ISSN 1311-8641 Å˙Î„‡ ÒÍ‡ çÂ‚ ÓÎÓ„Ëﬂ Bulgarian Neurologynevrologiabg.com/wp-content/uploads/2013/05/Tom-7-br.-1-mart-2007.pdfåéçéíÖêÄèàüíÄ ë levetiracetam

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

ë‰ÛÊÂÌËÂ ◊Å˙Î„‡ÒÍÓ ‰ÛÊÂÒÚ‚Ó ÔÓ ÌÂ‚ÓÎÓ„Ëfl“Official Journal of The Bulgarian Society of Neurology

íéå 7 / Åêéâ 1 åÄêí, 2007

VOLUME 7 / NUMBER 1MARCH, 2007

ëöÑöêÜÄçàÖ

éÅáéêà

äãÖíöóçÄ íÖêÄèàü èêà çÖÇêéãéÉàóçàáÄÅéãüÇÄçàüÅ. Ä‚‡ÏÓ‚‡, è. ÑËÏÓ‚‡, Ñ. ÅÓ·Â‚, Ç. ÅÓÊËÌÓ‚‡ . . . . . .4

åéãÖäìãüêçÄ ïÄêÄäíÖêàëíàäÄ à èÄíéÉÖçÖçèéíÖçñàÄãçÄPOLYOMAVIRUS HOMINIS 2 (Çàêìë JC)á. ä˙Î‚‡˜Â‚, ë. ëÎ‡‚Ó‚, à. çÂÌÍÓ‚, é. ä˙ÎÂ‚, Ä. ï‡‰ÊËflÌÂ‚4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

åéçéíÖêÄèàüíÄ ë LEVETIRACETAM (KEPPRA) èêàèÄêñàÄãçà ÖèàãÖèëàà Ç ëÇÖíãàçÄíÄ çÄåÖÑàñàçÄíÄ ÅÄáàêÄçÄ çÄ ÑéäÄáÄíÖãëíÇÄå. ê‡¯Â‚‡, è. ëÚ‡ÏÂÌÓ‚‡ . . . . . . . . . . . . . . . . . . . . . . . .12

éêàÉàçÄãçà ëíÄíàà

çÄêìòÖçàü çÄ áêàíÖãçéäéçëíêìäíàÇçàü èêÄäëàëèêà ãÖäé äéÉçàíàÇçé çÄêìòÖçàÖ à ÑÖåÖçíÖçëàçÑêéå Ç äöëçÄ ÇöáêÄëíê. å‡Ò‡Î‰ÊËÂ‚‡, è. ÄÚ‡Ì‡ÒÓ‚‡, å. ê‡È˜Â‚‡, . . . . . . . . .17

êÄÅéíçÄ èÄåÖí à ÖäáÖäìíàÇEç äéçíêéã èêàèÄñàÖçíà ë åçéÜÖëíÇÖçÄ ëäãÖêéáÄ ãÖäìÇÄçàë èêÖèÄêÄíÄ INTERFERON BETA 1bå. ê‡È˜Â‚‡, ã.í‡ÈÍÓ‚, ò. åÂı‡·Ë‡Ì, à. èÂÚÓ‚‡, ï.äÛ¯ÍÓ‚, ë. ë‡‡ÙÓ‚, Ä. ÄÌ‰ÂÂ‚‡, ë. Ç‡ÌÂ‚‡, Ñ. ëÚÓËÎÓ‚‡, ç. çËÍÓÂ‚ÒÍË, è. òÓÚÂÍÓ‚ . . . . . . . . . . .22

äéÉçàíàÇÖç ÖîÖäí çÄ éäëäÄêÅÄáÖèàç èêà èÄñàÖçíà ë îéäÄãçÄ ÖèàãÖèëàü ê. ÇÂÎËÁ‡Ó‚‡, ã. í‡ÈÍÓ‚ . . . . . . . . . . . . . . . . . . . . . . . .26

EîÖäíàÇçéëí à èéçéëàåéëí èêà ãÖóÖçàÖ çÄêÄáãàóçà íàèéÇÖ ÖèàãÖèëàü ì ÑÖñÄ ë CONVULEX CHRONO / SODIUM VALPROATE/ à. ãËÚ‚ËÌÂÌÍÓ Ñ.ïËÒÚÓ‚‡ . . . . . . . . . . . . . . . . . . . . .29

éèàëÄçàÖ çÄ äãàçàóçà ëãìóÄà

éëéÅÖçéëíà çÄ äéÉçàíàÇçàü èêéîàã èêà åìãíàëàëíÖåçÄ Äíêéîàüå. èÂÚÓ‚‡, ã. í‡ÈÍÓ‚, å. ê‡È˜Â‚‡, ò. åÂı‡·Ë‡Ì, ü. ÜÂÎÂ‚, Ñ. å‡ÒÎ‡Ó‚ . . . . . . . . . . . . . .33

äéçëEçëìë . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48

CONTENTS

REVIEWS

CELL THERAPY IN NEUROLOGICAL DISEASESB. Avramova, P. Dimova, Dr. Bobev, V. Bojinova . . . . . . . . .4

åéLECULAR CHARACTERISTICS AND PATHOGENETICPOTENTIALOF POLYOMAVIRUS HOMINIS 2 (JC VIRUS)Z. Kalvatchev, S. Slavov, I. Nenkov, é. Kalev3, A. Hadjianev4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

LEVETIRACETAM MONOTHERAPY IN PARTIAL EPILEPSIES IN THE LIGHT OF EVIDENCE-BASED MEDICINEM. Rascheva, P. Stamenova . . . . . . . . . . . . . . . . . . . . . . . .12

ORIGINAL PAPERS

IMPAIRMENTS OF VISUOCONSTRUCTIVE PRAXIS IN MILD COGNITIVE IMPAIRMENT (MCI) AND LATE LIFE DEMENTIA SYNDROMER. å‡ss‡ldjieva, P. Ätanassova, å. R‡ycheva . . . . . . . . . .17

WORKING MEMORY AND EXECUTIVE FUNCTIONS INPATIENTS WITH MULTIPLE SCLEROSIS TREATED WITHINTERFERON BETA 1 bM. Raycheva, L. Traykov, S. Mehrabian, I. Petrova, H. Krushkov, S. Sarafov, A. Andreeva,S. Vaneva, D. Stoilova, N. Nikoevsky, P. Shotekov . . . . . . . . . . . . . . .22

COGNITIVE EFFECT OF OXCARBAZEPINE IN PATIENTS WITH FOCAL EPILEPSYR. Velizarova, L. Traykov . . . . . . . . . . . . . . . . . . . . . . . . . .26

EFFECTIVENESS AND TOLERABILITY OF THERAPY FOR DIFFERENT TYPE OF EPILEPSY IN CHILDREN WITH CONVULEX CHRONO I. Litvinenko, D. Hristova . . . . . . . . . . . . . . . . . . . . . . . . .29

CASE REPORT

SPECIFICS OF THE COGNITIVE PROFILE IN MULTIPLE SYSTEM ATROPHYM. Petrova, L. Traykov, M. Raycheva, S. Mehrabian, Y. Jelev, D. Maslarov . . . . . . . . . . . . . . . . . .33

CONCENSUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48

ISSN 1311-8641

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

ë‰ÛÊÂÌËÂ ◊Å˙Î„‡ÒÍÓ ‰ÛÊÂÒÚ‚Ó ÔÓ ÌÂ‚ÓÎÓ„Ëfl“Official Journal of The Bulgarian Society of Neurology

êÖÑÄäñàéççÄ äéãÖÉàü

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EDITORS

Alexiev A. Sofia

Baldaranov D. Sofia

Bojinov St. Pleven

Bojinoba V. Sofia

Vassileva E. Sofia

Vassileva T. Plovdiv

Ganeva G. Sofia

Georgiev D. Sofia

Gerassimov B. Sofia

Gozmanov G. Plovdiv

Grigorova O. Sofia

Deleva N. Varna

Zahariev Z. Plovdiv

Ivanova L. Sofia

Ishpekova B. Sofia

Kolev O. Sofia

Manchev I. St. Zagora

Maslarov D. Sofia

Milanov I. Sofia

Milanova M. Sofia

Minchev D. Varna

Nikoevsky N. Sofia

Petrov I. Sofia

Petrova U. Sofia

Raychev I. Sofia

Rasheva M. Sofia

Stamenov B. Pleven

Titianova E. Sofia

Traykov L. Sofia

Tarnev I. Sofia

Havezova L. Varna

Hadjiev D. Sofia

Hadjipetrova E. Plovdiv

Haralanov L. Sofia

Tzankova Tz. Sofia

Chalakova N. Plovdiv

Charninkova S. Sofia

Shotekov P. Sofia

Yancheva S. Sofia

Publ

ishe

r Col

or S

tudi

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EDITOR IN CHIEF:I. Milanov, P. Stamenova, I. Velcheva SECRETARY:M. Daskalov

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ÔÓ ÒÎÂ‰ÌËfl Ì‡˜ËÌ:

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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‰‡-

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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‡

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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-

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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 neurology

-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:

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

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

1104.

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

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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.

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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

ëöÑöêÜÄçàÖ

éÅáéêà

äãÖíöóçÄ íÖêÄèàü èêà çÖÇêéãéÉàóçàáÄÅéãüÇÄçàüÅ. Ä‚‡ÏÓ‚‡, è. ÑËÏÓ‚‡, Ñ. ÅÓ·Â‚, Ç. ÅÓÊËÌÓ‚‡ . .4

åéãÖäìãüêçÄ ïÄêÄäíÖêàëíàäÄ àèÄíéÉÖçÖç èéíÖçñàÄãçÄPOLYOMAVIRUSHOMINIS 2 (Çàêìë JC)á. ä˙Î‚‡˜Â‚, ë. ëÎ‡‚Ó‚, à. çÂÌÍÓ‚, é. ä˙ÎÂ‚, Ä. ï‡‰ÊËflÌÂ‚4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

åéçéíÖêÄèàüíÄ ë LEVETIRACETAM (KEPPRA)èêà èÄêñàÄãçà ÖèàãÖèëàà Ç ëÇÖíãàçÄíÄçÄ åÖÑàñàçÄíÄ ÅÄáàêÄçÄ çÄÑéäÄáÄíÖãëíÇÄå. ê‡¯Â‚‡, è. ëÚ‡ÏÂÌÓ‚‡ . . . . . . . . . . . . . . . . . . . .12

éêàÉàçÄãçà ëíÄíàà

çÄêìòÖçàü çÄ áêàíÖãçéäéçëíêìäíàÇçàüèêÄäëàë èêà ãÖäé äéÉçàíàÇçé çÄêìòÖçàÖà ÑÖåÖçíÖç ëàçÑêéå Ç äöëçÄ ÇöáêÄëíê. å‡Ò‡Î‰ÊËÂ‚‡, è. ÄÚ‡Ì‡ÒÓ‚‡, å. ê‡È˜Â‚‡, . . . .17

êÄÅéíçÄ èÄåÖí à ÖäáÖäìíàÇEç äéçíêéãèêà èÄñàÖçíà ë åçéÜÖëíÇÖçÄ ëäãÖêéáÄãÖäìÇÄçà ë èêÖèÄêÄíÄ INTERFERON BETA 1bå. ê‡È˜Â‚‡, ã.í‡ÈÍÓ‚, ò. åÂı‡·Ë‡Ì, à. èÂÚÓ‚‡,ï. äÛ¯ÍÓ‚, ë. ë‡‡ÙÓ‚, Ä. ÄÌ‰ÂÂ‚‡, ë. Ç‡ÌÂ‚‡, Ñ. ëÚÓËÎÓ‚‡, ç. çËÍÓÂ‚ÒÍË, è. òÓÚÂÍÓ‚ . . . . . .22

äéÉçàíàÇÖç ÖîÖäí çÄ éäëäÄêÅÄáÖèàç èêà èÄñàÖçíà ë îéäÄãçÄ ÖèàãÖèëàü ê. ÇÂÎËÁ‡Ó‚‡, ã. í‡ÈÍÓ‚ . . . . . . . . . . . . . . . . . . . .26

EîÖäíàÇçéëí à èéçéëàåéëí èêà ãÖóÖçàÖçÄ êÄáãàóçà íàèéÇÖ ÖèàãÖèëàü ì ÑÖñÄ ë CONVULEX CHRONO / SODIUM VALPROATE/ à. ãËÚ‚ËÌÂÌÍÓ Ñ.ïËÒÚÓ‚‡ . . . . . . . . . . . . . . . .29

éèàëÄçàÖ çÄ äãàçàóçà ëãìóÄà

éëéÅÖçéëíà çÄ äéÉçàíàÇçàü èêéîàã èêà åìãíàëàëíÖåçÄ Äíêéîàüå. èÂÚÓ‚‡, ã. í‡ÈÍÓ‚, å. ê‡È˜Â‚‡, ò. åÂı‡·Ë‡Ì, ü. ÜÂÎÂ‚, Ñ. å‡ÒÎ‡Ó‚ . . . . . . . . .33

çéÇÄ PSEN1 åìíÄñàü èêà ÅöãÉÄêëäÄîÄåàãàü ë êÄççé çÄóÄãé à ÄíàèàóçÄäãàçàóçÄ äÄêíàçÄã. í‡ÈÍÓ‚, ò. åÂı‡·Ë‡Ì, Ä. âÓ‰‡ÌÓ‚‡, å. ê‡È˜Â‚‡,ê. ê‡‰ÂÏ‡ÍÂ, å äÛÚÒ, Ñ. å‡ÒÎ‡Ó‚, à. äÂÏÂÌÒÍË,ä. Ç‡Ì ÅÓÂÍıÓ‚ÂÌ . . . . . . . . . . . . . . . . . . . . . . . . . .36

çéÇÄ PSEN2 (Cys391Arg) åìíÄñàü èêàèÄñàÖçí ëöë ëèéêÄÑàóçÄ ÅéãÖëí çÄÄãñïÄâåÖê ë êÄççé çÄóÄãéã. í‡ÈÍÓ‚, ò. åÂı‡·Ë‡Ì, Ä. âÓ‰‡ÌÓ‚‡, É. çËÍÓÎÓ‚‡, à. ê‡È˜Â‚, å. ê‡È˜Â‚‡, ê ê‡‰ÂÏ‡ÍÂ, å. äÛÚÒ, à. äÂÏÂÌÒÍË, ä Ç‡Ì ÅÓÂÍıÓ‚ÂÌ . . . . .41

àçîéêåÄñàà à êÖñÖçáàà

53 ÉéÑàòçÄ çÄìóçÄ ëêÖôÄ çÄ ÄåÖêàäÄçë-äÄíÄ ÄëéñàÄñàü èé çÖÇêéåìëäìãçÄ àÖãÖäíêéÑàÄÉçéëíàóçÄ åÖÑàñàçÄ(AANEM) ÇöÇ ÇÄòàçÉíéç . . . . . . . . . . . . . . . .45

áÄ èêéî. óÄãåÄçéÇ – IN MEMORIAM . . . . .46

äéçëEçëìë ◊ ÑàÄÉçéëíàäÄ, êÖïÄÅàãàíÄ-ñàü, ãÖóÖçàÖ à ÄÑåàçàëíêàêÄçÖ çÄ ÑÖñÄë ñÖêÖÅêÄãçÄ èÄêÄãàáÄ“ . . . . . . . . . . . . . . . .48

CONTENTS

REVIEWS

CELL THERAPY IN NEUROLOGICAL DISEASESB. Avramova, P. Dimova, Dr. Bobev, V. Bojinova . . . .4

åéLECULAR CHARACTERISTICS AND PATHOGENETIC POTENTIALOF POLYOMAVIRUSHOMINIS 2 (JC VIRUS)Z. Kalvatchev, S. Slavov, I. Nenkov, é. Kalev3, A. Hadjianev4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

LEVETIRACETAM MONOTHERAPY IN PARTIAL EPILEPSIES IN THE LIGHT OF EVIDENCE-BASED MEDICINE

M. Rascheva, P. Stamenova . . . . . . . . . . . . . . . . . . .12

ORIGINAL PAPERS

IMPAIRMENTS OF VISUOCONSTRUCTIVE PRAXIS IN MILD COGNITIVE IMPAIRMENT (MCI) AND LATE LIFE DEMENTIA SYNDROMER. å‡ss‡ldjieva, P. Ätanassova, å. R‡ycheva . . . . .17

WORKING MEMORY AND EXECUTIVE FUNC-TIONS IN PATIENTS WITH MULTIPLE SCLEROSISTREATED WITH INTERFERON BETA 1bM. Raycheva, L. Traykov, S. Mehrabian, I. Petrova, H. Krushkov, S. Sarafov, A. Andreeva,S. Vaneva, D. Stoilova, N. Nikoevsky, P. Shotekov . . . . . . . . . .22

COGNITIVE EFFECT OF OXCARBAZEPINE IN PATIENTS WITH FOCAL EPILEPSYR. Velizarova, L. Traykov . . . . . . . . . . . . . . . . . . . . .26

EFFECTIVENESS AND TOLERABILITY OF THERAPY FOR DIFFERENT TYPE OF EPILEPSY IN CHILDREN WITH CONVULEX CHRONO I. Litvinenko, D. Hristova . . . . . . . . . . . . . . . . . . . .29

CASE REPORT

SPECIFICS OF THE COGNITIVE PROFILE IN MULTIPLE SYSTEM ATROPHYM. Petrova, L. Traykov, M. Raycheva, S. Mehrabian, Y. Jelev, D. Maslarov . . . . . . . . . . . . .33

NOVEL PSÖN1 MUTATTION IN A BULGARIANFAMILY PRESENTING WITH ATYPICAL EARLYONSET ALZHEIMER’S DISEASEL. Traykov, S. Mehrabian, A. Jordanova, M. Raycheva, R. Rademakers, M. Cruts, D. Maslarov, I. Kremensky, C. Van Broeckhoven . . . . . . . . . . . . . . . . . . . . . . . . .36

A NOVEL (Cys391Arg) PSEN2 MUTATTION IN A PATIENT WITH SPORADIC EARLY ONSETALZHEIMER DISEASEL. Traykov, S. Mehrabian, A. Jordanova, G. Nikolova, I. Raychev, M. Raycheva, R. Rademakers, M. Cruts, I. Kremensky, C. Van Broeckhoven . . . . . .41

INFORMATION AND ASSESSMENT

53 TH STUDY MEETINGS OF AMERICAN ASSOCIATE NEUROLOGICAL AND ELECTRO CARDIO MEDICINE IN WASHINGTON D.C. . . . . . . . . . . . . . . . . . . . . . .45

IN MEMORIAM - PROF. CHALMANOV . . . . . . .46

CONCENSUS

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48

SUMMARYCELL THERAPY IN NEUROLOGICAL DISEASES

B. Avramova1, P. Dimova2, Dr. Bobev1, V. Bojinova2

1Specialized Hospital for Children with OncohaematologicalDiseases - Sofia

2Clinic of Child Neurology, St. Naum University Hospital ofNeurology and Psychiatry - Sofia

Cell therapy is one of the most modern directions in todaymedical practice with a great potential for development andimprovement. In recent years, the scope of its use in variousdiseases is rapidly expanding. Especially attractive is the useof different stem cell types in the treatment of several seriousmalignant and benign disorders, including neurological, afterexhaustion of the options of their conventional therapy. Forthe success of such treatment is important to extensively studythe biology of stem cells, their types and potency, as well astheir possibility to transdifferentiate in different from the orig-inal cell lines. In the last decade, experimental studies on theefficacy of transplantations of embryonic and adult stem cellsin severe neurological disorders in children and adults areworldwide going on. The results of these studies convincing-ly demonstrate that best results could be expected from trans-plantations of embryonic stem cells or adult progenitors of thebrain cells.

KEY WORDS: transplantation, stem cells, haematopoietic,neurological diseases.

êÖáûåÖ

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äãûóéÇà Ñìåà: Ú‡ÌÒÔÎ‡ÌÚ‡ˆËfl, ÒÚ‚ÓÎÓ‚Ë ÍÎÂÚÍË, ıÂÏÓÔÓÂÚË˜ÌË, ÌÂ‚ÓÎÓ„Ë˜ÌË Á‡·ÓÎfl‚‡ÌËfl.

ÇöÇÖÑÖçàÖ

èÂÁ ÔÓÒÎÂ‰ÌËÚÂ „Ó‰ËÌË ÒÂ ÔÓÚ‚˙‰Ë ÔÂ‰ÔÓÎÓÊÂÌËÂ-ÚÓ, ˜Â ‚ ˜Ó‚Â¯ÍÓÚÓ ÚflÎÓ Ò˙˘ÂÒÚ‚Û‚‡Ú ÍÎÂÚÍË, ÒÔÓÒÓ·-ÌË ‰‡ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡Ú Ú‡‚Ï‡ÚË˜ÌÓ Ë ·ÓÎÂÒÚÌÓ Û‚Â‰ÂÌËÚ˙Í‡ÌË – Ú.Ì‡. ÒÚ‚ÓÎÓ‚Ë ÍÎÂÚÍË. íÂ ·flı‡ ËÁÓÎË‡ÌË ÓÚ‡ÁÎË˜ÌË Ú˙Í‡ÌË, ÓÚ Í˙‚ ÓÚ Ô˙ÔÌ‡ ‚˙‚ Ë ‰Û„Ë ËÁÚÓ˜-ÌËˆË, Ë ·flı‡ ÓÒ˙˘ÂÒÚ‚ÂÌË Â‰Ëˆ‡ ÂÍÒÔÂËÏÂÌÚ‡ÎÌË ÔÓ-Û˜‚‡ÌËfl Ì‡ ÒÔÓÒÓ·ÌÓÒÚÚ‡ ËÏ Á‡ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂ Ì‡ Ú˙Í‡-ÌËÚÂ, ÓÚ ÍÓËÚÓ ÔÓËÁıÓÊ‰‡Ú, Á‡ Ú‡ÌÒÙÓÏ‡ˆËfl ‚ ‰Û-„Ë ÍÎÂÚ˙˜ÌË ÚËÔÓ‚Â Ë Á‡ ÔËÎÓÊÂÌËÂÚÓ ËÏ ÔË ÎÂ˜ÂÌËÂÌ‡ ‡ÁÎË˜ÌË Á‡·ÓÎfl‚‡ÌËfl.

éÚÒÍÓÓ ‚ Å˙Î„‡Ëfl Á‡ÔÓ˜Ì‡ ÔËÎÓÊÂÌËÂÚÓ Ì‡ Ú‡Ì-ÒÔÎ‡ÌÚ‡ˆËfl Ì‡ Ì‡È-‰ÓÒÚ˙ÔÌËÚÂ ÒÚ‚ÓÎÓ‚Ë ÍÎÂÚÍË (ÍÓÒÚ-ÌÓÏÓÁ˙˜ÌËÚÂ) ÔË Á‡·ÓÎfl‚‡ÌËfl, ‡ÁÎË˜ÌË ÓÚ ıÂÏ‡ÚÓÎÓ-„Ë˜ÌËÚÂ, Ì‡Ô. ‚Ó‰ÂÌË Ë ÔË‰Ó·ËÚË ÌÂ‚ÓÎÓ„Ë˜ÌË. Ç „Ó-ÎflÏ‡ ˜‡ÒÚ ÓÚ ÒÎÛ˜‡ËÚÂ ÚÓ‚‡ Ò‡ Ú‚˙‰Â “ÂÍÒÔÂËÏÂÌ-Ú‡ÎÌË” ÚÂ‡ÔÂ‚ÚË˜ÌË ÏÂÚÓ‰Ë, Á‡ ÍÓËÚÓ ÌflÏ‡ ÛÚ‚˙‰Â-ÌË ÍËÚÂËË Ë ÒÚ‡Ì‰‡ÚËÁË‡ÌË ÓÔÂ‡ÚË‚ÌË ÔÓÚÓÍÓÎË,‡ ‚ ÌflÍÓË ÒÎÛ˜‡Ë Â ‰ÓÍ‡Á‡Ì‡ ÌÂÂÙÂÍÚË‚ÌÓÒÚÚ‡ ËÏ. Ç˙Á-ÌËÍ‚‡ ‚˙ÔÓÒ˙Ú, ‰ÓÍÓÎÍÓ ÚÂÁË ÂÍÒÔÂËÏÂÌÚ‡ÎÌË ÏÂÚÓ-‰Ë, ÌÂ·‡ÁË‡ÌË Ì‡ ‰ÓÍ‡Á‡ÚÂÎÒÚ‚‡, Ò‡ Ò˙‚ÏÂÒÚËÏË Ò ÎÂÍ‡-ÒÍ‡Ú‡ ÂÚËÍ‡ Ë ÔËÌˆËÔËÚÂ Ì‡ Ò˙‚ÂÏÂÌÌ‡Ú‡ ÏÂ‰ËˆËÌÒ-Í‡ Ì‡ÛÍ‡ Ë Ô‡ÍÚËÍ‡. á‡ ‰‡ ÔÓÚ‚˙‰ËÏ ÚÓ‚‡ Ò Ù‡ÍÚË, ˘ÂÔÂ‰ÒÚ‡‚ËÏ Ì‡Í‡ÚÍÓ ‰‡ÌÌË Á‡ ÂÒÚÂÒÚ‚ÓÚÓ, ‚Ë‰Ó‚ÂÚÂ Ë·ËÓÎÓ„Ë˜ÌÓÚÓ ÔÓ‚Â‰ÂÌËÂ Ì‡ ÒÚ‚ÓÎÓ‚ËÚÂ ÍÎÂÚÍË, ÛÚ‚˙-‰ÂÌËÚÂ Ó·Î‡ÒÚË Ì‡ ÚflıÌÓÚÓ ÔËÎÓÊÂÌËÂ Ë ÂÍÒÔÂËÏÂÌ-Ú‡ÎÌËÚÂ ÔÓÛ˜‚‡ÌËfl Ì‡ ‚˙ÁÏÓÊÌÓÒÚËÚÂ Á‡ ËÁÔÓÎÁ‚‡ÌÂ-ÚÓ ËÏ ÔË ÎÂ˜ÂÌËÂÚÓ Ì‡ ÌÂ‚ÓÎÓ„Ë˜ÌË Á‡·ÓÎfl‚‡ÌËfl.

ïÄêÄäíÖêàëíàäÄ çÄ ëíÇéãéÇàíÖ äãÖíäà

ëÚ‚ÓÎÓ‚ËÚÂ ÍÎÂÚÍË Ò‡ ÛÌËÍ‡ÎÌ‡ ÔÓÔÛÎ‡ˆËfl ÌÂ‰ËÙÂ-ÂÌˆË‡ÌË ÍÎÂÚÍË, ÍÓËÚÓ ËÏ‡Ú ‰‚Â ÓÒÌÓ‚ÌË Í‡˜ÂÒÚ‚‡ –‚˙ÁÔÓËÁ‚ÂÊ‰‡Ú ÒÂ ‚ Ë‰ÂÌÚË˜ÌË ÍÓÔËfl Ë ÒÂ ‰ËÙÂÂÌˆË-‡Ú ‰Ó ÔÓ-ÁÂÎË ÍÎÂÚÍË, ËÁ„‡Ê‰‡˘Ë ˜Ó‚Â¯ÍËÚÂ Ú˙Í‡ÌËË Ó„‡ÌË. éÚÍË‚‡Ú ÒÂ Ì‡ ‚ÒË˜ÍË ÂÚ‡ÔË ÓÚ ‡Á‚ËÚËÂÚÓÌ‡ Ó„‡ÌËÁÏ‡ Ë ÒÎÂ‰ ‡Ê‰‡ÌÂÚÓ Û˜‡ÒÚ‚‡Ú ‚ Â„ÂÌÂ‡ˆËfl-Ú‡ Ì‡ Ú˙Í‡ÌËÚÂ ‚ ÓÚ„Ó‚Ó Ì‡ ÙËÁËÓÎÓ„Ë˜Ì‡ ÍÎÂÚ˙˜Ì‡ Â-Ó„‡ÌËÁ‡ˆËfl, Û‚ÂÊ‰‡ÌÂ ËÎË Á‡·ÓÎfl‚‡ÌÂ (2,25).

íÂ ·Ë‚‡Ú ‰‚‡ ‚Ë‰‡ – ÂÏ·ËÓÌ‡ÎÌË (Öëä), ÔÎÛËÔÓÚÂ-ÌÚÌË, ÍÓËÚÓ ÒÂ ‰ËÙÂÂÌˆË‡Ú ÔÂÁ ÂÏ·ËÓÌ‡ÎÌËfl ÔÂËÓ‰‚ ÍÎÂÚ˙˜ÌË ÎËÌËË, ËÁ„‡Ê‰‡˘Ë ÚËÚÂ „ÂÏËÌ‡ÎÌË ÒÎÓflÌ‡ Á‡Ó‰Ë¯‡, Ë ‡‰ÛÎÚÌË (Äëä), ÍÓËÚÓ Ò˙˘ÂÒÚ‚Û‚‡Ú ‚ ˜Ó-‚Â¯ÍËfl Ó„‡ÌËÁ˙Ï ÔÂÁ ˆÂÎËfl ÏÛ ÊË‚ÓÚ Ë ÒÂ ‰ËÙÂÂÌˆË-‡Ú ‚ ÚÓ˜ÌÓ ÓÔÂ‰ÂÎÂÌË ÚËÔÓ‚Â ÒÓÏ‡ÚË˜ÌË ÍÎÂÚÍË, ËÁ„-‡Ê‰‡˘Ë ÓÔÂ‰ÂÎÂÌË Ú˙Í‡ÌË. íÂ Ò‡ ÏÛÎÚËÔÓÚÂÌÚÌË ËÌflÏ‡Ú ÔÓÚÂÌˆË‡Î Á‡ ‰ËÙÂÂÌˆË‡ˆËfl ‚ ÍÎÂÚÍË, ËÁ„‡Ê‰‡-˘Ë ‰Û„Ë Ú˙Í‡ÌË (24). í‡ÍË‚‡ Ò‡ Ì‡Ô. ıÂÏÓÔÓÂÚË˜ÌËÚÂ(ïëä), ÓÚ ÍÓËÚÓ ÔÓËÁıÓÊ‰‡Ú ‚ÒË˜ÍË Í˙‚ÌË ÍÎÂÚÍË;„‡ÒÚÓËÌÚÂÒÚËÌ‡ÎÌËÚÂ, ÓÒ˙˘ÂÒÚ‚fl‚‡˘Ë Â„ÂÌÂ‡ˆËfl-Ú‡ Ì‡ „‡ÒÚÓËÌÚÂÒÚËÌ‡ÎÌËÚÂ ÍÎÂÚ˙˜ÌË ÎËÌËË; ÒÚ‚ÓÎÓ-‚ËÚÂ ÍÎÂÚÍË, ÓÚ„Ó‚ÓÌË Á‡ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂ Ì‡ ÂÔË‰Â-Ï‡ÎÌËfl ÒÎÓÈ Ì‡ ÍÓÊ‡Ú‡; ÔÂÍÛÒÓËÚÂ Ì‡ „ÂÏËÌ‡ÚË‚ÌË-ÚÂ ÍÎÂÚÍË; ÌÂ‚‡ÎÌËÚÂ (çëä), ‰‡‚‡˘Ë Ì‡˜‡ÎÓÚÓ Ì‡ ÌÂ‚-ÓÌË, ‡ÒÚÓˆËÚË Ë ÓÎË„Ó‰ÂÌ‰ÓˆËÚË Ë ‰. ÇÒË˜ÍË ÚÂÁË‚Ë‰Ó‚Â ÍÎÂÚÍË Ò‡ ÌÂ‰ËÙÂÂÌˆË‡ÌË ÍÎÂÚÍË ‚ ‰ËÙÂÂÌˆË-‡ÌË Ú˙Í‡ÌË Ë Û˜‡ÒÚ‚‡Ú ‚ Â„ÂÌÂ‡ˆËflÚ‡ ËÏ (8).

Å˙Î„‡ÒÍ‡ çÂ‚ÓÎÓ„Ëfl Bulgarian Neurology 4Ï‡Ú, 2007

é·ÁÓ

äãÖíöóçÄ íÖêÄèàü èêà çÖÇêéãéÉàóçà áÄÅéãüÇÄçàüÅ. Ä‚‡ÏÓ‚‡1, è. ÑËÏÓ‚‡2, Ñ. ÅÓ·Â‚1, Ç. ÅÓÊËÌÓ‚‡2

1ëÔÂˆË‡ÎËÁË‡Ì‡ ·ÓÎÌËˆ‡ Á‡ ‡ÍÚË‚ÌÓ ÎÂ˜ÂÌËÂ Ì‡ ‰Âˆ‡ Ò ÓÌÍÓıÂÏ‡ÚÓÎÓ„Ë˜ÌË Á‡·ÓÎfl‚‡ÌËfl – ëÓÙËfl, ÖééÑ2ÑÂÚÒÍ‡ ÌÂ‚ÓÎÓ„Ë˜Ì‡ ÍÎËÌËÍ‡, ìëÅÄãçè ◊ë‚. ç‡ÛÏ” - ëÓÙËfl

ê‡ÁÎË˜ÌËÚÂ ÒÚ‚ÓÎÓ‚Ë ÍÎÂÚÍË ËÏ‡Ú ‡ÁÎË˜Ì‡ ÒÚÂÔÂÌÌ‡ ÔÓÚÂÌÚÌÓÒÚ, Ú.Â. ‰ËÙÂÂÌˆË‡ˆËÓÌÂÌ ÔÓÚÂÌˆË‡Î. áË-„ÓÚ‡Ú‡ Â Â‰ËÌÒÚ‚ÂÌ‡Ú‡ ÚÓÚËÔÓÚÂÌÚÌ‡ ÍÎÂÚÍ‡, ÓÚ ÍÓ-flÚÓ ÔÓËÁıÓÊ‰‡Ú ‚ÒË˜ÍË ÍÎÂÚÍË ‚ ˜Ó‚Â¯ÍÓÚÓ ÚflÎÓ.Öëä Ò‡ ÔÎÛËÔÓÚÂÌÚÌË Ë ÔËÚÂÊ‡‚‡Ú ÒÔÓÒÓ·ÌÓÒÚ Á‡ ‰Ë-ÙÂÂÌˆË‡ˆËfl ‚ ÂÏ·ËÓÌ‡ÎÌË Ë ÂÍÒÚ‡ÂÏ·ËÓÌ‡ÎÌËÍÎÂÚ˙˜ÌË ÚËÔÓ‚Â. íÂ ‰‡‚‡Ú Ì‡˜‡ÎÓÚÓ Ì‡ ‚ÒË˜ÍË ÒÓÏ‡-ÚË˜ÌË Ë Ì‡ „ÂÏËÌ‡ÚË‚ÌËÚÂ ÍÎÂÚÍË. Äëä Ò‡ ÏÛÎÚËÔÓ-ÚÂÌÚÌË Ë Ò‡ Ò Ó„‡ÌË˜ÂÌË ‚˙ÁÏÓÊÌÓÒÚË Á‡ Ú‡ÌÒ‰ËÙÂ-ÂÌˆË‡ˆËfl ‚ ‡ÁÎË˜ÌË ÓÚ ÓË„ËÌ‡ÎÌËÚÂ Á‡ Úflı ÍÎÂÚ˙˜ÌËÚËÔÓ‚Â. èÓÚÂÌÚÌÓÒÚÚ‡ ÒÚ‡‚‡ ÌÛÎÂ‚‡ ÔË Í‡ÈÌ‡Ú‡ ‰Ë-ÙÂÂÌˆË‡Ì‡ Ë ‚ËÒÓÍÓÒÔÂˆË‡ÎËÁË‡Ì‡ ÍÎÂÚÍ‡. é„‡ÌË˜Â-Ì‡Ú‡ Ú‡ÌÒ‰ËÙÂÂÌˆË‡ˆËfl Ì‡ Äëä ÔÓÚ‚˙Ê‰‡‚‡ Ô‡‡-‰Ë„Ï‡Ú‡ Ì‡ ‡Á‚ËÚËÂÚÓ, ˜Â ÍÎÂÚÍËÚÂ ÒÂ ‡Á‚Ë‚‡Ú ‚ÒÂÔÓ-ÂÒÚËÍÚË‚ÌÓ ‚ ÚflıÌ‡Ú‡ ÎËÌÂÈÌ‡ ÔËÌ‡‰ÎÂÊÌÓÒÚ ‰Ó‰ÂÙËÌËÚË‚ÌÓ Ë ÒÔÂˆËÙË˜ÌÓ ‰ËÙÂÂÌˆË‡ÌË ÍÎÂÚÍË Ì‡Ú˙Í‡ÌËÚÂ (8,16,24,27). ÑÓÍ‡Á‡ÌÓ Â, ˜Â Äëä ÏÓ„‡Ú ‰‡ ÒÂÚ‡ÌÒ‰ËÙÂÂÌˆË‡Ú ÔË ÓÔÂ‰ÂÎÂÌË ÛÒÎÓ‚Ëfl Ò‡ÏÓ ‚ÍÎÂÚÍË Ò ÔÓËÁıÓ‰ ÓÚ Â‰ËÌ Ë Ò˙˘ „ÂÏËÌ‡ÎÂÌ ÒÎÓÈ - Ì‡Ô-ËÏÂ ïëä ÒÂ Ú‡ÌÒ‰ËÙÂÂÌˆË‡Ú ‚ ÏÛÒÍÛÎÌË Ë ‚ ÍÎÂÚ-ÍËÚÂ, ËÁ„‡Ê‰‡˘Ë ·˙·Â˜ÌËÚÂ ÒÚÛÍÚÛË, ‡ çëä – ‚ÂÔË‰ÂÏ‡ÎÌË Ë ÔË„ÏÂÌÚÌË ÍÎÂÚÍË (8).

ïÂÏÓÔÓÂÚË˜ÌËÚÂ ÒÚ‚ÓÎÓ‚Ë ÍÎÂÚÍË, ÍÓËÚÓ Ò‡ ÚÂÏ‡Ì‡ Ì‡ÒÚÓfl˘Ëfl Ó·ÁÓ, Ò‡ ˜‡ÒÚ ÓÚ Ù‡ÏËÎËflÚ‡ Ì‡ Äëä. àÁ-ÚÓ˜ÌËˆË Ì‡ Ú‡ÍË‚‡ ÍÎÂÚÍË Ò‡ ÍÓÒÚÌËflÚ ÏÓÁ˙Í, Í˙‚Ú‡Ë Í˙‚Ú‡ ÓÚ Ô˙ÔÌ‡ ‚ÂÌ‡. íÂ Ò‡ ÓÒÌÓ‚‡Ú‡ Ì‡ ıÂÏÓÔÓÂÚË˜-Ì‡Ú‡ ÈÂ‡ıËfl Ë ‰‡‚‡Ú Ì‡˜‡ÎÓÚÓ Ì‡ ‚ÒË˜ÍË Í˙‚ÌËÍÎÂÚ˙˜ÌË ÎËÌËË ‚˙‚ ‚˙Á‡ÒÚÌËfl Ó„‡ÌËÁ˙Ï. ïëä Ò‡ Â‰ËÌ-ÒÚ‚ÂÌËÚÂ Äëä Ò ÓÚ‰‡‚Ì‡ ÛÚ‚˙‰ÂÌÓ ÚÂ‡ÔÂ‚ÚË˜ÌÓ ÔË-ÎÓÊÂÌËÂ ÔË Á‡·ÓÎfl‚‡ÌËfl Û ˜Ó‚ÂÍ‡. (17,22).

èêéìóÇÄçàü à èêàãéÜÖçàÖ çÄ ëíÇéãéÇàíÖäãÖíäà

èÓÛ˜‚‡ÌÂÚÓ Ì‡ ÒÚ‚ÓÎÓ‚ËÚÂ ÍÎÂÚÍË Á‡ÔÓ˜‚‡ Ò ÓÚÍË-Ú‡Ú‡ ÓÚ Joseph Altman Ë Gopal Das ÔÂÁ 1960 „. ÌÂ‚Ó„Â-ÌÂÁ‡, Ú.Â. Ì‡ÎË˜ËÂ Ì‡ ‡ÍÚË‚ÌË ÒÚ‚ÓÎÓ‚Ë ÍÎÂÚÍË ‚ ÏÓÁ˙Í‡,ÍÓÂÚÓ ÓÔÓ‚Â„‡‚‡ ‰Ó„Ï‡Ú‡, ˜Â ÒÎÂ‰ ‡Ê‰‡ÌÂÚÓ ÌÂ ÏÓ-„‡Ú ‰‡ ÒÂ Ó·‡ÁÛ‚‡Ú ÌÓ‚Ë ÌÂ‚ÓÌË. èÂÁ 1963 „.McCulloch Ë Till ÛÒÚ‡ÌÓ‚fl‚‡Ú Ì‡ÎË˜ËÂ Ì‡ Ò‡ÏÓ‚˙ÁÒÚ‡ÌÓ-‚fl‚‡˘Ë ÒÂ ÍÎÂÚÍË ‚ ÍÓÒÚÌËfl ÏÓÁ˙Í Ì‡ ÏË¯ÍË. íÓ‚‡ ÔÓÁ-‚ÓÎfl‚‡ ÔÂÁ 1968 „. ‰‡ ÒÂ ËÁ‚˙¯Ë Ô˙‚‡Ú‡ ÍÓÒÚÌÓÏÓÁ˙˜-Ì‡ Ú‡ÌÒÔÎ‡ÌÚ‡ˆËfl ÏÂÊ‰Û ‰‚‡Ï‡ ·ÎËÁÌ‡ˆË, Ò ÛÒÔÂ¯ÌÓÔÓ‚ÎËfl‚‡ÌÂ Ì‡ ÚÂÊ˙Í ‚Ó‰ÂÌ ËÏÛÌÂÌ ‰ÂÙËˆËÚ. èÂÁ 1978„. Ò‡ ÓÚÍËÚË ïëä ‚ ˜Ó‚Â¯Í‡ Í˙‚ ÓÚ Ô˙ÔÌ‡ ‚ÂÌ‡. èÂÁ1981 „. ÂÏ·ËÓÌ‡ÎÌË ÒÚ‚ÓÎÓ‚Ë ÍÎÂÚÍË Ò‡ ËÁÓÎË‡ÌË ÓÚ‚˙ÚÂ¯Ì‡Ú‡ ÍÎÂÚ˙˜Ì‡ Ï‡Ò‡ Ì‡ ÏË¯Ë ÂÏ·ËÓÌ, ‡ ÔÂÁ1992 „. Á‡ Ô˙‚Ë Ô˙Ú Ò‡ ÍÛÎÚË‚Ë‡ÌË çëä in vitro. èÂÁ1998 „. Thompson Ë Ò˙Ú. ËÁÓÎË‡Ú Ô˙‚‡Ú‡ ÎËÌËfl ÓÚ ˜Ó-‚Â¯ÍË Öëä ‚ ÛÌË‚ÂÒËÚÂÚ‡ Ì‡ Wisconsin.

íÓ‚‡ Ò‡ ÍÎ˛˜Ó‚ËÚÂ Ò˙·ËÚËfl ‚ ËÁÛ˜‡‚‡ÌÂÚÓ Ì‡ ÒÚ‚ÓÎÓ-‚ËÚÂ ÍÎÂÚÍË, ‰Ó‚ÂÎË ‰Ó ÏÌÓÊÂÒÚ‚Ó ËÁÒÎÂ‰‚‡ÌËfl Ë ÂÍÒÔÂ-ËÏÂÌÚË Á‡ ËÁflÒÌfl‚‡ÌÂ Ì‡ ÚÂıÌËÚÂ ÙÛÌÍˆËË Ë ‚˙ÁÏÓÊ-ÌÓÒÚË ËÏ ÔË ÎÂ˜ÂÌËÂÚÓ Ì‡ ÚÂÊÍË Á‡·ÓÎfl‚‡ÌËfl. íÓ‚‡‚ÂÏÂÌÌÓ Â Á‡ÚÛ‰ÌÂÌÓ ÓÚ Ì‡ÎÓÊÂÌÓÚÓ ÔÂÁ ˛ÎË 2006 „.ÓÚ ‡ÏÂËÍ‡ÌÒÍËfl ÔÂÁË‰ÂÌÚ ÅÛ¯ ‚ÂÚÓ Á‡ ÓÚÔÛÒÍ‡ÌÂ Ì‡ÒÂ‰ÒÚ‚‡ Á‡ ÔÓÛ˜‚‡ÌËfl Ì‡ Öëä ÓÚ ‡ÁÛ¯ÂÌË ÂÏ·ËÓÌË,ÍÓÂÚÓ ‰Ó‚Â‰Â ‰Ó ÒÂËÓÁÌË ‰ËÒÍÛÒËË.

èÂÁ ÔÂËÓ‰‡ 1998 - 2006 „. ËÏ‡ Ì‡‰ 500 ÔÛ·ÎËÍ‡ˆËË Á‡Ú‡ÌÒÔÎ‡ÌÚ‡ˆËË Ì‡ ÒÚ‚ÓÎÓ‚Ë ÍÎÂÚÍË ÔË ÌÂ‚ÓÎÓ„Ë˜ÌËÁ‡·ÓÎfl‚‡ÌËfl, ‰‚Â ÚÂÚË ÓÚ ÍÓËÚÓ Ò‡ ÒÎÂ‰ 2001 „. èÓ‚Â-˜ÂÚÓ ÓÚ Úflı Ò‡ ÔÓÒ‚ÂÚÂÌË Ì‡ ‡‚ÚÓÎÓÊÌËÚÂ ÍÓÒÚÌÓ-ÏÓÁ˙˜ÌË Ú‡ÌÒÔÎ‡ÌÚ‡ˆËË ÔË ÏÌÓÊÂÒÚ‚ÂÌ‡ ÒÍÎÂÓÁ‡(åë) - Â‰ÌÓ ÓÚ ÛÚ‚˙‰ÂÌËÚÂ ÚÂ‡ÔÂ‚ÚË˜ÌË ÔËÎÓÊÂÌËflÌ‡ ïëä.

èÓÍ‡Á‡ÌËflÚ‡ Á‡ Ú‡ÌÒÔÎ‡ÌÚ‡ˆËfl Ì‡ ïëä ÒÔÓÂ‰ Ö‚-ÓÔÂÈÒÍ‡Ú‡ „ÛÔ‡ Á‡ ÍÓÒÚÌÓÏÓÁ˙˜ÌË Ú‡ÌÒÔÎ‡ÌÚ‡ˆËË

(European Group for Blood and Marrow Transplantation –ÖBMT) ‚ÍÎ˛˜‚‡Ú ÒÎÂ‰ÌËÚÂ „ÛÔË Á‡·ÓÎfl‚‡ÌËfl:

ãÂ‚ÍÂÏËË – ÓÒÚ‡ ÎËÏÙÓ·Î‡ÒÚÌ‡, ÓÒÚ‡ ÏËÂÎÓË‰Ì‡,ıÓÌË˜Ì‡ ÏËÂÎÓË‰Ì‡, ÏËÂÎÓ‰ËÒÔÎ‡ÒÚË˜ÂÌ ÒËÌ‰ÓÏ, ÏËÂ-ÎÓÔÓÎËÙÂ‡ÚË‚ÌË ÒËÌ‰ÓÏË, ıÓÌË˜Ì‡ ÎËÏÙÓˆËÚÌ‡

åÛÎÚËÔÎÂÌ ÏËÂÎÓÏ Ë ·ÓÎÂÒÚË Ì‡ ÔÎ‡ÁÏ‡ÚË˜ÌËÚÂÍÎÂÚÍË

● ãËÏÙÓÏË● ëÓÎË‰ÌË ÚÛÏÓË ● ëËÌ‰ÓÏË Ì‡ ÍÓÒÚÌÓÏÓÁ˙˜Ì‡ ÌÂ‰ÓÒÚ‡Ú˙˜ÌÓÒÚ● ïÂÏÓ„ÎÓ·ËÌÓÔ‡ÚËË● àÏÛÌÌË ‰ÂÙËˆËÚË● ÇÓ‰ÂÌË Ì‡Û¯ÂÌËfl Ì‡ ÏÂÚ‡·ÓÎËÁÏ‡● Ä‚ÚÓËÏÛÌÌË Á‡·ÓÎfl‚‡ÌËflá‡ ‚ÒË˜ÍË ÚÂÁË Ú‡ÌÒÔÎ‡ÌÚ‡ˆËË ËÏ‡ ÛÚ‚˙‰ÂÌË ÔÓ-

ÚÓÍÓÎË Á‡ ÔÓ‚ÂÊ‰‡ÌÂÚÓ ËÏ, Á‡ ÔÓÎÛ˜‡‚‡ÌÂ Ì‡ ÍÎÂÚ˙˜ÌËflÏ‡ÚÂË‡Î, Á‡ ÔÓÙËÎ‡ÍÚËÍ‡Ú‡ Ë ÎÂ˜ÂÌËÂÚÓ Ì‡ ÛÒÎÓÊÌÂ-ÌËflÚ‡, Á‡ ÓÚ˜ËÚ‡ÌÂ Ì‡ ÂÁÛÎÚ‡ÚËÚÂ, Í‡ÍÚÓ Ë ÏÌÓ„ÓÒÚÓ„‡ ÓÚ˜ÂÚÌÓÒÚ Ì‡ ÔÓÒÓ˜ÂÌËÚÂ ‰ÂÈÌÓÒÚË.

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ç‡È–ÒÔÓÂÌ, Í‡ÍÚÓ Á‡ Å˙Î„‡Ëfl, Ú‡Í‡ Ë Á‡ ˜‡ÒÚ ÓÚÒ‚ÂÚÓ‚ÌËÚÂ ˆÂÌÚÓ‚Â, ÓÒÚ‡‚‡ ‚˙ÔÓÒ˙Ú, Í‡Í‚Ë ÍÎÂÚÍË‰‡ ÒÂ ËÁÔÓÎÁ‚‡Ú Á‡ Ú‡ÌÒÔÎ‡ÌÚ‡ˆËfl ÔË ÌÂ‚ÓÎÓ„Ë˜ÌË Á‡-·ÓÎfl‚‡ÌËfl. àÏ‡ ÏÌÓÊÂÒÚ‚Ó ÔÛ·ÎËÍ‡ˆËË Á‡ Ú‡ÌÒÔÎ‡ÌÚ‡-ˆËË Ì‡ ‡ÁÎË˜ÌË ÚËÔÓ‚Â ÍÎÂÚÍË. ÑÓÍ‡Á‚‡ ÒÂ ‚ÒÂ ÔÓ-Í‡ÚÂ-„ÓË˜ÌÓ, ˜Â Â‰ËÌÒÚ‚ÂÌÓ Öëä Ò‡ Ò ‚˙ÁÏÓÊÌÓÒÚË Á‡ ‰ËÙÂ-ÂÌˆË‡ˆËfl ‚˙‚ ‚ÒË˜ÍË ÍÎÂÚ˙˜ÌË ÚËÔÓ‚Â. íÂ‡ÔÂ‚ÚË˜ÌÓ-ÚÓ ËÏ ËÁÔÓÎÁ‚‡ÌÂ, Ó·‡˜Â, Â ‚ÒÂ Ó˘Â ÌÂ‚˙ÁÏÓÊÌÓ ÔÓ‡‰ËÚÛ‰ÌÓÒÚË ÔË ËÁÓÎË‡ÌÂÚÓ ËÏ Ë Â‰Ëˆ‡ ÏÓ‡ÎÌÓ-ÂÚË˜-ÌË, ÂÎË„ËÓÁÌË Ë ÔÓÎËÚË˜ÂÒÍË Ó„‡ÌË˜ÂÌËfl. íÓ‚‡ Â ÔË˜Ë-Ì‡Ú‡, Û˜ÂÌËÚÂ ‰‡ Ì‡ÒÓ˜‡Ú ÛÒËÎËflÚ‡ ÒË Í˙Ï ËÁÛ˜‡‚‡ÌÂ Ì‡‚˙ÁÏÓÊÌÓÒÚËÚÂ Á‡ ÚÂ‡ÔÂ‚ÚË˜ÌÓ ËÁÔÓÎÁ‚‡ÌÂ Ì‡ Äëä, ËÌ‡È-‚Â˜Â Ì‡ Ì‡È-ÎÂÒÌËÚÂ Á‡ ËÁÓÎË‡ÌÂ – ïëä. ÇÒÂ ÔÓ‚Â˜ÂˆÂÌÚÓ‚Â ÒÂ Á‡ÌËÏ‡‚‡Ú Ë Ò ÔÓÛ˜‚‡ÌËfl ‚˙ıÛ Ú‡ÌÒÔÎ‡Ì-Ú‡ˆËflÚ‡ Ì‡ ÒÔÂˆËÙË˜ÌËÚÂ Á‡ ÌÂ‚Ì‡Ú‡ ÒËÒÚÂÏ‡ ‡‰ÛÎÚ-ÌË çëä, ÚflıÌÓÚÓ ËÁÓÎË‡ÌÂ, ÔÂ‰Ú‡ÌÒÔÎ‡ÌÚ‡ˆËÓÌÌÓÏ‡ÌËÔÛÎË‡ÌÂ Ë ÔËÎÓÊÂÌËÂ ÔË ‡ÁÎË˜ÌË ÌÂ‚ÓÎÓ„Ë˜ÌËÁ‡·ÓÎfl‚‡ÌËfl.

Ñ‚‡ ÓÚ Ì‡È-¯ËÓÍÓ ÂÍÎ‡ÏË‡˘ËÚÂ ÒÂ ˆÂÌÚÓ‚Â Á‡ÍÎÂÚ˙˜Ì‡ Ú‡ÌÒÔÎ‡ÌÚ‡ˆËfl ÔË ÌÂ‚ÓÎÓ„Ë˜ÌË Á‡·ÓÎfl‚‡-ÌËfl Ò‡ ÛÒÍË – ‚ åÓÒÍ‚‡ Ë çÓ‚ÓÒË·ËÒÍ. éÒÓ·ÂÌÓ Ï‡˘‡·-Ì‡ Â ‰ÂÈÌÓÒÚÚ‡ Ì‡ ÚÓÁË ‚ åÓÒÍ‚‡, ˙ÍÓ‚Ó‰ÂÌ ÓÚ ÔÓÙ.Å˛ıÓ‚ÂˆÍË. ífl, ÒÔÓÂ‰ ‰‡ÌÌËÚÂ ÓÚ ÂÎÂÍÚÓÌÌ‡Ú‡ ÒÚ‡-ÌËˆ‡ Ë ÏÓÌÓ„‡ÙËfl ÓÚ 2003 „., Ó·ı‚‡˘‡ ¯ËÓÍ‡ Ô‡ÎËÚ‡ÓÚ ÚÂ‡ÔÂ‚ÚË˜ÌË Ï‡ÌËÔÛÎ‡ˆËË, ÔÓ‚Â˜ÂÚÓ ‚ËÒÓÍÓÚÂıÌÓ-ÎÓ„Ë˜ÌË (1). ë‡‚ÌËÚÂÎÌÓ „ÓÎflÏ Â ·ÓflÚ Ì‡ Ô‡ˆËÂÌÚËÚÂ,ÌÓ ÒÏÛ˘‡‚‡˘Ó Â, ˜Â ÚÓÁË ˆÂÌÚ˙ ÌflÏ‡ ÔÛ·ÎËÍ‡ˆËË ‚ ÌË-ÚÓ Â‰ÌÓ ÓÚ ‚Ó‰Â˘ËÚÂ ÒÔÂˆË‡ÎËÁË‡ÌË Â‚ÓÔÂÈÒÍË ËÎË‡ÏÂËÍ‡ÌÒÍË ÒÔËÒ‡ÌËfl, ‡ Ò‡ÏÓ ‚ ÛÒÍÓÚÓ ÒÔËÒ‡ÌËÂ “Å˛Î-ÎÂÚËÌ ˝ÍÒÔÂËÏÂÌÚ‡ÎÌÓÈ ·ËÓÎÓ„ËË Ë ÏÂ‰ËˆËÌ˚”. àÌÚÂ-ÂÒÌÓ Â, ˜Â ÏÂÚÓ‰ËÚÂ Ì‡ ÍÎÂÚ˙˜Ì‡ ÚÂ‡ÔËfl, ÍÓËÚÓ ÔÂ‰-Î‡„‡Ú Á‡ Ô‡ˆËÂÌÚËÚÂ Ò ÌÂ‚ÓÎÓ„Ë˜ÌË Á‡·ÓÎfl‚‡ÌËfl,‚ÍÎ˛˜‚‡Ú Ú‡ÌÒÔÎ‡ÌÚ‡ˆËË Ì‡ Öëä ËÎË ‡‰ÛÎÚÌË çëä, ÌÓÔ‡ÍÚË˜ÂÒÍË ÒÂ ÓÒ˙˘ÂÒÚ‚fl‚‡Ú Ò‡ÏÓ Ú‡ÌÒÔÎ‡ÌÚ‡ˆËË Ì‡ÍÓÒÚÌÓÏÓÁ˙˜ÌË ÍÎÂÚÍË, ·ÂÁ ‰‡ ÒÂ ÔÓÒÓ˜‚‡Ú ÍÓÌÍÂÚÌËÂÁÛÎÚ‡ÚË ÓÚ Ú‡ÁË ‰ÂÈÌÓÒÚ. èÓ‡‰Ë ÔÓÒÓ˜ÂÌËÚÂ Ù‡Í-ÚË, Ò˜ËÚ‡ÏÂ, ˜Â Â ÌÂÒÂËÓÁÌÓ ‰‡ ÒÂ ‚˙ÁÔËÂÏ‡Ú ËÎË ÍÓÔË-‡Ú Ú‡ÍË‚‡ ‰ÂÈÌÓÒÚË.

ôÂ ÒÔÂÏ ‚ÌËÏ‡ÌËÂÚÓ ÒË ‚˙ıÛ Ì‡È-ÌÓ‚ËÚÂ ÔÛ·ÎËÍ‡-ˆËË Á‡ ÍÎÂÚ˙˜Ì‡ ÚÂ‡ÔËfl ÔË ÌÂ‚ÓÎÓ„Ë˜ÌË Á‡·ÓÎfl‚‡ÌËfl‚˙‚ ‚Ó‰Â˘ËÚÂ ÌÂ‚ÓÎÓ„Ë˜ÌË, ÌÂ‚ÓıËÛ„Ë˜ÌË Ë Ú‡Ì-ÒÔÎ‡ÌÚ‡ˆËÓÌÌË ÒÔËÒ‡ÌËfl. íÂÁË ÔÛ·ÎËÍ‡ˆËË Ò‡ ‰ÓÒÚ‡ ÔÓ-ÚË‚ÓÂ˜Ë‚Ë.

Ç ÒÚ‡ÚËË, ÔÛ·ÎËÍÛ‚‡ÌË ÔÂÁ ÔÂËÓ‰‡ 2002–2006 „. ‚


ÂÌÓÏË‡ÌË ÏÂ‰ËˆËÌÒÍË ÒÔËÒ‡ÌËfl Í‡ÚÓ Neurosurgery,Journal of Neurosciences, Experimental Neurology, Lancet,Stem Cells Ë ‰. Ò‡ ÔÓÒÓ˜ÂÌË Ò‡‚ÌËÚÂÎÌÓ ‰Ó·Ë ÂÁÛÎÚ‡-ÚË ÓÚ Ú‡ÌÒÔÎ‡ÌÚ‡ˆËflÚ‡ Ì‡ ÍÓÒÚÌÓÏÓÁ˙˜ÌË ÒÚ‚ÓÎÓ‚ËÍÎÂÚÍË ÔË Á‡·ÓÎfl‚‡ÌËfl Ì‡ ÌÂ‚Ì‡Ú‡ ÒËÒÚÂÏ‡ Í‡ÚÓÚ‡‚Ï‡ÚË˜ÌË Û‚ÂÊ‰‡ÌËfl Ì‡ „Î‡‚ÌËfl Ë „˙·Ì‡˜ÌËfl ÏÓÁ˙ÍË ËÒıÂÏË˜ÌË ÏÓÁ˙˜ÌË Á‡·ÓÎfl‚‡ÌËfl.

èÂÁ 2005 „. Tao Ë Ma ÓÚ Vincent's Hospital ‚ ëË‰ÌË,Ä‚ÒÚ‡ÎËfl, Ò˙Ó·˘‡‚‡Ú, ˜Â ‚ ÍÓÒÚÌËfl ÏÓÁ˙Í Ì‡ ‚˙Á‡ÒÚ-ÌËfl ˜Ó‚ÂÍ ËÏ‡ ıÂÚÂÓ„ÂÌÌ‡ ÔÓÔÛÎ‡ˆËfl ÒÚ‚ÓÎÓ‚Ë ÍÎÂÚÍË,ÍÓflÚÓ ÔË ÔÓ‰ıÓ‰fl˘Ë ÂÍÒÔÂËÏÂÌÚ‡ÎÌË Ò˙ÒÚÓflÌËfl ÏÓÊÂ‰‡ ÔÓÍ‡ÊÂ ·ÂÎÂÁË Ì‡ Ú‡ÌÒ‰ËÙÂÂÌˆË‡ˆËfl ‚ ‡ÁÎË˜ÌË ÌÂ-ıÂÏÓÔÓÂÚË˜ÌË ÍÎÂÚÍË Í‡ÚÓ ÏËÓˆËÚË, ÌÂ‚‡ÎÌË ÍÎÂÚÍËË ıÂÔ‡ÚÓˆËÚË (Ú.Â. ÔÎ‡ÒÚË˜ÌÓÒÚ). Ä‚ÚÓËÚÂ ÔÂ‰ÒÚ‡-‚flÚ ‡ÌÌË Ù‡ÁË Ì‡ ÔÓÛ˜‚‡ÌËfl Á‡ ÎÂ˜ÂÌËÂ Ì‡ ÏËÓÍ‡‰ÂÌËÌÙ‡ÍÚ, ‡ÚËÚ Ë ÌÂ‚ÓÎÓ„Ë˜ÌË Á‡·ÓÎfl‚‡ÌËfl Ò ‡‚ÚÓ-ÎÓÊÌË ÍÓÒÚÌÓÏÓÁ˙˜ÌË ÍÎÂÚÍË (26). èÂÁ Ò˙˘‡Ú‡ „Ó‰ËÌ‡Bossolasco Ë Ò˙‡‚Ú. ÔÂ‰ÒÚ‡‚flÚ ÂÁÛÎÚ‡ÚËÚÂ ÒË ÓÚÔÓÛ˜‚‡ÌÂ Ì‡ ÒÔÓÒÓ·ÌÓÒÚÚ‡ Ì‡ ‡‰ÛÎÚÌËÚÂ ÍÓÒÚÌÓÏÓÁ˙˜-ÌË ÔÓ„ÂÌËÚÓÌË ÍÎÂÚÍË ‰‡ ÒÂ ‰ËÙÂÂÌˆË‡Ú ‚ ÌÂ‚Ó„ÎËfl(3). Sigurjonsson Ë Ò˙Ú. Ò˙˘Ó ÔÓÛ˜‚‡Ú ÌÂ‚Ó„ÂÌÌËfl ÔÓ-ÚÂÌˆË‡Î Ì‡ ˜Ó‚Â¯ÍËÚÂ ıÂÏÓÔÓÂÚË˜ÌË ÒÚ‚ÓÎÓ‚Ë ÍÎÂÚÍË,Í‡ÚÓ „Ë ËÏÔÎ‡ÌÚË‡Ú ‚ ÎÂÁËË Ì‡ ‡Á‚Ë‚‡˘ ÒÂ „˙·Ì‡˜ÂÌÏÓÁ˙Í Ì‡ ÍÓÍÓ¯Ë ÂÏ·ËÓÌ (20). Ä‚ÚÓËÚÂ Ô‡‚flÚ Á‡ÍÎ˛-˜ÂÌËÂ, ˜Â ÓÍÓÎÌ‡Ú‡ ÒÂ‰‡ ‚ Â„ÂÌÂË‡˘Ëfl „˙·Ì‡˜ÂÌÏÓÁ˙Í ÒÚËÏÛÎË‡ ÓÔÂ‰ÂÎÂÌ‡ ˜‡ÒÚ ÓÚ ïëä Í˙Ï ‰ËÙÂÂÌ-ˆË‡ˆËfl ‚ ÌÂ‚ÓÌË (20).

èÂÁ 2004 „. Lancet ÔÛ·ÎËÍÛ‚‡ ÂÁÛÎÚ‡ÚËÚÂ ÓÚ ÔÓÛ˜-‚‡ÌÂ Ì‡ ÍÎÂÚ˙˜Ì‡Ú‡ ÔÎ‡ÒÚË˜ÌÓÒÚ Ë ‚˙ÁÏÓÊÌÓÒÚËÚÂ Á‡‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂ Ì‡ „Î‡‚ÌËfl ÏÓÁ˙Í Ò ÍÓÒÚÌÓÏÓÁ˙˜ÌË ÍÎÂÚ-ÍË. ÑÓÍ‡Á‚‡ ÒÂ, ˜Â Û ˜Ó‚ÂÍ‡ Ò˙˘ÂÒÚ‚Û‚‡ ÔÓÒÚÌ‡Ú‡ÎÌ‡ÌÂ‚ÓÔÓÂÁ‡ Ë ˜Â ıÂÏÓÔÓÂÚË˜ÌËÚÂ ÍÎÂÚÍË ÏÓ„‡Ú ‰‡ ÒÂÚ‡ÌÒ‰ËÙÂÂÌˆË‡Ú ‚ ÌÂ‚ÓÌË, ‡ÒÚÓˆËÚË Ë ÏËÍÓ„ÎËfl(4). Ç ÏË¯Ë ÏÓ‰ÂÎ Ì‡ Û‚Â‰‡ Ì‡ „˙·Ì‡˜ÂÌ ÏÓÁ˙Í Ë Ú‡Ì-ÒÔÎ‡ÌÚ‡ˆËfl Ì‡ ïëä Â ÛÒÚ‡ÌÓ‚ÂÌÓ, ˜Â Ú‡ÌÒÔÎ‡ÌÚË‡ÌË-ÚÂ ÍÎÂÚÍË ÂÍÒÔÂÒË‡Ú ÒÔÂˆËÙË˜ÌË Ï‡ÍÂË Ì‡ ÌÂ‚‡ÎÌËÔÂ‰¯ÂÒÚ‚ÂÌËˆË, ÌÓ ÌÂ Ë Ì‡ ÌÂ‚ÓÌË (9).

Ç Ò˙˘ËÚÂ Ë ‰Û„Ë ÂÌÓÏË‡ÌË ÒÔËÒ‡ÌËfl Ô‡Í ÔÂÁ Ò˙-˘Ëfl ÔÂËÓ‰ Ò‡ ÔÛ·ÎËÍÛ‚‡ÌË ÒÚ‡ÚËË Á‡ ÔÓÛ˜‚‡ÌËfl Ò ÔÓ-ÚË‚ÓÔÓÎÓÊÌË ÔÓ ÁÌ‡Í ÂÁÛÎÚ‡ÚË Ë Á‡ÍÎ˛˜ÂÌËfl.

í‡Í‡ Ì‡ÔËÏÂ, ÔÂÁ 2006 „. Roybon Ë Ò˙‡‚Ú. ÓÔËÒ‚‡ÚÔÓÛ˜‚‡ÌÂ Ì‡ ‚˙ÁÏÓÊÌÓÒÚËÚÂ Á‡ ÒÚËÏÛÎË‡ÌÂ Ì‡ Ú‡ÌÒ-‰ËÙÂÂÌˆË‡ˆËflÚ‡ Ì‡ ‚ËÒÓÍÓÔÂ˜ËÒÚÂÌË ÏË¯Ë ‡‰ÛÎÚÌËïëä ‚ ÌÂ‚ÓÌË (18). èË ÓÚ„ÎÂÊ‰‡ÌÂ Ì‡ ÚÂÁË ÍÎÂÚÍË invitro Á‡Â‰ÌÓ Ò ÌÂ‚‡ÎÌË ÔÂÍÛÒÓË ËÎË ÔË Ú‡ÌÒÔÎ‡ÌÚË-‡ÌÂÚÓ ËÏ ‚ striatum ËÎË cerebellum Ì‡ ÏË¯ÍË ÚÂ ÒÂ ‰ËÙÂ-ÂÌˆË‡ÎË ‰Ó Ï‡ÍÓÙ‡„Ë/ÏËÍÓ„ÎËfl ËÎË Á‡„Ë‚‡ÎË. ë ÚÂÁËÂÁÛÎÚ‡ÚË ‡‚ÚÓËÚÂ ‰ÓÍ‡Á‚‡Ú, ˜Â ‡‰ÛÎÚÌËÚÂ ïëä Ìfl-Ï‡Ú Í‡Ô‡ˆËÚÂÚ ‰‡ ÒÏÂÌflÚ ıÂÏÓÔÓÂÚË˜Ì‡Ú‡ ÒË ÔËÌ‡‰-ÎÂÊÌÓÒÚ Ë ‰‡ ÒÂ ‰ËÙÂÂÌˆË‡Ú ‚ ÌÂ‚ÓÌË (18).

èÂÁ 2005 „. Massengale M. Ë Ò˙Ú. ÔÛ·ÎËÍÛ‚‡Ú ÂÁÛÎ-Ú‡ÚËÚÂ ÒË ÓÚ ÚÂÒÚ, ÔÓ‚Â‰ÂÌ Á‡ ÔÓÚ‚˙Ê‰‡‚‡ÌÂ ËÎËÓÚı‚˙ÎflÌÂ Ì‡ ÚÂÓËflÚ‡ Á‡ Ú‡ÌÒ‰ËÙÂÂÌˆË‡ˆËfl Ì‡ÍÓÒÚÌÓÏÓÁ˙˜ÌË ÍÎÂÚÍË ‚ ÌÂ‚ÓÌË Ë ‡ÒÚÓˆËÚË (15). èË‚ÒÂÍË ÓÚ ËÁÔÓÎÁ‚‡ÌËÚÂ ÏÓ‰ÂÎË Â Ì‡·Î˛‰‡‚‡ÌÓ ÌËÒÍÓ ÌË‚ÓÌ‡ ÂÌ„‡ÙÚË‡ÌÂ Ì‡ Ï‡ÍË‡ÌË ‰ÓÌÓÌË ÍÎÂÚÍË. íÂÁË Â-ÁÛÎÚ‡ÚË Í‡ÚÂ„ÓË˜ÌÓ ‰ÓÍ‡Á‚‡Ú, ˜Â ïëä Á‡Ô‡Á‚‡Ú ÎËÌÂÈ-Ì‡Ú‡ ÒË ÔËÌ‡‰ÎÂÊÌÓÒÚ ‚ „Î‡‚ÌËfl ÏÓÁ˙Í Ë ÌÂ ÔË‰Ó·Ë‚‡Ú·ÂÎÂÁË Ì‡ ÌÂ‚‡ÎÌË ÍÎÂÚÍË (15). é˘Â ÔÂÁ 2003 „. LongË Ò˙Ú. ÓÚ ñÂÌÚ˙‡ Á‡ ÍÎÂÚ˙˜Ì‡ Ë „ÂÌÌ‡ ÚÂ‡ÔËfl ‚ï˛ÒÚ˙Ì, ëÄô, Ó·Ó·˘‡‚‡Ú ÔÛ·ÎËÍ‡ˆËËÚÂ ÓÚ ·ÎËÁÍÓÚÓÏËÌ‡ÎÓ Á‡ Ì‡ÎË˜Ì‡ Ú‡ÌÒ‰ËÙÂÂÌˆË‡ˆËfl Ì‡ ÍÓÒÚÌÓÏÓÁ˙˜-ÌËÚÂ Äëä ‚ ÌÂ‚‡ÎÌË Ë ÍÎÂÚÍË ÓÚ ‰Û„Ë Ú˙Í‡ÌË, Í‡ÍÚÓË ‰‡ÌÌËÚÂ Á‡ ÎËÔÒ‡ Ì‡ Ú‡Í‡‚‡ ‚ ÔÓ-Í˙ÒÌËÚÂ ÔÛ·ÎËÍ‡ˆËË,Í‡ÚÓ ÓÚ·ÂÎflÁ‚‡Ú, ˜Â ÚÓ‚‡ Â Â‚ÓÎ˛ˆËfl ‚ ËÁÒÎÂ‰‚‡ÌËflÚ‡Ì‡ ÒÔÓÒÓ·ÌÓÒÚËÚÂ Ì‡ ‡‰ÛÎÚÌËÚÂ ÒÚ‚ÓÎÓ‚Ë ÍÎÂÚÍË (13).èÂÁ Ò˙˘‡Ú‡ „Ó‰ËÌ‡ Vitry Ë Ò˙Ú. ÔÓÚ‚˙Ê‰‡‚‡Ú ÔË

ÔÓÛ˜‚‡ÌÂ Ì‡ ÌÂ‚ÓÔÓÂÚË˜ÌËfl ÔÓÚÂÌˆË‡Î Ì‡ ÏË¯Ë ÂÏ·-ËÓÌ‡ÎÌË ÔÂÍÛÒÓË Ì‡ ïëä ÎËÔÒ‡Ú‡ Ì‡ ‰ËÙÂÂÌˆË‡ˆËflÌ‡ ÚÂÁË ÍÎÂÚÍË ‚ ÌÂ‚‡ÎÌË (29). ëÎÂ‰ ËÌÚ‡‚ÂÌÚËÍÛÎÌÓÂÌ„‡ÙÚË‡ÌÂ Ì‡ ıÂÏÓÔÓÂÚË˜ÌË ÔÂÍÛÒÓË ÚÂ ‰‡‚‡Ú Ì‡-˜‡ÎÓ Ì‡ ÏËÍÓ„ÎËfl, ‡ ÌÂ Ì‡ ÌÂ‚ÓÌË Ë „ÎËfl, ‰ÓÍ‡ÚÓ ÔËÚ‡ÌÒÔÎ‡ÌÚ‡ˆËfl Ì‡ ÂÏ·ËÓÌ‡ÎÌË ÌÂ‚ÓÒÙÂË ÚÂ ÙÓÏË-‡Ú ÏËÂÎËÌÓ‚Ë ÔÎ‡ÍË. àÁ‚Ó‰˙Ú Â, ˜Â Á‡ ÂÏËÂÎËÌËÁË‡˘‡ÚÂ‡ÔËfl Ì‡È-ÔÓ‰ıÓ‰fl˘‡ Â Ú‡ÌÒÔÎ‡ÌÚ‡ˆËflÚ‡ Ì‡ ÖëäËÎË çëä (29).

è‡‚Ë ‚ÔÂ˜‡ÚÎÂÌËÂ, ˜Â ‚ÒË˜ÍË ÂÍÒÔÂËÏÂÌÚ‡ÎÌË ÔÓ-Û˜‚‡ÌËfl, ÌÂÁ‡‚ËÒËÏÓ ÓÚ ÂÁÛÎÚ‡ÚËÚÂ ÒË, Ò‡ ‚˙ıÛ ÊË‚Ó-ÚËÌÒÍË ÏÓ‰ÂÎË. íÓ‚‡ ÔÓÍ‡Á‚‡, ˜Â ÚÂÁË ‚˙ÔÓÒË ‚ÒÂ Ó˘Â ÌÂÒ‡ Ì‡Ô˙ÎÌÓ ËÁflÒÌÂÌË Ë ÔË ÎËÔÒ‡ Ì‡ Í‡ÚÂ„ÓË˜ÌË ‰ÓÍ‡Á‡-ÚÂÎÒÚ‚‡ Á‡ ÂÙÂÍÚË‚ÌÓÒÚÚ‡ Ì‡ ‰‡‰ÂÌ ÚÂ‡ÔÂ‚ÚË˜ÂÌ ÏÂ-ÚÓ‰, Â ÌÂ‰ÓÔÛÒÚËÏÓ ÚÓÈ ‰‡ ÒÂ ÔËÎ‡„‡ ‚˙ıÛ ıÓ‡.

Robert Schwartz ‚ New England Journal of Medicine (ÒÂÔ-ÚÂÏ‚Ë 2006 „.) Ì‡È-‰Ó·Â Ó·Ó·˘‡‚‡ Ì‡ÎË˜ÌËÚÂ ‰Ó ÏÓ-ÏÂÌÚ‡ ÂÁÛÎÚ‡ÚË ÓÚ ÔÓÛ˜‚‡ÌËflÚ‡ Ì‡ ‚˙ÁÏÓÊÌÓÒÚËÚÂÁ‡ ïëä Ú‡ÌÒ‰ËÙÂÂÌˆË‡ˆËfl: “.... ë‚Â‰ÂÌËflÚ‡ Á‡ ÔÎÛË-ÔÓÚÂÌÚÌË ÒÚ‚ÓÎÓ‚Ë ÍÎÂÚÍË, ÍÓËÚÓ ÏÓ„‡Ú ‰‡ ÒÂ Ú‡ÌÒ-‰ËÙÂÂÌˆË‡Ú ‚ ÍÎÂÚÍË ÓÚ ‰Û„Ë ÍÎÂÚ˙˜ÌË ÎËÌËË, Ò‡Ò˙ÏÌËÚÂÎÌË. î‡ÍÚ Â, ˜Â Â‰ËÌË˜Ì‡, ÒÚÓ„Ó ‰ÂÙËÌË‡Ì‡ïëä ÓÚ ‚˙Á‡ÒÚÌ‡ ÏË¯Í‡ ... ÌflÏ‡ Í‡Ô‡ˆËÚÂÚ Á‡ ‰ËÙÂ-ÂÌˆË‡ˆËfl ‚ ‰Û„Ë ÊË‚ÓÚËÌÒÍË Ú˙Í‡ÌË, Í‡ÚÓ ÚÓ‚‡ ÌÂËÁÍÎ˛˜‚‡ Ò˙˘ÂÒÚ‚Û‚‡ÌÂÚÓ Ì‡ ÔÎÛËÔÓÚÂÌÚÌ‡ ÒÚ‚ÓÎÓ‚‡ÍÎÂÚÍ‡. ífl ÏÓÊÂ ‰‡ ÌÂ Â ïëä… ÖÍÒÔÂËÏÂÌÚËÚÂ Á‡ ‰Ó-Í‡Á‚‡ÌÂ Ì‡ÎË˜ËÂÚÓ Ì‡ ÔÎÛËÔÓÚÂÌÚÌË ÒÚ‚ÓÎÓ‚Ë ÍÎÂÚÍËÛ ‚˙Á‡ÒÚÌË Ò‡ Â¯‡‚‡˘Ë. èÓÌ‡ÒÚÓfl˘ÂÏ ÌflÏ‡ ÍÎËÌË˜ÌË‰ÓÍ‡Á‡ÚÂÎÒÚ‚‡ Á‡ ÚÓ‚‡.” (19).

Ö‰ËÌÒÚ‚ÂÌËÚÂ ÔÓÍ‡Á‡ÌËfl Á‡ Ú‡ÌÒÔÎ‡ÌÚ‡ˆËfl Ì‡ ïëäÒ ‰ÓÍ‡Á‡Ì ÂÙÂÍÚ ÔË ÌÂ‚ÓÎÓ„Ë˜ÌË Á‡·ÓÎfl‚‡ÌËfl Ò‡ ‡‚ÚÓ-ÎÓÊÌËÚÂ Ú‡ÌÒÔÎ‡ÌÚ‡ˆËË ÔË ‡‚ÚÓËÏÛÌÌË Á‡·ÓÎfl‚‡ÌËfl(åë Ë ÏË‡ÒÚÂÌËfl) Ë ‡ÎÓ„ÂÌÌËÚÂ Ú‡ÌÒÔÎ‡ÌÚ‡ˆËË ÔË‚Ó‰ÂÌË ÏÂÚ‡·ÓÎËÚÌË Ì‡Û¯ÂÌËfl. èË ÎËÁÓÁÓÏÌËÚÂ ËÔÂÓÍÒËÁÓÏÌË ·ÓÎÂÒÚË ËÎË ·ÓÎÂÒÚËÚÂ Ì‡ Ì‡ÚÛÔ‚‡ÌÂÚÓïëä ÌÂ ÒÂ ËÁÔÓÎÁ‚‡Ú Í‡ÚÓ Á‡ÏÂÒÚËÚÂÎÌ‡ ÍÎÂÚ˙˜Ì‡ ÚÂ-‡ÔËfl, ‡ ÔÓ-ÒÍÓÓ Í‡ÚÓ “ÔÓÏÔ‡” Á‡ ÎËÁÓÁÓÏÌË ÂÌÁËÏË, ÍÓ-ËÚÓ ‚ÎËÁ‡Ú ‚ Ì‡Û¯ÂÌËÚÂ ÍÎÂÚÍË Ì‡ ÂˆËÔËÂÌÚ‡ Ë‚˙Á‚˙˘‡Ú ÌÓÏ‡ÎÌËfl ËÏ ÏÂÚ‡·ÓÎËÁ˙Ï. èË ‡‚ÚÓËÏÛÌ-ÌËÚÂ Á‡·ÓÎfl‚‡ÌËfl ‰ÂÈÒÚ‚ËÂÚÓ Ì‡ Ú‡ÌÒÔÎ‡ÌÚË‡ÌËÚÂ‡‚ÚÓÎÓÊÌË ÒÚ‚ÓÎÓ‚Ë ÍÎÂÚÍË Ë ÔÂ‰¯ÂÒÚ‚‡˘‡Ú‡ ıËÏËÓ-ÚÂ‡ÔËfl Â ËÏÛÌÓÏÓ‰ÛÎË‡˘Ó.

èÂÁ 1997 „. Í˙Ï EBMT Â Ò˙Á‰‡‰ÂÌÓ Working party ofautoimmune diseases Á‡ ÓˆÂÌÍ‡ ˜ÂÁ ‡Ì‰ÓÏËÁË‡ÌË ÔÓÒ-ÔÂÍÚË‚ÌË ÍÓÌÚÓÎË‡ÌË ËÁÒÎÂ‰‚‡ÌËfl Ì‡ ÁÌ‡˜ÂÌËÂÚÓ Ì‡ÚÂÁË Ú‡ÌÒÔÎ‡ÌÚ‡ˆËË ÔË Ô‡ˆËÂÌÚË Ò ‡ÁÎË˜ÌË ‡‚ÚÓË-ÏÛÌÌË Á‡·ÓÎfl‚‡ÌËfl. á‡ ÔÂËÓ‰‡ 1996-2005 „., ÒÂ‰ Â„ËÒÚ-Ë‡ÌË 720 Ò˙Ó·˘ÂÌËfl ÓÚ 166 Ú‡ÌÒÔÎ‡ÌÚ‡ˆËÓÌÌËˆÂÌÚ˙‡ ‚ 27 ÒÚ‡ÌË Â ÛÒÚ‡ÌÓ‚ÂÌÓ, ˜Â Ì‡È-˜ÂÒÚ‡Ú‡ ‰Ë‡„-ÌÓÁ‡ Â åë. èÓÎÓÊËÚÂÎÌËflÚ ÓÚ„Ó‚Ó Ì‡ Ú‡ÁË ÚÂ‡ÔËfl ÂÓÍÓÎÓ 70%, ‡ Ò‚˙Á‡Ì‡Ú‡ Ò Ú‡ÌÒÔÎ‡ÌÚ‡ˆËflÚ‡ÒÏ˙ÚÌÓÒÚ - ÓÍÓÎÓ 7%. Ç ÏÂ‰ËˆËÌÒÍ‡Ú‡ ÎËÚÂ‡ÚÛ‡ Ò‡ÔÛ·ÎËÍÛ‚‡ÌË ·ÎËÁÓ 100 ÒÚ‡ÚËË, ÔÓÒ‚ÂÚÂÌË Ì‡ ÚÓÁË ÏÂ-ÚÓ‰ Á‡ ÎÂ˜ÂÌËÂ Ì‡ åë. êÂÁÛÎÚ‡ÚËÚÂ ÓÚ ÔÓÛ˜‚‡ÌËflÚ‡ÔÓÍ‡Á‚‡Ú Â‰ÛÍˆËfl ËÎË ËÁ˜ÂÁ‚‡ÌÂ Ì‡ ‚˙ÁÔ‡ÎËÚÂÎÌ‡Ú‡ ‡Í-ÚË‚ÌÓÒÚ (ÓˆÂÌÂÌ‡ ˜ÂÁ MRI) Ë ÍÎËÌË˜Ì‡ ÂÏËÒËfl ÌflÍÓÎÍÓ„Ó‰ËÌË ÒÎÂ‰ ÚÓ‚‡, ÔË ÎËÔÒ‡ Ì‡ ËÏÛÌÓÚÂ‡ÔËfl. ïËÔÓÚÂ-ÁËÚÂ Á‡ ÔÓ‰Ó·ÂÌËÂÚÓ Ò‡ ÁÌ‡˜ËÚÂÎÌ‡ ËÏÛÌÓÒÛÔÂÒËfl, ËÌ-‰ÛˆË‡Ì‡ ÓÚ ˆËÚÓÚÓÍÒË˜Ì‡Ú‡ ÚÂ‡ÔËfl, Ë Â„ÂÌÂ‡ˆËflÌ‡ “ÌÓ‚‡” ËÏÛÌÌ‡ ÒËÒÚÂÏ‡.

ôÂ ÔÂ‰ÒÚ‡‚ËÏ Ë Á‡ÍÎ˛˜ÂÌËflÚ‡ Ì‡ ÌflÍÓË ÓÚ ÔÓ-ÁÌ‡˜Ë-ÏËÚÂ ÔÓÛ˜‚‡ÌËfl Á‡ Ú‡ÌÒÔÎ‡ÌÚ‡ˆËË Ì‡ ïëä ÔË ‰Âˆ‡ Ò‚Ó‰ÂÌË ÏÂÚ‡·ÓÎËÚÌË Ì‡Û¯ÂÌËfl Ì‡ ÌÂ‚Ì‡Ú‡ ÒËÒÚÂÏ‡:

1.“äÓÒÚÌÓÏÓÁ˙˜Ì‡Ú‡ Ú‡ÌÒÔÎ‡ÌÚ‡ˆËfl Â ÂÙÂÍÚË‚ÌÓÎÂ˜ÂÌËÂ ÔË „ÎÓ·ÓË‰ÓÍÎÂÚ˙˜Ì‡, ÏÂÚ‡ıÓÏ‡ÚË˜Ì‡ Ë ‡‰Â-ÌÓÎÂ‚ÍÓ‰ËÒÚÓÙËfl, Ï‡ÌÓÁË‰ÓÁ‡, ÙÛÍÓÁË‰ÓÁ‡, ÒËÌ‰ÓÏËÚÂÌ‡ Hurler, Maroteaux-Lamy Ë Sly, ·ÓÎÂÒÚ Ì‡ Gaucher – ÚËÔ


III.” (10).2.èË ‡ÎÓ„ÂÌÌÓ Ú‡ÌÒÔÎ‡ÌÚË‡ÌË ‰Âˆ‡ Ò „ÎÓ·ÓË‰ÓÍ-

ÎÂÚ˙˜Ì‡ ÎÂ‚ÍÓ‰ËÒÚÓÙËfl (·ÓÎÂÒÚ Ì‡ Krabbe), ÔÓÒÎÂ‰ÂÌËÁ‡ 1-6 „., ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡ Ó·‡ÚËÏÓÒÚ Ì‡ ÒËÏÔÚÓÏËÚÂ Ò‡-ÏÓ ÔË Ô‡ˆËÂÌÚËÚÂ Ò Í˙ÒÌÓ Ì‡˜‡ÎÓ, ‰ÓÍ‡ÚÓ ÔË ÚÂÁË Ò‡ÌÌÓ Ì‡˜‡ÎÓ ËÏ‡ Ò‡ÏÓ ÔÓ‰Ó·ÂÌËÂ (11).

3.èË ‡ÎÓ„ÂÌÌ‡ Ú‡ÌÒÔÎ‡ÌÚ‡ˆËfl Ò Í˙‚ ÓÚ Ô˙ÔÌ‡ ‚˙‚Ì‡ ·Â·ÂÚ‡ Ò ·ÓÎÂÒÚ Ì‡ Krabbe, ÔÓÒÎÂ‰ÂÌË Á‡ 4 ÏÂÒ. ‰Ó 6„., ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡, ˜Â Ú‡ÌÒÔÎ‡ÌÚ‡ˆËflÚ‡ ÔË ÌÓ‚ÓÓ‰ÂÌË,‡ÒËÏÔÚÓÏÌË ·Â·ÂÚ‡ ÔÓ‰Ó·fl‚‡ ÁÌ‡˜ËÚÂÎÌÓ ıÓ‰‡ Ì‡ Á‡·Ó-Îfl‚‡ÌÂÚÓ, ‰ÓÍ‡ÚÓ ÔË ‚Â˜Â ÒËÏÔÚÓÏ‡ÚË˜ÌË Í˙Ï‡˜ÂÚ‡ÌÂ ‚Ó‰Ë ‰Ó Ò˙˘ÂÒÚ‚ÂÌÓ ÔÓ‰Ó·ÂÌËÂ (6).

4.èË ÒËÌ‰ÓÏ Ì‡ Hurler (ÏÛÍÓÔÓÎËÁ‡ı‡Ë‰ÓÁ‡ ÚËÔ I)ÒÎÂ‰ ‡ÎÓ„ÂÌÌ‡ Ú‡ÌÒÔÎ‡ÌÚ‡ˆËfl Ì‡ Í˙‚ ÓÚ Ô˙ÔÌ‡ ‚˙‚ ÒÂÓÚ˜ËÚ‡ 85% ÔÂÊË‚flÂÏÓÒÚ, ÔË ÌÓÏ‡ÎËÁË‡ÌÂ Ì‡ ÒÂ-ÛÏÌ‡Ú‡ Ë‰ÛÓÌË‰‡Á‡ Ë ÔÓ‰Ó·ÂÌË ÌÂ‚ÓÎÓ„Ë˜ÌË Ë ÒÓÏ‡-ÚË˜ÌË ·ÂÎÂÁË (23).

èÂÁ ÔÓÒÎÂ‰ÌËÚÂ „Ó‰ËÌË ÒÂ Ì‡ÚÛÔ‚‡ ÓÔËÚ Á‡ Ú‡Ì-ÒÔÎ‡ÌÚ‡ˆËfl Ì‡ ïëä ÔË ÎÂ˜ÂÌËÂÚÓ Ë Ì‡ ıÓÌË˜Ì‡Ú‡ ‚˙Á-Ô‡ÎËÚÂÎÌ‡ ‰ÂÏËÂÎËÌËÁË‡˘‡ ÔÓÎË‡‰ËÍÛÎÓÌÂ‚ÓÔ‡ÚËfl(CIDP) Ë ‡ÌÌ‡Ú‡ ‰ÂÚÒÍ‡ ÌÂ‚ÓÌ‡ÎÌ‡ ˆÂÓË‰-ÎËÔÓÙÛÒˆË-ÌÓÁ‡ (INCL). èÓÎÓÊËÚÂÎÌË Ë Ó·Ì‡‰ÂÊ‰‡‚‡˘Ë Ò‡ ÂÁÛÎÚ‡-ÚËÚÂ ÔË CIDP, ‚ÍÎ. ÔË POEMS (ÔÓÎËÌÂ‚ÓÔ‡ÚËfl, Ó„‡-ÌÓÏÂ„‡ÎËfl, ÂÌ‰ÓÍËÌÓÔ‡ÚËfl, M-ÔÓÚÂËÌ Ë ÍÓÊÌË ÔÓÏÂ-ÌË) (12,28), ‰ÓÍ‡ÚÓ ÔË INCL ÌÂ ÒÂ ÓÚ˜ËÚ‡ ÂÙÂÍÚ ÓÚ‡ÎÓ„ÂÌÌË Ú‡ÌÒÔÎ‡ÌÚ‡ˆËË Ì‡ ïëä (14).

ÉÓÎÂÏË Ì‡‰ÂÊ‰Ë ÒÂ ‚˙ÁÎ‡„‡Ú Ì‡ ÎÂ˜ÂÌËÂÚÓ Ò Ú‡Ì-ÒÔÎ‡ÌÚ‡ˆËË Ì‡ ÒÚ‚ÓÎÓ‚Ë ÍÎÂÚÍË ÔË ·ÓÎÂÒÚÚ‡ Ì‡ è‡-ÍËÌÒÓÌ (PD). Ç ÚÂÁË ÒÎÛ˜‡Ë, Ó·‡˜Â, ÒÚ‚ÓÎÓ‚ËÚÂ ÍÎÂÚÍË˘Â ·˙‰‡Ú ÂÏ·ËÓÌ‡ÎÌË ËÎË ‡‰ÛÎÚÌË çëä. ëÔÓÂ‰ StemCell Institute Í˙Ï ìÌË‚ÂÒËÚÂÚ‡ ‚ åËÌÂÒÓÚ‡, ëÄô, ÌÂ‚-ÓÚ‡ÌÒÔÎ‡ÌÚ‡ˆËflÚ‡ Í‡ÚÓ ÎÂ˜ÂÌËÂ Ì‡ PD ÔËÒ˙ÒÚ‚‡ ‚ÏÂ‰ËˆËÌÒÍËÚÂ ÔÓÛ˜‚‡ÌËflÚ‡ ÔÓ‚Â˜Â ÓÚ 15 „Ó‰ËÌË, ÌÓ Ï‡-ÒÓ‚ÓÚÓ u ÔËÎÓÊÂÌËÂ Â ‚ÒÂ Ó˘Â Â ‰‡ÎÂ˜ ‚ ·˙‰Â˘ÂÚÓ. èÂÁ2005 „. flÔÓÌÒÍË ËÁÒÎÂ‰Ó‚‡ÚÂÎË Ò˙Ó·˘‡‚‡Ú Á‡ Ú‡ÌÒÔÎ‡Ì-Ú‡ˆËfl Ì‡ Öëä ‚ ÏÓÁ˙Í Ì‡ ÏË¯ÍË Ò PD, Í‡ÚÓ ÓÚ·ÂÎflÁ‚‡Ú,˜Â ÔÓÎÓÊËÚÂÎÌËÚÂ ÂÁÛÎÚ‡ÚË Ò‡ ÔÂ‰‚‡ËÚÂÎÌË (30).

Å˙‰Â˘ËÚÂ ÚÂ‡ÔÂ‚ÚË˜ÌË ÏÂÚÓ‰Ë Á‡ ÎÂ˜ÂÌËÂ Ì‡ ÌÂ‚Ó-ÎÓ„Ë˜ÌË Á‡·ÓÎfl‚‡ÌËfl ‚ÒÂ ÔÓ‚Â˜Â ˘Â ÒÂ ‡Á¯Ëfl‚‡Ú, Í‡ÚÓ˘Â ‚ÍÎ˛˜‚‡Ú ÍÓÏ·ËÌ‡ˆËfl ÓÚ ÍÎÂÚ˙˜Ì‡ ÚÂ‡ÔËfl Ë „ÂÌÌÓËÌÊÂÌÂÒÚ‚Ó. ÉÎ‡‚ÌË Ó·Î‡ÒÚË Ì‡ ‰ÂÈÒÚ‚ËÂ Ì‡ Ú‡Í‡‚‡ ÚÂ-‡ÔËfl ˘Â ·˙‰‡Ú Ú‡‚Ï‡ÚË˜ÌËÚÂ Û‚ÂÊ‰‡ÌËfl Ì‡ „˙·-Ì‡˜ÌËfl ÏÓÁ˙Í Ë ÌflÍÓË ‚Ó‰ÂÌË ÏÂÚ‡·ÓÎËÚÌË Ì‡Û¯ÂÌËfl(5, 7).

Ç Á‡ÍÎ˛˜ÂÌËÂ ÏÓÊÂÏ ‰‡ ÔÓ‰˜ÂÚ‡ÂÏ, ˜Â ÍÎÂÚ˙˜Ì‡Ú‡ÚÂ‡ÔËfl Â ËÁÍÎ˛˜ËÚÂÎÌÓ ÒÎÓÊÂÌ, ‚ËÒÓÍÓÚÂıÌÓÎÓ„Ë˜ÂÌ Ë‚ËÒÓÍÓÒÔÂˆË‡ÎËÁË‡Ì ÚÂ‡ÔÂ‚ÚË˜ÂÌ ÏÂÚÓ‰, ÍÓÈÚÓÚfl·‚‡ ‰‡ ·˙‰Â ÔËÎ‡„‡Ì ÔË ÒÚÓ„Ë ËÌ‰ËÍ‡ˆËË, ÔÓÛÚ‚˙‰ÂÌË Ë ‚˙ÁÔËÂÚË ‚ Ò‚ÂÚ‡ ÔÓÚÓÍÓÎË Ë ÔË Á‡·ÓÎfl-‚‡ÌËfl Á‡ ÍÓËÚÓ ·ÂÁÒÔÓÌÓ ËÏ‡ ‰ÓÍ‡Á‡Ì ·Î‡„ÓÔËflÚÂÌÂÙÂÍÚ. ìÒËÎËflÚ‡ Ì‡ Ò‚ÂÚÓ‚Ì‡Ú‡ ÏÂ‰ËˆËÌÒÍ‡ Ó·˘ÂÒÚ‚Â-ÌÓÒÚ Úfl·‚‡ ‰‡ ·˙‰‡Ú Ì‡ÒÓ˜ÂÌË Í˙Ï ÔÂÓ‰ÓÎfl‚‡ÌÂ Ì‡ÚÛ‰ÌÓÒÚËÚÂ Á‡ ËÁÔÓÎÁ‚‡ÌÂ Ì‡ ÂÏ·ËÓÌ‡ÎÌËÚÂ ÒÚ‚ÓÎÓ‚ËÍÎÂÚÍË ÔË ÎÂ˜ÂÌËÂÚÓ Ì‡ ÚÂÊÍË Á‡·ÓÎfl‚‡ÌËfl Ë Í˙Ï ÔÓ-ÔÂˆËÁÌÓ ÓÔÂ‰ÂÎflÌÂ Ì‡ ÔÓÍ‡Á‡ÌËflÚ‡, ÏÂÚÓ‰ËÚÂ Á‡ ÔÓÎÛ-˜‡‚‡ÌÂ Ë ÚÂ‡ÔÂ‚ÚË˜ÌÓÚÓ ÔËÎÓÊÂÌËÂ Ì‡ ‡ÁÎË˜ÌËÚÂÚËÔÓ‚Â Äëä.

ãàíÖêÄíìêÄ1. Å˛ıÓ‚ÂˆÍË Ä.ë. í‡ÒÔÎ‡ÌÚ‡ˆËfl ÌÂ‚Ì˚ı ÍÎÂÚÓÍ Ë ÚÍ‡ÌÂ‚‡fl ËÌÊÂÌÂ-

Ëfl ÏÓÁ„‡ ÔË ÌÂ‚Ì˚ı ·ÓÎÂÁÌflı. àÁ‰. áÄé ◊äÎËÌËÍ‡ ‚ÓÒÒÚ‡ÌÓ‚ËÚÂÎÌÓÈËÌÚÂ‚ÂÌˆËÓÌ‡Î¸ÌÓÈ ÌÂ‚ÓÎÓ„ËË Ë ÚÂ‡ÔËË ◊çÂÈÓÇËÚ‡” 2003 „.

2. Borge O.J., Funderud S. Stem cells in adults. Tidsskr Nor Laegeforen 2001;121: 2398-401.

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5. Crystal R.G., Sondhi D., Hackett N.R. Clinical protocol. Administration of areplication deficient adeno-associated virus gene transfer vector expressingthe human CLN2 cDNA to the brain of children with late infantile neuronallipofuscinosis. Hum Gene Ther 2004; 15: 1131-1154.

6. Escolar M.L., Poe M.D., Provenzale J.M., et al. Transplantation of umbilicalcord blood in babies with infantile Krabbe’s disease. N Engl J Med. 2005;352: 2069-2081.

7. Han S.S., Fischer I. Neural stem cells and gene therapy: prospects for repair-ing the injured spinal cord. JAMA. 2000;283: 2300-1.

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Ä‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËfl:Ñ- èÂÚfl ëÚ. ÑËÏÓ‚‡, ‰ÏÑÂÚÒÍ‡ ÌÂ‚ÓÎÓ„Ë˜Ì‡ ÍÎËÌËÍ‡, ìëÅÄãçè “ë‚.ç‡ÛÏ” –IV ÍÏ.ìÎ. “Ñ- ã. êÛÒÂ‚” ‹11113 ëÓÙËflíÂÎ: 9702 – 232e-mail: [email protected]


SUMMARY

åéLECULAR CHARACTERISTICS AND PATHO-GENETIC POTENTIAL OF POLYOMAVIRUS HOMINIS

2 (JC VIRUS)

Z. Kalvatchev1, S. Slavov1, I. Nenkov2, é. Kalev3, A. Hadjianev4

1Laboratory of Molecular Virology, National Center ofInfectious and Parasitic Diseases;

2Faculty of Biology, University of Sofia “St. KlimentOhridski”;

3Laboratory of Neuropathology, Center of ClinicalPathology, Medical University – Sofia;

4Department of Neurosurgery, University Hospital “St. IvanRilski” – Sofia.

Polyomavirus hominis 2 is a member of the Polyomaviridaefamily and is considered as an etiological cause for the appear-ance and development of the Progressive MultifocalLeukoencephalopathy. JCV specific features and oncogenicpotential make it appropriate model for investigating the virally-induced cellular transformation. The presente review summa-rizes specialized information about the structure and the mainbiologic properties of the human polyoma virus JC.

KEY WORDS: human polyoma virus, JCV, polyomavirushominis-2.

êÖáûåÖ

Polyomavirus hominis 2 (‚ËÛÒ JC) Â ÔÂ‰ÒÚ‡‚ËÚÂÎ Ì‡Ù‡ÏËÎËflÚ‡ Polyomaviridae Ë ÒÂ Ó·Ò˙Ê‰‡ Í‡ÚÓ ÂÚËÓÎÓ„Ë˜-Ì‡ ÔË˜ËÌ‡ Á‡ ÔÓfl‚‡Ú‡ Ë ‡Á‚ËÚËÂÚÓ Ì‡ ÔÓ„ÂÒË‚Ì‡Ú‡ÏÛÎÚËÙÓÍ‡ÎÌ‡ ÎÂ‚ÍÓÂÌˆÂÙ‡ÎÓÔ‡ÚËfl. ëÔÂˆËÙË˜ÌËÚÂ ı‡-‡ÍÚÂËÒÚËÍË Ë ÓÌÍÓ„ÂÌÌËfl ÔÓÚÂÌˆË‡Î Ì‡ JCV „Ó ÔÂ‰Ò-Ú‡‚flÚ Í‡ÚÓ ÔÓ‰ıÓ‰fl˘ ÏÓ‰ÂÎ Á‡ ËÁÛ˜‡‚‡ÌÂ Ì‡ ‚ËÛÒ-ËÌ‰Û-ˆË‡Ì‡Ú‡ ÍÎÂÚ˙˜Ì‡ Ú‡ÌÒÙÓÏ‡ˆËfl. ç‡ÒÚÓfl˘ËflÚ Ï‡-ÚÂË‡Î Ó·Ó·˘‡‚‡ ÒÔÂˆË‡ÎËÁË‡Ì‡ ËÌÙÓÏ‡ˆËfl ÓÚÌÓÒÌÓ

ÒÚÛÍÚÛ‡Ú‡ Ë ÓÒÌÓ‚ÌËÚÂ ·ËÓÎÓ„Ë˜ÌË Ò‚ÓÈÒÚ‚‡ Ì‡ ˜Ó-‚Â¯ÍËflÚ ÔÓÎËÓÏÂÌ ‚ËÛÒ JC.

äãûóéÇà Ñìåà: óÓ‚Â¯ÍË ÔÓÎËÓÏÂÌ ‚ËÛÒ; JCV;Polyomavirus hominis-2.

Polyomavirus hominis 2, ‰ÓÒÍÓÓ ÔÓ-ËÁ‚ÂÒÚÂÌ Í‡ÚÓ JC ‚ËÛÒ (JCV), ÔËÌ‡‰ÎÂÊË Í˙Ï ÌÓ‚ÓÒÙÓÏË‡Ì‡Ú‡ ‚Ë-ÛÒÌ‡ Ù‡ÏËÎËfl Polyomaviridae (Cole & Conzen, 2001). íÓÈÂ ËÁÓÎË‡Ì Á‡ Ô˙‚Ë Ô˙Ú ÔÂÁ 1971 „. ÓÚ ÏÓÁ˙Í‡ Ì‡ Ô‡ˆË-ÂÌÚ Ò ËÌËˆË‡ÎË J.C., ÔÓ˜ËÌ‡Î ÓÚ ÔÓ„ÂÒË‚Ì‡ ÏÛÎÚËÙÓ-Í‡ÎÌ‡ ÎÂ‚ÍÓÂÌˆÂÙ‡ÎÓÔ‡ÚËfl (progressive multifocalleukoencephalopathy, PML) (ÙË„. 1). àÌÚÂÌÁË‚ÌËÚÂ ÏÓÎÂ-ÍÛÎflÌË ÔÓÛ˜‚‡ÌËfl ÔÂÁ ÔÓÒÎÂ‰ÌËÚÂ „Ó‰ËÌË ‰ÓÍ‡Á‚‡ÚÂÚËÓÔ‡ÚÓ„ÂÌÂÚË˜Ì‡Ú‡ ‚˙ÁÍ‡ ÏÂÊ‰Û JCV Ë PML (MajorE., 2001).

éÒÌÓ‚Ì‡ ÔË˜ËÌ‡ Á‡ Á‡ÒËÎÂÌËfl Ì‡Û˜ÂÌ Ë ÏÂ‰ËˆËÌÒÍË ËÌ-ÚÂÂÒ Í˙Ï JCV ÒÂ ‰˙ÎÊË Ì‡ ‚ËÒÓÍËflÚ ËÏ ÓÌÍÓ„ÂÌÂÌ ÔÓ-ÚÂÌˆË‡Î (Major E., 2001). éÚ ‰Û„‡ ÒÚ‡Ì‡, ÓÒÓ·ÂÌÓÒÚË-ÚÂ Ì‡ ÚÓÁË ‚ËÛÒ (ÓÚÌÓÒËÚÂÎÌÓ ÎÂÒÌ‡ ÍÛÎÚË‚‡ˆËfl, „ÂÌÓÏÒ ÛÌËÍ‡ÎÌ‡ Ó„‡ÌËÁ‡ˆËfl Ë ‰.) „Ó Ô‡‚flÚ ÔÓÎÂÁÂÌ ÏÓ‰ÂÎ Á‡ËÁÛ˜‡‚‡ÌÂ Ì‡ ‚ËÛÒ-ËÌ‰ÛˆË‡Ì‡Ú‡ Í‡ÌˆÂÓ„ÂÌÂÁ‡.

èÂ‰ÒÚ‡‚ÂÌËfl Ï‡ÚÂË‡Î Ó·Ó·˘‡‚‡ ÒÔÂˆË‡ÎËÁË‡Ì‡ËÌÙÓÏ‡ˆËfl ÓÚÌÓÒÌÓ ÒÚÛÍÚÛ‡Ú‡ Ë ÓÒÌÓ‚ÌËÚÂ ·ËÓÎÓ-„Ë˜ÌË Ò‚ÓÈÒÚ‚‡ Ì‡ ˜Ó‚Â¯ÍËflÚ ÔÓÎËÓÏÂÌ ‚ËÛÒ JC.é·Ò˙Ê‰‡Ú ÒÂ ÏÓÎÂÍÛÎflÌËÚÂ ÏÂı‡ÌËÁÏË Á‡ Â„ÛÎË‡ÌÂ Ì‡‚ËÛÒÌ‡Ú‡ ÏÛÎÚËÔÎËÍ‡ˆËfl (ÂÔÎËÍ‡ˆËfl) Ì‡ ÍÎÂÚ˙˜ÌÓ ÌË-‚Ó, Í‡ÍÚÓ Ë ÔÓ‡ÊÂÌËflÚ‡, ÍÓËÚÓ ÔÓÎËÓÏÌËÚÂ ‚ËÛÒËÔÂ‰ËÁ‚ËÍ‚‡Ú ‚ ˜Ó‚Â¯ÍËfl Ó„‡ÌËÁ˙Ï.

åéãÖäìãüêçÄ ïÄêÄäíÖêàëíàäÄ çÄ óéÇÖòäàèéãàéåÖç Çàêìë JC

JC ‚ËÛÒÌËÚÂ ˜‡ÒÚËˆË Ò‡ Ò ÔË·ÎËÁËÚÂÎÂÌ ‡ÁÏÂ ÓÚ 45nm ‚ ‰Ë‡ÏÂÚ˙ Ë ÔËÚÂÊ‡‚‡Ú ËÍÓÒ‡Â‰‡ÎÌ‡ ÒËÏÂÚËfl(ÙË„. 2). ÉÂÌÂÚË˜ÌËflÚ ËÏ Ï‡ÚÂË‡Î (ÒÛÔÂÒÔË‡ÎËÁË‡Ì‡Ñçä ÏÓÎÂÍÛÎ‡) Â Ó·‚ËÚ ÓÚ 3 ‚ËÛÒ-ÒÔÂˆËÙË˜ÌË ·ÂÎÚ˙˜ÌËÏÓÎÂÍÛÎË, ÙÓÏË‡˘Ë Í‡ÔÒË‰. ãËÔÒ‚‡ ‚˙Ì¯Ì‡ Ó·‚Ë‚Í‡ (ÒÛ-


é·ÁÓ

åéãÖäìãüêçÄ ïÄêÄäíÖêàëíàäÄ à èÄíéÉÖçÖçèéíÖçñàÄã çÄ POLYOMAVIRUS HOMINIS 2 (Çàêìë JC)

áÎ‡ÚÍÓ ä˙Î‚‡˜Â‚1, ë‚ÂÚÓÒÎ‡‚ ëÎ‡‚Ó‚1, à‚‡ÈÎÓ çÂÌÍÓ‚2, é„ÌflÌ ä˙ÎÂ‚3, ÄÒÂÌ ï‡‰ÊËflÌÂ‚4

1ã‡·Ó‡ÚÓËfl ÔÓ ÏÓÎÂÍÛÎflÌ‡ ‚ËÛÒÓÎÓ„Ëfl, ç‡ˆËÓÌ‡ÎÂÌ ñÂÌÚ˙ ÔÓ á‡‡ÁÌË Ë è‡‡ÁËÚÌË ÅÓÎÂÒÚË (çñáèÅ)2ÅËÓÎÓ„Ë˜ÂÒÍË î‡ÍÛÎÚÂÚ, ëÓÙËÈÒÍË ìÌË‚ÂÒËÚÂÚ ◊ë‚. äÎËÏÂÌÚ éıË‰ÒÍË”

3ã‡·Ó‡ÚÓËfl ÔÓ çÂ‚ÓÔ‡ÚÓÎÓ„Ëfl, åÂ‰ËˆËÌÒÍË ìÌË‚ÂÒËÚÂÚ – ëÓÙËfl4äÎËÌËÍ‡ ÔÓ ÌÂ‚ÓıËÛ„Ëfl, ìåÅÄã “ë‚. à‚‡Ì êËÎÒÍË”- ëÓÙËfl

îË„Û‡ 1. èÓ„ÂÒË‚Ì‡ ÏÛÎÚËÙÓÍ‡ÎÌ‡ ÎÂ‚ÍÓÂÌˆÂÙ‡ÎÓÔ‡ÚËfl: (‡) ÍÓÏÔ˛Ú˙ÌÓ-ÚÓÏÓ„‡ÙÒÍË Ó·‡Á; (·) Ï‡ÍÓÒÍÓÔÒÍË ËÁ„ÎÂ‰; (‚) ıËÒÚÓÎÓÎÓ„Ë˜Ì‡Ì‡ıÓ‰Í‡.

ÔÂÍ‡ÔÒË‰), ÍÓÂÚÓ ÔÂ‰ÔÓÎ‡„‡ ‚ËÒÓÍ‡ ÂÁËÒÚÂÌÚÌÓÒÚ Í˙ÏÎËÔË‰ÌË ‰ÂÚÂ„ÂÌÚË. ÇËËÓÌËÚÂ Ò˙‰˙Ê‡Ú 88% ·ÂÎÚ˙Í Ë12% Ñçä. ëÂ‰ËÏÂÌÚ‡ˆËÓÌÌËflÚ ËÏ ÍÓÂÙËˆËÂÌÚ ‚ Á‡ı‡Ó-ÁÂÌ „‡‰ËÂÌÚ Â 240S, ‡ ÔÎ‡‚‡˘‡Ú‡ ËÏ ÔÎ˙ÚÌÓÒÚ ‚ CsCl Â1,34 g/ml. ÇËÛÒËÚÂ Ò‡ Ò ÓÚÌÓÒËÚÂÎÌÓ ‚ËÒÓÍ‡ ÛÒÚÓÈ˜Ë-‚ÓÒÚ Í˙Ï ÚÓÔÎËÌÌ‡Ú‡ ËÌ‡ÍÚË‚‡ˆËfl.

JCV ÔËÚÂÊ‡‚‡ Í˙„Ó‚ ‰‚ÓÈÌÓ‚ÂËÊÂÌ Ñçä „ÂÌÓÏ,ËÁ„‡‰ÂÌ ÓÚ 5130 ·‡ÁÓ‚Ë ‰‚ÓÈÍË (ÙË„. 3). é„‡ÌË˜ÂÌ‡Ú‡„ÓÎÂÏËÌ‡ Ì‡ „ÂÌÓÏ‡ ÒÂ ÍÓÏÔÂÌÒË‡ ÙÛÌÍˆËÓÌ‡ÎÌÓ ˜ÂÁ‰ÂÈÒÚ‚ËÂÚÓ Ì‡ Ú.Ì‡. ÔÂÔÓÍË‚‡˘Ë ÒÂ „ÂÌË (overlappinggenes). ëÚÛÍÚÛÌÓ „ÂÌÓÏ˙Ú Â ‡Á‰ÂÎÂÌ Ì‡ ÚË ˜‡ÒÚË:Â„ÛÎ‡ÚÓÂÌ Â„ËÓÌ, ËÁ„‡‰ÂÌ ÓÚ 98 ·‡ÁÓ‚Ë ‰‚ÓÈÍË, ‡ÌÂÌ(Early, E) Â„ËÓÌ, ÍÓÈÚÓ ÍÓ‰Ë‡ Â„ÛÎ‡ÚÓÌËÚÂ (ÚÛÏÓ-ÌËÚÂ) ÔÓÚÂËÌË Ë Í˙ÒÂÌ (Late, L) Â„ËÓÌ, ÍÓ‰Ë‡˘ Í‡Ô-ÒË‰ÌËÚÂ ÔÓÚÂËÌË VP1, VP2, VP3 Ë ‡„ÌÓÔÓÚÂËÌ‡. ê‡Ì-ÌËÚÂ (ÌÂÒÚÛÍÚÛÌËÚÂ) ÔÓÚÂËÌË ËÏ‡Ú ËÁ‡ÁÂÌ‡ ÂÌÁËÏ-Ì‡ ‡ÍÚË‚ÌÓÒÚ Ë Ì‡Ô‡‚Îfl‚‡Ú ÒËÌÚÂÁ‡ Ì‡ ‚ËÛÒÌËÚÂ ÌÛÍ-ÎÂËÌÓ‚Ë ÍËÒÂÎËÌË, ‰ÓÍ‡ÚÓ Í˙ÒÌËÚÂ (ÒÚÛÍÚÛÌËÚÂ) ÔÓ-ÚÂËÌË Ò‡ ÍÓÏÔÓÌÂÌÚË Ì‡ ÁÂÎËfl ‚ËËÓÌ.

àÌÙÂÍÚË‡Ì‡Ú‡ ÍÎÂÚÍ‡ ÔÓËÁ‚ÂÊ‰‡ 2 Â„ÛÎ‡ÚÓÌË·ÂÎÚ˙Í‡ Ò ‚ËÒÓÍ ÓÌÍÓ„ÂÌÂÌ ÔÓÚÂÌˆË‡Î (Sweet T. M., et al.,2002). ÉÓÎÂÏËfl ÚÛÏÓÂÌ (T) ‡ÌÚË„ÂÌ Â Ò ÏÓÎÂÍÛÎÌÓ ÚÂ„ÎÓ81 kD Ë ÒÂ ÂÍÒÔÂÒË‡ ÔÂ‰ËÏÌÓ ‚ fl‰ÓÚÓ Ì‡ ÔÓ‡ÁÂÌ‡Ú‡ÍÎÂÚÍ‡, ÌÓ ÏÓÊÂ ‰‡ ÒÂ ÓÚÍËÂ Ë ÔÓ ÍÎÂÚ˙˜Ì‡Ú‡ ÏÂÏ·‡-Ì‡. íÓÈ ÔËÚÂÊ‡‚‡ ÔÓÎËÙÛÌÍˆËÓÌ‡ÎÌ‡ ‡ÍÚË‚ÌÓÒÚ,‚ÍÎ˛˜‚‡˘‡ ËÌËˆËË‡ÌÂÚÓ Í‡ÍÚÓ Ì‡ ÍÎÂÚ˙˜Ì‡Ú‡, Ú‡Í‡ Ë

Ì‡ ‚ËÛÒÌ‡Ú‡ Ñçä ÂÔÎËÍ‡ˆËfl, Â„ÛÎË‡ÌÂ Ì‡ ÒËÌÚÂÁ‡Ú‡Ì‡ ‡ÌÌËÚÂ Ë Í˙ÒÌËÚÂ ‚ËÛÒÌË ÔÓÚÂËÌË, ‡ÍÚË‚‡ˆËfl Ì‡Ú‡ÌÒÍËÔˆËflÚ‡ Ì‡ Í˙ÒÌËÚÂ ‚ËÛÒÌË ÔÓÚÂËÌË, Í‡ÍÚÓ ËÔÓ‰‰˙Ê‡ÌÂÚÓ Ì‡ ÍÎÂÚ˙˜Ì‡Ú‡ Ú‡ÌÒÙÓÏ‡ˆËfl. éÒ‚ÂÌÚÓ‚‡, í-‡ÌÚË„ÂÌ‡ Â ÒÔÓÒÓ·ÂÌ ‰‡ ÙÓÏË‡ ÍÓÏÔÎÂÍÒË Ò ‡Á-ÎË˜ÌË ÍÎÂÚ˙˜ÌË ·ÂÎÚ˙ˆË, ‚ÍÎ. 53, Ñçä-ÔÓÎËÏÂ‡Á‡Ú‡‡ÎÙ‡, 70 (heat-shock ÔÓÚÂËÌ), cdc2, ˆËÍÎËÌ, ÚÛ·ÛÎËÌ,105Rb, Í‡ÍÚÓ Ë Ò Rb-Ò‚˙Á‡ÌËfl 107.

å‡ÎÍËflÚ ÚÛÏÓÂÌ (t) ‡ÌÚË„ÂÌ Â„ÛÎË‡ ‚˙ÚÂÍÎÂÚ˙˜-Ì‡Ú‡ ‡ÍÛÏÛÎ‡ˆËfl Ì‡ ‚ËÛÒÌ‡ Ñçä Ë Ó·‡ÁÛ‚‡ ÙÛÌÍˆËÓÌ‡ÎÌËÍÓÏÔÎÂÍÒË Ò ‡ÁÎË˜ÌË ÍÎÂÚ˙˜ÌË ·ÂÎÚ˙ˆË, Ì‡Ô. ÚÛ·ÛÎËÌ ËÒ˙˘Ó Â ‚˙‚ÎÂ˜ÂÌ ‚ ÔÓˆÂÒËÚÂ Ì‡ ÍÎÂÚ˙˜Ì‡Ú‡ Ú‡ÌÒÙÓÏ‡-ˆËfl. JCV-ÚÛÏÓÌËÚÂ T- Ë t- ‡ÌÚË„ÂÌË ÏÓ„‡Ú ‰‡ ·˙‰‡ÚÓÚÍË‚‡ÌË ˜ÂÁ ËÏÛÌÓÂÌÁËÏÌ‡Ú‡ Â‡ÍˆËfl ELISA Ò ÔÓÏÓ˘-Ú‡ Ì‡ ÏÓÌÓÍÎÓÌ‡ÎÌË ‡ÌÚËÚÂÎ‡ Ë Ò ÛÒÔÂı ÒÂ ËÁÔÓÎÁ‚‡Ú Í‡ÚÓÒÔÂˆËÙË˜ÌË Ï‡ÍÂË Ì‡ ‚ËÛÒÌ‡Ú‡ ËÌÙÂÍˆËfl. éÒÌÓ‚ÌËÚÂÙÛÌÍˆËÓÌ‡ÎÌË ı‡‡ÍÚÂËÒÚËÍË Ì‡ Â„ÛÎ‡ÚÓÌËÚÂ ‚ËÛÒÌËÔÓÚÂËÌË Ò‡ ÔÂ‰ÒÚ‡‚ÂÌË Ì‡ Ú‡·Î. 1.

íË Ò‡ ÓÒÌÓ‚ÌËÚÂ ÒÚÛÍÚÛÌË ·ÂÎÚ˙ˆË, Ë‰ÂÌÚËÙËˆË-‡ÌË ÔË JCV - VP1, VP2 Ë VP3. VP1 Â Ò „ÓÎÂÏËÌ‡ 45 ÍD‡;ÚÓÈ ËÁ„‡Ê‰‡ ÔÓ-„ÓÎflÏ‡Ú‡ ˜‡ÒÚ Ì‡ ‚ËÛÒÌËfl Í‡ÔÒË‰ Ë ÂÓ·˘ ‡ÌÚË„ÂÌ Á‡ ‚ÒË˜ÍË ÔÓÎËÓÏ‡‚ËÛÒË. Vê2 Ë VP3 Ò‡ ÔÓ-Ï‡ÎÍËÚÂ Ò˙ÒÚ‡‚ÌË ·ÂÎÚ˙ˆË Ì‡ ‚ËÛÒÌËfl Í‡ÔÒË‰. Ö‰ÌÓ‚-ÂÏÂÌÌÓ Ò˙Ò ÒËÌÚÂÁ˙Ú Ì‡ ÚÂÁË ÔÓÚÂËÌË ÒÂ ÒËÌÚÂÁË‡ ËÂ‰ËÌ Ï‡Î˙Í (8 kDa) ·ÂÎÚ˙Í, Ì‡Â˜ÂÌ ‡„ÌÓÔÓÚÂËÌ, ÍÓÈÚÓË„‡Â ÓÎfl ÔË ‚ËÛÒÌ‡Ú‡ ÏÓÙÓ„ÂÌÂÁ‡, Ì‡È-‚ÂÓflÚÌÓ˜ÂÁ Á‡·‡‚flÌÂ Ì‡ ÔÓÎËÏÂËÁ‡ˆËflÚ‡ ÏÂÊ‰Û ÏÓÎÂÍÛÎËÚÂ Ì‡VP1, ‰ÓÍ‡ÚÓ ÚÂ ‚ÎflÁ‡Ú ‚ ÍÓÌÚ‡ÍÚ Ò ‚ËÛÒÌ‡Ú‡ Ñçä ‚ÍÎÂÚ˙˜ÌÓÚÓ fl‰Ó (Mahmud S. et al., 2002). ÇÒË˜ÍË ÚÂÁËÔÓÚÂËÌË ÒÂ ÒËÌÚÂÁË‡Ú ÔÓ ‚ÂÏÂ Ì‡ Í˙ÒÌ‡Ú‡ Ù‡Á‡ ÓÚÊËÁÌÂÌËfl ˆËÍ˙Î Ì‡ JCV Ë ÒÂ ÓÚÍË‚‡Ú ‚ ÔÂËÌÛÍÎÂ‡ÌÓ-ÚÓ ÔÓÒÚ‡ÌÒÚ‚Ó Ì‡ Á‡‡ÁÂÌ‡Ú‡ ÍÎÂÚÍ‡.

ÇËÛÒ˙Ú JC Â ÒÚÓ„Ó ‚Ë‰Ó‚Ó-ÒÔÂˆËÙË˜ÂÌ, Ú.Â. ÔÂÏË-ÒË‚ÌË Á‡ JC-ËÌÙÂÍˆËflÚ‡ Ò‡ Â‰ËÌÒÚ‚ÂÌÓ ˜Ó‚Â¯ÍËÚÂ ÍÎÂÚ-ÍË. èÓÚË˜‡ÌÂÚÓ Ì‡ JCV ËÌÙÂÍˆËflÚ‡ ‚ ÚÂÁË ÍÎÂÚÍËÓ·‡˜Â, ÏÓÊÂ ‰‡ ·˙‰Â ÔÓ‰ÛÍÚË‚ÌÓ Ë ÌÂÔÓ‰ÛÍÚË‚ÌÓ. èÓ-‰ÛÍÚË‚Ì‡Ú‡ ËÌÙÂÍˆËfl (ÙË„. 4) ÒÂ ı‡‡ÍÚÂËÁË‡ Ò ÂÔÎË-Í‡ˆËfl Ì‡ „ÂÌÓÏÌ‡Ú‡ Ñçä, ÔÓÒÎÂ‰‚‡Ì‡ ÓÚ Ò„ÎÓ·fl‚‡ÌÂ Ì‡ÁÂÎË ÊËÁÌÂÒÔÓÒÓ·ÌË (ËÌÙÂÍˆËÓÁÌË) ‚ËÛÒÌË ˜‡ÒÚËˆË.


îË„Û‡ 2. ëÚÛÍÚÛ‡ Ì‡ JC ÔÓÎËÓÏÌË ‚ËÛÒË

îË„Û‡ 3. ëıÂÏ‡ÚË˜ÌÓ ÔÂ‰ÒÚ‡‚flÌÂ Ì‡ „ÂÌÓÏ‡ Ì‡ JCV („ÂÌÓÚËÔ Mad1).

í‡·ÎËˆ‡ 1. êÂ„ÛÎ‡ÚÓÌË Ë ÒÚÛÍÚÛÌË Ë Â„ÛÎ‡ÚÓÌË ÔÓÚÂËÌË,ÍÓ‰Ë‡ÌË ÓÚ JCV

ÇËÛÒÂÌ çÛÍÎÂÓ- ÅÓÈ îÛÌÍˆËflÔÓÚÂËÌ ÚË‰Ì‡ ‡ÏËÌÓ

ÔÓÁËˆËfl Í-ÌËê‡ÌÂÌ ÍÓ‰Ë‡˘ Â„ËÓÌ:

í 5153-2722 695 àÌËˆËË‡Ú ‚ËÛÒÌ‡Ú‡ ÂÔÎËÍ‡ˆËfl;ÒÚËÏÛÎË‡Ú ÒËÌÚÂÁ‡ Ì‡ÍÎÂÚ˙˜Ì‡Ú‡ Ñçä; ÏÓ‰ÛÎË‡Ú ‡ÌÌ‡Ú‡Ë Í˙ÒÌ‡Ú‡ ‚ËÛÒÌ‡ Ú‡ÌÒÍËÔˆËfl;ÔÓ‚ÓÍË‡Ú Ë ÔÓ‰‰˙Ê‡Ú ÍÎÂÚ˙˜Ì‡Ú‡Ú‡ÌÒÙÓÏ‡ˆËfl

t 5153-4636 172 èÓ‚Ë¯‡‚‡Ú ÂÙÂÍÚË‚ÌÓÒÚÚ‡ Ì‡‚ËÛÒÌ‡Ú‡ Ñçä ÂÔÎËÍ‡ˆËfl

ä˙ÒÂÌ ÍÓ‰Ë‡˘ Â„ËÓÌ:

VP1 1564-2652 362 ÉÓÎflÏ Í‡ÔÒË‰ÂÌ ÔÓÚÂËÌ; Ë„‡ÂÓÒÌÓ‚Ì‡ ÓÎfl ÔË ËÁ„‡Ê‰‡ÌÂ Ì‡ËÍÓÒ‡Â‰ÓÌ‡; Û˜‡ÒÚ‚‡ ‚ Ì‡‚ÎËÁ‡ÌÂÚÓÌ‡ ‚ËÛÒ‡ ‚ „ÓÒÚÓÔËÂÏÌ‡Ú‡ ÍÎÂÚÍ‡;ÓÔÂ‰ÂÎfl ıÂÏ‡„ÎÛËÌË‡˘‡Ú‡‡ÍÚË‚ÌÓÒÚ Ì‡ ‚ËÛÒ‡

VP2 624-1679 351 å‡Î˙Í Í‡ÔÒË‰ÂÌ ÔÓÚÂËÌ; Û˜‡ÒÚ‚‡ ‚ËÁ„‡Ê‰‡ÌÂÚÓ Ì‡ ‚ËÛÒÌËÚÂ Í‡ÔÒÓÏÂË

VP3 981-1679 232 å‡Î˙Í Í‡ÔÒË‰ÂÌ ÔÓÚÂËÌ; Û˜‡ÒÚ‚‡ ‚ËÁ„‡Ê‰‡ÌÂÚÓ Ì‡ ‚ËÛÒÌËÚÂ Í‡ÔÒÓÏÂË

Agno 388-588 66 ìÎÂÒÌfl‚‡ Ò„ÎÓ·fl‚‡ÌÂÚÓ Ì‡ Í‡ÔÒË‰‡

ê‡ÁÎË˜ÌË ˜Ó‚Â¯ÍË ÍÎÂÚÍË Ò‡ ÔÂÏËÒË‚ÌË Á‡ JCV, ÌÓ ÂÙÂÍ-ÚË‚Ì‡ ÔÓ‰ÛÍÚË‚Ì‡ ÂÔÎËÍ‡ˆËfl Ì‡ JCV ÒÂ Ì‡·Î˛‰‡‚‡Â‰ËÌÒÚ‚ÂÌÓ ‚ ˜Ó‚Â¯ÍËÚÂ „ÎË‡ÎÌË ÍÎÂÚÍË. í˙È, Í‡ÚÓ ÔÓ-‰ÛÍÚË‚Ì‡Ú‡ ËÌÙÂÍˆËfl Â ÎËÚË˜Ì‡, ÚÂÁË ÍÎÂÚÍË ÒÂ Û‚ÂÊ-‰‡Ú (‡ÁÛ¯‡‚‡Ú) ÌÂÓ·‡ÚËÏÓ Ë ÍÎËÌË˜Ì‡Ú‡ ÔÓfl‚‡ Ì‡Ú‡ÁË ‰ÂÏËÂÎËÌËÁË‡˘‡ ËÌÙÂÍˆËfl Â ËÁ‚ÂÒÚÌ‡ Í‡ÚÓ ÔÓ„-ÂÒË‚Ì‡ ÏÛÎÚËÙÓÍ‡ÎÌ‡ ÎÂ‚ÍÓÂÌˆÂÙ‡ÎÓÔ‡ÚËfl (PML)

çÂÔÓ‰ÛÍÚË‚Ì‡ JCV ËÌÙÂÍˆËfl (ÙË„. 4) ÒÂ Ì‡·Î˛‰‡‚‡Ó·ËÍÌÓ‚ÂÌÓ, ÍÓ„‡ÚÓ ÔÓ ‚ÂÏÂ Ì‡ ‚ËÛÒÌ‡Ú‡ ÂÔÎËÍ‡ˆËfl ÌÂÒÂ ÒËÌÚÂÁË‡ ‡‰ÂÍ‚‡ÚÌÓ ÍÓÎË˜ÂÒÚ‚Ó í-‡ÌÚË„ÂÌ, ÍÓÈÚÓ ÂÂ„ÛÎ‡ÚÓ˙Ú Ì‡ ÂÔÎËÍ‡ˆËflÚ‡ Ì‡ ‚ËÛÒÌ‡Ú‡ Ñçä. Ç ÚÓ-ÁË ÒÎÛ˜‡È, ˆËÍÛÎflÌËfl ‚ËÛÒÂÌ „ÂÌÓÏ ÌÂ ÏÓÊÂ ‰‡ ÒÂ ÂÔ-ÎËˆË‡ Ë ÔÓÒÚÂÔÂÌÌÓ, ‚ ‡ÏÍËÚÂ Ì‡ ÌflÍÓÎÍÓ ‰ÌË, ËÁ˜ÂÁ‚‡ÓÚ ÍÎÂÚÍ‡Ú‡, ÍÓflÚÓ ÒË ‚˙Á‚˙˘‡ ÌÓÏ‡ÎÌËÚÂ Ò‚ÓÈÒÚ‚‡Ë Ì‡˜ËÌ Ì‡ ‡ÒÚÂÊ. íÓÁË ÔÓˆÂÒ Â ËÁ‚ÂÒÚÂÌ Ó˘Â Í‡ÚÓ‡·ÓÚË‚Ì‡ Ú‡ÌÒÙÓÏ‡ˆËfl. ë˙˘ÂÒÚ‚Û‚‡ Ó·‡˜Â Ë ‚˙Á-ÏÓÊÌÓÒÚÚ‡ ‚ËÛÒÌ‡Ú‡ Ñçä ‰‡ ÒÂ ËÌÚÂ„Ë‡ ‚ ÍÎÂÚ˙˜-ÌËfl „ÂÌÓÏ. ÄÍÓ ËÌÚÂ„‡ˆËflÚ‡ ÒÂ ËÁ‚˙¯Ë ‚ Ó·Î‡ÒÚÚ‡ Ì‡ÔÓ‰ıÓ‰fl˘ ÍÎÂÚ˙˜ÂÌ ÔÓÏÓÚÓ Á‡ ÂÍÒÔÂÒËfl Ì‡ ‚ËÛÒÌË-ÚÂ í-‡ÌÚË„ÂÌË, Ú‡ÌÒÙÓÏË‡ÌËflÚ ÙÂÌÓÚËÔ ˘Â ÒÂ Á‡Í-ÂÔË Ë ÚÓ„‡‚‡ ÔÓˆÂÒ˙Ú, ËÁ‚ÂÒÚÂÌ Í‡ÚÓ ÍÎÂÚ˙˜Ì‡Ú‡ÌÒÙÓÏ‡ˆËfl ÏÓÊÂ ‰‡ ·˙‰Â ÓÔÂ‰ÂÎÂÌ Í‡ÚÓ ÛÒÔÂ¯ÂÌ.ë˜ËÚ‡ ÒÂ, ˜Â JCV Â ÒÂ‰ ÓÒÌÓ‚ÌËÚÂ ÂÚËÓÎÓ„Ë˜ÌË Ù‡ÍÚÓ-Ë Á‡ ‚˙ÁÌËÍ‚‡ÌÂ Ë ‡Á‚ËÚËÂ Ì‡ Â‰Ëˆ‡ „ÎË‡ÎÌË ÚÛÏÓË –‡ÒÚÓˆËÚÓÏ, „ÎËÓ·Î‡ÒÚÓÏ, „ÎËÓÒ‡ÍÓÏ, ÓÎË„Ó‰ÂÌ‰Ó„ÎÓ-ËÏ, ÓÎË„Ó‡ÒÚÓˆËÚÓÏ, ÂÔÂÌ‰ËÏÓÏ (Major, E. et al., 1992).ç‡ÎËˆÂ Ò‡ Ó·‡˜Â Ë ‰ÓÍ‡Á‡ÚÂÎÒÚ‚‡ Á‡ ÔËÒ˙ÒÚ‚ËÂ Ì‡ JCV-Ñçä ÔË ÚÛÏÓË ËÁ‚˙Ì ÌÂ‚Ì‡Ú‡ ÒËÒÚÂÏ‡ - ÔË ÎÂ‚ÍÂ-ÏËË, ÎËÏÙÓÏË Ë ÚÛÏÓË Ì‡ ‰Â·ÂÎÓÚÓ ˜Â‚Ó, ÔË ÚÓ‚‡ Ò

‚ËÒÓÍ ‚ËÛÒÂÌ ÚÓ‚‡.êÂˆÂÔÚÓËÚÂ, Ò ÔÓÏÓ˘Ú‡ Ì‡ ÍÓËÚÓ JCV ÒÂ ÔËÍÂÔ‚‡

Í˙Ï ÔÓ‚˙ıÌÓÒÚÚ‡ Ì‡ ÍÎÂÚÍ‡Ú‡ Ò‡ ˜‡ÒÚË˜ÌÓ Óı‡‡ÍÚË-ËÁË‡ÌË. ÇÁ‡ËÓ‰ÂÈÒÚ‚ËflÚ‡ ‚ËÛÒ – ÍÎÂÚ˙˜ÂÌ ÂˆÂÔÚÓË„‡flÚ „Î‡‚Ì‡ ÓÎfl ‚ ÓÔÂ‰ÂÎflÌÂÚÓ Ì‡ ‚ËÛÒÌËfl ÚÓ-ÔËÁ˙Ï Ë Ú˙Í‡Ì-ÒÔÂˆËÙË˜Ì‡Ú‡ Ô‡ÚÓÎÓ„Ëfl, Ò‚˙Á‡Ì‡ Ò ‚Ë-ÛÒÌ‡Ú‡ ËÌÙÂÍˆËfl. VP1 ÓÚ JCV ıÂÏ‡„ÎÛÚËÌË‡ ˜Â‚ÂÌË-ÚÂ Í˙‚ÌË ÍÎÂÚÍË ÔÓ Ò‚˙Á‡Ì ÏÂı‡ÌËÁ˙Ï, ÍÓÂÚÓ ÒÂ ‰˙ÎÊËÌ‡ ÒË‡ÎÓ‚‡Ú‡ ÍËÒÂÎËÌ‡ ÔÓ ÔÓ‚˙ıÌÓÒÚÚ‡ ËÏ. ÉÓÒÚÓÔË-ÂÏÌËÚÂ ÍÎÂÚÍË Á‡ JCV Ò‡ ÓÎË„Ó‰ÂÌ‰ÓˆËÚË, ‡ÒÚÓˆËÚË,ò‚‡ÌÓ‚Ë ÍÎÂÚÍË, Ç-ÎËÏÙÓˆËÚË, ÚÓÌÁËÎ‡ÌË ÒÚÓÏ‡ÎÌËÍÎÂÚÍË, ÂÌ‡ÎÌË ÚÛ·ÛÎ‡ÌË ÍÎÂÚÍË Ë Ú.Ì. JCV ÂˆÂÔ-ÚÓ˙Ú, ˜ÂÁ ÍÓÈÚÓ ‚ËÛÒ˙Ú ÔÓÌËÍ‚‡ ‚ ÍÎÂÚÍ‡Ú‡ ÔÂ‰Ò-Ú‡‚Îfl‚‡ ÛÒÚÓÈ˜Ë‚ Ì‡ ÚËÔÒËÌ N-Ò‚˙Á‡Ì „ÎËÍÓÔÓÚÂËÌ,Ò˙‰˙Ê‡˘ α(2-6) – Ò‚˙Á‡Ì‡ ÒË‡ÎÓ‚‡ ÍËÒÂÎËÌ‡. íÓÁË ‚˙„ÎÂ-ıË‰‡ÚÂÌ ÂˆÂÔÚÓ Ò‚˙Á‚‡ JCV Ò ÍÎÂÚ˙˜Ì‡Ú‡ ÔÓ‚˙-ıÌÓÒÚ, ÌÓ ÌÂ Â ‰ÓÒÚ‡Ú˙˜ÂÌ ‰‡ ÓÒ˙˘ÂÒÚ‚Ë ËÌÚÂÌ‡ÎËÁ‡-ˆËflÚ‡ Ì‡ ‚ËÛÒ‡. 5çí

2ÄRÒÂÓÚÓÌËÌÓ‚ËflÚ ÂˆÂÔÚÓ Â

ÙÛÌÍˆËÓÌ‡ÎÌËflÚ ÂˆÂÔÚÓ Á‡ JCV Á‡ Ú‡ÁË ˆÂÎ. JCV ‚Ë-ÛÒ˙Ú ÔÓÌËÍ‚‡ ‚ ñçë, ÔËÍÂÔflÈÍË ÒÂ Í˙Ï 5çí

2ÄRÂ-

ˆÂÔÚÓ‡ Á‡ ÒÂÓÚÓÌËÌ ÔÓ ÔÓ‚˙ıÌÓÒÚÚ‡ Ì‡ „ÎË‡ÎÌËÚÂÍÎÂÚÍË. äÓ„‡ÚÓ ÒÂÓÚÓÌËÌÓ‚ËflÚ ÂˆÂÔÚÓ ÒÂ Á‡‰ÂÈ-ÒÚ‚‡, ÚÓÈ ‡ÍÚË‚Ë‡ Í‡ÒÍ‡‰‡, ÍÓflÚÓ ÔÓÁ‚ÓÎfl‚‡ Ì‡ ‚ËÛÒ‡‰‡ Ì‡‚ÎÂÁÂ ‚ ÍÎÂÚÍ‡Ú‡.

JCV Ì‡‚ÎËÁ‡ ‚ ÍÎÂÚÍ‡Ú‡ ÔÓ Ô˙Úfl Ì‡ ÍÎ‡ÚËÌ-Á‡‚ËÒËÏ‡-Ú‡ ÂÌ‰ÓˆËÚÓÁ‡. VP2 Ë VP3 Ò‡ ÏËËÒÚËÎË‡ÌË Ë ‚Á‡ËÏÓ-‰ÂÈÒÚ‚‡Ú Ò ÍÎÂÚ˙˜Ì‡Ú‡ ÏÂÏ·‡Ì‡, ÛÎÂÒÌfl‚‡ÈÍË Ì‡‚ÎËÁ‡-ÌÂÚÓ. ÇËÛÒ˙Ú ËÁÔÓÎÁ‚‡ ÏÂı‡ÌËÁÏ‡ Ì‡ Ì‡‚ÎËÁ‡ÌÂ Ì‡ ·ÂÎÚ˙-Í‡ Ú‡ÌÒÙÂËÌ ‚ ÍÎÂÚÍ‡Ú‡ Í‡ÚÓ ÒÂ Ì‡·Î˛‰‡‚‡ ÍÓ-ÎÓÍ‡ÎË-Á‡ˆËfl Ì‡ JCV ‚ËÛÒ‡ Ë Ú‡ÌÒÙÂËÌ‡ ‚ ÂÌ‰ÓÁÓÏËÚÂ. ç‡‚ÎË-Á‡ÌÂÚÓ ‚ ÂÌ‰ÓÁÓÏËÚÂ ÔÓÒÚ‡‚fl ‚ËÛÒ‡ ‚ ÍËÒÂÎ‡ ÒÂ‰‡, ÍÓÂ-ÚÓ ‚Ó‰Ë ‰Ó ÍÓÌÙÓÏ‡ˆËÓÌÌË ÔÓÏÂÌË ‚ ÌflÍÓÎÍÓ ‚ËÛÒÌË„ÎËÍÓÔÓÚÂËÌ‡, ÍÓÂÚÓ ÔÓ‰ÔÓÏ‡„‡ Ò˙·ÎË˜‡ÌÂÚÓ Ì‡ ‚ËÛÒ‡.ÇËÛÒÌ‡Ú‡ ËÌÙÂÍˆËfl Â ˜Û‚ÒÚ‚ËÚÂÎÌ‡ Í˙Ï ‡ÁÛ¯‡‚‡ÌÂ Ì‡ÂÌ‰ÓÁÓÏ‡ÎÌÓÚÓ ç. JCV ÌÂ Ì‡‚ÎËÁ‡ ‚ ÍÎÂÚÍ‡Ú‡ ÔÓ Ô˙Úfl Ì‡ÔÓÒÚ‡Ú‡ ‰ËÙÛÁËfl, ‡ ËÁËÒÍ‚‡ ‡ÍÚË‚ÌË ÍÎÂÚ˙˜ÌË Ú‡ÌÒÔÓ-ÚÌË ÒËÒÚÂÏË. ñËÚÓÔÎ‡ÁÏ‡ÚË˜ÌËflÚ Ú‡ÌÒÔÓÚ ‚ ÂÛÍ‡-ËÓÚÌËÚÂ ÍÎÂÚÍË Á‡‚ËÒË ÓÚ ÍÓÏÔÎÂÍÒÌÓÚÓ ‰ÂÈÒÚ‚ËÂ Ì‡ÏËÍÓÙËÎ‡ÏÂÌÚËÚÂ, ÏËÍÓÚÛ·ÛÎËÚÂ Ë ËÌÚÂÏÂ‰ËÂÌË-ÚÂ ÙËÎ‡ÏÂÌÚË. èË˜ËÌËÚÂÎflÚ Ì‡ êåL Â ÒËÎÌÓ Á‡‚ËÒËÏÓÚ ÚÓÁË ÍÎÂÚ˙˜ÂÌ ‡Ô‡‡Ú. î‡ÍÚ Â Ó·‡˜Â, ˜Â ÔÓ ‚ÂÏÂ Ì‡ÂÌ‰ÓˆËÚÓÁ‡Ú‡ ‚ Ú‡ÌÒÔÓÚË‡ÌÂÚÓ Ì‡ ‚ËËÓÌËÚÂ ‰Ó fl‰-ÓÚÓ Ë ‰ÂÔÓÚÂËÌËÁË‡ÌÂÚÓ Ì‡ ‚ËÛÒÌ‡Ú‡ Ñçä ‚ ÌËÚÓÂ‰ËÌ ÏÓÏÂÌÚ ÌÂ ÒÂ Ì‡·Î˛‰‡‚‡ Û˜‡ÒÚËÂÚÓ Ì‡ ÎËÁÓÁÓÏË.

ÇËÛÒÌ‡Ú‡ ÔÓÔÛÎ‡ˆËfl ÒÂ Ò˙ÒÚÓË ÓÚ ÚË ÚËÔ‡ ˜‡ÒÚË-ˆË: ËÌÙÂÍˆËÓÁÌË ‚ËËÓÌË, ˜ËÈÚÓ Í‡ÔÒË‰ËÚÂ Ò˙‰˙Ê‡ÚÂ‰Ì‡ ÒÛÔÂÒÔË‡ÎËÁË‡Ì‡ ‰‚ÓÈÌÓ- ‚ÂËÊÌ‡ ÏÓÎÂÍÛÎ‡ ‚Ë-ÛÒÌ‡ Ñçä, Ò‚˙Á‡Ì‡ Ò 4 ÍÎÂÚ˙˜ÌË ıËÒÚÓÌ‡: H2A, H2B,H3, H4; Ô‡ÁÌË Í‡ÔÒË‰Ë, ÍÓËÚÓ ÌÂ Ò˙‰˙Ê‡Ú ‚ËÛÒ-ÒÔÂˆË-ÙË˜Ì‡ Ñçä Ë ÔÒÂ‚‰Ó‚ËËÓÌË, ˜ËÈÚÓ Í‡ÔÒË‰Ë Ò˙‰˙Ê‡ÚÍÎÂÚ˙˜Ì‡ Ñçä.

åéãÖäìãüêçà åÖïÄçàáåà çÄ JCV- àçÑìñàêÄ-çÄíÄ äãÖíöóçÄ íêÄçëîéêåÄñàü

JCV Ë„‡Â Ò˙˘ÂÒÚ‚ÂÌ‡ ÓÎfl ‚ ÔÓˆÂÒËÚÂ Ì‡ Ï‡ÎË„ÌÂ-Ì‡Ú‡ ÍÎÂÚ˙˜Ì‡ Ú‡ÌÒÙÓÏ‡ˆËfl ˜ÂÁ ‚ËÛÒ-ÒÔÂˆËÙË˜ÌË-ÚÂ ÚÛÏÓÌË ‡ÌÚË„ÂÌË. íÂ ÔÓÚËÒÍ‡Ú ÂÒÚÂÒÚ‚ÂÌËÚÂ Á‡-˘ËÚÌË ÍÎÂÚ˙˜ÌË ÏÂı‡ÌËÁÏË. í-‡ÌÚË„ÂÌ˙Ú ÌflÏ‡ ÂÌÁËÏÌ‡‡ÍÚË‚ÌÓÒÚ Ë ËÁÔ˙ÎÌfl‚‡ ÙÛÌÍˆËËÚÂ ÒË ˜ÂÁ ‚Á‡ËÏÓ‰ÂÈ-ÒÚ‚ËÂ Ò ÍÎÂÚ˙˜ÌËÚÂ ÔÓÚÂËÌË. íÂ ÒÂ Ò‚˙Á‚‡Ú Ò ÔÓ‰ÛÍ-Ú‡ Ì‡ ÚÛÏÓÒÛÔÂÒÓÌËfl „ÂÌ 53, ÍÓÈÚÓ ÒÂ ÂÍÒÔÂÒË‡ÔË Û‚ÂÊ‰‡ÌÂ Ì‡ Ñçä Ë ÔÂ‰ËÁ‚ËÍ‚‡ ÒÔË‡ÌÂ Ì‡ ÍÎÂÚ˙˜-ÌËfl ˆËÍ˙Î ‚˙‚ Ù‡Á‡ G1 ˜ÂÁ trans-‡ÍÚË‚Ë‡ÌÂ Ì‡ „ÂÌ‡WAF1/CIP1 (ÙË„. 5). èÓ‰ÛÍÚ˙Ú Ì‡ ÚÓÁË „ÂÌ (21) ‚Á‡Ë-ÏÓ‰ÂÈÒÚ‚‡ ‰ËÂÍÚÌÓ Ò ÍÓÏÔÎÂÍÒ‡ ˆËÍÎËÌ/ˆËÍÎËÌ-Á‡‚ËÒË-Ï‡ ÍËÌ‡Á‡/PNCA (proliferating cell nuclear antigen), ÍÓÈÚÓ


îË„Û‡ 4. ÜËÁÌÂÌ ˆËÍ˙Î Ì‡ JCV. 1-‡‰ÒÓ·ˆËfl Ì‡ ‚ËËÓÌËÚÂ ‚˙ıÛÍÎÂÚ˙˜Ì‡Ú‡ ÔÓ‚˙ıÌÓÒÚ; 2-Ì‡‚ÎËÁ‡ÌÂ ‚ ÍÎÂÚÍ‡Ú‡ ÔÓÒÂ‰ÒÚ‚ÓÏ

ÂÌ‰ÓˆËÚÓÁ‡; 3-Ú‡ÌÒÔÓÚË‡ÌÂ ‰Ó fl‰ÓÚÓ Ì‡ ÍÎÂÚÍ‡Ú‡; 4-ÓÒ‚Ó·ÓÊ‰‡‚‡ÌÂ ÓÚ ÔÓ‚˙ıÌÓÒÚÌËÚÂ ÔÓÚÂËÌË; 5-Ú‡ÌÒÍËÔˆËfl Ì‡

‡ÌÌËÚÂ Ëêçä; 6-Ú‡ÌÒÎ‡ˆËfl Ì‡ ‡ÌÌËÚÂ ÔÓÚÂËÌË (T-‡ÌÚË„ÂÌË); 7-ÂÔÎËÍ‡ˆËfl Ì‡ ‚ËÛÒÌ‡Ú‡ Ñçä; 8-Ú‡ÌÒÍËÔˆËfl Ì‡ Í˙ÒÌËÚÂ Ëêçä; 9-

Ú‡ÌÒÎ‡ˆËfl Ì‡ Í˙ÒÌËÚÂ Í‡ÔÒË‰ÌË ÔÓÚÂËÌË; 10-Ò„ÎÓ·fl‚‡ÌÂ Ì‡‚ËËÓÌÌÓÚÓ ÔÓÚÓÏÒÚ‚Ó ‚ ÍÎÂÚ˙˜ÌÓÚÓ fl‰Ó; 11-Ì‡‚ÎËÁ‡ÌÂ Ì‡ ‚ËËÓÌËÚÂ

‚ ˆËÚÓÔÎ‡ÁÏÂÌËÚÂ Ú‡ÌÒÔÓÚÌË ‚ÂÁËÍÛÎË; 12-Ì‡ÔÛÒÍ‡ÌÂ Ì‡ ÍÎÂÚÍ‡Ú‡ÓÚ ‚ËËÓÌËÚÂ ˜ÂÁ ÒÎË‚‡ÌÂ Ì‡ Ú‡ÌÒÔÓÚÌËÚÂ ‚ÂÁËÍÛÎË Ò ÍÎÂÚ˙˜Ì‡Ú‡ÏÂÏ·‡Ì‡; 13-Ò‚Ó·Ó‰ÂÌ ÔÓÎËÓÏÂÌ ‚ËÛÒ. èË Ì‡ÒÚ˙Ô‚‡ÌÂ Ì‡ ÍÎÂÚ˙˜Ì‡

ÒÏ˙Ú, ‚ËËÓÌËÚÂ ËÁÚË˜‡Ú ÓÚ fl‰ÓÚÓ Ë ÎËÁË‡Ú ÍÎÂÚÍ‡Ú‡. ÇÌÂÔÂÏËÒË‚ÌË ÍÎÂÚÍË ÌÓÏ‡ÎÌÓ ÔÓÚË˜‡Ú Ô˙‚ËÚÂ ¯ÂÒÚ ÒÚ˙ÔÍË, ÌÓ

ÔÓÒÎÂ‰‚‡˘ËÚÂ Ò˙·ËÚËfl (7-12) ÌÂ ÒÂ ÒÎÛ˜‚‡Ú.

ÙÓÒÙÓËÎË‡ Ë ËÌ‡ÍÚË‚Ë‡ ÂÚËÌÓ·Î‡ÒÚÓÏÌËfl ÔÓÚÂËÌ.ä‡ÈÌËflÚ ÂÁÛÎÚ‡Ú Â ÒÔË‡ÌÂ Ì‡ ÍÎÂÚ˙˜ÌËfl ˆËÍ˙Î ‚ G1Ù‡Á‡, ÔË ÍÓÂÚÓ ‚˙ÁÌËÍÌ‡ÎËÚÂ ‚ Ñçä „Â¯ÍË ÒÂ ÔÓÔ‡-‚flÚ. ÄÍÓ „Â¯ÍËÚÂ ÌÂ ·˙‰‡Ú ÍÓË„Ë‡ÌË, 53 ËÌ‰ÛˆË‡ÔÓ„‡ÏË‡Ì‡ ÍÎÂÚ˙˜Ì‡ ÒÏ˙Ú (‡ÔÓÔÚÓÁ‡) ˜ÂÁ ÔÓÚËÒÍ‡-ÌÂ Ì‡ bcl2 „ÂÌ‡ Ë ‡ÍÚË‚Ë‡ÌÂ Ì‡ bax „ÂÌ‡.

í˙È Í‡ÚÓ JCV “‡Á˜ËÚ‡” Ì‡ ÍÎÂÚ˙˜ÌËfl ‡Ô‡‡Ú Á‡ ÒËÌ-ÚÂÁ Ì‡ Ñçä, ÌÂÓ·ıÓ‰ËÏÓ Â ‰‡ ÒÂ ÒÚËÏÛÎË‡ Ì‡‚ÎËÁ‡ÌÂÚÓÌ‡ ÍÎÂÚÍ‡Ú‡ ‚ S-Ù‡Á‡, ‡ ÌÂ ÒÔË‡ÌÂÚÓ Ì‡ ÍÎÂÚ˙˜ÌËflˆËÍ˙Î ‚ G1 Ù‡Á‡. ë‚˙Á‚‡ÌÂÚÓ Ë ‡ÁÛ¯‡‚‡ÌÂÚÓ Ì‡ 53ÓÚ ‚ËÛÒÌËflÚ í-‡ÌÚË„ÂÌ ‚Ó‰Ë ‰Ó Á‡Ó·ËÍ‡ÎflÌÂ Ì‡ Â„ÛÎ‡-ÚÓÌËÚÂ ÚÓ˜ÍË Ì‡ ÍÎÂÚ˙˜ÌËfl ˆËÍ˙Î ‚ G1/S Ë G2/M, ÔËÍÓÂÚÓ ÒÂ Ì‡ÚÛÔ‚‡Ú ÏÌÓÊÂÒÚ‚Ó ÏÛÚ‡ˆËË, ‚Ó‰Â˘Ë ‰ÓÏ‡ÎË„ÌÂÌ‡ Ú‡ÌÒÙÓÏ‡ˆËfl.

ÑÛ„‡Ú‡ ÓÒÌÓ‚Ì‡ ‡ÍÚË‚ÌÓÒÚ Ì‡ JCV-ÒÔÂˆËÙË˜ÌËÚÂ í-ÔÓÚÂËÌË ÒÂ ÔÓfl‚fl‚‡ ÔË ‚Á‡ËÏÓ‰ÂÈÒÚ‚ËÂÚÓ ËÏ ÒÔÂ‰ÒÚ‡‚ËÚÂÎËÚÂ Ì‡ ÂÚËÌÓ·Î‡ÒÚÓÏÌÓÚÓ ÚÛÏÓ-ÒÛÔÂ-ÒÓÌÓ ÒÂÏÂÈÒÚ‚Ó (ÙË„. 5). êÂÚËÌÓ·Î‡ÒÚÓÏÌËflÚ ÔÓÚÂËÌ(pRb) Â ÔÓ‰ÛÍÚ Ì‡ „ÂÌ‡ Rb-1 Ë ËÁÔ˙ÎÌfl‚‡ ÓÎflÚ‡ Ì‡ ÌÂ„‡-ÚË‚ÂÌ Â„ÛÎ‡ÚÓ Ì‡ ÍÎÂÚ˙˜ÌËfl ˆËÍ˙Î. ÄÍÚË‚ÌÓÒÚÚ‡ Ì‡pRb ÒÂ Â„ÛÎË‡ ÓÚ ÔÓˆÂÒËÚÂ Ì‡ ÙÓÒÙÓËÎË‡ÌÂ Ë ‰ÂÙÓÒ-ÙÓËÎË‡ÌÂ Ë ÒÂ ÔÓÏÂÌfl ÔÂÁ ‡ÁÎË˜ÌËÚÂ Ù‡ÁË Ì‡ ÍÎÂÚ˙˜-ÌËfl ˆËÍ˙Î. ÄÍÚË‚Ì‡Ú‡ ÙÓÏ‡ Ì‡ ÏÓÎÂÍÛÎ‡Ú‡ Â ‰ÂÙÓÒÙÓË-ÎË‡ÌËflÚ Rb. Ç˙‚ Ù‡Á‡ G0 Ë ‚ Ì‡˜‡ÎÓÚÓ Ì‡ Ù‡Á‡ G1, Rb Â‚ ‰ÂÙÓÒÙÓËÎË‡ÌÓ (‡ÍÚË‚ÌÓ) Ò˙ÒÚÓflÌËÂ, ‡ ÔÓ ‚ÂÏÂ Ì‡ Ù‡-ÁËÚÂ G1, S, G2 Ë M – ıËÔÂÙÓÒÙÓËÎË‡Ì Ú.Â., ÌÂ‡ÍÚË‚ÂÌ.îÓÒÙÓËÎË‡ÌÂÚÓ ÒÂ ËÁ‚˙¯‚‡ ÓÚ ̂ ËÍÎËÌ-Á‡‚ËÒËÏË ÍËÌ‡ÁË(cdÍ). èÓ ‚ÂÏÂ Ì‡ Ù‡Á‡Ú‡ G1 ‡ÍÚË‚Ë‡ÌËflÚ Rb ÒÂÒ‚˙Á‚‡ Ò Ú‡ÌÒÍËÔˆËÓÌÌËfl Ù‡ÍÚÓ E2F, ÍÓÂÚÓ ·ÎÓÍË‡Ú‡ÌÒÍËÔˆËflÚ‡ Ì‡ Ñçä. é·‡ÚÌÓ, Ó·‡ÁÛ‚‡ÌÂÚÓ Ì‡ Rb-í-‡ÌÚË„ÂÌÂÌ ÍÓÏÔÎÂÍÒ ‚Ó‰Ë ‰Ó ÓÒ‚Ó·ÓÊ‰‡‚‡ÌÂ Ì‡ Ú‡Ì-ÒÍËÔˆËÓÌÌËfl Ù‡ÍÚÓ Ö2F, ÍÓÂÚÓ ÒÚËÏÛÎË‡ Ú‡ÌÒÍËÔ-ˆËflÚ‡ Ì‡ Ñçä Ë ÔÓ„ÂÒËflÚ‡ Í˙Ï S Ù‡Á‡Ú‡ Ì‡ ÍÎÂÚ˙˜ÌËflˆËÍ˙Î. í-‡ÌÚË„ÂÌËÚÂ ‚Á‡ËÏÓ‰ÂÈÒÚ‚‡Ú Ë Ò ‰Û„Ë ÔÂ‰ÒÚ‡-‚ËÚÂÎË Ì‡ ÂÚËÌÓ·Î‡ÒÚÓÏÌÓÚÓ ÒÂÏÂÈÒÚ‚Ó – 107 Ë 130,ÍÓÂÚÓ Ò˙˘Ó ÒÚËÏÛÎË‡ ÍÎÂÚ˙˜ÌËfl ˆËÍ˙Î.

àÌÚÂ„Ë‡ÌËÚÂ Ë ÂÔËÁÓÏ‡ÎÌË ÙÓÏË Ì‡ JC-‚ËÛÒÌËfl„ÂÌÓÏ ÏÓ„‡Ú ‰‡ Ò˙˘ÂÒÚ‚Û‚‡Ú Â‰ÌÓ‚ÂÏÂÌÌÓ ‚ Â‰Ì‡ Ë Ò˙-˘‡ ÍÎÂÚÍ‡. Ç ÒÎÛ˜‡È Ì‡ ËÌÚÂ„‡ˆËfl, ‡ÍÓ ‚ËÛÒÌ‡Ú‡ Ñçä

ÒÂ ÓÍ‡ÊÂ ‚ ·ÎËÁÓÒÚ ‰Ó ÌflÍÓÈ ÓÚ ÍÎÂÚ˙˜ÌËÚÂ ÓÌÍÓ„ÂÌË (c-myc, c-ras, ËÎË ‰.), ÚÂ ÏÓ„‡Ú ‰‡ ·˙‰‡Ú ‡ÍÚË‚Ë‡ÌË. ë˙-˘ÂÒÚ‚Û‚‡Ú ‰‡ÌÌË Á‡ ‚Á‡ËÏÓ‰ÂÈÒÚ‚ËÂ ÏÂÊ‰Û ‚ËÛÒÌËÚÂí-‡ÌÚË„ÂÌË Ò ‡ÍÚË‚Ë‡ÌËfl Ò-ras, ÍÓÂÚÓ ÔÂ‰ËÁ‚ËÍ‡ÍÎÂÚ˙˜Ì‡ Ú‡ÌÒÙÓÏ‡ˆËfl (Reiss and Khalli, 2003). éÒ‚ÂÌÚÓ‚‡, ‚ „ÎË‡ÎÌËÚÂ ÍÎÂÚÍË Ò‡ Ì‡·Î˛‰‡‚‡ÌË ˆËÚÓ„ÂÌÂÚË˜-ÌË (ıÓÏÓÁÓÏÌË) ËÁÏÂÌÂÌËfl (‡ÎÂÎÌË Á‡„Û·Ë) ‚ ‡ÁÎË˜ÌËÛ˜‡ÒÚ˙ˆË Ì‡ ıÓÏÓÁÓÏ‡Ú‡, ‚ ÍÓflÚÓ ÒÂ Â ËÌÚÂ„Ë‡Î ‚Ë-ÛÒÌËflÚ „ÂÌÓÏ (Seth P. et al., 2003). í‡Í‡ ÏÓ„‡Ú ‰‡ ·˙‰‡ÚÁ‡„Û·ÂÌË ‚‡ÊÌË ÚÛÏÓ-ÒÛÔÂÒÓÌË „ÂÌË, Í‡ÚÓ Ì‡ÔËÏÂ53. íÓ˜ÌËÚÂ ÏÂı‡ÌËÁÏË Ì‡ ‚Á‡ËÏÓ‰ÂÈÒÚ‚ËÂÚÓ ÏÂÊ‰ÛJCV Ò ÍÎÂÚ˙˜ÌËflÚ „ÂÌÓÏ ÌÂ Ò‡ ‰ÓÒÚ‡Ú˙˜ÌÓ ÔÓÛ˜ÂÌË.

å‡ÎÍËflÚ t-‡ÌÚË„ÂÌ Ì‡ JCV Ò˙˘Ó ‰ÓÔËÌ‡Òfl Á‡ ‚ËÛÒ-Ì‡Ú‡ Ú‡ÌÒÙÓÏ‡ˆËfl Ì‡ ÍÎÂÚÍ‡Ú‡. çÂ„Ó‚‡Ú‡ ÍÓ-ÂÍÒÔÂ-ÒËfl Â ÌÂÓ·ıÓ‰ËÏ‡ Á‡ ËÌËˆËË‡ÌÂ Ú‡ÌÒÙÓÏ‡ˆËflÚ‡ Ì‡ ÓÔ-Â‰ÂÎÂÌË ˜Ó‚Â¯ÍË ÍÎÂÚÍË. t-‡ÌÚË„ÂÌ˙Ú ÔÓ‰ÔÓÏ‡„‡Ú‡ÌÒÙÓÏ‡ˆËflÚ‡ Ì‡ ÍÎÂÚÍ‡Ú‡ ÔË ÌËÒÍË ÌË‚‡ Ì‡ í-‡Ì-ÚË„ÂÌ. t-‡ÌÚË„ÂÌ˙Ú ÔËÚÂÊ‡‚‡ Ó·˘ N-Í‡ÂÌ J-Ñçä ‰Ó-ÏÂÌ Ò í-‡ÌÚË„ÂÌ‡, ÍÓÂÚÓ ÔÂ‰ÔÓÎ‡„‡ Ë Ò˙˘ËÚÂ ÙÛÌÍˆËË.àÏ‡ Ù‡ÍÚË ÍÓËÚÓ ‰ÓÍ‡Á‚‡Ú, ˜Â Ï‡ÎÍËflÚ t-‡ÌÚË„ÂÌ ÛÎÂÒ-Ìfl‚‡ ÔÂÏËÌ‡‚‡ÌÂÚÓ Ì‡ ÍÎÂÚÍËÚÂ ‚ S-Ù‡Á‡ Ì‡ ÍÎÂÚ˙˜ÌËflˆËÍ˙Î, ÍÓÂÚÓ ÔÂ‰ÓÒÚ‡‚fl ÓÔÚËÏ‡ÎÌË ÛÒÎÓ‚Ëfl Ì‡ JCV ‰‡ÒÂ ÂÔÎËˆË‡ Ë Ë„‡Â ‚‡ÊÌ‡ ÓÎfl ‚ ÔÓ„ÂÒË‡ÌÂÚÓ Ì‡PML Í‡ÍÚÓ Ë ‚ ÍÎÂÚ˙˜Ì‡Ú‡ Ú‡ÌÒÙÓÏ‡ˆËfl, Á‡Â‰ÌÓ Ò „Ó-ÎÂÏËfl í-‡ÌÚË„ÂÌ

áÄäãûóÖçàÖ

JCV ÔÂ‰ÒÚ‡‚Îfl‚‡ ÔÂÒÔÂÍÚË‚ÂÌ ÏÓ‰ÂÎ Á‡ ËÁÛ˜‡‚‡ÌÂÌ‡ ‚Á‡ËÏÓ‰ÂÈÒÚ‚ËÂÚÓ ÏÂÊ‰Û ËÏÛÌÌ‡Ú‡ Ë ÌÂ‚Ì‡Ú‡ ÒËÒ-ÚÂÏË. ëÎÂ‰ Ô˙‚‡Ú‡ ◊ÒÂ˘‡” Ò ˜Ó‚ÂÍ (Ó·ËÍÌÓ‚ÂÌÓ ‚‰ÂÚÒÍ‡Ú‡ ‚˙Á‡ÒÚ), ‚ËÛÒ˙Ú ÓÒÚ‡‚‡ ‚ Ó„‡ÌËÁÏ‡ ‚ Î‡ÚÂ-ÌÚÌÓ Ò˙ÒÚÓflÌËÂ, ·ÂÁ ÌËÍ‡Í‚Ë ÍÎËÌË˜ÌË ÔÓfl‚Ë. ãËÚË˜-ÌËfl ˆËÍ˙Î Ì‡ ‡Á‚ËÚËÂ Ë ‰ÂÒÚÛÍˆËfl Ì‡ ÔÓ‡ÁÂÌ‡Ú‡ ÌÂ‚-Ì‡ („ÎË‡ÎÌ‡) ÍÎÂÚÍ‡ ÒÂ ‡ÍÚË‚Ë‡ Ì‡ ÙÓÌ‡ Ì‡ ‡ÁÎË˜ÌË ËÏÛ-ÌÓ‰ÂÙËˆËÚÌË Ò˙ÒÚÓflÌËfl, ÍÓÂÚÓ ÏÓÊÂ ‰‡ ‰Ó‚Â‰Â ‰Ó Ù‡-Ú‡ÎÌË ‰ÂÏËÂÎËÌËÁË‡˘Ë Ò˙ÒÚÓflÌËÂ Ì‡ ÌÂ‚Ì‡Ú‡ ÒËÒÚÂ-Ï‡. èÓÛ˜‚‡ÌËflÚ‡ ‚˙ıÛ ÏÓÎÂÍÛÎflÌËÚÂ ÏÂı‡ÌËÁÏË Ì‡‚ËÛÒÌ‡Ú‡ Ô‡ÚÓ„ÂÌÂÁ‡ ·Ëı‡ ‡ÁÍËÎË ‚˙ÁÏÓÊÌÓÒÚËÚÂ Á‡·ÎÓÍË‡ÌÂ Ì‡ ËÌÙÂÍˆËflÚ‡ Ë ÌÂ‰ÓÔÛÒÍ‡ÌÂ Ì‡ Ì‡‚ÎËÁ‡ÌÂÚÓ Ë‚ ÎËÚË˜Ì‡ Ù‡Á‡.

ãàíÖêÄíìêÄ1. Cole, C. and Conzen, S. 2001. Polyomaviridae: The viruses and their replica-

tion. In: Fields Virology, IV-th ed. (Knipe, D and Howley P., Eds.),Lippincott Williams & Wilkins, Philadelphia, PA-19106, USA, vol.2, p 2141.

2. Mahmud S., Sadovska B. Barrucco R. Khaili K. (2002). FunctionalInteraction between JC Virus Late Regulatory Agnoprotein and Cellular Y-Box Binding Transcription Factor YB- 1. Journal of virology 76, 8: 3828-3838.

3. Major EO, Amemiya K, Tornatore CS, Houff SA, Berger JR (1992).Pathogenesis and molecular biology of progressive multifocal leukoen-cephalopathy, the JC virus-induced demyelinating disease of the humanbrain. Clin Microbiol Rev. 5, 1: 49-73.

4. Major E. (2001). Human polyomavirus. In: Fields Virology, IV-th ed. (Knipe,D and Howley P., Eds.), Lippincott Williams & Wilkins, Philadelphia, PA-19106, USA, vol.2, p 2175.

5. Reiss K., Khalli K. (2003) Viruses and cancer: lesions from the human poly-omaviruses, JCV. Oncogene 22, 42: 6517-6523.

6. Seth P, Diaz F, O Major E. (2003). Advances in the biology of JC virus andinduction of progressive multifocal leukoencephalopathy. Journal ofNeuroVirology 9, 2:236-246.

7. Sweet T. M., Del Valle L., Khalli K. (2002) Molecular Biology andImmmunoregulation of Human Neurotropic JC Virus in CNS. Journal ofCellular Phisiology pp 249- 256.

Ä‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËfl:‰Óˆ. ‰- áÎ‡ÚÍÓ ä˙Î‚‡˜Â‚, ‰.Ï.ã‡·Ó‡ÚÓËfl ÔÓ ÏÓÎÂÍÛÎflÌ‡ ‚ËÛÒÓÎÓ„Ëflç‡ˆËÓÌ‡ÎÂÌ ñÂÌÚ˙ ÔÓ á‡‡ÁÌË Ë è‡‡ÁËÚÌË ÅÓÎÂÒÚË(çñáèÅ)·ÛÎ.ëÚÓÎÂÚÓ‚ 44-Ä; 1233 ëÓÙËflÚÂÎ.: (02) 931-07-13/232Â-mail: [email protected]


îË„Û‡ 5. åÂı‡ÌËÁ˙Ï Ì‡ ·ÎÓÍË‡ÌÂ Ì‡ 53- Ë Rb-ÏÂ‰ËË‡Ì‡Ú‡ ÚÛÏÓÌ‡ÒÛÔÂÒËfl ÓÚ JCV.

SUMMARY

LEVETIRACETAM MONOTHERAPY IN PARTIALEPILEPSIES IN THE LIGHT OF EVIDENCE-BASED

MEDICINEM. Rascheva, P. Stamenova

Selecting an antiepilectic drug (AED) for monotherapy is adifficult challenge for every neurologist. First, we have 20available AED to choose, and second the fine balance is need-ed between the recommendations of official guidelines andthe need of individual patient with a number of issues notproperly reflected in randomised controlled trials (RCTs). Therecent criteria used for evaluation the quality of clinical stud-ies are evidence-based and rated them into four categories.The purpose is the new AED to demonstrate its superiority ornot-inferiority of efficacy, tolerability and safety in compari-son with old AEDs. There is a lack of well-designed, proper-ly conducted RCTs of class I and class II for monotherapy inpatients with partial-onset seizures.

In randomised, double-blind, head-to-head comparativestudy phase III, class I according to evidence-based criteria,levetiracetam (LEV) as monotherapy for newly diagnosedpatients with partial onset or generalized tonic-clonic seizureswas compared versus carbamazepine with controlled-release(CBZ – CR) in achieving 6- months seizure freedom. LEVdemonstrated similar efficacy and more favourable tolerabili-ty in a study with a non-inferiority design.

LEV has had a long way of obligatory clinical studies toassess its efficacy and effectiveness as monotherapy inpatients older than 16 years with partial onset seizures. Withthese indications LEV is licensed in Bulgaria since October2006. Excellent results of LEV monotherapy of I or II choicehave been confirmed by clinical practice with multiple retro-spective and open-label prospective studies.

KEY WORDS: monotherapy,levetiracetam, clinical trials,partial epilepsy, partial-onset seizures, efficacy, effectivenes.

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àÁ·Ó˙Ú Ì‡ ‡ÌÚËÂÔËÎÂÔÚË˜ÂÌ ÏÂ‰ËÍ‡ÏÂÌÚ (AEå) Í‡-ÚÓ ÏÓÌÓÚÂ‡ÔËfl ‚ ÎÂ˜ÂÌËÂÚÓ Ì‡ ÂÔËÎÂÔÒËflÚ‡ Â Â‰ÌÓ ÔÂ-‰ËÁ‚ËÍ‡ÚÂÎÒÚ‚Ó Á‡ ‚ÒÂÍË ÌÂ‚ÓÎÓ„ – ÓÚ Â‰Ì‡ ÒÚ‡Ì‡ ÔÓ-‡‰Ë ‰ÓÒÚ˙ÔÌÓÒÚÚ‡ Ì‡ 20 AEå Ë ÓÚ ‰Û„‡ ÔÓ‡‰Ë ÌÂÓ·-ıÓ‰ËÏÓÒÚÚ‡ ÓÚ Ì‡ÏË‡ÌÂ Ì‡ ÙËÌ ·‡Î‡ÌÒ ÏÂÊ‰Û ËÁËÒÍ‚‡-ÌËflÚ‡ ‚ ÔËÂÚËÚÂ ˙ÍÓ‚Ó‰ÒÚ‚‡ Ë ÍÓÌÒÂÌÒÛÒË Ë ËÌ‰Ë‚Ë-‰Û‡ÎÌËÚÂ ÌÛÊ‰Ë Ì‡ Ô‡ˆËÂÌÚ‡, ÍÓËÚÓ ÌÂ Ò‡ ÔÂ‰‚Ë‰ÂÌË ‚‡Ì‰ÓÏËÁË‡ÌËÚÂ ÍÓÌÚÓÎË‡ÌË ÔÓÛ˜‚‡ÌËfl (RCT).

ë˙‚ÂÏÂÌÌËÚÂ ÍËÚÂËË Á‡ ÍÎËÌË˜ÌË ÔÓÛ˜‚‡ÌËfl Ò˙ÒÒÍ‡Î‡ Ì‡ ÓˆÂÌÍ‡ Á‡ ÒÚÂÔÂÌÚ‡ Ì‡ ‰ÓÍ‡Á‡ÚÂÎÒÚ‚‡ „Ë ‡Á‰Â-Îfl ‚ 4 Í‡ÚÂ„ÓËË Ò ˆÂÎ Â‰ËÌ ÌÓ‚ ÄÖå ‰‡ ‰ÓÍ‡ÊÂ Ò‚ÓËÚÂÔÂ‰ËÏÒÚ‚‡ ËÎË ÔÓÌÂ ÌÂ ÔÓ-ÒÎ‡·‡Ú‡ ÒË ÂÙËÍ‡ÒÌÓÒÚ, ÔÓÌÓ-ÒËÏÓÒÚ Ë ·ÁÓÔ‡ÒÌÓÒÚ ‚ Ò‡‚ÌÂÌËÂ Ò ÍÎ‡ÒË˜ÂÒÍËÚÂ ÄÖå.ÇÒÂ Ó˘Â ËÏ‡ Ï‡ÎÍÓ RCT ÓÚ ÍÎ‡Ò I Ë II, Ò ‰Ó·˙ ‰ËÁ‡ÈÌ ËÔ‡‚ËÎÌÓ ÔÓ‚ÂÊ‰‡ÌË, Á‡ ÏÓÌÓÚÂ‡ÔËfl ÔË Ô‡ˆËÂÌÚË ÒÂÔËÎÂÔÚË˜ÌË ÔËÒÚ˙ÔË Ò Ô‡ˆË‡ÎÌÓ Ì‡˜‡ÎÓ. Ç ‡Ì‰ÓÏËÁË-‡ÌÓ, ‰‚ÓÈÌÓ-ÒÎflÔÓ Ò‡‚ÌËÚÂÎÌÓ ÔÓÛ˜‚‡ÌÂ Ù‡Á‡ III, ÓÚ-

„Ó‚‡fl˘Ó Ì‡ ÍËÚÂËËÚÂ Á‡ ÍÎ‡Ò I, LEV Í‡ÚÓ ÏÓÌÓÚÂ‡-ÔËfl Ì‡ ÌÓ‚Ó‰Ë‡„ÌÓÒÚËˆË‡ÌË Ô‡ˆËÂÌÚË Ò Ô‡ˆË‡ÎÌË ËÎË„ÂÌÂ‡ÎËÁË‡ÌË ÚÓÌË˜ÌÓ-ÍÎÓÌË˜ÌË ÔËÔ‡‰˙ˆË Â Ò‡‚Ìfl‚‡ÌÒ carbamazepine Ò ÍÓÌÚÓÎË‡ÌÓ ÓÒ‚Ó·ÓÊ‰‡‚‡ÌÂ (CBZ -CR) ‚ ÔÓÒÚË„‡ÌÂÚÓ Ì‡ 6 ÏÂÒÂ˜Ì‡ Ò‚Ó·Ó‰‡ ÓÚ ÔËÒÚ˙ÔË.êÂÁÛÎÚ‡ÚËÚÂ ‰ÂÏÓÌÒÚË‡Ú Ë‰ÂÌÚË˜Ì‡ ÂÙËÍ‡ÒÌÓÒÚ Ì‡Ò‡‚Ìfl‚‡ÌËÚÂ ÏÂ‰ËÍ‡ÏÂÌÚË Ë ÔÓ-‰Ó·‡ ÔÓÌÓÒËÏÓÒÚ Ì‡LEV.

LEV Â ËÁÏËÌ‡Î ‰˙Î„Ëfl Ô˙Ú Ì‡ Á‡‰˙ÎÊËÚÂÎÌË ÍÎËÌË˜ÌËÔÓÛ˜‚‡ÌËfl Á‡ ‰ÓÍ‡Á‚‡ÌÂ Ì‡ ÂÙËÍ‡ÒÌÓÒÚ Ë ÂÙÂÍÚË‚ÌÓÒÚÍ‡ÚÓ ÏÓÌÓÚÂ‡ÔËfl ÔË Ô‡ˆËÂÌÚË Ì‡‰ 16 „. Ò Ô‡ˆË‡ÎÌËÔËÔ‡‰˙ˆË Ò ËÎË ·ÂÁ ‚ÚÓË˜Ì‡ „ÂÌÂ‡ÎËÁ‡ˆËfl. ë ÚÂÁË ÔÓ-Í‡Á‡ÌËfl ÏÂ‰ËÍ‡ÏÂÌÚ˙Ú Â Ó‰Ó·ÂÌ Á‡ ÔËÎÓÊÂÌËÂ ‚ Å˙Î„‡-Ëfl ÓÚ ÏÂÒÂˆ ÓÍÚÓÏ‚Ë 2006 „.

éÚÎË˜ÌËÚÂ ÂÁÛÎÚ‡ÚË ÓÚ LEV ÏÓÌÓÚÂ‡ÔËfl Ì‡ I ËÎËII ËÁ·Ó Ò‡ ÔÓÚ‚˙‰ÂÌË ‚ ÍÎËÌË˜Ì‡Ú‡ Ô‡ÍÚËÍ‡ Ò ÏÌÓÊÂ-ÒÚ‚Ó ÂÚÓÒÔÂÍÚË‚ÌË Ë ÓÚ‚ÓÂÌË ÔÓÒÔÂÍÚË‚ÌË ÔÓÛ˜-‚‡ÌËfl.

äãûóéÇà Ñìåà: ÏÓÌÓÚÂ‡ÔËfl, levetiracetam, ÍÎË-ÌË˜ÌË ÔÓÛ˜‚‡ÌËfl, Ô‡ˆË‡ÎÌË ÂÔËÎÂÔÒËË, Ô‡ˆË‡ÎÌË ÂÔË-ÎÂÔÚË˜ÌË ÔËÒÚ˙ÔË, ÂÙËÍ‡ÒÌÓÒÚ, ÂÙÂÍÚË‚ÌÓÒÚ

ëÎÂ‰ 1989 „. ‰‚‡Ì‡‰ÂÒÂÚ ÌÓ‚Ë ‡ÌÚËÂÔËÎÂÔÚË˜ÌË ÏÂ‰Ë-Í‡ÏÂÌÚË (AEM) ·flı‡ ÎËˆÂÌÁË‡ÌË ‚ Ö‚ÓÔ‡ Ë Á‡Â‰ÌÓ ÒÍÎ‡ÒË˜ÂÒÍËÚÂ Ó·˘ËflÚ ËÏ ·ÓÈ ‰ÓÒÚË„Ì‡ 21. Ç˙ÔÂÍË ˜ÂÌÂ ‚ÒË˜ÍË Ò‡ ÎËˆÂÌÁË‡ÌË Á‡ ÏÓÌÓÚÂ‡ÔËfl, Ì‡ÎË˜ËÂÚÓ ËÏÒ˙Á‰‡‚‡ ‚˙ÁÏÓÊÌÓÒÚ Ì‡ Ô‡ÍÚËÍ‡ Á‡ 20 ‚‡Ë‡ÌÚ‡ Ì‡ ÏÓ-ÌÓÚÂ‡ÔËfl, 190 - Á‡ ÚÂ‡ÔËfl Ò ‰‚‡ ÄÖå Ë Ì‡‰ 1000- Ò ÚËÄÖå (16). ÉÓÎÂÏËflÚ ËÁ·Ó Û‚ÂÎË˜‡‚‡ ¯‡ÌÒ‡ Ì‡ Ô‡ˆËÂÌÚ‡Á‡ ÚÂ‡ÔÂ‚ÚË˜ÂÌ ÛÒÔÂı Ë ÓÚ„Ó‚ÓÌÓÒÚÚ‡ Ì‡ ÎÂÍÛ‚‡˘ËflÎÂÍ‡ Á‡ Ô‡‚ËÎÌËfl ËÁ·Ó. èË ÔÓ-„ÓÎflÏ‡Ú‡ ˜‡ÒÚ ÓÚ Ô‡-ˆËÂÌÚËÚÂ ÏÂ‰ËÍ‡ÏÂÌÚËÚÂ ÔÓÚËÒÍ‡Ú ÂÔËÎÂÔÚË˜ÌËÚÂÔËÒÚ˙ÔË ·ÂÁ ‰‡ ÔË˜ËÌfl‚‡Ú ÌÂÊÂÎ‡ÌË Ë ÌÂÔËÂÏÎË‚ËÒÚ‡ÌË˜ÌË ÂÙÂÍÚË, Í‡ÍÚÓ ÒÂ ‰ÓÍ‡Á‚‡ ‚ ÌÂÓ·ıÓ‰ËÏËÚÂ Â-„ËÒÚ‡ˆËÓÌÌË ÔÓÛ˜‚‡ÌËfl (12, 37). á‡ ‰‡ ·˙‰Â ÔËÎ‡„‡Ì‡‰ÂÍ‚‡ÚÌÓ Â‰ËÌ ÄÖå, Â ÌÂÓ·ıÓ‰ËÏÓ ‚˙Á ÓÒÌÓ‚‡ Ì‡ ÒÓÎË‰-ÌË ‰ÓÍ‡Á‡ÚÂÎÒÚ‚‡ ‰‡ Ò‡ ËÁflÒÌflÚ ÌÂ„Ó‚ËÚÂ Ù‡Ï‡ÍÓÎÓ„Ë˜-ÌË ı‡‡ÍÚÂËÒÚËÍË, ÓÚÌÓÒËÚÂÎÌ‡Ú‡ ÂÙËÍ‡ÒÌÓÒÚ Ë ÔÓ-ÌÓÒËÏÓÒÚ ÔË ‡ÁÎË˜ÌË ‚Ë‰Ó‚Â ÂÔËÎÂÔÒËfl. êÂÚÓÒÔÂÍ-ÚË‚ÌËÚÂ Ì‡·Î˛‰ÂÌËfl Ë ÓÔËÒ‡ÌËfl Ì‡ ÓÚ‰ÂÎÌË ÒÎÛ˜‡Ë ÌÂ Ò‡‰ÓÒÚ‡Ú˙˜ÌÓ Û·Â‰ËÚÂÎÌË ‰ÓÍ‡Á‡ÚÂÎÒÚ‚‡, ÔÓ‡‰Ë ÍÓÂÚÓÒÂ ËÁËÒÍ‚‡Ú ÔÓÒÔÂÍÚË‚ÌË ‡Ì‰ÓÏËÁË‡ÌË, ÍÓÌÚÓÎË‡-ÌË ÍÎËÌË˜ÌË ÔÓÛ˜‚‡ÌËfl Á‡ ÔÓÎÛ˜‡‚‡ÌÂ Ì‡ Ó·ÂÍÚË‚Ì‡ ËÌ-ÙÓÏ‡ˆËfl Á‡ ÍÎËÌË˜Ì‡Ú‡ ÒÚÓÈÌÓÒÚ Ì‡ ÌÓ‚ËÚÂ ÏÂ‰ËÍ‡-ÏÂÌÚË (40).

ä‡ÚÓ Ô˙‚‡ ÒÚ˙ÔÍ‡ Ò Ó„ÎÂ‰ ‡ÌÌ‡ ÍÎËÌË˜Ì‡ ÓˆÂÌÍ‡ Ì‡ÔÓÚÂÌˆË‡Î‡ Ì‡ Â‰ËÌ ÌÓ‚ ÄÖå, ÁÎ‡ÚÂÌ ÒÚ‡Ì‰‡Ú Ò‡ ÔÎ‡-ˆÂ·Ó-ÍÓÌÚÓÎË‡ÌËÚÂ ÔÓÛ˜‚‡ÌËfl Ò ‰ÓÔ˙Î‚‡˘‡ ÚÂ‡ÔËfl,ÔÓ‚ÂÊ‰‡ÌË ÔË Ô‡ˆËÂÌÚË, ÍÓËÚÓ Ò‡ Ò ÎÂ˜ÂÌËÂ, ÌÓ ·ÂÁÍÓÌÚÓÎ Ì‡ ÂÔËÎÂÔÚË˜ÌËÚÂ ÔËÒÚ˙ÔË. ÇÍÎ˛˜‚‡Ú ÒÂ ‰‚ÂÔ‡‡ÎÂÎÌË „ÛÔË – ‚ Â‰Ì‡Ú‡ ÒÂ ÔË·‡‚fl ËÁÒÎÂ‰‚‡ÌËflÚ ÏÂ-‰ËÍ‡ÏÂÌÚ, ‡ ‚ ‰Û„‡Ú‡ – ÔÎ‡ˆÂ·Ó. ÖÙËÍ‡ÒÌÓÒÚÚ‡ Ë ·ÂÁÓ-Ô‡ÒÌÓÒÚÚ‡ ÒÂ ‰ÓÍ‡Á‚‡ Ì‡ ·‡Á‡Ú‡ Ì‡ ÔÓ-‰Ó·ËÚÂ ÂÁÛÎÚ‡-ÚË ‚ „ÛÔ‡Ú‡ Ì‡ ÏÂ‰ËÍ‡ÏÂÌÚÓÁÌÓ ÚÂÚË‡ÌËÚÂ (40).çÂ‰ÓÒÚ‡Ú˙ˆË Ì‡ ‰ËÁ‡ÈÌ‡ Ò‡ ÙËÍÒË‡Ì‡Ú‡, ÔÓÌflÍÓ„‡ ÌÂ-‰ÓÒÚ‡Ú˙˜Ì‡ ‰ÓÁËÓ‚Í‡ Ì‡ ÄÖå, Í‡ÚÍËfl ÔÂËÓ‰ Ì‡ ÚÂÁË


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åéçéíÖêÄèàüíÄ ë LEVETIRACETAM (KEPPRA) èêàèÄêñàÄãçà ÖèàãÖèëàà Ç ëÇÖíãàçÄíÄ çÄ åÖÑàñàçÄíÄ

ÅÄáàêÄçÄ çÄ ÑéäÄáÄíÖãëíÇÄå. ê‡¯Â‚‡, è. ëÚ‡ÏÂÌÓ‚‡

çÂ‚ÓÎÓ„Ë˜Ì‡ ÍÎËÌËÍ‡ Ì‡ åÅÄã “ñ‡Ëˆ‡ âÓ‡ÌÌ‡” – ëÓÙËfl

ÔÓÛ˜‚‡ÌËfl, ‚˙ÁÏÓÊÌÓÒÚËÚÂ Á‡ Ù‡Ï‡ÍÓÍËÌÂÚË˜ÌË ËÙ‡Ï‡ÍÓ‰ËÌ‡ÏË˜ÌË ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ëfl, ÌÂ‰ÓÒÚ‡Ú˙˜ÌËfl·ÓÈ Ì‡ ‚ÍÎ˛˜‚‡ÌËÚÂ Ô‡ˆËÂÌÚË.

ÄÍÓ ÄÖå Â ÂÙËÍ‡ÒÂÌ Í‡ÚÓ ‰Ó·‡‚˙˜Ì‡ ÚÂ‡ÔËfl, ÚÓ‚‡ÌÂ ÓÁÌ‡˜‡‚‡ ˜Â ‰‡ÌÌËÚÂ ÏÓ„‡Ú ‰‡ ÒÂ ÂÍÒÚ‡ÔÓÎË‡Ú Á‡ÏÓÌÓÚÂ‡ÔËfl ÔË ÌÓ‚Ó‰Ë‡„ÌÓÒÚËˆË‡Ì‡ ÂÔËÎÂÔÒËfl. ëÎÂ‰-‚‡˘‡ ÒÚ˙ÔÍ‡ Ò‡ ÔÓÛ˜‚‡ÌËflÚ‡ Á‡ ÏÓÌÓÚÂ‡ÔËfl, ÍÓËÚÓ Ò‡Ò ‡ÁÎË˜ÂÌ ‰ËÁ‡ÈÌ:

● Í‡ÚÍÓÚ‡ÈÌ‡ ÍÓÌÚÓÎË‡Ì‡ ÏÓÌÓÚÂ‡ÔËfl - Ò ‡Ì-‰ÓÏËÁË‡ÌÂ Ì‡ Ô‡ˆËÂÌÚË Á‡ ÔÓÚÂÌˆË‡ÎÌÓ ÌÂ‚ÓıË-Û„Ë˜ÌÓ ÎÂ˜ÂÌËÂ Ì‡ ÂÔËÎÂÔÒËflÚ‡ ‚ 2 „ÛÔË – Â‰Ì‡Ú‡Â Ò ‰ÓÒÚ‡Ú˙˜Ì‡ ‰ÓÁËÓ‚Í‡ Ì‡ ËÁÎÂ‰‚‡ÌËfl ÄÖå, ‡‰Û„‡Ú‡ – Ò˙Ò ÒÛ·ÓÔÚËÏ‡ÎÌ‡ ‰ÓÁËÓ‚Í‡, Í‡ÚÓ ÒÂÒ‡‚Ìfl‚‡ ‚ÂÏÂÚÓ Á‡ ËÁÎËÁ‡ÌÂ ÓÚ ÔÓÛ˜‚‡ÌÂÚÓ ‚ 2-ÚÂ „ÛÔË). éÚ ÂÚË˜Ì‡ „ÎÂ‰Ì‡ ÚÓ˜Í‡ ÚÓ‚‡ ÌÂ ‰Ó·˙‰ËÁ‡ÈÌ,

● ËÁÚÂ„ÎflÌÂ – Á‡ÏflÌ‡ Ò ÏÓÌÓÚÂ‡ÔËfl (ÍÓÌ‚ÂÁËfl)– ÒÎÂ‰Í‡ÚÓ Ô‡ˆËÂÌÚ˙Ú Â ËÏ‡Î ‰Ó·˙ ÂÁÛÎÚ‡Ú ÓÚ ‰ÓÔ˙Î-‚‡˘‡Ú‡ ÚÂ‡ÔËfl ÓÚ ÌÓ‚ÓËÁÒÎÂ‰‚‡ÌËfl ÏÂ‰ËÍ‡ÏÂÌÚ,ÔÂ‰¯ÂÒÚ‚‡˘ËflÚ ÔÓÒÚÂÔÂÌÌÓ ÒÂ ËÁÚÂ„Îfl. ÄÍÓ ˜ÂÒ-ÚÓÚ‡Ú‡ Ì‡ ÂÔËÎÂÔÚË˜ÌËÚÂ ÔËÒÚ˙ÔË Ì‡‡ÒÚ‚‡ ËÎËÒÂ ÔÓfl‚flÚ ÒÚ‡ÌË˜ÌË fl‚ÎÂÌËfl, Ô‡ˆËÂÌÚ˙Ú ËÁÎËÁ‡ ÓÚÔÓÛ˜‚‡ÌÂÚÓ. àÁıÓ‰ÂÌ ÍËÚÂËÈ Á‡ ÂÙËÍ‡ÒÌÓÒÚ Â‚ÂÏÂÚÓ Ì‡ ËÁÎËÁ‡ÌÂ ËÎË ÔÓˆÂÌÚ˙Ú Ì‡ Ô‡ˆËÂÌÚËÚÂËÁÔ˙ÎÌËÎË Ù‡Á‡Ú‡ Ì‡ ÏÓÌÓÚÂ‡ÔËfl (8). íÓÁË ‰ËÁ‡ÈÌ ÂÔÓ-‰Ó·˙ Ë ˜ÂÒÚÓ ÔËÎ‡„‡Ì.

● ÔÓ‰˙ÎÊËÚÂÎÌË, ‡Ì‰ÓÏËÁË‡ÌË, Ò‡‚ÌËÚÂÎÌË ÔÓ-Û˜‚‡ÌËfl Ì‡ ËÁÒÎÂ‰‚‡ÌËfl ÏÂ‰ËÍ‡ÏÂÌÚ Ò ÍÎ‡ÒË˜ÂÒÍËÚÂÄÖå (valproate, carbamazepine), ‰ÓÍ‡Á‡ÎË ‚ Ô‡ÍÚË-Í‡Ú‡ ÂÙËÍ‡ÒÌÓÒÚÚ‡ ÒË (Â‰ËÌ ÓÚ Ì‡È-ËÌÙÓÏ‡ÚË‚-ÌËÚÂ ‰ËÁ‡ÈÌË Á‡ ÏÓÌÓÚÂ‡ÔËfl ÔË ÌÓ‚ÓÚÍËÚ‡ ÂÔË-ÎÂÔÒËfl). èÓÛ˜‚‡ÌËflÚ ÏÂ‰ËÍ‡ÏÂÌÚ Úfl·‚‡ ‰‡ ‰ÓÍ‡-ÊÂ, ˜Â Â ÔÓ-‰Ó·˙ ÓÚ ÍÎ‡ÒË˜ÂÒÍËfl (superiority –ËÁËÒÍ‚‡ÌËfl Ì‡ FDA, USA) ËÎË ˜Â ÔÓÌÂ ÌÂ Â ÔÓ-ÎÓ¯ ÓÚÌÂ„Ó (non- inferiority - ËÁËÒÍ‚‡ÌËfl Ì‡ EMEA, EU).

● èË ÎËÔÒ‡ Ì‡ ‰ÓÒÚ‡Ú˙˜ÌÓ Í‡˜ÂÒÚ‚ÂÌË Ò‡‚ÌËÚÂÎÌËÍÓÌÚÓÎË‡ÌË ÔÓÛ˜‚‡ÌËfl, ÒÂ ÔÛ·ÎËÍÛ‚‡Ú ÏÂÚ‡‡Ì‡-ÎËÁË Í‡ÚÓ ÂÔÂÁÂÌÚ‡ÚË‚ÌË ‰‡ÌÌË Á‡ Ò‡‚ÌËÚÂÎÌ‡ÂÙËÍ‡ÒÌÓÒÚ Ì‡ ‡ÁÎË˜ÌË ÄÖå ÓÚ ËÁ·‡ÌË ÓÚ ÎËÚÂ-‡ÚÛ‡Ú‡ ÔÓÛ˜‚‡ÌËfl (19, 34), ÍÓË„Ë‡ÌË Ò Â‰ËÌÒÚ‡ÚËÒÚË˜ÂÒÍË ÏÂÚÓ‰ (odd-ratio), ÓˆÂÌfl‚‡˘ ÂÙË-Í‡ÒÌÓÒÚÚ‡ Ò ·Ófl Ô‡ˆËÂÌÚË, ÌÂÓ·ıÓ‰ËÏË ‰‡ ÒÂ ÎÂÍÛ-‚‡Ú, Á‡ ‰‡ ÒÂ Ì‡ÏÂË Â‰ËÌ, ÓÚ„Ó‚‡fl˘ Ì‡ ÚÂ‡ÔËflÚ‡.èÓÒÎÂ‰ÌËflÚ ÏÂÚÓ‰ ÒÂ ÍËÚËÍÛ‚‡ Í‡ÚÓ ÔÓÚÂÌˆË‡Î-ÌÓ ÌÂ‡‰ÂÍ‚‡ÚÂÌ ÔË ‡ÁÔÂ‰ÂÎÂÌËÂÚÓ Ì‡ ÂÔËÎÂÔÚË˜-ÌËÚÂ ÔËÒÚ˙ÔË ‚ ÍÎËÌË˜ÌËÚÂ ÔÓÛ˜‚‡ÌËfl ‚˙ıÛÄÖå (31).

é·˘ÓÔËÂÚË ÍËÚÂËË Á‡ ÂÙËÍ‡ÒÌÓÒÚ, Ò‡ Ò‚Ó·Ó‰‡ ÓÚÂÔËÎÂÔÚË˜ÌË ÔËÒÚ˙ÔË, ÔÓˆÂÌÚ Ì‡ ÓÚ„Ó‚‡fl˘Ë Ì‡ ÚÂ-‡ÔËflÚ‡ Ò Â‰ÛÍˆËfl Ì‡ ÂÔËÎÂÔÚË˜ÌËÚÂ ÔËÒÚ˙ÔË Ì‡‰50%, ‚ÂÏÂÚÓ Ì‡ Ô˙‚Ëfl ÔÓfl‚ËÎ ÒÂ ÂÔËÎÂÔÚË˜ÂÌ ÔËÒÚ˙ÔËÎË Ì‡ ËÁÎËÁ‡ÌÂ ÓÚ ÔÓÛ˜‚‡ÌÂÚÓ (16), Í‡ÚÓ Ì‡ÔÓÒÎÂ‰˙ÍÔË ÓˆÂÌÍ‡ Ì‡ ÏËÓÍÎÓÌË˜ÌË ÔËÒÚ˙ÔË ÒÂ ‚ÍÎ˛˜‚‡ Ë ÌÓ‚ÔÓÍ‡Á‡ÚÂÎ - ·ÓÈ ‰ÌË ‚ ÒÂ‰ÏËˆ‡Ú‡ ·ÂÁ ÔËÒÚ˙ÔË (5). äË-ÚÂËË Á‡ ·ÂÁÓÔ‡ÒÌÓÒÚ Ë ÔÓÌÓÒËÏÓÒÚ, ÍÓËÚÓ ÒÂ ÓˆÂÌfl‚‡Ú,Ò‡ Ì‡ÎË˜ËÂ Ë ‚Ë‰ Ì‡ ÒÚ‡ÌË˜ÌËÚÂ fl‚ÎÂÌËfl, ÒÂËÓÁÌË ÒÚ‡-ÌË˜ÌË fl‚ÎÂÌËfl, Í˙ÒÌË ÛÒÎÓÊÌÂÌËfl, Í‡˜ÂÒÚ‚Ó Ì‡ ÊË‚ÓÚ,‚ÎËflÌËÂ ‚˙ıÛ ÍÓ„ÌËÚË‚ÌËÚÂ ÙÛÌÍˆËË, ÚÂ‡ÚÓ„ÂÌÌÓÒÚ(16). ÖÙÂÍÚË‚ÌÓÒÚÚ‡ ‚ÍÎ˛˜‚‡ ÂÙËÍ‡ÒÌÓÒÚ Ë ÔÓÌÓÒË-ÏÓÒÚ Ë ÒÂ ÓÔÂ‰ÂÎfl Ì‡ ·‡Á‡Ú‡ Ì‡ ‚ÂÏÂÚÓ Á‡ Á‡‰˙Ê‡ÌÂÌ‡ ‰‡‰ÂÌ‡ ÚÂ‡ÔËfl ËÎË Ì‡ % Ô‡ˆËÂÌÚË ÔÓ‰˙ÎÊËÎË ÚÂ‡-ÔËflÚ‡ ‰Ó Â‰Ì‡ Í‡ÈÌ‡, ÔÂ‰‚‡ËÚÂÎÌÓ ÓÔÂ‰ÂÎÂÌ‡ ‰‡Ú‡.à‰Â‡Î Á‡ ÔÓÛ˜‚‡ÌÂ Ì‡ Ì‡˜‡ÎÌ‡ ÏÓÌÓÚÂ‡ÔËfl Â Á‡‰˙Ê‡ÌÂÔÓÌÂ 48 ÒÂ‰ÏËˆË (20).

ç‡ ·‡Á‡Ú‡ Ì‡ ÚÂÁË flÒÌÓ ‰ÂÙËÌË‡ÌË ÍËÚÂËË Â ËÁ„‡-‰ÂÌ‡ ÂÈÚËÌ„ ÒÍ‡Î‡, „‡‰Ë‡˘‡ ÔÓÛ˜‚‡ÌËflÚ‡ ÒÔÓÂ‰ÒÚÂÔÂÌÚ‡ Ì‡ ‰ÓÍ‡Á‡ÚÂÎÒÚ‚‡Ú‡ (20), ÔÂ‰ÎÓÊÂÌ‡ ÓÚ äÓ-

ÏËÒËflÚ‡ ÔÓ ÒÚ‡Ì‰‡ÚË Í˙Ï ÄÏÂËÍ‡ÌÒÍ‡Ú‡ ÄÍ‡‰ÂÏËflÔÓ çÂ‚ÓÎÓ„Ëfl (19) Ë ILAE (20) – Ú‡·ÎËˆ‡ 1.

ë˙‚ÂÏÂÌÌËÚÂ Á‡‰˙ÎÊËÚÂÎÌË ÍËÚÂËË Á‡ ‚ÍÎ˛˜‚‡ÌÂÌ‡ Ì‡˜‡ÎÌ‡ ÏÓÌÓÚÂ‡ÔËfl Ò ÄÖå Ò‡ ÏÌÓ„Ó ÒÚÓ„Ë (20):

● ÑËÁ‡ÈÌ Ì‡ ‡Ì‰ÓÏËÁË‡ÌË ÍÓÌÚÓÎË‡ÌË ÔÓÛ˜‚‡ÌËfl;● åËÌËÏÛÏ – Ì‡ÎË˜ËÂ Ì‡ ‰‚ÓÈÌÓ-ÒÎflÔ ‰ËÁ‡ÈÌ;● èÓ‰˙ÎÊËÚÂÎÌÓÒÚ Ì‡ ÎÂ˜ÂÌËÂÚÓ ‡‚Ì‡ ËÎË Ì‡‰ 48

ÒÂ‰ÏËˆË;● ä‡ÚÓ ÔÓÍ‡Á‡ÌËfl Á‡ ÂÙËÍ‡ÒÌÓÒÚ - Ò‚Ó·Ó‰‡ ÓÚ

ÔËÒÚ˙ÔË Ì‡‰ 24 ÒÂ‰ÏËˆË, ‡ Á‡ ÂÙÂÍÚË‚ÌÓÒÚ – Á‡‰˙-Ê‡ÌÂ Ì‡ ÎÂ˜ÂÌËÂÚÓ Ì‡‰ 48 ÒÂ‰ÏËˆË;

● Ç ÒÎÛ˜‡È, ˜Â ÌÂ Â ‰ÂÏÓÌÒÚË‡Ì‡ “superiority”, ‡“non-inferiority”, ·ÓflÚ Ì‡ ËÁÒÎÂ‰‚‡ÌËÚÂ ‰‡ Â ‰ÓÒ-Ú‡Ú˙˜ÂÌ Á‡ ÁÌ‡˜ËÏÓÒÚ Í˙Ï Ò‡‚ÌËÚÂÎÌ‡Ú‡ „ÛÔ‡ÔÓÌÂ 80%;

● É‡ÌËˆËÚÂ ÔË “non inferiority” ‰‡ ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡ÚÌ‡‰ 20% ÓÚÌÓÒËÚÂÎÌ‡ ‡ÁÎËÍ‡ (20, 44).

á‡ ‰‡ ÒÂ ÔÂÔÓ˙˜‡ Ì‡ ·‡Á‡Ú‡ Ì‡ ‰ÓÍ‡Á‡ÚÂÎÒÚ‚‡Ú‡Â‰ËÌ ÄÖå (ÌË‚Ó Ä) Ò‡ ÌÂÓ·ıÓ‰ËÏË ÔÓÌÂ Â‰ÌÓ Û·Â‰ËÚÂÎÌÓÔÓÛ˜‚‡ÌÂ ÓÚ ÍÎ‡Ò I ËÎË ‰‚Â Ò Â‰ÌÓÔÓÒÓ˜ÌË Ë Û·Â‰ËÚÂÎÌË‰‡ÌÌË ÓÚ ÍÎ‡Ò II. çË‚Ó Ç ÂÈÚËÌ„ ËÁËÒÍ‚‡ ÔÓÌÂ Â‰ÌÓ Û·Â-‰ËÚÂÎÌÓ ÔÓÛ˜‚‡ÌÂ ÓÚ ÍÎ‡Ò II ËÎË ÔÓÌÂ ÚË ÓÚ ÍÎ‡Ò III ËÌË‚Ó ë ÂÈÚËÌ„ - ÔÓÌÂ ‰‚Â Û·Â‰ËÚÂÎÌË ÓÚ ÍÎ‡Ò III ÔÓÛ˜-‚‡ÌËfl (19).

ëÔÓÂ‰ ÚÂÁË ‚ËÒÓÍË ËÁËÒÍ‚‡ÌËfl ËÏ‡ Ï‡Í‡ Ë Ï‡ÎÍÓÔÓÛ˜‚‡ÌËfl ÓÚ ÍÎ‡Ò I Ë II Á‡ ÂÙËÍ‡ÒÌÓÒÚ Ë/ËÎË ÂÙÂÍÚË‚-ÌÓÒÚ Ì‡ ÄÖå ÔË ÌÓ‚ÓÓÚÍËÚË Ô‡ˆË‡ÎÌË ÂÔËÎÂÔÒËË,‰ÓÍ‡ÚÓ ÔË „ÂÌÂ‡ÎËÁË‡ÌËÚÂ ÂÔËÎÂÔÒËË ÎËÔÒ‚‡Ú ÔÓÛ˜-‚‡ÌËfl ÓÚ ÍÎ‡Ò I Ë II, ‡ ÔË ˛‚ÂÌËÎÌ‡Ú‡ ÏËÓÍÎÓÌË˜Ì‡ ÂÔË-ÎÂÔÒËfl ‰Ó ÒÍÓÓ Ë ÓÚ ÍÎ‡Ò III (20, 45). éÚ 55 RCT ÔË ÌÂ-Ë‰ËÓÔ‡ÚË˜Ì‡ Ô‡ˆË‡ÎÌ‡ ÂÔËÎÂÔÒËfl, Ò‡ÏÓ 4 ÔÓÛ˜‚‡ÌËfl Ò‡‰ÓÒÚË„Ì‡ÎË ÍÎ‡Ò I ÂÈÚËÌ„ Ì‡ ‰ÓÍ‡Á‡ÚÂÎÒÚ‚‡, 2 - ÍÎ‡Ò IIÂÈÚËÌ„, 37 – ÍÎ‡Ò III, ‡ ÓÒÚ‡Ì‡ÎËÚÂ 12 ÌÂ ‰‡‚‡Ú ‰ÓÒ-Ú‡Ú˙˜ÌÓ Û·Â‰ËÚÂÎÌË ‰‡ÌÌË Á‡ ÂÙËÍ‡ÒÌÓÒÚ Ë ÂÙÂÍÚË‚-ÌÓÒÚ (44). èÓÒÓ˜ÂÌ‡Ú‡ ÍÎ‡ÒËÙËÍ‡ˆËfl Ì‡ ÔÓÛ˜‚‡ÌËflÚ‡ ËÒÚÂÔÂÌÛ‚‡ÌÂÚÓ ËÏ Â ·‡Á‡ Á‡ ÔÂÔÓ˙ÍË ‚ÍÎ˛˜ÂÌË ‚ ˙ÍÓ-‚Ó‰ÒÚ‚‡Ú‡ Á‡ ÎÂ˜ÂÌËÂ Ì‡ ÂÔËÎÂÔÒËflÚ‡, ÌÓ ËÁ·Ó˙Ú Ì‡Ì‡È-ÔÓ‰ıÓ‰fl˘ ÏÂ‰ËÍ‡ÏÂÌÚ Á‡ ÍÓÌÍÂÚÌËfl Ô‡ˆËÂÌÚ ÓÒ-Ú‡‚‡ Ì‡ ÔÂˆÂÌÍ‡Ú‡ Ì‡ ÎÂÍ‡fl. êÂÈÚËÌ„ ÒÍ‡Î‡Ú‡, ÔÂ‰ÎÓ-ÊÂÌ‡ ÓÚ ILAE ÌÂ ˆÂÎË ‰‡ ·˙‰Â ÔÓÎÁ‚‡Ì‡ Ò Â„ÛÎ‡ÚÓÌË ˆÂ-ÎË, ‡ Â ÓÔËÚ Á‡ Ò˙Á‰‡‚‡ÌÂ Ì‡ ‡ÏÍ‡ Á‡ ÎÂ˜ÂÌËÂ Ì‡ ÌÓ‚ÓÓÚÍ-ËÚ‡ ÂÔËÎÂÔÒËfl (20).

Ç ÌÂ‰‡ÎÂ˜ÌÓ ÏËÌ‡ÎÓ ÔË ÌÓ‚ÓÓÚÍËÚ‡ ÂÔËÎÂÔÒËfl ÚÂ-‡ÔËflÚ‡ Á‡ÔÓ˜‚‡¯Â Ò 2 ÄÖå. Ä„ÛÏÂÌÚ ‚ ÔÓ‰ÍÂÔ‡ Ì‡ÔÓÎËÚÂ‡ÔËflÚ‡ ·Â¯Â ÔÂ‰ÔÓÎÓÊÂÌËÂÚÓ, ˜Â ‰‚‡ ÏÂ‰ËÍ‡-ÏÂÌÚ‡ Ò ‚˙ÁÏÓÊÌÓÒÚ Á‡ ÒËÌÂ„Ë˜ÌÓ ‰ÂÈÒÚ‚ËÂ, ÏÓ„‡Ú ‰‡ÔÓÒÚË„Ì‡Ú ÔÓ-‰Ó·‡ ÂÙËÍ‡ÒÌÓÒÚ ‚ ÔÓ-ÌËÒÍË ‰ÓÁË Ë ‰‡ÔË˜ËÌflÚ ÔÓ-Ï‡ÎÍÓ ÒÚ‡ÌË˜ÌË fl‚ÎÂÌËfl (32). àÁÒÎÂ‰‚‡ÌËfl‚ ÒÎÂ‰‚‡˘ËÚÂ „Ó‰ËÌË ‰ÓÍ‡Á‡ı‡, ˜Â ÏÂ‰ËÍ‡ÏÂÌÚÓÁÌËÚÂ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ëfl ÔË ÄÖå Ò ÔÓ‰Ó·ÂÌ ÏÂı‡ÌËÁ˙Ï Ì‡


í‡·ÎËˆ‡ 1. äÎ‡ÒËÙËÍ‡ˆËfl Ì‡ ÒÚÂÔÂÌÚ‡ Ì‡ ‰ÓÍ‡Á‡ÚÂÎÒÚ‚‡

êÂÈÚËÌ„ èÓÛ˜‚‡ÌÂäÎ‡Ò I èÓÒÔÂÍÚË‚ÌÓ, ‡Ì‰ÓÏËÁË‡ÌÓ, ÍÓÌÚÓÎË‡ÌÓ ÍÎËÌË˜ÌÓ

ÔÓÛ˜‚‡ÌÂ (RCT) ‚ ÂÔÂÁÂÌÚ‡ÚË‚Ì‡ ÔÓÔÛÎ‡ˆËfl Ò flÒÌËÔ˙‚Ë˜ÌË ÍËÚÂËË Á‡ ÓˆÂÌÍ‡, ‚ÍÎ˛˜‚‡˘Ë Ë ËÁÍÎ˛˜‚‡˘ËÍËÚÂËË, ÓÚÔ‡‰‡ÌËfl, Á‡ÏÂÌË, Ì‡‰ÂÊ‰ÌË ÓÒÌÓ‚ÌËı‡‡ÍÚÂËÒÚËÍË Ë ÂÍ‚Ë‚‡ÎÂÌÚÌÓÒÚ ÏÂÊ‰Û Ò‡‚Ìfl‚‡ÌËÚÂ„ÛÔË Ë Ò˙ÓÚ‚ÂÚÌ‡ ÒÚ‡ÚËÒÚËÍ‡

äÎ‡Ò II èÓÒÔÂÍÚË‚ÌÓ ÍÓÌÚÓÎË‡ÌÓ „ÛÔÓ‚Ó ÍÓıÓÚÌÓ ÔÓÛ˜‚‡ÌÂ(RCS) ‚ ÂÔÂÁÂÌÚ‡ÚË‚Ì‡ ÔÓÔÛÎ‡ˆËfl, ÌÓ Ò ÎËÔÒ‡ Ì‡ Â‰ÌÓ ÓÚËÁËÒÍ‚‡ÌËflÚ‡

äÎ‡Ò III ÇÒË˜ÍË ÓÒÚ‡Ì‡ÎË ÍÓÌÚÓÎË‡ÌË ÔÓÛ˜‚‡ÌËfl – ÂÒÚÂÒÚ‚ÂÌıÓ‰, ‚ ÂÔÂÁÂÌÚ‡ÚË‚Ì‡ ÔÓÔÛÎ‡ˆËfl

äÎ‡Ò IV ÑÓÍ‡Á‡ÚÂÎÒÚ‚‡ ÓÚ ÌÂÍÓÌÚÓÎË‡ÌË ÔÓÛ˜‚‡ÌËfl, ÓÚ‰ÂÎÌËÒÎÛ˜‡Ë, ÏÌÂÌËÂ Ì‡ ÂÍÒÔÂÚË

‰ÂÈÒÚ‚ËÂ Û‚ÂÎË˜‡‚‡Ú ËÒÍ‡ ÓÚ ÒÚ‡ÌË˜ÌË fl‚ÎÂÌËfl (29).åÓÌÓÚÂ‡ÔËflÚ‡ ÒÂ Ì‡ÎÓÊË Ò ÔÓ-ÌËÒÍËfl ËÒÍ ÓÚ ÒÚ‡-ÌË˜ÌË Â‡ÍˆËË Ë ÎÂÍ‡ÒÚ‚ÂÌË ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ëfl, Ò˙Ò Ò‡‚-ÌËÏ‡Ú‡ ÒË ÂÙËÍ‡ÒÌÓÒÚ, Ò Û‰Ó·ÒÚ‚ÓÚÓ Á‡ ·ÓÎÌËÚÂ, ÔÓ-ÌËÒÍ‡Ú‡ ˆÂÌ‡ Ë ÔÓ-‰Ó·Ó Í‡˜ÂÒÚ‚ÓÚÓ Ì‡ ÊË‚ÓÚ (43).êËÒÍ˙Ú ÓÚ „ÓÎÂÏË ÍÓÌ„ÂÌËÚ‡ÎÌË Ï‡ÎÙÓÏ‡ˆËË ÔË ‰Âˆ‡ËÁÎÓÊÂÌË in utero Ì‡ ÄÖå Â ÁÌ‡˜ËÚÂÎÌÓ ÔÓ-‚ËÒÓÍ ÔË ÔÓ-ÎËÚÂ‡ÔËfl ÓÚÍÓÎÍÓÚÓ ÔË ÏÓÌÓÚÂ‡ÔËfl (38). èË 30% -40% ÓÚ Ô‡ˆËÂÌÚËÚÂ I- Ú‡ Ë II ÏÓÌÓÚÂ‡ÔËfl Ò‡ ÌÂÂÙÂÍ-ÚË‚ÌË Ë ÔË Úflı ÒÂ Ì‡Î‡„‡ ‚ÍÎ˛˜‚‡ÌÂ Ì‡ ‰ÓÔ˙Î‚‡˘‡ ÚÂ-‡ÔËfl (29, 32). çÓ‚ËÚÂ ÄÖå ‰ÓÍ‡Á‚‡Ú ÂÙÂÍÚË‚ÌÓÒÚÚ‡ÒË Í‡ÚÓ ‰ÓÔ˙Î‚‡˘‡ ÚÂ‡ÔËfl ‚ ÍÎËÌË˜ÌË ÔÓÛ˜‚‡ÌËfl, Í‡-ÚÓ ÏÌÓ„Ó ÓÚ Úflı ÔÓ‡‰Ë ‰Ó·Ëfl ÔÓÙËÎ Ì‡ ÔÓÌÓÒËÏÓÒÚÒ‡ Í‡Ì‰Ë‰‡ÚË Á‡ ÏÓÌÓÚÂ‡ÔËfl, ‚ÍÎ˛˜ËÚÂÎÌÓ Ë Í‡ÚÓ Ì‡-˜‡ÎÌ‡ ÚÂ‡ÔËfl (8). àÁ·Ó˙Ú Ì‡ Â‰ËÌ ÄÖå ˘Â Á‡‚ËÒË ÓÚÌÂ„Ó‚‡Ú‡ ‡ÌÚËÂÔËÎÂÔÚË˜Ì‡ ÔÓÚÂÌÚÌÓÒÚ, ÒÔÂÍÚ˙˙Ú Ì‡ÂÙËÍ‡ÒÌÓÒÚ, Ù‡Ï‡ÍÓÍËÌÂÚË˜Ì‡Ú‡ ÏÛ ı‡‡ÍÚÂËÒÚËÍ‡,ÏÂı‡ÌËÁ˙Ï‡ Ì‡ ‰ÂÈÒÚ‚ËÂ, ÒÍÓÓÒÚÚ‡ Ì‡ ÚËÚ‡ˆËfl, ÎËÔ-Ò‡Ú‡ Ì‡ ÍÓ„ÌËÚË‚ÌË ‚ÎËflÌËfl, ıÓÏÓÌ‡ÎÌË ÂÙÂÍÚË, ‚Á‡Ë-ÏÓ‰ÂÈÒÚ‚Ëfl Ò ÔÂÓ‡ÎÌË ÔÓÚË‚ÓÁ‡˜‡Ú˙˜ÌË ÒÂ‰ÒÚ‚‡,Ì‡ ÚÂ‡ÚÓ„ÂÌÓÒÚ Ë ÚÓÍÒË˜ÌÓÒÚ (45).

Levetiracetam (LEV) Â ÄÖå ÓÚ ‚ÚÓÓ ÔÓÍÓÎÂÌËÂÒÚÛÍÚÛÌÓ ÔÓ‰Ó·ÂÌ Ì‡ ÔË‡ˆÂÚ‡Ï‡, Ò ÏÂı‡ÌËÁ˙Ï Ì‡‰ÂÈÒÚ‚ËÂ ‡ÁÎË˜ÂÌ ÓÚ ÚÓÁË Ì‡ ÔÓÁÌ‡ÚËÚÂ ‡ÌÚËÂÔËÎÂÔ-ÚË˜ÌË ÒÂ‰ÒÚ‚‡, Ò˙Ò ÒÔÂˆËÙË˜ÌÓ ÏflÒÚÓ Ì‡ Ò‚˙Á‚‡ÌÂ –SV2A, ÒËÌ‡ÔÚË˜ÂÌ ‚ÂÁËÍÛÎÂÌ ÔÓÚÂËÌ (33). åÂ‰ËÍ‡-ÏÂÌÚ˙Ú ÒÂ ÂÁÓ·Ë‡ ·˙ÁÓ ÒÎÂ‰ ÔÂÓ‡ÎÌÓ ÔËÎÓÊÂÌËÂ, ÒÔÓ˜ÚË 100 % ·ËÓÌ‡ÎË˜ÌÓÒÚ, Ò ÔËÍÓ‚‡ ÔÎ‡ÁÏÂÌ‡ ÍÓÌˆÂÌÚ-‡ˆËfl ÒÎÂ‰ 0,6 - 1,3 ˜., Ò ÎËÌÂÈÌ‡ Ù‡Ï‡ÍÓÍËÌÂÚËÍ‡, Ò ‚Â-ÏÂ Ì‡ ÔÓÎÛÊË‚ÓÚ 7 - 8 ˜., Ò ‰ÓÒÚË„‡ÌÂ Ì‡ ÔÓÒÚÓflÌÌË ÒÂ-ÛÏÌË ÌË‚‡ 2 ‰ÌË ÒÎÂ‰ ‰‚ÛÍ‡ÚÌÓ ‰ÌÂ‚ÌÓ ÔËÎÓÊÂÌËÂ, ·ÂÁ‡‚ÚÓËÌ‰ÛÍˆËfl Ì‡ ÏÂÚ‡·ÓÎËÁÏ‡ ÒË Ë ·ÂÁ ÔÓÚËÒÍ‡ÌÂ Ì‡˜ÂÌÓ‰Ó·ÌËÚÂ ˆËÚÓıÓÏÌË ÂÌÁËÏË ÓÚ ÒËÒÚÂÏ‡Ú‡ ê450ËÎË „Î˛ÍÓÓÌËÎ-Ú‡ÌÒÙÂ‡Á‡Ú‡, Ò „Î‡‚ÂÌ Ô˙Ú Ì‡ ÓÚ‰ÂÎfl-ÌÂ ˜ÂÁ ·˙·Â˜Ì‡ ÂÍÒÍÂˆËfl, Ú.Â. Â‰Ì‡ Ù‡Ï‡ÍÓÍËÌÂÚËÍ‡,·ÎËÁÍ‡ ‰Ó Ë‰Â‡ÎÌ‡Ú‡ (39). LEV Â ‰ÓÍ‡Á‡Î Ò‚ÓflÚ‡ ÂÙËÍ‡Ò-ÌÓÒÚ Ë ‰Ó·‡ ÔÓÌÓÒËÏÓÒÚ ‚ ÚË ÏÛÎÚËˆÂÌÚÓ‚Ë, ‰‚ÓÈ-ÌÓ-ÒÎÂÔË, ‡Ì‰ÓÏËÁË‡ÌË, ÍÓÌÚÓÎË‡ÌË ÔÓÛ˜‚‡ÌËfl ÔË„ÓÎflÏ ÍÓÌÚËÌ„ÂÌÚ ·ÓÎÌË Ò ÂÁËÒÚÂÌÚÌË Ô‡ˆË‡ÎÌË ÂÔË-ÎÂÔÒËË Í‡ÚÓ ‰Ó·‡‚˙˜Ì‡ ÚÂ‡ÔËfl Ò ÔÓ‰ÎÊËÚÂÎÌÓÒÚ Ì‡ÛÒÔÂ¯ÌÓ ÎÂ˜ÂÌËÂ Ì‡‰ 2 „Ó‰ËÌË (7, 14, 46). LEV Â ÛÒÔÂ¯ÂÌ Ë‚ ÚÂ‡ÔËflÚ‡ Ì‡ Ë‰ËÓÔ‡ÚË˜Ì‡Ú‡ „ÂÌÂ‡ÎËÁË‡Ì‡ ÂÔËÎÂÔ-ÒËfl (10), ÓÒÓ·ÂÌÓ ‚ ˛‚ÂÌËÎÌ‡Ú‡ ÏËÓÍÎÓÌË˜Ì‡ ÂÔËÎÂÔÒËfl(5), Á‡ ÎÂ˜ÂÌËÂÚÓ Ì‡ ÍÓflÚÓ Í‡ÚÓ ‰ÓÔ˙Î‚‡˘‡ ÚÂ‡ÔËfl ÂÓ‰Ó·ÂÌ ÔÂÁ 2006.

ä‡ÚÓ Ô˙‚‡ ÒÚ˙ÔÍ‡ Á‡ ÓˆÂÌÍ‡ Ì‡ ÂÙÂÍÚË‚ÌÓÒÚÚ‡ Ì‡Â‰ËÌ ÄÖå Í‡ÚÓ ÏÓÌÓÚÂ‡ÔËfl ÓÚ ‡Ì‰ÓÏËÁË‡ÌËÚÂÍÓÌÚÓÎË‡ÌË ÔÓÛ˜‚‡ÌËfl (RCT) Â ÔÓÛ˜‚‡ÌÂ Ò ‰ËÁ‡ÈÌ ËÁ-ÚÂ„ÎflÌÂ – Á‡ÏflÌ‡ ÔË ÔÂ‰ıÓ‰Ì‡ ‰ÓÔ˙Î‚‡˘‡ ÚÂ‡ÔËfl, ÍÓ-flÚÓ Â ·ËÎ‡ ÛÒÔÂ¯Ì‡ (8). íÓÁË ‰ËÁ‡ÈÌ Â ÔËÎÓÊÂÌ ÔË Ö‚Ó-ÔÂÈÒÍÓÚÓ ‰‚ÓÈÌÓ-ÒÎflÔÓ ÔÎ‡ˆÂ·Ó-ÍÓÌÚÓÎË‡ÌÓ ÔÓÛ˜‚‡ÌÂÌ‡ ÂÙËÍ‡ÒÌÓÒÚÚ‡ Ë ÔÓÌÓÒËÏÓÒÚÚ‡ Í˙Ï LEV ÔË Ô‡ˆËÂÌ-ÚË Ò ÂÙ‡ÍÚÂÌË Ô‡ˆË‡ÎÌË ÔËÔ‡‰˙ˆË (7). è‡ˆËÂÌÚË-ÚÂ, ÍÓËÚÓ Ò‡ ËÏ‡ÎË Â‰ÛÍˆËfl Ì‡ ÂÔËÎÂÔÚË˜ÌËÚÂ ÔËÒÚ˙-ÔË Ì‡‰ 50% Á‡ 12 ÒÂ‰ÏËˆË ‚˙‚ Ù‡Á‡Ú‡ Ì‡ ‰ÓÔ˙Î‚‡˘‡Ú‡ÚÂ‡ÔËfl Ò LEV, ÏËÌ‡‚‡Ú ‚ 12 ÒÂ‰ÏË˜Ì‡ Ù‡Á‡ Ì‡ ËÁÚÂ„Îfl-ÌÂ, ÒÎÂ‰ ÍÓflÚÓ ÓÒÚ‡‚‡Ú Ì‡ ÏÓÌÓÚÂ‡ÔËfl Ò LEV Á‡ 12 ÒÂ‰-ÏËˆË. éÚ 69 Ô‡ˆËÂÌÚË ÔÓ‰ıÓ‰fl˘Ë Á‡ ‚ÍÎ˛˜‚‡ÌÂ ÓÒÚ‡Ì‡-ÎË ÓÚ Ù‡Á‡Ú‡ Ì‡ ‰ÓÔ˙Î‚‡˘‡Ú‡ LEV ÚÂ‡ÔËfl, 49 ÛÒÔÂ¯ÌÓÔÂÏËÌ‡‚‡Ú Ì‡ ÏÓÌÓÚÂ‡ÔËfl. éÚ Úflı 36 Á‡‚˙¯‚‡ÚÔÓÛ˜‚‡ÌÂÚÓ, Í‡ÚÓ 9 Ô‡ˆËÂÌÚË Ì‡ LEV ÏÓÌÓÚÂ‡ÔËfl Ò‡Ò‚Ó·Ó‰ÌË ÓÚ ÔËÒÚ˙ÔË ÔÓ ‚ÂÏÂ Ì‡ ˆÂÎËfl ÔÂËÓ‰ Ì‡ ÏÓ-ÌÓÚÂ‡ÔËfl. ëÂ‰ÌËflÚ ÔÓˆÂÌÚ Ì‡ Ì‡Ï‡Îfl‚‡ÌÂ Ì‡ ˜ÂÒÚÓ-Ú‡Ú‡ Ì‡ Ô‡ˆË‡ÎÌËÚÂ ÔËÔ‡‰˙ˆË ‚ Ò‡‚ÌÂÌËÂ Ò ËÁıÓ‰ÌËflÔÂËÓ‰ Â 74%. ëÎÂ‰Ó‚‡ÚÂÎÌÓ, Ô‡ˆËÂÌÚË Ò Ô‡ˆË‡ÎÌË ÂÔË-ÎÂÔÚË˜ÌË ÔËÒÚ˙ÔË, ÍÓËÚÓ ÌÂ Ò‡ ·ËÎË ÍÓÌÚÓÎË‡ÌË Ò˙ÒÒÚ‡Ì‰‡ÚÌÓ ‡ÌÚËÂÔËÎÂÔÚË˜ÌÓ ÎÂ˜ÂÌËÂ ÏÓ„‡Ú ÛÒÔÂ¯ÌÓ

‰‡ ÔÂÏËÌ‡Ú Ì‡ ÚÂ‡ÔËfl Ò LEV, ‡ÍÓ Ò‡ ËÏ‡ÎË ÂÙÂÍÚ ÓÚ‰Ó·‡‚˙˜Ì‡Ú‡ ÚÂ‡ÔËfl Ò ÚÓÁË ÏÂ‰ËÍ‡ÏÂÌÚ Í˙Ï ÓÒÌÓ‚Ì‡-Ú‡ ËÏ ÚÂ‡ÔËfl. íÓ‚‡ Â Â‰ËÌ ÓÚÎË˜ÂÌ ÂÁÛÎÚ‡Ú, Í‡ÚÓ ÒÂËÏ‡ ÔÂ‰‚Ë‰, ˜Â ¯‡ÌÒ˙Ú Ì‡ Ô‡ˆËÂÚË Ò ÂÙ‡ÍÚÂÌ‡ ÂÔË-ÎÂÔÒËfl Á‡ Ò‚Ó·Ó‰‡ ÓÚ ÔËÒÚ˙ÔË Â ÏÌÓ„Ó Ï‡Î˙Í – ‰Ó 3%(29).

ëÎÂ‰‚‡˘ ÂÚ‡Ô ‚ ‡Á‚ËÚËÂÚÓ Ì‡ ÏÓÌÓÚÂ‡ÔËflÚ‡ Ò LEVÂ Ù‡Á‡ III ‡Ì‰ÓÏËÁË‡ÌÓ, ‰‚ÓÈÌÓ-ÒÎflÔÓ Ò‡‚ÌËÚÂÎÌÓ ÔÓ-Û˜‚‡ÌÂ Ì‡ ÌÓ‚Ó‰Ë‡„ÌÓÒÚËˆË‡ÌË Ô‡ˆËÂÌÚË Ò Ô‡ˆË‡ÎÌËËÎË „ÂÌÂ‡ÎËÁË‡ÌË ÚÓÌË˜ÌÓ-ÍÎÓÌË˜ÌË ÔËÔ‡‰˙ˆË (ËÁÍÎ˛-˜ÂÌË Ò‡ ÚÂÁË Ò Ë‰ËÓÔ‡ÚË˜Ì‡ „ÂÌÂ‡ÎËÁË‡Ì‡ ÂÔËÎÂÔÒËfl).ä‡ÚÓ ÏÂ‰ËÍ‡ÏÂÌÚ Á‡ Ò‡‚ÌÂÌËÂ, (‰ÂÏÓÌÒÚË‡Î ÔÓ-‚ËÒÓ-Í‡ ÂÙÂÍÚË‚ÌÓÒÚ ÓÚ phenobarbital Ë primidon, ÌË‚Ó Ä ÔÂ-ÔÓ˙Í‡ Á‡ Ì‡˜‡ÎÌ‡ ÏÓÌÓÚÂ‡ÔËfl ÔË Ô‡ˆË‡ÎÌË ÂÔËÎÂÔÒËËÒÔÓÂ‰ ILAE) Â ËÁ·‡Ì carbamazepine Ò ÍÓÌÚÓÎË‡ÌÓ ÓÒ-‚Ó·ÓÊ‰‡‚‡ÌÂ (CBZ - CR) ‚ ÔÓÒÚË„‡ÌÂÚÓ Ì‡ 6 ÏÂÒÂ˜Ì‡ Ò‚Ó-·Ó‰‡ ÓÚ ÔËÒÚ˙ÔË (12). ëÎÂ‰ ÚËÚË‡ÌÂ 3 ÒÂ‰ÏËˆË ÒÂ‰ÓÒÚË„‡Ú ÔË ÌÂÓ·ıÓ‰ËÏÓÒÚ ‰ÓÁË ‰Ó 3000 Ï„/‰ÌÂ‚ÌÓ LEVË 1200 Ï„/‰ÌÂ‚ÌÓ CBZ. ÇÍÎ˛˜ÂÌË Ò‡ 285 Ô‡ˆËÂÌÚË Ì‡ LEVË 291 Ì‡ CBZ (ITT). òÂÒÚ ÏÂÒÂ˜Ì‡ Ò‚Ó·Ó‰‡ ÓÚ ÔËÒÚ˙ÔËÂ ÔÓÒÚË„Ì‡Ú‡ ÔË 73% ÓÚ ÎÂÍÛ‚‡ÌËÚÂ Ò LEV Ë 72,8% ÓÚÚÂÁË Ò CBZ (îË„. 1), Ì‡ 12 ÏÂÒÂˆ – ÂÒÔÂÍÚË‚ÌÓ ÔË56,6% Ë 58,5%. èÓ-Ï‡ÎÍÓ Ò‡ Ô‡ˆËÂÌÚËÚÂ ‚ „ÛÔ‡Ú‡ ÒLEV, ÍÓËÚÓ Ò‡ ËÁÎÂÁÎË ÓÚ ÔÓÛ˜‚‡ÌÂÚÓ ‚ Ò‡‚ÌÂÌËÂ Ò ÚÂ-ÁË Ò CBZ ÔÓ‡‰Ë ÒÚ‡ÌË˜ÌË ÂÙÂÍÚË (Ò˙ÓÚ‚ÂÚÌÓ 16,1% Ë23%).

ëÎÂ‰Ó‚‡ÚÂÎÌÓ LEV Â ÂÙÂÍÚË‚ÂÌ Í‡ÚÓ ÚÂ‡ÔËfl Ì‡ Ô˙-‚Ë ËÁ·Ó ÔË ÌÓ‚Ó‰Ë‡„ÌÓÒÚËˆË‡ÌË Ô‡ˆËÂÌÚË Ò Ô‡ˆË‡Î-ÌË ËÎË Éíäè Ò ÔÓ‰Ó·ÌÓ ÌË‚Ó Ì‡ Ò‚Ó·Ó‰‡ ÓÚ ÔËÒÚ˙ÔË Á‡6 Ë 12 ÏÂÒÂˆ‡ Í‡ÚÓ CBZ Ë Ò ÔÓ-‰Ó·‡ ÔÓÌÓÒËÏÓÒÚ ÓÚ ÌÂ-„Ó. Ryvlin ÓˆÂÌfl‚‡ ‚ËÒÓÍÓ ÏÂÚÓ‰ÓÎÓ„ËflÚ‡ Ì‡ ÚÓ‚‡ ÔÓÛ˜-‚‡ÌÂ Í‡ÚÓ ÓÔËÚ Á‡ Á‡Ô˙Î‚‡ÌÂ Ì‡ ÔÓÔ‡ÒÚÚ‡ ÏÂÊ‰Û‰ÓÒÚ˙ÔÌËÚÂ ·‡ÁË‡ÌË Ì‡ ‰ÓÍ‡Á‡ÚÂÎÒÚ‚‡ ‰‡ÌÌË Ë ÍÎËÌË˜-Ì‡Ú‡ ËÌÚÛËˆËfl Ë Ô‡ÍÚËÍ‡, ÌÂÓ·ıÓ‰ËÏË ÔË ÎÂ˜ÂÌËÂÚÓÌ‡ ÂÔËÎÂÔÒËflÚ‡ (44). ëÔÓÂ‰ ÍËÚÂËËÚÂ Ì‡ ILAE ÔÓÛ˜-‚‡ÌÂÚÓ Â Ò ÂÈÚËÌ„ ÍÎ‡Ò I .

êÂÚÓÒÔÂÍÚË‚ÌËÚÂ Ì‡·Î˛‰ÂÌËfl Ë ÓÔËÒ‡ÌËfl Ì‡ ÓÚ‰ÂÎ-ÌË ÍÎËÌË˜ÌË ÒÎÛ˜‡Ë Á‡ ÛÒÔÂ¯Ì‡ ÏÓÌÓÚÂ‡ÔËfl Ò LEV ÔÂÓ·-Î‡‰‡‚‡Ú ÔÓ ·ÓÈ Ì‡‰ ÔÛ·ÎËÍ‡ˆËËÚÂ ÔË ÍÓÌÚÓÎË‡ÌËÔÓÛ˜‚‡ÌËfl.

● Alsaadi Ë Ò˙‡‚Ú. (4) ‚ ÂÚÓÒÔÂÍÚË‚ÌÓ ÔÓÛ˜‚‡ÌÂ Ì‡ÏÓÌÓÚÂ‡ÔËfl Ò LEV, Í‡ÚÓ ÚÂ‡ÔËfl Ì‡ Ô˙‚Ë ËÁ·Ó(ÔË 9) ËÎË Í‡ÚÓ ÍÓÌ‚ÂÁËfl ÔË ÌÂÛÒÔÂı ÓÚ ÔÂ‰¯Â-ÒÚ‚‡˘‡Ú‡ ‡ÌÚËÂÔËÎÂÔÚË˜Ì‡ ÚÂ‡ÔËfl (ÔË 28) ÔËÔ‡ˆËÂÌÚË Ò Ô‡ˆË‡ÎÌË ÔËÔ‡‰˙ˆË Ò˙Ò ËÎË ·ÂÁ ‚ÚÓ-Ë˜Ì‡ „ÂÌÂ‡ÎËÁ‡ˆËfl, ÛÒÚ‡ÌÓ‚fl‚‡Ú 35% Ò‚Ó·Ó‰‡ ÓÚÔËÒÚ˙ÔË Ë ‰Ó·‡ ÔÓÌÓÒËÏÓÒÚ (Ò‡ÏÓ 3 ÔÂÛÒÚ‡ÌÓ‚fl-


îË„. 1. ë‡‚ÌËÚÂÎÌÓ ÔÓÛ˜‚‡ÌÂ Ì‡ ÂÙËÍ‡ÒÌÓÒÚÚ‡ Ì‡ ÏÓÌÓÚÂ‡ÔËflÚ‡ ÒLEV Ë CBZ (Ò‚Ó·Ó‰‡Ú‡ ÓÚ ÔËÒÚ˙ÔË Á‡ 6 ÏÂÒÂˆ‡).

‚‡Ú ÎÂ˜ÂÌËÂÚÓ ÔÓ‡‰Ë ÒÚ‡ÌË˜ÌË fl‚ÎÂÌËfl). ● èË ÌÓ‚ÓÓÚÍËÚ‡ Ô‡ˆË‡ÎÌ‡ ÂÔËÎÂÔÒËfl Ò Ì‡˜‡ÎÌ‡

ÏÓÌÓÚÂ‡ÔËfl Ò LEV ÓÚ 13 Ô‡ˆËÂÌÚË, 11 ÔÓ‰˙ÎÊ‡-‚‡Ú ÎÂ˜ÂÌËÂÚÓ Ë ÒÎÂ‰ 6-ÚËfl ÏÂÒÂˆ, Í‡ÚÓ 6 Ò‡ Ò Ô˙ÎÂÌÍÓÌÚÓÎ, ‡ 5 – Ò Ì‡‰ 50% Â‰ÛÍˆËfl Ì‡ ÔËÔ‡‰˙ˆËÚÂ(3).

● Ç ‰˙Î„ÓÚ‡ÈÌÓ ÔÓÛ˜‚‡ÌÂ (46 ÒÎÛ˜‡Ë) Ò˙˘ËflÚ ÍÓÎÂÍ-ÚË‚ (2) ‰ÓÍ‡Á‚‡, ˜Â ÏÓÌÓÚÂ‡ÔËflÚ‡ Ò LEV Â ÂÙÂÍ-ÚË‚Ì‡ Ë ÒÂ ÔÓÌ‡Òfl ‰Ó·Â Í‡ÍÚÓ ÔË ÌÓ‚ÓÓÚÍËÚ‡,Ú‡Í‡ Ë ÔË ÚÛ‰Ì‡ Á‡ ÍÓÌÚÓÎ ÂÔËÎÂÔÒËfl, Í‡ÚÓ Ì‡12-ÚËfl ÏÂÒÂˆ ÓÚ ÎÂ˜ÂÌËÂÚÓ ÔË 2/3 ÓÚ ·ÓÎÌËÚÂÍÓÌÚÓÎ˙Ú Ì‡‰ ÂÔËÎÂÔÚË˜ÌËÚÂ ÔËÒÚ˙ÔË ÒÂ Á‡Ô‡Á‚‡ËÎË Â ÔÓ-‰Ó·˙.

● êÂÁÛÎÚ‡ÚËÚÂ ÓÚ „ÓÎflÏÓ ÂÚÓÒÔÂÍÚË‚ÌÓ ÔÓÛ˜‚‡-ÌÂ ÔË Ô‡ˆËÂÌÚË Ò ÂÁËÒÚÂÌÚÌË Ô‡ˆË‡ÎÌË Ë „ÂÌÂ‡-ÎËÁË‡ÌË ÂÔËÎÂÔÒËË (35) ÔÓÍ‡Á‚‡Ú, ˜Â ÓÚ 225 ÚÂÚË-‡ÌË Ò ‰Ó·‡‚˙˜Ì‡ LEV ÚÂ‡ÔËfl, 104 ÔÂÏËÌ‡‚‡Ú Ì‡ÏÓÌÓÚÂ‡ÔËfl, Í‡ÚÓ 60% ÓÚ Úflı ÓÚ„Ó‚‡flÚ Ì‡ ÎÂ-˜ÂÌËÂÚÓ Ë 49% Ò‡ Ò‚Ó·Ó‰ÌË ÓÚ ÂÔËÎÂÔÚË˜ÌËÔËÒÚ˙ÔË. èÓ- ‰Ó·Ë Ò‡ ÂÁÛÎÚ‡ÚËÚÂ ÔË Ô‡ˆËÂÌ-ÚËÚÂ Ò Ì‡˜‡ÎÌ‡ ÏÓÌÓÚÂ‡ÔËfl – Ò‚Ó·Ó‰‡ ÓÚ ÔËÔ‡‰˙-ˆË – ÔË 78%.

● ÅÎËÁÍË Ò‡ ÂÁÛÎÚ‡ÚËÚÂ ÓÚ ‰Û„Ó „ÓÎflÏÓ ÔÓÛ˜‚‡ÌÂÌ‡ ÔÓ‰˙ÎÊËÚÂÎÌ‡Ú‡ ÂÙËÍ‡ÒÌÓÒÚ Ì‡ LEV ÔË Ô‡ˆË-ÂÌÚË Ò ÂÙ‡ÍÚÂÌ‡ ÂÔËÎÂÔÒËfl (N=352) ÛÒÔÂ¯ÌÓÔÂÏËÌ‡ÎË ÓÚ ‰ÓÔ˙Î‚‡˘‡ ÚÂ‡ÔËfl Í˙Ï ÏÓÌÓÚÂ‡ÔËflÒ LEV ÔË ËÁÚÂ„ÎflÌÂ Ì‡ ·‡ÁÓ‚ËÚÂ ÄÖå. ìÒÔÂ¯ÌÓ Ò‡ÔÂÏËÌ‡ÎË Ì‡ ÏÓÌÓÚÂ‡ÔËfl 52, Í‡ÚÓ ÓÚ Úflı 46% Ò‡Ò‚Ó·Ó‰ÌË ÓÚ ÂÔËÎÂÔÚË˜ÌË ÔËÒÚ˙ÔË Á‡ ÔÂËÓ‰ Ì‡‰12 ÏÂÒÂˆ‡ Ë Ó˘Â 15% - Á‡ ÔÂËÓ‰ ÓÚ 6 ‰Ó 12 ÏÂÒÂˆ‡.àÁÚÂ„ÎflÌÂ Ì‡ 3 ÄÖå Â ÔÓÒÚË„Ì‡ÚÓ ÔË 37%, Ì‡ 2 –ÔË 40% Ë Ì‡ 1 – ÔË 23% (11).

● Ç ‰Û„Ó ÂÚÓÒÔÂÍÚË‚ÌÓ, Ò˙Ò ÒÂ‰Ì‡ ÔÓ‰˙ÎÊËÚÂÎ-ÌÓÒÚ 18 ÏÂÒÂˆ‡ ÔÓÛ˜‚‡ÌÂ, ÏÓÌÓÚÂ‡ÔËflÚ‡ Ò LEV ÂÔËÎ‡„‡Ì‡ ÔË ÒÏÂÒÂÌ‡ ÔÓÔÛÎ‡ˆËfl ÓÚ ‰Âˆ‡ Ë ‚˙Á‡ÒÚ-ÌË (35 ÒÎÛ˜‡Ë) Ò ÌÓ‚ÓÓÚÍËÚ‡ Ë Ò ÂÙ‡ÍÚÂÌ‡ ÂÔË-ÎÂÔÒËfl ‚ÍÎ˛˜ËÚÂÎÌÓ ÔË ÒËÏÔÚÓÏÌ‡ ÂÔËÎÂÔÒËfl ÔËÚÛÏÓË Ì‡ ñçë. êÂÁÛÎÚ‡ÚËÚÂ Ò‡ ÏÌÓ„Ó ‰Ó·Ë – 72%Ò‡ Ò‚Ó·Ó‰ÌË ÓÚ ÔËÒÚ˙ÔË, 32 ÔÓ‰˙ÎÊ‡‚‡Ú ÎÂ˜ÂÌËÂ-ÚÓ Ò ÏÓÌÓÚÂ‡ÔËfl, 8% ÓÚÔ‡‰‡Ú ÔÓ‡‰Ë ÒÚ‡ÌË˜ÌËfl‚ÎÂÌËfl (28).

● éÚ 77 ‚˙Á‡ÒÚÌË Ë 27 ‰Âˆ‡ ÎÂÍÛ‚‡ÌË Ò LEV Í‡ÚÓ ‰Ó-·‡‚˙˜Ì‡ ÚÂ‡ÔËfl, 8 ÓÚ ‚˙Á‡ÒÚÌËÚÂ Ë 4 ÓÚ ‰Âˆ‡Ú‡ÏËÌ‡‚‡Ú ÛÒÔÂ¯ÌÓ Ì‡ ÏÓÌÓÚÂ‡ÔËfl, Í‡ÚÓ 7 Ë 2 ÂÒ-ÔÂÍÚË‚ÌÓ Ò‡ Ò‚Ó·Ó‰ÌË ÓÚ ÂÔËÎÂÔÚË˜ÌË ÔËÒÚ˙ÔË(25).

● EÙÂÍÚ˙Ú ÓÚ ÏÓÌÓÚÂ‡ÔËflÚ‡ Ò LEV Â ÔÓ‰˙ÎÊËÚÂ-ÎÂÌ Ë Ô‡ˆËÂÌÚËÚÂ Ò‡ Ò ÏÌÓ„Ó ÌËÒÍ‡ ÒÂ‰ÏË˜Ì‡ ˜ÂÒÚÓ-Ú‡ Ì‡ ÔËÒÚ˙ÔËÚÂ, Ò˙Ò ÒÚ‡·ËÎÌÓ ‚˙‚ ‚ÂÏÂÚÓ ÔÓ-‰Ó·ÂÌËÂ. ÇÂÓflÚÌÓÒÚÚ‡ Á‡ Ò‚Ó·Ó‰‡ ÓÚ ÔËÒÚ˙ÔËÁ‡ ÔÓÌÂ 12 ÒÂ‰ÏËˆË Â 64,2%, Á‡ 6 ÏÂÒÂˆ‡ – 57,5%, Á‡ 1„. – 54,8%, ‡ Á‡ 3 „. – 52,2% (8).

● èË Ô‡ˆËÂÌÚË (N=37) Ò Ô‡ˆË‡ÎÌË ÔËÒÚ˙ÔË Ò ËÎË·ÂÁ ‚ÚÓË˜Ì‡ „ÂÌÂ‡ÎËÁ‡ˆËfl ÔË ÍËÔÚÓ„ÂÌÌ‡ ËÒËÏÔÚÓÏÌ‡ ÂÔËÎÂÔÒËfl, ÏÓÌÓÚÂ‡ÔËflÚ‡ Ò LEV, Í‡ÚÓÚÂ‡ÔËfl Ì‡ Ô˙‚Ë ËÎË Ì‡ ‚ÚÓË ËÁ·Ó Â ÛÒÔÂ¯Ì‡ ÔË78% (Â‰ÛÍˆËfl Ì‡ ÔËÒÚ˙ÔËÚÂ Ì‡‰ 50%) Ò˙Ò Ò‚Ó·Ó‰‡ÓÚ ÔËÒÚ˙ÔË ÔË 38%. ÖÙÂÍÚ˙Ú ‚˙‚ ‚ÂÏÂÚÓ ÂÔÓ‰˙ÎÊËÚÂÎÂÌ, ÒÚ‡ÌË˜ÌËÚÂ fl‚ÎÂÌËfl Ò‡ Â‰ÍË,„Î‡‚ÌÓ ÓÚ ÒÚ‡Ì‡ Ì‡ ÌÂ‚Ì‡Ú‡ ÒËÒÚÂÏ‡ Ë ÒÂ Ì‡·Î˛-‰‡‚‡Ú ÔË 8% ÓÚ ÒÎÛ˜‡ËÚÂ (24).

ÑÂˆ‡Ú‡ ˜ÂÒÚÓ ÒÂ ËÁÍÎ˛˜‚‡Ú ÓÚ ÍÎËÌË˜ÌË ÔÓÛ˜‚‡ÌËflÌ‡ ÄÖå ÔÂ‰Ë Ó‰Ó·ÂÌËÂÚÓ ËÏ Ë ÎËÔÒ‚‡Ú ÒÚËÏÛÎË Á‡ÔÓÛ˜‚‡ÌËfl ‚ Ú‡ÁË ÔÓÔÛÎ‡ˆËfl ÒÎÂ‰ Í‡ÚÓ ÄÖå ·˙‰Â Ó‰Ó·-ÂÌ. ë˙˘ÂÒÚ‚Û‚‡Ú Ë Â‰Ëˆ‡ ÏÂÚÓ‰ÓÎÓ„Ë˜ÌË ÔÓ·ÎÂÏË,Ò‚˙Á‡ÌË Ò ‡ÁÎË˜ÂÌ ÓÚ„Ó‚Ó ÔË ‡ÁÎË˜ÌËÚÂ ÂÔËÎÂÔÚË˜-ÌË ÒËÌ‰ÓÏË Ë ‚ ‡ÁÎË˜ÌËÚÂ ‚˙Á‡ÒÚÓ‚Ë „ÛÔË. àÁ‚Ó‰ËÚÂ

Á‡ ÂÙËÍ‡ÒÌÓÒÚ Ë ·ÂÁÓÔ‡ÒÌÓÒÚ ÓÚ ÍÎËÌË˜ÌËÚÂ ÔÓÛ˜‚‡ÌËflÔË ‚˙Á‡ÒÚÌËÚÂ ÌÂ ÏÓ„‡Ú ÔÓÒÚÓ ‰‡ ÒÂ ÂÍÒÚ‡ÔÓÎË‡ÚÍ˙Ï ÔÂ‰Ë‡ÚË˜ÌËÚÂ Ô‡ˆËÂÌÚË (21). ë ·Î‡„ÓÔËflÚÌ‡Ú‡ÒË Ù‡Ï‡ÍÓÍËÌÂÚËÍ‡, Û‰Ó·ÒÚ‚ÓÚÓ Ì‡ ÔËÎÓÊÂÌËÂ, ‰Ó·‡-Ú‡ ÔÓÌÓÒËÏÓÒÚ Ë ÎËÔÒ‡Ú‡ Ì‡ ÔÓÚËÒÍ‡ÌÂ Ì‡ ÍÓ„ÌËÚË‚ÌË-ÚÂ ÙÛÌÍˆËË, LEV ÒÂ ÍÎ‡ÒË‡ ÒÂ‰ ÌÓ‚ËÚÂ ÄÖå Í‡ÚÓ Â‰ËÌ‰Ó·˙ ÏÂ‰ËÍ‡ÏÂÌÚ Á‡ ÎÂ˜ÂÌËÂ Ì‡ ÂÔËÎÂÔÒËËÚÂ ÔË ‰Âˆ‡(21, 22, 41). êÂÚÓÒÔÂÍÚË‚ÌËÚÂ ÔÓÛ˜‚‡ÌËfl Á‡ ÏÓÌÓÚÂ‡-ÔËfl Ò LEV ÔË ‰Âˆ‡ ‰ÂÏÓÌÒÚË‡Ú ·ÎËÁÍË ÂÁÛÎÚ‡ÚË ÒÚÂÁË ÔË ‚˙Á‡ÒÚÌË.

● Ç ÔÓÛ˜‚‡ÌÂÚÓ Ì‡ Mintz Ë Ò˙‡‚Ú ÓÚ 55 ‰Âˆ‡ ÎÂÍÛ‚‡-ÌË Ò LEV, Ì‡ ÏÓÌÓÚÂ‡ÔËfl Ò‡ Ò‡ÏÓ 6, ÓÚ Úflı Ò Ô‡-ˆË‡ÎÌË ÍÓÏÔÎÂÍÒÌË ÔËÒÚ˙ÔË Ò‡ 5 Ë Ò ÌÂËÁflÒÌÂÌË - 1.èÂ‰¯ÂÒÚ‚‡˘‡ ÌÂÛÒÔÂ¯Ì‡ ÚÂ‡ÔËfl Ò 1-3 ÄÖå Ò‡ËÏ‡ÎË 4 Ë ‚˙ÔÂÍË ÚÓ‚‡ Ë ÔË 5 ÒÂ ÔÓÒÚË„‡ Ò‚Ó·Ó‰‡ÓÚ ÔËÒÚ˙ÔË Á‡ 6 ‰Ó 22 ÏÂÒÂˆ‡. çÂ Ò‡ Ì‡·Î˛‰‡‚‡ÌËÒÚ‡ÌË˜ÌË fl‚ÎÂÌËfl (36).

● éÚ Ó·˘Ó 81 ·ÓÎÌË ÎÂÍÛ‚‡ÌË Ò LEV ÓÚ ‰Û„Ó ÔÓÛ˜-‚‡ÌÂ, 19 Ò‡ ‰ÂˆÚ‡ Ò ÏÓÌÓÚÂ‡ÔËfl, Í‡ÚÓ 17 ÓÚ Úflı Ò‡‚ÍÎ˛˜ÂÌË ÔÓ‡‰Ë ÌÂÔÓ‚ÎËfl‚‡ÌÂ ÓÚ ÔÂ‰¯ÂÒÚ‚‡˘ËÄÖå. ë Ô‡ˆË‡ÎÌ‡ ÂÔËÎÂÔÒËfl Ò‡ 14, ‡ Ò „ÂÌÂ‡ÎËÁË‡-Ì‡ – 5. êÂ‰ÛÍˆËfl Ì‡ ÂÔËÎÂÔÚË˜ÌËÚÂ ÔËÒÚ˙ÔË Ì‡‰50% ÒÂ ÓÚ˜ËÚ‡ ÔË 67% ÓÚ ÎÂÍÛ‚‡ÌËÚÂ. èË 22% Ò‡Ì‡·Î˛‰‡‚‡ÌË ÔÓ‚Â‰ÂÌ˜ÂÒÍË ÔÓ·ÎÂÏË ËÎË ‚˙Á·Û‰‡, ‰Ó-‚ÂÎË ‰Ó ÒÔË‡ÌÂ Ì‡ ÏÂ‰ËÍ‡ÏÂÌÚ‡ ÔË ‰‚Â ‰Âˆ‡ (26).

● éÚ 50 ‰Âˆ‡, ÎÂÍÛ‚‡ÌË Ò LEV Á‡ ÂÙ‡ÍÚÂÌ‡ ÂÔËÎÂÔ-ÒËfl, Gustafson Ë Ò˙‡‚Ú. (23) ÛÒÚ‡ÌÓ‚fl‚‡Ú Ò‚Ó·Ó‰‡ÓÚ ÔËÒÚ˙ÔË ÔË 8 Ë ÛÒÔÂ¯ÌÓ ÔÂÏËÌ‡‚‡ÌÂ Ì‡ ÏÓÌÓ-ÚÂ‡ÔËfl ÔË 4. ë˙Ó·˘‡‚‡ ÒÂ Á‡ 90% ÓÚ„Ó‚‡fl˘Ë Ì‡ÏÓÌÓÚÂ‡ÔËflÚ‡ Ò LEV ‰Âˆ‡, 20% Ò‚Ó·Ó‰‡ ÓÚÔËÒÚ˙ÔË Ë ÒÂ‰Ì‡ Â‰ÛÍˆËfl Ì‡ ÂÔËÎÂÔÚË˜ÌËÚÂÔËÒÚ˙ÔË Ò 81%, ÔÓ-‚ËÒÓÍ‡ ÔË „ÂÌÂ‡ÎËÁË‡ÌËÚÂ,ÓÚÍÓÎÍÓÚÓ ÔË Ô‡ˆË‡ÎÌËÚÂ ÔËÒÚ˙ÔË (30).

● LEV ÏÓÌÓÚÂ‡ÔËflÚ‡ Â ÛÒÔÂ¯Ì‡ Ë ÔË ‰Âˆ‡ Ò ÌÓ‚Ó‰Ë-‡„ÌÓÒÚËˆË‡Ì‡ ‰Ó·ÓÍ‡˜ÂÒÚ‚ÂÌ‡ êÓÎ‡Ì‰Ó‚‡ ÂÔËÎÂÔ-ÒËfl Ò ÔÓ‚Ú‡fl˘Ë ÒÂ ‚ÚÓË˜ÌÓ„ÂÌÂ‡ÎËÁË‡ÌË ÚÓÌË˜-ÌÓ-ÍÎÓÌË˜ÌË ÔËÔ‡‰˙ˆË – Ô‡ˆËÂÌÚËÚÂ Ò‡ Ò‚Ó·Ó‰ÌËÓÚ ÔËÒÚ˙ÔË Á‡ ÔÂËÓ‰ ÓÚ 8 - 12 ÏÂÒÂˆ‡, ÌÂ Ò‡ Ì‡·-Î˛‰‡‚‡ÌË ÒÚ‡ÌË˜ÌË ÂÙÂÍÚË Í‡ÍÚÓ ‚ ÍÓ„ÌËˆËflÚ‡ ËÔÓ‚Â‰ÂÌËÂÚÓ, Ú‡Í‡ Ë ‚ Î‡·Ó‡ÚÓÌËÚÂ ËÁÒÎÂ‰‚‡ÌËfl(6, 18).

● éÔËÒ‚‡ ÒÂ ÔÓ‚ÎËfl‚‡ÌÂ ÓÚ ÏÓÌÓÚÂ‡ÔËfl Ò LEV Ì‡ 2ÓÚ 3 ‰Âˆ‡ Ò˙Ò ÒËÏÔÚÓÏÌ‡ Ô‡ˆË‡ÎÌ‡ ÂÔËÎÂÔÒËfl ÒÙÓÏ‡ Ì‡ ÂÁËÒÚÂÌÚÂÌ ÂÎÂÍÚË˜ÂÒÍË ÒÚ‡ÚÛÒ Ì‡ Ò˙-Ìfl (Ò ÌÂÔÂÍ˙ÒÌ‡ÚË ÓÒÚËfl-·‡‚Ì‡ ÔÓ ‚ÂÏÂ Ì‡ ·‡‚-ÌÓ‚˙ÎÌÓ‚Ëfl Ò˙Ì), Â‰ËÌ Ò‡‚ÌËÚÂÎÌÓ fl‰˙Í Ù‡Ï‡ÍÓ-ÂÁËÒÚÂÌÚÂÌ ÂÔËÎÂÔÚË˜ÂÌ ÒËÌ‰ÓÏ (13).

íÂÁË ÂÁÛÎÚ‡ÚË ‰ÓÍ‡Á‚‡Ú ÏÌÓ„Ó ‰Ó·‡ ÂÙËÍ‡ÒÌÓÒÚ ËÔÓÌÓÒËÏÓÒÚ, ·ÂÁÓÔ‡ÒÌÓÒÚ Ë ¯ËÓÍ ÚÂ‡ÔÂ‚ÚË˜ÂÌÒÔÂÍÚ˙ Ì‡ LEV.

Ç˙Á‡ÒÚÌËÚÂ Ô‡ˆËÂÌÚË Ó·ËÍÌÓ‚ÂÌÓ Ò‡ ËÁÍÎ˛˜‚‡ÌË ÓÚ‡Ì‰ÓÏËÁË‡ÌË ÍÓÌÚÓÎË‡ÌË ÍÎËÌË˜ÌË ÔÓÛ˜‚‡ÌËfl Ò ÌÓ-‚ËÚÂ ÄÖå Ò Ó„ÎÂ‰ ÔÓ-„ÓÎflÏ‡Ú‡ ˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚ Í˙ÏÒÚ‡ÌË˜ÌË ÂÙÂÍÚË, ÔÓ‡‰Ë ÔÓÏÂÌË ‚˙‚ Ù‡Ï‡ÍÓÍËÌÂÚË-Í‡Ú‡ Ë Ù‡Ï‡ÍÓ‰ËÌ‡ÏËÍ‡, Ò‚˙Á‡ÌË Ò ‚˙Á‡ÒÚÚ‡, ˜ÂÒÚ‡-Ú‡ Ò˙Ô˙ÚÒÚ‚‡˘‡ ÚÂ‡ÔËfl Á‡ ÔË‰ÛÊ‡‚‡˘Ë Á‡·ÓÎfl‚‡-ÌËfl, ÔÓ-‚ËÒÓÍ‡Ú‡ ÒÏ˙ÚÌÓÒÚ (9). LEV, ÍÓÈÚÓ Â Ò ·Î‡„ÓÔ-ËflÚÂÌ Ù‡Ï‡ÍÓÍËÌÂÚË˜ÂÌ ÔÓÙËÎ (ÏËÌËÏ‡ÎÌÓ Ò‚˙Á‚‡-ÌÂ Ò ÔÎ‡ÁÏÂÌËÚÂ ÔÓÚÂËÌË, ÎËÔÒ‡ Ì‡ ˜ÂÌÓ‰Ó·ÂÌ ÏÂÚ‡-·ÓÎËÁ˙Ï Ë Ì‡ ÎÂÍ‡ÒÚ‚ÂÌË ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ëfl (39) Â Â‰ËÌË‰Â‡ÎÂÌ ÏÂ‰ËÍ‡ÏÂÌÚ Á‡ ÚÂ‡ÔËfl ÔË ‚˙Á‡ÒÚÌË (27).

● èË 6-ÏÂÒÂ˜ÌÓ ÎÂ˜ÂÌËÂ Ì‡ Ô‡ˆËÂÌÚË Ì‡ ‚˙Á‡ÒÚ 62-92 „. ÒÂ Ì‡·Î˛‰‡‚‡ Ò‚Ó·Ó‰‡ ÓÚ ÔËÒÚ˙ÔË ÔË 57% ÓÚÎÂÍÛ‚‡ÌËÚÂ Ò LEV Í‡ÚÓ Ô˙‚‡ ËÎË ‚ÚÓ‡ ÏÓÌÓÚÂ‡-ÔËfl, ‚˙ÔÂÍË ˜Â ÔË ÔÓ‚Â˜ÂÚÓ ÓÚ ÒÎÛ˜‡ËÚÂ ÂÔËÎÂÔÒË-flÚ‡ Â ÒËÏÔÚÓÏÌ‡ Ò˙Ò ÒÂ‰Ì‡ ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ 12,6„. Ë 2/3 Ò‡ ·ËÎË ÎÂÍÛ‚‡ÌË ÌÂÛÒÔÂ¯ÌÓ Ò >1 ÄÖå (27).


● Ç ‰Û„Ó ÔÓÛ˜‚‡ÌÂ ÔË ‚˙Á‡ÒÚÌË Ô‡ˆËÂÌÚË Ò ÂÔËÎÂÔ-ÒËfl Ò LEV ÏÓÌÓÚÂ‡ÔËfl, ÔÓˆÂÌÚ˙Ú Ì‡ Ò‚Ó·Ó‰‡ ÓÚÔËÒÚ˙ÔË Â Ó˘Â ÔÓ-‚ËÒÓÍ Ë ‰ÓÒÚË„‡ 61,5%. éÚ 14·ÓÎÌË, 13 ÔÓ‰˙ÎÊ‡‚‡Ú ÎÂ˜ÂÌËÂÚÓ ÒÎÂ‰ 6 ÏÂÒÂˆ‡,‚ÒË˜ÍË ÓÚ„Ó‚‡flÚ Ì‡ ÚÂ‡ÔËflÚ‡ Ò ËÁÍÎ˛˜ÂÌËÂ Ì‡Â‰ËÌ (1).

● ä‡ÚÓ ÏÓÌÓÚÂ‡ÔËfl ÔË ‚˙Á‡ÒÚÌË LEV ‰ÂÏÓÌÒÚË-‡ ÔÓ-‰Ó·Ë ÂÁÛÎÚ‡ÚË ÔÓ ÓÚÌÓ¯ÂÌËÂ Ì‡ ÂÙËÍ‡Ò-ÌÓÒÚ ‚ Ò‡‚ÌÂÌËÂ Ò ÏÎ‡‰ËÚÂ, Í‡ÍÚÓ ÔË Ô‡ˆË‡ÎÌË,Ú‡Í‡ Ë ÔË „ÂÌÂ‡ÎËÁË‡ÌË ÔËÔ‡‰˙ˆË, ·ÂÁ Û‚ÂÎË˜‡‚‡-ÌÂ Ì‡ ˜ÂÒÚÓÚ‡Ú‡ Ì‡ ÒÚ‡ÌË˜ÌËÚÂ fl‚ÎÂÌËfl (42).

LEV Â ÔËÎ‡„‡Ì Í‡ÚÓ ÏÓÌÓÚÂ‡ÔËfl ÔË Ô‡ˆËÂÌÚ Ò Ó-ÚÓÚÓÔË˜Ì‡ ˜ÂÌÓ‰Ó·Ì‡ Ú‡ÌÒÔÎ‡ÌÚ‡ˆËfl ‚ ÍËÚË˜ÂÌÒÚ‡‰ËÈ Ì‡ ˜ÂÌÓ‰Ó·Ì‡ ‰ËÒÙÛÌÍˆËfl (ÔÓ‡‰Ë ‡ÎÍÓıÓÎÌ‡˜ÂÌÓ‰Ó·Ì‡ ˆËÓÁ‡ Ë ıÂÔ‡ÚËÚ ë) Ò ÂÔËÎÂÔÚË˜ÌËÔËÒÚ˙ÔË, ÍÓËÚÓ ÌÂ Ò‡ ÏÓ„ÎË ‰‡ ·˙‰‡Ú Ó‚Î‡‰flÌË Ò pheny-toin. èÓÒÚË„Ì‡Ú Â ÔÓ‰˙ÎÊËÚÂÎÂÌ Ô˙ÎÂÌ ÍÓÌÚÓÎ Ì‡ ÂÔË-ÎÂÔÚË˜ÌÚÂ ÔËÒÚ˙ÔË Ò ‰ÓÁËÓ‚Í‡ 1000 Ï„/‰ÌÂ‚ÌÓ LEV(15). A‚ÚÓËÚÂ ÔÓ‰˜ÂÚ‡‚‡Ú ‚‡ÊÌÓÒÚÚ‡ Ì‡ Ô‡‚ËÎÌËflËÁ·Ó Ì‡ ÄÖå Ò Ó„ÎÂ‰ ËÁ·fl„‚‡ÌÂÚÓ Ì‡ ËÒÍ‡ ÓÚ ıÂÔ‡ÚÓ-ÚÓÍÒË˜ÌÓÒÚ, ‚ÎÓ¯‡‚‡ÌÂÚÓ Ì‡ ÂÌˆÂÙ‡ÎÓÔ‡ÚËflÚ‡ ËÎË ÔÓ-ÏflÌ‡ ‚ ÔÎ‡ÁÏÂÌ‡Ú‡ ÍÓÌˆÂÌÚ‡ˆËfl Ì‡ ËÏÛÌÓÒÛÔÂÒË‚Ì‡Ú‡ÚÂ‡ÔËfl.

ÑÛ„ ÒÔÂˆË‡ÎÂÌ ÍÓÌÚËÌ„ÂÌÚ Ò‡ ·ÂÏÂÌÌËÚÂ Ò ÂÔËÎÂÔ-ÒËfl. ÇÒÂ Ó˘Â ËÏ‡ Ò‡ÏÓ Â‰ËÌË˜ÌË Ò˙Ó·˘ÂÌËfl Á‡ ÔÓ‚ÂÊ‰‡-Ì‡ ÏÓÌÓÚÂ‡ÔËfl Ò LEV ÔÓ ‚ÂÏÂ Ì‡ ·ÂÏÂÌÌÓÒÚ, ÌÂ ÒÂ Ò˙-Ó·˘‡‚‡ Á‡ Ï‡ÎÙÓÏ‡ˆËË, ÌÓ ‚ Â‰ÌÓ ÓÚ Ì‡·Î˛‰ÂÌËflÚ‡ ÒÂÛÒÚ‡ÌÓ‚fl‚‡ ˜Â 3 ÓÚ 11 ÌÓ‚ÓÓ‰ÂÌË ËÁÎÓÊÂÌË ‚˙ÚÂÛÚ-Ó·ÌÓ Ì‡ ÏÂ‰ËÍ‡ÏÂÌÚ‡ Ò‡ Ò ÌËÒÍÓ ÚÂ„ÎÓ ÔË ‡Ê‰‡ÌÂ (17,47). èÓ‰˜ÂÚ‡‚‡ ÒÂ ÌÂÓ·ıÓ‰ËÏÓÒÚÚ‡ ÓÚ ÌÓ‚Ë Â„ËÒÚ‡-ˆËË Ë Ì‡·Î˛‰ÂÌËfl.

éÚ ‰‡ÌÌËÚÂ ÓÚ ÍÎËÌË˜ÌËÚÂ ÔÓÛ˜‚‡ÌËfl Á‡ LEV Í‡ÚÓÏÓÌÓÚÂ‡ÔËfl ÔË Ô‡;Ë‡ÎÌË ÂÔËÎÂÔÒËË ÏÓ„‡Ú ‰‡ ÒÂ Ì‡Ô‡-‚flÚ ÒÎÂ‰ÌËÚÂ ËÁ‚Ó‰Ë:

● LEV Â ÂÙËÍ‡ÒÂÌ ÔË Ô‡ˆË‡ÎÌË ÂÔËÎÂÔÒËË Í‡ÚÓ‰ÓÔ˙Î‚‡˘‡ ÚÂ‡ÔËfl, Í‡ÍÚÓ Ë Í‡ÚÓ ‚ÚÓ‡ ÏÓÌÓÚÂ‡-ÔËfl, ÒÎÂ‰ ËÁÚÂ„ÎflÌÂ Ì‡ ÔËÎ‡„‡Ì‡Ú‡ ÌÂÛÒÔÂ¯ÌÓ ÔÂ‰-¯ÂÒÚ‚‡˘‡ ‡ÌÚËÂÔËÎÂÔÚË˜Ì‡ ÚÂ‡ÔËfl.

● LEV Â ÛÒÔÂ¯ÂÌ Í‡ÚÓ Ô˙‚‡ ÏÓÌÓÚÂ‡ÔËfl Ò ÓÒË„Ûfl-‚‡ÌÂ Ì‡ Ò‚Ó·Ó‰‡ ÓÚ ÔËÒÚ˙ÔË Á‡ ÔÓ‰˙ÎÊËÚÂÎÂÌ ÔÂ-ËÓ‰ ÓÚ ‚ÂÏÂ, ÂÙËÍ‡ÒÌÓÒÚ ‡‚Ì‡ Ò Ú‡ÁË Ì‡ Â‰ËÌ ÓÚÍÎ‡ÒË˜ÂÒÍËÚÂ ÏÂ‰ËÍ‡ÏÂÌÚË ‚ ÎÂ˜ÂÌËÂÚÓ Ì‡ Ô‡ˆË-‡ÎÌËÚÂ ÂÔËÎÂÔÒËË- CBZ.

● LEV e Ò ÔÓ-‰Ó·‡ ÔÓÌÓÒËÏÓÒÚ ÓÚ CBZ Í‡ÚÓ Ô˙‚‡ÏÓÌÓÚÂ‡ÔËfl ÔË Ô‡ˆË‡ÎÌË ÂÔËÎÂÔÒËË.

● ÖÙÂÍÚ˙Ú Ì‡ LEV Â ÔÓ‰˙ÎÊËÚÂÎÂÌ Ë ÌÂ ÒÂ ËÁ˜ÂÔ‚‡‚˙‚ ‚ÂÏÂÚÓ.

● LEV e Â‰ËÌ ÓÚ ÌÓ‚ËÚÂ ÄÖå, ËÁÏËÌ‡Î ‰˙Î„Ëfl Ô˙Ú Ì‡ËÁËÒÍ‚‡ÌËÚÂ ÓÚ ÏÂ‰ËˆËÌ‡Ú‡ Ì‡ ‰ÓÍ‡Á‡ÚÂÎÒÚ‚‡Ú‡ÔÓÛ˜‚‡ÌËfl, Á‡ ‰‡ ‰ÓÍ‡ÊÂ Ò‚ÓflÚ‡ ‚ËÒÓÍ‡ ÂÙËÍ‡ÒÌÓÒÚË ‰Ó·‡ ÔÓÌÓÒËÏÓÒÚ.

● éÔËÚ˙Ú ÓÚ ÍÎËÌË˜Ì‡Ú‡ Ô‡ÍÚËÍ‡, ÔÂ‰ÒÚ‡‚ÂÌ ‚ÏÌÓ„Ó·ÓÈÌËÚÂ ÂÚÓÒÔÂÍÚË‚ÌË Ë ÓÚ‚ÓÂÌË ÔÓÒ-ÔÂÍÚË‚ÌË ÔÓÛ˜‚‡ÌËfl, ÔÓÚ‚˙Ê‰‡‚‡ ÂÙÂÍÚË‚ÌÓÒÚ-Ú‡ Ì‡ ÏÓÌÓÚÂ‡ÔËflÚ‡ Ò LEV ÔË Ô‡ˆËÂÌÚË Ò Ô‡ˆË-‡ÎÌ‡ ÂÔËÎÂÔÒËfl, ‚ÍÎ˛˜ËÚÂÎÌÓ ÔË ÒÔÂˆËÙË˜ÌË ÍÓÌ-ÚËÌ„ÂÌÚË, Í‡ÚÓ ‰Âˆ‡ Ë ‚˙Á‡ÒÚÌË Ì‡‰ 60 „., ÔË ÒÎÛ-˜‡Ë Ò ÍÓÏÓ·Ë‰ÌÓÒÚ Ë ‰. Ë ‰‡‚‡ ‚˙ÁÏÓÊÌÓÒÚ Á‡ Â‰-Ì‡ ÌÓ‚‡ Ë ÏÌÓ„ÓÓ·Â˘‡‚‡˘‡ ÚÂ‡ÔÂ‚ÚË˜Ì‡ ‡ÎÚÂÌ‡-ÚË‚‡ ÔË ÎËÔÒ‡ Ì‡ ÍÓÌÚÓÎ ‚˙ıÛ ÔËÔ‡‰˙ˆËÚÂ ËÎËÌ‡ÎË˜ËÂ Ì‡ ÒÚ‡ÌË˜ÌË ÂÙÂÍÚË ÓÚ Ô˙‚ÓÌ‡˜‡ÎÌÓ ËÁ·-‡ÌËfl ÄÖå.

● Keppra® Â Ó‰Ó·ÂÌ Á‡ ÔËÎÓÊÂÌËÂ Û Ì‡Ò ÓÚ ÏÂÒÂˆ ÓÍ-ÚÓÏ‚Ë 2006, Í‡ÚÓ ÏÓÌÓÚÂ‡ÔËfl ÔË ÎÂ˜ÂÌËÂ Ì‡Ô‡ˆË‡ÎÌË ÔËÒÚ˙ÔË Ò ËÎË ·ÂÁ ‚ÚÓË˜Ì‡ „ÂÌÂ‡ÎËÁ‡-ˆËfl ÔË Ô‡ˆËÂÌÚË Ì‡‰ 16 „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ Ò ÌÓ‚Ó ‰Ë-‡„ÌÓÒÚËˆË‡Ì‡ ÂÔËÎÂÔÒËfl.

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Ä‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËfl:ÑÓˆ. å. ê‡¯Â‚‡äÎËÌËÍ‡ ÔÓ çÂ‚ÓÎÓ„ËflåÅÄã “ñ‡Ëˆ‡ âÓ‡ÌÌ‡”ìÎ. “ÅflÎÓ ÏÓÂ” 8ëÓÙËfle-mail: [email protected]


SUMMARY

IMPAIRMENTS OF VISUOCONSTRUCTIVE PRAXIS INMILD COGNITIVE IMPAIRMENT (MCI) AND LATE

LIFE DEMENTIA SYNDROMER. å‡ss‡ldjieva, P. Ätanassova, å. R‡ycheva

Impairments of visuoconstructive ability (praxis) are com-mon in different brain disorders, including dementia. Deficitof visuoconstructive abilities is observed in early stages ofdementia, its intensity and nature staying poorly defined. Thiswork administers two types of visuoconstructive tasks – withgraphic performance (drawing) and construction (assembling)in order to study the impairments of visuoconstructive praxisin mild cognitive impairment (MCI) and dementia as well asto examine if drawing and construction assess two separatetype of visuoconstructive praxis. In the study are included 90subjects, with mean age 67,6 /SD=8,59/, divided in threegroups of 30 subjects – with dementia in Alzheimer’s diseaseand vascular dementia, mild to moderate level, with MCI ofthe type multiple domains slightly impaired and healthy eld-erly. Results of the comparison with one-way ANOVA andBonferroni test, between the scores of the subjects withdementia, MCI and healthy controls, showed significant dif-ferences between them for the visuoconstructive tasks admin-istered, except for the pentagon drawing. Mean total scores forall visuoconstructive tasks showed that the group with MCIperformed more poorly than the healthy controls, the sameheld true in respect of the dementia group, compared withMCI and healthy controls. Four factors have been received byexploratory factor analysis – global cognitive functioning,visuoconstructive praxis, visuoperceptive ability and visu-ospatial judgment. Analysis of the factor loadings receivedshowed that visuoconstructive tasks with drawing (graphicperformance) and construction (assembling) did not differen-tiate in separate factors.

KEY WORDS: visuoconstructive ability, impairment,dementia, mild cognitive impairment.

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ç‡Û¯ÂÌËflÚ‡ Ì‡ ÁËÚÂÎÌÓ ÍÓÌÒÚÛÍÚË‚Ì‡Ú‡ ÒÔÓÒÓ·-ÌÓÒÚ (ÁËÚÂÎÌÓÍÓÌÒÚÛÍÚË‚ÌËfl Ô‡ÍÒËÒ - áäè ) Ò‡ ı‡-‡ÍÚÂÂÌ ÒËÏÔÚÓÏ ÔË ‡ÁÎË˜ÌË ÏÓÁ˙˜ÌË Á‡·ÓÎfl‚‡ÌËfl,‚ÍÎ˛˜ËÚÂÎÌÓ ‰ÂÏÂÌˆËfl. ÑÂÙËˆËÚ ‚ ÁËÚÂÎÌÓ ÍÓÌÒÚÛÍ-ÚË‚ÌËÚÂ ÒÔÓÒÓ·ÌÓÒÚË ÒÂ Ì‡·Î˛‰‡‚‡ Ó˘Â ‚ ‡ÌÌËÚÂ ÂÚ‡-ÔË ÓÚ ‡Á‚ËÚËÂÚÓ Ì‡ ‰ÂÏÂÌˆËfl, ÌÓ ÎËÔÒ‚‡Ú ‰‡ÌÌË Á‡ÒÚÂÔÂÌÚ‡ Ë ÔËÓ‰‡Ú‡ ÏÛ. ç‡ÒÚÓfl˘‡Ú‡ ‡·ÓÚ‡ ËÁÔÓÎÁ-‚‡ 2 ‚Ë‰‡ ÁËÚÂÎÌÓ ÍÓÌÒÚÛÍÚË‚ÌË Á‡‰‡˜Ë - Ò „‡ÙË˜ÌÓËÁÔ˙ÎÌÂÌËÂ /ËÒÛ‚‡ÌÂ/ Ë Ò ÍÓÌÒÚÛË‡ÌÂ (Ò„ÎÓ·fl‚‡ÌÂ), Á‡‰‡ ÔÓÛ˜Ë Ì‡Û¯ÂÌËflÚ‡ Ì‡ áäè ÔË ÎÂÍÓ ÍÓ„ÌËÚË‚ÌÓ Ì‡-Û¯ÂÌËÂ (ãäç) Ë ‰ÂÏÂÌÚÂÌ ÒËÌ‰ÓÏ Ë ‰‡ ÔÓ‚ÂË ‰‡ÎËËÒÛ‚‡ÌÂÚÓ Ë ÍÓÌÒÚÛË‡ÌÂÚÓ ‚ Í˙ÒÌ‡ ‚˙Á‡ÒÚ ÓˆÂÌfl-‚‡Ú ‰‚‡ ÓÚ‰ÂÎËÏË ‚Ë‰‡ áäè. àÁÒÎÂ‰‚‡ÌË Ò‡ 90 ÎËˆ‡,Ì‡ÒÂ‰Ì‡ ‚˙Á‡ÒÚ 67,6 „. (SD=8,59), ‡ÁÔÂ‰ÂÎÂÌË ‚ ÚË „Û-ÔË ÔÓ 30 - Ò ‰ÂÏÂÌÚÂÌ ÒËÌ‰ÓÏ ÔË ÅÓÎÂÒÚ Ì‡ ÄÎˆı‡ÈÏÂË Ò˙‰Ó‚‡ ‰ÂÏÂÌˆËfl, ÎÂÍ‡ ‰Ó ÛÏÂÂÌ‡ ÒÚÂÔÂÌ, Ò ÎÂÍÓ ÍÓ„ÌË-ÚË‚ÌÓ Ì‡Û¯ÂÌËÂ (ãäç) ÓÚ ÚËÔ‡ ÎÂÍÓ Ì‡Û¯ÂÌËÂ Ì‡ ‡Á-ÎË˜ÌË ÔÓÁÌ‡‚‡ÚÂÎÌË ÙÛÌÍˆËË Ë Á‰‡‚Ë ÎËˆ‡ ‚ Í˙ÒÌ‡ ‚˙Á-‡ÒÚ. êÂÁÛÎÚ‡ÚËÚÂ ÓÚ Ò‡‚ÌÂÌËÂÚÓ Ì‡ ÔÓÎÛ˜ÂÌËÚÂ ·‡ÎÓ-‚Â ÔË ÎËˆ‡Ú‡ Ò ‰ÂÏÂÌˆËfl, Ò ãäç Ë Á‰‡‚Ë, Ò one-wayANOVA Ë ÏÌÓÊÂÒÚ‚ÂÌÓ Ò‡‚ÌÂÌËÂ Ò ÚÂÒÚ Ì‡ Bonferroni,ÔÓÍ‡Á‚‡Ú ÁÌ‡˜ËÏË ‡ÁÎË˜Ëfl ÏÂÊ‰Û ÚËÚÂ ËÁÒÎÂ‰‚‡ÌË„ÛÔË Á‡ ËÁÔÓÎÁ‚‡ÌËÚÂ áä Á‡‰‡˜Ë, Ò ËÁÍÎ˛˜ÂÌËÂ Ì‡ ËÒÛÌ-Í‡Ú‡ Ì‡ ÔÂÚÓ˙„˙ÎÌËˆË. ëÂ‰ÌËÚÂ ÒÚÓÈÌÓÒÚË Ì‡ Ó·˘Ëfl·‡Î ÓÚ ‚ÒË˜ÍË áä Á‡‰‡˜Ë ÔÓÍ‡Á‚‡Ú ‚ÎÓ¯‡‚‡ÌÂ Ì‡ ËÁÔ˙ÎÌÂ-ÌËÂÚÓ ‚ „ÛÔ‡Ú‡ Ì‡ ãäç ‚ Ò‡‚ÌÂÌËÂ Ò „ÛÔ‡Ú‡ Ì‡ Á‰‡-‚ËÚÂ, Í‡ÍÚÓ Ë ‚ „ÛÔ‡Ú‡ Ì‡ ÎËˆ‡Ú‡ Ò ‰ÂÏÂÌˆËfl, ‚ Ò‡‚ÌÂ-ÌËÂ Ò ãäç Ë Á‰‡‚Ë. èË ÂÍÒÔÎÓ‡ÚË‚ÂÌ Ù‡ÍÚÓÂÌ ‡Ì‡ÎËÁÒÂ ÔÓÎÛ˜Ëı‡ ˜ÂÚËË Ù‡ÍÚÓ‡ - Ó·˘Ó ÍÓ„ÌËÚË‚ÌÓ ÙÛÌÍˆË-ÓÌË‡ÌÂ; áäè; ÁËÚÂÎÌÓÔÂˆÂÔÚË‚Ì‡ ÒÔÓÒÓ·ÌÓÒÚ Ë ÁË-ÚÂÎÌÓÔÓÒÚ‡ÌÒÚ‚ÂÌ‡ ÓˆÂÌÍ‡. ÄÌ‡ÎËÁ˙Ú Ì‡ ÔÓÎÛ˜ÂÌËÚÂÙ‡ÍÚÓÌË ÚÂ„Î‡ ÔÓÍ‡Á‚‡, ˜Â áä Á‡‰‡˜Ë Ò ËÒÛ‚‡ÌÂ (Ò „‡-ÙÓÏÓÚÓÂÌ ÂÎÂÏÂÌÚ) Ë Ò ÍÓÌÒÚÛË‡ÌÂ (Ò„ÎÓ·fl‚‡ÌÂ) ÌÂ ÒÂÓ·ÓÒÓ·fl‚‡Ú ‚ ÓÚ‰ÂÎÌË Ù‡ÍÚÓË.

äãûóéÇà Ñìåà: ÁËÚÂÎÌÓÍÓÌÒÚÛÍÚË‚Ì‡ ÒÔÓÒÓ·-ÌÓÒÚ, Ì‡Û¯ÂÌËÂ, ‰ÂÏÂÌˆËfl, ÎÂÍÓ ÍÓ„ÌËÚË‚ÌÓ Ì‡Û¯ÂÌËÂ.

éË„ËÌ‡ÎÌË ÒÚ‡ÚËËçÄêìòÖçàü çÄ áêàíÖãçé -äéçëíêìäíàÇçàü èêÄäëàë

èêà ãÖäé äéÉçàíàÇçé çÄêìòÖçàÖ à ÑÖåÖçíÖçëàçÑêéå Ç äöëçÄ ÇöáêÄëí

ê. å‡Ò‡Î‰ÊËÂ‚‡1, è. ÄÚ‡Ì‡ÒÓ‚‡2, å. ê‡È˜Â‚‡3

1äÎËÌËÍ‡ ÔÓ ÔÒËıË‡ÚËfl, ìåÅÄã - èÎÓ‚‰Ë‚2äÎËÌËÍ‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl, ìåÅÄã - èÎÓ‚‰Ë‚

3äÎËÌËÍ‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl, ìåÅÄã – “ÄÎÂÍÒ‡Ì‰Ó‚ÒÍ‡” – ëÓÙËfl

áËÚÂÎÌÓ ÍÓÌÒÚÛÍÚË‚ÌËflÚ Ô‡ÍÒËÒ (áäè) Â ‚ËÒ¯‡ÍÓÓ‚‡ ÙÛÌÍˆËfl, ÍÓflÚÓ ÒÂ ÔÓfl‚fl‚‡ ‚ ÒÔÓÒÓ·ÌÓÒÚ Á‡ Ò˙Â-‰ËÌfl‚‡ÌÂ (ËÌÚÂ„Ë‡ÌÂ) Ì‡ ÓÚ‰ÂÎÌË ˜‡ÒÚË ‚ Â‰ËÌÌÓ ˆflÎÓ(ˆflÎÓÒÚÂÌ Ó·ÂÍÚ). í‡ÁË ‡ÍÚË‚ÌÓÒÚ Â Ò‚˙Á‡Ì‡ Ò ÍÓÏ·ËÌË-‡ÌÂ ËÎË Ó„‡ÌËÁË‡ÌÂ, ÔË ÍÓËÚÓ ÔÓÒÚ‡ÌÒÚ‚ÂÌËÚÂ‚Á‡ËÏÓÓÚÌÓ¯ÂÌËfl ÏÂÊ‰Û Ò˙ÒÚ‡‚ÌËÚÂ ˜‡ÒÚË Ì‡ Ó·ÂÍÚ‡Úfl·‚‡ ‰‡ ·˙‰‡Ú ‡Á·‡ÌË, Á‡ ‰‡ ÒÂ ÔÓÎÛ˜Ë ÒËÌÚÂÁ ÏÂÊ‰ÛÚflı. ê‡ÁÎË˜ÌËÚÂ ‚Ë‰Ó‚Â ÁËÚÂÎÌÓ ÍÓÌÒÚÛÍÚË‚Ì‡ (áä)‡ÍÚË‚ÌÓÒÚ ÏÓ„‡Ú ‰‡ ÒÂ ÓÚÎË˜‡‚‡Ú ÔÓÏÂÊ‰Û ÒË ÔÓ ÒÎÓÊ-ÌÓÒÚ, ÔÓ ‚Ë‰‡ Ì‡ ‰‚ËÊÂÌËÂÚÓ, ÔÓ ÒÚÂÔÂÌÚ‡ Ì‡ ‡Ì„‡ÊË‡-ÌÂ Ì‡ ËÌÚÂÎÂÍÚÛ‡ÎÌÓÚÓ ÙÛÌÍˆËÓÌË‡ÌÂ, ÔÓ ÚÓ‚‡ ‰‡ÎËÍÓÌÒÚÛÍˆËflÚ‡ ËÏ‡ ‰‚Â ËÎË ÚË ÔÓÒÚ‡ÌÒÚ‚ÂÌË ËÁÏÂ-ÂÌËfl(5). á‡ÚÓ‚‡ ÚÂÒÚÓ‚ÂÚÂ Á‡ ËÁÒÎÂ‰‚‡ÌÂ Ì‡ áäè Ò˙‰˙-Ê‡Ú ‡ÁÎË˜ÌË ÔÓ ı‡‡ÍÚÂ Ë ÌË‚Ó Ì‡ ÒÎÓÊÌÓÒÚ Á‡‰‡˜Ë –ÔÓ‰ÂÊ‰‡ÌÂ Ì‡ Ô˙˜ËˆË Ë ·ÎÓÍ˜ÂÚ‡ ËÎË ËÒÛ‚‡ÌÂ (ÍÓÔË‡-ÌÂ) Ì‡ ÔÓÒÚË ‰‚ÛËÁÏÂÌË ËÎË ÔÓ-ÒÎÓÊÌË ÚËËÁÏÂÌË ÙË-„ÛË Ò ‡ÁÎË˜ÌË ‡ÁÏÂË Ë ÔÓÒÚ‡ÌÒÚ‚ÂÌË ‚Á‡ËÏÓÓÚÌÓ-¯ÂÌËfl. óÂÒÚÓ ÚÂÁË ÚÂÒÚÓ‚Â ÒÂ ËÁÔÓÎÁ‚‡Ú ‚Á‡ËÏÓÁ‡ÏÂÌfl-ÂÏÓ, Ì‡ ÓÒÌÓ‚‡Ú‡ Ì‡ ÔÂ‰ÔÓÎÓÊÂÌËÂÚÓ, ˜Â ‰ÂÙËˆËÚ˙Ú Ì‡áäè, ÓÁÌ‡˜‡‚‡Ì Í‡ÚÓ ÁËÚÂÎÌÓ ÍÓÌÒÚÛÍÚË‚Ì‡ ‡Ô‡ÍÒËfl(áäÄè), Â Â‰ËÌÌÓ Ì‡Û¯ÂÌËÂ, ÍÓÂÚÓ ÏÓÊÂ ‰‡ ·˙‰Â ÛÒÚ‡ÌÓ-‚ÂÌÓ ÔË ËÁÔ˙ÎÌÂÌËÂÚÓ Ì‡ ÍÓÈÚÓ Ë ‰‡ Â ÓÚ Úflı (6, 9). A.Benton (1985, ˆËÚ.ÔÓ 9) ÓÚ·ÂÎflÁ‚‡ ‡ÁÎË˜ÌËÚÂ ËÁËÒÍ‚‡-ÌËfl, ÍÓËÚÓ áä Á‡‰‡˜Ë ÔÓÒÚ‡‚flÚ ÔÓ ÓÚÌÓ¯ÂÌËÂ Ì‡ ‚ÌËÏ‡-ÌËÂÚÓ, ‰‚Ë„‡ÚÂÎÌËÚÂ ÛÏÂÌËfl, ÔÓÒÚ‡ÌÒÚ‚ÂÌ‡Ú‡ ÓˆÂÌ-Í‡, ËÌÚÂÎÂÍÚÛ‡ÎÌËÚÂ ÒÔÓÒÓ·ÌÓÒÚË Ë ‰ÓÔÛÒÍ‡ Ò˙˘ÂÒÚ‚Û-‚‡ÌÂÚÓ Ì‡ ÔÓÌÂ ‰‚‡ ‚Ë‰‡ áä ÒÔÓÒÓ·ÌÓÒÚË - ÔË „‡ÙË˜ÌÓËÁÔ˙ÎÌÂÌËÂ Ë ÔË ÍÓÌÒÚÛË‡ÌÂ, Ò„ÎÓ·fl‚‡ÌÂ.

áäÄè Â ı‡‡ÍÚÂÂÌ ÒËÏÔÚÓÏ ÔË ‡ÁÎË˜ÌË Á‡·ÓÎfl‚‡-ÌËfl Ì‡ „Î‡‚ÌËfl ÏÓÁ˙Í, ‚ÍÎ˛˜ËÚÂÎÌÓ ÔË ‰ÂÏÂÌˆËfl (9). íflÂ ‰Ó·Â ÔÓÛ˜ÂÌ‡ ÔË ÎÓÍ‡ÎÌË Û‚ÂÊ‰‡ÌËfl ‚ Îfl‚‡ Ë ‰flÒÌ‡ÏÓÁ˙˜Ì‡ ıÂÏËÒÙÂ‡ (3, 6, 10, 23), ÌÓ ÌÂ Ë ÔË ‰ÂÏÂÌÚÂÌÒËÌ‰ÓÏ, Ï‡Í‡ ˜Â ‚ ÔÓÒÎÂ‰ÌËÚÂ „Ó‰ËÌË Ì‡‡ÒÚ‚‡ ËÁÒÎÂ-‰Ó‚‡ÚÂÎÒÍËfl ËÌÚÂÂÒ Í˙Ï Ì‡Û¯ÂÌËflÚ‡ Ì‡ ËÒÛ‚‡ÚÂÎÌ‡-Ú‡ ÒÔÓÒÓ·ÌÓÒÚ ‚ Í˙ÒÌ‡ ‚˙Á‡ÒÚ (11, 14, 19, 20). ëÔÓÂ‰Moore and Wyke (1984) ‰ÂÙËˆËÚ ‚ áä ÒÔÓÒÓ·ÌÓÒÚË ÒÂÌ‡·Î˛‰‡‚‡ Ó˘Â ‚ ‡ÌÌËÚÂ ÂÚ‡ÔË ÓÚ ‡Á‚ËÚËÂÚÓ Ì‡ ‰Â-ÏÂÌˆËfl, ÌÓ ÎËÔÒ‚‡Ú ‰‡ÌÌË Á‡ ÒÚÂÔÂÌÚ‡ Ë ÔËÓ‰‡Ú‡ ÏÛ.é˘Â ÓÚ 60-ÚÂ „Ó‰ËÌË Ì‡ 20-ÚË ‚ÂÍ ÍÓÌÒÚÛÍÚË‚Ì‡Ú‡‡Ô‡ÍÒËfl (äÄè) ÒÂ ÒÏflÚ‡ Á‡ Â‰ËÌ ÓÚ Ì‡È-‡ÌÌËÚÂ ÒËÏÔ-ÚÓÏË Ì‡ ÅÓÎÂÒÚÚ‡ Ì‡ ÄÎˆı‡ÈÏÂ (ÅÄ) (Ajuriagerra, 1960,ˆËÚ. ÔÓ 27), ÌÓ Úfl ÓÒÚ‡‚‡ ÌÂ‰ÓÒÚ‡Ú˙˜ÌÓ ÔÓÛ˜ÂÌ‡. èËÅÄ ÁËÚÂÎÌËÚÂ ÙÛÌÍˆËË, Ò‚˙Á‡ÌË Ò ÓÍÓÚÓ Ë ˜ÂÂÔÌÓÏÓÁ˙˜ÌËÚÂ ÌÂ‚Ë, Ò‡ Ò‡‚ÌËÚÂÎÌÓ Ò˙ı‡ÌÂÌË, ÌÓ ‚ËÒ¯ËÚÂÁËÚÂÎÌË ÙÛÌÍˆËË ÒÂ Ì‡Û¯‡‚‡Ú (Mendez et al.,1990;Cronin-Golumb et al.,1991, ˆËÚ. ÔÓ 9). àÏ‡ ÎËÚÂ‡ÚÛÌË‰‡ÌÌË Ë Á‡ Ì‡Û¯ÂÌËfl ‚ áä ÒÔÓÒÓ·ÌÓÒÚ Û ‚˙Á‡ÒÚÌË Ò ÎÂ-ÍÓ ÍÓ„ÌËÚË‚ÌÓ Ì‡Û¯ÂÌËÂ (ãäç) (15), ÍÓÂÚÓ ÒÂ Ò‚˙Á‚‡ ÒÔÓ‚Ë¯ÂÌ ËÒÍ ÓÚ ‡Á‚ËÚËÂ Ì‡ ‰ÂÏÂÌˆËfl (2,8,15, 25). á‡-ÚÓ‚‡ Ì‡Û¯ÂÌËflÚ‡ Ì‡ áäè ÏÓ„‡Ú ‰‡ ·˙‰‡Ú ÍÓ„ÌËÚË‚ÂÌÏ‡ÍÂ Á‡ ÔÂ‰ÍÎËÌË˜ÌËÚÂ ÂÚ‡ÔË Ì‡ ‰ÂÏÂÌˆËflÚ‡. Ç‡Ê-ÌÓ Â ‰‡ ÔÓ‰˜ÂÚ‡ÂÏ, ˜Â äÄè fl‰ÍÓ ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡ ÔÓ ‰‡Ì-ÌË ÓÚ ‡Ì‡ÏÌÂÁ‡Ú‡, Á‡˘ÓÚÓ ÚÛ‰ÌÓÒÚËÚÂ ‚ ‰ÂÈÒÚ‚Ëfl Í‡-ÚÓ ÔÓ‰ÂÊ‰‡ÌÂ, ËÒÛ‚‡ÌÂ, ÍÓÌÒÚÛË‡ÌÂ ÏÓ„‡Ú ‰‡ ÌÂ ·˙-‰‡Ú Á‡·ÂÎflÁ‡ÌË ÓÚ Ô‡ˆËÂÌÚ‡ ËÎË ·ÎËÁÍËÚÂ ÏÛ ‚ Ì‡˜‡ÎÌË-ÚÂ ËÏ ÔÓfl‚Ë. ç‡‰ÂÊ‰ÌÓÚÓ Ë ‡ÌÌÓ ‡Á„‡ÌË˜‡‚‡ÌÂ Ì‡ÒÚÂÔÂÌÚ‡ Ë ı‡‡ÍÚÂ‡ Ì‡ ÚÂÁË Ì‡Û¯ÂÌËfl ‚ Í˙ÒÌ‡ ‚˙Á-‡ÒÚ Û‚ÂÎË˜‡‚‡ ‰ËÒÍËÏËÌ‡ÚË‚Ì‡Ú‡ ÚÓ˜ÌÓÒÚ Á‡ ÓˆÂÌÍ‡Ì‡ ËÒÍ‡ ÓÚ ‡Á‚ËÚËÂ Ì‡ ‰ÂÏÂÌˆËfl, ‡ Ì‡‚ÂÏÂÌÌ‡Ú‡ ÚÂ-‡ÔËfl Û‚ÂÎË˜‡‚‡ ¯‡ÌÒÓ‚ÂÚÂ Á‡ Á‡·‡‚flÌÂ Ì‡ ÍÓ„ÌËÚË‚ÌËÚÂÌ‡Û¯ÂÌËfl.

ç‡ÒÚÓfl˘‡Ú‡ ‡·ÓÚ‡ ËÁÔÓÎÁ‚‡ ‰‚‡ ‚Ë‰‡ ÁËÚÂÎÌÓÍÓÌÒÚÛÍÚË‚ÌË Á‡‰‡˜Ë - Ò „‡ÙË˜ÌÓ ËÁÔ˙ÎÌÂÌËÂ Ë ÒÍÓÌÒÚÛË‡ÌÂ (Ò„ÎÓ·fl‚‡ÌÂ), Ò ˆÂÎ: 1/ ‰‡ ÔÓÛ˜Ë áä Ì‡Û-¯ÂÌËfl ÔË ãäç Ë ‰ÂÏÂÌÚÂÌ ÒËÌ‰ÓÏ ‚ Í˙ÒÌ‡ ‚˙Á‡ÒÚ Ë 2/‰‡ ÔÓ‚ÂË ‰‡ÎË äÄ, ÔÓfl‚fl‚‡Ì‡ ÔË ÌÂÛÒÔÂı ‰‡ ·˙‰‡ÚËÁÔ˙ÎÌÂÌË ÚÂÁË ‚Ë‰Ó‚Â Á‡‰‡˜Ë Â Â‰ËÌÂÌ ‰ÂÙËˆËÚ ËÎË Úfl

‚ÍÎ˛˜‚‡ ‡ÁÎË˜ÌË ÓÚ‰ÂÎËÏË Â‰ËÌ ÓÚ ‰Û„ ‚Ë‰Ó‚Â áä Ì‡-Û¯ÂÌËfl.

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àÁÒÎÂ‰‚‡ÌË Ò‡ 90 ÎËˆ‡, Ì‡ ÒÂ‰Ì‡ ‚˙Á‡ÒÚ 67,6 „.(SD=8,59), ‡ÁÔÂ‰ÂÎÂÌË ‚ ÚË „ÛÔË ÔÓ 30 ÎËˆ‡ - Ò ‰ÂÏÂÌ-ÚÂÌ ÒËÌ‰ÓÏ, ÎÂÍ‡ ‰Ó ÛÏÂÂÌ‡ ÒÚÂÔÂÌ, Ò ãäç Ë Á‰‡‚Ë ÎË-ˆ‡ ‚ Í˙ÒÌ‡ ‚˙Á‡ÒÚ. ãËˆ‡Ú‡ Ò ‰ÂÏÂÌÚÂÌ ÒËÌ‰ÓÏ Ò‡ Ò ‚Â-ÓflÚÌ‡ ÅÄ Ë ‚ÂÓflÚÌ‡ Ò˙‰Ó‚‡ ‰ÂÏÂÌˆËfl (ëÑ), Ò˙ÓÚ‚ÂÚ-ÒÚ‚‡˘Ë Ì‡ ÍËÚÂËËÚÂ Ì‡ DSM-IV(4), NINCDS/ADRDA(22) Ë NINDS/AIREN (28). ëËÌ‰ÓÏ˙Ú Ì‡ ãäç Â ÓÚ ÚË-Ô‡ ÎÂÍÓ Ì‡Û¯ÂÌËÂ Ì‡ ‡ÁÎË˜ÌË ÔÓÁÌ‡‚‡ÚÂÎÌË ÙÛÌÍˆËË(mild cognitive impairment - multiple domains slightlyimpaired) (8, 26). Ç „ÛÔ‡Ú‡ Ì‡ Á‰‡‚ËÚÂ Ò‡ ‚ÍÎ˛˜ÂÌË ÎË-ˆ‡ Ì‡‰ 60 „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ, ·ÂÁ ÔÒËıË˜ÌË ËÎË ÒÓÏ‡ÚË˜ÌËÁ‡·ÓÎfl‚‡ÌËfl, ÍÓËÚÓ ÏÓ„‡Ú ‰‡ ÔÓ‚ÎËflflÚ Ò‡ÏÓÒÚÓflÚÂÎÌÓ-ÚÓ ËÏ ÂÊÂ‰ÌÂ‚ÌÓ ÙÛÌÍˆËÓÌË‡ÌÂ - ËÁÍÎ˛˜ÂÌË Ò‡ ÎËˆ‡ ÒËÒÚÓËfl Á‡ ÏÓÁ˙˜ÂÌ ËÌÒÛÎÚ, ˜ÂÂÔÌÓ-ÏÓÁ˙˜ÌË Ú‡‚ÏË,‚Ó‰ÂÌË Ë ‰Â„ÂÌÂ‡ÚË‚ÌË Á‡·ÓÎfl‚‡ÌËfl Ì‡ ñçë, ıÓÌË˜Ì‡ÁÎÓÛÔÓÚÂ·‡ Ò ‡ÎÍÓıÓÎ. 30 (33,3%) ÓÚ ËÁÒÎÂ‰‚‡ÌËÚÂ ÎËˆ‡Ò‡ Ò ÓÒÌÓ‚ÌÓ Ó·‡ÁÓ‚‡ÌËÂ; 35 (38,9%) - Ò˙Ò ÒÂ‰ÌÓ Ë 25(27,8%) - Ò ‚ËÒ¯Â Ë ÔÓÎÛ‚ËÒ¯Â Ó·‡ÁÓ‚‡ÌËÂ.

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1. Mini-Mental State Examination (MMSE) (16) - ·˙Î„‡-ÒÍË ÔÂ‚Ó‰ (17) - Í‡ÚÍ‡ „ÎÓ·‡ÎÌ‡ ÒÍ‡Î‡ Á‡ ÓˆÂÌÍ‡ Ì‡ ÍÓ„-ÌËÚË‚ÌÓÚÓ ÙÛÌÍˆËÓÌË‡ÌÂ (13, 24). è‡ˆËÂÌÚËÚÂ Ò ‰Â-ÏÂÌˆËfl, ‚ÍÎ˛˜ÂÌË ‚ ÚÓ‚‡ ÔÓÛ˜‚‡ÌÂ, ËÏ‡Ú Ó·˘ ·‡Î ÏÂÊ-‰Û 12 Ë 23 ‚ÍÎ˛˜ËÚÂÎÌÓ; ÎËˆ‡Ú‡ Ò ãäç - ÏÂÊ‰Û 24 Ë 27‚ÍÎ˛˜ËÚÂÎÌÓ, ‡ Á‰‡‚ËÚÂ ÎËˆ‡ – ·‡Î ‡‚ÂÌ ËÎË ÔÓ-„ÓÎflÏÓÚ 28.

2. êËÒÛÌÍ‡ Ì‡ ÔÂÚÓ˙„˙ÎÌËˆË ÔÓ Ì‡·Î˛‰‡‚‡Ì ÏÓ‰ÂÎ. íÓ-ÁË ÒÛ·ÚÂÒÚ ÓÚ MMSE Â ÓˆÂÌÂÌ Ò‡ÏÓÒÚÓflÚÂÎÌÓ Ë Â ‚ÍÎ˛-˜ÂÌ ‚ ÒÚ‡ÚËÒÚË˜ÂÒÍËfl ‡Ì‡ÎËÁ, Í‡ÚÓ áä ËÒÛ‚‡ÚÂÎÌ‡ Á‡-‰‡˜‡.

3. êËÒÛÌÍ‡ Ì‡ ÍÛ· ÔÓ ÔÂ‰ÒÚ‡‚‡ (·ÂÁ ÂÍÒÔÓÁËˆËfl Ì‡ ÏÓ-‰ÂÎ) - Â‰Ì‡ ÓÚ Ì‡È-˜ÂÒÚÓ ËÁÔÓÎÁ‚‡ÌËÚÂ Á‡‰‡˜Ë Á‡ ÓˆÂÌÍ‡Ì‡ áä Ì‡Û¯ÂÌËfl ÔË Ô‡ˆËÂÌÚË Ò ÎÓÍ‡ÎÌË ÏÓÁ˙˜ÌË Û‚ÂÊ-‰‡ÌËfl. êËÒÛÌÍËÚÂ Ì‡ ÔÂÚÓ˙„˙ÎÌËˆË Ë ÍÛ· Ò‡ ÓˆÂÌÂÌË ÒÔÓ-Â‰ ÏÓ‰ËÙËÍ‡ˆËfl Ì‡ ÒÍ‡Î‡Ú‡ Ì‡ Moore and Wyke (1984), ‚ÍÓflÚÓ ÒÂ ÓÚ˜ËÚ‡Ú ËÁÔÛÒÍ‡ÌÂ Ì‡ ÂÎÂÏÂÌÚË, ÍÓıÂÁËfl ËÙ‡„ÏÂÌÚ‡ˆËfl. äÛ·˙Ú ÒÂ ÓˆÂÌfl‚‡ Ë Á‡ ÔÂ‰ÒÚ‡‚flÌÂ Ì‡ÚËËÁÏÂÌÓÒÚÚ‡.

4. Block design – ÒÛ·ÚÂÒÚ ÓÚ ÚÂÒÚ‡ Á‡ ËÌÚÂÎË„ÂÌÚ-ÌÓÒÚ Ì‡ ÇÂÍÒÎÂ; Á‡‰‡˜‡Ú‡ ÔÂ‰ÒÚ‡‚Îfl‚‡ ÍÓÌÒÚÛË‡ÌÂ Ì‡Ì‡·Î˛‰‡‚‡ÌË ÏÓ‰ÂÎË – ‰‚Û-, ˜ÂÚËË-, ‰Â‚ÂÚ- Ë ¯ÂÒÚÌ‡‰Â-ÒÂÚ ÂÎÂÏÂÌÚÌË ÙË„ÛË, ÓÚ Â‰Ì‡Í‚Ë ÏÌÓ„Óˆ‚ÂÚÌË ÍÛ·˜Â-Ú‡. ÇÂÏÂÚÓ Á‡ ËÁÔ˙ÎÌÂÌËÂ Ì‡ Á‡‰‡˜‡Ú‡ ÌÂ Â ÓÚ˜ËÚ‡ÌÓ,ÔÓ‡‰Ë ‚˙Á‡ÒÚÚ‡ Ì‡ ËÁÒÎÂ‰‚‡ÌËÚÂ ÎËˆ‡. Å‡Î˙Ú ÔÂ‰ÒÚ‡‚-Îfl‚‡ ·ÓflÚ Ì‡ Ô‡‚ËÎÌÓ ‚˙ÁÔÓËÁ‚Â‰ÂÌËÚÂ ÏÓ‰ÂÎË.

5. ÅÂÌÚ˙Ì-ÚÂÒÚ (Åí), ÙÓÏ‡ “ë”, Ò ËÌÒÚÛÍˆËfl “Ä” -ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÂÌ ÚÂÒÚ Á‡ ÓˆÂÌÍ‡ Ì‡ ÁËÚÂÎÌ‡ ÔÂˆÂÔ-ˆËfl, Ô‡ÏÂÚ Ë ÁËÚÂÎÌÓ ÍÓÌÒÚÛÍÚË‚ÂÌ Ô‡ÍÒËÒ, Ò ‚ËÒÓÍ‡ÒÔÂˆËÙË˜ÌÓÒÚ ÔË Ó„‡ÌË˜ÌË ÏÓÁ˙˜ÌË Ì‡Û¯ÂÌËfl (7).

6. ÅÂÌÚ˙Ì-ÚÂÒÚ (Åí) - ÌÂÔÓÒÂ‰ÒÚ‚ÂÌ‡ ÂÔÓ‰ÛÍˆËflÌ‡ Ú‡·Î‡ ÓÚ ÙÓÏ‡ “Ö” ˜ÂÁ ÍÓÌÒÚÛË‡ÌÂ Ò ÔÎ‡ÒÚÏ‡ÒÓ-‚Ë Ô˙˜ËˆË.

ëíÄíàëíàóÖëäà ÄçÄãàá

á‡ Ò‡‚Ìfl‚‡ÌÂ Ì‡ ÂÁÛÎÚ‡ÚËÚÂ ‚ ÚËÚÂ „ÛÔË Ò‡ ËÁÔÓ-ÎÁ‚‡ÌË one-way ANOVA Ë ÚÂÒÚ Ì‡ Bonferroni Á‡ ÏÌÓÊÂ-ÒÚ‚ÂÌÓ Ò‡‚ÌÂÌËÂ. ë ˆÂÎ ‰‡ ËÁÒÎÂ‰‚‡ÏÂ „ÛÔË‡ÌÂÚÓ Ì‡ËÁÔÓÎÁ‚‡ÌËÚÂ ÓÚ Ì‡Ò ÚÂÒÚÓ‚Â Ì‡ ÓÒÌÓ‚‡Ú‡ Ì‡ ÍÓ„ÌËÚË‚-ÌËÚÂ ÒÔÓÒÓ·ÌÓÒÚË, Ì‡Û¯ÂÌËflÚ‡ Ì‡ ÍÓËÚÓ ÓˆÂÌfl‚‡Ú, ÂÔÓ‚Â‰ÂÌ Ù‡ÍÚÓÂÌ ‡Ì‡ÎËÁ (îÄ). òÂÒÚÚÂ ÚËÔ‡ „Â¯ÍË –ËÁÔÛÒÍ‡ÌÂ, ËÁÓÔ‡˜‡‚‡ÌÂ, ÔÂÒÂ‚Â‡ˆËfl, Ó·˙˘‡ÌÂ, „Â¯ÌÓ


‡ÁÔÓÎÓÊÂÌËÂ Ë „Â¯ÍË ‚ „ÓÎÂÏËÌ‡Ú‡ ÔË Åí, ÙÓÏ‡ “ë”,ËÌÒÚÛÍˆËfl “Ä” Ò‡ ‚ÍÎ˛˜ÂÌË Í‡ÚÓ ÔÓÏÂÌÎË‚Ë, ‚ÏÂÒÚÓÓ·˘Ëfl ·ÓÈ ‚ÂÌË Ë „Â¯ÌË ÂÔÓ‰ÛÍˆËË, Ò ˆÂÎ ‰‡ ÒÂ ÓÒË-„ÛË ÔÓ‚Â˜Â ËÌÙÓÏ‡ˆËfl Á‡ ËÌÚÂÔÂÚË‡ÌÂ Ì‡ ÂÁÛÎÚ‡-ÚËÚÂ ÓÚ îÄ. Ç˙ÁÍ‡Ú‡ ÏÂÊ‰Û ‡ÁÎË˜ÌËÚÂ áä Á‡‰‡˜Ë ÂËÁÒÎÂ‰‚‡Ì‡ Ò ÍÓÂÎ‡ˆËÓÌÂÌ ‡Ì‡ÎËÁ. ÇÍÎ˛˜‚‡ÌÂÚÓ Ì‡ ÔË·-ÎËÁËÚÂÎÌÓ ‡‚ÂÌ ·ÓÈ ÎËˆ‡ ÓÚ ÚËÚÂ Ó·‡ÁÓ‚‡ÚÂÎÌË‡‚ÌË˘‡ ËÏ‡ Á‡ ˆÂÎ ‰‡ Ì‡Ï‡ÎË ‚ÎËflÌËÂÚÓ Ì‡ Ó·‡ÁÓ‚‡ÌËÂ-ÚÓ ‚˙ıÛ ÔÓÎÛ˜ÂÌËÚÂ ÂÁÛÎÚ‡ÚË.

êÖáìãíÄíà

êÂÁÛÎÚ‡ÚËÚÂ ÓÚ Ò‡‚ÌÂÌËÂÚÓ Ì‡ ÔÓÎÛ˜ÂÌËÚÂ ·‡ÎÓ‚ÂÔË ÎËˆ‡Ú‡ Ò ‰ÂÏÂÌˆËfl, Ò ãäç Ë Á‰‡‚Ë, Ò one-wayANOVA, ÔÓÍ‡Á‚‡Ú ÁÌ‡˜ËÏË ‡ÁÎË˜Ëfl ÏÂÊ‰Û ÚËÚÂ ËÁÒ-ÎÂ‰‚‡ÌË „ÛÔË Á‡ ËÁÔÓÎÁ‚‡ÌËÚÂ áä Á‡‰‡˜Ë: ËÒÛÌÍ‡ Ì‡ ÍÛ·ÔÓ ÔÂ‰ÒÚ‡‚‡ (F=24.61; p=.000); ËÒÛÌÍ‡ Ì‡ ÔÂÚÓ˙„˙ÎÌË-ˆË (F=16.41; p=.000); Block design (F=56.55; p=.000); ÂÔ-Ó‰ÛÍˆËfl Ì‡ ‰‚ÛËÁÏÂÌË ÙË„ÛË ‚ Åí Ò ËÒÛ‚‡ÌÂ (Á‡ ‚ÂÌËÂÔÓ‰ÛÍˆËË F=30.29; p=.000; Á‡ ·ÓÈ „Â¯ÍË F=44.45;p=.000); Ë Åí Ò ÍÓÌÒÚÛË‡ÌÂ (F=73.90; p=.000). ëÂ‰ÌË-ÚÂ ÒÚÓÈÌÓÒÚË Ì‡ Ó·˘Ëfl ·‡Î ÓÚ áä Á‡‰‡˜Ë (Ú‡·Î.1), ÔÓ-Í‡Á‚‡Ú ‚ÎÓ¯‡‚‡ÌÂ Ì‡ ËÁÔ˙ÎÌÂÌËÂÚÓ ‚ „ÛÔ‡Ú‡ Ì‡ ãäç ‚Ò‡‚ÌÂÌËÂ Ò „ÛÔ‡Ú‡ Ì‡ Á‰‡‚ËÚÂ, Í‡ÍÚÓ Ë ‚ „ÛÔ‡Ú‡ Ì‡Ô‡ˆËÂÌÚËÚÂ Ò ‰ÂÏÂÌˆËfl, ‚ Ò‡‚ÌÂÌËÂ Ò ãäç Ë Á‰‡‚Ë.

èÓÎÛ˜ÂÌËÚÂ ÒÂ‰ÌË ÒÚÓÈÌÓÒÚË Ó·˘Ó ÓÚ ÚËÚÂ „ÛÔËÁ‡ ÓÚ‰ÂÎÌËÚÂ ‚Ë‰Ó‚Â „Â¯ÍË ÓÚ Åí- ËÒÛ‚‡ÌÂ ÔÓÍ‡Á‚‡ÚÔÓ-„ÓÎflÏ ·ÓÈ ËÁÔÛÒÍ‡ÌÂ (ı Ò. =4,02, SD=3,7) Ë ËÁÓÔ‡˜‡-‚‡ÌÂ (ı Ò. =3,94, SD=2,6) ‚ Ò‡‚ÌÂÌËÂ Ò ÔÂÒÂ‚Â‡ˆËËÚÂ(ı Ò. =1,06, SD=1,2) , Ó·˙˘‡ÌÂÚÓ (ı Ò. =1,22, SD=1,1), „Â¯ÌÓÚÓ ‡ÁÔÓÎÓÊÂÌËÂ (ı Ò. =1,77, SD=1,6) Ë „Â¯ÍË-ÚÂ ‚ „ÓÎÂÏËÌ‡Ú‡ (ı Ò. =0,51, SD=0,9) .

á‡ ‰‡ ÔÓ‚ÂËÏ ‡ÁÎËÍ‡Ú‡ ÏÂÊ‰Û ÍÓË „ÛÔË ÓÔÂ‰ÂÎflÒÚ‡ÚËÒÚË˜ÂÒÍË ÁÌ‡˜ËÏËÚÂ ‡ÁÎË˜Ëfl ÏÂÊ‰Û ÒÂ‰ÌËÚÂ·‡ÎÓ‚Â, ÔÓ‚Â‰ÓıÏÂ ÏÌÓÊÂÒÚ‚ÂÌÓ Ò‡‚ÌÂÌËÂ Á‡ ‚ÒflÍ‡ „Û-Ô‡ Ò ‚ÒflÍ‡ ÓÚ ÓÒÚ‡Ì‡ÎËÚÂ ‰‚Â, Ò ÚÂÒÚ Ì‡ Bonferroni. áÌ‡-˜ËÏË ‡ÁÎË˜Ëfl (p<.01) ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡Ú ÏÂÊ‰Û ÚËÚÂ„ÛÔË Á‡ ËÒÛÌÍ‡Ú‡ Ì‡ ÍÛ·, Á‡ Block design Ë Á‡ Åí – ËÒÛ-‚‡ÌÂ Ë ÍÓÌÒÚÛË‡ÌÂ. ê‡ÁÎËÍËÚÂ ‚ ·‡Î‡ ÓÚ ËÒÛÌÍ‡Ú‡ Ì‡ÔÂÚÓ˙„˙ÎÌËˆË ÌÂ Ò‡ ÒÚ‡ÚËÒÚË˜ÂÒÍË ÁÌ‡˜ËÏË Ò‡ÏÓ ÏÂÊ-‰Û Á‰‡‚ËÚÂ Ë ÎËˆ‡Ú‡ Ò ãäç (p=0.128).

ë ˆÂÎ ‰‡ ÔÓ‚ÂËÏ ‰‡ÎË ËÒÛ‚‡ÌÂÚÓ Ë Ò„ÎÓ·fl‚‡ÌÂÚÓ Ì‡„ÂÓÏÂÚË˜ÌË ÙË„ÛË ÓˆÂÌfl‚‡Ú ÓÚ‰ÂÎËÏË ‚Ë‰Ó‚Â áäè,ÔÓ‚Â‰ÓıÏÂ Ù‡ÍÚÓÂÌ ‡Ì‡ÎËÁ. èÓ‡‰Ë ‚Ë‰‡ Ì‡ ÔÓÒÚ‡‚ÂÌ‡-Ú‡ Á‡‰‡˜‡ – ‰‡ ÛÒÚ‡ÌÓ‚ËÏ Í‡Í‚Ë ÍÓÌÒÚÛÍÚË ÒÂ Ò˙‰˙-

Ê‡Ú ‚ ÔÓÏÂÌÎË‚ËÚÂ, ÓÚ‡Áfl‚‡˘Ë ÂÁÛÎÚ‡ÚËÚÂ ÓÚËÁÔ˙ÎÌÂÌËÂÚÓ Ì‡ áä Á‡‰‡˜Ë, Â ÔÓ‚Â‰ÂÌ ÂÍÒÔÎÓ‡ÚË‚ÂÌÙ‡ÍÚÓÂÌ ‡Ì‡ÎËÁ (îÄ). á‡ ËÁ‚ÎË˜‡ÌÂ Ì‡ Ù‡ÍÚÓËÚÂ Â ËÁ-ÔÓÎÁ‚‡Ì ÏÂÚÓ‰‡ Maximum Likelihood, ÍÓÈÚÓ ‰‡‚‡ ‚˙Á-ÏÓÊÌÓÒÚ ‰‡ ÒÂ ÓˆÂÌË ‡‰ÂÍ‚‡ÚÌÓÒÚÚ‡ Ì‡ ‰‡ÌÌËÚÂ (good-ness-of-fit) Í˙Ï ÏÓ‰ÂÎ‡. àÁÔÓÎÁ‚‡ÌËflÚ ÏÓ‰ÂÎ ÔÓÁ‚ÓÎfl‚‡ËÁ‚ÎË˜‡ÌÂÚÓ Ì‡ 4 Ù‡ÍÚÓ‡ (Ú‡·Î.2). èÓÎÛ˜ÂÌ‡Ú‡ ÒÚÓÈ-ÌÓÒÚ Ì‡ Kaiser-Meyer-Olkin .744, ÓÁÌ‡˜‡‚‡, ˜Â îÄ Â Ò‡‚-ÌËÚÂÎÌÓ ÔÓ‰ıÓ‰fl˘ ÏÂÚÓ‰ Á‡ ‡Ì‡ÎËÁ Ì‡ Ì‡¯ËÚÂ ‰‡ÌÌË.àÌÚÂÔÂÚË‡ÏÂ Ù‡ÍÚÓÌ‡Ú‡ Ï‡ÚËˆ‡ ·ÂÁ ÓÚ‡ˆËfl,Ú˙È Í‡ÚÓ ÔÓ‚ÂÊ‰‡ÏÂ ÂÍÒÔÎÓ‡ÚË‚ÂÌ, ‡ ÌÂ ÔÓÚ‚˙‰ËÚÂ-ÎÂÌ îÄ.

éÚ ÔÂ‰ÒÚ‡‚ÂÌËÚÂ ‚ Ú‡·Î.2 ÂÁÛÎÚ‡ÚË ÓÚ îÄ ÒÂ‚ËÊ‰‡, ˜Â áä Á‡‰‡˜Ë Ò ËÒÛ‚‡ÌÂ, Ú.Â. Ò „‡ÙÓÏÓÚÓÂÌ ÂÎÂ-ÏÂÌÚ Ë Ò ÍÓÌÒÚÛË‡ÌÂ (Ò„ÎÓ·fl‚‡ÌÂ) ÌÂ ÒÂ Ó·ÓÒÓ·fl‚‡Ú ‚ÓÚ‰ÂÎÌË Ù‡ÍÚÓË. ÄÌ‡ÎËÁ˙Ú Ì‡ ÔÓÎÛ˜ÂÌËÚÂ Ù‡ÍÚÓÌËÚÂ„Î‡ Ì‡ÒÓ˜‚‡ Í˙Ï Ì‡ÁÓ‚‡‚‡ÌÂ Ì‡ ˜ÂÚËËÚÂ Ù‡ÍÚÓ‡ ÛÒ-ÎÓ‚ÌÓ ÔÓ ÒÎÂ‰ÌËfl Ì‡˜ËÌ:

î‡ÍÚÓ 1 ÏÓÊÂ ‰‡ ÒÂ ÒÏflÚ‡ Á‡ Ó·˘ Ù‡ÍÚÓ – ÚÓÈ ËÏ‡Ù‡ÍÚÓÌË ÚÂ„Î‡ Ì‡‰ 0.2 ‚˙‚ ‚ÒË˜ÍË ËÁÔÓÎÁ‚‡ÌË ÚÂÒÚÓ‚Â.í‚˙‰Â ÌËÒÍË ÚÂ„Î‡ Ô˙‚ËflÚ Ù‡ÍÚÓ ËÏ‡ Ò‡ÏÓ ‚ ÍËÚÂ-ËËÚÂ ÓÚ Åí “Ó·˙˘‡ÌÂ” Ë “„Â¯ÍË ‚ „ÓÎÂÏËÌ‡Ú‡”. ÑÓ-ÏËÌË‡˘Ó Â ÚÂ„ÎÓÚÓ ÏÛ ‚ ÍËÚÂËfl “ËÁÔÛÒÍ‡ÌÂ” ÓÚ Åí,ÍÓÂÚÓ ÔÓÍ‡Á‚‡ Û˜‡ÒÚËÂ Ì‡ Ô‡ÏÂÚÚ‡ ‚ ÚÓÁË Ù‡ÍÚÓ. åÓ-ÊÂÏ ‰‡ Ì‡Â˜ÂÏ Ù‡ÍÚÓ 1 – Ó·˘Ó ÍÓ„ÌËÚË‚ÌÓ ÙÛÌÍˆËÓ-ÌË‡ÌÂ.

î‡ÍÚÓ 2 ËÏ‡ ‡ÁÔÂ‰ÂÎÂÌËÂ Ì‡ Ù‡ÍÚÓÌËÚÂ ÚÂ„Î‡,ÍÓÂÚÓ ÔÓÁ‚ÓÎfl‚‡ ÚÓÈ ‰‡ ·˙‰Â Ì‡Â˜ÂÌ áäè Í‡ÚÓ ÂÎÂÏÂÌÚÌ‡ ËÁÔ˙ÎÌËÚÂÎÌÓÚÓ ÙÛÌÍˆËÓÌË‡ÌÂ. ç‡È-‚ËÒÓÍË Ò‡ ÚÂ„-Î‡Ú‡ ÏÛ ‚ Åí-ÍÓÌÒÚÛË‡ÌÂ 0.806, ‚ Block design 0.501, ‚ËÁÓÔ‡˜‡‚‡ÌÂÚÓ Ì‡ ÂÔÓ‰ÛÍˆËËÚÂ ÓÚ Åí-ËÒÛ‚‡ÌÂ – 0.487Ë ‚ ËÒÛÌÍ‡Ú‡ Ì‡ ÍÛ· 0.462. ì˜‡ÒÚËÂÚÓ Ì‡ Ù‡ÍÚÓ 2 ‚ Ë-ÒÛÌÍ‡Ú‡ Ì‡ ÔÂÚÓ˙„˙ÎÌËˆË Â ÔÓ-ÒÎ‡·Ó – Ù‡ÍÚÓÌÓÚÓ ÚÂ„-ÎÓ Â 0.206. ëÔÓÂ‰ Ì‡Ò „Â¯Í‡Ú‡ “ËÁÓÔ‡˜‡‚‡ÌÂ” ÔË Åí-ËÒÛ‚‡ÌÂ, ‚ Ì‡È-„ÓÎflÏ‡ ÒÚÂÔÂÌ ÓÚ‡Áfl‚‡ Ì‡Û¯ÂÌËflÚ‡ Ì‡ÂÍÁÂÍÛÚË‚ÌËfl ÍÓÏÔÓÌÂÌÚ Ì‡ áä ÒÔÓÒÓ·ÌÓÒÚ.

î‡ÍÚÓ 3 ‰ÓÏËÌË‡ ‚ Ó·˙˘‡ÌÂÚÓ Ë ËÁÓÔ‡˜‡‚‡ÌÂÚÓ,Í‡ÚÓ ÍËÚÂËË Á‡ ËÁÔ˙ÎÌÂÌËÂÚÓ Ì‡ Åí- ËÒÛ‚‡ÌÂ. íÂÁË„Â¯ÍË ÒÂ ‚ÎËflflÚ ÒËÎÌÓ ÓÚ Ì‡Û¯ÂÌËflÚ‡ Ì‡ ÁËÚÂÎÌÓ-ÔÂˆÂÔÚË‚ÌËÚÂ ÒÔÓÒÓ·ÌÓÒÚË, Á‡ÚÓ‚‡ Ì‡ÁÓ‚‡‚‡ÏÂ ÚÓÁËÙ‡ÍÚÓ – ÁËÚÂÎÌÓÔÂˆÂÔÚË‚Ì‡ ÒÔÓÒÓ·ÌÓÒÚ.

ëÏflÚ‡ÏÂ, ˜Â Ù‡ÍÚÓÌËÚÂ ÚÂ„Î‡ Ì‡ Ù‡ÍÚÓ 4 ÔÓÁ‚ÓÎfl-‚‡Ú ÚÓÈ ‰‡ ·˙‰Â Ì‡Â˜ÂÌ ÁËÚÂÎÌÓÔÓÒÚ‡ÌÒÚ‚ÂÌ ‡Ì‡ÎËÁËÎË ÁËÚÂÎÌÓÔÓÒÚ‡ÌÒÚ‚ÂÌ‡ ÓˆÂÌÍ‡. ç‡Û¯ÂÌËflÚ‡ Ì‡ÒÔÓÒÓ·ÌÓÒÚÚ‡ Á‡ ‡Ì‡ÎËÁ Ì‡ ÔÓÒÚ‡ÌÒÚ‚ÂÌËÚÂ ‚Á‡ËÏÓ-ÓÚÌÓ¯ÂÌËfl ÏÂÊ‰Û ÂÎÂÏÂÌÚËÚÂ Ì‡ „ÂÓÏÂÚË˜ÌËÚÂ ÙË„Û-Ë - ÏÓ‰ÂÎË ÒÂ ÔÓfl‚fl‚‡Ú ‚ „ÓÎflÏ‡ ÒÚÂÔÂÌ ‚ ÓÚ‡ˆËflÚ‡,ËÁÓÔ‡˜‡‚‡ÌÂÚÓ, „Â¯ÍËÚÂ ‚ „ÓÎÂÏËÌ‡Ú‡ Ë ÔÓÒÚ‡Ì-ÒÚ‚ÂÌÓÚÓ ‡ÁÔÓÎÓÊÂÌËÂ ÔË Åí. áËÚÂÎÌÓ ÔÓÒÚ‡Ì-ÒÚ‚ÂÌ‡Ú‡ ÓˆÂÌÍ‡ Â Ò˙˘ÂÒÚ‚ÂÌ‡ Ë Á‡ ÍÓÔË‡ÌÂÚÓ Ì‡ ÔÂ-


í‡·Î.1 ëÂ‰ÌË ·‡ÎÓ‚Â ÓÚ ËÁÔ˙ÎÌÂÌËÂÚÓ ‚ ÚËÚÂ ËÁÒÎÂ‰‚‡ÌË „ÛÔË

áä Á‡‰‡˜‡ ÑË‡„ÌÓÒÚË˜Ì‡ ëÂ‰ÂÌ SD„ÛÔ‡ ·‡Î

äÛ· ÑÂÏÂÌˆËfl 5.13 2.06ãäç 7.77 2.80á‰‡‚Ë 10.03 3.15

èÂÚÓ˙„˙ÎÌËˆË ÑÂÏÂÌˆËfl 9.53 2.31ãäç 10.93 1.11á‰‡‚Ë 11.73 0.45

Block design ÑÂÏÂÌˆËfl 1.70 1.24ãäç 4.17 1.70á‰‡‚Ë 5.67 1.40

Åí ÑÂÏÂÌˆËfl 1.53 1.31ËÒÛ‚‡ÌÂ- ãäç 3.03 1.27‚ÂÌË á‰‡‚Ë 4.53 1.83Åí ÑÂÏÂÌˆËfl 17.17 4.26 ËÒÛ‚‡ÌÂ- ãäç 11.80 3.00„Â¯ÍË á‰‡‚Ë 8.60 3.29Åí ÑÂÏÂÌˆËfl 1.47 0.82 ÍÓÌÒÚÛË‡ÌÂ- ãäç 3.07 0.94‚ÂÌË á‰‡‚Ë 3.83 0.46

í‡·Î.2 î‡ÍÚÓÌË ÚÂ„Î‡

èÓÏÂÌÎË‚Ë î‡ÍÚÓ1 2 3 4

äÛ· .501 .462 - .036 - .154èÂÚÓ˙„˙ÎÌËˆË .500 .206 .262 - .343Block design .592 .501 .037 -.290Åí-ËÁÔÛÒÍ‡ÌÂ - .999 .030 .000 .000Åí-ËÁÓÔ‡˜‡‚‡ÌÂ - .196 - .487 - .552 .382Åí-ÔÂÒÂ‚Â‡ˆËfl .231 - .147 .052 .041Åí-Ó·˙˘‡ÌÂ .043 .076 .717 .421Åí-„Â¯ÌÓ‡ÁÔÓÎÓÊÂÌËÂ .248 -.190 - .151 .170Åí-„Â¯ÍË ‚„ÓÎÂÏËÌ‡Ú‡ .042 .061 .133 .224Åí-ÍÓÌÒÚÛË‡ÌÂ .576 .806 - .027 .028

ÚÓ˙„˙ÎÌËˆË Ë ËÒÛÌÍ‡Ú‡ ÔÓ ÔÂÒÚ‡‚‡ Ì‡ ÍÛ·.èÓÎÛ˜ÂÌËÚÂ ÓÚ Ì‡Ò ÂÁÛÎÚ‡ÚË ÓÚ ÓÒ˙˘ÂÒÚ‚ÂÌËfl ÍÓ-

ÂÎ‡ˆËÓÌÂÌ ‡Ì‡ÎËÁ Ì‡ Spearman (Ú‡·Î.3) Ò˙˘Ó ÌÂ ‰‡‚‡ÚÓÒÌÓ‚‡ÌËÂ Á‡ ÓÚ‰ÂÎflÌÂ Ì‡ áäè Ò „‡ÙÓÏÓÚÓÂÌ ÂÎÂÏÂÌÚÓÚ áäè Ò ÍÓÌÒÚÛË‡ÌÂ (Ò„ÎÓ·fl‚‡ÌÂ), Í‡ÚÓ ÒÔÂˆËÙË˜ÌË‚Ë‰Ó‚Â ÒÔÓÒÓ·ÌÓÒÚË.

äÓÂÎ‡ˆËflÚ‡ Ì‡ ·‡Î‡ ÓÚ ËÒÛÌÍ‡Ú‡ Ì‡ ÔÂÚÓ˙„˙ÎÌËˆËÒ Ó·˘ËflÚ ·‡Î ÓÚ ååSE Â 0.61 (<0.01).

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êÂÁÛÎÚ‡ÚËÚÂ ÓÚ ÚÓ‚‡ ÔÓÛ˜‚‡ÌÂ ÔÓÍ‡Á‚‡Ú, ˜Â ÎËˆ‡Ú‡Ò ãäç Ë Ò ÎÂÍ‡ ‰Ó ÛÏÂÂÌ‡ ‰ÂÏÂÌˆËfl ÔË ÅÄ Ë ëÑ ÔÓÍ‡Á-‚‡Ú Ì‡Û¯ÂÌËfl Ì‡ ÒÔ‡‚flÌÂÚÓ Ò˙Ò Á‡‰‡˜Ë Á‡ áäè, Ò‡‚ÌÂ-ÌÓ Ò ÚÓ‚‡ Ì‡ Á‰‡‚ËÚÂ ‚˙Á‡ÒÚÌË. ëÂ‰ÌËÚÂ ÒÚÓÈÌÓÒÚËÌ‡ Ó·˘ËÚÂ ·‡ÎÓ‚Â ÓÚ ËÁÔ˙ÎÌÂÌËÂÚÓ Ì‡ ‚ÒË˜ÍË áä Á‡‰‡˜Ë‚ ÚËÚÂ ‡Ì‡ÎËÁË‡ÌË „ÛÔË, ÁÌ‡˜ËÏÓ ÒÂ ‡ÁÎË˜‡‚‡Ú(ANOVA). åÌÓÊÂÒÚ‚ÂÌÓÚÓ Ò‡‚ÌÂÌËÂ ÏÂÊ‰Û ÓÚ‰ÂÎÌËÚÂ„ÛÔË ÔÓÍ‡Á‚‡, ˜Â ËÁÔ˙ÎÌÂÌËÂÚÓ Ì‡ ËÒÛÌÍ‡Ú‡ Ì‡ ÔÂ-ÚÓ˙„˙ÎÌËˆË ÌÂ ‡Á„‡ÌË˜‡‚‡ ÁÌ‡˜ËÏÓ Ë ÚËÚÂ ËÁÒÎÂ‰‚‡ÌË„ÛÔË. é·flÒÌÂÌËÂ Ì‡ ÚÓÁË ÂÁÛÎÚ‡Ú ÏÓÊÂ ‰‡ ÒÂ Ú˙ÒË ‚ÒÚÂÔÂÌÚ‡ Ì‡ ÒÎÓÊÌÓÒÚ Ì‡ ÙË„Û‡Ú‡ Ò ÔÂÚÓ˙„˙ÎÌËˆËÚÂ,Ò‡‚ÌÂÌ‡ Ò Ú‡ÁË Ì‡ ÍÛ·‡ Ë ÔÓÂ‰Ëˆ‡Ú‡ ÓÚ Ú‡·Î‡ Ì‡ Åí ÓÚÒÂËfl “ë” Ë “Ö”, Í‡ÍÚÓ Ë Ì‡ ÏÓ‰ÂÎËÚÂ ÓÚ Block design.ëÔÓÂ‰ De Renzi (27) ÍÓÔË‡ÌÂÚÓ Ì‡ ÙË„Û‡ Â Ì‡È-ÔÓÒ-ÚËfl Ì‡˜ËÌ Á‡ ÛÒÚ‡ÌÓ‚fl‚‡ÌÂ Ì‡ äÄè. êËÒÛÌÍ‡Ú‡ Ì‡ ÍÛ· ÂÚËËÁÏÂÌ‡ Á‡‰‡˜‡, ‡ ÔË Ú‡Í˙‚ ÚËÔ Á‡‰‡˜Ë Ò‡ ÛÒÚ‡ÌÓ‚Â-ÌË Ì‡Û¯ÂÌËfl ÔË Ô‡ˆËÂÌÚË, ÍÓËÚÓ ÒÂ ÒÔ‡‚flÚ ·ÂÁ „Â¯-ÍË Ò ‰‚ÛËÁÏÂÌË Á‡‰‡˜Ë Á‡ áäè (5, 9) . ë˙˘ÂÒÚ‚Û‚‡Ú ‰‡Ì-ÌË Á‡ ÒÔ‡‚flÌÂ ‚ ‡ÁÎË˜Ì‡ ÒÚÂÔÂÌ Ò ËÒÛ‚‡ÌÂ Ì‡ ÙË„ÛË ÓÚÔ‡ˆËÂÌÚË Ò Ì‡ÔÂ‰Ì‡Î‡ ‰ÂÏÂÌˆËfl, ÍÓËÚÓ ËÏ‡Ú ÌÛÎÂ‚ Â-ÁÛÎÚ‡Ú ÓÚ Block design (23). á‡ Ò˙Ê‡ÎÂÌËÂ ÎËÔÒ‚‡Ú ˆflÎÓ-ÒÚÌË ÔÓÛ˜‚‡ÌËfl Á‡ ‚ÎËflÌËÂÚÓ Ì‡ ÒÎÓÊÌÓÒÚÚ‡ Ì‡ÍÓÌÒÚÛÍÚË‚Ì‡Ú‡ Á‡‰‡˜‡ ‚˙ıÛ ËÁÔ˙ÎÌÂÌËÂÚÓ.

Ç Ì‡¯ÂÚÓ ÔÓÛ˜‚‡ÌÂ ÒÂ ÛÒÚ‡ÌÓ‚Ë ‰Ó·Â ËÁ‡ÁÂÌ‡ ÁÌ‡-˜ËÏ‡ ÍÓÂÎ‡ˆËfl ÏÂÊ‰Û ÂÁÛÎÚ‡ÚËÚÂ ÓÚ ËÒÛÌÍ‡Ú‡ Ì‡ÔÂÚÓ˙„˙ÎÌËˆËÚÂ Ë Ó·˘ÓÚÓ ÍÓ„ÌËÚË‚ÌÓ Ì‡Û¯ÂÌËÂ, ÓˆÂ-ÌÂÌÓ Ò MMSE. í‡Í‡‚‡ ‚˙ÁÍ‡ Â ÛÒÚ‡ÌÓ‚ÂÌ‡ Ë ÓÚ Cormacket al. (12), ÒÔÓÂ‰ ÍÓËÚÓ Úfl Â ı‡‡ÍÚÂÌ‡ ˜‡ÒÚ ÓÚ ÔÓÙË-Î‡ Ì‡ ÍÓ„ÌËÚË‚ÌÓÚÓ ÒÌËÊÂÌËÂ ÔË ÅÄ Ë ÅÓÎÂÒÚÚ‡ Ì‡è‡ÍËÌÒÓÌ, ÔË ÍÓËÚÓ ÍÓÌÒÚÛÍÚË‚ÌÓÚÓ Ì‡Û¯ÂÌËÂ ÒÂ‡Á‚Ë‚‡ ÔÓÔÓˆËÓÌ‡ÎÌÓ Ì‡ „ÎÓ·‡ÎÌÓÚÓ ÍÓ„ÌËÚË‚ÌÓ ÒÌË-ÊÂÌËÂ.

ç‡¯‡Ú‡ ËÌÚÂÔÂÚ‡ˆËfl Ì‡ Ù‡ÍÚÓÌ‡Ú‡ Ï‡ÚËˆ‡ Ò 4Ù‡ÍÚÓ‡ ÓÚ˜ËÚ‡ ‰ÓÒÂ„‡ ËÁ‚ÂÒÚÌËÚÂ ‰‡ÌÌË Á‡ ÒÚÛÍÚÛ-‡Ú‡ Ì‡ áä ÒÔÓÒÓ·ÌÓÒÚ. ÑÂÙËÌË‡ÈÍË ÍÓÌÒÚÛÍÚË‚ÌË-flÚ Ô‡ÍÒËÒ Í‡ÚÓ ÒÔÓÒÓ·ÌÓÒÚ Á‡ ‚˙ÁÔÓËÁ‚ÂÊ‰‡ÌÂ Ì‡ÒÎÓÊÌË ÔÓÒÚ‡ÌÒÚ‚ÂÌË Ó·‡ÁˆË, ÔË ÌÂÓ·ıÓ‰ËÏ‡ ÂÔÂ-ÁÂÌÚ‡ˆËfl ‚ ÏÓÁ˙Í‡ Ì‡ ˆflÎÓÒÚÌË ÔÓÒÚ‡ÌÒÚ‚ÂÌË ÒÚÛÍ-ÚÛË Ò ÓÔÂ‰ÂÎÂÌË ‚˙ÚÂ¯ÌË ‚Á‡ËÏÓÓÚÌÓ¯ÂÌËfl Ì‡ ‚ÒË˜-ÍË ÂÎÂÏÂÌÚË, ã. å‡‚ÎÓ‚ (1) ÓÚ˜ËÚ‡ ÚËÚÂ, ÛÒÚ‡ÌÓ‚ÂÌË‚ Ì‡¯ÂÚÓ ÔÓÛ˜‚‡ÌÂ ÂÎÂÏÂÌÚ‡ Ì‡ áäè – ÔÂˆÂÔÚË‚ÂÌ,ËÁÔ˙ÎÌËÚÂÎÂÌ Ë ÔÓÒÚ‡ÌÒÚ‚ÂÌ. Carlesimo et al. (10) ÔÛ·-ÎËÍÛ‚‡Ú ‰‡ÌÌË Á‡ ÓÒÌÓ‚Ì‡ ÓÎfl Ì‡: 1/ÁËÚÂÎÌÓÔÂˆÂÔÚË‚-ÌËfl ‰ÂÙËˆËÚ; 2/ÒÌËÊÂÌËÂÚÓ Ì‡ ‰‚Ë„‡ÚÂÎÌ‡Ú‡ ÂÙÂÍÚË‚-

ÌÓÒÚ; 3/Ì‡Û¯ÂÌËÂÚÓ Ì‡ ÒÔÓÒÓ·ÌÓÒÚÚ‡ Á‡ ÔÎ‡ÌË‡ÌÂ Ë4/Ó·˘ÓÚÓ ËÌÚÂÎÂÍÚÛ‡ÎÌÓ ÒÌËÊÂÌËÂ ‚ Ì‡Û¯ÂÌËÂÚÓ Ì‡áäè. ëÔÓÂ‰ Stub Ë Black (1985, ˆËÚ. ÔÓ 21) ÍÓÌÒÚÛÍ-ÚË‚Ì‡Ú‡ ÒÔÓÒÓ·ÌÓÒÚ Â Ò‚˙Á‡Ì‡ ‚ „ÓÎflÏ‡ ÒÚÂÔÂÌ Ò Ó·‡-·ÓÚÍ‡Ú‡ Ì‡ ÔÓÒÚ‡ÌÒÚ‚ÂÌ‡ ËÌÙÓÏ‡ˆËfl. E‰ÌÓ‚ÂÏÂÌ-ÌÓ Ò ÚÓ‚‡ ÒÂ Ò˜ËÚ‡ Á‡ ÛÒÚ‡ÌÓ‚ÂÌÓ, ˜Â ÁËÚÂÎÌÓ ÔÓÒÚ‡-ÌÒÚ‚ÂÌËÚÂ Ì‡Û¯ÂÌËfl Ò‡ ÔÓ-ËÁ‡ÁÂÌË ÔË ÅÄ ‚ Ò‡‚ÌÂÌËÂÒ ‰Û„ËÚÂ ÙÓÏË Ì‡ ‰ÂÏÂÌˆËfl ‚ Í˙ÒÌ‡ ‚˙Á‡ÒÚ (18) èË-Ó‰‡Ú‡ Ì‡ Ì‡Û¯ÂÌËflÚ‡, ÍÓËÚÓ ‚Ó‰flÚ ‰Ó ÁËÚÂÎÌÓ

ÍÓÌÒÚÛÍÚË‚ÂÌ ‰ÂÙËˆËÚ Í‡ÍÚÓ ÔË ÎÓÍ‡ÎÌË ÏÓÁ˙˜ÌË Û‚-ÂÊ‰‡ÌËfl, Ú‡Í‡ Ë ÔË ‰ÂÏÂÌÚÂÌ ÒËÌ‰ÓÏ Â ÚÂÏ‡ Ì‡ ËÌ-ÚÂÌÁË‚ÌË ÒÔÓÓ‚Â (9), ÌÓ ‚ÒÂ ÔÓ-˜ÂÒÚÓ ÒÂ ÔÓÒÓ˜‚‡ ‚˙ÁÍ‡-Ú‡ Ì‡ ÍÓÌÒÚÛÍÚË‚ÌËÚÂ Ì‡Û¯ÂÌËfl, Í‡ÚÓ ÂÍÁÂÍÛÚË‚ÂÌ‰ÂÙËˆËÚ Ò ÙÛÌÍˆËÓÌË‡ÌÂÚÓ Ì‡ ÙÓÌÚ‡ÎÌËÚÂ ÏÓÁ˙˜ÌËÒÚÛÍÚÛË (3, 27). éÒ˙˘ÂÒÚ‚ÂÌËflÚ ÓÚ Ì‡Ò îÄ ÔÓÍ‡Á‚‡,˜Â Ë ‰‚‡Ú‡ ‚Ë‰‡ áä Á‡‰‡˜Ë ÓˆÂÌfl‚‡Ú Ì‡Û¯ÂÌËflÚ‡ Ì‡ÁËÚÂÎÌ‡Ú‡ ÔÂˆÂÔˆËfl, Ì‡ ËÁÔ˙ÎÌËÚÂÎÌÓÚÓ ÙÛÌÍˆËÓÌË-‡ÌÂ Ë Ì‡ ÔÓÒÚ‡ÌÒÚ‚ÂÌ‡Ú‡ ÓˆÂÌÍ‡ Ë ÌÂ Ì‡ÒÓ˜‚‡ Í˙ÏÓ·ÓÒÓ·fl‚‡ÌÂ Ì‡ ËÒÛ‚‡ÌÂÚÓ Ë ÍÓÌÒÚÛË‡ÌÂÚÓ Ì‡ ÙË„ÛËÍ‡ÚÓ áä Á‡‰‡˜Ë, ÍÓËÚÓ ÓˆÂÌfl‚‡Ú ‡ÁÎË˜ÌË ‚Ë‰Ó‚Â áä Ì‡-Û¯ÂÌËfl. äÓÂÙËˆËÂÌÚ˙Ú ÓÚ ÍÓÂÎ‡ˆËflÚ‡ ÏÂÊ‰Û ÚÂÒ-ÚÓ‚ÂÚÂ Á‡ ÍÓÌÒÚÛË‡ÌÂ (Block design Ë Åí – ÍÓÌÒÚÛË-‡ÌÂ) e Ò Ì‡È-‚ËÒÓÍ‡ ÒÚÓÈÌÓÒÚ, ÌÓ Ú‚˙‰Â ·ÎËÁÍË ‰Ó ÌÂ-„Ó‚‡Ú‡ ÒÚÓÈÌÓÒÚ Ò‡ ÍÓÂÙËˆËÂÌÚËÚÂ ÓÚ ÍÓÂÎ‡ˆËflÚ‡ÏÂÊ‰Û Block design Ë ·ÓflÚ „Â¯ÍË ÓÚ Åí-ËÒÛ‚‡ÌÂ,Í‡ÍÚÓ Ë ÏÂÊ‰Û Åí – ÍÓÌÒÚÛË‡ÌÂ Ë ËÒÛÌÍ‡Ú‡ Ì‡ ÍÛ·.

ï‡‡ÍÚÂËÒÚËÍ‡Ú‡ Ì‡ „Â¯ÍËÚÂ ÓÚ Åí ÔÓÍ‡Á‚‡ ÔÂ-Ó·Î‡‰‡‚‡ÌÂ Ì‡ ËÁÔÛÒÍ‡ÌÂ Ë ËÁÓÔ‡˜‡‚‡ÌÂ ÔË ÎËˆ‡Ú‡ Ò ãäçË ‰ÂÏÂÌÚÂÌ ÒËÌ‰ÓÏ. àÁÔÛÒÍ‡ÌÂÚÓ Ì‡ ÂÎÂÏÂÌÚË Â ÛÒÚ‡-ÌÓ‚ÂÌÓ ÔË ‰ÂÏÂÌˆËfl Ë ÓÚ Moore et al., (23), Á‡Â‰ÌÓ Ò ËÁÓ-Ô‡˜‡‚‡ÌÂÚÓ Ì‡ ÔÓÒÚ‡ÌÒÚ‚ÂÌËÚÂ ‚Á‡ËÏÓÓÚÌÓ¯ÂÌËfl.

Ç Ó·Ó·˘ÂÌËÂ ÏÓÊÂ ‰‡ ÒÂ ÔÓÒÓ˜Ë ÔÓÚ‚˙Ê‰‡‚‡ÌÂÚÓ Ì‡Ì‡Û¯ÂÌËflÚ‡ Ì‡ áäè ÔË ËÒÛ‚‡ÌÂ Ë ÍÓÌÒÚÛË‡ÌÂ ÔËãäç Ë ÎÂÍ‡ Ë ÛÏÂÂÌ‡ ‰ÂÏÂÌˆËfl, ÍÓÂÚÓ ÔÓ‰ÍÂÔfl ËÁÔÓÎÁ-‚‡ÌÂÚÓ Ì‡ ÚÂÁË Ì‡Û¯ÂÌËfl Í‡ÚÓ ‡ÌÂÌ Ï‡ÍÂ ‚ ÔÓˆÂÒ‡Ì‡ ‰Ë‡„ÌÓÒÚËˆË‡ÌÂ Ì‡ ‰ÂÏÂÌÚÌËfl ÒËÌ‰ÓÏ. Ç Ì‡¯ÂÚÓÔÓÛ˜‚‡ÌÂ ÌÂ ÒÂ ÔÓÎÛ˜Ëı‡ ‰‡ÌÌË ‚ ÔÓÎÁ‡ Ì‡ Ó·ÓÒÓ·fl‚‡ÌÂÚÓÌ‡ ËÒÛ‚‡ÌÂÚÓ Ë ÍÓÌÒÚÛË‡ÌÂÚÓ Ì‡ ÙË„ÛË Í‡ÚÓ áä Á‡-‰‡˜Ë, ÍÓËÚÓ ÓˆÂÌfl‚‡Ú ‡ÁÎË˜ÌË ‚Ë‰Ó‚Â áä Ì‡Û¯ÂÌËfl.ë˜ËÚ‡ÏÂ, ˜Â ÚÛÍ Úfl·‚‡ ‰‡ ÒÂ ÓÚ˜ËÚ‡ ÒÔÂˆËÙËÍ‡Ú‡ Ì‡ÍÓ„ÌËÚË‚ÌËÚÂ Ì‡Û¯ÂÌËfl ÔË ‰ÂÏÂÌÚÂÌ ÒËÌ‰ÓÏ Ë ÔË‡Ì‡ÎËÁË‡ÌËfl ÓÚ Ì‡Ò ÚËÔ ãäç, ‡ ËÏÂÌÌÓ Ô‡‡ÎÂÎÌÓÚÓÒÌËÊÂÌËÂ Ì‡ ÒÔÂˆËÙË˜ÌË ÍÓ„ÌËÚË‚ÌË ÒÔÓÒÓ·ÌÓÒÚË Ì‡ ÙÓ-Ì‡ Ì‡ ÔÓ„ÂÒË‡˘ÓÚÓ ËÌÚÂÎÂÍÚÛ‡ÎÌÓ Ë Ó·˘Ó ÍÓ„ÌËÚË‚-ÌÓ ÒÌËÊÂÌËÂ, Á‡ ÍÓÂÚÓ ËÏ‡ ‚ÒÂ ÔÓ‚Â˜Â ‰‡ÌÌË.

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ÓˆÂÌÍ‡ Ì‡ ‡ÁÎË˜ÌË ÓÚ‰ÂÎËÏË ‚Ë‰Ó‚Â áä Ì‡Û¯ÂÌËfl;

ãàíÖêÄíìêÄ1. å‡‚ÎÓ‚, ã. èÂˆÂÔÚË‚Ì‡ ÔÂ‡·ÓÚÍ‡ Ë ÒÂÌÁÓÌË ÏÓ‰‡ÎÌÓÒÚË. ëÓÙËfl,

ÅÄç, 1981, 51.2. í‡ÈÍÓ‚, ã. ê‡ÌÌ‡ ‰Ë‡„ÌÓÒÚËÍ‡ Ì‡ ·ÓÎÂÒÚÚ‡ Ì‡ ÄÎˆı‡ÈÏÂ Ë Ò˙‰Ó‚‡Ú‡

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ˆÂÔˆËflÚ‡ Ë ÔÂ‰ÒÚ‡‚ÌÓÒÚÚ‡ Ì‡ ÁËÚÂÎÌ‡Ú‡ Ë Ú‡ÍÚËÎÌ‡Ú‡ ÒÂÌÁÓÌ‡ÏÓ‰‡ÎÌÓÒÚ: ÑËÒÂÚ‡ˆËfl. ëÓÙËfl, 1991.

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Ä‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËfl:èÎÓ‚‰Ë‚ 4002, ìåÅÄã “ë‚.ÉÂÓ„Ë”,äÎËÌËÍ‡ ÔÓ ÔÒËıË‡ÚËfl,ã‡·Ó‡ÚÓËfl ÔÓ ÔÒËıÓÎÓ„Ëfl,ê‡‰Í‡ å‡Ò‡Î‰ÊËÂ‚‡, ÚÂÎ.:032/602 485,Ö-mail: [email protected]


SUMMARY

WORKING MEMORY AND EXECUTIVE FUNCTIONSIN PATIENTS WITH MULTIPLE SCLEROSIS TREATED

WITH INTERFERON BETA 1 bM. Raycheva, L. Traykov, S. Mehrabian, I. Petrova, H.

Krushkov, S. Sarafov, A. Andreeva,S. Vaneva, D. Stoilova, N. Nikoevsky, P. Shotekov

Department of Neurology, UH “Alexandrovska”, MedicalUniversity, Sofia, Bulgaria

Patients with multiple sclerosis (MS) have been consistent-ly found to display deficits on tasks combining elements ofcomplex attention, working memory and information process-ing speed. Reduced information processing efficiency, conse-quent to impaired neural transmission, has been proposed asunderlying various cognitive deficits in patients with MS. Thestudy was aimed to evaluate the effects of Interferon-beta-1b(INF beta-1b) on the specified cognitive functions. The sub-jects were 52 patients with relapsing-remitting MS, mean age31.2 and 23 healthy controls, corresponding to age and edu-cation. Patients were assessed with neuropsychological bat-tery (Paced Auditory Serial Addition Test – PASAT, StroopTest, Trail Making Test Digit Symbol) at four time points - atbaseline (52 patients), at 6th month of treatment (34 patients),after one year (21 patients) and 15 patients - two years afterstarting treatment with INF beta-1b. The results demonstratesignificant difference between performance of MS group andcontrol group at baseline assessment of all studied cognitivefunctions. Significant effect was found on PASAT (errors ofommission) and Stroop Test at the second assessment (6months after starting treatment) (p<.05). The follow up at theend of the first and the second year show slight improvementof the performance without reaching the significant level. Theclear dynamic was evident in PASAT performance.

CONCLUSIONS: Our results are in line with the evidencethat INF beta-1b has beneficial effect on information process-ing speed and working memory capacity in patients withrelapsing-remitting MS.

KEY WORDS: Multiple sclerosis, neuropsychologicaltesting, working memory, Interferon beta 1-b.

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äãûóéÇà Ñìåà: åÌÓÊÂÒÚ‚ÂÌ‡ ÒÍÎÂÓÁ‡, ÌÂ‚ÓÔ-ÒËıÓÎÓ„Ë˜ÌÓ ËÁÒÎÂ‰‚‡ÌÂ, ‡·ÓÚÌ‡ Ô‡ÏÂÚ, Interferon beta 1-b.

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äÓ„ÌËÚË‚ÌËÚÂ Ì‡Û¯ÂÌËfl ÔË Ô‡ˆËÂÌÚË Ò ÏÌÓÊÂÒÚ-‚ÂÌ‡ ÒÍÎÂÓÁ‡ (åë) Ò‡ ‚‡ÊÂÌ ‡ÒÔÂÍÚ ÓÚ ÍÎËÌË˜Ì‡Ú‡ Í‡-ÚËÌ‡ Ì‡ ÚÓ‚‡ Á‡·ÓÎfl‚‡ÌÂ Ì‡Â‰ Ò˙Ò ÒÂÌÁÓÌËÚÂ Ë ‰‚Ë„‡-ÚÂÎÌË ‰ËÒÙÛÌÍˆËË. çÂÔ˙ÎÌÓˆÂÌÌÓ ÍÓ„ÌËÚË‚ÌÓ ÙÛÌÍˆËÓ-ÌË‡ÌÂ Ë ‚ÎÓ¯‡‚‡ÌÂ Ì‡ Í‡˜ÂÒÚ‚ÓÚÓ Ì‡ ÊË‚ÓÚ‡ ÔË Ô‡ˆË-ÂÌÚË Ò åë ÒÂ Ò˙Ó·˘‡‚‡ ‚ 45-65% ÓÚ ÒÎÛ˜‡ËÚÂ (14), ‡ Ì‡È-˜ÂÒÚÓ Á‡ÒÂ„Ì‡ÚËÚÂ ÍÓ„ÌËÚË‚ÌË ÒÙÂË Ò‡ Ô‡ÏÂÚÓ‚ËÚÂÔÓˆÂÒË Ë Û˜ÂÌÂÚÓ, ÒÍÓÓÒÚÚ‡ Ì‡ ËÌÙÓÏ‡ˆËÓÌÌ‡Ú‡ ÔÂ-‡·ÓÚÍ‡, ÒÎÓÊÌËÚÂ ÙÓÏË Ì‡ ‚ÌËÏ‡ÌËÂ, Â¯‡‚‡ÌÂÚÓ Ì‡ÔÓ·ÎÂÏÌË ÒËÚÛ‡ˆËË, ÍÓËÚÓ Ò‡ Ë ÂÍÓÎÓ„Ë˜ÌÓ ‚‡ÎË‰ÌË ËÌ-‰ËÍ‡ÚÓË Á‡ ÂÊÂ‰ÌÂ‚ÌÓÚÓ ÙÛÌÍˆËÓÌË‡ÌÂ (3, 5). èË Ô‡-ˆËÂÌÚËÚÂ Ò Më ÒËÒÚÂÏÌÓ ÒÂ Â„ËÒÚË‡Ú ÔÓ-ÌËÒÍË ÔÓÒ-ÚËÊÂÌËfl ÔÓ ÚÂÒÚÓ‚ÂÚÂ, ÍÓËÚÓ ÍÓÏ·ËÌË‡Ú ÂÎÂÏÂÌÚËÓÚ ‡·ÓÚÌ‡Ú‡ Ô‡ÏÂÚ, ÒÎÓÊÌËÚÂ ÂÍÁÂÍÛÚË‚ÌË ‡ÒÔÂÍÚËÌ‡ ‚ÌËÏ‡ÌËÂÚÓ Ë ·˙Á‡Ú‡ Ó·‡·ÓÚÍ‡ Ì‡ ËÌÙÓÏ‡ˆËflÚ‡(15, 6). ç‡Û¯ÂÌËflÚ‡ ‚ ÚÂÁË ÍÓ„ÌËÚË‚ÌË ÒÙÂË Ò‡ Ó·ÂÍÚÌ‡ ËÁÛ˜‡‚‡ÌÂ ‚ Â‰Ëˆ‡ ÔÓ-ÌÓ‚Ë ËÁÒÎÂ‰‚‡ÌËfl (3, 10). èÂ‰-ÔÓÎ‡„‡ ÒÂ, ˜Â Ì‡Ï‡ÎÂÌËÚÂ Í‡Ô‡ˆËÚÂÚ Ë ÒÍÓÓÒÚ Á‡ Ó·‡-


éË„ËÌ‡ÎÌË ÒÚ‡ÚËËêÄÅéíçÄ èÄåÖí à ÖäáÖäìíàÇEç äéçíêéã èêà èÄñàÖçíà

ë åçéÜÖëíÇÖçÄ ëäãÖêéáÄ ãÖäìÇÄçà ë èêÖèÄêÄíÄINTERFERON BETA 1B

å. ê‡È˜Â‚‡, ã.í‡ÈÍÓ‚, ò. åÂı‡·Ë‡Ì, à. èÂÚÓ‚‡, ï. äÛ¯ÍÓ‚, ë. ë‡‡ÙÓ‚, Ä. ÄÌ‰ÂÂ‚‡, ë. Ç‡ÌÂ‚‡, Ñ. ëÚÓËÎÓ‚‡, ç. çËÍÓÂ‚ÒÍË, è. òÓÚÂÍÓ‚

äÎËÌËÍ‡ ÔÓ çÂ‚ÓÎÓ„Ëfl, åÅÄã “ÄÎÂÍÒ‡Ì‰Ó‚ÒÍ‡”, åÂ‰ËˆËÌÒÍË ìÌË‚ÂÒËÚÂÚ, ëÓÙËfl

·ÓÚÍ‡ Ì‡ ËÌÙÓÏ‡ˆËflÚ‡, Í‡ÚÓ ÒÎÂ‰ÒÚ‚ËÂ ÓÚ Ì‡Û¯ÂÌÓ-ÚÓ ÔÂ‰‡‚‡ÌÂ Ì‡ ËÏÔÛÎÒ‡ ‚ ÌÂ‚Ì‡Ú‡ ÍÎÂÚÍ‡, ÎÂÊ‡Ú ‚ ÓÒ-ÌÓ‚‡Ú‡ Ì‡ Ì‡·Î˛‰‡‚‡ÌËÚÂ ÍÓ„ÌËÚË‚ÌË ‰ÂÙËˆËÚË.

ãÂ˜ÂÌËÂÚÓ Ò Interferon-beta-1b (INF-beta-1b) ÒÂ ÔËÂÏ‡Í‡ÚÓ ÂÙÂÍÚË‚ÌÓ Á‡ Â‰ÛˆË‡ÌÂ Ì‡ ˜ÂÒÚÓÚ‡Ú‡ Ì‡ÔËÒÚ˙ÔËÚÂ ÔË ÔËÒÚ˙ÔÌÓ-ÂÏËÚÂÌÚÂÌ ıÓ‰ (èê) Ì‡Më, Í‡ÍÚÓ Ë Á‡ Ó„‡ÌË˜‡‚‡ÌÂ Ì‡ ÔÓ„ÂÒËflÚ‡ ÔË ‚ÚÓ-Ë˜ÌÓ ÔÓ„ÂÒË‚Ì‡ ÙÓÏ‡ Ì‡ ·ÓÎÂÒÚÚ‡. çflÏ‡ ‰ÓÒÚ‡Ú˙˜-ÌÓ Í‡ÚÂ„ÓË˜ÌË ‰‡ÌÌË, Ó·‡˜Â, Á‡ ‚ÎËflÌËÂÚÓ ÏÛ ‚˙ıÛ ÌÂ‚-ÓÍÓ„ÌËÚË‚ÌËÚÂ ÙÛÌÍˆËË ÓÒÓ·ÂÌÓ ÔË ÔÓ-ÔÓ‰˙ÎÊËÚÂÎ-ÌÓ ÎÂ˜ÂÌËÂ. àÏ‡ Ò˙Ó·˘ÂÌËfl Á‡ ÔÓ‰Ó·ÂÌË ÁËÚÂÎÌÓ-Ô‡ÏÂ-ÚÓ‚Ë ÒÔÓÒÓ·ÌÓÒÚË ÔË ËÁ‚ÎË˜‡ÌÂ Ì‡ Ô‡ÏÂÚÓ‚ËÚÂ ÒÎÂ‰ËÒÎÂ‰ 2 „Ó‰Ë¯ÂÌ ÔËÂÏ Ì‡ 8 ÏÎÌ IU (12). Selby Ë Ò˙‡‚ÚÓË(1998) Â„ËÒÚË‡Ú ÔÓ-‰Ó·Ë ÔÓÒÚËÊÂÌËfl ‚˙‚ ‚Â·‡ÎÌ‡-Ú‡ Ô‡ÏÂÚ ÔË Ô‡ˆËÂÌÚË Ò èê Më ÎÂÍÛ‚‡ÌË ÔÓÌÂ 6 ÏÂÒÂ-ˆ‡ Ò Betaseron ‚ Ò‡‚ÌÂÌËÂ Ò Ô‡ˆËÂÌÚË ·ÂÁ ÎÂ˜ÂÌËÂ, ÌÓ ‡Á-ÎË˜ËflÚ‡ ÏÂÊ‰Û „ÛÔËÚÂ ÌÂ Ò‡ ÁÌ‡˜ËÏË. ÑÓÔÛÒÍ‡ ÒÂ Ò˙˘ÓÚ‡Í‡, ˜Â INF-beta 1b ÏÓÊÂ ‰‡ ‰Ó‚Â‰Â ‰Ó ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜-ÌË ‰ÂÙËˆËÚË ‚ ÂÁÛÎÚ‡Ú Ì‡ ÔÓÏÂÌË ‚ ÂÏÓˆËÓÌ‡ÎÌÓÚÓÒ˙ÒÚÓflÌËÂ ÒÎÂ‰ ÔÓ-ÔÓ‰˙ÎÊËÚÂÎÌÓ ÎÂ˜ÂÌËÂ, ÌÓ ‚ÒÂ Ó˘ÂÌflÏ‡ ‰Ó·Â ÍÓÌÚÓÎË‡ÌË ÔÓÛ˜‚‡ÌËfl ‚ Ú‡ÁË Ì‡ÒÓÍ‡.Barak Ë Achiron (2002) ÛÒÚ‡ÌÓ‚fl‚‡Ú ÁÌ‡˜ËÏÓ ÔÓ‰Ó·ÂÌËÂ‚ ÔÓˆÂÒËÚÂ Ì‡ ‚ÌËÏ‡ÌËÂÚÓ Ë ÁËÚÂÎÌ‡Ú‡ Ô‡ÏÂÚ ÒÎÂ‰Â‰ÌÓ„Ó‰Ë¯ÌÓ ÎÂ˜ÂÌËÂ Ò INF-beta 1b ‚ Ò‡‚ÌÂÌËÂ Ò ÌÂÚÂ-ÚË‡Ì‡Ú‡ ÍÓÌÚÓÎÌ‡ „ÛÔ‡. èÓ-ÌÓ‚Ë ‰‡ÌÌË ÔÓ‰ÍÂÔfl˘ËÚ‡ÁË ÚÂÌ‰ÂÌˆËfl Ò˙Ó·˘‡‚‡Ú Lanzillo Ë Ò˙‡‚ÚÓË (2006)ÒÎÂ‰ ‰‚Â„Ó‰Ë¯ÌÓ ÓÚ‚ÓÂÌÓ ÔÓÛ˜‚‡ÌÂ Ì‡ ‚ÎËflÌËÂÚÓ Ì‡ÔÂÔ‡‡Ú‡ ‚˙ıÛ ÍÓ„ÌËÚË‚ÌÓÚÓ ÙÛÌÍˆËÓÌË‡ÌÂ.

ñÖã

àÁÒÎÂ‰‚‡ÌÂ Ì‡ ‚ÎËflÌËÂÚÓ Ì‡ INF-beta-1b (Betaferon) ‚˙-ıÛ ‡·ÓÚÌ‡Ú‡ Ô‡ÏÂÚ Ë ÂÍÁÂÍÛÚË‚ÌËfl ÍÓÌÚÓÎ Ì‡ Ô‡ˆËÂÌ-ÚË Ò ÔËÒÚ˙ÔÌÓ-ÂÏËÚÂÌÚÂÌ ıÓ‰ Ì‡ ÔÓÚË˜‡ÌÂ Ì‡ åë.íÓ‚‡ Â ˜‡ÒÚ ÓÚ ÔÓÒÔÂÍÚË‚ÌÓ ÓÚ‚ÓÂÌÓ ÔÓÛ˜‚‡ÌÂ, ‚ ÍÓÂ-ÚÓ ÒÂ ÔÓÒÎÂ‰fl‚‡ Ò˙ÒÚÓflÌËÂÚÓ Ì‡ Ô‡ˆËÂÌÚË ÓÚ çÂ‚ÓÎÓ-„Ë˜Ì‡Ú‡ ÍÎËÌËÍ‡ Ì‡ åÅÄã “ÄÎÂÍÒ‡Ì‰Ó‚ÒÍ‡” ÓÚ 2000 „.

äéçíàçÉÖçí, åÖíéÑà à ÑàáÄâç çÄ èêéìóÇÄçÖíé

àáëãÖÑÇÄçà ãàñÄ

Ç ÔÓÛ˜‚‡ÌÂÚÓ Û˜‡ÒÚ‚‡Ú 52 Ô‡ˆËÂÌÚÍË Ì‡ ‚˙Á‡ÒÚÓÚ 23 ‰Ó 46 „. (ÒÂ‰Ì‡ ‚˙Á‡ÒÚ 31.2 „.), ÍÓËÚÓ ÒÂ ÔÓÒÎÂ-‰fl‚‡Ú ‰Ó Í‡fl Ì‡ ÎÂ˜ÂÌËÂÚÓ ËÏ Ò INF-beta-1b (Betaferon).êÂÁÛÎÚ‡ÚËÚÂ ÓÚ ËÁÒÎÂ‰‚‡ÌÂÚÓ ÒÂ Ò˙ÔÓÒÚ‡‚flÚ Ò ÍÓÌÚ-ÓÎÌ‡ „ÛÔ‡ ÓÚ 23 Á‰‡‚Ë ÊÂÌË, Ò˙ÓÚ‚ÂÚÒÚ‚‡˘Ë ÔÓ ‚˙Á-‡ÒÚ Ë Ó·‡ÁÓ‚‡ÌËÂ. ÇÒË˜ÍË ‚ÍÎ˛˜ÂÌË Ô‡ˆËÂÌÚË Ò‡ Ò ‰Â-ÙËÌËÚË‚Ì‡ ‰Ë‡„ÌÓÁ‡ åë ÒÔÓÂ‰ ÍËÚÂËËÚÂ Ì‡ Poser etal (1983), Ò ÔËÒÚ˙ÔÌÓ-ÂÏËÚÂÌÚÂÌ ıÓ‰ Ì‡ ÔÓÚË˜‡ÌÂ.èÓ‰˙ÎÊËÚÂÎÌÓÒÚÚ‡ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ Â ÓÚ 1 ‰Ó 18 „.(ÒÂ‰ÌÓ 5.8 „.), ‡ ·ÓflÚ Ì‡ ÔËÒÚ˙ÔËÚÂ ‚‡Ë‡ ÓÚ 2 ‰Ó 15(ÒÂ‰ÌÓ 4.5) Í‡ÚÓ Ò‡ Â„ËÒÚË‡ÌË ÔÓÌÂ ‰‚‡ Á‡ ÔÓÒÎÂ‰ÌË-ÚÂ 2 „.). ëÚÂÔÂÌÚ‡ Ì‡ ËÌ‚‡ÎË‰ËÁ‡ˆËfl ÓˆÂÌÂÌ‡ ÔÓ ÒÍ‡Î‡Ú‡EDSS (8) Â ‚ ‰Ë‡Ô‡ÁÓÌ‡ 2 – 4 (ÒÂ‰ÌÓ 2.8). çÂ Ò‡ ‚ÍÎ˛˜ÂÌËÔ‡ˆËÂÌÚË, Á‡ ÍÓËÚÓ ËÏ‡ ‰‡ÌÌË Á‡ ÁÎÓÛÔÓÚÂ·‡ Ò ‡ÎÍÓıÓÎË ÔÒËıÓ‡ÍÚË‚ÌË ‚Â˘ÂÒÚ‚‡, Á‡ ÔÒËıÓÚË˜ÂÌ ÂÔËÁÓ‰ ËÎË‰ÂÔÂÒËfl; ÍÓËÚÓ ËÏ‡Ú ÒÂËÓÁÌË ‰‚Ë„‡ÚÂÎÌË ËÎË ÒÂÌÁÓÌËÌ‡Û¯ÂÌËfl. ÇÒË˜ÍË Ô‡ˆËÂÌÚË Ò‡ Ò˙Ò ÒÂ‰ÌÓ ËÎË ‚ËÒ¯Â Ó·-‡ÁÓ‚‡ÌËÂ, Ò ÌÓÏ‡ÎÌÓ ÔÂÏÓ·Ë‰ÌÓ ËÌÚÂÎÂÍÚÛ‡ÎÌÓÙÛÌÍˆËÓÌË‡ÌÂ Ë ÓÚÌÓÒËÚÂÎÌÓ Ò˙ı‡ÌÂÌ ‡ÍÚÛ‡ÎÂÌ ÍÓ„ÌË-ÚË‚ÂÌ ÒÚ‡ÚÛÒ (Mini Mental State Examination = 28.6, ±1.3).

ÑàáÄâç çÄ àáëãÖÑÇÄçÖíé

è‡ˆËÂÌÚËÚÂ Ò‡ ÎÂÍÛ‚‡ÌË Ò 8 ÏÎÌ IU INF-beta-1b(Betaferon) ËÌÊÂÍÚË‡Ì ÔÓ‰ÍÓÊÌÓ ÔÂÁ ‰ÂÌ. ÑËÁ‡ÈÌ˙Ú Ì‡ÔÓÛ˜‚‡ÌÂÚÓ ‚ÍÎ˛˜‚‡ ˜ÂÚËËÍ‡ÚÌÓ ËÁÒÎÂ‰‚‡ÌÂ Ò Â‰Ì‡ ËÒ˙˘‡ ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜Ì‡ ÚÂÒÚÓ‚‡ ·‡ÚÂËfl – ÔÂ‰Ë Á‡ÔÓ˜-‚‡ÌÂ Ì‡ ÎÂ˜ÂÌËÂÚÓ, Ì‡ ¯ÂÒÚËfl ÏÂÒÂˆ ÓÚ ÎÂ˜ÂÌËÂÚÓ, ‚Í‡fl Ì‡ Ô˙‚‡Ú‡ „Ó‰ËÌ‡ Ë ‚ Í‡fl Ì‡ ‚ÚÓ‡Ú‡ „Ó‰ËÌ‡. ÇÔ˙‚ÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ Ò‡ Ó·ı‚‡Ì‡ÚË 52 Ô‡ˆËÂÌÚË, ÓÚ ÚflıÌ‡ 6-ÚË ÏÂÒÂˆ Ò‡ ËÁÒÎÂ‰‚‡ÌË 34, Ì‡ 12-ÚË ÏÂÒÂˆ 21, ‡ Ò‡-ÏÓ 15 Ò‡ ÔÓÒÎÂ‰ÂÌË ‰Ó Í‡fl Ì‡ ‚ÚÓ‡Ú‡ „Ó‰ËÌ‡

åÖíéÑà çÄ àáëãÖÑÇÄçÖ

Ç Ì‡¯ÂÚÓ ÔÓÛ˜‚‡ÌÂ Ô‡ˆËÂÌÚËÚÂ Ò‡ ËÁÒÎÂ‰‚‡ÌË Ò Ì‡È-˜ÂÒÚÓ ËÁÔÓÎÁ‚‡ÌËÚÂ ‚ ÔÓ‰Ó·ÌË ËÁÒÎÂ‰‚‡ÌËfl ÌÂ‚ÓÔÒËıÓ-ÎÓ„Ë˜ÌË ÏÂÚÓ‰ËÍË (7), ÍÓËÚÓ ÓˆÂÌfl‚‡Ú Ì‡Ï‡ÎÂÌ‡Ú‡ÂÙÂÍÚË‚ÌÓÒÚ Ì‡ ËÌÙÓÏ‡ˆËÓÌÌ‡Ú‡ ÔÂ‡·ÓÚÍ‡, ‡·ÓÚ-Ì‡Ú‡ Ô‡ÏÂÚ Ë ÂÍÁÂÍÛÚË‚ÌËfl ÍÓÌÚÓÎ: Paced AuditorySerial Addition Test (PASAT) – ÚÂÒÚ Á‡ ÒÎÛıÓ‚Ó ÔÓÒÎÂ‰fl-‚‡ÌÂ Ì‡ ÒÂËfl Â‰ÌÓˆËÙÂÌË ˜ËÒÎ‡, Í‡ÚÓ ËÁÒÎÂ‰‚‡ÌÓÚÓ ÎË-ˆÂ Úfl·‚‡ ‰‡ Ò˙·Ë‡ ‚ÒÂÍË ‰‚Â ÔÓÒÎÂ‰ÌË ˜ËÒÎ‡, ‡ ˜ËÒÎ‡Ú‡ÒÂ ÔÂ‰ÒÚ‡‚flÚ ÒÎÛıÓ‚Ó ÔÂÁ 3 ÒÂÍ. Ò˙„Î‡ÒÌÓ ÔÓˆÂ‰Û‡Ú‡ÓÔËÒ‡Ì‡ ÓÚ Rao Ë Ò˙‡‚ÚÓË (1991); Stroop Color-Word Test(ÚÂÒÚ Ì‡ ëÚÛÔ) – Ò˙‰˙Ê‡ ÚË ˜‡ÒÚË: 1. ˜ÂÚÂÌÂ Ì‡ ‰Û-ÏË ÓÁÌ‡˜‡‚‡˘Ë ˆ‚ÂÚÓ‚Â; 2. Ì‡ÁÓ‚‡‚‡ÌÂ Ì‡ ˆ‚ÂÚÓ‚Â; 3. Ì‡-ÁÓ‚‡‚‡ÌÂ Ì‡ ˆ‚ÂÚÓ‚ÂÚÂ Ì‡ Ì‡ÔÂ˜‡Ú‡ÌË ‰ÛÏË, ÓÁÌ‡˜‡‚‡˘Ëˆ‚flÚ ‡ÁÎË˜ÂÌ ÓÚ ÌÂÔÓÒÂ‰ÒÚ‚ÂÌÓ ‚˙ÁÔËÂÏ‡ÌËfl (ÍÓÌÙ-ÎËÍÚÌÓ ÔÓ‰ÛÒÎÓ‚ËÂ). íÓ‚‡ Ò‡ ÔÂ‰ÔÓ˜ËÚ‡ÌË ËÌÒÚÛÏÂÌ-ÚË, Á‡˘ÓÚÓ ÌÂ ‚ÍÎ˛˜‚‡Ú ‰Û„ ‰‚Ë„‡ÚÂÎÂÌ ÍÓÏÔÓÌÂÌÚ ÓÒ-‚ÂÌ ‚Â·‡ÎÌËfl ÓÚ„Ó‚Ó:

éÒ‚ÂÌ ÚÓ‚‡ Ò‡ ‰Ó·‡‚ÂÌË Ó˘Â ‰‚‡ ÚÂÒÚ‡, ÓˆÂÌfl‚‡˘ËÂÍÁÂÍÛÚË‚ÌËÚÂ ‡ÒÔÂÍÚË Ì‡ ‚ÌËÏ‡ÌËÂÚÓ Ë ÁËÚÂÎÌÓ-ÏÓ-ÚÓÌ‡Ú‡ ÍÓÓ‰ËÌ‡ˆËfl, ÔË ÍÓËÚÓ ËÏ‡ Ë ‰‚Ë„‡ÚÂÎÂÌ ÓÚ-„Ó‚Ó: Digit Symbol Test - ÔÓÔ˙Î‚‡ÌÂ Ì‡ ÎËÔÒ‚‡˘Ë ÒËÏ‚Ó-ÎË ÔÓ‰ Ò˙ÓÚ‚ÂÚÌË ˆËÙË; Trail Making Test (TMT) –Ò˙‰˙Ê‡ ‰‚Â ˜‡ÒÚË: ‚ ˜‡ÒÚ Ä ÒÂ ÔÓÒÎÂ‰fl‚‡Ú Ë Ò‚˙Á‚‡ÚÔÓÒÎÂ‰Ó‚‡ÚÂÎÌÓ ˜ËÒÎ‡Ú‡ ÓÚ ÂÒÚÂÒÚ‚ÂÌËfl Â‰, ‚ ˜‡ÒÚ ÅÒÂ ÔÓÒÎÂ‰fl‚‡Ú Â‰ÌÓ‚ÂÏÂÌÌÓ ˜ËÒÎ‡Ú‡ ÓÚ ÂÒÚÂÒÚ‚ÂÌËflÂ‰ Ë ·ÛÍ‚ËÚÂ ÓÚ ‡Á·ÛÍ‡Ú‡ Ë ÒÂ Ò‚˙Á‚‡Ú ‡ÎÚÂÌË‡˘Ó


í‡·ÎËˆ‡ 1. àÁÔÓÎÁ‚‡ÌË ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌË ÚÂÒÚÓ‚Â ÔË ‚ÒflÍÓ ËÁÒÎÂ‰‚‡ÌÂ,

ÍÓ„ÌËÚË‚ÌËÚÂ ÔÓˆÂÒË, ÍÓËÚÓ ÓˆÂÌfl‚‡Ú Ë Ò˙ÓÚ‚ÂÚÌËÚÂ ÔÓÍ‡Á‡ÚÂÎË

çÂ‚ÓÔÒË- äÓ„ÌËÚË‚ÂÌ ÔÓˆÂÒ èÓÍ‡Á‡ÚÂÎËıÓÎÓ„Ë˜ÂÌ (Á‡‚ËÒËÏË ÔÓÏÂÌÎË‚Ë)ÚÂÒÚPASAT ê‡·ÓÚÌ‡ Ô‡ÏÂÚ ÅÓÈ ÔÓÔÛÒÍË

ëÍÓÓÒÚ Ì‡ Ó·‡·ÓÚÍ‡ ÅÓÈ „Â¯ÌË ÓÚ„Ó‚ÓËÌ‡ ËÌÙÓÏ‡ˆËflÚ‡ ÅÓÈ ‚ÂÌË ÓÚ„Ó‚ÓËìÒÚÓÈ˜Ë‚ÓÒÚ Ë ‡ÁÔÂ‰ÂÎÂÌÓÒÚ Ì‡ ‚ÌËÏ‡ÌËÂÚÓÖÍÁÂÍÛÚË‚ÂÌ ÍÓÌÚÓÎ

Stroop Color- ÖÍÁÂÍÛÚË‚ÂÌ ÍÓÌÚÓÎ W - ·ÓÈ ÔÓ˜ÂÚÂÌËWord Test îÓÍÛÒË‡ÌÓ ‚ÌËÏ‡ÌËÂ ‰ÛÏË Á‡ 45 sec.

ìÒÚÓÈ˜Ë‚ÓÒÚ Í˙Ï ËÌÚÂÙÂÂÌˆËfl C - ·ÓÈ Ì‡ÁÓ‚‡ÌË ˆ‚ÂÚÓ‚Â - 45 sec.CW – ·ÓÈ ‚ÂÌËÍÓÌÙÎËÍÚÌË ÒÚËÏÛÎËÁ‡ 45 ÒÂÍINTFsc – ËÌÚÂÙÂÂÌÚÂÌ ·‡Î

Digit Symbol äÓÌˆÂÌÚ‡ˆËfl ÅÓÈ ‚ÂÌË Á‡ 90 ÒÂÍTest áËÚÂÎÌÓ-ÏÓÚÓÌ‡ ËÌÚÂ„‡ˆËflTrail Making ëÍÓÓÒÚÌÓ ÁËÚÂÎÌÓ ëÂÍÛÌ‰Ë Á‡ ˜‡ÒÚ ATest Ú˙ÒÂÌÂ ëÂÍÛÌ‰Ë Á‡ ˜‡ÒÚ Åó‡ÒÚ A èÂ‚ÍÎ˛˜‚‡ÌÂ Ì‡ ó‡ÒÚ Å ‚ÌËÏ‡ÌËÂÚÓ

‚˙‚ ‚˙ÁıÓ‰fl˘ Â‰ (˜ËÒÎÓ-·ÛÍ‚‡-˜ËÒÎÓ-·ÛÍ‚‡).ÇÒË˜ÍË ËÁÔÓÎÁ‚‡ÌË ÚÂÒÚÓ‚Â ËÏ‡Ú ‚ÂÏÂ‚Ë Ô‡‡ÏÂÚ-

Ë. ç‡ Ú‡·ÎËˆ‡ 1 Ò‡ ÔÂ‰ÒÚ‡‚ÂÌË ËÁÔÓÎÁ‚‡ÌËÚÂ ÚÂÒÚÓ‚Â,‡Ì„‡ÊË‡ÌËÚÂ ÍÓ„ÌËÚË‚ÌË ÔÓˆÂÒË Ë Ô‡‡ÏÂÚËÚÂ Á‡ÓˆÂÌÍ‡.

ëíÄíàëíàóÖëäà åÖíéÑà

ÄÌ‡ÎËÁ˙Ú Ì‡ ‰‡ÌÌËÚÂ Â ÔÓ‚Â‰ÂÌ Ò ÏÓ‰ÛÎË Á‡ ‡Ì‡ÎËÁ Ì‡ÒÂ‰ÌË ÒÚÓÈÌÓÒÚË ANOVA (UNIVARIATE), ‡ ÔË ·ÓÈ Ì‡ÎËˆ‡Ú‡ ‚ „ÛÔËÚÂ ÔÓ‰ 20 Ò‡ ËÁÔÓÎÁ‚‡ÌË ÌÂÔ‡‡ÏÂÚË˜ÌËÏÂÚÓ‰Ë Á‡ ÔÓ‚ÂÍ‡. èË ÓÔÂ‰ÂÎflÌÂ Ì‡ ÒÚ‡ÚËÒÚË˜ÂÒÍ‡-Ú‡ ÁÌ‡˜ËÏÓÒÚ Ì‡ ‡ÁÎËÍËÚÂ ÏÂÊ‰Û ÒÂ‰ÌËÚÂ ÒÚÓÈÌÓÒÚËÒ‡ ËÁÔÓÎÁ‚‡ÌË Ú‡‰ËˆËÓÌÌËÚÂ ÌË‚‡ – ÒÚ‡ÚËÒÚË˜ÂÒÍËÁÌ‡˜ËÏË ÔË α < 0.05, ÚÂÌ‰ÂÌˆËfl ÔË 0.05 < α < 0.10 ËÒÚ‡ÚËÒÚË˜ÂÒÍË ÌÂÁÌ‡˜ËÏË ÔË α > 0.10. èÂ‰Ë ‡Ì‡ÎËÁ‡ Ì‡‡ÁÎËÍËÚÂ ÏÂÊ‰Û „ÛÔÓ‚ËÚÂ ÒÂ‰ÌË ÒÚÓÈÌÓÒÚË ·Â¯ÂÌ‡Ô‡‚ÂÌ‡ ÔÓ‚ÂÍ‡ Á‡ ‡‚ÂÌÒÚ‚ÓÚÓ Ì‡ ‰ËÒÔÂÒËËÚÂ ÔÓÓÚ‰ÂÎÌËÚÂ ÔÓÍ‡Á‡ÚÂÎË. èË Ì‡ÎË˜ËÂ Ì‡ ‡ÁÎËÍË ‚ ‰ËÒÔÂ-ÒËËÚÂ Ì‡ ÔÓÍ‡Á‡ÚÂÎËÚÂ ·Â ËÁÔÓÎÁ‚‡Ì ÚÂÒÚ‡ Ì‡ Dunnett, ‡ÔË ÎËÔÒ‡ Ì‡ ÒÚ‡ÚËÒÚË˜ÂÒÍË ÁÌ‡˜ËÏË ‡ÁÎË˜Ëfl ‰‡ÌÌËÚÂÒÂ ËÁÒÎÂ‰‚‡Ú Ò ÚÂÒÚ‡ Bonferroni.

ïàèéíÖáà

1. é˜‡Í‚‡ÏÂ ÎÂ˜ÂÌËÂÚÓ ‰‡ ÔÓ‚ÎËflÂ ÔÓÎÓÊËÚÂÎÌÓ ‚˙ıÛ·˙ÁËÌ‡Ú‡ Ì‡ ÔÂ‡·ÓÚÍ‡Ú‡ Ì‡ ËÌÙÓÏ‡ˆËflÚ‡, ‡·ÓÚÌ‡-Ú‡ Ô‡ÏÂÚ Ë ÂÍÁÂÍÛÚË‚ÌËfl ÍÓÌÚÓÎ

● ç‡Ï‡Îfl‚‡ÌÂ Ì‡ ÔÓÔÛÒÍËÚÂ (PASAT)● èÓ‰Ó·fl‚‡ÌÂ Ì‡ ÔÓÒÚËÊÂÌËflÚ‡ ÔË ÚÂÒÚ‡ Ì‡

ëÚÛÔ● èÓ-‰Ó·Ë ÂÁÛÎÚ‡ÚË ‚ „‡ÙÓÏÓÚÓÌ‡Ú‡ ËÌÚÂ„‡-

ˆËfl Ë ÍÓ„ÌËÚË‚Ì‡Ú‡ ÔÓ‰‚ËÊÌÓÒÚ (Digit Symbol,TMT)

2.é˜‡Í‚‡ÏÂ ‡ÁÎË˜ÌÓ ÔÓ‚ÎËfl‚‡ÌÂ ‚ Á‡‚ËÒËÏÓÒÚ ÓÚ ‡Ì-„‡ÊË‡ÌÂÚÓ Ì‡ ‰‚Ë„‡ÚÂÎÌËÚÂ ÙÛÌÍˆËË.

● èÓ-ËÁ‡ÁÂÌÓ ÔÓ‰Ó·ÂÌËÂ ‚ Á‡‰‡˜ËÚÂ ·ÂÁ ‰‚Ë„‡ÚÂÎÂÌÍÓÏÔÓÌÂÌÚ

êÖáìãíÄíà

ÄÌ‡ÎËÁË‡ÌË Ò‡ ‡ÁÎËÍËÚÂ ‚ ÔÓÒÚËÊÂÌËflÚ‡ ÏÂÊ‰ÛÒÎÂ‰ÌËÚÂ ÓÙÓÏÂÌË „ÛÔË ËÁÒÎÂ‰‚‡ÌË ÎËˆ‡ – Á‰‡‚Ë ÍÓÌÚ-ÓÎË Ë 4 „ÛÔË Ô‡ˆËÂÌÚË: ÔÂ‰Ë ÎÂ˜ÂÌËÂ Ò Betaferon, ÒÎÂ‰6 ÏÂÒÂ˜ÌÓ ÎÂ˜ÂÌËÂ, ÒÎÂ‰ 1 „. Ë ÒÎÂ‰ 2 „. ÚÂ‡ÔËfl. èÓÎÛ˜Â-ÌËÚÂ ÂÁÛÎÚ‡ÚË Ò‡ ÔÂ‰ÒÚ‡‚ÂÌË Í‡ÚÓ ÒÂ‰ÌË ÒÚÓÈÌÓÒ-ÚË Á‡ ‚ÒflÍ‡ „ÛÔ‡ Ì‡ í‡·ÎËˆ‡ 2.

êÂÁÛÎÚ‡ÚËÚÂ Ò‡ ËÎ˛ÒÚË‡ÌË Ì‡ ÙË„. 1, ÙË„. 2 Ë ÙË„. 3ÔÓ ÓÚ‰ÂÎÌËÚÂ ÚÂÒÚÓ‚Â Á‡ ‰‚Â„Ó‰Ë¯ÌËfl ÔÂËÓ‰ Ì‡ ÔÓÒ-ÎÂ‰fl‚‡ÌÂ. áÌ‡˜ËÏË ‡ÁÎË˜Ëfl ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡Ú ÏÂÊ‰Û ÔÓÒ-ÚËÊÂÌËflÚ‡ Ì‡ ÍÓÌÚÓÎÌ‡Ú‡ „ÛÔ‡ Ë Ô˙‚ÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ

Ì‡ Ô‡ˆËÂÌÚËÚÂ Á‡ ÔÓ˜ÚË ‚ÒË˜ÍË ÔÓÍ‡Á‡ÚÂÎË ÓÚ ˜ÂÚËË-ÚÂ ÚÂÒÚ‡ (p < 0.05). ç‡È-ËÁfl‚ÂÌË Ò‡ ‡ÁÎËÍËÚÂ ÏÂÊ‰ÛÍÓÌÚÓÎÌ‡Ú‡ „ÛÔ‡ Ë Ô‡ˆËÂÌÚËÚÂ ÔÓ ÚÂÒÚ‡ PASAT – Ô‡-ˆËÂÌÚËÚÂ Ô‡‚flÚ ÔÓ‚Â˜Â ÔÓÔÛÒÍË (p = 0.021) Ë ‰ÓÔÛÒ-Í‡Ú ÔÓ‚Â˜Â „Â¯ÍË ÔË ÔÓÒÎÂ‰Ó‚‡ÚÂÎÌÓÚÓ Ò˙·Ë‡ÌÂ (p =0.043). èË ˜‡ÒÚ Å Ì‡ TMT ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡ ÁÌ‡˜ËÏÓ ÔÓ-Á‡-·‡‚ÂÌÓÚÓ ÔÂ‚ÍÎ˛˜‚‡ÌÂ Ì‡ ‚ÌËÏ‡ÌËÂÚÓ ÏÂÊ‰Û ˆËÙË Ë·ÛÍ‚Ë ÔË „ÛÔ‡Ú‡ Ì‡ Ô‡ˆËÂÌÚËÚÂ.

èË Ò‡‚Ìfl‚‡ÌÂ Ì‡ ÂÁÛÎÚ‡ÚËÚÂ ÓÚ ËÁıÓ‰ÌÓÚÓ ËÁÒ-ÎÂ‰‚‡ÌÂ Ë ‚ÚÓ‡Ú‡ ÓˆÂÌÍ‡ (Ì‡ ¯ÂÒÚËfl ÏÂÒÂˆ ÓÚ ÎÂ˜ÂÌË-ÂÚÓ), ÒÂ Ì‡·Î˛‰‡‚‡ ÔÓ‰Ó·fl‚‡ÌÂ Ì‡ ÔÓÒÚËÊÂÌËflÚ‡ ‚ ÔÓ-‚Â˜ÂÚÓ ‡ÒÔÂÍÚË Ì‡ ËÁÒÎÂ‰‚‡ÌËÚÂ ÔÓˆÂÒË. ç‡È-Ò˙˘ÂÒÚ-‚ÂÌ‡ ÔÓÏflÌ‡ ÒÂ ÓÚ˜ËÚ‡ ÔË ÚÂÒÚ‡ PASAT ÔÓ ÓÚÌÓ¯Â-ÌËÂ Ì‡ ÔÓÔÛÒÍËÚÂ, ÔË ÍÓËÚÓ ËÏ‡ ÚÂÌ‰ÂÌˆËfl Í˙Ï ÁÌ‡˜Ë-ÏÓ Ì‡Ï‡ÎÂÌËÂ ÒÔflÏÓ Ô˙‚ÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ (p = 0.061).

ÄÌ‡ÎËÁ˙Ú Ì‡ ‰‡ÌÌËÚÂ ÒÎÂ‰ Â‰ÌÓ„Ó‰Ë¯ÌÓ Ë ÒÎÂ‰ ‰‚Â„Ó-‰Ë¯ÌÓ ÎÂ˜ÂÌËÂ (ÒÔflÏÓ ËÁıÓ‰ÌËÚÂ ‰‡ÌÌË) ÔÓÍ‡Á‚‡ Ó·˘‡ÚÂÌ‰ÂÌˆËfl Í˙Ï ÔÓ‰Ó·ÂÌËÂ Ì‡ ÂÁÛÎÚ‡ÚËÚÂ, ·ÂÁ ‰‡ ÒÂ ‰ÓÒ-ÚË„‡Ú ÌË‚‡ Ì‡ ÁÌ‡˜ËÏÓÒÚ ÏÂÊ‰Û ÓÚ‰ÂÎÌËÚÂ ËÁÒÎÂ‰‚‡ÌËfl ÒËÁÍÎ˛˜ÂÌËÂ Ì‡ ·ÓflÚ ÔÓÔÛÒÍË ÔÓ ÚÂÒÚ‡ PASAT ‚ Í‡fl Ì‡Ô˙‚‡Ú‡ „Ó‰ËÌ‡ ÓÚ ÎÂ˜ÂÌËÂÚÓ. ç‡È-ËÁ‡ÁÂÌ‡ ‰ËÌ‡ÏËÍ‡ ÒÂÂ„ËÒÚË‡ ÔË ÚÂÒÚ‡ PASAT ÔË ‡ÁÎË˜ÌËÚÂ ‚Ë‰Ó‚Â„Â¯ÍË Ë ‚ ÔÓÍ‡Á‡ÚÂÎfl ÔÓ˜ÂÚÂÌË ‰ÛÏË Ì‡ ëÚÛÔ ÚÂÒÚ‡.

éÚÌÓÒËÚÂÎÌÓ Á‡‰˙Ê‡ÌÂ Ì‡ ÔÓÒÚËÊÂÌËflÚ‡ ÒÂ Ì‡·Î˛-‰‡‚‡ ÔË Á‡‰‡˜ËÚÂ, ÍÓËÚÓ Ò˙‰˙Ê‡Ú ‰‚Ë„‡ÚÂÎÂÌ ÍÓÏÔÓ-ÌÂÌÚ Ë ÓÚÌÓÒËÚÂÎÌÓ ÔÓ-ÒÎ‡·Ó ÍÓ„ÌËÚË‚ÌÓ Ì‡ÚÓ‚‡‚‡ÌÂ -Digit Symbol Ë Trail Making Test, ˜‡ÒÚ Ä.

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êÂÁÛÎÚ‡ÚËÚÂ ÓÚ ÚÓ‚‡ ÔÓÛ˜‚‡ÌÂ ÔÓÍ‡Á‚‡Ú Ì‡Û¯Â-ÌËfl ‚ ‡·ÓÚÌ‡Ú‡ Ô‡ÏÂÚ, ÂÍÁÂÍÛÚË‚ÌËfl ÍÓÌÚÓÎ Ë ‚ÌËÏ‡-ÌËÂÚÓ ÔË Ô‡ˆËÂÌÚË Ò ÎÂÍ‡ ÒÚÂÔÂÌ Ì‡ ÔËÒÚ˙ÔÌÓ-ÂÏË-ÚÂÌÚÌ‡ ÙÓÏ‡ Ì‡ åë. ëÎÂ‰ ‰‚Û„Ó‰Ë¯ÌÓ ÔÓÒÎÂ‰fl‚‡ÌÂ Ì‡ÚÂÁË ÍÓ„ÌËÚË‚ÌË ÔÓˆÂÒË Ì‡ ÙÓÌ‡ Ì‡ ÎÂ˜ÂÌËÂ Ò INF-beta-1b (Betaferon) ÒÂ Ì‡·Î˛‰‡‚‡ ÚÂÌ‰ÂÌˆËfl Í˙Ï ÔÓ‰Ó·fl‚‡ÌÂÌ‡ ÔÓÒÚËÊÂÌËflÚ‡ Í‡ÍÚÓ ÔÓ ÓÚ‰ÂÎÌËÚÂ ÌÂ‚ÓÔÒËıÓÎÓ-„Ë˜ÌË ÚÂÒÚÓ‚Â, Ú‡Í‡ Ë ‚ Á‡‚ËÒËÏÓÒÚ ÓÚ ÔÓ‰˙ÎÊËÚÂÎ-ÌÓÒÚÚ‡ Ì‡ ÔËÂÏ‡ Ì‡ ÏÂ‰ËÍ‡ÏÂÌÚ‡. ïËÔÓÚÂÁËÚÂ ÌË Á‡ÔÓÎÓÊËÚÂÎÌÓ ‚˙Á‰ÂÈÒÚ‚ËÂ ‚˙ıÛ ·˙ÁËÌ‡Ú‡ Ì‡ ÔÂ‡-·ÓÚÍ‡Ú‡ Ì‡ ËÌÙÓÏ‡ˆËflÚ‡, ‡·ÓÚÌ‡Ú‡ Ô‡ÏÂÚ Ë ÂÍÁÂÍÛ-ÚË‚ÌËfl ÍÓÌÚÓÎ ÒÂ ÔÓÚ‚˙Ê‰‡‚‡Ú ˜‡ÒÚË˜ÌÓ. èÓ‰Ó·Â-ÌËÂ ÒÂ Ì‡·Î˛‰‡‚‡ ÔË ÚÂÒÚ‡ PASAT (ÔÓÔÛÒÍË) Ë ÔË ‰‚‡ÓÚ ÔÓÍ‡Á‡ÚÂÎËÚÂ Ì‡ ëÚÛÔ ÚÂÒÚ‡. éÚ˜‡ÒÚË ÒÂ ÔÓÚ‚˙-Ê‰‡‚‡ ıËÔÓÚÂÁ‡Ú‡ ÌË Á‡ ÔÓ-ËÁ‡ÁÂÌËfl ÂÙÂÍÚ ‚˙ıÛ Á‡‰‡-˜Ë, ‡Ì„‡ÊË‡˘Ë ‡ÒÔÂÍÚË Ì‡ ‚ËÒ¯ËÚÂ ÍÓ„ÌËÚË‚ÌË ÔÓˆÂ-ÒË (TMT ˜‡ÒÚ Å), ÓÚÍÓÎÍÓÚÓ ÔË Á‡‰‡˜Ë Ò‚˙Á‡ÌË ÔÂ-‰ËÏÌÓ Ò „‡ÙÓÏÓÚÓÌ‡Ú‡ ËÌÚÂ„‡ˆËfl (TMT ˜‡ÒÚ Ä),Ú˙È Í‡ÚÓ ÚÂÌ‰ÂÌˆËflÚ‡ ÌÂ ‰ÓÒÚË„‡ ÌË‚Ó Ì‡ ÁÌ‡˜ËÏÓÒÚ.

èÂ‰Ë ‚ÒË˜ÍÓ ‰‡ÌÌËÚÂ ÓÚ ÔÓÛ˜‚‡ÌÂÚÓ ÔÓÍ‡Á‚‡Ú ÒÚ‡-


êÂÁÛÎÚ‡ÚË ÓÚ ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ ÔÓ „ÛÔË Ô‡ˆËÂÌÚË Ë Ì‡ ÍÓÌÚÓÎÌ‡Ú‡ „ÛÔ‡ (ÒÂ‰ÌË ÒÚÓÈÌÓÒÚË)

çÂ‚ÓÔÒËıÓÎÓ„Ë˜ÂÌ ÚÂÒÚ äÓÌÚÓÎÌ‡ „ÛÔ‡ àÁıÓ‰ÌÓ ËÁÒÎÂ‰‚‡ÌÂ ëÎÂ‰ 6 ÏÂÒÂˆ‡ ëÎÂ‰ 1 „Ó‰ËÌ‡ ëÎÂ‰ 2 „Ó‰ËÌËÔÓÍ‡Á‡ÚÂÎË n = 23 n = 52 n = 32 n = 21 n = 15Stroop CW TestW ‰ÛÏË 91,7 68,5‡ 73,4‡ 74,7‡ 77,2‡

C ˆ‚flÚ 75 64,6‡ 64,4‡ 65,8‡ 68,1CW ‰ÛÏË/ˆ‚flÚ 48,4 45,1 46,2 46,8 47,2àÌÚÂÙÂÂÌÚÂÌ ·‡Î 8,5 11,7 12,1 11,6 11,1PASATèÓÔÛÒÍË 1,2 3,6‡ 2,4‡ 2,1 · 2,6‡

ÉÂ¯ÍË 1,4 3,2‡ 2,9‡ 2,7‡ 1,9ÇÂÌË 27,5 23,5‡ 25,1 25,6 25,3Trail Making Testó‡ÒÚ Ä (ÒÂÍ) 35 47,4‡ 48,6‡ 48,1‡ 47,5‡

ó‡ÒÚ Å (ÒÂÍ) 74,6 106,4‡ 100,3‡ 98,4‡ 96,4‡

Digit Symbol 58,4 40,2‡ 43,6‡ 43,5‡ 44,2ãÂ„ÂÌ‰‡: ‡ – ÒÚ‡ÚËÒÚË˜ÂÒÍ‡ ÁÌ‡˜ËÏÓÒÚ ÒÔflÏÓ ÍÓÌÚÓÎÌ‡Ú‡ „ÛÔ‡; · - ÒÚ‡ÚËÒÚË˜ÂÒÍ‡ ÁÌ‡˜ËÏÓÒÚ ÒÔflÏÓ ËÁıÓ‰ÌÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ

ÚËÒÚË˜ÂÒÍË ÁÌ‡˜ËÏ‡ ‡ÁÎËÍ‡ ÔÓ ËÁÒÎÂ‰‚‡ÌËÚÂ ÍÓ„ÌËÚË‚-ÌË ÔÓˆÂÒË ÏÂÊ‰Û Ô‡ˆËÂÌÚËÚÂ Ò åë Ë Ò˙ÓÚ‚ÂÚÌ‡Ú‡ ÔÓ‚˙Á‡ÒÚ Ë Ó·‡ÁÓ‚‡ÌËÂ ÍÓÌÚÓÎÌ‡ „ÛÔ‡. èÓ‰Ó·ÌË ÂÁÛÎ-Ú‡ÚË Á‡ Ì‡ÎË˜ËÂ Ì‡ ÍÓ„ÌËÚË‚Ì‡ ‰ËÒÙÛÌÍˆËfl ‰ÓË Ë ÔËÓÚÌÓÒËÚÂÎÌÓ ÎÂÍË ÌÂ‚ÓÎÓ„Ë˜ÌËÚÂ Ì‡Û¯ÂÌËfl (EDSSÔË Ì‡¯ËÚÂ Ô‡ˆËÂÌÚË Â ‚ ‰Ë‡Ô‡ÁÓÌ‡ 2-4) Ò‡ Ò˙Ó·˘‡‚‡ÌË ËÓÚ ‰Û„Ë ‡‚ÚÓË (1, 17).

Ç Ì‡¯ÂÚÓ ËÁÒÎÂ‰‚‡ÌÂ Á‡ Ô˙‚Ë Ô˙Ú ‚ Å˙Î„‡Ëfl ÒÂ ËÁÔÓ-ÎÁ‚‡ ÛÚ‚˙‰ÂÌËflÚ ‚ ÔÓ‰Ó·ÌË ÔÓÛ˜‚‡ÌËfl ÚÂÒÚ PASAT Ë·Â¯Â ÔÓÚ‚˙‰ÂÌ‡ ÌÂ„Ó‚‡Ú‡ ˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚ Í˙Ï ÓÚÍ-Ë‚‡ÌÂ Ì‡ ÎÂÍË ÍÓ„ÌËÚË‚ÌË ‰ÂÙËˆËÚË ÔË Ô‡ˆËÂÌÚË Òåë. íÂÒÚ˙Ú Ú‡‰ËˆËÓÌÌÓ Â ÓÔÂ‰ÂÎflÌ Í‡ÚÓ ÓˆÂÌfl‚‡˘‡·ÓÚÌ‡Ú‡ Ô‡ÏÂÚ – ÍÓ„ÌËÚË‚ÂÌ ÔÓˆÂÒ, ÔË ÍÓÈÚÓ ÓÒ-ÌÓ‚Ì‡Ú‡ ı‡‡ÍÚÂËÒÚËÍ‡ Â Ò˙ı‡ÌÂÌËÂ Ë Ï‡ÌËÔÛÎË‡ÌÂÌ‡ ÚÂÍÛ˘‡Ú‡ ËÌÙÓÏ‡ˆËfl. àÏÂÌÌÓ ÔË Ú‡ÁË Á‡‰‡˜‡, ÍÓfl-ÚÓ ÒÂ ËÁÔ˙ÎÌfl‚‡ ‚˙‚ ‚ÂÏÂ‚Ë ‰ÂÙËˆËÚ, ÒÂ Ì‡·Î˛‰‡‚‡ÚÁÌ‡˜ËÏËÚÂ ‡ÁÎË˜Ëfl Ò ÍÓÌÚÓÎÌ‡Ú‡ „ÛÔ‡, ÓÚ Â‰Ì‡ ÒÚ‡-Ì‡, ‡ ÓÚ ‰Û„‡ ÒÂ ÓÚ˜ËÚ‡ ÔÓ‰Ó·ÂÌÓ ËÁÔ˙ÎÌÂÌËÂ ÒÎÂ‰¯ÂÒÚ ÏÂÒÂ˜ÌÓÚÓ Ë ÒÎÂ‰ Â‰ÌÓ„Ó‰Ë¯ÌÓÚÓ ÎÂ˜ÂÌËÂ ÒBetaferon. íÂÒÚ˙Ú PASAT Ò˙‰˙Ê‡ Ë ÒËÎÂÌ ÂÍÁÂÍÛÚË‚ÂÌÍÓÏÔÓÌÂÌÚ, ÍÓÂÚÓ ÒÂ ‚ËÊ‰‡ Ë ÓÚ ÒıÓ‰ÒÚ‚ÓÚÓ Ò ‰ËÌ‡ÏË-Í‡Ú‡ ‚ ÔÓÒÚËÊÂÌËflÚ‡ Ì‡ ‰Û„ËÚÂ ‰‚‡ ÚÂÒÚ‡, ÍÓËÚÓÓˆÂÌfl‚‡Ú ÂÍÁÂÍÛÚË‚ÌËfl ÍÓÌÚÓÎ - ÚÂÒÚ‡ Ì‡ ëÚÛÔ Ë‚ÚÓ‡Ú‡ ˜‡ÒÚ Ì‡ TMT. ÖÍÁÂÍÛÚË‚ÌËflÚ ÍÓÌÚÓÎ Â ÍÓ„ÌË-ÚË‚ÌËflÚ ÏÂı‡ÌËÁ˙Ï, ÍÓÈÚÓ ÍÓÓ‰ËÌË‡ ËÁÔ˙ÎÌÂÌËÂÚÓ Ì‡‰‚Â Â‰ÌÓ‚ÂÏÂÌÌÓ ÔÓÚË˜‡˘Ë Á‡‰‡˜Ë Ë ÔÓÚËÒÍ‡ Â‡ÍˆËfl-Ú‡ Í˙Ï ÌÂÌÛÊÌ‡Ú‡ Á‡ ÒËÚÛ‡ˆËflÚ‡ ËÌÙÓÏ‡ˆËfl. ÖÍÁÂÍÛ-ÚË‚ÌËÚÂ ÍÓÏÔÓÌÂÌÚË Ò‡ Â‰ÌË ÓÚ Ì‡È-˜ÂÒÚÓ Á‡ÒÂ„Ì‡ÚË-ÚÂ ÍÓ„ÌËÚË‚ÌË ÙÛÌÍˆËË ÔË Më Ë ÚÓ‚‡ Â ÔÂ‰Ë ‚ÒË˜ÍÓÒ‚˙Á‡ÌÓ Ò Ì‡Ï‡ÎÂÌ‡Ú‡ ÒÍÓÓÒÚ Ì‡ ËÌÙÓÏ‡ˆËÓÌÌ‡Ú‡ÔÂ‡·ÓÚÍ‡ (6). èË ÚÂÒÚ‡ PASAT Â Ì‡Ï‡ÎÂÌ ÍÓÌÚÓÎ˙Ú

‚˙ıÛ ‡ÚËÍÛÎ‡ÚÓÌËfl ÏÂı‡ÌËÁ˙Ï Ì‡ ÏËÒÎÂÌÓÚÓ ÔÓ‚Ú‡-flÌÂ Ë Â‰ÌÓ‚ÂÏÂÌÌÓÚÓ ÏËÒÎÂÌÓ Ò˙·Ë‡ÌÂ, ‡ ÔË ÚÂÒÚ‡Ì‡ ëÚÛÔ Â Ì‡Ï‡ÎÂÌ ÍÓÌÚÓÎ˙Ú ‚˙ıÛ ÌÂÔÓ‰ıÓ‰fl˘Ëfl ‡‚-ÚÓÏ‡ÚËÁË‡Ì ‚Â·‡ÎÂÌ ÓÚ„Ó‚Ó. ÖÍÁÂÍÛÚË‚ÌËflÚ ÍÓÌÚ-ÓÎ Â ‚ ÚflÒÌ‡ ‚˙ÁÍ‡ Ò˙Ò ÒÍÓÓÒÚÚ‡ Ì‡ ËÌÙÓÏ‡ˆËÓÌÌ‡-Ú‡ ÔÂ‡·ÓÚÍ‡, ÍÓflÚÓ ˜ÂÒÚÓ ÒÂ Á‡·‡‚fl ‡ÌÓ ‚ ıÓ‰‡ Ì‡ ·Ó-ÎÂÒÚÚ‡ Ë ÒÂ ÓÚ‡Áfl‚‡ ÔflÍÓ ‚˙ıÛ ËÁÔ˙ÎÌÂÌËÂÚÓ Ì‡ ÔÓ-‰Ó·ÌË ÍÓ„ÌËÚË‚ÌË Á‡‰‡˜Ë.

àÌÚÂÂÒ˙Ú Í˙Ï ‡ÌÌÓ ÓÚÍË‚‡ÌÂ Ì‡ ÍÓ„ÌËÚË‚ÌË ÔÓ-ÏÂÌË ÔË Ô‡ˆËÂÌÚË Ò åë Â ÓÒÌÓ‚‡ÚÂÎÂÌ, Á‡˘ÓÚÓ ËÏ‡ÔflÍÓ ÓÚÌÓ¯ÂÌËÂ Í˙Ï Í‡˜ÂÒÚ‚ÓÚÓ Ì‡ ÊË‚ÓÚ‡ ËÏ, ÓÚ Â‰-Ì‡ ÒÚ‡Ì‡, ‡ ÓÚ ‰Û„‡, Â Ò‚˙Á‡Ì Ò Ì‡ÏË‡ÌÂÚÓ Ì‡ ‰ÓÔ˙Î-ÌËÚÂÎÌË Ï‡ÍÂË Á‡ ÌÂ‚ÓÌ‡ÎÌ‡ ‰ÂÁËÌÚÂ„‡ˆËfl. êÂ‰Ëˆ‡Ò˙‚ÂÏÂÌÌË ËÁÒÎÂ‰‚‡ÌËfl ËÁÛ˜‡‚‡Ú ÍÓÂÎ‡ˆËËÚÂ Ì‡ ÔÓÒ-ÚËÊÂÌËflÚ‡ ÔË ÓÚ‰ÂÎÌË ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌË ÚÂÒÚÓ‚Â ËÏ‡„ÌËÚÌÓ-ÂÁÓÌ‡ÌÒÌË Ì‡ıÓ‰ÍË ÔË Ô‡ˆËÂÌÚË Ò åë (11,20) Ë ÔË Á‰‡‚Ë ÎËˆ‡ (2). èË Ô‡ˆËÂÌÚËÚÂ Â Ì‡ÎËˆÂ ÔÂ-‰ËÎÂÍˆËfl Á‡ ÙÓÌÚ‡ÎÌËÚÂ Ë Ô‡ËÂÚ‡ÎÌËÚÂ Â„ËÓÌË, ÍÓË-ÚÓ ÔÓÍ‡Á‚‡Ú ÔÓ-„ÓÎflÏ ÔÓˆÂÌÚ Ì‡ Á‡ÒÂ„Ì‡ÚÓ ·flÎÓ ‚Â˘Â-ÒÚ‚Ó, ‡ Ó·ÂÏ˙Ú Ì‡ ÎÂÁËËÚÂ Â ‚ËÒÓÍÓ ÍÓÂÎË‡Ì Ò ÚÂÒÚ‡PASAT. äÓ„ÌËÚË‚ÌËÚÂ ‰ËÒÙÛÌÍˆËË, ˜ÂÒÚÓ Ì‡·Î˛‰‡‚‡ÌË‰ÓË Ë ÔË ÎÂÍË ÙÓÏË Ì‡ åë, ÏÓ„‡Ú ‰‡ ÒÂ Ò‚˙Ê‡Ú Ò Ì‡-

Û¯ÂÌ‡Ú‡ ËÌÚÂ„‡ˆËfl ÏÂÊ‰Û ÙÓÌÚ‡ÎÌËÚÂ Ë Ô‡ËÂÚ‡Î-ÌË ÓÚ‰ÂÎË, ÍÓËÚÓ Ò‡ ÚflÒÌÓ Ò‚˙Á‡ÌË Ò ÔÓˆÂÒËÚÂ Ì‡ÒÎÓÊÌËÚÂ ÙÓÏË Ì‡ ‚ÌËÏ‡ÌËÂ Ë ‡·ÓÚÌ‡Ú‡ Ô‡ÏÂÚ.

ç‡¯ËÚÂ ÂÁÛÎÚ‡ÚË Ò‡ ‚ Ò˙ÓÚ‚ÂÚÒÚ‚ËÂ Ò Ì‡È-ÌÓ‚ËÚÂ‰‡ÌÌË Á‡ ‚ÂÓflÚÂÌ ÔÓÎÓÊËÚÂÎÂÌ ÂÙÂÍÚ Ì‡ INF-beta-1b‚˙ıÛ ÍÓ„ÌËÚË‚ÌÓÚÓ ÙÛÌÍˆËÓÌË‡ÌÂ Ì‡ Ô‡ˆËÂÌÚË ÒÔËÒÚ˙ÔÌÓ-ÂÏËÚÂÌÚÂÌ ıÓ‰ Ì‡ åë ÒÎÂ‰ ‰‚Â„Ó‰Ë¯ÌÓ ÔË-ÎÓÊÂÌËÂ Ì‡ ÔÂÔ‡‡Ú‡ ( 4,9). ìÒÚ‡ÌÓ‚ÂÌËÚÂ ÓÚ Ì‡Ò ÔÓfl-‚Ë Ì‡ ÔÓ‰Ó·ÂÌËÂ Ò‡ Ì‡È-flÒÌË ÒÎÂ‰ ¯ÂÒÚ ÏÂÒÂ˜ÌÓÚÓ ÎÂ˜Â-ÌËÂ, ‡ ÒÎÂ‰ ÚÓ‚‡ ÔÓ‰Ó·ÂÌËÚÂ ÔÓÍ‡Á‡ÚÂÎË ÌÂ ‰ÓÒÚË„‡ÚÌË‚‡ Ì‡ ÁÌ‡˜ËÏÓÒÚ Ë ÒÂ Ì‡·Î˛‰‡‚‡ ÓÚÌÓÒËÚÂÎÌÓ Á‡‰˙-Ê‡ÌÂ Ì‡ ÔÓÒÚËÊÂÌËflÚ‡. çÂ‰ÓÒÚ‡Ú˙Í Ì‡ ÔÂ‰ÒÚ‡‚ÂÌÓÚÓËÁÒÎÂ‰‚‡ÌÂ Â ÔÓÒÚÂÔÂÌÌÓÚÓ ÓÚÔ‡‰‡ÌÂ Ì‡ Ó·ı‚‡Ì‡ÚËÚÂÓÚÌ‡˜‡ÎÓ Ô‡ˆËÂÌÚË Ë Ò‡‚ÌËÚÂÎÌÓ Ï‡ÎÍ‡Ú‡ „ÛÔ‡ Ô‡ˆË-ÂÌÚÍË ÔÂÏËÌ‡ÎË ÔÂÁ ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌÓÚÓ ËÁÒÎÂ‰‚‡ÌÂÒÎÂ‰ ‰‚Â„Ó‰Ë¯Ì‡ ÚÂ‡ÔËfl Ò Betaferon, Í‡ÍÚÓ Ë ÎËÔÒ‡Ú‡ Ì‡ÔÓ‚ÚÓÌË ËÁÒÎÂ‰‚‡ÌËfl ÔË ÍÓÌÚÓÎÌ‡Ú‡ „ÛÔ‡.

Ç Á‡ÍÎ˛˜ÂÌËÂ, ËÁÒÎÂ‰‚‡ÌÂÚÓ ÔÓ‰ÍÂÔfl ‰ÓÒÂ„‡¯ÌËÚÂ ‰‡Ì-ÌË, ˜Â ÚÂ‡ÔËflÚ‡ Ò INF-beta-1b (Betaferon) Ì‡Â‰ Ò Ì‡Ï‡Îfl-‚‡ÌÂÚÓ Ì‡ ·Ófl Ì‡ ÔËÒÚ˙ÔËÚÂ Ë Á‡·‡‚flÌÂ Ì‡ ÔÓ„ÂÒËflÚ‡Ì‡ ·ÓÎÂÒÚÚ‡ Ò˙˘Ó Ú‡Í‡ Á‡‰˙Ê‡ ÍÓ„ÌËÚË‚ÌËfl ÛÔ‡‰˙Í ÔËÔ‡ˆËÂÌÚË Ò ÔËÒÚ˙ÔÌÓ-ÂÏËÚÂÌÚÂÌ ıÓ‰ Ì‡ åë.

ãàíÖêÄíìêÄ:1. í‡ÈÍÓ‚ ã., çËÍÓÎÓ‚‡ É., ò‡Îfl‚ÒÍ‡ Ä., à‚‡ÌÓ‚‡ ë., ÉÂÓ„ËÂ‚ Ñ., üÌ˜Â‚‡

ë.. ç‡Û¯ÂÌËfl ‚ Ô‡ÏÂÚÚ‡ Ë ÂÍÁÂÍÛÚË‚ÌËÚÂ ÙÛÌÍˆËË ÔË ·ÓÎÌË Ò ÏÌÓ-ÊÂÒÚ‚ÂÌ‡ ÒÍÎÂÓÁ‡. åÓÁ˙˜ÌÓ-Ò˙‰Ó‚Ë Á‡·ÓÎfl‚‡ÌËfl, 10, 2002, 2, 24-27.

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îË„. 1. PST om – ÔÓÔÛÒÍË ÔË PASAT; PST com – ÌÂ‚flÌÓ Ò˙·Ë‡ÌÂ ÔËPASAT

îË„. 2. Stroop W – ·ÓÈ ÔÓ˜ÂÚÂÌË ‰ÛÏËStroop C – ·ÓÈ Ì‡ÁÓ‚‡ÌË ˆ‚ÂÚÓ‚Ë

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Ä‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËfl: å‡„‡ËÚ‡ ê‡‰ÓÒÎ‡‚Ó‚‡ ê‡È˜Â‚‡, ‰.Ô. ìåÅÄã “ÄÎÂÍÒ‡Ì‰Ó‚ÒÍ‡”, äÎËÌËÍ‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl, ·ÛÎ. “ÉÂÓ„Ë ëÓÙËÈÒÍË” 1, ëÓÙËfl 1431ÚÂÎ.: 92 30 544e-mail: [email protected]


éË„ËÌ‡ÎÌË ÒÚ‡ÚËËäéÉçàíàÇÖç ÖîÖäí çÄ éäëäÄêÅÄáÖèàç èêà èÄñàÖçíà

ë îéäÄãçÄ ÖèàãÖèëàüê. ÇÂÎËÁ‡Ó‚‡, ã. í‡ÈÍÓ‚

ìåÅÄã “ÄÎÂÍÒ‡Ì‰Ó‚ÒÍ‡” äÎËÌËÍ‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl, åÂ‰ËˆËÌÒÍË ÛÌË‚ÂÒËÚÂÚ, ëÓÙËfl

SUMMARY

COGNITIVE EFFECT OF OXCARBAZEPINE INPATIENTS WITH FOCAL EPILEPSY

R. Velizarova, L. TraykovOxcarbazepine is a keto homologue of carbamazepine with

completely different metabolic profile. It is effectively used asmonotherapy or adjunctive therapy for partial seizures with orwithout secondarily generalized tonic-clonic seizures. Thereare a small number of limited and inconsistent dates concern-ing its cognitive profile.

The aim of this study is to investigate the pattern of cogni-tive disturbances in a group of adult patients with focal epilep-sy treated with Oxcarbazepine.

We investigated 16 patients with complex partial or sec-ondarily generalized seizures (MMSE = 29.3) as comparedwith 30 normal controls (MMSE = 29.1). The study groupswere closely matched in terms of age and education. All sub-jects were assessed by means of a comprehensive neuropsy-chological battery designed to measure reaction time, memo-ry, attention, naming, praxis and executive functions.

Patients with epilepsy had a significantly worse scores thanthe normal controls on the category verbal fluency (respec-tively 20.4 + 4.5 v/s 24.0 + 4.2, < 0.05) and on the literalverbal fluency (12.8 + 4.9 v/s 15.8 + 3.7, p<0.05). There is alack of significant differences with respect to all the rest oftests and scales.

The patients with epilepsy have a need of long-term anti-convulsant therapy. Oxcarbazepine has a favorable cognitiveprofile, probably connected with the lack of directly sup-pressing effect over the brain inhibitory mechanisms. Theefficacy and safety of Oxcarbazepine make it promising

antiepileptic drug for a long treatment.KEY WORDS: focal epilepsy, cognitive functions, memo-

ry, language, executive functions, oxcarbazepine.

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éÍÒÍ‡·‡ÁÂÔËÌ˙Ú Â ÍÂÚÓ ıÓÏÓÎÓ„ Ì‡ Í‡·‡Ï‡ÁÂÔËÌ‡ ÒÌ‡Ô˙ÎÌÓ ‡ÁÎË˜ÂÌ ÏÂÚ‡·ÓÎËÚÂÌ ÔÓÙËÎ, ÛÒÔÂ¯ÌÓ ÔËÎ‡-„‡Ì Á‡ ÏÓÌÓÚÂ‡ÔËfl Ë ‰ÓÔ˙Î‚‡˘Ó ÎÂ˜ÂÌËÂ Ì‡ Ô‡ˆËÂÌÚË ÒÔ‡ˆË‡ÎÌË ÔËÔ‡‰˙ˆË Ò˙Ò ËÎË ·ÂÁ ‚ÚÓË˜Ì‡ „ÂÌÂ‡ÎËÁ‡-ˆËfl. éÒÍ˙‰ÂÌ Â ·ÓflÚ Ì‡ ÔÛ·ÎËÍÛ‚‡ÌËÚÂ ‰Ó ÏÓÏÂÌÚ‡ÔÓÛ˜‚‡ÌËfl Á‡ ÌÂ„Ó‚Ëfl ÍÓ„ÌËÚË‚ÂÌ ÂÙÂÍÚ.

ñÂÎÚ‡ Ì‡ Ì‡ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡ÌÂ Â ‰‡ ÒÂ ËÁÒÎÂ‰‚‡ ÍÓ„-ÌËÚË‚ÌÓÚÓ ÙÛÌÍˆËÓÌË‡ÌÂ Ì‡ ‚˙Á‡ÒÚÌË ·ÓÎÌË Ò ÙÓÍ‡Î-Ì‡ ÂÔËÎÂÔÒËfl, ÎÂÍÛ‚‡˘Ë ÒÂ Ò ÓÍÒÍ‡·‡ÁÂÔËÌ.

àÁÒÎÂ‰‚‡ÌË Ò‡ 16 ·ÓÎÌË Ò ÍÓÏÔÎÂÍÒÌË Ô‡ˆË‡ÎÌË ÔË-Ô‡‰˙ˆË Ò˙Ò ËÎË ·ÂÁ ‚ÚÓË˜Ì‡ „ÂÌÂ‡ÎËÁ‡ˆËfl ÎÂÍÛ‚‡ÌË ÔÓ-‚Â˜Â ÓÚ ¯ÂÒÚ ÏÂÒÂˆ‡ Ò ÓÍÒÍ‡·‡ÁÂÔËÌ ‚ ÚÂ‡ÔÂ‚ÚË˜ÌË‰ÓÁË (ÒÂ‰ÌÓ 950 Ï„/‰Ì). ÇÒË˜ÍË Û˜‡ÒÚÌËˆË ‚ ÔÓÛ˜‚‡ÌÂ-ÚÓ Ò‡ ÓˆÂÌÂÌË Ò ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜Ì‡ ·‡ÚÂËfl ÔÂ‰Ì‡ÁÌ‡˜Â-Ì‡ ‰‡ ËÁÏÂ‚‡ ‚Â·‡ÎÌ‡ Ë ÌÂ‚Â·‡ÎÌ‡ Ô‡ÏÂÚ, ‚ÌËÏ‡ÌËÂ,Â‡ÍˆËÓÌÌÓ ‚ÂÏÂ, ÍÓÌÒÚÛÍÚË‚ÂÌ Ô‡ÍÒËÒ, Â˜Â‚Ë Ë ÂÍ-ÁÂÍÛÚË‚ÌË ÙÛÌÍˆËË. êÂÁÛÎÚ‡ÚËÚÂ Ì‡ „ÛÔ‡Ú‡ ·ÓÎÌË Ò‡Ò‡‚ÌÂÌË Ò ÚÂÁË Ì‡ Ò˙ÓÚ‚ÂÚÌ‡ ÔÓ ‚˙Á‡ÒÚ, ÔÓÎ Ë Ó·‡ÁÓ-‚‡ÚÂÎÂÌ ˆÂÌÁ, ÍÓÌÚÓÎÌ‡ „ÛÔ‡ Á‰‡‚Ë ÎËˆ‡.

è‡ˆËÂÌÚËÚÂ Ò ÂÔËÎÂÔÒËfl ÔÓÍ‡Á‚‡Ú ÁÌ‡˜ËÏÓ ÔÓ-ÎÓ¯ËÂÁÛÎÚ‡ÚË ÓÚ ÍÓÌÚÓÎÌ‡Ú‡ „ÛÔ‡ ‚ ÚÂÒÚÓ‚ÂÚÂ Á‡ Í‡ÚÂ-„ÓË‡ÎÌ‡ (Ò˙ÓÚ‚ÂÚÌÓ 20.4+4.5 ÒÔflÏÓ 24.0+4.2, < 0.05)Ë ÎËÚÂ‡ÎÌ‡ ‚Â·‡ÎÌ‡ ÙÎÛË‰ÌÓÒÚ (12.8+4.9 ÒÔflÏÓ15.8+3.7, p<0.05). çÂ ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡Ú ÁÌ‡˜ËÏË ‡ÁÎËÍË ÔÓÓÚÌÓ¯ÂÌËÂ Ì‡ ÓÒÚ‡Ì‡ÎËÚÂ ÚÂÒÚÓ‚Â Ë ÒÍ‡ÎË.

ÅÓÎÌËÚÂ Ò ÂÔËÎÂÔÒËfl ÒÂ ÌÛÊ‰‡flÚ ÓÚ ÔÓ‰˙ÎÊËÚÂÎÌÓÏÂ‰ËÍ‡ÏÂÌÚÓÁÌÓ ÎÂ˜ÂÌËÂ, ÍÓÂÚÓ Ó·ÛÒÎ‡‚fl ÌÂÓ·ıÓ‰ËÏÓ-ÒÚÚ‡ ÓÚ ÔÓÁÌ‡‚‡ÌÂ Ì‡ ıÓÌË˜ÌËÚÂ ÒÚ‡ÌË˜ÌË ÂÙÂÍÚË Ì‡ÄÖå, Ò˙˘ÂÒÚ‚ÂÌ‡ ˜‡ÒÚ, ÓÚ ÍÓËÚÓ Ò‡ ÍÓ„ÌËÚË‚ÌËÚÂ Ì‡-Û¯ÂÌËfl. éÍÒÍ‡·‡ÁÂÔËÌ ÔËÚÂÊ‡‚‡ ·Î‡„ÓÔËflÚÂÌ ÍÓ„-ÌËÚË‚ÂÌ ÔÓÙËÎ, ‚ÂÓflÚÌÓ Ò‚˙Á‡Ì Ò ÎËÔÒ‡Ú‡ Ì‡ ‰ËÂÍ-ÚÂÌ ÔÓ‰ÚËÒÍ‡˘ ÂÙÂÍÚ ‚˙ıÛ ËÌıË·ËÚÓÌËÚÂ ÏÂı‡ÌËÁÏËÌ‡ ÏÓÁ˙Í‡, ÍÓÂÚÓ „Ó Ô‡‚Ë Ì‡‰ÂÊ‰ÂÌ Ë ÒË„ÛÂÌ ÏÂ‰ËÍ‡-ÏÂÌÚ Á‡ ‰˙Î„ÓÒÓ˜Ì‡ ÛÔÓÚÂ·‡.

äãûóéÇà Ñìåà: ÙÓÍ‡ÎÌ‡ ÂÔËÎÂÔÒËfl, ÍÓ„ÌËÚË‚ÌËÙÛÌÍˆËË, Ô‡ÏÂÚ, Â˜, ÂÍÁÂÍÛÚË‚ÌË ÙÛÌÍˆËË, ÓÍÒÍ‡·‡ÁÂÔËÌ.

ÇöÇÖÑÖçàÖ

ÖÔËÎÂÔÒËflÚ‡ Â ÏÌÓ„ÓÒÚÂÔÂÌÂÌ Ë ÔÓ„ÂÒË‚ÂÌ ÔÓˆÂÒ.èÓÏÂÌËÚÂ, ‚˙ÁÌËÍ‚‡˘Ë Ì‡ ÍÎÂÚ˙˜ÌÓ Ë ÏÓÎÂÍÛÎflÌÓ ÌË-‚Ó, ÔÓ ‚ÂÏÂ Ì‡ ÔËÔ‡‰˙Í Ë ÒÎÂ‰ ÌÂ„Ó, Ì‡Û¯‡‚‡Ú ·‡Î‡ÌÒ‡ÏÂÊ‰Û ÂÍÒˆËÚ‡ÚÓÌ‡ Ë ËÌıË·ËÚÓÌ‡ ÌÂ‚ÓÚ‡ÌÒÏËÒËflË ËÏ‡Ú Á‡ Í‡ÂÌ ÂÙÂÍÚ Û‚ÂÎË˜ÂÌ‡ ıËÔÂ‚˙Á·Û‰ËÏÓÒÚ,ÔÂ‰ËÒÔÓÁËˆËfl Í˙Ï ÔÓ‚Ú‡fl˘Ë ÒÂ ÔËÔ‡‰˙ˆË Ë Á‡‰˙Î·Ó˜‡-‚‡˘ ÒÂ ÍÓ„ÌËÚË‚ÂÌ ‰ÂÙËˆËÚ (4). Ç ÔÓ‚Â˜ÂÚÓ ÒÎÛ˜‡Ë Ô‡ˆË-ÂÌÚËÚÂ Ò ÂÔËÎÂÔÒËfl ÒÂ ÌÛÊ‰‡flÚ ÓÚ ÔÓ‰˙ÎÊËÚÂÎÌÓ ÏÂ-‰ËÍ‡ÏÂÌÚÓÁÌÓ ÎÂ˜ÂÌËÂ, Ò Â‡ÎÌ‡ ‚˙ÁÏÓÊÌÓÒÚ Á‡ Ì‡ÒÎ‡„‚‡-ÌÂ ‚˙‚ ‚ÂÏÂÚÓ Ì‡ ıÓÌË˜ÌËÚÂ ÒÚ‡ÌË˜ÌË ÂÙÂÍÚË Ì‡ ‡Ì-ÚËÂÔËÎÂÔÚË˜ÌËÚÂ ÏÂ‰ËÍ‡ÏÂÌÚË (ÄÖå). èÓÁÌ‡‚‡ÌÂÚÓÌ‡ ÍÓ„ÌËÚË‚ÌËfl ÂÙÂÍÚ Ì‡ ÓÚ‰ÂÎÌËÚÂ ÄÖå ËÏ‡ „ÓÎflÏ‡Ô‡ÍÚË˜ÂÒÍ‡ ÒÚÓÈÌÓÒÚ ÔË ÔÂˆÂÌÍ‡Ú‡ Ì‡ ÓÚÌÓ¯ÂÌËÂ-ÚÓ ËÒÍ : ÔÓÎÁ‡ ÓÚ ÔÓ‚ÂÊ‰‡ÌÓÚÓ ÎÂ˜ÂÌËÂ.

éÍÒÍ‡·‡ÁÂÔËÌ (OXC) Â ÍÂÚÓ ıÓÏÓÎÓ„ Ì‡ Í‡·‡Ï‡ÁÂÔËÌ(CBZ) Ò Ì‡Ô˙ÎÌÓ ‡ÁÎË˜ÂÌ ÏÂÚ‡·ÓÎËÚÂÌ ÔÓÙËÎ. èË ˜Ó-‚ÂÍ‡ ÍÂÚÓ „ÛÔ‡Ú‡ ·˙ÁÓ ÒÂ Â‰ÛˆË‡ Ë ÒÂ ÔÓÎÛ˜‡‚‡ „Î‡‚-ÌËflÚ ‡ÍÚË‚ÂÌ ÏÂÚ‡·ÓÎËÚ Ì‡ OXC-ÏÓÌÓıË‰ÓÍÒË ‰ÂË-‚‡Ú. é‰Ó·ÂÌ Â ‚ Ö‚ÓÔ‡ ÔÂÁ 1999 „. Á‡ ÏÓÌÓÚÂ‡ÔËfl Ë‰ÓÔ˙Î‚‡˘Ó ÎÂ˜ÂÌËÂ Ì‡ Ô‡ˆËÂÌÚË Ò Ô‡ˆË‡ÎÌË ÔËÔ‡‰˙ˆËÒ˙Ò ËÎË ·ÂÁ ‚ÚÓË˜Ì‡ „ÂÌÂ‡ÎËÁ‡ˆËfl Ì‡‰ 6 „Ó‰Ë¯Ì‡ ‚˙Á-‡ÒÚ (3).

éÒÍ˙‰ÂÌ Â ·ÓflÚ Ì‡ ÔÛ·ÎËÍÛ‚‡ÌËÚÂ ‰Ó ÏÓÏÂÌÚ‡ ÔÓ-Û˜‚‡ÌËfl Á‡ ÍÓ„ÌËÚË‚ÌËfl ÂÙÂÍÚ Ì‡ OXC. ï‡‡ÍÚÂÌ‡ ÓÒÓ-·ÂÌÓÒÚ Ì‡ ËÁÔÓÎÁ‚‡ÌËÚÂ ‰ËÁ‡ÈÌË Ò‡ ÌËÒÍËÚÂ ‰ÓÁË Ì‡ OXCË Í‡ÚÍËÚÂ ÒÓÍÓ‚Â Ì‡ ÔÓÒÎÂ‰fl‚‡ÌÂ, ÍÓÂÚÓ ÌÂ ÔÓÁ‚ÓÎfl-‚‡ ËÁ„‡Ê‰‡ÌÂÚÓ Ì‡ Â‡ÎËÒÚË˜Ì‡ ÔÂ‰ÒÚ‡‚‡ Á‡ ÍÓ„ÌË-ÚË‚ÌËfl ÂÙÂÍÚ Ì‡ ÏÂ‰ËÍ‡ÏÂÌÚ‡.

ñÂÎÚ‡ Ì‡ Ì‡ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡ÌÂ Â ‰‡ ÒÂ ËÁÒÎÂ‰‚‡ÚÍÓ„ÌËÚË‚ÌËÚÂ ÙÛÌÍˆËË Ì‡ Ô‡ˆËÂÌÚË Ò ÍËÔÚÓ„ÂÌÌ‡ ÙÓ-Í‡ÎÌ‡ ÂÔËÎÂÔÒËfl, ÎÂÍÛ‚‡˘Ë ÒÂ Ò OXC Ë ‰‡ ÒÂ Ò˙ÔÓÒÚ‡‚flÚÂÁÛÎÚ‡ÚËÚÂ ËÏ Ò ÚÂÁË Ì‡ Á‰‡‚Ë ÍÓÌÚÓÎË.

äéçíàçÉÖçí à åÖíéÑà

àÁÒÎÂ‰‚‡ÌÂÚÓ Â ÔÓ‚Â‰ÂÌÓ ÔË 16 ·ÓÎÌË Ò ÍËÔÚÓ„ÂÌÌ‡ÙÓÍ‡ÎÌ‡ ÂÔËÎÂÔÒËfl, ‡Ï·ÛÎ‡ÚÓÌÓ ÎÂÍÛ‚‡ÌË Í˙Ï çÂ‚ÓÎÓ-„Ë˜Ì‡Ú‡ ÍÎËÌËÍ‡ Ì‡ ìåÅÄã “ÄÎÂÍÒ‡Ì‰Ó‚ÒÍ‡”.

èË ÔÓ‰·Ó‡ Ì‡ ·ÓÎÌËÚÂ Ò‡ ËÁÔÓÎÁ‚‡ÌË ÒÎÂ‰ÌËÚÂ ÍË-ÚÂËË Á‡ ‚ÍÎ˛˜‚‡ÌÂ: ÔÓÒÚË ËÎË ÍÓÏÔÎÂÍÒÌË Ô‡ˆË‡ÎÌËÔËÔ‡‰˙ˆË Ò ËÎË ·ÂÁ ‚ÚÓË˜Ì‡ „ÂÌÂ‡ÎËÁ‡ˆËfl; ÏÓÌÓÚÂ‡-ÔËfl Ò OXC > 6 ÏÂÒÂˆ‡; ‚˙Á‡ÒÚ ÓÚ 16 ‰Ó 55 „.; ÌÓÏ‡ÎÂÌÌÂ‚ÓÎÓ„Ë˜ÂÌ ÒÚ‡ÚÛÒ; ‰‡‚ÌÓÒÚ Ì‡ ÂÔËÎÂÔÒËflÚ‡ ÔÓ‚Â˜ÂÓÚ Â‰Ì‡ „Ó‰ËÌ‡; ÌÓÏ‡ÎÌ‡ ÍÓÏÔ˛Ú˙Ì‡ ËÎË Ï‡„ÌËÚÌÓ Â-ÁÓÌ‡ÌÒÌ‡ ÚÓÏÓ„‡ÙËfl.

Ç ÔÓÛ˜‚‡ÌÂÚÓ ÌÂ Ò‡ ‚ÍÎ˛˜ÂÌË ÒÎÂ‰ÌËÚÂ ·ÓÎÌË: ‡Ì‡Ï-ÌÂÒÚË˜ÌË ‰‡ÌÌË Á‡ ÂÔËÎÂÔÚË˜ÌË ÒÚ‡ÚÛÒË ËÎË ÔÓ‰˙ÎÊË-ÚÂÎÌÓÒÚ Ì‡ ÔËÔ‡‰˙ˆËÚÂ ÔÓ‚Â˜Â ÓÚ 5 ÏËÌÛÚË; ‡Ì‡ÏÌÂÒ-ÚË˜ÌË ‰‡ÌÌË Á‡ Ú‡‚ÏË, ‚˙ÁÔ‡ÎËÚÂÎÌË ËÎË ‰Â„ÂÌÂ‡ÚË‚-ÌË Á‡·ÓÎfl‚‡ÌËfl Ì‡ ñçë; ÁÎÓÛÔÓÚÂ·‡ Ò ‡ÎÍÓıÓÎ, ÏÂ‰ËÍ‡-ÏÂÌÚË ËÎË Ì‡ÍÓÚËˆË.

äÎËÌË˜Ì‡Ú‡ ı‡‡ÍÚÂËÒÚËÍ‡ Ì‡ Ô‡ˆËÂÌÚËÚÂ Ò OXC ÂÔÂ‰ÒÚ‡‚ÂÌ‡ Ì‡ Ú‡·Î. 1. ÅÓÎÌËÚÂ Ò ‚ÚÓË˜ÌÓ „ÂÌÂ‡ÎËÁË-

‡ÌË ÔËÔ‡‰˙ˆË (81%) Ò‡ ÔÓ‚Â˜Â ÓÚ ·ÓÎÌËÚÂ Ò Ô‡ˆË‡ÎÌËÔËÔ‡‰˙ˆË (19%), ÌÓ ˜ÂÒÚÓÚ‡Ú‡ Ì‡ ‚ÚÓË˜ÌÓ „ÂÌÂ‡ÎË-ÁË‡ÌËÚÂ ÔËÔ‡‰˙ˆË Â ÁÌ‡˜ËÚÂÎÌÓ ÔÓ-Ï‡ÎÍ‡ ÓÚ Ú‡ÁË Ì‡Ô‡ˆË‡ÎÌËÚÂ (0.1/ÏÂÒ ÒÔflÏÓ 2/ÏÂÒ). Ç ÔÓ‚Â˜ÂÚÓ ÒÎÛ˜‡ËÒÂ Í‡Ò‡Â Á‡ ‰˙Î„Ó„Ó‰Ë¯Ì‡ ÙÓÍ‡ÎÌ‡ ÂÔËÎÂÔÒËfl, ‰Ó·Â ÍÓÏ-ÔÂÌÒË‡Ì‡ ÒÎÂ‰ ‚ÍÎ˛˜‚‡ÌÂÚÓ Ì‡ OXC Ë ÔÓ‚ÂÊ‰‡ÌÂÚÓ Ì‡ÎÂ˜ÂÌËÂ ÏËÌËÏÛÏ 6 ÏÂÒÂˆ‡ Ò ÓÔÚËÏ‡ÎÌË ‰ÓÁË. èÓÍ‡Á‡ÚÂÎÁ‡ ÍÎËÌË˜ÌËfl ÂÙÂÍÚ Ì‡ OXC, ÓÒ‚ÂÌ ÌËÒÍ‡Ú‡ ÔËÒÚ˙ÔÌ‡˜ÂÒÚÓÚ‡, Ò‡ Ë ÖÖÉ ËÁÒÎÂ‰‚‡ÌËflÚ‡, ÍÓËÚÓ Ò‡ ÌÓÏ‡ÎÌËÔË 62% ÓÚ ·ÓÎÌËÚÂ. ë ÙÓÍ‡ÎÌË ‡·ÌÓÏÌÓÒÚË Ò‡ 38% ÓÚ·ÓÎÌËÚÂ, Í‡ÚÓ ÔË 32% ÎÓÍ‡ÎËÁ‡ˆËflÚ‡ Â ÚÂÏÔÓ‡ÎÌ‡, ‡

ÔË 6%-ÙÓÌÚ‡ÎÌ‡.ë ˆÂÎ Ò‡‚Ìfl‚‡ÌÂ ÂÁÛÎÚ‡ÚËÚÂ Ì‡ ·ÓÎÌËÚÂ, ‚ ÔÓÛ˜‚‡-

ÌÂÚÓ Ò‡ ‚ÍÎ˛˜ÂÌË Ë 30 ÍÎËÌË˜ÌÓ Á‰‡‚Ë ÎËˆ‡, ÍÓËÚÓ ÓÚ-„Ó‚‡flÚ ÔÓ ‚˙Á‡ÒÚ, ÔÓÎ Ë Ó·‡ÁÓ‚‡ÚÂÎÂÌ ˆÂÌÁ Ì‡ Ô‡ˆËÂÌ-ÚËÚÂ. íÂ ÌÂ Ò˙Ó·˘‡‚‡Ú ‰‡ÌÌË, ÌËÚÓ ËÏ‡Ú ÒËÏÔÚÓÏË Á‡Í‡Í‚ÓÚÓ Ë ‰‡ Â ÌÂ‚ÓÎÓ„Ë˜ÌÓ, ÔÒËıË‡ÚË˜ÌÓ ËÎË ÒÓÏ‡-ÚË˜ÌÓ Á‡·ÓÎfl‚‡ÌÂ. ÇÒË˜ÍË Ò‡ Ò ÌÓÏ‡ÎÌË Á‡ ‚˙Á‡ÒÚÚ‡ÂÎÂÍÚÓÂÌˆÂÙ‡ÎÓ„‡ÏË (ÖÖÉ).

äÓ„ÌËÚË‚ÌËÚÂ ÙÛÌÍˆËË ÔË ·ÓÎÌËÚÂ Ò ÂÔËÎÂÔÒËfl Ë„ÛÔ‡Ú‡ ÓÚ Á‰‡‚Ë ÍÓÌÚÓÎË Ò‡ ÓˆÂÌfl‚‡ÌË Ò ·‡ÚÂËfl,Ò˙ÒÚ‡‚ÂÌ‡ ÓÚ ÒÛ·ÚÂÒÚÓ‚Â Ë Ò˙Í‡ÚÂÌË ‚ÂÒËË Ì‡ ¯ËÓ-ÍÓ ËÁÔÓÎÁ‚‡ÌË ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌË ÏÂÚÓ‰ËÍË. é·˘ËflÚÍÓ„ÌËÚË‚ÂÌ Í‡Ô‡ˆËÚÂÚ Â ËÁÒÎÂ‰‚‡Ì Ò Mini Mental StateExamination (MMSE). ëÚÂÔÂÌÚÚ‡ Ì‡ ‰ÂÔÂÒË‚ÌÓÒÚ Â ÓÚ-˜ÂÚÂÌ‡ Ò˙Ò ÒÍ‡Î‡Ú‡ Ì‡ Zung. è‡ÏÂÚÚ‡ Â ËÁÒÎÂ‰‚‡Ì‡ Ò:Digit Span (foreward) ÓÚ Wechsler Adult Intelligence Scale(WAIS), Á‡ ÓˆÂÌÍ‡ Ò˙ÓÚ‚ÂÚÌÓ Ì‡ Í‡ÚÍÓÒÓ˜Ì‡Ú‡ Ô‡-ÏÂÚ; Word List Memory Test (WLMT) Á‡ ÓˆÂÌÍ‡ Ì‡ ‰˙Î„ÓÒ-Ó˜Ì‡ ‚Â·‡ÎÌ‡ ÂÔËÁÓ‰Ë˜Ì‡ Ô‡ÏÂÚ ˜ÂÁ ËÁÒÎÂ‰‚‡ÌÂ Ì‡ Ò‚Ó-·Ó‰ÌÓÚÓ ÔËÔÓÏÌflÌÂ Ë ‡ÁÔÓÁÌ‡‚‡ÌÂÚÓ Ë Copying FigureTest (Ò‚Ó·Ó‰ÌÓ ÔËÔÓÏÌflÌÂ) Á‡ ÓˆÂÌÍ‡ Ì‡ ‰˙Î„ÓÒÓ˜Ì‡Ú‡ÌÂ‚Â·‡ÎÌ‡ Ô‡ÏÂÚ. ç‡Û¯ÂÌËflÚ‡ ‚˙‚ ‚ÌËÏ‡ÌËÂÚÓ Ë ÂÍÁÂ-ÍÛÚË‚ÌËÚÂ ÙÛÌÍˆËË Ò‡ ËÁÒÎÂ‰‚‡ÌË Ò: Cancellation Test,Trail Making Test – Ä (TMT-A) Ë Ç (TMT-B), ÔË ÍÓËÚÓ ÒÂÓˆÂÌfl‚‡ ‚ÂÏÂÚÓ Á‡ ËÁÔ˙ÎÌÂÌËÂ Ì‡ ÚÂÒÚ‡; Stroop Test, ÔËÍÓÈÚÓ Òe Ô‡‚Ë ÓˆÂÌÍ‡ Ì‡ ·Ófl Ô‡‚ËÎÌÓ ÔÓ˜ÂÚÂÌË ‰ÛÏËÁ‡ 45 sec ‚ ÚÂÚ‡Ú‡ ˜‡ÒÚ Ì‡ ÚÂÒÚ‡; Verbal Fluency (·ÛÍ-‚‡ å) Ë Verbal Fluency (Í‡ÚÂ„ÓËfl- ÊË‚ÓÚÌË) ÔË ÍÓËÚÓÒÂ ÓˆÂÌfl‚‡ ·ÓflÚ Ì‡ „ÂÌÂË‡ÌËÚÂ ‰ÛÏË Á‡ 1 ÏËÌ.; DigitSymbol Test (ÒÛ·ÚÂÒÚ ÓÚ WAIS), ÔË ÍÓÈÚÓ ÒÂ ÓˆÂÌfl‚‡·Ófl Ì‡ Ô‡‚ËÎÌÓ Ì‡ÌÂÒÂÌËÚÂ ÒËÏ‚ÓÎË Á‡ ÓÔÂ‰ÂÎÂÌÓ ‚Â-ÏÂ (90 sec). ç‡ÁÓ‚‡‚‡ÌÂÚÓ Â ÓˆÂÌfl‚‡ÌÓ Ò Boston NamingTest. á‡ ËÁÒÎÂ‰‚‡ÌÂ Ì‡ Ô‡ÍÒËÒ‡ Â ËÁÔÓÎÁ‚‡Ì Copying FigureTest. êÂ‡ÍˆËÓÌÌÓÚÓ ‚ÂÏÂ Ì‡ ÒÎÛ˜‡ÈÌ‡Ú‡ ÔÓfl‚‡ Ì‡ ÁËÚÂ-ÎÂÌ ÒÚËÏÛÎ Â ËÁÏÂ‚‡ÌÓ ‚ msec ˜ÂÁ ÍÓÏÔ˛Ú˙Ì‡ ÔÓ„‡-Ï‡ SuperLab, ÔÓ‰ÛÍÚ Ì‡ Cedrus Corporation-USA.

Ñ‡ÌÌËÚÂ ÓÚ ËÁÒÎÂ‰‚‡ÌÂÚÓ Ò‡ Ó·‡·ÓÚÂÌË ÒÚ‡ÚËÒÚË-˜ÂÒÍË ˜ÂÁ t-test (unpaired) ‡Ì‡ÎËÁ.


í‡·Î. 1 äÎËÌË˜Ì‡ ı‡‡ÍÚÂËÒÚËÍ‡ Ì‡ Ô‡ˆËÂÌÚËÚÂ Ò OXC.

äÎËÌË˜ÌË Ô‡‡ÏÂÚË è‡ˆËÂÌÚË Ò OXCÇË‰ Ì‡ ÔËÔ‡‰˙ˆËÚÂ- èè/ÇÉíäè (%) 3/13 (19/81)

Ñ‡‚ÌÓÒÚ Ì‡ ÂÔËÎÂÔÒËflÚ‡ („Ó‰.) 1-22 (Ò. 6.1)

óÂÒÚÓÚ‡ Ì‡ èè ÔÓÒÎÂ‰Ì‡Ú‡ „Ó‰. (·./ÏÂÒÂ˜ÌÓ) 0-8 (Ò. 2)

óÂÒÚÓÚ‡ Ì‡ ÇÉíäè ÔÓÒÎÂ‰Ì‡Ú‡ „Ó‰. (·./ÏÂÒÂ˜ÌÓ) 0-0.3 (Ò. 0.1)

ãÂ˜ÂÌËÂ Ò OXC („Ó‰.) 0.5-1 (Ò. 0.8)

ÑÓÁË (mg/d) 900-1200 (Ò.950)

èÎ‡ÁÏÂÌË ÌË‚‡ Ì‡ OXC (mg/l) Ò.11.4

ÖÖÉ: çÓÏ‡ÎÌ‡- ·. ·ÓÎÌË (%) 10 (62%)

îÓÍ‡ÎÌË ‡·ÌÓÏÌÓÒÚË – ·. ·ÓÎÌË (%) 6 (38%)

- ÚÂÏÔÓ‡ÎÌ‡ ÎÓÍ‡ÎËÁ‡ˆËfl - 5 (32%)

- ÙÓÌÚ‡ÎÌ‡ ÎÓÍ‡ÎËÁ‡ˆËfl - 1 (6%)

äèè-ÍÓÏÔÎÂÍÒÌË Ô‡ˆË‡ÎÌË ÔËÔ‡‰˙ˆË; ÇÉíäè-‚ÚÓË˜ÌÓ

„ÂÌÂ‡ÎËÁË‡ÌË ÚÓÌË˜ÌÓ-ÍÎÓÌË˜ÌË ÔËÔ‡‰˙ˆË; OXC-ÓÍÒÍ‡·‡ÁÂÔËÌ.

êÖáìãíÄíà

ÑÂÏÓ„‡ÙÒÍ‡Ú‡ ı‡‡ÍÚÂËÒÚËÍ‡, ÂÁÛÎÚ‡ÚËÚÂ ÓÚËÁÒÎÂ‰‚‡ÌÂÚÓ Ì‡ ‰ÂÔÂÒË‚ÌÓÒÚÚ‡ (ÒÍ‡Î‡ Ì‡ Zung) ËMMSÖ Ì‡ Ô‡ˆËÂÌÚËÚÂ Ò OXC Ë Ì‡ Á‰‡‚ËÚÂ ÍÓÌÚÓÎË Ò‡ÔÂ‰ÒÚ‡‚ÂÌË Ì‡ Ú‡·Î. 2. çÂ ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡Ú ÁÌ‡˜ËÏË ‡Á-ÎËÍË ÏÂÊ‰Û „ÛÔËÚÂ Á‡ ÚÂÁË ÔÓÍ‡Á‡ÚÂÎË.

êÂÁÛÎÚ‡ÚËÚÂ ÓÚ ËÁÒÎÂ‰‚‡ÌÂÚÓ Ì‡ ‚ÌËÏ‡ÌËÂÚÓ Ë ÂÍÁÂ-ÍÛÚË‚ÌËÚÂ ÙÛÌÍˆËË, Ô‡ÍÒËÒ, Â‡ÍˆËÓÌÌÓÚÓ ‚ÂÏÂ,Í‡ÚÍÓÒÓ˜Ì‡Ú‡ Ë ÌÂ‚Â·‡ÎÌ‡Ú‡ ‰˙Î„ÓÒÓ˜Ì‡ Ô‡ÏÂÚ ÔË·ÓÎÌËÚÂ Ò OXC Ë ÔË Á‰‡‚ËÚÂ ÍÓÌÚÓÎË Ò‡ ÔÂ‰ÒÚ‡‚ÂÌËÌ‡ Ú‡·ÎËˆ‡ 3.

ÄÌ‡ÎËÁË‡ÌÂÚÓ Ì‡ ÚÂÁË ‰‡ÌÌË Ò t-test ÌÂ ÛÒÚ‡ÌÓ‚fl‚‡ÁÌ‡˜ËÏË ‡ÁÎËÍË ‚ Ò‡‚ÌÂÌËÂ Ò˙Ò Á‰‡‚ËÚÂ ÍÓÌÚÓÎË.

è‡ˆËÂÌÚËÚÂ Ò OXC „ÂÌÂË‡Ú ÁÌ‡˜ËÏÓ ÔÓ-Ï‡Î˙Í ·ÓÈ‰ÛÏË ÓÚ ÍÓÌÚÓÎËÚÂ ÔË ËÁÔ˙ÎÌÂÌËÂÚÓ Ì‡ ÚÂÒÚÓ‚ÂÚÂ Á‡Í‡ÚÂ„ÓË‡ÎÌ‡ Ë ÎËÚÂ‡ÎÌ‡ ‚Â·‡ÎÌ‡ ÙÎÛË‰ÌÓÒÚ, ·ÂÁ ‰‡ÔÓÍ‡Á‚‡Ú ÒÚ‡ÚËÒÚË˜ÂÒÍË ÁÌ‡˜ËÏÓÒÚË ÒÔflÏÓ ÍÓÌÚÓ-

ÎËÚÂ ÔÓ ÓÚÌÓ¯ÂÌËÂ Ì‡ Ì‡ÁÓ‚‡‚‡ÌÂÚÓ (BNT), Á‡Û˜‡‚‡ÌÂÚÓÌ‡ ‚Â·‡ÎÂÌ Ï‡ÚÂË‡Î, ÓÚ‰‡ÎÂ˜ÂÌÓÚÓ ÔËÔÓÏÌflÌÂ Ë ‡Á-ÔÓÁÌ‡‚‡ÌÂÚÓ.

éÅëöÜÑÄçÖ

è‡ˆËÂÌÚËÚÂ Ò ÍËÔÚÓ„ÂÌÌ‡ ÙÓÍ‡ÎÌ‡ ÂÔËÎÂÔÒËfl, ÎÂÍÛ-‚‡˘Ë ÒÂ Ò OXC ÔÓÍ‡Á‚‡Ú ÓÚÍÎÓÌÂÌËfl Ì‡ ‰‚Â ÓÚ ÓÚ˜ÂÚÂ-ÌËÚÂ 20 ÍÓ„ÌËÚË‚ÌË ı‡‡ÍÚÂËÒÚËÍË. ç‡Û¯ÂÌËflÚ‡ Á‡-Òfl„‡Ú Â‰ËÌÒÚ‚ÂÌÓ ‡ÒÔÂÍÚËÚÂ Ì‡ ‚Â·‡ÎÌ‡Ú‡ ÙÎÛË‰ÌÓÒÚ.

èËÎÓÊÂÌËflÚ ‰ËÁ‡ÈÌ ÒÔÓÏ‡„‡ ‰‡ ÒÂ ÓˆÂÌË ÍÓ„ÌËÚË‚-ÌËfl ÂÙÂÍÚ Ì‡ OXC, Í‡ÚÓ ÒÂ ËÁ·Â„ÌÂ ÏÓ˘ÌÓÚÓ ‚˙Á‰ÂÈ-ÒÚ‚ËÂ ‚˙ıÛ ÍÓ„ÌËˆËflÚ‡ Ì‡ ÔÓ‰ÎÂÊ‡˘‡Ú‡ ÌÂ‚ÓÔ‡ÚÓÎÓ-„Ëfl Ë ÒÂ ‡ÚÂÌ˛Ë‡, ‰ÓÍÓÎÍÓÚÓ Â ‚˙ÁÏÓÊÌÓ, ÓÎflÚ‡ Ì‡ÂÔËÎÂÔÚËÙÓÏÌ‡Ú‡ ‡ÍÚË‚ÌÓÒÚ.

çflÏ‡ÏÂ ÓÒÌÓ‚‡ÌËÂ ‰‡ Ó·Ò˙Ê‰‡ÏÂ ‚ÎËflÌËÂÚÓ Ì‡ ‚˙Á‡-ÒÚÚ‡ ËÎË Ó·‡ÁÓ‚‡ÌËÂÚÓ, Í‡ÚÓ Ù‡ÍÚÓ Ò˙‰ÂÈÒÚ‚‡˘ Á‡ÔÓ-ÒÎ‡·Ó ÍÓ„ÌËÚË‚ÌÓ ÔÂ‰ÒÚ‡‚flÌÂ Ì‡ ·ÓÎÌËÚÂ, ÔÓ‡‰ËÒÚ‡ÚËÒÚË˜ÂÒÍË ÌÂÒ˙˘ÂÒÚ‚ÂÌËÚÂ ‡ÁÎË˜Ëfl Ò ÍÓÌÚÓÎÌ‡-Ú‡ „ÛÔ‡ Á‰‡‚Ë ÎËˆ‡.

ÄÌ‡ÎËÁ˙Ú Ì‡ ÍÎËÌË˜ÌËÚÂ ÔÓÏÂÌÎË‚Ë Ì‡ ·ÓÎÌËÚÂ ÒOXC ÔÓÍ‡Á‚‡ ÁÌ‡˜ËÚÂÎÌ‡ ‰‡‚ÌÓÒÚ Ì‡ ÂÔËÎÂÔÒËflÚ‡ Ë Â‰Û-ˆË‡ÌË, ÌÓ ÌÂ Ì‡Ô˙ÎÌÓ Ó‚Î‡‰flÌË ÔËÔ‡‰˙ˆË Ò ÌËÒ˙Í ÔÓ-ˆÂÌÚ Ì‡ ËÌÚÂËÍÚ‡ÎÌË ÙÓÍ‡ÎÌË ‡·ÌÓÏÌÓÒÚË.

èÓ-ÌËÒÍËÚÂ ÓˆÂÌÍË, ÍÓËÚÓ ·ÓÎÌËÚÂ Ò OXC ÔÓÎÛ˜‡‚‡Ú‚ Ò‡‚ÌÂÌËÂ Ò ÍÓÌÚÓÎËÚÂ, ÔÓ ÓÚÌÓ¯ÂÌËÂ Ì‡ ‚Â·‡ÎÌ‡Ú‡ÙÎÛË‰ÌÓÒÚ ÓÚ‡Áfl‚‡Ú ÒÏÛ˘ÂÌËÂ ‚ ÍÓÌÚÓÎ‡ Ì‡ ‚Â·‡Î-Ì‡Ú‡ ‡ÒÓˆË‡ˆËfl Ë Ì‡ÒÓ˜‚‡Ú Í˙Ï ÙÓÌÚ‡ÎÌ‡ ÂÍÁÂÍÛÚË‚Ì‡‰ËÒÙÛÌÍˆËfl. íÂ Ó·‡˜Â, Ò‡ ÁÌ‡˜ËÚÂÎÌÓ ÔÓ-Ï‡ÎÍÓ Ë ÔÓ-ÎÂÍÓËÁ‡ÁÂÌË ÓÚ ÚÂÁË ÔË ÌÂÎÂÍÛ‚‡ÌËÚÂ ·ÓÎÌË Ò ÂÔËÎÂÔÒËfl (1,11, 12). OXC ÌÂ Á‡Òfl„‡ ‚ÌËÏ‡ÌËÂÚÓ Ë Ô‡ÏÂÚÚ‡, ÍÓËÚÓ Ò‡Ì‡È-‡ÌËÏËÚÂ ÍÓ„ÌËÚË‚ÌË ÙÛÌÍˆËË ÓÚ ‚˙Á‰ÂÈÒÚ‚ËÂÚÓÌ‡ ÄÖå (10).

ë˙„Î‡ÒÌÓ ËÁÌÂÒÂÌËÚÂ ‚ ÎËÚÂ‡ÚÛ‡Ú‡ ‰‡ÌÌË ÓÚ ÔÓ-Û˜‚‡ÌËfl ÔË Á‰‡‚Ë ‰Ó·Ó‚ÓÎˆË, OXC ÌÂ ‚ÎÓ¯‡‚‡ ÍÓ„ÌË-ÚË‚ÌËÚÂ ÙÛÌÍˆËË, ‰ÓË ÌÂ˘Ó ÔÓ‚Â˜Â-ÔÓ‰Ó·fl‚‡ ÒÍÓÓ-ÒÚÚ‡ Ì‡ ÔËÒ‡ÌÂ Ë ËÁÔ˙ÎÌÂÌËÂÚÓ Ì‡ Á‡‰‡˜ËÚÂ Á‡ ÙÓÍÛÒË‡-ÌÓ ‚ÌËÏ‡ÌËÂ (5). èÓÎÛ˜ÂÌËÚÂ ÓÚ Ì‡Ò ‰‡ÌÌË Á‡ ÍÓ„ÌËÚË‚-ÌËfl ÂÙÂÍÚ Ì‡ OXC Ò‡ ‚ Ò˙„Î‡ÒËÂ Ò˙Ò Ò˙Ó·˘ÂÌËÚÂ ÓÚ‰Û„Ë ‡‚ÚÓË (8, 13, 2, 9) ÔË Ô‡ˆËÂÌÚË Ò ÌÓ‚ÓÓÚÍËÚ‡ÂÔËÎÂÔÒËfl. Ç˙ÔÂÍË ÔÓ-‰˙Î„Ëfl ÔÂËÓ‰ Ì‡ ÔÓÒÎÂ‰fl‚‡ÌÂ ËÔÓ-‚ËÒÓÍËÚÂ ÚÂ‡ÔÂ‚ÚË˜ÌË ‰ÓÁË Ì‡ OXC ‚ Ì‡¯ÂÚÓ ÔÓ-Û˜‚‡ÌÂ, ÒÔflÏÓ ˆËÚË‡ÌËÚÂ ÓÚ ‰Û„Ë ‡‚ÚÓË (5, 9, 13),ÔÓÎÛ˜ÂÌËÚÂ ÂÁÛÎÚ‡ÚË ËÏ‡Ú ÒıÓ‰ÂÌ ı‡‡ÍÚÂ. ç‡·Î˛‰‡-‚‡ÌÓÚÓ ÒÏÛ˘ÂÌËÂ ‚˙‚ ‚Â·‡ÎÌ‡Ú‡ ÙÎÛË‰ÌÓÒÚ Â ˜ÂÒÚÓÒÂ˘‡ÌÓ ÔË Ô‡ˆËÂÌÚË Ò ÂÔËÎÂÔÒËfl Ë ·Ë ÏÓ„ÎÓ ‰‡ ÒÂ Ò‚˙-ÊÂ Ò Û‚ÂÊ‰‡˘Ëfl ÂÙÂÍÚ Ì‡ Ò‡ÏÓÚÓ Á‡·ÓÎfl‚‡ÌÂ.

Ç Á‡ÍÎ˛˜ÂÌËÂ, ÔÓÎÛ˜ÂÌËÚÂ ÂÁÛÎÚ‡ÚË ‰‡‚‡Ú ÓÒ-ÌÓ‚‡ÌËÂ ‰‡ ÒÂ Ò˜ËÚ‡, ˜Â OXC ÔËÚÂÊ‡‚‡ ·Î‡„ÓÔËflÚÂÌÍÓ„ÌËÚË‚ÂÌ ÔÓÙËÎ, ÍÓÂÚÓ Ì‡È-‚ÂÓflÚÌÓ ÒÂ ‰˙ÎÊË Ì‡ÎËÔÒ‡Ú‡ Ì‡ ‰ËÂÍÚÂÌ ÔÓ‰ÚËÒÍ‡˘ ÂÙÂÍÚ ‚˙ıÛ ËÌıË·Ë-ÚÓÌËÚÂ ÏÂı‡ÌËÁÏË Ì‡ ÏÓÁ˙Í‡ (6, 7). çÂÓ·ıÓ‰ËÏÓ ÂÔÓ‰˙ÎÊËÚÂÎÌÓ ÔÓÒÎÂ‰fl‚‡ÌÂ Ì‡ ÔÓ-¯ËÓÍ ÍÓÌÚËÌ„ÂÌÚÔ‡ˆËÂÌÚË ÓÚ ‡ÁÎË˜ÌË ‚˙Á‡ÒÚÓ‚Ë „ÛÔË Á‡ ‰ÓÔ˙Î‚‡ÌÂ Ì‡ËÌÙÓÏ‡ˆËflÚ‡ Á‡ ÍÓ„ÌËÚË‚ÌËfl ÂÙÂÍÚ Ì‡ OXC.

ãàíÖêÄíìêÄ1. ÇÂÎËÁ‡Ó‚‡ ê, ê‡‰ËÓÌÓ‚‡ å, ó‡‚‰‡Ó‚ Ñ, ê‡È˜Â‚‡ å, í‡ÈÍÓ‚ ã. äÓ„ÌË-

ÚË‚ÌË Ì‡Û¯ÂÌËfl ÔË Ô‡ˆËÂÌÚË Ò ÎÓÍ‡ÎËÁ‡ˆËÓÌÌÓ Ò‚˙Á‡Ì‡ ÂÔËÎÂÔÒËfl.Å˙Î„‡ÒÍ‡ çÂ‚ÓÎÓ„Ëfl 2004; ÚÓÏ4; ·ÓÈ 3: 136-9.

2. Aikia M, Kaviainen R, Sivenius J, Halonen T, Riekkinen RJ. Cognitiveeffects of oxcarbazepine and phenytoin monotherapy in newly diagnosedepilepsy: one year follow-up. Epilepsy Res 1992;11:199-203.

3. Aldenkamp AP, de Krom M, Rejs R. Newer antiepileptic drugs and cognitiveissues. Epilepsia, 2003;44(Suppl 4):21-29.

4. Clark S, Wilson W. Mechanisms of epileptogenesis and the expression ofepileptiform activity. In: The treatment of epilepsy: principles and practice.Williams &Wilkins, 1996, 53-81.

5. Curran HV, Java R. Memory and psychomotor effects of oxcarbazepine inhealthy human volunteers. Eur J Clin Pharmacol 1993;44:529-33.

6. Hirsch E, Schmitz B, Carreno M. Epilepsy, antiepileptic drugs (AEDs) andcognition. Acta Neurol Scand 2003;108(Suppl 180):23-32.


í‡·Î. 2: ÑÂÏÓ„‡ÙÒÍ‡ ı‡‡ÍÚÂËÒÚËÍ‡ Ë MMSÖ Ì‡ ‚ÍÎ˛˜ÂÌËÚÂ „ÛÔË

ï‡‡ÍÚÂËÒÚËÍË OXC (n=16) äÓÌÚÓÎË(n=30)èÓÎ (Ü/M) 9/7 18/12

Ç˙Á‡ÒÚ 25.0 (7.0) 29.9 (9.8)

é·‡ÁÓ‚‡ÌËÂ 11.3 (2.0) 11.3 (2.1)

MMS/30 29.3 (0.9) 29.1 (1.2)

Zung 32.4 (8.5) 30.9 (7.2)

MMSÖ = mini mental state examination. Zung-ÒÍ‡Î‡ Á‡ ‰ÂÔÂÒË‚ÌÓÒÚ.

Ñ‡ÌÌËÚÂ Ò‡ ÒÂ‰ÌË ‡ËÚÏÂÚË˜ÌË ±(SD).

í‡·Î. 3. êÂÁÛÎÚ‡ÚË ÓÚ ËÁÒÎÂ‰‚‡ÌÂÚÓ Ì‡ ‚ÌËÏ‡ÌËÂ, ÂÍÁÂÍÛÚË‚ÌËÙÛÌÍˆËË, Ô‡ÍÒËÒ, Â‡ÍˆËÓÌÌÓ ‚ÂÏÂ, Í‡ÚÍÓÒÓ˜Ì‡ Ë ÌÂ‚Â·‡ÎÌ‡

‰˙Î„ÓÒÓ˜Ì‡ Ô‡ÏÂÚ.

íÂÒÚ äÓÌÚÓÎË ÅÓÎÌË ê<Digit Symbol Test (·.) 55.5 ± 11.3 54.6 ± 12.8 0.8077

Stroop 3 (·.) 45.7 ± 9.2 47.9 ± 13.9 0.4845

Cancellation Ö (sec) 217.3 ± 54.4 202.7 ± 60.3 0.4742

Cancellation O (sec) 153.3 ± 33.2 144.5 ± 52.2 0.5387

TMT-A (sec) 44.8 ± 14.8 37.9 ± 9.9 0.2579

TMT-B (sec) 87.6 ± 28.1 76.9 ± 29.5 0.6550

Digit Span (foreward) 6.43 0.8 6.4 0.8 0.9894

Digit Span (backward) 5.3 ± 1. 1 5.8 ± 1.1 0.2521

è‡ÍÒËÒ 10.8 ± 0.5 10.8 ± 0.7 0.933

çÂ‚Â·‡ÎÌ‡ ‰˙Î„ÓÒÓ˜Ì‡ Ô‡ÏÂÚ 12.7 ± 1.6 12.7 ± 1.4 0.9814

êÂ‡ÍˆËÓÌÌÓ ‚ÂÏÂ 188.5 ± 43.4 213.9 ± 73.4 0.3159

Ñ‡ÌÌËÚÂ Ò‡ ÒÂ‰ÌË ‡ËÚÏÂÚË˜ÌË ±SD.

îË„Û‡ 1. êÂÁÛÎÚ‡ÚË ÓÚ ËÁÒÎÂ‰‚‡ÌÂ Ì‡ Â˜Â‚ËÚÂ ÙÛÌÍˆËË Ë ‚Â·‡ÎÌ‡Ú‡Ô‡ÏÂÚ ÔË Ô‡ˆËÂÌÚË Ò ÂÔËÎÂÔÒËfl ‚ Ò‡‚ÌÂÌËÂ Ò ÍÓÌÚÓÎÌ‡

„ÛÔ‡ Á‰‡‚Ë ÎËˆ‡.

7. Ketter TA, Post RM, Theodore WH. Positive and negative psychiatric effectsof antiepileptic drugs in patients with seizure disorders. Neurology1999;53(Suppl 2):S53-67.

8. Laaksonen R, Kaimola K, Grahn-Teravainen E, Waltimo O. A controlledclinical trial of the effects of carbamazepine and oxcarbazepine on memoryand attention. (Abstract). 16th International Epilepsy Congress, Hamburg,1985.

9. McKee PJ, Balacklaw J, Forrest G, et al. A double-blind, placebo-controlledinteraction study between oxcarbazepine and carbazepine, sodium valproateand phenytoin in epileptic patients. Br J Clin Pharmacol 1994;37:27-32.

10. Meador KJ, Loring DW, Ray PG, et al. Differential cognitive and behavioraleffects of carbamazepine and lamotrigine. Neurology 2001;56:1177-1182.

11. Prevey, ML., Delaney, RC., Cramer, JA., Mattson, RH. Complex partial andsecondarily generalized seizure patients: cognitive functioning prior to treat-ment with antiepileptic medication. Epilepsy Res, 30, 1998, 1-9.

12. Pulliainen, V., Kuikka, P., Jokelainen, M. Motor and cognitive functions innewly diagnosed adult seizure patients before antiepileptic medication. ActaNeurol Scand, 101, 2000, 73-78.

13. Sabers A, Moller A, Dam M, et al. Cognitive function and anticonvulsanttherapy : effect of monotherapy in epilepsy. Acta Neurol scand 1995;92:19-27.

Ä‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËfl: Ñ- êÂ‡Ì‡ ÇÂÎËÁ‡Ó‚‡, çÂ‚ÓÎÓ„Ë˜Ì‡ ÍÎËÌËÍ‡, ìåÅÄã“ÄÎÂÍÒ‡Ì‰Ó‚ÒÍ‡”, ·ÛÎ. “É. ëÓÙËÈÒÍË” ‹ 1, 1431 ëÓÙËfl, Å˙Î„‡Ëfl 02/92 30 671; 0887393821; e-mail:[email protected]


SUMMARY

EFFECTIVENESS AND TOLERABILITY OF THERAPYFOR DIFFERENT TYPE OF EPILEPSY IN CHILDREN

WITH CONVULEX CHRONOI. Litvinenko, D. Hristova

PURPOSE: The utility of Convulex chrono in the treat-ment of both generalized and partial epilepsies in children hasbeen demonstrated. This study was implemented in order tocollect additional clinical data on the effectiveness and tolera-bility of Convulex chrono used in patients newly or recentlydiagnosed with epilepsy.

METHODS: The study included 30 children newly orrecently diagnosed with generalized Ór partial epilepsies.Treatment was initiated with Convulex chrono given orally.The mean dose was 32,2 mg/kg daily. Seizure control andoccurrence of adverse events were assessed after tree monthsof treatment.

RESULTS: The retention rate in the study at tree-monthswas 93 % . At this time 73% of subjects were seizure-free andanother 20% were with more then 50% reduction of seizures.No serious side effects were observed – only in 2 cases lightadverse events of gastrointestinal tract were observed.

CONCLUSION: Convulex chrono is effective and showsunacceptable tolerability as a first-line therapy for childrenwith both generalized and partial epilepsies.

KEY WORDS: Convulex chrono, epilepsy, effectiveness,tolerability

êÖáûåÖ

ñÖã: ÑÂˆ‡ Ò ‡ÁÎË˜ÌË – „ÂÌÂ‡ÎËÁË‡ÌË Ë Ô‡ˆË‡ÎÌËÙÓÏË Ì‡ ÂÔËÎÂÔÒËfl Ò‡ ÚÂÚË‡ÌË Ò Convulex chrono.èÓÛ˜‚‡ÌÂÚÓ ‰‡‚‡ ‚˙ÁÏÓÊÌÓÒÚ Á‡ Ì‡ÚÛÔ‚‡ÌÂ Ì‡ÒÓ·ÒÚ‚ÂÌ ÍÎËÌË˜ÂÌ ÓÔËÚ Ò ÓÚ˜ËÚ‡ÌÂ ÂÙÂÍÚË‚ÌÓÒÚÚ‡ ËÔÓÌÓÒËÏÓÒÚÚ‡ ÔË ËÁÔÓÎÁ‚‡ÌÂÚÓ Ì‡ Convulex chrono Á‡ÎÂ˜ÂÌËÂ Ì‡ ÌÓ‚Ó‰Ë‡„ÌÓÒÚËˆË‡ÌË ·ÓÎÌË Ò ÂÔËÎÂÔÒËfl.

åÖíéÑ: èÓÛ˜‚‡ÌÂÚÓ Ó·ı‚‡˘‡ 30 ‰Âˆ‡ Ò ÌÓ‚Ó‰Ë‡„ÌÓÒ-ÚËˆË‡Ì‡ „ÂÌÂ‡ÎËÁË‡Ì‡ ËÎË Ô‡ˆË‡ÎÌ‡ ÂÔËÎÂÔÒËfl. á‡-ÔÓ˜Ì‡ÚÓ Â ÎÂ˜ÂÌËÂ Ò Ó‡ÎÌÓ ÔËÎÓÊÂÌËÂ Ì‡ Convulexchrono. ëÂ‰Ì‡Ú‡ ‰ÓÁ‡ Â 32,2 mg/kg Á‡ 24˜. ñÂÌÂÌ Â ÔÓÒ-ÚË„Ì‡ÚËflÚ ÍÓÌÚÓÎ Ì‡‰ ÔËÒÚ˙ÔËÚÂ Ë ÔÓfl‚‡Ú‡ Ì‡ÒÚ‡ÌË˜ÌË ÂÙÂÍÚË ‚ ‡ÏÍËÚÂ Ì‡ 3 ÏÂÒÂ˜ÌÓ Ì‡·Î˛‰ÂÌËÂ.

êÖáìãíÄíà: é·˘‡Ú‡ ÂÙÂÍÚË‚ÌÓÒÚ ÔÓ ÓÚÌÓ¯ÂÌËÂ Ì‡Â‰ÛÍˆËflÚ‡ Ì‡ ÔËÒÚ˙ÔËÚÂ ‚ ‡ÏÍËÚÂ Ì‡ ÚÂÚËfl ÏÂÒÂˆ·Â 93%. á‡ ÚÓÁË ÔÂËÓ‰ 73% ÓÚ ÒÎÛ˜‡ËÚÂ ·flı‡ Ò‚Ó·Ó‰ÌËÓÚ ÔËÒÚ˙ÔË, ‡ Ó˘Â 20% ÔÓÍ‡Á‡ı‡ Â‰ÛÍˆËfl Ì‡ ÔËÒÚ˙ÔË-ÚÂ Ò Ì‡‰ 50%. çÂ ·flı‡ Ì‡·Î˛‰‡‚‡ÌË ÒÂËÓÁÌË ÒÚ‡ÌË˜ÌËÂÙÂÍÚË - Ò‡ÏÓ ‚ 2 ÒÎÛ˜‡fl ËÏ‡¯Â ÔÓfl‚Ë ÓÚ ÒÚ‡Ì‡ Ì‡„‡ÒÚÓËÌÚÂÒÚËÌ‡ÎÌËfl Ú‡ÍÚ Ë ÚÓ ÎÂÍÓÒÚÂÔÂÌÌË.

áÄäãûóÖçàÖ: Convulex chrono Â ÂÙÂÍÚË‚ÂÌ Ë Ò ‰Ó·-‡ ÔÓÌÓÒËÏÓÒÚ ÔË ËÁÔÓÎÁ‚‡ÌÂÚÓ ÏÛ Í‡ÚÓ Ô˙‚Ó ÒÂ‰-ÒÚ‚Ó Á‡ ÎÂ˜ÂÌËÂ Ì‡ ‰Âˆ‡ Ò „ÂÌÂ‡ÎËÁË‡ÌË Ë Ô‡ˆË‡ÎÌËÂÔËÎÂÔÒËË.

äãûóéÇà Ñìåà: Convulex chrono, ÂÔËÎÂÔÒËfl, ÂÙÂÍ-ÚË‚ÌÓÒÚ, ÔÓÌÓÒËÏÓÒÚ.

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ÚË˜ÌË ÔËÒÚ˙ÔË1.ÉÂÌÂ‡ÎËÁË‡ÌË: ÚÓÌË˜ÌÓ-ÍÎÓÌË˜ÌË, ÚÓÌË˜ÌË, ÍÎÓ-

ÌË˜ÌË, ‡ÚÓÌË˜ÌË, ÏËÓÍÎÓÌË˜ÌË, ‡·Ò‡ÌÒË (1, 2, 4, 6, 17)2.è‡ˆË‡ÎÌË Ò˙Ò ËÎË ·ÂÁ ‚ÚÓË˜Ì‡ „ÂÌÂ‡ÎËÁ‡ˆËfl (5,

8, 9,13)Ç. ì‰Ó·ÌË Á‡ ÔËÎÓÊÂÌËÂ ‚ ‰ÂÚÒÍ‡ ‚˙Á‡ÒÚ ÔÓ‡‰Ë Ì‡-

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ÍÓÌ‚ÛÎÒË‚ÂÌ (6, 10) Ë ÌÂÍÓÌ‚ÛÎÒË‚ÂÌ (1, 7).Ñ. å‡ÎÍÓ Ë ‰Ó·Â ËÁ‚ÂÒÚÌË ÒÚ‡ÌË˜ÌË ÂÙÂÍÚË (1)Ö. ç‡ÎË˜ÌË ıÓÌÓ ÙÓÏË, ÍÓËÚÓ ÔÓÒÚË„‡Ú ÒÚ‡·ËÎÌ‡

éË„ËÌ‡ÎÌË ÒÚ‡ÚËËÖîÖäíàÇçéëí à èéçéëàåéëí èêà ãÖóÖçàÖ çÄ êÄáãàóçà íàèéÇÖ ÖèàãÖèëàà ì ÑÖñÄ ë CONVULEX CHRONO /SODIUM VALPROATE/

à. ãËÚ‚ËÌÂÌÍÓ, Ñ. ïËÒÚÓ‚‡1

ÑÂÚÒÍ‡ ÌÂ‚ÓÎÓ„Ë˜Ì‡ ÍÎËÌËÍ‡, ä‡ÚÂ‰‡ ÔÓ ÔÂ‰Ë‡ÚËfl, åì – ëÓÙËfl1åÂ‰ËˆËÌÒÍË ˆÂÌÚ˙ ◊ÑÂÚÒÍÓ Á‰‡‚Â”

ÒÂÛÏÌ‡ ÍÓÌˆÂÌÚ‡ˆËfl Ë Ò˙Á‰‡‚‡Ú Û‰Ó·ÒÚ‚Ó Í‡ÚÓ ‚˙Á-ÏÓÊÂÌ ‰‚ÛÍ‡ÚÂÌ ÔËÂÏ ‚ ‡ÏÍËÚÂ Ì‡ 24 ˜‡Ò‡ (8)

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éÚ‰‡‚Ì‡ ËÏ‡ÏÂ ÓÔËÚ ÓÚ ÔËÎÓÊÂÌËÂÚÓ Ì‡ Ó·ËÍÌÓ‚Â-ÌËfl Convulex – Ì‡ÚËÂ‚‡ ÒÓÎ Ì‡ ‚‡ÎÔÓÂ‚‡Ú‡ ÍËÒÂÎËÌ‡ ‚ÒËÓÔÌ‡ Ë Ú‡·ÎÂÚÌ‡ ÙÓÏ‡ ÔË ÎÂ˜ÂÌËÂ Ì‡ ‰Âˆ‡ Ò ‡ÁÎË˜-ÌË ÙÓÏË Ì‡ ÂÔËÎÂÔÒËfl.

ëÂ„‡ ÒË ÔÓÒÚ‡‚ËıÏÂ Á‡ ˆÂÎ ‰‡ ÓˆÂÌËÏ ÂÙÂÍÚË‚ÌÓÒÚÚ‡Ë Ì‡‰ÂÊ‰ÌÓÒÚÚ‡ Ì‡ Ú‡·ÎÂÚÍËÚÂ Convulex chrono Ò Û‰˙Î-ÊÂÌÓ ‰ÂÈÒÚ‚ËÂ ÓÚ 300 Ë 500 Ï„ ‚ ‡ÏÍËÚÂ Ì‡ Â‰ÌÓ ÔÓÒ-ÔÂÍÚË‚ÌÓ ÓÚ‚ÓÂÌÓ ÔÓÛ˜‚‡ÌÂ.

í‡ÁË ‡ÁÌÓ‚Ë‰ÌÓÒÚ Ì‡ ÏÂ‰ËÍ‡ÏÂÌÚ‡ ËÏ‡ ‚ÒË˜ÍË ÔÂË-ÏÛ˘ÂÒÚ‚‡ Ì‡ ıÓÌÓ ÙÓÏËÚÂ – ÔÓÁ‚ÓÎfl‚‡ ‰‚ÛÍ‡ÚÂÌÔËÂÏ, Ò ÍÓÂÚÓ ÛÎÂÒÌfl‚‡ ÍÓÌÚÓÎ‡ ÓÚ ÒÚ‡Ì‡ Ì‡ Ó‰ËÚÂ-ÎËÚÂ Ì‡‰ ÔÓ‚ÂÊ‰‡ÌÓÚÓ ÎÂ˜ÂÌËÂ Ë ÔÂ‰ÔÓÎ‡„‡ ÔÓ-ÒÚ‡·ËÎ-ÌË ÔÎ‡ÁÏÂÌË ÍÓÌˆÂÌÚ‡ˆËË.

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ç‡·Î˛‰‡‚‡ıÏÂ 30 ‰Âˆ‡ Ì‡ ‚˙Á‡ÒÚ ÏÂÊ‰Û 4 Ë 17 „Ó‰Ë-ÌË - ÒÂ‰ÌÓ 10,3 „.(SD±2,68), 17 ÏÓÏË˜ÂÚ‡ Ë 13 ÏÓÏ˜ÂÚ‡,Ò ‡ÁÎË˜ÌË ÔÓ ÙÓÏ‡ ÂÔËÎÂÔÒËË – „ÂÌÂ‡ÎËÁË‡ÌË Ë Ô‡ˆË-‡ÎÌË. è‡ˆËÂÌÚËÚÂ ·flı‡ Ò ÌÓ‚ÓÓÚÍËÚ‡ ÂÔËÎÂÔÒËfl Ò Ì‡È-Ï‡ÎÍÓ 2 ÔËÒÚ˙Ô‡ Á‡ ÔÓÒÎÂ‰ËflÚ ÏÂÒÂˆ ÔÂ‰Ë Á‡ÔÓ˜‚‡ÌÂ Ì‡ÎÂ˜ÂÌËÂÚÓ, ‡ Ï‡ÍÒËÏ‡ÎÌËflÚ ·ÓÈ ÔËÒÚ˙ÔË ÔË Â‰ËÌ ÓÚÒÎÛ˜‡ËÚÂ Ò ‡·Ò‡ÌÒÌ‡ ÂÔËÎÂÔÒËfl ‰ÓÒÚË„‡ı‡ ‰Ó ‰ÂÒÂÚÍË ‚‡ÏÍËÚÂ Ì‡ 24 ˜. Ñ‡‚ÌÓÒÚÚ‡ Ì‡ ÂÔËÎÂÔÒËflÚ‡ ·Â Ì‡È-„Ó-ÎflÏ‡ ÔË Â‰ÌÓ ÓÚ ‰Âˆ‡Ú‡ Ò ÉÂÌÂ‡ÎËÁË‡Ì‡ ÂÔËÎÂÔÒËfl ÒÙÂ·ËÎÌË „˙˜Ó‚Â + ÒËÌ‰ÓÏ (GEFS+), ÍÓÂÚÓ ËÏ‡¯Â Ô˙-‚Ë ÔËÒÚ˙ÔË ÔÓ‰ ÙÓÏ‡Ú‡ Ì‡ ÙÂ·ËÎÌË „˙˜Ó‚Â Ì‡ 11 Ë 19ÏÂÒ. ‚˙Á‡ÒÚ Ë ËÁfl‚‡ Ì‡ ÌÓ‚Ë ‰‚‡ Éíäè ÔË ‡ÙÂ·ËÎËÚÂÚÌ‡ 4 „Ó‰. Ë 6 ÏÂÒ. èÓÒÎÂ‰ÌËÚÂ ·flı‡ ÔÓ‚Ó‰‡ Á‡ ÔÓÒÚ‡‚flÌÂÌ‡ ‰Ë‡„ÌÓÁ‡Ú‡ Ë Á‡ÔÓ˜‚‡ÌÂ Ì‡ ÎÂ˜ÂÌËÂÚÓ. èË ‚ÒË˜ÍË ‰Â-ˆ‡ ÒÂ ÒÚ‡ÚË‡ ÎÂ˜ÂÌËÂ Ò äÓÌ‚ÛÎÂÍÒ ıÓÌÓ ÔÓ‰ ÙÓÏ‡Ú‡Ì‡ ÏÓÌÓÚÂ‡ÔËfl.

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èÂËÓ‰˙Ú Ì‡ Ì‡·Î˛‰ÂÌËÂ Á‡ ÒÂ„‡ Â Í‡ÚÓ ÏËÌËÏÛÏ 3ÏÂÒÂˆ‡.

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è‡ˆË‡ÎÌËÚÂ ÂÔËÎÂÔÒËË ÒÂ ‡ÁÔÂ‰ÂÎflı‡ ÔÓ ÒÎÂ‰ÌËflÌ‡˜ËÌ: êÓÎ‡Ì‰Ó‚‡ ÂÔËÎÂÔÒËfl – 3 ‰Âˆ‡, Ò ÔÓÒÚË Ô‡ˆË‡ÎÌËÔËÒÚ˙ÔË – 2 ‰Âˆ‡, Ò ÍÓÏÔÎÂÍÒÌË Ô‡ˆË‡ÎÌË ÔËÒÚ˙ÔË Ë Ò‡‰‚ÂÁË‚ÌË – ÔÓ 1 ‰ÂÚÂ.

èË 17 ÓÚ Ì‡·Î˛‰‡‚‡ÌËÚÂ Ô‡ˆËÂÌÚË Â ÔÓ‚Â‰ÂÌÓÏÓÁ˙Í-ËÁÓ·‡Áfl‚‡˘Ó ËÁÒÎÂ‰‚‡ÌÂ ëí ËÎË üåêí Ì‡ ñçë.

èË 6 ÓÚ ‰Âˆ‡Ú‡ Â ÛÚÓ˜ÌÂÌ‡ ÂÚËÓÎÓ„ËflÚ‡ Ì‡ ÂÔËÎÂÔ-ÒËflÚ‡:

● Ö‰ÌÓ ÓÚ ‰Âˆ‡Ú‡ Â Ò íÛ·ÂÓÁÌ‡ ÒÍÎÂÓÁ‡● Ñ‚Â Ò‡ Ò ‰ÓÍ‡Á‡Ì‡ ıËÔÓÍ‡ÏÔ‡ÎÌ‡ ÒÍÎÂÓÁ‡● Ö‰ÌÓ ËÏ‡ ÔÓÂÌˆÂÙ‡ÎÌ‡ ÍËÒÚ‡● Ö‰ÌÓ Â Ò ÍÓÓ‚‡ ‡ÚÓÙËfl● Ö‰ÌÓ Â Ò ÔÓÒÚÚ‡‚Ï‡ÚË˜Ì‡ ÂÔËÎÂÔÒËflÑ‚Â ÓÚ ‰Âˆ‡Ú‡ ËÏ‡Ú Ù‡ÏËÎÌ‡ Ó·ÂÏÂÌÂÌÓÒÚ, Ô˙‚Ó-

Ì‡˜‡ÎÌ‡Ú‡ ËÁfl‚‡ Â ÔÓ‰ ÙÓÏ‡Ú‡ Ì‡ ÙÂ·ËÎÌË „˙˜Ó‚Â,ÔÓÒÎÂ‰‚‡ÌË ÓÚ Ú‡ÍË‚‡ ÔË ‡ÙÂ·ËÎËÚÂÚ Ë Ì‡È-‚ÂÓflÚÌÓÒÂ Í‡Ò‡Â Á‡ ÉÂÌÂ‡ÎËÁË‡Ì‡ ÂÔËÎÂÔÒËfl Ò ÙÂ·ËÎÌË „˙˜Ó‚Â+ ÒËÌ‰ÓÏ.

íË ÓÚ ‰Âˆ‡Ú‡ ÔÓÍË‚‡Ú ÍÎËÌË˜ÌËÚÂ Ë ÖÖÉ ÍËÚÂËËÁ‡ êÓÎ‡Ì‰Ó‚‡ ÂÔËÎÂÔÒËfl.

êÖáìãíÄíà

ÖÙÂÍÚË‚ÌÓÒÚÚ‡ ÓÚ ÔËÎÓÊÂÌÓÚÓ ÎÂ˜ÂÌËÂ Ò Convulexchrono Â ÔÂˆÂÌÂÌ‡ ÔÓ ÒÚÂÔÂÌÚ‡ Ì‡ Â‰ÛÍˆËfl Ì‡ ÔËÒÚ˙-ÔËÚÂ ‚ ÔÓˆÂÌÚË – Ô˙ÎÌÓ ÍÛÔË‡ÌÂ (100%), ÁÌ‡˜ËÏ‡ Â-‰ÛÍˆËfl (Ò Ì‡‰ 50%) Ë ÒÎ‡· ÂÙÂÍÚ – Â‰ÛÍˆËfl Ò ÔÓ-Ï‡ÎÍÓÓÚ 50%, ÓÚ˜ÂÚÂÌ‡ Ì‡ Ô˙‚Ëfl Ë Ì‡ ÚÂÚËfl ÏÂÒÂˆ ÓÚ Ì‡-˜‡ÎÓÚÓ Ì‡ Ì‡·Î˛‰ÂÌËÂÚÓ Ë Â ÓÚ‡ÁÂÌ‡ Ì‡ ÙË„.3.

èË 22 ‰Âˆ‡ Ì‡·Î˛‰‡‚‡ıÏÂ Ô˙ÎÌÓ ÍÛÔË‡ÌÂ Ì‡ ÔËÒÚ˙-ÔËÚÂ ‚ Í‡fl Ì‡ 3 ÏÂÒÂ˜ÌËfl ÔÂËÓ‰ Ì‡ Ì‡·Î˛‰ÂÌËÂ. èË 18


îË„.1 ê‡ÁÔÂ‰ÂÎÂÌËÂ Ì‡ Ì‡·Î˛‰‡‚‡ÌËÚÂ Ô‡ˆËÂÌÚË ÒÔÓÂ‰ ‚Ë‰‡ Ì‡ÔËÒÚ˙ÔËÚÂ ‚ ‡·ÒÓÎ˛ÚÂÌ ·ÓÈ Ë ‚ % (n=30).

îË„.2. ê‡ÁÔÂ‰ÂÎÂÌËÂ Ì‡ Ô˙‚Ë˜ÌÓ „ÂÌÂ‡ÎËÁË‡ÌËÚÂ ÔËÒÚ˙ÔË ‚‡·ÒÓÎ˛ÚÂÌ ·ÓÈ Ë ‚ % (n = 30).

îË„.3. ëÚÂÔÂÌ Ì‡ Â‰ÛÍˆËfl Ì‡ ÔËÒÚ˙ÔËÚÂ ÔË ‡ÁÎË˜ÌËÚÂ ÙÓÏË Ì‡ÂÔËÎÂÔÒËfl –ÍÛÔË‡ÌÂ -100%, ÁÌ‡˜ËÏ‡ Â‰ÛÍˆËfl Ò Ì‡‰ 50% Ë ÒÎ‡· ÂÙÂÍÚ I

Â‰ÛÍˆËfl ÔÓ‰ 50%

ÓÚ Úflı ÂÙÂÍÚ˙Ú Â ÔÓÒÚË„Ì‡Ú Ó˘Â ‚ Ô˙‚Ëfl ÏÂÒÂˆ ÔË‰ÓÁ‡ Ì‡ Convulex chrono 25–30 mg/kg. èË 4 ‰ÓÁ‡Ú‡ Â ÔÓ-Í‡˜ÂÌ‡ ‰Ó 40 mg/kg., ÒÎÂ‰ ÍÓÂÚÓ Ò˙˘Ó Â ÔÓÒÚË„Ì‡ÚÓ Ô˙Î-ÌÓÚÓ ÍÛÔË‡ÌÂ. èË ‰‚Â ÓÚ ‰Âˆ‡Ú‡ ÒÎÂ‰ ÌÂÔ˙ÎÌÓ ÔÓ‚ÎËfl-‚‡ÌÂ Â ‰Ó·‡‚ÂÌ carbamazepine, ÔË ‰Û„Ë ‰‚Â oxcarba-mazepine Ë ÔË ˜ÂÚËË - clonazepam.

ë·ÓÌ‡Ú‡ ÂÙÂÍÚË‚ÌÓÒÚ Á‡ ‚ÒË˜ÍË ‚Ë‰Ó‚e ÂÔËÎÂÔÒËË eÒÎÂ‰Ì‡Ú‡ (ÙË„.4) – Ô˙ÎÌÓ ÍÛÔË‡ÌÂ Ì‡ ÔËÒÚ˙ÔËÚÂ ‚ 73%,ÁÌ‡˜ËÏ‡ Â‰ÛÍˆËfl (Ò ÔÓ‚Â˜Â ÓÚ 50%) ‚ 20% ÓÚ ÒÎÛ˜‡ËÚÂË ÒÎ‡· ÂÙÂÍÚ (Â‰ÛÍˆËfl Ò ÔÓ-Ï‡ÎÍÓ ÓÚ 50%) ‚ 7 % ÓÚ Ì‡·-Î˛‰‡‚‡ÌËÚÂ ‰Âˆ‡.

ëÂ‰Ì‡Ú‡ Ô˙‚ÓÌ‡˜‡ÎÌ‡ ‰ÓÁ‡ Ì‡ ÏÂ‰ËÍ‡ÏÂÌÚ‡ ÒÎÂ‰ÚËÚË‡ÌÂÚÓ ÏÛ ·Â 32,2 mg/kg (SD±2,68). èË Ú‡Í‡ ‰Ó-ÁË‡ÌËfl Convulex chrono ·flı‡ ÓÚ˜ÂÚÂÌË ÒÂÛÏÌË ÍÓÌˆÂ-ÌÚ‡ˆËË Ì‡ ‚ÒË˜ÍË Ô‡ˆËÂÌÚË Ì‡‰ 350 µmol/l, ÚÓÂÒÚ ‚ ÚÂ-‡ÔÂ‚ÚË˜Ì‡Ú‡ ÁÓÌ‡. èË ÔÓ‚Â˜Â ÓÚ ÔÓÎÓ‚ËÌ‡Ú‡ (16 ‰Âˆ‡)ÚÓ ·Â ‚ „ÓÌËÚÂ „‡ÌËˆË Ì‡ ÚÂ‡ÔÂ‚ÚË˜Ì‡Ú‡ ÁÓÌ‡ - ÏÂÊ-‰Û 500 Ë 700 µmol/l.

Ç ÖÖÉ ËÁÒÎÂ‰‚‡ÌÂÚÓ ÔË ÒÚ‡ÚË‡ÌÂ Ì‡ ÎÂ˜ÂÌËÂÚÓ ËÒÎÂ‰ Ô˙‚Ëfl, Í‡ÍÚÓ Ë ÒÎÂ‰ ÚÂÚËfl ÏÂÒÂˆ Ò‡ ÓÚ˜ÂÚÂÌËÒÎÂ‰ÌËÚÂ ÔÓÏÂÌË ÙË„.5. ç‡È-‰Ó·Ë ÂÁÛÎÚ‡ÚË Ò‡ ÓÚ˜Â-ÚÂÌË ÔÓ ÓÚÌÓ¯ÂÌËÂ Ì‡ „ÂÌÂ‡ÎËÁË‡Ì‡Ú‡ ‚˙Á·Û‰Ì‡ ‡Í-ÚË‚ÌÓÒÚ ‚ ÖÖÉ – ÍÛÔË‡Ì‡ ÔË 7 ÓÚ 10 ÒÎÛ˜‡fl ‚ ‡ÏÍËÚÂÌ‡ Ô˙‚Ëfl ÏÂÒÂˆ ÓÚ ÎÂ˜ÂÌËÂÚÓ Ë ÔË Ó˘Â ‰‚‡ ‚ ‡ÏÍËÚÂ‰Ó 3 ÏÂÒÂˆ. ë Ô˙ÎÌÓ ÍÛÔË‡ÌÂ ‚ ‡ÏÍËÚÂ Ì‡ Ô˙‚Ëfl ÏÂÒÂˆÒ‡ 4 ÓÚ ‰Âˆ‡Ú‡ Ò ‡·Ò‡ÌÒÌË ÂÔËÎÂÔÒËË – ÍÓÂÚÓ ÍÓÂÎË‡ ËÒ ÓÚÎË˜ÌËfl ÍÎËÌË˜ÂÌ ÂÙÂÍÚ ÔË ÚÂÁË Ô‡ˆËÂÌÚË. èË ‰Û-„ËÚÂ 2 ‡·Ò‡ÌÒÌË ÂÔËÎÂÔÒËË ËÏ‡¯Â ÁÌ‡˜ËÏÓ ÔÓ‰Ó·ÂÌËÂ·ÂÁ Ô˙ÎÌÓ ÍÛÔË‡ÌÂ ‚ ‡ÏÍËÚÂ Ì‡ Ô˙‚Ëfl ÏÂÒÂˆ, ÌÓ ÒÎÂ‰‰Ó·‡‚flÌÂ Í˙Ï ÚÂ‡ÔËflÚ‡ Ì‡ clonazepam ‚ Í‡fl Ì‡ ÚÂ-ÚËfl ÏÂÒÂˆ Ë ÔË Úflı ÌÂ ÒÂ Â„ËÒÚË‡ „ÂÌÂ‡ÎËÁË‡Ì‡ Ô‡-ÓÍÒËÁÏ‡ÎÌ‡ ‡ÍÚË‚ÌÓÒÚ ÓÚ ÒÔÂˆËÙË˜ÂÌ ÚËÔ. ÑÛ„ËÚÂ 2ÒÎÛ˜‡fl Ò Ô˙ÎÌÓ ÔÓ‚ÎËfl‚‡ÌÂ ÔÓ ÓÚÌÓ¯ÂÌËÂ „ÂÌÂ‡ÎËÁË‡Ì‡-Ú‡ Ô‡ÓÍÒËÁÏ‡ÎÌ‡ ‡ÍÚË‚ÌÓÒÚ ‚ ÖÖÉ ‚ ‡ÏÍËÚÂ Ì‡ Ô˙-‚Ëfl ÏÂÒÂˆ ·flı‡ ‰‚ÂÚÂ Ô‡ˆËÂÌÚ˜ÂÚ‡ Ò ÉÂÌÂ‡ÎËÁË‡Ì‡ ÂÔË-ÎÂÔÒËfl Ò ÙÂ·ËÎÌË „˙˜Ó‚Â + ÒËÌ‰ÓÏ. ë Ô˙ÎÌÓ ÔÓ‚ÎËfl‚‡-ÌÂ Ì‡ „ÂÌÂ‡ÎËÁË‡ÌËfl ÚËÔ ÔÓÏÂÌË ‚ ‡ÏÍËÚÂ Ì‡ Ô˙‚ËflÏÂÒÂˆ ÓÚ ÎÂ˜ÂÌËÂÚÓ ·Â Ë Â‰ËÌ Ô‡ˆËÂÌÚ Ò Éíäè ÔÓ ‚ÂÏÂÌ‡ Ò˙Ì.

èË Ó„ÌË˘ÌËfl ÚËÔ ÔÓÏÂÌË Ò ‚ÚÓË˜Ì‡ „ÂÌÂ‡ÎËÁ‡ˆËfl– ÌÓÏ‡ÎËÁ‡ˆËfl ÒÂ Ì‡·Î˛‰‡‚‡ ‚ 5 ÓÚ 8-ÚÂ ÒÎÛ˜‡fl ‚ Í‡fl Ì‡Ô˙‚Ëfl ÏÂÒÂˆ Ë ‚ Ó˘Â 2 ‰Ó 3 ÏÂÒÂˆ.

èË Ó„ÌË˘ÌËfl ÚËÔ ÔÓÏÂÌË ‚ ÖÖÉ ‚ 6 ÓÚ 11-ÚÂ ‰Âˆ‡ËÏ‡ Ô˙ÎÌÓ ÍÛÔË‡ÌÂ Ì‡ ÙÓÍÛÒ‡ ‚ Í‡fl Ì‡ Ô˙‚Ëfl ÏÂÒÂˆ ËÔË Ó˘Â 2 ‰Ó Í‡fl Ì‡ ÚÂÚËfl ÏÂÒÂˆ.

èË 3 ÓÚ ÒÎÛ˜‡ËÚÂ Ò Ó„ÌË˘ÌË ÔÓÏÂÌË ‚ ÔÓ Â‰ËÌ ÓÚÚÂÁË Ò Ô˙‚Ë˜ÌÓ Ë Ò ‚ÚÓË˜ÌÓ „ÂÌÂ‡ÎËÁË‡Ì ÚËÔ ‚˙Á·Û‰-ÌË Ô‡ÚÂÌË ÌflÏ‡¯Â Ô˙ÎÌÓ ÍÛÔË‡ÌÂ ‚ ‡ÏÍËÚÂ Ì‡ ÚËÏÂ-ÒÂ˜ÌËfl ÔÂËÓ‰ Ì‡ Ì‡·Î˛‰ÂÌËÂ. íÓ‚‡ Ò‡ ÔÂ‰ËÏÌÓ Ô‡ˆËÂÌ-ÚË Ò ‰ÓÍ‡Á‡Ì‡ Ó„‡ÌË˜Ì‡ ÎÂÁËfl – ‰Âˆ‡Ú‡ Ò ÚÛ·ÂÓÁÌ‡ÒÍÎÂÓÁ‡, Ò ÔÓÂÌˆÂÙ‡ÎÌ‡Ú‡ ÍËÒÚ‡, Ò ÔÓÒÚÚ‡‚Ï‡ÚË˜Ì‡

ÂÔËÎÂÔÒËfl Ë Ò ıËÔÓÍ‡ÏÔ‡ÎÌ‡ ÒÍÎÂÓÁ‡, Í‡ÍÚÓ Ë Â‰ÌÓ ÓÚ‰Âˆ‡Ú‡ Ò Éíäè ·ÂÁ ÛÚÓ˜ÌÂÌ‡ ÂÚËÓÎÓ„Ëfl.

èË Â‰ÌÓ ÓÚ ‰Âˆ‡Ú‡ ÔË ‡·ÒÓÎ˛ÚÌÓ ÒË„ÛÌË ÂÔËÎÂÔ-ÚË˜ÌË ÔËÒÚ˙ÔË ÎËÔÒ‚‡ı‡ ‚˙Á·Û‰ÌË ÔÓÏÂÌË Í‡ÍÚÓ ‚ ËÁ-

ıÓ‰ÌËÚÂ Ú‡Í‡ Ë ‚ ÍÓÌÚÓÎÌËÚÂ ÖÖÉ ËÁÒÎÂ‰‚‡ÌËfl. èË 7 ÓÚ ‰Âˆ‡Ú‡ ‚ Ì‡˜‡ÎÌÓÚÓ ÖÖÉ Ì‡Â‰ Ò Ô‡ÓÍÒËÁ-

Ï‡ÎÌ‡Ú‡ ‡ÍÚË‚ÌÓÒÚ ÓÚ ‡ÁÎË˜ÂÌ ÚËÔ ÒÂ Ì‡·Î˛‰‡‚‡ı‡ Ë‰ËÙÛÁÌË ÔÓÏÂÌË ‚ ÓÒÌÓ‚Ì‡Ú‡ ‡ÍÚË‚ÌÓÒÚ, Í‡ÚÓ Ò‡ÏÓ ÔË2 ÓÚ Úflı ÚÂÁË ÔÓÏÂÌË Ï‡Í‡ Ë ‚ ÔÓ-ÒÎ‡·‡ ÒÚÂÔÂÌ ÔÂ-ÒËÒÚË‡ı‡ ‚ Í‡fl Ì‡ ÚËÏÂÒÂ˜ÌËfl ÔÂËÓ‰ Ì‡ Ì‡·Î˛‰Â-ÌËÂ.èË Â‰ÌÓÚÓ ÚÓ‚‡ Ò˙‚Ô‡‰‡¯Â Ë Ò˙Ò Á‡‰˙Ê‡ÌÂ Ì‡ Ó„-ÌË˘ÌËÚÂ ÔÓÏÂÌË ÓÚ ‚˙Á·Û‰ÂÌ ÚËÔ Ë ÌÂÔ˙ÎÌËfl ÍÎËÌË˜ÂÌÂÙÂÍÚ – ‰ÂÚÂÚÓ Ò ÚÛ·ÂÓÁÌ‡ ÒÍÎÂÓÁ‡.

èË ‚ÒË˜ÍË ËÁÒÎÂ‰‚‡ÌË ‰Âˆ‡ ÎËÔÒ‚‡ı‡ ÓÚÍÎÓÌÂÌËfl ÓÚÒÚ‡Ì‡ Ì‡ Ú‡ÌÒ‡ÏËÌ‡ÁÌ‡Ú‡ ‡ÍÚË‚ÌÓÒÚ, Í‡ÍÚÓ ËÁıÓ‰ÌÓÚ‡Í‡ Ë ÔË ÍÓÌÚÓÎÌÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ Ì‡ Ô˙‚Ëfl ÏÂÒÂˆ ÓÚÎÂ˜ÂÌËÂÚÓ.

ëÚ‡ÌË˜ÌË ÔÓfl‚Ë ÓÚ ÚËÔ‡ „‡‰ÂÌÂ Ë Â‰ÌÓÍ‡ÚÌÓÔÓ‚˙˘‡ÌÂ ·Â Ì‡·Î˛‰‡‚‡ÌÓ ÔË 2 ‰Âˆ‡, ÔË ÍÓËÚÓ Ò Ì‡Ï‡-Îfl‚‡ÌÂ Ì‡ ‰ÓÁ‡Ú‡ ÓÔÎ‡Í‚‡ÌËflÚ‡ ÒÂ ÔÂÓ‰ÓÎflı‡.

èË ÌËÚÓ Â‰ËÌ ÓÚ Ô‡ˆËÂÌÚËÚÂ ÌÂ ÒÂ Ì‡ÎÓÊË ÔÂÛÒÚ‡-ÌÓ‚fl‚‡ÌÂ Ì‡ ÎÂ˜ÂÌËÂÚÓ Ò Convulex chrono, ÔÓ‡‰Ë ÒÚ‡-ÌË˜ÌË fl‚ÎÂÌËfl ËÎË ÔÓ‡‰Ë ÎËÔÒ‡ Ì‡ ÂÙÂÍÚË‚ÌÓÒÚ.

éÅëöÜÑÄçÖ

ÄÌ‡ÎËÁ˙Ú Ì‡ ÔÓÎÛ˜ÂÌËÚÂ ÂÁÛÎÚ‡ÚË ÔÓÍ‡Á‚‡ ‰Ó·˙ÍÎËÌË˜ÂÌ ÂÙÂÍÚ – ‚ ÔÂÓ·Î‡‰‡‚‡˘‡Ú‡ ˜‡ÒÚ ÓÚ ÒÎÛ˜‡ËÚÂËÏ‡ Ô˙ÎÌÓ ÍÛÔË‡ÌÂ ËÎË ÁÌ‡˜ËÏ‡ Â‰ÛÍˆËfl Ì‡ ÔËÒÚ˙ÔËÚÂÔË ÔÓ‰˜ÂÚ‡ÌÓ ‰Ó·‡ ÔÓÌÓÒËÏÓÒÚ.

ÖÙÂÍÚË‚ÌÓÒÚÚ‡ Ì‡ Convulex chrono Â „ÓÎflÏ‡, Í‡ÍÚÓÔË Ô˙‚Ë˜ÌÓ „ÂÌÂ‡ÎËÁË‡ÌË, Ú‡Í‡ Ë ÔË Ó„ÌË˘ÌË Ò ‚ÚÓ-Ë˜Ì‡ „ÂÌÂ‡ÎËÁ‡ˆËfl ÔËÒÚ˙ÔË. íÓ‚‡ Ò˙‚Ô‡‰‡ Ò ÎËÚÂ‡-ÚÛÌËÚÂ ‰‡ÌÌË, ÍÓËÚÓ ÒÓ˜‡Ú ÂÙÂÍÚË‚ÌÓÒÚ Ì‡ ‚‡ÎÔÓ‡-ÚËÚÂ ÔË ÚÓÁË ‚Ë‰ ÔËÒÚ˙ÔË Ò‡‚ÌËÏ‡ Ò Ú‡ÁË Ì‡ carba-mazepine, phenitoin Ë phenobarbital, ÌÓ ÔË ÁÌ‡˜ËÏÓ ÔÓ-‰Ó·‡ ÔÓÌÓÒËÏÓÒÚ (1, 8, 14, 16, 17). VPA Ò‡ ÔÓ-ÂÙÂÍÚË‚ÌËÓÚ lamotrigine Ë topiramat ÔË Ë‰ËÓÔ‡ÚË˜ÌË „ÂÌÂ‡ÎËÁË‡-ÌË ÂÔËÎÂÔÒËË (12). Ç ÛÌËÒÓÌ Ò ÓÚ˜ÂÚÂÌËfl ÍÎËÌË˜ÂÌ ÂÙÂÍÚÒ‡ Ë ÂÁÛÎÚ‡ÚËÚÂ ÔÓ ÓÚÌÓ¯ÂÌËÂ ÔÓ‚ÎËfl‚‡ÌÂ Ô˙‚Ë˜ÌÓ Ë‚ÚÓË˜ÌÓ „ÂÌÂ‡ÎËÁË‡ÌËÚÂ ÔÓÏÂÌË ‚ ÖÖÉ ËÁÒÎÂ‰‚‡ÌÂ-ÚÓ.

Convulex chrono Â ÓÒÓ·ÂÌÓ ÔÓ‰ıÓ‰fl˘ Á‡ ÚÂÚË‡ÌÂ Ì‡Ô‡ˆËÂÌÚË Ò ‡·Ò‡ÌÒÌË ÂÔËÎÂÔÒËË, ÔË ÍÓËÚÓ ËÏ‡ÏÂ ÔÓ˜ÚË‚˙‚ ‚ÒË˜ÍË ÒÎÛ˜‡Ë Ô˙ÎÌÓ Ó‚Î‡‰fl‚‡ÌÂ Ì‡ ÔËÒÚ˙ÔËÚÂ, ÔÓ-‰Ó·ÌÓ Ì‡ Ò˙Ó·˘‡‚‡ÌÓÚÓ Ë ÓÚ ‰Û„Ë ‡‚ÚÓË, ÒÔÓÂ‰ ÍÓË-ÚÓ ÂÙÂÍÚ˙Ú Â Ò‡‚ÌËÏ Ò ÚÓÁË Ì‡ ÂÚÓÒÛÍÒËÏË‰ËÚÂ (3, 8).

à ÔË ‡ÁÎË˜ÌËÚÂ ‚Ë‰Ó‚Â Ô‡ˆË‡ÎÌË ÔËÒÚ˙ÔË ÂÙÂÍ-


îË„.4. ë·ÓÌ‡ ÂÙÂÍÚË‚ÌÓÒÚ Á‡ ‚ÒË˜ÍË ‚Ë‰Ó‚Â ÔËÒÚ˙ÔË ‚ ‡·ÒÓÎ˛ÚÂÌ·ÓÈ Ë ‚ % (n=30).

îË„.5. èÓ‚ÎËfl‚‡ÌÂ Ì‡ ‡ÁÎË˜ÌËÚÂ ÚËÔÓ‚Â ‚˙Á·Û‰Ì‡ ‡ÍÚË‚ÌÓÒÚ ‚ ÖÖÉ Ì‡1 Ë Ì‡ 3 ÏÂÒ. ÓÚ Ì‡˜‡ÎÓÚÓ Ì‡ ÎÂ˜ÂÌËÂÚÓ Ò ÍÓÌ‚ÛÎÂÍÒ ıÓÌÓ.

ÚË‚ÌÓÒÚÚ‡ Ì‡ Convulex chrono Ò˙˘Ó Â „ÓÎflÏ‡ – ‚ 70% Á‡Ì‡¯ÂÚÓ Ì‡·Î˛‰ÂÌËÂ ËÏ‡Ú Ô˙ÎÌÓ ÍÛÔË‡ÌÂ Ì‡ ÔËÒÚ˙ÔË-ÚÂ Ë Ò˙˘ÂÒÚ‚ÂÌÓ Ì‡Ï‡Îfl‚‡ÌÂ Ì‡ Ó„ÌË˘ÌËfl ÚËÔ ÔÓÏÂÌË‚ ÖÖÉ. ãËÚÂ‡ÚÛÌËÚÂ ‰‡ÌÌË Ò˙˘Ó ÒÓ˜‡Ú ‰Ó·‡ ÂÙÂÍ-ÚË‚ÌÓÒÚ ÔË Ô‡ˆË‡ÎÌ‡ ÂÔËÎÂÔÒËfl, Ò‡‚ÌËÏ‡ Ò Ú‡ÁË Ì‡carbamazepine Ë phenitoin (1, 10, 13, 14).

é·˘‡Ú‡ ÂÙÂÍÚË‚ÌÓÒÚ Á‡ ‚ÒË˜ÍË ‚Ë‰Ó‚Â ÔËÒÚ˙ÔË ÔËÌ‡¯ÂÚÓ Ì‡·Î˛‰ÂÌËÂ Â - Ô˙ÎÌÓ ÍÛÔË‡ÌÂ (Ò‚Ó·Ó‰ÌË ÓÚÔËÒÚ˙ÔË) 73%, ÁÌ‡˜ËÏ‡ Â‰ÛÍˆËfl (Ò ÔÓ‚Â˜Â ÓÚ 50%) ‚20% Ë ÒÎ‡· ÂÙÂÍÚ (Ì‡Ï‡Îfl‚‡ÌÂ Ò ÔÓ-Ï‡ÎÍÓ ÓÚ 50%) ‚ 7 %ÓÚ ÒÎÛ˜‡ËÚÂ. ëÎÛ˜‡ËÚÂ Ò˙Ò ÒÎ‡· ÂÙÂÍÚ Ò‡ Ì‡ Ô‡ˆËÂÌÚË ÒÔÓ‰ÎÂÊ‡˘Ë Ó„‡ÌË˜ËÌË ÔÓÏÂÌË ‚ ñçë.

ëÚ‡ÌË˜ÌËÚÂ ÂÙÂÍÚË Ò‡ Â‰ÍË, ÔÂ‰‚Ë‰ËÏË Ë ‰Ó „ÓÎfl-Ï‡ ÒÚÂÔÂÌ ÔÂÓ‰ÓÎËÏË. Ç ‡ÏÍËÚÂ Ì‡ Ì‡¯ÂÚÓ Ì‡·Î˛‰Â-ÌËÂ ÚÂ Ò‡ Ò‡ÏÓ ÔË ‰‚Â ‰Âˆ‡ ÓÚ ÒÚ‡Ì‡ Ì‡ „‡ÒÚÓËÌÚÂÒ-ÚËÌ‡ÎÌËfl Ú‡ÍÚ – „‡‰ÂÌÂ Ë ÔÓ‚˙˘‡ÌÂ, ÌÓ Ò ÔÂıÓ‰ÂÌ ı‡-‡ÍÚÂ, Í‡Í‚ËÚÓ Ò‡ Ë ‰‡ÌÌËÚÂ ÓÚ ÒıÓ‰ÌË ÔÓÛ˜‚‡ÌËfl Ì‡‰Û„Ë ‡‚ÚÓË (8, 14). Ç Ì‡·Î˛‰‡‚‡Ì‡Ú‡ ÓÚ Ì‡Ò „ÛÔ‡ ÎËÔÒ-‚‡ı‡ ÔÓÏÂÌË ÓÚ ÒÚ‡Ì‡ Ì‡ ˜ÂÌÓ‰Ó·ÌËÚÂ ÔÓ·Ë. çÂ ·fl-ı‡ Ì‡·Î˛‰‡‚‡ÌË ‰Û„Ë ÒÚ‡ÌË˜ÌË fl‚ÎÂÌËfl, Í‡ÚÓ Ì‡‰‰‡‚‡-ÌÂ Ì‡ ÚÂ„ÎÓ, ÍÓÒÓÔ‡‰ Ë ÔÓÏÂÌË ‚ Í˙‚Ì‡Ú‡ Í‡ÚËÌ‡, Í‡Í-‚ËÚÓ Ò‡ ËÁ‚ÂÒÚÌË Á‡ VPA, ÌÓ ÒÓÍ˙Ú Á‡ Ì‡·Î˛‰ÂÌËÂ Á‡ÒÂ-„‡ Â Ò‡ÏÓ 3 ÏÂÒÂ˜ÂÌ Ë ‰ÓÍÓÎÍÓÚÓ ÔÓÛ˜‚‡ÌÂÚÓ Â ÓÚ‚ÓÂ-ÌÓ, Ì‡·Î˛‰ÂÌËÂÚÓ ‚˙ıÛ ÚÂÁË Ô‡ˆËÂÌÚË ˘Â ÔÓ‰˙ÎÊË.

è‡‚Ë ‚ÔÂ˜‡ÚÎÂÌËÂ, ˜Â ÔË ÛÏÂÂÌË ‰ÓÁË Ì‡ ÍËÎÓ„‡ÏÚÂÎÂÒÌ‡ Ï‡Ò‡ – ÓÍÓÎÓ 30Ï„ Convulex chrono ÔÓÍ‡Á‚‡ ‚ËÒÓ-ÍË ÒÂÛÏÌË ÍÓÌˆÂÌÚ‡ˆËË – Í˙Ï „ÓÌËÚÂ „‡ÌËˆË Ì‡ ÚÂ-‡ÔÂ‚ÚË˜Ì‡Ú‡ ÁÓÌ‡. íÓ‚‡ „Ó‚ÓË Á‡ ‰Ó·‡Ú‡ ÛÒ‚ÓflÂÏÓÒÚÌ‡ ÏÂ‰ËÍ‡ÏÂÌÚ‡, ÔÓÒÚË„‡ÌÂ Ì‡ ‰Ó·Ë ÔÎ‡ÁÏÂÌË ÌË‚‡, ÍÓÂ-ÚÓ ÂÙÎÂÍÚË‡ ‚ ‰Ó·Ë ÂÁÛÎÚ‡ÚË ÓÚ ÎÂ˜ÂÌËÂÚÓ.

ïÓÌÓ ÙÓÏ‡Ú‡ ÓÒ‚ÂÌ Ò ‰Ó·Ëfl ÂÙÂÍÚ Ë ÒÚ‡·ËÎÌ‡ ÒÂ-ÛÏÌ‡ ÍÓÌˆÂÌÚ‡ˆËfl Â Û‰Ó·ÂÌ Á‡ ‰Âˆ‡ ‚ Û˜ËÎË˘Ì‡ ‚˙Á-‡ÒÚ ÔÓ‡‰Ë ËÁ·fl„‚‡ÌÂ ÌÂÓ·ıÓ‰ËÏÓÒÚÚ‡ ÓÚ Ó·Â‰ÂÌ ÔË-ÂÏ, ÍÓÈÚÓ Â ÚÛ‰ÂÌ Á‡ ÍÓÌÚÓÎË‡ÌÂ ÓÚ ÒÚ‡Ì‡ Ì‡ Ó‰Ë-ÚÂÎËÚÂ.

àáÇéÑà

● Convulex chrono Â Ò ‰Ó·˙ ÍÎËÌË˜ÂÌ ÂÙÂÍÚ ÔÓ ÓÚ-ÌÓ¯ÂÌËÂ ÍÛÔË‡ÌÂ, Í‡ÍÚÓ Ì‡ „ÂÌÂ‡ÎËÁË‡ÌË, Ú‡Í‡ ËÌ‡ Ô‡ˆË‡ÎÌË ÂÔËÎÂÔÚË˜ÌË ÔËÒÚ˙ÔË

● Ç ÛÏÂÂÌË ‰ÓÁË Ì‡ ÔËÎÓÊÂÌËÂ Ò˙Á‰‡‚‡ ‰Ó·ËÔÎ‡ÁÏÂÌË ÍÓÌˆÂÌÚ‡ˆËË

● ÑÓ·Â ÔÓ‚ÎËfl‚‡ Ô‡ÓÍÒËÁÏ‡ÎÌ‡Ú‡ ‡ÍÚË‚ÌÓÒÚ ÓÚ„ÂÌÂ‡ÎËÁË‡Ì ËÎË Ó„ÌË˘ÂÌ ÚËÔ ‚ ÖÖÉ

● éÚÎË˜‡‚‡ ÒÂ Ò ‰Ó·‡ ÔÓÌÓÒËÏÓÒÚ Ë ÎËÔÒ‡ Ì‡ ÁÌ‡-˜ËÏË ÒÚ‡ÌË˜ÌË ÂÙÂÍÚË

ãàíÖêÄíìêÄ1. Aldenkamp A, Vigevano F, Arzimanoglou A, Covanis A. Role of valproate

across the ages. Treatment of epilepsy in children. Acta Neurol Scand Suppl.2006;184:1-13

2. Benbadis SR. Practical management issues for idiopathic generalized epilep-sies. Epilepsia. 2005;46 Suppl 9:125-32

3. Callaghan N, O’Hare J, O’Driscoll D, O’Neill B, Daly M. Comparative studyof ethosuximide and sodium valproate in the treatment of absence seizures(petit mal). Dev Med Child Neurol. 1982; 24: 830-836

4. Camfield C, Camfield P Management guidelines for children with idiopathicgeneralized epilepsy. Epilepsia. 2005;46 Suppl 9:112-6

5. Davis R, Peters DH, McTavish D. Valproic acid. A reappraisal of its pharma-cological properties and clinical efficacy in epilepsy. Drugs. 1994Feb;47(2):332-72

6. Destina Yalcin A, Forta H, Kilic E. Overlap cases of eyelid myoclonia withabsences and juvenile myoclonic epilepsy. Seizure. 2006 Sep;15(6):359-65.Epub 2006 Jun 21

7. Dirik E, Yis U, Hudaoglu O, Kurul S. Nonconvulsive status epilepticus andneurodevelopmental delay. Pediatr Neurol. 2006 Sep;35(3):209-12

8. Guerrini R. Valproate as a mainstay of therapy for pediatric epilepsy. PaediatrDrugs. 2006;8(2):113-29

9. Johannessen SI, Ben-Menachem E. Management of focal-onset seizures: anupdate on drug treatment. Drugs. 2006;66(13):1701-25

10. Kuncikova M. A multinational Observational Study of Effectiveness andTolerability of First-line Monoterapy with Sodium Valproate (Depakine) forPartial Epilepsy. Epilepsia. 2005; 46, Suppl 6: p184

11. Misra UK, Kalita J, Patel R. Sodium valproate vs phenytoin in status epilep-ticus: a pilot study. Neurology. 2006 Jul 25;67(2):340-2

12. Nicolson A, R E Appleton, D W Chadwick, D F Smith. The relationshipbetween treatment with valproate, lamotrigine, and topiramate and the prog-nosis of the idiopathic generalized epilepsies. J Neurol Neurosurg Psychiatry.2004; 75:75-79

13. Penry JK, Dean JC. Valproate monoterapy in partial seizures. Am J Med.1988; 84: 14-16

14. Perucca E. Pharmacological and therapeutic properties of valproate: a sum-mary after 35 years of clinical experience. CNS Drugs. 2002;16(10):695-714

15. Pinder RM, Brougden RN, Speight TM, Avery GS. Sodium valproat: areview of its pharmacological properties and therapeutic efficacy in epilepsy.Drugs. 1977; 13: 81-123

16. Verity CM, Hosking G, Easter DJ. A multicentre comparative trial of sodiumvalproate and carbamazepine in pediatric epilepsy: the Pediatric EPITEGCollaborative Group. Dev Med Child Neurol. 1995; 37:97-108

17. Wilder BJ, Ramsay RE, Murphy JV, Karas BJ, Marquardt K, Hammond EJ.Comparison of valproic acid and phenytoin in newly diagnosed tonic-clonicseizures. Neurology. 1983 Nov;33(11):1474-6.


SUMMARY

SPECIFICS OF THE COGNITIVE PROFILE INMULTIPLE SYSTEM ATROPHY

M. Petrova, L. Traykov, M. Raycheva, S. Mehrabian, Y. Jelev, D. Maslarov

Multiple system atrophy (MSA) is a progressive neurode-generative disorder, clinically characterised by a combinationof autonomic failures such as parkinsonism, cerebellar andpyramidal dysfunction. Along with the development of move-ment impairments many patients with MSA also demonstrateimpairments of cognitive functions in a normal general cogni-tive functioning.

The purpose of our study is a detailed examination of cog-nitive functions in a patient with MSA, in order to identify aspecific impairment, which could contribute to earlier identi-fication of the disease.

We are presenting the case of a 52 years old man with prob-able MSA and a fast progressing neurological deficit continu-ing for about 6 years. The clinical picture encompasses dom-inant, severe cerebellar dysfunction in combination with auto-nomic and urinary dysfunction, parkinsonism and pyramidalsigns, but a normal general cognitive functioning (MMSE =29). In addition, the patient has been examined with detailedneuropsychological battery designed to measure episodicmemory, language, attention and executive functions. Thepatient’s results were compared with those of 15 age matchednormal controls.

The neuropsychological evaluation revealed a mild impair-ment of free recall and a normal cued recall, and recognitionof the Free and Cued Selective Reminding Test. Furthermore,the patient showed mild deficiency of attention’s scope andworking memory with several executive aspects (digit span,phonemic verbal fluency and Stroop test).

In conclusion, the data revealing a significant impairmentof executive functions in combination with mild deficiency infree recalling in our patient, support the idea, that mild cogni-tive impairments are often found in MSA. The detailed neu-ropsychological examination and the knowledge of the cogni-tive profile of these patients play an important role in the dis-crimination of MSA from other disorders manifested withparkinsonism and cognitive impairments, such as Pakinson’sdisease and Progressive supranuclear palsy, even in earlierstages of the disease.

KEY WORDS: diagnosis, cognitive impairment, multiplesystem atrophy.

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çÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ ‡ÁÍË‚‡ ÎÂÍÓ Ì‡Û-¯ÂÌÓ Ò‚Ó·Ó‰ÌÓ ÔËÔÓÏÌflÌÂ, ‰ÓÍ‡ÚÓ ÛÎÂÒÌÂÌÓÚÓ ÔËÔÓÏ-ÌflÌÂ Ë ‡ÁÔÓÁÌ‡‚‡ÌÂÚÓ ÔË FCSRT Ò‡ Ò˙ı‡ÌÂÌË, Í‡ÍÚÓ ËÎÂÍ ‰ÂÙËˆËÚ ‚ Ó·ı‚‡Ú‡ Ì‡ ‚ÌËÏ‡ÌËÂÚÓ Ë ‡·ÓÚÌ‡Ú‡ Ô‡-ÏÂÚ Ò Ì‡Û¯ÂÌËÂ ‚ ÌflÍÓË ÂÍÁÂÍÛÚË‚ÌË ‡ÒÔÂÍÚË (digitspan, ÙÓÌÂÏÌ‡ ‚Â·‡ÎÌ‡ ÙÎÛË‰ÌÓÒÚ Ë Stroop ÚÂÒÚ).

Ç Á‡ÍÎ˛˜ÂÌËÂ ‰‡ÌÌËÚÂ Á‡ ÁÌ‡˜ËÏÓ Ì‡Û¯ÂÌËÂ Ì‡ ÂÍÁÂ-ÍÛÚË‚ÌË ÙÛÌÍˆËË ‚ Ò˙˜ÂÚ‡ÌËÂ Ò ÎÂÍ ‰ÂÙËˆËÚ ‚ Ò‚Ó·Ó‰ÌÓ-ÚÓ ÔËÔÓÏÌflÌÂ ÔË Ì‡¯Ëfl Ô‡ˆËÂÌÚ ÔÓ‰ÍÂÔflÚ Ë‰ÂflÚ‡ Á‡˜ÂÒÚÓÚÓ Ì‡ÎË˜ËÂ Ì‡ ÎÂÍË ÍÓ„ÌËÚË‚ÌË Ì‡Û¯ÂÌËfl ÔËMëA. èÓ‰Ó·ÌÓÚÓ ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌÓ ËÁÒÎÂ‰‚‡ÌÂ Ë ÔÓÁ-Ì‡‚‡ÌÂÚÓ Ì‡ ÍÓ„ÌËÚË‚ÌËfl ÔÓÙËÎ ÔË ÚÂÁË ·ÓÎÌË ËÏ‡ÚÒ˙˘ÂÒÚ‚ÂÌÓ ÏflÒÚÓ ‚ ‡Á„‡ÌË˜‡‚‡ÌÂÚÓ Ì‡ åëÄ ÓÚ ‰Û-„Ë Á‡·ÓÎfl‚‡ÌËfl, ÔÓfl‚fl‚‡˘Ë ÒÂ Ò Ô‡ÍËÌÒÓÌËÁ˙Ï Ë ÍÓ„ÌË-ÚË‚ÌË Ì‡Û¯ÂÌËfl, Í‡ÚÓ è‡ÍËÌÒÓÌÓ‚‡ ·ÓÎÂÒÚ Ë èÓ„Â-ÒË‚Ì‡ ÒÛÔ‡ÌÛÍÎÂ‡Ì‡ Ô‡‡ÎËÁ‡, ‰ÓË Ë ‚ Ì‡˜‡ÎÌËÚÂ ÒÚ‡-‰ËË Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ.

äãûóéÇà Ñìåà: ‰Ë‡„ÌÓÁ‡, ÍÓ„ÌËÚË‚ÌË Ì‡Û¯ÂÌËfl,ÏÛÎÚËÒËÒÚÂÏÌ‡ ‡ÚÓÙËfl.

åÛÎÚËÒËÒÚÂÏÌ‡Ú‡ ‡ÚÓÙËfl (åëÄ) Â ÔÓ„ÂÒË‚ÌÓÌÂ‚Ó‰Â„ÂÌÂ‡ÚË‚ÌÓ Á‡·ÓÎfl‚‡ÌÂ, ÍÓÂÚÓ ÍÎËÌË˜ÌÓ ÒÂ ı‡-‡ÍÚÂËÁË‡ Ò ‡ÁÌÓÓ·‡ÁÌ‡ ÍÓÏ·ËÌ‡ˆËfl ÓÚ ‡‚ÚÓÌÓÏÌËÌ‡Û¯ÂÌËfl, Ô‡ÍËÌÒÓÌËÁ˙Ï, ˆÂÂ·ÂÎ‡ÌË Ë ÔË‡ÏË‰ÌË Ì‡-Û¯ÂÌËfl. åëÄ ÒÂ ‡Á„ÎÂÊ‰‡ Í‡ÚÓ ÒÔÓ‡‰Ë˜ÌÓ Á‡·ÓÎfl‚‡ÌÂ,‚˙ÔÂÍË ˜Â Ì‡ÒÍÓÓ Ò‡ ÔÛ·ÎËÍÛ‚‡ÌË ‰‡ÌÌË Á‡ ‰‚‡ ÒÎÛ˜‡fl ‚„ÂÏ‡ÌÒÍ‡ Ù‡ÏËÎËfl Ì‡ åëÄ Ò ‚ÂÓflÚÌÓ ‡‚ÚÓÁÓÏÌÓ ‰ÓÏË-Ì‡ÌÚÌÓ ÛÌ‡ÒÎÂ‰fl‚‡ÌÂ (16). ç‡ Ô‡ÍÚËÍ‡ ‚ÒË˜ÍË Ô‡ˆËÂÌÚËÒ åëÄ ËÏ‡Ú ‡ÁÎË˜ÌË ÔÓ ÒÚÂÔÂÌ ‡‚ÚÓÌÓÏÌË Ì‡Û¯ÂÌËfl ‚Ò˙˜ÂÚ‡ÌËÂ Ò ÔÂ‰ÓÏËÌ‡ÌÚÂÌ Ô‡ÍËÌÒÓÌËÁ˙Ï (åëÄ-è) ËÎËÒ ÔÂ‰ÓÏËÌ‡ÌÚÌ‡ ˆÂÂ·ÂÎ‡Ì‡ ÒËÏÔÚÓÏ‡ÚËÍ‡ (åëÄ-ñ).

á‡·ÓÎÂ‚‡ÂÏÓÒÚÚ‡ ÓÚ åëÄ ÒÂ ÓˆÂÌfl‚‡ Ì‡ 0.6 Ì‡ 100 000, ‡ ·ÓÎÂÒÚÌÓÒÚÚ‡ Ì‡ 1.86-4.9 Ì‡ 100 000 Ì‡ÒÂÎÂ-ÌËÂ. ëÂ‰Ì‡Ú‡ ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ ÓÚ Ì‡˜‡ÎÌËÚÂ ÒËÏÔ-ÚÓÏË ‰Ó ‡Á‚ËÚËÂÚÓ Ì‡ ÍÓÏ·ËÌË‡Ì‡ ÏÓÚÓÌ‡ Ë ‡‚ÚÓ-ÌÓÏÌ‡ ‰ËÒÙÛÌÍˆËfl Â ÒÂ‰ÌÓ 2 „Ó‰ËÌË (ÓÚ 1-10 „.). ëÂ‰Ì‡-Ú‡ ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ ÓÚ Ì‡˜‡ÎÌËÚÂ ÒËÏÔÚÓÏË ‰Ó ‚˙Á-ÌËÍ‚‡ÌÂÚÓ Ì‡ ÌÂÓ·ıÓ‰ËÏÓÒÚ ÓÚ ÔÓÎÁ‚‡ÌÂÚÓ Ì‡ ÔÓÏÓ˘ÌÓÒÂ‰ÒÚ‚Ó Á‡ ÔË‰‚ËÊ‚‡ÌÂ, ËÁÔÓÎÁ‚‡ÌÂÚÓ Ì‡ ËÌ‚‡ÎË‰Ì‡ ÍÓ-ÎË˜Í‡, ÔËÍÓ‚‡‚‡ÌÂÚÓ Í˙Ï ÎÂ„ÎÓ Ë ÒÏ˙Ú Â ÂÒÔÂÍÚË‚ÌÓ3, 5, 8 Ë 9 „Ó‰ËÌË. è‡ˆËÂÌÚËÚÂ Ò åëÄ-è ËÏ‡Ú ÔÓ-·˙ÁÓ


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èêà åìãíàëàëíÖåçÄ Äíêéîàüå. èÂÚÓ‚‡1, ã. í‡ÈÍÓ‚1, å. ê‡È˜Â‚‡1, ò. åÂı‡·Ë‡Ì1, ü. ÜÂÎÂ‚1, Ñ. å‡ÒÎ‡Ó‚2

1åÅÄã “ÄÎÂÍÒ‡Ì‰Ó‚ÒÍ‡”, äÎËÌËÍ‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl, åÂ‰ËˆËÌÒÍË ìÌË‚ÂÒËÚÂÚ, ëÓÙËfl2éÚ‰ÂÎÂÌËÂ ÔÓ çÂ‚ÓÎÓ„Ëfl, è˙‚‡ åÅÄã - ëÓÙËfl

ÙÛÌÍˆËÓÌ‡ÎÌÓ ‚ÎÓ¯‡‚‡ÌÂ ‚ Ò‡‚ÌÂÌËÂ Ò Ô‡ˆËÂÌÚËÚÂ ÒåëÄ-ñ, Í‡ÚÓ Ó˜‡Í‚‡Ì‡Ú‡ ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ Ì‡ ÊË‚ÓÚË ÔË ‰‚‡Ú‡ ÔÓ‰ÚËÔ‡ Â ÒıÓ‰Ì‡ (15). Ö‰Ì‡ ÚÂÚ‡ ÓÚ Ô‡ˆË-ÂÌÚËÚÂ Ò˙Ò ÒÔÓ‡‰Ë˜Ì‡ ÓÎË‚ÓÔÓÌÚÓˆÂÂ·ÂÎ‡Ì‡ ‡ÚÓ-ÙËfl ‡Á‚Ë‚‡Ú Í‡ÚËÌ‡Ú‡ Ì‡ åëÄ ‚ ‡ÏÍËÚÂ Ì‡ 5 „Ó‰ËÌËÓÚ Ì‡˜‡ÎÓÚÓ, Í‡ÚÓ ÔÂıÓ‰˙Ú ÒÂ Ò‚˙Á‚‡ Ò ÔÓ-ÎÓ¯‡ ÔÓ„-ÌÓÁ‡ Á‡ ÔÂÊË‚flÂÏÓÒÚÚ‡ (2).

á‡Â‰ÌÓ Ò ‡Á‚ËÚËÂÚÓ Ì‡ ‰‚Ë„‡ÚÂÎÌËÚÂ Ì‡Û¯ÂÌËflÏÌÓ„Ó Ô‡ˆËÂÌÚË Ò åëÄ ‰ÂÏÓÌÒÚË‡Ú Ì‡Û¯ÂÌËfl Ì‡ÍÓ„ÌËÚË‚ÌËÚÂ ÙÛÌÍˆËË, ÔË ÌÓÏ‡ÎÌÓ Ó·˘Ó ÍÓ„ÌËÚË‚ÌÓÙÛÌÍˆËÓÌË‡ÌÂ. Ç Ò˙ÓÚ‚ÂÒÚ‚ËÂ Ò˙Ò Ò˙˘ÂÒÚ‚Û‚‡˘Ëfl ‚ÏÓÏÂÌÚ‡ ÏÂÊ‰ÛÌ‡Ó‰ÂÌ ÍÓÌÒÂÌÒÛÒ Á‡ ‰Ë‡„ÌÓÁ‡Ú‡ Ì‡åëÄ, Ì‡ÎË˜ËÂÚÓ Ì‡ ‰ÂÏÂÌˆËfl Â ËÁÍÎ˛˜‚‡˘ ÍËÚÂËÈ Á‡Á‡·ÓÎfl‚‡ÌÂÚÓ (3). èÓ‚Â‰ÂÌËÚÂ ÔÓÛ˜‚‡ÌËfl ‰‡‚‡Ú ÔÓ-ÚË‚ÓÂ˜Ë‚Ë ‰‡ÌÌË Á‡ ÚËÔ‡ Ì‡ ÍÓ„ÌËÚËÌËÚÂ Ì‡Û¯ÂÌËflÔË åëÄ.

èÂÁ 1991 „. Sullivan Ò˙Ó·˘‡‚‡, ˜Â ÒÚÛÍÚÛÌÓÚÓ ‚˙‚-ÎË˜‡ÌÂ Ì‡ ÔÛÚ‡ÏÂÌ‡ ÔË åëÄ ‚Ó‰Ë ‰Ó ‰ËÒÙÛÌÍˆËfl Ì‡ Ô˙-‚Ë˜Ì‡Ú‡ ÏÓÚÓÌ‡ Ë Ó·ËÚÓÙÓÌÚ‡ÎÌ‡Ú‡ ÍÓ‡ ÔË Ò˙ı-‡ÌÂÌËÂ, Í‡ÍÚÓ Ì‡ ‰Û„ËÚÂ ÙÓÌÚ‡ÎÌË Â„ËÓÌË, Ú‡Í‡ Ë Ì‡Ô‡ËÂÚ‡ÎÌ‡Ú‡ Ë ÚÂÏÔÓ‡ÎÌ‡ ÍÓ‡ (14). ÑÛ„Ó ÔÓÛ˜‚‡ÌÂÛÒÚ‡ÌÓ‚fl‚‡ ÔÓ-‰ËÙÛÁÌ‡ ‰ËÒÙÛÌÍˆËfl Ì‡ ÙÓÌÚ‡ÎÌËfl ÎÓ·,ÔÓ‰Ó·Ì‡ Ì‡ Ú‡ÁË Ì‡·Î˛‰‡‚‡Ì‡ ÔË Ô‡ˆËÂÌÚË Ò è‡ÍËÌÒÓ-ÌÓ‚‡ ·ÓÎÂÒÚ (èÅ) Ë èÓ„ÂÒË‚Ì‡ ÒÛÔ‡ÌÛÍÎÂ‡Ì‡ Ô‡‡ÎËÁ‡(èëè) (9). ê‡ÌÌËÚÂ ÒÚ‡‰ËË Ì‡ åëÄ ÔÓÌflÍÓ„‡ ÒÂ ‡Á„‡ÌË-˜‡‚‡Ú ÚÛ‰ÌÓ ÍÎËÌË˜ÌÓ ÓÚ èÅ Ë èëè (7). Ö‰ËÌË˜ÌËÒ‡‚ÌËÚÂÎÌË ÔÓÛ˜‚‡ÌËfl Ì‡ Ô‡ˆËÂÌÚË Ò ÚÂÁË Á‡·Îfl‚‡ÌËflÒ˙Ó·˘‡‚‡Ú, ˜Â Ô‡ˆËÂÌÚËÚÂ Ò åëÄ ËÏ‡Ú ÔÓÙËÎ Ì‡ ÍÓ„-ÌËÚË‚ÌÓ Ì‡Û¯ÂÌËÂ Ò˙Ò ÒÔÂˆËÙË˜ÌË ÔÓÏÂÌË ‚ ÂÍÁÂÍÛ-ÚË‚ÌËÚÂ ÙÛÌÍˆËË ÔÓ‰Ó·ÂÌ Ì‡ ÚÂÁË ÔË Ô‡ˆËÂÌÚË Ò èÅ.(10,8)

ñÂÎÚ‡ Ì‡ Ì‡¯ÂÚÓ ÔÓÛ˜‚‡ÌÂ Â ‰ÂÚ‡ÈÎÌÓ ËÁÒÎÂ‰‚‡ÌÂ Ì‡ÍÓ„ÌËÚË‚ÌËÚÂ ÙÛÌÍˆËË ÔË Ô‡ˆËÂÌÚ ÒÚ‡‰‡˘ ÓÚ MëÄÁ‡ Ë‰ÂÌÚËÙËˆË‡ÌÂ Ì‡ ÒÔÂˆËÙË˜ÌË Ì‡Û¯ÂÌËfl, ÍÓËÚÓ ‰‡‰ÓÔËÌÂÒ‡Ú Á‡ ‡ÌÌÓÚÓ ‡ÁÔÓÁÌ‡‚‡ÌÂ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ.éÒÓ·ÂÌÓ ‚ÌËÏ‡ÌËÂ Â ÓÚ‰ÂÎÂÌÓ Ì‡ ËÁÒÎÂ‰‚‡ÌÂÚÓ Ì‡ Ô‡ÏÂÚ-Ú‡ Ë ÂÍÁÂÍÛÚË‚ÌËÚÂ ÙÛÌÍˆËË.

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èÂ‰ÒÚ‡‚flÏÂ ÒÎÛ˜‡È Ì‡ ‚ÂÓflÚÌ‡ åëÄ (3) ÔË 52-„Ó-‰Ë¯ÂÌ Ï˙Ê Ò ·˙ÁÓ ÔÓ„ÂÒË‡˘‡ ÌÂ‚ÓÎÓ„Ë˜Ì‡ ÒËÏÔÚÓ-Ï‡ÚËÍ‡ Ë ÎÂÍË ÍÓ„ÌËÚË‚ÌË Ì‡Û¯ÂÌËfl. éÔÎ‡Í‚‡ÌËflÚ‡ Ò‡Ò ‰‡‚ÌÓÒÚ ÓÍÓÎÓ ¯ÂÒÚ „Ó‰ËÌË ÔÂ‰Ë ÔÓÒÚ˙Ô‚‡ÌÂÚÓ ‚ ÍÎË-ÌËÍ‡Ú‡ ÔÂÁ flÌÛ‡Ë 2006 „.

è˙‚ËÚÂ ÓÔÎ‡Í‚‡ÌËfl Ì‡ Ô‡ˆËÂÌÚ‡ ‰‡ÚË‡Ú ÓÚ ÓÍÓÎÓ2000 „. ÍÓ„‡ÚÓ ÒÂ ÔÓfl‚fl‚‡ ÌÂÒÚ‡·ËÎÌÓÒÚ ÔË ıÓ‰ÂÌÂ, Á‡-·‡‚ÂÌ Ë ÌÂflÒÂÌ „Ó‚Ó Ë Ì‡Û¯ÂÌËÂ ‚˙‚ ÙËÌËÚÂ ‰‚ËÊÂÌËflÌ‡ ‰flÒÌ‡ ˙Í‡, Ì‡È-ËÁ‡ÁÂÌË ÔË ÔËÒ‡ÌÂ. èÂÁ 2002 „. ÒÂÔË·‡‚flÚ Ë ËÏÔÂ‡ÚË‚ÌË ÔÓÁË‚Ë Á‡ ÛËÌË‡ÌÂ Ò ËÁÔÛÒÍ‡-ÌÂ ÔÂÁ ÌÓ˘Ú‡, Í‡ÍÚÓ Ë ÓÚÓÒÚ‡ÚË˜ÌË ÔÓfl‚Ë Ò ÌÂÍÓÎ-ÍÓÍ‡ÚÌË Ô‡‰‡ÌËfl. èÂÁ ÔÂËÓ‰‡ 2002-2004 „. ÓÔÎ‡Í‚‡ÌË-flÚ‡ ÔÓ„ÂÒË‚ÌÓ ÒÂ Á‡ÒËÎ‚‡Ú. Ç Ì‡˜‡ÎÓÚÓ Ì‡ 2005 „. ÒÂÔÓfl‚fl‚‡ ‰ÓÔ˙ÎÌËÚÂÎÌ‡ ÌÂÒ˙˜ÌÓÒÚ ‚ ‰‚ËÊÂÌËflÚ‡ Ì‡ ˙-ˆÂÚÂ, Í‡ÚÓ ‚˙ÁÌËÍ‚‡ Ë ÌÂÓ·ıÓ‰ËÏÓÒÚÚ‡ ÓÚ ·‡ÒÚÛÌ ÔËıÓ‰ÂÌÂ. éÚ Í‡fl Ì‡ 2005 „. ÌÂÒÚ‡·ËÎÌÓÒÚÚ‡ ÔË ‰‚ËÊÂ-ÌËÂ ÒÂ Á‡ÒËÎ‚‡ ‰Ó ÌÂÓ·ıÓ‰ËÏÓÒÚ ÓÚ ˜ÛÊ‰‡ ÔÓÏÓ˘ ÔËÔË‰‚ËÊ‚‡ÌÂ ËÁ‚˙Ì ‰ÓÏ‡. èÓ ÓÚÌÓ¯ÂÌËÂ Ì‡ ÏËÌ‡Î‡Ú‡‡Ì‡ÏÌÂÁ‡ Ë ‰Û„Ë ÔË‰ÛÊ‡‚‡˘Ë Á‡·ÓÎfl‚‡ÌËfl, Ô‡ˆËÂÌÚ˙ÚË ÌÂ„Ó‚ËÚÂ ·ÎËÁÍË Ò˙Ó·˘‡‚‡Ú Á‡ ÒÚÂÌÓÍ‡‰ÂÌ ÔËÒÚ˙Ô ËÛÒÚ‡ÌÓ‚ÂÌ WPW-ÒËÌ‰ÓÏ ÔÂÁ 1996 „.

éÚ Ì‡Ô‡‚ÂÌËÚÂ ËÁÒÎÂ‰‚‡ÌËfl ÔÂ‰Ë ıÓÒÔËÚ‡ÎËÁ‡ˆËfl-Ú‡ Ì‡ ÎËÍ‚Ó (06.2002 „.) – Ó·˘Ó ËÁÒÎÂ‰‚‡ÌÂ Ë ÂÎÂÍÚÓÙÓ-ÂÁ‡ ‚ ÌÓÏ‡. äí Ì‡ „Î‡‚ÂÌ ÏÓÁ˙Í (2001 „.) – ‚ ÌÓÏ‡, åêíË åê ‡Ì„ËÓ„‡ÙËfl (02.2002 „.) – ·ÂÁ Ô‡ÚÓÎÓ„Ë˜ÌË ËÁÏÂÌÂ-ÌËfl, åêí Ì‡ „Î‡‚ÂÌ ÏÓÁ˙Í (2003 „.) – ·ÂÁ Ô‡ÚÓÎÓ„Ë˜ÌË ËÁ-ÏÂÌÂÌËfl. Ö‚ÓÍË‡ÌË ÔÓÚÂÌˆË‡ÎË (06.2002 „.) áÖè- ‰‚ÛÒÚ-

‡ÌÌÓ ÒÂ Â„ËÒÚË‡ ÁËÚÂÎÌ‡ ‡ÙÂÂÌÚ‡ˆËfl Ò ÎÂÍÓ Û‰˙Î-ÊÂÌÓ ÔÓ‚Ó‰ÌÓ ‚ÂÏÂ Ë ‰ËÒÍÂÚÌË ‰‡ÌÌË Á‡ ÌÂ‰Ó·‡ ÒËÌı-ÓÌËÁ‡ˆËfl Ì‡ ‡ÙÂÂÌÚÌËfl ÔÓÚÓÍ ÔË ÏÓÌÓÍÛÎflÌ‡ ÒÚË-ÏÛÎ‡ˆËfl Ì‡ Îfl‚Ó ÓÍÓ, ëÖè – ‰‚ÛÒÚ‡ÌÌÓ ÒÎÛıÓ‚‡ ‡ÙÂÂÌ-Ú‡ˆËfl Ì‡ ÒÚ‚ÓÎÓ‚Ó ÌË‚Ó Ò ÌÓÏ‡ÎÌÓ ÔÓ‚Ó‰ÌÓ ‚ÂÏÂ, ÌÂ‰Ó·Â Ó„‡ÌËÁË‡Ì ‡ÙÂÂÌÚÂÌ ÔÓÚÓÍ Ì‡ ‚ËÒÓÍÓ ÒÚ‚ÓÎÓ‚ÓÌË‚Ó ‚ Îfl‚Ó ÔË ÒÚËÏÛÎ‡ˆËfl Ì‡ Îfl‚Ó ÛıÓ. éÚÓÌÂ‚ÓÎÓ„Ë˜-ÌÓ ËÁÒÎÂ‰‚‡ÌÂ (06.2002 „.) – ˆÂÌÚ‡ÎÂÌ ÓÚÓÌÂ‚ÓÎÓ„Ë˜ÂÌÒËÌ‰ÓÏ Ò˙Ò Ò‡‚ÌËÚÂÎÌÓ ÎÂÍÓ Ì‡·ÂÎflÁ‡Ì‡ ÒÔÓÌÚ‡ÌÌ‡ ‚ÂÒ-ÚË·ÛÎ‡Ì‡ ÒËÏÔÚÓÏ‡ÚËÍ‡, ‰‚ÛÒÚ‡ÌÌÓ ÎÂÍÓ Á‚ÛÍÓÔËÂÏ-ÌÓ Ì‡Ï‡ÎÂÌËÂ Ì‡ ÒÎÛı‡ (ã>Ñ). ÑÓÔÎÂÓ‚‡ ÒÓÌÓ„‡ÙËfl(11.2005 „.) - ·ÂÁ ÓÒÓ·ÂÌÓÒÚË. ÖåÉ (2002 „.) – ÌÂ ÒÂ ÛÒÚ‡-ÌÓ‚fl‚‡Ú ‰‡ÌÌË Á‡ ÔÓÎËÌÂ‚ËÚÌ‡ Û‚Â‰‡, ÎËÔÒ‚‡Ú ‰‡ÌÌË Á‡ÚÂÏÓ; ÖåÉ ‰‡ÌÌË Á‡ ÍÓÂÌ˜Â‚‡ Û‚Â‰‡ Á‡ ë6, ë7, ë8; ÌÂÒÂ ÛÒÚ‡ÌÓ‚fl‚‡ Ì‡Û¯ÂÌËÂ Ì‡ ÌÂ‚ÌÓ-ÏÛÒÍÛÎÌÓÚÓ ÔÂ‰‡‚‡-ÌÂ.

èÓ ÓÚÌÓ¯ÂÌËÂ Ì‡ Ù‡ÏËÎÌ‡Ú‡ ‡Ì‡ÏÌÂÁ‡ Ò‡ ÛÒÚ‡ÌÓ‚ÂÌË‰‡ÌÌË Á‡ ÎÂÎfl Ë ‰fl‰Ó Ò Ô‡ÏÂÚÓ‚Ë Ì‡Û¯ÂÌËfl Ò Í˙ÒÌÓ Ì‡˜‡-ÎÓ Ë ·‡˘‡ Ò ËÒıÂÏË˜ÂÌ ÏÓÁ˙˜ÂÌ ËÌÒÛÎÚ ‚˙‚ ‚ÂÚÂ·Ó-·‡-ÁËÎ‡Ì‡Ú‡ ÒËÒÚÂÏ‡ Ë Ô‡ÏÂÚÓ‚Ë Ì‡Û¯ÂÌËfl;

éÚ Ó·ÂÍÚË‚ÌÓÚÓ Ò˙ÒÚÓflÌËÂ ÒÓÏ‡ÚË˜ÌËflÚ ÒÚ‡ÚÛÒ Â·ÂÁ ÓÒÓ·ÂÌÓÒÚË. éÚ ÌÂ‚ÓÎÓ„Ë˜ÌËfl ÒÚ‡ÚÛÒ ÒÂ ÛÒÚ‡ÌÓ‚fl-‚‡ ‰ËÒÍÓÓ‰ËÌ‡ˆËÓÌÂÌ ÒËÌ‰ÓÏ (Ô‡ÎÂÓ- Ë ÌÂÓˆÂÂ·ÂÎ‡ÂÌ)Ò ÚÂÊÍ‡ ÒÚ‡ÚË˜Ì‡ Ë ÎÓÍÓÏÓÚÓÌ‡ ‡Ú‡ÍÒËfl, ‰ËÒÏÂÚËflË ËÌÚÂÌˆËÓÌÂÌ ÚÂÏÓ ÔË ÌÓÒÓÔÓÍ‡Á‡ÎÂ˜Ì‡ Ë ÍÓÎflÌÌÓ-ÒÚ˙Ô‡ÎÌ‡ ÔÓ·Ë ‰‚ÛÒÚ‡ÌÌÓ, ‡Ú‡ÍÒË˜Ì‡ ‰ËÁ‡ÚËfl Ë‡‰Ë‡‰ÓıÓÍËÌÂÁ‡ ‰‚ÛÒÚ‡ÌÌÓ; ÂÍÒÚ‡ÔË‡ÏË‰ÂÌ ÒËÌ‰ÓÏ –(Ò ·‡‰ËÍËÌÂÁËfl, ‰ËÒÍÂÚÌÓ Ë„Ë‰ÌÓ ÔÓ‚Ë¯ÂÌ ÏÛÒÍÛÎÂÌÚÓÌÛÒ ‚ ˜ÂÚËËÚÂ Í‡ÈÌËÍ‡, ÔË‚Â‰ÂÌ‡ ÔÓÁ‡, ÎËÔÒ‚‡˘ËÙËÁËÓÎÓ„Ë˜ÌË ÒËÌÍËÌÂÁËË ‚ ˙ˆÂÚÂ, ıËÔÓÙÓÌËfl Ë ·‡‰ËÙ-ÂÌËfl; ÔË‡ÏË‰ÌË ·ÂÎÂÁË Ò ·ÓÎÂÒÚÌÓ ÓÊË‚ÂÌË ÒÛıÓÊËÎÌËË Ì‡‰ÍÓÒÚÌË ÂÙÎÂÍÒË Ò ‡Á¯ËÂÌË ÂÙÎÂÍÒÓ„ÂÌÌË ÁÓÌË ‚˜ÂÚËËÚÂ Í‡ÈÌËÍ‡ Ë Å‡·ËÌÒÍË (+) ‚ Îfl‚Ó; ÔÒÂ‚‰Ó·ÛÎ·‡-ÂÌ ÒËÌ‰ÓÏ Ò ÔÓÎÓÊËÚÂÎÌË Ó‡ÎÌË ‡‚ÚÓÏ‡ÚËÁÏË; ‡‚ÚÓ-ÌÓÏÌË Ë Ú‡ÁÓ‚Ó-ÂÁÂ‚Ó‡ÌË Ì‡Û¯ÂÌËfl Ò ËÁ‡ÁÂÌ‡ Ó-ÚÓÒÚ‡ÚË˜Ì‡ ıËÔÓÚÓÌËfl Ë ËÏÔÂ‡ÚË‚ÌË ÔÓÁË‚Ë Á‡ ÛËÌË-‡ÌÂ. ë˙ı‡ÌÂÌÓ Ó·˘Ó ÍÓ„ÌËÚË‚ÌÓ ÙÛÌÍˆËÓÌË‡ÌÂ(ååSE=29).

è‡‡ÍÎËÌË˜ÌËÚÂ ËÁÒÎÂ‰‚‡ÌËfl Á‡ Í˙‚ Ë ÛËÌ‡ Ò‡ ‚ „‡-ÌËˆ‡Ú‡ Ì‡ ÌÓÏ‡Ú‡. ëÂÛÏÌË ËÁÒÎÂ‰‚‡ÌËfl Á‡ ãÛÂÒ (-). KTÌ‡ „Î‡‚ÂÌ ÏÓÁ˙Í – ÍÓÓ‚‡ Ë Ï‡ÎÍÓÏÓÁ˙˜Ì‡ ‡ÚÓÙËfl. ÇÂ„Â-ÚÓÎÓ„Ë˜ÌÓ ËÁÒÎÂ‰‚‡ÌÂ (ÏÓÌËÚÓËÌ„) – ÔÓÎÓÊËÚÂÎÌ‡ Ó-ÚÓÒÚ‡ÚË˜Ì‡ Â‡ÍˆËfl. äÓÌÒÛÎÚ‡ˆËfl Ò ËÌÚÂÌËÒÚ(01.2006„.) – ÔÂ‰‚Ë‰ ËÁ‡ÁÂÌ‡Ú‡ ıËÔÓÚÓÌËfl ÒÂ ÔÂÔÓ˙˜-‚‡ ÎÂ˜ÂÌËÂ Ò Novadral 2-3x1 ‰‡ÊÂ.

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è‡ˆËÂÌÚ˙Ú Â ËÁÒÎÂ‰‚‡Ì Ò ÔÓ‰Ó·Ì‡ ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜Ì‡·‡ÚÂËfl, Ò˙ÒÚ‡‚ÂÌ‡ ÓÚ 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) Á‡ ÓˆÂÌÍ‡ Ì‡Í‡ÚÍÓÒÓ˜Ì‡ ‚Â·‡ÎÌ‡ Ô‡ÏÂÚ, Í‡ÍÚÓ Ë Ò Buschke Freeand Cued Selective Reminding Test (FCSRT) Á‡ ÓˆÂÌÍ‡ Ì‡‚Â·‡ÎÌ‡ ÂÔËÁÓ‰Ë˜Ì‡ Ô‡ÏÂÚ ˜ÂÁ ËÁÒÎÂ‰‚‡ÌÂ Ì‡ Ò‚Ó·Ó‰ÌÓ-ÚÓ ÔËÔÓÏÌflÌÂ, Ó·˘ÓÚÓ (Ò‚Ó·Ó‰ÌÓ Ë ÛÎÂÒÌÂÌÓ) ÔËÔÓÏ-ÌflÌÂ Ë ‡ÁÔÓÁÌ‡‚‡ÌÂÚÓ. ÇÌËÏ‡ÌËÂÚÓ Ë ÂÍÁÂÍÛÚË‚ÌËÚÂÙÛÌÍˆËË Ò‡ ËÁÒÎÂ‰‚‡ÌË Ò: Trail Making Test – Ä (TMT-A) ËÇ (TMT-B); Modified Card Sorting Test (MCST); ÇÂ·‡ÎÌ‡ÙÎÛË‰ÌÓÒÚ (ÙÓÌÂÏÌ‡), ÔË ÍÓflÚÓ ÒÂ ÓˆÂÌfl‚‡ Ó·˘ËflÚ·ÓÈ ÂÎÂÏÂÌÚË Ë Stroop Test. êÂ˜Ú‡ Â ËÁÒÎÂ‰‚‡Ì‡ Ò Í‡Ú-Í‡ ‚ÂÒËfl Ì‡ Boston Naming Test (BNT) Ë Ò ÇÂ·‡ÎÌ‡ ÙÎÛ-Ë‰ÌÓÒÚ (Í‡ÚÂ„ÓË‡ÎÌ‡), ÔË ÍÓflÚÓ ÒÂ ÓˆÂÌfl‚‡ Ó·˘ËflÚ·ÓÈ ÂÎÂÏÂÌÚË ‚ ÚËÚÂ Í‡ÚÂ„ÓËË. êÂÁÛÎÚ‡ÚËÚÂ ÓÚËÁÒÎÂ‰‚‡ÌÂÚÓ Ì‡ ·ÓÎÌËfl Ò‡ Ò˙ÔÓÒÚ‡‚flÌË Ò ÚÂÁË Ì‡ „ÛÔ‡ÓÚ 15 Ò˙ÓÚ‚ÂÚÌË ÔÓ ‚˙Á‡ÒÚ ÍÎËÌË˜ÌÓ Á‰‡‚Ë ÎËˆ‡.

êÂÁÛÎÚ‡ÚËÚÂ ÓÚ ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ Ò‡


ÔÂ‰ÒÚ‡‚ÂÌË ‚ Ú‡·ÎËˆ‡Ú‡. Ñ‡ÌÌËÚÂ ÒÓ˜‡Ú Ò˙ı‡ÌÂÌÓ Ó·-˘Ó ÍÓ„ÌËÚË‚ÌÓ ÙÛÌÍˆËÓÌË‡ÌÂ (ååSE = 29).

èË Ô‡ÏÂÚÓ‚ËÚÂ ÚÂÒÚÓ‚Â, ‡Ì‡ÎËÁ˙Ú ÔÓÍ‡Á‚‡, ˜Â ÔË·ÓÎÌËfl ÒÂ Ì‡·Î˛‰‡‚‡ ÌÓÏ‡ÎÌ‡ ‚˙ÁıÓ‰fl˘‡ ÍË‚‡ Ì‡ Á‡Û˜‡-‚‡ÌÂ. ãÂÍÓ Â Ì‡Û¯ÂÌÓ Ò‚Ó·Ó‰ÌÓÚÓ ÔËÔÓÏÌflÌÂ, ‰ÓÍ‡ÚÓÛÎÂÒÌÂÌÓÚÓ ÔËÔÓÏÌflÌÂ Ë ‡ÁÔÓÁÌ‡‚‡ÌÂÚÓ Ò‡ Ò˙ı‡ÌÂÌË.ä‡ÚÓ ˆflÎÓ ÔÓˆÂÒËÚÂ Ò‚˙Á‡ÌË Ò ÔÎ‡ÌË‡ÌÂ Ë ÍÓÌˆÂÔÚÛ-‡ÎËÁ‡ˆËfl Ò‡ Ò˙ı‡ÌÂÌË, Í‡ÚÓ ÒÂ Ì‡·Î˛‰‡‚‡ ÎÂÍ ‰ÂÙËˆËÚ ‚Ó·ı‚‡Ú‡ Ì‡ ‚ÌËÏ‡ÌËÂÚÓ Ë ‡·ÓÚÌ‡Ú‡ Ô‡ÏÂÚ Ò Ì‡Û¯Â-ÌËÂ ‚ ÌflÍÓË ÂÍÁÂÍÛÚË‚ÌË ‡ÒÔÂÍÚË (digit span, ÙÓÌÂÏÌ‡‚Â·‡ÎÌ‡ ÙÎÛË‰ÌÓÒÚ Ë Stroop ÚÂÒÚ).

ë Ó„ÎÂ‰ ‡Ì‡ÏÌÂÒÚË˜ÌËÚÂ ‰‡ÌÌË Á‡ ÔÓÒÚÂÔÂÌÌÓ ÔÓ„Â-ÒË‡˘‡ ‰ËÒÍÓÓ‰ËÌ‡ˆËÓÌÌ‡ ÒËÏÔÚÓÏ‡ÚËÍ‡, ‚ Ò˙˜ÂÚ‡ÌËÂÒ ·‡‰ËÍËÌÂÁËfl Ë Ú‡ÁÓ‚Ó-ÂÁÂ‚Ó‡ÌË Ì‡Û¯ÂÌËfl; ÍÎËÌË˜-Ì‡Ú‡ Í‡ÚËÌ‡ Ò ‰ÓÏËÌË‡˘ Ô‡ÎÂÓ- Ë ÌÂÓˆÂÂ·ÂÎ‡ÂÌ ‰ËÒ-ÍÓÓ‰ËÌ‡ˆËÓÌÂÌ ÒË‰ÓÏ, ‚ Ò˙˜ÂÚ‡ÌËÂ Ò ‡‚ÚÓÌÓÏÌË Ë Ú‡-ÁÓ‚Ó-ÂÁÂ‚Ó‡ÌË Ì‡Û¯ÂÌËfl, Ô‡ÍËÌÒÓÌËÁ˙Ï Ë ÔË‡ÏË‰-ÌË ·ÂÎÂÁË, Í‡ÚÓ Ë ÂÁÛÎÚ‡ÚËÚÂ ÓÚ äí Ë ‚Â„ÂÚÓÎÓ„Ë˜ÌÓËÁÒÎÂ‰‚‡ÌÂ Ë ‚ Ò˙ÓÚ‚ÂÚÒÚ‚ËÂ Ò˙Ò Ò‚ÂÚÓ‚ÌËÚÂ ÍÓÌÒÂÌÒÛÒ-ÌË ÍËÚÂËË (3), ÒÂ ÔËÂ ‰Ë‡„ÌÓÁ‡Ú‡ ‚ÂÓflÚÌ‡ åëÄ.

éÅëöÜÑÄçÖ

èÂ‰ÒÚ‡‚flÏÂ ÒÎÛ˜‡È Ì‡ Ô‡ˆËÂÌÚ Ò åëÄ, ÍÓÈÚÓ ÔÂ‰Ò-Ú‡‚Îfl‚‡ ËÌÚÂÂÒ ÔÓ‡‰Ë ‚Ë‰‡ Ì‡ ÛÒÚ‡ÌÓ‚ÂÌËÚÂ ÌÂ‚ÓÔ-ÒËıÓÎÓ„Ë˜ÌË Ì‡Û¯ÂÌËfl ÔË Ò˙ı‡ÌÂÌÓ Ó·˘Ó ÍÓ„ÌËÚË‚ÌÓÙÛÌÍˆËÓÌË‡ÌÂ. Ñ‡ÌÌËÚÂ ÒÓ˜‡Ú Á‡ ÁÌ‡˜ËÏÓ Ì‡Û¯ÂÌËÂÔË ÚÂÒÚÓ‚ÂÚÂ Á‡ ÓˆÂÌÍ‡ Ì‡ ÂÍÁÂÍÛÚË‚ÌË ÙÛÌÍˆËË ‚ Ò˙-˜ÂÚ‡ÌËÂ Ò ÎÂÍ ‰ÂÙËˆËÚ ‚ Ò‚Ó·Ó‰ÌÓÚÓ ÔËÔÓÏÌflÌÂ.

êÂÁÛÎÚ‡ÚËÚÂ ÓÚ ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌÓÚÓ ËÁÒÎÂ‰‚‡ÌÂÔË Ì‡¯Ëfl ÒÎÛ˜‡È Ò˙ÓÚ‚ÂÚÒÚ‚‡Ú Ì‡ ‰‡ÌÌËÚÂ ÔÓÎÛ˜ÂÌËÓÚ Burk K. Ë Ò˙Ú. (1) ÔË ËÁÒÎÂ‰‚‡ÌÂ Ì‡ ÍÓ„ÌËÚË‚ÌËflÔÓÙËÎ Ì‡ Ô‡ˆËÂÌÚË Ò åëÄ-ñ. Ç ÚÓ‚‡ ÔÓÛ˜‚‡ÌÂ ‡‚ÚÓË-ÚÂ Ó·‡˜Â, ÛÒÚ‡ÌÓ‚fl‚‡Ú ÔÓ-ÚÂÊÍË Ì‡Û¯ÂÌËfl ‚˙‚ ‚Â·‡Î-Ì‡Ú‡ Ô‡ÏÂÚ Á‡ ‡ÁÎËÍ‡ ÓÚ ÂÁÛÎÚ‡ÚËÚÂ ÔË ËÁÒÎÂ‰‚‡ÌËflÓÚ Ì‡Ò ·ÓÎÂÌ.

ç‡Û¯ÂÌËflÚ‡ ‚ ÂÍÁÂÍÛÚË‚ÌËÚÂ ÙÛÌÍˆËË ÒÂ ÛÒÚ‡ÌÓ‚fl-‚‡Ú Í‡ÚÓ Ì‡È-‡ÌÂÌ ÍÓ„ÌËÚË‚ÂÌ ‰ÂÙËˆËÚ ÔË Ô‡ˆËÂÌÚËÒ˙Ò Á‡·ÓÎfl‚‡ÌËfl Ì‡ ·‡Á‡ÎÌËÚÂ „‡Ì„ÎËË, ‚ ÚÓ‚‡ ˜ËÒÎÓ Ë ÔËåëÄ. èË ÓÔËÚ Á‡ ‡Á„‡ÌË˜‡‚‡ÌÂ Ì‡ Ô‡ÍËÌÒÓÌÓ‚ËÚÂÒËÌ‰ÓÏË ‚ Ò˙ÓÚ‚ÂÒÚ‚ËÂ Ò ÔÓÏÂÌËÚÂ ‚ ÂÍÁÂÍÛÚË‚ÌËÚÂ

ÙÛÌÍˆËË Lange Ë Ò˙Ú. (6) ÛÒÚ‡ÌÓ‚fl‚‡Ú, ˜Â Ô‡ˆËÂÌÚËÚÂÒ èëè ÔÓÍ‡Á‚‡Ú ÔÓ-ÚÂÊÍÓ Ì‡Û¯ÂÌËÂ ‚ Ò‡‚ÌÂÌËÂ Ò Ô‡-ˆËÂÌÚËÚÂ Ò èÅ Ë åëÄ, Í‡ÚÓ ÂÁÛÎÚ‡ÚËÚÂ ÔË ÔÓÒÎÂ‰-ÌËÚÂ ‰‚Â „ÛÔË Ò‡ ÒıÓ‰ÌË. íÂÁË ‰‡ÌÌË ÒÂ ÔÓÚ‚˙Ê‰‡‚‡Ú ËÓÚ Â‰Ëˆ‡ ‰Û„Ë ‡‚ÚÓË ( 9, 8,12). ÇÌËÏ‡ÌËÂ Á‡ÒÎÛÊ‡‚‡ÔÓÛ˜‚‡ÌÂÚÓ Ì‡ Soliveri Ë Ò˙Ú. (12), ÍÓËÚÓ Ò˙Ó·˘‡‚‡ÚÁ‡ ÔÓ-ÌËÒÍ‡ ÛÒÔÂ‚‡ÂÏÓÒÚ Ì‡ ÚÂÒÚ‡ Á‡ ‚Â·‡ÎÌ‡ ÙÎÛË‰-ÌÓÒÚ ÔË Ô‡ˆËÂÌÚË Ò åëÄ, ‚ Ò‡‚ÌÂÌËÂ Ò ÚÂÁË ÒÚ‡‰‡˘ËÓÚ èÅ. è‡‚Ë ‚ÔÂ˜‡ÚÎÂÌËÂ, Ó·‡˜Â, ÔÓ-ÚÂÊÍ‡Ú‡ ÍÎËÌË˜Ì‡ÒËÏÔÚÓÏ‡ÚËÍ‡ Ì‡ Ô‡ˆËÂÌÚËÚÂ ‚ÍÎ˛˜ÂÌË ‚ ÔÓÛ˜‚‡ÌÂÚÓÌ‡ Soliveri Ë Ò˙Ú. (12). ëÎÂ‰Ó‚‡ÚÂÎÌÓ ‡ÍÓ ÔËÂÏÂÏ, ˜Â‚Â·‡ÎÌ‡Ú‡ ÙÎÛË‰ÌÓÒÚ ÔË Ô‡ˆËÂÌÚË Ò åëÄ ‚ ‡ÌÌËÚÂÒÚ‡‰ËË Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ Â ÔÓ‰Ó·Ì‡ Ì‡ Ú‡ÁË ÔË èÅ Ë Â ÔÓ-ÚÂÊÍÓ Ì‡Û¯ÂÌ‡ ‚ ÔÓ-Í˙ÒÌËÚÂ ÒÚ‡‰ËË, ÚÓ ÚÓ„‡‚‡ ‚ÂÓ-flÚÌÓ ÔË åëÄ ËÏ‡ ÔÓ-·˙ÁÓ ‚ÎÓ¯‡‚‡ÌÂ ‚˙‚ ‚Â·‡ÎÌ‡Ú‡ÙÎÛË‰ÌÓÒÚ ‚ Ò‡‚ÌÂÌËÂ Ò èÅ (6).

Ç ÒÚÂÏÂÊ‡ ÒË ‰‡ Ó·flÒÌËÏ Ì‡ÎË˜ËÂÚÓ Ì‡ ‰ËÁÂÍÁÂÍÛÚË-‚ÂÌ ÒËÌ‰ÓÏ Ò ‡Ì‡ÚÓÏË˜Ì‡Ú‡ ÎÓÍ‡ÎËÁ‡ˆËfl Ì‡ ÎÂÁËËÚÂ ÔËåëÄ, ÏÓÊÂÏ ‰‡ Î‡ÌÒË‡ÏÂ ‰‚Â ıËÔÓÚÂÁË. è˙‚‡Ú‡ ÌËÓÚ‚ÂÊ‰‡ ‚ Ú˙ÒÂÌÂ Ì‡ ÎÂÁËËÚÂ ‚ Ó·Î‡ÒÚÚ‡ Ì‡ ‡ÒÓˆË‡-ÚË‚Ì‡Ú‡ ˜ÂÎÌ‡ ÍÓ‡, ÔÓ‡‰Ë Ù‡ÍÚ‡, ˜Â ÚÓÁË ÚËÔ ÓÚÍÎÓ-ÌÂÌËfl Ò‡ Ì‡È-˜ÂÒÚË ÔË ·ÓÎÌË Ò ˜ÂÎÌË ÎÂÁËË. ÇÚÓ‡Ú‡ ıË-ÔÓÚÂÁ‡ ÌË Ì‡ÒÓ˜‚‡ Í˙Ï Ú˙ÒÂÌÂ Ì‡ ÎÂÁËË ‚˙‚ ‚˙ÁÍËÚÂ Ì‡˜ÂÎÌËfl ‰flÎ Ò ·‡Á‡ÎÌËÚÂ „‡Ì„ÎËË Ë/ËÎË Ï‡ÎÍËfl ÏÓÁ˙Í.

Ñ‡ÌÌËÚÂ ÓÚ ÎËÚÂ‡ÚÛ‡Ú‡ Ò‡ ‚ ÔÓ‰ÍÂÔ‡ ÔÂ‰ËÏÌÓÌ‡ ‚ÚÓ‡Ú‡ ıËÔÓÚÂÁ‡. êÂÁÛÎÚ‡ÚËÚÂ ÓÚ ÒÚÛÍÚÛÌËÚÂÔ‡ÚÓ‡Ì‡ÚÓÏË˜ÌË ÔÓÛ˜‚‡ÌËfl ÔË Ô‡ˆËÂÌÚË Ò åëÄ ÔÓ-Í‡Á‚‡Ú ‚˙‚ÎË˜‡ÌÂ Ì‡ ÙÓÌÚ‡ÎÌËÚÂ ‰flÎÓ‚Â ÔÂ‰ËÏÌÓ ‚Ì‡ÔÂ‰Ì‡ÎËÚÂ ÒÚ‡‰ËË Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ (13). èË Ô‡ˆËÂÌ-ÚËÚÂ Ò ÔÂÓ·Î‡‰‡‚‡˘ Ô‡ÍËÌÒÓÌËÁ˙Ï (åëÄ-è) ‰Â„ÂÌÂ‡-ˆËflÚ‡ Ì‡ ÔÛÚ‡ÏÂÌ Ë ÌÛÍÎÂÛÒ Í‡Û‰‡ÚÛÒ ÒÂ Ò˜ËÚ‡Ú Í‡ÚÓÏ‡ÍÂ Á‡ Á‡·ÓÎfl‚‡ÌÂÚÓ, ‡ ÔË ÚÂÁË Ò ÔÂÓ·Î‡‰‡‚‡˘ ˆÂÂ-·ÂÎ‡ÂÌ ÒËÌ‰ÓÏ (åëÄ-ñ) Ï‡ÍÂ Â ˆÂÂ·ÂÎ‡Ì‡Ú‡ ‡ÚÓ-ÙËfl (3,7). èÓÁÌ‡‚‡ÈÍË ÏÌÓ„Ó·ÓÈÌËÚÂ ‚Á‡ËÏÓ‚˙ÁÍË Ì‡˜ÂÎÌËfl ‰flÎ Ò ÔÓ‰ÍÓÓ‚ËÚÂ ÒÚÛÍÚÛË, Ú‚˙‰Â ‚ÂÓflÚÌÓÂ fl‚ÎÂÌËflÚ‡ Ì‡ ‰ËÒÍÓÌÂÍˆËfl Ì‡ ˜ÂÎÌËfl ‰flÎ, ‰˙ÎÊ‡˘Ë ÒÂ Ì‡‰Â„ÂÌÂ‡ˆËfl Ì‡ ·‡Á‡ÎÌËÚÂ „‡Ì„ÎËË Ë/ËÎË Ï‡ÎÍËfl ÏÓÁ˙Í, ‰‡Ò‡ ÓÚ„Ó‚ÓÌË Á‡ Ì‡Û¯ÂÌËflÚ‡ ‚ ÂÍÁÂÍÛÚË‚ÌËÚÂ Ë Ô‡ÏÂ-ÚÓ‚Ë ÙÛÌÍˆËË.

í‡ÁË ıËÔÓÚÂÁ‡ Ì‡ÏË‡ ˜‡ÒÚË˜ÌÓ ÔÓÚ‚˙Ê‰ÂÌËÂ ‚ Ìfl-ÍÓË ËÁÒÎÂ‰‚‡ÌËfl Ò ÙÛÌÍˆËÓÌ‡ÎÌË ÌÂ‚ÓËÁÓ·‡Áfl‚‡˘Ë ÏÂ-ÚÓ‰Ë (11), ÍÓËÚÓ ÛÒÚ‡ÌÓ‚fl‚‡Ú ˜ÂÎÂÌ ıËÔÓÏÂÚ‡·ÓÎËÁ˙ÏÔË ËÌÙ‡ÍÚË ‚ Ï‡ÎÍËfl ÏÓÁ˙Í ·ÂÁ Ì‡ÎË˜ËÂ Ì‡ åêí ‰‡ÌÌËÁ‡ ÎÂÁËË ‚ ˜ÂÎÌËfl ‰flÎ, Í‡ÍÚÓ Ë ‚ ËÁÒÎÂ‰‚‡ÌËfl ‰ÂÏÓÌÒÚË-‡˘Ë ˆÂÂ·ÂÎ‡Ì‡ ‡ÍÚË‚ÌÓÒÚ ÔÓ ‚ÂÏÂ Ì‡ ËÁÔ˙ÎÌÂÌËÂ Ì‡ÚÂÒÚÓ‚Â Á‡ ÂÍÁÂÍÛÚË‚ÌË ÙÛÌÍˆËË Ë ‚Â·‡ÎÌ‡ Ô‡ÏÂÚ (4,5).êÂÁÛÎÚ‡ÚËÚÂ ÓÚ Ì‡ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡ÌÂ, ÔÓÍ‡Á‚‡˘Ë ‰Â-ÙËˆËÚ ‚ ÂÍÁÂÍÛÚË‚ÌËÚÂ Ë Ô‡ÏÂÚÓ‚Ë ÙÛÌÍˆËË ÔË ·ÓÎÂÌÒ åëÄ-ñ, ÔÂ‰ÒÚ‡‚Îfl‚‡Ú ‰ÓÔ˙ÎÌËÚÂÎÂÌ ‡„ÛÏÂÌÚ ‚ ÔÓÎ-Á‡ Ì‡ Ú‡ÁË ıËÔÓÚÂÁ‡.

Ç Á‡ÍÎ˛˜ÂÌËÂ, ÓÔËÒ‡ÌËÂÚÓ Ì‡ Ì‡¯Ëfl Ô‡ˆËÂÌÚ Ë ‡Ì‡-ÎËÁ˙Ú Ì‡ ÎËÚÂ‡ÚÛ‡Ú‡ ÒÓ˜‡Ú ÌÂ‰‚ÛÒÏËÒÎÂÌÓ „ÓÎflÏÓÚÓÁÌ‡˜ÂÌËÂ Ì‡ ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ ‚ ‰Ë‡„ÌÓÒ-ÚË˜ÌËfl ÔÓˆÂÒ Ì‡ åëÄ, ‰ÓË ‚ Ì‡˜‡ÎÌËÚÂ ÒÚ‡‰ËË Ì‡ Á‡-·ÓÎfl‚‡ÌÂÚÓ. èÓ‰Ó·ÌÓÚÓ ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌÓ ËÁÒÎÂ‰‚‡ÌÂË ÔÓÁÌ‡‚‡ÌÂÚÓ Ì‡ ÍÓ„ÌËÚË‚ÌËfl ÔÓÙËÎ ÔË ÚÂÁË ·ÓÎÌËËÏ‡Ú Ò˙˘ÂÒÚ‚ÂÌÓ ÏflÒÚÓ ‚ ‡Á„‡ÌË˜‡‚‡ÌÂÚÓ Ì‡ åëÄÓÚ ‰Û„Ë Á‡·ÓÎfl‚‡ÌËfl ÔÓfl‚fl‚‡˘Ë ÒÂ Ò Ô‡ÍËÌÒÓÌËÁ˙Ï ËÍÓ„ÌËÚË‚ÌË Ì‡Û¯ÂÌËfl, Í‡ÚÓ èÅ Ë èëè.

ãàíÖêÄíìêÄ1. Burk, K., Daum, I., Rub, U. Cognitive function in multiple system atrophy of

the cerebellar type. Mov Disord., 21, 2006, 772-6.2. Gilman, S., Little, R., Johanns, J., Heumann, M., Kluin, K.J., Junck, L.,

Koeppe, R.A., An, H. Evolution of sporadic olivopontocerebellar atrophy intomultiple system atrophy. Neurology, 55, 2000, 527-32.

3. Gilman, S., Low, P.A., Quinn, N., Albanese, A., Ben-Shlomo, Y., Fowler,C.J., Kaufmann, H., Klockgether, T., Lang, A.E., Lantos, P.L., Litvan, I.,


êÂÁÛÎÚ‡ÚË ÓÚ ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌËÚÂ ÚÂÒÚÓ‚Â ÔË ·ÓÎÂÌ Ò åëÄ ËÁ‰‡‚Ë ÍÓÌÚÓÎË.

íÂÒÚÓ‚Â åëÄ äÓÌÚÓÎËMMS 29 29.5 (0.5)

ÖÍÁÂÍÛÚË‚ÌË ÙÛÌÍˆËËTrail Making Test Ä 55 49.67 (14.8)

Stroop Test 30 37.27 (6.2)

Trail Making Test B 105 105.6 (30.9)

MCST (Í‡ÚÂ„ÓËË) 6 6.0 (0.0)

ÇÂ·‡ÎÌ‡ ÙÎÛË‰ÌÓÒÚ (å) 5 14.9(3.2)

Digit span (backward) 3 5.1 (1.0)

è‡ÏÂÚDigit Span 5 6.5(0.9)

FCSRT Ò‚Ó·Ó‰ÌÓ Ô. 28 29.01 (4.7)

FCSRT Ó·˘Ó Ô. 47 46.3 (1.2)

FCSRT ‡ÁÔÓÁÌ‡‚‡ÌÂ 16 16

ë‚Ó·Ó‰ÌÓ ÓÚ‰‡ÎÂ˜ÂÌÓ Ô. 11 12.1 (2.4)

é·˘Ó ÓÚ‰‡ÎÂ˜ÂÌÓ Ô. 16 15.9 (0.2)

êÂ˜ÇÂ·‡ÎÌ‡ ÙÎÛË‰ÌÓÒÚ (ÊË‚ÓÚÌË) 24 24.7 (4.0)

BNT 15 14.9(0.3)

Ñ‡ÌÌËÚÂ Ò‡ ÒÂ‰ÌË ‡ËÚÏÂÚË˜ÌË (SD).

MCST = Modified Card Sorting Test; BNT = Boston Naming test, FCSRT =

Free and Cued Selective Reminding Test, Ô = ÔËÔÓÏÌflÌÂ.

Mathias, C.J., Oliver, E., Robertson, D., Schatz, I., Wenning, G.K. Consensusstatement on the diagnosis of multiple system atrophy. J Neurol Sci., 163,1999, 94-8.

4. Grasby, P.M., Frith, C.D., Friston, K., Frackowiak, R.S., Dolan, R.J.Activation of the human hippocampal formation during auditory-verbal long-term memory function. Neurosci Lett, 163, 1993, 185-188.

5. Kim, S.G., Ugurbil, K., Strick, P.L. Activation of a cerebellar output nucleusduring cognitive processing. Science, 265, 1994, 949-951.

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Ä‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËfl: Ñ- å. èÂÚÓ‚‡,ìåÅÄã “ÄÎÂÍÒ‡Ì‰Ó‚ÒÍ‡”,äÎËÌËÍ‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl, ·ÛÎ. “ÉÂÓ„Ë ëÓÙËÈÒÍË” 1, ëÓÙËfl 1431ÚÂÎ: 02/92 30 350Â-mail: [email protected]


éÔËÒ‡ÌËÂ Ì‡ ÍÎËÌË˜ÂÌ ÒÎÛ˜‡ÈçéÇÄ PSEN1 åìíÄñàü èêà ÅöãÉÄêëäÄ îÄåàãàü ë êÄççéçÄóÄãé à ÄíàèàóçÄ äãàçàóçÄ äÄêíàçÄ çÄ ÅéãÖëííÄ

çÄ ÄãñïÄâåÖêã. í‡ÈÍÓ‚1, ò. åÂı‡·Ë‡Ì1, Ä. âÓ‰‡ÌÓ‚‡2, å. ê‡È˜Â‚‡1, ê. ê‡‰ÂÏ‡ÍÂ3, å. äÛÚÒ3,

Ñ. å‡ÒÎ‡Ó‚4, à. äÂÏÂÌÒÍË2, ä. Ç‡Ì ÅÓÂÍıÓ‚ÂÌ3

1äÎËÌËÍ‡ ÔÓ çÂ‚ÓÎÓ„Ëfl, åÅÄã “ÄÎÂÍÒ‡Ì‰Ó‚ÒÍ‡”, åÂ‰ËˆËÌÒÍË ìÌË‚ÂÒËÚÂÚ, ëÓÙËfl2ã‡·Ó‡ÚÓËfl ÔÓ åÓÎÂÍÛÎflÌ‡ è‡ÚÓÎÓ„Ëfl, åÂ‰ËˆËÌÒÍË ìÌË‚ÂÒËÚÂÚ, ëÓÙËfl

3ä‡ÚÂ‰‡ ÔÓ åÓÎÂÍÛÎflÌ‡ ÉÂÌÂÚËÍ‡, ìÌË‚ÂÒËÚÂÚ ÄÌÚ‚ÂÔÂÌ, ÅÂÎ„Ëfl4éÚ‰ÂÎÂÌËÂ ÔÓ çÂ‚ÓÎÓ„Ëfl, è˙‚‡ åÅÄã - ëÓÙËfl

SUMMARY

NOVEL PSÖN1 MUTATTION IN A BULGARIAN FAMI-LY PRESENTING WITH ATYPICAL EARLY ONSET

ALZHEIMER’S DISEASE

L. Traykov, S. Mehrabian, A. Jordanova, M. Raycheva, R.Rademakers, M. Cruts, D. Maslarov, I.Kremensky,

C. Van BroeckhovenDepartment of Neurology, “Alexandrovska” Hospital

Medical University, Sofia, BulgariaLaboratory of Molecular Pathology, Medical University,

Sofia, BulgariaMolecular Genetics Department, University of Antwerp,

Antwerpen, BelgiumDepartment of Neurology, First Hospital - Sofia

Alzheimer’s disease (AD) is a neurodegenerative disordertypically resulting in memory loss, visuospatial deficits, andrelative sparing of personality until late in the disease course.Mutations in 3 genes are associated with familial cases ofearly onset AD: amyloid precursor protein (APP), Presenilin1 (PSEN1), and Presenilin 2 (PSEN2).

We studied a Bulgarian family with seven affected patientsin three generations. A novel Leu424Phe mutation in thePSEN1 gene that results in early onset Alzheimer’s diseasewas identified.

The initial symptoms of the first observed patient wereapathy and depression at the age of 54 years. He was managedby antidepressants for a period of two years without effect. Bythe age of 57 years he had moderate dementia (MMSE=15) inaddition to behavior disturbances. Neuropsychological fol-

low-up showed a rapid progression of the disease with asevere dementia at the age of 59 (MMSE=0) and grand malepilepsy.

The initial symptoms of the second patient were forgetful-ness, behavioral changes like aggression, anxiety, delusions,and hallucinations at the age of 61 years. One year later, theneuropsychological examination revealed moderate dementia(MMSE=16). Six months later, the neuropsychological evalu-ation showed rapid progression of the disease with MMSE=8.The neuroimaging examinations of both patients showedsevere brain atrophy with white matter changes.

The clinical picture of the other 5 affected members fromthis family was characterized by marked behavioral abnor-malities in addition to cognitive impairment with different ageof onset.

We identified a novel PSEN1mutation in a large BulgarianAD family presented by marked behavioral abnormalities andcognitive impairment in all patients and epilepsy in one ofthem.

KEY WORDS: Presenilin 1, familial Alzheimer’s disease,atypical clinical feature

êÖáûåÖ

ÅÓÎÂÒÚÚ‡ Ì‡ ÄÎˆı‡ÈÏÂ (ÅÄ) Â ÌÂ‚Ó‰Â„ÂÌÂ‡ÚË‚ÌÓÁ‡·ÓÎfl‚‡ÌÂ ı‡‡ÍÚÂËÁË‡˘Ó ÒÂ Ò Ô‡ÏÂÚÓ‚Ë Ì‡Û¯ÂÌËfl,ÁËÚÂÎÌÓ-ÔÓÒÚ‡ÌÒÚ‚ÂÌË Ì‡Û¯ÂÌËfl Ë Ò‡‚ÌËÚÂÎÌÓÒ˙ı‡ÌÂÌË ÔÓ‚Â‰ÂÌ˜ÂÒÍË Â‡ÍˆËË ‚ Ì‡˜‡ÎÓÚÓ. î‡ÏËÎÌËÚÂÒÎÛ˜‡Ë Ì‡ ÅÄ Ò ‡ÌÌÓ Ì‡˜‡ÎÓ ÒÂ ‡ÒÓˆËË‡Ú Ò ÏÛÚ‡ˆËË ‚ÚË „ÂÌ‡: Amyloid Precursor Protein (APP), Presenilin 1(PSEN1) Ë Presenilin 2 (PSEN2).

àÁÒÎÂ‰‚‡ÌÂÚÓ ÒÂ ÔÓ‚ÂÊ‰‡ ÔË ·˙Î„‡ÒÍ‡ Ù‡ÏËÎËfl Ò˙ÒÒÂ‰ÂÏ Á‡ÒÂ„Ì‡ÚË ˜ÎÂÌÓ‚Â ‚ ÚË ÔÓÍÓÎÂÌËfl. ìÒÚ‡ÌÓ‚fl‚‡ ÒÂÌÓ‚‡ ÏÛÚ‡ˆËfl ‚ PSÖN1 (Leu424Phe) „ÂÌ‡, ÍÓflÚÓ ÔË˜ËÌfl-‚‡ ·ÓÎÂÒÚ Ì‡ ÄÎˆı‡ÈÏÂ Ò ‡ÌÌÓ Ì‡˜‡ÎÓ.

èË Ô˙‚Ëfl Ô‡ˆËÂÌÚ ÒÂ ÔÓfl‚fl‚‡Ú ‡Ô‡ÚËfl Ë ‰ÂÔÂÒËflÌ‡ 54 „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ. èÓ‚ÂÊ‰‡ ÒÂ ÎÂ˜ÂÌËÂ Ò ‡ÌÚË‰ÂÔ-ÂÒ‡ÌÚË Á‡ ‰‚Â „Ó‰ËÌË ·ÂÁ ÂÙÂÍÚ. ç‡ 57 „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚÒÂ ÛÒÚ‡ÌÓ‚fl‚‡ ÛÏÂÂÌ‡ ‰ÂÏÂÌˆËfl (MMSE=15) ‚ Ò˙˜ÂÚ‡-ÌËÂ Ò ÔÓ‚Â‰ÂÌ˜ÂÒÍË Ì‡Û¯ÂÌËfl. äÎËÌË˜ÌÓÚÓ Ë ÌÂ‚ÓÔÒË-ıÓÎÓ„Ë˜ÌÓ ÔÓÒÎÂ‰fl‚‡ÌÂ ÔÓÍ‡Á‚‡ ·˙Á‡ ÔÓ„ÂÒËfl Ì‡ Á‡·Ó-Îfl‚‡ÌÂÚÓ ‰Ó ÒÚÂÔÂÌ ÚÂÊÍ‡ ‰ÂÏÂÌˆËfl (MMSE=0) Ì‡ 59„Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ Ò ÔÓfl‚‡ Ì‡ ÔËÒÚ˙ÔË Ì‡ „‡Ì‰ Ï‡Î ÂÔË-ÎÂÔÒËfl.

è˙‚ËÚÂ ÒËÏÔÚÓÏË Ì‡ ‚ÚÓËfl Ô‡ˆËÂÌÚ Ò‡ Ô‡ÏÂÚÓ‚ËÌ‡Û¯ÂÌËfl, ÔÓ‚Â‰ÂÌ˜ÂÒÍË ‡ÁÒÚÓÈÒÚ‚‡ Í‡ÚÓ ‡„ÂÒËfl,ÚÂ‚ÓÊÌÓÒÚ, Ì‡ÎÛ‰ÌÓÒÚË Ë ı‡Î˛ˆËÌ‡ˆËË Ì‡ 61 „Ó‰Ë¯Ì‡‚˙Á‡ÒÚ. Ö‰Ì‡ „Ó‰ËÌ‡ ÔÓ-Í˙ÒÌÓ, ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌÓÚÓËÁÒÎÂ‰‚‡ÌÂ ÔÓÍ‡Á‚‡ ÛÏÂÂÌ‡ ‰ÂÏÂÌˆËfl (MMSE=16). ëÎÂ‰ 6ÏÂÒÂˆ‡ ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡ ·˙Á‡ ÔÓ„ÂÒËfl Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓÒ˙Ò ÁÌ‡˜ËÏ ÍÓ„ÌËÚË‚ÂÌ ÒÔ‡‰ ‰Ó ÒÚÂÔÂÌ Ì‡ ÚÂÊÍ‡ ‰ÂÏÂÌ-ˆËfl (MMSE=8). åêí Ì‡ „Î‡‚ÂÌ ÏÓÁ˙Í ÔÓÍ‡Á‚‡ ‰‡ÌÌË Á‡ ÍÓ-Ó‚‡ ‡ÚÓÙËfl Ë ÔÓÏÂÌË Ì‡ ÔÓ‰ÍÓÓ‚ÓÚÓ ·flÎÓ ‚Â˘ÂÒÚ‚ÓË ÔË ‰‚‡Ï‡Ú‡ Ô‡ˆËÂÌÚË. äÎËÌË˜Ì‡Ú‡ Í‡ÚËÌ‡ Ì‡ ‰Û„Ë-ÚÂ Á‡ÒÂ„Ì‡ÚË ˜ÎÂÌÓ‚Â Ì‡ Ú‡ÁË Ù‡ÏËÎËfl ÒÂ ËÁfl‚fl‚‡ ÔÂ-‰ËÏÌÓ Ò ÔÓ‚Â‰ÂÌ˜ÂÒÍË ‡ÁÒÚÓÈÒÚ‚‡ ‚ Ò˙˜ÂÚ‡ÌËÂ Ò ·˙ÁÓÔÓ„ÂÒË‡˘‡ ‰ÂÏÂÌˆËfl.

Ç Á‡ÍÎ˛˜ÂÌËÂ, ÔÂ‰ÒÚ‡‚flÏÂ ÌÓ‚‡ PSEN1 ÏÛÚ‡ˆËfl ÔË·˙Î„‡ÒÍ‡ Ù‡ÏËÎËfl Ò ÅÄ Ò ‡ÌÌÓ Ì‡˜‡ÎÓ Ë ‡ÚËÔË˜Ì‡ ÍÎË-ÌË˜Ì‡ Í‡ÚËÌ‡: ÁÌ‡˜ËÏË ÔÓ‚Â‰ÂÌ˜ÂÒÍË ‡ÁÒÚÓÈÒÚ‚‡,·˙ÁÓ ÔÓ„ÂÒË‡˘‡ ‰ÂÏÂÌˆËfl Ë ÂÔËÎÂÔÒËfl ÔË Â‰ËÌ ÓÚÚflı.

äãûóéÇà Ñìåà: èÂÒÂÌÂÎËÌ1, Ù‡ÏËÎÌ‡ ·ÓÎÂÒÚ Ì‡ÄÎˆı‡ÈÏÂ, ‡ÚËÔË˜Ì‡ ÍÎËÌË˜Ì‡ Í‡ÚËÌ‡.

ÇöÇÖÑÖçàÖ

ÅÓÎÂÒÚÚ‡ Ì‡ ÄÎˆı‡ÈÏÂ (ÅÄ) Â ÌÂ‚Ó‰Â„ÂÌÂ‡ÚË‚ÌÓÁ‡·ÓÎfl‚‡ÌÂ, ˜ËÂÚÓ Ì‡˜‡ÎÓ ËÏ‡ ÓÚÌÓÒËÚÂÎÌÓ ÒÚeÂÓÚË-ÔÂÌ ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÂÌ ÙÂÌÓÚËÔ, ı‡‡ÍÚÂËÁË‡˘ ÒÂ Ò‡ÏÌÂÒÚË˜ÂÌ ÚËÔ Ô‡ÏÂÚÓ‚Ë Ì‡Û¯ÂÌËfl, ÎÂÍË ÂÍÁÂÍÛÚË‚-ÌË Ì‡Û¯ÂÌËfl, ‡Ù‡ÚË˜ÌË Ì‡Û¯ÂÌËfl, Ì‡È-˜ÂÒÚÓ Ò ‰ÂÙË-ˆËÚ ‚ ÍÓÌÙÓÌÚ‡ˆËÓÌÌÓÚÓ Ì‡ÁÓ‚‡‚‡ÌÂ, Ò˙˘ÂÒÚ‚ÂÌË ÁË-ÚÂÎÌÓ-ÔÓÒÚ‡ÌÒÚ‚ÂÌË Ì‡Û¯ÂÌËfl, Ò˙Ò Ò‡‚ÌËÚÂÎÌÓÒ˙ı‡ÌÂÌË ÔÓ‚Â‰ÂÌ˜ÂÒÍË Â‡ÍˆËË ‚ Ì‡˜‡ÎÓÚÓ (1). çÂ‚ÓÔ-ÒËıË‡ÚË˜Ì‡Ú‡ Í‡ÚËÌ‡ Ì‡ ÅÄ ÌÂ Â ÒÔÂˆËÙË˜Ì‡, ÌÓ ‚ Ì‡Ô-Â‰Ì‡ÎËÚÂ ÒÚ‡‰ËË ÒÂ Ì‡·Î˛‰‡‚‡Ú ÔÓfl‚Ë Ì‡ ‡Ô‡ÚËfl, ‚˙Á-·Û‰‡, ÚÂ‚ÓÊÌÓÒÚ Ë ‡Á‰‡ÁÌËÚÂÎÌÓÒÚ. åÌÓ„Ó Ò‡ Â‰ÍËË ÌÂÚËÔË˜ÌË ÔÓfl‚ËÚÂ Ì‡ ÔÓ‚Â‰ÂÌ˜ÂÒÍË ‡ÁÒÚÓÈÒÚ‚‡,‰ÂÁËÌıË·ËˆËfl, Ì‡ÎÛ‰ÌÓÒÚË Ë ÁËÚÂÎÌË ı‡Î˛ˆËÌ‡ˆËË, ÓÒÓ-·ÂÌÓ ‚ Ì‡˜‡ÎÓÚÓ Ì‡ ·ÓÎÂÒÚÚ‡ (10).

èÂÁ ÔÓÒÎÂ‰ÌËÚÂ „Ó‰ËÌË, ÏÓÎÂÍÛÎflÌÓ-„ÂÌÂÚË˜ÌËflÚ‡Ì‡ÎËÁ Ì‡ ÏÓÌÓ„ÂÌÌË ÌÂ‚Ó‰Â„ÂÌÂ‡ÚË‚ÌË Á‡·ÓÎfl‚‡ÌËflÔÓÒÚË„Ì‡ „ÓÎflÏ ÛÒÔÂı ‚ Ì‡ÒÓÍ‡ Ë‰ÂÌÚËÙËˆË‡ÌÂ Ì‡ „ÂÌÂ-ÚË˜ÌËÚÂ ‰ÂÙÂÍÚË ÔË ÚÂÁË Á‡·ÓÎfl‚‡ÌËfl. èËÏÂ Á‡ ÚÓ-‚‡ Ò‡ ÏÛÚ‡ˆËË ‚ „ÂÌ Á‡ ÒËÌÚÂÁ‡ Ì‡ Ämyloid êrecursorêrotein (Goate, et al., 1991), Presenilin 1 (Sherrington, et al.,1995) Ë Presenilin 2 (Levy – L‡had, et al., 1995a) ÔË Ù‡ÏËÎ-ÌË ÒÎÛ˜‡Ë Ì‡ ·ÓÎÂÒÚ Ì‡ ÄÎˆı‡ÈÏÂ (ÅÄ) Ò ‡ÌÌÓ Ì‡˜‡ÎÓ. ÑÓÏÓÏÂÌÚ‡ Ò‡ Ò˙Ó·˘ÂÌË 25 APP, 155 PSEN1 Ë 10 PSEN2 ÏÛ-Ú‡ˆËË ÔË˜ËÌËÎË Ù‡ÏËÎÌ‡ ÅÄ. ÉÂÌ˙Ú Á‡ PSEN1 Â ‡ÁÔÓÎÓ-ÊÂÌ ‚˙ıÛ ıÓÏÓÁÓÏ‡ 14q24.3 (11, 13, 18). èÓ‚Â˜ÂÚÓPSEN1 ÏÛÚ‡ˆËË Ò‡ ÔÓ„Â¯ÌÓÒÏËÒÎÂÌË, ‚Ó‰Â˘Ë ‰Ó Á‡Ïfl-Ì‡Ú‡ Ì‡ Â‰ËÌË˜ÌË ÍÓÌÒÂ‚‡ÚË‚ÌË ‡ÏËÌÓÍËÒÂÎËÌË. PSEN1Â ÏÂÏ·‡ÌÂÌ ÔÓÚÂËÌ Ë Â ˜‡ÒÚ ÓÚ γ-ÒÂÍÂÚ‡ÁÂÌ ÍÓÏÔ-ÎÂÍÒ, ‡Ì„‡ÊË‡Ì ‚ ÔÓÚÂÓÎËÁ‡Ú‡ Ì‡ APP Ë Ó·‡ÁÛ‚‡ÌÂÚÓÌ‡ βÄ4 ÔÓÚÂËÌ – ÓÒÌÓ‚ÌËflÚ ÍÓÏÔÓÌÂÌÚ Ì‡ ‡ÏËÎÓË‰ÌË-

ÚÂ ÔÎ‡ÍË ÔË ÅÄ. (2, 5, 7, 17).ç‡È-˜ÂÒÚÓ ÅÄ Ò ÛÒÚ‡ÌÓ‚ÂÌ „ÂÌÂÚË˜ÂÌ ‰ÂÙÂÍÚ ËÏ‡ ÚË-

ÔË˜ÂÌ Á‡ ·ÓÎÂÒÚÚ‡ ÍÎËÌË˜ÂÌ ÙÂÌÓÚËÔ. Ç˙ÔÂÍË ÚÓ‚‡, ÔÓ-ÌflÍÓ„‡ ÓÔÂ‰ÂÎÂÌ‡ ÏÛÚ‡ˆËfl ‚Ó‰Ë ‰Ó ÁÌ‡˜ËÚÂÎÌË ‚‡Ë‡ˆËË‚˙‚ ÙÂÌÓÚËÔ‡ - ‡ÁÎËÍË ‚ Ì‡˜‡ÎÓÚÓ, ÚÂÊÂÒÚÚ‡ Ë ÍÎËÌË˜-Ì‡Ú‡ Í‡ÚËÌ‡ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ (12).

ñÂÎÚ‡ Ì‡ Ì‡¯ÂÚÓ ÔÓÛ˜‚‡ÌÂ Â ËÁÒÎÂ‰‚‡ÌÂ Ì‡ ÙÂÌÓÚËÔ‡Ì‡ Á‡ÒÂ„Ì‡ÚËÚÚÂ ˜ÎÂÌÓ‚Â ‚ 3 ÔÓÍÓÎÂÌËfl ÓÚ ·˙Î„‡ÒÍ‡ Ù‡-ÏËÎËfl Ò ÅÄ Ò ‡ÌÌÓ Ì‡˜‡ÎÓ, ÔË˜ËÌÂÌ‡ ÓÚ ÌÓ‚‡ PSEN1 ÏÛ-Ú‡ˆËfl (Leu424Phe).


è˙‚ËflÚ Ô‡ˆËÂÌÚ Â Ï˙Ê Ì‡ 57 „Ó‰ËÌË ÍÓÌÒÛÎÚË‡Ì ‚ÍÎËÌËÍ‡Ú‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl Ì‡ åÅÄã “ÄÎÂÍÒ‡Ì‰Ó‚ÒÍ‡” Á‡Ô˙‚Ë Ô˙Ú ÔÂÁ ÒÂÔÚÂÏ‚Ë 2003 „. è‡ˆËÂÌÚ˙Ú Ë ÌÂ„Ó‚Ë-ÚÂ ·ÎËÁÍË Ò˙Ó·˘‡‚‡Ú Á‡ ‰ÂÔÂÒË‚Ì‡ ÒËÏÔÚÓÏ‡ÚËÍ‡, ÎËÔ-Ò‡ Ì‡ ËÌÚÂÂÒË, ·ÂÁËÌËˆË‡ÚË‚ÌÓÒÚ Ë ÔÓÌflÍÓ„‡ ‡Á‰‡ÁÌË-ÚÂÎÌÓÒÚ, ÔÓfl‚ËÎË ÒÂ Ì‡ 54 „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ. ãÂÍÛ‚‡Ì Â Ò‡ÌÚË‰ÂÔÂÒ‡ÌÚË ‰‚Â „Ó‰ËÌË ·ÂÁ ÂÙÂÍÚ. èÓfl‚fl‚‡Ú ÒÂÔÓ„ÂÒË‡˘Ë Ô‡ÏÂÚÓ‚Ë Ì‡Û¯ÂÌËfl, ‡ÁÒÂflÌÓÒÚ Ë ‰ÂÁÓ-ËÂÌÚ‡ˆËfl, ‚ Ò˙˜ÂÚ‡ÌËÂ Ò ÔÓ‚Â‰ÂÌ˜ÂÒÍË ÓÚÍÎÓÌÂÌËfl Ë ‰Â-ÁËÌıË·ËˆËfl Ì‡ 56 „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ. íÓ„‡‚‡ ÔÓ‡‰Ë ÌÂÒÔ-‡‚flÌÂ Ò ÔÓÙÂÒËÓÌ‡ÎÌËÚÂ ‰ÂÈÌÓÒÚË Â ÓÒ‚Ó·Ó‰ÂÌ ÓÚ ‡-·ÓÚ‡. éÚ ÌflÍÓÎÍÓ ÏÂÒÂˆ‡ ÌÂ ÏÓÊÂ ‰‡ ¯ÓÙË‡ Ë ÒÂ ÓÚ˜Ë-Ú‡ ÌÂÒÔ‡‚flÌÂ Ò ÂÊÂ‰ÌÂ‚ÌËÚÂ ‰ÂÈÌÓÒÚË, Í‡ÚÓ ÒÔ‡‚flÌÂ ÒÙËÌ‡ÌÒËËÚÂ Ë Ô˙ÚÛ‚‡ÌÂ ‰Ó ÌÂÔÓÁÌ‡Ú‡ ‰ÂÒÚËÌ‡ˆËfl.

éÚ ÌÂ‚ÓÎÓ„Ë˜ÌËfl ÒÚ‡ÚÛÒ ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡ Â‰ËÌÒÚ‚ÂÌÓ‰‚ÛÒÚ‡ÌÌÓ ÔÓÎÓÊËÚÂÎÂÌ ÂÙÎÂÍÒ Ì‡ å‡ËÌÂÒÍÛ-ê‡‰Ó‚Ë-˜Ë. ç‡ÎËˆÂ Â ÛÏÂÂÌ ‰ÂÏÂÌÚÂÌ ÒËÌ‰ÓÏ Ò ‡Ô‡ÚËfl, ÒÓˆË‡Î-ÌÓ ËÁÓÎË‡ÌÂ Ë ÎËÔÒ‡ Ì‡ ËÌÚÂÂÒË (MMSE=15).

ëÓÏ‡ÚË˜ÌËflÚ ÒÚ‡ÚÛÒ Â ·ÂÁ ÓÒÓ·ÂÌÓÒÚË. è‡‡ÍÎËÌË˜-ÌËÚÂ ËÁÒÎÂ‰‚‡ÌËfl Ì‡ Í˙‚ Ë ÛËÌ‡ Ò‡ ‚ „‡ÌËˆ‡Ú‡ Ì‡ ÌÓ-Ï‡Ú‡. àÁÒÎÂ‰‚‡ÌËÚÂ ÒÂÛÏÌË ÌË‚‡ Ì‡ Ç12, ÙÓÎËÂ‚‡ ÍËÒÂ-ÎËÌ‡, TSH Ë ÒÂÓÎÓ„Ë˜ÌËÚÂ ËÁÒÎÂ‰‚‡ÌËfl ‚ Ì‡ÒÓÍ‡ ÒËÙËÎËÒË HIV Ò‡ ÌÓÏ‡ÎÌË. äí Ì‡ „Î‡‚ÂÌ ÏÓÁ˙Í ‰ÓÍÛÏÂÌÚË‡ ËÁ-‡ÁÂÌ‡ ÍÓÓ‚‡ ‡ÚÓÙËfl, ÔÂ‰ËÏÌÓ ÚÂÏÔÓÓ-Ô‡ËÂÚ‡ÎÌÓÒ ‡Á¯ËÂÌË ‚ÂÌÚËÍÛÎË. ÖÖÉ Â ÌÓÏ‡ÎÌ‡ Á‡ ‚˙Á‡ÒÚÚ‡.

çÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ ÛÒÚ‡ÌÓ‚fl‚‡ ÛÏÂÂÌÓËÁ‡ÁÂÌ ‰ÂÏÂÌÚÂÌ ÒËÌ‰ÓÏ. ÇÂ·‡ÎÌ‡Ú‡ ÂÔËÁÓ‰Ë˜Ì‡ Ô‡-ÏÂÚ Â ÛÏÂÂÌÓ Í˙Ï ÚÂÊÍÓ Ì‡Û¯ÂÌ‡ Ò ÔÓ‰˜ÂÚ‡Ì ‰ÂÙË-ˆËÚ ‚ ÓÚÒÓ˜ÂÌÓÚÓ ‚˙ÁÔÓËÁ‚ÂÊ‰‡ÌÂ Ë ‡ÁÔÓÁÌ‡‚‡ÌÂÚÓ(70%). ìÒÚ‡ÌÓ‚fl‚‡ ÒÂ ÍÓ„ÌËÚË‚ÂÌ ÛÔ‡‰˙Í Ë ‚ ‰Û„Ë ÍÓ„ÌË-ÚË‚ÌË ÒÙÂË: ‰ÂÁÓËÂÌÚ‡ˆËfl ÔÂ‰ËÏÌÓ Á‡ ‚ÂÏÂ, ÚÂÊ˙Í‰ËÁÂÍÁÂÍÛÚË‚ÂÌ ÒËÌ‰ÓÏ, ÒËÎÌÓ Ó„‡ÌË˜ÂÌ Ó·ı‚‡Ú Ì‡‚ÌËÏ‡ÌËÂÚÓ Ë Ì‡Ï‡ÎÂÌ‡ ‚Â·‡ÎÌ‡ ÙÎÛÂÌÚÌÓÒÚ. ÖÁËÍÓ‚Ë-ÚÂ ÙÛÌÍˆËË ÔË ‡Á„Ó‚Ó Ë Ì‡ÁÓ‚‡‚‡ÌÂ Ò‡ ÓÚÌÓÒËÚÂÎÌÓÒ˙ı‡ÌÂÌË. ãÂÍ ‰ÂÙËˆËÚ ÒÂ Ì‡·Î˛‰‡‚‡ ‚ Á‡‰‡˜ËÚÂ Á‡ÍÓÌÒÚÛÍÚË‚ÂÌ Ô‡ÍÒËÒ.

Ö‰Ì‡ „Ó‰ËÌ‡ ÔÓ-Í˙ÒÌÓ (˛ÎË 2003„.) ÒÂ ÔÓ‚ÂÊ‰‡ ‡Ï·ÛÎ‡-ÚÓÌÓ ÌÂ‚ÓÎÓ„Ë˜ÌÓ Ë ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌÓ ËÁÒÎÂ‰‚‡ÌÂ.éÚ˜ËÚ‡ ÒÂ ·˙Á‡ ÔÓ„ÂÒËfl Ì‡ Ô‡ÏÂÚÓ‚ËÚÂ ÓÔÎ‡Í‚‡ÌËfl ËÌÂÒÔÓÒÓ·ÌÓÒÚ Á‡ ÒÔ‡‚flÌÂ Ò ÂÊÂ‰ÌÂ‚ÌËÚÂ ‰ÂÈÌÓÒÚË Ì‡ÙÓÌ‡ Ì‡ ÎÂ˜ÂÌËÂ Ò Aricept 10 mg Ì‡ ‰ÂÌ. çÂ‚ÓÎÓ„Ë˜ÌËflÚÒÚ‡ÚÛÒ ÛÒÚ‡ÌÓ‚fl‚‡ ‰‚ÛÒÚ‡ÌÌÓ ÔÓÎÓÊËÚÂÎÌË å‡ËÌÂÒ-ÍÛ-ê‡‰Ó‚Ë˜Ë Ë ‰‚ÛÒÚ‡ÌÌÓ ÔÓÎÓÊËÚÂÎÌË ÂÙÎÂÍÒË Ì‡ïÓÙÏ‡Ì Ë í¸ÓÏÌÂ. èË ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌÓÚÓ ËÁÒÎÂ‰‚‡-ÌÂ Â ‰ÓÍÛÏÂÌÚË‡Ì ÁÌ‡˜ËÚÂÎÂÌ ÍÓ„ÌËÚË‚ÂÌ ÛÔ‡‰˙Í ËÚÂÊÍÓ ËÁ‡ÁÂÌ ‰ÂÏÂÌÚÂÌ ÒËÌ‰ÓÏ (ååSÖ=8). è‡ÏÂÚÓ-‚ËÚÂ ÔÓˆÂÒË ÔÓÍ‡Á‚‡Ú ÌÂ‚˙ÁÏÓÊÌÓÒÚ Á‡ Á‡Û˜‡‚‡ÌÂÚÓ Ì‡ÌÓ‚‡ ËÌÙÓÏ‡ˆËfl. ç‡ÎËˆÂ Â ÚÂÊÍ‡ ÍÓÌÒÚÛÍÚË‚Ì‡ ‡Ô-‡ÍÒËfl - ÌÂ‚˙ÁÏÓÊÌÓ Ò‡ÏÓÒÚÓflÚÂÎÌÓ ËÒÛ‚‡ÌÂ. ìÒÚ‡ÌÓ-‚fl‚‡ ÒÂ ÛÏÂÂÌ‡ Ë‰Â‡ÚÓÌ‡ ‡Ô‡ÍÒËfl Ë ‡„‡ÙËfl. ç‡ÁÓ‚‡-‚‡ÌÂÚÓ Â ÚÂÊÍÓ Ì‡Û¯ÂÌÓ. åêí Ì‡ „Î‡‚ÂÌ ÏÓÁ˙Í (îË„Û‡ 1) ‰ÓÍÛÏÂÌÚË‡ ÔÓ„ÂÒË‡˘‡ ÍÓÓ‚‡ ‡ÚÓÙËfl ÒÔÓ‰ÍÓÓ‚Ë ıËÔÂËÌÚÂÌÁÌË ÔÓÏÂÌË ‚ ·flÎÓÚÓ ÏÓÁ˙˜ÌÓ ‚Â-˘ÂÒÚ‚Ó.


èÂÁ ˛ÌË 2005 „. ÒÂ ÔÓ‚ÂÊ‰‡ ÍÓÌÚÓÎÂÌ ‡Ï·ÛÎ‡ÚÓÂÌÔÂ„ÎÂ‰ Ò ÌÂ‚ÓÎÓ„Ë˜ÌÓ Ë ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌÓ ËÁÒÎÂ‰‚‡ÌÂÔÓ‡‰Ë ‚ÎÓ¯‡‚‡ÌÂ Ì‡ Ò˙ÒÚÓflÌËÂÚÓ Ò˙Ò ÒËÎÌÓ ËÁ‡ÁÂÌË Ì‡-Û¯ÂÌËfl ‚ Ô‡ÏÂÚÓ‚ËÚÂ Ë ÔÓÁÌ‡‚‡ÚÂÎÌËÚÂ ÙÛÌÍˆËË Ë ÔÓ-fl‚‡ Ì‡ „‡Ì‰ Ï‡Î ÂÔËÎÂÔÒËfl. ÅÓÎÌËflÚ Â ‡Ô‡ÚË˜ÂÌ, ÔÓÌflÍÓ-„‡ Ò ‚˙Á·Û‰‡ Ë ‡„ÂÒËfl, ÌÓ Ì‡Ô˙ÎÌÓ ÔÓ‰‚ËÊÂÌ Ë Ò ÚÂÊ˙Í ‰Â-ÏÂÌÚÂÌ ÒËÌ‰ÓÏ (ååSÖ=0). ç‡ÎËˆÂ Â ËÌÍÓÌÚËÌÂÌˆËfl Ì‡Ú‡ÁÓ‚ËÚÂ ÂÁÂ‚Ó‡Ë. çÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌÓÚÓ ËÁÒÎÂ‰‚‡ÌÂÛÒÚ‡ÌÓ‚fl‚‡ ÒËÎÌÓ Ó„‡ÌË˜ÂÌ‡ ÒÔÓÌÚ‡ÌÌ‡ Â˜ Ò ÏÌÓÊÂÒÚ-‚Ó ÔÂÒÂ‚Â‡ˆËË. è‡ˆËÂÌÚ˙Ú ÚÛ‰ÌÓ ‡Á·Ë‡ ‡Á„Ó‚Ó-Ì‡Ú‡ Â˜. ìÒÚ‡ÌÓ‚fl‚‡ ÒÂ ÚÂÊÍ‡ ‡ÌÓÏËfl, ÛÏÂÂÌÓ ËÁ‡ÁÂ-Ì‡ ÁËÚÂÎÌ‡ ÔÂ‰ÏÂÚÌ‡ ‡„ÌÓÁËfl.

è‡‡ÍÎËÌË˜ÌËÚÂ ËÁÒÎÂ‰‚‡ÌËfl Ì‡ Í˙‚ Ë ÛËÌ‡ ÓÚÌÓ‚ÓÒ‡ ‚ „‡ÌËˆËÚÂ Ì‡ ÌÓÏ‡Ú‡. ÖÖÉ ÔÓÍ‡Á‚‡ ÎÂÍË ‰ËÙÛÁÌËÌÂÒÔÂˆËÙË˜ÌË ÔÓÏÂÌË Ò ·‡‚ÌÓ‚˙ÎÌÓ‚‡ ‡ÍÚË‚ÌÓÒÚ. ÖÔË-ÎÂÔÚË˜ÌËÚÂ ÔËÒÚ˙ÔË Ò‡ ÍÛÔË‡ÌË ÓÚ ÎÂ˜ÂÌËÂ Ò ‰ÂÔ‡ÍËÌıÓÌÓ.

èÂÁ ÒÎÂ‰‚‡˘‡Ú‡ „Ó‰ËÌ‡ Á‡·ÓÎfl‚‡ÌÂÚÓ ·˙ÁÓ ÔÓ„Â-ÒË‡ ‰Ó ‚Â„ÂÚ‡ÚË‚ÂÌ ÒÚ‡‰ËÈ Ò ÌÂ‚˙ÁÏÓÊÌÓÒÚ Á‡ ÔË‰-‚ËÊ‚‡ÌÂ, ‰ÂÍÛ·ËÚ‡ÎÌË ‡ÌË Ë ÔÓ‚Ú‡fl˘Ë ÒÂ ‰Ëı‡ÚÂÎÌË ËÛÓËÌÙÂÍˆËË.

èË Ï‡ÈÍ‡Ú‡ Ë ÎÂÎflÚ‡ Ì‡ Ô‡ˆËÂÌÚ‡ (Ï‡ÈÍ‡ Ì‡ ‚ÚÓËflÔ‡ˆËÂÌÚ) (îË„Û‡ 2) Ò‡ ÛÒÚ‡ÌÓ‚ÂÌË Ô‡ÏÂÚÓ‚Ë ÒÏÛ˘ÂÌËfl,ÔÓ‚Â‰ÂÌ˜ÂÒÍË ‡ÁÒÚÓÈÒÚ‚‡ Ë ÔÒËıÓÚË˜ÌË ÔÓfl‚Ë (ÔÓ

‡Ì‡ÏÌÂÒÚË˜ÌË ‰‡ÌÌË ·ÂÁ ÏÂ‰ËˆËÌÒÍ‡ ‰ÓÍÛÏÂÌÚ‡ˆËfl) Ì‡75 Ë 55 „Ó‰ËÌË, ÂÍÁËÚË‡ÎË Ò‡ Ì‡ 84 Ë 60 „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚÒ Í‡ÚËÌ‡Ú‡ Ì‡ ÚÂÊÍ‡ ‰ÂÏÂÌˆËfl.

èË ˜Ë˜Ó ÏÛ (îË„Û‡ 2) Ò‡ ÛÒÚ‡ÌÓ‚ÂÌË Ô‡ÏÂÚÓ‚Ë ÒÏÛ-˘ÂÌËfl Ë ÔÓ‚Â‰ÂÌ˜ÂÒÍË ‡ÁÒÚÓÈÒÚ‚‡ Ò ÚÂÊÍ‡ ÙËÁËÍ‡ÎÌ‡‡„ÂÒËfl, Í‡ÚÓ ‰ÓÏËÌË‡˘‡ ÍÎËÌË˜Ì‡ Í‡ÚËÌ‡ (ÔÓ ‡Ì‡Ï-ÌÂÒÚË˜ÌË ‰‡ÌÌË ·ÂÁ ÏÂ‰ËˆËÌÒÍ‡ ‰ÓÍÛÏÂÌÚ‡ˆËfl) Ì‡ 60 „Ó-‰ËÌË, ÂÍÁËÚË‡Î Â Ì‡ 70 „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ Ò Í‡ÚËÌ‡Ú‡ Ì‡ÚÂÊÍ‡ ‰ÂÏÂÌˆËfl.

ãÂÎflÚ‡ Ì‡ Ô‡ˆËÂÌÚ‡ (îË„Û‡ 2), ÍÓflÚÓ Â Ì‡ 85 „Ó‰ËÌËËÏ‡ ÒËÏÔÚÓÏË Ì‡ ÚÂÊÍ‡ ‰ÂÏÂÌˆËfl. è‡ˆËÂÌÚÍ‡Ú‡ ÌÂ ÏÓ-ÊÂ ‰‡ ·˙‰Â ËÁÒÎÂ‰‚‡Ì‡ ÔÓ‡‰Ë ÓÚÍ‡Á Ì‡ ·ÎËÁÍËÚÂ.

èË ‚ÚÓËfl Ô‡ˆËÂÌÚ, Ï˙Ê Ì‡ 62 „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ, ÂÔÓ‚Â‰ÂÌ ‡Ï·ÛÎ‡ÚÓÂÌ ÔÂ„ÎÂ‰ ‚ ÍÎËÌËÍ‡Ú‡ ÔÓ ÌÂ‚ÓÎÓ-„Ëfl Ì‡ åÅÄã “ÄÎÂÍÒ‡Ì‰Ó‚ÒÍ‡” Á‡ Ô˙‚Ë Ô˙Ú ÔÂÁ ˛ÌË2003 „. è˙‚ËÚÂ ÒËÏÔÚÓÏË Ò‡ Ò Ì‡˜‡ÎÓ 61 „Ó‰Ë¯Ì‡ ‚˙Á-‡ÒÚ Ë ÒÂ ı‡‡ÍÚÂËÁË‡Ú Ò ÔÓ‚Â‰ÂÌ˜ÂÒÍË ‡ÁÒÚÓÈÒÚ‚‡Ë ı‡‡ÍÚÂÓ‚Ë ÔÓÏÂÌË Í‡ÚÓ ÔÓÚËÒÌ‡ÚÓÒÚ, ÎËÔÒ‡ Ì‡ÊÂÎ‡ÌËfl, Ì‡ÎÛ‰ÌÓÒÚË, ÒÓˆË‡ÎÌÓ ËÁÓÎË‡ÌÂ Ë ÔÂÌÂ·Â„‚‡-ÌÂ Ì‡ ‚˙Ì¯ÌËfl ÒË ‚Ë‰, ÁËÚÂÎÌË ı‡Î˛ˆËËÌ‡ˆËË Ë ‡„ÂÒËfl.éÚ ÔÂ‰Ë 6 ÏÂÒÂˆ‡ ÒÂ ÔÓfl‚ËÎË ÔÓ„ÂÒË‡˘Ë Ô‡ÏÂÚÓ‚ËÌ‡Û¯ÂÌËfl, Ò „Â¯ÍË ‚ ËÁÔ˙ÎÌÂÌËÂ Ì‡ Á‡‰‡˜Ë, Ò‚˙Á‡ÌË ÒÓ„‡ÌËÁ‡ˆËfl, ‰ÂÁÓËÂÌÚ‡ˆËfl Ë ·ÂÎÂÁË Á‡ ÌÂÒÔ‡‚flÌÂ ÒÂÊÂ‰ÌÂ‚ÌË ‰ÂÈÌÓÒÚË. ç‡ 50 „Ó‰ËÌË Â ÔÂÌÒËÓÌË‡Ì ÔÓ ·Ó-ÎÂÒÚ ÔÓ‡‰Ë ˆËÓÁ‡ Ì‡ ˜ÂÂÌ ‰Ó·, Ì‡È-‚ÂÓflÚÌÓ Ò ÂÚË-ÎË˜Ì‡ „ÂÌÂÁ‡. ÅÎËÁÍËÚÂ Ò˙Ó·˘‡‚‡Ú Á‡ Â‰Ó‚Ì‡ ÁÎÓÛÔÓÚÂ-·‡ Ò ‡ÎÍÓıÓÎ ÓÚ ‰˙Î„Ë „Ó‰ËÌË. éÚ Â‰Ì‡ „Ó‰ËÌ‡ Â ÔÂÛÒÚ‡-ÌÓ‚ËÎ ÛÔÓÚÂ·‡Ú‡ Ì‡ ‡ÎÍÓıÓÎ. çÂ‚ÓÎÓ„Ë˜ÌËflÚ ÒÚ‡ÚÛÒÓÚÍË‚‡ ÔÓ-ÓÊË‚ÂÌË ëçê ‚ „ÓÌËÚÂ Í‡ÈÌËˆË, Ò ÔÓÎÓÊË-ÚÂÎÂÌ ÂÙÎÂÍÒ Ì‡ å‡ËÌÂÒÍÛ-ê‡‰Ó‚Ë˜Ë ‚ ‰flÒÌÓ. ìÒÚ‡ÌÓ-‚fl‚‡ ÒÂ ÛÏÂÂÌÓ ËÁ‡ÁÂÌ‡ ‰ÂÏÂÌˆËfl (MMSE=16). ëÓÏ‡-ÚË˜ÌËflÚ ÒÚ‡ÚÛÒ Â ·ÂÁ ÓÒÓ·ÂÌÓÒÚË. è‡‡ÍÎËÌË˜ÌËÚÂËÁÒÎÂ‰‚‡ÌËfl Ì‡ Í˙‚ Ë ÛËÌ‡ Ò‡ ‚ „‡ÌËˆ‡Ú‡ Ì‡ ÌÓÏ‡Ú‡.äí Ì‡ „Î‡‚ÂÌ ÏÓÁ˙Í ‰ÓÍÛÏÂÌÚË‡ ËÁ‡ÁÂÌ‡ ÍÓÓ‚‡ ‡ÚÓ-ÙËfl Ò ‡Á¯ËÂÌË ‚ÂÌÚËÍÛÎË.

çÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ ÛÒÚ‡ÌÓ‚fl‚‡ ÛÏÂÂÌÓÌ‡Û¯ÂÌ‡ ÓËÂÌÚ‡ˆËfl ÔÂ‰ËÏÌÓ Á‡ ‚ÂÏÂ. ÇÂ·‡ÎÌ‡Ú‡ÂÔËÁÓ‰Ë˜Ì‡ Ô‡ÏÂÚ Â ÛÏÂÂÌÓ Í˙Ï ÚÂÊÍÓ Ì‡Û¯ÂÌ‡ Ò ÔÓ‰-˜ÂÚ‡Ì ‰ÂÙËˆËÚ ‚ ÓÚÒÓ˜ÂÌÓÚÓ Ò‡ÏÓÒÚÓflÚÂÎÌÓ ‚˙ÁÔÓ-ËÁ‚ÂÊ‰‡ÌÂ (0%) Ë ‡ÁÔÓÁÌ‡‚‡ÌÂÚÓ (85%). ìÒÚ‡ÌÓ‚fl‚‡ ÒÂÚÂÊ˙Í ‰ËÁÂÍÁÂÍÛÚË‚ÂÌ ÒËÌ‰ÓÏ, ÒËÎÌÓ Ó„‡ÌË˜ÂÌ Ó·ı-‚‡Ú Ì‡ ‚ÌËÏ‡ÌËÂÚÓ Ë ÏÌÓ„Ó Â‰ÛˆË‡Ì‡ ‚Â·‡ÎÌ‡ ÙÎÛÂ-ÌÚÌÓÒÚ. ç‡ÎËˆÂ Ò‡ ÛÏÂÂÌÓ Í˙Ï ÚÂÊÍÓ ËÁ‡ÁÂÌË Ì‡Û¯Â-ÌËfl ‚ ÍÓÌÒÚÛÍÚË‚ÌËfl Ô‡ÍÒËÒ. ç‡ÁÓ‚‡‚‡ÌÂÚÓ Â ÎÂÍÓ Ì‡-Û¯ÂÌÓ.

ëÎÂ‰ ¯ÂÒÚ ÏÂÒÂˆ‡, Ô‡ˆËÂÌÚ˙Ú ÒÂ ıÓÒÔËÚ‡ÎËÁË‡ ‚ÍÎËÌËÍ‡Ú‡ ÔÓ‡‰Ë ·˙Á‡ ÔÓ„ÂÒËfl Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ Ì‡ÙÓÌ‡ Ì‡ ÎÂ˜ÂÌËÂ Ò ÖÍÒÂÎÓÌ. ìÒÚ‡ÌÓ‚fl‚‡ ÒÂ ÔÓ„ÂÒËfl Ì‡


îË„Û‡ 1. åêí Ì‡ „Î‡‚ÂÌ ÏÓÁ˙Í Ì‡ Ô˙‚Ëfl Ô‡ˆËÂÌÚ

îË„Û‡ 2. êÓ‰ÓÒÎÓ‚ËÂ Ì‡ Ù‡ÏËÎËfl Ò ·ÓÎÂÒÚ Ì‡ ÄÎˆı‡ÈÏÂ Ò ‡ÌÌÓ Ì‡˜‡ÎÓÒ Leu424Phe ÏÛÚ‡ˆËfl ‚ PSÖN1 „ÂÌ‡

ÍÓ„ÌËÚË‚ÌËfl ÛÔ‡‰˙Í Ò ‚ÎÓ¯‚‡ÌÂ Ì‡ Ô‡ÏÂÚÓ‚ËÚÂ ÙÛÌÍˆËËË ËÁ‡ÁÂÌ ‰ÂÙËˆËÚ ‚ ÂÊÂ‰ÌÂ‚ÌËÚÂ ‰ÂÈÌÓÒÚË. çÂ‚ÓÎÓ-„Ë˜ÌËflÚ ÒÚ‡ÚÛÒ ÛÒÚ‡ÌÓ‚fl‚‡ ÔÓ-ÓÊË‚ÂÌË ëçê ‚ „ÓÌËÚÂÍ‡ÈÌËˆË, Ò ÔÓÎÓÊËÚÂÎÂÌ ÂÙÎÂÍÒ Ì‡ å‡ËÌÂÒÍÛ-ê‡‰Ó‚Ë-˜Ë ‚ ‰flÒÌÓ Ë ‰‚ÛÒÚ‡ÌÂÌ ‰Â·ÂÌ ıÓËÁÓÌÚ‡ÎÂÌ ÌËÒÚ‡„˙Ï.

ëÓÏ‡ÚË˜ÌËflÚ ÒÚ‡ÚÛÒ Â ·ÂÁ ÓÒÓ·ÂÌÓÒÚË. è‡‡ÍÎËÌË˜-ÌËÚÂ ËÁÒÎÂ‰‚‡ÌËfl Ì‡ Í˙‚ Ë ÛËÌ‡ Ò‡ ‚ „‡ÌËˆ‡Ú‡ Ì‡ ÌÓ-Ï‡Ú‡. àÁÒÎÂ‰‚‡ÌËÚÂ ÒÂÛÏÌË ÌË‚‡ Ì‡ Ç12, ÙÓÎËÂ‚‡ ÍËÒÂ-ÎËÌ‡, TSH Ë ÒÂÓÎÓ„Ë˜ÌËÚÂ ËÁÒÎÂ‰‚‡ÌËfl ‚ Ì‡ÒÓÍ‡ ÒËÙËÎËÒË HIV Ò‡ ÌÓÏ‡ÎÌË.

äÓÌÚÓÎÌÓÚÓ ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌÓ ËÁÒÎÂ‰‚‡ÌÂ ÛÒÚ‡ÌÓ-‚fl‚‡ ÚÂÊÍÓ ËÁ‡ÁÂÌ ‰ÂÏÂÌÚÂÌ ÒËÌ‰ÓÏ (MMSE=10). è‡-ˆËÂÌÚ˙Ú Â Ò ÚÂÊÍ‡ ‰ÂÁÓËÂÌÚ‡ˆËfl Á‡ ‚ÂÏÂ Ë ÏflÒÚÓ.ç‡ÎËˆÂ Â ÁÌ‡˜ËÚÂÎÌÓ ‚ÎÓ¯‡‚‡ÌÂ Ì‡ Ô‡ÏÂÚÓ‚ËÚÂ ÔÓˆÂÒË,ÚÂÊÍ‡ ÍÓÌÒÚÛÍÚË‚Ì‡ ‡Ô‡ÍÒËfl, ÒËÎÌÓ Ó„‡ÌË˜ÂÌ‡ Ë ÒÔÂÒÂ‚Â‡ˆËË ‚Â·‡ÎÌ‡ ÙÎÛÂÌÚÌÓÒÚ. äÓÌÒÛÎÚ‡ˆËflÚ‡ ÒÓÚÓÌÂ‚ÓÎÓ„ ÔÓÍ‡Á‚‡ ˆÂÌÚ‡ÎÂÌ ÓÚÓÌÂ‚ÓÎÓ„Ë˜ÂÌ ÒËÌ‰-ÓÏ. EEÉ ÛÒÚ‡ÌÓ‚fl‚‡ ÂÔËÁÓ‰Ë˜Ì‡ ·‡‚ÌÓ‚˙ÎÌÓ‚‡ ‡ÍÚË‚-ÌÓÒÚ ‰‚ÛÒÚ‡ÌÌÓ Ô‡ËÂÚÓ-ÚÂÏÔÓ‡ÎÌÓ.

Mêí Ì‡ „Î‡‚ÂÌ ÏÓÁ˙Í (ÙË„Û‡ 3) ÔÓÍ‡Á‚‡ ‰ËÙÛÁÌ‡ ÍÓÓ-‚‡ ‡ÚÓÙËfl Ò ÔÓ‰ÍÓÓ‚Ë ıËÔÂËÌÚÂÌÁÌË ÔÓÏÂÌË Ì‡ ·flÎÓ-ÚÓ ÏÓÁ˙˜ÌÓ ‚Â˘ÂÒÚ‚Ó.

ÉÖçÖíàóçà àáëãÖÑÇÄçàü

èË ‰‚‡Ï‡Ú‡ Á‡ÒÂ„Ì‡ÚË ËÌ‰Ë‚Ë‰Ë ÓÚ ÒÂÏÂÈÒÚ‚ÓÚÓ ÂÔÓ‚Â‰ÂÌÓ ‰ËÂÍÚÌÓ ÒÂÍ‚ÂÌË‡ÌÂ Ì‡ ‚ÒË˜ÍËÚÂ 13 ÂÍÁÓÌ‡ ËÂÍÁÓÌ-ËÌÚÓÌÌË „‡ÌËˆË Ì‡ PSEN1 „ÂÌ‡. éÚÍËÚ‡ e ÌÛÍ-ÎÂÓÚË‰Ì‡ Á‡ÏflÌ‡ ‚Ó‰Â˘‡ ‰Ó ÔÓ„Â¯ÌÓÒÏËÒÎÂÌ‡Ú‡ ÏÛÚ‡-ˆËfl Leu424Phe ‚ 12-ÚË ÂÍÁÓÌ (ÙË„Û‡ 4). Leu424Phe ÌÂ ·Â-¯Â ÓÚÍËÚ‡ ‚ 200 ·˙Î„‡ÒÍË ÍÓÌÚÓÎÌË ËÌ‰Ë‚Ë‰‡, ÍÓÂÚÓ‰ÓÍ‡Á‚‡ Ô‡ÚÓ„ÂÌÌËfl Ë ı‡‡ÍÚÂ.

éÅëöÜÑÄçÖ

èÂ‰ÒÚ‡‚flÏÂ Ù‡ÏËÎÂÌ ÒÎÛ˜‡È Ì‡ ·ÓÎÂÒÚ Ì‡ ÄÎˆı‡ÈÏÂÒ ‡ÌÌÓ Ì‡˜‡ÎÓ, ÔË˜ËÌÂÌ‡ ÓÚ ÌÓ‚‡ Leu424Phe / PSEN1ÏÛÚ‡ˆËfl. èÂ‰ÒÚ‡‚ÂÌ‡Ú‡ Ù‡ÏËÎËfl ÔÂ‰ÒÚ‡‚Îfl‚‡ ËÌÚÂ-ÂÒ ‚ Ì‡ÒÓÍ‡ ‡ÌÌ‡ ÔÓfl‚‡ Ë ·˙Á‡ ÔÓ„ÂÒËfl Ì‡ ÍÓ„ÌËÚË‚-ÌË Ì‡Û¯ÂÌËfl ‰Ó ÒÚÂÔÂÌ Ì‡ ÚÂÊÍ‡ ‰ÂÏÂÌˆËfl, ‚ Ò˙˜ÂÚ‡-ÌËÂ Ò ‡ÚËÔË˜Ì‡ ÍÎËÌË˜Ì‡ Í‡ÚËÌ‡ Ì‡ ÔÓ‚Â‰ÂÌ˜ÂÒÍË‡ÁÒÚÓÈÒÚ‚‡ Ë ÙÓÌÚ‡ÎÌË ÒËÏÔÚÓÏË ‚ ‡ÌÌ‡Ú‡ Ù‡Á‡ Ì‡Á‡·ÓÎfl‚‡ÌÂÚÓ Ë ÂÔËÎÂÔÒËfl ÔË Â‰ËÌ ÓÚ Úflı.

èË ‰‚‡Ï‡Ú‡ ËÁÒÎÂ‰‚‡ÌË Ô‡ˆËÂÌÚË, ‰Ë‡„ÌÓÁ‡Ú‡ ÒÂ ÔÓÒ-Ú‡‚Ë ÔÓ ‚ÂÏÂ Ì‡ ÛÏÂÂÌÓ ËÁ‡ÁÂÌ‡ ‰ÂÏÂÌˆËfl. Ñ‚‡Ï‡Ú‡ÔÓÍ‡Á‚‡Ú ÏÌÓ„Ó ·˙Á‡ ÔÓ„ÂÒËfl Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ Ò˙ÒÒËÎÌÓ ÔÓ‰˜ÂÚ‡ÌË ÔÓ‚Â‰ÂÌ˜ÂÒÍË ‡ÁÒÚÓÈÒÚ‚‡, ı‡‡ÍÚÂ-Ó‚Ë ÔÓÏÂÌË, Â‰ÛˆË‡Ì‡ Â˜ Ë ÒÓˆË‡ÎÌÓ ËÁÓÎË‡ÌÂ ‚ Ì‡-˜‡ÎÓÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ, Ò˙˜ÂÚ‡ÌÓ Ò ÚÂÊ˙Í Ô‡ÏÂÚÓ‚ ‰Â-ÙËˆËÚ Ë ÚÂÊ˙Í ‰ËÁÂÍÁÂÍÛÚË‚ÂÌ ÒËÌ‰ÓÏ ÔË Ò‡‚ÌËÚÂÎ-ÌÓ ÔÓ-Ò˙ı‡ÌÂÌË ÂÁËÍÓ‚Ë ÙÛÌÍˆËË. èË ‚ÚÓËfl Ô‡ˆËÂÌÚ Â‚˙ÁÏÓÊÌÓ Á‡Ï˙„Îfl‚‡ÌÂ Ì‡ ÍÎËÌË˜Ì‡Ú‡ Í‡ÚËÌ‡ ÔÓ‡‰ËÂÍÒÂˆË‚Ì‡Ú‡ ÛÔÓÚÂ·‡ Ì‡ ‡ÎÍÓıÓÎ, ÌÓ Á‡·ÓÎfl‚‡ÌÂÚÓ ÔÓ„-ÂÒË‡ ÔË ÔÂÛÒÚ‡ÌÓ‚fl‚‡ÌÂ Ì‡ ÔËÂÏ‡ ÏÛ Ó˘Â ‚ Ì‡˜‡ÎÓ-ÚÓ Ì‡ ÔÓfl‚‡Ú‡ Ì‡ ÒËÏÔÚÓÏËÚÂ. èË ‡ÁÎË˜ÌËÚÂ ˜ÎÂÌÓ‚ÂÌ‡ Ú‡ÁË Ù‡ÏËÎËfl ÒÂ Ì‡·Î˛‰‡‚‡ ‡ÁÎË˜Ì‡ ‚˙Á‡ÒÚ Ì‡ ‰Â-·˛Ú Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ.

èË Ù‡ÏËÎÌ‡ ÅÄ, ‡ÒÓˆËË‡Ì‡ Ò APP Ë PSÖN ÏÛÚ‡ˆËË,Á‡·ÓÎfl‚‡ÌÂÚÓ ‰Â·˛ÚË‡ Ó·ËÍÌÓ‚ÂÌÓ ÔÂ‰Ë 60 „Ó‰Ë¯Ì‡‚˙Á‡ÒÚ, ˜ÂÒÚÓ ‰ÓË Ë ÏÌÓ„Ó ÔÓ-‡ÌÓ. Lippa Ë Ò˙‡‚Ú. (8)ÔÛ·ÎËÍÛ‚‡Ú ÂÁÛÎÚ‡ÚËÚÂ ÒË ÓÚ ËÁÒÎÂ‰‚‡ÌÂÚÓ Ì‡ 90 Ô‡-ˆËÂÌÚ‡ Ò ‰ÓÏËÌ‡ÌÚÌ‡ ÙÓÏ‡ Ì‡ ÅÄ Ò ‡ÌÌÓ Ì‡˜‡ÎÓ, ÍÓËÚÓËÏ‡Ú ‡ÁÎË˜ÌË ÏÛÚ‡ˆËË ‚ ÄPP, PSEN1 Ë PSEN2 „ÂÌËÚÂ.íÂ ÓÚÍË‚‡Ú, ˜Â ‚˙Á‡ÒÚÚ‡ Ì‡ Ì‡˜‡ÎÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ Ë‚˙Á‡ÒÚÚ‡ Ì‡ ÎÂÚ‡ÎÌËfl ËÁıÓ‰ Ì‡ Ô‡ˆËÂÌÚËÚÂ Â ÁÌ‡˜ËÏÓÔÓ-‡ÌÌ‡ ÔË ÌÓÒËÚÂÎËÚÂ Ì‡ PSEN1 Ë Äêê ÏÛÚ‡ˆËË ‚Ò‡‚ÌÂÌËÂ Ò ÌÓÒËÚÂÎËÚÂ Ì‡ PSEN2 ÏÛÚ‡ˆËË.

ç‡È-˜ÂÒÚÓ ÅÄ Ò ÛÒÚ‡ÌÓ‚ÂÌ „ÂÌÂÚË˜ÂÌ ‰ÂÙÂÍÚ ËÏ‡ ÚË-ÔË˜ÂÌ Á‡ ·ÓÎÂÒÚÚ‡ ÍÎËÌË˜ÂÌ ÙÂÌÓÚËÔ. ç‡·Î˛‰‡‚‡Ú ÒÂ,Ó·‡˜Â ÁÌ‡˜ËÚÂÎÌË ÏÂÊ‰ÛÙ‡ÏËÎÌË ‚‡Ë‡ˆËË. èË ÌflÍÓË ÂÌ‡ÎËˆÂ ‡ÒÓˆË‡ˆËfl Ò ÔÓ‚Â‰ÂÌ˜ÂÒÍË ‡ÁÒÚÓÈÒÚ‚‡, ÂÔËÎÂÔ-ÒËfl, ÏËÓÍÎÓÌÛÒ, ÒÔ‡ÒÚË˜Ì‡ Ô‡‡Ô‡ÂÁ‡, Ô‡ÍËÌÒÓÌËÁ˙ÏËÎË ÙÓÌÚÓ-ÚÂÏÔÓ‡ÎÌ‡ ‰ÂÏÂÌˆËfl (12).

äÎËÌË˜Ì‡ ÓÒÓ·ÂÌÓÒÚ ÔË Ô‡ˆËÂÌÚË Ò PSÖN ÏÛÚ‡ˆËË ÂÌ‡ÎË˜ËÂÚÓ Ì‡ ÔÓ‚Â‰ÂÌ˜ÂÒÍË ‡ÁÒÚÓÈÒÚ‚‡ Ë ÁËÚÂÎÌË ı‡-Î˛ˆËÌ‡ˆËË (6). Ç Ú‡ÁË ‚˙ÁÍ‡ ‚ÌËÏ‡ÌËÂ Á‡ÒÎÛÊ‡‚‡ Ë ÍÓÂ-Î‡ˆËflÚ‡ Ì‡ÏÂÂÌ‡ ÏÂÊ‰Û ÔÓÁËˆËflÚ‡ Ì‡ ÏÛÚ‡ˆËËÚÂ ‚PSEN1 „ÂÌ‡ Ë Ì‡ÎË˜ËÂÚÓ Ì‡ ‡ÏËÎÓË‰Ì‡ ‡Ì„ËÓÔ‡ÚËfl ‚ÏÓÁ˙˜ÌËÚÂ Ò˙‰Ó‚Â, ‚Ó‰Â˘‡ ‰Ó ÎÂÁËË ‚ ÔÓ‰ÍÓÓ‚ÓÚÓ ·flÎÓÏÓÁ˙˜ÌÓ ‚Â˘ÂÒÚ‚Ó. í‡ÁË ÌÂ‚ÓÔ‡ÚÓÎÓ„Ë˜Ì‡ Ì‡ıÓ‰Í‡ Â ÛÒ-Ú‡ÌÓ‚ÂÌ‡ ÔË Ô‡ˆËÂÌÚË Ò PSEN1 ÏÛÚ‡ˆËË ÒÎÂ‰ ÍÓ‰ÓÌ 200(9). ãËÚÂ‡ÚÛÌËÚÂ ‰‡ÌÌË ÒÓ˜‡Ú, ˜Â ÌflÍÓË ÓÚ PSÖN ÏÛ-Ú‡ˆËË ÒÂ ÔÓfl‚fl‚‡Ú Ò ÍÎËÌË˜Ì‡Ú‡ Í‡ÚËÌ‡ Ì‡ ÙÓÌÚ‡ÎÌ‡‰ÂÏÂÌˆËfl (Raux et al 2000, Tang-Wai et al 2002, Dermaut etal. 2004). èË Ô˙‚‡Ú‡ ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡ Ô‡ÚÓÎÓ„Ë˜ÌË ÔÓ-ÏÂÌË ÔÓ ÚËÔ‡ Ì‡ ÅÄ ‚˙‚ ÙÓÌÚ‡ÎÌËÚÂ ‰flÎÓ‚Â. èË ‚ÚÓ-‡Ú‡ ÏÛÚ‡ˆËfl ÒÂ Í‡Ò‡Â Á‡ ÌÂ„‡ÚË‚ÂÌ ‰ÓÏËÌ‡ÌÚÂÌ ÂÙÂÍÚ,


îË„Û‡ 3. åêí Ì‡ „Î‡‚ÂÌ ÏÓÁ˙Í Ì‡ ‚ÚÓËfl Ô‡ˆËÂÌÚ

‚Ó‰Â˘ ‰Ó ËÌıË·ËˆËfl Ì‡ γ-ÒÂÍÂÚ‡Á‡. èË ÚÂÚ‡Ú‡ ÏÛ-Ú‡ˆËfl Ô‡ÚÓ„ÂÌÂÁ‡Ú‡ Â ÌÂflÒÌ‡. á‡ ËÁflÒÌfl‚‡ÌÂ Ì‡ Ó·˘‡Ú‡Ô‡ÚÓ„ÂÌÂÁ‡ Ì‡ ÅÄ Ò ÙÂÌÓÚËÔ Ì‡ ÙÓÌÚÓÚÂÏÔÓ‡ÎÌ‡ ‰Â-ÏÂˆËfl Â ÌÂÓ·ıÓ‰ËÏÓ ËÁÒÎÂ‰‚‡ÌÂ Ì‡ ÔÓ-„ÓÎflÏ ·ÓÈ Ô‡ˆËÂÌ-ÚË ÓÚ Á‡ÒÂ„Ì‡ÚËÚÂ Ù‡ÏËÎËË Ë ÓÚÍË‚‡ÌÂ Ì‡ ÌÓ‚Ë Ù‡ÏË-ÎËË Ò ÚÓÁË ÙÂÌÓÚËÔ. àÏ‡ Â‰ËÌË˜ÌÓ Ò˙Ó·˘ÂÌËÂ ÓÚ ‡ÙË-Í‡ÌÒÍ‡ Á‡ÒÂ„Ì‡Ú‡ Ù‡ÏËÎËfl Ò PSÖN ÏÛÚ‡ˆËfl, ÍÓflÚÓ ÔÓ-Í‡Á‚‡ ÔÓ‚Â‰ÂÌ˜ÂÒÍË ÔÓÏÂÌË Ë ‰ÂÁËÌıË·ËˆËfl, Í‡ÚÓ Ô˙‚ËÔÓfl‚Ë Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ (16).

äÎËÌË˜Ì‡Ú‡ Í‡ÚËÌ‡ Ì‡ ‰ÓÏËÌË‡˘Ë Ë ‡ÌÌË ÔÓ‚Â‰ÂÌ-˜ÂÒÍËÚÂ ÓÚÍÎÓÌÂÌËfl (R Queralt, 2000) ÏÓÊÂ ‰‡ ÒÂ Ó·flÒÌË Ò‰‡ÌÌËÚÂ Á‡ ÔÓ‰ÍÓÓ‚Ë ÔÓÏÂÌË ÛÒÚ‡ÌÓ‚ÂÌË Ì‡ åêí Ë Á‡Òfl-„‡ÌÂ Ì‡ ÙÓÌÚ‡ÎÌË Ë ÙÓÌÚÓ-ÒÛ·ÍÓÚËÍ‡ÎÌË Í˙„Ó‚Â (14).

Ç Á‡ÍÎ˛˜ÂÌËÂ, ÓÔËÒ‚‡ÏÂ ÌÓ‚‡ Leu424Phe / PSEN1 ÏÛ-Ú‡ˆËfl ÔË Ù‡ÏËÎÌ‡ ·ÓÎÂÒÚ Ì‡ ÄÎˆı‡ÈÏÂ Ò ‡ÌÌÓ Ì‡˜‡ÎÓÒ˙Ò Á‡ÒÂ„Ì‡ÚË ˜ÎÂÌÓ‚Â ‚ ÚË ÔÓÍÓÎÂÌËfl. íÓ‚‡ Â ÚÂÚ‡Ú‡Ù‡ÏËÎËfl Ò ÅÄ Ë Ë‰ÂÌÚËÙËˆË‡Ì „ÂÌÂÚË˜ÂÌ ‰ÂÙÂÍÚ ‚Å˙Î„‡Ëfl. äÎËÌË˜ÌÓ ÙÂÌÓÚËÔ˙Ú ÒÂ ı‡‡ÍÚÂËÁË‡ Ò ‡Ì-ÌÓ Ì‡˜‡ÎÓ, ·˙Á‡ ÔÓ„ÂÒËfl Ì‡ ‰ÂÏÂÌˆËfl, Ò˙˜ÂÚ‡Ì‡ Ò ÔÓ‚Â-‰ÂÌ˜ÂÒÍË ‡ÁÒÚÓÈÒÚ‚‡ Ë ÙÓÌÚ‡ÎÌË ÒËÏÔÚÓÏË, Í‡ÚÓ‡ÚËÔË˜ÌË ÍÎËÌË˜ÌË ·ÂÎÂÁË ÔË ÅÄ.

ÉÂÌÂÚË˜ÌÓ ÚÂÒÚÛ‚‡ÌÂ ÒÂ ÔÂÔÓ˙˜‚‡ ÔË Ù‡ÏËÎÌË ÒÎÛ-˜‡Ë Ë ÔË ÒÎÛ˜‡Ë Ò Ì‡˜‡ÎÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ ÔÂ‰Ë 65 „Ó-‰Ë¯Ì‡ ‚˙Á‡ÒÚ. ÄÍÓ ‚ ·˙‰Â˘Â ÒÂ ÛÒÚ‡ÌÓ‚Ë ÎÂ˜ÂÌËÂ Á‡ ÚÂ-ÁË Á‡·ÓÎfl‚‡ÌËfl, Ô‡ˆËÂÌÚËÚÂ Ò Ë‰ÂÌÚËÙËˆË‡Ì „ÂÌÂÚË˜ÂÌ‰ÂÙÂÍÚ Ë ÛÚÓ˜ÌÂÌ‡ Ô‡ÚÓ„ÂÌÂÁ‡ Ò‡ Ì‡È-ÔÓ‰ıÓ‰fl˘ËÚÂ ÒÎÛ-˜‡Ë Á‡ ÚÂ‡ÔÂ‚ÚË˜ÌËÚÂ ËÌÚÂ‚ÂÌˆËË.

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15. Raux, G., Gantier, R., Thomas-Anterion, C., Boulliat, J., Verpillat, P.,Hannequin, D., Brice, A., Frebourg, T., Campion, D. Dementia with promi-nent frontotemporal features associated with L113P presenilin 1 mutation.Neurology, 55, 2000, 10, 1577-1578.

16. Rippon, G.A., Crook, R., Baker, M., Halvorsen, E., Chin, S., Hutton, M.,Houlden, H., Hardy, J., Lynch, T. Presenilin 1 mutation in an african ameri-can family presenting with atypical Alzheimer dementia. Arch Neurol., 60,2003, 6, 884-888.

17. Rogaev, E.I., Sherrington, R., Rogaeva, E.A., Levesque, G., Ikeda, M., Liang,Y., Chi, H., Lin, C., Holman, K., Tsuda, T. Familial Alzheimer's disease inkindreds with missense mutations in a gene on chromosome 1 related to theAlzheimer's disease type 3 gene. Nature, 376, 1995, 6543, 775-778.

18. Schellenberg, G.D., Kamino, K., Bryant, E.M., Moore, D., Bird, T.D. Geneticheterogeneity, Down syndrome, and Alzheimer disease. Prog Clin Biol Res,379, 1992, 215-226.

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Ä‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËfl: ÑÓˆ ‰- ã˙˜ÂÁ‡ ÑËÌ˜Ó‚ í‡ÈÍÓ‚ ìåÅÄã “ÄÎÂÍÒ‡Ì‰Ó‚ÒÍ‡”, äÎËÌËÍ‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl, ·ÛÎ. “ÉÂÓ„Ë ëÓÙËÈÒÍË” 1, ëÓÙËfl 1431ÚÂÎ.: 92 30 752e-mail: [email protected]


SUMMARY

A NOVEL (Cys391Arg) PSEN2 MUTATTION IN APATIENT WITH SPORADIC EARLY ONSET

ALZHEIMER DISEASE

L. Traykov, S. Mehrabian, A. Jordanova, G. Nikolova, I. Raychev, M. Raycheva,

R. Rademakers, M. Cruts, I. Kremensky, C. Van Broeckhoven

Alzheimer’s Disease (AD) is the most common cause ofdementia and may be present in familial and sporadic forms.Mutations in 3 genes - amyloid precursor protein (APP),Presenilin 1 (PSEN1), and Presenilin 2 (PSEN2) - are associ-ated with early onset AD.

We studied the phenotype of Bulgarian AD patient with ‡PSEN2 mutation. DNA sequencing of PSEN2 and detailedclinical, neuropsychological, and neuroimaging examinationswere performed.

The proband is a 62 years old teacher with no personal orfamily history of neurological disease. The initial symptomsat age 54 years were difficulties in maintaining concentrationand mild memory disturbances, not affecting activities ofdaily living. The first neuropsychological evaluation at age 56showed impairment of short-term and episodic memory, with-out other cognitive deficits, thus suggesting the diagnosis ofmild cognitive impairment (MCI). Upon re-examination ayear later the psychometric testing showed orientation andexecutive function deficits. A CT scan revealed bitemporallobar atrophy. An initial diagnosis of probable AD was sug-gested. At 60 years of age the patient was still working as ateacher (MMSE=26). The brain MRI revealed marked corticalatrophy, enlargement of ventricles and white matter changes.The last neuropsychological examination documented mild tomoderate dementia (MMSE=18) at 62 years old. The patientis discharged.

We identified de novo PSEN2 (Cys391Arg) mutation in apatient with sporadic AD. There are several reports of patientswith PSEN2 mutations clinically characterized by long-termprogression. Similarly, our patient had a clinical course ofMCI for 3 years before development of dementia, which sug-gest long disease duration.

KEY WORDS: Presenilin 2, sporadic Alzheimer’s disease,clinical feature

êÖáûåÖ

ÅÓÎÂÒÚÚ‡ Ì‡ ÄÎˆı‡ÈÏÂ (ÅÄ) Â ÓÒÌÓ‚Ì‡ ÔË˜ËÌ‡ Á‡ ‰Â-ÏÂÌˆËfl Ë ÏÓÊÂ ‰‡ ÒÂ ÔÓfl‚Ë Í‡ÚÓ Ù‡ÏËÎÌ‡ Ë ÒÔÓ‡‰Ë˜Ì‡ÙÓÏ‡. ÅÄ Ò ‡ÌÌÓ Ì‡˜‡ÎÓ ÒÂ ‡ÒÓˆËË‡ Ò ÏÛÚ‡ˆËË ‚ ÚË„ÂÌ‡: Amyloid Precursor Protein (APP), Presenilin 1 (PSEN1)Ë Presenilin 2 (PSEN2).

èÓÛ˜‚‡ÏÂ ÙÂÌÓÚËÔ‡ Ì‡ ·˙Î„‡ÒÍË Ô‡ˆËÂÌÚ Ò ÌÓ‚‡ ÏÛ-Ú‡ˆËfl ‚ PSÖN 2 (Cys391Arg) „ÂÌ‡. èÂ‰ÒÚ‡‚flÏÂ „ÂÌÂ-

ÚË˜ÌË, ÍÎËÌË˜ÌË, ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌË Ë ÌÂ‚ÓËÁÓ·‡Áfl‚‡-˘Ë ‰‡ÌÌË Á‡ ÚÓÁË Ô‡ˆËÂÌÚ.

èÓ·‡Ì‰˙Ú Â Û˜ËÚÂÎ Ì‡ 62 „Ó‰ËÌË ·ÂÁ ‡Ì‡ÏÌÂÒÚË˜ÌË‰‡ÌÌË Á‡ Ù‡ÏËÎÌ‡ Ó·ÂÏÂÌÂÌÓÒÚ ÔÓ ÓÚÌÓ¯ÂÌËÂ Ì‡ Ô‡ÏÂ-ÚÓ‚Ë Ë ÍÓ„ÌËÚË‚ÌË Ì‡Û¯ÂÌËfl. è˙‚ËÚÂ ÒËÏÔÚÓÏË Ì‡Ô‡ˆËÂÌÚ‡ ÒÂ ÔÓfl‚fl‚‡Ú Ì‡ 54 „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ. ç‡·Î˛‰‡-‚‡ÌË Ò‡ Á‡ÚÛ‰ÌÂÌËfl ‚ ÍÓÌˆÂÌÚ‡ˆËflÚ‡ Ë ÎÂÍË Ô‡ÏÂÚÓ‚ËÌ‡Û¯ÂÌËfl ·ÂÁ ‰ÂÙËˆËÚ ‚ ÂÊÂ‰ÌÂ‚ÌËÚÂ Ë ÔÓÙÂÒËÓÌ‡ÎÌË-ÚÂ ‰ÂÈÌÓÒÚË. è˙‚ÓÚÓ ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌÓ ËÁÒÎÂ‰‚‡-ÌÂ/ÔÓ‚Â‰ÂÌÓ Ì‡ 56 „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ/ ÔÓÍ‡Á‚‡ ‰ÂÙËˆËÚ ‚Í‡ÚÍÓÒÓ˜Ì‡Ú‡ Ë ÂÔËÁÓ‰Ë˜Ì‡Ú‡ Ô‡ÏÂÚ (MMSE=27) ·ÂÁ‰Û„Ë ÍÓ„ÌËÚË‚ÌË Ì‡Û¯ÂÌËfl Ë ÒÂ ÔÓÒÚ‡‚fl ‰Ë‡„ÌÓÁ‡Ú‡ÎÂÍË ÍÓ„ÌËÚË‚ÌË Ì‡Û¯ÂÌËfl (ãäç). Ö‰Ì‡ „Ó‰ËÌ‡ ÔÓ-Í˙Ò-ÌÓ, ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡Ú Ì‡Û¯ÂÌËfl ‚ ÓËÂÌÚ‡ˆËflÚ‡ Ë ÂÍÁÂÍÛ-ÚË‚ÌËÚÂ ÙÛÌÍˆËË (MMSE=26). äÄí Ì‡ „Î‡‚ÂÌ ÏÓÁ˙Í ÔÓ-Í‡Á‚‡ ÍÓÓ‚‡ ‡ÚÓÙËfl, ÔÂ‰ËÏÌÓ ÚÂÏÔÓ‡ÎÌÓ. èÓÒÚ‡‚flÒÂ ‰Ë‡„ÌÓÁ‡Ú‡ ‚ÂÓflÚÌ‡ ·ÓÎÂÒÚ Ì‡ ÄÎˆı‡ÈÏÂ. ç‡ 60 „Ó-‰Ë¯Ì‡ ‚˙Á‡ÒÚ, Ô‡ˆËÂÌÚ˙Ú Ó˘Â ‡·ÓÚË Í‡ÚÓ Û˜ËÚÂÎ(MMSE=24). åêí Ì‡ „Î‡‚ÂÌ ÏÓÁ˙Í ÛÒÚ‡ÌÓ‚fl‚‡ ÚÂÊÍ‡ ÍÓ-Ó‚‡ ‡ÚÓÙËfl, ÔÂ‰ËÏÌÓ ÚÂÏÔÓ‡ÎÌÓ. èÓÒÎÂ‰ÌÓÚÓ ÌÂ‚-ÓÔÒËıÓÎÓ„Ë˜ÌÓ ËÁÒÎÂ‰‚‡ÌÂ ‰ÓÍÛÏÂÌÚË‡ ÎÂÍ Í˙Ï ÛÏÂÂÌ‰ÂÏÂÌÚÂÌ ÒËÌ‰ÓÏ (MMSE=18) Ì‡ 62 „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ.è‡ˆËÂÌÚ˙Ú Â ÓÒ‚Ó·Ó‰ÂÌ ÓÚ ‡·ÓÚ‡.

Ç Á‡ÍÎ˛˜ÂÌËÂ, ÓÔËÒ‚‡ÏÂ de novo PSEN2 (Cys391Arg)ÏÛÚ‡ˆËfl ÔË Ô‡ˆËÂÌÚ Ò˙Ò ÒÔÓ‡‰Ë˜Ì‡ ·ÓÎÂÒÚ Ì‡ ÄÎˆı‡È-ÏÂ Ò ‡ÌÌÓ Ì‡˜‡ÎÓ. çflÍÓË ÓÚ ÓÔËÒ‡ÌËÚÂ ‚ ÎËÚÂ‡ÚÛ‡-Ú‡ ÙÂÌÓÚËÔË Ì‡ Ô‡ˆËÂÌÚË Ò ·ÓÎÂÒÚ Ì‡ ÄÎˆı‡ÈÏÂ ËPSEN2 ÏÛÚ‡ˆËË ÒÂ ı‡‡ÍÚÂËÁË‡Ú Ò ‰˙Î„Ó„Ó‰Ë¯Ì‡ÔÓ„ÂÒËfl. îÂÌÓÚËÔ˙Ú Ì‡ Ì‡¯Ëfl Ô‡ˆËÂÌÚ Ì‡ÔÓ‰Ó·fl‚‡ÍÎËÌË˜Ì‡ Í‡ÚËÌ‡ Ì‡ ãÂÍÓ äÓ„ÌËÚË‚ÌÓ ç‡Û¯ÂÌËÂ 3 „Ó-‰ËÌË ÔÂ‰Ë ‡Á‚ËÚËÂÚÓ Ì‡ ‰ÂÏÂÌÚÂÌ ÒËÌ‰ÓÏ, ÍÓÂÚÓÔÂ‰ÔÓÎ‡„‡ ÔÓ-·‡‚Ì‡ ÔÓ„ÂÒËfl Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ.

äãûóéÇà Ñìåà: èÂÒÂÌÂÎËÌ 2, ÒÔÓ‡‰Ë˜Ì‡ ·ÓÎÂÒÚÌ‡ ÄÎˆı‡ÈÏÂ, ÍÎËÌË˜Ì‡ Í‡ÚËÌ‡.

ÇöÇÖÑÖçàÖ

ÅÓÎÂÒÚÚ‡ Ì‡ ÄÎˆı‡ÈÏÂ (ÅÄ) Â ÔÓ„ÂÒË‡˘Ó ÌÂ‚Ó‰Â-„ÂÌÂ‡ÚË‚ÌÓ Á‡·ÓÎfl‚‡ÌÂ Ò ÍÓÏÔÎÂÍÒÌ‡ ÂÚËÓÎÓ„Ëfl. ÉÂÌÂ-ÚË˜ÌË Ù‡ÍÚÓË Ë Ù‡ÍÚÓË ÓÚ ÓÍÓÎÌ‡Ú‡ ÒÂ‰‡ Ë„‡flÚ‚‡ÊÌ‡ ÓÎfl Á‡ ÂÍÒÔÂÒËflÚ‡ Ì‡ ÙÂÌÓÚËÔ‡. ÅÄ Â ÓÒÌÓ‚Ì‡ÔË˜ËÌ‡ Á‡ ‰ÂÏÂÌˆËfl Ë ÏÓÊÂ ‰‡ ÒÂ ÔÓfl‚Ë Í‡ÚÓ Ù‡ÏËÎÌ‡Ë ÒÔÓ‡‰Ë˜Ì‡ ÙÓÏ‡ (14).

éÚ 1991 „Ó‰ËÌ‡ ÂÁÛÎÚ‡ÚËÚÂ ÓÚ „ÂÌÂÚË˜ÌËÚÂ ÔÓ-Û˜‚‡ÌËfl Ò‡ ‰Ó‚ÂÎË ‰Ó Ë‰ÂÌÚËÙËˆË‡ÌÂ Ì‡ ÏÛÚ‡ˆËË Ë ÔÓ-ÎËÏÓÙËÁÏË, ÍÓËÚÓ ÏÓ„‡Ú ‰‡ ÔË˜ËÌflÚ ÅÄ ËÎË ‰‡ Û‚ÂÎË-˜‡Ú ËÒÍ‡ ÓÚ ‡Á‚ËÚËÂ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ (19). ëÎÛ˜‡ËÚÂÌ‡ ÅÄ Ò ‡ÌÌÓ Ì‡˜‡ÎÓ Á‡ ÏÓÏÂÌÚ‡ Ò‡ ‡ÒÓˆËË‡ÌË Ò ÏÛÚ‡-ˆËË ‚ ÚË „ÂÌ‡: „ÂÌ Á‡ ÒËÌÚÂÁ‡ Ì‡ Ämyloid êrecursorêrotein (APP, Goate, et al., 1991), Presenilin 1 (PSEN1,Sherrington, et al., 1995) Ë Presenilin 2 (PSEN2, Levy –L‡had, et al., 1995a). íÂÁË ÏÛÚ‡ˆËË Ò‡ ÔË˜ËÌ‡ Á‡ 30-50%ÓÚ ‡‚ÚÓÁÓÏÌÓ-‰ÓÏËÌ‡ÌÚÌËÚÂ ÒÎÛ˜‡Ë Ë ÓÍÓÎÓ 5% ÓÚ‚ÒË˜ÍË ÒÎÛ˜‡È Ò ÅÄ. ÑÓ ÏÓÏÂÌÚ‡ Ò‡ Ò˙Ó·˘ÂÌË 27 APP, 157


éÔËÒ‡ÌËÂ Ì‡ ÍÎËÌË˜ÂÌ ÒÎÛ˜‡ÈçéÇÄ PSEN2 (CYS391ARG) åìíÄñàü èêà èÄñàÖçí ëöë

ëèéêÄÑàóçÄ ÅéãÖëí çÄ ÄãñïÄâåÖê ë êÄççé çÄóÄãéã. í‡ÈÍÓ‚1, ò. åÂı‡·Ë‡Ì1, Ä. âÓ‰‡ÌÓ‚‡2, É. çËÍÓÎÓ‚‡4, à. ê‡È˜Â‚4, å. ê‡È˜Â‚‡1,

ê. ê‡‰ÂÏ‡ÍÂ3, å. äÛÚÒ3, à. äÂÏÂÌÒÍË2, ä. Ç‡Ì ÅÓÂÍıÓ‚ÂÌ3

1äÎËÌËÍ‡ ÔÓ çÂ‚ÓÎÓ„Ëfl, åÅÄã “ÄÎÂÍÒ‡Ì‰Ó‚ÒÍ‡”, åÂ‰ËˆËÌÒÍË ìÌË‚ÂÒËÚÂÚ, ëÓÙËfl2ã‡·Ó‡ÚÓËfl ÔÓ åÓÎÂÍÛÎflÌ‡ è‡ÚÓÎÓ„Ëfl, åÂ‰ËˆËÌÒÍË ìÌË‚ÂÒËÚÂÚ, ëÓÙËfl

3ä‡ÚÂ‰‡ ÔÓ åÓÎÂÍÛÎflÌ‡ ÉÂÌÂÚËÍ‡, ìÌË‚ÂÒËÚÂÚ ÄÌÚ‚ÂÔÂÌ, ÅÂÎ„Ëfl4äÎËÌËÍ‡ ÔÓ çÂ‚ÓÎÓ„Ëfl, ëÅÄãçè “ë‚ ç‡ÛÏ”, åÂ‰ËˆËÌÒÍË ìÌË‚ÂÒËÚÂÚ, ëÓÙËfl

PSEN1 Ë Ò‡ÏÓ 9 PSEN2 ÏÛÚ‡ˆËË ÔË˜ËÌËÎË ÅÄ. ê‡ÁÎË˜ÌË-ÚÂ ÔÓÛ˜‚‡ÌËfl ÔÓÍ‡Á‚‡Ú, ˜Â ˜ÂÒÚÓÚ‡Ú‡ Ì‡ PSEN ÏÛÚ‡-ˆËË ÒÂ‰ Ô‡ˆËÂÌÚË Ò ‡‚ÚÓÁÓÏÌÓ-‰ÓÏËÌ‡ÌÚÂÌ ÚËÔ ÛÌ‡ÒÎÂ-‰fl‚‡ÌÂ Â ‚ËÒÓÍ‡, ‚ Ò‡‚ÌÂÌËÂ Ò ÌËÒÍ‡Ú‡ ˜ÂÒÚÓÚ‡ ÔË Ô‡-ˆËÂÌÚË Ò˙Ò ÒÔÓ‡‰Ë˜Ì‡ ÅÄ ËÎË ÌÂ‡‚ÚÓÁÓÏÌÓ-‰ÓÏËÌ‡ÌÚÂÌÚËÔ ÛÌ‡ÒÎÂ‰fl‚‡ÌÂ (13, 14).

PSEN2 „ÂÌ˙Ú Â ÓÚÍËÚ ÔÂÁ 1995 „. (11) ‚˙Á ÓÒÌÓ‚‡ Ì‡ÒıÓ‰ÒÚ‚ÓÚÓ ÏÛ Ò PSEN1 „ÂÌ‡. íÓÈ ÒÂ Ì‡ÏË‡ ‚ ıÓÏÓÁÓ-ÏÂÌ ‡ÈÓÌ 1q42.3. àÌÚÂÂÒÌÓÚÓ Â, ˜Â Á‡ „ÂÌÂÚË˜Ì‡Ú‡ÒÍ‡˜ÂÌÓÒÚ Ò ÚÓÁË ‡ÈÓÌ Â Ò˙Ó·˘ÂÌÓ Ô˙ÌÓÌ‡˜‡ÎÌÓ ‚ Ú. Ì‡. ÇÓÎÊÍÓ-ÉÂÏ‡ÌÒÍ‡ „ÛÔ‡ ÓÚ ÒÂÏÂÈÒÚ‚‡ Ò ÅÄ,ÍÓËÚÓ Ô˙‚Ó ÂÏË„Ë‡Ú ÓÚ ÉÂÏ‡ÌËfl ‚ êÛÒËfl, ‡ ÔÓ-Í˙ÒÌÓ‚ ëÄô. Ç ÚÂÁË ÒÂÏÂÈÒÚ‚‡ Â ÓÚÍËÚ‡ ÏÛÚ‡ˆËflÚ‡Äsn141Ile ‚ PSÖN2 „ÂÌ‡ (11). Ç ÌflÍÓÎÍÓ Á‡ÒÂ„Ì‡ÚË ˜ÎÂÌÓ-‚Â Ì‡ Ú‡ÁË Ù‡ÏËÎËfl Ò‡ ÛÒÚ‡ÌÓ‚ÂÌË ‡ÏËÎÓË‰Ì‡ ‡Ì„ËÓÔ‡-ÚËfl Ë ÏÓÁ˙˜Ì‡ ıÂÏÓ‡„Ëfl (16). PSEN1 Ë PSEN2 „ÂÌËÚÂ Ò‡‚ËÒÓÍÓ ıÓÏÓÎÓÊÌË ‚ ÍÓ‰Ë‡˘ËÚÂ Û˜‡ÒÚ˙ˆË, ÌÓ ÒÂ ‡ÁÎË-˜‡‚‡Ú ‚ ËÌÚÓÌÌËÚÂ ÒË ÔÓÒÎÂ‰Ó‚‡ÚÂÎÌÓÒÚË, ÍÓÂÚÓ ÔÓ-Í‡Á‚‡, ˜Â ÚÂ ÌÂ Ò‡ ‚˙ÁÌËÍÌ‡ÎË ‚ ÂÁÛÎÚ‡Ú Ì‡ Â‚ÓÎ˛ˆËÓÌÌÓÏÎ‡‰‡ „ÂÌÓÏÌ‡ ÂÍÓÏ·ËÌ‡ˆËfl. à ‰‚‡Ú‡ „ÂÌ‡ ËÏ‡Ú ÏÌÓ„ÓÚ‡ÌÒÍËÔËÚË, ÍÓËÚÓ ËÏ‡Ú ÒÔÂˆËÙË˜Ì‡ ÂÍÒÔÂÒËfl ‚ ‡Á-ÎË˜ÌË Ú˙Í‡ÌË (11).

èÓ-„ÓÎflÏ‡Ú‡ ˜‡ÒÚ ÓÚ PSÖN ÏÛÚ‡ˆËË Ò‡ ÔÓ„Â¯ÌÓÒÏËÒÎÂÌË, ‚Ó‰Â˘Ë ‰Ó Á‡ÏflÌ‡ Ì‡ Â‰ËÌË˜ÌË ‡ÏËÌÓÍËÒÂÎËÌË.ë˙Ó·˘ÂÌË Ò‡ ‰‚‡ ÒÔÎ‡ÈÒËÌ„ ‰ÂÙÂÍÚ‡ Ë ‡ÁÎË˜ÌË „ÂÌÓÏÌË‰ÂÎÂˆËË. åÛÚ‡ˆËËÚÂ Ë ‚ ‰‚‡Ú‡ „ÂÌ‡ Á‡Òfl„‡Ú ÍÓÌÒÂ‚‡-ÚË‚ÌË ‡ÏËÌÓÍËÒÂÎËÌË. êÓÎflÚ‡ Ì‡ PSÖN2 ·ÂÎÚ˙Í‡ ‚ Ô‡-ÚÓ„ÂÌÂÁ‡Ú‡ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ ÓÒÚ‡‚‡ ÌÂflÒÌ‡. Ç ÌflÍÓÎÍÓÙÛÌÍˆËÓÌ‡ÎÌË ËÁÒÎÂ‰‚‡ÌËfl Â ÔÓÍ‡Á‡ÌÓ, ˜Â ‚ÒË˜ÍËÚÂ PSEN

ÏÛÚ‡ˆËË ËÏ‡Ú “gain of function” ÂÙÂÍÚ Í‡ÚÓ Ì‡Û¯‡-‚‡Ú Ô‡‚ËÎÌÓÚÓ ‡Á„‡Ê‰‡ÌÂ Ì‡ Äêê ·ÂÎÚ˙Í‡, Í‡ÚÓ ÔÓÚÓÁË Ì‡˜ËÌ ÒÂ ÒÂÍÂÚË‡Ú ·ÂÚ‡-‡ÏËÎÓË‰ÌË ÔÂÔÚË‰Ë, ÍÓ-ËÚÓ ÒÂ Ì‡ÚÛÔ‚‡Ú ‚ ÏÓÁ˙Í‡ Ì‡ Ô‡ˆËÂÌÚËÚÂ Ë ‚Ó‰flÚ ‰ÓÎÂÁËË ı‡‡ÍÚÂÌË Á‡ ÅÄ (3, 8, 11, 17).

ñÂÎÚ‡ Ì‡ Ì‡¯ÂÚÓ ÔÓÛ˜‚‡ÌÂ Â ËÁÒÎÂ‰‚‡ÌÂ Ì‡ ·˙Î„‡ÒÍËÔ‡ˆËÂÌÚ Ò˙Ò ÒÔÓ‡‰Ë˜Ì‡ ÅÄ Ò ‡ÌÌÓ Ì‡˜‡ÎÓ, ÔË˜ËÌÂÌ‡ ÓÚÌÓ‚‡ PSEN2 ÏÛÚ‡ˆËfl (Cys391Arg).


èÓ·‡Ì‰˙Ú Â Ô‡ˆËÂÌÚ Ì‡ 56 „Ó‰ËÌË, ıÓÒÔËÚ‡ÎËÁË‡Ì Á‡Ô˙‚Ë Ô˙Ú ÔÂÁ flÌÛ‡Ë 2001„ ‚ ÍÎËÌËÍ‡Ú‡ ÔÓ ÌÂ‚ÓÎÓ„ËflÌ‡ ëÅÄãçè "ë‚. ç‡ÛÏ". éÚ ÓÍÓÎÓ 2 „Ó‰ËÌË Á‡·ÂÎflÁ‡ÎÔÓÒÚÂÔÂÌÌÓ fl‚ËÎÓ ÒÂ Ì‡Û¯ÂÌËÂ ‚ Ô‡ÏÂÚÚ‡ Á‡ ·ÎËÁÍË Ò˙-·ËÚËfl - Á‡·‡‚fl ÚÂÎÂÙÓÌÌË ÌÓÏÂ‡, ÔÓ˙˜ÍË, ÔÎ‡ÌË‡ÌË‰ÂÈÌÓÒÚË. ë˙Ó·˘‡‚‡ Á‡ ÎÂÍÓ ÔÓ„ÂÒË‡ÌÂ Ì‡ ÓÔÎ‡Í‚‡ÌË-flÚ‡ ÒË ÓÚ 5-6 ÏÂÒÂˆ‡, ÌÓ ÔÓ‰˙ÎÊ‡‚‡ ‰‡ ËÁÔ˙ÎÌfl‚‡ Í‡˜Â-ÒÚ‚ÂÌÓ ·ÂÁ ‰ÂÙËˆËÚ ‰ÂÈÌÓÒÚÚ‡ ÒË Ì‡ Û˜ËÚÂÎ Ë ÂÊÂ‰ÌÂ‚-ÌËÚÂ ÒË ‰ÂÈÌÓÒÚË. ëÚ‡Ì‡Î Ï‡ÎÍÓ ÔÓ-·‡‚ÂÌ ‚ ÏËÒÎÂÌÂÚÓ Ë‚ ÔËÒ‡ÌÂÚÓ, Ò ÎÂÍÓ ÔÓÌËÊÂÌ‡ ËÌËˆË‡ÚË‚ÌÓÒÚ Ë ÒÔÓÒÓ·-ÌÓÒÚ Á‡ ÔÎ‡ÌË‡ÌÂ Ì‡ ‰ÂÈÌÓÒÚË. çflÏ‡ ‡Ì‡ÏÌÂÒÚË˜Ë ‰‡Ì-ÌË Á‡ Ù‡ÏËÎÌ‡ Ó·ÂÏÂÌÂÌÓÒÚ ÔÓ ÓÚÌÓ¯ÂÌËÂ Ì‡ Ô‡ÏÂÚÓ‚Ë,ÍÓ„ÌËÚË‚ÌË Ë ÔÓ‚Â‰ÂÌ˜ÂÒÍË Ì‡Û¯ÂÌËfl.

ëÓÏ‡ÚË˜ÌËflÚ Ë ÌÂ‚ÓÎÓ„Ë˜ÌËflÚ ÒÚ‡ÚÛÒ Ò‡ ·ÂÁ ÓÒÓ·Â-ÌÓÒÚË. è‡‡ÍÎËÌË˜ÌËÚÂ ËÁÒÎÂ‰‚‡ÌËfl Ì‡ Í˙‚ Ë ÛËÌ‡ Ò‡ ‚„‡ÌËˆ‡Ú‡ Ì‡ ÌÓÏ‡Ú‡. àÁÒÎÂ‰‚‡ÌËÚÂ ÒÂÛÏÌË ÌË‚‡ Ì‡Ç12, ÙÓÎËÂ‚‡ ÍËÒÂÎËÌ‡, TSH Ë ÒÂÓÎÓ„Ë˜ÌËÚÂ ËÁÒÎÂ‰‚‡ÌËfl‚ Ì‡ÒÓÍ‡ ÒËÙËÎËÒ Ë HIV Ò‡ ÌÓÏ‡ÎÌË. äí Ì‡ „Î‡‚ÂÌ ÏÓÁ˙Í‰ÓÍÛÏÂÌÚË‡ ÛÏÂÂÌÓ ËÁ‡ÁÂÌ‡ ÍÓÓ‚‡ ‡ÚÓÙËfl Ò ÔÂ-


îË„Û‡ 1. åêí Ì‡ „Î‡‚ÂÌ ÏÓÁ˙Í Ì‡ ÔÓ·‡Ì‰‡

‰ËÏÌÓ Á‡Òfl„‡ÌÂ Ì‡ ıËÔÓÍ‡ÏÔ‡ÎÌÓ-‡ÏË„‰‡Î‡ÌËfl ÍÓÏÔÎÂÍÒ.ÖÖÉ ÔÓÍ‡Á‚‡ ‰Ó·Â Ó„‡ÌËÁË‡Ì‡ ÓÒÌÓ‚Ì‡ ‡ÍÚË‚ÌÓÒÚ, ·Ë-ÓÍˆËÔËÚ‡ÎÌË Ó„ÌË˘ÌË ÔÓÏÂÌË ÓÚ ·‡‚ÌË ‚˙ÎÌË ÔÓ-ËÁ‡-ÁÂÌË ‚ ‰flÒÌÓ.

çÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ ÛÒÚ‡ÌÓ‚fl‚‡ ‰ÂÙËˆËÚÂ‰ËÌÒÚ‚ÂÌÓ Ì‡ Í‡ÚÍÓÒÓ˜Ì‡Ú‡ Ë ‰˙Î„ÓÒÓ˜Ì‡Ú‡ Ô‡ÏÂÚ(ååSÖ=27). èÓÒÚ‡‚ÂÌ‡ Â ‰Ë‡„ÌÓÁ‡Ú‡ ÎÂÍÓ ÍÓ„ÌËÚË‚ÌÓÌ‡Û¯ÂÌËÂ, Ì‡È-‚ÂÓflÚÌÓ Ò ‰Â„ÂÌÂ‡ÚË‚Ì‡ „ÂÌÂÁ‡.

Ö‰Ì‡ „Ó‰ËÌ‡ ÔÓ-Í˙ÒÌÓ (57„.) Â ıÓÒÔËÚ‡ÎËÁË‡Ì ‚ ÍÎËÌË-Í‡Ú‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl Ì‡ åÅÄã “ÄÎÂÍÒ‡Ì‰Ó‚ÒÍ‡” Á‡ ‰ÓÛ-ÚÓ˜Ìfl‚‡ÌÂ Ì‡ ‰Ë‡„ÌÓÁ‡Ú‡. éÚ˜ËÚ‡ ÒÂ ·‡‚Ì‡ ÔÓ„ÂÒËfl Ì‡Ô‡ÏÂÚÓ‚ËÚÂ ÓÔÎ‡Í‚‡ÌËfl Ë ‚ÒÂ Ó˘Â ÒÔ‡‚flÌÂ Ò ÂÊÂ‰ÌÂ‚ÌË-ÚÂ Ë ÔÓÙÂÒËÓÌ‡ÎÌË ‰ÂÈÌÓÒÚË. çÂ‚ÓÎÓ„Ë˜ÌËflÚ ÒÚ‡ÚÛÒ ÂÌÓÏ‡ÎÂÌ. è‡‡ÍÎËÌË˜ÌËÚÂ ËÁÒÎÂ‰‚‡ÌËfl Ì‡ Í˙‚ Ë ÛËÌ‡,ÎÛÏ·‡ÎÂÌ ÎËÍ‚Ó Ë ‰ÓÔÎÂÓ‚‡ ÒÓÌÓ„‡ÙËfl Ì‡ Í‡ÌË‡ÎÌËÚÂË ÂÍÒÚ‡Í‡ÌË‡ÎÌËÚÂ Ò˙‰Ó‚Â Ò‡ ‚ ÌÓÏ‡. ÖÖÉ ÔÓÍ‡Á‚‡ ÎÂ-ÍË ‰ËÙÛÁÌË ÌÂÒÔÂˆËÙË˜ÌË ÔÓÏÂÌË. èË ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜-ÌÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ Â ‰ÓÍÛÏÂÌÚË‡Ì ÏÌÓ„Ó ÎÂÍ ÒÔ‡‰ Ì‡ Ó·˘ËflÍÓ„ÌËÚË‚ÂÌ Í‡Ô‡ˆËÚÂÚ (ååSÖ=26), Ò ‰ÓÔ˙ÎÌËÚÂÎÌÓ Ì‡-Û¯ÂÌËÂ ‚˙‚ ‚ÌËÏ‡ÌËÂÚÓ Ë ‰ËÁÂÍÁÂÍÛÚË‚ÂÌ ÒËÌ‰ÓÏ.åêí Ì‡ „Î‡‚ÂÌ ÏÓÁ˙Í (îË„Û‡ 1) ‰ÓÍÛÏÂÌÚË‡ ÚÂÊÍ‡ ÍÓ-Ó‚‡ ‡ÚÓÙËfl, ÔÂ‰ËÏÌÓ ÚÂÏÔÓ‡ÎÌÓ Ò ÔÓ‰ÍÓÓ‚Ë ıËÔÂ-ËÌÚÂÌÁÌË ÔÓÏÂÌË ‚ ·flÎÓÚÓ ÏÓÁ˙˜ÌÓ ‚Â˘ÂÒÚ‚Ó. èÓÒÚ‡-‚ÂÌ‡ Â ‰Ë‡„ÌÓÁ‡Ú‡ ‚ÂÓflÚÌ‡ ·ÓÎÂÒÚ Ì‡ ÄÎˆı‡ÈÏÂ.

Ç ÒÎÂ‰‚‡˘ËÚÂ ÚË „Ó‰ËÌË ÒÂ ÓÚ˜ËÚ‡ ÎÂÍÓ ‚ÎÓ¯‡‚‡ÌÂÌ‡ ÒËÏÔÚÓÏ‡ÚËÍ‡Ú‡, Í‡ÚÓ ÒÂ ÔÓfl‚fl‚‡Ú Ë Ì‡Û¯ÂÌËflÔË ËÁÔ˙ÎÌÂÌËÂÚÓ Ì‡ ÔÓ-ÒÎÓÊÌË Á‡‰‡˜Ë ÓÚ ÂÊÂ‰ÌÂ‚ËÂÚÓ.èÂÁ ˛ÌË 2004 „. ÒÂ ÔÓ‚ÂÊ‰‡ ÍÓÌÚÓÎÂÌ ‡Ï·ÛÎ‡ÚÓÂÌÔÂ„ÎÂ‰ Ò ÌÂ‚ÓÎÓ„Ë˜ÌÓ Ë ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌÓ ËÁÒÎÂ‰‚‡ÌÂ.ç‡ 60 „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ ÔË Ô‡ˆËÂÌÚ‡ Â Ì‡ÎËˆÂ Ë Á‡ÚÛ‰-ÌÂÌËÂ ÔË Ì‡ÏË‡ÌÂ Ì‡ ÌflÍÓË ‰ÛÏË, ÎÂÍË Á‡ÚÛ‰ÌÂÌËflÔË ËÁ‚˙¯‚‡ÌÂ Ì‡ ÂÊÂ‰ÌÂ‚ÌËÚÂ Ë ÔÓÙÂÒËÓÌ‡ÎÌËÚÂ‰ÂÈÌÓÒÚË, ÌÓ ‚ÒÂ Ó˘Â ‡·ÓÚË Í‡ÚÓ Û˜ËÚÂÎ. çÂ‚ÓÎÓ„Ë˜-ÌËflÚ ÒÚ‡ÚÛÒ Â ÌÓÏ‡ÎÂÌ. çÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌÓÚÓ ËÁÒÎÂ‰-‚‡ÌÂ ‰ÓÍÛÏÂÌÚË‡ ÎÂÍ ‰ÂÏÂÌÚÂÌ ÒËÌ‰ÓÏ (ååSÖ=24) ÒÚÂÊÍÓ Ì‡Û¯ÂÌËÂ ‚ ÌÂÔÓÒÂ‰ÒÚ‚ÂÌÓ Ë ÓÚ‰‡ÎÂ˜ÂÌÓ ÔË-ÔÓÏÌflÌÂ Ò ‰ÂÙËˆËÚ ‚ ‡ÁÔÓÁÌ‡‚‡ÌÂ (80%) Ë ÏÌÓ„Ó ËÌÚ-ÛÁËË. ç‡ÎËˆÂ Â Ò˙˘Ó ÚÂÊÍÓ Á‡Òfl„‡ÌÂ Ë Ì‡ ÌÂ‚Â·‡ÎÌ‡Ú‡Ô‡ÏÂÚ Ë ÎÂÍ‡ ÍÓÌÒÚÛÍÚË‚Ì‡ ‡Ô‡ÍÒËfl. ÑÓÔ˙ÎÌËÚÂÎÌÓÒÂ ÔÓfl‚ËÎË ÎÂÍË Ì‡Û¯ÂÌËfl ‚ Ì‡ÁÓ‚‡‚‡ÌÂÚÓ Ë ‚Â·‡ÎÌ‡-Ú‡ ÙÎÛÂÌÚÌÓÒÚ.

èÂÁ ÒÎÂ‰‚‡˘ËÚÂ 2 „Ó‰ËÌË Á‡·ÓÎfl‚‡ÌÂÚÓ ·‡‚ÌÓ ÔÓ„-ÂÒË‡ Ò ÔÓÒÚÂÔÂÌÌÓ Á‡‰˙Î·Ó˜‡‚‡ÌÂ Ì‡ ÍÓ„ÌËÚË‚ÌËÚÂÌ‡Û¯ÂÌËfl. ÅÎËÁÍËÚÂ Ò˙Ó·˘‡‚‡Ú Á‡ ÛÏÂÂÌ ‰ÂÙËˆËÚ ‚ÂÊÂ‰ÌÂ‚ÌËÚÂ ‰ÂÈÌÓÒÚË. ë‡ÏÓÒÚÓflÚÂÎÌÓ ÒÂ ÒÔ‡‚fl ÒÎË˜Ì‡Ú‡ ÒË ıË„ËÂÌ‡ Ë Ó·ÎË˜‡ÌÂ, ÌÓ ËÏ‡ ÌÛÊ‰‡ ÓÚ ÔÓÏÓ˘ÔË Ô‡Á‡Û‚‡ÌÂ, ÒÔ‡‚flÌÂ Ò ÙËÌ‡ÌÒËËÚÂ Ë ËÁÔÓÎÁ‚‡ÌÂ Ì‡Ú‡ÌÒÔÓÚÌËÚÂ ÒÂ‰ÒÚ‚‡. è‡ˆËÂÌÚ˙Ú Â ÓÒ‚Ó·Ó‰ÂÌ ÓÚ‡·ÓÚ‡ ÒÎÂ‰ 6 ÏÂÒÂˆ‡. èÓÒÎÂ‰ÌÓÚÓ ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÌÓËÁÒÎÂ‰‚‡ÌÂ ÔÂÁ 2006 „. ‰ÓÍÛÏÂÌÚË‡ ÛÏÂÂÌ ‰ÂÏÂÌÚÂÌÒËÌ‰ÓÏ (MMSE=18) Ì‡ 62 „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ. ç‡ÎËˆÂ ÂÒÔ‡‰ ‚ Ô‡ÏÂÚÓ‚ËÚÂ ÔÓˆÂÒË Ò ÚÂÊÍÓ Ì‡Û¯ÂÌËÂ ‚ Á‡Û˜‡-‚‡ÌÂ Ì‡ ÌÓ‚‡ ËÌÙÓÏ‡ˆËfl Ë ‡ÁÔÓÁÌ‡‚‡ÌÂ (65%). ìÒÚ‡ÌÓ-‚fl‚‡ ÒÂ ÍÓ„ÌËÚË‚ÂÌ ÛÔ‡‰˙Í Ë ‚ ‰Û„Ë ÍÓ„ÌËÚË‚ÌË ÒÙÂË:ÛÏÂÂÌ‡ ‰ÂÁÓËÂÌÚ‡ˆËfl Á‡ ‚ÂÏÂ Ë ÏflÒÚÓ, ÚÂÊ˙Í ‰Ë-ÁÂÍÁÂÍÛÚË‚ÂÌ ÒËÌ‰ÓÏ, ÒËÎÌÓ Ó„‡ÌË˜ÂÌ Ó·ı‚‡Ú Ì‡ ‚ÌË-Ï‡ÌËÂÚÓ Ë Ì‡Ï‡ÎÂÌ‡ ‚Â·‡ÎÌ‡ ÙÎÛÂÌÚÌÓÒÚ. çÂ ‡Á·Ë‡ÔÓ-ÒÎÓÊÌË ËÌÒÚÛÍˆËË Ë Á‡‰‡˜Ë. ÖÁËÍÓ‚ËÚÂ ÙÛÌÍˆËËÔË ‡Á„Ó‚Ó Ë Ì‡ÁÓ‚‡‚‡ÌÂ Ò‡ ÎÂÍÓ Ì‡Û¯ÂÌË. ãÂÍ ‰ÂÙË-ˆËÚ ÒÂ Ì‡·Î˛‰‡‚‡ Ë ‚ Á‡‰‡˜ËÚÂ Á‡ ÍÓÌÒÚÛÍÚË‚ÂÌ Ô‡Í-ÒËÒ. ç‡ÎËˆÂ Â ÚÂÊ˙Í ‰ÂÙËˆËÚ ‚ ÁËÚÂÎÌÓ-ÔÓÒÚ‡Ì-ÒÚ‚ÂÌËÚÂ ÙÛÌÍˆËË.

å‡ÈÍ‡ ÏÛ Â ÔÓ˜ËÌ‡Î‡ Ì‡ 79 „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ ÓÚ ÏÓÁ˙-˜ÂÌ ËÌÒÛÎÚ ·ÂÁ Ô‡ÏÂÚÓ‚Ë Ì‡Û¯ÂÌËfl. Å‡˘‡ ÏÛ Â ÔÓ˜ËÌ‡Î Ì‡72 „Ó‰ËÌË Ò˙˘Ó ·ÂÁ Ô‡ÏÂÚÓ‚Ë Ì‡Û¯ÂÌËfl. è‡ˆËÂÌÚ˙Ú ËÏ‡·‡Ú Ì‡ 65 „Ó‰ËÌË, ÍÓÈÚÓ Â ÍÎËÌË˜ÌÓ Á‰‡‚.

ÉÖçÖíàóçà àáëãÖÑÇÄçàü

èË ÔÓ·‡Ì‰‡ Â ÔÓ‚Â‰ÂÌÓ ‰ËÂÍÚÌÓ ÒÂÍ‚ÂÌË‡ÌÂ Ì‡PSEN2 „ÂÌ‡. Ç ÂÍÁÓÌ 11, Â ÓÚÍËÚ‡ ÌÛÍÎÂÓÚË‰Ì‡ Á‡ÏflÌ‡g.12199í>ë, ‚Ó‰Â˘‡ ‰Ó ÔÓ„Â¯ÌÓÒÏËÒÎÂÌ‡Ú‡ ÏÛÚ‡ˆËflCys391Arg. åÛÚ‡ˆËflÚ‡ ÒÂ Ì‡ÏË‡ ‚ 391-Ë ÍÓ‰ÓÌ Ì‡ PSEN2 „ÂÌ‡. í‡ÁË ÏÛÚ‡ˆËfl ÌÂ Â ÓÚÍËÚ‡ ‚ Á‰‡‚Ëfl ·‡Ú Ì‡ Ô‡-ˆËÂÌÚ‡ Ë 200 ·˙Î„‡ÒÍË ÍÓÌÚÓÎÌË ËÌ‰‚Ë‰‡, ÍÓÂÚÓ Â‰ÓÔ˙ÎÌËÚÂÎÂÌ Ù‡ÍÚÓ Á‡ ‰ÓÍ‡Á‚‡ÌÂ Ì‡ Ô‡ÚÓ„ÂÌÌËfl È ı‡-‡ÍÚÂ.

éÅëöÜÑÄçÖ

èÂ‰ÒÚ‡‚flÏÂ ÒÔÓ‡‰Ë˜ÂÌ ÒÎÛ˜‡È Ì‡ ·ÓÎÂÒÚ Ì‡ ÄÎˆı‡È-ÏÂ Ò ‡ÌÌÓ Ì‡˜‡ÎÓ, ÔË˜ËÌÂÌ‡ ÓÚ ÌÓ‚‡Cys391Arg /PSEN2 ÏÛÚ‡ˆËfl. ç‡¯ËflÚ ÒÎÛ˜‡È ÔÂ‰ÒÚ‡‚-Îfl‚‡ ËÌÚÂÂÒ ‚ Ì‡ÒÓÍ‡ fl‰˙Í „ÂÌÂÚË˜ÂÌ ‰ÂÙÂÍÚ ÔË ÅÄ(PSÖN2 ÏÛÚ‡ˆËfl) Ò˙Ò ÒÔÓ‡‰Ë˜ÂÌ ı‡‡ÍÚÂ, ·‡‚Ì‡ ÔÓ„-ÂÒËfl Ì‡ ÍÓ„ÌËÚË‚ÌË Ì‡Û¯ÂÌËfl Ò ‰˙Î„Ó„Ó‰Ë¯ÌÓ ÔÓÚË-˜‡ÌÂ Í‡ÚÓ ÎÂÍÓ ÍÓ„ÌËÚË‚ÌÓ Ì‡Û¯ÂÌËÂ.

èË Ô‡ˆËÂÌÚ‡ ‰Ë‡„ÌÓÁ‡Ú‡ ÒÂ ÔÓÒÚ‡‚fl ÔË Ì‡ÎË˜ËÂ Ì‡ÎÂÍÓ ÍÓ„ÌËÚË‚ÌÓ Ì‡Û¯ÂÌËÂ. è‡ˆËÂÌÚ˙Ú ÔÓÍ‡Á‚‡ ·‡‚Ì‡ÔÓ„ÂÒËfl Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ Ò ÍÎËÌË˜Ì‡Ú‡ Í‡ÚËÌ‡ Ì‡ ÎÂ-ÍÓ ÍÓ„ÌËÚË‚ÌÓ Ì‡Û¯ÂÌËÂ 3 „Ó‰ËÌË ÔÂ‰Ë ‡Á‚ËÚËÂÚÓ Ì‡‰ÂÏÂÌÚÂÌ ÒËÌÓÏ. äÎËÌË˜Ì‡Ú‡ Í‡ÚËÌ‡ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ(ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÂÌ Ë ÔÓ‚Â‰ÂÌ˜ÂÒÍË ÔÓÙËÎ) ÌÂ ÒÂ ‡ÁÎË˜‡-‚‡ ÓÚ ÚËÔË˜Ì‡Ú‡ Í‡ÚËÌ‡ Ì‡ ÅÄ. ãËÚÂ‡ÚÛÌËÚÂ ‰‡ÌÌË(19) Ò˙Ó·˘‡‚‡Ú Á‡ ‰Â·˛Ú Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ ÔË PSEN2ÏÛÚ‡ˆËË ‰ÓË ÒÎÂ‰ 70 „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ. á‡ ÚÓ‚‡ Â ‚˙Á-ÏÓÊÌÓ Ï‡ÒÍË‡ÌÂ ÔÓfl‚‡Ú‡ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ ÔË ·‡˘‡Ú‡Ì‡ Ô‡ˆËÂÌÚ‡, ÍÓÈÚÓ Â ÔÓ˜ËÌ‡Î Ì‡ 72 „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ.

î‡ÏËÎËËÚÂ Ò PSÖN2 ÏÛÚ‡ˆËË ÔÓÍ‡Á‚‡Ú ÔÓ-¯ËÓÍË‚‡Ë‡ˆËË ‚˙‚ ‚˙Á‡ÒÚÚ‡ Ì‡ Ì‡˜‡ÎÓÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓÏÂÊ‰Û ÓÚ‰ÂÎÌËÚÂ ˜ÎÂÌÓ‚Â. ëÂ‰Ì‡Ú‡ ‚˙Á‡ÒÚ Ì‡ Ì‡˜‡ÎÓ-ÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ ÔË ÌÓÒËÚÂÎËÚÂ Ì‡ PSÖN2 Â 59±7 Ë ÂÔÓ-‚ËÒÓÍ‡ ÓÚÍÓÎÍÓÚÓ ÔË PSÖN1 Ë Äêê ÏÛÚ‡ˆËËÚÂ (12).

èË Ô‡ˆËÂÌÚ Ò ÚËÔË˜Ì‡ ÍÎËÌË˜Ì‡ Í‡ÚËÌ‡ Ì‡ ÅÄ Ë Ì‡-˜‡ÎÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ ÔÓ‰ 60 „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ, ÛÒÚÌÓ‚fl-‚‡ÌÂÚÓ Ì‡ ËÁ‚ÂÒÚÌ‡ Ô‡ÚÓ„ÂÌÌ‡ ÏÛÚ‡ˆËfl ‚ APP, PSEN1 ËPSEN2 „ÂÌËÚÂ ÔÓ‰ÒÍ‡Á‚‡ Ò „ÓÎflÏ‡ ‚ÂÓflÚÌÓÒÚ Ô‡ÚÓ„ÂÌÂ-ÚË˜Ì‡Ú‡ ËÏ ÓÎfl, ‚˙ÔÂÍË ˜Â Ò˙˘ÂÒÚ‚Û‚‡Ú ·ÂÌË„ÌÂÌËÁ‡ÏÂÌË Ì‡ ‡ÏËÌÓÍËÒÂÎËÌË, ÍÓËÚÓ ÌÂ ‚Ó‰flÚ ‰Ó Ì‡Û¯ÂÌ‡-Ú‡ ËÏ ÙÛÌÍˆËfl Ë ÌÂ ÒÂ ‡ÒÓˆËË‡Ú Ò Û‚ÂÎË˜ÂÌ ËÒÍ Á‡ ÔÓfl-‚‡ Ì‡ ÅÄ (14). á‡ ÔÓ-ÒË„ÛÌÓÚÓ ‰ÓÍ‡Á‚‡ÌÂ Ì‡ Ô‡ÚÓ„ÂÌÌ‡Ú‡ÙÛÌÍˆËfl Ì‡ ÌÓ‚‡ ÏÛÚ‡ˆËfl Ò‡ ÓÚ ÔÓÎÁ‡ ÌÂ‚ÓÔ‡ÚÓÎÓ„Ë˜ÌÓ-ÚÓ ËÁÒÎÂ‰‚‡ÌÂ Ì‡ ÏÓÁ˙Í‡ Á‡ ‚ÂËÙËˆË‡ÌÂ Ì‡ ‰Ë‡„ÌÓÁ‡Ú‡ÅÄ, ÔÓ-ÔÓ‰Ó·ÌË Ñçä ‡Ì‡ÎËÁË Ë Ò˙‚Ô‡‰‡ÌÂ Ì‡ ÛÒÚ‡ÌÓ‚Â-Ì‡Ú‡ ÏÛÚ‡ˆËfl ‚ ˜ÎÂÌÓ‚Â, ÍÓËÚÓ Ò‡ ‡Á‚ËÎË Á‡·ÓÎfl‚‡ÌÂÚÓËÎË ÎËÔÒ‡Ú‡ È ‚ ÔÓ-„ÓÎflÏ ·ÓÈ Á‰‡‚Ë ËÌ‰‚Ë‰Ë ÓÚ Ò˙˘‡-Ú‡ ÔÓÔÛÎ‡ˆËfl.

àÌÚÂÔÂÚ‡ˆËflÚ‡ Ì‡ ÚÂÁË ‰‡ÌÌË ÔÓÌflÍÓ„‡ ÒÂ ÛÒÎÓÊ-Ìfl‚‡ ÓÚ ÚÓ‚‡, ˜Â Ù‡ÏËÎËËÚÂ Ò‡ Ï‡ÎÍË ËÎË Ó‰ËÚÂÎËÚÂ Ò‡ÔÓ˜ËÌ‡ÎË ‚ ‡ÌÌ‡ ‚˙Á‡ÒÚ. á‡ÚÓ‚‡ ÔÂˆÂÌÍ‡ Á‡ Ô‡ÚÓ„ÂÌ-Ì‡Ú‡ ÙÛÌÍˆËfl Ì‡ ÌÓ‚‡ ÏÛÚ‡ˆËfl ÔË Â‰ËÌÒÚ‚ÂÌ Á‡ÒÂ„Ì‡Ú˜ÎÂÌ ÓÚ ÒÂÏÂÈÒÚ‚ÓÚÓ ÒÂ ‚ÎËflÂ Ë ÓÚ ‰ÓÔ˙ÎÌËÚÂÎÌË Ù‡Í-ÚÓË Í‡ÚÓ ‚˙Á‡ÒÚÚ‡ Ì‡ Ô˙‚ËÚÂ ÒËÏÔÚÓÏË (9).

ç‡È-˜ÂÒÚÓ ÅÄ Ò ÛÒÚ‡ÌÓ‚ÂÌ „ÂÌÂÚË˜ÂÌ ‰ÂÙÂÍÚ ËÏ‡ ÚË-ÔË˜ÂÌ Á‡ ·ÓÎÂÒÚÚ‡ ÍÎËÌË˜ÂÌ ÙÂÌÓÚËÔ. Ç˙ÔÂÍË ÚÓ‚‡, ÔÓ-ÌflÍÓ„‡ ÓÔÂ‰ÂÎÂÌ‡ ÏÛÚ‡ˆËfl ‚Ó‰Ë ‰Ó ÁÌ‡˜ËÚÂÎÌË ‚‡Ë‡ˆËË‚˙‚ ÙÂÌÓÚËÔ‡ - ‡ÁÎËÍË ‚ Ì‡˜‡ÎÓÚÓ, ÚÂÊÂÒÚÚ‡ Ë ÍÎËÌË˜-Ì‡Ú‡ Í‡ÚËÌ‡ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ. ç‡·Î˛‰‡‚‡Ú ÒÂ Ë ÁÌ‡˜Ë-ÚÂÎÌË ÏÂÊ‰ÛÙ‡ÏËÎÌË ‚‡Ë‡ˆËË (15). çflÍÓË ÓÚ ÓÔËÒ‡ÌË-ÚÂ ‚ ÎËÚÂ‡ÚÛ‡Ú‡ (13, 17) ÙÂÌÓÚËÔË Ì‡ Ô‡ˆËÂÌÚË Ò ÅÄË PSEN2 ÏÛÚ‡ˆËË, ÒÂ ı‡‡ÍÚÂËÁË‡Ú Ò˙˘Ó Ò ‰˙Î„Ó„Ó-‰Ë¯Ì‡ ÔÓ„ÂÒËfl Ë ÍÎËÌË˜Ì‡ Í‡ÚËÌ‡ Ì‡ ãäç ÌflÍÓÎÍÓ „Ó-‰ËÌË ÔÂ‰Ë ‡Á‚ËÚËÂÚÓ Ì‡ ‰ÂÏÂÌÚÂÌ ÒËÌ‰ÓÏ. ÇÌËÏ‡ÌËÂÁ‡ÒÎÛÊ‡‚‡ Ë ÍÓÂÎ‡ˆËflÚ‡ Ì‡ÏÂÂÌ‡ ÏÂÊ‰Û ÔÓÁËˆËflÚ‡ Ì‡ÏÛÚ‡ˆËËÚÂ ‚ PSEN „ÂÌËÚÂ Ë Ì‡ÎË˜ËÂÚÓ Ì‡ ‡ÏËÎÓË‰Ì‡


‡Ì„ËÓÔ‡ÚËfl ‚ ÏÓÁ˙˜ÌËÚÂ Ò˙‰Ó‚Â, ‚Ó‰Â˘‡ ‰Ó ÎÂÁËË ‚ ÔÓ‰-ÍÓÓ‚ÓÚÓ ·flÎÓ ÏÓÁ˙˜ÌÓ ‚Â˘ÂÒÚ‚Ó. í‡ÁË ÌÂ‚ÓÔ‡ÚÓÎÓ„Ë˜-Ì‡ Ì‡ıÓ‰Í‡ Â ÛÒÚ‡ÌÓ‚ÂÌ‡ ÔË Ô‡ˆËÂÌÚË Ò PSEN1 ÏÛÚ‡ˆËËÒÎÂ‰ ÍÓ‰ÓÌ 200 (12). ÄÏËÎÓË‰Ì‡ ‡Ì„ËÓÔ‡ÚËfl Ò ÏÓÁ˙˜Ì‡ ıÂ-ÏÓ‡„Ëfl Â Ì‡ÏÂÂÌ‡ Ò˙˘Ó Ë ÔË ÌflÍÓË ÒÂÏÂÈÒÚ‚‡ ÓÚÇÓÎÊÍÓ-ÉÂÏ‡ÌÒÍ‡ „ÛÔ‡ Ò PSEN2 ÏÛÚ‡ˆËfl (16).

åÛÚ‡ˆËËÚÂ ‚ PSEN2 „ÂÌ‡ Ò‡ fl‰ÍÓ ÛÒÚ‡ÌÓ‚fl‚‡ÌË „Â-ÌÂÚË˜ÌË ‰ÂÙÂÍÚË. è˙‚‡Ú‡ ÏÛÚ‡ˆËfl Â ÛÒÚ‡ÌÓ‚ÂÌ‡ ÔË„ÓÎflÏ‡ „ÛÔ‡ Ù‡ÏËÎËË Ò ‡ÁÎË˜Ì‡ ÍÛÎÚÛ‡ Ë ÂÚÌË˜ÂÒÍËÔÓËÁıÓ‰. ëÎÂ‰ ÚÓ‚‡ Ò‡ ÓÔËÒ‡ÌË Ò‡ÏÓ ÌflÍÓÎÍÓ Ú‡ÍË‚‡ ÏÛ-Ú‡ˆËË (2, 5, 6, 10, 13). çflÍÓË Ù‡ÏËÎËË ÔÓÍ‡Á‚‡Ú „ÓÎflÏ‡‚‡Ë‡ˆËfl ‚˙‚ ‚˙Á‡ÒÚÚ‡ Ì‡ Ì‡˜‡ÎÓÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ Ë‰ÓË Ò‡ ÓÔËÒ‡ÌË ÌflÍÓË ÒÎÛ˜‡Ë Ì‡ ÌÂÔ˙ÎÌ‡ ÔÂÌÂÚ‡ÌÚÌÓÒÚ(6, 1, 4). éÔËÒ‡ÌËÚÂ ‚‡Ë‡ˆËË ‚˙‚ ‚˙Á‡ÒÚÚ‡ Ì‡ Ì‡˜‡ÎÓ-ÚÓ Ò ÓÍÓÎÓ 20 „Ó‰ËÌË ‚ ‡ÁÎË˜ÌËÚÂ ˜ÎÂÌÓ‚Â Ì‡ Â‰Ì‡ Ù‡ÏË-ÎËfl ÔÓÍ‡Á‚‡Ú ‚‡Ë‡ˆËË ‚˙‚ ÙÂÌÓÚËÔ‡. íÓÁË Ù‡ÍÚ, ‚ Ò˙˜Â-Ú‡ÌËÂ Ò ÓÔËÒ‡ÌËÚÂ ‰Û„Ë ÒÔÓ‡‰Ë˜ÌË ÒÎÛ˜‡Ë Ì‡ PSÖN ÏÛ-Ú‡ˆËËÚÂ, Â ‚‡ÊÂÌ ÔË ‡Á‡·ÓÚ‚‡ÌÂ Ì‡ ËÌ‰ËÍ‡ˆËË Á‡ „Â-ÌÂÚË˜ÌÓ ÚÂÒÚÛ‚‡ÌÂ, „ÂÌÂÚË˜ÌÓÚÓ ÍÓÌÒÛÎÚË‡ÌÂ Ë ‡Á-‚ËÚËÂÚÓ Ì‡ ÒÚ‡ÚÂ„ËË Á‡ Á‡·‡‚flÌÂ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ ÔËÚÂÁË Ô‡ˆËÂÌÚË. (4)

Ç Á‡ÍÎ˛˜ÂÌËÂ, ÓÔËÒ‚‡ÏÂ ÌÓ‚‡ Cys391Arg / PSEN2 ÏÛ-Ú‡ˆËfl ÔË ÒÔÓ‡‰Ë˜Ì‡ ·ÓÎÂÒÚ Ì‡ ÄÎˆı‡ÈÏÂ Ò ‡ÌÌÓ Ì‡-˜‡ÎÓ. íÓ‚‡ Â ‰ÂÒÂÚ‡Ú‡ ÏÛÚ‡ˆËfl ‚ Ò‚ÂÚ‡ Ë Ô˙‚‡ ‚ Å˙Î„‡-Ëfl ÛÒÚ‡ÌÓ‚ÂÌ‡ ‚˙ıÛ PSEN2 „ÂÌ‡. äÎËÌË˜ÌÓ ÙÂÌÓÚËÔ˙ÚÒÂ ı‡‡ÍÚÂËÁË‡ Ò Ì‡˜‡ÎÓ Ì‡ 54 „Ó‰ËÌË Ë ÍÎËÌË˜Ì‡ Í‡-ÚËÌ‡ Ì‡ ÎÂÍÓ ÍÓ„ÌËÚË‚ÌÓ Ì‡Û¯ÂÌËÂ 3 „Ó‰ËÌË ÔÂ‰Ë ‡Á-‚ËÚËÂÚÓ Ì‡ ‰ÂÏÂÌÚÂÌ ÒËÌ‰ÓÏ, ÍÓÂÚÓ ÔÂ‰ÔÓÎ‡„‡ ÔÓ-·‡‚Ì‡ ÔÓ„ÂÒËfl Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ. çflÍÓË ÓÚ ÓÔËÒ‡ÌËÚÂ ‚ÎËÚÂ‡ÚÛ‡Ú‡ ÙÂÌÓÚËÔË Ì‡ Ô‡ˆËÂÌÚË Ò ÅÄ Ë PSEN2 ÏÛ-Ú‡ˆËË, ÒÂ ı‡‡ÍÚÂËÁË‡Ú Ò˙˘Ó Ò ‰˙Î„Ó„Ó‰Ë¯Ì‡ ÔÓ„Â-ÒËfl Ë ÔÓ-Í˙ÒÌÓ Ì‡˜‡ÎÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ, ‚ Ò‡‚ÌÂÌËÂ Ò ÏÛ-Ú‡ˆËË ‚ PSÖN1 Ë Äêê.

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mosome-1 related familial Alzheimer's disease. Ann Neurol., 1996, 40, 932-936.

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4. Ezquerra, M., Lleo, A.,Castellvi, M., Queralt, R., Santacruz, P.,Pastor, P.,Molinuevo, J.L., Blesa, R., Oliva, R. A Novel Mutation in the PSEN2 Gene(T430M) Associated With Variable Expression in a Family With Early-OnsetAlzheimer Disease. Arch Neurol., 60, 2003, 8, 1149-1151.

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19. Tedde, A., Nacmias, B., Ciantelli, M., Forleo, P., Cellini, E., Bagnoli, S.,Piccini, C., Caffarra, P., Ghidoni, E., Paganini, M., Bracco, L., Sorbi, S.Identification of New Presenilin Gene Mutations in Early-Onset FamilialAlzheimer Disease. Arch Neurol, 60, 2003, 1149-1151.

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● Quality of Life in Neuromuscular Disease ●New Directions in Assessment of Nerve and

Muscle Function. èÓ ‚ÂÏÂÚÓ Ì‡ ‚ÒÂÍË ÍÛÒ ÒÂ ËÁÌ‡Òflı‡ ÓÚ ˜Â-

ÚËË ‰Ó ÔÂÚ ÎÂÍˆËË. ÇÒÂÍË ÍÛÒ Á‡‚˙¯‚‡¯Â ÒÚÂÒÚ, ÔË ÍÓÈÚÓ ÍÛÒËÒÚËÚÂ ÔÓÎÛ˜‡‚‡ı‡ ÍÂ-‰ËÚÌË ÚÓ˜ÍË (3.5 CME).

èé ÇêÖåÖ çÄ äéçÉêÖëÄ ëÖ èêéÇÖÑéïÄÉéãüå Åêéâ êÄÅéíçà ëêÖôà

(WORKSHOPS). Ç çüäéà éí íüï ÅüïÄ áÄ-ëÖÉçÄíà Çöêèéëà

èé ëãÖÑçàíÖ íÖåà:

SFEMG Basics, SFEMG Advanced, EMG NeedleBasics; Magnetic Stimulation; Repetitive NerveStimulation Ë ‰. ì˜‡ÒÚËÂÚÓ ‚˙‚ ‚ÒÂÍË WorkshopÌÓÒÂ¯Â ÔÓ 1.75 ÍÂ‰ËÚÌË ÚÓ˜ÍË.

Ç ÔÓÒÚÂÌ‡Ú‡ ÒÂÒËfl Ì‡ ÍÓÌ„ÂÒ‡ ÔÂ‰ÒÚ‡‚Ëı‰ÓÍÎ‡‰ Ì‡ ÚÂÏ‡: ◊Ö‰ËÌË˜ÌË Ë ÏÌÓ„ÓÍ‡ÚÌË Ä-‚˙ÎÌË ÔË Ô‡ˆËÂÌÚË Ò ‰Ë‡·ÂÚÌ‡ ÔÓÎÂÌÂ‚ÓÔ‡ÚËfl”ÓÚ ÍÓÎÂÍÚË‚ Alexandrov, A.S., Muradyan, N.,Daskalov, M. Ishpekova, B.A. ÇÒË˜ÍË ÔÂ‰ÒÚ‡‚ËÎËÔÓÒÚÂËÚÂ Ì‡ ‰‚ÂÚÂ ÔÓÒÚÂÌË ÒÂÒËË ÔÓÎÛ˜Ëı‡ ÔÓ1.75 ÍÂ‰ËÚÌË ÚÓ˜ÍË. åÌÓ„Ó ÓÚ Ì‡Ô‡‚ÂÌËÚÂÔÓÒÚÂË ·flı‡ ÒÔÓÌÒÓË‡ÌË ÓÚ ÄÄNÖå.

ÇÓ‰Â˘Ë ‚ ÚÂıÌÓÎÓ„Ë˜ÌÓ ÓÚÌÓ¯ÂÌËÂ ÙËÏË(GOLD, BRONZE, SILVER, VIASYS, XLTEK,CADWELL, WILEY Ë ‰.) Ó„‡ÌËÁË‡ı‡ ËÁÎÓÊ·‡Ì‡ ‡Ô‡‡ÚÛ‡ Ë Ì‡ Ì‡È-ÌÓ‚‡ ÎËÚÂ‡ÚÛ‡ ‚ Ó·Î‡-ÒÚÚ‡ Ì‡ ÖÖÉ Ë ÖåÉ.

ç‡Í‡fl ËÒÍ‡Ï ‰‡ ËÁÍ‡Ê‡ ·Î‡„Ó‰‡ÌÓÒÚÚ‡ ÒË Ì‡ÄÏÂËÍ‡ÌÒÍ‡Ú‡ ‡ÒÓˆË‡ˆËfl ÔÓ ÌÂ‚ÓÏÛÒÍÛÎÌ‡ ËÂÎÂÍÚÓ‰Ë‡„ÌÓÒÚË˜Ì‡ ÏÂ‰ËˆËÌ‡ Á‡ ÓÚÔÛÒÌ‡Ú‡Ú‡ÒÚËÔÂÌ‰Ëfl Ë ‚˙ÁÏÓÊÌÓÒÚÚ‡ Á‡ Û˜‡ÒÚËÂ ‚ 53-‡Ú‡„Ó‰Ë¯Ì‡ ÒÂ˘‡ ‚˙‚ Ç‡¯ËÌ„ÚÓÌ. ëÎÂ‰‚‡˘ËflÚÍÓÌ„ÂÒ Ì‡ AANEM ˘Â ÒÂ ÔÓ‚Â‰Â ÔÂÁ ÓÍÚÓÏ‚Ë2007„. ‚˙‚ îËÌËÍÒ, ÄËÁÓÌ‡. çflÍÓË ÓÚ Ï‡ÚÂË‡-ÎËÚÂ ÓÚ Ò˙ÒÚÓflÎËfl ÒÂ ÍÓÌ„ÂÒ ‚˙‚ Ç‡¯ËÌ„ÚÓÌ Ò‡Ì‡ ‡ÁÔÓÎÓÊÂÌËÂ ÔË ‡‚ÚÓ‡.


àÌÙÓÏ‡ˆËË Ë ÂˆÂÌÁËË53 ÉéÑàòçÄ çÄìóçÄ ëêÖôÄ çÄ ÄåÖêàäÄçëäÄíÄ

ÄëéñàÄñàü èé çÖÇêéåìëäìãçÄ à ÖãÖäíêéÑàÄÉçéëíàóçÄ åÖÑàñàçÄ (AANEM) ÇöÇ

ÇÄòàçÉíéçÄÎÂÍÒ‡Ì‰˙ ë‚. ÄÎÂÍÒ‡Ì‰Ó‚

àÌÒÚËÚÛÚ ÔÓ ÅËÓÙËÁËÍ‡, Å˙Î„‡ÒÍ‡ ÄÍ‡‰ÂÏËfl Ì‡ ç‡ÛÍËÚÂÖ mail: [email protected] or [email protected]

èÓÙ.‰- ÇÂÎË˜ÍÓ ç‡È‰ÂÌÓ‚ ó‡ÎÏ‡ÌÓ‚, ‰ÏÌ(01.05.1932 - 12.02.2007)

èÓÙ. ‰- ÇÂÎË˜ÍÓ ó‡ÎÏ‡ÌÓ‚ Â Ó‰ÂÌ Ì‡ 01.05.1932„.‚ Ò. Ñ‡„‡Ì‡, ãÓ‚Â¯ÍÓ. Ç Ó‰ÌÓÚÓ ÒË ÒÂÎÓ ÚÓÈÔÓÎÛ˜‡‚‡ ÓÒÌÓ‚ÌÓ Ë ÔÓ„ËÏÌ‡ÁË‡ÎÌÓ Ó·‡ÁÓ‚‡ÌËÂ, ‡ „ËÏÌ‡ÁË‡ÎÌÓ – ‚ „.ü·Î‡ÌËˆ‡. é˘Â Í‡„Ó Û˜ÂÌËÍÔÓÍ‡Á‚‡ ‚ËÒÓÍË ‰Ó·Ó‰ÂÚÂÎË: ÚÛ‰ÓÎ˛·ËÂ, ˜Û‚ÒÚ‚Ó Á‡ ÓÚ„Ó‚ÓÌÓÒÚ Í˙Ï ÓÍÓÎÌËÚÂ Ë Í˙Ï ÒÂ·Â ÒË ÒÓ„ÎÂ‰ Ì‡ ‚ËÒÓÍËÚÂ ˆÂÎË, ÍÓËÚÓ ÒË ÔÓÒÚ‡‚fl. ê‡·ÓÚË Í‡ÚÓ ÂÎÂÍÚÓÚÂıÌËÍ Ë Û˜‡ÒÚ‚‡ ‡ÍÚË‚ÌÓ ‚ÂÎÂÍÚËÙËÍ‡ˆËflÚ‡ Ì‡ Ó‰ÌÓÚÓ ÒË ÒÂÎÓ.

èÂÁ 1962„. Á‡‚˙¯‚‡ ‚ åÂ‰ËˆËÌÒÍËfl Ù‡ÍÛÎÚÂÚ Ì‡ Çåà ëÓÙËfl Ò ÓÚÎË˜ÂÌ ÛÒÔÂı. Ç ÒÚÛ‰ÂÌÚÒÍËÚÂÒË „Ó‰ËÌË Á‡Â‰ÌÓ Ò ÛÒ˙‰ËÂÚÓ Á‡ ÛÒ‚Ófl‚‡ÌÂ Ì‡ ÁÌ‡ÌËfl, ÚÓÈ ÒÂ ÚÛ‰Ë Ë Á‡ ËÁ‰˙ÊÍ‡Ú‡ ÒË. ÅËÎ Â‰ÂÏÓÌÒÚ‡ÚÓ ÔÓ ‡Ì‡ÚÓÏËfl, ‡ ÔÂÁ ÔÓÒÎÂ‰ÌËÚÂ „Ó‰ËÌË ÓÚ ÒÎÂ‰‚‡ÌÂÚÓ ÒË ‡·ÓÚË ‚ äÎËÌËÍ‡Ú‡ ÔÓ„‡ÒÚÓÂÌÚÂÓÎÓ„Ëfl ÔË ‰Óˆ. ÄÚ‡Ì‡Ò å‡ÎÂÂ‚. ëÎÂ‰ ‰ËÔÎÓÏË‡ÌÂÚÓ ÒË Á‡ÔÓ˜‚‡ ‡·ÓÚ‡ ÔÓ‡ÁÔÂ‰ÂÎÂÌËÂ ‚ Ò. ëÚ‡‚ÂˆË, èÎÂ‚ÂÌÒÍÓ.

ÇÒÂÓÚ‰‡ÈÌÓÒÚÚ‡, ÒÂ·ÂÓÚËˆ‡ÌËÂÚÓ, Ò ÍÓÂÚÓ ÒÂ ÔÓ‰„ÓÚ‚fl Á‡ ·˙‰Â˘‡Ú‡ ÔÓÙÂÒËfl ÌÂ ÓÒÚ‡‚‡ÚÌÂÁ‡·ÂÎflÁ‡ÌË Ë Ó˘Â ÔË Á‡‚˙¯‚‡ÌÂ Ì‡ ‚ËÒ¯ÂÚÓ ÒË Ó·‡ÁÓ‚‡ÌËÂ Â ÔÓÍ‡ÌÂÌ ÓÚ ÔÓÙ. ä‡‰‡ÌÓ‚ ‰‡ ÓÒÚ‡ÌÂÌ‡ ‡·ÓÚ‡ ‚ ä‡ÚÂ‰‡Ú‡ ÔÓ ‡Ì‡ÚÓÏËfl. Ñ- ÇÂÎË˜ÍÓ ó‡ÎÏ‡ÌÓ‚ ÓÚÍÎÓÌfl‚‡ ÔÂ‰ÎÓÊÂÌËÂÚÓ, ‚˙ÔÂÍËÛ‰Ó‚ÎÂÚ‚ÓÂÌËÂÚÓ, ÍÓÂÚÓ ÚÓ ÔÂ‰ËÁ‚ËÍ‚‡ Í‡ÚÓ ÓˆÂÌÍ‡.

Ç Í‡fl Ì‡ ¯Â‰ÂÒÂÚÚÂ „Ó‰ËÌË ÒÎÂ‰ ÍÓÌÍÛÒ Á‡ÔÓ˜‚‡ ‡·ÓÚ‡ Í‡ÚÓ Ì‡Û˜ÂÌ Ò˙ÚÛ‰ÌËÍ ‚ àÌÒÚËÚÛÚ‡ÔÓ ‡ÌÚÓÔÓÎÓ„Ëfl Ì‡ ÅÄç, ‡ ‚ Ì‡˜‡ÎÓÚÓ Ì‡ ÒÂ‰ÂÏ‰ÂÒÂÚÚÂ Â ÔËÂÚ Á‡ Â‰Ó‚ÂÌ ‡ÒËÒÚÂÌÚ ÔÓ ÌÂ‚ÓÎÓ„Ëfl‚ çàçèç Í˙Ï åÄ, „. ëÓÙËfl. àÁ„‡Ê‰‡ÌÂÚÓ Ì‡ ÔÓÙ. ó‡ÎÏ‡ÌÓ‚ Í‡ÚÓ Û˜ÂÌ Ë ËÁÒÎÂ‰Ó‚‡ÚÂÎ ÔÓÔÓ·ÎÂÏËÚÂ Ì‡ Ô‡ÍËÌÒÓÌËÁÏ‡ ‚ Ì‡È-„ÓÎflÏ‡ ÒÚÂÔÂÌ ÒÂ ‰˙ÎÊË Ì‡ ÌÂ„Ó‚Ëfl Û˜ËÚÂÎ ÔÓ ÚÓ‚‡ ‚ÂÏÂ ÔÓÙ.É‡Ì˜Ó É‡ÌÂ‚. Ç Í‡fl Ì‡ ÒÂ‰ÂÏ‰ÂÒÂÚÚÂ „Ó‰ËÌË ÚÓÈ ÒÔÂˆË‡ÎËÁË‡ ÌÂ‚ÓÎÓ„Ëfl ‚ ÉÂÏ‡ÌËfl Í‡ÚÓÒÚËÔÂÌ‰Ë‡ÌÚ Ì‡ îÓÌ‰‡ˆËfl ◊ÄÎÂÍÒ‡Ì‰˙ ÙÓÌ ïÛÏ·ÓÎÚ”.

èÂÁ 1984„. ÔÓÙ. ó‡ÎÏ‡ÌÓ‚ Á‡˘ËÚ‡‚‡ Í‡Ì‰Ë‰‡ÚÒÍ‡ ‰ËÒÂÚ‡ˆËfl Ì‡ ÚÂÏ‡ ”ÖÔË‰ÂÏËÓÎÓ„Ëfl Ì‡Ô‡ÍËÌÒÓÌËÁÏ‡ ‚ „. ëÓÙËfl Ë ãÓ‚Â¯Í‡ Ó·Î‡ÒÚ”, ‡ ÔÂÁ 1993„. - ‰ÓÍÚÓÒÍ‡ ‰ËÒÂÚ‡ˆËfl Ì‡ ÚÂÏ‡ ”äÓÏÔÎÂÍÒÌÓ ÔÓÛ˜‚‡ÌÂ Ì‡ ÂÔË‰ÂÏËÓÎÓ„ËflÚ‡ Ì‡ Ô‡ÍËÌÒÓÌËÁÏ‡ ‚ Å˙Î„‡Ëfl”.


IN MEMORIAM

ç‡Û˜ÌÓÚÓ Ú‚Ó˜ÂÒÚ‚Ó Ì‡ ÔÓÙ.ÇÂÎË˜ÍÓ ó‡ÎÏ‡ÌÓ‚ Â ÓÚ‡ÁÂÌÓ ‚ ÏÌÓ„Ó 156 Ì‡Û˜ÌË Ò˙Ó·˘ÂÌËfl Ë 3ÏÓÌÓ„‡ÙËË ÔÓ ÔÓ·ÎÂÏËÚÂ Ì‡ ÂÔË‰ÂÏËÓÎÓ„ËflÚ‡ Ì‡ Ô‡ÍËÌÒÓÌËÁÏ‡. èÓÛ˜‚‡ÌËflÚ‡ ÏÛ Ì‡ Ú‡ÁË ÚÂÏ‡ËÏ‡Ú Ì‡È-„ÓÎflÏ ÔËÌÓÒÂÌ ı‡‡ÍÚÂ Ë ÏÛ ‰ÓÌ‡ÒflÚ ÏÂÊ‰ÛÌ‡Ó‰Ì‡ ËÁ‚ÂÒÚÌÓÒÚ Ë ÔËÁÌ‡ÌËÂ.

ä‡ÚÓ ÛÌË‚ÂÒËÚÂÚÒÍË ÔÂÔÓ‰‡‚‡ÚÂÎ ÔÓÙ. ó‡ÎÏ‡ÌÓ‚ ÒÂ ÔË‰˙Ê‡ Í˙Ï Ì‡È-ÔflÍÓ Ë flÒÌÓ ËÁÎ‡„‡ÌÂÌ‡ Ò˙˘ÌÓÒÚÚ‡ Ì‡ ÔÂÔÓ‰‡‚‡Ì‡Ú‡ Ï‡ÚÂËfl. ãÂÍˆËËÚÂ ÒË ËÁÌ‡Òfl Ì‡ ‰ÓÒÚ˙ÔÂÌ Á‡ ÒÎÛ¯‡ÚÂÎËÚÂ ÂÁËÍ,Í‡ÚÓ ·Ó„‡ÚÓ „Ë ÓÌ‡„ÎÂ‰fl‚‡ Ò ÔÂ‰ÒÚ‡‚flÌÂ Ì‡ ·ÓÎÌË.

èÓÙ. ó‡ÎÏ‡ÌÓ‚ Â ËÌËˆË‡ÚÓ Ì‡ Ò˙Á‰‡‚‡ÌÂÚÓ Ë ËÁ„‡Ê‰‡ÌÂÚÓ Ì‡ êÂÔÛ·ÎËÍ‡ÌÒÍË ÌÂ‚ÓÎÓ„Ë˜ÂÌ‰ËÒÔ‡ÌÒÂ Í˙Ï ä‡ÚÂ‰‡Ú‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl Ì‡ åì ëÓÙËfl. èÂÁ 1996„. ÚÓÈ ÓÒÌÓ‚‡‚‡ îÓÌ‰‡ˆËfl◊è‡ÍËÌÒÓÌËÁ˙Ï” Ë ÒÚ‡‚‡ ÌÂËÌ ‰˙Î„Ó„Ó‰Ë¯ÂÌ ÔÂ‰ÒÂ‰‡ÚÂÎ.

èÓÙ. ó‡ÎÏ‡ÌÓ‚ ÎË˜ÌÓ Ó„‡ÌËÁË‡ Ë ˙ÍÓ‚Ó‰Ë ÏÌÓÊÂÒÚ‚Ó ÒËÏÔÓÁËÛÏË Ë ÍÓÌÙÂÂÌˆËË ÔÓÔÓ·ÎÂÏËÚÂ Ì‡ è‡ÍËÌÒÓÌÓ‚‡Ú‡ ·ÓÎÂÒÚ, Û˜‡ÒÚ‚‡ Ë ‚ „ÓÎflÏ ·ÓÈ ÏÂÊ‰ÛÌ‡Ó‰ÌË ÍÓÌ„ÂÒË. íÓÈ Â ˜ÎÂÌÌ‡ û„Ó-ËÁÚÓ˜Ì‡Ú‡ Ö‚ÓÔÂÈÒÍ‡ ‡ÒÓˆË‡ˆËfl ÔÓ ÌÂ‚ÓÎÓ„Ëfl Ë Ì‡ Ö‚ÓÔÂÈÒÍ‡Ú‡ ÄÒÓˆË‡ˆËfl ÔÓè‡ÍËÌÒÓÌËÁ˙Ï ◊EPDTA”.

ä‡ÚÓ ˙ÍÓ‚Ó‰ËÚÂÎ Ì‡ êÂÔÛ·ÎËÍ‡ÌÒÍËfl ÌÂ‚ÓÎÓ„Ë˜ÂÌ ‰ËÒÔ‡ÌÒÂ ÔÓÙ. ó‡ÎÏ‡ÌÓ‚ ÔÓ‰„ÓÚ‚Ë ÏÌÓ„ÓÒÔÂˆË‡ÎËÒÚË ÌÂ‚ÓÎÓÁË, ‡ Ò˙˘Ó Ë Í‡Ì‰Ë‰‡ÚË Ì‡ ÏÂ‰ËˆËÌÒÍËÚÂ Ì‡ÛÍË ÔÓ ÌÂ‚ÓÎÓ„Ëfl. éÒÓ·ÂÌË „ËÊËÔÓÎ‡„‡ Ë Á‡ ÔÓ‰„ÓÚÓ‚Í‡Ú‡ Ë Í‚‡ÎËÙËÍ‡ˆËflÚ‡ Ì‡ ÏÎ‡‰ËÚÂ ÏÂ‰ËˆËÌÒÍË Í‡‰Ë.

ä‡ÍÚÓ ‚ Â‰Ëˆ‡ Ò‚ÓË ÔÛ·ÎËÍ‡ˆËË, Ú‡Í‡ Ë ÔÂ‰ ‰˙Ê‡‚ÌËÚÂ Ó„‡ÌË ‚ Á‰‡‚ÂÓÔ‡Á‚‡ÌÂÚÓ ÚÓË ÒÂÁ‡ÒÚ˙Ô‚‡ Á‡ ÔÓ‰Ó·fl‚‡ÌÂ Ì‡ ÌÂ‚ÓÎÓ„Ë˜Ì‡Ú‡ ÔÓÏÓ˘ ÔË Ô‡ÍËÌÒÓÌÓ‚Ó ·ÓÎÌËÚÂ, Á‡ ÚflıÌ‡Ú‡Âı‡·ËÎËÚ‡ˆËfl Ë ÂÒÓˆË‡ÎËÁ‡ˆËfl.

á‡ Ò‚ÓflÚ‡ ‚ÒÂÒÚ‡ÌÌ‡Ú‡ ÎÂÍ‡ÒÍ‡,ÔÂÔÓ‰‡‚‡ÚÂÎÒÍ‡,Ì‡Û˜ÌÓ-ËÁÒÎÂ‰Ó‚‡ÚÂÎÒÍ‡, Ì‡Û˜ÌÓ-Ó„‡ÌËÁ‡ˆËÓÌÌ‡ Ë Ó·˘ÂÒÚ‚ÂÌ‡ ‰ÂÈÌÓÒÚ ÔÓÙ.ÇÂÎË˜ÍÓ ó‡ÎÏ‡ÌÓ‚ Â Û‰ÓÒÚÓfl‚‡Ì Ò Â‰Ëˆ‡ÛÌË‚ÂÒËÚÂÚÒÍË Ì‡„‡‰Ë.

èÓÙÂÒÓ ÇÂÎË˜ÍÓ ç‡È‰ÂÌÓ‚ ó‡ÎÏ‡ÌÓ‚ ÓÒÚ‡‚‡ ‚ Ô‡ÏÂÚÚ‡ Ì‡ ·˙Î„‡ÒÍËÚÂ ÎÂÍ‡Ë ÌÂ‚ÓÎÓÁË Ò·Ó„‡ÚÓÚÓ ÒË Ì‡Û˜ÌÓ Ú‚Ó˜ÂÒÚ‚Ó, Ò Ó„‡ÌËÁ‡ÚÓÒÍËÚÂ ÒË ÔËÌÓÒË Ë Ò ÔËÏÂ‡ ÒË Ì‡ ÔÓÙÂÒËÓÌ‡ÎÌ‡‚ÒÂÓÚ‰‡ÈÌÓÒÚ.


1. éèêÖÑÖãÖçàÖ“ÑÂÚÒÍ‡ ˆÂÂ·‡ÎÌ‡ Ô‡‡ÎËÁ‡ (Ññè)” e „ÛÔ‡ ÓÚ

ÌÂÔÓ„ÂÒË‡˘Ë, ÌÓ ˜ÂÒÚÓ ÔÓÏÂÌfl˘Ë ÒÂ ÒËÌ‰ÓÏË

Ì‡ ÏÓÚÓÌÓ Û‚ÂÊ‰‡ÌÂ, ‚ ÂÁÛÎÚ‡Ú ÓÚ ÎÂÁËË ËÎË ‡ÌÓ-

Ï‡ÎËË Ì‡ ÏÓÁ˙Í‡, ‚˙ÁÌËÍ‚‡˘Ë ‚ ‡ÌÌËÚÂ ÂÚ‡ÔË ÓÚ

ÌÂ„Ó‚ÓÚÓ ‡Á‚ËÚËÂ (Mutch et al. 1992). éÒ‚ÂÌ ÏÓÚÓ-

ÌÓÚÓ ‡ÁÒÚÓÈÒÚ‚Ó, ‚˙ÁÏÓÊÌ‡ Â Û‚Â‰‡Ú‡ Ë Ì‡ ‰Û-

„Ë ÙÛÌÍˆËË Ò ÏÓÚÓÌË ÂÎÂÏÂÌÚË („Ó‚Ó, ı‡ÌÂÌÂ, ÙË-

Ì‡ ÏÓÚÓËÍ‡, Ó˜ÌË ‰‚ËÊÂÌËfl), ÒÂÌÁÓÌË, Ó·Û˜ËÚÂÎÌË

Ë ÍÓ„ÌËÚË‚ÌË ËÎË ÔÓ‚Â‰ÂÌ˜ÂÒÍË Ì‡Û¯ÂÌËfl, ‚ÍÎ˛˜‚‡-

˘Ë ‰ÂÙËˆËÚ Ì‡ ‚ÌËÏ‡ÌËÂÚÓ Ò ıËÔÂÍËÌÂÚË˜ÌÓ

‡ÁÒÚÓÈÒÚ‚Ó, ‰ÂÔÂÒËfl ËÎË ‡ÁÒÚÓÈÒÚ‚‡ ÓÚ ‡Û-

ÚËÒÚË˜ÌËfl ÒÔÂÍÚ˙. (M.Bax, J.K.Brown 2004).

2. óÖëíéíÄóÂÒÚÓÚ‡ Ì‡ Ññè ‚ Ö‚ÓÔ‡ Â 2,0 - 2,5/1000 ÌÓ‚Ó-

Ó‰ÂÌË ‰Âˆ‡. ç‡·Î˛‰‡‚‡ ÒÂ ÏÌÓ„Ó ÔÓ-˜ÂÒÚÓ ÔË ÒÎÂ‰-

ÌËÚÂ „ÛÔË ÌÓ‚ÓÓ‰ÂÌË Ò:

● çÂ‰ÓÌÓÒÂÌÓÒÚ. èË ‡Ê‰‡ÌÂ ÔÂ‰Ë 33 „ÂÒÚ‡ˆË-

ÓÌÌ‡ ÒÂ‰ÏËˆ‡ („.Ò.) Ññè Â 30 Ô˙ÚË ÔÓ-˜ÂÒÚ‡

(Kuban, Levington 1994), Í‡ÚÓ 24,8œ Ò‡ Ò Ññè

(West Australian Cerebral Palsy Register 1986-

1992).

● çÂÁflÎÓÒÚ (Small for gestational age). éÚ Ó‰Â-

ÌËÚÂ Ò ÚÂ„ÎÓ < 1500 g – 60-80œ Ò‡ Ññè (Stanley

et al. 1997, Escobar et al 1991)

● ÄÒÙËÍÒËfl: èË ÌËÒÍË ÒÚÓÈÌÓÒÚË Ì‡ ÄÔ„‡, ÌÂÓ-

Ì‡Ú‡ÎÌË ÒËÌ‰ÓÏË Ë ÌÂÓÌ‡Ú‡ÎÌË „˙˜Ó‚Â: Ññè

ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡ ÔË 1.3 - 545.5œ (Ellenberg,

Nelson 1988)

● åÓÁ˙˜ÂÌ Í˙‚ÓËÁÎË‚ Ë/ËÎË ÔÂË‚ÂÌÚËÍÛÎÌ‡ÎÂ‚ÍÓÏ‡Î‡ˆËfl. éÚ Ó‰ÂÌËÚÂ Ò ÏÓÁ˙˜ÂÌ Í˙‚ÓËÁ-

ÎË‚ 50-100œ – 48% Ò‡ Ò Ññè (Leviton 1993); 80-

100% ÓÚ ‰Âˆ‡Ú‡ Ò ÔÂË‚ÂÌÚËÍÛÎÌ‡ ÎÂ‚ÍÓÏ‡-Î‡ˆËfl (PVL) Ò‡ Ò Ññè (Leviton,Paneth 1990)

● åÌÓ„ÓÔÎÓ‰Ì‡ ·ÂÏÂÌÌÓÒÚ. Ññè Â 2.44 - 7.23

Ô˙ÚË ÔÓ-˜ÂÒÚ‡ ÔË ·ÎËÁÌ‡ˆË (Pharoah and Cooke

1996) Ë 47.4 – 52.6 Ô˙ÚË ÔÓ-˜ÂÒÚ‡ ÔË ÚËÁÌ‡ˆË

(Pharoah and Cooke 1996).

3. ÖíàéãéÉàüéÒÌÓ‚ÌËÚÂ ÔË˜ËÌË Á‡ Ññè ÒÂ „ÛÔË‡Ú ÔÓ ‚ÂÏÂ

Ì‡ ËÁfl‚‡ Í‡ÚÓ:

èÂÌ‡Ú‡ÎÌË Ù‡ÍÚÓË – „ÂÌÂÚË˜ÌË, ÙËÁË˜ÂÒÍË,

ıËÏË˜ÂÒÍË Ë ËÌÙÂÍˆËÓÁÌË, ÍÓËÚÓ Ó·ÛÒÎfl‚flÚ ‡ÁÎË˜ÌË

ÏÓÁ˙˜ÌË Ï‡ÎÙÓÏ‡ˆËË ËÎË ‚Ó‰ÂÌË ÂÌˆÂÙ‡ÎËÚË

(Òytomegalovirus, herpes simplex virus, rubeÓçlla, toxo-

plasma) ÔË˜ËÌfl‚‡Ú ÓÍÓÎÓ 30% ÓÚ Ññè.

èÂËÌ‡Ú‡ÎÌË Ù‡ÍÚÓË – Ó‰Ó‚‡Ú‡ ‡ÒÙËÍÒËfl, ıË-

ÔÓÍÒË˜ÌÓ - ËÒıÂÏË˜Ì‡Ú‡ ÂÌˆÂÙ‡ÎÓÔ‡ÚËfl (ïàÖ),

ÏÓÁ˙˜ÌËÚÂ Í˙‚ÓËÁÎË‚Ë Ë Ú‡‚ÏË Ó·ÛÒÎ‡‚flÚ ÓÒÌÓ‚-

Ì‡Ú‡ ˜‡ÒÚ ÓÚ Ññè (60%). áÌ‡˜ËÚÂÎÌÓ ÔÓ - ‡ÌËÏË Ò‡

ÌÂ‰ÓÌÓÒÂÌËÚÂ ÌÓ‚ÓÓ‰ÂÌË, ÓÒÓ·ÂÌÓ ÚÂÁË Ò ÚÂ„ÎÓ ÔÓ‰

1500 „. - ÓÍÓÎÓ 40% ÓÚ Úflı ‡Á‚Ë‚‡Ú Ññè.

èÓÒÚ‡Ì‡Ú‡ÎÌË Ù‡ÍÚÓË – ÂÌˆÂÙ‡ÎËÚË, ÏÂÌËÌ„Ë-

ÚË, ‰Ëı‡ÚÂÎÌ‡ ÌÂ‰ÓÒÚ‡Ú˙˜ÌÓÒÚ, ‰ÂıË‰‡Ú‡ˆËfl, ˜Â-

ÂÔÌÓ-ÏÓÁ˙˜ÌË Ú‡‚ÏË, Rh ÌÂÒ˙‚ÏÂÒÚËÏÓÒÚ Ë ÚÂÊ-

Í‡ ·ËÎËÛ·ËÌÂÏËfl ‚ ÌÂÓÌ‡Ú‡ÎÌËfl ÔÂËÓ‰ Ó·ÛÒÎ‡‚flÚ

ÓÍÓÎÓ 10% ÓÚ ÒÎÛ˜‡ËÚÂ Ì‡ Ññè (M.Bax, J.K.Brown

2004).


ÑàÄÉçéëíàäÄ,

êÖïÄÅàãàíÄñàü, ãÖóÖçàÖ

à ÄÑåàçàëíêàêÄçÖ

çÄ ÑÖñÄ

ë ñÖêÖÅêÄãçÄ èÄêÄãàáÄ

äéçëÖçëìë

àÁ„ÓÚ‚ËÎË Ç. ÅÓÊËÌÓ‚‡1, à. ó‡‚‰‡Ó‚2

1ÑÂÚÒÍ‡ ÌÂ‚ÓÎÓ„Ë˜Ì‡ ÍÎËÌËÍ‡, ìëÅÄãçè ◊ë‚. ç‡ÛÏ” – ëÓÙËfl2ëÔÂˆË‡ÎËÁË‡Ì‡ ÅÓÎÌËˆ‡ Á‡ ÑÓÎÂÍÛ‚‡ÌÂ, èÓ‰˙ÎÊËÚÂÎÌÓ ãÂ˜ÂÌËÂ Ë êÂı‡·ËÎËÚ‡ˆËfl Ì‡ ÑÂˆ‡ ñÂÂ·‡ÎÌ‡ è‡‡ÎËÁ‡

“ë‚.ëÓÙËfl” – ëÓÙËfl

ç‡È- Ò˙˘ÂÒÚ‚ÂÌ‡ Á‡ ‚˙ÁÌËÍ‚‡ÌÂÚÓ Ì‡ Ññè Â ÚÂÊ-

Í‡Ú‡ ‡ÒÙËÍÒËfl. Ç ÏÌÓ„Ó ÒÎÛ˜‡Ë ÔË Ññè ÌÂ ÒÂ ËÁflÒÌfl-

‚‡Ú ÔË˜ËÌËÚÂ. èÂ‰ÔÓÎ‡„‡ ÒÂ, ˜Â Úfl Â ÂÁÛÎÚ‡Ú ÓÚ

fl‚ÌË Â‰ËÌË˜ÌË ÔË˜ËÌË, ÌÓ ÔÓ-˜ÂÒÚÓ Ô‡ÚÓ„ÂÌÂÁ‡Ú‡ Â

ÍÓÏÔÎÂÍÒÌ‡. (Nelson 1986, Blair and Stanley 1993,

Myers 1972, Williams 1993).

4. ÑàÄÉçéëíàñàêÄçÖ çÄ Ññè● åËÌËÏ‡ÎÌ‡ ‚˙Á‡ÒÚ Á‡ ÔÓÒÚ‡‚flÌÂ Ì‡ ‰Ë‡„ÌÓ-

Á‡Ú‡ Ññè Â ÒÎÂ‰ 18-ÚËfl ÏÂÒÂˆ.

● ÑË‡„ÌÓÁ‡Ú‡ ◊ëÔÂˆËÙË˜ÌÓ ‡ÁÒÚÓÈÒÚ‚Ó ‚‡Á‚ËÚËÂÚÓ Ì‡ ‰‚Ë„‡ÚÂÎÌËÚÂ ÙÛÌÍˆËË” ÒÂÔÓÒÚ‡‚fl ‰Ó 18 ÏÂÒÂ˜Ì‡ ‚˙Á‡ÒÚ ÔË ÓÔÂ‰ÂÎÂ-ÌË ÍÎËÌË˜ÌË ·ÂÎÂÁË, ÔË ÌÂÓ·ıÓ‰ËÏÓÒÚ ÔÓ‰Í-ÂÔÂÌË Ë ÓÚ Ó·‡ÁÌË ËÁÒÎÂ‰‚‡ÌËfl. ÑË‡„ÌÓÁ‡Ú‡◊ëÔÂˆËÙË˜ÌÓ ‡ÁÒÚÓÈÒÚ‚Ó ‚ ‡Á‚ËÚËÂÚÓ Ì‡‰‚Ë„‡ÚÂÎÌËÚÂ ÙÛÌÍˆËË “ (ëêêÑî) Ò ÍÓ‰ F82ÔÓ åäÅ 10 ÒÂ ÔÓ‰ÍÂÔfl Ò ÚÂÏËÌ‡ «ñÂÌÚ‡ÎÌÓÍÓÓ‰ËÌ‡ˆËÓÌÌÓ ÒÏÛ˘ÂÌËÂ (ñäë) Ò˙Ò ÒÚÂÔÂÌ(ÏÌÓ„Ó ÎÂÍ‡, ÎÂÍ‡, ÒÂ‰Ì‡ Ë ÚÂÊÍ‡) Ë Á‡ÔÎ‡¯Â-ÌÓÒÚ (ÒÔ‡ÒÚË˜Ì‡, ‰ËÒÚÓÌË˜Ì‡, ıËÔÓÚÓÌË˜Ì‡,‡ÒËÏÂÚË˜ÌÓ ‡ÁÔÂ‰ÂÎÂÌËÂ Ì‡ ÏÛÒÍÛÎÌËflÚÓÌÛÒ, ıÓÏÓ„ÂÌÌÓ ‰‚Ë„‡ÚÂÎÌÓ ËÁÓÒÚ‡‚‡ÌÂ)».

èÓÒÚ‡‚fl ÒÂ ÔË ‰Âˆ‡ ÓÚ ËÒÍÓ‚ËÚÂ „ÛÔË (ÌÂ‰Ó-

ÌÓÒÂÌË, ÌÂÁÂÎË, ÒÎÂ‰ ‡ÒÙËÍÒËfl, ÒÎÂ‰ ÏÓÁ˙˜ÂÌ Í˙-

‚ÓËÁÎË‚, ·ÎËÁÌ‡ˆË) ÔË Ì‡ÎË˜ËÂ Ì‡ ‰‚Ë„‡ÚÂÎÌÓ

ËÁÓÒÚ‡‚‡ÌÂ, ÓÚÍÎÓÌÂÌËfl ‚ ÔÓÁËˆËÓÌÌ‡Ú‡ Â‡Í-

ÚË‚ÌÓÒÚ, ÔÂÒËÒÚË‡ÌÂ Ì‡ ÔËÏËÚË‚ÌË ÂÙÎÂÍ-

ÒË Ë Ì‡Û¯ÂÌ‡ ÍÓÓ‰ËÌ‡ˆËfl Ì‡ ‰‚ËÊÂÌËflÚ‡,

ÔÓ‰ÍÂÔÂÌË ËÎË ÌÂ ÓÚ ÂÁÛÎÚ‡ÚËÚÂ Ì‡ Ó·‡ÁÌ‡-

Ú‡ ‰Ë‡„ÌÓÒÚËÍ‡. ÑË‡„ÌÓÁ‡Ú‡ Â ÔÂıÓ‰Ì‡ Ë Ì‡ÒÓ˜-

‚‡ Í˙Ï ÓÔÂ‰ÂÎÂÌ‡ ÒÚÂÔÂÌ Ì‡ ËÒÍ Á‡ ‡Á‚ËÚËÂ Ì‡

Ññè Ë ÔÓ‰˜ÂÚ‡‚‡ ÌÂÓ·ıÓ‰ËÏÓÒÚÚ‡ ÓÚ ÔÓÒÎÂ-

‰fl‚‡ÌÂ Ë ‚ÍÎ˛˜‚‡ÌÂ Ì‡ ‡‰ÂÍ‚‡ÚÌ‡ Âı‡·ËÎËÚ‡-

ˆËfl Ë ÎÂ˜ÂÌËÂ ÔË ÌÂÓ·ıÓ‰ËÏÓÒÚ.

5. äãÄëàîàäÄñàü çÄ Ññè äÎ‡ÒËÙËˆË‡ÌÂÚÓ Ì‡ ‡ÁÎË˜ÌËÚÂ ÚËÔÓ‚Â ˆÂÂ·-

‡ÎÌ‡ Ô‡‡ÎËÁ‡ ÒÂ ·‡ÁË‡ Ì‡ ÍÎËÌË˜ÌÓÚÓ ÓÔËÒ‡ÌËÂ Ì‡

ÚËÔ‡, ÚÓÔÓ„‡ÙËflÚ‡ Ë ÚÂÊÂÒÚÚ‡ Ì‡ ÏÓÚÓÌËÚÂ Û‚-

ÂÊ‰‡ÌËfl (F.Stanley et all 2000).

èé äãàçàóçÄ äÄêíàçÄ:

● ëÔ‡ÒÚË˜Ì‡

● ÑËÒÍËÌÂÚË˜Ì‡ (‡ÚÂÚÓË‰Ì‡)

● ÄÚ‡ÍÒË˜Ì‡/ıËÔÓÚÓÌË˜Ì‡

● ëÏÂÒÂÌË

ê‡ÁÎË˜ÌËÚÂ ÚËÔÓ‚Â Ì‡ ‰‚Ë„‡ÚÂÎÌË ‡ÁÒÚÓÈÒÚ‚‡

ÏÓ„‡Ú ‰‡ Ò˙˘ÂÒÚ‚Û‚‡Ú Ò˙‚ÏÂÒÚÌÓ. èÓ‚Â˜ÂÚÓ ÒÔÂ-

ˆË‡ÎËÒÚË ÍÎ‡ÒËÙËˆË‡Ú Ò˙„Î‡ÒÌÓ ‰ÓÏËÌË‡˘‡Ú‡

ÙÓÏ‡, ÌÓ Úfl ‚‡Ë‡ ‚˙‚ ‚ÂÏÂÚÓ ÔË ‚ÒÂÍË ÓÚ‰ÂÎÂÌ

ÒÎÛ˜‡È.

èé íéèéÉêÄîàü:

äÎ‡ÒËÙËÍ‡ˆËflÚ‡ ÔÓ ÚÓÔÓ„‡ÙËfl ÒÂ ÔËÎ‡„‡ Ì‡È-

ÏÌÓ„Ó ÔË ÒÔ‡ÒÚË˜ÌËfl ÚËÔ, Á‡˘ÓÚÓ Ó·ËÍÌÓ‚ÂÌÌÓ ÔË

‰Û„ËÚÂ ÙÓÏË Â ‚ÍÎ˛˜ÂÌÓ ˆflÎÓÚÓ ÚflÎÓ.

1. ä‚‡‰ËÔÎÂ„Ëfl – Í‚‡‰ËÔ‡ÂÚË˜ÌËflÚ ÒËÌ‰ÓÏ

Á‡Òfl„‡ ˜ÂÚËËÚÂ Í‡ÈÌËÍ‡, Í‡ÚÓ ˙ˆÂÚÂ Ò‡ Â‰Ì‡Í‚Ó

ËÎË ÔÓ‚Â˜Â Û‚Â‰ÂÌË ÓÚ Í‡Í‡Ú‡. ëËÌÓÌËÏË Ò‡ ÚÂÚ-

‡ÔÎÂ„ËflÚ‡ Ë ‰‚ÓÈÌ‡ ıÂÏËÔÎÂ„Ëfl.

2. ÑËÔÎÂ„Ëfl – Í‡Í‡Ú‡ Ò‡ ÔÓ-ÚÂÊÍÓ Û‚Â‰ÂÌË ÓÚ

˙ˆÂÚÂ. çflÍÓÈ ÍÎËÌËˆËÒÚË ‡Á„‡ÌË˜‡‚‡Ú Ô‡‡ÔÎÂ-„Ëfl (Ô‡‡Ô‡ÂÁ‡) ËÎË ‰ËÔÎÂ„Ëfl I, ÔË ÍÓËÚÓ ˙ˆÂÚÂ Ò‡

ÌÓÏ‡ÎÌË ËÎË ÏËÌËÏ‡ÎÌÓ Á‡ÒÂ„Ì‡ÚË, ÓÚ ‰ËÔÎÂ„Ëfl II,Í˙‰ÂÚÓ ˙ˆÂÚÂ Ò‡ ‚Ë‰ËÏÓ Á‡ÒÂ„Ì‡ÚË. Ç ÔÓ‚Â˜ÂÚÓ ÒÎÛ-

˜‡Ë ÚÂÁË ÒÛ·„ÛÔË ÒÂ ‚˙ÁÔËÂÏ‡Ú Á‡Â‰ÌÓ Í‡ÚÓ ‰ËÔÎÂ-

„Ëfl.

3. ïÂÏËÔÎÂ„Ëfl (ıÂÏËÔ‡ÂÁ‡)– ÎÂ‚ÓÒÚ‡ÌÌ‡ Ò˙Ò Á‡Òfl-

„‡ÌÂ Ì‡ Îfl‚‡Ú‡ ÒÚ‡Ì‡ Ì‡ ÚflÎÓÚÓ Ó·ËÍÌÓ‚ÂÌÌÓ Ò ÔÓ-

Û‚Â‰ÂÌ „ÓÂÌ Í‡ÈÌËÍ; ‰ÂÒÌÓÒÚ‡ÌÌ‡ – ÍÓflÚÓ Â ÔÓ-

˜ÂÒÚ‡ ÓÚ ÎÂ‚ÓÒÚ‡ÌÌ‡Ú‡.

èÓÌflÍÓ„‡ ÒÂ Ì‡·Î˛‰‡‚‡Ú Ë ÔÓ-Ï‡ÎÍ‡ ÒËÏÂÚË˜-

ÌÓÒÚ ‚ ‡ÁÔÂ‰ÂÎÂÌËÂÚÓ, ÍÓÂÚÓ ÔÓÁ‚ÓÎfl‚‡ ÔÓfl‚‡Ú‡

Ì‡ ÚÂÏËÌË, Í‡ÚÓ ÏÓÌÓÔÎÂ„Ëfl Ë ÚËÔÎÂ„Ëfl.

èé ÖíàéãéÉàü:

áÌ‡˜ËÚÂÎÌ‡ ˜‡ÒÚ ÓÚ ˆÂÂ·‡ÎÌ‡Ú‡ Ô‡‡ÎËÁ‡ ËÏ‡

ÏÛÎÚËÙ‡ÍÚÓÌ‡ ÂÚËÓÎÓ„Ëfl.

é„‡ÌË˜ÂÌ ·ÓÈ ÂÚËÓÎÓ„Ë˜ÌË Ù‡ÍÚÓË ÏÓ„‡Ú ‰‡

ÔË˜ËÌfl‚‡Ú ÒÔÂˆËÙË˜Ì‡ ÍÎËÌË˜Ì‡ Í‡ÚËÌ‡:

● èÂÌ‡Ú‡ÎÌËflÚ Ï‡È˜ËÌ ÈÓ‰ÂÌ ‰ÂÙËˆËÚ Ó·ÛÒÎ‡‚fl

ÒÔ‡ÒÚË˜Ì‡ ‰ËÔÎÂ„Ëfl Ò ÏÛÚËÁ˙Ï Ë ÚÂÊ˙Í ËÌÚÂ-

ÎÂÍÚÛ‡ÎÂÌ ‰ÂÙËˆËÚ.

● “Kern-icter” ÔÓ‡‰Ë Í˙‚ÌÓ„ÛÔÓ‚‡ ÌÂÒ˙‚ÏÂÒÚË-

ÏÓÒÚ ‚Ó‰Ë ‰Ó ıÓÂÓ‡ÚÂÚÓÁ‡.

● íÂÊÍ‡Ú‡ ÌÂ‰ÓÌÓÒÂÌÓÒÚ, Ò˙˜ÂÚ‡Ì‡ Ò ÔÂË‚ÂÌÚ-

ËÍÛÎ‡Ì‡ ıÂÏÓ‡„Ëfl ÔË˜ËÌfl‚‡ ÒÔ‡ÒÚË˜Ì‡ ‰ËÔ‡-

ÂÁ‡ Ò ÌÓÏ‡ÎÌË ÍÓ„ÌËÚË‚ÌË ÙÛÌÍˆËË.

● ïÓÏÓÁÓÏÌËÚÂ, ÏÂÚ‡·ÓÎËÚÌË Ë „ÂÌÂÚË˜ÌË ‰Â-

ÙÂÍÚË ‚Ó‰flÚ ‰Ó ‰‚Ë„‡ÚÂÎÌË ÓÚÍÎÓÌÂÌËfl Ë ‰Û-

„Ë ‚Ó‰ÂÌË ‡ÌÓÏ‡ÎËË.

● íÂÊÍËflÚ Í˙ÒÂÌ ËÌÚ‡Ô‡Ú‡ÎÂÌ ËÒıÂÏË˜ÂÌ ËÌ-

ÒÛÎÚ ÔË ÁflÎÓ, ‰ÓÌÓÒÂÌÓ ‰ÂÚÂ ÔË˜ËÌfl‚‡ ‰ËÒÍË-

ÌÂÁËfl Ò ÌÓÏ‡ÎÌÓ ÍÓ„ÌËÚË‚ÌÓ ‡Á‚ËÚËÂ.

6. äãàçàóçÄ äÄêíàçÄ çÄ êÄáãàóçàíÖîéêåà:

6.1. ëèÖñàîàóçé êÄáëíêéâëíÇé Ç êÄáÇàíàÖ-

íé çÄ ÑÇàÉÄíÖãçàíÖ îìçäñàà

ë ñÖçíêÄãçé äééêÑàçÄñàéççé

ëåìôÖçàÖ (ëêêÑî-ñäë)

● àÁÓÒÚ‡‚‡ÌÂ Ì‡ ‰‚Ë„‡ÚÂÎÌÓÚÓ ‡Á‚ËÚËÂ Ë ÔÓÁË-

ˆËÓÌÌÓ-·‡Î‡ÌÒÌËÚÂ ÏÂı‡ÌËÁÏË

● àÁÓÒÚ‡‚‡ÌÂ ËÎË ‡·ÌÓÏ‡ÎÌ‡ ÔÓÁËˆËÓÌÌ‡ Â‡Í-

ÚË‚ÌÓÒÚ

● íÛÔÌ‡ ıËÔÓÚÓÌËfl ÍÓÏ·ËÌË‡Ì‡ Ò ÔÓÏÂÌË ‚

ÏÛÒÍÛÎÌËfl ÚÓÌÛÒ ÓÚ ıËÔÓ-, ıËÔÂ- Ë ‰ËÒÚÓÌË˜ÂÌ

ı‡‡ÍÚÂ

● èÂÒËÒÚÂÌˆËfl Ì‡ ÔËÏËÚË‚ÌË ÂÙÎÂÍÒË

● êÂÙÎÂÍÒÌ‡ ıËÔÂ‚˙Á·Û‰ËÏÓÒÚ Ë Ì‡ÎË˜ËÂ Ì‡ Ô‡ÚÓ-

ÎÓ„Ë˜ÌË ÂÙÎÂÍÒË

● ëÚ‡·ËÁ˙Ï – ÍÓÌ‚Â„Ë‡˘ /‰Ë‚Â„Ë‡˘ ÒÎÂ‰ 5-

Ëfl ÏÂÒÂˆ

● èÓ·ÎÂÏË Ò ı‡ÌÂÌÂÚÓ – ‰ËÒÍÓÓ‰ËÌ‡ˆËfl ÏÂÊ‰Û


ÒÛÍ‡ÌÂ/ÔÂ„Î˙˘‡ÌÂ Ë ‰Ë¯‡ÌÂ

● àÌÒÛÙËˆËÂÌˆËfl ‚ Ë‰Â‡ˆËflÚ‡

6.2. ÑÖíëäÄ ñÖêÖÅêÄãçÄ èÄêÄãàáÄ (Ññè)

éÅôà ÅÖãÖáà èêà Çëàóäà îéêåà çÄ ñÖêÖÅêÄãçÄ èÄêÄãàáÄ:

1. Ñ‚Ë„‡ÚÂÎÌÓ ËÁÓÒÚ‡‚‡ÌÂ ÔÓ‡‰Ë Á‡·‡‚flÌÂ ËÎË ‡·-

ÌÓÏ‡ÎÌÓ ‡Á‚ËÚËÂ Ì‡ ÔÓÁËˆËÓÌÌÓ-·‡Î‡ÌÒÌËÚÂ

ÏÂı‡ÌËÁÏË, ÍÓËÚÓ Ò‡ ‚˙ÚÂ¯Ì‡ ˜‡ÒÚ ÓÚ ÏÓ-

ÚÓÌËÚÂ ÛÏÂÌËfl Ë ÚflıÌÓÚÓ ÛÒ‚Ófl‚‡ÌÂ.

2. èÂÒËÒÚË‡ÌÂ Ì‡ ÔËÏËÚË‚ÌË ÂÙÎÂÍÒË Ë ÏÂı‡-

ÌËÁÏË, ·ÎÓÍË‡˘Ë ËÎË ‰ÂÙÓÏË‡˘Ë ÔÓÁËˆËÓÌÌÓ-

·‡Î‡ÌÒÌËÚÂ ÏÂı‡ÌËÁÏË Ì‡ ÌÓ‚ÓÓ‰ÂÌÓÚÓ

3. ì‚Â‰ÂÌ‡ ÏÓÚÓÌ‡ ÍÓÓ‰ËÌ‡ˆËfl, Ò˙˜ÌÓÒÚ Ë Ó·-

‡ÚÌ‡ ‚˙ÁÍ‡

4. ëÎ‡·ÓÒÚ Ì‡ ÚÛÔÌ‡Ú‡ ÏÛÒÍÛÎ‡ÚÛ‡ ÍÓÏ·ËÌË‡-

Ì‡ Ò ÚÓÌÛÒÓ‚Ë ÓÚÍÎÓÌÂÌËfl (ıËÔÂÚÓÌËfl, ıËÔÓ-

ÚÓÌËfl, ‰ËÒÚÓÌËfl) ‚ Í‡ÈÌËˆËÚÂ

5. çÂ‡‰ÂÍ‚‡ÚÌË ÔÓÁËˆËË Ë Ò‚˙Á‡ÌÂ Ò Úflı ÔÓÎÓÊÂ-

ÌËfl

6. àÁ‡ÁÂÌ‡ ÂÙÎÂÍÒÌ‡ ‚˙Á·Û‰ËÏÓÒÚ

7. åÛÒÍÛÎÌ‡ ·ËÓÏÂı‡ÌË˜Ì‡ Ú‡ÌÒÙÓÏ‡ˆËfl – ÔÓ-

ÏflÌ‡ ‚˙‚ ‚ËÒÍÓ-ÂÎ‡ÒÚË˜ÌËÚÂ Ò‚ÓÈÒÚ‚‡

8. äÓÒÚÌË Ë ÒÚ‡‚ÌË ‰ÂÙÓÏ‡ˆËË ÔË ËÁ‡ÒÚ‚‡ÌÂ-

ÚÓ Ì‡ ‰ÂÚÂÚÓ

ëèÄëíàóçÄ ñÖêÖÅêÄãçÄ èÄêÄãàáÄ

é·˘Ë ı‡‡ÍÚÂËÒÚËÍË: ëÔ‡ÒÚË˜ÌÓ ÔÓ‚Ë¯ÂÌ ÏÛÒ-

ÍÛÎÂÌ ÚÓÌÛÒ,ÍÓÈÚÓ ÒÂ Á‡ÒËÎ‚‡ ÔË ‚˙Á·Û‰‡, ÒÚ‡ı ËÎË

·ÓÎÍ‡; ‡·ÌÓÏ‡ÎÌË ÔÓÁËˆËË, Ò‚˙Á‡ÌË Ò ‡ÌÚË„‡‚ËÚ‡-

ˆËÓÌÌ‡Ú‡ ÏÛÒÍÛÎ‡ÚÛ‡ Ì‡ ÂÍÒÚÂÌÁÓËÚÂ Ì‡ ‰ÓÎÌËÚÂ

Í‡ÈÌËˆË Ë ÙÎÂÍÒÓËÚÂ Ì‡ „ÓÌËÚÂ Í‡ÈÌËˆË; ‚ÓÎÂ‚Ë-

ÚÂ ‰‚ËÊÂÌËfl Ò‡ ·‡‚ÌË, ÚÓÏ‡‚Ë; ÏÛÒÍÛÎÌ‡ ÍÓ-ÍÓÌÚ-

‡ÍˆËfl, ‚Ó‰Â˘‡ ‰Ó Á‡„Û·‡ Ì‡ ËÁÓÎË‡ÌË Ë ‰ËÒÍÂÚÌË

‰‚ËÊÂÌËfl Ò‚˙Á‡ÌË Ò ÙËÌÌ‡Ú‡ ÍÓÓ‰ËÌ‡ˆËfl.

● ÑËÔÎÂ„Ëfl. çÂ‚ÓÎÓ„Ë˜ÌÓ ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡ ‰ÓÎÌ‡

ÒÔ‡ÒÚË˜Ì‡ Ô‡‡Ô‡ÂÁ‡ ËÎË Í‚‡‰ËÔ‡ÂÚË˜ÂÌ

ÒËÌ‰ÓÏ Ò ÔÂÓ·Î‡‰‡‚‡ÌÂ Ì‡ ‰ÓÎÌ‡Ú‡ Ô‡‡Ô‡ÂÁ‡

Ò ÍÓÌÚ‡ÍÚÛË Ì‡ ‡ıËÎÓ‚ËÚÂ ÒÛıÓÊËÎËfl, ÍÓÎÂÌ-

ÌËÚÂ ÒÚ‡‚Ë, ‡‰‰ÛÍÚÓÌË Ë/ËÎË ‚˙ÚÂ¯ÌÓÓÚ‡-

ÚÓÌË ÍÓÌÚ‡ÍÚÛË Ì‡ Ú‡ÁÓ·Â‰ÂÌËÚÂ ÒÚ‡‚Ë,

Ô‡ÚÓÎÓ„Ë˜ÌË ÂÙÎÂÍÒË ÓÚ „ÛÔ‡Ú‡ Ì‡ Babinski

‰‚ÛÒÚ‡ÌÌÓ, ÍÎÓÌÛÒË Ì‡ ÒÚ˙Ô‡Î‡Ú‡. í‡ÁË ÙÓÏ‡

Â ÔÓ-·Î‡„ÓÔËflÚÌ‡, Ú˙È Í‡ÚÓ ÔÓ-fl‰ÍÓ ËÏ‡ ÂÔË-

ÎÂÔÚË˜ÌË ÔËÔ‡‰˙ˆË (16 - 27%) Ë ËÌÚÂÎÂÍÚÛ‡ÎÂÌ

‰ÂÙËˆËÚ.

● ïÂÏËÔÎÂ„Ëfl. çÂ‚ÓÎÓ„Ë˜ÌÓ ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡ ˆÂÌÚ-

‡ÎÌ‡Ú‡ ıÂÏËÔ‡ÂÁ‡ Ò ÎÂÁËfl Ì‡ n. facialis ÔÓ

ˆÂÌÚ‡ÎÂÌ ÚËÔ. åÛÒÍÛÎÌËflÚ ÚÓÌÛÒ Â ÒÔ‡ÒÚË˜ÌÓ

ÔÓ‚Ë¯ÂÌ ‚˙‚ ÙÎÂÍÒÓËÚÂ Ì‡ ˙Í‡Ú‡ Ë ÂÍÒÚÂÌÁÓ-

ËÚÂ Ì‡ Í‡Í‡. ëÛıÓÊËÎÌËÚÂ Ë Ì‡‰ÍÓÒÚÌË ÂÙ-

ÎÂÍÒË Ò‡ ÓÊË‚ÂÌË, ËÏ‡ Ô‡ÚÓÎÓ„Ë˜ÌË ÂÙÎÂÍÒË ÓÚ

„ÛÔ‡Ú‡ Ì‡ Babinski Ë Rossolimo, ÍÎÓÌÛÒË Ì‡ ÒÚ˙-

Ô‡ÎÓÚÓ, ÍÓÌÚ‡ÍÚÛË, ‚˙ÁÏÓÊÌË Ò‡ ‡ÚÂÚÓÁÌË

ıËÔÂÍËÌÂÁË ‚ Ô‡ÂÚË˜Ì‡Ú‡ ˙Í‡. è‡ÂÚË˜ÌËÚÂ

Í‡ÈÌËˆË ˜ÂÒÚÓ Ò‡ ıËÔÓÚÓÙË˜ÌË. ÅÓÎÌËÚÂ ÔÓ-

ıÓÊ‰‡Ú ÔÓ-Í˙ÒÌÓ Ò ÔÓıÓ‰Í‡ ÚËÔ “Wernicke -

Mann”. èË 68% ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡ Ë ıÂÏËıËÔÂÒÚÂ-

ÁËfl, Ì‡È-˜ÂÒÚÓ ÒÚÂÂÓ‡„ÌÓÁËfl, Ì‡Û¯ÂÌ ‰‚ÛÏÂ-

ÌÓ - ÔÓÒÚ‡ÌÒÚ‚ÂÌ ÛÒÂÚ. åÓÚÓÌ‡ ‰ËÁÎ‡ÎËfl Ë

‰ËÁ‡ÚËfl ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡Ú ÔË ÓÍÓÎÓ 25%. ç‡-

Û¯ÂÌËflÚ‡ Ì‡ ‚ËÒ¯ËÚÂ ÍÓÓ‚Ë ÙÛÌÍˆËË (Ô‡Í-

ÒËÒ, „ÌÓÁËÒ, ÚÂÎÂÒÌ‡ ÓËÂÌÚ‡ˆËfl) Á‡ÚÛ‰Ìfl‚‡Ú

Ó·Û˜ÂÌËÂÚÓ. ç‡‰ 50% ÓÚ ÒÎÛ˜‡ËÚÂ Ò‡ Ò ÙÓÍ‡ÎÌË

Ë/ËÎË ‚ÚÓË˜ÌÓ-„ÂÌÂ‡ÎËÁË‡ÌË ÂÔËÎÂÔÚË˜ÌË

ÔËÔ‡‰˙ˆË, ˜ÂÒÚÓ Ò ‡ÌÌÓ Ì‡˜‡ÎÓ (‰Ó 18 ÏÂÒÂ˜Ì‡

‚˙Á‡ÒÚ).

● ä‚‡‰ËÔÎÂ„Ëfl. çÂ‚ÓÎÓ„Ë˜ÌÓ ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡Ú:

ˆÂÌÚ‡ÎÌ‡ Í‚‡‰ËÔ‡‡ÂÁ‡, Ò˙Ò ÒÔ‡ÒÚË˜ÌÓ ÔÓ‚Ë-

¯ÂÌ ÚÓÌÛÒ Ò ÙÎÂÍÒËfl Ì‡ ˙ˆÂÚÂ Ë ÂÍÒÚÂÌÁËfl, ‡‰-

‰ÛÍˆËfl Ë ‚˙ÚÂ¯Ì‡ ÓÚ‡ˆËfl ‚ ‰ÓÎÌËÚÂ Í‡ÈÌË-

ˆË, ÍÓÌÚ‡ÍÚÛË, ÏÌÓ„Ó ÊË‚Ë ÒÛıÓÊËÎÌË Ë Ì‡‰-

ÍÓÒÚÌË ÂÙÎÂÍÒË Ò ‡Á¯ËÂÌË ÂÙÎÂÍÒÓ„ÂÌÌË Á‡-

ÌË, ÔÓÎÓÊËÚÂÎÌË Ô‡ÚÓÎÓ„Ë˜ÌË ÂÙÎÂÍÒË ÓÚ „Û-

ÔËÚÂ Ì‡ Babinski Ë Rossolimo; ÔÒÂ‚‰Ó·ÛÎ·‡ÂÌ

ÒËÌ‰ÓÏ; ÂÍÒÚ‡ÔË‡ÏË‰ÂÌ ÒËÌ‰ÓÏ Ò ‰ËÒÚ‡ÎÌË

ıËÔÂÍËÌÂÁËË ËÎË ‰ËÒÚÓÌËË; Ó˜Â‰‚Ë„‡ÚÂÎÌ‡

ÒËÏÔÚÓÏ‡ÚËÍ‡, ‡ÚÓÙËfl Ì‡ ÁËÚÂÎÌËÚÂ ÌÂ‚Ë,

ËÁÓÒÚ‡‚‡ÌÂ ‚ „Ó‚ÓÌÓÚÓ ‡Á‚ËÚËÂ Ë ËÌÚÂÎÂÍÚÛ-

‡ÎÂÌ ‰ÂÙËˆËÚ. ÖÔËÎÂÔÚË˜ÌË ÔËÒÚ˙ÔË Ò‡ Ì‡ÎËˆÂ

‚ Ì‡‰ 52 % ÓÚ ÒÎÛ˜‡ËÚÂ.

ÑàëäàçÖíàóçÄ (ÄíÖíéàÑçÄ) ñÖêÖÅêÄãçÄ èÄêÄãàáÄ

ÖÍÒÚ‡ÔË‡ÏË‰ÌËflÚ ÒËÌ‰ÓÏ ÒÂ Ï‡ÌËÙÂÒÚË‡

ÔÓÒÚÂÔÂÌÌÓ ÔÂÁ Ô˙‚ËÚÂ „Ó‰ËÌË ÓÚ ÊË‚ÓÚ‡. Ç Ì‡˜‡-

ÎÓÚÓ Â Ì‡ÎËˆÂ ÏÛÒÍÛÎÌ‡ ıËÔÓÚÓÌËfl. ÄÚÂÚÓÁÌËÚÂ Ë

‰ËÒÚÓÌÌË ıËÔÂÍËÌÂÁËË ÒÂ ÔÓfl‚fl‚‡Ú Ì‡È-˜ÂÒÚÓ ÏÂÊ-

‰Û 1 Ë 2 „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ. ãÓÍ‡ÎËÁË‡Ú ÒÂ ‚ ÏÛÒÍÛÎ‡-

ÚÛ‡Ú‡ Ì‡ Í‡ÈÌËˆËÚÂ, ÂÁËÍ‡, „˙ÎÚ‡ÚÂÎÌ‡Ú‡ Ë ÙÓÌ‡-

ÚÓÌ‡ ÏÛÒÍÛÎ‡ÚÛ‡, ‡ÍÚË‚Ë‡Ú ÒÂ ÓÚ ÒÂÚË‚ÌË ÒÚË-

ÏÛÎË, ÂÏÓˆËË. ìÒÚ‡ÌÓ‚fl‚‡ ÒÂ ÂÍÒÚ‡ÔË‡ÏË‰Ì‡ ‰ËÁ‡-

ÚËfl. ÑÂˆ‡Ú‡ ÔÓıÓÊ‰‡Ú Í˙ÒÌÓ (ÏÂÊ‰Û 2,5 Ë 4 „.

‚˙Á‡ÒÚ), ‚ Á‡‚ËÒËÏÓÒÚ ÓÚ ÔÂÒËÒÚË‡ÌÂÚÓ Ì‡ ¯ËÈ-

ÌËÚÂ ÚÓÌË˜ÌË ÂÙÎÂÍÒË Ë Ò˙Ô˙ÚÒÚ‚‡˘ËÚÂ ÔË‡ÏË‰-

ÌË Û‚ÂÊ‰‡ÌËfl. àÌÚÂÎÂÍÚ˙Ú Â ÌÓÏ‡ÎÂÌ, ÌÓ Û˜ËÎË˘-

ÌËÚÂ ÛÏÂÌËfl Ò‡ Á‡ÚÛ‰ÌÂÌË ÓÚ ÌÂÔÂÍ˙ÒÌ‡ÚËÚÂ

ÂÍÒÚ‡ÔË‡ÏË‰ÌË ıËÔÂÍËÌÂÁË, Ì‡Û¯ÂÌ‡Ú‡ ‡ÚËÍÛ-

Î‡ˆËfl Ë Ò˙Ô˙ÚÒÚ‚‡˘‡Ú‡ ‚ ÌflÍÓË ÒÎÛ˜‡Ë „ÎÛıÓÚ‡.

ÄíÄäëàóçÄ / ïàèéíéçàóçÄ ñÖêÖÅêÄãçÄ èÄêÄãàáÄ

àÁfl‚fl‚‡ ÒÂ Ò ‡ÌÌ‡ ÏÛÒÍÛÎÌ‡ ıËÔÓÚÓÌËfl Ë ÔÓ-Í˙ÒÌÓ

Ò ÔÓfl‚Ë Ì‡ ÒÚ‡ÚË˜Ì‡ Ë ÎÓÍÓÏÓÚÓÌ‡ ‡Ú‡ÍÒËfl. ìÒ-

Ú‡ÌÓ‚fl‚‡Ú ÒÂ Ë ÒÛıÓÊËÎÌ‡ Ë Ì‡‰ÍÓÒÚÌ‡ ıËÔÂÂÙÎÂÍ-

ÒËfl, Ô‡ÚÓÎÓ„Ë˜ÌË ÂÙÎÂÍÒË, Â˜Â‚Ë Ì‡Û¯ÂÌËfl Ë ËÌ-

ÚÂÎÂÍÚÛ‡ÎÂÌ ‰ÂÙËˆËÚ (50%).

7. ÑàÄÉçéëíàóçÄ åÖíéÑéãéÉàüèêà ÑÖñÄ ë ñäë à Ññè

äãàçàóçà àáëãÖÑÇÄçàü

1. èÓÒÎÂ‰fl‚‡ÌÂ ‰ËÌ‡ÏËÍ‡Ú‡ Ì‡ ÔËÏËÚË‚Ì‡Ú‡


ÂÙÎÂÍÒÓÎÓ„Ëfl

2. àÁÒÎÂ‰‚‡ÌÂ Ì‡ Ô‡ÚÓÎÓ„Ë˜Ì‡ ÂÙÎÂÍÒÓÎÓ„Ëfl

3. åÓÚÓÒÍÓÔËfl (ÒÔÓÌÚ‡ÌÌ‡ ‰‚Ë„‡ÚÂÎÌ‡ ‡ÍÚË‚-

ÌÓÒÚ) – ÏÓÚÓÌÓ ÚÂÒÚÛ‚‡ÌÂ – Gross Motor

Function Classification System, Gross Motor

Function Measurment

4. àÁÒÎÂ‰‚‡ÌÂ Ì‡ ÏÛÒÍÛÎÂÌ ÚÓÌÛÒ - Modified

Ashworth Scale

5. äËÌÂÁËÓÎÓ„Ë˜ÂÌ ÒÍËÌËÌ„ (ÔÓÁËˆËÓÌÌ‡ ‰‚Ë„‡ÚÂÎ-

Ì‡ Â‡ÍÚË‚ÌÓÒÚ) – ÌÂ‚ÓÍËÌÂÁËÓÎÓ„Ë˜Ì‡ ‰Ë‡„-

ÌÓÒÚËÍ‡ ÔÓ ÇÓÈÚ‡

6. àÁÒÎÂ‰‚‡ÌÂ Ì‡ ı‡ÌËÚÂÎÌËÚÂ ÛÏÂÌËfl - ÚÂÒÚÓ‚Â

7. àÁÒÎÂ‰‚‡ÌÂ Ì‡ ÔÒËıË˜ÌËÚÂ ÙÛÌÍˆËË - ÚÂÒÚÓ‚Â

ãÄÅéêÄíéêçà àáëãÖÑÇÄçàü

1. í‡ÌÒÙÓÌÚ‡ÌÂ‡ÎÌ‡Ú‡ ÂıÓ„‡ÙËfl ‰Ó 6 ÏÂÒÂ˜Ì‡

‚˙Á‡ÒÚ ÒÂ ÔËÎ‡„‡ Á‡ ‰Ë‡„ÌÓÒÚËÍ‡ Ë ÔÓÒÎÂ‰fl-

‚‡ÌÂ. ÇËÁÛ‡ÎËÁË‡Ú ÒÂ ÔÂË‚ÂÌÚËÍÛÎÌ‡ ËÎË ÍËÒ-

ÚË˜Ì‡ ıËÔÂÂıÓ„ÂÌÌÓÒÚ, ËÌÚ‡‚ÂÌÚËÍÛÎÌË

Í˙‚ÓËÁÎË‚Ë, ‚ÂÌÚËÍÛÎÌ‡ ‰ËÎ‡Ú‡ˆËfl Ë ‰.

2. çÂ‚ÓËÁÓ·‡Áfl‚‡˘ËÚÂ ËÁÒÎÂ‰‚‡ÌËfl Ò‡ Ì‡È-ËÌ-

ÙÓÏ‡ÚË‚ÌË Á‡ ÂÚËÓÎÓ„Ë˜ÌÓÚÓ ËÁflÒÌfl‚‡ÌÂ Ì‡

Ññè.

● äí Ì‡ „Î‡‚ÌËfl ÏÓÁ˙Í Â Ô‡ÚÓÎÓ„Ë˜Ì‡ ÔË 77% ÓÚ

‰Âˆ‡Ú‡ Ò Ññè Ë ‡ÁÍË‚‡ ÍËÒÚË, ÍÓÓ‚‡ ‡ÚÓ-

ÙËfl, ÒËÏÂÚË˜Ì‡ ËÎË ‡ÒËÏÂÚË˜Ì‡ ‚ÂÌÚËÍÛÎÌ‡

‰ËÎ‡Ú‡ˆËfl.

● åêí Ì‡ „Î‡‚ÌËfl ÏÓÁ˙Í Â Ô‡ÚÓÎÓ„Ë˜Ì‡ ÔË 89% ÓÚ

ÒÎÛ˜‡ËÚÂ Ò Ññè Ë Â Ì‡È-ËÌÙÓÏ‡ÚË‚Ì‡ Á‡ ‚ËÁÛ‡-

ÎËÁË‡ÌÂ Ì‡ ÏÓÁ˙˜ÌË Ï‡ÎÙÓÏ‡ˆËË (ÎËÁÂÌˆÂÙ‡-

ÎËfl/ Ô‡ıË„ËËfl, ÏËÍÓÔÓÎË„ËËfl, ÍÓÚËÍ‡ÎÌË

‰ËÒÔÎ‡ÁËË, ÚÛ·ÂË ÔË ÚÛ·ÂÓÁÌ‡ ÒÍÎÂÓÁ‡, ÒÛ·-

ÍÓÚËÍ‡ÎÌË Ë ÌÓ‰ÛÎ‡ÌË ıÂÚÂÓÚÓÔËË), ÒÍÎÂÓ-

ÚË˜ÌË ÔÓÏÂÌË, Á‡·‡‚ÂÌ‡ ÏËÂÎËÌËÁ‡ˆËfl, ËÒıÂ-

ÏË˜ÌË Ë ÍËÒÚÓÁÌË ÎÂÁËË.

3. ÉÂÌÂÚË˜ÌË ËÁÒÎÂ‰‚‡ÌËfl ÒÂ ËÁ‚˙¯‚‡Ú ÔË ÓÔÂ-

‰ÂÎÂÌË ÚËÔÓ‚Â ÏÓÁ˙˜ÌË Ï‡ÎÙÓÏ‡ˆËË, ‡ ÏÂÚ‡·Ó-

ÎËÚÌË - ÔË ÎËÔÒ‡ Ì‡ ‰Û„‡ ÔË˜ËÌ‡ ËÎË ÔÓ„Â-

ÒËfl.

4. äÓ‡„ÛÎ‡ˆËÓÌÌËÚÂ ËÁÒÎÂ‰‚‡ÌËfl ÔË 13-37% ÓÚ

‰Âˆ‡Ú‡ Ò ÔÂ-Ë ÔÂËÌ‡Ú‡ÎÌË ÏÓÁ˙˜ÌË ËÌÙ‡ÍÚË

Ë ıÂÏËÔÎÂ„Ë˜Ì‡ ÙÓÏ‡ Ì‡ Ññè ‡ÁÍË‚‡Ú ‰ÂÙË-

ˆËÚ Ì‡ Ù‡ÍÚÓ V Ì‡ Í˙‚ÓÒ˙ÒË‚‡ÌÂÚÓ, ‡ÌÚË-

ÙÓÒÙÓÎËÔË‰ÌË ‡ÌÚËÚÂÎ‡, Protein ë Ë Protein S

‰ÂÙËˆËÚ.

5.ÖÎÂÍÚÓÂÌˆÂÙ‡ÎÓ„‡ÙËflÚ‡ Â ÌÂÓ·ıÓ‰ËÏ‡ ÔË

Ò˙Ô˙ÚÒÚ‚‡˘‡ ÂÔËÎÂÔÒËfl.

8. ÑàîÖêÖçñàÄãçÄ ÑàÄÉçéáÄÑñè ÒÂ ‡Á„‡ÌË˜‡‚‡ ÓÚ:

● ç‡ÒÎÂ‰ÒÚ‚ÂÌË ÏÂÚ‡·ÓÎËÚÌË ÂÌˆÂÙ‡ÎÓÔ‡ÚËË(ÙÂÌËÎÍÂÚÓÌÛËfl, ıËÒÚË‰ËÌÂÏËfl), ËÌÙ‡ÌÚËÎÌË-

ÚÂ ÙÓÏË Ì‡ ÌÂ‚ÓÎËÔË‰ÓÁË („‡Ì„ÎËÓÁË‰ÓÁË, ˆÂ-

ÓË‰ - ÎËÔÓÙÛÒˆËÌÓÁË Ë ÒË‡ÎË‰ÓÁË) Ë ÎÂ‚ÍÓ‰ËÒÚ-

ÓÙËË (ÏÂÚ‡ıÓÏ‡ÚË˜Ì‡, ÚËÔ Krabbe, ÚËÔ

Alexander, ÚËÔ ëanavan Ë ÚËÔ Pelizaeus -

Merzbacher). èË Úflı ÔÓ„ÂÒË‡˘Ó ÒÂ ‡Á‚Ë‚‡Ú

Í‚‡‰ËÔ‡ÂÚË˜ÂÌ, ˆÂÂ·ÂÎ‡ÂÌ ÒËÌ‰ÓÏ, ËÌÚÂ-

ÎÂÍÚÛ‡ÎÂÌ Â„ÂÒ, ‡Ï‡‚ÓÁ‡ Ë ÂÔËÎÂÔÚË˜ÌË ÔË-

Ô‡‰˙ˆË Ë ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡ ÒÔÂˆËÙË˜ÂÌ ÏÂÚ‡·ÓÎË-

ÚÂÌ ‰ÂÙÂÍÚ ËÎË ÂÌÁËÏÂÌ ‰ÂÙËˆËÚ, ‡ ‚ äí Ë

åêí- ÔÓ„ÂÒË‡˘‡ ÏÓÁ˙˜Ì‡ ‡ÚÓÙËfl ËÎË ‰ÂÏË-

ÂÎËÌËÁ‡ˆËfl.

● çÂ‚Ó-ÏÛÒÍÛÎÌË Á‡·ÓÎfl‚‡ÌËfl, ÔÓÚË˜‡˘Ë Ò ÏÛÒ-

ÍÛÎÌ‡ ıËÔÓÚÓÌËfl, Á‡·‡‚ÂÌÓ ÏÓÚÓÌÓ ‡Á‚ËÚËÂ:

ÒÔËÌ‡ÎÌ‡ ÏÛÒÍÛÎÌ‡ ‡ÚÓÙËfl I-II ÚËÔ (Werdnig -Hoffman); ‚Ó‰ÂÌË ÏËÓÔ‡ÚËË; ÍÓÌ„ÂÌËÚ‡ÎÌ‡ ÏÛÒ-ÍÛÎÌ‡ ‰ËÒÚÓÙËfl; Ì‡ÒÎÂ‰ÒÚ‚ÂÌ‡ ÒÂÚË‚ÌÓ-ÏÓ-ÚÓÌ‡ ÌÂ‚ÓÔ‡ÚËfl - ÚËÔ III (Dejerine - Sottas). Ç ÚÂÁË ÒÎÛ˜‡Ë ÒÂ ÛÒÚ‡-

ÌÓ‚fl‚‡Ú ı‡‡ÍÚÂÌË ÖåÉ ÔÓÏÂÌË Ë „ÂÌÂÚË˜ÌË

‰ÂÙÂÍÚË.

● ëËÌ‰ÓÏ Ì‡ Louis Barr Ë Ì‡ÒÎÂ‰ÒÚ‚ÂÌË ‡Ú‡ÍÒËË.

á‡·ÓÎfl‚‡ÌËflÚ‡ ÔÓÚË˜‡Ú Ò ÔÓ„ÂÒË‡˘ ˆÂÂ-

·ÂÎ‡ÂÌ ÒËÌ‰ÓÏ.

● ëËÌ‰ÓÏ Ì‡ Rett – ÔË ÌÓÏ‡ÎÌÓ ‡Á‚ËÚË ‰Âˆ‡ Á‡-

ÔÓ˜‚‡Ú ÌÂ‚ÓÔÒËıÓÎÓ„Ë˜ÂÌ Â„ÂÒ, ËÁfl‚fl‚‡Ú ÒÂ

‡ÛÚËÁ˙Ï, ÒÚÂÂÓÚËÔÌË ‰‚ËÊÂÌËfl Ì‡ ˙ˆÂÚÂ,

ÂÔËÎÂÔÚË˜ÌË ÔËÔ‡‰˙ˆË.

● ÖÌˆÂÙ‡ÎÓÔ‡ÚËË ÔË HIV (ÒÚ‡ˆËÓÌË‡ÌË Ë ÔÓ„-

ÂÒË‡˘Ë). ìÒÚ‡ÌÓ‚fl‚‡Ú ÒÂ ÒÂÓÎÓ„Ë˜ÌË ‰‡ÌÌË

Á‡ HIV ËÌÙÂÍˆËfl Ë ÔÓ„ÂÒË‡˘‡ ÂÌˆÂÙ‡ÎÓÔ‡-

ÚËfl ÔË ÌÂÓËÁÓ·‡Áfl‚‡˘ËÚÂ ËÁÒÎÂ‰‚‡ÌËfl.

9. ÄãÉéêàíöå çÄ êÖïÄÅàãàíÄñàüà ãÖóÖçàÖ:

éí 1 åÖëÖñ Ñé 1 É. 6 åÖëÖñÄ.

1. äËÌÂÁËÚÂ‡ÔËfl

● êÂÙÎÂÍÒÌÓ-ÔÂ‰ËÁ‚ËÍ‡ÌÓ ÔË‰‚ËÊ‚‡ÌÂ ÔÓ ÇÓÈÚ‡

● çÂ‚Ó‡Á‚ÓÈÌÓ ÎÂ˜ÂÌËÂ ÔÓ ÅÓ·‡Ú

2. å‡„ÌËÚÌÓ ÔÓÎÂ

3. ÖÎÂÍÚÓÒÚËÏÛÎ‡ˆËË – ÔË ÒÔÂˆËÙË˜ÌË ËÌ‰ËÍ‡-

ˆËË

4. ïËÔÂ·‡Ì‡ ÓÍÒË„ÂÌ‡ˆËfl

5. èÒËıÓÎÓ„Ë˜Ì‡ ‰Ë‡„ÌÓÒÚËÍ‡ Ë ËÌÚÂ‚ÂÌˆËfl - Ù‡-

ÏËÎÌ‡

6. ãÓ„ÓÔÂ‰Ë˜Ì‡ ‰Ë‡„ÌÓÒÚËÍ‡ Ë ËÌÚÂ‚ÂÌˆËfl

● ï‡ÌËÚÂÎÌ‡ ÚÂ‡ÔËfl

● èÂ‰-Â˜Â‚‡ Âı‡·ËÎËÚ‡ˆËfl

7. åÂ‰ËÍ‡ÏÂÌÚÓÁÌÓ ÎÂ˜ÂÌËÂ

● ÄÌÚËÂÔËÎÂÔÚË˜ÌË ÏÂ‰ËÍ‡ÏÂÌÚË (ÔË ËÌ‰ËÍ‡-

ˆËË)

● èÒËıÓÒÚËÏÛÎ‡ÌÚË (ÔË ‰Âˆ‡ Ò˙Ò Á‡·‡‚ÂÌ‡ ËÎË

ÎËÔÒ‚‡˘‡ Ë‰ÂÓÏÓÚÓËÍ‡).


éí 1É. 6å. Ñé 3 ÉéÑàçà


● êÂÙÎÂÍÒÌÓ-ÔÂ‰ËÁ‚ËÍ‡ÌÓ ÔË‰‚ËÊ‚‡ÌÂ ÔÓ ÇÓÈÚ‡


● ‰Û„Ë

2. èÓÁËˆËÓÌÌ‡ ÚÂ‡ÔËfl

3. ÖÎÂÍÚÓÒÚËÏÛÎ‡ˆËË

4. íÂÏÓÚÂ‡ÔËfl

● íÓÔÎËÌÌÓ ÎÂ˜ÂÌËÂ

5. ã‡ÁÂÌ‡-‡ÍÛÔÛÌÍÚÛ‡


7. èÒËıÓÎÓ„Ë˜Ì‡ ËÌÚÂ‚ÂÌˆËfl

● ËÌ‰Ë‚Ë‰Û‡ÎÌ‡

● Ù‡ÏËÎÌ‡

8. ãÓ„ÓÔÂ‰Ë˜Ì‡ ËÌÚÂ‚ÂÌˆËfl:

● ÔÂ‰-Â˜Â‚‡ Âı‡·ËÎËÚ‡ˆËfl

9. åÂ‰ËÍ‡ÏÂÌÚÓÁÌÓ ÎÂ˜ÂÌËÂ:


ˆËË)


ÎËÔÒ‚‡˘‡ Ë‰ÂÓÏÓÚÓËÍ‡)

● åËÓÂÎ‡ÍÒ‡ÌÚË – Ä¯Û˙Ú > 2ÒÚ.:

- ÔÂÓ‡ÎÌÓ (Mydocalm, Baclofen Ë ‰.)

- ËÌÚ‡ÏÛÒÍÛÎÌÓ (ÅÓÚÛÎËÌÓ‚ íÓÍÒËÌ Ä) - ÒÎÂ‰ 2

„Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ

éí 4 Ñé 7 ÉéÑàçà


● êÂÙÎÂÍÒÌÓ ÔÂ‰ËÁ‚ËÍ‡ÌÓ ÔË‰‚ËÊ‚‡ÌÂ ÔÓ ÇÓÈÚ‡


● ÄÌ‡ÎËÚË˜Ì‡ ÍËÌÂÁËÚÂ‡ÔËfl

● ‰Û„Ë


3. åÂı‡ÌÓÚÂ‡ÔËfl


5. íÓÔÎËÌÌË ÔÓˆÂ‰ÛË:

● íÂÏÓÚÂ‡ÔËfl

● äËÓÚÂ‡ÔËfl

6. ïË‰ÓÚÂ‡ÔËfl



9. èÒËıÓÎÓ„Ë˜Ì‡ ËÌÚÂ‚ÂÌˆËfl:

● àÌ‰Ë‚Ë‰Û‡ÎÌ‡

● î‡ÏËÎÌ‡


● ÉÓ‚ÓÌ‡

● êÂ˜Â‚‡

11. ÑÂÙÂÍÚÓÎÓ„Ë˜Ì‡ ËÌÚÂ‚ÂÌˆËfl –

● åÓÌÚÂÒÓËÚÂ‡ÔËfl

● èËÎÓÊÌË Ë„Ë Ë Á‡ÌËÏ‡ÌËfl

● ÑÂÈÌÓÒÚË ÓÚ ÂÊÂ‰ÌÂ‚ÌËfl ÊË‚ÓÚ



ˆËË)

● èÒËıÓÒÚËÏÛÎ‡ÌÚË (ÔË ‰Âˆ‡ Ò˙Ò Á‡·‡‚ÂÌ‡ Ë‰ÂÓ-

ÏÓÚÓËÍ‡)

● åËÓÂÎ‡ÍÒ‡ÌÚË - ÔÂÓ‡ÎÌË (Mydocalm, Baclofen

Ë ‰.) ËÎË ËÌÚ‡ÏÛÒÍÛÎÌË (ÅÓÚÛÎËÌÓ‚ íÓÍÒËÌ Ä ).

éí 8 Ñé 18 ÉéÑàçà




● ÑÛ„Ë




5. íÓÔÎËÌÌË ÔÓˆÂ‰ÛË:

● íÂÏÓ-ÚÂ‡ÔËfl

● äËÓ-ÚÂ‡ÔËfl





ˆËË)


ÎËÔÒ‚‡˘‡ Ë‰ÂÓÏÓÚÓËÍ‡)

● åËÓÂÎ‡ÍÒ‡ÌÚË - ÔÂÓ‡ÎÌË (Mydocalm, Baclofen

Ë ‰.) ËÎË ËÌÚ‡ÏÛÒÍÛÎÌË (ÅÓÚÛÎËÌÓ‚ íÓÍÒËÌ Ä ).

9. èÒËıÓÎÓ„Ë˜Ì‡ ËÌÚÂ‚ÂÌˆËfl:

● àÌ‰Ë‚Ë‰Û‡ÎÌ‡

● î‡ÏËÎÌ‡


● ÉÓ‚ÓÌ‡ Âı‡·ËÎËÚ‡ˆËfl

● êÂ˜Â‚‡ Âı‡·ËÎËÚ‡ˆËfl

11. ì˜Â·ÌË Á‡ÌËÏ‡ÌËfl Ë ÔÓÙÂÒËÓÌ‡ÎÌÓ ÓËÂÌÚË‡-

ÌÂ.

12. êÂÍË‡ˆËfl – ÒÔÓÚÌË ‰ÂÈÌÓÒÚË, ‡‰‡ÔÚË‡Ì‡

ÙËÁË˜ÂÒÍ‡ ‡ÍÚË‚ÌÓÒÚ


13. éÔÂ‡ÚË‚ÌÓ ÎÂ˜ÂÌËÂ (ÔË ÒÚ‡ÚË˜ÌË ÍÓÌÚ‡Í-

ÚÛË Ë ‰ÂÙÓÏ‡ˆËË)

çÄÑ 18 ÉéÑàçà



● ‰Û„Ë




5. íÓÔÎËÌÌË ÔÓˆÂ‰ÛË





ˆËË)

● åËÓÂÎ‡ÍÒ‡ÌÚË – ÔÂÓ‡ÎÌË (Mydocalm,

Baclofen Ë ‰.) ËÎË ËÌÚ‡ÏÛÒÍÛÎÌË (ÅÓÚÛÎËÌÓ‚

íÓÍÒËÌ Ä).

9. èÒËıÓÎÓ„Ë˜Ì‡ ËÌÚÂ‚ÂÌˆËfl –

● ËÌ‰Ë‚Ë‰Û‡ÎÌ‡

● Ù‡ÏËÎÌ‡

10. êÂÍË‡ˆËfl – ÒÔÓÚÌË ‰ÂÈÌÓÒÚË, ‡‰‡ÔÚË‡Ì‡

ÙËÁË˜ÂÒÍ‡ ‡ÍÚË‚ÌÓÒÚ

11. éÔÂ‡ÚË‚ÌË ËÌÚÂ‚ÂÌˆËË (ÔË ÒÚ‡ÚË˜ÌË

ÍÓÌÚ‡ÍÚÛË Ë ‰ÂÙÓÏËÚÂÚË)

10. íÖêÄèàü

10.1. åÖÑàäÄåÖçíéáçÄ íÖêÄèàü

➢➢ ãÂ˜ÂÌËÂ Ì‡ ÒÔ‡ÒÚËˆËÚÂÚ‡.● Baclofen (0,4 ‰Ó 2 mg/kg) Ò ÌËÒÍ‡ Ì‡˜‡ÎÌ‡ ‰ÓÁ‡ ‚

3 - 4 ÔËÂÏ‡ Ë ÔÓ‚Ë¯‡‚‡ÌÂ ÔÂÁ 3 ‰ÌË Ò˙Ó·‡ÁÌÓ

ÂÙÂÍÚ‡. èË ‰Âˆ‡ Ì‡ 1 - 2 „. ‰ÓÁ‡Ú‡ Â 10 - 20

mg/‰ÌÂ‚ÌÓ, Ì‡ 2-6 „.- 20 - 30 mg/‰ÌÂ‚ÌÓ, 6 - 10 „.-

30 - 60 mg/‰ÌÂ‚ÌÓ.

● Biperiden (Akineton) - 0,5 - 1 mg/‰ÌÂ‚ÌÓ Á‡ ‰Âˆ‡

ÓÚ 1 ‰Ó 3 „., ÓÚ 1 ‰Ó 3 Ï„/‰ÌÂ‚ÌÓ ÔË ‰Âˆ‡ ÓÚ 3

‰Ó 15 „.

● Tetrazepam (Myolastan) - 50 Ï„/‰ÌÂ‚ÌÓ, ÔË ‚˙Á‡-

ÒÚÌË ‰Ó 150 Ï„/‰ÌÂ‚ÌÓ

● Mydocalm - ÓÚ 50 mg ‰Ó 300-450 mg ÒÔÓÂ‰ ÍÎË-

ÌË˜ÌËfl ÂÙÂÍÚ.

● ãÓÍ‡ÎÌËÚÂ ‡ÔÎËÍ‡ˆËË Ò ÅÓÚÛÎËÌÓ‚ íÓÍÒËÌ Ä ÔÓ-

‰Ó·fl‚‡Ú ÒÔ‡ÒÚËˆËÚÂÚ‡ Á‡ 4 ‰Ó 8 ÏÂÒÂˆ‡.

➢➢ çÓÓÚÓÔÌÓ ÎÂ˜ÂÌËÂ. ● Piracetam (Nootropil, Pyr‡mem) 30-50 mg/kg

● Deanol (Cleregyl amp. 0,5g ‚ 5 ml ËÎË Rizatarun Á‡

‰Âˆ‡ ÙÎ‡ÍÓÌË 2 g ‚ 20 ml- 0,5- 1,0 g/ ‰ÌÂ‚ÌÓ ÔÂÓ-

‡ÎÌÓ - ÍÛÒÓ‚Â 1-3 ÏÂÒÂˆ‡

● Cerebrolysin 1.0 ml- 1-2 amp./‰ÌÂ‚ÌÓ 15-20 ‰ÌË,

ÔÂÁ ‰ÂÌ 2-3 ÒÂ‰ÏËˆË.

➢➢ ÄÌÚËÂÔËÎÂÔÚË˜ÌÓ ÎÂ˜ÂÌËÂ ÒÂ ÔËÎ‡„‡ ÔË ÂÔË-

ÎÂÔÚË˜ÂÌ ÒËÌ‰ÓÏ ÒÔÓÂ‰ ‚Ë‰‡ Ì‡ ÂÔËÎÂÔÚË˜ÌË-

ÚÂ ÔËÔ‡‰˙ˆË (valproate, carbamazepine, oxcar-

bazepine, lamotrigine, topiramate, levetiracetam,

gabapentin, tiagabine, clonazepam)

10.2. îàáàéíÖêÄèàü (**)

● äËÌÂÁËÚÂ‡ÔËfl – ÒÚËÏÛÎË‡ ÍÓÓ‰ËÌ‡ˆËflÚ‡ Ì‡

‰‚ËÊÂÌËflÚ‡, ÔÓ‰ÚËÒÍ‡ ÔËÏËÚË‚ÌËÚÂ ÏÂı‡ÌËÁ-

ÏË Ë ÏÓ‰ÂÎË Ì‡ ‰‚ËÊÂÌËfl, ‡ÍÚË‚Ë‡ ÏÂı‡ÌËÁÏË-

ÚÂ Ì‡ ‚ÂÚËÍ‡ÎËÁ‡ˆËfl, Á‡ÒËÎ‚‡ ÓÔÂ‰ÂÎÂÌË ÏÛÒ-

ÍÛÎË Ë ÏÛÒÍÛÎÌË „ÛÔË, ÒÚËÏÛÎË‡ ‡‚ÌÓ‚ÂÒÌËÚÂ

ÏÂı‡ÌËÁÏË Ë ÓËÂÌÚ‡ˆËflÚ‡ ‚ ÒıÂÏ‡Ú‡ Ì‡ ÚflÎÓ-

ÚÓ Ë ÔÓÒÚ‡ÌÒÚ‚ÓÚÓ, Á‡ÒËÎ‚‡ ÚÓÙËÍ‡Ú‡ Ë ÛÒ-

ÍÓfl‚‡ Í˙‚ÓÚÓÍ‡ Ì‡ ÏÛÒÍÛÎ‡, ÒÚËÏÛÎË ÂˆÂÔ-

ÚÓÌËfl ‡Ô‡‡Ú ‚ ÏÛÒÍÛÎËÚÂ, èçë Ë ñçë, ÔÓ‰-

‰˙Ê‡ ÂÎ‡ÒÚË˜ÌÓÒÚÚ‡ Ì‡ ÏÛÒÍÛÎËÚÂ Ë ‡ÁÚÂ„-

ÎË‚ÓÒÚÚ‡ Ì‡ ÒÛıÓÊËÎÌËÚÂ ‚˙ÁÍË Ë Í‡ÔÒÛÎË,

ÒÚËÏÛÎË‡ ÒÂÌÁÓÌ‡Ú‡ ËÌÚÂ„‡ˆËfl,

● çËÒÍÓ˜ÂÒÚÓÚÌÓ ËÏÔÛÎÒÌÓ Ï‡„ÌËÚÌÓ ÔÓÎÂ – ÔÓ-

‰Ó·fl‚‡ ÓÚÎ‡„‡ÌÂÚÓ Ì‡ ÍËÒÎÓÓ‰‡ ‚ Ú˙Í‡ÌËÚÂ,

ÒÚËÏÛÎË‡ ÓÍÒË‰‡ÚË‚ÌËÚÂ ÔÓˆÂÒË, ıÂÔ‡ËÌÓ-

ÔÓ‰Ó·ÌÓ Ë ÔÓÚË‚ÓÓÚÓ˜ÌÓ ‰ÂÈÒÚ‚ËÂ, ÒÚËÏÛÎË‡

‡ÍÒÓÌÌ‡Ú‡ ÂËÌÂ‚‡ˆËfl.

● ÖÎÂÍÚÓÒÚËÏÛÎ‡ˆËË – Á‡ÒËÎ‚‡ÌÂ Ì‡ ÓÔÂ‰ÂÎÂÌË

ÏÛÒÍÛÎË, ÔÓ‰˙Ê‡ÌÂ Ì‡ ÒÂÌÁÓÌ‡Ú‡ ËÌÚÂ„‡ˆËfl Ë

ÂÎ‡ÒÚË˜ÌÓÒÚÚ‡ Ì‡ ÏÛÒÍÛÎËÚÂ

● íÂÏÓÚÂ‡ÔËfl – ÏËÓÂÎ‡ÍÒË‡˘ Ë ÚÓÙË˜ÂÌ

ÂÙÂÍÚ

● ïË‰ÓÚÂ‡ÔËfl - ÏËÓÂÎ‡ÍÒË‡˘ Ë ÚÓÙË˜ÂÌ

ÂÙÂÍÚ, Í‡ÍÚÓ Ë ÒÚËÏÛÎË‡ÌÂ Ì‡ ÒÂÌÁÓÌ‡Ú‡ ËÌ-

ÚÂ„‡ˆËfl

● åÂı‡ÌÓÚÂ‡ÔËfl – Á‡ÒËÎ‚‡ÌÂ ÓÔÂ‰ÂÎÂÌË ÏÛÒÍÛÎË

Ë ÏÛÒÍÛÎÌË „ÛÔË, Í‡ÍÚÓ Ë ÍÓÓ‰ËÌ‡ˆËflÚ‡ Ì‡ ÓÔ-

Â‰ÂÎÂÌË ‰‚ËÊÂÌËfl Ë ÂÎÂÏÂÌÚË ÓÚ ‰‚Ë„‡ÚÂÎÌËfl

‡ÍÚ ÔÓÒÂ‰ÒÚ‚ÓÏ ÓÔÂ‰ÂÎÂÌË ÛÂ‰Ë

● èÓÁËˆËÓÌÌÓ ÎÂ˜ÂÌËÂ – ÒÚËÏÛÎË‡ÌÂ Ì‡ ÒÂÌÁÓÌ‡-

Ú‡ ËÌÚÂ„‡ˆËfl, ÒÚËÏÛÎË‡ÌÂ ÍÓÌÚÓÎ‡ Ì‡ „Î‡-

‚‡Ú‡, ÚÛÔ‡ Ë Í‡ÈÌËˆËÚÂ, ÔÓ‰Ó·fl‚‡ÌÂ ÓËÂÌ-

Ú‡ˆËflÚ‡ ‚ ÔÓÒÚ‡ÌÒÚ‚ÓÚÓ, ÒÚËÏÛÎË‡ÌÂ Ì‡

‡ÌÚË„‡‚ËÚ‡ˆËÓÌÌËÚÂ ÏÂı‡ÌËÁÏË

● ã‡ÁÂ‡ÍÛÔÛÌÍÚÛ‡ – Ì‡Ï‡Îfl‚‡ ˜‡ÒÚË˜ÌÓ ÏÛÒÍÛÎ-

ÌËfl ıËÔÂÚÓÌÛÒ Ë Ò‡ÎË‚‡ˆËflÚ‡, ‡ÍÚË‚Ë‡ Ë‰ÂÓ-

ÏÓÚÓËÍ‡Ú‡ Ë ÒÔÓÌÚ‡ÌÌËÚÂ ‰‚ËÊÂÌËfl

10.3. ïàèÖêÅÄêçÄ éäëàÉÖçÄñàü

êÂ‡ÍÚË‚Ë‡ "·ÂÁ‰ÂÈÌËÚÂ" (idling) ÌÂ‚ÓÌË; ÔÓ‚Ë-

¯‡‚‡ ÔÎ‡ÒÚË˜ÌÓÒÚÚ‡ Ì‡ ñçë; ÔÓ‰Ó·fl‚‡ ‡ÁÔÓÒÚ-

‡ÌÂÌËÂÚÓ Ì‡ ÍËÒÎÓÓ‰‡, ˜ÂÁ ÔÓÍ‡˜‚‡ÌÂ ÍËÒÎÓÓ‰Ì‡

Ì‡ÎË˜ÌÓÒÚ ‚ Ú˙Í‡ÌÚ‡; ÒÚËÏÛÎË‡ Ù‡„ÓˆËÚÓÁ‡Ú‡;

‚˙ÁÒÚ‡ÌÓ‚fl‚‡ ËÌÚÂ„ËÚÂÚ‡ Ì‡ Í˙‚ÌÓ-ÏÓÁ˙˜Ì‡Ú‡

·‡ËÂ‡ Ë ÍÎÂÚ˙˜ÌËÚÂ ÏÂÏ·‡ÌË; Û‚ÂÎË˜‡‚‡ ÍÎÂÚ˙˜-


ÌÓÚÓ ‰Ë¯‡ÌÂ Ë Ì‡Ï‡Îfl‚‡ ÍÎÂÚ˙˜ÌËÚÂ ÒÚ‡ÌË˜ÌË

ÔÓ‰ÛÍÚË - ˆËÚÓÍËÌËÚÂ; ÒÚËÏÛÎË‡ ÌÂÓ‚‡ÒÍÛÎ‡ËÁ‡-

ˆËflÚ‡.

10.4. êÖäêàÄñàü

óÂÁ ‡‰‡ÔÚË‡ÌË ÒÔÓÚÌË Ë/ËÎË ‰‚Ë„‡ÚÂÎÌË Á‡ÌË-

Ï‡ÌËfl Ë ‰ÂÈÌÓÒÚË Ò ÚÂıÌËÚÂ ÔÂ‰‡„Ó„Ë˜ÂÒÍË Ë ÔÒËıÓ-

ÎÓ„Ë˜ÌË ‡ÒÔÂÍÚË (“ÙËÚ&Ù˙Ì”) ÒÂ ÒÚËÏÛÎË‡ ‰‚Ë„‡-

ÚÂÎÌÓÚÓ ‡Á‚ËÚËÂ Ë ÂÏÓˆËÓÌ‡ÎÌÓÚÓ ‡‚ÌÓ‚ÂÒËÂ Ì‡

‰ÂÚÂÚÓ Ë ÒÂ ÛÎÂÒÌfl‚‡ ÒÓˆË‡ÎÌ‡Ú‡ ÏÛ ‡‰‡ÔÚ‡ˆËfl –

Ú‡ÌˆË, ÔÎÛ‚‡ÌÂ, ÚÂ‡ÔÂ‚ÚË˜Ì‡ ÂÁ‰‡, ·‡ÒÍÂÚ·ÓÎ Ë

‰Û„Ë.

** èÓ‰Ó·ÌÓÒÚËÚÂ ÔÓ ÔÓÍ‡Á‡ÌËfl, ÔÓÚË‚ÓÔÓÍ‡Á‡-

ÌËfl Ë ÏÂÚÓ‰ÓÎÓ„Ëfl, ˘Â ·˙‰‡Ú ÔÛ·ÎËÍÛ‚‡ÌË ‚

Ì‡Û˜ÌÓÚÓ ÒÔËÒ‡ÌËÂ “îËÁËÍ‡ÎÌ‡ åÂ‰ËˆËÌ‡, êÂ-

ı‡·ËÎËÚ‡ˆËfl Ë á‰‡‚Â”

10.5. éèÖêÄíàÇçé ãÖóÖçàÖ

● çÂ‚ÓıËÛ„Ë˜ÌÓ ÎÂ˜ÂÌËÂ. èË ÔÓ„ÂÒË‡˘‡

‚˙ÚÂ¯Ì‡ ıË‰ÓˆÂÙ‡ÎËfl - ¯˙ÌÚË‡ÌÂ; ÔË ÍËÒ-

ÚË, ÔÓÚË˜‡˘Ë Ò ÔÓ‚Ë¯ÂÌÓ ‚˙ÚÂ˜ÂÂÔÌÓ Ì‡Îfl-

„‡ÌÂ Ë ÔË ÚÂ‡ÔÂ‚ÚË˜ÌÓ - ÂÁËÒÚÂÌÚÌË ˜ÂÒÚË

ÙÓÍ‡ÎÌË ÂÔËÎÂÔÚË˜ÌË ÔËÒÚ˙ÔË ÒÎÂ‰ ÔÂˆËÁÌ‡

ÔÂıËÛ„Ë˜Ì‡ ÓˆÂÌÍ‡ - ÎÓÍ‡ÎÌ‡ ÂÁÂÍˆËfl Ì‡ ÎÂ-

ÁËflÚ‡; Á‡‰Ì‡ ËÁÓÚÓÏËfl.

● éÚÓÔÂ‰Ë˜ÌÓÚÓ ÎÂ˜ÂÌËÂ. ñÂÎË ÒÚ‡·ËÎËÁË‡ÌÂ

Ì‡ ÔÓÁ‡Ú‡ Ì‡ Í‡ÈÌËˆËÚÂ Ò ÓÚÂÁÌË ÒÂ‰ÒÚ‚‡.

èË ËÁ‡ÁÂÌË ÍÓÌÚ‡ÍÚÛË, Ì‡Û¯‡‚‡˘Ë ÔÓÁ‡Ú‡

Ì‡ ÚflÎÓÚÓ, ÒÂ ÓÒ˙˘ÂÒÚ‚fl‚‡ ÚÂÌ‰ÓÂÎÓÌ„‡ˆËfl.

11. éêÉÄçàáÄñàü èêà ÑàÄÉçéëíàñàêÄçÖ,ãÖóÖçàÖ à êÖïÄÅàãàíÄñàü çÄ ÑÖñÄíÄ

ëöë ëêêÑî-ñäë à Ññè 1. è‡ˆËÂÌÚË Ó‰ÂÌË Ò ÔÂ- ËÎË ÔÂËÌ‡Ú‡ÎÌ‡ Ô‡ÚÓ-

ÎÓ„Ëfl ÓÚ Ó‰ËÎÌËfl ‰ÓÏ ÒÂ Ì‡ÒÓ˜‚‡Ú Í˙Ï ÒÔÂˆË‡-

ÎËÁË‡Ì‡ ·ÓÎÌËˆ‡ Á‡ ‰Âˆ‡ Ò ˆÂÂ·‡ÎÌ‡ Ô‡‡ÎËÁ‡,

Í˙‰ÂÚÓ ÒÂ ÓÒ˙˘ÂÒÚ‚fl‚‡Ú ËÁÒÎÂ‰‚‡ÌËfl ÓÚ ÂÍËÔ Ò

ÌÂ‚ÓÎÓ„, ÙËÁËÓÚÂ‡ÔÂ‚Ú, ÍÎËÌË˜ÂÌ ÔÒËıÓÎÓ„ Ë

ÎÓ„ÓÔÂ‰, Í‡ÚÓ ÒÂ ÓÔÂ‰ÂÎfl Ò˙ÓÚ‚ÂÚÌ‡ ÔÓ„‡Ï‡

Á‡ ÍÓÏÔÎÂÍÒÌ‡ ÏÂ‰ËÍÓ-ÔÂ‰‡„Ó„Ë˜ÂÒÍ‡ Âı‡·ËÎË-

Ú‡ˆËfl Ë ÎÂ˜ÂÌËÂ.

2. ãË˜ÌËÚÂ ÎÂÍ‡Ë Ë ÒÔÂˆË‡ÎËÒÚË ÔÓ ‰ÂÚÒÍË ·ÓÎÂÒ-

ÚË ËÎË ÒÔÂˆË‡ÎËÒÚË ÔÓ ‰ÂÚÒÍ‡ ÌÂ‚ÓÎÓ„Ëfl ÒÎÂ-

‰flÚ Á‡ ‡ÌÌÓÚÓ ÌÂ‚ÌÓ-ÔÒËıË˜ÌÓ ‡Á‚ËÚËÂ Ì‡

Á‰‡‚ËÚÂ ‰Âˆ‡ Ë ‰Âˆ‡Ú‡ ÓÚ ËÒÍÓ‚ËÚÂ „ÛÔË Ë

ÔË ÍÓÌÒÚ‡Ú‡ˆËfl Ì‡ ËÁÓÒÚ‡‚‡ÌÂ ‚ ÌÂ‚ÌÓ-ÏÓ-

ÚÓÌÓÚÓ ‡Á‚ËÚËÂ Ì‡ÒÓ˜‚‡Ú Ô‡ˆËÂÌÚ‡ Í˙Ï

‰ÂÚÒÍ‡ ÌÂ‚ÓÎÓ„Ë˜Ì‡ ÍÎËÌËÍ‡/ÓÚ‰ÂÎÂÌËÂ Á‡ ÔÓ-

‚ÂÊ‰‡ÌÂ Ì‡ ˆÂÎÂÌ‡ÒÓ˜ÂÌË ËÁÒÎÂ‰‚‡ÌËfl Á‡ ‰ËÙÂ-

ÂÌˆË‡ÎÌ‡ ‰Ë‡„ÌÓÁ‡ Ë ËÁflÒÌfl‚‡ÌÂ Ì‡ ÂÚËÓÔ‡ÚÓ-

„ÂÌÂÁ‡Ú‡ Ì‡ Ññè Ë ÍÎ‡ÒËÙËˆË‡ÌÂ Ò˙„Î‡ÒÌÓ

ËÁËÒÍ‚‡ÌËflÚ‡ Ì‡ Â„ËÒÚËÚÂ ‚ Öë (äí, åêí Ì‡

„Î‡‚ÂÌ ÏÓÁ˙Í, íîÖ, ‰ÓÔÎÂÒÓÌÓ„‡ÙÒÍË ËÁÒÎÂ‰-

‚‡ÌËfl, ‚ËÛÒÓÎÓ„Ë˜ÌË/, ÒÂÓÎÓ„Ë˜ÌË ËÁÒÎÂ‰‚‡ÌËfl

Á‡ ‚Ó‰ÂÌË ËÌÙÂÍˆËË).

3.ëÎÂ‰ ËÁflÒÌfl‚‡ÌÂ Ì‡ ‰Ë‡„ÌÓÁ‡Ú‡ Ë ÙÓÏ‡Ú‡ Ì‡

Ññè, ‰ÂÚÂÚÓ ÒÂ Ì‡ÒÓ˜‚‡ Á‡ ÔÓ‚ÂÊ‰‡ÌÂ Ì‡ ÍÓÏÔ-

ÎÂÍÒÌ‡ ÏÂ‰ËÍÓ-ÔÂ‰‡„Ó„Ë˜ÂÒÍ‡ Âı‡·ËÎËÚ‡ˆËfl ‚

ÒÔÂˆË‡ÎËÁË‡ÌË ·ÓÎÌËˆË Á‡ Âı‡·ËÎËÚ‡ˆËfl ËÎË

ÓÚ‰ÂÎÂÌËfl Á‡ ÙËÁËÍ‡ÎÌ‡ Ë Âı‡·ËÎËÚ‡ˆËÓÌÌ‡ ÏÂ-

‰ËˆËÌ‡ Í˙Ï ÏÌÓ„ÓÔÓÙËÎÌË ËÎË ÒÔÂˆË‡ÎËÁË‡ÌË

·ÓÎÌËˆË Á‡ ‡ÍÚË‚ÌÓ ÎÂ˜ÂÌËÂ ËÎË ÒÔÂˆË‡ÎËÁË‡ÌË

·ÓÎÌËˆË Á‡ ‰ÓÎÂÍÛ‚‡ÌÂ, ÔÓ‰˙ÎÊËÚÂÎÌÓ ÎÂ˜ÂÌËÂ Ë

Âı‡·ËÎËÚ‡ˆËfl.

4. èË Ò˙ÏÌÂÌËÂ Á‡ ÂÔËÎÂÔÒËfl ÔË ‰Âˆ‡ Ò Ññè ÎË˜-

ÌËflÚ ÎÂÍ‡ Ì‡ÒÓ˜‚‡ Ô‡ˆËÂÌÚ‡ Í˙Ï ‰ÂÚÒÍË ÌÂ‚-

ÓÎÓ„ Á‡ ÒÔÂˆË‡ÎËÁË‡ÌË ÖÖÉ ËÁÒÎÂ‰‚‡ÌËfl Ë Ò˙-

ÓÚ‚ÂÚÌÓ ÎÂ˜ÂÌËÂ.

5. èË Ò˙ÏÌÂÌËÂ Á‡ Á‡‰˙ÊÍ‡ ‚ ÛÏÒÚ‚ÂÌÓÚÓ ‡Á‚Ë-

ÚËÂ ‰Âˆ‡Ú‡ Ò Ññè ÒÂ Ì‡ÒÓ˜‚‡Ú Á‡ ÔÒËıÓÎÓ„Ë˜Ì‡

ÓˆÂÌÍ‡ ÓÚ ÍÎËÌË˜ÂÌ ÔÒËıÓÎÓ„ Ë ÔÓ‚ÂÊ‰‡ÌÂ Ì‡

ÒÔÂˆË‡ÎËÁË‡ÌË ËÌÚÂ‚ÂÌˆËË Á‡ ÒÚËÏÛÎË‡ÌÂ Ì‡

ÍÓ„ÌËÚË‚ÌËÚÂ ÔÓˆÂÒË. èË ÌÂÓ·ıÓ‰ËÏÓÒÚ ÔÂ-

‰Ë‡Ú˙˙Ú, ÌÂ‚ÓÎÓ„˙Ú ËÎË ‰ÂÚÒÍËflÚ ÌÂ‚ÓÎÓ„

Ì‡ÁÌ‡˜‡‚‡Ú ÌÓÓÚÓÔÌÓ ÎÂ˜ÂÌËÂ.

6. èË ÁËÚÂÎÌË Û‚ÂÊ‰‡ÌËfl ÎË˜ÌËflÚ ÎÂÍ‡ Ì‡ÒÓ˜-

‚‡ Ô‡ˆËÂÌÚËÚÂ Í˙Ï ÒÔÂˆË‡ÎËÒÚ- ÓÙÚ‡ÎÏÓÎÓ„.

7. è‡ˆËÂÌÚËÚÂ Ò Ññè ÔÓ‚ÂÊ‰‡Ú ÍÓÏÔÎÂÍÒÌ‡ ÏÂ-

‰ËÍÓ-ÔÂ‰‡„Ó„Ë˜ÂÒÍ‡ Âı‡·ËÎËÚ‡ˆËfl ‚ ÒÔÂˆË‡ÎË-

ÁË‡ÌË ·ÓÎÌËˆË Á‡ Âı‡·ËÎËÚ‡ˆËfl, ÒÔÂˆË‡ÎËÁË‡-

ÌË ·ÓÎÌËˆË Á‡ ‰ÓÎÂÍÛ‚‡ÌÂ, ÔÓ‰˙ÎÊËÚÂÎÌÓ ÎÂ˜Â-

ÌËÂ Ë Âı‡·ËÎËÚ‡ˆËfl ËÎË ÓÚ‰ÂÎÂÌËfl ÔÓ ÙËÁËÓ-

ÚÂ‡ÔËfl Ë Âı‡·ËÎËÚ‡ˆËfl Í˙Ï ÏÌÓ„ÓÔÓÙËÎÌË

ËÎË ÒÔÂˆË‡ÎËÁË‡ÌË ·ÓÎÌËˆË Á‡ ‡ÍÚË‚ÌÓ ÎÂ˜ÂÌËÂ

8. Ññè Â ıÓÌË˜ÌÓ Á‡·ÓÎfl‚‡ÌÂ Ë Ô‡ˆËÂÌÚËÚÂ ÔÓ‰-

ÎÂÊ‡Ú Ì‡ ‰ËÒÔ‡ÌÒÂËÁ‡ˆËfl Ë ÔÓÒÎÂ‰fl‚‡ÌÂ ÓÚ

ÎË˜ÂÌ ÎÂÍ‡, ÒÔÂˆË‡ÎËÒÚ ‰ÂÚÒÍË ÌÂ‚ÓÎÓ„/ÌÂ‚Ó-

ÎÓ„.


ãàíÖêÄíìêÄ1. Å‡‰‡ÎflÌ, ã.é., ÜÛ·‡, ã.í., ÇÒÂ‚ÓÎÓÊÒÍ‡fl, ç.å. ÑÂÚÒÍËÂ ˆÂ-

Â·‡Î¸Ì˚Â Ô‡‡ÎË˜Ë. Ç: êÛÍÓ‚Ó‰ÒÚ‚Ó ÔÓ ÌÂ‚ÓÎÓ„ËË ‡ÌÌÂ„Ó‰ÂÚÒÍÓ„Ó ‚ÓÁ‡ÒÚ‡. åÓÒÍ‚‡: “á‰ÓÓ‚fl”, 1980, 273-311.

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