Page 1

íàó÷íî-ïðàêòè÷åñêèé ìåäèöèíñêèé æóðíàë

the scientific and practical medical journal

16+ 7

(76)

Àêóøåðñòâî. Ãèíåêîëîãèÿ Ýíäîêðèíîëîãèÿ Obstetrics. Gynecology Endocrinology

7 (76) 2013


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

«ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ» ¹ 7 (76) / 2013             

                                                     ­€‚ƒ€‚­ƒ„­…



Ìàëüöåâ Ñòàíèñëàâ Âèêòîðîâè÷ — ä.ì.í., ïðîôåññîð, maltc@mail.ru

 Ã.Ø. Ìàíñóðîâà, ê.ì.í., gsm98@mail.ru

    Ë.È. Ìàëüöåâà, ä.ì.í., ïðîôåññîð À.Î. Ïîçäíÿê, ä.ì.í., ïðîôåññîð





 ãîñóäàðñòâåííàÿ ìåäèöèíñêàÿ àêàäåìèÿ» ÌÇ ÐÔ  



œ œ šŠ†‡’“¤™¥‚Šœ˜œœ‚ˆ ‰¦

œ œž ‰‡™¤™¥‚Šœ˜œœ‚ˆ ‰¦ œœ ‡™ “¤™¥‚Šœ˜œœ‚ˆ ‰¦ œœ‡™–‰“¤™¥‚Šœ˜œœ‚ˆ ‰¦ žœœ‰Š‰‡‰“ ”¤™¥‚Šœ˜œœ‚ˆ ‰¦ žœ œ‡ˆ“¤™¥‚Šœ˜œœ‚ˆ ‰¦

œœŠ¤™¥‚Šœ˜œœ‚ˆ ‰¦ Ô.À. Õàáèðîâ (Êàçàíü), ä.ì.í., ïðîôåññîð

 Äèðåêòîð: Ä.À. ßøàíèí / dir@mfvt.ru Âûïóñêàþùèé ðåäàêòîð: Þ.Â. Äîáðÿêîâà / mfvt@mfvt.ru Ðóêîâîäèòåëü îòäåëà ðåêëàìû: Ë.Þ. Ðóäàêîâà / gmasternn@mail.ru

 420012, ÐÒ, ã. Êàçàíü, óë. Ùàïîâà, 26,  ­€€ ‚ƒ„…­ òåë. (843) 267-60-96 (ìíîãîêàíàëüíûé) å-mail: mfvt@mfvt.ru www.mfvt.ru / www.pmarchive.ru Ëþáîå èñïîëüçîâàíèå ìàòåðèàëîâ áåç ðàçðåøåíèÿ ðåäàêöèè çàïðåùåíî. Çà ñîäåðæàíèå ðåêëàìû ðåäàêöèÿ îòâåòñòâåííîñòè íå íåñåò. Ñâèäåòåëüñòâî î ðåãèñòðàöèè ÑÌÈ ÏÈ ¹ ÔÑ77-37467 îò 11.09.2009 ã. âûäàíî Ôåäåðàëüíîé ñëóæáîé ïî íàäçîðó â ñôåðå ñâÿçè, èíôîðìàöèîííûõ òåõíîëîãèé è ìàññîâûõ êîììóíèêàöèé.

ISSN 2072-1757 (print) ISSN 2307-3217 (online) †‡ˆ‰‰Š ‹ Œ†Œˆ †Ž‘ ’ “”‰•  ˆ‰– ‡  “—’ “—“’‚ ‰˜ ”‰ ’ ˜‰ˆ  ’‚ “ ˆ ‡™—’ ‡‰”‰šˆ  ‡ ”‰ ’ †”‰›Š‰ ’ˆ†‰˜Š‰•Š“  ˆŠˆ  œ Âñå ðåêëàìèðóåìûå â äàííîì èçäàíèè ëåêàðñòâåííûå ïðåïàðàòû, èçäåëèÿ ìåäèöèíñêîãî íàçíà÷åíèÿ è ìåäèöèíñêîå îáîðóäîâàíèå èìåþò ñîîòâåòñòâóþùèå ðåãèñòðàöèîííûå óäîñòîâåðåíèÿ è ñåðòèôèêàòû ñîîòâåòñòâèÿ.

ÏÎÄÏÈÑÍÛÅ ÈÍÄÅÊÑÛ: ž‡Œ‰ˆ‰”™ 37140.  Ðåñïóáëèêàíñêîì ‡Œ‰Ÿ”— 16848

16+

Îòïå÷àòîíà â òèïîãðàôèè: ‰ˆ‰ “•ˆ‰” ‚ ã. Êàçàíü, óë. Õ. Òàêòàøà, ä. 105 Äàòà ïîäïèñàíèÿ â ïå÷àòü: 21.02.2014 “—’Š¡€¢œ€£œ­€„…

Òèðàæ 3 000 ýêç.

Ê.Ø. Çûÿòäèíîâ (Êàçàíü) – ïðåäñåäàòåëü, ä.ì.í., ïðîôåññî𠧜 œ ’˜Š‰‰“¤ ¥‚Šœ˜œœ‚ˆ ‰ œŸœ ’˜“¤™¥‚Šœ˜œœ‚ˆ ‰ œ œ‡—“¤¥‚Šœ˜œœ‚ˆ ‰ œžœ—‹ ¤™¥‚Šœ˜œœ‚ˆ ‰ Ã.Ð. Âàãàïîâà (Êàçàíü), ä.ì.í., ïðîôåññîð Ð.Ø. Âàëèåâ (Êàçàíü), ä.ì.í., ïðîôåññî𠜁œŠ› ‰“¤†¥‚Šœ˜œœ‚ˆ ‰ Ð.X. Ãàëååâ (Êàçàíü), ä.ì.í., ïðîôåññîð À.Ñ. Ãàëÿâè÷ (Êàçàíü), ä.ì.í., ïðîôåññîð Ë.È. Ãåðàñèìîâà (×åáîêñàðû), ä.ì.í., ïðîôåññî𠜞œ‡—š”¤“¥‚Šœ˜œœ‚ˆ ‰‚”‡‰œ  Þ.Â. Ãîðáóíîâ (Èæåâñê), ä.ì.í., ïðîôåññîð Ñ.À. Äâîðÿíñêèé (Êèðîâ), ä.ì.í., ïðîôåññîð Â.Ì. Äåëÿãèí (Ìîñêâà), ä.ì.í., ïðîôåññî𠞜Ÿœ‰‰¤ ¥‚Šœ˜œœ‚ˆ ‰ Ë.Å. Çèãàíøèíà (Êàçàíü), ä.ì.í., ïðîôåññîð À.Ì. Êàðïîâ (Êàçàíü), ä.ì.í., ïðîôåññîð Â.Í. Êðàñíîæåí (Êàçàíü), ä.ì.í., ïðîôåññîð Í.Í. Êðþêîâ (Ñàìàðà), ä.ì.í., ïðîôåññîð Ê. Ëèôøèö (ÑØÀ, Õüþñòîí), ê.ì.í., ïðîôåññîð Î.È. Ëèíåâà (Ñàìàðà), ä.ì.í., ïðîôåññîð Â.Ã. Ìàéäàííèê (Êèåâ), ä.ì.í., ïðîôåññîð

œœ– ¤“¥‚Šœ˜œœ‚ˆ ‰‚”‡‰œ  È.Ñ. Ìàëêîâ (Êàçàíü), ä.ì.í., ïðîôåññî𠁜œ ’•‡“¤™¥‚Šœ˜œœ‚ˆ ‰ Ñ.Í. Íàâðóçîâ (Òàøêåíò), ä.ì.í., ïðîôåññî𠞜 œ —“¤ ‹‰¥‚Šœ˜œœ‚ˆ ‰ œžœ™“¤‹‡¥‚œ˜œœ Â.Ô. Ïðóñàêîâ (Êàçàíü), ä.ì.í., ïðîôåññîð À.È. Ñàôèíà (Êàçàíü), ä.ì.í., ïðîôåññîð Í.Ï. Ñåòêî (Îðåíáóðã), ä.ì.í., ïðîôåññî𠞜œ ˜‰š†‡“¤ ¥‚Šœ˜œœ‚ˆ ‰‚”‡‰œ  Â.Õ. Ôàçûëîâ (Êàçàíü), ä.ì.í., ïðîôåññî𠜜Ÿ’“¤™¥‚Šœ˜œœ‚ˆ ‰ Ð.Ø. Õàñàíîâ (Êàçàíü), ä.ì.í., ïðîôåññîð À.Ï. Öèáóëüêèí (Êàçàíü), ä.ì.í., ïðîôåññîð Å.Ã. Øàðàáðèí (Íèæíèé Íîâãîðîä), ä.ì.í., ïðîôåññîð

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß

1


2

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß     

................................................................................................................................................................................................................................................................ 77   

€‚                ............ 21          34         ............................................................................................. 34  45         ............................................................................................................................... 45    ƒ€       ............................................................................................................ 52    57   ­................................................................................................................................................................... 57            63 63       „…       ...................................................................................... 68           ....................................................................................................................................... 73                          ..................................................................................................................................................................... 78            ......................................................... 84     ............................................................................................. 89             94                   ...................................................................................... 98                  103        ‚‘’ †   ‡ˆ €       ‰ 109  ‚‚“ Š        114     ‹ …‡         €-го    ‚‚…

   ‰......................................................................................................................................................................................................................... 118

    ‚€“     ‡  124          ­  ‰‰ 130 ‚”‘       ‚”” Œ ‡     133          ‚”’ Ž       ­   139     Ž     ‡   ­  ‚““     144

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


‘7 (76) декабрь 2013 г.

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

3

ɇəɅɉȼɀɋɈɃɅɀȻɌȻɈȿȻɅɉȽȻȽȿɀɆɗɅɃɈ €‚ƒ    

   148 ɈȻɊɉɂȿɀɀȽȻȻɈɍɋɎɈɉȽɉɇȾɉɋȼɀɈɅɉȻɊɓȽȻəɅɆɈȿɉɇɀɈɍɗɀȽȻɃȻɏɋɉɆɖɒɀȽɃȽɅɎɆɃɅɉȽ  

   

      €„… 

   152 ɆɈɐȻɏɃɂɉȽȻɌɌɅɌɀɇȼȻɀȽɉȽɈɀɌɍɀɋɉȽɀȽɇȻɇȻɀȽȻ       

  159 €„† ɀɇȽȻɌɃɆɀȽɌɅȻɚɌɆȼɆȻɓɅɉȽȻ €‡…         

 162  ȾȻɊɉɆɚɅɉȽȻȽȽɅɉɆɉɌɅɉȽɍȻȼɋɃɍȽɃɈ 

 

       

 

 €‡„  

    165  ɇɅɃɌɇȻɄɆɉȽȻ  

 ­

   169 €‡†             €ˆ€         171        €ˆ‡        176                                   €ƒ„     185     €†‰           190            €†ƒ         198              

…‰Š      ­        203    …‰ˆ €        ­ 207

      …€€       211 Е.Н. СЛАВНОВА Технология BD SurePath при раке молочной железы для иммуноцитохимии....................................................................................................................................... 221             ……‡         226   

…Š€       231          …Š„ ‚  ƒ     235       

„  ­    ƒ …Š†   239 И.В. КЛЮЧАРОВ, А.А. ХАСАНОВ Эволюция гормональной контрацепции. Краткий очерк.................................................................................................................................................................................. 249  ɂɫɩɨɥɶɡɨɜɚɧɢɟɧɚɬɭɪɚɥɶɧɵɯɤɨɦɩɥɟɤɫɨɜɮɟɪɦɟɧɬɢɪɨɜɚɧɧɵɯɩɢɳɟɜɵɯɜɨɥɨɤɨɧɢɤɨɪɨɬɤɨɰɟɩɨɱɟɱɧɵɯɠɢɪɧɵɯɤɢɫɥɨɬɩɪɢɥɟɱɟɧɢɢɩɢɟɥɨɧɟɮɪɢɬɚɭɞɟɬɟɣ 253 258

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


Ă?Ă?Ă€ĂŠĂ’ĂˆĂ—Ă…Ă‘ĂŠĂ€Ă&#x; ĂŒĂ…Ă„ĂˆĂ–ĂˆĂ?Ă€

4

‘7 (76) Đ´ĐľĐşĐ°ĐąŃ€ŃŒ 2013 Đł.

¹  ¹ 7 (76) / 2013 CIENTIFIC AND PRACTICAL MEDICN

                                                              Â?Â?Â?Â?Â? Â?Â? Â

Editor-in-chief: S.V. Maltsev, D. Med. Sc., Professor maltc@mail.ru Editorial secretary: G.S. Mansurova, Cand. Med. Sc., gsm98@mail.ru Scientific consultants of number: L.I. Maltseva, D. Med. Sc., Professor A.O. Pozdnyak, D. Med. Sc., Professor



Editorial Board:

 Medical Academy   

‚  †Â? Â?—˜€ ™  €   š – † Â?—˜€ ™  €   š  ™  Â?—˜€ ™  €   š  • ™Â?—˜€ ™  €   š ›  ™Â? —˜€ ™  €   š › Âœ ž „ Â?—˜€ ™  €   š ž  ”—˜€ ™  €   š ›—˜€ ™  €   

Editorial Counsil:   Â&#x;”” Â?ÂĄ  ¢ ÂŽ Â? € ™  €   

     Â Â? Â? Publishing editor: J.V. Dobryakova / mfvt@mfvt.ru Head of advertising department: L.Y. Rudakova / gmasternn@mail.ru

   Â?Â?  ­Â?€‚ƒ€€ „ Â? €Â?…€

   �  €„ † ‡­�� tel. (843) 267-60-96 e-mail: mfvt@mfvt.ru, www.mfvt.ru/www.pmarchive.ru

This magazine extends among the broad audience of practising doctors at specialized exhibitions, thematic actions, in profile treatment-and-prophylactic establishments by address delivery and a subscription. All medical products advertised in the given edition, products of medical destination and the medical equipment have registration certificates and certificates of conformity.

ISSN 2072-1757 (print) ISSN 2307-3217 (online) Any use of materials without the permission of edition is forbidden. Editorial office does not responsibility for the contents of advertising material. ƒ     ˆ     ‰Š ‹ŒŽ‘‘’‘Â?…‘­­  “ Â?  “” •Â?†”– Service for Supervision in sphere of Communications, Information Technology and Mass Communications.

16+

 ��� � � ­€‚�ƒ ­„‚€‚�ƒƒƒ� ƒ ��………  

E.N. Akhmadeeva (Ufa), D. Med. Sc., Professor • –  ” Â?—˜€ ™  €    L.A. Balykova (Saransk), D. Med. Sc., Professor  › ÂŁ”—˜€ ™  €     Â? ””— Â?˜€ ™  €    V.M. Delyagin (Moscow), D. Med. Sc., Professor ›  –” Â?—˜€ ™  €    ‚  – Â?—˜€ ™  €     ™ ¤Â?—£Â?˜€ ™  €    ‚  ¤Â?—˜€ ™  €     ¤”Â? —˜€ ™  €    L.I. Gerasimova (Cheboksary), D. Med. Sc., Professor P.V. Glybochko (Moscow), D. Med. Sc., Professor, RAMS corresponding member Yu.V. Gorbunov (Izhevsk), D. Med. Sc., Professor ™ „ Â?—˜€ ™  €    ‚   Â?—˜€ ™  €    › Âœ  —˜€ ™  €    Âœ Âœ ”Â? Â?—˜€ ™  €    C. Lifschitz (USA, Houston), PhD, professor O.I. Lineva (Samara), D. Med. Sc., Professor A.D. Makatsariya (Moscow), D. Med. Sc., Professor, RAMS corresponding member •  ™ Â?—˜€ ™  €    › ¤ ™”—Â?˜€ ™  €    ™  ™” Â?—˜€ ™  €    S.N. Navruzov (Tashkent), D. Med. Sc., Professor V.A. Nasyrov (Bishkek), D. Med. Sc., Professor ™ ›  Â?—• ž˜€ÂŽ ™ 

› – Â? Â?—˜€ ™  €    •  —˜€ ™  €    E.G. Sharabrin (Nizhniy Novgorod), D. Med. Sc., Professor N.P. Setko (Orenburg), D. Med. Sc., Professor V.M. Timerbulatov (Ufa), D. Med. Sc., Professor, RAMS corresponding member  ƒ†Â?—˜€ ™  €    ¤ ‚ ›ˆ„ Â?—˜€ ™  €    ‚  ›Â?—˜€ ™  €    › – Â&#x; —™˜€ ™  €     ¢ Â&#x;ˆ—˜€ ™  €   

OBSTETRICS. GYNECOLOGY. ENDOCRINOLOGY


‘7 (76) декабрь 2013 г.

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

5

OBSTETRICS. GYNECOLOGY. ENDOCRINOLOGY CONTENT

/,7(5$785(5(9,(:6 69$.,16+,1$92%,76$'=(0'$1'5((9$$'0$.$76$5,<$  77 92%,76$'=(69$.,16+,1$0'$1'5((9$$'0$.$76$5,<$                 21 (%3(5('(5<$(9$7%36+(1,&+1,.29$$'0$.$76$5,<$ 34         34 /,0$/76(9$(19$6,/(9$ 45           45 *2./,9/(1',9./<8&+$529 52       '.K.+,=52(9$,$0,.+$</,',16678/(9$ 57     57 /,0$/76(9$'01,.2*26<$1             63 63 56=$0$/((9$9./$=$5(9$1$&+(5(3$129$$9)5,=,1$0(=+(/(=29$ 68          

25,*,1$/$57,&/(6 0(=+(/(=29$/,0$/76(9$73=(3+,529$'(76<3/$.29           73 73 /(7(5(*8/29$/'(*$0%(5',(9$1,78.+9$76+,1$$<X7(5(*8/29$932671,.29 78                     7$2%26.$/29$(<X*/8.+29<X9,*1$729$,$7,729$$96<8=(9$            84 (<X$1752329$99.252%29/56$3+,8//,1$0,0$=,729$         89 ,91(<3+(/',(52*2=+,1$89672/<$529$$9'$1,/,1$,16.8329$297,.+$1,1$ 94             ,$$%2<$10($%2<$19*%252',1//0$/,.29693$9/292<X'52%,1%9526+$.150$57,526<$1=9,9$17629$$33$9/29$ $$(5(0((9$Ⱥ$*25%$1<X$*21&+$529$/,,9$6+&+(1.2 98             <X$'8'$5(9$9$*85(9$ 103  

        ­    

ENDOCRINOLOGY ȺȺ&+(51<$(9$1Ⱥ.5$9&+81 α 109             99.+$=,(9 114        (*'2526+1$.5$9&+81 118                 719$6,/.29$7%%$./$(9$6,0$7$(9<X$5<%,1$ 124      )$1$6<%8//,1$*59$*$329$%<X3$6+$(9         130 050,.,7<8.22.+,=+1<$.<X,.$5$&+(176(9 133     

    139         

OBSTETRICS. GYNECOLOGY. ENDOCRINOLOGY


6

Ă?Ă?Ă&#x20AC;Ă&#x160;Ă&#x2019;Ă&#x2C6;Ă&#x2014;Ă&#x2026;Ă&#x2018;Ă&#x160;Ă&#x20AC;Ă&#x; Ă&#x152;Ă&#x2026;Ă&#x201E;Ă&#x2C6;Ă&#x2013;Ă&#x2C6;Ă?Ă&#x20AC;

â&#x20AC;&#x2DC;7 (76) докайŃ&#x20AC;Ń&#x152; 2013 Đł.

6$783,.29$/,=$.+$529$                        144  0<X.2%(51,.($6$1'$.29$9'(/.,1                 148  1$32='(Y(9$$175812920*25%(1.2$36+9$<8./1'20(17(9$,$)52/<&+(9,9.8/,.29    

                              152 

/1.+$),=29$66.6(0%$(9291(67(529(90$0$(9$ Â                     159  (09$6,/(96.$<$6/%/$6+.29$                     162 

&/,1,&$/&$6( *$32/<$.29$99.2/26.297$%5,79,1 Â            Â?      Â?                    Â?   Â? 165 

%5,()5(32576 0.,60$</29$  Â?        Â   169

'58*6$1'(4,30(17 2,/,1(9$<,67(51,1  ­              171 (%752,..90,1.(9,&+/<X3786+.,1$  Â&#x20AC;      

       176 *)727&+,(9'&K*8/08+$00('29$'6/(9,76.$<$'<X/2*8129$9.267$512<  Â         

                 

  185 *%',..(  ­                190 /9326,6((9$739$6,/(9$(93+,/.,1$$6&+80$.29  Â&#x201A;         198 213(6,.,10<X7,.+212990.8.6(1.2739$6,/(9$0$5$70$129  ­               Â&#x192;     203 09&+(%529$  Â&#x201E;      Â&#x2026;  207 9$129,.29$(95<%$/.$          211 E.N. SLAVNOVA BD SurePath technology in breast cancer for immunocytochemistry................................................................................................................................................................ 221

         226         231     

Nonspecific vulvovaginitis: possibilities of local therapy....................................................................................................................................................... 235

            239 I.V. KLYUCHAROV, A.A. KHASANOV Evolution of hormonal contraception. Brief history................................................................................................................................................................................................... 249

              253

 258

OBSTETRICS. GYNECOLOGY. ENDOCRINOLOGY


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

7

ÎÁÇÎÐÛ ËÈÒÅÐÀÒÓÐÛ 

Ñ.Â. ÀÊÈÍÜØÈÍÀ, Â.Î. ÁÈÖÀÄÇÅ, Ì.Ä. ÀÍÄÐÅÅÂÀ, À.Ä. ÌÀÊÀÖÀÐÈß

Ïåðâûé Ìîñêîâñêèé ãîñóäàðñòâåííûé ìåäèöèíñêèé óíèâåðñèòåò èì. È.Ì. Ñå÷åíîâà, 119991, ã. Ìîñêâà, óë. Òðóáåöêàÿ, ä. 8, ñòð. 2

Òðîìáîòè÷åñêàÿ ìèêðîàíãèîïàòèÿ Àêèíüøèíà Ñâåòëàíà Âëàäèìèðîâíà — êàíäèäàò ìåäèöèíñêèõ íàóê, íàó÷íûé ñîòðóäíèê êàôåäðû àêóøåðñòâà è ãèíåêîëîãèè ìåäèêîïðîôèëàêòè÷åñêîãî ôàêóëüòåòà, 109004, ã. Ìîñêâà, óë. Çåìëÿíîé Âàë, ä. 62, ñòð. 1, òåë. +7-903-238-80-48, e-mail: gemostasis@mail.ru Áèöàäçå Âèêòîðèÿ Îìàðîâíà — äîêòîð ìåäèöèíñêèõ íàóê, ïðîôåññîð êàôåäðû àêóøåðñòâà è ãèíåêîëîãèè ìåäèêî-ïðîôèëàêòè÷åñêîãî ôàêóëüòåòà, 109004, ã. Ìîñêâà, óë. Çåìëÿíîé Âàë, ä. 62, ñòð. 1, òåë. +7-926-231-38-29, e-mail: gemostasis@mail.ru Àíäðååâà Ìàðãàðèòà Äàð÷èåâíà — êàíäèäàò ìåäèöèíñêèõ íàóê, äîêòîðàíò êàôåäðû àêóøåðñòâà è ãèíåêîëîãèè ìåäèêîïðîôèëàêòè÷åñêîãî ôàêóëüòåòà, 109004, ã. Ìîñêâà, óë. Çåìëÿíîé Âàë, ä. 62, ñòð. 1, òåë. +7-918-388-61-11, e-mail: gemostasis@mail.ru Ìàêàöàðèÿ Àëåêñàíäð Äàâûäîâè÷ — äîêòîð ìåäèöèíñêèõ íàóê, ïðîôåññîð, ÷ë.-êîðð. ÐÀÌÍ, çàâåäóþùèé êàôåäðîé àêóøåðñòâà è ãèíåêîëîãèè ìåäèêî-ïðîôèëàêòè÷åñêîãî ôàêóëüòåòà, 109004, ã. Ìîñêâà, óë. Çåìëÿíîé Âàë, ä. 62, ñòð. 1, òåë. +7-903-728-08-97, e-mail: gemostasis@mail.ru                     ­ €‚     ƒ„…†€   †        …  ‚   ­† †‚‚           ƒ   ‚­ †‚ƒ ­

   ††‚  †‚ €‚­­†‚… ‡            ƒ  

S.V. AKINSHINA, V.O. BITSADZE, M.D. ANDREEVA, A.D. MAKATSARIYA I.M. Sechenov First Moscow State Medical University, 8 Trubetskaya St., bld.2, Moscow, Russian Federation 119991

Thrombotic microangiopathy Akinshina S.V. — Cand. Med. Sc., research associate of the Department of Obstetrics and Gynecology of Public Health faculty, 62 Zemlyanoy Val St., bld. 1, Moscow, Russian Federation 109004, tel. +7-903-238-80-48, e-mail: gemostasis@mail.ru Bitsadze V.O. — D. Med. Sc., Professor of the Department of Obstetrics and Gynecology of Public Health faculty, 62 Zemlyanoy Val St., bld.1., Moscow, Russian Federation 109004, tel. +7-926-231-38-29, e-mail: gemostasis@mail.ru Andreeva M.D. — Cand. Med. Sc., Doctoral Candidate of the Department of Obstetrics and Gynaecology of Public Health faculty, 62 Zemlyanoy Val St., bld. 1, Moscow, Russian Federation 109004, tel. +7-918-388-61-11, e-mail: gemostasis@mail.ru Makatsariya A.D. — D. Med. Sc., Professor, corresponding member of RAMS, Head of the Department of Obstetrics and Gynaecology of Public Health faculty, 62 Zemlyanoy Val St., bld. 1, Moscow, Russian Federation 109004, tel. +7-903-728-08-97, e-mail: gemostasis@mail.ru ˆ‰‰Š‹ŒŽ‹‘‹’‰‰“”‹‰ŠŽ•”–•‰“—‰ŠŽ•”–•—˜‰•Œ‹’“—Œ™ŽŒ™Žš››Š‹”•œ˜‰“—™Ž‹”“—‘˜’žŽ•”‹Š‹ŒšŽ“’“’ž™—‹ž‰ŠŽ•”–•—˜‰•Œ‹’“š š’ž  ‘˜’žŽ•”‹ šŽ‹ Ž‹Ÿ‹Ž‹ž ‰• ‰ŠŽ•”–•‰“— ”“—Ž•š’¡“•Œš‰Š˜ ¢’‹ •Ÿ ‰Š‹ ”š£•Ž ‰Ž“¡¡‹Ž‘ Ÿ•Ž ‰Š‹ ‹”‹Ž¡‹’—‹ •Ÿ ‰ŠŽ•”–•‰“— ”“—Ž•š’¡“•Œš‰Š˜“‘ŒŽ‹¡’š’—˜›Š“‘Ÿš—‰•Œ‹’‘¡Ž‹š‰ŒŽ•‘Œ‹—‰‘Ÿ•Ž‘‰™ž˜“’¡‰Š‹Œš‰Š•¡‹’‹‘“‘•Ÿ‰ŠŽ•”–•‰“—”“—Ž•š’¡“•Œš‰Š˜“’‰Š‹ —•’‰‹¤‰•ŸŒŠ˜‘“•œ•¡“—šœ—Šš’¡‹‘“’Š‹”•‘‰š‘“‘ž™Ž“’¡ŒŽ‹¡’š’—˜ˆ‰‰Š‹‘š”‹‰“”‹‰Š‹ž“‘—•¥‹Ž˜•Ÿ‰Š‹”•œ‹—™œšŽ”‹—Šš’“‘”‘•Ÿ ‰ŠŽ•”–•‰“—”“—Ž•š’¡“•Œš‰Š˜šœœ•¦‘’‹¦“’‘“¡Š‰‘•’‰Š‹Œš‰Š•¡‹’‹‘“‘•Ÿ‰ŠŽ•”–•‰“——•”Œœ“—š‰“•’‘š‘‘•—“š‰‹ž¦“‰ŠŒŽ‹¡’š’—˜š‘¦‹œœ š‘‰Š‹Œš‰Š•¡‹’‹‘“‘•Ÿ‰Š‹‘•—šœœ‹žŒœš—‹’‰šœ•–‘‰‹‰Ž“——•”Œœ“—š‰“•’‘“’—œ™ž“’¡‘‹¥‹Ž‹ŒŽ‹‹—œš”Œ‘“š  ‰ŠŽ•”–•‰“—”“—Ž•š’¡“•Œš‰Š˜Š‹”•‘‰š‘“‘Š‹”•œ˜‰“—š’‹”“šŒŽ‹¡’š’—˜‘˜’žŽ•”‹

 

            

           

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


8

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

                                                                                               ­ €    ‚‚ƒ     ƒ„…†…‡ˆ‰Š‹Œ ŽŽ‘’  Ž“”  ŽŽ     ‚‚ƒ  •–—  ˜™ ššššš›­ƒ œ  Ž™šž”š      ‚‚ƒ Ÿ                               ‚  ‚‚ƒ        ¡                     ¢     ‚‚ƒ                       ž        £¤¥•                ‚    ‚‚ƒ               ¤¥•      Ÿ  ‚‚ƒ             ¦                             ž      §           Œ‘ž š¨’‚‚ƒ           ©       £¦•ž      ‚‚ƒ    ¤¥•         ‚‚ƒ         ªš      ¤¥•       ‚‚ƒŸ ªš¨‚‚ƒ  ¦          ‚‚ƒ

    ™”¨     ¤¥• «   ˜­ƒ ‚‚ƒ ¬¢•               ‚‚ƒ                         ‚‚ƒ         ƒ      ‚‚ƒ “š¨ª­ƒ    Œ‚‚ƒ¤¥•’       Ÿ      

‘7 (76) декабрь 2013 г.               ¤¥•  ‚‚ƒ¦   ¤¥• ‚‚ƒ      

 ƒ    ¤¥•  ‚‚ƒ    ¦                ¤¥•‚‚ƒ œ ¤¥•®‚‚ƒ ƒ                 ‚‚ƒ             ‚‚ƒ                   ¦      Œ   ’   ‚‚ƒ        —ž –           ¯°± « ²³²´„µž ˜       ‚‚ƒ        ²³²´„µž ˜      ¶  ²³²´„µ ˜                 ƒ       ²³²´„µ  ˜   ‚‚ƒ                          ž          ¢        ‚‚ƒ     Ÿ           ‚‚ƒ 

  ‚‚ƒ                                        ¯°± ¥       ²³²´„µ ˜ Œ  ²³²´„µ  ˜      ‘ž š¨’ ‚‚ƒ                      ƒ          ‚‚ƒ    ˜žª‚               ‚‚ƒ ¥                    ‚‚ƒ                      ª­ Ÿ           ƒ                      ‚‚ƒ‚                    ¦             Œ  ’     ´…Š‡ˆ ˆ‰ Š‹   Ž”›        ¯°±‚‚ƒ      ¯°± ‚‚ƒ‘­    -

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.               ˜Ÿ — ¯

 ˜Ÿ  ˜  Ÿ 

 €š¯ 

  ®˜ €š ­ -   € « œ Ÿ    ° ±™²š€ —   ­  «  ­  ³™ ´µš -

˜  €  Ÿš €—˜   ­¶‰· ­     ¸¸™¦¸µš €    Ÿš ¨™ Ÿ  €¨©ªš¯  Ÿ €ž Ÿš  ¯ ±—™    ¨©ª ° Ÿ   ¯ -  ¹¹ «¹œ Ÿ    €  º  ª­š -

˜ ¹  Ÿ€™

 š ® Ÿ ¨©ª¹¯     

                              ­   €  ‚     €   ‚   ƒ       ‚   ‚„  ƒ ƒ… †‡ˆ  ‚ ˆ‰… Š€ ‚  

   

      ­ €‚ƒ„…„†‡ˆ‰Š„†‚†ƒ‹ˆ‡‚ŒŒŽ‘ŠŽ‡ˆ‚…ˆ’„‡“‡ŠŽ‹”Ž…‘Ž†ƒ„† ‡•‘ˆ   ‹Ž‡„–…  —   

    ˜  ™—  š›   œ œ˜   ž—       

˜       œ   Ÿ™—˜ ™

 ¡¢£› ¤   ¥ŠŒ‚† ˆ‡ ‚Œ› € ¦¦§š  ˜    ™

  

 

 œ    Ÿœ  œ ¨©ª Ÿ     ¨©ªŸŸ˜  «    Ÿ     ¡¬£› ®  «      ­

9

‹‹ŠŒ     ‚     €   € € ‚   ‚ € Ž    ‘ ’­“ “ ­” •––—   ˜  ‚ ‚ ™šŒ „• —˜€€›  ›• —œ ž  Ÿ   ›ƒ ¡¢£… €¤¥¦š  Œ  ƒƒƒ€€‚ Ÿ € €      €™š ‹‹ŠŽ     ‚ƒ   ƒ  ƒ ‚ Œ   ‚  ‚ƒ‹‹Š    ¡¢£… € ‹ ‚   ›  Œ  ‚ €Œ  ƒ   ™š  ‹‹Š  § ‰  ƒ ƒ    €›¨ƒ  €  ©  ƒ ƒ ••˜ ˆ  Ÿ     ›¨ƒ  ¢ ª”…«­”­¬Ÿ  …   ®   ¡¢£ ¯‘°¢£›  Ÿ   ±² ‰  Ÿ ±²  ¡¢£€Œ Ÿ   €‚ƒ  ›  ³ —¥´ —µ¶—œ–ˆ  ƒ €‚ƒ  € ·¸·¹º—»   ›¨ƒ Œ›¤»¦§€ ‚     ¡¢£ €›‚   ‚  €   Ÿ     Œ   ‚   ¼€   ¡¢£  ›¨     › ƒ   ›  €›     › ‚› ‰  ©¡¢£ ‚€‚ƒ  ¡¢£ ‚›  Œ ‚ €    ½ª   ‚ € €‚  ‚   €ƒ ¡¢£… ‹    ƒ  ¡¢£    —–€ „› ©¡¢£¤´¦³ ±²¯‘°¢£       Ÿ    ¨ ‡…  ƒ  €  ¢ ª”…«­”­¬ ¯‘°¢£‰€      ›   ·¸·¹º —»  €›      ¡¢£      €›¨ ‚   €› ›¨     † €    › ¯‘°¢£€Ÿ ›     º¾£…   ¿À… ¶‰€Ÿ  Œ›¨ ƒ      ‚  Œ    Ÿ    €› ‚ƒ   —

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


10

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

                                                      ­ €‚ƒ „           …†…‡ˆ‰ Š‚            ‹Œ  ŠŽŒ‘ ’­  “   ­    ” ‹Œ‘•          

                 ­               ­ –        —  ­        ­ —“              ­   “  ­        ­          ­             ­          „­     ­  ˜              ™   ˜        š       —     —              ›              —     —        …†…‡ˆ‰ Š‚            …†…‡ˆ‰ Š‚     ‹“ŠŒ‘           ­…†…‡ˆ‰Š‚     €ŠŒƒ    …†…‡ˆ‰Š‚           —           ­­     ‹Œ‘ œ     ­ ­     ­     “ — —           ­    žŒ‘   ŸŒ         €ŠŠƒ ¡           “ — —             €Žƒ „                   ¢   …†…‡ˆ‰ Š‚                 £¤¥¦§ ¨© ¦¥ ”ŸŒŒŒ•   ˜                  ˜              €ŠŸƒ

‘7 (76) декабрь 2013 г. „              ­     ª      ­      “   ˜   Ÿ“«  €Š‚ƒ ˜   

   —        “           ­— “  ­   

                 ¬®¯™ ­ ­         ”     • °  “         ‚  °                           ­              —    ±           ˜           ²          ž«Ÿ “ž«‚          €Š«ƒ ³—   ­             ­                —    š                                ´¨µ£¶¶·¨©¦¥”Š¸¸¹•       ˜    º³      ­ ­                   €Š‹ƒ          ­              ­                             

»   ˜         ¨·¼¨¥“½¦¥¦¾¨ ¿ À         ”ÁÂÕ     

˜  -

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.         ­ €‚ƒ‚„‚…†‚„ ‡­ˆ‰Š„‰Š…        ­    ‹Œ‹Ž‘’ ƒ… “   ”•–  —˜™  —  š› ­  ›š š œ   ‚ƒ ž ˜ š     —  Ÿ      ­    ‚„   ‡  š      ˜ ˆ‰Š„‰Š…   ›         ‹Œ‹Ž‘’ ƒ… ¡  ¢”£  ‹Œ‹Ž‘’ ƒ…     ‚…      ˜ˆ‰Š„‰Š…   ‚„¢”£¤ ›˜   ‹Œ‹Ž‘’ ƒ…  ¤    ‹Œ‹Ž‘’ ƒ…  Ÿš ›  ”•–    ‹Œ‹Ž‘’ƒ…     ›  ˜  š   šš ›  ž š ¥¦§¨ˆˆ¡ ‡ ©  ˜ š   š  ‡  ­   ‡  š­™˜  ˆ•ª«¬ ƒ®‰‰š      ¥¦§¨ˆˆ¡    ›  ‡ ˜ ™ ˜  ˆ  ›˜— ¥¦§¨ˆˆ¡  ‡ ™ ˜  ›   ˜ šš  ›  ¡ › ­   —  ‡— œ¬Žœ¬¯†   « °±²  ˜   ›    ˜ ™ ˜—   — ›        ¥¦§¨ˆˆ¡     “  ¥¦§¨ˆˆ¡ ‡   ›   §³ž  ‚´§ µƒ¶· ‚      ›   ‡   ­   ¢…£    §…    Ÿ §… ž  ‡   §… ›  ƒ®‰¸š Ž²«««¹¥¦§   “š ©  ˜  —  ‡§…˜©   §…         ­ Ÿ ¥¦§¨ˆˆ¡ º —    ¥¦§¨ˆˆ¡ —» ­ ‡  ›       ž    ­ ˜  › š  ™ ˜  Ÿ  š   š    ˜ ©    ™   —      šš ›     š  ‡  ™   

   › š  §¼® µƒ½· ¾  ƒ®Š„ š  Ž±¿ ‹°¹ÀÁª        ­ ‡  ›— šš   ©    ™  ž    ­ ˜ ™     š   ­  ›   š­   ¡

 Ž°± °  ºƒ®®½»      ¥¦ˆ¨ˆˆ¡    ™ ˜—  š  ­­   š       ›   › ™ŸŸ   ©™ —  µƒ‰·³ š ˆˆ¡ ­¥¦§

11

  ™    ¤ ¹ š º¢Œ®¼»™ ˜——­ š ­š—Â   ™ ˜—˜ ™ ¥¦§¨ˆˆ¡  ˜    ­     ™ — à   ©   ›   ›— ›  ­   ˜    ­   ™ ˜š  ‡  š¥¦§¨ˆˆ¡          ˆ ­ ˆˆ¡¨¥¦§     ­   š —›­—      ˜   ­   ›— ¨ š­ › — —  ›­  —  ™ š¡™š­        ­  š šˆˆ¡¨¥¦§ Ę©    ­šˆˆ¡  ª±« ‘¹  •     © ‹Œ‹Ž‘’ƒ…ž  —š­—  — › ©Ÿ     ˜˜ ‹Œ‹Ž‘’ ƒ…  š   š ™ Ÿ  ‡   ™š š ›      Ÿ ‹Œ‹Ž‘’ƒ…Ã      ˜ Ÿ  š  —Ÿˆˆ¡ –   ›   ƒ‰¸†     ‰Š„ˆ ‰Š…  ‹Œ‹Ž‘’ ƒ…        —  ¥ ‹Œ‹Ž‘’ ƒ…  —®Å…Š¥ „® ™         ©  ‹Œ‹Ž‘’ ƒ… µƒ®· ¥ ‹Œ‹Ž‘’ ƒ… ™   ™  ­  ‡  — —— ˜      š›    —› —    ºÃ†ˆ‚» ‚  ‹Œ‹Ž‘’ƒ…—     š ­š ‹Œ‹Ž‘’ ƒ…  ­       š˜   º’» º»   š   º¹»‰›  — ƒ   ‡ºÀƹ»„ Àªµƒ®„¸·º„»     ­€‚ƒ

¥­      ˜    šš š‹Œ‹Ž‘’ƒ…“š  ½¼    š‹Œ‹Ž‘’ƒ…š›  ˜ Ÿ  ­   ‡ ˆ ‡  Ÿ ‹Œ‹Ž‘’ ƒ…    ˜  šš   — šš— — š š    šš  Ÿ  ˜  ‡  ¼¸Ç ž     ­ Ÿ‹Œ‹Ž‘’ƒ…‡›  ˜Ÿ  ›­  Ÿ ˆˆ¡ -

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


12

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

                       ­ €‚  ƒ „       „­‚  ‚ ‚   ‚  ‚ ‚ ­‚   ‚            …†‡ˆ‰Š ‹Œ ‰ˆ Ž‘’’“      ­   ­    ”•…  –­     ­  ­  —˜™­  ”•…™  š›     ­­  ­–­œ‡žŸ¡—‹‡ ”•…™     ¢ „  —˜  ­ ­­  —˜   ­ ­  š‘› £  „   ”•…™ ­ ­ƒ­  ƒ„ ­        ‚    „ ”•…™     ­ ­ ƒ­       ­   ‚    ‚    ­  ­   £   ­         ‚   ¢    ­ ­­    ‚  ƒ–  ƒ  ­ ¤ 

  ‚ –    „ ”•…™   ¢  ­­€¢‚–   ƒ     ­ ¥   ­ ‚  ­   ‚    ­  ­   ‘¡ŸŸ‚ ƒ ­ „”•…™   š‘‘› ¦­  ­     ­       ­  ­   §¨€© ¦ ‚   ª  Ÿ«      „     ­      „        ‘           š‘›¢¢­     ­    ‚    ‚  ­‚       ‚‚  ­    ƒ                

    ‚   „      ¬‰®¯‹ ‹Œ ‰ˆ Ž‘’’“      Ÿ’˜    ­     ”•…™ šª›¥­¢­    ­ƒ   ƒ „   ­  „  ”•…™  °  ±²³ Ž –  ­ ­ƒ­ŸŸ™´Ÿ˜   „  ­¤‚          ­              ‚ ‚­ ­­­    ‚  ­  ‚     ­   ­ ‚  ‚ ­   „       ­ ­     

‘7 (76) декабрь 2013 г.  ­    ‚  ­– ­  ‚      µ­­­„  ­   „ ‚   ƒ–„    ‚ ƒ–‚„Ž „ ­“ £‚          ƒ  Œ†¶Œ‹Œ‰ˆŽ‘’’Ÿ“  ‚  ™  ‚ ­  š‘Ÿ›   ‚     ƒ   §  © §¨€©€‚ ­ ­­­ ·¤ 

    ¬‰®¯‹ ‹Œ ‰ˆ Ž‘’’“         ­   „ ¸ ¹‹®¶‹Š        ‘    ƒ       šª›        º  ­ ­­         ƒ   »   ƒ       ‚ „       »  ƒ  ­§¨€©   ­  Ž  „„  “   „„      ­ƒ „¸‰   ©            ‚­    °¼© …¸¹‹®¶‹Š ½ ¨€© ­ ­­ „  ¦  ‚  ­ ­     „   ­  „    §  © š‘—› ° „       ­         ‚‚¤     ¢     ƒ­   ‚           ™ –  ¢‚      §¨€© ¥        ƒ     „   ƒ­§¨€©    „ ‚¢     

¾ž‡ž¿®ÀˆŒ¾‰ŠŠ   ‘¡        ´‘—  ´ªŸ  »„„  ­­–   ´’˜ ¬†¶žˆÁ‹ˆˆ   –¡—   ´ªŸ ´«’¥¢­ ­    ­­   ƒ    —Ÿ˜­     ­  ­­‚‚‚    »    ƒ         ƒ    ƒ    ƒ ƒ      ­   ƒ   ’‘     ´«‘  ´«´    ƒ ¢„„ ­      -

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

13

ǺȈȉȓȐȞȈ ǬȐȈȋȕȖșȚȐȟȍșȒȐȍȗȖȌȝȖȌȣȐșȗȖȓȤȏțȍȔȣȍȗȘȐȚȘȖȔȉȖȚȐȟȍșȒȖȑȔȐȒȘȖȈȕȋȐȖȗȈȚȐȐ 

 

  

 ƒ 

‰

                                    ­ ­ ‚  € ‚ƒ   ­ ƒ ‚

‚„  ‚ ‚„…‚ ‚       ‚­   ‚    †‡ ‚ˆ‚   ‚‰ ƒ ‚‰­­   €  ‚ †       ‚     ‚ ƒ  ‡ ‚Š †­‹ ŒŠŽ ‘’“ ‘”•– ‚—‡    ‚‰ ƒ ˜ˆ˜™š›œž ‚‰ ˜ˆ˜™š›œž ˜ˆ˜™š›œž € ‚‰Ÿ¡¢ ‚­ ƒ ‚  ˜ˆ˜™š›œž ‚     ƒ­ ‹¤¥¦§¨ ›¥›©¨ª«§§¬¥¥– ‚ ž ® ¯°± £ ‚      ‚ †‡     ‚— ­ ‹  ²  ­              ­­ –    ƒ    ƒ  ‚  ‚

     

               

                           ­€‚ƒ„……„†      ‡           ˆ‰Š‹ŒŽ

      ‘’ “

         Š‹‹Ž       ”   ƒ•–—˜„—…“†  ”                   ”             ™ š -

   ”   ……‰     ” „— “    ˆ—‰›–œ“  ž  ”Ÿ¡‘     ”      ¡     ” ™     ”    ƒ¢  †           ‡  ž          ” ‡  ™  ›    £ƒ‘’¤  ¥ ¦§ ¨©§ª€ †         ”   ¢      ¢ ‡  ™  

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


14

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

                                                                       ­€€‚ƒ      „   …† ‡ˆ    †    ‰Š‹Œ       †             †   Š    †       Ž‘     ’                  †             ‘Ž     “…“”•–—˜            ™       ™™ “…“”•–—˜    †   ™š       ™             ™     “…“”•–—˜    ›œž          ‰ŠŸŒ    ™              ™      “…“”•– —˜            “…“”•– —˜  ™    š                      „           ™         ’            ¡   …¢£¤¥¦¥§‚¨ ©Šªª«¬†    ™          †    ‰˜ªŒ ‡    ™    †     „         †   š†„    Ž  š       “…“”•– —˜†        †                     ™         •¦‚®  –¯°¨±‚± ©Šªª˜¬†

  š ™      ‹  ²          “…“”•– —˜      ‰˜—Œ          ¡ ˜     š           

²      ™    „ 

          —Š˜—³    Ž‘             ‰—† ŠŠŒ ´            —  Šµ—ªª ªªª ‰—Œ      ™†      †     „  ›œž†   †     † †    “…“”•–—˜†        -

‘7 (76) декабрь 2013 г. „  † 

        „  

          ›œž†              †        ™š            “…“”•–—˜¶  †           “…“”•– —˜    †    “…“”•–—˜       Ž   ™  ‡·    ™         „    † ™       †     “…“”•–—˜             „       †             „     Ž         “…“”•– —˜                        š     †  ——³    Ž‘      †  —µ³ ¸     †   ¹«³                š        µ                              ‘ Ž     ¹š¶  ‘Ž                     †    º»¼¼½ †                   

        š  †   º»¼¼½                       † ¾‚§¿¥§ ‚¨©Šªªª¬† Àª³ š                  †    Ž‘         †             ™  º»¼¼½  Ž‘          Ž‘   º»¼¼½            †º»¼¼½                 ©     „   ¹Š     „¬†     „                „‰˜ŠŒ     Ž‘           ™       Ž‘  Ÿµ³† ¸‹ª³‰ŠŠŒ †   ™ ‘Ž†  „     †     ™š           ™š         Ž‘           º»¼¼½     †                      †   †           -

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.                               ­€            ‚ ­ ƒ „     €       €  …    ‚  †        ‡   ˆ  ‚   ­‰‚    Š ‡‹      ‚    †                ŒŒŽ ‘’­        ‚   ­ “”•–—˜”™š›œž­…ŸŸ¡ˆ  ‚„††   †  €¢£¤¥  ¦ ‚      ‚  ‘ ’­§ ‚      „††   †¢£¤¥     †  €      ‘ ¨’­ ‰         ‚                   ‚      ‚

   ‚     ¢£¤¥   ­‰   €       ­   “œ››™‡©ª«š¬ ­ …®Œ®ˆ  ‚       Š ‡‹   ¨ŒŽ­    ‚ „    †   ­ ¯ ‚      €      

‡  †      ‚      ­°    

‚ 

               ‚€ ‚ €    ‚       ‚  ­ £               €            ±²¢    ­ ‰         „ €   €      ­              ±²¢    ŒŽ    ‚        † …            ˆ         ­ ƒ     ‚€   €         €  †  ³´´´   µ¶·     µ¶· ŒŒ‡¦ŒŒŽ­¸           

 ‚    ‚        ‚     ‚   ‚­ ¹š¬›“º˜«š¹­ ­ …®Œ ˆ ‚              †      ‘’­ £ „       Š ‡‹       ¦ ­Š       Ž ‚   ‚     „ †-

15

 ­ ‰     ®    ‚† ‚† ‚  »ŒŒ   ‚                 ‚     ‚    †€ ­ ‰ ®»        ‚                  ­¼      ŒŒŒŒŒ¥     ½ ¡Ž  ‚         ‚    ‚‚  †­ ƒ    ¾¿¢  † ‚€€­‰ ‚       £ÀÁ     ­      Ÿ  ‚­    

            €

   ¢£¤¥­ ˜©•œšš›œž­ …ŸŸÂˆ „¥¢£¤         €  ‘ ¡’­ڞž ¹™˜”žš•…ŸŸÂˆ  ‚ ‚Ä  ® ‡    ‚     ‚      ‚             ‚„  †‚     † ­      ‚ ‚   € „    ‚‘ ¦’­   ¥¢£¤     †­                  ¢£¤¥  »Œ  ŒŽ­ ‰ „††               źƙ¬Ç«›š™¬  Ÿ¡Ÿ ­ ¼    †      µ¶·‡       €       €                      †    €     ‚      ‚  ¥¢£¤   ‚   †   ŠÈ¤­    †                  „††           †         €    ®‡ ‘ ’­£ €   †      € †                     „                             ‚

          ‚  ­ œ˜”š›œž­ …ŸŸˆ  †  „††               ‚        ‚      †‘ Œ’­¯    €‚‚¥‚  ‚-

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


16

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

        

   1) плазмаферез

2) свежезамороженная „ „  плазма  

3) криопреципитироŽ ‰ ванная плазма (очи   ”  щенная от мультимеˆš›œ‡ ров vWF, фибриноге  ‡ на, фибронектина)  

  €   

£ˆ  

§ˆ     ˆ ¨ˆˆ ‡‰  ‡‰  Ÿ‰    

    

      ­  €‚­­ ƒ„ ƒ  „…†‡    ˆ ‰ Š  ˆ ‹     ˆˆ „ˆ ‰      Œ   †    ƒ   ƒ      Œ ­   ˆˆ ­­ ­  ‡  ˆŠ     ‰ Ž‘    €‚­­ Œ ‡ ’         ‰ „‘Œ “ƒ  ’ ” ”   •–•—˜™Ž Ž‘    ­    „‡ ’  „    

  ž ‰€‚­­ ‡­“Ÿ‡     Œ“ƒ  ‡ˆ    ¡ ¢          „ „      ­“Ÿ‡     “    ¦–§‰‡ ƒ  ’ˆˆŒ ‘Ž¤¥ ¢           „ „      ­“Ÿ‡     †      ‘    „ „      ­“Ÿ‡     “ƒ  ’ˆˆŒ ¢      „ „      ­“Ÿ‡     ŸŽ †     ‡ˆ    ˆŒ  Œ © ¤¥¥ ­“Ÿ „ª    ˆŒ  „ ¨ˆ  

 



                     

     ­€‚ ƒ„      …       

     

           †„‡ˆ

‰      Š ‹           Œ‹             „Ž‘‡Ž’        “  “     ‹  “         ”•–– —˜ ™ƒššƒ›    “  „  -

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.           ­€‚ ƒ  „    ……†       ‡  ˆ‚ †      ‡   ‚  ‰         „ „           ‡Š‹ŠŒŽ‘   ’     „    ˆ ‡‡    “  „  ”„„ ‡“­€‚•‡ Š‹ŠŒŽ‘ „ –   „  – —  ‡ ‚ ƒ   ˜™……†  

           –   —ˆˆ„„ –– š‚ ›‚œ            „ –   ……†Š‹ŠŒŽ‘   —ˆˆ      

ˆ  ‡‡  ‚ •‡         š„   ž‹  •–›     ˆˆ      —‚ …   „     —ˆˆ    ……†    ˆ  ‚Ÿ¡¢¢£¤‚š­­›„

„ ‡  ……† ‡„    ‡  „     ­€‚ …    ‡     ¥   „– „‚ † — –    „       „  ……†‚ •     – „ ‡    š ˆ ¦     ›‚ ™ „     ‡ „    „ –   – — ……† „ ‡„    ‚ †„ ‡‡ —ˆˆ„      ¥ „§£¨ ˆˆ‚†¥— – – –  – ˆ  ¥

     –„   ‚ ©–   —  ‡  ‡„      

 ¥ ‡‡        ˜™ ……†   „  – „ –  –—  ‚ •‡ „      ……†      ‡    –   ˆ     ‚ •  ‡     –    „   ˆ  -

17

 –  –    – ……†   „         ‚ ‰   

    ‡    ……† ‡ –  –     ¥–    ‚ ˜     –  ˆ ˆ  „  –  ˆ     –        –    ‡

‡ ˆ  „ ‚‰–„ –– „        – ‡ š     ›‚ ‰   ©…     ‡ˆ   ‡ ‚ •         ˜™……†     „„  ‡   „            ‚ • –  – —ˆˆ ‡ „   — ‚ ™ —  „ 

   ˆ ˜™  –¥  ¥ „    ‚ • §£¨‡ „ „ 

     – ‡  „ —ˆˆ„   š        ª«¬   —›‚ †    –   „ 

¥„ ‡ — ‚‰       „    

 „ “      –   – ‚  „   šŸ¡¢¢¡®¯¢‚ ­­›  —ˆˆ„   ˜™……† ‡ ­€‚ ° — „ –„      ……†˜™         ‚ …   

      ™      ¥   –   ‡ –  –           ¨¯±Ž²¨¤  ³€‚ †‡‡         ˆ……† „   „‡‡  ‡  „    ‡  ‚ †  ¨´µ¢¯¶¡®¯¢‚š­­”› „ —      ……†  „   §£¨  — ˆ    ³€‚ ·¶§·®µ¸ ‡—ˆˆ„ — ……†  „  — ‚ …    Œ¯¶®¡®¯¢‚š­­­› „ —

–  •  ¥– §£¨’€‚

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


18

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

          ­ €€‚­­ƒ  ƒ„ …† ƒ‡†  ƒ ˆ‰ Š‹†Š  ŒŽ­  ­‘ƒ… ƒŠ…   ƒƒ’†„‹ƒ“‰“”•–—˜™—šŒŠ‹Š  „‡   ’‹’  ‹ „   ­  €€  Š Š  „‡› ŠŠŠ‹„ƒ  ‚†‹„Š Œƒ„   ‹  ŠŠ ƒ’ † ƒ  ­„ƒ ƒ ‚­­ƒ‡ ƒ    ƒ‹ œŠ’„Š„ƒ‹ƒƒƒ‚ ’‡†„‘ƒ ƒ†ž­‹Š„   ƒ‹ ‡ƒ    ’‹†’ ƒ‘Š  ‘  ƒ‘Š… ‹ ’‘Žƒ›‘† ƒ   ‘… ƒ‹ŠŠ…    ›‡ Œ ‹  Š ††„  ’ †‹ ’ „‡Š  ‚   „‘Š…††„Ÿ¡†¢ ƒŠŠŠ‹„ƒ … ‹  „  £¤  „ƒ… „ ¥¦—§‹Š‹£¤ ¨ƒ„ ­†£¤‹ “©ª««ˆ¬® “¯«°ˆ„ƒ ­‡ƒ¥±—§‹††„ Š  ‡„ †„ „Ž  †‹ „…‹ Š‚ “¯«°ˆ²€€ ’ ƒ„ ­ “‰“”•– —˜ ƒ  ’ „ ‡‹‡  ƒ‘‹‡ ³†Š     ‹  ’† ƒ„  “‰“”•– —˜  ‹  ƒ  „  ‡›  „‡ ƒ Š‹   ƒ “‰“”•– —˜ ² † Š  ’… Š… ‡   ‘ ƒ„  “‰“”•– —˜ ‹’ ‡‹‡  ‡ƒ  „ƒ‘ƒ‘­‚†­„†Š ƒ†„ €€ƒ ƒƒ  ‘ ƒ… ‹… ƒ„  “‰“”•– —˜ ‹Š ‡  ‹  †„‡ƒ‡“‰“”•–—˜™š  ´ƒŠ…Š‹‹‘ ƒŠ… …‹ „‘ƒ  ƒ†‹Š‡‘‚ †Š ŠŠŠ †‹ „  ‘„Š‘‡Œ’ › ††ƒ‹ƒƒ„‘ƒ „‘ƒ   ƒ  †…  „‘ƒ  ƒ† ŠŠŠ „‡ ‘  ’ ŠŠ‡Š ­‹†‘ƒ›   ­ƒ­Œ„…ƒŠ„ƒ „‹“‰“”•–—˜‘ ’†„Š‡ƒ  †-

‘7 (76) декабрь 2013 г. ‘ƒ „  ­ ‚† ­ ³†ƒ‹‹Š‹‡ ’ ƒŠ  ­­…   „ ­ “‰“”•– —˜ Œ‘ƒ…‹††‡’ ‡  †‹ Š’… … ’  „   ‘ ‚ƒ µ¶··¦Ž Œ Š Š ƒ Š Š †‹ „‘ƒ  ƒ† ‹‘‡ › ¸ †  ƒ‘‡  …   ƒ… ŠŠŠ „Š  ‘  †‘ƒ    ¹Š †ƒ „‘ƒ ƒ†ƒ‡ ‹‘ Š „ ƒƒ ‘Š   ‘’‡‹‡…ƒ ƒ  Š’ ­ †‹  µ¶··¦Ž  Œ‹’ „ †„ƒ ‹‘Š †‹ „‘ƒ  ƒ† ‹‹„‡„‘‡­‘†ƒ‚††‘ƒ†   ‹„‡ ‚­­ƒ  †  ºž€»¨¼€½¨¼ — ¾ ¿ÀÁ  ¾  ª “ –ÀÁ ¿®® © ¶ –ÀÁ ±± Á  ¯ ÿÄÄ Åà ÀÆǤ– È É®Æ Ž£ Ĭª ¶£ Ĭª Ǧ© ª À¬  ű®Á ʎ–ÀÁ¿  ®¬ Ä© ¢¢µ ® ®  ª Ë—˜” ¬ÌË Â ˜˜Í˨—ŽÎ  •©Æ •Ç µ   ¯ˆ ˆÁ©§  •· Ï À©

® ª © ¬ È© Á©§ À Á©§À¬± À ±¿©±¿©   Á  Å  Ä –  ®Ž ¬® ® È   © ¬Ä  —Ì°ÎŽ—Ì̗¢¢“ǵ   Ë—ÌÌ«Ë Â «Ë¨ÎŽÌ ˜¤¿© ”·  Ó   ª¬ ı Áª ® ®ÈÁ©§ À Á©§À¬± À ±¿©±¿©  Ä Á

 ¬ À ¿©

 À ®¬ Ä© Ð Á  © È £ §© ÄÈ À©ŽÀ

 ª±©

® ¢¢à ®¦© À¯ ®ˆ  µ

  Ë—Ë —Í˨˜¡Ž« ¯¿ªª  ¦Ñ© ®”¯ ¿ÒÒ ¥•Á©§ À À© ª ± Á¬ Á  ¬ À ¿©  À ®¬ Ä©  Ä Á©§ À Á©§À¬± À ±¿©±¿© ¢¢¾ Ä ¬Ï Ë—Ë °Í˜Ë¨Θ—Ž° «” Æ Ç·¯¿Ä¬ˆ¾•© ǵ  Å ¿®¿ ¬ ©ª ± ® È À©ÂÏÏÏÐ £ §© ÄÈ À©¿   ©® ÀÁ© À© ±® ªÁ©§ ÀÁ©§À¬± À±¿©±¿© ¢¢Ñ¶ ªÇ” ÄË—ÌÎË ˜¡Ë ¨—˜Ž—˜« ° ¯ È  • ” ª ©¬ ¯ Ñ Ê ®± À®  Á  ± Áª ® ® Ä Á©

  È •Á©§ À Á©§À¬± À ±¿©±¿©  Ä Á  ¬ À ¿©  À®¬ È© ¢¢¯ ˆ ¶Ó±µ   Ë—Ë «Í˜Ë ¨«˜°Ž«°— ¡¤¿© ”·  É ÔÀ À¬È £ §© ÄÈ À©ŽÀ

 ª ±©

®  È   Ä ÀÕ¿ © ÄÁ©§ ÀÁ©§À¬± À±¿©±¿© ¢¢à © ®ˆ µ

  Ë—ÌÌÎË ——Í˨«̎— Î · ©  ˆ ¦®ŽÄ ©©Á

 Á  ¬ ÀŽ¿©  À ®¬ Ä© Ð À À 

®± À®¢¢“©ÀÁ¦ Ä ©Ë—ËΖ¿±± Ë¡¡°®Ž¡Î® Ì·  þ©  ©Ç–¿Älj  •Á©§ ÀÁ©§À¬± À ±¿©±¿© ¢¢µ   ÇËË«–¿±± ˜Ë–°Ž—— — –ÀÁ © ” –¿Ä lj ©§ ©ª Ç ¾©  © µ ª  Ǔ “ÀÕ¿ © ÄÁ©§ ÀÁ©§À¬± À±¿©±¿© Ä  ± È  ¿ ¿ © ®± ® ¢¢µ ® ®  ª Ë—˜” ¬ÌË ˜˜ Í˨——Ž˜ —— –ÀÁ ±Á©® ¯µ   Ä  ¾ © ш   Ä  µ ¿  ·¦ ¤© ª   Ä ®

® Ö À ª   Á©§ À Á©§À¬± À ±¿©±¿©  Ä¿ ¿   ® Á “‰“”•–—˜ª ¢¢Ñ Ä• ×Ä®ÀÁ©¥

®ÆÄË ˜Ë —¡ÍÌ˨Ž — ¤¿©  ” ·   à –± À¬  Á©§ À Á©§À¬± À±¿©±¿© ¢¢“ǵ   ËË °Í—ˡ̏ —˜ ¤¿©  ” ‰ ÔÀ  À  ¬ È   £ §© Ä È À©ŽÀ

 ª ±©

®  Á©§ ÀÁ©§À¬± À±¿©±¿© ¢¢¶Ó± ©¯ ˆ ©Ä  ®À•Á ©Ë˜Ë —Í˨˜Ž«« — •®  µ” ” À¿ ©  ÀÁ ®®  Á©§ À Á©§À¬± À ±¿©±¿© ¢¢–  •Á©§µ ®ËË ˜Í«Ë¨«̎«¡ —« ¯ ¿ÒÒ  ¥ ¥ §¿® ©  ” –  Ä©  ”   à  ©  ±Á© À¬®±± ÄÄ ®

® ±©ª© ®®   ± ® Ž© ® ® Á  ¬ À ¿©  À®¬ Ä© Ê Á ¿© ª À ® ª ® ÄÀ ¢¢¾ Ä ¬Ï Ë —ÌÌ°Ë Ì͗˨Ύ° —°µ  ® Æ ¾” ¿© •¾ Ä µ  –¬®  À ¿±¿® ©¬Á  ®¿® ÄÁ©§ ÀÁ©§À¬± À±¿©±¿© Ð À ® © ±© Ä  © ¿© ©  Ê¢¢ˆ ¯Á ¿  ˘Ë ͎«Ë¨˜««ŽÎ —¡ ¾ ©±  ‰ •   ¯ ˆ±   À      Á©§ À  À© ª ± Á¬¢¢µ ® ®  ª Ë—˜” ¬ÌË ˜˜ Í˨̰Ž— —Î ” ©  ‰ Ç ÈÈ  ¶“ £ Æ® © à   •Á©§ À Á©§À¬± À ±¿©±¿©  Ä ®±© Ä À Á  ¬ ÀŽ¿©  À ®¬ Ä©  ± ® ®

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


Ă?Ă?Ă&#x20AC;Ă&#x160;Ă&#x2019;Ă&#x2C6;Ă&#x2014;Ă&#x2026;Ă&#x2018;Ă&#x160;Ă&#x20AC;Ă&#x; Ă&#x152;Ă&#x2026;Ă&#x201E;Ă&#x2C6;Ă&#x2013;Ă&#x2C6;Ă?Ă&#x20AC;

â&#x20AC;&#x2DC;7 (76) докайŃ&#x20AC;Ń&#x152; 2013 Đł.  

       Â?  Â? Â?Â?Â?Â? Â?

 ­Â&#x20AC; Â&#x201A; Â&#x192; Â&#x201E; Â&#x2026; Â&#x201E;­ Â&#x2020;Â&#x2021;

Â&#x192;Â&#x2020;Â&#x201A;  Â?Â&#x2C6;Â&#x2C6;      Â? Â&#x2030;Â&#x2030; Â?Â&#x2030;

Â?Â&#x2C6; Â&#x160;Â&#x2039; ­ Â&#x152;Â?Â&#x201E;Â&#x17D;Â&#x201E;Â&#x2018;Â&#x2020;Â&#x152;Â? 

Â&#x192;Â&#x2020;Â&#x201A;  Â?Â&#x2C6; Â&#x192;  Â&#x152;  Â? Â?Â? 

Â?  Â&#x2018;Â&#x2021; Â&#x2020;  Â&#x2026;Â&#x2019; Â&#x2026;  Â&#x2018; Â&#x2018;  Â&#x201C; Â&#x201D;  Â&#x201E;Â&#x17D;Â&#x201E;Â&#x2018;Â&#x2020;Â&#x152;Â   Â&#x2021;Â&#x192;

Â&#x201A;  Â?Â&#x2C6;  Â&#x2018;Â&#x2021;Â?      Â?  Â?  Â?

Â?Â? Â&#x2022;Â&#x192; Â&#x2013; Â&#x2020;Â&#x2021;Â&#x2014;Â&#x2021; Â&#x2019;  

Â&#x192;Â&#x2DC;Â&#x201E;  Â?Â&#x2C6;Â&#x2C6;Â?   Â Â?  Â? Â&#x2030;Â Â?

Â?  Â&#x2022; Â&#x192; Â&#x2013;  Â&#x2021; Â&#x152; Â&#x2026;  Â&#x2020; Â&#x17D; Â&#x20AC;     Â&#x2020; Â&#x2122;Â&#x2019; Â&#x2020;Â&#x2020;Â&#x2021;Â&#x161;Â?Â&#x2021;Â&#x203A;Â&#x152;Â&#x2021; Â&#x20AC;Â&#x2021; Â&#x201E;

 Â&#x201A;  Â?Â&#x2C6; Â&#x2018;Â&#x2021;Â?      Â?  Â? Â&#x2C6;Â?Â?

Â?Â? Â&#x152;Â&#x192; Â&#x17D; Â&#x201A; Â&#x192; Â&#x201E; Â&#x20AC;Â&#x20AC;  Â&#x153;Â&#x2021;Â&#x2014;Â&#x201E;Â&#x17D;Â&#x201E;Â&#x2018;Â&#x2020;Â&#x152;Â Â&#x2021; Â&#x17E;

   Â?Â&#x2C6;Â&#x2C6;Â?   Â&#x2C6;Â Â   Â? Â?Â?

Â?  ­ Â&#x; Â&#x2DC;  Â&#x2020; Â&#x2021; Â? Â&#x2021; Â&#x2021;

ÂĄ Â&#x2DC;  Â?Â&#x2C6;Â&#x2C6;   Â?Â?Â&#x152;  Â? Â?Â&#x2030;

Â?Â&#x2030;  Â&#x192; Â&#x152; Â&#x2026; Â&#x152; Â&#x2018;Â&#x2019;Â&#x17E;Â&#x20AC; Â&#x2DC; Â&#x201A;­ Â&#x2022; ÂĄÂ&#x2021;Â&#x2021;

Â&#x201E;Â&#x192;Â&#x2026;Â&#x2021;Â&#x17D;  Â?     Â?  Â?   Â?Â?

Â?  Â&#x20AC;Â&#x2019; Â&#x2022; Â&#x201E;  Â&#x152;Â&#x2019; Â&#x2026; Â&#x201A;  Â&#x2019; Â&#x2013; Â&#x201E;     Â&#x2DC;  ¢Â&#x17E; Â&#x2021; Â&#x2DC;Â&#x201E;Â&#x152;Â&#x2021;Â&#x2022;

Â&#x2013;Â&#x; Â&#x192;Â&#x2018;      Â? Â&#x2030;  Â?   Â?

Â?  Â&#x201E; ­  Â&#x2018;Â&#x2021;   Â&#x2021;ÂŁ ÂĄ ¤ÂĽÂŚ §Â&#x2021;ÂŚ Â&#x201E; Â&#x17E;  ÂĄ ÂŚ Â&#x201E;    Â&#x2021;

 Â&#x201A;  Â?Â&#x2C6; Â&#x2018;Â&#x2021;Â?      Â?  Â?  Â?Â?

Â? Â&#x2026;Â&#x201A; Â&#x192; Â&#x201E; Â&#x152;Â&#x192; Â&#x17D; ­ Â&#x2020; §Â?  ¤Â&#x201E;Â&#x17D;Â&#x201E;Â&#x2018;Â&#x2020;Â&#x152;Â? ¼     Â&#x2021;¤Â&#x2020;Â&#x2020;Â&#x161;ÂĽ

Â&#x161;Â&#x2021;Â&#x201A;Â&#x2020;   Â?Â&#x2C6;Â&#x2C6;      Â?Â&#x2030;  Â? Â?Â?Â?

 Â&#x2C6;   Â&#x2018;  ­  Â&#x201E;Â&#x2021;   § Â? Â&#x2014;Â&#x153; Â&#x2021;

Â&#x152;Â&#x2020;Â&#x201A;  Â?Â&#x2C6;Â&#x2C6;Â?   Â? Â Â?  Â? Â&#x2030;Â?Â?

REFERENCES 1. Kentouche K., Voigt A., Schleussner E., Schneppenheim R., Budde U., Beck J.F., StefaĹ&#x201E;ska-Windyga E., Windyga J. Pregnancy in Upshaw-Schulman syndrome. Hamostaseologie, 2013, vol. 33, no. 2, pp. 144-148. DOI: 10.5482/HAMO-13-04-0025. 2. Torok T.J., Holman R.C., Chorba T.L. Increasing mortality from thrombotic thrombocytopenic purpura in the United States â&#x20AC;&#x201C; Analysis of national mortality data, 1968-1991. American Journal of Hematology, 1995, vol. 50, no. 2, pp. 84-90. DOI: 10.1002/ ajh.2830500203. 3. Furlan M., Lammle B. Aetiology and pathogenesis of thrombotic thrombocytopenic purpura and haemolytic uraemic syndrome: The role of von Willebrand factor-cleaving protease. Best Practice and Research in Clinical Haematology, 2001, vol. 14, no. 2, pp. 437-454. DOI: 10.1053/beha.2001.0142. 4. Ruggenenti P., Noris M., Remuzzi G. Thrombotic microangiopathy, hemolytic uremic syndrome, and thrombotic thrombocytopenic purpura. Kidney International, 2001, vol. 60, no. 3, pp. 831-846. DOI: 10.1046/j.1523-1755.2001.060003831.x. 5. Moake J.L., Rudy C.K., Troll J.H., et al. Unusually large plasma factor VIII: vonWillebrand factor multimers in chronic relapsing thrombotic thrombocytopenic purpura. New England Journal of Medicine, 1982, vol. 307, no. 23, pp. 1432-1435. 6. Raife T., Montgomery R. New aspects in the pathogenesis and threatment of thrombotic thrombocytopenic purpura and hemolytic uremic synfrome. Reviews in Clinical and Experimental Hematology, 2001, vol. 5, no. 3, pp. 536-561. DOI: 10.1046/j.14680734.2001.00044.x. 7. Furlan M., Lammle B. Deficiency of von Willebrand factor-cleaving protease in familial and acquired thrombotic thrombocytopenic purpura. Bailliereâ&#x20AC;&#x2122;s Clinical Haematology, 1998, vol. 11, no. 2, pp. 509-14. 8. Loirat C. Post-diarrhea hemolytic-uremic syndrome: Clinical aspects. Archives de Pediatrie, 2001, vol. 8, Suppl. 4, pp. 776-784. DOI: 10.1016/S0929-693X(01)80196-2. (in French). 9. Lammle B., Kremer J., Studt J.D., et al. Thrombotic thrombocytopenic purpura. Hematology Journal, 2004, vol. 5, Suppl 3, pp. S6-S11. 10. Schaller M., Studt J.-D., Voorberg J., Kremer Hovinga JA. Acquired thrombotic thrombocytopenic purpura development of an autoimmune response. Hamostaseologie, 2013, vol. 33, no. 2, pp. 121-130. DOI: 10.5482/HAMO-12-12-0023. 11. Schiphorst R.H., van de Kar N.C., van den Heuvel L.P. From gene to disease; congenital thrombotic thrombocytopenic purpura due to mutations in the ADAMTS13 gene. Nederlands Tijdschrift voor Geneeskunde, 2003, vol. 147, no. 49, pp. 2422-2424. (in Dutch). 12. Furlan M., Lammle B. Splenectomy in thrombotic thrombocytopenic purpura [2]. American Journal of Hematology, 2000, vol. 64, no. 1, p. 79.

19

      

                  Â?     Â? Â?      Â?Â?  ­ Â?Â&#x20AC; Â&#x201A; Â&#x192;Â&#x201E;Â&#x201E;Â&#x2026;Â&#x201A;Â&#x192;Â&#x2020;Â&#x2021;Â&#x201A;Â&#x2C6;Â&#x2026;Â&#x2030;Â&#x201E;Â?Â&#x2030; Â&#x192;Â?Â&#x160;Â&#x2039; Â&#x152;­ Â&#x20AC; Â&#x152; Â&#x17D;  Â?  Â?Â&#x2018;Â&#x17D;Â&#x17D; Â&#x17D; Â&#x17D;     Â?       Â&#x17D; Â&#x201A;Â&#x192;Â&#x201E;Â&#x201E;Â&#x2026;Â&#x201A;Â&#x2019;Â&#x2020;Â&#x192;Â&#x201A;Â&#x2C6;Â&#x2021;Â&#x2030;Â?Â&#x2019; ­ Â&#x20AC;Â&#x201C; Â&#x160;Â&#x152;Â&#x201D; Â?    Â?       Â?Â&#x2018;  Â?  Â?Â&#x2018;Â&#x17D; Â&#x17D; Â&#x17D;     Â&#x2022;   Â&#x20AC;  Â&#x201A;Â&#x192;Â&#x201E;Â&#x201E;Â&#x201A;Â&#x2013;Â&#x201E;Â&#x2020;Â&#x201A;Â&#x2C6;Â&#x2021;Â?Â&#x2014; Â&#x2026;  Â&#x152; Â&#x2DC;  Â&#x2122; Â&#x2022;     Â? Â?  Â&#x2018; Â&#x17D;  Â? Â?Â&#x2018;Â&#x17D;Â&#x17D; Â&#x17D; Â?Â&#x2018; Â&#x2018;   Â&#x17D;  Â&#x2018;  Â&#x17D; Â&#x201A;Â&#x192;Â&#x201E;Â&#x201E;Â&#x201A;Â&#x2030;Â&#x2020;Â&#x2026;Â&#x201A;Â&#x2C6;Â&#x192;Â&#x201E;Â&#x192;Â?Â&#x2019; Â&#x2014;   Â&#x160;Â&#x152;    ­ Â?   Â&#x17D; Â&#x2018;   Â&#x17D;  Â&#x2018;  Â&#x201C;Â&#x20AC; Â&#x201A;Â&#x2019;Â&#x2019;Â&#x2013;Â&#x201A;Â&#x2026;Â&#x2020;Â&#x192;Â&#x201A;Â&#x2C6;Â&#x2026;Â&#x2021;Â?Â&#x2014;Â&#x2021; Â&#x2030; Â&#x152;Â&#x160;  ­Â&#x201C;­ Â?Â&#x2018;Â&#x17D; Â&#x17D;  Â&#x2018;  Â&#x152; Â&#x2122; Â&#x201A;Â&#x2019;Â&#x2019;Â&#x2013;Â&#x201A;Â&#x192;Â&#x2020;Â&#x201A;Â&#x2C6;Â&#x2021;Â?Â&#x2019;Â&#x2026; Â&#x2013;Â&#x2039; Â&#x20AC; Â&#x201C; Â&#x17D; Â&#x17D;         Â&#x161;    Â?  Â?Â&#x2018;Â&#x17D; Â&#x17D; Â&#x17D;      Â&#x203A;Â&#x17D;Â&#x2122; Â&#x201A;Â&#x192;Â&#x201E;Â&#x201E;Â&#x201A;Â&#x2030;Â&#x2020;Â&#x201A;Â&#x2C6;Â&#x2030;Â&#x2013;Â?Â&#x2013; Â&#x2021;Â&#x160;Â&#x153;Â?Â&#x17E;Â&#x2122;­    Â?  Â&#x17D; Â&#x2018;Â?  Â?  Â&#x17D;  Â&#x20AC;  Â&#x201A;Â&#x192;Â&#x201E; Â&#x2018;Â&#x192;Â&#x2019;Â&#x201A; Â&#x2020;Â&#x192;Â&#x201A;Â&#x2C6;Â&#x2026;Â&#x2019;Â?Â&#x2014;Â&#x2019; Â&#x2019; Â&#x152; Â&#x20AC;Â&#x2DC;Â&#x2122;Â&#x17E;Â&#x160;  ­Â&#x201C;Â&#x;Â&#x17D;      Â? Â?Â&#x2018;Â&#x17D;Â&#x17D; Â&#x17D; Â?Â&#x2018; Â&#x2018;   Â&#x201D;Â&#x17D; Â&#x201E;Â&#x2021;Â&#x17D;   Â&#x2122;Â&#x2022; Â&#x201A;Â&#x2019;Â&#x2019;Â&#x2021;Â&#x201A; Â&#x192;Â&#x2014;Â&#x2020;Â&#x2030;Â&#x201A;Â&#x2C6;Â&#x2019;Â&#x2021;Â?Â&#x2026;Â&#x201E; Â&#x2026;Â&#x201E; ­  Â&#x152; Â&#x152;ÂĄ ÂĄÂ&#x201C;Â&#x17D;Â&#x2018;   Â&#x17D;      Â?  Â?Â&#x2018;Â&#x17D; Â&#x17D; Â&#x17D; Â?Â&#x17D;  Â&#x17D;  Â&#x201D;  Â&#x17D; Â&#x2018;  Â&#x20AC; Â&#x201A; Â&#x2019;Â&#x2019;Â&#x2019;Â&#x201A;Â&#x2030;Â&#x192;Â&#x2020;Â&#x201A;Â&#x2C6;Â&#x2014;Â&#x2030;Â?Â&#x2013; Â&#x2026;Â&#x2039; Â&#x152;Â&#x2122;  Â&#x201C;  Â&#x201C;  Â&#x152;­ Â&#x20AC;Â&#x152;Â&#x201D; Â?         Â?  Â?Â&#x2018;Â&#x17D; Â&#x17D; Â&#x17D; ¢    Â&#x17D;    Â?      Â&#x20AC;  Â&#x201A;Â&#x192;Â&#x201E;Â&#x201E;Â&#x2026;Â&#x201A; Â&#x192;Â&#x2026;Â&#x2020;Â&#x2030;Â&#x201A;Â&#x2C6;Â&#x2013;Â&#x2021;Â&#x2013;Â?Â&#x2019;Â&#x2014; Â&#x2026;Â&#x192;  Â? Â&#x160;Â&#x2018; Â&#x201C;     Â?  Â?Â&#x2018;Â&#x17D;Â&#x17D; Â&#x17D;   ­ Â?Â&#x20AC; Â&#x201A;Â&#x192;Â&#x201E;Â&#x201A; Â&#x201C;Â&#x17D;Â&#x17D;Â&#x201A;Â&#x2C6;Â&#x192;Â?Â&#x201E;

13. Furlan M. Deficient activity of von Willebrand factor-cleaving protease in thrombotic thrombocytopenic purpura. Expert Review of Cardiovascular Therapy, 2003, vol. 1, no. 2, pp. 243-255. 14. Tsai H.-M. Molecular mechanisms in thrombotic thrombocytopenic purpura. Seminars in Thrombosis and Hemostasis, 2004, vol. 30, no. 5, pp. 549-557. DOI: 10.1055/s-2004-835675. 15. Remuzzi G., Galbusera M., Salvadori M., et al. Bilateral nephrectomy stopped disease progression in plasma-resistant hemolytic uremic syndrome with neurological signs and coma. Kidney International, 1996, vol. 49, no. 1, pp. 282-286. 16. Hamasaki K., Mimura T., Kanda H., et al. Systemic lupus erythematosus and thrombotic thrombocytopenic purpura: A case report and literature review. Clinical Rheumatology, 2003, vol. 22, no. 4-5, pp. 355-358. DOI: 10.1007/s10067-003-0742-1. 17. Karpman D., Tati R. Complement activation in thrombotic microangiopathy. Hamostaseologie, 2013, vol. 33, no 2, pp. 96-104. DOI: 10.5482/HAMO-12-12-0025. 18. Mitra D., Jaffe E.A., Weksler B., et al. Thrombotic thrombocytopenic purpura and sporadic hemolytic-uremic syndrome plasmas induce apoptosis in restricted lineages of human microvascular endothelial cells. Blood, 1997, vol. 89, no. 4, pp. 1224-1234. 19. Lammle R., Hovinga J. A. K., Alberio L. Thrombotic thrombocytopenic purpura. Journal of Thrombosis and Haemostasis, 2005, vol. 3, no. 8, pp. 1663-1675. DOI: 10.1111/j.15387836.2005.01425.x. 20. Zheng X.L. Structure-function and regulation of ADAMTS-13 protease. Journal of Thrombosis and Haemostasis, 2013, vol. 11, Suppl. 1, pp. 11-23. DOI: 10.1111/jth.12221. 21. Miyata T., Kokame K., Matsumoto M., Fujimura Y. ADAMTS13 activity and genetic mutations in Japan. Hamostaseologie, 2013, vol. 33, no. 2, pp. 131-137. DOI: 10.5482/HAMO-12-11-0017. 22. George J.N. Thrombotic thrombocytopenic purpura: A syndrome that keeps evolving. Journal of Clinical Apheresis, 2004, vol. 19, no. 2, pp. 63-65. DOI: 10.1002/jca.20008. 23. George J.N., Vesely S.K., Terrell D.R., et al. The Oklahoma Thrombotic Thrombocytopenic Purpura-Haemolytic Uraemic Syndrome Registry: A model for clinical research, education and patient care. Hamostaseologie, 2013, vol. 33, no. 2, pp. 105-112. DOI: 10.5482/ HAMO-12-10-0016. 24. Studt J.D., Hovinga J.A., Radonic R., et al. Familial acquired thrombotic thrombocytopenic purpura: ADAMTS13 inhibitory autoantibodies in identical twins. Blood, 2004, vol. 103, no. 11, pp. 4195-4197. DOI: 10.1182/blood-2003-11-3888. 25. Lian E.C. Thrombotic thrombocytopenic purpura â&#x20AC;&#x201C; A syndrome caused by multiple pathogenetic mechanisms. Investigacion Clinica, 2001, vol. 42, Suppl. 1, pp. 75-86.

Ă&#x20AC;Ă&#x160;Ă&#x201C;Ă&#x2DC;Ă&#x2026;Ă?Ă&#x2018;Ă&#x2019;Ă&#x201A;Ă&#x17D;. Ă&#x192;Ă&#x2C6;Ă?Ă&#x2026;Ă&#x160;Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;. Ă?Ă?Ă&#x201E;Ă&#x17D;Ă&#x160;Ă?Ă&#x2C6;Ă?Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;


20

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

26. Berns J.S., Kaplan B.S., Mackow R.C., Hefter L.G. Inherited hemolytic uremic syndrome in adults. American Journal of Kidney Diseases, 1992, vol. 19, no. 4, pp. 331-334. 27. Rock G.A., Shumak K.H., Buskard N.A., et al. Comparison of plasma exchange with plasma infusion in the treatment of thrombotic thrombocytopenic purpura. Canadian Apheresis Study Group. New England Journal of Medicine, 1991, vol. 325, no. 6, pp. 393-397. 28. Alberio L. My patient is thrombocytopenic! Is (s)he? Why? And what shall I do?: A practical approach to thrombocytopenia. Hamostaseologie, 2013, vol. 33, no. 2, pp. 83-94. DOI: 10.5482/ HAMO-13-01-0003. 29. Kremer H.J.A., Studt J.D., Lammle B. The von Willebrand factor-cleaving protease (ADAMTS-13) and the diagnosis of thrombotic thrombocytopenic purpura (TTP). Pathophysiology of Haemostasis and Thrombosis, 2003, vol. 33, no. 5-6, pp. 417-421. DOI: 10.1159/000083839. 30. Furlan M., Lammle B. Assays of von Willebrand factor-cleaving protease: A test for diagnosis of familial and acquired thrombotic thrombocytopenic purpura. Seminars in Thrombosis and Hemostasis, 2002, vol. 28, no. 2, pp. 167-172. DOI: 10.1055/s-2002-27819. 31. Dong J.F., Whitelock J., Bernardo A., Ball C., Cruz M.A. Variations among normal individuals in the cleavage of endothelialderived ultra-large von Willebrand factor under flow. Journal of Thrombosis and Haemostasis, 2004, vol. 2, no. 8, pp. pp. 14601466. DOI: 10.1111/j.1538-7836.2004.00830.x. 32. Downes K.A., Yomtovian R., Tsai H.M., et al. Relapsed thrombotic thrombocytopenic purpura presenting as an acute cerebrovascular accident. Journal of Clinical Apheresis, 2004, vol. 19, no. 2, pp. 86-89. DOI: 10.1002/jca.20007. 33. Tsai H.M., Shulman K. Rituximab induces remission of cerebral ischemia caused by thrombotic thrombocytopenic purpura. European Journal of Haematology, 2003, vol. 70, no. 3, pp. 183-185. DOI: 10.1034/j.1600-0609.2003.00026.x

‘7 (76) декабрь 2013 г. 34. McMinn J.R., George J.N. Evaluation of women with clinically suspected thrombotic thrombocytopenic purpura-hemolytic uremic syndrome during pregnancy. Journal of Clinical Apheresis, 2001, vol. 16, no. 4, pp. 202-209. DOI: 10.1002/jca.10005. 35. McCrae K.R., Cines D.B. Thrombotic microangiopathy during pregnancy. Seminars in Hematology, 1997, vol. 34, no. 2, pp. 148-158. 36. Bell W.R., Kickler T.S. Thrombocytopenia in pregnancy. Rheumatic Disease Clinics of North America, 1997, vol. 23, no. 1, pp. 183-194. DOI: 10.1016/S0889-857X(05)70322-7. 37. Yarranton H., Machin S.J. An update on the pathogenesis and management of acquired thrombotic thrombocytopenic purpura. Current Opinion in Neurology, 2003, vol. 16, no. 3, pp. 367-373. DOI: 10.1097/00019052-200306000-00018. 38. Knöbl P.N. Treatment of thrombotic micro-angiopathy with a focus on new treatment options. Hamostaseologie, 2013, vol. 33, no. 2, pp. 149-159. DOI: 10.5482/HAMO-13-01-0004. 39. Bell W.R., Braine H.G., Ness P.M., Kickler T.S. Improved survival in thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. Clinical experience in 108 patients. New England Journal of Medicine, 1991, vol. 325, no. 6, pp. 398-403. 40. Mant M.J., Turner A.R., Bruce D., Ritchie C., Larratt L.M. Splenectomy during partial remission in thrombotic thrombocytopenic purpura with prolonged plasma exchange dependency. American Journal of Hematology, 1999, vol. 62, no. 1, pp. 56-57. 41. Yomtovian R., Niklinski W., Silver B., Sarode R., Tsai H.M. Rituximab for chronic recurring thrombotic thrombocytopenic purpura: A case report and review of the literature. British Journal of Haematology, 2004, vol. 124, no. 6, pp. 787-795. DOI: 10.1111/j.13652141.2004.04836.x. 42. Vanhoorelbeke K., De Meyer S.F. Animal models for thrombotic thrombocytopenic purpura. Journal of Thrombosis and Haemostasis, 2013, vol. 11, Suppl. 1, pp. 2-10. DOI: 10.1111/jth.12255.

ÍÎÂÎÅ Â ÌÅÄÈÖÈÍÅ. ÈÍÒÅÐÅÑÍÛÅ ÔÀÊÒÛ ÄÅÔÈÖÈÒ ÂÈÒÀÌÈÍÀ D ÓÂÅËÈ×ÈÂÀÅÒ ÐÈÑÊ ÏÐÅÝÊËÀÌÏÑÈÈ ÂÎ ÂÐÅÌß ÁÅÐÅÌÅÍÍÎÑÒÈ Æåíùèíû ñ äåôèöèòîì âèòàìèíà D ïîäâåðãàþòñÿ ðèñêó ðàçâèòèÿ ïðåýêëàìïñèè òÿæåëîé ñòåïåíè, óñòàíîâèëè ó÷åíûå. Ðåçóëüòàòû íîâåéøåãî èññëåäîâàíèÿ áûëè îïóáëèêîâàíû â æóðíàëå Epidemiology. Ïðè÷èíû ïðåýêëàìïñèè áåðåìåííûõ äî êîíöà íå èçó÷åíû, õîòÿ íåêîòîðûå ñïåöèàëèñòû íàçûâàþò íåóäîâëåòâîðèòåëüíîå ïèòàíèå, âûñîêèé óðîâåíü æèðà â îðãàíèçìå ëèáî íåäîñòàòî÷íûé êðîâîòîê â ìàòêå.  ñâîåì íîâîì èññëåäîâàíèè ó÷åíûå èç Âûñøåé øêîëû çäðàâîîõðàíåíèÿ Ïèòòñáóðãñêîãî óíèâåðñèòåòà âûÿñíèëè, ÷òî äåôèöèò âèòàìèíà D ó áåðåìåííûõ æåíùèí ñâÿçàí ñ ïîâûøåííûì ðèñêîì ïðåýêëàìïñèè è ãåñòàöèîííîãî äèàáåòà.  èññëåäîâàíèè ïðèíÿëè ó÷àñòèå 700 áåðåìåííûõ æåíùèí, ó êîòîðûõ ðàçâèëàñü ïðåýêëàìïñèÿ, è 3000 çäîðîâûõ áåðåìåííûõ æåíùèí. Ó÷åíûå âçÿëè îáðàçöû êðîâè ó÷àñòíèö íà ñðîêå 22 íåäåëè áåðåìåííîñòè è ñðàçó ïîñëå ðîäîâ, ó íîâîðîæäåííûõ ñðàçó ïîñëå ðîæäåíèÿ áûëà âçÿòà ïðîáà êðîâè èç ïóïîâèíû íà íàëè÷èå ïðåäøåñòâåííèêà âèòàìèíà D – 25-ãèäðîêñèâèòàìèíà D. Àíàëèç ïðîäåìîíñòðèðîâàë, ÷òî æåíùèíû ñ íåäîñòàòî÷íûì óðîâíåì âèòàìèíà D íà 40% áûëè áîëåå ñêëîííû ê ðàçâèòèþ ïðåýêëàìïñèè ïî ñðàâíåíèþ ñ êîíòðîëüíîé ãðóïïîé. «Äàæå ìèíèìàëüíàÿ íåõâàòêà âèòàìèíà D ïî÷òè âäâîå óâåëè÷èâàåò ðèñê âîçíèêíîâåíèÿ òîêñåìèè íà ïîçäíèõ ñðîêàõ áåðåìåííîñòè. Ó äåòåé, ðîæäåííûõ ìàòåðüþ ñ ïðåýêëàìïñèåé âî âðåìÿ áåðåìåííîñòè, â ïÿòü ðàç âûøå ðèñê íàñòóïëåíèÿ ðàííåé ñìåðòè, ÷åì ó òåõ, êîòîðûå áûëè ðîæäåíû îò çäîðîâûõ ìàòåðåé», — îòìå÷àåò äîêòîð Ìàðê Êëåáàíîô (Mark Klebanoff), âåäóùèé àâòîð èññëåäîâàíèÿ. Äèåòà ñ íèçêèì ñîäåðæàíèåì áåëêà ïðè íàëè÷èè àìèíîêèñëîò, ïîäàâëÿþùèõ âûðàáîòêó èíñóëèíîïîäîáíîãî ôàêòîðà ðîñòà-1, ïîçèòèâíî ñêàçàëàñü íà ðèñêå ðàçâèòèÿ ðàêà è äèàáåòà. Ïî ìàòåðèàëàì Medical News Today, ôåâðàëü 2014 ã. Èñòî÷íèê: Medlinks.ru

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


â&#x20AC;&#x2DC;7 (76) докайŃ&#x20AC;Ń&#x152; 2013 Đł.

Ă?Ă?Ă&#x20AC;Ă&#x160;Ă&#x2019;Ă&#x2C6;Ă&#x2014;Ă&#x2026;Ă&#x2018;Ă&#x160;Ă&#x20AC;Ă&#x; Ă&#x152;Ă&#x2026;Ă&#x201E;Ă&#x2C6;Ă&#x2013;Ă&#x2C6;Ă?Ă&#x20AC;

21



Ă&#x201A;.Ă&#x17D;. Ă Ă&#x2C6;Ă&#x2013;Ă&#x20AC;Ă&#x201E;Ă&#x2021;Ă&#x2026;. Ă&#x2018;.Ă&#x201A;. Ă&#x20AC;Ă&#x160;Ă&#x2C6;Ă?Ă&#x153;Ă&#x2DC;Ă&#x2C6;Ă?Ă&#x20AC;, Ă&#x152;.Ă&#x201E;. Ă&#x20AC;Ă?Ă&#x201E;Ă?Ă&#x2026;Ă&#x2026;Ă&#x201A;Ă&#x20AC;, Ă&#x20AC;.Ă&#x201E;. Ă&#x152;Ă&#x20AC;Ă&#x160;Ă&#x20AC;Ă&#x2013;Ă&#x20AC;Ă?Ă&#x2C6;Ă&#x; Ă?üðâÝÊ Ă&#x152;ÎùêÎâùêèÊ ãÎùóäà ðùòâüííÝÊ ÏüäèÜèíùêèÊ óíèâüðùèòüò èÏ. Ă&#x2C6;.Ă&#x152;. Ă&#x2018;üáüíÎâà, 119991, Ă&#x152;Îùêâà, óÍ. Ă&#x2019;ðóåüÜêàÿ, ä. 8, ùòð. 2

Ă&#x2019;ðÎÏåÎýÏåÎÍèáüùêèü ÎùÍÎÌíüíèÿ, ùâÿçà ííÝü Ăą Ă&#x17D;Ă&#x2013;Ă&#x201D;Ă&#x201C;Ă?Ă Ă?Ă&#x201C;Ă&#x2030;Ă&#x2021;Ă&#x2019;Ă&#x17D;Ă&#x2039;Ă&#x2018;Ă&#x2030;Ă&#x2013;Ă&#x201D;Ă&#x201C;Ă&#x2018;Ă&#x201C;Â&#x2019;Ă&#x2021;Ă&#x2014;Ă&#x2039;Ă?Ă Ă&#x2019;Ă&#x;Ă&#x2122;Ă&#x2022;Ă&#x2039;Ă&#x201D;Ă&#x2022;Ă&#x201C;Ă&#x160;ž¹Ă&#x2014;Ă&#x17D;Ă&#x2030;Ă&#x2019;Ă&#x;Ă&#x2122; Ă&#x2014;Ă&#x2039;Ă&#x2122;Ă&#x2019;Ă&#x201C;Ă?Ă&#x201C;Â&#x2019;Ă&#x17D;Ă?sĂ&#x17D;Ă&#x2019;Ă&#x160;Ă&#x2022;Ă&#x201C;Ă&#x2018;Â&#x2019;Ă&#x17D;Ă&#x201D;Ă&#x2039;Ă&#x2022;Ă&#x2013;Ă&#x2014;Ă&#x17D;Ă&#x2018;žĂ?Ă&#x2020;Ă&#x161;Ă&#x17D;Ă&#x17D;Ă&#x2020;Ă&#x17D;Ă&#x203A;Ă&#x2019;Ă&#x17D;ÂąĂ&#x201C;Ă&#x2030; Ă&#x20AC;êèíßøèíà Ă&#x2018;âüòÍàíà Ă&#x201A;ÍàäèÏèðÎâíà â&#x20AC;&#x201D; êàíäèäàò ÏüäèÜèíùêèþ íàóê, íàóáíÝÊ ùÎòðóäíèê êàôüäðÝ àêóøüðùòâà è ãèíüêÎÍÎãèè ÏüäèêÎïðÎôèÍàêòèáüùêÎãÎ ôàêóÍßòüòà, 109004, ĂŁ. Ă&#x152;Îùêâà, óÍ. Ă&#x2021;üÏÍÿíÎÊ Ă&#x201A;Ă ĂŤ, ä. 62, ùòð. 1, òüÍ. +7-903-238-80-48, e-mail: gemostasis@mail.ru à èÜàäçü Ă&#x201A;èêòÎðèÿ Ă&#x17D;ÏàðÎâíà â&#x20AC;&#x201D; äÎêòÎð ÏüäèÜèíùêèþ íàóê, ïðÎôüùùÎð êàôüäðÝ àêóøüðùòâà è ãèíüêÎÍÎãèè ÏüäèêÎ-ïðÎôèÍàêòèáüùêÎãÎ ôàêóÍßòüòà, 109004, ĂŁ. Ă&#x152;Îùêâà, óÍ. Ă&#x2021;üÏÍÿíÎÊ Ă&#x201A;Ă ĂŤ, ä. 62, ùòð. 1, òüÍ. +7-926-231-38-29, e-mail: gemostasis@mail.ru Ă&#x20AC;íäðüüâà Ă&#x152;àðãàðèòà Ă&#x201E;àðáèüâíà â&#x20AC;&#x201D; êàíäèäàò ÏüäèÜèíùêèþ íàóê, äÎêòÎðàíò êàôüäðÝ àêóøüðùòâà è ãèíüêÎÍÎãèè ÏüäèêÎïðÎôèÍàêòèáüùêÎãÎ ôàêóÍßòüòà, 109004, ĂŁ. Ă&#x152;Îùêâà, óÍ. Ă&#x2021;üÏÍÿíÎÊ Ă&#x201A;Ă ĂŤ, ä. 62, ùòð. 1, òüÍ. +7-918-388-61-11, e-mail: gemostasis@mail.ru Ă&#x152;àêàÜàðèÿ Ă&#x20AC;Íüêùàíäð Ă&#x201E;àâÝäÎâèá â&#x20AC;&#x201D; äÎêòÎð ÏüäèÜèíùêèþ íàóê, ïðÎôüùùÎð, áÍ.-ĂŞĂŽĂ°Ă°. Ă?Ă&#x20AC;Ă&#x152;Ă?, çàâüäóÞÚèÊ êàôüäðÎÊ àêóøüðùòâà è ãèíüêÎÍÎãèè ÏüäèêÎ-ïðÎôèÍàêòèáüùêÎãÎ ôàêóÍßòüòà, 109004, ĂŁ. Ă&#x152;Îùêâà, óÍ. Ă&#x2021;üÏÍÿíÎÊ Ă&#x201A;Ă ĂŤ, ä. 62, ùòð. 1, òüÍ. +7-903-728-08-97, e-mail: gemostasis@mail.ru                    Â?    Â?  Â?    Â?   Â?    Â? Â? Â?  Â?  Â?Â?    

V.O. BITSADZE, S.V. AKINSHINA, M.D. ANDREEVA, A.D. MAKATSARIYA I.M. Sechenov First Moscow State Medical University, 8 Trubetskaya St., bld. 2, Moscow, Russian Federation 119991

Thromboembolic complications related to the use of assistive reproductive treatment. Ovarian hyperstimulation syndrome Akinshina S.V. â&#x20AC;&#x201D; Cand. Med. Sc., research associate of the Department of Obstetrics and Gynecology of Public Health faculty, 62 Zemlyanoy Val St., bld. 1., Moscow, Russian Federation 109004, tel. +7-903-238-80-48, e-mail: gemostasis@mail.ru Bitsadze V.O. â&#x20AC;&#x201D; D. Med. Sc., Professor of the Department of Obstetrics and Gynecology of Public Health faculty, 62 Zemlyanoy Val St., bld. 1, Moscow, Russian Federation 109004, tel. +7-926-231-38-29, e-mail: gemostasis@mail.ru Andreeva M. D. â&#x20AC;&#x201D; Candidate of Medical Science, doctoral candidate of the Department of Obstetrics and Gynecology of Public Health faculty, 62 Zemlyanoy Val St., bld. 1, Moscow, Russian Federation 109004, tel. +7-918-388-61-11, e-mail: gemostasis@mail.ru Makatsariya A.D. â&#x20AC;&#x201D; D. Med. Sc., Professor, corresponding member of RAMS, Head of the Department of Obstetrics and Gynecology of Public Health faculty, 62 Zemlyanoy Val St., bld. 1, Moscow, Russian Federation 109004, tel.+7-903-728-08-97, e-mail: gemostasis@mail.ru ­Â&#x20AC;Â&#x201A;Â&#x192;Â&#x201E;Â&#x2026;Â&#x2020;Â&#x2021;Â&#x2C6;Â&#x201A;Â&#x2030;Â&#x2020;Â&#x160;Â&#x2021;Â&#x2039;Â&#x160;Â&#x160;Â&#x201A;Â&#x160;Â&#x2026;Â&#x20AC;Â&#x201A;Â&#x201E;Â&#x2020;Â&#x160;Â&#x152;Â&#x17D;Â&#x192;Â&#x2021;Â&#x2026;Â&#x2018;Â&#x201E;Â&#x160;Â&#x17D;Â&#x2018;Â&#x201E;Â&#x2026;Â&#x20AC;Â&#x201E;Â&#x2018;Â&#x2019;Â&#x201C;Â&#x2018;Â&#x201A;Â&#x2019;Â&#x201C;Â&#x2018;Â&#x2C6;Â&#x2020;Â&#x2021;Â&#x2021;Â&#x2018;Â&#x2019;Â&#x201D;Â&#x2C6;Â&#x2020;Â&#x2021;Â&#x192;Â&#x2026;Â&#x2020;Â&#x2018;Â&#x2022;Â&#x160;Â&#x201C;Â&#x201A;Â&#x17D;Â&#x2018;Â&#x201E;Â&#x201A;Â&#x2039;Â&#x160;Â&#x2020;Â&#x2022;Â&#x2013;Â&#x192;Â&#x160;Â&#x160;Â&#x2020;Â&#x160;Â&#x2026;Â&#x201A;Â&#x2030;Â&#x201E;Â&#x201A;Â&#x201D;Â&#x201E;Â&#x2018;Â&#x2030;Â&#x2039;Â&#x2021;Â&#x2026;Â&#x2020;Â&#x2014;Â&#x201A;Â&#x2026;Â&#x201E;Â&#x201A;Â&#x192;Â&#x2026;Â&#x2019;Â&#x201A;Â&#x2022;Â&#x2026;Â&#x2DC;Â&#x201A;Â&#x201E;Â&#x201A;Â&#x2122;Â&#x2020;Â&#x2026;Â&#x20AC;Â&#x2020;Â&#x160; Â&#x201A;Â&#x2014;Â&#x192;Â&#x2C6;Â&#x2039;Â&#x192;Â&#x2026;Â&#x201A;Â&#x2030;Â&#x2026;Â&#x20AC;Â&#x201A;Â&#x201E;Â&#x2018;Â&#x2C6;Â&#x201A;Â&#x2018;Â&#x17D;Â&#x192;Â&#x2021;Â&#x161;Â&#x2039;Â&#x2020;Â&#x201E;Â&#x201A;Â&#x2030;Â&#x192;Â&#x2022;Â&#x2030;Â&#x2013;Â&#x201A;Â&#x2022;Â&#x201A;Â&#x2026;Â&#x2020;Â&#x2021;Â&#x2030;Â&#x201A;Â&#x17D;Â&#x201A;Â&#x2021;Â&#x2026;Â&#x160;Â&#x2018;Â&#x17D;Â&#x201C;Â&#x2C6;Â&#x2018;Â&#x2018;Â&#x2030;Â&#x2021;Â&#x2018;Â&#x192;Â&#x2013;Â&#x2039;Â&#x2C6;Â&#x192;Â&#x2026;Â&#x2020;Â&#x2018;Â&#x2022;Â?Â&#x192;Â&#x160;Â&#x2122;Â&#x201A;Â&#x2C6;Â&#x2C6;Â&#x192;Â&#x160;Â&#x160;Â&#x203A;Â&#x160;Â&#x2026;Â&#x201A;Â&#x2019;Â&#x2020;Â&#x2021;Â&#x2020;Â&#x2022;Â&#x153;Â&#x192;Â&#x2019;Â&#x2019;Â&#x192;Â&#x2026;Â&#x2020;Â&#x2018;Â&#x2022;Â&#x201E;Â&#x201A;Â&#x160;Â&#x201D;Â&#x2018;Â&#x2022;Â&#x160;Â&#x201A;Â&#x160;Â&#x203A;Â&#x2022;Â&#x2030;Â&#x201E;Â&#x2018;Â&#x2019;Â&#x201A;Â&#x17E;Â&#x201D;Â&#x201A;Â&#x2021;Â&#x2020;Â&#x192;Â&#x2C6; Â&#x17D;Â&#x2018;Â&#x2021;Â&#x2039;Â&#x160;Â&#x2020;Â&#x160;Â&#x2018;Â&#x2022;Â&#x2026;Â&#x20AC;Â&#x201A;Â&#x201D;Â&#x192;Â&#x2026;Â&#x20AC;Â&#x2018;Â&#x2013;Â&#x201A;Â&#x2022;Â&#x201A;Â&#x160;Â&#x2020;Â&#x160;Â&#x192;Â&#x2022;Â&#x2030;Â&#x2021;Â&#x2C6;Â&#x2020;Â&#x2022;Â&#x2020;Â&#x2021;Â&#x192;Â&#x2C6;Â&#x2018;Â&#x2014;Â&#x192;Â&#x201E;Â&#x2020;Â&#x192;Â&#x2022;Â&#x20AC;Â&#x203A;Â&#x201D;Â&#x201A;Â&#x201E;Â&#x160;Â&#x2026;Â&#x2020;Â&#x2019;Â&#x2039;Â&#x2C6;Â&#x192;Â&#x2026;Â&#x2020;Â&#x2018;Â&#x2022;Â&#x160;Â&#x203A;Â&#x2022;Â&#x2030;Â&#x201E;Â&#x2018;Â&#x2019;Â&#x201A;Â&#x;Â&#x201A;Â&#x201E;Â&#x160;Â&#x2018;Â&#x2022;Â&#x192;Â&#x2C6;Â&#x192;Â&#x2022;Â&#x2030;Â&#x2020;Â&#x2022;Â&#x2026;Â&#x201A;Â&#x201E;Â&#x2022;Â&#x192;Â&#x2026;Â&#x2020;Â&#x2018;Â&#x2022;Â&#x192;Â&#x2C6;Â&#x201A;ÂĄÂ&#x201D;Â&#x201A;Â&#x201E;Â&#x2020;Â&#x201A;Â&#x2022;Â&#x2021;Â&#x201A;Â&#x2020;Â&#x2022;Â&#x2026;Â&#x20AC;Â&#x201A;Â&#x201D;Â&#x201E;Â&#x201A;Â&#x2014;Â&#x201A;Â&#x2022;Â&#x2026;Â&#x2020;Â&#x2018;Â&#x2022; Â&#x2018;Â&#x17D;Â&#x2026;Â&#x20AC;Â&#x201E;Â&#x2018;Â&#x2019;Â&#x201C;Â&#x2018;Â&#x160;Â&#x2020;Â&#x160;Â&#x2020;Â&#x2022;Â&#x201D;Â&#x192;Â&#x2026;Â&#x2020;Â&#x201A;Â&#x2022;Â&#x2026;Â&#x160;Â&#x201A;Â&#x2022;Â&#x201E;Â&#x2018;Â&#x2C6;Â&#x2C6;Â&#x201A;Â&#x2030;Â&#x2020;Â&#x2022;Â&#x2026;Â&#x20AC;Â&#x201A;¢£¤Â&#x201D;Â&#x201E;Â&#x2018;Â&#x2013;Â&#x201E;Â&#x192;Â&#x2019;Â&#x2020;Â&#x160;Â&#x2030;Â&#x201A;Â&#x160;Â&#x2021;Â&#x201E;Â&#x2020;Â&#x201C;Â&#x201A;Â&#x2030;  Â&#x2026;Â&#x20AC;Â&#x201E;Â&#x2018;Â&#x2019;Â&#x201C;Â&#x2018;Â&#x160;Â&#x2020;Â&#x160;Â?Â&#x201E;Â&#x201A;Â&#x201D;Â&#x201E;Â&#x2018;Â&#x2030;Â&#x2039;Â&#x2021;Â&#x2026;Â&#x2020;Â&#x2014;Â&#x201A;Â&#x2026;Â&#x201A;Â&#x2021;Â&#x20AC;Â&#x2022;Â&#x2018;Â&#x2C6;Â&#x2018;Â&#x2013;Â&#x2020;Â&#x201A;Â&#x160;Â?Â&#x192;Â&#x2021;Â&#x161;Â&#x2039;Â&#x2020;Â&#x201E;Â&#x201A;Â&#x2030;Â&#x192;Â&#x2022;Â&#x2030;Â&#x2013;Â&#x201A;Â&#x2022;Â&#x201A;Â&#x2026;Â&#x2020;Â&#x2021;Â&#x2026;Â&#x20AC;Â&#x201E;Â&#x2018;Â&#x2019;Â&#x201C;Â&#x2018;Â&#x201D;Â&#x20AC;Â&#x2020;Â&#x2C6;Â&#x2020;Â&#x192;Â?Â&#x2018;Â&#x2014;Â&#x192;Â&#x201E;Â&#x2020;Â&#x192;Â&#x2022;Â&#x20AC;Â&#x203A;Â&#x201D;Â&#x201A;Â&#x201E;Â&#x160;Â&#x2026;Â&#x2020;Â&#x2019;Â&#x2039;Â&#x2C6;Â&#x192;Â&#x2026;Â&#x2020;Â&#x2018;Â&#x2022;Â&#x160;Â&#x203A;Â&#x2022;Â&#x2030;Â&#x201E;Â&#x2018;Â&#x2019;Â&#x201A;

Ă&#x20AC;Ă&#x160;Ă&#x201C;Ă&#x2DC;Ă&#x2026;Ă?Ă&#x2018;Ă&#x2019;Ă&#x201A;Ă&#x17D;. Ă&#x192;Ă&#x2C6;Ă?Ă&#x2026;Ă&#x160;Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;. Ă?Ă?Ă&#x201E;Ă&#x17D;Ă&#x160;Ă?Ă&#x2C6;Ă?Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;


22

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

                                          ­€‚ƒ„­         …†‡    ˆ        ‰Š…‹…   Œ             ­  Ž       ‘             ‘‘   ‰’“”‹ Ž         Š…                ‰ •– ‚‚—‹€ƒ     Š… ‘         Œ Š…        …†‡                ”  ˜                                  ‘    ™   ­     ‘              †                         Œ    Š                 ‘  š–    ’›”€œƒ†                             ­ ­€ ‚ €  ­ €  ƒ   „ ­€     … †‡ˆ†‰­ ƒ­  ­ ­  „ Š€  „ ‡ ƒ ­ ­   ­      ˆ†‰    €  ­   ­€  ‹ŒŽ‘Œ’       ­„  Š“ ‡  ˆ†‰   ‚  ƒ „€

“  ‡€‚  Š ­ ƒ”‰•–—‰•–„­€            „­  ˜™šƒ‚ Š  ƒ  ‡  ‡ › ƒ  ­          ­ 

‘7 (76) декабрь 2013 г. ­ƒ œž ˜Ÿš ¡  ‡ „­  ƒ€ €  ­   ­ƒ ­ ‡œž“„„‡         ƒ   ‡   ­  ­     ŠŠ  ‡ 

‰•–„  ƒ    

¢œ ‰ ­  ‡    ƒ  ƒ  ¢œ  ­  ­      ƒ   ”£¤•— œ  Š    ­ƒ £¤• 

 ¥   ƒ   ƒ £¤•­€   ¦¦¦¦¦¦¦¦§  €€ ­ „€ ­Š  ƒ  ƒ¨€˜™š ž     ‡ ƒ“  ‰• ƒ „„„ £¤• Š„­€‰      ‰• ‚     ƒ Š„“ ‡ ­ ‡ ˜©š¢   ­    ‚ € Š“    ­  ­  „ ­ ‡€£¤•ƒ   ƒ€ 

  ‡  ­ƒ       ­ ª ƒ€« ‚  ‡ ” —               • ‰  ‰  ­  ¢  ƒ ¬ƒ€ €€ ƒ  „€ ®­­                    ®„   Š   ‡   ‡ ­   € “ƒ ¢œ  Šƒ  €     ¢œ ­ „“  Šƒ œž¯  ¢œ ­ „“ ­   €  Ÿ¯¯¯¯ƒ    „ ƒ‰•– ‚  ƒ  „ Š ­ €  ¨ „“   ¢œŠ “€­ €¯ ™¯˜°š‰ ­ ­±Œ²³´’…µ”¯¯¨— ­­ ‡‡ ¯¶   ­ƒ  ‚  ƒ  „€    ‡   ‡ ­   € ˜š  ·¯¸   ‚  ƒ „›ƒ ƒ  ƒ Š“  -

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.                                                                                                ­      €                    ‚           ƒ„          …ƒ† ‡                       ˆ‰„     Š ‹ŒŽ                   €    ­       ‘’‡ ƒ‰                                            ‘’‡ “             ‘’‡            ”‰”‚       ǸȖȓȤȚȘȖȔȉȖȜȐȓȐȐȊȗȈȚȖȋȍȕȍȏȍȚȘȖȔȉȖȚȐȟȍșȒȐȝ ȖșȓȖȎȕȍȕȐȑ ȗȘȖȋȘȈȔȔ ȊșȗȖȔȖȋȈȚȍȓȤȕȣȝ ȘȍȗȘȖȌțȒȚȐȊȕȣȝȚȍȝȕȖȓȖȋȐȑ                    ‹ŒŽ         •  –—˜™š›œ— “   žƒ‚Ÿ        ”ƒ      ‹ŒŽ              ¡ ‹ŒŽ     …„† ’      ‹ŒŽ¢ˆ‰ˆ¢    ‹ŒŽ         ””ƒ£ ‹ŒŽ¤                          ¥   ƒ  ‹ŒŽ   ”£      ¦§ ¨—š©—œ …£† –ª˜š«¬®¯  žƒƒŸ             °°°  ±  ‹       ¦§ ¨—š©—œ  ²³´¦µ ¶ˆ„„³          ‹ŒŽ•         £¢                         ƒ„ …·†’                                  

23

  ‘          €                                                        ǶȞȍȕȒȈ ȜȈȒȚȖȘȖȊ ȘȐșȒȈ ȚȘȖȔȉȖȚȐȟȍșȒȐȝ ȖșȓȖȎȕȍȕȐȑȗȍȘȍȌȐșȗȖȓȤȏȖȊȈȕȐȍȔȊșȗȖȔȖȋȈȚȍȓȤȕȣȝȘȍȗȘȖȌțȒȚȐȊȕȣȝȚȍȝȕȖȓȖȋȐȑ •                                                       ž¸‚  Ÿ         ‘’‡            €      ¤     ¦§ ¨—š©—œ  ¹ƒƒ”“ ²³´¦µ ¶ˆ„„³             ‘’‡           €         …”†¤                   Š                        ‘                                          ‡                          ”‰‚£    ”‰¢     …”†Š    €      ‘’‡ €          ¥                          

        “      €         ”žº»°‰”Ÿ                              ¼           “½‹                                     •       “½“          €          

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


24

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

                                         ­€ €   ‚ƒ   „      €   ­   ­  ­  ­­      … ­ € † ­     ­          „  ‡ˆ‰…Š    €  „                   Š €   ­   €  ­                     €  ­                    ­    ­ ­‹         † ­ Œ Ž       €    ­      „        € €­ Œ  Ž   Œ   Ž  € ­  ­    Œ  Ž   Œ€Ž       € ­‘€                ­  ­        €       €…Š      € €       ‡ˆ‰…Š   €  ‚ƒ‚ ’   € „  ­€„“”• ­ –ŠŠ—’    „   €  †            ­   ˜™      „      

˜™    „„             š›    œ˜™   Š…Š”• „ ’ „  ˜™     ” ”ž• –ŠŸ— ƒ     ˜™      ­              „     ­             ¡ ­   ˜™                 –Š¢—†„           „

‘7 (76) декабрь 2013 г.                               ­€ ‚ƒ        „   …  †‡   ˆ   ‰Š‹ŒŽŽ‘’†                      ˆ “”        …       ‹ Таблица 2. Факторы риска развития СГЯ Характеристика пациентки: Молодой возраст (<30 лет) Низкая масса тела СГЯ в анамнезе Сидром поликистозных яичников Использование высоких доз гонадотропинов для стимуляции овуляции Применение ХГЧ, а не прогестерона для поддержки лютеиновой фазы Большое количество антральных в яичнике, по данным УЗИ, до начала стимуляции овуляции Быстрый рост концентрации эстрадиола (>2500 пг/мл) Большое число полученных ооцитов (>20) Наступление беременности                                               ­               €   ‚                      ƒ„…†  ‡                      ˆ

             

‰Š‹Œ                               ‡                   Š‹ Ž                     ‰              Š‹              Œ           €  

  ƒ‘†                             ’   €                €            

                              

                       

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.                                    ­€       

  ‚      ƒ               ‚             „„      ƒ          ƒ ‚          ­   

                    …†‡ˆ          ‚  €­€         ‚ ‚   ‚          

€           €     ‰       ƒ  ­             ­€     Š     €                  ‹         ‚           …Œˆ ‹   ­      ‚       €      Ž        „ „   ‘’’             €   ‘’’       ‘’’      “”   €     ‹ ‚   ‚     ‘’’            •  

‘’’                 €                €  €         •                    €€     

    €              –                             €  

 ‹    ­        -

25

    ­      Š—„†Š—„˜Š—„™Š—„†š Š—„†š ›œž„            ‚           Š—„†Ÿ   ‚        €  ­     ‘     

  „†¡¢£¤¥„†   ‚

 „†¡¦£¤¥„†  ‚     €                    ‚   ‚    §  „  ¨   ¡¦£¤¥„†¡¢£¤¥„†  ‚    …†™ˆ©        ‚        ¡¦£¤¥„†        ©„  ª      €   €€…†™ˆ‰      €      ­       €            €  

    ‚  •  ‚ ­       €       ‚    ¢«¬ž            ƒ„   ¢«¬ž  

    ‚  ­€       ƒ„        ­    ¢«¬ž   ‰   “”   €‘–‰¢«¬ž €€

   …†Œˆ®   “”            ­  ¢«¬ž        ‚             €     …†šˆ¯   ‘–‰¢«¬ž                ­  ‹    

 ¢«¬ž  €   ° ­ 

 ¢«¬ž ±²³´†µµŒ…†µˆ¢«¬ž        „€     €   

      ¢«¬ž          ¢¶ž   

            ƒ        €    ¢«¬ž   ¢«¬ž 

€       ¤„·         ƒ     ¢«¬ž €   ¢«¬ž„±†„¸  €     

   °   

 ¢«¬ž

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


26

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

                                         ­    €‚      ­ €      ­ ƒ          ­   ‚       ­    „              

   …†   ­­  ­     ­­    

    …‡      ­     ­­

    ­­

   ˆ…   …   …†      ‰    ­  ‚                    Š­            ‹  …   …           ­  „  €      ­ Œ    

  †      Ž  …†  …    …  ‘  €€   ­­       …­  ­    ’“”•”–    †            —  ‚         

 €    ‚   ­­   €    ­   ‚   

  ­ ­                           …  …† ˆ    ­€    

       ­ 

€ ‚     ­­         ˆ˜

     ‚    …       ‚          ‚  ­ ‚ …    ­  €     ­­   €   ­     ˜   …    ‚  ‚‚       €     €        ‚ ‚  ‚    € 

   €   …†   …      ‚  –™š–“ ›œ   žžŠ  €    €        ­  ‚  ­     ­                 …†     ­ …†  ‚      Ÿ‹¡ ¢  ‚           ‚    ˜   

  ‚      ¢      €        ‚      …

             £          

     € €    ­ ­ ‚ …     ‚   ‚  

€  € †         ­­  ¤    ­€          …€     ‚¥‘¦ Ÿž¡ §   €     ¨£©     €     † 

  ª‘ƒª‘‚    …€     «‘¬© 

‘7 (76) декабрь 2013 г. ­      ­   ‘ ¨‘  …  …  …    ª‘  ‚ …   ¨£©— …  €      ­       ‚ …    ‚        «‘¬  … ¥‘¦ƒ    

  ¥‘¦  €   †       ­       ­  Œ        ­   ­       ‚ ­  Ÿ¡§ €

˜

                       €     «‘¬Ÿ¡ ® ¢   ”¯ €         °­   ˜     €         §  € ˜

    ”¯           …  ‚ …«‘¬˜   ”¯ ˜  … ‚ ­ «‘¬ Ÿ±¡ —  ­ ˜     ”¯

   ­       ‚ €  €˜

   ”¯  ­  € ­ ‚  ˆ       €   ”¯  «‘¬        ”¯…    ­ ‚  ²   «‘¬  … ‚ †           …      ‚

  ˜     ”¯        €  ˜

    ”¯ 

   «‘¬ €   …    ­      «‘¬   ”¯ ­   ‚        Ÿ‰¡ « ‚     ”¯  «‘¬ ‚   €   €˜   „       €    ˜

    ”¯ ‚     €   ­  €    «‘¬€      ­   —  ”¯  ‚   ­    ­       ­€ ­         «‘¬  €   € ­               … 

€ ­ ‚   ¢        †      ˜…†    …    ˆ«‘¬ ­      ‚ ‹‹±‹‹ ˜ …   ²    «‘¬     ˜  

      ­     …      ‚  ­ ­    …  ‚ …«‘¬ŸŽ¡ € ‚ ­ €˜          € … ­   

­     ­      …†  «‘¬ ¨      ­   «‘¬ ¢         ­   «‘¬      ­        ³´µ¶™· «   ‹‹ Ÿ¸¡ ¢    ­   ­    

 

 …            …     ‚ … ‚ † ­  «‘¬ŸŠ¡ƒ         € ­          ­  €   ˜

  ¹    ­ ³´µ¶™·«   •“”•·™–    

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.                              ­          €€€    ‚ƒ„…  †‡ˆ‰ Š               € € € ‹  ‚ƒ„…†‡ˆ‰  Œ    Œ Ž       € ‘€     ’“ ”•–—˜™         š›œ    ž Ÿ     ‚ƒ„…              Š €  €   š›œ      €€€   €   €    €   € € € Œ    ¡         €€€Œ Ÿ    €Ÿ     ¢  €€ Ÿ  Ÿ  ŠŒ     €  ‘  €   €     Ÿ   Ÿ  €   ­Œ  €         ‚ƒ„… ‘     £       ‚ƒ„…          Ÿ  Œ     ‘ €     

€ Ÿ  €        

                 ­   € £       € €¤  € Œ  ¤    ¥   ’¦  ­ €     ‘  €    €   Œ€        Ÿ   €  ­         €               ¢  €Œ Ÿ   Œ€   €€  

27

   

‚ƒ„…† € ‡ ˆ‡   ­‰†Š‹   ‰        †    ­   ­    ŒŽ   ‘’       Œ œ§–§¨ ƒ  ©‰“  ª €      ¥  €Œ€Œ ¦‘ €Œ                 ­ ‘   Ÿ €  Ÿ «§™¬¨˜œ  ¥’®®“¦’ ¯  Ž  € €Œ€€€ ‘Ÿ     € €     ­ €  Œ Œˆ

 Œ¤      €    €        ˆ    €Œ              €Œ         Œ€  Ž   €Œ  

   °    €    ’®¥  ±°±¦  €©  ­ €   ž ¯ˆ± €  €         ¢      €  ‘       €€€€ŒŸ       €€€ €Œ  Œ  

€  €   Œ   Ÿ

    €      €  €         €        €

€  ­           ©±   „²™³´µ¬—  ¤Ÿ       ž      ¯“ˆ   ‘     ­ ¤      €          €    €  ‘     ¥«²³¶´ ©‰± ·•¨˜²— ©©±¦  £         Œ     €Œ Œ€  

     

        

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


28

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

  

  

  

‰  

                       ­€‚       ƒ       „       ƒ …†‡ˆ„    …                  ƒ …‡‡ˆ„

 …‡ŠŠŠ       ‹                 

       Œ

 ­    “ ”   ”    …†‡ˆ  …‡ŠŠŠ •   ‰ ”–

    —   …‡Š  ˜ — 

Ž ‘’ ­    ™   ”   ”    …‡‡ˆ  …‡ŠŠŠ ‰ …”–

    —   ‡Š  Œ  ‹     •            

š    ›             ›       ”    ”      ” ‹      ”   ”    ”    œ ž         ‘  —   ” ” ”  œ Ÿ     ”   ”  ”        › †      ¡¢   ‘      œž —                                                        ­€‚ƒ  „   „­…†‡         ˆ‰Š  ˆ‰‹            …†‡     „    ­                ­       „   

­        …†‡                    Œ…            Ž                              …†‡ ‘ ’        ‘  “‚ƒ         „     ‘                   ”        …†‡           Ž     •‚ƒ     –—             ­      ˜        ™š€‚ƒ      ’                         ­        ›œžŸ‚‚€   ¡¢ƒ ‘        “¢ƒ 

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.                ­  €  ‚‚ƒ„…  †  ‡ˆ‰Š‹Š Œ       ŽŽ‚­     ‘  ’“’ ”“”­   • –—˜   •™  ˜ †šš • •   ƒ„…        ‘   ”   •  ›      œ    ­  ž•    Ž    •        –œ        š       †   š  •  ‘ Ÿ¡¢  •  £¤ ¥¥¥  ‘  ’š •  ƒ„… ™ ‘‘ ‘ƒ¦£¤¥¥¥­   †š        ‘ ‘   “§ƒ    ƒ„… 

 ƒ‘  ƒ„…          ƒƒ„… ¨„© € œ— œ ­  †    • —–  ª•       ”       • •™ š  † •  • ƒ„…    ™            ’• š   ‘ •«—¨„©–€  ¬    •‘   †    ‘   ’®¯“  °’ — ‘‘­ ±‘ 

29

ª±²° †‘  š        •   †• ³˜­ ´– µ­µ ••    •  • •      š•  † †‘  “ •    † •     †¶·¸ •   ‘    ‘      ¶   • ƒ„…    —– £¹º»¼½‰ ž    œœ–­• – ’••ƒ„…• • —    ™  •     † š           ‘ •   ¾ ƒ„… — ‘   ” ‘ • •        ­     ƒ    œ  £¹¿Š‹ˆŸ À       ŽŽÁ­    – ®• ƒ„…        ™ ™   ±  ‘     ‘ Â—­–Á †     •ƒ„…ބ ބ•   ™   ƒ„… †•     •     š  ²      ‘ ‘“§ƒ•™••‘  ބ     • ‘ •  †     ƒ„…     Ä ƒ—

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


30

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

           



                       - ­€‚ƒ   „…† …‡†         

- ˆ………€‰  Š‹Œ          “  ­€‚ƒ   „…†

      …‡ ˆ………€‰  

             

Ž

  Š‹Œ    ”“   †           ­€‚ƒ    



…ˆ•†‹† ˆ…Œ•……€‰‹†•–  ƒ ‘€’‡ˆ   —   †      

         “  ­€‚   

Ž

   †  Š                

Ž

   † ƒ 

  

“    † ­€‚ƒ   …ˆ•†‹† ˆ…Œ•……€‰‹†•–           ­€‚ Š     

     ­€‚Š‹Œ    ”“  “                 ˜˜˜  † 

  †          

   ­       ” “    ‘€†

 † ­          

         ™   ­€‚Š‹Œ    ”“  ‘€ 

    ­€‚

š †  

“  ­€‚Š‹Œ    ” “    †    

    ”   

­€‚     

 † ”›   

 †  

    

œ  

  ­€‚ƒ •†‹†   ž…€‰‹† •– ”› †     Ÿ

  

                                                       ­€                 ‚   ­€            ƒ 

                       ­€        „…†‡ˆ‰Š‡‹ˆ Œ    Ž‘’“’”       ƒ    • –                   ­€           ƒ  ƒ           ­€ƒ  — ˜

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.                                              

     ­€‚                   ƒ „  …†  †        †       ‡        †              †     †     ˆ‰        † ƒ               „Š       ‡     „Š †                „Š    ‰                   

  †   

31

   ’“  —  ’“   †              

ǸȍȒȖȔȍȕȌȈȞȐȐȗȖȗȘȖȜȐȓȈȒȚȐȒȍȚȘȖȔȉȖȏȖȊ țȗȈȞȐȍȕȚȖȒȊȒȓȦȟȍȕȕȣȝȊȗȘȖȋȘȈȔȔȣȅDzǶ ‡  ‹‰                 †   † …                 †     

         

      

   Œ Ž‘ ’“  †  †    ”                 †    ’“  †   • – ’“      †  †

’        ‹‰                 ‡          

    ‹‰      

 ‹‰

                       ˜Ž   

 ‹‰   

  †    †    ™          ˜š            ™ †

        Ž›œžŽ

˜  †                      Œ œ­‘          Ÿ¡¢£¤ ¥€€ž¡  † †     Œ¦ § ‘         ’   

          Œ  ‘  ¨   ˜›œ   §   ‰              Œ™©™ £˜ªš «œ  ‘ ’ 

‹‰                 

    §   …       

  

                      …   

   

¬®™¯ƒ©™°ƒ© ˜±²³´µ¶·Ÿ¸¹²²¹º»¡¼²½µ¾²¶¾¿À³¹µ³²µÁ¼²½À¹¿¶¿¶À´´¿´¾²Âõ¶Ã²½¾¿µ¶§§¢ÄŤ²½¹µÂƽÂÀ¾²Çš››¨±µÈœ«²ÃÇɵ³˜¦Ê€Çƒ€š­œ¦Ž š¥¼À¶Ë·¸¿¶´Ì²¹Íη»¹²È¿²ÏµÁĽ½²¹²Ð¾¹²Å¿¾Ñ²²½Ȳ¿¶ ¾¼¹µÅ̵´¿´¿¶½¹²Í¶À¶ÃÑÒĶÅÀ´Ó¿¶Í¾¼²Ô»¤¡Ô̲¼¿¶Â¾¼²óµ¾§§ Ρ¼¹µÅÌ¢À²Åµ´¾Çš››€»ÄÍÇɵ³¦Ê¨Çƒ˜€ž­œž ­¤µÍµ³¿¶µ»¥µÃÿÀŸÕ£²Â¿·¸µ¹¿»Ÿ²¾À³¢Ñ½²¹ÃµÀÍijÀÌ¿³¿¾Ñ¼¿Í¼¾¿´´Ä²ÁÀþµ¹À¶Â³µÏ¾¿´´Ä²ÁÀþµ¹½À¾¼ÏÀÑ¿¶¼¿Ì¿¾µ¹³²È²³´¿¶ ´²È²¹²µÈÀ¹¿À¶¼Ñ½²¹´¾¿ÅijÀ¾¿µ¶´Ñ¶Â¹µÅ²Ò½µ´´¿Ì³²À´´µÃ¿À¾¿µ¶Ï¿¾¼ 󿶿ÃÀ³µÄ¾ÃµÅ²§§Ö³µµÂ¥µÀÍij£¿Ì¹¿¶µ³Ñ´¿´Çš››­»½¹Çɵ³˜¦ ʭǃšžžœ¨š ¦×µÂÀÅÀ¢£ÄÓÄÂÀΏ×À¹Ä̲¢²¾À³·¾À¾Ä´µÁ¾¼²õÀÍijÀ¾¿µ¶ À¶ÂØ̹¿¶µ³Ñ¾¿Ã´Ñ´¾²Å´¿¶µÈÀ¹¿À¶¼Ñ½²¹´¾¿ÅijÀ¾¿µ¶´Ñ¶Â¹µÅ²§§£²¹¾¿³ ·¾²¹¿³Ç˜Ùـ·²½Çɵ³€€Ê­Çƒ¦˜žœš¦ Ž¤¿Ãÿ¸¥²¹¶²ÃÀ£·¿Å²µ¶²¤²¾À³ºÅ½ÀþµÁ¼¿Í¼³Ñ½Ä¹¿Ø²Â Ĺ¿¶À¹Ñ £·¢ À¶Â ¹²ÃµÅÌ¿¶À¶¾ £·¢ µ¶ ¼À²Åµ´¾À´¿´Ò À¶ µ½²¶œ³À̲³ ¹À¶ÂµÅ¿Ú²Âõ¶¾¹µ³³²Â¾¹¿À³§§¢ÄŤ²½¹µÂÇš››¦»½¹Çɵ³˜Ù ʦǃ¨­¨œ¦¨ €¤Àµ»×¥¼¿¾ÓÀ¹ÀƏŸ¿³Ó¿»»·ÄÌóÀÈ¿À¶Ȳ¿¶¾¼¹µÅ̵´¿´Áµ³³µÏ¿¶Í ºÉ£ À¶Â µÈÀ¹¿À¶ ¼Ñ½²¹´¾¿ÅijÀ¾¿µ¶Ò À ÃÀ´² ¹²½µ¹¾ §§ ¢ÄÅ ¤²½¹µÂÇš››Ž«²ÃÇɵ³š›Ê˜šÇƒ­­›žœ˜š ž«²³È¿Í¶²»¤µÚ²¶Ì²¹Í··Ñ´¾²ÅÀ¾¿Ã¹²È¿²ÏµÁÂÀ¾Àõ¶Ã²¹¶¿¶Í ²¾¿µ½À¾¼µ³µÍѵÁµÈÀ¹¿À¶¼Ñ½²¹´¾¿ÅijÀ¾¿µ¶´Ñ¶Â¹µÅ²§§º¶¾Î£²¹¾¿³˵Ų¶´Ÿ²ÂÇš››š·²½œÛþÇɵ³¦žÊŽÇƒš˜˜œš€ ¨»È²Ã¿³³À´Î££À³Ãµ¶²¡»¹¹µ³¿ÍÀ»¥ÛÈÀ¹¿À¶¼Ñ½²¹´¾¿ÅijÀ¾¿µ¶ ´Ñ¶Â¹µÅ²§§¥¹¿¾¥À¹²¥³¿¶Çš››¦ÛþÇɵ³š›Ê¦Çƒ€žÙœÙŽ ٫ij¿¾ÚÓÑŸ¥µ¼²¶·Öº¶ÌÀ³»²¾À³º¶Ã¹²À´²Â½¹²ÈÀ³²¶Ã²µÁ ¾¼¹µÅ̵½¼¿³¿À Àŵ¶Í ϵŲ¶ Ï¿¾¼ ´²È²¹² µÈÀ¹¿À¶ ¼Ñ½²¹´¾¿ÅijÀ¾¿µ¶ ´Ñ¶Â¹µÅ²§§£²¹¾¿³·¾²¹¿³Çš››šŸÀ¹Çɵ³žžÊ­Çƒ¦€­œž

˜›ÜÄ̳À¶¢·Õ¿Â··»ÌÀ̶²¼¢»²¾À³»ÃÝÄ¿¹²ÂÀ¶Â¿¶¼²¹¿¾²Â¾¼¹µÅ̵½¼¿³¿ÀҿŽ³¿ÃÀ¾¿µ¶¿¶¹²ÃĹ¹²¶¾ºÉ£À¶Â²Å̹ѵ¾¹À¶´Á²¹ ÁÀ¿³Ä¹²§§¢ÄŤ²½¹µÂÇš››€ÛþÇɵ³š˜Ê˜›Çƒš€Ù¦œ¨ ˜˜Þ ‡              Ò    œ  Ç“ š››¦ÇšŽ˜  ˜š ÛÄ ß¥ ×Àµ ßà àÀ¿ ·à ²¾ À³ ¡¼¹µÅ̵²Å̵³¿´Å ÀÁ¾²¹ µÈÀ¹¿À¶ ´¾¿ÅijÀ¾¿µ¶Ò ´ÄÃò´´Áij ÅÀ¶ÀͲŲ¶¾ µÁ À ϵÅÀ¶ Ï¿¾¼ ´Ä½²¹¿µ¹´ÀÍ¿¾¾À³´¿¶Ä´¾¼¹µÅ̵´¿´ÀÁ¾²¹ºÉ£À¶Â²Å̹ѵ¾¹À¶´Á²¹Ò ÃÀ´²¹²½µ¹¾§§¢ÄŤ²½¹µÂÇš››­±µÈÇɵ³˜¨Ê˜˜Ç ƒš­žŽœ¨˜ ˜­Õ¶´ÓµÍ»¢²¶¹¿Ó´´µ¶ŸƶÀ¶Â²¹Ÿ²¾À³á¹µ´½²Ã¾¿È²´¾ÄÂÑ µÁ¾¼²󿶿ÃÀ³À¶Â³À̵¹À¾µ¹Ñ½À¹ÀŲ¾²¹´µÁ½À¾¿²¶¾´¿¶ϼµÅµÈÀ¹¿À¶ ¼Ñ½²¹´¾¿ÅijÀ¾¿µ¶´Ñ¶Â¹µÅ²²Ȳ³µ½²ÂÂĹ¿¶Íõ¶¾¹µ³³²ÂµÈÀ¹¿À¶¼Ñ½²¹´¾¿ÅijÀ¾¿µ¶Áµ¹¿¶È¿¾¹µÁ²¹¾¿³¿ÚÀ¾¿µ¶§§£²¹¾¿³·¾²¹¿³Ç˜ÙÙÙŸÀÑÇɵ³ž˜ ʎǃ¨›¨œ˜¦ ˜¦£²³Ì²¹ÌÀÄŤՏ«¿²Â¹¿Ã¼×¸µ¶Àµ¾¹µ½¼¿¶œ¹²³²À´¿¶Í¼µ¹Åµ¶² À¶¾À͵¶¿´¾´ÒÏ¿³³¾¼²Ñ¹²½³Àò¾¼²À͵¶¿´¾´â§§¤²½¹µÂÖ¿µÅ²ÂÛ¶³¿¶²Ç š››­ÎÀ¶œ£²ÌÇɵ³€Ê˜Çƒ¦­œŽ­ ˜Žáµ³¿´¼ÄÓË㏷ü²¶Ó²¹Î¸ÛÈÀ¹¿À¶µÈ²¹´¾¿ÅijÀ¾¿µ¶´Ñ¶Â¹µÅ²§§ £²¹¾¿³·¾²¹¿³Ç˜Ù€ÙŸÀќÎĶÇɵ³š›Ê­Çƒ¦¦­œŽ› ˜€«À¶¿²³ß¸²ÈÀՏ»Å¿¾»²¾À³·µ³Ä̳²²¶Âµ¾¼²³¿À³À¶Â½³À¾²³²¾ ´²³²Ã¾¿¶´¿¶´²¹ÄÅÀ¶ÂÀ´Ã¿¾¿ÃäĿµÁϵŲ¶Ï¿¾¼µÈÀ¹¿À¶¼Ñ½²¹´¾¿ÅijÀ¾¿µ¶´Ñ¶Â¹µÅ²§§»ÅΤ²½¹µÂºÅÅĶµ³Çš››˜ŸÀ¹Çɵ³¦ŽÊ­Ç ƒ˜Ž¦œ€› ˜žßÀ¶ã˲¿Ã¼¢»Ö²¹¶À¹¾Ë²¾À³ÉÀ´ÃijÀ¹²¶Âµ¾¼²³¿À³͹µÏ¾¼ ÁÀþµ¹ ŒÉÕ¸£‘ Ų´´²¶Í²¹ ¹¿Ìµ¶Äó²¿Ã Àÿ ŒÅ¤±»‘ ²Ð½¹²´´¿µ¶ ¿¶ ³Ä¾²¿¶¿Ú²Â¼ÄÅÀ¶͹À¶Ä³µ´Àò³³´¿¶È¿¾¹µ§§Î¥³¿¶նµù¿¶µ³Ÿ²¾ÀÌÇ ˜ÙÙ­«²ÃÇɵ³žžÊ€Çƒ˜žš­œŽ

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


32

Ă?Ă?Ă&#x20AC;Ă&#x160;Ă&#x2019;Ă&#x2C6;Ă&#x2014;Ă&#x2026;Ă&#x2018;Ă&#x160;Ă&#x20AC;Ă&#x; Ă&#x152;Ă&#x2026;Ă&#x201E;Ă&#x2C6;Ă&#x2013;Ă&#x2C6;Ă?Ă&#x20AC;

â&#x20AC;&#x2DC;7 (76) докайŃ&#x20AC;Ń&#x152; 2013 Đł.

     

       Â?Â?Â?Â?Â?Â? Â? ­Â&#x20AC;Â?Â&#x201A;Â&#x192;Â?Â&#x201E;Â&#x2026; Â&#x201E;Â?Â&#x2020;Â&#x2021;Â&#x2C6;  Â&#x2030;Â&#x2020;Â&#x160;Â?Â&#x2026;Â&#x2039;Â?     Â&#x152;   Â&#x2021;          Â? Â&#x17D; Â? Â&#x201E;Â&#x201E;Â&#x2018; Â&#x2026;Â&#x160;Â? Â&#x2019;­Â&#x2019;Â?Â&#x201A;Â?Â&#x20AC;Â&#x20AC;Â&#x2026;Â&#x201C;Â&#x201C; Â?Â?Â&#x160;Â&#x201D; Â&#x2030;Â&#x2022;Â&#x2021;Â&#x160;Â&#x160; Â?Â&#x2C6;   Â&#x152;    Â&#x2020;  Â&#x2013;       Â&#x160;Â&#x2039;  Â?Â&#x201E;Â&#x201E;Â&#x201C;Â&#x160;Â? ­Â?Â&#x201A;Â&#x2019;Â&#x20AC;Â&#x2019;Â&#x2026;Â&#x201E; Â?Â&#x2014;Â&#x2C6;Â?Â&#x2C6;Â&#x152;Â&#x2DC;Â&#x2122; Â&#x2039;Â&#x160;Â&#x2039;Â&#x161;      Â&#x152;        Â?  Â&#x160;Â&#x203A; Â?Â&#x201E;Â&#x201E;Â&#x20AC;Â&#x160;Â? Â&#x192;Â&#x201C;­Â?Â&#x201A;Â&#x20AC;Â&#x2018;Â&#x2026;Â&#x201C;Â&#x20AC; Â?Â?Â&#x153;   Â&#x2030; Â&#x2DC; 

 Â&#x2026;    Â&#x152; Â&#x2026;   Â&#x152;   Â&#x160;Â&#x2039;  Â?Â?Â?Â?Â?Â&#x160;Â? Â&#x2018;­Â&#x2018;Â?Â&#x201A;Â&#x2019;Â&#x2019;Â?Â?Â&#x2026; Â?Â&#x2019; Â&#x152; Â&#x2030; Â&#x2030;

 Â&#x2021; Â&#x2030;  Â&#x2030;Â&#x2020;  Â&#x2039;Â?   Â&#x2C6; Â&#x153;Â&#x2DC;Â&#x2DC;Â&#x153;  Â&#x2013; Â&#x2021; Â&#x2026; Â&#x2020;  Â&#x152;     Â?Â?Â&#x201E;Â&#x201E;Â&#x2019;Â&#x201D; Â? ­Â?Â?Â&#x201A;Â?Â?Â&#x2019;Â&#x201E;Â&#x2026;Â&#x192;Â&#x201C; Â?Â&#x192;Â&#x17E;Â&#x152;Â&#x2030; Â&#x2021; Â&#x2021;Â&#x2030;Â&#x17E;     Â&#x153;  

          Â&#x160; Â?Â?Â?Â?Â?Â&#x2122;Â? ­Â?Â?Â&#x201A;Â&#x192;Â&#x2026;Â&#x201E; Â?Â&#x20AC;Â&#x2C6;

Â&#x160;Â Â&#x2122;Â&#x;Â&#x2122;   

     ÂĄ Â?Â&#x201E;Â&#x201E;Â&#x192;Â&#x160;Â? Â?­Â?Â&#x201A;Â?Â&#x2018;Â&#x2026;Â&#x2019;Â&#x2019; Â?Â&#x201C; Â&#x203A;                 Â&#x2013;          Â&#x2021;Â&#x2026; Â&#x2021;Â&#x2026;Â&#x201C;      Â&#x152;   Â&#x2122;Â&#x2030;Â?Â&#x201E;Â&#x201E;Â&#x201E; Â? Â&#x2018;­Â&#x2019;Â?Â&#x201A;Â&#x192;Â?Â&#x2026;Â&#x201E; Â?Â&#x2018;  Â&#x203A; Â&#x203A;  Â&#x201D;Â&#x2020; Â&#x2039;   ÂĄ 

    ¢Â&#x2013;  

 

        Â? Â? Â?Â?Â? Â? Â?Â? ­Â&#x20AC; Â&#x201A;Â&#x192; Â&#x201E;Â&#x2026;Â&#x201E; Â&#x20AC;Â&#x2020; Â&#x2021;  

Â&#x2C6;  Â?Â&#x2030;Â&#x2030;  Â&#x2030; Â?  Â?Â? Â? Â&#x160; Â&#x2039;Â&#x2026;Â&#x152;  Â&#x160;  ­Â&#x2021;Â&#x2021; Â&#x2021;  Â&#x2020;    

 Â&#x152; Â&#x201E;    Â? Â?Â?Â? Â&#x2030; Â&#x192;Â&#x17D; Â&#x2018;  Â&#x2026;Â&#x2019; Â&#x201E; Â&#x17D;Â&#x2021;  Â&#x2020;Â&#x2021;Â&#x2021;

Â&#x201C; Â&#x2039;Â&#x2021;  Â?  Â&#x201D; Â? Â&#x201D;Â&#x201D;Â?   Â&#x17D;Â&#x2022; ­ Â&#x2013;  Â&#x152; Â&#x2014;  ­  Â&#x2014;     Â&#x201C; Â&#x2021; Â&#x2021;Â&#x2021; Â&#x2020; 

Â&#x2C6;Â&#x20AC; Â?Â&#x2030;Â&#x2030;   Â? Â? Â?  Â&#x2030;Â? Â? Â&#x17D;Â&#x160; Â&#x2DC;Â&#x2021;Â&#x2122;  Â&#x2021;Â&#x2026;Â&#x201E; Â&#x161;      Â&#x2021;Â&#x2021;    Â&#x203A;  Â&#x2021;  

Â&#x2C6;Â&#x20AC; Â?Â&#x152;  Â  Â? Â?Â?Â?  Â&#x2C6;Â&#x2026;Â&#x201E; Â&#x17D; Â&#x20AC;Â&#x2020;Â&#x153; Â&#x201C; Â&#x2018; Â&#x2022;Â&#x201C; Â&#x17D;Â&#x2021; Â&#x192;   Â&#x203A;Â&#x2021;Â&#x2021;

­ Â&#x2C6; Â?Â&#x2030;Â&#x2030;    Â? Â?Â? Â&#x201D; Â&#x2019;Â&#x20AC; Â&#x2DC;Â&#x2122; Â&#x17E; Â&#x2019;  Â&#x2021;Â&#x2020;Â&#x2022;Â&#x2014;      Â&#x203A;    Â&#x2021; Â&#x2021;

   Â?­    Â?  Â?  Â&#x152;Â&#x2018; Â&#x2019;Â&#x201C; Â&#x17D; Â&#x17E;Â&#x152; Â&#x2039;  Â&#x2021;Â&#x2021;Â&#x203A; 

   Â?  Â? Â? Â?Â&#x201D;Â?   Â&#x161; Â&#x20AC; Â&#x2014;  Â&#x201C;  Â&#x2DC;  Â&#x2DC;Â&#x2026; Â&#x160;  ­Â&#x2026; Â&#x17D;  Â&#x153;   

Â&#x2039;Â&#x161;Â&#x2021;   Â&#x201E;  Â&#x201D;   Â? Â?Â?   Â&#x2019;Â&#x2021;Â&#x201E;   Â&#x17D; Â&#x201E;Â&#x2022;Â&#x; Â&#x192;­ Â&#x201E; Â&#x17D; Â&#x153;  Â&#x2021; Â&#x2021;Â&#x2021;

Â&#x17D;Â&#x2021;Â&#x2039;Â&#x161;Â&#x2021; Â&#x2021;  Â&#x17D;      Â? Â?Â?  Â? Â&#x192;Â&#x; Â&#x2018;ÂĄ­ Â&#x2DC; Â&#x153;¢Â&#x17D;Â&#x20AC;Â&#x153;ÂŁÂ&#x203A;Â&#x2020;  Â&#x2021;Â&#x2021; Â&#x2021;Â&#x2021;Â&#x2021;

Â&#x153;Â&#x20AC; Â?Â&#x2030;Â&#x2030;Â?  Â?  Â?  Â?Â?

REFERENCES 1. Nelson S.M., Greer I.A. The potential role of heparin in assisted conception. Human Reproduction Update, 2008, vol. 14, no. 6, pp. 623-645. DOI: 10.1093/humupd/dmn031. 2. Chan W.S., Ginsberg J.S. A review of upper extremity deep vein thrombosis in pregnancy: Unmasking the â&#x20AC;&#x2DC;ARTâ&#x20AC;&#x2122; behind the clot. Journal of Thrombosis and Haemostasis, 2006, vol. 4, no. 8, pp. 1673-1677. DOI: 10.1111/j.1538-7836.2006.02026.x. 3. Rogolino A., Coccia M.E., Fedi S., Gori A.M., et al. Hypercoagulability, high tissue factor and low tissue factor pathway inhibitor levels in severe ovarian hyperstimulation syndrome: Possible association with clinical outcome. Blood Coagulation and Fibrinolysis, 2003, vol. 14, no. 3, pp. 277-282. DOI: 10.1097/00001721-200304000-00009. 4. Kodama H., Fukuda J., Karube H., et al. Status of the coagulation and fibrinolytic systems in ovarian hyperstimulation syndrome. Fertility and Sterility, 1996, vol. 66, no. 3, pp. 417-424. 5. Ricci G., Cerneca F., Simeone R., et al. Impact of highly purified urinary FSH and recombinant FSH on haemostasis: An open-label, randomized, controlled trial. Human Reproduction, 2004, vol. 19, no. 4, pp. 838-848. DOI: 10.1093/humrep/deh185. 6. Rao A.K., Chitkara U., Milki A.A. Subclavian vein thrombosis following IVF and ovarian hyperstimulation: A case report. Human Reproduction, 2005, vol. 20, no. 12, pp. 3307-3312. DOI: 10.1093/ humrep/dei235. 7. Delvigne A., Rozenberg S. Systematic review of data concerning etiopathology of ovarian hyperstimulation syndrome. International Journal of Fertility and Womenâ&#x20AC;&#x2122;s Medicine, 2002, vol. 47, no. 5, pp. 211-226. 8. Avecillas J.F., Falcone T., Arroliga A.C. Ovarian hyperstimulation syndrome. Critical Care Clinics, 2004, vol. 20, no. 4, pp. 679-695. DOI: 10.1016/j.ccc.2004.05.003. 9. Dulitzky M., Cohen S.B., Inbal A., et al. Increased prevalence of thrombophilia among women with severe ovarian hyperstimulation syndrome. Fertility and Sterility, 2002, vol. 77, no. 3, pp. 463-467. DOI: 10.1016/S0015-0282(01)03218-6. 10. Qublan H.S., Eid S.S., Ababneh H.A. et al. Acquired and inherited thrombophilia: implication in recurrent IVF and embryo transfer failure. Human Reproduction, 2006, vol. 21, no. 10, pp. 2694-2698. DOI: 10.1093/humrep/del203. 11. Bitsadze V.O. Patogenez, printsipy diagnostiki i profilaktiki oslozhneniy beremennosti, obuslovlennykh trombofiliey. Dokt. med. nauk diss. Avtoref. [Pathogenesis, principles of diagnosis and prevention of pregnancy complications due to thrombophilia. Dr. med. sci. diss. Synopsis]. Moscow, 2004. 251 p. 12. Ou Y.C., Kao Y.L., Lai S.L., et al. Thromboembolism after ovarian stimulation: successful management of a woman with superior sagittal sinus thrombosis after IVF and embryo transfer: Case report. Human Reproduction, 2003, vol. 18, no. 11, pp. 2375-2381. DOI: 10.1093/ humrep/deg470. 13. Enskog A., Henriksson M., Unander M., et al. Prospective study of the clinical and laboratory parameters of patients in whom ovarian

hyperstimulation syndrome developed during controlled ovarian hyperstimulation for in vitro fertilization. Fertility and Sterility, 1999, vol. 71, no. 5, pp. 808-814. DOI: 10.1016/S0015-0282(99)00090-4. 14. Felberbaum R.E., Diedrich K. Gonadotrophin-releasing hormone antagonists: Will they replace the agonists? Reproductive BioMedicine Online, 2003, vol. 6, no. 1, pp. 43-53. 15. Polishuk W.Z., Schenker J.G. Ovarian overstimulation syndrome. Fertility and Sterility, 1969, vol. 20, no. 3, pp. 443-450. 16. Daniel Y., Geva E., Amit A., et al. Soluble endothelial and platelet selectins in serum and ascitic fluid of women with ovarian hyperstimulation syndrome. American Journal of Reproductive Immunology, 2001, vol. 45, no. 3, pp. 154-160. 17. Yan Z., Weich H.A., Bernart W., et al. Vascular endothelial growth factor (VEGF) messenger ribonucleic acid (mRNA) expression in luteinized human granulosa cells in vitro. Journal of Clinical Endocrinology and Metabolism, 1993, vol. 77, no. 6, pp. 1723-1725. Journal of Clinical Endocrinology and Metabolism 18. Albert C., Garrido N., Mercader A., et al. The role of endothelial cells in the pathogenesis of ovarian hyperstimulation syndrome. Molecular Human Reproduction, 2002, vol. 8, no. 5, pp. 409-418. 19. Rizk B., Aboulghar M., Smitz J., Ron-El R. The role of vascular endothelial growth factor and interleukins in the pathogenesis of severe ovarian hyperstimulation syndrome. Human Reproduction Update, 1997, vol. 3, no. 3, pp. 255-266. DOI: 10.1093/humupd/3.3.255. 20. Gordon J.D., Mesiano S., Zaloudek C.J., Jaffe RB. Vascular endothelial growth factor localization in human ovary and fallopian tubes: possible role in reproductive function and ovarian cyst formation. Journal of Clinical Endocrinology and Metabolism, 1996, vol. 81, no. 1, pp. 353-359. 21. Kamat B.R., Brown L.F., Manseau E.J., et al. Expression of vascular permeability factor/vascular endothelial growth factor by human granulosa and theca lutein cells. Role in corpus luteum development. American Journal of Pathology, 1995, vol. 146, no. 1, pp. 157-165. 22. Wang T.H., Horng S.G., Chang C.L., et al. Human chorionic gonadotropin-induced ovarian hyperstimulation syndrome is associated with up-regulation of vascular endothelial growth factor Journal of Clinical Endocrinology and Metabolism, 2002, vol. 87, no. 7, pp. 3300-3308. DOI: 10.1210/jc.87.7.3300. 23. Todorow S., Schricker S.T., Siebzehnruebl E.R., Neidhardt B., Wildt L., Lang N. Von Willebrand factor: An endothelial marker to monitor in-vitro fertilization patients with ovarian hyperstimulation syndrome. Human Reproduction, 1993, vol. 8, no. 12, pp. 2039-2046. 24. Ogawa S., Minakami H., Araki S., Ohno T., et al. A rise of the serum level of von Willebrand factor occurs before clinical manifestation of the severe form of ovarian hyperstimulation syndrome. Journal of Assisted Reproduction and Genetics, 2001, vol. 18, no. 2, pp. 114-119. DOI: 10.1023/A:1026590910462. 25. Balasch J., Arroyo V., FĂĄbregues F. et al. Neurohormonal and hemodynamic changes in severe cases of the ovarian hyperstimulation syndrome. Annals of Internal Medicine, 1994, vol. 121, no. 1, pp. 27-33.

Ă&#x20AC;Ă&#x160;Ă&#x201C;Ă&#x2DC;Ă&#x2026;Ă?Ă&#x2018;Ă&#x2019;Ă&#x201A;Ă&#x17D;. Ă&#x192;Ă&#x2C6;Ă?Ă&#x2026;Ă&#x160;Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;. Ă?Ă?Ă&#x201E;Ă&#x17D;Ă&#x160;Ă?Ă&#x2C6;Ă?Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г. 26. Pellicer A., Albert C., Mercader A. et al. The pathogenesis of ovarian hyperstimulation syndrome: in vivo studies investigating the role of interleukin-1beta, interleukin-6, and vascular endothelial growth factor. Fertility and Sterility, 1999, vol. 71, no. 3, pp. 482-489. 27. Goldsman M.P., Pedram A., Dominguez C.E. et al. Increased capillary permeability induced by human follicular fluid: a hypothesis for an ovarian origin of the hyperstimulation syndrome. Fertility and Sterility, 1995, vol. 63, no. 2, pp. 268-272. 28. Mathur R., Kailasam C., Jenkins J. Review of the evidence base strategies to prevent ovarian hyperstimulation syndrome. Human Fertility, 2007, vol. 10, no. 2, pp. 75-85. DOI: 10.1080/14647270601111239. 29. Yoshii F., Ooki N., Shinohara Y., et al. Multiple cerebral infarctions associated with ovarian hyperstimulation syndrome. Neurology, 1999, vol. 53, no. 1, pp. 225-227. 30. Cluroe A.D., Synek B.J. A fatal case of ovarian hyperstimulation syndrome with cerebral infarction. Pathology, 1995, vol. 27, no. 4, pp. 344-346. 31. Abuzeid M.I., Nassar Z., Massaad Z., et al. Pigtail catheter for the treatment of ascites associated with ovarian hyperstimulation syndrome. Human Reproduction, 2003, vol. 18, no. 2, pp. 370-373. DOI: 10.1093/humrep/deg074. 32. Abramov Y., Elchalal U., Schenker J.G. Febrile morbidity in severe and critical ovarian hyperstimulation syndrome: A multicentre study. Human Reproduction, 1998, vol. 13, no. 11, pp. 3128-3131.

33

33. Hitkari J.A., Rowe T.P., von Dadelszen P. Activated protein C and the ovarian hyperstimulation syndrome: Possible therapeutic implications. Medical Hypotheses, 2006, vol. 66, no. 5, pp. 929-933. DOI: 10.1016/j.mehy.2005.08.058. 34. Borenstein R., Elhalah U., Lunenfeld B., Schwartz Z.S. Severe ovarian hyperstimulation syndrome: A reevaluated therapeutic approach. Fertility and Sterility, 1989, vol. 51, no. 5, pp. 791-795. 35. Navot D., Bergh P.A., Laufer N. Ovarian hyperstimulation syndrome in novel reproductive technologies: prevention and treatment. Fertility and Sterility, 1992, vol. 58, no. 2, pp. 249-261. 36. Gergely R.Z., Paldi E., Erlik Y., Makler A. Treatment of ovarian hyperstimulation syndrome by antihistamine. Obstetrics and Gynecology, 1976, vol. 47, no. 1, pp. 83-85. 37. Balasch J., Fabregues F., Arroyo V., Jimenez W., Creus M., Vanrell J.A. Treatment of severe ovarian hyperstimulation syndrome by a conservative medical approach. Acta Obstetricia et Gynecologica Scandinavica, 1996, vol. 75, no. 7, pp. 662-667. 38. Chan W.S., Dixon M.E. The “ART” of thromboembolism: A review of assisted reproductive technology and thromboembolic complications. Thrombosis Research, 2008, vol.121, no. 6, pp. 713-726. DOI: 10.1016/j.thromres.2007.05.023.

ÍÎÂÎÅ Â ÌÅÄÈÖÈÍÅ. ÈÍÒÅÐÅÑÍÛÅ ÔÀÊÒÛ ÌÈÍÇÄÐÀ ÈÇÐÀÈËß ÂÂÎÄÈÒ ÎÃÐÀÍÈ×ÅÍÈß ÍÀ ÝÊÎ Ìèíèñòåðñòâî çäðàâîîõðàíåíèÿ Èçðàèëÿ íà÷èíàåò îãðàíè÷èâàòü êîëè÷åñòâî ïðîöåäóð ýêñòðàêîðïîðàëüíîãî îïëîäîòâîðåíèÿ (ÝÊÎ), íà êîòîðûå æåíùèíû èìåþò ïðàâî â ðàìêàõ Íàöèîíàëüíîé ïðîãðàììû ìåäèöèíñêîãî ñòðàõîâàíèÿ. Äî ñèõ ïîð æåíùèíû â âîçðàñòå äî 45 ëåò, êîòîðûå íå èìåþò äâîèõ äåòåé, èìåëè ïðàâî íà íåîãðàíè÷åííîå êîëè÷åñòâî ïðîöåäóð ÝÊÎ, ôèíàíñèðóåìûõ ãîñóäàðñòâîì. 21 ÿíâàðÿ ìèíèñòåðñòâîì áûëà èçäàíà íîâàÿ äèðåêòèâà, íàêëàäûâàþùàÿ îïðåäåëåííûå îãðàíè÷åíèÿ. Áîëüøèíñòâî æåíùèí òåïåðü áóäóò îãðàíè÷åíû âîñåìüþ öèêëàìè ÝÊÎ.  äèðåêòèâå òàêæå ãîâîðèòñÿ, ÷òî ÷åðåç ÷åòûðå ïîñëåäîâàòåëüíûõ öèêëà, â õîäå êîòîðûõ íå ñìîãëè èìïëàíòèðîâàòü ýìáðèîí, èëè âîñüìè öèêëîâ, â ðåçóëüòàòå êîòîðûõ íå ñìîãëè îñóùåñòâèòü áåðåìåííîñòü, æåíùèíà äîëæíà âñòðåòèòüñÿ ñî ñâîèìè ìåäèêàìè è ñîöèàëüíûì ðàáîòíèêîì, ÷òîáû îáñóäèòü âàðèàíòû äàëüíåéøåãî ëå÷åíèÿ. Æåíùèíû ñòàðøå 42 ëåò áóäóò îãðàíè÷åíû òðåìÿ öèêëàìè ÝÊÎ, åñëè ýìáðèîí íå óäàñòñÿ èìïëàíòèðîâàòü â ýòî âðåìÿ.  ýòîì âîçðàñòå øàíñû íà óñïåøíóþ áåðåìåííîñòü ïîñëå òðåõ íåóäà÷ ïîäðÿä áëèçêè ê íóëþ. Íîâàÿ äèðåêòèâà òàêæå ïîçâîëÿåò æåíùèíàì â âîçðàñòå 39 ëåò è ñòàðøå ñðàçó æå íà÷àòü ëå÷åíèå ñ ïîìîùüþ ÝÊÎ. Äî ñèõ ïîð æåíùèíû, êîòîðûå äîáèâàëèñü ÝÊÎ, áûëè îáÿçàíû âíà÷àëå ïîïðîáîâàòü äðóãèå âèäû ëå÷åíèÿ áåñïëîäèÿ, òàêèå êàê òàáëåòêè èëè èíúåêöèè. È åñëè ýòè ïðîöåäóðû, íåîäíîêðàòíî ïîâòîðåííûå, íå äàâàëè ðåçóëüòàòîâ, æåíùèíû ìîãëè ïðèñòóïàòü ê ÝÊÎ. Ìèíèñòåðñòâî ïðèçíàåò, ÷òî ïîðîé ýòî ïðàâèëî âûíóæäàëî âïóñòóþ òðàòèòü äðàãîöåííîå âðåìÿ æåíùèí, ÷åé âîçðàñò ïðèáëèæàåòñÿ ê êîíöó ïèêà ðîæäàåìîñòè, ïîñêîëüêó ïîñëå 40 ëåò ðåïðîäóêòèâíàÿ ñïîñîáíîñòü îðãàíèçìà ðåçêî ïàäàåò. Ðàçðåøåíèå ýòèì æåíùèíàì íà÷èíàòü ïðîöåäóðû ñðàçó ñ ÝÊÎ óâåëè÷èâàåò èõ øàíñû çàáåðåìåíåòü. Îäíà èç ðåêîìåíäàöèé ñîâåòà, êîòîðóþ ìèíèñòåðñòâî íå ïðèíÿëî, — ñíèçèòü ìàêñèìàëüíûé âîçðàñò äëÿ ëå÷åíèÿ ÝÊÎ è îãðàíè÷èòü åãî 44 ãîäàìè. ôåâðàëü 2014 ã. Èñòî÷íèê: MIGnews.com

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


34

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.



Å.Á. ÏÅÐÅÄÅÐßÅÂÀ, Ò.Á. ÏØÅÍÈ×ÍÈÊÎÂÀ, À.Ä. ÌÀÊÀÖÀÐÈß Ïåðâûé Ìîñêîâñêèé ãîñóäàðñòâåííûé ìåäèöèíñêèé óíèâåðñèòåò èì. È.Ì. Ñå÷åíîâà, 119991, Ìîñêâà, óë. Òðóáåöêàÿ, ä. 8, ñòð. 2

Ðîëü òðîìáîôèëèè â ïàòîãåíåçå îñëîæíåíèé áåðåìåííîñòè ó æåíùèí ñ ìåòàáîëè÷åñêèì ñèíäðîìîì Ïåðåäåðÿåâà Åêàòåðèíà Áîðèñîâíà — êàíäèäàò ìåäèöèíñêèõ íàóê, ìëàäøèé íàó÷íûé ñîòðóäíèê íàó÷íî-èññëåäîâàòåëüñêîãî îòäåëåíèÿ «Îõðàíà ìàòåðèíñòâà è äåòñòâà» íàó÷íî-èññëåäîâàòåëüñêîãî öåíòðà, òåë. +7-903-144-40-73, e-mail: katya-oleg@yandex.ru Ïøåíè÷íèêîâà Òàòüÿíà Áîðèñîâíà — êàíäèäàò ìåäèöèíñêèõ íàóê, ìëàäøèé íàó÷íûé ñîòðóäíèê íàó÷íî-èññëåäîâàòåëüñêîãî îòäåëåíèÿ «Îõðàíà ìàòåðèíñòâà è äåòñòâà» íàó÷íî-èññëåäîâàòåëüñêîãî öåíòðà, òåë. +7-903-144-40-72, e-mail: tanya-katya@yandex.ru Ìàêàöàðèÿ Àëåêñàíäð Äàâèäîâè÷ — äîêòîð ìåäèöèíñêèõ íàóê, ïðîôåññîð, ÷ëåí-êîððåñïîíäåíò ÐÀÌÍ, çàâåäóþùèé êàôåäðîé àêóøåðñòâà è ãèíåêîëîãèè ìåäèêî-ïðîôèëàêòè÷åñêîãî ôàêóëüòåòà, òåë. +7-903-728-08-97, e-mail: gemostasis@mail.ru                                                          ­               

E.B. PEREDERYAEVA, T.B. PSHENICHNIKOVA, A.D. MAKATSARIYA I.M. Sechenov First Moscow State Medical University, 8-2 Trubetskaya St., Moscow, Russian Federation, 119991

The role of thrombophilia in the pathogenesis of pregnancy complications in women with metabolic syndrome Perederyaeva E.B. — Cand. Med. Sc., Junior research scientist of scientific and research division «Maternity and child welfare service» of Scientific and Research Center, tel. +7-903-1444073, e-mail: katya-oleg@yandex.ru Pshenichnikova T.B. — Cand. Med. Sc., Junior research scientist of scientific and research division «Maternity and child welfare service» of Scientific and Research Center, tel. +7-903-144-40-72, e-mail: tanya-katya@yandex.ru Makatsariya A.D. — D. Med. Sc., Professor, Corresponding member of RAMS, Head of the Department of Obstetrics and Gynecology of Public Health Faculty, tel. +7-903-728-08-97, e-mail: gemostasis@mail.ru €‚ƒ„…†‡ˆ‰Š‹ŒŽ‘†’‚ˆŠ“ˆŽ‚Š”‘‚„Ž„’†Œ•“†’‚Œ†–‘‚”‘†Ž—‰ƒˆ˜‚„•‚€‚ƒ„…†‡ˆ‰Š‹ŒŽ‘†’‚ˆŠƒ™‚‘ˆŠš–„‰ƒ†‘–†‘Ž‚˜‚‡†”ˆŒ•˜„‘ˆ†—Š †…Šƒ‚ƒ‘ˆ‰‰†’”‡ˆ‰„ƒˆ†ŒŠ›‚Œ‚ƒˆ‰™‹”†œ…‘ˆŒ†‡‹ŠˆŠˆŒ“†’‚Œ“ˆƒ™’‚ƒ„…†‡ˆ‰Š‹ŒŽ‘†’‚ˆŒ‰†Œž—Œ‰ƒˆ†Œ“ˆƒ™†ƒ™‚‘–†‘’Š†–ƒ™‘†’…†”™ˆ‡ˆ„ ‰„—Š‚„…Œ†‘’„‡ˆƒˆ‚Š†–ˆ’”‡„Œƒ„ƒˆ†Œƒ‘†”™†…‡„ŠƒˆŒ˜„Šˆ†Œ”‡„‰‚Œƒ„ƒˆ†ŒŸƒ’„‹‰„—Š‚•‚Šƒ†ŠˆŠ”‘†•‘‚ŠŠˆ†Œ”™‚ƒ†”‡„‰‚Œƒ„‡ˆŒŠ—–œ‰ˆ‚Œ‰‹ Š‹ŒŽ‘†’‚†–ˆŒƒ‘„—ƒ‚‘ˆŒ‚•‘†“ƒ™‘‚ƒ„‘Ž„ƒˆ†Œ†–„–‚ƒ—ŠŠ‹ŒŽ‘†’‚†–„–‚ƒ—Š‡†ŠŠ„ƒƒ™‚ƒˆ’‚†–”‘‚•Œ„Œ‰‹  ’‚ƒ„…†‡ˆ‰Š‹ŒŽ‘†’‚ƒ™‘†’…†”™ˆ‡ˆ„”‘‚•Œ„Œ‰‹

                                  

                   ­    €-

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.                                         ­€            ‚€€ƒ„              …                

   †           ‡ˆ‰Š

‹                                  Œ Žˆ‘’ “”•–—˜™š“ ›   œ‡Šž Žˆ‘’Ÿ ¡•¢£•”¤¥ › ›      œ‡’Šž Žˆ‘ŸŸ ¦•—§•£“ › ¨œ‡©Šž Žˆ‘Ÿ‘ ª—–˜—£« ›  œ‡ŸŠž Ž ˆ‘‘ˆ   ¬®¯”£¤¯”– °  ›      œ‡‘Šž Ž ˆ‘‘ˆ   ±•²”¯£³¯ ¦  ›       œ‡ˆ´Šž Ž ˆ‘‘   ¦•µ£š¶· ¸ ¡  ›  

          œ ‡ˆˆŠž Žˆ‘‘‰ ¹£³š“ ›  œ‡ˆŠž Ž ˆ‘‘Ÿ   ‹  … º  ›    œ ‡ˆŠž Žˆ‘‘Ÿ ƒ » ‹ ›   ¼œ‡ˆ‰Š

½        ›  œ›       œ

º ¾ ¿ ˆ‘               ‚€À„     †            Á ­ ˆ‘‰Ÿ                 ‡Š  ‹ ˆ‘Ÿ´ 

† ¡ ¥—£•Ã•˜™Ä ¸•¯£¢—”™¤     ›   œ ‡ˆŠ  ‹ ´´ˆ   ÅÁÆ ÇÇÇ ‚șɘ¤ ʔ•—¤Ë•£¤ °—££•˜ÇÇÇÌ€Íń     ›  œ

Î 

   “ ¡ ¦•—§•£ˆ‘ŸŸ  › ¨œ †  Å †† “ ¡ ¦•—§•£   ††   ¨ Ï              ‚ź„  

  ‚ÐрÀ„       “  ¦•—§•£

                    ‡©Š  Ñ   ˆ‘Ÿ‘ ª—–˜—£«   ›  œ             ‚

     Ì      „            † ź ‡ŸŠ  ‹                     ­€  ҝ ÌÓ                   ´     Ò                   -

35

        Ó           À

Ó        

‹ Ó        ´       ‹Æ  † Œ ´ †  Ì    €            ´ Ì´ †    †         ƒˆ´ Ó  ˆ´        ‹ Ó       

  Ӎ   ˆ©‡ˆ’ˆ©Š

Ð      ˆ‘‘  ¬—”·•” ±                        ‚€ƒ‹Æ΄    €€ƒ ­€  Ð        ­€ ›¤¢•µË—˜˜ԗÔÕµÕ£™”¯Ë•œ  ›    œ ­     Ó   Î 

 ֗×ɕ¤ ±   €‹ƒÆÎ             ‚ÐƄ   

 … Ï   › œ           † † †

     ‹     

  €À      €À­€‡ˆŸŠ

Æ ‹Òƒ          ‚ˆ‘‘Ÿ„Œ Ž†  ‚   „ ž Ž     ž Ž    ž Ž          ‚ÑÁº„   €Àž Ž     ž Ž  ž Ž   ž Ž ž Ž  

Ñ    ­€  ‹

  Œ Ž    ž Ž  ž Ž    ž Ž ž Ž      ž Ž  Ó ž Ž†  ž ŽÓ      †ž Ž   ž Ž   ž Ž  Œ                †

 †          ˆ‚°ÈLj„  ‹   Ÿ´     

                   ‚€Î ؄  Æ     

    ÐрÀ€€ƒ ÎÓ       €Î Ø           Ìى    ‹ 

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


36

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

                   ­ €  ‚     ƒ   „              ‚     … „  ­   ­€  ­   †    †‡† ˆ‰ † ­€  ­    Š  ‹  Š   Œ „        ˆŽˆ  ˆ‘ˆ’“   ”  †„ƒ      ƒ  ­†‚ †  …„    Š‹ƒ   ƒ„  ”  •–  ˆ  †  ­  ƒ †­†     ”  ”       Œ„†   ƒ  ƒ „   „ƒƒ    Œ † „­ €ƒ     ”­ … „­ƒ     ” ­€  ” ƒ ‘’ ˆ ƒ …„ —”­… ‚˜™  š       †     

”ƒ …„  ƒ   ” …„  ­     ˆ’   …„  ”                                                                                                               ­€‚€ƒ€„…†‡‡ˆ‰                                  Š‹

‘7 (76) декабрь 2013 г.        Œ†Ž‘ ’          “                ’                                                 Œ”‡‘ •  Š‹ –       —                …          ‰          ‹   Š‹                   ‹    ˜     ‹™š …›œžŸ¡ •¢£€¡¤£¥¡ ¦€¥¥£Ÿ …›­¦ §§§‰ †‡‡¨‰     ©   ª              «¬¨‡†…   ‰«¬®®…   ‰      «¬¨ˆ‡ ¯   «¨°Ž ¯    ±‹ ²³ ³ ´µ‡ ¯   ´¨‡µ ¯ …    ‰ ´ˆ‡ ¯   ´¨†Ž¯…   ‰      ¨”‡¯®ˆ   «¬¨¨‡¯ «°¨¯   †‡‡”   š         …›š¶·‰      ¨        ¸¹‹šº          

‹   ‹’†“šº¸¹‹  º             ˜    Š  ¸Š•«†ˆ¯†¯»•«µ‡ …«¨‡‡‰  «”ˆ …®¼ˆ‰    «µ‡  †        •º«¨ˆ‡¯ …«¨¼¯‰ ²³ ³´µ‡¯ …´¨‡¯‰  ´ˆ‡ ¯ …´¨†¯‰   š’«¨”‡¯®ˆ  º  ¨¨‡“¨†ˆ ¯      †   ¨µ‡“†‡‡¯ Œ”¨”†‘ ’               ½                 ˜         –            •    — …»•‰–                »—    …»¹‰             ˜   –‡Ž   –‡®       ¨ š         »•¯»¹ ‡Ž     ‡®   

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.             ­  € ‚ ƒ   ƒ „„„… „…     †…‡ˆ ƒ … ‰    Š‰ „ „  ‡„€… „ ‰ €…‡„    „ ‡   „…„‹Œ Ž‡„…  „ ‘† ‡† ‡  ƒ  ’ ’† ‰     ‰   „  ƒ   „… „€ „      ‡ ““  ‰   ‚”’•  –—“’˜      „‡„ ‡„   „ €…     „ ‡    ™šš š›œ Š „…  ƒ       „     ž   „ „   ‰  ‹Œ     „ „ ‰ „ „ „  Œ’ „  ƒ    „  ƒ …  „ ž…  ‰ ‰…  ‰…  „ „     „    „  ‰ ‰ „‚”’•   ’˜   ’Ÿ   ’­     … ‡„…“¡—¢’ ˜ £¡—¢’˜   „‰ ƒ‰ „  … ƒ „ …„ƒ… „  ’„      „  „‰   ‡   †  ‰ ™š¤ šŸœ Š „… „ ¥Ž ƒ ‡  ‰  ƒ    ‡ „ „ …‰ „“¦’˜§’š˜¨¡ ¡©›Ÿ¤š¡ª  “¦’Ÿ ’˜«› ª¡  ¨¬®’¯ ’š­ª—       „ „ „ … ‰ „ “¦’˜§  “¦’Ÿ  £¡—¢’˜  ¡›  °±’   ™š«œ Š €„  ƒ„  ‡  ƒ…     ƒ  ²  „…… „… „  ‡„    € „„ „‡   ‰ ‰ ƒ         ƒ     „‡„ ŒŒ¥ Œ „‡…  „ ‡„   ‡  €…  „  „‡„ ŒŒ¥ „  ƒ   ‡„ ƒ‡ ƒ™š­œ Š   „ ƒ ‡  ‰  ŒŒ¥   „„ ƒ   £““   „ „  –—“’˜    „  ‡„    ‡„    „ ŒŒ¥ Š „ –—“’˜  £““ ‰   ”        „ ‡‹Œ™šœ ž„ ‰ ‰ ƒ     „      … „ „

37

„  „  „‡  „  ‡„   ‰   ƒ  ™œ ž  ‹„ ‹”   ƒ…   ƒ       ‰ „ ‰ ‰ ƒ    „  £““   „ „ „    ƒ   „  „       „ ƒ    ‰™˜œ  ‡ „ „ ‰ ‰ ƒ  „ „  ‹Œ   „  „   „  ’Ÿ „  „„‰      Œƒ „ € ƒƒ‡„    „   ‰ „„ƒ  ‡  „„… ƒ‰ „ ƒ ³  ƒ‰      „ €…       ‰  Š˜­¤ ƒ„ ‡„ €    ƒ   „   ‰ „   ƒ  ž  ƒ    ƒ  „ „  ´  ƒ „        ƒ„„   ‡„ „  ƒ  „ ‡ ’˜–—“’˜   ƒ‡ƒ „   ‰‹ „ „–—“’˜„‡„     ´µ  ‰       ‰       –—“’˜ †  „ ‰ … „‰  „      ƒ¶  „–—“’˜‹Œ™š­ ›œ ·©¸¹º»¼½¾¾ ‹Œ     ƒ‡„„ –—“’˜ ™›œ   „      ƒ  „ „‡„ ‰ ‰ µ³˜’˜ „ ‡ „ Š „ „ ‰ ‰ –—“’˜ ‡ ‡„  „ ‡    ‰  ’      ‡‰…ƒ „    ™› ›˜œ ž ‡ „„‰ ‰ „ –—“’˜‰ ƒ   –—“’˜„ „  ƒ   „ „ ‡   ‰  „ ‡ „       „  „ •’ … ƒ‰ „ –—“’˜  ‡  †     ‰          ‰  „‰  „  ²     ƒ‰     „ –—“’ ˜ „ ‰ ƒ‡ Ž‰ ‰ –—“’˜„ ‡ „  „  ¤’   –—“’˜ „ ƒ† „ ƒ ‰„‰ „ ‡   ƒ „  „  ‡  Ž µ³˜’˜    Œ „‡ „   ƒ  ƒ  „ –—“’˜ ‡ † ™›˜ ›œ Œ ‡ –—“’˜     „ ‰ ´   ‡ „  ¿žŒ  ´¿’˜ ‚”’•    ƒ‰ „§ „  ƒƒ „  ‡’““ ƒ‰  ƒ „  „    ‡ –—“’˜„†      ƒ‰ „§™›˜ ›œ

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


38

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

      ­€‚  ƒ    „   …†‡„  ˆ  „  ‰Š‹Œ Ž  ƒ „  ˆ‘ …‡’‡“„  †ˆ“†‡„   ” ˆˆ   „ Šƒ † “„   •–—˜–™    ˆ ‡  ”     „    –‡ †‡ ƒ ‡    †  „   „   ˜–  š  –—– ˆ ‡  ƒ ” ˜–—˜–›  „  …‡ˆˆ‡ƒ†  „ „ “  ˆ „  †    œ  † ” ‡žŸ„ ‡‘‡‘  ‡ † ˆ     †        ‡ƒ  š ƒ„  ¡¢  ”‡     ƒ†  “ƒ†  †„ ƒ† ‡‡„ …‘„¡¢ƒ ƒ† ”‡ † ‡Žž  £ …„       ˆ  ¡¢       ”  †                ˆ ˆ   ‡ˆ     ‡‡‡ „ “ ƒ“ ¤ ”‘„‘”„‡ ‡ ‘ „     ˆ •‹Šž™  ‡ƒ†‘      †   ˆ  ˆ˜¥ ƒ ‡¡¢ ”   ’‡ƒ     ƒ„ƒ†¡¢    „†‡ƒ   Ž„†¡¢„‡  ‡  ƒ„ ‡ †  Š †     ‡‡‡ ƒ‡„ ¡¢ ‹„‘¦¥§  …Š¢ ƒ“   ƒ ” †   ƒ  ƒ‡“ ”‡    “ ˆ  “ †‡   ƒ¤ ‡ƒ „  •Š¤¢™ ‘‡        ”‡„”‡    ƒ „†”‡ “ˆ „ ƒ Š¤¢ ‡‡‡ † †   ƒ‡   ”     ˆ ¨ ˜˜ ’   ƒ   „     ” -

‘7 (76) декабрь 2013 г.  “ ˆ¢ †  ††    ƒ   „ „ƒ† †”  †‡ Š ”‡       “ ˆ† ƒ ”‡ ’‘‡‡‡  ’„ ‡  † £ ‡ˆ    ”‡ƒ© …Š ¢ •¦¦™  „ †    “ ˆ  ’     ‡  ” †  ˆ†ˆ ‡’ª«  „   ‡‘ †   ’ „      ƒ ˆ†‘ †  “ †‘ ˆ ‡ ‹ ƒ ‘„ ‡‡†„ †‡ ‡  ”     ˆ †‘ ‡§˜« ¢…Š•£§§™  ’ ƒ†ƒ  ‡‡‡  ‡ †  ‡† •ƒ §«™    ‡† ‡†  ’ ƒ† ‡   ”    ˆ ƒ    ‡   ‡  ‡    ƒ† ‡¦˜§ ¬Œ®­€‚¯   ’ƒƒ ”ˆ † „ Ÿ°•‡ƒ› „ ƒ›Ÿ°™ƒ “ˆ  ‡   ˆ  ˆ †‡Ÿ  ‡„  ƒƒ†‘    ‘„ƒ˜ …   ‡„     † ƒ‡“ ƒ“ ƒ ”   „‡  ‘   „ ’ § ƒ„‡  “   ƒ   „ ”    ’†ƒ‘˜§ ˜¦ ¨ ’©§©¦ „‡“ ƒ ƒ”¦„Ž“†„† “„§    „‡“ ƒ  †‘ ’¤ † „    ‘   „ † Ž¡š ±£¦  —£ „‡„  ”   ¦ „  „  “   ƒ   ¡‘„ „‡  ‘    ’    „ …„   ”‡  ƒ„  „ƒ “   ‘ ˜£˜   œ‘ žž  “ ¡¢ ƒ    „†  †   † ‘  †‡      ƒ‘ƒ„¡¢š ¥¦ª«ƒ‘¡¢ „‡ „ °„   ‡  ‡  ˜« ’ ‡ ‡ “ „ ƒ    £« ƒ‘ œ „

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.                ­      €   ‚­ƒ  „   ­ …      ­†   

  ‡  ˆ   ­…‰Š ‹ Œ €Ž‘ €­…’’’“ †­ ­ƒ   ”ƒ         ­    ‘•–Œ  …€ ­­€ €    —     †   ƒ   €ˆ ƒ  ’’’  ‰ŠŠ‹ Œ  ­… ˜—   ­ ƒ     ƒ ‘•–Œ…   ‰Š‹Œ — €      ­ ƒ    € €            ƒ   ­     ‰‹ ‘ ­ …  ­  ‚    „… ­    …  ­ …    …­†…€  ­†€­  ƒ      ­  ­ …    ­†€    ™  €‘­ … …€   ­­   €   € ­†            ­  ˆ­­ ­†   … € ­   …€  €           €‰ŠŠš‹ ”ƒ€ † …  … ‰Š›‹ Œ   ˜”               …     €     ƒ ­ ’’’        ’’’ƒ  …­­         …   †   œž    ‰“‹ Œ  —…€ ––       …       ‡ŠŠ   ­­‘Š  ­    € ­     Š €€         Ÿ    ­ ‡‡‡      ‡ ‚¡¢““„‰Š ‹ Œ  ­… ˜—   …€ ˆ    ­ ƒ             …   €  ­€  

39

    £     †  ‡‡ Œ     ¤   ­€      ­    €    

ˆƒ  €‰Š‹ Œ  Ž‘ €     … †€­   ‡“   ƒ      … ­†… €   ­  Œ ™     ­  †ˆ¤   ­€  €…­ˆƒ  ‰ŠŠ‹   …  ˆ  ­† ­    †   ­  Ÿ  ­  … ­ ­   …  …€…   ……” ­ ­  ƒ …  …   …€ ‰Šš ‡‹ ¥   €               €   ­   … †    † ­    ‘     €     † ­¦§’ ‘ˆ  ­   …ƒ˜–­¦§’  ­­¦§’ ­ˆ          €    ‰‡‹ ¨  €­      …€ ­…  €     ­…€  … €        ™ † €ƒ €  ­†  ­    €    €  €  ­ ©Ÿ” ™        ™          …  €   

€   …   ­ƒ­…  ˜       €† ­     ˆ ­  ™   

 …  €€   € ­ €­ €ª ­†ˆ  €   ­…  ‰ Š‹ — ­  € ­­  ˆ ˜  ˆƒ€ ˆƒ€      €  € €­ ­ † ­…  -

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


40

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

                                                                    

        ­ €‚  ƒ €‚„           …              †  €‚‡ †„       ˆ‰„             Š† ‹                  Œ      

Ž                              ‘        …  ’“                               ’“  ’  “ …      €‚‡ †      „         …               

”    •–•„    — „ •–•            ˜ „ •–•      —      ˜ „•–•  ™š›   

 •–• 

œ  Œ Œ   •–Ž                          … žŸ¡ Ÿ¢£

¤    Œ  Œ -

‘7 (76) декабрь 2013 г.                 ¥¦„     •š„                           §¨©©€          

Ž                   „   ¥      ª             Ž               Œ

¤               Ž                      «Ž   †¬¬®ž¯Ÿ£

             „ ‹ †¬¬¡    Œ        ’¯¢¡ Ÿ°±¡°“  €‚‡ †     ’¯¢¡Ÿ°±Ÿ°“€‚‡ †  ²   «Ž            €‚‡ † ’¯¢¡ Ÿ°±¡°“  •– ‡±³  ­ €‚       €‚‡ †   …    €‚‡ †                     ‹                                         „  •š  «Ž       €‚‡ †           Œ€‚‡

†         

 

 

ŒŒ •–„  «Ž                  -

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

41

   

   

                      ­€‚ƒ                 ­    ƒ „      …      ­  ­  † …­ ‡          €‚ƒ    ˆ‰   Š€‚ˆ‰  ­        Š€‚  ˆ‰ ‹    

            ­ ­   ŒŽ‘ ’  Œ  Ž‘ †    ‡             ­Ž‘ “        ”          €‚ƒ •   † ‘‡     -

      Œ    ­     ­­      ­  Œ     ­     ­     Œ       ­ ­ –   — Œ†    €‚ƒ     Œ ‡ Œ Œ­   Œ ­     ­ —    ­    Œ ­      ­         ˜       ­ ­

      ­         Œ    Œ  ­           Œ   ­  Œ  ­„     ­ ’       ™ š         Œ                   Ž‘   -

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


42

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

                                                                  ­­€ ‚ƒ          „‚…†‡††ˆ ‰Šƒ‹ŒŽƒ‘ŒŽ „’“Š’  ”’•’   –—„—”„‡‡ –’    ˜Ž™’‹šƒš “› š  ” ’• ’    –——†”‡œ— ž’“šŸ Š‹’  •  

  ˜˜¡  ’ ”–——¢£ž„—‚”¤–œžž ‡ ¥¦§¨©©ª ­©«¬®ª ¯ °¨§ª±¦©®² ¬³´µ¶¦·¨¸ ®´ ¹¦·¨´ ˜˜ º´ » º²ªµ ¼ª²°¨µ”–———”½¦©„„¾£–”Œž„¾–¾ ¢º¿¦Àª¶¦€Á¶¨Âª©µ®Á ´Ä®ÁÅ®¨´À¦º°¨§ª±¦©®²ª¬Â¨²§¬¦Æ ¨¬¬¨´§®ª©¦±¨¬®§³˜˜ Âª§¦©¦À®ª»¦·ª”„dž¢”½¦©„„”Œ––† –žœ † °¨È´¨¶§  É«È©·ª´´  ³Â¨¶§¦´®¨ ª´µ Ê®ª±¨§¨¬ ·¨©©®§«¬ ˜˜ ʨ«§¬²È°¨µ¯”„džœ”½¦©„ǁ”Œ¢†¾¾„ ¾»¨ª¿¨´Á°»¦©¨¦Æ®´¬«©®´¶¨¬®¬§ª´²¨®´È«·ª´µ®¬¨ª¬¨˜˜Ê®ª±¨§¨¬”„Çœœ”½¦©ž¾£„–”Œ„¢Ç¢„†—¾ œ ɪ©ª´ ¼° ÅȨ µ¨ªµ©³ Ë«ª¶§¨§• «Â¨¶±¦µ³ ¦±¨¬®§³ À©«²¦¬¨ ®´§¦©¨¶ª´²¨ ȳ¨¶§¶®À©³²¨¶®µ¨·®ª ª´µ ȳ¨¶§¨´¬®¦´ ˜˜ º¶²È Ì´§¨¶´ °¨µ”„ǜǁ”½¦©„‡Ç”€„¢„‡„¢–— ǁ¥Í¦¶´§¦¶Â€Á¦¶¦´ª¶³µ®¬¨ª¬¨ª´µ¦±¨¬®§³˜˜°¨µ®²¦À¶ªÂÈ®ª” „ÇDŽ”½¦©„ž¼„”€‡¢‡¾ „— ʨζ¦´Ä¦ » Ψ¶¶ª´´®´®   Ì´¬«©®´ ¶¨¬®¬§ª´²¨• º ·«©§®Æª²¨§¨µ ¬³´µ¶¦·¨¶¨¬Â¦´¬®±©¨Ʀ¶¼ÌÊÊ°¦±¨¬®§³ȳ¨¶§¨´¬®¦´µ®¬©®Â®µ¨·®ª ª´µª§È¨¶¦¬²©¨¶¦§®²²ª¶µ®¦¿ª¬²«©ª¶µ®¬¨ª¬¨˜˜Ê®ª±¨§¨¬Áª¶¨”„ÇDŽ” ½¦©‡£ž”€„¾ž„LJ „„ »¨¬´®²Ï ­° ̦´®² ±ª¬®¬ ¦Æ ȳ¨¶§¨´¬®¦´ ®´¬«©®´ ¶¨¬®¬§ª´²¨ ¿ª¬²«©ª¶µ®¬¨ª¬¨ª´µ¶¨©ª§¨µµ®¬¦¶µ¨¶¬ÅȨ·¨²Èª´®¬·¦ÆЬ³´µ¶¦·¨¸Ñ˜˜ º·¯³Â¨¶§¨´¬”„ÇǞºÂ¶”½¦©†£‡”„–žÒ„ž‡Ò „– ´Ä®Á¥«¬¨§§¦­Áª¶¶ª¶¦»º¬¬¦²®ª§®¦´¦Æ·«©§®Â©¨¶®¬Ïƪ²§¦¶¬Ʀ¶²ª¶µ®¦¿ª¬²«©ª¶µ®¬¨ª¬¨ª´µ¿®¬²¨¶ª©¦±¨¬®§³ºµ¨ªµ©³Ë«ª¶§¨§ ¦¶¬¨Ó§¨§ÔÌ´•Ê®§¬È«´È¨®§¨§ª©¨µ¬˜˜Õ±¨¬®§³®´ «¶¦Â¨­¦´µ¦´• ­®±±¨³”„ÇLJ”Œ‡„„„œ „ž“ցׁ¡›ØŒ       ” Ÿ „ÇÇ¢”†ž „‡Ùځ“’   ې  ‚•     ˜˜ ¡ ”„ÇÇǁ”£œ”¤¢Ç†¾ „¢ ¨´¨Æ¨©µ ° ­¨¦´Èª¶µ§Ü ʪ¬ ·¨§ª±¦©®¬²È¨ Ò³´µ¶¦·¨ ˜˜ ʨ«§¬²Èè¬ܨ¬”„Çœ—”£ž†”€¢‡¢¢¢„ „† š ‰™ ¡ ‰“ ¡ ‹“   ›       Ý       •      ” ’•Ž  –—„—”¾ž „¾š‹Š“   ˜˜’   Ќ   Ý ”’–—„—”¤–ž–¾ „œ ¥ª¶Ï¨¶ ʁ¯ °ª§¨¶´ª© ´«§¶®§®¦´ ƨ§ª© ´«§¶®§®¦´ ª´µ µ®¬¨ª¬¨ ®´ ©ª§¨¶©®Æ¨˜˜¼«§¶®§®¦´”„ÇǾҨ”½¦©„ž£„ǁ”Œœ—¾„ž „ǁ¡ ŽŠ‰ځŽ’  •”Ÿ •Ÿ  –——„ –—™ŽÞ›  ”‹ •‘×’Ž–——„ –„ ’  ’Þ ¡        •     ”’„ÇǾ –– › Œ    ˜     ށŽ š “Š ’  ” ¤ • Š    ¤  ’Ž› –——ž”¤dž„„Ç–„Ç–ž‡ –ž™ ŠŠ’ ׁŽ›Ö    ” ’• ’    –——‡”¤–„†–ž–

‘7 (76) декабрь 2013 г.                ­€ ‚‚ƒƒ„…†ƒ‡… ˆ    ‰Š‹‰­Š  ‰ŠŒ  Š Š  Œ  Œ  Š     Ž         ‘    ‹  ‹ Œ     ’’­  ‚‚ “„Š”‡•–ˆˆ„†–ˆ—ˆ — ˜™š›œž™žŸ¡ ¢£ ¤¥›ž›¦™§Ÿ¡™ ¨ž©¦™ž›™ ª›«©š›žž¡¬¡ ®›§¯©¥©ž§©°¯¡¥±ž²œ§š™«©¯¡¥›¦™§Ÿ›š§›ž®³¡š¡š ©ª«¡³™´®›§µ Ÿ©ž®š™®ž©°Ÿ¶·š™ž±Š‚‚ƒ˜ƒ‚ „¸Œ ¸¹ ºŒ » ­ Œ Œ     ¼½¼¾’’¸¹Œ–‡‡… “„‡Š”•ƒ–ˆ†„ … Œ€Š ŒŠ‰“  » ­   ‹ Œ    ‘Œ’’ ¹Œ ‚‚ “„‡Š”ˆ•…‚†ˆ ‡  ¹Š  Š€  ¿ Œ  Œ  Œ ’’ ‚‚¹Œ“–„Š” •–—†ƒ— ƒ‚ ‰Œ†  ÀŠ Œ†   ‹ Œ  Œ »     ’’ ­ ‚‚­ “ƒ‡Š”•‚‡†–ƒ ƒ– Á    ­ » Œ      ‘   ¸    Œ ÁŒ»  Œ   ‘      ‘        Œ    Âà Á    Š » Œ      ‘       ŒŒ   Ã’’¹‚‚–“…ˆŠ”–‡ •…—†‡„ ƒ   Œ     ‰Œ‘‰  ’’ ‚‚ƒ“‡Š  Œ–„†–‡ ƒƒ   Š     Š ‘ Š     Œ  ’’Œ­ ‚‚ƒŒ“ƒŠ ”•‡ƒ†… ƒ À  Š ­¼ ¹Š    Š  ‘‘   »  »‘ Œ†     »  †–    »  ‘         Œ     Œ ’’­ ‚‚”ˆ–––ƒ–†––ƒ„ ƒˆ   Š ‰Ä ¹Š   Œ ‰      ‘† »‹  ‘       †‹  »‹  ’’Œ  » ­ ‚‚ˆŒ“–ˆŠ”•„‚†… ƒ—¿Š     Š¿                ‹ Ž       ‘Å  ‹      ‘‘‘   »  †–    † »  ‘  ’’­   ‚‚ˆ “…Š”‡•––†— ƒ„Æ©®©™ª©Ç¤È©§«¡«©›§É™Ÿ«³É¡¥›š¡³´›¨š¡ªɳ¡ª¡§É©¥›«™¥±ž²œ ʛ«¡Ÿ›ž¡ª › «³¡š¯¡´›¥›› ° ¯™³™š™žž²œ § š™«©¯¡¥›¦™§Ÿ›š §›ž®³¡š¡š › ¬™§«¡¨¡š ’’ Ë©«™³›©¥² ½ ·¯›¥™Ìž¡¬¡ ͧ™³¡§§›Ì§Ÿ¡¬¡ž©°¦ž¡¬¡´¡³°š©ÎË©«±›ϛ«ÐÑËŠ‚‚‡˜ ƒ…  Œ   ŒÅ          » Œ   ’’ ¹ »   –‡‡‚ Œ… ‡†ƒ– ƒ‡  ‰Š ‰Š»   Å  ‹‘ ‘     Œ † Œ ’’ ­  –‡‡…“–Š”•—‡†ˆ ‚  Œ Š  Œ        Å    ‘ Œ‘   »  †–’’  ¹Œ ‘ ‚‚»“…Š”––•–ƒˆ„†–ƒ— 41. Макацария А.Д., Бицадзе В.О. Тромбофилии и противотромботическая терапия в акушерской практике. — М.: Триада-Х. — 2003. — 904 с. 42. Cigolini M., Tonoli M., Borgato L. et al. Expression of plasminogen activator inhibitor-1 in human adipose tissue: a role for TNF-alpha? // Atherosclerosis. — 1999 Mar. — Vol. 143, № 1. — Р. 81-90. 43. Dimova E.Y., Samoylenko A., Kietzmann T. Oxidative stress and hypoxia: implications for plasminogen activator inhibitor-1 expression // Antioxid Redox Signal. — 2004 Aug. — Vol. 6, № 4. — Р. 777-91. 44. Vaughan D.E. PAI-1 and atherothrombosis // J Thromb Haemost. — 2005. — Vol. 3. — Р. 1879-83. 45. Бицадзе В.О. Патогенез, принципы диагностики и профилактики осложнений беременности, обусловленных тромбофилией: автореф. дис. ... д-ра мед. наук. — М., 2004. 46. Бицадзе В.О., Макацария А.Д., Баймурадова С.М., Акиньшина С.В. Профилактика повторных гестозов у пациенток с тромбофилией // Материалы XI Всероссийского научного форума «Мать и Дитя». — М., 2010. — С. 29-30. 47. Бицадзе В.О., Макацария А.Д., Хизроева Д.Х. и др. Тромбофилия как важнейшее звено патогенеза осложнений беременности // Практическая медицина. — 2012. — № 5. — С. 22-29. 48. Серов В.Н. Послеродовые нейроэндокринные заболевания. — М.: Медицина, 1978. — 246 с. 49. Серов В.Н., Прилепская В.Н., Овсянникова Т.В. Гинекологическая эндокринология. — М.: МЕДпресс-информ. — 2012. — С. 279-326.

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

43

50. Серов В.Н., Кан Н.И. Клинико-патогенетические варианты гормональной недостаточности яичников у женщин с метаболическим синдромом // Акушерство и гинекология. — 2004. — № 5. — С. 29-34. 51. Castro L.C., Avina R.L. Maternal obesity and pregnancy outcomes // Curr Opin Obstet Gynecol. — 2002 Dec. — Vol. 14, № 6. — Р. 601-6. 52. Shaw G.M., Velie E.M., Schaffer D. Risk of neural tube defectaffected pregnancies among obese women // JAMA. — 1996 Apr 10. — Vol. 275, № 14. — Р. 1127-8. 53. Werler M.M., Louik C., Shapiro S., Mitchell A.A. Prepregnant weight in relation to risk of neural tube defects // JAMA. — 1996 Apr 10. — Vol. 275, № 14. — Р. 1089-92. 54. Бериханова Р.Р. Особенности течения беременности, родов, послеродового периода у пациенток с метаболическим синдромом: автореф. дис. ... канд. мед. наук. — Волгоград, 2009. 55. Саркисова А.В. Течение беременности и родов у женщин с метаболическим синдромом: автореф. дис. ... канд. мед. наук. — М., 2004. 56. Соколов Е.И., Манухин И.Б., Мочалов А.А., Невзоров О.Б. Нарушения в системе гемостаза и его коррекция у беременных с метаболическим синдромом // Лечащий врач. — 2011. — № 3. — С. 43-47. 57. Николаева-Балл Д.Р., Кан Н.И. Состояние адаптационных механизмов у женщин с метаболическим синдромом и гестозом в III триместре беременности // Биомедицинский журнал. — 2012. — Т. 13. — С. 803-818. http://www.medline.ru/public/art/tom13/art67.html 58. Кузьмина-Крутецкая С.Р., Репина М.А. Метаболический синдром у женщин. — СПб: Изд-во Н-Л, 2011. — 76 с.

59. Чернуха Е.А., Чернуха Г.Е. Ведение беременности и родов у женщин с ожирением // Акушерство и гинекология. — 1992. — № 1. — С. 68-73. 60. Макаров И.О., Шилов Е.М., Петунина Н.А. и др. Течение беременности, родов и послеродового периода у женщин с метаболическим синдромом // Российский вестник акушера-гинеколога. — 2012. — № 3. — С. 36-41. 61. Бурумкулова Ф.Ф., Петрухин В.А., Коваленко Т.С., Титова Т.В., Головченко М.А. Гестационный сахарный диабет — междисциплинарная проблема / Материалы X юбилейного Всероссийского научного форума «Мать и дитя». — М., 2009. — С. 30-31. 62. Горохова Л.Г. Динамика обмена углеводов и липидов в системе мать-плод-новорожденный при ожирении у женщин: автореф. дис. … канд. биол. наук. — Иркутск, 1995. — 19 с. 63. Ерченко Е.Н. Патофизиологические особенности углеводного и липидного обменов и состояние новорожденных у беременных с избыточной массой тела и ожирением: автореф. дис. ... канд. мед. наук. — М., 2009. — 28 с. 64. Передеряева Е.Б. Основные принципы ведения беременности и безопасного родоразрешения у женщин с метаболическим синдромом: автореф. дис. ... канд. мед. наук. — М., 2006. — 24 с. 65. Передеряева Е.Б., Пшеничникова Т.Б., Баймурадова С.М., Макацария А.Д. Ведение беременности и родов у больных с метаболическим синдромом и тромбофилией // Врач. — 2006. — № 14. — С. 45-47. 66. Пшеничникова Е.Б., Пшеничникова Т.Б., Макацария А.Д. Роль тромбофилии в развитии акушерской патологии у женщин с метаболическим синдромом // Акушерство и гинекология. — 2006. — № 4. — С. 15-19.

REFERENCES 1. Makolkin V.I. Metabolicheskiy sindrom [Metabolic syndrome]. Moscow, Medical Information Agency Publ., 2010. 144 p. 2. Makatsariya A.D., Pshenichnikova E.B., Pshenichnikova T.B., Bitsadze V.O. Metabolicheskiy sindrom i trombofiliya v akusherstve i ginekologii [Metabolic syndrome and thrombophilia in obstetrics and gynecology]. Moscow, Medical Information Agency Publ., 2006. 480 p. 3. Mychka V.B., Chazova I.E. Metabolic syndrome: Diagnosis and differentiated approach to treatment. Kachestvo zhizni. Meditsina, 2005, no. 3, pp. 28-33. (in Russ.). 4. Botella Llusia J. Metabolic syndrome X in women. Anales de la Real Academia Nacional de Medicina, 2000, vol. 117, no. 2, pp. 317-327. (in Spanish). 5. Avogaro P., Crepaldi G., Enzi G., Tiengo A. Metabolic aspects of essential obesity. Epatologia Roma, 1965, vol. 11, no. 3, pp. 226-238. (in Italian). 6. Mehnert H., Kuhlmann H. Hypertonie and diabetes mellitus. Deutsches medizinisches Journal, 1968. vol. 19, no. 16, pp. 567-571. (in German). 7. Reaven G.M. Role of insulin resistance in human disease. Diabetes, 1988, vol. 37, no. 12, pp. 1595-1607. 8. Kaplan N.M. The deadly quartet: Upper-body obesity, glucose intolerance, hypertriglyceridemia and hypertension. Archives of Internal Medicine, 1989, vol. 149, no. 7, pp. 1514-1520. 9. Bjorntorp P. Coronary disease and obesity. Medicographia, 1991, vol. 13, no. 1, pp. 45-47. 10. DeFronzo R., Ferrannini E. Insulin resistance: A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dislipidemia and atherosclerotic cardio-vascular disease. Diabetes Care, 1991, vol. 4, no. 3, pp. 173-194. 11. Resnick L.M. Ionic basis of hypertension, insulin resistance, vascular disease, and related disorders. The mechanism of “syndrome X”. American Journal of Hypertension, 1993, vol. 6, no. 4, pp. 123s-134s. 12. Enzi G., Busetto L., Carraro R. Association of multiple risk factors for cardiovascular disease and visceral obesity. A deadly quartet or sextet? Obesity in Europe. London, John Libbey Publ. 1994, pp. 411-418. 13. Volkova E.G., Kalev O.F. Rukovodstvo po korrektsii lipidnykh narusheniy i ateroskleroza u bol’nykh sakharnym diabetom [Manual for correction of lipid disorders and atherosclerosis in patients with diabetes]. Chelyabinsk, 1995. 63 p. 14. Zimin Yu.V. Metabolic disorders within the metabolic syndrome X (insulin resistance syndrome): The need for strict application of diagnostic criteria for the syndrome. Kardiologiya, 1999, no. 8, pp. 59-67. (in Russ.). 15. Henefeld M., LeonhardtW. The metabolic syndrome. Deutsche Gesundheitswesen, 1980, no. 36, pp. 545-551. (in German). 16. Belotserkovtseva L.D., Kovalenko L.V., Korneeva E.V., Mayer Yu.I., Shishanok O.Yu., Erchenko E.N. Osobennosti metabolicheskogo sindroma u zhenshchin v razlichnye periody zhizni: patogenez, klinika, diagnostika, lechenie [Features of the metabolic syndrome in women in different stages of life: Pathogenesis, clinical manifestations, diagnosis, treatment]. Moscow, Academy of Natural Sciences Publ., 2010. 73 p. 17. Borovkova E.I. Prenatal care for patients with overweight and obesity. Mat. obrazov. semin. “Reproduktivnoe zdorov’e zhenshchin vne i vo vremya beremennosti” [Mat. educ. semin. “Women’s reproductive health out of, and during pregnancy”]. Moscow, 2010. pp. 23-27. 18. Barker D.J. Maternal nutrition, fetal nutrition, and disease in later life. Nutrition, 1997, vol. 13, no. 19, pp. 807-813. 19. Kuzin A.I., Lengin Yu.A. Metabolicheskiy sindrom: klinicheskie i populyatsionnye aspekty [Metabolic syndrome: clinical and population aspects]. Chelyabinsk, 2001. 90 p.

20. Dmitriev A.N. Ozhirenie i metabolicheskiy sindrom [Obesity and metabolic syndrome]. Ekaterinburg, Ural State Medical Academy Publ., 2001. 160 p. 21. Mamedov M.N. Komponenty metabolicheskogo sindroma u bol’nykh s arterial’noy gipertoniey. Kand. med. nauk diss. Avtoref. [Components of the metabolic syndrome in patients with hypertension. Cand. med. sci. diss. Synopsis]. Moscow, 1997. 22. Belyakov N.A., Mazurov V.I., eds. Ozhirenie. Rukovodstvo dlya vrachey [Obesity. Guide for physicians]. St. Petersburg, SPb MAPO Publ., 2003, pp. 96-119. 23. Dedov I.I., Mel’nichenko G.A. Ozhirenie. Etiologiya, patogenez, klinicheskie aspekty [Obesity. Etiology, pathogenesis, clinical aspects]. Moscow, Medical Information Agency Publ., 2004, pp. 216-232. 24. Eckel R.H. Obesity: Mechanisms and clinical management. Philadelphia, Lippincott Williams & Wilkins Publ., 2003, pp. 378-398. 25. Wannamethee S.G., Lowe G.D.O., Shaper A.G., Rumley A., Lennon L., Whincup P.H. Insulin resistance, haemostatic and inflammatory markers and coronary heart disease risk factors in Type 2 diabetic men with and without coronary heart disease. Diabetologia, 2004, vol. 47, no. 9, pp. 1557-1565. DOI: 10.1007/s00125-004-1491-7. 26. Semikhnenko I.N. Klinicheskoe znachenie vitaminnogo disbalansa u bol’nykh s metabolicheskim sindromom. Kand. med. nauk diss. Avtoref. [Clinical significance of vitamin imbalance in patients with metabolic syndrome. Cand. med. sci. diss. Synopsis]. Tyumen’, 2003. 30 p. 27. Boucher B.J. Inadequate vitamin D status: Does it contribute to the disorders comprising syndrome ‘X’? British Journal of Nutrition, 1998, vol. 79, no. 4, pp. 315-327. 28. Chiu K.C., Chu A., Go V.L.W., Saad M.F. Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction. American Journal of Clinical Nutrition, 2004, vol. 79, no. 5, pp. 820-825. 29. Takaya J., Higashino H., Kobayashi Y. Intracellular magnesium and insulin resistance. Magnesium Research, 2004, vol. 17, no. 2, pp. 126-136. 30. Guerrero-Romero F., Rodrigues-Moran M. Low serum magnesium levels and metabolic syndrome. Acta Diabetologica, 2002, vol. 39, no. 4, pp. 209-213. DOI: 10.1007/s005920200036. 31. Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults. Executive Summary of the third report of the National Cholesterol Education Program (NOEP) Expert Panel on detection, evaluation and Treatment of high blood Cholesterol in Adults (Adult Treatment Panel III). JAMA: The Journal of the American Medical Association, 2001, vol. 285, no. 19, pp. 2486-2497. DOI:10.1001/jama.285.19.2486. 32. AACE position statement on insulin resistance syndrome. ACE guidelines for glycemic control. Endocrine Practice, 2003, vol. 9, Suppl. 1, pp. 7-19. 33. Aldhahi W., Hamdy O. Adipokines, inflammation, and the endothelium in diabetes. Current Diabetes Reports, 2003, vol. 3, no. 4, pp. 293-298. 34. Festa A., D’Agostino R. Jr., Tracy R.P., Haffner S.M. Elevated levels of acute-phase proteins and plasminogen activator inhibitor-1 predict the development of type 2 diabetes: The insulin resistance atherosclerosis study. Diabetes, 2002, no. 51, pp. 1131-1137. 35. Hoekstra T., Geleijnse J.M., Schouten E.G., Kok F.J., Kluft C. Relationship of C-reactive protein with components of the metabolic syndrome in normal-weight and overweight elderly. Nutrition, Metabolism and Cardiovascular Diseases, 2005, vol. 15, no. 4, pp. 270-278. DOI: 10.1016/j.numecd.2005.01.004. 36. Aso Y., Wakabayashi S., Yamamoto R. et al. Metabolic syndrome accompanied by hypercholesterolemia is strongly associated with proinflammatory state and impairment of fibrinolysis in patients with type

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


44

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

2 diabetes: synergistic effects of plasminogen activator inhibitor-1 and thrombin-activatable fibrinolysis inhibitor. Diabetes Care, 2005, vol. 28, no. 9, pp. 2211-2216. 37. Gadaeva Z.K. Frequency and spectrum of polymorphisms of proinflammatory cytokines and thrombophilia in women with metabolic syndrome and gestosis. Mat. X yubileyn.Vseross. nauch. foruma “Mat’ i Ditya” [Proc. 10th Jubilee All-Russ. Sci. Forum “Mother and Child”]. Moscow, “MEDI Ekspo” Publ., 2009, p. 42. 38. Andersen P. Hypercoagulability and reduced fibrinolysis in hyperlipidemia: Relationship to the metabolic cardiovascular syndrome. Journal of Cardiovascular Pharmacology, 1992, vol. 20, Suppl. 8, pp. S29-S31. 39. Imperatore G., Riccardi G., Iovine C., Rivellese A.A., Vaccaro O. Plasma fibrinogen: A new factor of the metabolic syndrome: A population-based study. Diabetes Care, 1998, vol. 21, no. 4, pp. 649-654. DOI: 10.2337/diacare.21.4.649. 40. Skurk T., Hauner H. Obesity and impaired fibrinolysis: Role of adipose production of plasminogen activator inhibitor-1. International Journal of Obesity, 2004, vol. 28, no. 11, pp. 1357-1364. DOI: 10.1038/sj.ijo.0802778. 41. Makatsariya A.D., Bitsadze V.O. Trombofilii i protivotromboticheskaya terapiya v akusherskoy praktike [Thrombophilia and antithrombotic therapy in obstetric practice]. Moscow, Triada-X Publ., 2003. 904 p. 42. Cigolini M., Tonoli M., Borgato L., Frigotto L., Manzato F., Zeminian S., Cardinale C., et al. Expression of plasminogen activator inhibitor-1 in human adipose tissue: A role for TNF-alpha? Atherosclerosis, 1999, vol. 143, no. 1, pp. 81-90. DOI: 10.1016/S00219150(98)00281-0. 43. Dimova E.Y., Samoylenko A., Kietzmann T. Oxidative stress and hypoxia: Implications for plasminogen activator inhibitor-1 expression. Antioxidants and Redox Signaling, 2004, vol. 6, no. 4, pp. 777-791. DOI: 10.1089/1523086041361596. 44. Vaughan D.E. PAI-1 and atherothrombosis. Journal of Thrombosis and Haemostasis, 2005, vol. 3, no. 8, pp. 1879-1883. DOI: 10.1111/j.1538-7836.2005.01420.x. 45. Bitsadze V.O. Patogenez, printsipy diagnostiki i profilaktiki oslozhneniy beremennosti, obuslovlennykh trombofiliey. Dokt. med. nauk. diss. Avtoref. [Pathogenesis, principles of diagnosis and prevention of complications in pregnancy due to thrombophilia. Dr. med. sci. diss. Synopsis]. Moscow, 2004. 46. Bitsadze V.O., Makatsariya A.D., Baymuradova S.M., Akin’shina S.V. Prevention of repeated gestoses in patients with thrombophilia. Mat. XI Vseross. nauch. foruma “Mat’ i Ditya” [Proc. 11th All-Russ. Sci. Forum “Mother and Child”]. Moscow, “MEDI Ekspo” Publ., 2010, pp. 29-30. 47. Bitsadze V.O., Makatsariya A.D., Khizroeva D.Kh., et al. Thrombophilia as a key link in the pathogenesis of pregnancy complications. Prakticheskaya meditsina, 2012, no. 5, pp. 22-29. (in Russ.). 48. Serov V.N. Poslerodovye neyroendokrinnye zabolevaniya [Postnatal neuroendocrine diseases]. Moscow, Meditsina Publ., 1978. 246 p. 49. Serov V.N., Prilepskaya V.N., Ovsyannikova T.V. Ginekologicheskaya endokrinologiya [Gynecological endocrinology]. Moscow, MEDpress-inform Publ., 2012, pp. 279-326. 50. Serov V.N., Kan N.I. Clinical pathogenetic variants of ovarian hormone deficiency in women with metabolic syndrome. Akusherstvo i ginekologiya, 2004, no. 5, pp. 29-34. (in Russ.). 51. Castro L.C., Avina R.L. Maternal obesity and pregnancy outcomes. Current Opinion in Obstetrics and Gynecology, 2002, vol. 14, no. 6, pp. 601-606. DOI: 10.1097/00001703-200212000-00005. 52. Shaw G.M., Velie E.M., Schaffer D. Risk of neural tube defectaffected pregnancies among obese women. JAMA: The Journal of the American Medical Association, 1996, vol. 275, no. 14, pp. 1127-1128.

‘7 (76) декабрь 2013 г. 53. Werler M.M., Louik C., Shapiro S., Mitchell A.A. Prepregnant weight in relation to risk of neural tube defects. JAMA: The Journal of the American Medical Association, 1996, vol. 275, no. 14, pp. 1089-1092. 54. Berikhanova R.R. Osobennosti techeniya beremennosti, rodov, poslerodovogo perioda u patsientok s metabolicheskim sindromom. Kand. med. nauk. diss. Avtoref. [Peculiarities of pregnancy, childbirth, postpartum period in patients with metabolic syndrome. Cand. med. sci. diss. Synopsis]. Volgograd, 2009. 55. Sarkisova A.V. Techenie beremennosti i rodov u zhenshchin s metabolicheskim sindromom. Kand. med. nauk. diss. Avtoref. [The course of pregnancy and childbirth in women with metabolic syndrome. Cand. med. sci. diss. Synopsis]. Moscow, 2004. 56. Sokolov E.I., Manukhin I.B., Mochalov A.A., Nevzorov O.B. Hemostatic disorders and their correction in women with metabolic syndrome. Lechashchiy vrach, 2011, no. 3, pp. 43-47. (in Russ.). 57. Nikolaeva-Ball D.R., Kan N.I. The state of adaptive mechanisms of women with metabolic syndrome and gestosis in the third term of pregnancy. Biomeditsinskiy zhurnal, 2012, vol. 13, pp. 803-818. Available at: http://www.medline.ru/public/art/tom13/art67.html. (in Russ.). 58. Kuz’mina-Krutetskaya S.R., Repina M.A. Metabolicheskiy sindrom u zhenshchin [The metabolic syndrome in women]. St. Petersburg, N-L Publ., 2011. 76 p. 59. Chernukha E.A., Chernukha G.E. Management of pregnancy and childbirth in women with obesity. Akusherstvo i ginekologiya, 1992, no. 1, pp. 68-73. (in Russ.). 60. Makarov I.O., Shilov E.M., Petunina N.A., Borovkova E.I., Shemanaeva T.V., Bayramova M.A. The course of pregnancy, labor, and postpartum in women with metabolic syndrome. Rossiyskiy vestnik akushera-ginekologa, 2012, vol. 12, no. 3, pp. 36-41. (in Russ.). 61. Burumkulova F.F., Petrukhin V.A., Kovalenko T.S., Titova T.V., Golovchenko M.A. Gestational diabetes – an interdisciplinary problem. Mat. X yubileyn.Vseross. nauch. foruma “Mat’ i Ditya” [Proc. 10th Jubilee All-Russ. Sci. Forum “Mother and Child”]. Moscow, “MEDI Ekspo” Publ., 2009, pp. 30-31. 62. Gorokhova L.G. Dinamika obmena uglevodov i lipidov v sisteme mat’-plod-novorozhdennyy pri ozhirenii u zhenshchin. Kand. biol. nauk. diss. Avtoref. [Dynamics of carbohydrate and lipids exchange in the system mother-fetus-newborn in women with obesity. Cand. biol. sci. diss. Synopsis]. Irkutsk, 1995. 19 p. 63. Erchenko E.N. Patofiziologicheskie osobennosti uglevodnogo i lipidnogo obmenov i sostoyanie novorozhdennykh u beremennykh s izbytochnoy massoy tela i ozhireniem. Kand. med. nauk. diss. Avtoref. [Pathophysiological features of carbohydrate and lipid metabolism, and newborns status in pregnant women with overweight and obesity. Cand. med. sci. diss. Synopsis]. Moscow, 2009. 28 p. 64. Perederyaeva E.B. Osnovnye printsipy vedeniya beremennosti i bezopasnogo rodorazresheniya u zhenshchin s metabolicheskim sindromom. Kand. med. nauk. diss. Avtoref. [Basic principles of pregnancy management and safe delivery in women with metabolic syndrome. Cand. med. sci. diss. Synopsis]. Moscow, 2006. 24 p. 65. Perederyaeva E.B., Pshenichnikova T.B., Baymuradova S.M., Makatsariya A.D. Management of pregnancy and childbirth in patients with metabolic syndrome and thrombophilia. Vrach, 2006, no. 14, pp. 45-47. (in Russ.). 66. Pshenichnikova E.B., Pshenichnikova T.B., Makatsariya A.D. Role of thrombophilia in the development of obstetric diseases in females with metabolic syndrome. Akusherstvo i ginekologiya, 2006, no. 4, pp. 15-19. (in Russ.).

ÏÎÄÏÈÑÍÎÉ ÈÍÄÅÊÑ ÆÓÐÍÀËÀ «ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ»

 ÊÀÒÀËÎÃÅ «ÐÎÑÏÅ×ÀÒÜ» 37140  ÐÅÑÏÓÁËÈÊÀÍÑÊÎÌ ÊÀÒÀËÎÃÅ ÔÏÑ «ÒÀÒÀÐÑÒÀÍ ÏÎ×ÒÀÑÛ» 16848 ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

45



Ë.È. ÌÀËÜÖÅÂÀ1, Ý.Í. ÂÀÑÈËÜÅÂÀ2 Êàçàíñêàÿ ãîñóäàðñòâåííàÿ ìåäèöèíñêàÿ àêàäåìèÿ, 420012, ã. Êàçàíü, óë. Ìóøòàðè, ä. 11 2 Èíñòèòóò óñîâåðøåíñòâîâàíèÿ âðà÷åé ÌÇ Ð×, 428032, ã. ×åáîêñàðû, Êðàñíàÿ ïëîùàäü, ä. 3

1

  â ðåïðîäóêòèâíîì çäîðîâüå æåíùèíû Ìàëüöåâà Ëàðèñà Èâàíîâíà — äîêòîð ìåäèöèíñêèõ íàóê, ïðîôåññîð, çàâåäóþùàÿ êàôåäðîé àêóøåðñòâà è ãèíåêîëîãèè № 1, òåë. (843) 236-46-41, e-mail: laramalc@mail.ru1 Âàñèëüåâà Ýëüâèðà Íèêîëàåâíà — êàíäèäàò ìåäèöèíñêèõ íàóê, äîöåíò êàôåäðû àêóøåðñòâà è ãèíåêîëîãèè, òåë. +7-903-345-86-65, e-mail: elnikvas@mail.ru2                                                         

                                ­€                €   ­         €                   ‚         

                              €   

L.I. MALTSEVA1, E.N. VASILEVA2 Kazan State Medical Academy, 11 Mushtari St., Kazan, Russian Federation 420012 2 Postgraduate Medical Institute of the MH RCh, 3 Krasnaya Ploshchad, Cheboksary, Russian Federation 428032

1

New approaches to assessment of the role of vitamin D in reproductive health of women Maltseva L.I. — D. Med. Sc., Head of the Department of Obstetrics and Gynecology № 1, tel. (843) 236-46-41, e-mail: laramalc@mail.ru1 Vasileva E.N. — Cand. Med. Sc., Assistant professor of the Department of Obstetrics and Gynecology, tel. +7-903-345-86-65, e-mail: elnikvas@mail.ru2 ƒ„…†‡„ˆ‰Š‹Œ„ŠˆŒŽ„‘†‘‘’Œ„†…Š‰“„…””Š†•…”–„‘—‘„ˆŒ•˜‰„ˆ™…”ŠŒ†–‰„’š†‘Œ˜•†–‰„‘Š†‘Š‘ Œ†ˆŒŠ– ‡Š…†›’•„Œ‘Žˆ‰–’‡Š ‘…–Šˆ™…” ’œ›’ˆŠ‘ †˜…„‘‡ ‡˜•…„ž•Š‘Œ•Š–’‘„‘ ‰„†›Š…Š‘ ‡Šˆ…†•”Š†•…”ž–’›•Š‡‘Ÿ„™”žŠ–ŒŠˆ…†™Š’œ“’‡Šˆ’œ–Šž–’‰˜Œ…„šŠ†™Š†–Š‰Š‹Œ„Šˆ… „ˆš„…†‡„ˆ¡ž–Š™ˆ†ˆ…“’‡Šˆ†–Š†…ŠšŠˆ”„™”Š––„‘—’œ‰Š‹Œ„ŠˆŒŽ¢…„‘ž–’šŠ‰…”†…š„…†‡„ˆ‰Š‹Œ„ŠˆŒŽŒ†˜‘Š‘…”Š„ˆœŠ–…„•„…Ž†ˆ‰ †•‘’ †œœŠŒ…‘ …”Š ™Š‘…†…„’ˆ Œ’˜–‘Š †ˆ‰ ”Š†•…” ’œ ‰Š‘ŒŠˆ‰†ˆ…‘ ž–Šˆ†…†••Ž †ˆ‰ „ˆ œ˜…˜–Š  ƒ„…†‡„ˆ  ‰Š‹Œ„ŠˆŒŽ ‰˜–„ˆ™ ž–Š™ˆ†ˆŒŽ „‘ †‘‘’Œ„†…Š‰ “„…” ž–’›•Š‡‘ ’œ ž•†ŒŠˆ…†• „ˆ‘˜œ‹Œ„ŠˆŒŽ  –„‘— „ˆŒ–Š†‘Š ’œ Š‡Š–™ŠˆŒŽ Œ†Š‘†–Š†ˆ ‘ŠŒ…„’ˆ  ›„–…” ’œ Œ”„•‰–Šˆ “„…” •’“ ›’‰Ž “Š„™”… ™Š‘…†…„’ˆ†•‰„†›Š…Š‘ ž–Š‡†…˜–Š‰Š•„šŠ–Ž ž–ŠŠŒ•†‡ž‘„† „ˆŒ–Š†‘Š‰„ˆ£†‡‡†…’–Ž–Š‘ž’ˆ‘Š†ˆ‰Šˆ‰’…”Š•„†•‰Ž‘œ˜ˆŒ…„’ˆƒ„…†‡„ˆ ‰Š‹Œ„ŠˆŒŽ„ˆœŠ…˜‘‰ŠžŠˆ‰‘’ˆ…”ŠŒ’ˆ…Šˆ…’œ…”Š‡†…Š–ˆ†•š„…†‡„ˆ¤Š‰„Œ†‡Šˆ…’˜‘Œ’––ŠŒ…„’ˆ’œš„…†‡„ˆ‰Š‹Œ„ŠˆŒŽŒ†ˆ”†šŠ† ”˜™Š„‡ž†Œ…’ˆ…”Š”Š†•…”Œ†–Š‘…–†…Š™Ž„ˆ…”Šž–ŠšŠˆ…„’ˆ’œš†–„’˜‘‰„‘Š†‘Š‘  š„…†‡„ˆ‰Š‹Œ„ŠˆŒŽ –Šž–’‰˜Œ…„šŠ”Š†•…” ™Š‘…†…„’ˆŒ’˜–‘Š ž•†ŒŠˆ…†•„ˆ‘˜œ‹Œ„ŠˆŒŽ ž–ŠŠŒ•†‡ž‘„† ™Š‘…†…„’ˆ†•‰„†›Š…Š‘

                 

           

          

                 ­  €        ‚ ƒ„…    † ­ €         

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


46

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

                            ­€‚ƒ„… †          ‡ ˆ ‰Š…‹Œ                   Ž‘… ’  † Ž‘    ˆ       “    ”  •ˆ– Œ            —       ‡  ‰Š…‹  ˆ  ‰Š…‹ ‡  “       ˆ    

 ˆ            ˜   Ž‘     ”       ˆ    ˆ  ˆ ˆ ˆ                 Œ     ‹™™™ˆ     ˆ         ˆ   ˆ           ˆ  •‹– Œ  “ š  ›ˆ

   ”        ”œ              ˆ     ˆ  ˆ    ˆ  ˆ“ •žŸ–¡ †  

  ”      ” ”         •¢ˆ ™– £                 “    ”  ˆ”  ˆ          ˆ 

ˆ ˆ   ˆ    Œ  ” ”     ˆ    ˆ ˆ ”   ˆ ˆ “ ¡¤¥•ˆ– Œ            ¡      ˆ                      ”  ˆ   ˆ ‰Š…‹          ¦ Ž‘

“         ”      ˆ         ˆ 

 ˆ “  ˆ ”

‘7 (76) декабрь 2013 г.

   ”           §“         “ ”          ˆ        ¥                           — “

 ˆ ˆ“     “ˆ        ˆ    •‹– ¡          ˆ  ˆ  ”  ˆ        ¨“                 ‰Š… ¥               Œ       “     ‰Š…‹ˆ  “ †           ©  ™© … ”     ˜     ˆ      ”   •‹ž– §               ª ˆ            ˜        «    ˆ†  ‰Š…       ‰Š…         Œ      “ˆ  ˆ  

•«–     ”         ¦   ”           “ˆ      ” œ           ¬     †   ˜¡…    ”    ˆ        ”•– £      †           ‡   ‡        ‡     ˜       ˜¡   ”           Œ  ¢¢™             ˜¡…¦”˜¡ˆ  ˆ     ‰Š…‹ ”ˆ      ”      ¦ ‰Š…‹    ™ ©      «     ” ˜¡ˆ   ” 

©     ˜¡ •ƒ– „®¯°± ²³    ™™ƒ…  ˆ     ‰Š…‹      

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.          ­  €‚ƒ ‚„……  † ‡    ˆ††… ††„  ‰ˆ Š  ‹ ˆ      ‚    †…†ˆ‡  ‚    … …  ‡ƒ   Œ…„… „†„  …„  †„ ˆŽ†Ž†  ‘ † †   ’ ˆ  ­ Œ„  †Ž† Ž†   “”… …  ‘ ƒ   …ˆ     …   ‡ …”ˆ   †ˆ  • †ˆ   –—     ‚„ …ˆ „„  †‚  ˆ       †  …     † †  † –— ”  ˜ ‚†…†   † ‚       ˜ ‚†  † † ˆ „ ˆ‚Ž    †   …†……ˆŽ ™š›œžˆ

Ÿˆ †    ˆ ‚ ‚ …†   ¡ š ¢£¤¥  ‚ˆ†   ­   †  …  ‚ƒ  ‚†„ˆ… …†ˆ†‚„…†„„†   ­ Œ  † „ †† „ˆ    †…ˆ ˆ‡‚„‡ƒ„ˆ„‚ „ …   ¦  Œ  ‚      † … ƒ Ž†

Ÿ   Ž  †  §  ¨ž© ž”„ …„ †…   … ††  €¨¨ ‚ƒ  ª  ‚  †Ž†  ­ ˆ «  ‚ƒˆ  †  †ƒ ‡  ˆ ‚ƒ ‡   žž ˜¬  ˆ    ‚ † ‡   … ††ˆ   †  „” ­ ®ˆ† ¯  “°±¥²     žžŠ  … ­¨­†ƒ„‚ƒ®…ˆ†‚³« ‚ƒˆ  †  ¨žž”€žž ˜¬    †‡‚ƒˆ† ¨

47

Œ ˆ †  Ÿˆ        žž˜¬ ­³ … ˆ†‚ ‚ … … ‰  ¬‚ˆ       †… … ‚      ž« †† ‚ˆ  ‡     ††…  žˆ¨  ‹  †  „ ´ µ¶¡  ²·­ ž  –—¸“¹—¥¸ ²· ³    †   Œµ¶¡ ‚ƒ †   ­† ¨žž ˜¬ˆ žžž ˜¬  ¨žžž ˜¬    Œ  –—¸“¹—¥¸  † †† † žžž ˜¬  ¨žžž ˜¬º  Ÿ †  †„ ”…„  „ „ ˜‚ … ††   ·žˆ¨ˆ     ‚  … ††  ‚      …  † »žˆžžž    † †  ·žˆžžž   ¼    ‡  … ††ˆ †‡ƒ ¨žžž ˜¬    ª‚ †‚„   †Ž††     ’ žˆ‰­½  ´ž €‰” ž ½·žˆž ³

®     ­ ž‚ƒ„ „  Ž„ … †† †ˆ  ¨žžž ˜¬ Ž      „ ‚ƒ     ˆ † Ž   ‡ƒ     … ¨ž…º€  ¾ † †   ‚…ˆ  ‚        †‚ ‚„„…  ˆ †…  †…³ˆ‰

  ¾‘¿   †…†„ Àƒ‡† ”…†ˆ„’† ‚    † ‡ƒ ‚  …    ‚    †‚   …‡  ¾  † ¡Á¢³Â  ‚      ­  „ ¾‘¿  ¼   ­ž…º €ˆ³”  ¾‘¿†„„ Œ†‚  ‚     ­   ‡     Šˆ ­ž  Œ  …  ˆ      ­       † ¾‘¿ † ‡   ‚ƒˆ   ‚ …‡   †-

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


48

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

       

                             ­€‚€ƒ„„…   †‡ˆˆ‰Š   

            ‡‹  Œ   ‡‹†Ž‘Š‹’“           ‡   ǹȗȖȕȚȈȕȕȣȍ ȗȘȍȎȌȍȊȘȍȔȍȕȕȣȍȘȖȌȣ†”•Š –  — ˜           ”•™       

— š ›—        ™   “    —   “  œ  ˜™      š  š ™   ——ž‡”    š     ˜       “

    ‹‡ ™‘€Ÿ¡€¢£¤  —š‡‹†Ž‘Š         ”    

   ˜™   —  šš ˜—™       ˜    ”•¥  ˜™“      ˜  ˜™    š   “  š  š ™     ¦§¨™ ©ª«¬™ ˜”• ¥  ”•™                š  “  ™œš   ¥ ®‡‡   ¯„…Ÿ°‚ §­   ±  “   ™      ˜      “     • ”•  ˜  ˜  ™ “ ™ ˜² ˜˜   ™             ™      ‘„¢¢³¡¯´‹     ™   ȅDzǶ Ȑ ȗȍв     “ȘȍȕȖș ȥȔȉȘȐȖȕȖ™    œ    ¨  š˜   š       ™‡‹†Ž‘Š‡†‚µˆ™–®–™ ¶ˆ™ˆˆŠ·¸¹ 

     š    ‡‹†Ž‘Š—  ˜   ®± ™ º»·      ‡‹†Ž‘Š  —  ˜     º»·¨š ©  ǹȐȕȌȘȖȔ ȗȖȓȐȒȐșȚȖȏȕȣȝ ȧȐȟȕȐȒȖȊ †”»¼Š       

‘7 (76) декабрь 2013 г. œ  ˜        ˜  ˜ ·   —  š˜            ™ “

     

  ™ ¨  š  ™        š”»¼™ 

  š   

 —   ™    ™½¾™  š™    ºž   

  š        ½   ¿À   œ 

        ¥       

˜ ™   ˜ ˜ —  ”»¼™     ¥          ™ 

™  ™”»¼»                       š   ™ ˜—™ “    ¨™ ˜š — ·— œ                    “ š  © Á     ‡‹†Ž‘Š       š   ”»¼ †™Â™‰ ’Š™       “†‡ˆ™‡Â®™±’Š¥ ™  ™    ”»¼   œ —š–™® ½     ˜‡‹†Ž‘Š       ȘȈȒȈ Á   ™   ‡‹†Ž‘Š  ™‡‹†Ž‘Š‡  ˜ “ ™ ˜       ˜š™    ™  š       “œ   ǝǖ    

—š   ˜ ™  

˜   ™    ÄÅÃƱ™ ˜      Ç»   “ ™  œ    š  ˜ “  ”          —  š™        ˜  ˜   š™    ˜      ™  ™  —š      “     —   ¥   ™‡‹†·ÇŠ‡  •Ç»        ˜šÈ š  •Ç»   ‡‹†Ž‘Š‰™±ˆ   ”˜ ¨ —     ˜  †  ˜ “   ®‡‡ ˜ “  ®©®šŠ ™ ™™ ±’   ‡‹†·ÇŠ      ©É  ™  ‡‹†Ž‘Š  ‡ ’   “˜      ‰™±ˆ 

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

49

                            

    

     

     ­­ €‚        ƒ            „­…† ‡  ˆ‰ ‰Š  „‹

  

 Π          

 Ž … …   … ƒ ˆ ‘­‹ 

   …   ˆ’‹ ‡  … 

    “     ‰­‹  ”  Š        

   ˆˆ­­ €‚    „  ˆ­­ … Ž  …Œ     •–—˜™  Š  

 ˆ„ “      … ƒ  ”…  š  …   ›            ˆœ’­‘ˆœœ  ‰‰  ­­ 

Œ     ‘  …ƒ  …  ž     ­­­­‰„­­­

Œ   ˆœ­­­­­­… ‡ 

   

”    ƒ… … š Œ   Ÿ„œ ­¡ ‡  ”              … Ž

 ¢         šŒ

 ƒ       ƒ  ƒ

Œ ƒ£  ”      …      ›        Š    ”Š  Ž

 ”           „ Ž  ”¤¥Ž

    ”   ƒ … ƒ 

 Ž        Œ

      ”Š…            “ ”    Ž          Œ

 š…ƒ  ¦              ”     “    Œ     ”Š “ Ž

   ” Œ ”šŒ

 š…Ÿ ­¡  §   ƒ       Š 

        …Š   -

             ”                 “

 “¨          ©ª «‰­­€‚    “† Š “Š    ”    …     „  „­‘  …†        š   … “ ƒ    …             ˆ¬­­   ­­­ €‚ › Œ       ” 

Œ Œ

„ ‰­…†Ÿ‰¬œˆˆ¡  ‡   

  

 

   ­­­€‚†  ˆ‘ˆ‰     ƒ   Žšš ƒ    … Š   “  “Ÿ ˆ¡ ¨      ­­¬­­ ˆ‰­­€‚      ”        “Š  ®    š Œ              ƒ  …   Š ”     Œ…   “  …

  “   ƒ    … Š  “ ƒ  ”     ›    “   ƒ  “  “    

  Œ  š Œ       Š     Œ

     ƒ  ”    

    …

  “ “    ž  ”                „     

               “ Žšš      ¯       …     “    “    “  ƒ  Š“  ›        …    °     …    …   Ž        

           Š 

   … ‡                 “  

 “    “  ƒ      “    Š …  “  

±®‚²®² ˆ³´µ¶–™·¸¸¹¶¶ºº¶»™¼½º¾¿™—À¿˜Á¶Â»¿¶˜»Ã—˜Á¿˜¼ÄºÂ»¿¶˜»Ã ½˜™¹¶¶˜Á½»–¿˜¶—˜Áµ—–—»–¿˜¶¼Ã¼™¶À¼†·¸³´µ¶–™ōƹ—¿Ç¹††È¿½´ ¥¶¼ÉĖ¼Ê­­’Ê¤½´œËÊ·ˆˆ’‘ˆœ ½´¿»Ç̶͍̍Á¿»—´µ–½Î–¶¼¼Ï¾¿™—À¿˜Á¶Â»¿¶˜»Ã†͍̍½´¿»Ç†† ÉИδÑ̶ÁÊ­­’Ê¤½´„’Ë„Ê·‰‰‘¬ˆ „¿Î¹µ–¶¾—´¶˜»¶½º¾¿™—À¿˜¿˜¼ÄºÂ»¿¶˜»Ã¿˜Ò´—»Ç—˜ÁÓ¹¿™¶µ–¶Î˜—˜™ Ó½À¶˜–¶¼¿Á¿˜Î¿˜™¹¶˜½–™¹¶–˜Ř¿™¶Áƙ—™¶¼—˜Á™¹¶¿–˜¶½˜—™¶¼†ȽÁ˜—– ԍ̍Ÿ¶™—´¡††ÑÉꖍÊ­­’Ê¤½´ˆ„’ËÊ·  ’‘    ¤¿™—À¿˜  Á¶Â»¿¶˜»Ã —˜Á ¿˜¼ÄºÂ»¿¶˜»Ã ¿˜ µ–¶Î˜—˜™ Ó½À¶˜Ï — ´½˜Î¿™ÄÁ¿˜—´¼™ÄÁƤ³½´À¶¼Ÿ¶™—´¡††ȖÑÉꖍÊ­­œÊ¤½´ˆ­ ˉÊ·¬’‰‘¬¬ˆ ѽ¹˜¼½˜՗Θ¶–֍ԍÄ´¼¶Ã¸Ö¾¿™—À¿˜Á¶Â»¿¶˜»Ã—˜Á ¿˜¼ÄºÂ»¿¶˜»Ã¿¼»½ÀÀ½˜ÁĖ¿˜Îµ–¶Î˜—˜»Ã†ѽ¹˜¼½˜Ÿ¶™—´¡†† ³ÀÑ·¶–¿˜—™½´Ê­ˆˆÊ¤½´¬ËˆÊ·’‘ˆ ‰ԗµ¿´´½˜˜¶³¤¿™—À¿˜Á¶Â»¿¶˜»ÃÁĖ¿˜Îµ–¶Î˜—˜»ÃÀ—ÿÀµ—¿– À—™¶–˜—´—˜Áº¶™—´½Ä™»½À¶¼††̶Á¿»—´õ½™¹¶¼¶¼Ê­ˆ­Ê¤½´’  ˈÊ·’ˆ‘’ ’·–½»¶¶Á¿˜Î¼½º™¹¶–—˜Çº½–ÄÀ½˜¾¿™—À¿˜†ƍ³ԗ˜¹—À‘ɶÓ ¶™—´††ȖÑÉꖍÊ­ˆˆÊ¤½´ˆ­ËˆÊ·ˆ  ‘ˆ‰ ¬½´´¿¼ȍՍ³¼¼¶¼¼À¶˜™½ºÁ¿¶™—–þ¿™—À¿˜–¶×Ä¿–¶À¶˜™¼ÁĖ¿˜Î µ–¶Î˜—˜»Ã—˜Á´—»™—™¿½˜†ȍՍ½´´¿¼֍ԍ՗Θ¶–††³ÀэÖ´¿˜ÉꖍÊ ­­ Ê¤½´’œËÊ·’ˆ’‘’‰ œ—™™—ƍ³´º—¹—À̍—¾¿¶¼·¶™—´¾¿™—À¿˜Á¶Â»¿¶˜»Ã¿˜ µ–¶Î˜—˜™Ó½À¶˜º–½À—˜½˜‘ÐĖ½µ¶—˜¶™¹˜¿»À¿˜½–¿™Ãµ½µÄ´—™¿½˜Ê —˜¿˜™¶–¾¶˜™¿½˜—´¼™ÄÁÆ†Èѕϳ˜ؘ™¶–˜—™¿½˜—´ѽĖ˜—´½ºÒ¼™¶™–¿»¼ —˜Á•Ã˜—¶»½´½ÎÍÊ­­Ê¤½´ˆ­œË¬Ê·œ­‘œ­¬

ˆ­¶—˜¶Ã¥·¤¿™—À¿˜¿˜¹¶—´™¹—˜ÁÁ¿¼¶—¼¶†¥·¶—˜¶Ã†† Ö´¿˜Ñ³Àƽ»ɶµ¹–½´Ê­­¬Ê¤½´„ËÊ·ˆ„‘ˆ ˆ ˆˆ ¤¿™—À¿˜  Á¶Â»¿¶˜»Ã —˜Á µ–¶Î˜—˜»ÃÏ ͖½À µ–¶»½˜»¶µ™¿½˜ ™½ Ò¿–™¹†ƍÔ¶Ó¿¼¶™—´††̽´Éę–ͽ½Á¥¶¼Ê­ˆ­Ê¤½´ Ë¬Ê ·ˆ­œ‘ˆˆ­ ˆÍęĖ¶¹¶—´™¹¿Àµ´¿»—™¿½˜¼½ºµ–¶˜—™—´—˜Á¶—–´Ã´¿º¶¾¿™—À¿˜¼™—™Ä¼ †¥ÌÔÄ»—¼¶™—´††Éꖍ¥¶¾Ê­­¬Ê¤½´‰‰ËˆÊ·’ˆ­‘’­ ˆ„—´´½–—˜ȍ·ؘÙĶ˜»¶½º¾¿™—À¿˜Á¶Â»¿¶˜»Ã½˜º¶–™¿´¿™Ã—˜Á –¶µ–½ÁÄ»™¿¾¶—Ò¿´¿™Ã¿˜™¹¶º¶À—´¶–—™†ȍ·—´´½–—˜Í¶ÔÄ»—††э Éꖍʈœ¬­Ê¤½´ˆˆ­Ë¬Ê·ˆ’„‘ˆ¬­ ˆ  Ú½¾—»¼ ֍ƍ ¤¿™—À¿˜  ¿˜ ÁĖ¿˜Î µ–¶Î˜—˜»Ã —˜Á ´—»™—™¿½˜Ï À—™¶–˜—´º¶™—´—˜Á˜¶½˜—™—´½Ä™»½À¶¼º–½À¹ÄÀ—˜—˜Á—˜¿À—´¼™ÄÁ¿¶¼† ֍ƍÚ½¾—»¼††³ÀÑÖ´¿˜ÉꖍÊ­­¬Ê¤½´¬¬ËÊ·­Æ‘¬Æ ˆ̗™¶–˜—´¾¿™—À¿˜Á¶Â»¿¶˜»Ã¿˜»–¶—¼¶¼™¹¶–¿¼Ç½ºµ–¶‘¶»´—Àµ¼¿—† ȽÁ˜—–ԍ̍††ÑÖ´¿˜ИÁ½»–¿˜½´̶™—ҍÊ­­’Ê¤½´œ ËœÊ·„ˆ’‘„ ˆ‰³Ò˜½–À—´ˆ‘Á¿¹ÃÁ–½Ûþ¿™—À¿˜À¶™—Ò½´¿¼À¿˜µ–¶¶»´—Àµ¼¿—† ·³ÄÎļ™Ÿ¶™—´¡††³ÀÑÒ¼™¶™•Ã˜¶»½´ÊˆœœÊ¤½´ˆ‰‰Ë Ê ·ˆœ‘ˆœœ ˆ’¥½Ò¿˜¼½˜֍э³´—˜¿¼̍֍՗Θ¶–֍ԍ½´´¿¼ȍՍѽ¹˜¼½˜  ·´—¼À— ‘¹ÃÁ–½Ûþ¿™—À¿˜  ´¶¾¶´¼ ¿˜ ¶—–´Ã‘½˜¼¶™ ¼¶¾¶–¶ µ–¶¶»´—Àµ¼¿—†֍э¥½Ò¿˜¼½˜¶™—´††³À¶–¿»—˜ѽĖ˜—´½ºÒ¼™¶™–¿»¼ —˜Á•Ã˜¶»½´½ÎÍÊ­ˆ­Ê¤½´­„Ë Ê·„‰‰¶ˆ‘„‰‰¶‰ ˆ¬ ȗǶ– ³Ì —¶–¿ ƍ ֗À—–ν і ֍³ мµ¿˜½´— э³ ƙĶҶ ³Ì³˜¶¼™¶Á»—¼¶‘»½˜™–½´¼™ÄÁýºÀ¿Áζ¼™—™¿½˜¾¿™—À¿˜Á¶Â»¿¶˜»Ã —˜Á–¿¼Ç½º¼¶¾¶–¶µ–¶¶»´—Àµ¼¿—†³ÌȗǶ–Ÿ¶™—´¡††ÑÖ´¿˜ИÁ½»–¿˜½´ ̶™—ҍÊ­ˆ­Ê¤½´œËˆˆÊ·ˆ­‘ˆ­œ

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


50

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

19. Maternal vitamin D and fetal growth in early-onset severe preeclampsia / Robinson C.J. et al. //Am. J. Obstet. Gynecol. — 2011. — Vol. 204, № 6. — P. 556 e1-556 e4. 20. Hewison M. Vitamin D and the immune system: new perspectives on an old theme / M. Hewison // Endocrinol Metab Clin North Am. — 2010. — Vol. 39, № 2. — P. 365-379, table of contents. 21. Vitamin D and regulation of placental inflammation / N.Q. Liu [et al.] // J Immunol. — 2011. — Vol. 186, № 10. — P. 5968-5974. 22. First trimester vitamin D, vitamin D-binding protein, and subsequent preeclampsia / C.E. Powe [et al.] // Hypertension. — 2010. — Vol. 56, № 4. — P. 758-763. 23. Maternal vitamin D status in pregnancy and adverse pregnancy outcomes in a group at high risk for preeclampsia / A.W. Shand et al. // BJOG. — 2010. — Vol. 117, № 13. — P. 1593-1598. 24. Vitamin D supplementation and reduced risk of preeclampsia in nulliparous women / M. Haugen et al. // Epidemiology. — 2009. — Vol. 20, № 5. — P. 720-726. 25. Wagner C., McNeil R., Ebeling M. et al. Medical University of South Carolina, Charleston, SC, USA. Analysis of Two Randomized Vitamin D3 Supplementation Trials during Pregnancy: Health Characteristics and Outcomes. — 2012, Unpublished work. 26. Hollis B.W., Johnson D., Hulsey T.C. et al. Vitamin D supplementation during pregnancy: Double-blind, randomized clinical trial of safety and effectiveness // J. Bone Miner. Res. — 2011. — Vol. 26. — Р. 2341-2357. 27. Leffelaar E.R. Maternal early pregnancy vitamin D status in relation to fetal and neonatal growth: Results of the multi-ethnic Amsterdam Born Children and their Development cohort / E.R. Leffelaar, T.G.M. Vrijkotte, M. van Eijsden // B. J. Nutr. — 2010. — Vol. 104, № 1. — P. 108-117. 28. Maternal vitamin D status during pregnancy and child outcomes / C.R. Gale [et al.] // Eur J Clin Nutr. — 2008. — Vol. 62, № 1. — P. 68-77. 29. Maternal plasma 25-hydroxyvitamin D concentrations and the risk for gestational diabetes mellitus / C. Zhang et al. // PLoS One. — 2008. — Vol. 3, № 11. — art. No e3753.

30. First trimester maternal vitamin D status and risk of gestational diabetes (GDM): A nested case-control study / A.M. Baker [et al.] // Diabetes Metab. Res. Rev. — 2012. — Vol. 28, № 2. — P. 164-168. 31. Lau S.L., Gunton J.E., Athayde N.P., Byth K., Cheung Yu. Serum 25-hydroxyvitamin D and glycated hemoglobin levels in women with gestational diabetes mellitus // Med. J. Aust. — 2011. — Vol. 194, № 7. — Р. 334-337. 32. Association between vitamin D deficiency and primary cesarean section / A. Merewood et al. // J. Clin. Endocrinol. Metab. — 2009. — Vol. 94, № 3. — P. 940-945. 33. Hensel K.J., Randis T.M., Gelber S.E., Ratner A.J. Pregnancyspecific association of vitamin D deficiency and bacterial vaginosis // Am. J. Obstet. Gynecol. — 2011. — Vol. 204, № 1. — P. 41 e1-41 e9. 34. Bodnar L.M. The prevalence of preterm birth and season of conception / L.M. Bodnar, H.N. Simhan // Paediatr Perinat Epidemiol. — 2008. — Vol. 22, № 6. — P. 538-545. 35. Hollis B.W. Randomized controlled trials to determine the safety of vitamin D supplementation during pregnancy and lactation / B.W. Hollis, C.L. Wagner // Fourteenth workshop on vitamin D. — Brugee, Belgium, 2009. — P. 134. 36. Ozkan S., Jindal S., Greenseid K. et al. Replete vitamin В stores predict reproductive success following in vitro fertilization // Fertil Steril. — 2010. — Vol. 94, № 4. — Р. 1314-1319. 37. Role of vitamin D treatment in glucose metabolism in polycystic ovary syndrome / K. Kotsa [et al.] // Fertil Steril. — 2009. — Vol. 92, № 3. — P. 1053-1058. 38. Wehr E. Effect of vitamin D3 treatment on glucose metabolism and menstrual frequency in polycystic ovary syndrome women: A pilot study / E. Wehr, T.R. Pieber, B. Obermayer-Pietsch // J Endocrinol Invest. — 2011. — Vol. 34, № 10. — P. 757-763. 39. Hossein-Nezhad A., Holick M.F. Vitamin D for health: A global perspective // Mayo Clinic Proceedings. — June 2013. — Vol. 88, № 7. — P. 720-755. 40. Grundmann M., Versen-Höynck F. Vitamin D — roles in women's reproductive health? // Reproductive Biology and Endocrinology. — 2011. — Vol. 9. — art. No.146.

REFERENCES 1. Alpert P.T., Shaikh U. The effects of vitamin D deficiency and insufficiency on the endocrine and paracrine systems. Biological Research for Nursing, 2007, vol. 9, no. 2, pp. 117-129. DOI: 10.1177/1099800407308057. 2. Holick M.F. Medical progress: vitamin D deficiency. New England Journal of Medicine, 2007, vol. 357, no. 3, pp. 266-281. DOI: 10.1056/ NEJMra070553. 3. Bodnar L.M., Simhan H.N., Powers R.W., Frank M.P., Cooperstein E., Roberts J.M. High prevalence of vitamin D insufficiency in black and white pregnant women residing in the northern United States and their neonates. Journal of Nutrition, 2007, vol. 137, no. 2, pp. 447-452. 4. Holmes V.A., Barnes M.S., Alexander H.D., McFaul P., Wallace J.M.W. Vitamin D deficiency and insufficiency in pregnant women: A longitudinal study. British Journal of Nutrition, 2009, vol. 102, no. 6, pp. 876-881. DOI: 10.1017/S0007114509297236. 5. Johnson D.D., Wagner C.L., Hulsey T.C., Vitamin D deficiency and insufficiency is common during pregnancy. American Journal of Perinatology, 2011, vol. 28, no.1, pp. 7-12. DOI: 10.1055/s-0030-1262505. 6. Lapillonne A. Vitamin D deficiency during pregnancy may impair maternal and fetal outcomes. Medical Hypotheses, 2010, vol. 74, no. 1, pp. 71-75. DOI: 10.1016/j.mehy.2009.07.054. 7. Lanham-New S.A., Buttriss J.L., Miles L.M., et al. Proceedings of the rank forum on vitamin D. British Journal of Nutrition, 2011, vol. 105, no. 1, pp. 144-156. DOI: 10.1017/S0007114510002576. 8. Hollis B.W., Wagner C.L. Assessment of dietary vitamin D requirements during pregnancy and lactation. American Journal of Clinical Nutrition, 2004, vol. 79, no. 5, pp. 717-726. 9. Datta S., Alfaham M., Davies D.P., et al. Vitamin D deficiency in pregnant women from a non-European ethnic minority population – An interventional study. BJOG: An International Journal of Obstetrics and Gynaecology, 2002, vol. 109, no. 8, pp. 905-908. DOI: 10.1016/ S1470-0328(02)01171-0. 10. Heaney R.P. Vitamin D in health and disease. Clinical Journal of the American Society of Nephrology, 2008, vol. 3, no. 5, pp. 1535-1541. DOI: 10.2215/CJN.01160308. 11. Lewis S., Lucas R.M., Halliday J., Ponsonby A.-L. Vitamin D deficiency and pregnancy: From preconception to birth. Molecular Nutrition and Food Research, 2010, vol. 54, no. 8, pp. 1092-1102. DOI: 10.1002/mnfr.201000044. 12. Lucas R.M., Ponsonby A.-L., Pasco J.A., Morley R. Future health implications of prenatal and early-life vitamin D status. Nutrition Reviews, 2008, vol.66, no. 12, pp. 710-720. DOI: 10.1111/j.17534887.2008.00126.x. 13. Halloran B.P., Deluca H.F. Influence of vitamin D deficiency on fertility and reproductive ability in the female rat. Journal of Nutrition, 1980, vol. 110, no. 8, pp. 1573-1580. 14. Kovacs C.S. Vitamin D in during pregnancy and lactation: Maternal, fetal and neonatal outcomes from human and animal studies. American Journal of Clinical Nutrition, 2008, vol. 88, no. 2, pp. 520S-528S.

15. Bodnar L.M., Catov J.M., Simhan H.N. Maternal vitamin D deficiency increases the risk of preeclampsia. Journal of Clinical Endocrinology and Metabolism, 2007, vol. 92, no. 9, pp. 3517-3522. DOI: 10.1210/jc.2007-0718. 16. August P., Marcaccio B., Gertner J.M., et al. Abnormal 1,25-dihydroxyvitamin D metabolism in preeclampsia. American Journal of Obstetrics and Gynecology, 1992, vol. 166, no. 4, pp. 1295-1299. 17. Robinson C.J., Alanis M.C., Wagner C.L., Hollis B.W., Johnson D.D. Plasma 25-hydroxyvitamin D levels in early-onset severe preeclampsia. American Journal of Obstetrics and Gynecology, 2010, vol. 203, no. 4, pp. 366 e1-366 e6. DOI: 10.1016/j.ajog.2010.06.036. 18. Baker A.M., Haeri S., Camargo Jr., C.A., Espinola J.A., Stuebe A.M. A nested case-control study of midgestation vitamin D deficiency and risk of severe preeclampsia. Journal of Clinical Endocrinology and Metabolism, 2010, vol. 95, no. 11, pp. 5105-5109. DOI: 10.1210/jc.2010-0996. 19. Robinson C.J., Wagner C.L., Hollis B.W., Baatz J.E., Johnson D.D. Maternal vitamin D and fetal growth in early-onset severe preeclampsia. American Journal of Obstetrics and Gynecology, 2011, vol. 204, no. 6, pp. 556 e1-556 e4. DOI: 10.1016/j.ajog.2011.03.022 20. Hewison M. Vitamin D and the immune system: New perspectives on an old theme. Endocrinology and Metabolism Clinics of North America, 2010, vol. 39, no. 2, pp. 365-379. DOI: 10.1016/j.ecl.2010.02.010. 21. Liu N.Q., Kaplan A.T., Lagishetty V., et al. Vitamin D and the regulation of placental inflammation. Journal of Immunology, 2011, vol. 186, no. 10, pp. 5968-5974. DOI: 10.4049/jimmunol.1003332. 22. Powe C.E., Seely E.W., Rana S., et al. First trimester vitamin D, vitamin D binding protein, and subsequent preeclampsia. Hypertension, 2010, vol. 56, no. 4, pp. 758-763. DOI: 10.1161/ HYPERTENSIONAHA.110.158238. 23. Shand A.W., Nassar N., Von Dadelszen P., Innis S.M., Green T.J. Maternal vitamin D status in pregnancy and adverse pregnancy outcomes in a group at high risk for pre-eclampsia. BJOG: An International Journal of Obstetrics and Gynaecology, 2010, vol. 117, no. 13, pp. 1593-1598. DOI: 10.1111/j.1471-0528.2010.02742.x. 24. Haugen M., Brantsaeter A.L., Trogstad L., et al. Vitamin D supplementation and reduced risk of preeclampsia in nulliparous women. Epidemiology, 2009, vol. 20, no. 5, pp. 720-726. 25. Wagner C., McNeil R., Ebeling M. et al. Analysis of Two Randomized Vitamin D3 Supplementation Trials during Pregnancy: Health Characteristics and Outcomes. Medical University of South Carolina, Charleston, SC, USA. 2012. Unpublished work. 26. Hollis B.W., Johnson D., Hulsey T.C., et al. Vitamin D supplementation during pregnancy: Double-blind, randomized clinical trial of safety and effectiveness. Journal of Bone and Mineral Research, 2011, vol. 26, no. 10, pp. 2341-2357. DOI: 10.1002/jbmr.463. 27. Leffelaar E.R., Vrijkotte T.G.M., Van Eijsden M. Maternal early pregnancy vitamin D status in relation to fetal and neonatal growth: Results of the multi-ethnic Amsterdam Born Children and their Development cohort. British Journal of Nutrition, 2010, vol. 104, no. 1, pp. 108-117. DOI: 10.1017/S000711451000022X.

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г. 28. Gale C.R., Robinson S.M., Harvey N.C., et al. Maternal vitamin D status during pregnancy and child outcomes. European Journal of Clinical Nutrition, 2008, vol. 62, no. 1, pp. 68-77. DOI: 10.1038/sj.ejcn.1602680. 29. Zhang C., Qiu, C., Hu F.B., et al. Maternal plasma 25-hydroxyvitamin D concentrations and the risk for gestational diabetes mellitus. PLoS ONE, 2008, vol. 3, no. 11, art. no. e3753. DOI: 10.1371/journal.pone.0003753. 30. Baker A.M., Haeri S., Camargo C.A., Stuebe A.M., Boggess K.A. First-trimester maternal vitamin D status and risk of gestational diabetes (GDM): A nested case-control study. Diabetes/Metabolism Research and Reviews, 2012, vol. 28, no. 2, pp. 164-168. DOI: 10.1002/dmrr.1282. 31. Lau S.L., Gunton J.E., Athayde N.P., Byth K., Cheung Yu. Serum 25-hydroxyvitamin D and glycated hemoglobin levels in women with gestational diabetes mellitus. Medical Journal of Australia, 2011, vol. 194, no. 7, pp. 334-337. 32. Merewood A., Mehta S.D., Chen T.C., Bauchner H., Holick M.F. Association between vitamin D deficiency and primary cesarean section. Journal of Clinical Endocrinology and Metabolism, 2009, vol. 94, no. 3, pp. 940, 945. DOI: 10.1210/jc.2008-1217. 33. Hensel K.J., Randis T.M., Gelber S.E., Ratner A.J. Pregnancyspecific association of vitamin D deficiency and bacterial vaginosis. American Journal of Obstetrics and Gynecology, 2011, vol. 204, no. 1, pp. 41 e1-41 e9. DOI: 10.1016/j.ajog.2010.08.013.

51

34. Bodnar L.M., Simhan H.N. The prevalence of preterm birth and season of conception. Paediatric and Perinatal Epidemiology, 2008, vol. 22, no. 6, pp. 538-545. DOI: 10.1111/j.1365-3016.2008.00971.x. 35. Hollis B.W., Wagner C.L. Randomized controlled trials to determine the safety of vitamin D supplementation during pregnancy and lactation. Fourteenth workshop on vitamin D. Brugge, Belgium, Oct. 4-8, 2009, p. 134. 36. Ozkan S., Jindal S., Greenseid K., et al. Replete vitamin D stores predict reproductive success following in vitro fertilization. Fertility and Sterility, 2010, vol. 94, no. 4, pp. 1314-1319. DOI: 10.1016/ j.fertnstert.2009.05.019. 37. Kotsa K., Yavropoulou M.P., Anastasiou O., Yovos J.G. Role of vitamin D treatment in glucose metabolism in polycystic ovary syndrome. Fertility and Sterility, 2009, vol. 92, no. 3, pp. 1053-1058. DOI: 10.1016/j.fertnstert.2008.07.1757. 38. Wehr E., Pieber T.R., Obermayer-Pietsch B. Effect of vitamin D3 treatment on glucose metabolism and menstrual frequency in polycystic ovary syndrome women: A pilot study. Journal of Endocrinological Investigation, 2011, vol. 34, no. 10, pp. 757-763. DOI: 10.3275/7748. 39. Hossein-Nezhad A., Holick M.F. Vitamin D for health: A global perspective. Mayo Clinic Proceedings, 2013, vol. 88, no. 7, pp. 720-755. DOI: 10.1016/j.mayocp.2013.05.011. 40. Grundmann M., von Versen-Höynck F. Vitamin D – roles in women’s reproductive health? Reproductive Biology and Endocrinology, 2011, vol. 9, no. 2, art. no. 146. DOI: 10.1186/1477-7827-9-146.

ÍÎÂÎÅ Â ÌÅÄÈÖÈÍÅ. ÈÍÒÅÐÅÑÍÛÅ ÔÀÊÒÛ ÊÀËÎÐÈÉÍÎÅ ÏÈÒÀÍÈÅ ÌÀÒÅÐÈ ÂÎ ÂÐÅÌß ÁÅÐÅÌÅÍÍÎÑÒÈ ÌÎÆÅÒ ÏÎÂËÈßÒÜ ÍÀ ÐÀÇÂÈÒÈÅ ÌÎÇÃÀ ÌËÀÄÅÍÖÀ Âûñîêîêàëîðèéíàÿ äèåòà âî âðåìÿ áåðåìåííîñòè ìîæåò ïðèâåñòè ê èçìåíåíèÿì â ðàçâèòèè ìîçãà ìëàäåíöà, óñòàíîâèëè ó÷åíûå èç ÑØÀ. Ýòè èçìåíåíèÿ ìîãóò âûçâàòü ðàçâèòèå îæèðåíèÿ â áóäóùåì. Êàê îêàçàëîñü, ïèòàíèå ñ âûñîêèì ñîäåðæàíèåì æèðîâ âî âðåìÿ áåðåìåííîñòè ñâÿçàíî ñ èçìåíåíèÿìè â ãèïîòàëàìóñå ìûøåé — ÷àñòè ìîçãà, âàæíîé äëÿ ðåãóëèðîâàíèÿ îáìåíà âåùåñòâ â îðãàíèçìå. Æèâîòíûå áûëè ïîäâåðæåíû â áóäóùåì ïîâûøåííîìó ðèñêó ðàçâèòèÿ îæèðåíèÿ è äèàáåòà âòîðîãî òèïà ïî ñðàâíåíèþ ñ æèâîòíûìè, ÷üè ìàòåðè ïîëó÷àëè ïðàâèëüíîå ïèòàíèå. Ïîëó÷åííûå äàííûå îáúÿñíÿþò, ïî÷åìó äåòè ðîäèòåëåé, ñòðàäàþùèõ îæèðåíèåì, ÷àùå äðóãèõ ñòàëêèâàþòñÿ ñ èçáûòî÷íûì âåñîì â áóäóùåì. Ïèòàíèå âî âðåìÿ áåðåìåííîñòè èìååò áîëüøîå çíà÷åíèå äëÿ çäîðîâüÿ ðîæåíèöû è ðåáåíêà. Áîëåå òîãî, îíî èìååò äîëãîñðî÷íûå ïîñëåäñòâèÿ, êîòîðûå ïîâûøàþò âåðîÿòíîñòü ðàçâèòèÿ ñåðäå÷íî-ñîñóäèñòûõ çàáîëåâàíèé, îæèðåíèÿ, îñòåîïîðîçà è äàæå ðàêà. Ó÷åíûå íàñòîÿòåëüíî ñîâåòóþò æåíùèíàì âî âðåìÿ áåðåìåííîñòè íå óïîòðåáëÿòü ìíîãî ñïåöèé, îñîáåííî ñîëè è ñàõàðà. Âðåäíû äëÿ çäîðîâüÿ è ïðîäóêòû áûñòðîãî ïèòàíèÿ (õîò-äîãè èëè ãàìáóðãåðû). Ïàãóáíî âëèÿåò íà îðãàíèçì ñîäåðæàíèå â ïðîäóêòàõ àðîìàòèçàòîðîâ, êîíñåðâàíòîâ è ðàçëè÷íûõ êðàñèòåëåé èñêóññòâåííîãî ïðîèñõîæäåíèÿ. Òàêæå íå ðåêîìåíäóåòñÿ óïîòðåáëÿòü ñûðûå ïðîäóêòû, íåäîñòàòî÷íî ïðîâàðåííûå èëè ïðîæàðåííûå, áóäü òî ìÿñî, ÿéöà èëè ìîðåïðîäóêòû. Íå ñîâåòóþò ïîòðåáëÿòü ñûð ñ ïëåñåíüþ, íåïàñòåðèçîâàííîå ìîëîêî, à òàêæå ïðîäóêòû íåèçâåñòíîãî ïðîèñõîæäåíèÿ. Èç íàïèòêîâ ñòîèò îãðàíè÷èòü ïîòðåáëåíèå êðåïêîãî ÷àÿ èëè êîôå è, êîíå÷íî, àëêîãîëÿ. Ïî ìàòåðèàëàì Medical News2014 Today Ïî ìàòåðèàëàì Medical News Today, ôåâðàëü ã. Èñòî÷íèê: Medlinks.ru

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


52

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.



Ã.Î. ÊËÈÂËÅÍÄ, È.Â. ÊËÞ×ÀÐΠÊàçàíñêèé ãîñóäàðñòâåííûé ìåäèöèíñêèé óíèâåðñèòåò, 420012, ã. Êàçàíü, óë. Áóòëåðîâà, ä. 49

Ñîâðåìåííûé âçãëÿä íà ëå÷åíèå ìåòîòðåêñàòîì  Êëèâëåíä Ãóëüíàðà Îëåãîâíà — àñïèðàíò êàôåäðû àêóøåðñòâà è ãèíåêîëîãèè № 1, òåë. +7-904-764-09-87, e-mail: akridared@yahoo.com Êëþ÷àðîâ Èãîðü Âàëåðüåâè÷ — êàíäèäàò ìåäèöèíñêèõ íàóê, äîöåíò êàôåäðû àêóøåðñòâà è ãèíåêîëîãèè № 1, òåë. +7-917-28-244-74, e-mail: klyucharoff@yandex.ru      

                      

                      ­€€   

    

         ‚ƒ„      

 … †    ‡… ˆˆ†   

                         

  

G.O. KLIVLEND, I.V. KLYUCHAROV Kazan State Medical University, 49 Butlerova St., Kazan, Russian Federation 420012

Contemporary view on treatment of the early stage          Klivlend G.O. — post-graduate student of the department of obstetrics and gynecology № 1, òel. +7-904-764-09-87, e-mail: akridared@yahoo.com Klyucharov I.V. — Candidate of Medical Science, Assistant professor of the department of obstetrics and gynecology № 1, òel. +7-917-282-44-74, e-mail: klyucharoff@yandex.ru ‰Š‹ŒŽ‘‹’Œ“”’•Œ’–”Ž”—˜“™Ž—š››š”’›’Œ–’”—˜•Ž‹œšžš–˜šŸ‹œ’Ÿ’›Žž’Œ’•Œš¡‘—‹“¢’™˜™‹’›‹œ’‹Œ’Ž‹›’”‹šŸ£œ“—œ“”›Ž¤šŒ“‹˜šŸ —Ž™’™“™•Œš¢“¡’¡£“‹œŽ™‘Œ–“—ŽžŽ••ŒšŽ—œ¥”£Ž™ŸšŒ‹œ’¦Œ™‹‹“›’•‘§ž“™œ’¡Œ’•šŒ‹šŸ‹œ’‘™’šŸ›’‹œš‹Œ’ŠŽ‹’‹š‹Œ’Ž‹’Š‹ŒŽ‘‹’Œ“”’ •Œ’–”Ž”—˜¨œ’•ŒŽ—‹“—Žž’Š•’Œ“’”—’“”‹œ’‹Œ’Ž‹›’”‹šŸ’Š‹ŒŽ‘‹’Œ“”’•Œ’–”Ž”—˜£“‹œ›’‹œš‹Œ’ŠŽ‹’Žžžš£’¡‹Žž©“”–šŸ“‹™œ“–œ’Ÿ ¦—“’”—˜ Ž”¡ ™’—‘Œ“‹˜ ™‘§¤’—‹ ‹š ‹œ’ Ÿšžžš£“”– “”¡“—Ž‹“š”™ Ž”¡ Ž••ž“—Ž‹“š” —š”¡“‹“š”™ ªš£’¢’Œ “” «‘™™“Ž ‹œ’ •Œš•šŒ‹“š” šŸ ›’‹œš‹Œ’ŠŽ‹’ “” ‹œ’‹Œ’Ž‹›’”‹šŸ’Š‹ŒŽ‘‹’Œ“”’•Œ’–”Ž”—˜“™… †£œ“ž’š¢’Œ™’Ž™“‹“™… ˆˆ†¨œ’ŽŒ‹“—ž’¡’™—Œ“§’™‹œ’‘™’šŸ›’‹œš‹Œ’ŠŽ‹’‹š‹Œ’Ž‹ ’Š‹ŒŽ‘‹’Œ“”’•Œ’–”Ž”—˜‹œŽ‹œŽ¢’Ÿš‘”¡£“¡’Ž••ž“—Ž‹“š”Ž§ŒšŽ¡Ž”¡“™–“¢’”‹œ’Ž”Žž˜™“™šŸ‹œ’Œ’™‘ž‹™šŸ“‹™Ž••ž“—Ž‹“š”  ’Š‹ŒŽ‘‹’Œ“”’•Œ’–”Ž”—˜’ŽŒž˜™‹Ž–’”š”š•’ŒŽ‹“¢’›’¡“—Ž›’”‹Žž‹Œ’Ž‹›’”‹›’‹œš‹Œ’ŠŽ‹’

      

          

       ­€‚ƒ        „€… †               €ƒ      „‡… ˆ  ‰           -

            ‰             ‰   Š  

       ‹   ŒŽ ‰         ‘’‹“                € ”‡

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.                                                                ­€‚ƒ      „„…„†…„‡…              ……„‡† ˆ     ‰             Š   ˆ     ‰    Š   …    ‹Œ  Š Ž Š   ‘’“’”…     Š •–—      Œ ˜ …   ‹    …  …ƒ ˆ    ‹      … Œ—                    Š   …‹Œ—         …            …             Œ—  Š  …        …™„–  …         Ž…    Œ—  …     Œ   … 

”                  „„ ˆ  ‹   ‹ ‹—         …‹Œ—  Š  „ ‘          ‚Œ Œ ˜           š         š ‹        ›œžš     ‹      š             ‹ š      ‹    Œš           Œ      Ÿ    Œ ˜     ¡¢£ Ž † ˆ¤¥”š     … ›œž……†Ž… ¦§¨©”š      ª  „„  –       Œ     …‚   ‹   Ž¦«¬®™”‚   —       Ž¦§¨© •”… Œ ˜  Œ… Š    …  ‹   …     ‹   … 

…   …    

     …        ‹   …     …   …  ‹       Ÿ     Œ ˜    Ž…†¦«¬®¦§¨©”… -

53

   ›œž…       …  ‹    — …  ¡¢£Ž†¤‘¥ ”„…„ ¯ ——                  „„…„…„†˜°   ±…°  ±…°   ±…  ‹    ­         ¡¢£…          ‹  ¡¢£† ˆ¤¥– ‹    Ž ²               ›œž”    Ž … …”­      Œ      †¥   ˆ        ‹      Œ           Ž³  ™‡    ”„„…„†­             „„… „•… „ƒ Ÿ           Œ       ²       ‹ Œ—  ˜¡¢£  …  „†‡‹  ƒ  …      —‹ ¡¢£„†‡„†  ­      Œ              „ ¥  Ž„……†…ƒ”…Œ—  Š     …„¥ Ž……•…™”­      Š  Œ     ‰          †¥„  –Œ †   † •¥   „…„…„† ‘‹—‹  Š  …  —     …     ƒ…„ƒž         ´¡¢£  …  Š  …  Š Œ Žµ––  ”„†…„ƒ ­  Œ                 ‹  ´¡¢£       ƒ  •… „™…  ‹     „³   „•…„ƒ¯‹   … ¡¢£    ‹    …      „ƒ–     ‹  — … ´¡¢£    Œ   „ “               ¡µ  „³      … Œ      …  ´¡¢£…   …      … ²   …    ’ 

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


54

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

                                     ­€‚ƒ  „…†  ‡ ˆ     ‰        Š  ‹  Œ    Ž‘ ‰ ’ ‰      “         ”•   Š   ˆ  ‹ˆ‹ ­€‚ƒ   Œ ‰      ‹ˆ           ˆ         ˆ   – • —           ‹    ˆ      ‹ˆ ‹  ­€‚ƒ   €            ­€‚ƒ   ‘­     Ž    ­€‚ƒ‡    ˆ  ˆ         ˆ ’˜ „      ‹ ˆ  ‰         ˆ  ˆ ‰  ‘ “™ˆ˜  –   ˆ  ˆ‡šš ‹                   ‡šš     ›      ‰      ‹ˆ  ‹ ‡  „                  ”˜œ    ”  – ž           ˆ ‰ ˆ‰   ‹ˆ‰ ˆ ‹        • Ÿ         ‹   •“­     ›   ‹  “­–     ™             ˆ ‰ ˆ  ›ˆ                 ˆ  ˆ     ›     • ™‰           • ”•”„      ‰    €‚ƒ  ™       ‹    ˆ‰     ˆ        ‘˜       ‹  €‚ƒ   “ ¡¢£     ‹ˆ‹€‚ƒ “¡¢£ ‰   ˜•  Š‹   ‡šš         ‹      ™  ‡šš      ˆ       ‹   ›  —            ‹      ™  ‰  Œ      š      ‹       

‘7 (76) декабрь 2013 г.               ‘ ˜ ž    ‡šš  ¤ ˆ      ‰  “ ¡   š    ‹   ‹      ‡ ˆ  ‰  ƒ   ‡    ˆ   Ž˜­•ˆ’      › ˆ         ˆ‘•¥ ‹           ­ š   ¦     ‹        ‹       ‘­      “  ‹ˆ       ‹ ‰             •—  ‹     ‹    ˆ  š ›   €‚ƒ• §›        ‹     š ˆ  —™ŠŸ  ‹    ‰    ˆš  ˆ               ¨Š„…†     ˆ    • †­    ˆ   ›     ‹      ­˜ ‰   ˆ Œ‰ •˜  ©        ‹        ‹           ­  ˆ  ‰   ˆ        ‹     ™‰            ‹ š               ‰       Ž ‹   ‹ ‹ ‡ ‹’¦ ­  ˆ   ‹  ‰     ‹            ˜™  – ‹            ˜ ¥ ‹     ˆ    ‰     ˆ    ‡  ‡šš ‹     ‘ Ÿ   ‡         ˆ                – ¨    ˆ Œ‰ ˆ      ‹         ˆ   ˆ    ˜•   Ÿª« Ž     ˆ  ‹   ’  ‘˜–             

  ‰  Ž                  ‹     ‰ ’  ‰  •  —    › ‹         Ž‘•“˜•¬’• Š      ‰                  Ž ‘¬ ’ ˜˜ ˜‘ ¦           Ž   -

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


Ă?Ă?Ă&#x20AC;Ă&#x160;Ă&#x2019;Ă&#x2C6;Ă&#x2014;Ă&#x2026;Ă&#x2018;Ă&#x160;Ă&#x20AC;Ă&#x; Ă&#x152;Ă&#x2026;Ă&#x201E;Ă&#x2C6;Ă&#x2013;Ă&#x2C6;Ă?Ă&#x20AC;

â&#x20AC;&#x2DC;7 (76) докайŃ&#x20AC;Ń&#x152; 2013 Đł.

55

                                Â?   Â?Â?Â?        Â?      Â? ­Â&#x20AC;Â&#x201A;    Â&#x192;Â&#x192; Â&#x201E;Â&#x2026;Â&#x2020;   Â&#x2021;Â&#x2C6;   Â?     Â&#x2030;  Â&#x160;            

   Â&#x2039;     Â&#x2C6; Â&#x2021;Â&#x2021;Â&#x152;   Â&#x192;   Â&#x17D; Â?   Â&#x2018;Â&#x152;Â&#x2C6;Â&#x2019;Â&#x2039;Â&#x201C; Â&#x160;Â&#x201D;   Â&#x2030; Â?Â&#x160;  Â&#x2039;Â&#x201D;Â&#x201C;Â&#x2030; Â&#x2030; Â?       Â&#x201C;Â&#x201D;     Â?Â?Â?      Â&#x160;  Â?   Â?     Â&#x2039;Â&#x160;    Â&#x201D;Â&#x201C;Â&#x160; Â? Â&#x2C6;  Â&#x2021; Â&#x201E;      Â&#x160;Â&#x160;Â&#x2030;  Â&#x201D;

Đ&#x203A;иŃ&#x201A;ĐľŃ&#x20AC;Đ°Ń&#x201A;Ń&#x192;Ń&#x20AC;Đ° 1. Đ&#x201D;ивакОва Т.ĐĄ., ĐĄĐ°Ń&#x2021;ок ĐŽ.Đ?. Đ­ĐşŃ&#x201A;ОпиŃ&#x2021;ĐľŃ ĐşĐ°Ń? йоŃ&#x20AC;ĐľĐźĐľĐ˝Đ˝ĐžŃ Ń&#x201A;Ń&#x152; (Ń?Ń&#x201A;иОНОгиŃ?, Đ´Đ¸Đ°ĐłĐ˝ĐžŃ Ń&#x201A;ика, Ń ĐžĐ˛Ń&#x20AC;оПоннŃ&#x2039;Đľ ĐżŃ&#x20AC;ĐľĐ´Ń Ń&#x201A;авНониŃ? Đž Ń&#x2026;иŃ&#x20AC;Ń&#x192;Ń&#x20AC;гиŃ&#x2021;ĐľŃ ĐşĐžĐź и ПодикаПонŃ&#x201A;ОСнОП НоŃ&#x2021;онии) // Đ&#x2019;ĐľŃ Ń&#x201A;ник Đ&#x2019;Đ&#x201C;Đ&#x153;ĐŁ. â&#x20AC;&#x201D; 2004. â&#x20AC;&#x201D; Т. 3, â&#x201E;&#x2013; 2. â&#x20AC;&#x201D; ĐĄ. 5-12. 2. ĐĄŃ&#x201A;Ń&#x20AC;иМакОв Đ?.Đ?., Đ&#x201D;авŃ&#x2039;дОв Đ?.Đ&#x2DC;., ШаŃ&#x2026;НаПОва Đ&#x153;.Đ?., Đ&#x2018;оНОŃ&#x2020;ĐľŃ&#x20AC;кОвŃ&#x2020;ова Đ&#x203A;.Đ&#x201D;. Đ&#x2019;ноПаŃ&#x201A;ĐžŃ&#x2021;наŃ? йоŃ&#x20AC;ĐľĐźĐľĐ˝Đ˝ĐžŃ Ń&#x201A;Ń&#x152;. â&#x20AC;&#x201D; Đ&#x153;.: Đ&#x153;одиŃ&#x2020;ина, 2001. â&#x20AC;&#x201D; 215 Ń . 3. Tanaka T., Hayashi H., Kutsuzawa T., Fujimoto S., Ichinoe K. Treatment of interstitial ectopic pregnancy with methotrexate: report of a successful case // Fertility and Sterility. â&#x20AC;&#x201D; 1982. â&#x20AC;&#x201D; Vol. 37, â&#x201E;&#x2013; 6. â&#x20AC;&#x201D; P. 851-852. 4. Tang A., Baartz D., Khoo S.K. A medical management of interstitial ectopic pregnancy: A 5-year clinical study // Australian and New Zealand Journal of Obstetrics and Gynaecology. â&#x20AC;&#x201D; 2006. â&#x20AC;&#x201D; Vol. 46, â&#x201E;&#x2013; 2. â&#x20AC;&#x201D; P. 107-111. 5. Hoover K.W., Tao G., Kent C.K. Trends in the diagnosis and treatment of ectopic pregnancy in the United States // Obstetrics and Gynecology. â&#x20AC;&#x201D; 2010. â&#x20AC;&#x201D; Vol. 115, â&#x201E;&#x2013; 3. â&#x20AC;&#x201D; P. 495-502. 6. Lozeau A.M., Potter B. Diagnosis and management of ectopic pregnancy // American Family Physician. â&#x20AC;&#x201D; 2005. â&#x20AC;&#x201D; Vol. 72, â&#x201E;&#x2013; 9. â&#x20AC;&#x201D; P. 1707-1714. 7. Lecuru F., Bernard J.P., Mac-Cordick C., Boucaya V., Taurelle R. Methotrexate provides significant cost savings for the treatment of unruptured ectopic pregnancy // Clinical Drug Investigatin â&#x20AC;&#x201D; 1998. â&#x20AC;&#x201D; Vol. 15, â&#x201E;&#x2013; 5. â&#x20AC;&#x201D; P. 405-411. 8. Đ?Đ¸Ń Đ˛Đ°Đ˝Đ´ĐľŃ&#x20AC; Đ&#x161;., Đ­Đ˛Đ°Đ˝Ń Đ?. Đ?ĐşŃ&#x192;Ń&#x2C6;ĐľŃ&#x20AC;Ń Ń&#x201A;вО. ĐĄĐżŃ&#x20AC;авОŃ&#x2021;ник Đ&#x161;аНиŃ&#x201E;ĐžŃ&#x20AC;Đ˝Đ¸ĐšŃ ĐşĐžĐłĐž Ń&#x192;нивоŃ&#x20AC;Ń Đ¸Ń&#x201A;ĐľŃ&#x201A;Đ°. â&#x20AC;&#x201D; Đ&#x153;.: Đ&#x;Ń&#x20AC;Đ°ĐşŃ&#x201A;ика, 1999. â&#x20AC;&#x201D; 706 c. 9. Jermy K., Thomas J., Doo A., Bourne T. The conservative management of interstitial pregnancy // BJOG: An International Journal of Obstetrics and Gynaecology. â&#x20AC;&#x201D; 2004. â&#x20AC;&#x201D; Vol. 111, â&#x201E;&#x2013; 11. â&#x20AC;&#x201D; P. 1283-1288. 10. Ramakrishnan K., Scheid D.C. Ectopic pregnancy: Expectant management or immediate surgery? An algorithm to improve outcomes // Journal of family practice. â&#x20AC;&#x201D; 2006. â&#x20AC;&#x201D; Vol. 55, â&#x201E;&#x2013;. 6. â&#x20AC;&#x201D; P. 517-522. 11. Murray H., Baakdah H., Bardell T., Tulandi T. Diagnosis and treatment of ectopic pregnancy // Canadian Medical Association Journal. â&#x20AC;&#x201D; 2005. â&#x20AC;&#x201D; Vol. 173, â&#x201E;&#x2013; 8. â&#x20AC;&#x201D; P. 905-912. 12. Medical management of ectopic pregnancy // Obstetrics and Gynaecology. â&#x20AC;&#x201D; 2008. â&#x20AC;&#x201D; Vol. 111, â&#x201E;&#x2013; 6. â&#x20AC;&#x201D; P. 1479-1485. 13. Tenore J.L. Ectopic Pregnancy // American Family Physician. â&#x20AC;&#x201D; 2000. â&#x20AC;&#x201D; Vol. 61, â&#x201E;&#x2013; 4. â&#x20AC;&#x201D; P. 1080-1088. 14. Medical treatment of ectopic pregnancy // Fertility and Sterility. â&#x20AC;&#x201D; 2008. â&#x20AC;&#x201D; Vol. 90, â&#x201E;&#x2013; 5 (suppl.) â&#x20AC;&#x201D; S.206-212. 15. Barnhart K.T. Clinical practice. Ectopic pregnancy // The New England Journal Of Medicine. â&#x20AC;&#x201D; 2009. â&#x20AC;&#x201D; Vol. 361, â&#x201E;&#x2013; 4. â&#x20AC;&#x201D; P. 379-387. 16. Lipscomb G.H., Stovall T.G.., Ling F.W. Primary care: Nonsurgical treatment of ectopic pregnancy // The New England Journal Of Medicine. â&#x20AC;&#x201D; 2000. â&#x20AC;&#x201D; Vol. 343, â&#x201E;&#x2013; 18. â&#x20AC;&#x201D; P. 1325-1329. 17. Nama V., Manyonda I. Tubal ectopic pregnancy: diagnosis and management // Arch. Gynecol. Obstet. â&#x20AC;&#x201D; 2009. â&#x20AC;&#x201D; Vol. 279, â&#x201E;&#x2013; 4. â&#x20AC;&#x201D; P. 443-453. 18. Olofsson J.I., Poromaa I.S., Ottander U., Kjellberg L., Damber M.G.. Clinical and pregnancy outcome following ectopic pregnancy; a prospective study comparing expectancy, surgery and systemic methotrexate treatment // Acta Obstet. Gynecol. Scand. â&#x20AC;&#x201D; 2001. â&#x20AC;&#x201D; Vol. 80, â&#x201E;&#x2013; 8. â&#x20AC;&#x201D; P. 744-749. 19. Fernandez H., Lelaidier C., Thouvenez V., Frydman R. The use of a pretherapeutic, predictive score to determine inclusion criteria for the non-surgical management of ectopic pregnancy // Human Reproduction â&#x20AC;&#x201D; 1991. â&#x20AC;&#x201D; Vol. 6, â&#x201E;&#x2013; 7. â&#x20AC;&#x201D; P. 995-998. 20. Elito J. Jr., Reichmann A.P., Uchiyama M.N., Camano L. Predictive score for the systemic treatment of unruptured ectopic pregnancy with

a single dose of methotrexate // International Journal of Gynecology and Obstetrics. â&#x20AC;&#x201D; 1999. â&#x20AC;&#x201D; Vol. 67, â&#x201E;&#x2013; 2. â&#x20AC;&#x201D; P. 75-79. 21. Min H.M., Young H.L., Kyung T.L., Jae H.Y., Seong H.P. Outcome prediction for treatment of tubal pregnancy using an intramuscular methotrexate protocol // Journal of Ultrasound in Medicine. â&#x20AC;&#x201D; 2008. â&#x20AC;&#x201D; Vol. 27, â&#x201E;&#x2013; 10. â&#x20AC;&#x201D; P. 1461-1467. 22. Nazac A., Gervaise A., Bouyer J., de Tayrac R., Capella-Allouc S., Fernandez H. Predictors of success in methotrexate treatment of women with unruptured tubal pregnancies // Ultrasound Obstet Gynecol. â&#x20AC;&#x201D; 2003. â&#x20AC;&#x201D; Vol. 21, â&#x201E;&#x2013; 2. â&#x20AC;&#x201D; P. 181-185. 23. Nguyen Q., Kapitz M., Downes K., Silva C. Are early human chorionic gonadotropin levels after methotrexate therapy a predictor of response in ectopic pregnancy? // Am J Obstet Gynecol. â&#x20AC;&#x201D; 2010. â&#x20AC;&#x201D; Vol. 202, â&#x201E;&#x2013; 6. â&#x20AC;&#x201D; P. 630e1-630e5. 24. Hajenius P.J., Engelsbel S., Mol B.W., Van der Veen F., Ankum W.M., Bossuyt P.M., Hemrika D.J., Lammes F.B. Randomised trial of systemic methotrexate versus laparoscopic salpingostomy in tubal pregnancy // Lancet. â&#x20AC;&#x201D; 1997. â&#x20AC;&#x201D; Vol. 350, â&#x201E;&#x2013; 9080. â&#x20AC;&#x201D; P. 774-779. 25. Lehner R., Kucera E., Jirecek S., Egarter C., Husslein P. Ectopic pregnancy // Arch. Gynecol. Obstet. â&#x20AC;&#x201D; 2000. â&#x20AC;&#x201D; Vol. 263, â&#x201E;&#x2013; 3. â&#x20AC;&#x201D; P. 87-92. 26. Barnhart K.T., Gosman G., Ashby R., Sammel M. The medical management of ectopic pregnancy: a meta-analysis comparing ÂŤsingle doseÂť and ÂŤmultidoseÂť regimens // Obstetrics and Gynecology. â&#x20AC;&#x201D; 2003. â&#x20AC;&#x201D; Vol. 101, â&#x201E;&#x2013; 4. â&#x20AC;&#x201D; P. 778-784. 27. Hajenius P.J., Mol F., Mol B.W., Bossuyt P.M., Ankum W.M., Van der Veen F. Interventions for tubal ectopic pregnancy // Cochrane database of systematic reviews (Online). â&#x20AC;&#x201D; 2007. â&#x20AC;&#x201D; V.1:CD000324. 28. Alshimmiri M.M., Al-Saleh E.A., Al-Harmi J.A., AlSalili M.B., Al Adwani A., Ibrahim M.E. Treatment of ectopic pregnancy with a single intramuscular dose of methotrexate // Arch Gynecol Obstet. â&#x20AC;&#x201D; 2003. â&#x20AC;&#x201D; Vol. 268, â&#x201E;&#x2013; 3. â&#x20AC;&#x201D; P.181-183. 29. Erdem M., Erdem A., Arslan M., Oc A., Biberoglu K., Gursoy R. Single-dose methotrexate for the treatment of unruptured ectopic pregnancy // Arch Gynecol Obstet. â&#x20AC;&#x201D; 2004. â&#x20AC;&#x201D; Vol. 270, â&#x201E;&#x2013; 4. â&#x20AC;&#x201D; P. 201-204. 30. Nieuwkerk P.T., Hajenius P.J., Ankum W.M., Van der Veen F., Wijker W., Bossuyt P.M. Systemic methotrexate therapy versus laparoscopic salpingostomy in patients with tubal pregnancy. Part I. Impact on patientsâ&#x20AC;&#x2122; health-related quality of life // Fertil Steril. â&#x20AC;&#x201D; 1998. â&#x20AC;&#x201D; Vol. 70, â&#x201E;&#x2013; 3. â&#x20AC;&#x201D; P. 511-517. 31. Overton C. Prompt diagnosis vital in ectopic pregnancy // The Practitioner. â&#x20AC;&#x201D; 2008. â&#x20AC;&#x201D; Vol. 252, â&#x201E;&#x2013; 1704. â&#x20AC;&#x201D; P. 32-36. 32. Nieuwkerk P.T., Hajenius P.J., Ankum W.M., Van der Veen F., Wijker W., Bossuyt P.M. Systemic methotrexate therapy versus laparoscopic salpingostomy in patients with tubal pregnancy. Part II. Patient preferences for systemic methotrexate // Fertil Steril. â&#x20AC;&#x201D; 1998. â&#x20AC;&#x201D; Vol. 70, â&#x201E;&#x2013; 3. â&#x20AC;&#x201D; P. 518-22. 33. Yao M., Tulandi T., Kaplow M., Smith A.P. A comparison of methotrexate versus laparoscopic surgery for the treatment of ectopic pregnancy: a cost analysis // Hum Reprod. â&#x20AC;&#x201D; 1996. â&#x20AC;&#x201D; Vol. 11, â&#x201E;&#x2013; 12. â&#x20AC;&#x201D; P. 2762-2766. 34. Alexander J.M., Rouse D.J., Varner E., Austin J.M. Jr. Treatment of the small unruptured ectopic pregnancy: a cost analysis of methotrexate versus laparoscopy // Obstet Gynecol. â&#x20AC;&#x201D; 1996. â&#x20AC;&#x201D; Vol. 88, â&#x201E;&#x2013; 1. â&#x20AC;&#x201D; P. 123-127. 35. Krag Moeller L.B., Moeller C., Thomsen S.G., Andersen L.F. et all. Success and spontaneous pregnancy rates following systemic methotrexate versus laparoscopic surgery for tubal pregnancies: A randomized trial // Acta Obstet Gynecol Scand. â&#x20AC;&#x201D; 2009. â&#x20AC;&#x201D; Vol. 88, â&#x201E;&#x2013; 12. â&#x20AC;&#x201D; P. 1331-1337.

REFERENCES 1. Divakova T.S., Sachek Yu.A. Ectopic pregnancy (Etiology, diagnosis, modern concepts of surgical and medical treatment). Vestnik Vitebskogo gosudarstvennogo meditsinskogo universiteta [Bulletin of Vitebsk State Medical University], 2004, vol. 3, no. 2, pp. 5-12. (in Russ.). 2. Strizhakov A.N., Davydov A.I., Shakhlamova M.N., Belotserkovtseva L.D. Vnematochnaya beremennostâ&#x20AC;&#x2122; [Ectopic pregnancy]. Moscow, Meditsina Publ., 2001. 215 p. 3. Tanaka T., Hayashi H., Kutsuzawa T., Fujimoto S., Ichinoe K. Treatment of interstitial ectopic pregnancy with methotrexate: Report of a successful case. Fertility and Sterility, 1982, vol. 37, no. 6, pp. 851-852.

4. Tang A., Baartz D., Khoo S.K. A medical management of interstitial ectopic pregnancy: A 5-year clinical study. Australian and New Zealand Journal of Obstetrics and Gynaecology, 2006, vol. 46, no. 2, pp. 107-111. DOI: 10.1111/j.1479-828X.2006.00537.x. 5. Hoover K.W., Tao G., Kent C.K. Trends in the diagnosis and treatment of ectopic pregnancy in the United States. Obstetrics and Gynecology, 2010, vol. 115, no. 3, pp. 495-502. DOI: 10.1097/ AOG.0b013e3181d0c328. 6. Lozeau A.M., Potter B. Diagnosis and management of ectopic pregnancy. American Family Physician, 2005, vol. 72, no. 9, pp. 1707-1714.

Ă&#x20AC;Ă&#x160;Ă&#x201C;Ă&#x2DC;Ă&#x2026;Ă?Ă&#x2018;Ă&#x2019;Ă&#x201A;Ă&#x17D;. Ă&#x192;Ă&#x2C6;Ă?Ă&#x2026;Ă&#x160;Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;. Ă?Ă?Ă&#x201E;Ă&#x17D;Ă&#x160;Ă?Ă&#x2C6;Ă?Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;


56

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

7. Lecuru F., Bernard J.P., Mac-Cordick C., Boucaya V., Taurelle R. Methotrexate provides significant cost savings for the treatment of unruptured ectopic pregnancy. Clinical Drug Investigation, 1998, vol. 15, no. 5, pp. 405-411. 8. Evans A.T., Niswander K.R. Manual of obstetrics. Philadelphia, Lippincott Williams & Wilkins Publ., 1995. 560 p. (Russ. ed.: Nisvander K., Evans A. Akusherstvo. Spravochnik Kaliforniyskogo universiteta. Moscow, Praktika Publ., 1999. 706 p.). 9. Jermy K., Thomas J., Doo A., Bourne T. The conservative management of interstitial pregnancy. BJOG: An International Journal of Obstetrics and Gynaecology, 2004, vol. 111, no. 11, pp. 1283-1288. DOI: 10.1111/j.1471-0528.2004.00442.x. 10. Ramakrishnan K., Scheid D.C. Ectopic pregnancy: Expectant management or immediate surgery? An algorithm to improve outcomes. Journal of Family Practice, 2006, vol. 55, no. 6, pp. 517-522. 11. Murray H., Baakdah H., Bardell T., Tulandi T. Diagnosis and treatment of ectopic pregnancy. CMAJ: Canadian Medical Association Journal, 2005, vol. 173, no. 8, pp. 905-912. DOI: 10.1503/ cmaj.050222. 12. Medical management of ectopic pregnancy. Obstetrics and Gynecology, 2008, vol. 111, no. 6, pp. 1479-1485. DOI: 10.1097/ AOG.0b013e31817d201e. 13. Tenore J.L. Ectopic pregnancy. American Family Physician, 2000, vol. 61, no. 4, pp. 1080-1088. 14. Medical treatment of ectopic pregnancy. Fertility and Sterility, 2008, vol. 90, no. 5 (suppl.), pp. S206-S212. DOI: 10.1016/j.fertnstert.2008.08.049. 15. Barnhart K.T. Clinical practice. Ectopic pregnancy. New England Journal of Medicine, 2009, vol. 361, no. 4, pp. 379-387+334. DOI: 10.1056/NEJMcp0810384. 16. Lipscomb G.H., Stovall T.G.., Ling F.W. Primary care: Nonsurgical treatment of ectopic pregnancy. New England Journal of Medicine, 2000, vol. 343, no. 18, pp. 1325-1329. DOI: 10.1056/ NEJM200011023431807. 17. Nama V., Manyonda I. Tubal ectopic pregnancy: Diagnosis and management. Archives of Gynecology and Obstetrics, 2009, vol. 279, no. 4, pp. 443-453. DOI: 10.1007/s00404-008-0731-3. 18. Olofsson J.I., Poromaa I.S., Ottander U., Kjellberg L., Damber M.G.. Clinical and pregnancy outcome following ectopic pregnancy; a prospective study comparing expectancy, surgery and systemic methotrexate treatment. Acta Obstetricia et Gynecologica Scandinavica, 2001, vol. 80, no. 8, pp. 744-749. DOI: 10.1034/j.1600-0412.2001.080008744.x. 19. Fernandez H., Lelaidier C., Thouvenez V., Frydman R. The use of a pretherapeutic, predictive score to determine inclusion criteria for the non-surgical management of ectopic pregnancy. Human Reproduction, 1991, vol. 6, no. 7, pp. 995-998. 20. Elito J. Jr., Reichmann A.P., Uchiyama M.N., Camano L. Predictive score for the systemic treatment of unruptured ectopic pregnancy with a single dose of methotrexate. International Journal of Gynecology and Obstetrics, 1999, vol. 67, no. 2, pp. 75-80. DOI: 10.1016/S0020-7292(99)00114-9. 21. Min H.M., Young H.L., Kyung T.L., Jae H.Y., Seong H.P. Outcome prediction for treatment of tubal pregnancy using an intramuscular methotrexate protocol. Journal of Ultrasound in Medicine, 2008, vol. 27, no. 10, pp. 1461-1467. 22. Nazac A., Gervaise A., Bouyer J., de Tayrac R., Capella-Allouc S., Fernandez H. Predictors of success in methotrexate treatment of women with unruptured tubal pregnancies. Ultrasound in Obstetrics and Gynecology, 2003, vol. 21, no. 2, pp. 181-185. DOI: 10.1002/uog.9.

‘7 (76) декабрь 2013 г. 23. Nguyen Q., Kapitz M., Downes K., Silva C. Are early human chorionic gonadotropin levels after methotrexate therapy a predictor of response in ectopic pregnancy? American Journal of Obstetrics and Gynecology, 2010, vol. 202, no. 6, pp. 630e1-630e5. DOI: 10.1016/ j.ajog.2010.03.022. 24. Hajenius P.J., Engelsbel S., Mol B.W., Van der Veen F., Ankum W.M., Bossuyt P.M., Hemrika D.J., Lammes F.B. Randomised trial of systemic methotrexate versus laparoscopic salpingostomy in tubal pregnancy. The Lancet, 1997, vol. 350, no. 9080, pp. 774-779. DOI: 10.1016/S0140-6736(97)05487-1. 25. Lehner R., Kucera E., Jirecek S., Egarter C., Husslein P. Ectopic pregnancy. Archives of Gynecology and Obstetrics, 2000, vol. 263, no. 3, pp. 87-92. 26. Barnhart K.T., Gosman G., Ashby R., Sammel M. The medical management of ectopic pregnancy: A meta-analysis comparing “single dose” and “multidose” regimens. Obstetrics and Gynecology, 2003, vol. 101, no. 4, pp. 778-784. DOI: 10.1016/S0029-7844(02)03158-7. 27. Hajenius P.J., Mol F., Mol B.W., Bossuyt P.M., Ankum W.M., Van der Veen F. Interventions for tubal ectopic pregnancy. Cochrane Database of Systematic Reviews (Online), 2007, no. 1, pp. CD000324. 28. Alshimmiri M.M., Al-Saleh E.A., Al-Harmi J.A., AlSalili M.B., Al Adwani A., Ibrahim M.E. Treatment of ectopic pregnancy with a single intramuscular dose of methotrexate. Archives of Gynecology and Obstetrics, 2003, vol. 268, no. 3, pp.181-183. DOI: 10.1007/s00404-002-0357-9. 29. Erdem M., Erdem A., Arslan M., Oc A., Biberoglu K., Gursoy R. Single-dose methotrexate for the treatment of unruptured ectopic pregnancy. Archives of Gynecology and Obstetrics, 2004, vol. 270, no. 4, pp. 201-204. 30. Nieuwkerk P.T., Hajenius P.J., Ankum W.M., Van der Veen F., Wijker W., Bossuyt P.M.M. Systemic methotrexate therapy versus laparoscopic salpingostomy in patients with tubal pregnancy. Part I. Impact on patients’ health-related quality of life. Fertility and Sterility, 1998, vol. 70, no. 3, pp. 511-517. DOI: 10.1016/S00150282(98)00212-X. 31. Overton C. Prompt diagnosis vital in ectopic pregnancy. The Practitioner, 2008, vol. 252, no. 1704, pp. 32-36. 32. Nieuwkerk P.T., Hajenius P.J., Ankum W.M., Van der Veen F., Wijker W., Bossuyt P.M. Systemic methotrexate therapy versus laparoscopic salpingostomy in patients with tubal pregnancy. Part II. Patient preferences for systemic methotrexate. Fertility and Sterility, 1998, vol. 70, no. 3, pp. 518-522. DOI: 10.1016/S00150282(98)00213-1. 33. Yao M., Tulandi T., Kaplow M., Smith A.P. A comparison of methotrexate versus laparoscopic surgery for the treatment of ectopic pregnancy: A cost analysis. Human Reproduction, 1996, vol. 11, no. 12, pp. 2762-2766. 34. Alexander J.M., Rouse D.J., Varner E., Austin J.M. Jr. Treatment of the small unruptured ectopic pregnancy: A cost analysis of methotrexate versus laparoscopy. Obstetrics and Gynecology, 1996, vol. 88, no. 1, pp. 123-127. DOI: 10.1016/0029-7844(96)00086-5. 35. Krag Moeller L.B., Moeller C., Thomsen S.G., Andersen L.F., Lundvall L., Lidegaard O., Kjer J.J., et al. Success and spontaneous pregnancy rates following systemic methotrexate versus laparoscopic surgery for tubal pregnancies: A randomized trial. Acta Obstetricia et Gynecologica Scandinavica, 2009, vol. 88, no. 12, pp. 1331-1337. DOI: 10.3109/00016340903188912.

ÍÎÂÎÅ Â ÌÅÄÈÖÈÍÅ. ÈÍÒÅÐÅÑÍÛÅ ÔÀÊÒÛ ÍÅÊÎÒÎÐÛÅ ÏÐÎÁÈÎÒÈÊÈ ÌÎÃÓÒ ÏÎÌÎ×Ü ÆÅÍÙÈÍÀÌ ÑÁÐÎÑÈÒÜ ÂÅÑ È ÑÎÕÐÀÍÈÒÜ ÐÅÇÓËÜÒÀÒ ÄÎËÃÎÅ ÂÐÅÌß Ðàíåå áûëî äîêàçàíî, ÷òî ìèêðîôëîðà êèøå÷íèêà òó÷íûõ ëþäåé îòëè÷àåòñÿ îò ìèêðîôëîðû áîëåå ñòðîéíûõ Ðàíåå áûëî äîêàçàíî, ÷òî ìèêðîôëîðà êèøå÷íèêà òó÷íûõ ëþäåé îòëè÷àåòñÿ îò ìèêðîôëîðû áîëåå ðåøèëè èíäèâèäîâ. Ïðè÷èíà ïðîñòà: ñîñòàâ áàêòåðèé ìåíÿåòñÿ â çàâèñèìîñòè îò ñîñòàâà ðàöèîíà. Ó÷åíûå ñòðîéíûõ èíäèâèäîâ. Ïðè÷èíà ïðîñòà: ñîñòàâ áàêòåðèé ìåíÿåòñÿ â çàâèñèìîñòè îò ñîñòàâà ðàöèîíà. Ó÷åíûå ïðîâåðèòü, ìîæíî ëè èçìåíèòü ñîñòàâ êèøå÷íûõ áàêòåðèé ïðè äîáàâëåíèè ïðîáèîòèêîâ, ïåðåäàåò Spire ðåøèëè ïðîâåðèòü, ìîæíî ëè èçìåíèòü ñîñòàâ êèøå÷íûõ áàêòåðèé ïðè äîáàâëåíèè ïðîáèîòèêîâ, ïåðåäàåò Healthcare. ×òîáû ïðîâåðèòü ýòî, îíè ñîáðàëè ãðóïïó èç 125 òó÷íûõ ìóæ÷èí è æåíùèí. Ó÷àñòíèêîâ èññëåäîâàíèÿ Spire Healthcare. ×òîáû ïðîâåðèòü ýòî, ñíèæåíèÿ îíè ñîáðàëè ãðóïïó 125åùå òó÷íûõ Ó÷àñòíèêîâ ïîñàäèëè íà 12-íåäåëüíóþ ïðîãðàììó âåñà. Çàòåìèçøåë îäèíìóæ÷èí ïåðèîäèâæåíùèí. 12 íåäåëü, íàöåëåííûé íà èññëåäîâàíèÿ ïîñàäèëè íà 12-íåäåëüíóþ ïðîãðàììó ñíèæåíèÿ âåñà. Çàòåì øåë åùå îäèí ïåðèîä â 12 ñîõðàíåíèå âåñà. íåäåëü, íàöåëåííûé íà ñîõðàíåíèå âåñà. Çà âñå âðåìÿ ýêñïåðèìåíòà 50% äîáðîâîëüöåâ ïðèíèìàëè ïî 2 òàáëåòêè ïðîáèîòèêîâ êàæäûé äåíü. Îñòàëüíûå âñå âðåìÿ ýêñïåðèìåíòà 50% äîáðîâîëüöåâ ïðèíèìàëè ïîïîòåðÿëè 2 òàáëåòêè ïðîáèîòèêîâ êàæäûé äåíü. — Çà ïëàöåáî. ×åðåç 12 íåäåëü æåíùèíû, ïèâøèå ïðîáèîòèêè, â ñðåäíåì 4,4 êèëîãðàììà.  ãðóïïå Îñòàëüíûå — ïëàöåáî. ×åðåç 12 íåäåëü æåíùèíû, ïèâøèå ïðîáèîòèêè, ïîòåðÿëè â ñðåäíåì 4,4 êèëîãðàììà. ïëàöåáî ñíèæåíèå ñîñòàâëÿëî 2,6 êèëîãðàììà. Íà âåñ ìóæ÷èí ïðîáèîòèêè íå âëèÿëè. Ïîñëå ïåðâûõ 12 íåäåëü  ãðóïïå ïëàöåáî ñíèæåíèå ñîñòàâëÿëî êèëîãðàììà. ïðîáèîòèêè íå âëèÿëè. Ïîñëå òåðÿòü ïðèíèìàâøèå ïëàöåáî æåíùèíû ñìîãëè2,6 ïîääåðæàòü âåñ,Íàà âåñ âîò ìóæ÷èí ïðèíèìàâøèå ïðîáèîòèêè ïðîäîëæàëè ïåðâûõ 12 íåäåëü ïðèíèìàâøèå ïëàöåáî æåíùèíû ñìîãëè ïîääåðæàòü âåñ, à âîò ïðèíèìàâøèå ïðîáèîòèêè êèëîãðàììû. ïðîäîëæàëè òåðÿòü êèëîãðàììû. Èñòî÷íèê: Meddaily.ru ôåâðàëü 2014 ã. È M dd il

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

57



Ä.Õ. ÕÈÇÐÎÅÂÀ, È.À. ÌÈÕÀÉËÈÄÈ, Í.Ñ. ÑÒÓ˨ÂÀ Ïåðâûé Ìîñêîâñêèé ãîñóäàðñòâåííûé óíèâåðñèòåò èìåíè È.Ì. Ñå÷åíîâà, 119991, ã. Ìîñêâà, óë. Òðóáåöêàÿ, ä. 8, ñòð. 2

Çíà÷åíèå îïðåäåëåíèÿ ïðîòåèíà Ñ â àêóøåðñêîé ïðàêòèêå Õèçðîåâà Äæàìèëÿ Õèçðèåâíà — êàíäèäàò ìåäèöèíñêèõ íàóê, àññèñòåíò êàôåäðû àêóøåðñòâà è ãèíåêîëîãèè ìåäèêî-ïðîôèëàêòè÷åñêîãî ôàêóëüòåòà, òåë. +7-915-361-90-73, e-mail: gemostasis@mail.ru Ñòóë¸âà Íàäåæäà Ñåðãååâíà — êàíäèäàò ìåäèöèíñêèõ íàóê, àññèñòåíò êàôåäðû àêóøåðñòâà è ãèíåêîëîãèè ìåäèêî-ïðîôèëàêòè÷åñêîãî ôàêóëüòåòà, òåë. +7-915-361-90-73, e-mail: gemostasis@mail.ru Ìèõàéëèäè Èðèíà Àðõèìåäîâíà — àñïèðàíò êàôåäðû àêóøåðñòâà è ãèíåêîëîãèè ìåäèêî-ïðîôèëàêòè÷åñêîãî ôàêóëüòåòà, òåë. +7-903-798-08-97, e-mail: gemostasis@mail.ru                         ­­      ­­ €    ­­‚ƒ „        …        †         ‡   †„   ­ … ­   €   …         †         ˆ  ‡  … ˆ † ‚ ‰   †  ­  Š              ‚  ‹            ­ ŒŽ   „     † ‚

D.Kh. KHIZROEVA, I.A. MIKHAYLIDI, N.S. STULEVA I.M. Sechenov First Moscow State Medical University, 8-2 Trubetskaya St., Moscow, Russian Federation, 119991

Significance of protein C determination in obstetric practice Khizroeva D.Kh.— Cand. Med. Sc., Assistant of the Department of Obstetrics and Gynecology of Public Health Faculty, tel. +7-915-361-90-73, e-mail: gemostasis@mail.ru Stuleva N.S.— Cand. Med. Sc., Assistant of the Department of Obstetrics and Gynecology of Public Health Faculty, tel. +7-915-361-90-73, e-mail: gemostasis@mail.ru Mikhaylidi I.A. — postgraduate student of the Department of Obstetrics and Gynecology of Public Health Faculty, tel. +7-915-361-90-73, e-mail: gemostasis@mail.ru ‘’“”•’–— ˜™š’–“›    “›’–™•‘’“›œ ž“’Ÿ ’Ÿ– –›—š’Ÿ–¡“•¡ ˜™š’–“›  ™–‘–˜’š™   ™–‘–˜’š™¢  •‘’“”•’–— £¤ ˜™š’–•¢–¢   •˜š¡“˜š˜™š’“›•™–‘–˜’š™•›—“›’–œ™“›¢ Ÿ•¢”•™“š¥¢–¦¦–‘’¢š›’Ÿ–Ÿ–§š¢’•’“‘¢¤¢’–§•›’“‘š•œ¥¡•›’–¦¦–‘’•›—’Ÿ–“§§¥›–¢¤¢’–§ ‘¤’š˜™š’–‘’“”––¦¦–‘’‚Œ•¡¥–š¦˜™š’–“›“¢£–¢’—–§š›¢’™•’–—ž“’Ÿ˜™š’Ÿ™š§£š’“‘•›—“›¨•§§•’š™¤‘š§˜¡“‘•’“š›¢‘•¥¢–—£¤˜™š’–“› —–©‘“–›‘¤š™”“š¡•’“š›š¦“’¢¦¥›‘’“š›¢ žŸ“‘Ÿ“›‘¡“›“‘•¡˜™•‘’“‘–•˜˜–•™•¢“¢‘Ÿ–§“‘¢’™šª– “›¨•§§•’š™¤—“¢–•¢– •’Ÿ–™š¢‘¡–™š¢“¢  ”•¢‘¥¡•™‘š§˜¡“‘•’“š›¢•›—š£¢’–’™“‘˜™š£¡–§¢‚«–•™›“›œ•›—¥›—–™¢’•›—“›œ’Ÿ–£“š¡šœ“‘•¡¦¥›‘’“š›š¦˜™š”“—–¢‘š›’™š¡š”–™‘š„ •œ¥¡•’“š›•›—“›¨•§§•’“š›•›—¥›—–™¢’•›—“›œ’Ÿ–¥¢–š¦—™¥œ¢ž“’Ÿ˜™š’–“›•¢•›’“‘š•œ¥¡•›’•›—‘¤’š˜™š’–‘’š™“›‘¡“›“‘•¡˜™•‘’“‘–š¦ •˜Ÿ¤¢“‘“•›‚  •‘’“”•’–—˜™š’–“› –›—š’Ÿ–¡“•¡˜™š’–“›™–‘–˜’š™ ¦•‘’š™Œ«–“—–›§¥’•’“š› ™–¢“¢’•›‘– ’Ÿ™š§£š¢–¢‚

          

     

                      

                                  

           -

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


58

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

                         ­€‚ƒ„… †‡ˆ…‰ Š Š   ‹ Œ ­   Ž‘  ’ “­  ”• ­      Š †ˆˆ–ˆ—˜          ™    šš  Š   ›šœ ž  Š†‡ˆ…‰‚   ŠŸ‹­Š Ÿ  ‘  Ÿ         ¡           ’Ÿ ¢      †‡ˆ…‰‚   ¡€‚ƒ…†£‡‡¤ˆ¥“    ­   ¦ƒ„—§ˆ˜ ¨˜©‚…          Š ›„‹     ­  Š  ’Ÿ ¢    Ÿ  ­   ­ Ÿ  ‘‹    ­­‘ ‘  ­   ‹  “ ª¤˜¤ˆ§ ¨—¤«˜˜‚…  ¬„®¤ˆ      ¡      ¢ Š     ­­‘ ‘     Ÿ    ­  “ŠŠ¯°    ­           ‘     Ÿ “ŠŠ “ Ÿ    Ÿ       ’    “ŠŠ       ­              ­   ¢         ­ ±²³´¨††‡—¤„§  µ    ¶¡‹¯¶° ž ¦­     ”¶••• Ÿ  ¢          ‘  ­‘ Ÿ  ¶•••Ÿ  ‘ Ÿ ·•••Ÿ   ‹ŸŠ Ÿ ž   Ÿ      ­­          

                 ­€ ‚ƒ    „… ­  †      ‚‡ƒƒƒ ˆ ‰ ­   ­     …Š‹   €      ­   Š Š €   …ŒŽ‘’“”•Š     

   Š… Š Š         •Š Š – ­   –    Š     Š

Š   Š  —  ŠŠ    ­ 

  … Ž‘’“     ­    …     ­  -

‘7 (76) декабрь 2013 г.   … Œ˜™…” …  Š  Š Š  … š            …   €      Ž‘’“Œ›”  …  ŠŠ   ›ƒƒƒ  – ­  Š•   ‹›ƒ‡ƒŠ – … Ž‘’“œ›ž    

                      

            ­€  ‚ƒ    „…†€‡ ˆ ‰Š€   ‹ ˆ‹ Œ  Ž ‘ ˆ       ’      ˆ ˆ  “”††•–“”………†‚ƒ  —    ‹  ˆ‹  ‹           ˜   ˆ  Œ  Ž ‚  †™ ˆ    ‹ ‹       ˆ   ƒ  ƒƒ š       ‡  ‹ˆ

™Ÿ˜™…Ž‘’“Š† ˜™…   Š   Œ”  ­‹Š›Œ¡›‘”Š Œ‘¢”Š…Œ‘’”‘’Š ˜™…        ˜™…‘¢    ‘’††   Š•£Š† Š…‘’­†    Š      ­  ­  €

˜™…–   ŠŠ   ¤    ‘¢     ˜™…  ­ Š ­    •­    ˜™…       Š ˆ    Š …  €

˜™…

Š­†

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.                           ­€ ­€  ­€ ­€ ‚  ƒ„     ­ …† …  ƒ  ƒ…‡   ˆ ‰‡ ‡

        ­Š ‡ƒ„     …ƒ‰          ­€  „       ­‹ „    ­€       ŒŽ‘’“Š      ­€    … ‡

…”€‰­€•‡   „     ŒŽ –’“ ‰…  ­€    € —˜’’’’ Š­€„…ƒ™šˆ  †     › ­€­€ …†  • ‡ •  •  „    „…ƒ  œ   ž   ­ Ÿ€¡ ¢†…   ž ‡ †‡    Š   ‡ …        †‡  ˆ   †  ­€¡      ­       ‡     …ƒ ‰ ˆ         Š   ƒ„        ž   ­€ £   ‰    „        ŒŽ ‘’“ †  … † ¤ ­€¡ ‡ ‡

  „    ­‹¥–¦   Š ­Š ­€   †  ‡  Š       ”€ ”€  …  §’’ ’’’     ­€Š ­€„…ƒ™š•‡ „    ŒŽ––“  ŒŽ‘“§ ¢     ­€Š „    ­€      ‡        ™ž  ­Š    ­€Š    ƒ ƒ™š ‡ ƒƒ­€

         

…ƒ …ˆ ƒ … • Š ‡  •   Š  ‡„… ‡ ƒ 

 ¤    šŠ‡  Š  ƒ      œˆ‡ …   ¨™š©  Š     ˜™©˜ •ˆ‡ Š• ‡ • •     Š …ˆ    ˆ‡ … •  •Š †     … •    Š  „   „  ˆ‡ …  …   ¥ªŠ‘¦™š‡      Š ¨™š©Š‡   ¨™š©™©˜ ¥ª¦ ™š ‡        ¡«    ™©˜  ¨™š©  ‡ •  •Š  „  • ˜Š •Š† ƒ„•    …    ¨™š©   ƒ„• Š ‡™šŠ  ¨™š©Š ™©˜¥ªŠ¬Š®¦¢‡      ‡Š ‡  … ƒ„  Š

59

 ™©˜  ¨™š©   ƒ ‡     • ˆ  ™š   Š ‡      Š     ˜     ˜ ž˜™˜Š    §   ¨ ¯«¨©§Š  °Šš±˜˜°²š±˜¬³´µ§¶´€¡˜¶š©–Š ™©–‹·§†  Š‡  Š Š…™š  ƒˆ‡ … •‡ • • ¥‘¸¦› §’ Šˆ ƒ •  ¹ §’ Šˆ ƒ • ‡      …  …ƒŠ ‡ œ   …         … ˆ ˆ‡ …     

  ¢     ˆ‡   „         †‡   … •  ‡  †     ‡   ‡  ˆ‡  º  …¹ ‡ ƒ

Š…ƒ •      ¹ ‡ †„•

‡‡ † …  ƒ ƒ ˆ‡   †  •       †‡   ‡ …   

•Š† ˆ‡ … • •Š†   …¹    …   Š  ˆ ƒ‡          

   ˆ    ‡

     ‡ ‡          •        Š   †          

     † …ƒ   •    „„  ˆ‡ …  …  › Š    ¹   ˆ‡ … …   ƒ„

 ¹     ˆ‡      Š  

Š  Š   ƒ   »       ¹  ƒ       …  † Š     ‡    ¹    • •  ¹      …Š  …   Š   Š  ¹     ‡£  †  …        ¼ ‡   ‡        ‡  ¹ Š   …              …   ¢ „

   §’’  •     ¼  •‡      ƒ …   …     Š ‡      … ƒ   ƒ     …  ¹ƒ    º      Š‡ Š  …    ‡ •Š   ‡  •ŠŠ… ‡ †       •  …•    ¹…    …  ½   …‡      ‡  ‡ ƒ …  …    £¢‡‡               „ƒ„

      ½             ˆ  ¥–¦   Š     †    … ‡      ‡     †   ›Š -

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


60

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

                                 

        

        

       ­    € 

           ‚          ƒ„…      †‡ˆ†‰…Š   ‹      Œ    Žˆ‘’ƒ“ ” €•ˆ     ‹     

     Œ           Š  ”            –     •ˆ                  —     Š  

       ”  ˜™š‡           ˜™š‡        

ˆ •ˆ                           

            —     Œ            Š  •      Œ                               š   ›œžŸ         

            

    

      ¡‹ ›œžŸ                              ›œžŸ              ˆ˜¢ ›œžŸ                •        

                       £               ›œžŸ¤›œžŸ    ›œžŸ            

 ¥ ¦ ¤›œžŸ        ¡         ›œžŸ       ¡          ˆ    ¡          ¡

   §¨£     ˆ

    ›œžŸ      ¤›œžŸ            ˆ˜¢ ¤›œžŸˆ              ©Œ    ›œžŸ            š  Š    

   ›œžŸ                  š   ›œžŸ Š  Œ           ›œžŸ ¤›œžŸ

‘7 (76) декабрь 2013 г. ª

™ƒ   ›œžŸ”     –«ƒ– ¬š®     ›œžŸ 

     Œ          Œ       ˜              

    Π

   ’™†ˆ™‡“            ¡ˆŸ 

      Š    §¨š§¨                                       ©

        

     ¡ˆŸ      §¯   £                            

 Œ     °¨±²³¨´µ¶ ´· ¨²  ™««ƒ  ’™ƒ“       Œ           Š   Œ 



       •    Œ   ¡      Š           §¸§š¸§¨ §  ¸§š¸§¡ˆ   Š    ¸§¨      ¹   

  ¸§     ¡ ˜  §            €   º¸º¨ €      ¡”

   ¬œžˆŸ  ¸§ˆ ¯   

    Œ    ‡»   ¼ ©Œ     ¸§¨     ¡     Œ ¸§¨    ¼ ©Œ    

   ¸§¨        ¸§    ¬½¾Ž†–     Š

     ¬œžˆ   ¸§   ¹  §¨ ©     Œ  § ¿´ÀÁ´Â

      £  Š

   Π

  

    ¡ ©Œ   

 ¡   ¸§ ¿´ÀÁ´Â    츏ˆ   —               

          ¸§¿´ÀÁ´Â £         ¡ˆ        ‡†ˆ–†…              ©    Œ ¡”    ¸§ÄŽ†–  Š ¡ˆ       Œ                 

 

  ¡ ¡ ¡   ¡  ”    Š § Œƒ††††        

   ¡ ™†† †††  

    — »   Å    

 Æ •    



  ¡¡¡ ’Ž™‡“

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.                               ­  €‚    ‚   ƒƒ   „       … †‡ˆ‰Šˆ‹Œ ‡Œ ŠŽ ‘’‚       “ ”••„       –•—    ˜™‡š›Šˆ‹š‡ŒŠŽ‘•„„„’‚­        €‚  ƒ”  € ‚   ‚­     œ•ž –•— Ÿ      ¡Šˆ‡ ¢£ ‡Œ ŠŽ ‘’ ” ‚     €      ‚    €    ¤¥‡š‹‡›–•ž— ¦¦     ‘§’   “ “ƒ   ‘’¨ •’ƒ“¦  ‚    ‘

  ’© ’ƒ“  “     ‘   ’© ª’ƒ“ ‘ ’‚ ƒ ¨ ’  ƒ“              ¦¦    © ’  “ ƒ“  © ’ ƒ“¦ ¤Š¤œœœŠ© ’    “       «   ¢‘

¦’ ¬     

 

       ‚    ‚       ƒ           ”  ƒ  ƒ  ®  Ÿ®    ƒ¯ƒ ¦ € ‚ ¦ƒ ” ¦‚ °¤ °¤œœœŠ “¨       §ƒ“¦  ‚   “ “‚   “”ƒ  ƒ ‘’     “”ƒ     ƒ     ‚  ƒ      ”  “ ‚  “”    ‘

¦’‚ “ “¨ ± “ ¦ © ±    ‘ ’© ±¦  ¯© ± © ±   “  “     ”© ±  “” © ±²Ÿ© ±  “   “ ¦“      ³   

 ¦   ƒ ‚     ƒ ¦       ³ 

¦    ” ƒ       ¦ ‚ƒ               

61

                                                   ­      €  ‚   ƒ  „…†  ‡… †    ‚    „…   ƒ ƒ 

³    ƒ      ‚  “” ¦ ´        ¦    •                      ¦          ƒƒ  ¬         ‚        “   ¯                  µ¶«  Ÿ      “         ž•ªµ¶«  ´   ‚       ƒ ƒ          ƒ     €ƒ ƒ   Ÿ   ¦¦      §        ‘ ‚¢‚’©        ƒ     ”ƒƒ  ƒƒ ¦    ¦   ¤ · ‚        ¦                  €‚    « ‚  ¸´ ‚     € ‚    ‚ƒ  ‚   ‚ ‚ ‚¹ ‚      ‚  ƒ   ‚ º¯¸‚ ‚  € ¯  “‚   ”ƒ        €       ƒ  ƒ         ‚  ƒ   -

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


62

Ă?Ă?Ă&#x20AC;Ă&#x160;Ă&#x2019;Ă&#x2C6;Ă&#x2014;Ă&#x2026;Ă&#x2018;Ă&#x160;Ă&#x20AC;Ă&#x; Ă&#x152;Ă&#x2026;Ă&#x201E;Ă&#x2C6;Ă&#x2013;Ă&#x2C6;Ă?Ă&#x20AC;

â&#x20AC;&#x2DC;7 (76) докайŃ&#x20AC;Ń&#x152; 2013 Đł.

 

            ���   � 

­     Â&#x20AC;        Â?    Â&#x201A;        Â&#x192; Â&#x201E;Â&#x2026;Â&#x2020;Â&#x2021;Â&#x2C6;Â&#x2030;Â&#x160;Â&#x2039;Â&#x152;Â&#x2039;Â&#x17D;Â&#x2018;Â&#x2039;Â&#x17D;Â&#x2030;Â&#x2039;Â&#x160;Â&#x2021;Â&#x2019; Â&#x201C;         

   Â&#x201D;    Â&#x2022;Â&#x2013;Â&#x2022;Â&#x2014;Â&#x2014;Â&#x2014; Â&#x201C;Â&#x2DC;     Â    Â&#x201A;    Â&#x201C;  Â&#x2122; Â&#x201D; Â&#x201E;Â&#x161;Â&#x203A;Â?Â&#x153; -

             Â?   Â? Â?      Â? Â?  Â?    Â?     ­    Â?          Â?         Â?    Â&#x20AC;             ­     ­  Â?Â&#x201A;Â? Â?   Â?  Â&#x201A;Â? Â&#x192;Â&#x201A;Â&#x201A;       Â? Â?        Â&#x192;Â&#x201A;Â&#x201A;  Â?  Â?  Â&#x201E;      Â?   Â? 

Đ&#x203A;Đ&#x2DC;ТĐ&#x2022;Đ Đ?ТУРĐ? 1. Weiler H. Multiple receptor-mediated functions of activated protein C. // Hamostaseologie. â&#x20AC;&#x201D; 2011. â&#x20AC;&#x201D; Vol. 31, â&#x201E;&#x2013; 3 â&#x20AC;&#x201D; P. 185-195. 2. Patracchini P., Aiello V., Palazzi P., Calzolari E., Bernardi F. Sublocalization of the human protein C gene on chromosome 2q13-14 // Hum.Genet. â&#x20AC;&#x201D; 1989. â&#x20AC;&#x201D; Vol. 81. â&#x20AC;&#x201D; P. 191-192. 3. Đ&#x201C;Ń&#x192;Ń Đ¸Đ˝Đ° Đ?.Đ?., Đ&#x201C;Ń&#x192;Ń Đ¸Đ˝Đ° Đ?.Đ&#x2018;. Đ&#x201C;оноŃ&#x201A;иŃ&#x2021;ĐľŃ ĐşĐ¸Đľ Đ´ĐľŃ&#x201E;окŃ&#x201A;Ń&#x2039; ĐżŃ&#x20AC;Đž- и Đ°Đ˝Ń&#x201A;икОагŃ&#x192;ĐťŃ?Đ˝Ń&#x201A;Đ˝Ń&#x2039;Ń&#x2026; йоНкОв как Ń&#x201E;Đ°ĐşŃ&#x201A;ĐžŃ&#x20AC;Ń&#x2039; Ń&#x20AC;Đ¸Ń ĐşĐ° вонОСнŃ&#x2039;Ń&#x2026; Ń&#x201A;Ń&#x20AC;ОПйОСОв // Đ&#x153;одиŃ&#x2020;Đ¸Đ˝Ń ĐşĐ¸Đľ Đ˝ĐžĐ˛ĐžŃ Ń&#x201A;и. â&#x20AC;&#x201D; 2006. â&#x20AC;&#x201D; â&#x201E;&#x2013; 9. â&#x20AC;&#x201D; ĐĄ. 10-14. 4. Đ&#x201C;ĐžŃ&#x20AC;йаŃ&#x2021;ова Đ&#x203A;.Đ . Đ?оКŃ&#x20AC;ОпŃ&#x20AC;ĐžŃ&#x201A;окŃ&#x201A;ивнОо Đ´ĐľĐšŃ Ń&#x201A;вио кНиниŃ&#x2021;ĐľŃ ĐşĐ¸Ń&#x2026; ĐżŃ&#x20AC;ĐžŃ&#x201A;оинаС ĐłĐľĐźĐžŃ Ń&#x201A;аСа: авŃ&#x201A;ĐžŃ&#x20AC;ĐľŃ&#x201E;. Đ´Đ¸Ń . â&#x20AC;Ś Đ´-Ń&#x20AC;Đ° йиОН. наŃ&#x192;Đş. â&#x20AC;&#x201D; Đ&#x153;ĐžŃ ĐşĐ˛Đ°, 2008. â&#x20AC;&#x201D; 49 Ń . 5. Spek C.A., Reitsma P.H. Genetic risk factors for venous thrombosis // Molecular Genetics and Metabolism. â&#x20AC;&#x201D; 2000. â&#x20AC;&#x201D; Vol. 71, â&#x201E;&#x2013; 1-2. â&#x20AC;&#x201D; P. 51-61. 6. Larsen T.B., Lassen J.F., Brandslund I., Byriel L., Petersen G.B., Nørgaard-Pedersen B. The Arg506Gln mutation (FV Leiden) among a cohort of 4188 unselected Danish newborns // Thrombosis Research. â&#x20AC;&#x201D; 1998. â&#x20AC;&#x201D; Vol. 89, â&#x201E;&#x2013; 5. â&#x20AC;&#x201D; P. 211-215. 7. Voetsch B., Loscalzo J. Genetic determinants of arterial thrombosis // Arteriosclerosis, Thrombosis, and Vascular Biology â&#x20AC;&#x201D; 2004. â&#x20AC;&#x201D; Vol. 24, â&#x201E;&#x2013; 2. â&#x20AC;&#x201D; P. 216-229. 8. Mosnier L.O., Zlokovic B.V., Griffin J.H. The cytoprotective protein C pathway // Blood. â&#x20AC;&#x201D; 2007 Apr 15. â&#x20AC;&#x201D; Vol. 109, â&#x201E;&#x2013; 8. â&#x20AC;&#x201D; Đ . 3161-72. 9. Griffin J.H., Mosnier L.O., Zlokovic B.V. Protein C anticoagulant and cytoprotective pathways // International Journal of Hematology. â&#x20AC;&#x201D;

2012 Apr. â&#x20AC;&#x201D; Vol. 95, â&#x201E;&#x2013; 4. â&#x20AC;&#x201D; Đ . 333-45. DOI: 10.1007/s12185-0121059-0. Epub 2012 Apr 5. 10. Chen X.D., Tian L., Li M., Jin W., Zhang H.-K., Zheng C.-F. Relationship between endothelial cell protein C receptor gene 6936A/G polymorphisms and deep venous thrombosis // Chinese Medical Journal. â&#x20AC;&#x201D; 2011 Jan. â&#x20AC;&#x201D; Vol. 124, â&#x201E;&#x2013; 1. â&#x20AC;&#x201D; Đ . 72-75. 11. Saposnik B., Reny J.-L., Gaussem P., Emmerich J., Aiach M., Gandrille S. A haplotype of the EPCR gene is associated with increased plasma levels of sEPCR and is a candidate risk factor for thrombosis // Blood February 15. â&#x20AC;&#x201D; 2004. â&#x20AC;&#x201D; Vol. 103, â&#x201E;&#x2013; 4. â&#x20AC;&#x201D; Đ . 1311-1318. 12. Đ&#x153;акаŃ&#x2020;Đ°Ń&#x20AC;иŃ? Đ?.Đ&#x201D;., Đ&#x2018;иŃ&#x2020;адСо Đ&#x2019;.Đ&#x17E;. ТŃ&#x20AC;ОПйОŃ&#x201E;иНии и ĐżŃ&#x20AC;ĐžŃ&#x201A;ивОŃ&#x201A;Ń&#x20AC;ОПйОŃ&#x201A;иŃ&#x2021;ĐľŃ ĐşĐ°Ń? Ń&#x201A;ĐľŃ&#x20AC;апиŃ? в Đ°ĐşŃ&#x192;Ń&#x2C6;ĐľŃ&#x20AC;Ń ĐşĐžĐš ĐżŃ&#x20AC;Đ°ĐşŃ&#x201A;ико. â&#x20AC;&#x201D; Đ&#x153;.: ТŃ&#x20AC;иада-ĐĽ, 2003. 13. Dahlbäck B., Carlsson M., Svensson P.J. Familial thrombophilia due to a previously unrecognized mechanism characterized by poor anticoagulant response to activated protein C: prediction of a cofactor to activated protein C // Proc Natl Acad Sci U S A. â&#x20AC;&#x201D; 1993 February 1. â&#x20AC;&#x201D; Vol. 90, â&#x201E;&#x2013; 3. â&#x20AC;&#x201D; Đ . 1004-1008. 14. Gerhardt A., Scharf R.E., Beckmann M.W. et al. Prothrombin and factor V mutations in women with a history of thrombosis during pregnancy and the puerperium // N Engl J Med. â&#x20AC;&#x201D; 2000. â&#x20AC;&#x201D; Vol. 342. â&#x20AC;&#x201D; Đ . 374-80. 15. Meinardi J.R., Middeldorp S., de Kam P.J., Koopman M.M.W., Van Pampus E.C.M., HamulyĂĄk K., Prins M.H., et al. Increased risk for fetal loss in carriers of the factor V Leiden mutation // Annals of Internal Medicine. â&#x20AC;&#x201D; 1999. â&#x20AC;&#x201D; Vol. 130, â&#x201E;&#x2013; 9. â&#x20AC;&#x201D; P. 736-739. 16. BarĂŠ S.N., PĂłka R., Balogh I., Ajzner E. Factor V Leiden as a risk factor for miscarriage and reduced fertility // Aust N Z J Obstet Gynaecol. â&#x20AC;&#x201D; 2000 May. â&#x20AC;&#x201D; Vol. 40, â&#x201E;&#x2013; 2. â&#x20AC;&#x201D; Đ . 186-90.

REFERENCES 1. Weiler H. Multiple receptor-mediated functions of activated protein C. Hamostaseologie, 2011, vol. 31, no. 3, pp. 185-195. DOI: 10.5482/ha-1166. 2. Patracchini P., Aiello V., Palazzi P., Calzolari E., Bernardi F. Sublocalization of the human protein C gene on chromosome 2q13-14. Human Genetics, 1989, vol. 81, no. 2, pp. 191-192. 3. Gusina A.A., Gusina N.B. Genetic defects in the pro- and anticoagulant proteins as risk factors for venous thrombosis. Meditsinskie novosti, 2006, no. 9, pp. 10-14. (in Russ.). 4. Gorbacheva L.R. Neyroprotektivnoe deystvie klyuchevykh proteinaz gemostaza. Dokt. biol. nauk. diss. Avtoref. [Neuroprotective effect of key hemostasis proteinase. Dr. biol. sci. diss. Synopsis]. Moscow, 2008. 49 p. 5. Spek C.A., Reitsma P.H. Genetic risk factors for venous thrombosis. Molecular Genetics and Metabolism, 2000, vol. 71, no. 1-2, pp. 51-61. DOI: 10.1006/mgme.2000.3051. 6. Larsen T.B., Lassen J.F., Brandslund I., Byriel L., Petersen G.B., Nørgaard-Pedersen B. The Arg506Gln mutation (FV Leiden) among a cohort of 4188 unselected Danish newborns. Thrombosis Research, 1998, vol. 89, no. 5, pp. 211-215. DOI: 10.1016/S00493848(98)00010-3. 7. Voetsch B., Loscalzo J. Genetic determinants of arterial thrombosis. Arteriosclerosis, Thrombosis, and Vascular Biology, 2004, vol. 24, no. 2, pp. 216-229. DOI: 10.1161/01.ATV.0000107402.79771.fc. 8. Mosnier L.O., Zlokovic B.V., Griffin J.H. The cytoprotective protein C pathway. Blood, 2007, vol. 109, no. 8, pp. 3161-3172. DOI: 10.1182/blood-2006-09-003004. 9. Griffin J.H., Mosnier L.O., Zlokovic B.V. Protein C anticoagulant and cytoprotective pathways. International Journal of Hematology, 2012, vol. 95, no. 4, pp. 333-345. DOI: 10.1007/s12185-012-1059-0.

10. Chen X.D., Tian L., Li M., Jin W., Zhang H.-K., Zheng C.-F. Relationship between endothelial cell protein C receptor gene 6936A/G polymorphisms and deep venous thrombosis. Chinese Medical Journal, 2011, vol. 124, no. 1, pp. 72-75. DOI: 10.3760/cma. j.issn.0366-6999.2011.01.014. 11. Saposnik B., Reny J.-L., Gaussem P., Emmerich J., Aiach M., Gandrille S. A haplotype of the EPCR gene is associated with increased plasma levels of sEPCR and is a candidate risk factor for thrombosis. Blood, 2004, vol. 103, no. 4, pp. 1311-1318. DOI: 10.1182/ blood-2003-07-2520. 12. Makatsariya A.D., Bitsadze V.O. Trombofilii i protivotromboticheskaya terapiya v akusherskoy praktike [Thrombophilia and antithrombotic therapy in obstetric practice]. Moscow, Triada-X Publ., 2003. 904 p. 13. Dahlbäck B., Carlsson M., Svensson P.J. Familial thrombophilia due to a previously unrecognized mechanism characterized by poor anticoagulant response to activated protein C: Prediction of a cofactor to activated protein C. Proceedings of the National Academy of Sciences of the United States of America, 1993, vol. 90, no. 3, pp. 1004-1008. DOI: 10.1073/pnas.90.3.1004. 14. Gerhardt A., Scharf R.E., Beckmann M.W., Struve S., Bender H.G., Pillny M., Sandmann W., Zotz R.B. Prothrombin and factor V mutations in women with a history of thrombosis during pregnancy and the puerperium. New England Journal of Medicine, 2000, vol. 342, no. 6, pp. 374-380. DOI: 10.1056/NEJM200002103420602. 15. Meinardi J.R., Middeldorp S., de Kam P.J., Koopman M.M.W., Van Pampus E.C.M., Hamulyåk K., Prins M.H., et al. Increased risk for fetal loss in carriers of the factor V Leiden mutation. Annals of Internal Medicine, 1999, vol. 130, no. 9, pp. 736-739. 16. BarÊ S.N., Póka R., Balogh I., Ajzner E. Factor V Leiden as a risk factor for miscarriage and reduced fertility. Australian and New Zealand Journal of Obstetrics and Gynaecology, 2000, vol. 40, no. 2, pp. 186-190.

Ă&#x20AC;Ă&#x160;Ă&#x201C;Ă&#x2DC;Ă&#x2026;Ă?Ă&#x2018;Ă&#x2019;Ă&#x201A;Ă&#x17D;. Ă&#x192;Ă&#x2C6;Ă?Ă&#x2026;Ă&#x160;Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;. Ă?Ă?Ă&#x201E;Ă&#x17D;Ă&#x160;Ă?Ă&#x2C6;Ă?Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

63



Ë.È. ÌÀËÜÖÅÂÀ1, Ä.Ì. ÍÈÊÎÃÎÑßÍ2 1 Êàçàíñêàÿ ãîñóäàðñòâåííàÿ ìåäèöèíñêàÿ àêàäåìèÿ, 420012, ã. Êàçàíü, óë. Ìóøòàðè, ä. 11 2 Ðåñïóáëèêàíñêàÿ êëèíè÷åñêàÿ áîëüíèöà № 2 ÌÇ ÐÒ, 420012, ã. Êàçàíü, óë. ×åõîâà, ä. 2

Ñîâðåìåííûé âçãëÿä íà ïðèìåíåíèå ïðîãåñòåðîíà  Ìàëüöåâà Ëàðèñà Èâàíîâíà — äîêòîð ìåäèöèíñêèõ íàóê, ïðîôåññîð, çàâåäóþùàÿ êàôåäðîé àêóøåðñòâà è ãèíåêîëîãèè № 1, òåë. (843) 236-46-41, e-mail: laramalc@mail.ru1 Íèêîãîñÿí Äèàíà Ìåëèêîâíà — âðà÷ ðîäèëüíîãî îòäåëåíèÿ, òåë. +7-905-311-29-14, e-mail: diananiko@mail.ru2                                                                                                               

L.I. MALTSEVA1, D.M. NIKOGOSYAN2 1 Kazan State Medical Academy, 51 Bolshaya Krasnaya St., Kazan, Russian Federation 420015 2 Republican Clinical Hospital № 2, 1à Chekhova St., Kazan, Russian Federation 420012

Modern view on the use of progesterone to reduce the risk of premature delivery Maltseva L.I. — D. Med. Sc., Head of the Department of Obstetrics and Gynecology № 1, tel. (843) 236-46-41, e-mail: laramalc@mail.ru1 Nikogosyan D.M. — physician of maternity ward, tel. +7-905-311-29-14, e-mail: diananiko@mail.ru2 ­€‚ ƒ„…†‡‚… …†‡† ˆ‰ ƒ‡Š‹ŠŒ†‡Šˆ‰ ‚Ž‘’Š‚‰’“ ˆŽ  „”ˆ•‚–‡‚”ˆ‰‚ Žˆ” ”Š–— ”‚…ƒ’‡Šˆ‰ ˆŽ „”‚˜†‡ƒ”‚ …‚‹Š™‚”“ †‰… „‚”Š‰†‡†‹ ’ˆ˜„‹Š’†‡Šˆ‰– †”‚ •Š™‚‰ š‚†‰Š‰•Žƒ‹ …†‡† ˆ‰ Ž‚†‡ƒ”‚– ˆŽ ‡€‚ Š‰›ƒ‚‰’‚ ˆŽ ˜Š’”ˆ‰ŠŒ‚… „”ˆ•‚–‡‚”ˆ‰‚ †‰… „”ˆ•‚–‡‚”ˆ‰‚ ’†„”ˆ†‡‚ ˆ‰ ”‚…ƒ’‡Šˆ‰ ˆŽ ‡€‚Š‰’Š…‚‰’‚ˆŽ„”‚˜†‡ƒ”‚…‚‹Š™‚”“†‰…„‚”Š‰†‡†‹ˆƒ‡’ˆ˜‚–Š‰œˆ˜‚‰œŠ‡€†–“˜„‡ˆ˜†‡Š’–‚™‚”‚†‰…„”‚˜†‡ƒ”‚†žˆ”‡Šˆ‰’‹Š‰Š’†”‚ …Š–’ƒ––‚… Ÿ†–‚… ˆ‰ ‡€‚ ‚™†‹ƒ†‡Šˆ‰ ˆŽ ‡€‚ ”‚–ƒ‹‡– ˆŽ ”†‰…ˆ˜ŠŒ‚… ’‹Š‰Š’†‹  „‹†’‚žˆ’ˆ‰‡”ˆ‹‹‚… –‡ƒ…Š‚– œ†– ’‹‚†”‹“ …‚˜ˆ‰–‡”†‡‚… ‡€‚ ž‚‰‚‘‡ˆŽ‰†‡ƒ”†‹„”ˆ•‚–‡‚”ˆ‰‚ „”Š˜†”Š‹“Š‡–˜Š’”ˆ‰ŠŒ‚…Žˆ”˜ Žˆ”†‰‚ŽŽ‚’‡Š™‚”‚…ƒ’‡Šˆ‰ˆŽ‡€‚”Š–—ˆŽ„”‚˜†‡ƒ”‚…‚‹Š™‚”“  „”‚˜†‡ƒ”‚…‚‹Š™‚”“ „”ˆ•‚–‡‚”ˆ‰‚ ˆƒ‡’ˆ˜‚– ”Š–—”‚…ƒ’‡Šˆ‰

                                                  ­         €   ‚                          ƒ „  ­         €         €     € -

      €        €   …†                  ­         €   €  €  ‡ˆ          ‰ƒ‡                                      Š          €

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


64

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

                     ­€   ­ ‚€ ­ƒ „…†‡ˆ‰Š‡‹ŒŽˆ‰‹‘’ˆ‰       ­    „  “‘ŠŠ     ”••  „Œ–—     ­ ƒ ˜ ™ š™   €  ‚› œžŸ ¡š          ‚ ”••  ¢  ™™£Œ  ‚ š ‚ ‚ š™  š  ••  ‚         €      ‚  ™™ ”•• › ¤Œ  ™  ¤Œ¥¦§   ¨©ª      ‚     Ÿ   ™  €­™ ”••«™‚ €          ‚  ¬  ® ®¯ˆ‰     ™‚  ™ ¬      ™   ›†ˆ‰‡Š°±²³®ˆˆ‰´‘Ž‰Š´‘µˆ°‰‡°Ÿ ™  ™      ‚     ‚   š™ ”œ„ ˜ž§š™› ™ …¶…Ÿ ‚ ™ ™ •š    ·    ‚      œž     ‚         ƒ¶……¸¹ˆ‡ˆ°±œ …ž‚    ™           ¹º¹»›¨™• ™  Ÿ  ‚    •  ¶……¶¼­ ›½¸Ÿ‚  €    Œ¶…   ¸ …    „¾¶…š      € ¸ ¾ ¿    ‚       ¸     À     š    €    ‚‚ €    ¢ ¸„¾ ˜Á¸¾ … Á¸¶¾˜¶Â ƒ”‚      œ ž     ™ ƒ    ‚ š    ‚ €    

   š  ‚‚ €  ‚      ­ €­™ ‚  ¬ ™   ‚‚€ ­    ”      

‘7 (76) декабрь 2013 г.   ”•• ™   œ ¶ž ¦™          ‚  ¬•              €          „ ­   ™ ‚ € œ ž ƒ   €   ­š  šš™   ¼­       ……   ¶½Œ™¸½Œ€ €       ‚ ¬     ­™ €      ‚‚    š     ¬         ‚ ­ ­    ¸½   › ˜Ÿ     ›¶˜ÂŸ §      Ãœ ¸ž  ¶½¶…‚ ­  š™ ¶…Œ¶   ‚ À ½ ¶ ­   š™ ‚ Ä ‚        ¶…                    ¶……  

    ‚¶½Œ™ ¸¸Œ€ € §¶ ¸½     €        š™  Å           ¶Â€  ‚¸½½Âº‰Š´ÆŽœ ½ž   ™    ‚Œ    š               ¾  š  ” ­Ç    ™›·«Ÿ  ˜Â  š     ‚  ™·« ¾    ƒ ¶… …  ‚       œ ž   €  ”••  ‚      ‚   ‚   ™•  š™ÈÈ‚      ¸¸Åš™™  ™ … ‚ €    • É   š™ €      ‚  ™š™™  ¥ ™        ™  ‚­­ ÀÊ  š™   ÈÈ  ‚  •       ‚         ‚­€   

 š™  ‚ š™   ÀÊ ¾   š€­ 

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.                                     ­€ ‚    ƒƒ „ …†    ‡ˆ‰ Š                            ‹     †                                  …  Œ€ƒ€   Ž       ‚ŠŒ­ŠŒ „  ‚ƒ­Œ„‘ ­                    ‚     „           ‘   ’        ‚  ƒ€„   …                “                 ”    €    ƒŠ      ” •          Œ­ ­           €­ƒŒ   –Š­  €— ˜   ”           ƒ€  ”  ƒŒ           ™                                  š      ”   €­ƒƒ”˜”            ƒ€” •                      ƒ     ›”            €­ƒ   ˜    € ” ƒ€   €ƒˆ˜ ”             ƒŒ  ” ‚‹‘ Šœ Š ž •“ ­ˆŠ„        

65

     ‚‹‘  œ Š ž •“ —­Š—„   ­  ‚‹‘ ƒœ Š ž •“ ­—ƒ„ …  Ÿ¡¢£¤¥¦ § ‡Œ‰         Œ­ ­           ‚   €— ”„  ”        š   ”     ‚    „–   ˜                               ˆŒ ”  ‘      ”   Ž     Œ­ ­          ”ˆ¨­—­ƒ¨ƒˆ­ ˜    ”         •   ’          Š  ”   ‡—­‰…  ‡—‰          —­€”            …             ” …         —­ƒ  ‚‹‘–œ •“ ­Œƒ„ ”     ‚ƒ€ ƒ œ©ª„  ‚€—Šœ©ª„        ‚ƒ  Œœ©ªŠ„ «¬¢®£®¯¥£¬°‡—‰     ””ƒ€  Ž        •  ”                      Š‡Š‰“    Š      ”  ”     š   ”         ­      ƒ€­     ±²³´µŸ§Ÿ‡‰¶ €€ ”     ‚ƒŒ   ”„ †  ’    Š­ƒ    ·“­ “   ‚Š „”¸  ƒŠ   – €ˆ ·   — žƒƒ–€ ž

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


66

Ă?Ă?Ă&#x20AC;Ă&#x160;Ă&#x2019;Ă&#x2C6;Ă&#x2014;Ă&#x2026;Ă&#x2018;Ă&#x160;Ă&#x20AC;Ă&#x; Ă&#x152;Ă&#x2026;Ă&#x201E;Ă&#x2C6;Ă&#x2013;Ă&#x2C6;Ă?Ă&#x20AC;

                            Â?Â?Â?Â?Â?Â?Â?  Â?         Â?   Â? Â?­Â?Â&#x20AC;Â&#x201A;Â?Â? Â?Â&#x192; Â? Â?Â?Â?   Â?Â&#x192;      Â?  Â&#x201A;   Â&#x201A; Â&#x201A;  Â&#x201E;Â&#x20AC;Â&#x2026;  Â?   Â? Â&#x201A;Â?      Â?Â&#x192; Â?Â?   Â&#x2020; Â&#x2021;   Â?Â? Â&#x201A; Â?Â&#x192;  Â?    Â?Â&#x192;   ­    Â?Â&#x192;      Â?   Â&#x201A;   Â&#x201A;  Â&#x201A;    Â&#x201A;  Â? Â?  Â&#x2C6;Â&#x2030; Â&#x160;Â?Â&#x192;    Â&#x201A;Â?  Â&#x201A;  Â?   Â&#x201A;  Â&#x201A;  Â&#x201A;   Â? Â&#x201A;Â?Â?   Â? Â&#x2039;Â?Â?Â&#x152;Â&#x152;Â?       Â&#x152;    Â?       Â?  Â?Â&#x192;Â? Â&#x152; Â?Â&#x17D;  Â&#x2018;Â&#x152;   Â?  Â&#x2021;Â&#x2019;    Â?  Â? Â&#x201C; Â&#x2039;    Â? Â?Â&#x192; ­Â&#x201A; Â&#x201D;Â&#x2022;Â&#x2022;Â&#x201A;     Â?Â&#x192;     Â?­Â?      Â&#x201A;   Â&#x201A;  Â&#x201A;  Â&#x2018;Â&#x2013; Â&#x201C;    Â?  Â?   Â?  Â?  Â&#x160;   Â?  Â?     Â?Â&#x192; Â&#x201A;Â?         Â&#x201A;     Â&#x2019; Â&#x2014;Â? Â?  Â?    Â?Â&#x192; Â&#x2DC;       Â? ­  Â&#x2039;Â&#x2026;Â&#x2122;  Â?Â&#x161;Â&#x203A;Â&#x153;Â&#x2019; Â&#x201A; Â?Â&#x201A;Â?Â?Â&#x192;Â?Â?Â?Â&#x192;Â&#x2019;    Â?       Â&#x2021;Â&#x2021;  Â&#x201E;      Â?  Â?Â&#x192;Â?             Â&#x2019;Â&#x2019;   Â?  Â?­Â?  Â&#x2021;Â&#x2019;    Â?Â&#x192;   Â&#x17E; Â?Â&#x201A;Â? Â?Â&#x192;Â?Â?Â?Â&#x192;  Â&#x201D;  Â?Â&#x192;Â&#x;  Â&#x; Â&#x2020; Â?    Â&#x201D;   ÂĄ ¢£¤¼Œ§¨ Â&#x2C6;Â&#x2030; Â? Â&#x201D;Â&#x2022;Â&#x2022;Â&#x201A; Â&#x192;  Â?Â&#x192;  Â?Â&#x152;Â&#x2039;ŠÂ&#x161;Â&#x17D;Â&#x152;     Â? Â?­Â?Â&#x2021;Â?Â?Â&#x201D;          Â&#x201A; Â&#x201A; Â&#x2013;Â&#x2021; Â&#x201A;   Â&#x2026; Â? Â? Â?  Â?Â&#x192;  Â?     Â?Â&#x192;      Â?  Â?           Â&#x201A;  Â&#x201A;Â?    Â?Â&#x192; Â&#x201A;    Â?Â&#x192;   Â?Â&#x192; Š  Â? Â? Â&#x201A;Â?  Â&#x201A;Â? Â&#x201D;Â&#x2022;Â&#x2022;Â&#x201A; Â&#x192; Â&#x201A;   Â&#x201A; Â?  Â?Â&#x192; Â?Â?   Â?  Â&#x201A;          Â?  Â?Â&#x192;Â?ŠÂ?Â?Â? Â?  Â? Â&#x192;Â&#x2021;Â&#x2021;Â?   Â&#x2019;  Â?   Â? Â&#x201A;    Â&#x201A;  Â&#x152;Â&#x2021; Â&#x201A; Â?Â?  Â?        Â?Â&#x201A; Â&#x201E;Â?Â?Â&#x192;    Â&#x2018;Â&#x2019;Â&#x2021;Â&#x201C; Â&#x192; Â?Â?Â?     Â?Â? Â&#x2021;Â&#x2021;    Â?Â?  Â?   Â&#x201A; Â&#x2019;Â&#x;Â? Â&#x201E;Â&#x2019;Â&#x2021;Â? Â&#x201A;Â?Â&#x192; Â&#x201A;Â?Â?     Â&#x152;  Â&#x2014; Â?  Â&#x201A;     Â? Â?Â&#x192;    Â&#x201A;    Â&#x2022;Â&#x201A;­  Â?   Â&#x201A;  Â&#x201A;   Â&#x2021;  Š  Â&#x2021;Â&#x2021;    Â?Â&#x192;   Â&#x201A; Â?Â&#x201A;  -

â&#x20AC;&#x2DC;7 (76) докайŃ&#x20AC;Ń&#x152; 2013 Đł.                                      Â?Â?Â?Â?Â?Â?Â?Â?           ­Â?Â?Â?Â&#x20AC;Â?Â?   Â&#x201A;­Â&#x192;Â&#x201E;   Â&#x201A; Â?Â&#x201A;Â&#x2026;Â&#x2020;       Â?Â?    Â&#x2020;  Â? Â&#x2020; Â&#x2021;Â&#x2C6;Â?Â&#x201A;Â&#x2030;                Â&#x2020; Â?Â&#x201A; Â&#x2026;Â&#x160;Â&#x201E;Â&#x2039;Â&#x2020; Â&#x201E;           Â&#x201E;            Â&#x152;            Â&#x201A; Â?Â&#x201A;Â&#x2026;     Â&#x17D;Â&#x2018;Â&#x2019;  ­Â? Â&#x2C6;Â&#x160;  Â&#x2019;Â&#x2030;Â&#x192; Â&#x2021;  Â&#x201A;Â&#x20AC;  Â&#x160;  

    Â&#x2021; Â&#x160;  Â&#x2021; Â&#x20AC;Â&#x2C6; Â?Â&#x160; Â&#x201C;Â&#x201D;Â&#x2021;Â&#x201A;Â&#x20AC; Â?Â&#x160;     Â?Â?    Â&#x2020;      Â?     Â&#x2C6;Â?Â&#x201A;      Â&#x17D;Â&#x2018;Â&#x2019; Â&#x2021;  Â?Â? Â?Â&#x160;  Â&#x2019;Â&#x2030;Â&#x192; Â&#x2021;  Â&#x2026; Â&#x2026;Â&#x160;  Â    Â&#x2021;  Â?Â?Â?Â&#x160;  

  Â&#x2021;Â&#x20AC;  Â&#x160; Â&#x201C;Â&#x201D;Â&#x2021;­Â&#x201A;  Â&#x2022; Â&#x2020;               Â&#x2020;    Â&#x2020; Â&#x2013;      Â&#x2020; Â&#x2014;       Â&#x2020;Â&#x201C;Â&#x2020;                       Â&#x201A;Â&#x20AC; Â&#x201C;                                      Â&#x2020;  Â&#x2DC;      Â&#x2020;                     Đ&#x203A;Đ&#x2DC;ТĐ&#x2022;Đ Đ?ТУРĐ? 1. Behrman R.E., Butler A.S., editors // Preterm Birth: Causes, Consequences, and Prevention. Institute of Medicine of the National Academies. â&#x20AC;&#x201D; The National Academies Press; Washington D.C. â&#x20AC;&#x201D; 2007. â&#x20AC;&#x201D;772 p. 2. Ananth C.V., Joseph K.S., Oyelese Y. et al. Trends in preterm birth and perinatal mortality among singletons: United States, 1989 through 2000 // Obstet. Gynecol. â&#x20AC;&#x201D; 2005. â&#x20AC;&#x201D; Vol. 105. â&#x20AC;&#x201D; Đ . 1084-91. 3. Jackson R.A., Gibson K.A., Wu Y.W., Croughan M.S. Perinatal outcomes in singletons following in vitro fertilization: a meta_analysis // Obstet. Gynecol. â&#x20AC;&#x201D; 2004. â&#x20AC;&#x201D; Vol. 103. â&#x20AC;&#x201D; Đ . 551-63. 4. Goldenberg R.L., Iams J.D., Mercer B.M. et al. The preterm prediction study: the value of new vs. standard risk factors in predicting early and all spontaneous preterm births //Am. J. Public. Health. â&#x20AC;&#x201D; 1998. â&#x20AC;&#x201D; Vol. 88. â&#x20AC;&#x201D; Đ . 233-238. 5. Đ&#x153;акаŃ&#x2020;Đ°Ń&#x20AC;иŃ? Đ?.Đ&#x201D;. Đ&#x153;ĐľŃ&#x201A;айОНиŃ&#x2021;ĐľŃ ĐşĐ¸Đš Ń Đ¸Đ˝Đ´Ń&#x20AC;ОП и ниСкОПОНокŃ&#x192;ĐťŃ?Ń&#x20AC;Đ˝Ń&#x2039;Đľ гопаŃ&#x20AC;инŃ&#x2039; / Đ?.Đ&#x201D;. Đ&#x153;акаŃ&#x2020;Đ°Ń&#x20AC;иŃ?, Đ&#x2022;.Đ&#x2018;.Đ&#x;ĐľŃ&#x20AC;одоŃ&#x20AC;Ń?ова, Т.Đ&#x2018;.Đ&#x;Ń&#x2C6;ониŃ&#x2021;никОва // Consilium Medicum. â&#x20AC;&#x201D; 2006. â&#x20AC;&#x201D; Т. 8, â&#x201E;&#x2013; 6. 6. Dan Farine Đ&#x153;оМдŃ&#x192;наŃ&#x20AC;ОднаŃ? и овŃ&#x20AC;ĐžĐżĐľĐšŃ ĐşĐ°Ń? Ń&#x2C6;кОНа нопŃ&#x20AC;ĐľŃ&#x20AC;Ń&#x2039;внОгО ОйŃ&#x20AC;аСОваниŃ? в поŃ&#x20AC;инаŃ&#x201A;ОНОгии, ноОнаŃ&#x201A;ОНОгии и Ń&#x20AC;опŃ&#x20AC;ОдŃ&#x192;ĐşŃ&#x201A;ивнОК ПодиŃ&#x2020;инŃ&#x2039;. â&#x20AC;&#x201D; Press School ФНОŃ&#x20AC;онŃ&#x2020;иŃ?, 2013. 7. Romero R., Espinoza J., Kusanovic J. et al. The preterm parturition syndrome // BJOG. â&#x20AC;&#x201D; 2006. â&#x20AC;&#x201D; Vol. 113. â&#x20AC;&#x201D; Đ . 17-42. 8. Romero R., Nicolaides K., Conde-Agudelo A. et al. Vaginal progesterone in women with an asymptomatic sonographic short cervix in the midtrimester decreases preterm delivery and neonatal morbidity: A systematic review and metaanalysis of individual patient

Ă&#x20AC;Ă&#x160;Ă&#x201C;Ă&#x2DC;Ă&#x2026;Ă?Ă&#x2018;Ă&#x2019;Ă&#x201A;Ă&#x17D;. Ă&#x192;Ă&#x2C6;Ă?Ă&#x2026;Ă&#x160;Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;. Ă?Ă?Ă&#x201E;Ă&#x17D;Ă&#x160;Ă?Ă&#x2C6;Ă?Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

67

data. // Am. J. Obstet. Gynecol. — 2012. — Vol. 206, № 2. — P. 124. e1-124.e19. 9. Leitich H., Brunbauer M., Kaider A. et al. Cervical length and dilation of the internal as detected by vaginal ultrasonography as markers for preterm delivery: a systematic review. // Am J Obstet Gynecol. — 1999. — Vol. 181. — Р. 1465-1472. 10. Meis P., Klebanoff M. Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate // New England Journal of Medicine. — 2003 Jun. — Vol. 348. — Р. 2379-2385. 11. Fonseca E.B., Bittar R.E. Prophylactic administration of progesterone by vaginal suppository to reduce the incidence of spontaneous preterm birth in women at increased risk // AJOG. — 2003 Feb. — Vol. 188. — Р. 419-24. 12. Marc J.N.C. Keirse Progesteron administration in pregnancy may prevent preterm delivery // BJOG. — 1990. — Vol. 97. — Р. 149-154. 13. Fonseca E.B., Celik E., Parra M. et al. Progesterone and the risk of preterm birth among women with a short cervix // N Engl J Med. — 2007. — Vol. 357. — Р. 462-469. 14 DeFranco E.A., O’Brien J.M., Adair C.D. et al. Vaginal progesterone is associated with a decrease in risk for early preterm birth and improved neonatal outcome in women with a short cervix: a secondary analysis from a randomized, double-blind, placebo-controlled trial // Ultrasound Obstet Gynecol. — 2007. — Vol. 30. — Р. 697-705. 15. Vaisbuch E., Hassan S.S., Mazaki-Tovi S. et al. Patients with an asymptomatic short cervix (<or=15 mm) have a high rate of subclinical intraamniotic inflammation: implications for patient counseling // Am J Obstet Gynecol. — 2010. — Vol. 202, № 5. — P. 433.e1-433.e8.

16. Dodd J.M., Flenady V., Cincotta R., Crowther C.A. Prenatal administration of progesterone for preventing preterm birth // Cochrane Database of Systematic Reviews. — 2006; Issue 1. Art. No.: CD004947; (last updated on 31 December 2008). 17 Northen A., Norman G., Anderson K. Follow up of children exposed in utero to 17 alpha-hydroxyprogesterone caproate compared with placebo // Obstetrics and Gynecology. — 2007. — Vol. 110. — Р. 865-872. 18. Caritis S., Rouse D., Peaceman A et al. Prevention of preterm birth in triplets using 17 alpha-hydroxyprogesterone caproate: a randomized controlled trial // Obstetrics and Gynecology. —2009. — Vol. 113. — Р. 285-292. 19. Norman J., Mackenzie F., Owen P. et al. Progesterone for the prevention of preterm birth in twin pregnancy (STOPPIT): a randomized, double-blind, placebo-controlled study and meta-analysis // The Lancet. — 2009. — Vol. 373. — Р. 2034-2040. 20. Нassan S.S., Romero R., Vidyadhari D. Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix // Ultrasound Obstet Gynecol. — 2011. — Vol. 38. — Р. 18-31. 21 Romero J., Rebarber A., Saltzman D.H., Schwartz R. et al The prediction of recurrent preterm birth in patients on 17-alpha-hydroxyprogesterone caproate using serial fetal fibronectin and cervical length // Am J Obstet Gynecol. — 2012 Jul. — Vol. 207, № 1. — 51.e1-5. 22. Grobman W. Randomised controlled trial of progesterone treatment for preterm birth preventon in nulliparous women with cervical length less than 20 mm // American Journal Of Obstetrics and Gynecology. — 2012 Jan. — Vol. 206, Issue 1, Supplement. — S367.

REFERENCES 1. Behrman R.E., Butler A.S., eds. Preterm birth: Causes, consequences, and prevention. Washington, DC, The National Academies Press Publ., 2007. 772 p. 2. Ananth C.V., Joseph K.S., Oyelese Y., Demissie K., Vintzileos A.M. Trends in preterm birth and perinatal mortality among singletons: United States, 1989 through 2000. Obstetrics and Gynecology, 2005, vol. 105, no. 5, pp. 1084-1091. DOI: 10.1097/01.AOG.0000158124.96300.c7. 3. Jackson R.A., Gibson K.A., Wu Y.W., Croughan M.S. Perinatal outcomes in singletons following in vitro fertilization: A meta_analysis. Obstetrics and Gynecology, 2004, vol. 103, no. 3, pp. 551-563. DOI: 10.1097/01.AOG.0000114989.84822.51. 4. Goldenberg R.L., Iams J.D., Mercer B.M., et al. The preterm prediction study: The value of new vs. standard risk factors in predicting early and all spontaneous preterm births. American Journal of Public Health, 1998, vol. 88, no. 2, pp. 233-238. 5. Makatsariya A.D., Perederyaeva E.B., Pshenichnikova T.B. Metabolic syndrome and low molecular weight heparins. Consilium Medicum, 2006, vol. 8, no. 6, pp. 35-41. (in Russ.). 6. Dan Farine International and European School of Continuing Education in Perinatology, Neonatology and Reproductive Medicine. Florence Press School. 2013. 7. Romero R., Espinoza J., Kusanovic J., et al. The preterm parturition syndrome. BJOG: An International Journal of Obstetrics and Gynaecology, 2006, vol. 113, suppl. 3, pp. 17-42. DOI: 10.1111/j.14710528.2006.01120.x. 8. Romero R., Nicolaides K., Conde-Agudelo A., et al. Vaginal progesterone in women with an asymptomatic sonographic short cervix in the midtrimester decreases preterm delivery and neonatal morbidity: A systematic review and metaanalysis of individual patient data. American Journal of Obstetrics and Gynecology, 2012, vol. 206, no. 2, pp. 124.e1-124.e19. DOI: 10.1016/j.ajog.2011.12.003. 9. Leitich H., Brunbauer M., Kaider A., et al. Cervical length and dilation of the internal as detected by vaginal ultrasonography as markers for preterm delivery: A systematic review. American Journal of Obstetrics and Gynecology, 1999, vol. 181, no. 6, pp. 1465-1472. 10. Meis P., Klebanoff M., Thom E., et al. Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate. New England Journal of Medicine, 2003, vol. 348, no. 24, pp. 2379-2385. DOI: 10.1056/NEJMoa035140. 11. Da Fonseca E.B., Bittar R.E., Carvalho M.H.B., Zugaib M. Prophylactic administration of progesterone by vaginal suppository to reduce the incidence of spontaneous preterm birth in women at increased risk: A randomized placebo-controlled double-blind study. American Journal of Obstetrics and Gynecology, 2003, vol. 188, no. 2, pp. 419-424. DOI: 10.1067/mob.2003.41. 12. Marc J.N.C. Keirse Progesteron administration in pregnancy may prevent preterm delivery. BJOG: An International Journal of

Obstetrics and Gynaecology, 1990, vol. 97, no. 2, pp. 149-154. DOI: 10.1111/j.1471-0528.1990.tb01740.x. 13. Fonseca E.B., Celik E., Parra M., et al. Progesterone and the risk of preterm birth among women with a short cervix. New England Journal of Medicine, 2007, vol. 357, no. 5, pp. 462-469. DOI: 10.1056/ NEJMoa067815 14 DeFranco E.A., O’Brien J.M., Adair C.D., et al. Vaginal progesterone is associated with a decrease in risk for early preterm birth and improved neonatal outcome in women with a short cervix: A secondary analysis from a randomized, double-blind, placebo-controlled trial. Ultrasound in Obstetrics and Gynecology, 2007, vol. 30, no. 5, pp. 697-705. DOI: 10.1002/uog.5159. 15. Vaisbuch E., Hassan S.S., Mazaki-Tovi S., et al. Patients with an asymptomatic short cervix (<or=15 mm) have a high rate of subclinical intraamniotic inflammation: Implications for patient counseling. American Journal of Obstetrics and Gynecology, 2010, vol. 202, no. 5, pp. 433.e1-433.e8. DOI: 10.1016/j.ajog.2010.02.007. 16. Dodd J.M., Flenady V., Cincotta R., Crowther C.A. Prenatal administration of progesterone for preventing preterm birth. Cochrane Database of Systematic Reviews (Online), 2006, no. 1, art. no. CD004947. 17 Northen A., Norman G., Anderson K. Follow up of children exposed in utero to 17 alpha-hydroxyprogesterone caproate compared with placebo. Obstetrics and Gynecology, 2007, vol. 110, no. 4, pp. 865-872. DOI: 10.1097/01.AOG.0000281348.51499.bc. 18. Caritis S., Rouse D., Peaceman A., et al. Prevention of preterm birth in triplets using 17 alpha-hydroxyprogesterone caproate: A randomized controlled trial. Obstetrics and Gynecology, 2009, vol. 113, no. 2, pt. 1, pp. 285-292. DOI: 10.1097/AOG.0b013e318193c677. 19. Norman J., Mackenzie F., Owen P., et al. Progesterone for the prevention of preterm birth in twin pregnancy (STOPPIT): A randomized, double-blind, placebo-controlled study and meta-analysis. The Lancet, 2009, vol. 373, no. 9680, pp. 2034-2040. DOI: 10.1016/ S0140-6736(09)60947-8. 20. Нassan S.S., Romero R., Vidyadhari D., et al. Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: A multicenter, randomized, double-blind, placebo-controlled trial. Ultrasound in Obstetrics and Gynecology, 2011, vol. 38, no. 1, pp. 18-31. DOI: 10.1002/uog.9017. 21 Romero J., Rebarber A., Saltzman D.H., Schwartz R., et al The prediction of recurrent preterm birth in patients on 17-alpha-hydroxyprogesterone caproate using serial fetal fibronectin and cervical length. American Journal of Obstetrics and Gynecology, 2012, vol. 207, no. 1, pp. 51.e1-51.e5. DOI: 10.1016/j.ajog.2012.04.024. 22. Grobman W. Randomised controlled trial of progesterone treatment for preterm birth preventon in nulliparous women with cervical length less than 20 mm. American Journal of Obstetrics and Gynecology, 2012, vol. 206, suppl. no. 1, p. S367.

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


Ă?Ă?Ă&#x20AC;Ă&#x160;Ă&#x2019;Ă&#x2C6;Ă&#x2014;Ă&#x2026;Ă&#x2018;Ă&#x160;Ă&#x20AC;Ă&#x; Ă&#x152;Ă&#x2026;Ă&#x201E;Ă&#x2C6;Ă&#x2013;Ă&#x2C6;Ă?Ă&#x20AC;

68

â&#x20AC;&#x2DC;7 (76) докайŃ&#x20AC;Ń&#x152; 2013 Đł.



Ă?.Ă&#x2018;. Ă&#x2021;Ă&#x20AC;Ă&#x152;Ă&#x20AC;Ă&#x2039;Ă&#x2026;Ă&#x2026;Ă&#x201A;Ă&#x20AC;1, Ă&#x201A;.Ă&#x160;. Ă&#x2039;Ă&#x20AC;Ă&#x2021;Ă&#x20AC;Ă?Ă&#x2026;Ă&#x201A;Ă&#x20AC;1, Ă?.Ă&#x20AC;. Ă&#x2014;Ă&#x2026;Ă?Ă&#x2026;Ă?Ă&#x20AC;Ă?Ă&#x17D;Ă&#x201A;Ă&#x20AC;2, Ă&#x20AC;.Ă&#x201A;. Ă&#x201D;Ă?Ă&#x2C6;Ă&#x2021;Ă&#x2C6;Ă?Ă&#x20AC;2, Ă&#x152;.Ă&#x2026;. Ă&#x2020;Ă&#x2026;Ă&#x2039;Ă&#x2026;Ă&#x2021;Ă&#x17D;Ă&#x201A;Ă&#x20AC;3 Ă&#x160;à çàíùêàÿ ãÎùóäàðùòâüííàÿ ÏüäèÜèíùêàÿ àêàäüÏèÿ, 420015, ĂŁ. Ă&#x160;àçàíß, óÍ. à ÎÍßøàÿ Ă&#x160;ðàùíàÿ, ä. 51 2 Ă&#x201A;ÎÍÌùêàÿ Ă&#x2013;Ă&#x192;Ă , 425005, ĂŁ. Ă&#x201A;ÎÍÌùê, óÍ. Ă&#x160;ðÝÍÎâà, ä. 6 3 Ă?üùïóåÍèêàíùêàÿ êÍèíèáüùêàÿ åÎÍßíèÜà â&#x201E;&#x2013; 2, 420043 ĂŁ. Ă&#x160;àçàíß, óÍ. Ă&#x2014;üþÎâà, ä. 1Ă 

1

   à óòÎàíòèòüÍ Ă­Ă  ðàçâèòèü ãüùòàÜèÎííÎãÎ ïðÎÜüùùà Ă&#x2021;àÏàÍüüâà Ă?Îçà Ă&#x2018;üÏüíÎâíà â&#x20AC;&#x201D; äÎêòÎð ÏüäèÜèíùêèþ íàóê, ïðÎôüùùÎð êàôüäðÝ àêóøüðùòâà è ãèíüêÎÍÎãèè â&#x201E;&#x2013; 1, òüÍ. (843) 236-46-41, e-mail: zamaleewa@rambler.ru1 Ă&#x2039;àçàðüâà Ă&#x201A;ĂĽĂ­ĂĽĂ°Ă  Ă&#x160;àÏèÍßüâíà â&#x20AC;&#x201D; âðàá àêóøüð-ãèíüêÎÍÎã, ùÎèùêàòüÍß êàôüäðÝ àêóøüðùòâà è ãèíüêÎÍÎãèè â&#x201E;&#x2013; 1, òüÍ. +7-961-379-75-97, e-mail: Venera-Lazareva@mail.ru1 Ă&#x2014;üðüïàíÎâà Ă?àòàÍßÿ Ă&#x20AC;ÍüêùàíäðÎâíà â&#x20AC;&#x201D; êàíäèäàò ÏüäèÜèíùêèþ íàóê, çàâüäóÞÚàÿ ðÎäèÍßíÝÏ ÎòäüÍüíèüÏ, òüÍ. +7-961-376-96-06, e-mail: nat26@list.ru2 Ă&#x201D;ðèçèíà Ă&#x20AC;íàùòàùèÿ Ă&#x201A;ÍàäèÏèðÎâíà â&#x20AC;&#x201D; âðàá àêóøüð-ãèíüêÎÍÎã, òüÍ. +7-905-182-53-03, e-mail: nastja-frizina@rambler.ru2 Ă&#x2020;üÍüçÎâà Ă&#x152;àðèÿ Ă&#x2026;âãüíßüâíà â&#x20AC;&#x201D; âðàá àêóøüð-ãèíüêÎÍÎã, òüÍ. +7-919-627-13-66, e-mail: gelezovaam@gmail.com3                                                  Â?         

R.S. ZAMALEEVA1, V.K. LAZAREVA1, N.A. CHEREPANOVA2, A.V. FRIZINA2, M.E. ZHELEZOVA3 1 Kazan State Medical Academy, 51 Bolshaya Krasnaya St., Kazan, Russian Federation 420015 2 Volzhsk Central Clinical Hospital, 6 Krylova St., Volzhsk, Russian Federation 425005 3 Republican Clinical Hospital â&#x201E;&#x2013; 2, 1Ă Chekhova St., Kazan, Russian Federation 420043

Contemporary concept of the impact of regulatory autoantibodies to gestational process Zamaleeva R.S. â&#x20AC;&#x201D; D. Med. Sc., Professor of the Department of Obstetrics and Gynecology â&#x201E;&#x2013; 1, tel. (843) 236-46-41, e-mail: zamaleewa@rambler.ru1 Lazareva V.K. â&#x20AC;&#x201D; obstetrician-gynecologist, external doctorate student of the Department of Obstetrics and Gynaecology â&#x201E;&#x2013; 1, tel. +7-961-379-75-97, e-mail: Venera-Lazareva@mail.ru1 Cherepanova N.A. â&#x20AC;&#x201D; Cand. Med. Sc., Head of the maternity department, tel. +7-961-376-96-06, e-mail: nat26@list.ru2 Frizina A.V. â&#x20AC;&#x201D; obstetrician-gynecologist, tel. +7-905-182-53-03, e-mail: nastja-frizina@rambler.ru2 Zhelezova M.E. â&#x20AC;&#x201D; obstetrician-gynecologist, tel. +7-919-627-13-66, e-mail: gelezovaam@gmail.com3 Â?Â?Â? ­Â&#x20AC;Â&#x201A;Â&#x192;Â&#x201E;Â&#x2026;Â&#x2020;Â&#x20AC;Â&#x201A; Â&#x201E;Â&#x20AC;­Â&#x20AC; Â&#x201A;Â&#x192;Â&#x20AC;Â&#x2020;Â&#x201A;Â&#x2021;Â&#x2C6;Â&#x192;Â&#x2030;Â&#x2021;Â?Â&#x160;Â&#x20AC;Â&#x201E;Â?Â&#x192;Â&#x2020;Â?Â&#x192;Â&#x2039;Â&#x201A;Â&#x152;Â?Â&#x2C6;Â&#x20AC;Â&#x160;Â&#x2021;Â&#x17D;Â&#x2018;Â&#x192;­Â?Â&#x17D; ­Â&#x20AC;Â&#x201E;Â&#x2021;Â&#x2020;Â&#x160;Â&#x201A;Â&#x201E; Â&#x2018;Â?Â&#x2020;Â&#x201A;Â&#x160;Â&#x192;Â&#x2039;Â&#x2021;Â&#x2018;Â&#x2018; Â&#x2020;Â?Â&#x160;Â&#x2026;Â&#x160;Â&#x201A;Â?Â&#x2018;Â&#x201A;Â&#x192;Â&#x2018;Â&#x192;Â&#x2020;Â&#x2021;Â&#x201A;Â&#x192;Â&#x201E;Â&#x201A;Â&#x152;Â?Â&#x2019;Â?Â&#x201E;Â&#x160;Â&#x2021;Â&#x160;Â&#x201A;Â&#x20AC;Â&#x2020;Â&#x17D;Â?Â&#x192;Â&#x2039;Â&#x20AC;Â&#x2020; Â&#x2021;Â&#x2020;Â&#x201A;Â?Â&#x201E;Â&#x2020;Â&#x20AC;­Â&#x2018;Â&#x2021;­Â&#x2021;Â? Â&#x201C;Â&#x20AC;Â&#x201D;Â&#x2021;Â&#x2020;Â?Â&#x2021;Â&#x2020;Â&#x201A;Â&#x192;Â&#x20AC;Â&#x17D;Â&#x17D;Â&#x192; Â&#x2020;Â&#x201A;Â&#x201A;Â&#x152;Â?Â&#x2039;Â&#x20AC;Â&#x17D;Â&#x201A;Â&#x201A;Â&#x152;Â&#x20AC;Â&#x201A;Â&#x2019;Â?Â&#x201E;Â&#x160;Â&#x2021;Â&#x160;Â&#x201A;Â?Â&#x2020;Â&#x201A;Â&#x17D;Â&#x152;Â&#x20AC;Â&#x2020;Â?Â?Â&#x160;Â&#x2021;Â&#x2020;Â&#x201A;Â&#x152;Â?Â&#x17D;Â&#x192;Â&#x2020;Â&#x201A;Â?Â&#x2020;Â&#x201A;Â&#x192;Â&#x2039;Â&#x201E;Â?Â? ­Â&#x20AC;Â&#x201A;Â&#x192;Â&#x201E;Â&#x2026;Â&#x20AC; Â&#x201A;Â&#x192;Â&#x20AC;Â&#x2020;Â&#x201A;Â&#x2021;Â&#x2C6;Â&#x192;Â&#x2030;Â&#x2021;Â?Â&#x160;Â&#x192;Â&#x17D;Â&#x17D; Â&#x201E;Â&#x2030; Â&#x201E;Â&#x2021;Â&#x2020;Â?Â&#x2019;Â&#x201E;Â?Â&#x17D;­Â&#x2021;Â&#x2020;Â&#x2021;Â&#x17D;Â&#x20AC;­ Â&#x201E;Â?Â&#x2018;Â&#x192;Â&#x2022;Â&#x20AC;Â&#x2C6;­Â?Â&#x2030;Â&#x2021;Â&#x160;Â&#x201A; Â&#x201E;Â&#x2C6;Â&#x20AC;Â&#x2020;Â&#x17D;Â?Â&#x160;Â&#x201A;Â&#x152;Â?Â&#x2C6;Â&#x2021;Â?Â&#x160;Â&#x17D;Â&#x2021;Â?Â&#x2020;Â&#x201A;Â&#x2021;Â&#x2013;Â&#x17D;Â&#x20AC;Â&#x2020;Â&#x2030;Â&#x2019;Â&#x201E;Â&#x20AC;Â&#x17D;Â&#x201A;Â&#x2021;Â&#x17D;Â&#x20AC;­Â&#x2021;Â&#x2020;Â&#x201A;Â?Â&#x201E;Â?Â&#x160;Â&#x201A;Â&#x2021;Â&#x160;Â&#x201E;Â?Â&#x2019;Â&#x201E;Â?Â&#x160;Â?Â&#x2020;Â&#x201A;Â?Â&#x2030;Â&#x2C6;Â&#x2026;Â&#x160;Â&#x2019;Â?Â&#x17D;Â&#x2021;Â&#x20AC;­Â&#x2021;Â&#x201A;Â&#x2021;Â?Â&#x160;Â&#x192;Â&#x2039;Â&#x201A;Â&#x152;Â?Â&#x17D;Â&#x192;Â&#x2020;Â&#x201A;Â?Â&#x2020;Â&#x201A;Â&#x192;Â&#x2039;Â&#x2022;Â&#x20AC;Â&#x201E;Â&#x2021;Â&#x192; Â&#x160;Â&#x20AC; Â&#x201A;Â&#x192;Â&#x20AC;Â&#x2020;Â&#x201A;Â&#x2021;Â&#x2C6;Â&#x192;Â&#x2030;Â&#x2021;Â?Â&#x160; Â&#x20AC;Â&#x201A;Â&#x201A;Â&#x152;Â?Â&#x2020;Â&#x192;Â&#x201E;Â&#x2018;Â&#x20AC;­Â&#x20AC;Â&#x2020;Â&#x2030;Â&#x17D;Â&#x192;Â&#x2018;Â&#x2019;­Â&#x2021;Â&#x17D;Â&#x20AC;Â&#x201A;Â?Â&#x2030;Â&#x2019;Â&#x201E;Â?Â?Â&#x2020;Â&#x20AC;Â&#x2020;Â&#x17D;Â&#x2026;  Â&#x201E;Â?Â? ­Â&#x20AC;Â&#x201A;Â&#x192;Â&#x201E;Â&#x2026;Â&#x20AC; Â&#x201A;Â&#x192;Â&#x20AC;Â&#x2020;Â&#x201A;Â&#x2021;Â&#x2C6;Â&#x192;Â&#x2030;Â&#x2021;Â?Â&#x160;pregnancy complicationsÂ&#x2030;Â&#x2021;Â&#x160;Â&#x192;Â&#x201E;Â&#x2030;Â?Â&#x201E;Â&#x160;Â&#x192;Â&#x2039;Â&#x2021;Â&#x2018;Â&#x2018; Â&#x2020;Â?Â&#x201E;Â?Â? ­Â&#x20AC;Â&#x201A;Â&#x2021;Â&#x192;Â&#x2020;

                                                  -

     Â? Â? Â? Â?        Â?     Â?  Â?      Â?     ­  Â&#x20AC;       Â&#x20AC;  Â?             -

Ă&#x20AC;Ă&#x160;Ă&#x201C;Ă&#x2DC;Ă&#x2026;Ă?Ă&#x2018;Ă&#x2019;Ă&#x201A;Ă&#x17D;. Ă&#x192;Ă&#x2C6;Ă?Ă&#x2026;Ă&#x160;Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;. Ă?Ă?Ă&#x201E;Ă&#x17D;Ă&#x160;Ă?Ă&#x2C6;Ă?Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.                        ­ € ‚    ƒ    ƒ  „…†  €    ‡      €  ˆ  ‰ Š       €        ‡     ‹  Œ ƒ    Ž ‘    ƒ      € ‡ ƒ   €   €’ƒ ­€ ƒ    ‘     € €     ’ “          ’       ”  ’  ƒ ‡  €              ‡ ‡   •           ƒ  ƒ€   –                         ƒ   ƒ€        ‡   ƒ    —  €’   ­€          ’            ‡   ‡ƒ˜  ”  €     ‹Š   Œ ‡    ‡ €   €’   ƒ€ Ž   ™‡ š Š     ƒ €‹ ‡ 

Œ               ­          ’     ™ ƒ š  ƒ  ’ ƒ ƒ   ƒ    Ž  ­˜˜ ›     € ƒ           …  ‹     Œ   ‚   ’ ‚   ‚       € ‡†     ƒ   

      ’      œ    ‹  

69

žŸ¡žŒ  €   ™š            ƒ      ’ €          ‡             €   •   €’ƒ             ‚€  ¢    ‚€   ‹  £¤¥         ƒ        ƒ    Œ         ‡  ƒ  €  ˜¦ ˜ —   ’         „…†     € €       ’  —         [ ]      €            ‡     €§   ™‡  ‡‡ ‡š ƒ   €˜­˜‰‘  ƒ     ‚    „    ƒ  ƒ  ƒ ƒ ‡ ƒ    €ƒ­  ƒ ƒ ’  ƒ € ˜  €      ’        €  ‡            €                   €   €  ƒ        £¤¥     € ¨©ª  „…†    ‡‡  ‡‡ ƒ   €¦­    €¦­  —  ­       €   €       ‚€      €   ’  €   Š   ’              €   ”«Š­—­† — ¬®…ƒ˜Ž    ’ Ž ¯€    ’‚€       —€       €      — ’  €

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


70

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

           ­   €  ‚ƒ     €     „…†‡  ­  €   €  ˆ  €€ ‰‚Š‹Œ Ž € Œ‘Œ  ‰‚’‹        “€ ” “€         €  Œ   €   ­   ˆ   ­   € €•  €     ” ”  ˆ  ” €‰‚……ƒ…‚‹Œ Ž        –‚ƒƒ—˜ ™… š›ˆ€€€€    €  € €€ „   ­”  €­€   € €  € € €€ €‡      €€          “€   œ  ‚žŠ†   œ  Ÿž‚†    œ  ‚’¡†Œ  €€    ­ ¡¢†Œ—   €    € €      €      ­Œ Ž       €­€ €       ­”Œ —      € € ”  €­”  €Œ Ž €   € —™    ž£† €  €œ Ÿ’†  œ ’‚†Œ˜ €   € € €     € € € ‰‚¡‹Œ      ­               Œ ¤ € ­ €  €   €    ¥…   €€€ ˆˆ€ ¦§žŸ —˜  ¨š©ª «¬– ©«© «š…ƒƒŒ ® ž¢† €  €    “€  £¢    €€ “€           €      ¦§žŸ «¬– ©«© «š…ƒƒ  ¨š©ª  € œ  —˜  ‘¯  °…Ž        £ƒ†‰‚…………£‹Œ Ž € ¦ Œ™Œ ± ²ŒŒ  ˜ŒŒ ‰…¢‹         ³´¨   ­ —˜  € €€ €  „µ¦ƒƒ‚‚Ÿ¶ µ¦ƒ‚Ÿ‚…‡ €   „·¸¹ƒŸ£ƒƒ ·¸–ƒ¡‚…ƒ‡    € „˜¦¦§‡ € ” ˆˆ ­“€          …¢£ž ­ €  €­­ ­

‘7 (76) декабрь 2013 г. “€…¢    €€   ­ ­  ­ € ”  €  ” €­  €­Œ ˜     €  “€     ­ “ €  ”  ­    €    “ €  € €  €  ­ €         €Œ         “€   ”    €€‰…¢‹Œ™€    €  ˆˆ ­ ”   €  €   €€  €       €      ­   € ‰‚……¢‹Œ ¤€        €  ³³³ €  ”  € €     € €  „ºµ»‡      ­€ €     €€€ ˆˆ€  €€   ”    Š¡†    €€ ”­ € €‰…Ÿ‹Œ    ”    ” ­       €   €€Œ Ž ­    €    €   –‚ƒƒ ˆ  € €€€   €     €      € ± ¦Œ™Œ ‰…ž‹  € €     €    €€   €­Œ ®  €   €€      € €    ”  €“€  €  €­€     ” ‰…¡…Š‹Œ —    ­ ŒŒ€‰…’‹­  €±¦–‚ƒƒŒ Ž €     ˆ  €  €€ €  ­   ˆ€  ˆ …ž  ‚‚†¶    ­   …Ÿ ‚£†Œ € €     ˆ ”      ”  € €      €     € €­        €    ”       €€­ €   ”      €  Œ

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

71

ЛИТЕРАТУРА 1. Poletaev A.B., Churilov L.P. Immunophysiology, natural autoimmunity and human health // Вестник Международной академии наук (Русская секция). — 2009. — № 1. — С. 11-16. 2. Shoenfeld Y. Etiology and pathogenetic mechanisms of the antiphospholipid syndrome unraveled / Y. Shoenfeld // Trends in Immunology. — 2003. — Vol. 24, № 1. — P. 2-4. 3. Schwarts R.S. Anti-DNA antibodies and the problem of autoimmunity / R.S. Schwarts // Cell Immunol. — 1986. — Vol. 99, № 1. — Р. 38-43. 4. Takeuchi Y. Autoimmunity and its association with non-organspecific antibodies and subclinical alterations of women with a history of pregnancy loss or preeclampsia / Y. Takeuchi // Journal of Reproductive Immunology. — 1988. — Vol. 2. — P. 234-239. 5. Lacroix-Desmazes S. Self-reactive antibodies (natural autoantibodies) in healthy individuals / S. Lacroix-Desmazes, S.V. Kaveri, L. Mouthon et al. // J. Immunol. Methods. — 1998. — Vol. 216. — P. 117-137. 6. Полетаев А.Б. Регуляторные ауто-АТ / А.Б. Полетаев // Сб. научн. трудов: Моноклональные антитела в нейробиологии. — Новосибирск, 1995. — С. 37-47. 7. Poletaev A., Osipenko L. General network of natural autoantibodies as Immunological Homunculus (Immunculus) // Autoimmunity Review. — 2003. — Vol. 2, 5. — Р. 264-271. 8. Мальцев С.В., Полетаев А.Б., Мансурова Г.Ш. Диагностическое и прогностическое значение определения естественных аутоантител к почечным антигенам в развитии пиелонефрита у детей // Педиатрия. — 2007. — Т. 86, № 6. — Р. 60-64. 9. Полетаев А.Б. Физиологическая иммунология (естественные аутоантитела и проблемы наномедицины) / А.Б. Полетаев. — М.: Миклош, 2010. — 218 с. 10. Cohen I.R. The Immunological gomunculus speaks in microarray / I.R. Cohen // Natural autoimmunity in physiology and pathology abstracts. — 2005. — P. 13. 11. Zaichik A.Sh. Autoimmune regulation of genetically determined cell functions in health and disease / A.Sh. Zaichik, L.P. Churilov, V.J. Utekhin // Pathophysiology. — 2008. — Vol. 15. — 191-207. 12. Замалеева Р.С. Клиническое значение определения уровня регуляторных аутоантител для оценки риска развития гестоза / Р.С. Замалеева, Л.И. Мальцева, Н.А. Черепанова, С.В. Букатина, М.А. Нюхнин // Практическая медицина. — 2009. — № 2 (34). — С. 68-71. 13. Dennenberg V. The role of the uterine environment upon instrumental fear conditioning in autoimmune mice // Cб.: Условный рефлекс в системе нейронаук. — Ленинград, 1991. — C. 37-38. 14. Tеппермен Дж. Физиология обмена веществ и эндокринной системы / Дж. Tеппермен, Х. Tеппермен. — М.: Мир, 1989. — С. 274-314. 15. Smith C. Pregnancy complicated by plasminogen activator inhibitor type 1 deficiency/ C. Smith, Y.S. Thornton // South Med J. — 2010. — Vol. 103, № 12. — Р. 1259-60.

16. Сухих Г.Т. Иммунология беременности / Г.Т. Сухих, Л.В. Ванько. — М.: РАМН, 2003. — 400 с. 17. Нюхнин М.А. Клиническое значение оценки содержания естественных аутоантител для оптимизации тактики ведения беременных с отягощенным акушерским анамнезом: автореф. дис. ... канд. мед. наук / М.А. Нюхнин. — Казань, 2007. — 24 с. 18. Полетаев А.Б. Аутоантитела и иммунопатология беременности / А.Б. Полетаев, Ф.Алиева // Практическая медицина. — 2010. — № 4(43). — С. 20-24. 19. Серова О.Ф. Предгравидарная подготовка женщин с невынашиванием беременности (патогенетическое обоснование, критерии эффективности): автореф. дис. … д-ра мед. наук / О.Ф. Серова. — М., 2000. — 46 с. 20. Мерзлякова А.А. Аутоантитела к нативной ДНК при синдроме задержки развития плода / А.А. Мерзлякова, А.Ф. Добротина, В.В. Немов, С.Г. Ивашкина // Материалы IV Российского форума «Мать и дитя». — М.: МИК, 2002. — С. 421. 21. Taylor R.N. Review: Immunobiology of preeclampsia / R.N. Taylor // American Journal of Reproductive Immunology. — 1997. — Vol. 37, № 1. — Р. 79-86. 22. Сидорова И.С. Лечение и профилактика нарушений в системе гемостаза в акушерско-гинекологической практике / И.С. Сидорова, Т.В. Овсянникова, Н.А. Шешукова // Гинекология. — 2005. — Т. 7, № 2. 23. Черепанова Н.А. Клиническое значение уровней регуляторных аутоантител для оценки риска развития гестоза: автореф. дис. … канд. мед. наук / Н.А. Черепанова. — Казань, 2008. — 24 с. 24. Макаров О.В., Богатырев Ю.А., Осипова Н.А. Значение аутоантител в патогенезе преэклампсии // Акушерство и гинекология. — 2012. — № 4-1. — С. 16-21. 25. Букатина С.В. Клиническое значение уровней регуляторных аутоантител для оценки риска развития кровотечения в родах и послеродовом периоде: автореф. дис. … канд. мед. наук / С.В. Букатина. — Казань, 2011. — 24 с. 26. Беседина М.В. Влияние материнских аутоантител к белкам нервной ткани и белковым фракциям во время беременности на показатели здоровья новорожденных и детей раннего возраста: автореф. дис. … канд. мед. наук / М.В. Беседина. — Москва, 2004. — 25 с. 27. Замалеева Р.С. Нарушения развития плода у беременных с экстрагенитальными заболеваниями, их профилактика и лечение: автореф. дис. … канд. мед. наук / Р.С. Замалеева. — Казань, 1993. — 43 с. 28. Ключников С.О. Новые иммунобиотехнологии в перинатологии и педиатрии / С.О. Ключников, А.Б. Полетаев, Т.С. Будыкина, Г.А. Генералова // В сб. лекции по педиатрии. — М.: РГМУ. — 2001. — Т. 1. — С. 243-267. 29. Тареева Т.Г., Ткачева И.И., Микаелян А.В. и др. / Способ прогнозирования перинатальной патологии у беременных с хроническими инфекционно-воспалительными заболеваниями // Описание изобретения к патенту Российской Федерации. №2003135754/15, 2005.07.20.

REFERENCES 1. Poletaev A.B., Churilov L.P. Immunophysiology, natural autoimmunity and human health. Vestnik Mezhdunarodnoy akademii nauk (Russkaya sektsiya), 2009, no. 1, pp. 11-16. (in Russ.). 2. Shoenfeld Y. Etiology and pathogenetic mechanisms of the antiphospholipid syndrome unraveled. Trends in Immunology, 2003, vol. 24, no. 1, pp. 2-4. DOI: 10.1016/S1471-4906(02)00007-8. 3. Schwarts R.S. Anti-DNA antibodies and the problem of autoimmunity. Cellular Immunology, 1986, vol. 99, no. 1, pp. 38-43. 4. Takeuchi Y. Autoimmunity and its association with non-organspecific antibodies and subclinical alterations of women with a history of pregnancy loss or preeclampsia. Journal of Reproductive Immunology, 1988, vol. 2, pp. 234-239. 5. Lacroix-Desmazes S., Kaveri S.V., Mouthon L., Ayouba A., Malanchère E., Coutinho A., Kazatchkine M.D. Self-reactive antibodies (natural autoantibodies) in healthy individuals. Journal of Immunological Methods, 1998, vol. 216, no. 1-2, pp. 117-137. DOI: 10.1016/S0022-1759(98)00074-X. 6. Poletaev A.B. Regulatory autoantibodies. Sb. nauch. tr.: Monoklonal’nye antitela v neyrobiologii [Coll. sci. pap.: Monoclonal antibodies in neurobiology]. Novosibirsk, 1995, pp. 37-47. 7. Poletaev A., Osipenko L. General network of natural autoantibodies as Immunological Homunculus (Immunculus). Autoimmunity Reviews, 2003, vol. 2, no. 5, pp. 264-271. DOI: 10.1016/S15689972(03)00033-8. 8. Mal’tsev S.V., Poletaev A.B., Mansurova G.Sh. Determination of natural autoantibodies against renal antigens – diagnostic and prognostic role in development pediatrics. Pediatriya, 2007, vol. 86, no. 6, pp. 60-64. (in Russ.). 9. Poletaev A.B. Fiziologicheskaya immunologiya (estestvennye autoantitela i problemy nanomeditsiny) [Physiological immunology (natural autoantibodies and problems of nanomedicine)]. Moscow, Miklosh Publ., 2010. 218 p. 10. Cohen I.R. The Immunological gomunculus speaks in microarray. Natural autoimmunity in physiology and pathology abstracts. 2005. p. 13.

11. Zaichik A.Sh., Churilov L.P., Utekhin V.J. Autoimmune regulation of genetically determined cell functions in health and disease. Pathophysiology, 2008, vol. 15, no. 3, pp. 191-207. DOI: 10.1016/j. pathophys.2008.07.002. 12. Zamaleeva R.S., Mal’tseva L.I., Cherepanova N.A., Bukatina S.V., Nyukhnin M.A. Clinical value of definition of a level of regulatory autoantibodies for an estimation of risk of development of gestosis. Prakticheskaya meditsina, 2009, no. 34, pp. 68-71. (in Russ.). 13. Dennenberg V. The role of the uterine environment upon instrumental fear conditioning in autoimmune mice. Uslovnyy refleks v sisteme neyronauk: Tez. dokl. Vsesoyuz. simp. Leningrad, 16-19 apr. 1991 g. [Conditioned reflex in the system of neurosciences: Abst. pap. All-Union symp. Leningrad, Apr. 16-19, 1991]. Leningrad, Nauka Publ., 1991, pp. 37-38. 14. Tepperman J. Metabolic and endocrine physiology. Chicago, Year Book Medical Publ., 1969. 335 p. (Russ. ed. Teppermen Dzh. Fiziologiya obmena veshchestv i endokrinnoy sistemy. Moscow, Mir Publ., 1989, pp. 274-314.). 15. Smith C., ThorntonY.S. Pregnancy complicated by plasminogen activator inhibitor type 1 deficiency. Southern Medical Journal, 2010, vol. 103, no. 12, pp. 1259-1260. DOI: 10.1097/ SMJ.0b013e3181faee7e. 16. Sukhikh G.T., Van’ko L.V. Immunologiya beremennosti [Immunology of pregnancy]. Moscow, Russ. Acad. Med. Sci. Publ., 2003. 400 p. 17. Nyukhnin M.A. Klinicheskoe znachenie otsenki soderzhaniya estestvennykh autoantitel dlya optimizatsii taktiki vedeniya beremennykh s otyagoshchennym akusherskim anamnezom. Kand. med. nauk diss. Avtoref. [The clinical significance of evaluating the content of natural autoantibodies to optimize the management of pregnant women with a complicated obstetric history. Cand. med. sci. diss. Synopsis]. Kazan’, 2007. 24 p. 18. Poletaev A.B., Alieva F. Autoantibodies and immunopathology of pregnancy. Prakticheskaya meditsina, 2010, no. 43, pp. 20-24. (in Russ.). 19. Serova O.F. Predgravidarnaya podgotovka zhenshchin s nevynashivaniem beremennosti (patogeneticheskoe obosnovanie, kriterii effektivnosti). Dokt. med. nauk diss. Avtoref. [Pregravid preparing of

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


72

Ă?Ă?Ă&#x20AC;Ă&#x160;Ă&#x2019;Ă&#x2C6;Ă&#x2014;Ă&#x2026;Ă&#x2018;Ă&#x160;Ă&#x20AC;Ă&#x; Ă&#x152;Ă&#x2026;Ă&#x201E;Ă&#x2C6;Ă&#x2013;Ă&#x2C6;Ă?Ă&#x20AC;

women with miscarriage (pathogenetic substantiation, efficiency criteria). Dr. med. sci. diss. Synopsis]. Moscow, 2000. 46 p. 20. Merzlyakova A.A., Dobrotina A.F., Nemov V.V., Ivashkina S.G. Autoantibodies to native DNA in fetal growth retardation. Mat. IV Ross. foruma â&#x20AC;&#x153;Matâ&#x20AC;&#x2122; i Dityaâ&#x20AC;? [Proc. 4th Russ. Forum â&#x20AC;&#x153;Mother and Childâ&#x20AC;?]. Moscow, â&#x20AC;&#x153;MEDI Ekspoâ&#x20AC;? Publ., 2002, p. 421. 21. Taylor R.N. Review: Immunobiology of preeclampsia. American Journal of Reproductive Immunology, 1997, vol. 37, no. 1, pp. 79-86. 22. Sidorova I.S. OvsyannikovaT.V., Sheshukova N.A. Treatment and prevention of disorders of hemostasis in obstetric and gynecological practice. Ginekologiya, 2005, vol. 7, no. 5, pp. 36-48. (in Russ.). 23. Cherepanova N.A. Klinicheskoe znachenie urovney regulyatornykh autoantitel dlya otsenki riska razvitiya gestoza. Kand. med. nauk diss. Avtoref. [Clinical significance of regulatory levels of autoantibodies to assess the risk of gestosis. Cand. med. sci. diss. Synopsis]. Kazanâ&#x20AC;&#x2122;, 2008. 24 p. 24. Makarov O.V., Bogatyrev Yu.A., Osipova N.A. Significance of autoantibodies in the pathogenesis of preeclampsia. Akusherstvo i ginekologiya, 2012, no. 4, pp. 16-21. (in Russ.). 25. Bukatina S.V. Klinicheskoe znachenie urovney regulyatornykh autoantitel dlya otsenki riska razvitiya krovotecheniya v rodakh i poslerodovom periode. Kand. med. nauk diss. Avtoref. [Clinical sig-

â&#x20AC;&#x2DC;7 (76) докайŃ&#x20AC;Ń&#x152; 2013 Đł. nificance of regulatory levels of autoantibodies to assess the risk of bleeding during childbirth and the postpartum period. Cand. med. sci. diss. Synopsis]. Kazanâ&#x20AC;&#x2122;, 2011. 24 p. 26. Besedina M.V. Vliyanie materinskikh autoantitel k belkam nervnoy tkani i belkovym fraktsiyam vo vremya beremennosti na pokazateli zdorovâ&#x20AC;&#x2122;ya novorozhdennykh i detey rannego vozrasta. Kand. med. nauk diss. Avtoref. [Influence of maternal autoantibodies to nerve tissue proteins and protein fractions during pregnancy on the health of newborns and infants. Cand. med. sci. diss. Synopsis]. Moscow, 2004. 25 p. 27. Zamaleeva R.S. Narusheniya razvitiya ploda u beremennykh s ekstragenitalâ&#x20AC;&#x2122;nymi zabolevaniyami, ikh profilaktika i lechenie. Kand. med. nauk diss. Avtoref. [Developmental disorders of the fetus in pregnant women with extragenital diseases, their prevention and treatment. Cand. med. sci. diss. Synopsis]. Kazanâ&#x20AC;&#x2122;, 1993. 43 p. 28. Klyuchnikov S.O., Poletaev A.B., Budykina T.S., Generalova G.A. New immunobiotechnology in perinatology and pediatrics. Sbornik lektsiy po pediatrii [Collection of lecture on pediatrics]. Moscow, RSMU Publ., 2001, vol. 1, pp. 243-267. 29. Tareeva T.G., Tkacheva I.I., Mikaelyan A.V., et al. A method for predicting perinatal pathology in women with chronic infectiousinflammatory diseases. Description of the patent of the Russian Federation â&#x201E;&#x2013;2003135754/15, 2005.07.20. (in Russ.).

 Ă?üðüä òüÏ ĂŞĂ ĂŞ Îòïðàâèòß ùòàòßÞ â ðüäàêÜèÞ ÌóðíàÍà         Â?  Ă?àïðàâÍÿüòü Íè Ă&#x201A;Ăť ÎòùêàíèðÎâàííÎü ðüêÎÏüíäàòüÍßíÎü ïèùßÏÎ óáðüÌäüíèÿ, çàâüðüííÎü ÎòâüòùòâüííÝÏ ÍèÜÎÏ (ïðÎðüêòÎð, çàâ. êàôüäðÎÊ, íàóáíÝÊ ðóêÎâÎäèòüÍß), ÎòùêàíèðÎâàííÝÊ ÍèÜüíçèÎííÝÊ äÎãÎâÎð.  Ă?üçÞÏü Ă­ĂĽ ĂŹĂĽĂ­ĂĽĂĽ 6-8 ùòðÎê Ă­Ă  ðóùùêÎÏ è àíãÍèÊùêÎÏ ÿçÝêàþ äÎÍÌíÎ ÎòðàÌàòß, áòÎ ùäüÍàíÎ è ïÎÍóáüííÝü ðüçóÍßòàòÝ, Ă­ĂŽ Ă­ĂĽ àêòóàÍßíÎùòß ĂŻĂ°ĂŽĂĄĂŤĂĽĂŹĂť.  Ă?èùóíêè äÎÍÌíÝ åÝòß áüðíÎ-åüÍÝÏè, ÜèôðÝ è òüêùò Ă­Ă  ðèùóíêàþ Ă­ĂĽ ĂŹĂĽĂ­ĂĽĂĽ 12-ĂŁĂŽ ĂŞĂĽĂŁĂŤĂż, â òàåÍèÜàþ Ă­ĂĽ äÎÍÌíÝ äóåÍèðÎâàòßùÿ äàííÝü, ïðèâÎäèÏÝü â òüêùòü ùòàòßè. Ă&#x2014;èùÍÎ òàåÍèÜ Ă­ĂĽ äÎÍÌíÎ ïðüâÝøàòß ïÿòè, òàåÍèÜÝ äÎÍÌíÝ ùÎäüðÌàòß Ă­ĂĽ ĂĄĂŽĂŤĂĽĂĽ 5-6 ùòÎÍåÜÎâ.  Ă&#x2013;èòèðÎâàíèü ÍèòüðàòóðíÝþ èùòÎáíèêÎâ â ùòàòßü è ÎôÎðÏÍüíèü ùïèùêà ÍèòüðàòóðÝ äÎÍÌíÎ ùÎÎòâüòùòâÎâàòß òðüåÎâàíèÿÏ ðüäàêÜèè: ùïèùÎê ÍèòüðàòóðÝ ùÎùòàâÍÿüòùÿ â ïÎðÿäêü ÜèòèðÎâàíèÿ èùòÎáíèêÎâ, Ă­ĂŽ Ă­ĂĽ ĂŻĂŽ àÍôàâèòó. Ă&#x2020;óðíàÍ ÂŤĂ?ðàêòèáüùêàÿ ÏüäèÜèíà âêÍÞáüí Ă?ðüçèäèóÏÎÏ Ă&#x201A;Ă&#x20AC;Ă&#x160; â Ă?üðüáüíß âüäóÚèþ ðüÜüíçèðóüÏÝþ íàóáíÝþ ÌóðíàÍÎâ è èçäàíèÊ, â êÎòÎðÝþ äÎÍÌíÝ åÝòß ÎïóåÍèêÎâàíÝ ÎùíÎâíÝü íàóáíÝü ðüçóÍßòàòÝ äèùùüðòàÜèÊ Ă­Ă  ùÎèùêàíèü óáüíÎÊ ùòüïüíè äÎêòÎðà è êàíäèäàòà íàóê.

Ă&#x20AC;Ă&#x160;Ă&#x201C;Ă&#x2DC;Ă&#x2026;Ă?Ă&#x2018;Ă&#x2019;Ă&#x201A;Ă&#x17D;. Ă&#x192;Ă&#x2C6;Ă?Ă&#x2026;Ă&#x160;Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;. Ă?Ă?Ă&#x201E;Ă&#x17D;Ă&#x160;Ă?Ă&#x2C6;Ă?Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;


‘7 (76) декабрь 2013 г.

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

73

ÎÐÈÃÈÍÀËÜÍÛÅ ÑÒÀÒÜÈ 

Ì.Å. ÆÅËÅÇÎÂÀ1, Ë.È. ÌÀËÜÖÅÂÀ1, Ò.Ï. ÇÅÔÈÐÎÂÀ1, Ä.Ý. ÖÛÏËÀÊÎÂ2 Êàçàíñêàÿ ãîñóäàðñòâåííàÿ ìåäèöèíñêàÿ àêàäåìèÿ, 420015, ã. Êàçàíü, óë. Áîëüøàÿ Êðàñíàÿ, ä. 51 2 Êàçàíñêèé ãîñóäàðñòâåííûé ìåäèöèíñêèé óíèâåðñèòåò, 420012, ã. Êàçàíü, óë. Áóòëåðîâà, ä. 49

1

      Æåëåçîâà Ìàðèÿ Åâãåíüåâíà — êàíäèäàò ìåäèöèíñêèõ íàóê, äîöåíò êàôåäðû àêóøåðñòâà è ãèíåêîëîãèè № 1, òåë.: (843) 236-45-11, +7-919-627-13-66. e-mail: gelezovam@gmail.com1 Ìàëüöåâà Ëàðèñà Èâàíîâíà — äîêòîð ìåäèöèíñêèõ íàóê, ïðîôåññîð, çàâåäóþùàÿ êàôåäðîé àêóøåðñòâà è ãèíåêîëîãèè № 1, òåë. +7-905-314-40-51, e-mail: laramalc@mail.ru1 Çåôèðîâà Òàòüÿíà Ïåòðîâíà — äîêòîð ìåäèöèíñêèõ íàóê, ïðîôåññîð êàôåäðû àêóøåðñòâà è ãèíåêîëîãèè № 1, òåë. +7-987-290-45-99, e-mail: tzefirova@gmail.com1 Öûïëàêîâ Äìèòðèé Ýäóàðäîâè÷ — äîêòîð ìåäèöèíñêèõ íàóê, ïðîôåññîð, çàâåäóþùèé êàôåäðîé ïàòîëîãè÷åñêîé àíàòîìèè, òåë. +7-919-723-14-482                            ­     €         ‚  ƒ                „„ƒ …            †     …     

M.E. ZHELEZOVA1, L.I. MALTSEVA1, T.P. ZEPHIROVA1, D.E. TSYPLAKOV2 1 Kazan State Medical Academy, 51 Bolshaya Krasnaya St., Kazan, Russian Federation 420015 2 Kazan State Medical University, 49 Butlerova St., Kazan, Russian Federation 420012

Clinical course and outcomes of rapid and accelerated labor in women Zhelezova M.E. — Cand. Med. Sc., associate professor of the department of obstetrics and gynecology № 1, tel.: (843) 236-45-11, +7-919-627-13-66. e-mail: gelezovam@gmail.com1 Maltseva L.I. — D. Med. Sc., Professor, Head of the department of obstetrics and gynecology № 1, tel. +7-905-314-40-51, e-mail: laramalc@mail.ru1 Zephirova T.P. — D. Med. Sc., Professor of the department of obstetrics and gynecology № 1, tel. +7-987-290-45-99, e-mail: tzefirova@gmail.com1 Tsyplakov D.E. — D. Med. Sc., Professor, Head of the Department of pathological anatomy, tel. +7-919-723-14-482 ‡ˆ‰Š‹ŒŽ‰‘’“‹”Ž‹•ˆŒˆ’–’—˜Ž™‹Œˆš—˜‰’—›‹™—œŽŒ”‘šŒˆš”Ž‹’‘”‘‰Œ‰‹š“Œž—Ž‘ˆ Ÿ—›‹ˆŸ‘‰Šœ˜““‰‹Ž›š˜ŽŒ‰‘—ˆ—œ•‹™‰Œ‰‘—ˆŒŽ‹ ŒˆŒ“–¡‹š‡‰ŸŒ™œ—˜ˆš‰ŠŒ‰‘ˆ—œ’Œ™‹™Œ’‰—œš‹“‘¢‹Ž–ŸŒ™Œ’’—›”Œˆ‘‹šž–¢ŒŽ‘—˜™›Œ‰‹ŽˆŒ“Œˆš”‹Ž‘ˆŒ‰Œ“’—›”“‘’Œ‰‘—ˆ™ŸŠ‹Ž‹ ™—œ‰‘ˆ£˜Ž‘‹™‰—ž‘Ž‰Š’ŒˆŒ“—œŒ›—‰Š‹Ž”ŒŽ‰‘Œ“”Ž‹›Œ‰˜Ž‹š‹‰Œ’Š›‹ˆ‰—œˆ—Ž›Œ““–“—’Œ“‘¡‹š”“Œ’‹ˆ‰Œ‘ˆ‰ŽŒ˜‰‹Ž‘ˆ‹Š–”—¤‘Œš—›‘ˆŒ‰‹š ¥—›”“‘’Œ‰‘—ˆ™—œ‹ŒŽ“–ˆ‹—ˆŒ‰Œ“”‹Ž‘—šŸ‹Ž‹—ž™‹Ž¢‹š‘ˆ‚—œˆ‹Ÿž—Žˆ™‡ˆŒ›Œ£—Ž‘‰–—œ’Œ™‹™ŽŒ”‘šŒˆš”Ž‹’‘”‘‰—˜™“Œž—ŽŒŽ‹™˜ž£‹’‰ ˆ—‰‰—Œ“¢˜™Š–”‹ŽŒ’‰‘¢‘‰–ž˜‰‰—“—Ÿ‹Ž‹šŽ‹™‘™‰Œˆ’‹—œ’‹Ž¢‘¤˜‰‹Ž‘¦—Ž”Š—“—•‘’Œ“Œˆš‘››˜ˆ—Š‘™‰—’Š‹›‘’Œ“ŒˆŒ“–™‹™—œ‰Š‹’‹Ž¢‘¤˜‰‹Ž‘ ‘ˆŸ—›‹ˆŸ‘‰ŠŽŒ”‘šŒˆš”Ž‹’‘”‘‰Œ‰‹š“Œž—ŽŸ‹Ž‹š—ˆ‹   † ŽŒ”‘š Œˆš ”Ž‹’‘”‘‰Œ‰‹š “Œž—Ž ›Œ‰‹ŽˆŒ“ ’—›”“‘’Œ‰‘—ˆ™ ”‹Ž‘ˆŒ‰Œ“ ’—›”“‘’Œ‰‘—ˆ™ ›—Ž”Š—“—•‘’Œ“ ŒˆŒ“–™‘™ ‘››˜ˆ—Š‘™‰— ’Š‹›‘’Œ“ŒˆŒ“–™‘™

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


74

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

                   

                                           ­€‚ƒ„ …†‡  ˆ‰ Š                               ‹                                                 Œ        Ž                          ‘ ’ ’         “    ”    •–—˜‘ „   ˆ        Š       ™                                                        …†Œ              š     €  ’   ’                                  –                „  ’       › ‡                                                 

   

               ­      €‚ ƒ„…†‡ˆ‰Šˆ‹…Œ€                  Ž        

‘    

 ‘       ‚’“  ”•–‚”•–—‡ˆ‹…     —˜ —— ™               ‘                  ‘š  –            ›                     œ 

        

‘7 (76) декабрь 2013 г.   š        ‘š   ›‘    ‘š                 

              ž        

           Ÿ¡‚–¢—  £  —— ‘š Ÿ”   £ ¤      ¡¡       ‘    Ÿ””£¥   ‘š     Ÿ  ¦‚¡§¡­¦€‚§¡¦    ‹¨˜­© ¨˜¡£ ›‘       –    ™      

 ” ¦¡§¦¢ª””

  ¦§¦—               –   š ‘š       Ž   

      ‘        Ÿ  £  ‘    Ÿ‰«¨˜˜‚©¬®˜˜£       š   ‘            š¯  ‘          ‘   ™  ‘š   ¦€°      ”… Ÿ    ±    £  ”     –     ‘  

š   ²€¡°   ‘š     ‘              

       ’¦‘š            Ÿ  £  

  

      ’     Ÿ­¢°£   ¦‘š               Ÿx¦¨¡¦¡©¨˜˜˜—£“     Ÿ‰«¨˜¢©³˜˜£ ‘       Ÿ  £       ‘š ´         —¡  Ÿ‡¨¦’µ…Œ¶·Šx¦¨­˜©¨˜˜—£ Ž    ‘         ‘š        Ÿ  £        ¢°  Ÿ ¦€¦°    x¦¨€¦’© ¨˜˜˜­£ ¸            –         ‘ – ¸                   

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.                  ­€         ‚    ƒ (x„…†‡ˆƒ‰ …ŠˆŠŠ„ ‹ ­     ˆ ‚      ˆ‚Œ   Ž    ‘­  ’  ’ ­

 “†„”    ­­ ‡•† “†•”   †Š   ‘’ ˆ­­†ƒ–‘ € ’   x„…•Šˆ•‰ …ŠˆŠŠŠ†ˆ ­       ‘ ‘‘ˆ ­ ­‘ ‚Œ—   ‘  ­           ‘’  x„…†ˆˆ …Šˆ†‰ x„…Šˆ„˜ˆ …Šˆƒ‡ ‹     ‘     ‘ ­Œ’‚Œ‘  ƒ•ˆ­€        x„…˜‰…ŠˆŠ† ™­ ‘‚  ‘  ‘ ‘ ‘‘‚       ­  ­Œ ‘      ˆ ‘ ­  ˆ    ‘  ’ ‚Œ    ‚ ‘   ­ ­‚’ ’  ˆ          ‚  ‡†  ˆ  ˆ    ‘ €‘        €        Š   ‚    ‚Œ ‘        x„…ƒƒ‰…ŠˆŠ†ˆ     Œ’ ‘     ƒŠ  „„ˆx„…‡‰…ŠˆŠ•   ‘’ ‘‚‘  ­ ‘  ‹   •˜  ƒ         ’ (x„…•Ž‰…ŠˆŠŽˆ     ­ †ƒˆx„…‡ƒ‰…ŠˆŠ• —­  ­ ‘ˆ ‚Œ   ‘‚­‘­ ‘ ˆ  ˆ  Œ ’   †ƒ   ‘    ­‚’ ’ ‘ ‹­   ‘  ‘   ­    • ­  ‚‘­  ‘ š     „‡    € ’   ­ ‘‚  x„…Ž‰…ŠˆŠŠ˜‚   ­ ’‘­‘­††‚Œ x„…•‰…ŠˆŠƒ  ­   ­ ’    •š‡† ­ ‹  ­­  ‘    ‘ ˆ    ­       ‘ ‘     ›  œ ‘  ‘  žŠ†„ ˆ   ­    ’   ­ €      Œ  ‚ Ÿ Ž˜ž†‡  x„…‡‰ …ŠˆŠ• ‘ ‘   ˆ ‚-

75

Œ­ ‘’‘•­­      ‘   ­’ ’ ‘ ‚   ˆ‡Š ‚Œ ­ ­‘ ‘­ ‘‘­‘ˆ ‘‘ ‚‘ ’     ­    ¡…„‰ ¢…ŠŠŠƒ ­  ‘‚      ‘ ‚­‘    ˆ      £¤…Šˆ„Ž‰¥ŠˆŠƒ  ‘‘ ’  € ƒˆ   Œ  ’     ­ x„…ƒ‰…ŠˆŠ†Ž

­ˆ ‚‘ ­­   ’   ­     ‚Œ ‘ ‘  ‘‘   ­Œ‘‘ Œ   ‘ˆ   ­   ‘ ‘’ ‘ ­  ­’    ­    ‘ ‘‘­­  ‘‘‘­ ‘ ’   ‘Œ    ¦§¨©ª«¬® ¯ª£¢ª£¨°¬ª§ˆ ±²¨³ª´µˆ ¶¦ˆ ·¸  Œ  ’¹       ˆ     ‘     ’    ’     ‘‘     ˆ  ‚   ˆœ’     ‡ˆ›  €    •‡  ˆ   ‚Œ   ­ ’ ‘‘   ˆ  ‚      ‘  º ­  ‘ ’  ‘ ’  ‘‘             ‘   ­­ ‚   ˆ­ ‘ˆ „‡Žƒž•‘„‡ž†ƒ‘     °…Š††‰ ¢…Š˜ › ‘  ˆ    Œ ‘ ‘  ‘  ’ˆ„­ †ŠŸ ­  ‘’ ˆx„…Š‰…Šˆ•˜­­ ‚       ­  •ŽŠžŠˆƒ‘ º š  ‚­    ‘   ‘  ‘ ‘   ‘•›‘ˆ  ­  ­     ‚­Œ‘‘™ ‚­       ‡‡  » Ž   ‘ ‘   ­ ‚‘­ ‘ ‚ ‘‘­’ ’ ‘      ƒ‡  ¼      ‘‚  Ÿ    ‚  ‚ˆ  ƒŠ’ ‘™ ‘  ­  †• ‚Œˆ ‘   ŒŸƒ›€ ’ ’  ‘ ˆ   ‚Œ  ‘  ‚       ‚ ‘  ‘  x„…‡‰ …Šˆ„˜ › ­  ­ ­   ˆ   ½‘

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


76

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

                     ­€‚­ ƒ        ­€‚ „ …†    ‡ ˆ † ‰  † ƒ ‡  Š      ‡       €‹­‹     Œ              Ž‘‚‚„’‘‹ ‡   ‡   †  †   ƒ“      ”  Œ    ƒ•†           x­‘‚€„ ‘† Š    • –  —  ‚˜  † •    † ƒ  “‡  ƒ Œ  ƒ  ”  ‡ ™‡      ƒ  ‹”   ‡       ƒ   š›Š ” †‡   ‡ ” †    ­”     ­‚”    ‡            ” †           œ   ž  ” Ÿ      ‹”  ƒ   ‡      ƒ    ¡       ‰    † ”    ƒ     Œ ‡ ˜              ‰    ƒ ¢  ƒ            ƒ    ‡ ˆ        ‰‰†  ‡      ‡          ƒ    Š    †      ‰ ƒ  œ  †          ˆ  Œ     £ œ    † ¤¥˜›†¦§˜†    ž—† Œ†              ƒ          ƒ    ˜     ƒ  †         ‡  ƒ  ‰ ƒ• ƒ     ƒ ƒ†          œ      Œ    ƒ  ƒ       •         ‡ ˆ  ˜    œ          ˆ   •   †                     ƒ    ­  †‚   € ƒ      £        ƒ  ƒ     ƒ         † Š¨†  †   †   ©  ª ‡ ˆ    ƒ   ‡ƒ ƒ‰  ˆ ƒ•        ‡           ‰ˆ Œ  Œƒ   ƒ     £     Œƒ      ƒ    Œ   ¢–“       Ÿƒ 

‘7 (76) декабрь 2013 г.   Œ     ƒ¢–“ 

 ©      Š •      †— †   œœ      œ† œ           ƒ    • †     ƒ       †        £    Œ  ‡ƒ   ¢–“        ¢             •  †    †            Œ    ƒ    ‡ Œ  ¢–“ «¨ž  †   ƒ      ž    ©  ª    ¬‘­   ‡ƒ  ƒ     Œƒ       “ †­‡ ˆ     Œ  ƒ     ˆ       ƒ ˜  Œ    Œ  ƒ    †      ¬‘   ‡    •      ‡†

       £  ‡          ƒ‰  œ         £           ‰    Œ ƒ  ¢–“        ‡     •ƒŒ  ¢–“      ‡‰ˆ ‡     ‚       ‡    Œ †     Œ    ƒ      £     Œ † ƒŒ   ¢–“      †   ƒ     ž¢–“   © †  ‡‰ˆŒ† œ  Œ  †   ƒ  ‡   • †   ƒ ¢–“       ª‡ ˆ   ¬‘‚  ‰ƒ     †  •† ƒ     ‡    “ †        ‡‰ˆ    Œ  ƒ   ‰ˆœ †    ‰ˆ    Œ   ‡ ¬‘­  £     ƒ            ƒ œ         £              ‰Œ  ‰¢–“

         Œƒ 

 Ÿƒ    Œ œ    †     ˆ   ˆ †   ƒ ¢–“    © § ¢–“     œ  ‰ˆ ‡     ƒ•

œ  ƒ      †    ‡•  ‡     ™   Œ     Œ       Œ     ƒ  ˆ           ƒ   ƒ —     ƒ‰  œ   ƒ    ‡   œƒ  œƒ †  ‡ƒ Œ   ƒ    Œ  ™ƒ  ƒ‰ƒ  ‡   ‡          £     Œ  -

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


Ă?Ă?Ă&#x20AC;Ă&#x160;Ă&#x2019;Ă&#x2C6;Ă&#x2014;Ă&#x2026;Ă&#x2018;Ă&#x160;Ă&#x20AC;Ă&#x; Ă&#x152;Ă&#x2026;Ă&#x201E;Ă&#x2C6;Ă&#x2013;Ă&#x2C6;Ă?Ă&#x20AC;

â&#x20AC;&#x2DC;7 (76) докайŃ&#x20AC;Ń&#x152; 2013 Đł.

77

                  Â? Â?Â?   Â? Â?  Â? ­    Â&#x20AC;Â? Â&#x201A;   Â&#x201A;   Â&#x201A;Â&#x192;  Â&#x201E;            Â?     Â&#x192;   Â? Â&#x201A;Â&#x192;Â&#x201E;  

 Â?Â&#x201E;    Â?   Â&#x192;Â?  Â&#x201A;Â&#x192;  Â&#x201E;     Â&#x192;       Â? Â? Â&#x192;  Â&#x201A;Â&#x192;   Â?          Â&#x192;   Â&#x201A;Â&#x201E;  Â&#x2026;Â&#x2020;Â&#x2021;Â?   Â&#x192;  Â&#x201A;Â&#x192;    Â?   Â&#x2021;Â&#x2C6;Â&#x2030;   -

Â&#x160;Â&#x2039;Â&#x152;Â Â&#x17D;   Â&#x192;   Â&#x2018;Â&#x152;  Â&#x2019;  Â&#x192;   Â?    Â&#x201C;Â&#x2039;Â&#x152;  

 Â?Â&#x201E;    Â?    Â?    Â&#x2039;Â&#x2026;Â&#x152;   Â? Â&#x192;    Â&#x2018;Â&#x201D;Â&#x152; Â&#x201E; Â&#x2022;   Â? Â?     Â? Â?    Â&#x192; Â&#x192;  Â?Â&#x2013; Â&#x192; Â?       Â? Â&#x192;Â? Â&#x2014;  Â?  Â&#x201E;  Â? Â&#x192; Â?   Â&#x201E;  Â&#x192;  Â?Â?Â&#x201A;Â&#x192;Â&#x201E;      Â?     Â&#x192; Â&#x192;Â&#x192;Â?Â&#x192;Â?   Â&#x2013;Â&#x192;      Â&#x192;

Đ&#x203A;Đ&#x2DC;ТĐ&#x2022;Đ Đ?ТУРĐ? 1. Đ Đ°Đ´ĐˇĐ¸Đ˝Ń ĐşĐ¸Đš Đ&#x2019;.Đ&#x2022;. Đ?ĐşŃ&#x192;Ń&#x2C6;ĐľŃ&#x20AC;Ń ĐşĐ°Ń? Đ°ĐłŃ&#x20AC;ĐľŃ Ń Đ¸Ń?. â&#x20AC;&#x201D; Đ&#x153;.: Đ&#x2DC;Сд-вО Status Praesens, 2011. â&#x20AC;&#x201D; 688 Ń . 2. ХавиŃ&#x2020;киК Đ?.Đ&#x201C;. ĐĄŃ&#x201A;Ń&#x20AC;Ń&#x192;ĐşŃ&#x201A;Ń&#x192;Ń&#x20AC;Đ° анОПаНиК Ń&#x20AC;ОдОвОК Đ´ĐľŃ?Ń&#x201A;оНŃ&#x152;Đ˝ĐžŃ Ń&#x201A;и в Ń ĐžĐ˛Ń&#x20AC;оПоннОП Đ°ĐşŃ&#x192;Ń&#x2C6;ĐľŃ&#x20AC;Ń Ń&#x201A;во: кНиникО-Ń Ń&#x201A;Đ°Ń&#x201A;Đ¸Ń Ń&#x201A;иŃ&#x2021;ĐľŃ ĐşĐ¸Đľ Đ°Ń ĐżĐľĐşŃ&#x201A;Ń&#x2039; // Đ&#x2013;Ń&#x192;Ń&#x20AC;наН Đ°ĐşŃ&#x192;Ń&#x2C6;ĐľŃ&#x20AC;Ń Ń&#x201A;ва и ĐśĐľĐ˝Ń ĐşĐ¸Ń&#x2026; йОНоСноК. â&#x20AC;&#x201D; 2005. â&#x20AC;&#x201D; Т. 54, â&#x201E;&#x2013; 2. â&#x20AC;&#x201D; ĐĄ. 17-22. 3. ХидОŃ&#x20AC;Ова Đ&#x2DC;.ĐĄ. ФиСиОНОгиŃ? и паŃ&#x201A;ОНОгиŃ? Ń&#x20AC;ОдОвОК Đ´ĐľŃ?Ń&#x201A;оНŃ&#x152;Đ˝ĐžŃ Ń&#x201A;и. â&#x20AC;&#x201D; Đ&#x153;.: Đ&#x153;Đ&#x2022;Đ&#x201D;ĐżŃ&#x20AC;ĐľŃ Ń , 2000. â&#x20AC;&#x201D; 320 Ń . 4. Đ&#x;Ń&#x20AC;ĐžŃ&#x2026;ĐžŃ&#x20AC;онкО Đ .Đ&#x2DC;. Đ&#x;Ń&#x20AC;ОгнОСиŃ&#x20AC;Ованио и ĐżŃ&#x20AC;ĐžŃ&#x201E;иНакŃ&#x201A;ика анОПаНиК Ń&#x20AC;ОдОвОК Đ´ĐľŃ?Ń&#x201A;оНŃ&#x152;Đ˝ĐžŃ Ń&#x201A;и Ń&#x192; МонŃ&#x2030;ин Ń Ń ĐžĐľĐ´Đ¸Đ˝Đ¸Ń&#x201A;оНŃ&#x152;нОŃ&#x201A;каннŃ&#x2039;Пи Đ´Đ¸Ń ĐżĐťĐ°ĐˇĐ¸Ń?Пи: авŃ&#x201A;ĐžŃ&#x20AC;ĐľŃ&#x201E;. Đ´Đ¸Ń . â&#x20AC;Ś канд. Под. наŃ&#x192;Đş. â&#x20AC;&#x201D; Đ&#x161;иов, 2010. â&#x20AC;&#x201D; 22 Ń . 5. Chan E.C. Human myometrial genes are differentially expressed in labor: a suppression subtractive hybridization study / E.C. Chan, S. Fraser, S. Yin, G. Yeo et al. / Journal of Clinical Endocrinology and Metabolism. â&#x20AC;&#x201D; 2002. â&#x20AC;&#x201D; Vol. 87, â&#x201E;&#x2013; 6. â&#x20AC;&#x201D; P. 2435-2441. 6. Yellon S.M. The role of leukocyte traffic and activation in parturition / S.M. Yellon, A.M. Mackler, M.A. Kirby // Journal of the Society for Gynecologic Investigation. â&#x20AC;&#x201D; 2003. â&#x20AC;&#x201D; Vol. 10, â&#x201E;&#x2013; 6. â&#x20AC;&#x201D; P. 323-338. 7. Chambers S. Vaginal infections, cervical ripening and preterm delivery/ S. Chambers, J.C. Pons, A. Richard, M. Chiesa // European Journal of Obstetrics Gynecology and Reproductive Biology. â&#x20AC;&#x201D; 1991. â&#x20AC;&#x201D; Vol. 38, â&#x201E;&#x2013; 2. â&#x20AC;&#x201D; P. 103-108. 8. Hagberg H. Role of cytokines in preterm labour and brain injury / H. Hagberg, C. Mallard, B. Jacobsson // BJOG: An International Journal of Obstetrics and Gynaecology. â&#x20AC;&#x201D; 2005. â&#x20AC;&#x201D; Vol. 112, â&#x201E;&#x2013; 1. â&#x20AC;&#x201D; P. 16-18. 9. Maul H. Cervical ripening: biochemical, molecular, and clinical considerations / H. Maul, L. Mackay, R.E. Garfield // Clinical Obstetrics and Gynecology. â&#x20AC;&#x201D; 2006. â&#x20AC;&#x201D; Vol. 49, â&#x201E;&#x2013; 3. â&#x20AC;&#x201D; P. 551-563. 10. Bowen J.M. Cytokines of the placenta and extra-placental membranes: roles and regulation during human pregnancy and parturition / J.M. Bowen, L. Chamley, J.A. Keelan, M.D. Mitchell // Placenta. â&#x20AC;&#x201D; 2002. â&#x20AC;&#x201D; Vol. 23, â&#x201E;&#x2013; 4. â&#x20AC;&#x201D; P. 257-273. 11. Adeniji A.O. Cervico-vaginal foetal fibronectin: a predictor of cervical response at pre-induction cervical ripening / A.O. Adeniji, O. Olayemi, A.A. Odukogbe, A. Oladokun // We s t A f r i c a n J o u r n a l o f M e d i c i n e . â&#x20AC;&#x201D; 2 0 0 5 . â&#x20AC;&#x201D; Vo l . 2 4 , â&#x201E;&#x2013; 4 . â&#x20AC;&#x201D; P. 334-337. 12. Đ?ĐľŃ Ń&#x201A;ĐľŃ&#x20AC;онкО Đ&#x2014;.Đ&#x2019;. Đ&#x161;ĐťĐ°Ń Ń Đ¸Ń&#x201E;икаŃ&#x2020;иОннŃ&#x2039;Đľ кОнŃ&#x2020;опŃ&#x2020;ии Đ´Đ¸Ń ĐżĐťĐ°ĐˇĐ¸Đ¸ Ń ĐžĐľĐ´Đ¸Đ˝Đ¸Ń&#x201A;оНŃ&#x152;нОК Ń&#x201A;кани || Đ&#x2014;Đ´ĐžŃ&#x20AC;ОвŃ&#x152;Đľ Ń&#x20AC;ойонка. â&#x20AC;&#x201D; 2010. â&#x20AC;&#x201D; â&#x201E;&#x2013; 5 (26). â&#x20AC;&#x201D; ĐĄ. 11-13. 13. Đ&#x2018;Ń&#x192;Ń?нОва ĐĄ.Đ?., ХавоНŃ&#x152;ов ĐĄ.Đ&#x2019;., Đ&#x201C;Ń&#x20AC;иŃ&#x2C6;ин Đ&#x2019;.Đ&#x203A;., ХонŃ&#x2021;акОва Т.Đ?. Đ?окОŃ&#x201A;ĐžŃ&#x20AC;Ń&#x2039;Đľ Đ°Ń ĐżĐľĐşŃ&#x201A;Ń&#x2039; паŃ&#x201A;ОгоноСа ĐżŃ&#x20AC;ĐžĐťĐ°ĐżŃ Đ° гониŃ&#x201A;аНиК // Đ?ĐşŃ&#x192;Ń&#x2C6;ĐľŃ&#x20AC;Ń Ń&#x201A;вО и гинокОНОгиŃ?. â&#x20AC;&#x201D; 2001. â&#x20AC;&#x201D; â&#x201E;&#x2013; 3. â&#x20AC;&#x201D; ĐĄ. 39-43.

REFERENCES 1. Radzinskiy V.E. Akusherskaya agressiya [Aggression in obstetrics]. Moscow, Status Praesens Publ., 2011. 688 p. 2. Savitskiy A.G. The structure of uterine contractions anomalies in contemporary obstetrics: Clinical and statistical aspects. Zhurnal akusherstva i zhenskikh bolezney, 2005, vol. 54, no. 2, pp. 17-22. (in Russ.). 3. Sidorova I.S. Fiziologiya i patologiya rodovoy deyatelâ&#x20AC;&#x2122;nosti [Physiology and pathology of labor]. Moscow, MEDpress Publ., 2000. 320 p. 4. Prokhorenko R.I. Prognozirovanie i profilaktika anomaliy rodovoy deyatelâ&#x20AC;&#x2122;nosti u zhenshchin s soedinitelâ&#x20AC;&#x2122;notkannymi displaziyami. Kand. med. nauk diss. Avtoref. [Prediction and prevention of anomalies of labor in women with connective tissue dysplasia. Cand. med. sci. diss. Synopsis]. Kiev, 2010. 22 p. 5. Chan E.C., Fraser S., Yin S., Yeo G., Kwek K., Fairclough R.J., Smith R. Human myometrial genes are differentially expressed in labor: A suppression subtractive hybridization study. Journal of Clinical Endocrinology and Metabolism, 2002, vol. 87, no. 6, pp. 2435-2441. DOI: 10.1210/jc.87.6.2435. 6. Yellon S.M., Mackler A.M., Kirby M.A. The role of leukocyte traffic and activation in parturition. Journal of the Society for Gynecologic Investigation, 2003, vol. 10, no. 6, pp. 323-338. DOI: 10.1016/ S1071-5576(03)00116-3. 7. Chambers S., Pons J.C., Richard A., Chiesa M., Bouyer J., Papiernik E. Vaginal infections, cervical ripening and preterm delivery. European Journal of Obstetrics Gynecology and Reproductive Biology, 1991, vol. 38, no. 2, pp. 103-108. 8. Hagberg H., Mallard C., Jacobsson B. Role of cytokines in preterm labour and brain injury. BJOG: An International Journal of Obstetrics and Gynaecology, 2005, vol. 112, suppl. 1, pp. 16-18. DOI: 10.1111/j.1471-0528.2005.00578.x. 9. Maul H., MacKay L., Garfield R.E. Cervical ripening: Biochemical, molecular, and clinical considerations. Clinical Obstetrics and Gynecology, 2006, vol. 49, no. 3, pp. 551-563. DOI: 10.1097/00003081-200609000-00015. 10. Bowen J.M., Chamley L., Keelan J.A., Mitchell M.D. Cytokines of the placenta and extra-placental membranes: Roles and regulation during human pregnancy and parturition. Placenta, 2002, vol. 23, no. 4, pp. 257-273. DOI: 10.1053/plac.2001.0782. 11. Adeniji A.O., Olayemi O., Odukogbe A.A., Oladokun A., Adeniji O.I., Egbewale B.E., Omigbodun A.O. Cervico-vaginal foetal fibronectin: A predictor of cervical response at pre-induction cervical ripening. West African Journal of Medicine, 2005, vol. 24, no. 4, pp. 334-337. 12. Nesterenko Z.V. Classification concept of connective tissue dysplasia. Zdorovâ&#x20AC;&#x2122;e rebenka, 2010, no. 5 (26), pp. 11-13. (in Russ.). 13. Buyanova S.N., Savelâ&#x20AC;&#x2122;ev S.V., Grishin V.L., Senchakova T.N. Some aspects of genitalia prolapce pathogenesis. Akusherstvo i ginekologiya, 2001, no. 3, pp. 39-43. (in Russ.).

Ă&#x20AC;Ă&#x160;Ă&#x201C;Ă&#x2DC;Ă&#x2026;Ă?Ă&#x2018;Ă&#x2019;Ă&#x201A;Ă&#x17D;. Ă&#x192;Ă&#x2C6;Ă?Ă&#x2026;Ă&#x160;Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;. Ă?Ă?Ă&#x201E;Ă&#x17D;Ă&#x160;Ă?Ă&#x2C6;Ă?Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;


78

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.



Ë.Å. ÒÅÐÅÃÓËÎÂÀ1,2, Ë.Ä. ÝÃÀÌÁÅÐÄÈÅÂÀ3, Í.È. ÒÓÕÂÀÒØÈÍÀ1, À.Þ. ÒÅÐÅÃÓËÎÂ1,3, À.Â. ÏÎÑÒÍÈÊÎÂ1 1 Ðåñïóáëèêàíñêàÿ êëèíè÷åñêàÿ áîëüíèöà ÌÇ ÐÒ, 420064, ã. Êàçàíü, óë. Îðåíáóðãñêèé Òðàêò, ä. 138 2 Êàçàíñêàÿ ãîñóäàðñòâåííàÿ ìåäèöèíñêàÿ àêàäåìèÿ, 420012, ã. Êàçàíü, óë. Ìóøòàðè, ä. 11 3 Êàçàíñêèé ãîñóäàðñòâåííûé ìåäèöèíñêèé óíèâåðñèòåò, 420012, ã. Êàçàíü, óë. Áóòëåðîâà, ä. 49

rÇÍÐÎÛÒßÏÔÓÊÙÓʱ±ÓÒÖËÕÉÇ×ÎÉÒÓѾ ÓՒÇÒÓÖÓÙÕÇÒÆâÝËѾÐËÛËÒÎâÜËËÛÒÓÏ áåðåìåííîñòè â çàâèñèìîñòè îò ðåçóëüòàòîâ óëüòðàçâóêîâîãî èññëåäîâàíèÿ ñ öâåòîâûì äîïëåðîâñêèì êàðòèðîâàíèåì Òåðåãóëîâà Ëèëèàíà Åôèìîâíà — êàíäèäàò ìåäèöèíñêèõ íàóê, çàâåäóþùàÿ îòäåëåíèåì óëüòðàçâóêîâîé äèàãíîñòèêè ÐÊÁ, äîöåíò êàôåäðû óëüòðàçâóêîâîé äèàãíîñòèêè ÊÃÌÀ, òåë. (843) 264-54-14, e-mail: tereg1@mail.ru1,2 Ýãàìáåðäèåâà Ëþöèÿ Äìóõòàñèáîâíà — êàíäèäàò ìåäèöèíñêèõ íàóê, äîöåíò êàôåäðû àêóøåðñòâà è ãèíåêîëîãèè ¹ 1 ÊÃÌÓ, òåë. +7-904-765-22-62, e-mail: lutsia1@yandex.ru3 Òóõâàòøèíà Íàèëÿ Èðøàòîâíà — çàâåäóþùàÿ îòäåëåíèåì ãèíåêîëîãèè ÐÊÁ, òåë. +7-903-313-71-78, e-mail: tuxvatshina@bx.ru1 Òåðåãóëîâ Àíäðåé Þðüåâè÷ — êàíäèäàò ìåäèöèíñêèõ íàóê, àññèñòåíò êàôåäðû îíêîëîãèè, ëó÷åâîé äèàãíîñòèêè è ëó÷åâîé òåðàïèè ÊÃÌÓ, âðà÷ îòäåëåíèÿ ðåíòãåíîõèðóðãèè ÐÊÁ, òåë. +7-917-269-58-40, e-mail: tereg@yandex.ru1,3 Ïîñòíèêîâ Àëåêñàíäð Âèêòîðîâè÷ — âðà÷ îòäåëåíèÿ ðåíòãåíîõèðóðãèè ÐÊÁ, òåë. +7-960-048-11-98, e-mail: sasha-postnicov@inbox.ru1          

                      

       

   

  ­ €

    ­   

 ­     ‚ƒ„  …†  

   ­          

      €            …             † ‡    

   ˆ            €    ‰Š‹… Œ     

       ‰Š‹           

      ‚ƒ„ €        

L.E. TEREGULOVA1,2, L.D. EGAMBERDIEVA3, N.I. TUKHVATSHINA1, A.Yu. TEREGULOV1,3, A.V. POSTNIKOV1 1 Republican Clinical Hospital of the Ministry of Health, 138 Orenburgskiy Trakt, Kazan, Russian Federation 420064 2 Kazan State Medical Academy, 11 Mushtari St., Kazan, Russian Federation 420012 3 Kazan State Medical University, 16 Butlerova St., Kazan, Russian Federation 420012

Various approach to conservative organ preservation treatment of cervical pregnancy depending on the result of the ultrasound investigation with color Doppler imaging

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


Ă?Ă?Ă&#x20AC;Ă&#x160;Ă&#x2019;Ă&#x2C6;Ă&#x2014;Ă&#x2026;Ă&#x2018;Ă&#x160;Ă&#x20AC;Ă&#x; Ă&#x152;Ă&#x2026;Ă&#x201E;Ă&#x2C6;Ă&#x2013;Ă&#x2C6;Ă?Ă&#x20AC;

â&#x20AC;&#x2DC;7 (76) докайŃ&#x20AC;Ń&#x152; 2013 Đł.

79

Teregulova L.E. â&#x20AC;&#x201D; Cand. Med. Sc., Head of Department of ultrasonic diagnosis of Republican Clinical Hospital, assistant professor of the Department of ultrasonic diagnosis of Kazan State Medical Academy, tel. (843) 264-54-14, e-mail: tereg1@mail.ru1,2 Egamberdieva L.D. â&#x20AC;&#x201D; Cand. Med. Sc., assistant professor of the Department of Obstetrics and Gynecology š 1 Kazan State Medical University, tel. +7-904-765-22-62, e-mail: lutsia1@yandex.ru3 Tykhvatshina N.I. â&#x20AC;&#x201D; Head of the Department of Gynecology of Republican Clinical Hospital, tel. +7-903-313-71-78, e-mail: tuxvatshina@bx.ru1 Teregulov A.Yu. â&#x20AC;&#x201D; Cand. Med. Sc., assistant professor of the Department of oncology, radiation diagnosis and radiotherapy of KSMU, physician of X-ray surgery of Republican Clinical Hospital, tel. +7-917-269-58-40, e-mail: tereg@yandex.ru1,3 Postnikov A.V. â&#x20AC;&#x201D; physician of the Department of X-ray surgery of Republican Clinical Hospital, tel. +7-960-048-11-98, e-mail: sasha-postnicov@inbox.ru1        12 cases of differentiated organ preservation treatment of cervical pregnancy using proprietory diagnostic techniques and treatment             are presented. Ultrasonic criteria of the chorion invasion in case of cervical pregnancy were revealed (unclear boundary of chorion,             Â?  Â?Â?Â? thickening of the chorion, reducing its echogenisity, visualization of blood flow in the chorion in B-mode, increase of blood flow in CDI,   ­Â?Â&#x20AC;       thinning of cervix). In 3 cases the signs of chorion invasion were found, and patients were successfully carried out a combination of  Â?    Â? Â&#x201A;   minimally invasive organ-preserving methods of treatment (uterine arteries embolisation with intra-arterial injection of methotrexate and      ­          introduction of methotrexate in the gestational sac), leaving the dead gestational sac in the cervix that afterwards resolved within three  Â?Â&#x192;  Â&#x201E;Â&#x2026;       months. In 9 cases there were no signs of chorion invasion; in 4 cases there was conducted successful removal of gestational sac after     Â&#x201E;Â&#x2020;          preliminary uterine arteries embolisation; in 5 cases gestational sac was successfully removed in usual manner without prior uterine     arteries embolization under conditions of operation room . words: cervical  pregnancy,  chorion  invasion,      Doppler Â?  imaging, uterine arteries embolisation,   Key ultrasound  investigation, color    methotrexate.

                         Â?Â?    Â?  Â?  Â?       Â?   Â? Â?   Â?Â?  Â?Â? Â?Â?   ­    Â&#x20AC;     Â? Â?Â?­Â&#x201A;    Â? Â?  Â&#x192;   Â&#x201E;Â&#x201E;Â&#x201E;Â&#x2026;Â&#x2020;Â&#x201E;Â&#x201E;Â&#x201E;   Â&#x201E;Â&#x2021; Â?Â&#x201A;Â?    Â&#x2C6; Â&#x2030;  Â&#x160;  Â&#x192;      Â?Â&#x192;   Â?  Â&#x2039; Â? Â?   Â?  Â&#x192;  Â&#x192;   Â?     Â&#x152;    Â?     Â?Â&#x17D;Â&#x2030;Â&#x2018;Â&#x2020; Â&#x20AC;  Â?Â?            Â?   Â?  Â&#x2030;         ­   Â&#x192;Â&#x192;      Â?   Â?      Â&#x192;    Â&#x160;      ­    Â?   Â? Â?   Â&#x192;  Â?      Â? Â&#x2019; ­        Â?     Â?   Â?      Â?  Â&#x17D;      Â? ­   Â&#x192;      Â?   Â&#x160;    Â?  Â? Â?  Â&#x201C;Â&#x201A; Â&#x201D;               Â&#x201A;    Â&#x2018;Â&#x201E;Â?Â&#x2018;Â&#x2020;Â&#x2021; Â&#x2C6;   Â? Â&#x201A;      Â? Â&#x192;  

     Â&#x192; Â? Â&#x201D;      Â&#x192; Â?Â?    Â?Â&#x160;                 ­Â?        Â?Â?    Â&#x2022; Â&#x201A; Â? Â&#x2013;    Â?Â?    Â?  Â?      Â&#x2030;              Â&#x192;    Â?         Â&#x2014;Â&#x201C;Â&#x2DC;      Â&#x2014;Â&#x201C;Â&#x2DC;     Â?Â&#x2122;Â&#x161;Â&#x2019;Â?           Â? Â&#x201A;Â&#x203A;Â? Â? Â&#x201A;  Â&#x153;Â?  Â&#x17E;  Â&#x192;   Â&#x2020; Â&#x; Â&#x2030;        Â?   Â?           Â&#x192;   Â&#x160;  ÂĄ Â&#x2030;       Â?      Â&#x192;    Â? ­Â?  Â&#x201A;  ¢  Â?       Â&#x192;Â?           Â&#x192;       Â?  Â? Â&#x160;Â?   Â&#x192;   Â?       Â?     Â&#x2026;     Â&#x192;   Â&#x192;   Â&#x201E;  Â?     Â?   Â?    Â&#x2C6; Â&#x201A; Â?  Â?   Â&#x2018; Â&#x2020;  Â&#x201A;           Â?Â&#x192;   Â&#x2026;¢Â&#x2C6; ÂŁ¤¼Œ§Œ¨ŠªÂŤÂŁ¼Ž¯Š°Âą¼Ž²³¯´²§ ²¯ÂŚÂŽ   Â&#x160; Â&#x192;  Â&#x192;      Â&#x;Â&#x152; 

Ă&#x20AC;Ă&#x160;Ă&#x201C;Ă&#x2DC;Ă&#x2026;Ă?Ă&#x2018;Ă&#x2019;Ă&#x201A;Ă&#x17D;. Ă&#x192;Ă&#x2C6;Ă?Ă&#x2026;Ă&#x160;Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;. Ă?Ă?Ă&#x201E;Ă&#x17D;Ă&#x160;Ă?Ă&#x2C6;Ă?Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;


80

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

                     ­€‚  ƒ „…   †‡ˆ‰   ŠŠŠŠ‹ŒŽ     ‘ ’“”•Š……  –  —    ’ ˜    „   …      ’                  ’  … ……   ™‡š€ ˜     ƒ ’ —   šš€ ˜„  …’  …      ’    …          …   ’     ›’  „      ’ ƒ  ‘€ œ        ž       …   „       Ÿ’               …’„            ’… ƒ  ¡    š…   ƒ ’    

‘7 (76) декабрь 2013 г. 

               

   ­   € ‚ ƒ ­   „

 ‚     š     ¢ƒ   ’£ ¤      ¥š­¦§ …—’   —… …™—…       …     …  §  §   ¥š

‘‹   …¨  … © ¥    ª —    ’ …©        –        …   …’ «¬›  ‡‘   « ’®‡ˆ‰ ŠŠ šŠŠ   ‹ŒŽ˜     ­     …… Œ ƒ … €    …    …       ’  —   …   ˜  …        …           …        ŸŒ“……     ’ ƒ¤ ¦ §   …’  …            ’     „           ’ …   ’   Š      Š      «¬› …      ’    ƒ §  … …’  …               …   -

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


‘7 (76) декабрь 2013 г.

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

81

                                                                                  ­€‚­ƒ„   …             

†                 ‡          ˆ    „‡               ˆ ‰ ‡    ‡    Š‹Œ      ˆ         

ˆ   ‰„ Ž                ‘   ’““”•– ­€‚­ƒ„                  —˜     -   €™š‘ ›œ ž                   Ÿ š     ¡    „        Ÿ        ‡    ¢ ‡    ‡              „ Œ     Š‹Œ     „‡ ˆ   ‰ˆ         Ž   ‰                   £         „‡¤¢         ¥   „     Ÿ                  ‡  ‡    ‡      ˆ ‡  Š‹Œ       ¥„ ˆ     ‰ -   ­ ˆ      ‡‰        €‚             ­       ¥„ †           ˆ‡  ¤‰            ‰  ¦            ‡      ‰                                               ‰              ‰            ‰          ‰  ‡ ˆ‰    §     ˆ                    ‡    

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


82

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

                 

              

‘7 (76) декабрь 2013 г.

                       ­    €  ‚    ƒ„ …     †‡ˆ   ‚      ƒ ­  ­    ƒ  ‰„­ „ƒ ˆ    ƒ      Š‹      Š‚   ƒ   € ­ …‚ ƒ ‚    Œ  „€Ž‹‚        ‚  ‘‹’“   ­    …‹ ‚  ’    ”Œ      €  „ ‚ „    ‰    ‚„    €  ‚   ‰  ‚” ”  ‰ Š ­  € „‚ „ 

  … ‹  ­       ­  • „ŒŒ     –    ‚      Ž   ­ €        ‰    ƒ ‚          - ‰     ‰ 

    ‚„        €        ‹        ­    ­    ”Œ   —  

ƒ  „         ˆ          ƒ‰„­  ­ ƒ        †‡ˆ ‚‘…‹ ‚  … 

ƒ     ‚    „„   Œ   „   „   Š ‚ „      ­   „         ‰  ‚„       Š ‹Ž        ˜   ‚             €   ‚  ­­ Œ   „       ‰  ‚„   ‚      ­ ­   ™ € 

      

 š      ‚     ‰ 

     ‚             ƒ ‚   …  

 ˜  …‚ ƒ ‚    Œ  „  ‚‚ ‰    ‚  ‚ ‚””­   ”  ‚  Ž­Š     ƒ ‚      ‘      ƒƒ      „      ­  ­              ­      Ž      š’ ‰““   Ž    ”  ”‰““  ““   ­ „  ­ ‚  ƒ ‚      ­“‚  

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


Ă?Ă?Ă&#x20AC;Ă&#x160;Ă&#x2019;Ă&#x2C6;Ă&#x2014;Ă&#x2026;Ă&#x2018;Ă&#x160;Ă&#x20AC;Ă&#x; Ă&#x152;Ă&#x2026;Ă&#x201E;Ă&#x2C6;Ă&#x2013;Ă&#x2C6;Ă?Ă&#x20AC;

â&#x20AC;&#x2DC;7 (76) докайŃ&#x20AC;Ń&#x152; 2013 Đł.

83

         

            

               Â 



Â?  Â? Â?   

 

       Â 

  Â?      Â? Â   Â?   -

                                  Â?    Â?         Â? Â?Â?  Â?    Â?­ 



       

          Â?Â?  Â? Â?    Â?Â? ­­    Â&#x20AC; Â&#x201A;Â&#x201A;Â&#x192;

  Â&#x20AC;   Â&#x20AC;   Â?   Â&#x201A;Â&#x201A;Â&#x192; Â&#x201E; Â&#x2026;Â&#x2020;  Â&#x20AC;   Â&#x20AC; Â?Â?Â&#x2021;Â&#x201E;Â&#x2C6;Â&#x2030;Â&#x2030;Â&#x160;Â&#x2021; Â&#x2039;Â&#x2039;Â&#x152;Â&#x2039;Â&#x160; Â&#x2C6; Â?  Â&#x17D;Â&#x2020; Â&#x201E;Â&#x2018;Â&#x201E;Â? Â? Â&#x2019; Â?   Â&#x201C;   Â&#x201D;      Â?Â?  Â? Â?     Â?Â?  Â? Â&#x2019;Â&#x201D;­­Â&#x201C;     Â&#x2020;Â&#x2022;Â&#x2021;Â&#x2013;Â&#x2013;Â&#x2039;Â&#x2021;Â&#x2014;Â&#x2DC;Â&#x2021; Â&#x2122;Â&#x152;Â&#x2122;Â&#x161; Â&#x2DC; Â? Â&#x2026; Â&#x203A;Â&#x153;  Â&#x17E; Â&#x201E;Â&#x203A;Â&#x;  Â&#x2022;  Â&#x2022; Â&#x153; Â?     Â?Â?ÂĄÂ&#x2021;Â&#x201E;¢Â&#x201E; Â&#x2022;Â&#x2013;Â&#x2013;Â&#x160;Â&#x2021;Â&#x2C6;Â&#x2030;Â&#x2DC;Â? Â&#x161; £¤¼Œ§¨Šª§ ÂŹ Ž¯°¼Œ Âą ²°³´¾Š° ¾¯¨œ¡¡°¸ š´ºº´Š¡œ ŒŒŠŒ³¨Ÿ ¯¨¾¯´Ÿ¼°³Š½¨³¨°§¡´º´œ¸ÂŁ³¨ž³¤´´ª´šŠ¡½Š³¯´š¨¯³ŠºŠ¿³Š´¡¡ŸŒŒŠŒ³¨Ÿ¯¨¾¯´Ÿ¼°³Š´¡­­²ŸŠ³¨Ÿ¤¸Ă&#x20AC;Ă Ă&#x201A;¯Š¡ŒŸ¨¡Â&#x2021;Ă&#x192;´¡Ÿ´¡¢Ă&#x201E;§¨Ă&#x20AC;¯³§¨¡´¡ Ă&#x20AC;¼¤ºŠŒ§Š¡œĂ&#x2026;¯´¼¾Â&#x2021;Â&#x2013;Â&#x2013;Â&#x2013;Â&#x2021;Â&#x2DC;Â&#x2DC;Â&#x2DC;Â&#x152;Â&#x2DC;Â&#x161;Â&#x2C6; Ă&#x2020;Ă&#x2026;Š¡Œ¤¼¯œ ²Âą Ă&#x2021;¯³¨Œ ÂŽĂ&#x2C6; à ¨Š¡ ÂŽÂą¨³ ÂŤÂş ²¯º¸ ŸŠœ¡´ŒŠŒ ¡Ÿ ³¯¨³Ă&#x2030;¨¡³´š°¨¯½Š°º¾¯¨œ¡¡°¸Š¡¡Š¡½Š³¯´š¨¯³ŠºŠ¿³Š´¡¾¯´œ¯Ă&#x2030;­­ Ă&#x2021;¨¯³Šº¹³¨¯ŠºÂ&#x2021;Â&#x2013;Â&#x2013;Â&#x161;Â&#x2021;Ă&#x160;´ºÂ&#x2122;Â&#x2021;Â&#x2013;Â&#x2122;Â&#x2122;Â&#x152;Â&#x2013;Â&#x2122;Â&#x2013; Â&#x2122;Â?Â&#x2019; Â&#x2022; Â&#x203A; Â? Â&#x2026;  Ă&#x2039;ÂĄ Â?Â?Â? ÂĄ Â? Â?Â?  Â&#x20AC;   Â&#x20AC;Â&#x2021;Â&#x203A;Â&#x203A; Â&#x20AC; ¢Â&#x152; Â&#x203A;Ă&#x152;Â&#x201E;Â&#x2013;Â&#x2013;Â&#x2122;Â&#x2021; Ă&#x2020;Â&#x152;Ă&#x2020;Ă&#x2020; Â&#x2039; Â&#x2020;      Â&#x203A;Â&#x153;  Â?  ÂĄÂ?Â?  Â&#x201D; Â? Â&#x20AC;   Â&#x20AC;Â&#x2021;Â&#x203A;Â&#x203A; Â&#x20AC; ¢Â&#x152; Â&#x203A;Ă&#x152;Â&#x201E;Â&#x2013;Â&#x2013;Â&#x2039;Â&#x2021; Â&#x2DC;Ă&#x2020;Â&#x2C6; Â&#x160;Â&#x; Â&#x2020; Â&#x203A; Â? Â&#x2026; Â&#x2020; Â&#x20AC; Â&#x2020;Â&#x17D; Â?Â? Â&#x20AC;   Â&#x20AC;Â&#x2021;Â&#x201E;¢Â&#x201E; Â&#x20AC;Â&#x2013;Â&#x161;Â&#x2039;Â&#x2021; Â&#x2C6;Ă&#x2020; Â&#x2013;Â&#x201C; Â?  Â&#x2020;Â&#x17D; Â?Â?Â?  Â&#x2C6;Â&#x152;     Â&#x2021;Â&#x17D; Â?¢Â&#x201E; Â&#x2022;Â&#x2013;Â&#x2039;Â&#x2DC;Â&#x2021;Â&#x2021; Â&#x2030;Â&#x2122; Â&#x2030;´º¡Ă&#x201E;²Ă&#x2C6;§¡Ÿº¨¯Ă&#x20AC;²Ă?¨ŒŒĂ&#x192;Ă&#x17D;Ž´¯¯ŠŒ´¡Ă?Ă&#x2C6;Ă&#x2C6;¨¯½Š°º¾¯¨œ¡¡°¸Ă&#x2030;¡œ¨ŸŠ³§´¼³§¸Œ³¨¯¨°³´Ă&#x2030;¸ÂŁ°Œ¨¯¨¾´¯³­­Ă?à ¨¾¯´ŸŽ¨ŸÂ&#x2021; Â&#x2013;Â&#x160;Â&#x2013;Â&#x2021;Ă&#x160;´ºÂ&#x2DC;Â&#x161;Â&#x2021;Â&#x2C6;Â&#x161;Â&#x152;Â&#x2C6;Â&#x161;Â&#x2DC; ŽŒ§Š°§ÂąÂŁÂźĂ&#x2030;´¡Ă?Ă&#x2018;¨ºŒ¡¨¯Ă&#x2026;¨³ÂŤÂşĂ&#x2C6;¨¯½Š°º¹§Š¯´Ÿª¯°¨¯°ºœ¨Ă&#x2030;¸¤¨³§¨³¯¨³Ă&#x2030;¨¡³Ă&#x2030;´ŸºŠ³¸´š°§´Š°¨š´¯°¨¯½Š°º¾¯¨œ¡¡°¸­­ Ă?ÂĽĂ&#x2030;à ¨¾¯´ŸÂ&#x2021;Â&#x2C6;Â&#x2030;Â&#x2030;Â&#x2C6;Â&#x2021;Ă&#x160;´ºÂ&#x2039;Â&#x2021;Â&#x161;Â&#x2013;Â&#x2DC;Â&#x152;Â&#x161;Â&#x2013;Â&#x2122; Â&#x2C6;Ă?¯Ÿ¸ Ă&#x201E;Ă? Ă?¸Œ³¨¯´Œ°´¾Š° ¯¨Œ¨°³Š´¡ ´š ÂŤ °¨¯½Š°º ¨°³´¾Š° ¾¯¨œ¡¡°¸­­Ă?ÂŁĂ&#x2030;ÂŁÂŚÂŚĂ&#x2026;¸¡¨°´ºĂ&#x192;¾¯´ŒÂ&#x2021;Â&#x2C6;Â&#x2030;Â&#x2030;Â&#x2C6;Â&#x2021;Ă&#x160;´ºÂ&#x2013;Â&#x2021;Â&#x2DC;Â&#x2039;Â&#x2030;Â&#x152;Â&#x2DC;Â&#x2039;

                              Â?Â?Â?Â?Â?Â?    ­Â&#x20AC;Â&#x20AC; Â&#x201A; Â&#x20AC; Â&#x192;­Â&#x201E;Â&#x2026;­Â&#x2020; Â&#x2021; Â&#x2C6;  Â&#x2030;Â&#x160; Â&#x2039;                  Â&#x152;       Â?Â?Â?Â?Â&#x17D;  Â?  Â&#x2018;Â&#x2019;Â&#x2018; Â&#x201A; Â&#x2021; Â&#x192;Â&#x2021;Â&#x201E;Â&#x2026;Â&#x201E;Â&#x20AC; Â&#x201E;   Â&#x201C;Â&#x160; Â&#x160;  Â&#x201D; Â&#x160; Â&#x2039;     Â&#x2022;         Â&#x201D;          Â?Â?Â&#x17D;  Â?  Â&#x2018;Â&#x2018;Â&#x20AC; Â&#x201A; Â&#x2019;Â&#x2013; Â&#x192;Â&#x2018;Â&#x2020;Â&#x2026;Â&#x2018;Â&#x2021; Â&#x2013;Â&#x2030;Â&#x2014;Â&#x201C;Â&#x2030;Â&#x201C;Â&#x201C;Â&#x201C;Â&#x2014;Â&#x2022;        Â&#x201D;             Â&#x2030;    Â&#x2DC; Â?Â?Â? Â&#x160;Â&#x201C; ­Â&#x20AC;Â&#x20AC; Â&#x201A; Â&#x2013; Â&#x192;Â&#x2020;Â&#x20AC;Â&#x2026;Â&#x2020;Â&#x20AC;Â&#x2021; Â&#x2019;   Â&#x2DC; Â&#x2122;Â&#x201C; 

 Â?Â&#x2122;    Â&#x201A;    Â    

 Â&#x2DC;    Â?Â?Â&#x2C6;Â&#x160;Â? Â&#x2018;Â&#x2020; Â&#x201A; Â&#x2021;Â&#x2021; Â&#x192;Â&#x2018;Â&#x2026;Â&#x2018; Â&#x2020;   Â&#x201C;  Â&#x2122;Â&#x2014;      Â&#x2022;                      Â&#x152;  Â&#x161;     Â&#x2DC;Â?Â?Â&#x2030;  Â&#x2018;Â&#x2018;Â&#x2020; Â&#x201A;  Â&#x192;­Â&#x2013;Â&#x2013;Â&#x2026;­Â&#x2013;Â&#x2021;­ Â&#x2018;Â&#x2039;  Â&#x2DC;Â&#x201C;Â&#x2039;Â&#x203A;  Â&#x201C;   Â&#x153;  Â&#x2022; Â&#x152; Â&#x2030;  Â?Â&#x2039;  

Â&#x2022;Â&#x201C; ­Â&#x20AC;Â&#x20AC;Â&#x2019;  Â&#x201A; ­Â&#x201E; Â&#x192;Â&#x2018;­Â&#x2026;Â&#x2018;Â&#x2021; ­Â&#x20AC;  Â&#x203A; Â&#x201C;  Â&#x201C;          

    Â&#x2DC;        Â?Â?    Â&#x201C;  ­Â&#x20AC;Â&#x20AC;Â&#x2020; Â&#x201A; Â&#x2018;Â&#x20AC; Â&#x192;Â&#x2019;Â&#x2026;Â&#x20AC; ­ Â&#x17E;Â&#x;¥¢£ ¤ÂĽ Œ§¨Šª ¤ÂŤ ÂŹÂŽÂŻÂ&#x;¢£§¨° ÂąÂ&#x17E; ² ²¢°£³ ´¢¨²ªÂ&#x;£°³§£¨¢ª¥ª¾ª¨§ªœªª¾¨¢¡ÂŻÂŞÂ&#x;ª¸ª¨¨¢²³§Â?Â?šÂ&#x;¢¯¥ª¸ºÂ&#x;ÂŞÂťÂ&#x;¢ŠŽŸ½§§  ­Â&#x20AC; ž­ ÂąÂ&#x2018;Â&#x2026;Â&#x2021;­ ­­Â&#x201C;  Â&#x201D;ÂżÂ&#x201C; Â? Â?               

         Â?Â?  Â&#x2030;   Â&#x2018;Â&#x2018;Â&#x2019; Â&#x201A; ­ Â&#x192;Â&#x2020;Â&#x2013;Â&#x20AC;Â&#x2026;Â&#x2013;

REFERENCES 1. Adamyan L.V., Chernova I.S., Kozachenko A.V. Modern approaches to the treatment of ectopic pregnancy. Tekhnologii XXI veka v ginekologii. Sb. mat. XXI Mezhdunar. kongr. [21st Century Technologies in Gynecology. Coll. Mat. 21st Int. Congr.]. Moscow, 2008, pp. 177-178. 2. Korsak V.S., Korshunov M.Yu., Mikhaylov A.V., Isakova E.V., Kirsanov A.A., Polyanin A.A. On the problem of ectopic pregnancy after IVF. Problemy reproduktsii, 1997, no. 3, pp. 61-64. (in Russ.). 3. Strizhakov A.N., Davydov A.I., Shakhlamova M.N., Belotserkovtseva L.D. Vnematochnaya beremennostâ&#x20AC;&#x2122; [Ectopic pregnancy]. Moscow, Meditsina Publ., 1998. 203 p. 4. Abusheikha N., Marcus S. Ectopic pregnancy following assisted reproductive technology. A textbook of in vitro fertilization and assisted reproduction. London, The Parthenon Publ. Group, 1999, pp. 333-342. 5. Ginsburg E.S., Frates M.C., Rein M.S., et al. Early diagnosis and treatment of cervical pregnancy in an in vitro fertilization program. Fertility and Sterility, 1994, vol. 61, no. 5, pp. 966-969. 6. Aylamazyan E.K., Ryabtseva I.T. Neotlozhnaya pomoshchâ&#x20AC;&#x2122; pri ekstremalâ&#x20AC;&#x2122;nykh sostoyaniyakh v ginekologii [Emergency care in extreme conditions in gynecology]. Nizhniy Novgorod, N. Novgorod State Med. Acad. Publ., 1996, pp. 51-55. 7. Kulakov V.I., Selezneva N.D., Krasnopolâ&#x20AC;&#x2122;skiy V.I. Operativnaya ginekologiya [Operative gynecology]. Nizhniy Novgorod, N. Novgorod State Med. Acad. Publ., 1997, 352 p. 8. Braude I.L. Neotlozhnaya khirurgiya v akusherstve i ginekologii [Emergency surgery in obstetrics and gynecology]. Moscow, Medgiz Publ., 1947, p. 25. 9. Persianinov L.S. Akusherskiy seminar. Izd. 2-e [Seminar on obstetrics. 2nd ed.]. Tashkent, Meditsina Publ., 1973, vol. 1, p. 106. 10. Nolan T.E., Chandler P.E., Hess L.W., Morrison J.C. Cervical pregnancy managed without hysterectomy. A case report. Journal of Reproductive Medicine for the Obstetrician and Gynecologist, 1989, vol. 34, no. 3, pp. 241-243. 11. Mashiach S., Admon D., Oelsner G., et al. Cervical Shirodkar cerclage may be the treatment modality of choice for cervical pregnancy. Human Reproduction, 2002, vol. 17, no. 2, pp. 493-496. 12. Hardy T.J. Hysteroscopic resection of a cervical ectopic pregnancy. Journal of the American Association of Gynecologic Laparoscopists, 2002, vol. 9, no. 3, pp. 370-371. DOI: 10.1016/S1074-3804(05)60419-7.

13. Lin H., Kung F.T. Combination of laparoscopic bilateral uterine artery ligation and intraamniotic methotrexate injection for conservative management of cervical pregnancy. Journal of the American Association of Gynecologic Laparoscopists, 2003, vol. 10, no. 2, pp. 215-218. DOI: 10.1016/S1074-3804(05)60302-7. 14. Nelson R.M. Bilateral internal iliac artery ligation in cervical pregnancy: Conservation of reproductive function. American Journal of Obstetrics and Gynecology, 1979, vol. 134, no. 2, pp. 145-150. 15. Lobel S.M., Meyerovitz M.F., Benson C.C., et al. Preoperative angiographic uterine artery embolization in the management of cervical pregnancy. Obstetrics and Gynecology, 1990, vol. 76, no. 5, suppl., pp. 938-941. 16. Ryu K.Y., Kim S.R., Cho S.H., Song S.-Y. Preoperative uterine artery embolization and evacuation in the management of cervical pregnancy: Report of two cases. Journal of Korean Medical Science, 2001, vol. 16, no. 6, pp. 801-804. 17. Farabow W.S., Fulton J.W., Flecther V. et al. Cervical pregnancy treated with methotrexate. North Carolina Medical Journal, 1983, vol. 44, pp. 91-93. 18. Hung T.-H., Shau W.-Y., Hsieh T.-T., et al. Prognostic factors for an unsatisfactory primary methotrexate treatment of cervical pregnancy: A quantitative review. Human Reproduction, 1998, vol. 13, no. 9, pp. 2636-2642. DOI: 10.1093/humrep/13.9.2636. 19. Banu L.P., Chowdhury S., Begum K., Islam F., Tasnim S. Cervical ectopic pregnancy: Case report. Journal of Bangladesh College of Physicians and Surgeons, 2007, vol. 25, no. 2, pp. 92-94. 20. Cerveira I., Costa C., Santos F., Santos L., Cabral F. Cervical ectopic pregnancy successfully treated with methotrexate injection. Fertility and Sterility, 2008, vol. 90, no. 5, pp. 2005.e7-2005.e10. DOI: 10.1016/j.fertnstert.2008.01.017. 21. Orlov V.I., Linde V.A., Dubrovina S.O., Ermolova N.V., Zinkin V.I., Markarâ&#x20AC;&#x2122;yan I.V. ĐĄonservative management of cervical pregnancy. Problemy reproduktsii, 2011, no. 2, pp. 39-42. (in Russ.). 22. Spitzer D., Steiner H., Graf A., et al. Conservative treatment of cervical pregnancy by curettage and local prostaglandin injection. Human Reproduction, 1997, vol. 12, no. 4, pp. 860-866. DOI: 10.1093/ humrep/12.4.860.

ЌвоŃ&#x201A;Đ˝Ń&#x2039;Đľ Ń&#x20AC;Đ¸Ń Ń&#x192;нки вŃ&#x2039; ПОМоŃ&#x201A;Đľ ĐżĐžŃ ĐźĐžŃ&#x201A;Ń&#x20AC;ĐľŃ&#x201A;Ń&#x152; на Ń Đ°ĐšŃ&#x201A;Đľ www.pmarchive.ru

Ă&#x20AC;Ă&#x160;Ă&#x201C;Ă&#x2DC;Ă&#x2026;Ă?Ă&#x2018;Ă&#x2019;Ă&#x201A;Ă&#x17D;. Ă&#x192;Ă&#x2C6;Ă?Ă&#x2026;Ă&#x160;Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;. Ă?Ă?Ă&#x201E;Ă&#x17D;Ă&#x160;Ă?Ă&#x2C6;Ă?Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;


84

Ă?Ă?Ă&#x20AC;Ă&#x160;Ă&#x2019;Ă&#x2C6;Ă&#x2014;Ă&#x2026;Ă&#x2018;Ă&#x160;Ă&#x20AC;Ă&#x; Ă&#x152;Ă&#x2026;Ă&#x201E;Ă&#x2C6;Ă&#x2013;Ă&#x2C6;Ă?Ă&#x20AC;

â&#x20AC;&#x2DC;7 (76) докайŃ&#x20AC;Ń&#x152; 2013 Đł.



Ă&#x2019;.Ă&#x20AC;. Ă&#x17D;Ă Ă&#x17D;Ă&#x2018;Ă&#x160;Ă&#x20AC;Ă&#x2039;Ă&#x17D;Ă&#x201A;Ă&#x20AC;1, Ă&#x2026;.Ă&#x17E;. Ă&#x192;Ă&#x2039;Ă&#x201C;Ă&#x2022;Ă&#x17D;Ă&#x201A;1,3, Ă&#x17E;.Ă&#x201A;. Ă&#x2C6;Ă&#x192;Ă?Ă&#x20AC;Ă&#x2019;Ă&#x17D;Ă&#x201A;Ă&#x20AC;2, Ă&#x2C6;.Ă&#x20AC;. Ă&#x2019;Ă&#x2C6;Ă&#x2019;Ă&#x17D;Ă&#x201A;Ă&#x20AC;2, Ă&#x20AC;.Ă&#x201A;. Ă&#x2018;Ă&#x17E;Ă&#x2021;Ă&#x2026;Ă&#x201A;Ă&#x20AC;3 1 Ă&#x201C;ðà ÍßùêèÊ ãÎùóäàðùòâüííÝÊ ÏüäèÜèíùêèÊ óíèâüðùèòüò, 620028, ĂŁ. Ă&#x2026;êàòüðèíåóðã, óÍ. Ă?üïèíà, ä. 3 2 Ă&#x2013;üíòðàÍßíàÿ ãÎðÎäùêàÿ åÎÍßíèÜà š 7, 620137, ĂŁ. Ă&#x2026;êàòüðèíåóðã, óÍ. Ă&#x201A;èÍÎíÎâà, ä. 33 3 Ă&#x2013;üíòðàÍßíàÿ ãÎðÎäùêàÿ åÎÍßíèÜà š 2, 620077, ĂŁ. Ă&#x2026;êàòüðèíåóðã, óÍ. Ă&#x152;ÎùêÎâùêàÿ, ä. 2

Ă&#x17D;ðãà íèçàÜèÿ ÏüäèÜèíùêÎÊ ïÎÏÎÚè ÌüíÚèíàÏ Ăą ÎùÍÎÌíüíèÿÏè ïÎùÍüðÎäÎâÎãÎ ïüðèÎäà â êðóïíÎÏ ïðÎÏÝøÍüííÎÏ ãÎðÎäü Ă&#x17D;åÎùêàÍÎâà Ă&#x2019;àòßÿíà Ă&#x20AC;íàòÎÍßüâíà â&#x20AC;&#x201D; äÎêòÎð ÏüäèÜèíùêèþ íàóê, çàâüäóÞÚàÿ êàôüäðÎÊ àêóøüðùòâà è ãèíüêÎÍÎãèè, òüÍ.: (343) 254-69-20, +7-912-283-76-31, e-mail: oboskalova.tat@yandex.ru1 Ă&#x192;ÍóþÎâ Ă&#x2026;âãüíèÊ Ă&#x17E;ðßüâèá â&#x20AC;&#x201D; êàíäèäàò ÏüäèÜèíùêèþ íàóê, äÎÜüíò êàôüäðÝ àêóøüðùòâà è ãèíüêÎÍÎãèè, çàÏüùòèòüÍß ãÍàâíÎãÎ âðàáà, òüÍ.: (343) 372-96-42, 8-922-224-14-11, e-mail: doc@cgb7.ru1,3 Ă&#x2C6;ãíàòÎâà Ă&#x17E;Íèÿ Ă&#x201A;èêòÎðÎâíà â&#x20AC;&#x201D; âðàá àêóøüð-ãèíüêÎÍÎã ÎåùüðâàÜèÎííÎãÎ àêóøüðùêÎãÎ ÎòäüÍüíèÿ, òüÍ. +7-904-988-19-27, ĂĽ-mail: ignatova97@rambler.ru2 Ă&#x2019;èòÎâà Ă&#x2C6;ðèíà Ă&#x20AC;ÍüêùàíäðÎâíà â&#x20AC;&#x201D; âðàá àêóøüð-ãèíüêÎÍÎã ÎòäüÍüíèÿ ÎåÚüÊ ãèíüêÎÍÎãèè, òüÍ. +7-904-988-19-26, ĂĽ-mail: irina_titova_1976@list.ru2 Ă&#x2018;Þçüâà Ă&#x20AC;íàùòàùèÿ Ă&#x201A;ÍàäèÏèðÎâíà â&#x20AC;&#x201D; çàâüäóÞÚàÿ ÎòäüÍüíèüÏ ÏüäèÜèíùêÎÊ ïðÎôèÍàêòèêè, òüÍ.: (343) 389-89-11, +7-904-547-97-03, ĂĽ-mail: ns_s@mail.ru3                                                               Â?  Â? Â?             Â?Â?  ­Â&#x20AC;Â? Â&#x201A; Â&#x192;      Â&#x201E;    Â&#x2026;Â&#x2020;Â&#x2020;Â&#x2020;Â&#x2026;Â&#x2020;Â&#x2020;Â&#x2021;  Â&#x2026;Â&#x2020;Â&#x2020;Â&#x2C6;Â&#x2026;Â&#x2020;Â&#x2030;Â&#x2026; Â&#x160;Â?    Â&#x2039;    Â&#x201E;      Â&#x152;   Â?     Â&#x2039; Â?  Â?    Â&#x17D;   Â?  Â&#x2039;  Â&#x201E;  Â? Â?       Â?          Â?       

Â? Â&#x152;     Â     Â?      Â&#x201E;    Â&#x152;       

T.A. OBOSKALOVA1, E.Yu. GLUKHOV1,3, Yu.V. IGNATOVA2, I.A. TITOVA2, A.V. SYUZEVA3 1 Ural State Medical University, 3 Repina St., Ekaterinburg, Russian Federation 620028 2 Central Municipal Hospital š 7, 33 Vilonova St, Ekaterinburg, Russian Federation 620137 3 Central Municipal Hospital š 2, 2 Moskovskaya St., Ekaterinburg, Russian Federation 620077

Delivery of health care for women with complications of postpartum period in a large industrial city Oboskalova T.A. â&#x20AC;&#x201D; D. Med. Sc., Head of Department of Obstetrics & Gynecology, tel.: (343) 254-69-20, +7-912-283-76-31, e-mail: oboskalova.tat@yandex.ru1 Glukhov E.Yu. â&#x20AC;&#x201D; Cand. Med. Sc., Associate Professor of the Department of Obstetrics & Gynecology, Deputy Chief Doctor, tel.: (343) 372-96-42, +7-922-224-14-11, e-mail: doc@cgb7.ru1,3 Ignatova Yu.V. â&#x20AC;&#x201D; Doctor of the Observational Obstetric Department ; tel. +7-904-988-19-27, ĂĽ-mail: ignatova97@rambler.ru2 Titova I.A. â&#x20AC;&#x201D; Doctor of the Gynecology Department, tel. +7-904-988-19-262 Syuzeva A.V. â&#x20AC;&#x201D; Head of the Department of Medical Prophylaxis, tel.: (343) 389-89-11, +7-904-547-97-03, ĂĽ-mail: ns_s@mail.ru3

Ă&#x20AC;Ă&#x160;Ă&#x201C;Ă&#x2DC;Ă&#x2026;Ă?Ă&#x2018;Ă&#x2019;Ă&#x201A;Ă&#x17D;. Ă&#x192;Ă&#x2C6;Ă?Ă&#x2026;Ă&#x160;Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;. Ă?Ă?Ă&#x201E;Ă&#x17D;Ă&#x160;Ă?Ă&#x2C6;Ă?Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

85

                                                            

                            ­    € ‚     ƒ        ƒ     „       ƒ           ƒ   

                                                                                                           ­€ ‚ƒ                    „ …  …      †‚‡ˆ­‰ Šƒ                        …  ­† Šƒ‹    … ……        …                                       

                                             ­      ­€€  €€         €       €      €           ­  €    €   ‚ ƒ   ­€€                     

 „                         €      € …†‡ˆ   ‰                       Š‹ˆ ŒŽ‹ … ‘  ‰   ‡’’’‡’’“   ‡’’‡’”‡ ‰ ƒ   •–     ” “                  ”‚ ’’’   —  ” 

   ”†‡ ‡˜”†‚ ‡“  ‡ƒ ”‚‘‡‚ “˜™™ š›’ ’’™œ •                                       ­                                     €                     •        ‡“    — ”œ                        ž ‡œ        ž †œ                          ž™œ        ­   „   ­                                ­€€  š ”œ      ­    Ž         €                      ­     Ÿ¡ˆ                       ” “  ™   ”‡’”“’   ¢      €     ‘“£ ‡’’’        €          š‡  œ                                               •            € Ÿ¡ˆ €    

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


86

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

                                                        ­  €‚ €   ƒ„                                       „ … †     €‡          †     ˆƒ‰ƒŠ            ‹                           ƒ‰ƒ      ŒŽ‘           ˆ…Š’ 

            Œ      “‘ ”•– — ˜   ™     ˆ  š›–– Š “     „       ”           „  ŒŽ‘       †           ˆ   š‰’œŠ“          ­      

          ­­       € €      € €‚ ƒ    € €     €   €„    „       €   €…  ­„ „

‘7 (76) декабрь 2013 г.

„€     „†‡ˆ‰Š‹ŠŒŽ ‘’“”„          • –      —   ˜  „         ™šƒ   ›™š™ œž›Ÿ        – „–– œ Ÿ ¡          –­€ ¡¢¡ „    ¡¢¡ £š¤ƒ  € ƒ ƒ¤š™£™œžŸ        ­ –­€   •   ˜  ¡¢¡ „–­ ƒƒ¥­ ¦            ¤š¥    ›š›§  ƒ     ™šƒ œžŸ ¥£š§ œžŸ        „     –      ––­€   €              ƒšƒ ›š™ƒ œž£Ÿ •      „            …     …       €„­  ¨£ƒ© ˜    „  –­  „  ™    ›ª§   €¡¢¡   „  ¤£        ¤ª›› ƒ›ª§‚ž ¢ – „   „  ››£    ƒ›ªƒ§¥ª›§‚ž       „ €„      •   ¥¥£     ¤£§ ¡     …  ¥™ª¤£ œ£¤§Ÿ™ª™ƒ›œ£ƒ§Ÿ    •    „     « –„  ¬   …         €     „„   ¥›šƒ£ œ›ª¤§Ÿƒ ™š™ƒ œ£›ª§Ÿž£ ˜   ®®¯£›ªœ£›ª™§Ÿ€    –            ˜ƒ  € ¤ƒƒª¤œƒª¥™§Ÿœž£Ÿ 

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

87

         ­  €   ‚              

           

                     ­€ ­   ‚ƒ „  …               …  † ††‡‡‚ ƒƒ ˆ  ‰ Š 

   

 ‹    Š ŠŒ…Ž Œ           Ž  Š Š     ­†        …       ‘  €­­  ’‚ ƒƒ “  Š  Š ‰

 Š                     Œ …  ƒ ”… Š    Ž ‰      Š  …       …  •  …‡‡€… ƒ “ … ‰ ŒŒ…  ŠŠŠ     ŠŠŽ Š  Š   Š  …

  

…  ……   ƒ–  … 

 ‰         Š …— …˜“™ Š …  Š…      Š   ‰  ŠŒ Š‰  Š  …  …   Š   …

 …  Ž Žƒ” … 

  Š  …  …

  ŠŠ      

  Šƒš ŠŠŽŠŒ

   Š  Ž‹



     

 Š‰    ŠŽ    Ž   ‰ Ž‰

 …   Šƒ ›Š    Š  Š  Š    Š  ‹  …    Š Ž Œ   



      

 — ƒ “ Š   

   ŽŠ   Œ   

… …   Š— Œ   …    Š    Š   Š ‰

ƒ Š …  … ŠŠŠ     …… ŠŽ  ‰  ‰ 

   … 

Œ Ž    Š  … ‰    ŠƒœŠ‰

 Š  …  …  Š       ‰   ƒ ž   Š ŠŠŠ  Ž  

  ƒ “  Š 

  ŠŠ     …        ‰Ž Š   Š  …    ‹… ƒ“

 Š Ž

 ‰ …   Š   … — Œ   Œ    

Œ  ƒ –    Œ ŠŠ‹  

  ŒŒŒ    

   Œ  ƒ “ 

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


88

Ă?Ă?Ă&#x20AC;Ă&#x160;Ă&#x2019;Ă&#x2C6;Ă&#x2014;Ă&#x2026;Ă&#x2018;Ă&#x160;Ă&#x20AC;Ă&#x; Ă&#x152;Ă&#x2026;Ă&#x201E;Ă&#x2C6;Ă&#x2013;Ă&#x2C6;Ă?Ă&#x20AC;

â&#x20AC;&#x2DC;7 (76) докайŃ&#x20AC;Ń&#x152; 2013 Đł.

                          Â  Â?       Â?     Â Â?                     Â  Â?   Â?  Â? 

 Â?              ­Â&#x20AC;Â&#x201A;                       

        Â

 Â&#x192;Â Â&#x201E;                       

 Â&#x2026;Â&#x2020;Â&#x2021;               Â  Â&#x2C6;Â Â&#x2030;    Â      

 Â&#x160; Â&#x201E;                                               Â

            Â Â?

Â?Â?  Â?Â?

   ­Â&#x20AC;  Â?Â&#x201A;Â&#x201A;   Â? Â?  Â?Â&#x192;Â&#x201E;Â&#x2026;Â&#x2026;Â&#x2020;Â&#x192;Â&#x2021;Â&#x192;Â&#x2C6;Â&#x2030;Â?Â&#x160; Â&#x201E;   Â? Â&#x2039; Â?     Â?

Â? Â?  Â?Â?

  Â&#x152;Â&#x17D;  Â&#x152; Â&#x152; Â&#x2018; Â&#x201A;Â&#x201A; 

  Â&#x152;Â&#x2039;

 ­  Â&#x192;Â&#x201E;Â&#x2026;Â&#x2026;Â&#x2019;Â&#x192;Â&#x2021;Â&#x201E;Â&#x192;Â&#x2C6;Â&#x201C;Â? Â&#x2030; Â&#x201D;  Â&#x2022;  Â&#x2013;  Â&#x2013;   Â&#x201D;  Â&#x2C6;  Â&#x2013; Â&#x2C6;      ­  Â&#x2022;Â&#x201A;Â&#x201A;  Â? Â?  Â?Â&#x192;Â&#x201E;Â&#x2026;Â&#x2026;Â&#x2026;Â&#x192; Â&#x2021;Â&#x2020;Â&#x192;Â&#x2C6;Â&#x2030;Â&#x2014;Â?Â&#x2030;Â&#x2019; Â&#x2014; Â&#x2DC;   Â&#x2122;  Â&#x161;  Â&#x161;  Â&#x152;Â&#x2022;   Â&#x2DC;   

 Â&#x203A; Â&#x2122;Â&#x153;  Â&#x2018; Â&#x152;Â&#x2039;   Â? Â&#x201A;Â&#x201A;  Â?Â&#x192;Â&#x201E;Â&#x2026;Â&#x2026;Â&#x201E;Â&#x192;Â&#x2021;Â&#x2030;Â&#x192;Â&#x2014;Â&#x192;Â&#x2C6;Â&#x201E;Â?Â&#x2030; Â&#x2020;Â&#x17E;Â  Â?Â&#x2C6; Â Â&#x203A;Â&#x161; Â&#x2C6;Â Â&#x2022;  Â&#x161;Â&#x2C6;Â&#x152;  Â&#x20AC;   Â?Â&#x2018; Â&#x152;Â&#x201A;Â&#x201A;Â&#x161;   

 

Â&#x2039;Â&#x2039;  Â?Â?Â?  Â?Â&#x192;Â&#x;Â&#x;Â&#x;Â&#x192;Â&#x2021;Â&#x192;Â&#x2C6;Â&#x2014;Â&#x201C;Â?Â&#x2020;Â&#x2026; Â&#x160;ÂĄ  Â&#x161; ¢  Â&#x201D; Â?  Â&#x161;Â&#x2122;  ÂŁ   Â&#x17E;Â&#x2DC;  Â&#x20AC;     Â? Â&#x2018; Â&#x152; Â&#x201A;Â&#x201A; 

 Â&#x152;Â&#x2039;

 ­  Â&#x192;Â&#x201E;Â&#x2026;Â&#x2026;Â&#x201C;Â&#x192;Â&#x2021;Â&#x201E;Â&#x192;Â&#x2C6;Â&#x2014;Â&#x2030;Â?Â&#x2014;Â&#x;  

                 

      Â Â? Â? Â?

   Â?

Â?Â? Â? 

Â? Â? Â? ­­Â&#x20AC;Â?Â&#x201A;Â&#x192;Â?Â&#x201E;Â&#x2026;Â&#x2020; Â&#x2021; Â&#x2C6;Â&#x2030;Â&#x160; Â&#x2030; Â&#x2039;Â&#x152; Â&#x17D; Â&#x2026;Â&#x2C6;  Â&#x2030;  Â&#x2018; Â?   Â&#x2030; Â?        Â? Â&#x2019; Â&#x2030;  Â?Â? Â&#x2C6; Â&#x201C;Â&#x2C6; Â&#x2030; Â&#x201D;Â?Â&#x2C6;  ­­Â&#x2020;Â?Â&#x192;Â&#x2020;­ Â&#x2022;              Â&#x2013; Â&#x2014;    Â&#x152;

 Â&#x160; Â?   Â&#x2014; Â&#x2019; Â&#x2030; Â?Â&#x2DC; Â?     Â&#x2122;  Â?Â?Â&#x161; Â&#x2030; Â?     Â&#x2122; Â? ­­Â&#x203A;Â?Â&#x201A;Â&#x192;Â?Â&#x20AC;Â&#x2026;Â&#x2021; Â&#x192;­Â&#x153;Â&#x17E;Â&#x;¥¢£¤ÂĽÂ&#x17E;Â&#x;¥Œ§§¨Â&#x153;ŠÂ&#x;¢ªŒ£¤¨£Â&#x17E;ÂŹŽ¢Â&#x;¯°ªÂ&#x17E;ÂŹ¹°£¨°§²¨ª£°Œ§¹ Â&#x17E;²£¨Â&#x;ª¨¹Â&#x17E;Â&#x;¨Â&#x17E;§¹¨ª£°Œ§Â&#x2DC;Â&#x;¨¹¢£¹Œ²Â&#x17E;³´¨Â&#x2026;¾¨Â&#x17E;Â&#x;ÂśÂ&#x;Œ¹œ¨ª£°´¨¹¢Â&#x;´¨°Â&#x17E;§ª¨Â?Â? ¡¸¾§¨ªš¥¹£¨£Â&#x153;°Œº¨œÂ&#x;ÂŚÂťÂ? ­­Â&#x20AC;Â?Â&#x201A;Â&#x201E;Â&#x201E;ÂźÂ&#x2020;½Â?Â&#x20AC;Â&#x2021;Â&#x2026;Â&#x20AC;Â&#x2022;Â&#x2020; Â&#x192;Â&#x192; žŒœ¿°§¹ Ă&#x20AC; à §£°¥°Œ£°ª ÂśÂ&#x;Œœ¾Â&#x17E;Ă&#x201A;°¹ Â&#x;¨¯°Ă&#x192;¨§¹ Â&#x17E;§ ÂťÂ&#x;¢¯¹ ²ŒÂ&#x; ª¨¹Â&#x17E;Â&#x;¨Â&#x17E;§¹¨ª£°Œ§Â?Ă&#x20AC;žŒœ¿°§¹ ¤ÂŽĂ&#x192;Â&#x17E;°Â?Â? ÂĽÂŚÂŞÂŤÂ&#x;Â&#x17E;§¨Ă&#x201E;Â&#x17E;ÂŁÂ&#x17E;ÂĄÂ&#x17E;¹¨Ž¾¹£ º¨´Â? ­­Â?Â&#x201A; Â?Ă&#x2026;Â&#x192;­Â&#x2020; Â&#x192;  ¤Â&#x;¨§ª Ă&#x20AC;Ă&#x2020; ÂŽĂ&#x192;Â&#x17E;° ¤Ă&#x2020; à §£°¥°Œ£°ª Â&#x;¨¯°Ă&#x192;¨§¹ ²ŒÂ&#x; ¨§ŒĂ&#x192;¨£Â&#x;°£°¹ Â&#x17E;²£¨Â&#x;¨°´¨Â&#x;ÂľŸ¼ŒªÂ&#x;Â&#x17E;§¨º¨´°¨Ă&#x2021;½Â?Â?Š¨º¨œÂ&#x;Œ¢ª£°´¨ž¨Â&#x17E;ÂŹÂŁÂŤĂ&#x20AC;°¥Â&#x;Â&#x17E;Â&#x;Âľ Â? ­­ Â?Ă&#x2C6;¹¹¢¨Â&#x2022;

REFERENCES 1. Frolova O.G., Tokova Z.Z. Key performance indicators of the activity of obstetric-and-gynecological services and reproductive health. Akusherstvo i ginekologiya, 2005, no. 1, pp. 3-6. (in Russ.). 2. Frolova O.G. Organization of primary obstetric and gynecological care at the present stage. Rossiyskiy meditsinskiy zhurnal, 2008, no. 2, pp. 7-11. (in Russ.). 3. Manukhin I.B., Burduli G.M., Selivanova G.B. Sepsis after complications in childbirth. Akusherstvo i ginekologiya, 2000, no. 5, pp. 34-38. (in Russ.). 4. Nikonov A.P., Volkova O.V., Razmakhnina N.I., Gurskaya T.Yu. Endometritis prevention in cesarean operation. Ginekologiya, 2002, vol. 4, no. 3, pp. 2-3. (in Russ.). 5. Kulinich S.I., Trusov Yu.V., Sukhinina E.V. Modern features of postpartum endometritis. Vestnik Rossiyskoy assotsiatsii akusherovginekologov [Bulletin of the Russian Association of Obstetricians and Gynecologists], 1999, no. 1, pp. 47-50. (in Russ.). 6. Zhestkov A.V., Shlyapnikov M.E., Reshetnikova V.P., Arutyunyan K.N. Antibiotic treatment of postpartum endometritis. Uralâ&#x20AC;&#x2122;skiy meditsinskiy zhurnal, 2007, no. 2, pp. 43-49. (in Russ.).

7. Kulakov V.I., Gurtovoy B.L., Ankirskaya A.S., Antonov A.G. Topical problems of antimicrobial therapy and prevention of infections in obstetrics, gynecology and neonatology. Akusherstvo i ginekologiya, 2004, no. 1, pp. 3-6. (in Russ.). 8. Medzhidova D.R., Omarov S.-M.A., Abdusalamova Z.K. Improving the diagnostics of postoperative endometritis. Mat. VIII Vseross. foruma ÂŤMatâ&#x20AC;&#x2122; i DityaÂť [Proc. 8th All-Russ. Forum â&#x20AC;&#x153;Mother and Childâ&#x20AC;?]. Moscow, â&#x20AC;&#x153;MEDI Ekspoâ&#x20AC;? Publ., 2006, p. 160. 9. Akimkin V.G. The nosocomial infection prevention system in Russia. Service of hospital epidemiologists: Results and prospects of development. Epidemiologiya i infektsionnye bolezni, 2005, no. 1, pp. 4-8. (in Russ.) 10. Barbut F. Carbonne B., Truchot F., Spielvogel C., Jannet D., Goderel I., Lejeune V., Milliez J. Surgical site infections after cesarean section: Results of a five-year prospective surveillance. Journal de Gynecologie Obstetrique et Biologie de la Reproduction, 2004, vol. 33, no. 6, pp. 487-496. 11. Hopkins L., Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database of Systematic Reviews, 2007, no. 4, art. no. CD001136. DOI: 10.1002/14651858.CD001136. 12. French L.M., Smaill F.M. Antibiotic regimens for endometritis after delivery. Cochrane Database of Systematic Reviews, 2002, no. 1, art. no. CD001067. DOI: 10.1002/14651858.CD001067.

Ă&#x20AC;Ă&#x160;Ă&#x201C;Ă&#x2DC;Ă&#x2026;Ă?Ă&#x2018;Ă&#x2019;Ă&#x201A;Ă&#x17D;. Ă&#x192;Ă&#x2C6;Ă?Ă&#x2026;Ă&#x160;Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;. Ă?Ă?Ă&#x201E;Ă&#x17D;Ă&#x160;Ă?Ă&#x2C6;Ă?Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;


‘7 (76) декабрь 2013 г.

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

89



Å.Þ. ÀÍÒÐÎÏÎÂÀ1, Â.Â. ÊÎÐÎÁÎÂ2, Ë.Ð. ÑÀÔÈÓËËÈÍÀ2, Ì.È. ÌÀÇÈÒÎÂÀ1 1 Êàçàíñêàÿ ãîñóäàðñòâåííàÿ ìåäèöèíñêàÿ àêàäåìèÿ, 420011, ã. Êàçàíü, óë. Ìóøòàðè, ä. 11 2 Ãîðîäñêàÿ êëèíè÷åñêàÿ áîëüíèöà № 7, 420103, ã. Êàçàíü, óë. Ìàðøàëà ×óéêîâà, ä. 54

Îöåíêà êðèòåðèåâ ôåðòèëüíîñòè ó ïàöèåíòîê   àðòåðèé Àíòðîïîâà Åëåíà Þðüåâíà — êàíäèäàò ìåäèöèíñêèõ íàóê, äîöåíò êàôåäðû àêóøåðñòâà è ãèíåêîëîãèè № 2, òåë. (843) 555-73-03, e-mail: antropoval@mail.ru1 Êîðîáîâ Âëàäèìèð Âèêòîðîâè÷ — êàíäèäàò ìåäèöèíñêèõ íàóê, âðà÷ àíãèîõèðóðãè÷åñêîãî îòäåëåíèÿ, òåë. (843) 236-80-52, e-mail: korobov@mail.ru2 Ñàôèóëëèíà Ëèëèÿ Ðèôãàòîâíà — êàíäèäàò ìåäèöèíñêèõ íàóê, âðà÷ óëüòðàçâóêîâîé äèàãíîñòèêè, òåë. (843) 236-86-14, e-mail: korobov@mail.ru2 Ìàçèòîâà Ìàäèíà Èðåêîâíà — äîêòîð ìåäèöèíñêèõ íàóê, äîöåíò êàôåäðû àêóøåðñòâà è ãèíåêîëîãèè № 2, òåë. (843) 555-73-03, e-mail: madina13@list.ru1

                                                                  ­  

E.Yu. ANTROPOVA1, V.V. KOROBOV2, L.R. SAPHIULLINA2, M.I. MAZITOVA1 1 Kazan State Medical Academy, 11 Mushtari St., Kazan, Russian Federation 420011 2 City Clinical Hospital № 7, 54 Marshala Chuykova St., Kazan, Russian Federation 420103

Criteria for fertility in women with uterine fibroid after uterine artery embolization Antropova E.Yu. — Cand. Med. Sc., Associate Professor of the Department of Obstetrics and Gynecology № 2, tel. (843) 555-73-03, e-mail: antropoval@mail.ru1 Korobov V.V. — Cand. Med. Sc., Doctor of Angiosurgical Department, tel. (843) 236-80-52, e-mail: korobov@mail.ru2 Saphiullina L.R. — Cand. Med. Sc., Ultrasonic Medical Investigation Specialist, tel. (843) 236-86-14, e-mail: korobov@mail.ru2 Mazitova M.I. — D. Med. Sc., Associate Professor of the Department of Obstetrics and Gynecology № 2, tel. (843) 555-73-03, e-mail: madina13@list.ru1 €‚ƒ„…‚†‡ˆ‰Š†‹Œ‹Ž‘…‰…„’ˆ“†ƒ‹‚‘ƒ†…”Žˆ…„’ ‚‹ˆ‰†Œˆ…•‰ˆ“”ˆ†ƒ‰Œ†–—ƒ„‰˜‹’ˆ†ƒ”ˆ†ƒ‰Œ†‹ƒˆ†ƒ‘†™—„Ž‰…‹ˆ‰„Œ•‹…™‹˜†š“††’’†‡ˆ „’”ˆ†ƒ‰Œ†‹ƒˆ†ƒ‘†™—„Ž‰…‹ˆ‰„Œ„Œˆ“†’”Œ‡ˆ‰„Œ‹Ž…ˆ‹ˆ”…„’ˆ“†„Š‹ƒ‰†…—‘‹……†……‰Œ›ˆ“†Ž†Š†Ž„’…†œ“„ƒ™„Œ†…†‡“„…ˆƒ”‡ˆ”ƒ†„’„Š‹ƒ‰†… ‹Œ˜™‘„™‹‘„”…”ˆ†ƒ‰Œ†„Š‹ƒ‰†…—Ž„„˜…”‚‚Ž‘‹Œ˜Œ„˜†…„Œž„‚‚Ž†ƒ‚‹ƒ‹™†ˆ†ƒ…•‹……ˆ”˜‰†˜Ÿ„‡‹Ž‰¡‹ˆ‰„Œ„’ˆ“†™‹¢„ƒŒ„˜†…‹ˆˆ“† —„ˆˆ„™‹Œ˜ˆ”—”Ž‹ƒ‹Œ›Ž†…„’”ˆ†ƒ”…ˆ„”ˆ†ƒ‰Œ†‹ƒˆ†ƒ‘†™—„Ž‰¡‹ˆ‰„Œƒ†˜”‡†…—Ž„„˜£„•‹Œ˜˜†Š†Ž„‚…“‘‚„„Š‹ƒ‰„Œ‰…™—‘ˆ‘‚†„’Ž”ˆ†‹Ž ‚“‹…†˜†’†‡ˆŸ„‡‹Ž‰¡‹ˆ‰„Œ„’Œ„˜†…‰Œˆ“†’ƒ„Œˆ‹Œ˜—‹‡¤”ˆ†ƒ‰Œ†•‹ŽŽ…˜„†…Œ„ˆ‹’’†‡ˆˆ“†„Š‹ƒ‰†…—Ž„„˜£„•‹Œ˜˜„†…Œ„ˆƒ†˜”‡†ˆ“†‰ƒ ’”Œ‡ˆ‰„Œ‹Ž‹‡ˆ‰Š‰ˆ‘—†’„ƒ†‹Œ˜‹’ˆ†ƒ†™—„Ž‰¡‹ˆ‰„Œ  ”ˆ†ƒ‰Œ†–—ƒ„‰˜”ˆ†ƒ‰Œ†‹ƒˆ†ƒ‘†™—„Ž‰…‹ˆ‰„Œ

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


90

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г. ™  ƒ 

 ¨•  „                 ­   €‚    ƒ    ­  „   

…  †   †     ‡ˆ‰  † ƒ        ƒ Š   †         ‹†    ƒƒ  Œ  ƒƒ     † ƒ      Ž‘’     ’  Š  “  ƒ  ”    ”•      –       ”  †  †         ƒ   † ‹ ƒ   —     ˆ˜        Œ  ‹ †   † ƒ    ƒƒ ˜™…†   †    †  šˆ   ‹ ƒ  ˆ˜   †   ƒ   ƒ   ›—‹  œ †      †            † ­ƒ

Œ        ‘…      œ•      ”œ   ‰ƒƒ   ƒƒ žŸ¡¢£¤¢¥¦ ¢ § ¨©¨ª«¬¤£®ž®¯¤’   ™   †      †          °—   ‘        …      † Š     ±       †    ƒž²³±´¬´µ°®¶³·ª

                         ­ €      ‚ ƒ  „          ƒ…   ­…      † ‚ † „   ­‡ ƒ ˆ† †    …   ‚ ƒ ‰ „Š‹ŒŽ‘’“”Ž   •            † –—„    „      †‚ ˜  ™ ­       ­ ƒ „    ­    ˆ     † ‚    ‚      †    

­    š›•œ ™                  ‚     šžœ„           šœ     

 ‚ †   Ÿ   †    ­       „ ­ †        ‚              €    †         ‚  †  ‚ † †            ¡            ž¢           £    ¤       „      „           „  ‚     † „ ƒ   †        ¥  ™          

 ™

 ƒ  

 ˆ •        ˜    ž¦ ˜  §           

 ƒ  †      

               £ƒ¸¹  

ˆ 

££ƒ¸¹€

º

ˆ 

º

»ž¼½

»ž¼½

¾ž¼½

»ž¼½

»ž¼½

¾ž¼½

‘ 

¿À€¼¿„

‚¼

¿¼Á¿€

-

-

-

œ  —  

€¿Â¼„€

À‚¼€Â

¼Á‚

-

-

-

œ ƒ 

„¼‚€

À¼‚„

„¼Á€

-

-

-

œ  

¿À„¼€ÁÂ

¿‚‚¿¼€Â¿

¿¼Á€„

À€Â¼‚€

€ÁÀ¼€ÁÂÂÃ

„¼ÁÀÃÃ

œ  — 

„‚¼€Á„

¿Á‚¼Á„

¿‚¼Á€Â

„„¼‚‚

¿¼‚„Ã

À¼Á€

        

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

91

                         š ‚     ˆœ®‰

¬ €

ŒŽ‚“

•–

•

—

’





’

’





’’°

’

—



°

°



‹  ˆ¯ª‰

‹  ˆ¯ª‰

              ­                     š ‚     ˆœ®‰

¬ €

ŒŽ‚“

•–

•



—

’



’’—

—

’’—



°

—

’’



—°

—



‹  ˆ¯ª‰

‹  ˆ¯ª‰

               €­                              ­€  ‚€   ‚                  ƒ„ …­†‚‚                 ‚  €   ‚   ­­†‚     € €‡      €ˆ­ ‰ Š     € ­‚ € ‹­‚ €  ‚€   ƒ€  € ­€  ‚€‡    ‚ ‚€‡   €  €    ˆŒŽ ‘  ’  ‚“”•–‘——‰  „  ‚ ˜­     ­      €   ƒ€ ˆŒŽ‘‚“”•–‘ ‰‹­€  ˆŒŽ ‘ — ‚“ •– ‘ ’‰      € •‹­€  €     ‚    „      „ ˆŒŽ ‘ — ‚“” •– ‘ ’‰ Ž        ‚‚€ ‚  ­€    €  ™‚       ƒ  ­  ‚   ‚ ­†      ‚ ­‚ €   ‹ ­‚ €        ‘ ­  ‚ ­  €   ‚       €       ‚  ‚ -

‚       €     ­    š ›œž          ‚    ˜€  ‚ ƒ€‚‚ Ÿ   ¡     ’¢             ‚ ‚    ­ „    € ‹˜€ œ£        ­   ˆ¢   ‰    ˜€      ƒ„ „˜€ˆ¤Œ¥‰ˆ’— ‚ ƒ“  ˆ¦§—‰‰    ­€    ‚ ˆ¢  ‰‘¤Œ¥ ƒ„ ˜€ˆŸ’ “‚ ˆ¦§‰‰ –   ­€   ‚  ­ „ €      ¨œˆ­ ‰ › ­     ‡               ˆ       ‚ ‰  „   ‚  ‚       ‚ ‚   ­€                ˆ­ ‰ š  ƒ‚‚ ˜      ­ ­€    ‚    ‚‚ ‚ ƒ     ƒ„    €     ­         ˆ   ­ ‚ € ­‰ˆ©ª”«ª‰ ž                    €  ‹ ­       ‚      Š     -

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


92

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

                                                             ­€‚ƒ„ …††‚‡     ˆ                      ‰†€ ­‚Šƒ„…††‚‡‹    ŒŽ                        ‘      ŒŽ        ’         ‰‚ƒ                    ’        ’   “   ’ €”‚ƒ                ‰†ƒ         ’                   ’           •                  ŒŽ     ’  –           —’     

     ”†ƒ                  ˜ € ŒŽ—’           •          ‹ —    ’     €ŒŽ                        ™š› œ…†† ‡         (      ˆ‘ž‹‘(œ…†† ‡     ’   ›       ŒŽ                   ’   

   ’    ˜ 

  €Ÿ”     ŒŽ  ’              ’                   •       

       ŒŽ ¡      ŒŽ     •                 ’    ¡                           •                        ˜    

     ŒŽ                  ’     ’ ’  ˜ € ’  •            ŒŽ˜                      ŒŽ ™š› ˆ €‚­”    ¢„  ˆ ”Š†‚­” ‚  ¢ …††‚‡‡ š            ’  ŒŽ ’     £                 ’      “  ’    -

‘7 (76) декабрь 2013 г.                         

    ŒŽ         £                      ’  ›    —’   £                  ’ ’     £    ŒŽ¤  Š‰­†‰  3„  €­†‚ 3‡ “  €                         ‡ 

            £ ’     ’—    ‹—                 ˆ     ˆ     ¥                   ”Š­† ‰         ‡ ‹    ’ ’    £       ˆ‰      ˆ ”       ’     £      ŒŽ        —’          ¡                                €­††Š  ‹’                          ’            ˜ €ŒŽ‚‚ƒ         ’         “€”‚ƒ    ‰†ƒ             ’£                  ¦€‹ ‚”ƒ      ‚€‰ƒ   —       ’    “                        ¦€  ‚ ƒ  ‹ˆ €ƒ      ‹        ’             ¦€ §ƒ ‹ˆ †ƒ   ‚    –      

  

               ’     ™š›¦€¨©†§”„ª©”  ‡ «          ŒŽ          ’            €       ’ ’“ ’       ’    ˆ     €   ŒŽ             ’  ˆ ‰          ’      ¦€‹—’        ŒŽ       ‘  ’       ’         ŒŽ          ’                               ’    “  ’                  -

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


Ă?Ă?Ă&#x20AC;Ă&#x160;Ă&#x2019;Ă&#x2C6;Ă&#x2014;Ă&#x2026;Ă&#x2018;Ă&#x160;Ă&#x20AC;Ă&#x; Ă&#x152;Ă&#x2026;Ă&#x201E;Ă&#x2C6;Ă&#x2013;Ă&#x2C6;Ă?Ă&#x20AC;

â&#x20AC;&#x2DC;7 (76) докайŃ&#x20AC;Ń&#x152; 2013 Đł.

93

                                 Â       Â?Â?             Â? Â?Â?  Â?     Â?  

   Â?  Â?Â?           ­Â&#x20AC;Â&#x20AC;Â&#x201A;  Â&#x192;    Â&#x201E;

    

   Â?Â? Â&#x2026; Â?Â?Â&#x2020;Â&#x2021;            Â?   Â?  ­Â&#x201E;Â&#x2C6;Â&#x2030;Â&#x160;Â&#x201A;Â&#x2039;   Â?  Â?          Â&#x152;Â&#x17D; Â?  Â&#x2018; Â? Â?  Â&#x2019;  Â? Â?      Â?                      Â? Â?    Â&#x2019;  Â?  Â?                          Â&#x201C;   Â&#x192; Â&#x201D;Â&#x20AC;Â&#x201A;Â&#x2022;  Â?Â?    Â?Â&#x2013;Â?  

   Â&#x192; Â&#x201C;     

Â&#x2018;    Â? Â?   

       Â?Â?          Â&#x2019; Â?Â&#x201C; Â?    Â?Â?        Â&#x2C6;  Â&#x2039;       Â&#x201C;       Â&#x192;   

         Â?  Â&#x152;          Â?       Â?  Â&#x192;    Â&#x2019;  Â? Â?  Â&#x2014;  Â?Â?    Â?

 Â?   Â&#x192;     Â&#x2DC;Â&#x20AC;Â&#x201A;  Â? Â&#x2022;     Â?   Â?   Â  Â?     Â?     Â? Â&#x152;   Â?        Â?     Â&#x2019;  Â? Â?Â?Â?   Â?    Â&#x2014;   Â?    Â

 Â?   Â?    Â?Â?   Â?

       Â&#x192;  Â&#x201D;Â&#x20AC;Â&#x201A;    Â&#x2022;    Â&#x192;   Â&#x192;   Â?  Â&#x2019;   Â? Â?    Â&#x2019;    Â&#x192;   Â?    

Đ&#x203A;Đ&#x2DC;ТĐ&#x2022;Đ Đ?ТУРĐ? 1. Tropeano G. Uterine artery embolzaiton for fibroids does not have adverse effects on ovarian reserve in regularly cycling women younger than 40 years / G. Tropeano, C. Di Stasi, K. Litwicka, et al // Fertil. Steril. 2004. â&#x20AC;&#x201D; Vol. 81, â&#x201E;&#x2013; 4. â&#x20AC;&#x201D; P. 1055-1061. 2. Walker W.J. Uterine artery embolization for symptomatic fibroids: clinical results in 400 women with imaging follow up / W.J. Walker, J.P. Pelage // BJOG 2002. â&#x20AC;&#x201D; â&#x201E;&#x2013; 109. â&#x20AC;&#x201D; P. 1262-1272. 3. Đ&#x2018;ĐžŃ&#x20AC;Đ¸Ń ĐžĐ˛Đ° Đ&#x17E;.Đ&#x201C;. ЭПйОНиСаŃ&#x2020;иŃ? ПаŃ&#x201A;ĐžŃ&#x2021;Đ˝Ń&#x2039;Ń&#x2026; Đ°Ń&#x20AC;Ń&#x201A;ĐľŃ&#x20AC;иК как ПоŃ&#x201A;Од в аНгОŃ&#x20AC;иŃ&#x201A;По Ń&#x201A;ĐľŃ&#x20AC;апии Пи-ОП ПаŃ&#x201A;ки: авŃ&#x201A;ĐžŃ&#x20AC;ĐľŃ&#x201E;. Đ´Đ¸Ń . â&#x20AC;Ś канд. Под. наŃ&#x192;Đş / Đ&#x17E;.Đ&#x201C;. Đ&#x2018;ĐžŃ&#x20AC;Đ¸Ń ĐžĐ˛Đ°. â&#x20AC;&#x201D; Đ&#x2018;Đ°Ń&#x20AC;наŃ&#x192;Đť, 2004. â&#x20AC;&#x201D; 24 Đľ.: иН. 4. Đ?Ń&#x20AC;иниŃ&#x2021;ова Đ?.Đ&#x2019;. Đ&#x2019;НиŃ?нио Ń?ПйОНиСаŃ&#x2020;ии ПаŃ&#x201A;ĐžŃ&#x2021;Đ˝Ń&#x2039;Ń&#x2026; Đ°Ń&#x20AC;Ń&#x201A;ĐľŃ&#x20AC;иК на Ń&#x201E;Ń&#x192;нкŃ&#x2020;иОнаНŃ&#x152;нОо Ń Đž-Ń Ń&#x201A;ĐžŃ?нио Ń?иŃ&#x2021;никОв и Ń?ндОПиОПоŃ&#x201A;Ń&#x20AC;иŃ? Ń&#x192; МонŃ&#x2030;ин Ń&#x20AC;опŃ&#x20AC;ОдŃ&#x192;ĐşŃ&#x201A;ивнОгО вОСŃ&#x20AC;Đ°Ń Ń&#x201A;Đ° Ń ĐźĐ¸ĐžĐźĐžĐš ПаŃ&#x201A;ки: авŃ&#x201A;ĐžŃ&#x20AC;ĐľŃ&#x201E;. Đ´Đ¸Ń . â&#x20AC;Ś канд. Под. наŃ&#x192;Đş / Đ?.Đ&#x2019;. Đ?Ń&#x20AC;иниŃ&#x2021;ова. â&#x20AC;&#x201D; Đ&#x153;ĐžŃ ĐşĐ˛Đ°, 2006. â&#x20AC;&#x201D; 24 Đľ.: иН. 5. Payne J.F. Embolic microspheres within ovarian arterial vasculature after uterine artery embolization / J.F. Payne, S.J. Robb oy, A. F. H a n e y / / Obstet. Gynecol. â&#x20AC;&#x201D; 2002. â&#x20AC;&#x201D; Vol. 100, â&#x201E;&#x2013; 5. â&#x20AC;&#x201D; P. 883-886.

REFERENCES 1. Tropeano G., Di Stasi C., Litwicka K., Romano D., Draisci G., Mancuso S. Uterine artery embolzaiton for fibroids does not have adverse effects on ovarian reserve in regularly cycling women younger than 40 years. Fertility and Sterility, 2004, vol. 81, no. 4, pp. 1055-1061. 2. Walker W.J., Pelage J.P. Uterine artery embolization for symptomatic fibroids: Clinical results in 400 women with imaging follow up. BJOG: An International Journal of Obstetrics and Gynaecology, 2002, vol. 109, no. 11, pp. 1262-1272. DOI: 10.1046/j.1471-0528.2002.01449.x. 3. Borisova O.G. Embolizatsiya matochnykh arteriy kak metod v algoritme terapii miom matki. Kand. med. nauk diss. Avtoref. [Uterine artery embolization as a method in the algorithm of uterine fibroid therapy. Cand. med. sci. diss. Synopsis]. Barnaul, 2004. 24 p. 4. Arinicheva A.V. Vliyanie embolizatsii matochnykh arteriy na funktsionalâ&#x20AC;&#x2122;noe sostoyanie yaichnikov i endomiometriya u zhenshchin reproduktivnogo vozrasta s miomoy matki Kand. med. nauk diss. Avtoref. [Effect of uterine artery embolization on the functional state of the ovaries and endomyometritis in women of reproductive age with hysteromyoma. Cand. med. sci. diss. Synopsis]. Moscow, 2006. 24 p. 5. Payne J.F., Robboy S.J., Haney A.F. Embolic microspheres within ovarian arterial vasculature after uterine artery embolization. Obstetrics and Gynecology, 2002, vol. 100, no. 5, pp. 883-886. DOI: 10.1016/S0029-7844(02)02270-6.

WWW.MFVT.RU

Ă&#x20AC;Ă&#x160;Ă&#x201C;Ă&#x2DC;Ă&#x2026;Ă?Ă&#x2018;Ă&#x2019;Ă&#x201A;Ă&#x17D;. Ă&#x192;Ă&#x2C6;Ă?Ă&#x2026;Ă&#x160;Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;. Ă?Ă?Ă&#x201E;Ă&#x17D;Ă&#x160;Ă?Ă&#x2C6;Ă?Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;


Ă?Ă?Ă&#x20AC;Ă&#x160;Ă&#x2019;Ă&#x2C6;Ă&#x2014;Ă&#x2026;Ă&#x2018;Ă&#x160;Ă&#x20AC;Ă&#x; Ă&#x152;Ă&#x2026;Ă&#x201E;Ă&#x2C6;Ă&#x2013;Ă&#x2C6;Ă?Ă&#x20AC;

94

â&#x20AC;&#x2DC;7 (76) докайŃ&#x20AC;Ń&#x152; 2013 Đł.

   

Ă&#x2C6;.Ă&#x201A;. Ă?Ă&#x2026;Ă&#x2030;Ă&#x201D;Ă&#x2026;Ă&#x2039;Ă&#x153;Ă&#x201E;1, Ă&#x2C6;.Ă&#x2026;. Ă?Ă&#x17D;Ă&#x192;Ă&#x17D;Ă&#x2020;Ă&#x2C6;Ă?Ă&#x20AC;1, Ă&#x201C;.Ă&#x201A;. Ă&#x2018;Ă&#x2019;Ă&#x17D;Ă&#x2039;Ă&#x;Ă?Ă&#x17D;Ă&#x201A;Ă&#x20AC;1, Ă&#x20AC;.Ă&#x201A;. Ă&#x201E;Ă&#x20AC;Ă?Ă&#x2C6;Ă&#x2039;Ă&#x2C6;Ă?Ă&#x20AC;2, Ă&#x2C6;.Ă?. Ă&#x2018;Ă&#x160;Ă&#x201C;Ă?Ă&#x17D;Ă&#x201A;Ă&#x20AC;1, Ă&#x17D;.Ă&#x201A;. Ă&#x2019;Ă&#x2C6;Ă&#x2022;Ă&#x20AC;Ă?Ă&#x2C6;Ă?Ă&#x20AC;1 Ă&#x2018;à ðàòÎâùêèÊ ãÎùóäàðùòâüííÝÊ ÏüäèÜèíùêèÊ óíèâüðùèòüò èÏ. Ă&#x201A;.Ă&#x2C6;. Ă?àçóÏÎâùêÎãÎ, 410012, ĂŁ. Ă&#x2018;àðàòÎâ, óÍ. Ă . Ă&#x160;àçàáßÿ, ä. 112 2 Ă&#x2013;Ă?Ă&#x2C6;Ă&#x2C6; ýïèäüÏèÎÍÎãèè Ă?ÎùïÎòðüåíàäçÎðà, 111123, ĂŁ. Ă&#x152;Îùêâà, óÍ. Ă?ÎâÎãèðüüâùêàÿ, ä. 3Ă 

1

              Ă?üÊôüÍßä Ă&#x2C6;ðèíà Ă&#x201A;ÎÍßäüÏàðÎâíà â&#x20AC;&#x201D; êàíäèäàò ÏüäèÜèíùêèþ íàóê, äÎÜüíò êàôüäðÝ àêóøüðùòâà è ãèíüêÎÍÎãèè Ă&#x201D;Ă?Ă&#x160; è Ă?Ă?Ă&#x2018;, òüÍ. (8452) 51-67-98, e-mail: kafed-ra@yandex.ru1 Ă?ÎãÎÌèíà Ă&#x2C6;ðèíà Ă&#x2026;âãüíßüâíà â&#x20AC;&#x201D; äÎêòÎð ÏüäèÜèíùêèþ íàóê, äÎÜüíò, çàâüäóÞÚàÿ êàôüäðÎÊ àêóøüðùòâà è ãèíüêÎÍÎãèè Ă&#x201D;Ă?Ă&#x160; è Ă?Ă?Ă&#x2018;, òüÍ. (8452) 51-67-98, e-mail: itg.r@yandex.ru1 Ă&#x2018;òÎÍÿðÎâà Ă&#x201C;Íßÿíà Ă&#x201A;ÍàäèÏèðÎâíà â&#x20AC;&#x201D; êàíäèäàò ÏüäèÜèíùêèþ íàóê, àùùèùòüíò êàôüäðÝ àêóøüðùòâà è ãèíüêÎÍÎãèè Ă&#x201D;Ă?Ă&#x160; è Ă?Ă?Ă&#x2018;, òüÍ. (8452) 51-67-98, e-mail: kafed-ra@yandex.ru1 Ă&#x201E;àíèÍèíà Ă&#x20AC;Ă­Ă­Ă  Ă&#x201A;àÍüíòèíÎâíà â&#x20AC;&#x201D; ùòàðøèÊ íàóáíÝÊ ùÎòðóäíèê ÍàåÎðàòÎðèè èÏÏóíÎÍÎãèè è åèÎòüþíÎÍÎãèè, òüÍ. (495) 672-11-29, e-mail: kafed-ra@yandex.ru2 Ă&#x2018;êóïÎâà Ă&#x2C6;ðèíà Ă?èêÎÍàüâíà â&#x20AC;&#x201D; àùùèùòüíò êàôüäðÝ àêóøüðùòâà è ãèíüêÎÍÎãèè Ă&#x201D;Ă?Ă&#x160; è Ă?Ă?Ă&#x2018;, òüÍ. (8452) 51-67-98, e-mail: kafed-ra@yandex.ru1 Ă&#x2019;èþàíèíà Ă&#x17D;Íßãà Ă&#x201A;ÍàäèÏèðÎâíà â&#x20AC;&#x201D; ùòóäüíòêà 6-ĂŁĂŽ êóðùà, òüÍ. (8452) 51-67-98, e-mail: kafed-ra@yandex.ru1       Â? Â?Â?Â?   ­ Â&#x20AC; Â?Â&#x201A; Â?Â&#x201A;Â&#x192;  Â?Â&#x201E; ­   Â&#x2026;Â&#x2020;Â? Â&#x2021;Â?Â&#x2C6; Â&#x2030;Â?Â&#x2030;Â&#x2021;Â? Â?Â?Â&#x160;Â?Â?

I.V. NEYPHELD NEYPHELD11,, I.E. I.E. ROGOZHINA ROGOZHINA11,, U.V. U.V. STOLYAROVA STOLYAROVA11,, A.V. A.V. DANILINA DANILINA22,, I.N. I.N. SKUPOVA SKUPOVA11,, O.V. O.V. TIKHANINA TIKHANINA11 I.V. 1 1 Saratov State Medical University named after V.I. Razumovsky, 112 Bolshaya Kazachya St., Saratov, V.I. Razumovsky, Saratov State Medical University, 112 Bolshaya Kazachya St., Saratov, Russian Federation Federation 410012 410012 Russian 22Central Scientific-Research Institute of Epidemiology of Rospotrebnadzor, 3a Novogireevskaya St., Central Scientific-Research Institute of Epidemiology of Rospotrebnadzor, 3a Novogireevskaya St., Moscow, Russian Russian Federation Federation 111123 111123 Moscow,

Rationale correction of immunological disorders in patients with gynecologic and oncologic problems during cyclic chemotherapy Neyfeld I.V. â&#x20AC;&#x201D; Cand. Med. Sc., Associate Professor of the Department of Obstetrics and Gynecology of Advanced Training Faculty and Professional Retraining of Specialists, òüÍ. (8452) 51-67-98, e-mail: kafed-ra@yandex.ru1 Rogozhina I.E. â&#x20AC;&#x201D; D. Med. Sc., Assistant Professor, Head of Department of Obstetrics and Gynecology of Advanced Training Faculty and Professional Retraining of Specialists, tel. (8452) 51-67-98, e-mail: itg.r@yandex.ru1 Stolyarova U.V. â&#x20AC;&#x201D; Cand. Med. Sc., Assistant of the Department of Obstetrics and Gynecology of Advanced Training Faculty and Professional Retraining of Specialists, tel. (8452) 51-67-98, e-mail: kafed-ra@yandex.ru1 Danilina A.V. â&#x20AC;&#x201D; Senior Research Associate of the Laboratory of Immunology and Biotechnology, tel. (495) 672-11-29, e-mail: kafed-ra@yandex.ru2 Skupova I.N. â&#x20AC;&#x201D; Assistant at the Department of Obstetrics and Gynecology of Advanced Training Faculty and Professional Retraining of Specialists, tel. (8452) 51-67-98, e-mail: kafed-ra@yandex.ru1 Tikhanina O.V. â&#x20AC;&#x201D; Student of the 6th year, tel. (8452) 51-67-98, e-mail: kafed-ra@yandex.ru1

Ă&#x20AC;Ă&#x160;Ă&#x201C;Ă&#x2DC;Ă&#x2026;Ă?Ă&#x2018;Ă&#x2019;Ă&#x201A;Ă&#x17D;. Ă&#x192;Ă&#x2C6;Ă?Ă&#x2026;Ă&#x160;Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;. Ă?Ă?Ă&#x201E;Ă&#x17D;Ă&#x160;Ă?Ă&#x2C6;Ă?Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

95

                         ­­    

                                         ­      €  

          ‚      ­ƒ                              ‚     „ …†‡  ˆ†‡      €†           ‚      †     ‡     „  ‰ €  ˆŠŠ    ‚   ‚  

         ­ €‚ƒ „…† ‡ˆˆ‰†          Š    ‹ ‚ ŒŽ‘’“† ””Œ•–– ’“Š‰‡­ — Š ŠŽ •†­     —    ‚˜™‡ˆ‰     Š ‚˜™‡š‰      ”†  ŽŠ    ‡  –†––‘›­  Ž †  Š  œ  ž”Ž­‘   ‚‡­†­†‘­‰    Š   Ÿ       ‚  ‡‰      ‡‘  Ž

 ‹Ž †ŽŠ†  ‘ˆ†¡‡†•   ¢ ­”    Š † ­”  Š  Š ”  Ž ” £‹¤¥ ”          ¦§¨©ª«¬®¯®¯¯°± ¨°²³°±¥Œ””Ž´µ‘¶ ‹   Š   ¦§¨§·±§·¯¨• –

      ¸     €Š ­” † ­  

          Š ‚  “‰†     Ž   ŽŠ Š Ž  ŠŠ ‚­¹–†–‘¥­¹–†–‘¥­º–†–‘‰ ¸      Š  ­   †  Ž Š    ŽŠ‚­¹–†–‘¥  ­¹–†–‘¥ ­º–†–‘‰ » Š ”     Ž        ŠŽŠ  Ž  ‚ ­¹–†–‘¥  ­¹–†–‘¥  ­º–†–‘‰¥  Š    ” ‚­¹–†–‘¥­¹–†–‘¥­º–†–‘‰  —  Š ­”   Š        ‚­¹–†–‘¥­¹–†–‘¥­º–†–‘‰

¸      Š  Ž‚ “‰  †Ž ŽŽ¼½¾ ­†Š

ǺȈȉȓȐȞȈ ǹȘȈȊȕȐȚȍȓȤȕȈȧȝȈȘȈȒȚȍȘȐșȚȐȒȈȘȈșșȔȈȚȘȐȊȈȍȔȣȝȋȘțȗ           ǹȚȈȌȐȧȏȈȉȖȓȍȊȈȕȐȧ 

 



-





-

ǫȐșȚȖȓȖȋȐȟȍșȒȐȑȚȐȗȖȗțȝȖȓȐ       

­

­­­

-

€ ‚     





-

ƒ  „„       

 



-





-

… ‚    

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

96

‘7 (76) декабрь 2013 г.

              

             š›œžŸ „­

‚­ 

   

  

¡›œž    

   

  

  

  

¡ ­ ›œž

         









 ­





 ­­

€ 

‚ƒ„… † 

 

 

 



 ­

 



‡ ­­

‡

ƒ„…† 

‡

‡





€­

€€

€

 ­­



ƒˆ…‡† 

€







­

€

‡

‡  ­­



‰Š‰

 €

€

 

€€‡

 ­

€



 ­­



‹ Œ     Ž    

‡

‡



‡­





  ­­



­

‡



€ ­­



‘’“



‡

‡‡



”‰ • –•–  •



‡‡

 



• •

‡



€



   ­  ­



  ­­

€



­­



­­



—      ˜  

‡





 

€€­



‡

—™







€

­



‡

—š



‡



€‡

‡­





 ­­

€

›ˆœ•ž

‡



  

 

­

€

‡

‡­­

  

›ˆ •ž

‡ 

‡

€

 

‡ ­

‡

‡

€€­­



€€   ‡ ­­

                         ­€    ‚ƒ„ ƒ„  ƒ„…ƒ„     †                         ‡   ˆ‰‚‰Š‹ ††                         ‡  Œ‰‚‰Š‹              ­   €    ­  ‚­ ƒ „­ ­ ­   … ‚ ­  ‚  

†€   €   ‚ „­ ‚ ‡ ­ ˆ ­‰Š‹    ŒŽ‘  ‚­ ­„ „­  ­ „ 

 ’­“ ”­ ­   „­   ­ ’­•–

‚  ­ ­    —   —  …˜ˆ „   ˆ  ‚ „­   ƒ   ‚­  ­ ­     ‡      € ‚„­ ­’­† ‚††‚­ ­„ ’­‚ …‡‚­„     ­­  ˆ  ‚­’ƒ­ ŒŽ‘ˆ†€  ­   „ ­       ˆ­  ™”  „­  ­  ‚ ­  ƒ „­­ ­  …—

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


Ă?Ă?Ă&#x20AC;Ă&#x160;Ă&#x2019;Ă&#x2C6;Ă&#x2014;Ă&#x2026;Ă&#x2018;Ă&#x160;Ă&#x20AC;Ă&#x; Ă&#x152;Ă&#x2026;Ă&#x201E;Ă&#x2C6;Ă&#x2013;Ă&#x2C6;Ă?Ă&#x20AC;

â&#x20AC;&#x2DC;7 (76) докайŃ&#x20AC;Ń&#x152; 2013 Đł.

97

    

          Â  Â?

                       Â? Â?      Â?Â?        ­Â&#x20AC;Â&#x201A;       Â&#x192;Â&#x20AC;Â&#x201E;Â&#x201A; Â? Â&#x2026;Â&#x2020;Â&#x2021;Â&#x2C6;Â&#x2C6;Â&#x2C6;Â&#x201A; Â&#x2030; Â&#x2020;      Â&#x2C6;Â&#x2C6;Â&#x2C6;Â&#x201A;Â&#x160;Â&#x2030;Â?   Â&#x2C6;Â&#x192;Â&#x2039;Â&#x201A; Â&#x160;Â&#x2030; Â&#x152;Â&#x2021;     Â?      Â?Â&#x152; Â?   Â&#x20AC;Â&#x201A; Â?        Â?Â?      Â&#x152;Â&#x2021;                     Â&#x2020;    Â? Â?   ­Â&#x2C6;Â&#x2C6;Â&#x201A; Â?    Â&#x160;  Â&#x2C6; Â&#x192;Â&#x17D;Â&#x201A;          Â&#x2039;Â&#x17D;Â&#x17D;Â&#x17D;Â&#x201A;­Â&#x201A;    Â&#x2018;        Â&#x2C6;Â&#x2019;Â&#x192;Â&#x201A;Â? Â&#x201C;   ­Â&#x201A;     Â&#x192;Â&#x2039;Â&#x201A;Â&#x160;Â&#x2020;   Â&#x2C6;Â&#x2C6;Â&#x2C6;Â&#x201A; Â&#x160;    Â&#x201D;Â? Â&#x2020;     Â?     Â?   Â&#x2022; Â&#x17D;Â&#x2030;  Â?Â? Â?         Â&#x2020;  Â&#x17D; Â&#x2C6;Â&#x192;Â&#x201E;Â&#x201A;               Â&#x2013;             Â?Â&#x152; Â? Â?     -

Â&#x2020;   ­Â&#x2030; Â?Â? Â&#x17D;Â&#x2030;Â?Â?Â&#x2020;  Â&#x152; Â?Â&#x2C6;Â&#x2019;Â&#x192;Â&#x192;Â&#x2039;Â&#x201A;                 Â?Â&#x2020;   Â?Â?Â? Â&#x2014;             Â?  Â?                       Â&#x2020; Â?    Â&#x2030;Â&#x2DC;Â&#x2019;Â&#x2019;Â&#x192;  Â&#x2020;   Â&#x2030;Â&#x2DC;Â&#x2019;Â&#x2019;Â&#x192;   Â&#x2122;  Â&#x161;           Â&#x2020;Â&#x2021;   Â&#x2C6; Â? Â&#x152;   Â?Â&#x152;  Â?Â&#x152;    Â?   Â?       Â?Â? Â&#x152;  Â&#x152;     Â?Â&#x152;Â&#x2021;         Â&#x152;Â&#x2021;  Â?Â&#x152;  Â&#x161;    Â?Â&#x152; Â? Â&#x203A;     Â?       Â?           Â&#x2020;  Â?Â?  Â&#x152;Â&#x2021;   Â&#x153;             Â&#x152;Â&#x2021;  Â? Â?        

Đ&#x203A;Đ&#x2DC;ТĐ&#x2022;Đ Đ?ТУРĐ? 1. Đ&#x2018;Đ°Ń&#x20AC;Ń&#x2039;Ń&#x2C6;никОв Đ?.ĐŽ. Đ&#x2019;СаиПООŃ&#x201A;нОŃ&#x2C6;онио ОпŃ&#x192;Ń&#x2026;ОНи и иППŃ&#x192;ннОК Ń Đ¸Ń Ń&#x201A;оПŃ&#x2039; ĐžŃ&#x20AC;ганиСПа // Đ&#x;Ń&#x20AC;Đ°ĐşŃ&#x201A;иŃ&#x2021;ĐľŃ ĐşĐ°Ń? ОнкОНОгиŃ?. â&#x20AC;&#x201D; 2003. â&#x20AC;&#x201D; Т. 4, â&#x201E;&#x2013; 3. â&#x20AC;&#x201D; ĐĄ. 127-130. 2. Radke J., Schmidt D., Bohme M. et al. Leukocytes and lymphocyte subsets in peripheral blood and malignant ascites of patients with ovarian cancer // Geburt.und Frauenh. â&#x20AC;&#x201D; 1994. â&#x20AC;&#x201D; Vol. 54, â&#x201E;&#x2013; 12. â&#x20AC;&#x201D; P. 675-678. 3. Đ&#x161;адагидСо Đ&#x2014;.Đ&#x201C;. ХОвŃ&#x20AC;оПоннŃ&#x2039;Đľ Đ˛ĐžĐˇĐźĐžĐśĐ˝ĐžŃ Ń&#x201A;и кНиниŃ&#x2021;ĐľŃ ĐşĐžĐš иППŃ&#x192;нОНОгии в ОнкОНОгии // Đ&#x2019;ĐľŃ Ń&#x201A;ник Đ Đ?Đ&#x153;Đ?. â&#x20AC;&#x201D; 2002. â&#x20AC;&#x201D; â&#x201E;&#x2013; 1. â&#x20AC;&#x201D; ĐĄ. 4-8. 4. Đ&#x201C;ĐžŃ&#x20AC;ĐąŃ&#x192;нОва Đ&#x2019;.Đ?. ХОвŃ&#x20AC;оПоннŃ&#x2039;Đľ Đ˛ĐžĐˇĐźĐžĐśĐ˝ĐžŃ Ń&#x201A;и НокаŃ&#x20AC;Ń Ń&#x201A;воннОК Ń&#x201A;ĐľŃ&#x20AC;апии Ń&#x20AC;ака Ń?иŃ&#x2021;никОв // ХОвŃ&#x20AC;оПоннŃ&#x2039;Đľ Ń?ĐşŃ ĐżĐľŃ&#x20AC;иПонŃ&#x201A;Đ°ĐťŃ&#x152;Đ˝Ń&#x2039;Đľ и кНиниŃ&#x2021;ĐľŃ ĐşĐ¸Đľ пОдŃ&#x2026;ОдŃ&#x2039; Đş Đ´Đ¸Đ°ĐłĐ˝ĐžŃ Ń&#x201A;ико и Ń&#x20AC;Đ°Ń&#x2020;иОнаНŃ&#x152;нОПŃ&#x192; НоŃ&#x2021;ониŃ&#x17D; Ń&#x20AC;ака Ń?иŃ&#x2021;никОв. â&#x20AC;&#x201D; Đ&#x153;., 2001. â&#x20AC;&#x201D; ĐĄ. 66-67. 5. Mancini G., Carbonara A., Heremans J.F. Immunochemical quantitation of antitgens by single radial immunodiffusion // Immunochemistry. â&#x20AC;&#x201D; 1965. â&#x20AC;&#x201D; Vol. 2, â&#x201E;&#x2013; 3. â&#x20AC;&#x201D; Đ . 235-254.

REFERENCES 1. Baryshnikov A.Yu. The relationship of a tumor and immune system. Prakticheskaya onkologiya, 2003, vol. 4, no. 3 (15), pp. 127-130. (in Russ.). 2. Radke J., Schmidt D., Bohme M., Morenz J., Weise W. Leukocytes and lymphocyte subsets in peripheral blood and malignant ascites of patients with ovarian cancer. Geburtshilfe und Frauenheilkunde, 1994, vol. 54, no. 12, pp. 675-678. (in German). 3. Kadagidze Z.G. Modern possibilities of clinical immunology in oncology. Vestnik Rossiyskoy akademii meditsinskikh nauk [Bulletin of the Russian Academy of Medical Sciences], 2002, no. 1, pp. 4-8. (in Russ.). 4. Gorbunova V.A. Modern possibilities of drug therapy for ovarian cancer. Sovremennye eksperimentalâ&#x20AC;&#x2122;nye i klinicheskie podkhody k diagnostike i ratsionalâ&#x20AC;&#x2122;nomu lecheniyu raka yaichnikov [Modern experimental and clinical approaches to the diagnosis and rational treatment of ovarian cancer]. Moscow, 2001, pp. 66-67. 5. Mancini G., Carbonara A., Heremans J.F. Immunochemical quantitation of antitgens by single radial immunodiffusion. Immunochemistry, 1965, vol. 2, no. 3, pp. 235-254.

Ă&#x20AC;Ă&#x160;Ă&#x201C;Ă&#x2DC;Ă&#x2026;Ă?Ă&#x2018;Ă&#x2019;Ă&#x201A;Ă&#x17D;. Ă&#x192;Ă&#x2C6;Ă?Ă&#x2026;Ă&#x160;Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;. Ă?Ă?Ă&#x201E;Ă&#x17D;Ă&#x160;Ă?Ă&#x2C6;Ă?Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;


98

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.



È.À. ÀÁÎßÍ, Ì.Å. ÀÁÎßÍ, Â.Ã. ÁÎÐÎÄÈÍ, Ë.Ë. ÌÀËÈÊÎÂ, Ñ.Â. ÏÀÂËÎÂ, Î.Þ. ÄÐÎÁÈÍ, Á.Â. ÐÎØÀÊ, Í.Ð. ÌÀÐÒÈÐÎÑßÍ, Ç.Â. ÈÂÀÍÖÎÂÀ, À.Ï. ÏÀÂËÎÂÀ, À.À. ÅÐÅÌÅÅÂÀ, À.À. ÃÎÐÁÀÍÜ, Þ.À. ÃÎÍ×ÀÐÎÂÀ, Ë.È. ÈÂÀÙÅÍÊÎ Êëèíèêî-äèàãíîñòè÷åñêèé öåíòð «Çäîðîâüå», 344011, ã. Ðîñòîâ-íà-Äîíó, ïåð. Äîëîìàíîâñêèé, ä. 70/3

sÓÚÎÇÐàÒÓá±ÓÒÓÑÎÛËÖ±ÇÆáØØ˱×ÎÉÒÓÖ×à ÖÎѾÐà×ÇÒÒßÙÓÔËÕÇÚÎϾÌËÒÝÎÒ ðåïðîäóêòèâíîãî âîçðàñòà Àáîÿí Èãîðü Àðòåìîâè÷ — äîêòîð ìåäèöèíñêèõ íàóê, ïðîôåññîð, ãëàâíûé âðà÷, òåë. (863) 269-57-57, e-mail: zdorovie@donpac.ru Àáîÿí Ìàðèíà Åôèìîâíà — êàíäèäàò ìåäèöèíñêèõ íàóê, çàìåñòèòåëü ãëàâíîãî âðà÷à, òåë. (863) 267-31-29, e-mail: zdorovie@donpac.ru Áîðîäèí Âàäèì Ãðèãîðüåâè÷ — êàíäèäàò ìåäèöèíñêèõ íàóê, çàâåäóþùèé õèðóðãè÷åñêèì îòäåëåíèåì № 2, òåë. (863) 269-57-57, e-mail: vadimboro@mail.ru Ìàëèêîâ Ëåîíèä Ëåîíèäîâè÷ — êàíäèäàò ìåäèöèíñêèõ íàóê, çàâåäóþùèé õèðóðãè÷åñêèì îòäåëåíèåì № 1, òåë. (863) 269-57-57, e-mail: orgmetod_zdorovie@donpac.ru Ïàâëîâ Ñåðãåé Âàëåíòèíîâè÷ — êàíäèäàò ìåäèöèíñêèõ íàóê, çàâåäóþùèé îðãàíèçàöèîííî-ìåòîäè÷åñêèì îòäåëîì, òåë. (863) 269-57-57, e-mail: orgmetod_zdorovie@donpac.ru Äðîáèí Îëåã Þðüåâè÷ — âðà÷-ãèíåêîëîã, òåë. (863) 269-57-57, e-mail: orgmetod_zdorovie@donpac.ru Ðîøàê Áîðèñ Âëàäèñëàâîâè÷ — âðà÷-õèðóðã, òåë. (863) 269-57-57, e-mail: orgmetod_zdorovie@donpac.ru Ìàðòèðîñÿí Íàèð Ðàôàèëîâè÷ — êàíäèäàò ìåäèöèíñêèõ íàóê, âðà÷-õèðóðã, òåë. (863) 269-57-57, e-mail: orgmetod_zdorovie@donpac.ru Èâàíöîâà Çëàòà Âëàäèìèðîâíà — âðà÷-ãèíåêîëîã, òåë. (863) 269-57-57, e-mail: orgmetod_zdorovie@donpac.ru Ïàâëîâà Àëüáèíà Ïåòðîâíà — êàíäèäàò ìåäèöèíñêèõ íàóê, äîöåíò, âðà÷-ãèíåêîëîã, òåë. (863) 269-57-57, e-mail: orgmetod_zdorovie@donpac.ru Åðåìååâà Àíàñòàñèÿ Àëåêñàíäðîâíà — êàíäèäàò ìåäèöèíñêèõ íàóê, âðà÷ îðãàíèçàöèîííî-ìåòîäè÷åñêîãî îòäåëà, òåë. (863) 269-57-57, e-mail: orgmetod_zdorovie@donpac.ru Ãîðáàíü Àëåêñåé Àëåêñàíäðîâè÷ — âðà÷ àíåñòåçèîëîã-ðåàíèìàòîëîã, òåë. (863) 269-57-57, e-mail: orgmetod_zdorovie@donpac.ru Ãîí÷àðîâà Þëèÿ Àëåêñàíäðîâíà — êàíäèäàò ìåäèöèíñêèõ íàóê, âðà÷-îíêîëîã, òåë. (863) 269-57-57, e-mail: julya.andryushenko@yandex.ru Èâàùåíêî Ëàðèñà Èãîðåâíà — âðà÷-ñòàòèñò, òåë. (863) 269-57-57, e-mail: orgmetod_zdorovie@donpac.ru    

                                 

 ­  

        €‚ƒ„……ƒ       †­ …‡…‚      ˆ†  †

                     

   

 

I.A. ABOYAN, M.E. ABOYAN, V.G. BORODIN, L.L. MALIKOV, S.V. PAVLOV, O.Yu. DROBIN, B.V. ROSHAK, N.R. MARTIROSYAN, Z.V. IVANTSOVA, A.P. PAVLOVA, A.A. EREMEEVA, À.A. GORBAN, Yu.A. GONCHAROVA, L.I. IVASHCHENKO Clinical and Diagnostic Russian Federation Federation diagnostic Center center «Health», 70/3 Dolomanovsky Ave., Rostov-on-Don, Rostov-on-Don, Russian 344011

Social and economic efficiency of simultaneous operations in women of reproductive age

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


Ă?Ă?Ă&#x20AC;Ă&#x160;Ă&#x2019;Ă&#x2C6;Ă&#x2014;Ă&#x2026;Ă&#x2018;Ă&#x160;Ă&#x20AC;Ă&#x; Ă&#x152;Ă&#x2026;Ă&#x201E;Ă&#x2C6;Ă&#x2013;Ă&#x2C6;Ă?Ă&#x20AC;

â&#x20AC;&#x2DC;7 (76) докайŃ&#x20AC;Ń&#x152; 2013 Đł.

99

Aboyan I.A. â&#x20AC;&#x201D; D. Med. Sc., professor, Head Physician, tel. (863) 269-57-57, e-mail: zdorovie@donpac.ru Aboyan M.E. â&#x20AC;&#x201D; Cand. Med. Sc., Deputy Head Physician, tel. (863) 267-31-29, e-mail: zdorovie@donpac.ru Borodin V.G. â&#x20AC;&#x201D; Cand. Med. Sc., Head of the Surgical Department â&#x201E;&#x2013; 2, tel. (863) 269-57-57, e-mail: vadimboro@mail.ru Malikov L.L. â&#x20AC;&#x201D; Cand. Med. Sc., Head of the Surgical Department â&#x201E;&#x2013; 1, tel. (863) 269-57-57, e-mail: orgmetod_zdorovie@donpac.ru Pavlov S.V. â&#x20AC;&#x201D; Cand. Med. Sc., Head of organizational and methodical department, tel. (863) 269-57-57, e-mail: orgmetod_zdorovie@donpac.ru Drobin O.Yu. â&#x20AC;&#x201D; gynecology doctor, tel. (863) 269-57-57, e-mail: orgmetod_zdorovie@donpac.ru Roshak B.V. â&#x20AC;&#x201D; operating surgeon, tel. (863) 269-57-57, e-mail: orgmetod_zdorovie@donpac.ru Martirosyan N.R. â&#x20AC;&#x201D; Cand. Med. Sc., operating surgeon, tel. (863) 269-57-57, e-mail: orgmetod_zdorovie@donpac.ru Ivantsova Z.V. â&#x20AC;&#x201D; gynecology doctor, tel. (863) 269-57-57, e-mail: orgmetod_zdorovie@donpac.ru Pavlova A.P. â&#x20AC;&#x201D; Cand. Med. Sc., associate professor, gynecology doctor, tel. (863) 269-57-57, e-mail: orgmetod_zdorovie@donpac.ru Eremeeva A.A. â&#x20AC;&#x201D; Cand. Med. Sc., physician of organizational and methodical department, tel. (863) 269-57-57, e-mail: orgmetod_zdorovie@donpac.ru Gorban A.A. â&#x20AC;&#x201D; anesthesiologist and resuscitator, tel. (863) 269-57-57, e-mail: orgmetod_zdorovie@donpac.ru Goncharova Yu.A. â&#x20AC;&#x201D; Cand. Med. Sc., oncologist, tel. (863) 269-57-57, e-mail: julya.andryushenko@yandex.ru Ivashchenko L.I. â&#x20AC;&#x201D; Doctor Statistician, tel. (863) 269-57-57, e-mail: orgmetod_zdorovie@donpac.ru                                       Â?Â?Â?Â?  Â?            ­  Â? Â&#x20AC;          

                      Â? Â?Â?Â? ­Â?Â&#x20AC;  Â&#x201A;Â&#x192;   Â&#x192;    Â&#x201E;Â&#x2026;Â&#x2020; Â&#x2021;  Â&#x2C6;       Â&#x2030; Â&#x160;Â&#x2039;Â&#x152;Â&#x17D;Â&#x17D;Â&#x2039;Â&#x2018;Â&#x2019;Â&#x201C;Â&#x2039;Â&#x152;Â&#x201D;  Â&#x2026;Â&#x2022;Â&#x2013;Â&#x2026;  Â&#x201E;Â?Â&#x2020; Â&#x2014;Â&#x201A;  Â?   Â&#x2026;Â&#x2022;Â&#x2013;Â&#x2DC;     Â&#x2122;Â&#x161; Â&#x203A;   Â&#x161;Â&#x203A; Â&#x153; Â&#x201E;­Â&#x2020;Â&#x17E;Â?        Â?       Â&#x192;Â?      Â?      Â&#x192; Â&#x192;Â?Â? Â&#x201E;Â&#x;  ÂĄÂ&#x2020; ¢    Â?     Â&#x192;     Â?  Â? ÂŁÂ?       Â&#x192;        Â&#x2030;Â&#x192;          Â?  Â?  Â?   Â?Â?   Â?Â&#x192;      Â?Â?        Â?     Â&#x192;Â?Â&#x201A;¤¤     Â&#x201E;Â&#x2DC; Â&#x2013;Â&#x2020;Â?        Â?                    Â&#x201A;    Â&#x192;   Â&#x192;Â?Â&#x192; Â&#x192;  Â? Â&#x201E;ÂĽÂ&#x2020; ÂŚ       Â?  -

    Â&#x201E;Â&#x2022;Â&#x2020;               Â&#x201A;  Â&#x201A;¤¤ Â&#x201E;Â&#x2026;Â?  Â&#x2026;Â&#x2026;Â&#x2020; §  Â?      Â? Â?  Â?       Â?  Â&#x201A;  Â?       Â?Â&#x192;             Â&#x192;  Â?     ¨ Š ÂŞ        Š ¢  Â?Â&#x201A;           Â?    Â?     Â?  Â?  Â&#x201A;  Â?          Â&#x201A;Â? Â&#x201A;¤¤            Â?  Â?Â? Â&#x;Â&#x2026;Â?     Â?   Â? ÂŤÂ?Â?Â?­ Â?Â?Â&#x2026;­ÂŹ  Ž¢Â&#x17E;Â&#x2021; Â&#x2C6;ÂŁ     Â?       Â?    Â?  Â&#x2026;Â&#x2013;Â?                  ÂŽ Â?   Â?­¼         Â?     Â?   Â? Â?  Â?ÂĽ Â&#x;Â?              ¨    Â?  ¨Â?    ÂŽÂ?  Â?ÂŻ Â&#x2026;    Â?    ° Â?    

Ă&#x20AC;Ă&#x160;Ă&#x201C;Ă&#x2DC;Ă&#x2026;Ă?Ă&#x2018;Ă&#x2019;Ă&#x201A;Ă&#x17D;. Ă&#x192;Ă&#x2C6;Ă?Ă&#x2026;Ă&#x160;Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;. Ă?Ă?Ă&#x201E;Ă&#x17D;Ă&#x160;Ă?Ă&#x2C6;Ă?Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;


100

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

                       ­ €    ‚       ƒ       

„          …      †     …‡  ˆ    ‡ ˆ       ‰  ‡  … Š    …             …       ‹   ‡          ‡ˆ Œ  ‡    Ž ‘   Ž   Ž         ‡ˆ    ‡    ‡      ‡‡ Œ ’ …    ˆ     Œ Žˆ Ž   ‡    Ž  ‹  ‡     Œ       Ž     ‰  ‡      ˆ     Œ   Ž       ‡  ‡    ‘  ‰  ‰     ˆ  ‡Ž “ “  ” Ž  •€ƒ–­ ——”˜™š›œ›ž“œ“Ÿ“‹ž˜€Ÿ 

‡ ——”˜™ ¡ ‰  ‰     › ¡     ˆ  Œ  Š  ‡      ‡‡   ‡                            

‘7 (76) декабрь 2013 г.             

        ­      €‚  ƒ  ƒ ƒ

„ …   ‚  ‚  ‚ƒ    †„†„„‡ ˆ‰„„ Š„‡ ‹‰ Œ ŽŽ†­‘ ’ †† “”“… •…†€– “€ • €… “… •…‘–‘…“—•   ††   ˜˜  ™ 

          ”  ˜   ƒ    ƒ ƒ †€– ˜˜  š˜ …    ƒƒ˜ — ƒ   … ˜   

   ƒ    …   

   €       š       €   š        ‘     ˜ –‘  ˜˜       …       ƒ  „ › ƒ ˜  ˜ œžŸ„ ž„¡žžˆ ¢ ˆ šœ£¤‘  ƒ  ƒ  ˜  ”   œ¥ „žŸ„ ¡„¡ž  ™” šš–  –¡¦„ž§„¡žžŸ¢ ¨©¤‘ ˜ ª˜ ¤‘ ˜ ˜    ƒ  ˜ ª   ”šš–¥ „  ¡©„ž§„¡žž¦  ‚ž¦„žˆ„¡žžŸ¢¡ž¡

          

£ 

‘˜

 «’ ¨¡

€˜

 «’¡ˆ§



 „

¬

 „

¬

€˜

§¦

© ¨

 ¦

©žž

®žž©

–  ƒ ˜  ƒ ˜ 

ˆ¦

¡¡¨

©§

¡‹‹

®žž©

¯ ‚

¡ˆ

ˆ‹

33

ˆ¦

®žž©

°

¡

¡¡

¡§

 §

®žž©

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

101

                   

‘ 

’   

ˆ  “



”   

‚Œ•­ƒ

€€•­„

Šƒ•­‚

€Š•­Œ

ƒ„•­Š Œ…­• š

€•­… „…•­€š

ˆ  – “      “ —˜™ “  

ǷȘȐȔȍȟȈȕȐȍ ²ȌȖșȚȖȊȍȘȕȣȍȖȚȓȐȟȐȧȔȍȎȌțȋȘțȗȗȈȔȐȗȘȐS    

”   ›œ€ †

ˆ   ›œ Œƒ†

 



ž



ž

—Ÿ

Š…

‚…‚

­„

ƒ…€

 œ…ƒ¡ œ­­­­€

¢   

€

„

ƒ

ƒ

 œ€…€¡ œ­­­Š



­

-

Š

…

 œ„„¡ œ­­ŒŠ

                                   ­€‚ƒ‚„…†‡­ˆ‰    Š    ‹  Œ    ‹    Ž  ‹   ‹ 

     ‘ Œ      ‹ Ž       ’“‘”• ‹“–• ‹ 

—  ‹ ‹  ˜‹ ™          ‹ ‹™ ‹ Š      ‹ 

     ‹       

   ˜   ’š›––“— œ             ‹   ‹    žŸ–––Ÿ–‘¡  ‹ ‹ ¢        ‹    ‹ ˜œ‘Ÿ”Ÿ–•  ‹Ž             ‹   ‹   £‘“¤ž ¥…ˆ¦ˆ§ƒˆ… ¨‰Š     ©”ª•£‘«¤ ¢                ‹    Š‹ ¬ ‹    ‹  ‹  ‹     

   ‹  ž® ¬¢ ’‘¯¯”—              Š   ‹  ‹    ˜            ‹ 

  ‹    Ÿª«• £‘”¤ Œ° ­¥°ˆ€€±²³‰ˆ§§’‘¯ª‘—       ¡ª•   ¢   ˜¢‹           ‹     ‹       ˜Ž‹  ‹ ‘–¯•  £‘ª¤ž  Š    ‹    ˜  ¢                                                   

   ­   €‚‚‚€ ƒ   „ …„ƒ  †   ……   ‡                      ……‚   ˆ     ‰†     ­‚Š‹           „­         Œ­Šƒ……Š        Ž         ‰  ‰                   ‡‡               ‰  ŠŒ€‚          ­  „„‚…

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


102

Ă?Ă?Ă&#x20AC;Ă&#x160;Ă&#x2019;Ă&#x2C6;Ă&#x2014;Ă&#x2026;Ă&#x2018;Ă&#x160;Ă&#x20AC;Ă&#x; Ă&#x152;Ă&#x2026;Ă&#x201E;Ă&#x2C6;Ă&#x2013;Ă&#x2C6;Ă?Ă&#x20AC;

          Â?Â?    Â?    Â?   Â?Â?        Â? Â? ­ Â&#x20AC;Â&#x20AC; Â? Â? Â?Â&#x201A;  Â?Â? Â?Â?  ­    Â&#x201A; Â&#x20AC;Â&#x20AC;   Â? Â&#x201A;     Â?  Â?Â?Â&#x201A;Â? Â&#x201A;Â&#x192; Â? Â&#x201A;Â&#x201E;Â?Â&#x2026;Â&#x2020;Â?Â&#x192;  Â?  Â&#x201A;      Â?   Â?  Â?Â&#x201A;   Â&#x2021;  Â&#x201E;Â&#x2C6;Â&#x2030;  Â&#x2026;Â? Â&#x160;   Â&#x160; Â?   Â?Â?Â?Â&#x2039;  Â&#x201A;Đ&#x203A;Đ&#x2DC;ТĐ&#x2022;Đ Đ?ТУРĐ? 1. ФодОŃ&#x20AC;Ов Đ?.Đ&#x2019;., Đ&#x161;Ń&#x20AC;игоŃ&#x20AC; Đ?.Đ&#x201C;., Đ&#x161;ОНŃ&#x2039;гин Đ?.Đ&#x2019;., Đ&#x161;ĐžŃ&#x2021;Đ°Ń&#x201A;кОв Đ?.Đ&#x2019;. Đ&#x17E;днОПОПонŃ&#x201A;Đ˝Ń&#x2039;Đľ ОпоŃ&#x20AC;Đ°Ń&#x2020;ии. ТоŃ&#x20AC;ПинОНОгиŃ? (ОйСОŃ&#x20AC; НиŃ&#x201A;ĐľŃ&#x20AC;Đ°Ń&#x201A;Ń&#x192;Ń&#x20AC;Ń&#x2039; и Ń ĐžĐąŃ Ń&#x201A;воннОо ĐżŃ&#x20AC;одНОМонио) // миŃ&#x20AC;Ń&#x192;Ń&#x20AC;гиŃ?. â&#x20AC;&#x201D; 2011. â&#x20AC;&#x201D; â&#x201E;&#x2013; 7. â&#x20AC;&#x201D; ĐĄ. 72-76. 2. Reiffersceid Đ&#x153;. Der simultaneingziff in der Bayychhohle-ChirurgischeAspekte // Zent. Bl. Chir. â&#x20AC;&#x201D; 1971. â&#x20AC;&#x201D; Bd. 5. â&#x20AC;&#x201D; S 2010. 3. мнОŃ&#x2026; Đ&#x203A;.Đ&#x2DC;., ФоНŃ&#x2039;Ń&#x2C6;иноŃ&#x20AC; Đ&#x2DC;.ĐĽ. ХиПŃ&#x192;ĐťŃ&#x152;Ń&#x201A;аннŃ&#x2039;Đľ ОпоŃ&#x20AC;Đ°Ń&#x2020;ии в ĐąŃ&#x20AC;Ń&#x17D;Ń&#x2C6;нОК ĐżĐžĐťĐžŃ Ń&#x201A;и // миŃ&#x20AC;Ń&#x192;Ń&#x20AC;гиŃ?. â&#x20AC;&#x201D; 1976. â&#x20AC;&#x201D; â&#x201E;&#x2013; 4.â&#x20AC;&#x201D; ĐĄ. 75-79. 4. Đ?ĐťŃ&#x152;Ń&#x201A;ПаŃ&#x20AC;Đş Đ&#x2022;.Đ&#x153;. ХиПŃ&#x192;ĐťŃ&#x152;Ń&#x201A;аннŃ&#x2039;Đľ НапаŃ&#x20AC;ĐžŃ ĐşĐžĐżĐ¸Ń&#x2021;ĐľŃ ĐşĐ¸Đľ ОпоŃ&#x20AC;Đ°Ń&#x2020;ии (Đ&#x17E;йСОŃ&#x20AC; НиŃ&#x201A;ĐľŃ&#x20AC;Đ°Ń&#x201A;Ń&#x192;Ń&#x20AC;Ń&#x2039;) // Đ&#x2019;ĐľŃ Ń&#x201A;ник Ń&#x2026;иŃ&#x20AC;Ń&#x192;Ń&#x20AC;гии. â&#x20AC;&#x201D; 2007. â&#x20AC;&#x201D; Т. 166, â&#x201E;&#x2013; 4. â&#x20AC;&#x201D; ĐĄ. 117-125. 5. Đ&#x201C;аНиПОв Đ&#x17E;.Đ&#x2019;., Đ&#x2014;иганŃ&#x2C6;ин Đ&#x201D;.Đ&#x153;., ТŃ&#x192;ĐšŃ Đ¸Đ˝ ĐĄ.Đ ., Đ&#x201D;ПиŃ&#x201A;Ń&#x20AC;иова Đ­.ĐŽ., ФаКСŃ&#x192;ННин Т.Đ ., ШкŃ&#x192;ндин Đ?.Đ&#x2019;. Đ&#x203A;ĐľŃ&#x2021;онио йОНŃ&#x152;Đ˝Ń&#x2039;Ń&#x2026; Ń Ń ĐžŃ&#x2021;ĐľŃ&#x201A;аннОК паŃ&#x201A;ОНОгиоК ĐžŃ&#x20AC;ганОв ПаНОгО Ń&#x201A;аСа Ń ĐżŃ&#x20AC;иПонониоП НапаŃ&#x20AC;ĐžŃ ĐşĐžĐżĐ¸Ń&#x2021;ĐľŃ ĐşĐ¸Ń&#x2026; Ń&#x201A;ĐľŃ&#x2026;нОНОгиК // Đ­Đ˝Đ´ĐžŃ ĐşĐžĐżĐ¸Ń&#x2021;ĐľŃ ĐşĐ°Ń? Ń&#x2026;иŃ&#x20AC;Ń&#x192;Ń&#x20AC;гиŃ?. â&#x20AC;&#x201D; 2012. â&#x20AC;&#x201D; â&#x201E;&#x2013; 3. â&#x20AC;&#x201D; ĐĄ. 25-28. 6. Đ&#x153;Đ°ĐšŃ Ń&#x201A;Ń&#x20AC;онкО H.A., Đ&#x2018;ĐľŃ&#x20AC;Нов Đ&#x2DC;.Đ&#x2019;., Đ&#x2018;Đ°Ń ĐžŃ A.C., Đ&#x2018;Đ°Ń ĐžŃ ĐĄ.Ф. ХиПŃ&#x192;ĐťŃ&#x152;Ń&#x201A;аннŃ&#x2039;Đľ Ń?ндОвидоОŃ&#x2026;иŃ&#x20AC;Ń&#x192;Ń&#x20AC;гиŃ&#x2021;ĐľŃ ĐşĐ¸Đľ вПоŃ&#x2C6;Đ°Ń&#x201A;оНŃ&#x152;Ń Ń&#x201A;ва ĐżŃ&#x20AC;и СайОНованиŃ?Ń&#x2026; ПаŃ&#x201A;ки и ĐżŃ&#x20AC;идаŃ&#x201A;кОв, Ń ĐžŃ&#x2021;ĐľŃ&#x201A;Đ°Ń&#x17D;Ń&#x2030;иŃ&#x2026;Ń Ń? Ń Đ˝ĐľĐžŃ ĐťĐžĐśĐ˝ĐľĐ˝Đ˝Ń&#x2039;Пи Ń&#x201E;ĐžŃ&#x20AC;ПаПи МоНŃ&#x2021;нОкаПоннОК йОНоСни // Đ&#x2013;Ń&#x192;Ń&#x20AC;наН Đ°ĐşŃ&#x192;Ń&#x2C6;ĐľŃ&#x20AC;Ń Ń&#x201A;ва и ĐśĐľĐ˝Ń ĐşĐ¸Ń&#x2026; йОНоСноК. â&#x20AC;&#x201D; 2008. â&#x20AC;&#x201D; Т. LVII, â&#x201E;&#x2013; 3. â&#x20AC;&#x201D; ĐĄ. 18-23. 7. Jocko J.A., Shenassa H., Singh S.S. The role of appendectomy in gynaecologic surgery: a canadian retrospective case series // J. Obstet. Gynecol. Can. â&#x20AC;&#x201D; 2013. â&#x20AC;&#x201D; Vol. 35, N 1. â&#x20AC;&#x201D; P. 44-48. 8. Yi Q.H., Ling S.R., Chen K.M., He W.R., Li L., Yi C.J.Evaluation of the clinical value of simultaneous hysterectomy and bilateral salpingectomy in perimenopausal women // Zhonghua Fu Chan Ke Za Zhi. â&#x20AC;&#x201D; 2012. â&#x20AC;&#x201D; Vol. 47, N 2. â&#x20AC;&#x201D; Đ . 110-114. 9. Đ&#x201D;Ń&#x20AC;ОнОва Đ&#x2019;.Đ&#x203A;., Đ&#x201D;Ń&#x20AC;ОнОв Đ?.Đ&#x2DC;., Đ&#x161;Ń&#x20AC;Ń&#x17D;Ń&#x2021;ина Đ&#x2022;.Đ?., Đ˘ĐľŃ ĐťŃ&#x17D;Đş Đ .ĐĄ., Đ&#x203A;Ń&#x192;Ń&#x2020;онкО Đ&#x2022;.Đ&#x2019;., Đ?Đ°Ń Ń&#x201A;Đ°Ń&#x2C6;онкО Đ&#x153;.Đ&#x2DC;. ХиПŃ&#x192;ĐťŃ&#x152;Ń&#x201A;аннŃ&#x2039;Đľ ОпоŃ&#x20AC;Đ°Ń&#x2020;ии ĐżŃ&#x20AC;и Ń ĐžŃ&#x2021;ĐľŃ&#x201A;аннŃ&#x2039;Ń&#x2026; Ń&#x2026;иŃ&#x20AC;Ń&#x192;Ń&#x20AC;гиŃ&#x2021;ĐľŃ ĐşĐ¸Ń&#x2026; и гинокОНОгиŃ&#x2021;ĐľŃ ĐşĐ¸Ń&#x2026; СайОНованиŃ?Ń&#x2026; // ĐŁĐşŃ&#x20AC;Đ°Đ¸Đ˝Ń ĐşĐ¸Đš ĐśŃ&#x192;Ń&#x20AC;наН Ń&#x2026;иŃ&#x20AC;Ń&#x192;Ń&#x20AC;гии. â&#x20AC;&#x201D; 2013. â&#x20AC;&#x201D; â&#x201E;&#x2013; 2 (21). â&#x20AC;&#x201D; ĐĄ. 143-151. 10. Đ&#x2DC;Ń&#x2030;онкО Đ?.Đ&#x2DC;., Đ?ĐťĐľĐşŃ Đ°Đ˝Đ´Ń&#x20AC;Ов Đ&#x203A;.ĐĄ., Đ&#x2019;одоŃ&#x20AC;никОва Đ?.Đ&#x2019;., Đ&#x2013;ОНОйОва Đ&#x153;.Đ?., ШиŃ&#x2C6;кОв Đ?.Đ&#x153;., ШŃ&#x192;ĐťŃ&#x192;Ń&#x201A;кО Đ?.Đ&#x153;., Раннов Đ&#x2DC;.Đ&#x2018;. Đ&#x17E;Ń&#x2020;онка кНиниŃ&#x2021;ĐľŃ ĐşĐžĐš и Ń?кОнОПиŃ&#x2021;ĐľŃ ĐşĐžĐš Ń?Ń&#x201E;Ń&#x201E;окŃ&#x201A;Đ¸Đ˛Đ˝ĐžŃ Ń&#x201A;и Ń Đ¸ĐźŃ&#x192;ĐťŃ&#x152;Ń&#x201A;аннŃ&#x2039;Ń&#x2026; ОпоŃ&#x20AC;Đ°Ń&#x2020;иК в гинокОНОгии // Đ&#x2019;ĐľŃ Ń&#x201A;ник нОвŃ&#x2039;Ń&#x2026; ПодиŃ&#x2020;Đ¸Đ˝Ń ĐşĐ¸Ń&#x2026; Ń&#x201A;ĐľŃ&#x2026;нОНОгиК. â&#x20AC;&#x201D; 2006. â&#x20AC;&#x201D; Т. XIII, â&#x201E;&#x2013; 4. â&#x20AC;&#x201D; ĐĄ. 109-112. 11. ШаŃ&#x201A;ĐžŃ&#x2026;ина Đ&#x2DC;.Đ&#x2019;., ЯкОвНов Đ&#x17E;.Đ&#x201C;., Đ&#x2DC;.Đ&#x201C;. Đ&#x203A;ĐľŃ&#x2030;онкО Đ&#x2DC;.Đ&#x201C;. ЭкОнОПиŃ&#x2021;ĐľŃ ĐşĐ°Ń? Ń?Ń&#x201E;Ń&#x201E;окŃ&#x201A;Đ¸Đ˛Đ˝ĐžŃ Ń&#x201A;Ń&#x152; Ń Đ¸ĐźŃ&#x192;ĐťŃ&#x152;Ń&#x201A;аннŃ&#x2039;Ń&#x2026; ОпоŃ&#x20AC;Đ°Ń&#x2020;иК в ĐłĐžŃ ĐżĐ¸Ń&#x201A;аНо воŃ&#x201A;ĐľŃ&#x20AC;анОв вОКн // Đ&#x201C;ĐžŃ ĐżĐ¸Ń&#x201A;Đ°ĐťŃ&#x152;наŃ? ПодиŃ&#x2020;ина. â&#x20AC;&#x201D; 2012. â&#x20AC;&#x201D; â&#x201E;&#x2013; 8. â&#x20AC;&#x201D; ĐĄ. 154-155. 12. ĐĄŃ&#x201A;Ń&#x20AC;иМоНоŃ&#x2020;киК Đ&#x2019;.Đ&#x2019;., Đ Ń&#x192;Ń&#x201A;онйŃ&#x192;Ń&#x20AC;Đł Đ&#x201C;.Đ&#x153;., Đ&#x2013;оПŃ&#x2021;Ń&#x192;Мина Т.ĐŽ., Đ?ĐťŃ&#x152;Ń&#x201A;ПаŃ&#x20AC;Đş Đ&#x2022;.Đ&#x153;. ЭкОнОПиŃ&#x2021;ĐľŃ ĐşĐ°Ń? Ń?Ń&#x201E;Ń&#x201E;окŃ&#x201A;Đ¸Đ˛Đ˝ĐžŃ Ń&#x201A;Ń&#x152; Ń Đ¸ĐźŃ&#x192;ĐťŃ&#x152;Ń&#x201A;аннŃ&#x2039;Ń&#x2026; ОпоŃ&#x20AC;Đ°Ń&#x2020;иК в Ń&#x2026;иŃ&#x20AC;Ń&#x192;Ń&#x20AC;гии и гинокОНОгии // Đ&#x153;ĐžŃ ĐşĐžĐ˛Ń ĐşĐ¸Đš Ń&#x2026;иŃ&#x20AC;Ń&#x192;Ń&#x20AC;гиŃ&#x2021;ĐľŃ ĐşĐ¸Đš ĐśŃ&#x192;Ń&#x20AC;наН. â&#x20AC;&#x201D; 2008. â&#x20AC;&#x201D; â&#x201E;&#x2013; 1. â&#x20AC;&#x201D; ĐĄ. 26-29. 13. Đ&#x;Ń&#x2021;оНŃ&#x152;никОв ĐĄ.ĐĄ., ТонŃ&#x2021;Ń&#x192;Ń&#x20AC;ин Ш.Đ?., Đ&#x;Đ°Ń&#x2C6;кОв Đ&#x;.Đ&#x;. ЭкОнОПиŃ&#x2021;ĐľŃ ĐşĐ°Ń? Ń?Ń&#x201E;Ń&#x201E;окŃ&#x201A;Đ¸Đ˛Đ˝ĐžŃ Ń&#x201A;Ń&#x152; Ń&#x2026;иŃ&#x20AC;Ń&#x192;Ń&#x20AC;гиŃ&#x2021;ĐľŃ ĐşĐ¸Ń&#x2026; вПоŃ&#x2C6;Đ°Ń&#x201A;оНŃ&#x152;Ń Ń&#x201A;в // миŃ&#x20AC;Ń&#x192;Ń&#x20AC;гиŃ?. â&#x20AC;&#x201D; 1990. â&#x20AC;&#x201D; â&#x201E;&#x2013; 11. â&#x20AC;&#x201D; ĐĄ. 137-139. 14. Đ&#x2DC;ванОв Đ&#x2019;.Đ&#x2019;., Đ&#x;Ń&#x192;Ń&#x2021;кОв Đ&#x161;.Đ&#x2019;. Đ&#x17E;днОПОПонŃ&#x201A;Đ˝Ń&#x2039;Đľ НапаŃ&#x20AC;ĐžŃ ĐşĐžĐżĐ¸Ń&#x2021;ĐľŃ ĐşĐ¸Đľ ОпоŃ&#x20AC;Đ°Ń&#x201A;ивнŃ&#x2039;Đľ вПоŃ&#x2C6;Đ°Ń&#x201A;оНŃ&#x152;Ń Ń&#x201A;ва ĐżŃ&#x20AC;и Ń ĐžŃ&#x2021;ĐľŃ&#x201A;аннŃ&#x2039;Ń&#x2026; СайОНованиŃ?Ń&#x2026; ĐžŃ&#x20AC;ганаŃ&#x2026; ĐąŃ&#x20AC;Ń&#x17D;Ń&#x2C6;нОК ĐżĐžĐťĐžŃ Ń&#x201A;и и ПаНОгО Ń&#x201A;аСа Ń&#x192; паŃ&#x2020;ионŃ&#x201A;Ов Ń ĐžĐśĐ¸Ń&#x20AC;ониоП // Đ&#x2019;ĐľŃ Ń&#x201A;ник наŃ&#x2020;иОнаНŃ&#x152;нОгО ПодикО-Ń&#x2026;иŃ&#x20AC;Ń&#x192;Ń&#x20AC;гиŃ&#x2021;ĐľŃ ĐşĐžĐłĐž Ń&#x2020;онŃ&#x201A;Ń&#x20AC;Đ° иП. Đ?.Đ&#x2DC;. Đ&#x;иŃ&#x20AC;ОгОва. â&#x20AC;&#x201D; 2011. â&#x20AC;&#x201D; â&#x201E;&#x2013; 4. â&#x20AC;&#x201D; ĐĄ. 65-68. 15. Đ&#x2018;Đ°Ń&#x192;Нина Đ?.Đ&#x2019;., Đ&#x2018;Đ°Ń&#x192;Нина Đ&#x2022;.Đ?. ХиПŃ&#x192;ĐťŃ&#x152;Ń&#x201A;аннŃ&#x2039;Đľ ОпоŃ&#x20AC;Đ°Ń&#x2020;ии в Ń&#x2026;иŃ&#x20AC;Ń&#x192;Ń&#x20AC;гии и гинокОНОгии // Đ&#x2019;ĐľŃ Ń&#x201A;ник Ń&#x2026;иŃ&#x20AC;Ń&#x192;Ń&#x20AC;гии иП. Đ&#x2DC;.Đ&#x2DC;. Đ&#x201C;Ń&#x20AC;окОва. â&#x20AC;&#x201D; 2004. â&#x20AC;&#x201D; Т. 163, â&#x201E;&#x2013; 2. â&#x20AC;&#x201D; ĐĄ. 87-91. 16. Stevens M.L., Hubert B.C., Wenzel F.J. Combined gynecologic surgical procedures and cholecystectomy // Am. J. Obst. Gynecol. â&#x20AC;&#x201D; 1984. â&#x20AC;&#x201D; Vol. 149. â&#x20AC;&#x201D; P. 350-354. 17. Đ?йаŃ&#x2C6;ин Đ&#x2019;.Đ&#x201C;. Đ&#x;НанОваŃ? Ń&#x2026;иŃ&#x20AC;Ń&#x192;Ń&#x20AC;гиŃ&#x2021;ĐľŃ ĐşĐ°Ń? пОПОŃ&#x2030;Ń&#x152; йОНŃ&#x152;Đ˝Ń&#x2039;Đź гинокОНОгиŃ&#x2021;ĐľŃ ĐşĐžĐłĐž ĐżŃ&#x20AC;ĐžŃ&#x201E;иНŃ? в Ń&#x192;Ń ĐťĐžĐ˛Đ¸Ń?Ń&#x2026; Ń&#x201A;ĐľŃ&#x20AC;Ń&#x20AC;иŃ&#x201A;ĐžŃ&#x20AC;иаНŃ&#x152;нОК Ń Đ¸Ń Ń&#x201A;оПŃ&#x2039; ПодиŃ&#x2020;Đ¸Đ˝Ń ĐşĐžĐłĐž ĐžĐąĐľŃ ĐżĐľŃ&#x2021;ониŃ? // Đ&#x2019;ОоннО-ПодиŃ&#x2020;Đ¸Đ˝Ń ĐşĐ¸Đš ĐśŃ&#x192;Ń&#x20AC;наН. â&#x20AC;&#x201D; 1997. â&#x20AC;&#x201D; Т. 318, â&#x201E;&#x2013; 9. â&#x20AC;&#x201D; ĐĄ. 19-24. 18. McSherry C.K., Glenn F. Biliary Tract Surgery Concomitant with Other Intra-abdominal Operations // Ann. Surg. â&#x20AC;&#x201D; 1981. â&#x20AC;&#x201D; Vol. 193. â&#x20AC;&#x201D; P. 169-175.

â&#x20AC;&#x2DC;7 (76) докайŃ&#x20AC;Ń&#x152; 2013 Đł.             Â? Â?

Â?Â?     Â?     ­ Â?Â&#x20AC;Â?Â&#x201A;       Â?  Â&#x192;Â&#x201E;Â&#x192;Â&#x2026; Â&#x2020;Â&#x201E;Â&#x2021;Â&#x2C6;Â?Â&#x2030;        ­   Â? ­  Â?     Â?Â? Â&#x160;     ­    

  �­�

Â&#x2039;  Â?  Â&#x2039;Â&#x152;Â&#x152;   Â? Â&#x2030;   ­

 ­ Â? ­Â?  Â?            ­    ­Â? Â?               ­ Â?Â?Â?Â?Â?Â?          ­Â? Â? Â? REFERENCES 1. Fedorov A.V., Kriger A.G., Kolygin A.V., Kochatkov A.V. One stage operations. Terminology (Literature review and own suggestion). Khirurgiya, 2011, no. 7, pp. 72-76. (in Russ.). 2. Reiffersceid Đ&#x153;. Simultaneous intervention in the abdomen â&#x20AC;&#x201C; surgical aspects. Zentralblatt fur Chirurgie, 1971, vol. 5, p. 2010. (in German). 3. Khnokh L.I., Felyshiner I.Kh. Simultaneous operations in the abdominal cavity. Khirurgiya, 1976, no. 4, pp. 75-79. (in Russ.). 4. Alâ&#x20AC;&#x2122;tmark E.M. Simultaneous laparoscopic surgery (Literature review). Vestnik khirurgii, 2007, vol. 166, no. 4, pp. 117-125. (in Russ.). 5. Galimov O.V., Ziganshin D.M., Tuysin S.R., Dmitrieva E.Yu., Fayzullin T.R., Shkundin A.V. Laparoscopic treatment of patients with combined pelvic organs pathology. Endoskopicheskaya khirurgiya, 2012, vol. 18, no. 3, pp. 25-28. (in Russ.). 6. Maystrenko H.A., Berlev I.V., Basos A.C., Basos S.F. Simultaneous endovideosurgical interventions in gynecological patients with concurrent non-complicated gallstone disease. Zhurnal akusherstva i zhenskikh bolezney, 2008, vol. 57, no. 3, pp. 18-23. (in Russ.). 7. Jocko J.A., Shenassa H., Singh S.S. The role of appendectomy in gynaecologic surgery: A Canadian retrospective case series. Journal of Obstetrics and Gynaecology Canada, 2013, vol. 35, no. 1, pp. 44-48. 8. Yi Q.H., Ling S.R., Chen K.M., He W.R., Li L., Yi C.J. Evaluation of the clinical value of simultaneous hysterectomy and bilateral salpingectomy in perimenopausal women. Zhonghua Fu Chan Ke Za Zhi [Chinese Journal of Obstetrics and Gynecology], 2012, vol. 47, no. 2, pp. 110-114. (in Chinese). 9. Dronova V.L., Dronov A.I., Kryuchina E.A., Teslyuk R.S., Lutsenko E.V., Nastashenko M.I. Simultaneous operations in combined surgical and gynecological diseases. Ukrainskiy zhurnal khirurgii, 2013, no. 2 (21), pp. 143-151. (in Russ.). 10. Ishchenko A.I., Aleksandrov L.S., Vedernikova N.V., Zholobova M.N., Shishkov A.M., Shulutko A.M., Rannev I.B. Evaluation of clinical and economical effectiveness of simultaneous operations in gynecology. Vestnik novykh meditsinskikh tekhnologiy, 2006, vol. 13, no. 4, pp. 109-112. (in Russ.). 11. Shatokhina I.V., Yakovlev O.G., I.G. Leshchenko I.G. Economic efficiency of simultaneous operations in the hospital for war veterans. Gospitalâ&#x20AC;&#x2122;naya meditsina, 2012, no. 8, pp. 154-155. (in Russ.). 12. Strizheletskiy V.V., Rutenburg G.M., Zhemchuzhina T.Yu., Alâ&#x20AC;&#x2122;tmark E.M. Economic efficiency of simultaneous operations in surgery and gynecology. Moskovskiy khirurgicheskiy zhurnal, 2008, no. 1, pp. 26-29. (in Russ.). 13. Pchelâ&#x20AC;&#x2122;nikov S.S., Tenchurin Sh.A., Pashkov P.P. Economic efficiency of surgical interventions. Khirurgiya, 1990, no. 11, pp. 137-139. (in Russ.). 14. Ivanov V.V., Puchkov K.V. Single-step laparoscopic operation in patients with combined diseases of the organs of abdominal cavity and pelvis with obesity. Vestnik natsionalâ&#x20AC;&#x2122;nogo mediko-khirurgicheskogo tsentra im. N.I. Pirogova [Bulletin of the National Medical and Surgical Center named after N.I. Pirogov], 2011, no. 4, pp. 65-68 (in Russ.). 15. Baulina N.V., Baulina E.A. Simultaneous operations in surgery and gynecology. Vestnik khirurgii im. I.I. Grekova, 2004, vol. 163, no. 2, pp. 87-91. (in Russ.). 16. Stevens M.L., Hubert B.C., Wenzel F.J. Combined gynecologic surgical procedures and cholecystectomy. American Journal of Obstetrics and Gynecology, 1984, vol. 149, no. 3, pp. 350-354. 17. Abashin V.G. Planned surgical aid to gynecologic profile patients in the conditions of territorial health-care system. Voenno-meditsinskiy zhurnal, 1997, vol. 318, no. 9, pp. 19-24. (in Russ.). 18. McSherry C.K., Glenn F. Biliary tract surgery concomitant with other intraabdominal operations. Annals of Surgery, 1981, vol. 193, no. 2, pp. 169-175.

Ă&#x20AC;Ă&#x160;Ă&#x201C;Ă&#x2DC;Ă&#x2026;Ă?Ă&#x2018;Ă&#x2019;Ă&#x201A;Ă&#x17D;. Ă&#x192;Ă&#x2C6;Ă?Ă&#x2026;Ă&#x160;Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;. Ă?Ă?Ă&#x201E;Ă&#x17D;Ă&#x160;Ă?Ă&#x2C6;Ă?Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

103



Þ.À. ÄÓÄÀÐÅÂÀ, Â.À. ÃÓÐÜÅÂÀ Àëòàéñêèé ãîñóäàðñòâåííûé ìåäèöèíñêèé óíèâåðñèòåò, 656038, Àëòàéñêèé êðàé, ã. Áàðíàóë, ïð. Ëåíèíà, ä. 40

Îòäàëåííûå ïîñëåäñòâèÿ ðàäèàöèîííîãî âîçäåéñòâèÿ íà æåíñêîå íàñåëåíèå, ïðîæèâàþùåå íà òåððèòîðèè, ïðèëåãàþùåé ê Ñåìèïàëàòèíñêîìó ïîëèãîíó Äóäàðåâà Þëèÿ Àëåêñååâíà — êàíäèäàò ìåäèöèíñêèõ íàóê, àññèñòåíò êàôåäðû àêóøåðñòâà è ãèíåêîëîãèè ÔÏÊ è ÏÏÑ, òåë. +7-906-941-30-26, e-mail: julia.dudareva@mail.ru Ãóðüåâà Âàëåíòèíà Àíäðååâíà — äîêòîð ìåäèöèíñêèõ íàóê, ïðîôåññîð, çàâåäóþùàÿ êàôåäðîé àêóøåðñòâà è ãèíåêîëîãèè ÔÏÊ è ÏÏÑ, òåë. (3852) 68-96-22, å-mail: ag.fpk@mail.ru                           ­  ­ €   ‚ ­ ƒ   ­   „ ‚ ­   

Yu.A. DUDAREVA, V.A. GUREVA Altai State Medical University, 40 Lenina Ave., Barnaul, the Altai Territory, Russian Federation 656038

   female population living in the area adjacent to the Semipalatinsk test site Dudareva Yu.A. — Cand. Med. Sc., Assistant of the Department of Obstetrics and Gynecology of Advanced Training Faculty and Professional Retraining of Specialists, tel. +7-906-941-30-26, e-mail: julia.dudareva@mail.ru Gureva V.A. — D. Med. Sc., Professor, Head of the Department of Obstetrics and Gynecology of Advanced Training Faculty and Professional Retraining of Specialists, tel. (3852) 68-96-22, e-mail: ag.fpk@mail.ru …†‡ˆ‰Š‹ŒŽ‘’‰“”‡‘•–’‘Ž— ˜Ž™‡ŒŠ”‡š”‡‘‡Œ’‡ˆ‰Œ’†‰‘Š”’‰“–‡…†‡ŠŒŠ–›‘‰‘Ž—”‡š”Žˆ•“’‰œ‡ŠŒˆš†›‘‰“Š–†‡Š–’†Ž—˜Ž™‡Œˆ‰”‡“’–› ”Šˆ‰Š’‡ˆŠ’Š’‰™‡Ž—ŠŒ•“–‡Š”‡žš–Ž‘‰ŽŒŽŒŸ•‹•‘’  Š’’†‡¡‡™‰šŠ–Š’‰Œ‘¢’‡‘’‘‰’‡Š‘˜‡––Š‘’†‡‰”ˆ‡‘“‡ŒˆŠŒ’‘Ž—’†‡£”‘’ŠŒˆ ‘‡“ŽŒˆ‹‡Œ‡”Š’‰ŽŒ…†‡†‰‹†š”‡œŠ–‡Œ“‡Ž—‡ž’”Š‹‡Œ‰’Š–‹›Œ‡“Ž–Ž‹‰“Š–šŠ’†Ž–Ž‹›¤Ž’†‰Œˆ‰”‡“’–›‡žšŽ‘‡ˆ’Ž”Šˆ‰Š’‰ŽŒ˜Ž™‡ŒŠŒˆ’†‡‰” ˆŠ•‹†’‡”‘ŠŒˆ‹”ŠŒˆˆŠ•‹†’‡”‘‰‘‘†Ž˜Œ  ”Šˆ‰Š’‰ŽŒ‡žšŽ‘•”‡ˆ‡‘“‡ŒˆŠŒ’‘”‡š”Žˆ•“’‰œ‡†‡Š–’†

                                ­       €  ‚   ‚   ƒ    „…    †     

   €… …    …€     ‡ˆ… €‰ˆ‰Š   ƒ   …    …  € €‹      Œ     

…     ‚    

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


104

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

                                              

   ­    €  ‚ ƒ            „     …               †‡‡ˆ  

    

 ‰ˆ             …             ­­     ­ ­­ Š        ‡ ‹  

                     ­      ­                         ­Š                               …­              ‡   †‡‰‡     †Œ  Œ     Ž ­   ‘   ­        ’ Œ “ ƒ       ­ Ž  ”   Ž  •    –                                  †‡‡‰          ‹                         ­           …­          ‡ˆ‚†‡‰‡   •  –­ Š   —Ž                ­   ” …            ’˜      “      ƒƒ  „— …           …             ‹      

                      ­   ­    ­ ­               ‹  …™™’˜    “ •†‡™™Œ†‡šˆ –…­            —     ‡   †‡‰‡   •     †Œ  –    ›           ˜   … …­   ƒƒ  ­  ŒŽ ­   • œ–‹ •˜†–…’˜      “ ‡   ˜      ­        ”      •  Œ  –          ­                             

‘7 (76) декабрь 2013 г. •†‡š†Œ†‡ – Š    ‰ ’˜      “ ˜   •˜–                      ˜   † ”    Ž                        •   –   

    …­      ‹   ™Œ   … ††   Š    ­ …­             —     ‡   †‡‰‡  ˜   •˜™–   š™    ­                        

       ­  ŽŒ   ­  •ž ­  – ƒ                       ­  Ž               ­                             Ÿ                          ›       ­  ŽŒ   ­            —      

         ­     ¡   ­   •¢ ­†ˆˆ–    £¤¥ £ £¦ £Š   §¥£ Š    …                             ¨… ©ƒ  ­    ­  ­                                

 FŒ   ¨… ª— ”                              ­   ¡ Ž ­                       §   j Š     n(j– Š       ­  ­        jŒ   «¬® L¬® Š Ž    jŒ        ¯ ¬ ¯¬ Š    iŒ          ‹      ­   ­           ­    ­                 

        ­¥¦°¦¬±¦¬©° ˆ¥£¥¥†²¥³¯©´µ

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.                 

                               ­            €  ‚              ƒ „…††† ‡        ‚     

  €  ˆ       ‰…††††ˆŠ   ‹              ŒŽ €              ‘‘Œ’ŽŒ   ƒ„‘ƒ„†Œ’ˆ“ „  ƒ‘€     ƒ”Œ’‘“ Š…††† 

105

€ €   €    € € ‚  š†›                      ­€€      

‚          ƒ              „ €€         

                                                                •    € €      €  € €    €‚      €        „ˆŠ „”†Š „‘ˆŠ –     ‰—††‘Š€    ‡                   “ˆŽˆ”   ˜€™‡­ 

­          €   ‚ƒ„…„† •                €           Œ“Œ’ŽŒ–”’ˆ“–Š …††††„ ­ €  €             „„“’Ž–    ƒ “Œ’‘ˆ– …††††  ‡    œ        €       € € š› ž ƒ ““’„ˆ–€„†’†–†Œ’†–€                  €            ‹  ‚

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


106

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

          

                              ­           €€   ‚ ƒ   „    € ƒ        „     … „  „ †       „ ‡           „     ‡      „  ˆ     -

   „     ‰Š ‚‹ Œ‰ Œ‹ ‚ Ž‹ ‚ ‘’ „         “”•– –Œ‹—  ˜      € ‚‡       ‡   ‡         „  ˆ        ‘‹‰ ‹‚‘ Š‚Œ Œ’“—  ƒ         ‡‡ „      ˆ           „           ­                „ ƒ  “  –––  —           ‡      –                                            ­ €‚      € ƒ „ ­ …     ƒƒ „    € ƒ „     † „    „ ‡

 ƒ „   

         ƒ „‚    ­ …  ‚ „  €ƒ „   ˆ ƒ„  ‰   ƒƒ ‚   ƒƒ ‚€ƒ  ­  ‚ƒ‚ €ƒ

‚‚  -

                ­€‚‚  ƒ„



   

S P

  ­ €

‚ ‚ƒ„

‡ ˆ  ‰Š‡ ƒ‚ƒ †‚ƒ„ ‹‡ €‚ŒŒ

 †‚ ‚†„ ­€

Ž‡‚ ‡‰- ‚ ‚ „  ­ˆ

 Š‹‡ ƒ‚ †‚ €ˆ‚‘‘ 

          

 







S P S P S P S P S P

‚ ‚…

†‚† ‚„

†‚ƒ ‚ †‚ ‚„

‚ ‚

‚ ‚„ ƒ‚ ‚

‚ ‚

 ‚† ‚ „

‚ ‚

ƒ‚ƒ ‚…

‚† ‚

‚ ‚

†…‚† ‚„

 ‚ƒ …‚†

‚† ‚

‚† †‚„

‚ ‚†

‚ ‚„ ‚ ‚

‚ ‚

…‚† †‚…

‚† ‚

†‚ ‚„

‚ ‚

        

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

107

                                                     

†“”‰ †“”‰ †“”‰ †“”‰ •– S P •– S P •– S P •– S P

     

†“”‰ †“”‰ •– S P •– S P

‡‡–‡˜

–

–˜

‡–­

‡–˜

–­

’ ‚   €  ‡‡–‡˜ †——‡‰

‡–­

–˜

–

­­–˜

–

™     ƒ  †   –˜        „Œ ‰

‡–

­–˜

–‡

–˜

–­

š‚  ‡‡–‡ †—‰

–‡

‡‡–˜

–

’  

     ƒ  Œ „  „  †—­—­­‰

‡–˜ –

                             

                    

          

  

                    ­€­‚ ƒ„„‚ …€†‡     ˆ…  

 ƒ ‰                                    …„‚…­‚ƒ…‡    

 ƒ Š                                    ­…‚ ƒ‹„‚ ……‹‡    

 ƒ Œ        

…  

            ƒ 



  ƒ     €„‡  

             

        ƒŽŽ‘„  „‘€Ž‡‚ ’€€€€Ž “     ”       •                               ”   



           –“—    ˜   — 

      

  

   ˆ… 

  ” €™ƒƒ €‹…†         …­ƒ„ •       



                          ­       €         ‚             ƒ  „          …           „‚  „ †‡ˆˆ‰      €…Šƒ ‚„‚…    † ‡‰ ‹           ŒŠ   ‚„   €  …   Œ „       „                       ŒŠ             ƒ          „  ƒ      „   Ž           ƒ            „  ƒ   Œ „   „   ƒ ‚   ‚    €  ƒ ‚ ƒ               ƒ          ƒ    ‚  ‘€ƒ    ƒ   -

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


108

Ă?Ă?Ă&#x20AC;Ă&#x160;Ă&#x2019;Ă&#x2C6;Ă&#x2014;Ă&#x2026;Ă&#x2018;Ă&#x160;Ă&#x20AC;Ă&#x; Ă&#x152;Ă&#x2026;Ă&#x201E;Ă&#x2C6;Ă&#x2013;Ă&#x2C6;Ă?Ă&#x20AC;

                                          Â?  Â? Â?  Â?           Â? ­Â&#x20AC;  Â? Â? Â? Â?  Â&#x201A; Â?       Â? Â? Â&#x192;­Â&#x201E;     Â?          Â? 

               Â? Â? Â?Â?   ­Â?  Â&#x20AC;   Â? Â?Â?  Â&#x201A;  Â&#x20AC;Â?  Â&#x192;  Â? Â&#x201E;Â&#x2026;Â&#x20AC;  Â&#x20AC;Â&#x2020;  ­   Â&#x2021;  Â? Â? Â?Â?  ­Â?Â&#x201A;Â&#x20AC;Â?Â&#x2C6;Â&#x2030;Â&#x160;Â&#x2020;Â&#x2039; Â?Â&#x152;Â&#x17D;Â&#x17D;Â&#x2018;  Â&#x2018;Â&#x2019;Â&#x201E; Â&#x201C;Â&#x201D;Â&#x201D;Â&#x2022;Â&#x2013;Â&#x2020;Â&#x2014; Â&#x152; Â&#x2019;Â&#x20AC;    Â&#x2022;Â? Â&#x2DC;  Â? Â&#x2026;Â&#x2122;  Â&#x20AC;  Â?   Â&#x2026;Â&#x161;Â&#x2122;   

    Â&#x2018;Â&#x203A;Â?  Â&#x201E;Â&#x20AC; Â&#x2DC;Â&#x161;   Â?Â?  Â? Â&#x2018; Â&#x20AC;   Â&#x2022;Â&#x201E;Â&#x201E; Â&#x2018;Â&#x192;  ­  Â&#x153; Â&#x2020;  Â&#x201E; Â&#x20AC; Â&#x201D; Â&#x2022;Â&#x2020; Â&#x17E; Â?Â&#x20AC; Â&#x2018; Â&#x;Â&#x;Â&#x2039; Â&#x2013;      ÂĄÂ?   ¢Â&#x20AC; Â? 

Â&#x2DC; Â?  Â&#x2018; Â&#x201E;Â&#x201E;Â? Â&#x2021;Â&#x2022;Â&#x201E; Â&#x2018; Â&#x201D; Â&#x2C6; ÂŁÂŁ Â&#x161; Â&#x2022; ¢Â&#x201D;Â&#x152;Â&#x17D;Â&#x17D;Â&#x2039;Â&#x201D;¤Â&#x2013;Â&#x201D;Â&#x2022;Â&#x160;Â&#x2020;Â&#x160;Â&#x2039; Â&#x160;Â&#x2018;Â&#x2DC; ÂĄ ÂĽ ÂŚ¢Â&#x2022;Â?Â&#x2DC;  Â? Â&#x20AC;Â?    Â&#x2026;Â&#x161;Â&#x2122;   

 Â?   Â&#x2018;Â&#x203A; Â?  Â&#x;Â&#x160;Â&#x; Â&#x2018;Â&#x20AC;  Â&#x201E;Â&#x20AC; Â&#x2DC;Â&#x161;   Â?Â? Â? Â&#x2018;Â&#x20AC; Â&#x2022;Â&#x201E;Â&#x201E;Â&#x2018; Â&#x;Â&#x160;Â&#x; Â&#x2018;Â&#x20AC; ÂŁÂŁ  Â&#x20AC;  Â&#x2018; Â&#x201E;Â&#x201E;Â? Â&#x2021;Â&#x2022;Â&#x201E; Â&#x2018;Â&#x201D;Â&#x2C6;Â&#x201D;Â&#x;Â&#x;Â&#x160;Â&#x201D;¤Â&#x152;Â&#x201D;Â&#x2022;Â&#x2013;Â&#x2014;Â&#x2020;Â&#x160;Â&#x201A; Â&#x201A; ÂĄ   Â?    ÂĽ  ÂŚ¢ Â&#x17E; Â?Â&#x201E;Â?    Â&#x2DC;Â? Â&#x2022;Â&#x201E;Â&#x2018; Â&#x2018;   Â&#x2018;  Â? ÂŁÂŁ  Â&#x20AC;  Â&#x2018; Â&#x201E;Â&#x201E;Â?Â&#x2021;Â&#x2022;Â&#x201E;Â&#x2018;Â&#x201D;Â&#x2C6;Â&#x201D;Â&#x;Â&#x;Â&#x160;Â&#x201D; ¤Â&#x201D;Â&#x2022;Â&#x201A;Â&#x2020;Â&#x; Â&#x2039; ÂĽ  ÂŚ¢  ÂĄ   ÂĄÂ?        Â?Â?Â&#x20AC;Â?Â? Â&#x2018;Â&#x2DC; Â?¢ Â&#x2022;Â? Â&#x201D;  Â&#x20AC; Â&#x152;Â&#x17D;Â&#x17D;Â&#x152;Â&#x201D;Â&#x2013;§Â&#x17D;                    Â?Â?Â? Â?Â?Â?  Â?­Â&#x20AC;Â&#x201A;Â&#x192;Â&#x201E;Â&#x2026;Â&#x2020;  Â&#x2021;­Â&#x2C6;­Â&#x2030;Â&#x160;Â&#x2039;Â?Â&#x152;Â&#x17D;­Â&#x2018;Â&#x2019;Â&#x201A;­Â&#x20AC;Â&#x2019;Â&#x2C6;Â&#x201C;Â&#x201D;Â&#x2019;Â&#x2019; Â&#x2022;Â&#x2019;Â&#x2030;Â&#x2019;Â&#x17D;Â?Â&#x201E;Â&#x2013;Â&#x2014;Â&#x2014;Â&#x2019;Â&#x201E;Â&#x17D;Â&#x2C6; Â&#x160;Â&#x2014;Â&#x17D;Â&#x2026;Â&#x2019;Â&#x2DC;Â&#x17D;Â&#x160;Â&#x20AC;Â?Â&#x201E;Â&#x2122;Â&#x160;Â&#x20AC;Â&#x161;Â&#x2C6;Â&#x203A;Â&#x2DC;Â&#x153;Â&#x2019;­Â&#x17E;Â&#x17E;Â&#x2039;­Â?Â&#x2C6;­ Â&#x;Â&#x;Â&#x192;¥¢Â&#x2013;Â&#x201D;ÂĄÂ&#x2013;£¤Â?ÂŁÂĽŒ§£Â? Â&#x201C;Â&#x160; ÂŁÂ?ÂŁ ÂŁ ¤¨ Šª ÂŤÂŹ ÂŽ ÂŻÂŹ  ÂŻ°° ¹¹  ¹Ž   ² Âą     Š¹ Âł  ¹Ž   ´ Âľ ÂŽ   ÂŁ¤Âą ÂŁÂ  °   ÂŻÂŹ ϫ ¡ °   °   ´ ¸ ´ŽÂą Š  Âą  š´Â&#x203A;   Âş ÂŽ ¹ Š ÂŽÂą ÂŞ ¹ŽÂą ŠÂź Âą £¤¤¤Â?ÂŁÂ Âą ÂŁÂŁÂ&#x2022;Â? Â&#x161;Â&#x2019;Â&#x2039;Â&#x17D;Â?Â&#x2122;Â&#x2019;Â&#x2019;Â&#x161;Â&#x2019;Â&#x2013;Â&#x17E;Â?½Â&#x2019;Â&#x20AC;Â?Â&#x160; Â&#x160;žÂ?Â&#x201E;Â&#x2039;Â&#x2019;ÂżÂ?Â&#x2019;Ă&#x20AC;Â&#x153;Â&#x2019;Ă Â&#x2019;Â&#x201E;Â&#x17D;Â?Â&#x160;Â&#x2030;Â&#x2C6;Â&#x160;Â&#x2030;Â&#x17D;Â&#x2026;Â&#x2019;Ă&#x20AC;Â&#x160;Â&#x2039;Â&#x2018; Â&#x160;Â&#x2014;Â&#x17D;Â&#x2026;Â&#x2019;­Â&#x17D;Â&#x160;Â&#x20AC;Â?Â&#x201E;Â&#x161;Â&#x160;Â&#x20AC;Â&#x161;Â&#x201E;­Â&#x2C6;Â&#x2020;­ Â&#x17D;Ă&#x201A;Â&#x201E;Â&#x160;Â&#x20AC;Â&#x20AC;Â?Â&#x2C6;Â&#x2C6;Â?Â&#x160;Â&#x2030;Â?Â&#x2030;Â&#x201A;­Â&#x17E;­Â&#x2030;£¤¤Â&#x201C;Â&#x160; ÂŁ ÂŁÂ?ÂŚÂŁÂ  ÂŁÂ&#x201D;Â&#x2019;Â&#x2019; Â&#x201A;Â&#x201C;Â&#x192;Â&#x201E;Â&#x2026;Â&#x2020;  Â?Â&#x201A;Â&#x2021;Â&#x201E;Ă&#x192;Â&#x160;Â&#x2030;­ ½Ă&#x192;Â&#x201A;Â&#x2019;Â&#x17D;­ Ă&#x201E;Â&#x2026;Â&#x2019;Â&#x2013;Â&#x2014;Â&#x2014;Â&#x2019;Â&#x201E;Â&#x17D;Â&#x160;Â&#x2014;Â&#x2013;Ă&#x2026;Â&#x17E;Â&#x160;Â&#x2C6;Â&#x2020;Â&#x2039;Â&#x2019;Â&#x17D;Â&#x160;Â&#x17D;Â&#x2026;Â&#x2019;Â&#x2DC;Â&#x17D;Â&#x160;Â&#x20AC;Â?Â&#x201E;Â&#x2122;Â&#x160;Â&#x20AC;Â&#x161;Â&#x2C6;Â&#x160;Â&#x2030;Ă&#x2020;Â&#x2039;Â&#x2019;žÂ&#x2030;­Â&#x2030;Â&#x201E;Ă&#x201A;Ă&#x201E;Â&#x2019;Â&#x2039;Â&#x20AC;Â?Â&#x2030;­Â&#x17D;Â?Â&#x160;Â&#x2030;Â?Â&#x2030;Ă&#x2021;Â?Â&#x2039;Â&#x160;Â&#x2C6;Â&#x2026;Â?Â&#x20AC;­­Â&#x2030;½ Â&#x201D;­ž­Â&#x2C6;­Â&#x2018;Â?Â&#x203A;Ă&#x2020;Â&#x2039;Â&#x2019; Â?Â&#x20AC;Â?Â&#x2030;­Â&#x2039;Ă&#x201A;Â&#x153;Â&#x2019;Â&#x17E;Â&#x160;Â&#x2039;Â&#x17D;Â&#x2DC;Â&#x17D;Â&#x160;Â&#x20AC;Â?Â&#x201E;Â&#x2122;Â&#x160;Â&#x20AC;Â&#x161;¥­Â&#x2C6;Â&#x2020;­ Â&#x17D;Ă&#x201A;ÂĄÂ&#x160;Â&#x20AC;Â&#x20AC;Â?Â&#x2C6;Â&#x2C6;Â?Â&#x160;Â&#x2030;Ă&#x2021;Â?Â&#x2039;Â&#x160;Â&#x2C6;Â&#x2026;Â?Â&#x20AC;­Â&#x201A;­Â&#x17E;­Â&#x2030;£¤§Â?Â&#x201C;Â&#x160; Ă&#x2C6;ÂŁÂŁÂŁÂŁĂ&#x2C6;                                                  Â?Â?Â?Â?Â? Â?Â? ­Â?Â?Â&#x20AC;Â&#x201A;Â&#x192;Â&#x201E;Â&#x201A;Â&#x192;Â&#x201A; Â&#x192; Â&#x2026;Â&#x2020;Â&#x2021;Â&#x2C6;Â&#x2030;Â&#x160;Â&#x2039;Â&#x152;Â&#x2020; Â&#x17D;Â&#x2018; Â&#x2019;Â&#x201C;Â&#x201D;Â&#x2022;Â&#x2013;Â&#x201D;Â&#x2014; Â&#x160;Â&#x2DC;Â&#x2039;Â&#x2013;Â&#x201D;Â&#x2122;Â&#x2014;Â&#x2021;Â&#x161;Â&#x2039;Â&#x203A;Â&#x2039; Â&#x2013;Â&#x201D;Â&#x153;Â&#x161;Â&#x2039;Â&#x201D;Â&#x2013;Â&#x2C6;Â&#x2014;Â&#x2013;Â&#x2021;Â&#x201D;Â&#x152;Â&#x2013;Â&#x2039;Â&#x203A;Â&#x2039; Â&#x201D;Â&#x153;Â&#x201C;Â&#x2030;Â&#x2122;Â&#x2014;Â&#x2013;Â&#x201D;Â&#x2022;Â&#x2013;Â&#x2020;Â&#x201D;Â&#x2021;Â&#x160;Â&#x2039;Â&#x17E;Â&#x;ÂĄÂ&#x2014;Â&#x2DC;Â&#x2014;¢Â&#x2014;Â&#x2013;Â&#x2013;Â&#x2039;Â&#x2021;Â&#x2C6;Â&#x2014;ÂŁÂ&#x201D;Â&#x2DC;Â&#x2039;Â&#x17E;Â&#x2039;Â&#x152;Â&#x2030;¤Â&#x2014;Â&#x2013;ÂĽÂ&#x201D;Â&#x2013;ÂŚÂ&#x2DC;Â&#x201D;ÂĄÂ&#x2DC;Â&#x2014;¤Â&#x2013;Â&#x;Â&#x160;Â&#x2021;Â&#x2014;Â&#x201C;Â&#x2DC;Â&#x2014;Â&#x161;Â&#x201D;§Â&#x2014;Â&#x2122;Â&#x2020;¨Â&#x2020;Â&#x152;Â&#x2C6;Â&#x2039;Â&#x2DC;Â&#x2014;ŠÂ&#x17E;Â&#x201D;Â&#x2021;ÂŞÂ&#x161;Â&#x2020;Â&#x2013;Â&#x17E;ÂĄÂ&#x201D;Â&#x2039;Â&#x201C;Â&#x2013;Â&#x2020;Â&#x2030;Â&#x161;Â?ÂŤÂ&#x2039;Â&#x2021;Â&#x161;Â&#x152;Â&#x2020; Â&#x201A;ÂŹÂ&#x201A;Â?Â&#x201A;Â&#x201A;Â&#x2021;

â&#x20AC;&#x2DC;7 (76) докайŃ&#x20AC;Ń&#x152; 2013 Đł.                       Â?Â?Â?Â?  ­Â&#x20AC;Â&#x201A;  Â&#x192; Â&#x201E; Â&#x201A;Â&#x2026;Â?Â&#x2020;Â&#x2021;

Â&#x20AC;     ­     Â&#x192;      Â&#x201A;  Â&#x192;   Â&#x201E;  Â&#x192;  Â&#x2C6;  

REFERENCES 1. Zelenkevich I.B., Orekhovskiy V.M., Ostapenko V.A. Medical consequences of the Chernobylâ&#x20AC;&#x2122; disaster. Belarusâ&#x20AC;&#x2122; i Chernobylâ&#x20AC;&#x2122;: 15 trudnykh let. Mat. mezhdunar. nauch.-prakt. konf. â&#x20AC;&#x153;Meditsinskie posledstviya Chernobylâ&#x20AC;&#x2122;skoy katastrofy. 15 let spustyaâ&#x20AC;?. Gomelâ&#x20AC;&#x2122;, 4-6 apr. 2001 g. [Belarus and Chernobylâ&#x20AC;&#x2122;: 15 hard years. Proc. int. sci.-pract. conf. â&#x20AC;&#x153;Medical consequences of the Chernobylâ&#x20AC;&#x2122; disaster. 15 years later. Gomelâ&#x20AC;&#x2122;, April 4-6, 2001]. Minsk, 2001, pp. 3-7. 2. Gurâ&#x20AC;&#x2122;eva V.A. Sostoyanie zdorovâ&#x20AC;&#x2122;ya zhenshchin v dvukh pokoleniyakh, prozhivayushchikh na territorii, podvergsheysya radiatsionnomu vozdeystviyu pri ispytaniyakh yadernogo ustroystva na Semipalatinskom poligone. Dokt. med. nauk diss. Avtoref. [Womenâ&#x20AC;&#x2122;s health in two generations living in the territory exposed to radiation during the test of a nuclear device on Semipalatinsk test site. Dr. med. sci. diss. Synopsis]. St. Ptersburg, 1996. 34 p. 3. Zakharenkov V.V., Kolyado V.B. Scientific substantiation and realization of the program â&#x20AC;&#x153;Semipalatinsk test site â&#x20AC;&#x201C; Altaiâ&#x20AC;?. Byulletenâ&#x20AC;&#x2122; Sibirskogo otdeleniya Rossiyskoy akademii meditsinskikh nauk [Bulletin of the Siberian Branch of the Russian Academy of Medical Sciences], 2006, no. 3, pp. 41-46. (in Russ.). 4. Algazin A.I., Kiselev V.I., Shoykhet Ya.N. Health status of populations living in areas exposed to radiation in 1949 during the test of a nuclear device at the Semipalatinsk test site in 1949. Vestnik nauchnoy programmy â&#x20AC;&#x153;Semipalatinskiy poligon â&#x20AC;&#x201C; Altaiâ&#x20AC;?, 1994, no. 2, pp. 37-45. (in Russ.). 5. Kiselev V.I., Loborev V.M., Shoykhet Ya.N. Problems of quantifying the impact of the Semipalatinsk test site on the population of the Altai Territory. Vestnik nauchnoy programmy â&#x20AC;&#x153;Semipalatinskiy poligon â&#x20AC;&#x201C; Altaiâ&#x20AC;?, 1994, no. 1, pp. 5-9. (in Russ.). 6. Shoykhet Ya.N., Kiselev V.I., Kolyado I.B., et al. Meditsinskie posledstviya oblucheniya na slede yadernogo vzryva [Medical consequences of irradiation on the nuclear explosion trace]. Barnaul, Siberian Branch of the Russian Academy of Medical Sciences Publ., 2002. 380 p. 7. Liberman A.N. Radiatsiya i reproduktivnoe zdorovâ&#x20AC;&#x2122;e [Radiation and reproductive health]. St. Petersburg, 2003. 233 p. 8. Schull W.J., Otake M., Neel J.V. Genetic effects of the atomic bombs: A reappraisal. Science, 1981, vol. 213, no. 4513, pp. 1220-1227. 9. Shoykhet Ya.N., Kozlov V.A., Konenkov V.I., Kiselev V.I., Sennikov S.V., Kolyado I.B., Algazin A.I., Kolyado V.B., Zaytsev E.V. Immunnaya sistema naseleniya, podvergshegosya radiatsionnomu vozdeystviyu na slede yadernogo vzryva [The immune system of the population exposed to radiation on the trail of the nuclear explosion]. Barnaul, 2000. 179 p. 10. Ivanov V.K., Tsyb A.F., Ivanov S.I. Likvidatory Chernobylâ&#x20AC;&#x2122;skoy katastrofy: radiatsionno-epidemiologicheskiy analiz meditsinskikh posledstviy [Liquidators of the Chernobyl catastrophe: Radiation-epidemiological analysis of the medical consequences]. Moscow, Galanis Publ., 1999. 312 p. 11. Beebe G.W. Reflections on the work of the Atomic Bomb Casualty Commission in Japan. Epidemiologic Reviews, 1979, vol. 1, pp. 184-210. 12. Neel J.V., Schull W.J., McDonald D.J., et al. The effect of exposure to the atomic bombs on pregnancy termination in Hiroshima and Nagasaki: Preliminary report. Hiroshima, Japan, Atomic Bomb Casualty Commission, 1953, vol. 6, pp. 112-116. 13. Robbins J., Rall J.E., Conard R.A. Late effects of radioactive iodine in fallout. Combined clinical staff conference at the National Institutes of Health. Annals of Internal Medicine, 1967, vol. 66, no. 6, pp. 1214-1242 14. Pastukhova E.I. Vliyanie khronicheskogo nizkointensivnogo izlucheniya na iskhody beremennostey i rodov u zhenshchin pribrezhnykh sel reki Techa. Kand. biol. nauk diss. Avtoref. [Effect of long-lasting lowlevel radiation on the outcomes of pregnancies and births in women of Techa riverside villages. Cand. biol. sci. diss. Synopsis]. Moscow, 2012. 22 p.

WWW.PMARCHIVE.RU Ă&#x2018;Ă&#x20AC;Ă&#x2030;Ă&#x2019; Ă&#x2020;Ă&#x201C;Ă?Ă?Ă&#x20AC;Ă&#x2039;Ă&#x20AC; ÂŤĂ?Ă?Ă&#x20AC;Ă&#x160;Ă&#x2019;Ă&#x2C6;Ă&#x2014;Ă&#x2026;Ă&#x2018;Ă&#x160;Ă&#x20AC;Ă&#x; Ă&#x152;Ă&#x2026;Ă&#x201E;Ă&#x2C6;Ă&#x2013;Ă&#x2C6;Ă?Ă&#x20AC;Âť Ă&#x20AC;Ă&#x160;Ă&#x201C;Ă&#x2DC;Ă&#x2026;Ă?Ă&#x2018;Ă&#x2019;Ă&#x201A;Ă&#x17D;. Ă&#x192;Ă&#x2C6;Ă?Ă&#x2026;Ă&#x160;Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;. Ă?Ă?Ă&#x201E;Ă&#x17D;Ă&#x160;Ă?Ă&#x2C6;Ă?Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

109

ÝÍÄÎÊÐÈÍÎËÎÃÈß 

À.À. ×ÅÐÍßÅÂÀ, Í.À. ÊÐÀÂ×ÓÍ Èíñòèòóò ïðîáëåì ýíäîêðèííîé ïàòîëîãèè èì. Â.ß. Äàíèëåâñêîãî ÍÀÌÍ Óêðàèíû, 61002, Óêðàèíà, ã. Õàðüêîâ, óë. Àðòåìà, ä. 10

           íåàëêîãîëüíîé æèðîâîé áîëåçíüþ ïå÷åíè ×åðíÿåâà Àííà Àëåêñàíäðîâíà — ìëàäøèé íàó÷íûé ñîòðóäíèê îòäåëåíèÿ ôàðìàêîòåðàïèè ýíäîêðèííûõ çàáîëåâàíèé, òåë. +38057-315-11-88, e-mail: annakholodnaja@mail.ru Êðàâ÷óí Íîííà Àëåêñàíäðîâíà — äîêòîð ìåäèöèíñêèõ íàóê, ïðîôåññîð, çàìåñòèòåëü äèðåêòîðà ïî íàó÷íîé ðàáîòå, çàâåäóþùàÿ îòäåëåíèåì ôàðìàêîòåðàïèè ýíäîêðèííûõ çàáîëåâàíèé, òåë. +38057-315-44-56, e-mail: kravchunna@mail.ru                       ­   €‚ƒ„…†…€    ‡               ˆ‚ƒ„…†‰     †        †Š‹ Œ €  Ž† ­ ‹  €‹   †

À.À. CHERNYAEVA, N.À. KRAVCHUN V.Ya. Danilevsky Institute of Endocrine Pathology Problems of National Academy of Medical Sciences V. Danilevsky Institute of Endocrine Pathology Problems of National Academy of Medical sciences of the Ukraine, Ukraine, 10 10Artema ArtemaSt., St.,Kharkov, Kharkov,Ukraine Ukraine, 61002 61002

 ­€ ‚‚ƒ   in patients with type „ƒ…€€‚€††‚­…­ƒ­‡ˆ­­ ƒ†ˆ† fatty liver disease Chernyaeva A.A. — Junior researcher Associate of the Department of pharmacotherapy of endocrine diseases, tel. +38057-315-11-88, e-mail: annakholodnaja@mail.ru Kravchun N.A. — D. Med. Sc., Professor, Deputy Director for Science, Head of the Department of pharmacotherapy of endocrine diseases, tel. +38057-315-44-56, e-mail: kravchunna@mail.ru

‘’“”•–—“˜™š“”˜›œ˜š–œšžŸ“—’—’š”—¡ž¢›£—’š•˜—“¤“—¢›£¥¡™—“£¡œ˜—“›œ•™˜¢—›¦“œš•”•—¡¥›–œš˜–›”“”£•˜—›–‘§¨“œ©•—“šœ—”Ÿ“—’ —¢©š­ž“•ªš—š”¥š™™“—¡”“œ˜›¥ª“œ•—“›œŸ“—’œ›œ•™˜›’›™“˜£•——¢™“¤š–ž“”š•”š§«¨¬®†‘’š™š•ž“œ¯–›™š›£—’“”˜¢—›¦“œš“œ—’šžš¤š™›© ¥šœ—›£“œ”¡™“œ–š”“”—•œ˜š•œž›œš˜›¥©›œšœ—›£—’š¥š—•ª›™“˜”¢œž–›¥šˆ§«¨¬®ˆŸ•”˜›œ°–¥šž†±—Ÿ•”šž¡˜šž—’•——’š˜’•œ¯š ›£‘§¨“”žš©šœžšœ—›œ•–—š–“•™©–š””¡–š™š¤š™”•œž—’š•¯š›£©•—“šœ—”†‘’š–š™•—“›œ”’“©›£‘§¨Ÿ“—’—’šª“›˜’š¥“˜•™•˜—“¤“—¢›£—’š “œ²•¥¥•—›–¢©–›˜š””“œ™“¤š–Ÿ•”©–›¤šž†±—Ÿ•”£›¡œž—’•—“œ˜–š•”šž•˜—“¤“—¢›£—¡¥›–œš˜–›”“”£•˜—›–“”•˜˜›¥©•œ“šžª¢•œ“œ˜–š•”š›£±¬Ž†  —¢©š­ž“•ªš—š”¥š™™“—¡”‹œ›œ•™˜›’›™“˜£•——¢™“¤š–ž“”š•”š‹—¡¥›–œš˜–›”“”£•˜—›–†

                ­€­‚ ƒ„    …        †     ‡ˆ†‰

Š ‹ ‹  ‡ˆ  …     Œ‰      Ž     ‰ ‹ ‹   †      ƒ‘­„

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


110

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

                               ­  €‚ƒ„…†‡ˆ‰ €‚ƒ„      Š‹ Œ ­ Ž     €‚‘ ­  ’…“”ˆ‰€‚ƒ„’              ‰ „ €‚ƒ„  ’ Ž  ‹    • ­’    ’’…†–—˜ˆ‰

 ’’€‚ƒ„™‰„      š˜› ’  €‚ƒ„    ™…††ˆ‰„™€‚ƒ„…œˆ‰  ­       €‚ƒ„‰€‚ƒ„“‡Œž–›’    €‚ƒ„  ž˜Œ†˜˜› ‰Ÿ’¡—Œ   €‚ƒ„ ’¡†Œ  €‚ƒ„…œ†žˆ‰              ‹  ’  ’   ‰                ‰   ­                              ¢Œ   •­’     ’ £‘…†”ˆ‰ €‚ƒ„         ’ ’‰„   ‹    ’       ­  Œ¤ ¥€¦Œ¤  Œ”  §Œ” Œœ  §Œœ  ‰     ’  Œ ‰£  €‚ƒ„ ’   §Œ” §Œœ¥€¦Œ¤‰ ¥€¦Œ¤   ­’    ’ ‹  ­ ‹   ‹ Œ    •­­‰   ¥€¦Œ¤   ‹ •­ -

‘7 (76) декабрь 2013 г.

        …†ˆ‰ €      ’          • •   ¨©ª«Œ‡   •   ’ •’      ’       ‰ ™  ¥€¦Œ¤    …†“ˆ‰ Ÿ ’  €‚‘  •  € ¥€¦Œ¤                 ’’ ¥€¦Œ¤…†—ˆ‰£¥€¦Œ¤  •    ¬®¯Œ— ‹   ’ …†šˆ‰  ¥€¦Œ¤       ‹’   ’ €‚ƒ„‰†‰ ǸȐșțȕȖȒ ǴȍȝȈȕȐȏȔ ȜȖȘȔȐȘȖȊȈȕȐȧ ȋȐȗȍȘȗȘȖȌțȒȞȐȐ ǼǵǶĮ

§Œ” §Œœ  ’ ’ ° ’Œ ‹­± ’       ­ Œ ‰Ÿ §Œ” §Œœ   ’    …†–ˆ‰ Ÿ ’  €‚‘     …†œˆ‰          ’ ‡–˜²³´—µ† ²³´‡¶ ¢Œ ­‹ ’ ’  ’‹’    „¦§‰ € ­ ‹ ’   ’    ¥€¦Œ¤ ­   ‹ ’   ­­ ‹  ‚£¥       ’…†”ˆ‰

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

111

ǺȈȉȓȐȞȈ ǨȒȚȐȊȕȖșȚȤǼǵǶĮțȉȖȓȤȕȣȝǹǬȋȖȚȐȗȈ  

    

     ­

€‚

­ƒ„… †„

†‡­…„ ‡

ˆˆ

 ƒ‡… ‡‰

 †… †ƒ

Š‹ŒŽ ‘

„…‡†

­†…‡’ƒ

“‡‡‡

”Œ‘”

‡ƒ…‡‡‡ ­

‡’„…‡‡‡„

“‡‡‡

•”– ‘

‡ƒ­„…†

’‰„…­ƒ

“‡‡

”— ˆ‘

‰†…‡

†’…‡„

˜™š

‡­…‰­

’†… ‡„

Œˆ‘

„†ƒ…‡„‰

††…‡­„

›šˆ‘

’ …‡ƒ

’ ‡…‡† 

œž Ÿ¡

’„’…‡„‰

’‡…‡­’



                                      ­ €          ‚ƒ„…   †€†€ ‡ ­   †    ˆ ‚‰„ Š   ˆ   ­  €    ­    €  ‹ € †   Œ          € †   Ž              ­   †   ‚‘„Š†††††€† ‡’Œ ††  †  €    ‡                                    ­             ­  €‚             €            ƒ €            „…†      €‚‡ˆ‰…             Š                  €­     ‹



“‡‡

        

   ŒŽ ‘         Š’ ˆ   “ Ž  ”    •–   —˜•‚™š ›      ˜™  šš ­     € ‡ˆ ‰…    —  ‚  —Œœ›žš­• Ÿ ­    —Œœ›ž¡­¢ Ÿ ­       —£¤¥™¦›ž§­¨©›­    ™¢      “ª«‰¨Ÿ‰ ™š   —‰š©    ›      €‚         ­™•—‰¨©›¬             –¢—˜§©›¬     €       ®    ­    ­  ¯    —ª›   ¯ —›­     ­    —“ª›ª   °€ ªŸ        ‚ªŸ±¢­§¨­  ¬±¢­¡¢Ž     ® ‚   —²‡›      ‚€       ‘„ …ˆ  ”­ Ž  ³ ´…  ­ ªŒ ¬            — ª›        —ª›        ‹  …„  Œœ­Œœ¬ €   ‚    ‘µ ”   ‘ˆ  …”­£¤™¦ ¬   „…†            ¶·¸¹¸º»¼½¾—¿ÀÁÀ›  ªŠ‘  ”­‡ … ­‹    “‡              —‡ˆ›   ° ™˜¢   ­     ¬ —ˆˆ›    ¡¢   ­          ˆ         ³  -

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

112

‘7 (76) декабрь 2013 г.

        

 

    





  

  





 





 ­€ ‚ƒ



 



„…ƒ

 

 

†‡ˆ‰

  

 

­ €    ‚ Š‹ŒŽ 

 ­€ ‚ƒ

‘‹Œ ‘’

“‚ ”­• n 

““‚ ”­• n 

“““‚ ”–• n

“‚ ”• n

““‚ ”­• n

“““‚ ”–• n

 

  ““­“““

 “­“““

   

  “­““

  “­“““

 

  

        ­€‚ ƒ„ …†‡ ˆ ‰Š ƒ‹Œ Ž†‘’Š ƒ‹Œ…†‘ ……“‰…… „€ ”“•‚ ‘…†‘ ‘…   ‘ƒ  †‘ˆ …… ‘  – †‘…‘‘ˆ  –   “…“  ‘ †‘ —˜˜™†  š††…‘€›—˜˜™†š††…‘…†‘ †…Š„…†œ‘†…†…ƒ†ƒ‹“…“  “ “ € ž‘ —˜˜™†‘    … ……†‘ † Ÿ¡‡ ¢    Š †… †   € ›—˜˜™†  š††…‘   ‘‹ ƒ Šƒ‹‘‘† ˆƒ‹ –„€ž‘ —˜˜™†‘š††…‘…† …†† ‘ †…‘…†…Š ‘†ƒˆ‘€ ”‘  š †‘ …  ƒœ  €„  Ÿ ¡ ¢

Ÿ£ ‡Ž ‰

¢€  ¤ ˆ‘……† † ‘    †…†…† …†…†–­„ ”“•‚ Š… ƒ ‘ ‘™†ƒ Šƒ ‘ˆ ƒ‘ ƒŸŽ¥‡ Š ƒ‹…Œ Ž†‘……†…†–­„”“•‚ ŽŠ ƒ‹Œ Ž†‘Šˆ”“•‚¢€›‘ˆ…†‘ ƒ‹†‘Š €‘ƒ‹‘™†…Œ Ž †‘”“•‚Šƒ …†Š ƒ…„     Š ƒ…„ ¦”Ž§ Ÿ¡‰‡¢  Ÿ  ¡‡‰¢    …††…† ¨€ ”‘ …†‘  …†   ‘†…†¦”Ž§Š ƒ‹…‘‹‘ƒ‘Š† Ž †‘…†‘…”“•‚ˆ‘……†† “Œ€ ¤‹‘‘ ˆ‘…†‘ ‘ ™‘…ˆ ¦”Ž§—˜˜™† š††…‘‘…†‘ ‘‘ ™‘ …ˆ  ¦”Ž§ … ‘ˆ‘†  “…“  Ÿ©ª‡ ’ ¨¢€ ‚ † ‘  ™‘ …ˆ  Šƒ ‘ Š‘‘  ¦”Ž§    Ÿ©ª‡ ’

¨¢ † …† …††    ¦”Ž§  ‘†…†‘ˆ†”“€ ‚‘‘

  ˆ …‘ «Ž‰    ‘™† …†‘‘–­‹ Œ Ž †‘  …†‘…”“•‚…‘…‘†…ˆƒ Ÿ ‡¡‡¢Ÿ ¡ ¢  …††…†€‚ …‘Šƒ ƒ …†‘†…†…ˆ‘ ƒœ ˜‘† …‘  †  …–   …† …††  ……† ™…… …‘ ‘†…‘ † ƒ‹‹‘ˆ€ ¬†ƒ‘†¦”Ž§†‘Š œˆ‘ ‘ˆ†š…‘† ƒ„‘‘ ˆ…‘—†™†‘Š ƒ‹Œ Ž †‘…†‘… ƒŠ ƒ‹Œ Ž †‘  …†‘ … “  ‘ „ ‘……„ † ‘€ “‘ ˆ  ƒ‹ ‘ƒ‹ …† …††  …† ¦”Ž§Š ƒ‹Œ Ž†‘…‘†‘ƒ †…‘ ¦”Ž§‘‹ … „ˆ‘……†† †­‘„ € ®…†   †  ”“•‚  ¦”Ž§ ‘†† †ƒ…‘ ƒ  ƒ˜†ˆ…††…† ‘†™†„…†–… ‘¯‡°€ ¬…†‘ …† ‘†…† ¦”Ž§  Š ƒ‹ Œ Ž †‘  ˆ‘……† † “ŒŸ†‘Š € ¢€ “‘ ˆ  ¦”Ž§  ˆ‘……† † ˆ‘…†‘ Š ƒ‹ƒ …‘™†…†‘œ ˆ‘…†‘ † …‘‘† … ‘ƒ †‘†ƒ ¯°€”Š‹††† † † …†Œ  † ¦”Ž§…­…†ƒœ Š ƒ‹… † …† –ˆ‘Š ‘‰ŽŠ   †Ÿ†‘Š €¢€ † †—†Š…  ˆ…†ƒ‘…†š Š ƒ‹Œ Ž†‘…†‘…”“•‚…   † Š‘€   € ‚ƒœƒ„   ˜‘†‘ ˆ‘ ‹ „Ž§Š ƒ‹…‘‹‘ƒ‘Š† Ž†‘ … ‘  „ „ Š ˆ –  †‘†­– —†™†‘‘ˆ†

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


Ă?Ă?Ă&#x20AC;Ă&#x160;Ă&#x2019;Ă&#x2C6;Ă&#x2014;Ă&#x2026;Ă&#x2018;Ă&#x160;Ă&#x20AC;Ă&#x; Ă&#x152;Ă&#x2026;Ă&#x201E;Ă&#x2C6;Ă&#x2013;Ă&#x2C6;Ă?Ă&#x20AC;

â&#x20AC;&#x2DC;7 (76) докайŃ&#x20AC;Ń&#x152; 2013 Đł.

113

     

             Â Â  Â?   Â?Â?       Â?              Â?Â?

                  �        �  �  �             

         Â?Â?Â?Â? ­Â&#x20AC;Â? Â&#x201A;Â&#x192;Â?Â&#x201E;Â&#x192;Â&#x2026;Â&#x2020;  Â&#x2021;Â&#x2C6;  Â? Â&#x2030;Â&#x160;Â&#x160;  Â&#x2039;Â&#x152;    Â&#x2020;Â&#x2C6;  Â&#x17D; Â&#x2018; Â&#x2C6; 

Â&#x2019;  Â&#x201C;Â&#x2C6; Â&#x2020;Â?Â?Â&#x2021;Â&#x2C6; Â&#x201A; Â?Â&#x201D; Â&#x201A;Â&#x2022;Â?Â&#x201D;  Â&#x2020;Â&#x2C6;Â Â?Â?Â?Â?Â&#x201A;Â&#x192;Â&#x192;Â&#x2013;Â?Â&#x2014;Â&#x2026;Â&#x2DC; Â&#x2014; Â&#x2021;Â&#x201C;  Â&#x20AC;  Â&#x17D;Â&#x2020;Â&#x2C6; Â&#x17D;  Â&#x2C6;Â&#x152;  Â&#x2020;Â? Â&#x2020;  Â&#x201A; Â&#x2018;Â&#x160;Â&#x160;Â&#x2C6; Â&#x2020;Â&#x152;Â&#x201A; Â&#x2019;Â&#x2020; Â&#x2020;Â&#x152; Â? Â&#x20AC;Â&#x2021;Â&#x201C; Â&#x201A;Â&#x20AC;Â&#x2021;Â&#x201A;Â?Â&#x2022;Â?Â&#x2020;Â&#x2C6;Â Â?Â? Â&#x17D;Â&#x2020;Â&#x2C6;   Â?Â&#x192;Â&#x192;Â&#x201E;Â?Â&#x2122;Â&#x201E;Â&#x161;Â&#x203A;Â&#x2013;Â&#x153;Â?Â&#x2013;Â&#x2013;Â&#x161; Â&#x2026;Â   Â&#x17E;  Â&#x17D; Â&#x2039;Â&#x2C6; Â&#x201C;Â&#x152;  Â&#x2C6;Â&#x152;  Â&#x;  Â&#x2019; Â&#x152;ÂĄÂ&#x17D; Â&#x2019;Â&#x2020;Â Â&#x2019;Â&#x152;Â&#x2020; Â&#x;

Â&#x2020;Â&#x152;ÂĄ Â&#x160;Â&#x17D;Â&#x2020;Â&#x2C6;Â&#x2019;   Â?Â&#x17E;   Â&#x201A;Â&#x17E; Â&#x2021;Â&#x201A;  Â&#x2C6;Â&#x2020; Â&#x17D;Â?Â?Â? Â&#x2039; Â&#x2020;Â&#x2C6; Â&#x2020; Â&#x2C6; Â&#x201D;Â&#x2C6;Â&#x2019;Â? Â&#x192;Â?Â&#x2122;Â?Â&#x161; Â&#x2DC;¢Â&#x2022;Â&#x17D; Â&#x152; Â&#x17D;Â&#x2020;Â&#x2C6;Â&#x2020;  Â&#x2020;Â&#x201C;  Â&#x2019;Â&#x2020;  Â&#x2020;Â? Â&#x2019;  Â&#x2018; Â&#x2C6;   Â? Â&#x2022; ¢ Â?Â? Â&#x201D; Â&#x17D;Â&#x2020;Â&#x2C6; Â&#x2020;Â&#x2C6; Â&#x2020; Â&#x2018;  Â&#x201A;Â?Â&#x192;Â&#x192;Â&#x2DC;Â? Â&#x2122;Â&#x2DC;Â?Â&#x2026;Â&#x2013; ÂŁÂ&#x2C6; Â&#x2022;Â&#x2030; Â&#x2020;Â&#x2C6;Â&#x17D;  Â&#x2C6;Â&#x152;  Â&#x;   Â&#x2019; Â&#x17D; Â?Â&#x2022;Â&#x2C6; Â&#x201A;Â&#x20AC;Â?Â&#x2030; Â&#x2C6; Â&#x201A;¤Â&#x20AC;ÂĽÂ&#x201C;Â&#x152;Â&#x2C6;Â?Â? Â? Â&#x17D;Â&#x2020;Â&#x2C6; Â&#x2C6; Â&#x2039;Â?Â?Â?Â?Â&#x2022;Â&#x2020;Â&#x201A;Â&#x192;Â&#x192;Â&#x161;Â?Â&#x192;Â&#x2020; Â&#x201E;Â&#x201D;Â&#x20AC;Â&#x17E;Â&#x201D; Â&#x2C6;Â&#x2039; Â&#x2039;Â&#x2C6;   Â&#x2020; Â&#x2020; Â&#x17D;  Â&#x2020;Â&#x2020;Â&#x201C; Â&#x2020;   Â&#x2020;Â&#x17D; Â&#x2020;  Â&#x17D;Â&#x2020;Â&#x2C6;   Â&#x2020; Â&#x2C6;   Â&#x2C6;Â&#x17D;Â&#x2020;Â&#x2C6;  Â&#x2C6; Â? Â&#x20AC;Â&#x17E; Â&#x201D; Â?Â?  Â&#x2039;  Â&#x2020; ÂŚÂ&#x2020;Â&#x152; Â? Â&#x192;Â?Â&#x2122;Â?Â&#x161;Â&#x2014;Â&#x192;Â&#x192; Â&#x2013; Â&#x201D; Â&#x201D; Â&#x17E;Â&#x2C6;Â&#x152;   Â&#x;   Â&#x2019; Â&#x152; Â&#x17D;  Â? Â&#x201D;Â&#x201D;Â&#x201A;  Â&#x201A;Â&#x2021;Â&#x201C; Â?Â?Â&#x20AC;Â&#x;  Â&#x2019;Â?Â&#x192;Â?Â&#x2122;Â&#x2014;Â?Â&#x2014; Â&#x161;Â?Â&#x201A;Â&#x17E;§Â&#x2C6;  Â&#x2020;Â&#x2020;  Â&#x2C6;Â&#x152; Â&#x2020;Â?Â&#x17E;Â?¨ ŠÂ?Â?Â&#x2020;Â&#x2020; Â&#x2020;Â&#x2C6; Â&#x;Â&#x201C;  Â&#x2020; Â&#x2018; Â&#x201A;Â&#x201A;Â&#x2C6; Â&#x2C6;Â?Â&#x192;Â&#x192;Â&#x201E;Â?Â&#x2122;Â&#x2026;Â? Â&#x2014;Â&#x2DC;Â&#x2014;Â&#x161; Â&#x192; Â?Â&#x17D;Â&#x2020;Â&#x2C6;  Â&#x2020;  Â?          Â? Â?Â? Â?  Â&#x2020;Â&#x2020; Â&#x160; Â&#x201A;Â&#x192;Â&#x192;Â&#x201E;Â?Â&#x2014;Â&#x2020;           

                 Â?Â?   Â?Â?  ­Â?Â&#x20AC;Â?Â&#x201A;Â&#x192;Â&#x201E;Â&#x2026;Â? Â&#x2020;Â&#x2021;­Â&#x2C6; Â&#x2030;  Â?Â&#x160;  Â&#x2039;Â&#x152;  Â&#x17D; Â&#x2018;  Â&#x2019; Â&#x152;Â&#x160;  Â&#x2039;Â&#x192;Â&#x152;Â&#x201C;   Â&#x152;  Â&#x2018;Â?Â?  Â&#x2021;Â?Â&#x20AC;Â&#x2021;Â? Â&#x201D;Â&#x2021;Â&#x2022; Â&#x2026;Â? Â&#x201A;Â&#x201C;Â&#x152;Â&#x160;     Â&#x2013;Â&#x201C;Â&#x2014;Â&#x2DC;Â&#x2013; Â&#x17D; Â&#x17D;  Â&#x2122; Â&#x152;Â&#x201C;Â&#x192;Â&#x201C; Â&#x2039;Â&#x192;  Â&#x201C;Â&#x17D;Â&#x2039;Â?Â?  Â&#x2021;Â? Â&#x20AC;Â&#x2021; Â?Â&#x201D;Â&#x2021;­ Â&#x2026;Â&#x2021; Â&#x2021;    Â&#x2018;        Â&#x192;Â&#x160;Â&#x161;Â&#x192; Â&#x203A;Â?Â?    Â&#x152; Â?Â&#x2C6;Â&#x2C6;Â&#x2C6;Â?Â&#x20AC; Â&#x2022;Â&#x192;Â&#x201E;Â&#x2026;Â?Â&#x201D;Â&#x2021;Â&#x2026;  Â&#x2021;Â&#x2026;Â&#x2026; Â&#x2026;     Â&#x17D;      Â&#x2039; Â&#x17D;  Â&#x2018;    Â&#x153;      Â&#x2018;   Â&#x192; Â&#x20AC;  Â&#x2020; Â&#x192;Â&#x17E;Â?Â?  Â&#x201C;Â&#x17D;Â&#x2039;Â?Â?  Â&#x2C6;Â?Â&#x20AC;Â&#x2021;Â&#x2C6;Â&#x192; Â&#x201E;­Â?Â&#x201D;Â&#x2C6;Â?­ Â&#x201A;Â&#x2021; ­   Â&#x2013;   Â&#x2018;    Â&#x17D;Â&#x2039;    Â&#x2039;  Â&#x2014; Â&#x17D;  Â&#x192;Â&#x;  Â&#x192;    ÂĄÂ&#x;Â&#x2018; Â?Â?  Â?Â&#x20AC;Â&#x192;Â&#x201E;­Â?Â&#x201D;Â&#x2021;Â&#x201A;  Â&#x2021;Â&#x2026; Â&#x2022; Â&#x2013;  ¢ Â&#x203A;Â&#x2018;  Â&#x2013; Â&#x192; Â&#x161;Â&#x192;Â&#x201C;Â&#x201C;ÂŁ Â&#x2039;  ¤  Â&#x;Â&#x2018; Â?Â?  Â&#x2030;Â? Â&#x20AC;Â?Â&#x2C6;Â&#x192;Â&#x201E;Â&#x2022;Â?Â&#x201D;Â&#x2C6;Â&#x201A;Â&#x2C6; Â&#x2C6;­  Â&#x2030;Â&#x2DC;Â&#x2039;Â&#x2013; Â&#x17D;    Â&#x17D;  ÂĽ Â&#x153;         

  Â&#x;Â&#x2018; Â&#x17D; Â&#x2DC;Â&#x2039;Â&#x192;          Â? Â?Â?Â? ­Â&#x20AC;Â&#x201A;Â&#x192;Â&#x201E;Â&#x2026;Â&#x2020; Â&#x2021;Â&#x2026;Â&#x2026;Â&#x2026; Â&#x2020;Â&#x20AC;Â&#x2026;Â&#x2026;Â&#x201A;Â&#x2C6; Â&#x2030;Â&#x20AC;Â&#x2030;Â&#x160;Â&#x2026;Â&#x2026;Â&#x201A; Â&#x2030;Â&#x2026;Â&#x2030;Â&#x20AC;Â&#x2026; Â?Â?Â&#x2039;Â&#x152;Â&#x17D;Â&#x2018;Â&#x2019; Â&#x2021;Â&#x201C;Â&#x2019;Â&#x201A;Â&#x201D;Â&#x2026;Â&#x160;Â&#x192; Â&#x2022; Â? Â?   Â&#x2013;Â&#x152;Â&#x2026;Â&#x2030;  Â&#x2014;  Â&#x2DC;Â&#x2021;Â&#x2122;Â&#x161; Â?Â&#x2030; Â&#x2DC; Â&#x201A;  Â&#x2026;Â&#x2019; Â&#x2DC;Â&#x2026;Â&#x2026;  Â?Â&#x2030;Â&#x203A;Â&#x192;Â&#x2021; Â&#x2026;Â&#x2026;Â&#x2014; Â&#x2013;Â&#x152;Â&#x2026;Â&#x2030; Â&#x153;Â&#x2014;Â&#x2030;Â?Â&#x2030; Â&#x201C;Â&#x2019;Â&#x201A;Â&#x2C6;Â&#x153; Â&#x160;Â&#x192;Â&#x17E;  Â&#x2026;­ Â&#x; Â?  Â&#x2022; Â&#x2022;Â&#x;

REFERENCES 1. Ametov A.S. Sakharnyy diabet 2-go tipa. Problemy i resheniya [Diabetes mellitus type 2. Problems and solutions]. Moscow, GEOTARMedia Publ., 2011. 704 p. 2. Balabolkin M.I., Klebanova E.M., Kreminskaya V.M. Differentsialâ&#x20AC;&#x2122;naya diagnostika i lechenie endokrinnykh zabolevaniy [Differential diagnostics and treatment of endocrine diseases]. Moscow, Medical Information Agency Publ., 2008, p. 345. 3. Bueverov A.O. Bogomolov P.O., Maevskaya M.V. Pathogenetic treatment of non-alcoholic steatohepatitis: Justification, efficacy, safety. Terapevticheskiy arkhiv, 2007, vol. 79, no. 8, pp. 88-92. (in Russ.). 4. Geyvandova N.I., Belova N.G., Aleksandrovich G.A. Serum cytokines in patients with nonalcoholic fatty liver disease and their relationship with the evidence of the morphological changes. Meditsinskiy vestnik Severnogo Kavkaza, 2011, vol. 21, no. 1, pp. 9-12. (in Russ.). 5. Zilov A.V. The liver in the metabolic syndrome and insulin resistance: A view of the endocrinologist. Klinicheskie perspektivy gastroenterologii, gepatologii, 2005, no. 5, pp. 14-18. (in Russ.). 6. Ivashkin V.T., Drapkina O.M., Shulâ&#x20AC;&#x2122;pekova Yu.O. Diagnostika i lechenie nealkogolâ&#x20AC;&#x2122;noy zhirovoy bolezni pecheni [Diagnosis and treatment of nonalcoholic fatty liver disease]. Moscow, M-Vesti Publ., 2009. 20 p. 7. Kovaleva O.N. Correction of cytokine aggression in cardiovascular failure: Theoretical background and practical skills. Sertseva nedostatnŃ&#x2013;stâ&#x20AC;&#x2122;, 2011, no. 2, pp. 93-100. (in Russ.). 8. Komshilova K.A., Troshina E.A., Butrova S.A.. Non-alcoholic fatty liver disease. Ozhirenie i metabolism, 2011, no. 3, pp. 3-11. (in Russ.). 9. Mammaev S.N., Bagomedova N.V., Bogomolov P.O., Mazhidov A.I., Abakarova G.G., Khalimova Z.A. Cytokine system in nonalcoholic steatohepatitis. Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii, 2007, vol. 17, no. 4, pp. 35-39. (in Russ.). 10. Roytberg G.E., ed. Metabolicheskiy sindrom [Metabolic syndrome]. Moscow, MEDpress-inform Publ., 2007. 223 p. 11. Alberti K.G.M.M., Zimmet P., Shaw J. Metabolic syndrome â&#x20AC;&#x201C; a new world-wide definition. A consensus statement from the International Diabetes Federation. Diabetic Medicine, 2006, vol. 23, no. 5, pp. 469-480. DOI: 10.1111/j.1464-5491.2006.01858.x. 12. Browning J.D., Horton J.D. Molecular mediators of hepatic steatosis and liver injury. Journal of Clinical Investigation, 2004, vol. 114, no. 2, pp. 147-152. DOI: 10.1172/JCI200422422. 13. Hui J.M., Hodge A., Farrell G.C., et al. Beyond insulin resistance in NASH: TNF-alpha or adiponectin? Hepatology, 2004, vol. 40, no. 1, pp. 46-54. DOI: 10.1002/hep.20280. 14. Marchesini G., Brizi M., Morselli-Labate A.M., et al. Association of nonalcoholic fatty liver disease with insulin resistance. American Journal of Medicine, 1999, vol. 107, no. 5, pp. 450-455. DOI: 10.1016/S0002-9343(99)00271-5. 15. Milner K.-L., van der Poorten D., Xu A., et al. Adipocyte fatty acid binding protein levels relate to inflammation and fibrosis in nonalcoholic fatty liver disease. Hepatology, 2009, vol. 49, no. 6, pp. 1926-1934. DOI: 10.1002/hep.22896. 16. Musso G., Gambino R., Cassader M. Non-alcoholic fatty liver disease from pathogenesis to management: An update. Obesity Reviews, 2010, vol. 11, no. 6, pp. 430-445. DOI: 10.1111/j.1467789X.2009.00657.x 17. Stefan N., Kantartzis K., Häring H.-U. Causes and metabolic consequences of fatty liver. Endocrine Reviews, 2008, vol. 29, no. 7, pp. 939-960. DOI: 10.1210/er.2008-0009. 18. Targher G. Non-alcoholic hepatic steatosis and its relation to increased plasma biomarkers of inflammation and endothelial dysfunction in non-diabetic men. Role of visceral adipose tissue. Diabetic Medicine, 2005, vol. 22, no. 10, pp. 1354-1358. DOI: 10.1111/j.14645491.2005.01646.x. 19. Torer N., Ozenirler S., Yucel A., Bukan N., Erdem O. Importance of cytokines, oxidative stress and expression of BCL-2 in the pathogenesis of non-alcoholic steatohepatitis. Scandinavian Journal of Gastroenterology, 2007, vol. 42, no. 9, pp. 1095-1101. DOI: 10.1080/00365520701286680. 20. Utzschneider K.M., Kahn S.E. Review: The role of insulin resistance in nonalcoholic fatty liver disease. Journal of Clinical Endocrinology and Metabolism, 2006, vol. 91, no. 12, pp. 4753-4761. DOI: 10.1210/jc.2006-0587.

Ă&#x20AC;Ă&#x160;Ă&#x201C;Ă&#x2DC;Ă&#x2026;Ă?Ă&#x2018;Ă&#x2019;Ă&#x201A;Ă&#x17D;. Ă&#x192;Ă&#x2C6;Ă?Ă&#x2026;Ă&#x160;Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;. Ă?Ă?Ă&#x201E;Ă&#x17D;Ă&#x160;Ă?Ă&#x2C6;Ă?Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;


114

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.



Â.Â. ÕÀÇÈÅÂ Èíñòèòóò ïðîáëåì ýíäîêðèííîé ïàòîëîãèè èì. Â.ß. Äàíèëåâñêîãî ÍÀÌÍ Óêðàèíû, 61002, Óêðàèíà, ã. Õàðüêîâ, óë. Àðòåìà, ä. 10

    æåëåçû Õàçèåâ Âàäèì Âèòàëüåâè÷ — êàíäèäàò ìåäèöèíñêèõ íàóê, çàâåäóþùèé îòäåëåíèåì ýíäîêðèííîé õèðóðãèè è ãèíåêîëîãèè, e-mail: khaziev@mail.ru                      ­€‚ƒ„   ­ … †‡ ˆ‰ ƒŠ   ˆ‹ƒ     ‚ƒŒ ‹Ž    †‡  Ž ˆ‰…    ­€‚ƒ Ž  ‹  €…‚   ­   ‚­ƒ     €‚     ­  ­ƒ

V.V. KHAZIEV Institute of Endocrine Pathology namedPathology after V.J. Problems DanilevskyofNAMS of Ukraine, Kharkiv, V.Ya. Danilevsky Institute of Endocrine National Academy10 ofArtema MedicalSt., Sciences Ukraine 61002 10 Artema St., Kharkov, Ukraine, 61002 of the Ukraine,

 ­­€ gland Khaziev V.V. — Cand. Med. Sc., Head of the Department of Endocrine Surgery and Gynecology, e-mail: khaziev@mail.ru

‘’““”•–“——˜™š™›œžŸ™¡“–¢Ÿ˜š— £  £  ¤¢——Ÿ¥¦˜“¦˜š›™§§˜œ¥§¢–¢¦“š™¨¢—¦–¥©— ›™§§˜œ¥§¢–œ¢šœ“–—¦–¥©—¢š¦ •¢•˜§§¢–žŸ’ž–™˜¦œ¢šœ“–—¦–¥©—ƒª”•–“——˜™š™› £ †‡ƒˆ‰¢š¦§¢œ¡™›“”•–“——˜™š™› ¤¢—œ’¢–¢œŸ“–˜—Ÿ˜œ›™–›™§§˜œ¥§¢– ¢¦“š™¨¢—ƒ«™§§˜œ¥§¢–œ¢šœ“–¦–¥©—’¢¦¬£ “”•–“——˜™š˜šˆ™›œ¢—“—¢š¦¬£¢š¦ ¤“–“š™Ÿ¦“Ÿ“œŸ“¦ƒ®¢œ¡™›¬£  “”•–“——˜™š ’˜©’›–“¯¥“šœž™›¬£¢š¦ ¦“°š˜Ÿ˜™š†‡  Ž ˆ‰¤¢—Ÿž•˜œ¢§›™–•¢•˜§§¢–žŸ’ž–™˜¦œ¢šœ“–ƒ¬™¨•¢–˜—™š™› Ÿ’“¦¢Ÿ¢¨¢ž±“¥—“›¥§›™–¦˜››“–“šŸ˜¢§¦˜¢©š™—˜—™›Ÿ’ž–™˜¦›™§§˜œ¥§¢–š“™•§¢—˜¢ƒ  œžŸ™¡“–¢Ÿ˜š— Ÿ’ž–™˜¦ ›™§§˜œ¥§¢–¢¦“š™¨¢ •¢•˜§§¢–žœ¢–œ˜š™¨¢ ›™§§˜œ¥§¢–œ¢–œ˜š™¨¢ƒ

                                                             ­€€€‚ ƒ  „ …      †        ‡ˆ‰Š‹ŒŽ‘‰’“” • ƒ– — ˜ ™       €š›œ                 

­€ž€Ÿ‚¡žœ ƒ–„      †   ¢     †       ƒ– ­€£‚ ¤

 †             ƒ–› ¥ €¥  €š —  ƒ–    †               ¦­€§€›‚            ƒ–€ §¨€Ÿ    †©ƒ– „      ­€¥‚ ª      †  „ ƒ–   †„    ­€š‚©    

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

115

  ­€ ‚‚ƒ„   º„ˆ ’ † ƒ ƒ

¸€‚˜ ½ ¤ ¯‚ƒ­‰‹ œ Ž …ƒ 

» ™ƒ‚†ƒ ˜ ½¥ ¶

¯‚ƒ­‰‹ œ Ž …ƒ 

Œ…™ƒ‚†ƒ ˜ ½¾ ¯‚ƒ­‰‹ œ  Ž …ƒ

²£³

®®



µš˜šš

®®

¥

˜

-



˜

²£ 

®

¥

·˜

-



˜

®®

µ

¾¤˜³¤

-



˜

®

³

µ¾˜¤³

²£š¤ ¹    Œƒ©ª¿«¬Ž …ƒ´ ª®«¬‰™Ž …ƒ™´ ª®®«¬ƒ™Ž …ƒ™´ ª®®®«¬ ƒž

  ­€‚ƒ„ …ƒ­‚…ƒ‚ †‡ƒˆ‰Šƒƒƒ‹ Œ Ž„ …ƒ€ ƒ ‘  ’ƒ„““ ”•–—  ˜ ƒ … ™   €†™  …ƒ™­    ‹ € š ‹ ›™ €ŠŠƒƒ  ƒ ƒ  † ƒ‚ €…œ  ƒžœ „  Ÿ†ƒ   š ‹ ›„€ƒ™ ‰œ¡™œ„ ‚ …ƒ…‹ ¢œ     …­œ‚† …ƒ ‚…€ † ’ƒ„ …’‚’  ’˜…ƒ€…Š † ƒ  ‰ƒ†  ƒ  …‚‹£ ˜ ƒ‚‰‚…­œ‚ œ Ž …ƒ ƒ ƒ˜ œ      ¤ˆ¥ † ‚‰ƒ‚’ …™’ ƒ™…œ‰¦ ’’¤‹Œ …€š„„ €Šƒ‚’ ‰¦ ™€ƒ  ‚™…  Ž …ƒ … ƒœ ’ ‚’  ‹ §‚œ …­œ™ ƒ ™  ƒœ‚’  …’‚’   ’ Š ™ƒ„    ¢  ƒ€„Ž…™‹ ¨ „’ †ƒ ‚     £Ÿ €…  ƒ¡¤¥€¦    ­­  œ ƒ ƒ…ƒ€ …‚’  …ž ©ªˆ«¬Ž  ­     …ƒ˜ª®«¬‰™Ž …ƒ™˜ª®®«¬ƒ™Ž …ƒ™˜ª®®®«¬ ƒ  œ        ­  - ž‹         Ÿ £    ¦ £  §¡  Œš’Ž¨©ªŽ«šª˜Ž•¦  ¯ Š ™ƒ‚’ €’ °± ‰‘€œ €… £  §Ÿ  Œš’Ž¨©ªŽ«šª˜Ž•¦                   ƒ™ ™Ž …ƒ™œ ²£³       ƒ¡¤¥€£ ž … ´ µš˜š¶ ƒ‹ ‹ ²£  ‰ Ž …ƒƒ™€œ‚’ ’…’† ¥ ¡¦£ ƒ¡¬¥€ Œš’Ž¨©ªŽ«šª˜Ž•¦ ®       - ´ ·˜¶ ƒ‹ ‹ ¸   ‚ ‰ €¡     ­     ™ƒ‚  ƒ   š¤ ¹   Ž    ¯   ­       …ƒƒœ€€‚’ £°±¦           Š - Š ™ƒ‚’€°±‹ ºœ …ƒ   ™ƒ„ ²£³  ‰ £²±¦   Š ¡–ž    ƒ »¢°±‹ ¸   ²£³ ƒ„ƒ           ¶ …ƒ€‚’ ˜ €   ƒ† ‰  £³Ž´©–µ–´©¶˜•·¦   Š - …œ‘ ©  ‰…­œ† ­  

 ‘    -  œ† ƒ  € ƒ„ €ŠŠ„ œ ‰       -  ƒž™ …’†  ‹ ¼  ™          ¸    ƒ ‚ †  ™ƒ† ‚ ²£    ‰   ‰    -    š¤ ¹ ˜   €‚’ ™’ Ž  œ¸        - …ƒ™€‚’ƒ ƒ˜         ‘¡™ƒƒ‚€‚‹

                             

                 ­     €‚      ƒ‚      

 „€…†‡           ­­            „€† ˆ‰  Š    ‰  ‹ ­    ŒŽ‘’“Ž”•–Œ—Ž”•˜‘™š’ ›    ‰             

                

    „€€†œ          ……‚      ž…‚­     Ÿ€ Ÿ‚             „€ƒ €¡†

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


116

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

        

    

                     ­€‚ƒ„…ƒ†  ‡  ˆ  ˆ    ‰    ˆ ƒ       ˆ  „Š‹Œ­ 

     Ž‘     ƒ ’     ‡       ‚ƒ…ƒ “ ”    ‰    ­€  „Š‹Œ­    ”       ”         ”  ˆ ˆ    

      

           ­€‚‚­ ­ ƒ„ ­€ …†‡‡ˆ…‰Š…‹†ŒŽŠ‡ †‘’“’”•–—˜™ š›œž Ÿ–¡œ“˜¢˜™£›˜¤™˜¥¡œ¦œ¤¤–¥’¤˜¡§˜¡–˜¨›œ¦ ©˜©–¤¤˜¡ª›•ª¡œ–«¥˜¡¥–¨œ—˜¬–›”¥¤–¨–¥œ©˜›•œ¤œ®–¥˜¤¦£˜›’¡£”˜¨«¤œ¨®Ž ›£¡—©¡œ®¨œ”–”‚‚¯¨«œ¥¡°…†‡‡±…²œ¤³Œ ‰Š…´³‡ŠŽˆ Š¯”µ¤–¨®£¡™ ¶¡œ•¨· Ÿ˜’©›—˜¨¨¸£›˜¤´£¡”©£¥›–§£”¦œ¡–—©¡œ§£«˜¨«—œ¡£˜¥¥’¡˜›£¥¤˜””–¹¥˜›–œ¨œ¦›•ª¡œ–«£©–›•£¤–˜¤›’—œ¡”‚‚ °º¤–¨¯¨«œ¥¡–¨œ¤™£›˜»…†‡‡ˆ…²œ¤±Š ‰±…´Š†ˆŒŽŠ†±¼ ¼‘œ’“˜“–” ½’”¨˜¨›œ¾ ¾’¾ž™£›˜¤¾´º¿Ž»˜”£«£À©¡£””–œ¨”–®¨˜›’¡£œ¦—˜¤–®¨˜¨¥ª–¨¦œ¤¤–¥’¤˜¡›•ª¡œ–«›’—œ¡”‚‚¯¨«œ¥¡–¨£Ž ¿£¤˜›£«º˜¨¥£¡…†‡‡Á…²œ¤¼ ‰†…´ŠˆŽŠ± ³–£«µ–£¤˜™ ™˜¥£¤’¥•° ¶œ¡—˜¨¯½˜¤£¥›–¨ŽŠ–”¨œ›˜¨’¨–§£¡”˜¤ —˜¡“£¡ œ¦ —˜¤–®¨˜¨¥ª –¨ ›•ª¡œ–« ¨œ«’¤˜¡ «–”£˜”£ –¨ ¥•–¤«¡£¨ ˜¨« ˜«œ¤£”¥£¨›”‚‚°º¤–¨¯¨«œ¥¡–¨œ¤™£›˜»…†‡‡†…²œ¤ˆÁ ‰±… ´¼¼Ž¼¼³ Œ㖮£¡™¾ ˜¥“–¢¾´‘œ¤¤–¥’¤˜¡›•ª¡œ–«¤£”–œ¨” £¤£—£¨›”›•˜› ˜¦¦£¥› »œ›• «–˜®¨œ”–” ˜¨« ©¡œ®¨œ”–” ‚‚ ° ¸’¡® Ĩ¥œ¤ … †‡‡³ … ²œ¤ˆ± ‰Š…´‡ˆŽŠ Á¾”˜¸ŕ£¡œ¤£œ¦–——’¨œ•–”›œ¥•£—–¥˜¤—˜¡“£¡”–¨›•£«–˜®¨œ”–” œ¦ ¦œ¤¤–¥’¤˜¡ ©˜››£¡¨£« ¤£”–œ¨” œ¦ ›•£ ›•ª¡œ–« ‚‚ ¯¨«œ¥¡–¨£ ´˜›•œ¤ … †‡‡³…²œ¤Œ…´†±³ŽŠ‡±        

                 

 

       

   

  

        

­ €‚ƒƒ€„€­……†‡ƒ ˆ ˆ‰ˆ‰ˆ  Šˆ  ‹    ŒŽ  

    

 

 ‘      ­ ’ €‚ƒƒ…€……“€­…„ƒ†…„… ƒ ‰   Œ  †”   

 •    †

  



  –     —

     

   ­ €˜€ƒ€ ­‡‡†‡˜„  Š     •  

  

      ’ ™‰­ €‚ƒƒƒ€“€ ­† ‚ Ž  ŠŠ ‰    ”   Š ˆ ’   †  š–             ™    € ˜€ “€›…˜ƒ†…ƒ   ‰™       —       † †     



      †      

 œ    œ  ­ €…€ “€›˜ƒ†˜‚

                                  ­€‚  ƒ„ …†‚ ‡  † ˆ ‰Š ‰‹ ŠŒƒŽŠ                  ­€‘ ƒ„‡’“ …‡„†‘ ”  Ž’ • –’ —  –’ ‹  †                                          †      ƒ  ˆ ˜ ™  ­­‘ ƒ„š’“„ ‚„­†‚‡ ‘  Ž’ • –’ ‹  †   Ž     ›  †       ‰  ‹     ˆ      —    ­­‘ ƒ„’“ …„„š†„„‡ €œžŸ¡¢£¤¥¦§¨’©ª«ª¤¬®¯£°ªŸ±²ª³¥¢¡ž¡´´µ¢ª¶¡·ª¸¡´¡¹ž£¤ªºª ³»¦³Ÿž¢¡¦ ¼ž·ž½´¡¢¥¢· ¶¡·ª¤ž½¥·¡¢¥ “‘ ³ ¼ªª°ž½¥¶¡ª¢¢ª¾ ¶¡·ªŸªº¡¹ž£¤ª¾ ¼¡¥º¢ª£·¡¤ž ²Ÿª¤¥¹ž    

      ­€‚ƒ„ …† ‡ˆ‰­„­Š ‹ Œ‚ˆŽ‰‘’ ‹ “”•‚€’” • ‡ –”——Ž‰Ž˜‘”­€ Ž™š‰Ž’’”‚˜‚—ƒ›‘‚œŽ‰­‘”˜’”˜—‚€€”ƒž€­‰Ÿ­‰”­˜‘‚—š­š”€€­‰›ƒ­‰ƒ”˜‚Š­¡ ­˜”ŠŠž˜‚„”’‘‚ƒ„ŽŠ”ƒ­€’‘ž¢›­˜¢”‘’¢”­£˜‚’‘”ƒž‘”€”‘›

¤žŠ­˜¥­‘„‚€‚£›•‚€¦§¨ ©­’’Ž‰‹ª«¥”‘Š­˜ª «¥”€ƒ„ …«¬­®ž”˜†¯¬”˜Ž˜ŽŽ¢€Ž ­’š”‰­‘”‚˜ˆ”‚š’›‚—š­š”€€­‰›‘„›‰‚”¢ƒ­‰ƒ”˜‚Š­¡–”­£˜‚’‘”ƒž‘”€”‘›‚— ƒ›‘‚œŽ‰­‘”˜”ŠŠž˜‚’‘­”˜”˜£

¯­˜ƒŽ‰•‚€ §¨¨¦ –‚ƒœ„‚‰˜–°‚‰˜”ƒ±­œ «¬‰­˜œŽ††«‹ƒ„‰‚¢Ž‰‹Ž‘­€¥­‘‘Ž‰˜’ ‚— Ž™š‰Ž’’”‚˜ ‚— ƒ›‘‚’œŽ€Ž‘­€ š‰‚‘Ž”˜’ ”˜ „žŠ­˜ ‘„›‰‚”¢ £€­˜¢ ­˜¢‘„›‰‚”¢ƒ­‰ƒ”˜‚Š­’

–”——Ž‰Ž˜‘”­‘”‚˜²¨•‚€¦ §¦¨  ¬‚˜’Žƒ­ ³ ©Ž’€­˜¢ ´ ª ¤‚Ž”Ž ´ ‹‚ˆ‰”˜„‚‹”Š‚Ž’ ª ¥­‘‘Ž‰˜ ‚— Ž™š‰Ž’’”‚˜ ‚— ”˜‘Ž‰ŠŽ¢”­‘Ž ƒ›‘‚œŽ‰­‘”˜ µ€­ŠŽ˜‘’ ”˜ ‘„Ž ‘„›‰‚”¢ £€­˜¢¡ ­˜ ”ŠŠž˜‚„”’‘‚ƒ„ŽŠ”ƒ­€ ’‘ž¢› ‚— ’”Šš€Ž ­˜¢ ’‘‰­‘”µŽ¢ Žš”‘„Ž€”­€‘›šŽƒ›‘‚œŽ‰­‘”˜’

•”‰ƒ„‚°’‡‰ƒ„”Ÿ¨•‚€¶¦ ¦§¦¶ ¦ Œ­—­Ž€ ‹´« ªƒ·Ž‚°˜³›’’Ž˜ ¸« ‡’­ ‹“ ¤”£„Š‚€Žƒž€­‰ °Ž”£„‘ƒ›‘‚œŽ‰­‘”˜­˜¢ƒ›‘‚œŽ‰­‘”˜”˜‘„Ž¢”­£˜‚’”’‚—‘„›‰‚”¢‘žŠ‚‰’

ª‚¢Ž‰˜¥­‘„‚€¶•‚€¨«¦§¦

REFERENCES 1. Abrosimov A.Yu., Shkurko O.A. Analysis of cycline DI expression in thyroidal papillary microcarcinomas. Rossiyskiy onkologicheskiy zhurnal, 2008, no. 3, pp. 26-30. (in Russ.). 2. Fukushima M., Ito Y., Hirokawa M., et al. Macrofollicular variant of papillary thyroid carcinoma: Its clinicopathological features and longterm prognosis. Endocrine Journal, 2009, vol. 56, no. 3, pp. 503-508. DOI: 10.1507/endocrj.K08E-346. 3. Eszlinger M., Krohn К., Hauptmann S., et al. Perspectives for improved and more accurate classification of thyroid epithelial tumors. Journal of Clinical Endocrinology and Metabolism, 2008, vol. 93, no. 9, pp. 3286-3294. DOI: 10.1210/jc.2008-0201. 4. Foukakis Т., Gusnanto A., Au A.Y.M., et al. A PCR-based expression signature of malignancy in follicular thyroid tumors. Endocrine-Related Cancer, 2007, vol. 14, no. 2, pp. 381-391. DOI: 10.1677/ERC-06-0023. 5. Niedziela M., Maceluch J., Korman E. Galectin-3 is not an universal marker of malignancy in thyroid nodular disease in children and adolescents. Journal of Clinical Endocrinology and Metabolism, 2002, vol. 87, no. 9, pp. 4411-4415. DOI: 10.1210/jc.2002-020387.

6. Zeiger M.A., Dackiw A.P.B. Follicular thyroid lesions, elements that affect both diagnosis and prognosis. Journal of Surgical Oncology, 2005, vol. 89, no. 3, pp. 108-113. DOI: 10.1002/jso.20186. 7. Asa S. The role of immunohistochemical markers in the diagnosis of follicular patterned lesions of the thyroid. Endocrine Pathology, 2005, vol. 16, no. 4, pp. 295-309. DOI: 10.1385/EP:16:4:295. 8. Casey M.B., Lohse C.M., Lloyd R.V. Distinction between papillary thyroid hyperplasia and papillary thyroid carcinoma by immunohistochemical staining for cytokeratin 19, galectin-3 and HBME-1. Endocrine Pathology, 2003, vol. 14, no. 1, pp. 55-60. DOI: 10.1385/ EP:14:1:55. 9. Kim K.-H., Suh K.-S., Kang D.-W., Kang D.-Y. Mutations of the BRAF gene in papillary thyroid carcinoma and in Hashomoto’s thyroiditis. Pathology International, 2005, vol. 55, no. 9, pp. 540-545. DOI: 10.1111/j.1440-1827.2005.01866.x. 10. Sack M.J., Astengo-Osuna C., Lin B.T.-Y., Battifora H., LiVolsi V.A. HMBE-1 immunostaining in thyroid fine-needle aspirations: A useful marker in the diagnosis of carcinoma. Modern Pathology, 1997, vol. 10, no. 7, pp. 668-674.

        

   ­€€€‚ƒ  „ €…†‡ˆ ˆ‰ „„ŠŠ‚ „ˆŠ€…†‡ˆ „ „ € ‹„   „    ˆŠ  €…†‡ˆ  ­Œ…ŽŒ……‚ƒ

  …„             

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г. 11. Williams E.D. Two proposals regarding the terminology of thyroid tumors. International Journal of Surgical Pathology, 2000, vol. 8, no. 3, pp. 181-183. 12. Franke W.W., Schmid E., Osborn M., Weber K. Intermediatesized filaments of human endothelial cells. Journal of Cell Biology, 1979, vol. 81, no. 3, pp. 570-580. 13. Raphael S.J., Apel R.L., Asa S.L. Brief report: Detection of high-molecularweight cytokeratins in neoplastic and non-neoplastic thyroid tumors using microwave antigen retrieval. Modern Pathology, 1995, vol. 8, no. 8, pp. 870-872. 14. Moll R., Franke W.W., Schiller D.L., et al. The catalog of human cytokeratins polypeptides: Pattern of expression in normal epithelia, tumors and cultured cells. Cell, 1982, vol. 31, no. 1, pp. 11-24. 15. Dockhorn-Dworniczak B., Franke W.W., Schroder S., Czernobilsky B., Gould V. E., Boecker W. Patterns of expression of cytoskeletal proteins in human thyroid gland and thyroid carcinomas. Differentiation, 1987, vol. 35‚ no. 1, pp. 53-71. 16. Fonseca E.‚ Nesland J.M.‚ Hoeie J.‚ Sobrinho-Simoes M. Pattern of expression of intermediate cytokeratin filaments in the thyroid gland: An immunohistochemical study of simple and stratified epithelial-type cytokeratins. Virchows Archiv, 1997, vol. 430‚ no. 3, 239-245. DOI: 10.1007/BF01324808. 17. Fonseca E.‚ Nesland J.M.‚ Sobrinho-Simoes M. Expression of stratified epithelial-type cytokeratins in hyalinizing trabecular adenomas supports their relationship with papillary carcinomas of the thyroid. Histopathology, 1997, vol. 31‚ no. 4, pp. 330-335.

117

18. Zelinskaya A.V.‚ Bozhok Yu.M. Immunocytochemical detection of cytokeratin N17 in preoperative cytological diagnostics of human thyroid cancer. Onkologiya, 2000, vol. 2, no. 1-2, pp. 56-60. (in Russ.). 19. Baloch Z.W.‚ Abraham S.‚ Roberts S.‚ Livolsi V.A. Differential expression of cytokeratins in follicular variant of papillary carcinoma: an immunohistochemical study and its diagnostic utility. Human Pathology, 1999, vol. 30, no. 10, pp. 1166-1171. DOI: 10.1016/S00468177(99)90033-3. 20. Nasser S.M., Pitman M.B., Pilch B.Z., Faquin W.C. Fine-needle aspiration biopsy of papillary thyroid carcinoma: Diagnostic utility of cytokeratin 19 immunostaining. Cancer, 2000, vol. 90‚ no. 5, pp. 307-311. DOI: 10.1002/1097-0142(20001025)90:5<307::AID-CNCR7>3.0.CO;2-N. 21. Dockhorn-Dworniczak B., Franke W.W., Schroder S., Czernobilsky B., Gould V. E., Boecker W. Patterns of expression of cytoskeletal proteins in human thyroid gland and thyroid carcinomas. Differentiation, 1987, vol. 35‚ no. 1, pp. 53-71. 22. Fonseca E.‚ Nesland J.M.‚ Hoeie J.‚ Sobrinho-Simoes M. Pattern of expression of intermediate cytokeratin filaments in the thyroid gland: An immunohistochemical study of simple and stratified epithelial-type cytokeratins. Virchows Archiv, 1997, vol. 430‚ no. 3, 239-245. DOI: 10.1007/BF01324808. 23. Rafael S.J., McKeown-Eyssen G., Asa S.L. High-molecularweight cytokeratin and cytokeratin-19 in the diagnosis of thyroid tumors. Modern Pathology, 1994, vol. 7, no. 3, pp. 295-300.

ÍÎÂÎÅ Â ÌÅÄÈÖÈÍÅ. ÈÍÒÅÐÅÑÍÛÅ ÔÀÊÒÛ ÁÎËÜØÈÍÑÒÂÎ ÆÅÍÙÈÍ Â ÑØÀ ÑÒÐÀÄÀÞÒ ÎÒ ÏÎÑËÅÐÎÄÎÂÎÉ ÄÅÏÐÅÑÑÈÈ Áîëüøèíñòâî æåíùèí ÑØÀ ñòðàäàþò îò äîëãîñðî÷íîé ïîñëåðîäîâîé äåïðåññèè, óñòàíîâèëè ó÷åíûå. Ðåçóëüòàòû íîâåéøåãî èññëåäîâàíèÿ áûëè îïóáëèêîâàíû â æóðíàëå JAMA.  îñíîâíîì ñèìïòîìû ïîñëåðîäîâîé äåïðåññèè ïðîõîäÿò, îäíàêî â íåêîòîðûõ ñëó÷àÿõ ñèìïòîìû ñòàíîâÿòñÿ ïðîäîëæèòåëüíûìè è äîâîëüíî òÿæåëûìè. Çà÷àñòóþ ýòî ïðîÿâëÿåòñÿ â ñèìïòîìàõ, òàêèõ êàê: óõóäøåíèå íàñòðîåíèÿ, ïå÷àëü, ïëàêñèâîñòü è ðàçäðàæèòåëüíîñòü, ïðîáëåìû ñ àïïåòèòîì, áåññîííèöà, ÷óâñòâî îäèíî÷åñòâà, ñàìîóíè÷èæåíèå, õðîíè÷åñêàÿ óñòàëîñòü è èñòîùåííîñòü, ïîñòîÿííîå íåîáîñíîâàííîå ÷óâñòâî òðåâîãè çà ðåáåíêà. Ïîñëåðîäîâàÿ äåïðåññèÿ c ïñèõîëîãè÷åñêîé òî÷êè çðåíèÿ ìîæåò ðàññìàòðèâàòüñÿ êàê ðåàêöèÿ íà åñòåñòâåííûé êðèçèñ ðîæäåíèÿ ðåáåíêà è èçìåíåíèå ñòðóêòóðû ñåìüè. ×àñòî îíà ñâÿçàíà ñ òðóäíîñòüþ äëÿ ìîëîäîé ìàòåðè ïðèâûêíóòü ê ñâîåé íîâîé ðîëè, áîëüøèìè ôèçè÷åñêèìè è ýìîöèîíàëüíûìè íàãðóçêàìè, èíîãäà ýòî ñâÿçàíî ñ íåãîòîâíîñòüþ ê ðîëè ìàòåðè. Îáû÷íî ïîñëåðîäîâàÿ äåïðåññèÿ âîçíèêàåò â ïåðâûå 4-6 íåäåëü ïîñëå ðîäîâ è ðåäêî ïðîõîäèò ñàìà ïî ñåáå.  õîäå èññëåäîâàíèÿ îáíàðóæåíî, ÷òî îêîëî 38% æåíùèí ñ ïîñëåðîäîâîé äåïðåññèåé èìåëè õðîíè÷åñêèå ñèìïòîìû. Áîëåå òîãî, èç ÷èñëà æåíùèí, êîòîðûì áûëà îêàçàíà ìåäèöèíñêàÿ ïîìîùü, 50% ñòðàäàëè îò äåïðåññèè íà ïðîòÿæåíèè áîëåå 1 ãîäà ïîñëå ðîæäåíèÿ ðåáåíêà. ×òî æå êàñàåòñÿ æåíùèí, êîòîðûå íå ïîëó÷èëè ñîîòâåòñòâóþùåãî ëå÷åíèÿ, 30% ïàöèåíòîê ñ ïîñëåðîäîâîé äåïðåññèåé íàõîäèëèñü â ýòîì ñîñòîÿíèè â òå÷åíèå 3 ëåò ïîñëå ðîäîâ. Ó÷åíûå îòìå÷àþò, ÷òî â íåêîòîðûõ ðåäêèõ ñëó÷àÿõ ïîñëåðîäîâàÿ äåïðåññèÿ ìîæåò ïåðåéòè â áîëåå ñåðüåçíîå ðàññòðîéñòâî — ïñèõîç. Èñòî÷íèê: Medlinks.ru

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


118

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

ɍȾɄ

Å.Ã. ÄÎÐÎØ, Í.À. ÊÐÀÂ×ÓÍ Èíñòèòóò ïðîáëåì ýíäîêðèííîé ïàòîëîãèè èì. Â.ß. Äàíèëåâñêîãî ÍÀÌÍ Óêðàèíû, 61002, ã. Õàðüêîâ, óë. Àðòåìà, ä. 10

                 ñ íåàëêîãîëüíîé æèðîâîé áîëåçíüþ ïå÷åíè Äîðîø Åëåíà Ãðèãîðüåâíà — àñïèðàíò îòäåëåíèÿ ôàðìàêîòåðàïèè ýíäîêðèííûõ çàáîëåâàíèé, òåë. +38057-315-11-88, e-mail: dorosh84@ukr.net Êðàâ÷óí Íîííà Àëåêñàíäðîâíà — äîêòîð ìåäèöèíñêèõ íàóê, ïðîôåññîð, çàìåñòèòåëü äèðåêòîðà ïî íàó÷íîé ðàáîòå, çàâåäóþùàÿ îòäåëåíèåì ôàðìàêîòåðàïèè ýíäîêðèííûõ çàáîëåâàíèé, òåë. +38057-315-44-56, e-mail: kravchunna@mail.ru                               ­€‚ ƒ                „    ­€…        †  „‡ ‡  ‚    …  …     …  …     ‚

E.G. DOROSH, N.A. KRAVCHUN DanilevskyInstitute InstituteofofEndocrine EndocrinePathology PathologyProblems ProblemsofofNational NationalAcademy AcademyofofMedical MedicalSciences sciences V.Ya.V.Danilevsky of Ukraine, the Ukraine, 10 Artema Kharkov, Ukraine 61002 of the 10 Artema St., St., Kharkov, Ukraine, 61002

 ­€ ‚ƒ‚ ­€‚€ „‚…€† parameters in patients with type 2 diabetes mellitus € †„…€ € ‡€ˆ  †ˆ€†‰Š€ƒ‚­€‚‚ Dorosh E.G. — graduate student of Department of pharmacotherapy of endocrine diseases, tel. +38057-315-11-88, e-mail: dorosh84@ukr.net Kravchun N.A. — D. Med. Sc., Professor, Deputy Director for Science, Head of the Department of pharmacotherapy of endocrine diseases, tel. +38057-315-44-56, e-mail: kravchunna@mail.ru ˆ‰Š‹ŒŽ‘’“Š”Ž•–‘Š”8 ,VR SURVWDJODQGLQ“Š—Š“‹˜–‘Ž”ŒŠ“‹Ž‘™˜Ž™šŠŽ‹›™“‘’œ‹Œ‹šŠŽŠŒ”‘˜Ž‰Šœ‹Ž‘Š˜Ž”ž‘Ž‰ŽŸœŠ–‘‹›ŠŽŠ”šŠ““‘Ž•” ¡¢’™š›‘˜Š–ž‘Ž‰˜™˜ ‹“’™‰™“‘’£‹ŽŽŸ“‘—ŠŒ–‘”Š‹”Š¤¥¦§¡‚ˆ‰ŠŒ™“Š™£Ž‰Šš‹‘˜‘˜–‘’‹Ž™Œ™£™¨‘–‹Ž‘—Š”ŽŒŠ”” ©”™ œŒ™”Ž‹ª“‹˜–‘˜‘˜ ¤¥¦§¡£™Œš‹Ž‘™˜ž‰‘’‰š‹Ÿ›Š‹–‘‹ª˜™”Ž‘’š‹Œ«ŠŒ™£Š˜–™Ž‰Š“‘‹“–Ÿ”£•˜’Ž‘™˜‹˜–‹Ž‰ŠŒ™ªŠ˜Š”‘”‰‹”›ŠŠ˜Š”Ž‹›“‘”‰Š–‚   8 ,VR SURVWDJODQGLQ,ŽŸœŠ–‘‹›ŠŽŠ”šŠ““‘Ž•”…˜™˜ ‹“’™‰™“‘’£‹ŽŽŸ“‘—ŠŒ–‘”Š‹”Š…™¨‘–‹Ž‘—Š”ŽŒŠ””…“‘œ‘–œŠŒ™¨‘–‹Ž‘™˜‚

                             ­  ­€‚ƒ    ƒ ƒƒƒ ­„     ƒ   ƒ     …†  ‡ˆ ‰ƒ€ €   €-

 Š  ‹ŒŽ ƒ   ‡‘’‘   „‡ˆ  ƒ ““‡…‡†  ƒ‚ ƒ ‚    ­„ „    ­ƒ   „  ­   ”•–—Š „‡ˆ …’˜†™  ”•–—Šƒƒƒ­   ­ƒ ˆ­  ”•–—Š „­        

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.        ­€ ‚ƒ „…  …†…†‡…‡ˆ‡€  ‰  

Š ‡­ƒ …‡  ‹  ‹ ­ƒ …‚ ­ ŒŽ‘  ‡  ­­ ‡ ˆ      ’‡ƒ ‡“  ’”•–—˜”™ š–›œž“  ‡   ‚‡­   €­ † ‚‡ ƒ  ƒ  Ÿ   ‚­†¡Ÿ  „    ¢£¤¤…    ’  ‡“ ¢ ˆ ‰’‡“…‰  ‡   ‰ ‡    †…   ‰   ƒ¥ ¦‹¥ … § ¨©§ … ª ¨©ª    ‡ ˆ  ƒ‡ ‰†  ‡­€  ‡‰‚ Œ§…«‘ ¬‚ … ƒ ‡ƒ­…‡ ƒ‡  † ­ …  Š‚­  ‚ Œª…®‘    ‡ … ‡ ’‡  “­… ‚ ­€ƒ    ‚‡ ƒ ‡€ „ˆ‡ ƒ ‡ ƒ … ‚­€ƒ ƒ ˆ†­ Œ£¤… ££‘ ‡  ‹    ‡ ‡ ‹¯  ‡ ƒ  ‡  ‡‡  ‚ ‡†  ‡ †‚‡ ƒ‡‡ƒ ƒ ‚ ‡…   ƒ††ƒ‡‡ …  ‡      … ‡ Œ£‘  ‰       ‡  ‹  ††ª ‡   Œ£°‘ª ‡ˆ‡ ‚   †ƒ   ƒ‡  …    ‡ ±¥ ²³±¥ Œ£´…£Ž‘ª ‡   ˆ ‡… ‚   ƒ ƒ‡‰ ‚‡‡ ‰‰‡ ƒ‚‚µ‡‚ ƒ‡ …ª ‡ ‡    ‹      Œ£Ž…£§‘¢‡ ‡  „ ª ‡  ‡ ƒ ‚ƒ… „ ‚  ‡†…    Œ£«£®‘   ‡ …   ª ‡   †    ‰ ‡  ­†‚‡

119

†‚ € ƒ  ƒ ‡ƒ        Œ££‘ ‡ ª ‡  ‚ ƒ      …      ‡… ‡… ‚ ‚  ‰†    ‹‚‡  «« ‚ ƒ    …   ƒ °         

¨  … ‡    Ž«…§¶…¤§£ ‡· °¤ ¨¨ …‡ ŽŽ…®¶£…«‡·´    ‡    ‰  ¨¨¨  …‡ §£…´¶§…®§‡… £¤ ‡ ƒ † ¨¸  … ‡   °°…ª¶°…¤°‡…‡¨ª…°¶£…Ž‡…¨¨ª…´¶¤…§ª ‡…¨¨¨®…Ž¶¤…®§‡  ‡ ª ‡     ‡ ‰  ‡  ‚  ’ª˜™–¹º–™”»¼œ ½©¨¾¿“ ‰  ½¼À– ©˜Áœ ¾Â˜œ¼Âœ™… à   ‡     Ä ‹¯‡‡ ‡ ƒ Ÿ … ƒ ¬Ÿ …‡ ƒ ‹Ÿ … ˆ ƒ ¬Ÿ ­‡‡‡ Å  ‰ ‡    ˆ‰‰†  €‡ Æ ‡ †   ‰‰‚Å„‚  ‚…‚  ‡­    

 „    £ ‚­‡„ ‚ ˆ ƒ  ‡ †‡               ­

  ‰  ¬   ‰   ¬  ‡ ‡  Ç ¦ Ÿˆ‰‰† ‡    „    ȍ‡  ‚ ‡  ­   ‚ ÉÊ¿£Â   ‡    ‚€ ƒ-

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


120

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

       

             ­ €‚ƒ„    …  †‡    

      †ˆ„   ‰ Š‰ Š‹   Œ   „    Ž…  †  

  ‘ ‰ €  ’  “        

  ­  …         ‡ ‘ 

  ­ ’         ‡ ‘ ‹    ‰ ” ’ Œ  •–—   ‘ ˜™š›‰ œ    œž ‹ ‘ Ÿ œž¡  ¢  ™      ‹… ’         £        „ Ž‹ …‰ ‘‹                ‹  ¤   ž¥¦­   ž ‡     ‹   Ž‹  ­ ¦ ‡    §   ‰  ‹ ‹     ‹ Ž‹

¨š­š©‰Œ   ’ …Ž‹  ”’   …  ’    ‹ ‹     ‹ Ž‹

¨š­š©‰ ǸȍȏțȓȤȚȈȚȣȐșșȓȍȌȖȊȈȕȐȧȐȐȝȖȉșțȎȌȍȕȐȍ  …‘ ªŽ ‘’    ™  ‹   «–¬  ®ª¯­®¥°™­™ ¢ ­ ‹      §      ’      ™   Ž «–¬ ‡ ™š™­™¥ª°­© ¢  ¨š­š©   ±š Ž  §      Ž

 ’  ‡ ®ª­ª¥¯­š ¢

¨š­šš±‰Œ ‘     § Ž‹  ‘ªŽ ‘  „™ ‹ «–¬     Ž         

™ ¨š­š©­ ‰±­‰™‰

‘7 (76) декабрь 2013 г.  ‘‹   ­ ‹  ªŽ    ‹‘  

       ­ ‘‹         Œ  ”   Ž‰ €  ‘

„   ’     ™   «–¬   Œ       Ž  ­ Ž         Ž  … ‹ … ‡™ «–¬‰  Ž  Ž  … † ‘     § Ž‹ —­—— „ ‘„  „   ™      Ž

’  ‰±‰ ǸȐșțȕȖȒ ǻȘȖȊȍȕȤȐȏȖȗȘȖșȚȈȋȓȈȕȌȐȕȈ

¬      ’ … Ž ‘ ªŽ Ž   ‘ „™ «–¬‰   Œ  ’ ‘‘” „’  ²¡š­°ƒ¨š­š©­—«²¡š­°ƒ¨š­š©­“ ²¡š­°ƒ¨š­š©­†²¡š­°ƒ¨š­š©‰‘  ’     ™   Ž «–¬ ‘ -

          

   

   

      

 



ˆ€Œ‹‹‹ˆ €Œ‹‹‹ˆ ‚€Œ‹‹‹ˆ

 ­

€‚ƒ„…ƒ‚„ †‡ˆƒ

‚„‰€…‚ƒƒ †‡ƒ

‚€‰„…‚„ †‡ˆŠ

‰„ƒ…‹‹ †‡ˆ‹

Ž ­

€„…ˆ‹‰ †‡ˆƒ

‰‹‚…ƒ †‡ƒ

€€‚…ƒˆ †‡ˆŠ

‚ˆ‹…ˆ‹Š †‡ˆ‹

‘ ­

ˆ‹‰‹…ˆ’‚ †‡ˆƒ

Š„Š…ˆ‹ƒ †‡ƒ

Š‰Š…ˆƒ †‡ˆŠ

€Š„‰…ˆŠ‚ †‡ˆ‹

ˆ€Œ‹‹‰ €Œ‹‹‰ ‚€Œ‹‹‰

Ž ­

…‹‚ †‡ˆƒ

‚…‹ †‡ƒ

ˆ…‹€ †‡ˆŠ

ˆ‹…‹€ †‡ˆ‹

ˆ€Œ‹‹‰ €Œ‹‹ˆ ‚€Œ‹‹‰

’ ­

‚’ƒ‚…€ †‡‚

‹…’€‰ †‡‚‹

‚’’…ƒ‹‚ †‡€

‚‹’…€‹ †‡ˆ‹

ǷȘȐȔȍȟȈȕȐȍȘ²ȌȖșȚȖȊȍȘȕȖșȚȤȘȈȏȓȐȟȐȑȔȍȎȌțȋȘțȗȗȈȔȐȗȖWȒȘȐȚȍȘȐȦǹȚȤȦȌȍȕȚȈ

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß

“ˆŒ‹‹‰ “ˆ‚Œ‹‹‹ˆ “ˆ€Œ‹‹‹ˆ “‚Œ‹‹‰ “€Œ‹‹‰


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.

121

ǺȈȉȓȐȞȈ ǷȖȒȈȏȈȚȍȓȐȜțȕȒȞȐȖȕȈȓȤȕȖȋȖșȖșȚȖȧȕȐȧȗȍȟȍȕȐ   -  ­ 

€

 ‚ 



  

 



 

 ƒ „… 

‚†‡ˆ‚‚‡

‚†ˆ‚‚‰

‚‰Šˆ‚‚‡

‚‹ˆ‚

ƒ „… 

‚ˆ‚‹

‚Šˆ‚Œ

‚Šˆ‚

‚‹‰ˆ‚‰

‹Ž‚‚‰ ‹Ž‚‚‰ Œ‹Ž‚‚

 ƒ… ƒ

‚‡‡ˆ‚‚‡

‚‡‡ˆ‹Š

‚‡‰ˆ‚‚‰

‚†ˆ‚Œ

‹Ž‚‚‰ Œ‹Ž‚‚‰

‘ ’“ „…  

‡‰‰ˆ‰‰ Š

‡Œ†‡ˆ‡ 

‡‰‚‰ˆ‹‡†Œ 

ŠŒˆ‰

‹Ž‚‚‚ ‹Ž‚‚‚ Œ‹Ž‚‚‚

ƒ “”•

‡†ˆ‚‹Œ 

Šˆ‚ Š

Œˆ‚Œ ‹

ˆ‚Œ

‹Ž‚‚ ‹Ž‚‚ ŒŽ‚‚‰

– —˜•…

†‹ˆ‚‡ 

‚††ˆ‚‚ŒŠ

ˆ‚‚Š 

‚‰ˆ‚

‹Ž‚‚‚ ŒŽ‚‚‚ Œ‹Ž‚‚



       ǺȈȉȓȐȞȈ ǷȖȒȈȏȈȚȍȓȐțȋȓȍȊȖȌȕȖȋȖȖȉȔȍȕȈ



  

™ Œ

š›œžŸ

‡‰ˆ‚ Œ



™™ Œ‚ †‡ˆ‚‰ Œ

   

 ‹



‡‚‹ˆ‚‡ Š

Ž‚‚‰

                        ­ € ‚ƒ    €   „  € „€„€ … …†„  †€ ‡†‡ ˆ‰­ ……†   †Š  €‡   ˆ‰ ­   ‹  †ƒ­   € € †‡  „ ƒ … „ €†    ƒ Œ€„† †   €‹   „ €   €†‡†‡  €€  „€„ €  € €‹Ž‘’…“”Œ‡„   ‘ƒ Œ   €      ’•“–  €‡ †‡  ’…“”Œ  € —‚  ‹    € †‡  † ˆ‰ ­   —ƒ

Œ‘€   ‹ ‹    Š „ € ˜™š‚› €†‡ ˆ‰­  „ ’…“”Œ  ‹  †  ˆ‰ ­    „ƒƒ …€    † €    €Ž € €†‡ ˆ‰­ ’…“”Œ  ‹ †’…“”Œ (ƒ— œ„    €„ € Ž   €ž ‚  ­ Ÿ  ¡   †  € €    ‡ †‡ ˆ‰­  ‹  † ƒ Œ      €  „€‹       €†‡ˆ‰­  „ ’…“”Œ€  ˆ‰ ­    „  ’…“”Œ     €„Š‡  € €  „ ƒ ¢      €  Œœ£‰–œ‰– ¤–€†‡†„† -

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

122

‘7 (76) декабрь 2013 г.

      …† ‡ †‘’ ‡ ” • ‡ †‘ ‡ †‘… ‡ – 

 ‚—‚˜   ™ ‡

    

  ˆ ‰Š‹ “Žˆ‹ ‰Š‹ ˆ ‰Š‹ ˆŒ‹ ‰Š‹ ˆŽ ‰ŠŽ ˆ‹ ‰ŠŽ “ŒˆŒ ‰Š “Œˆ ‰Š‹



    ­€   ‚€ ƒ„   

 

 3  Œˆ Žˆ‹ ‰Š ‰Š ˆ “Žˆ‹ ‰Š ‰Š ˆ ŽˆŒ ‰Š ‰Š ˆŽ ˆ ‰Š ‰Š ˆ ˆ ‰Š ‰Š ˆ ˆŽ ‰Š ‰Š ““ˆŽ“ Œ‹“ˆ“‹ ‰ŠŽ ‰Š “ˆŽ “‹ˆ“ ‰ŠŒ ‰Š

 

 

ǷȘȐȔȍȟȈȕȐȍȘ²ȌȖșȚȖȊȍȘȕȖșȚȤȘȈȏȓȐȟȐȑȔȍȎȌțȋȘțȗȗȈȔȐȗȖWȒȘȐȚȍȘȐȦǹȚȤȦȌȍȕȚȈ    

-        









­€‚ ­ƒ„…

††„‡ˆ‰Š„‹‹ ŒŽ

†‘„‘’‰Š„†† ŒŽ‹

†‹„“Š‰Š„ ŒŽˆ

‘“„”‰‡„†† ŒŽŠ‡

Šˆ•‡„‡‡Š ˆ•‡„‡‡Š ”ˆ•‡„‡‡Š

–­„—

“ Q 

“ Q 

“ Q 

“ Q 

Ș Ș Ș

ǫȓȖȉțȓȐȕĮ

“ Q 

“ Q 

“ Q 

“ Q 

ǫȓȖȉțȓȐȕĮ

“ Q 

“ Q 

“ Q 

“ Q 

Ș Ș Ș

ǃȋȓȖȉțȓȐȕ

“ Q 

“ Q 

“ Q 

“ Q 

Ș Ș Ș

ǫȓȖȉțȓȐȕDŽ

“ Q 

“ Q 

“ Q 

“ Q 

  

ǷȘȐȔȍȟȈȕȐȍȘ²ȌȖșȚȖȊȍȘȕȖșȚȤȘȈȏȓȐȟȐȑȔȍȎȌțȋȘțȗȗȈȔȐȗȖWȒȘȐȚȍȘȐȦǹȚȤȦȌȍȕȚȈ                                ­   €‚ƒ„… …    †            

 €‚ƒ„…           … €‚ƒ„     ­‡  …             ­€‚ƒ„ ˆ 

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


Ă?Ă?Ă&#x20AC;Ă&#x160;Ă&#x2019;Ă&#x2C6;Ă&#x2014;Ă&#x2026;Ă&#x2018;Ă&#x160;Ă&#x20AC;Ă&#x; Ă&#x152;Ă&#x2026;Ă&#x201E;Ă&#x2C6;Ă&#x2013;Ă&#x2C6;Ă?Ă&#x20AC;

â&#x20AC;&#x2DC;7 (76) докайŃ&#x20AC;Ń&#x152; 2013 Đł.

123

                     Â? Â?Â?  Â?   ­  Â&#x20AC;Â&#x201A;Â&#x192;Â&#x201E;Â&#x2026;Â? ­Â&#x2020;  Â&#x2021; Â&#x2021;Â&#x2C6;Â&#x2021; Â&#x2030; Â?  Â&#x160;Â&#x2039; Â&#x160;Â&#x2039;  Â&#x20AC;Â&#x201A;Â&#x192;Â&#x201E;Â&#x2026;­ Â? 

Â?

 ­

Â?­ 

     

                   Â?Â?Â?Â?   ­   Â&#x20AC; Â&#x201A; 

 Â&#x192;    Â&#x201E; Â&#x2026;Â&#x2020;Â&#x192; Â&#x2021;Â&#x2020;Â&#x192; Â&#x2020;Â&#x192; Â&#x2021;Â&#x2020;Â&#x2C6;Â&#x192; Â&#x201A; Â&#x2030;   Â&#x192;   ­ Â&#x160;   Â&#x192;   Â?Â&#x2039;Â?Â&#x2020;Â&#x192;   Â&#x2026;Â&#x152;    Â&#x17D; Â&#x2C6;Â&#x192; Â&#x201A;       

Đ&#x203A;Đ&#x2DC;ТĐ&#x2022;Đ Đ?ТУРĐ? 1. Đ?ПоŃ&#x201A;Ов Đ?.ĐĄ. ĐĄĐ°Ń&#x2026;Đ°Ń&#x20AC;Đ˝Ń&#x2039;Đš диайоŃ&#x201A; 2-гО Ń&#x201A;ипа. Đ&#x;Ń&#x20AC;ОйНоПŃ&#x2039; и Ń&#x20AC;ĐľŃ&#x2C6;ониŃ? / Đ?.ĐĄ. Đ?ПоŃ&#x201A;Ов. â&#x20AC;&#x201D; Đ&#x153;.: Đ&#x201C;Đ­Đ&#x17E;ТĐ?Đ -Đ&#x153;одиа, 2012. â&#x20AC;&#x201D; 704 Ń . 2. Kozak B.M. International Diabetes Federation (IDF) highlights growing global impact of diabetes in 5th edition of the Diabetes Atlas / B.M. Kozak, M.Y. Tjota, K.L. Close // J. of Diabetes. â&#x20AC;&#x201D; 2012. â&#x20AC;&#x201D; Vol. 4, â&#x201E;&#x2013; 1. â&#x20AC;&#x201D; P. 8-17. 3. Đ&#x153;иŃ&#x2026;Đ°ĐťŃ&#x152;Ń&#x2021;Ń&#x192;Đş Đ&#x203A;.Đ&#x153;., Đ&#x2022;Ń&#x201E;иПОва Đ?.ĐĄ. Đ?оаНкОгОНŃ&#x152;на МиŃ&#x20AC;Ова Ń&#x2026;вОŃ&#x20AC;Ойа поŃ&#x2021;Ń&#x2013;нки / Đ&#x203A;.Đ&#x153;. Đ&#x153;иŃ&#x2026;Đ°ĐťŃ&#x152;Ń&#x2021;Ń&#x192;Đş, Đ?.ĐĄ. Đ&#x201E;Ń&#x201E;Ń&#x2013;ПОв // Đ&#x153;оМдŃ&#x192;наŃ&#x20AC;ОднŃ&#x2039;Đš Ń?ндОкŃ&#x20AC;инОНОгиŃ&#x2021;ĐľŃ ĐşĐ¸Đš ĐśŃ&#x192;Ń&#x20AC;наН. â&#x20AC;&#x201D; 2010. â&#x20AC;&#x201D; â&#x201E;&#x2013; 2 (26). â&#x20AC;&#x201D; ĐĄ. 71-82. 4. мвОŃ&#x20AC;ĐžŃ Ń&#x201A;iнка Đ&#x2019;.Đ&#x153;., Đ&#x2019;ĐťĐ°Ń ĐľĐ˝ĐşĐž Đ?.Đ&#x2019;. Đ&#x2019;пНив МиŃ&#x20AC;ОвОŃ&#x2014; Đ´Đ¸Ń Ń&#x201A;Ń&#x20AC;ĐžŃ&#x201E;iŃ&#x2014; поŃ&#x2021;iнки в пОŃ&#x201D;днаннi С ПоŃ&#x201A;айОНiŃ&#x2021;ниП Ń Đ¸Đ˝Đ´Ń&#x20AC;ОПОП на ĐžŃ ĐžĐąĐťĐ¸Đ˛ĐžŃ Ń&#x201A;i поŃ&#x20AC;ойiĐłŃ&#x192; ĐŚĐ&#x201D; / Đ&#x2019;.Đ&#x153;. мвОŃ&#x20AC;ĐžŃ Ń&#x201A;iнка, Đ?.Đ&#x2019;. Đ&#x2019;ĐťĐ°Ń ĐľĐ˝ĐşĐž // Đ&#x153;оМдŃ&#x192;наŃ&#x20AC;ОднŃ&#x2039;Đš Ń?ндОкŃ&#x20AC;инОНОгиŃ&#x2021;ĐľŃ ĐşĐ¸Đš ĐśŃ&#x192;Ń&#x20AC;наН. â&#x20AC;&#x201D; 2007. â&#x20AC;&#x201D; â&#x201E;&#x2013; 5 (11). â&#x20AC;&#x201D; ĐĄ. 65-70. 5. ĐĄĐ°Ń&#x2026;Đ°Ń&#x20AC;Đ˝Ń&#x2039;Đš диайоŃ&#x201A;: Đ´Đ¸Đ°ĐłĐ˝ĐžŃ Ń&#x201A;ика, НоŃ&#x2021;онио, ĐżŃ&#x20AC;ĐžŃ&#x201E;иНакŃ&#x201A;ика / пОд Ń&#x20AC;од. Đ&#x2DC;.Đ&#x2DC;. Đ&#x201D;одОва, Đ&#x153;.Đ&#x2019;. Đ¨ĐľŃ Ń&#x201A;акОвОК. â&#x20AC;&#x201D; Đ&#x153;ĐžŃ ĐşĐ˛Đ°: Đ&#x153;Đ&#x2DC;Đ?, 2011. â&#x20AC;&#x201D; 808 Ń . 6. Day C.P. Steatohepatitis: A tale of two ÂŤhitsÂť? / C.P. Day, O.F. W. James // Gastroenterology. â&#x20AC;&#x201D; 1998. â&#x20AC;&#x201D; Vol. 114, â&#x201E;&#x2013; 4. â&#x20AC;&#x201D; P. 842-845. 7. Garc M.C. Non-alcoholic steatohepatitis / M.C. Garc // Journal of Gastroenterology and Hepatology. â&#x20AC;&#x201D; 2001. â&#x20AC;&#x201D; Vol. 24. â&#x20AC;&#x201D; P. 395-402. 8. Fassio E. Natural history of nonalcoholic steatohepatitis: a longitudinal study of repeat liver biopsies / E. Fassio, E. Alvarez, N. Dominguez et al. // Hepatology. â&#x20AC;&#x201D; 2004. â&#x20AC;&#x201D; Vol. 40, â&#x201E;&#x2013; 4. â&#x20AC;&#x201D; P. 820-826. 9. Vendemiale G. Mitochondrial oxidative injury and energy metabolism alteration in rat fatty liver: effect of the nutritional status / G. Vendemiale, I. Grattagliano, P. Caraceni et al. // Hepatology. â&#x20AC;&#x201D; 2001. â&#x20AC;&#x201D; Vol. 33, â&#x201E;&#x2013; 4. â&#x20AC;&#x201D; P. 808-815. 10. Đ&#x2019;Đ°Ń&#x20AC;Ń&#x2C6;Đ°Đ˛Ń ĐşĐ¸Đš Đ&#x2018;.ĐŻ., Đ&#x201C;аНакŃ&#x201A;иОнОва Đ&#x203A;.Đ&#x;., Đ&#x2022;ĐťŃ&#x152;Ń&#x2021;анинОва ĐĄ.Đ?., ТОНПаŃ&#x2021;ова Đ?.Đ&#x2019;. Đ?ĐşŃ&#x201A;Đ¸Đ˛Đ˝ĐžŃ Ń&#x201A;Ń&#x152; внŃ&#x192;Ń&#x201A;Ń&#x20AC;икНоŃ&#x201A;ĐžŃ&#x2021;Đ˝Ń&#x2039;Ń&#x2026; Đ°Đ˝Ń&#x201A;Đ¸ĐžĐşŃ Đ¸Đ´Đ°Đ˝Ń&#x201A;Đ˝Ń&#x2039;Ń&#x2026; Ń&#x201E;ĐľŃ&#x20AC;ПонŃ&#x201A;Ов Ń&#x192; йОНŃ&#x152;Đ˝Ń&#x2039;Ń&#x2026; гипоŃ&#x20AC;Ń&#x201A;ОниŃ&#x2021;ĐľŃ ĐşĐžĐš йОНоСнŃ&#x152;Ń&#x17D; // ТоŃ&#x20AC;аповŃ&#x201A;иŃ&#x2021;ĐľŃ ĐşĐ¸Đš Đ°Ń&#x20AC;Ń&#x2026;ив. â&#x20AC;&#x201D; 2000. â&#x20AC;&#x201D; â&#x201E;&#x2013; 4. â&#x20AC;&#x201D; ĐĄ. 51-53. 11. Elesber A.A. Plasma 8-iso-prostaglandin F2alpha, a marker of oxidative stress, is increased in patients with acute myocardial infarction / A.A. Elesber, P.J. Best, R.J. Lennon, V. Mathew et al. // Free Radical Research. â&#x20AC;&#x201D; 2006. â&#x20AC;&#x201D; Vol. 40, â&#x201E;&#x2013; 4. â&#x20AC;&#x201D; Đ . 385-391. 12. Đ&#x2019;НадиПиŃ&#x20AC;Ов ĐŽ.Đ?. ХвОйОднŃ&#x2039;Đľ Ń&#x20AC;адикаНŃ&#x2039; в йиОНОгиŃ&#x2021;ĐľŃ ĐşĐ¸Ń&#x2026; Ń Đ¸Ń Ń&#x201A;оПаŃ&#x2026; / ĐŽ.Đ?. Đ&#x2019;НадиПиŃ&#x20AC;Ов // ĐĄĐžŃ&#x20AC;ĐžŃ ĐžĐ˛Ń ĐşĐ¸Đš ОйŃ&#x20AC;аСОваŃ&#x201A;оНŃ&#x152;Đ˝Ń&#x2039;Đš ĐśŃ&#x192;Ń&#x20AC;наН. â&#x20AC;&#x201D; 2000. â&#x20AC;&#x201D; Т. 6, â&#x201E;&#x2013; 12. â&#x20AC;&#x201D; ĐĄ. 13-19. 13. Zayika M.N. 8 isoprostane as a marker of oxidative stress at the patients with chronic heart failure / M.N. Zayika, O.N. Kovalyova // Sixteen European Meeting on Hypertension. â&#x20AC;&#x201D; 2006. â&#x20AC;&#x201D; P. 341. 14. Ciabattoni G. In vivo formation of 8-epi-prostaglandin F2 in diabetes mellitus: ef-fects of tight metabolic control and vitamin E supplementati-on / G. Ciabattoni, A. Consoli, E. Vitacolonna et al. // Thromb. Haemost. â&#x20AC;&#x201D; 1998. â&#x20AC;&#x201D; Vol. 29. â&#x20AC;&#x201D; P. 232-233. 15. Cracowski J.L. Isoprostanes: new markers of oxidative stress. Fundamental and clinical data / J.L. Cracowski, F. Stanke-Labesque, G. Bessard // Revue de Medecine Interne. â&#x20AC;&#x201D; 2000. â&#x20AC;&#x201D; Vol. 21, â&#x201E;&#x2013; 3. â&#x20AC;&#x201D; Đ . 304-307. 16. Lawson J.A. Isoprostanes: formation, analysis and use as indices of lipid peroxidation in vivo / J.A. Lawson, J. Rokach, G.A. FitzGerald // Journal of Biological Chemistry. â&#x20AC;&#x201D; 1999. â&#x20AC;&#x201D; Vol. 274, â&#x201E;&#x2013; 35. â&#x20AC;&#x201D; Đ . 24441-24444. 17. Đ&#x201C;ĐľŃ&#x20AC;Đ°Ń Đ¸ĐźŃ&#x2021;Ń&#x192;Đş Đ?.Đ?. ĐŁŃ&#x20AC;ОвонŃ&#x152; 8-иСОпŃ&#x20AC;ĐžŃ Ń&#x201A;ана, Đ°ĐşŃ&#x201A;Đ¸Đ˛Đ˝ĐžŃ Ń&#x201A;Ń&#x152; Ń Ń&#x192;поŃ&#x20AC;ĐžĐşŃ Đ¸Đ´Đ´Đ¸Ń ĐźŃ&#x192;Ń&#x201A;аСŃ&#x2039; и каŃ&#x201A;аНаСŃ&#x2039; Ń&#x192; йОНŃ&#x152;Đ˝Ń&#x2039;Ń&#x2026; гипоŃ&#x20AC;Ń&#x201A;ОниŃ&#x2021;ĐľŃ ĐşĐžĐš йОНоСнŃ&#x152;Ń&#x17D; Ń Đ¸ĐˇĐąŃ&#x2039;Ń&#x201A;ĐžŃ&#x2021;нОК ĐźĐ°Ń Ń ĐžĐš Ń&#x201A;оНа и ОМиŃ&#x20AC;ониоП / Đ?.Đ?. Đ&#x201C;ĐľŃ&#x20AC;Đ°Ń Đ¸ĐźŃ&#x2021;Ń&#x192;Đş, Đ&#x17E;.Đ?. Đ&#x161;ОваНова, Đ?.Đ?. ĐĄĐ°Ń&#x201E;Đ°Ń&#x20AC;гаНина-Đ&#x161;ĐžŃ&#x20AC;ниНОва // Đ&#x161;Đ°Ń&#x20AC;Đ´Đ¸ĐžĐ˛Đ°Ń ĐşŃ&#x192;ĐťŃ?Ń&#x20AC;наŃ? Ń&#x201A;ĐľŃ&#x20AC;апиŃ? и ĐżŃ&#x20AC;ĐžŃ&#x201E;иНакŃ&#x201A;ика. â&#x20AC;&#x201D; 2012. â&#x20AC;&#x201D; â&#x201E;&#x2013; 11. â&#x20AC;&#x201D; ĐĄ. 33. 18. Greco A. Isoprostanes, novel markers of oxidative injury, help understanding the pathogenesis of neurodegenerative diseases / A. Greco, L. Minghetti, G. Levi // Neurochem. Res. â&#x20AC;&#x201D; 2000. â&#x20AC;&#x201D; Vol. 25. â&#x20AC;&#x201D; Đ . 1357-1364. 19. Tacconelli S. Measurement of 8-iso-prostaglandin F2alpha in biological fluids as a measure of lipid peroxidation / S. Tacconelli, M.L. Capone, P. Patrignani // Methods Mol Biol. â&#x20AC;&#x201D; 2010. â&#x20AC;&#x201D; Vol. 644. â&#x20AC;&#x201D; P. 165-178. 20. Duncombe W.G. The colorimetric micro-determination of longchain fatty acids [Text] / W. G. Dumcombe // Biochemical Journal â&#x20AC;&#x201D; 1963. â&#x20AC;&#x201D; Vol. 188. â&#x201E;&#x2013; 1. â&#x20AC;&#x201D; P. 7-10.

REFERENCES 1. Ametov A.S. Sakharnyy diabet 2-go tipa. Problemy i resheniya [Type 2 diabetes mellitus. Problems and solutions]. Moscow, GEOTARMedia Publ., 2012. 704 p. 2. Kozak B.M., Tjota M.Y., Close K.L. International Diabetes Federation (IDF) highlights growing global impact of diabetes in 5th edition of the Diabetes Atlas. Journal of Diabetes, 2012, vol. 4, no. 1, pp. 8-17. 3. Mikhalâ&#x20AC;&#x2122;chuk L.M., EfŃ&#x2013;mov A.S. Non-alcoholic fatty liver disease. MŃ&#x2013;zhnarodniy endokrinologŃ&#x2013;chniy zhurnal, 2010, no. 2 (26), pp. 71-82. (in Ukrain.) 4. Khvorostinka V.M., Vlasenko A.V. Effect of fatty liver dystrophy in combination with metabolic syndrome features in course of diabetes. MŃ&#x2013;zhnarodniy endokrinologŃ&#x2013;chniy zhurnal, 2007, no. 5 (11), pp. 65-70. (in Ukrain.) 5. Dedov I.I., Shestakova M.V., eds. Sakharnyy diabet: diagnostika, lechenie, profilaktika [Diabetes mellitus: Diagnosis, treatment, prevention]. Moscow, Medical Information Agency Publ., 2011. 808 p. 6. Day C.P., James O.F.W. Steatohepatitis: A tale of two â&#x20AC;&#x153;hitsâ&#x20AC;?? Gastroenterology, 1998, vol. 114, no. 4, pp. 842-845. DOI: 10.1016/ S0016-5085(98)70599-2. 7. Garc M.C. Non-alcoholic steatohepatitis. Journal of Gastroenterology and Hepatology, 2001, vol. 24, pp. 395-402. 8. Fassio E., Alvarez E., DomĂ­nguez N., Landeira G., Longo C. Natural history of nonalcoholic steatohepatitis: a longitudinal study of repeat liver biopsies. Hepatology, 2004, vol. 40, no. 4, pp. 820-826. DOI: 10.1002/hep.20410. 9. Vendemiale G., Grattagliano I., Caraceni P., Caraccio G., Domenicali M., Dallâ&#x20AC;&#x2122;Agata M., Trevisani F., et al. Mitochondrial oxidative injury and energy metabolism alteration in rat fatty liver: Effect of the nutritional status. Hepatology, 2001, vol. 33, no. 4, pp. 808-815. DOI: 10.1053/jhep.2001.23060. 10. Varshavskiy B.Ya., Galaktionova L.P., Elâ&#x20AC;&#x2122;chaninova S.A., Tolmacheva N.V. Activity of intracellular antioxidant enzymes in patients with hypertension. Terapevticheskiy arkhiv, 2000, no. 4, pp. 51-53. (in Russ.). 11. Elesber A.A., Best P.J., Lennon R.J., Mathew V., Rihal C.S., Lerman L.O., Lerman A. Plasma 8-iso-prostaglandin F2alpha, a marker of oxidative stress, is increased in patients with acute myocardial infarction. Free Radical Research, 2006, vol. 40, no. 4, pp. 385-391. DOI: 10.1080/10715760500539154 12. Vladimirov Yu.A. Free radicals in biological systems. Sorosovskiy obrazovatelâ&#x20AC;&#x2122;nyy zhurnal, 2000, vol. 6, no. 12, pp. 13-19. (in Russ.). 13. Zayika M.N., Kovalyova O.N. 8 isoprostane as a marker of oxidative stress at the patients with chronic heart failure. 16th European Meeting on Hypertension, Madrid, Spain. 2006. p. 341. 14. DavĂŹ G., Ciabattoni G., Consoli A., Mezzetti A., Falco A., Santarone S., Pennese E., Vitacolonna E., Patrono C., et al. In vivo formation of 8-iso-prostaglandin and platelet activation in diabetes mellitus: Effects of improved metabolic control and vitamin E supplementation. Circulation, 1999, vol. 99, no. 2, pp. 224-229. 15. Cracowski J.L., Stanke-Labesque F., Bessard G. Isoprostanes: New markers of oxidative stress. Fundamental and clinical data. Revue de Medecine Interne, 2000, vol. 21, no. 3, pp. 304-307. DOI: 10.1016/S0248-8663(00)80056-9. (in French). 16. Lawson J.A., Rokach J., FitzGerald G.A. Isoprostanes: formation, analysis and use as indices of lipid peroxidation in vivo. Journal of Biological Chemistry, 1999, vol. 274, no. 35, pp. 24441-24444. DOI: 10.1074/jbc.274.35.24441. 17. Gerasimchuk N.N., Kovaleva O.N., Safargalina-Kornilova N.A. Level 8-isoprostane, superoxide dismutase and catalase activity in hypertensive patients with overweight and obesity. Kardiovaskulyarnaya terapiya i profilaktika, 2012, no. 11, p. 33. (in Russ.). 18. Greco A., Minghetti L., Levi G. Isoprostanes, novel markers of oxidative injury, help understanding the pathogenesis of neurodegenerative diseases. Neurochemical Research, 2000, vol. 25, no. 9-10, pp. 1357-1364. 19. Tacconelli S., Capone M.L., Patrignani P. Measurement of 8-isoprostaglandin F2alpha in biological fluids as a measure of lipid peroxidation. Methods in Molecular Biology, 2010, vol. 644, pp. 165-178. DOI: 10.1007/978-1-59745-364-6_14. 20. Duncombe W.G. The colorimetric micro-determination of longchain fatty acids. Biochemical Journal, 1963, vol. 188, no. 1, pp. 7-10.

Ă&#x20AC;Ă&#x160;Ă&#x201C;Ă&#x2DC;Ă&#x2026;Ă?Ă&#x2018;Ă&#x2019;Ă&#x201A;Ă&#x17D;. Ă&#x192;Ă&#x2C6;Ă?Ă&#x2026;Ă&#x160;Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;. Ă?Ă?Ă&#x201E;Ă&#x17D;Ă&#x160;Ă?Ă&#x2C6;Ă?Ă&#x17D;Ă&#x2039;Ă&#x17D;Ă&#x192;Ă&#x2C6;Ă&#x;


124

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.



Ò.Í. ÂÀÑÈËÜÊÎÂÀ1, Ò.Á. ÁÀÊËÀÅÂÀ2, Ñ.È. ÌÀÒÀÅÂ3, Þ.À. ÐÛÁÈÍÀ1 Òþìåíñêàÿ ãîñóäàðñòâåííàÿ ìåäèöèíñêàÿ àêàäåìèÿ, 625023, ã. Òþìåíü, óë. Îäåññêàÿ, ä. 54 2 Îáëàñòíàÿ áîëüíèöà № 19, 625017, ã. Òþìåíü, óë. Àâòîðåìîíòíàÿ, ä. 2à 3 Íàó÷íûé öåíòð ïðîôèëàêòè÷åñêîãî è ëå÷åáíîãî ïèòàíèÿ Òþìåíñêîãî íàó÷íîãî öåíòðà ÑÎ ÐÀÌÍ, 625001, ã. Òþìåíü, óë. ßìñêàÿ, ä. 71à/1

1

 ñîñóäèñòîé ïàòîëîãèè Âàñèëüêîâà Òàòüÿíà Íèêîëàåâíà — äîêòîð ìåäèöèíñêèõ íàóê, ïðîôåññîð êàôåäðû ãîñïèòàëüíîé òåðàïèè ñ êóðñîì ýíäîêðèíîëîãèè, òåë. (3452) 42-09-00, e-mail: vasilkovatn@rambler.ru1 Áàêëàåâà Òàòüÿíà Áîðèñîâíà — âðà÷-òåðàïåâò, òåë. +7-919-922-06-52, e-mail: tatyanka03@yandex.ru2 Ìàòàåâ Ñåðãåé Èâàíîâè÷ — äîêòîð ìåäèöèíñêèõ íàóê, ïðîôåññîð, äèðåêòîð, òåë. (3452) 42-09-00, e-mail: mataevci@rambler.ru3 Ðûáèíà Þëèÿ Àëåêñàíäðîâíà — âðà÷-èíòåðí, òåë. +7-922-485-45-91, e-mail: doctorulia555@mail.ru1                      ­                 €   ‚ƒ„         …„  … …  

T.N. VASILKOVA1, T.B. BAKLAEVA2, S.I. MATAEV3, Yu.A. RYBINA1 1 Tyumen State Medical Academy, 54 Odesskaya St., Tyumen, Russian Federation 625023 2 Regional Hospital №19, 2à Avtoremontnaya St., Tyumen, Russian Federation 625017 3 Scientific Centre of prophylactic and therapeutic nutrition of Tyumen Research Center of Siberian Branch of the Russian Academy of Medical Sciences, 71a/1 Yamskaya St., Tyumen, Russian Federation 625001

Significance of obesity in cardiovascular pathology Vasilkova T. N. — D. Med. Sc., Professor of the Department of Hospital Therapy with a course of Endocrinology, tel. (3452) 42-09-00, e-mail: vasilkovatn@rambler.ru1 Baklaeva T. B. — general physician, tel. +7-919-922-06-52, e-mail: tatyanka03@yandex.ru2 Mataev S.I. — D. Med. Sc., Professor, Director, tel. (3452) 42-09-00, e-mail: mataevci@rambler.ru3 Rybina Yu.A. — doctor-inter, tel. +7-922-485-45-91, e-mail: doctorulia555@mail.ru1 †‡ˆ‰Š‹ŒŠ‰Ž‘ˆŽ’‹“ˆ”Ž‰‹•Ž””Ž‘–Š‰ˆ—‰ˆ‰Š‘‹“ˆ˜Ž™š–—‘–Š‰•Ž‘‰Š–ˆ™ˆ–—‘ˆ˜‘Ž‘Š‘’ˆ•‹ŠŽ›‰ˆœŠ–ˆ”ŒŽ’‹“ˆ•ˆ‘‹›™Œ‹ Š‰œ™Žžˆ–‹“—‹Š‘œ™ŽœŽ™‹ŠŽ‘‹Ž‹“ˆ–ˆžˆšŽœ”ˆ‘‹Ž’Ž‡ˆ‰Š‹ŒŸ™Ž˜‰‹“ˆ’™ˆ¡›ˆ‘•ŒŽ’•—™–ŠŽž—‰•›š—™•“—‘Ÿˆ‰¢“ˆ”Ž‰‹•Ž””Ž‘•—›‰ˆ Ž’•—™–ŠŽž—‰•›š—™•Ž”œšŠ•—‹ŠŽ‘‰Š‰ˆ£—•‹šŒ‹“ˆžŠ‰•ˆ™—š€Š‘‹ˆ™‘—š—‡–Ž”Š‘—š‚Ž‡ˆ‰Š‹Œ¤‹‹“ˆœ™ˆ‰ˆ‘‹‹Š”ˆ‹“ˆ™ˆ—™ˆ‰ˆžˆ™—š‘Ž‘Š‘ž—‰Šžˆ —’’Ž™–—‡šˆ‰—’ˆšŽ˜•Ž‰‹”ˆ‹“Ž–‰‹Ž—‰‰ˆ‰‰‹“ˆ‘—‹›™ˆŽ’’—‹–ˆœŽ‰Š‹ŠŽ‘Š‘žŠžŽ  —™‹ˆ™Š—š“Œœˆ™‹ˆ‘‰ŠŽ‘“ˆ—™‹Ž‡ˆ‰Š‹Œ™Š‰¥”ˆ‹“Ž–

                                    ­    €     ‚ ƒ   ‚      €  ƒ     „     ƒ  -

          …†­  ‡ ƒ‡   ‚

  ˆ‚

‰

  Š‡      

  ‚    ‚  Š  ‹  ˆ    ‹ƒ ­„  ‚    ŒŽ‡Œ ‡­   

 …†„    ‡ Š ‰ˆ „‡-

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


‘7 (76) декабрь 2013 г.

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

125

                              ­­€              ‚    ƒ  „             … †           ‡ˆ„‰Š  ‚‹­ ­      ƒ  Œ †    †  ƒ      ƒ  ƒ    ƒ      †         ƒ          † ‡ŒŽŠ ‘ Ž †  ’    †  ƒ  

 ƒ  †     “  ‰ †  ƒ      ƒ                ƒ  † ”…† ƒ † ƒ   ƒ  ‚    • ƒ         ƒ   ƒ†         “ƒ  †        ­€‚ƒ„…†       † “   †ƒ – —   ƒ             ˜  ƒ††    ‡   ˆ ‘    †  “† ‰  Š‹ŒŽ†  “† ƒ  ™        ‘                 ’Ž’†       †  “   ƒ     “ ”  ‘    “ †ƒ  † €   •–’† ƒ  †        “  ‘ ‘    ‡           “  ‘    ‡  Š  †       ‰—˜ ™—š™›Ž—˜ €Žœ††        ˆ   ‘     “           ‘‘“  ‡š›Š  “ œ  ž  “      ‘      ž›Ž†  ‡š  …›  “Š   …      † ƒ    Ÿ “  ƒ      ‡ —    ‘      ™–Ž†  “         † ““   —         “  “  ŸŸ ™ŒŸŸ†    ƒ              —      † †         †   š¡ …›  “ ™Š‹†       …  ƒ    Ž  “        ƒƒ        ™¡Œ†     †     †       †     ¢‰    ‡  ƒ“Š ‡   ¢£—† ““Š     ƒ   ¤  ¥ ¤—¥†   ƒ  †    ¢€ †ƒ  †        “†ƒ  —  ŠžŽ†          —¦  “   Œ “  “ …   †       “    § †       ‡    ¨     Š   ‡    † ‘    —© ‘—©†     Š   ‡‘     ’£

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


126

ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

                                      ­€       ‚  ƒ­

 „ƒ  …†€          …„†‡…  „ „ „ˆ ˆ ‰Š‹Œˆ Ž… „     ƒ             „ „ „ †„   ­ „  †€  †€ „  †„       †€ ƒ‡ ­  ­ ­ †  …   †‡ ­ „­ „    …   …     „    „ˆ ‘„  „ …„­ ­ „„  „ † „ „ „  ­ „ „„  „    ‚    †‡…†€ „ „   ‚„ „„  „      „ ­  ……             

ƒ „    „„† ’““”ˆ ”†        „ƒ        „   ­          …  „     „ „ „ˆ • „ ­ …ƒ ‚…„  „ „ „ƒ €‡  „„    ˆ–  … „               ˆ•ƒ  „€    „      † „  †    „   …  „ „ „   „      „„†  †‡     ­ „ „   ­ —  ƒ  „‚  †‡­  „  „ „   ƒ    “˜   ­“‘‰Œˆ Ž…™š „…†„    „ ƒ      …ƒ „„  „ “‘   €   …„€‚   „ ””›ˆ•€ …„€ „„   œžŸœ¡¢ £¤¥¦§¨ ©œ¡ª«¬ †    „ƒ    †‡ “˜  ™š      …  … ™š  … ®    ¯°  †‡  „   “‘   ±²°ˆ – —      „ „€   † …  ™š —  „   ¯²° †‡   „ ­ „   ­   ƒ­ ™šˆ ’ƒ † „„   œžŸœ¡¢ £¤¥¦§¨ ©œ¡ª«¬       “‘ „     ˆ ­„  †  … ™š … ³  „†   †‡  “˜   … ƒ   …  ™š „ƒ     “‘    ‰Œˆ › „ „ƒ      “‘ †    ƒ      „ „„   ´¡¨µ¦¥¢¶¨µ ·«¨¡¸ ©¸œ¹¬          …     …  „ƒ    „ ™š  …ƒ  … „  „ „  „ƒ “‘   …†€   „†€  € „  €  ˆ… …    †€‚    “‘„      ™šº    †   „ „„     Š²°„… † † “‘ „„    „ƒ„    „    ˆ • ‹»‹ ˆ ¼ˆ ½¨¾¿¨¥  „       ƒ  „ ƒ   ­ „  „ ‡   „ ­ “‘

‘7 (76) декабрь 2013 г. „ — „   „ À„ƒ†  Á‰ˆ²Œˆ ”„ ‡   ‡ƒ­  —„„ ƒ  “‘ …   „  …„ „     … „  „„ …„    „ …„  ‚ˆ ” …  “‘     †     †     ƒ   „   „  ‚­     …  …          ƒ „ˆ Ž…  „„†      …     ­ „ „   “˜ˆÂ† —  …„ „„   ƒ    „   …   „†    … „ „†‚   „  „… „ „„†€ „     ƒ „‰Œˆ Ž  ƒ†€ “‘ „   ƒ†    …ƒ  …    „ ­ „    „   ƒ  ™š ‚ „  …„   ‚     … ˆ ”    „      “˜  ƒ†€ “‘ „   ƒ†        „„  ‚     …    …‡   ‡­  „ …„­ ‚­     … ˆ ™       ƒ …    ƒ†€“‘„   ƒ†   „€    †     †„    ‚       „    „ € †     …„   ‚     … ˆ   ­ „ …„  „‚„ ‰³Œˆ

­   †‡ ™š     „     ƒ„ … „…  † „   à  ­ Ä—     ƒ   „‡   …„   „    …  „    „  „ † …     „ˆ •†„  „…† † „     „   „   „ …   à ˆ–    …  †‡Ä„… † „      ƒ  ™š     ƒ „  ˆ • „ €  †‡  „…  † „   ƒ          „ „ †… ††   „ƒ „             „     „ ­ „    ‡  „ ˆ Å  „      ‡  ……      ˆ –    „€  …    à         …  …   „‡­   …   ­    ‚   —„…„           à ˆ Ž…†  „   †‡   …„    „„  ­„ „†  ‡ „  ƒ  ‚     … ˆ Ž    „      „  „‡  „ „ „„  ‡  „ …„  ‚     …   … Ĉ –   ƒ …“˜ †‡„… † „   „   „„ „„  „  ‚…„  „ „„ „  ˆ     „ …     “‘  „€    ƒ‡ …    „Æ   †‡  ƒ  “‘Ç „  †  …ˆ • ƒ  „  €    À ‡ „Á †„ …  „   „     „‚     …    

ÀÊÓØÅÐÑÒÂÎ. ÃÈÍÅÊÎËÎÃÈß. ÝÍÄÎÊÐÈÍÎËÎÃÈß


ÏÐÀÊÒÈ×ÅÑÊÀß ÌÅÄÈÖÈÍÀ

‘7 (76) декабрь 2013 г.                                        ­€  ‚ ƒ       ­          „ … † ‡ ˆ     ‚   „‰‰       „„       ‚Š…   ‹            ­„Œ­†ŒŽ‘’“­“             ”   Ž      ‘’“ … ‡•–—˜–™•š›œ›žŸ¡¢ž¢£–œ›žŸ¤ ¥¡Ÿ¦ —ž§¡¢Ÿ›ž¤¡ž ˜¢žœ›šŸ¡ž§ –ž¨©ª› «ž¦¡¬¡Ÿ¡¢ž®      ‰Š       Ž    ™‘¯°®       ­ ±‚Œ ™     ‚‰  ®       ­          ²           ƒ ­     Ž         ‰„Œ ­‰