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ISSN 1311-8641

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology àÁ‰‡ÌË ̇ Å˙΄‡ÒÍÓÚÓ ‰ÛÊÂÒÚ‚Ó ÔÓ Ì‚ÓÎÓ„Ëfl Official Journal of The Bulgarian Society of Neurology íéå 2 / Åêéâ 2 ûãà , 2002

VOLUME 2 / NUMBER 2 JULY, 2002

ëöÑöêÜÄçàÖ

CONTENTS

éÅáéêà ë˙‚ÂÏÂÌÌË ‡ÒÔÂÍÚË Ì‡ ÂÚËÓÔ‡ÚÓ„ÂÌÂÁ‡Ú‡ ̇ ÒË̉Óχ ̇ Guillain-Barre ü. ïËÒÚÓ‚, å. чÒ͇ÎÓ‚, ñ. ñ‡ÌÍÓ‚‡, å.éÓÁÓ‚‡ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42

REVIEWS Current aspects of the ethiopathogenesis of Guillain- Barre Syndrome Y.Hristov,M.Daskalov, Ts.Tsankova, M.Orosova . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42

ë˙‚ÂÏÂÌÌÓ Î˜ÂÌË ̇ ÒË̉Óχ ̇ Guillain Barre ü.ïËÒÚÓ‚,ñ.ñ‡ÌÍÓ‚‡, å.чÒ͇ÎÓ‚, è.ëÚ‡ÏÂÌÓ‚‡,ä.ïËÒÚÓ‚‡, Ö.LJ‚ÂÍ . . . . . . . . . . . . . . . . . .45

Current treatment of Guillain-Barre Syndrome Y.Hristov, Ts.Tsankova, M.Daskalov, P.Stamenova K.Hristova, E.Vavrek . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45

éêàÉàçÄãçà ëíÄíàà ÇÎËflÌË ̇ ıÂÏÓÂÓÎӄ˘ÌËÚ ÔÓ͇Á‡ÚÂÎË Ë Ò‰ÌÓÚÓ ‡ÚÂˇÎÌÓ Ì‡Îfl„‡Ì ‚˙ıÛ ÏÓÁ˙˜ÌËfl Í˙‚ÂÌ ÚÓÍ ÔË ·ÓÎÌË Ò Ú‡ÌÁËÚÓÌË ËÒıÂÏ˘ÌË ‡Ú‡ÍË Ë Â‰ÌÓÒÚ‡ÌÌË ÏÓÁ˙˜ÌË ËÌÙ‡ÍÚË à.ÇÂΘ‚‡, ë.ü̘‚‡, Ö.íËÚflÌÓ‚‡ . . . . . . . . . . . . . . . . . . . .49

ORIGINAL PAPERS Effects of the hemorheological parameters and the mean arterial blood pressure on the cerebral blood flow in patients with transient ischemic attacks and unilateral cerebral infarctions

äÎËÌ˘ÌË Ë ÂÎÂÍÚÓÏËÓ„‡ÙÒÍË ÔÓÛ˜‚‡ÌËfl ÔË ·ÓÎÌË Ò ÓÒÚ‡ Ë ıÓÌ˘̇ ‚˙ÁÔ‡ÎËÚÂÎ̇ ‰ÂÏËÂÎËÌËÁË‡˘‡ ÔÓÎËÌ‚ÓÔ‡ÚËfl å.чÒ͇ÎÓ‚ , Ñ.Äڇ̇ÒÓ‚‡, ç.åÛ‡‰flÌ, ë.çÓ‚‡˜ÍÓ‚‡, è.ëÚ‡ÏÂÌÓ‚‡, Å.à¯ÔÂÍÓ‚‡ . . . . . . . . . . . . . .53

Clinical and electromyographic studies in patients with acute and chronic inflammatory demyelinating polyneuropathy M.Daskalov, D.Atanasova, N.Muradian, S.Novachkova, P.Stamenova, B.Ishpekova . . . . . . . . . . . . . . .53

燯ËflÚ ÓÔËÚ Ò Î˜ÂÌË ̇ ÒË̉Óχ ̇ ÉËÎÂÌ-ŇÂ Ò ËÌÚ‡‚ÂÌÓÁÂÌ ËÏÛÌÓ„ÎÓ·ÛÎËÌ ñ. ñ‡ÌÍÓ‚‡, ü. ïËÒÚÓ‚, è. ëÚ‡ÏÂÌÓ‚‡, å. чÒ͇ÎÓ‚, Ç. íÓ̘‚‡, í. ëÚÂÙ‡ÌÓ‚, É. Å·„Ó‚, ç. ëËÏÂÓÌÓ‚, å. Ñ‡„Ë‚, å. åË·ÌÓ‚‡, à. ëÚ‡ËÍÓ‚, å. ꇉ‚‡, ë. ÇÂÎÍÓ‚‡ . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58

Our experience in Guillain-Barre Syndrom with intravenous immunoglobulin Ts.Tsankova, Y.Hristov, P.Stamenova, M.Daskalov, V.Toncheva, T.Stefanov, G.Blagoev, N.Simeonov, M.Dragiev, M.Milanova, I.Staikov, M.Radeva, S.Velkova . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58

ÖÎÂÍÚÓÏËÓ„‡ÙÒÍÓ ÔÓÛ˜‚‡Ì ÔË ·ÓÎÌË Ò ÎÛÏ·ÓÒ‡Í‡ÎÌË ‚ÂÚ·Ó„ÂÌÌË ‡‰ËÍÛÎÓÔ‡ÚËË ë.çÓ‚‡˜ÍÓ‚‡, ã.ñÂÌÍÓ‚‡, Å.à¯ÔÂÍÓ‚‡ . . . . . . . . . . . . . . . .61

Electromyographical study in patients with lumbosacral spondylolitic radiculopathies S.Novachkova, L.Cenkov, B.Ishpekova . . . . . . . . . . . . . . . . . . .61

àëíéêàü çÄ ÅöãÉÄêëäÄíÄ çÖÇêéãéÉàü 50 „Ó‰ËÌË ç‡Û˜ÌÓ ÑÛÊÂÒÚ‚Ó Ì‡ Ì‚ÓÎÓÁËÚÂ, ÔÒËıˇÚËÚÂ Ë Ì‚ÓıËÛÁËÚ ‚ èÎÓ‚‰Ë‚ Ç.åËÚkÓ‚ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64

HYSTORY OF BULGARIAN NEUROLOGY Fifty years Scientific Society of Neurology, Psychiatry and Neurosurgery in Plovdiv V.Mitkov . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64

I.Velcheva, S.Yancheva, E.Titianova . . . . . . . . . . . . . . . . . . . .49


Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology àÁ‰‡ÌË ̇ Å˙΄‡ÒÍÓÚÓ ‰ÛÊÂÒÚ‚Ó ÔÓ Ì‚ÓÎÓ„Ëfl Official Journal of The Bulgarian Society of Neurology êÖÑÄäñàéççÄ äéãÖÉàü

EDITORS

ÄÎÂÍÒË‚ Ä. ŇÈÍۯ‚ ë. ÅÂÎÓÔËÚÓ‚‡ ã. ÅÓÊËÌÓ‚ ëÚ. LJÒË΂‡ í. ÇÂ΂‡ ëÚ. ɇÌ‚‡ É. ÉÂÓ„Ë‚ Ñ. ÉÂ‡ÒËÏÓ‚ Å. ÉË„ÓÓ‚‡ é. ÑÂ΂‡ ç. ÑÂÌÒÍË Ç á‡ı‡Ë‚ á. à‚‡ÌÓ‚‡ ã. à¯ÔÂÍÓ‚‡ Å. âÓÚÓ‚‡ ê. äÓ΂ é. ä˛˜ÛÍÓ‚ å. å‡Ì˜Â‚ à. åË·ÌÓ‚ à. åË̘‚ Ñ. çËÍÓ‚ÒÍË ç. èÂÚÓ‚ à. èÓÔÓ‚‡ å. ꇯ‚‡ å. ÂÁÓ‚‡ ã. ÊË‚ Ñ. ÊËÔÂÚÓ‚‡ Ö. ñ‡ÌÍÓ‚‡ ñ. ñ‚ÂÚ‡ÌÓ‚‡ Ö. 󇂉‡Ó‚ Ñ. ó‡ÎχÌÓ‚ Ç. ó‡Î˙ÍÓ‚‡ ç. òÓÚÂÍÓ‚ è. ü̘‚‡ ë.

Alexiev A. Baykushev S. Belopitova L. Bojinov St. Vassileva T. Veleva St. Ganeva G. Georgiev D. Gerassimov B Grigorova O. Deleva N. Drensky V. Zahariev Z. Ivanova L. Ishpekova B. Iotova R. Kolev O. Kyuchukov M. Manchev I. Milanov I. Minchev D. Nikoevsky N. Petrov I. Popova M. Rasheva M. Havezova L. Hadjiev D. Hadjipetrova E. Tzankova Tz. Tzvetanova E. Chavdarov D. Chalmanov D. Chalakova N. Shotekov P. Yancheva S.

ëÓÙËfl èÎÓ‚‰Ë‚ ëÓÙËfl è΂ÂÌ èÎÓ‚‰Ë‚ ëÓÙËfl ëÓÙËfl ëÓÙËfl ëÓÙËfl ëÓÙËfl LJ̇ LJ̇ èÎÓ‚‰Ë‚ ëÓÙËfl ëÓÙËfl ëÓÙËfl ëÓÙËfl ëÓÙËfl ëÚ.ᇄÓ‡ ëÓÙËfl LJ̇ ëÓÙËfl ëÓÙËfl è΂ÂÌ ëÓÙËfl LJ̇ ëÓÙËfl èÎÓ‚‰Ë‚ ëÓÙËfl ëÓÙËfl ëÓÙËfl ëÓÙËfl èÎÓ‚‰Ë‚ ëÓÙËfl ëÓÙËfl

Sofia Sofia Sofia Pleven Plovdiv Sofia Sofia Sofia Sofia Sofia Varna Varna Plovdiv Sofia Sofia Sofia Sofia Sofia St. Zagora Sofia Varna Sofia Sofia PlÂven Sofia Varna Sofia Plovdiv Sofia Sofia Sofia Sofia Plovdiv Sofia Sofia

ÉãÄÇçà êÖÑÄäíéêà Ñ.ó‡Í˙Ó‚, è. ëÚ‡ÏÂÌÓ‚‡, à. ÇÂΘ‚‡

EDITORS IN CHIEF D. Chakarov, P. Stamenova, I. Velcheva

ëÖäêÖíÄê å. чÒ͇ÎÓ‚

SECRETARY M. Daskalov


Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology ìäÄáÄçàÖ áÄ ÄÇíéêàíÖ

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl

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INSTRUCTION FOR AUTHORS

Bulgarian Neurology

is the official journal of the Bulgarian Society of Neurology. It will consider for publication papers in neurology and related areas in the following categories: -Editorials, consisting of up to 3 pages, when approved by the Editorial Board -Original papers - up to 8 pages, including tables, figures and references. An abstract in Bulgarian and English up to 40 rows on a separate sheet is required. The abstract should contain title, authors, objective, background, methods, results and conclusions plus up to 6 keywords. The original papers include short introduction, material, methods results, discussion and references. The title page should carry the full title, the short running title, the authors with their initials, academic degrees, institutional affiliations, address for correspondence, with telephone, fax and e-mail -Short communications and case reports up to 3 pages -Review articles up to 10 pages -Book reviews and information. It includes information for new books, congresses and conferences, new drugs, future events in neurology -Letters to the Editor with comments on previously published papers, short case reports and discussion on current problems -The manuscripts should be submitted on diskette / 3.5 inch/ using Word 6/Windows 96 or Word7/Windows 98 with a printed copy. The tables should be presented on separate sheets with a short heading The illustrations /figures, diagrams, formulas/ should be ready for reproduction. Explanatory legends should be provided on a separate sheet of paper . References should be presented in alphabetic order on a separate sheet with all authors` names and full title of papers . In the text the authors should be indicated by the number from the reference list . The reference should be presented as follows: Journal paper : (1) author(s), (2)title, (3) journal name ( as abbreviated in Index Medicus ). (4) volume, (5) year of publication, (6) journal number , (7) inclusive pages. Example: Andersen, G., Vestergaard, K., Lauritzen, L. Effective treatment of poststroke depression with the selective serotonin reuptake inhibitor citalopram. Stroke, 25, 1994, 6, 10991104. Book : (1) author(s), (2) title, (3) city of publication, (4) publisher, (5) year of publication , (6) pages. Example : Calligaro,K., DeLaurentis, D., Baker, W. Management of Extracranial Cerebrovascular Disease.Philadelphia-New York, Lippincott - Raven Publishers, 1997, 217. References to books : (1) authors(s), (2) chapter title, (3) title of book, (4) editor(s), (5) city of publication, (6) publisher, (7) year of publication, (8) specific pages. Example : Binnie, C. , Jeavsons , .M. Photosensitive epilepsies. In : Epileptic syndromes in infancy, childhood and adolescence , eds. J.Roger, M. Bureau, Ch.Dravet, F.E. Dreifuss, A.Perret , P.Wolf. London, John Libbey & Company, Ltd, 1992, 299-305. The articles are considered for publication on the understanding that the presented material has not been published or is being submitted elsewhere before appearing in BULGARIAN NEUROLOGY. Authors should indicate that ethical approval of the study was granted and that informed consent was given. All authors should approve and sign the final manuscript. Manuscript with one copy (or a diskette and a copy) should be sent to the following address: Sofia 1504, Bulgaria, 8, Bialo more str. Department of Neurology University Hospital ◊ Queene Jovanna“: Prof. P. Stamenova


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ëöÑöêÜÄçàÖ

CONTENTS

éÅáéêà éÚÌÓÒÌÓ Í˙ÒÚÓ҇̇ڇ ËÌÂ‚‡ˆËfl ̇ ÏÛÒÍÛÎËÚ ̇ ˙͇ڇ Å. à¯ÔÂÍÓ‚‡ . . . . . . . . . . . . . . . . . . . . . . . . . . . .36

REVIEWS On the cross innervation of the muscles of the hand

ë˙‚ÂÏÂÌÌË ‡ÒÔÂÍÚË Ì‡ ÂÚËÓÔ‡ÚÓ„ÂÌÂÁ‡Ú‡ ̇ ÒË̉Óχ ̇ Guillain-Barre ü. ïËÒÚÓ‚, å. чÒ͇ÎÓ‚, ñ. ñ‡ÌÍÓ‚‡, å.éÓÁÓ‚‡ . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42

Current aspects of the ethiopathogenesis of Guillain- Barre Syndrome Y.Hristov,M.Daskalov, Ts.Tsankova, M.Orosova . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42

ë˙‚ÂÏÂÌÌÓ Î˜ÂÌË ̇ ÒË̉Óχ ̇ Guillain Barre ü.ïËÒÚÓ‚,ñ.ñ‡ÌÍÓ‚‡, å.чÒ͇ÎÓ‚, è.ëÚ‡ÏÂÌÓ‚‡,ä.ïËÒÚÓ‚‡, Ö.LJ‚ÂÍ . . . . . . . .45

Current treatment of Guillain-Barre Syndrome Y.Hristov, Ts.Tsankova, M.Daskalov, P.Stamenova K.Hristova, E.Vavrek . . . . . . . . . . . . . . . . . . . . . . .45

éêàÉàçÄãçà ëíÄíàà ÇÎËflÌË ̇ ıÂÏÓÂÓÎӄ˘ÌËÚ ÔÓ͇Á‡ÚÂÎË Ë Ò‰ÌÓÚÓ ‡ÚÂˇÎÌÓ Ì‡Îfl„‡Ì ‚˙ıÛ ÏÓÁ˙˜ÌËfl Í˙‚ÂÌ ÚÓÍ ÔË ·ÓÎÌË Ò Ú‡ÌÁËÚÓÌË ËÒıÂÏ˘ÌË ‡Ú‡ÍË Ë Â‰ÌÓÒÚ‡ÌÌË ÏÓÁ˙˜ÌË ËÌÙ‡ÍÚË à.ÇÂΘ‚‡, ë.ü̘‚‡, Ö.íËÚflÌÓ‚‡ . . . . . . . . . . .49

ORIGINAL PAPERS Effects of the hemorheological parameters and the mean arterial blood pressure on the cerebral blood flow in patients with transient ischemic attacks and unilateral cerebral infarctions I.Velcheva, S.Yancheva, E.Titianova . . . . . . . . . . .49

äÎËÌ˘ÌË Ë ÂÎÂÍÚÓÏËÓ„‡ÙÒÍË ÔÓÛ˜‚‡ÌËfl ÔË ·ÓÎÌË Ò ÓÒÚ‡ Ë ıÓÌ˘̇ ‚˙ÁÔ‡ÎËÚÂÎ̇ ‰ÂÏËÂÎËÌËÁË‡˘‡ ÔÓÎËÌ‚ÓÔ‡ÚËfl å.чÒ͇ÎÓ‚ , Ñ.Äڇ̇ÒÓ‚‡, ç.åÛ‡‰flÌ, ë.çÓ‚‡˜ÍÓ‚‡, è.ëÚ‡ÏÂÌÓ‚‡, Å.à¯ÔÂÍÓ‚‡ . . . .53

Clinical and electromyographic studies in patients with acute and chronic inflammatory demyelinating polyneuropathy M.Daskalov, D.Atanasova, N.Muradian, S.Novachkova, P.Stamenova, B.Ishpekova . . . . . .53

燯ËflÚ ÓÔËÚ Ò Î˜ÂÌË ̇ ÒË̉Óχ ̇ ÉËÎÂÌ-ŇÂ Ò ËÌÚ‡‚ÂÌÓÁÂÌ ËÏÛÌÓ„ÎÓ·ÛÎËÌ ñ. ñ‡ÌÍÓ‚‡, ü. ïËÒÚÓ‚, è. ëÚ‡ÏÂÌÓ‚‡, å. чÒ͇ÎÓ‚, Ç. íÓ̘‚‡, í. ëÚÂÙ‡ÌÓ‚, É. Å·„Ó‚, ç. ëËÏÂÓÌÓ‚, å. Ñ‡„Ë‚, å. åË·ÌÓ‚‡, à. ëÚ‡ËÍÓ‚, å. ꇉ‚‡, ë. ÇÂÎÍÓ‚‡ . . . . . . . . . . . . . . . . . . . .58

Our experience in Guillain-Barre Syndrom with intravenous immunoglobulin Ts.Tsankova, Y.Hristov, P.Stamenova, M.Daskalov, V.Toncheva, T.Stefanov, G.Blagoev, N.Simeonov, M.Dragiev, M.Milanova, I.Staikov, M.Radeva, S.Velkova . . . . . . . . . . . . . . . . . . . . . .58

ÖÎÂÍÚÓÏËÓ„‡ÙÒÍÓ ÔÓÛ˜‚‡Ì ÔË ·ÓÎÌË Ò ÎÛÏ·ÓÒ‡Í‡ÎÌË ‚ÂÚ·Ó„ÂÌÌË ‡‰ËÍÛÎÓÔ‡ÚËË ë.çÓ‚‡˜ÍÓ‚‡, ã.ñÂÌÍÓ‚‡, Å.à¯ÔÂÍÓ‚‡ . . . . . . .61

Electromyographical study in patients with lumbosacral spondylolitic radiculopathies S.Novachkova, L.Cenkov, B.Ishpekova . . . . . . . . .61

àëíéêàü çÄ ÅöãÉÄêëäÄíÄ çÖÇêéãéÉàü 50 „Ó‰ËÌË ç‡Û˜ÌÓ ÑÛÊÂÒÚ‚Ó Ì‡ Ì‚ÓÎÓÁËÚÂ, ÔÒËıˇÚËÚÂ Ë Ì‚ÓıËÛÁËÚ ‚ èÎÓ‚‰Ë‚ Ç.åËÚkÓ‚ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64

HYSTORY OF BULGARIAN NEUROLOGY Fifty years Scientific Society of Neurology, Psychiatry and Neurosurgery in Plovdiv V.Mitkov . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64

B.Ishpekova . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36


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é·ÁÓ éíçéëçé äêöëíéëÄçÄíÄ àçÖêÇÄñàü çÄ åìëäìãàíÖ çÄ êöäÄíÄ Å. à¯ÔÂÍÓ‚‡ ç‚ÓÎӄ˘̇ ÍÎËÌË͇, ìÌË‚ÂÒËÚÂÚÒ͇ ·ÓÎÌˈ‡ "ñ‡ˈ‡ âÓ‡Ì̇" å‰ˈËÌÒÍË ìÌË‚ÂÒËÚÂÚ - ëÓÙËfl

SUMMARY ON THE CROSS INNERVATION OF THE MUSCLES OF THE HAND B. Ishpekova The disorders in the innervation of the muscles of the arm have been known for quite a lot of time. However, they are not also taken into consideration, which may lead to false conclusions arrived at after an EMGstudy. Martin-Gruber's anaesthemosis is most common; where n. medianus becomes part of n. ulnaris at the forearm. Martin-Gruber's anaesthemosis most often steams from n. interosseus. Martin-Gruber's anaesthemosis is most often found under the carpal tunnel syndrome. The anaesthemosis is less frequent in the cases of carpal channel syndrome. The anaesthemosis is less frequent in cases of n. ulnaris becoming part of n. medianus again in the forearm. Riche-Cannieu's anaesthemosis has been proved anatomically in a large number of examined individuals, where the arm between the recurrent branch from the deep branch of n. ulnaris becomes part of n. medianus. Nowadays the electroneurographic techniques have contributed to specifying the innervation of the muscles of the arm, and the frequency of disorders. In the cases when n. ulnaris and n. medianus are impaired, the EMGmedical doctor must always take into account Riche-Cannieu's anaesthemosis. The so called "ulnar hand" is likely to be found when n. medianus is severely impaired, with preserved muscles of the tenar. Key words: EMG, Martin-Gruber's anaesthemosis, RicheCannieu's anaesthemosis, n. medianus, n. ulnaris êÖáûåÖ ÄÌÓχÎËËÚ ‚ ËÌÂ‚‡ˆËflÚ‡ ̇ ÏÛÒÍÛÎËÚ ̇ ˙͇ڇ Ò‡ ËÁ‚ÂÒÚÌË ÓÚ‰‡‚̇, ÌÓ Ú Ì ‚Ë̇„Ë Ò ‚ÁËÏ‡Ú ‚ Ô‰‚ˉ, ÍÓÂÚÓ ÏÓÊ ‰‡ ·˙‰Â Ô˘Ë̇ Á‡ ÔÓ„¯ÌË Á‡Íβ˜ÂÌËfl ÔË ÂÎÂÍÚÓÌ‚Ó„‡ÙÒÍÓÚÓ ËÁÒΉ‚‡ÌÂ. ç‡È-˜ÂÒÚÓ Ò¢‡Ì‡  ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ̇ Martin-Gruber, ÔË ÍÓflÚÓ ‰‚Ë„‡ÚÂÎÂÌ ÍÎÓÌ ÓÚ n.medianus ÔÂÏË̇‚‡ Í˙Ï n.ulnaris ‚ ӷ·ÒÚÚ‡ ̇ Ô‰Ï˯Ìˈ‡Ú‡. Ä̇ÒÚÓÏÓÁ‡Ú‡ ̇ Martin - Gruber ̇È-˜ÂÒÚÓ ÔÓËÁÎËÁ‡ ÓÚ n.interosseus anterior. èË ÒË̉Óχ ̇ ͇Ô‡ÎÌËfl ͇̇ΠÏÓÊ ‰‡ Ò ÓÚÍË ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ̇ Martin - Gruber. èÓ-fl‰ÍÓ Ò Ò¢‡ ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ÓÚ n.ulnaris Í˙Ï n.medianus Ò˙˘Ó ‚ ӷ·ÒÚÚ‡ ̇ Ô‰Ï˯Ìˈ‡Ú‡. Ä̇ÚÓÏ˘ÌÓ Â ‰Ó͇Á‡Ì‡ ‚ „ÓÎflÏ ÔÓˆÂÌÚ ËÁÒΉ‚‡ÌË Îˈ‡ ‡Ì‡ÒÚÓÏÓÁ‡ ̇ Riche Cannieu, ÔË ÍÓflÚÓ ‚ ˙͇ڇ ÏÂÊ‰Û ‚˙Á‚‡ÚÂÌ ÍÎÓÌ ÓÚ ‰˙ηÓÍËfl ÍÎÓÌ Ì‡ n.ulnaris Ò ÔËÒ˙‰ËÌfl‚‡ Í˙Ï n.medianus. ÑÌÂÒ Ò ÔÓÏÓ˘Ú‡ ̇ ÂÎÂÍÚÓÌ‚Ó„‡ÙÒÍËÚ ÏÂÚÓ‰ËÍË Ò ÛÚÓ˜Ìfl‚‡ ËÌÂ‚‡ˆËflÚ‡ ̇ ÏÛÒÍÛÎËÚ ̇ ˙͇ڇ Ë ˜ÂÒÚÓÚ‡Ú‡ ̇ ‡ÌÓχÎËËÚÂ. äÓ„‡ÚÓ Ò‡ Û‚‰ÂÌË n.ulnaris Ë n.medianus, ÂÎÂÍÚÓÏËÓ„‡ÙËÒÚ‡ Úfl·‚‡ ‰‡ Ëχ Ô‰‚ˉ Ë ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ̇ Riche -

Cannieu. Ç˙ÁÏÓÊÌÓ Â ‰‡ Ò ÛÒÚ‡ÌÓ‚Ë Ú.Ì. ÛÎ̇̇ ˙͇ ("all ulnar hand") ÔË ÚÂÊÍÓ Û‚Âʉ‡Ì ̇ n.medianus, ÌÓ Ò˙Ò Á‡Ô‡ÁÂÌË ÏÛÒÍÛÎË Ì‡ ÚÂ̇‡. äβ˜Ó‚Ë ‰ÛÏË: ÖåÉ, ‡Ì‡ÒÚÓÏÓÁ‡ ̇ Martin-Gruber, ‡Ì‡ÒÚÓÏÓÁ‡ ̇ Riche-Cannieu, n. medianus, n. ulnaris. ÄÌÓχÎËËÚ ‚ ËÌÂ‚‡ˆËflÚ‡ ̇ ÏÛÒÍÛÎËÚ ̇ ˙͇ڇ Ò‡ ËÁ‚ÂÒÚÌË ÓÚ‰‡‚̇, ÌÓ Ú Ì ‚Ë̇„Ë Ò ‚ÁËÏ‡Ú ‚ Ô‰‚ˉ, ÍÓÂÚÓ ÏÓÊ ‰‡ ·˙‰Â Ô˘Ë̇ Á‡ ÔÓ„¯ÌË Á‡Íβ˜ÂÌËfl ÔË ÂÎÂÍÚÓÌ‚Ó„‡ÙÒÍÓÚÓ ËÁÒΉ‚‡ÌÂ. N. medianus ËÌÂ‚Ë‡ m.abductor pollicis brevis, m. opponens pollicis Ë ÔÓ‚˙ıÌÓÒÚ̇ڇ „·‚‡ ̇ m.flexor pollicis brevis, ‡ Ò˙˘Ó Ë mm. lumbricales I Ë II. N.ulnaris ËÌÂ‚Ë‡ ÏÛÒÍÛÎËÚ ̇ ıËÔÓÚÂÌÂ‡: m.abductor digiti minimi, m. flexor digiti minimi brevis Ë m.opponeus digiti minimi; ÏÛÒÍÛÎËÚ ̇ ‰Î‡ÌÚ‡: mm. interossei dorsalis Ë mm. palmares Ë mm.lumbricales III Ë IV. åÌÓ„Ó ˜ÂÒÚÓ ‰‚Ë„‡ÚÂÎ̇ڇ Ë ÒÂÚ˂̇ ËÌÂ‚‡ˆËfl ̇ ˙͇ڇ Ëχ ‡Ì‡ÚÓÏ˘ÌË ‡ÌÓχÎËË (Ò‚˙Á‚‡Ì ̇ ‰ËÌ ÌÂ‚ Ò ‰Û„). ç‡È-˜ÂÒÚÓ Ò¢‡Ì‡  ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ̇ Martin-Gruber, ÔË ÍÓflÚÓ ‰‚Ë„‡ÚÂÎÂÌ ÍÎÓÌ ÓÚ n.medianus ÔÂÏË̇‚‡ Í˙Ï n.ulnaris ‚ ӷ·ÒÚÚ‡ ̇ Ô‰Ï˯Ìˈ‡Ú‡. èÓ-fl‰ÍÓ Ò Ò¢‡ ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ÓÚ n.ulnaris Í˙Ï n.medianus Ò˙˘Ó ‚ ӷ·ÒÚÚ‡ ̇ Ô‰Ï˯Ìˈ‡Ú‡ (36). Ä̇ÚÓÏ˘ÌÓ Â ‰Ó͇Á‡Ì‡ ‚ „ÓÎflÏ ÔÓˆÂÌÚ ËÁÒΉ‚‡ÌË Îˈ‡ ‡Ì‡ÒÚÓÏÓÁ‡ ̇ Riche - Cannieu, ÔË ÍÓflÚÓ ‚ ˙͇ڇ ÏÂÊ‰Û ‚˙Á‚‡ÚÂÌ ÍÎÓÌ ÓÚ ‰˙ηÓÍËfl ÍÎÓÌ Ì‡ n.ulnaris Ò ÔËÒ˙‰ËÌfl‚‡ Í˙Ï n.medianus. Ç ÔÓ-χÎ˙Í ÔÓˆÂÌÚ (ÓÍÓÎÓ 3 %) ÔË ËÁÒΉ‚‡Ì ̇ ÚÛÔÌË ˙ˆÂ Sunderland (1946)  ̇·Î˛‰‡‚‡Ì‡ ‡Ì‡ÒÚÓÏÓÁ‡ ÓÚ n.medianus Í˙Ï m.interosseus dorsalis I. àÌÂ‚Ë‡Ì ̇ ÚÂ̇‡ ÓÚ n.ulnaris Ë ‡Ì‡ÒÚÓÏÓÁ‡ Ò‡ÏÓ Ì‡ ÒÂÚË‚ÌËÚ ‚·Í̇ ‚ Ô‰Ï˯Ìˈ‡Ú‡ ÓÚ n.ulnaris Í˙Ï n.medianus Ò‡ ̇·Î˛‰‡‚‡ÎË Santoro, (1973) Ë Hopf, (1990). ë˙‰ËÌÂÌËÂÚÓ ÏÂÊ‰Û n.medianus Ë n.ulnaris ‚ Ô‰Ï˯Ìˈ‡Ú‡ Á‡ Ô˙‚Ë Ô˙Ú Â ÓÔËÒ‡ÌÓ ‡Ì‡ÚÓÏ˘ÌÓ ÓÚ Martin (1763) ÔÓ Í˙ÒÌÓ ÓÚ Gruber (1870) ÔË ‰ËÒÂ͈ËË Ì‡ ÚÛÔÓ‚Â (10 - 30%). Ä̇ÒÚÓÏÓÁ‡Ú‡ ÏÓÊ ‰‡ ·˙‰Â ÓÚ Â‰ËÌ ËÎË ÌflÍÓÎÍÓ ÍÎÓ̇. çÂ‚ÌËÚ ‚·Í̇ Ú˙„‚‡Ú ÓÚ n.medianus ‚ „Ó̇ڇ ˜‡ÒÚ Ì‡ Ô‰Ï˯Ìˈ‡Ú‡ ÏÂÊ‰Û m.flexor digitorum sublimis Ë m.flexor digitorum profundus, ‰ËÒÚ‡ÎÌÓ ÓÚ m.pronator teres Ë ÏÂÊ‰Û ‰‚ÂÚ „·‚Ë Ì‡ m.pronator teres. Ä̇ÒÚÓÏÓÁ‡Ú‡ ÏÓÊ ‰‡ ÔÓËÁÎËÁ‡ Ò‡ÏÓ ÓÚ ÔÓ‚˙ıÌÓÒÚÌËfl ËÎË ‰˙ηÓÍËflÚ ÍÎÓÌ ËÎË ÓÚ ‰‚‡Ú‡. ë‚˙Á‚‡ÌÂÚÓ Ì‡ ÍÎÓ̇ Ò n.ulnaris ÒÚ‡‚‡ ̇ ‡Á΢ÌÓ ‡ÁÒÚÓflÌË ÓÚ olecranon ulnae. óÂÒÚÓ ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ Ò ÓÚ‰ÂÎfl ÓÚ ˜ËÒÚÓ ‰‚Ë„‡ÚÂÎÌËfl ÍÎÓÌ n.interosseus anterior . ëÔÓ‰ ·Ófl ‡ÍÒÓÌË Û˜‡ÒÚ‚‡˘Ë ‚ ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ Ë ÒÔÓ‰ ÏÛÒÍÛÎË, ÍÓËÚÓ ËÌÂ‚Ë‡Ú Ò ӷÓÒÓ·fl‚‡Ú ÚË ‚ˉ‡ ‡ÍÒÓÌË (39; 34): I ‚ˉ ËÌÂ‚Ë‡ Ò‡ÏÓ m.abductor digiti minimi Ë ÏÓÊ ‰‡ Ì Ò ‡ÁÍË ÔÓ ‚ÂÏ ̇ ÛÚËÌÌÓÚÓ ÖåÉ ËÁÒΉ‚‡ÌÂ. II ‚ˉ ËÌÂ‚Ë‡Ú Ò‡ÏÓ m.interosseus dorsalis I. III ‚ˉ ËÌÂ‚Ë‡Ú m.adductor pollicis brevis, Ò¢‡ Ò ÏÌÓ„Ó fl‰ÍÓ Ë ÚÛ‰ÌÓ Ò ÓÚÍË‚‡ (ÙË„. 1).


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îË„. 1 Ä̇ÒÚÓÏÓÁ‡ ̇ Martin-Gruber I. ‚ˉ ËÌÂ‚Ë‡ m.abductor digiti minimi; II. ‚ˉ - m.interosseus dorsalis I; III. ‚ˉ - m.adductor pollicis brevis (Oh, 1984).

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îË„. 3 ëåÄè Óڂ‰ÂÌ ÓÚ m.abductor pollicis brevis ÔË Á‰‡‚Ë. ÑËÒÚ‡Î̇ ·ÚÂ̈Ëfl 3.7 ms,‡ÏÔÎËÚÛ‰‡ 23.6 mV ÔÓÍÒËχ· ·ÚÂ̈Ëfl 7.3, ‡ÏÔÎËÚÛ‰‡ 22.1 mV Ë ëè 58.1 m/s.

åÌÓ„Ó ÔÓ-˜ÂÒÚ‡  ÍÓÏ·Ë̇ˆËflÚ‡ ̇ ÚËÚ ‚ˉ‡ ̇ ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ̇ Martin - Gruber. ÄÍÒÓÌËÚ ̇ n.medianus, ÍÓËÚÓ ÔÂÏË̇‚‡Ú Í˙Ï n.ulnaris ‚ Ô‰Ï˯Ìˈ‡Ú‡ ËÌÂ‚Ë‡Ú ıËÔÓÚÂ̇‡, m.interosseus dorsalis I Ë m.adductor pollicis (ÙË„. 2).

îË„. 4 ‡ ëåÄè Óڂ‰ÂÌ ÓÚ ÚÂ̇‡ ÔË ÒÚËÏÛÎË‡Ì ̇ n.medianus Ò ‰ËÒÚ‡Î̇ ‡ÏÔÎËÚÛ‰‡ 14.4 mV Ë ÔÓÍÒËχÎ̇ 14.1mV

îË„. 2 Ä̇ÒÚÓÏÓÁ‡Ú‡ ̇ Martin - Gruber. äÓÏ·Ë̇ˆËfl ÓÚ ÚËÚ ‚ˉ‡.

óÂÒÚÓÚ‡Ú‡ ̇ ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ̇ Martin - Gruber ‚‡Ë‡ ‚ Ô‰ÂÎËÚ ÓÚ 7.7% (13) ‰Ó 25 % (10; 5). ìÒÚ‡ÌÓ‚fl‚‡ Ò Ò˙˘Ó Ë ‰‚ÛÒÚ‡ÌÌÓ ‚ 68 % (16). ê‡ÌÌÓÚÓ ‡ÁÔÓÁ̇‚‡Ì ̇ ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ̇ MartinGruber ÏÓÊ ‰‡ ·˙‰Â ‰Ó͇Á‡Ì‡ ˜ÂÁ ÔÓÒÚ ÒÍËÌËÌ„ ÏÂÚÓ‰. åÂÚÓ‰˙Ú Ò ÓÒÌÓ‚‡‚‡ ̇ Ò‡‚Ìfl‚‡Ì ̇ ‡ÏÔÎËÚÛ‰‡Ú‡ ̇ ëMÄè ÓÚ ÚÂ̇‡. èË ÒÚËÏÛÎË‡Ì ̇ n.medianus ‚ ÍËÚ͇ڇ ÔË Á‰‡‚Ë ıÓ‡ ‡ÏÔÎËÚÛ‰‡Ú‡ ̇ ëMÄè Â Ò 20 % ÔÓ-‚ËÒÓ͇ ÓÚ Ú‡ÁË ÔË ÒÚËÏÛÎË‡Ì ‚ ·Í˙Úfl, Ú˙È Í‡ÚÓ Ò ÔÓÎÛ˜‡‚‡ ÔÓ-‰Ó·‡ ÒËÌıÓÌËÁ‡ˆËfl ‚ ‰ËÒÚ‡Î̇ڇ ÚӘ͇ (ÙË„. 3). é˘Â ÔÓ-ÚÓ˜ÂÌ Â ÏÂÚÓ‰˙Ú Ì‡ Oh (1984). äÓ„‡ÚÓ ËÁ‚˙¯‚‡Ï ËÁÒΉ‚‡Ì Á‡ ‰‡ Ò ‰Ó͇Ê ̇΢ˠËÎË ÎËÔÒ‡ ̇ ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ̇ Martin - Gruber  ÌÂÓ·ıÓ‰ËÏÓ ‰‡ Ò ÒÚËÏÛÎË‡Ú n.n. medianus Ë ulnaris ‚ ÍËÚ͇ڇ Ë Î‡Í˙Úfl, ͇-

îË„. 4 · ëåÄè Óڂ‰ÂÌ ÓÚ ıËÔÓÚÂ̇‡ ÔË ÒÚËÏÛÎË‡Ì ̇ n.medianus ÚÓ Ò Óڂ‰ ëåÄè ÓÚ ÚË ÏÂÒÚ‡: ÚÂ̇, ıËÔÓÚÂ̇ Ë m.interosseus dorsalis I. ç‡È-̇Ô‰ Ò ÒÚËÏÛÎË‡ n.medianus Ë Ò ÓÚ‚Âʉ‡ ëåÄè ÓÚ ÚÂ̇‡. èÓÎÛ˜‡‚‡Ú Ò M-ÓÚ„Ó‚ÓË Ò ÓÚˈ‡ÚÂÎÌÓ ÓÚÍÎÓÌÂÌËÂ Ë ÌÓχÎÌË ‡ÏÔÎËÚÛ‰Ë (ÙË„.4‡) ç‡ ‚ÚÓÓ ÏflÒÚÓ ÓÚÌÓ‚Ó Ò ÒÚËÏÛÎË‡ n.medianus, ÌÓ


‡ÔËÎ, 2002

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

îË„. 4 ‚ ëåÄè Óڂ‰ÂÌ ÓÚ m.interosseus dorsalis ÔË ÒÚËÏÛÎË‡Ì ̇ n.medianus Ò ‰ËÒÚ‡Î̇ ‡ÏÔÎËÚÛ‰‡ 0.5 mV Ë ÔÓÍÒËχÎ̇ 0.4 mV ÓÚ‚Âʉ‡˘ËÚ ÂÎÂÍÚÓ‰Ë Ò‡ ÔÓÒÚ‡‚ÂÌË ‚˙ıÛ ıËÔÓÚÂ̇‡. ä‡ÚÓ ÂÁÛÎÚ‡Ú ÏÓÊ ‰‡ Ò ÔÓÎÛ˜Ë å-ÓÚ„Ó‚Ó Ò ÔÓÎÓÊËÚÂÎÌÓ ÓÚÍÎÓÌÂÌËÂ Ë Ò ÌËÒ͇ ‡ÏÔÎËÚÛ‰‡, ÍÓÂÚÓ Ò ‰˙ÎÊË Ì‡ Ó·ÂÏÌÓ ÔÓ‚Âʉ‡ÌÂ, ËÎË ‚˙Ó·˘Â ‰‡ ÎËÔÒ‚‡ ÓÚ„Ó‚Ó (ÙË„. 4 ·). ç‡ ÚÂÚÓ ÏflÒÚÓ Ò ÒÚËÏÛÎË‡ n.medianus Ë ÓÚ m.interosseus dorsalis I Ò ÓÚ‚Âʉ‡ ëåÄè Ò ÌËÒ͇ ‡ÏÔÎËÚÛ‰‡ Ë ÔÓÎÓÊËÚÂÎÌÓ ÓÚÍÎÓÌÂÌË (ÙË„. 4 ‚). èË ÒÚËÏÛÎË‡Ì ̇ n.ulnaris Ë ÓÚ‚Âʉ‡Ì ÓÚ Ó·Ë˜‡ÈÌËÚ ÏÂÒÚ‡ - ÓÚ ıËÔÓÚÂ̇ Ë m.interosseus dorsalis I, ëåÄè Â Ò ÌÓχÎ̇ ‡ÏÔÎËÚÛ‰‡ Ë ÓÚˈ‡ÚÂÎÌÓ ÓÚÍÎÓÌÂÌË (ÙË„.4 „, ‰).

38

îË„. 4 ‰ ëåÄè Óڂ‰ÂÌ ÓÚ m.interosseus dorsalis I ÔË ÒÚËÏÛÎË‡Ì ̇ n.ulnaris Ò ‰ËÒÚ‡Î̇ ‡ÏÔÎËÚÛ‰‡ 19.8 mV Ë ÔÓÍÒËχÎ̇ 19.8mV

îË„. 4  ëåÄè Óڂ‰ÂÌ ÓÚ m.abductor pollicis brevis ÔË ÒÚËÏÛÎË‡Ì ̇ n.ulnaris Ò ‰ËÒÚ‡Î̇ ‡ÏÔÎËÚÛ‰‡ 4.5 mV Ë ÔÓÍÒËχÎ̇ 4.0 mV

îË„. 4 „ ëåÄè Óڂ‰ÂÌ ÓÚ m.abductor digiti minimi ÔË ÒÚËÏÛÎË‡Ì ̇ n.ulnaris Ò ‰ËÒÚ‡Î̇ ‡ÏÔÎËÚÛ‰‡ 14.5 mV Ë ÔÓÍÒËχÎ̇ 14.0mV ä‡ÚÓ Ò ÒÚËÏÛÎË‡ n.ulnaris Ë Ò ËÁ‚˙¯Ë ÓÚ‚Âʉ‡Ì ÓÚ ÚÂ̇‡ ëåÄè Â Ò ÔÓ-ÌËÒ͇ ‡ÏÔÎËÚÛ‰‡ Ë ÔÓÎÓÊËÚÂÎÌÓ ÓÚÍÎÓÌÂÌË (ÙË„. 4 Â). ÄÍÓ Â Ì‡Îˈ ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ̇ Martin-Gruber ÔË ÒÚËÏÛÎË‡Ì ̇ n.medianus ‚ ·Í˙Úfl, ÓÚ ıËÔÓÚÂ̇‡ Ò ÓÚ‚Âʉ‡ ëåÄè Ò ‚ËÒÓ͇ ‡ÏÔÎËÚÛ‰‡ Ë ÓÚˈ‡ÚÂÎÌÓ ÓÚÍÎÓÌÂÌË (ÙË„. 4 Ê). ᇠ‰‡ ·˙‰Â ËÁÒΉ‚‡ÌÂÚÓ ÔÓ-ÚÓ˜ÌÓ Â ÌÂÓ·ıÓ‰ËÏÓ ËÌÚÂÌÁËÚÂÚ‡ ̇ ÒÚËÏÛ· ‰‡  ÒÛÔ‡Ï‡ÍÒËχÎÂÌ ‚˙‚ ‚Ò˘ÍË ÚÓ˜ÍË Ì‡ ÒÚËÏÛ·ˆËfl.éÚ‚Âʉ‡˘ËflÚ ÂÎÂÍÚÓ‰ ÒΉ‚‡ ‰‡ Ò ÔÓÒÚ‡‚Ë ‚˙ıÛ ÏÓÚÓ̇ڇ ÁÓ̇, ÍÓÂÚÓ ÓÒË„Ûfl‚‡ ÓÚ‚Âʉ‡Ì ̇ ëåÄè Ò Ì‡˜‡Î̇ Ì„‡Ú˂̇ Ù‡Á‡. èÂÁ 1966 Mannerfelt ‰Ó͇Á‚‡ ̇΢ˠ̇ ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ÓÚ n.medianus Í˙Ï n.ulnaris ˜ÂÁ ·ÎÓ͇‰‡ ̇ n.ulnaris,

îË„. 4 Ê ëåÄè Óڂ‰ÂÌ ÓÚ m.abductor digiti minimi ÔË ÒÚËÏÛÎË‡Ì ̇ n.medianus ‚ ӷ·ÒÚÚ‡ ̇ ·Í˙Úfl (‡Ì‡ÒÚÓÏÓÁ‡ ̇ Martin - Gruber) ÔÓÍÒËχÎÌÓ ÓÚ ‡Ì‡ÒÚÓÏÓÁ‡Ú‡. ç‡ ÚÓ‚‡ ÌË‚Ó ÌÂ‚˙Ú Ì ‰‡‚‡ ÏÓÚÓÂÌ ÍÎÓÌ. N.ulnaris e ‰‡Î˜ ÓÚ n.medianus. ÅÎÓ͇ ̇ ÚÓ‚‡ ÌË‚Ó Â ·ÂÁÓÔ‡ÒÂÌ. äËÚÂËËÚ Á‡ Ô˙ÎÂÌ ·ÎÓÍ Ò‡: ‚‡ÁӉ˷ڇˆËfl ̇ ÛÎ̇̇ڇ ˜‡ÒÚ Ì‡ ˙͇ڇ; Ô˙Î̇ Á‡„Û·‡ ̇ ÒÂÚË‚ÌÓÒÚÚ‡ ̇ ÔÂÚË Ô˙ÒÚ; Ô‡‡ÎËÁ‡ ̇ ÏÛÒ-


‡ÔËÎ, 2002

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

ÍÛÎËÚÂ, ËÌÂ‚Ë‡ÌË ÓÚ n.ulnaris. ᇠ‰‡ Ò ‰Ó͇Ê ̇΢ˠ̇ ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ̇ MartinGruber ÔË ·ÓÎÌË Ò Ô˙Î̇ Û‚‰‡ ̇ n.ulnaris ‚ ӷ·ÒÚÚ‡ ̇ ·Í˙Úfl  ÌÂÓ·ıÓ‰ËÏÓ ‰‡ Ò Ëχ Ô‰‚ˉ ÒΉÌÓÚÓ: 1.Ì Ò ÓÚ‚Âʉ‡ ëåÄè ÓÚ m.abductor digiti minimi ÔË ÒÚËÏÛÎË‡Ì ̇ n.ulnaris ‚ ·Í˙Úfl. 2.ÓÚ‚Âʉ‡ Ò ëåÄè ÓÚ m.abductor digiti minimi ÔË ÒÚËÏÛÎË‡Ì ̇ n.medianus ‚ ·Í˙Úfl. 3.ÓÚ‚Âʉ‡ Ò ëåÄè ÓÚ m.abductor digiti minimi ÔË ÒÚËÏÛÎË‡Ì ̇ n.ulnaris ‚ ÍËÚ͇ڇ. 4.Ì Ò ÓÚ‚Âʉ‡ ëåÄè ÓÚ m.abductor digiti minimi ÔË ÒÚËÏÛÎË‡Ì ̇ n.medianus ‚ ÍËÚ͇ڇ (ÙË„. 5).

îË„. 5 Ä̇ÒÚÓÏÓÁ‡ ̇ Martin-Gruber Ë ÚÂÊ͇ Û‚‰‡ ̇ n.ulnaris ‚ ·Í˙Úfl (ËÒ. Ñ. ó‡Í˙Ó‚) èË Ô˙Î̇ Û‚‰‡ ̇ n.ulnaris ‚ ·Í˙Úfl Ë Ì‡Î˘Ë ̇ ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ̇ Martin-Gruber, Ôӂ˜ÂÚÓ ÏÛÒÍÛÎË (m.interosseus dorsalis I Ë m.abductor pollicis) Ì ҇ Á‡Ò„̇ÚË, ‡ ‚ ÌflÍÓË ÒÎÛ˜‡Ë ‰‡Ê Ì  Á‡ÒÂ„Ì‡Ú Ë m.abductor digiti minimi. åÓÊ ‰‡ ·˙‰‡Ú Û‚‰ÂÌË ÒÂÚË‚ÌËÚ ‚·Í̇ ̇ χÎÍËfl Ô˙ÒÚ Ë ÛÎ̇̇ڇ ˜‡ÒÚ Ì‡ ˜ÂÚ‚˙ÚË Ô˙ÒÚ, Ú˙È Í‡ÚÓ ‡Ì‡ÒÚÓÏÓÁ‡Ú‡  ÓÚ ˜ËÒÚ ‰‚Ë„‡ÚÂÎÂÌ ÍÎÓÌ. Ç˙Á ÓÒÌÓ‚‡ ̇ ÚÂÁË ÍËÚÂËË ÏÓÊ ‰‡ Ò ÔÓÚ‚˙‰Ë, ˜Â Ëχ ÎÂÁËfl ̇ n.ulnaris ‚ ·Í˙Úfl (41; 17). åÌÓ„Ó fl‰ÍÓ n.medianus ÏÓÊ ̇Ô˙ÎÌÓ ‰‡ ÔÓÂÏ ÙÛÌ͈ËflÚ‡ ̇ n.ulnaris ("all median hand"), ˆfl·ڇ ˙͇ ‰‡ Ò ËÌÂ‚Ë‡ ÓÚ n.medianus (23). Kimura (1976) ÓÔËÒ‚‡ Ú. ̇. ÙËÁËÓÎӄ˘ÌÓ ·ÎÓÍË‡Ì ("Collision technique") ÔË ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ̇ MartinGruber. N medianus Ò ÒÚËÏÛÎË‡ ‰ÌÓ‚ÂÏÂÌÌÓ ‚ ÍËÚ͇ڇ Ë Î‡Í˙Úfl Ë Ò „ËÒÚË‡ Ô‰ËÁ‚Ë͇ÌËfl ëåÄè ÓÚ ÚÂ̇̇ڇ ÂÏËÌÂ̈Ëfl. ÄÌÚˉÓÏÌËÚ ËÏÔÛÎÒË ÓÚ ‰ËÒÚ‡Î̇ڇ ÒÚËÏÛ·ˆËfl ̇ n.medianus ‚ ÍËÚ͇ڇ ·ÎÓÍË‡Ú ÓÚÓ‰ÓÏÌËÚ ËÏÔÛÎÒË ÓÚ ÔÓÍÒËχÎ̇ڇ ÏÛ ÒÚËÏÛ·ˆËfl ‚ ·Í˙Úfl Ë Ì Ò Á‡ÔËÒ‚‡ ëåÄè ÓÚ ÚÂ̇‡. ÄÍÓ Ò˙˘ÂÒÚ‚Û‚‡ ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ̇ Martin - Gruber ÓÚÓ‰ÓÏÌËÚ ËÏÔÛÎÒË ÔÂÏË̇‚‡Ú ÔÂÁ ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ Í˙Ï n.medianus Ë Ò ÓÚ‚Âʉ‡ Ô‰ËÁ‚ËÍ‡Ì ëåÄè ÓÚ ÚÂ̇‡ Ë ıËÔÓÚÂ̇‡. óÂÁ ÚÓÁË ÏÂÚÓ‰ ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ̇ Martin Gruber Ò ÛÒÚ‡ÌÓ‚fl‚‡ ‚ 17 % ÓÚ ËÁÒΉ‚‡ÌËÚ Îˈ‡. ê‡Á΢ÌËÚ ‡‚ÚÓË Ì‡ÏË‡Ú ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ̇ Martin-Gruber ÓÚ 10.5 ‰Ó 44 % ÓÚ ËÁÒΉ‚‡ÌËÚ ·ÓÎÌË (19; 13; 10; 41). èÓÁ̇‚‡ÌÂÚÓ Ì‡ ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ̇ Martin

39

- Gruber  ‚‡ÊÌÓ Á‡ ÚÓ˜ÌÓÚÓ ÓÔ‰ÂÎflÌ ÒÍÓÓÒÚÚ‡ ̇ ÔÓ‚Âʉ‡Ì ÔÓ ‰‚Ë„‡ÚÂÎÌËÚ ‚·Í̇ ̇ n.medianus Ë n.ulnaris. èË Ô˙Î̇ ÎÂÁËfl ̇ n.medianus ‚ ÍËÚ͇ڇ ÏÓÊ ‰‡ Ò ÛÒÚ‡ÌÓ‚Ë ˜‡ÒÚ˘̇ ‰ÂÌÂ‚‡ˆËfl ̇ ÚÂ̇̇ڇ ÏÛÒÍÛ·ÚÛ‡, Ú˙È Í‡ÚÓ Ò ËÌÂ‚Ë‡ ÓÚ n.ulnaris. èË ÒÚËÏÛÎË‡Ì ̇ n.medianus ‚ ÍËÚ͇ڇ Ì Ò ÓÚ‚Âʉ‡ ëåÄè, ‰Ó͇ÚÓ ÔË ÔÓ‰Ó·ÌÓ ÒÚËÏÛÎË‡Ì ̇ n.ulnaris ÚÓÈ Â Ò ‚ËÒÓ͇ ‡ÏÔÎËÚÛ‰‡ Ë Ì‡˜‡Î̇ Ì„‡Ú˂̇ Ù‡Á‡. Ä̇ÒÚÓÏÓÁ‡Ú‡ ̇ Martin - Gruber ̇È-˜ÂÒÚÓ ÔÓËÁÎËÁ‡ ÓÚ n.interosseus anterior. èË ·ÓÎÌË Ò Ô˙Î̇ Û‚‰‡ ̇ ÚÓÁË ÍÎÓÌ Ò ÛÒÚ‡ÌÓ‚fl‚‡ Á‡Òfl„‡Ì ̇ ‰˙ηÓÍËÚ ÙÎÂÍÒÓË Ì‡ ԇΈ‡, II Ô˙ÒÚ Ë Ì‡ m.pronator teres, ÌÓ Ò˙˘Ó ÏÓÊ ‰‡ Ëχ Û‚Âʉ‡Ì ̇ χÎÍËÚ ÏÛÒÍÛÎË Ì‡ ˙͇ڇ (35). èË ÒË̉Óχ ̇ ͇Ô‡ÎÌËfl ͇̇ΠÏÓÊ ‰‡ Ò ÓÚÍË ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ̇ Martin - Gruber. ÄÍÓ ÔË ÒÚËÏÛÎË‡Ì ̇ n.medianus ‚ ·Í˙Úfl ëåÄè Óڂ‰ÂÌ ÓÚ ÚÂ̇‡ Â Ò ÔÓ‚ËÒÓ͇ ‡ÏÔÎËÚÛ‰‡ Ë Ò ÔÓÎÓÊËÚÂÎÌÓ ÓÚÍÎÓÌÂÌËÂ, ‡ ÔË ÒÚËÏÛÎË‡Ì ‚ ÍËÚ͇ڇ ‡ÏÔÎËÚÛ‰‡Ú‡ ̇ ëåÄè  ÔÓÌËÒ͇ Ë Ò ÓÚˈ‡ÚÂÎÌÓ ÓÚÍÎÓÌÂÌËÂ, ÚÓ Â Ì‡Îˈ ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ̇ Martin - Gruber (ÙË„. 6).

îË„. 6 ëåÄè Óڂ‰ÂÌ ÓÚ ÚÂ̇‡ ÔË ÒÚËÏÛÎË‡Ì ̇ n.medianus ‚ ·Í˙Úfl Ë ÍËÚ͇ڇ ÔË ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ̇ Martin - Gruber Ë ÒË̉ÓÏ Ì‡ ͇Ô‡ÎÌËfl ͇̇Î.

è˘Ë̇ڇ  ÔÂÏË̇‚‡ÌÂÚÓ Ì‡ ËÏÔÛÎÒ‡ ÔÓ ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ̇ Martin-Gruber ÔÓ-‡ÌÌÓÚÓ ÏÛ ‰ÓÒÚË„‡Ì ‰Ó ÚӘ͇ڇ ̇ ÓÚ‚Âʉ‡Ì ‚ Ò‡‚ÌÂÌËÂ Ò ËÏÔÛÎÒ‡ ÔÂÏË̇‚‡˘ ÔÓ ‚·Í̇ڇ ÔÂÁ ͇Ô‡ÎÌËfl ͇̇Î. 燘‡Î̇ڇ ÔÓÎÓÊËÚÂÎ̇ Ù‡Á‡  ÓÚ Á‰‡‚ËÚ ‚·Í̇, ÍÓËÚÓ ËÁ·fl„‚‡Ú ÍÓÏÔÂÒËflÚ‡ ‚ ͇Ô‡ÎÌËfl ͇̇Î. èÓÍÒËχÎ̇ڇ ·ÚÂ̈Ëfl  ÌÓχÎ̇, ‰ËÒÚ‡Î̇ڇ Û‰˙ÎÊÂ̇ Ë ÒÍÓÓÒÚÚ‡ ̇ ÔÓ‚Âʉ‡Ì ÔÓ ‰‚Ë„‡ÚÎÌËÚ ‚·Í̇ ̇ n.medianus Á‡ Û˜‡ÒÚ˙͇ ·Í˙Ú-ÍËÚ͇  ÏÌÓ„Ó ‚ËÒÓ͇. ëÚËÏÛÎË‡ÌÂÚÓ Ì‡ n.ulnaris ‚ ·Í˙Úfl Ë ÍËÚ͇ڇ Ô‰ËÁ‚ËÍ‚‡ ëåÄè ÓÚ ıËÔÓÚÂ̇‡ Ë m.interosseus dorsalis I Ò ‚ËÒÓÍË ‡ÏÔÎËÚÛ‰Ë Ë ÓÚˈ‡ÚÂÎÌÓ ÓÚÍÎÓÌÂÌË (ÙË„. 7). íÓ‚‡ Ò‡ ‰ÓÔ˙ÎÌËÚÂÎÌË ÍËÚÂËË ÔË ‰Ó͇Á‚‡Ì ̇ ÒË̉Óχ ̇ ͇Ô‡ÎÌËfl Í‡Ì‡Î Ë ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ̇ Martin Gruber (10). Ä̇ÒÚÓÏÓÁ‡Ú‡ ÓÚ n.ulnaris Í˙Ï n.medianus ‚ Ô‰Ï˯Ìˈ‡Ú‡  ÏÌÓ„Ó ÔÓ-fl‰Í‡ (2; 3; 27). ᇠÔ˙‚Ë Ô˙Ú ÚÓ‚‡ Ò˙‰ËÌÂÌË  ÓÔËÒ‡ÌÓ ÓÚ Marinacci (1964), a ÔÓ-Í˙ÒÌÓ Hopf (1979) fl ̇˘‡ ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ̇ Marinacci (ÙË„. 8). äÓm‡r Ë Ò˙‡‚ÚÓË (1978) ÓÔËÒ‚‡Ú ·ÓÎÂÌ Ò Ô˙ÎÌÓ ÔÂÍ˙Ò‚‡Ì ̇ n.medianus ‚ ӷ·ÒÚÚ‡ ̇ ·Í˙Úfl Ë ÛÒÚ‡ÌÓ‚fl‚‡Ú ˜‡ÒÚ˘̇ Ô‡‡ÎËÁ‡ ̇ ÏÛÒÍÛÎËÚÂ. óÂÁ ÂÎÂÍÚÓÌ‚Ó„‡ÙÒÍÓÚÓ ËÁÒΉ‚‡Ì Ú ‰Ó͇Á‚‡Ú ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ‚ Ô‰Ï˯Ìˈ‡Ú‡ ÓÚ n.ulnaris k˙Ï n.medianus. TaÁË ‡Ì‡ÒÚÓÏÓÁ‡ ÏÓÊ ‰‡ ·˙‰Â ‰Ó͇Á‡Ì‡ Ë ˜ÂÁ ‡ÏÔÎËÚÛ‰‡Ú‡ ̇ ëåÄè ÓÚ ÚÂ̇‡. èË ÒÚËÏÛÎË‡Ì ̇ n.medianus ‚ ÍËÚ͇ڇ ‡ÏÔÎËÚÛ‰‡Ú‡ ̇ ëåÄè  ÏÌÓ„Ó ÔÓ-‚ËÒÓ͇, ÓÚ-


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îË„. 7 ëåÄè Óڂ‰ÂÌ ÓÚ m.abductor digiti minimi (‡) ëåÄè Óڂ‰ÂÌ ÓÚ m.interosseus dorsalis I. (·) ÍÓÎÍÓÚÓ ÔË ÒÚËÏÛÎË‡Ì ‚ ·Í˙Úfl. é·‡ÚÌÓÚÓ Ò ÔÓÎÛ˜‡‚‡, ÍÓ„‡ÚÓ Ò ÒÚËÏÛÎË‡ n.ulnaris Ë Ò ÓÚ‚Âʉ‡ ëåÄè ÓÚ ıËÔÓÚÂ̇‡, ‡ÏÔÎËÚÛ‰‡Ú‡  ÔÓ-ÌËÒ͇ ÔË ÒÚËÏÛÎË‡Ì ‚ ÍËÚ͇ڇ, ÓÚÍÓÎÍÓÚÓ ÔË ÒÚËÏÛÎË‡Ì ‚ ·Í˙Úfl (36; 27). T‡ÁË ‡Ì‡ÒÚÓÏÓÁ‡ Ò˙˘Ó ÏÓÊ ‰‡ ‰‡‰Â ÔÓ„¯ÌÓ Á‡Íβ˜ÂÌË ÔË Ì‡Î˘ËÂ Ë Ì‡ ÒË̉Óχ ̇ ͇Ô‡ÎÌËfl ͇̇Π(8). Marinacci (1964, 1968) ÓÔËÒ‚‡ ·ÓÎÂÌ, ÔË ÍÓ„ÓÚÓ ‚Ò˘ÍË ÏÛÒÍÛÎË Ì‡ ˙͇ڇ Ò ËÌÂ‚Ë‡Ú ÓÚ n.ulnaris ("all ulnar hand"). Oh Ë Ò˙‡‚ÚÓË (1995) ÓÔËÒ‚‡Ú ‰‚ÓÈ̇ ‡Ì‡ÒÚÓÏÓÁ‡ medianus - ulnaris Ë ulnaris - medianus. é˘Â ÏË̇ÎËfl ‚ÂÍ Brooks (1886) ÔË ‰ËÒÂ͈ËË Ì‡ ÚÛÔӂ ̇ÏË‡ ‚ ÓÚ‰ÂÎÌË ÒÎÛ˜‡Ë, ˜Â n.ulnaris ËÌÂ‚Ë‡ ‚Ò˘ÍË ÏÛÒÍÛÎË Ì‡ ˙͇ڇ. Rountree (1949) ̇ÏË‡ ÓÍÓÎÓ 20 % ‚‡ˇˆËË ‚

ËÌÂ‚‡ˆËflÚ‡ ̇ ÏÛÒÍÛÎËÚ ̇ ˙͇ڇ, Ò‡ÏÓ ÓÚ n.ulnaris ËÎË ÓÚ n.medianus. ÑÌÂÒ Ò ÔÓÏÓ˘Ú‡ ̇ ÂÎÂÍÚÓÌ‚Ó„‡ÙÒÍËÚ ÏÂÚÓ‰ËÍË Ò ÛÚÓ˜Ìfl‚‡ ËÌÂ‚‡ˆËflÚ‡ ̇ ÏÛÒÍÛÎËÚ ̇ ˙͇ڇ Ë ˜ÂÒÚÓÚ‡Ú‡ ̇ ‡ÌÓχÎËËÚ (38). ᇠ‡ÁÎË͇ ÓÚ ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ̇ Martin - Gruber, kÓflÚÓ Ò ‡ÁÔÓÁ̇‚‡ ÔÓ-ÎÂÒÌÓ Ë ÔÓ-˜ÂÒÚÓ, ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ̇ Riche - Cannieu Ò ÔÓÔÛÒ͇ ËÎË Ì Ò ӷ˙˘‡ ‚ÌËχÌËÂ. Riche Ë Cannieu (1897) ÓÔËÒ‡ı‡ ‡Ì‡ÚÓÏ˘ÌÓ ‚ ˙͇ڇ ‡Ì‡ÒÚÓÏÓÁ‡ ÏÂÊ‰Û ‚˙Á‚‡ÚÂÌ ‰˙ηÓÍ ÍÎÓÌ Ì‡ n.ulnaris, ÍÓÈÚÓ Á‡‚Ë‚‡ ̇‰ ͇Ô‡ÎÌËfl Í‡Ì‡Î Ë Ò ÔËÒ˙‰ËÌfl‚‡ Í˙Ï n.medianus Ë ËÌÂ‚Ë‡ ÚÂ̇̇ڇ ÏÛÒÍÛ·ÚÛ‡. èÓ-Í˙ÒÌÓ ÔË ÔÓ‰Ó·ÌÓ ‡Ì‡ÚÓÏ˘ÌÓ ËÁÒΉ‚‡Ì Ò˙˘‡Ú‡ ‡Ì‡ÒÚÓÏÓÁ‡  ÛÒÚ‡ÌÓ‚Â̇ ‚ ÓÚ 15 ‰Ó 77 % ÓÚ ËÁÒΉ‚‡ÌË ÚÛÔÓ‚Â (11; 29; 1) (ÙË„. 9).

îË„. 9 Ä̇ÒÚÓÏÓÁ‡ ̇ Riche-Cannieu (Dumitru Ë Ò˙‡‚ÚÓË, 1988)

îË„. 8 Ä̇ÒÚÓÏÓÁ‡Ú‡ ̇ Marinacci

C ÂÎÂÍÚÓÙËÁËÓÎӄ˘ÌÓ ËÁÒΉ‚‡Ì Kimura Ë Ayyar (1984) ÛÒÚ‡ÌÓ‚fl‚‡Ú ‚ 79 % ÓÚ ËÁÒΉ‚‡ÌËÚ Îˈ‡ ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ̇ Riche - Cannieu. íÓ‚‡ ÔÓ͇Á‚‡, ˜Â Úfl ÏÓÊ ‰‡ Ò ÔËÂÏ ͇ÚÓ ÌÓχÎÌÓ ‡Ì‡ÚÓÏ˘ÌÓ Ò˙‰ËÌÂÌË ‚ Ô‡Îχ̇ڇ ˜‡ÒÚ Ì‡ ˙͇ڇ ÏÂÊ‰Û ‰˙ηÓÍËflÚ ÍÎÓÌ Ì‡


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n.ulnaris Ë n.medianus. ÑÓ͇Á‚‡ÌÂÚÓ Ì‡ Ú‡ÁË ‡Ì‡ÒÚÓÏÓÁ‡ ÒÚ‡‚‡ ˜ÂÁ Ò‡‚ÌÂÌË ̇ ‡ÏÔÎËÚÛ‰‡Ú‡ ̇ ëåÄè Óڂ‰ÂÌ ÓÚ ÚÂ̇‡ ÔË ÒÚËÏÛÎË‡Ì ̇ n.medianus Ë ulnaris ‚ ÍËÚ͇ڇ. ÄÍÓ ‡ÏÔÎËÚÛ‰‡Ú‡ ̇ ëåÄè ÔË ÒÚËÏÛÎË‡Ì ̇ ‰‚‡Ú‡ ÌÂ‚‡  ‰̇͂‡ , ÚÓ‚‡  ‰Ó͇Á‡ÚÂÎÒÚ‚Ó, ˜Â ÚÂ̇˙Ú Ëχ ‰‚ÓÈ̇ ËÌÂ‚‡ˆËfl. èË Ò‡‚ÌÂÌË ̇ ‡ÏÔÎËÚÛ‰ËÚ ̇ Óڂ‰ÂÌËfl ëåÄè ÏÓÊ ‰‡ Ò ÓÔ‰ÂÎË ÍÓÈ ÌÂ‚ ‰ÓÏËÌË‡. ÄÍÓ ‡ÏÔÎËÚÛ‰‡Ú‡ ÔË ÒÚËÏÛÎË‡Ì ̇ n.medianus  ÔÓ-„ÓÎflχ, ÚÓ ‰ÓÏËÌË‡ n.medianus Ë Ó·‡ÚÌÓ, ‡ÍÓ ‡ÏÔÎËÚÛ‰‡Ú‡  ÔÓ-„ÓÎflχ ÔË ÒÚËÏÛÎË‡Ì ̇ n.ulnaris ÚÓ ‰ÓÏËÌË‡ ËÌÂ‚‡ˆËflÚ‡ ̇ n.ulnaris (33; 31). Dumitru Ë Ò˙ÚÛ‰ÌËˆË (1988) ËÁ‚˙¯Ëı‡ ÂÎÂÍÚÓÙËÁËÓÎӄ˘ÌÓ ËÁÒΉ‚‡Ì Á‡ ‰Ó͇Á‚‡Ì ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ̇ Riche Cannieu, ͇ÚÓ Á‡ÔËÒ‚‡ı‡ ëåÄè Ò Ë„ÎÂÌË ÂÎÂÍÚÓ‰Ë ÓÚ m.abductor pollicis brevis, m.abductor digiti minimi, m.interosseus dorsalis I Ë m.flexor carpi radialis ÔË ÒÚËÏÛÎË‡Ì ̇ n.medianus Ë n.ulnaris ‚ ÍËÚ͇ڇ Ë Î‡Í˙Úfl. äÓ„‡ÚÓ Ò‡ Û‚‰ÂÌË n.ulnaris Ë n.medianus, ÂÎÂÍÚÓÏËÓ„‡ÙËÒÚ‡ Úfl·‚‡ ‰‡ Ëχ Ô‰‚ˉ Ë ‡Ì‡ÒÚÓÏÓÁ‡Ú‡ ̇ Riche Cannieu. Ç˙ÁÏÓÊÌÓ Â ‰‡ Ò ÛÒÚ‡ÌÓ‚Ë Ú.Ì. ÛÎ̇̇ ˙͇ ("all ulnar hand") ÔË ÚÂÊÍÓ Û‚Âʉ‡Ì ̇ n.medianus,ÌÓ Á‡Ô‡ÁÂÌË ÏÛÒÍÛÎË Ì‡ ÚÂ̇‡. ëÂÚ˂̇ڇ ‡Ì‡ÒÚÓÏÓÁ‡ ‚ Ô‰Ï˯Ìˈ‡Ú‡ Ò Ò¢‡ ÏÌÓ„Ó fl‰ÍÓ. ífl  ÓÔË҇̇ ÓÚ Santoro Ë Ò˙ÚÛ‰ÌËˆË (1983) ÔË ËÁÒΉ‚‡Ì ̇ ·ÓÎÌË Ò˙Ò ÒË̉Óχ ̇ ͇Ô‡ÎÌËfl ͇̇Î. ãàíÖêÄíìêÄ

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ĉÂÒ Á‡ ÍÓÂÒÔÓ̉Â̈Ëfl: èÓÙ. ‰- Å. à¯ÔÂÍÓ‚‡ ëÓÙËfl 1504, ÛÎ. "ÅflÎÓ ÏÓÂ" 8, ìÅ "ñ‡ˈ‡ âÓ‡Ì̇" äÎËÌË͇ ÔÓ Ì‚ÓÎÓ„Ëfl, íÂÎ. 43-44-525


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é·ÁÓ ëöÇêÖåÖççà ÄëèÖäíà çÄ ÖíàéèÄíéÉÖçÖáÄíÄ çÄ ëàçÑêéåÄ çÄ GUILLAIN-BARRE ü. ïËÒÚÓ‚, å. чÒ͇ÎÓ‚, ñ. ñ‡ÌÍÓ‚‡, å. éÓÁÓ‚‡ ä‡Ú‰‡ ÔÓ Ì‚ÓÎÓ„Ëfl - åì, ëÓÙËfl åÅÄã "ñ‡ˈ‡ âÓ‡Ì̇", ëÓÙËfl SUMMARY CURRENT ASPECTS OF THE ETHIOPATOGENESIS OF GUILLAIN-BARRE SYNDROME Y. Hristov, M. Daskalov, Ts. Tsankova, M. Orosova The Guillain-Barre Syndrome (GBS) represents an acute form of autoimmune poliradiculoneuropathy characterised by sluggish paralysis, tendon and periosteal areflexia, non-persistant sensitivity disorder and protein-cellular dissociation in the liquor. The current study is focused on the problems of the disease etiology and pathogenesis, taking into account the latest scientific data. Most common factors causing infectious diseases prior to GBS are as follows: Campylobacter jejuni, Mycoplasma pneumoniae, Human immunodeficiency virus, Haemofilus influenze 1b, Cytomegalovirus, Epstein-Barr virus, more rarely chlamidia, Hepatitis B, streptococci Group A, rabies, influenza on pigs, influenza, morbilli, denga, filariosis, varicella zoster, haemorrhage tick disease. Multiple other sickness states and incidents can be found related when associated with the GBS: neoplasmas, lymphomas, autoimmune disorders, collagenous-vascular affection, sarcoidosis, pregnancy, surgical interventions, epidural anaesthesia, vaccination to warn off rabies, tetanus, varicella and hepatitis Ç. Although concidered earlier as a single disease with a few variants, GBS is presently identified as a group of syndromes with several subtypes. The standard GBS is manifested as an acute or subacute monophase multifocal demyelinisation of the peripheral nerves. The hypothesis assumes that this is an immune-mediated demyelinisation, encompassing humoral and cellular components of the immune system through macrophagesinduced demyelinisation of the peripheral nerves. Key words: Guillain-Barre Syndrome, ethiology, immunology . êÖáûåÖ ëË̉ÓÏ˙Ú Ì‡ Guillain-Barre (ëÉÅ)  ÓÒÚ‡ ‡‚ÚÓËÏÛÌ̇ ÔÓÎË‡‰ËÍÛÎÓÌ‚ÓÔ‡ÚËfl, ı‡‡ÍÚÂËÁË‡˘‡ ÒÂ Ò ‚flÎË Ô‡‡ÎËÁË, ÒÛıÓÊËÎ̇ Ë Ì‡‰ÍÓÒÚ̇ ‡ÂÙÎÂÍÒËfl, ÌÂÔÓÒÚÓflÌÌÓ Ì‡Û¯ÂÌË ̇ ÒÂÚË‚ÌÓÒÚÚ‡ Ë ·ÂÎÚ˙˜ÌÓ - ÍÎÂÚ˙˜Ì‡ ‰ËÒӈˇˆËfl ‚ ÎËÍ‚Ó‡. é·ÂÍÚ Ì‡ ̇ÒÚÓfl˘Ëfl Ó·ÁÓ Ò‡ ÔÓ·ÎÂÏËÚ ̇ ÂÚËÓÎÓ„ËflÚ‡ Ë Ô‡ÚÓ„ÂÌÂÁ‡Ú‡ ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ, ‚ Ò‚ÂÚÎË̇ڇ ̇ Ò˙‚ÂÏÂÌÌËÚ ̇ۘÌË ‰‡ÌÌË. ç‡È - ˜ÂÒÚËÚ Ô˘ËÌËÚÂÎË Ì‡ ËÌÙÂ͈ËÓÁÌË Á‡·ÓÎfl‚‡ÌËfl, Ô‰¯ÂÒÚ‚‡˘Ë ëÉÅ Ò‡: Campylobacter jejuni, Mycoplasma pneumoniae, Human immunodeficiency virus, Haemofilus influenzae 1b , Cytomegalovirus, Epstein-Barr ‚ËÛÒ. èÓ - ‰ÍË ËÌÙÂ͈ËÓÁÌË Á‡·ÓÎfl‚‡ÌËfl Ò‡: ı·ÏˉËÈ̇ ËÌÙÂ͈Ëfl, ıÂÔ‡ÚËÚ Ç, ËÌÙÂ͈Ëfl ÓÚ ÒÚÂÔÚÓÍÓÍË „ÛÔ‡ A, ·flÒ, „ËÔ, ÏÓ·ËÎË, ‰ÂÌ„‡, ÙË·ËÓÁ‡, ‚‡ˈ· ÁÓÒÚÂ, ·ÈÏÒ͇ ·ÓÎÂÒÚ. éÒ‚ÂÌ Úflı ‰ˈ‡ ‰Û„Ë Á‡·ÓÎfl‚‡ÌËfl Ë Ë̈ˉÂÌÚË Ò ÔÓÒÓ˜‚‡Ú ͇ÚÓ ‡ÒÓˆËË‡˘Ë Ò Ò˙Ò Á‡·ÓÎfl‚‡ÌÂÚÓ: ÌÂÓÔ·ÁÏË, ÎËÏÙÓÏË, ‡‚ÚÓËÏÛÌÌË Á‡·ÓÎfl‚‡ÌËfl, ÍÓ·„ÂÌÌÓ - Ò˙‰Ó‚Ë Á‡·ÓÎfl‚‡ÌËfl, Ò‡ÍÓˉÓÁ‡, ·ÂÏÂÌ-

ÌÓÒÚ, ıËÛ„˘ÂÒÍË ËÌÚÂ‚Â̈ËË, ÂÔˉÛ‡Î̇ ‡ÌÂÒÚÂÁËfl, ‚‡ÍÒË̇ˆËË ÒÂ˘Û ·flÒ, ÚÂÚ‡ÌÛÒ, ‚‡ˈ· Ë ıÂÔ‡ÚËÚ Ç. Ç˙ÔÂÍË ˜Â ÔÓ - ‡ÌÓ ëÉÅ Â ‡Á„ÎÂʉ‡Ì ͇ÚÓ Â‰ËÌÌÓ Á‡·ÓÎfl‚‡ÌÂ Ò ‚‡ˇÌÚË, Ò„‡ Ò ‡Á„ÎÂʉ‡ ͇ÚÓ „ÛÔ‡ ÓÚ ÒË̉ÓÏË Ò ÌflÍÓÎÍÓ ‡Á΢ÌË ÒÛ·ÚËÔ‡. ä·Ò˘ÂÒÍËflÚ ëÉÅ ÔÓÚ˘‡ ͇ÚÓ ÓÒÚ‡ ËÎË ÔÓ‰ÓÒÚ‡, ÏÓÌÓÙ‡Á̇ ÏÛÎÚËÙÓ͇Î̇ ‰ÂÏËÂÎËÌËÁ‡ˆËfl ̇ ÔÂËÙÂÌËÚ ÌÂ‚Ë. è‰ÔÓ·„‡ ÒÂ, ˜Â ÚÓ‚‡  ËÏÛÌÓωËË‡Ì‡, Ë̉ۈË‡Ì‡ ÓÚ Ï‡ÍÓÙ‡„ËÚ ‰ÂÏËÂÎËÌËÁ‡ˆËfl, ‚ ÍÓflÚÓ Ò‡ ‚˙‚ΘÂÌË ıÛÏÓ‡ÎÌË Ë ÍÎÂÚ˙˜ÌË ÍÓÏÔÓÌÂÌÚË Ì‡ ËÏÛÌ̇ڇ ÒËÒÚÂχ. äβ˜Ó‚Ë ‰ÛÏË: ëË̉ÓÏ Ì‡ Guillain-Barre, ÂÚËÓÎÓ„Ëfl, ËÏÛÌÓÎÓ„Ëfl. ëË̉ÓÏ˙Ú Ì‡ Guillain-Barre (ëÉÅ)  ÓÒÚ‡ ‡‚ÚÓËÏÛÌ̇ ÔÓÎË‡‰ËÍÛÎÓÌ‚ÓÔ‡ÚËfl, ı‡‡ÍÚÂËÁË‡˘‡ ÒÂ Ò ‚flÎË Ô‡‡ÎËÁË, ÒÛıÓÊËÎ̇ Ë Ì‡‰ÍÓÒÚ̇ ‡ÂÙÎÂÍÒËfl, ÌÂÔÓÒÚÓflÌÌÓ Ì‡Û¯ÂÌË ̇ ÒÂÚË‚ÌÓÒÚÚ‡ Ë ·ÂÎÚ˙˜ÌÓ - ÍÎÂÚ˙˜Ì‡ ‰ËÒӈˇˆËfl ‚ ÎËÍ‚Ó‡. (2) Ç˙ÔÂÍË ˜Â ÔÓ - ‡ÌÓ ëÉÅ Â ‡Á„ÎÂʉ‡Ì ͇ÚÓ Â‰ËÌÌÓ Á‡·ÓÎfl‚‡ÌÂ Ò ‚‡ˇÌÚË, Ò„‡ Ò ‡Á„ÎÂʉ‡ ͇ÚÓ „ÛÔ‡ ÓÚ ÒË̉ÓÏË Ò ÌflÍÓÎÍÓ ‡Á΢ÌË ÒÛ·ÚËÔ‡. èÓ̇ÒÚÓfl˘ÂÏ Ò ‡Á„‡Ì˘‡‚‡Ú ÌflÍÓÎÍÓ ÍÎËÌ˘ÌË ‚‡ˇÌÚ‡ ËÎË ÒÛ·ÚËÔӂ ̇ ëÉÅ ( 퇷Îˈ‡ 1.) 퇷Îˈ‡ 1. äÎËÌ˘ÌË ‚‡ˇÌÚË Ì‡ ÒË̉Óχ ̇ Guillan-Barre ( ÔÓ Y. Lindenbaum , J T Kissel, J R Mendell, Neurol Clinics 2001; 19- 1) ❖ LJˇÌÚË Ò Ô‰ÓÏËÌË‡˘‡ Ò··ÓÒÚ : éÒÚ‡ ËÌÙ·χÚÓ̇ ÔÓÎË‡‰ËÍÛÎÓÌ‚ÓÔ‡ÚËfl (éàÑèç) éÒÚ‡ ÏÓÚÓÌÓ-ÒÂÌÁÓ̇ (éåëÄç)

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éÒÚ‡ ÏÓÚÓ̇ ‡ÍÒÓ̇Î̇ Ì‚ÓÔ‡ÚËfl (éåÄç) ❖ LJˇÌÚË Ò ‰Û„Ë ‰ÓÏËÌË‡˘Ë ÔËÁ̇ˆË ëË̉ÓÏ Ì‡ Miller-Fisher éÒÚ‡ ԇ̇‚ÚÓÌÓÏ̇ Ì‚ÓÔ‡ÚËfl ëÔÓ‰ ‡Á΢ÌË ‡‚ÚÓË „Ӊ˯̇ڇ ˜ÂÒÚÓÚ‡ ̇ ÒË̉Óχ ̇ Guillain-Barre  ÓÚ 1 - 1,5 / 100,000 ÊËÚÂÎË (10). ᇷÓÎfl‚‡ÌÂÚÓ Ò ̇·Î˛‰‡‚‡ ÔÓ - ˜ÂÒÚÓ ÔÂÁ ‚·ÊÌËÚ ÏÂÒÂˆË Ì‡ „Ó‰Ë̇ڇ Ë ÁËχڇ. Ç ÛÏÂÂÌËfl ÔÓflÒ Ì‡ ÄÏÂË͇, Ö‚ÓÔ‡ Ë Ä‚ÒÚ‡ÎËfl ëÉÅ Ò „ËÒÚË‡, ·ÂÁ ‰‡  ÓÚ·ÂÎflÁ‡Ì‡ ÒÂÁÓÌÌÓÒÚ. Ç äËÚ‡È Ë à̉Ëfl ÒÎÛ˜‡ËÚ Ò ۂÂ΢‡‚‡Ú ÔÂÁ ÎÂÚÌËÚ ÏÂÒˆË. 燷≇‚‡ Ò ·ËÙ‡ÁÓ‚Ó ‚˙Á‡ÒÚÓ‚Ó ‡ÁÔ‰ÂÎÂÌË ̇ ·ÓÎÂÒÚÚ‡ - ‰ËÌ ÔËÍ ‚˙‚ ‚˙Á‡ÒÚÚ‡ 15 - 35 „Ó‰ËÌË Ë ‚ÚÓË - ‚˙‚ ‚˙Á‡ÒÚÚ‡ 50 -75 „Ó‰ËÌË. ç‡ ‚˙Á‡ÒÚ ÔÓ‰ 20 „Ó-


‡ÔËÎ, 2002

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

‰ËÌË Ò‡ 30% ÓÚ Ô‡ˆËÂÌÚËÚÂ; ÓÚ Úflı 2/3 Ò‡ ‰Âˆ‡ ÔÓ‰ 8 „Ӊ˯̇ ‚˙Á‡ÒÚ. ш‡ ÔÓ‰ 2 „Ó‰ËÌË ·ÓΉۂ‡Ú ÏÌÓ„Ó fl‰ÍÓ. Ñ‚‡Ú‡ ÔÓ· Ò Á‡Òfl„‡Ú Ò‡‚ÌËÚÂÎÌÓ Â‰Ì‡Í‚Ó, ͇ÚÓ Ò˙ÓÚÌÓ¯ÂÌËÂÚÓ Ï˙ÊÂ: ÊÂÌË Â 1.5 : 1 ( 3:2). (10) àÁıÓ‰˙Ú Á‡‚ËÒË ÓÚ ÏÌÓ„Ó Ù‡ÍÚÓË. èÓÎÓÌ„Ë‡Ì‡ ËÌ‚‡ÎˉËÁ‡ˆËfl Ò ̇·Î˛‰‡‚‡ ‚ „ÓÎflχ ˜‡ÒÚ ÓÚ ·ÓÎÌËÚÂ, ̇È-‚Â˜Â Ò éåÄç ( 5). êÂÁˉۇÎÌË Ì‚ÓÎӄ˘ÌË ÛÒÎÓÊÌÂÌËfl ‚ ‡Á΢̇ ÒÚÂÔÂÌ Ò ̇·Î˛‰‡‚‡Ú ‚ 10%-40% ÓÚ ÒÎÛ˜‡ËÚÂ. (25) åÓ‰ÂÌËÚ ‰ÓÒÚËÊÂÌËfl ̇ ÚÂıÌÓÎӄ˘̇ڇ ωˈË̇ Ë ÔÓ - ÒÔˆˇÎÌÓ Ò˙Á‰‡‚‡ÌÂÚÓ Ì‡ ‡Ô‡‡ÚË Á‡ ‚ÂÌÚËÎË‡Ì ÔÓ‰ ÔÓÎÓÊËÚÂÎÌÓ Ì‡Îfl„‡ÌÂ Ë ‚˙‚Âʉ‡ÌÂÚÓ Ì‡ Ô·ÁχÙÂÂÁ‡Ú‡ ‰Ó‚‰Óı‡ ‰Ó ‰‡Ï‡Ú˘ÌÓ ÔÓ‰Ó·fl‚‡Ì ̇ ÔÓ„ÌÓÁ‡Ú‡ ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ. ëÏ˙ÚÌÓÒÚÚ‡ ÒÔÓ‰ ‡Á΢ÌË ‡‚ÚÓË Ò ‰‚ËÊË ÓÚ 3% ‰Ó 10%.(18). ç‡È-˜ÂÒÚË Ô˘ËÌË Á‡ Ù‡Ú‡ÎÂÌ ËÁıÓ‰ Ò‡: ÂÒÔË‡ÚÓÂÌ ‰ËÒÚÂÒ ÒË̉ÓÏ ÔË ‚˙Á‡ÒÚÌË Ò˙Ò ËÎË ·ÂÁ ÒÂÔÒËÒ, ÚÂÊÍË ‡‚ÚÓÌÓÏÌË ‰ËÒ„Û·ÚÓÌË Ì‡Û¯ÂÌËfl, ·ÂÎÓ‰Ó·ÌË ËÌÙÂ͈ËË ÓÚ ÔÓÎÓÌ„Ë‡Ì‡Ú‡ ËÌÚÛ·‡ˆËfl Ë ·ÂÎÓ‰ӷ̇ ÚÓÏ·ÓÂÏ·ÓÎËfl. çflÍÓË Ì‡˘‡Ú ÒË̉Óχ ̇ Guillain-Barre "ÔÓÚÓÚËÔ Ì‡ ËÌÙÂ͈ËÓÁ̇ ·ÓÎÂÒÚ". èӂ˜ ÓÚ ‰‚ ÚÂÚË ÓÚ Ô‡ˆËÂÌÚËÚ Ò˙Ó·˘‡‚‡Ú, ˜Â Ò‡ ËχÎË Ô‰ıÓʉ‡˘Ó ËÌÙÂ͈ËÓÁÌÓ Á‡·ÓÎfl‚‡Ì 1 - 4 Ò‰ÏËˆË ÔÂ‰Ë Ì‡˜‡ÎÓÚÓ Ì‡ ‡Ú‡Í‡Ú‡.(1) ç‡È-˜ÂÒÚËÚ Ô˘ËÌËÚÂÎË Ì‡ ËÌÙÂ͈ËÓÁÌË Á‡·ÓÎfl‚‡ÌËfl, Ô‰¯ÂÒÚ‚‡˘Ë ëÉÅ Ò‡: Campylobacter jejuni , Mycoplasma pneumoniae(14) , Human immunodeficiency virus (HIV) (4), Haemofilus influenza 1b, Cytomegalovirus, Epstein-Barr ‚ËÛÒ. èÓ-‰ÍË ËÌÙÂ͈ËÓÁÌË Á‡·ÓÎfl‚‡ÌËfl Ò‡: ı·ÏˉËÈ̇ ËÌÙÂ͈Ëfl, ıÂÔ‡ÚËÚ B (11), ÒÚÂÔÚÓÍÓÍÓ‚Ë ËÌÙÂ͈ËË ÓÚ „ÛÔ‡ A, ·flÒ, „ËÔ, ÏÓ·ËÎË (11) ‰ÂÌ„‡ (25), ÙË·ËÓÁ‡ (25), ‚‡ˈ· ËÎË ıÂÔÂÒ ÁÓÒÚÂ (25), ·ÈÏÒ͇ ·ÓÎÂÒÚ(22). éÒ‚ÂÌ Úflı ‰ˈ‡ ‰Û„Ë Á‡·ÓÎfl‚‡ÌËfl Ë Ë̈ˉÂÌÚË Ò ÔÓÒÓ˜‚‡Ú ͇ÚÓ ‡ÒÓˆËË‡˘Ë Ò Ò˙Ò ëÉÅ: ÌÂÓÔ·ÁÏË, ÎËÏÙÓÏË, ‡‚ÚÓËÏÛÌÌË Á‡·ÓÎfl‚‡ÌËfl, ÍÓ·„ÂÌÌÓ - Ò˙‰Ó‚Ë Á‡·ÓÎfl‚‡ÌËfl, Ò‡ÍÓˉÓÁ‡, ·ÂÏÂÌÌÓÒÚ, ıËÛ„˘ÂÒÍË ËÌÚÂ‚Â̈ËË, ÂÔˉÛ‡Î̇ ‡ÌÂÒÚÂÁËfl, ‚‡ÍÒË̇ˆËË ÒÂ˘Û ·flÒ, ÚÂÚ‡ÌÛÒ, ‚‡ˈ· Ë ıÂÔ‡ÚËÚ Ç (25) èÂÁ 1976 „Ó‰Ë̇ ‚ ç˛ ÑÊ˙ÒË, ëÄô,  ̇·Î˛‰‡‚‡Ì‡ ÂÔˉÂÏËfl ÓÚ ëÉÅ ÒΉ ‚‡ÍÒË̇ˆËfl Ò ÔÓÚË‚Ó„ËÔ̇ ‚‡ÍÒË̇ (16). íÂÁË ‰‡ÌÌË ı‚˙ÎflÚ Ò‚ÂÚÎË̇ ‚˙ıÛ ÌflÍÓË ÒÚ‡ÌË ÓÚ Ô‡ÚÓ„ÂÌÂÁ‡Ú‡ ̇ ËÏÛÌÓωËË‡Ì‡Ú‡ Ì‚ÓÔ‡ÚËfl Ë ÔÓÚ˘‡ÌÂÚÓ Ì‡ ·ÓÎÂÒÚÚ‡. (12). ç‡ ·‡Á‡Ú‡ ̇ 1034 ÒÎÛ˜‡fl Harthwitz ES Ë Ò˙‡‚Ú. (11) ÛÒÚ‡ÌÓ‚fl‚‡Ú, ˜Â ‚ 58% ÓÚ ÒÎÛ˜‡ËÚ ·ÓÎÂÒÚÚ‡ Ò Ô‰¯ÂÒÚ‚‡ ÓÚ ÂÒÔË‡ÚÓÌÓ Á‡·ÓÎfl‚‡ÌÂ, 22% - ÓÚ „‡ÒÚÓËÌÚÂÒÚË̇ÎÌÓ, 5% - ÓÚ Ôӂ‰Â̇ ÓÔÂ‡Ú˂̇ ËÌÚÂ‚Â̈Ëfl Ë 4,5% - ÓÚ ‚‡ÍÒË̇ˆËfl. Ç ÔÓ - ÌÓ‚Ó ËÁÒΉ‚‡Ì ̇ Jacobs Ë Ò˙‡‚Ú. Ò ÛÒÚ‡ÌÓ‚fl‚‡, ˜Â Ì‡È - ˜ÂÒÚËÚ Ô‰¯ÂÒÚ‚‡˘Ë ËÌÙÂ͈ËË Ò‡: ‚ 32% Campylobacter jejuni, 13% Cytomegalovirus, 10% Epstein-Barr ‚ËÛÒ, 5% Mycoplasma pneumoniae, 1% Haemofilus influenza, 1% Parainfluenza 1 ‚ËÛÒ, 1% Influenza Ä ‚ËÛÒ, 1% Influenza Ç ‚ËÛÒ, 1% Adenoviruses, 1% Herpes zoster ‚ËÛÒ. (14) Campylobacter jejuni ‰ÓÏËÌË‡ ‚ ÎËÚÂ‡ÚÛ‡Ú‡ ͇ÚÓ Ì‡È - ˜ÂÒÚ ËÌÙÂ͈ËÓÁÂÌ ‡„ÂÌÚ, Ô‰¯ÂÒÚ‚‡˘ ëÉÅ. (14,23) Ç Á‡Ô‡‰ÌËÚ ÒÚ‡ÌË ÚÓÈ Ò ‰Ó͇Á‚‡ ÔË 33% ÓÚ Á‡·ÓÎÂÎËÚÂ, ‡ ‚ äËÚ‡È Ë üÔÓÌËfl - ÔË 45-60%.(11,14,29). ëΉ ËÌÙÂ͈Ëfl Ò Campylobacter jejuni ëÉÅ ÔÓÚ˘‡ ÚÂÊÍÓ, Ò ‡Á‚ËÚË ̇ ‡ÍÒÓ̇Î̇ ‰Â„ÂÌÂ‡ˆËfl, ÍÓflÚÓ Ò Ò¢‡ Ò‡ÏÓÒÚÓflÚÂÎÌÓ ËÎË ‚ ÍÓÏ·Ë̇ˆËfl Ò ‰ÂÏËÂÎËÌËÁ‡ˆËfl Ë Ëχ ÎÓ¯‡ ÔÓ„ÌÓÁ‡ (6). í‡ÁË Í‡ÚË̇  ÛÒÚ‡ÌÓ‚Â̇ ÔË „ÛÔ‡ Á‡·ÓÎÂÎË ‰Âˆ‡ ‚ äËÚ‡È. èË 90% ÓÚ Úflı Ò‡ ÛÒÚ‡ÌÓ‚ÂÌË ÒÂÓÎӄ˘ÌË ‰Ó͇Á‡ÚÂÎÒÚ‚‡ Á‡ Campylobacter jejuni ËÌÙÂ͈Ëfl. (20) éÒÓ·ÂÌ ËÌÚÂÂÒ ÔÂÒÚ‡‚Îfl‚‡ Campylobacter jejuni -ÒÂÓÚËÔ Penner19, Ò‚˙Á‚‡Ì Ò

43

ëÉÅ.(17) ÑÓ͇Á‡Ì‡  ıÓÏÓÎÓÊÌÓÒÚ ÏÂÊ‰Û ˜‡ÒÚ ÓÚ ÎËÔÓÔÓÎËÁ‡ı‡ˉ̇ڇ Ò˙ÒÚ‡‚͇ ̇ Penner19 Ë Í‡·Óıˉ‡ÚÌËfl Í‡È ̇ „‡Ì„ÎËÓÁˉ GM1 (13). íÓÁË Ù‡ÍÚ ÔÓ‰ÍÂÔfl ıËÔÓÚÂÁ‡Ú‡, ˜Â ‚ ÌflÍÓË ÒÎÛ˜‡Ë ëÉÅ ÏÓÊ ‰‡ ·˙‰Â ωËË‡Ì ÓÚ ÍÓÒ‡ÍÚË‚ÌË ‡ÌÚËÚ·, ̇ÒÓ˜ÂÌË ÒÂ˘Û ÔÂËÙÂÌÓÌÂ‚ÌËfl ÏËÂÎËÌ, ˜ËflÚÓ ÔÓ‰Û͈Ëfl  ÚË„ÂË‡Ì‡ ÓÚ ‚˙̯ÌË ıÓÏÓÎÓÊÌË ‡ÌÚË„ÂÌË. èË ëÉÅ, ‡ÒÓˆËË‡Ì Ò ˆËÚÓÏ„‡ÎÓ‚ËÛÒ̇ ËÌÙÂ͈Ëfl, ÔÓ-˜ÂÒÚÓ Ò ‚˙‚΢‡Ú Í‡ÌˇÎÌËÚ ÌÂ‚Ë Ë ÔËÒ˙ÒÚ‚‡ ÔÓ - ÚÂÊ͇ ÒÂÌÁÓ̇ Û‚‰‡, ‡ ‚ ÒÂÛχ ̇ ·ÓÎÌËÚ Ò ÓÚÍË‚‡Ú ‡ÌÚËÚ· ÒÂ˘Û „‡Ì„ÎËÓÁˉ GM2(25). ç Ò˙˘ÂÒÚ‚Û‚‡Ú, Ó·‡˜Â, ‰Ó͇Á‡ÚÂÎÒÚ‚‡, ˜Â Cytomegalovirus Û‚Âʉ‡ ‰ËÂÍÚÌÓ ÌÂ‚ËÚ ÔË ëÉÅ. ä‡ÚÓ „ÂÌÂÚ˘ÂÌ ËÒÍÓ‚ Ù‡ÍÚÓ Á‡ ·ÓÎÂÒÚÚ‡ Ò ÔÓÒÓ˜‚‡ ıÓÏÓÁË„ÓÚÌÓÒÚ ÔÓ ‡ÎÂÎ FcyRIIa-H131, ‰Ó͇Á‚‡Ì‡ ˜ÂÒÚÓ ÔË ·ÓÎÌË ÓÚ ëÉÅ. èÓÚ˘‡ÌÂÚÓ Ì‡ ·ÓÎÂÒÚÚ‡ ÔË ıÓ‡ Ò ÚÓÁË „ÂÌÓÚËÔ Â ÔÓ - ÚÂÊÍÓ. (2,25) ä·Ò˘ÂÒÍËflÚ ëÉÅ ÔÓÚ˘‡ ͇ÚÓ ÓÒÚ‡ ËÎË ÔÓ‰ÓÒÚ‡, ÏÓÌÓÙ‡Á̇ ÏÛÎÚËÙÓ͇Î̇ ‰ÂÏËÂÎËÌËÁ‡ˆËfl ̇ ÔÂËÙÂÌËÚ ÌÂ‚Ë. è‰ÔÓ·„‡ ÒÂ, ˜Â ÚÓ‚‡  ËÏÛÌÓωËË‡Ì‡, Ë̉ۈË‡Ì‡ ÓÚ Ï‡ÍÓÙ‡„ËÚ ‰ÂÏËÂÎËÌËÁ‡ˆËfl ̇ ÔÂËÙÂÌËÚ ÌÂ‚Ë, ‚ ÍÓflÚÓ Ò‡ ‚˙‚ΘÂÌË ıÛÏÓ‡ÎÌË Ë ÍÎÂÚ˙˜ÌË ÍÓÏÔÓÌÂÌÚË Ì‡ ËÏÛÌ̇ڇ ÒËÒÚÂχ. çflχ, Ó·‡˜Â, ˉÂÌÚËÙˈË‡ÌË ÚÓ˜ÌÓ ÓÔ‰ÂÎÂÌË ‡ÌÚË„ÂÌË, ÒÂ˘Û ÍÓËÚÓ ‰‡  ̇ÒÓ˜ÂÌ ÚÓÁË ËÏÛÌÂÌ ÓÚ„Ó‚Ó. à‰ÂflÚ‡ Á‡ ËÏÛÌÓÔ‡ÚÓ„ÂÌÂÁ‡Ú‡ ̇ ÒË̉Óχ ̇ Guillain-Barre ˉ‚‡ ÓÚ Ì‡Û˜ÌËÚ ‡Á‡·ÓÚÍË Ì‡ Waksman Ë Adams ÓÚ 1959 „Ó‰Ë̇ (31). í ÓÔËÒ‚‡Ú ÂÍÒÔÂËÏÂÌÚ‡ÎÂÌ ÏÓ‰ÂÎ, ÔÓ‰Ó·ÂÌ Ì‡ ÒË̉Óχ ̇ Guillain-Barre, ÍÓÈÚÓ Ì‡˘‡Ú ÂÍÒÔÂËÏÂÌÚ‡ÎÂÌ ‡ÎÂ„˘ÂÌ Ì‚ËÚ (ÖÄç). ì˜ÂÌËÚ ÛÒÚ‡ÌÓ‚fl‚‡Ú, ˜Â ËÌÓÍÛ·ˆËflÚ‡ ̇ Á‡ÈˆË Ò ‡ÌÚË„ÂÌ ÓÚ ÔÂËÙÂÌË ÌÂ‚Ë ‚Ó‰Ë ‰Ó ÒËÏÂÚ˘̇ Ô‡‡ÎËÁ‡ ̇ Í‡ÈÌˈËÚ ‚ ‡ÏÍËÚ ̇ 2 Ò‰ÏˈË. Ç ÚÓÁË ÒÎÛ˜‡È ‡Á‚ËÚËÂÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ Ò Ë̉ۈË‡ ÓÚ í- ÎËÏÙÓˆËÚËÚÂ, ÍÓÂÚÓ ÔÓ‰Ò͇Á‚‡ ÔÓ - ‚‡Ê̇ڇ ÓÎfl ̇ ÍÎÂÚ˙˜ÌÓωËË‡ÌËfl ËÏÛÌËÚÂÚ. Ç ÔÓ‰ÍÂÔ‡ ̇ ÚÓ‚‡ Ò‡ ‰‡ÌÌËÚ Á‡ ‚ËÒÓÍË ÌË‚‡ ̇ IL-2 ˆÂÔÚÓËÚ ‚ Í˙‚Ú‡ ̇ ·ÓÎÌË Ò˙Ò ëÉÅ (28). ÖÍÒÔÂËÏÂÌÚ‡ÎÌËflÚ ‡ÎÂ„˘ÂÌ Ì‚ËÚ Â ÍÎËÌ˘ÌÓ, ÂÎÂÍÚÓÙËÁËÓÎӄ˘ÌÓ Ë Ô‡ÚÓÎӄӇ̇ÚÓÏ˘ÌÓ ÔÓ‰Ó·ÂÌ Ì‡ ëÉÅ, Ìo e ‚˙ÁÏÓÊÌÓ ËÏÛÌÓÎӄ˘ÌËflÚ ÏÂı‡ÌËÁ˙Ï, ÔÓ ÍÓÈÚÓ Ò ‡Á‚Ë‚‡, ‰‡  ‡Á΢ÂÌ ÓÚ ÚÓÁË ÔË ëÉÅ. àχ ÒÂËÓÁÌË ‰Ó͇Á‡ÚÂÎÒÚ‚‡ ‚ ÔÓ‰ÍÂÔ‡ ̇ ‚‡Ê̇ڇ ÓÎfl Ë Ì‡ ıÛÏÓ‡ÎÌËfl ËÏÛÌÂÌ ÓÚ„Ó‚Ó ‚ Ô‡ÚÓ„ÂÌÂÁ‡Ú‡ ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ. àÌÚ‡Ì‚‡ÎÌÓÚÓ ËÌÊÂÍÚË‡Ì ̇ ÒÂÛÏ ÓÚ ÊË‚ÓÚÌÓ Ò ÖÄç Ô‰ËÁ‚ËÍ‚‡ in vitro ‰ÂÏËÂÎËÌËÁ‡ˆËfl (27). èÓ‰Ó·ÌË ÂÁÛÎÚ‡ÚË Ò‡ ÔÓÒÚ˄̇ÚË Ë ÔË ËÁÔÓÎÁ‚‡Ì ̇ ÒÂÛÏ ÓÚ ·ÓÎÌË Ò˙Ò ëË̉Óχ ̇ Guillain-Barre(5). ÄÌÚËÚ·, ÙËÍÒË‡ÌË ‚˙ıÛ ë1 ÍÓÏÔÎÂÏÂÌÚ‡ ( ‡ÌÚË PNM - ‡ÌÚËÚ· ÒÂ˘Û ÏËÂÎË̇ ̇ ÔÂËÙÂÌËÚ ÌÂ‚Ë ), Ò ‰Ó͇Á‚‡Ú ‚ ÒÂÛχ ̇ ·ÓÎÌË ‚ ÓÒÚ‡Ú‡ Ù‡Á‡ ̇ ëÉÅ Ë ÍÎË˙ÌÒ˙Ú Ì‡ ÚÂÁË ‡ÌÚËÚ· ÍÓÂÎË‡ ‰Ó·Â Ò ÔÓ‰Ó·fl‚‡ÌÂÚÓ Ì‡ Ì‚ÓÎӄ˘ÌËfl ÒÚ‡ÚÛÒ. (15) è‰ÔÓ·„‡ ÒÂ, ˜Â ÍÓÏÔÎËÏÂÌÚÒ‚˙Á‡ÌËÚ ‡ÌÚËÚ· Ò‡ ̇ÒÓ˜ÂÌË ÒÂ˘Û ÌÂÛÚ‡ÎÌËÚ „ÎËÍÓÎËÔË‰Ë Ë ‰Û„Ë ÍÓÏÔÓÌÂÌÚË Ì‡ PNM. åËÂÎËÌ˙Ú Ì‡ ÔÂËÙÂÌËÚ ÌÂ‚Ë Â ‡Á΢ÂÌ ÓÚ ÏËÂÎË̇ ̇ ñçë Ë ‚ÂÓflÚÌÓ ÏÂı‡ÌËÁÏ˙Ú Ì‡ ‰ÂÏËÂÎËÌËÁ‡ˆËfl ‚ ÔÂËÙÂËflÚ‡ Ë ‚ „·‚ÌËfl ÏÓÁ˙Í Â ‡Á΢ÂÌ. ç‡È - ‚‡ÊÌËÚ ÔÓÚÂËÌË Ì‡ ÔÂËÙÂÌËfl ÏËÂÎËÌ Ò‡ P0, MBP Ë P2. àχ ÏÌÓ„Ó ‡Á΢ÌË ÎËÔË‰Ë ‚ ÏËÂÎË̇ ̇ ÔÂËÙÂÌËÚ ÌÂ‚Ë: „‡Î‡ÍÚÓˆÂ·ÓÁˉ, ÒÛÎÙ‡Úˉ, LM1, GM1, GD1a, GD1b, GQ1b, Asilo - GM1, SGPG, Fossman -‡ÌÚË„ÂÌ (19), ÍÓËÚÓ Ô‰ËÁ‚ËÍ‚‡Ú „ÓÎflÏ ËÌÚÂÂÒ. Ç ÂÍÒÔÂËÏÂÌÚ‡ÎÌË ÏÓ‰ÂÎË Ì‡ ëÉÅ Ò‡ ÓÚÍË‚‡ÌË ‡ÌÚËÚ· ÒÂ˘Û ê2 Ë „‡Î‡ÍÚÓˆÂ·ÓÁˉ‡ ̇ ÏËÂÎË̇ ̇ ÔÂËÙÂÌËÚ ÌÂ‚Ë, ÌÓ ÔË ıÓ‡ Ú ҇ ˉÂÌÚËÙˈË‡ÌË Ò‡ÏÓ ‚ ‰ÍË ÒÎÛ˜‡Ë. èË ÌflÍÓË Ô‡ˆËÂÌÚË Ò ÓÒÓ·ÂÌÓ ÓÒÚÓ Ë ÚÂÊÍÓ ÔÓÚ˘‡Ì ̇ ·ÓÎÂÒÚÚ‡ Ëχ ‰Ó͇Á‡ÚÂÎÒÚ‚‡, ˜Â Ú‡„ÂÚÌËflÚ ‡Ì-


‡ÔËÎ, 2002

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

ÚË„ÂÌ Â „‡Ì„ÎËÓÁˉ. ÄÌÚË„‡Ì„ÎËÓÁˉÌËÚ ‡ÌÚËÚ· Ô˂΢‡Ú ‚ÌËχÌËÂÚÓ Ì‡ ËÁÒΉӂ‡ÚÂÎËÚ ͇ÚÓ ‚˙ÁÏÓÊÌË ‡„ÂÌÚË, Ô˘ËÌfl‚‡˘Ë ÌÂ‚ÌËÚ ۂÂ‰Ë ÔË ëÉÅ. (8) í˙ÒÂÌÂÚÓ Ì‡ ıÛÏÓ‡ÎÌË Ï‡ÍÂË ÔÓ͇Á‚‡ ‡ÌÚËÚ· Í˙Ï GM1, LM 1, b-tubulin(3). ÄÌÚËÚ· ÒÂ˘Û Gå1 Ò ÛÒÚ‡ÌÓ‚fl‚‡Ú ÔË 10-30% ÓÚ Ô‡ˆËÂÌÚËÚ Ò˙Ò ëÉÅ (30,19), ‡ ÍÓ„‡ÚÓ Â ‡ÒÓˆËË‡Ì Ò C. jejuni- ËÌÙÂ͈Ëfl - ÔË 60% ÓÚ Ô‡ˆËÂÌÚËÚÂ. àχ ‰Ó͇Á‡ÚÂÎÒÚ‚‡ Á‡ Ò˙˘ÂÒÚ‚Û‚‡˘‡ Í˙ÒÚÓ҇̇ ‡ÍÚË‚ÌÓÒÚ ÏÂÊ‰Û C. jejuni- ËÌÙÂ͈Ëfl Ë ëÉÅ (32). ëÔÓ‰ ÌflÍÓË, ̇΢ËÂÚÓ Ì‡ ÚÂÁË ‡ÌÚËÚ· ÓÚ‰ËÙÂÂ̈Ë‡ ÔÓ‰„ÛÔ‡ ÓÚ ·ÓÎÌË Ò ÔÓ- ÚÂÊÍÓ ÔÓÚ˘‡Ì ̇ ·ÓÎÂÒÚÚ‡ (9). é·˘‡Ú‡ ˜ÂÒÚÓÚ‡ ̇ ‡ÌÚËÚ·ڇ ÒÂ˘Û ÍËÒÂÎË „ÎËÍÓÔÂÔÚË‰Ë Â 68% . ÄÌÚËÚ· ÒÂ˘Û „‡Ì„ÎËÓÁˉ GQ1b Ò‡ ÓÔËÒ‚‡ÌË ÔË 90% ÓÚ ÒÎÛ˜‡ËÚ Ò˙Ò ÒË̉Óχ ̇ Miller-Fisher.(33) ÄÌÚËÚ· ÒÂ˘Û ‰Û„ËÚ „‡Ì„ÎËÓÁË‰Ë GD1a Ë GD1b Ò‡ ÓÔËÒ‡ÌË Ë ÔË ÚÂÊ˙Í ‡ÍÒÓ̇ÎÂÌ ëÉÅ. (34) ó‡ÒÚ ÓÚ ËÁÒΉӂ‡ÚÂÎËÚ Á‡ÒÚ˙Ô‚‡Ú ÚÂÁ‡Ú‡, ˜Â Ì Ò˙˘ÂÒÚ‚Û‚‡ ÍÓ·ˆËfl ÏÂÊ‰Û ÚÂÊÂÒÚÚ‡, ËÁıÓ‰‡ ËÎË ‚ˉ‡ ̇ ÔÓÎËÌ‚ÓÔ‡ÚËflÚ‡ (‡ÍÒÓ̇Î̇ ËÎË ‰ÂÏËÂÎËÌËÁË‡˘‡) Ë ‡ÌÚËÚ·ڇ Í˙Ï C.jejuni ËÎË „‡Ì„ÎËÓÁˉËÚÂ. (30). ç  flÒ̇ ‰ÓÍ‡È ÓÎflÚ‡ ̇ ‡ÌÚË - GM1 - ‡ÌÚËÚ·ڇ ‚ Ô‡ÚÓ„ÂÌÂÁ‡Ú‡, ÌÓ Ëχ ‰Ó͇Á‡ÚÂÎÒÚ‚‡, ˜Â ÒÂÛÏ Ì‡ ·ÓÎÂÌ Ò ‡ÌÚË GM1 - ‡ÌÚËÚ· Ô‰ËÁ‚ËÍ‚‡ ‰ÂÏËÂÎËÌËÁ‡ˆËfl. Ç ÔÓÛ˜‚‡Ì ̇ ÍËÚ‡ÈÒÍË Ô‡ˆËÂÌÚË, ‚ 60% ÓÚ ÒÎÛ˜‡ËÚ ̇ éåÄç  ËχÎÓ ÒË„ÌËÙË͇ÚÌÓ ÔÓ͇˜ÂÌË ÚËÚË Ì‡ IgG ‡ÌÚËÚ· ÒÂ˘Û GD1a Ë Ò‡ÏÓ ÔË 4% ÓÚ ÚÂÁË Ò éàÑèç (8). á̇˜ËÚÂÎÂÌ ·ÓÈ ÓÚ Ô‡ˆËÂÌÚËÚÂ Ò éMëAç ËÏ‡Ú ÒÂÛÏÌË ‡ÌÚËÚ· Í˙Ï GM1. éÍÓÎÓ 21% ÓÚ ·ÓÎÌËÚ ËÏ‡Ú ‚ËÒÓÍË ÌË‚‡ ̇ IgG - ‡ÌÚËÚ· ÒÂ˘Û LM1 („ÎËÍÓÔÂÔÚˉ ÎÓ͇ÎËÁË‡Ì ‚ ÏËÂÎË̇ ̇ ÔÂËÙÂÌËÚ ÌÂ‚Ë). íÓÈ, ÏÓÊ ·Ë,  ÒÔˆËÙ˘ÂÌ Ú‡„ÂÚÂÌ ‡ÌÚË„ÂÌ ÔË ÌflÍÓË ·ÓÎÌË Ò˙Ò ëÉÅ. ÇËÒÓÍË ÒÂÛÏÌË ÚËÚË Ì‡ IgG ËÎË Igå ‡ÌÚËÚ·, ÍÓËÚÓ Ò‚˙Á‚‡Ú ÒÂÎÂÍÚË‚ÌÓ b-tubulin, Ò ÓÚÍË‚‡Ú ‚ 20% ÓÚ Ô‡ˆËÂÌÚËÚ (7). éÒ‚ÂÌ ‡ÌÚËÚ·ڇ Ëχ Ë ‰Û„Ë Ù‡ÍÚÓË, ÍÓËÚÓ Û˜‡ÒÚ‚‡Ú ‚ ËÏÛÌÌËfl ÓÚ„Ó‚Ó ÔË ëÉÅ. íÓ‚‡ Ò‡ ë3‡ Ë ë5‡ Ù‡ÍˆËË Ì‡ ÍÓÏÔÎÂÏÂÌÚ‡, ÎËÏÙÓÍËÌË, ‡‰ıÂÁËÓÌÌË ÏÓÎÂÍÛÎË. (18,21). Ç˙ÁÏÓÊÌÓ Â, ÒÂÍˆËflÚ‡ ̇ ÚÂÁË ÌÂÒÔˆËÙ˘ÌË ËÌÙ·χÚÓÌË ÔÓ‰ÛÍÚË ‰‡ Ë̉ۈË‡ Ô˙‚˘̇ ‰ÂÏËÂÎËÌËÁ‡ˆËfl, ÌÓ Ú‡ÁË ıËÔÓÚÂÁ‡ Ò ÌÛʉ‡Â ÓÚ ÂÍÒÔÂËÏÂÌÚ‡ÎÌÓ ÔÓÚ‚˙ʉ‡‚‡ÌÂ. í˙ÒÂÌÂÚÓ Ì‡ ÒÔˆËÙ˘ÌË ‰ÂÏËÂÎËÌËÁË‡˘Ë ‡ÌÚËÚ· ÔÓ‰˙Îʇ‚‡. Ç˙ÔÓÒ˙Ú Á‡ Ú‡„ÂÚÌËfl ÌÓ‰‡ÎÂÌ ‡ÌÚË„ÂÌ ÔË éåÄç Ë éåëÄç ÔÓ‰˙Îʇ‚‡ ‰‡ ·˙‰Â ËÁflÒÌfl‚‡Ì. èË ‰‚ÂÚ Ò˙ÒÚÓflÌËfl ÏÓÎÂÍÛÎfl̇ڇ ÏËÏËÍËfl Ò Ô‰·„‡ ͇ÚÓ Ó·flÒÌÂÌË ̇ Ô˙‚˘̇ڇ ‡ÍÒÓ̇Î̇ ‡Ú‡Í‡ (12, 26). á̇ ÒÂ, ˜Â ‰‚ÂÚ Á‡·ÓÎfl‚‡ÌËfl Ò ‡Á‚Ë‚‡Ú ÒΉ ËÌÙÂ͈Ëfl Ò Í‡ÏÔËÎÓ·‡ÍÚÂ Ë Â ‰ÓÒÚ‡ ‡Ú‡ÍÚË‚ÌÓ ‰‡ Ò ‡Á„ÎÂʉ‡ ËÏÛÌÌËflÚ ÓÚ„Ó‚Ó ͇ÚÓ Ì‡ÒÓ˜ÂÌ Â‰ÌÓ‚ÂÏÂÌÌÓ ÒÂ˘Û ·‡ÍÚÂËfl Ë ÒÂ˘Û ÌÓ‰‡Î̇ڇ ‡ÍÒÓÎÂχ. (9) èË Í·Ò˘ÂÒÍËfl ëÉÅ ‰ÂÏËÂÎËÌËÁ‡ˆËflÚ‡ Ò ÔËÂχ Á‡ Ô˙‚˘ÂÌ Ô‡ÚÓÎӄ˘ÂÌ ÔÓˆÂÒ (15), ‡ ‡ÍÒÓ̇Î̇ڇ ‰Â„ÂÌÂ‡ˆËfl - ͇ÚÓ ‚ÚÓ˘ÂÌ ËÎË ÒÎÛ˜‡ÈÌÓ Ì‡·Î˛‰‡‚‡Ì ÂÙÂÍÚ. èÂËÙÂÌËÚ ÌÂ‚Ë ÏÓ„‡Ú ‰‡ ·˙‰‡Ú Á‡Ò„̇ÚË Ì‡ ‚Ò˘ÍË ÌË‚‡ - ÓÚ ÍÓÂ̘ÂÚ‡Ú‡ ‰Ó ‰ËÒÚ‡ÎÌËÚ ËÌÚ‡ÏÛÒÍÛÎÌË ÍÎÓ̘ÂÚ‡, ÌÓ Û‚‰ËÚ Á‡Òfl„‡Ú Ì‡È - ÏÌÓ„Ó ‚ÂÌÚ‡ÎÌËÚ ÍÓÂ̘ÂÚ‡, ÔÓÍÒËχÎÌËÚ ÒÔË̇ÎÌË ÌÂ‚Ë Ë ÔÓ - ‰ÓÎÌËÚ Í‡ÌˇÎÌË ÌÂ‚Ë. àÌÚÂÌÁ˂̇ڇ ËÌÙ·χˆËfl ÏÓÊ ‰‡ ‰Ó‚‰ ‰Ó ‡ÍÒÓ̇Î̇ ‰Â„ÂÌÂ‡ˆËfl, ͇ÚÓ ÒΉÒÚ‚Ë ̇ ̇·Î˛‰‡‚‡ÌËfl ÚÓÍÒ˘ÂÌ ÂÙÂÍÚ. åÂı‡ÌËÁÏ˙Ú Ì‡ ‰ÂÏËÂÎËÌËÁ‡ˆËflÚ‡ Ò ҂˙Á‚‡ Ò ÎËÏÙÓˆËÚ̇ ËÎË Ï‡ÍÓÙ‡„ˇÎ̇ ËÌÙËÎÚ‡ˆËfl (24). è‰ÔÓ·„‡ ÒÂ, ˜Â ÎËÏÙÓˆËÚËÚ ÔÂÏË̇‚‡Ú ÔÂÁ ẨÓÚ· ̇ ẨÓÌ‚‡ÎÌËÚ Ò˙‰Ó‚Â Ë ÔÓÔ‡‰‡Ú ‚ ÔÂˇÍÒÓ̇ÎÌÓÚÓ ÔÓÒÚ‡ÌÒÚ‚Ó. å‡ÍÓÙ‡„ËÚ ‡Ú‡ÍÛ‚‡Ú ·‡Á‡Î̇ڇ ·-

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ÏË̇ ̇ ò‚‡ÌÓ‚ËÚ ÍÎÂÚÍË Ë ‡ÁÛ¯‡‚‡Ú ÏËÂÎËÌÓ‚‡Ú‡ Ó·‚˂͇ ̇ ‡ÍÒÓ̇. àÌÙ·χÚÓÌËÚ ËÌÙËÎÚ‡ÚË Ò˙‰˙Ê‡Ú „·‚ÌÓ Ï‡ÍÓÙ‡„Ë Ë í - ÎËÏÙÓˆËÚË. Ç ò‚‡ÌÓ‚ËÚ ÍÎÂÚÍË Ò ۂÂ΢‡‚‡ ÂÍÒÔÂÒËflÚ‡ ̇ ÍÎ‡Ò II ‡ÌÚË„ÂÌË, ÍÓÂÚÓ Ò˙Á‰‡‚‡ ‚˙ÁÏÓÊÌÓÒÚ ò‚‡ÌÓ‚ËÚ ÍÎÂÚÍË ‰‡ Ë„‡flÚ ÓÎflÚ‡ ̇ ‡ÌÚË„ÂÌ Á‡ ‡‚ÚÓ‡ÍÚË‚ÌËÚ í-ÎËÏÙÓˆËÚË Ë ‡ÍÚË‚‡ÚÓ ̇ ‰ÂÒÚÛ͈ËflÚ‡ ̇ ÏËÂÎË̇. ë ̇Ô‰‚‡Ì ̇ ÔÓˆÂÒ‡, ‚ ‰ÓÔ˙ÎÌÂÌË ̇ Û‚Âʉ‡ÌÂÚÓ Ì‡ ÏËÂÎË̇ Ò ̇·Î˛‰‡‚‡ Ë ‡ÍÒÓ̇ÎÌÓ Á‡Òfl„‡ÌÂ. Ç ÂÁÛÎÚ‡Ú Ì‡ ÚÓ‚‡ ̇ÒÚ˙Ô‚‡ ‡ÚÓÙËfl ̇ ËÌÂ‚Ë‡ÌËÚ ÏÛÒÍÛÎË. ÄÍÓ ‡ÍÒÓ̇ÎÌËÚ ۂÂ‰Ë Ò‡ ‰ËÒÚ‡ÎÌË, Ú·ڇ ̇ ÌÂ‚ÌËÚ ÍÎÂÚÍË ÔÂÊË‚fl‚‡Ú Ë ÏÓÊ ‰‡ Ò Ә‡Í‚‡ ÔÓÒΉ‚‡˘‡ ‡ÍÒÓ̇Î̇ „ÂÌÂ‡ˆËfl; ‡ÍÓ, Ó·‡˜Â, Ò‡ ÔÓÍÒËχÎÌË, ÍÎÂÚ˙˜ÌÓÚÓ ÚflÎÓ ÛÏË‡ Ë Ìflχ ‡ÍÒÓ̇Î̇ „ÂÌÂ‡ˆËfl. áÄäãûóÖçàÖ ëË̉ÓÏ˙Ú Ì‡ Guillain-Barre Â Ì‡È - ˜ÂÒÚ‡Ú‡ Ô˘Ë̇ Á‡ ÓÒÚ‡ ÔÂËÙÂ̇ Ô‡‡ÎËÁ‡ ‚ ÒÚ‡ÌËÚÂ, Í˙‰ÂÚÓ Ì Ò „ËÒÚË‡Ú ÒÎÛ˜‡Ë Ò ÔÓÎËÓÏËÂÎËÚ. Ç˙ÔÂÍË, ˜Â ÔÓ-‡ÌÓ Â ‡Á„ÎÂʉ‡Ì ͇ÚÓ Â‰ËÌÌÓ Á‡·ÓÎfl‚‡ÌÂ Ò ÍÎËÌ˘ÌË ‚‡ˇÌÚË, Ò„‡ Ò ‡Á„ÎÂʉ‡ ͇ÚÓ „ÛÔ‡ ÓÚ ÒË̉ÓÏË Ò ÌflÍÓÎÍÓ ‡Á΢ÌË ÒÛ·ÚËÔ‡ (4). Å˙‰Â˘ËÚ ‡ÒÔÂÍÚË Ì‡ ̇ۘÌËÚ ËÁÒΉ‚‡ÌËfl Ò‡ ̇ÒÓ˜ÂÌË Í˙Ï Ë‰ÂÌÚËÙˈË‡Ì ̇ Ú‡„ÂÚÌËÚ ‡ÌÚË„ÂÌË Ì‡ ËÏÛÌÌËfl ÓÚ„Ó‚Ó Ë ÚÓ˜ÌËfl ÏÂı‡ÌËÁ˙Ï, ÔÓ ÍÓÈÚÓ ‰ÂÈÒÚ‚‡Ú ÏËÂÎËÌÓÚÓÍÒ˘ÌËÚÂ Ë Ì‚ÓÚÓÍÒ˘ÌËÚ ıÛÏÓ‡ÎÌË Ë ÍÎÂÚ˙˜ÌË Ù‡ÍÚÓË. ãàíÖêÄíìêÄ 1. чÒ͇ÎÓ‚ å , çËÍÓ‚ÒÍË ç, âÓ‰‡ÌÓ‚ Ç, ìÁÛÌÓ‚ ç, äÂ̇Ó‚ è. èÓÎË‡‰ËÍÛÎÓÌ‚ËÚ Ì‡ Guillain-Barre. èÓ·ÎÂÏË Ì‡ Ì‚ÓÎÓ„ËflÚ‡, ÔÒËıˇÚËflÚ‡ Ë Ì‚ÓıËÛ„ËflÚ‡. íÓÏ ïIV, 1986; 63 - 72 2 Asbury AK New concepts of Guillain-Barre syndrome. J Child Neurol2000;15:183-91 3. Cannoly AM, Pestronk A, Trotter JL et all. High titer selective anti - ? - tubulin antibodies in chronic inflammatory demyelinating polyneuropathy. Neurology 1993; 43: 557 - 562 4. Cornbalth PR, McArthus JC, Kennedy PGE et al: Inflamatory demyelinating peripheral neuropathy associated with human T - cell lymphotropic virus type III infection. Ann Neurol 1987; 21: 32 - 8 5. Feasby TE, Hahn AF, Brown WF, et al: Severe axonal degeneration in acute Guillain-Barre syndrome: Evidence of two different mechanisms? J Neurol Sci 1993;116:185-192 6. Feasby TE, Hughes RA: Campylobacter jejuni, antiganglioside antibodies, and Guillain-Barre syndrome. Neurology 1998;51:340-342 7. Griffin JW, Li CY, Ho TW, et al: Pathology of the motor-sensory axonal Guillain-Barre syndrome. Ann Neurol 1996;39:17-28, 8. Hao Q, Saida T, Kuroki S, et al: Antibodies to gangliosides and galactocerebroside in other identified infections. J Neuroimmunol 1998; 81:116-126 9. Ho TW, Willison HJ, Nachamkin I, et al: Anti-GD 1a antibody is associated with axonal but not demyelinating forms of Guillain-Barre syndrome. Ann Neurol 1999;45:168-173 10. 21. Hughes RA, Rees JH. Clinical and epidemiological features of Guillain-Barre syndrome. J Infection Dis. 1997;176 Suppl 2: S92-S98. 11. 22. Harthrwitz ES, Holman RC, Nelson DB, Schonberger LB. National surveillance for Guillain-Barre syndrome: January 1978 - March 1979, Neurology 1983; 33:150 - 157 12. Harthwitz ES, Schonberger LB, Nelson DB, et al: Guillain-Barre syndrome and the 1978-1979 influenza vaccine. N Engl J Med 1981; 304:1557-1561 13. Jacobs BC, van Doorn PA, Schmitz PI et all. Campylobacter Jejuniinfection and anti- GM1 - antibodies in Guillain-Barre syndrome . Ann Neurol 1996; 40:181 - 87 14. Jacobs B C, Rothbarth P H, van der Meche F G A et al. The spectrum of antecedent infections in Guillain-Barre syndrome. Neurology 1998; 51: 1110 - 1115 15. Koski CL: Guillain-Barre syndrome and chronic inflammatory demyelinating polyneuropathy: Pathogenesis and treatment. Semin Neurol 1994; 14:123-130 16. 28. Kurland LT, Widerholt WC, Kirkpatrick JW et al. Swine influenza vaccine and Guillain-Barre syndrome : epidemic or artifact. Arch Neurol 1985; 1089 90 17. Kuroky S, Saida T, Nukina M et all. Campylobacter Jejuni Strains from patients with Guillain-Barre syndrome belong mostly to Panner Serogroup 19 and Contain ?-N-acetylglucosamine residues. Ann Neurol 1993; 33: 243- 247 18. Ma FF, Nishimura M, Mine H, et al: HLA and T-cell receptor gene polymorphisms in Guillain-Barre syndrome. Neurology 1998; 51:379-384 19. Mazurami RK, Wiegant H, Nores GA. Antibodies presant in normal human plasma. J Neuroimmunol 1994; 50:215 - 220 20. McKhann GM, Combalath DR, Griffin JW et all. Acute motor axonal neuropathy a frequent cause of acute flaccid paralysis in China. Ann Neurology 1993; 33: 333-42 21. Oka N, Akiguchi I, Kawasaki T et all. Elevated Serum levels of endothelial leucocytes adhesion molecules in Guillain-Barre syndrome and chronic inflammatory demyelinating polyneuropathy. Ann. Neurol 1994; 35: 621 - 624 22. Pachner A R, Steer A C: The traid of neurologic manifestations of Lyme dis-


Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

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ese: Meningitis cranial neutitis and radiculoneuritis. Neurology 1985; 35 - 47 23. Rees J H, Soudain S E, Gregson N A, Hughes R A C. A prospective case control study to investigate the relationship between Campylobacter jejuni infection and Guillain-Barre syndrome. N Engl J Med 1995;333:1374-9 24. Ropper AH: The Guillain-Barre syndrome. N Engl J Med 1992; 326:11301136 25. Ropper A, Wijdicks E, Truax B. Guillain-Barre syndrome. Contemporary neurology series. Philadelphia, FA. Davis, 1991 26. Sheikh KA, Nachamkin I, Ho TW, et al: Campylobacter jejuni lipopolysaccharides in Guillain-Barre syndrome: Molecular mimicry and host susceptibility. Neurology 1998; 51:371-378 27. Saida T, Saida K, Silberberg DH et al. Transfer of demyelination by intraneural injection of experimental allergic neuritis serum. Nature 1978; 272: 639 - 43 28. Taylor WA, Huges RAS: T Lymphocyte activation antigens in Guillain-Barre syndrome and Chronic ideopathic demyelinating polyradiculoneuropathy. J Neuroimmunol 1989; 24: 33-39 29. Visser LH, van der Meche FG, Meulstee J, et al. Cytomegalovirus infection and Guillain-Barre syndrome: The clinical electrrophysiologycal and prognostic features. Neurology 1996; 47: 668 - 673 30. Vriesendorp FJ, Triggs WJ, Mayer RF. Electrophysiological studies in Guillain-Barre syndrome: correlation with antibodies to GM1, GD1B and Campylobacter jejuni. J Neurology 1995; 242(7): 460-5

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31. Waksman BH, Adams RD: Allergic neuritis: Experimental disease in rabbits induced by peripheral nervous tissue and adjuvants. J Exp Med; 1955;102: 213 32. Walish FSCronin M, Koblar S et all. Assotiation between glicoconjugate antibodies and Campylobacter infection on patients with Guillain-Barre syndrome J Neuroimmunol 1991; 34: 43-51 33. Willison Hj, Veitch J, Paterson G et all. Miller Fisher syndrome is assotiated with serum antibodies to GQ1b ganglioside. J Neurol Neurosurg Psych 1993; 58:204-206 34. Yuki N, Yamada M, Sato S et all. Assotiation of IgG anti-GD1a antibody with severe Guillain-Barre syndrome. Muscule Nerve 1993; 16: 642 - 647

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SUMMARY

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CURRENT TREATMENT OF GUILLAIN-BARRE SYNDROME Y. Hristov, Ts. Tsankova, å. Daskalov, P. Stamenova, K. Hristova, E. VavreÍ The Guillain-Barre Syndrome (GBS) is an acute demyelinating disease of the peripheral nerve system characterised by a progressive muscular weakness, in the course of which lifethreatening symptoms might be developed, i.e., bulbar paralysis, peripheral respiratory insufficiency, disautonomy. Most patients reach full recovery but despite the great achievements in the field of intensive care lately, yet 5% of the cases have lethal outcome, and 10% remain at different level of inability. The treatment of GBS features several major targets: 1) Reduction of the immune-effect mechanisms during the acute phase of the disease and minimising of the distribution of damage; 2) Stimulation of the axonal regeneration and reinnervation during the recovery phase; 3) Speeding up of the recovery process and taking precautions against permanent invalidation of the patient. The goals stated above are achievable only through the complex application of immune-modulating therapy and intensive care. The current therapy of GBS is based on the good understanding of the disease autoimmune patogenesis and the role of the immune-modulating therapy as a strategic factor for these patients. Nevertheless, all authors agree that intensive care is the milestone for the treatment of Guillain-Barre Syndrome.

ëË̉ÓÏ˙Ú Ì‡ Guillain-Barre (ëÉÅ)  ÓÒÚÓ ‰ÂÏËÂÎËÌËÁË‡˘Ó Á‡·ÓÎfl‚‡Ì ̇ ÔÂËÙÂ̇ڇ ÌÂ‚̇ ÒËÒÚÂχ, ı‡‡ÍÚÂËÁË‡˘Ó ÒÂ Ò ÔÓ„ÂÒ˂̇ ÏÛÒÍÛÎ̇ Ò··ÓÒÚ, ‚ ıÓ‰‡ ̇ ÍÓÂÚÓ ÏÓÊ ‰‡ Ò ‡Á‚ËflÚ Á‡ÒÚ‡¯‡‚‡˘Ë ‚ËÚ‡ÎÌËÚ ÙÛÌ͈ËË ÒËÏÔÚÓÏË - ·Ûη‡̇ Ô‡‡ÎËÁ‡, ÔÂËÙÂ̇ ‰Ëı‡ÚÂÎ̇ ̉ÓÒÚ‡Ú˙˜ÌÓÒÚ, ‰ËÁ‡‚ÚÓÌÓÏËfl. èӂ˜ÂÚÓ Ô‡ˆËÂÌÚË ‰ÓÒÚË„‡Ú Ô˙ÎÌÓ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂ, ÌÓ ‚˙ÔÂÍË „ÓÎÂÏËfl ̇Ô‰˙Í Ì‡ ËÌÚÂÌÁË‚ÌÓÚÓ Î˜ÂÌËÂ, 5% Á‡‚˙¯‚‡Ú ÎÂÚ‡ÎÌÓ, ‡ 10% ÓÒÚ‡‚‡Ú Ò ‡Á΢̇ ÔÓ ÒÚÂÔÂÌ ËÌ‚‡ÎˉËÁ‡ˆËfl. ã˜ÂÌËÂÚÓ Ì‡ ëÉÅ Ëχ ÌflÍÓÎÍÓ ‚‡ÊÌË ˆÂÎË: 1)Ó„‡Ì˘‡‚‡Ì ̇ ËÏÛÌÌËÚ ÂÙÂÍÚÓÌË ÏÂı‡ÌËÁÏË ‚ ÓÒÚ‡Ú‡ Ù‡Á‡ ̇ ·ÓÎÂÒÚÚ‡, ÏËÌËÏËÁË‡Ì ‡ÁÔÓÒÚ‡ÌÂÌËÂÚÓ Ì‡ Û‚‰ËÚÂ; 2) ÒÚËÏÛÎË‡Ì ̇ ‡ÍÒÓ̇Î̇ڇ „ÂÌÂ‡ˆËfl Ë ÂËÌÂ‚‡ˆËfl ‚ ÒÚ‡‰Ëfl ̇ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂ; 3) ÛÒÍÓfl‚‡Ì ÔÓˆÂÒ‡ ̇ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂ Ë Ô‰ԇÁ‚‡Ì ̇ ·ÓÎÌËfl ÓÚ ÔÂχÌÂÌÚ̇ ËÌ‚‡ÎˉËÁ‡ˆËfl. éÒ˙˘ÂÒÚ‚fl‚‡ÌÂÚÓ Ì‡ ÚÂÁË ˆÂÎË Ò ÔÓÒÚË„‡ ˜ÂÁ ÍÓÏÔÎÂÍÒÌÓÚÓ ÔË·„‡Ì ̇ ËÏÛÌÓÏÓ‰ÛÎË‡˘‡ ÚÂ‡ÔËfl Ë ËÌÚÂÌÁË‚ÌË „ËÊË. ë˙‚ÂÏÂÌÌÓÚÓ Î˜ÂÌË ̇ ëÉÅ Ò ·‡ÁË‡ ̇ ‡Á·Ë‡ÌÂÚÓ Á‡ ‡‚ÚÓËÏÛÌ̇ڇ Ô‡ÚÓ„ÂÌÂÁ‡ ̇ ·ÓÎÂÒÚÚ‡, ÍÓÂÚÓ Â Ô‚˙̇ÎÓ ËÏÛÌÓÏÓ‰ÛÎË‡˘‡Ú‡ ÚÂ‡ÔËfl ‚ ÒÚ‡Ú„˘ÂÒ͇ ÔË Ú‡ÍË‚‡ ·ÓÎÌË. çÓ ‚Ò˘ÍË ‡‚ÚÓË Ò‡ Ò˙„·ÒÌË, ˜Â Í‡È˙„˙ÎÌËflÚ Í‡Ï˙Í ‚ ΘÂÌËÂÚÓ Ì‡ ÒË̉Óχ ̇ Guillain-Barre Ò‡ ËÌÚÂÌÁË‚ÌËÚ „ËÊË.

Key words: Guillain-Barre Syndrome, treatment, plasma replacement, intravÂnous immunoglobulin, intensive care.

ëË̉ÓÏ˙Ú Ì‡ Guillain-Barre (ëÉÅ)  ̇È-˜ÂÒÚÓ ÓÒÚÓ ËÎË ÔÓ‰ÓÒÚÓ ‰ÂÏËÂÎËÌËÁË‡˘Ó Á‡·ÓÎfl‚‡Ì ̇ ÔÂËÙÂ̇ڇ ÌÂ‚̇ ÒËÒÚÂχ, ı‡‡ÍÚÂËÁË‡˘Ó ÒÂ Ò ÔÓ„Â-

äβ˜Ó‚Ë ‰ÛÏË: ëË̉ÓÏ Ì‡ Guillain-Barre, ΘÂÌËÂ, Ô·ÁχÁ‡ÏÂÒÚ‚‡ÌÂ, ËÌÚ‡‚ÂÌÓÁÂÌ ËÏÛÌÓ„ÎÓ·ÛÎËÌ, ËÌÚÂÌÁË‚ÌË „ËÊË.


‡ÔËÎ, 2002

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

Ò˂̇ ÏÛÒÍÛÎ̇ Ò··ÓÒÚ, ‚ ıÓ‰‡ ̇ ÍÓÂÚÓ ÏÓÊ ‰‡ Ò ‡Á‚ËflÚ Á‡ÒÚ‡¯‡‚‡˘Ë ‚ËÚ‡ÎÌËÚ ÙÛÌ͈ËË ÒËÏÔÚÓÏË ·Ûη‡̇ Ô‡‡ÎËÁ‡, ÔÂËÙÂ̇ ‰Ëı‡ÚÂÎ̇ ̉ÓÒÚ‡Ú˙˜ÌÓÒÚ, ‰ËÁ‡‚ÚÓÌÓÏËfl. èӂ˜ÂÚÓ Ô‡ˆËÂÌÚË ‰ÓÒÚË„‡Ú Ô˙ÎÌÓ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂ, ÌÓ ‚˙ÔÂÍË „ÓÎÂÏËfl ̇Ô‰˙Í Ì‡ ËÌÚÂÌÁË‚ÌÓÚÓ Î˜ÂÌËÂ, 5% Á‡‚˙¯‚‡Ú ÎÂÚ‡ÎÌÓ, ‡ 10% ÓÒÚ‡‚‡Ú Ò ‡Á΢̇ ÔÓ ÒÚÂÔÂÌ ËÌ‚‡ÎˉËÁ‡ˆËfl.(1,30) ã˜ÂÌËÂÚÓ Ì‡ ëÉÅ Ëχ ÌflÍÓÎÍÓ ‚‡ÊÌË ˆÂÎË: 1)Ó„‡Ì˘‡‚‡Ì ̇ ËÏÛÌÌËÚ ÂÙÂÍÚÓÌË ÏÂı‡ÌËÁÏË ‚ ÓÒÚ‡Ú‡ Ù‡Á‡ ̇ ·ÓÎÂÒÚÚ‡, ÏËÌËÏËÁË‡Ì ‡ÁÔÓÒÚ‡ÌÂÌËÂÚÓ Ì‡ Û‚‰ËÚÂ; 2) ÒÚËÏÛÎË‡Ì ̇ ‡ÍÒÓ̇Î̇ڇ „ÂÌÂ‡ˆËfl Ë ÂËÌÂ‚‡ˆËfl ‚ ÒÚ‡‰Ëfl ̇ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂ; 3) ÛÒÍÓfl‚‡Ì ÔÓˆÂÒ‡ ̇ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂ Ë Ô‰ԇÁ‚‡Ì ̇ ·ÓÎÌËfl ÓÚ ÔÂχÌÂÌÚ̇ ËÌ‚‡ÎˉËÁ‡ˆËfl. éÒ˙˘ÂÒÚ‚fl‚‡ÌÂÚÓ Ì‡ ÚÂÁË ˆÂÎË Ò ÔÓÒÚË„‡ ˜ÂÁ ÍÓÏÔÎÂÍÒÌÓÚÓ ÔË·„‡Ì ̇ ËÏÛÌÓÏÓ‰ÛÎË‡˘‡ ÚÂ‡ÔËfl Ë ËÌÚÂÌÁË‚ÌË „ËÊË. ÉÓÎÂÏËflÚ Ì‡Ô‰˙Í ‚ ΘÂÌËÂÚÓ Ì‡ ëÉÅ Á‡ÔÓ˜‚‡ ÒΉ ÇÚÓ‡Ú‡ ë‚ÂÚӂ̇ ‚ÓÈ̇, ÍÓ„‡ÚÓ Ò ‡Á‚Ë‚‡Ú Ò˙‚ÂÏÂÌÌËÚ ÏÂÚÓ‰Ë Ì‡ ËÁÍÛÒÚ‚Â̇ ·ÂÎÓ‰ӷ̇ ‚ÂÌÚË·ˆËfl (àÅÇ). Ç Ì‡˜‡ÎÓÚÓ Ì‡ 50-Ú „Ó‰ËÌË Ì‡ ÏË̇ÎËfl ‚ÂÍ Ò ‚Íβ˜‚‡Ú ÍÓÚËÍÓÒÚÂÓˉËÚÂ, ‡ ‚ Í‡fl ̇ 70-Ú „Ó‰ËÌË, ÒΉ ‚˙ÁÔËÂχÌ ̇ ‡‚ÚÓËÏÛÌ̇ڇ „ÂÌÂÁ‡ ̇ ·ÓÎÂÒÚÚ‡, Ò ‚˙‚Âʉ‡ ‚ ÛÔÓÚ·‡ Ô·ÁχÁ‡ÏÂÒÚ‚‡Ì (èá), ‡ ÔÓ - Í˙ÒÌÓ Ë ËÌÚ‡‚ÂÌÓÁÂÌ ËÏÛÌÓ„ÎÓ·ÛÎËÌ (à‚à„) (23,25) àåìçéåéÑìãàêÄôÄ íÖêÄèàü èêà ëàçÑêéåÄ çÄ GUILLAIN-BARRE Ç ÔÓÒΉÌÓÚÓ ‰ÂÒÂÚËÎÂÚË Òڇ̉‡ÚÌÓÚÓ Î˜ÂÌË ̇ ëÉÅ Á‡‰˙ÎÊËÚÂÎÌÓ ‚Íβ˜‚‡ èá ËÎË à‚à„. í ҇ Â‰Ì‡Í‚Ó ÂÙÂÍÚË‚ÌË Ë ‰ۈË‡Ú Ò 50% ‚ÂÏÂÚÓ Á‡ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂ, ‡ÍÓ Ò ‚Íβ˜‡Ú ÔÂÁ Ô˙‚ËÚ ‰‚ Ò‰ÏËˆË ÓÚ ‡Ú‡Í‡Ú‡ ̇ ·ÓÎÂÒÚÚ‡. (8) èãÄáåÄáÄåÖëíÇÄçÖ è·ÁχÁ‡ÏÂÒÚ‚‡ÌÂÚÓ Ò Ô‚˙˘‡ ‚ Òڇ̉‡ÚÌÓ Î˜ÂÌË ÒΉ ÔÓÒΉӂ‡ÚÂÎÌËÚ ÔÓÛ˜‚‡ÌËfl ̇ GB Study Group 1985 „Ó‰Ë̇ Ë French Cooperative Group ÔÂÁ 1983 Ë 1992 „Ó‰Ë̇. êÂÁÛÎÚ‡ÚËÚ ÔÓ͇Á‚‡Ú, ˜Â èá ÒÍ˙Òfl‚‡ ÔÂÒÚÓfl ̇ ÂÒÔË‡ÚÓ Ë ÛÒÍÓfl‚‡ ÏÓÚÓÌÓÚÓ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂ. (10,11,13,15) èË èá, ıÛÏÓ‡ÎÌËÚ هÍÚÓË - ‡ÌÚËÚ·, ËÏÛÌÌË ÍÓÏÔÎÂÍÒË, ÍÓÏÔÎÂÏÂÌÚ Ë ‰Û„ËڠωˇÚÓË Ì‡ ‚˙ÁÔ‡ÎÂÌËÂÚÓ Ò ÓÚÒÚ‡Ìfl‚‡Ú ÏÂı‡Ì˘ÌÓ. èá Â Ò Ì‡È - ‰Ó·˙ ÂÙÂÍÚ, ‡ÍÓ Ò ÔËÎÓÊË ÔÂÁ Ô˙‚‡Ú‡ Ò‰Ïˈ‡ ÓÚ Ì‡˜‡ÎÓÚÓ Ì‡ ·ÓÎÂÒÚÚ‡. (10,11, 13). àÁÔ˙ÎÌÂÌËÂÚÓ Ì‡ èá ËÁËÒÍ‚‡ ÒÔˆˇÎÌÓ ÔÓ‰„ÓÚ‚ÂÌ ÔÂÒÓÌ‡Î Ë ÚÂıÌË͇. ÇÒ˘ÍË Ô‡ˆËÂÌÚË Ò Ô‰ÓÏË̇ÌÚ̇ ÏÓÚÓ̇ Ò··ÓÒÚ Ò‡ ͇̉ˉ‡ÚË Á‡ ÚÓ‚‡ ΘÂÌËÂ. çflχ ÒÚËÍÚÌÓ „·ÏÂÌÚË‡Ì‡ ÚÂıÌË͇ Á‡ ÔÓ‚Âʉ‡Ì ̇ èá. éÔÚËχÎÌËflÚ ·ÓÈ Ì‡ Ôӈ‰ÛËÚÂ, ÒÔÓ‰ Ôӂ˜ÂÚÓ ‡‚ÚÓË,  4 - 5, ËÁ‚˙¯‚‡ÌË ÔÂÁ ‰ÂÌ ‚ ÔÓ‰˙ÎÊÂÌË ̇ 7 - 14 ‰ÌË, ÔË ÍÓÂÚÓ Ò Á‡ÏÂÌfl ÚÓÚ‡ÎÌÓ 200 - 250 ml / kg Ô·Áχ. (8,13, 19,21,23,25,27, 33). Hughes Ë Ò˙‡‚ÚÓË ÔÂÔÓ˙˜‚‡Ú ÔË èá ‰‡ Ò ËÁÔÓÎÁ‚‡ ‡Î·ÛÏËÌ Í‡ÚÓ Á‡ÏÂÒÚ‚‡˘ ÙÎÛˉ (50 ml/kg), χ¯ËÌË Ò ÔÓÒÚÓflÌÂÌ ÔÓÚÓÍ Ë ˆÂÌÚ‡ÎÂÌ ‚ÂÌÓÁÂÌ Ô˙Ú.(15) êÂÁÛÎÚ‡ÚËÚ ÓÚ îÂÌÒÍÓÚÓ ÔÓÛ˜‚‡Ì ÔÓ͇Á‚‡Ú, ˜Â ÓÔÚËχÎÌËflÚ ·ÓÈ Ôӈ‰ÛË ÔË ÔÓ‰‚ËÊÌË Ô‡ˆËÂÌÚË Â 2, ÔË ·ÓÎÌË Ì‡ ÂÒÔË‡ÚÓ -4 ‰Ó 6, ÔË ÎÂÍË ÒÎÛ˜‡Ë - 2, ÔË ÛÏÂÂÌÓ ÚÂÊÍËÚ - 4, ÔË Ô‡ˆËÂÌÚË Ò ÏÌÓ„Ó ÚÂÊÍË ÍÎËÌ˘ÌË ËÁfl‚Ë - 4 ‰Ó 6 Ô·ÁχÁ‡ÏÂÒÚ‚‡ÌËfl. (9,13) è·ÁχÁ‡ÏÂÒÚ‚‡ÌÂÚÓ Ò ËÁ‚˙¯‚‡ ˜ÂÁ ÛÎÚ‡ÙËÎÚ‡ˆËfl ËÎË ˆÂÌÚÓÙÛ„Ë‡ÌÂ, Ò Ï‡¯ËÌË Á‡ ÔÓÒÚÓflÌÂÌ ËÎË ËÌÚÂÏËÚÂÌÚÂÌ ÔÓÚÓÍ. àÁÔÓÎÁ‚‡ Ò ÔÂËÙÂÂÌ ËÎË ˆÂÌÚ‡ÎÂÌ ‚ÂÌÓÁÂÌ Í‡ÚÂÚ˙. èË Ú˙ÌÍË ÔÂËÙÂÌË ‚ÂÌË Ò ÔÓÒÚ‡‚fl ˆÂÌÚ‡ÎÂÌ ‚ÂÌÓÁÂÌ Í‡ÚÂÚ˙ ̇ v. subclavia ËÎË v. jugularis externa. çÂ

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Ò ÔÂÔÓ˙˜‚‡ v. femoralis ÔÓ‡‰Ë ËÒ͇ ÓÚ ‡Á‚ËÚË ̇ ‰˙ηÓÍË ÚÓÏ·ÓÁË. óÂÒÚÓÚ‡Ú‡ ̇ ÛÒÎÓÊÌÂÌËflÚ‡ ÔË Ô·ÁχÙÂÂÁ‡ ‰ÓÒÚË„‡ 16% (31,32) Ë Ì‡È - ˜ÂÒÚÓ Ò ̇·Î˛‰‡‚‡Ú: Ú‡ÌÁËÚÓ̇ ıËÔÓÚÓÌËfl, ÍÓ‡„Û·ˆËÓÌÌË Ë ÂÎÂÍÚÓÎËÚÌË Ì‡Û¯ÂÌËfl, ÚÓÏ·ÂÏ·ÓÎËÁ˙Ï, ‡ÌÂÏËfl, ıËÔÓ͇ΈËÂÏËfl ÓÚ ˆËÚ‡Ú‡ ̇ Á‡ÏÂÒÚ‚‡˘ËÚ ÙÎÛˉË, ıËÔÓχ„ÌÂÁËÂÏËfl, ËÌÙÂ͈ËË ÓÚ Í‡Ì˛ÎËÚÂ, ÒÂÔÒËÒ, ‡ÒÂÔÚ˘ÂÌ ÏÂÌËÌ„ËÚ, Ú‡ÌÒÏËÒË‚ÌË ËÌÙÂ͈ËË, ‡Ì‡ÙË·ÍÚ˘ÌË ‡͈ËË, „·‚Ó·ÓÎËÂ. èÓÒÚ‡‚flÌÂÚÓ Ì‡ ˆÂÌÚ‡ÎÂÌ ‚ÂÌÓÁÂÌ Í‡ÚÂÚ˙ ÌÓÒË ‰ÓÔ˙ÎÌËÚÂÎÌË ËÒÍÓ‚Â ÓÚ ‚˙ÁÌËÍ‚‡Ì ̇ ÔÌ‚ÏÓÚÓ‡ÍÒ, Í˙‚ÂÌÂ, ÔÛÎÏÓ̇ÎÂÌ ÂÏ·ÓÎËÁ˙Ï, ‰˙ηÓÍË ÚÓÏ·ÓÁË. éÔ‡ÒÌÓÒÚÚ‡ ÓÚ Ú‡ÌÒÏËÒË‚ÌË ËÌÙÂ͈ËË Ò ӄ‡Ì˘‡‚‡ ÓÚ ÛÔÓÚ·‡Ú‡ ̇ ‡Î·ÛÏËÌ Á‡ Á‡ÏÂÒÚ‚‡ÌÂ. è·ÁχÙÂÂÁ‡Ú‡ ÏÓÊ ‰‡ ÂÍÁ‡ˆÂ·Ë‡ ÚẨÂ̈ËflÚ‡ Í˙Ï ıËÔÓÚÓÌËfl, Ò‚˙Á‡Ì‡ Ò ı‡‡ÍÚÂ̇ڇ Á‡ ëÉÅ ‰ËÁ‡‚ÚÓÌÓÏËfl. è·ÁχÁ‡ÏÂÒÚ‚‡Ì  ÔÓ͇Á‡ÌÓ ÔË ‚˙Á‡ÒÚÌË Ô‡ˆËÂÌÚË Ò ‰Ó·˙ ‚ÂÌÓÁÂÌ ‰ÓÒÚ˙Ô, ÔË Ò‚˙ı˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚ Í˙Ï à‚à„, ·ÂÏÂÌÌÓÒÚ, ÍÓÌ„ÂÒÚ˂̇ Ò˙‰Â˜Ì‡ ̉ÓÒÚ‡Ú˙˜ÌÓÒÚ, Â̇Î̇ ËÌÒÛÙˈËÂ̈Ëfl, ‰ÂÙˈËÚ Ì‡ IgA, ͇ÍÚÓ Ë ÔË ·ÓÎÌË Ò Miller-Fisher ÒË̉ÓÏ Ë ÓÒÚ‡ ԇ̇‚ÚÓÌÓÏ̇ Ì‚ÓÔ‡ÚËfl. (28,34) àçíêÄÇÖçéáÖç àåìçéÉãéÅìãàç Ç ÔÓÒΉÌÓÚÓ ‰ÂÒÂÚËÎÂÚË ̇ ÏË̇ÎËfl ‚ÂÍ Â Ô‰ÎÓÊÂÌ ÌÓ‚ ÂÙÂÍÚË‚ÂÌ ÒÔÓÒÓ· Á‡ ΘÂÌË ̇ ëÉÅ Ò ÔÓÏÓ˘Ú‡ ̇ à‚à„. åÂı‡ÌËÁÏ˙Ú Ì‡ ‰ÂÈÒÚ‚Ë ̇ à‚à„ Â Ò‚˙Á‡Ì Ò ÌÂÛÚ‡ÎËÁË‡Ì ̇ ‡‚ÚÓ‡ÌÚËÚ·ڇ, ÔÓÚËÒ͇Ì ̇ ÔÓ‰Û͈ËflÚ‡ ËÏ, ÒÛÔÂÒËfl ̇ ‡ÌÚËÚflÎÓÁ‡‚ËÒËχڇ ÚÓÍÒ˘ÌÓÒÚ, Û‚Â΢‡‚‡Ì ͇ڇ·ÓÎËÁχ ̇ ẨӄÂÌÌËÚ ‡ÌÚËÚ· ˜ÂÁ ̇Òˢ‡Ì ̇ FcRn-Ú‡ÌÒÔÓÚÌËÚ ˆÂÔÚÓË, ÒÛÔÂÒËfl ̇ ÂÍÒÔÂÒËflÚ‡ ̇ ÔÓËÌÙ·χÚÓÌËÚ هÍÚÓË Ì‡ ‚˙ÁÔ‡ÎÂÌËÂÚÓ - ˆËÚÓÍËÌË, IL-1b, TNF-a.(6) èÓ Ò‚ÓflÚ‡ ÂÙÂÍÚË‚ÌÓÒÚ ËÏÛÌÓ„ÎÓ·ÛÎËÌ˙Ú Â ‡‚ÂÌ Ì‡ Ô·ÁχÙÂÂÁ‡Ú‡, ÌÓ Ëχ ÔÓ - χÎÍÓ ÒÚ‡Ì˘ÌË ÂÙÂÍÚË. ã˜ÂÌËÂÚÓ Ò à‚à„ ÒÍ˙Òfl‚‡ ÔÂÒÚÓfl ̇ àÅÇ, ÛÒÍÓfl‚‡ ÔÓˆÂÒ‡ ̇ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂ Ë ‚Ó‰Ë ‰Ó ÔÓ-‰Ó·˙ ËÁıÓ‰ ̇ 1fl Ë 3-fl ÏÂÒˆ ÒΉ ̇˜‡ÎÓÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ. (26) ì‰Ó·ÂÌ Â Á‡ ÔË·„‡Ì ‚ ÓÚ‰‡Î˜ÂÌË ‡ÈÓÌË, Í˙‰ÂÚÓ Ìflχ ÚÂıÌË͇ Ë ÔÂÒÓ̇ΠÁ‡ ÔÓ‚Âʉ‡Ì ̇ èá. è‰ÔÓ˜ËÚ‡ Ò ÔË ‰Âˆ‡, ÔÓ‡‰Ë ÔÓ-ÎÂÒÌËfl ̇˜ËÌ Ì‡ ËÁÔ˙ÎÌÂÌËÂ. èÓ-ÂÙÂÍÚË‚ÂÌ Â ‚ ÒÎÛ˜‡Ë ̇ ‰Ó͇Á‡ÌË IgG ‡ÌÚËÚ· ÒÂ˘Û GM1, GM1b ËÎË GaINAc-GD1a, ÔË Ô‰ÓÏË̇ÌÚÌÓ ÏÓÚÓÌË ÙÓÏË Ì‡ ëÉÅ, ÔË ÔÓ‰˜Âڇ̇ ıÂÏÓ‰Ë̇Ï˘̇ ÌÂÒÚ‡·ËÎÌÓÒÚ, ÔË ·ÓÎÌË Ò ‰Ë‡˘ÌË ÔÓ‰ÓÏË, ËÌÙÂ͈ËÓÁÌË Á‡·ÓÎfl‚‡ÌËfl (HIV), ÚÛ‰ÂÌ ‚ÂÌÓÁÂÌ ‰ÓÒÚ˙Ô, ˆˉ˂ ̇ ÏÛÒÍÛÎ̇ڇ Ò··ÓÒÚ. (14,35) éÒ‚ÂÌ ÚÓ‚‡ ÏÓÊ ‰‡ Ò ÔË·„‡ Á‡ ΘÂÌËÂ Ë Ì‡ ÒË̉Óχ ̇ Miller-Fisher.(3) Ç Ñ‡ÚÒÍÓ ËÁÒΉ‚‡Ì ҇ Ò‡‚Ìfl‚‡ÌË ÂÙÂÍÚËÚ ̇ à‚à„ (0,4g/kg) Ë èá (200-250 ml/kg), ËÁ‚˙¯ÂÌË ÔÂÁ Ô˙‚ËÚ ‰‚ Ò‰ÏËˆË ÓÚ Ì‡˜‡ÎÓÚÓ Ì‡ ·ÓÎÂÒÚÚ‡.(31) êÂÁÛÎÚ‡ÚËÚ ÔÓ͇Á‚‡Ú ÔÓ - ‰Ó·Ë ÂÁÛÎÚ‡ÚË Á‡ à‚à„ - ÔÓ ‰Ó·Ó Ò‰ÌÓ ‚ÂÏ ̇ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂ Ë ÔÓ-Í‡Ú˙Í ÔÂÒÚÓÈ Ì‡ ÂÒÔË‡ÚÓ. èÓÒΉ‚‡ÎËÚ ÔÓÛ˜‚‡ÌËfl ÔÓ͇Á‚‡Ú, ˜Â Ìflχ Á̇˜Ëχ ‡ÁÎË͇ ÔÓ ÓÚÌÓ¯ÂÌË ÏÓÚÓÌÓÚÓ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂ Ë Í‡ÈÌËfl ËÁıÓ‰ ÏÂÊ‰Û „ÛÔËÚ ·ÓÎÌË, ÚÂÚË‡ÌË Ò èá ËÎË à‚à„.(4,31) èÓÒΉÌËflÚ ÏÂÚ‡‡Ì‡ÎËÁ ̇ ÔÓ‰Ó·ÌË ÒÚÛ‰ËË Â Ì‡Ô‡‚ÂÌ ÓÚ Cochrane Neuromuscular Disease Groupe (17) ëÚả‡Ú̇ڇ ÚÂıÌË͇ ̇ ÔË·„‡Ì ̇ à‚à„ Â ‰ÓÁ‡ 0,4 g/kg/‰ÂÌ ‚ ÔÓ‰˙ÎÊÂÌË ̇ ÔÂÚ ÔÓÒΉӂ‡ÚÂÎÌË ‰ÌË ‰Ó Ó·˘‡ ‰ÓÁ‡ 2g/kg.(8,10) çflÍÓË ‡‚ÚÓË ÔÓÒÓ˜‚‡Ú ·Î‡„ÓÔËflÚÂÌ ÂÙÂÍÚ ÓÚ Ì‡Á̇˜‡‚‡Ì ̇ ÚÓÚ‡Î̇ڇ ‰ÓÁ‡ Á‡ ‰‚‡ ‰ÌË.(6) óÂÒÚÓÚ‡Ú‡ ̇ ÛÒÎÓÊÌÂÌËflÚ‡ ÓÚ ÚÂ‡ÔËfl Ò à‚à„ Â ‡Á΢̇ ‚ ‡Á΢ÌËÚ ÔÓÛ˜‚‡ÌËfl (4,6% - 10%), ‡ ̇ ÍÓÏ·ËÌË‡ÌÓÚÓ ÔË·„‡Ì à‚à„ Ë èá - 7% (6,24,31).


‡ÔËÎ, 2002

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

ëÔÂÍÚ˙˙Ú Ì‡ ÍÓÏÔÎË͇ˆËËÚ ‚Íβ˜‚‡: ÛÏÂÂÌÓ „·‚Ó·ÓÎËÂ, Ïˇ΄ËË, ‚ÚËÒ‡ÌËfl, ‰Ë‡ÙÓÂÁ‡, Ò‚˙ıÓ‚Ó‰Ìfl‚‡ÌÂ, ıËÔÓÚÂÌÁËfl, ıËÔÂÚÂÌÁËfl, „‡‰ÂÌÂ, ÔÓ‚˙˘‡ÌÂ, ‡ÒÂÔÚ˘ÂÌ ÏÂÌËÌ„ËÚ, ÌÂÛÚÓÔÂÌËfl, ÓÒÚ‡ ÚÛ·Û·̇ ÌÂÍÓÁ‡, ‡Ì‡ÙË·ÍÒËfl, ‡ÒÓˆËË‡Ì‡ Ò ‰ÂÙˈËÚ Ì‡ IgA, Ú‡ÌÁËÚÓÌÓ Û‚Â΢‡‚‡Ì ̇ Ú‡ÌÒ‡ÏË̇ÁËÚÂ, Ôӂ˯‡‚‡Ì ̇ ‚ËÒÍÓÁËÚÂÚ‡ ̇ Í˙‚Ú‡, ̇‡ÒÚ‚‡Ì ÚËÚ˙‡ ̇ ‡ÌÚË‚ËÛÒÌËÚ ËÎË ‡ÌÚË·‡ÍÚÂˇÎÌËÚ ‡ÌÚËÚ· ‰Ó 6 Ô˙ÚË ÒΉ 2 - 3Ú‡ Ò‰Ïˈ‡ ÓÚ ËÌÙÛÁËflÚ‡, ıËÔÓ̇ÚËÂÏËfl (8). ç‡È - ÒÂËÓÁÌÓÚÓ ÛÒÎÓÊÌÂÌË  ÚÛ·Û·̇ڇ ÌÂÍÓÁ‡ ÔË ·ÓÎÌË Ò Ô‰ıÓʉ‡˘Ó ·˙·˜ÌÓ Á‡·ÓÎfl‚‡ÌÂ.(30) èË Ô‡ˆËÂÌÚË, ÍÓËÚÓ ËÏ‡Ú Á‡·ÓÎfl‚‡ÌÂ, ÍÓÏÔÓÏÂÚË‡˘Ó ·˙·˜̇ڇ ÙÛÌ͈Ëfl (̇ÔËÏÂ ‰Ë‡·ÂÚ) ËÎË ÒÚ‡‰‡Ú ÓÚ ıÓÌ˘ÌÓ ·˙·˜ÌÓ Á‡·ÓÎfl‚‡ÌÂ, ͇ÍÚÓ Ë ÔË ‚˙Á‡ÒÚÌË ·ÓÎÌË, Ò ̇χÎfl‚‡ ‰ÓÁ‡Ú‡ Ë ÒÍÓÓÒÚÚ‡ ̇ ËÌÙÛÁËËÚÂ. èÓ‰ÛÍÚËÚ ̇ à‚à„, ÍÓËÚÓ Ò˙‰˙Ê‡Ú Á‡ı‡ÓÁ‡, ÔÓ - ÎÂÒÌÓ ÔÓ‚ÓÍË‡Ú ·˙·˜̇ ̉ÓÒÚ‡Ú˙˜ÌÓÒÚ, Á‡‡‰Ë ÍÓÂÚÓ Ò ÔÂÔÓ˙˜‚‡ ‰‡ ·˙‰‡Ú ËÁ·fl„‚‡ÌË ÔË ËÒÍÓ‚Ë ·ÓÎÌË (31). èË ‰ÂÙˈËÚ Ì‡ IgA Ò ËÌÙÛÁË‡ à‚à„ Ò ÏÌÓ„Ó ÌËÒÍÓ Ò˙‰˙ʇÌË ̇ IgA (Gammagard SD) ( 27). ë˙˘ÂÒÚ‚Û‚‡ ÚÂÓÂÚ˘ÂÌ ËÒÍ Á‡ Ô‰‡‚‡Ì ̇ ËÌÙÂ͈ËË. èË ‰ÓÍÛÏÂÌÚË‡Ì‡ Ò‚˙ı˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚ ËÎË ‰ÂÙˈËÚ Ì‡ IgA Ë ÛÒÚ‡ÌÓ‚fl‚‡Ì ̇ ‡ÌÚË-IgE/IgG aÌÚËÚ·, ÔÂÔ‡‡Ú˙Ú Ì Ò ̇Á̇˜‡‚‡. äÓÏ·ËÌË‡ÌÓÚÓ ÔË·„‡Ì ̇ èá Ë à‚à„ Â ËÁÒΉ‚‡ÌÓ ÓÚ PE/Sandoglobulin GBS-ÒÚÛ‰ËflÚ‡, ͇ÚÓ Ì  ÍÓÌÒÚ‡ÚË‡ÌÓ Ô‰ËÏÒÚ‚Ó Ô‰ ÏÓÌÓÚÂ‡ÔËflÚ‡ Ò èá ËÎË à‚à„. Ç ÔÓÛ˜‚‡ÌÂÚÓ Ò‡ ËÁ‚˙¯‚‡ÌË 5 Ò‡ÌÒ‡ ̇ èá 50ml/kg Á‡ 8-13 ‰ÌË, Ò ÔÓÒΉ‚‡˘‡ ËÌÙÛÁËfl ̇ à‚à„ 0,4mg/kg Á‡ 5 ‰ÌË (24) èËÎÓÚÌÓ ËÁÒΉ‚‡Ì ̇ ÂÙÂÍÚ‡ ÓÚ ÍÓÏ·ËÌË‡Ì‡Ú‡ ÛÔÓÚ·‡ ̇ à‚à„ 0,4mg/kg Ò Metylprednisolon 500mg/‰ÂÌ ÔÓ͇Á‚‡ ÔÓ - ‰Ó·Ó Ò‰ÌÓ ‚ÂÏ ̇ ÔÓ‰Ó·fl‚‡ÌÂ, ÌÓ ÔÓ ÓÚÌÓ¯ÂÌË ‚ÂÏÂÚÓ Á‡ ‰ÓÒÚË„‡Ì ̇ ÌÂÁ‡‚ËÒËÏÓÒÚ Ì‡ Ôˉ‚ËÊ‚‡ÌÂÚÓ Ìflχ ÒË„ÌËÙË͇ÌÚ̇ ‡ÁÎË͇ Ò˙Ò Òڇ̉‡ÌÓÚÓ Î˜ÂÌË .(7,16) êˆˉ˂ËÚ ̇ ÒËÏÔÚÓÏËÚ ÒΉ ΘÂÌËÂ Ò à‚à„ Ë èá Ò‡ Ò˙ÓÚ‚ÂÚÌÓ 8% Ë 11%. (5,32) èË ÔÓfl‚‡Ú‡ ̇ ˆˉ˂ ÒΉ Ô˙‚Ó̇˜‡ÎÌÓ ÔÓ‚ÎËfl‚‡ÌÂ, ÌflÍÓË ‡‚ÚÓË ÔÂÔÓ˙˜‚‡Ú ‚ÚÓË ÍÛÒ Ì‡ ΘÂÌËÂ. (27) ÑÓ ÏÓÏÂÌÚ‡ Ìflχ ͇Ú„Ó˘ÌË ‰‡ÌÌË ‚ ÔÓÎÁ‡ ̇ à‚à„ ÒÂ˘Û èá ËÎË Ó·‡ÚÌÓ. àÁ·Ó˙Ú Ì‡ ‰̇ ÓÚ ‰‚ÂÚ ÚÂ‡ÔËË Á‡‚ËÒË ÓÚ Ë̉˂ˉۇÎÌËÚ ÓÒÓ·ÂÌÓÒÚË Ì‡ Ô‡ˆËÂÌÚ‡ Ë Á‡·ÓÎfl‚‡ÌÂÚÓ. è·ÁχÁ‡ÏÂÒÚ‚‡ÌÂÚÓ ËÁËÒÍ‚‡ ÒÔˆˇÎ̇ ÚÂıÌË͇ Ë ÔÂÒÓ̇Î, ÌÓ Ô˙Í ÒÚÓÈÌÓÒÚÚ‡ ÏÛ Â Á̇˜ËÚÂÎÌÓ ÔÓ-ÌËÒ͇ (22). äéêíàäéëíÖêéàÑà Ç ÔÓ-ÒÚ‡Ó ÔÓÛ˜‚‡Ì Ò ÔÓ͇Á‚‡ ·Î‡„ÓÔËflÚÂÌ ÂÙÂÍÚ ÓÚ ÔËÎÓÊÂÌË ̇ ‡‰ÂÌÓÍÓÚËÍÓÚÓÔÂÌ ıÓÏÓÌ. (29) èÓÒΉÌËflÚ ÏÂÚ‡‡Ì‡ÎËÁ ̇ ‚Ò˘ÍË ‡Ì‰ÓÏËÁË‡ÌË ÒÚÛ‰ËË Á‡Íβ˜‡‚‡, ˜Â ÍÓÚËÍÓÒÚÂÓˉËÚ ÌflÏ‡Ú Ô‰ËÏÒÚ‚‡ Ë Ì Ò ÔÂÔÓ˙˜‚‡Ú ÔË Î˜ÂÌË ̇ ëÉÅ.(18) àçíÖçáàÇçé ãÖóÖçàÖ êÖëèàêÄíéêçÄ èéÑÑêöÜäÄ èË·ÎËÁËÚÂÎÌÓ 30% ÓÚ Ô‡ˆËÂÌÚËÚ Ò˙Ò ëÉÅ Ò ÌÛʉ‡flÚ ÓÚ àÅÇ.(21,27) ÑËı‡ÚÂÎ̇ڇ ̉ÓÒÚ‡Ú˙˜ÌÓÒÚ (Ñç), Ô˘ËÌÂ̇ ÓÚ ÌÂ‚ÌÓ-ÏÛÒÍÛÎ̇ڇ ‰ËÒÙÛÌ͈Ëfl,  ÓÒÓ·ÂÌÓ ÓÔ‡Ò̇, Á‡˘ÓÚÓ Ì‡ÒÚ˙Ô‚‡ ÒÛ·ÍÎËÌ˘ÌÓ, ·ÂÁ Ә‚ˉÌË ÍÎËÌ˘ÌË ·ÂÎÂÁË Ì‡ ÔÛÎÏÓ̇Î̇ ‰ËÒÙÛÌ͈Ëfl. ÇËÚ‡ÎÌËflÚ Í‡Ô‡ˆËÚÂÚ ÏÓÊ ‰‡ Ô‡‰Ì ‰Ó ÌËÒÍË ÌË‚‡, ÔÂ‰Ë ·ÂÎÂÁËÚ ̇ ıËÔÓÍÒÂÏËfl ‰‡ Ò ÔÓfl‚flÚ, ‡ ıËÔÂ͇·ËflÚ‡  Í˙ÒÂÌ ·Â΄. é·ËÍÌÓ‚ÂÌÓ Ñç Ò ‡Á‚Ë‚‡ ‰Ó Í‡fl ̇ Ô˙‚‡Ú‡ Ò‰Ïˈ‡, ÌÓ Â ‚˙ÁÏÓÊÌÓ ‰‡  ̇ÎËˆÂ Ó˘Â ÔË ÔËÂχÌ ̇ ·ÓÎÌËfl.

47

èÓÌ ÚË Ù‡ÍÚÓ‡ ÔÓ‚ÎËfl‚‡Ú ‡Á‚ËÚËÂÚÓ Ì‡ éÑç ÔË ëÉÅ: 1)„ÎÓ·‡Î̇ Ò··ÓÒÚ Ì‡ ÂÒÔË‡ÚÓ̇ڇ ÏÛÒÍÛ·ÚÛ‡, ‚Ӊ¢‡ ‰Ó ̇‰ÂÍ‚‡Ú̇ ‡Î‚ÂÓ·̇ ‚ÂÌÚË·ˆËfl Ë ıËÔÂ͇ÔÌËfl;2) ̇χÎÂÌ ‚ËÚ‡ÎÂÌ Í‡Ô‡ˆËÚÂÚ ÔÓ‡‰Ë Ò··ÓÒÚ Ì‡ ÂÒÔË‡ÚÓÌËÚ ÏÛÒÍÛÎË, ÍÓÂÚÓ ‚Ó‰Ë ‰Ó ÌÂÂÙÂÍÚË‚ÌÓ ÓÚ͇¯ÎflÌÂ, ̇Û¯ÂÌÓ ÓÚ‰ÂÎflÌ ̇ ÒÂÍÂÚË ÓÚ Ú‡ıÂÓ-·ÓÌıˇÎÌÓÚÓ ‰˙‚Ó Ë ‡Á‚ËÚË ̇ ‡ÚÂÎÂÍÚ‡ÁË; 3) ·Ûη‡̇ ‰ËÒÙÛÌ͈Ëfl, ÍÓflÚÓ Ô‰ËÁ‚ËÍ‚‡ ̇Û¯ÂÌÓ „˙ÎÚ‡ÌÂ Ë ÓÚ͇¯ÎflÌÂ Ë ‡ÒÔË‡ˆËfl.(12) éˆÂÌ͇ڇ ̇ ÌÂÓ·ıÓ‰ËÏÓÒÚÚ‡ ÓÚ ‚ÂÌÚË·ÚÓ̇ ÔÓ‰‰˙Ê͇ ËÁËÒÍ‚‡ ·ÎËÁÍÓ ÍÎËÌ˘ÌÓ Ì‡·Î˛‰ÂÌËÂ Ë ÒÂËfl ÓÚ ËÁÏÂ‚‡ÌËfl. ç‡È - ÔÓÎÂÁÌË ÔÓ͇Á‡ÚÂÎË Ò‡ ‚ËÚ‡ÎÂÌ Í‡Ô‡ˆËÚÂÚ (Çä), χÍÒËχÎÌÓÚÓ ËÌÒÔË‡ÚÓÌÓ (åàç) Ë Ï‡ÍÒËχÎÌÓÚÓ ÂÍÒÔË‡ÚÓÌÓ Ì‡Îfl„‡Ì (åÖç). í Ò ËÁÏÂ‚‡Ú ̇ 6 ËÎË 8 ˜‡Ò‡. ᇠ‡ÌÌÓ Û·‚flÌ ̇ ÍËÒÎÓӉ̇ڇ ‰ÂÒ‡ÚÛ‡ˆËfl, Ô‡ˆËÂÌÚËÚ Úfl·‚‡ ‰‡ ·˙‰‡Ú ÏÓÌËÚÓË‡ÌË Ò ÔÛÎÒÓÍÒËÏÂÚ˙. èË Çä <1.5 L Úfl·‚‡ ‰‡ Ò ÏÓÌËÚÓË‡Ú Í˙‚ÌËÚ „‡ÁÓ‚Â, ÔË Çä < 1L e ̇Îˈ Á‡‰˙Ê͇ ̇ ÒÂÍÂÚË. àÁ‚˙Ì ÍÎËÌ˘ÌËÚ Ë̉Ë͇ÚÓË - ·Ûη‡̇ ‰ËÒÙÛÌ͈Ëfl, ‡‚ÚÓÌÓÏ̇ ÌÂÒÚ‡·ËÎÌÓÒÚ, ·Ë·ÚÂ‡Î̇ Ù‡ˆË‡Î̇ Ô‡‡ÎËÁ‡ Ë ·˙Á ÔÓ„ÂÒ Ì‡ ·ÓÎÂÒÚÚ‡, ÔË ÓÔ‰ÂÎflÌ ÌÂÓ·ıÓ‰ËÏÓÒÚÚ‡ ÓÚ àÅÇ ÌflÍÓË ‚Íβ˜‚‡Ú Ë "Ô‡„" ̇ ÂÒÔË‡ÚÓÌËÚ هÍÚÓË (20): 1)Çä < 20 mL/kg; 2) åàç <30 cm H2O; 3) åÖç <40 cm H2O. íÂÁË Ô‡‡ÏÂÚË ÔÓ͇Á‚‡Ú ̇‰ 30% ‰Û͈Ëfl ̇ ÔÛÎÏÓ̇Î̇ڇ ÙÛÌ͈Ëfl Ë Ò‡ Ë‚ÂÒÚÌË Í‡ÚÓ "Ô‡‚ËÎÓ 20/30/40", ÍÓÂÚÓ ÔÓÁ‚ÓÎfl‚‡ ‡ÌÌÓ Ë‰ÂÌÚËÙˈË‡Ì ̇ ·ÓÎÌËÚÂ Ò éÑç Ë ÔÂÏÂÒÚ‚‡ÌÂÚÓ ËÏ ‚ ËÌÚÂÌÁ˂̇ ÍÎËÌË͇; ‚Ò˘ÍË Ô‡ˆËÂÌÚË Ò Çä< 20 mL/kg Ò Ô‚Âʉ‡Ú Á‡ ‡ÍÚË‚ÌÓ Ì‡·Î˛‰ÂÌË ‚ ‡ÌËχˆËfl. à̉Ë͇ˆËËÚ Á‡ ẨÓÚ‡ı‡Î̇ ËÌÚÛ·‡ˆËfl ‚Íβ˜‚‡Ú:1) ÇK<12 ml/kg; 2) Ì„‡ÚË‚ÌÓ ËÌÒÔË‡ÚÓÌÓ Ì‡Îfl„‡Ì < 25 H2O; 3) ıËÔÓÍÒÂÏËfl Ò ê‡é2 < 80 mmHg; 4) Á‡ÚÛ‰ÌÂÌÓ „˙ÎÚ‡ÌÂ Ë ÓÚ͇¯ÎflÌ ̇ ÒÂÍÂÚË.(12,21,27) àÌÚÛ·‡ˆËflÚ‡ ÔÓÁ‚ÓÎfl‚‡: ÒÂÔ‡Ë‡Ì ̇ ‰Ëı‡ÚÂÎÌËÚ Ô˙Úˢ‡, ÍÓÂ͈Ëfl ̇ ıËÔÓÍÒÂÏËflÚ‡ Ë ıËÔÂ͇·ËflÚ‡, ÔÓ˜ËÒÚ‚‡Ì ̇ Ú‡ıÂfl Ë ·ÓÌıË ÓÚ Á‡‰˙ʇÌËÚ ÒÂÍÂÚË, ÔÓÙË·ÍÚË͇ ̇ ·ÂÎÓ‰Ó·ÌËÚ ÛÒÎÓÊÌÂÌËfl Ë ıÂÏÓ‰Ë̇Ï˘ÌËÚ ̇Û¯ÂÌËfl. ä‡ÚÓ ‚˙ÁÏÓÊÌË ÛÒÎÓÊÌÂÌËfl ÔÓ ‚ÂÏ ̇ ËÌÚÛ·‡ˆËflÚ‡ ÏÓ„‡Ú ‰‡ Ò ̇·Î˛‰‡‚‡Ú ıËÔÓÚÂÌÁËfl, ·‡‰Ë͇‰Ëfl, ‡ËÚÏËfl, ıËÔÓÍÒÂÏËfl, ‡ÒÔË‡ˆËfl. ê‡ÌÌÓÚÓ ÔÓ„ÌÓÁË‡Ì ̇ ËÌÚÛ·‡ˆËflÚ‡ Ë ÓÒ˙˘ÂÒÚ‚fl‚‡ÌÂÚÓ u ÔË Ì‡Ô˙ÎÌÓ ÔÓ‰„ÓÚ‚Â̇ Ó·ÒÚ‡Ìӂ͇, ‰Ó „ÓÎflχ ÒÚÂÔÂÌ „‡‡ÌÚË‡Ú Ó„‡Ì˘Â̇ ÔÓfl‚‡ ̇ ÚÂÁË ÍÓÏÔÎË͇ˆËË. ëΉ ËÌÚÛ·‡ˆËflÚ‡ Ò Á‡ÔÓ˜‚‡ àÅÇ, Ú˙È Í‡ÚÓ Ôӂ˜ÂÚÓ Ô‡ˆËÂÌÚË Ò‡ Ò ‡ÚÂˇÎ̇ ıËÔÓÍÒÂÏËfl Ë ıËÔÂ͇·Ëfl. ëÚ‡Ú„ËflÚ‡ ̇ ‚ÂÌÚË·ˆËfl Á‡‚ËÒË ÓÚ Ó·˘ÓÚÓ Ò˙ÒÚÓflÌË ̇ Ô‡ˆËÂÌÚ‡ Ë ˆÂÎË ‰‡ ‚˙ÁÒÚ‡ÌÓ‚Ë Ë ÔÓ‰‰˙ʇ ‡Î‚ÂÓ·ÌËfl Ó·ÂÏ, ͇ÚÓ ËÁ·fl„‚‡ Ò‚˙ı‡Á‰Û‚‡Ì ̇ ‡Î‚ÂÓÎËÚ ÔÓÒ‰ÒÚ‚ÓÏ ÎËÏËÚË‡Ì ̇ ‰Ëı‡ÚÂÎÌËfl Ó·ÂÏ Ë Ì‡Îfl„‡ÌÂÚÓ.(12,20) åÂÚÓ‰˙Ú Ì‡ àÅÇ Á‡‚ËÒË ÓÚ Ò˙ÒÚÓflÌËÂÚÓ Ì‡ Ô‡ˆËÂÌÚ‡ Ë ‚ˉ‡ ̇ ·ÂÎÓ‰Ó·ÌËÚ ÛÒÎÓÊÌÂÌËfl. ç‡È-Ô‡ÍÚËÍÛ‚‡Ì  ÂÊËÏ˙Ú Ì‡ ÍÓÌÚÓÎË‡Ì‡ ÔÓ Ó·ÂÏ àÅÇ, ÍÓÈÚÓ Ò ÔÓ‚Âʉ‡ ÔË ‰Ëı‡ÚÂÎÂÌ Ó·ÂÏ 10-12mL/kg, ÂÒÔË‡ÚÓ̇ ˜ÂÒÚÓÚ‡ 12/min, ÓÚÌÓ¯ÂÌË ËÌÒÔËËÛÏ:ÂÍÒÔËËÛÏ 1:2-3, FiO2 (ÍËÒÎÓӉ̇ ÍÓ̈ÂÌÚ‡ˆËfl ‚˙‚ ‚‰Ë¯‚‡Ì‡Ú‡ ÒÏÂÒ) < 0,5. ë‰̇ڇ ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ Ì‡ àÅÇ ÔË ëÉÅ Â 3 Ò‰ÏˈË, ÍÓÂÚÓ Ì‡Î‡„‡ ‡Ì̇ Ú‡ıÂÓÒÚÓÏËfl ̇ ·ÓÎÌËfl. ÉËÊËÚ Á‡ Ô‡ˆËÂÌÚ‡ ̇ ÂÒÔË‡ÚÓ ‚Íβ˜‚‡Ú: ‡‰‡ÔÚ‡ˆËfl Í˙Ï ÂÒÔË‡ÚÓ‡ ˜ÂÁ ÔÓ‰ıÓ‰fl˘‡ Ò‰‡ˆËfl , „ÛÎfl̇ ‡ÒÔË‡ˆËfl ̇ ÒÂÍÂÚËÚÂ, ÔÓÏfl̇ ̇ ÔÓÁˈËflÚ‡ ̇ Ô‡ˆËÂÌÚ‡ ̇ ‰‚‡ ˜‡Ò‡ Ò ˆÂÎ ÔÓ- ‰Ó·Ó ‰ÂÌË‡Ì ̇ ÒÂÍÂÚËÚÂ, ӂ·ÊÌfl‚‡Ì ̇ ÔÓ‰‡‚‡ÌËfl ‚˙Á‰Ûı. ÇÂÌÚËÎË‡ÌËÚ ԇˆËÂÌÚË Ò ÌÛʉ‡flÚ ÓÚ ÔÓ‚Âʉ‡Ì ̇ ·ÂÎÓ‰ӷ̇ ÙËÁËÓÚÂ‡ÔËfl Á‡ ÔÓ-‰Ó·Ó ‰ÂÌË‡Ì ̇ ÒÂÍÂÚËÚÂ Ë ÔÓÙË·ÍÚË͇ ̇ ·ÂÎÓ‰Ó·ÌËÚ ËÌÙÂ͈ËË. íÓ-


‡ÔËÎ, 2002

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

‚‡ ‚Íβ˜‚‡ ÔÓÒÚÛ‡ÎÂÌ ‰Â̇Ê, χÌÛ‡Î̇ ıËÔÂ‚ÂÌÚË·ˆËfl Ò Ó·ÂÏ 1,5 Ô˙ÚË Ì‡‰ ‰Ëı‡ÚÂÎÌËfl Ó·ÂÏ Ì‡ ·ÓÎÌËfl Ë Î‡‚‡Ê Ò ÙËÁËÓÎӄ˘ÂÌ ÒÂÛÏ Á‡ ÔÓÙË·ÍÚË͇ ̇ ‡ÚÂÎÂÍÚ‡ÁËÚÂ Ë ÔÓ-‰Ó·Ó ‰ÂÌË‡Ì ̇ ÒÂÍÂÚËÚÂ. èÂÛÒÚ‡ÌÓ‚fl‚‡ÌÂÚÓ Ì‡ àÅÇ ÒÚ‡‚‡ ÔË ÒΉÌËÚ ÛÒÎÓ‚Ëfl: ‰Ëı‡ÚÂÎÂÌ Ó·ÂÏ Ì‡‰ 12 mL/kg, Ì„‡ÚË‚ÌÓ ËÌÒÔË‡ÚÓÌÓ Ì‡Îfl„‡Ì >20 cmH2O, ÔÓ‰‰˙ʇÌ ̇ PaO2>80 mmHg ÔË Ò˙‰˙ʇÌË ̇ ÍËÒÎÓÓ‰‡ ‚˙‚ ‚‰Ë¯‚‡ÌËfl ‚˙Á‰Ûı <0.6, ÔÓ‰‰˙ʇÌ ̇ ÌÓÏÓ͇ÔÌËfl (ê‡ëé2 35mmHg), ÎËÔÒ‡ ̇ Ú‡ıË͇‰Ëfl, ËÁÔÓÚfl‚‡ÌÂ Ë ÔÒËı˘ÂÒÍÓ Ì‡ÔÂÊÂÌËÂ. íÂıÌË͇ڇ ̇ ÓÚ‚ËÍ‚‡Ì Úfl·‚‡ ‰‡ ÔÓÁ‚ÓÎfl‚‡ ̇ ·ÓÎÌËfl ‰‡ ‰Ë¯‡ ÒÔÓÌÚ‡ÌÌÓ Á‡ ÔÓ - ‰˙Î„Ë ÔÂËÓ‰Ë, ÔË ÔÓÒÚÂÔÂÌÌÓ ‰ۈË‡Ì ̇ ÔÓ‰‰˙ʇ˘ÓÚÓ Ì‡Îfl„‡ÌÂ. ÖÍÒÚÛ·‡ˆËflÚ‡ ËÎË Á‡Ú‚‡flÌÂÚÓ Ì‡ Ú‡ıÂÓÒÚÓÏ̇ڇ Í‡Ì˛Î‡ Ò ËÁ‚˙¯‚‡, ÒΉ ͇ÚÓ ·ÓÎÌËflÚ Â ÓÚ‚ËÍ̇ΠÓÚ ‡Ô‡‡Ú‡ Ë Â ‚ Ò˙ÒÚÓflÌË ‰‡ ÓÚ͇¯Îfl Ë Ô„Î˙˘‡ ÂÙÂÍÚË‚ÌÓ. á‡Ú‚‡flÌÂÚÓ Ì‡ Í‡Ì˛Î‡Ú‡ ÒÚ‡‚‡ ÒΉ ͇ÚÓ Ò ‰Ó͇ÊÂ, ˜Â Ìflχ „‡ÌÛ·ˆËË Ë ÒÚËÍÚÛË ‚ Ú‡ıÂflÚ‡. ïÖåéÑàçÄåàóçÄ èéÑêöÜäÄ ÅÓÎÌËÚ Ò˙Ò ëÉÅ ËÏ‡Ú ÔÓ‰˜Âڇ̇ ‰ËÁ‡‚ÚÓÌÓÏËfl. åÓÌËÚÓË‡ÌÂÚÓ Ì‡ Ò˙‰Â˜Ì‡Ú‡ ‰ÂÈÌÓÒÚ Ë ‡ÚÂˇÎÌÓÚÓ Ì‡Îfl„‡Ì ‰ÂÏÓÌÒÚË‡ ‡ÁÌÓÓ·‡ÁÌË ËÚ˙ÏÌË Ë ÔÓ‚Ó‰ÌËÍÓ‚Ë Ì‡Û¯ÂÌËfl - ÒËÌÛÒÓ‚‡ Ú‡ıË͇‰Ëfl, ÒËÌÛÒÓ‚‡ ·‡‰Ë͇‰Ëfl, ÄV-·ÎÓÍÓ‚Â, ÒÛÔ‡‚ÂÌÚËÍÛ·ÌË ÂÍÒÚ‡ÒËÒÚÓÎË, ıËÔÓ- ËÎË ıËÔÂÚÓÌËfl. é·ËÍÌÓ‚ÂÌÓ ÚÂÁË Ì‡Û¯ÂÌËfl Ò‡ ·˙ÁÓÔÂıÓ‰ÌË Ë Ì ̇·„‡Ú ÒÔˆˇÎÌÓ Î˜ÂÌËÂ. å‰Ë͇ÏÂÌÚÓÁ̇ڇ ÍÓÂ͈Ëfl Úfl·‚‡ ‰‡ ·˙‰Â ÏÌÓ„Ó ‚ÌËχÚÂÎ̇ Ë ‰‡ Ò ̇Á̇˜‡‚‡ ÓÚ Í‡‰ËÓÎÓÁË. è‰ÔÓ˜ËÚ‡Ú Ò ÔÂÔ‡‡ÚË Ò Í‡ÚÍÓ ‰ÂÈÒÚ‚ËÂ. Å‡‰Ë͇‰ËflÚ‡ Ò ÔÓ‚ÎËfl‚‡ ÛÒÔ¯ÌÓ ÓÚ ‡ÚÓÔËÌ, ‡ÍÓ Â ÒËÏÔÚÓχÚ˘̇. èË Ô˙ÎÂÌ ÄV ·ÎÓÍ Ò ÔÓÒÚ‡‚fl ÔÂÈÒÏÂÈÍ˙. ïËÔÂÚÂÌÁËflÚ‡ Ò ÔÓ‚ÎËfl‚‡ ÓÚ ÌËÚÓÔÂÔ‡‡ÚË. ÅÂÚ‡ - ·ÎÓÍÂË Ì Ò ÔÂÔÓ˙˜‚‡Ú, Á‡‡‰Ë ËÒ͇ ÓÚ ‚˙ÁÌËÍ‚‡Ì ̇ ͇‰Ë‡Í ‡ÂÒÚ, ÌÓ ÒÔÓ‰ ÌflÍÓË ‡‚ÚÓË (27) Ò‡ ÔÓ‰ıÓ‰fl˘Ë ÔË ·ÓÎÌË Ò ÔÓ-Ú‡È̇ Ú‡ıË͇‰Ëfl. ïËÔÓÚÂÌÁËflÚ‡ ÔÓÌflÍÓ„‡ ÏÓÊ ‰‡  ÏÌÓ„Ó ‰˙ηÓ͇. ífl Ò ‚ÎËfl ‰Ó· ÓÚ Ó·ÂÏÌÓ Á‡ÏÂÒÚ‚‡ÌÂ, ËÎË ÔÓÒÚ‡‚flÌ ‚ ÔÓÁˈËfl íẨÂÎÂÌ·Û„; ÒËÏÔ‡ÚËÍÓÏËÏÂÚˈËÚ ÏÓ„‡Ú ‰‡ ËÏ‡Ú Á‡ÒËÎÂÌ ‚‡ÁÓÔÂÒÓÂÌ ÂÙÂÍÚ ÔÓ‡‰Ë ‰ÂÌÂ‚‡ˆËÓÌ̇ Ò‚˙ı˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚ. (27) èË ‚˙ÁÒÚ‡ÌÓ‚fl‚‡Ì ̇ ‰‚Ë„‡ÚÂÎ̇ڇ ‡ÍÚË‚ÌÓÒÚ, ·ÓÎÌËÚ Úfl·‚‡ ‰‡ ·˙‰‡Ú ÒΉÂÌË Ë ÎÂÍÛ‚‡ÌË Á‡ ÓÚÓÒÚ‡Ú˘̇ ıËÔÓÚÓÌËfl. éÅôà ÉêàÜà áÄ Åéãçàü àÏÓ·ËÎËÁ‡ˆËflÚ‡ ‚Ó‰Ë ‰Ó ‚ÂÌÓÁ̇ ÒÚ‡Á‡, Û‚Â΢‡‚‡ ËÒ͇ ÓÚ ‡Á‚ËÚË ̇ ‚ÂÌÓÁÌË ÚÓÏ·ÓÁË Ë ·ÂÎÓ‰Ó·ÂÌ ÂÏ·ÓÎËÁ˙Ï. ífl ÔÓÚÂ̈Ë‡ Ë ‡Á‚ËÚËÂÚÓ Ì‡ ÍÓÊÌË ÛΈÂ‡ˆËË, ÏÛÒÍÛÎÌË Í‡ÏÔË Ë ÍÓÌÚ‡ÍÚÛË. íÂÁË ÍÓÏÔÎË͇ˆËË Ò ÔÓÙË·ÍÚË‡Ú Ò ‰ӂÌÓÚÓ ÔË·„‡Ì ̇ ÌËÒÍÓÏÓÎÂÍÛÎflÂÌ ıÂÔ‡ËÌ, ÍÓÏÔÂÒË‡˘Ë ˜Ó‡ÔË, ˜ÂÒÚÓ Ó·˙˘‡Ì ̇ ·ÓÎÌËfl ‚ ΄ÎÓÚÓ Ë ÔÓÒÚ‡‚flÌ ̇ ‚˙Á„·‚Ì˘ÍË ÓÍÓÎÓ ÏÂÒÚ‡Ú‡, ÔÓ‰ÎÓÊÂÌË Ì‡ Ì‡È - „ÓÎflÏ Ì‡ÚËÒÍ; ÔÓÒÚ‡‚flÌ ̇ ÓÚÂÁË Ì‡ „ÎÂÁÂÌËÚ Á‡ Ô‰ԇÁ‚‡Ì ÓÚ ÍÓÌÚ‡ÍÚÛË Ë Ì‡È - ‡ÌÌÓ Á‡ÔÓ˜‚‡Ì ̇ Âı‡·ËÎËÚ‡ˆËflÚ‡. 臈ËÂÌÚËÚ Ò˙Ò ëÉÅ Ò‡ ÔÓ‰ÎÓÊÂÌË Ì‡ ‚ËÒÓÍ ËÒÍ ÓÚ ‡Á‚ËÚË ̇ ÌÓÁÓÍÓÏˇÎÌË ËÌÙÂ͈ËË Ë ÒÂÔÒËÒ. íÓ‚‡ Ò ÓÚ̇Òfl ÓÒÓ·ÂÌÓ Á‡ ̇ÒÚ‡ÌÂÌËÚ ‚ ËÌÚÂÌÁË‚ÌËÚ ÓÚ‰ÂÎÂÌËfl. ç‡È - ˜ÂÒÚËÚ ÏÂÒÚ‡ ̇ ÌÓÁÓÍÓÏˇÎÌË ËÌÙÂ͈ËË Ò‡ ·ÂÎËflÚ ‰Ó·, ÏÂÒÚ‡Ú‡ ̇ ‚ÂÌÂÔÛÌ͈Ëfl, ÛË̇ÌËflÚ Ú‡ÍÚ. èË ÚÓ‚‡ Ò‡ ‚˙ÁÏÓÊÌË Ô˙‚˘ÌÓ ẨӄÂÌÌË ËÌÙÂ͈ËË (Ô‡ˆËÂÌÚ˙Ú Ò ËÌÙÂÍÚË‡ ÓÚ ÒÓ·ÒÚ‚Â̇ ÙÎÓ‡ Haemophilus influenzae, Streptococcus pneumoniae, Escherichia coli), ‚ÚÓ˘ÌÓ ẨӄÂÌÌË ËÎË ‰ËÒÚ‡ÌÚÌË ËÌÙÂ͈ËË (Ô˘ËÌÂÌË ÓÚ Ó„‡ÌËÁÏË ÓÚ „‡ÒÚÓËÌÚÂÒÚË̇ÎÌËfl Ú‡ÍÚ Ë „˙ÎÓÚÓ - Acinetobacter spp, Serratia spp, Klebsiella) ËÎË ÂÍÁÓ„ÂÌÌË (‰ËÂÍÚÌÓ ÔÂÌÂÒÂÌË ÏËÍÓÓ-

48

„‡ÌËÁÏË ÓÚ ÓÍÓÎ̇ڇ Ò‰‡ ̇ ËÌÚÂÌÁË‚ÌÓÚÓ ÓÚ‰ÂÎÂÌË ‚˙ıÛ Ô‡ˆËÂÌÚ‡ - Staphylococcus spp).(2) ä˙Ï ÚÓ‚‡ Ô‰‡ÁÔÓ·„‡Ú ‚ÂÌÓÁÌËÚ ͇ÚÂÚË, ËÌÚÛ·‡ˆËÓÌÌËÚ Ú˙·Ë, ÛË̇ÌËÚ ͇ÚÂÚË, Ò‰‡ˆËflÚ‡ Ë ËÏÓ·ËÎËÁ‡ˆËflÚ‡ ÔË ·ÓÎÌË Ì‡ ‚ÂÌÚË·ÚÓ, ÍÓÏÔÓÏÂÚË‡Ì‡Ú‡ ËÏÛÌ̇ Á‡˘ËÚ‡, ¯ËÓ͇ڇ Ë ÌÂÓÔ‡‚‰‡Ì‡ ÛÔÓÚ·‡ ̇ ‡ÌÚË·ËÓÚˈË, „ÓÎflÏ ·ÓÈ Ô‡ˆËÂÌÚË Ì‡ ‰ÌÓ ÏflÒÚÓ. èÓÙË·ÍÚË͇ڇ ËÁËÒÍ‚‡ ‰ӂÌÓ ÏËÂÌ ̇ ˙ˆÂÚÂ, ÒÏfl̇ ̇ ‚ÂÌÓÁÌËÚ ͇ÚÂÚË Ì‡ 72 ˜‡Ò‡, „ËÊË Á‡ ÛÂÚ‡ÎÌËfl ͇ÚÂÚ˙, ‡ÒÔË‡ˆËfl ̇ ÒÂÍÂÚËÚÂ, ÔÓ‰‰˙ʇÌ ̇ ˆflÎÓÒÚÂÌ ÚÓ‡ÎÂÚ, Ó·‡·ÓÚ͇ ̇ ‰ÂÍÛ·ËÚÛÒËÚÂ. ÅÓÎÌËÚ Ò˙Ò ëÉÅ ˜ÂÒÚÓ ‡Á‚Ë‚‡Ú ËÎÂÛÒ, ÍÓÈÚÓ Â ÔÓÒΉˈ‡ ̇ ‰ËÁ‡‚ÚÓÌÓÏËflÚ‡. ã˜ÂÌËÂÚÓ ËÁËÒÍ‚‡ ‚ÂÏÂÌÌÓ ÔÂÛÒÚ‡ÌÓ‚fl‚‡Ì ̇ ÂÌÚÂ‡ÎÌÓÚÓ ı‡ÌÂÌÂ, ‡‰ÂÍ‚‡Ú̇ Âıˉ‡Ú‡ˆËfl, ÔÓÒÚ‡‚flÌ ̇ ̇ÁÓ„‡ÒÚ‡Î̇ ÒÓ̉‡ Ë „‡ÁÓ‚‡ Ú˙·‡ Ë ÔË·„‡Ì ̇ ÔËˉÓÒÚË„ÏËÌ. ÅÓÎ͇ڇ ÔË ëÉÅ Â ÔÓÌflÍÓ„‡ ÒËÎ̇ Ë ËÁËÒÍ‚‡ ÒÔˆˇÎÌÓ Î˜ÂÌËÂ. àÁÔÓÎÁ‚‡Ú Ò ÌÂ̇ÍÓÚ˘ÌË ‡Ì‡Î„ÂÚˈË, ‡ÌÚËÍÓÌ‚ÛÎÒ‡ÌÚË ËÎË ÓÔËÓˉË.(27) ĉÂÍ‚‡ÚÌÓÚÓ Ô‡ÂÌÚÂ‡ÎÌÓ Ë ÂÌÚÂ‡ÎÌÓ ı‡ÌÂÌ ҇ ÓÚ Ò˙˘ÂÒÚ‚ÂÌÓ Á̇˜ÂÌË Á‡ ·˙ÁÓ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡Ì ̇ Ô‡ˆËÂÌÚËÚÂ. éÒÌÓ‚ÂÌ ÔÓ·ÎÂÏ ÔÓÒÚ‡‚flÚ ·ÓÎÌËÚ Ò˙Ò ëÉÅ, ÍÓËÚÓ ËÏ‡Ú „˙ÎÚ‡ÚÂÎÌË Ì‡Û¯ÂÌËfl. èË Úflı Ò ÔÓÒÚ‡‚fl ̇ÁÓ„‡ÒÚ‡Î̇ ÒÓ̉‡ Ë ‚˙ÁÏÓÊÌÓ Ì‡È-‡ÌÓ (48 ˜‡Ò‡ ÒΉ ‡Á‚ËÚË ̇ ÓÒÚ‡Ú‡ ‡Ú‡Í‡), ‡ÍÓ Ìflχ ÔÓÚË‚ÓÔÓ͇Á‡ÌËfl, Ò Á‡ÔÓ˜‚‡ ÂÌÚÂ‡ÎÌÓ ı‡ÌÂÌÂ. èË Ô‡‡ÎËÁË‡ÌËÚ ԇˆËÂÌÚË Ò „˙ÎÚ‡ÚÂÎÌË Ì‡Û¯ÂÌËfl Ò ÔÓ‚Âʉ‡ ÒÏÂÒÂÌÓ ı‡ÌÂÌ (Ô‡ÂÌÚÂ‡ÎÌÓ Ë ÂÌÚÂ‡ÎÌÓ). àÁËÒÍ‚‡ÌËflÚ‡ Ò‡ Âʉ̂ÌËflÚ ‚ÌÓÒ Ì‡ ÔÓÚÂËÌË ‰‡ Ì  ÔÓ‰ 0,7 -1 g/kg, ‚ÌÓÒ˙Ú Ì‡ 10% χÒÚÌË ÂÏÛÎÒËË ‰‡  ÏËÌËÏÛÏ 1L, ÌÂÔÓÚÂËÌÓ‚ËÚ ͇ÎÓËË ‰‡ Ò‡ 83-146 kal/kg (ÔË Ò˙ÓÚÌÓ¯ÂÌË χÒÚË:‚˙„ÎÂıˉ‡ÚË 1:2). (2) áÄäãûóÖçàÖ ë˙‚ÂÏÂÌÌÓÚÓ Î˜ÂÌË ̇ ëÉÅ Ò ·‡ÁË‡ ̇ ‡Á·Ë‡ÌÂÚÓ Á‡ ‡‚ÚÓËÏÛÌ̇ڇ Ô‡ÚÓ„ÂÌÂÁ‡ ̇ ·ÓÎÂÒÚÚ‡, ÍÓÂÚÓ Â Ô‚˙̇ÎÓ ËÏÛÌÓÏÓ‰ÛÎË‡˘‡Ú‡ ÚÂ‡ÔËfl ‚ ÒÚ‡Ú„˘ÂÒ͇ ÔË Ú‡ÍË‚‡ ·ÓÎÌË. çÓ ‚Ò˘ÍË ‡‚ÚÓË Ò‡ Ò˙„·ÒÌË, ˜Â Í‡È˙„˙ÎÌËflÚ Í‡Ï˙Í ‚ ΘÂÌËÂÚÓ Ì‡ ÒË̉Óχ ̇ Guillain-Barre Ò‡ ËÌÚÂÌÁË‚ÌËÚ „ËÊË. èÓÒΉÌËÚ ‰ÓÒÚËÊÂÌËfl ̇ Ò˙‚ÂÏÂÌ̇ڇ ÚÂ‡ÔËfl ̇ ëÉÅ ‚Íβ˜‚‡Ú ‰‚ÓÈÌÓ ÙËÎÚË‡ÌÓ Ô·ÁχÁ‡ÏÂÒÚ‚‡ÌÂ, ËÏÛÌÓÏÓ‰ÛÎË‡˘‡ ÚÂ‡ÔËfl, ̇ÒÓ˜Â̇ ÒÂ˘Û ËÌÙ·χÚÓÌËÚ ˆËÚÓÍËÌË, ΘÂÌËÂ, ÒÚËÏÛÎË‡˘Ó „ÂÌÂ‡ˆËflÚ‡ ̇ ÔÂËÙÂÌËÚ ÌÂ‚Ë. ä‡ÚÓ ÔÓÚÂ̈ˇÎÌË ÌÓ‚Ë ËÏÛÌÓÏÓ‰Û·ÚÓË, ̇ÔÓÒΉ˙Í Ò ÔÂÔÓ˙˜‚‡Ú ÌflÍÓË ÏÓÌÓÍÎÓ̇ÎÌË ‡ÌÚËÚ· ÒÂ˘Û TNF-a. ê‡Á‡·ÓÚ‚‡Ú Ò ÚÂ‡ÔËË Á‡ ÛÒË΂‡Ì ̇ ‡ÍÒÓ̇Î̇ڇ „ÂÌÂ‡ˆËfl ˜ÂÁ ËÁÔÓÎÁ‚‡Ì ̇ Ì‚Ó- Ë „ÎËÓÚÓÙ˘ÌË Ù‡ÍÚÓË. (27) ãàíÖêÄíìêÄ 1. чÒ͇ÎÓ‚ å. èÓÎËÌ‚ÓÔ‡ÚËË. äÎËÌ˘̇ Ì‚ÓÎÓ„Ëfl ÚÓÏ II, ê‰. ë. ü̘‚‡. àÁ‰. " á̇ÌËÂ", ëÓÙËfl, 2000; 53 - 64 2. . Adam S, Forrest S. ABC supportive care. BMJ 1999; 319: 175-178 3. Arakawa Y, Yoshimura M, Kobayashi S, et al: The use of intravenous immunoglobulin in Miller Fisher syndrome. Brain Dev 1993;15:231-233 4. Bril V, IiseWK,Pearce R, Dhanani A et al. Pilot trial of immunoglobulin versus plasma exchange in patients with Guillain-Barre syndrome. Neulogy 1996,46: 100-3 5. Castro LH, Ropper AH: Human immune globulin infusion in Guillain-Barre syndrome: Worsening during and after treatment. Neurology 1993; 43:1034-1036 6. Dalakas MC. Intravenous immunoglobulin in the treatment of autoimmune neuromuscular diseases: present status and practical therapeutic guidelines. Muscule Nerve 1999; 22: 1479 - 1497 7. Dutch Guillain-Barre Study Group Treatment of Guillain-Barre syndrome with high dose immune globulin combined with methylprednisolone: a pilot study. Ann Neurol 1994;35:749 - 752 8. Fanion D, Joyce D M. Guillain-BarrÈ Syndrome. eMedicine Journal 2001; 2: 12 - 2 9. French Cooperative Group on Plasma Exchange in GuillainBarre syndrome: Appropriated number of plasme exchanges in Guillain-Barre syndrome. Ann Neurol 1997; 41: 298 - 306 10. French Cooperative Group on Plasma Exchange in GuillainBarre syndrome: Efficiency of plasma exchange in Guillain-Barre syndrome: Role


Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

‡ÔËÎ, 2002

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25.Ropper A, Wijdicks E, Traux B. Guillain-Barre syndrome. Philadelphia, USA, F. A. Davis, 1991 26. Singhi SC, Jayshree M, Singhi P et al. Immunoglobulin in very severe childhood Guillain-Barre syndrome.Ann Trop Pediatr 1999;19:167-174 27. Spies J M, Sheikh K A. Management of Guillain-Barre syndrome, Expert Rev. Neutotherapeutics 2001; 1: 119 - 129 28. Suarez GA, Fealey RD, Camilleri M, et al: Idiopathic autonomic neuropathy: Clinical, neurophysiologic, and follow-up studies on 27 patients. Neurology 1994; 44:1675-1682 29. Swick HM,McQuillen MP.The use of steroids treatment of ideopatic polyneuritis. Neurology 1976; 26:205-212 30. Tan E, Hajinazarian M, Bay W, et al: Acute renal failure resulting from intravenous immunoglobulin therapy. Arch Neurol 1993; 50:137-139 31. Van der Merche FGA, Schmirz PIM. The Dutch Guillain-Barre Study Group. A randomised trial comparing i.v. immune globuline and plasma exchange in Guillain-Barre syndrome. N Engl J Med 1992, 326: 1123- 29 32. Visser LH, van der Meche FG, Meulstee J, et al: Risk factors for treatment related clinical fluctuations in Guillain-Barre syndrome: Dutch Guillain-Barre Study Group. J Neurol Neurosurg Psych 1998; 64:242-244 33. Wijdics E F M.Guillain-Barre syndrome. Mayo Foundation for medical education andresearch, USA, Tiger Medical Systems Inc, 2000 34. Yuki N, Miyatake T, Ohsawa T: Beneficial effect of plasmapheresis on Fisher's syndrome. Muscle Nerve 1993; 16:1267-1268 35. Zifko U, Drlicek M, Senautka G, et al: High dose immunoglobulin therapy is effective in the Miller Fisher syndrome. J Neurol 1994;241:178-9

ĉÂÒ Á‡ ÍÓÂÒÔÓ̉Â̈Ëfl: Ñ- ü. ïËÒÚÓ‚ ç‚ÓÎӄ˘̇ ÍÎËÌË͇ åÅÄã ◊ ñ‡ˈ‡ âÓ‡Ì̇“, ëÓÙËfl ÚÂÎ. 43 44 540

éË„Ë̇ÎÌË ÒÚ‡ÚËË ÇãàüçàÖ çÄ ïÖåéêÖéãéÉàóçàíÖ èéäÄáÄíÖãà à ëêÖÑçéíé ÄêíÖêàÄãçé çÄãüÉÄçÖ Çöêïì åéáöóçàü äêöÇÖç íéä èêà Åéãçà ë íêÄçáàíéêà àëïÖåàóçà ÄíÄäà à ÖÑçéëíêÄççà åéáöóçà àçîÄêäíà à. ÇÂΘ‚‡, ë. ü̘‚‡, Ö. íËÚflÌÓ‚‡ ä‡Ú‰‡ ÔÓ Ì‚ÓÎÓ„Ëfl ÔË Çåà-ëÓÙËfl, ëÔˆˇÎËÁË‡Ì‡ ·ÓÎÌˈ‡ Á‡ ‡ÍÚË‚ÌÓ Î˜ÂÌË ÔÓ Ì‚ÓÎÓ„Ëfl Ë ÔÒËıˇÚËfl "ë‚ÂÚË ç‡ÛÏ" ÖÄÑ

SUMMARY EFFECTS OF THE HEMORHEOLOGICAL PARAMETERS AND THE MEAN ARTERIAL BLOOD PRESSURE ON THE CEREBRAL BLOOD FLOW IN PATIENTS WITH TRANSIENT ISCHEMIC ATTACKS AND UNILATERAL CEREBRAL INFARCTIONS I.Velcheva, S.Yancheva, E.Titianova Department of Neurology, University Specilized Hospital of Neurology and Psychiatry "St. Naum" The aim of the study is to follow the relationship between the blood viscosity parameters and the cerebral blood flow (CBF) and their dependence from the changes of the mean arterial blood pressure (MABP) in patients with ischemic cerebrovascular disease (CVD). Included in the study were 92 patients,39 women and 53

men, mean age 57 years. According to the type of the CVD the patients were distributed in two groups:44 with transient ischemic attacks(TIAs) and 48 with unilateral cerebral infarctions(UCI). Another division according to the MABP values was accomplished, where 35 patients (15 with TIAs and 18 with UCI) have MABP<100 and 59 patients (29 with TIAs and 30 with UCI) have MABP≥100. The hemorheological investigation reveals predominant increase of fibrinogen (Fib) an plasma viscosity (PV), which is marked in the group with UCI. Most prominent are the correlations of hematocrit (Ht) with the neurosonographic velocity parameters of the extracranial cerebral arteries and with the regional cerebral blood flow(rCBF). The significant relationships of PV concern only the rCBF values. In this way the greater influence of Ht as main determinant of blood viscosity on blood flow in the major arteries and of PV on the blood flow in the microcirculation is confirmed.


Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

‡ÔËÎ, 2002

The influence of MABP on the relationship between the hemorheological variables and the cerebral blood flow deserves special interest. The correlations predominate in the subgroup with normal MABP values. They are negative for Ht and Fib with the neurosonographic velocity parameters and positive for Ht with rCBF for a wide range of cerebral regions in both groups with TIAs and UCI. In the patients with UCI and MABP≥ 100 the correlations of Ht and Fib with the neurosonographic parameters and the rCBF on the contralateral to the cerebral infarction side are positive. Such dependence of CBF from the hemorheological variables could be due to compensatory vasodilation following Ht and Fib increase in order to keep permanent CBF. Hypertension and blood viscosity parameters are risk factors for CVD. The complex investigation of their unfavorable effects and their therapeutic influence would contribute for the reduction of this risk. Key words: arterial blood pressure, cerebral blood flow, hemorheology êÖáûåÖ ñÂÎÚ‡ ̇ ÔÓÛ˜‚‡ÌÂÚÓ Â ‰‡ Ò ÔÓÒΉflÚ ‚Á‡ËÏÓÓÚÌÓ¯ÂÌËflÚ‡ ÏÂÊ‰Û ÔÓ͇Á‡ÚÂÎËÚ ̇ Í˙‚ÌËfl ‚ËÒÍÓÁËÚÂÚ /äÇ/ Ë ÏÓÁ˙˜ÌËfl Í˙‚ÂÌ ÚÓÍ /åäí/ Ë Úflı̇ڇ Á‡‚ËÒËÏÓÒÚ ÓÚ ÔÓÏÂÌËÚ ̇ Ò‰ÌÓÚÓ ‡ÚÂˇÎÌÓ Ì‡Îfl„‡Ì /ëÄç/ ÔË ·ÓÎÌË Ò ËÒıÂÏ˘ÌË Ì‡Û¯ÂÌËfl ̇ ÏÓÁ˙˜ÌÓÚÓ Í˙‚ÓÓ·‡˘ÂÌËÂ. èÓÛ˜‚‡ÌÂÚÓ Â Ôӂ‰ÂÌÓ ÔË 92 ·ÓÎÌË, 39 ÊÂÌË Ë 53 Ï˙Ê ̇ Ò‰̇ ‚˙Á‡ÒÚ 57.0±8.6 „. Ç Á‡‚ËÒËÏÓÒÚ ÓÚ ‚ˉ‡ ̇ ÏÓÁ˙˜ÌÓÒ˙‰Ó‚‡Ú‡ ·ÓÎÂÒÚ /åëÅ/ ·ÓÎÌËÚ ҇ ‡ÁÔ‰ÂÎÂÌË ‚ 2 „ÛÔË: 44 Ò Ú‡ÌÁËÚÓÌË ËÒıÂÏ˘ÌË ‡Ú‡ÍË /íàÄ/ Ë 48 Ò Â‰ÌÓÒÚ‡ÌÌË ÏÓÁ˙˜ÌË ËÌÙ‡ÍÚË /Öåà/. ç‡Ô‡‚ÂÌÓ Â Ë ‰Û„Ó ÛÒÎÓ‚ÌÓ ‡Á‰ÂÎflÌ ‚ Á‡‚ËÒËÏÓÒÚ ÓÚ ÒÚÓÈÌÓÒÚËÚ ̇ ëÄç, ÍÓÂÚÓ ‚Íβ˜‚‡ 35 ·ÓÎÌË /15 Ò íàÄ Ë 18 Ò Öåà/ Ò˙Ò ëÄç< 100 Ë 59 ·ÓÎÌË /29 Ò íàÄ Ë 30 Ò Öåà/ Ò˙Ò ëÄç ≥100. ïÂÏÓÂÓÎӄ˘ÌÓÚÓ ËÁÒΉ‚‡Ì ‡ÁÍË‚‡ Ôӂ˯ÂÌË Ô‰ËÏÌÓ Ì‡ ÙË·ËÌÓ„Â̇ /îàÅ/ Ë Ô·ÁÏÂÌËfl ‚ËÒÍÓÁËÚÂÚ /èÇ/, ÍÓÂÚÓ Â ÔÓ‰˜ÂÚ‡ÌÓ ‚ „ÛÔ‡Ú‡ Ò Öåà. èÂӷ·‰‡‚‡Ú Á̇˜ËÏËÚ ÍÓ·ˆËË Ì‡ ıÂχÚÓÍËÚ‡ /ïí/ Ò˙Ò ÒÍÓÓÒÚÌËÚ ԇ‡ÏÂÚË ÓÚ ÒÓÌÓ„‡ÏËÚ ̇ ͇ÓÚËÒÌËÚÂ Ë ‚ÂÚ·‡ÎÌËÚ ‡ÚÂËË Ë Ò „ËÓ̇ÎÌËfl åäí /åäí/. á̇˜ËÏËÚ ÍÓ·ˆËË Ì‡ èÇ Ò‡ Ò‡ÏÓ Ò˙Ò ÒÚÓÈÌÓÒÚËÚ ̇ åäí. íÂÁË Ì‡·Î˛‰ÂÌËfl ÔÓÚ‚˙ʉ‡‚‡Ú Á̇˜ÂÌËÂÚÓ Ì‡ ïí ͇ÚÓ ÓÒÌÓ‚ÂÌ ‰ÂÚÂÏË̇ÌÚ Ì‡ äÇ Ë ‚ÎËflÌËÂÚÓ ÏÛ ‚˙ıÛ Í˙‚ÌËfl ÚÓÍ ‚ χ„ËÒÚ‡ÎÌËÚ ÏÓÁ˙˜ÌË ‡ÚÂËË, ͇ÍÚÓ Ë ÓÔ‰ÂÎfl˘‡Ú‡ ÓÎfl ̇ èÇ Á‡ Í˙‚ÌËfl ÚÓÍ ‚ ÏËÍÓˆËÍÛ·ÚÓ̇ڇ Ò˙‰Ó‚‡ ÏÂʇ. ëÔˆˇÎÌÓ ‚ÌËχÌË Á‡ÒÎÛʇ‚‡ ‚ÎËflÌËÂÚÓ Ì‡ ‡ÚÂˇÎÌÓÚÓ Ì‡Îfl„‡Ì ‚˙ıÛ ‚Á‡ËÏÓÓÚÌÓ¯ÂÌËflÚ‡ ̇ ıÂÏÓÂÓÎӄ˘ÌËÚ ÔÓ͇Á‡ÚÂÎË Ò åäí. äÓ·ˆËËÚ ÏÂÊ‰Û ÚÂÁË ÔÓ͇Á‡ÚÂÎË Ò‡ ÔÓ-ÒËÎÌÓ ËÁ‡ÁÂÌË ÔË ÌÓχÎÌË ÒÚÓÈÌÓÒÚË Ì‡ ëÄç. í ҇ ÓÚˈ‡ÚÂÎÌË Á‡ ïí Ë îàÅ Ò˙Ò ÒÍÓÓÒÚÌËÚ ÒÓÌÓ„‡ÙÌË ÔÓ͇Á‡ÚÂÎË Ë ÔÓÎÓÊËÚÂÎÌË Á‡ ïí Ë åäí Á‡ ¯ËÓÍ ‰Ë‡Ô‡ÁÓÌ ÏÓÁ˙˜ÌË Ó·Î‡ÒÚË Ë ÔË ‰‚ÂÚ „ÛÔË ËÁÒΉ‚‡ÌË ·ÓÎÌË Ò íàÄ Ë Öåà. èË ·ÓÎÌËÚÂ Ò Öåà Ë ëÄç≥100 ÍÓ·ˆËËÚ ̇ ïí Ë îàÅ Ò Ì‚ÓÒÓÌÓ„‡ÙÌËÚ ÔÓ͇Á‡ÚÂÎË Ë Ò åäí ̇ ÔÓÚË‚ÓÔÓÎÓÊ̇ڇ ̇ ÏÓÁ˙˜ÌËfl ËÌÙ‡ÍÚ ÒÚ‡Ì‡ Ò‡ ÔÓÎÓÊËÚÂÎÌË. èӉӷ̇ Á‡‚ËÒËÏÓÒÚ Ì‡ åäí ÓÚ ÔÓÏÂÌËÚ ̇ ıÂÏÓÂÓÎӄ˘ÌËÚ ԇ‡ÏÂÚË ÏÓÊ ‰‡ ̇ÒÚ˙ÔË ‚ÒΉÒÚ‚Ë ̇ ÍÓÏÔÂÌÒ‡ÚÓ̇ ‚‡ÁӉ˷ڇˆËfl ÔË Ôӂ˯ÂÌË ̇ ïí Ë îàÅ, ˆÂÎfl˘‡ ‰‡ ÔÓ‰‰˙ʇ ÔÓÒÚÓflÌÒÚ‚ÓÚÓ Ì‡ åäí. ÄÚÂˇÎ̇ڇ ıËÔÂÚÓÌËfl Ë äÇ Ò‡ ËÒÍÓ‚Ë Ù‡ÍÚÓË

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Á‡ åëÅ. äÓÏÔÎÂÍÒÌÓÚÓ ÔÓÛ˜‚‡Ì ̇ Ì··„ÓÔËflÚÌËÚ ËÏ ÂÙÂÍÚË Ë Ì‡ ÚÂ‡Ô‚Ú˘ÌÓÚÓ ËÏ ÔÓ‚ÎËfl‚‡Ì ˘Â ‰ÓÔËÌÂÒ Á‡ ÒÌËʇ‚‡Ì ̇ ÚÓÁË ËÒÍ. äβ˜Ó‚Ë ‰ÛÏË: ‡ÚÂˇÎÌÓ Ì‡Îfl„‡ÌÂ, ÏÓÁ˙˜ÂÌ Í˙‚ÂÌ ÚÓÍ, ıÂÏÓÂÓÎÓ„Ëfl ÖÍÒÔÂËÏÂÌÚ‡ÎÌË Ë ÍÎËÌ˘ÌË ÔÓÛ˜‚‡ÌËfl ÔÓ͇Á‚‡Ú Á‡‚ËÒËÏÓÒÚ Ì‡ ÏÓÁ˙˜Ì‡Ú‡ ıÂÏÓ‰Ë̇ÏË͇ ÓÚ ÍÓη‡ÌËÂÚÓ Ì‡ Ò‰ÌÓÚÓ ‡ÚÂˇÎÌÓ Ì‡Îfl„‡Ì /ëÄç/ Ë ÓÚ ÔÓÏÂÌËÚ ̇ Í˙‚ÌËfl ‚ËÒÍÓÁËÚÂÚ /äÇ/. ìÒÚ‡ÌÓ‚ÂÌÓ Â, ÒÌËÊÂÌËÂÚÓ Ì‡ ÏÓÁ˙˜ÌËfl Í˙‚ÂÌ ÚÓÍ /åäí/ ‚ÒΉÒÚ‚Ë ̇ Ôӂ˯ÂÌË ̇ äÇ Ò ÍÓÏÔÂÌÒË‡ ˜ÂÁ Ôӂ˯ÂÌË ̇ ‡ÚÂˇÎÌÓÚÓ Ì‡Îfl„‡ÌÂ Ë ˜ÂÁ ‚‡ÁӉ˷ڇˆËfl /6, 9/. Ç ÛÒÎÓ‚ËflÚ‡ ̇ ̇Û¯Â̇ ‚‡ÁӉ˷ڇˆËfl, ÔË ÒÚÂÌÓÁ‡ ËÎË ÚÓÏ·ÓÁ‡ ̇ χ„ËÒÚ‡Î̇ڇ ‡ÚÂËfl, Í˙‚ÓÒ̇·‰fl‚‡˘‡ ËÁÒΉ‚‡ÌËÚ ÏÓÁ˙˜ÌË ÁÓÌË, ‚ËÒÓÍËflÚ äÇ ‚Ó‰Ë ‰Ó ‰Û͈Ëfl ̇ åäí /9/. èÓ‰Ó·ÌÓ Ò˙ÒÚÓflÌË ̇ Ô‡ÒË‚ÌÓ ÒΉ‚‡Ì ̇ ÔÓÏÂÌËÚ ̇ äÇ ÓÚ åäí Ò ̇·Î˛‰‡‚‡ ÔË Ì‡Î˘Ë ̇ ÒÏÛÚÂ̇ ‡‚ÚÓ„Û·ˆËfl Í˙Ï ÔÓÏÂÌËÚ ̇ ‡ÚÂˇÎÌÓÚÓ Ì‡Îfl„‡ÌÂ, ÔË ÍÓflÚÓ Ì Ò ÓÒ˙˘ÂÒÚ‚fl‚‡ ÍÓÏÔÂÌÒ‡ÚÓ̇ ‚‡ÁӉ˷ڇˆËfl /8,11/. èË ÏÓÁ˙˜ÌÓÒ˙‰Ó‚‡ ·ÓÎÂÒÚ /åëÅ/ ÍÓÏÔÂÌÒ‡ÚÓ̇ڇ ‰Ë·ڇˆËfl ̇ ÏÓÁ˙˜ÌËÚ Ò˙‰Ó‚  ÒËÎÌÓ Á‡ÚÛ‰ÌÂ̇ ÔÓ‡‰Ë Ò˙ÔÓ‚Óʉ‡˘ËÚ fl ‡ÚÂÓÒÍÎÂÓÚ˘ÌË Ë ıËÔÂÚÓÌ˘ÌË Ò˙‰Ó‚Ë ÎÂÁËË. Ç ÚÂÁË ÒÎÛ˜‡Ë ËÁÔ˙Í‚‡ ÓÎflÚ‡ ̇ äÇ Ë Ì„ӂËÚ ÓÒÌÓ‚ÌË ‰ÂÚÂÏË̇ÌÚË: ıÂχÚÓÍËÚ, ÙË·ËÌÓ„ÂÌ, Ô·ÁÏÂÌ ‚ËÒÍÓÁËÚÂÚ, ÂËÚÓˆËÚ̇ ‡„„‡ˆËfl Ë ‰ÂÙÓÏËÛÂÏÓÒÚ Á‡ „ÛÎË‡Ì ̇ ÔÓÏÂÌËÚ ̇ åäí /12, 17/. äÎËÌ˘ÌË ÔÓÛ˜‚‡ÌËfl ‚˙ıÛ ‚Á‡ËÏÓÓÚÌÓ¯ÂÌËflÚ‡ ̇ ıÂÏÓÂÓÎӄ˘ÌËÚ هÍÚÓË Ò˙Ò ÒÍÓÓÒÚÌËÚ ÔÓ͇Á‡ÚÂÎË Ì‡ Í˙‚ÌËfl ÚÓÍ ÓÚ ÒÓÌÓ„‡ÏËÚ ̇ χ„ËÒÚ‡ÎÌËÚÂ Ë ·‡Á‡ÎÌËÚ ÏÓÁ˙˜ÌË ‡ÚÂËË Ë Ò „ËÓ̇ÎÌËfl åäí, ËÁÏÂ‚‡Ì Ò Â‰ÌÓÙÓÚÓÌ̇ ÂÏËÒËÓÌ̇ ÍÓÏÔ˛Ú˙̇ ÚÓÏÓ„‡ÙËfl Ò ËÌı‡ÎË‡Ì ̇ 133ï ‡ÁÍË‚‡Ú ÒÌËÊÂÌË ̇ Í˙‚ÌËfl ÚÓÍ ÔË Ôӂ˯ÂÌË ̇ ıÂχÚÓÍËÚ‡ /2, 3, 5, 13/. èË ·ÓÎÌË Ò ıÓÌ˘ÌË ÏÓÁ˙˜ÌË ËÌÙ‡ÍÚË ‚ËÒÓÍËÚ ÒÚÓÈÌÓÒÚË Ì‡ Ô·ÁÏÂÌËfl ‚ËÒÍÓÁËÚÂÚ ÍÓÂÎË‡Ú Ò˙Ò ÒÌËÊÂÌË ̇ Ë̉ÂÍÒ‡ ̇ ‚‡ÁÓÏÓÚÓ̇ ‡ÍÚË‚ÌÓÒÚ Ì‡ Ò‰ÌËÚ ÏÓÁ˙˜ÌË ‡ÚÂËË / 11, 18 /. ñÂΠ̇ ÔÓÛ˜‚‡ÌÂÚÓ Â ‰‡ Ò ÔÓÒΉflÚ ‚Á‡ËÏÓÓÚÌÓ¯ÂÌËflÚ‡ ÏÂÊ‰Û ÔÓ͇Á‡ÚÂÎËÚ ̇ äÇ Ë åäí Ë Úflı̇ڇ Á‡‚ËÒËÏÓÒÚ ÓÚ ÔÓÏÂÌËÚ ̇ ëÄç ÔË ·ÓÎÌË Ò ËÒıÂÏ˘ÌË Ì‡Û¯ÂÌËfl ̇ ÏÓÁ˙˜ÌÓÚÓ Í˙‚ÓÓ·‡˘ÂÌËÂ. äéçíàçÉÖçí à åÖíéÑà èÓÛ˜‚‡ÌÂÚÓ Â Ôӂ‰ÂÌÓ ÔË 92 ·ÓÎÌË /39 ÊÂÌË Ë 53 Ï˙ÊÂ, Ò‰̇ ‚˙Á‡ÒÚ 57.0±8.6„./ Ò ËÒıÂÏ˘ÌË Ì‡Û¯ÂÌËfl ̇ ÏÓÁ˙˜ÌÓÚÓ Í˙‚ÓÓ·‡˘ÂÌËÂ. Ç Á‡‚ËÒËÏÓÒÚ ÓÚ ‚ˉ‡ ̇ åëÅ ·ÓÎÌËÚ ҇ ‡ÁÔ‰ÂÎÂÌË ‚ ‰‚ „ÛÔË: 44 /23 ÊÂÌË Ë 21 Ï˙ÊÂ, Ò‰̇ ‚˙Á‡ÒÚ 56.6±6.5 „./ Ò Ú‡ÌÁËÚÓÌË ËÒıÂÏ˘ÌË ‡Ú‡ÍË /íàÄ/ Ë 48 /17 ÊÂÌË Ë 31 Ï˙ÊÂ, Ò‰̇ ‚˙Á‡ÒÚ 56.6±11.1 „./ Ò Â‰ÌÓÒÚ‡ÌÌË ÏÓÁ˙˜ÌË ËÌÙ‡ÍÚË /Öåà/. èË ·ÓÎÌËÚÂ Ò íàÄ ËÁÒΉ‚‡ÌÂÚÓ Â Ôӂ‰ÂÌÓ ÓÚ 1 Ò‰Ïˈ‡ ‰Ó 1 „Ó‰Ë̇ ÒΉ ÔÂÊË‚ÂÌËfl ÏÓÁ˙˜ÂÌ Ë̈ˉÂÌÚ. ÅÓÎÌËÚÂ Ò Öåà Ò‡ ÔÂÊË‚ÂÎË ÏÓÁ˙˜ÂÌ ËÌÙ‡ÍÚ ‚ ·‡ÒÂÈ̇ ̇ Ò‰̇ ÏÓÁ˙˜Ì‡ ‡ÚÂËfl Ë ËÏ‡Ú ÓÒÚ‡Ú˙˜ÂÌ Ì‚ÓÎӄ˘ÂÌ ‰ÂÙˈËÚ. Ñˇ„ÌÓÁ‡Ú‡  ÔÓÚ‚˙‰Â̇ Ò ÍÓÏÔ˛Ú˙̇ ÚÓÏÓ„‡ÙËfl ̇ „·‚ÌËfl ÏÓÁ˙Í. èË ‚Ò˘ÍË ·ÓÎÌË Â ËÁÏÂ‚‡ÌÓ ‡ÚÂˇÎÌÓÚÓ Ì‡Îfl„‡Ì ÔÓ Ï‡Ì¯ÂÚÌËfl ÒÔÓÒÓ· Ë Â ËÁ˜ËÒÎfl‚‡ÌÓ ëÄç ÔÓ ÙÓÏÛ·ڇ ̇ Wiggers. ÅÓÎÌËÚ ҇ ÛÒÎÓ‚ÌÓ ‡Á‰ÂÎÂÌË Ì‡ ‰‚ ÔÓ‰„ÛÔË ‚ Á‡‚ËÒËÏÓÒÚ ÓÚ ÓÔÚËχÎÌËÚ ÒÚÓÈÌÓÒÚË Ì‡ ëÄç ÔÓ ÓÚÌÓ¯ÂÌË ̇ Ò˙‰Â˜ÌÓ-Ò˙‰Ó‚Ëfl ËÒÍ /14/: Ò˙Ò ëÄç≥100 /29 ·ÓÎÌË Ò íàÄ, ëÄç=106.5±6.1 mm Hg Ë 30 ·ÓÎÌË Ò Öåà, ëÄç=107.4±9.9 mm Hg/ Ë Ò˙Ò ëÄç<100 /15 ·ÓÎÌË Ò íàÄ, ëÄç= 93.9±4.5 mm Hg Ë 18 ·ÓÎÌË Ò Öåà,


Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

‡ÔËÎ, 2002

ëÄç=92.2±6.1 mm Hg/. ïÂÏÓÂÓÎӄ˘ÌÓÚÓ ËÁÒΉ‚‡Ì ‚Íβ˜‚‡ ÓÔ‰ÂÎflÌ ̇ ıÂχÚÓÍËÚ /ïí/ ÔÓ ˆÂÌÚÓÙÛÊÂÌ ÏÂÚÓ‰, ̇ Ô·ÁÏÂÌ ‚ËÒÍÓÁËÚÂÚ /èÇ/ ‚ mPa.s Ò Í‡ÔËÎflÂÌ ‚ËÒÍÓÁËÏÂÚ˙ Ë Ì‡ ÙË·ËÌÓ„ÂÌ /îàÅ/ ‚ g/l ÔÓ ÍÓ‡„Û·ˆËÓÌÂÌ ÏÂÚÓ‰ ̇ Clauss. äÓÌÚÓÎÌË ËÁÒΉ‚‡ÌËfl Ò‡ Ôӂ‰ÂÌË ÔË 80 ÍÎËÌ˘ÌÓ Á‰‡‚Ë Îˈ‡ /50 ÊÂÌË Ë 30 Ï˙ÊÂ, Ò‰̇ ‚˙Á‡ÒÚ 53.4±7.9 „./ ·ÂÁ ÓÒÌÓ‚ÌËÚ ËÒÍÓ‚Ë Ù‡ÍÚÓË Á‡ åëÅ. ê„ËÓ̇ÎÌËflÚ ÏÓÁ˙˜ÂÌ Í˙‚ÂÌ ÚÓÍ /åäí/  ËÁÒΉ‚‡Ì Ò SPECT /Tomomatic 32, Medimatic - чÌËfl/ Ò ËÌı‡ÎË‡Ì ̇ 133 Xenon. ë‰ÌËÚ ÒÚÓÈÌÓÒÚË Ë Òڇ̉‡ÚÌËÚ ÓÚÍÎÓÌÂÌËfl ̇ Ò‰ÌËfl ıÂÏËÒÙÂÂÌ Í˙‚ÂÌ ÚÓÍ /Òïäí/ Ë åäí ‚ ml/100g/min ‚˙‚ ÙÓÌÚ‡ÎÌËÚ /î/, ÙÓÌÚÓ-ÚÂÏÔÓ‡ÎÌËÚ /î-í/, ÚÂÏÔÓ‡ÎÌËÚ /í/, ÚÂÏÔÓÓ-Ó͈ËÔËÚ‡ÎÌËÚ /í-é/, Ó͈ËÔËÚ‡ÎÌËÚ /é/ ӷ·ÒÚË Ë Ú‡Î‡ÏÛÒËÚ /í‡Î/ Ò‡ ËÁ˜ËÒÎfl‚‡ÌË ‚ ÒÂÁ, ‡ÁÔÓÎÓÊÂÌ Ì‡ 5 ÒÏ Ì‡‰ Ó·ËÚÓχÚÛÒ̇ڇ ÎËÌËfl /éå+5 cm/. /4/ ë ÔÓÏÓ˘Ú‡ ̇ ÔÓÒÚÓflÌÌÓ‚˙ÎÌÓ‚‡ ‰ÓÔÎÂÓ‚‡ ÒÓÌÓ„‡ÙËfl Ò ˆ‚ÂÚÂÌ ÒÔÂÍÚ‡ÎÂÌ ‡Ì‡ÎËÁ ̇ Ì‚ÓÒÓÌÓ„‡ÏËÚ /Vasoscan, Sonicaid - ÄÌ„ÎËfl/ Ò‡ ËÁÒΉ‚‡ÌË Ó·˘ËÚ /éëÄ/, ‚˙Ú¯ÌËÚ Ò˙ÌÌË /ÇëÄ/ Ë ‚ÂÚ·‡ÎÌËÚ /ÇÄ/ ‡ÚÂËË Ì‡ „·‚‡Ú‡. éÔ‰ÂÎflÌË Ò‡ ÓÒÌÓ‚ÌËÚ Ì‚ÓÒÓÌÓ„‡ÙÌË ÔÓ͇Á‡ÚÂÎË - χÍÒËχÎ̇ ÒËÒÚÓÎ̇ ˜ÂÒÚÓÚ‡ /max A/, Í‡È̇ ‰Ë‡ÒÚÓÎ̇ ˜ÂÒÚÓÚ‡ /max D/ Ë̉ÂÍÒ‡ ̇ ÔÂÙËÙÂ̇ Ò˙‰Ó‚‡ ÂÁËÒÚÂÌÚÌÓÒÚ Ì‡ èÛˆÂÎÓ /RP/. äÓÌÚÓÎÌË ÔÓÛ˜‚‡ÌËfl Ò‡ Ôӂ‰ÂÌË ÔË 40 ÍÎËÌ˘ÌÓ Á‰‡‚Ë Îˈ‡ /17 Ï˙ÊÂ Ë 23 ÊÂÌË, Ò‰̇ ‚˙Á‡ÒÚ 48.7±11.4 „./. чÌÌËÚ ÓÚ ÔÓÛ˜‚‡ÌÂÚÓ Ò‡ Ó·‡·ÓÚÂÌË ÒÚ‡ÚËÒÚ˘ÂÒÍË Ò ‚‡ˇˆËÓÌÂÌ Ë ÍÓ·ˆËÓÌÂÌ ‡Ì‡ÎËÁË. êÖáìãíÄíà ïÂÏÓÂÓÎӄ˘ÌÓÚÓ ËÁÒΉ‚‡Ì ‡ÁÍË‚‡ Ôӂ˯ÂÌË ̇ ïí, îàÅ Ë èÇ ÔË ·ÓÎÌËÚÂ Ò ËÒıÂÏ˘ÌË Ì‡Û¯ÂÌËfl ̇ ÏÓÁ˙˜ÌÓÚÓ Í˙‚ÓÓ·‡˘ÂÌËÂ. è·ÁÏÂÌËflÚ ‚ËÒÍÓÁËÚÂÚ Ë ÙË·ËÌÓ„ÂÌ˙Ú Ò‡ Á̇˜ËÏÓ Ôӂ˯ÂÌË Ë ‚ ‰‚ÂÚ „ÛÔË ·ÓÎÌË, ‡ Á‡ ıÂχÚÓÍËÚ‡ Ôӂ˯ÂÌËÂÚÓ Â Á̇˜ËÏÓ Ò‡ÏÓ ‚ „ÛÔ‡Ú‡ Ò Öåà /<0.05/ /Ú‡·Îˈ‡ 1/. 퇷Îˈ‡ 1. ë‰ÌË ÒÚÓÈÌÓÒÚË Ë Òڇ̉‡ÚÌË ÓÚÍÎÓÌÂÌËfl ̇ ıÂÏÓÂÓÎӄ˘ÌËÚ ÔÓ͇Á‡ÚÂÎË ÔË ·ÓÎÌËÚÂ Ë ÍÓÌÚÓÎËÚ ÉÛÔ‡

ïí

îàÅ

èÇ

íàÄ /n=44/ Öåà /n=48/ äÓÌÚÓÎË /n=80/

0.45±0.007

2.98±0.09*

1.39±0.017***

0.47±0.007*

3.12±0.09***

1.39±0.08***

0.45±0.03

2.71±0.49

1.31±0.05

51

퇷Îˈ‡ 2. ë‰ÌË ÒÚÓÈÌÓÒÚË Ë Òڇ̉‡ÚÌË ÓÚÍÎÓÌÂÌËfl ̇ ÒÓÌÓ„‡ÙÌËÚ ÔÓ͇Á‡ÚÂÎË Ì‡ Ò˙ÌÌËÚÂ Ë ‚ÂÚ·‡ÎÌËÚ ‡ÚÂËË ÔË ·ÓÎÌËÚÂ Ò åëÅ èÓ͇Á‡ÚÂÎË /kHz/ ÇëÄ max A

ëÚ‡Ì‡

äÓÌÚÓÎË íàÄ Öåà (n=40) (n=44) (n=48) ã /àë 2.06±0.38 1.90±0.43 1.70±0.61+++ /Ñ/çë/ 2.06±0.35 1.92±0.46 1.87±0.53+++ max D ã /àë/ 0.59±0.14 0.54±0.23 0.38±0.17+++ Ñ/çë/ 0.58±0.16 0.56±0.23 0.48±0.19** RP ã /àë/ 0.67±0.05 0.67±0.07 0.68±0.19 Ñ/çë/ 0.68±0.04 0.68±0.07 0.71±0.08 ÇÄ max A ã /àë/ 1.15±0.35 1.14±0.30 1.07±0.38 Ñ/çë/ 1.11±0.34 0.97±0.30** 0.98±0.31 max D ã /àë/ 0.34±0.08 0.33±0.08 0.30±0.09 Ñ/çë/ 0.32±0.09 0.30±0.10 0.30±0.09 RP ã /àë/ 0.64±0.07 0.65±0.06 0.64±0.13 Ñ/çë/ 0.64±0.10 0.60±0.12* 0.62±0.12 +++p<0.001 - Á̇˜ËÏÓÒÚ ÒÔflÏÓ ÍÓÌÚÓÎ̇ڇ „ÛÔ‡; *<0.05, **p<0.01 - Á̇˜ËÏÓÒÚ ÒÔflÏÓ ÍÓÌÚ‡Î‡ÚÂ‡Î̇ڇ ÒÚ‡Ì‡ àë - ËÌÙ‡ÍÚ̇ ÒÚ‡Ì‡ çë - ÌÂËÌÙ‡ÍÚ̇ ÒÚ‡Ì‡ ÌˈË. 燷≇‚‡ Ò ÚẨÂ̈Ëfl Í˙Ï ÒÌËÊÂÌËÂÚÓ ÏÛ ‚ ÚÂÏÔÓ‡ÎÌËfl ‰flÎ, ÚÂÏÔÓÓ-Ó͈ËÔËÚ‡ÎÌÓ Ë ÙÓÌÚÓÚÂÏÔÓ‡ÎÌÓ. ç‡È-ÒËÎÌÓ Â ÒÌËÊÂÌËÂÚÓ Ì‡ Òïäí Ë åäí ÔË Öåà Ë Ì‡ ÒÚ‡Ì‡Ú‡ ̇ Ò˙‰Ó‚Ëfl Ë̈ˉÂÌÚ /Ú‡·Îˈ‡ 3/. Ç „ÛÔ‡Ú‡ Ò íàÄ ıÂχÚÓÍËÚ˙Ú ÍÓÂÎË‡ Á̇˜ËÏÓ Ò Ï‡ÍÒËχÎ̇ڇ ÒËÒÚÓÎ̇ ˜ÂÒÚÓÚ‡ ÓÚ ÒÓÌÓ„‡ÏËÚ ̇ 퇷Îˈ‡ 3. ë‰ÌË ÒÚÓÈÌÓÒÚË Ë Òڇ̉‡ÚÌË ÓÚÍÎÓÌÂÌËfl ̇ Ò ïäí åäí ÔË ·ÓÎÌËÚÂ Ò íàÄ Ë Öåà èÓ͇Á‡ÚÂÎË /ml/100g/min/ Òåäí åäí - î åäí - î-í  åäí - í  åäí í-é  åäí é  åäí í‡Î

íàÄ ã 64.7±9.1 61.5±14.3 60.9±15.7 54.6±13.9 54.4±12.1 69.9±15.6 92.4±16.7

Ñ 65.4±9.4 64.5±16.1 64.7±14.9 56.4±16.8 52.4±10.6 70.4±16.3 95.2±20.6

Öåà àë 55.7±10.2 65.2±20.9 47.6±16.1 43.9±16.5 46.3±17.2 63.4±16.4 77.1±21.3

çë 64.4±16.9** 66.4±16.1 55.3±15.3 53.1±17.0* 51.7±13.8** 65.2±15.8 85.8±19.4**

* < 0.05, ** p < 0.01 - Á̇˜ËÏÓÒÚ ÒÔflÏÓ ÍÓÌÚ‡Î‡ÚÂ‡Î̇ڇ ÒÚ‡Ì‡

*<0=05, *** p<0=001 - Á̇˜ËÏÓÒÚ ÒÔflÏÓ ÍÓÌÚÓÎËÚ àÁÒΉ‚‡ÌÂÚÓ Ò ÔÓÒÚÓflÌÌÓ‚˙ÎÌÓ‚‡ ‰ÓÔÎÂÓ‚‡ ÒÓÌÓ„‡ÙËfl ÔÓ͇Á‚‡ ‡Á΢̇ ˜ÂÒÚÓÚ‡ Ë ÚÂÊÂÒÚ Ì‡ ·ÓÎÂÒÚÌËfl Ò˙‰Ó‚ ÔÓˆÂÒ Ì‡ ÂÍÒÚ‡Í‡ÌˇÎÌËÚ ÏÓÁ˙˜ÌË ‡ÚÂËË ÔË ·ÓÎÌËÚÂ Ò åëÅ. èË ·ÓÎÌËÚÂ Ò Öåà Á‡˜ÂÒÚfl‚‡Ú ıÂÏÓ‰Ë̇Ï˘ÌÓ Á̇˜ËÏËÚ ÒÚÂÌÓÁË Ì‡ ‚˙Ú¯̇ڇ Ò˙Ì̇ ‡ÚÂËfl. ëÍÓÓÒÚÌËÚ ÔÓ͇Á‡ÚÂÎË Ì‡ ÇëÄ Ò‡ Á̇˜ËÏÓ ÒÌËÊÂÌË ÒÔflÏÓ ÍÓÌÚÓÎËÚ ‚ „ÛÔ‡Ú‡ Ò Öåà, Í˙‰ÂÚÓ Ò ̇·Î˛‰‡‚‡ Á̇˜ËÏÓ ÒÌËÊÂÌË ̇ Í‡È̇ڇ ‰Ë‡ÒÚÓÎ̇ ˜ÂÒÚÓÚ‡ ̇ ÒÚ‡Ì‡Ú‡ ̇ ËÌÙ‡ÍÚ‡. ë‰ÌËÚ ÒÚÓÈÌÓÒÚË Ë Òڇ̉‡ÚÌËÚ ÓÚÍÎÓÌÂÌËfl ̇ Ì‚ÓÒÓÌÓ„‡ÙÌËÚ ԇ‡ÏÂÚË Ì‡ χ„ËÒÚ‡ÎÌËÚ ‡ÚÂËË Ì‡ „·‚‡Ú‡ Ò‡ ÔÓ͇Á‡ÌË Ì‡ Ú‡·Îˈ‡ 2. ë‰ÌËflÚ ïäí ÔË ·ÓÎÌËÚÂ Ò íàÄ Â ‚ ÌÓχÎÌË „‡-

‰ÂÒÌËÚ ÇëÄ, ͇ÍÚÓ Ë Ò Ï‡ÍÒËχÎÌËÚ ÒËÒÚÓÎÌË Ë Í‡ÈÌËÚ ‰Ë‡ÒÚÓÎÌË ˜ÂÒÚÓÚË ÓÚ ÒÓÌÓ„‡ÏËÚ ̇ ΂ËÚ ÇÄ. íÂÁË ÍÓ·ˆËË ÒÚ‡‚‡Ú ÔÓ-‚ËÒÓÍË ‚ ÔÓ‰„ÛÔ‡Ú‡ Ò˙Ò ëÄç < 100 Ë Ò Á‡„Û·‚‡Ú ÔË ·ÓÎÌËÚ Ò˙Ò ëÄç ≥ 100. ç Ò ÛÒÚ‡ÌÓ‚fl‚‡Ú Á̇˜ËÏË Á‡‚ËÒËÏÓÒÚË Ì‡ îàÅ Ë èÇ Ò Ì‚ÓÒÓÌÓ„‡ÙÌËÚ ÔÓ͇Á‡ÚÂÎË ÔË ·ÓÎÌËÚÂ Ò íàÄ. èË Ò˙˘ËÚ ·ÓÎÌË ÍÓ·ˆËËÚ ̇ ıÂÏÓÂÓÎӄ˘ÌËÚ ÔÓ͇Á‡ÚÂÎË Ò˙Ò Òïäí Ë åäí Á‡Ô‡Á‚‡Ú Ò‚Ófl ÓÚˈ‡ÚÂÎÂÌ Á̇Í. Ç Ó·˘‡Ú‡ „ÛÔ‡ Ò íàÄ Ú ҇ Á̇˜ËÏË Ò‡ÏÓ Á‡ îàÅ Ë èÇ Ë ÔÂÒËÒÚË‡Ú ÔË ëÄç<100. àÌÚÂÂÒ Ô‰ËÁ‚ËÍ‚‡Ú ‚Á‡ËÏÓÓÚÌÓ¯ÂÌËflÚ‡ ̇ ïí Ò åäí: ÓÚÒ˙ÒÚ‚Ë ̇ Á̇˜ËÏË ÍÓ·ˆËË ‚ ˆfl·ڇ „ÛÔ‡ Ò íàÄ, Á̇˜ËÏË ÔÓÎÓÊËÚÂÎÌË ÔË ëÄç <100 Ë Á̇˜ËÏË ÓÚˈ‡ÚÂÎÌË ÔË ëÄç ≥ 100 /Ú‡·ÎËˆË 4, 5 Ë 6/. èË ·ÓÎÌËÚÂ Ò Öåà Ò ̇·Î˛‰‡‚‡Ú Á̇˜ËÏË ÓÚˈ‡ÚÂÎÌË Á‡‚ËÒËÏÓÒÚË ÏÂÊ‰Û ïí Ë Ï‡ÍÒËχÎÌËÚ ÒËÒÚÓÎÌË Ë ‰Ë‡ÒÚÓÎÌË ˜ÂÒÚÓÚË Ì‡ Ò˙ÌÌËÚ ‡ÚÂËË Ì‡ ÒÚ‡Ì‡Ú‡ ̇ ËÌÙ‡ÍÚ‡. Ç ÔÓ‰„ÛÔ‡Ú‡ Ò˙Ò ëÄç < 100 ÚÂÁË ÍÓ·ˆËË ÒÚ‡‚‡Ú ÔÓ-‚ËÒÓÍË. èË ·ÓÎÌËÚ Ò˙Ò ëÄç≥100 Á‡‚ËÒËÏÓÒÚËÚ ÏÂÊ‰Û ïí Ë ÒÍÓÓÒÚÌËÚ ÔÓ͇Á‡ÚÂÎË Ì‡ ÍÓÌÚ‡Î‡ÚÂ‡ÎÌËÚ ̇ ÏÓÁ˙˜ÌËfl ËÌÙ‡ÍÚ ÇëÄ Ë ÓÚ


‡ÔËÎ, 2002

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

퇷Îˈ‡ 4. á̇˜ËÏË Á‡‚ËÒËÏÓÒÚË ÏÂÊ‰Û ıÂχÚÓÍËÚ‡, Ì‚ÓÒÓÌÓ„‡ÙÌËÚ ÔÓ͇Á‡ÚÂÎË Ë åäí ÔË ·ÓÎÌËÚÂ Ò åëÅ èÓ͇Á‡ÚÂÎË íàÄ(n=44) Öåà(n=48) ïí - max A ÑÇëÄ -0.41** ïí - max Ä ãÇÄ -0.42** ïí - max D ãÇÄ -0.59** ïí - max A ÇëÄ àë -0.36* ïí - max D ÇëÄ àë -0.33* î - max A ÇëÄ çë -0.33* î - max D ÇëÄ çë -0.35* î - RP ÇëÄ çë +0.29* ïí - åäí î çë +0.31* ïí - åäí î-í çë +0.30* ïí - åäí í çë +0.30* ïí - åäí í-é çë +0.28* î - åäí î-í Ñ -0.35* î - åäí í‡Î Ñ -0.44* èÇ - åäí í‡Î ã -0.36* * p < 0.05, ** p < 0.01 퇷Îˈ‡ 5 . á̇˜ËÏË Á‡‚ËÒËÏÓÒÚË ÏÂÊ‰Û ıÂχÚÓÍËÚ‡, Ì‚ÓÒÓÌÓ„‡ÙÌËÚ ÔÓ͇Á‡ÚÂÎË Ë åäí ÔË ·ÓÎÌËÚ Ò˙Ò ëÄç ≥ 100 èÓ͇Á‡ÚÂÎË íàÄ(n=44) Öåà(n=48) ïí - max A ÇëÄ çë + 0.47* ïí - max D ÇëÄ çë + 0.38* ïí - max D ÇÄ àë + 0.41* ïí - max A ÇÄ çë +0.52** ïí - RP ÇÄ çë +0.48* î - RP ÇëÄ çë +0.46* ïí - åäí í-é Ñ -0.54** ïí - åäí í‡Î ã -0.53* ïí - åäí î-í çë +0.57** ïí - åäí í çë +0.65*** î - åäí î àë +0.68*** èÇ - åäí î-í çë -0.74*** èÇ - åäí í çë -0.70*** èÇ - åäí í-é çë -0.63** *p<0.05, ** p<0.01 *** p<0.001 ‰‚ÂÚ ÇÄ Ò‡ Á̇˜ËÏË ÔÓÎÓÊËÚÂÎÌË. äÓ·ˆËËÚ ̇ ïí Ò Ì‚ÓÒÓÌÓ„‡ÙÌËÚ ÔÓ͇Á‡ÚÂÎË Ì‡ ÌflÍÓË ÓÚ ÚÂÁË ‡ÚÂËË ÔË ëÄç < 100 Ò‡ Á̇˜ËÏË ÓÚˈ‡ÚÂÎÌË /‚Ê. Ú‡·ÎËˆË 4, 5 Ë 6/. ᇠ‡ÁÎË͇ ÓÚ ïí ÙË·ËÌÓ„ÂÌ˙Ú ÍÓÂÎË‡ Á̇˜ËÏÓ Ò˙Ò ÒÓÌÓ„‡ÙÌËÚ ÔÓ͇Á‡ÚÂÎË Ò‡ÏÓ ‚ „ÛÔ‡Ú‡ Ò Öåà. 燷≇‚‡Ú Ò ÓÚˈ‡ÚÂÎÌË Á‡‚ËÒËÏÓÒÚË Ì‡ îàÅ Ò Ï‡ÍÒËχÎÌËÚ ÒËÒÚÓÎÌË Ë ‰ËÒÚÓÎÌË ˜ÂÒÚÓÚË Ë Ò RP ÓÚ ÒÓÌÓ„‡ÏËÚ ̇ ÔÓÚË‚ÓÔÓÎÓÊÌËÚ ̇ ËÌÙ‡ÍÚ‡ ÇëÄ. èË ëÄç < 100 ÍÓ·ˆËËÚ ̇ îàÅ Ò˙Ò ÒÍÓÓÒÚÌËÚ ÔÓ͇Á‡ÚÂÎË Ò‡ ‚ËÒÓÍË ÓÚˈ‡ÚÂÎÌË Á‡ ıÓÏÓ·ÚÂ‡ÎÌËÚ ̇ ËÌÙ‡ÍÚ‡ ÇëÄ Ë ÇÄ Ë Á‡ ÍÓÌÚ‡Î‡ÚÂ‡ÎÌËÚ ÇëÄ. ÇÒ˘ÍË ÍÓ·ˆËË Ì‡ ïí Ò˙Ò ÒÚÓÈÌÓÒÚËÚ ̇ Òïäí Ë åäí Ò‡ Á̇˜ËÏË ÔÓÎÓÊËÚÂÎÌË, ‡ ÍÓ·ˆËËÚ ̇ èÇ Ò åäí - Ò‡ Á̇˜ËÏË ÓÚˈ‡ÚÂÎÌË Á‡ ÔÓÚË‚ÓÔÓÎÓÊ̇ڇ ̇ ÏÓÁ˙˜ÌËfl ËÌÙ‡ÍÚ ÒÚ‡Ì‡ ÔË ëÄç<100, Ë ÓÒÓ·ÂÌÓ ÔË ëÄç ≥100. éÅëöÜÑÄçÖ êÂÁÛÎÚ‡ÚËÚ ÓÚ Ôӂ‰ÂÌËÚ ÍÓ·ˆËÓÌÌË ÔÓÛ˜‚‡ÌËfl ‡ÁÍË‚‡Ú Á‡‚ËÒËÏÓÒÚË ÏÂÊ‰Û ÔÓ͇Á‡ÚÂÎËÚ ̇ äÇ,

52

퇷Îˈ‡ 6. á̇˜ËÏË Á‡‚ËÒËÏÓÒÚË ÏÂÊ‰Û ıÂχÚÓÍËÚ‡, Ì‚ÓÒÓÌÓ„‡ÙÌËÚ ÔÓ͇Á‡ÚÂÎË Ë åäí ÔË ·ÓÎÌËÚ Ò˙Ò ëÄç < 100 èÓ͇Á‡ÚÂÎË íàÄ(n=44) Öåà(n=48) ïí - max D ãÇëÄ -0.74*** ïí- RP ãÇëÄ +0.74*** ïí - max D ÑÇëÄ -0.73*** ïí- RP ãÇëÄ +0.65** ïí - max Ä ãÇÄ -0.77*** ïí - max D ãÇÄ -0.81*** ïí - max D ÇÄ àë -0.70*** ïí - max A ÇëÄ àë -0.51* î - max A ÇëÄ àë -0.56* î - max D ÇëÄ àë -0.85*** î - max A ÇëÄ çë -0.61** î - max D ÇëÄ çë -0.72*** î - max D ÇÄ àë -0.76*** ïí - åäí í Ñ +0.56** ïí - åäí í-é ã +0.78*** ïí - åäí í-é Ñ +0.65** ïí - åäí í‡Î ã +0.54** ïí - åäí í çë +0.63** ïí - åäí î çë +0.62** ïí - åäí é àë +0.58** ïí - åäí é çë +0.68** ïí - åäí í‡Î àë -0.58** èÇ - åäí í‡Î ã -0.52** èÇ - åäí í‡Î Ñ -0.40* èÇ - åäí í-é çë -0.54** î - åäí é àë -0.45* *p<0.05, ** p<0.01, *** p<0.001 Ì‚ÓÒÓÌÓ„‡ÙÌËÚ ԇ‡ÏÂÚË ÓÚ ÂÍÒÚ‡Í‡ÌˇÎÌËÚ ÏÓÁ˙˜ÌË ‡ÚÂËË Ë åäí. èÂӷ·‰‡‚‡Ú Á̇˜ËÏËÚ ÍÓ·ˆËË Ì‡ ïí Ò˙Ò ÒÍÓÓÒÚÌËÚ ԇ‡ÏÂÚË ÓÚ ÒÓÌÓ„‡ÏËÚ ̇ ͇ÓÚËÒÌËÚÂ Ë ‚ÂÚ·‡ÎÌËÚ ‡ÚÂËË Ë Ò åäí. á̇˜ËÏËÚ ÍÓ·ˆËË Ì‡ èÇ Ò‡ Ò‡ÏÓ Ò˙Ò ÒÚÓÈÌÓÒÚËÚ ̇ åäí. íÂÁË Ì‡·Î˛‰ÂÌËfl ÔÓÚ‚˙ʉ‡‚‡Ú Á̇˜ÂÌËÂÚÓ Ì‡ ïí ͇ÚÓ ÓÒÌÓ‚ÂÌ ‰ÂÚÂÏË̇ÌÚ Ì‡ äÇ Ë ‚ÎËflÌËÂÚÓ ÏÛ ‚˙ıÛ Í˙‚ÌËfl ÚÓÍ ‚ χ„ËÒÚ‡ÎÌËÚ ÏÓÁ˙˜ÌË ‡ÚÂËË, ͇ÍÚÓ Ë ÓÔ‰ÂÎfl˘‡Ú‡ ÓÎfl ̇ èÇ Á‡ Í˙‚ÌËfl ÚÓÍ ‚ ÏËÍÓˆËÍÛ·ÚÓ̇ڇ Ò˙‰Ó‚‡ ÏÂʇ /12, 19/. éÚÒ˙ÒÚ‚ËÂÚÓ Ì‡ Á̇˜ËÏË Á‡‚ËÒËÏÓÒÚË Ì‡ èÇ Ë Ì‚ÓÒÓÌÓ„‡ÙÌËÚ ÔÓ͇Á‡ÚÂÎË ÔË ·ÓÎÌËÚÂ Ò íàÄ Ë Öåà Ë Ì‡ îàÅ Ë Ì‚ÓÒÓÌÓ„‡ÙÌËÚ ÔÓ͇Á‡ÚÂÎË ÔË íàÄ ÏÓÊ ‰‡ Ò ҂˙ÊÂ Ò ÌËÒ͇ڇ ˜ÂÒÚÓÚ‡ ̇ ‚ËÒÓÍÓÒÚÂÔÂÌÌË Í‡ÓÚËÒÌË ÒÚÂÌÓÁË,ÔË ÍÓËÚÓ ÌflÍÓË ‡‚ÚÓË Ì‡ÏË‡Ú Ôӂ˯ÂÌË ̇ ÚÂÁË ıÂÏÓÂÓÎӄ˘ÌË Ô‡‡ÏÂÚË /10/. ëÔˆˇÎÌÓ ‚ÌËχÌË Á‡ÒÎÛʇ‚‡ ‚ÎËflÌËÂÚÓ Ì‡ ‡ÚÂˇÎÌÓÚÓ Ì‡Îfl„‡Ì ‚˙ıÛ ‚Á‡ËÏÓÓÚÌÓ¯ÂÌËflÚ‡ ̇ ıÂÏÓÓÎӄ˘ÌËÚ هÍÚÓË Ò åäí. äÓ·ˆËËÚ ÏÂÊ‰Û ÚÂÁË ÔÓ͇Á‡ÚÂÎË Ò‡ ÔÓ-ÒËÎÌÓ ËÁ‡ÁÂÌË ÔË ÌÓχÎÌË ÒÚÓÈÌÓÒÚË Ì‡ ‡ÚÂˇÎÌÓÚÓ Ì‡Îfl„‡ÌÂ.í ҇ ÓÚˈ‡ÚÂÎÌË Á‡ ïí Ë îàÅ Ò˙Ò ÒÍÓÓÒÚÌËÚ ÒÓÌÓ„‡ÙÌË ÔÓ͇Á‡ÚÂÎË Ë ÔÓÎÓÊËÚÂÎÌË Á‡ ïí Ë åäí Á‡ ¯ËÓÍ ‰Ë‡Ô‡ÁÓÌ ÏÓÁ˙˜ÌË Ó·Î‡ÒÚË Ë ÔË ‰‚ÂÚ „ÛÔË ËÁÒΉ‚‡ÌË ·ÓÎÌË. èË ·ÓÎÌËÚÂ Ò Öåà Ë ëÄç ≥ 100 ÍÓ·ˆËÚ ̇ ïí Ë îàÅ Á‡ ÍÓÌÚ‡Î‡ÚÂ‡Î̇ڇ ̇ ÏÓÁ˙˜ÌËfl ËÌÙ‡ÍÚ ÒÚ‡Ì‡ Ò‡ ÔÓÎÓÊËÚÂÎÌË. é˜Â‚ˉÌÓ ‚ ÒÎÛ˜‡ËÚÂ Ò ÓÚÌÓÒËÚÂÎÌÓ Á‡Ô‡ÁÂÌ ‚‡ÁÓÏÓÚÓÂÌ ÂÁÂ‚ ̇ ÏÓÁ˙˜ÌËÚ ‡ÚÂËË Ì‡ÒÚ˙Ô‚‡ ‚‡ÁÓÏÓÚÓ̇ ̇„·҇ Í˙Ï ÔÓÏÂÌËÚ ̇ ïí Ë îàÅ /7/. 燯ËÚ ÂÁÛÎÚ‡ÚË Ò‡ ‚ Ò˙„·ÒËÂ Ò ‰‡ÌÌËÚ ̇ Muizelaa et al./11/ , ÒÔÓ‰ ÍÓËÚÓ ÔÓÏÂÌËÚ ‚ ‰Ë‡ÏÂÚ˙‡ ̇ Í˙‚ÓÌÓÒÌËÚ Ò˙‰Ó‚ ÔË ‡ÚÂˇÎ̇ ıËÔÓÚÓÌËfl ËÎË ‚ËÒÓÍ äÇ Ò‡ ÔÓ-„ÓÎÂÏË, ÓÚÍÓÎÍÓÚÓ ÔË ÚÂÁË Ò ‡ÚÂ-


Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

‡ÔËÎ, 2002

ˇÎ̇ ıËÔÂÚÓÌËfl ËÎË ÒÌËÊÂÌ äÇ. í Ò ÔÓÚ‚˙ʉ‡‚‡Ú Ë ÓÚ ‡Ì‡ÎËÁ‡ ̇ ÍÓÏÔÎÂÍÒÌÓÚÓ ‚ÎËflÌË ̇ ‚˙Á‡ÒÚÚ‡, ıÂÏÓÂÓÎӄ˘ÌËÚ ÔÓ͇Á‡ÚÂÎË Ë ëÄç ‚˙ıÛ Ì‚ÓÒÓÌÓ„‡ÙÌËÚ ԇ‡ÏÂÚË Ì‡ Í˙‚ÌËfl ÚÓÍ ‚ ÂÍÒÚ‡Í‡ÌˇÎÌËÚ ‡ÚÂËË Ì‡ „·‚‡Ú‡ ÔË åëÅ, ÔË ÍÓËÚÓ Á‡ ·ÓÎÌËÚÂ Ò íàÄ Ò ÓÚÍÓfl‚‡ ÂÙÂÍÚ‡ ̇ ïí, ‡ ÔË ·ÓÎÌËÚÂ Ò ıÓÌ˘ÌË ÏÓÁ˙˜ÌË ËÌÙ‡ÍÚË ÔÂӷ·‰‡‚‡ ÂÙÂÍÚ‡ ̇ ëÄç /3,15/. 燯ËÚ ÔÓÛ˜‚‡ÌËfl ÔÓ͇Á‚‡Ú, ˜Â èÇ Ó͇Á‚‡ ‰ËÂÍÚÂÌ, ÌÂÁ‡‚ËÒ¢ ÓÚ ëÄç ÂÙÂÍÚ ‚˙ıÛ åäí. èÓ-ÌÓ‚Ë ÂÍÒÔÂËÏÂÌÚ‡ÎÌË ÔÓÛ˜‚‡ÌËfl ÔÓÒÓ˜‚‡Ú ÚÓÁË ÂÓÎӄ˘ÂÌ ÔÓ͇Á‡ÚÂΠ͇ÚÓ Ì‡È-‚‡ÊÂÌ ÓÔ‰ÂÎfl˘ Ù‡ÍÚÓ Á‡ åäí /16/. ïÂÏÓÂÓÎӄ˘ÌËÚ ̇Û¯ÂÌËfl Ë ‡ÚÂˇÎ̇ڇ ıËÔÂÚÓÌËfl Ò‡ Ù‡ÍÚÓË,ÍÓËÚÓ Ôӂ˯‡‚‡Ú ËÒ͇ ÓÚ ËÒıÂÏ˘ÂÌ ÏÓÁ˙˜ÂÌ ËÌÒÛÎÚ Ë ‚ÎÓ¯‡‚‡Ú Ì„ӂ‡Ú‡ ÔÓ„ÌÓÁ‡ /19/. äÓÏÔÎÂÍÒÌÓÚÓ ËÁÛ˜‡‚‡Ì ̇ ÚÂıÌËÚ Ì··„ÓÔËflÚÌË ÂÙÂÍÚË Ë ÚÂ‡Ô‚Ú˘ÌÓÚÓ ËÏ ÔÓ‚ÎËfl‚‡Ì ˘Â ‰ÓÔËÌÂÒ Á‡ ÒÌËʇ‚‡Ì ̇ ÚÓÁË ËÒÍ. ãàíÖêÄíìêÄ 1. ÇÂΘ‚‡, à., íËÚflÌÓ‚‡, Ö., ÄÎÂÍ҇̉Ó‚‡, Ñ., чÏflÌÓ‚, è. éˆÂÌ͇ ̇ ‚‡ÁÓÏÓÚÓ̇ڇ ‡ÍÚË‚ÌÓÒÚ ‚ Ò‰̇ڇ ÏÓÁ˙˜Ì‡ ‡ÚÂËfl ÔË ·ÓÎÌË Ò ıÓÌ˘ÌË Â‰ÌÓÒÚ‡ÌÌË ÏÓÁ˙˜ÌË ËÌÙ‡ÍÚË ÔÓÒ‰ÒÚ‚ÓÏ Ú‡ÌÒÍ‡ÌˇÎ̇ ‰ÓÔÎÂÓ‚‡ ÒÓÌÓ„‡ÙËfl. Å˙΄‡Ò͇ Ì‚ÓÎÓ„Ëfl, 1, 2000, 1, 13-17. 2. ÇÂΘ‚‡, à., ÊË‚, Ñ., ü̘‚‡, ë., ÅÓ‚‡, Ñ., èÂÚÛÌfl¯Â‚, Ç. ïÂÏÓÂÓÎӄ˘ÌË ÔÓÏÂÌË Ë ÏÓÁ˙˜ÂÌ Í˙‚ÂÌ ÚÓÍ ÔË ËÒıÂÏ˘ÌË Ì‡Û¯ÂÌËfl ̇ ÏÓÁ˙˜ÌÓÚÓ Í˙‚ÓÓ·‡˘ÂÌËÂ. åÓÁ˙˜ÌÓÒ˙‰Ó‚Ë Á‡·ÓÎfl‚‡ÌËfl, 2, 1994, 1, 11-15. 3. íËÚflÌÓ‚‡, Ö., ÇÂΘ‚‡, à., ü̘‚‡, ë., ä‡ÎËÌÓ‚, ä., èÂÚÛÌfl¯Â‚, Ç., ÊË‚, Ñ. ç‚ÓÒÓÌÓ„‡ÙÒ͇ ÓˆÂÌ͇ ̇ ‚ÎËflÌËÂÚÓ Ì‡ ‚˙Á‡ÒÚÓ‚Ëfl Ù‡ÍÚÓ, Ò‰ÌÓÚÓ ‡ÚÂˇÎÌÓ Ì‡Îfl„‡ÌÂ Ë ÌflÍÓË ıÂÏÓÂÓÎӄ˘ÌË ÔÓ͇Á‡ÚÂÎË ‚˙ıÛ Í˙‚ÌËfl ÚÓÍ ‚ ÂÍÒÚ‡Í‡ÌˇÎÌËÚ ‡ÚÂËË Ì‡ „·‚‡Ú‡ ÔË ·ÓÎÌË Ò ËÒıÂÏ˘ÌË Ì‡Û¯ÂÌËfl ̇ ÏÓÁ˙˜ÌÓÚÓ Í˙‚ÓÓ·‡˘ÂÌËÂ. åÓÁ˙˜ÌÓÒ˙‰Ó‚Ë Á‡·ÓÎfl‚‡ÌËfl, 8, 2000, 1, 17-22. 4. ü̘‚‡, ë. Ñˇ„ÌÓÒÚ˘̇ ÒÚÓÈÌÓÒÚ Ì‡ ‰ÌÓÙÓÚÓÌ̇ڇ ÂÏËÒËÓÌ̇ ÍÓÏÔ˛Ú˙̇ ÚÓÏÓ„‡ÙËfl ÔË ËÒıÂÏ˘ÌË Ì‡Û¯ÂÌËfl ̇ ÏÓÁ˙˜ÌÓÚÓ Í˙‚ÓÓ·‡˘ÂÌËÂ. ÑÓÍÚ. ÑËÒ., ë., 1989. 5. Brass, L.M., Pavlikas, S.G., De Vivo, D., Piomelli, S., Mohr, J. Transcranial Doppler measurements of the middle cerebral artery. Effects of hematocrit. Stroke, 19, 1988, 12, 1466-1469.

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6. Cinar, Y., Demir, G., Pac, M., Cinar, A.B. Effect of hematocrit on blood pressure via hyperviscosity. Am. J. Hypertens., 12, 1999, 7, 739-743. 7. Fan, F., Chen, R., Schuessler, G., Chien, S. Effects of hematocrit variations on regional hemodynamics and oxygen transport in the dog. Am. J. Physiol., 238, 1980, H545-H552. 8. Kummer von, R., Sharf, J., Back, T., Reuch, K., Machens, H.G., Wildemann, B. Autoregulatory capacity and the effect of isovolemic hemodilution on local blood flow. Stroke,19, 1988, 5, 594-597. 9. Lenz, C., Frietsch, T., Futterer, C., von Achen, K., Kuschinsky, W., Waschke, K.F., Influence of blood viscosity on blood flow in the forebrain but not hindcrain after carotid occlusion in rats. J. Cereb. Blood Flow Metab., 20, 2000, 6, 947-955. 10. Mercuri, M., Orecchine, G., Suste, C.Z., Tazza, D., Cinffetti, G. Correlation between hemorheological parameters and carotid atherosclerosis in stroke. Angiology, 40, 1989, 283-286. 11. Muizelaar, J.P., Wei, E.P., Kontos, H.A., Becker, D.P. Cerebral blood flow is regulated by changes in blood pressure and in blood viscosity alike. Stroke, 17, 1986, 1, 44-48. 12. Schmid-Schonbein, H., Teitel, P. The Aachen clinical hemorheological test profile& a proposal for the documentation of hemorheological data in clinical medicine. Clinical Hemorheology, 1984, 1, suppl., 49-62. 13. Schuurman, P.R., Albreht, U.W. Intraopeerative changes of transcranial Doppler velocity& relation to arterial oxygen content and whole-blood viscosity. Ultrasound in Med. & Biol., 25, 1999, 1, 151-154. 14. The Fifth Report of the Joint National Committee in High Blood Pressure (JNCV), Oct. 30, 1992. National Institute of Health, New York. 15. Titianova, E., Velcheva, I., Mateev, P. Effects of aging and hematocrit on cerebral blood flow velocity in patients with unilateral cerebral infarctions - a Doppler ultrasound evaluation. Angiology, 44, 1993, 2, 100 -106. 16. Tomiyama, Y., Brain, J.E., Todd, M.M. Plasma viscosity and cerebral blood flow. Am. J. Physiol. Heart Circ Physiol., 279, 2000, 4, H1949-H1954. 17. Velcheva, I. Hemorheological disturbances in cerebrovascular diseases. In: International Conference on Biorheology and School for young scientists, Sofia, 1822 October, 2000, 116-120. 18. Velcheva, I., Antonova, N., Titianova, E., Alexandrova, D., Damianov, P. Do blood viscosity parameters influence cerebral vasomotor reactivity? In: In: International Conference on Biorheology and School for young scientists, Sofia, 1822 October, 2000, 116-120. 19. Wannamethee, G., Perry, I., Shaper, A., Hematocrit,hypertension and risk of stroke. J. Intern. Med., 235, 1994, 163-168.

ĉÂÒ Á‡ ÍÓÂÒÔÓ̉Â̈Ëfl: ‰Óˆ. ‰- à. ÇÂΘ‚‡, ‰.Ï. ìëÅÄãçè "ë‚ÂÚË ç‡ÛÏ", ÛÎ. "çËÍÓ· êÛÒ‚" 1, 1113 ëÓÙËfl ÚÂÎ.: 70-9 0-31 e-mail: ivelcheva@yahoo.com

éË„Ë̇ÎÌË ÒÚ‡ÚËË äãàçàóçà à ÖãÖäíêéåàéÉêÄîëäà èêéìóÇÄçàü èêà Åéãçà ë éëíêÄ à ïêéçàóçÄ ÇöáèÄãàíÖãçÄ ÑÖåàÖãàçàáàêÄôÄ èéãàçÖÇêéèÄíàü å. чÒ͇ÎÓ‚, Ñ. Äڇ̇ÒÓ‚‡, ç. åÛ‡‰flÌ, ë. çÓ‚‡˜ÍÓ‚‡, è. ëÚ‡ÏÂÌÓ‚‡, Å. à¯ÔÂÍÓ‚‡ ç‚ÓÎӄ˘̇ ÍÎËÌË͇, åÅÄã "ñ‡ˈ‡ âÓ‡Ì̇", ëÓÙËfl SUMMARY CLINICAL AND ELECTROMYOGRAPHIC STUDIES IN PATIENTS WITH ACUTE AND CHRONIC INFLAMMATORY DEMYELINATING POLYNEUROPATHY M. Daskalov, D. Atanasova, N. Muradian, S. Novachkova, P. Stamenova, B. Ishpekova The aim of the study is to compare the clinical and EMG characteristics in patients with GBS and CIDP to estimate the correlation between the clinical course of the disease and the EMG data, and to define the prognostic value of the latter.

The examination was made with thirty-five patients, divided into two groups according to certain clinical and EMG criteria: GBS (22, twenty-two patients), and CIDP (13, thirteen patients). Motor conduction studies were performed with needle concentric and surface electrodes. Sensory conduction studies were performed by the antidromic method. The cases where there were viral infections, preceding the GBS, are much more frequent (76,9%), than those preceding the CIDP (30,7%). The cranial nerves are involved in 54,5% in patients with GBS, and in 30,7% in patients with CIDP. Ten percent of the patients in the GBS group show features typical of OMAN, OMSAN and MFS. The cases which show axonal damage have a slower and more incomplete recovery than


‡ÔËÎ, 2002

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

those with demyelination. At the early stage of the disease in patients with GBS the changes in F waves are more significant than the elevation of CSF proteins. The partial conduction block in the motor and sensory nerves is well manifested; so are certain other features, typical of demyelination. There is a rich denervation activity as early as the second month from the onset of the disease; it progresses to a full bio-electric silence during the third year. There is a slow conduction velocity (CV) and SNAP are usually absent. Key words: GBS, CIDP, EMG, conduction block, polyneuropathy êÖáûåÖ ñÂÎÚ‡ ̇ ̇ÒÚÓfl˘ÓÚÓ ËÁÒΉ‚‡Ì  ‰‡ Ò Ò‡‚ÌflÚ ÍÎËÌ˘ÌËÚÂ Ë ÂÎÂÍÚÓÏËÓ„‡ÙÒÍË (ÖåÉ) ÔÓ͇Á‡ÚÂÎË ÔË Ô‡ˆËÂÌÚË Ò˙Ò ÒË̉ÓÏ Ì‡ ÉËÎÂÌ-Ň (ëÉÅ) Ë ıÓÌ˘̇ ‚˙ÁÔ‡ÎËÚÂÎ̇ ‰ÂÏËÂÎËÌËÁË‡˘‡ ÔÓÎËÌ‚ÓÔ‡ÚËfl (ïÇÑè), ‰‡ Ò ÛÒÚ‡ÌÓ‚Ë ÍÓ·ˆËfl ÏÂÊ‰Û ÍÎËÌ˘ÌËfl ıÓ‰ ̇ Á‡·ÓÎfl‚‡ÌËflÚ‡ Ë ÖåÉ ‰‡ÌÌËÚÂ, ͇ÍÚÓ Ë ‰‡ Ò ÓÔ‰ÂÎË ÔÓ„ÌÓÒÚ˘̇ڇ ÒÚÓÈÌÓÒÚ Ì‡ ÔÓÒΉÌËÚÂ. àÁÒΉ‚‡ÌÂÚÓ Â Ôӂ‰ÂÌÓ ÔË 35 Ô‡ˆËÂÌÚË, ÍÓËÚÓ Ò‡ ‡Á‰ÂÎÂÌË ‚ ‰‚ „ÛÔË ÒÔÓ‰ ÍÎËÌ˘ÌË Ë ÖåÉ ÍËÚÂËË-ëÉÅ (22 Ô‡ˆËÂÌÚË)Ë ïÇÑè (13 Ô‡ˆËÂÌÚË). ëÍÓÓÒÚÚ‡ ̇ ÔÓ‚Âʉ‡Ì ÔÓ ‰‚Ë„‡ÚÂÎÌËÚ ‚·Í̇ ̇ ÔÂËÙÂÌËÚ ÌÂ‚Ë Â ËÁÒΉ‚‡Ì‡ Ò ÔÓ‚˙ıÌÓÒÚÌË Ë ÍÓ̈ÂÌÚ˘ÌË Ë„ÎÂÌË ÂÎÂÍÚÓ‰Ë. èÓ‚Ó‰ËÏÓÒÚÚ‡ ÔÓ ÒÂÚË‚ÌËÚ ‚·Í̇  ËÁÒΉ‚‡Ì‡ ˜ÂÁ ‡ÌÚˉÓÏÂÌ ÏÂÚÓ‰. èË 17 ·ÓÎÌË Ò˙Ò ëÉÅ Ë ÔË 10 Ò ïÇÑè  Ôӂ‰ÂÌÓ ÎËÍ‚ÓÓÎӄ˘ÌÓ ËÁÒΉ‚‡ÌÂ. óÂÒÚÓÚ‡Ú‡ ̇ Ô‰¯ÂÒÚ‚‡˘Ë ‚ËÛÒÌË ËÌÙÂ͈ËË ÔË ëÉÅ Â ÔÓ„ÓÎflχ (76,9%) ÓÚ Ú‡ÁË ÔË ïÇÑè (30,7%). óÂÂÔÌÓ-ÏÓÁ˙˜ÌËÚ ÌÂ‚Ë Ò‡ ‡Ì„‡ÊË‡ÌË ‚ ·ÓÎÂÒÚÌËfl ÔÓˆÂÒ ÔË 54,5% ÓÚ ·ÓÎÌËÚ Ò˙Ò ëÉÅ Ë ÔË 30,7% ÓÚ ·ÓÎÌËÚÂ Ò ïÇÑè. ÑÂÒÂÚ ÔÓˆÂÌÚ‡ ÓÚ Ô‡ˆËÂÌÚËÚ ‚ „ÛÔ‡Ú‡ ̇ ëÉÅ ÔÓ͇Á‚‡Ú ÒËÏÔÚÓÏË ı‡‡ÍÚÂÌË Á‡ éåÄç, éåëÄç Ë ÒË̉ÓÏ Ì‡ åËÎÂ-î˯Â. Ç Ò‡‚ÌÂÌËÂ Ò ‰ÂÏËÂÎËÌËÁË‡˘ËÚ ‚‡ˇÌÚË, ‡ÍÒÓ̇ÎÌËÚ ËÏ‡Ú Á‡·‡‚ÂÌÓ Ë ÌÂÔ˙ÎÌÓ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂ. èË ëÉÅ ‚ ‡ÌÌËfl ÒÚ‡‰ËÈ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ F ‚˙ÎÌËÚ ҇ ÔÓ-˜Û‚ÒÚ‚ËÚÂÎÂÌ Ï‡ÍÂ Á‡ ÔÓÒÚ‡‚flÌ ̇ ‰Ë‡„ÌÓÁ‡Ú‡ ‚ Ò‡‚ÌÂÌËÂ Ò Û‚Â΢ÂÌÓÚÓ ÌË‚Ó Ì‡ ·ÂÎÚ˙͇ ‚ ˆÂ·ÓÒÔË̇Î̇ڇ Ú˜ÌÓÒÚ. ç‡Îˈ  ˜‡ÒÚ˘ÂÌ ·ÎÓÍ Ì‡ ÔÓ‚Âʉ‡Ì ÔÓ ‰‚Ë„‡ÚÂÎÌËÚÂ Ë ÒÂÚË‚ÌË ‚·Í̇, ͇ÍÚÓ Ë ‰Û„Ë ·ÂÎÂÁË Á‡ ‰ÂÏËÂÎËÌËÁ‡ˆËfl. èË ïÇÑè ‰ÂÌÂ‚‡ˆËÓÌ̇ڇ ‡ÍÚË‚ÌÓÒÚ Â ·Ó„‡Ú‡ Ó˘Â Ì‡ ‚ÚÓËfl ÏÂÒˆ ÓÚ Ì‡˜‡ÎÓÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ Ò Â‚ÓβˆËfl ‰Ó Ô˙ÎÌÓ ·ËÓÂÎÂÍÚ˘ÌÓ Ï˙Θ‡ÌË ̇ ÚÂÚ‡Ú‡ „Ó‰Ë̇. ëÍÓÓÒÚÚ‡ ̇ ÔÓ‚Âʉ‡Ì ÔÓ ‰‚Ë„‡ÚÂÎÌËÚ ‚·Í̇  Á‡·‡‚Â̇ Ë Ó·ËÍÌÓ‚ÂÌÓ ëçÄè ÎËÔÒ‚‡. äβ˜Ó‚Ë ‰ÛÏË: ëÉÅ, ïÇÑè, ÖåÉ, ·ÎÓÍ Ì‡ ÔÓ‚Âʉ‡ÌÂ, ÔÓÎËÌ‚ÓÔ‡ÚËfl ëË̉ÓÏ˙Ú Ì‡ ÉËÎÂÌ-Ň (ëÉÅ)  ËÏÛÌÌÓωËË‡Ì ÓÒÚ˙ ÔÓÎË‡‰ËÍÛÎÓÌ‚ËÚ, ˜ÂÒÚÓ Ò‚˙Á‡Ì Ò Ô‰¯ÂÒÚ‚‡˘‡ ÌÂÒÔˆËÙ˘̇ ËÌÙÂ͈Ëfl (13). íÓÈ Â ‚Ӊ¢‡ Ô˘Ë̇ Á‡ ‡Á‚ËÚË ̇ ÓÒÚ‡ ‚fl· Ô‡‡ÎËÁ‡ ÔË ‚˙Á‡ÒÚÌË Ë ‰Âˆ‡ (21,25). ëÏflÚ‡ ÒÂ, ˜Â ëÉÅ Â ıÂÚÂÓ„ÂÌÂÌ ÒË̉ÓÏ, Ò˙ÒÚ‡‚ÂÌ ÓÚ ‡Á΢ÌË ÒÛ·ÚËÔÓ‚Â, ̇ ·‡Á‡Ú‡ ̇ ÍÎËÌ˘ÌË, ÂÎÂÍÚÓÙËÁËÓÎӄ˘ÌË Ë Ô‡ÚÓÏÓÙÓÎӄ˘ÌË ÍËÚÂËË (14). ç‡È-˜ÂÒÚËfl ÍÎËÌ˘ÂÌ ‚‡ˇÌÚ Ì‡ ëÉÅ Â ÓÒÚ‡Ú‡ ‚˙ÁÔ‡ÎËÚÂÎ̇ ‰ÂÏËÂÎËÌËÁË‡˘‡ ÔÓÎËÌ‚ÓÔ‡ÚËfl (éÇÑè), ÔË ÍÓflÚÓ ‚Ó‰Â˘Ë Ò‡ ÚÂÊ͇ ÏÛÒÍÛÎ̇ Ò··ÓÒÚ, ÓÚÒ··ÂÌË ‰Ó ÎËÔÒ‚‡˘Ë ÒÛıÓÊËÎÌÓ-̇‰ÍÓÒÚÌË ÂÙÎÂÍÒË, Ò ‰Ó·Ó͇˜ÂÒÚ‚ÂÌ ıÓ‰ Ë Ô˙ÎÌÓ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡Ì ÔË Ôӂ˜ÂÚÓ Ô‡ˆËÂÌÚË (19,21). ï‡‡ÍÚÂ̇  ·ÂÎÚ˙˜ÌÓ-ÍÎÂÚ˙˜Ì‡Ú‡ ‰ËÒӈˇˆËfl ‚ ÎËÍ‚Ó‡, eÎÂÍÚÓÙËÁËÓÎӄ˘ÌÓ Ò ÛÒÚ‡ÌÓ‚fl‚‡ ‰ÂÏËÂÎËÌËÁ‡ˆËfl ̇ ÏÓÚÓÌËÚÂ Ë ÒÂÚË‚ÌË ÌÂ‚Ë (8,11,20), ‡ Ô‡ÚÓÏÓÙÓÎӄ˘ÌÓ - ‡Á΢̇ ÒÚÂÔÂÌ Ì‡ ÎËÏÙÓˆËÚ̇ ËÌÙËÎÚ‡ˆËfl Ë Ï‡ÍÓÙ‡„ÓωËË‡Ì‡ ‰ÂÏËÂÎË-

54

ÌËÁ‡ˆËfl (16). ïÓÌ˘̇ڇ ‚˙ÁÔ‡ÎËÚÂÎ̇ ‰ÂÏËÂÎËÌËÁË‡˘‡ ÔÓÎËÌ‚ÓÔ‡ÚËfl (ïÇÑè)  ıÓÌ˘ÌÓ-ÔÓ„ÂÒ˂̇ ËÎË ÔËÒÚ˙ÔÌÓˆˉ˂Ë‡˘‡ ÒËÏÂÚ˘̇ ÒÂÌÁÓ-ÏÓÚÓ̇ ÔÓÎËÌ‚ÓÔ‡ÚËfl Ò ÔÓ‰Ó·ÌË ÎËÍ‚ÓÓÎӄ˘ÌË, ÂÎÂÍÚÓÙËÁËÓÎӄ˘ÌË Ë Ô‡ÚÓÏÓÙÓÎӄ˘ÌË ‰‡ÌÌË (22). éÚ‰ËÙÂÂ̈Ë‡ÌÂÚÓ Ì‡ ‰‚ÂÚ ÙÓÏË Â ‚‡ÊÌÓ Á‡ ÍÎËÌ˘̇ڇ Ô‡ÍÚË͇, Ú˙È Í‡ÚÓ ÚÂ‡Ô‚Ú˘ÌÓÚÓ Ôӂ‰ÂÌËÂ, ÔÓ„ÌÓÁ‡Ú‡ Ë ËÁıÓ‰‡ ̇ ‰‚ÂÚ Á‡·ÓÎfl‚‡ÌËfl Ò ‡Á΢‡‚‡Ú. ñÂÎÚ‡ ̇ ̇ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡Ì  ‰‡ Ò Ò‡‚ÌflÚ ÍÎËÌ˘ÌËÚÂ Ë ÂÎÂÍÚÓÙËÁËÓÎӄ˘ÌË ÔÓ͇Á‡ÚÂÎË ÔË Ô‡ˆËÂÌÚË Ò˙Ò ëÉÅ Ë ïÇÑè, ‰‡ Ò ÛÒÚ‡ÌÓ‚Ë ÍÓ·ˆËfl ÏÂÊ‰Û ÍÎËÌ˘ÌËfl ıÓ‰ ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ Ë ÂÎÂÍÚÓÙËÁËÓÎӄ˘ÌËÚ ‰‡ÌÌË, ͇ÍÚÓ Ë ‰‡ Ò ÓÔ‰ÂÎË ÔÓ„ÌÓÒÚ˘̇ڇ ÓÎfl ̇ ÔÓÒΉÌËÚÂ. äãàçàóÖç äéçíàçÉÖçí àÁÒΉ‚‡ÌË Ò‡ Ó·˘Ó 35 Ô‡ˆËÂÌÚË, ÓÚ ÍÓËÚÓ 22 ÔÓ͇Á‚‡Ú ÒËÏÔÚÓÏË, ı‡‡ÍÚÂÌË Á‡ ëÉÅ Ë 13 Ô‡ˆËÂÌÚË - Á‡ ïÇÑè, ÍÓËÚÓ Ò‡ ·ËÎË Ì‡ ÒÚ‡ˆËÓ̇ÌÓ Î˜ÂÌË ‚ åÅÄã "ñ‡ˈ‡ âÓ‡Ì̇" - Ì‚ÓÎӄ˘̇ ÍÎËÌË͇. ÇÒ˘ÍË ·ÓÎÌË ËÁÔ˙ÎÌfl‚‡Ú ÍÎËÌ˘ÌËÚÂ, ÂÎÂÍÚÓÏËÓ„‡ÙÒÍË Ë ÎËÍ‚ÓÓÎӄ˘ÌË ÍËÚÂËË Á‡ ëÉÅ Ë ïÇÑè (7,8). ê‡ÁÔ‰ÂÎÂÌËÂÚÓ Ì‡ ·ÓÎÌËÚ ÔÓ ‚˙Á‡ÒÚ Ë ÔÓÎ Ò‡ Ô‰ÒÚ‡‚ÂÌË ‚ Ú‡·Îˈ‡1. åÖíéÑà 퇷Î.1. ê‡ÁÔ‰ÂÎÂÌË ̇ ·ÓÎÌËÚ ÔÓ ‚˙Á‡ÒÚ Ë ÔÓÎ. é·˘ ·ÓÈ èÓÎ (Ï/Ê) Ç˙Á‡ÒÚ

ëÉÅ 22 16/6 39,5„.(12-69)

ïÇÑè 13 9/4 48,2„.(38-61)

ÇÒ˘ÍË Ô‡ˆËÂÌÚË Ò‡ ÔÓÒΉÂÌË ÔÓ ÓÚÌÓ¯ÂÌË ̇ Ì‚ÓÎӄ˘ÌËfl ÒÚ‡ÚÛÒ Ë ÂÎÂÍÚÓÏËÓ„‡ÙÒÍË Ò Ó„Î‰ ‰Ë̇ÏË͇ڇ ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ. èË 17 ·ÓÎÌË Ò˙Ò ëÉÅ Ë 10 ·ÓÎÌË Ò ïÇÑè  Ôӂ‰ÂÌÓ ÎËÍ‚ÓÓÎӄ˘ÌÓ ËÁÒΉ‚‡ÌÂ. ÖÎÂÍÚÓÏËÓ„‡ÙÒÍÓÚÓ ËÁÒΉ‚‡Ì  ËÁ‚˙¯ÂÌÓ Ò ‡Ô‡‡Ú Phasis II, Ò‚˙Á‡Ì Ò ÔÂÒÓ̇ÎÂÌ ÍÓÏÔ˛Ú˙ (Pentium, CPUAMD k5-p100MHz) Á‡ ‡Ì‡ÎËÁ Ë Ô‰ÒÚ‡‚flÌ ̇ ‰‡ÌÌËÚÂ. ᇠ˄ÎÂ̇ ÖåÉ Ì‡ ÏÛÒÍÛÎËÚ ̇ Í‡ÈÌˈËÚ Ò ËÁÔÓÎÁ‚‡ı‡ ÍÓ̈ÂÌÚ˘ÌË Ë„ÎÂÌË ÂÎÂÍÚÓ‰Ë; ëÍÓÓÒÚÚ‡ ̇ ÔÓ‚Âʉ‡Ì ÔÓ ‰‚Ë„‡ÚÂÎÌËÚ ‚·Í̇ ̇ ÔÂËÙÂÌËÚ ÌÂ‚Ë ËÁÒΉ‚‡ıÏ ˜ÂÁ ÒÚËÏÛ·ˆËfl ‚ ‰‚ ÚÓ˜ÍË Ò ·ËÔÓÎflÂÌ ÔÓ‚˙ıÌÓÒÚÂÌ ÂÎÂÍÚÓ‰ Ë ÓÚ‚Âʉ‡ıÏÂ Ò ÍÓ̈ÂÌÚ˘ÌË Ë„ÎÂÌË ËÎË ÔÓ‚˙ıÌÓÒÚÌË ÂÎÂÍÚÓ‰Ë; çÂ‚̇ڇ ÔÓ‚Ó‰ËÏÓÒÚ ÔÓ ÒÂÚË‚ÌËÚ ‚·Í̇ ÓÔ‰ÂÎflıÏ ˜ÂÁ ‡ÌÚˉÓÏÂÌ ÏÂÚÓ‰ Ë ÓÚ‚Âʉ‡ıÏÂ Ò Ô˙ÒÚÂÌӂˉÌË ÔÓ‚˙ıÌÓÒÚÌË ÂÎÂÍÚÓ‰Ë; àÁÒΉ‚‡Ì ̇ F ‚˙Î̇ ÔÓ‚Âʉ‡ıÏ ˜ÂÁ ÒÚËÏÛÎË‡ÌÂ Ò ËÌÚÂÌÁËÚÂÚ Ì‡ ÒÚËÏÛ· 15% ̇‰ Ô‡„Ó‚Ëfl Ë ÛÒ‰Ìfl‚‡ıÏ 16 F ‚˙ÎÌË. êÖáìãíÄíà äãàçàóçÄ ïÄêÄäíÖêàëíàäÄ éÚ 22 Ô‡ˆËÂÌÚË Ò˙Ò ëÉÅ - ‰Â‚ÂÚ ËÏ‡Ú ‰ÂÏËÂÎËÌËÁË‡˘ ÚËÔ Ì‡ Û‚‰‡ (éÇÑè), ‰‚‡Ï‡ - ‡ÍÒÓ̇ÎÂÌ ÚËÔ (éåÄç - ÓÒÚ‡ ÏÓÚÓ̇ ‡ÍÒÓ̇Î̇ Ì‚ÓÔ‡ÚËfl Ë éåëÄç - ÓÒÚ‡ ÏÓÚÓÌÓ-ÒÂÚ˂̇ ‡ÍÒÓ̇Î̇ Ì‚ÓÔ‡ÚËfl), ‰ËÌ Â Ò Í‡ÚË̇ڇ ̇ ÒË̉Óχ ̇ Miller-Fisher, ‡ ‰ÂÒÂÚ Ô‡ˆËÂÌÚË ËÏ‡Ú ÒÏÂÒÂÌ ı‡‡ÍÚÂ - ‰ÂÏËÂÎËÌËÁË‡˘ Ë ‡ÍÒÓ̇ÎÂÌ. éÚ 22 ·ÓÎÌË Ò˙Ò ëÉÅ, ÓÒÂÏ Ò‡ ËχÎË Ô‰¯ÂÒÚ‚‡˘‡ ËÌÙÂ͈Ëfl ̇ „ÓÌËÚ ‰Ëı‡ÚÂÎÌË Ô˙Úˢ‡, ‰‚‡Ï‡ - „‡ÒÚÓËÌÚÂÒÚË̇ÎÌË ÓÔ·͂‡ÌËfl (ÓÚ 1‰ÂÌ ‰Ó 2 Ò‰ÏËˆË ÔÂ-


Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

‡ÔËÎ, 2002

‰Ë ÔÓfl‚‡Ú‡ ̇ Ô˙‚ËÚ ÒËÏÔÚÓÏË). èË ÚËχ ·ÓÎÌË Ò ÛÒÚ‡ÌÓ‚fl‚‡ ÚÂÊÍÓ ÙËÁ˘ÂÒÍÓ Ì‡ÚÓ‚‡‚‡Ì ÌÂÔÓÒ‰ÒÚ‚ÂÌÓ ÔÂ‰Ë Ì‡˜‡ÎÓÚÓ Ì‡ ÒËÏÔÚÓχÚË͇ڇ. èË ÓÒڇ̇ÎËÚ ·ÓÎÌË Ì  ÛÒÚ‡ÌÓ‚ÂÌ ÔÓ‚ÓÍË‡˘ ÏÓÏÂÌÚ. å‡ÍÒËχÎÌËfl Ì‚ÓÎӄ˘ÂÌ ‰ÂÙˈËÚ ÔË éÇÑè Ò ‰ÓÒÚË„‡ ÒΉ ‰‚ Ò‰ÏˈË, ‰Ó͇ÚÓ ÔË ïÇÑè - ÒΉ ‰‚‡ ÏÂÒˆ‡. èË ËÁÒΉ‚‡ÌËÚ ·ÓÎÌË Ò ïÇÑè, Á‡·ÓÎfl‚‡ÌÂÚÓ ÔÓÚ˘‡ ÔÓ ıÓÌ˘ÌÓ-ÔÓ„‡‰ËÂÌÚÂÌ (Ò‰ÂÏ ·ÓÎÌË) Ë ıÓÌ˘ÌÓ-ÂÏËÚÂÌÚÂÌ ÚËÔ (¯ÂÒÚ ·ÓÎÌË). èË ÔÓÒΉÌËÚ ӷ˘ËflÚ ·ÓÈ Ì‡ ÔËÒÚ˙ÔËÚ  ‰‚‡ Á‡ ÔÂËÓ‰ ÓÚ 6 ÏÂÒˆ‡ ‰Ó 6 „Ó‰ËÌË ÔË ‰‚‡Ï‡ ·ÓÎÌË; ÚË ÔËÒÚ˙Ô‡ Á‡ ÔÂËÓ‰ ÓÚ 1 „Ó‰Ë̇ ÔË ÚËχ ·ÓÎÌË, ‡ ÔË Â‰ËÌ ·ÓÎÂÌ - 11 ÔËÒÚ˙Ô‡ Á‡ ÔÂËÓ‰ ÓÚ ˜ÂÚËË „Ó‰ËÌË. 燘‡ÎÌËÚ Ì‚ÓÎӄ˘ÌË ÒËÏÔÚÓÏË Ì‡ ëÉÅ Ë ïÇÑè Ò‡ Ô‰ÒÚ‡‚ÂÌË ‚ Ú‡·Îˈ‡ 2. 퇷Î.2. 燘‡ÎÌË ÒËÏÔÚÓÏË ëËÏÔÚÓÏ åÛÒÍÛÎ̇ Ò··ÓÒÚ ÅÓÎ͇ è‡ÂÒÚÂÁËË è‡ÂÁ‡ ̇ VII óåç ÑËÔÎÓÔËfl

ëÉÅ ÅÓÈ 9 7 8 1 1

ïÇÑè ÅÓÈ 7 2 9 1

ê‡Á„˙̇ڇڇ ÍÎËÌ˘̇ ͇ÚË̇ ÔË Ì‡¯ËÚ ԇˆËÂÌÚË Ò éÇÑè Ò Ô‰ÒÚ‡‚fl Ò ‚flÎË Ô‡ÂÁË Ì‡ Í‡ÈÌˈËÚÂ, ËÁ‡ÁÂÌË ‚ ‡Á΢̇ ÒÚÂÔÂÌ - ‰Ó Ô΄Ëfl, Ó·ı‚‡˘‡˘Ë ÔÓÍÒËχÎ̇ڇ Ë ‰ËÒÚ‡Î̇ ÏÛÒÍÛ·ÚÛ‡; ıËÔÓ- ‰Ó ‡ÂÙÎÂÍÒËfl, ıËÔÓÚÓÌËfl; ÒÂÚË‚ÌË Ì‡Û¯ÂÌËfl - ‰ËÒÚ‡ÎÌË Ô‡ÂÒÚÂÁËË, ıËÔÂÒÚÂÁËfl, ıËÔÂÂÒÚÂÁËfl ËÎË ÒÔÓÌÚ‡Ì̇ ·ÓÎ͇; ‡Ì„‡ÊË‡Ì ̇ ˜ÂÂÔÌÓ-ÏÓÁ˙˜ÌËÚ ÌÂ‚Ë (óåç) ÔË ÌflÍÓË ·ÓÎÌË - ̇È-˜ÂÒÚÓ VII ‰‚ÛÒÚ‡ÌÌÓ, ÒΉ‚‡ÌË ÓÚ IX Ë X. ì ‰ËÌ ·ÓÎÂÌ Â ÓÔËÒ‡Ì ÍÎËÌ˘ÂÌ ‚‡ˇÌÚ Ì‡ ëÉÅ - ÒË̉ÓÏ Ì‡ Miller-Fisher: ‚˙̯̇ ÓÙÚ‡ÎÏÓÔ΄Ëfl, ‡Ú‡ÍÒËfl, ÒÛıÓÊËÎÌÓ-̇‰ÍÓÒÚ̇ ‡ÂÙÎÂÍÒËfl, ·ÂÁ Ô‡ÂÁË ‚ Í‡ÈÌˈËÚÂ. èË 17 ·ÓÎÌË ‡ÁÔÓÒÚ‡ÌÂÌËÂÚÓ Ì‡ ÒËÏÔÚÓÏËÚ Ëχ ‡ÒˆẨÂÌÚÂÌ ı‡‡ÍÚÂ Ë ÔË ÔÂÚ - ‰ÂÒˆẨÂÌÚÂÌ. ì ÔÂÚ ·ÓÎÌË Ò‡ ̇·Î˛‰‡‚‡ÌË ‰Ëı‡ÚÂÎÌË Ì‡Û¯ÂÌËfl, ͇ÚÓ ÔË Â‰ËÌ ÓÚ Úflı Ò ̇ÎÓÊË ‰‡ Ò Ôӂ‰ àÅÇ Ë ‰Û„Ë ‡ÌËχˆËÓÌÌË ÏÂÓÔËflÚËfl. ᇠԇˆËÂÌÚËÚ Ò˙Ò ëÉÅ Ò‰ÌËfl ÔÂÒÚÓÈ ‚ ÍÎËÌË͇ڇ  31 ‰ÌË. ÇÒ˘ÍË ·ÓÎÌË Ò‡ ËÁÔËÒ‡ÌË Ò˙Ò Á̇˜ËÚÂÎÌÓ ÔÓ‰Ó·ÂÌËÂ, ͇ÚÓ ÓÒÚ‡‚‡ ‰‡ ÔÂÒËÒÚË‡Ú ‡ÂÙÎÂÍÒËfl Ë ÒÂÚË‚ÌË Ì‡Û¯ÂÌËfl. çflχ ÒÎÛ˜‡Ë Ò ÎÂÚ‡ÎÂÌ ËÁıÓ‰. äÎËÌ˘̇ڇ ͇ÚË̇ ÔË Ô‡ˆËÂÌÚËÚÂ Ò ïÇÑè  Ô‰ÒÚ‡‚Â̇ Ò ÔÓÒÚÂÔÂÌÌÓ ‡Á‚Ë‚‡˘Ë Ò ԇÂÁË Ë ÒÂÚË‚ÌË Ì‡Û¯ÂÌËfl, ıËÔÓÚÓÙËË Ì‡ ÏÛÒÍÛ·ÚÛ‡Ú‡, ıËÔÓ- ‰Ó ‡ÂÙÎÂÍÒËfl, ‡ ÔË ÌflÍÓË Ô‡ˆËÂÌÚË Ë ÔÂıÓ‰ÌÓ Ì‡Û¯ÂÌË ̇ ÙÛÌ͈ËËÚ ̇ óåç. éÒÌÓ‚ÌËÚ Ì‚ÓÎӄ˘ÌË ÒËÏÔÚÓÏË ÔË Ì‡¯ËÚ ·ÓÎÌË Ò éÇÑè Ë ïÇÑè Ò‡ ÔÓ͇Á‡ÌË ‚ Ú‡·Îˈ‡ 3. àÁÒΉ‚‡Ì ̇ ÎËÍ‚Ó‡  ̇Ô‡‚ÂÌÓ ÔË 17 ·ÓÎÌË Ò˙Ò ëÉÅ Ë ÔË 10 ·ÓÎÌË Ò ïÇÑè. èË ‚Ò˘ÍË Â ÛÒÚ‡ÌÓ‚Â̇ ·ÂÎÚ˙˜ÌÓ-ÍÎÂÚ˙˜Ì‡ ‰ËÒӈˇˆËfl. èË ëÉÅ Ò‰̇ڇ ÒÚÓÈÌÓÒÚ Ì‡ Ó·˘Ëfl ·ÂÎÚ˙Í ‚ ÎÛÏ·‡ÎÌËfl ÎËÍ‚Ó  170,9 mg%, ÔË ÌÓχÎÂÌ ·ÓÈ Ì‡ ÍÎÂÚÍËÚÂ. èË ïÇÑè Ò‰̇ڇ ÒÚÓÈÌÓÒÚ Â 151 mg%, Ò˙˘Ó ÔË ÌÓχÎÂÌ ·ÓÈ Ì‡ ÍÎÂÚÍËÚÂ. ÖãÖäíêéîàáàéãéÉàóçà êÖáìãíÄíà ç‚ÓÙËÁËÓÎӄ˘ÌËÚ ËÁÒΉ‚‡ÌËfl Ò‡ ÔÓ‚Âʉ‡ÌË ÓÚ ÚÂÚËfl ‰ÂÌ ‰Ó ‰Â‚ÂÚËfl ÏÂÒˆ Á‡ Ô‡ˆËÂÌÚË Ò˙Ò ëÉÅ Ë ÓÚ ‚ÚÓËfl ÏÂÒˆ ‰Ó ÔÂÚ‡Ú‡ „Ó‰Ë̇ Á‡ ïÇÑè ÒΉ ̇˜‡ÎÓÚÓ

55

Ta·Î.3. éÒÌÓ‚ÌË Ì‚ÓÎӄ˘ÌË ÒËÏÔÚÓÏË ëËÏÔÚÓÏ è‡ÂÁË ‰ËÒÚ>ÔÓÍÒ ÔÓÍÒ>‰ËÒÚ ‰ËÙÛÁÌË ïËÔÓ Ë ‡ÂÙÎÂÍÒËfl ÅÓÎ͇ è‡ÂÒÚÂÁËË ïËÔÂÒÚÂÁËfl 옇ÒÚË ̇ óåç VII IX - X III - IV- VI MÛÒÍÛÎÌË ‡ÚÓÙËË ç‡Û¯Â̇ ÔÓıӉ͇ í‡ÁÓ‚Ó-ÂÁÂ‚Ó‡ÌË Ì‡Û¯ÂÌËfl ÑËı‡ÚÂÎÌË Ì‡Û¯ÂÌËfl èÓÒÚÛ‡ÎÂÌ ÚÂÏÓ ãËˆÂ‚Ë ÏËÓÍËÏËË

éÇÑè ÅÓÈ 21 7 6 8 22 9 14 17 12 11 4 3 2 12 2 4 -

ïÇÑè ÅÓÈ 12 7 1 4 13 3 11 8 4 1 3 7 10 1 1

̇ Á‡·ÓÎfl‚‡ÌÂÚÓ. èÓÎÛ˜ÂÌËÚ ÂÁÛÎÚ‡ÚË ‡Ì‡ÎËÁË‡ıÏ Ò˙„·ÒÌÓ ÂÎÂÍÚӉˇ„ÌÓÒÚ˘ÌËÚ ÍËÚÂËË Á‡ ëÉÅ Ë ïÇÑè (7,8). èË 10 Ô‡ˆËÂÌÚË Ò˙Ò ëÉÅ Ò ÛÒÚ‡ÌÓ‚fl‚‡ ‰ÂÏËÂÎËÌËÁË‡˘ ÚËÔ Ì‡ ÔÓÎËÌ‚ËÚ̇ Û‚‰‡, ÔË ‰‚‡Ï‡ Ô‡ˆËÂÌÚË - ‡ÍÒÓ̇ÎÂÌ ÚËÔ, ‡ ÔË 10 Ô‡ˆËÂÌÚË - ÒÏÂÒÂÌ ÚËÔ (‰ÂÏËÂÎËÌËÁË‡˘ Ë ‡ÍÒÓ̇ÎÂÌ). éÇÑè. óÂÚËË Ô‡ˆËÂÌÚË, ËÁÒΉ‚‡ÌË ‚ ‡ÌÂÌ ÒÚ‡‰ËÈ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ (15-25 ‰ÂÌ) ËÏ‡Ú ÌÓχÎ̇ ÒÍÓÓÒÚ Ì‡ 퇷Î.4. ÖÎÂÍÚÓÙËÁËÓÎӄ˘ÌË ÔÓ͇Á‡ÚÂÎË Á‡ ëÉÅ çÖêÇ

ëè (m/s)

n. ulnaris n.peroneus

50,5±1,2 49,9±0,8

n. ulnaris n.peroneus

43,2±0,3 33,6±1,7

ÑãÇ (ms)

èãÇ (ms)

ëÉÅ (ÒΉ 20 ‰ÂÌ) 4,0±0,1 9,5±0,7 16,9±0,7 ëÉÅ (̇‰ 2 ÏÂÒˆ‡) 5,0±0,2 11,4±1,6 21,4±1,9

ãËÔÒ‚‡ å-ÓÚ„. (%)

ãËÔÒ‚‡ F ‚˙Î̇ (%)

Ä ‚˙ÎÌË (%)

8

70 100

100 100

8

50 100

100 100

ÔÓ‚Âʉ‡Ì ÔÓ ‰‚Ë„‡ÚÂÎÌËÚÂ Ë ÒÂÚË‚ÌË ÌÂ‚ÌË ‚·Í̇. èË ‰‚‡Ï‡ Ô‡ˆËÂÌÚË Ò „ËÒÚË‡ ÎÂÍÓ Á‡·‡‚Â̇ ÒÍÓ퇷Î.5. ÖÎÂÍÚÓÙËÁËÓÎӄ˘ÌË ÔÓ͇Á‡ÚÂÎË Á‡ ïÇÑè çÖêÇ

ëè (m/s)

n. ulnaris n.peroneus n.facialis

19,8±0,5 21,6±3,4

ÑãÇ (ms)

èãÇ (ms) ãËÔÒ‚‡ å-ÓÚ„. (%) 16,2±2,3 29,0±4,1 0 24,5±5,3 56,6±5,3 54 ãÇ-12,8±1,8 0,3±0,03

ãËÔÒ‚‡ F ‚˙Î̇ (%) 100 100 100

Ä ‚˙ÎÌË (%) 8 15,4 8

ÓÒÚ ÒΉ 30-fl ‰ÂÌ Ë ÔË ÚËχ Ô‡ˆËÂÌÚË - Á̇˜ËÚÂÎÌÓ Á‡·‡‚Â̇ ÒÍÓÓÒÚ ÏÂÊ‰Û 2 Ë 6 ÏÂÒˆ ÓÚ Ì‡˜‡ÎÓÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ. èË ¯ÂÒÚ Ô‡ˆËÂÌÚË Ò ÛÒÚ‡ÌÓ‚fl‚‡ ˜‡ÒÚ˘ÂÌ ·ÎÓÍ Ì‡ ÔÓ‚Âʉ‡Ì Á‡ „ÓÌË Í‡ÈÌËˆË - ÒÔ‡‰‡Ì ̇ ÔÓÍÒËχÎÌËfl ÒÛχÂÌ ÏÓÚÓÂÌ ‡ÍˆËÓÌÂÌ ÔÓÚÂ̈ˇΠ(ëåÄè) Ò Ôӂ˜ ÓÚ 20% ‚ Ò‡‚ÌÂÌËÂ Ò ‰ËÒÚ‡ÎÌËfl, ‡ Á‡ ‰ÓÎÌË Í‡ÈÌËˆË -Ôӂ˜ ÓÚ 50% (ÙË„.1). èË ÚÂÁË ¯ÂÒÚ ·ÓÎÌË Ì Ò „ËÒÚË‡ ÚÂÏÔÓ‡Î̇ ‰ËÒÔÂÒËfl. èË ‚Ò˘ÍË Ô‡ˆËÂÌÚË Ò‡ ̇ÎËˆÂ Ë ‰Û„ËÚ ·ÂÎÂÁË Á‡ ‰ÂÏËÂÎËÌËÁ‡ˆËfl: Û‰˙ÎÊÂÌÓ ‰ËÒÚ‡ÎÌÓ Î‡ÚÂÌÚÌÓ ‚ÂÏ (ÑãÇ), ÎËÔÒ‡ ̇ F ‚˙ÎÌË ËÎË Ì‡Ï‡ÎÂÌ ÔÓˆÂÌÚ Ì‡ F-‚˙ÎÌËÚÂ Ë Ò Û‰˙ÎÊÂÌË Î‡ÚÂ̈ËË Ì‡ F ‚˙ÎÌËÚ (ÙË„.2), Ë Ì‡Î˘Ë ̇ Ä ‚˙ÎÌË.


‡ÔËÎ, 2002

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

îË„.1. ëÔ‡‰‡Ì ̇ ÔÓÍÒËχÎ̇ڇ ëåÄè ‡ÏÔÎËÚÛ‰‡ Ò 91% ÒÔflÏÓ ‰ËÒÚ‡Î̇ڇ ‡ÏÔÎËÚÛ‰‡ Á‡ n.tibialis.

ëÚÓÈÌÓÒÚËÚ Á‡ ÒÍÓÓÒÚËÚ ̇ ÔÓ‚Âʉ‡Ì ÔÓ ‰‚Ë„‡ÚÂÎÌËÚ ÌÂ‚ÌË ‚·Í̇, ‡ÏÔÎËÚÛ‰ËÚ ̇ ëåÄè, F- Ë Ä ‚˙ÎÌËÚ Á‡ ÓÒÚ‡Ú‡ Ë ıÓÌ˘̇ ÙÓχ Ò‡ Ô‰ÒÚ‡‚ÂÌË ‚ Ú‡·Îˈ‡ 4 Ë Ú‡·Îˈ‡ 5. éåÄç. ÖÎÂÍÚÓÙËÁËÓÎӄ˘̇ڇ ı‡‡ÍÚÂËÒÚË͇ ̇ Ô‡ˆËÂÌÚ‡ Ò éåÄç ̇ 20-fl ‰ÂÌ Â: ÌÓχÎÌË ÒÍÓÓÒÚ Ì‡ ÔÓ‚Âʉ‡Ì ÔÓ ‰‚Ë„‡ÚÂÎÌËÚÂ Ë ÒÂÚË‚ÌË ‚·Í̇, ÑãÇ, ÒÔ‡‰‡Ì ̇ ëåÄè ‡ÏÔÎËÚÛ‰‡Ú‡ ÓÚ m. exteusor oligitorum brevis Ò 50% ÔË ÔÓÍÒËχÎ̇ ÒÚËÏÛ·ˆËfl ‚ Ò‡‚ÌÂÌËÂ Ò ‰ËÒÚ‡Î̇ڇ, Û‰˙ÎÊÂÌÓ Î‡ÚÂÌÚÌÓ ‚ÂÏ ̇ F ‚˙ÎÌËÚÂ Ë Ì‡Ï‡ÎÂÌ ÔÓˆÂÌÚ Ì‡ Ò˙˘ËÚÂ Ë ÓÚ‚Âʉ‡Ì ̇ Ä ‚˙Î̇ (ÙË„.2). îË„.2. ç‡Ï‡ÎÂÌ ÔÓˆÂÌÚ Ì‡ F- ‚˙ÎÌËÚÂ Ò Ô‰ıÓʉ‡˘Ë Ä ‚˙ÎÌË.

éåëÄç. èË Ô‡ˆËÂÌÚ‡ Ò éåëÄç Ò ÛÒÚ‡ÌÓ‚fl‚‡Ú ÌÓχÎÌË ÒÍÓÓÒÚË Ì‡ ÔÓ‚Âʉ‡Ì ÔÓ ‰‚Ë„‡ÚÂÎÌËÚÂ Ë ÒÂÚË‚ÌË ‚·Í̇, ͇ÍÚÓ Ë ÌÓχÎÌÓ ÑãÇ; ÒÔ‡‰‡Ì ̇ ‡ÏÔÎËÚÛ‰ËÚ ̇ ÏÓÚÓÌËfl Ë ÒÂÚË‚ÂÌ ÓÚ„Ó‚Ó, ÎËÔÒ‡ ̇ F ‚˙ÎÌË Ë „ËÒÚË‡Ì ̇ Ä ‚˙ÎÌË. ëË̉ÓÏ Ì‡ åËÎÂ-î˯Â. ëÍÓÓÒÚËÚ ̇ ÔÓ‚Âʉ‡Ì ÔÓ ‰‚Ë„‡ÚÂÎÌËÚÂ Ë ÒÂÚË‚ÌË ‚·Í̇, ÑãÇ Ë ‡ÏÔÎËÚÛ‰ËÚ ̇ ÏÓÚÓÌËfl Ë ÒÂÚË‚ÂÌ ÓÚ„Ó‚Ó Ò‡ ‚ „‡ÌˈËÚ ̇ ÌÓχڇ ÔË Ô‡ˆËÂÌÚ‡ Ò˙Ò ÒË̉ÓÏ˙Ú Ì‡ Miller-Fisher. ìÒÚ‡ÌÓ‚fl‚‡ Ò ̇χÎÂÌ ÔÓˆÂÌÚ Ì‡ F ‚˙ÎÌËÚÂ, Û‰˙ÎÊÂÌË Î‡ÚÂ̈ËË Ì‡ Ò˙˘ËÚÂ, ͇ÍÚÓ Ë Û‰˙ÎÊÂ̇ ·ÚÂ̈Ëfl ̇ ÏË„‡ÚÂÎÌËfl ÂÙÎÂÍÒ. éÚ ËÁÒΉ‚‡ÌËÚ 13 Ô‡ˆËÂÌÚË Ò ïÇÑè, Û Ò‰ÂÏ ÓÚ Úflı Ò ÛÒÚ‡ÌÓ‚fl‚‡ ‰ÂÏËÂÎËÌËÁË‡˘ ÚËÔ Ì‡ Û‚‰‡,‡ ÔË ¯ÂÒÚ - ‰ÂÏËÂÎËÌËÁË‡˘ ÚËÔ Ò Ì‡ÒÎÓÊÂ̇ ‡ÍÒÓ̇Î̇ ÍÓÏÔÓÌÂÌÚ‡.

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èË ‚Ò˘ÍË Ô‡ˆËÂÌÚË Ò ïÇÑè Ò ÛÒÚ‡ÌÓ‚fl‚‡Ú Á‡·‡‚ÂÌË ÒÍÓÓÒÚË Ì‡ ÔÓ‚Âʉ‡Ì ÔÓ ‰‚Ë„‡ÚÂÎÌËÚÂ Ë ‚·Í̇ ‚˙‚ ‚Ò˘ÍË ËÁÒΉ‚‡ÌË ÔÂËÙÂÌË ÌÂ‚‡, Û‰˙ÎÊÂÌÓ ÑãÇ, ÎËÔÒ‡ ̇ F ‚˙ÎÌË Ë Û‰˙ÎÊÂÌÓ Î‡ÚÂÌÚÌÓ ‚ÂÏ ̇ Ò˙˘ËÚÂ. èË ‰Â‚ÂÚ Ô‡ˆËÂÌÚË Â ÒÌËÊÂ̇ ‡ÏÔÎËÚÛ‰‡Ú‡ ̇ ëåÄè, ‡ ÔË ‰‚‡Ï‡ ÓÚ Úflı  ̇ÎËˆÂ Ë ˜‡ÒÚ˘ÂÌ ·ÎÓÍ Ì‡ ÔÓ‚Âʉ‡Ì ‚ ‰‚‡ ËÎË Ôӂ˜ ÏÓÚÓÌË ÌÂ‚‡ Ë Ì‡Î˘Ë ̇ Ä ‚˙ÎÌË. ç‡È-˜ÂÒÚÓ ÒÂÚË‚ÂÌ ÓÚ„Ó‚Ó ÎËÔÒ‚‡ ӯ ‚ ̇˜‡ÎÓÚÓ ËÎË ‡ÏÔÎËÚÛ‰‡Ú‡ ÏÛ ÔÓÒÚÂÔÂÌÌÓ ÒÔ‡‰‡ Ò ÔÓ„ÂÒËflÚ‡ ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ. ÖåÉ ËÁÒΉ‚‡Ì  Ôӂ‰ÂÌÓ ÔË 16 Ô‡ˆËÂÌÚË Ò˙Ò ëÉÅ. èË ‚Ò˘ÍË ËÁÒΉ‚‡ÌË ‰ÂÌÂ‚‡ˆËÓÌ̇ ‡ÍÚË‚ÌÓÒÚ Ì Ò „ËÒÚË‡ ÔÂ‰Ë 15-fl ‰ÂÌ ÓÚ Ì‡˜‡ÎÓÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ. èË Â‰ËÌ Ô‡ˆËÂÌÚ Ò ÛÒÚ‡ÌÓ‚Ë ÒÔÓÌÚ‡Ì̇ ‡ÍÚË‚ÌÓÒÚ ÓÚ Â‰ËÌ˘ÌË ÙË·ËÎÂÌË ÔÓÚÂ̈ˇÎË (îè), Óڂ‰ÂÌË Ì‡ 15-fl ‰ÂÌ ÓÚ Ì‡˜‡ÎÓÚÓ, ÔË ÔÂÚ Ô‡ˆËÂÌÚË Ò „ËÒÚË‡ ·Ó„‡Ú‡ ÒÔÓÌÚ‡Ì̇ ‡ÍÚË‚ÌÓÒÚ ÓÚ îè Ë ÔÓÎÓÊËÚÂÎÌË ÓÒÚË ‚˙ÎÌË (èéÇ) ̇ 2-3 ÏÂÒˆ ÓÚ Ì‡˜‡ÎÓÚÓ, ‡ ÔË ‰‚‡Ï‡ Ô‡ˆËÂÌÚË Ì‡ 8-9 ÏÂÒˆ. èË ÔÂÚ ·ÓÎÌË Ò˙Ò ëÉÅ Ò „ËÒÚË‡ı‡ Ë ÂËÌÂ‚‡ˆËÓÌÌË ÔÓÚÂ̈ˇÎË Ì‡ 26-8 Ë 9 ÏÂÒˆ. ÅËÓÂÎÂÍÚ˘̇ڇ ‡ÍÚË‚ÌÓÒÚ ÏÂÊ‰Û 2 Ë 9 ÏÂÒˆ ÔË ÎÂ͇ ÏÛÒÍÛÎ̇ ÍÓÌÚ‡ÍˆËfl (ãåä) Ò Ò˙ÒÚÓ¯ ÓÚ „ÓÎflÏ ÔÓˆÂÌÚ ÒËÎÌÓ ÔÓÎËÙ‡ÁÌË ‡ÍˆËÓÌÌË ÔÓÚÂ̈ˇÎË (Äè). èË ‰‚‡Ï‡ ·ÓÎÌË ‚ 2 Ë 8 ÏÂÒˆ ÓÚ Ì‡˜‡ÎÓÚÓ ÛÒÚ‡ÌÓ‚ËıÏ Ô˙ÎÌÓ ·ËÓÂÎÂÍÚ˘ÌÓ Ï˙Θ‡ÌË ÓÚ Ï‡ÎÍËÚ ÏÛÒÍÛÎË Ì‡ Í‡Í‡Ú‡. ÖåÉ ËÁÒΉ‚‡Ì ·Â¯Â ÔËÎÓÊÂÌÓ Ì‡ ‚Ò˘ÍË Ô‡ˆËÂÌÚË Ò ïÇÑè. èË ‰ÂÒÂÚ ÓÚ Úflı Ò ÛÒÚ‡ÌÓ‚Ë ·Ó„‡Ú‡ ÒÔÓÌÚ‡Ì̇ ‡ÍÚË‚ÌÓÒÚ ÓÚ îè Ë èéÇ ÏÂÊ‰Û ‚ÚÓËfl ÏÂÒˆ Ë ÔÂÚ‡Ú‡ „Ó‰Ë̇ ÓÚ Ì‡˜‡ÎÓÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ. èË ÚËχ ÓÚ Úflı Ò „ËÒÚË‡ı‡ ‰ËÌ˘ÌË Ù‡ÒˆËÍÛ·ˆËË ÏÂÊ‰Û ‚ÚÓËfl ÏÂÒˆ Ë Ô˙‚‡Ú‡ „Ó‰Ë̇. ì ‰ËÌ Ô‡ˆËÂÌÚ Ì‡ ‚ÚÓ‡Ú‡ „Ó‰Ë̇ Ò Á‡ÔËÒ‡ı‡ Ú.̇. "ÒÚ‡ÌÌË" Á‡ÎÔÓ‚Â ÓÚ Ï‡ÎÍËÚ ÏÛÒÍÛÎË Ì‡ ˙ˆÂÚÂ Ë Í‡Í‡Ú‡. èË Ò‰ÂÏ Ô‡ˆËÂÌÚË Ò ÛÒÚ‡ÌÓ‚Ëı‡ ÂËÌÂ‚‡ˆËÓÌÌË Äè ÏÂÊ‰Û ‚ÚÓËfl ÏÂÒˆ Ë ÔÂÚ‡Ú‡ „Ó‰Ë̇. èË ‚Ò˘ÍË ËÁÒΉ‚‡ÌË ·ÓÎÌË ·ËÓÂÎÂÍÚ˘̇ڇ ‡ÍÚË‚ÌÓÒÚ ÔË ãåä Ò Ò˙ÒÚÓ¯ ÓÚ ÔÓÎËÙ‡ÁÌË Äè Ò Û‰˙ÎÊÂÌÓ ‚ÂÏÂÚ‡ÂÌ (10-18 ms) Ë ‚ËÒÓÍË ‡ÏÔÎËÚÛ‰Ë (8-10 mV). èË Ï‡ÍÒËχÎ̇ ÏÛÒÍÛÎ̇ ÍÓÌÚ‡ÍˆËfl Ò „ËÒÚË‡ı‡ ÒËÎÌÓ ‡Á‰ÂÌË Á‡ÔËÒË ‰Ó ‰ËÌ˘ÌË Äè. èË Ò‰ÂÏ ·ÓÎÌË ÎËÔÒ‚‡¯Â ‚Ó΂‡ ‡ÍÚË‚ÌÓÒÚ ÓÚ ÏÛÒÍÛÎËÚ ËÌÂ‚Ë‡ÌË ÓÚ n.fibularis, ÛÒÚ‡ÌÓ‚ÂÌÓ ÏÂÊ‰Û ‚ÚÓËfl ÏÂÒˆ Ë ˜ÂÚ‚˙Ú‡Ú‡ „Ó‰Ë̇. èË ¯ÂÒÚ ·ÓÎÌË ÏÂÊ‰Û ‚ÚÓËfl ÏÂÒˆ Ë ÚÂÚ‡Ú‡ „Ó‰Ë̇ ÓÚ Ì‡˜‡ÎÓÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ Ò „ËÒÚË‡ Ô˙ÎÌÓ ·ËÓÂÎÂÍÚ˘ÌÓ Ï˙Θ‡ÌË ÓÚ Ï‡ÎÍËÚ ÏÛÒÍÛÎË Ì‡ Í‡Í‡Ú‡. éÅëöÜÑÄçÖ èË Ò‡‚Ìfl‚‡Ì ̇ ÔÓÎÛ˜ÂÌËÚ ÍÎËÌ˘ÌË Ë ÖåÉ ÂÁÛÎÚ‡ÚË ÓÚ Ì‡¯ÂÚÓ ÔÓÛ˜‚‡ÌÂ Ò ÔÛ·ÎËÍÛ‚‡ÌË ‰Ó ÚÓÁË ÏÓÏÂÌÚ ‰‡ÌÌË ÓÚ ‡Á΢ÌË ‡‚ÚÓË (2,4,9,10), ËÁÔÓÎÁ‚‡˘Ë Ò˙˘ËÚ ‰Ë‡„ÌÓÒÚ˘ÌË ÍËÚÂËË Á‡ ëÉÅ Ë ïÇÑè, ÛÒÚ‡ÌÓ‚ËıÏ ÒıÓ‰ÌË ÂÁÛÎÚ‡ÚË. è‰¯ÂÒÚ‚‡˘Ë ÔÓ‚ÓÍË‡˘Ë Ò˙ÒÚÓflÌËfl Ò ̇·Î˛‰‡‚‡Ú ÔÓ-˜ÂÒÚÓ ÔË ëÉÅ (59,0% ÓÚ ÒÎÛ˜‡ËÚÂ), ͇ÚÓ ÓÚ Úflı 76,9% Ò‡ Ô‰¯ÂÒÚ‚‡ÌË ÓÚ ‚ËÛÒ̇ ËÌÙÂ͈Ëfl ̇ „ÓÌËÚ ‰Ëı‡ÚÂÎÌË Ô˙Úˢ‡ ËÎË „‡ÒÚÓËÌÚÂÒÚË̇ÎÌËfl Ú‡ÍÚ - 10-15 ‰ÌË ÔÂ‰Ë Ì‡˜‡ÎÓÚÓ Ì‡ ÒËÏÔÚÓÏËÚÂ. èË ïÇÑè ÔÓˆÂÌÚ‡ ̇ Ô‰¯ÂÒÚ‚‡˘Ë Á‡·ÓÎfl‚‡ÌËfl  ÔÓ-χÎ˙Í (30,7%). èÓ ÎËÚÂ‡ÚÛÌË ‰‡ÌÌË, ÔË ëÉÅ , óåç ÏÓ„‡Ú ‰‡ ·˙‰‡Ú ‚˙‚ΘÂÌË ‚ ·ÓÎÂÒÚÌËfl ÔÓˆÂÒ ‚ ÓÍÓÎÓ 45-75% ÓÚ ÒÎÛ˜‡ËÚ (1). ãˈ‚‡Ú‡ Ë ÓÓÙ‡Ë̄‡Î̇ Ò··ÓÒÚ Ó·ËÍÌÓ‚ÂÌÓ Ò ‡Á‚Ë‚‡Ú ÒΉ Á‡Òfl„‡Ì ̇ Í‡ÈÌˈËÚÂ Ë ÏÛÒÍÛÎËÚ ̇ ÚflÎÓÚÓ. 燯ËÚ ÂÁÛÎÚ‡ÚË Ò‡ ‚ Ò˙„·ÒËÂ Ò ÚÂÁË ‰‡ÌÌË - ÔË 54,5% ÓÚ ·ÓÎÌËÚ Ò˙Ò ëÉÅ Ò ÛÒÚ‡ÌÓ‚Ëı‡ ÎÂÁËË Ì‡ óåç, ͇ÚÓ ÔË 91,6% ÓÚ Úflı - ÚÓ‚‡ ÂVII óåç. èË ïÇÑè ÔÓˆÂÌÚ‡ ̇ ‡Ì„‡ÊË‡Ì ̇ óåç  30,7%.


‡ÔËÎ, 2002

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

éåÄç Ë éåëÄç Ò‡ ‡ÍÒÓ̇ÎÌËÚ ‚‡ˇÌÚË Ì‡ ëÉÅ. Ç ËÁÒΉ‚‡Ì‡Ú‡ ÓÚ Ì‡Ò „ÛÔ‡ 10% ÔÓ͇Á‚‡Ú ÒËÏÔÚÓÏË ı‡‡ÍÚÂÌË Á‡ ÚÂÁË ‰ÍË Ò˙ÒÚÓflÌËfl. Ñ‚‡Ú‡ ‚‡ˇÌÚ‡ ËÏ‡Ú ı‡‡ÍÚÂ̇ ÖåÉ Ì‡ıӉ͇. Ç Ò‡‚ÌÂÌËÂ Ò éÇÑè Ú ËÏ‡Ú Á‡·‡‚ÂÌÓ Ë ÌÂÔ˙ÎÌÓ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂ. èË Ô‡ˆËÂÌÚËÚÂ Ò ïÇÑè ‡Á‚ËÚËÂÚÓ Ì‡ ÏÛÒÍÛÎÌË ‡ÚÓÙËË Ò ̇·Î˛‰‡‚‡ Ӣ ‚ ‡ÌÌËfl ÒÚ‡‰ËÈ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ (53,8%) ‚ Ò‡‚ÌÂÌËÂ Ò éÇÑè (9,0%). Ç ıÓ‰‡ ̇ ·ÓÎÂÒÚÌËfl ÔÓˆÂÒ ÛÒÎÓÊÌÂÌËfl ÓÚ ÒÚ‡Ì‡ ̇ ‡‚ÚÓÌÓÏ̇ڇ Ë ‰Ëı‡ÚÂÎ̇ ÒËÒÚÂÏË Ò ̇·Î˛‰‡‚‡ı‡ ËÁÍβ˜ËÚÂÎÌÓ ÔË Ô‡ˆËÂÌÚË Ò éÇÑè (27,2%). èË ïÇÑè ÔÓ‰Ó·ÌË ÍÓÏÔÎË͇ˆËËÌ Ì Ò „ËÒÚË‡ı‡. ç‚ÓÙËÁËÓÎӄ˘ÌËÚ ÂÁÛÎÚ‡ÚË, ÔÓÎÛ˜ÂÌË ÔË ËÁÒΉ‚‡Ì ̇ Ô‡ˆËÂÌÚËÚ Ò˙Ò ëÉÅ Ë ïÇÑè ÔÓÚ‚˙ʉ‡‚‡Ú Ò˙Ó·˘ÂÌËflÚ‡ ̇ ‰Û„Ë ‡‚ÚÓË (15,18,20). èË ëÉÅ ‚ ‡ÌÌËfl ÒÚ‡‰ËÈ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ ‡·ÌÓÏÌËÚ F ‚˙ÎÌË Ò‡ ÔÓ˜Û‚ÒÚ‚ËÚÂÎÂÌ Ï‡ÍÂ Á‡ ÔÓÒÚ‡‚flÌ ̇ ‰Ë‡„ÌÓÁ‡Ú‡ ‚ Ò‡‚ÌÂÌËÂ Ò Û‚Â΢ÂÌÓÚÓ ÌË‚Ó Ì‡ ·ÂÎÚ˙͇ ‚ ˆÂ·ÓÒÔË̇Î̇ڇ Ú˜ÌÓÒÚ. ëÍÓÓÒÚËÚ ̇ ÔÓ‚Âʉ‡Ì ÔÓ ‰‚Ë„‡ÚÂÎÌËÚÂ Ë ÒÂÚË‚ÌË ‚·Í̇ Ò‡ ÌÓχÎÌË ‚ ̇˜‡ÎÌËfl ÒÚ‡‰ËÈ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ, ͇ÚÓ ÎÂÍÓ ËÎË Á̇˜ËÚÂÎÌÓ Ò Á‡·‡‚flÚ Ò Ì‡Ô‰‚‡Ì ̇ ‰ÂÏËÂÎËÌËÁË‡˘Ëfl ÔÓˆÂÒ. ìÒÚ‡ÌÓ‚fl‚‡ Ò ˜‡ÒÚ˘ÂÌ ·ÎÓÍ Ì‡ ÔÓ‚Âʉ‡Ì - Á‡ „ÓÌË Í‡ÈÌËˆË ÒÔ‡‰‡Ì ̇ ÔÓÍÒËχÎ̇ڇ ëåÄè ‡ÏÔÎËÚÛ‰‡ Ò Ôӂ˜ ÓÚ 20% ‚ Ò‡‚ÌÂÌËÂ Ò ‰ËÒÚ‡Î̇ڇ ‡ÏÔÎËÚÛ‰‡ Ë Ò Ôӂ˜ ÓÚ 50% ÒÔ‡‰‡Ì Á‡ ‰ÓÎÌËÚ Í‡ÈÌˈË. ç‡Îˈ ҇ Ë ‰Û„ËÚ ÔËÁ̇ˆË Á‡ ‰ÂÏËÂÎËÌËÁ‡ˆËfl (Û‰˙ÎÊÂÌÓ ÑãÇ, ̇΢ˠ̇ Ä ‚˙ÎÌË) (6). ᇠéåÄç  ı‡‡ÍÚÂÌÓ ÌÓχÎÌË ÒÍÓÓÒÚË Ì‡ ÔÓ‚Âʉ‡Ì ÔÓ ‰‚Ë„‡ÚÂÎÌËÚÂ Ë ÒÂÚË‚ÌË ‚·Í̇, ˜‡ÒÚ˘ÂÌ ·ÎÓÍ Ì‡ ÔÓ‚Âʉ‡ÌÂ, ͇ÚÓ Ò „ËÒÚË‡ ·˙ÁÓ ÒÔ‡‰‡Ì ̇ ëåÄè ‡ÏÔÎËÚÛ‰‡Ú‡. í‡ÁË Ì‡ıӉ͇ Ò Ò˙ÔÓ‚Óʉ‡ ÓÚ ‡Ì̇ ÔÓfl‚‡ ̇ ‰ÂÌÂ‚‡ˆËÓÌ̇ ‡ÍÚË‚ÌÓÒÚ ÔË ÖåÉ ËÁÒΉ‚‡Ì - ·ÂÎÂÁË, ı‡‡ÍÚÂÌË Á‡ ‰ËÒÚ‡Î̇ ‡ÍÒÓ̇Î̇ ‰Â„ÂÌÂ‡ˆËfl ̇ ÔÂËÙÂÌËÚ ÌÂ‚Ë. ç‡Î˘ËÂÚÓ Ì‡ ˜‡ÒÚ˘ÂÌ ·ÎÓÍ Ì‡ ÔÓ‚Âʉ‡Ì ÔË éåÄç Ò ӷflÒÌfl‚‡ Ò ‡Á‚ËÚËÂÚÓ Ì‡ ‡Ì̇ ‰ÂÏËÂÎËÌËÁ‡ˆËfl, Ò˙Ô˙ÚÒÚ‚‡˘‡ ‡ÍÒÓ̇Î̇ڇ Û‚‰‡ (12). éÚ ‰Û„‡ ÒÚ‡Ì‡ Ò ÔÓ„ÂÒËflÚ‡ ̇ ‰ÂÏËÂÎËÌËÁË‡˘Ëfl ÔÓˆÂÒ ÔË Ô‡ˆËÂÌÚËÚ Ò˙Ò ëÉÅ Í˙Ï ÓÒÏËflÚ ÏÂÒˆ Ò ̇Ò·„‚‡Ú ÖåÉ ·ÂÎÂÁË Á‡ ‚ÚÓ˘̇ ‡ÍÒÓ̇Î̇ Û‚‰‡ - ÒÔ‡‰‡Ì ‡ÏÔÎËÚÛ‰ËÚ ̇ ëåÄè ËÎË ÛÒÚ‡ÌÓ‚fl‚‡Ì ̇ Ô˙ÎÌÓ ·ËÓÂÎÂÍÚ˘ÌÓ Ï˙Θ‡ÌËÂ. èË ·ÓÎÌËÚÂ Ò ıÓÌ˘̇ ÙÓχ ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ ‡ÏÔÎËÚÛ‰ËÚ ̇ ëåÄè Ò‡ ÒËÎÌÓ Ì‡Ï‡ÎÂÌË, ‡ ‰ËÒÚ‡ÎÌËÚ ·ÚÂ̈ËË Ò‡ ÒËÎÌÓ Û‰˙ÎÊÂÌË. èË ‚Ò˘ÍË ËÁÒΉ‚‡ÌË ·ÓÎÌË ÎËÔÒ‚‡ F ‚˙Î̇ڇ, ÒÍÓÓÒÚÚ‡ ̇ ÔÓ‚Âʉ‡Ì ÔÓ ‰‚Ë„‡ÚÂÎÌËÚ ‚·Í̇  Á‡·‡‚Â̇ Ë Ó·ËÍÌÓ‚ÂÌÓ ÒÂÚË‚ÂÌ ÓÚ„Ó‚Ó Ì Ò ÓÚ‚Âʉ‡ (3). èË ÖåÉ ËÁÒΉ‚‡Ì ‰ÂÌÂ‚‡ˆËÓÌ̇ڇ ‡ÍÚË‚ÌÓÒÚ Â ·Ó„‡Ú‡ Ó˘Â Ì‡ ‚ÚÓËfl ÏÂÒˆ ÓÚ Ì‡˜‡ÎÓÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ, Ò Â‚ÓβˆËfl ‰Ó Ô˙ÎÌÓ ·ËÓÂÎÂÍÚ˘ÌÓ Ï˙Θ‡ÌË ̇ ÚÂÚ‡Ú‡ „Ó‰Ë̇. èË Â‰ËÌ ·ÓÎÂÌ Ò ïÇÑè ÔÓ‚Âʉ‡ÌÂÚÓ ÔÓ n. facialis  Á̇˜ËÚÂÎÌÓ Á‡·‡‚ÂÌÓ (32 ms), Ú.Â. Û‚Â΢ÂÌÓ 8 Ô˙ÚË ‚ Ò‡‚ÌÂÌËÂ Ò ÌÓχڇ. èË Ò˙˘ËflÚ ·ÓÎÂÌ ÛÒÚ‡ÌÓ‚ËıÏ Îˈ‚‡ ÏËÓÍËÏËfl, ÍÓÂÚÓ „Ó‚ÓË Ë Á‡ fl‰Â̇ ÎÂÁËfl ̇ Îˈ‚Ëfl ÌÂ‚. èË ‰Û„ ·ÓÎÂÌ Ò ïÇÑè Ëχ¯Â ÍÎËÌ˘ÌË ‰‡ÌÌË Á‡ ÔÓÒÚÛ‡ÎÂÌ ÚÂÏÓ. èÓ‰Ó·ÌË ÓÔËÒ‡ÌËfl Á‡ Îˈ‚‡ ÏËÓÍËÏËfl Ë ÔÓÒÚÛ‡ÎÂÌ ÚÂÏÓ ÔË ·ÓÎÌË Ò ïÇÑè fl‰ÍÓ Ò Ò¢‡Ú ‚ ÎËÚÂ‡ÚÛ‡Ú‡(5, 17, 24). ëÏflÚ‡ ÒÂ, ˜Â ÖåÉ ‰‡ÌÌËÚ Á‡ ÔÓÌËÊÂ̇ ‡ÏÔÎËÚÛ‰‡ ̇ ëåÄè ËÎË Ô˙ÎÌÓ ·ËÓÂÎÂÍÚ˘ÌÓ Ï˙Θ‡ÌËÂ, ̇΢ˠ̇ ÒÔÓÌÚ‡Ì̇ ‡ÍÚË‚ÌÓÒÚ ‚ ÔÓÍÓÈ Ò‡ ‚‡ÊÌË ÔÓ„ÌÓÒÚ˘ÌË ÖåÉ ·ÂÎÂÁË Á‡ ËÁıÓ‰‡ ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ, ÓÒÓ·ÂÌÓ ÔË ÒÎÛ˜‡ËÚ Ò˙Ò Á‡Ú„̇ÚÓ ÍÎËÌ˘ÌÓ ÔÓÚ˘‡Ì (23). Ç˙‚΢‡ÌÂÚÓ ‚ ·ÓÎÂÒÚÌËfl ÔÓˆÂÒ Ì‡ Í‡ÌˇÎÌË ÌÂ‚Ë, Ô‰¯ÂÒÚ‚‡˘‡ „‡ÒÚÓËÌÚÂÒÚË̇Î̇ ËÌÙÂ͈Ëfl, ÔÓ‰˙ÎÊËÚÂÎÂÌ Ô·ÚÓ ÔÂËÓ‰, ÌÛʉ‡Ú‡ ÓÚ ÔÓ‰˙ÎÊËÚÂÎ̇ ËÁÍÛÒÚ‚Â̇ ·ÂÎÓ‰ӷ̇ ‚ÂÌÚË·ˆËfl Ò‡ Ù‡ÍÚÓË, ÓÔ‰ÂÎfl-

57

˘Ë ÔÓ-Ì··„ÓÔËflÚ̇ڇ ÔÓ„ÌÓÁ‡ ÔÓ ÓÚÌÓ¯ÂÌË ̇ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂÚÓ, ÍÓÂÚÓ Ò Ò˙Ó·˘‡‚‡ Ë ÓÚ ‰Û„Ë ‡‚ÚÓË (23). äÓÏÔÎÂÍÒÌÓÚÓ ÖåÉ ËÁÒΉ‚‡Ì ‰‡‚‡ ‚˙ÁÏÓÊÌÓÒÚ Á‡ ‡ÌÌÓ ÔÓÒÚ‡‚flÌ ̇ ‰Ë‡„ÌÓÁ‡Ú‡, ÔÓ„ÌÓÁ‡Ú‡ Ë Ô‡‚ËÎÌÓÚÓ Î˜ÂÌË ̇ ÓÒÚ‡Ú‡ Ë ıÓÌ˘̇ ‚˙ÁÔ‡ÎËÚÂÎ̇ ‰ÂÏËÂÎËÌËÁË‡˘‡ ÔÓÎËÌ‚ÓÔ‡ÚËfl. ãàíÖêÄíìêÄ: 1. чÒ͇ÎÓ‚ å, âÓ‰‡ÌÓ‚ Å, çËÍÓ‚ÒÍË ç, ìÁÛÌÓ‚ ç, äÂ̇Ó‚ è. óÂÒÚÓÚ‡ ̇ Û‚Âʉ‡Ì ̇ Í‡ÌˇÎÌËÚ ÌÂ‚Ë ÔË ·ÓÎÌË Ò ÔÓÎË‡‰ËÍÛÎÓÌ‚ËÚ Ì‡ Guillain-Barre. ç‚ÓÎ. èÒËıˇÚ. ç‚ÓıËÛ„. 1987;2:44-46. 2. чÒ͇ÎÓ‚ å, çËÍÓ‚ÒÍË Ç, âÓ‰‡ÌÓ‚ Å, ìÁÛÌÓ‚ ç, äÂ̇Ó‚ è. èÓÎË‡‰ËÍÛÎÓÌ‚ËÚ Ì‡ Guillain-Barre. èÓ·ÎÂÏË Ì‡ Ì‚ÓÎÓ„ËflÚ‡, ÔÒËıˇÚËflÚ‡ Ë Ì‚ÓıËÛ„ËflÚ‡ 1986;14:63-71. 3. à¯ÔÂÍÓ‚‡ Å, çÓ‚‡˜ÍÓ‚‡ ë, 퇘‚ Ä. ä˙Ï ÂÎÂÍÚÓÏËÓ„‡Ù̇ڇ ı‡‡ÍÚÂËÒÚË͇ ̇ ÔÓÎË‡‰ËÍÛÎÓÌ‚ËÚ‡ ÚËÔ Guillain-Barre. ç‚ÓÎ èÒËıˇÚ ç‚ÓıË 1981;2:150-154. 4. ï‡‡Î‡Ï·Ë‚ à, ë˙·Â‚ ä, ó‡Í˙Ó‚ Ñ. ïÓÌ˘̇ ÙÓχ ̇ ÔÓÎË‡‰ËÍÛÎÓÌ‚ËÚ‡ ÚËÔ Guillain-Barre. ç‚ÓÎ. èÒËıˇÚ. ç‚ÓıËÛ„. 1979;5:357-361. 5. ï‡ËÁ‡ÌÓ‚ å, ç‰flÎÍÓ‚ ë, ê‡È˜Â‚ ê, à¯ÔÂÍÓ‚‡ Å, ñ‡ÌÍÓ‚ Ç,邘‡Ó‚‡ è.èÓÎË‡‰ËÍÛÎÓÌ‚ËÚ ÚËÔ Guillai-Barre Ò ÚÂÏÓ. ç‚ÓÎ èÒËıˇÚ ç‚ÓıË 1985;6:47-49. 6. ïËÒÚÓ‚‡ ã, ÄÎÂÍ҇̉Ó‚ Ä, à¯ÔÂÍÓ‚‡ Å. Ñˇ„ÌÓÒÚ˘̇ ÒÚÓÈÌÓÒÚ Ì‡ Ä-‚˙ÎÌË. Scripta periodica 2001;4:49-54. 7. Ad Hoc Subcommittee of the American Academy of Neurology AIDS Task Force. Research criteria for diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP). Report from an Ad Hoc Subcommittee of the American Academy of Neurology AIDS Task Force. Neurology 1991;41:617-618. 8. Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain-Barre syndrome. Ann Neurol 1990;27:21-24. 9. Barohn RJ, Kissel JT, Warmolts JR, Mendell JR. Chronic inflammatory demyelinating polyradiciloneuropathy. Clinical characteristics, course and recommendations for diagnostic criteria. Arch Neurol 1989;46:878-884. 10. Cornblath DR, Sumner AJ, Daube J, Gilliatt RW, Brown WF, Parry GJ, Albers JW, Miller RG, Petajan J. Conduction block in clinical practice. Muscle Nerve 1991;14:869-871. 11. Cornblath DR. Electrophysiology in Guillain-Barre syndrome. Ann Neurol 1990;27(Suppl):17-20. 12. Feasby TE, Hahn AF, Brown WF, Bolton CF, Gilbert JJ, Koopman WJ. Severe axonal degeneration in acute Guillain-Barre syndrome: evidence of two different mechanisms. J Neurol Sci 1993;116:185-192. 13. Hahn AF. Guillain-Barre syndrome. Lancet 1998;352:635-641. 14. Hughes RAC. The concept and classification of Guillain-Barre syndrome and related disorders. Rev Neurol 1995;151:291-294 (Editorial). 15. Kimura J, Butzer J.F-wave conduction velocity in Guillain-Barre syndrome.Arch Neurol 1975;32:524-529. 16. Lu JL, Sheikh KA, Wu HS, Zhang J, Jiang ZF, Cornblath DR, McKhann GM, Asbury AK, Griffin JW, Ho TW. Physiologic-pathologic correlation in GuillainBarre syndrome in children. Neurology 2000;54:33-39. 17. Mateer JE, Gutmann L, McComas CF. Myokymia in Guillain-Barre syndrome. Neurology 1983;33:374-376. 18. Olney RK. Consensus criteria for the diagnosis of partial conduction block. Muscle Nerve 1999;22:225-229. 19. Prineas JW.Pathology of the Guillain-Barre syndrome. Ann Neurol 1981; 9:6-19. 20. Ropper A, Wijdicks E, Shahani B. Electrodiagnostic abnormalities in 113 consecutive patients with Guillain-Barre syndrome. Arch Neurol 1990;47:881-887. 21. Ropper AH, Wijdicks EFM, Truax BT. Guillain-Barre syndrome. Philadelphia: FA Davis, 1991. 22. Saperstein DS, Katz JS, Amato AA, Barohn RJ. Clinical spectrum of chronic acquired demyelinating polyneuropathies. Muscle Nerve 2001;24:311-324. 23. The Italian Guillain-Barre Study Group. The prognosis and main prognostic indicators of Guillain-Barre syndrome. A multicentre prospective study of 297 patients. Brain 1996;119:2053-2061. 24. Van Zandycke M, Martin JJ, Vande Gaer L, Van den Heyning P. Facial myokymia in the Guillain-Barre syndrome: a clinicopathologic study. Neurology 1982;32:744-748. 25. Wu HS, Liu TC, Lu ZL, et al. A prospective clinical and electrophysiologic survey of acute flaccid paralysis in Chinese children. Neurology 1997;49:1723-1725.

ĉÂÒ Á‡ ÍÓÂÒÔÓ̉Â̈Ëfl: ÑÓˆ. å. чÒ͇ÎÓ‚ ëÓÙËfl 1504, ÛÎ."ÅflÎÓ ÏÓÂ"8, åÅÄã "ñ‡ˈ‡ âÓ‡Ì̇"-ÖÄÑ, äÎËÌË͇ ÔÓ Ì‚ÓÎÓ„Ëfl, íÂÎ. 43-44-210


Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

‡ÔËÎ, 2002

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éË„Ë̇ÎÌË ÒÚ‡ÚËË çÄòàüí éèàí ë ãÖóÖçàÖ çÄ ëàçÑêéåÄ çÄ GUILLAIN-BARRE ë àçíêÄÇÖçéáÖç àåìçéÉãéÅìãàç ñ. ñ‡ÌÍÓ‚‡, ü. ïËÒÚÓ‚, è. ëÚ‡ÏÂÌÓ‚‡, å. чÒ͇ÎÓ‚, Ç.íÓ̘‚‡, í. ëÚÂÙ‡ÌÓ‚, É. Å·„Ó‚, ç. ëËÏÂÓÌÓ‚, å. Ñ‡„Ë‚, å. åË·ÌÓ‚‡, à. ëÚ‡ÈÍÓ‚, å. ꇉ‚‡, ë. ÇÂÎÍÓ‚‡ ä‡Ú‰‡ ÔÓ Ì‚ÓÎÓ„Ëfl -åì, ëÓÙËfl åÅÄã "ñ‡ˈ‡ âÓ‡Ì̇", ëÓÙËfl SUMMARY OUR EXPERIENCE IN GUILLAIN-BARRE SYNDROME TREATMENT WITH INTRAVENOUS IMMUNOGLOBULIN Ts. Tsankova, Y. Hristov, P. Stamenova, M. Daskalov, V.íoncheva, T. Stefanov, G. Blagoev, N. Simeonov, M. Dragiev, M. Milanova, I. Staikov, M. Radeva, S. Velkova Results from the treatment of 32 patients (21 men and 11 women) having the Guillain-Barre Syndrome are presented; 27 of the patients developed acute inflammatory demyelinating polyneuropathy, 3 had predominantly axon-type polyneuropathy and 2 showed the Miller-Fisher variant. The diagnosis was formulated based on the clinical data supported by liquor and electromyographic examination. 28 of the patients passed immune-modulating treatment with intravenous immunoglobulin (IvIg); 9 of them received the generally used high dose of 2g/kg, while the remaining 19 patients got from 0,5 to 1g/kg. Artificial lung ventilation (ALV) and probe feeding was applied to 7 patients who developed respiratory deficiency and bulbar paralysis. 28 patients (87,5%) who had recovered to an acceptable degree were sent home or to a rehabilitation center; 4 died due to somatic complications. The results from the treatment concerning the duration of the clinical "plateau" and the intensive therapy, the appearance of initial signs of recovery following the immune-modulating cure, the stay at the stationary and the time for regain of normal unaided walking have been compared to published reference data. The conclusions about the beneficial effect of IvIg to reduce the period of clinical health improvement and recovery of the patients were confirmed. Special attention should be paid to the relatively low percentage of patients admitted to the hospital with generalized weakness and lesion of cranial nerves who needed ALV later on. The results, achieved for the initial improvement day and the period for regain of independent walking ability, were satisfactory. Practically insignificant was the percentage of clinical fluctuations. It was confirmed that patients with electromyographic data about heavy axon damage and denervation show prolonged disease suffering and incomplete recovery. No serious side effects related to the IvIg treatment were registered. Key words: Guillain-Barre Syndrome, intravenous immunoglobulin therapy êÖáûåÖ è‰ÒÚ‡‚ÂÌË Ò‡ ÂÁÛÎÚ‡ÚËÚ ÓÚ Î˜ÂÌËÂÚÓ Ì‡ 32 ·ÓÎÌË (21 Ï˙ÊÂ Ë 11 ÊÂÌË) Ò˙Ò ÒË̉Óχ ̇ Guillain-Barre - 27 Ò ÓÒÚ‡ ‚˙ÁÔ‡ÎËÚÂÎ̇ ‰ÂÏËÂÎËÌËÁË‡˘‡ ÔÓÎËÌ‚ÓÔ‡ÚËfl, 3 Ò Ô‰ËÏÌÓ ‡ÍÒÓ̇ÎÂÌ ÚËÔ ÔÓÎËÌ‚ÓÔ‡ÚËfl Ë 2 Ò ‚‡ˇÌÚ Ì‡ Miller - Fisher. Ñˇ„ÌÓÁ‡Ú‡  ÔÓÒÚ‡‚Â̇ ÔÓ

ÍÎËÌ˘ÌË ‰‡ÌÌË, ÔÓ‰ÍÂÔÂÌË ÓÚ ÎËÍ‚ÓÌÓ Ë ÂÎÂÍÚÓÏËÓ„‡ÙÒÍÓ ËÁÒΉ‚‡ÌÂ. ç‡ 28 ÓÚ ·ÓÎÌËÚ  Ôӂ‰ÂÌÓ ËÏÛÌÓÏÓ‰ÛÎË‡˘Ó ΘÂÌËÂ Ò ËÌÚ‡‚ÂÌÓÁÂÌ ËÏÛÌÓ„ÎÓ·ÛÎËÌ (à‚à„), ͇ÚÓ 9 Ò‡ ÔÓÎÛ˜ËÎË Ó·˘ÓÔËÂÚ‡Ú‡ ‚ËÒÓ͇ ‰ÓÁ‡ 2g/kg, ‡ ÓÒڇ̇ÎËÚ 19 - ÓÚ 0,5 ‰Ó 1g/kg. ç‡ 7 ·ÓÎÌË Ò ‡Á‚Ë· Ò ‰Ëı‡ÚÂÎ̇ ̉ÓÒÚ‡Ú˙˜ÌÓÒÚ Ë ·Ûη‡̇ Ô‡‡ÎËÁ‡ Ò‡ Ôӂ‰ÂÌË ËÁÍÛÒÚ‚Â̇ ·ÂÎÓ‰ӷ̇ ‚ÂÌÚË·ˆËfl (àÅÇ) Ë ÒÓÌ‰Ó‚Ó ı‡ÌÂÌÂ. ë ‡Á΢̇ ÒÚÂÔÂÌ Ì‡ ÔÓ‰Ó·ÂÌË ҇ ËÁÔËÒ‡ÌË ‚ ‰Óχ¯Ì‡ ËÎË Ò‡Ì‡ÚÓˇÎ̇ Ó·ÒÚ‡Ìӂ͇ 28 ·ÓÎÌË (87,5%), ‡ 4 Ò‡ ÔÓ˜Ë̇ÎË ÓÚ ÒÓχÚ˘ÌË ÛÒÎÓÊÌÂÌËfl. êÂÁÛÎÚ‡ÚËÚ ÓÚ Î˜ÂÌËÂÚÓ ÔÓ ÓÚÌÓ¯ÂÌË ̇ ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚÚ‡ ̇ ÍÎËÌ˘ÌÓÚÓ "Ô·ÚÓ" Ë Ì‡ ËÌÚÂÌÁ˂̇ڇ ÚÂ‡ÔËfl, ‚ÂÏÂÚÓ Ì‡ Ô˙‚ÓÚÓ ÔÓ‰Ó·ÂÌË ÒΉ ËÏÛÌÓÏÓ‰ÛÎË‡˘ÓÚÓ Î˜ÂÌËÂ, ÔÂÒÚÓfl ‚ ÒÚ‡ˆËÓ̇‡ Ë ‚ÂÏÂÚÓ Á‡ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡Ì ̇ Ò‡ÏÓÒÚÓflÚÂÎ̇ڇ ÔÓıӉ͇ Ò‡ Ò‡‚ÌÂÌË Ò ‰‡ÌÌËÚ ÓÚ ÎËÚÂ‡ÚÛ‡Ú‡. èÓÚ‚˙‰ÂÌË Ò‡ ËÁ‚Ó‰ËÚ ÓÚÌÓÒÌÓ ·Î‡„ÓÔËflÚÌËfl ÂÙÂÍÚ Ì‡ à‚à„ Á‡ Ò˙Í‡˘‡‚‡Ì ‚ÂÏÂÚÓ Á‡ ÍÎËÌ˘ÌÓ ÔÓ‰Ó·ÂÌËÂ Ë ‚˙ÁÒÚ‡ÌÓ‚fl‚‡Ì ̇ ·ÓÎÌËÚÂ. è‡‚Ë ‚Ô˜‡ÚÎÂÌË Ò‡‚ÌËÚÂÎÌÓ ÌËÒÍËflÚ ÔÓˆÂÌÚ ·ÓÎÌË, ÔÓÒÚ˙ÔËÎË Ò „ÂÌÂ‡ÎËÁË‡Ì‡ Ò··ÓÒÚ Ë ÎÂÁËfl ̇ Í‡ÌˇÎÌË ÌÂ‚Ë, ÍÓËÚÓ Ò‡ ‰ÓÒÚ˄̇ÎË ‰Ó àÅÇ. ᇉӂÓÎËÚÂÎÌË Ò‡ ÂÁÛÎÚ‡ÚËÚ ÔÓ ÓÚÌÓ¯ÂÌË ‰ÂÌfl ̇ Ô˙‚ÓÚÓ ÔÓ‰Ó·ÂÌËÂ Ë ‚ÂÏÂÚÓ Á‡ Ò‡ÏÓÒÚÓflÚÂÎ̇ ÔÓıӉ͇. ë‡‚ÌËÚÂÎÌÓ Ï‡Î˙Í Â ÔÓˆÂÌÚ˙Ú Ì‡ ÍÎËÌ˘ÌË ÙÎÛÍÚÛ‡ˆËË. èÓÚ‚˙‰ËÚÂÎÌÓ Â Ì‡·Î˛‰ÂÌËÂÚÓ Á‡ ÔÓ-ÔÓ‰˙ÎÊËÚÂÎÌÓ ÔÓÚ˘‡ÌÂ Ë ÌÂÔ˙ÎÌÓ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡Ì ÔË ·ÓÎÌË Ò ÂÎÂÍÚÓÏËÓ„‡ÙÒÍË ‰‡ÌÌË Á‡ ÚÂÊÍÓ ‡ÍÒÓ̇ÎÌÓ Û‚Âʉ‡ÌÂ Ò ‰ÂÌÂ‚‡ˆËfl. ç ҇ ̇·Î˛‰‡‚‡ÌË ÒÂËÓÁÌË ÒÚ‡Ì˘ÌË fl‚ÎÂÌËfl, Ò‚˙Á‡ÌË Ò Î˜ÂÌËÂÚÓ Ò à‚à„. äβ˜Ó‚Ë ‰ÛÏË: ëË̉ÓÏ Ì‡ Guillain-Barre, ËÏÛÌÓÏÓ‰ÛÎË‡˘‡ ÚÂ‡ÔËfl, ËÌÚ‡‚ÂÌÓÁÂÌ ËÏÛÌÓ„ÎÓ·ÛÎËÌ èÂÁ ÔÓÒΉÌËÚ ‰ÂÒÂÚË̇ „Ó‰ËÌË Òڇ̉‡ÚÌÓÚÓ Ôӂ‰ÂÌË ÔË ÒË̉Óχ ̇ Guillain-Barre (ëÉÅ) Ò ÔÓÏÂÌË ÓÚ Ò‡ÏÓ ÔÓ‰‰˙ʇ˘Ë „ËÊË ‰Ó ‚Íβ˜‚‡ÌÂ Ë Ì‡ ËÏÛÌÓÏÓ‰ÛÎË‡˘Ë ÚÂ‡ÔËË Í‡ÚÓ Ô·ÁχÁ‡ÏÂÒÚ‚‡Ì (èá) Ë ËÌÚ‡‚ÂÌÓÁÂÌ ˜Ó‚¯ÍË ËÏÛÌÓ„ÎÓ·ÛÎËÌ (à‚à„) (1, 2, 11,13,14,15). èӂ˜ÂÚÓ ‡‚ÚÓË Ë ‡Ì‰ÓÏËÁË‡ÌË Ò‡‚ÌËÚÂÎÌË ÔÓÛ˜‚‡ÌËfl Ò‡ ÒÚ˄̇ÎË ‰Ó Á‡Íβ˜ÂÌËÂ, ˜Â ‰‚‡Ú‡ ‚ˉ‡ ËÏÛÌÓÏÓ‰ÛÎË‡˘Ó ΘÂÌË ҇ Â‰Ì‡Í‚Ó ÂÙÂÍÚË‚ÌË, ‡ÍÓ Á‡ÔÓ˜Ì‡Ú ‚ Ô˙‚ËÚ ‰‚ Ò‰ÏËˆË Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ (3,5,9,14,16), ͇ÚÓ ÂÙÂÍÚË‚ÌÓÒÚÚ‡ ËÏ Ëχ ÓÚÌÓ¯ÂÌË Ì ÚÓÎÍÓ‚‡ Í˙Ï ÎÂÚ‡ÎËÚÂÚ‡, ÍÓÎÍÓÚÓ Í˙Ï ‚ÂÏÂÚÓ Ë ÒÚÂÔÂÌÚ‡ ̇ ÍÎËÌ˘ÌÓ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡Ì (1,4,8,9,11,12,13,14). ÇÒ ԇÍ, ΘÂÌËÂÚÓ Ò à‚à„ Ëχ Ô‰ËÏÒÚ‚‡ Ô‰ èá ͇ÚÓ ÔÓ- ‰ÓÒÚ˙ÔÌÓ, χ͇ Ë ÔÓ- ÒÍ˙ÔÓ, ÔÓ-ÎÂÒÌÓ ÔËÎÓÊËÏÓ Ë ‚ ·ÓίËÌÒÚ‚ÓÚÓ ÒÎÛ˜‡Ë ·ÂÁ ÒÂËÓÁÌË ÒÚ‡Ì˘ÌË fl‚ÎÂÌËfl (3,4,8,10,11). éÔ‡ÒÌÓÒÚÚ‡ ÓÚ ÔÂ̇ÒflÌ ̇ ÌflÍÓË ‚ËÛÒÌË ËÌÙÂ͈ËË Â ÔÓ˜ÚË ËÁÍβ˜Â̇ ·Î‡„Ó‰‡ÂÌË ̇ ÚËÂÚ‡ÔÌË Ôӈ‰ÛË Á‡ ÒË„ÛÌÓÒÚ ÔË ËÁ„ÓÚ‚flÌ ̇ Ô·ÁÏÂÌËfl ÔÓ‰ÛÍÚ, ‡ ÔÂÔ‡‡Ú˙Ú Gammagard - SD ( Baxter)


‡ÔËÎ, 2002

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

Ò ÏËÌËχÎÌÓ Ò˙‰˙ʇÌË ̇ Ig A  ·ÂÁÓÔ‡ÒÂÌ Á‡ Ô‡ˆËÂÌÚË Ò ‰ÍËfl ‰ÂÙˈËÚ Ì‡ IgA (4,10,13). íÂ‡ÔËfl Ò à‚à„ Ò ÔÂÔÓ˙˜‚‡ ͇ÚÓ ÏÂÚÓ‰ ̇ Ô˙‚Ë ËÁ·Ó ÔË Ï‡ÎÍË ‰Âˆ‡ Ë ÔÓÒÚ‡Ë ·ÓÎÌË ( ÓÚ 2 ÏÂÒˆ‡ ‰Ó 93 „Ó‰ËÌË ÔÓ Sater Ë Rostami) (11), ͇ÍÚÓ Ë ÔË ·ÓÎÌË Ò Í‡‰Ëo‚‡ÒÍÛ·̇ ÌÂÒÚ‡·ËÎÌÓÒÚ, Ò Ô‰ËÏÌÓ ÏÓÚÓÌË ÒËÏÔÚÓÏË Ë Ò ‰Ó͇Á‡ÌË ‡ÌÚËÚ· ÒÂ˘Û GM1 (7,9,13,16). ëÔÓ‰ Hadden Ë Ò˙Ú. (5), ÔË ˜ËÒÚÓ ÏÓÚÓÌËfl ëÉÅ ÔÓ-ÂÙÂÍÚ˂̇  ÍÓÏ·Ë̇ˆËflÚ‡ èá/à‚à„. ëÔˆËÙ˘ÌËÚ ÏÂı‡ÌËÁÏË Ì‡ ‰ÂÈÒÚ‚Ë ̇ à‚à„ ‚Ò Ӣ Ò ËÁflÒÌfl‚‡Ú (4,11,13). ëÔÓ‰ Kaveri Ë Ò˙Ú. (6), ÍÓËÚÓ ‡Á„‡Ì˘‡‚‡Ú ·˙ÁË ËÏÛÌÓÏÓ‰Û·ÚÓÌË Ë ‰˙΄ÓÒÓ˜ÌË ÂÁÛÎÚ‡ÚË ÓÚ Î˜ÂÌËÂÚÓ Ò à‚à„, ·Î‡„ÓÔËflÚÌËflÚ ÏÛ ÂÙÂÍÚ ÔË ‡‚ÚÓËÏÛÌÌËÚ Á‡·ÓÎfl‚‡ÌËfl Ì Ò ‰˙ÎÊË ÔÓÒÚÓ Ì‡ Ô‡ÒË‚ÂÌ Ú‡ÌÒÙÂ ̇ ÌÂÛÚ‡ÎËÁË‡˘Ë ‡ÌÚËˉËÓÚËÔÌË ‡ÌÚËÚ· ÒÂ˘Û ‡‚ÚÓ‡ÌÚËÚ·ڇ, ‡ ̇ ÔÓÏfl̇ ‚ ÒÚÛÍÚÛ‡Ú‡ Ë ‰Ë̇ÏË͇ڇ ̇ ˉËÓÚËÔ̇ڇ ÏÂʇ, Á‡ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡Ì ̇ ÙËÁËÓÎӄ˘ÌËfl ÍÓÌÚÓΠ̇‰ ËÏÛÌËÚÂÚ‡. è‰ÔÓ·„‡Ú Ò ÏÌÓ„ÓÒÚ‡ÌÌË ÂÙÂÍÚË Í‡ÚÓ: ÏÓ‰ÛÎË‡Ì ̇ Fc-ˆÂÔÚÓÌÓ Ï‰ËË‡Ì‡Ú‡ Ù‡„ÓˆËÚÓÁ‡, ÔÓÌËʇ‚‡Ì ÂÍÒÔÂÒËflÚ‡ ̇ ÔÓËÌÙ·χÚÓÌË ˆËÚÓÍËÌË Ë ÔÓÚËÒ͇Ì ‡ÍÚË‚ÌÓÒÚÚ‡ ̇ ÍÓÏÔÎÂÏÂÌÚ‡, ÏÓ‰ÛÎË‡Ì ̇ í-ÍÎÂÚ˙˜Ì‡Ú‡ ÙÛÌ͈Ëfl, ̇χÎfl‚‡Ì ÔÓ‰Û͈ËflÚ‡ ̇ ‡ÌÚËÚ·, ÔÓÏÂÌË ‚ ‡ÁÚ‚ÓËÏÓÒÚÚ‡ Ë ÍÎË˙ÌÒ‡ ̇ ËÏÛÌÌË ÍÓÏÔÎÂÍÒË, Á‡ÒË΂‡Ì ̇ ÂÏËÂÎËÌËÁ‡ˆËflÚ‡ (4,6,11,13,15). ê¯ÂÌËÂÚÓ Á‡ Á‡ÔÓ˜‚‡Ì ̇ ËÏÛÌÓÏÓ‰ÛÎË‡˘Ó ΘÂÌËÂ Ò à‚à„ Ò ·‡ÁË‡ ̇ ÚÂÊÂÒÚÚ‡, Ò ÍÓflÚÓ Ò Ô‰ÒÚ‡‚flÚ ·ÓÎÌËÚÂ, ÒÍÓÓÒÚÚ‡ ̇ ÔÓ„ÂÒË‡ÌÂ Ë ‚ÂÏÂÚÓ Ì‡ Ô˙‚Ëfl ÒËÏÔÚÓÏ (11). Spies Ë Ò˙Ú. (13) „Ó ÔÂÔÓ˙˜‚‡Ú Ë ÔË ·ÓÎÌË Ò ÎÂÍ ËÎË ÛÏÂÂÌ ‰ÂÙˈËÚ Ë Ì‡ÒÚÓfl‚‡Ú Á‡ ‚Íβ˜‚‡ÌÂÚÓ ÏÛ ‰Ó ‰̇ Ò‰Ïˈ‡ ÓÚ Á‡·ÓÎfl‚‡ÌÂÚÓ. ë‡ÏÓÒÚÓflÚÂÎÌÓÚÓ ÔËÎÓÊÂÌË ̇ ÍÓÚËÍÓÒÚÂÓË‰Ë ÔË ëÉÅ Ò ÓÚı‚˙Îfl ÓÚ ‚Ò˘ÍË ‡‚ÚÓË (9,13,14). ᇠÔÓ‚Â͇ ̇ ‰Ó·ËÚ ÂÁÛÎÚ‡ÚË ÓÚ ÔËÎÓÚÌÓÚÓ ‰‡ÚÒÍÓ ÔÓÛ˜‚‡Ì ÓÚÌÓÒÌÓ ÍÓÏ·ËÌË‡Ì‡ ÚÂ‡ÔËfl à‚à„/MethylprednisolÓne 5 ı 500mg, ÔÓ̇ÒÚÓfl˘ÂÏ Ú˜ ÔÓÒÔÂÍÚË‚ÌÓ ÏÛÎÚˈÂÌÚÓ‚Ó ‡Ì‰ÓÏËÁË‡ÌÓ ÔÓÛ˜‚‡Ì (13) äéçíàçÉÖçí à åÖíéÑàäÄ á‡ ÔÂËÓ‰‡ 1995 - 2002 „Ó‰Ë̇, ‚ äÎËÌË͇ڇ ÔÓ Ì‚ÓÎÓ„Ëfl ̇ åÅÄã “ñ‡ˈ‡ âÓ‡Ì̇” Ò‡ ÎÂÍÛ‚‡ÌË 32 ·ÓÎÌË Ò˙Ò ëÉÅ - 21 Ï˙ÊÂ Ë 11 ÊÂÌË Ì‡ ‚˙Á‡ÒÚ ÓÚ 15 ‰Ó 67 „Ó‰ËÌË Ë Ò‰̇ ‚˙Á‡ÒÚ 40 „Ó‰ËÌË. Ñˇ„ÌÓÁ‡Ú‡  ÓÒÌÓ‚‡Ì‡ ̇ ÍÎËÌ˘ÌË ‰‡ÌÌË Á‡ ÓÒÚÓ Ë ÔÓ‰ÓÒÚÓ ‡Á‚Ë· Ò ÔÓÎËÌ‚ÓÔ‡ÚËfl, ÔÓ‰ÍÂÔÂÌË ÓÚ ÎËÍ‚ÓÌÓ Ë ÂÎÂÍÚÓÏËÓ„‡ÙÒÍÓ ËÁÒΉ‚‡Ì (Ò˙„·ÒÌÓ ‰Ë‡„ÌÓÒÚ˘ÌËÚ ÍËÚÂËË Á‡ ëÉÅ ÔÓ Asbury Ë Cornttaltt 1990) . ë ËÁÍβ˜ÂÌË ̇ ˜ÂÚËËχ ·ÓÎÌË Ò ˜ËÒÚÓ ÏÓÚÓ̇ ÒËÏÔÚÓχÚË͇ Ë Ì‡ ‰‚‡Ï‡ ·ÓÎÌË Ò ‚‡ˇÌÚ‡ ̇ Miller-Fisher, ÔË ÓÒڇ̇ÎËÚ Ò ͇҇ Á‡ ÒËÏÂÚ˘̇ ÒÂÌÁÓÌÓ-ÏÓÚÓ̇ ÔÓÎËÌ‚ÓÔ‡ÚËfl Ò ÔÂӷ·‰‡‚‡Ì ̇ ‰‚Ë„‡ÚÂÎÌËÚ ̇Û¯ÂÌËfl. èË 22 ·ÓÎÌË ÍÎËÌ˘̇ڇ ͇ÚË̇ ‚Íβ˜‚‡ Ë Û‚Âʉ‡ÌËfl ‚ ‡Á΢̇ ÒÚÂÔÂÌ Ì‡ ˜ÂÂÔÌÓ - ÏÓÁ˙˜ÌË ÌÂ‚Ë - ‰‚ÛÒÚ‡Ì̇ Îˈ‚‡, ·Ûη‡̇ Ô‡‡ÎËÁ‡ Ë/ËÎË Ó˜Â‰‚Ë„‡ÚÂÎÌË Ô‡ÂÁË. åÓÌËÚÓË‡ÌÂÚÓ Ì‡ ‚„ÂÚ‡ÚË‚ÌËÚ ÙÛÌ͈ËË ÛÒÚ‡ÌÓ‚fl‚‡ ÔË 12 ·ÓÎÌË ÓÚ ÎÂÍË ‰Ó ÚÂÊÍÓ ËÁ‡ÁÂÌË ÒËÏÔÚÓÏË Ì‡ ‰ËÁ‡‚ÚÓÌÓÏËfl - Ú‡ıË͇‰Ëfl, ÂÍÒÚ‡ÒËÒÚÓÎ̇ ‡ËÚÏËfl, ‡ÚÂˇÎ̇ ıËÔÂ - ËÎË ıËÔÓÚÓÌËfl, ıËÔÂıˉÓÁ‡. èË 7 ·ÓÎÌË Ò  ̇ÎÓÊË· ËÁÍÛÒÚ‚Â̇ ·ÂÎÓ‰ӷ̇ ‚ÂÌÚË·ˆËfl (àÅÇ) ÔÂÁ Ú‡ıÂÓÒÚÓχ Ë ÒÓÌ‰Ó‚Ó ı‡ÌÂÌÂ. ë ËÁÍβ˜ÂÌË ̇ 7 ·ÓÎÌË, ÔË ÓÒڇ̇ÎËÚ Ò˙˘ÂÒÚ‚Û‚‡Ú ‡Ì‡ÏÌÂÒÚ˘ÌË ‰‡ÌÌË Á‡ Ô‰ıÓʉ‡˘Ë ÓÚ 7 ‰Ó 20 ‰ÌË Á‡·ÓÎfl‚‡ÌËfl ËÎË ‰Û„Ë Ô‰ÔÓ·„‡ÂÏË ËÒÍÓ‚Ë Ù‡ÍÚÓË, ‡ ËÏÂÌÌÓ: „ËÔÓÔÓ‰Ó·ÌÓ Á‡·ÓÎfl‚‡ÌÂ Ò Ù·ËÎËÚÂÚ, ͇ڇ ̇ „ÓÌËÚ ‰Ëı‡ÚÂÎÌË Ô˙Úˢ‡ Ë Ïˇ΄Ëfl ÔË 14 ·ÓÎÌË,

59

„‡ÒÚÓËÌÚÂÒÚË̇ÎÌÓ Á‡·ÓÎfl‚‡Ì ÔË 8 ·ÓÎÌË, ıÓÏÓÎÓÊ̇ Ú‡ÌÒÔ·ÌÚ‡ˆËfl Ë HZV-ËÌÙÂ͈Ëfl ÔË 1 ·ÓÎÂÌ Ò ÌÂıÓ‰ÊÍËÌÓ‚ ÎËÏÙÓÏ, ‡Ê‰‡ÌÂ Ò ËÌÚ‡‚ÂÌÓÁ̇ ‡ÌÂÒÚÂÁËfl - 1 ·ÓÎ̇, ıÂÓËÌÓ‚‡ ‡·ÒÚËÌÂÌÚÌÓÒÚ - 1 ·ÓÎÂÌ. ãËÍ‚ÓÌÓÚÓ ËÁÒΉ‚‡Ì ̇ 25 ·ÓÎÌË ÔÓ͇Á‚‡ ·ÂÎÚ˙˜ÌÓ - ÍÎÂÚ˙˜Ì‡ ‰ËÒӈˇˆËfl Ò˙Ò ÒÚÓÈÌÓÒÚË Ì‡ Ó·˘Ëfl ·ÂÎÚ˙Í ÓÚ 0,78 g/l ‰Ó 7,0 g/l Ë Ò‰̇ ÒÚÓÈÌÓÒÚ 2,23 g/l. èË ÓÒڇ̇ÎËÚ ·ÓÎÌË ‡Ì̇ڇ ÎÛÏ·‡Î̇ ÔÛÌ͈Ëfl  ‚ÂÓflÚ̇ Ô˘Ë̇ Á‡ ÌÓχÎÌËÚ ÒÚÓÈÌÓÒÚË Ì‡ ÎËÍ‚ÓÌËÚ ÔÓÚÂËÌË. ÖÎÂÍÚÓÏËÓ„‡ÙÒÍÓÚÓ ËÁÒΉ‚‡Ì ÔË Ôӂ˜ÂÚÓ ·ÓÎÌË Â Ò ‰‡ÌÌË Á‡ „ÂÌÂ‡ÎËÁË‡ÌÓ ÔÂËÙÂÌÓÒÚ‚ÓÎÓ‚Ó Û‚Âʉ‡Ì ÓÚ ‰ÂÏËÂÎËÁË‡˘ ËÎË ÒÏÂÒÂÌ ÚËÔ, Ì‡È - ˜ÂÒÚÓ Í‡ÍÚÓ Ì‡ ‰‚Ë„‡ÚÂÎÌËÚÂ, ڇ͇ Ë Ì‡ ÒÂÚË‚ÌËÚ ÌÂ‚ÌË ‚·Í̇. èË ÚËχ ·ÓÎÌË ·Â¯Â ÛÒÚ‡ÌÓ‚ÂÌÓ ÚÂÊÍÓ ‡ÍÒÓ̇ÎÌÓ Û‚Âʉ‡ÌÂ Ò ‰ÂÌÂ‚‡ˆËfl. ç‡ 28 ·ÓÎÌË, ̇‰ Ò Ó·˘ËÚ „ËÊË, ËÌÚÂÌÁ˂̇ ÚÂ‡ÔËfl Ë ÒËÏÔÚÓχÚ˘ÌÓ Î˜ÂÌËÂ, Ò Ôӂ‰ ËÏÛÌÓÏÓ‰ÛÎË‡˘Ó ΘÂÌËÂ Ò à‚à„. ç‡ 9 ·ÓÎÌË Ò ‚Îfl Ô˙Î̇ڇ Ó·˘ÓÔËÂÚ‡ ‰ÓÁ‡ ÓÚ 2 g/kg Immunovenin (‡ÏÔÛÎË ÓÚ 5%, 5ml), ‡ÁÔ‰ÂÎÂ̇ ‚ 5 ÔÓÒΉӂ‡ÚÂÎÌË ‰ÌË. èË Â‰ËÌ ÓÚ ÚÂÁË ·ÓÎÌË Ò ÔÓ‰˙ÎÊËÚÂÎÌÓ “Ô·ÚÓ” Ë Á‡‰˙ηӘ‡‚‡Ì ̇ ‰Ëı‡ÚÂÎ̇ڇ ̉ÓÒÚ‡Ú˙˜ÌÓÒÚ ÒΉ ÎÂÍÓ ÔÓ‰Ó·ÂÌËÂ, Ò ̇ÎÓÊË ‰‡ Ò Ôӂ‰ ÔÓ‚ÚÓÂÌ ÍÛÒ à‚à„ ÔÂÁ ‚ÚÓËfl ÏÂÒˆ ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ. èË 19 ·ÓÎÌË Ò‡ ÔËÎÓÊÂÌË ÔÓ-χÎÍË ‰ÓÁË - ÓÚ 0,5 ‰Ó 1 g/kg. Ñ‚‡Ï‡ ÓÚ ÚÂÁË ·ÓÎÌË Ò‡ ÎÂÍÛ‚‡ÌË Ò˙Ò Ò‰ÌË ‰ÓÁË Venoglobulin, ‡ ‰Û„Ë ‰‚‡Ï‡ Ò à‚à„ Ë Methylprednisolone. ÇÎË‚‡ÌËflÚ‡ Ò ÔÓ‚Âʉ‡ı‡ ÔÂÁ ˆÂÌÚ‡ÎÂÌ ‚ÂÌÓÁÂÌ Ô˙Ú, Ò Ì‡˜‡Î̇ ÒÍÓÓÒÚ 20 ͇ÔÍË/ÏËÌÛÚ‡ Ë ÔÓÒΉ‚‡˘‡, ÔË ‰Ó·‡ ÔÓÌÓÒËÏÓÒÚ - 40 ͇ÔÍË/ÏËÌÛÚ‡. ç‡ ˜ÂÚËËχ ÓÚ ·ÓÎÌËÚ Ì  ÔÓ‚Âʉ‡ÌÓ ËÏÛÌÌÓ Î˜ÂÌËÂ, ‡ Ò‡ÏÓ ËÌÚÂÌÁ˂̇ ÚÂ‡ÔËfl Ë ÒËÏÔÚÓχÚ˘ÌÓ Î˜ÂÌËÂ. èË ·ÓÎÌËÚ ̇ à‚à„ ·flı‡ ËÁÍβ˜ÂÌË ÒÂËÓÁÌË ·˙·˜ÌË Á‡·ÓÎfl‚‡ÌËfl Ë ÍÓÌ„ÂÒÚ˂̇ Ò˙‰Â˜Ì‡ ̉ÓÒÚ‡Ú˙˜ÌÓÒÚ. êÖáìãíÄíà èÓÛ˜‚‡ÌËÚ ·ÓÎÌË Ò‡ ÔÂÒÚÓflÎË ‚ ÒÚ‡ˆËÓ̇‡ ÓÚ 11 ‰Ó 100 ‰ÌË. ë‰ÌËflÚ ÔÂÒÚÓÈ Â 43 ‰ÌË, ‡ Ò‰ÌËflÚ ÔÂÒÚÓÈ Ò‡ÏÓ Ì‡ ÎÂÍÛ‚‡ÌËÚÂ Ò Ô˙Î̇ ‰ÓÁ‡ à‚à„ Â 39 ‰ÌË. ÄÍÓ Ò ËÁÍβ˜Ë ‰ËÌ ·ÓÎÂÌ Ò ‡ÍÒÓ̇ÎÂÌ ÚËÔ ÔÓÎËÌ‚ÓÔ‡ÚËfl Ë ıÂÓËÌÓ‚‡ Á‡‚ËÒËÏÓÒÚ, ˜ËÈÚÓ ÔÂÒÚÓÈ flÁÍÓ Ò ÓÚ΢‡‚‡ ÓÚ ‰Û„ËÚÂ, ÚÓ‚‡ Ò˙ÓÚÌÓ¯ÂÌË ÒÚ‡‚‡ 41 Í˙Ï 31 ‰ÌË. Ñ‚‡‰ÂÒÂÚ Ë ÓÒÂÏ ÓÚ ·ÓÎÌËÚ (87,5%) Ò‡ ËÁÔËÒ‡ÌË ÓÚ ÍÎËÌË͇ڇ ‚ ‰Óχ¯Ì‡ Ó·ÒÚ‡Ìӂ͇ ËÎË Ì‡ÒÓ˜ÂÌË Í˙Ï Ò‡Ì‡ÚÓˇÎÌÓ Î˜ÂÌËÂ, Ò ‡Á΢̇ ÒÚÂÔÂÌ Ì‡ ÔÓ‰Ó·ÂÌËÂ. óÂÚËËχ ·ÓÎÌË (12,5%) Ò‡ ÔÓ˜Ë̇ÎË - ‚Ò˘ÍË Ò ‚fl· Í‚‡‰ËÔ΄Ëfl, ·Ûη‡̇ Ô‡‡ÎËÁ‡ Ë ‰Ëı‡ÚÂÎ̇ ̉ÓÒÚ‡Ú˙˜ÌÓÒÚ, ̇ ÌÂÔÂÍ˙Ò̇ڇ àÅÇ Ë ÒÓÌ‰Ó‚Ó ı‡ÌÂÌÂ. è˘ËÌËÚ Á‡ ÒÏ˙ÚÚ‡ Ò‡ ÎÓ·Û·̇ ÔÌ‚ÏÓÌËfl, ÒÂÔÒËÒ, ·ÂÎÓ‰Ó·ÂÌ ÚÓÏ·ÂÏ·ÓÎËÁ˙Ï Ë ÚÂÊ͇ ‰ËÁ‡‚ÚÓÌÓÏËfl. ։̇ ÔÓ˜Ë̇·  ·Ë· Ò‡ÏÓ Ì‡ ËÌÚÂÌÁ˂̇ ÚÂ‡ÔËfl, ‡ ÓÒڇ̇ÎËÚ - ̇ ËÌÚÂÌÁ˂̇ ÚÂ‡ÔËfl Ë Ï‡ÎÍË ‰ÓÁË à‚à„. ÇÂÏÂÚÓ Á‡ ÛÒÚ‡ÌÓ‚fl‚‡Ì ̇ Ô˙‚ÓÚÓ ÔÓ‰Ó·ÂÌË ÒΉ ̇˜‡ÎÓÚÓ Ì‡ ËÏÛÌÓÏÓ‰ÛÎË‡˘ÓÚÓ Î˜ÂÌË ÔË ËÁÔËÒ‡ÌËÚ ·ÓÎÌË Â ÓÚ 1-fl ‰Ó 25-fl ‰ÂÌ , Ò‰ÌÓ 9 ‰ÌË. èË ·ÓÎÌËÚ ̇ Ô˙Î̇ ‰ÓÁ‡ à‚à„, ÚÓ Â ÓÚ 1-fl ‰Ó 20-fl ‰ÂÌ, Ò‰ÌÓ 7 ‰ÌË. ë‡ÏÓÒÚÓflÚÂÎ̇ ÔÓıӉ͇ ‚ ‡ÏÍËÚ ̇ ‰‚ Ò‰ÏËˆË ÔË ËÏÓ·ËÎËÁË‡ÌËÚ ԇˆËÂÌÚË ËÎË ÔÓ‰Ó·Â̇ ÔË Ú‡ÍË‚‡ Ò˙Ò Á‡ÚÛ‰ÌÂ̇ ÔÓıӉ͇ ÔË ÔÓÒÚ˙Ô‚‡ÌÂÚÓ,  ÛÒÚ‡ÌÓ‚Â̇ Á‡ 10 ·ÓÎÌË. ÑÓ Â‰ËÌ ÏÂÒˆ ÓÚ Î˜ÂÌËÂÚÓ Ò‡ ÔÓıÓ‰ËÎË 9 ·ÓÎÌË, ÓÚ Â‰ËÌ ‰Ó ‰‚‡ ÏÂÒˆ‡ - 7 ·ÓÎÌË. ÅÂÁ Ò‡ÏÓÒÚÓflÚÂÎ̇ ÔÓıӉ͇ ‰Ó ÚÂÚËfl ÏÂÒˆ Ò‡ ÓÒڇ̇ÎË Ò‡ÏÓ ‰‚‡Ï‡ ·ÓÎÌË Ò ‰Ó͇Á‡Ì‡ ÂÎÂÍÚÓÏËÓ„‡ÙÒÍË ‡ÍÒÓ̇Î̇ ÔÓÎËÌ‚ÓÔ‡ÚËfl Ò ‰ÂÌÂ‚‡ˆËfl.


‡ÔËÎ, 2002

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

ÇÂÏÂÚÓ Ì‡ ÏÂı‡Ì˘̇ڇ ‚ÂÌÚË·ˆËfl ÔË Ì‡¯ËÚ ·ÓÎÌË Â ÓÚ 20 ‰Ó 90 ‰ÌË (Ò‰ÌÓ 35 ‰ÌË), Ò ÔÓÒÚÂÔÂÌÌÓ ÔÂÏË̇‚‡Ì Í˙Ï ËÁˆflÎÓ Ò‡ÏÓÒÚÓflÚÂÎÌÓ ‰Ë¯‡ÌÂ Ë Ì‡˜‡ÎÓ Ì‡ “ÓÚ‚ËÍ‚‡Ì ÓÚ ‡Ô‡‡Ú‡” Ò‰ÌÓ ÓÍÓÎÓ 20 -fl ‰ÂÌ. éÚ 20-Ú ·ÓÎÌË, ÔÓÒÚ˙ÔËÎË Ò „ÂÌÂ‡ÎËÁË‡Ì‡ ÏÛÒÍÛÎ̇ Ò··ÓÒÚ Ë ÎÂÁËfl ̇ Í‡ÌˇÎÌË ÌÂ‚Ë, 13 Ì ҇ ‰ÓÒÚ˄̇ÎË ‰Ó àÅÇ Ë 12 Ò‡ ËÁ·fl„̇ÎË ÒÓÌ‰Ó‚Ó ı‡ÌÂÌÂ. èË ÌËÚÓ Â‰ËÌ ÓÚ ÎÂÍÛ‚‡ÌËÚÂ Ò à‚à„ ·ÓÎÌË Ì ÒÏ ̇·Î˛‰‡‚‡ÎË ÒÂËÓÁÌË ÒÚ‡Ì˘ÌË fl‚ÎÂÌËfl Ë Ò‡ÏÓ Â‰ËÌ ·ÓÎÂÌ ‡„Ë‡ Ò Ù·ËÎËÚÂÚË, ÍÓÂÚÓ Ì‡ÎÓÊË Ì‡Ï‡Îfl‚‡Ì ÒÍÓÓÒÚÚ‡ Ë ‰Ì‚̇ڇ ‰ÓÁ‡ ̇ ‚ÎË‚‡ÌÂÚÓ. éÅëöÜÑÄçÖ å‡Í‡ Ë ÒÍÓÏÂÌ, ̇¯ËflÚ ÓÔËÚ ÔÓ ÓÚÌÓ¯ÂÌˠΘÂÌËÂÚÓ Ì‡ ÓÒÚ‡Ú‡ ‚˙ÁÔ‡ÎËÚÂÎ̇ ‰ÂÏËÂÎËÌËÁË‡˘‡ ÔÓÎËÌ‚ÓÔ‡ÚËfl Ë ‰Û„Ë ‚‡ˇÌÚË Ì‡ ÒË̉Óχ ̇ GuillainBarre Ò à‚à„ Â ÔËÓÌÂÒÍË Á‡ Å˙΄‡Ëfl. 燷β‰ÂÌËflÚ‡ ÌË ÔÓÚ‚˙ʉ‡‚‡Ú ÂÁÛÎÚ‡ÚËÚ ̇ ‰Û„Ë ‡‚ÚÓË Ë ¯ËÓÍË ÔÓÛ˜‚‡ÌËfl, ˜Â à‚à„ Ëχ ·Î‡„ÓÔËflÚÂÌ ÂÙÂÍÚ Á‡ Ò˙Í‡˘‡‚‡Ì ‚ÂÏÂÚÓ Ì‡ ÍÎËÌ˘ÌÓ ÔÓ‰Ó·ÂÌËÂ Ë ‚˙ÁÒÚ‡ÌÓ‚fl‚‡Ì ̇ ·ÓÎÌËÚÂ. (4,8,9,11,12,13,14) èË Ôӂ˜ÂÚÓ Ì‡¯Ë ·ÓÎÌË ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚÚ‡ ̇ “Ô·ÚÓÚÓ” Ì  „ÓÎflχ Ë Ò‡ÏÓÒÚÓflÚÂÎÌÓÚÓ ÔÓıÓʉ‡Ì  Ò‡‚ÌËÚÂÎÌÓ ‡ÌÓ. íÓ‚‡, ÍÓÂÚÓ Â ÓÒÓ·ÂÌÓ ‚‡ÊÌÓ Â, ˜Â „ÓÎflÏ ·ÓÈ ·ÓÎÌË Ò ËÁfl‚Â̇ ‚fl· Í‚‡‰ËÔ‡ÂÁ‡ Ë Á‡‡Ì„‡ÊË‡Ì ̇ Í‡ÌˇÎÌË ÌÂ‚Ë ÔË ÔÓÒÚ˙Ô‚‡ÌÂÚÓ, Ì ‰ÓÒÚ˄̇ı‡ ‰Ó ÚÂÊ͇ ·Ûη‡̇ Ô‡‡ÎËÁ‡ Ë ‰Ëı‡ÚÂÎ̇ ̉ÓÒÚ‡Ú˙˜ÌÓÒÚ, ÍÓÂÚÓ Ëχ ÓÚÌÓ¯ÂÌËÂ Ë Í˙Ï ¯‡ÌÒÓ‚ÂÚ ËÏ Á‡ ÔÂÊË‚fl‚‡ÌÂ, ÌÂÁ‡‚ËÒËÏÓ ÓÚ ‚˙ÁÏÓÊÌÓÒÚËÚ Á‡ Ô˙ÎÌÓˆÂÌ̇ ËÌÚÂÌÁ˂̇ ÚÂ‡ÔËfl ‚ ÍÎËÌË͇ڇ. ë‰̇ڇ ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ Ì‡ àÅÇ ÔË Ì‡¯ËÚ ·ÓÎÌË Ì Ò ÓÚ΢‡‚‡ Ò˙˘ÂÒÚ‚ÂÌÓ ÓÚ ‰‡ÌÌËÚ ̇ ‰Û„Ë ‡‚ÚÓË (10,12), ÌÓ Ô‡‚Ë ‚Ô˜‡ÚÎÂÌË Ò‡‚ÌËÚÂÎÌÓ ÌËÒÍËflÚ ÔÓˆÂÌÚ (21,9%) ̇¯Ë ·ÓÎÌË, ‰ÓÒÚ˄̇ÎË ‰Ó Ú‡ÍÓ‚‡ ΘÂÌË ‚ Ò‡‚ÌÂÌËÂ Ò 25-33% ÔÓ ÎËÚÂ‡ÚÛÌË ‰‡ÌÌË. (11,16) 燯ËÚ ̇·Î˛‰ÂÌËfl Ò‡ ‚ ÔÓÚ‚˙ʉÂÌË ̇ ËÁ‚Ó‰ËÚ ̇ ‰Û„Ë ‡‚ÚÓË ( 5,11,13 ), ˜Â Í˙ÒÌÓÚÓ Ë ÌÂÔ˙ÎÌÓˆÂÌÌÓ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡Ì ҇ Ò‚˙Á‡ÌË Ì‡ Ô˙‚Ó ÏflÒÚÓ Ò ÚËÔ‡ ̇ ÔÓÎËÌ‚ÓÔ‡ÚËflÚ‡. é·ËÍÌÓ‚ÂÌÓ ÚÓ‚‡ Ò‡ ·ÓÎÌË Ò ÂÎÂÍÚÓÏËÓ„‡ÙÒÍË ‰Ó͇Á‡ÌÓ ÚÂÊÍÓ ‡ÍÒÓ̇ÎÌÓ Û‚Âʉ‡Ì ̇ ÔÂËÙÂÌËÚ ÌÂ‚Ë. èÓÚ‚˙‰ËÚÂÎÌË Ò‡ Ë ÂÁÛÎÚ‡ÚËÚ ÌË ÓÚ ÎËÍ‚ÓÌÓÚÓ ËÁÒΉ‚‡ÌÂ, Ò˙ÔÓÒÚ‡‚ÂÌÓ Ò ÍÎËÌ˘̇ڇ ͇ÚË̇ (11). ë˙‰˙ʇÌËÂÚÓ Ì‡ ÔÓÚÂËÌË ‚ ÎËÍ‚Ó‡ ̇ ·ÓÎÌËÚ Ò˙Ò ëÉÅ ÏÓÊ ‰‡ ̇‰‚Ë¯Ë Ôӂ˜ ÓÚ 10 Ô˙ÚË ÌÓχÎÌÓÚÓ, ÌÓ Ìflχ Á̇˜Ëχ ‚˙Á͇ ÏÂÊ‰Û ÒÚÂÔÂÌÚ‡ ̇ ıËÔÂÔÓÚÂËÌ‡ıËflÚ‡ Ë ÍÎËÌ˘̇ڇ ÚÂÊÂÒÚ. èÓˆÂÌÚ˙Ú Ì‡ ÍÎËÌ˘ÌË ÙÎÛÍÚÛ‡ˆËË ÔË Ì‡¯ËÚ ·ÓÎÌË Â ÎÂÍÓ ÔÓ-χÎ˙Í ÓÚ Ò˙Ó·˘‡‚‡ÌËÚ ‚ ÎËÚÂ‡ÚÛ‡Ú‡ 811% (9,13). í‡ÍË‚‡ ÛÒÚ‡ÌÓ‚ËıÏ ҇ÏÓ ÔË ‰‚‡Ï‡ ·ÓÎÌË (6%). çË Ò ÒÓÎˉ‡ËÁË‡ÏÂ Ò ‡‚ÚÓËÚÂ, ÍÓËÚÓ Ô‰ÔÓ·„‡Ú, ˜Â ÙÎÛÍÚÛ‡ˆËËÚ Ì ҇ Ò‚˙Á‡ÌË Ò ‚ˉ‡ ̇ ËÏÛÌÓÏÓ‰ÛÎË‡˘ÓÚÓ Î˜ÂÌËÂ, ÌËÚÓ Ò ‚ÂÏÂÚÓ Ì‡ ‚Íβ˜‚‡ÌÂÚÓ ÏÛ, ‡ Ò ÓÒÓ·ÂÌÓÒÚËÚ ̇ ÍÎËÌ˘ÌËfl ‚‡ˇÌÚ Ì‡ ëÉÅ Ë Ò Â‰Ì‡ ÔÓ- ÔÓ‰˙ÎÊËÚÂÎ̇ ËÏÛÌ̇ ‡Ú‡Í‡ (11,13,16). èË ·ÓÎÌË Ò ‚ÎÓ¯‡‚‡Ì ÒΉ Ô˙‚Ó̇˜‡ÎÌÓ ÔÓ‰Ó·ÂÌËÂ Ë ÔË “Á‡Ú„̇ÚÓ” ÔÓÚ˘‡˘Ë ÒÎÛ˜‡Ë ÌË ÔÂÔÓ˙˜‚‡ÏÂ, ÔÓ‰Ó·ÌÓ Ì‡ van Meche Ë Ò˙Ú.(9) Ë Spies Ë Ò˙Ú. (13), ÔÓ‚ÚÓÂÌ ÍÛÒ Ò à‚à„. Ç Ò˙„·ÒËÂ Ò Ó·˘ÓÔËÂÚÓÚÓ ‚ ÎËÚÂ‡ÚÛ‡Ú‡ ÒÚ‡ÌӂˢÂ, ÌË Ì ÔË·„‡Ï ҇ÏÓÒÚÓflÚÂÎÌÓ Î˜ÂÌËÂ Ò ÍÓÚËÍÓÒÚÂÓË‰Ë ÔË ëÉÅ. ç‡ Â‰ËÌ ÓÚ ·ÓÎÌËÚÂ Ò ÔÓ-·‡‚ÌÓ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡Ì ·Â¯Â ÔËÎÓÊÂÌÓ Î˜ÂÌËÂ Ò Methylprednisolone ÔÂ‰Ë Ô‚Âʉ‡ÌÂÚÓ ÏÛ ‚ ÍÎËÌË͇ڇ.

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áÄäãûóÖçàÖ ëË̉ÓÏ˙Ú Ì‡ Guillain-Barre ‚ ˆflÎÓÚÓ ÒË ÏÌÓ„ÓÓ·‡ÁË ̇ ËÏÛÌ̇ Ô‡ÚÓ„ÂÌÂÁ‡ Ë ÍÎËÌ˘ÌË ‚‡ˇÌÚË Â Á‡Ò„‡ Ì‡È - ÛÒÔ¯ÌÓ ÎÂÍÛ‚‡ÌÓÚÓ ‡‚ÚÓËÏÛÌÌÓ Á‡·ÓÎfl‚‡ÌÂ Ò Ú‡Í˙‚ Ô‰ÔÓ·„‡ÂÏÓ ÔÓÎËÏÓ‰‡ÎÂÌ ËÏÛÌÓÏÓ‰Û·ÚÓ ͇ÚÓ ËÌÚ‡‚ÂÌÓÁÌÓ ÔËÎÓÊÂÌËfl ËÏÛÌÓ„ÎÓ·ÛÎËÌ ‚ ÛÒÚ‡ÌÓ‚ÂÌËÚ ‚ËÒÓÍË ‰ÓÁËÓ‚ÍË. 燉ÂʉËÚ Á‡ ·ÎËÁÍÓÚÓ ·˙‰Â˘Â Ò ҂˙Á‚‡Ú Ò ‰‚ ÓÒÌÓ‚ÌË ÒÚ‡Ú„ËË: ÒÔˆËÙ˘ÌË ËÏÛÌÓÚÂ‡ÔËË Á‡ ÔÓÚË‚Ó‰ÂÈÒÚ‚Ë ̇ ÒÔˆËÙ˘ÌË ËÏÛÌÓÔ‡ÚÓÎӄ˘ÌË ÏÂı‡ÌËÁÏË ‚ ÓÒÚ‡Ú‡ Ù‡Á‡ Ë ÔÓÚÂ͈Ëfl ̇ Ì‚‡ÎÌËfl ÒÛ·ÒÚ‡Ú, Á‡ÒË΂‡Ì ̇ ‡ÍÒÓ̇Î̇ڇ „ÂÌÂ‡ˆËfl Ë Ó„‡Ì̇ڇ ÂËÌÂ‚‡ˆËfl ‚˙‚ ‚˙ÁÒÚ‡ÌÓ‚ËÚÂÎÌËfl ÔÂËÓ‰. ãàíÖêÄíìêÄ 1. Å˚ÍÓ‚‡, é.Ç., ÅÓÈÍÓ, Ä.ç., å‡ÒÎÓ‚‡, é.à.ÇÌÛÚË‚ÂÌÌÓ ÔËÏÂÌÂÌË ËÏÏÛÌÓ„ÎÓ·ÛÎËÌÓ‚ ‚ Ì‚ÓÎÓ„ËË. (é·ÁÓ ÎËÚÂ‡ÚÛ˚ Ë ÒÓ·ÒÚ‚ÂÌÌ˚ ̇·Î˛‰ÂÌËfl). ç‚ÓÎÓ„. ÊÛÌ. 2000; 5: 32 - 39 2. чÒ͇ÎÓ‚, å., äÂ̇Ó‚, èÎ., âÓ‰‡ÌÓ‚, Å. éÒÚ˙ ÔÓÎË‡‰ËÍÛÎÓÌ‚ËÚ Ì‡ Guillain-Barre. ë˙‚ÂÏÂÌÌË ÔÓ·ÎÂÏË Ì‡ ÚÂ‡ÔËflÚ‡. ç‚ÓÎÓ„Ëfl , ÔÒËıˇÚËfl Ë Ì‚ÓıËÛ„Ëfl. Vol XXVI, 1987, 5, 58 - 62 3. å‡ÁÓ΂ÒÍËÈ, û.Ç. ã˜ÂÌË ÓÒÚÓÈ Ë ıÓÌ˘ÂÒÍÓÈ ‚ÓÒÔ‡ÎËÚÂθÌÓÈ ‰ÂÏËÂÎËÌËÁËÛ˛˘ÂÈ ÔÓÎË‡‰ËÍÛÎÓÌ‚ÓÔ‡ÚËË. êåÜ 2001; 7-8: 334-337 4. Dalakas, MC. Mechanism of Action of Intravenous Immunoglobulin and Therapeutic Consideration in the Treatment of Autoimmune Neurologic Diseases. Neurology 1998 ( Suppl.5); 51: 2-8. 5. Hadden, R.D.M, Karoh, H., Hartung, H.P., Zeilasek, J., Weissbrick, B., Schubert, J., Weishaupt, A., Cornbalth, D.R., Swan, A.V., Huges, R.A.C., Toyka, K.V. and the Plasma Exchange / Sandoglobulin Guillain-Barre Syndrome Trial Group. Preceding infectionsq immune factorsq and outcome in Sandoglobulin Guillain-Barre Syndrome. Neurology 2001; 56: 6- 27. 6. Kaveri, S.V., Mouthon,L.,Kazatchine,M.D. Immunomodalating effects of intravenous immunoglobuline in autoimmune, and inflamatory diseases. Neurology 1994;57:2-5 7. Lindenbaum, Y., Kissel, J. T., Mendell, J. R. Neurologic Treatment approaches for Guillain-Barre Syndrome and chronic inflammatory demyelinating polyradiculoneuropathy. W. B. Saunders Company, USA, Neurologic Clinics 200, 19: 1 8. Van der Meche, F.G.A.. The Guillain-Barre Syndrome: plasma exchange or immunoglobulin intravenously. J. Neurol. Neurosurg.Psychiatry. 1994 (Suppl), 3334. 9. Van der Meche, F.G.A., van Doorn, P.A.. Guillain-Barre Syndrome. Curr. Opinion Neurol. 2000; 6: 507-516. 10. Rutter, G.H. Requirements for safety and quality of intravenous immunoglobuline G preparations. J. Neurol. Neurosurg.Psychiatry. 1994 (Suppl ): S2-S5. 11. Sater, R.A., Rostami A. Treatment of Guillain-Barre Syndrome with Intravenous immunoglobulin. Neurology 1998; 51(Suppl 5):S9-S15 12. Singhi, S.C., Jayshree, M., Singhi, P., Banerjee, S., Prabhakar, S. Intravenous immunoglobulin in very sever childhood Guillain-Barre Syndrome. Ann. Trop. Paediatr. 1999; 19: 167- 174. 13. Spies, J. M., Sheikh, K. A. Management of Guillain-Barre syndrome, Expert Rev. Neutotherapeutics 2001; 1: 119 - 129. 14. Suarez, G.A. Treatment of acute polineuropathies. Rev. Neurology 1999; 29: 171 - 174. 15. Toyka, K.V. Eithy three years of the Guillain-Barre Syndrome: clinical and immunopathologic aspects, current and future treatment. Rev. Neurology.1999; 10: 849-856. 16. Visser, L.H., van der Meche, F.G., Meulstee, J., et al: Risk factors for treatment related clinical fluctuations in Guillain-Barre syndrome: Dutch Guillain-Barre Study Group. J Neurol Neurosurg Psychiatry 1998; 64:242-244

ĉÂÒ Á‡ ÍÓÂÒÔÓ̉Â̈Ëfl: ÑÓˆ. ñ. ñ‡ÌÍÓ‚‡ ç‚ÓÎӄ˘̇ ÍÎËÌË͇ åÅÄã "ñ‡ˈ‡ âÓ‡Ì̇", ëÓÙËfl íÂÎ. 43 44 540


Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

‡ÔËÎ, 2002

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éË„Ë̇ÎÌË ÒÚ‡ÚËË ÖãÖäíêéåàéÉêÄîëäé èêéìóÇÄçÖ èêà Åéãçà ë ãìåÅé-ëÄäêÄãçà ÇÖêíÖÅêéÉÖççà êÄÑàäìãéèÄíàà ë. çÓ‚‡˜ÍÓ‚‡*, ã. ñÂÌÍÓ‚ **, Å. à¯ÔÂÍÓ‚‡* * ëÓÙËfl, ìÌË‚ÂÒËÚÂÚÒ͇ ·ÓÎÌˈ‡ "ñ‡ˈ‡ âÓ‡Ì̇", äÎËÌË͇ ÔÓ Ì‚ÓÎÓ„Ëfl ** ëÓÙËfl, ìÌË‚ÂÒËÚÂÚÒ͇ ·ÓÎÌˈ‡ "ñ‡ˈ‡ âÓ‡Ì̇ ", äÎËÌË͇ ÔÓ Ì‚ÓıËÛ„Ëfl

SUMMARY ELECTROMYOGRAPHICAL STUDY BY PATIENTS WITH LUMBOSACRAL SPONDYLOLITIC RADICULOPATHIES S. Novachkova , L. Cenkov, B. Ishpekova Seventeen patients with heavy lumbosacral damage have been electromyographycally studied. Computer Tomography /CT/and Sacokaudography /SKG/ prove significant pathology of the vertebral column. The following methods have been applied: 1 /Needle electromyography /EMG/ ;2 ./ F- wave examination ; 3. /Magnetic stimulation and registration of the spinal motor evoked potentials /SMEP/. Best corresponding to the CT and SKG dates is the SMEP examination. Important in these cases are the absence of answer, the prolonged latency and even the lower amplitude of the damaged side. The EMG- pattern registered by needle electrods shows significant pathological changes on the level of damage. F- wave method is the easiest for applying, but in this cases important is also reporting of the frequency of its appearance. Key words: EMG, lumbosacral damage,spinal motor evoked potential, F- wave.

·ÚÂ‡ÎËÁË‡Ì‡ ÎÂÁËfl ‡‰ËÓÎӄ˘ÌËÚ ÏÂÚÓ‰Ë ÏÓ„‡Ú ‰‡ ·˙‰‡Ú Ì„‡ÚË‚ÌË Ë Ô‡ÚÓ„ÂÌÂÚ˘ÌËÚ ÏÂı‡ÌËÁÏË Ì‡ ÍÎËÌ˘̇ڇ ÒËÏÔÚÓχÚË͇ ÓÒÚ‡‚‡Ú ÌÂflÒÌË /14/. ÖÎÂÍÚÓÏËÓ„‡ÙÒÍÓÚÓ /Ö å É/ ËÁÒΉ‚‡Ì Ô‰·„‡ Á̇˜ËÚÂÎÌË ‚˙ÁÏÓÊÌÓÒÚË Á‡ ÛÒÚ‡ÌÓ‚fl‚‡Ì ÌË‚ÓÚÓ Ë ÚÂÊÂÒÚÚ‡ ̇ Û‚Âʉ‡ÌÂÚÓ Ì‡ ÎÛÏ·Ó-Ò‡Í‡ÎÌËÚ ÍÓÂ̘ÂÚ‡, Á‡ ‚ÂËÙˈË‡Ì ̇ Ô˘ËÌËÚ Á‡ ÓÚÔ‡‰ÌËÚ ÒÂÚË‚ÌË Ë ‰‚Ë„‡ÚÂÎÌË ÔÓÏÂÌË Ë Á‡ ÔÓÒΉfl‚‡Ì ‡Á‚ËÚËÂÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ. èË Ô‡ˆËÂÌÚËÚÂ Ò ÎÛÏ·Ó-Ò‡Í‡ÎÌË ÍÓÂÌ˜Â‚Ë ÒË̉ÓÏË Ò ÔË·„‡Ú ‡Á΢ÌË ÖåÉ- ÏÂÚÓ‰Ë Ì‡ ËÁÒΉ‚‡ÌÂ/1, 2, 3, 6, 15/. ç‡‰ Ò Ë„ÎÂ̇ڇ ÖåÉ, Ò ÍÓflÚÓ Ò ÛÒÚ‡ÌÓ‚fl‚‡ ‰ÂÌÂ‚‡ˆËfl Ë Ì‡Î˘Ë ̇ Ô‰ÌÓ- ÍÓÂÌ˜Â‚Ë ÔÓÏÂÌË, ÛÚËÌÌÓ Ò ÔË·„‡Ú Ë ËÁÒΉ‚‡ÌÂÚÓ Ì‡ F- ‚˙Î̇ڇ Ë ç- ÂÙÎÂÍÒ‡ /1, 2, 3,6,15/. Ç ÔÓÒΉÌÓ ‚ÂÏ ‚Ò Ôӂ˜ ‡‚ÚÓË ‰Ó͇Á‚‡Ú ‰Ë‡„ÌÓÒÚ˘̇ڇ ÒÚÓÈÌÓÒÚ Ì‡ ÒÔË̇ÎÌËÚ ÏÓÚÓÌË Ô‰ËÁ‚Ë͇ÌË ÔÓÚÂ̈ˇÎË /ëåÖè/, ÔÓÎÛ˜ÂÌË ˜ÂÁ ‰ËÂÍÚ̇ ÔÓ‚˙ıÌÓÒÚ̇ ‚ËÒÓÍÓ‚ÓÎÚ‡Ê̇ ÂÎÂÍÚ˘̇ ÒÚËÏÛ·ˆËfl ÔËÎÓÊÂ̇ ‚˙ıÛ „˙·Ì‡˜ÌËfl ÒÚ˙η /1, 2, 5, 7, 8, 9/. é˘Â ÔÓ-ÌÓ‚ ÏÂÚÓ‰  χ„ÌËÚ̇ڇ ÒÚËÏÛ·ˆËfl, ÍÓflÚÓ Â ·ÂÁ·ÓÎÂÁÌÂ̇, ÌÓ ËÁËÒÍ‚‡ ÒÔˆˇÎ̇ ‡Ô‡‡ÚÛ‡ /4, 5, 7, 11, 16/. Ç Ì‡ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡Ì ÒË ÔÓÒÚ‡‚ËıÏ Á‡ ˆÂÎ ‰‡ ‰Ó͇ÊÂÏ ËÌÙÓχÚË‚ÌÓÒÚÚ‡ ̇ ÓÒÌÓ‚ÌËÚ ÖåÉ ÏÂÚÓ‰Ë ÔË Ô‡ˆËÂÌÚË ÔÓ‰ÎÂʇ˘Ë ̇ ıËÛ„˘̇ ËÌÚÂ‚Â̈Ëfl.

êÖáûåÖ àÁÒΉ‚‡ÌË Ò‡ ÂÎÂÍÚÓÏËÓ„‡ÙÒÍË 17 ·ÓÎÌË Ò ÚÂÊ͇ Û‚‰‡ ‚ ÎÛÏ·ÓÒ‡Í‡Î̇ڇ ӷ·ÒÚ, ÔË ÍÓËÚÓ ÍÓÏÔ˛Ú˙̇ڇ ÚÓÏÓ„‡ÙËfl /äÄí/ Ë /ËÎË Ò‡ÍÓ͇ۉӄ‡ÙËflÚ‡ /ëäÉ/ ‰Ó͇Á‚‡Ú Á̇˜ËÚÂÎ̇ Ô‡ÚÓÎÓ„Ëfl ̇ „˙·Ì‡˜ÌËfl ÒÚ˙η. èË·„‡ÌË Ò‡ ÒΉÌËÚ ÏÂÚÓ‰ËÍË: 1/ à„ÎÂ̇ ÂÎÂÍÚÓÏËÓ„‡ÙËfl; 2/ àÁÒΉ‚‡Ì ̇ F- ‚˙Î̇ڇ ; 3/ 凄ÌËÚ̇ ÒÚËÏÛ·ˆËfl Ë ÓÚ‚Âʉ‡Ì ̇ ÒÔË̇ÎÌËÚ ÏÓÚÓÌË Â‚ÓÍË‡ÌË ÔÓÚÂ̈ˇÎË /ëåÖè/. ç‡È-„ÓÎflÏÓ Ò˙ÓÚ‚ÂÚÒÚ‚ËÂ Ò ‰‡ÌÌËÚ ÓÚ äÄí Ë ëäÉ Ëχ ËÁÒΉ‚‡ÌÂÚÓ Ì‡ ëåÖè. éÚ Á̇˜ÂÌË  ÎËÔÒ‡Ú‡ ̇ ÓÚ„Ó‚Ó, Û‰˙ÎÊÂ̇ڇ ·ÚÂ̈Ëfl Ë ‰ÓË Ò‡ÏÓ ÔÓ-ÌËÒ͇ڇ ‡ÏÔÎËÚÛ‰‡ ̇ ÒÚ‡Ì‡Ú‡ ̇ Û‚‰‡Ú‡. ÖåÉ Í‡ÚË̇ڇ, Óڂ‰Â̇ Ò Ë„ÎÂÌ ÂÎÂÍÚÓ‰, Á̇˜ËÚÂÎÌÓ Ò ÔÓÏÂÌfl ÒÔÓ‰ ÌË‚ÓÚÓ Ë ÚÂÊÂÒÚÚ‡ ̇ ÔÓ‡ÊÂÌËÂÚÓ. F- ‚˙Î̇ڇ  ̇È-ÎÂÒÌÓ ÔËÎÓÊËχ, ÌÓ ‚‡ÊÌÓ Â ÓÚ˜ËÚ‡ÌÂÚÓ Ë Ì‡ ˜ÂÒÚÓÚ‡Ú‡ ̇ ÔÓÎÛ˜‡‚‡ÌÂÚÓ Ë. äβ˜Ó‚Ë ‰ÛÏË: ÖåÉ, ÎÛÏ·Ó-Ò‡Í‡Î̇ Û‚‰‡, ÒÔË̇ÎÌË ÏÓÚÓÌË Ô‰ËÁ‚Ë͇ÌË ÔÓÚÂ̈ˇÎË, F- ‚˙Î̇. 臈ËÂÌÚËÚÂ Ò ‚ÂÚ·Ó„ÂÌÌË ÎÛÏ·Ó-Ò‡Í‡ÎÌË ‡‰ËÍÛÎÓÔ‡ÚËË Ò‡ ÏÌÓ„Ó ˜ÂÒÚÓ c¢‡ÌË ‚ Ì‚ÓÎӄ˘̇ڇ Ë Ì‚ÓıËÛ„˘̇ڇ Ô‡ÍÚË͇ /1, 2/. çÓ‚ËÚ ‡‰ËÓÎӄ˘ÌË ÚÂıÌËÍË Ô‡‚flÚ ‚˙ÁÏÓÊÌÓ ‚ËÁÛ‡ÎËÁË‡ÌÂÚÓ Ì‡ ÍÓÂ̘‚‡Ú‡ ÍÓÏÔÂÒËfl ‚ ÂÁÛÎÚ‡Ú Ì‡ ‰ËÒÍÓ‚‡ ıÂÌËfl ËÎË ÒÚÂÒÌÂÌ ‚ÂÚ·‡ÎÂÌ Í‡Ì‡Î ÔË ÏÌÓ„Ó ÒÎÛ˜‡Ë. ̇ ÎÛÏ·ÓÒ‡Í‡Î̇ ‡‰ËÍÛÎÓÔ‡ÚËfl /1, 2, 6, 14/. Ç ÌflÍÓË ÒÎÛ˜‡Ë ÔË

äãàçàóÖç åÄíÖêàÄã à åÖíéÑà çÄ àáëãÖÑÇÄçÖ àÁÒΉ‚‡ÌË Ò‡ 17 Ô‡ˆËÂÌÚ‡- 11 Ï˙ÊÂ Ë 6 ÊÂÌË Ì‡ ‚˙Á‡ÒÚ ÓÚ 38 ‰Ó 62 „ Ò ÍÓÏÔÂÒËÓÌ̇ Ô‰̇ ‡‰ËÍÛÎÓÔ‡ÚËfl ̇ L5 Ë S1,‡ ÔË ÌflÍÓË Ë Ì‡ L3 Ë L4 ÍÓÂ̘ÂÚ‡. äoÏÔ˛Ú˙̇ڇ ‡ÍÒˇÎ̇ ÚÓÏÓ„‡ÙËfl /äÄí/ Ë Ò‡ÍÓ͇ۉӄ‡ÙËflÚ‡ /ëäÉ/ ‰ÂÏÓÌÒÚË‡Ú ÚÂÊ͇ Ô‡ÚÓÎÓ„Ëfl ̇ „˙·Ì‡˜ÌËfl ÒÚ˙η ̇ ÚÓ‚‡ ÌË‚Ó: ‰ËÒÍÓ‚‡ ıÂÌËfl- ÔÓ·ÔÒ Ì‡ ‰ÌÓ ËÎË ‰‚ ÌË‚‡ /L4-L5, L5- S1, L3- L4/ Ò ÍÓÏÔÂÒËfl ̇ Ò˙ÓÚ‚ÂÚÌÓÚÓ ÍÓÂÌ˜Â Ë /ËÎË ÒÚÂÒÌÂÌ ‚ÂÚ·‡ÎÂÌ Í‡Ì‡Î. ÖåÉ - ËÁÒΉ‚‡ÌÂÚÓ Ò ËÁ‚˙¯Ë ‚ ··Ó‡ÚÓËflÚ‡ ̇ ÍÎËÌË͇ ÔÓ Ì‚ÓÎÓ„Ëfl, åÅÄã "ñ‡ˈ‡ âÓ‡Ì̇", ëÓÙËfl, c ÂÎÂÍÚÓÏËÓ„‡Ù ESAOTE BIOMEDICA Ë Ï‡„ÌËÚÂÌ ÒÚËÏÛ·ÚÓ MX 5500 AM ESAOTE BIOMEDICA. èË·„‡ÌË Ò‡ ÒΉÌËÚ ÏÂÚÓ‰ËÍË: 1. à„ÎÂ̇ ÖåÉ Á‡ Ú˙ÒÂÌ ̇ ‰ÂÌÂ‚‡ˆËfl Ë ÚÂÊÍË Ô‰ÌÓ- ÍÓÂÌ˜Â‚Ë ÔÓÏÂÌË ÔÓ Òڇ̉‡ÚÌËÚ ÍËÚÂËË Á‡ ÓˆÂÌ͇ ̇ ÖåÉ- ͇ÚË̇ڇ. 2. àÁÒΉ‚‡Ì ̇ F-‚˙Î̇ڇ ÓÚ nn.fibularis Ë tibialis ·ÚÂÌÚÌÓ ‚ÂÏ /ãÇ/ Ë ÔÓˆÂÌÚ Ì‡ ÔÓÎÛ˜‡‚‡ÌÂ. èË ÓˆÂÌ͇ڇ ËÁıÓʉ‡ıÏ ÓÚ Ì‡¯ËÚÂ Ë ÎËÚÂ‡ÚÛÌËÚ ‰‡ÌÌË /3/. 3.àÁÒΉ‚‡Ì ̇ ÒÔË̇ÎÌËÚ ÏÓÚÓÌË Â‚ÓÍË‡ÌË ÔÓÚÂ̈ˇÎË /ëåÖè/ ̇ ‡Á΢ÌË ÌË‚‡ ‰ÌÓ‚ÂÏÂÌÌÓ ‰‚ÛÒÚ‡ÌÌÓ. éÚ‚Âʉ‡ıÏÂ Ò ÔÓ‚˙ıÌÓÒÚÌË ÂÎÂÍÚÓ‰Ë ÓÚ mm.tibialis anterior, mm extensor digitorum brevis, mm abductor.hallucis, ‡ ÔÓÌflÍÓ„‡ Ë ÓÚ mm quadriseps femoris.


Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

‡ÔËÎ, 2002

62

èËÂχıÏ ÓÚ‚Âʉ‡ÌÂÚÓ ÓÚ mm quadriceps femoris ͇퇷Î. 1: èË·„‡ÌË ÖåÉ- ÏÂÚÓ‰ËÍË Ë Ô‡ÚÓÎӄ˘ÌË ÚÓ ÔÓ͇Á‡ÚÂÎÌÓ Á‡ Û‚‰‡ Ô‰ËÏÌÓ Ì‡ L2, L 3, ÓÚ mm. ÓÚÍÎÓÌÂÌËfl ‚ ÔÓ͇Á‡ÚÂÎËÚ ÔË „ÛÔ‡Ú‡ Ô‡ˆËÂÌÚË tibialis anterior Á‡ Û‚‰‡ Ô‰ËÏÌÓ Ì‡ L4 Ô‰ÌÓ- ÍÓÂ̘Â, ÓÚ mm. ext.digitorum brevis - Á‡ L5 Ë ÓÚ mm abductor hal- ÖåÉ-ÔÓ͇Á‡ÚÂÎË àÁÒΉ‚‡ÌË ÏÛÒÍÛÎË / ÌÂ‚Ë lucis - Á‡ S1 /7/.ëÚËÏÛÎË‡˘‡Ú‡ ·Ó·Ë̇ ÔÓÒÚ‡‚flıÏ ‚˙ÅÓÈ % ıÛ L1 Á‡ m.quadriceps femoris, Ë ÔÓ- ‰ËÒÚ‡ÎÌÓ /L 3- S 1/ Á‡ àÉãÖçÄ Ö å É ÓÒڇ̇ÎËÚ ÏÛÒÍÛÎË. éÚ˜ËÚ‡ıÏ ãÇ Ë ‡ÏÔÎËÚÛ‰ËÚ /A/ ÑÂÌÂ‚‡ˆËfl 17 36,2 ̇ ëåÖè ‰‚ÛÒÚ‡ÌÌÓ. íÂÊÍË Ô‰ÌÓ-ÍÓ. àÁÒΉ‚‡ÌË Ò‡ Ò Ë„ÎÂÌË ÂÎÂÍÚÓ‰Ë 47 ÏÛÒÍÛ·, F-‚˙ÎÌË- ÔÓÏÂÌË 44 93,6 Ú ÓÚ 31 ÌÂ‚‡ Ë ëåÖè ÓÚ 43 ÏÛÒÍÛ· ‰‚ÛÒÚ‡ÌÌÓ é·˘Ó ËÁÒΉ‚‡ÌË 47 ÏÛÒÍÛ· /Ú‡·Î.1 Ë 2/. êÖáìãíÄíà F-ÇöãçÄ ÖåÉ- ̇ıÓ‰ÍËÚ ÔË ‚ÒÂÍË Ô‡ˆËÂÌÚ ÔÓ ÓÚ‰ÂÎÌÓ Ò‡ ÔÓ͇Á‡ÌË Ì‡ Ú‡·Î.1. ãËÔÒ‚‡ 4 12,9 èË Ë„ÎÂ̇ڇ ÖåÉ ‰ÂÌÂ‚‡ˆËfl ÛÒÚ‡ÌÓ‚ËıÏ ‚ 17 ÏÛÒ- ì‰˙ÎÊÂÌÓ ãÇ 5 16,1 ÍÛ·, ÔÓ-˜ÂÒÚÓ ‚ Ôӂ˜ ÓÚ Â‰ËÌ ÏÛÒÍÛÎ ÔË ‰‡‰ÂÌ Ô‡ˆË- çÓχÎÌÓ ãÇ 22 70,9 ÂÌÚ. àÁ‡ÁÂÌË Ô‰ÌÓ-ÍÓÂÌ˜Â‚Ë ÔÓÏÂÌË Ò ‰ۈË‡Ì èÓÎÛ˜‡‚‡Ì ÔÓ‰ 50 % 27 87,0 ·ÓÈ Ì‡ ÏÓÚÓÌËÚ ‰ËÌËˆË Ë Û‚Â΢ÂÌ ÔÓˆÂÌÚ ÔÓÎË- é·˘Ó ËÁÒΉ‚‡ÌË 31 ÌÂ‚‡ Ù‡ÁÌË ÔÓÚÂ̈ˇÎË Ò ‚ËÒÓ͇ ‡ÏÔÎËÚÛ‰‡ „ËÒÚË‡ıÏ ÔË Ôӂ˜ÂÚÓ ·ÓÎÌË- 93,6%. èÓ˜ÚË ÔË ‚Ò˘ÍË ÒÎÛ˜‡Ë ë å Ö è ÏÛÒÍÛÎËÚÂ Ò ÚÂÊÍË ÔÓÏÂÌË Ò˙ÓÚ‚ÂÚÒÚ‚‡Ú ̇ ÔÓÒÓ˜ÂÌÓÚÓ ÓÚ äÄí Ë ëäÉ ÌË‚Ó Ì‡ Û‚Âʉ‡ÌÂ. èË ÌflÍÓË / 4, 7 ãËÔÒ‚‡ ‰ÌÓÒÚ‡ÌÌÓ 8 18 Ë 13 ÒÎÛ˜‡È/, ÖåÉ-‰‡ÌÌËÚ „Ó‚ÓflÚ Á‡ ÚÂÊÍË ÔÓÏÂÌË Ì‡ ᇷ‡‚ÂÌÓ ãÇ Â‰ÌÓÒÚ‡ÌÌÓ 16 37,2 Ôӂ˜ ÌË‚‡ /퇷Î. 1/. çÓχÎÌÓ ãÇ ‰‚ÛÒÚ‡ÌÌÓ 19 44,2 èË „ÛÔ‡Ú‡ ÓÚ 17 Ô‡ˆËÂÌÚ‡  ËÁÒΉ‚‡Ì‡ F- ‚˙Î̇ڇ çËÒ͇ Ä Â‰ÌÓÒÚ‡ÌÌÓ 33 76,7 ÓÚ 31 ÌÂ‚‡ /nn fibularis Ë tibialis /ÒÔÓ‰ ÌË‚ÓÚÓ Ì‡ Û‚Â- çÓχÎ̇ Ä ‰‚ÛÒÚ‡ÌÌÓ 2 4,6 ‰‡ ÔÓ äÄí Ë ëäÉ,ÌÓ ÔË 2 ÓÚ Úflı /ÒÎÛ˜‡Ë 7 Ë 15/  ËÁÒΉ- é·˘Ó ËÁÒΉ‚‡ÌË 43 ÏÛÒÍÛ· ‰‚ÛÒÚ‡ÌÌÓ ‚‡Ì‡ ÔË Ôӂ˜ ÌÂ‚Ë ÒÔÓ‰ ÓÔ·͂‡ÌËflÚ‡ ̇ Ô‡ˆËÂÌÚËÚÂ. ãËÔÒ‡ ̇ F- ‚˙Î̇  ÛÒÚ‡ÌÓ‚Â̇ ÔË 4 ÌÂ‚‡, Û‰˙ÎÊÂ- ãÇ Ì‡ ëåÖè ̇ ÒÚ‡Ì‡Ú‡ ̇ Û‚‰‡Ú‡ ÒÏ ÛÒÚ‡ÌÓ‚ËÎË ‚ ÌÓ ãÇ - ÔË 5 ÌÂ‚‡. èÓÎÛ˜‡‚‡Ì ̇ F-‚˙Î̇ڇ ‚ χÎ˙Í 37,2%. ÄÏÔÎËÚÛ‰‡Ú‡ ̇ ëåÖè ̇ ÒÚ‡Ì‡Ú‡ ̇ Û‚‰‡ÔÓˆÂÌÚ /ÔÓ‰ 50%/ ÓÚ ÔËÎÓÊÂÌËÚ ÒÚËÏÛÎË ÒÏ ÛÒÚ‡- Ú‡  ·Ë· ÔÓ-ÌËÒ͇ ‚ Ò‡‚ÌÂÌË Ò˙Ò Á‰‡‚‡Ú‡ ÔË 33 ÏÛÒÌÓ‚ËÎË ‚ 87% ÓÚ ÌÂ‚ËÚÂ. ÍÛ· /94,3 % ÓÚ ÏÛÒÍÛÎËÚÂ,ÓÚ ÍÓËÚÓ Â „ËÒÚË‡Ì èË ‚Ò˘ÍË Ô‡ˆËÂÌÚË Ò‡ ËÁÒΉ‚‡ÌË ëåÖè ÔË ÒÚËÏÛ- ëåÖè/. Ç Ú‡ÁË „ÛÔ‡ Ò‡ ‚Ò˘ÍË Ô‡ˆËÂÌÚË, ÔË ÍÓËÚÓ Â Î‡ˆËfl ‚ ÎÛÏ·‡Î̇ڇ ӷ·ÒÚ Ë ÓÚ‚Âʉ‡Ì ÓÚ 43 ‰‚ÓÈÍË ÛÒÚ‡ÌÓ‚ÂÌÓ Á‡·‡‚ÂÌÓ ãÇ Ì‡ ëåÖè Ë ‰Û„Ë- Ò ÌÓχÎÌÓ ÏÛÒÍÛÎË. éÚ Ú‡·ÎˈËÚ Ò ‚Ëʉ‡, ˜Â ‰ÌÓÒÚ‡Ì̇ ÎËÔÒ‡ ãÇ. ̇ ëåÖè ÒÏ ÛÒÚ‡ÌÓ‚ËÎË ‚ 8 ÏÛÒÍÛ· /18,0%/, Û‰˙ÎÊÂÌÓ í‡·Î. 2: àÁÒΉ‚‡ÌË Ô‡ˆËÂÌÚË Ë ÌË‚‡ ̇ Û‚Âʉ‡Ì ÔÓ äÄí, ëäÉ Ë ÖåÉ- ÔÓÏÂÌË ‚ ‡ÍÚË‚ÌÓÒÚÚ‡, F- ‚˙Î̇ڇ Ë ëåÖè è. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17.

çË‚Ó Ì‡ Û‚. èÓ äÄí Ë ëä

àÁÒÎ.ÏÛÒÍ. 1 2

L4-5, L5-S1 L3-4, L4-5, L5-S1 L4-5, L5-S1 L5 - S1 L5-S1 L5- S1 L4-5 L4-5, L5- S1 L3- 4,L4- 5, L5-S1 L3- 4, L4- 5 L4- 5 L3- 4, L4- 5, L5- S1 L4- L5 L4- 5, L5- S1 L3- 4, L5- 5 L3- 4, L4- 5 L5- S1 OÅôé %

3 4 3 3 2 2 3 3 3 2 2 3 3 3 3 2 3 47

2 0 0 2 0 0 0 1 3 2 0 1 3 0 3 0 0 17 36,2

3

1

2 3 3 3 2 2 3 3 3 2 2 3 3 3 2 2 3 44 93,6

2 2 2 2 2 2 2 2 2 1 1 2 2 2 2 1 2 31

F - ‚˙Î̇ 2 3

4

5

6

1

2

ëåÖè 3

4

5

6

1 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 4 12,9

0 0 2 1 2 2 2 0 2 1 1 1 1 2 2 1 2 22 70,9

10% 25% 25% 40% 100% 10% 25% 30% 40% 10% 10% 40% 25% 30% 10% 100% /-/

/-/ /-/ 18% 30% 56% 20% 30% /-/ 50% /-/ /-/ 50% /-/ 10% 10% /-/ /-/

3 3 3 2 2 2 2 3 3 2 2 3 3 3 2 2 3 43

0 0 0 0 0 0 0 0 2 0 0 0 3 3 0 0 0 8 18,6

0 0 0 1 0 0 1 3 1 0 1 2 0 0 2 2 3 16 37,2

3 3 3 1 2 2 1 0 0 2 1 1 0 0 0 0 0 19 44,2

3 3 3 2 2 2 2 3 1 1 1 3 0 0 2 2 3 33 76,7

0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 2 4,6

1 1 0 1 0 0 0 1 0 0 0 1 0 0 0 0 0 5 16,1

àÁÒΉ‚‡ÌË ÏÛÒÍÛÎË:1.ÅÓÈ ; 2. ÑÂÌÂ‚‡ˆËfl ; 3. íÂÊÍË ÍÓÂÌ˜Â‚Ë ÔÓÏÂÌË F- ‚˙Î̇ : 1.ÅÓÈ ËÁÒΉ‚‡ÌË ÌÂ‚Ë ; 2. ãËÔÒ‚‡ F- ‚˙Î̇ ; 3. ᇷ‡‚ÂÌÓ ã Ç ; 4. çÓχÎÌÓ ãÇ ; 5. èÓÎÛ˜‡‚‡Ì ÔÓ‰ 50 % ; 6.èÓÎÛ˜‡‚‡Ì ̇‰ 50% ëåÖè : 1.éÚ‚Âʉ‡Ì ÓÚ ÏÛÒÍÛÎË ; 2. ãËÔÒ‚‡ ‰ÌÓÒÚ. ; 3. ãÇ- Û‰˙ÎÊÂÌÓ ;4. ãÇ - ·.Ó. ; 5. Ä- ÌËÒ͇ ; 6.Ä- ·.Ó.


‡ÔËÎ, 2002

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

éÅëöÜÑÄçÖ à àáÇéÑà ä‡ÍÚÓ Ò ‚Ëʉ‡ ÓÚ Ô‰ÒÚ‡‚ÂÌËÚ ÂÁÛÎÚ‡ÚË ı‡‡ÍÚÂ˙Ú Ì‡ ÖåÉ- ̇ıӉ͇ڇ ÔÓÎÛ˜Â̇ Ò Ë„ÎÂÌ ÂÎÂÍÚÓ‰ ÓÒÚ‡‚‡ ÏÌÓ„Ó Ò˙˘ÂÒÚ‚ÂÌ ÍËÚÂËÈ Á‡ ÓˆÂÌ͇ڇ ̇ ÌË‚ÓÚÓ Ë ÒÚÂÔÂÌÚ‡ ̇ Û‚‰‡Ú‡.í‡ÍË‚‡ ÂÁÛÎÚ‡ÚË Ò˙Ó·˘‡‚‡Ú Ë ‰Û„Ë ‡‚ÚÓË,ËÁÒΉ‚‡ÎË ÎÛÏ·Ó-Ò‡Í‡ÎÌËÚ ‡‰ËÍÛÎÂÌË ÒË̉ÓÏË /6, 16/. èË Ôӂ˜ÂÚÓ ÓÚ ËÁÒΉ‚‡ÌËÚ ԇˆËÂÌÚË ÚÂÁË ‰‡ÌÌË ÍÓÂÎË‡Ú Ò˙Ò Á‡Íβ˜ÂÌËÂÚÓ Ì‡ äÄí Ë ëäÉ. àÁÒΉ‚‡ÌÂÚÓ Ì‡ F- ‚˙Î̇ڇ Ò ÔË·„‡ ÛÚËÌÌÓ ÔË Ô‡ˆËÂÌÚËÚÂ Ò ÎÛÏ·Ó- Ò‡Í‡ÎÌË ‡‰ËÍÛÎÂÌË ÒË̉ÓÏË.ífl  ÔÓ͇Á‡ÚÂÎ̇ Á‡ Û‚‰‡ ̇ Ô‰ÌËÚ ÍÓÂ̘ÂÚ‡ /2, 3, 6, 7, 16/.íÂıÌË͇ڇ Á‡ ÓÒ˙˘ÂÒÚ‚fl‚‡ÌÂÚÓ Ë Â ÎÂÒÌÓ ËÁÔ˙ÎÌËχ /3/. ëÔÓ‰ ÌflÍÓË ‡‚ÚÓË Úfl  ÚÓÎÍÓ‚‡ ËÌÙÓχÚ˂̇, ÍÓÎÍÓÚÓ Ë ËÁÒΉ‚‡ÌÂÚÓ Ò Ë„ÎÂÌ ÂÎÂÍÚÓ‰ ̇ Ò˙ÓÚ‚ÂÚÌËÚ ÏÛÒÍÛÎË /6/. ãËÔÒ‡Ú‡ ̇ F-‚˙Î̇ ËÎË Á‡·‡‚ÂÌÓÚÓ ãÇ ÔË „ÛÔ‡Ú‡ Ô‡ˆËÂÌÚË Ò˙ÓÚ‚ÂÚÒÚ‚‡Ú ̇ ËÁÓ·‡Áfl‚‡˘ËÚ ÏÂÚÓ‰Ë ‚ ÓÍÓÎÓ 1/3 ÓÚ ËÁÒΉ‚‡ÌËÚ ÌÂ‚Ë .èÓÔÓ͇Á‡ÚÂÎÌÓ ÔË Ì‡¯ËÚ ·ÓÎÌË Â,˜Â ‚ ̇‰ 80% ÓÚ ÌÂ‚ËÚ F- ‚˙Î̇ Ò ÔÓÎÛ˜‡‚‡ ÚÛ‰ÌÓ Ë ‚ ÔÓ‰ 50 % ÓÚ ÔËÎÓÊÂÌËÚ ÒÚËÏÛÎË. ç‡È- „ÓÎflχ ËÌÙÓχÚ˂̇ ÒÚÓÈÌÓÒÚ Ë Ì‡È-„ÓÎflχ ÍÓ·ˆËfl Ò ‰‡ÌÌËÚ ÓÚ äÄí Ë ëäÉ ÒÔÓ‰ ̇¯ÂÚÓ ÔÓÛ˜‚‡Ì Ëχ ËÁÒΉ‚‡ÌÂÚÓ Ì‡ ëåÖè . åÂÚÓ‰˙Ú Â ÓÔËÒ‡Ì ÓÚ åarsden Ë Ò˙ÚÛ‰ÌËˆË /1982/, ÍÓËÚÓ ÔÓ͇Á‚‡Ú, ˜Â ÏÓÚÓÌË Ô‰ËÁ‚Ë͇ÌË ÓÚ„Ó‚ÓË ÏÓ„‡Ú ‰‡ Ò ÔÓÎÛ˜‡Ú ÔË ÔÓ‚˙ıÌÓÒÚ̇ ÂÎÂÍÚ˘ÂÒ͇ ÒÚËÏÛ·ˆËfl ̇ ˆÂ‚Ë͇ÎÌËfl Ë ÎÛÏ·‡ÎÌËfl Û˜‡ÒÚ˙Í Ì‡ „˙·Ì‡˜ÌËfl ÒÚ˙η /9, 10, 13/. Ç ÔÓÒΉÒÚ‚Ë Ò ‰Ó͇Á‚‡,˜Â ÒÚËÏÛ·ˆËflÚ‡ Á‡Òfl„‡ ÔÓÍÒËχÎ̇ڇ ˜‡ÒÚ Ì‡ ÏÓÚÓÌËÚ ÍÓÂ̘ÂÚ‡ ·ÎËÁÓ ‰Ó foramen intervertebrale /12, 13/. Ç˙‚Âʉ‡ÌÂÚÓ Ì‡ χ„ÌËÚ̇ڇ ÒÚËÏÛ·ˆËfl Ô‡‚Ë ÏÂÚÓ‰‡ ·ÂÁ·ÓÎÂÁÌÂÌ Á‡ Ô‡ˆËÂÌÚ‡ Ë Ò „ÓÎÂÏË Ô‰ËÏÒÚ‚‡, ‚˙ÔÂÍË ˜Â ÔÓ‡‰Ë „ÓÎflχڇ ÔÓ‚˙ıÌÓÒÚ Ì‡ ÒÚËÏÛÎË‡˘Ëfl ÂÎÂÍÚÓ‰ ‚˙ÁÌËÍ‚‡Ú ÌflÍÓË ÒÔÓÌË ‚˙Ô- ÓÒË ÔÓ ÓÚÌÓ¯ÂÌË ̇ ÒÚÛÍÚÛËÚÂ, ÍÓËÚÓ Ò ‚˙Á·Ûʉ‡Ú /4, 5, 7, 10, 13, 16/. 燯ÂÚÓ ËÁÒΉ‚‡Ì ÔË Ô‡ˆËÂÌÚË Ò ‰Ó͇Á‡ÌË Û‚Âʉ‡ÌËfl ‚ ÎÛÏ·Ó- Ò‡Í‡ÎÌËfl ÓÚ‰ÂÎ ‰Ó͇Á‚‡Ú, ˜Â ˜ÂÁ χ„ÌËÚ̇ڇ ÒÚËÏÛ·ˆËfl ÏÓÊ ‰‡ Ò ÛÒÚ‡ÌÓ‚Ë ÎËÔÒ‡ ̇ ëåÖè ËÎË Á‡·‡‚ÂÌÓ ãÇ Ì‡ Ò˙ÓÚ‚ÂÚÌÓÚÓ ÌË‚Ó Ë ‚ ÏÌÓ„Ó „ÓÎflÏ ÔÓˆÂÌÚ ÓÚ ËÁÒΉ‚‡ÌËÚ - ̇χÎÂ̇ ‡ÏÔÎËÚÛ‰‡ ̇ ÒÚ‡Ì‡Ú‡ ̇ Û‚‰‡Ú‡. èÓÒΉÌËflÚ Ô‡‡ÏÂÚ˙ /Ä/ Á‡‚ËÒË ÓÚ ÏÌÓ„Ó ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ëfl Ë ‚‡Ë‡, ÔÓ‡‰Ë ÍÓÂÚÓ Á‡‰˙ÎÊËÚÂÎÌÓ Â Ò‡‚ÌÂÌËÂÚÓ ÓÚ ‰‚ÂÚ ÒÚ‡ÌË. èË ‡ÁÎËÍË Ôӂ˜ ÓÚ 50% ÚÓ‚‡ ÏÓÊ ‰‡  ÏÌÓ„Ó Ò˙˘ÂÒÚ‚ÂÌ ÔËÁÌ‡Í ÔË ÓÚÒ˙ÒÚ‚Ë ̇ ‰ÂÌÂ‚‡ˆËfl Ë ÍÓ̉Û͈ËÓÌÂÌ ·ÎÓÍ. çflÍÓË ‡‚ÚÓË ‡Á„ÎÂʉ‡Ú ÍÓÂ̘‚ËÚ ۂÂ‰Ë Í‡ÚÓ Ò‚ÓÂÓ·‡ÁÌË ÚÛÌÂÎÌË ÒË̉ÓÏË Ò ÎÓ͇Î̇ ‰ÂÏËÂÎËÌËÁ‡ˆËfl ‚ ÁÓ̇ڇ ̇ ÍÓÏÔÂÒËflÚ‡ Ë ‰ÓÔ˙ÎÌËÚÂÎÌË ‡ÍÚË‚ÌË ÍÓÂÌ˜Â‚Ë ÔÓÏÂÌË- ‚˙ÁÔ‡ÎËÚÂÎÌË, ÚÓÙ˘ÌË, Ò˙‰Ó‚Ë /2/. Ç ÂÁÛÎÚ‡Ú Ì‡ ÚÓ‚‡ Ò Á‡·‡‚fl ÔÓ‚Âʉ‡ÌÂÚÓ ‚ ̇È- ÔÓÍÒËχÎÌËfl Ò„ÏÂÌÚ Ì‡ ÔÂËÙÂÌËfl ‰‚Ë„‡ÚÂÎÂÌ Ì‚ÓÌ. èË ÏÌÓ„Ó ÒÎÛ˜‡Ë ‚Ó‰Â˘Ó Â ÔËÚËÒ͇ÌÂÚÓ Ì‡ ÍÓÂ̘ÂÚÓ Ë ‡ÍÒÓ̇Î̇ Û‚‰‡, ÍÓÂÚÓ Â Ô˘Ë̇ Á‡ ÔÓ- ÌËÒ͇ڇ ‡ÏÔÎËÚÛ‰‡ ̇ ÓÚ„Ó‚ÓËÚ /11, 14/. èӂ˜ÂÚÓ ÏÛÒÍÛÎË Ì‡ Í‡Í‡Ú‡ ËÏ‡Ú ÔÓÎË‡‰ËÍÛÎÂ̇ ËÌÂ‚‡ˆËfl /14/, ÔÓ‡‰Ë ÍÓÂÚÓ ÒÏflÚ‡ÏÂ, ˜Â  Ô‡‚ËÎÌÓ ËÁÒΉ‚‡ÌÂÚÓ Ì‡ ëåÖè ̇ Ôӂ˜ ÌË‚‡. èË ‚Ò˘ÍË ÒÎÛ˜‡Ë Ò ÏÓÚÓÂÌ ‰ÂÙˈËÚ Ëχ ÒË„ÌËÙË͇ÌÚÌË ‡ÁÎËÍË ‚ ãÇ Ì‡ Á‡Ò„̇ڇ Ë ÌÂÁ‡Ò„̇ڇ ÒÚ‡Ì‡ /14/. èË ÌflÍÓË Ô‡ˆËÂÌÚË ·ÂÁ ‰‡ÌÌË Á‡ Û‚‰‡ ̇ Ò˙Ò‰ÌËÚ ÌË‚‡ ÔÓ äÄí Ë ëäÉ Ò˙˘Ó ÛÒÚ‡ÌÓ‚ËıÏ ÔÓÏfl̇ ‚ ëåÖè, ÍÓÂÚÓ Ò Ò˙Ó·˘‡‚‡ Ë ÓÚ ‰Û„Ë ‡‚ÚÓË /2, 14/. íÓ‚‡ „Ó‚ÓË Á‡ ËÁ‚ÂÒÚÌÓ ÒÛ·ÍÎËÌ˘ÌÓ ÔÓÚ˘‡Ì ̇ ÔÓ‡ÊÂÌËÂÚÓ Ì‡ Ôӂ˜ „˙·Ì‡˜ÌÓÏÓÁ˙˜ÌË ÌË‚‡, ÍÓÂÚÓ ÏÓÊ ‰‡ Ò ‰Ó͇ÊÂ Ò ÔÓÒÓ˜ÂÌËÚÂ

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ÖåÉ- ÏÂÚÓ‰Ë. çÂÓ·ıÓ‰ËÏÓ Â ‰‡ Ò ÔÓ‰˜ÂÚ‡Â,˜Â ÍÓÏÔÎÂÍÒÌÓÚÓ ÂÎÂÍÚÓÏËÓ„‡ÙÒÍÓ ËÁÒΉ- ‚‡Ì ̇ Ô‡ˆËÂÌÚËÚÂ Ò ‡‰ËÍÛÎÂÌË ÒË̉ÓÏË Â Ì‡‰ÂʉÌÓ Ò‰ÒÚ‚Ó ‚ Ò˙˜ÂÚ‡ÌËÂ Ò Ì‚ÓËÁÓ·‡Áfl‚‡˘ËÚ ‰Ë‡„ÌÓÒÚ˘ÌË ÏÂÚÓ‰Ë Á‡ ÎÓ͇ÎËÁË‡ÌÂ, ͇ÍÚÓ Ë Á‡ ÓÔ‰ÂÎflÌe ̇ ÚÂÊÂÒÚÚ‡ Ë Â‚ÓβˆËflÚ‡ ̇ Ô‡ÚÓÎӄ˘ÌËfl ÔÓˆÂÒ. ãàíÖêÄíìêÄ: 1. ɘ‚ Ä. É.: äÓÂÌ˜Â‚Ë ÏÓÚÓÌË Ë ‰ÂχÚÓÏÌË Â‚ÓÍË‡ÌË ÔÓÚÂ̈ˇÎË ‚ ‰Ë‡„ÌÓÒÚË͇ڇ ̇ ÎÛÏ·Ó- Ò‡Í‡ÎÌËÚ ‰ËÒÍÓ„ÂÌÌË ‡‰ËÍÛÎËÚË, ä‡Ì‰Ë‰‡ÚÒ͇ ‰ËÒÂÚ‡ˆËfl, ëÓÙËfl, 1995. 2. ÜÂÎflÁÍÓ‚ ï.: äÎËÌËÍÓ- ÂÎÂÍÚÓÙËÁËÓÎӄ˘ÌÓ ÔÓÛ˜‚‡Ì ̇ Ô‰ÌÓÍÓÂ̘‚ËÚ ۂÂ‰Ë ÔË ‚ÂÚ·Ó„ÂÌÌË ‡‰ËÍÛÎÓÔ‡ÚËË, ä‡Ì‰. ‰ËÒÂÚ‡ˆËfl, èÎÓ‚‰Ë‚, 1991. 3. à¯ÔÂÍÓ‚‡ Å., ë. çÓ‚‡˜ÍÓ‚‡, à. åË·ÌÓ‚, å. äÓÒÚÓ‚‡ : àÁÒΉ‚‡Ì ̇ F- ‚˙Î̇ڇ ̇ n. tibialis Ë n. fibularis ÔË Á‰‡‚Ë Ë ·ÓÎÌË Ò ÔÓÍÒËχÎÌË Ë ‰ËÒÚ‡ÎÌË Û‚Â‰Ë Ì‡ ÔÂËÙÂÌËfl ‰‚Ë„‡ÚÂÎÂÌ Ì‚ÓÌ, ç‚ÓÎÓ„Ëfl, ÔÒËıˇÚËfl Ë Ì‚ÓıËÛ„Ëfl, 1986, 1, 56 - 59. 4. Brown W.F.,Bolton C. F. :"Clinical Electromyography", Boston, Butteworth, 1993. 5. Eisen A.: Cortical and Peripheral Nerve Magnetic Stimulation, Methods in clinical Neurophysiology, 1992, 3, 64- 84. 6. Fisher M. A.: Electrophysiology of radiculopathies, Clin.Neurophysiology, 2002, 113, 3, 317- 335. 7. Hufnagel A., Jeger M., Elger C. E. : Transcranial magnetic stimulation. Spezific and nonspezific facilitation of magnetic motor evoked potentials, J.of Neurol., 1990, 237 : 416- 419. 8. Kimura J. : Electrodiagnosis in diseases of nerve and muscle, Phyladelphia, F. A. Davis, 1984, 353- 398. 9. Marsden C.D., Merton H.P., Morton H.P. : Percutaneus stimulation of spinal cord and brain : pyramidal tract conduction velocyty in man, J. Physiol. /London/,1982, 328, p. 6. 10. Mills K. R., Murray N. M. .F. : Electrical stimulation over the human vertebral column . Wich neural elements are exited ?, Electroenceph. clin. Neurophysiol. 1986, 63, 582 - 589. 11. Raynor E.M.,Shefner J.M.,Ross M.H.,Logigian E.L.,Hinchey J.A.: Root stimulation studies in the evaluation of patients with motor neuron disease, Neurology,1998, 50, 6, 1907-1909. 12. Schmidt U. D., Walker G., Hess C. W., Schmidt J .: Magnetic and elektrical stimulation of cervical motor roots : technique, site and mechanisms of exitation, J. Neurol. Neuros. Psychiat., 1990, 53, 770 - 777. 13. Swash M., Snooks St.: Motor conduction velocity in the human spinal cord, J. Physiol. /London/, 1985, 360, p. 50. 14. Tabaraut F., Hugon J., Chazot F., Morreau J., : Motor evoked responses after lumbal spinal stimulation in patients with L5 or S1 radicular involvement Electroenc.clin. neurophysiol., 1989, 72, 334 - 339. 15. Weber F., Albert U .:Electrodiagnostic examination of lumbosacral radiculopathies, Electromyography Clin.Neurophysiology, 2000, 40, 4, 231- 236. 16. Wehling P. : The potential role of transcranial magnetic stimulation in the diagnosis of lumbosacral radiculopathies, Z. Ortop. Und Grenzgeb., 1991, 129, 1, 6 - 11.

ĉÂÒ Á‡ ÍÓÂÒÔÓ̉Â̈Ëfl: Ñ- ë. çÓ‚‡˜ÍÓ‚‡ åÅÄã "ñ‡ˈ‡ âÓ‡Ì̇" ÖÄÑ, äÎËÌË͇ ÔÓ Ì‚ÓÎÓ„Ëfl ìÎ." ÅflÎÓ ÏÓÂ" N 8, 1504, ëÓÙËfl


‡ÔËÎ, 2002

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

64

50 ÉéÑàçà çÄìóçé ÑêìÜÖëíÇé çÄ çÖÇêéãéáàíÖ, èëàïàÄíêàíÖ à çÖÇêéïàêìêáàíÖ Ç èãéÇÑàÇ 1

èÓÙ. ‰- Ç. åËÚÍÓ‚, ‰ÏÌ

çÄóÄãé. ç‡Û˜ÌÓÚÓ ‰ÛÊÂÒÚ‚Ó Ì‡ Ì‚ÓÎÓÁËÚÂ, ÔÒËıˇÚËÚÂ Ë Ì‚ÓıËÛÁËÚ ‚ èÎÓ‚‰Ë‚ Á‡ÔÓ˜‚‡ ‰ÂÈÌÓÒÚÚ‡ ÒË ÔÂÁ ÔÂËÓ‰‡ ̇ Ó·˘‡Ú‡ ͇Ú‰‡ ÔÓ Ì‚ÓÔÒËıˇÚËfl ̇ Çåà, ÍÓ„‡ÚÓ ˙ÍÓ‚Ó‰ËÚÂÎ Ìa ͇Ú‰‡Ú‡  ÌÂÈÌËflÚ ÓÒÌÓ‚ÓÔÓÎÓÊÌËÍ ÔÓÙ. ‰- äËËÎ óÓ·ÍÓ‚ /1946 -1953 „./.

‚‡ÌÒ͇, Ò Ò˙·Ë‡Ú ÎÂ͇Ë, ‡·ÓÚÂ˘Ë ‚ ӷ·ÒÚÚ‡ ̇ Ì‚ÓÎÓ„ËflÚ‡, ÔÒËıˇÚËflÚ‡ Ë Ì‚ÓıËÛ„ËflÚ‡. èÓ‚Ó‰ Á‡ ÚÓ‚‡ Ò˙·Ë‡Ì  ۘ‰fl‚‡ÌÂÚÓ, ÔÓ ËÌˈˇÚË‚‡Ú‡ ̇ ÎÂ͇ÒÍËfl ÍÓÎÂÍÚË‚ ̇ Ì‚ÓÔÒËıˇÚ˘̇ ÍÎËÌË͇, ̇ ç‡Û˜ÌÓ ‰ÛÊÂÒÚ‚Ó Ì‡ Ì‚ÓÎÓÁËÚÂ, ÔÒËıˇÚËÚÂ Ë Ì‚ÓıËÛÁËÚÂ. í‡ÍË‚‡ ‰ÛÊÂÒÚ‚‡ ÔÓ ÚÓ‚‡ ‚ÂÏ ‚ èÎÓ‚‰Ë‚

ë˙Á‰‡‰ÂÌÓ Í‡ÚÓ ÒÂ͈Ëfl Í˙Ï éÍ˙ÊÌÓÚÓ Ì‡Û˜ÌÓ ‰ÛÊÂÒÚ‚Ó Ì‡ ÚÂ‡Ô‚ÚËÚ ‚ èÎÓ‚‰Ë‚ ̇ 10 ˛ÌË 1952 „., ÚÓ Ì‡‚˙¯‚‡ ÔÂÁ 2002 „. Ò‚ÓflÚ‡ 50-„Ӊ˯ÌË̇. ì˜‰ÂÌÓ Â ‚ ÌflÍÓ„‡¯Ì‡Ú‡ Ò„‡‰‡ ̇ Ì‚ÓÔÒËıˇÚ˘̇ڇ ÍÎËÌË͇ ‚ ˆÂÌÚ˙‡ ̇ „‡‰‡, ̇ÒÚ‡ÌÂ̇ ÚÓ„‡‚‡ ‚ ·Ë‚¯ËÚ Ò˙Ò‰ÌË ˜‡ÒÚÌË ÍÎËÌËÍË Ì‡ ‰- ëڇȘ‚ Ë ‰- èÓÔÓ‚, ̇ÏË‡˘Ë Ò ÏÂÊ‰Û ÛÎˈ‡ ä‡ÎË å‡ÍÓ ‹ 17 Ë ‰Ì¯ÌËfl ·ÛÎ. ñ‡ ÅÓËÒ III ӷ‰ËÌËÚÂÎ, 126‡ /ÒÌËÏ͇ ‹ 1/. Ç Â‰Ì‡ ÔËflÚ̇ ˛ÌÒ͇ ‚˜Â, ‚ 19 ˜‡Ò‡ Ë 45 ÏËÌÛÚË, Ô˯ ‚ ‰ÓÍ·‰‡ ÒË Á‡ Ì„ӂ‡Ú‡ 25 „Ӊ˯̇ ‰ÂÈÌÓÒÚ ‰˙΄ӄӉ˯ÌËflÚ ÒÂÍÂÚ‡ ̇ ‰ÛÊÂÒÚ‚ÓÚÓ ‰- è. åÓΉÓ-

Ò‡ ËχÎË ÚÂ‡Ô‚ÚËÚÂ, ıËÛÁËÚÂ, ÙÚËÁˇÚËÚÂ Ë ‰. è˙‚ÓÚÓ Û˜‰ËÚÂÎÌÓ Ò˙·‡ÌËÂ, ÓÚ‡ÁÂÌÓ ‚ ÔÓÚÓÍÓÎ ‹ 1 ̇ ‰ÛÊÂÒÚ‚ÓÚÓ, Ò Ô‰Ò‰‡ÚÂÎÒÚ‚‡ ÓÚ ÔÓÙ. äËËÎ óÓ·ÍÓ‚, ‡ ÒÂÍÂÚ‡  ‰- èÂÌ͇ åÓΉӂ‡ÌÒ͇. ç‡ ÌÂ„Ó ÔËÒ˙ÒÚ‚‡Ú, ͇ÍÚÓ Â ÔÓÚÓÍÓÎË‡ÌÓ, 19 ‰Û¯Ë: ÔÓÙ. ä. óÓ·ÍÓ‚, ‰Óˆ. í. á‡ÔflÌÓ‚, ‰- áÎ. ëÔ‡ÒÓ‚, ‰- ü. ç‡Ï˘‚, ‰- ã. îËÎËÔÓ‚, ‰- Ñ. äËÚÓ‚, ‰- í. 퇯‚, ‰- Ç. åËÚÍÓ‚, ‰- ç. ìÁÛÌÓ‚, ‰- Ä. ÑʇΉÂÚË, ‰- Ç. âÓ̘‚, ‰- è. åÓΉӂ‡ÌÒ͇, ‰- å. LJÌÚÓ‚, ‰- à‚. 䇷ίÍÓ‚, ‰- àÎ. ÉÂ˜Â‚, ‰- ï. ÄÎÂÍ҇̉Ó‚, ‰- à‚. ÑÂ̘‚, ‰- å. Ñ‡„Ë‚ Ë ‰- ëÚ. ÑÓ·‚‡.ç‡ Û˜‰ËÚÂÎ-

ëÚ‡ÚËflÚ‡  ËÁ„ÓÚ‚Â̇ ‚˙Á ÓÒÌÓ‚‡ ̇ χÚÂˇÎË Ì‡ ‰- è. åÓΉӂ‡ÌÒ͇

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‡ÔËÎ, 2002

ÔÓÙ. äËËÎ óÓ·ÍÓ‚

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

‰Óˆ. í‡ÈÍÓ á‡ÔflÌÓ‚

ÌÓÚÓ Ò˙·‡ÌË Ò ‡ÁËÒÍ‚‡Ú ÌflÍÓË ‡‰ÏËÌËÒÚ‡ÚË‚ÌÓÓ„‡ÌËÁ‡ˆËÓÌÌË ‚˙ÔÓÒË Ë Ò ËÁ·Ë‡ Ô˙‚ÓÚÓ ˙ÍÓ‚Ó‰ÒÚ‚Ó Ì‡ ÒÂ͈ËflÚ‡ Ò Ô‰Ò‰‡ÚÂÎ ‰Óˆ. í‡ÈÍÓ á‡ÔflÌÓ‚, Á‡Ï. Ô‰Ò‰‡ÚÂÎ ‰- à‚. 䇷ίÍÓ‚ Ë ÒÂÍÂÚ‡ ‰- Ç. âÓ̘‚. 燷ÂÎflÁ‚‡Ú ÒÂ Ë ÓÒÌÓ‚ÌËÚ Á‡‰‡˜Ë ̇ ‰ÛÊÂÒÚ‚ÓÚÓ: 1. àÁ̇ÒflÌ ̇ ̇ۘÌË ‰ÓÍ·‰Ë ‚ èÎÓ‚‰Ë‚ Ë ÓÍ˙„‡ 2. èÓ‚Âʉ‡Ì ̇ ÔÓÒ‚ÂÚ̇ ‰ÂÈÌÓÒÚ Ò‰ „‡Ê‰‡ÌÒÚ‚ÓÚÓ 3. èÓ‰ÔÓχ„‡Ì ̇ ÓÍ˙ÁËÚ ‚ Θ·ÌÓ-‰Ë‡„ÌÓÒÚ˘̇ڇ Ë Ì‡Û˜Ì‡Ú‡ ËÏ ‰ÂÈÌÓÒÚ. àÁ·Ë‡ ÒÂ Ë ÍÓÏËÒËfl, ÍÓflÚÓ ‰‡ ·˙‰Â ‚ ÛÒÎÛ„‡ ̇ ÓÍ˙Ê̇ڇ Á‰‡‚̇ ÒÎÛÊ·‡, ͇ÚÓ Ò˙‚¢‡ÚÂÎÂÌ Ó„‡Ì ÔÓ Ì‚ÓÔÒËıˇÚ˘ÌËÚ ‚˙ÔÓÒË. éÔ‰ÂÎflÚ Ò Ò˙˘Ó ÌflÍÓË ÓÚ„Ó‚ÓÌËˆË ÔÓ ÓÍÓÎËË. èÎÓ‚‰Ë‚Ò͇ڇ ÒÂ͈Ëfl  Ô˙‚‡ ‚ ÒÚ‡Ì‡Ú‡, ÍÓflÚÓ Ó·Â‰ËÌfl‚‡ ÚËÚ ÒÓ‰ÌË Ï‰ˈËÌÒÍË ÒÔˆˇÎÌÓÒÚË. èÓ ÚÓ‚‡ ‚ÂÏ ‚ ëÓÙËfl Ò˙˘Ó Ëχ ÒÂ͈Ëfl, ÌÓ Úfl  ÔÓ Ì‚ÓÎÓ„Ëfl Ë ÔÒËıˇÚËfl. éÒÌÓ‚‡Ì‡ ÔÂ‰Ë Ì‡¯‡Ú‡, ‚ ̇˜‡ÎÓÚÓ ÒË Úfl  Í˙Ï ë˙˛Á‡ ̇ Á‰‡‚ÌËÚ ‡·ÓÚÌËˆË ‚ Å˙΄‡Ëfl, ‡ ÒΉ ÚÓ‚‡ - Í˙Ï Ì‡Û˜ÌÓÚÓ ‰ÛÊÂÒÚ‚Ó Ì‡ ÚÂ‡Ô‚ÚËÚÂ. èöêÇà ëíöèäà à ÉéÑàçà. ÇÚÓÓÚÓ ÔÓ ‰ Ò˙·‡ÌË ̇ ‰ÛÊÂÒÚ‚ÓÚÓ Ò ÔÓ‚Âʉ‡ ‰‚ Ò‰ÏËˆË ÒΉ ÓÒÌÓ‚‡‚‡ÌÂÚÓ ÏÛ - ̇ 24 ˛ÌË 1952 „. ç‡ ÌÂ„Ó Ò ËÁ̇Òfl Ô˙‚ËflÚ Ì‡Û˜ÂÌ ‰ÓÍ·‰ "ê‡ÌÌË Ë Í˙ÒÌË Ì‚ÓÚ˘ÌË ÔÓfl‚Ë ÔË ÚÛ·ÂÍÛÎÓÁÌË Á‡·ÓÎfl‚‡ÌËfl" ÓÚ í. á‡ÔflÌÓ‚, å. LJÌÚÓ‚ Ë è. åÓΉӂ‡ÌÒ͇. ëÙÓÏË‡ÌÓ ÓÚ ÌÂÍÓΈË̇ ÂÌÚÛÒˇÒÚË, ÚÓ ÛÍÂÔ‚‡ Ò‡‚ÌËÚÂÎÌÓ ·˙ÁÓ, ÛÚ‚˙ʉ‡‚‡ Ò ͇ÚÓ ‡‚ÚÓËÚÂÚ̇ ̇ۘ̇ Ó·˘ÌÓÒÚ, Ó„‡ÌËÁË‡ ËÌÚÂÂÒÌË Ò˙·‡ÌËfl, Ô˂΢‡ „ÓÒÚË Ë ÓÚ ‰Û„Ë ÒÔˆˇÎÌÓÒÚË Ë Û‚Â΢‡‚‡ ·Ófl ̇ ˜ÎÂÌÓ‚ÂÚ ÒË. èÂÁ 1955 „. Ú ҇ ‚˜ 32-χ, ‡ ÔÓ-Í˙ÒÌÓ, ÍÓ„‡ÚÓ Í˙Ï ÌÂ„Ó Ò ÔËÒ˙‰ËÌfl‚‡Ú Ì‚ÓÎÓÁËÚÂ Ë ÔÒËıˇÚËÚ ÓÚ ï‡ÒÍÓ‚Ó, ä˙‰Ê‡ÎË Ë è‡Á‡‰ÊËÍ, ÚÂıÌËflÚ ·ÓÈ Â Ì‡È‚ËÒÓÍ Ë ‰ÓÒÚË„‡ ˜ËÒÎÓÚÓ 143 ‰Û¯Ë ë˙·‡ÌËflÚ‡ ̇ ‰ÛÊÂÒÚ‚ÓÚÓ Ò ÔÓ‚Âʉ‡Ú 2 Ô˙ÚË ÏÂÒ˜ÌÓ /·ÂÁ ÏÂÒˆËÚ ÔÂÁ ‚‡Í‡ÌˆËÓÌÌËÚ ÔÂËÓ‰Ë/, ÌÂËÁÏÂÌÌÓ ‚ ÓÔ‰ÂÎÂÌÓ ‚ÂÏ /‚ÚÓÌËÍ, 19˜‡Ò‡/ Ë ÏflÒÚÓ Ì‡È-̇Ô‰ ‚ Ó·˘‡Ú‡ Ì‚ÓÔÒËıˇÚ˘̇ ÍÎËÌË͇, ‡ ÒΉ ÚÓ‚‡ - ‚ ‡ÒËÒÚÂÌÚÒ͇ڇ ÒÚ‡fl ̇ ‰Ì¯̇ڇ ÔÒËıˇÚ˘̇ ÍÎËÌË͇. Ö‰ËÌ˘ÌË Ò˙·‡ÌËfl, Ú˙ÊÂÒÚ‚ÂÌË ËÎË ‚ ̇ˆËÓ̇ÎÂÌ Ï‡˘‡· Ò‡ ÔÓ‚Âʉ‡ÌË ‚ ‡Û‰ËÚÓËËÚ ̇ ·ÓÎÌˈ‡Ú‡, ‡ Ò˙˘Ó ڇ͇ - ‚ „. ï‡ÒÍÓ‚Ó Ë „. ä˙‰Ê‡ÎË. éÚ˜ËÚ‡ÌÂÚÓ Ì‡ ‰ÂÈÌÓÒÚÚ‡ ÏÛ Ë ËÁ·Ó˙Ú Ì‡ ÌÓ‚Ó ˙ÍÓ‚Ó‰ÒÚ‚Ó Ò ËÁ‚˙¯‚‡Ú Ó·ËÍÌÓ‚ÂÌÓ ÔÂÁ 2 „Ó‰ËÌË. ÑÛÊÂÒÚ‚ÓÚÓ Ò ‚Ó‰Ë ÒÂ͈Ëfl ‰Ó 9 Ï‡È 1961 „. ç‡ Ú‡-

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ÁË ‰‡Ú‡ ÚÓ Ò ÓÚ‰ÂÎfl ÓÚ ÚÂ‡Ô‚ÚËÚÂ Ë ÒÚ‡‚‡ Ò‡ÏÓÒÚÓflÚÂÎÌÓ ‰ÛÊÂÒÚ‚Ó Ì‡ Ì‚ÓÎÓÁËÚÂ, ÔÒËıˇÚËÚÂ Ë Ì‚ÓıËÛÁËÚÂ Ò Ô˙‚ Ô‰Ò‰‡ÚÂÎ ÔÓÙ. ä. óÓ·ÍÓ‚, Á‡Ï. Ô‰Ò‰‡ÚÂÎ ‰- ã. ç‡Ï˘‚ Ë ‰‚‡Ï‡ ÒÂÍÂÚ‡Ë /‰- è. åÓΉӂ‡ÌÒ͇ Ë ‰- å. Ñ‡„Ë‚/. ë ÚÓÁË Ò‚ÓÈ Ó„‡ÌËÁ‡ˆËÓÌÂÌ ‡ÍÚ ÚÓ ËÁÔ‚‡‚‡ ëÓÙËÈÒ͇ڇ ÒÂ͈Ëfl. ç‡ 25 ÌÓÂÏ‚Ë 1961 „., ÔÓ ‚ÂÏ ̇ IV-Ú‡ ̇ˆËÓ̇Î̇ ÍÓÌÙÂÂ̈Ëfl ̇ ·˙΄‡ÒÍËÚ Ì‚ÓÎÓÁË Ë ÔÒËıˇÚË, ‚ ëÓÙËfl Ò ۘ‰fl‚‡ êÂÔÛ·ÎË͇ÌÒÍÓ Ì‡Û˜ÌÓ Ï‰ˈËÌÒÍÓ ‰ÛÊÂÒÚ‚Ó Ì‡ Ì‚ÓÎÓÁËÚÂ Ë ÔÒËıˇÚËÚÂ. èÎÓ‚‰Ë‚ÒÍÓÚÓ ‰ÛÊÂÒÚ‚Ó ÒÚ‡‚‡ Ì„ӂ ÍÎÓÌ ÔË ‚Ò˘ÍÓ 12 ÍÎÓ̇ ‚ ÒÚ‡Ì‡Ú‡ - ‚ ëÓÙËfl, èÎÓ‚‰Ë‚, LJ̇, Åfl·, ä‡ÎÛÍÓ‚Ó, ãӂ˜, ëÚ‡‡ ᇄÓ‡, êÛÒÂ, í˙ÌÓ‚Ó, ÅÛ„‡Ò, ï‡ÒÍÓ‚Ó, Ç‡ˆ‡, è΂ÂÌ Ë òÛÏÂÌ. àÁ·‡ÌÓ Â ˙ÍÓ‚Ó‰ÒÚ‚Ó Ò Ô‰Ò‰‡ÚÂÎ ‡Í‡‰. É. ìÁÛÌÓ‚, Á‡Ï. Ô‰Ò‰‡ÚÂÎ ÔÓÙ. É. ç‡ÒÚ‚, ÒÂÍÂÚ‡ í. ÉÂ̘‚ Ë ˜ÎÂÌÓ‚Â ÔÓÙ. ë. ÅÓÊËÌÓ‚, ÔÓÙ. Ö. ò‡‡ÌÍÓ‚, ÒÚ. Ì. Ò˙Ú. É. ɇÌ‚, ÒÚ.Ì. Ò˙Ú. ÇÎ. à‚‡ÌÓ‚, ‰Óˆ. ê. äÓÈÌÓ‚, ‰- ëÚ. ÑÓ·‚‡, ‰- É. çËÍÓÎÓ‚ Ë ‰- à. à‚‡ÌÓ‚. èÂÁ ÒΉ‚‡Ì‡Ú‡ 1962 „. Í˙Ï ÂÔÛ·ÎË͇ÌÒÍÓÚÓ ‰ÛÊÂÒÚ‚Ó Ì‡ Ì‚ÓÎÓÁËÚÂ Ë ÔÒËıˇÚËÚ Ò ÔÂı‚˙Îfl ÒÂ͈ËflÚ‡ ̇ Ì‚ÓıËÛÁËÚ /ëÓÙËfl/, ˜ËÒÎfl˘‡ Ò ÔÂ‰Ë ÚÓ‚‡ Í˙Ï ıËÛ„˘ÂÒÍÓÚÓ Ì‡Û˜ÌÓ ‰ÛÊÂÒÚ‚Ó. èÂÁ 1965 „. ‚ ‡ÏÍËÚ ̇ ̇¯ÂÚÓ ‰ÛÊÂÒÚ‚ÓÚÓ Ò ÒÙÓÏË‡ ÒÂ͈Ëfl ÔÓ ‰ÂÚÒ͇ Ì‚ÓÎÓ„Ëfl Ë ÔÒËıˇÚËfl Ò 12 ˜ÎÂ̇. ᇠÌÂËÌ Ô‰Ò‰‡ÚÂÎ Ò ËÁ·Ë‡ ‰Óˆ. Ç. âÓ̘‚, ‡ ÒÂÍÂÚ‡Ë Ò‡ ‰- Å. ä˙ÒÚ‚ Ë ‰- Ä. ëÚÓflÌÓ‚. èÓ‡‰Ë χÎÍËfl ·ÓÈ ˜ÎÂÌÓ‚Â Ë ÎËÔÒ‡Ú‡ ̇ ‰ÂÚÒÍÓ ÔÒËıˇÚ˘ÌÓ ÓÚ‰ÂÎÂÌË ‚ èÎÓ‚‰Ë‚ Ú‡ÁË ÒÂ͈Ëfl ‡Á‚Ë‚‡ Ú‚˙‰Â Í‡ÚÍÓÚ‡È̇ Ë ‡ÌÂÏ˘̇ ‰ÂÈÌÓÒÚ. ê˙ÍÓ‚Ó‰ÒÚ‚Ó. ëΉ ÓÒÌÓ‚‡‚‡Ì ̇ ‰ÛÊÂÒÚ‚ÓÚÓ Ë ÔÂÁ Ô˙‚ËÚ „Ó‰ËÌË ÓÚ ‰ÂÈÌÓÒÚÚ‡ ÏÛ Ô‰Ò‰‡ÚÂÎË Ì‡ Ì„ӂÓÚÓ ˙ÍÓ‚Ó‰ÒÚ‚Ó Ò‡ ÔÓÙ. í. á‡ÔflÌÓ‚ Ë ÔÓÙ. ä. óÓ·ÍÓ‚. ëΉ ÒÏ˙ÚÚ‡ ̇ ÔÓÙ. óÓ·ÍÓ‚ Ë ÔÂÏÂÒÚ‚‡ÌÂÚÓ Ì‡ ÔÓÙ. á‡ÔflÌÓ‚ ‚ ëÓÙËfl, Ô‰Ò‰‡ÚÂÎË Ì‡ Ó·˘ÓÚÓ Ì‡Û˜ÌÓ ‰ÛÊÂÒÚ‚Ó ÒÚ‡‚‡Ú ÔÓÒΉӂ‡ÚÂÎÌÓ ÔÓÙ. í. 퇯‚, ÔÓÙ. Ç. åËÚÍÓ‚ Ë ÔÓÙ. Ñ. äËÚÓ‚, ÒÏÂÌfl˘Ë Ò ÔÂÁ ‰‚ „Ó‰ËÌË Ì‡ ÓÚ‡ˆËÓÌÂÌ ÔË̈ËÔ. ëÂÍÂÚ‡Ë Ò‡ ·ËÎË ‰- Ç. âÓ̘‚ ‰- è. åÓΉӂ‡ÌÒ͇, ‰- å. Ñ‡„Ë‚ Ë ‰. óÎÂÌӂ ̇ ˙ÍÓ‚Ó‰ÒÚ‚ÓÚÓ ÔÂÁ ‡Á΢ÌË „Ó‰ËÌË Ò‡ ·ËÎË ‰Óˆ. ü. ç‡Ï˘‚, ‰- Ç. Ň··‡ÌÓ‚‡, ‰- ë. ëÚÂÙ‡ÌÓ‚, ‰- â. ä‡Ò˙Ó‚, ‰- ëÚ. àΘ‚ÒÍË, ‰- â. ëÚÓËÏÂÌÓ‚, ‰- å. êӄ΂, ‰- Ä. îÂÓ‰ÓÓ‚, ‰- ä. äÓΘ‚, ‰- 3. á‡ı‡Ë‚, ‰- ë. ãflÚÓ‚, ‰- ä. ëÚ‡ÏÂÌÓ‚‡, ‰- Ä. å‡Ì‰‡ÎË‚ Ë ‰Û„Ë. ç‡È-‰˙Î˙„ "ÒÚ‡Ê" ‚ ˙ÍÓ‚Ó‰ÒÚ‚ÓÚÓ Ì‡ Ó·˘ÓÚÓ ‰ÛÊÂÒÚ‚Ó /̇‰ 20 „Ó‰ËÌË/ Ëχ ‰- è. åÓΉӂ‡ÌÒ͇, ‡·ÓÚË· Ô‰ËÏÌÓ Í‡ÚÓ ÒÂÍÂÚ‡. ÑÖâçéëí é˘Â ÓÚ Ò˙Á‰‡‚‡ÌÂÚÓ ÒË ‰ÛÊÂÒÚ‚ÓÚÓ Á‡ÊË‚fl‚‡ ËÚÏ˘ÂÌ Ë Ô˙ÎÌÓÍ˙‚ÂÌ ÊË‚ÓÚ, ‡Á„˙˘‡ÈÍË ‡ÁÌÓÓ·‡Á̇ ̇ۘ̇, Ó„‡ÌËÁ‡ˆËÓÌ̇, Ó·˘ÂÒÚ‚ÂÌÓ-ÔÓÒ‚ÂÚ̇ Ë ‰Û„‡ ‡ÍÚË‚ÌÓÒÚ. èÓÒÚÂÔÂÌÌÓ ÚÓ Ò ÓÙÓÏfl ͇ÚÓ ËÒÚËÌÒ͇ Ò˙‚ÂÏÂÌ̇ ¯ÍÓ· Á‡ Ó·Û˜ÂÌËÂ Ë Í‚‡ÎËÙË͇ˆËfl ̇ Ï·‰ËÚÂ, ‡ Ë Ì‡ ÔÓ-‚˙Á‡ÒÚÌËÚ Ì‚ÓÎÓÁË, ÔÒËıˇÚË Ë Ì‚ÓıËÛÁË ÓÚ èÎÓ‚‰Ë‚ Ë Ò˙Ò‰ÌËÚ ÓÍ˙ÁË ÓÚ ûÊ̇ Å˙΄‡Ëfl . í‡ÁË Ì„ӂ‡ ÓÎfl Á‡ÒÎÛʇ‚‡ ÓÒÓ·ÂÌÓ ËÁÚ˙Í‚‡ÌÂ, Ú˙È Í‡ÚÓ ÔÓ ÚÓ‚‡ ‚ÂÏ ҇ÏÓ ÔÓÙ. ä. óÓ·ÍÓ‚, ‰Óˆ. í.


‡ÔËÎ, 2002

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

á‡ÔflÌÓ‚, ‰- à‚. 䇷ίÍÓ‚ Ë ‰- áÎ. ëÔ‡ÒÓ‚ Ò‡ ÒÔˆˇÎËÒÚË ÔÓ Ì‚ÓÎÓ„Ëfl Ë ÔÒËıˇÚËfl, ‡ ‰- ü. ç‡Ï˘‚ ÒÔˆˇÎËÒÚ ÔÓ Ó·˘‡ ıËÛ„Ëfl Ò ‰‚„Ӊ˯ÂÌ Ì‚ÓıËÛ„˘ÂÒÍË ÒÚ‡Ê ‚ ëÓÙËfl. ÇÒ˘ÍË ‰Û„Ë ˜ÎÂÌӂ ̇ ‰ÛÊÂÒÚ‚ÓÚÓ ÔÂÁ ̇È-‡ÌÌËfl ÏÛ ÔÂËÓ‰, ‡·ÓÚÂ˘Ë ‚˙‚ Çåà Ë Á‰‡‚̇ڇ ÏÂʇ, Ò‡ ·ÂÁ ÒÔˆˇÎÌÓÒÚ ÔÓ Ì‚ÓÎÓ„Ëfl, ÔÒËıˇÚËfl ËÎË Ì‚ÓıËÛ„Ëfl. ÑÌ‚ÌËflÚ ‰ ̇ Á‡Ò‰‡ÌËflÚ‡ ̇ ‰ÛÊÂÒÚ‚ÓÚÓ Ò ÔÓ‰·Ë‡ ڇ͇, ˜Â ‰‡ Á‡‰Ó‚ÓÎfl‚‡ ËÌÚÂÂÒËÚ ̇ ˜ÎÂÌÓ‚ÂÚ ÓÚ ÚËÚ ‰ËÒˆËÔÎËÌË. é·ËÍÌÓ‚ÂÌÓ ‚ ÌÂ„Ó Ò ‚Íβ˜‚‡Ú ̇ۘÌË ‰ÓÍ·‰Ë Ò ‡ÁÌÓÓ·‡Á̇ ÚÂχÚË͇ - ÓÚ Ë‰ÂÈÌÓÚÂÓÂÚ˘̇ ‰Ó ˜ËÒÚÓ Ô‡ÍÚ˘ÂÒ͇, ÓˆÂÌ͇ ̇ ÌflÍÓË Û˜ÂÌËfl Ë ‚˙Á„ÎÂ‰Ë ‚ Ì‚ÓÎÓ„ËflÚ‡ Ë ÔÒËıˇÚËflÚ‡, ˆÂÌÁËË Ì‡ ÌÓ‚ÓËÁÎÂÁÎË ÍÌË„Ë Ë ÏÓÌÓ„‡ÙËË, ‰ÓÍ·‰‚‡Ì ̇ Á‡‚˙¯ÂÌË Ì‡Û˜ÌË ‡Á‡·ÓÚÍË ‚ ÓÚ‰ÂÎÌËÚ ÍÎËÌËÍË, ‰ÂÏÓÌÒÚ‡ˆËË Ì‡ ËÌÚÂÂÒÌË, ‰ÍË ËÎË ÚÛ‰ÌË Á‡ ‰Ë‡„ÌÓÁ‡ Á‡·ÓÎfl‚‡ÌËfl, ÒÔÓ‰ÂÎflÌ ̇ ÓÔËÚ‡ Ë ÂÁÛÎÚ‡ÚËÚ ÓÚ ÍÎËÌ˘ÌÓÚÓ ËÁÔÓ·‚‡Ì ̇ ‡Á΢ÌË ÎÂ͇ÒÚ‚ÂÌË Ò‰ÒÚ‚‡, Ó·Ò˙ʉ‡Ì ̇ Ó„‡ÌËÁ‡ˆËÓÌÌË ‚˙ÔÓÒË, ˜ÂÒÚ‚‡ÌËfl ̇ „Ӊ˯ÌËÌË Ë ˛·ËÎÂË Ë Ô. ì˜ÂÌËÂÚÓ Ì‡ à. è. 臂ÎÓ‚ Ë Ì„ӂËÚ ۘÂÌˈË, ¯ËÓÍÓ ‡ÁÔÓÒÚ‡Ìfl‚‡ÌÓ ÓÚ ÔÓÙ. ä. óÓ·ÍÓ‚,  Ô‰ÏÂÚ Ì‡ ÌÂχÎÍÓ ‰ÓÍ·‰Ë ÔÂÁ Ô˙‚ËÚ „Ó‰ËÌË ÓÚ ÊË‚ÓÚ‡ ̇ ‰ÛÊÂÒÚ‚ÓÚÓ, ËÁ̇ÒflÌË ÓÚ Ò‡ÏËfl ÌÂ„Ó ËÎË Ò˙ÚÛ‰ÌˈËÚ ÏÛ. Ä‚ÚÓË Ì‡ ‰ÓÍ·‰ËÚÂ Ë Û˜‡ÒÚÌËˆË ‚ ‡ÁËÒÍ‚‡ÌËflÚ‡ Ò‡ Ì ҇ÏÓ Ô‰ÒÚ‡‚ËÚÂÎËÚ ̇ ÚËÚ ÍÎËÌËÍË, ÌÓ Ë ÍÓ΄ËÚ ÓÚ Á‰‡‚̇ڇ ÏÂʇ ‚ÚÓ‡ „‡‰Ò͇ ·ÓÎÌˈ‡, éÍ˙ÊÌËfl ÔÒËıÓ-Ì‚ÓÎӄ˘ÂÌ ‰ËÒÔ‡ÌÒÂ, ÔÓÎËÍÎËÌËÍËÚÂ Ë ‰Û„Ë Á‰‡‚ÌË Á‡‚‰ÂÌËfl. é·˘ÓÚÓ Ì‡Û˜ÌÓ ‰ÛÊÂÒÚ‚Ó Ì‡ Ô‡ÍÚË͇ ·Â ‰̇ ‚ÚÓ‡ ËÁ‚˙Ì͇Ú‰Â̇ Ó·˘ÂÒÚ‚Â̇ ÙÓχ ̇ ‰ÂÈÌÓÒÚ ‚ ӷ·ÒÚÚ‡ ̇ Ì‚ÓÎÓ„ËflÚ‡, ÔÒËıˇÚËflÚ‡ Ë Ì‚ÓıËÛ„ËflÚ‡ Í˙Ï ÚÓ„‡‚‡¯ÌËÚ ͇Ú‰Ë Ë ÍÎËÌËÍË, ËÁË„‡Î‡ ÌÂÓˆÂÌËÏÓ ÔÓÎÓÊËÚÂÎÌÓ ‚˙Á‰ÂÈÒÚ‚Ë ̇ ÚflıÌÓÚÓ ‡Á‚ËÚËÂ. ÑÛı˙Ú Ì‡ Ì‚ÓÔÒËıˇÚ˘ÌËfl ÔÂËÓ‰ ÔÂ‰Ë ‡Á‰ÂÎflÌÂÚÓ Ì‡ Ó·˘‡Ú‡ ͇Ú‰‡ ÔÓ‰˙ÎÊË Ò˙˘ÂÒÚ‚Û‚‡ÌÂÚÓ ÒË ˜ÂÁ Ó·˘ÓÚÓ ‰ÛÊÂÒÚ‚Ó Ó˘Â Ò ‰‚ ‰ÂÒÂÚËÎÂÚËfl Ë Ôӂ˜Â. á‡ÒÎÛʇ‚‡Ú ÓÚ·ÂÎflÁ‚‡Ì ÌflÍÓË ÔÓ-Ò˙˘ÂÒÚ‚ÂÌË ËÁfl‚Ë Ì‡ ‰ÛÊÂÒÚ‚ÓÚÓ ‚ ÔÂÁ ËÁÚÂÍÎËfl ÔÂËÓ‰. èÂÁ 1962 „. ÚÓ Ó„‡ÌËÁË‡ χÎ͇ ̇ۘ̇ ÒÂÒËfl ‚ Ò. ŇÌfl, ä‡ÎÓ‚ÒÍÓ, ‚˙ıÛ "êÂı‡·ËÎËÚ‡ˆËflÚ‡ ̇ Ó„‡Ì˘ÌËÚ Á‡·ÓÎfl‚‡ÌËfl ̇ „˙·Ì‡˜ÌËfl ÏÓÁ˙Í Ë ÔÂËÙÂ̇ڇ ÌÂ‚̇ ÒËÒÚÂχ", ‡ ÔÂÁ 1964 „., Ô‡Í Ú‡Ï - ‚ÚÓ‡ ̇ۘ̇ ÍÓÌÙÂÂ̈Ëfl ‚˙ıÛ "êÂı‡·ËÎËÚ‡ˆËflÚ‡ ̇ Ì‚ÓÎӄ˘ÌËÚ Á‡·ÓÎfl‚‡ÌËfl" . óÎÂÌÓ‚ÂÚ ̇ ‰ÛÊÂÒÚ‚ÓÚÓ ‚ÁÂÏ‡Ú ‡ÍÚË‚ÌÓ Û˜‡ÒÚË ÔÂÁ 1964 ‚ „ËÓ̇Î̇ڇ Ò¢‡ ÔÓ ‚˙ÔÓÒËÚ ̇ ‰ËÒÍÓ„ÂÌÌËfl Ë¯Ë‡Ò Ë Ì„ӂÓÚÓ Î˜ÂÌË ‚ 臂ÂÎ ·‡Ìfl Ë ‚ Ôӂ‰Â̇ڇ ‚˙‚ ÇÂÎËÍÓ í˙ÌÓ‚Ó ç‡ˆËÓ̇Î̇ ÍÓÌÙÂÂ̈Ëfl ÔÓ ÔÓÎËÍÎËÌ˘̇ڇ Ì‚ÓÎӄ˘̇ ÔÓÏÓ˘. Ç ‰ÛÊÂÒÚ‚ÓÚÓ Ò ӷÒ˙ʉ‡Ú Ó·ÒÚÓÈÌÓ ÔÓÂÍÚÓÔ·ÌÓ‚ÂÚ Á‡ ÔÂÒÔÂÍÚË‚ÌÓÚÓ ‡Á‚ËÚË ̇ Ì‚ÓÎӄ˘̇ڇ Ë ÔÒËıˇÚ˘̇ڇ ÔÓÏÓ˘ Û Ì‡Ò Á‡ ÔÂËÓ‰‡ 1965 - 1989 „. ÇÁÂχ Û˜‡ÒÚË ‚ Ó„‡ÌËÁË‡ÌÂÚÓ Ì‡ ̇ˆËÓ̇Î̇ ̇ۘ̇ ÍÓÌÙÂÂ̈Ëfl ÔÂÁ 1970 „. ‚ èÎÓ‚‰Ë‚, ÔÓÒ‚ÂÚÂ̇ ̇ Í·ÒËÙË͇ˆËflÚ‡ Ë ÌÓÏÂÌÍ·ÚÛ‡Ú‡ ̇ ÌÂ‚ÌËÚÂ Ë ÔÒËı˘ÌËÚ Á‡·ÓÎfl‚‡ÌËfl.ë˙˘ËflÚ ‚˙ÔÓÒ Â Ó·Ò˙ʉ‡Ì „Ó‰ËÌË ÔÂ‰Ë ÚÓ‚‡ ‚ ‰ÛÊÂÒÚ‚ÓÚÓ. ç‡ ÍÓÌÙÂÂ̈ËflÚ‡ Ò‡ ËÁÌÂÒÂÌË 3 ÓÒÌÓ‚ÌË ‰ÓÍ·‰‡ Ë 9 Ò˙‰ÓÍ·‰‡.èÂÁ 1971 „. ‚ èÎÓ‚‰Ë‚ Ò ÔÓ‚Âʉ‡ IV-Ú‡ ÔÓ‰-

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̇ Ò¢‡ ÏÂÊ‰Û Ì‚ÓÎÓÁË, ÔÒËıˇÚË Ë Ì‚ÓıËÛÁË ÓÚ ëÍÓÔËÂ, ç˯, ëÓÙËfl Ë èÎÓ‚‰Ë‚. èÎÓ‚‰Ë‚ÒÍÓÚÓ Ì‡Û˜ÌÓ ‰ÛÊÂÒÚ‚Ó ÒÚ‡‚‡ ‰ÓχÍËÌ Ë Ì‡ „Ӊ˯̇ڇ ̇ۘ̇ ÒÂÒËfl ÔÓ ÍÎËÌ˘̇ ÂÎÂÍÚÓÂ̈ÂÙ‡ÎÓ„‡ÙËfl Ë ÂÎÂÍÚÓÙËÁËÓÎÓ„Ëfl ÔÂÁ 1973 „., ̇ ÍÓflÚÓ Ò ËÁ̇ÒflÚ 25 ̇ۘÌË ‰ÓÍ·‰‡ Ë Ò˙Ó·˘ÂÌËfl. ÑÛÊÂÒÚ‚ÓÚÓ Ó„‡ÌËÁË‡ ˜ÂÒÚ‚‡ÌËfl ̇ ‰ˈ‡ „Ӊ˯ÌËÌË Ë ˛·ËÎÂË. èÂÁ 1957 „. Ò ˜ÂÒÚ‚‡ Ú˙ÊÂÒÚ‚ÂÌÓ 60-„Ӊ˯ÌË̇ڇ ̇ ÔÓÙ. ä. óÓ·ÍÓ‚, ÔÂÁ 1960 „. - 30-„Ӊ˯̇ڇ Ì‚ÓÎӄ˘̇ Ë ÔÂÔÓ‰‡‚‡ÚÂÎÒ͇ ‰ÂÈÌÓÒÚ Ì‡ ÔÓÙ. í. á‡ÔflÌÓ‚, ‡ ÔÂÁ 1973 „. Ò ËÁ̇Òfl ‰ÓÍ·‰ Á‡ ÔÓÙ. Ä. Ö. üÌ˯‚ÒÍË ÔÓ ÔÓ‚Ó‰ 100 „Ó‰ËÌË ÓÚ ÓʉÂÌËÂÚÓ ÏÛ. óÂÒÚ‚‡ ÒÂ Ë 75-Ú‡ „Ӊ˯ÌË̇ ̇ ‰Óˆ. ü. ç‡Ï˘‚ ÔÂÁ 1985 „. òÂÒÚ ÏÂÒˆ‡ ÒΉ ÒÏ˙ÚÚ‡ ̇ ÔÓÙ. ä. óÓ·ÍÓ‚ Ò Ô‡‚Ë ‚˙ÁÔÓÏÂ̇ÚÂÎÌÓ Ò˙·‡ÌËÂ Ò „ÓÒÚË ÓÚ ˆfl·ڇ ÒÚ‡Ì‡. éÚÔ˜‡Ú‚‡ ÒÂ Ë ‚˙ÁÔÓÏÂ̇ÚÂÎÂÌ Ò·ÓÌËÍ "äËËÎ óÓ·ÍÓ‚ in memoriam". èÓ-Í˙ÒÌÓ, ÒΉ 5 Ë 10 „Ó‰ËÌË ÓÚ ÒÏ˙ÚÚ‡ ÏÛ, ‚ 1968 Ë 1973 „., Ò ÔÓ‚Âʉ‡Ú ‰Û„Ë Ò˙·‡ÌËfl ÔÓ ÚÓÁË ÔÓ‚Ó‰. óÂÒÚ‚‡ Ò Ú˙ÊÂÒÚ‚ÂÌÓ Ë 80-„Ӊ˯ÌË̇ڇ ÓÚ Ì„ӂÓÚÓ ÓʉÂÌËÂ. íÂÁË ËÁfl‚Ë Ò‡ Ú‚˙‰Â ÒÍÓÏÌÓ ËÁ‡ÁÂ̇ ·Î‡„Ó‰‡ÌÓÒÚ Í˙Ï ÔÓÙ. óÓ·ÍÓ‚ ÓÚ Ì‡Ò Ì„ӂËÚ ۘÂÌˈË. ÉÓÎflχ  ӷ˘ÂÒÚ‚Â̇ڇ Ë Ì‡Û˜ÌÓ-ÔÓÒ‚ÂÚ̇ڇ ‰ÂÈÌÓÒÚ Ì‡ ‰ÛÊÂÒÚ‚ÓÚÓ. çÂ„Ó‚Ë ˜ÎÂÌÓ‚Â ÂÊ„ӉÌÓ ËÁ̇ÒflÚ Ì‡Û˜ÌÓ-ÔÓÔÛÎflÌË Á‰‡‚ÌË ·ÂÒ‰Ë, ÌÂfl‰ÍÓ - ̇‰ 50 60 „Ӊ˯ÌÓ. èÓÔÛÎflËÁË‡Ú Ò ̇ۘÌË Á̇ÌËfl Ë ‚ ÔÂÒ‡Ú‡, ˜ÂÁ ÎÂ͈ËË ‚ ‡Á΢ÌË ‚˜ÂÌË ÍÛÒÓ‚Â, ÎÂÍÚÓËË Í˙Ï ë˙˛Á‡ ̇ ̇ۘÌËÚ ‡·ÓÚÌËˆË ‚ èÎÓ‚‰Ë‚ Ë Ô. èÓÙ. Ç. åËÚÍÓ‚, ‰- Å. äÛÍ·‰ÊË‚ Ë ‰- è. åÓΉӂ‡ÌÒ͇ Ò‡ ̇È-‡ÍÚË‚ÌË ‚ Ó„‡ÌËÁË‡Ì‡Ú‡ ̇¯ËÓÍÓ ‚ „‡‰‡ ÔÓÔ‡„‡Ì‰‡ ÒÂ˘Û ‡ÎÍÓıÓÎËÁχ Ë Ú˛Ú˛ÌÓÔÛ¯ÂÌÂÚÓ. óÎÂÌӂ ̇ ‰ÛÊÂÒÚ‚ÓÚÓ „ÓÒÚÛ‚‡Ú Ò ËÁ̇ÒflÌ ̇ ̇ۘÌË ‰ÓÍ·‰Ë ̇ ‰Û„Ë ‰ÛÊÂÒÚ‚‡ Û Ì‡Ò /ëÓÙËfl, ëÚ‡‡ ᇄÓ‡/, Û˜‡ÒÚ‚‡Ú ‚ ‰ˈ‡ ÏÂʉÛ̇Ó‰ÌË ÒËÏÔÓÁËÛÏË Ë ÍÓÌ„ÂÒË. íÓ Ò ÔÓÒ¢‡‚‡ ÓÚ ÏÌÓ„Ó „ÓÒÚË Í‡ÍÚÓ ÓÚ ÒÚ‡Ì‡Ú‡, ڇ͇ Ë ÓÚ ˜ÛÊ·Ë̇. éÒÓ·ÂÌÓ ËÌÚÂÂÒÌË Ò‡ ·ËÎË „ÓÒÚÛ‚‡ÌËflÚ‡ ̇ ˜ÛʉÂÒÚ‡ÌÌË ÒÔˆˇÎËÒÚË ÓÚ êÛÏ˙ÌËfl, û„ÓÒ·‚Ëfl, ëëëê, ÉÑê, Ä‚ÒÚËfl, îêÉ, î‡ÌˆËfl, ÄÌ„ÎËfl, ïÓ·̉Ëfl Ë ëÄô, .˜ËÈÚÓ ·ÓÈ Ì‡‰ı‚˙Îfl 45 ‰Û¯Ë. í Ò Ô‰ÒÚ‡‚flÚ Ô‰ ‰ÛÊÂÒÚ‚ÓÚÓ Ò Ì‡Û˜ÌË ‰ÓÍ·‰Ë Ë ÒÔÓ‰ÂÎflÚ Ô‰ Ì‡Ò ‚˙ÎÌÛ‚‡˘ËÚ „Ë ÔÓ·ÎÂÏË. àÁÌÂÒÂÌËÚ ÓÚ Úflı ‰ÓÍ·‰Ë Ò‡ ‰ÓÍÛÏÂÌÚË‡ÌË ÔÓ Á‡„·‚Ëfl, ‡‚ÚÓË Ë ‰‡ÚË ÓÚ ‰- è. åÓΉӂ‡ÌÒ͇ ͇ÚÓ ÒÂÍÂÚ‡ ̇ ‰ÛÊÂÒÚ‚ÓÚÓ . çflÍÓË ÓÚ ÚÂÁË ‰ÓÍ·‰Ë Ò Ô‰ËÏÌÓ Ì‚ÓÎӄ˘̇ ÚÂχÚË͇ Ò‡ ÔÓÒÓ˜ÂÌË ‚ ÍÌË„‡Ú‡ "ÅÂÎÂÊÍË Í˙Ï ËÒÚÓËflÚ‡ ̇ Ì‚ÓÎÓ„ËflÚ‡ ‚ èÎÓ‚‰Ë‚ÒÍËfl Í‡È" /Ç. åËÚÍÓ‚, 2000 „./. 燂˙¯ËÎÓ 25-Ú‡ ÒË „Ӊ˯ÌË̇ Ó·˘ÓÚÓ Ì‡Û˜ÌÓ ‰ÛÊÂÒÚ‚Ó ÓÒÚ‡‚fl ·Ó„‡Ú‡ Ë ‡ÁÌÓÓ·‡Á̇ ‰ÂÈÌÓÒÚ. ÑÛ¯‡, ‰‚Ë„‡ÚÂÎ Ë ÌÂÛÏÓËÏ Ó„‡ÌËÁ‡ÚÓ ̇ Ì„ӂËÚ ËÁfl‚Ë Â ‰ è. åÓΉӂ‡ÌÒ͇. èӂ‰ÂÌË Ò‡ ÔÓ˜ÚË 300 ̇ۘÌË Á‡Ò‰‡ÌËfl Ò ËÁÌÂÒÂÌË Ì‡‰ 500 ‰ÓÍ·‰‡, ÏÂÊ‰Û ÍÓËÚÓ - 39 ÓÚ ËÁÚ˙Í̇ÚË ˜ÛʉÂÒÚ‡ÌÌË ÒÔˆˇÎËÒÚË. èÓÒ¢‡ÂÏÓÒÚÚ‡ ̇ Ò˙·Ë‡ÌËflÚ‡  ·Ë· ‚Ë̇„Ë „ÓÎflχ, Ò‰ÌÓ - ÓÚ 3040 ‰Ó 50 ‰Û¯Ë. ᇠ˜ÂÚ‚˙Ú‚ÂÍӂ̇ڇ Ú‚Ó˜ÂÒ͇ Ë Ó·˘ÂÒÚ‚ÂÌÓ-ÔÓÎÂÁ̇ ‰ÂÈÌÓÒÚ Ì‡ ̇ۘÌÓÚÓ ‰ÛÊÂÒÚ‚Ó ‰- è. åÓΉӂ‡Ì-


‡ÔËÎ, 2002

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

Ò͇ ËÁ„ÓÚ‚Ë Ó·ÒÚÓÂÌ ÓÚ˜ÂÚÂÌ ‰ÓÍ·‰ ‚ Ó·ÂÏ Ì‡ 12 χ¯ËÌÓÔËÒÌË ÒÚ‡ÌˈË, ÍÓÈÚÓ Úfl ËÁÌÂÒ ̇ Ì„ӂÓÚÓ ÔÓÒΉÌÓ Á‡Ò‰‡ÌËÂ, Ò˙ÒÚÓflÎÓ Ò ̇ 2 ‰ÂÍÂÏ‚Ë 1977 „, ÑÓ‚ÓÎÌË ÓÚ ËÁ‚˙¯ÂÌÓÚÓ ÔÂÁ ËÁÚÂÍÎËÚ 25 „Ó‰ËÌË, ÓÚ‡ÁÂÌÓ ‚ ÓÚ˜ÂÚÌËfl ‰ÓÍ·‰, ̇ÒËÚÂÌ Ò ÏÌÓ„Ó Ù‡ÍÚË Ë Ò˙Ò Ò˙ÓÚ‚ÂÚ̇ ÂÏÓˆËÓ̇Î̇ Óˆ‚ÂÚ͇, Ô‰ÒÚÓ¯ ‡Á‰ÂÎflÌ ̇ ‰ÛÊÂÒÚ‚ÓÚÓ Ë Ó·ÓÒÓ·fl‚‡Ì ̇ ÚË Ò‡ÏÓÒÚÓflÚÂÎÌË ÔÓ-χÎÍË ‰ÛÊÂÒÚ‚‡ ÔÓ Ì‚ÓÎÓ„Ëfl, ÔÓ ÔÒËıˇÚËfl Ë ÔÓ Ì‚ÓıËÛ„Ëfl. íÓ‚‡ ·Â ‚˜ ̇Ô‡‚ÂÌÓ ‚ ëÓÙËfl. è‰ÒÚÓ¯ ‰‡ Ò ËÁ‚˙¯Ë Ë ‚ èÎÓ‚‰Ë‚ÒÍËfl ÍÎÓÌ. Ç ‰ÓÍ·‰‡ ÒË ‰- è. åÓΉӂ‡ÌÒ͇ ‡ÁÍË‚‡ Ì ҇ÏÓ Î˘ÌÓÚÓ ÒË ÂÏÓˆËÓ̇ÎÌÓ ËÁÊË‚fl‚‡Ì ÔÓ ÔÓ‚Ó‰ ̇ ‡ÁÎ˙͇ڇ, ÌÓ Ô‡‚Ë ‚Ò˘ÍË ÌË Ò˙Ô˘‡ÒÚÌË Ì‡ ÚÓÁË ÏÓÏÂÌÚ. ô ÒË ÔÓÁ‚ÓÎfl ‰‡ ˆËÚË‡Ï ÌflÍÓË Á‡Íβ˜ËÚÂÎÌË Ô‡Ò‡ÊË ÓÚ Á‡Ô‡ÁÂÌËfl ÓË„Ë̇ÎÂÌ ÂÍÁÂÏÔÎfl ̇ ‰ÓÍ·‰‡, ÔÓ‰ ÍÓÈÚÓ ‚ÒÂÍË ÓÚ Ì‡Ò ·Ë Ò ÔÓ‰ÔËÒ‡Î Ë Ò„‡. Ç Úflı ÓÒÓ·ÂÌÓ ÓÒÂÁ‡ÂÏÓ Ò ˜Û‚ÒÚ‚‡ Ë ÌÂÈÌËflÚ Ú‚Ó˜ÂÒÍË ÂÏÓˆËÓ̇ÎÂÌ Á‡fl‰ ͇ÚÓ ‰˙΄ӄӉ˯ÂÌ ÒÂÍÂÚ‡ ̇ Ó·˘ÓÚÓ Ì‡Û˜ÌÓ ‰ÛÊÂÒÚ‚Ó. ᇂ˙¯‚‡ÈÍË ËÁÎÓÊÂÌËÂÚÓ ÒË Ò ÔˆÂÌ͇ Á‡ ‚ËÒÓÍÓ ÌË‚Ó Ì‡ ̇ۘÌËfl ÊË‚ÓÚ ‚ ‰ÛÊÂÒÚ‚ÓÚÓ, Úfl ÒÔÓ‰ÂÎfl, ˜Â ËÁÔËÚ‚‡ "Ìfl͇͂‡ ÓÒÓ·Â̇ ‡‰ÓÒÚ Ò ÌÓÚÍË Ì‡ „Ó‰ÓÒÚ Á‡ ÚÓ‚‡, ˜Â ÔÂÁ ÚÓÁË ˜ÂÚ‚˙Ú ‚ÂÍ ÌË ÒÏ Ô‡‚ËÎË Ì¢Ó, ÓÒÏËÒÎflÎË ÒÏ ÊË‚ÓÚ‡ ÒË Ò ÌÂ˘Ó ‰Ó·Ó. Ç Ì‡¯ÂÚÓ ‰ÛÊÂÒÚ‚Ó ‚Ò˘ÍË ‡·ÓÚËıÏÂ Ò Ô·Ï". à ÔÓ-̇ڇÚ˙Í: "Ç Ô‡ÏÂÚÚ‡ ÏË ‚˙ÁÍ˙Ò‚‡Ú ̇È-flÍÓ Ô˙‚ËÚ „Ó‰ËÌË ÓÚ ‰ÛÊÂÒÚ‚ÓÚÓ, ‡ ÚÓ‚‡ Ò‡ Ë Ô˙‚ËÚ „Ó‰ËÌË Ì‡ ÎÂ͇Ò͇ڇ ÏË Ô‡ÍÚË͇. à ‚Ë̇„Ë "‚Ëʉ‡Ï" ÔÓ‰˙΄ӂ‡Ú‡Ú‡ χ҇ ‚ „ÓÌËfl ÂÚ‡Ê Ì‡ Ì‚ÓÔÒËıˇÚ˘̇ڇ ÍÎËÌË͇, ̇ӷËÍÓÎÂ̇ ÓÚ Ï·‰Ë, ʇ‰ÌË Á‡ Á̇ÌËfl, Ú˙ÒÂ˘Ë ıÓ‡. à ‰‡ÎË ·ÛÈÌËflÚ Ú‚Ó˜ÂÒÍË Ô·Ï˙Í Ì‡ ÔÓÙ. óÓ·ÍÓ‚ ÌË ÔÓ‰Âχ¯Â, ‰‡ÎË ÚÓ‚‡ ·Â¯Â ҇χڇ Ï·‰ÓÒÚ, ‰‡ÎË ·flıÏ ҂ËÍ̇ÎË ‰‡ Ô˙ÎÌËÏ ÊË‚ÓÚ‡ ÒË Ò ˆÂÌÌÓ Ò˙‰˙ʇÌËÂ, ÌÓ Ë ÌË Ô·ÏÚflıÏÂ... èÓÌflÍÓ„‡ ˜‡ÒÓ‚ÌËÍ˙Ú, ÓÚÏÂ‚‡˘ Ò‰ÌÓ˘ÌËÚ ˜‡ÒÓ‚Â, ÌË "̇ÔÓÏÌfl¯Â", Ò˙‚ÒÂÏ ÁÂÏÌÓ, ˜Â  Í‡ÈÌÓ ‚ÂÏ ‰‡ ÔÂÍ‡ÚËÏ Û‚Î˜ÂÌËÂÚÓ ÒË. Ö‰ÌÓ‚ÂÏÂÌÌÓ Ò ‚Ò˘ÍÓ ÚÓ‚‡ ËÁÔËÚ‚‡Ï Ìfl͇͂‡ ÚËı‡ Ú˙„‡. ÑÛÊÂÒÚ‚ÓÚÓ Â Ò‚˙Á‡ÌÓ Ò ÏÓflÚ‡ Ï·‰ÓÒÚ, ÚÓ Â ·ËÎÓ ˜‡ÒÚ ÓÚ ÏÓfl ÊË‚ÓÚ. íÓ Â ÔÛÎÒË‡ÎÓ Á‡Â‰ÌÓ Ò ÏÂÌ, ‡Á Ò˙Ï ÒÚ‡‰‡Î‡ Á‡Â‰ÌÓ Ò Ì„Ó. á‡Â‰ÌÓ ÓÒÚ‡flıÏÂ. ç‡ÎÓÊËı‡ Ò ÌÓ‚Ë ÙÓÏË .Á‡ "ÓÒÚ‡flÎÓÚÓ" ‚˜ ‰ÛÊÂÒÚ‚Ó, ÚÓ Úfl·‚‡¯Â ‰‡ Ò ‡Á‰ÂÎË ÔÓ ÓÚ‰ÂÎÌË ÒÔˆˇÎÌÓÒÚË. éÚË‚‡ ÒË ÌÂÁ‡·ÂÎflÁ‡ÌÓ Ë Ì‡¯ÂÚÓ ‚ÂÏÂ. çÂ͇ ÒË ÔÓÊ·ÂÏ ‰‡ ·˙‰ÂÏ Ó˘Â ‰˙Î„Ó ‚ÂÏ -"ÊËÁÌÂÌË Ë Ú‚Ó˜ÂÒÍË ‡ÍÚË‚ÌË. çÂ͇ Ï·‰ËÚ ÍÓÎÂ„Ë ËÁÊË‚ÂflÚ ‚Ò˘ÍË Ì‡¯Ë ‡‰ÓÒÚË Ë Ó·Ó„‡ÚflÚ ÊË‚ÓÚ‡ ÒË Ó˘Â Ôӂ˜ Ò˙Ò Á̇ÌËfl! çÂ͇ ‚Ò˘ÍË ËχÏ Á‰‡‚Â Ë ÒËÎË ‰‡ ‡·ÓÚËÏ ‚Ò ڇ͇ ‰Ó· - Ë Ó˘Â ÔÓ-‰Ó·Â!" „. èÎÓ‚‰Ë‚, 2 ‰ÂÍÂÏ‚Ë 1977 „. ëÂÍÂÚ‡:/Ô/ ‰- è.åÓΉӂ‡ÌÒ͇ ífl ÓÒÚ‡‚Ë „ËÊÎË‚Ó Ò˙ı‡ÌÂÌË ˆÂÌÌË ‡ıË‚ÌË Ï‡ÚÂˇÎË ‚ ·Ë·ÎËÓÚÂ͇ڇ ̇ ͇Ú‰‡Ú‡ ÔÓ ÔÒËıˇÚËfl Á‡ ‰ÂÈÌÓÒÚÚ‡ ̇ ̇ۘÌÓÚÓ ‰ÛÊÂÒÚ‚Ó, ÌÓ ÌflÍÓË ÓÚ Úflı /ÓÚ˜ÂÚÌË ‰ÓÍ·‰Ë, ÙÓÚÓÒÌËÏÍË ÓÚ ˜ÂÒÚ‚‡ÌËfl ̇ „Ӊ˯ÌËÌË Ë ‰Û„Ë/ Ò Ò˙ı‡Ìfl‚‡Ú Ë ‚ ‰Óχ¯Ì‡Ú‡ ÌË ·Ë·ÎËÓÚÂ͇,˜‡ÒÚ ÓÚ ÍÓËÚÓ ËÁÔÓÎÁ‚‡ı ‚ ̇ÒÚÓfl˘‡Ú‡ ÒÚ‡ÚËfl ç‡ Ò˙˘‡Ú‡ ‰‡Ú‡, 22 ‰ÂÍÂÏ‚Ë 1977 „., ÔÓÙ. Ç. åËÚ-

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ÍÓ‚, ÔÓÒΉÂÌ è‰Ò‰‡ÚÂΠ̇ Ó·˘ÓÚÓ Ì‡Û˜ÌÓ ‰ÛÊÂÒÚ‚Ó, Á‡ÍË‚‡ ÔÓÒΉÌÓÚÓ ÓÚ˜ÂÚÌÓ Ò˙·‡ÌË ̇ ÚÓ‚‡ ‰ÛÊÂÒÚ‚Ó Ë ËÁ͇Á‚‡ ÔÓÊ·ÌË Á‡ ÔÓ-Ò‚ÂÚÎË ÔÂÒÔÂÍÚË‚Ë Ì‡ ·˙‰Â˘ËÚ ҇ÏÓÒÚÓflÚÂÎÌË Ì‡Û˜ÌË ‰ÛÊÂÒÚ‚‡ ÔÓ Ì‚ÓÎÓ„Ëfl, ÔÒËıˇÚËfl Ë Ì‚ÓıËÛ„Ëfl, ͇ÚÓ ËÏ ÔÂÔÓ˙˜‚‡ ‰‡ Ì ÔÂÍ˙Ò‚‡Ú ̇Ô˙ÎÌÓ ÍÓÌÚ‡ÍÚËÚ ÔÓÏÂÊ‰Û ÒË Ë ‰‡ Ò˙ı‡Ìfl‚‡Ú ÛÚ‚˙‰ÂÌËÚ ÔÓÎÓÊËÚÂÎÌË Ú‡‰ËˆËË èéÇíéêçé çÄóÄãé ç Á‡Í˙ÒÌfl‚‡Ú Ôӂ‰ÂÌËÚ ÔÂÁ ‰ÂÍÂÏ‚Ë 1977 „. ËÁ·ÓÌË Ò˙·‡ÌËfl Á‡ Ô˙‚ËÚ ˙ÍÓ‚Ó‰ÒÚ‚‡ ̇ ÌÓ‚ÓÒ˙Á‰‡‰ÂÌËÚ ҇ÏÓÒÚÓflÚÂÎÌË Ì‡Û˜ÌË ‰ÛÊÂÒÚ‚‡ ÔÓ ÒÔˆˇÎÌÓÒÚË. ᇠÔ‰Ò‰‡ÚÂÎË Ì‡ ÚÂÁË ‰ÛÊÂÒÚ‚‡ Ò ËÁ·Ë‡Ú ÔÓÙ. Å. åËÚÍÓ‚ ̇ ̇ۘÌÓÚÓ ‰ÛÊÂÒÚ‚Ó Ì‡ Ì‚ÓÎÓÁËÚÂ, ÔÓÙ. í. 퇯‚ - ̇ ÔÒËıˇÚËÚÂ Ë ÔÓÙ. Ñ. äËÚÓ‚ ̇ Ì‚ÓıËÛÁËÚÂ. Ñ- è. åÓΉӂ‡ÌÒ͇  ËÁ·‡Ì‡ Á‡ ÒÂÍÂÚ‡ ̇ ̇ۘÌÓÚÓ ‰ÛÊÂÒÚ‚Ó Ì‡ ÔÒËıˇÚËÚÂ. ífl  ÒÂÍÂÚ‡ Ë ‚ ÒΉ‚‡ÎËÚ ˙ÍÓ‚Ó‰ÒÚ‚‡ ̇ ‰ÛÊÂÒÚ‚ÓÚÓ Ì‡ ÔÒËıˇÚËÚ ‰Ó ÌÂÈÌÓÚÓ ÔÂÌÒËÓÌË‡Ì ÔÂÁ 1985 „. ç‡ 10 ˛ÌË 2002 „.  50-„Ӊ˯ÌË̇ڇ ̇ ̇ۘÌÓÚÓ ‰ÛÊÂÒÚ‚Ó Ì‡ Ì‚ÓÎÓÁËÚÂ, ÔÒËıˇÚËÚÂ Ë Ì‚ÓıËÛÁËÚ ‚ èÎÓ‚‰Ë‚ Ë Ì‡ ̇ÒΉËÎËÚ „Ó Ò‡ÏÓÒÚÓflÚÂÎÌË ‰ÛÊÂÒÚ‚‡ ÔÓ ÒÔˆˇÎÌÓÒÚË. ᇠʇÎÓÒÚ Ú‡ÁË „Ӊ˯ÌË̇ Ì ˘Â ·˙‰Â ÔÓ˜ÂÚÂ̇ ÓÚ ÏÌÓÁË̇ ÌÂ„Ó‚Ë Û˜‰ËÚÂÎË Ë ˜ÎÂÌÓ‚Â, ÍÓËÚÓ Ì ҇ ‚˜ ÏÂÊ‰Û ÊË‚ËÚÂ: ‰- à‚‡Ì ÑÂ̘‚, ÔÓÙ. äËËÎ óÓ·ÍÓ‚, ‰- à‚‡Ì ä‡·Î¯ÍÓ‚, ‰- à‚‡Ì íÛÌ‚, ‰- ÄÒÂÌ ëÚÓflÌÓ‚, ‰- à‚‡Ì͇ í‡Ì‚‡, ‰Óˆ. üÌÍÓ ç‡Ï˘‚, ÒÚ. Ì. Ò. åËÌ˜Ó Ñ‡„Ë‚, ‰- ÑËÏËÚ˙ ÄÔÓÒÚÓÎÓ‚, ‰- ç‡È‰ÂÌ ëÚÓflÌÓ‚, ‰- ÄÌ„ÂÎ íÓÏÓ‚, ‰- ã‡Ï·Ó ïËÒ‡ÌÚÓ‚, ÔÓÙ. í‡ÈÍÓ á‡ÔflÌÓ‚, ÔÓÙ. ÑËÏËÚ˙ äËÚÓ‚, ÔÓÙ. á·ÚÍÓ ëÔ‡ÒÓ‚, ‰- LJÒËΠŇڇÍÎË‚, ‰- èÂÌ͇ åÓΉӂ‡ÌÒ͇ Ë ‰Û„Ë, ÓÒÚ‡‚ËÎË ÌÂÁ‡Î˘ËÏË ‰ËË ÒΉ Ò· ÒË. Ñ˙ηÓÍ ÔÓÍÎÓÌ Ô‰ Ò‚ÂÚ·ڇ ËÏ Ô‡ÏÂÚ. ëΉ Í‡ÚÍÓ ËÁÎÓÊÂ̇ڇ ËÒÚÓËfl ̇ ̇ۘÌÓÚÓ ‰ÛÊÂÒÚ‚Ó Ì‡ Ì‚ÓÎÓÁËÚÂ, ÔÒËıˇÚËÚÂ Ë Ì‚ÓıËÛÁËÚ ‚ èÎÓ‚‰Ë‚, ·Ëı ÊÂ·Π‰‡ ÔË·‡‚fl, ˜Â ‰˙ηÓÍÓ Ò ‚˙ÎÌÛ‚‡Ï ‚ ̇‚˜ÂËÂÚÓ Ì‡ Ì„ӂ‡Ú‡ 50-„Ӊ˯ÌË̇. à ‰ÌÂÒ, ͇ÍÚÓ ÔÂ‰Ë 25 „Ó‰ËÌË ÔË ‡Á‰ÂÎflÌÂÚÓ ÏÛ, ËÁÔËÚ‚‡Ï ˜Û‚ÒÚ‚Ó Ì‡ „ÓÎflÏÓ Á‡‰Ó‚ÓÎÒÚ‚Ó ÓÚ Ì„ӂ‡Ú‡ ˆflÎÓÒÚ̇ ‰ÂÈÌÓÒÚ Ë Ò˙˘Â‚ÂÏÂÌÌÓ - ˜Û‚ÒÚ‚Ó Ì‡ ÓÒÓ·Â̇ Ú˙„‡ Á‡ ·ÂÁ‚˙Á‚‡ÚÌÓ ËÁÚÂÍÎÓÚÓ Ú‚Ó˜ÂÒÍÓ ‚ÂÏÂ. éÒÏËÒÎflÈÍË Ú‡ÁË ËÒÚÓËfl, ‚Ò˘ÍË ÒÏ ÏÓ‡ÎÌÓ Á‡‰˙ÎÊÂÌË ‰‡ „Ή‡ÏÂ Ò ‚fl‡ ̇Ô‰ Á‡ Ӣ ÔÓ-„ÓÎflχ ‡ÍÚË‚ÌÓÒÚ ‚ ӷ·ÒÚÚ‡ ̇ Ì‚ÓÎÓ„ËflÚ‡, ÔÒËıˇÚËflÚ‡ Ë Ì‚ÓıËÛ„ËflÚ‡ ÔÂÁ ÒΉ‚‡ÎËÚ „Ó‰ËÌË, Ò ÍÓÂÚÓ ˘Â ‰‡‰ÂÏ Ò‚Ófl ÌÂÓˆÂÌËÏ ÔËÌÓÒ Í˙Ï Á‰‡‚ÌÓÚÓ ·Î‡„ÓÔÓÎۘˠ̇ ·˙΄‡ÒÍËfl ̇Ó‰.


‡ÔËÎ, 2002

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

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ÑÄççàíÖ éí èêéìóÇÄçÖíé EVIDENCE ëéóÄí, óÖ áÄ 48 ëÖÑåàñà èÄñàÖçíàíÖ, ãÖäìÇÄçà ë REBIF àåÄí åçéÉé èé-Ééãüå òÄçë ÑÄ çÖ èêÖÜàÇÖüí èêàëíöè, Ç ëêÄÇçÖçàÖ ë èÄñàÖçíàíÖ çÄ AVONEX êÂÁÛÎÚ‡ÚËÚ ÓÚ ÔÓÛ˜‚‡ÌÂÚÓ EVIDENCE-Rebif (·ÂÚ‡ ËÌÚÂÙÂÓÌ - 1‡ ÚË Ô˙ÚË Ò‰Ï˘ÌÓ s.c.) ÒÂ˘Û Avonex (·ÂÚ‡ ËÌÚÂÙÂÓÌ 1‡ - ‰ËÌ Ô˙Ú Ò‰Ï˘ÌÓ i.m.) Á‡ 48 Ò‰Ï˘ÂÌ ÔÂËÓ‰ ·flı‡ Ô‰ÒÚ‡‚ÂÌË ÓÚ Ñ- ï.èÂÌ˘ (å‰ˈËÌÒÍË ìÌË‚ÂÒËÚÂÚ ÇÂÏÓÌÚ), ËÁÒΉӂ‡ÚÂÎ ÓÚ Ì‡Û˜Ì‡Ú‡ „ÛÔ‡ EVIDENCE, ̇ „Ӊ˯̇ڇ Ò¢‡ ̇ ÄÏÂË͇ÌÒ͇ڇ Ä͇‰ÂÏËfl ÔÓ ç‚ÓÎÓ„Ëfl (ÄÄç). (Rockland, MA, USA, April 16, 2002 - Serono, S.A.) "ǘ  Ò˙‚ÒÂÏ flÒÌÓ, ˜Â ÍÎËÌ˘ÌÓÚÓ Ô‚˙ÁıÓ‰ÒÚ‚Ó Ì‡ Rebif ÒÔflÏÓ Avonex ÔÓ ÓÚÌÓ¯ÂÌË Ô‰ÓÚ‚‡Úfl‚‡Ì ̇ ÔËÒÚ˙ÔËÚ Ò Á‡Ô‡Á‚‡ Ë ‚ ‡ÏÍËÚ ̇ 48 Ò‰ÏˈË" - ͇Á‡ Ñ- èÂÌ˘. "íÓ‚‡  ÏÌÓ„Ó Ò˙˘ÂÒÚ‚ÂÌ ÂÁÛÎÚ‡Ú ‚ ΘÂÌËÂÚÓ Ì‡ åë, ͇ÍÚÓ Á‡ ÎÂ͇ËÚÂ, ڇ͇ Ë Á‡ Ô‡ˆËÂÌÚËÚÂ". éÒÌÓ‚ÌËflÚ ÔÓ͇Á‡ÚÂÎ Á‡ Ò‡‚ÌÂÌË ‚ EVIDENCE  ·ÓflÚ Ì‡ Ô‡ˆËÂÌÚËÚ ·ÂÁ ÔËÒÚ˙Ô ÎÂÍÛ‚‡ÌË Ò Rebif Ë Avonex ‚ ÔÓ‰˙ÎÊÂÌË ̇ 24 Ò‰ÏˈË. ᇠ48 Ò‰ÏËˆË 62% ÓÚ Ô‡ˆËÂÌÚËÚÂ, ÎÂÍÛ‚‡ÌË Ò Rebif ÓÒÚ‡‚‡Ú ·ÂÁ ÔËÒÚ˙Ô, ‚ Ò‡‚ÌÂÌËÂ Ò 52% Á‡ Avonex (ÒÚ‡ÚËÒÚ˘ÂÒÍË Á̇˜Ëχ ‡ÁÎË͇: p=0.009). èÓ ÔÓ͇Á‡ÚÂÎfl "Ò‚Ó·Ó‰ÂÌ ÓÚ ÔËÒÚ˙Ô", Ô‡ˆËÂÌÚËÚ ̇ Rebif ÔÓ͇Á‚‡Ú 19% Ô‚˙ÁıÓ‰ÒÚ‚Ó, ‚ Ò‡‚ÌÂÌËÂ Ò ÚÂÁË Ì‡ Avonex, ‚ ‡ÏÍËÚ ̇ 48 Ò‰ÏˈË. í‡ÁË ‡ÁÎË͇ Ò Á‡Ô‡Á‚‡ ÌÂÔÓÏÂÌÂ̇ ÓÚ ÓÚ˜ÂÚÂÌËÚ ÂÁÛÎÚ‡ÚË Á‡ 24 Ò‰Ï˘ÂÌ ÔÂËÓ‰. Ç Ò‡‚ÌÂÌËÂ Ò Ô‡ˆËÂÌÚËÚ ̇ Avonex, ÚÂÁË Ì‡ Rebif ËÏ‡Ú 30% ‰Û͈Ëfl ÔÓ ÓÚÌÓ¯ÂÌË ̇ ÔÓfl‚‡ ̇ Ô˙‚Ëfl ÔËÒÚ˙Ô ‚ ÔÓ‰˙ÎÊÂÌË ̇ 48-Ú Ò‰ÏËˆË Ì‡ ÔÓÛ˜‚‡ÌÂÚÓ ( < 0,003). éÒÌÓ‚ÌËÚ ÔÓ͇Á‡ÚÂÎË Á‡ Ò‡‚ÌÂÌË ÓÚ üåê, ÓÚ‡Áfl‚‡˘Ë ÏÓÁ˙˜ÌËÚ ÎÂÁËË, Ò‡ ËÁÏÂ‚‡ÌËÚ í2 ÎÂÁËË. 臈ËÂÌÚËÚ ̇ Rebif ËÏ‡Ú Á̇˜ËÚÂÎÌÓ ÔÓ-χÎÍÓ ‡ÍÚË‚ÌË ÎÂÁËË Ì‡ üåê (0,9), Ò‡‚ÌÂÌË Ò ÚÂÁË Ì‡ Avonex (1,4). í‡ÁË ÓÚÌÓÒËÚÂÎ̇ ‰Û͈Ëfl ÓÚ 36 % ‚ ÔÓÎÁ‡ ̇ Rebif  ۷‰ËÚÂÎ̇ Ë ÒÚ‡ÚËÒÚ˘ÂÒÍË Á̇˜Ëχ ( < 0,001). èÓ ÓÚÌÓ¯ÂÌË ̇ ·ÂÁÓÔ‡ÒÌÓÒÚÚ‡, 48-Ò‰Ï˘ÌÓÚÓ ÔÓÛ˜‚‡Ì ÔÓ͇Á‚‡, ˜Â Ë Rebif Ë Avonex Ò‡ Ò‚˙Á‡ÌË Ò˙Ò ÒıÓ‰ÂÌ ÔÓÙËΠ̇ ÒÚ‡Ì˘ÌËÚ ÂÙÂÍÚË, ‚Íβ˜‚‡˘ „ËÔÓÔÓ‰Ó·ÌË ÒËÏÔÚÓÏË, „·‚Ó·ÓÎËÂ, ÓÚÔ‡‰Ì‡ÎÓÒÚ Ë ÏÛÒÍÛÎÌË ·ÓÎÍË. Ç ÍÓ·ˆËfl Ò ÔÓ-‚ËÒÓ͇ڇ ‰ÓÁ‡ Ë ÔÓ-˜ÂÒÚ‡Ú‡ ÏÛ ‡ÔÎË͇ˆËfl, ΘÂÌËÂÚÓ Ò Rebif ÔÓ͇Á‚‡ ‚ Á̇˜ËÚÂÎÌÓ ÔÓ- ‚ËÒÓÍ ÔÓˆÂÌÚ ÓÚ ÒÎÛ˜‡ËÚ ÒΉÌËÚ ÒÚ‡Ì˘ÌË ÂÙÂÍÚË: ‡͈ËË Ì‡ ÏflÒÚÓÚÓ Ì‡ ‡ÔÎË͇ˆËflÚ‡ (83 % ÒÂ˘Û 28 %); ÔÓÏÂÌË ‚ ˜ÂÌÓ‰Ó·ÌËÚ ÂÌÁËÏË (18% ÒÂ˘Û 9%) Ë ÔÓÏÂÌË ‚ ÍÓ΢ÂÒÚ‚ÓÚÓ Ì‡ ·ÂÎËÚ Í˙‚ÌË ÍÎÂÚÍË (11% ÒÂ˘Û 5%). íÂÁË ÒÚ‡Ì˘ÌË ÂÙÂÍÚË ÌÂÁ̇˜ËÚÂÎÌÓ ÔÓ‚ÎËfl‚‡Ú ÒÔÓÒÓ·ÌÓÒÚÚ‡ ̇ Ô‡ˆËÂÌÚ‡ ‰‡ ·˙‰Â ÎÂÍÛ‚‡Ì, ‡ ÔË Ô‡ˆËÂÌÚËÚÂ, ÒÔflÎË Î˜ÂÌËÂÚÓ, Á‡‡‰Ë ÚÂÁË ÂÙÂÍÚË, Ìflχ ÒÚ‡ÚËÒÚ˘ÂÒÍË Á̇˜Ëχ ‡ÁÎË͇ ÏÂÊ‰Û Rebif Ë Avonex (5 % ÒÂ˘Û 3%). èÓ ÓÚÌÓ¯ÂÌË ̇ ÚÂÊÍËÚ ÒÚ‡Ì˘ÌË ÂÙÂÍÚË, Ì  ÓÚ·ÂÎflÁ‡Ì‡ ‡ÁÎË͇ ÏÂÊ‰Û Rebif Ë Avonex. çÂ˘Ó Ôӂ˜Â, Ó·˘ËflÚ ÔÓˆÂÌÚ Ì‡ Ô‡ˆËÂÌÚËÚ ÓÒڇ̇ÎË Ì‡ ÚÂ‡ÔËfl ÔÂÁ ‚Ò˘ÍËÚ 48 Ò‰ÏËˆË Â Ú‚˙‰Â ÒıÓ‰ÂÌ : 93% Á‡ Rebif ÒÂ˘Û 94% Á‡ Avonex. ÖÙÂÍÚ‡ ̇ ÌÂÛÚ‡ÎËÁË‡˘ËÚ ‡ÌÚËÚ· ‚Ò Ӣ Ì  ̇Ô˙ÎÌÓ ËÁflÒÌÂÌ*. éÚ ÚÓ‚‡ ÔÓÛ˜‚‡Ì  ‚ˉËÏÓ, ˜Â ‡ÌÚËÚ·ڇ Ì ÔÓ‚ÎËfl‚‡Ú Ò˙˘ÂÒÚ‚ÂÌÓ ÍÎËÌ˘̇ڇ ͇ÚË̇ Ë Ì ÓÔÓÓ˜‡‚‡Ú ÍÎËÌ˘ÌÓÚÓ Ô‚˙ÁıÓ‰ÒÚ‚Ó Ì‡ Rebif . èÓÛ˜‚‡ÌÂÚÓ EVIDENCE  ̇È-„ÓÎflÏÓÚÓ Ò˙‚ÂÏÂÌÌÓ ÔÓÛ˜‚‡ÌÂ, ÍÓÂÚÓ ÔflÍÓ Ò‡‚Ìfl‚‡ ‰‚ ÓÚ ÎÂ͇ÒÚ‚‡Ú‡, ÔÓ‚ÎËfl‚‡˘Ë ‡Á‚ËÚËÂÚÓ Ì‡ ÏÌÓÊÂÒÚ‚Â̇ڇ ÒÍÎÂÓÁ‡ ‚ ÌÂÈ̇ڇ ÔËÒÚ˙ÔÌÓ - ÂÏËÚÂÌÚ̇ ÙÓχ. 臈ËÂÌÚËÚ ҇ ·ËÎË ÓˆÂÌfl‚‡ÌË ÏÌÓ„ÓÍ‡ÚÌÓ ÔÓ ‚ÂÏ ̇ ÔÓÛ˜‚‡ÌÂÚÓ, ÍÎËÌ˘ÌÓ Ë ÔÓ üåê. èÓÛ˜‚‡ÌÂÚÓ Â ÓÚÍËÚÓ, ‡Ì‰ÓÏËÁË‡ÌÓ, ÒÎflÔÓ Á‡ ÓˆÂÌËÚÂÎËÚ (ÓˆÂÌfl‚‡˘ËÚ „Ë Ì‚ÓÎÓÁË Ë ÂÌÚ„ÂÌÓÎÓÁË Ò‡ ·ËÎË "Á‡ÒÎÂÔÂÌË" ÔÓ ÓÚÌÓ¯ÂÌË ̇ ‚ˉ‡ ̇ ÔËÂχÌËfl ËÌÚÂÙÂÓÌ), ‚Íβ˜‚‡ 677 Ô‡ˆËÂÌÚ‡, Ò ÔËÒÚ˙ÔÌÓ-ÂÏËÚÂÌÚ̇ ÙÓχ ̇ åë, Ì ÎÂÍÛ‚‡ÌË ‰Ó ÏÓÏÂÌÚ‡ Ò ËÌÚÂÙÂÓÌË, ̇ ‚˙Á‡ÒÚ 18-55 „. ÓÚ 56 åë ˆÂÌÚ˙‡ ‚ ëÄô, ä‡Ì‡‰‡ Ë Ö‚ÓÔ‡. Rebif  ӉӷÂÌ ‚ Ö‚ÓÔ‡ ÔÂÁ 1998 „. Ë ÓÚ ÚÓ„‡‚‡  „ËÒÚË‡Ì ‚ ̇‰ 70 ÒÚ‡ÌË ÔÓ Ò‚ÂÚ‡. èÂÁ 2001 „. Rebif ÒË Á‡‚Ó˛‚‡ ‚Ó‰Â˘Ë ÔÓÁˈËË ‚ ÚÂÁË ‰˙ʇ‚Ë, ͇ÚÓ Ò‰ÒÚ‚Ó Ì‡ Ô˙‚Ë ËÁ·Ó ‚ ΘÂÌËÂÚÓ Ì‡ Ô‡ˆËÂÌÚË Ò èêåë Ò Ô‡Á‡ÂÌ ‰flÎ 38% Ë ÔÓ‰‡Ê·Ë ÓÚ 379.6 ÏÎÌ. ‰Ó·‡, ·ÂÁ ‰‡ ÔËÒ˙ÒÚ‚‡ ̇ ‡ÏÂË͇ÌÒÍËfl Ô‡Á‡. èÓÛ˜‚‡ÌÂÚÓ EVIDENCE ·Â¯Â Íβ˜˙Ú Á‡ ‡ÏÂË͇ÌÒÍËfl Ô‡Á‡ Á‡ Rebif. ç‡ 07.03.2002 „. ÄÏÂË͇ÌÒ͇ڇ äÓÏËÒËfl ÔÓ ÎÂ͇ÒÚ‚ÂÌËÚ Ò‰ÒÚ‚‡ Ó‰Ó·Ë Rebif, Á‡ ΘÂÌË ̇ Ô‡ˆËÂÌÚËÚÂ Ò èêåë ‚ ëÄô, ÍÓÂÚÓ ÔÓÌËʇ‚‡ ˜ÂÒÚÓÚ‡Ú‡ ̇ ÔËÒÚ˙ÔËÚÂ Ë ÓÚ·„‡ ËÌ‚‡ÎˉËÁ‡ˆËflÚ‡. Ç Å˙΄‡Ëfl ΘÂÌËÂÚÓ Ò ÔÂÔ‡‡Ú‡ Rebif  ̇Ô˙ÎÌÓ ·ÂÁÔ·ÚÌÓ Á‡ Ô‡ˆËÂÌÚËÚÂ. *Goodin DS, Frohman EM, Garmany GP et al.Disease Modifying Therapies in Multiple Sclerosis.Report of the Therapeutics and Technology Assessment Subcommittee of the AAN and the MS Council for Clinical Practice Guidelines.Neurology 2002; 58:169 - 178, 175.

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