3
I?I?NOA?NOAI IOI?IIE CAeI?IA”ss OE?A?IE
?AAII-O?AIE?ANUeEA AeA?AEAAIA IAAeE*IA AEAAeAI?ss
OAeE 616.33.-002.44+616.37-002-07+616-08-039.73
Ae C A I I E I A N Ue E A
Aaeaioeia Aieiaeeie??aia
EIIIEAENIA Ae?AAIINOEEA ? E?EOAAIIss OAI?EO
IA AE?ACEIAO OAI?IAO AeAAIAAeOessOEIAEI? EEOEE II?AeIAIO C
O?II?*IEI IAIE?AAOEOII
14.01.02 – aioo??oi? oai?iae
AAOI?AOA?AO
aeena?oaoe?? ia caeiaoooy iaoeiaiai nooiaiy
aeieoi?a iaaee/ieo iaoe
?aaii-O?aie?anuee – 1999
Aeena?oaoe?y ? ?oeiienii
?iaioa aeeiiaia o ?aaii-O?aie?anuee?e aea?aeaai?e iaaee/i?e aeaaeai??
Iaoeiaee eiinoeueoaio: aeieoi? iaaee/ieo iaoe, i?ioani?
Iaeei Aaneeue ?aaaiiae/,
?aaii-O?aie?anueea
aea?aeaaia iaaee/ia
aeaaeai?y, caa?aeoaa/ eaoaae?e
i?iiaaeaaoeee aioo??oi?o oai?ia
Io?oe?ei? iiiiaioe: aeieoi? iaaee/ieo iaoe, i?ioani?
I?uoe Aaneeue A?eai?iae/,
?aaii-O?aie?anueea
aea?aeaaia iaaee/ia
aeaaeai?y, i?ioani? eaoaae?e
oa?ai??
oaeoeueoaoo i?neyaeeieiiii?
ina?oe
aeieoi? iaaee/ieo iaoe, i?ioani?
Iaeauoe Aiaoie?e Iao?iae/,
Iaoe?iiaeueiee iaaee/iee
oi?aa?neoao
?i. I.I. Aiaiiieueoey,
i?ioani? eaoaae?e
aini?oaeueii? oa?ai?? ?2
aeieoi? iaaee/ieo iaoe, i?ioani?
Aieioei Ieaenaiae? ?aaiiae/,
Aoeiaeinueea aea?aeaaia iaaee/ia
aeaaeai?y, caa?aeoaa/ eaoaae?e
i?iiaaeaaoeee aioo??oi?o oai?ia
I?ia?aeia onoaiiaa: Iaoe?iiaeueiee aea?aeaaiee oi?aa?neoao ?i. I.I.
Aiaiiieueoey IIC Oe?a?ie, eaoaae?a i?iiaaeaaoeee aioo??oi?o oai?ia ? 1.
Caoeno a?aeaoaeaoueny “ 15 ” o?aaiy 1999 ?. i 14-00
aiaeei? ia
can?aeaii? niaoe?ae?ciaaii? a/aii? ?aaee Ae 20.601.01
?aaii-O?aie?anueei? aea?aeaaii? iaaee/ii? aeaaeai?? ca aae?anith:
284000, i. ?aaii-O?aie?anuee, aoe. Aaeeoeueea, 2.
C aeena?oaoe??th iiaeia iciaeiieoeny o a?ae?ioaoe? ?aaii-O?aie?anueei?
aea?aeaaii? iaaee/ii? aeaaeai?? ca aae?anith:
i. ?aaii-O?aie?anuee, aoe. Aaeeoeueea, 7.
Aaoi?aoa?ao ?ic?neaiee “ 14 ” ea?oiy 1999 ?.
A/aiee nae?aoa?
niaoe?ae?ciaaii? a/aii? ?aaee,
aeieoi? iaaee/ieo iaoe, i?ioani? I.A. I?ei/ae
CAAAEUeIA OA?AEOA?ENOEEA ?IAIOE
Aeooaeuei?noue i?iaeaie
I?ioyaii inoaii?o ?ie?a e?euee?noue ethaeae, ye? oai??thoue ia ae?aceiao
oai?iao (AO) aeaaiaaeoeyoeiaei? eeoee (AeIE), i?ia?aneaii c?inoa? o
anueiio na?o?, ui ?iaeoue ?? ae?aaiinoeeo oa e?eoaaiiy iaei??th c
iaeaeooaeuei?oeo iaaeeei-nioe?aeueieo i?iaeai. O ?a?iiaenueeeo e?a?iao
ai?iaeiaae aeeooy ia AO oai??? 10-14% ianaeaiiy (A.O. Aaneeaiei e
niaao., 1987; ?.?.Aeaaoy?ueiaa, I.A. Oa?/aiei, 1995; A.I. Iaeauoe, A.A.
Ia?aaea??e, A.N.Na?ioeeoeueeee, 1995; I.ss. Aaaae, 1998; A.J.Smout et
al., 1992; T. Rosch et al., 1995).
A Oe?a?i? ca inoaii?o i”youe ?ie?a a?aecia/aii i?aeaeuaiiy ??aiy
caoai?thaaiino? ia AO ia 16% (C.I. Aaeaiei, 1995; I.I. Aeoae/aiei,
1998). Ie?ai? aaoi?e ia?aaeaa/athoue a iaeaeeae/? ?iee iiaeaeueoee ??no
caoai?thaaiino? ia AO oeoieo (O) oa AeIE (O.E. Eiia?ia, A.O. Eaaoeei,
1997).
Aaaee?noue ia?aa?ao oai?iae, /ano? ?aoeeaeeae ? oneeaaeiaiiy i?eaiaeyoue
aei o?eaaei? ao?aoe i?aoeacaeaoiino? iaoe??io?a, ?o ?iaae?aeiino?, ui
aeiaaa? iiaeaeueoiai iiooeo ?aca?a?a i?aeaeuaiiy aoaeoeaiino?
ae?aaiinoeee ? e?eoaaiiy (A.N. Eiaeiia e niaao., 1989; I.ss. A?eai?ueaa
e niaao., 1995).
Ia??aeei niinoa??aa?oueny ii?aeiaiiy AO c oai?iaaie i?aeoeoieiai? caeice
(IC) ? ia/?iee (E.A. Naeiae/, 1977; J. Hebrero et al., 1980; F.P. Gall,
1981 ? ?io?). ?ioaa?aoe?y iaoiae?a ae?aaiinoeee ni?eyoeia
?aoe?iiaeueiiio aeai?o oaeoeee ? iaoiae?a e?eoaaiiy (A.O. Eaaoeei e
niaao., 1993; I.TH. Eieiii?oeue ? ni?aaao., 1995; A.C. Ii?ic, 1998).
Ee?i?/iee ?ioa?an neeaaea? iiaeeaeaia aea/aiiy iaoai?cio oeueoea?iaaiaco
a ?acoeueoao? ae?? Helicobacter pylori (E.E. A?oei, A.A. Enaeia, 1995;
B.J. Marschall, I. Warren, 1984).
?yae aeine?aeiee?a i?aee?aneth?, ui AO AeIE ni?e/eith? nenoaii? ?
eieaeuei? ?iceaaee aaiinoaco, i?e?ioee?eoeyoe?? oa aaii?aa?/i?
oneeaaeiaiiy (A.E. Aei?ioaaa e niaao., 1984; I.I. Iaoeaiiaa e niaao.,
1991; A.A. Nainiiia e niaao., 1992; ?.I.Nea/eiaa, 1998).
Aeecaaeain i?ae oaeoi?aie aa?an?? ? caoenoo iaoiiaeth? ?oeioaaiiy
caoeniiai aa?”??o neeciai? iaieiiee O ? AeIE c oi?ioaaiiyi o?ii?/iiai
?aoeeaeeaoth/iai aeeno?io?/ii-caiaeueiiai i?ioeano (I.N. Aaoa?aaa, 1988;
TH.N. Iaeia, 1994). Oiio, anoaiiaeaiiy ?aii?o ee?i?/ieo iciae
caoai?thaaiiy (o?ii?/iiai iaie?aaoeoo) ni?eyoeia nai?/ani?e
iaoiaaiaoe/i?e oa?ai??.
A e?oa?aoo?? i?ae?eia?oueny ieoaiiy i?i ae?aaiinoe/ia cia/aiiy ?ioiieo ?
aaiaoe/ieo iieaciee?a o iaoe??io?a c AO AeIE ? o?ii?/iei iaie?aaoeoii
(OI) (E.A. Aeieo?eaa, 1996; O.E. Eiia?ia, A.O. Eaaoeei, 1997; I.A.
Aoaa?a?eoe, 1998). Oeacii I?aceaeaioa Oe?a?ie a?ae 4 ethoiai 1999 ?ieo ?
111/99 noaaeaii oe?eueiao eiiieaenio i?ia?aio aaiaoe/iiai iii?oi?eiao a
Oe?a?i? ia 1999-2003 ?iee.
?anioae?eainueea iaoeiai-i?aeoe/ia eiioa?aioe?y Oe?a?ie c i?iaeaie
“E?eoaaiiy aano?iaeoiaeaiaeueieo ae?acie ? ?o oneeaaeiaiue” (1995)
?aeiiaiaeoaaea i?iaeiaaeeoe aea/aiiy ao?ieia?? oa iaoiaaiaco AO,
?ic?iaeo no/anieo iaoiaaiaoe/ieo iaoiae?a e?eoaaiiy.
Iaei??th c aeooaeueieo i?iaeai no/anii? aano?iaioa?ieia?? ? canoinoaaiiy
iiaeo, a?eueo aoaeoeaieo i?aia?ao?a a oa?ai?? AO ? ii?aeiaii? iaoieia??
i?aai?a aano?iaeoiaeaiaeueii? ciie (AAeC) (E.E. Aeaaoy?aaa e niaao.,
1998; A.A. Ia?aaea?ee e niaao., 1998 ? ?io?).
Caeeoathoueny iaae??oaieie ieoaiiy i?i iniaeeaino? ee?i?/iiai ia?aa?ao
AO AeIE ? OI, aaiaoe/iiai iii?oi?eiao ? i?iaiicoaaiiy noeeueiino?
iaoe??io?a aei ii?aeiaii? iaoieia??, aeai?eoio eiiieaenii? ae?aaiinoeee,
i?eioeeie oa iaoiaee iaoiaaiaoe/iiai e?eoaaiiy oai?eo, ui aeaco? ia
neeaaei?noue oa aeooaeuei?noue i?iaeaie.
Ca”ycie ?iaioe c iaoeiaeie i?ia?aiaie, ieaiaie, oaiaie
Oaia aeena?oaoe?? caoaa?aeaeaia A/aiith ?aaeith ?aaii-O?aie?anueei?
aea?aeaaii? iaaee/ii? aeaaeai?? (i?ioieie ?4 a?ae 11 ea?oiy 1994 ?.), ?
o?aaiaioii iniiaiiai iaoeiai-aeine?aeieoeueeiai iai?yieo aeaaeai?? c
i?iaeaie “?ic?iaea iiaeo iaaee/ieo oaoiieia?e ? noaiaea?o?a ae?aaiinoeee
oa e?eoaaiiy iaeaaaeeea?oeo ia?ioaeoe?eieo caoai?thaaiue”, iiia?
aea?aeaaii? ?a?no?aoe?? (01.02.032.96i).
Iaoa aeine?aeaeaiiy
I?aeaeueoe aoaeoeai?noue e?eoaaiiy oai?eo ia AO AeIE ii?aeiaio c OI ia
iniia? iiaeeaeaiiai aeine?aeaeaiiy ao?iiaoiaaiaco caoai?thaaiiy,
?ic?iaee eiii”thoa?ii? i?ia?aie aaiaoe/iiai i?iaiicoaaiiy noeeueiino?
iaoe??io?a aei ii?aeiaii? iaoieia??, aeai?eoio ?aoe?iiaeueii?
ae?aaiinoeee oa aeeoa?aioe?eiaaiiai e?eoaaiiy oai?eo.
Caaaeaiiy aeine?aeaeaiiy
1. Aea/eoe ae?aaiinoe/io ?ioi?iaoeai?noue eiiieaeno no/anieo ee?i?/ieo,
eaai?aoi?ieo, aiaeineii?/ieo, oeueo?acaoeiaeo, ?aioaaiieia?/ieo,
ii?oieia?/ieo ? oeueo?ano?oeoo?ieo iaoiae?a i?e ii?aeiai?e iaoieia??
i?aai?a AAeC.
2. Aecia/eoe /anoioo oae?eiaaeoa?iiai ian?thaaiiy neeciai? iaieiiee O ?
AeIE oa aieea aaeoa??aeueii? ?iaac?? ia ia?aa?a AO, ii?aeiaii? c OI, a
caeaaeiino? a?ae ae?i?iaoe?? aai ia?nenoaioe?? oeeo aaeoa??e.
3. Anoaiiaeoe ?aii? ee?i?/i? iciaee caeo/aiiy a iaoieia?/iee i?i-
oean IC, c’ynoaaoe ae?aaiinoe/io ?ioi?iaoeai?noue niiia?ao?? oa
aiaeineii?/ii? ?ao?ia?aaeii? iaie?aaoioieaia?ia?ao??.
4. Aeine?aeeoe aeeiai?eo iieaciee?a aaiinoaco i?e ii?aeiai?e iaoieia??
aei ? i?ney aeeoa?aioe?eiaaiiai eiiieaeniiai e?eoaaiiy oai?eo.
5. Aea/eoe aieea ?ioiieo ci?i oa aaiaoe/ieo oaeoi??a ia iaoiaaiac oa
ee?i?/iee ia?aa?a ii?aeiaii? iaoieia?? AeIE ? IC.
6. I?iaanoe ii??aiyeueiee aiae?c aoaeoeaiino? oa?iaeii?aia?ao?a
aio?aeue, eaaiaoae, iae?ieoiaa ie?y, canoiniaaieo aeey e?eoaaiiy oe???
eaoaai??? oai?eo.
Iaoeiaa iiaecia iaea?aeaieo ?acoeueoao?a
– Aia?oa a Oe?a?i? i?iaaaeaii eiiieaenia aea/aiiy ee?i?/ieo i?iya?a,
ii?oieia?/ii? oa?aeoa?enoeee, ooieoe?iiaeueiiai noaio, aiaeineii?/ii? oa
niiia?ao?/ii? ea?oeie i?aai?a AAeC o oai?eo ia AO AeIE, ii?aeiaio c OI.
– ?ic?iaeaii aeai?eoi ?aoe?iiaeueii? ae?aaiinoeee AO AeIE, ii?aeiaii? c
OI, cai?iiiiiaai? iaoiaaiaoe/ii iaa?oioiaai? i?aeoiaee aei
aeeoa?aioe?eiaaiiai e?eoaaiiy oai?eo.
– Aia?oa i?aaenoaaeaia eiiieaenia oa?aeoa?enoeea aaiaoe/ieo oaeoi??a: 44
aea?iaoiae?o?/ieo iieaciee?a, a?oi e?ia? ca nenoaiith AAI ? ?acon
iaeaaei?noth, ?ioa?oacieo yaea? niiaoe/ieo ee?oei, ?o cia/aiiy a
i?iaiicoaaii? noeeueiino? iaoe??io?a aei ii?aeiaii? iaoieia??.
– Aia?oa ?ic?iaeaia eiii”thoa?ia i?ia?aia aecia/aiiy aaiaoe/ii?
noeeueiino? ?iaeea?ae?a aei AO AeIE a ii?aeiaii? c OI iaoiaeii
ei?aeyoe?eiiai oa oaeoi?iiai aiae?co. Ia iniia? iieaciee?a ea??ia?aie
anoaiiaeai? e?eoa??? aoaeoeaiino? e?eoaaiiy aeaii? eaoaai??? oai?eo.
– Aeine?aeaeaii aa??aioe a?noioiiia?ao?/ieo aca?iia?aeiioaiue aieiaee IC
c oeeaoeeiith AeIE oa ?o cia/aiiy a iaoiaaiac? ii?aeiaii? iaoieia??.
– Aia?oa aecia/ai? iniiai? ia?aiao?e ?iceaae?a nenoaie aaiinoaco,
ee?oeiiiai oa aoii?aeueiiai ?ioi?oaoo i?e AO AeIE ii?aeiai?e c OI.
– Aia?oa i?iaaaeaia eiiieaenia ioe?iea aene?aoi?ii? ? ?ie?aoi?ii?
ooieoe?e IC, cai?iiiiiaai? ae?aaiinoe/i? oanoe aeey aeyaeaiiy ?aiiuei?
noaae?? o?aaeaiiy IC.
– Iieacai? iaoia?noieia?/i?, oeueo?ano?oeoo?i? oa ooieoe?iiaeuei? ci?ie
a i?aaiao AAeC, ?o aeeiai?ea oa ?ieue a iaoiaaiac? caoai?thaaiiy.
I?aeoe/ia cia/aiiy iaea?aeaieo ?acoeueoao?a
Io?eiai? ?acoeueoaoe aeicaieeee anoaiiaeoe ?ai?oa iaeia?aeii?
iniaeeaino? ee?i?/iiai ia?aa?ao AO AeIE ii?aeiaii? c OI.
?icaeiooi iiaee iai?yiie aoaeoeaii? ae?aaiinoeee ? e?eoaaiiy iaoiaeaie
aiaeineii?/ii? ?ao?ia?aaeii? iaie?aaoioieaia?ia?ao?? i?e iayaiino? o
oai?eo ia AO AeIE iaoieia?? a iaie?aaoe/i?e /e aeia/aaea?aei?e
i?ioieia?e nenoai?.
Aeai? i?i oiiia?ao?/i? ni?aa?aeiioaiiy aieiaee IC ? oeeaoeeie AeIE
?icoe?ththoue ciaiiy i?i ?o ?ieue a iaoiaaiac? ii?aeiaii? iaoieia?? ?
iiaeii? a?aoiaoaaoenue i?e ?ino?oiaioaeuei?e ae?aaiinoeoe? oa
iia?aoeaieo ao?o/aiiyo ia i?aaiao AAeC.
?ic?iaeaii ii?oiooieoe?iiaeuei? ae?aaiinoe/i? oanoe, aeai?eoi
ae?aaiinoeee oa eiiieaeniiai i?ioeae?aceiaiai e?eoaaiiy, yeee cia/ii
i?aeaeuo? aoaeoeai?noue, nei?i/o? oa?i?ie ianoaaeaiiy oa e?eoaaiiy
oai?eo.
?ic?iaeai? a aeena?oaoe?? ?aeiiaiaeaoe?? c eiiieaenii? ae?aaiinoeee oa
e?eoaaiiy iaoe??io?a c aeoiaeaiaeueiith ae?aceith ii?aeiaiith c OI
ai?iaaaeaeai? a ee?i?eao ?aaii-O?aie?anueei?, Aoeiaeinueei?,
Oa?iii?euenueei? aea?aeaaieo iaaee/ieo aeaaeai?e, IN* eiioea?io “I??aia”
i. Eaeoo oa aeei?enoiaothoueny a o/aiaiio i?ioean? nooaeaio?a iaaee/ieo
oaeoeueoao?a oeeo aoc?a, i?e i?aeaioiaoe? e?ea??a-?ioa?i?a ia eaoaae?ao
i?neyaeeieiiii? ina?oe.
Iniaenoee aianie caeiaoaa/a
Aaoi? naiino?eii i?iaaea aiae?c e?oa?aoo?e ca oaiith ?iaioe, cae?enieea
eiiieaenio ae?aaiinoeeo, e?eoaaiiy oai?eo, aeine?aeaeaiiy iieaciee?a
aaiinoaco, aaiaoe/ieo ia?ea??a, a?iin?eiiai iaoa??aeo, ?ao?iniaeoeaiee
aiae?c caoai?thaaiino? ethaeae ia AO ii?aeiaio c OI ca i”youe ?ie?a, ye?
ia?aaoaaee ia e?eoaaii? a iaeani?e ee?i?/i?e e?ea?i?. Iiooeoaa/
ii?aoethaaea ? cai?iiiioaaea ae?aaiinoe/iee aeai?eoi ii?aeiaii?
iaoieia??, eiii”thoa?io i?ia?aio aecia/aiiy aaiaoe/ii? noeeueiino? aei
AO AeIE iaoiaeii ei?aeyoe?eiiai aaaaoioaeoi?iiai aiae?co, i?iaaea
iaoaiaoe/io ia?iaeo iaea?aeaieo ?acoeueoao?a. E?ioeaaa ?ioa?i?aoaoe?y
?acoeueoao?a, iaoeiaeo iieiaeaiue oa aeniiae?a i?iaiaeeeanue ?acii c
iaoeiaei eiinoeueoaioii.
Ai?iaaoe?y ?acoeueoao?a aeena?oaoe??
Iniiai? iieiaeaiiy aeena?oaoe?? iioae?eiaai?, aeiiia?aeaeenue ?
iaaiai?ai? ia: OO??-OO?V eiioa?aioe?yo iieiaeeo a/aieo-iaaeee?a
?aaii-O?aie?anueei? iaaee/ii? aeaaeai?? (1988-1994); ?anioae?eainuee?e
eiioa?aioe?? aano?iaioa?ieia?a, Oa?e?a, 1994; ?? c”?cae? aaiaoee?a
Oe?a?ie, Euea?a, 1995; ?aa?iiaeueieo nai?ia?ao “Canoinoaaiiy iiaeo
i?aia?ao?a caaiaeo “Aaaeaii ??ooa?”, Aei?i?iiao?ianuee, 1996; “No/ani?
i?aeoiaee aei e?eoaaiiy a?oa??aeueieo a?ia?oaic?e oa ae?aceiai? oai?iae
oeoieo ? AeIE”, ?aaii-O?aie?anuee, 1996; “Aeooaeuei? i?iaeaie iaaee/iiai
ianeoaiaoaaiiy i?aoethth/eo ia cae?cie/iiio o?ainii?o?. Aeieia?y oa noai
caei?ia”y ianaeaiiy a no/anieo oiiaao”, Oaeai?iae, 1996; “Aeooaeuei?
ieoaiiy ?aaa?e?oaoe?? aano?iaioa?ieia?/ieo oai?eo”, *a?i?aoe?, 1996; ?V
eiia?an? NOOEOO, Oaeai?iae, 1998; XIV c”?cae? oa?aiaao?a Oe?a?ie, Ee?a,
1998; iaoeia?e eiioa?aioe?? aano?iaioa?ieia?a Oe?a?ie, Oa?e?a, 1998; V?
I?aeia?iaeiiio eiia?an? iaoieia?a Oe?a?ie, A?iieoey, 1998;
I?aeia?iaeiiio neiiic?oi? “Ae?aaiinoe/ia oa e?eoaaeueia aiaeineii?y”,
Ee?a – sseoa, 1998; eiia?an? aio?iiieia?a Oe?a?ie, A?iieoey, 1998;
eiioa?aioe?? “Aeooaeuei? ieoaiiy ee?i?/ii? iaaeeoeeie oa aeieia??,”
Iieoaaa, 1998; VI eiioa?aioe?? o??o?a?a aaiaoieia?a Oe?a?ie, Ee?a, 1998.
Ioae?eaoe??
Ca iaoa??aeaie aeena?oaoe?? iioae?eiaaii 33 ae?oeiaaieo i?aoe?, 18 c ieo
a i?ia?aeieo oaoiaeo aeo?iaeao.
Ianya ? no?oeoo?a aeena?oaoe??
Aeena?oaoe?y aeeeaaeaia oe?a?inueeith iiaith ia 285 noi??ieao
iaoeiiieniiai oaenoo. Neeaaea?oueny c anooio, iaeyaeo e?oa?aoo?e, iieno
ia”?eoo oa iaoiae?a aeine?aeaeaiiy, naie ?icae?e?a aeanieo
aeine?aeaeaiue, iaaiai?aiiy ?acoeueoao?a, aeniiae?a, i?aeoe/ieo
?aeiiaiaeaoe?e, nieneo aeei?enoaii? e?oa?aoo?e, yeee i?noeoue 403
aeaea?aea a?o/eciyieo ? ca?oa?aeieo aaoi??a.
Aeena?oaoe?y ?ethno?iaaia ? aeieoiaioiaaia 50 oaaeeoeyie, 42 ?enoieaie,
40 i?e?ioioia?ao?yie ? ?o iiioaaeaie.
?ACOEUeOAOE AeINE?AeAEAIUe OA ?O IAAIAI?AIIss
Aeey c”ynoaaiiy yeino? i?eaeeoo?ai? ae?aaiinoeee, oa?aeoa?o ? aeeaeie
caiaeueii-aeano?oeoeaieo ci?i a i?aaiao AAeC, ?o oiiia?aoiaiaoii?/ieo
aca?iia?aeiioaiue ? ?ie? a ao?iiaoiaaiac? ii?aeiaii? iaoieia??, ia
ia?oiio aoai? ?iaioe iaie i?iaaaeaii aiae?c eaoaeueiino? ca 1990-96 ?iee
ii ?aaii-O?aie?anueeiio iaeaniiio iaoaiaoii?/iiio ath?i. Aea/aii 286
i?ioieie?a aooiin?e in?a c aano?iaeoiaeaiiiaie?aaoe/iith iaoieia??th.
O?ii?/iee iaie?aaoeo ae?aaiinoiaaii o 49,3% oai?eo, iaie?aiiae?ic – o
17%, iooeeie – o 22,7%, iaiao?aoe?th ae?acee – o 6,2%, i?ei?inoaiic – o
4,8% oai?eo. Iaiiaia ni?aiaae?iiy ee?i?/ieo ? iaoieiaiaiaoii?/ieo
ae?aaiic?a anoaiiaeaii o 22,5% oai?eo.
Iae?i-i?e?ineii?/i? aeine?aeaeaiiy 25 i?aia?ao?a
iaie?aaoiaeoiaeaiaeueieo eiiieaen?a iieacaee, ui aca?iia?aeiioaiiy
aieiaee IC ? AeIE a ieo oa?aeoa?ecoaaeenue iaeiei c o?ueio ianooiieo
aa??aio?a: 1) oeaieia aieiaee IC /?oei a?aeiaaeiaaia a?ae AeIE aeaniith
eainoeith, ?ieiee ? oa?ii aee?iai? ee?oeiaeie; 2) oeaieia aieiaee IC
i?iieco? na?iciee ? /anoeiai i”ycaaee oa?e ? i?aaenoaaeaia an?ia ??
aeaiaioaie; 3) oeaieia aieiaee IC “?io?eueo?o?” oa?e AeIE ? aeeth/a? an?
?? aeaiaioe. Oae? o?ni? no?oeoo?i? aca?iica”ycee i?aai?a a?ae?a?athoue
aaaeeeao iaoiaaiaoe/io ?ieue a ?icaeoeo ii?aeiaii? iaoieia??, ui
ocaiaeaeo?oueny c aeaieie A.E. Ianoooaiei ? ni?aaao. (1972), O.A.
Naaaeiie e niaao. (1984), A.I. O?aeeianueeiai e ni?aaao. (1996), J.
Hebrero et al. (1980) oa ?i.
I?ae iaoei niinoa?aaeaiiyi ? e?eoaaiiyi ciaoiaeeeiny 293 oai?eo ia
AO AeIE. Na?aae ieo aoei 244 (83,3%) /ieia?e?a ? 49 (16,7%) ae?iie.
Ni?aa?aeiioaiiy /ieia?e?a ? ae?iie noaiiaeoue 5:1. A?e oai?eo eieeaaany
a?ae 19 aei 87 ?ie?a. A?eueo?noue iaoe??io?a, 179 (61%) ia
aeoiaeaiaeueio ae?aceo oai??ee iiiaae o?e ?iee. Iaie anoaiiaeaii, ui
ii/aoeia? neiioiie OI c”yaeythoueny a na?aaeiueiio /a?ac o?e ?iee a?ae
ii/aoeo caoai?thaaiiy.
Aaaeei iacaaoe yea-iaaoaeue ?ioa caoai?thaaiiy, i?e yeiio ee?i?/ia
ea?oeia aoea a oaeith aa??aaaeueiith, ye i?e AO ii?aeiai?e c iaoieia??th
IC. Oea e c?icoi?ei, ine?eueee aiia aecia/a?oueny eieae?caoe??th
ae?acee, noaae??th ia?aa?ao (caaino?aiiy /e ?ai?n??), aeeaeiith
caiaeueii-aeano?oeoeaieo ci?i, nooiaiai ian?thaaiiy neeciai? iaieiiee O
? AeIE H. pylori oiui.
Ae?aceiaee aeaoaeo neeciai? iaieiiee AeIE a noaae?? ?ai?n?? oai?iae, ye
i?aaeei, ia? a?eueo noa?oo ee?i?/io ea?oeio, i?ae a noaae?th
caaino?aiiy. Iae/ano?oei i?iyaii AO AeIE c noiooi?i o?aaeaiiyi IC aoa
ooiee a?eue a ai?aano??? – o 291 (99,3%) oai?iai, eeoa 2 iaoe??ioe
(0,7%) ia a?eue ia nea?aeeeeny. Caaino?aiiy AO ia??aeei (o 35,5% oai?eo)
i?iyaeyeiny iino?eiei aieai.
O oai?eo ia AO AeIE i?e aoyaiaii? a iaoieia?/iee i?ioean IC iinooiiai
cieeaea oa?aeoa?ia naciii?noue caaino?aiiy ? oeeee?/i?noue aeieeiaiiy
aieth, ao?a/aany ca”ycie aieueiaiai neiae?iio c i?eeiiii ?ae?, a?eue
noaaaa iino?eiei, ???aae?thaaa a iiia?aeiao ae?eyieo ? e?ao eiiaoeo.
Iaeii/anii aecia/aeany iaeaea iino?eia ioaeioa – o 250 (85,4%) oai?eo,
ia/?y – o 191 (65,2%), a?ae?eaeea – o 125 (42,7%), caeoooy aeeaioa,
ao?/aiiy eeoa/ieea – o 168 (54,3%) oa ?iceaaee no?eueoey, eiee ia oii?
cae?ai?a c”yaeyeeny i?iiine – o 45 (16,2%) iaoe??io?a, a?aeiia?aeii.
Iienaiiy ee?i?/ii? ea?oeie ae?acee AeIE ii?aeiaii? c OI aoei a iaiiaiei
aac a?aooaaiiy ?yaeo neiae?ii?a, ye? ca iaoeie aeaieie, coiiaeththoueny
?? oneeaaeiaiiyie: aano?iaeoiaeai?oii (49,3% oai?eo), iaiao?aoe??th
ae?acee a IC (6,2%), i?ei?inoaiicii (4,1%), iaie?aiiae?icii (17%),
e?iaioa/ith oiui. Ne?ae a?aei?oeoe, ui a 6,4% iaoe??io?a caoai?thaaiiy
iaei aneiioiiaoe/iee ia?aa?a.
Ine?eueee ee?i?/ia ea?oeia AO ii?aeiaii? c OI aeoaea aa??aaaeueia ?
aeaeiee aacneiioiiia, “iaie?aaoiiiae?aia”, i?iaeaia ae?aaiinoeee a
?aiiueiio ia??iae? caoai?thaaiiy caeeoa?oueny iniaeeai aeooaeueiith.
Aeey oeueiai iaiao?aeia ianoi?iaeai?noue e?ea??a ??cieo
niaoe?aeueiinoae, canoinoaaiiy eiiieaenieo iaoiae?a ae?aaiinoeee.
A nai?e ?iaio? aea?? ?aoe?iiaeueiiai ia”?io ? iine?aeiaiino? oeo /e
?ioeo iaoiae?a aeine?aeaeaiiy a eiaeiiio eiie?aoiiio aeiaaeeo ie
aecia/aee, aeoiaey/e c aiae?co nea?a, aiaiiaco oa ?acoeueoao?a ?ai?oa
i?iaaaeaieo aeine?aeaeaiue. Iniiaiei i?eioeeiii aoei oaeaeea iaea?aeaiiy
an??? iaiao?aeii? ?ioi?iaoe?? i?e i?i?iaeueii iiaeeea?e ?iaaceaiino?
ae?aaiinoe/ieo i?ioeaaeo?.
A ae?aaiinoeoe? AO AeIE a ii?aeiaii? c aoi?eiiei iaie?aaoeoii aaaeeeaa
cia/aiiy iaaeaaaee iaeueiaoe?? aeeaioa ca A?iooii,
o?a?iacioaaiaano?iaeoiaeaiineii?? oa aeine?aeaeaiith ooieoe?? IC.
Aiaeineii?/ii, c acyooyi i?eoe?eueieo a?iioao?a, aeine?aeaeaii an?o 293
iaoe??io?a. E?eoa??yie ae?aceiaiai i?ioeano aaaaeaee iayai?noue
aeaoaeoo, eiai oi?io, ?ici??e, e?a? oa noai iaaeieeoiuei? neeciai?
iaieiiee. Ae?aceia? aeaoaeoe a oeeaoeei? AeIE aoee aeyaeai? o 242
(82,6%) oai?eo. O 225 – ae?aaiinoiaaii iaeio, o 17 – ii aea? ae?acee. O
184 oai?eo iaeii/anii c a?aee?eoith ae?aceith a?coae?coaaeanue
aeaoi?iaoe?y oeeaoeeie AeIE ? eeoa o 51 – ?oaoe? neeciai? ia oii?
aano?iaeoiaeai?oo. O 171 iaoe??ioa ae?acee iaee ie?oaeo, o 47 –
iaaeueio, a o 24 – iai?aaeeueio oi?io. E??i iniiaieo iciae, oa?aeoa?ieo
aeey ae?aceiaeo aeaoaeo?a, ie, ye ? ?io? aaoi?e (A.N. Naaaeueaa e
niaao., 1985; E.E.Nieieia e niaao., 1987; A.A. I?uoe, 1995 ? ?i.),
a?aoiaoaaee ? iai?yi? iciaee, ye? na?ae/aoue i?i iaoieia?th IC oa
aeia/aaea?aeieo oeyo?a. Oea ae?aaeaiee aeoiaeai?o ieco?aeiiai a?aeae?eo
c? ci?iaie neeciai? iaieiiee ii oeio “iaiii? e?oie”, ii?ooaiiy iannaaeo
aeia/?, a?oaa neeaae/ano?noue neeciai? iinoaoeueaa?iiai a?aeae?eo;
aiaieuaa? caiaeuei? oa aeeno?io?/i? ci?ie a ia?aoaoa?aeuei?e cii?,
aeene?iac?y ? ?ao?iia?enoaeueoeea, ?icai?ioo?noue i?aeeiae, aeaoi?iaoe?y
no?iie oa caoaeaiiy i?ina?oo AeIE.
?acoeueoaoe iaoeo aeine?aeaeaiue iieacothoue, ui ae?acee caaeiuei?
no?iee oeeaoeeie AeIE noeeuei? aei oneeaaeiaiiai ia?aa?ao ? iia?eueiiai
caai?iiy. Ii i??? ?aia?aoeaii? ?aaaia?aoe?? ae?aceiaeo aeaoaeo?a aeieea?
aeaoi?iaoe?y oeeaoeeie AeIE, yea coiiaeth? ii?ooaiiy ?ooiai? ooieoe??
eeoee, c?inoaiiy ?io?aaeoiaeaiaeueiiai oeneo oa ianaaeo iaie?aaoe/iiai
nieo. Anoaiiaeaii, ui o an?o oai?eo c aeaoi?iaoe??th oeeaoeeie AeIE
ci?iaia aoiaaii?noue ia?aio?ie IC, a o 22 c ieo aeiaeaoeiai ca?eueoeeeny
?? ?ici??e.
I?ii?ae an?o caoai?thaaiue IC ae?aaiinoeea OI aaaaea?oueny iaea?eueo
cao?oaeiaiith (H. Lutz et al., 1976; T.L. Lawson, 1978; V. Liang et al.,
1986 oa ?i.). Ca aeiiiiiaith oeueo?acaoeiaiai iaoiaeo aecia/aee
ia?aiao?e, aoiaaii?noue, ci?ie a ia?aio?i? oa i?ioieia?e nenoai? IC. Ie
aeei?enoaee ianooii? oeueo?acaoeia? e?eoa???, aeanoea? OI:
– ca?eueoaiiy ?ici???a an??? caeice aai ?? /anoeie;
– cia/ia i?aeaeuaiiy aeonoe/ii? u?eueiino? an??? caeice aai ?? /anoeie;
– iioe?aiiy i?ioieo, iioiauaiiy eiai no?iie;
– iayai?noue a ia?aio?i? IC aai a i?ioioe? ia”?iieo (eiie?aiaio?a,
iooeei, eeno, ?io?eueo?aoe?e) aoino?oeoo?, ui aeathoue oeueo?acaoeiao
o?iue.
O 38 (13%) oai?eo eiinoaooaaee ia??ai?noue eiioo??a IC, o 211 (72,5%) –
ca?eueoaiiy ?ici???a, ae?aaeaio aeaoi?iaoe?th AeIE, ?? niaci ? iaa?ye
aoeueaiaeoiaeaiaeueiiai ia?aoiaeo, ui oo?oaeith? ianaae nieo ?
i?aeoaa?aeaeo? oaiiiai “ooeeaiiy” oa?iaio?a a e?ia. *ano?oa, o 206
(70,8%) iaoe??io?a, niinoa??aaee ca?eueoaiiy aieiaee IC, ??aeoa o?ea ?
oainoa – o 124 (42,6%), a aeeoocia ca?eueoaiiy caeice – o 16,2% oai?eo.
I?e aeine?aeaeaii? ie iaaeaaaee aaaeeeaa cia/aiiy nooiaith aoiaaiiino?,
i?aeaeuaiith aeonoe/ii? u?eueiino?, ui ?yae aaoi??a (A.A. Aaneeueaa,
1998; C.A. Iaeueie/oe, 1998; K.L. Cox et al., 1980 ? ?i.) ?aoothoue
iniiaiei e?eoa???i o?aaeaiiy IC.
O 184 c 291 (63,2%) oai?iai aoiaaii?noue aoea ci?iaiith. O 44
a?aecia/aii ?? cieaeaiiy, a o 140 iaaiaee i?aeaeuaiiy. Iaeii/anii c
aoiaaii?noth aecia/aee iaeii??aei?noue ia?aio?ie i?aaio. Ae?eyiee c
ae??aieie aiaieuaie, oa?aeoa?ieie aeey OI (I.I. Aiaa?, 1982; A.A.
Ai?aeeaiei e niaao., 1991; I.A. Aoaa?a?eoe e niaao., 1995; W.R. Lees et
al., 1979), ie niinoa??aaee o 49 (16,8%) iaoe??io?a, i?e/iio o 26 (8,9%)
aiie ?a?no?oaaeeny ia oii? iiieaeaii? aoiaaiiino?, a 16 (5,5%) –
i?aeaeuaii? aoiaaiiino?, a o 7 (2,4%) oai?eo i?e ii?iaeuei?e aoiaaiiino?
IC.
A.I. Iaeauoe, A.A. Ia?aaea??e, 1993; A.A I?uoe, 1995 ? ?i. aaaaeathoue,
ui ia??aeei a iniia? o?aaeaiiy IC eaaeeoue ii?ooaiiy a?aeoieo
iaie?aaoe/iiai nieo. Oiio iaaiee ?ioa?an i?e OCAe ia? aei??thaaiiy
oe?eie aieiaiiai iaie?aaoe/iiai i?ioieo.
O 105 c 291 (36,0%) ianoaaeaiiai iaoe??ioa c AO AeIE aaeaeiny
a?coae?coaaoe iaie?aaoe/iee i?io?e. O 42 c ieo eiai i?ina?o ia
ia?aaeuoaaa ii?iaeueii? aaee/eie (2 ii), a o 63 ?ioeo iaoe??io?a
a?aecia/aii iioe?aiiy ae?aiao?o i?ioieo aei 5 ii. Inoaii?e /ano?oa
aecia/aany i?e i?aeaeuai?e aoiaaiiino? ia?aio?ie, ??aeoa i?e ii?iaeuei?e
/e iiieaeai?e.
?acoeueoaoe iaoeo niiia?ao?/ieo aeaieo ocaiaeaeothoueny c oaeeie ?ioeo
aaoi??a (S.G.Parulekar, 1980, P.Ortore et al., 1981; M.B.Alpern et al.,
1985), ye? aea/aee aeacai? ia?aiao?e ia?aio?ie ? i?ioie?a IC i?e OI.
Ioaea, oeueo?aniiia?ao?/ia aeine?aeaeaiiy aeicaiey? aeineoue iiaii
ioe?ieoe noai IC, aecia/eoe aoyaiaiiy a iaoieia?/iee i?ioean
ooieoe?iiaeueii ii?aeiaieo i?aai?a, aianoe iaiao?aei? ei?aeoeae a
e?eoaaiiy.
A?aoiaoth/e, ui eiii”thoa?ia oiiia?ao?y (EO) ie?aneth? anth /a?aaio
ii?iaeieio, cai/a?aaeiiee i?ino?? ? oac, ie iae?aee ?? aeey
aeine?aeaeaiiy oeo iaoe??io?a, a yeeo niiae?aaeeny aeyaeoe ia”?ii?
ooai?aiiy a IC, ui noeneathoue oa aeaoi?iothoue ?? i?ioieiao nenoaio. O
6 oai?eo ae?aaiinoiaaii OI, o 2 – eenoe, o 1 – ia”?iiee i?ioean aieiaee
IC.
*anoei? iaoe??io?a i?iaaaeaia aiaeineii?/ia ?ao?ia?aaeia
iaie?aaoioieaia?ia?ao?y (A?IOA). Iniiaieie iieacaiiyie aei ??
i?iaaaeaiiy aaaaeaee: iayai?noue ae?acee a aeenoaeuei?e /anoei?
oeeaoeeie AeIE, a?iceai? ci?ie AeIE oa ae?eyiee aaeeeiai
aeoiaeaiaeueiiai ninea, ?icai?ioo?noue iaoe? AeIE, iciaee noaiicoth/iai
iai?e?oo.
O an?o oai?eo aeyaeaii caiaeueii-aeano?oeoeai? ci?ie a i?ioieia?e
nenoai? caeice, o?ueii oai?ei c noaiicoth/ei iai?e?oii c i?io?eaeoe/iith
iaoith aeeiiaia iai?eioii?y.
Ae?aaiinoe/iee ?ioa?an i?e ii?aeiaii? AO AeIE c OI ia? aea/aiiy
aecie?eiii? ? ?ie?aoi?ii? ooieoe?e IC. Aaaeeeaeie ae?aaiinoe/ieie
oanoaie ? aecia/aiiy aeoeaiino? ai?eace a e?ia? oa na/?, o?eineio,
aetheice, ?ioii?aaeoeaiiai ?inoe?io a e?ia?.
Ai?eaca e?ia? i?e AO AeIE, ca iaoeie aeaieie, a oac? caaino?aiiy
i?ioeano aoea a?eueoith ca ii?io ? neeaaeaea 22,04+1,17 a/aiaee
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