰ (-) Â ÔÓÒÚ‡‚flÌ ‚ ÚÓ˜Í‡Ú‡Cz’ (Ì‡ 2 ÒÏ. Á‡‰ ëz ÔÓ 10-20 ÏÂÊ‰ÛÌ‡Ó‰Ì‡Ú‡ ÖÖÉ ÒËÒ-ÚÂÏ‡), ‡ ÂÙÂÂÌÚÌËflÚ ‚ ÚÓ˜Í‡Ú‡ Fpz. àÁÔÓÎÁ‚‡Ì‡ Â ¯Ë-Ó˜ËÌ‡ Ì‡ ÎÂÌÚ‡Ú‡ ÓÚ 1 ‰Ó 250 Hz ÔË ÂÔÓı‡ 150 ms.


í‡·ÎËˆ‡ 1. åÂÒÚ‡ Ì‡ ‡ÁÔÓÎ‡„‡ÌÂ Ì‡ ÒÚËÏÛÎË‡˘ËÚÂ ÂÎÂÍÚÓ‰Ë Á‡ ÑëÖè

ÑÂÏ‡ÚÓÏ ä‡ÚÓ‰ ÄÌÓ‰L3 ç‡ 45Ó Î‡ÚÂ‡ÎÌÓ Ë ÔÓÍÒËÏ‡ÎÌÓ ÓÚ ‡ÌÓ‰‡ èÓ ÒÂ‰ËÌÌ‡Ú‡ ÎËÌËfl Ì‡ 10 ÒÏ. Ì‡‰ „ÓÌËfl ˙· Ì‡ Ô‡ÚÂÎ‡Ú‡

L4 ç‡ 6 ÒÏ. ‰ËÒÚ‡ÎÌÓ ÓÚ ‰ÓÎÌËfl ˙· Ì‡ Ô‡ÚÂÎ‡Ú‡ çÂÔÓÒÂ‰ÒÚ‚ÂÌÓ ‰ËÒÚ‡ÎÌÓ

‚˙ıÛ ÏÂ‰Ë‡ÎÌ‡Ú‡ ÔÓ‚˙ıÌÓÒÚ Ì‡ ÚË·ËflÚ‡

L5 ç‡ 3.5 ÒÏ. Ì‡Á‡‰ ÓÚ „˙ÌÍ‡Ú‡ ÏÂÊ‰Û 1 Ë 2 Ô˙ÒÚ çÂÔÓÒÂ‰ÒÚ‚ÂÌÓ ‰ËÒÚ‡ÎÌÓ

S1 ç‡ 3.5 ÒÏ. Ì‡Á‡‰ ÓÚ ÏÂÚÓÚ‡Á‡ÎÌ‡Ú‡ ÒÚ‡‚‡ çÂÔÓÒÂ‰ÒÚ‚ÂÌÓ ‰ËÒÚ‡ÎÌÓ

Ì‡ 5 Ô˙ÒÚ ‚˙ıÛ ‚˙Ì¯ÌËflÚ ˙· Ì‡ ıÓ‰ËÎÓÚÓ

í‡·ÎËˆ‡ 2. êÂÁÛÎÚ‡ÚË ÓÚ ÌÂ‚ÓÙËÁËÓÎÓ„Ë˜ÌËÚÂ Ë ÌÂ‚ÓËÁÓ·‡Áfl‚‡˘ËÚÂ ËÁÒÎÂ‰‚‡ÌËfl

ÑëÖè Ë ëÖèë ‰‡ÌÌË Á‡ ÚËÔË˜Ì‡ ãëëë 38(67.8%)

ë ‰‡ÌÌË Á‡ ‚ÂÓflÚÌ‡ ãëëë 3 (5.4%)

ë ‰‡ÌÌË Á‡ ‡·ÌÓÏÌÓÒÚ ‚ 1 ËÎË 2 ÎÛÏ·ÓÒ‡Í‡ÎÌË ÍÓÂÌ˜ÂÚ‡ 11(19.6%)

è‡ˆËÂÌÚË Ò ÌÓÏ‡ÎÌË ÑëÖè Ë ëÖè 4 (7.2%)

ÖåÉë ‰‡ÌÌË Á‡ Û‚Â‰‡ Ì‡ ÔÓ‚Â˜Â ÓÚ 2 ÍÓÂÌ˜ÂÚ‡ 22 (39.3%)

ë ‰‡ÌÌË Á‡ Û‚Â‰‡ Ì‡ 1 ËÎË 2 ÍÓÂÌ˜ÂÚ‡ 26 (46.4%)

çÓÏ‡ÎÌ‡ ÖåÉ 8 (14.3%)

çÂ‚ÓËÁÓ·‡Áfl‚‡˘Ë ËÁÒÎÂ‰‚‡ÌËflë ‰‡ÌÌË Á‡ ãëëë 37(66.0%)

ëÎÂ‰ÓÔÂ‡ÚË‚ÂÌ ‡‡ıÌÓË‰ËÚ 4 (7.2%)

íBC ÒÔÓÌ‰ËÎËÚ 1 (1.8%)

ÖÔË‰ÛËÚ 1 (1.8%)

ë ‰‡ÌÌË Ó·flÒÌfl‚‡˘Ë ‡Ì„‡ÊË‡ÌÂÚÓ Ì‡ 1 ËÎË 2 ÍÓÂÌ˜ÂÚ‡ 11(19.6%)

çÓÏ‡ÎÌ‡ Ì‡ıÓ‰Í‡ 2 (3.6%)

àÁÏÂ‚‡Ì‡ Â ‡·ÒÓÎ˛ÚÌ‡Ú‡ ÔËÍÓ‚‡ Î‡ÚÂÌˆËfl Ì‡ Ô˙‚ËflÔÓÁËÚË‚ÂÌ ÔËÍ Ì‡ ÍÓÓ‚Ëfl ÔÓÚÂÌˆË‡Î (P38 ÒÎÂ‰ ÒÚËÏÛÎ‡-ˆËfl Ì‡ n.tibialis Ë Ò˙ÓÚ‚ÂÚÌÓ ê1 Á‡ ÑëÖè). ÄÏÔÎËÚÛ‰‡Ú‡Ì‡ ÔÓÚÂÌˆË‡Î‡ Â ËÁÏÂ‚‡Ì‡ ÓÚ Ì‡È-ÌËÒÍ‡Ú‡ ÚÓ˜Í‡ Ì‡Ô˙‚Ëfl ÔÓÁËÚË‚ÂÌ ÔËÍ ‰Ó ÔËÍ‡ Ì‡ N2.

ÇÒÂ Ó˘Â ÌflÏ‡ Â‰ËÌÓ‰Û¯ÌÓ ÏÌÂÌËÂ ‚ ÎËÚÂ‡ÚÛ‡Ú‡ Á‡ÓˆÂÌÍ‡ Ì‡ ÑëÖè ‡·ÌÓÏÌÓÒÚËÚÂ. äËÚÂËËÚÂ ÍÓËÚÓÒÏÂ ËÁÔÓÎÁ‚‡ÎË ÒÂ ·‡ÁË‡Ú Ì‡ Î‡·Ó‡ÚÓÌËflÚ ÓÔËÚ, ÌÓ-Ï‡ÚË‚ÌËÚÂ ‰‡ÌÌË Á‡ Ì‡¯‡Ú‡ Î‡·Ó‡ÚÓËfl Ë ÚÂÁË ÔÛ·ÎË-ÍÛ‚‡ÌË ‚ ÎËÚÂ‡ÚÛ‡Ú‡ (1, 2, 3, 12). á‡ ‡·ÌÓÏÌ‡ Î‡ÚÂÌ-ˆËfl Â ÔËÂÏ‡Ì‡ Ú‡ÁË ÍÓflÚÓ Ì‡‰ı‚˙Îfl 2.5 ëÑ ËÎË ÔÓ‚Â˜ÂÓÚ 3.5 ms ‡ÁÎËÍ‡ Ò ÍÓÌÚ‡Î‡ÚÂ‡ÎÌËfl ÔËÍ. Ä·ÌÓÏÌÓÒ-

ÚË ‚ ‡ÏÔÎËÚÛ‰‡Ú‡ Ò‡ ‰ÂÙËÌË‡ÌË ÍÓ„‡ÚÓ ê1/N2 ‡ÏÔÎË-ÚÛ‰‡Ú‡ Â ÔÓ-Ï‡ÎÍ‡ ÓÚ 0.2 µV, ËÎË ÔÓ-Ï‡ÎÍÓ ÓÚ 1/3 ÓÚÍÓÌÚ‡Î‡ÚÂ‡ÎÌ‡Ú‡. á‡ ÚËÔË˜Ì‡ Á‡ ãëëë Ì‡ıÓ‰Í‡ ÔËÂ-Ï‡ÏÂ ‰‚ÛÒÚ‡ÌÌÓ Ô‡ÚÓÎÓ„Ë˜ÌË ëÖè Ë ÔÓÌÂ 2 ‡·ÌÓÏÌËÁ‡ÔËÒ‡ ÓÚ ÑëÖè, Á‡ ‚ÂÓflÚÌ‡ ÔÓÌÂ 3 ‡·ÌÓÏÌË Á‡ÔËÒ‡ ÓÚÑëÖè ÔË ÌÓÏ‡ÎÌË ËÎË Â‰ÌÓÒÚ‡ÌÌÓ ‡·ÌÓÏÌË ÚË·Ë‡Î-ÌË ëÖè.

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íËÔË˜ÌË ÂÎÂÍÚÓÙËÁËÓÎÓ„Ë˜ÌË ‰‡ÌÌË Á‡ ÒÔËÌ‡ÎÌ‡ ÒÚÂ-ÌÓÁ‡ (‰‚ÛÒÚ‡ÌÌÓ ‡·ÌÓÏÌË ëÖè ‚ Ò˙˜ÂÚ‡ÌËÂ Ò ‰‚ÛÒÚ-‡ÌÌÓ ‡·ÌÓÏÌË ÑëÖè, îË„.1‡.) ÛÒÚ‡ÌÓ‚fl‚‡ÏÂ ÔË 38 ÓÚÔ‡ˆËÂÌÚËÚÂ. èË 31 ÓÚ Úflı ãëëë Â ÔÓÚ‚˙‰ÂÌ‡ ÓÚ ÌÂ‚-ÓËÁÓ·‡Áfl‚‡˘ÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ, ÔË 4 Ò‡ ÛÒÚ‡ÌÓ‚ÂÌË åêí‰‡ÌÌË Á‡ ÔÓÒÚÓÔÂ‡ÚË‚ÂÌ ‡‡ıÌÓË‰ËÚ, ÔË 1 ÚÛ·ÂÍÛÎÓ-ÁÂÌ ÒÔÓÌ‰ËÎËÚ, ÔË 1 ÂÔË‰ÛËÚ ÒÎÂ‰ ÒÔËÌ‡ÎÌ‡ ‡ÌÂÒÚÂÁËfl.èË Â‰ËÌ ÓÚ Ô‡ˆËÂÌÚËÚÂ Ò ÂÎÂÍÚÓÙËÁËÓÎÓ„Ë˜ÌË ‰‡ÌÌËÁ‡ ãëëë ÌÂ ·Â ÛÒÚ‡ÌÓ‚ÂÌ‡ Ô‡ÚÓÎÓ„Ëfl ÓÚ ÌÂ‚ÓËÁÓ·‡Áfl-‚‡˘ÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ. (ÙË„. 2)

èË ‚ÒË˜ÍËÚÂ 12 Ô‡ˆËÂÌÚ‡ Ò ÍÎ‡ÒË˜ÂÒÍË ÍÎËÌË˜ÌËÒËÏÔÚÓÏË Ì‡ ãëëë Ò˙˘‡Ú‡ ·Â ÔÓÚ‚˙‰ÂÌ‡ ˜ÂÁ ëÖè,ÑëÖè, Ë ‡‰ËÓÎÓ„Ë˜ÌÓ.

èË 3 Ô‡ˆËÂÌÚ‡ ÛÒÚ‡ÌÓ‚fl‚‡ÏÂ ÑëÖè Ë ëÖè ‰‡ÌÌË Á‡‚ÂÓflÚÌ‡ ãëëë (‡·ÌÓÏÌÓÒÚ ‚ ÑëÖè Á‡ ÔÓ‚Â˜Â ÓÚ 2 ÍÓ-ÂÌ˜ÂÚ‡, ÔË ëÖè ÓÚ n.tibialis ‚ ‡ÏÍËÚÂ Ì‡ 2 ëÑ ÓÚ ÌÓ-Ï‡Ú‡ (ÙË„. 3). à ÔË ÚËÏ‡Ú‡ Ô‡ˆËÂÌÚ‡ ãëëë Â ÔÓÚ‚˙-‰ÂÌ‡ ÓÚ ÌÂ‚ÓËÁÓ·‡Áfl‚‡˘ÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ.

èË 3 Ô‡ˆËÂÌÚ‡ Ò ‰‡ÌÌË Á‡ ãëëë ÓÚ ÌÂ‚ÓËÁÓ·‡Áfl‚‡-˘ËÚÂ ÏÂÚÓ‰Ë, ëÖè Ë ÑëÖè Ò‡ ÌÓÏ‡ÎÌË.

èËÂÏ‡ÈÍË Ì‡ıÓ‰ÍËÚÂ ÓÚ ÌÂ‚ÓËÁÓ·‡Áfl‚‡˘ËÚÂ ËÁÒ-ÎÂ‰‚‡ÌËfl Í‡ÚÓ “ÁÎ‡ÚÂÌ ÒÚ‡Ì‰‡Ú” Á‡ ‰Ë‡„ÌÓÁ‡Ú‡ Ì‡


îË„. 1‡. íËÔË˜ÂÌ Á‡ ãëëë ÑëÖè Ë ëÖè Á‡ÔËÒ ÔË Ô‡ˆËÂÌÚ Ì‡ 51 „. ÒÍÎËÌËÍ‡ Ì‡ “ÔÒÂ‚‰ÓÍÎ‡Û‰ËÍ‡ˆËÓ”. Ä·ÌÓÏÌÓ Û‰˙ÎÊÂÌË, ÌÂ‰Ó·Â

ÍÓÌÙË„ÛË‡ÌË, ÌËÒÍÓ‡ÏÔÎËÚÛ‰ÌË ÍÓÓ‚Ë ÔÓÚÂÌˆË‡ÎË ÒÎÂ‰ÒÚËÏÛÎ‡ˆËfl Ì‡ n.tibialis ‰‚ÛÒÚ‡ÌÌÓ. ãËÔÒ‚‡˘ ÍÓÓ‚ ÔÓÚÂÌˆË‡Î ÓÚ S1‚ ‰flÒÌÓ, ‡·ÌÓÏÌÓ Û‰˙ÎÊÂÌ ‚ Îfl‚Ó, ‡·ÌÓÏÌÓ Û‰˙ÎÊÂÌ ÔÓÚÂÌˆË‡Î ÓÚL5 ‚ ‰flÒÌÓ Ò ‡ÁÎËÍ‡ Ï/Û ÍÓÌÚ‡Î‡ÚÂ‡ÎÌËfl ÔÓÚÂÌˆË‡Î ÓÚ 11.4 ms.çÓÏ‡ÎÌË Î‡ÚÂÌˆËË Ì‡ Ô˙‚Ëfl ÔÓÁËÚË‚ÂÌ ÔËÍ Ì‡ ÔÓÚÂÌˆË‡ÎËÚÂ ÓÚ

L4 ‰‚ÛÒÚ‡ÌÌÓ, ÌÓ ÔÓÚÂÌˆË‡Î‡ ‚ Îfl‚Ó Â ÌÂ‰Ó·Â ÍÓÌÙË„ÛË‡Ì.

îË„. 2. ëÖè ÒÎÂ‰ ÒÚËÏÛÎ‡ˆËfl Ì‡ n.tibialis Ë ÑëÖè ÒÎÂ‰ ÒÚËÏÛÎ‡ˆËfl Ì‡S1 ‰ÂÏ‡ÚÓÏË ‚ Îfl‚Ó („ÓÌ‡ „‡ÙËÍ‡) Ë ‰flÒÌÓ (‰ÓÎÌ‡ „‡ÙËÍ‡) ÔË

Ï˙Ê Ì‡ 50 „. Ä·ÌÓÏÌÓ ÔÓÎÓÌ„Ë‡ÌË Î‡ÚÂÌˆËË Ì‡ ÎÛÏ·‡ÎÌËflÔÓÚÂÌˆË‡Î (LP) Ë ê38 ‰‚ÛÒÚ‡ÌÌÓ Ñ>ã, ÔË ÌÓÏ‡ÎÌË ÒÚÓÈÌÓÒÚË Ì‡ˆÂÌÚ‡ÎÌÓÚÓ ÔÓ‚Ó‰ÌÓ ‚ÂÏÂ (ëëí). Ä·ÌÓÏÌË ‡·ÒÓÎ˛ÚÌË Î‡ÚÂÌˆËË

Ì‡ ê1 ÒÎÂ‰ ÒÚËÏÛÎ‡ˆËfl Ì‡ S1 ‰‚ÛÒÚ‡ÌÌÓ Ñ>ã. Ç ÒÎÛ˜‡fl Ò‡ Ì‡ÎËˆÂÂÎÂÍÚÓÙËÁËÓÎÓ„Ë˜ÌË Ï‡ÍÂË Á‡ ÒÚÂÌÓÁ‡ Ì‡ ‚ÂÚÂ·‡ÎÌËfl Í‡Ì‡Î,

ÍÓflÚÓ ÌÂ ·Â ÔÓÚ‚˙‰ÂÌ‡ Ì‡ ÌÂ‚ÓËÁÓ·‡Áfl‚‡˘ÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ.äÎËÌË˜Ì‡Ú‡ Ì‡ıÓ‰Í‡ ÔË Ô‡ˆËÂÌÚ‡ ÒÂ Ò˙ÒÚÓÂ¯Â ÓÚ ·ÓÎÍË ‚ Í˙ÒÚ‡ ËÁ‡‰ÌÓ ÒÚ‡ÌË˜Ì‡Ú‡ ˜‡ÒÚ Ì‡ ‰‚‡Ú‡ Í‡Í‡ Ò ‰‡‚ÌÓÒÚ ÓÚ 9 ÏÂÒÂˆ‡, ·ÂÁ

ËÁ‡ÁÂÌ‡ ÓÚÔ‡‰Ì‡ ‡‰ËÍÛÎÂÌ‡ ÒËÏÔÚÓÏ‡ÚËÍ‡. ÖåÉ, Ò‡ÍÓÍ‡Û‰Ó„‡ÙËflË äí – ·.Ó.

îË„. 1·. åêí ÔË Ò˙˘ËflÚ Ô‡ˆËÂÌÚ.

ãëëë ÔÓÎÛ˜‡‚‡ÏÂ ÒÎÂ‰ÌËÚÂ ÂÁÛÎÚ‡ÚË: ÓÚ 37 Ô‡ˆËÂÌÚ‡Ò ÛÒÚ‡ÌÓ‚ÂÌ‡ ÓÚ ÌÂ‚ÓËÁÓ·‡Áfl‚‡˘ËÚÂ ËÁÒÎÂ‰‚‡ÌËflãëëë ÔË 34 (91.8%) ÑëÖè ‡‰ÂÍ‚‡ÚÌÓ fl ÔÓÚ‚˙Ê‰‡‚‡ÚÍ‡ÚÓ ÔË 31 (83.8%) ‡·ÌÓÏÌÓÒÚËÚÂ ‚ ÑëÖè ÒÂ Ò˙˜ÂÚ‡-‚‡Ú Ë Ò ‡·ÌÓÏÌË ëÖè ÓÚ n.tibialis. èË 3 (8.1%) Ô‡ˆËÂÌ-Ú‡ ÑëÖè Ë ëÖè ÌÂ ÔÓÚ‚˙Ê‰‡‚‡Ú ‡‰ËÎÓ„Ë˜Ì‡Ú‡ Ì‡-ıÓ‰Í‡ Ë ÔË 1 (2.7%) Ò‡ Ì‡ÎËˆÂ ÂÎÂÍÚÓÙËÁËÓÎÓ„Ë˜ÌË ‰‡Ì-ÌË Á‡ ãëëë ·ÂÁ ÌÂ‚ÓËÁÓ·‡Áfl‚‡˘Ó ÔÓÚ‚˙Ê‰ÂÌËÂ. èË18 (48.6%) ÓÚ ÚÂÁË Ô‡ˆËÂÌÚË Ò‡ ÛÒÚ‡ÌÓ‚ÂÌË ÖåÉ ‰‡ÌÌËÁ‡ Á‡Òfl„‡ÌÂ Ì‡ ÔÓ‚Â˜Â ÓÚ 2 ÍÓÂÌ˜ÂÚ‡. ê‡ÁÎËÍ‡Ú‡ Â ÒÚ‡-ÚËÒÚË˜ÂÒÍË ÁÌ‡˜ËÏ‡ - χ2=5.1; 0.05>(χ2)>0.01.

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Ç ÓˆÂÌÍ‡Ú‡ Ì‡ ıÓÌË˜ÌËÚÂ, ‡Ì„‡ÊË‡˘Ë ÌflÍÓÎÍÓ ÎÛÏ-·ÓÒ‡Í‡ÎÌË ÌË‚‡, Ò ÏÛÎÚËÔÎÂÌÓ ÍÓÂÌ˜Â‚Ó Á‡Òfl„‡ÌÂ Á‡·Ó-Îfl‚‡ÌËfl, Í‡ÍÚÓ ÔË ãëëë (Ò‚˙Á‡Ì‡ Ò ıÓÌË˜Ì‡ ÍÓÏÔÂ-ÒËfl Ì‡ ‰˙Î„Ë ÒÂ„ÏÂÌÚË Ì‡ ‰ÓÁ‡ÎÌËÚÂ ÍÓÂÌ˜ÂÚ‡), Â Ì‡ÎË-ˆÂ ÁÌ‡˜ËÚÂÎÌ‡ ÙËÁËÓÎÓ„Ë˜Ì‡ Ó·ÓÒÌÓ‚Í‡ Á‡ Ó˜‡Í‚‡ÌÂ Ì‡ ‡·-ÌÓÏÌË ÑëÖè Ë ëÖè (6, 8, 9, 15). ç‡¯ËÚÂ ÂÁÛÎÚ‡ÚË Ò˙-˘Ó ÔÓÚ‚˙Ê‰‡‚‡Ú ÚÓ‚‡. ãëëë ÔÂ‰ÒÚ‡‚Îfl‚‡ ÔÓ-ÓÒÓ·ÂÌÒÎÛ˜‡È Ì‡ ÎÛÏ·‡ÎÌÓ Ë Ò‡Í‡ÎÌÓ ÍÓÂÌ˜Â‚Ó Á‡·ÓÎfl‚‡ÌÂ. íflÁ‡Òfl„‡ ÓÒÌÓ‚ÌÓ ÔÂ‰ÌËÚÂ Ë Á‡‰ÌËÚÂ ÍÓÂÌ˜ÂÚ‡ ÔÓÍÒË-Ï‡ÎÌÓ ÓÚ ÚflıÌÓÚÓ Ò˙Â‰ËÌfl‚‡ÌÂ ‚ ÍÓÂÌ˜Â‚ËÚÂ Ï‡Ì¯ÓÌË‚ Î‡ÚÂ‡ÎÌËÚÂ ÂˆÂÒÛÒË. á‡ ‡ÁÎËÍ‡ ÓÚ ‡‰ËÍÛÎÓÔ‡ÚË-ËÚÂ ÓÚ ıÂÌË‡Ì ‰ËÒÍ, Ë„ÎÂÌ‡Ú‡ ÖåÉ ÔË ãëëë ÔÓÍ‡Á‚‡ÏËÌËÏ‡ÎÌË ‡·ÌÓÏÌÓÒÚË ‚ ÏÛÒÍÛÎ‡ÚÛ‡Ú‡ Ì‡ Í‡Í‡Ú‡ ËÔ‡‡ÒÔËÌ‡ÎÌÓ (8, 12, 14). èÂ‰ÔÓÎ‡„‡ ÒÂ, ˜Â ÚÓ‚‡ Â ‚ ÂÁÛÎ-Ú‡Ú Ì‡ ‰ÂÏËÂÎËÌËÁ‡ˆËfl, ‡ÍÒÓÌÓÒÚÂÌÓÁ‡ ËÎË ‡ÍÒÓÌ‡ÎÌ‡ ‰Â-„ÂÌÂ‡ˆËfl Ì‡ ‰˙Î„Ë ÌÂ‚ÌË ‚Î‡ÍÌ‡, ÍÓËÚÓ ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡ÚÌ‡ ÏÌÓ„ÓÚÓ ÌË‚‡ ÔÂÁ ÍÓËÚÓ ˜Û‚ÒÚ‚ËÚÂÎÌËÚÂ, ÎÂÒÌÓ ‡-ÌËÏË, ÔÂ‰ÌË Ë Á‡‰ÌË ÍÓÂÌ˜ÂÚ‡ ÔÂÏËÌ‡‚‡Ú Ó·‡ÁÛ‚‡ÈÍËÍ‡Û‰‡ ÂÍ‚ËÌ‡ ‚ ıÓ‰‡ ËÏ ÔÂÁ ÒÔËÌ‡ÎÌËfl Í‡Ì‡Î. àÁ‡ÁÂÌ‡Ú‡ÓÒÚ‡ ÍÓÂÌ˜Â‚‡ ÍÓÏÔÂÒËfl ÓÚ ıÂÌË‡Ì ‰ËÒÍ ÔË˜ËÌfl‚‡‰ÓÒÚ‡Ú˙˜Ì‡ Û‚Â‰‡ ‚Ó‰Â˘‡ ‰Ó ‡ÍÒÓÌ‡ÎÌ‡ Á‡„Û·‡ Ë ÔÓÒÎÂ‰-‚‡˘‡Ú‡ ‰ÂÌÂ‚‡ˆËfl, ÍÓËÚÓ ‰Ó·Â ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡Ú ˜ÂÁÖåÉ. èÓ-ÒÎ‡·‡Ú‡ Ë ÔÓÒÚÂÔÂÌÌÓ Ì‡ÒÚ˙Ô‚‡˘‡ ÍÓÏÔÂÒËflÔË ãëëë ÔË˜ËÌfl‚‡ Á‡·‡‚flÌÂ Ì‡ ÌÂ‚ÌÓÚÓ ÔÓ‚ÂÊ‰‡ÌÂÌ‡È-‰Ó·Â ÛÒÚ‡ÌÓ‚fl‚‡ÌÓ ˜ÂÁ ÑëÖè Ë ëÖè, ‡Ì‡ÎÓ„Ë˜ÌÓ Ì‡ÔÓÎÓÌ„Ë‡ÌÂÚÓ Ì‡ ‰ËÒÚ‡ÎÌ‡Ú‡ ÒÂÚË‚Ì‡ Î‡ÚÂÌˆËfl ÛÒÚ‡-ÌÓ‚fl‚‡ÌÓ ÔË ‰Û„ËÚÂ ÔÂËÙÂÌÓ ÌÂ‚ÌË ÚÛÌÂÎ ÒËÌ‰ÓÏË(7, 8). ê‡Á·Ë‡ ÒÂ ÌÂ Â ‚˙ÁÏÓÊÌÓ Ò‡ÏÓ ˜ÂÁ ËÁÒÎÂ‰‚‡ÌÂ Ì‡Â‚ÓÍË‡ÌËÚÂ ÔÓÚÂÌˆË‡ÎË ‰‡ ÒÂ Ì‡Ô‡‚Ë ‡ÁÎËÍ‡ ÏÂÊ‰Ûãëëë, ‡‡ıÌÓË‰ËÚ ËÎË ‰Û„Ë ıÓÌË˜ÌË ÍÓÏÔÂÒË‚ÌË Ò˙Ò-ÚÓflÌËfl, ÍÓËÚÓ Á‡Òfl„‡Ú ÔÓ‚Â˜Â ÓÚ Â‰ÌÓ ÍÓÂÌ˜Â. èÓ‡‰ËÚÓ‚‡ Kraft (2003) ÔÂÔÓ˙˜‚‡ ÚÂÏËÌ‡ ÏÌÓÊÂÒÚ‚ÂÌ‡ ÍÓ-ÂÌ˜Â‚‡ ·ÓÎÂÒÚ, Í‡ÚÓ ÔÓ-ÍÓÂÍÚÂÌ ÓÚ ãëëë, ÔË ËÌÚÂ-ÔÂÚË‡ÌÂ Ì‡ ÂÁÛÎÚ‡ÚËÚÂ ÓÚ ÑëÖè ËÁÒÎÂ‰‚‡ÌÂÚÓ (8).ä‡ÚÓ ÒÂ ËÏ‡ ÔÂ‰‚Ë‰, ˜Â ãëëë ÒÂ ‡Á‚Ë‚‡ ÔÓÒÚÂÔÂÌÌÓ,ÏÌÓ„Ó ‚ÂÓflÚÌÓ Â ÒÚÂÔÂÌÚ‡ Ì‡ ‡·ÌÓÏÌÓÒÚ ‰‡ ·˙‰Â ‡Á-ÎË˜Ì‡ ÏÂÊ‰Û ÓÚ‰ÂÎÌËÚÂ ÌË‚‡. í‡Í‡ Ò˙˘Ó ÌÂ ‚ËÌ‡„Ë ËÏ‡‰ËÂÍÚÌ‡ ‚˙ÁÍ‡ ÏÂÊ‰Û ‡·ÌÓÏÌÓ ÑëÖè ÌË‚Ó Ë ÌË‚ÓÚÓÌ‡ ÒÚÂÌÓÁ‡ ÛÒÚ‡ÌÓ‚ÂÌÓ ˜ÂÁ ÌÂ‚ÓËÁÓ·‡Áfl‚‡˘‡Ú‡ ÚÂı-ÌËÍ‡. éÚÍÎÓÌÂÌËflÚ‡ ÓÚ ÌÓÏ‡Ú‡ ‚ ëÖè Ë ÑëÖè ÔËãëëë ÍÓÂÒÔÓÌ‰Ë‡Ú Ò ÙËÁËÓÎÓ„Ë˜ÌÓÚÓ Á‡·‡‚flÌÂ Ì‡ ÔÓ-‚Ó‰ËÏÓÒÚÚ‡ ‚ ÏÌÓ„Ó ÍÓÂÌ˜ÂÚ‡ ÓÚ Í‡Û‰‡ ÂÍ‚ËÌ‡ Ë‰‚ÛÒÚ‡ÌÌÓ ÔÓ n.tibialis.

ë˙˘ÂÒÚ‚Û‚‡˘‡Ú‡ ÎËÚÂ‡ÚÛ‡ Á‡ ÔËÎÓÊÂÌËÂÚÓ Ì‡ÑëÖè ÔË ãëëë Â Ó„‡ÌË˜ÂÌ‡. èÓ‡‰Ë ËÁÔÓÎÁ‚‡ÌËÚÂ ‡Á-ÎË˜ÌË ÏÂÚÓ‰Ë Ë ‡Ì‡ÎËÁË Â ÚÛ‰ÌÓ ‰‡ ÒÂ ‰ÓÒÚË„ÌÂ ‰Ó ÍÓÌ-ÒÂÌÒÛÒ Á‡ ÁÌ‡˜ÂÌËÂÚÓ Ì‡ ÑëÖè ‚ ‰Ë‡„ÌÓÁ‡Ú‡ Ë ÓˆÂÌÍ‡Ú‡ Ì‡ãëëë ·‡ÁË‡ÈÍË ÒÂ Ì‡ ÔÛ·ÎËÍÛ‚‡ÌËÚÂ ‰‡ÌÌË (7). Qureshi ËÒ˙Ú. (1999) ÔÂ‰ÒÚ‡‚flÚ ÂÁÛÎÚ‡ÚË ÓÚ ÒÎflÔÓ ÔÓÛ˜‚‡ÌÂÌ‡ 30 Ô‡ˆËÂÌÚ‡, Ì‡ÒÓ˜ÂÌË Á‡ ÓˆÂÌÍ‡ Ì‡ ‚ÂÓflÚÌ‡ ãëëë Ë‰ÓÒÚË„‡Ú ‰Ó ËÁ‚Ó‰‡, ˜Â ÑëÖè Ò‡ ÔÓ-‰Ó·˙ ÏÂÚÓ‰ ÓÚ åêí‚ ÓÔÂ‰ÂÎflÌÂÚÓ ÍÓË Ô‡ˆËÂÌÚË ËÏ‡Ú ‰ÓÒÚ‡Ú˙˜ÌÓ ËÁ‡ÁÂÌ‡ãëëë Ë Ò‡ ÔÓ‰ıÓ‰fl˘Ë Á‡ ıËÛ„Ë˜Ì‡ ‰ÂÍÓÏÔÂÒËfl. (12).Hillman Ë Ò˙Ú. (2000) ÔÓÛ˜‚‡Ú 78 Ô‡ˆËÂÌÚ‡, Í‡ÚÓ ‚‰ÓÔ˙ÎÌÂÌËÂ ÓˆÂÌfl‚‡Ú Ë ÒÎÂ‰ÓÔÂ‡ÚË‚ÌËflÚ ËÁıÓ‰. êÂÁÛÎÚ‡-ÚËÚÂ Ò‡ ‰ÓË ÔÓ-‰Ó·Ë ÓÚ ÔÂ‰Ë¯ÌÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ ‚ ÓÔÂ-‰ÂÎflÌÂÚÓ Ì‡ Ô‡ˆËÂÌÚËÚÂ ÌÛÊ‰‡Â˘Ë ÒÂ ÓÚ ıËÛ„Ë˜ÌÓ ÎÂ-˜ÂÌËÂ. (4). à ‰‚ÂÚÂ ÔÓÛ˜‚‡ÌËfl Ò‡ ·‡ÁË‡ÌË Ò‡ÏÓ Ì‡ ÂÁÛÎ-Ú‡ÚËÚÂ ÓÚ ÑëÖè. çËÂ Ò˜ËÚ‡ÏÂ ˜Â ‰‚ÛÒÚ‡ÌÌ‡Ú‡ ‡·ÌÓ-ÏÌÓÒÚ ‚ ëÖè Â ÔÓ-ÔÓÍ‡Á‡ÚÂÎÌ‡ Á‡ ãëëë ÓÚ ‰‚ÛÒÚ‡ÌÌ‡‡·ÌÓÏÌÓÒÚ ‚ ÑëÖè. Ç ‰Û„Ó Ì‡¯Â ÔÓÛ˜‚‡ÌÂ Á‡ ÒÚÓÈÌÓ-ÒÚÚ‡ Ì‡ ëÖè Ë ÑëÖè ÔË ÓÒÚË ‰ËÒÍÓ„ÂÌÌË ‡‰ËÍÛÎÓÔ‡-ÚËË (ÌÂÔÛ·ÎËÍÛ‚‡ÌË ‰‡ÌÌË) ÛÒÚ‡ÌÓ‚fl‚‡ÏÂ ÏÌÓ„Ó ÌËÒ˙ÍÔÓˆÂÌÚ Ì‡ ‡·ÌÓÏÌÓÒÚ ‚ ëÖè. èË 6 ÓÚ ÒÎÛ˜‡ËÚÂ ÒÑëÖè ‰‡ÌÌË Á‡ Â‰ÌÓ‚ÂÏÂÌÌ‡ Û‚Â‰‡ Ì‡ L5 Ë S1 ÍÓÂÌ˜ÂÚ‡Â‰ÌÓÒÚ‡ÌÌÓ, ÔÓÎÛ˜‡‚‡ÏÂ ÌÓÏ‡ÎÌË ëÖè ÒÎÂ‰ ÒÚËÏÛÎ‡ˆËfl


îË„. 3·. åêí ÔË Ò˙˘ËflÚ Ô‡ˆËÂÌÚ.

îË„. 3‡. ëÖè ÒÎÂ‰ ÒÚËÏÛÎ‡ˆËfl Ì‡ n.tibialis Ë ÑëÖè ÒÎÂ‰ ÒÚËÏÛÎ‡ˆËflÌ‡ L5 Ë S1 ‰ÂÏ‡ÚÓÏË ‚ Îfl‚Ó („ÓÌ‡ „‡ÙËÍ‡) Ë ‰flÒÌÓ (‰ÓÎÌ‡ „‡ÙËÍ‡)

ÔË Ï˙Ê Ì‡ 36 „. Ä·ÒÓÎ˛ÚÌ‡Ú‡ Î‡ÚÂÌˆËfl Ì‡ ê38 ‰‚ÛÒÚ‡ÌÌÓ Â ‚‡ÏÍËÚÂ Ì‡ 2 ëÑ ÓÚ ÌÓÏ‡Ú‡. ãËÔÒ‚‡˘Ë ÍÓÓ‚Ë ÔÓÚÂÌˆË‡ÎË ÒÎÂ‰

ÒÚËÏÛÎ‡ˆËfl Ì‡ S1 ‰‚ÛÒÚ‡ÌÌÓ. Ä·ÌÓÏÌË ‡·ÒÓÎ˛ÚÌË Î‡ÚÂÌˆËË Ì‡ ê1ÒÎÂ‰ ÒÚËÏÛÎ‡ˆËfl Ì‡ L5 ‰‚ÛÒÚ‡ÌÌÓ, ã>Ñ. ÖÎÂÍÚÓÙËÁËÓÎÓ„Ë˜ÌË

‰‡ÌÌË ËÌ‰ËˆË‡˘Ë ‰‚ÛÒÚ‡ÌÌ‡ Û‚Â‰‡ Ì‡ L5 Ë S1 ÒÂÚË‚ÌË ÍÓÂÌ˜ÂÚ‡,Í‡ÚÓ Á‡ S1 ÍÓÂÌ˜ÂÚ‡ ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡ ·ÎÓÍ Ì‡ ÔÓ‚ÂÊ‰‡ÌÂ. ç‡ıÓ‰Í‡

Ì‡ÒÓ˜‚‡˘‡ ‚ÂÓflÚÌ‡ ãëëë.

Ì‡ n.tibialis ÓÚ Ò˙˘‡Ú‡ ÒÚ‡Ì‡. èË ÌËÚÓ Â‰ËÌ ÓÚ ÚÂÁË 6Ô‡ˆËÂÌÚ‡ ÌÂ ÛÒÚ‡ÌÓ‚fl‚‡ÏÂ ‰‡ÌÌË Á‡ ÒÚÂÌÓÁ‡ Ì‡ ‚ÂÚÂ·-‡ÎÌËfl Í‡Ì‡Î ÓÚ ÌÂ‚ÓËÁÓ·‡Áfl‚‡˘ÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ. íÂÁË‰‡ÌÌË, Í‡ÍÚÓ Ë ‚ËÒÓÍËflÚ ÔÓˆÂÌÚ ‰‚ÛÒÚ‡ÌÌÓ ‡·ÌÓÏÌËëÖè ÔÓÎÛ˜ÂÌË ‚ Ì‡ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡ÌÂ ÔÓÚ‚˙Ê‰‡‚‡ÚÔÂ‰ÔÓÎÓÊÂÌËÂÚÓ, ˜Â ‡·ÌÓÏÌÓÒÚÚ‡ Ì‡ ÚË·Ë‡ÎÌËÚÂ ëÖèÓÒ‚ÂÌ ÓÚ ÔÓÎË‡‰ËÍÛÎÂÌ‡Ú‡ Û‚Â‰‡ Ò‡ ‚ Á‡‚ËÒËÏÓÒÚ Ë ÓÚıÓÌË˜ÌÓÒÚÚ‡ Ì‡ ÔÓˆÂÒ‡.

åÂÚÓ‰ËÍ‡Ú‡ Â ÌÂËÌ‚‡ÁË‚Ì‡, Á‡ÔËÒËÚÂ Ò‡ Ò‡‚ÌËÚÂÎÌÓÎÂÒÌË Á‡ ÔÓÎÛ˜‡‚‡ÌÂ Ë ËÌÚÂÔÂÚ‡ˆËfl Ë ÍÓ„‡ÚÓ Ò‡ ÓÒ˙˘Â-ÒÚ‚ÂÌË ÍÓÂÍÚÌÓ ‰‡‚‡Ú ‰Ó·Ó ‰ÓÍ‡Á‡ÚÂÎÒÚ‚Ó Á‡ ÚËÔ‡Ì‡ ÌÂ‚ÓÙËÁËÓÎÓ„Ë˜Ì‡Ú‡ ‰ËÒÙÛÌÍˆËfl ÔË ãëëë. ë˜ËÚ‡-ÏÂ, ˜Â ëÖè Ë ÑëÖè ÏÓ„‡Ú ‰‡ ·˙‰‡Ú ÍËÚÂËÈ ‰ÓÍÓÎÍÓÌ‡ıÓ‰ÍËÚÂ ÓÚ ÌÂ‚ÓËÁÓ·‡Áfl‚‡˘ËÚÂ ÏÂÚÓ‰Ë Ò‡ ÍÎËÌË˜-ÌÓ ÁÌ‡˜ËÏË Ë Ò˙ÓÚ‚ÂÚÌÓ ‰‡ ·˙‰‡Ú ÔÓÎÂÁÌË ‚ ÔÂˆÂÌÍ‡Ú‡ÍÓË Ô‡ˆËÂÌÚË Ò‡ Ì‡È-ÔÓ‰ıÓ‰fl˘Ë Á‡ ıËÛ„Ë˜Ì‡ ‰ÂÍÓÏÔÂ-ÒËfl Ó˘Â ‚ ‡ÌÌËÚÂ ÒÚ‡‰ËË Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ.

ãàíÖêÄíìêÄ1. ÉÂ˜Â‚, Ä.: äÓÂÌ˜Â‚‡ Í‡ÚÓ„‡ÙËfl ˜ÂÁ ÏÓÚÓÌË Ë ÒÂÌÁÓÌË Â‚ÓÍË‡ÌËÔÓÚÂÌˆË‡ÎË ÓÚ ÎÛÏ·Ó-Ò‡Í‡ÎÌ‡Ú‡ Ó·Î‡ÒÚ. åÂÚÓ‰ Ë ÔËÎÓÊÂÌËÂ. NeurologiaBalkanica, 1997, vol. 1-2: 25-30.2. äÓÒÚÓ‚, ä., èÂÚÓ‚, à‚., à‚‡ÌÓ‚‡, à‚.: ëÓÏ‡ÚÓÒÂÌÁÓÌË Â‚ÓÍË‡ÌË ÔÓ-ÚÂÌˆË‡ÎË ÓÚ n.tibialis, n.medianus Ë ÎÛÏ·Ó-Ò‡Í‡ÎÌËÚÂ ‰ÂÏ‡ÚÓÏË – ÌÓÏ‡-ÚË‚ÌË ‰‡ÌÌË. Å˙Î„‡ÒÍ‡ ÌÂ‚ÓÎÓ„Ëfl (ÔÓ‰ ÔÂ˜‡Ú). 3. êÛÒÂ‚, ê., ÅÓÌÂ‚‡, ç., íÓˆÂ‚, ç., êÓÒÏ‡ÌÓ‚, Ç., ÄÒÔ‡ÛıÓ‚, Ä.: ÑÂÏ‡ÚÓÏ-ÌË ÒÓÏ‡ÚÓÒÂÌÁÓÌË Â‚ÓÍË‡ÌË ÔÓÚÂÌˆË‡ÎË Ë ÒÚÂÒ – ËÁÒÎÂ‰‚‡ÌÂ Ì‡ ÚË·Ë‡ÎÌËÒÓÏ‡ÚÓÒÂÌÁÓÌË Â‚ÓÍË‡ÌË ÔÓÚÂÌˆË‡ÎË ÔË ·ÓÎÌË Ò ÎÛÏ·‡ÎÌ‡ ÒÔËÌ‡ÎÌ‡ ÒÚÂ-ÌÓÁ‡. éÚÓÔÂ‰Ëfl Ë Ú‡‚Ï‡ÚÓÎÓ„Ëfl, 1995; 32: 202-211.4. Hillman. L., Kraft. GH., Massagli. T. Lumbosacral stenosis: dermatomalsomatosensory evoked potentials versus imaging and clinical outcomes after sur-

gery. Muscle & Nerve 2000;23(10):1630.5. Jensen. M.C., Brandt-Zawadzke. M.N., Obuchowski. N., et al. Magnetic res-onance imaging of the lumbar spine in people without back pain. N Engl J Med1994;2(331):69–73.6. Kati H.A., Sedgwick. E.M. Evaluation of the dermatomal somatosensoryevoked potentials in the diagnosis of lumbo-sacral root compression. J Neurol1987;50:1204–10.7. Kraft. G.H., Aminof. M.J., Baran. E.M., et al. Somatosensory evoked poten-tials: clinical uses. Muscle Nerve 1998;21:252–8.8. Kraft. G.H. A physiological approach to the evaluation of lumbosacral spinalstenosis. Phys Med Rehabil Clin N Am 1998;9:1–8. 9. Kraft, G.H.: Dermatomal somatosensory-evoked potentials in the evaluationof lumbosacral spinal stenosis. Phys Med Rehabil Clin N Am 2003; 14:71–7510. Qureshi. A.A., Hillman. L., Kraft. G.H. Dermatomal somatosensory evokedpotentials predict surgery for lumbosacral spinal stenosis better than magnetic res-onance imaging. Muscle Nerve 1999;2(9):1322–3.11. Simpson. J.A. Electrical signs in diagnosis of carpal tunnel and related syn-dromes. J Neurol Neurosurg Psychiatry 1956;19:275–80.12. Slimp. J.C., Rubner. D.E., Snowden. M.L., et al. Dermatomal somatosensoryevoked potentials: cervical, thoracic, and lumbosacral levels. ElectroencephalogrClin Neurophysiol 1992; 84:55–70.13. Snowden. M.L., Haselkorn. J., Kraft. G.H., et al. Dermatomal somatosensoryevoked potentials in lumbosacral spinal stenosis. Muscle Nerve 1992;15:1036–44.14. Snowden. M.L., Haselkorn. J., Kraft. G.H., et al. Dermatomal somatosensoryevoked potentials, electromyography and radiologic imaging in lumbosacral spinalstenosis [abstract]. Arch Phys Med Rehabil 1992;73:89.15. Tokuhashi. Y., Santoh. K., Funami .S. A quantitative evaluation of sensory dys-function in lumbosacral radiculopathy. Spine 1991;16:1321–8.16. Wall. E.J., Cohen. M.S., Massie. J.B., et al. Cauda equina anatomy: 1.Intrathecal Nerve Root Organization. Spine 1990;15(12):1244–7.

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éË„ËÌ‡ÎÌË ÒÚ‡ÚËËèöêÇàíÖ ÅöãÉÄêëäà ÑÖñÄ ë GEFS+ ëàçÑêéå à ëàçÑêéå

çÄ DRAVET ë åìíÄñàà Ç ÉÖç SCN1A(SCN1A åìíÄñàà èêà GEFS+ à ëàçÑêéå çÄ DRAVET)

à‚ ëÚ. à‚‡ÌÓ‚, ‰.Ï1, à‚. ãËÚ‚ËÌÂÌÍÓ, ‰.Ï.2, Ñ. ïËÒÚÓ‚‡2, ã. äÎ‡ÂÒ4, ä. äÎÂÈÒ5, Ä. ëÛÎÒ4, ã. ÑÂÔÂ4, Ñ. ÄÛ‰ÂÌ‡ÂÚ4, è. ÑÂ ûÌ„4,5, Ä. âÓ‰‡ÌÓ‚‡, ‰.Ï.3,4

1äÎËÌËÍ‡ ÔÓ ÔÂ‰Ë‡ÚËfl Ë ÏÂ‰ËˆËÌÒÍ‡ „ÂÌÂÚËÍ‡, ìåÅÄã ◊ë‚. ÉÂÓ„Ë”- èÎÓ‚‰Ë‚; 2äÎËÌËÍ‡Ú‡ ÔÓ ‰ÂÚÒÍ‡ ÌÂ‚ÓÎÓ„Ëfl Ì‡ ìÌË‚ÂÒËÚÂÚÒÍ‡ ÒÔÂˆË‡ÎËÁË‡Ì‡ ·ÓÎÌËˆ‡ Á‡ ÎÂ˜ÂÌËÂ Ì‡ ‰Âˆ‡, ëÓÙËfl;

3ã‡·Ó‡ÚÓËfl ÔÓ ÏÓÎÂÍÛÎflÌ‡ Ô‡ÚÓÎÓ„Ëfl, ëÓÙËÈÒÍË ÏÂ‰ËˆËÌÒÍË ÛÌË‚ÂÒËÚÂÚ; 4éÚ‰ÂÎ ÔÓ ÏÓÎÂÍÛÎflÌ‡ „ÂÌÂÚËÍ‡, ìÌË‚ÂÒËÚÂÚ Ì‡ ÄÌÚ‚ÂÔÂÌ; 5äÎËÌËÍ‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl, ìÌË‚ÂÒËÚÂÚÒÍ‡ ·ÓÎÌËˆ‡, ÄÌÚ‚ÂÔÂÌ

SUMMARY

THE FIRST BULGARIAN INFANTS WITH GEFS+ ORDRAVET SYNDROME IN WHICH SCN1A MUTATION

WAS DISCOVERED I. St. Ivanov, I. Litvinenko, D.Hristova, L. Claes, K. Claeys,

A. Suls, L. Deprez, D. Audenaert, P. De Jonghe and A.Jordanova

Background: The frequent association of SCN1A muta-tions with Dravet syndrome (SMEI) and generalized epilepsywith febrile seizures+ syndrome (GEFS+) suggest its use as adiagnostic tool.

Purpose: To analyze the phenotype of the first Bulgarianpatients with identified SCN1A mutations, to correlate it to thegenotype and to suggest indications for SCN1A mutationscreening in everyday practice. Patients: Twenty-two probandsof Bulgarian families compatible with GEFS+ or SMEI pheno-types that were treated in the Neuropediatric Departments of theUniversity Hospitals of Plovdiv and Sofia. Methods: Allprobands underwent clinical, EEG and brain imaging investiga-tions and were followed-up for periods between 18 mo. and 8yrs. All were screened for mutations in SCN1A and if positive

the relatives were also tested. Results: SCN1A mutations werefound in 5 probands. The first two were patients from GEFS+families that presented with “FS+” or “FS and focal seizures”phenotypes. One of them had a missense Thr841Met mutationin the DIIS3 domain of the protein that was inherited from theasymptomatic father. The second child had also a missenseArg604His mutation, affecting the junction between DI and DIIdomains that was inherited from an “FS” mother. The next twoprobands had de novo mutations in the DIS5-S6 domains – anonsense Ärg377Stop mutation and a missense Leu378Glnmutation. Their phenotype was Dravet syndrome. The lastproband also demonstrated SMEI phenotype. Her mutation wasnonsense Arg1329Stop in the DIIIS4 domain. Several clinicaland EEG peculiarities hindered the correct syndromic diagno-sis in the first months after seizure onset. Conclusions:Diagnosing SCN1A mutation paves the way to idiopathic gen-eralized epilepsy. All patients with febrile seizures of earlyonset (before 12 mo.), with prolonged seizures and with a pos-itive family history for febrile seizures or epilepsy are indicat-ed for SCN1A mutation screening.

Key words: GEFS+, Dravet syndrome, SCN1A mutation,screening.

êÖáûåÖ

ÇËÒÓÍ‡Ú‡ ˜ÂÒÚÓÚ‡ Ì‡ SCN1A ÏÛÚ‡ˆËË ÔË Ô‡ˆËÂÌÚËÒ˙Ò ÒËÌ‰ÓÏ Ì‡ Dravet (SMEI) Ë Ò‡‚ÌËÚÂÎÌÓ ˜ÂÒÚÓÚÓ ÈÓÚÍË‚‡ÌÂ ÔË ÒÂÏÂÈÒÚ‚‡ Ò˙Ò ÒËÌ‰ÓÏ‡ Ì‡ „ÂÌÂ‡ÎËÁË‡-Ì‡ ÂÔËÎÂÔÒËfl Ò ÙÂ·ËÎÌË „˙˜Ó‚Â+ (GEFS+) Û‚ÂÎË˜‡‚‡ ‰Ë-‡„ÌÓÒÚË˜ÌËÚÂ ‚˙ÁÏÓÊÌÓÒÚË ‚ ÌÂ‚ÓÔÂ‰Ë‡ÚË˜Ì‡Ú‡Ô‡ÍÚËÍ‡. ñÂÎÚ‡ Ì‡ Ì‡ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡ÌÂ Â ‰‡ ÒÂ ‡Ì‡-ÎËÁË‡ ÍÎËÌË˜Ì‡Ú‡ ËÁfl‚‡ ÔË Ô˙‚ËÚÂ ·˙Î„‡ÒÍË Ô‡ˆËÂÌ-ÚË Ò ÛÒÚ‡ÌÓ‚ÂÌ‡ ÏÛÚ‡ˆËfl ‚ „ÂÌ SCN1A Ë ÚflıÌ‡Ú‡ ÙÂÌÓ-ÚËÔ-„ÂÌÓÚËÔÌ‡Ú‡ ÍÓÂÎ‡ˆËfl, Í‡ÍÚÓ Ë ‰‡ ÒÂ ÔÂ‰ÎÓÊ‡ÚËÌ‰ËÍ‡ˆËË Á‡ ÒÍËÌËÌ„ Á‡ ÏÛÚ‡ˆËfl ‚ SCN1A. äÓÌÚËÌ-„ÂÌÚ Ì‡ ËÁÒÎÂ‰‚‡ÌÂÚÓ Ò‡ 22 ÔÓ·‡Ì‰‡-‰Âˆ‡ ÓÚ ·˙Î„‡ÒÍËÒÂÏÂÈÒÚ‚‡ Ò ÍÎËÌË˜ÌË ‰‡ÌÌË Á‡ GEFS+ ËÎË SMEI, ÍÓËÚÓÒ‡ ÔÓÚ˙ÒËÎË ÌÂ‚ÓÔÂ‰Ë‡ÚË˜Ì‡ ÔÓÏÓ˘ ‚ ìÌË‚ÂÒËÚÂ-ÚÒÍËÚÂ ·ÓÎÌËˆË Ì‡ èÎÓ‚‰Ë‚ Ë ëÓÙËfl. åÂÚÓ‰ËÍ‡: èÓ-·‡Ì‰ËÚÂ Ò‡ ËÁÒÎÂ‰‚‡ÌË ÍÎËÌË˜ÌÓ, ˜ÂÁ ÖÖÉ Ë ÌÂ‚ÓËÁÓ·‡-Áfl‚‡˘Ë ÏÂÚÓ‰Ë Ë ÔÓÒÎÂ‰fl‚‡ÌË Á‡ ÔÂËÓ‰ ÓÚ 18 ÏÂÒ. ‰Ó 8„Ó‰ËÌË. ÇÒË˜ÍËÚÂ Ò‡ ÒÍËÌË‡ÌË Á‡ ÏÛÚ‡ˆËfl ‚ SCN1A „Â-Ì‡ Ë ÔË ÛÒÚ‡ÌÓ‚fl‚‡ÌÂ Ì‡ Ú‡Í‡‚‡ Ò‡ ËÁÒÎÂ‰‚‡ÌË Ó‰ÒÚ‚Â-ÌËˆËÚÂ. êÂÁÛÎÚ‡ÚË: SCN1A ÏÛÚ‡ˆËË Ò‡ ÛÒÚ‡ÌÓ‚ÂÌË ÔË5 ÔÓ·‡Ì‰‡. è˙‚ËÚÂ ‰‚‡ ÔËÌ‡‰ÎÂÊ‡Ú Ì‡ ÒÂÏÂÈÒÚ‚‡ ÒÔÓfl‚Ë Ì‡ GEFS+ Í‡ÚÓ ÚÂıÌËÚÂ ÙÂÌÓÚËÔË Ò‡ Ò˙ÓÚ‚ÂÚ-ÌÓ ◊FS+” Ë “FS Ë ÙÓÍ‡ÎÌË „˙˜Ó‚Â”. èË Ô˙‚ÓÚÓ ‰ÂÚÂ ÂÓÚÍËÚ‡ missense ÏÛÚ‡ˆËfl Thr841Met ‚ DIIS3 ‰ÓÏÂÌ Ì‡ÔÓÚÂËÌ‡, ÍÓflÚÓ Â ÛÌ‡ÒÎÂ‰ÂÌ‡ ÓÚ ‡ÒËÏÔÚÓÏ‡ÚË˜ÂÌ ·‡-˘‡. èË ‚ÚÓÓÚÓ Â ÛÒÚ‡ÌÓ‚ÂÌ‡ missense ÏÛÚ‡ˆËflArg604His, Á‡Òfl„‡˘‡ ‚˙ÁÍ‡Ú‡ ÏÂÊ‰Û DI and DII ‰ÓÏÂÌË.åÛÚ‡ˆËflÚ‡ Â ÛÌ‡ÒÎÂ‰ÂÌ‡ ÓÚ Ï‡ÈÍ‡ Ò FS+ ÙÂÌÓÚËÔ. ÑÛ-„Ë ‰‚‡ ÔÓ·‡Ì‰‡ ËÏ‡Ú de novo ÏÛÚ‡ˆËË ‚ DIS5-S6domains – nonsense ÏÛÚ‡ˆËfl Ärg377Stop Ë missense ÏÛÚ‡-ˆËfl Leu378Gln. îÂÌÓÚËÔÌ‡Ú‡ ËÏ ËÁfl‚‡ Â SMEI. èÂÚÓÚÓ‰ÂÚÂ Ò˙˘Ó ÔÓfl‚fl‚‡ SMEI ÙÂÌÓÚËÔ, ÍÓÈÚÓ ÒÂ ‡ÒÓˆËË‡ Ònonsense ÏÛÚ‡ˆËfl Arg1329Stop ‚ DIIIS4 ‰ÓÏÂÌ. êÂ‰Ëˆ‡ÍÎËÌË˜ÌË Ë ÖÖÉ ÓÒÓ·ÂÌÓÒÚË Á‡ÚÛ‰Ìfl‚‡Ú Ô‡‚ËÎÌ‡Ú‡ÒËÌ‰ÓÏÌ‡ ‰Ë‡„ÌÓÁ‡ ‚ Ô˙‚ËÚÂ ÏÂÒÂˆË ÓÚ ‰Â·˛Ú‡ Ì‡ ÂÔË-ÎÂÔÚË˜ÌËÚÂ ÔËÒÚ˙ÔË. àÁ‚Ó‰Ë: ÑÓÍ‡Á‚‡ÌÂÚÓ Ì‡ SCN1AÏÛÚ‡ˆËfl Ì‡ÒÓ˜‚‡ ÍÎËÌË˜Ì‡Ú‡ ‰Ë‡„ÌÓÁ‡ ‚ ÔÓÒÓÍ‡ Ë‰ËÓÔ‡-ÚË˜Ì‡ „ÂÌÂ‡ÎËÁË‡Ì‡ ÂÔËÎÂÔÒËfl. ÇÒË˜ÍË Ô‡ˆËÂÌÚË Ò ÙÂ·-ËÎÌË „˙˜Ó‚Â Ò ‡ÌÌÓ Ì‡˜‡ÎÓ (ÔÂ‰Ë 1 „Ó‰. ‚˙Á‡ÒÚ), Ò Ì‡-ÎË˜ËÂ Ì‡ ÔÓÎÓÌ„Ë‡ÌË ÙÂ·ËÎÌË „˙˜Ó‚Â Ë Ì‡ Ù‡ÏËÎÌÓÒÚÒ ÙÂ·ËÎÌË „˙˜Ó‚Â ËÎË ÂÔËÎÂÔÒËfl Ò‡ ÔÓÍ‡Á‡ÌË Á‡ ÒÍËÌËÌ„Ì‡ ÏÛÚ‡ˆËË ‚ SCN1A „ÂÌ‡.

äÎ˛˜Ó‚Ë ‰ÛÏË: GEFS+, ÒËÌ‰ÓÏ Ì‡ Dravet , SCN1A ÏÛ-Ú‡ˆËfl, ÒÍËÌËÌ„.

SUMMARY

Background: The frequent association of SCN1A muta-tions with Dravet syndrome (SMEI) and generalized epilepsywith febrile seizures+ syndrome (GEFS+) suggest its use as adiagnostic tool. Purpose: To analyze the phenotype of the firstBulgarian patients with identified SCN1A mutations, to cor-relate it to the genotype and to suggest indications for SCN1Amutation screening in everyday practice. Patients: Twenty-twoprobands of Bulgarian families compatible with GEFS+ orSMEI phenotypes that were treated in the NeuropediatricDepartments of the University Hospitals of Plovdiv and Sofia.Methods: All probands underwent clinical, EEG and brainimaging investigations and were followed-up for periodsbetween 18 mo. and 8 yrs. All were screened for mutations inSCN1A and if positive the relatives were also tested. Results:SCN1A mutations were found in 5 probands. The first twowere patients from GEFS+ families that presented with “FS+”or “FS and focal seizures” phenotypes. One of them had amissense Thr841Met mutation in the DIIS3 domain of theprotein that was inherited from the asymptomatic father. Thesecond child had also a missense Arg604His mutation, affect-

ing the junction between DI and DII domains that was inher-ited from an “FS” mother. The next two probands had de novomutations in the DIS5-S6 domains – a nonsense Ärg377Stopmutation and a missense Leu378Gln mutation. Their pheno-type was Dravet syndrome. The last proband also demonstrat-ed SMEI phenotype. Her mutation was nonsenseArg1329Stop in the DIIIS4 domain. Several clinical and EEGpeculiarities hindered the correct syndromic diagnosis in thefirst months after seizure onset. Conclusions: DiagnosingSCN1A mutation paves the way to idiopathic generalizedepilepsy. All patients with febrile seizures of early onset(before 12 mo.), with prolonged seizures and with a positivefamily history for febrile seizures or epilepsy are indicated forSCN1A mutation screening.

Key words: GEFS+, Dravet syndrome, SCN1A mutation,screening.

ìÇéÑ

ëËÌ‰ÓÏ˙Ú ◊„ÂÌÂ‡ÎËÁË‡Ì‡ ÂÔËÎÂÔÒËfl Ò ÙÂ·ËÎÌË„˙˜Ó‚Â +” (GEFS+) Â ÓÔËÒ‡Ì ÔÂÁ 1997 ÓÚ I. Scheffer Ë S.Berkovic. íÓÈ ÔÂ‰ÒÚ‡‚Îfl‚‡ ˜ÂÒÚ Ù‡ÏËÎÂÌ ‡‚ÚÓÁÓÏÌÓ-‰Ó-ÏËÌ‡ÌÚÂÌ ÂÔËÎÂÔÚË˜ÂÌ ÒËÌ‰ÓÏ, ÔÓfl‚ÂÌ ÔÂ‰ËÏÌÓ ˜ÂÁ„ÂÌÂ‡ÎËÁË‡ÌË ÚÓÌË˜ÌÓ-ÍÎÓÌË˜ÌË „˙˜Ó‚Â (Éíäè) Ò ËÎË·ÂÁ ÙÂ·ËÎËÚÂÚ. Ç Ï‡ÎÍ‡ ˜‡ÒÚ ÓÚ ˜ÎÂÌÓ‚ÂÚÂ Ì‡ ËÁÒÎÂ‰-‚‡ÌËÚÂ ÒÂÏÂÈÒÚ‚‡ ÚÂÁË „˙˜Ó‚Â ÒÂ Ò˙˜ÂÚ‡‚‡Ú Ò ‡·Ò‡ÌÒË,‡ÚÓÌË˜ÌË ËÎË ÏËÓÍÎÓÌË˜ÌË ÔËÒÚ˙ÔË (18, 19). ëÂ‰ ÌÓÒË-ÚÂÎËÚÂ Ì‡ „ÂÌÂÚË˜ÌËfl ‰ÂÙÂÍÚ ‚ ÌflÍÓË Ù‡ÏËÎËË ÒÂ ÓÚÍ-Ë‚‡Ú Ë ÙÂÌÓÚËÔÌË ÔÓfl‚Ë Ì‡ ÏËÓÍÎÓÌË˜ÌÓ-‡ÒÚ‡ÚË˜Ì‡ÂÔËÎÂÔÒËfl (2, 13, 16, 18, 19), Ò-Ï Ì‡ Dravet (13), ‰ÂÚÒÍ‡ ‡·-Ò‡ÌÒÌ‡ Ë ‰Û„Ë Ë‰ËÓÔ‡ÚË˜ÌË „ÂÌÂ‡ÎËÁË‡ÌË ÂÔËÎÂÔÒËË (2,16, 18) ËÎË ÍÓÏ·ËÌ‡ˆËË ÓÚ Éíäè Ò ËÎË ·ÂÁ ÙÂ·ËÎËÚÂÚ ËÙÓÍ‡ÎÌË „˙˜Ó‚Â (3). èË 10% ÓÚ GEFS+ ÒÂÏÂÈÒÚ‚‡Ú‡Ò‡ ÛÒÚ‡ÌÓ‚ÂÌË ‰ÂÙÂÍÚË ‚ „ÂÌËÚÂ Ì‡ ‡ÎÙ‡-1, ‡ÎÙ‡-2 ËÎË ·Â-Ú‡-1 ÒÛ·Â‰ËÌËˆËÚÂ Ì‡ ‚ÓÎÚ‡ÊÌÓ-Á‡‚ËÒËÏËÚÂ Ì‡ÚËÂ‚ËÍ‡Ì‡ÎË (SCN1A, SCN2A Ë SCN1B „ÂÌË, ÎÓÍ‡ÎËÁË‡ÌË Ò˙-ÓÚ‚ÂÚÌÓ ‚˙ıÛ 2q21-q33, 2q23-q24.3, 19q13.1) ËÎË ‚ „ÂÌ‡Á‡ „‡Ï‡ - 2 ÒÛ·Â‰ËÌËˆ‡Ú‡ Ì‡ Ä-ÂˆÂÔÚÓ‡ Á‡ „‡Ï‡-‡ÏËÌÓ-Ï‡ÒÎÂÌ‡ ÍËÒÂÎËÌ‡ (GABRAG2) ‚ „ÂÌÂÚË˜ÂÌ ÎÓÍÛÒ 5q31.1-q33.1 (3, 4, 9, 11).

ç‡È-˜ÂÒÚÓ ÓÚÍË‚‡ÌËÚÂ „ÂÌÂÚË˜ÌË ‰ÂÙÂÍÚË ÔËGEFS+ Ò‡ ÏÛÚ‡ˆËËÚÂ ‚ SCN1A (3). ÉÂÌ˙Ú ÍÓ‰Ë‡ ·ÂÎÚ˙-˜ÂÌ ÔÓ‰ÛÍÚ, Ò˙ÒÚÓfl˘ ÒÂ ÓÚ 4 ıÓÏÓÎÓÊÌË ‰ÓÏÂÌ‡ (DI –DIV). ÇÒÂÍË ÓÚ Úflı Â Ò˙ÒÚ‡‚ÂÌ ÓÚ 6 Ú‡ÌÒÏÂÏ·‡ÌÌËÒÂ„ÏÂÌÚ‡ (S1-S6). S5-S6 Ò‡ ÔÓÓÓ·‡ÁÛ‚‡˘‡Ú‡ (ÙÛÌÍˆËÓ-Ì‡ÎÌÓ ‡ÍÚË‚Ì‡Ú‡) ˜‡ÒÚ Ì‡ Í‡Ì‡Î‡, ‡ S4 ÔÂ‰ÒÚ‡‚Îfl‚‡‚ÓÎÚ‡ÊÌËfl ÒÂÌÁÓ (5).

èÂÁ 2001 L. Claes et al. ÛÒÚ‡ÌÓ‚fl‚‡Ú ÏÛÚ‡ˆËË ‚SCN1A „ÂÌ‡ ÔË ÒÔÓ‡‰Ë˜ÌË (ÌÂ-Ù‡ÏËÎÌË) ÒÎÛ˜‡Ë Ì‡ ÒËÌ‰-ÓÏ Ì‡ Dravet (SMEI, ÚÂÊÍ‡ ÏËÓÍÎÓÌË˜Ì‡ ÂÔËÎÂÔÒËfl ‚‡ÌÌ‡ ‰ÂÚÒÍ‡ ‚˙Á‡ÒÚ). íÓÁË ÒËÌ‰ÓÏ Â fl‰Í‡ ÂÔËÎÂÔÚË˜-Ì‡ ÂÌˆÂÙ‡ÎÓÔ‡ÚËfl, ‰Â·˛ÚË‡˘‡ ÔÂÁ Ô˙‚‡Ú‡ „Ó‰ËÌ‡ ÒÙÂ·ËÎÌË „˙˜Ó‚Â Ò ËÁ‡ÁÂÌ‡ Î‡ÚÂ‡ÎËÁ‡ˆËfl Ë „ÓÎflÏ‡ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ. èÂÁ ‚ÚÓ‡Ú‡ „Ó‰ËÌ‡ ÒÂ ‰Ó·‡‚flÚ ÏË-ÓÍÎÓÌË˜ÌË „˙˜Ó‚Â Ë ‡ÚËÔË˜ÌË ‡·Ò‡ÌÒË. óÂÒÚË Ò‡ ÍÓÏÔÎÂ-ÍÒÌËÚÂ Ô‡ˆË‡ÎÌË ÔËÒÚ˙ÔË (äèè). èÓ„ÂÒË‚ÂÌÛÏÒÚ‚ÂÌ Ë ÏÓÚÓÂÌ ‰ÂÙËˆËÚ ÒÂ ‡Á‚Ë‚‡ Ó·ËÍÌÓ‚ÂÌÓ ÒÎÂ‰2 „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ (1, 8). åÛÚ‡ˆËË ‚ SCN1A „ÂÌ‡ ÒÂ ÓÚÍ-Ë‚‡Ú ÔË Ì‡‰ 80% ÓÚ ÒÎÛ˜‡ËÚÂ Ò˙Ò SMEI (5). íÂ Ò‡ Ì‡È-˜ÂÒÚÓ de novo ‚˙ÔÂÍË Ì‡ÎË˜ËÂÚÓ Ì‡ Ù‡ÏËÎÌÓÒÚ Ò ÂÔË-ÎÂÔÒËfl ËÎË ÙÂ·ËÎÌË „˙˜Ó‚Â ÔË ÔÓÎÓ‚ËÌ‡Ú‡ ÓÚ Ô‡ˆËÂÌ-ÚËÚÂ (6, 20). èË ÌflÍÓË ÒÎÛ˜‡Ë Ò˙Ò SCN1A ÏÛÚ‡ˆËfl ÍÎË-ÌË˜ÌËÚÂ ËÁfl‚Ë Ò‡ ÔÓ-ÎÂÍË Ë ‡‚ÚÓËÚÂ „Ë ÓÁÌ‡˜‡‚‡Ú Í‡ÚÓ◊„‡ÌË˜Ì‡” ËÎË ◊ÎÂÍ‡” SMEI ËÎË ÂÁËÒÚÂÌÚÌ‡ ‰ÂÚÒÍ‡ÂÔËÎÂÔÒËfl Ò Éíäè (ICEGTCS) (5, 20).

ÉÂÌÓÚËÔ-ÙÂÌÓÚËÔÌËÚÂ ÍÓÂÎ‡ˆËË ÔË SCN1A ÏÛÚ‡-ˆËËÚÂ ÔÓÍ‡Á‚‡Ú, ˜Â nonsense (·ÂÁÒÏËÒÎÂÌËÚÂ) ÏÛÚ‡ˆËË,‚Ó‰Â˘Ë ‰Ó ÒÍ˙ÒÂÌ ·ÂÎÚ˙˜ÂÌ ÔÓ‰ÛÍÚ, ÔÂ‰ÓÔÂ‰ÂÎflÚ


ÎËÔÒ‡ Ì‡ ÙÛÌÍˆËfl Ì‡ Ì‡ÚËÂ‚Ëfl Í‡Ì‡Î Ë ÒÂ ÓÚÍË‚‡Ú ÔÂ-‰ËÏÌÓ ÔË SMEI (5, 10), ‰ÓÍ‡ÚÓ missense (ÔÓ„Â¯ÌÓ-ÒÏËÒÎÂÌËÚÂ) ÏÛÚ‡ˆËË, ÔÓÏÂÌfl˘Ë Ò‡ÏÓ ÍËÌÂÚËÍ‡Ú‡ Ì‡Í‡Ì‡Î‡, ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡Ú ÔÂ‰ËÏÌÓ ÔË ÍÎ‡ÒË˜ÂÒÍËflGEFS+ ÙÂÌÓÚËÔ (5).

Ç Ì‡ÒÚÓfl˘ÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ ÔÂ‰ÒÚ‡‚flÏÂ Ô˙‚ËÚÂ ÔÂÚ·˙Î„‡ÒÍË ÒÂÏÂÈÒÚ‚‡ Ò ÂÔËÎÂÔÚË˜ÂÌ ÒËÌ‰ÓÏ ‚ ‡ÏÍËÚÂÌ‡ GEFS+ ËÎË SMEI Ë ÛÒÚ‡ÌÓ‚ÂÌ‡ ÏÛÚ‡ˆËfl ‚ SCN1A „ÂÌ‡.

äéçíàÉÖçí/èÄñàÖçíà

àÁÒÎÂ‰‚‡ÌË Ò‡ 22 ÔÓ·‡Ì‰‡ Ì‡ ‚˙Á‡ÒÚ ÓÚ 0 ‰Ó 18 „Ó‰.,ÔÓÚ˙ÒËÎË ‡Ï·ÛÎ‡ÚÓÌ‡ ËÎË ·ÓÎÌË˜Ì‡ ÏÂ‰ËˆËÌÒÍ‡ ÔÓÏÓ˘ÔÓ ÔÓ‚Ó‰ ÂÔËÎÂÔÚË˜ÌË ÔËÒÚ˙ÔË ‚ ÌÂ‚ÓÎÓ„Ë˜ÌËÚÂ Í‡·Ë-ÌÂÚË Ë ÓÚ‰ÂÎÂÌËfl Ì‡ äÎËÌËÍ‡Ú‡ ÔÓ ÔÂ‰Ë‡ÚËfl Ë ÏÂ‰ËˆË-ÌÒÍ‡ „ÂÌÂÚËÍ‡ Ì‡ ìåÅÄã ◊ë‚. ÉÂÓ„Ë”, èÎÓ‚‰Ë‚, Ë äÎË-ÌËÍ‡Ú‡ ÔÓ ‰ÂÚÒÍ‡ ÌÂ‚ÓÎÓ„Ëfl Ì‡ ìÌË‚ÂÒËÚÂÚÒÍ‡ ÒÔÂˆË-‡ÎËÁË‡Ì‡ ·ÓÎÌËˆ‡ Á‡ ÎÂ˜ÂÌËÂ Ì‡ ‰Âˆ‡, ëÓÙËfl. ìÒÎÓ‚ËÂ Á‡‚ÍÎ˛˜‚‡ÌÂ ‚ ËÁÒÎÂ‰‚‡ÌÂÚÓ ·Â Ì‡ÎË˜ËÂ Ì‡ ÍÎËÌË˜ÌË ‰‡ÌÌËÁ‡ SMEI ËÎË GEFS+.

àÁÒÎÂ‰‚‡ÌÂÚÓ Â ÔÓ‚Â‰ÂÌÓ Ò˙Ò Ò˙„Î‡ÒËÂÚÓ Ì‡ Ô‡ˆËÂÌ-ÚËÚÂ Ë ‚ Ò˙ÓÚ‚ÂÚÒÚ‚ËÂ Ò ËÁËÒÍ‚‡ÌËflÚ‡ Ì‡ äÓÏËÒËËÚÂÔÓ ÏÂ‰ËˆËÌÒÍ‡ ÂÚËÍ‡ Ì‡ åÂ‰ËˆËÒÍËÚÂ ÛÌË‚ÂÒËÚÂÚË ‚èÎÓ‚‰Ë‚ Ë ëÓÙËfl Ë ìÌË‚ÂÒËÚÂÚ‡ Ì‡ ÄÌÚ‚ÂÔÂÌ, ÅÂÎ„Ëfl.

åÖíéÑàäà

äÎËÌË˜ÌÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ Ì‡ ÔÓ·‡Ì‰ËÚÂ Â ËÁ‚˙¯ÂÌÓÓÚ ‡‚ÚÓËÚÂ (à.à., à.ã, Ñ.ï.) Ë ‚ÍÎ˛˜‚‡¯Â ‡Ì‡ÏÌÂÁ‡ Á‡ÂÔËÎÂÔÚË˜ÌË ÔËÒÚ˙ÔË Ì‡ ÔÓ·‡Ì‰‡ Ë ÒÂÏÂÈÒÚ‚ÓÚÓ ÏÛ,ÔÂÏÓ·Ë‰Ì‡ ‡Ì‡ÏÌÂÁ‡, ÓˆÂÌÍ‡ Ì‡ ÌÂ‚ÓÎÓ„Ë˜ÂÌ, ÒÓÏ‡ÚË-˜ÂÌ ÒÚ‡ÚÛÒ Ë ÌÂ‚ÌÓ-ÔÒËıË˜ÂÒÍÓ ‡Á‚ËÚËÂ (çèê). ÖÖÉ ÂÔÓ‚ÂÊ‰‡Ì‡ Ò ‰Ë„ËÚ‡ÎÌË ‡Ô‡‡ÚË Ë ÏÓÌÚ‡Ê Ì‡ ÂÎÂÍÚÓ-‰ËÚÂ ÔÓ ÒËÒÚÂÏ‡Ú‡ 10-20. ÇÒË˜ÍË ‰Âˆ‡ Ò ÓÚ‚ÓÂÌ‡ ÙÓÌ-Ú‡ÌÂÎ‡ Ò‡ ÒÍËÌË‡ÌË Á‡ „Û·Ë ÒÚÛÍÚÛÌË ÎÂÁËË ˜ÂÁÚ‡ÌÒÙÓÌÚ‡ÌÂÎÌ‡ ÂıÓ„‡ÙËfl (íîÖ), ‡ ÔË ÒÎÛ˜‡ËÚÂ Ò ÚÂ-‡ÔÂ‚ÚË˜ÌÓ-ÂÁËÒÚÂÌÚÌ‡ ÂÔËÎÂÔÒËfl Ò‡ ËÁ‚˙¯ÂÌË äí Ëåêí Ì‡ ÏÓÁ˙Í‡.

Ñçä Â ÂÍÒÚ‡ıË‡Ì‡ ÓÚ ÔÂËÙÂÌ‡ Í˙‚ ÔË ‚ÒË˜ÍËÔÓ·‡Ì‰Ë. åÛÚ‡ˆËÓÌÌËflÚ ÒÍËÌËÌ„ Â ËÁ‚˙¯ÂÌ ˜ÂÁ ‰Ë-ÂÍÚÌÓ Ñçä ÒÂÍ‚ÂÌË‡ÌÂ Ì‡ ‚ÒË˜ÍËÚÂ 26 ÂÍÁÓÌ‡ Ì‡SCN1A „ÂÌ‡ Ò˙„Î‡ÒÌÓ ÓÔËÒ‡Ì‡ ‚Â˜Â ÏÂÚÓ‰ËÍ‡ (7). èË ÛÒ-Ú‡ÌÓ‚fl‚‡ÌÂ Ì‡ ÏÛÚ‡ˆËfl ‚ ËÌ‰ÂÍÒÌËfl Ô‡ˆËÂÌÚ Ò‡ ËÁÒÎÂ‰-‚‡ÌË Ë ÓÒÚ‡Ì‡ÎËÚÂ ˜ÎÂÌÓ‚Â Ì‡ ÒÂÏÂÈÒÚ‚ÓÚÓ Ò ˆÂÎ ‰‡ ÒÂÔÓÚ‚˙‰Ë ÒÂ„Â„‡ˆËflÚ‡ Ì‡ ·ÓÎÂÒÚÚ‡ Ò ÛÒÚ‡ÌÓ‚ÂÌ‡Ú‡ „Â-ÌÓÚËÔÌ‡ ‚‡Ë‡ˆËfl. èË ÒÎÛ˜‡ËÚÂ Ò de novo ÏÛÚ‡ˆËfl ·‡-˘ËÌÒÚ‚ÓÚÓ Â ÔÓÚ‚˙‰ÂÌÓ „ÂÌÂÚË˜ÌÓ.

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åÛÚ‡ˆËË ‚ SCN1A „ÂÌ‡ ·flı‡ ÛÒÚ‡ÌÓ‚ÂÌË ÔË 5 ÓÚ ËÁÒ-ÎÂ‰‚‡ÌËÚÂ 22 ÔÓ·‡Ì‰‡ (23%) (í‡·Î. 1). ÇÒË˜ÍËÚÂ ·flı‡ÓÚ ·˙Î„‡ÒÍË ÂÚÌË˜ÂÒÍË ÔÓËÁıÓ‰.

è‡ˆËÂÌÚ 1 Â ÏÓÏË˜Â Ò ÙÂÌÓÚËÔÌ‡ ËÁfl‚‡ Ì‡ GEFS+ (‚‡-Ë‡ÌÚ FS+, Ú.Â. ÙÂ·ËÎÌË Ë ‡ÙÂ·ËÎÌË Éíäè). ÖÔËÎÂÔ-ÚË˜ÌËflÚ ÒËÌ‰ÓÏ ÒÂ ÔÓfl‚fl‚‡ ‚ ÔÂËÓ‰‡ 12 – 19 ÏÂÒ. ‚˙ÁÒ 4 Éíäè Ò ‡‰‚ÂÁË‚Ì‡ ÍÓÏÔÓÌÂÌÚ‡ Ì‡‰flÒÌÓ – Ô˙‚ËÚÂ 3„˙˜‡ Ò‡ ÙÂ·ËÎÌË, ‡ ˜ÂÚ‚˙ÚËflÚ - ‡ÙÂ·ËÎÂÌ. ÖÖÉ ËÁÒ-ÎÂ‰‚‡ÌËflÚ‡ ÛÒÚ‡ÌÓ‚fl‚‡Ú ÓÒÚÓ‚˙ÎÌÓ‚‡ ‡ÍÚË‚ÌÓÒÚ ‚Îfl-‚Ó Á‡‰ÌÓ-ÚÂÏÔÓ‡ÎÌÓ ËÎË ‚‰flÒÌÓ ÓÍˆËÔËÚ‡ÎÌÓ. ãÂ˜ÂÌËÂ Ò‚‡ÎÔÓ‡Ú 20 Ï„/Í„ Á‡ÔÓ˜‚‡ ÓÚ 2 „Ó‰. ‚˙Á‡ÒÚ. ãËÔÒ‚‡ÚÌÓ‚Ë „˙˜Ó‚Â Í‡ÚÓ ‰ÂÚÂÚÓ ‚ ÏÓÏÂÌÚ‡ Â Ì‡ 5 „Ó‰. ‚˙Á-‡ÒÚ.

Ç ÔÂÏÓ·Ë‰Ì‡Ú‡ ‡Ì‡ÏÌÂÁ‡ ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡ ÌÂ‰ÓÌÓÒÂ-ÌÓÒÚ Ò ÚÂ„ÎÓ ÔË ‡Ê‰‡ÌÂÚÓ 1250 „, Í‡ÍÚÓ Ë ÔÂıÓ‰Ì‡ÏÛÒÍÛÎÌ‡ ıËÔÓÚÓÌËfl Ë ÎÂÍ‡ ‰ËÎ‡Ú‡ˆËfl Ì‡ ÒÛ·‡‡ıÌÓË‰ÌË-ÚÂ ÔÓÒÚ‡ÌÒÚ‚‡ Ë ÙÓÌÚ‡ÎÌËÚÂ Ó„‡ Ì‡ 7 ÏÂÒ. ‚˙Á-‡ÒÚ. çÂ‚ÓÎÓ„Ë˜ÌËflÚ ÒÚ‡ÚÛÒ Ë ‡Á‚ËÚËÂ ÒÂ ÌÓÏ‡ÎËÁË-

‡Ú ÒÎÂ‰ Ô˙‚‡Ú‡ „Ó‰ËÌ‡. î‡ÏËÎÌ‡Ú‡ ‡Ì‡ÏÌÂÁ‡ ÒÂ ÓÚÎË-˜‡‚‡ Ò ·‡Ú Ì‡ ·‡˘‡Ú‡ Ò „˙˜Ó‚Â Ì‡ 3 „Ó‰. ‚˙Á‡ÒÚ (ÌÂÛ-ÚÓ˜ÌÂÌË Í‡ÚÓ ÙÂ·ËÎÌË ËÎË ‡ÙÂ·ËÎÌË).

ÉÂÌÂÚË˜ÌÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ ÛÒÚ‡ÌÓ‚fl‚‡ ıÂÚÂÓÁË„ÓÚÌ‡missense ÏÛÚ‡ˆËfl Thr841Met ‚ DIIS3 ‰ÓÏÂÌ ÔË ÏÓÏË˜Â-ÚÓ Ë ÌÂÈÌËflÚ ·‡˘‡. Å‡˘‡Ú‡ ÌËÍÓ„‡ ÌÂ Â ËÏ‡Î ÔËÒÚ˙ÔË,ÒÛÒÔÂÍÚÌË Á‡ ÂÔËÎÂÔÚË˜ÌË Ë ÌÂ„Ó‚‡Ú‡ ÖÖÉ Ì‡ 37 „Ó‰.‚˙Á. Â ÌÓÏ‡ÎÌ‡.

è‡ˆËÂÌÚ 2 e ÏÓÏ˜Â Ò ÙÂÌÓÚËÔ Ì‡ GEFS+ (‚‡Ë‡ÌÚÙÂ·ËÎÌË Ë ÙÓÍ‡ÎÌË „˙˜Ó‚Â). èÓfl‚fl‚‡ ÒÂ Ò ÚË ÙÂ·ËÎ-ÌË Éääè ‚ ÔÂËÓ‰‡ ÓÚ 10 ‰Ó 15 ÏÂÒ. ‚˙Á‡ÒÚ, Ô˙‚ËflÚÓÚ ÍÓËÚÓ Ò ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ ÓÍÓÎÓ 30 ÏËÌ. ÖÖÉ ‡ÁÍ‡-‚‡ ‰ËÙÛÁÌË ÓÒÚË ‚˙ÎÌË Ò ‰ÓÏËÌË‡ÌÂ ‚ ÓÍˆËÔËÚ‡ÎÌËÚÂË ÚÂÏÔÓ‡ÎÌËÚÂ Ó·Î‡ÒÚË. èÓÙËÎ‡ÍÚËÍ‡ Ì‡ ÌÓ‚Ë ÙÂ·-ËÎÌË „˙˜Ó‚Â Ò ÙÂÌÓ·‡·ËÚ‡Î 4 Ï„/Í„ Â Á‡ÔÓ˜Ì‡Ú‡ Ì‡ 12ÏÂÒ. ‚˙Á‡ÒÚ, ÍÓÈÚÓ Â Á‡ÏÂÌÂÌ Ò ‚‡ÎÔÓ‡Ú 22Ï„/Í„ ÒÎÂ‰ÚÂÚËfl „˙˜. ãËÔÒ‚‡Ú ÌÓ‚Ë ÔËÒÚ˙ÔË Ë ÔËÂÏ‡ Ì‡ ‡Ì-ÚËÍÓÌ‚ÛÎÒ‡ÌÚ Â ÒÔflÌ Ì‡ 4 „Ó‰. ‚˙Á‡ÒÚ. Ç ÒÎÂ‰‚‡˘ËÚÂ 2„Ó‰ËÌË Ò‡ Ì‡·Î˛‰‡‚‡ÌË ‰‚‡ ÔËÒÚ˙Ô‡ ÓÚ ÔÓ‚˙˘‡ÌÂ, ÔÓ„-ÎÂ‰ Ì‡Îfl‚Ó Ë ÒÚÛÔÓ ·ÂÁ ‡ÚÓÌËfl Ë ·ÂÁ „˙˜Ó‚Â Ò ÔÓ‰˙Î-ÊËÚÂÎÌÓÒÚ ÓÍÓÎÓ 2 ÏËÌ. ç‡ 6 „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ ÒÂ ËÁfl‚fl-‚‡ ÓÚÌÓ‚Ó Éíäè Ò ÔÓ„ÎÂ‰ Ì‡ÒÚ‡ÌË ÔË ÙÂ·ËÎËÚÂÚ.ÖÖÉ Ì‡ 6 Ë 7 „Ó‰. ‚˙Á‡ÒÚ ÔÓÍ‡Á‚‡Ú ÓÍˆËÔËÚ‡ÎÌË ÓÒÚË‚˙ÎÌË Ë ÍÓÏÔÎÂÍÒË ÔËÍ‡-·‡‚Ì‡. éÚÌÓ‚Ó Â ‚˙‚Â‰ÂÌ ‚‡ÎÔÓ-‡Ú 20Ï„/Í„, ‚Ó‰Â˘ ‰Ó Ô˙ÎÌ‡ ÂÏËÒËfl. çÂ Ò‡ ÛÒÚ‡ÌÓ‚fl‚‡ÌË‡·ÌÓÏÌÓÒÚË ‚ ÌÂ‚ÓÎÓ„Ë˜ÌËflÚ ÒÚ‡ÚÛÒ, çèê Ë íîÖ.

èÂÏÓ·Ë‰Ì‡Ú‡ ‡Ì‡ÏÌÂÁ‡ ÒÂ ÓÚÎË˜‡‚‡ Ò ÔÂ‰ÚÂÏËÌ-Ì‡ Ó‰Ó‚‡ ‰ÂÈÌÓÒÚ, ÌÓ ·ÂÏÂÌÌÓÒÚÚ‡ Á‡‚˙¯‚‡ ‚ ÒÓÍ Ë·ÂÁ ‡ÒÙËÍÒËfl. å‡ÈÍ‡Ú‡ Ì‡ ÔÓ·‡Ì‰‡ Â ËÏ‡Î‡ ÚË ÙÂ·ËÎ-ÌË „˙˜‡ ÔÂÁ Ô˙‚‡Ú‡ ÒË „Ó‰ËÌ‡, ‡ ÌÂÈÌËflÚ ·‡˘‡ – Â‰ËÌÙÂ·ËÎÂÌ „˙˜.

ÉÂÌÂÚË˜ÌÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ Ì‡ SCN1A „ÂÌ‡ ÔË ‰ÂÚÂÚÓ ËÓ‰ËÚÂÎËÚÂ ÓÚÍË‚‡ missense ÏÛÚ‡ˆËfl Arg60His ÔËÔÓ·‡Ì‰‡ Ë Ï‡ÈÍ‡Ú‡. åÛÚ‡ˆËflÚ‡ Á‡Òfl„‡ ‚˙ÁÍ‡Ú‡ ÏÂÊ-‰Û DI Ë DII ‰ÓÏÂÌË Ì‡ ÔÓÚÂËÌ‡.

è‡ˆËÂÌÚ 3 Â ÏÓÏË˜Â Ò ÔÓfl‚‡ Ì‡ ÚËÔË˜Ì‡ SMEI. ífl‰Â·˛ÚË‡ Ò ÙÂ·ËÎÌË Éíäè ÓÚ 7 ÏÂÒ. ‚˙Á., ˜ÂÒÚÓ Î‡ÚÂ-‡ÎËÁË‡ÌË Ë Ò ÔÓÒÚËÍÚ‡ÎÌ‡ Ô‡ÂÁ‡. èËÒÚ˙ÔÌ‡Ú‡ ˜ÂÒ-ÚÓÚ‡ Â ‚ËÒÓÍ‡ – ÒÂ‰ÌÓ 2-3 ÏÂÒÂ˜ÌÓ, ÔÓÌflÍÓ„‡ ‰Ó 3 ‰ÌÂ‚-ÌÓ. ä˙Ï Â‰ÌÓ„Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ ÒÂ ‰Ó·‡‚flÚ ÏËÓÍÎÓÌË˜ÌË,‡·Ò‡ÌÒÌË Ë ‡ÚÓÌË˜ÌË ÔËÒÚ˙ÔË Ò ˜ÂÒÚÓÚ‡ ‰Ó 7-9 Ì‡ ‰ÂÌ.ëÎÂ‰ 1 „Ó‰. 11 ÏÂÒ. ‚˙Á‡ÒÚ. Éíäè Á‡ÔÓ˜‚‡Ú ‰‡ ÒÂ ÔÓfl‚fl-‚‡Ú Ë ·ÂÁ ÙÂ·ËÎËÚÂÚ Ò ˜ÂÒÚÓÚ‡ 1-2 ÏÂÒÂ˜ÌÓ. çÂ‚ÓÎÓ-„Ë˜ÌËflÚ ÒÚ‡ÚÛÒ Ë çèê Ò‡ ÌÓÏ‡ÎÌË ÔÂÁ Ô˙‚ËÚÂ ‰‚Â „Ó-‰ËÌË, ‡ ÒÎÂ‰ ÚÓ‚‡ ÒÂ ÓÚ˜ËÚ‡ ÔÂ‰ËÏÌÓ Â˜Â‚Ó ËÁÓÒÚ‡‚‡-ÌÂ. ÖÖÉ ÔÂÁ Ô˙‚‡Ú‡ „Ó‰ËÌ‡ ‡ÁÍË‚‡ ˜ÂÒÚË ÓÒÚË ‚˙Î-ÌË Ë ÍÓÏÔÎÂÍÒË ÔËÍ‡-·‡‚Ì‡ ÔÂ‰ËÏÌÓ ‚ ÓÍˆËÔËÚ‡ÎÌ‡Ú‡Ó·Î‡ÒÚ, ‰ÓÍ‡ÚÓ ‚ ÒÎÂ‰‚‡˘ËÚÂ „Ó‰ËÌË ÔÂÓ·Î‡‰‡‚‡Ú ˜ÂÒ-ÚË „ÂÌÂ‡ÎËÁË‡ÌË ‡Áfl‰Ë ÓÚ ÔËÍ‡-·‡‚Ì‡ ‚˙ÎÌ‡. åêí Ì‡ñçë Ì‡ 2 „Ó‰. ‚˙Á. ÌÂ ÓÚÍË‚‡ ÒÚÛÍÚÛÌË ‡·ÌÓÏÌÓÒ-ÚË, ‡ Ò‡ÏÓ ÒÛÒÔÂÍÚÌÓ Á‡·‡‚flÌÂ ‚ ÏËÂÎËÌËÁ‡ˆËflÚ‡. åÓÌÓ-Ë ÔÓÎËÚÂ‡ÔËflÚ‡ Ò ÙÂÌÓ·‡·ËÚ‡Î, Í‡·‡Ï‡ÁÂÔËÌ, ‚‡ÎÔÓ-‡Ú, ÍÎÓÌ‡ÁÂÔ‡Ï Ë ÂÚÓÒÛÍÒËÏË‰ ÌÂ ‰Ó‚ÂÊ‰‡ ‰Ó ÁÌ‡˜ËÏ‡ Â-‰ÛÍˆËfl ‚ ÔËÒÚ˙ÔÌ‡Ú‡ ˜ÂÒÚÓÚ‡ Ë ÚÂÊÂÒÚ. ë‡ÏÓ ‰Ó·‡-‚flÌÂÚÓ Ì‡ ÚÓÔË‡Ï‡Ú 7 Ï„/Í„ ‚Ó‰Ë ‰Ó Ì‡Ï‡Îfl‚‡ÌÂ Ì‡ ÏË-ÓÍÎÓÌË˜ÌËÚÂ ‡·Ò‡ÌÒË Ë ‡ÚÓÌË˜ÌËÚÂ ÔËÒÚ˙ÔË ‰Ó 2 Ì‡ÏÂÒÂˆ Ë Ì‡ Éíäè ‰Ó ÓÍÓÎÓ 1 Ì‡ 3 ÏÂÒÂˆ‡.

èÂÏÓ·Ë‰Ì‡Ú‡ ‡Ì‡ÏÌÂÁ‡ Â ÌÓÏ‡ÎÌ‡, ‡ Ù‡ÏËÎÌ‡Ú‡ ÛÒ-Ú‡ÌÓ‚fl‚‡ Ô˙‚Ë ·‡ÚÓ‚˜Â‰ Ì‡ ·‡˘‡Ú‡ Ò ˜ÂÒÚË ÙÂ·ËÎÌË„˙˜Ó‚Â ‰Ó 3-4 „Ó‰. ‚˙Á‡ÒÚ Ë ÌÓÏ‡ÎÌÓ ‡Á‚ËÚËÂ.

ÉÂÌÂÚË˜ÌÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ Ì‡ ÔÓ·‡Ì‰‡ Ë Ó‰ËÚÂÎËÚÂÓÚÍË de novo nonsense ÏÛÚ‡ˆËfl Arg377Stop ÔË ‰ÂÚÂ-ÚÓ, ÍÓflÚÓ ÒÂ Ì‡ÏË‡ ‚ ·ÂÎÚ˙˜Ì‡ Ó·Î‡ÒÚ DIS5-S6.

è‡ˆËÂÌÚ 4 Â ÏÓÏ˜Â Ò ÙÂÌÓÚËÔÌË ÔÓfl‚Ë, Ì‡ÒÓ˜‚‡˘ËÍ˙Ï SMEI. éÚ 5 ÏÂÒ. ‚˙Á. Á‡ÔÓ˜‚‡Ú ‡ÙÂ·ËÎÌË ÔËÒÚ˙-ÔË ÓÚ ÔÓ‚˙˘‡ÌÂ Ë ‚ÚÂÌ˜‚‡ÌÂ Ò/·ÂÁ ‡ÚÓÌËfl Á‡ 1-5 ÏËÌ.



ÔË ˜ÂÒÚÓÚ‡ ÓÍÓÎÓ 1 ÏÂÒÂ˜ÌÓ. ç‡ 7 ÏÂÒ. ‚˙Á‡ÒÚ ÒÂ ‰Ó·‡-‚flÚ ıÂÏËÍÎÓÌË˜ÌË ËÎË Î‡ÚÂ‡ÎËÁË‡ÌË Éíäè ÔË ÌËÒ˙ÍÙÂ·ËÎËÚÂÚ ËÎË ·ÂÁ ÙÂ·ËÎËÚÂÚ. óÂÒÚÓÚ‡Ú‡ Â ÓÍÓÎÓÂ‰ËÌ ÔËÒÚ˙Ô ÏÂÒÂ˜ÌÓ, ÌÓ ÒÂ ÓÔËÒ‚‡Ú Ë ÍÎ‡ÒÚ˙Ë ÓÚ 3„˙˜‡ ‚ Â‰ËÌ ‰ÂÌ ÔË ÔÓ-‚ËÒÓÍ ÙÂ·ËÎËÚÂÚ. ëÎÂ‰ Â‰ÌÓ„Ó-‰Ë¯Ì‡ ‚˙Á‡ÒÚ Ò‡ ÔÓfl‚fl‚‡Ú Ë Â‰ÍË ÏËÓÍÎÓÌËË. çÂ‚ÓÎÓ-„Ë˜ÌËflÚ ÒÚ‡ÚÛÒ Ë çèê Ò‡ ÌÓÏ‡ÎÌË ‰Ó ÔÓÒÎÂ‰ÌËfl ÔÂ„-ÎÂ‰ Ì‡ 18 ÏÂÒ. ‚˙Á‡ÒÚ. Ñ‚ÂÚÂ Ì‡ÎË˜ÌË ÖÖÉ ‰Ó 1 „Ó‰.5ÏÂÒ. ‚˙Á‡ÒÚ ÌÂ ÛÒÚ‡ÌÓ‚fl‚‡Ú Û·Â‰ËÚÂÎÌ‡ ÂÔËÎÂÔÚË-ÙÓÏÂÌ‡ ‡ÍÚË‚ÌÓÒÚ. äí Ì‡ 7 ÏÂÒ. ‚˙Á‡ÒÚ Â Ò˙˘Ó ÌÓ-Ï‡ÎÌ‡. ãÂ˜ÂÌËÂÚÓ Â Á‡ÔÓ˜Ì‡ÚÓ Ò ‚‡ÎÔÓ‡Ú Ì‡ 6 ÏÂÒ. ‚˙Á-‡ÒÚ. êÂ‰ÛÍˆËfl Ì‡ ËÍÚ‡ÎÌ‡Ú‡ ˜ÂÒÚÓÚ‡ ‰Ó ÓÍÓÎÓ 1 Ì‡ 2ÏÂÒÂˆ‡ Â ÔÓÒÚË„Ì‡ÚÓ Ò ‚‡ÎÔÓ‡Ú 45Ï„/Í„ Ë ÍÎÓÌ‡ÁÂÔ‡Ï0.01Ï„/Í„.

Ç ÔÂÏÓ·Ë‰Ì‡Ú‡ ‡Ì‡ÏÌÂÁ‡ Ò˙˘Ó ÒÂ ÓÚÍË‚‡ Ô‡ÚÓÎÓ-„Ë˜Ì‡ ·ÂÏÂÌÌÓÒÚ, ÌÓ Úfl Á‡‚˙¯‚‡ ‚ ÚÂÏËÌ Ë ·ÂÁ ‡ÒÙËÍ-ÒËfl. î‡ÏËÎÌ‡Ú‡ ‡Ì‡ÏÌÂÁ‡ ÒÂ ÓÚÎË˜‡‚‡ Ò˙Ò ÒÂÒÚ‡ Ì‡Ï‡ÈÍ‡Ú‡ Ò ÌflÍÓÎÍÓ ÙÂ·ËÎÌË „˙˜‡ ‰Ó 3 „Ó‰. ‚˙Á‡ÒÚ, ‡ÒÎÂ‰ 24 „Ó‰. ‚˙Á‡ÒÚ -ÏËÓÍÎÓÌË˜ÌË ‡·Ò‡ÌÒË Ë äèè, ÍÛÔË-‡ÌË Ò ‚‡ÎÔÓ‡Ú Ë Î‡ÏÓÚËÊËÌ.

ÉÂÌÂÚË˜ÌÓÚÓ ÒÍËÌË‡ÌÂ Ì‡ SCN1A „ÂÌ‡ ÔË ÔÓ·‡Ì‰‡,Ó‰ËÚÂÎËÚÂ ÏÛ, ÒÂÒÚ‡Ú‡ Ì‡ Ï‡ÈÍ‡Ú‡ Ë ÌÂÈÌËÚÂ Ó‰Ë-ÚÂÎË ÛÒÚ‡ÌÓ‚Ë missense ÏÛÚ‡ˆËfl Leu378Gln Ò‡ÏÓ ÔË ‰Â-ÚÂÚÓ. åÛÚ‡ˆËflÚ‡ Â de novo Ë ÒÂ Ì‡ÏË‡ ‚ ·ÂÎÚ˙˜ÂÌ ‰Ó-ÏÂÌ DIS5-S6.

è‡ˆËÂÌÚ 5 Â ÏÓÏË˜Â Ò ÔÓfl‚‡ Ì‡ ÚËÔË˜Ì‡ SMEI. ífl ‰Â-·˛ÚË‡ Ì‡ 5-ÏÂÒÂ˜Ì‡ ‚˙Á‡ÒÚ Ò Éíäè Ò ˜ÂÒÚÓÚ‡ ÓÍÓÎÓ 1Á‡ 1-2 ÏÂÒ., ÌflÍÓË ÓÚ ÍÓËÚÓ Ò Î‡ÚÂ‡ÎËÁ‡ˆËfl Ì‡Îfl‚Ó Ë ÒÔÓÒÚËÍÚ‡ÎÌ‡ ıÂÏËÔ‡ÂÁ‡. íË ÓÚ „˙˜Ó‚ÂÚÂ ‰Ó 12 ÏÂÒ.‚˙Á. ÔÂ‡ÒÚ‚‡Ú ‚ ÍÓÌ‚ÛÎÒË‚ÂÌ ÒÚ‡ÚÛÒ. ÇÒË˜ÍË ÔËÒÚ˙-ÔË Ò‡ ÔÓ‚ÓÍË‡ÌË ÓÚ ËÌÚÂÍÛÂÌÚÌ‡ ËÌÙÂÍˆËfl Ò ËÎË ·ÂÁÙÂ·ËÎËÚÂÚ. èÂÁ ‚ÚÓ‡Ú‡ „Ó‰ËÌ‡ ÒÂ ‰Ó·‡‚flÚ Â‰ÍË ‡·-Ò‡ÌÒË, ‡ Ò˙˘Ó Ë 4 – 5 Í‡ÚÍÓÚ‡ÈÌË ÚÓÌË˜ÌË ÔËÒÚ˙Ô‡(Ó·˙˘‡ÌÂ Ó˜ËÚÂ Ì‡„ÓÂ Ë Á‡„Û·‡ Ì‡ Ò˙ÁÌ‡ÌËÂ Á‡ ÒÂÍÛÌ‰Ë).çÂ‚ÓÎÓ„Ë˜ÌËflÚ ÒÚ‡ÚÛÒ Ë çèê Ò‡ ÌÓÏ‡ÎÌË ÔÂÁ Ô˙‚‡Ú‡„Ó‰ËÌ‡, ÌÓ ÒÎÂ‰ ÚÓ‚‡ Ì‡ÒÚ˙Ô‚‡ ËÁÓÒÚ‡‚‡ÌÂ ‚ ÏÓÚÓÌÓÚÓ Ë„Ó‚ÓÌÓ ‡Á‚ËÚËÂ – ÔÓıÓÊ‰‡ ÓÍÓÎÓ 1 „. 10 ÏÂÒ., ‡ Â˜ÌËÍÓ-‚ËflÚ Á‡Ô‡Ò Ì‡ 3,5 „Ó‰. Â Ò‡ÏÓ 10 -15 ‰ÛÏË. ÖÖÉ Ì‡ 12 ÏÂÒ.‚˙Á‡ÒÚ ÔÓÍ‡Á‚‡ Ò‡ÏÓ Á‡ÎÔÓ‚Â ·‡‚ÌÓ‚˙ÎÌÓ‚‡ ‡ÍÚË‚ÌÓÒÚ‚˙‚ ÙÓÌÚÓ-ˆÂÌÚÓ-Ô‡ËÂÚ‡ÎÌËÚÂ Ó·Î‡ÒÚË, ‡ Ì‡ 3 „Ó‰.‚˙Á‡ÒÚ ‚ ‰flÒÌÓ Ô‡ËÂÚ‡ÎÌÓ ÒÂ Â„ËÒÚË‡Ú ·‡‚ÌË ‚˙ÎÌËË Û‰ËÏÂÌÚ‡ÌË ÍÓÏÔÎÂÍÒË – ÓÒÚ‡-·‡‚Ì‡ ‚˙ÎÌ‡ Ò ‚ÚÓË˜-Ì‡ „ÂÌÂ‡ÎËÁ‡ˆËfl. äí Ì‡ 12 ÏÂÒ. ‚˙Á‡ÒÚ (ÒÎÂ‰ ÌflÍÓÎÍÓ ÍÓÌ-‚ÛÎÒË‚ÌË ÒÚ‡ÚÛÒ‡) ‡ÁÍË‚‡ ÎÂÍË ‰‚ÛÒÚ‡ÌÌË ÙÓÌÚ‡ÎÌË‡ÚÓÙË˜ÌË ÎÂÁËË. ãÂ˜ÂÌËÂÚÓ Ò ‚‡ÎÔÓ‡Ú 20mg/kg, Á‡ÔÓ˜-Ì‡ÚÓ Ì‡ 12 ÏÂÒ. ‚˙Á‡ÒÚ Â‰ÛˆË‡ „˙˜Ó‚‡Ú‡ ˜ÂÒÚÓÚ‡ ‰ÓÂ‰ËÌ Ì‡ 3-4 ÏÂÒ. ÇÔÓÒÎÂ‰ÒÚ‚ËÂ Â ‰Ó·‡‚ÂÌ ÍÎÓÌ‡ÁÂÔ‡Ï Ò ˜‡Ò-ÚË˜ÌÓ ÔÓ‚ÎËfl‚flÌÂ.

ãËÔÒ‚‡Ú ‡·ÌÓÏÌÓÒÚË ‚ ÔÂÏÓ·Ë‰Ì‡Ú‡ Ë Ù‡ÏËÎÌ‡‡Ì‡ÏÌÂÁ‡.

ìÒÚ‡ÌÓ‚ÂÌ‡Ú‡ ÏÛÚ‡ˆËfl ‚ SCN1A „ÂÌ‡ Â nonsense -Arg1329Stop. ç‡ÏË‡ ÒÂ ‚ DIIIS4 Ó·Î‡ÒÚ Ì‡ ·ÂÎÚ˙˜ÌËflÔÓ‰ÛÍÚ. åÛÚ‡ˆËflÚ‡ Â ÛÒÚ‡ÌÓ‚ÂÌ‡ ÔË ÔÓ·‡Ì‰‡, ‡ Ó-‰ËÚÂÎËÚÂ ÌÂ Ò‡ ËÁÒÎÂ‰‚‡ÌË ‰Ó ÏÓÏÂÌÚ‡.

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SCN1A ÏÛÚ‡ˆËË Ò‡ ÛÒÚ‡ÌÓ‚ÂÌË ÔË 5 ‰Âˆ‡ Ò ÙÂ·ËÎÌÓ-‡ÒÓˆËË‡ÌË ÔËÒÚ˙ÔË - ‰‚Â Ò ÚËÔË˜ÌË ÙÂÌÓÚËÔÌË ËÁfl‚ËÌ‡ GEFS+ Ë ÚË – Ò˙Ò SMEI. ãËÔÒ‡Ú‡ Ì‡ Â„ÂÒ ‚ çèê ËÌ‡ ÂÔËÎÂÔÚËÙÓÏÂÌ‡ ‡ÍÚË‚ÌÓÒÚ ÔË Ô‡ˆËÂÌÚ 4 Ò‚˙Á‚‡-ÏÂ Ò ÌÂ‰ÓÒÚ‡Ú˙˜ÌÓÚÓ ÍÎËÌË˜ÌÓ Ë ÖÖÉ ÔÓÒÎÂ‰fl‚‡ÌÂ. èËÔ‡ˆËÂÌÚ 5 ÎËÔÒ‡Ú‡ Ì‡ „ÂÌÂ‡ÎËÁË‡Ì‡ ËÌÚÂËÍÚ‡ÎÌ‡ Ô‡-ÓÍÒËÁÏ‡ÎÌ‡ ‡ÍÚË‚ÌÓÒÚ ÌÂ ÓÚı‚˙Îfl ‚‡Ë‡ÌÚ Ì‡ SMEI ÒÓÚÒ˙ÒÚ‚‡˘Ë ÏËÓÍÎÓÌË˜ÌË ÔËÒÚ˙ÔË (8). ÇÒË˜ÍË ÓÔËÒ‡ÌËÒÎÛ˜‡Ë ËÏ‡Ú ÔÓ-‡ÌÌ‡ ËÁfl‚‡ (ÏÂÊ‰Û 5 Ë 12 ÏÂÒ.‚˙Á‡ÒÚ) ‚Ò‡‚ÌÂÌËÂ Ò Ó·Ë˜‡ÈÌ‡Ú‡ Á‡ ÙÂ·ËÎÌË „˙˜Ó‚Â (ÒÎÂ‰ 12

ÏÂÒ.‚˙Á‡ÒÚ) (17).éÔËÒ‡ÌËÚÂ 5 Ô‡ˆËÂÌÚ‡ ËÎ˛ÒÚË‡Ú ‚˙ÁÏÓÊÌËÚÂ

ÚÛ‰ÌÓÒÚË ÔË ÍÎ‡ÒËÙËˆË‡ÌÂ Ì‡ ÂÔËÎÂÔÚË˜ÌËfl ÒËÌ‰-ÓÏ, Ò‚˙Á‡Ì Ò ÙÂ·ËÎÌË „˙˜Ó‚Â ÔÂÁ Ô˙‚ËÚÂ ÏÂÒÂˆËÒÎÂ‰ ÌÂ„Ó‚Ëfl ‰Â·˛Ú. èË ‚ÒË˜ÍË ÓÔËÒ‡ÌË ÔÓ-„ÓÂ ÒÎÛ˜‡ËÉíäè Ò‡ Ò Î‡ÚÂ‡ÎËÁ‡ˆËfl Ë ˜ÂÒÚÓ Ò ÙÓÍ‡ÎÌË ÔÓÒÚËÍÚ‡Î-ÌË Ô‡ÂÁË, ÍÓÂÚÓ Â ÚËÔË˜ÌÓ Á‡ SMEI Ë Â ‚˙ÁÏÓÊÌÓ ÔËGEFS+ (1, 3). Ç˙ÁÏÓÊÂÌ Â Ë ‰Â·˛Ú Ò äèè (Ì‡Ô. Ô‡ˆËÂÌÚ4). ÉÂÌÂ‡ÎËÁË‡Ì‡ Ô‡ÓÍÒËÁÏ‡ÎÌ‡ ‡ÍÚË‚ÌÓÒÚ ÒÂ ÛÒÚ‡ÌÓ-‚fl‚‡ fl‰ÍÓ (Ò‡ÏÓ ÔË Ô‡ˆËÂÌÚ 3). çflÍÓË ‡‚ÚÓË Ò˙˘ÓÔËÂÏ‡Ú ÙÓÍ‡ÎÌËÚÂ ÖÖÉ ‡·ÌÓÏÌÓÒÚË ÔË GEFS+ ËSMEI Í‡ÚÓ ˜ÂÒÚË (8, 16, 19), ‡ „ÂÌÂ‡ÎËÁË‡Ì‡Ú‡ ËÌÚÂ-ÍËÚ‡ÎÌ‡ ÂÔËÎÂÔÚËÙÓÏÂÌ‡ ‡ÍÚË‚ÌÓÒÚ Á‡ fl‰Í‡ (14, 18).çÂÓ·ıÓ‰ËÏÓ Â ‰ÓÒÚ‡Ú˙˜ÌÓ ‰˙Î„Ó ÔÓÒÎÂ‰fl‚‡ÌÂ, ÔË ÍÓÂ-ÚÓ ‰‡ ÒÂ ÛÒÚ‡ÌÓ‚flÚ Â‚ÂÌÚÛ‡ÎÌ‡ ÒÏflÌ‡ ‚ Î‡ÚÂ‡ÎËÁ‡ˆËfl-Ú‡, ÎËÔÒ‡Ú‡ Ì‡ Ú‡ÈÌ‡ ÙÓÍ‡ÎÌ‡ ÂÔËÎÂÔÚËÙÓÏÂÌ‡ ‡Í-ÚË‚ÌÓÒÚ Ì‡ ÖÖÉ ËÎË ‰Ó·‡‚flÌÂ Ì‡ ÌÓ‚Ë ‚Ë‰Ó‚Â ÔËÒÚ˙ÔËÁ‡ ‰‡ ÏÓÊÂ ‰‡ ÒÂ ÔÂˆÂÌË Ò ÔÓ-„ÓÎflÏ‡ ÒË„ÛÌÓÒÚ, ˜Â ÂÔË-ÎÂÔÒËflÚ‡ Â „ÂÌÂ‡ÎËÁË‡Ì‡, ‡ ÌÂ ÙÓÍ‡ÎÌ‡. óÂÒÚÓ ÒÂ˘‡ÌË-ÚÂ Ô‡ÚÓÎÓ„Ë˜Ì‡ ·ÂÏÂÌÌÓÒÚ, ÔÂ‰ÚÂÏËÌÌÓ ‡Ê‰‡ÌÂ,ÔÂËÌ‡Ú‡ÎÌ‡ ‡ÒÙËÍÒËfl, ÏÓÁ˙˜ÌÓ-‡ÚÓÙË˜ÌË ÎÂÁËË ÏÓ„‡Ú‰‡ ÔÓ‰‚Â‰‡Ú ‚ ÔÓÒÓÍ‡ ÒËÏÔÚÓÏ‡ÚË˜Ì‡ ÂÔËÎÂÔÒËfl, Ó˘ÂÔÓ‚Â˜Â ÍÓ„‡ÚÓ Ò‡ Ò˙˜ÂÚ‡ÌË Ò ÙÓÍ‡ÎÌË ÍÎËÌË˜ÌË Ë ÖÖÉÒËÏÔÚÓÏË. íÂÁË Ò˙Ó·‡ÊÂÌËfl Ó·ÛÒÎ‡‚flÚ Ô‡ÍÚË˜ÂÒÍÓÚÓÁÌ‡˜ÂÌËÂ Ì‡ „ÂÌÂÚË˜ÌÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ. ìÒÚ‡ÌÓ‚fl‚‡ÌÂÚÓÌ‡ ı‡‡ÍÚÂÂÌ „ÂÌÂÚË˜ÂÌ ‰ÂÙÂÍÚ (Í‡ÍÚÓ ÏÛÚ‡ˆËË ‚SCN1A Á‡ SMEI Ë GEFS+) Ì‡ÒÓ˜‚‡ ‰Ë‡„ÌÓÒÚË˜ÌÓÚÓ ÏËÒ-ÎÂÌÂ ‚ ÔÓÒÓÍ‡ „ÂÌÂ‡ÎËÁË‡Ì‡ Ë‰ËÓÔ‡ÚË˜Ì‡ ÂÔËÎÂÔÒËfl.ê‡ÌÌ‡Ú‡ ‰Ë‡„ÌÓÁ‡ Ì‡ GEFS+ ËÎË SMEI ËÏ‡ ÌÂ Ò‡ÏÓ ÔÓ„-ÌÓÒÚË˜ÌÓ ÁÌ‡˜ÂÌËÂ, ÌÓ Â ÓÒÓ·ÂÌÓ ‚‡ÊÌ‡ Á‡ Ô‡‚ËÎÌËfl ËÁ-·Ó Ì‡ ‡ÌÚËÍÓÌ‚ÛÎÒË‚ÌÓ ÎÂ˜ÂÌËÂ ÔË SMEI (ÔÂ‰ÔÓ˜ËÚ‡-ÌÂ Ì‡ ÚÓÔË‡Ï‡Ú Ë ËÁ·fl„‚‡ÌÂ Ì‡ Î‡ÏÓÚËÊËÌ, Í‡·‡Ï‡-ÁÂÔËÌ Ë ‚Ë„‡·‡ÚËÌ) (1).

ÄÌ‡ÎËÁ˙Ú Ì‡ ÍÓÂÎ‡ˆËflÚ‡ „ÂÌÓÚËÔ-ÙÂÌÓÚËÔ ÔÓÚ‚˙-Ê‰‡‚‡ ÒÚ‡ÌÓ‚Ë˘ÂÚÓ, ˜Â missense ÏÛÚ‡ˆËËÚÂ Ó·ÛÒÎ‡‚flÚÔÓ-ÎÂÍË ÍÎËÌË˜ÌË ËÁfl‚Ë (Ô‡ˆËÂÌÚË 1 Ë 2) Ë ÌÂÔ˙ÎÌ‡ ÔÂÌÂÚ-‡ÌÚÌÓÒÚ (·‡˘‡Ú‡ Ì‡ Ô‡ˆËÂÌÚ 1), ‰ÓÍ‡ÚÓ nonsense ÏÛÚ‡-ˆËËÚÂ ‚Ó‰flÚ ‰Ó ÚËÔË˜Ì‡ ÚÂÊÍ‡ SMEI (Ô‡ˆËÂÌÚË 3 Ë 5) (5,10). Missense ÏÛÚ‡ˆËËÚÂ ‚ ÔÓÓÓ·‡ÁÛ‚‡˘‡Ú‡ ˜‡ÒÚ Ò˙˘ÓÏÓ„‡Ú ‰‡ ÔÂ‰ËÁ‚ËÍ‡Ú SMEI (Ô‡ˆËÂÌÚ 4).

î‡ÏËÎÌÓÒÚÚ‡ Ò ÙÂ·ËÎÌË „˙˜Ó‚Â Ë ÂÔËÎÂÔÒËfl ÔË denovo ÏÛÚ‡ˆËfl (ÔË Ô‡ˆËÂÌÚË 3 Ë 4) ÔÓ‰ÍÂÔflÚ ıËÔÓÚÂ-Á‡Ú‡, ˜Â ÏÛÚ‡ˆËËÚÂ ‚ SCN1A „ÂÌ‡ ÌÂ Ò‡ Â‰ËÌÒÚ‚ÂÌËflÚÙ‡ÍÚÓ, ÓÔÂ‰ÂÎfl˘ ÍÎËÌË˜Ì‡Ú‡ ËÁfl‚‡ Ò ÂÔËÎÂÔÒËfl (12,18, 19, 20). èÓ ÚÓÁË ÔÓ‚Ó‰ L. A. Harkin et al., (2002) ÔÂ‰-ÔÓÎ‡„‡Ú ·ËÎËÌÂ‡ÎÌÓ ÛÌ‡ÒÎÂ‰fl‚‡ÌÂ, ‡ C. Losin et al. (2003)Ó·˙˘‡Ú ‚ÌËÏ‡ÌËÂ Ì‡ ÏÓ‰ËÙËˆË‡˘ËflÚ ÂÙÂÍÚ Ì‡ ÂÔË„Â-ÌÂÚË˜ÌËÚÂ Ù‡ÍÚÓË. ÄÌ‡ÏÌÂÒÚË˜ÌËÚÂ Ë Ó·‡ÁÌËÚÂ ËÁÒ-ÎÂ‰‚‡ÌËfl Ì‡ÒÓ˜‚‡Ú Í˙Ï ÔÂËÌ‡Ú‡ÎÂÌ ˆÂÂ·‡ÎÂÌ ‰ËÒÚ-ÂÒ ÔË Ô‡ˆËÂÌÚ 1, ÍÓÈÚÓ ÏÓÊÂ ‰‡ ·˙‰Â ÓÚÍÎ˛˜‚‡˘ Ù‡Í-ÚÓ Á‡ ÍÎËÌË˜Ì‡ ËÁfl‚‡ Ì‡ GEFS+. è‡ÚÓÎÓ„Ë˜Ì‡ ·ÂÏÂÌ-ÌÓÒÚ ÒÂ ÓÚÍË‚‡ Ë ÔË Ô‡ˆËÂÌÚË 2 Ë 4. ÖÚÓ Á‡˘Ó ÛÒÚ‡-ÌÓ‚fl‚‡ÌÂÚÓ Ì‡ SCN1A ÏÛÚ‡ˆËË ÌÂ ÓÚı‚˙Îfl ÌÂÓ·ıÓ‰Ë-ÏÓÒÚÚ‡ ÓÚ Ú˙ÒÂÌÂ Ì‡ ÂÔË„ÂÌÂÚË˜ÌË Ù‡ÍÚÓË, ÏÓ‰ËÙË-ˆË‡˘Ë ÙÂÌÓÚËÔÌ‡Ú‡ ÔÓfl‚‡.

Ç Á‡ÍÎ˛˜ÂÌËÂ, ÛÒÚ‡ÌÓ‚fl‚‡ÌÂÚÓ Ì‡ SCN1A ÏÛÚ‡ˆËËÔÓ‰ÍÂÔfl ÍÎËÌË˜Ì‡Ú‡ ‰Ë‡„ÌÓÁ‡ SMEI ËÎË GEFS+ Ë ËÏ‡‚‡ÊÌÓ ÚÂ‡ÔÂ‚ÚË˜ÌÓ Ë ÔÓ„ÌÓÒÚË˜ÌÓ ÁÌ‡˜ÂÌËÂ. èË ÒÎÛ-˜‡Ë Ò ÙÂ·ËÎÌË „˙˜Ó‚Â, ‡ÌÌÓÚÓ Ì‡˜‡ÎÓ Ì‡ ÙÂ·ËÎÌËÚÂ„˙˜Ó‚Â (ÔÂ‰Ë 1 „Ó‰. ‚˙Á‡ÒÚ), Ì‡ÎË˜ËÂÚÓ Ì‡ ÔÓÎÓÌ„Ë‡-ÌË ÙÂ·ËÎÌË „˙˜Ó‚Â Ë Ì‡ Ù‡ÏËÎÌÓÒÚ Ò ÙÂ·ËÎÌË „˙˜Ó‚ÂËÎË ÂÔËÎÂÔÒËfl Ò‡ ËÌ‰ËÍ‡ˆËË Á‡ „ÂÌÂÚË˜ÌÓ ËÁÒÎÂ‰‚‡ÌÂ Á‡SCN1A ÏÛÚ‡ˆËË, ‡ ÔË ÓÚËˆ‡ÚÂÎÂÌ ÂÁÛÎÚ‡Ú – Ë Á‡ ÏÛ-Ú‡ˆËË ‚ ÓÒÚ‡Ì‡ÎËÚÂ GEFS+ ‡ÒÓˆËË‡ÌË „ÂÌË. MissenseÏÛÚ‡ˆËËÚÂ ÒÂ Ò‚˙Á‚‡Ú ÔÓ-˜ÂÒÚÓ Ò ÔÓ-ÎÂÍË ÍÎËÌË˜ÌËÔÓfl‚Ë (GEFS+), ‡ nonsense ÏÛÚ‡ˆËËÚÂ – Ò˙Ò SMEI. ÖÔË-


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SUMMARY

ATYPICAL VARIANTS OF GUILLAIN-BARRE SYNDROME

D. Atanasova, M. DaskalovThe Guillain-Barre syndrome (GBS) is an acute immuno-

mediated polyradiculoneuritis with annual incidence of 1-2/100 000. It is a heterogenous syndrome with a wide clinicalspectrum, different course, severity, progression and outcome.Classically it presents as an acute progressive ascending sym-metrical weakness with areflexia. The aim of the study is topresent several atypical clinical variants of GBS, which arediagnosed in the department of neurology of UH “TzaritzaYoanna”. We present cases with cranio-pharyngeal-cervical-brachial variant of GBS; predominantly painfull presentationof GBS and variant of two-phase course of GBS. The patientsare diagnosed via neurological examination, electrodiagnosticstudies and cerebrospinal fluid examination. All patients weretreated with intravenous immunoglobulin and we have esti-mated excellent therapeutic effect. Our cases are unusual clin-ical variants of GBS, which are very important to know inorder to avoid misdiagnosing, delaying of the treatment andpoor outcome.

Key words: Guillain-Barre syndrome, GBS, cranio-pha-ryngeal-cervical-brachial variant, pain, immunovenin.

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äÎ˛˜Ó‚Ë ‰ÛÏË: ëËÌ‰ÓÏ Ì‡ ÉËÎÂÌ-Å‡Â, ëÉÅ, Í‡ÌËÓ-Ù‡ËÌ„Ó-ˆÂ‚ËÍÓ-·‡ıË‡ÎÂÌ ‚‡Ë‡ÌÚ, ·ÓÎÍ‡, ËÏÛÌÓ‚ÂÌËÌ.

ëËÌ‰ÓÏ˙Ú Ì‡ ÉËÎÂÌ-Å‡Â (ëÉÅ) Â ÓÒÚ˙ ËÏÛÌÌÓÏÂ‰Ë-Ë‡Ì ÔÓÎË‡‰ËÍÛÎÓÌÂ‚ËÚ Ò „Ó‰Ë¯Ì‡ Á‡·ÓÎÂ‚‡ÂÏÓÒÚ 1-2/100 ıËÎ Ì‡ÒÂÎÂÌËÂ (1). ë˙‚ÂÏÂÌÌ‡Ú‡ ÔÂ‰ÒÚ‡‚‡ Á‡ ëÉÅ ÂËÁ„‡‰ÂÌ‡ ‚˙Á ÓÒÌÓ‚‡ Ì‡ ÍÎËÌË˜ÌË, ÂÎÂÍÚÓÙËÁËÓÎÓ„Ë˜ÌË ËÎËÍ‚ÓÓÎÓ„Ë˜ÌË ÍËÚÂËË, ÍÓËÚÓ „Ó Ó·ÓÒÓ·fl‚‡Ú Í‡ÚÓÂ‰ËÌ ıÂÚÂÓ„ÂÌÂÌ ÒËÌ‰ÓÏ, Ò˙ÒÚ‡‚ÂÌ ÓÚ ÌflÍÓÎÍÓ ÒÛ·ÚË-


„ÂÌÂÚË˜ÌË Ù‡ÍÚÓË Í‡ÚÓ ÔÂ- Ë ÔÂËÌ‡Ú‡ÎÌ‡ ‡ÒÙËÍÒËfl Ë‰Û„Ë ÏÓ„‡Ú ‰‡ ÔÓ‚ÎËflflÚ Ì‡ ÙÂÌÓÚËÔÌ‡Ú‡ ËÁfl‚‡ Ì‡SCN1A ÏÛÚ‡ˆËËÚÂ.

Ä‚ÚÓËÚÂ ËÁÍ‡Á‚‡Ú ·Î‡„Ó‰‡ÌÓÒÚ Ì‡ Ô‡ˆËÂÌÚËÚÂ Á‡ÚflıÌ‡Ú‡ ÓÚÁË‚˜Ë‚ÓÒÚ.

àÁÒÎÂ‰‚‡ÌÂÚÓ Â ÒÔÓÌÒÓË‡ÌÓ ÓÚ Specific SupportAction program Ì‡ EU (Á‡ Ä. â.)

ãàíÖêÄíìêÄ1. ÅÓÊËÌÓ‚‡ Ç. äÎËÌË˜Ì‡ ı‡‡ÍÚÂËÒÚËÍ‡, ‰ËÙÂÂÌˆË‡ÎÌ‡ ‰Ë‡„ÌÓÁ‡ ËÔÓ„ÌÓÁ‡ ÔË ÒËÌ‰ÓÏ Ì‡ Dravet, ÏËÓÍÎÓÌË˜ÌÓ-‡ÒÚ‡ÚË˜Ì‡ ÂÔËÎÂÔÒËfl Ë ÒËÌ‰-ÓÏ Ì‡ LennoxGastaut. Ç: «ÜË‚ÓÚ ‚ ‡‚ÌÓ‚ÂÒËÂ» (ë·ÓÌËÍ ÓÚ ‰ÓÍÎ‡‰Ë Ì‡ ï˛·ËÎÂÈÌ‡ ÍÓÌÙÂÂÌˆËfl ÔÓ ÂÔËÎÂÔÒËfl «å‡„ÌÓÎËfl 2004», 11-12.6.2004). ëÓÙËfl,Öcopharm, 2004, 3-16. 2. Audenaert D, Claes L, Ceulemans B. A deletion in SCN1B is associated withfebrile seizures and early-onset absence epilepsy. Neurology, 61, 2003, 854-856.3. Bonanni P, Malacarne M, Moro F, et al. Generalized epilepsy with febrileseizures plus (GEFS+): Clinical spectrum in seven Italian families unrelated toSCN1A, SCN1B, and GABRG2 gene mutations. Epilepsia, 45, 2004, 2, 149-158. 4. Boulac S, Huberfeld G, Gourfinkel-An I, et al. First genetic evidence ofGABA (A) receptor dysfunction in epilepsy: a mutation in the gamma2-subunitgene. Nat Genet, 28, 2001, 1, 46-48.5. Ceulemans BP, Claes LR, Lagae LG. Clinical correlations of mutations in theSCN1A gene: from febrile seizures to severe myoclonic epilepsy in infancy.Pediatr Neurol, 30, 2004, 4, 236-43. 6. Claes L, Ceulemans B, Audenaert D, et al. De novo SCN1A mutations are amajor cause of severe myoclonic epilepsy of infancy. Hum Mutat, 21, 2003, 615-621. 7. Claes L, Del-Favero J, Ceulemans B et al. De novo mutations in the sodium-channel gene SCN1A cause severe myoclonic epilepsy of infancy. Am J HumGenet, 68, 2001, 1327-1332. 8. Dravet Ch., Bureau M, Oguni H, et al. Severe myoclonic epilepsy in infancy(Dravet syndrome). In: J. Roger, M. Bureau, Ch. Dravet, P. Genton, CA Tassinary,P Wolf (Eds.). Epileptic syndromes in infancy, childhood and adolescence.Eastleigh, UK, John Libey, 2002, 81-103.

9. Escayg A, MacDonald BT, Meisler MH, et al. Mutations of SCN1A, encod-ing a neuronal sodium channel, in two families with GEFS+2. (Letter). NatureGenetics, 24, 2000, 343-345. 10.Fujiwara T, Sugawara T, Mazaki-Miyazaki E, et al. Mutations of the sodiumchannel alpha-subunit type I (SCN1A) in intractable childhood epilepsies with fre-quent tonic-clonic seizures. Brain 126, 2003, pt 3, 531-546. 11. George AL Jr. Molecular basis of inherited epilepsy. Arch Neurol, 61, 2004,473- 478.12. Guerrini R, Aicardi J. Epileptic encephalopathies with myoclonic seizures ininfants and children (severe myoclonic epilepsy and myoclonic-astatic epilepsy). JClin Neurophysiol, 20, 2003, 6, 449-61. 13. Harkin LA, Bowser DN, Dibbens LM, et al. Truncation of the GABAA-receptor gamma 2 subunit in a family with generalized epilepsy with febrileseizures plus. Am J Hum Genet, 70, 2002, 530-536. 14. Lerche H, Weber YG, Baier H et al. Generalized epilepsy with febrileseizures plus. Neurology, 57, 2001, 1191-1198.15. Losin C, Rhodes T, Desai RR et al. Epilepsy-associated dysfunction in thevoltage-gated neuronal sodium channel SCN1A. J Neurosci, 23, 2003, 36, 11289-11295.16. Marini C, Harkin LA, Wallace RH, et al. Childhood absence epilepsy andfebrile seizures: a family with a GABAA receptor mutation. Brain, 126, 2003, 230-240.17. Offringa M., Moyer VA. Evidence based management of seizures associatedwith fever. BMJ 323, 2001, 1111-1114.18. Scheffer I, Berkovic S. Generalized epilepsy with febrile seizures plus. Agenetic disorder with heterogeneous clinical phenotypes. Brain, 120, 1997, 479-490.19. Singh R, Scheffer IS, Crossland K, et al. Generalized epilepsy with febrileseizures plus: a common childhood-onset genetic epilepsy syndrome. Ann Neurol,45, 1999, 75-81.20. Stafstrom C. SCN1A in SMEI, ICEGTC, and GEFS+: Alphabet soup oremerging genotypic-phenotypic clarity? Epilepsy Curr, 3, 2003, 6, 219-220.

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çÂ‚ÓÎÓ„Ë˜ÌËfl ÒÚ‡ÚÛÒ ÔË ıÓÒÔËÚ‡ÎËÁ‡ˆËflÚ‡ (2-Ë‰ÂÌ ÓÚ Ì‡˜‡ÎÓÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ) ÓÚÍË‚‡ ‰‡ÌÌË Á‡ ÔÂ-ËÙÂÌ‡ ÎÂÁËfl ‰ÂÒÌËfl ÎËˆÂ‚ ÌÂ‚; ÎÂÍÓ ËÁ‡ÁÂÌ‡ ·ÛÎ·‡Ì‡Ô‡‡ÎËÁ‡: ‰ËÒÙ‡„Ëfl, ‰ËÁ‡ÚËfl, ‰ËÒÙÓÌËfl; Ì‡Ï‡ÎÂÌ‡ ÏÛÒ-ÍÛÎÌ‡ ÒËÎ‡ (ÔÓ ååí - 4/5) ‚ ÔÓÍÒËÏ‡ÎÌËÚÂ ÓÚ‰ÂÎË Ì‡„ÓÌËÚÂ Í‡ÈÌËˆË ÔË Á‡Ô‡ÁÂÌË ÔÓ ÒËÎ‡ Ë Ó·ÂÏ ‰‚ËÊÂÌËflÁ‡ ‰ÓÎÌË Í‡ÈÌËˆË; ÒÛıÓÊËÎÌÓ-Ì‡‰ÍÓÒÚÌ‡ ıËÔÓÂÙÎÂÍÒËfl‚ ˙ˆÂÚÂ Ë ‡ÂÙÎÂÍÒËfl ‚ Í‡Í‡Ú‡; ‚˙Á·Û‰ÌË ÒÂÚË‚ÌË Ì‡-Û¯ÂÌËfl – ÒÔÓÌÚ‡ÌÌË ·ÓÎÍË ‚ ÏÛÒÍÛÎËÚÂ Ì‡ ‰‚ÂÚÂ ÔÂ‰-ÏË¯ÌËˆË, ·ÂÁ Ó·ÂÍÚË‚ÌË ÒÂÚË‚ÌË ‡ÁÒÚÓÈÒÚ‚‡.

éÚ ÔÓ‚Â‰ÂÌËÚÂ ËÁÒÎÂ‰‚‡ÌËfl Ì‡ Ô˙ÎÌ‡ Í˙‚Ì‡ Í‡ÚËÌ‡,·ËÓıËÏËfl, ÂÎÂÍÚÓÎËÚË, ıÂÏÓÒÚ‡ÁÂÓÎÓ„Ë˜ÌË ÔÓÍ‡Á‡ÚÂÎË,Í‡ÍÚÓ Ë ÔÓÒÎÂ‰fl‚‡ÌÂ Ì‡ Í˙‚Ì‡Ú‡ Á‡ı‡ ÌÂ ÒÂ ÛÒÚ‡ÌÓ‚Ë-ı‡ ÓÍÎÓÌÂÌËfl ÓÚ ÌÓÏ‡Ú‡. ÑÓÔÎÂÓ‚‡Ú‡ ÒÓÌÓ„‡ÙËfl ÌÂ‡ÁÍË ‰‡ÌÌË Á‡ ıÂÏÓ‰ËÌ‡ÏË˜ÌÓ ÁÌ‡˜ËÏË ÔÓÏÂÌË ‚ÂÍÒÚ‡- Ë ËÌÚ‡Í‡ÌË‡ÎÌËÚÂ ÏÓÁ˙˜ÌË Ò˙‰Ó‚Â. éÚ ÏÌÓ-„ÓÍ‡ÚÌÓ ÔÓ‚Â‰ÂÌËÚÂ ÂÎÂÍÚÓÏËÓ„‡ÙÒÍË ËÁÒÎÂ‰‚‡ÌËfl(ÓÚ 2-fl ‰ÂÌ ‰Ó 5-fl ÏÂÒÂˆ ÓÚ Ì‡˜‡ÎÓÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ) ÒÂÓÚı˙ÎË ‚˙ÁÏÓÊÌÓÒÚÚ‡ Á‡ Ì‡Û¯ÂÌËfl ‚ ÌÂ‚ÌÓ-ÏÛÒÍÛÎ-ÌÓÚÓ ÔÂ‰‡‚‡ÌÂ, ÌÓ ÒÂ ÛÒÚ‡ÌÓ‚Ëı‡ ‰‡ÌÌË Á‡ ‡ÍÒÓÌ‡ÎÌÓ Á‡-Òfl„‡ÌÂ Ì‡ ‰ÂÒÌËfl ÎËˆÂ‚ ÌÂ‚, XI Ë XII óåç, Í‡ÍÚÓ Ë‰‚ÛÒÚ‡ÌÌ‡ ‡ÍÒÓÌ‡ÎÌ‡ Û‚Â‰‡ Ì‡ n. musculocutaneus Ë n.axillaris. êÂ„ËÒÚË‡ ÒÂ Ë ÔÂËÙÂÌÓ-ÒÚ‚ÓÎÓ‚‡ Û‚Â‰‡ Ì‡ÒÂÚË‚ÌËÚÂ ‚Î‡ÍÌ‡, Í‡ÍÚÓ Ë „ÂÌÂ‡ÎËÁË‡Ì‡ ÍÓÂÌ˜Â‚‡ Û‚-Â‰‡ ‚ ˜ÂÚËËÚÂ Í‡ÈÌËÍ‡. ç‡ Ô˙‚Ëfl ÏÂÒÂˆ ÓÚ Ì‡˜‡ÎÓÚÓÌ‡ Á‡·ÓÎfl‚‡ÌÂÚÓ ÒÂ Â„ËÒÚË‡ Ó·ËÎÌ‡ ‰ÂÌÂ‚‡ˆËfl ‚ ÔÓÍ-ÒËÏ‡ÎÌËÚÂ ÏÛÒÍÛÎË Ì‡ ˙ˆÂÚÂ Ë ÔÓ-ÎÂÍÓ ËÁ‡ÁÂÌ‡ ‚ ÔÓÍ-ÒËÏ‡ÎÌËÚÂ ÏÛÒÍÛÎË Ì‡ Í‡Í‡Ú‡, ‡ÁÂ‰ÂÌË Á‡ÔËÒË ÔËÏ‡ÍÒËÏ‡ÎÌ‡ ÏÛÒÍÛÎÌ‡ ÍÓÌÚ‡ÍˆËfl. ç‡ 10-fl ‰ÂÌ ÒÂ ÔÓ‚Â‰ÂÎÛÏ·‡ÎÌ‡ ÔÛÌÍˆËfl Ë ËÁÒÎÂ‰‚‡ÌÂ Ì‡ ÎËÍ‚Ó‡ Á‡ ·ÂÎÚ˙˜ÌÓ-ÍÎÂÚ˙˜Ì‡ ‰ËÒÓˆË‡ˆËfl. ìÒÚ‡ÌÓ‚Ë ÒÂ ıËÔÂÔÓÚÂËÌÓ‡ıËfl(108,3Ï„%) ·ÂÁ ‰‡ÌÌË Á‡ ÔÎÂÓˆËÚÓÁ‡ (10 ÍÎÂÚÍË). éÚ ‚Ë-

ÛÒÓÎÓ„Ë˜ÌËÚÂ ËÁÒÎÂ‰‚‡ÌËfl ÒÂ ÓÚÍËı‡ ‰‡ÌÌË Á‡ Â‡ÍÚË-‚Ë‡Ì‡ EBV ËÌÙÂÍˆËfl Ò ÔÓ‚Ë¯ÂÌ ÚËÚ˙ Ì‡ ‡ÌÚËÚÂÎ‡ ‚ÒÂÛÏ‡ Ë ÎËÍ‚Ó‡. çÂ ÒÂ ËÁÓÎË‡ı‡ ÂÌÚÂÓ‚ËÛÒË.

å‡ÍÒËÏ‡ÎÌËflÚ ÔËÍ Ì‡ ‡Á‚ËÚËÂ Ì‡ Ó„ÌË˘Ì‡Ú‡ ÌÂ‚Ó-ÎÓ„Ë˜Ì‡ ÒËÏÔÚÓÏ‡ÚËÍ‡ ÔË Ô‡ˆËÂÌÚ‡ ‰ÓÒÚË„Ì‡ Ì‡ ‰Â‚Â-ÚËfl ‰ÂÌ ÓÚ Ì‡˜‡ÎÓÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ. èÓ‡‰Ë Ì‡Û¯Â-ÌËfl ‚ „˙ÎÚ‡ÌÂÚÓ ÒÂ Á‡ÔÓ˜Ì‡ ı‡ÌÂÌÂ ÔÂÁ Ì‡ÁÓ„‡ÒÚ‡ÎÌ‡ÒÓÌ‰‡. Ç˙Á ÓÒÌÓ‚‡ Ì‡ ÍÎËÌË˜ÌË ‰‡ÌÌË Á‡ ÔÓ‰ÓÒÚÓ ‡Á‚Ë-ÚËÂ Ì‡ ‰Ëı‡ÚÂÎÌ‡ ÌÂ‰ÓÒÚ‡Ú˙˜ÌÓÒÚ – Ú‡ıË‰ËÒÔÌÂfl, Á‡Ú-Û‰ÌÂÌËfl ‚ ÓÚı‡˜‚‡ÌÂÚÓ, Ì‡ ÓÒÏËfl ‰ÂÌ Ô‡ˆËÂÌÚ˙Ú ·Â¯ÂÓÓÚ‡ıÂ‡ÎÌÓ ËÌÚÛ·Ë‡Ì Ë ÔÓÒÚ‡‚ÂÌ Ì‡ àÅÇ Á‡ 3 ‰ÌË,‚ÔÓÒÎÂ‰ÒÚ‚ËÂ Ú‡ıÂÓÒÚÓÏË‡Ì. èÓ‡‰Ë ÚÂÊÍÓ ÔÓÚË-˜‡˘‡Ú‡ ·ÛÎ·‡Ì‡ Ô‡ÂÁ‡ ÒÂ Ì‡ÎÓÊË ÔËÎ‡„‡ÌÂ Ì‡ ‰‚ÛÍ‡Ú-ÌË ÎÂ˜Â·ÌË ÍÛÒÓ‚Â Ò ËÌÚ‡‚ÂÌÓÁÂÌ ËÏÛÌÓ„ÎÓ·ÛÎËÌ (ËÏÛ-ÌÓ‚ÂÌËÌ) ‚ ‰ÓÁËÓ‚Í‡ 0,2 g/ kg ‚ 5 ÔÓÒÎÂ‰Ó‚‡ÚÂÎÌË ‰ÌË. ÇÂÁÛÎÚ‡Ú ÓÚ ÔËÎÓÊÂÌÓÚÓ ÎÂ˜ÂÌËÂ Ë Â‡ÌËÏ‡ˆËÓÌÌË ÏÂ-ÓÔËflÚËfl Ì‡ ¯ÂÒÚËfl ÏÂÒÂˆ ÓÚ Ì‡˜‡ÎÓÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂ-ÚÓ ÒÂ ÔÓÒÚË„Ì‡ Ô˙ÎÌÓ Ó·‡ÚÌÓ ‡Á‚ËÚËÂ Ì‡ Ó„ÌË˘Ì‡Ú‡ÌÂ‚ÓÎÓ„Ë˜Ì‡ ÒËÏÔÚÓÏ‡ÚËÍ‡ – ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂ Ì‡ „˙Î-Ú‡ÌÂÚÓ, „Ó‚Ó‡ Ë ÒËÎ‡Ú‡ Ì‡ „ÓÌËÚÂ Í‡ÈÌËˆË.

Ç˙Á ÓÒÌÓ‚‡ Ì‡ ‰‡ÌÌËÚÂ ÓÚ ‡Ì‡ÏÌÂÁ‡Ú‡ Á‡ ÔÂ‰¯ÂÒÚ‚‡-˘Ó ‚ËÛÒÌÓ Á‡·ÓÎfl‚‡ÌÂ, ÓÒÚÓÚÓ ‡Á‚ËÚËÂ Ì‡ ÚÂÊÍ‡ ·ÛÎ-·‡Ì‡ Ô‡ÂÁ‡ Ë ÎËˆÂ‚‡ ÒÎ‡·ÓÒÚ, Í‡ÍÚÓ Ë ÒÎ‡·ÓÒÚ Ì‡ ÔÓÍ-ÒËÏ‡ÎÌ‡Ú‡ ÏÛÒÍÛÎ‡ÚÛ‡ Ì‡ „ÓÌËÚÂ Í‡ÈÌËˆË, ÖåÉ ‰‡Ì-ÌËÚÂ Á‡ ‡ÍÒÓÌ‡ÎÌÓ Á‡Òfl„‡ÌÂ Ì‡ Í‡Û‰‡ÎÌ‡Ú‡ „ÛÔ‡ ˜ÂÂÔÌÓ-ÏÓÁ˙˜ÌË ÌÂ‚Ë Ë ÔÂËÙÂÌË ÌÂ‚Ë, ËÌÂ‚Ë‡˘Ë ÏÛÒÍÛÎËÚÂÌ‡ ÏË¯ÌËˆ‡Ú‡, ‰‡ÌÌËÚÂ ÓÚ ÎÛÏ·‡ÎÌËfl ÎËÍ‚Ó Á‡ ·ÂÎÚ˙˜-ÌÓ-ÍÎÂÚ˙˜Ì‡ ‰ËÒÓˆË‡ˆËfl Ë Â‡ÍÚË‚Ë‡Ì‡ EBV ËÌÙÂÍˆËflÌË ‰‡‰Óı‡ ÓÒÌÓ‚‡ÌËÂ ‰‡ ÔËÂÏÂÏ, ˜Â Ì‡È-‚ÂÓflÚÌÓ ÒÂ Í‡-Ò‡Â Á‡ fl‰ÍÓ ÓÔËÒ‚‡ÌËfl ‚ ÎËÚÂ‡ÚÛ‡Ú‡ Ù‡ËÌ„Ó-ˆÂ‚Ë-ÍÓ-·‡ıË‡ÎÂÌ ‚‡Ë‡ÌÚ Ì‡ ÒËÌ‰ÓÏ‡ Ì‡ ÉËÎÂÌ-Å‡Â (ËÁÓÎË-‡Ì‡ ÎËˆÂ‚‡, ÓÓÙ‡ËÌ„Â‡ÎÌ‡, ¯ËÈÌ‡ ÒÎ‡·ÓÒÚ, ‚ÍÎ˛˜Ë-ÚÂÎÌÓ Ë Ì‡ „ÓÌËÚÂ Í‡ÈÌËˆË ·ÂÁ Á‡Òfl„‡ÌÂ Ì‡ ‰ÓÎÌË Í‡È-ÌËˆË) (8).

èêÖÑàåçé ÅéãÖáçÖçÄ îéêåÄ çÄ ëÉÅ

ÜÂÌ‡ Ì‡ 42 „Ó‰ ÒÂ ıÓÒÔËÚ‡ÎËÁË‡ ÔÓ ÔÓ‚Ó‰ Ì‡ ‚ÌÂÁ‡ÔÌÓÔÓfl‚ËÎ‡ ÒÂ ÒËÎÌ‡ ‰ËÙÛÁÌ‡ ·ÓÎÍ‡ ‚ „˙·Ì‡˜ÌËfl ÒÚ˙Î· Ë ÏÛÒ-ÍÛÎËÚÂ Ì‡ ˜ÂÚËËÚÂ Í‡ÈÌËÍ‡. ç‡ ÒÎÂ‰‚‡˘Ëfl ‰ÂÌ ÒÂ ‡Á-‚ËÎ‡ ÎÂÍÓ ËÁ‡ÁÂÌ‡ ÒÎ‡·ÓÒÚ ‚ ÔÓÍÒËÏ‡ÎÌËÚÂ Ë ‰ËÒÚ‡ÎÌËÓÚ‰ÂÎË Ì‡ ‰ÓÎÌË Í‡ÈÌËˆË, Í‡ÍÚÓ Ë ÎÂÍÓ Á‡ÚÛ‰ÌÂÌËÂ ‚ÔÓıÓ‰Í‡Ú‡. èÂÚ ‰ÌË ÔÂ‰Ë Ì‡˜‡ÎÓÚÓ Ì‡ ÒËÏÔÚÓÏ‡ÚËÍ‡-Ú‡ Ô‡ˆËÂÌÚÍ‡Ú‡ Â ËÏ‡Î‡ ÚÂÏÔÂ‡ÚÛ‡ ‰Ó 38 „‡‰ÛÒ‡.èÂ„ÎÂ‰‡Ì‡ ÓÚ ÎÂÍ‡ Ë Ì‡ÒÓ˜ÂÌ‡ Á‡ ıÓÒÔËÚ‡ÎËÁ‡ˆËfl Ò ‚Â-ÓflÚÌ‡ ‰Ë‡„ÌÓÁ‡: ÏËÓ„ÂÌÌ‡ Û‚Â‰‡.

çÂ‚ÓÎÓ„Ë˜ÌËfl ÒÚ‡ÚÛÒ ÔË ıÓÒÔËÚ‡ÎËÁ‡ˆËflÚ‡ (4-ÚË‰ÂÌ ÓÚ Ì‡˜‡ÎÓÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ) ÔÓÍ‡Á‡ Ì‡Ï‡ÎÂÌ‡ ÏÛÒ-ÍÛÎÌ‡ ÒËÎ‡ Á‡ ÔÓÍÒËÏ‡ÎÌËÚÂ Ë ‰ËÒÚ‡ÎÌË „ÛÔË Ì‡ ‰ÓÎÌË-ÚÂ Í‡ÈÌËˆË (ÔÓ ååí 4/5); ÒÛıÓÊËÎÌÓ-Ì‡‰ÍÓÒÚÌ‡ ıËÔÓ-ÂÙÎÂÍÒËfl; ËÁ‡ÁÂÌË ‚˙Á·Û‰ÌË ÒÂÚË‚ÌË Ì‡Û¯ÂÌËfl – ÒÔÓÌ-Ú‡ÌÌ‡ Ë Ô‡ÎÔ‡ÚÓÌ‡ ·ÓÎÂÁÌÂÌÂÌÓÒÚ ÔÓ ÏÛÒÍÛÎËÚÂ Ì‡ ˜Â-ÚËËÚÂ Í‡ÈÌËÍ‡ Ë „˙·Ì‡˜ÌËfl ÒÚ˙Î·, ·ÂÁ Ó·ÂÍÚË‚ÌËÔÓÏÂÌË ‚ ÒÂÚË‚ÌÓÒÚÚ‡.

éÚ ‰‚ÛÍ‡ÚÌÓ ÔÓ‚Â‰ÂÌËÚÂ ÂÎÂÍÚÓÏËÓ„‡ÙÒÍË ËÁÒ-ÎÂ‰‚‡ÌËfl (Ì‡ 9-ÚË Ë 24-ÚË ‰ÂÌ) ÌÂ ÒÂ ÛÒÚ‡ÌÓ‚Ëı‡ ‰‡ÌÌË Á‡ÔÂËÙÂÌÓ-ÒÚ‚ÓÎÓ‚‡ Û‚Â‰‡ Ì‡ ÌÂ‚ËÚÂ Ì‡ ˜ÂÚËËÚÂÍ‡ÈÌËÍ‡. êÂ„ËÒÚË‡ ÒÂ ËÁ‡ÁÂÌ‡ ÍÓÂÌ˜Â‚‡ Û‚Â‰‡ ‚ „Ó-ÌË Ë ‰ÓÎÌË Í‡ÈÌËˆË, Í‡ÍÚÓ Ë Á‡Òfl„‡ÌÂ Ì‡ ÒÂÚË‚ÌËÚÂ ‚Î‡Í-Ì‡ ‚ Í‡Í‡Ú‡. éÚ ÔÓ‚Â‰ÂÌÓÚÓ Ì‡ 12-fl ‰ÂÌ ÎËÍ‚ÓÌÓ ËÁÒ-ÎÂ‰‚‡ÌÂ ÒÂ ÛÒÚ‡ÌÓ‚Ë ·ÂÎÚ˙˜ÌÓ-ÍÎÂÚ˙˜Ì‡ ‰ËÒÓˆË‡ˆËfl (ıË-ÔÂÔÓÚÂËÌÓ‡ıËfl – 76,1Ï„%, ·ÂÁ ‰‡ÌÌË Á‡ ÔÎÂÓˆËÚÓÁ‡).

å‡ÍÒËÏ‡ÎÌËfl ÔËÍ Ì‡ ‚ÎÓ¯‡‚‡ÌÂ ÔË Ô‡ˆËÂÌÚÍ‡Ú‡ ·Â-¯Â ‰‚‡ ‰ÌË. èÓ ‚ÂÏÂ Ì‡ ıÓÒÔËÚ‡ÎËÁ‡ˆËflÚ‡ ÔÂÒËÒÚË‡-ı‡ ÒËÎÌË ·ÓÎÍË ÔÓ ÏÛÒÍÛÎËÚÂ, Í‡ÚÓ ÒËÎ‡Ú‡ ‚ Í‡ÈÌËˆËÚÂÓÒÚ‡Ì‡ ÌÂÔÓÏÂÌÂÌ‡ – Ô‡ˆËÂÌÚÍ‡Ú‡ Á‡Ô‡ÁË Ô˙ÎÌ‡Ú‡ ÒËÔÓ‰‚ËÊÌÓÒÚ. èÓ‚Â‰Â ÒÂ 5 ‰ÌÂ‚ÂÌ ÍÛÒ Ì‡ ÎÂ˜ÂÌËÂ Ò ËÏÛ-


ÌÓ‚ÂÌËÌ ‚ ‰ÓÁ‡ 0,4 g/ kg, Í‡ÚÓ Ì‡ 11-fl ‰ÂÌ ËÏ‡¯Â Ì‡˜‡ÎÌÓÔÓ‰Ó·ÂÌËÂ ‚˙‚ ‚˙Á·Û‰Ì‡Ú‡ ÒÂÚË‚Ì‡ ÒËÏÔÚÓÏ‡ÚËÍ‡. ç‡‚ÚÓËfl ÏÂÒÂˆ ÓÚ Ì‡˜‡ÎÓÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ ÒÂ ÓÚ˜ÂÚÂÔ˙ÎÌÓ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂ Ì‡ Ó„ÌË˘Ì‡Ú‡ ÌÂ‚ÓÎÓ„Ë˜Ì‡ ÒËÏÔ-ÚÓÏ‡ÚËÍ‡.

àÏ‡ÈÍË ÔÂ‰‚Ë‰ ÓÒÚÓÚÓ ‡Á‚ËÚËÂ Ì‡ ‚˙Á·Û‰ÂÌ ÒÂÚË-‚ÂÌ Ë ‚ ÁÌ‡˜ËÚÂÎÌÓ ÔÓ-ÎÂÍ‡ ÒÚÂÔÂÌ Ì‡ ‰‚Ë„‡ÚÂÎÂÌ ÌÂ‚Ó-ÎÓ„Ë˜ÂÌ ‰ÂÙËˆËÚ, ÔÂ‰¯ÂÒÚ‚‡˘Ó ‚ËÛÒÌÓ Á‡·ÓÎfl‚‡ÌÂ, ‰‡-ÌËÚÂ ÓÚ ÖåÉ Á‡ ËÁ‡ÁÂÌ‡ ÍÓÂÌ˜Â‚‡ Û‚Â‰‡, ÎËÍ‚ÓÌ‡Ú‡Ì‡ıÓ‰Í‡ Á‡ ·ÂÎÚ˙˜ÌÓ-ÍÎÂÚ˙˜Ì‡ ‰ËÒÓˆË‡ˆËfl, Í‡ÍÚÓ Ë ‰Ó·-Ëfl ÚÂ‡ÔÂ‚ÚË˜ÂÌ ÂÙÂÍÚ ÓÚ ËÌÚ‡‚ÂÌÓÁÂÌ ËÏÛÌÓ„ÎÓ·Û-ÎËÌ, ÔËÂıÏÂ ˜Â ÒÂ Í‡Ò‡Â Á‡ ÓÒÚ˙ ÔÓÎË‡‰ËÍÛÎÓÌÂ‚ËÚÚËÔ ÉËÎÂÌ-Å‡Â – ÔÂ‰ËÏÌÓ ·ÓÎÂÁÌÂÌ‡ ÙÓÏ‡.

ÇÄêàÄçí çÄ ëÉÅ ë ÑÇìîÄáÖç ïéÑ çÄ èêéíàóÄçÖ

ÜÂÌ‡ Ì‡ 48 „Ó‰ Ò ÓÒÚÓ ÔÓfl‚ËÎÓ ÒÂ ËÁÚ˙Ô‚‡ÌÂ ‚ ‰ËÒ-Ú‡ÎÌËÚÂ ÓÚ‰ÂÎË Ì‡ „ÓÌËÚÂ Ë ‰ÓÎÌË Í‡ÈÌËˆË, ÍÓÂÚÓ Ì‡ÒÎÂ‰‚‡˘Ëfl ‰ÂÌ ‡ÒˆÂÌ‰Ë‡ÎÓ Ë Ó·ı‚‡Ì‡ÎÓ ÔÓÍÒËÏ‡ÎÌËÚÂÛ˜‡ÒÚ˙ˆË. èÓfl‚ËÎ‡ ÒÂ ·ÓÎÍ‡ ‚ Ó·Î‡ÒÚÚ‡ Ì‡ „˙·Ì‡˜ÌËflÒÚ˙Î·, Í‡ÍÚÓ Ë ÒÎ‡·ÓÒÚ ÔÂ‰ËÏÌÓ ‚ ‰ËÒÚ‡ÎÌËÚÂ ÏÛÒÍÛ-ÎË Ì‡ Í‡Í‡Ú‡. èÓ„ÂÒËflÚ‡ Ì‡ ÒËÏÔÚÓÏ‡ÚËÍ‡Ú‡ ‰ÓÒ-ÚË„Ì‡Î‡ Ò‚Ófl ÔËÍ ‰Ó ‰ÂÒÂÚËfl ‰ÂÌ, ÍÓ„‡ÚÓ ÒÎ‡·ÓÒÚÚ‡Ó·ı‚‡Ì‡Î‡ Ë ˙ˆÂÚÂ, ÔÓıÓ‰Í‡Ú‡ ÒËÎÌÓ ÒÂ Á‡ÚÛ‰ÌËÎ‡, ·Ë-Î‡ ‚˙ÁÏÓÊÌ‡ Ò‡ÏÓ Ò ÔË‰ÛÊËÚÂÎ. è‡ˆËÂÌÚÍ‡Ú‡ ÌÂ Ò˙Ó·-˘‡‚‡ Á‡ ÔÂ‰¯ÂÒÚ‚‡˘‡ ‚ËÛÒÌ‡ ËÌÙÂÍˆËfl ËÎË ‰Û„Ó ÓÚÍ-Î˛˜‚‡˘Ó Ò˙ÒÚÓflÌËÂ. èÂ„ÎÂ‰‡Ì‡ ÓÚ ÎÂÍ‡ Ë Ì‡ÒÓ˜ÂÌ‡ Ò‚ÂÓflÚÌ‡ ‰Ë‡„ÌÓÁ‡: ÓÒÚ˙ ÔÓÎË‡‰ËÍÛÎÓÌÂ‚ËÚ.

éÚ ÌÂ‚ÓÎÓ„Ë˜ÌËfl ÔÂ„ÎÂ‰ ÔË ıÓÒÔËÚ‡ÎËÁ‡ˆËflÚ‡ ÒÂÛÒÚ‡ÌÓ‚fl‚‡Ú ‰‡ÌÌË Á‡ ÔÂËÙÂÌ‡ Í‚‡‰ËÔ‡ÂÁ‡, ÔÓ-ËÁ‡-ÁÂÌ‡ Á‡ ‰ÓÎÌË Í‡ÈÌËˆË (ÔÓ ååí 3/5); ÒËÎÌÓ Á‡ÚÛ‰ÌÂÌ‡ÔÓıÓ‰Í‡; ÒÛıÓÊËÎÌÓ-Ì‡‰ÍÓÒÚÌ‡ ıËÔÓÂÙÎÂÍÒËfl ‚ ˙ˆÂÚÂË ‡ÂÙÎÂÍÒËfl ‚ Í‡Í‡Ú‡; ‚˙Á·Û‰ÌË ÒÂÚË‚ÌË Ì‡Û¯ÂÌËfl –Ô‡ÂÒÚÂÁËË Ë ·ÓÎÍË ÔÓ „˙·Ì‡˜ÌËfl ÒÚ˙Î·, ·ÂÁ Ó·ÂÍÚË‚ÌËÒÂÚË‚ÌË ÔÓÏÂÌË.

éÚ ÔÓ‚Â‰ÂÌÓÚÓ ÂÎÂÍÚÓÏËÓ„‡ÙÒÍÓ ËÁÒÎÂ‰‚‡ÌÂ (Ì‡13-fl ‰ÂÌ ÓÚ Ì‡˜‡ÎÓÚÓ) Ò‡ Ì‡ÎËˆÂ ‰‡ÌÌË Á‡ ÔÓÎËÌÂ‚ËÚÌ‡Û‚Â‰‡ – ÒÏÂÒÂÌ ÚËÔ, ÔÂ‰ËÏÌÓ ‰ÂÏËÂÎËÌËÁË‡˘, Í‡ÍÚÓ ËËÁ‡ÁÂÌË ÍÓÂÌ˜Â‚Ë ÔÓÏÂÌË ‚ „ÓÌË Ë ‰ÓÎÌË Í‡ÈÌËˆË.ãËÍ‚ÓÌÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ (Ì‡ 11-fl ‰ÂÌ) ÔÓÍ‡Á‚‡ ·ÂÎÚ˙˜ÌÓ-ÍÎÂÚ˙˜Ì‡ ‰ËÒÓˆË‡ˆËfl – ıËÔÂÔÓÚÂËÌÓ‡ıËfl 136Ï„%, ·ÂÁ‰‡ÌÌË Á‡ ÔÎÂÓˆËÚÓÁ‡.

èË Ô‡ˆËÂÌÚÍ‡Ú‡ ÒÂ ÔÓ‚Â‰Â 5 ‰ÌÂ‚ÂÌ ÍÛÒ Ì‡ ÎÂ˜ÂÌËÂ ÒËÌÚ‡‚ÂÌÓÁÂÌ ËÏÛÌÓ„ÎÓ·ÛÎËÌ (ËÏÛÌÓ‚ÂÌËÌ) ‚ ‰ÓÁ‡ 0,4 g/ kg.

ç‡ 14-fl ‰ÂÌ ÓÚ Ì‡˜‡ÎÓÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ ÒÂ ÓÚ˜ÂÚÂÔÓ‰Ó·ÂÌËÂ ‚ Ó„ÌË˘Ì‡Ú‡ ÌÂ‚ÓÎÓ„Ë˜Ì‡ ÒËÏÔÚÓÏ‡ÚËÍ‡ ËÌ‡ 20-fl ‰ÂÌ Ô‡ˆËÂÌÚÍ‡Ú‡ ·Â¯Â ‰ÂıÓÒÔËÚ‡ÎËÁË‡Ì‡ Ò˙ÒÁÌ‡˜ËÚÂÎÌÓ ÔÓ‰Ó·ÂÌËÂ – ‚˙ÁÏÓÊÌ‡ ÔÓıÓ‰Í‡, ·ÂÁ ÔË‰Û-ÊËÚÂÎ Ë ·ÂÁ ‚˙Á·Û‰Ì‡ ·ÓÎÍÓ‚‡ ÒËÏÔÚÓÏ‡ÚËÍ‡. èÂÚ ‰ÌËÔÓ-Í˙ÒÌÓ (Ì‡ 15-fl ‰ÂÌ ÓÚ Ô˙‚ÓÌ‡˜‡ÎÌÓÚÓ ÔÓ‰Ó·ÂÌËÂ)ÓÚÌÓ‚Ó ÒÂ ÔÓfl‚ËÎ‡ ÒÎ‡·ÓÒÚ ‚ ‰ÓÎÌË Í‡ÈÌËˆË, ÔÓıÓ‰Í‡Ú‡ÒËÎÌÓ ÒÂ Á‡ÚÛ‰ÌËÎ‡, Í‡ÚÓ Á‡ ÌflÍÓÎÍÓ ‰ÌË ÒÎ‡·ÓÒÚÚ‡ ‡Ò-ˆÂÌ‰Ë‡Î‡ Ë Ó·ı‚‡Ì‡Î‡ „ÓÌËÚÂ Í‡ÈÌËˆË Ë ‰Ëı‡ÚÂÎÌ‡Ú‡ÏÛÒÍÛÎ‡ÚÛ‡. ê‡Á‚Ë ÒÂ ‚flÎ‡ Í‚‡‰ËÔÎÂ„Ëfl (ÔÓ ååí 0/5),ÒÛıÓÊËÎÌÓ-Ì‡‰ÍÓÒÚÌ‡ ‡ÂÙÎÂÍÒËfl Ë ÔÓ‡‰Ë ÍÎËÌË˜ÌË ‰‡Ì-ÌË Á‡ ‡Á‚ËÚËÂ Ì‡ ‰Ëı‡ÚÂÎÌ‡ ÌÂ‰ÓÒÚ‡Ú˙˜ÌÓÒÚ ·ÓÎÌ‡Ú‡·Â ÓÓÚ‡ıÂ‡ÎÌÓ ËÌÚÛ·Ë‡Ì‡, ‚ÔÓÒÎÂ‰ÒÚ‚ËÂ Ú‡ıÂÓÚÓ-ÏË‡Ì‡ Ë ÔÓÒÚ‡‚ÂÌ‡ Ì‡ ËÁÍÛÒÚ‚ÂÌ‡ ·ÂÎÓ‰Ó·Ì‡ ‚ÂÌÚËÎ‡-ˆËfl (àÅÇ) – ÂÊËÏ IPPV Á‡ 20 ‰ÌË. èÂÁ ÚÓÁË ÔÂËÓ‰ Ò‡Â„ËÒÚË‡ÌË ‡ÁÒÚÓÈÒÚ‚‡ ‚ ‡‚ÚÓÌÓÏÌ‡Ú‡ ÌÂ‚Ì‡ ÒËÒ-ÚÂÏ‡ – ÔÂıÓ‰ÌË ıËÔÓÚÓÌËfl, Ú‡ıËÍ‡‰Ëfl, ÂÚÂÌˆËÓÌÌËÌ‡Û¯ÂÌËfl. èÓ‚Â‰Â ÒÂ ÍÓÌÚÓÎÌÓ ËÁÒÎÂ‰‚‡ÌÂ Ì‡ ÎÛÏ·‡ÎÂÌÎËÍ‚Ó – ·ÂÁ ÁÌ‡˜ËÚÂÎÌ‡ ‰ËÌ‡ÏËÍ‡ ‚ ÍÓÎË˜ÂÒÚ‚ÓÚÓ Ì‡·ÂÎÚ˙Í‡ – 117 Ï„% Ë ·ÂÁ ÔÎÂÓˆËÚÓÁ‡. ÇËÛÒÓÎÓ„Ë˜ÌËÚÂËÁÒÎÂ‰‚‡ÌËfl Á‡ EBV, CMV Ë HSV ‚ ÎËÍ‚Ó Ë ÒÂÛÏ ÔÓÍ‡-Á‡ı‡ ÓÚËˆ‡ÚÂÎÌË ÂÁÛÎÚ‡ÚË. èÓ‚Â‰Â ÒÂ ‚ÚÓË ÍÛÒ Ì‡

ÎÂ˜ÂÌËÂ Ò ËÏÛÌÓ‚ÂÌËÌ ‚ ‰ÓÁ‡ 0,4 g/ kg ‚ ÚË ÔÓÒÎÂ‰Ó‚‡ÚÂÎ-ÌË ‰ÌË. áÌ‡˜ËÚÂÎÌÓ ÔÓ‰Ó·ÂÌËÂ ‚ Ó„ÌË˘Ì‡Ú‡ ÌÂ‚ÓÎÓ„Ë˜-Ì‡ ÒËÏÔÚÓÏ‡ÚËÍ‡ ÒÂ ÓÚ˜ÂÚÂ Ì‡ ÚÂÚËfl ÏÂÒÂˆ ÒÎÂ‰ Ì‡˜‡-ÎÓÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ – ‚flÎ‡ Í‚‡‰ËÔ‡ÂÁ‡ (ÔÓ ååí 3/5),ÔÓıÓ‰Í‡Ú‡ ‚ÒÂ Ó˘Â Â ÌÂ‚˙ÁÏÓÊÌ‡, Ô‡ˆËÂÌÚÍ‡Ú‡ ÔÓ‚ÂÊ‰‡‡ÍÚË‚Ì‡ ‰‚Ë„‡ÚÂÎÌ‡ Âı‡·ËÎËÚ‡ˆËfl Ë ÙËÁËÓÚÂ‡ÔËfl.

ä‡Ò‡Â ÒÂ Á‡ Ô‡ˆËÂÌÚÍ‡ Ò ÓÒÚÓ ‡Á‚ËÚËÂ Ì‡ ÔÓÎËÌÂ‚Ë-ÚÂÌ ÒËÌ‰ÓÏ – ÔÂ‰ËÏÌÓ ‰‚Ë„‡ÚÂÎÂÌ, ‰ÓÍ‡Á‡Ì ÂÎÂÍÚÓ-ÙËÁËÓÎÓ„Ë˜ÌÓ Ë ÎËÍ‚ÓÓÎÓ„Ë˜ÌÓ, ÔË ÍÓflÚÓ ÒÎÂ‰ Ô˙‚ÓÌ‡-˜‡ÎÌÓ ÓÚ˜ÂÚÂÌÓ ÔÓ‰Ó·ÂÌËÂ ‚ Ó„ÌË˘Ì‡Ú‡ ÌÂ‚ÓÎÓ„Ë˜Ì‡ÒËÏÔÚÓÏ‡ÚËÍ‡ ÒÂ Â„ËÒÚË‡ ‚ÚÓË ÔËÍ Ì‡ Á‡·ÓÎfl‚‡ÌÂ-ÚÓ Ò ÏÌÓ„Ó ÔÓ-ÚÂÊÍÓ ‡Á‚ËÚËÂ Ì‡ ÍÎËÌË˜Ì‡Ú‡ Í‡ÚËÌ‡‰Ó Í‚‡‰ËÔÎÂ„Ëfl Ë ‰Ëı‡ÚÂÎÌ‡ ÌÂ‰ÓÒÚ‡Ú˙˜ÌÓÒÚ ËÁËÒÍ‚‡-˘‡ àÅÇ.

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ëËÌ‰ÓÏ˙Ú Ì‡ ÉËÎÂÌ – Å‡Â Â ÓÚÌÓÒËÚÂÎÌÓ fl‰ÍÓ ÒÂ-˘‡˘Ó ÒÂ Á‡·ÓÎfl‚‡ÌÂ Ò „Ó‰Ë¯Ì‡ Á‡·ÓÎÂ‚‡ÂÏÓÒÚ 1-2/ 100ıËÎ Ì‡ÒÂÎÂÌËÂ (1). èÂ‰ÒÚ‡‚Îfl‚‡ ıÂÚÂÓ„ÂÌÂÌ ÒËÌ‰ÓÏ Ò¯ËÓÍ ÍÎËÌË˜ÂÌ ÒÔÂÍÚ˙, Ò ‡ÁÎË˜ÂÌ ıÓ‰, ÚÂÊÂÒÚ, ÔÓ„-ÂÒËfl Ë ËÁıÓ‰ (7). èË „ÓÎflÏ‡ ˜‡ÒÚ ÓÚ Ô‡ˆËÂÌÚËÚÂ ÚÓÈÔÓÚË˜‡ Ò ÍÎ‡ÒË˜ÂÒÍ‡Ú‡ Í‡ÚËÌ‡ ÓÚ ÓÒÚÓ ‡Á‚Ë‚‡˘‡ ÒÂ‚˙ÁıÓ‰fl˘‡ ÒËÏÂÚË˜Ì‡ ÒÎ‡·ÓÒÚ Ë ÒÛıÓÊËÎÌÓ-Ì‡‰ÍÓÒÚÌ‡‡ÂÙÎÂÍÒËfl.

èË 90% ÓÚ ÒÎÛ˜‡ËÚÂ Ò˙Ò ëÉÅ ‚ ‡ÁÎË˜ÂÌ ÒÚ‡‰ËÈ Ì‡Á‡·ÓÎfl‚‡ÌÂÚÓ ÒÂ ÔÓfl‚fl‚‡ ÒÔÓÌÚ‡ÌÌ‡ ·ÓÎÍ‡ ÎÓÍ‡ÎËÁË‡Ì‡ ‚„˙·Ì‡˜ÌËfl ÒÚ˙Î·, ÏÛÒÍÛÎËÚÂ Ì‡ ÚflÎÓÚÓ ËÎË Í‡ÈÌËˆË-ÚÂ. èË 50% ÓÚ Ô‡ˆËÂÌÚËÚÂ ÏÓÊÂ ‰‡ ·˙‰Â Ô˙‚ÓÌ‡˜‡ÎÌ‡ËÁfl‚‡ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ (2). åÂı‡ÌËÁÏ˙Ú Á‡ ‚˙ÁÌËÍ‚‡ÌÂ Ì‡·ÓÎÍ‡Ú‡ Â ÏÌÓ„ÓÙ‡ÍÚÓÂÌ: ÂÁÛÎÚ‡Ú ÓÚ ‰ËÙÛÁÌÓ ‚˙ÁÔ‡-ÎÂÌËÂ Ì‡ ÍÓÂÌ˜ÂÚ‡Ú‡ Ì‡ ÔÂËÙÂÌËÚÂ ÌÂ‚Ë, Ì‡ ÔÓ-Í˙ÒÂÌÂÚ‡Ô - ÂÁÛÎÚ‡Ú ÓÚ ‰˙Î„ÓÚ‡ÈÌÓ Ó·ÂÁ‰‚ËÊ‚‡ÌÂ Ì‡ Ô‡ˆË-ÂÌÚËÚÂ. èÓ‚Â˜ÂÚÓ Ô‡ˆËÂÌÚË ÓÔËÒ‚‡Ú ·ÓÎÍ‡Ú‡ Í‡ÚÓ Ô‡-Â˘‡, ÔÓ·ÓÊ‰‡˘‡, ÔÓÌflÍÓ„‡ Í‡ÚÓ ÏÛÒÍÛÎÌ‡ ÚÂÒÍ‡, ÎÓ-Í‡ÎËÁË‡Ì‡ ÔÂ‰ËÏÌÓ ‚ ‰ÓÎÌËÚÂ Í‡ÈÌËˆË Ë ÔÓÚÂÊÂÌËÂ-ÚÓ Ì‡ „˙·Ì‡˜ÌËfl ÒÚ˙Î·. ÑÛ„Ë ÓÔËÒ‚‡ÌË ·ÓÎÍÓ‚Ë ÒËÌ‰Ó-ÏË ÔË ëÉÅ Ò‡ ÏË‡Î„Ë˜ÌË ÓÔÎ‡Í‚‡ÌËfl, ÔÓÌflÍÓ„‡ Ò˙ÔÓ‚Ó-‰ÂÌË Ò ·ÓÎÂÁÌÂÌË Í‡ÏÔË ‚ Ô‡ÒˆËÚÂ; ÔÓ‚Ë¯ÂÌ‡ ÎÓÍ‡ÎÌ‡ÏÛÒÍÛÎÌ‡ ˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚ; ‚ËÒˆÂ‡Î„Ëfl (9). Ç ÎËÚÂ‡-ÚÛ‡Ú‡ fl‰ÍÓ ÒÂ ÒÂ˘‡Ú ÓÔËÒ‡ÌËfl Ì‡ ÒÎÛ˜‡Ë Ì‡ ëÉÅ, ÔÓ-ÚË˜‡˘Ë Í‡ÚÓ ‡‰ËÍÛÎÂÌË ÙÓÏË ·ÂÁ ‡Á‚ËÚËÂ Ì‡ ËÁ‡ÁÂ-ÌË ‰‚Ë„‡ÚÂÎÌË Ô‡ÂÁË (10). ê‡ÌÌÓÚÓ ‰Ë‡„ÌÓÒÚËˆË‡ÌÂ Ì‡Ú‡ÍË‚‡ Ô‡ˆËÂÌÚË Â ÓÒÓ·ÂÌÓ ‚‡ÊÌÓ Ò Ó„ÎÂ‰ ·˙ÁÓ ËÁÍÎ˛˜-‚‡ÌÂ Ì‡ ¯ËÓÍ ÒÔÂÍÚ˙ Á‡·ÓÎfl‚‡ÌËfl, ÍÓËÚÓ ÏÓ„‡Ú ‰‡ÔÓÚÂÍ˙Ú Ò ÓÒÚ˙ ·ÓÎÍÓ‚ ÒËÌ‰ÓÏ (Â‚Ï‡ÚÓÎÓ„Ë˜ÌË, ÓÒ-ÚÂÓÏËÂÎËÚ, ÒÂÔÚË˜ÂÌ ‡ÚËÚ, Ú‡‚Ï‡, Ò˙‰Ó‚Ë Á‡·ÓÎfl-‚‡ÌËfl Ì‡ „˙·Ì‡˜ÌËfl ÏÓÁ˙Í, ÏËÓ„ÂÌÌË Û‚Â‰Ë). á‡ÔÓ˜‚‡ÌÂ-ÚÓ Ì‡ Ò˙ÓÚ‚ÂÚÌÓ ÎÂ˜ÂÌËÂ Ò ËÌÚ‡‚ÂÌÓÁÂÌ ËÏÛÌÓ„ÎÓ·ÛÎËÌÂ Â¯‡‚‡˘Ó Á‡ ÔÓ„ÌÓÁ‡Ú‡ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ. çflÍÓË ‡‚ÚÓ-Ë Ì‡ÏË‡Ú ÔÓÎÓÊËÚÂÎÌ‡ ÍÓÂÎ‡ˆËfl ÏÂÊ‰Û ËÌÚÂÁË‚ÌÓ-ÒÚÚ‡ Ì‡ ·ÓÎÍ‡Ú‡ ÔË ıÓÒÔËÚ‡ÎËÁ‡ˆËflÚ‡ Ë ÚÂÊÂÒÚÚ‡ Ì‡ÌÂ‚ÓÎÓ„Ë˜ÌËfl ‰ÂÙËˆËÚ, Í‡ÚÓ Ò˜ËÚ‡Ú ˜Â ÚÓ‚‡ ÌflÏ‡ ÓÚ-ÌÓ¯ÂÌËÂ Í˙Ï ÔÓ„ÌÓÁ‡Ú‡ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ (10)

êfl‰ÍÓ ÒÂ˘‡Ì ‚‡Ë‡ÌÚ Ì‡ ëÉÅ Â Ù‡ËÌ„Ó-ˆÂ‚ËÍÓ-·‡-ıË‡ÎÌËfl ÍÎËÌË˜ÂÌ ‚‡Ë‡ÌÚ, ÍÓÈÚÓ ÒÂ ÓÔËÒ‚‡ Í‡ÚÓ ËÁÓÎË-‡Ì‡ ÎËˆÂ‚‡, ÓÓÙ‡ËÌ„Â‡ÎÌ‡ Ë ¯ËÈÌ‡ ÒÎ‡·ÓÒÚ, ‚ÍÎ˛˜Ë-ÚÂÎÌÓ Ë Ì‡ „ÓÌËÚÂ Í‡ÈÌËˆË ·ÂÁ Á‡Òfl„‡ÌÂ Ì‡ ‰ÓÎÌËÚÂÍ‡ÈÌËˆË (8). çÂ„Ó‚ÓÚÓ ‰Ë‡„ÌÓÒÚËˆË‡ÌÂ Â ÓÒÓ·ÂÌÓÚÛ‰ÌÓ ÔÓ‡‰Ë ÏÌÓ„ÓÓ·‡ÁËÂÚÓ ÓÚ Á‡·ÓÎfl‚‡ÌËfl, ÍÓËÚÓÏÓ„‡Ú ‰‡ ÔÓÚÂÍ‡Ú Ò ‡Á‚ËÚËÂ Ì‡ ·ÛÎ·‡Ì‡ Ô‡ÂÁ‡ (Ò˙‰Ó-‚Ë, ‚˙ÁÔ‡ÎËÚÂÎÌË, ‰Â„ÂÌÂ‡ÚË‚ÌË, ÚÛÏÓÌË Ë ‰Û„Ë ÔÓ-ˆÂÒË ‚ ÏÓÁ˙˜ÌËfl ÒÚ‚ÓÎ). éÒÓ·ÂÌÓ ‚‡ÊÌË ÚÛÍ Ò‡ ÔÓ‚ÂÊ-‰‡ÌÂÚÓ Ì‡ ÂÎÂÍÚÓÏËÓ„‡ÙÒÍÓ Ë ÎËÍ‚ÓÓÎÓ„Ë˜ÌÓ ËÁÒÎÂ‰-‚‡ÌÂ. ÖåÉ ‡ÁÍË‚‡ ‰‡ÌÌË Á‡ ‡ÍÒÓÌ‡ÎÌÓ Á‡Òfl„‡ÌÂ Ì‡ Í‡Û-‰‡ÎÌ‡Ú‡ „ÛÔ‡ óåç, Í‡ÍÚÓ Ë Ì‡ ÔÂËÙÂÌËÚÂ ÌÂ‚ËËÌÂ‚Ë‡˘Ë ÏË¯ÌËˆ‡Ú‡. ãËÍ‚ÓÓÎÓ„Ë˜ÌÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ


‰ÓÍ‡Á‚‡ ·ÂÎÚ˙˜ÌÓ-ÍÎÂÚ˙˜Ì‡ ‰ËÒÓˆË‡ˆËfl. èË Ì‡‚ÂÏÂÌÌÓË ‚ ‡‰ÂÍ‚‡ÚÌ‡ ‰ÓÁ‡ Á‡ÔÓ˜Ì‡ÚÓ ÎÂ˜ÂÌËÂ Ò ËÌÚ‡‚ÂÌÓÁÂÌËÏÛÌÓ„ÎÓ·ÛÎËÌ ÒÂ ÔÓ‰Ó·fl‚‡ ‚ „ÓÎflÏ‡ ÒÚÂÔÂÌ ‰‡ÎÂ˜Ì‡Ú‡ÔÓ„ÌÓÁ‡ Ì‡ Ô‡ˆËÂÌÚ‡.

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Ç Á‡ÍÎ˛˜ÂÌËÂ Úfl·‚‡ ‰‡ ÒÂ ÓÚ·ÂÎÂÊË ÌÂÓ·ıÓ‰ËÏÓÒÚ-Ú‡ ÓÚ ÔÓÁÌ‡‚‡ÌÂ Ì‡ ¯ËÓÍËfl ÍÎËÌË˜ÂÌ ÒÔÂÍÚ˙ Ì‡ ëÉÅ,Á‡ ‰‡ ÌÂ ÒÂ ‰ÓÔÛÒÍ‡ „Â¯ÌÓ ‰Ë‡„ÌÓÒÚËˆË‡ÌÂ, Á‡·‡‚flÌÂ Ì‡-˜‡ÎÓÚÓ Ì‡ ÒÔÂˆËÙË˜ÌÓÚÓ ÎÂ˜ÂÌËÂ Ë ÛÚÂÊÌfl‚‡ÌÂ ËÁıÓ‰‡ Ì‡Á‡·ÓÎfl‚‡ÌÂÚÓ.

ãàíÖêÄíìêÄ:1. Asbury AK, Cornblath DR. Assessment of current diagnostic criteria forGuillain-Barre syndrome. Ann Neurol 1990;27:21-24.2. Cha-Kim A. Guillain-Barre syndrome.J eMedicine 2001;2:1-21.3. Cornblath DR. Electrophysiology in Guillain-Barre syndrome. Ann Neurol1990;27(Suppl):17-20.4. Grand’Maison F, Feasby TE, Hahn AF, Koopman WJ. Recurrent Guillain-Barre syndrome: clinical and laboratory features. Brain 1992;115:1093-1106.5. Hahn AF. Guillain-Barre syndrome. Lancet 1998;352:635-641.6. Hughes R, Rees J.Guillain-Barre syndrome.Current Opinion in Neurology1994;7:386-392.7. Hughes RAC. The concept and classification of Guillain-Barre syndrome andrelated disorders. Rev Neurol 1995;151:291-294 (Editorial).8. Koga M, Yuki N, Ariga T, Morimatsu M, Hirata K. Is IgG anti-GT1a anti-body associated with pharyngeal-cervical-brachial weakness or oropharyngealpalsy in Guillain-Barre syndrome? J Neuroimmunol 1998;86:74-79.9. MoulinDE, Hagen N, Feasby TE, Amirch R, Hahn A. Pain in Guillain-Barresyndrome. Neurology 1997;48:328-31.10. Manners PJ, Murray KJ. Guillain-Barre syndrome presenting with severemusculoskeletal pain. Acta Paediatr 1992;81:1049-51.

Ä‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËfl:Ñ- ÑË‡Ì‡ ÄÚ‡Ì‡ÒÓ‚‡ëÓÙËflìÎ. ÅflÎÓ ÏÓÂ 7ìåÅÄã “ñ‡Ëˆ‡ âÓÌÌ‡”, ÍÎËÌËÍ‡ ÔÓ ÌÂ‚ÓÎÓ„ËflTel: + 359/ 2 9432 525e-mail: [email protected]


SUMMARY

A CASE OF OPTIC RETROCHIASMAL LESION WITHDEMYELINATING ETIOLOGY

A. Oscar, S. Cherninkova, P. Shotekov, R. Kalpachki,A. Bocheva, B. Milev

A case of 20 year old woman, R.N.B., is presented, suffer-ing multiple sclerosis who developed an acute retrochiasmaloptic lesion with involvement of the right internal capsule,verified by MRI, as a new manifestation of the main demyeli-nating disease. The retrochiasmal lesion clinically appeared asa left upper homonymous quadrantopia. The perimetric defectwas objectified by the method of automated computedperimetry. The dynamic neuroophthalmological follow up fora period of 2 months showed no evidence of a perimetricdefect with total regression of the field defect. The case pres-ents a casuistic interest as an example of typical retrochiasmallesion in the context of multiple sclerosis.

Keywords: computed perimetry, multiple sclerosis,retrochiasmal lesion, homonymous quadrantopsia.

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ç‡È-˜ÂÒÚËÚÂ ‰ÂÙÂÍÚË Ì‡ ÁËÚÂÎÌÓÚÓ ÔÓÎÂ ÔË ÚÂÁËÔ‡ˆËÂÌÚË Ò‡ ıÓÏÓÌËÏÌËÚÂ ıÂÏË‡ÌÓÔÒËË /10/. ä‚‡‰‡ÌÚ‡-ÌÓÔÒËË ÒÂ ÒÂ˘‡Ú ÔË 27% ÓÚ Ô‡ˆËÂÌÚËÚÂ. éÚ ÓÔËÒ‡ÌË-ÚÂ ‚ ÎËÚÂ‡ÚÛ‡Ú‡ Ô‡ˆËÂÌÚË 38% Ò‡ ËÏ‡ÎË ÍÓÌ„ÛÂÌÚ-ÌË ‰ÂÙÂÍÚË /17/.

èÂ‰ÒÚ‡‚flÏÂ ÚËÔË˜ÂÌ ÒÎÛ˜‡È Ì‡ 20 „Ó‰Ë¯Ì‡ Ô‡ˆËÂÌÚ-Í‡, ê.ç.Å., ÒÚ‡‰‡˘‡ ÓÚ MS, Ò ÂÚÓıË‡ÁÏ‡ÎÌÓ Á‡Òfl„‡ÌÂÌ‡ ÁËÚÂÎÌ‡Ú‡ ‡ÙÂÂÌÚÌ‡ ÒËÒÚÂÏ‡, ÎÂÍÛ‚‡Ì‡ ÔÂÁ ÏÂÒÂˆ‰ÂÍÂÏ‚Ë 2004 „Ó‰ËÌ‡ ‚ çÂ‚ÓÎÓ„Ë˜Ì‡ äÎËÌËÍ‡ Ì‡ ìÌË‚Â-ÒËÚÂÚÒÍ‡ “ÄÎÂÍÒ‡Ì‰Ó‚ÒÍ‡“ ·ÓÎÌËˆ‡.

ÄÌ‡ÏÂÌÁ‡: ëÌÂÚ‡ ÔÓ ‰‡ÌÌË Ì‡ Ô‡ˆËÂÌÚÍ‡Ú‡ Ë ÔË‰Û-Ê‡‚‡˘‡Ú‡ ÏÂ‰ËˆËÌÒÍ‡ ‰ÓÍÛÏÂÌÚ‡ˆËfl. èÓÒÚ˙Ô‚‡ Á‡ Ô˙-‚Ë Ô˙Ú ‚ çÂ‚ÓÎÓ„Ë˜Ì‡ äÎËÌËÍ‡ Á‡ ‰Ë‡„ÌÓÒÚË˜ÌÓ ÛÚÓ˜-Ìfl‚‡ÌÂ Ë ÚÂ‡ÔÂ‚ÚË˜ÌÓ ÔÓ‚ÎËfl‚‡ÌÂ ÔÓ ÔÓ‚Ó‰ Ì‡ ÔÂÒËÒ-ÚË‡˘Ë ÓÔÎ‡Í‚‡ÌËfl ÓÚ Á‡Ï˙„ÎÂÌÓ ÁÂÌËÂ. éÍÓÎÓ Â‰ËÌ ÏÂ-ÒÂˆ ÔÂ‰Ë Ì‡ÒÚÓfl˘‡Ú‡ ıÓÒÔËÚ‡ÎËÁ‡ˆËfl ÒÂ ÔÓfl‚ËÎË ‰‚ÓÈ-ÌÓ ‚ËÊ‰‡ÌÂ, ÒÎ‡·ÓÒÚ Ë ËÁÚ˙Ô‚‡ÌÂ ‚ ÎÂ‚Ëfl Í‡Í, ÍÓËÚÓÓÚÁ‚Û˜‡ÎË ÒÔÓÌÚ‡ÌÌÓ, Â‰Ì‡ ÒÂ‰ÏËˆ‡ ÔÂ‰Ë ÔÓÒÚ˙Ô‚‡ÌÂ-ÚÓ.

ëÓÏ‡ÚË˜ÂÌ ÒÚ‡ÚÛÒ: ÇÂÁËÍÛÎ‡ÌÓ ‰Ë¯‡ÌÂ, ·ÂÁ ‰Ó·‡-‚ÂÌË ıËÔÓ‚Â. êëÑ, Ò ˜ÂÒÚÓÚ‡ 72Û‰./ÏËÌ, Äç 110/70mmHg. äÓÂÏ- ÏÂÍ, ÌÂ·ÓÎÂÁÌÂÌ, ˜ÂÂÌ ‰Ó· Ë ÒÎÂÁÍ‡ ÌÂ ÒÂÔ‡ÎÔË‡Ú Û‚ÂÎË˜ÂÌË. ä‡ÈÌËˆË- ·ÂÁ ÓÚÓˆË Ë ‚‡ËˆË, Ò˙ı-‡ÌÂÌË ÔÂËÙÂÌË ÔÛÎÒ‡ˆËË.

çÂ‚ÓÎÓ„Ë˜ÂÌ ÒÚ‡ÚÛÒ: èË ÔÓÒÚ˙Ô‚‡ÌÂÚÓ: ä‚‡‰Ë-ÔË‡ÏË‰ÂÌ ÒËÌ‰ÓÏ- ·ÓÎÂÒÚÌÓ ÓÊË‚ÂÌË ëçê Á‡ ˜ÂÚËËÚÂÍ‡ÈÌËÍ‡, ÎËÔÒ‚‡Ú ÍÓÂÏÌË ÂÙÎÂÍÒË; ÑËÒÍÓÓ‰ËÌ‡ˆËÓ-ÌÂÌ ÒËÌ‰ÓÏ- ÎÂÍ‡ ‰ËÌ‡ÏË˜Ì‡ ‡Ú‡ÍÒËfl, ÔÓ‚Â˜Â ‚‰flÒÌÓ; ãÂ-‚ÓÒÚ‡ÌÌ‡ „ÓÌ‡ ıÓÏÓÌËÏÌ‡ Í‚‡‰‡ÌÚ‡ÌÓÔÒËfl. EDSS=3.0 (P1, CII1, BS0, S0, BB0, V3, Cb0); èË ËÁÔËÒ‚‡ÌÂÚÓ:Í‚‡‰ËÔË‡ÏË‰ÂÌ ÒËÌ‰ÓÏ, ‰ËÒÍÂÚÌÓ ÒÏÛÚÂÌ‡ ‰˙Î·ÓÍ‡ÒÂÚË‚ÌÓÒÚ Á‡ ‰ÓÎÌË Í‡ÈÌËˆË, ÎÂ‚ÓÒÚ‡ÌÂÌ Ô‡‡ˆÂÌÚ‡-ÎÂÌ ıÓÏÓÌËÏÂÌ ÒÍÓÚÓÏ; EDSS= 2.5 (P1, CII0, BS0. S1,BBo, V2, Cb0).

àÁÒÎÂ‰‚‡ÌËfl: ëìÖ 3; Hb 13.1; Htc 32.1; Er 5.15; Leuco20.2; Trom 305; Glu 4.38; Creat 94; Ó·˘ ·ÂÎÚ˙Í 66; ‡Î·Û-ÏËÌ 44.1; ÒÂÛÏÌ‡ ÂÎÂÍÚÓÙÓÂÁ‡: ÌÓÏ‡ÎÌ‡; Ig G 6.59 g/l,Ig A 1.52 g/l, Ig M 1.34 g/l; åËÍÓÎÛÂÒ (-); ÛËÌ‡- ÒÔÂˆË-ÙË˜ÌÓ ÚÂ„ÎÓ 1005, Â‰ËÌË˜ÌË ÎÂ‚ÍÓˆËÚË Ì‡ ÔÓÎÂ.

ãÛÏ·‡ÎÂÌ ÎËÍ‚Ó: ÔÓÁ‡˜ÌÓÒÚ Ô˙ÎÌ‡; ÙË·ËÌÓ‚‡ ÏÂ-Ê‡ ÌflÏ‡; ÖËÚÓˆËÚË 341x106/l; ãÂ‚ÍÓˆËÚË 45ı106/l;·ÂÎÚ˙Í 0.3 g/l; „Î˛ÍÓÁ‡ 2.37 mmol/l; ıÎÓË‰Ë 125 mmol/l;


îË„.1Ä) åÛÎÚËÔÎÂÌÌË, ıËÔÂËÌÚÂÌÁÌË ‚ í2 Ó„ÌË˘ÌË ÔÓ‡ÊÂÌËfl Ì‡

ÔÂË‚ÂÌÚËÍÛÎ‡ÌÓÚÓ ·flÎÓ ÏÓÁ˙˜ÌÓ ‚Â˘ÂÒÚ‚Ó, Í‡ÍÚÓ Ë Ì‡ ÍÓÓÌ‡‡‰Ë‡Ú‡; ÔÓÒÎÂ‰ÌËÚÂ Ò‡ Ò Ó‚ÓË‰Ì‡ ÙÓÏ‡, ÓËÂÌÚË‡ÌË Ò ‰˙Î„‡Ú‡ ÒË

ÓÒ ÔÂÔÂÌ‰ËÍÛÎflÌÓ Ì‡ ÂÔÂÌ‰ËÏÌ‡Ú‡ ÔÓ‚˙ıÌÓÒÚ Ì‡ Î‡ÚÂ‡ÎÌËÚÂÏÓÁ˙˜ÌË ‚ÂÌÚËÍÛÎË.

Å) é„ÌË˘Ì‡ ‰ÂÏËÂÎËÌËÁ‡ˆËfl ‚ Ó·Î‡ÒÚÚ‡ Ì‡ Á‡‰ÌÓÚÓ ÍÓÎflÌÓ Ì‡ Í‡ÔÒÛÎ‡ËÌÚÂÌ‡ ‚ ‰flÒÌÓ- ıËÔÂËÌÚÂÌÁÌ‡ ı‡‡ÍÚÂËÒÚËÍ‡ ‚ í2 ÒÂËËÚÂ.

Ç) íËÔË˜ÌË ÏÌÓÊÂÒÚ‚ÂÌË ÔÓ‡ÊÂÌËfl Ì‡ ÔÂË‚ÂÌÚËÍÛÎ‡ÌÓÚÓ ·flÎÓÏÓÁ˙˜ÌÓ ‚Â˘ÂÒÚ‚Ó ‰‚ÛÒÚ‡ÌÌÓ, ÔÂ‰ÓÏËÌ‡ÌÚÌÓ ‚ ‰flÒÌÓ, Í‡ÚÓ

ÎÂÁËËÚÂ Ò‡ ÏÌÓ„Ó ÔÓ-ÓÚ˜ÂÚÎË‚Ó ‰ÂÏ‡ÍË‡ÌË Ì‡ ÍÓÓÌ‡ÌËÚÂ í2-FLAIR ÒÂËË.

A Å

Ç

ÂÎÂÍÚÓÙÓÂÁ‡: γ- „ÎÓ·ÛÎËÌË Û‚ÂÎË˜ÂÌË. Ç γ- ÁÓÌ‡Ú‡ Ì‡ÎË-˜ËÂ Ì‡ ‰‚Â ÒÎ‡·Ó ËÁ‡ÁÂÌË Ù‡ÍˆËË; Ig G 83.6 mg/l, Ig A2.43mg/l, Ig M 4.5mg/l, ‡Î·ÛÏËÌ 195.1 mg/l. àÁÒÎÂ‰‚‡ÌÂ Ì‡ÒÂÛÏ‡ Á‡ Î‡ÈÏÒÍ‡ ·ÓÎÂÒÚ: /-/ ÓÚ.

å‡„ÌËÚÌÓ ÂÁÓÌ‡ÌÒÌ‡ ÚÓÏÓ„‡ÙËfl Ì‡ „Î‡‚ÂÌÏÓÁ˙Í Ë ˆÂ‚ËÍ‡ÎÂÌ ÓÚ‰ÂÎ Ì‡ „˙·Ì‡˜ÌËfl ÒÚ˙Î·- ÓÚ-˜ÂÚÎË‚Ó “Ì‡ÚÓ‚‡‚‡ÌÂÚÓ Ò ÎÂÁËË” Ì‡ ·flÎÓÚÓ ÏÓÁ˙˜ÌÓ ‚Â-˘ÂÒÚ‚Ó- ÒÛ·ÍÓÚËÍ‡ÎÌÓ ÚÂÏÔÓ‡ÎÌÓ Ë ÚÂÏÔÓÓ- Ô‡Ë-ÂÌÚ‡ÎÌÓ ‚Îfl‚Ó Ò ‡Ì„‡ÊË‡ÌÂ Ì‡ Í˙ÒËÚÂ ËÌÚÂˆÂÔÚË‚ÌË‚Î‡ÍÌ‡, Í‡ÍÚÓ Ë ‚ ‰ÂÒÌËfl ˆÂÌÚÛÏ ÒÂÏËÓ‚‡ÎÂ. èÂË‚ÂÌÚ-ËÍÛÎ‡ÌÓ- ‰‚ÛÒÚ‡ÌÌÓ, ÔÂË Í‡ÎÓÁÌÓ Ë ‰˙Î·ÓÍÓ ÚÂÏÔÓ-

‡ÎÌÓ, ‚ Ú.˜. ‚ ÒÚËÓ- Ô‡ÎË‰‡Ì‡Ú‡ ÒËÒÚÂÏ‡ ‚‰flÒÌÓ. ÑÂ-ÏËÂÎËÌËÁ‡ˆËÓÌÌ‡ ÎÂÁËfl Ë ‚ Á‡‰ÌÓÚÓ Í‡˜Â Ì‡ ‰flÒÌ‡Ú‡Í‡ÔÒÛÎ‡ ËÌÚÂÌ‡ /îË„.1- ‡, ·, ‚/. àÌÙ‡ÚÂÌÚÓË‡ÎÌÓÚÓ·flÎÓ ÏÓÁ˙˜ÌÓ ‚Â˘ÂÒÚ‚Ó, ÏÓÁ˙˜ÌËfl ÒÚ‚ÓÎ Ë ¯ËÈÌËfl ÏËÂ-ÎÂÎ‡ÚË‚ÌÓ ËÌÚ‡ÍÚÌË. çÂ ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡Ú ·ÂÎÂÁË Ì‡ Ç‡ÎÂ-ËÂ‚‡ ‰Â„ÂÌÂ‡ˆËfl Ë Ô‡ÂÌıËÏÌ‡ ‡ÚÓÙËfl Ì‡ ÏÓÁ˙˜ÌËflÔ‡ÂÌıËÏ. ç‡ıÓ‰Í‡Ú‡ ÓÚ„Ó‚‡fl Ì‡ ÔÓ„‡‰ËÂÌÚÌ‡ ÙÓÏ‡Ì‡ ‰ËÒÂÏËÌË‡Ì‡ ÒÍÎÂÓÁ‡.

ÖåÉ- çÓÏ‡ÎÌ‡ ÒÍÓÓÒÚ Ì‡ ÔÓ‚ÂÊ‰‡ÌÂ Ì‡ ‰‚Ë„‡ÚÂÎ-ÌËÚÂ ‚Î‡ÍÌ‡ Ì‡ ËÁÎÒÂ‰‚‡ÌËÚÂ ÌÂ‚Ë Ì‡ Í‡Í‡Ú‡.

Ö‚ÓÍË‡ÌË ÔÓÚÂÌˆË‡ÎË- áÖè- ÔÓ‰˜ÂÚ‡ÌÓ ÒÏÛÚÂÌ‡


îË„.2Ä äÓÏÔ˛Ú˙Ì‡ ÔÂËÏÂÚËfl (Ô. 11 full field) – ÎÂ‚ÓÒÚ‡ÌÌ‡„ÓÌ‡ ıÓÏÓÌËÏÌ‡ Í‚‡‰‡ÌÚ‡ÌÓÔÒËfl– ‰flÒÌÓ ÓÍÓ.

îË„.2Å äÓÏÔ˛Ú˙Ì‡ ÔÂËÏÂÚËfl (Ô. 11 full field) – ÎÂ‚ÓÒÚ‡ÌÌ‡„ÓÌ‡ ıÓÏÓÌËÏÌ‡ Í‚‡‰‡ÌÚ‡ÌÓÔÒËfl– Îfl‚Ó ÓÍÓ.

îË„.3Ä äÓÏÔ˛Ú˙Ì‡ ÔÂËÏÂÚËfl (Ô. 11 full field) – ÌÓÏ‡ÎËÁ‡ˆËfl Ì‡ÁËÚÂÎÌÓÚÓ ÔÓÎÂ ÒÎÂ‰ ‰‚ÛÏÂÒÂ˜ÂÌ ÔÂËÓ‰ – ‰flÒÌÓ ÓÍÓ.

îË„.3Å äÓÏÔ˛Ú˙Ì‡ ÔÂËÏÂÚËfl (Ô. 11 full field) – ÌÓÏ‡ÎËÁ‡ˆËfl Ì‡ÁËÚÂÎÌÓÚÓ ÔÓÎÂ ÒÎÂ‰ ‰‚ÛÏÂÒÂ˜ÂÌ ÔÂËÓ‰ – Îfl‚Ó ÓÍÓ.

ÁËÚÂÎÌ‡ ‡ÙÂÂÌÚ‡ˆËfl ‰‚ÛÒÚ‡ÌÌÓ ÔË ÏÓÌÓÍÛÎflÌ‡ÒÚËÏÛÎ‡ˆËfl Ì‡ Îfl‚Ó ÓÍÓ Ë ‚ ÔÓ- ÒÎ‡·‡ ÒÚÂÔÂÌ ÔË ÒÚËÏÛ-Î‡ˆËfl Ì‡ ‰flÒÌÓ ÓÍÓ, Í‡ÚÓ Ë ‚ ‰‚‡Ú‡ ÒÎÛ˜‡fl ÔÓÏÂÌËÚÂ Ò‡Ò ÔÂ‚ÂÒ ‚ Îfl‚‡Ú‡ ıÂÏËÒÙÂ‡. Ï.Ò. ëÖè- ‰‚ÛÒÚ‡ÌÌÓ ÒÎÛ-ıÓ‚‡ ‡ÙÂÂÌÚ‡ˆËfl Ì‡ ÒÚ‚ÓÎÓ‚Ó ÌË‚Ó Ò ÌÓÏ‡ÎÌÓ ÔÓ‚Ó‰-ÌÓ ‚ÂÏÂ. åÌÓ„Ó ‰ËÒÍÂ‡ÚÌË ‰‡ÌÌË Á‡ ÌÂ‰Ó·Â Ó„‡ÌËÁË-‡Ì ‡ÙÂÂÌÚÂÌ ÔÓÚÓÍ Ì‡ ‚ËÒÓÍÓ ÒÚ‚ÓÎÓ‚Ó ÌË‚Ó ‚ Îfl‚Ó,ÔÓ- ‰Ó·Â ËÁ‡ÁÂÌÓ ÔË ÍÓÒ- ÒÚËÏÛÎ‡ˆËfl Ì‡ ‰flÒÌÓ ÛıÓ.

éÚ ÔÓ‚Â‰ÂÌËÚÂ ÍÓÌÒÛÎÚ‡ˆËË ÒÂ ÛÒÚ‡ÌÓ‚Ë ÒÎÂ‰ÌÓÚÓ:çÂ‚ÓÓÙÚ‡ÎÏÓÎÓ„: VOD= 0.9-1.0, VOD= 0.9-1.0 (Ò

Ì‡„Î‡Ò‡). äÓÏÔ˛Ú˙Ì‡ ÔÂËÏÂÚËfl (Ô. 11 full field)- ÎÂ-‚ÓÒÚ‡ÌÌ‡ „ÓÌ‡ ıÓÏÓÌËÏÌ‡ Í‚‡‰‡ÌÚ‡ÌÓÔÒËfl /îË„.2/.é˜ÌË ‰˙Ì‡: è‡ÔËÎË, Ò˙‰Ó‚Â, ÂÚËÌË, Ï‡ÍÛÎË- ‚ ÌÓÏ‡. ç‡-ÎËˆÂ Â ÂÚÓıË‡ÁÏ‡ÎÌ‡ ÎÂÁËfl Ì‡ ÁËÚÂÎÌ‡Ú‡ ‡ÙÂÂÌÚÌ‡ÒËÒÚÂÏ‡. ÑË‡„ÌÓÁ‡: ç‡ÎËˆÂ Â ÂÚÓıË‡ÁÏ‡ÎÌ‡ ÎÂÁËfl Ì‡ÁËÚÂÎÌ‡Ú‡ ‡ÙÂÂÌÚÌ‡ ÒËÒÚÂÏ‡. èË ÍÓÌÚÓÎÌËÚÂ ÌÂ‚-ÓÓÙÚ‡ÎÏÓÎÓ„Ë˜ÌË ÔÂ„ÎÂ‰Ë ÒÂ ÓÚ˜ÂÚÂ Á‡ ÔÂËÓ‰ ÓÚ 2ÏÂÒÂˆ‡ Ô˙ÎÌÓ Ó·‡ÚÌÓ ‡Á‚ËÚËÂ Ì‡ ıÓÏÓÌËÏÌËfl Í‚‡‰‡Ì-ÚÓÔÒË˜ÂÌ ‰ÂÙÂÍÚ ‰Ó ÒÚÂÔÂÌ Ì‡ ÌÓÏ‡ÎËÁ‡ˆËfl /îË„.3/.

éÚÓÌÂ‚ÓÎÓ„: Ñ‡ÌÌË Á‡ ˆÂÌÚ‡ÎÂÌ ‚ÂÒÚË·ÛÎ‡ÂÌÒËÌ‰ÓÏ.

áÄäãûóÖçàÖ

èÂ‰ÒÚ‡‚ÂÌ Â ÒÎÛ˜‡È Ì‡ 20 „Ó‰Ë¯Ì‡ ·ÓÎÌ‡ Ò ‡ÍÛÚÌÓ‡Á‚ËÚËÂ Ì‡ ıÓÏÓÌËÏÂÌ Í‚‡‰‡ÌÚÓÔÒË˜ÂÌ ‰ÂÙÂÍÚ, ËÁ‡ÁÌ‡ ÂÚÓıË‡ÁÏ‡ÎÌ‡ ÎÂÁËfl Ì‡ ÁËÚÂÎÌ‡Ú‡ ‡ÙÂÂÌÚÌ‡ ÒËÒ-ÚÂÏ‡. èÂËÏÂÚË˜ÌËflÚ ‰ÂÙÂÍÚ Â Ó·ÂÍÚË‚ËÁË‡Ì Ò ÏÂ-ÚÓ‰‡ Ì‡ ‡‚ÚÓÏ‡ÚËÁË‡Ì‡Ú‡ ÒÚ‡ÚË˜Ì‡ ÔÂËÏÂÚËfl. èËıÓÒÔËÚ‡ÎËÁ‡ˆËflÚ‡ Ì‡ ·ÓÎÌ‡Ú‡ ‚ ìåÅÄã “ÄÎÂÍÒ‡Ì‰Ó‚Ò-Í‡”, äÎËÌËÍ‡ ÔÓ çÂ‚ÓÎÓ„Ëfl, ‚˙Á ÓÒÌÓ‚‡ Ì‡ ‡Ì‡ÏÌÂÒÚË˜-ÌËÚÂ ‰‡ÌÌË, ÌÂ‚ÓÎÓ„Ë˜ÌËfl ÒÚ‡ÚÛÒ, ÎËÍ‚ÓÓÎÓ„Ë˜ÌËÚÂ,ÌÂ‚ÓËÁÓ·‡Áfl‚‡˘Ë Ë ‰Û„Ë ÏÂÚÓ‰Ë Ì‡ ËÁÒÎÂ‰‚‡ÌÂ Â ‰ÓÍ‡-Á‡ÌÓ Ì‡ÎË˜ËÂ Ì‡ ‰ÂÙËÌËÚË‚Ì‡ ÏÌÓÊÂÒÚ‚ÂÌ‡ ÒÍÎÂÓÁ‡, ˆÂ-Â·Ó- ÒÔËÌ‡ÎÌ‡ ÙÓÏ‡ Ò ÂÏËÚÂÌÚÂÌ ıÓ‰ Ì‡ ÔÓÚË˜‡ÌÂ.êÂÁÛÎÚ‡Ú˙Ú ÓÚ åêí ÌË ‰‡‚‡ ÓÒÌÓ‚‡ÌËÂ Ì‡ ÔËÂÏÂÏ, ˜ÂÔÂËÏÂÚË˜ÌËfl ‰ÂÙÂÍÚ ÒÂ ‰˙ÎÊË Ì‡ ÔÎ‡Í‡, ‡ÁÔÓÎÓÊÂÌ‡ ‚Á‡‰ÌÓÚÓ Í‡˜Â Ì‡ ‰flÒÌ‡Ú‡ Í‡ÔÒÛÎ‡ ËÌÚÂÌ‡ /11, 15, 18/.èÓ Ô‡‚ËÎÓ ‰ËÙÂÂÌˆË‡ÎÌ‡Ú‡ ‰Ë‡„ÌÓÁ‡ Ì‡ ıÓÏÓÌËÏÌËÚÂÔÂËÏÂÚË˜ÌË ‰ÂÙÂÍÚË ‚ÍÎ˛˜‚‡ Â‰Ëˆ‡ Á‡·ÓÎfl‚‡ÌËfl Ì‡ˆÂÌÚ‡ÎÌ‡Ú‡ ÌÂ‚Ì‡ ÒËÒÚÂÏ‡, Í‡ÚÓ Ò˙‰Ó‚Ë, ÌÂÓÔÎ‡ÒÚË˜-ÌË, ‚˙ÁÔ‡ÎËÚÂÎÌË, ‰ÂÏËÂÎËÌËÁ‡‡˘Ë Ë Ô /6/. èË ‰ËÌ‡-ÏË˜ÌÓÚÓ ÌÂ‚ÓÓÙÚ‡ÎÏÓÎÓ„Ë˜ÌÓ ÔÓÒÎÂ‰fl‚‡ÌÂ Ì‡ ·ÓÎÌ‡-Ú‡ ıÓÏÓÌËÏÌËflÚ Í‚‡‰‡ÌÚÓÔÒË˜ÂÌ ‰ÂÙÂÍÚ ÔÂÚ˙ÔflÔ˙ÎÌÓ Ó·‡ÚÌÓ ‡flÁ‚ËÚËÂ ‰Ó ÒÚÂÔÂÌ Ì‡ ÌÓÏ‡ÎËÁ‡ˆËfl Ì‡ÁËÚÂÎÌÓÚÓ ÔÓÎÂ Á‡ ÔÂËÓ‰ ÓÚ 2 ÏÂÒÂˆ‡. èÓ‰Ó·ÂÌ ·Î‡„ÓÔ-ËflÚÂÌ ıÓ‰ Ì‡ ÁËÚÂÎÌ‡Ú‡ ÒËÏÔÚÓÏ‡ÚËÍ‡ Á‡ Í‡Ú˙Í ÔÂ-ËÓ‰ ÓÚ ‚ÂÏÂ Â Ó·Ë˜‡ÂÌ Á‡ ÏÌÓÊÂÒÚ‚ÂÌ‡Ú‡ ÒÍÎÂÓÁ‡ /5,

9/. èÓ‡‰Ë ÏÌÓ„Ó ÌËÒÍ‡Ú‡ ˜ÂÒÚÓÚ‡ Ì‡ ÍÎËÌË˜ÌÓ ËÁfl‚ÂÌË-ÚÂ ÂÚÓıË‡ÁÏ‡ÎÌË ÎÂÁËË ÔË ·ÓÎÌË Ò ÏÌÓÊÂÒÚ‚ÂÌ‡ ÒÍÎÂ-ÓÁ‡, ÓÔËÒ‡ÌËflÚ ÒÎÛ˜‡È ÔÂ‰ÒÚ‡‚Îfl‚‡ Í‡ÁÛËÒÚË˜ÂÌ ËÌÚÂ-ÂÒ.

ãàíÖêÄíìêÄ1. óÂÌËÌÍÓ‚‡, ë., é. ä‡Î‡Ù‡ÚÓ‚‡. àÁÓÔÚÂÌÓ- ÔÂËÏÂÚË˜ÌË ËÁÒÎÂ‰‚‡ÌËflÔË ·ÓÎÌË Ò ÏÌÓÊÂÒÚ‚ÂÌ‡ ÒÍÎÂÓÁ‡. çÂ‚ÓÎÓ„Ëfl, ÔÒËıË‡ÚËfl Ë ÌÂ‚ÓıËÛ-„Ëfl, 1987, 26, 1, 41- 46.2. óÂÌËÌÍÓ‚‡, ë., Ç. ÑËÏÓ‚‡. äÓÏÔ˛Ú˙ÌÓ- ÔÂËÏÂÚË˜ÌËflÚ ÏÂÚÓ‰ ‚‰Ë‡„ÌÓÒÚËÍ‡Ú‡ Ì‡ ÓÔÚË˜Ì‡Ú‡ ÙÓÏ‡ Ì‡ ÏÌÓÊÂÒÚ‚ÂÌ‡ ÒÍÎÂÓÁ‡. Å˙Î„‡ÒÍËÓÙÚ‡ÎÏÓÎÓ„Ë˜ÂÌ ÔÂ„ÎÂ‰, 1999, 4, 24-26..3. Betsuin, Y., Y. Mashima, H. Ohde, “et al.”. Clinical application of the Ïulti-focal VEPs. Curr-Eye-Res, 2001, 22, 1, 54-63.4. Borruat, F., Siatkowski R., Schatz N. “et. al.”. Symptomatic retrochiasmallesions in multiple sclerosis. Neurology, 1993, 43, 1430- 1432.5. Bunin, Aia, A. Iakovlev. Pathology of the lateral geniculate body and visualfunction. Vestn-Oftalmol, 2003, 119, 1, 46-9. 6. Friedman, D. Multiple sclerosis simulating a mass lesion. J-Neuroophthalmol, 2000, 20, 3, 147-153 7. Hawkins K, M. Behrens. Homonymous hemianopia in multiple sclerosis. BrJ Ohthalmol, 1975, 59, 334-337.8. Herbst, H., A. Ketabi, P. Thier, ”et al.”. J. Comparison of psychophysical andevoked potential methods in the detection of visual deficits in multiple sclerosis.Electroencephalogr Clin Neurophysiol, 1997, 104, 82–90.9. Hornabrook R., DH Miller, M. Newton, “et al”. Frequent involvement of theoptic radiation in patients with acute isolated optic neuritis. Neurology, 1992, 42,77–79.10. Gunduz, K., K. Cansu, S. Bulduklar, “et al.”. Homonymous Hemianopsia asthe Initial Manifestation of Multiple Sclerosis. Ophthalmologica, 1998, 212, 215-220.11. Mao-Draayer, Y., H. Panitch. Alexia without agraphia in multiple sclerosis:case report with magnetic resonance imaging localization. Mult-Scler, 2004, 10,705-707.12. McDonald, W., D. Barnes. The ocular manifestations of multiple sclerosis.Abnormalities of the afferent visual system. J Neurol Neurosurg Psychiatry, 1992,55, 747–752.13. Patterson, V., J. Heron. Visual field abnormalities in multiple sclerosis. JNeurol Neurosurg Psychiatry, 1980, 43, 205–209.14. Plant, G., A. Kermode, G. Turano, “et al”. Symptomatic retrochiasmallesions in multiple sclerosis: clinical features, visual evoked potentials and magnet-ic resonance imaging. Neurology, 1992, 42, 68–76.15. Rosenblatt, M., M. Behrens, M. Zweifach, “et al”. Magnetic resonance imag-ing of optic tract involvement in multiple sclerosis. Am J Ophthalmol, 1987, 104,74-79.16. Tsuda, H., H.Ishikawa, H. Matsunaga, “et al.”. A neuro-ophthalmologicalanalysis in 80 cases of multiplesclerosis. Rinsho-Shinkeigaku, 2004, 44, 8, 513-521.17. Tsuda, H, H. Ishikawa, M. Iwata, “et al.”. A case of multiplesclerosis withincongruous homonymous hemianopia due to lateral geniculate body lesion.Rinsho-Shinkeigaku, 2003, 43, 370-373. 18.Walderveen, M., F. Barkhof, O.Hommes, “et al”. Correlating MR imaging and clinical disease activity in multiplesclerosis: relevance of hypointense lesions on short TR/short- TE (T1-weighted)spin-echo images. Neurology,1995, 45, 1684–1690.

Ä‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËfl:Ñ- ÄÎÂÍÒ‡Ì‰˙ éÒÍ‡,ëÓÙËfl, ÅÛÎ. “É. ëÓÙËÈÒÍË” 1, ä‡ÚÂ‰‡ ÔÓ çÂ‚ÓÎÓ„Ëfl,äÎËÌËÍ‡ ÔÓ çÂ‚ÓÎÓ„Ëfl, ìåÅÄã “ÄÎÂÍÒ‡Ì‰Ó‚ÒÍ‡”e-mail: [email protected]: +359 888 87 47 60ëÎ. ÚÂÎ.: 02 9230 466


SUMMARY

EXTRACRANIAL CONTINUOUS WAVE DOPPLERSONOGRAPHY IN ACUTE AORTIC DISSECTION

E. VassilevaAcute aortic dissection is the leading cause of death in

patients with aortic pathology. The case of atypical acuteaortic dissection is presented. Extracranial continuouswave Doppler sonography revealed signs of involvementof the right common carotid, right subclavian and verte-bral artery.

56 year old patient with arterial hypertension, withsudden appearance of left side hemiplegy and vomisment.All laboratory investigation, as well as chest radiography,electrocardiography were normal. CT of the brainrevealed early signs of right sided brain infarction.

The aortic dissection with involvement of the follow-ing artery – right innominate artery, right common carotidartery, right subclavian artery was suspected afterextracranial doppler sonography as well as transcranialdoppler sonography data analysis.

Key words: aortic dissection, Doppler sonography.

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îË„.1. äí Ì‡ „Î‡‚ÂÌ ÏÓÁ˙Í – ÚË ˜‡Ò‡ ÒÎÂ‰ ‚˙ÁÌËÍ‚‡ÌÂ Ì‡ ËÒıÂÏË˜ÌËflËÌÒÛÎÚ – ‡ÌÌË ·ÂÎÂÁË Ì‡ ËÒıÂÏËfl ‚ ‰flÒÌ‡ ÏÓÁ˙˜Ì‡ ıÂÏËÒÙÂ‡.

ÑflÒÌ‡ ÒÚ‡Ì‡: ËÌ‰ËÂÍÚÌË ‰‡ÌÌË Á‡ Ì‡ÎË˜ËÂ Ì‡‰‚ÓÂÌ ÎÛÏÂÌ ‚ Ó·˘‡Ú‡ Ò˙ÌÌ‡ ‡ÚÂËfl (ÙË„.2), ÎËÔÒ‡ Ì‡Í˙‚ÓÚÓÍ ‚ ‰flÒÌ‡ ‚˙ÚÂ¯Ì‡ Ò˙ÌÌ‡ ‡ÚÂËfl, ‰‡ÌÌË Á‡‰ËÒÂÍ‡ˆËfl Ì‡ ‰flÒÌ‡ ÔÓ‰ÍÎ˛˜Ë˜Ì‡ ‡ÚÂËfl (ÙË„.3), ÁÌ‡-˜ËÏ‡ ‡ÒËÏÂÚËfl ‚ ‰ÓÔÎÂÓ‚ËÚÂ ÍË‚Ë Ì‡ ‡ÚÂËfl·‡ıË‡ÎËÒ (ÙË„.4 Ä Ë Å), ‚ËÒÓÍÓÂÁËÒÚÂÌÚÂÌ Ô‡ÚÂÌ ÒÂÚÓ„‡‰Ì‡ ÍÓÏÔÓÌÂÌÚ‡ ‚ ‰flÒÌ‡ ‚ÂÚÂ·‡ÎÌ‡ ‡ÚÂ-Ëfl (ÙË„.5). Ñ‡ÌÌËÚÂ Ò‡ ‚ Ò˙ÓÚ‚ÂÚÒÚ‚ËÂ Ò ÛÒÚ‡ÌÓ‚Â-Ì‡Ú‡ ‡ÁÎËÍ‡ ‚ ‡ÚÂË‡ÎÌÓÚÓ Ì‡Îfl„‡ÌÂ Ì‡ ‰‚ÂÚÂ ˙ˆÂ– 150/90 ‚ Îfl‚Ó, 100/70 ‚ ‰flÒÌÓ.

ãfl‚‡ ÒÚ‡Ì‡: ÔÓ‚Ë¯ÂÌÓ Ò˙‰Ó‚Ó Ò˙ÔÓÚË‚ÎÂÌËÂ Ì‡Ó·˘‡Ú‡ Ò˙ÌÌ‡ ‡ÚÂËfl, ÌÓÏ‡ÎÂÌ Í˙‚ÓÚÓÍ Á‡ Îfl‚‡‚˙ÚÂ¯Ì‡ Ò˙ÌÌ‡ ‡ÚÂËfl Ë Îfl‚‡ ÔÓ‰ÍÎ˛˜Ë˜Ì‡ ‡ÚÂ-Ëfl, ÍÓÏÔÂÌÒ‡ÚÓÌÓ ÔÓ‚Ë¯ÂÌ Í˙‚ÓÚÓÍ ‚ Îfl‚‡ ‚Â-ÚÂ·‡ÎÌ‡ ‡ÚÂËfl.

íêÄçëäêÄçàÄãçÄ ÑéèãÖêéÇÄ ëéçéÉêÄîàü

çÓÏ‡ÎÂÌ Í˙‚ÓÚÓÍ Á‡ ÒÂ‰Ì‡, ÔÂ‰Ì‡ Ë Á‡‰Ì‡ÏÓÁ˙˜ÌË ‡ÚÂËË ‚ Îfl‚Ó, ÒËÎÌÓ Â‰ÛˆË‡Ì – ‰Ó ÎËÔÒ-‚‡˘ Í˙‚ÓÚÓÍ ‚ ‰flÒÌ‡ ÒÂ‰Ì‡ ÏÓÁ˙˜Ì‡ ‡ÚÂËfl(ÙË„.6Ä Ë Å)

ÄÌ‡ÎËÁ˙Ú Ì‡ ‰‡ÌÌËÚÂ ÓÚ ÔÓ‚Â‰ÂÌÓÚÓ ‰ÓÔÎÂÒÓ-ÌÓ„‡ÙÒÍÓ ËÁÒÎÂ‰‚‡ÌÂ Ì‡ÒÓ˜Ëı‡ Í˙Ï ‰ËÒÂÍ‡ˆËfl Ì‡‡ÓÚÌ‡Ú‡ ‰˙„‡ Ò ‡Ì„‡ÊË‡ÌÂ Ì‡ ‡ÚÂËËÚÂ, ËÁıÓ‰fl˘ËÓÚ ÌÂfl –ÚÛÌÍÛÒ ·‡ıËÓˆÂÙ‡ÎËÍÛÒ, ‰flÒÌ‡ Ó·˘‡ Ò˙ÌÌ‡‡ÚÂËfl, ‰flÒÌ‡ ÔÓ‰ÍÎ˛˜Ë˜Ì‡ ‡ÚÂËfl. ëÎÂ‰‚‡˘ËflÂÚ‡Ô – ÔÓ‚ÂÊ‰‡ÌÂ Ì‡ ˆ‚ÂÚÌ‡ ‰ÛÔÎÂÍÒ ‰ÓÔÎÂÓ‚‡ ÒÓ-ÌÓ„‡ÙËfl Ë ÂıÓÍ‡‰ËÓ„‡ÙËfl ÌÂ ·Â ÓÒ˙˘ÂÒÚ‚ÂÌ ÔÓ‡‰ËÎÂÚ‡ÎÌËfl ËÁıÓ‰ Ì‡ Ô‡ˆËÂÌÚ‡, Ì‡ÒÚ˙ÔËÎ ‚ÌÂÁ‡ÔÌÓ ÒÍ‡ÚËÌ‡Ú‡ Ì‡ ÒË‚ Ì‡ ıÂÏÓ‰ËÌ‡ÏËÍ‡Ú‡ Ë ÒÔË‡ÌÂ Ì‡Ò˙‰Â˜Ì‡ ‰ÂÈÌÓÒÚ – 19 ˜‡Ò‡ ÒÎÂ‰ ÔÓfl‚‡ Ì‡ ÒËÏÔÚÓÏ‡-ÚËÍ‡Ú‡.

è‡ÚÓ‡Ì‡ÚÓÏË˜ÌËÚÂ ‰‡ÌÌË ÔÓÚ‚˙‰Ëı‡ Ì‡ÎË˜ËÂÚÓÌ‡ ‰ËÒÂÍ‡ˆËfl Ì‡ ‡ÓÚÌ‡Ú‡ ‰˙„‡ – ÚËÔ Ä ÔÓ ëÚ‡Ì‰ÙÓ-‰ÒÍ‡Ú‡ ÍÎ‡ÒËÙËÍ‡ˆËfl, Ò Ì‡˜‡ÎÓ ÓÚ ‡ÓÚÌ‡Ú‡ ÍÎ‡Ô‡,‰ËÒÂÍË‡ÌÂ Ì‡ ÚÛÌÍÛÒ ·‡ıËÓˆÂÙ‡ÎËÍÛÒ, ‰flÒÌ‡ Ó·˘‡Ò˙ÌÌ‡ ‡ÚÂËfl Ë ‰flÒÌ‡ ÔÓ‰ÍÎ˛˜Ë˜Ì‡ ‡ÚÂËfl Ò Ó·ÚÛ-Ë‡ÌÂ ËÁıÓ‰‡ Ì‡ ‚˙ÚÂ¯Ì‡Ú‡ Ò˙ÌÌ‡ ‡ÚÂËfl, Í‡ÍÚÓË ÛÔÚÛ‡ Ì‡ ‰ËÒÂÍ‡ˆËflÚ‡ ‚ ÔÂËÍ‡‰‡ Ò ıÂÏÓÔÂË-Í‡‰.

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ä‡Ò‡Â ÒÂ Á‡ Ô‡ˆËÂÌÚ, ÔÓÒÚ˙ÔËÎ ÔÓ ÒÔÂ¯ÌÓÒÚ ‚ ÍÎË-ÌËÍ‡Ú‡, Ò ı‡‡ÍÚÂÌ‡ ÍÎËÌË˜Ì‡ Í‡ÚËÌ‡, Ì‡ÒÓ˜‚‡˘‡Í˙Ï ÓÒÚ˙ ÏÓÁ˙˜ÌÓÒ˙‰Ó‚ ËÌˆË‰ÂÌÚ. èÓ‚Â‰ÂÌ‡Ú‡ÍÓÏÔ˛Ú˙Ì‡ ÚÓÏÓ„‡ÙËfl ÔÓÚ‚˙‰Ë Ì‡ÎË˜ËÂÚÓ Ì‡ ËÒ-ıÂÏË˜ÂÌ ËÌÒÛÎÚ. é˘Â Ì‡ ÚÓÁË ÂÚ‡Ô ‚ÔÂ˜‡ÚÎÂÌËÂ Ì‡Ô-‡‚Ë Ó·ÂÏ‡ Ì‡ ÏÓÁ˙˜Ì‡Ú‡ ËÒıÂÏËfl – Ì‡ÎËˆÂ ·flı‡ ‡Ì-ÌË äí ‰‡ÌÌË Á‡ ËÒıÂÏËfl ‚ ˆÂÎËfl Ò˙‰Ó‚ ·‡ÒÂÈÌ Ì‡ ‰flÒÌ‡ÒÂ‰Ì‡ Ë ÔÂ‰Ì‡ ÏÓÁ˙˜ÌË ‡ÚÂËË, ÍÓÂÚÓ Â Â‰Ì‡ ÓÚ ı‡-‡ÍÚÂÌËÚÂ ÓÒÓ·ÂÌÓÒÚË Ì‡ ÏÓÁ˙˜ÌËÚÂ ËÌÒÛÎÚË ÔË‰ËÒÂÍ‡ˆËfl Ì‡ ‡ÓÚ‡Ú‡. èÓ‚Â‰ÂÌ‡Ú‡ ÂÎÂÍÚÓÍ‡‰Ë-Ó„‡ÙËfl Ë Í‡‰ËÓÎÓ„Ë˜Ì‡ ÍÓÌÒÛÎÚ‡ˆËfl ‰Ó‚Â‰Óı‡ ‰ÓÁ‡ÍÎ˛˜ÂÌËÂ Á‡ Ì‡ÎË˜ËÂ Ì‡ ‡ÚÂË‡ÎÌ‡ ıËÔÂÚÓÌËfl, ·ÂÁ‰Û„Ë Í‡‰ËÓÎÓ„Ë˜ÌË Á‡·ÓÎfl‚‡ÌËfl. ç‡Ô‡‚ÂÌ‡Ú‡ÂÌÚ„ÂÌÓ„‡ÙËfl Ì‡ ·flÎ ‰Ó· ÌÂ ÔÓÍ‡Á‡ Ô‡ÚÓÎÓ„Ë˜ÌËÔÓÏÂÌË. á‡ÔÓ˜Ì‡ÚÓ ·Â ÛÚËÌÌÓ ÎÂ˜ÂÌËÂ Ë Ì‡·Î˛‰Â-ÌËÂ. Ç ÚÓÁË ÒÎÛ˜‡È Â‰ËÌÒÚ‚ÂÌÓ ‰‡ÌÌËÚÂ ÓÚ ÍÓÌ‚ÂÌˆË-ÓÌ‡ÎÌ‡Ú‡ ÂÍÒÚ‡Í‡ÌË‡ÎÌ‡ ‰ÓÔÎÂÓ‚‡ ÒÓÌÓ„‡ÙËfl Ì‡-ÒÓ˜Ëı‡ Í˙Ï ‰Ë‡„ÌÓÒÚËˆË‡ÌÂ Ì‡ ÓÒÌÓ‚ÌÓÚÓ Á‡·ÓÎfl‚‡-ÌÂ. éÒ˙˘ÂÒÚ‚fl‚‡ÌÂÚÓ Ì‡ ˆ‚ÂÚÌ‡ ‰ÛÔÎÂÍÒ ‰ÓÔÎÂÓ‚‡ÒÓÌÓ„‡ÙËfl ÔË ‰ËÒÂÍ‡ˆËfl Ì‡ Ó·˘‡Ú‡ Ò˙ÌÌ‡ ‡ÚÂËfl·Ë ÛÎÂÒÌËÎÓ ÁÌ‡˜ËÚÂÎÌÓ ‰Ë‡„ÌÓÒÚËÍ‡Ú‡, ÔÓ‡‰Ë ‚˙Á-ÏÓÊÌÓÒÚÚ‡ Á‡ ‰ËÂÍÚÌÓ ‚ËÁÛ‡ÎËÁË‡ÌÂ Ì‡ ÔÓˆÂÒ‡ ÒÛÒÚ‡ÌÓ‚fl‚‡ÌÂ Ì‡ÎË˜ËÂÚÓ Ì‡ ‰‚ÓÂÌ ÎÛÏÂÌ Ë ‰ËÒÂÍË‡-


îË„.2 ÑÓÔÎÂÓ‚‡ Ì‡ıÓ‰Í‡ ‚ ‰flÒÌ‡ Ó·˘‡ Ò˙ÌÌ‡ ‡ÚÂËfl

îË„.3 ÑÓÔÎÂÓ‚‡ Ì‡ıÓ‰Í‡ ÓÚ ‰flÒÌ‡ ÔÓ‰ÍÎ˛˜Ë˜Ì‡ ‡ÚÂËfl

˘‡ ÏÂÏ·‡Ì‡. äÎËÌË˜Ì‡Ú‡ Í‡ÚËÌ‡ Ì‡ ÓÒÚ‡Ú‡ ‡ÓÚÌ‡ ‰ËÒÂÍ‡-

ˆËfl Â ËÁÍÎ˛˜ËÚÂÎÌÓ ı‡‡ÍÚÂÌ‡, ÔÓ‡‰Ë ÍÓÂÚÓ ‚ ÏÌÓ-„Ó ÒÎÛ˜‡Ë ‰Ë‡„ÌÓÁ‡Ú‡ ÒÂ ÔÓÒÚ‡‚fl Ó˘Â ‚˙Á ÓÒÌÓ‚‡ Ì‡‡Ì‡ÏÌÂÒÚË˜ÌË ‰‡ÌÌË, ÒÓÏ‡ÚË˜ÂÌ Ë Í‡‰ËÓÎÓ„Ë˜ÂÌÒÚ‡ÚÛÒ. èË Ì‡¯Ëfl Ô‡ˆËÂÌÚ Ó·‡˜Â Â Ì‡ÎËˆÂ ‡ÚËÔË˜ÌÓÔÓÚË˜‡˘‡ ‰ËÒÂÍ‡ˆËfl Ì‡ ‡ÓÚÌ‡Ú‡ ‰˙„‡. ç‡ Ô˙‚ÓÏflÒÚÓ ÎËÔÒ‚‡ ·ÓÎÍÓ‚‡ ÒËÏÔÚÓÏ‡ÚËÍ‡, ÍÓflÚÓ Â ÓÚÓÒÌÓ‚ÌÓ ÁÌ‡˜ÂÌËÂ Á‡ ‰Ë‡„ÌÓÁ‡Ú‡. ÅÓÎÍ‡ ÒÂ ÒÂ˘‡ ÔË95% ÓÚ ÒÎÛ˜‡ËÚÂ Ò ‡ÓÚÌ‡ ‰ËÒÂÍ‡ˆËfl Ë Ó·ËÍÌÓ‚ÂÌÓ ÂÓÒÚ‡, ÒËÎÌ‡, ‡ÁÍ˙Ò‚‡˘‡, Ò ÚËÔË˜Ì‡ ÎÓÍ‡ÎËÁ‡ˆËfl.åÓÊÂ ‰‡ ÒÂ ËÁÎ˙˜‚‡ ‚ „˙‰Ì‡Ú‡ ÒÚÂÌ‡ (ÔË ‰ËÒÂÍ‡ˆËflÌ‡ ‚˙ÁıÓ‰fl˘‡Ú‡ ‡ÓÚ‡), Í˙Ï ¯ËflÚ‡, ˜ÂÎ˛ÒÚËÚÂ –ÔË ‡Ì„‡ÊË‡ÌÂ Ì‡ ‡ÓÚÌ‡Ú‡ ‰˙„‡, ‡ ÔË Á‡Òfl„‡ÌÂ Ì‡‰ÂÒˆÂÌ‰ÂÌÚÌ‡Ú‡ ‡ÓÚ‡ – ‰‡ ËÏ‡ ËÌÚÂÒÍ‡ÔÛÎ‡Ì‡ ÎÓ-

Í‡ÎËÁ‡ˆËfl. ç‡È-ËÌÚÂÌÁË‚Ì‡ Â ‚ Ì‡˜‡ÎÓÚÓ Ì‡ ÔÓˆÂÒ‡,Á‡ ‡ÁÎËÍ‡ ÓÚ Ú‡ÁË ÔË ÏËÓÍ‡‰ÂÌ ËÌÙ‡ÍÚ.

ë‡ÏÓ ‚ 2 ‰Ó 5% ÓÚ ÒÎÛ˜‡ËÚÂ ÏÓÊÂ ‰‡ ÎËÔÒ‚‡ ·ÓÎÍÓ-‚‡ ÒËÏÔÚÓÏ‡ÚËÍ‡ (8). à ÚÓ˜ÌÓ ÚÂÁË ÒÎÛ˜‡Ë ÔÂ‰Ò-Ú‡‚Îfl‚‡Ú ‰Ë‡„ÌÓÒÚË˜ÂÌ ÔÓ·ÎÂÏ, Ú˙È Í‡ÚÓ Ô‡‚ËÎ-ÌÓÚÓ ÎÂ˜ÂÌËÂ Á‡Í˙ÒÌfl‚‡. çÂÌ‡‚ÂÏÂÌÌÓÚÓ ‰Ë‡„ÌÓÒÚË-ˆË‡ÌÂ Â ÔÂ‰ÔÓÒÚ‡‚Í‡ ÓÒ‚ÂÌ Á‡ ÌÂÔ‡‚ËÎÌÓ ÔÓ‚Â‰Â-ÌËÂ, ÌÓ Ë Á‡ ÔËÎÓÊÂÌËÂ Ì‡ ÔÓÚË‚ÓÔÓÍ‡Á‡ÌË ÏÂ‰ËÍ‡-ÏÂÌÚË. Ç ÎËÚÂ‡ÚÛ‡Ú‡ Ò‡ ÓÔËÒ‡ÌË ÒÎÛ˜‡Ë Ì‡ ÔËÎÓ-ÊÂÌËÂ Ì‡ ÚÓÏ·ÓÎËÚË˜Ì‡ ÚÂ‡ÔËfl ÔË Ô‡ˆËÂÌÚË ÒÓÒÚ‡ ‡ÓÚÌ‡ ‰ËÒÂÍ‡ˆËfl, ÔÓÚÂÍÎ‡ Ò ÍÎËÌË˜Ì‡Ú‡Í‡ÚËÌ‡ Ì‡ ÏËÓÍ‡‰ÂÌ ËÌÙ‡ÍÚ (9-12). Ç Â‡Ú‡ Ì‡ÚÓÏ·ÓÎËÁ‡Ú‡, ÔÓ‰Ó·ÂÌ ËÒÍ Ò˙˘ÂÒÚ‚Û‚‡ Ë Á‡ Ô‡ˆË-ÂÌÚËÚÂ Ò ËÒıÂÏË˜ÂÌ ËÌÒÛÎÚ, ÂÁÛÎÚ‡Ú ÓÚ ‡ÓÚÌ‡ ‰Ë-ÒÂÍ‡ˆËfl. èËÎÓÊÂÌËÂÚÓ Ì‡ Ú˙Í‡ÌÂÌ ÔÎ‡ÁÏËÌÓ„ÂÌ ‡Í-


îË„.5. ÇËÒÓÍÓÂÁËÒÚÂÌÚÂÌ Ô‡ÚÂÌ Ò ÂÚÓ„‡‰Ì‡ ÍÓÏÔÓÌÂÌÚ‡ ‚ ‰flÒÌ‡ ‚ÂÚÂ·‡ÎÌ‡ ‡ÚÂËfl.

îË„. 4Ä Ë Å. áÌ‡˜ËÏ‡ ‡ÒËÏÂÚËfl ‚ ‰‚ÂÚÂ ·‡ıË‡ÎÌË ‡ÚÂËË.

A

Å

ÚË‚‡ÚÓ ‚ ÚÂÁË ÒÎÛ˜‡Ë ·Ë ‰Ó‚ÂÎÓ ‰Ó ‡ÌÌ‡ ÒÏ˙Ú ÔÓ-‡‰Ë ıÂÏÓÚÓ‡ÍÒ, ıÂÏÓÔÂËÍ‡‰, Í‡ÍÚÓ Ë ‰Ó Á‡·‡‚flÌÂÌ‡ Â‚ÂÌÚÛ‡ÎÌÓ ıËÛ„Ë˜ÌÓ ÎÂ˜ÂÌËÂ.

ëÎÂ‰‚‡˘ ‚‡ÊÂÌ ·ÂÎÂ„, ÍÓÈÚÓ ‚ Ì‡¯Ëfl ÒÎÛ˜‡È ·Â¯ÂÌ‡ÎËˆÂ, Â ÛÒÚ‡ÌÓ‚fl‚‡ÌÂ Ì‡ ÔÛÎÒÓ‚Ë ‡ÁÎËÍË ‚ Í‡ÈÌË-ˆËÚÂ. ê‡ÁÎËÍ‡Ú‡ ‚ ‡ÚÂË‡ÎÌÓÚÓ Ì‡Îfl„‡ÌÂ ·Â Â‰ËÌ-ÒÚ‚ÂÌËflÚ ı‡‡ÍÚÂÂÌ Á‡ ÚÓ‚‡ Á‡·ÓÎfl‚‡ÌÂ ÒËÏÔÚÓÏ,‚˙ÔÂÍË ˜Â Ú‡Í‡‚‡ ÏÓÊÂ ‰‡ ÒÂ ÛÒÚ‡ÌÓ‚Ë Ë ÔË ıÓÌË˜-Ì‡ ÚÓÏ·ÓÁ‡ Ì‡ ÔÓ‰ÍÎ˛˜Ë˜Ì‡Ú‡ ‡ÚÂËfl.

Ç ÔÂ‰ÒÚ‡‚eÌËfl ÒÎÛ˜‡È ÎËÔÒ‚‡ı‡ Ó·Ë˜‡ÈÌËÚÂ Í‡-‰ËÓÎÓ„Ë˜ÌË ÒËÏÔÚÓÏË: ‰Ë‡ÒÚÓÎÂÌ ¯ÛÏ Ì‡ ‡ÓÚ‡Ú‡,‡ÓÚÌ‡ ËÌÒÛÙËˆËÂÌˆËfl, ‡ÚÂË‡ÎÌ‡ ıËÔÓÚÓÌËfl, Í‡-‰ËÓ„ÌÂÌ ¯ÓÍ, ÔÓ‚Ë¯ÂÌÓ ˆÂÌÚ‡ÎÌÓ ‚ÂÌÓÁÌÓ Ì‡Îfl„‡ÌÂ,Ë ‰.

çÂ‚ÓÎÓ„Ë˜Ì‡ ÒËÏÔÚÓÏ‡ÚËÍ‡ ÒÂ Â„ËÒÚË‡ ‚ 18%‰Ó 30% ÓÚ ÒÎÛ˜‡ËÚÂ Ò ‡ÓÚÌ‡ ‰ËÒÂÍ‡ˆËfl (3). èËÔÓÍÒËÏ‡ÎÌ‡ ‰ËÒÂÍ‡ˆËfl Ì‡È-˜ÂÒÚ‡Ú‡ ÔÓfl‚‡ Â ÏÓÁ˙˜-Ì‡Ú‡ ËÒıÂÏËfl, ‰ÓÍ‡ÚÓ ‰ËÒÚ‡ÎÌ‡Ú‡ ‰ËÒÂÍ‡ˆËfl ÒÂ ËÁfl-‚fl‚‡ Ò „˙·Ì‡˜ÌÓÏÓÁ˙˜Ì‡ ËÒıÂÏËfl Ë ËÒıÂÏË˜ÌË ÌÂ‚Ó-Ô‡ÚËË. àÒıÂÏË˜ÂÌ ËÌÒÛÎÚ, ÂÁÛÎÚ‡Ú Ì‡ ÓÒÚÓ Ì‡ÒÚ˙-ÔËÎ‡ Í‡ÓÚË‰Ì‡ Ó·ÒÚÛÍˆËfl ÒÂ ÓÚÍË‚‡ ÔË 5 ‰Ó 10%ÓÚ ÒÎÛ˜‡ËÚÂ Ò ‡ÓÚÌ‡ ‰ËÒÂÍ‡ˆËfl. ëËÏÔÚÓÏ‡ÚËÍ‡Ú‡ÓÚ ÒÚ‡Ì‡ Ì‡ „˙·Ì‡˜ÌËfl ÏÓÁ˙Í Â Ï‡ÎÍÓ ÔÓ-˜ÂÒÚ‡ Ë‚ÍÎ˛˜‚‡ ‡ÁÎË˜ÌË ÒËÌ‰ÓÏË: Ú‡ÌÒ‚ËÁÛ‡ÎÌ‡ ÎÂÁËfl Ì‡„Î‡‚ÌËfl ÏÓÁ˙Í, ÔÓ„ÂÒË‚Ì‡ ÏËÂÎÓÔ‡ÚËfl, ÒÔËÌ‡ÎÂÌ ËÌ-Ù‡ÍÚ, Ô‡‡ÔÎÂ„Ëfl, ÔÓÌflÍÓ„‡ Ò ÔÂıÓ‰ÂÌ ı‡‡ÍÚÂ,Í‚‡‰ËÔÎÂ„Ëfl Ë ‰.

êÂÌÚ„ÂÌÓ„‡ÙËflÚ‡ Ì‡ Ò˙ˆÂÚÓ Ë ·ÂÎËÚÂ ‰Ó·Ó‚ÂÔÓÍ‡Á‚‡Ú ‚ 80-90% ÓÚ ÒÎÛ˜‡ËÚÂ ‡Á¯ËÂÌËÂ Ì‡ ÏÂ‰Ë-‡ÒÚËÌ‡ÎÌ‡Ú‡ ÒflÌÍ‡, ÓÒÓ·ÂÌÓ ‚ „ÓÌ‡Ú‡ ˜‡ÒÚ Ë ÔÓ ÔÓ-

ÒÓÍ‡ Ì‡Îfl‚Ó. èÓÎÛ˜‡‚‡Ú ÒÂ ‰‡ÌÌË Á‡ Í‡‰ËÓÏÂ„‡ÎËfl,ÔÂËÍ‡‰ÂÌ ËÎË ÔÎÂ‚‡ÎÂÌ ËÁÎË‚, ÓÒÓ·ÂÌÓ ÎÂ‚ÓÒÚ‡-ÌÂÌ, ‡Á„˙Ì‡Ú‡ Ë ÔÓÏËÌË‡˘‡ ‡ÓÚÌ‡ ÒflÌÍ‡, “ÂÙÂÍÚÌ‡ ‰‚ÓÈÌËfl ÎÛÏÂÌ”. êÂÌÚ„ÂÌÓ„‡ÙËflÚ‡ Â ·˙Á ‰Ë‡„ÌÓÒ-ÚË˜ÂÌ ÚÂÒÚ, ÌÓ ‚ ‰Ó 20% ÓÚ ÒÎÛ˜‡ËÚÂ Ó·‡˜Â ÏÓÊÂ ‰‡Â ÌÂ„‡ÚË‚Ì‡ (13), Í‡ÍÚÓ ·Â¯Â ‚ Ì‡¯Ëfl ÒÎÛ˜‡È.

Ö‰ËÌÒÚ‚ÂÌËflÚ ‰Û„ ÓÔËÒ‡Ì ‚ ·˙Î„‡ÒÍ‡Ú‡ ÎËÚÂ‡-ÚÛ‡ ÒÎÛ˜‡È Ì‡ ÓÒÚ‡ ‰ËÒÂÍ‡ˆËfl Ì‡ ‡ÓÚ‡Ú‡ Ò˙Ò Á‡Òfl-„‡ÌÂ Ò˙‰Ó‚ÂÚÂ Ì‡ ‡ÓÚÌ‡Ú‡ ‰˙„‡, ÍÓÈÚÓ Â ËÁÒÎÂ‰‚‡Ì Ò‰ÓÔÎÂÓ‚‡ ÒÓÌÓ„‡ÙËfl, Í‡Ò‡Â Ô‡ˆËÂÌÚ Ò ÚËÔË˜Ì‡ ÍÎË-ÌË˜Ì‡ Í‡ÚËÌ‡, ˜ËflÚÓ ‰Ë‡„ÌÓÁ‡ Â ÔÓÒÚ‡‚ÂÌ‡ ˜ÂÁÚ‡ÌÒÚÓ‡Í‡ÎÌ‡ Ë Ú‡ÌÒÂÁÓÙ‡„Â‡ÎÌ‡ ÂıÓÍ‡‰ËÓ„‡-ÙËfl. á‡ ‡ÁÎËÍ‡ ÓÚ Ì‡Ò å ëÚ‡ÌÂ‚‡ Ë ‰. ‰ÓÍÎ‡‰‚‡ÚÂÁÛÎÚ‡ÚËÚÂ ÓÚ ˆ‚ÂÚÌ‡Ú‡ ‰ÛÔÎÂÍÒ ‰ÓÔÎÂÓ‚‡ ÒÓÌÓ„-‡ÙËfl (14), ÍÓËÚÓ Ò‡ ÓÒÓ·ÂÌÓ ÔÓÍ‡Á‡ÚÂÎÌË Á‡ Ú‡Í‡‚‡Ô‡ÚÓÎÓ„Ëfl.

Ç Á‡ÍÎ˛˜ÂÌËÂ ÛÒÚ‡ÌÓ‚fl‚‡ÌÂÚÓ Ì‡ ‡ÁÎËÍ‡ ‚ ‡ÚÂ-Ë‡ÎÌÓÚÓ Ì‡Îfl„‡ÌÂ Ì‡ ‰‚ÂÚÂ ˙ˆÂ Ë ÔÂˆËÁÌÓÚÓ ‰ÓÔ-ÎÂÒÓÌÓ„‡ÙÒÍÓ ËÁÒÎÂ‰‚‡ÌÂ ‰ÓË Ò ÛÚËÌÌ‡ ÂÍÒÚ‡Í-‡ÌË‡ÎÌ‡ ‰ÓÔÎÂÓ‚‡ ÒÓÌÓ„‡ÙËfl ÏÓ„‡Ú ‰‡ ·˙‰‡Ú ÓÚÔÓÎÁ‡ ‚ ‰Ë‡„ÌÓÒÚËÍ‡Ú‡ Ì‡ ‡ÚËÔË˜ÌÓ ÔÓÚË˜‡˘‡Ú‡‰ËÒÂÍ‡ˆËfl Ì‡ ‡ÓÚÌ‡Ú‡ ‰˙„‡ Ò˙Ò Á‡Òfl„‡ÌÂ Ì‡ Ò˙‰Ó‚ÂÚÂËÁıÓ‰fl˘Ë ÓÚ ÌÂfl.

ãàíÖêÄíìêÄ1. Anagnopoulos C, Prabhakar M, Kittle C et al. Aortic dissection and dissec-tion aneurysm. Am J Cardiol. 1972, 30, 263-73.2. Sarasin F, Louis-Simonet M, Gaspoz J et al. Detecting acute thoracic aorticdissection in the emergency department time constraints and choice of the optimaldiagnostic test. Ann Emerg Med 1996. 28, 278-88. 3. Bickerstaff L, Pairolero P, Hollier L et al. Thoracic aortic aneurysms: a popu-lation-based study. Surgery. 1982, 92, 1103-8.4. Svensjo S, Bengtsson H, Berrdqvist D. Thoracic and thoracoabdominal aortic


îË„ 6 Ä Ë Å. ãfl‚‡ Ë ‰flÒÌ‡ ëåÄ. ãËÔÒ‚‡ Í˙‚ÓÚÓÍ ‚ ‰flÒÌ‡ ÒÂ‰Ì‡ ÏÓÁ˙˜Ì‡ ‡ÚÂËfl

Ä

Å

aneurysm and dissection: an investigation based on autopsy. Br J Surg. 1996, 83,68-71.5. Erbel R, Alfonso F, Boileau C et al. Diagnosis and management of aortic dis-section Task Force Report Eur Heart J.2001,22,1642-1681.6. Burke M, Aghababian R, Blackbourne B. Use of autopsy results in the emer-gency department quality assurance plan. Ann Emerg Med. 2000, 18, 46-50.7. Sullvan P, Wolfson A, Leckey R et al. Diagnosis of acute thoracic aortic dis-section in the emergency department. Am J Emerg Med. 2000, 18, 46-50.8. Khan I. ëlinical Manifestations of Äortic Dissection. J Clin Basic Cardiology,2001, 4, 254-267.9. Khoury N, Borzak S, Gokli et al. Inadvertent thrombolytic administration inpatients without myocardial infarction: clinical features and outcome. Ann EmergMed 1006. 28, 289-93.10. Marian A, Harris S, Pickett J et al. Inadvertent administration of rtPA to apatient with type 1 aortic dissection and subsequent cardiac tamponade. Am JEmerg Med. 1993, 11, 613-5.11. Flemming K, Brown R. Acute Cerebral infarction Caused by AorticDissection: Caution in the Thrombolytic Era. Stroke. 1999 ,30, 477-478.

12. Kamp T, Goldschmidt-Clermont P, Brinker J et al. Myocardial infarction,aortic dissection and thrombolytic therapy. Am Heart J. 1994, 128, 1234-1237.13. Earnest F, Muhm J, Sheedy P. Roentgenographic findings in thoracic aorticdissection. Mayo Clin Proc. 1979, 54, 43-50.14. ëÚ‡ÌÂ‚‡ å, ê‡‰Â‚‡ ë., àÎËÂ‚ ê. éÒÚ‡ ‰ËÒÂÍ‡ˆËfl Ì‡ ‡ÓÚ‡Ú‡ I ÚËÔ ÔÓÑÂ ÅÂÈÍË Ò˙Ò Á‡Òfl„‡ÌÂ Ì‡ Ò˙‰Ó‚ÂÚÂ Ì‡ ‡ÓÚÌ‡Ú‡ ‰˙„‡. ÑË‡„ÌÓÒÚË˜ÂÌ Ë ÚÂ‡-ÔÂ‚ÚË˜ÂÌ ÛÎÚ‡Á‚ÛÍ 2004, 2 , 123-127.



éÔËÒ‡ÌËÂ Ì‡ ÍÎËÌË˜ÌË ÒÎÛ˜‡ËÄêíÖêàÄãçà à ÇÖçéáçà íêéåÅéíàóçà àçñàÑÖçíà

èêà ïéåéáàÉéí áÄ îÄäíéê V LEIDENñ. ñ‡ÌÍÓ‚‡1, à. ëÚ‡ÈÍÓ‚1, å. ê‡¯Â‚‡1, Ö. Ç‡‚ÂÍ1, Ä. ñÓÌ˜Â‚‡2

1äÎËÌËÍ‡ ÔÓ çÂ‚ÓÎÓ„Ëfl, ìåÅÄã “ñ‡Ëˆ‡ âÓ‡ÌÌ‡” 2ñÂÌÚ‡ÎÌ‡ ÍÎËÌË˜Ì‡ Î‡·Ó‡ÚÓËfl, ìåÅÄã “ÄÎÂÍÒ‡Ì‰Ó‚ÒÍ‡ ÅÓÎÌËˆ‡”

SUMMARY

ARTERIAL AND VENOUS THROMBOTIC INCIDENCES IN A PATIENT HOMOZYGOUS

FOR THE FACTOR V LEIDENTz. Tzankova, I. Staikov, M. Rascheva, E. Vavrek,

A. TzonchevaThe factor V Leiden thrombophilia is caused by one

point mutation in the gene for factor V, which is responsi-ble for the coagulation. The mutation produces a resist-ance to the activated protein C and a hypercoagulablestate. The clinical features are rather variable, accordingthe genotype, predisposing factors and the other accompa-nying factors for thrombophilia. The main clinical demon-stration is venous thrombembolism with the most commonlocalization in the deep veins of the legs. Although thereare reports for a myocardial infarction and strokes in youngindividuals, the thrombophilia is considered to be not veryrisky for an arterial thrombosis.

We report a case of a young patient homozygous for thefactor V Leiden with transient ischemic attacks and anischemic stroke at a young age and a recurrent deep veinphlebothrombosis of the legs, with a pulmonary thrombe-mbolism after the age of 29 years. Other accompanyingpathogenetic factors are an early arterial hypertension, apolycitemia, a moderate hyperhomocysteinemia, anepisodic increasing of the levels of the anticardiolipin anti-bodies, obesity and immobilization. After the proving ofthe factor V Leiden mutation with a DNA analysis, thepatient is treated with an anticoagulative therapy. Becauseof the lack of effect of Sintrom on the examined factors ofthe coagulation, the oral anticoagulative therapy is replacedwith a low molecular weight heparin.

In conclusion we discuss the necessity of an examina-tion of the factor V Leiden-mutation in young patients with

recurrent vascular incidences. Key Words: Factor V Leiden, venous thrombosis, arte-

rial thrombosis, epilepsy, anticoagulative therapy.

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î‡ÍÚÓ V Leiden (F V Leiden) ÚÓÏ·ÓÙËÎËflÚ‡ ÒÂ‰˙ÎÊË Ì‡ Â‰Ì‡ ÚÓ˜ÍÓ‚‡ ÏÛÚ‡ˆËfl ‚ „ÂÌ‡ Á‡ Ù‡ÍÚÓ V Ì‡Í˙‚ÓÒ˙ÒË‚‡ÌÂÚÓ, ÔË˜ËÌfl‚‡˘‡ ÂÁËÒÚÂÌÚÌÓÒÚ Í˙Ï‡ÍÚË‚Ë‡Ì ÔÓÚÂËÌ C Ë ıËÔÂÍÓ‡„ÛÎ‡ˆËÓÌÂÌ ÒÚ‡ÚÛÒ.äÎËÌË˜Ì‡Ú‡ u ËÁfl‚‡ Â Ú‚˙‰Â ‚‡Ë‡·ËÎÌ‡ ‚ Á‡‚ËÒË-ÏÓÒÚ ÓÚ „ÂÌÓÚËÔ‡, ÓÚ Ì‡ÎË˜ËÂ Ì‡ ÔÂ‰‡ÁÔÓÎ‡„‡˘ËÓ·ÒÚÓflÚÂÎÒÚ‚‡ ËÎË Ì‡ Ò˙Ô˙ÚÒÚ‚‡˘Ë ‰Û„Ë Ù‡ÍÚÓËÁ‡ ÚÓÏ·ÓÙËÎËfl. ÉÎ‡‚Ì‡Ú‡ u ÍÎËÌË˜Ì‡ Ï‡ÌËÙÂÒÚ‡ˆËfl Â‚ÂÌÓÁÂÌ ÚÓÏ·ÂÏ·ÓÎËÁ˙Ï Ò Ì‡È-˜ÂÒÚ‡ ÎÓÍ‡ÎËÁ‡ˆËfl ‰˙Î-·ÓÍËÚÂ ‚ÂÌË Ì‡ Í‡Í‡Ú‡. çÂ ÒÂ ÒÏflÚ‡ ÓÒÓ·ÂÌÓ ËÒÍÓ‚‡Á‡ ‡ÚÂË‡ÎÌË ÚÓÏ·ÓÁË, Ï‡Í‡ ˜Â ËÏ‡ Ò˙Ó·˘ÂÌËfl Á‡ÏËÓÍ‡‰ÂÌ ËÌÙ‡ÍÚ Ë ËÒıÂÏË˜ÌË ËÌÒÛÎÚË ÔË ÏÎ‡‰ËıÓ‡.

èÂ‰ÒÚ‡‚ÂÌ Â ÒÎÛ˜‡È Ì‡ ıÓÏÓÁË„ÓÚ Á‡ Factor VLeiden ÔÂÚ˙ÔflÎ Ú‡ÌÁËÚÓÌË ËÒıÂÏË˜ÌË ‡Ú‡ÍË Ë ËÒ-ıÂÏË˜ÂÌ ÏÓÁ˙˜ÂÌ ËÌÒÛÎÚ ‚ ˛ÌÓ¯ÂÒÍ‡ ‚˙Á‡ÒÚ Ë ÂˆË‰Ë-‚Ë‡˘Ë ‰˙Î·ÓÍË ÙÎÂ·ÓÚÓÏ·ÓÁË Ì‡ Í‡Í‡Ú‡ Ò ·ÂÎÓ‰Ó-·ÂÌ ÚÓÏ·ÂÏ·ÓÎËÁ˙Ï ÒÎÂ‰ 29 „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ. ä‡ÚÓÒ˙Ô˙ÚÒÚ‚‡˘Ë Ô‡ÚÓ„ÂÌÂÚË˜ÌË Ù‡ÍÚÓË ‚ ÒÎÛ˜‡fl Ò‡‡ÌÌ‡ Ï‡ÎË„ÌÂÌ‡ ‡ÚÂË‡ÎÌ‡ ıËÔÂÚÓÌËfl, ÔÓÎËˆËÚÂ-ÏËfl, ÛÏÂÂÌ‡ ıËÔÂıÓÏÓˆËÒÚËÌÂÏËfl, ÂÔËÁÓ‰Ë˜ÌÓ Á‡‚Ë-¯‡‚‡ÌÂ Ì‡ ‡ÌÚËÍ‡‰ËÓÎËÔËÌÓ‚Ë ‡ÌÚËÚÂÎ‡, Ì‡‰ÌÓÏÂÌÓÚÂ„ÎÓ Ë ËÁ‚ÂÒÚÌ‡ ËÏÓ·ËÎËÁ‡ˆËfl. ëÎÂ‰ ‰ÓÍ‡Á‚‡ÌÂ Ì‡ F VLeiden ÏÛÚ‡ˆËflÚ‡ Ò Ñçä ‡Ì‡ÎËÁ Â ÓÒÚ‡‚ÂÌ Ì‡ ÔÓÒÚÓ-flÌÌ‡ ‡ÌÚËÍÓ‡„ÛÎ‡ÌÚÌ‡ ÚÂ‡ÔËfl, Í‡ÚÓ ÔÂÓ‡ÎÌËflÚÍÛÏ‡ËÌÓ‚ ‡ÌÚËÍÓ‡„ÛÎ‡ÌÚ Â Á‡ÏÂÌÂÌ Ò ÌËÒÍÓÏÓÎÂÍÛÎfl-ÂÌ ıÂÔ‡ËÌ ÔÓ‡‰Ë ÔÓÍ‡Á‡Ì‡ ÌÂÂÙÂÍÚË‚ÌÓÒÚ Ì‡Sintrom ‚˙ıÛ ËÁÒÎÂ‰‚‡ÌËÚÂ ÔÓÍ‡Á‡ÚÂÎË Ì‡ Í˙‚ÓÒ˙-ÒË‚‡ÌÂ.


Ç Á‡ÍÎ˛˜ÂÌËÂ ÒÂ Ó·Ò˙Ê‰‡ ÌÂÓ·ıÓ‰ËÏÓÒÚÚ‡ ÓÚ ËÁÒ-ÎÂ‰‚‡ÌÂ Ë Ì‡ F V L – ÏÛÚ‡ˆËfl ÔË ÂˆË‰Ë‚Ë‡˘Ë Ò˙‰Ó-‚Ë ËÌˆË‰ÂÌÚË ‚ ÏÎ‡‰‡ ‚˙Á‡ÒÚ.

äÎ˛˜Ó‚Ë ‰ÛÏË: F V – ã‡È‰ÂÌ, ‚ÂÌÓÁÌË ÚÓÏ·ÓÁË,‡ÚÂË‡ÎÌË ÚÓÏ·ÓÁË, ÂÔËÎÂÔÒËfl, ‡ÌÚËÍÓ‡„ÛÎ‡ÌÚÌ‡ÚÂ‡ÔËfl.

èË ÌÓÏ‡ÎÌ‡ ıÂÏÓÒÚ‡Á‡ ‡ÍÚË‚Ë‡ÌËflÚ Protein C(APC) Ó„‡ÌË˜‡‚‡ Í˙‚ÓÒ˙ÒË‚‡ÌÂÚÓ ˜ÂÁ ÔÓÚÂÓÎË-ÚË˜Ì‡ ËÌ‡ÍÚË‚‡ˆËfl Ì‡ Ù‡ÍÚÓË Va Ë VIIIa. á‡ ‰‡ ÔÓÒ-ÚË„ÌÂ Ú‡ÁË ÂÙÂÍÚË‚ÌÓÒÚ ÒÂ ÌÛÊ‰‡Â ÓÚ Â‰ËÌ ÌÂÂÌÁË-ÏÂÌ Ù‡ÍÚÓ – Protein S. îÂÌÓÏÂÌ˙Ú ÂÁËÒÚÂÌÚÌÓÒÚÍ˙Ï APC ÒÂ Ò‚˙Á‚‡ Ò ıÓÏÓ Ë ıÂÚÂÓÁË„ÓÚÌÓÒÚ Á‡ Â‰Ì‡ÚÓ˜ÍÓ‚‡ ÏÛÚ‡ˆËfl ‚ „ÂÌ‡ Á‡ Ù‡ÍÚÓ V, ÔË˜ËÌfl‚‡˘‡ÒËÌÚÂÁ‡ Ì‡ ‰ÂÙÂÍÚÌ‡ ÏÓÎÂÍÛÎ‡ (F V Q 506 ËÎË F VLeiden), ÍÓflÚÓ ÒÂ ËÌ‡ÍÚË‚Ë‡ Á‡·‡‚ÂÌÓ ÓÚ APC (3) ËÔË˜ËÌfl‚‡ ÎÂÍ ıËÔÂÍÓ‡„ÛÎ‡ˆËÓÌÂÌ ÒÚ‡ÚÛÒ (7). ÄÎÂÎÌ‡-Ú‡ ˜ÂÒÚÓÚ‡ Ì‡ Ú‡ÁË ÏÛÚ‡ˆËfl ‚ Dutch ÔÓÔÛÎ‡ˆËflÚ‡ ÂÓÍÓÎÓ 2% Ë Â ‰ÂÒÂÚËÌ‡ Ô˙ÚË ÔÓ-‚ËÒÓÍ‡ ÓÚ Ú‡ÁË Ì‡‚ÒË˜ÍË ‰Û„Ë ËÁ‚ÂÒÚÌË „ÂÌÂÚË˜ÌË ËÒÍÓ‚Ë Ù‡ÍÚÓË Á‡ÚÓÏ·ÓÁË Á‡Â‰ÌÓ.

ÑË‡„ÌÓÒÚËˆË‡ÌÂ Ì‡ F V Leiden ÚÓÏ·ÓÙËÎËflÚ‡ ÒÂËÁ‚˙¯‚‡ ˜ÂÁ ÍÓ‡„ÛÎ‡ˆËÓÌÂÌ ÒÍËÌËÌ„ ÚÂÒÚ, ·‡ÁË‡ÌÌ‡ aPTT ËÎË ˜ÂÁ ÏÓÎÂÍÛÎflÌÓ „ÂÌÂÚË˜ÌÓ ÚÂÒÚÛ‚‡ÌÂ(2,5,7).

ïÂÚÂÓÁË„ÓÚÌÓÒÚ Á‡ F V Leiden ÒÂ Ò‚˙Á‚‡ Ò ÎÂÍÓÔÓ‚Ë¯ÂÌ ËÒÍ Á‡ ‚ÂÌÓÁÌ‡ ÚÓÏ·ÓÁ‡ Ë ÒÂ ÛÌ‡ÒÎÂ‰fl‚‡ ‡‚-ÚÓÁÓÏÌÓ ‰ÓÏËÌ‡ÌÚÌÓ. ïÓÏÓÁË„ÓÚÌÓÒÚ Ë ÏÌÓ„Ó ÔÓ-‚Ë-ÒÓÍ ÚÓÏ·ÓÚË˜ÂÌ ËÒÍ ÒÂ ÛÌ‡ÒÎÂ‰fl‚‡ ÔÓ ‡‚ÚÓÁÓÏÌÓÂˆÂÒË‚ÂÌ ÚËÔ (7).

ÉÎ‡‚Ì‡Ú‡ ÍÎËÌË˜Ì‡ Ï‡ÌËÙÂÒÚ‡ˆËfl Ì‡ F V LeidenÚÓÏ·ÓÙËÎËflÚ‡ Ò ‚ÂÌÓÁÂÌ ÚÓÏ·ÂÏ·ÓÎËÁ˙Ï Ò Ì‡È-˜ÂÒ-Ú‡ ÎÓÍ‡ÎËÁ‡ˆËfl ‰˙Î·ÓÍËÚÂ ‚ÂÌË Ì‡ Í‡Í‡Ú‡, ÌÓ ËÏ‡ÓÔËÒ‡ÌË ÒÎÛ˜‡Ë Ò ÚÓÏ·ÓÁ‡ Ì‡ ˆÂÌÚ‡ÎÌ‡Ú‡ ÂÚËÌ‡ÎÌ‡‚ÂÌ‡, Ì‡ ‰Û‡ÎÂÌ ÒËÌÛÒ Ë Ì‡ ıÂÔ‡Ú‡ÎÌ‡ ‚ÂÌ‡. èË ·Â-ÏÂÌÌË ÊÂÌË ÓÒ‚ÂÌ ÚÓÏ·ÂÏ·ÓÎËÁ˙Ï ÏÓÊÂ ‰‡ ÔÂ‰ËÁ‚Ë-Í‡ Ë Á‡„Û·‡ Ì‡ ÔÎÓ‰‡ ÒÎÂ‰ Ô˙‚Ó ÚËÏÂÒÂ˜ËÂ, ÔÂÂÍÎ‡-ÏÔÒËfl ËÎË ÓÚÎÂÔ‚‡ÌÂ Ì‡ ÂÚËÌ‡Ú‡. èÂÓ·Î‡‰‡‚‡ ÏÌÂ-ÌËÂÚÓ, ˜Â ÌÂ Â ÁÌ‡˜ËÏ ËÒÍÓ‚ Ù‡ÍÚÓ Á‡ ‡ÚÂË‡ÎÌËÚÓÏ·ÓÁË (2,7), Ï‡Í‡ ˜Â ËÏ‡ ÓÚ‰ÂÎÌË Ò˙Ó·˘ÂÌËfl Á‡ËÌÙ‡ÍÚË Ì‡ ÏËÓÍ‡‰‡ ÔË ÏÎ‡‰Ë ıÓ‡ Ò˙Ò Ë ·ÂÁ ‰Û„ËÍ‡‰ËÓ‚‡ÒÍÛÎ‡ÌË ËÒÍÓ‚Ë Ù‡ÍÚÓË, Í‡ÍÚÓ Ë Á‡ ËÒıÂ-ÏË˜ÌË ËÌÒÛÎÚË ÔË ‰Âˆ‡ Ë ÏÎ‡‰Ë ‚˙Á‡ÒÚÌË (1,9).

äãàçàóÖç ëãìóÄâ

èÂ‰ÒÚ‡‚flÏÂ ÍÎËÌË˜ÂÌ ÒÎÛ˜‡È Ì‡ ıÓÏÓÁË„ÓÚ Á‡ F VLeiden Ò ÔÓÒÎÂ‰Ó‚‡ÚÂÎÌÓ ‡Á‚ËÚËÂ Ì‡ ËÒıÂÏË˜ÌËÏÓÁ˙˜ÌË ËÌˆË‰ÂÌÚË Ë ÂˆË‰Ë‚Ë‡˘Ë ‰˙Î·ÓÍË ÙÎÂ·ÓÚ-ÓÏ·ÓÁË Ì‡ Í‡Í‡Ú‡ Ò ·ÂÎÓ‰Ó·ÂÌ ÚÓÏ·ÂÏ·ÓÎËÁ˙Ï.

è‡ˆËÂÌÚ˙Ú Åíà Ì‡ 30 „Ó‰ËÌË Â ÔÓÁÌ‡Ú Ì‡ äÎËÌËÍ‡-Ú‡ ÓÚ ÔÂÚÌ‡‰ÂÒÂÚËÌ‡ „Ó‰ËÌË, Ì‡ÒÓ˜ÂÌ Í˙Ï Ì‡Ò Á‡ Ì‡·-Î˛‰ÂÌËÂ ÓÚ ÇÚÓ‡ ‰ÂÚÒÍ‡ ÒÔÂˆË‡ÎËÁË‡Ì‡ ·ÓÎÌËˆ‡.àÏ‡ Ù‡ÏËÎÌ‡ Ó·ÂÏÂÌÂÌÓÒÚ Ò ‡ÚÂË‡ÎÌ‡ ıËÔÂÚÓÌËfl(Äï) ÔÓ ‰‚ÂÚÂ „ÂÌÂÚË˜ÌË ÎËÌËË, ·ÂÁ ‰‡ÌÌË Á‡ ‡ÌÌË ËÂˆË‰Ë‚Ë‡˘Ë Ò˙‰Ó‚Ë ËÌˆË‰ÂÌÚË. á‡ Ô˙‚Ë Ô˙Ú ÏÛ ÂËÁÏÂÂÌÓ ‚ËÒÓÍÓ Í˙‚ÌÓ Ì‡Îfl„‡ÌÂ 140/110 Ì‡ ‰Â‚ÂÚ „Ó-‰Ë¯Ì‡ ‚˙Á‡ÒÚ. é˘Â ÔÂÁ ÒÎÂ‰‚‡˘ËÚÂ ÌflÍÓÎÍÓ „Ó‰ËÌËÁ‡‰˙Ê‡ Ú‡ÈÌ‡ ‚ËÒÓÍÓÒÚÂÔÂÌÌ‡ Äï Ò Ï‡ÎË„ÌÂÌ ıÓ‰, ÒÏÌÓ„ÓÍ‡ÚÌË ıËÔÂÚÓÌË˜ÌË ÍËÁË, ÔÓÚË˜‡˘Ë Ò Í˙‚-ÌÓ Ì‡Îfl„‡ÌÂ ‰Ó 220/120. éÚ ÔÓ‚Â‰ÂÌË Ó·ÒÚÓÈÌË ËÁÒ-ÎÂ‰‚‡ÌËfl, ‚ÍÎ˛˜ËÚÂÎÌÓ ÂÌÓ‚‡ÁÓ„‡ÙËfl, äÄí Ì‡Ì‡‰·˙·Â˜ÌËÚÂ ÊÎÂÁË, ıÓÏÓÌ‡ÎÌË Ë ËÏÛÌÓÎÓ„Ë˜ÌË ËÁÒ-ÎÂ‰‚‡ÌËfl Â ÓÚı‚˙ÎÂÌ‡ ÚÂÁ‡Ú‡ Á‡ ÂÌ‰ÓÍËÌÌÓ Ó·ÛÒÎÓ-‚ÂÌ‡ Äï, ÂÌÓ‚‡Á‡ÎÌ‡ ıËÔÂÚÓÌËfl Ë Ú‡Í‡‚‡, Ò‚˙Á‡Ì‡Ò˙Ò ÒËÒÚÂÏÌÓ Á‡·ÓÎfl‚‡ÌÂ Ì‡ Ò˙Â‰ËÌËÚÂÎÌ‡Ú‡ Ú˙Í‡Ì.

ç‡ ˜ÂÚËËÌ‡‰ÂÒÂÚ „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ ÒÎÂ‰ ÔÓÂ‰Ì‡ıËÔÂÚÓÌË˜Ì‡ ÍËÁ‡ Ë flÁÍÓ ÔÓÌËÊ‡‚‡ÌÂ Ì‡ Í˙‚ÌÓÚÓÌ‡Îfl„‡ÌÂ Ò ıÎÓÙ‡ÁÓÎËÌ ÒÂ Ò˙·ÛÊ‰‡ ·ÎÂ‰, ËÁÔÓÚÂÌ, ·‡-‰ËÍ‡‰Ë˜ÂÌ, Ò ÌÂflÒÂÌ „Ó‚Ó. å‡ÎÍÓ ÔÓ-Í˙ÒÌÓ ÒÂ ÔÓfl‚fl‚‡‰ÂÒÌÓÒÚ‡ÌÌ‡ ˆÂÌÚ‡ÎÌ‡ ÎËˆÂ‚‡ Ô‡ÂÁ‡, ÒÚ‡Ì‡Î ÒÓÏÌÓ-ÎÂÌÚÂÌ, Ì‡ ‚ÂÏÂÌ‡ ÔÒËıÓÏÓÚÓÌÓ ‚˙Á·Û‰ÂÌ. èË ÒÚ‡-ˆËÓÌË‡ÌÂ ‚ ÌÂ‚ÓÎÓ„Ë˜Ì‡ ÍÎËÌËÍ‡ Â ÔÂˆÂÌÂÌÓ, ˜Â ÂÔÂÍ‡‡Î Ú‡ÌÁËÚÓÌ‡ ËÒıÂÏË˜Ì‡ ‡Ú‡Í‡ ‚ ·‡ÒÂÈÌ‡ Ì‡Îfl‚‡Ú‡ ÒÂ‰Ì‡ ÏÓÁ˙˜Ì‡ ‡ÚÂËfl.

ç‡ ÒÂ‰ÂÏÌ‡‰ÂÒÂÚ „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ ÔË RR 220/110Ô‡‚Ë ÌÓ‚ ÏÓÁ˙˜ÌÓ-Ò˙‰Ó‚ ËÌˆË‰ÂÌÚ Ò ÎÂ‚ÓÒÚ‡ÌÌ‡ˆÂÌÚ‡ÎÌ‡ ıÂÏËÔ‡ÂÁ‡ Ò Û˜‡ÒÚËÂ Ì‡ VII óåç, ÎÂ‚ÓÒÚ-‡ÌÌ‡ ıÂÏËıËÔÂÒÚÂÁËfl Ë ıÂÏË‡ÌÓÔÒËfl.

èÂÁ Ò˙˘‡Ú‡ (1991) „Ó‰ËÌ‡ ÔÓÎÛ˜‡‚‡ Á‡ Ô˙‚Ë Ô˙Ú„ÂÌÂ‡ÎËÁË‡Ì ÚÓÌË˜ÌÓ-ÍÎÓÌË˜ÂÌ „˙˜ Ò˙Ò Á‡„Û·‡ Ì‡Ò˙ÁÌ‡ÌËÂ Ë ÔÂı‡Ô‚‡ÌÂ Ì‡ ÂÁËÍ‡. éÚ ÚÓ„‡‚‡ ÔÂËÓ‰Ë˜ÌÓËÏ‡ ÔÓÎËÏÓÙÌË ÔËÒÚ˙ÔË, Ì‡È-˜ÂÒÚÓ Ò ı‡‡ÍÚÂ Ì‡‚ÚÓË˜ÌÓ „ÂÌÂ‡ÎËÁË‡ÌË Ô‡ˆË‡ÎÌË ÏÓÚÓÌË. çÂÍÓÎ-ÍÓÍ‡ÚÌÓ ÒÎÂ‰ ÂÔËÎÂÔÚË˜ÂÌ ÔËÔ‡‰˙Í ËÎË Ì‡ ÙÓÌ‡ Ì‡‚ËÒÓÍÓ Í˙‚ÌÓ Ì‡Îfl„‡ÌÂ ÔÓÎÛ˜‡‚‡ Á‡‰˙Î·Ó˜‡‚‡ÌÂ Ì‡ ÎÂ-Í‡Ú‡ ÓÒÚ‡Ú˙˜Ì‡ ÌÂ‚ÓÎÓ„Ë˜Ì‡ ÒËÏÔÚÓÏ‡ÚËÍ‡ ‚ Îfl‚Ó.

ç‡Â‰ Ò ÔÂËÓ‰Ë˜ÌËfl ÍÓÌÚÓÎ Ì‡ ÖÖÉ, äÄí Ë åêí Ì‡„Î‡‚ÌËfl ÏÓÁ˙Í (·ÂÁ ËÁfl‚ÂÌË ËÌÙ‡ÍÚÌË ÁÓÌË), ‰‚ÛÒÚ-‡ÌÌ‡ Í‡ÓÚË‰Ì‡ ‡Ì„ËÓ„‡ÙËfl (·ÂÁ ‰ÓÎÓ‚ËÏË Ô‡ÚÓÎÓ-„Ë˜ÌË ÔÓÏÂÌË) ÌÂÍÓÎÍÓÍ‡ÚÌÓ Ò‡ ËÁ‚˙¯‚‡ÌË Ë ‚ÒË˜ÍË·ËÓıËÏË˜ÌË Ë ıÂÏ‡ÚÓÎÓ„Ë˜ÌË ËÁÒÎÂ‰‚‡ÌËfl. éÚ ÔÓÒÎÂ‰-ÌËÚÂ Ô‡‚Ë ‚ÔÂ˜‡ÚÎÂÌËÂ, ˜Â Ï‡Í‡ Ë ‚ ÂÙÂÂÌÚÌË „‡-ÌËˆË, ÒÚÓÈÌÓÒÚËÚÂ Ì‡ ıÂÏÓ„ÎÓ·ËÌ‡, ÂËÚÓˆËÚËÚÂ ËıÂÏ‡ÚÓÍËÚ‡ Ò‡ ‚ËÌ‡„Ë ÓÍÓÎÓ „ÓÌ‡Ú‡ „‡ÌËˆ‡ Ì‡ ÌÓ-Ï‡Ú‡. Ö‰ÌÓÍ‡ÚÌÓ Ò‡ ÛÒÚ‡ÌÓ‚ÂÌË Á‡‚Ë¯ÂÌË ÒÚÓÈÌÓÒ-ÚË Ì‡ ÎËÔË‰ËÚÂ Ò ÌËÒÍ‡ ÔÎ˙ÚÌÓÒÚ. àÁÍÎ˛˜ÂÌ Â ‰ÂÙË-ˆËÚ Ì‡ Protein C Ë Antitrombin III. èË ËÁÒÎÂ‰‚‡ÌÂ Á‡ ‡Ì-ÚËÍ‡‰ËÓÎËÔËÌÓ‚Ë ‡ÌÚËÚÂÎ‡ Â‰ÌÓÍ‡ÚÌÓ Â ÛÒÚ‡ÌÓ‚Â-Ì‡ ÔÓ‚Ë¯ÂÌ‡ ÒÚÓÈÌÓÒÚ Ì‡ IgM (21 ÔË ÌÓÏ‡ 11). àÁÒ-ÎÂ‰‚‡ÌÂÚÓ Á‡ ˆËÍÛÎË‡˘Ë ËÏÛÌÌË ÍÓÏÔÎÂÍÒË Â ‚ ÌÓ-Ï‡.

ë ‰Ë‡„ÌÓÁ‡ “ÄÚÂË‡ÎÌ‡ ıËÔÂÚÓÌËfl III ÒÚ., Ò˙ÒÚÓ-flÌËÂ ÒÎÂ‰ ÏÌÓ„ÓÍ‡ÚÌË ıËÔÂÚÓÌË˜ÌË ÍËÁË Ë ËÒıÂÏË-˜ÂÌ ËÌÒÛÎÚ ‚ ÅÑëåÄ, Ò˙‰Ó‚‡ ÂÔËÎÂÔÒËfl” ·ÓÎÌËflÚ „Ó-‰ËÌË Ì‡Â‰ Â Ò ÔÓÒÚÓflÌÌ‡ ‡ÌÚËıËÔÂÚÂÌÁË‚Ì‡ Ë Ò˙‰Ó-‡Á¯Ëfl‚‡˘‡ ÚÂ‡ÔËfl Ë Ò ‡ÁÎË˜ÌË ‡ÌÚËÂÔËÎÂÔÚË˜ÌËÏÂ‰ËÍ‡ÏÂÌÚË. èÓÒÎÂ‰Ì‡Ú‡ ÒıÂÏ‡ Ì‡ ‡ÌÚËÍÓÌ‚ÛÎÒË‚Ì‡ÚÂ‡ÔËfl, ÔÓÍ‡Á‡Î‡ Ì‡È-‰Ó·‡ ÂÙÂÍÚË‚ÌÓÒÚ, Â Lamictal200 mg + KÂppra 3000 mg ‰ÌÂ‚ÌÓ.

èÂÁ ÔÓÎÂÚÚ‡ Ì‡ 2004 „Ó‰ËÌ‡ Á‡ÔÓ˜‚‡ ‰‡ ÒÂ ÓÔÎ‡Í-‚‡ ÓÚ ·ÓÎÍË Ò˙Ò ÒÚfl„‡˘ ı‡‡ÍÚÂ ‚ „˙‰ÌËfl ÍÓ¯ Ë ÎÂ-Í‡ ÒÎ‡·ÓÒÚ ‚ Í‡Í‡Ú‡ ÔË ÛÏÓ‡. ëÎÂ‰ ÂÌÚ„ÂÌÓ„‡ÙËËÌ‡ „˙·Ì‡˜ÌËfl ÒÚ˙Î· Ë ÖåÉ Ò ‰‡ÌÌË Á‡ ÍÓÂÌ˜Â‚‡ Û‚Â-‰‡ Ì‡ ˆÂ‚ËÍ‡ÎÌË Ë ÎÛÏ·ÓÒ‡Í‡ÎÌË ÌË‚‡ Â ÔËÂÚ‡ ‰Ë‡„-ÌÓÁ‡: “ÑÂÙÓÏË‡˘‡ ÒÔÓÌ‰ËÎÓÁ‡ Ò ‡‰ËÍÛÎÂÂÌ ÒËÌ‰-ÓÏ; é·ÂÁËÚ‡Ò.” éÚ Î‡·Ó‡ÚÓÌËÚÂ ËÁÒÎÂ‰‚‡ÌËfl ÔÓÚÓ‚‡ ‚ÂÏÂ Ô‡‚Ë ‚ÔÂ˜‡ÚÎÂÌËÂ ‚ËÒÓÍ‡ ÒÚÓÈÌÓÒÚ Ì‡ÔÓÚÓÏ·ËÌÓ‚ÓÚÓ ‚ÂÏÂ (120%) Ë „‡ÌË˜ÌË ÒÚÓÈÌÓÒ-ÚË Ì‡ Er (5.49 x 1012/l), Hb (167 g/l) Ë Ht (0.49), Ò ÎÂÍÓÁ‡‚Ë¯ÂÌË ää Ë ãÑï.

èÂÁ ÂÒÂÌÚ‡ Ì‡ Ò˙˘‡Ú‡ „Ó‰ËÌ‡ ÒÂ ‰Ë‡„ÌÓÒÚËˆË‡ÍÎËÌË˜ÌÓ Ë ÑÓÔÎÂÒÓÌÓ„‡ÙÒÍË ÙÂÏÓÓÔÓÔÎËÚÂ‡ÎÌ‡ÙÎÂ·ÓÚÓÏ·ÓÁ‡ ÔÓÒÎÂ‰Ó‚‡ÚÂÎÌÓ Ì‡ ‰‚‡Ú‡ Í‡Í‡, Ò Â-ˆË‰Ë‚Ë‡˘ ı‡‡ÍÚÂ. èÓ ÔÓ‚Ó‰ Ì‡ ÔÓ‚Ú‡fl˘Ë ÒÂ ·Ó‰Â-ÊË ‚ „˙‰ËÚÂ, Á‡‰Ûı, Í‡¯ÎËˆ‡ Ë ÙÂ·ËÎËÚÂÚ ÒÂ ÎÂÍÛ‚‡‰‚ÛÍ‡ÚÌÓ ‚ ÔÛÎÏÓÎÓ„Ë˜Ì‡ ÍÎËÌËÍ‡ Ò ‰Ë‡„ÌÓÁ‡: “ÅÂÎÓ‰-Ó·ÂÌ ÚÓÏ·ÂÏ·ÓÎËÁ˙Ï – ıÓÌË˜ÌÓ ÂˆË‰Ë‚Ë‡˘‡ ÏËÍ-ÓÂÏ·ÓÎË˜Ì‡ ÙÓÏ‡”. á‡ÔÓ˜‚‡ ÎÂ˜ÂÌËÂ Ò ‡ÌÚËÍÓ‡„ÛÎ‡-ÌÚÌË ‰ÓÁË ËÌÚ‡‚ÂÌÓÁÂÌ Heparin, ‚ËÒÓÍË ‰ÓÁË (2 x 1.0ml) Fraxiparine Ë ‚ ÔÓÒÎÂ‰ÒÚ‚ËÂ Ò ÔÂÓ‡ÎÂÌ ‡ÌÚËÍÓ‡„Û-Î‡ÌÚ. ç‡ ÙÓÌ‡ Ì‡ ÛÏÂÂÌ‡ ‰ÓÁ‡ Sintrom ÔÂÒËÒÚË‡ÌÓÏ‡ÎÌÓ ËÎË Û‰˙ÎÊÂÌÓ (‰Ó 130%) ÔÓÚÓÏ·ËÌÓ‚Ó ‚Â-

ÏÂ Ë ·˙ÁÓ Ò˙ÒË‚‡ÌÂ Ì‡ Í˙‚Ú‡ ÔË ‚ÂÌÂÔÛÌÍˆËfl. ïÂ-ÏÓ„ÎÓ·ËÌ˙Ú ‰ÓÒÚË„‡ ÒÚÓÈÌÓÒÚ 195 g/l Ë ÂËÚÓˆËÚË-ÚÂ – Ì‡‰ 6 x 1012/l. àÁÍ‡Á‚‡ ÒÂ Ò˙ÏÌÂÌËÂ Á‡ ÔÓÎËˆËÚÂ-ÏËfl. àÁÒÎÂ‰‚‡ÌË Ò‡ ÓÚÌÓ‚Ó Protein C Ë Antithrombin III– ‚ ÌÓÏ‡.

èÓfl‚‡Ú‡ Ì‡ ‰˙Î·ÓÍË ÙÎÂ·ÓÚÓÏ·ÓÁË, Ì‡ÎÓÊË ËÁÒÎÂ‰-‚‡ÌÂ Ì‡ ıÓÏÓˆËÒÚËÌ ‚ Í˙‚ Ë ÛËÌ‡ ‚ Î‡·Ó‡ÚÓËflÚ‡Á‡ Ú˙Í‡ÌÌË Ï‡ÍÂË. ìÒÚ‡ÌÓ‚ÂÌ‡Ú‡ ÛÏÂÂÌ‡ ıËÔÂıÓ-ÏÓˆËÒÚËÌÂÏËfl (16.79 µmol/l ÔË ÌÓÏ‡ 3.4 ‰Ó 13.8µmol/l) ·Â¯Â ÔÓ‚Ó‰ Á‡ „ÂÌÂÚË˜ÌÓ ËÁÒÎÂ‰‚‡ÌÂ Á‡ Ò˙ÓÚ‚Â-ÚÂÌ „ÂÌÂÚË˜ÂÌ ÔÓÎËÏÓÙËÁ˙Ï (Ñçä ‡Ì‡ÎËÁ ‚ Î‡·Ó‡-ÚÓËflÚ‡ ÔÓ ÏÓÎÂÍÛÎflÌ‡ Ô‡ÚÓÎÓ„Ëfl Ì‡ ëÅÄãÄÉ “å‡È-˜ËÌ ‰ÓÏ”). çÂ ÒÂ ÛÒÚ‡ÌÓ‚Ëı‡ ‰‡ÌÌË Á‡ ÏÂÚËÎÂÌÚÂÚ‡-ıË‰ÓÙÓÎ‡Ú Â‰ÛÍÚ‡ÁÂÌ ÔÓÎËÏÓÙËÁ˙Ï. ìÒÚ‡ÌÓ‚Ë ÒÂıÓÏÓÁË„ÓÚÌÓ ÌÓÒËÚÂÎÒÚ‚Ó Ì‡ ÏÛÚ‡ˆËfl ÔË R 506 Q(Ù‡ÍÚÓ V Leiden), ÔË ÎËÔÒ‡ Ì‡ ÏÛÚ‡ˆËfl Á‡ ÔÓÚÓÏ-Ï·ËÌÓ‚Ëfl „ÂÌ G 22010A.

ÑÓÍ‡Á‚‡ÌÂÚÓ Ì‡ F V Leiden ÏÛÚ‡ˆËflÚ‡ Ë ˆflÎ‡Ú‡ÍÎËÌËÍÓ-Î‡·Ó‡ÚÓÌ‡ ÍÓÌÒÚÂÎ‡ˆËfl ÔË ·ÓÎÌËfl Ì‡Î‡„‡ÔÓÒÚÓflÌÌÓ ÎÂ˜ÂÌËÂ Ò˙Ò Sintrom. èÓ‡‰Ë ÌÂÁ‡‰Ó‚ÓÎË-ÚÂÎÌÓ, ‰ÓË ÎËÔÒ‚‡˘Ó ÔÓ‚ÎËfl‚‡ÌÂ Ì‡ ÔÓÍ‡Á‡ÚÂÎËÚÂ Ì‡Í˙‚ÓÒ˙ÒË‚‡ÌÂ (INR 0,92 ÔË 2 1/2 Ú‡·ÎÂÚÍË Sintrom‰ÌÂ‚ÌÓ, 1.0 – ÔË ÒÂ‰ÏË˜ÌÓ ÎÂ˜ÂÌËÂ Ò 3 Ú‡·ÎÂÚÍË ‰ÌÂ‚-ÌÓ Ë 0.72 – ÔË Û‚ÂÎË˜ËÌ‡ ‰ÌÂ‚Ì‡ ‰ÓÁ‡ Ì‡ 3 1/2 Ú‡·ÎÂÚ-ÍË), ÒÎÂ‰ ÍÓÌÒÛÎÚ‡ˆËfl Ò ıÂÏ‡ÚÓÎÓ„ Ë ıÂÏÓÒÚ‡ÁËÓÎÓ„ ÒÂ‚ÁÂ Â¯ÂÌËÂ ‰‡ ÓÒÚ‡ÌÂ Ì‡ ÔÓÒÚÓflÌÌÓ ÎÂ˜ÂÌËÂ ÒFraxiparine 0.4 ml s.c. ‰ÌÂ‚ÌÓ.

éÅëöÜÑÄçÖ:

èÓ‚Â˜ÂÚÓ ‡‚ÚÓË, Á‡ÔÓÁÌ‡ÚË Ò ÔÓ·ÎÂÏ‡, Ò‡ Ò˙„Î‡Ò-ÌË, ˜Â ÍÎËÌË˜Ì‡Ú‡ ËÁfl‚‡ Ì‡ F V Leiden ÚÓÏ·ÓÙËÎËflÚ‡Â ËÁÍÎ˛˜ËÚÂÎÌÓ ‚‡Ë‡·ËÎÌ‡ (7,8). çÂÏ‡ÎÍÓ ÌÓÒËÚÂÎËÌ‡ ÏÛÚ‡ˆËflÚ‡ ÌËÍÓ„‡ ÌÂ ‡Á‚Ë‚‡Ú ÚÓÏ·ÓÁË. êÓ‰ËÚÂ-ÎËÚÂ Ì‡ Ì‡¯Ëfl ·ÓÎÂÌ, ‚ÂÓflÚÌÓ ıÂÚÂÓÁË„ÓÚË Á‡ F VLeiden, ‰ÓÒÂ„‡ ÌflÏ‡Ú Ú‡Í‡‚‡ ‡Ì‡ÏÌÂÁ‡. å‡Í‡, ˜Â ÏÌÓ-ÁËÌ‡ ‡Á‚Ë‚‡Ú ÚÓÏ·ÓÁ‡Ú‡ Â‰‚‡ ‚ Ò‡‚ÌËÚÂÎÌÓ Ì‡Ô-Â‰Ì‡Î‡ ‚˙Á‡ÒÚ, ÌflÍÓË ËÏ‡Ú ÂˆË‰Ë‚Ë‡˘ ÚÓÏ·ÂÏ-·ÓÎËÁ˙Ï ÔÂ‰Ë ‰‡ Ì‡‚˙¯‡Ú 30 „Ó‰ËÌË. Ç Ì‡¯Ëfl ÒÎÛ˜‡ÈÚÓ‚‡ ÒÚ‡‚‡ ÒÎÂ‰ 29 „Ó‰Ë¯Ì‡Ú‡ ÏÛ ‚˙Á‡ÒÚ. éÒ‚ÂÌ ‚˙Á-‡ÒÚÚ‡, Í‡ÚÓ ‰Û„Ë ÔÂ‰‡ÁÔÓÎ‡„‡˘Ë Ù‡ÍÚÓË ÒÂ ÔË-ÂÏ‡Ú ıËÛ„Ë˜ÌË, ÓÒÓ·ÂÌÓ ÓÚÓÔÂ‰Ë˜ÌË ËÌÚÂ‚ÂÌˆËË,·ÂÏÂÌÌÓÒÚ, ËÏÓ·ËÎËÁ‡ˆËfl, ËÁÔÓÎÁ‚‡ÌÂ Ì‡ ÍÓÌÚ‡ˆÂÔ-ÚË‚Ë Ë ˆÂÌÚ‡ÎÂÌ ‚ÂÌÓÁÂÌ Í‡ÚÂÚ˙, ÔÓ‰˙ÎÊËÚÂÎÌÓıÓÏÓÌ‡ÎÌÓ ÎÂ˜ÂÌËÂ, Ú˛Ú˛ÌÓÔÛ¯ÂÌÂ. èÓÙÂÒËflÚ‡ Ì‡Ì‡¯Ëfl Ô‡ˆËÂÌÚ Â Ò‚˙Á‡Ì‡ Ò ÔÓ‰˙ÎÊËÚÂÎÌÓ ÔÂÍ‡‚‡-ÌÂ ‚ ÒÂ‰Ì‡ÎÓ ÔÓÎÓÊÂÌËÂ; ÔË·‡‚fl ÒÂ Ë Ù‡ÍÚÓ˙Ú Ì‡‰-ÌÓÏÂÌÓ ÚÂ„ÎÓ Ë ÔÓ˜ÚË ÔÓÒÚÓflÌÂÌ ÒÚÂÒ.

àÌÚÂÂÒÌË Ò‡ ‚Á‡ËÏÓÓÚÌÓ¯ÂÌËflÚ‡ ‚ Ì‡ÒÓÍ‡ Ì‡ ËÒ-Í‡ ÏÂÊ‰Û F V Leiden ÏÛÚ‡ˆËflÚ‡ Ë ‰Û„Ë ‚Ó‰ÂÌË ËÎËÔË‰Ó·ËÚË ËÒÍÓ‚Ë Ù‡ÍÚÓË Í‡ÚÓ ‰ÂÙËˆËÚ Ì‡ ÂÒÚÂ-ÒÚ‚ÂÌËÚÂ ‡ÌÚËÍÓ‡„ÛÎ‡ÌÚË, ‡ÌÚËÙÓÒÙÓÎËÔË‰ÂÌ ÒËÌ‰-ÓÏ, ıÓÏÓˆËÒÚËÌÂÏËfl, ÏÛÚ‡ˆËË Ì‡ ÔÓÚÓÏ·ËÌÓ‚Ëfl„ÂÌ Ë ‰. Ö‰Ì‡ ÍÓÏ·ËÌ‡ˆËfl ÓÚ ËÒÍÓ‚Ë Ù‡ÍÚÓË ÏÓÊÂ‰‡ ÔÓ‚ÓÍË‡ ÚÓÏ·ÓÁË Ë ‚ ‡ÌÌ‡ ‰ÂÚÒÍ‡ ‚˙Á‡ÒÚ (7).èË ÓÔËÒ‡ÌËfl ÓÚ Ì‡Ò ÒÎÛ˜‡È „ÂÌÌ‡Ú‡ ÏÛÚ‡ˆËfl ÒÂ Ò˙˜Â-Ú‡‚‡ Ò ‡ÚÂË‡ÎÌ‡ ıËÔÂÚÓÌËfl, ÛÏÂÂÌË, ÌÓ ÔÂÒËÒÚË-‡˘Ë Ì‡Û¯ÂÌËfl ‚ ıÂÏÓÂÓÎÓ„ËflÚ‡, Ï‡Í‡ Ë ËÌˆË‰ÂÌÚ-ÌÓ ÛÒÚ‡ÌÓ‚ÂÌ ˙ÒÚ Ì‡ ‡ÌÚËÍ‡‰ËÓÎËÔËÌÓ‚Ë ‡ÌÚËÚÂÎ‡.Ç˙ÔÂÍË ÛÏÂÂÌÓÚÓ Á‡‚Ë¯ÂÌËÂ Ì‡ ıÓÏÓˆËÒÚËÌ‡, ÚÓÈÒ˙˘Ó Û˜‡ÒÚ‚‡ ‚ Ô‡ÚÓ„ÂÌÂÁ‡Ú‡ Ì‡ ÚÓÏ·ÓÁËÚÂ ˜ÂÁ ÂÌ-‰ÓÚÂÎÌËÚÂ Û‚ÂÊ‰‡ÌËfl, ÍÓËÚÓ ÔË˜ËÌfl‚‡.

é·˘Ó ÏÌÂÌËÂ Â, ˜Â F V Leiden ÌÂ Â ÁÌ‡˜ËÚÂÎÂÌ ËÒ-ÍÓ‚ Ù‡ÍÚÓ Á‡ ‡ÚÂË‡ÎÌË ÚÓÏ·ÓÁË, ÌÓ ËÏ‡ Ì‡·Î˛‰Â-ÌËfl Ë Ò˙Ó·˘ÂÌËfl Á‡ Ú‡ÍË‚‡ ËÌˆË‰ÂÌÚË Û ‰Âˆ‡ Ë ÏÎ‡‰ËÒ˙Ò Ë ·ÂÁ ‰Û„Ë Í‡‰ËÓ‚‡ÒÍÛÎ‡ÌË ËÒÍÓ‚Ë Ù‡ÍÚÓË(1,7,9). èË Ì‡¯Ëfl ·ÓÎÂÌ Â Ì‡ÎËˆÂ ÒÂËÓÁÌÓ Ò˙‰Ó‚Ó Á‡·Ó-

Îfl‚‡ÌÂ Ò Ï‡ÎË„ÌÂÌ ıÓ‰ Ó˘Â ‚ ‡ÌÌ‡ ‚˙Á‡ÒÚ. Ç˙ÔÂÍËÂÍÒÚÂÏÌËÚÂ ÍÓÎÂ·‡ÌËfl Ì‡ Í˙‚ÌÓÚÓ Ì‡Îfl„‡ÌÂ Ë ÎËÔÒ‡Ì‡ ‰ÓÍ‡Á‡Ì‡ ÚÓÏ·ÓÁ‡ ÓÚ ‡Ì„ËÓ„‡ÙÒÍÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ,ÌËÂ ÒÏÂ ÒÍÎÓÌÌË ‰‡ ‰ÓÔÛÒÌÂÏ Ë ÓÎflÚ‡ Ì‡ „ÂÌÂÚË˜ÌËfl‰ÂÙÂÍÚ ‚ ‡Á‚ËÚËÂÚÓ Ì‡ ÏÓÁ˙˜ÌÓ-Ò˙‰Ó‚‡Ú‡ Ô‡ÚÓÎÓ„ËflÓ˘Â ‚ Û˜ËÎË˘Ì‡ ‚˙Á‡ÒÚ.

ãÂ˜ÂÌËÂÚÓ Ì‡ Ô‡ˆËÂÌÚË Ò F V Leiden ÚÓÏ·ÓÙËÎËflÁ‡‚ËÒË ÓÚ ÍÎËÌË˜ÌËÚÂ Ó·ÒÚÓflÚÂÎÒÚ‚‡. è˙‚‡Ú‡ ÓÒÚ-‡ ÚÓÏ·ÓÁ‡ ÒÂ ÚÂÚË‡ ÛÚËÌÌÓ Ò ËÌÚ‡‚ÂÌÓÁÂÌ ÌÂÙ-‡ÍˆËÓÌË‡Ì Heparin ËÎË ÌËÒÍÓÏÓÎÂÍÛÎflÂÌ ÒÛ·ÍÛÚ‡-ÌÂÌ Heparin, ÔÓÒÎÂ‰‚‡ÌË ÓÚ ÔÂÓ‡ÎÂÌ ‡ÌÚËÍÓ‡„ÛÎ‡ÌÚÁ‡ 3 ‰Ó 6 ÏÂÒÂˆ‡. ÖÙÂÍÚË‚Ì‡ ‡ÌÚËÍÓ‡„ÛÎ‡ˆËfl ÒÂ ÔÓÒÚË-„‡ ÔË INR 2.5 (ÚÂ‡ÔÂ‚ÚË˜ÌË „‡ÌËˆË ÓÚ 2 ‰Ó 3).èÓ‰˙ÎÊËÚÂÎÌ‡ ÔÂÓ‡ÎÌ‡ ‡ÌÚËÍÓ‡„ÛÎ‡ˆËfl Úfl·‚‡ ‰‡ÒÂ Ó·Ò˙Ê‰‡ ÔË ÂˆË‰Ë‚Ë‡˘ ÚÓÏ·ÂÏ·ÓÎËÁ˙Ï, ÏÛÎ-ÚËÔÎÂÌË ıÂÏÓÒÚ‡ÁÌË ‡·ÌÓÏÌÓÒÚË ËÎË ‰Û„Ë Ò˙Ô˙Ú-ÒÚ‚‡˘Ë Ó·ÒÚÓflÚÂÎÒÚ‚‡ ËÎË ıÓÏÓÌ‡ÎÌË ËÒÍÓ‚Ë Ù‡Í-ÚÓË, Í‡ÍÚÓ Ë ÔË ıÓÏÓÁË„ÓÚË Á‡ F V Leiden.

èÓ Ú‡ÁË ÒıÂÏ‡ Â Á‡ÔÓ˜Ì‡ÚÓ ÎÂ˜ÂÌËÂÚÓ Ë ÔË Ì‡¯ËflÔ‡ˆËÂÌÚ. èË Ì‡ÎË˜ËÂÚÓ Ì‡ ÂˆË‰Ë‚Ë‡˘ ·ÂÎÓ‰Ó·ÂÌÚÓÏ·ÂÏ·ÓÎËÁ˙Ï, Äï ÌÂ Â ÔÂˆÂÌÂÌ‡ Í‡ÚÓ ÔÓÚË‚ÓÔÓ-Í‡Á‡ÌËÂ Á‡ ‰ÓÒÚ‡Ú˙˜Ì‡ ‡ÌÚËÍÓ‡„ÛÎ‡ˆËfl. á‡ Ò˙Ê‡ÎÂÌËÂ,ÌÂÔÓ‚ÎËfl‚‡ÌÂÚÓ Ì‡ ÔÓÍ‡Á‡ÚÂÎËÚÂ Ì‡ Í˙‚ÓÒ˙ÒË‚‡ÌÂÓÚ ÔÓ„ÂÒË‚ÌÓ Û‚ÂÎË˜‡‚‡ÌË ‰ÓÁË Sintrom Ì‡Î‡„‡ ÓÚÍ‡ÁÓÚ ÌÂ„Ó Ë ÒÏflÌ‡Ú‡ ÏÛ Ò ÌËÒÍÓÏÓÎÂÍÛÎÂÌ ıÂÔ‡ËÌ. é·flÒ-ÌÂÌËÂ Á‡ ÌÂÂÙÂÍÚË‚ÌÓÒÚÚ‡ Ì‡ ÏÂ‰ËÍ‡ÏÂÌÚ‡ ÏÓÊÂ ‰‡ÒÂ Ú˙ÒË ‚˙‚ ‚˙ÁÏÓÊÌÓÒÚÚ‡ ÍÛÏ‡ËÌÓ‚ËÚÂ ‡ÌÚËÍÓ‡-„ÛÎ‡ÌÚË Í‡ÚÓ ‡ÌÚ‡„ÓÌËÒÚË Ì‡ Vit.K ‰‡ ÔÓÌËÊ‡‚‡ÚÍÓÌˆÂÌÚ‡ˆËflÚ‡ Ë ‡ÍÚË‚ÌÓÒÚÚ‡ Ì‡ Protein C Ë ProteinS.

Ç Á‡ÍÎ˛˜ÂÌËÂ, ÔË Ì‡ÎË˜ËÂ Ì‡ ÚÓÏ·ÓÚË˜ÌË ËÚÓÏ·ÂÏ·ÓÎË˜ÌË ËÌˆË‰ÂÌÚË ÔË ÏÎ‡‰Ë ·ÓÎÌË, ÓÒÓ·ÂÌÓÂˆË‰Ë‚Ë‡˘Ë, Úfl·‚‡ ‰‡ ÒÂ ËÁÒÎÂ‰‚‡ Ë F V Leiden –Â‰ËÌ ÔÓ-Ï‡ÎÍÓ ÔÓÔÛÎflÂÌ, ÌÓ Ú‚˙‰Â ‡ÁÔÓÒÚ‡ÌÂÌÔ‡ÚÓ„ÂÌ Á‡ ÚÓÏ·ÓÙËÎËfl.

ãàíÖêÄíìêÄ1. Allroggen A., Dittrich R., Ritter M., et al. Homozygosity for Factor V Leidenmutation and ischemic stroke: two case-reports and review of the literature.J.Neurol, 2004; 251:1406-1407.2. Baglin T., Luddington R., Brown K., et al. Incidence of recurrent venousthromboembolism in relation to clinical and thrombophilic risk factors: prospectivecohort study. Lancet, 2003; 362:523-526.3. Bertina R.M, Koeleman B.P., Koster T., et al. Mutation in blood coagulationfactor V associated with resistance to activated protein C. Nature, 1994; 369:64-67.4. Clark P., Twaddle S., Walker J.D., et al. Cost-effectiveness of screening forthe factor V Leiden mutation in pregnant women. Lancet, 2002; 359:1919-1920.5. Gerhardt A., Scharf R.E. Beckmann M.W., et al. Prothrombin and Factor VMutations in Women with a History of Thrombosis during Pregnancy and thePuerperium. N Engl J Med, 2000; 342:374-380.6. Greengard J.S., Eichinger S., Griffin J.H., et al. Variability of thrombosisamong homozygous siblings with resistance to activated protein C due to anArg>Gin mutation in the gene for factor V. N Engl J Med, 1994; 331:1559-1562.7. Kujovich J.L, Factor V Leiden Thrombophilia (Hereditary Resistance toActivated Protein C, Factor V Leiden Mutation). Gene Reviews, 2004; V8. Simoni P., Scudeller A., Girolami A. Factor V Leiden and Thrombophilia.N.Engl.J.Med, 1994; 332:1381-1382.9. Zenz W., Bodo Z., Plotho J., et al. Factor V Leiden and Prothrombin Gene G20210 A Variant in Children with Ischemic Stroke. Thromb Haemost, 1998;80:763-766.

Ä‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËfl:‰Óˆ. ñÂÌÍ‡ ñ‡ÌÍÓ‚‡, ‰.Ï.äÎËÌËÍ‡ ÔÓ çÂ‚ÓÎÓ„ËflìåÅÄã “ñ‡Ëˆ‡ âÓ‡ÌÌ‡”ÛÎ. ÅflÎÓ ÏÓÂ 81527 ëÓÙËflÚÂÎ: 9432 540


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