.

Рання діагностика порушень мінеральної щільності кісткової тканини у хворих на ревматоїдний артрит: Автореф. дис… канд. мед. наук / О.П. Борткевич,

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Oe?a?inueeee iaoeiai-aeine?aeiee ?inoeooo ea?ae?ieia?? ?i. aeaae.
I.Ae.No?aaeanea IIC Oe?a?ie.

Ai?oeaae/ Ieaa Iao?iae/

OAeE: 616.72-002.77-018.4-079.5

?aiiy ae?aaiinoeea ii?ooaiue i?ia?aeueii? u?eueiino? e?noeiai? oeaieie o
oai?eo ia ?aaiaoi?aeiee a?o?eo.

14.01.12 – ?aaiaoieia?y

Aaoi?aoa?ao

aeena?oaoe?? ia caeiaoooy iaoeiaiai nooiaiy

eaiaeeaeaoa iaaee/ieo iaoe

Ee?a -1999

Aeena?oaoe??th ? ?oeiien.

?iaioa aeeiiaia a Oe?a?inueeiio iaoeiai-aeine?aeiiio ?inoeooo?
ea?ae?ieia?? ?i.aeaae.I.Ae.No?aaeanea IIC Oe?a?ie

Iaoeiaee ea??aiee: aeieoi? iaaee/ieo iaoe, i?ioani? Eiaaeaiei Aieiaeeie?
Ieeieaeiae/ , aee?aeoi? , caa?aeoaa/ a?aeae?eaiiy ee?i?/ii? ?aaiaoieia??
Oe?a?inueeiai iaoeiai-aeine?aeiiai ?inoeoooo ea?ae?ieia?? ?i.aeaae.
I.Ae. No?aaeanea IIC Oe?a?ie

Io?oe?ei? iiiiaioe: aeieoi? iaaee/ieo iaoe, i?ioani? Na?ioeeoeueeee
Aiaoie?e Noai?neaaiae/, caa?aeoaa/ eaoaae?e aini?oaeueii? oa?ai?? ?2
Iaoe?iiaeueiiai iaaee/iiai oi?aa?neoaoo ?i.I.I. Aiaiiieueoey IIC Oe?a?ie

aeieoi? iaaee/ieo iaoe, i?ioani? Aaaei?ia E?ae?y sse?aia, i?ioani?
eaoaae?e n?iaeii? iaaeeoeeie Ee?anueei? iaaee/ii? aeaaeai??
i?neyaeeieiiii? ina?oe ?i.I.E. Ooieea IIC Oe?a?ie

I?ia?aeia onoaiiaa: Aei?i?iiao?ianueea aea?aeaaia iaaee/ia aeaaeai?y IIC
Oe?a?ie, eaoaae?a aini?oaeueii? oa?ai?? ?2.

Caoeno a?aeaoaeaoueny 16 ethoiai 1999?. i 14 aiaeei? ia can?aeaii?
niaoe?ae?ciaaii? a/aii? ?aaee Ae 26.616.01. i?e Oe?a?inueeiio
iaoeiai-aeine?aeiiio ?inoeooo? ea?ae?ieia?? ?i.aea. I.Ae.No?aaeanea
(252151, i.Ee?a, aoe. Ia?iaeiiai iiie/aiiy , 5 ).

C aeena?oaoe??th iiaeia iciaeiieoeny o a?ae?ioaoe? Oe?a?inueeiai
iaoeiai-aeine?aeiiai ?inoeoooo ea?ae?ieia?? ?i.aeaae.I.Ae.No?aaeanea
(252151, i.Ee?a, aoe. Ia?iaeiiai iiie/aiiy , 5 ).

Aaoi?aoa?ao ?ic?neaiee 16 n?/iy 1999?.

A/aiee nae?aoa?

niaoe?ae?ciaaii? a/aii? ?aaee Aeaye N.?.

CAAAEUeIA OA?AEOA?ENOEEA ?IAIOE

Aeooaeuei?noue i?iaeaie. ?aaiaoi?aeiee a?o?eo (?A) – iaeia c iniiaieo
i?iaeai no/anii? ?aaiaoieia??, ui iia’ycaia, ianaiia?aae, c aenieith
eiai iioe?ai?noth na?aae ?aaiaoe/ieo oai?ia (ae?oaa i?noea i?ney
?aaiaoecio), yea a na?aaeiueiio neeaaea? a iiioeyoe?? 0,37% (Eiaaeaiei
A.I. oa ni?aaao., 1997). ?A i?ecaiaeeoue aei ?aiiuei? ?iaae?aeecaoe??
in?a ia?aaaaeii i?aoeacaeaoiiai a?eo (i?ney 5 ?ie?a caoai?thaaiiy
i?aoeacaeaoi?noue ao?a/athoue 50% oai?eo; Eaeiaeia A.I. e niaao.,1986),
a oaeiae aenieiai ?eceeo ?icaeoeo oneeaaeiaiue, na?aae yeeo cia/ia
i?noea iin?aeathoue (O?aiea TH., ?oiaa A., 1995; Arriagada I.,
Arinoviche R., 1997) ii?ooaiiy i?ia?aeueiiai iai?io e?noeiai? oeaieie
(EO) o aeaeyae? inoaiiai?e ??ciiai nooiaiy oa inoaiii?ico (II). Inoaii?e
i?e ?A – aoi?eiiee i?iya caoai?thaaiiy, ui i?ecaiaeeoue aei oyaeeeo
iane?aee?a, cie?aia aei iaoieia?/ieo (niiioaiieo) ia?aeii?a, ?ecee yeeo
o ?ac? ?A neeaaea? aei 2,5% (Laan N. et al., 1995). Na?aae ia?aeii?a
iaea?eueo iaaacia/i? eiii?an?ei? ia?aeiie o?e o?aaoe?a, oeeee noaaiiai?
e?noee, ?aaa?, aeenoaeueiiai a?aeae?eo i?iiaiaai? e?noee oa ?i.,
iniaeeai o ae?iie (Beat A. et al., 1991; Melton L., 1993). Ia aeoieo
aenia?o?a AIIC, II iin?aea? o?ao? i?noea a ?aeoeiao iniiaieo
iaaeeei-nioe?aeueieo i?iaeai no/aniino? (i?ney na?oeaai-noaeeiieo
caoai?thaaiue oa oeoe?iaiai ae?aaaoo) ? ia?oa – ca?aae ?ioeo
iaoaaie?/ieo ?iceaae?a EO (Menninger I. et al., 1995). Ca aeaieie AIIC,
aeecueei 25% ae?iie o a?oe? aei 65 ?ie?a iathoue eiii?an?ei? ia?aeiie
o?aaoe?a, a 20% – ia?aeiie e?noie ia?aaeie?//y (Keen R., Spector O.,
1995). I?iaeaia ? iniaeeai aeooaeueiith aeey Oe?a?ie a ca’yceo c oei, ui
cia/io /anoeo caaaeueii? iiioeyoe?? ianaeaiiy noaiiaeyoue iniae noa?oi?
a?eiai? a?oie (25,6% aai 13,2 iei /ieia?e o a?oe? 55 ?ie?a oa noa?o?), a
oaeiae /a?ac aaeeeo /enaeuei?noue ianaeaiiy, ui i?iaeeaa? ia
?aae?iaeoeaii caa?oaeiaieo oa?eoi??yo (Ei?ae A.A. e niaao., 1995). A
Oe?a?i?, ca aeaieie ?inoeoooo aa?iioieia??, ?ecee ia?aeii?a ia oe? II
iathoue aeecueei 4,7 iei in?a aai 10,7% anueiai ianaeaiiy (Iiai?icithe
A.A. e niaao.,1995). Oaeei /eiii, iaiao?aei?noue i?io?eaeoeee ?
e?eoaaiiy II ? eiai oneeaaeiaiue, iniaeeai o oai?eo ia ?A, ia aeeeeea?
noii?a?a, a aoaeoeai?noue oeeo caoiae?a caeaaeeoue ianaiia?aae a?ae eiai
?aiiuei? ae?aaiinoeee (Aieoaooae E., Oaaoe A., 1997). Iaaea/ai?noue
noaio i?ia?aeueii? u?eueiino? (IU) EO i?e ?A coiiaeth?oueny
iaaecae/aeiith neeaaei?noth i?iaeaie, ine?eueee aecia/ath/e noai IU EO
ne?ae a?aoiaoaaoe aaaaoi /eiiee?a: nenoaii? ? eieaeuei? ci?ie a EO, ?o
ni?aa?aeiioaiiy, noaoue ? a?e oai?eo, aeoeai?noue ? o?eaae?noue
i?ioeano, ooieoe?iiaeueio iaaeinoaoi?noue iii?ii-?ooiaiai aia?aoo,
iniaeeaino? e?eoaaiiy, a oiio /ene? i?ecia/aiiy aetheiei?oeeinoa?i?ae?a
(AEN), ye? iathoue ?aiooaoe?th inoaio?iiieo aaaio?a, ui ni?e/eiththoue
?ic??aeaeaiiy EO (Gough A. et al., 1994; Celiker R. et al., 1995;
Geusens ?., 1995; Tlustochowicz W. et al., 1996; Compston J. et al..,
1997). AEiaeai c aeuaiaaaaeaieo aniaeo?a i?iaeaie aeinoaoiuei ia
aea/aiee ye ca ei?aeiiii, oae ? a Oe?a?i?, iacaaaeath/e ia oa, ui i?i
?icaeoie II o oai?eo ia ?A na?ae/aoue aeai? ?aioaaiia?ao??
(Aei?ieaeiioia A.I. e niaao., 1981) . Aei iniaeeainoae inoaiiai?/ieo
noai?a o ?ac? ?A iaeaaeaoue: iaaieiia i?ia?anoaaiiy i?ioeano c ?icaeoeii
ia oa?i?iaeueieo noaae?yo II, a?aenooi?noue iayaii? ee?i?/ii?
neiioiiaoeee aae aei ?icaeoeo iaoieia?/ieo ia?aeii?a ye ia?oeo nooo?aeo
i?iya?a caoai?thaaiiy, oiaoi ?? iiaeii oa?aeoa?ecoaaoe ye “oeoo
ai?aeai?th” (Iiae?ooiye A.I., 1997), iaaecae/aeii aeniea aa?o?noue
e?eoaaiiy II ia noaae?? ee?i?/ieo i?iya?a (Riggs A., Melton L., 1995).
Iai?eeeaae, o?iainoaaiiy i?ia?aie c II o NOA neeaaeaei 10 ie?ae aeiea??a
a 1994 ?ioe? (Ei?ae A.A. e niaao., 1997) .

Ca’ycie ?iaioe c iaoeiaeie i?ia?aiaie, ieaiaie, oaiaie. Oaia
aeena?oaoe?eii? ?iaioe ? o?aaiaioii ieaiiai? iaoeiai? ?iaioe
a?aeae?eaiiy ee?i?/ii? ?aaiaoieia?? Oe?a?inueeiai IAe? ea?ae?ieia?? ?i.
aeaae. I.Ae.No?aaeanea IIC Oe?a?ie ca oaiith “?ic?iaeoe e?eoa??? ioe?iee
?ai?n?? oa i?iaiicoaaiiy ia?aa?ao ?aaiaoe/ieo caoai?thaaiue c
aooi?ioiieie oa ?ioiieiiieaenieie iaoai?ciaie ?icaeoeo a caeaaeiino?
a?ae oaoiieia?? e?eoaaiiy” ( ? aea?ae?a?no?aoe?? Ae?0198O004010 ).

Iaoa ? iniiai? caaaeaiiy aeine?aeaeaiiy. Iaoa ?iaioe – aaeineiiaeeoe
ae?aaiinoeeo ?A ia iniia? aea/aiiy noaio IU, anoaiiaeoe caeiiii??iino?
ao?aoe EO i?ia?aeueiiai eiiiiiaioa ia ??cieo aoaiao ?icaeoeo
caoai?thaaiiy, a oaeiae aecia/eoe caeaaei?noue oaii?a ?icaeoeo
inoaiiai?/ieo ci?i o oeeo oai?eo a?ae noao?, a?eo oai?eo, iniaeeainoae
ia?aa?ao ?A, a oaeiae iniaeeainoae i?ecia/aiiai e?eoaaiiy, ioe?ieoe
ni?aa?aeiioaiiy i?ae nenoaiieie ? eieaeueieie ii?ooaiiyie IU.

I?ae /an aeeiiaiiy ?iaioe ae??ooaaeeny oae? caaaeaiiy:

· Aea/eoe noai i?ia?ae?caoe?? e?noeiai? nenoaie oa oa?aeoa? ii?ooaiue a
eiiiaeoi?e oa aoa/ano?e ?a/iaeiao EO o oai?eo ia ?A oa in?a aac
iaoieia?? iii?ii-?ooiaiai aia?aoo.

· Anoaiiaeoe cia/aiiy oioiiii? aeaineoiiao??? (OAeI) aeey ?aiiuei?
ae?aaiinoeee ii?ooaiue IU o oai?eo ia ?A.

· Ni?anoaaeoe ae?aaiinoe/io cia/ou?noue oa ?ioi?iaoeai?noue
?aioaaiieia?/iiai aeine?aeaeaiiy oa OAeI a ?aii?e ae?aaiinoeoe?
cacia/aieo ii?ooaiue ia ??cieo aoaiao ?icaeoeo ?A.

· Ioe?ieoe ?ieue ie?aieo /eiiee?a (o?eaae?noue ? aeoeai?noue
caoai?thaaiiy, oa?aeoa? o?aaeaiiy i?aai?a ? nenoai, e?eoaaiiy AEN,
nooi?iue ooieoe?iiaeueii? iaaeinoaoiino? iii?ii-?ooiaiai aia?aoo oa ?i.)
o oi?ioaaii? aaia?ae?ciaaiiai o?aaeaiiy EO o oai?eo ia ?A ? ni?anoaaeoe
?o c ?acoeueoaoaie OAeI.

· Ioe?ieoe ae?aaeai?noue ci?i o ??cieo eiiiiiaioao EO o oai?eo ia ?A ia
iiiaio ii/aoeo ee?i?/ii? iai?oanoaoe?? caoai?thaaiiy oa i?inoaaeeoe ?o
aeeiai?eo caeaaeii a?ae iniaeeainoae ia?aa?ao ?aaiaoi?aeiiai i?ioeano.

· Anoaiiaeoe cia/aiiy eiiieaenii? oa?ai?? ianoa?i?aeieie
i?ioecaiaeueieie i?aia?aoaie (IICI), AEN ? aaciaeie i?aia?aoaie aeey
ee?i?ei-ooieoe?iiaeueii? noaa?e?caoe?? caiaeueiiai i?ioeano, a oaeiae
caiia?aaiiy i?ia?anoaaiith aeai?ia?ae?caoe?? EO.

· Aea/eoe aieea AEN ia noai EO o oai?eo ia ?A (iieacaiiy, o?eaae?noue
canoinoaaiiy, aeicoaaiiy); i?iaiae?coaaoe ni?aa?aeiioaiiy ei?enoue-?ecee
i?ae /an canoinoaaiiy AEN o aeaii? eaoaai??? oai?eo, a oaeiae ioe?ieoe
iia?/io ae?th oeeo i?aia?ao?a ia EO.

Iaoeiaa iiaecia iaea?aeaieo ?acoeueoao?a. O ?acoeueoao? i?iaaaeaiiai
aeine?aeaeaiiy aia?oa anoaiiaeaii, ui:

– o oai?eo ia ?A niinoa??aathoueny ii?ooaiiy IU aoa/anoi? ? eiiiaeoii?
?a/iaeie EO, i?e/iio caeaa?eueoiai (aeecueei 80%) aiie iathoue oa?aeoa?
aaia?ae?ciaaii? inoaiiai??, ui noai?th? ia?aaeoiiae aeey ?icaeoeo II
(yeee niinoa??aa?oueny o 30% oai?eo) oa iaoieia?/ieo ia?aeii?a.

– ci?ie IU aoa/anoi? ? eiiiaeoii? ?a/iaeie EO o oai?eo ia ?A
a?aeaoaathoueny c ??ciith ?ioaineai?noth, yea caeaaeeoue a?ae aino?ioe
i?ioeano, eiai o?eaaeino?, a?eo ? noao? iaoe??io?a, a oaeiae a?ae
iayaiino? nenoaiieo i?iya?a caoai?thaaiiy.

– ?niothoue ??ci? oeie ao?aoe i?ia?aeueiiai eiiiiiaioa o oai?eo ia ?A: ?
oei – c ia?aaaaeiith ao?aoith aoa/anoi? ?a/iaeie, a ?? – eiiiaeoii?
?a/iaeie EO.

– aeieeiaiiy aaia?ae?ciaaii? inoaiiai?? o oai?eo ia ?A iiaea neoaeeoe
iaeiei c ia?ea??a caoai?thaaiiy (ii?yae c ee?i?/ieie, eaai?aoi?ieie oa
?aioaaiieia?/ieie iciaeaie ?A).

– ?nio? i?yiee ei?aeyoeaiee ca’ycie i?ae oaeaee?noth ao?aoe EO
i?ia?aeueiiai eiiiiiaioa oa eaai?aoi?ieie iieacieeaie
(na?iiiceoeai?noue, OIA, N-?aaeoeaiee a?eie (N?A), oa ??aaiue
aaiiaeia?io e?ia?).

I?aeoe/ia cia/aiiy iaea?aeaieo ?acoeueoao?a. Ia iniia? i?iaaaeaieo
aeine?aeaeaiue anoaiiaeaia iaiao?aei?noue OAeI a ?aii?e ae?aaiinoeoe?
ii?ooaiue IU EO o oai?eo ia ?A ? ia?aaaae ?? iaae ?aioaaiieia?/iei
aeine?aeaeaiiyi noiniaii ?ioi?iaoeaiino? ? /ooeeaino? iaoiaeo.
Eiiieaenia ianoaaeaiiy (OAeI, ee?i?/i?, eaai?aoi?i? oa ?ino?oiaioaeuei?
iaoiaee ae?aaiinoeee) aeicaiey? aecia/eoe iniaeeaino? ii?ooaiue IU EO o
oai?eo ia ?A.

Iaa?oioiaaia iaiao?aei?noue nai?/aniiai ii/aoeo aaeaeaaoii? oa?ai?? ?A
ia ?aii?o noaae?yo caoai?thaaiiy (IICI, aacia? i?aia?aoe, AEN) c iaoith
i?eai?/aiiy caiaeueiiai i?ioeano ? ciaioaiiy ao?aoe EO i?ia?aeueiiai
eiiiiiaioa.

Aecia/aii ??ciee aieea AEN ia EO ia ?aii?o noaae?yo ?A ? o ?ac?
o?eaaeiai ia?aa?ao caoai?thaaiiy.

?ic?iaeaii e?eoa??? ioe?iee i?ia?anoaaiiy ?A ia iniia? ?acoeueoao?a
OAeI o ii?aeiaii? c ee?i?ei-eaai?aoi?ieie aeaieie (iniaeeai c
iieacieeaie aeoeaiino? caiaeueiiai i?ioeano – OIA, ?aaiaoi?aeiee oaeoi?
(?O), N?A, a oaeiae aeoeai?noth eiiieaiaioa (NI50)).

Anoaiiaeaii, ui aecia/aiiy eaai?aoi?ieo iieaciee?a (eaeueoe?e, oinoi?,
eoaeia oinoaoaca e?ia?) ia ? aaaeeeaei o ae?aaiinoeoe? II ? inoaiiai?e
i?e ?A.

?acoeueoaoe aeine?aeaeaiiy ao?eai? a i?aeoeeo ?iaioe ?aaiaoieia?/ieo
a?aeae?eaiue oeaio?aeueii? i?nueei? ee?i?/ii? e?ea?i? i. Ee?aa,
ee?i?/ii? e?ea?i? ? 6 i. Ee?aa, Aieeinueei? iaeanii? ee?i?/ii? e?ea?i?,
a a?aeae?eaii? ee?i?/ii? ?aaiaoieia?? Oe?a?inueeiai IAe? ea?ae?ieia??
?i. aeaae. I.Ae. No?aaeanea, ui i?aeoaa?aeaeo?oueny a?aeiia?aeieie
aeoaie i?i ai?iaaaeaeaiiy.

Iniaenoee aianie caeiaoaa/a. Aianie aaoi?a a io?eiai? ?acoeueoaoe ?
iniiaiei ? iieyaa? o aeai?? ia’?io oa iaoiae?a aeine?aeaeaiiy,
iinoaiiaoe? iaoe oa oi?ioethaaii? caaaeaiue, i?iaaaeaii? ee?i?/ieo
aeine?aeaeaiue (ianoaaeaiiy oai?iai ia ?A ca anoaiiaeaiei i?ioieieii).
Aaoi? iniaenoi aeeiiaa aeaineoiiao?e/i? aeine?aeaeaiiy ca aeiiiiiaith
i?eeaaeo NK-364A ? ioe?iea io?eiai? ?acoeueoaoe, i?iaiae?coaaa
?aioaaiia?aie oai?eo ? aeaa e?euee?nio ioe?ieo ?iaeaen?a ?a?ao?eaoe?? EO
oa ?acoeueoao?a eaai?aoi?ieo ? a?io?i?/ieo aeine?aeaeaiue, i?ia?a
ocaaaeueiaiiy ? noaoenoe/io ia?iaeo ?acoeueoao?a aeine?aeaeaiiy,
i?aeaiooaaa iaoeia? aeai? aei ioae?eaoe??, a oaeiae ioi?iea
aeena?oaoe?eio ?iaioo.

Ai?iaaoe?y ?acoeueoao?a aeena?oaoe??. Iniiai? iieiaeaiiy aeena?oaoe??
aoee i?aaenoaaeai? ia: ia?o?e Oe?a?inuee?e iaoeiai-i?aeoe/i?e
eiioa?aioe?? “Inoaiii?ic: ai?aeai?ieia?y, ee?i?ea, ae?aaiinoeea,
e?eoaaiiy oa i?io?eaeoeea” (Ee?a, a?oaeaiue 1995), Oe?a?inuee?e
iaoeiai-i?aeoe/i?e eiioa?aioe?? “Aeooaeuei? i?iaeaie ?aaiaoe/ieo
caoai?thaaiue o ae?oae oa i?aee?oe?a” (Oa?e?a, ea?oaiue 1996), IX EULAR
Symposium (Madrid, October 8th, 1996 ), iaoeiai-i?aeoe/ieo eiioa?aioe?yo
“Aeooaeuei? i?iaeaie aa??ao?e/ii? i?oiiaae??” (Ee?a, eenoiiaae 1996,
eenoiiaae 1998), Ae?oaiio Iaoe?iiaeueiiio eiia?an? ?aaiaoieia?a Oe?a?ie
(Ee?a, aa?anaiue 1997).

Ai?iaaoe?y aeena?oaoe?? a?aeaoeany 27 aeiaoiy 1998 ?. ia ni?eueiiio
can?aeaii? a?aeae?eaiue ee?i?/ii? ?aaiaoieia??, oai?ia i?iea?aea oa aaae
na?oey, na?oeaai? iaaeinoaoiino?, ?aae?i?cioiiieo iaoiae?a
aeine?aeaeaiiy OIAe? ea?ae?ieia?? ?i. aeaae. I.Ae.No?aaeanea.

Ioae?eaoe??. Ca iaoa??aeaie aeena?oaoe?? iioae?eiaaii 10 ?ia?o, o oiio
/ene? 5 noaoae o i?ia?aeieo iaoeiaeo aeaeaiiyo (c ieo 1 iiiiin?aia) oa 5
oac ia I?aeia?iaeieo eiia?anao, eiioa?aioe?yo oa c’?caeao, io?eiaii
iaoaio ia aeiao?ae.

No?oeoo?a aeena?oaoe??. Aeena?oaoe?y neeaaea?oueny c? anooio, iaeyaeo
e?oa?aoo?e, 4 ?icae?e?a, aeniiae?a, i?aeoe/ieo ?aeiiaiaeaoe?e, nieneo
aeei?enoaieo aeaea?ae. Iniiaiee ci?no aeena?oaoe?? aeeeaaeaiee ia 107
noi??ieao iaoeiiieniiai oaenoo ? i?noeoue 33 oaaeeoe?, oa 3 iaethiee.
Nienie e?oa?aoo?e i?noeoue 236 aeaea?ae, c ieo 117 ee?eeeoeath.

INIIAIEE CI?NO ?IAIOE

Ee?i?/ia oa?aeoa?enoeea oai?eo. Ianoaaeaii 199 oai?eo ia ?A ? 540 in?a
aac nea?a c aieo iii?ii-?ooiaiai aia?aoo (anueiai 739 in?a). Na?aae
oai?eo ia ?A, ye? neeaaeaee iniiaio a?oio ianoaaeaiiy (IA), aoei 157
ae?iie o a?oe? 18-76 ?ie?a, na?aaei?e a?e – 48,141,23 ?ieo ? 42 /ieia?ee
o a?oe? 18-74 ?ie?a, na?aaei?e a?e 48,482,59 ?ieo; 75 ae?iie (47,8%)
ia?aaoaaee a iinoiaiiiaoc?. O?eaae?noue caoai?thaaiiy noaiiaeea 5,851,27
?ieo (a?ae 0.17 aei 37 ?ie?a). O an?o iaoe??io?a IA ae?aaiic aoa
aa?eo?eiaaiee ca?aeii c e?eoa??yie Aia?eeainueei? ?aaiaoieia?/ii?
anioe?aoe?? (A?A, 1987). Aeoeai?noue ? nooiaiy aoea o 29 (14,6%), ?? – o
128 (64,3%), ??? – o 42 (21,1%) oai?eo. ?aioaaiieia?/i? ci?ie ? noaae??
aeyaeai? o 20, ?? – o 95, ??? – o 58, IV – o 26 oai?eo.
Oaeaeeii?ia?anoth/ee ia?aa?a ?A niinoa??aaany o 43,
iia?eueiii?ia?anoth/ee – o 156 oai?eo. Iiceoeaiee ?O ciaeaeaii o 38,36%
oai?eo, a?ae’?iiee – o 61,64%. Ooieoe?iiaeueia iaaeinoaoi?noue
iii?ii-?ooiaiai aia?aoo ? nooiaiy aeyaeaia o 28, ?? – o 134, ??? – o 37
oai?eo. O an?o oai?eo iaea i?noea noaeiaiaa oi?ia ?A, a o 76 (38,2%)
aiia noi?iaiaeaeoaaeany a?noea?aeueieie i?iyaaie (?aaiaoi?aei? aoceeee,
aooi?ioiia aiai?y, e?ioaaeaiiiao?y, aaneoe?o, o?aaeaiiy na?oey, eaaai?a,
ia/?iee). Eiio?ieueio a?oio ianoaaeaieo (EA) neeaee 540 in?a aac nea?a c
aieo iii?ii-?ooiaiai aia?aoo, ye? i?iaeeaathoue o ??cieo ?aa?iiao
Oe?a?ie, o a?oe? a?ae 18 aei 86 ?ie?a (na?aaei?e a?e 46,131,25 ?ieo):
/ieia?e?a – 237, ae?iie – 303 (c ieo a iinoiaiiiaocaeueiee ia??iae –
115).

Iaoiaee aeine?aeaeaiiy. Ii?yae c ?aoaeueiei aiae?cii ee?i?/iiai
ia?aa?ao ?A an?i oai?ei i?iaiaeeee eiiieaenia ianoaaeaiiy. Iniiaiei
iaoiaeii ioe?iee noaio EO aoa iaoiae iaeiioioiiii? aeaineoiiao???
(aani?aoe?iiao???) ia e?noeiaiio aeaineoiiao?? NK-364A (“GAMMA Muvek
Corp.”) c ?cioiiii eiae-125 a yeino? aeaea?aea ?ii?coth/iai
aei?ii?ithaaiiy. Oi/i?noue aei??o – 1-2%. Aeai? aeaineoiiao??? aecia/aee
ca iieacieeaie BM? – ai?noii i?ia?aeueieo ?a/iaei a EO (a/ni), ? IU –
i?ia?aeueiith u?euei?noth EO (a/ni2), ye? a naith /a?ao ii??aithaaee c
ii?iaeueieie iieacieeaie o??? ae naii? a?eiai? a?oie (Z-iieaciee), a
oaeiae c iieacieeaie iieiaeeo caei?iaeo in?a, ye? iathoue i?e e?noeiai?
iane (O-iieaciee) (Iiai?icithe A.A., 1997). Noai EO ca ?acoeueoaoaie
OAeI ioe?ithaaee a?aeiia?aeii aei no/anii? eeaneo?eaoe?? inoaiiai?e oa
II (WHO Techn.Rep.Ser., 1994). E??i oiai, aeei?enoiaoaaee:
?aioaaiieia?/iee iaoiae aeine?aeaeaiiy c o?aooaaiiyi ye a?coaeueieo
iciae II, oae ? ii?oiiao?e/ieo ?iaeaen?a (ia?eoa??eiiai ? oeaio?aeueiiai
?iaeaen?a Barnett-Nordin) (Niocye I.E.,1988), ee?i?ei-eaai?aoi?i? oa
?ino?oiaioaeuei? aeine?aeaeaiiy (caaaeuei? aiae?ce e?ia? oa na/?,
a?io?i?/i? iieacieee – caaaeueiee a?eie ? o?aeoe??, N?A, eiiieaiaioa?io
aeoeai?noue ne?iaaoee e?ia?, n?aeiao eeneioo, na?iioei?ae ne?iaaoee
e?ia?, na/iaeio, e?aaoei?i, o?a?eiiaai, ??ai? eaeueoe?th, oinoi?o oa
eoaeii? oinoaoace a ne?iaaooe? e?ia?); ca iaiao?aeiino? – aeine?aeaeaiiy
na/? ca Ia/eii?aieii oa Ceiieoeueeei; aeeoaeuei? i?iae, oeueo?acaoeiaa
aeine?aeaeaiiy i?aai?a /a?aaii? ii?iaeieie, oa?iiiao??y. Caaaeuei?
aiae?ce e?ia? oa na/?, aecia/aiiy a?io?i?/ieo iieaciee?a e?ia?
(iayai?noue aino?ioaciaeo a?ee?a, i?ioa?iia?aia) i?iaiaeeee ca
caaaeueiii?eeiyoith iaoiaeeeith. Eiiieaiaioa?io aeoeai?noue ne?iaaoee
a?oa??aeueii? ? aaiicii? e?ia? aecia/aee ca 50% aaiie?cii
nainea?e?ciaaieo a?eo?ioeeo?a aa?aia. Aeey ooi/iaiiy oa?aeoa?o o?aaeaiiy
na?oeaaiai i’yca /anoei? oai?eo i?iaiaeeee aeaeo?iea?ae?ia?ao?th,
oiiiea?ae?ia?ao?th, aoiea?ae?ia?ao?th.

C /enea iieaciee?a OAeI aeey iii?oi?eiao noaio EO aoa aea?aiee Z –
iieaciee (a?aeoeeaiiy IU a?ae ii?iaeueieo aeey aeaii? a?eiai? a?oie
cia/aiue, ae?aaeaia a iaeeieoeyo noaiaea?oiiai a?aeoeeaiiy (SD)), yeee
iaea?eueo a?aeiia?aea? aeiiaai, iaiao?aeiei aeey iiaiioe?iiiai
aeeiai?/iiai niinoa?aaeaiiy iacaeaaeii a?ae a?eo, noao? oai?eo oa ?ioeo
ci?iieo.

Io?eiai? aeai? ia?iaeai? ca aeiiiiiaith iaoaiaoe/ii-noaoenoe/ieo
iaoiae?a (Aai/eeiaa E.A., Aai/eeia A.A., 1974; Oeoa? ?.A., 1988), a
oaeiae i?ia?aie noaoenoe/ii? ia?iaee aeaieo SPSS 8.0 for Windows (1998)
a?aeiia?aeii aei i?aaee aa??aoe?eii? noaoenoeee.

?acoeueoaoe aeanieo aeine?aeaeaiue, ?o iaaiai?aiiy. Aiae?c io?eiaieo
?acoeueoao?a na?ae/eoue, ui ii?ooaiiy IU a IA niinoa??aaeiny o 81%
oai?eo; na?aae in?a EA ca a?aenooiino? nea?a c aieo iii?ii-?ooiaiai
aia?aoo – o 14,4%; inoaiiai?? neeaaeaee 51 ? 9,5%, a?aeiia?aeii.
Inoaiii?ic aoa aeyaeaiee o 30% in?a ?c IA ?o 4,8% ?c EA. O ae?iie IA
iayai?noue inoaiiai?e ? II neeaaeaea 53 ? 30%, o /ieia?e?a – 38 ? 33%
a?aeiia?aeii, oiae? ye na?aae in?a EA /anoioa inoaiiai?e ? II neeaaeaea
o ae?iie 10,9 ? 5,9%, a o /ieia?e?a – 7,9 ? 3,3%, a?aeiia?aeii.
Anoaiiaeaii, ui iacaeaaeii a?ae a?eo IU o oai?eo ia ?A a ii??aiyii? c
ianoaaeaieie EA cieaeaia a on?o aeine?aeaeoaaieo ae?eyieao neaeaoa
(p0.1). Aaaeeeaei ? oie oaeo, ui iia??oaiiy
iieaciee?a OAeI ia??aeei iaei i?noea o oai?eo ia ?A ca a?aenooiino?
iaoieia?/ieo ci?i ia ?aioaaiia?aiao /e ca iayaiino? eeoa iciae II e?noie
eenoae ? i?iiaiaai-cai’ynoeiaeo noaeia?a (noaae?? 0 – ?). Caneoaiao? ia
oaaao oa, ui ia oeeo noaae?yo cia/aiiy ia?eoa??eiiai ?iaeaeno
Barnett-Nordin o 63% oai?eo aoee aeu?, i?ae o?, ui na?ae/aoue i?i
iayai?noue eieaeueiiai II. Ioaea, OAeI aeicaiey? aeyaeoe ii?ooaiiy IU ia
?aii?o noaae?yo ?icaeoeo ?A, eiee ?aioaaiieia?/ii oe? ci?ie ua ia
i?inoaaeothoueny.

O iiaeaeueoiio aoa i?iaaaeaiee aiae?c caeaaeiino? noaio IU a?ae
o?eaaeino? caoai?thaaiiy. Ca iaoeie aeaieie, c? ca?eueoaiiyi o?eaaeino?
?A IU cieaeo?oueny. Iaeiae oea cieaeaiiy ia? iae?i?eiee oa?aeoa?:
iaea?eueo aeniea oaeaee?noue aeai?ia?ae?caoe??, iniaeeai aoa/anoiai
eiiiiiaioa EO, niinoa??aa?oueny a ia?o? 2 – 5 ?ie?a a?ae ii/aoeo
caoai?thaaiiy; iaaeae? i?ioean oi/a ? oiia?eueith?oueny, aea ia
coieiy?oueny, ni?e/eithth/e oi?ioaaiiy eeane/iiai II ? a ?yae? aeiaaee?a
iaoieia?/ieo ia?aeii?a (ca iaoeie aeaieie – o 20,6% oai?eo; o ?ac?
noaeiaiai? oi?ie ?A – o 17,1%, noaeiaiai-a?noea?aeueii? – o 26,31%).
Iaeneiaeueia ?ic??aeaeaiiy EO niinoa??aaeiny ca o?eaaeino? oai?iae
a?eueoa 10 ?ie?a (r=0,85). Aeyaeaia aeenioe?aoe?y a oaeaeeino? ?aiiuei?
ao?aoe i?ia?aeueiiai eiiiiiaioa EO o ??cieo oai?eo: ca oiia aaeaeaaoiiai
i?eai?/aiiy aeoeaiino? caiaeueiiai i?ioeano ia ia?oiio ?ioe?
caoai?thaaiiy aiia neeaea 2,1 – 10,6% caeaaeii a?ae i?noey aei??o,
oiae? ye o ?ac? ia?nenooth/i? aeoeaiino? ?A – 9,1 – 21,5%, a?aeiia?aeii.
Oaeiae ciaeaeaii i?yiee ei?aeyoeaiee ca’ycie nooiaiy inoaiiai?/ieo ci?i
c oaeeie ia?aiao?aie aeoeaiino? caiaeueiiai i?ioeano, ye: iiceoeai?noue
ca ?O (r=0,74), OIA (r=0,68), ia?nenooth/a aenie? ??ai? N?A (r=0,82).

Ioaea, aaeaeaaoia oa?ai?y ?A ca aeiiiiiaith IICI, AEN oa aaciaeo
i?aia?ao?a ? iaeii/anii caniaii i?eai?/aiiy i?ioean?a aeai?ia?ae?caoe??
EO, a iaaaoeaiee aieea AEN (iaa?oue o ?ac? canoinoaaiiy “aa?aneaieo”
iaoiaeee – ioeuen-oa?ai?? iaaeaenieeie aeicaie AEN) ia i?inoaaeo?oueny
ia aeaiiio aoai?. Iaeiae ia a?eueo i?ci?o noaae?yo ?icaeoeo ?A
i?ecia/aiiy AEN i?ecaiaeeoue ii?yae ?c caaaeueiia?aeiieie oneeaaeiaiiyie
c aieo o?aaiiai o?aeoo, aiaeie?eiii? nenoaie, AEN-caeaaei?noth aei
eaoano?io?/ii? aeai?ia?ae?caoe?? EO c oi?ioaaiiyi II ? i?aeaeuaiei
?eceeii ia?aeii?a. Oae, na?aaei?e Z-iieaciee IU neeaa o a?oiao oai?eo,
ui i?eeiaee AEN, (–1,98) aeey aoa/anoi? ?a/iaeie ? (–1,29) aeey
eiiiaeoii?, a oie /an, ye o a?oi? oai?eo, ye? ia i?eeiaee AEN,
a?aeiia?aeii (–1,65) ? (–1,14). Ca oiia ca?eueoaiiy o?eaaeino?
i?eeiio AEN IU ??cei cieaeo?oueny, aeinyaath/e i?ney i?eeiio a?eueoa 5
?ie?a (–2,910,30) aeey aoa/anoi?, ? (–2,680,25) aeey eiiiaeoii? ?a/iaei,
ui a??ia?aeii iaioa, i?ae o oeo, ye? i?eeiaee AEN iaioa i?ae 1 ??e
(p7,5 ia (p>0,05), iacaeaaeii a?ae oa?i?io i?eeiio
AEN (aei 1 ?ieo, aei 5 ?ie?a /e a?eueoa 5 ?ie?a); oi/a a?oie aoee
ni?anoaaeai? ca iniiaieie ee?i?ei-eaai?aoi?ieie iieacieeaie, a?eii,
noaooth oa o?eaae?noth i?eeiio AEN.

Aeey ioe?iee aieeao /eiieea ?iiia?e?caoe?? ia ?icaeoie inoaiiai?/iiai
neiae?iio o oai?eo ia ?A iaea?eueo aaaiieie aoee iieacieee ?aieiai?
neooino?, Noaioi?aenueei? aieaoe noaio caei?ia’y, a oaeiae /ano
i?ioiaeaeaiiy 15 i ? eenoueiai? neee (oaaeeoey 1 ):

Oaaeeoey 1

Iieacieee ooieoe?iiaeueiiai noaoono o oai?eo ia ?A caeaaeii a?ae noaio
EO (ca aeaieie OAeI)

Iieacieee ooieoe?iiaeueiiai noaoonoNoai EO (aeai? OAeI)Ii?ia
(n=27)Inoaiiai?y (n=81)Inoaiii?ic (n=40)Noia?ii ii IA?aieiaa neoo?noue,
oa40,68,072,001,6*78,33,4*70,44,2Iieacieee Noaioi?ae-nueei? aieaoe,
aaee26,66,734,33,540,22,9*32,83,1*an i?ioiaeaeaiiy 15 i,
n.28,26,448,92,1*46,42,8*44,32,8Eenoueiaa neea, ea12,84,0 8,62,4
9,22,0 11,23,2

I?ei?oea. * – ??cieoey iieaciee?a a??ia?aeia (?0.1). Ia aeyaeaii
ei?aeyoe?? i?ae ae?aaeai?noth inoaiiai?? /e II ca aeaieie OAeI ?
iai?yiii ci?i oeeo ia?ea??a, ui aeicaiey? aaaaeaoe, ui aecia/aiiy
inoaii?o ia ia? nooo?aiai cia/aiiy a ae?aaiinoeoe? ii?ooaiue IU EO.

Oaeei /eiii, aeei?enoaiiy iaoiaeo OAeI o i?aeoeoe? ee?i?/ii?
?aaiaoieia?? aeicaiey? ia ?aii?o noaae?yo ?icaeoeo ?A ae?aaiinooaaoe
ii?ooaiiy IU o aeaeyae? inoaiiai?e ??ciiai nooiaiy ? II, nai?/anii
i?ecia/aoe aaeaeaaoio oa?ai?th, oeei naiei caiia?aath/e ?icaeoeia?
iaoieia?/ieo ia?aeii?a o oai?eo.

AENIIAEE

1. I?ia?aeueia u?euei?noue e?noeiai? oeaieie o oai?eo ia ?A a ii??aiyii?
c iniaaie aac iaoieia?? c aieo iii?ii-?ooiaiai aia?aoo nooo?ai cieaeaia
o ia?aaaaeii? ?o a?eueoino? (aeecueei 80% in?a). Oea i?ecaiaeeoue aei
nooo?aiai i?aeaeuaiiy ?eceeo iaoieia?/ieo ia?aeii?a, ye?
niinoa??aathoueny o 17,1 – 26,31% oai?eo.

2. Ii?ooaiiy i?ia?aeueii? u?eueiino? e?noeiai? oeaieie cono??/athoueny o
ae?iie /ano?oa, i?ae o /ieia?e?a (a?aeiia?aeii aeecueei 83 ? 71%),
i?e/iio nooo?aa i?aeaeuaiiy oaeaeeino? aeai?ia?ae?caoe??
niinoa??aa?oueny c ii/aoeii iaiiiaoce (p

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