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THE THICKNESS OF THE CAROTID INTIMA-MEDIA COMPLEX OF THE COMMON CAROTID ARTERY IN CHILDREN WITH HYPERTENSION

January 2014

January 2014
79(1):90-92

Authors:

Bogomolets National Medical University

The thickness of the carotid intima-media complex of the common carotid artery in children with hypertension G. Mandryka, N. Khaitovych, R Terletskyi, L. Misiura Bogomolets National Medical University, Kyiv, Ukraine Summary: The vast majority (91.7%) of teenagers with hypertension regardless of the disease (stable or labile) revealed thickening of the carotid intima-media complex (IMC). There was a positive correlation between the thickness of the carotid IMC and averagedaily blood pressure (r = 0,55, P <0,05). Keywords: hypertension, children, diagnostics, bloodpressure, carotid intima-media complex.

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ISSN 1996-353X

¹ 1 (79)

2014

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ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ

Àñîíîâ À.Î. , Ìàðóøêî Þ.Â. , Ã³÷êà Ñ.Ã.

ÎÑÎÁËÈÂÎÑÒ² ÏÅÐÅÁ²ÃÓ ÕÐÎÍ²×ÍÎÃÎ

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Àíòîíåíêî Î. Â., Ñêðèïíèê Ð. Ë.,

Òèõîí÷óê Í. À., Þð÷åíêî Î.Â.

ÌÎÐÔÎËÎÃ²×Í² ÒÀ ÔÅÍÎÒÈÏÎÂ² ÎÑÎÁËÈÂÎÑÒ²

ÊË²ÒÈÍ ÊÎÍ’ÞÍÊÒÈÂÈ Ó ÕÂÎÐÈÕ ÍÀ ÑÈÍÄÐÎÌ

“ÑÓÕÎÃÎ ÎÊÀ” Â ÏÅÐ²ÌÅÍÎÏÀÓÇ² 57

Äàð÷èê Þ.Â.

ÂÍÓÒÐ²ØÍÜÎØËÓÍÎ×ÊÎÂ² ÊÐÎÂÎÂÈËÈÂÈ

Ó ÍÅÄÎÍÎØÅÍÈÕ ÍÎÂÎÍÀÐÎÄÆÅÍÈÕ:

ÔÀÊÒÎÐÈ ÐÈÇÈÊÓ, ÎÑÎÁËÈÂÎÑÒ² ÏÀÒÎÃÅÍÅÇÓ,

ÎÑÍÎÂÍ² ÌÅÒÎÄÈ Ë²ÊÓÂÀÍÍß ÒÀ ÏÐÎÔ²ËÀÊÒÈÊÈ 61

Æàêóí Í.Â., ×èðâà Î.Ñ.

ÂÈÇÍÀ×ÅÍÍß ÑÒÓÏ²Íß ÊÎËÎÍÈÇÀÖ²¯ HELICOBACTER

PYLORI Â ÑËÈÇÎÂ²É ÎÁÎËÎÍÖ² ØËÓÍÊÀ

ÏÐÈ ÕÐÎÍ²×ÍÎÌÓ ÀÒÐÎÔ²×ÍÎÌÓ ÃÀÑÒÐÈÒ² 64

Çàõàðóê Õ.Ì., Ïåòðèê ².Â., Ãàøîê Â.Â., Òåëåê³ ß.Ì.

ÂÏËÈÂ “ÅÑÑÅÍÖ²ÀËª ÔÎÐÒÅ Í” ÒÀ ÊÂÅÐÖÅÒÈÍÓ

ÍÀ ÏÎÊÀÇÍÈÊÈ ßÊÎÑÒ² ÆÈÒÒß ÕÂÎÐÈÕ

ÍÀ ÕÐÎÍ²×ÍÅ ÎÁÑÒÐÓÊÒÈÂÍÅ ÇÀÕÂÎÐÞÂÀÍÍß

ËÅÃÅÍÜ ²Ç ÑÓÏÓÒÍ²Ì ÕÐÎÍ²×ÍÈÌ ÏÀÍÊÐÅÀÒÈÒÎÌ 67

Êîñòîãëîäîâ À.Â., ßêîâåíêî Â.Î.,

Áîäíàð Ë.Â., Áàçäèðºâ Â.Â.

ÌÎÐÔÎËÎÃ²×ÍÀ Ä²ÀÃÍÎÑÒÈÊÀ ÇÓÁ×ÀÑÒÈÕ ÍÅÎÏËÀÇ²É

ÒÎÂÑÒÎ¯ ÊÈØÊÈ 70

Êðàâ÷åíêî Í.Ê., Ìåëüíèê Â.Ñ., Ñàâ÷óê Î.Ì.

ÓÐÎÂÅÍÜ ÔÀÊÒÎÐÀ ÔÎÍ ÂÈËËÅÁÐÀÍÄÀ

Ó ÏÀÖÈÅÍÒÎÂ Ñ ÈØÅÌÈ×ÅÑÊÈÌ ÈÍÑÓËÜÒÎÌ 73

Êðèâåøêî À.Ñ., ßêîâåíêî Â.Î., Áàçäèðºâ Â.Â.

ÊÀÐÖÈÍÎ¯ÄÈ ØËÓÍÊÀ ² ÊÈØÅ×ÍÈÊÀ 76

Ëàçàð÷óê Ã.Î., Áîäíàð Ë.Â., Áàçäèðºâ Â.Â.

ÄÈÑÏËÀÇ²ß ÅÏ²ÒÅË²ß ØËÓÍÊÎÂÎ-ÊÈØÊÎÂÎÃÎ ÒÐÀÊÒÓ 8 0

Ëîãàí³õ³íà Ê.Þ., Êîçàðåíêî Ò.Ì.

ÐÎËÜ ÌÓËÜÒÈÄÅÒÅÊÒÎÐÍÎ¯ ÊÎÌÏ’ÞÒÅÐÍÎ¯

ÒÎÌÎÃÐÀÔ²¯ Ó Ä²ÀÃÍÎÑÒÈÖ² ÌÅÒÀÑÒÀÇ²Â ÐÀÊÓ

ÃÎÐÒÀÍ² Ï²ÑËß ÊÎÌÁ²ÍÎÂÀÍÎÃÎ Ë²ÊÓÂÀÍÍß 84

Ëóïàðåíêî Â.À, ßêîâåíêî Â.Î., Êóðèê Î.Ã.

ÐÎÇÏÎÂÑÞÄÆÅÍ²ÑÒÜ ÏÎÂÅÐÕÍÅÂÈÕ ÊÎËÎÐÅÊÒÀËÜÍÈÕ

ÍÅÎÏËÀÇ²É ÇÀ ÄÀÍÈÌÈ Â²ÄÅÎ²ËªÎÊÎËÎÍÎÑÊÎÏ²¯

Ó ÂÓÇÜÊÎÌÓ ÑÏÅÊÒÐ² ÑÂ²ÒËÀ (NBI) Ç ÂÈÑÎÊÈÌ

ÇÁ²ËÜØÅÍÍßÌ 87

Ìàíäðèêà Þ.Ð., Õàéòîâè÷ Ì.Â.,

Òåðëåöüêèé Ð.Â., Ì³ñþðà Ë.².

ÒÎÂÙÈÍÀ ÊÎÌÏËÅÊÑÓ ²ÍÒÈÌÀ-ÌÅÄ²À ÇÀÃÀËÜÍÎ¯

ÑÎÍÍÎ¯ ÀÐÒÅÐ²¯ Ó Ä²ÒÅÉ Ç ÀÐÒÅÐ²ÀËÜÍÎÞ

Ã²ÏÅÐÒÅÍÇ²ªÞ 90

Ìåë³êñåòÿí À. Â., Ô³ëîíåíêî Ê. Â., Êóðèê Î.Ã.

ÍÅÉÐÎÅÍÄÎÊÐÈÍÍ² ÊË²ÒÈÍÈ Ó ÂÎÃÍÈÙÀÕ

ÀÄÅÍÎÌ²ÎÇÀ, ÐÅÒÐÎÖÅÐÂ²ÊÀËÜÍÎÃÎ ÅÍÄÎÌÅÒÐ²ÎÇÀ

² ÅÍÄÎÌÅÒÐ²Î²ÄÍÈÕ Ê²ÑÒÀÕ ßª×ÍÈÊ²Â 93

Ìèíèíà À.Þ.

ÊËÈÍÈ×ÅÑÊÈÅ È ÈÌÌÓÍÎËÎÃÈ×ÅÑÊÈÅ ÀÑÏÅÊÒÛ

ËÅ×ÅÍÈß ÁÎËÜÍÛÕ Ñ ÀÊÓÑÒÈ×ÅÑÊÎÉ ÍÅÂÐÈÍÎÌÎÉ

ÐÀÄÈÎÕÈÐÓÐÃÈ×ÅÑÊÈÌ ÌÅÒÎÄÎÌ 96

CLINICAL MEDICINE

A. Asonov, Yu. Marushko, S. Gichka

FEATURES OF THE CHRONIC GASTRODUODENITIS

IN CHILDREN WITH ZINC DEFICIENCY

E. Antonenko, R. Skrypnyk,

N. Tihonchuk, O. Yurchenko

MORPHOLOGICAL AND PHENOTYPICAL

PARTICULARITIES OF THE CONJUNCTIVAL2S CELLS

BESIDE SICK SYNDROME “DRY EYE” IN PERIMENOPAUZE

Y. Darchyk

INTRAVENTRICULAR HEMORRHAGES IN PREMATURE

NEWBORNS: RISK FACTORS, PATHOGENESIS CONCEPTS,

MAIN PREVENTIVE AND THERAPEUTIC

METHODS

N. Zhakun, O. Chirva

STUDY OF EXTENT OF COLONIZATION

OF HELICOBACTER PYLORI IN GASTRIC MUCOSA

AT CHRONIC ATROPHY GASTRITIS

K. Zaharuk, I. Petryk, V. Gashok, Ja. Teleki

INFLUENCE OF “ESSENTIALE FORTE N” AND QUERCETIN

ON THE QUALITY OF LIFE OF PATIENTS WITH CHRONIC

OBSTRUCTIVE PULMONARY DISEASE COMBINED WITH

CHRONIC PANCREATITIS

A. Kostoglodov, O. Yakovenko,

L. Bodnar, V. Bazdyrev

MORPHOLOGICAL DIAGNOSTIC OF COLON

SERRATUM ADENOMA

N. Kravchenko, O. Savchuk, V. Melnyk

VON WILLEBRAND FACTOR LEVEL IN PATIENTS WITH

ISCHEMIC STROKE

A. Kriveshko, V. Yakovenko, V. Bazdyrev

CARCINOIDS OF THE STOMACH AND INTESTINES

G. Lazarchuk, L. Bodnar, V. Bazdyrev

DYSPLASIA IN GASTRO-INTESTINAL TRACT

Ê. Loganikhina, Ò. Kozarenko

ROLE OF MULTIDETECTED COMPUTER TOMOGRAPHY

IN DIAGNOSIS OF LARYNGEAL CANCER METASTASES

AFTER COMBINED TREATMENT

V. Luparenko, V. Yakovenko, O. Kyryk

REVALENCE OF SUPERFICIAL COLORECTAL NEOPLASIA

ON THE RESULTS OF VIDEOILEOCOLONOSCOPY

WITH NARROW BAND IMAGING (NBI) AND HIGH

MAGNIFICATION

G. Mandryka, N. Khaytovych,

R. Terletskyi, L. Misyura

THE THICKNESS OF THE CAROTID INTIMA-MEDIA

COMPLEX OF THE COMMON CAROTID ARTERY

IN CHILDREN WITH HYPERTENSION

A. Meliksetyan, K. Filonenko, O. Kyryk

GNEUROENDOCRINAL CELLS IN THE ADENOMYOSIS,

RETROCERVICAL ENDOMETRIOSIS FOCUSES

AND IN ENDOMETRIOID OVARIAN CYSTS

Minina A.

CLINICAL AND IMMUNOLOGICAL ASPECTS

OF TREATMENT OF PATIENTS WITH ACOUSTIC

NEURINOVA BY A RADIOSURGICAL METHOD

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

Íàçàðêî Í.Ì.

ÂÏËÈÂ ÇÀÑÎÁ²Â Ô²ÇÈ×ÍÎ¯ ÐÅÀÁ²Ë²ÒÀÖ²¯ ÍÀ ßÊ²ÑÒÜ ÆÈÒÒß

ÎÑ²Á ÌÎËÎÄÎÃÎ Â²ÊÓ Ç ÄÈÑÔÓÍÊÖ²ªÞ ÆÎÂ×ÍÎÃÎ

Ì²ÕÓÐÀ ÒÀ ÍÀßÂÍ²ÑÒÞ Á²Ë²ÀÐÍÎÃÎ ÑËÀÄÆÓ 100

Íå÷â³äîâà Â. Â., Ëàçàð÷óê Ã. Î., Â.Î. ßêîâåíêî

ÌÎÐÔÎËÎÃ²×ÍÀ Ä²ÀÃÍÎÑÒÈÊÀ ÑÒÐÀÂÎÕÎÄÓ

ÁÀÐÐÅÒÒÀ 104

Îë³íèê Î.Þ.

²ÍÒÅÐËÅÉÊ²Í-8 ÒÀ ÑÒÀÍ ÎÊÑÈÄÀÍÒÍÎ-

ÏÐÎÒÈÎÊÑÈÄÀÍÒÍÎÃÎ ÃÎÌÅÎÑÒÀÇÓ Ó ÕÂÎÐÈÕ

ÍÀ ÂÈÐÀÇÊÎÂÓ ÕÂÎÐÎÁÓ ØËÓÍÊÀ

ÒÀ ÄÂÀÍÀÄÖßÒÈÏÀËÎ¯ ÊÈØÊÈ, ÏÎªÄÍÀÍÓ

Ç ÖÓÊÐÎÂÈÌ Ä²ÀÁÅÒÎÌ, Ó ÄÈÍÀÌ²Ö² Ë²ÊÓÂÀÍÍß 10 8

Ñåïèõàíîâà Ì.Ì., Ñîêîëîâà Ë.È.

ÑÐÀÂÍÈÒÅËÜÍÛÉ ÀÍÀËÈÇ ÓÐÎÂÍß ÈÍÂÀËÈÄÈÇÀÖÈÈ

È ÏÎÊÀÇÀÒÅËÅÉ ÊÀ×ÅÑÒÂÀ ÆÈÇÍÈ Ó ÁÎËÜÍÛÕ

Ñ ÐÀÑÑÅßÍÍÛÌ ÑÊËÅÐÎÇÎÌ ÐÀÇÍÛÕ

ÂÎÇÐÀÑÒÍÛÕ ÃÐÓÏÏ 111

Ñîáîëü Â.Î., Ëèçîãóá Â.Ã.,

Ìîøêîâñüêà Þ.Î., Áîíäàð÷óê Î.Ì.

ÅÔÅÊÒÈÂÍ²ÑÒÜ ÀÃÎÍ²ÑÒ²Â ÄÎÔÀÌ²ÍÎÂÈÕ ÐÅÖÅÏÒÎÐ²Â

Ó Ë²ÊÓÂÀÍÍ² ÕÂÎÐÈÕ ÍÀ ÀÐÒÅÐ²ÀËÜÍÓ Ã²ÏÅÐÒÅÍÇ²Þ

Ç ÑÓÏÓÒÍ²Ì ÎÆÈÐ²ÍÍßÌ 115

Òðà÷óê Ð. Ñ., Äÿ÷óê Ì.Ä., Æóðàâ÷àê À.Ç.

ÌÎÐÔÎËÎÃ²×ÍÀ ÎÖ²ÍÊÀ Ä²¯ ËÀÇÅÐÀ DORNIER

MEDILAS D UROBEAM 940 ÍÌ ÍÀ ÒÊÀÍÈÍÓ

ÏÅÐÅÄÌ²ÕÓÐÎÂÎ¯ ÇÀËÎÇÈ 119

Öèìáàë Â.Ì.

ÎÑÎÁËÈÂÎÑÒ² ÌÅÒÀÁÎË²ÇÌÓ ÑÏÎËÓ×ÍÎ¯ ÒÊÀÍÈÍÈ

Ó Ä²ÒÅÉ Ç Ä²ÀÁÅÒÈ×ÍÎ¯ ÍÅÔÐÎÏÀÒ²ªÞ 123

K. Chympoy, L. Khlopan, I. Nemish, M. Bobyk

ASSOCIATION OF MARKERS OF THE SYSTEM

OF FIBRINOLYSIS OF THE BLOOD PLASMA WITH

POLYMORPHISM OF SELENOENZYMES GENES

IN PATIENTS WITH CHRONIC DIFFUSE LIVER DISEASES 127

×óäíîâåöü À. Â., Êîíîâàëåíêî ².

ÀÒÐÓÏÍÀ ÒÐÀÍÑÏËÀÍÒÀÖ²ß ÏÅ×²ÍÊÈ Ó Ë²ÊÓÂÀÍÍ²

¯¯ ÒÅÐÌ²ÍÀËÜÍÈÕ ÇÀÕÂÎÐÞÂÀÍÜ 130

Øêðüîáà À.Î., Ì³ò÷åíêî Î.².,

Ëàâðèê À.Ñ., Ðîìàíîâ Â.Þ.

ÂÏËÈÂ ÌÅÄÈÊÀÌÅÍÒÎÇÍÈÕ ÒÀ Õ²ÐÓÐÃ²×ÍÈÕ ÌÅÒÎÄ²Â

Ë²ÊÓÂÀÍÍß ÍÀ ÏÐÎÔ²ËÜ ÀÐÒÅÐ²ÀËÜÍÎÃÎ ÒÈÑÊÓ

Ó ÕÂÎÐÈÕ ÍÀ ÌÎÐÁ²ÄÍÅ ÎÆÈÐ²ÍÍß ² ÀÐÒÅÐ²ÀËÜÍÓ

Ã²ÏÅÐÒÅÍÇ²Þ 136

Øîâêîâàÿ Î.Â.

ÏÎÐ²ÂÍßËÜÍÀ ÎÖ²ÍÊÀ ÌÅÒÎÄ²Â ÊÎÌÁ²ÍÎÂÀÍÎÃÎ

Ë²ÊÓÂÀÍÍß ÕÂÎÐÈÕ ÍÀ ÐÀÊ ÃÎÐÒÀÍ² ²²² ÑÒÀÄ²¯ 142

Þðêîâñüêà ª.Ã. , Æåãóëîâè÷ Ç.ª.

ÇÌ²ÍÈ ÊË²Í²×ÍÈÕ ÏÐÎßÂ²Â ÃÅÍÅÐÀË²ÇÎÂÀÍÎÃÎ

ÏÀÐÎÄÎÍÒÈÒÓ ÏÐÈ ÇÀÑÒÎÑÓÂÀÍÍ²

ÎÊËÞÇ²ÉÍÈÕ ØÈÍ 145

²ÑÒÎÐ²ß ÌÅÄÈÖÈÍÈ

Ìàë³êîâ Î.Â., Äçåâóëüñüêà ².Â., ²ãíàò³ùåâ Ì.Ð.,

Ãîí÷àðîâ Â.Ë., Âèäåðêî Ð.Â., Êîâàëü÷óê À.Â.

ÂÈÄÀÒÍÈÉ ÀÍÀÒÎÌ ÏÐÎÔÅÑÎÐ

ÀÐÑÅÍ²É Â²ÊÒÎÐÎÂÈ× ÑÒÀÐÊÎÂ 149

N. Nazarko

EFFECT OF PHYSICAL REHABILITATION ON QUALITY

OF LIFE IN YOUNG PERSONS WITH GALLBLADDER

DYSFUNCTION AND BILIARY SLUDGE

V. Nechvidova, G. Lazarchuk, O. Yakovenko

MORPHOLOGICAL DIAGNOSTIC OF BARRET’S

ESOPHAGUS

O. Olinyk

INTRELEUKIN-8 AND THE OXIDANT-ANTIOXIDANT

HOMEOSTASIS IN PATIENTS WITH GASTRIC AND

DUODENAL ULCERS, COMBINED WITH THE DIABETES

MELLITUS, IN THE DYNAMICS OF TREATMENT

M. Sepihanova, L. Sokolova

COMPARATIVE ANALYSIS OF THE LEVEL OF DISABILITY

AND QUALITY OF LIFE INDICES IN PATIENTS WITH

MULTIPLE SCLEROSIS IN DIFFERENT

AGE GROUPS

V. Sobol, V. Lizogub,

J. Ìîshkovska, Bondarchuk A.

EFFICIENCY AGONISTS DOFAMINE RECEPTORS

IN THE TREATMENT OF HYPERTENSIVE PATIENTS

WITH CONCOMITANT OBESITY

R. Trachuk, M. Dyachuk, A. Zhuravchak

MORPHOLOGICAL ESTIMATION OF LASER DORNIER

MEDILAS D UROBEAM INFLUENCE FOR PROSTATE

TISSUE

V. Tsymbal

METABOLISM FEATURES OF CONNECTIVE TISSUE

AT CHILDREN WITH DIABETIC NEPHROPATHY

×èìïîé Ê.À., Õëîïàí Ë.²., Íåì³ø ².Ë., Áîáèê Ì.Â.

ÀÑÎÖ²ÀÖ²ß ÌÀÐÊÅÐ²Â ÑÈÑÒÅÌÈ Ô²ÁÐÈÍÎË²ÇÓ ÏËÀÇÌÈ

ÊÐÎÂ² Ç² ÏÎË²ÌÎÐÔ²ÇÌÎÌ ÃÅÍ²Â ÑÅËÅÍÎÅÍÇÈÌ²Â

Ó ÕÂÎÐÈÕ ÍÀ ÕÐÎÍ²×Í² ÄÈÔÓÇÍ² ÇÀÕÂÎÐÞÂÀÍÍß

ÏÅ×²ÍÊÈ

A. Chudnovets, ². Konovalenko

LIVER’S CADAVERIC TRANSPLANTATION IN THE

TREATMENT OF IT’S TERMINAL DISEASES

A. Shkroba, O. Mitchenko,

A. Lavrik, V. Romanov

EFFECT OF MEDICAL AND SURGICAL TREATMENTS

FOR BLOOD PRESSURE PROFILE IN PATIENTS

WITH MORBID OBESITY AND HYPERTENSION

O.V. Shovkovaya

COMPARATIVE ASSESSMENT OF METHODS OF COMBINED

TREATMENT LARYNGEAL CANCER III STAGE

Ye. Yurkovska, Z. Zhegulovich

CHANGES OF CLINICAL MANIFESTATION

OF GENERALIZED PERIODONTITIS UNDER OCCLUSAL

SPLINTS TREATMENT

HISTORY OF MEDICINE

A. Malikov, I. Dzevulska, M. Ignatischev,

V. Honcharov, R. Viderko, A. Kovalchuk

THE GREAT ANATOMY PROFESSOR

ARSENIY VIKTOROVYCH STARKOV

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REVIEWS

I. Buslenko

PROBLEMS OF DIAGNOSIS AND CLASSIFICATION

OF NON-HODGKIN’S LYMPHOMA

A. Vysotskyi

BREAST CANCER METASTASIS TO THE BONE:

MECHANISMS OF BONE LOSS AND TREATMENT

A. Vodynik, U. Dibrova

PECULIARITIES OF THE PANDEMIC OF INFLUENZA A

(H1N1) 2009 IN UKRAINE

O. Karpenko, V. Kondratiuk

NON-STEROIDAL ANTI-INFLAMMATORY DRUG

AND ARTERIAL HYPERTENSION – PROBLEM

OF MODERN CARDIOLOGY

K. Malyarchuk

USAGE OF TUMOR MARKERS IN THE DIAGNOSIS

OF CANCER

A. Firsova

THE USAGE OF FAST TRACK SURGERY TACTIC

AS A PROPHYLAXIS OF POST-OPERATIVE

COMPLICATIONS AFTER ABDOMINAL CAVITY

SURGERIES

HIGHER MEDICAL EDUCATION

S. Telemukha

BRAINSTORM AS A METHOD OF IMPLEMENTATION

OF INTERACTIVE LEARNING

INSTRUCTIONS FOR AUTHORS

ÎÃËßÄÈ

Áóñëåíêî Þ.À.

ÏÐÎÁËÅÌÛ ÄÈÀÃÍÎÑÒÈÊÈ È ÊËÀÑÑÈÔÈÊÀÖÈÈ

ÍÅÕÎÄÆÊÈÍÑÊÈÕ ËÈÌÔÎÌ 152

Âèñîöüêèé À.Î.

ÌÅÒÀÑÒÀÇÈ ÐÀÊÓ ÌÎËÎ×ÍÎ¯ ÇÀËÎÇÈ (ÐÌÇ) Ó Ê²ÑÒÊÈ:

ÌÅÕÀÍ²ÇÌ Ê²ÑÒÊÎÂÎ¯ ÄÅÑÒÐÓÊÖ²¯ ÒÀ ¯Õ Ë²ÊÓÂÀÍÍß 1 5 5

Âîäÿíèê À.À., Ä³áðîâà Þ.Â.

ÄÅßÊ² ÎÑÎÁËÈÂÎÑÒ² ÏÅÐÅÁ²ÃÓ ÏÀÍÄÅÌ²¯ ÃÐÈÏÓ À

(H1N1) 2009 ÐÎÊÓ ÍÀ ÒÅÐÈÒÎÐ²¯ ÓÊÐÀ¯ÍÈ 158

Êàðïåíêî Î.Î., Êîíäðàòþê Â.ª.

ÍÅÑÒÅÐÎ¯ÄÍ² ÏÐÎÒÈÇÀÏÀËÜÍ² ÏÐÅÏÀÐÀÒÈ

ÒÀ ÀÐÒÅÐ²ÀËÜÍÀ Ã²ÏÅÐÒÅÍÇ²ß – ÏÐÎÁËÅÌÀ

ÑÓ×ÀÑÍÎ¯ ÊÀÐÄ²ÎËÎÃ²¯ 160

Ìàëÿð÷óê Å. À.

ÈÑÏÎËÜÇÎÂÀÍÈÅ ÎÍÊÎÌÀÐÊÅÐÎÂ Â ÄÈÀÃÍÎÑÒÈÊÅ

ÎÍÊÎËÎÃÈ×ÅÑÊÎÉ ÏÀÒÎËÎÃÈÈ 164

Ôèðñîâà À.Â.

ÏÐÈÌÅÍÅÍÈÅ ÒÀÊÒÈÊÈ FAST TRACK SURGERY

ÊÀÊ ÏÐÎÔÈËÀÊÒÈÊÀ ÏÎÑËÅÎÏÅÐÀÖÈÎÍÍÛÕ

ÎÑËÎÆÍÅÍÈÉ ÏÐÈ ÎÏÅÐÀÖÈßÕ ÍÀ ÁÐÞØÍÎÉ

ÏÎËÎÑÒÈ 167

ÂÈÙÀ ÌÅÄÈ×ÍÀ ÎÑÂ²ÒÀ

Òåëåìóõà Ñ.Á.

ÌÎÇÊÎÂÈÉ ØÒÓÐÌ ßÊ ÌÅÒÎÄ ÐÅÀË²ÇÀÖ²¯

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ÓÌÎÂÈ ÏÓÁË²ÊÀÖ²¯ 172

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Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÑÎÖ²ÀËÜÍÀ ÌÅÄÈÖÈÍÀ / SOCIAL MEDICINE

Âñòóï. Ï³îäåðì³¿ (ãí³éíè÷êîâ³ çàõâîðþâàííÿ øê³ðè), ÿê³

â³äíîñÿòü äî ãðóïè ³íôåêö³éíèõ äåðìàòîç³â, º îäí³ºþ ç âàæ-

ëèâèõ ïðîáëåì ñó÷àñíî¿ äåðìàòîëîã³¿. Àêòóàëüí³ñòü ï³î-

äåðì³é âèçíà÷àº ¿õ çíà÷íà ïîøèðåí³ñòü ÿê ñåðåä äèòÿ÷îãî,

òàê ³ äîðîñëîãî êîíòèíãåíòó íàñåëåííÿ êðà¿íè, à òàêîæ òåí-

äåíö³ÿ öèõ äåðìàòîç³â äî á³ëüø òÿæêîãî êë³í³÷íîãî ïåðå-

á³ãó íà ñó÷àñíîìó åòàï³, ùî, çîêðåìà, çóìîâëåíî ôîðìó-

âàííÿì ó ï³îêîê³â (çáóäíèê³â ï³îäåðì³é) ðåçèñòåíòíîñò³ äî

àíòèáàêòåð³àëüíèõ çàñîá³â ñèñòåìíî¿ òà òîï³÷íî¿ ä³¿ [1, 2, 7].

Çàëåæíî â³ä çáóäíèêà, ï³îäåðì³¿ ïîä³ëÿþòü òà ñòðåïòî-

êîêîâ³ (ñòðåïòîäåðì³¿), ñòàô³ëîêîêîâ³ (ñòàô³ëîäåðì³¿) òà

çì³øàí³ (çóìîâëåí³ ñòðåïòî- é ñòàô³ëîêîêàìè, ñèíüîãí³é-

íîþ òà êèøêîâîþ ïàëè÷êàìè, ãðóïîþ ïðîòåÿ òà ³í.). Çà

ãëèáèíîþ çàëÿãàííÿ çàïàëüíîãî ïðîöåñó â øê³ð³, ðîçð³ç-

íÿþòü ïîâåðõíåâ³ òà ãëèáîê³ ï³îäåðì³¿. Çà ãîñòðîòîþ ïåðå-

á³ãó, ãí³éíè÷êîâ³ çàõâîðþâàííÿ øê³ðè ïîä³ëÿþòü íà

ãîñòð³, ï³äãîñòð³ òà õðîí³÷í³ ï³îäåðì³¿. Âîäíî÷àñ ï³îäåðì³¿

áóâàþòü ïåðâèíí³ òà âòîðèíí³ (ÿê óñêëàäíåííÿ ³íøèõ äåð-

ìàòîç³â – àëåðãîäåðìàòîç³â, êîðîñòè òà ³í.) [2, 6].

Ó ðîçâèòêó é ïåðåá³ãó ï³îäåðì³é âàæëèâå çíà÷åííÿ

ìàþòü ÿê åêçîãåíí³ (òðàâìè é ì³êðîòðàâìè òà çàáðóäíåí-

íÿ øê³ðè, ïåðåîõîëîäæåííÿ ÷è ïåðåãð³âàííÿ ç ïîñèëåíèì

ïîòîâèä³ëåííÿì ³ ìàöåðàö³ºþ øê³ðè òà ³í.), òàê ³ åíäîãåíí³

÷èííèêè (åíäîêðèíîïàò³¿, ³ìóíí³ ðîçëàäè, çàõâîðþâàííÿ

îðãàí³â òðàâëåííÿ, âîãíèùà õðîí³÷íî¿ ³íôåêö³¿, îáì³íí³

ïîðóøåííÿ òîùî) [3, 4].

Çà äàíèìè êë³í³÷íèõ ñïîñòåðåæåíü, ï³îäåðì³¿ â îñòàíí³

ðîêè â³äçíà÷àþòüñÿ òîðï³äíèì ïåðåá³ãîì ç óðàæåííÿì

çíà÷íèõ ä³ëÿíîê øê³ðè, õðîí³çàö³ºþ ïðîöåñó, ðîçâèòêîì

ãëèáîêèõ ôîðì ³ç ôîðìóâàííÿì ðóáöåâèõ çì³í øê³ðè, ùî,

â ö³ëîìó, º ïðè÷èíîþ âòðàòè õâîðèìè ïðàöåçäàòíîñò³,

çíèæåííÿ ÿêîñò³ ¿õ æèòòÿ òà ñîö³àëüíî¿ àêòèâíîñò³ [2, 5].

Òàêèì ÷èíîì, ïîøèðåí³ñòü ãí³éíè÷êîâèõ çàõâî-

ðþâàíü øê³ðè, çðîñòàííÿ ê³ëüêîñò³ òÿæêèõ, ãëèáîêèõ òà

ñõèëüíèõ äî ðåöèäèâ³â ôîðì ï³îäåðì³é âèçíà÷àþòü àêòó-

ÓÄÊ 616 – 002.3 – 036:313.1] (477.83)

ÑÒÀÍ ÒÀ ÄÈÍÀÌ²ÊÀ ÇÀÕÂÎÐÞÂÀÍÎÑÒ²

ÍÀ Ï²ÎÄÅÐÌ²¯ Ó ÆÈÒÅË²Â ËÜÂ²ÂÑÜÊÎ¯ ÎÁËÀÑÒ²

Äàøêî Ì.Î.1, Äåíèñåíêî Î.².2

1 Ëüâ³âñüêèé íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ì. Äàíèëà Ãàëèöüêîãî, ì. Ëüâ³â, Óêðà¿íà

2 Áóêîâèíñüêèé äåðæàâíèé ìåäè÷íèé óí³âåðñèòåò, ì.×åðí³âö³, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: ï³îäåðì³¿, çàõâîðþâàí³ñòü, äèíàì³êà.

àëüí³ñòü äîñë³äæåíü ùîäî âèçíà÷åííÿ åò³îïàòîãåíåòè÷-

íèõ òà åï³äåì³îëîã³÷íèõ ÷èííèê³â äàíî¿ ãðóïè ³íôåêö³é-

íèõ äåðìàòîç³â ç ìåòîþ ðîçðîáêè íàóêîâî îãðóíòîâàíèõ

ðåêîìåíäàö³¿ ùîäî îïòèì³çàö³¿ ¿õ ë³êóâàííÿ òà ïðîô³ëàê-

òèêè [1].

Ìåòà ðîáîòè: âèâ÷èòè ñòàí, äèíàì³êó òà ñòðóêòóðó çàõ-

âîðþâàíîñò³ íà ï³îäåðì³¿ ñåðåä äèòÿ÷îãî ³ äîðîñëîãî íà-

ñåëåííÿ Ëüâ³âñêî¿ îáëàñò³ (Ãàëè÷èíè) çà îñòàíí³ 3 ðîêè

(2010–2012 ðð.).

Ìàòåð³àëè òà ìåòîäè. Ïðîâåäåíî àíàë³ç ñòàòèñòè÷íèõ

äàíèõ ùîäî ñòðóêòóðè òà äèíàì³êè çàõâîðþâàíîñò³ íà

ï³îäåðì³¿ ñåðåä æèòåë³â Ëüâ³âñüêî¿ îáëàñò³ (Ãàëè÷èíè) íà

ï³äñòàâ³ âèâ÷åííÿ òà àíàë³çó äàíèõ 3552 àìáóëàòîðíèõ êàð-

òîê òà 274 ³ñòîð³é õâîðîáè ïàö³ºíò³â – ìåøêàíö³â

Ëüâ³âñüêî¿ îáëàñò³ (Ãàëè÷èíè), ÿê³ îòðèìàëè ë³êóâàííÿ ç

ïðèâîäó ï³îäåðì³é âïðîäîâæ 2010–2012 ðîê³â.

Ðåçóëüòàòè òà îáãîâîðåííÿ. Àíàë³ç äàíèõ ùîäî

ê³ëüêîñò³ õâîðèõ íà ï³îäåðì³¿ – ìåøêàíö³â Ëüâ³âñüêî¿ îá-

ëàñò³ (Ãàëè÷èíè), ÿê³ áóëè ä³àãíîñòîâàí³ íà àìáóëàòîðíî-

ìó ïðèéîì³ (òàáë. 1), çàñâ³ä÷èâ, ùî âïðîäîâæ îñòàíí³õ

òðüîõ ðîê³â (2010–2012 ðð.) ÷àñòêà õâîðèõ íà ï³îäåðì³¿ ó

çàãàëüí³é ñòðóêòóð³ õâîðèõ äåðìàòîëîã³÷íîãî ïðîô³ëþ

ìàº òåíäåíö³þ äî çðîñòàííÿ (íà 1,02%). Âîäíî÷àñ âñòà-

íîâëåíî ÷³òêó òåíäåíö³þ äî çá³ëüøåííÿ (íà 1,76%) ÷àñòêè

õâîðèõ íà ãí³éíè÷êîâ³ çàõâîðþâàííÿ øê³ðè ñåðåä çàãàëü-

íî¿ ê³ëüêîñò³ ãîñï³òàë³çîâàíèõ ó 2010–2012 ðð. ïàö³ºíò³â ó

äåðìàòîëîã³÷íå â³ää³ëåííÿ îáëàñíîãî øê³ðíî-âåíåðîëîã³-

÷íîãî äèñïàíñåðó.

Äàí³ ùîäî ïîøèðåíîñò³ ï³îäåðì³é ñåðåä ìåøêàíö³â

Ëüâ³âñüêî¿ îáëàñò³ (Ãàëè÷èíè) çàëåæíî â³ä óìîâ ¿õ ïðîæè-

âàííÿ (ó ì³ñüêèõ ÷è ñ³ëüñüêèõ íàñåëåíèõ ïóíêòàõ) íàâåäå-

íî â òàáëèö³ 2.

Çà äàíèìè òàáë. 2, íà ãí³éíè÷êîâ³ çàõâîðþâàííÿ øê³ðè

ó Ëüâ³âñüê³é îáëàñò³ ÷àñò³øå õâîð³þòü æèòåë³ ì³ñò (66,3–

75,4% ïðîòè 24,6–33,7% – ìåøêàíö³â ñ³ë). Ïðè öüîìó

Òàáëèöÿ 1.

×àñòêà õâîðèõ íà ï³îäåðì³¿ – ìåøêàíö³â Ëüâ³âñüêî¿ îáëàñò³

ñåðåä àìáóëàòîðíèõ òà ñòàö³îíàðíèõ õâîðèõ

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÑÎÖ²ÀËÜÍÀ ÌÅÄÈÖÈÍÀ / SOCIAL MEDICINE

âñòàíîâëåíî ÷³òêó òåíäåíö³þ äî çðîñòàííÿ çà îñòàíí³ òðè

ðîêè (íà 9,1% ó 2012 ðîö³ ïðîòè 2010 ðîêó) ê³ëüêîñò³

ïàö³ºíò³â, õâîðèõ íà ï³îäåðì³¿, ñåðåä ìåøêàíö³â ì³ñò

Ãàëè÷èíè.

Äàí³ ùîäî ðîçïîä³ëó àìáóëàòîðíèõ òà ñòàö³îíàðíèõ

õâîðèõ íà ï³îäåðì³¿ – ìåøêàíö³â Ëüâ³âñüêî¿ îáëàñò³ çà â³êîì

íàâåäåíî â òàáëèö³ 3. Çà äàíèìè òàáë. 3, ñåðåä ìåøêàíö³â

Ãàëè÷èíè íà ï³îäåðì³¿ ÷àñò³øå õâîð³þòü îñîáè äîðîñëîãî

â³êó (57,8%–64,1%), ìåíøó ÷àñòêó (35,9%–42,1%) ñêëà-

äàþòü îñîáè äèòÿ÷îãî òà ï³äë³òêîâîãî â³êó. Ñåðåä 1544 ïà-

ö³ºíò³â äèòÿ÷îãî òà ï³äë³òêîâîãî â³êó, ó ÿêèõ áóëî ä³àãíîñòî-

âàíî ãí³éíè÷êîâ³ çàõâîðþâàííÿ øê³ðè, íàéá³ëüøó ÷àñòêó

ñêëàëè ó÷í³ ³ ñòóäåíòè (622 – 40,3%), ð³äøå íà ãí³éíè÷êîâ³

äåðìàòîçè õâîð³þòü ä³òè â³êîì â³ä 2 äî 6 ðîê³â, ÿê³ â³äâ³äóþòü

äîøê³ëüí³ çàêëàäè (325–21,0%), íåîðãàí³çîâàí³ ä³òè â³êîì äî

2 ðîê³â (302 – 19,6%) òà ä³òè 2-6 ðîê³â (295 – 19,1%). Ñåðåä

2282 îñ³á äîðîñëîãî â³êó ï³îäåðì³¿ íàé÷àñò³øå ä³àãíîñòó-

âàëè ó ïàö³ºíò³â 19–20 òà 20-29 ðîê³â (705 – 30,9%), ð³äøå ó

â³ö³ 30-39 ðîê³â – 468 îñ³á (20,5%), 40–49 ðîê³â – 425 õâîðèõ

(18,6%), 50–59 ðîê³â – 307 õâîðèõ (13,5%), 60–69 ðîê³â – 285

õâîðèõ (12,5%), 70 ðîê³â ³ ñòàðø³ – 92 õâîð³ (4,0%). Òàêèì

÷èíîì, ñåðåä äîðîñëîãî êîíòèíãåíòó õâîðèõ íà ï³îäåðì³¿

ïåðåâàæíó á³ëüø³ñòü (83,5%) ñêëàëè îñîáè àêòèâíîãî

ïðàöåçäàòíîãî â³êó, ùî âèçíà÷àº âàæëèâå ìåäè÷íå òà ñî-

ö³àëüíå çíà÷åííÿ ãí³éíè÷êîâèõ çàõâîðþâàíü øê³ðè.

Òàêîæ ñë³ä â³äçíà÷èòè, ùî, íåçâàæàþ÷è íà âèÿâëåíó

òåíäåíö³þ äî çìåíøåííÿ (íà 7,0%) ê³ëüêîñò³ äîðîñëèõ

îñ³á, õâîðèõ íà ï³îäåðì³¿, ñåðåä àìáóëàòîðíèõ õâîðèõ

Ëüâ³âùèíè (òàáë. 3), âïðîäîâæ îñòàíí³õ òðüîõ ðîê³â

â³äçíà÷àºòüñÿ òåíäåíö³ÿ äî çðîñòàííÿ (íà 4,7%) ÷àñòêè äî-

ðîñëèõ õâîðèõ íà ï³îäåðì³¿ ñåðåä ãîñï³òàë³çîâàíèõ

ïàö³ºíò³â, ùî ñâ³ä÷èòü ïðî á³ëüø òÿæêèé ¿õ êë³í³÷íèé ïå-

ðåá³ã ³ íåîáõ³äí³ñòü ñòàö³îíàðíîãî ë³êóâàííÿ òàêèõ

ïàö³ºíò³â ç ïîðóøåííÿì ¿õ ïðàöåçäàòíîñò³.

Äàí³ ùîäî ðîçïîä³ëó äîðîñëîãî êîíòèíãåíòó õâîðèõ

íà ï³îäåðì³¿ – ìåøêàíö³â Ëüâ³âñüêî¿ îáëàñò³ çà ñòàòòþ íà-

âåäåíî â òàáëèö³ 4.

Çã³äíî äàíèõ, íàâåäåíèõ ó òàáëèö³ 4, íà ãí³éíè÷êîâ³ çàõ-

âîðþâàííÿ øê³ðè ó Ëüâ³âñüê³é îáëàñò³ äåùî ÷àñò³øå õâî-

ð³þòü îñîáè ÷îëîâ³÷î¿ ñòàò³ (51,4%-–5,5% ïðîòè 44,5%–

48,6% – îñ³á æ³íî÷î¿ ñòàò³). Ðàçîì ç òèì, â îñòàíí³ ðîêè

â³äçíà÷àºòüñÿ òåíäåíö³ÿ äî çðîñòàííÿ ê³ëüêîñò³ îñ³á æ³íî-

÷î¿ ñòàò³, õâîðèõ íà ï³îäåðì³¿, ÿê ñåðåä àìáóëàòîðíîãî (íà

4,1% – ó 2012 ðîö³ ïðîòè 2010 ðîêó), òàê ³ ñòàö³îíàðíîãî

êîíòèíãåíòó ïàö³ºíò³â (íà 7,9% – ó 2012 ðîö³ ïðîòè 2010

ðîêó) – ìåøêàíö³â Ãàëè÷èíè.

Òàáëèöÿ 2.

Ñï³ââ³äíîøåííÿ ñåðåä õâîðèõ íà ï³îäåðì³¿ ìåøêàíö³â ì³ñò òà ñ³ë Ëüâ³âñüêî¿ îáëàñò³

Òàáëèöÿ 3.

Ðîçïîä³ë õâîðèõ íà ï³îäåðì³¿ – ìåøêàíö³â Ëüâ³âñüêî¿ îáëàñò³ çà â³êîì

Òàáëèöÿ 4.

Ðîçïîä³ë äîðîñëèõ õâîðèõ íà ï³îäåðì³¿ – ìåøêàíö³â Ëüâ³âñüêî¿ îáëàñò³ çà ñòàòòþ

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÑÎÖ²ÀËÜÍÀ ÌÅÄÈÖÈÍÀ / SOCIAL MEDICINE

Àíàë³ç ðîçïîä³ëó õâîðèõ íà ï³îäåðì³¿ ó Ëüâ³âñüêî¿ îá-

ëàñò³ çà íîçîëîã³÷íèìè ôîðìàìè çàñâ³ä÷èâ, ùî íàéá³ëü-

øó ÷àñòêó ñêëàäàþòü ïàö³ºíòè ³ç ñòàô³ëîäåðì³ÿìè – 1587

(41,5%), íà äðóãîìó ì³ñö³ çà ÷àñòîòîþ – çì³øàí³ ³íôåêö³¿

øê³ðè (ó 1273 îñ³á – 33,3%), ð³äøå ðåºñòðóþòüñÿ ñòðåïòî-

äåðì³¿ – ó 966 (25,25%) ïàö³ºíò³â. Ïðè öîìó, õâîðèõ íà ï³î-

äåðì³¿, ÿê³ âèíèêëè ïåðâèííî, áóëî 2654 (73,19%) îñ³á, à

âòîðèí³ ï³îäåðì³¿, ÿê³ ðîçâèíóëèñÿ ÿê óñêëàäíåííÿ àòîï³÷-

íîãî äåðìàòèòó, êîðîñòè, òîêñèêîäåðì³¿, ãåðïåñó ÷è ³íøèõ

çàõâîðþâàíü øê³ðè – ä³àãíîñòîâàíî ó 1172 (26,81%)

ïàö³ºíò³â.

Äàí³ ùîäî ðîçïîä³ëó äîðîñëîãî òà äèòÿ÷îãî êîíòèí-

ãåíòó õâîðèõ íà ï³îäåðì³¿ çàëåæíî â³ä ãëèáèíè çàëÿãàííÿ

çàïàëüíîãî ïðîöåñó â øê³ð³ íàâåäåíî â òàáëèö³ 5.

Çà äàíèìè òàáëèö³ 5, óïðîäîâæ îñòàíí³õ òðüîõ ðîê³â

íà òåðèòîð³¿ Ãàëè÷èíè â³äçíà÷àºòüñÿ òåíäåíö³ÿ äî çìåí-

øåííÿ ñåðåä ä³òåé òà ï³äë³òê³â ê³ëüêîñò³ ïîâåðõíåâèõ

ôîðì ãí³éíè÷êîâèõ çàõâîðþâàíü øê³ðè (³ìïåòèãî, îñò³î-

ôîë³êóë³òè, ôîë³êóë³òè) òà òë³ çðîñòàííÿ çàãàëüíî¿ òà

â³äíîñíî¿ ê³ëüêîñò³ õâîðèõ íà ãëèáîê³ ôîðìè ï³îäåðì³é

(ôóðóíêóëè, êàðáóíêóëè, åêòèìè), ÿê³ ñóïðîâîäæóþòü-

ñÿ òðèâàëèì ïåðåá³ãîì òà ôîðìóâàííÿì ñò³éêèõ êîñìå-

òè÷íèõ çì³í øê³ðè, ïðè÷îìó, ÿê ñåðåä àìáóëàòîðíîãî,

òàê ³ ñòàö³îíàðíîãî êîíòèíãåíòó ïàö³ºíò³â. Îñîáëèâî

ñë³ä â³äçíà÷èòè çðîñòàííÿ ê³ëüêîñò³ ãëèáîêèõ ôîðì

ãí³éíè÷êîâèõ çàõâîðþâàíü øê³ðè ñåðåä äîðîñëîãî íàñå-

ëåííÿ Ëüâ³âñüêî¿ îáëàñò³, ÿê³ îòðèìàëè ë³êóâàííÿ â àìáó-

ëàòîðíèõ óìîâàõ (íà 5,7% – ó 2012 ðîö³ ïðîòè 2010 ðîêó)

òà â óìîâàõ ñòàö³îíàðó (íà 8,9% – ó 2012 ðîö³ ïðîòè 2010

ðîêó).

Ðîçïîä³ëó äîðîñëîãî òà äèòÿ÷îãî êîíòèíãåíòó õâîðèõ

íà ï³îäåðì³¿ Ëüâ³âñüêî¿ îáëàñò³ çà òðèâàë³ñòþ ïåðåá³ãó

ãí³éíè÷êîâèõ äåðìàòîç³â íàâåäåíî â òàáëèö³ 6.

ßê çàñâ³ä÷óþòü äàí³, íàâåäåí³ â òàáëèö³ 6, óïðîäîâæ

2010–2012 ðð. ñåðåä ìåøêàíö³â Ëüâ³âñüêî¿ îáëàñò³ â³äçíà-

÷àºòüñÿ òåíäåíö³ÿ äî çðîñòàííÿ çàãàëüíî¿ òà â³äíîñíî¿

ê³ëüêîñò³ õâîðèõ íà ï³îäåðì³¿ ç òðèâàëèì õðîí³÷íèì ïåðå-

á³ãîì (ôóðóíêóëüîç, õðîí³÷í³ âèðàçêîâ³ ï³îäåðì³¿ òîùî),

Òàáëèöÿ 5.

Ðîçïîä³ë õâîðèõ íà ï³îäåðì³¿ ó Ëüâ³âñüê³é îáëàñò³ çà ãëèáèíîþ óðàæåííÿ øê³ðè

Òàáëèöÿ 6.

Ðîçïîä³ë õâîðèõ íà ï³îäåðì³¿ ó Ëüâ³âñüê³é îáëàñò³ çà òðèâàë³ñòþ ïåðåá³ãó

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÑÎÖ²ÀËÜÍÀ ÌÅÄÈÖÈÍÀ / SOCIAL MEDICINE

ÿê³ ñóïðîâîäæóþòüñÿ ïîðóøåííÿì ä³ºçäàòíîñò³ õâîðèõ,

ðîçâèòêîì ïñèõîåìîö³éíèõ ðîçëàä³â ïàö³ºíò³â, çíèæåí-

íÿì ÿêîñò³ ¿õ æèòòÿ òà ñîö³àëüíî¿ àêòèâíîñò³. Òàê, ñåðåä

àìáóëàòîðíèõ ïàö³ºíò³â ÷àñòêà òàêèõ õâîðèõ ó 2012 ðîö³

ïîð³âíÿíî ç 2010 ðîêîì çðîñëà íà 3,1%, à ñåðåä ñòàö³îíàð-

íèõ õâîðèõ – íà 5,0%. Âñå öå îáãðóíòîâóº àêòóàëüí³ñòü ïðî-

âåäåííÿ íàóêîâèõ äîñë³äæåíü ùîäî ç’ÿñóâàííÿ åò³îïàòîãå-

íåòè÷íèõ ÷èííèê³â ðîçâèòêó ãëèáîêèõ òà õðîí³÷íèõ ôîðì

ãí³éíè÷êîâèõ çàõâîðþâàíü øê³ðè ñåðåä ìåøêàíö³â Ãàëè-

÷èíè ç ìåòîþ ðîçðîáêè íàóêîâî îáãðóíòîâàíèõ çàõîä³â

ùîäî îïòèì³çàö³¿ ¿õ ë³êóâàííÿ òà ïðîô³ëàêòèêè.

Âèñíîâêè.

1. Óïðîäîâæ îñòàíí³õ òðüîõ ðîê³â (2010–2012 ðð.) íà

òåðèòîð³¿ Ëüâ³âñüêî¿ îáëàñò³ â³äçíà÷àºòüñÿ çðîñòàííÿ ÷àñò-

êè õâîðèõ íà ï³îäåðì³¿ ó ñòðóêòóð³ ïàòîëîã³¿ øê³ðè ÿê

ñåðåä àìáóëàòîðíîãî (4,95% – ó 2012 ð. ïðîòè 3,92% –

ó 2010 ð.), òàê ³ ñòàö³îíàðíîãî êîíòèíãåíòó (5,19% – ó 2012 ð.

ïðîòè 3,42% – ó 2010 ð.) ïàö³ºíò³â.

2. Íàéá³ëüøà ïîøèðåí³ñòü ï³îäåðì³é ó Ëüâ³âñüê³é

îáëàñò³ â³äçíà÷àºòüñÿ ñåðåä ó÷í³âñüêî¿ òà ñòóäåíòñüêî¿ ìî-

ëîä³ (40,3% ó ñòðóêòóð³ ïàö³ºíò³â äèòÿ÷îãî â³êó) òà îñ³á

àêòèâíîãî ïðàöåçäàòíîãî â³êó (83,5% äîðîñëîãî êîíòèí-

ãåíòó õâîðèõ), ð³äøå íà ï³îäåðì³¿ õâîð³þòü ä³òè ðàííüîãî

äèòÿ÷îãî â³êó òà îñîáè ïåíñ³éíîãî â³êó.

3. Ñåðåä õâîðèõ íà ï³îäåðì³¿ íà òåðèòîð³¿ Ãàëè÷èíè

ïåðåâàæàþòü ìåøêàíö³ ì³ñò òà îñîáè ÷îëîâ³÷î¿ ñòàò³ çà

òåíäåíö³¿ äî çðîñòàííÿ ñåðåä ãîñï³òàë³çîâàíèõ ïàö³ºíò³â

÷àñòêè îñ³á æ³íî÷î¿ ñòàò³.

4. Â îñòàíí³ ðîêè (2010-2012 ðð.) íà òåðèòîð³¿

Ëüâ³âñüêî¿ îáëàñò³ êîíñòàòîâàíî çðîñòàííÿ ÷àñòêè õâîðèõ

íà ãëèáîê³ òà õðîí³÷í³ ôîðìè ãí³éíè÷êîâèõ çàõâîðþâàíü

øê³ðè, îñîáëèâî ñåðåä îñ³á àêòèâíîãî ïðàöåçäàòíîãî â³êó

(íà 5,9% òà 3,5% â³äïîâ³äíî).

5. Çðîñòàííÿ íà òåðèòîð³¿ Ãàëè÷èíè çàãàëüíî¿

ê³ëüêîñò³ òà ÷àñòêè ãîñï³òàë³çîâàíèõ õâîðèõ íà ï³îäåðì³¿, à

òàêîæ çá³ëüøåííÿ ê³ëüêîñò³ ïàö³ºíò³â ³ç òÿæêèìè êë³í³÷íè-

ìè ôîðìàìè ãí³éíè÷êîâèõ çàõâîðþâàíü øê³ðè, îáóìîâ-

ëþº àêòóàëüí³ñòü ïîãëèáëåíèõ íàóêîâèõ äîñë³äæåíü ùîäî

âèâ÷åííÿ åò³îïàòîãåíåòè÷íèõ ÷èííèê³â ðîçâèòêó ï³î-

äåðì³é ó ìåøêàíö³â Ëüâ³âñüêî¿ îáëàñò³ ç ìåòîþ îïòèì³-

çàö³¿ ¿õ ë³êóâàííÿ òà ïðîô³ëàêòèêè.

Ðåöåíçåíò:ä.ì.í., ïðîôåñîð Ñòåïàíåíêî Â.².

Ë²ÒÅÐÀÒÓÐÀ

1. Âîëêîñëàâñêàÿ Â.Í. Ñîñòîÿíèå çàáîëåâàåìîñòè èíôåê-

öèîííîé, ïàðàçèòàðíîé è ãðèáêîâîé ïàòîëîãèåé êîæè â Óê-

ðàèíå // Äåðìàòîëîã³ÿ òà âåíåðîëîã³ÿ – 2002. – ¹ 3. – Ñ. 67-70.

2. Ãàëíèê³íà Ñ.Î. Ï³îäåðì³¿ // ²íôåêö³éí³ õâîðîáè. – 2009. –

¹ 2. – Ñ. 85-93.

3. Äþäþí À.Ä., Ïîë³îí Í.Í., Áàøìàêîâ Ä.Ã. [òà ³í.] Ôóçè-

ä³ºâà êèñëîòà â ë³êóâàíí³ ä³òåé, õâîðèõ íà ï³îäåðì³¿ // Óêðà¿íñü-

êèé æóðíàë äåðìàòîëîã³¿, âåíåðîëîã³¿, êîñìåòîëîã³¿. – 2011. –

¹ 2. – Ñ. 87-91.

4. Êàëþæíà Ë.Ä., Ïàöåëÿ Ì.Â., Áîé÷óê À.Ì. [òà ³í.] Îö³í-

êà åôåêòèâíîñò³ ë³êóâàííÿ ïðåïàðàòîì “Öèòåàë” ïðè ³íôåê-

ö³éíèõ äåðìàòîçàõ òà âóãðîâ³é õâîðîá³ // Óêðà¿íñüêèé æóðíàë

äåðìàòîëîã³¿, âåíåðîëîã³¿, êîñìåòîëîã³¿. – 2013. – ¹ 2. –

Ñ. 154-157.

5. Ôåäîòîâ Â.Ï., Ãîðáóíöîâ Â.Â., Ïîðîíèê Ë.À. [òà ³í.]

Ëîìåêñèí-êðåì ó òåðàï³¿ äåðìàòîì³êîç³â òà ³íøèõ ³íôåêö³éíèõ

çàõâîðþâàíü øê³ðè ³ ñëèçîâèõ îáîëîíîê // Äåðìàòîâåíåðîëîã³ÿ.

Êîñìåòîëîã³ÿ. Ñåêñîïàòîëîã³ÿ. – 2008. – ¹ 1-2. – Ñ. 337-340.

6. Burden of paediatric pyoderma and scabies in North West

Queensland / J. Whitehall, D. Kuzulugil, K. Sheldrick, A. Wood // J.

Paediatrics and Child and Health. – 2013, Vol. 49, ¹ 2. – Ð. 141-143.

7. Chriba M. Beclometasone inhaler used to treat pyoderma

gangrenosum / M. Chriba, A.M. Skellett, N.J. Levell // Clinical and

Experimental Dermatology. – 2010. – Vol. 35, ¹ 3. – P. 337-338.

ÑÎÑÒÎßÍÈÅ È ÄÈÍÀÌÈÊÀ ÇÀÁÎËÅÂÀÅÌÎÑÒÈ

ÍÀ ÏÈÎÄÅÐÌÈÈ Ó ÆÈÒÅËÅÉ ËÜÂÎÂÑÊÎÉ

ÎÁËÀÑÒÈ

Äàøêî Ì.Î.1, Äåíèñåíêî Î.È.2

1Ëüâîâñüêèé íàöèîíàëüíûé ìåäèöèíñêèé

óíèâåðñèòåò èìåíè Äàíèëà Ãàëèöüêîãî,

ã. Ëüâîâ, Óêðàèíà

2Áóêîâèíñüêèé ãîñóäàñòâåííûé ìåäèöèíñêèé

óíèâåðñèòåò, ã.×åðíîâöû, Óêðàèíà

Ðåçþìå. Â ñòàòüå ïðåäñòàâëåíû äàííûå îòíîñèòåëü-

íî ñòðóêòóðû è äèíàìèêè çàáîëåâàåìîñòè íà ïèîäåð-

ìèè ñðåäè äåòñêîãî è âçðîñëîãî íàñåëåíèÿ Ëüâîâñêîé

îáëàñòè (Ãàëè÷èíû) çà ïîñëåäíèå òðè ãîäà (2010–

2012 ãã.). Óñòàíîâëåí åæåãîäíûé ðîñò êîëè÷åñòâà áîëü-

íûõ íà ïèîäåðìèè â îáëàñòè, âûñøóþ çàáîëåâàåìîñòü

ñðåäè ãîðîäñêèõ æèòåëåé è ëèö àêòèâíîãî òðóäîñïîñîá-

íîãî âîçðàñòà, à òàêæå óâåëè÷åíèÿ ÷àñòè áîëüíûõ ñ ãëó-

áîêèìè è õðîíè÷åñêèìè ôîðìàìè ãíîéíè÷êîâûõ çàáî-

ëåâàíèé êîæè, êîòîðûå íóæäàþòñÿ â ñòàöèîíàðíîì ëå-

÷åíèè. Ðåçóëüòàòû ïðîâåäåííîãî àíàëèçà ïîêàçûâàþò

íåîáõîäèìîñòü èçó÷åíèÿ ýòèîïàòîãåíåòè÷åñêèõ ôàêòî-

ðîâ ãíîéíè÷êîâûõ çàáîëåâàíèé êîæè ó îáèòàòåëåé ðåãè-

îíà ñ öåëüþ îïòèìèçàöèè èõ ëå÷åíèÿ è ïðîôèëàêòèêè.

Êëþ÷åâûå ñëîâà: ïèîäåðìèè, çàáîëåâàåìîñòü,

äèíàìèêà.

CONDITION AND DYNAMICS OF INCIDENCE

OF PIODERMIYA IN INHABITANTS

OF THE LVIV REGION

Ì. Dashko1, Î. Denisenko2

1Danylo Halytsky Lviv National Medical University,

Lviv, Ukraine

2Bukovinian State Medical University,

Chernivtsy, Ukraine

Summàry. The article presents data on structure and

dynamics of the piodermiya incidence among children and

adults from Lviv region for the last three years (2010–2012).

Annual growth of the number of piodermiya patients in the

region, high disease incidence among the city residents

and also among people of active capable age, and increase

in patients with deep and chronic forms of pustulous

diseases of skin who need hospitalisation is established.

The results of the carried-out analysis indicate the need to

study etiopathogenetical factors of pustulous disease of

skin among region inhabitants in order to optimize their

treatment and prevention.

Key words: piodermiya, incidence, dynamics.

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÑÎÖ²ÀËÜÍÀ ÌÅÄÈÖÈÍÀ / SOCIAL MEDICINE

Àêòóàëüí³ñòü òåìè. Ãëîáàë³çàö³éí³ ïðîöåñè ó ñâ³ò³,

³íòåãðàö³éí³ ïðîöåñè â Óêðà¿í³, çîêðåìà ¿¿ ñóñï³ëüí³é òà

îñâ³òí³é ãàëóçÿõ, â³ëüíèé äîñòóï äî áóäü-ÿêî¿ ³íôîðìàö³¿, â

òîìó ÷èñë³ íåöåíçóðîâàíî¿, ñïîíóêàþòü âëàäó òà îñâ³òÿí

äî ïðèâåäåííÿ áàãàòüîõ ÿâèù ó â³äïîâ³äí³ñòü ç ºâðîïåé-

ñüêèìè ñòàíäàðòàìè. Íà íàø ïîãëÿä, àêòóàëüíèì º äîñë³ä-

æåííÿ ïðîáëåì ôîðìóâàííÿ ñòàòåâî¿ îñâ³÷åíîñò³ ó ñó-

÷àñíèõ óêðà¿íñüêèõ ï³äë³òê³â.

Ìåòà ðîáîòè ïîëÿãàº â îêðåñëåíí³ òà àíàë³ç³ ïðîáëåì

ôîðìóâàííÿ ñòàòåâî¿ îñâ³÷åíîñò³ ó ñó÷àñíèõ óêðà¿íñüêèõ

ï³äë³òê³â, à òàêîæ ïîð³âíÿíí³ ïðîáëåì ñòàòåâî¿ îñâ³÷åíîñò³

óêðà¿íñüêèõ òà çàðóá³æíèõ ï³äë³òê³â.

Ìåòîäè äîñë³äæåííÿ: àíàë³òè÷íèé, ñèñòåìíèé, îïè-

ñîâèé, ïîð³âíÿëüíèé, îïèòóâàííÿ øëÿõîì àíêåòóâàííÿ.

Ðåçóëüòàòè òà îáãîâîðåííÿ. Ïîíÿòòÿ ñòàòåâî¿ îñâ³òè òà

ñòàòåâî¿ îñâ³÷åíîñò³ äîñë³äæóþòüñÿ â÷åíèìè – ïðåäñòàâíè-

êàìè áàãàòüîõ ãàëóçåé çíàíü, çîêðåìà, ïåäàãîãàìè, ïñèõîëî-

ãàìè, ñîö³îëîãàìè, ìåäèêàìè òîùî. Ç òî÷êè çîðó ïåäàãîã³êè

òà ïñèõîëîã³¿ ñòàòåâà îñâ³òà – öå ñèñòåìà ìåäèêî-ïñèõîëîã³÷-

íèõ çàõîä³â ç âèõîâàííÿ ó ä³òåé, ï³äë³òê³â, ìîëîä³ òà áàòüê³â

ïðàâèëüíîãî ñòàâëåííÿ äî ïèòàíü ì³æñòàòåâèõ â³äíîñèí [4].

Â ñîö³îëîã³¿ ïîíÿòòþ “ñòàòåâà îñâ³òà” äàºòüñÿ íàñòóïíå òëó-

ìà÷åííÿ: ñòàòåâà îñâ³òà – öå ïðîöåñ ãåíäåðíî¿ ñîö³àë³çàö³¿,

ùî çä³éñíþºòüñÿ çà äîïîìîãîþ ñïðÿìîâàíèõ àáî ñïîíòàí-

íèõ ä³é, ÿê³ äîïîìàãàþòü äèòèí³ ñòàòè ÷îëîâ³êîì ÷è æ³íêîþ,

ñïðèéíÿòè ³ñíóþ÷³ â ñóñï³ëüñòâ³ íîðìè ³ ïðàâèëà ó âçàº-

ìèíàõ ì³æ ñòàòÿìè ó òðóäîâîìó, ãðîìàäñüêîìó òà îñîáè-

ñòîìó æèòò³ [6]. Øèðîêî ðîçãëÿäàþòü ð³çí³ àñïåêòè ñòàòå-

âî¿ îñâ³òè ïñèõîëîãè. Òàê, À.Ã.Õð³ïêîâà ³ Ä.Â.Êîëåñîâ

âèçíà÷àþòü ñòàòåâå âèõîâàííÿ ÿê “ïðîöåñ, ñïðÿìîâàíèé

íà âèðîáëåííÿ ÿêîñòåé, ðèñ, âëàñòèâîñòåé, à òàêîæ óñòà-

íîâîê îñîáèñòîñò³, ùî âèçíà÷àþòü íåîáõ³äí³ ñóñï³ëüñòâó

â³äíîñèíè ëþäèíè ç ïðåäñòàâíèêàìè ³íøî¿ ñòàò³” [11].

Ì³æíàðîäíå òåõí³÷íå êåð³âíèöòâî ç³ ñòàòåâî¿ ïðîñâ³òè

(ÞÍÅÑÊÎ, Ñåêö³ÿ ç ïðîáëåì Â²Ë/ÑÍ²Äó) íàâîäèòü íà-

ñòóïíå âèçíà÷åííÿ äàíîãî òåðì³íà: ñòàòåâà îñâ³òà – öå

â³äïîâ³äíèé ó â³êîâîìó òà êóëüòóðíîìó â³äíîøåíí³ ï³äõ³ä

äî íàâ÷àííÿ ïðî ñòàòåâ³ â³äíîñèíè øëÿõîì íàäàííÿ íàó-

êîâî òî÷íî¿, ðåàë³ñòè÷íî¿ òà îá’ºêòèâíî¿ ³íôîðìàö³¿ [7] .

Â ñâîºìó äîñë³äæåíí³ ï³ä ïîíÿòòÿì ñòàòåâî¿ îñâ³òè ìè

áóäåìî ðîçóì³òè ñèñòåìó ö³ëåñïðÿìîâàíèõ ì³ð òà çàõîä³â

ç ôîðìóâàííÿ ó ä³òåé, ìîëîä³ òà áàòüê³â ñòàòåâî¿ îñâ³÷å-

íîñò³. À ï³ä ïîíÿòòÿì “ñòàòåâî¿ îñâ³÷åíîñò³” – ñèñòåìó

â³äïîâ³äíèõ çíàíü ç àíàòîì³¿ òà ô³ç³îëîã³¿ ëþäèíè, ã³ã³ºíè,

êîíòðàöåïö³¿, ïëàíóâàííÿ ñ³ì’¿, ãåíäåðíî¿ ñîö³îëîã³¿, åòè-

êè, ïñèõîëîã³¿, à òàêîæ ïðàâîâèõ çíàíü, ÿê³ äîçâîëÿþòü

ÓÄÊ 613.88-053.81(477)

ÏÐÎÁËÅÌÈ ÔÎÐÌÓÂÀÍÍß ÑÒÀÒÅÂÎ¯ ÎÑÂ²×ÅÍÎÑÒ²

ÑÓ×ÀÑÍÎ¯ ÌÎËÎÄ² ÓÊÐÀ¯ÍÈ

Êîõàíñüêà À.². 1, Ðîìàíþê ².Ä. 2

1 Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Î.Î.Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

2 Êè¿âñüêèé ìåäè÷íèé óí³âåðñèòåò Óêðà¿íñüêî¿ àñîö³àö³¿ íàðîäíî¿ ìåäèöèíè, ì. Êè¿â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: ñòàòåâà îñâ³÷åí³ñòü, îñâ³òà, ìîëîäü.

îñîáèñòîñò³ êåðóâàòè ñâî¿ì ñòàòåâèì æèòòÿì, íå ï³äïàäà-

þ÷è ï³ä âïëèâ ³íøèõ ³ çáåð³ãàþ÷è ñâîº ïñèõ³÷íå òà ðåïðî-

äóêòèâíå çäîðîâ’ÿ.

Ñåðåä çàðóá³æíèõ â÷åíèõ ´ðóíòîâíèìè äîñë³äæåííÿ-

ìè äàíî¿ òåìè º ðîáîòè Í.Ôåíòàõóí òà êîëåêòèâó êîëåã, ÿê³

âèâ÷àëè ñòàâëåííÿ áàòüê³â, â÷èòåë³â òà ñòóäåíò³â äî ñòàòå-

âî¿ îñâ³òè â øêîë³, â ÿêèõ àâòîðè ðîáëÿòü íàñòóïíèé âèñ-

íîâîê: ïåðåâàæíà á³ëüø³ñòü îïèòàíèõ â ïðîöåñ³ äîñë³ä-

æåííÿ óñâ³äîìëþþòü âàæëèâ³ñòü âèêëàäàííÿ ñòàòåâî¿

îñâ³òè â øêîë³. Çà äàíèìè íàóêîâö³â, á³ëüø³ñòü ðåñïîí-

äåíò³â ââàæàþòü íàéá³ëüø ïðîäóêòèâíèìè ïðîãðàìàìè ç

äàíî¿ äèñöèïë³íè ò³, ùî çàñíîâàí³ íà óòðèìàíí³ â³ä ñåêñó

äëÿ ä³òåé ìîëîäøî¿ øêîëè ³ íà ñòðèìàíîñò³ äëÿ ä³òåé ñå-

ðåäíüî¿ ³ ñòàðøî¿ øê³ë. Àâòîðè òàêîæ íàãîëîøóþòü íà

òîìó, ùî øê³ëüíà ñòàòåâà îñâ³òà ïîâèííà ö³ëêîì ï³äïîðÿä-

êîâóâàòèñü ïîòðåáàì ä³òåé, áàòüê³â òà â÷èòåë³â [17].

Àìåðèêàíñüê³ â÷åí³ Êåòð³í Ô.Ñòðåíäæåð-Õîëë òà Äåâ³ä

Â. Õîëë ó ñâîºìó äîñë³äæåíí³ ïåðåêîíëèâî äîâîäÿòü íèçü-

êó åôåêòèâí³ñòü àìåðèêàíñüêî¿ ñèñòåìè ñòàòåâî¿ îñâ³òè,

ÿêà çàñíîâàíà íà ïðîïàãàíä³ óòðèìàííÿ â³ä äîøëþáíèõ

ñòàòåâèõ ñòîñóíê³â. Àâòîðè ï³äêðåñëþþòü: ìàþ÷è íà ìåò³

çíèçèòè ïîêàçíèêè ï³äë³òêîâî¿ âàã³òíîñò³ â ÑØÀ, ïðîãðàìè,

áàçîâàí³ íà óòðèìàíí³ â³ä äîøëþáíîãî ñåêñó, àáñîëþòíî

íå âïëèâàþòü íà ö³ öèôðè, ³ íàâïàêè – â îêðåìèõ øêîëàõ, ó

ÿêèõ ñòàòåâà îñâ³òà ìàº êîìïëåêñíèé ³íôîðìàö³éíèé ³ âè-

õîâíèé, à íå ñòðèìóâàëüíèé õàðàêòåð, ê³ëüê³ñòü âàã³òíèõ

ä³â÷àò-ï³äë³òê³â çíà÷íî ìåíøà, í³æ çàãà ëüíîíàö³îíàëüíà [14].

À.Ëåâ³ñ-Áàðíåä ó ñâî¿é ïðàö³ “What do school children

want from sex education?” (“×îãî õî÷óòü ä³òè â³ä ñòàòåâî¿

îñâ³òè?”) âèä³ëÿº íàñòóïí³ çàñàäîâ³ ïðèíöèïè ñòàòåâî¿ îñâ³-

òè: ïðîâåäåííÿ çàíÿòü ó íåâåëèêèõ ãðóïàõ ñòóäåíòàìè-ìå-

äèêàìè çàì³ñòü øê³ëüíèõ â÷èòåë³â, ëàêîí³çì ³ ÷³òê³ñòü ó

âèêëàäåíí³ ìàòåð³àëó, ïðîâåäåííÿ äèñêóñ³é íà óðîêàõ [10].

Áëèçüêèìè äî ïîïåðåäíüî¿ ïðàö³ º ñòàò³ Äæ.Ñòåôåíñî-

íà òà éîãî êîëåã ³ Äåâ³äà À.Ðîññà. Òàê, êîëåêòèâ Äæ.Ñòå-

ôåíñîíà ï³ñëÿ âèâ÷åííÿ äîâãîòðèâàëî¿ åôåêòèâíîñò³ â

øêîëàõ Àíãë³¿ ïðîãðàì ñòàòåâî¿ îñâ³òè, ùî çàñíîâàí³ íà

âçàºìîä³¿ òà âçàºìîäîïîìîç³ ì³æ ï³äë³òêàìè, çðîáèëè âèñ-

íîâîê: äîñë³äæóâàíà íèìè ìîäåëü ñòàòåâîãî âèõîâàííÿ

ìîëîä³ º äîñèòü åôåêòèâíîþ ³ ïåðñïåêòèâíîþ [15]. Íàä

äîñë³äæåííÿì äàíî¿ òåìè ïðàöþâàâ òàêîæ Äåâ³ä À.Ðîññ,

ÿêèé ïåðåðàõîâóº íåãàòèâí³ ñòîðîíè ïðîãðàì ñòàòåâî¿

îñâ³òè, çàñíîâàíèõ íà âèêëàäàíí³ äèñöèïë³íè îäíîë³òêà-

ìè: ïî-ïåðøå, òðóäíîù³ â ï³äãîòîâö³ òàêèõ âèêëàäà÷³â, ïî-

äðóãå, ïåâí³ ðèçèêè ïîâ’ÿçàí³ ç òèì, ùî â³äñóòí³ âàæ³ë³

êîíòðîëþ, àäæå êîíòðîëþâàòè ïåäàãîã³÷íó ä³ÿëüí³ñòü äî-

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÑÎÖ²ÀËÜÍÀ ÌÅÄÈÖÈÍÀ / SOCIAL MEDICINE

ðîñëîãî â÷èòåëÿ íàáàãàòî ïðîñò³øå. Íàóêîâåöü ââàæàº,

ùî ïîïóëÿðí³ñòü äàíî¿ ìîäåë³ ñòàòåâîãî âèõîâàííÿ ñåðåä

øêîëÿð³â íå º äîñòàòíüîþ ïðè÷èíîþ äëÿ ïî÷àòêó øèðî-

êîãî çàñòîñóâàííÿ ö³º¿ ìîäåë³ [13].

Ïðîáëåìè, ÿê³ äîñë³äæóþòüñÿ â ñòàòò³ ³íä³éñüêèõ â÷åíèõ

Í.Òð³ïàò³ òà Ò.Â.Ñåêåðà, ïåâíîþ ì³ðîþ ñï³âïàäàþòü ³ç

ïðîáëåìàìè ñòàòåâî¿ îñâ³÷åíîñò³ óêðà¿íñüêèõ ï³äë³òê³â. Àâ-

òîðè ðîáëÿòü âèñíîâîê, ùî ìîëîäü ²íä³¿ óñâ³äîìëþº íå-

îáõ³äí³ñòü ñòàòåâî¿ îñâ³òè (àáî “family life education” – FLE),

îñîáëèâî â ñó÷àñíîìó ñîö³óì³, â ÿêîìó îñòàíí³ì ÷àñîì

â³äáóâàþòüñÿ äîêîð³íí³ ñâ³òîãëÿäí³ òà êóëüòóðí³ ïåðåòâî-

ðåííÿ. Îäíàê äàíå äîñë³äæåííÿ âèÿâèëî, ùî ëèøå ïîëîâè-

íà íåîäðóæåíèõ æ³íîê ä³éñíî îòðèìàëà äîñòóï äî ïåâíèõ

ôîðì ñòàòåâî¿ îñâ³òè, ïðè öüîìó àâòîðè íàãîëîøóþòü, ùî,

ïîïðè ð³çêó íåîáõ³äí³ñòü óïðîâàäæåííÿ ïðîãðàì ñòàòåâî¿

îñâ³òè â øêîë³, âëàäà êðà¿íè ÷èíèòü öüîìó çíà÷íèé îï³ð [16].

Ï³äòâåðäæóº äóìêó á³ëüøîñò³ ñâ³òîâèõ â÷åíèõ äîñë³ä-

æåííÿ àâñòðàë³éñüêîãî íàóêîâöÿ Ã. Àëìàõáîá³ – àâòîð

ñòàòò³ “Youth in India ready for sex education? Emerging

evidence from national surveys” âêîòðå âèñëîâëþº ï³äòðèì-

êó âïðîâàäæåííþ êîìïëåêñíî¿ ïðîãðàìè øê³ëüíî¿ ñòàòå-

âî¿ îñâ³òè, ÿêà ìàº áóòè ðîçðîáëåíà óðÿäîâèìè òà íåóðÿäî-

âèìè ãðîìàäñüêèìè îðãàí³çàö³ÿìè çà ï³äòðèìêè çàñîá³â

ìàñîâî¿ ³íôîðìàö³¿, ðåë³ã³éíèõ ãðîìàä, à òàêîæ ó ò³ñíîìó

ñï³âðîá³òíèöòâ³ ç áàòüê³âñüêèìè êîì³òåòàìè. Íà äóìêó â÷å-

íèõ, îäíèì ³ç êëþ÷îâèõ ôàêòîð³â, ùî çàòðèìóþòü ðîçâèòîê

³ âò³ëåííÿ â æèòòÿ âèùåçãàäàíèõ ïðîãðàì, º ïåðåêîíàííÿ

ïðåäñòàâíèê³â äåÿêèõ êóëüòóð, çã³äíî ç ÿêèìè ñòàòåâà îñâ³òà

ïîâèííà çóìîâèòè ð³çêå ï³äâèùåííÿ ñåêñóàëüíî¿ àêòèâ-

íîñò³ ñåðåä ìîëîä³, ³, âíàñë³äîê öüîãî, çðîñòàííÿ ð³âíÿ çàõ-

âîðþâàíîñò³ íà Â²Ë/ÑÍ²Ä, ÷èñëà ï³äë³òêîâèõ âàã³òíîñòåé,

òîùî. Àâòîð ñòàòò³ çàçíà÷àº: äàí³ áàãàòüîõ äîñë³äæåíü ïåðå-

êîíëèâî äîâîäÿòü, ùî ñàìå ³ãíîðóâàííÿ ñòàòåâî¿ îñâ³òè º

ïðè÷èíîþ òèõ ïðîáëåì, çàãîñòðåííÿ ÿêèõ íåïîêî¿òü ïðåä-

ñòàâíèê³â òðàäèö³éíèõ êóëüòóð [1].

Àíàë³ç ïðàöü ðîñ³éñüêèõ â÷åíèõ (².Ñ. Êîí, ª.Ñ.Òðóò³íà,

².Â. Æóðàâëüîâà, Ò.Ì.Ðåçåð) äîçâîëÿº ââàæàòè, ùî é ñåðåä

äîñë³äíèê³â áëèçüêèõ äî Óêðà¿íè çà ñîö³îêóëüòóðíèì ðîçâèò-

êîì êðà¿í ïàíóþòü ñõîæ³ íàñòðî¿: á³ëüø³ñòü íàóêîâö³â íàâî-

äÿòü àðãóìåíòè çà âïðîâàäæåííÿ ñòàòåâî¿ îñâ³òè â øêîëàõ.

Â óìîâàõ øâèäêîãî ðîçïîâñþäæåííÿ åï³äåì³¿ Â²Ë/

ÑÍ²Ä ó á³ëüøîñò³ êðà¿í ñâ³òó ñåêö³ºþ ÎÎÍ ç ïèòàíü îñâ³òè,

íàóêè òà êóëüòóðè áóëî ðîçðîáëåíî Ì³æíàðîäíå òåõí³÷íå

êåð³âíèöòâî ç³ ñòàòåâî¿ îñâ³òè (International Technical

Guidance on Sexuality Education), ÿêå çàñíîâàíå íà ðåòåëü-

íîìó îãëÿä³ ôàêòè÷íî¿ ³íôîðìàö³¿ ïðî ïðîãðàìè ñòàòåâî¿

îñâ³òè ³ ðîçðàõîâàíå íà êåð³âíèê³â ³ ïðîôåñ³éíèõ ïðàö³â-

íèê³â ñåêòîð³â îñâ³òè òà îõîðîíè çäîðîâ’ÿ.

Â äàíîìó äîêóìåíò³ àðãóìåíòîâàíî äîâåäåíà

äîö³ëüí³ñòü âïðîâàäæåííÿ åôåêòèâíèõ ïðîãðàì ç³ ñòàòå-

âî¿ îñâ³òè, à òàêîæ ñïðîñòîâàí³ îñíîâí³ ïîáîþâàííÿ, ïî-

â’ÿçàí³ ç äàíèì ïèòàííÿì. Íà äóìêó ôàõ³âö³â, åôåêòèâí³

ïðîãðàìè ç³ ñòàòåâî¿ îñâ³òè:

1) çàëó÷àþòü äî ðîçðîáêè íàâ÷àëüíèõ ïðîãðàì åêñ-

ïåðò³â, ùî çàéìàþòüñÿ äîñë³äæåííÿìè â îáëàñò³ ñåêñó-

àëüíîãî æèòòÿ ëþäèíè, çì³í ïîâåä³íêè ³ âèâ÷åííÿì ñóì³-

æíèõ òåîðåòè÷íèõ ïðîáëåì ïåäàãîã³êè;

2) âðàõîâóþòü êóëüòóðí³ ö³ííîñò³ òà íàÿâí³ñòü ðåñóðñ³â

(íàïðèêëàä, âèçíà÷åííÿ òåðì³íó íàâ÷àííÿ, êâàë³ô³êàö³¿

â÷èòåë³â, ïîòðåá ó ïðèì³ùåííÿõ ³ ìàòåð³àëüíèõ ðåñóðñàõ);

3) çä³éñíþþòü ï³ëîòíå âèïðîáóâàííÿ ïðîãðàìè

³ ï³äòðèìóþòü ïîñò³éíèé çâîðîòíèé çâ’ÿçîê ç ó÷íÿìè, ç

ìåòîþ îòðèìàííÿ ³íôîðìàö³¿ ïðî òå, íàñê³ëüêè ïðîãðàìà

çàäîâîëüíÿº ¿õí³ âèìîãè;

4) êîíöåíòðóþòü óâàãó íà ÿñíèõ ö³ëÿõ ïðè ðîçðîáö³

çì³ñòó íàâ÷àëüíî¿ ïðîãðàìè, âèçíà÷åíí³ ï³äõîä³â ³

çä³éñíåíí³ çàõîä³â. Â³äïîâ³äíð, ö³ë³ ïîâèíí³ âêëþ÷àòè ïðî-

ô³ëàêòèêó Â²Ë, ³íøèõ ²ÏÑØ òà / àáî íåáàæàíî¿ âàã³òíîñò³;

5) êîíöåíòðóþòü óâàãó íà îñîáëèâèõ ôîðìàõ ðèçèêî-

âî¿ ñåêñóàëüíî¿ òà çàõèñíî¿ ïîâåä³íêè, ÿê³ áåçïîñåðåäíüî

ïîâ’ÿçàí³ ç ö³ëÿìè îõîðîíè çäîðîâ’ÿ;

6) ðîçãëÿäàþòü êîíêðåòí³ ñèòóàö³¿, ÿê³ ìîæóòü ïðèâåñ-

òè äî íåáàæàíîãî ñòàòåâîãî êîíòàêòó áåç çàïîá³ãàííÿ,

à òàêîæ ñïîñîáè íåäîïóùåííÿ òàêèõ ñèòóàö³é àáî âèõîäó

ç íèõ;

7) óïðîâàäæóþòü ìåòîäè âèêëàäàííÿ, ÿê³ ïåðåäáà÷à-

þòü àêòèâíó ó÷àñòü ó÷í³â ³ äîïîìàãàþòü ¿ì îáãîâîðþâàòè

³ çàñâîþâàòè ³íôîðìàö³þ;

8) äàþòü íàóêîâî äîñòîâ³ðíó ³íôîðìàö³þ ïðî ðèçèêè,

ïîâ’ÿçàí³ ç³ ñòàòåâèìè êîíòàêòàìè áåç çàñòîñóâàííÿ êîíò-

ðàöåïòèâ³â, à òàêîæ ïðî åôåêòèâí³ñòü ð³çíèõ ìåòîä³â êîíò-

ðàöåïö³¿;

9) ïðèä³ëÿþòü óâàãó îñîáèñòèì ö³íí³ñíèì îð³ºíòèðàì

³ óÿâëåííÿì, ùî ñêëàëèñÿ â ñ³ì’¿ òà ñåðåä îäíîë³òê³â â ïè-

òàííÿõ, ÿê³ ñòîñóþòüñÿ âñòóïó â ñåêñóàëüí³ â³äíîñèíè òà/

àáî ñòàòåâèõ çâ’ÿçê³â ç ê³ëüêîìà ïàðòíåðàìè;

10) ðîçâèâàþòü â³äïîâ³äí³ íàâè÷êè òà âì³ííÿ çàñòîñî-

âóâàòè ¿õ íà ïðàêòèö³;

11) âèâ÷àþòü òåìè â ëîã³÷í³é ïîñë³äîâíîñò³ [7].

Äîñë³äæóþòü òåìó ñòàòåâî¿ îñâ³òè ³ ñó÷àñí³ óêðà¿íñüê³

â÷åí³, à ñàìå, Ë.À. ßêóáîâà ó ñâî¿é ñòàòò³, àíàë³çóþ÷è ð³çí³

ôîðìè ñòàòåâî¿ îñâ³òè ó ñâ³ò³, ðîáèòü íàñòóïíèé âèñíî-

âîê: Óêðà¿í³ íåîáõ³äíî ðîçðîáèòè òà çàïðîâàäèòè ïðîïå-

äåâòè÷í³ îñâ³òíüî-âèõîâí³ ïðîãðàìè ÿê îäèí ç îñíîâíèõ

øëÿõ³â âèð³øåííÿ êîìïëåêñó ñîö³àëüíî-ïåäàãîã³÷íèõ, ìå-

äèêî-á³îëîã³÷íèõ ³ åòè÷íî-ïñèõîëîã³÷íèõ ïðîáëåì ó ôîð-

ìóâàíí³ ñòàòåâî¿ êóëüòóðè ï³äë³òê³â. Ïðè÷îìó, íà äóìêó

äîñë³äíèö³, âèùåçãàäàí³ ïðîãðàìè ïîâèíí³ ðîçðîáëÿòèñÿ

ó ïðîöåñ³ ò³ñíî¿ âçàºìîä³¿ ñ³ì’¿ òà îñâ³òíüî-âèõîâíèõ óñòà-

íîâ ÿê ³íñòèòóò³â, ùî ìàþòü íàéñèëüí³øèé âïëèâ íà ôîð-

ìóâàííÿ ñòàòåâî¿ êóëüòóðè ï³äë³òê³â. Íà â³äì³íó â³ä

á³ëüøîñò³ çàõ³äíèõ â÷åíèõ, Ë.À.ßêóáîâà àêöåíòóº óâàãó

íà òîìó, ùî ï³äë³òêàì “íåîáõ³äí³ îñîáèñòîñò³, ÷èé àâòîðè-

òåò âîíè âèçíàþòü, ³ ÿê³ ìîæóòü ñòàòè äëÿ íèõ âç³ðöÿìè

òîãî, ùî öíîòà íå ò³ëüêè ïðèéíÿòíà, àëå é (…) ºäèíî ïðà-

âèëüíà æèòòºâà ïîçèö³ÿ” [18]. Öþ äóìêó ïîä³ëÿº é

Â.Ï. Êðàâåöü, ÿêèé ó ñâîºìó äîñë³äæåíí³ âèçíà÷àº íå

ëèøå îñíîâí³ çàâäàííÿ ñåêñóàëüíî¿ îñâ³òè ìîëîä³, à é

øëÿõè àäàïòàö³¿ çàðóá³æíèõ ïðîãðàì äî â³ò÷èçíÿíî¿ ïåäà-

ãîã³÷íî¿ ïðàêòèêè ç óðàõóâàííÿì êóëüòóðíèõ òà ìîðàëü-

íèõ ö³ííîñòåé òðàäèö³éíîãî óêðà¿íñüêîãî ñóñï³ëüñòâà.

¥ðóíòóþ÷èñü íà ïðàöÿõ ².Ñ.Êîíà, Ò.Â.Ãîâîðóíà, àâòîð íà-

âîäèòü ñâîþ ãðàäàö³þ øê³ëüíî¿ ïðîãðàìè ñòàòåâî¿ îñâ³òè:

ïåðøà ñòàä³ÿ äëÿ ä³òåé 6–10 ðîê³â, äðóãà – äëÿ 11–13-ð³÷íèõ

ï³äë³òê³â, òðåòÿ – äëÿ ó÷í³â 14–16 ðîê³â. Òàêîæ Â.Ï. Êðà-

âåöü âèñëîâëþº äîñèòü ñì³ëèâó äëÿ óêðà¿íñüêî¿ ñó÷àñíî¿

ñï³ëüíîòè ³äåþ ïðî ïî÷àòîê ñòàòåâîãî âèõîâàííÿ ä³òåé ùå

ó äîøê³ëüíîìó â³ö³ [9].

Ã. Ãðàáîâà âèçíà÷àº ìåòó ñâîº¿ ïðàö³, ÿê àíàë³ç ïîãëÿä³â

óêðà¿íñüêèõ òà çàðóá³æíèõ â÷åíèõ íà ïðîáëåìó ñòàòåâîãî

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÑÎÖ²ÀËÜÍÀ ÌÅÄÈÖÈÍÀ / SOCIAL MEDICINE

âèõîâàííÿ, âèîêðåìëåíí³ êðèòåð³¿ â ôîðìóâàííÿ éîãî

çì³ñòó òà çàâäàíü ç óðàõóâàííÿì ïîçèòèâíîãî äîñâ³äó

³íøèõ êðà¿í ñâ³òó â óìîâàõ çì³íåííÿ òðàäèö³éíèõ ïîãëÿä³â

íà ïèòàííÿ ñòàòåâîãî âèõîâàííÿ òà îñâ³òè [5]. Öå ïèòàííÿ

òàêîæ âèâ÷àº Ñ.Â. Áåçóøêî, ÿêèé, çîêðåìà, íàãîëîøóº íà

íåîáõ³äíîñò³ ïîºäíàííÿ ñòàòåâî-ðîëüîâîãî òà îñîáèñò³ñíî-

îð³ºíòîâàíîãî ï³äõîä³â äî ñòàòåâîãî âèõîâàííÿ ó øêîë³.

Á³ëüøó óâàãó íàóêîâåöü ïðèä³ëÿº ôîðìóâàííþ â ó÷í³â

ñïðèéíÿòëèâî¿ ó ñóñï³ëüñòâ³ ãåíäåðíî¿ ïîâåä³íêè, âèðîá-

ëåííÿ àäåêâàòíîãî ñòàâëåííÿ äî êðàñè, ëþáîâ³, ôîðìóâàí-

íÿ äîáðîçè÷ëèâèõ â³äíîñèí ì³æ ä³â÷àòàìè òà õëîïöÿìè,

ùî, íà íàøó äóìêó, äóæå âàæëèâî. Â ñó÷àñíîìó óêðà¿íñü-

êîìó ñóñï³ëüñòâ³, Ñ.Â.Áåçóøêî âèîêðåìëþº íåîáõ³äíèé

åòàï ðîçâèòêó ñòàòåâî¿ îñâ³÷åíîñò³ ñåðåä íàñåëåííÿ çàãà-

ëîì ³ ìîëîä³, çîêðåìà, – óïðîâàäæåííÿ ð³çíèõ ôîðì òà

ìåòîä³â ïðîñâ³òè ä³òåé ùîäî ãåíäåðíîãî âèõîâàííÿ [2] .

Íà òë³ ÷èñëåííèõ çàÿâ óêðà¿íñüêèõ íàóêîâö³â ùîäî íå-

îáõ³äíîñò³ ðîçðîáëåííÿ òà âïðîâàäæåííÿ ïðîãðàìè ñòà-

òåâî¿ îñâ³òè äëÿ ó÷í³âñüêî¿ ìîëîä³ Ò.ª. Áîé÷åíêî ó ñâî¿é

ñòàòò³ ïðîâîäèòü àíàë³ç ä³þ÷î¿ ïðîãðàìè íàâ÷àëüíîãî

ïðåäìåòó “Îñíîâè çäîðîâ’ÿ”, ÿêà ïåâíîþ ì³ðîþ ì³ñòèòü

ó ñîá³ äåÿê³ åëåìåíòè ñòàòåâîãî âèõîâàííÿ. Äîñë³äíèê ââà-

æàº çà ïîòð³áíå ïîäàëüøå îáãîâîðåííÿ ïèòàíü ç äàíî¿

òåìè øèðîêîþ ãðîìàäñüê³ñòþ Óêðà¿íè, à òàêîæ ïîäàëüøå

âèâ÷åííÿ öèõ ïèòàíü íàóêîâöÿìè [3].

¥ðóíòîâí³ äîñë³äæåííÿ ç òåìè ñòàòåâîãî âèõîâàííÿ òà

ñòàòåâî¿ îñâ³÷åíîñò³ ìîëîä³ áóëè ïðîâåäåí³ Î.Â.Áÿëèê, ÿêà

ñèñòåìàòèçóâàëà çíàííÿ ïðî ìîäåë³ òà ôîðìè ñòàòåâîãî

âèõîâàííÿ ó ñâ³ò³ íà âèîêðåìèëà ïîçèòèâíèé äîñâ³ä, íà

ÿêèé ïîòð³áíî ñïèðàòèñü óêðà¿íñüêèì â÷åíèì òà óðÿäîâ-

öÿì ïðè ðîçðîáö³ ïðîãðàì ñòàòåâîãî âèõîâàííÿ äëÿ

óêðà¿íñüêî¿ ìîëîä³.

Ò.Ï. ²âàõíåíêî äîñë³äæóº ïðîáëåìó ôîðìóâàííÿ ñòà-

òåâî¿ îñâ³÷åíîñò³ ï³äë³òê³â ç ïåäàãîã³÷íî¿ òî÷êè çîðó –

â÷åíèé âèñâ³òëþº âïëèâ ïåäàãîãà íà íàïðàâëåí³ñòü îñî-

áèñòîñò³, çîêðåìà, ³ íà ñåêñóàëüíó ïîâåä³íêó [8]. Ñ.Â. Ðî-

ìàíöîâà âèñâ³òëþº ïðèíöèïè ñòàòåâîãî âèõîâàííÿ ÿê

îäèí ³ç îñíîâíèõ ìåòîä³â çàïîá³ãàííÿ ñåêñóàëüíîìó

íàñèëüñòâó ùîäî íåïîâíîë³òí³õ [12].

Ç ìåòîþ îçíàéîìëåííÿ, âëàñíå, ç þíàöüêîþ òî÷êîþ

çîðó ùîäî ïðîáëåì ¿õ ñòàòåâî¿ îñâ³÷åíîñò³ íàìè áóëî

ïðîâåäåíî ïèñüìîâå îïèòóâàííÿ øëÿõîì àíêåòóâàííÿ.

Àíêåòà ñêëàäàëàñü ç òðüîõ áëîê³â ïèòàíü, ñåðåä ÿêèõ áóëè

³ âåðèô³êàö³éí³. Ïåðøèé áëîê ñêëàäàâñÿ ç ïèòàíü ïðî îñî-

áèñò³ äàí³: ñòàòü, óòî÷íåííÿ â³êó, ì³ñöÿ íàâ÷àííÿ, ì³ñöÿ

ïðîæèâàííÿ, ïðîõàííÿ çà áàæàííÿì çàçíà÷èòè íîìåð ìî-

á³ëüíîãî òåëåôîíó äëÿ ìîæëèâîñò³ ïåðåâ³ðêè ôàêòó àíêå-

òóâàííÿ íàóêîâèì êåð³âíèêîì òà çà íåîáõ³äíîñò³ óòî÷-

íåíí³ â³äïîâ³äåé. Äðóãèé áëîê ñêëàäàâñÿ ç ïèòàíü ùîäî

îá³çíàíîñò³ ìîëîä³ â òåì³ ñòàòåâî¿ îñâ³÷åíîñò³, òàêîæ ïè-

òàííÿ öüîãî áëîêó ìàëè âèÿâèòè, ÿê³ ïðè÷èíè, íà äóìêó

ìîëîä³, ïðèçâîäÿòü äî ÿâèùà ðàííüîãî ñòàòåâîãî æèòòÿ, ³

ÿê³ ÷èííèêè ìàþòü íàéá³ëüøèé âïëèâ íà ôîðìóâàííÿ

ñòàòåâî¿ îñâ³÷åíîñò³ ëþäèíè â ñó÷àñíîìó óêðà¿íñüêîìó

ñîö³óì³. Ïèòàííÿ òðåòüîãî áëîêó äàëè çìîãó ç’ÿñóâàòè

ñòàâëåííÿ ìîëîä³ äî ââåäåííÿ ñïåö³àëüíîãî êóðñó ç³ ñòà-

òåâî¿ îñâ³òè â øêîë³/óí³âåðñèòåò³ ³ òå, õòî ñàìå ïîâèíåí

ïðîâîäèòè çàíÿòòÿ ç äàíî¿ äèñöèïë³íè. Çàãàëîì íàìè áóëî

îïèòàíî 56 îñ³á ï³äë³òêîâîãî ³ þíàöüêîãî â³êó ç íèõ 30

æ³íî÷î¿ ñòàò³ òà 26 ÷îëîâ³÷î¿ â³êîì â³ä 16 äî 25 ðîê³â,

ñåðåäí³é â³ê ðåñïîíäåíò³â ñêëàâ 19 ðîê³â.

Àíàë³ç ïèòàíü äðóãîãî áëîêó äîçâîëèâ âèÿâèòè, ùî ïå-

ðåâàæíà á³ëüø³ñòü (80%) ïðåäñòàâíèê³â ñó÷àñíî¿ ìîëîä³

Óêðà¿íè ÷óëè ïðî ïîíÿòòÿ ñòàòåâî¿ îñâ³÷åíîñò³, ìàéæå òàêà

ñàìà ê³ëüê³ñòü àíêåòîâàíèõ (76%) îáðàëà çà âèçíà÷åííÿ òåð-

ì³íà íàñòóïíå: “ñòàòåâà îñâ³÷åí³ñòü – öå ñèñòåìà â³äïîâ³ä-

íèõ çíàíü ç àíàòîì³¿ òà ô³ç³îëîã³¿ ëþäèíè, ã³ã³ºíè, êîíòðà-

öåïö³¿, ïëàíóâàííÿ ñ³ì’¿, ãåíäåðíî¿ ñîö³îëîã³¿, åòèêè,

ïñèõîëîã³¿, à òàêîæ ïðàâîâ³ çíàííÿ”. Òàêèì ÷èíîì, ìîæå-

ìî çðîáèòè âèñíîâîê, ùî ï³äë³òêè ³íòó¿òèâíî ðîçóì³þòü,

ÿêèé çì³ñò ìàº ïîíÿòòÿ ñòàòåâî¿ îñâ³÷åíîñò³. Îïèòóâàííÿ

âèÿâèëî, ùî àêòóàëüíèì äëÿ óêðà¿íñüêî¿ ñï³ëüíîòè öå

ïèòàííÿ ââàæàþòü ïîíàä 75% ðåñïîíäåíò³â. Òàêîæ, â õîä³

àíàë³çó â³äïîâ³äåé íà ïèòàííÿ ïåðøîãî áëîêó, ìè ç’ÿñóâà-

ëè, ÿêèé ðîçïîä³ë ì³æ ïðè÷èíàìè ðàííüîãî ïî÷àòêó ñòà-

òåâîãî æèòòÿ (ðèñ. 1) ³ ì³æ ÷èííèêàìè, ùî âïëèâàþòü íà

ôîðìóâàííÿ ñòàòåâî¿ îá³çíàíîñò³ ó ï³äë³òê³â (ðèñ. 2).

Íàéá³ëüø ïðèéíÿòíèì â³êîì ïî÷àòêó ñòàòåâîãî æèòòÿ

îïèòàí³ ââàæàþòü â³ê 17,7 ðîê³â. Íà ö³é íåâ³äïîâ³äíîñò³

ì³æ áàæàíèì ³ ôàêòè÷íèì â³êîì ïî÷àòêó ñòàòåâîãî æèòòÿ

â Óêðà¿í³ àêöåíòóâàëè óâàãó é ³íø³ â³ò÷èçíÿí³ äîñë³äíèêè.

Àíàë³ç â³äïîâ³äåé íà ïèòàííÿ òðåòüîãî áëîêó äàâ çìî-

ãó ç’ÿñóâàòè, ÿê ñàìå ñòàâèòüñÿ ñó÷àñíà ìîëîäü äî ïðîâå-

äåííÿ ó øêîë³/óí³âåðñèòåò³ çàíÿòü ç³ ñòàòåâî¿ îñâ³òè. Òàê,

65,7% îïèòàíèõ ââàæàþòü, ùî ñïåö³àëüíèé êóðñ ³ç äàíî¿

òåìè º íåîáõ³äíèì êîìïîíåíòîì îñâ³òè, 11,4% ââàæàþòü

éîãî çàéâèì àáî øê³äëèâèì, 22,9% áàéäóæå, ÷è áóäå

âïðîâàäæåíèé ïîä³áíèé êóðñ. Ñåðåä ðåñïîíäåíò³â 47,4%

õîò³ëè á â³äâ³äóâàòè çàíÿòòÿ ç³ ñòàòåâî¿ îñâ³òè, à 21,1% – íå

ëèøå â³äâ³äóâàòè, à é áðàòè ó÷àñòü â ðîçðîáö³ ïðîãðàì

êóðñó. Ìè âèÿâèëè íàñòóïíèé ðîçïîä³ë ì³æ âïîäîáàííÿ-

ìè þíàê³â òà ä³â÷àò, ùîäî òîãî, õòî ñàìå ìàº ïðîâîäèòè

çàíÿòòÿ ó ðàìêàõ âèùåçãàäàíîãî ñïåöêóðñó (ðèñ. 3):

Âèñíîâêè. Â íèí³øí³õ óìîâàõ ñó÷àñíå ³íôîðìàö³éíå

ñóñï³ëüñòâî Óêðà¿íè çóñòð³ëîñÿ ³ç ñåðéîçíîþ ïðîáëåìîþ –

ïðîáëåìîþ íåñïðîìîæíîñò³ çàñòàð³ëèõ ìåòîä³â âèõîâàííÿ

Ðèñ. 1. Ïðè÷èíè ðàíüîãî ïî÷àòêó ñòàòåâîãî æèòòÿ

Ðèñ. 2. ×èííèêè, ÿê³ âïëèâàþòü íà ôîðìóâàííÿ

ñòàòåâî¿ îñâ³÷åíîñò³ ï³äë³òê³â

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÑÎÖ²ÀËÜÍÀ ÌÅÄÈÖÈÍÀ / SOCIAL MEDICINE

ËÈÒÅÐÀÒÓÐÀ

1. Almahbobi G. Multiculturalism and inconsistency in the

perception of sex education in Australian society. //AMJ. – 2012. –

¹5. – ñ.624-625.

2. Áåçóøêî Ñ.Â., Ïåäàãîã³÷í³ óìîâè ãåíäåðíîãî âèõîâàííÿ

ó÷í³â îñíîâíî¿ øêîëè ó ïîçàêëàñí³é ä³ÿëüíîñò³.//Ïåäàãîã³÷íèé àëü-

ìàíàõ. – 2013. – ¹17. – ñ.15-16.

3. Áîé÷åíêî Ò.ª. Ñòàòåâå âèõîâàííÿ ó÷í³âñüêî¿ ìîëîä³

Óêðà¿íè. //Òåîð³ÿ òà ìåòîäèêà óïðàâë³ííÿ îñâ³òîþ. – 2010. –

¹ 4. – ññ.1,12.

4. Áîëüøàÿ ñîâåòñêàÿ ýíöèêëîïåäèÿ: Â 30 ò. – Ì.: “Ñîâåò-

ñêàÿ ýíöèêëîïåäèÿ”, 1969-1978

5. Ãðàáîâà Ã. Îñíîâí³ ï³äõîäè äî ñòàòåâîãî âèõîâàííÿ â

óêðà¿íñüê³é òà çàðóá³æí³é ïåäàãîã³ö³. //Ïîð³âíÿëüíî-ïåäàãîã³÷í³

ñòóä³¿. – 2012. – ¹ 4(14). – ñ.1.

6. Æóðàâëåâà È.Â. Ðåïðîäóêòèâíîå çäîðîâüå ïîäðîñòêîâ è

ïðîáëåìû ïîëîâîãî ïðîñâåùåíèÿ. // Ñîöèîëîãèÿ çäîðîâüÿ è ìå-

äèöèíû. – 2004. – ñ.134.

7. International Technical Guidance on Sexuality Education. An

evidence-informed approach for schools, teachers and health educators. –

Section on HIV and AIDS Division for the Coordination of UN Priorities

in Education. UNESCO. – ED. – 2009. – /WS/36 REV3. p.22.

8. ²âàõíåíêî Ò.Ï., Ñîö³àëüíî-ïåäàãîã³÷í³ àñïåêòè âïëèâó íà

ôîðìóâàííÿ ñåêñóàëüíî¿ êóëüòóðè ìîëîä³. //Ïåäàãîã³÷íà íàóêà:

³ñòîð³ÿ, òåîð³ÿ, ïðàêòèêà, òåíäåíö³¿ ðîçâèòêó. – 2010. – ¹1. – ñ.3.

9. Êðàâåöü Â. Ï. Àêòóàëüí³ ïðîáëåè ñåêñóàëüíî¿ îñâ³òè ó÷í-

³âñüêî¿ ìîëîä³. // Íàóêîâ³ çàïèñêè. Ñåð³ÿ: Ïåäàãîã³êà. — 2012. —

¹ 4. – ññ.70, 74-75.

10 . Lewis-Barned A. What do school children want from sex edu-

cation? // J Fam Plann Reprod Health Care. – 2010. ¹2. – pp. 93, 95

11. Îðëîâ Þ.Ì. Ïîëîâîå âîñïèòàíèå, êàê çâåíî ñòàíîâëå-

íèÿ ëè÷íîñòè. – Ì.: Ïðîñâåùåíèå – ñ.202

12. Ðîìàíöîâà Ñ.Â. Îñâ³òà ÿê ñïîñ³á çàïîá³ãàííÿ ñåêñóàëü-

íîìó íàñèëüñòâó ùîäî íåïîâíîë³òí³õ â Óêðà¿í³. //Äîïîâ³äü/Þðè-

äè÷í³ ³ ïîë³òè÷í³ íàóêè – êðèì³íàëüíå ïðàâî (êðèì³íîëîã³ÿ) ³ êðè-

ì³íàë³ñòèêà. – 2013. – ñ.8-9.

13 . Ross D.A. Approaches to sex education: peer-led or teacher-

led? // PLoS Med. – 2008. – ¹11. – p.1537.

14. Stanger-Hall KF, Hall DW. Abstinence-only education and

teen pregnancy rates: why we need comprehensive sex education in

the U.S. //PLoS One. – 2011. – ¹10. – p.6.

15. Stephenson J, Strange V, Allen E, Copas A, Johnson A, Bonell C,

Babiker A, Oakley A; RIPPLE Study Team. The long-term effects of a

peer-led sex education programme (RIPPLE): a cluster randomised trial

in schools in England. //PLoS Med. – 2008. ¹5(11). – p.1548.

16 . Tripathi N, Sekher TV. Youth in India ready for sex education?

Emerging evidence from national surveys. //PLoS One. – 2013. –

¹8(8). – pp.6-8.

17 . Fentahun N, Assefa T, Alemseged F, Ambaw F. Parents’ per-

ception, students’ and teachers’ attitude towards school sex education.

//Ethiop J Health Sci. – 2012. – ¹22(2). – pp.99

18. ßêóáîâà Ë. À. Îñîáëèâîñò³ ôîðìóâàííÿ ñòàòåâî¿ êóëü-

òóðè ï³äë³òê³â. – 2009. – ñ. 199.

çàáåçïå÷èòè íàëåæíå ñåðåäîâèùå äëÿ ôîðìóâàííÿ ñòàòå-

âî¿ îñâ³÷åíîñò³ ìîëîä³. Öÿ ïðîáëåìà íå º óí³êàëüíîþ –

á³ëüø³ñòü êðà¿í ñâ³òó çíàéøëè âèõ³ä ³ç ö³º¿ êðèçè àáî æ

çíàõîäÿòüñÿ â ïðîöåñ³ ïîøóê³â. Àíàë³ç äîñë³äíèöüêèõ

ïðàöü â³ò÷èçíÿíèõ íàóêîâö³â äîçâîëèâ çðîáèòè íàñòóïíèé

âèñíîâîê: íàóêîâà ñï³ëüíîòà Óêðà¿íè äîñèòü äîáðå îçíàé-

îìëåíà ³ç ïðîãðàìàìè ñòàòåâî¿ îñâ³òè ³ ìîæëèâèìè âàð³-

àíòàìè âèêëàäàííÿ äàíî¿ äèñöèïë³íè. Âàæëèâî çàóâàæè-

òè, ùî ïåðåâàæíà á³ëüø³ñòü íàóêîâö³â, âèâ÷àþ÷è äàíå

ïèòàííÿ, íàãîëîøóþòü íà íåîáõ³äíîñò³ ðîçðîáêè óêðà¿í-

ñüêèì óðÿäîì ïðîãðàì ñòàòåâîãî âèõîâàííÿ.

Â ïðîöåñ³ ñâîº¿ ðîáîòè ìè ç’ÿñóâàëè, ùî óêðà¿íñüêà

ìîëîäü óñâ³äîìëþº íåîáõ³äí³ñòü ââåäåííÿ â ó÷áîâèõ çàêëà-

äàõ ïåâíîãî ñïåö³àëüíîãî êóðñó ç³ ñòàòåâî¿ îñâ³òè, ïðè öüî-

ìó ÷àñòèíà þíàöòâà ãîòîâà ïðèéìàòè àêòèâó ó÷àñòü â ðîç-

ðîáö³ ïðîãðàì ³ç äàíî¿ äèñöèïë³íè. Îòæå, áåðó÷è äî óâàãè

íàÿâí³ñòü íèçêè çàãàëüíîäåðæàâíèõ ïðîáëåì (çá³ëüøåííÿ

ê³ëüêîñò³ àáîðò³â ñåðåä íåïîâíîë³òí³õ, çðîñòàííÿ ð³âíÿ çàõ-

âîðþâàíîñò³ íà ÇÏÑØ òà ³íø.), ÿê³ âèêëèêàí³ íèçüêèì

ð³âíåì ñòàòåâî¿ îñâ³÷åíîñò³ íàñåëåííÿ, – ç îäíîãî áîêó, ³

óñâ³äîìëåííÿ ìîëîääþ àêòóàëüíîñò³ öèõ ïðîáëåì – ç ³íøî-

ãî, ââàæàºìî çà ïîòð³áíå ââåäåííÿ â øê³ëüíèé òà/àáî óí³-

âåðñèòåòñüêèé êóðñ íàâ÷àííÿ äèñöèïë³íè ç³ ñòàòåâî¿ îñâ³òè.

Ïðè öüîìó ïîòð³áíî çàóâàæèòè, ùî íåîáõ³äíå ïîäàëüøå

âèâ÷åííÿ â³äîìèõ ñèñòåì âèêëàäàííÿ ö³º¿ äèñöèïë³íè ³ ðî-

áîòà ç òðàíñôîðìàö³¿ ¿õ ó â³äïîâ³äíîñò³ äî îñîáëèâîñòåé

óêðà¿íñüêîãî ñîö³óìó. Ïðè÷îìó îáîâ’ÿçêîâèì, íà íàøó

äóìêó, º çàëó÷åííÿ ãðîìàäñüêîñò³ äî äàíî¿ ðîáîòè.

Ðåöåíçåíò: àêàäåì³ê ÍÀÏÍ Óêðà¿íè,

ä. ïñèõ. í, ïðîôåñîð Ìàêñèìåíêî Ñ.Ä.

Ðèñ. 3. Âèêëàäà÷ êóðñó ñòàòåâî¿ îñâ³÷åíîñò³

ÏÐÎÁËÅÌÛ ÔÎÐÌÈÐÎÂÀÍÈß

ÑÅÊÑÓÀËÜÍÎÉ ÎÁÐÀÇÎÂÀÍÎÑÒÈ

ÑÎÂÐÅÌÅÍÍÎÉ ÌÎËÎÄ¨ÆÈ ÓÊÐÀÈÍÛ

Êîõàíñêàÿ À.È.1, Ðîìàíþê È.Ä.2

1Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò

èìåíè À.À. Áîãîìîëüöà, ã. Êèåâ, Óêðàèíà

2Êèåâñêèé ìåäèöèíñêèé óíèâåðñèòåò

Óêðàèíñêîé àññîöèàöèè íàðîäíîé ìåäèöèíû,

ã. Êèåâ, Óêðàèíà

Ðåçþìå. Â ñòàòüå ðàññìîòðåíû îñíîâíûå ïðîáëåìû

ôîðìèðîâàíèÿ ïîëîâîé îáðàçîâàííîñòè ñîâðåìåííîé

óêðàèíñêîé ìîëîäåæè. Ïðîàíàëèçèðîâàíû àêòóàëüíûå

èññëåäîâàíèÿ ýòîãî âîïðîñà, êîòîðûå ïðèíàäëåæàò îòå-

÷åñòâåííûì è çàðóáåæíûì ó÷åíûì. Îñâåùåíî îòíîøå-

íèå þíîøåñòâà ê ââåäåíèþ êóðñà ïîëîâîãî âîñïèòàíèÿ â

ó÷åáíûõ çàâåäåíèÿõ.

Êëþ÷åâûå ñëîâà: ïîëîâîå âîñïèòàíèå, ìîëîäåæü.

THE PROBLEMS IN FORMING

OF SEXUAL A WARENESS

OF THE MODERN YOUTH UKRAINE

A. Kohanska1, I. Romanuk2

1Bogomolets National Medical University,

Kyiv, Ukraine,

2Kiev Medical University of Ukrainian Association

of Folk Medicine, Kyiv, Ukraine

Summàry. The main problems of formation of modern

sexual education of Ukrainian youth have been studied in

the article. The article also presents an analysis of the current

researches that were made by the domestic and foreign

scholars. The attitude of young people to the introduction of

the course of sex education in schools has also been

enlightened.

Key words: sex education, youth.

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÑÎÖ²ÀËÜÍÀ ÌÅÄÈÖÈÍÀ / SOCIAL MEDICINE

ÓÄÊ 616.43-084 : 61-057.875

ÏÐÎÔ²ËÀÊÒÈÊÀ ÅÍÄÎÊÐÈÍÍÈÕ ÇÀÕÂÎÐÞÂÀÍÜ

ÑÅÐÅÄ ÑÒÓÄÅÍÒ²Â-ÌÅÄÈÊ²Â

Í³êîëàºíêî Ñ.².

Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Î.Î.Áîãîìîëüöÿ, ì.Êè¿â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: ïðîô³ëàêòèêà, åíäîêðèíí³ çàõâîðþâàííÿ, ñòóäåíò-ìåäèê.

Àêòóàëüí³ñòü. Çàãàëüíà ê³ëüê³ñòü õâîðèõ íà ïîðóøåí-

íÿ åíäîêðèííî¿ ñèñòåìè, ðîçëàäè ñèñòåì õàð÷óâàííÿ òà

ïîðóøåííÿ îáì³íó ðå÷îâèí ñêëàäàº 3 954 016 óêðà¿íö³â

(ñòàíîì íà ê³íåöü 2012 ðîêó) [ÄÓ “²íñòèòóò åíäîêðèíî-

ëîã³¿ òà îáì³íó ðå÷îâèí ³ì. Â. Ï. Êîì³ñàðåíêà ÍÀÌÍ Óê-

ðà¿íè]. ×èñåëüí³ñòü íàñåëåííÿ Óêðà¿íè ñòàíîì íà 1 ñ³÷íÿ

2014 ðîêó äîð³âíþº 45 426 200 [çà äàíèìè Äåðæàâíî¿

ñëóæáè ñòàòèñòèêè Óêðà¿íè]. Îòæå, â ñåðåäíüîìó 8,7 %

óêðà¿íö³â ñòðàæäàþòü â³ä åíäîêðèííèõ ðîçëàä³â[1].

Ñóìàðíî õâîðîáè åíäîêðèííî¿ ñèñòåìè â ñòðóêòóð³

âñ³õ õâîðîá ó 2012 ðîö³ çàéíÿëè 4 ì³ñöå – â ïåðøó ÷åðãó çà

ðàõóíîê ïàòîëîã³¿ ùèòîïîä³áíî¿ çàëîçè (â á³ëüø í³æ 1,5

ì³ëüÿðä³â æèòåë³â çåìíî¿ êóë³ ³ñíóº ðèçèê íåäîñòàòíüîãî

âæèâàííÿ éîäó, â 300 ì³ëüéîí³â ô³êñóºòüñÿ çá³ëüøåííÿ

ùèòîïîä³áíî¿ çàëîçè, à â 20 ì³ëüéîí³â – ðîçóìîâà

â³äñòàë³ñòü â ðåçóëüòàò³ éîäíî¿ íåäîñòàòíîñò³) [3]. Íàâå-

äåíí³ äàíí³, íà íàø ïîãëÿä, ðîáëÿòü äîñë³äæåííÿ ð³çíèõ

àñïåêò³â ïðîô³ëàêòèêè åíäîêðèííèõ çàõâîðþâàíü âêðàé

àêòóàëüíèìè.

Ìåòà ðîáîòè ïîëÿãàº â àíàë³ç³ âèêîðèñòàííÿ ñòóäåíòà-

ìè ìåäè÷íîãî óí³âåðñèòåòó ³ìåí³ Î.Î.Áîãîìîëüöÿ ïðîô³-

ëàêòèêè åíäîêðèííèõ çàõâîðþâàíü.

Äëÿ âèð³øåííÿ ïîñòàâëåíî¿ ìåòè ñòàâèìî ïåðåä ñî-

áîþ íàñòóïí³ çàâäàííÿ: – ïðîàíàë³çóâàòè îñíîâí³ ìåòîäè

ïðîô³ëàêòèêè åíäîêðèííèõ çàõâîðþâàíü, çàïðîïîíîâà-

íèõ â³ò÷èçíÿíèìè â÷åíèìè; – àíàë³ç âèêîðèñòàííÿ ñòó-

äåíòàìè ìåäè÷íîãî óí³âåðñèòåòó ³ìåí³ Î.Î.Áîãîìîëüöÿ

ïðîô³ëàêòèêè åíäîêðèííèõ çàõâîðþâàíü.

Îòðèìàí³ ðåçóëüòàòè. Çàãàëüí³ ìåòîäè ïðîô³ëàêòèêè

âàðòî ïîä³ëèòè çã³äíî íàéïîøèðåí³øèõ åíäîêðèííèõ çàõ-

âîðþâàíü, à ñàìå, öóêðîâîãî ä³àáåòó, îæèð³ííÿ òà çàõâî-

ðþâàíü, ñïðè÷èíåíèõ äåô³öèòîì éîäó â îðãàí³çì³. Òàê,

öóêðîâèé ä³àáåò çã³äíî îñòàííüî¿ êëàñèô³êàö³¿ éîãî ôîðì

(1999) ìàº òàê³ òèïè:

– 1 òèïó. Â öüîìó âèïàäêó äåñòðóêö³ÿ Â-êë³òèí åêçî-

êðèííî¿ ÷àñòèíè ï³äøëóíêîâî¿ çàëîçè ïðèâîäèòü äî àáñî-

ëþòíî¿ íåäîñòà÷³ ³íñóë³íó. Ïðè öüîìó 90% âèïàäê³â ñïðè-

÷èíåí³ àóòî³ìóííèìè ôàêòîðàìè, à ³íø³ 10 % –

³ä³îïàòè÷íèé ä³àáåò (ðîçâèâàºòüñÿ â ðåçóëüòàò³ ðàïòîâî¿

ñìåðò³ òà àïîïòîçà Â-êë³òèí áåç áóäü-ÿêèõ â³äîìèõ ïðè-

÷èí).

– 2 òèïó. Õàðàêòåðèçóºòüñÿ â³äíîñíîþ íåñòà÷åþ ³íñó-

ë³íó ³ äîâãî íå ïîòðåáóº ³íñóë³íîòåðàï³¿ äëÿ çáåðåæåííÿ

æèòòÿ. Ðàí³øå öåé ä³àáåò íàçèâàëè “ä³àáåòîì ë³òí³õ”: ðîç-

âèâàºòüñÿ çàçâè÷àé ï³ñëÿ 40 ðîê³â; àáî “ä³àáåòîì îãðÿä-

íèõ”, áî 80% õâîðèõ ìàþòü çàéâó âàãó.

– ãåñòàö³éíèé ä³àáåò. Ðîçâèâàºòüñÿ ò³ëüêè ï³ä ÷àñ âàã³ò-

íîñò³ òà ïðîõîäèòü ï³ñëÿ ïîëîã³â.

– ³íø³ ñïåöèô³÷í³ òèïè ä³àáåòó. Çàçâè÷àé ñïðè÷èíåí³

ãåíåòè÷íèìè â³äõèëåííÿìè, ÿê³ âèêëèêàþòü ïîðóøåííÿ

íà ÿêîìóñü ³ç åòàï³â ìåòàáîë³çìó ãëþêîçè, â òîìó ÷èñë³

³ ÷åðåç ìóòàö³¿ ìîëåêóëè ³íñóë³íó.

Áëàãîñêëîííà ß.Â., Øëÿõòî Å.Â., Áàáåíêî À.Þ. ââàæà-

þòü, ùî âèùå íàâåäåíà õàðàêòåðèñòèêà äîâîäèòü – ïðîô-

³ëàêòèö³ ÿê òàê³é ï³ääàºòüñÿ ëèøå ÖÄ 2 òèïó (çàïîá³ãòè

àóòî³ìóííèì õâîðîáàì, à òèì á³ëüøå ³ä³îïàòè÷íèì äóæå

âàæêî; äîñë³äæåííÿ ïðè÷èí òà íàñë³äê³â ãåñòàö³éíîãî ä³à-

áåòó ëèøå íåäàâíî ïî÷àëèñÿ, òîìó ä³ºâ³ ìåòîäè ïðîô³ëàê-

òèêè ùå íå ðîçðîáëåí³) [4].

Îñíîâíèé øëÿõ ïîïåðåäæåííÿ ÖÄ 2 òèïó – öå äîòðè-

ìàííÿ çäîðîâîãî ñïîñîáó æèòòÿ: – â³äìîâà â³ä òþòþíîïà-

ë³ííÿ òà îáìåæåííÿ âæèâàííÿ àëêîãîëþ; – çìåíøåííÿ

âæèâàííÿ ïðîäóêò³â ç ëåãêîçàñâîþâàíîþ ãëþêîçîþ (ñî-

ëîäîù³, ò³ñòå÷êà òà òîðòè, à òàêîæ õë³áîïåêàðñüê³ âèðîáè ³ç

ïøåíè÷íîãî áîðîøíà); – ðåãóëÿðí³ ô³çè÷í³ íàâàíòàæåííÿ

(ðåêîìåíäîâàíî íå ìåíøå 30 õâèëèí êîæíîãî äíÿ); – äîò-

ðèìàííÿ ðåæèìó õàð÷óâàííÿ (ìåõàí³çìè íàêîïè÷åííÿ

åíåðã³¿ òà ãëþêîçè, êîòð³ ìàþòü ïåð³îäè÷íèé õàðàêòåð); –

ðåãóëÿðí³ ïåðåâ³ðêè ð³âíÿ ãëþêîçè òà ãë³êîçèëüîâàíîãî ãå-

ìîãëîá³íó, ùî º îáîâ’ÿçêîâèì äëÿ ëþäåé ç³ ñïàäêîâîþ

ñõèëüí³ñòþ äî ä³àáåòó (ïðîòå, îñòàíí³é ìåòîä äîñòóïíèé

ëèøå â ë³êàðíÿõ ³ ÷àñò³øå âèêîðèñòîâóºòüñÿ äëÿ ä³àãíîñòèêè).

Ó ùèòîïîä³áíî¿ çàëîçè º òðè óí³êàëüí³ ÿêîñò³, ³ îäíîþ ç

íèõ º òå, ùî äëÿ ñèíòåçó ãîðìîí³â ïîòð³áåí íåîðãàí³÷íèé

éîä ÿêèé íàäõîäèòü â îðãàí³çì ³ç çîâí³. Òîìó íàé÷àñò³øå

öÿ çàëîçà ñòðàæäàº ÷åðåç íåäîñòàòíþ ê³ëüê³ñòü éîäó. Òàê³

õâîðîáè îòðèìàëè çàãàëüíó íàçâó éîäîäåô³öèòí³.

Äåô³öèò éîäó ÷åðåç éîãî âïëèâ íà ðîçâèòîê ìîçêó,

ïîã³ðøóº ÿê³ñòü æèòòÿ ì³ëüéîí³â ëþäåé òà º ïðè÷èíîþ

â³äñòàâàííÿ ó ô³çè÷íîìó òà ïñèõ³÷íîìó ðîçâèòêó. Äëÿ

ìîëîäî¿ ëþäèíè, îñîáëèâî ò³º¿, ùî íàâ÷àºòüñÿ ó âèùîìó

íàâ÷àëüíîìó çàêëàä³ ³ ìàº ³íôîðìàö³éíå ïåðåâàíòàæåííÿ

âêðàé âàæëèâèì º ïðîô³ëàêòèêà ñàìå éîäîäèô³öèòíèõ

çàõâîðþâàíü. Ó ñâ³òîâîìó ìàñøòàá³ äåô³öèò éîäó º ºäè-

íîþ ïðè÷èíîþ óðàæåííÿ ãîëîâíîãî ìîçêó, ÿêó ìîæíà

ïîïåðåäèòè. Ëþäè, ÿê³ æèâóòü ó ðàéîíàõ, òÿæêî âðàæåíèõ

ÉÄÇ, ìîæóòü ìàòè êîåô³ö³ºíò ðîçóìîâîãî ðîçâèòêó (IQ)

íà 13,5 ïóíêò³â íèæ÷èé, í³æ íà ïîð³âíþâàíèõ òåðèòîð³ÿõ,

äå äåô³öèòó éîäó íåìàº. Òàêà ðîçóìîâà â³äñòàë³ñòü áåçïî-

ñåðåäíüî ïîçíà÷àºòüñÿ íà çäàòíîñò³ ä³òåé äî íàâ÷àííÿ,

çäîðîâ’¿ æ³íîê, ÿêîñò³ æèòòÿ ñóñï³ëüñòâà òà ïðîäóêòèâ-

íîñò³ åêîíîì³êè [2].

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÑÎÖ²ÀËÜÍÀ ÌÅÄÈÖÈÍÀ / SOCIAL MEDICINE

Çã³äíî ç ðåêîìåíäàö³ÿìè ÂÎÎÇ äîáîâà íîðìà éîäó –

150 ìêã/äîáó. Ïðè íåäîñòàòí³é ê³ëüêîñò³ (ìåíøå 50 ìêã/

äîáó) â ùèòîïîä³áí³é çàëîç³ çìåíøóºòüñÿ ñèíòåç ãîð-

ìîí³â, ùî ïðèâîäèòü äî ðîçâèòêó çîáà, ³ âê³íö³-ê³íö³â – äî

ã³ïîòèðåîçó (ïîë³åòîëîã³÷íèé ñèíäðîì, êë³í³÷íèé ïðîÿâ

ÿêîãî, íåçàëåæíî â³ä ïðè÷èíè, º íàñë³äêîì çìåíøåííÿ

ôóíêö³é ùèòîïîä³áíî¿ çàëîçè, çíèæåííÿ ñèíòåçó ãîðìî-

íó òèðîêñèíó òà éîãî íåäîñòàòíÿ ä³ÿ íà òêàíèíè òà îðãà-

íè). ²ñíóº ïåðâèííèé, âòîðèííèé òà òðåòèííèé ã³ïîòèðåî-

çè. ² îäíà ç ïðè÷èí ã³ïîòèðåîç³â – éîäîäåô³öèò.

Òàêîæ, îäíå ç ìîæëèâèõ çàõâîðþâàíü, âèêëèêàíå öèì

ôàêòîðîì, – äèôóçíèé òà äèôóçíî-âóçëîâèé íåòîêñè÷íèé

çîá. Öÿ õâîðîáà º íàñë³äêîì ï³äâèùåíî¿ ÷óòëèâîñò³ ùèòî-

ïîä³áíî¿ çàëîçè äî ä³¿ òèðåîòðîïíîãî ãîðìîíó (ÒÒÃ), ÿê

êîìïåíñàòîðíà ðåàêö³ÿ ïðè íàÿâíîñò³ ôàêòîð³â, ùî çíèæó-

þòü ñèíòåç òèðåî¿äíèõ ãîðìîí³â. Íàâåäåí³ âèùå çàõâîðþ-

âàííÿ, õî÷à ³ º ïîë³åòîëîã³÷íèìè, ïðîòå íàéò³ñí³øå ïîâ’ÿ-

çàí³ ç éîäîäåô³öèòîì, òîìó ï³äëÿãàþòü ïðîô³ëàêòèö³.

Ã.ß. ªðæàê òà Í.Â.Êîíüêîâà ðåêîìåíäóþòü òàê³ çàõîäè

ïðîô³ëàêòèêè éîäîäåô³öèòíèõ çàõâîðþâàíü: – âæèâàííÿ

äîäàòêîâîãî éîäó â ðàö³îí (ç ðèáîþ, ìîðåïðîäóêòàìè,

éîäîâàíîþ ñ³ëëþ òîùî); – äîäàòêîâå âæèâàííÿ â³òàì³í³â

À, Â1, Â6, Â12, Ñ òà Å; – äîñòàòí³ ïðîòå íå âèñíàæëèâ³

ô³çè÷í³ íàâàíòàæåííÿ [3].

Îòæå, á³ëüø³ñòü çàõîä³â ïðîô³ëàêòèêè ñïðÿìîâàí³ íà

ï³äòðèìàííÿ ïîòð³áíî¿ êîíöåíòðàö³¿ éîäó â îðãàí³çì³. Ç

ö³ºþ ìåòîþ ÂÎÎÇ ïîïóëÿðèçóº òà ïîøèðþº âèêîðèñòàí-

íÿ éîäîâàíî¿ ñîë³, ÿê íàéäåøåâøîãî òà øâèäêîãî ñïîñîáó

ââåäåííÿ äîäàòêîâîãî éîäó â îðãàí³çì [3].

Îæèð³ííÿ, àáî íàäëèøêîâà âàãà – íàéá³ëüø ïîøèðåíå

ïîðóøåííÿ, ÿêå çóñòð³÷àºòüñÿ â ëþäåé. Åï³äåì³îëîã³÷í³

äîñë³äæåííÿ àìåðèêàíñüêèõ ñòðàõîâèõ êîìïàí³é ïîêàçàëè,

ùî ñòóï³íü ñìåðòíîñò³ ëþäåé ç îæèð³ííÿì íàáàãàòî âèùèé

çà çâè÷àéíèé: âîíè ïðèéíÿëè çà 100% ñìåðòí³ñòü ëþäåé ç

íîðìàëüíîþ âàãîþ, òîä³ ó ñï³ââ³äíîøåíí³ ñìåðòí³ñòü õâî-

ðèõ íà îæèð³ííÿ ² ñòàä³¿ ñêëàëà 178%, ²² ñòàä³¿ – 225%, à

ñìåðòí³ñòü äîñë³äæóâàíèõ ç îæèð³ííÿì ²²² ñòàä³¿ áóëà â 3-4

ðàçè âèùà, í³æ â ëþäåé ç íîðìàëüíîþ âàãîþ [4].

Çàãàëüíà ïðîô³ëàêòèêà îæèð³ííÿ âêëþ÷àº òàê³ çàõîäè: –

äîòðèìàííÿ çäîðîâîãî ñïîñîáó õàð÷óâàííÿ: 1) íå âæèâà-

òè âåëèêó ê³ëüê³ñòü âóãëåâîä³â (îñîáëèâî ñîëîäîù³â, ñî-

ëîäêèõ íàïî¿â, õë³áà, ¿æ³ ç “ôàñò-ôóä³â”); 2) ¿ñòè áàãàòî

îâî÷³â, ôðóêò³â òà êë³òêîâèíè (íàéêðàùå â ïåðø³é ïîëî-

âèí³ äíÿ, òîìó ùî â³òàì³íè ïðèñêîðþþòü çàãàëüíèé îáì³í

ðå÷îâèí); – äîòðèìóâàòèñÿ âèñîêîãî ð³âíÿ ô³çè÷íî¿ òà

ñîö³àëüíî¿ àêòèâíîñò³; – êîíòðîëü çà ñïîæèòîþ â äåíü

ê³ëüê³ñòþ êàëîð³é (îñîáëèâî àêòóàëüíî äëÿ ëþäåé ç³

ñõèëüí³ñòþ äî îæèð³ííÿ); – äîòðèìàííÿ ÷àñîâîãî ðåæèìó

õàð÷óâàííÿ [6].

Ìè âèñóíóëè ïîïåðåäíþ ðîáî÷ó ã³ïîòåçó, ùî ð³âåíü

ãîòîâíîñò³ ñòóäåíò³â-ìåäèê³â âèêîðèñòîâóâàòè ïðîô³ëàê-

òè÷í³ çàõîäè ùîäî åíäîêðèííèõ çàõâîðþâàíü, âëàñíå, äëÿ

ñåáå º äîñèòü íèçüêèì, àëå ñàìå âîíè º òèìè, õòî ïîòåí-

ö³éíî áóäå çàñòîñîâóâàòè ¿õ ó ñâî¿é ïðîôåñ³éí³é ìåäè÷í³é

ïðàêòèö³. Â ìåæàõ çàçíà÷åíî¿ ã³ïîòåçè, ô³êñóºòüñÿ íåãî-

òîâí³ñòü ìàéáóòí³õ ë³êàð³â äî êàðäèíàëüíèõ ùîäåííèõ çà-

õîä³â ïðîô³ëàêòèêè âëàñíîãî çäîðîâ’ÿ.

Íàìè áóëî ïðîâåäåíî ïèñüìîâå îïèòóâàííÿ ñòó-

äåíò³â ïåðøîãî êóðñó (150 îñ³á) Íàö³îíàëüíîãî ìåäè÷-

íîãî óí³âåðñèòåòó ³ìåí³ Î.Î.Áîãîìîëüöÿ ç ìåòîþ àíàë³-

çó âèêîðèñòàííÿ íèìè ïðîô³ëàêòèêè åíäîêðèííèõ çàõ-

âîðþâàíü äëÿ çáåðåæåííÿ ñâîãî çäîðîâ’ÿ. Àíêåòà ñêëà-

äàëàñÿ ç òðüîõ áëîê³â. Â ïåðøîìó áóëè çàïèòàííÿ íà

âèçíà÷åííÿ ð³âíÿ çàãàëüíèõ çíàíü ç ïðîô³ëàêòèêè åí-

äîêðèííèõ çàõâîðþâàíü; äðóãèé áëîê ñêëàäàâñÿ ç ïè-

òàíü ùîäî êîíêðåòíèõ ìåòîä³â ïðîô³ëàêòèêè, ÿêèìè êî-

ðèñòóþòüñÿ ñòóäåíòè; òðåò³é ñòâîðåíèé ç ìåòîþ

âèçíà÷åííÿ ñòàòåâî¿, â³êîâî¿ òà ðåã³îíàëüíî¿ ñòðóêòóðè

îïèòàíèõ.

Ñåðåä àíêåòîâàíèõ âèÿâèâñÿ 71% îñ³á æ³íî÷î¿ ñòàò³, òà

29% – ÷îëîâ³÷î¿ (ðèñ.1. “Ñòàòåâà ñòðóêòóðà”).

Çà â³êîì ñòóäåíòè ïåðøîãî êóðñó ðîçïîä³ëèëèñÿ òà-

êèì ÷èíîì (ðèñ. 2. “Â³êîâà ñòðóêòóðà”):

Òàêîæ, ñåðåä îïèòàíèõ âèÿâèëèñÿ æèòåë³ Êèºâà, Êè¿â-

ñüêî¿, Õìåëüíèöüêî¿, Õåðñîíñüêî¿, Äí³ïðîïåòðîâñüêî¿,

Äîíåöüêî¿, ×åðêàñüêî¿ òà Çàêàðïàòñüêî¿ îáëàñòå, ÿê³ ðîç-

ïîä³ëèëèñÿ òàêèì ÷èíîì (ðèñ. 3. “Ðåã³îíàëüíà ñòðóêòóðà”):

Íà æàëü, ó÷àñíèêàìè àíêåòóâàííÿ íå áóëî äàíî 100%

ïðàâèëüíèõ â³äïîâ³äåé íà æîäíå ç ïèòàíü, êîòðå ïåðåäáà-

÷àëî îäíîçíà÷íèé âàð³àíò ïðàâèëüíî¿ â³äïîâ³ä³.

Ïðàâèëüíå âèçíà÷åííÿ ïðîô³ëàêòèêè (â ìåäèöèí³)

äàëè 82 â³äñîòêè ñòóäåíò³â; ïðàâèëüíå âèçíà÷åííÿ öóêðî-

âîãî ä³àáåòó – 78,6%; ùî òàêå îæèð³ííÿ çíàëè ëèøå 68%.

Ñüîãîäí³ 1/5 ëþäñüêî¿ ïîïóëÿö³¿ ñòðàæäàº â³ä îæèð³í-

íÿ. Öåé ôàêò ïðèïóñòèëè 35,7 â³äñîòê³â îïèòàíèõ. Ïðîòå

Ðèñ.1. Ñòàòåâà ñòðóêòóðà.

Ðèñ. 2. Â³êîâà ñòðóêòóðà.

Ðèñ. 3. Ðåã³îíàëüíà ñòðóêòóðà.

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â íàñòóïíîìó çàïèòàíí³ [ßê³ íàéïîøèðåí³ø³ çàõâîðþâàí-

íÿ åíäîêðèííî¿ ñèñòåìè â ä³òåé òà ï³äë³òê³â?] ñòóäåíòè

â³ääàëè ïåðåâàãó îæèð³ííþ, õî÷à íàñïðàâä³ â Óêðà¿í³ íà

öå çàõâîðþâàííÿ ñòðàæäàº 1,23% íàñåëåííÿ. Ë³äåðîì º

õâîðîáè ùèòîïîä³áíî¿ çàëîçè (3,38% íàñåëåííÿ), ³ öóê-

ðîâèé ä³àáåò çàãàëîì âðàçèâ 2,9% ëþäåé â Óêðà¿í³.

Â³äïîâ³ä³ íà ïèòàííÿ “ßê Âè ââàæàºòå, ïðîô³ëàêòèö³

ÿêèõ åíäîêðèííèõ õâîðîá âàòðî ïðèä³ëÿòè íàéá³ëüøå óâà-

ãè?”, çàéíÿëè òàêó ñòðóêòóðó (äîïóñêàëîñÿ ê³ëüêà âàð³-

àíò³â ïðàâèëüíèõ â³äïîâ³äåé) (ðèñ. 4. “ßê Âè ââàæàºòå,

ïðîô³ëàêòèö³ ÿêèõ åíäîêðèííèõ õâîðîá âàòðî ïðèä³ëÿòè

íàéá³ëüøå óâàãè?”):

Â³äïîâ³ä³ íà ïèòàííÿ: “Ä³ºòà – öå ïðîô³ëàêòèêà ÷è ë³êó-

âàííÿ?”, ðîçïîä³ëèëèñÿ òàêèì ÷èíîì (ðèñ. 5. “Ä³ºòà – öå

ë³êóâàííÿ ÷è ïðîô³ëàêòèêà?”):

Îòæå, á³ëüø³ñòü îïèòàíèõ äóìàþòü, ùî ä³ºòà öå ïðîô³-

ëàêòèêà. Ïðîòå êëàñè÷íî ä³ºòè (â ìåäèöèí³) ââàæàþòüñÿ

ë³êóâàííÿì. Ùå Ã³ïïîêðàò (4 ñòîë³òòÿ äî í. å.) â ñâî¿ êíèç³

“Ä³ºòåòèêà” ï³äêðåñëèâ âàæëèâ³ñòü ë³êóâàëüíîãî õàð÷ó-

âàííÿ â çàãàëüíîìó êîìïëåêñ³ òåðàïåâòè÷íèõ çàñîá³â.

“Íàø³ õàð÷îâ³ ðå÷îâèíè ïîâèíí³ áóòè ë³êóâàëüíèì çàñî-

áîì, à ë³êóâàëüí³ çàñîáè ïîâèíí³ áóòè õàð÷îâèìè ðå÷îâè-

íàìè”, – ïèñàâ â³í [5].

Ñüîãîäí³, íà äóìêó Ì. Ãë³áîâà, ä³ºòà – öå “àëãîðèòì

õàð÷óâàííÿ”, – òå ùî ìîæíà ³ íå ìîæíà ¿ñòè, â ÿê³é

ê³ëüêîñò³, ÿê ÷àñòî ³ â ÿêèé ÷àñ, ÿêèì ñïîñîáîì ïðèãîòó-

âàííÿ. ²ñíóº òàêà êëàñèô³êàö³ÿ:

1) ë³êóâàëüí³ ä³ºòè;

2) îçäîðîâëþâàëüí³ ä³ºòè;

3) ä³ºòè äëÿ çìåíøåííÿ/çá³ëüøåííÿ ìàñè ò³ëà.

Ïðîòå ó âñ³õ âèïàäêàõ ä³ºòè çàñòîñîâóþòüñÿ âæå ïðè

íàÿâí³é ïðè÷èí³ (çàõâîðþâàííÿ, íàäëèøêîâà âàãà, ïîñò

îïåðàö³éí³ ñòàíè òîùî). Ïðîô³ëàêòèêà æ ïîêëèêàíà íà çà-

ïîá³ãàííÿ ö³º¿ ïðè÷èíè, òîáòî êîëè ôàêòó íàÿâíîñò³ çàõâî-

ðþâàííÿ íåìàº. Îòæå, ç öüîãî âèïëèâàº, ùî ä³ºòè – öå

ïåðø çà âñå ìåòîä ë³êóâàííÿ. Àëå ¿õ ÷àñòî ïëóòàþòü ³ç ñèñ-

òåìàìè õàð÷óâàííÿ, êîòð³ ³ çàñòîñîâóþòü ÿê ïðîô³ëàêòèêó.

Íà ïèòàííÿ: “ßê³ ïðîäóêòè âàðòî âæèâàòè äëÿ ïðîô³-

ëàêòèêè éîäîäåô³öèò³â?”, ñòóäåíòè â³äïîâ³ëè â ñåðåäíüî-

ìó ïðàâèëüíî [â³ðí³ âàð³àíòè ìîðñüêà ðèáà òà ìîðåïðî-

äóêòè ³ éîäîâàíà ñ³ëü] (ðèñ. 6. “Ïðîäóêòè, ÿê³ âàðòî

âæèâàòè äëÿ ïðîô³ëàêòèêè éîäîäåô³öèòó”):

Ç ïèòàííÿì: “ßê³ ïðîäóêòè íå ïîòð³áíî âæèâàòè äëÿ

ïðîô³ëàêòèêè îæèð³ííÿ òà öóêðîâîãî ä³àáåòó?” , ñèòóàö³ÿ

ñêëàëàñÿ òðîõè ã³ðøå, òîìó ùî áàãàòî îïèòàíèõ íå âèáðà-

ëè ³íø³ ïðàâèëüí³ âàð³àíòè, îêð³ì ÿê êîíäèòåðñüêèõ âè-

ðîá³â òà õë³áîïåêàðñüêèõ âèðîá³â ³ç ïøåíè÷íîãî áîðîøíà

[ïðàâèëüí³ â³äïîâ³ä³ 1), 3), 5), 6), 7)](ðèñ. 7. “ßê³ ïðîäóêòè

íå ïîòð³áíî âæèâàòè äëÿ ïðîô³ëàêòèêè îæèð³ííÿ òà öóê-

ðîâîãî ä³àáåòó”):

Ïåðåéäåìî áåçïîñåðåäíüî äî îñíîâíî¿ ÷àñòèíè àíêå-

òè – Áëîêó ²².

²ç âñ³õ îïèòàíèõ ëèøå 28,5% âæèâàþòü çàõîä³â äëÿ ïðîô³-

ëàêòèêè öóêðîâîãî ä³àáåòó (ðèñ. 8. “Ïðîô³ëàêòèêà ÖÄ”):

Ùîäî çàõîä³â, ÿê³ âèêîðèñòîâóþòü ö³ 28,5 â³äñîòêè ñòó-

äåíò³â, ñêëàëàñÿ òàêà ñèòóàö³ÿ (ðèñ. 9. “Ìåòîäè ïðîô³ëàê-

òèêè ÖÄ”).

Ìåòîäàìè çàïîá³ãàííÿ õâîðîáàì ùèòîïîä³áíî¿ çàëî-

çè êîðèñòóþòüñÿ 42,8 â³äñîòêè ñòóäåíò³â-ìåäèê³â ïåðøîãî

êóðñó (ðèñ. 10. “Ïðîô³ëàêòèêà çàõâîðþâàíü ùèòîïîä³áíî¿

çàëîçè”).

² â³äïîâ³äíî ðîçïîä³ë âèáðàíèõ âàð³àíò³â íà çàïèòàííÿ:

“ßê³ ìåòîäè ïðîô³ëàêòèêè çàõâîðþâàíü ùèòîïîä³áíî¿ çà-

ëîçè Âè âèêîðèñòîâóºòå?” (ðèñ. 11. “Ìåòîäè ïðîô³ëàêòè-

êè çàõâîðþâàíü ùèòîïîä³áíî¿ çàëîçè”).

² ùîäî ïðîô³ëàêòèêè îæèð³ííÿ, òî ñèòóàö³ÿ çì³íèëàñÿ

íà êðàùå, ³ ê³ëüê³ñòü ëþäåé, êîòð³ çàïîá³ãàþòü öüîìó ðîç-

ëàäó ïåðåéøëà çà ïîëîâèíó â³ä çàãàëüíèõ îïèòàíèõ ³ ñêëà-

ëà 53.6 â³äñîòêà ïîçèòèâíèõ â³äïîâ³äåé (ðèñ. 12. “Ïðîô³-

ëàêòèêà îæèð³ííÿ” òà ðèñ. 13. “Ìåòîäè ïðîô³ëàêòèêè

îæèð³ííÿ”).

Îòæå, òàê³ ðåçóëüòàòè àíêåòóâàííÿ ñåðåä ñòóäåíò³â-

ïåðøîêóðñíèê³â ìåäè÷íîãî óí³âåðñèòåòó.

Ðèñ. 4. ßê Âè ââàæàºòå, ïðîô³ëàêòèö³ ÿêèõ åíäîêðèííèõ

õâîðîá âàòðî ïðèä³ëÿòè íàéá³ëüøå óâàãè.

Ðèñ. 6. Ïðîäóêòè, ÿê³ âàðòî âæèâàòè äëÿ ïðîô³ëàêòèêè

éîäîäåô³öèòó

Ðèñ. 7. “ßê³ ïðîäóêòè íå ïîòð³áíî âæèâàòè

äëÿ ïðîô³ëàêòèêè îæèð³ííÿ òà öóêðîâîãî ä³àáåòó

Ðèñ. 5. Ä³ºòà – öå ë³êóâàííÿ ÷è ïðîô³ëàêòèêà?

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Ðèñ. 13. Ìåòîäè ïðîô³ëàêòèêè îæèð³ííÿ.

Ðèñ. 12. Ïðîô³ëàêòèêà îæèð³ííÿ.

Ðèñ. 8. Ïðîô³ëàêòèêà ÖÄ.

Ðèñ. 11. Ìåòîäè ïðîô³ëàêòèêè çàõâîðþâàíü ùèòîïîä³áíî¿ çàëîçè

Ðèñ. 9. Ìåòîäè ïðîô³ëàêòèêè ÖÄ.

Ðèñ. 10. Ïðîô³ëàêòèêà çàõâîðþâàíü ùèòîïîä³áíî¿ çàëîçè.

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Âèñíîâêè. Áóëî ïðîâåäåíî ñîö³îëîã³÷íå äîñë³äæåííÿ

ç ìåòîþ âèçíà÷åííÿ ð³âíÿ îá³çíàíîñò³ ç ïèòàíü ïðîô³ëàê-

òèêè íàéïîøèðåí³øèõ åíäîêðèííèõ çàõâîðþâàíü ñåðåä

ñòóäåíò³â ìåäè÷íîãî óí³âåðñèòåòó. Âèõîäÿ÷è ç îòðèìàíèõ

äàíèõ (íàâåäåí³ âèùå), ìîæíà çðîáèòè âèñíîâîê ïðî

íèçüêèé ð³âåíü çíàíü òà çàö³êàâëåíîñò³ â ö³é ãàëóç³. Ç îãëÿ-

äó íà òå, ùî áóëè îïèòàí³ ìàéáóòí³ ë³êàð³, áàæàíî âæèòè

çàõîä³â ç âèð³øåííÿ ö³º¿ ïðîáëåìè. Äëÿ öüîãî ïîòð³áíî

ïðîâîäèòè âíóðò³øíüîâóç³âñüê³ ïðîãðàìè ç:

1) ïîøèðåííÿ ³íôîðìàö³¿ ïðî ðèçèêè çàõâîðþâà-

íîñò³ òà íàñë³äêè öèõ íåäóã;

2) ïðîïàãóâàííÿ ìåòîä³â ¿õíüî¿ ïðîô³ëàêòèêè;

3) ïåð³îäè÷íîãî ìîí³òîðèíãó ñòàíó çäîðîâ’ÿ åíäî-

êðèííî¿ ñèñòåìè ñòóäåíò³â.

Ðåöåíçåíò: ä.ìåä.í., ïðîôåñîð Áîäíàð Ï.Ì.

Ë²ÒÅÐÀÒÓÐÀ

1. “Äîâ³äíèê îñíîâíèõ ïîêàçíèê³â ä³ÿëüíîñò³ åíäîêðèíîëî-

ã³÷íî¿ ñëóæáè Óêðà¿íè çà 2012 ð³ê” , – ¹1/2013 Äîäàòîê 1, Òîì

18. – “Åíäîêðèíîëîã³ÿ” Íàóêîâî-ïðàêòè÷íèé æóðíàë ÄÓ “²íñòè-

òóò åíäîêðèíîëîã³¿ òà îáì³íó ðå÷îâèí ³ì. Â. Ï. Êîì³ñàðåíêà

ÍÀÌÍ Óêðà¿íè”, 2013. – 36.

2. Îö³íþâàííÿ éîäîäåô³öèòíèõ çàõâîðþâàíü òà ìîí³òî-

ðèíã ¿õ óñóíåííÿ: Ïîñ³áíèê äëÿ êåð³âíèê³â ïðîãðàì. – Òðåòº âèäàí-

íÿ. – Ê.: “Ê.².Ñ.”, 2008. – 104 ñ.

3. ªðæàê Ã. ß. Ïðîô³ëàêòèêà éîäîäåô³öèòíèõ çàõâîðþ-

âàíü: äàéäæåñò /óêëàä.: Ã.ß. ªðæàê, ðåä. Í.Â. Êîíüêîâà – Äí³ïðî-

ïåòðîâñüê: ÄÎÍÌÁ, 2012. - 12 ñ.

4. Áëàãîñêëîííàÿ ß. Â. Ýíäîêðèíîëîãèÿ: ó÷åáíèê äëÿ ìå-

äèöèíñêèõ âóçîâ. / Áëàãîñêëîííàÿ ß. Â., Øëÿõòî Å. Â., Áàáåí-

êî À. Þ. – 2-å óçä., èñïð. è äîï. – ÑÏá.: ÑïåöËèò, 2007. –

400 ñ.

5. Áàðàíîâñêèé À. Þ. Äèåòîëîãèÿ: ðóêîâîäñòâî/ Áàðàíîâñ-

êèé À. Þ. Èçäàòåëüñêèé äîì “Ïèòåð”.- 2008 ã. ñ. 1022.

6. Prevention and Treatment of Pediatric Obesity: An Endocrine

Society Clinical Practice Guideline Based on Expert Opinion. [Gilbert

P. August, Sonia Caprio, Ilene Fennoy and others]. – First published

in the Journal of Clinical Endocrinology & Metabolism. December

2008, 93(12): 4576–4599.

7. Ñòàòèñòè÷í³ äàí³ ïðî ÷èñåëüí³ñòü íàñåëåííÿ Óêðà¿íè

ñòàíîì íà 1 ñ³÷íÿ 2014. [Åëåêòðîííèé ðåñóðñ]. – Ðåæèì äîñòó-

ïó: URL: http://www.ukrstat.gov.ua/operativ/operativ2014/ds/kn/kn_u/

kn0114_u.html/. – íàçâà ç åêðàíó.

ÏÐÎÔÈËÀÊÒÈÊÀ ÝÍÄÎÊÐÈÍÍÛÕ

ÇÀÁÎËÅÂÀÍÈÉ ÑÐÅÄÈ ÑÒÓÄÅÍÒÎÂ-ÌÅÄÈÊÎÂ

Íèêîëàåíêî Ñ.È.

Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò

èìåíè À.À. Áîãîìîëüöà, ã. Êèåâ, Óêðàèíà

Ðåçþìå. Ñåãîäíÿ ðàññòðîéñòâà ðàáîòû ùèòîâèäíîé

æåëåçû, äèàáåò è îæèðåíèå – ñàìûå ðàñïðîñòðàíåí-

íûå ýíäîêðèííûå çàáîëåâàíèÿ, ÷àñòü èç êîòîðûõ íå

ïîääàåòñÿ ëå÷åíèþ, à òðåáóåò ïîñòîÿííîé ãîðìîíàëü-

íîé òåðàïèè èëè õèðóðãè÷åñêèõ âìåøàòåëüñòâ. Â ñòàòüå

ïðèâåäåíû ðåçóëüòàòû ñîöèîëîãè÷åñêîãî îïðîñà ñòóäåí-

òîâ-ìåäèêîâ îòíîñèòåëüíî ãîòîâíîñòè èñïîëüçîâàòü ïðî-

ôèëàêòè÷åñêèå ìåðû ýíäîêðèííûõ çàáîëåâàíèé, ñîá-

ñòâåííî, äëÿ ñåáÿ, âåäü èìåííî îíè ÿâëÿþòñÿ òåìè, êòî

ïîòåíöèàëüíî áóäåò ïðèìåíÿòü èõ â ñâîåé ïðîôåññèî-

íàëüíîé ìåäèöèíñêîé ïðàêòèêå.

Êëþ÷åâûå ñëîâà: ïðîôèëàêòèêà, ýíäîêðèííûå

çàáîëåâàíèÿ, ñòóäåíò-ìåäèê.

THE PREVENTION OF ENDOCRINE DISEASES

AMONG MEDICAL STUDENTS

S. Nikolaienko

Bogomolets National Medical University, Kyiv, Ukraine

Summàry. Today the thyroid disorders, diabetes and

obesity are the most common endocrine diseases; part of

them can’t be treated at all and requires regular hormone

therapy or surgery. The article presents the results of a poll

of medical students regarding the level of their readiness to

use preventive measures of endocrine diseases, in fact, for

themselves, because they are the ones who will potentially

use them in their professional medical practice.

Key words: prevention, endocrine diseases, medical

students.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÑÎÖ²ÀËÜÍÀ ÌÅÄÈÖÈÍÀ / SOCIAL MEDICINE

ÓÄÊ: 616-056.5-056.2-053.84

ÑÓÁÚÅÊÒÈÂÍÀß ÑÀÌÎÎÖÅÍÊÀ ÇÄÎÐÎÂÜß

Â ÇÀÂÈÑÈÌÎÑÒÈ ÎÒ ÊÓÐÅÍÈß

È ÔÈÇÈ×ÅÑÊÎÉ ÏÎÄÃÎÒÎÂËÅÍÍÎÑÒÈ

Îâäèé Ì.À., Êîðøàê Â.Ì., Òàðòà÷íà Ì.Â.

Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò èìåíè À.À.Áîãîìîëüöà, Êèåâ, Óêðàèíà

Êëþ÷åâûå ñëîâà: ôèçè÷åñêàÿ ïîäãîòîâëåííîñòü, ñòóäåíòû, êóðåíèå, ôóíêöèîíàëüíûå ïîêàçàòåëè.

Âñòóï. Ïðîáëåìà ïîâûøåíèÿ óðîâíÿ è ðåçåðâîâ çäî-

ðîâüÿ ñòóäåí÷åñêîé ìîëîäåæè òðåáóåò äåòàëüíîãî èçó÷å-

íèÿ, êàê â îòíîøåíèè ñîñòîÿíèÿ îêðóæàþùåé ñðåäû, òàê

è âîçäåéñòâèÿ íåãàòèâíûõ ôàêòîðîâ íà îðãàíèçì. Îñîáîå

ìåñòî ñðåäè ýòèõ âîïðîñîâ ïðèíàäëåæèò ïðîáëåìå êóðå-

íèÿ, êîòîðîå ñïîñîáñòâóåò óõóäøåíèþ ôóíêöèîíàëüíîãî

ñîñòîÿíèÿ êàðäèîðåñïèðàòîðíîé ñèñòåìû îðãàíèçìà,

âîçíèêíîâåíèþ çàáîëåâàíèé ñèñòåìû êðîâîîáðàùåíèÿ,

äûõàíèÿ è ïèùåâàðåíèÿ, îíêîëîãè÷åñêèõ çàáîëåâàíèé

[1, 7, 8].

Íà ñîâðåìåííîì ýòàïå ðàçâèòèÿ ìåäèöèíû ïîäõîä ê

îöåíêå çäîðîâüÿ îñíîâûâàåòñÿ íå òîëüêî íà îáúåêòèâíûõ

äàííûõ, íî è íà ñóáúåêòèâíîì âîñïðèÿòèè ñàìèì ÷åëîâå-

êîì ïñèõîëîãè÷åñêèõ, ýìîöèîíàëüíûõ è ñîö³àëüíî-ýêî-

íîìè÷åñêèõ àñïåêòîâ åãî æèçíè, òî åñòü íà óðîâíå êà÷å-

ñòâà åãî æèçíè. Åñëè òåëî çäîðîâîå, íî íåò îùóùåíèÿ

ðàäîñòè è ïîëíîòû æèçíè, òî ýòî óæå áîëåçíü. Àíàëèç òàê

íàçûâàåìûõ ñóáúåêòèâíûõ ïîêàçàòåëåé ïîäðîáíî ðàçðà-

áîòàí, à èõ èçìåðèòåëüíûå ñâîéñòâà ÷åòêî î÷åð÷åíû [2,

3]. Ñèãíàëû î ñîñòîÿíèè çäîðîâüÿ, ïîñòóïàþùèå èç

âíåøíåé ñðåäû îðãàíèçìà, åãî îðãàíîâ è òêàíåé, äîñòèãà-

þò ÖÍÑ , ãäå è ôîðìèðóåòñÿ ÷óâñòâî áëàãîïîëó÷èÿ èëè

íåáëàãîïîëó÷èÿ. Â çàâèñèìîñòè îò ïàìÿòè î áëàãîïîëó-

÷èè (âíóòðåííåé ìîäåëè çäîðîâüÿ), êîòîðàÿ õðàíèòñÿ â

ÖÍÑ è ôîðìèðóåòñÿ â ïðîöåññå îíòîãåíåçà, ÷åëîâåê âîñ-

ïðèíèìàåò ëþáîå âíåøíåå âîçäåéñòâèå ïî-ñâîåìó.

Ñàìîîöåíêà çäîðîâüÿ ñóùåñòâåííî âèäîèçìåíÿåòñÿ òàê-

æå â ïðîöåññå èíäèâèäóàëüíîé æèçíè ÷åëîâåêà [4, 5] .

Èçâåñòíî, ÷òî èìåííî ôóíêöèîíàëüíûé óðîâåíü êàð-

äèîðåñïèðàòîðíîé ñèñòåìû ÷àñòî óõóäøàåò ñàìîîùó-

ùåíèå ÷åëîâåêà è îãðàíè÷èâàåò ñïîñîáíîñòü îðãàíèçìà

ê ýôôåêòèâíîìó âûïîëíåíèþ ìûøå÷íîé ðàáîòû òîåñòü

ñíèæàåò óðîâåíü åãî ôèçè÷åñêîé ïîäãîòîâëåííîñòè ×å-

ëîâåê, èìåþùèé âûñîêèé óðîâåíü ôèçè÷åñêîé ïîäãîòîâ-

ëåííîñòè, õàðàêòåðèçóåòñÿ îòíîñèòåëüíî áîëüøèì îáúå-

ìîì äâèãàòåëüíûõ óìåíèé è íàâûêîâ, âûñîêèìè

ôóíêöèîíàëüíûìè âîçìîæíîñòÿìè êàðäèîðåñïèðàòîð-

íîé, âûäåëèòåëüíîé, òåðìîðåãóëÿòîðíîé ñèñòåì, õîðî-

øèì òåëîñëîæåíèåì [7]. Â ñòðóêòóðå ôèçè÷åñêîé ïîäãî-

òîâëåííîñòè ÷åëîâåêà âûäåëÿþòñÿ ïðåèìóùåñòâåííî

ñëåäóþùèå ïàðàìåòðû: ôóíêöèÿ êàðäèîðåñïèðàòîðíîé

ñèñòåìû, ñîäåðæàíèå æèðîâîé òêàíè â îðãàíèçìå, ìû-

øå÷íàÿ ñèëà, àýðîáíàÿ âûíîñëèâîñòü, ãèáêîñòü. Ýòè ïà-

ðàìåòðû íàïðÿìóþ ñâÿçàíû ñ ïîêàçàòåëÿìè êà÷åñòâà

æèçíè ÷åëîâåêà è èìåþò ñóùåñòâåííîå çíà÷åíèå â ïðå-

äîòâðàùåíèè áîëüøèíñòâà ïðîáëåì ñî çäîðîâüåì.

Èñõîäÿ èç ïðèâåäåííûõ ëèòåðàòóðíûõ äàííûõ, ìîæíà

ïðåäïîëàãàòü, ÷òî îòêàç îò êóðåíèÿ óæå â ñòóäåí÷åñêîì

âîçðàñòå ïîçâîëèò ïðåäóïðåäèòü ðÿä çàáîëåâàíèé, áóäåò

ñïîñîáñòâîâàòü óëó÷øåíèþ êà÷åñòâà æèçíè, îïòèìèçà-

öèè ïðîöåññà îáó÷åíèÿ è áîëåå êà÷åñòâåííîé ïîäãîòîâêå

èõ ê áóäóùåé ïðîôåññèè. Îöåíêà âëèÿíèÿ òàáàêîêóðåíèÿ

íà ôèçè÷åñêóþ ïîäãîòîâëåííîñòü âî âçàèìîäåéñòâèè ñ

ïîêàçàòåëÿìè ñàìîîöåíêè ñâîåãî çäîðîâüÿ ñòóäåíòîâ

ìîæåò òàêæå ðàññìàòðèâàòüñÿ êàê ôàêòîð ôîðìèðîâàíèÿ

ïîëîæèòåëüíîé ìîòèâàöèè ê îòêàçó îò êóðåíèÿ è ñàìî-

êîððåêöèè ôèçè÷åñêîé ïîäãîòîâëåííîñòè .

Öåëü ðàáîòû: îáúåêòèâèçèðîâàòü âëèÿíèÿ òàáàêîêó-

ðåíèÿ íà ôèçè÷åñêóþ ïîäãîòîâëåííîñòü è ñàìîîöåíêó

çäîðîâüÿ ñòóäåíòîâ äëÿ ôîðìèðîâàíèÿ ìîòèâàöèè îòêàçà

îò âðåäíîé ïðèâû÷êè è ñàìîêîððåêöèè ôèçè÷åñêîé ïîä-

ãîòîâëåííîñòè.

Ìàòåðèàëû è ìåòîäû èññëåäîâàíèÿ. Èññëåäîâàíèå

ïðîâåäåíî ó 2892 ñòóäåíòîâ 4-ãî êóðñà ìåäèöèíñêîãî ôà-

êóëüòåòà ÍÌÓ âî âðåìÿ ïðàêòè÷åñêèõ çàíÿòèé ïî ôèçè-

÷åñêîé ðåàáèëèòàöèè è ñïîðòèâíîé ìåäèöèíå Ñðåäíèé

âîçðàñò îáñëåäîâàííûõ ñòóäåíòîâ ñîñòàâèë 21,4±0,3. ãîäà.

Äëÿ ñðàâíåíèÿ âñå ñòóäåíòû ðàçäåëåíû íà äâå ãðóïïû: 1 –

áåç ïðèâû÷êè òàáàêîêóðåíèÿ (íåêóðÿùèå); 2 – èìåþùèå

ïðèâè÷êó òàáàêîêóðåíèÿ (êóðÿùèå).

Ðàñïðîñòðàíåííîñòü, èíòåíñèâíîñòü è çàâèñèìîñòü

îò òàáàêîêóðåíèÿ ñðåäè ñòóäåíòîâ îïðåäåëÿëè ñ ïîìî-

ùüþ ðàçðàáîòàííîé íàìè àíêåòû íà îñíîâå ëèòåðàòóð-

íûõ äàííûõ. Äëÿ ñàìîîöåíêè ñâîãî çäîðîâüÿ áûë âûáðàí

è àäàïòèðîâàí ê íàøèì óñëîâèÿì èçâåñòíûé îïðîñíèê

SF – 36. Ñòðóêòóðíûé ôóíäàìåíò ôèçè÷åñêîé ïîäãîòîâ-

ëåííîñòè îïðåäåëÿëè âåëè÷èíàìè èíäåêñà ìàññû òåëà

(ÈÌÒ) âåñ,êã\ ðîñò,ì². Ôóíêöèîíàëüíûé ïîòåíöèàë ôèçè-

÷åñêîé ïîäãîòîâëåííîñòè îïðåäåëÿëè âåëè÷èíàìè:

1) ïóëüñîâîé ñòîèìîñòè âûïîëíåííîé ñòàíäàðòíîé ðàáî-

òû, ïóëüñ / Âò [6]; 2) æèçíåííîãî èíäåêñà (ÆÈ), êàê ñîîò-

íîøåíèå æèçíåííîé åìêîñòè ëåãêèõ (ìë) ê ìàññå òåëà

(êã); 3 ) ñèëîâîãî èíäåêñà (ÑÈ) ,êàê ïðîöåíòíîå ñîîòíîøå-

íèå ìàêñèìàëüíî âîçìîæíîé ñèëû ïðàâîé êèñòè ïðè äè-

íàìîìåòðèè (êã) ê ìàññå òåëà (êã); 4 ) ãèáêîñòè – êàê ëè-

íåéíîå ðàññòîÿíèå (ñì) îò êîí÷èêîâ ñðåäíèõ ïàëüöåâ

êèñòåé ê ïëîùàäè ñòóïåíüêè íà êîòîðîé ñòîèò èññëåäóå-

ìûé ( íóëåâîå çíà÷åíèå ) ïðè íàêëîíå âïåðåä, íå ñãèáàÿ

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÑÎÖ²ÀËÜÍÀ ÌÅÄÈÖÈÍÀ / SOCIAL MEDICINE

Òàáëèöà 1.

Ôèçè÷åñêàÿ ïîäãîòîâëåííîñòü â çàâèñèìîñòè îò ïðèâû÷êè êóðåíèÿ (Ì±m)

* ñòàòèñòè÷åñêè äîñòîâåðíàÿ ðàçíèöà

íîã è óäåðæèâàÿ ýòî ïîëîæåíèå â òå÷åíèå äâóõ ñåêóíä.

Ñòàòèñòè÷åñêóþ îáðàáîòêó ðåçóëüòàòîâ èññëåäîâàíèÿ

ïðîâîäèëè ïîñëå ñîçäàíèÿ áàçû äàííûõ â ñèñòåìàõ

Microsoft Excel. Ñðåäíèå ïîêàçàòåëè îáñëåäîâàííûõ îï-

ðåäåëÿëè ñ ïîìîùüþ ïàêåòà àíàëèçà â ñèñòåìå Microsoft

Excel. Äîñòîâåðíîñòü ðàçëè÷èé ñðåäíèõ ïîêàçàòåëåé â

ãðóïïàõ ñðàâíåíèÿ îïðåäåëÿëè êðèòåðèÿìè Ñòþäåíòà.

Ðåçóëüòàòû è èõ îáñóæäåíèå. Íà ïðèâû÷êó ñèñòåìàòè-

÷åñêîãî êóðåíèÿ óêàçàëè â àíêåòàõ 41,2 % îïðîøåííûõ ñòó-

äåíòîâ ìóæñêîãî ïîëà, ÷òî áûëî ïî÷òè íà óðàâíå Åâðîïåé-

ñêîãî Ñîþçà (46 – 42% ) è çíà÷èòåëüíî ìåíüøå, ÷åì ïî

Óêðàèíå ( 60 – 66 % ). Ñðåäè ñòóäåíòîâ æåíñêîãî ïîëà òàêóþ

ïðèâû÷êó èìåëè 17,8% îïðîøåííûõ ñòóäåíòîê, ÷òî áûëî

ñóùåñòâåííî ìåíüøåé âåëè÷èíîé, ÷åì â Åâðîïåéñêîì Ñî-

þçå è ïî Óêðàèíå ( 28 è 32 % ). Ñðåäè êóðèëüùèêîâ áîëü-

øèíñòâî ñòóäåíòîâ ìóæñêîãî è æåíñêîãî ïîëà (65,2 è 89,4 %)

âûêóðèâàëè äî 10 ñèãàðåò â ñóòêè è òîëüêî åäèíè÷íûå

ñòóäåíòû âûêóðèâàëè áîëåå 20 ñèãàðåò. Çàâèñèìîñòü îò

íèêîòèíà ó áîëüøèíñòâà êóðèëüùèêîâ ìóæñêîãî è æåíñêî-

ãî ïîëà ( 80,4 è 90,9 % ) áûëà äîñòàòî÷íî íèçêîé. Ñâèäåòåëü-

ñòâîì ýòîìó áûëî òî, ÷òî ñòóäåíòû íå êóðÿò ñðàçó æå ïîñëå

ïðîáóæäåíèÿ, â çàïðåùåííûõ ìåñòàõ, êîãäà áîëåþò è ìîãóò

ëåãêî îòêàçàòüñÿ îò êóðåíèÿ â ìåñòàõ, ãäå ýòî çàïðåùåíî.

Ñòðóêòóðíûé ôóíäàìåíò ôèçè÷åñêîé ïîäãîòîâëåí-

íîñòè ïî âåëè÷èíå ÈÌÒ ó áîëüøèíñòâà ñòóäåíòîâ (71,8%)

áûë â ïðåäåëàõ íîðìàëüíûõ âåëè÷èí (20 – 25 êã/ì2) è â

ñðåäíåì ñîñòàâëÿë 21,7 ± 0,02 êã/ì2, ìåíüøå 19,9 êã/ì2 –

îáíàðóæåí ó 10,5%, à áîëüøå 25 êã/ì2 – ó 17,7% îáñëåäî-

âàííûõ. Ñóùåñòâåííîé ðàçíèöû â ïðîïîðöèîíàëüíîñòè

ìàññû òåëà ðîñòó ó ñòóäåíòîâ, èìåþùèõ ïðèâè÷êó êóðå-

íèÿ ïî ñðàâíåíèþ ñî ñòóäåíòàìèè áåç òàêîé ïðèâè÷êè íå

ïðîñëåæèâàåòñÿ ( òàáë. 1).

Êàê âèäíî èç ïðåäñòàâëåííÿõ äàíûõ, íåñìîòðÿ íà øè-

ðîêîðàñïðîñòðàíåííîå ñóæäåíèå ìîëîäåæè î ïîëîæè-

òåëüíîì âëèÿíèè êóðåíèÿ íà ìàññó òåëà, ñóùåñòâåííîé

ðàçíèöû ÈÌÒ â ãðóïïàõ ñðàâíåíèÿ íå âûÿâëåíî (Ð>0,05).

Ôóíêöèîíàëüíûé ïîòåíöèàë ôèçè÷åñêîé ïîäãîòîâ-

ëåííîñòè ïî âåëè÷èíå ÆÈ ó êóðÿùèõ ñòóäåíòîâ ìóæñêî-

ãî ïîëà áûë íåçíà÷èòåëüíî ìåíøå â ñðàâíåíèè ñ íåêóðÿ-

ùèìè ñòóäåíòàìè è â îáåèõ ãðóïïàõ íå ñîîòâåòñòâîâàë

íîðìàëüíûì çíà÷åíèÿì (íîðìà 65 – 70 ìë / êã ). Ó íåêóðÿ-

ùèõ ñòóäåíòîê ýòîò ïîêàçàòåëü â ñðåäíåì áûë ïðèáëèæåí

ê ïðåäåëàì íîðìû è ñîñòàâè 54,9±1,13 ìë / êã ( íîðìà 55 –

60 ìë / êã.) ó êóðÿùèõ ñòóäåíòîê ïîêàçàòåëü áûë íèæå íà

3%, íî íå áûëî îáíàðóæåíî äîñòîâåðíîãî ðàçëè÷èÿ ìåæ-

äó ãðóïàìè ñðàâíåíèÿ (Ð>0,05).

Ñèëîâîé èíäåêñ â ãðóïïå êóðÿùèõ ñòóäåíòîâ ìóæñêî-

ãî ïîëà ñîñòàâëÿë â ñðåäíåì 61,3 ± 1,14 % (íîðìà 70 –

75%), ÷òî íà 5% ìåíøå â ñðàâíåíèè ñ íåêóðÿùèìè ñòó-

äåíòàìè (Ð>0,05). Ó êóðÿùèõ è íåêóðÿùèõ ñòóäåíòîê ñèëî-

âîé èíäåêñ èìåë ïðèáëèçèòåëüíî îäèíàêîâûå çíà÷åíèÿ è

íå äîñòèãàë óðîâíÿ íîðìû ( íîðìà 50 %).

Ïóëüñîâàÿ ñòîèìîñòü âûïîëíåííîé ñòóäåíòàìè ñòàí-

äàðòíîé íàãðóçêè ó êóðÿùèõ ìóæñêîãî ïîëà â ñðåäíåì

ñîñòàâëÿëà 1,24 ± 0,06 ïóëüñ /Âò, ó íåêóðÿùèõ – ýòîò ïîêà-

çàòåëü ñîñòàâèë 1,02±0,07 ïóëüñ /Âò, ÷òî ÿâëÿëîñü ñâèäå-

òåëüñòâîì íèçêîãî óðîâíÿ àýðîáíûõ âîçìîæíîñòåé â

îáåèõ ãðóïàõ, ïðè ýòîì èìåëî ñòàòèñòè÷åñêè äîñòîâåð-

íóþ ðàçíèöó â ãðóïïàõ ñðàâíåíèÿ (Ð<0,05). Ó æåíùèí

îáåèõ ãðóïï ïóëüñîâàÿ ñòîèìîñòü ñòàíäàðòíîé íàãðóçêè

èìåëà ïîõîæèé õàðàêòåð è ñîîòâåòñòâîâàëà íèçêîìó

óðîâíþ. Ïðåäñòàâëåííûå ìàòåðèàëû òàêæå ñâèäåòåëü-

ñòâóþò, ÷òî îáùàÿ âûíîñëèâîñòü ñòóäåíòîâ ñ ïðèâû÷êîé

êóðåíèÿ èìååò òåíäåíöèþ ê ñíèæåíèþ ïî ñðàâíåíèþ ñî

ñòóäåíòàìè áåç òàêîé ïðèâè÷êè.

Ãèáêîñòü ó áîëüøèíñòâà ñòóäåíòîâ (85,8%) áûëà áîëü-

øå íóëåâîãî çíà÷åíèå è â ñðåäíåì ñîñòàâèëà ïëþñ 10,3 ±

±0,06 ñì. Íóëåâîå çíà÷åíèå ýòîãî ïîêàçàòåëÿ îòìå÷àëîñü

ó 8,6% îáñëåäîâàííûõ. Íåäîñòàòî÷íàÿ ãèáêîñòü òóëîâèùà

îáíàðóæåíà ëèøü ó 5,6% ñòóäåíòîâ. Äîñòîâåðíîé ðàçíè-

öû ãèáêîñòè ñòóäåíòîâ â çàâèñèìîñòè îò ïðèâû÷êè êóðå-

íèÿ íå âûÿâëåíî ( Ð≥0,05).

Ñîñòîÿíèå ñâîãî çäîðîâüÿ íà ìîìåíò îáñëåäîâàíèÿ

áîëüøàÿ ÷àñòü íåêóðÿùèõ ñòóäåíòîâ (58,3 % ìóæ÷èí è

54% æåíùèí) ñóáüåêòèâíî îöåíèëè êàê õàðîøåå. Ñðåäè

êóðÿùèõ òàêèõ ñòóäåíòîâ áûëî ìåíøå (43,9 % è 42,4 %

ñîîòâåòñòâåííî). Ïî ñðàâíåíèþ ñ ïðîøëûì ãîäîì áîëü-

øàÿ ÷àñòü îïðîøåííûõ íåêóðÿùèõ ìóæ÷èí è æåíùèí

(58,3% è 65,4 %) è êóðÿùèõ (56,1% è 62,2 %) îöåíèëè ñâîå

çäîðîâüå ïðèáëèçèòåëüíî òàêèì æå – áåç èçìåíåíèé. Ôè-

çè÷åñêîå è ýìîöèîíàëüíîå ñîñòîÿíèå îïðîøåíûõ ñòó-

äåíòîâ âíå çàâèñèìîñòè îò ïðèâè÷êè òàáàêîêóðåíèÿ íå

ìåøàëî îáùàòüñÿ ñ ñåìüåé, äðóçÿìè è â êîëëåêòèâå.

Âûâîäû.

1. Êóðåíèå ñðåäè ñòóäåí÷åñêîé ìîëîäåæè ðàñïðîñò-

ðàíåíî íà óðîâíå Åâðîïåéñêîãî Ñîþçà è â ìåíüøåé

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÑÎÖ²ÀËÜÍÀ ÌÅÄÈÖÈÍÀ / SOCIAL MEDICINE

ìåðå, ÷åì â ñðåäíåì ïî Óêðàèíå. Êóðèëüùèêè íå çàâèñÿò

îò êóðåíèÿ òàáàêà è âûêóðèâàþò äî 10 ñèãàðåò â ñóòêè.

2. Ñòðóêòóðíûé ôóíäàìåíò ôèçè÷åñêîé ïîäãîòîâëåí-

íîñòè íå çàâèñèò îò ïðèâè÷êè êóðåíèÿ, ìàñà òåëà áîëü-

øèíñòâà êóðÿùèõ è íåêóðÿùèõ ñòóäåíòîâ ñîîòâåòñòâîâà-

ëà èõ ðîñòó, ÷òî åùå ðàç ñâèäåòåëüñòâóåò î ëæèâîñòè

îáûâàòåëüñêîé íàäåæäû íà ðåãóëÿöèþ ìàññû òåëå â

ðåçóëüòàòå êóðåíèÿ.

3. Î âëèÿíèè êóðåíèÿ íà ôóíêöèîíàëüíûé ïîòåíöèàë

ôèçè÷åñêîé ïîäãîòîâëåííîñòè ñòóäåí÷åñêîé ìîëîäåæè

äîñòîâåðíûõ ñâèäåòåëüñòâ òàêæå íå âèÿâëåíî, íî âëèÿíèå

êóðåíèÿ íà ôèçè÷êñêóþ ðàáîòîñïîñîáíîñòü òðåáóåò

äàëüíåéøèõ èññëåäîâàíèé.

4. Ñîñòîÿíèå ñâîãî çäîðîâüÿ íà ìîìåíò îáñëåäîâà-

íèÿ ñòóäåíòû áåç ïðèâû÷êè êóðåíèÿ ÷àùå îöåíèâàþò

êàê õàðîøåå ïî ñðàâíåíèþ ñ êóðÿùèìè. Äëÿ òàêîé ñàìî-

îöåíêè âåðîÿòíî íå ïîñëåäíþþ ðîëü ó ñòóäåíòîâ- ìåäè-

êîâ èãðàåò è îáùåïðèíÿòîå ìíåíèå î âðåäå êóðåíèÿ íà

çäîðîâüå.

5. Ñîñòîÿíèå ñâîãî çäîðîâüÿ ïî ñðàâíåíèþ ñ ïðî-

øëûì ãîäîì áîëüøèíñòâî ñòóäåíòîâ îöåíèâàþò òàêèì

æå (áåç èçìåíåíèé). Ôèçè÷åñêîå è ýìîöèîíàëüíîå ñî ñòîÿ-

íèå îïðîøåíûõ ñòóäåíòîâ âíå çàâèñèìîñòè îò ïðèâè÷êè

òàáàêîêóðåíèÿ íå ìåøàëî îáùàòüñÿ ñ ñåìüåé, äðóçÿìè è

â êîëëåêòèâå

6. Â èçó÷åíèè âëèÿíèÿ òàáàêîêóðåíèÿ íà ôèçè÷åñêóþ

ïîäãîòîâëåííîñòü è ñàìîîöåíêó çäîðîâüÿ íàðÿäó ñ ðàñïðî-

ñòðàíåííûìè ìåäèöèíñêèìè èññëåäîâàíèÿìè îáåçàòåëüíî

íóæíî èñïîëüçîâàòü ìåäèêîïñèõîëîãè÷åñêèå ìåòîäû.

Ðåöåíçåíò: ä.ìåä.í., ïðîôåñîð Ëèçîãóá Â.Ã.

ËÈÒÅÐÀÒÓÐÀ

1. Âàðòàíÿí Ô. Å. ÂÎÇ è áîðüáà ñ êóðåíèåì â ìèðå: ñòðà-

òåãèè è òåíäåíöèè / Ô. Å Âàðòàíÿí, Ê. Ï. Øàõîâñêèé // Íàðêîëî-

ãèÿ.-2003.-¹.4.-Ñ. 2-4.

2. Íèâèê À.À., Èîíîâà Ò.È. Ðóêîâîäñòâî ïî èññëåäîâà-

íèþ êà÷åñòâà æèçíè â ìåäèöèíå. Ñ.- Ïåòåðáóðã. Èçäàòåëü-

ñêèé Äîì “Íåâà”;Ì: “ÎËÌÀ-ÏÐÅÑÑ” Çâåçäíûé ìèð. 2002.–

320 ñ.

3. Íîñêî Ì.Î. Âïëèâ çàíÿòü ç ô³çè÷íî¿ êóëüòóðè íà ñòàí

çäîðîâ’ÿ òà ô³çè÷íó ï³äãîòîâëåí³ñòü ñòóäåíòñüêî¿ ìîëîä³ /

Ì.Î. Íîñêî, À.Ï Êðèâåíêî // Ïåäàãîã³êà, ïñèõîëîã³ÿ òà ìåäèêî-

á³îëîã³÷í³ ïðîáëåìè ô³çè÷íîãî âèõîâàííÿ ³ ñïîðòó. Çá.íàóê. ïð. –

Õàðê³â. ÕÕØ, 2004. – ¹22. – Ñ.14–18.

4. Ñòðàòåã³ÿ ôîðìóâàííÿ çäîðîâîãî ñïîñîáó æèòòÿ.

Ìàòåð³àëè êîíôåðåíö³¿. Êè¿â,19–20 æîâòíÿ 2000 ð. – 236 ñ.

5. Òþòþí àáî çäîðîâ’ÿ â Óêðà¿í³. Çá³ðêà ³íôîðìàö³éíèõ

ìàòåð³àë³â. Êè¿â, 1997. - 215 ñ.

6. Øàïîâàëîâà Â.À.Êîðøàê Â.Ì.,Øèìåë³ñ ².Â., Õàëòàãàðî-

âà Â.Ì. Ñïîñ³á âèçíà÷åííÿ ô³çè÷íî¿ ïðàöåçäàòíîñò³ ëþäèíè.

Ïàòåíò 34351 À.// Áþë. ¹1.-2001ð.

7. Cavender J.B. Effects of smoking on survival and morbidity

in patients randomized to medical or surgical therapy in the Coronary

Artery Surgery Study (CASS): 10-year follow-up/ J.B. Cavender,

W.J. Rogers, L.D. Fisher [et al.] // J Am Coll Cardiol.– 1992. –Vol. 20. –

P. 287–294.

8. Michael K Freeman. Concentrating risk: a systematic analysis

of the global smoking epidemic /Michael K Freeman // The Lancet. –

2013. –Vol. 381- P.52.

ÑÓÁ’ªÊÒÈÂÍÀ ÑÀÌÎÎÖ²ÍÊÀ ÇÄÎÐÎÂ’ß

Â ÇÀËÅÆÍÎ Â²Ä ÊÓÐ²ÍÍß

ÒÀ Ô²ÇÈ×ÍÎ¯ Ï²ÄÃÎÒÎÂËÅÍÎÑÒ²

Îâä³é Ì.Î., Êîðøàê Â.Ì., Òàðòà÷íà Ì.Â.,

Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò

³ìåí³ Î.Î.Áîãîìîëüöÿ, Êè¿â, Óêðà¿íà

Ðåçþìå. Ñòàòòÿ ïðèñâÿ÷åíà ïðîáëåì³ ïîøèðåíîñò³

êóð³ííÿ ñåðåä ñòóäåíòñüêî¿ ìîëîä³, éîãî âïëèâó íà ñòàí

çäîðîâ’ÿ òà ô³çè÷íó ï³äãîòîâëåí³ñòü. Íàìè áóëî âñòàíîâ-

ëåíî, ùî ïîøèðåí³ñòü êóð³ííÿ ñåðåä ñòóäåíòñüêî¿ ìî-

ëîä³ áóëà íà ð³âí³ ªâðîïåéñüêîãî Ñîþçó òà ñêëàëà ñåðåä

÷îëîâ³ê³â 41,2%, ñåðåä æ³íîê 17,8%. Íàìè íå áóëî âèÿâ-

ëåíî çâ’ÿçêó ì³æ êóð³ííÿì òà ³íäåêñîì ìàñè ò³ëà, æèòòº-

âèì òà ñèëîâèì ³íäåêñîì, íàòîì³ñòü ó ÷îëîâ³ê³â, ÿê³ ìàëè

çâè÷êó êóð³ííÿ ð³âåíü ô³çè÷íî¿ ïðàöåçäàòíîñò³ áóâ äîñ-

òîâ³ðíî íèæ÷èì ó ïîð³âíÿíí³ ç ÷îëîâ³êàìè áåç çâè÷êè

êóð³ííÿ. Ñòàí ñâîãî çäîðîâ’ÿ ñòóäåíòè ç³ çâè÷êîþ êóð³ííÿ

îö³íþâàëè íèæ÷å â ïîð³âíÿíí³ ç³ ñòóäåíòàìè áåç çâè÷êè

êóð³ííÿ.

Êëþ÷îâ³ ñëîâà: ô³çè÷íà ï³äãîòîâëåí³ñòü, ñòóäåíòè,

êóð³ííÿ, ôóíêö³îíàëüí³ ïîêàçíèêè.

SUBJECTIVE SELF-ASSESSMENT

OF HEALTH IN ADDICTED TO SMOKING

AND PHYSICAL FITNESS

M. Ovdii, V. Korshak, M. Tartachna

Bogomolets National Medical University, Kyiv, Ukraine

Summary. The article presents the prevalence of

smoking among students and impact of smoking on health

and physical fitness. We found the prevalence of smoking

among students was at the level of the European Union

and average 41.2% smokers men and 17.8 % smokers

women. We didn’t find the relation between smoking status

and body mass index , life and power index, but we examined

that smokers men had the low level of physical performance

than nonsmokers men. Health level smokers students was

lower than nonsmokers students.

Key words: physical fitness, students, smoking,

functional performance.

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÑÎÖ²ÀËÜÍÀ ÌÅÄÈÖÈÍÀ / SOCIAL MEDICINE

Âñòóï. Â óìîâàõ îáìåæåíèõ ô³íàíñîâèõ, ëþäñüêèõ òà

³íøèõ ðåñóðñ³â çäîðîâ’ÿ ÿê ôóíäàìåíòàëüíèé òîâàð º îä-

íèì ³ç âàð³àíò³â ðîçïîä³ëó ðåñóðñ³â äåðæàâè, òîìó ïðîöåñ

éîãî ñòâîðåííÿ ìàº áóòè åôåêòèâíèì. Òàëë³ííñüêà õàðò³ÿ

ñòèìóëþâàëà ä³àëîã êðà¿í çà òàêèìè ñòðàòåã³÷íèìè ïèòàí-

íÿìè, ÿê âàæëèâ³ñòü ³íâåñòóâàííÿ ó ñèñòåìè îõîðîíè çäî-

ðîâ’ÿ, ¿õ ðåôîðìóâàííÿ ³ ï³äòðèìêà îñíîâíèõ ôóíêö³é. Åêñ-

ïåðòè ÂÎÎÇ, ó ñï³âïðàö³ ç ïðåäñòàâíèêàìè ñôåðè îõîðîíè

çäîðîâ’ÿ ªâðîïåéñüêîãî ðåã³îíó çàêëèêàþòü äî çàïðî-

âàäæåííÿ äåðæàâíèõ ïðîãðàì ùîäî ïîêðàùåííÿ çäîðîâ’ÿ

íàñåëåííÿ òà äîñòóïíîñò³ ïîñëóã ç îõîðîíè çäîðîâ’ÿ [15].

Ó ñâîþ ÷åðãó, óêðà¿íñüêà ïðîãðàìà åêîíîì³÷íèõ ðå-

ôîðì íà 2010-2014 ðîêè “Çàìîæíå ñóñï³ëüñòâî, êîíêóðåíòî-

ñïðîìîæíà åêîíîì³êà, åôåêòèâíà äåðæàâà” âêëþ÷àº â ñåáå

áëîê “Ðåôîðìà ìåäè÷íîãî îáñëóãîâóâàííÿ”, êëþ÷îâèìè

ïèòàííÿìè ÿêî¿ º îðãàí³çàö³éíî-ñòðóêòóðíå òà ô³íàíñîâî-

åêîíîì³÷íå ðîçìåæóâàííÿ ó ñôåð³ îõîðîíè çäîðîâ’ÿ [3].

Ó Ñóìñüê³é îáëàñò³ ðîçðîáëåíà ³ ä³º ñòðàòåã³ÿ ñîö³àëü-

íî-åêîíîì³÷íîãî ðîçâèòêó íà ïåð³îä äî 2015 ðîêó “Íîâà

Ñóìùèíà – 2015”, äå âåëèêå çíà÷åííÿ ïðèä³ëåíå ðåôîð-

ìóâàííþ ñèñòåìè îõîðîíè çäîðîâ’ÿ îáëàñò³ ç ìåòîþ ïî-

êðàùåííÿ ÿêîñò³ ³ äîñòóïíîñò³ ìåäè÷íèõ ïîñëóã íà ðåã³î-

íàëüíîìó ð³âí³ [14].

Àíàë³ç äîñâ³äó ðåôîðìóâàííÿ ìåäè÷íî¿ ãàëóç³ ó

ï³ëîòíèõ ðåã³îíàõ Óêðà¿íè âèÿâèâ íèçüêó îá³çíàí³ñòü òà

â³äñóòí³ñòü ðîçóì³ííÿ ãðîìàäîþ íîâèõ “ïðàâèë ãðè” ó

ìåäè÷í³é ñôåð³, ùî ³ âèêëèêàº ñòàãíàö³éíó ñèòóàö³þ ç ïåðå-

òâîðåííÿìè. Äëÿ çàáåçïå÷åííÿ ðîçóì³ííÿ “ÿê³ ìàþòü

áóòè ä³¿” ó ò³é ÷è ³íø³é ñèòóàö³¿ ìåäè÷íîãî îáñëóãîâóâàí-

íÿ ³ “ïðàâèëüíîãî” ñïðèéíÿòòÿ ïðîöåñ³â ðåôîðìóâàííÿ

íåîáõ³äíèì º ðåàë³çàö³ÿ ï³äãîòîâ÷îãî (³íôîðìàö³éíî-ìî-

òèâàö³éíîãî) åòàïó ðåôîðìè, ùî áóäå ³í³ö³þâàòè ¿¿ åôåê-

òèâíå ³ á³ëüø “ãëàäêå” ïðîâåäåííÿ.

Ïèòàííÿ ì³æíàðîäíîãî äîñâ³äó ðåôîðìóâàííÿ îõî-

ðîíè çäîðîâ’ÿ ÷åðåç ïðèçìó ðåôîðì òà äîñë³äæåííþ

ïðîöåñ³â ðåôîðìóâàííÿ ãàëóç³ îõîðîíè çäîðîâ’ÿ Óêðà¿íè

ïðèñâÿ÷åí³ ïðàö³ Þ. Â. Âîðîíåíêà [5], Â. Ì. Ëºõàí [6],

Â. Ô. Ìîñêàëåíêà [7], Ò. Ï. Ïîï÷åíêà [9]. Ã. Î. Ñëàáêîãî

[11], À. Â. Ñòåïàíåíêî [13].

Ðåçóëüòàòè ñîö³îëîã³÷íîãî îïèòóâàííÿ îðãàí³çàòîð³â

îõîðîíè çäîðîâ’ÿ ç ïèòàíü ïî³íôîðìîâàíîñò³ òà ãîòîâ-

íîñò³ äî ïðîâåäåííÿ ñòðóêòóðíî¿ ïåðåáóäîâè ñèñòåìè

îõîðîíè çäîðîâ’ÿ íàâåäåí³ ó ïðàö³ Ã. ß. Ïàðõîìåíêà [8].

Ãðóíòîâíî âèâ÷åí³ ïèòàííÿ ìîòèâàö³¿ ïðàö³ ìåäè÷íèõ

ïðàö³âíèê³â ó ðîáîò³ ðîñ³éñüêîãî äîñë³äíèêà Ñ. Â. Øèø-

ÓÄÊ 614.2 (477.52)

Ï²ÄÂÈÙÅÍÍß Ð²ÂÍß ²ÍÔÎÐÌÀÖ²ÉÍÎ-ÌÎÒÈÂÀÖ²ÉÍÎ¯

ÊÎÌÏÎÍÅÍÒÈ ÐÅÔÎÐÌÈ ÌÅÄÈ×ÍÎ¯ ÃÀËÓÇ²

Ó ÑÓÌÑÜÊÎÌÓ ÐÅÃ²ÎÍ²

Òàðàñåíêî Ñ.Â., Ñì³ÿíîâ Â.À., Ñì³ÿíîâà Þ.Î.

Ìåäè÷íèé ³íñòèòóò Ñóìñüêîãî äåðæàâíîãî óí³âåðñèòåòó, ì. Ñóìè, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: ï³äãîòîâ÷èé åòàï ðåôîðìè, ³íôîðìàö³éíî-ìîòèâàö³éíà êîìïîíåíòà, ãàëóçü îõîðîíè

çäîðîâ’ÿ, ³íôîðìàö³éíà êàìïàí³ÿ.

ê³íà [17]. Çîêðåìà, äîâåäåíî, ùî ðåôîðìè ãàëóç³ îõîðîíè

çäîðîâ’ÿ ìàþòü âðàõîâóâàòè îñîáëèâîñò³ ìîòèâàö³¿ ïðàö³

ðîá³òíèê³â äàíî¿ ñôåðè.

Ìåòîþ äîñë³äæåííÿ º îá´ðóíòóâàííÿ ã³ïîòåçè ïðî ïî-

çèòèâíèé âïëèâ íà ïðîöåñè ðåôîðìóâàííÿ ìåäè÷íî¿ ãàëóç³

ï³äâèùåííÿ ð³âíÿ ³íôîðìàö³éíî-ìîòèâàö³éíî¿ êîìïîíåíòè

ðåôîðìè ó Ñóìñüê³é îáëàñò³ øëÿõîì âèâ÷åííÿ ³íôîðìàö³é-

íèõ ïîòðåá ãðîìàäè, äóìêè åêñïåðò³â, ðîçðîáëåííÿ òà ðåà-

ë³çàö³¿ ³íôîðìàö³éíî¿ êàìïàí³¿ ùîäî ï³äâèùåííÿ îá³çíà-

íîñò³ ïðî ðåôîðìóâàííÿ ãàëóç³ îõîðîíè çäîðîâ’ÿ ó ðåã³îí³.

Ìàòåð³àëè òà ìåòîäè äîñë³äæåííÿ. Ó õîä³ äîñë³äæåí-

íÿ áóëè çàñòîñîâàí³ ïðîåêòíèé òà ³íñòèòóö³îíàëüíèé

ï³äõ³ä, ñèñòåìíèé ìåòîä, ìåòîäè ñèíòåçó òà àíàë³çó.

Ðåçóëüòàòè äîñë³äæåííÿ. Àíàë³ç äîñâ³äó çä³éñíåííÿ

ðåôîðì îõîðîíè çäîðîâ’ÿ â ð³çíèõ êðà¿íàõ âêàçóº íà ñ³ì

ôàêòîð³â, ùî â³ä³ãðàþòü öåíòðàëüíó ðîëü ó çä³éñíåíí³ ïå-

ðåòâîðåíü: ïîë³òè÷íà âîëÿ ³ êåð³âíèöòâî; ÷àñîâ³ ðàìêè;

ô³íàíñîâà ï³äòðèìêà; ñòðàòåã³÷í³ ñîþçè; óïðàâë³ííÿ ïðî-

öåñîì; ï³äòðèìêà ãðîìàäñüêîñò³; òåõí³÷íà ³íôðàñòðóêòó-

ðà ³ ïîòåíö³àë [11].

Îêð³ì óìîâ ³ õàðàêòåðó ïðîöåñó ðåôîðì, êëþ÷îâèìè

âèçíà÷àëüíèìè ôàêòîðàìè ¿õ çä³éñíåííÿ º ÷îòèðè ãðóïè

ó÷àñíèê³â äàíîãî ïåðåòâîðåííÿ: íàñåëåííÿ, ìåäè÷í³

ðîá³òíèêè, ïîë³òè÷í³ ä³ÿ÷³ ³ ÷èíîâíèêè, à òàêîæ çàö³êàâ-

ëåí³ ãðóïè [10].

Øèðîêà ï³äòðèìêà ðåôîðìè ìîæå áóòè åôåêòèâíèì

êàòàë³çàòîðîì çì³í, ÿê ³ ¿¿ â³äñóòí³ñòü ìîæå áóòè ³ñòîòíîþ

ïåðåøêîäîþ.

Îñê³ëüêè â Óêðà¿í³ ïðèéíÿòòÿ ð³øåíü ÿê íà äåðæàâíî-

ìó, òàê ³ ì³ñöåâîìó ð³âíÿõ çíàõîäÿòüñÿ ï³ä âïëèâîì ìå-

äè÷íèõ ïðàö³âíèê³â, íà ùî âêàçóþòü ñïåö³àë³ñòè â îáëàñò³

ñîö³àëüíî¿ ìåäèöèíè òà åêñïåðòè ç ³íøèõ êðà¿í, òî âàæëè-

âèì ïîçèòèâíèì ôàêòîðîì º íàÿâí³ñòü ìåäè÷íèõ ïðàö³â-

íèê³â ó ïðèõèëüíèêàõ ðåôîðìè îõîðîíè çäîðîâ’ÿ, ôîð-

ìóâàííÿ ¿õ ìîòèâàö³¿ äî ïåðåòâîðåíü [11].

Ï³ä ìîòèâàö³ºþ ðîçóì³þòü ñïîíóêàííÿ äî ä³¿ ïåâíèì

ìîòèâîì àáî ãðóïîþ ìîòèâ³â, ÿê ïðîöåñ âèáîðó ì³æ

ð³çíèìè ìîæëèâèìè ä³ÿìè, ùî âèçíà÷àþòü ö³ëåñïðÿìî-

âàí³ñòü ïîâåä³íêè ñóá’ºêò³â. Ïîíÿòòÿ ìîòèâàö³¿ õàðàêòåðè-

çóº çì³ñò ìîòèâ³â ³ ¿õ ñèëó [16].

Íåãàòèâí³ òåíäåíö³¿ ó ðåàë³çàö³¿ ãðîìàäÿíàìè Óêðà¿íè

êîíñòèòóö³éíîãî ïðàâà íà îõîðîíó çäîðîâ’ÿ àðãóìåíòó-

þòü äîö³ëüí³ñòü ðåôîðìóâàííÿ â³ò÷èçíÿíî¿ ìåäè÷íî¿ ãà-

ëóç³. Òàê, óêðà¿íö³ ïîñò³éíî ñêàðæàòüñÿ íà íåçàäîâ³ëüíèé

ð³âåíü ìåäè÷íî¿ äîïîìîãè, íèçüêó ÿê³ñòü, íåñâîº÷àñí³ñòü

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÑÎÖ²ÀËÜÍÀ ÌÅÄÈÖÈÍÀ / SOCIAL MEDICINE

òà íåäîñòóïí³ñòü ïîñëóã îõîðîíè çäîðîâ’ÿ. Ôðàãìåíòàðí³

îðãàí³çàö³éíî-ñòðóêòóðí³ ïåðåòâîðåííÿ, ÿê³ º ïåðøèìè

êðîêàìè ðåôîðìóâàííÿ ñôåðè îõîðîíè çäîðîâ’ÿ, ïîêè

ùî íå ïðèçâåëè äî ï³äâèùåííÿ äîñòóïíîñò³ ìåäè÷íèõ

ïîñëóã òà ¿õ ÿêîñò³.

Â³äñóòí³ñòü ðîçóì³ííÿ îñíîâíèõ íàïðÿìê³â ðåôîðìè

â óÿâëåíí³ óêðà¿íñüêî¿ ãðîìàäè, ïåâíà “îñîáèñòà ïðîòè-

ä³ÿ” ìåäè÷íèõ ïðàö³âíèê³â ïðîöåñàì ïåðåòâîðåíü, íå-

ñôîðìîâàí³ñòü ñèñòåìè ãðîìàäñüêîãî ìîí³òîðèíãó ó ïè-

òàííÿõ íàäàííÿ ìåäè÷íèõ ïîñëóã (òîáòî, íåäîñòàòíº

³íôîðìàö³éíå, ìîòèâàö³éíå çàáåçïå÷åííÿ ïðîöåñó ðå-

ôîðìóâàííÿ) âêðàé óñêëàäíþº ñïðèéíÿòòÿ ðåôîðìè îõî-

ðîíè çäîðîâ’ÿ â Óêðà¿í³ óñ³ìà âåðñòâàìè ãðîìàäÿíñüêîãî

ñóñï³ëüñòâà ³ ïîòðåáóº ðîçðîáëåííÿ ³ ðåàë³çàö³¿ ï³äãîòîâ-

÷îãî åòàïó ðåôîðìè äëÿ âèð³øåííÿ äàíèõ ïèòàíü. Çîêðå-

ìà, ìîâà éäå ïðî ñòâîðåííÿ ñèñòåìè ³íôîðìàö³éíî-ìî-

òèâàö³éíî¿ ï³äòðèìêè ðåôîðìè ³ âèêîðèñòàííÿ ¿¿ ó ÿêîñò³

ìîäåë³ äëÿ ³íøèõ ðåã³îí³â Óêðà¿íè.

Çàêîíè Óêðà¿íè: “Ïðî âíåñåííÿ çì³í äî Îñíîâ çàêîíî-

äàâñòâà Óêðà¿íè ïðî îõîðîíó çäîðîâ’ÿ ùîäî óäîñêîíà-

ëåííÿ íàäàííÿ ìåäè÷íî¿ äîïîìîãè” â³ä 07.07.2011 ¹ 3611-

VI òà “Ïðî ïîðÿäîê ïðîâåäåííÿ ðåôîðìóâàííÿ ñèñòåìè

îõîðîíè çäîðîâ’ÿ ó Â³ííèöüê³é, Äí³ïðîïåòðîâñüê³é, Äî-

íåöüê³é îáëàñòÿõ òà ì³ñò³ Êèºâ³” â³ä 07.07.2011 ¹ 3612-VI

ïåðåäáà÷àþòü çì³íè ñèñòåìè îõîðîíè çäîðîâ’ÿ ó çàçíà÷å-

íèõ ï³ëîòíèõ ðåã³îíàõ ç ïîäàëüøèì àíàë³çîì ðåçóëüòàò³â

äîñâ³äó ðåôîðìóâàííÿ òà âèêîðèñòàííÿì éîãî íà çàãàëü-

íîäåðæàâíîìó ð³âí³ [1, 2].

ÌÎÇ Óêðà¿íè ðîçðîáëåíèé Ïëàí çàõîä³â ùîäî ³íôîð-

ìàö³éíî¿ ï³äòðèìêè ðåôîðìóâàííÿ ñèñòåìè îõîðîíè çäî-

ðîâ’ÿ ó ðàìêàõ Ïðîãðàìè åêîíîì³÷íèõ ðåôîðì íà 2010–

2014 ðîêè “Çàìîæíå ñóñï³ëüñòâî, êîíêóðåíòîñïðîìîæíà

åêîíîì³êà, åôåêòèâíà äåðæàâà”, ÿêèé ïåðåäáà÷àº çàáåçïå-

÷åííÿ øèðîêîãî âèñâ³òëåííÿ ó çàñîáàõ ìàñîâî¿ ³íôîðìàö³¿

åòàïíîñò³, ðåçóëüòàò³â òà ðèçèê³â ðåôîðìóâàííÿ îõîðîíè

çäîðîâ’ÿ, çîêðåìà, ïðîâåäåííÿ ïðåñ-êëóá³â, êðóãëèõ ñòîë³â,

ãàðÿ÷èõ òåëåôîííèõ ë³í³é ç ðåôîðìóâàííÿ, ñòâîðåííÿ

â³äïîâ³äíèõ ðîçä³ë³â íà âåá-ñàéòàõ îáëàñíèõ óïðàâë³íü îõî-

ðîíè çäîðîâ’ÿ òîùî [4]. Íà ñàéò³ ÌÎÇ Óêðà¿íè ôóíêö³îíóº

îêðåìèé ðîçä³ë – “Ðåôîðìà ìåäè÷íîãî îáñëóãîâóâàííÿ”.

Àëå ôîðìàëüíå äåêëàðóâàííÿ ³íôîðìàö³éíî¿

ï³äòðèìêè ðåôîðìóâàííÿ ñèñòåìè îõîðîíè çäîðîâ’ÿ çà

îñòàíí³ äâà ðîêè íå ïðèçâåëî äî çðîñòàííÿ îá³çíàíîñò³

ãðîìàäè ó ïèòàííÿõ ïåðåòâîðåíü ìåäè÷íî¿ ñôåðè òà

ñïðè÷èíèëî íåïðèéíÿòòÿ ³, íàâ³òü, ïðîòèä³þ ðåôîðì³

á³ëüø³ñòþ íàñåëåííÿ êðà¿íè.

Òàê, ïðî íåðîçóì³ííÿ ñóò³ ìåäè÷íî¿ ðåôîðìè îðãàí³-

çàòîðàìè îõîðîíè ñâ³ä÷àòü ðåçóëüòàòè ñîö³îëîã³÷íîãî

îïèòóâàííÿ, ïðîâåäåíîãî ó Ñóìñüêîìó ðåã³îí³ ó 2012 ð.:

âïëèâ ðåôîðìè îõîðîíè çäîðîâ’ÿ â Óêðà¿í³ íà ÿê³ñòü ìå-

äè÷íî¿ äîïîìîãè íå çìîãëè îö³íèòè 50 % îïèòàíèõ, ùî

ñâ³ä÷èòü àáî ïðî íèçüêó ³íôîðìàö³éíó îá³çíàí³ñòü îðãàí³-

çàòîð³â îõîðîíè çäîðîâ’ÿ, àáî ïðî íåñïðèéíÿòòÿ çì³í â

ñèñòåì³ ìåäè÷íîãî îáñëóãîâóâàííÿ ó ö³ëîìó [12].

Òàêèì ÷èíîì, ñèñòåìíà ðîç’ÿñíþâàëüíà ðîáîòà ó

ãðîìàä³ ùîäî ïðîöåñ³â ðåôîðìóâàííÿ, ÿêà º ôàêòîðîì

åôåêòèâíîãî ïðîâåäåííÿ ðåôîðìè, ìàº áóòè ïîñèëåíà.

²íôîðìàö³éí³ çàõîäè ìàþòü áóòè íàïðàâëåí³ íà óñâ³-

äîìëåííÿ îñíîâíîãî çì³ñòó ðåôîðìè ñèñòåìè îõîðîíè

çäîðîâ’ÿ Óêðà¿íè, à ñàìå:

1) ðîçìåæóâàííÿ ìåäè÷íî¿ äîïîìîãè çà ð³âíÿìè íà-

äàííÿ;

2) ïîêðàùåííÿ ÿêîñò³ òà äîñòóïíîñò³ ìåäè÷íî¿ äîïî-

ìîãè;

3) ïð³îðèòåòíèé ðîçâèòîê ïåðâèííî¿ ìåäè÷íî¿ äîïî-

ìîãè íà çàñàäàõ ñ³ìåéíî¿ ìåäèöèíè òà åêñòðåíî¿

ìåäè÷íî¿ äîïîìîãè (ñòâîðåííÿ êîìïëåêñíî¿ ñèñ-

òåìè ïåðâèííî¿ ìåäèêî-ñàí³òàðíî¿ äîïîìîãè, îð³-

ºíòîâàíî¿ íà îáñëóãîâóâàííÿ íà ñ³ìåéíîìó ð³âí³,

ùî ï³äòðèìóºòüñÿ ãíó÷êîþ ³ ÷óòëèâîþ ë³êàðíÿíîþ

ñèñòåìîþ (ñòàö³îíàð);

4) ï³äâèùåííÿ åôåêòèâíîñò³ óïðàâë³ííÿ øëÿõîì âïðî-

âàäæåííÿ ñèñòåìè ìîòèâàö³¿ äëÿ ìåäè÷íèõ ïðàö³â-

íèê³â òà ïîêðàùåííÿ óìîâ ¿õ ïðàö³;

5) ñòâîðåííÿ óìîâ äëÿ ðîçøèðåííÿ ñàìîñò³éíîñò³ ïî-

ñòà÷àëüíèê³â ìåäè÷íèõ ïîñëóã – çàêëàä³â îõîðîíè

çäîðîâ’ÿ.

Â³äïîâ³äíî, ³íôîðìàö³éíà êàìïàí³ÿ ùîäî ï³äâèùåííÿ

îá³çíàíîñò³ ïðî ðåôîðìóâàííÿ ìåäè÷íî¿ ãàëóç³ ó Ñóìñü-

êîìó ðåã³îí³, íà íàøó äóìêó, âêëþ÷àº òàê³ åòàïè:

1. Âèâ÷åííÿ ãðîìàäñüêî¿ òà åêñïåðòíî¿ äóìêè ùîäî

íàãàëüíèõ ïèòàíü, ÿê³ íåîáõ³äíî âèñâ³òëèòè äëÿ ðîçóì³í-

íÿ ãðîìàäñüê³ñòþ ïðîöåñ³â ðåôîðìóâàííÿ ãàëóç³ îõîðî-

íè çäîðîâ’ÿ: à) îñíîâíèõ ôàêòîð³â çàáåçïå÷åííÿ ÿêîñò³

ìåäè÷íîãî îáñëóãîâóâàííÿ; á) îñíîâíèõ åôåêòèâíèõ êà-

íàë³â êîìóí³êàö³é ó ðîçð³ç³ ï³äâèùåííÿ ïî³íôîðìîâà-

íîñò³ ãðîìàäè (ñòâîðåííÿ ïàêåòó àíêåò äëÿ îïèòóâàííÿ

ãðîìàäè, ³íòåðâ’þ åêñïåðò³â, ñåð³ÿ ôîêóñ-ãðóï ç òåìàòèêè

äîñë³äæåííÿ: ÿê³ñòü ³ äîñòóïí³ñòü ìåäè÷íèõ ïîñëóã (îö³í-

êà îðãàí³çàòîðàìè îõîðîíè çäîðîâ’ÿ); çàäîâîëåí³ñòü

ïàö³ºíò³â (îö³íêà ïðåäñòàâíèêàìè ãðîìàäè); ìîòèâàö³ÿ

ìåäè÷íîãî ïåðñîíàëó (îö³íêà ë³êàðÿìè òà ³íòåðíàìè);

îïèòóâàííÿ ãðîìàäè â îñíîâíèõ ðàéîííèõ öåíòðàõ òà

ó ì. Ñóìè.

2. Ñòâîðåííÿ ³íôîðìàö³éíîãî ñåðåäîâèùà, ñïðèÿò-

ëèâîãî äëÿ ñïðèéíÿòòÿ ðåôîðìè ãàëóç³, øëÿõîì ïðîâå-

äåííÿ ³íôîðìàö³éíî¿ êàìïàí³¿ ç ïèòàíü ðåôîðìóâàííÿ ãà-

ëóç³ îõîðîíè çäîðîâ’ÿ ç âèêîðèñòàííÿì øèðîêîãî

ñïåêòðó êàíàë³â êîìóí³êàö³¿: âèñòóïè åêñïåðò³â îõîðîíè

çäîðîâ’ÿ ç ïèòàíü ðåôîðìóâàííÿ ìåäè÷íî¿ ãàëóç³ ó ðåã³î-

íàëüíèõ òåëå- òà ðàä³î- åô³ðàõ; ïðåñ-êîíôåðåíö³¿ ç ïèòàíü

ðåôîðìóâàííÿ ìåäè÷íî¿ ãàëóç³ äëÿ ì³ñöåâèõ ÇÌ² ³ ò.ï.

3. Ðîçðîáêà òà àïðîáàö³ÿ òèïîâîãî áàçîâîãî ñåì³íà-

ðó ç ïèòàíü ðåôîðìóâàííÿ ãàëóç³ îõîðîíè çäîðîâ’ÿ äëÿ

ìåäè÷íèõ ïðàö³âíèê³â òà ñòóäåíò³â Ìåäè÷íîãî ³íñòèòóòó.

4. Àíàë³ç äîñâ³äó ðåàë³çàö³¿ ï³äãîòîâ÷îãî (³íôîðìà-

ö³éíî-ìîòèâàö³éíîãî) åòàïó ðåôîðìóâàííÿ ìåäè÷íî¿

ãàëóç³ ó ï³ëîòíèõ ðåã³îíàõ òà éîãî êîðåãóâàííÿ.

5. Íàïðàöþâàííÿ ðåêîìåíäàö³é ç óäîñêîíàëåííÿ ðå-

ã³îíàëüíî¿ ïîë³òèêè ùîäî ðåôîðìóâàííÿ ìåäè÷íî¿ ñôåðè

òà ï³äâèùåííÿ ÿêîñò³ ìåäè÷íîãî îáñëóãîâóâàííÿ.

Êîðîòêîòðèâàëèìè íàñë³äêàìè òàêî¿ ³íôîðìàö³éíî-

ïðîñâ³òíèöüêî¿ êàìïàí³¿ ùîäî ï³äâèùåííÿ îá³çíàíîñò³

íàñåëåííÿ òà ìåäè÷íèõ ïðàö³âíèê³â ó ïðîöåñàõ ðåôîðìó-

âàííÿ ãàëóç³ îõîðîíè çäîðîâ’ÿ º:

1) âèçíà÷åííÿ ìîæëèâîñòåé åôåêòèâíîãî âïëèâó íà

ãðîìàäñüêó äóìêó ùîäî ïðîâàäæåííÿ ðåôîðìè;

2) ñòâîðåííÿ òèïîâîãî êîíñïåêòó áàçîâîãî ñåì³íàðó,

âèêîðèñòàííÿ ÿêîãî äîçâîëÿº ï³äâèùèòè ïî³íôîð-

ìîâàí³ñòü ìåäè÷íèõ ïðàö³âíèê³â ùîäî çì³í ó ìå-

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÑÎÖ²ÀËÜÍÀ ÌÅÄÈÖÈÍÀ / SOCIAL MEDICINE

äè÷í³é ñôåð³ òà ñôîðìóâàòè ìîòèâàö³þ äëÿ ¿õ àäåê-

âàòíîãî ïðèéíÿòòÿ;

3) ï³äâèùåííÿ îá³çíàíî ñò³ ãðîìàäñüêîñò³ òà ìåäè÷íèõ

ïðàö³âíèê³â ùîäî ö³ëåé òà î÷³êóâàíèõ ðåçóëüòàò³â

ðåôîðìóâàííÿ ìåäè÷íî¿ ãàëóç³ â ðåã³îí³;

4) íàäàííÿ ðåêîìåíäàö³¿ äëÿ ÌÎÇ Óêðà¿íè ç óäîñêî-

íàëåííÿ äåðæàâíî¿ ïîë³òèêè ùîäî ðåôîðìóâàííÿ

ìåäè÷íî¿ ñôåðè òà ï³äâèùåííÿ ÿêîñò³ ìåäè÷íîãî

îáñëóãîâóâàííÿ.

Äîâãîòðèâàëèìè íàñë³äêàìè ³íôîðìàö³éíî¿ êàìïàí³¿

äëÿ ï³äâèùåííÿ îá³çíàíîñò³ ùîäî ðåôîðìóâàííÿ ìåäè÷-

íî¿ ãàëóç³ ó Ñóìñüêîìó ðåã³îí³ º:

1) ïîêðàùåííÿ åôåêòèâíîñò³ óïðàâë³íñüêèõ ïðîöåñ³â ðå-

ôîðìóâàííÿ ìåäè÷íî¿ ñôåðè íà ðåã³îíàëüíîìó ð³âí³;

2) íàïðàöþâàííÿ ó ñòâîðåíí³ êîìóí³êàö³éíî¿ ïëàò-

ôîðìè ïðîöåñó ðåôîðìóâàííÿ ãàëóç³ îõîðîíè çäî-

ðîâ’ÿ ó Ñóìñüêîìó ðåã³îí³;

3) ìîæëèâ³ñòü âèêîðèñòàííÿ ³íøèìè ðåã³îíàìè Óê-

ðà¿íè íàïðàöüîâàíîãî äîñâ³äó ç ï³äâèùåííÿ ïî-

³íôîðìîâàíîñò³ ãðîìàäè òà åôåêòèâíîñò³ ïðîâåäåí-

íÿ ðåôîðìóâàííÿ ìåäè÷íî¿ ãàëóç³;

4) çðîñòàííÿ çàö³êàâëåíîñò³ ìåäè÷íèõ ôàõ³âö³â ó ïðî-

öåñàõ ðåôîðìóâàííÿ ìåäè÷íî¿ ãàëóç³;

5) âïðîâàäæåííÿ ñó÷àñíèõ íîâèõ ï³äõîä³â äî îðãàí³-

çàö³¿ ìåäè÷íîãî îáñëóãîâóâàííÿ íà ðåã³îíàëüíî-

ìó ð³âí³ äëÿ ï³äâèùåííÿ ßÌÄ.

Âèñíîâêè. Òàêèì ÷èíîì, äëÿ ñïðèéíÿòòÿ ïðîöåñ³â ðå-

ôîðìóâàííÿ îõîðîíè çäîðîâ’ÿ íàñåëåííÿì òà ìåäè÷íè-

ìè ïðàö³âíèêàìè íåîáõ³äíèì º äåòàëüíå ðîçðîáëåííÿ íà

ðåã³îíàëüíîìó ð³âí³ ï³äãîòîâ÷îãî (³íôîðìàö³éíî-ìîòè-

âàö³éíîãî) åòàïó ðåôîðìè, ùî áóäå ³í³ö³þâàòè ¿¿ åôåêòèâ-

íå ïðîâåäåííÿ.

Ðåöåíçåíò: ä.ìåä.í., ïðîôåñîð Âàñèëüºâà ².Â.

Ë²ÒÅÐÀÒÓÐÀ

1. Çàêîí Óêðà¿íè “Ïðî âíåñåííÿ çì³í äî Îñíîâ çàêîíîäàâñòâà

Óêðà¿íè ïðî îõîðîíó çäîðîâ’ÿ ùîäî óäîñêîíàëåííÿ íàäàííÿ ìåäè÷-

íî¿ äîïîìîãè” â³ä 07.07.2011 ¹ 3611-VI [Åëåêòðîííèé ðåñóðñ]. –

Ðåæèì äîñòóïó: http://zakon2.rada.gov.ua/laws/show/3611-17.

2. Çàêîí Óêðà¿íè “Ïðî ïîðÿäîê ïðîâåäåííÿ ðåôîðìóâàííÿ

ñèñòåìè îõîðîíè çäîðîâ’ÿ ó Â³ííèöüê³é, Äí³ïðîïåòðîâñüê³é, Äî-

íåöüê³é îáëàñòÿõ òà ì³ñò³ Êèºâ³” â³ä 07.07.2011 ¹ 3612-VI [Åëåê-

òðîííèé ðåñóðñ]. – Ðåæèì äîñòóïó: http://zakon2.rada.gov.ua/

laws/show/3612-17.

3. Ïðîãðàìà åêîíîì³÷íèõ ðåôîðì íà 2010-2014 ð.ð. “Çàìîæíå

ñóñï³ëüñòâî, êîíêóðåíòîñïðîìîæíà åêîíîì³êà, åôåêòèâíà äåð-

æàâà” [Åëåêòðîííèé ðåñóðñ]. – Ðåæèì äîñòóïó: http://

president.gov.ua›docs/Programa_reform_FINAL_1.pdf.

4. Ïëàí çàõîä³â ùîäî ³íôîðìàö³éíî¿ ï³äòðèìêè ðåôîðìóâàí-

íÿ îõîðîíè çäîðîâ’ÿ ó ðàìêàõ Ïðîãðàìè åêîíîì³÷íèõ ðåôîðì íà

2010-2014 ðîêè “Çàìîæíå ñóñï³ëüñòâî, êîíêóðåíòîñïðîìîæíà

åêîíîì³êà, åôåêòèâíà âëàäà” / Ðåôîðìà ìåäè÷íîãî îáñëóãîâó-

âàííÿ. ²íôîðìàö³éíèé ñóïðîâ³ä ðåôîðì [Åëåêòðîííèé ðåñóðñ]. –

Ðåæèì äîñòóïó: http://www.moz.gov.ua/ua/portal/hsr_infsr/.

5. Êíÿçåâè÷ Â.Ì. Îõîðîíà çäîðîâ’ÿ Óêðà¿íè: ñòàí, ïðîáëåìè,

ïåðñïåêòèâè / Ã.Î. Ñëàáêèé, Þ.Â. Âîðîíåíêî, Â.Ô. Ìîñêàëåíêî

òà ³í. – Ê., 2009 . – 437 ñ.

6. Ëºõàí Â.Ì. Îõîðîíà çäîðîâ’ÿ Óêðà¿íè: ïðîáëåìè òà íà-

ïðÿìêè ðîçâèòêó // Â³ñíèê ñîö³àëüíî¿ ã³ã³ºíè òà îðãàí³çàö³¿ îõî-

ðîíè çäîðîâ’ÿ . – 2011. – ¹ 4. – Ñ. 5-18.

7. Ìîñêàëåíêî Â.Ô. Íàóêîâ³ îñíîâè âò³ëåííÿ íîâî¿ ºâðîïåéñü-

êî¿ ñòðàòåã³¿ “Çäîðîâ’ÿ – 2020” / Â.Ô. Ìîñêàëåíêî, Ò.Ñ. Ãðóçºâà,

Ë.². Ãàë³ºíêî // Ñõ³æíîºâðîïåéñüêèé æóðíàë ãðîìàäñüêîãî çäî-

ðîâ’ÿ. – 2012. – ¹ 4. – Ñ. 42-50.

8. Ïàðõîìåíêî Ã.ß. Ñòàâëåííÿ êåð³âíèê³â çàêëàä³â îõîðîíè

çäîðîâ’ÿ äî ðåôîðìóâàííÿ ñèñòåìè íàäàííÿ ìåäè÷íî¿ äîïîìîãè /

Ã. ß Ïàðõîìåíêî // Â³ñíèê ñîö³àëüíî¿ ã³ã³ºíè òà îðãàí³çàö³¿ îõîðî-

íè çäîðîâ’ÿ . – 2011. – ¹ 4. – Ñ. 67-69.

9. Ïîï÷åíêî Ò. Ï. Ðåôîðìóâàííÿ ñôåðè îõîðîíè çäîðîâ’ÿ â Óê-

ðà¿í³: îðãàí³çàö³éíå, íîðìàòèâíî-ïðàâîâå òà ô³íàíñîâî-åêîíîì³÷íå

çàáåçïå÷åííÿ : àíàë³ò. äîï. / Ò. Ï. Ïîï÷åíêî. – Ê.: Í²ÑÄ, 2012. – 96 ñ.

10. Ñàëòìàí Ð.Á. Ðåôîðìû çäðàâîîõðàíåíèÿ â Åâðîïå: àíà-

ëèç ñîâðåìåííûõ ñòðàòåãèé / Ð.Á. Ñàëòìàí, Äæ. Ôèãåéðàñ. –

Ì.: Ãýîòàð Ìåäèöèíà. – 432 ñ.

11. Ñëàáêèé Ã.À. Ê âîïðîñó î ðåôîðìèðîâàíèè ñèñòåìû çäðà-

âîîõðàíåíèÿ: ìåæäóíàðîäíûé îïûò / Ã.À. Ñëàáêèé, Ã.ß. Ïàðõî-

ìåíêî // Óêðà¿íñüêèé ìåäè÷íèé ÷àñîïèñ. – 2012. – ¹ 3. – Ñ. 26–9.

12. Ñì³ÿíîâ Â.À. Îö³íêà ÿêîñò³ ìåäè÷íî¿ äîïîìîãè íàñåëåí-

íþ Ñóìñüêî¿ îáëàñò³ / Â.À. Ñì³ÿíîâ, À.Ì. Êîñòåíêî // Óêðà¿íà.

Çäîðîâ’ÿ íàö³¿. – 2012. – ¹ 2-3. – Ñ. 218-220.

13. Ñòåïàíåíêî À.Â. ²íñòðóìåíò äëÿ ïàö³ºíò³â, çàëó÷åíèõ äî

óïðàâë³ííÿ ÿê³ñòþ ìåäè÷íî¿ äîïîìîãè. ªâðîïåéñüêèé äîñâ³ä ðåàë³-

çàö³¿ ïðèíöèï³â äîêàçîâî¿ ìåäèöèíè / À.Â. Ñòåïàíåíêî, Î.Í. Ë³ùè-

øèíà, Î.Ì. Êðàâåöü // Óêðà¿íñüêèé ìåäè÷íèé ÷àñîïèñ. – 2010. –

¹ 2. – Ñ. 19 – 31.

14. Ñòðàòåã³ÿ ðîçâèòêó Ñóìñüêî¿ îáëàñò³ íà ïåð³îä äî 2015

ðîêó “Íîâà Ñóìùèíà – 2015”. – Ñóìè, 2010. – 119 ñ.

15. Òàëëèííñêàÿ õàðòèÿ: Ñèñòåìû çäðàâîîõðàíåíèÿ äëÿ

çäîðîâüÿ è áëàãîñîñòîÿíèÿ / Åâðîïåéñêàÿ ìèíèñòåðñêàÿ êîí-

ôåðåíöèÿ ÂÎÇ ïî ñèñòåìàì çäðàâîîõðàíåíèÿ: “Ñèñòåìû çäðàâî-

îõðàíåíèÿ-Çäîðîâüå-Áëàãîñîñòîÿíèå”. – Òàëëèíí, Ýñòîíèÿ,

25–27 èþíÿ 2008 ã. [Ýëåêòðîííûé ðåñóðñ]. – Ðåæèì ://

www.euro.who.int/document/E91438R.pdf.

16. Õåêõàóçåí Õ. Ìîòèâàöèÿ è äåÿòåëüíîñòü. – 2-å èçä. –

ÑÏá.: Ïèòåð; Ì.: Ñìûñë, 2003 – 860 ñ.

17. Øèøêèí Ñ.Â. Ðîññèéñêîå çäðàâîîõðàíåíèå: ìîòèâàöèÿ

âðà÷åé è îáùåñòâåííàÿ äîñòóïíîñòü / Ïîä ðåä. Ñ.Â. Øèøêèíà. –

Ì.: Íåçàâèñèìûé èíñòèòóò ñîöèàëüíîé ïîëèòèêè, 2008. – 288 ñ.

ÏÎÂÛØÅÍÈÅ ÓÐÎÂÍß ÈÍÔÎÐÌÀÖÈÎÍÍÎ-

ÌÎÒÈÂÀÖÈÎÍÍÎÉ ÊÎÌÏÎÍÅÍÒÛ ÐÅÔÎÐÌÛ

ÌÅÄÈÖÈÍÑÊÎÉ ÎÒÐÀÑËÈ Â ÑÓÌÑÊÎÌ ÐÅÃÈÎÍÅ

Òàðàñåíêî Ñ.Â., Ñì³ÿíîâ Â.À., Ñì³ÿíîâà Þ.Î.

Ìåäèöèíñêèé èíñòèòóò Ñóìñêîãî

ãîñóäàðñòâåííîãî óíèâåðñèòåòà, ã. Ñóìû, Óêðàèíà

Ðåçþìå. Â ñòàòüå îáîñíîâàíà ãèïîòåçà î ïîëîæè-

òåëüíîì âëèÿíèè íà ïðîöåññû ðåôîðìèðîâàíèÿ ìåäè-

öèíñêîé îòðàñëè ïîâûøåíèÿ óðîâíÿ èíôîðìàöèîííî-

ìîòèâàöèîííîé êîìïîíåíòû ðåôîðìû â Ñóìñêîì ðåãè-

îíå ïóòåì èçó÷åíèÿ èíôîðìàöèîííûõ ïîòðåáíîñòåé íà-

ñåëåíèÿ, êîíñóëüòàöèé ýêñïåðòîâ, èíôîðìàöèîííîé

êàìïàíèè ïî ïîâûøåíèþ îñâåäîìëåííîñòè î ðåôîðìè-

ðîâàíèè îòðàñëè çäðàâîîõðàíåíèÿ.

Êëþ÷åâûå ñëîâà: ïîäãîòîâèòåëüíûé ýòàï ðåôîðìû,

èíôîðìàöèîííî-ìîòèâàöèîííàÿ êîìïîíåíòà, çäðàâî-

îõðàíåíèå, èíôîðìàöèîííàÿ êàìïàíèÿ.

INCREASING THE LEVEL OF INFORMATIONAL

AND MOTIVATIONAL COMPONENT OF HEALTH

CARE REFORM IN SUMY REGION

S. Tarasenko, V. Smiianov, J. Smiianova

Medical Institute of Sumy State University,

Sumy, Ukraine

Summary. This article proves the hypothesis of a positive

impact of increasing the level of informational and

motivational component of the medical reform in Sumy

region on the process of medical reforming by information

needs of the population investigating, expert consultations,

informational campaign on the health care reforming

awareness raising.

Key words: the preparatory stage of the reform,

informational and motivational component, health care field,

informational campaign.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÒÅÎÐÅÒÈ×ÍÀ ÌÅÄÈÖÈÍÀ / HEORETICAL MEDICINE

Âñòóï. Ñó÷àñíèé íàóêîâî-òåõí³÷íèé ïðîãðåñ ïîâ’ÿçà-

íèé ³ç íîâèìè â³äêðèòòÿìè ó ãàëóç³ ìàòåð³àëîçíàâñòâà.

²äåíòèô³êàö³ÿ ïðèðîäíèõ òà ñèíòåç øòó÷íèõ íàíîìàòåð³-

àë³â â³äêðèâàþòü ìîæëèâîñò³ ÿê ó âèâ÷åíí³ ô³ç³îëîã³÷íèõ

ïðîöåñ³â, ùî ïðîò³êàþòü â îðãàí³çì³, òàê ³ ìîæóòü ñëóãó-

âàòè á³ëüø åôåêòèâíèìè çàñîáàìè äëÿ ä³àãíîñòèêè ³ ë³êó-

âàííÿ áàãàòüîõ ñîö³àëüíî âàæëèâèõ ³ ïîøèðåíèõ çàõâîðþ-

âàíü [3, 4]. Çîêðåìà, îäíèì ç òàêèõ çàõâîðþâàíü º àíåì³ÿ,

íà ÿêó çà äàíèìè Âñåñâ³òíüî¿ îðãàí³çàö³¿ îõîðîíè çäîðî-

â’ÿ ñòðàæäàº áëèçüêî ÷âåðò³ íàñåëåííÿ Çåìë³. Îñíîâíèìè

ïðè÷èíàìè àíåì³¿ º äåô³öèò çàë³çà â îðãàí³çì³ òà ïîë³äåô³-

öèòí³ ñòàíè [9, 24, 43].

Îäíèì ³ç îñíîâíèõ ïðèíöèï³â ìåäè÷íî¿ äîïîìîãè õâî-

ðèì íà çàë³çîäåô³öèòíó àíåì³þ º ïðèçíà÷åííÿ ïðåïàðàò³â

çàë³çà äëÿ â³äíîâëåííÿ ïóëó öüîãî á³ìåòàëó â îðãàí³çì³.

Îäíàê ³ñíóþ÷³ ë³êàðñüê³ çàñîáè º íåäîñòàòíüî åôåêòèâíè-

ìè ³ áåçïå÷íèìè, ùî ïîâ’ÿçàíî ³ç ïîíèæåíîþ á³îäîñòóïí-

³ñòþ åëåìåíòàðíîãî çàë³çà ³, ÿê íàñë³äîê, íåîáõ³äí³ñòþ çàñ-

òîñóâàííÿ ïîð³âíÿíî âèñîêèõ äîç äëÿ äîñÿãíåííÿ

òåðàïåâòè÷íîãî åôåêòó [18]. Öå, â ñâîþ ÷åðãó, ìîæå ïðè-

çâîäèòè äî ðîçâèòêó ïîá³÷íèõ åôåêò³â òà ïðîÿâ³â òîêñè÷-

íîñò³. Ç îãëÿäó íà òå, ùî íàíîðîçì³ðí³ ÷àñòèíêè ìàþòü

á³ëüøó á³îëîã³÷íó àêòèâí³ñòü íà ìîëåêóëÿðíîìó ð³âí³, âèâ-

÷åííÿ ôàðìàêîëîã³÷íèõ ³ òîêñèêîëîã³÷íèõ âëàñòèâîñòåé

íàíî÷àñòèíîê çàë³çà (Í×Ç) ÿê ïîòåíö³éíî¿ ñóáñòàíö³¿ äëÿ

ñòâîðåííÿ ïðîòèàíåì³÷íîãî ë³êàðñüêîãî çàñîáó º àêòóàëü-

íèì çàâäàííÿì [5]. Çà äàíèìè [10, 19, 37] íàíî÷àñòèíêè îê-

ñèä³â çàë³çà (Í×ÎÇ), çîêðåìà ìàãíåòèòó (Fe3O4), ïðèçâîäÿòü

äî ñòèìóëÿö³¿ ìåòàáîë³çìó çàë³çà â îðãàí³çì³, âêëþ÷åííÿ

öüîãî á³îìåòàëó ó ñêëàä ãåìîãëîá³íó òà ïîñèëåííÿ åðèò-

ðîïîåçó, ùî ðîáèòü ïåðñïåêòèâíèì çàñòîñóâàííÿ öèõ

íàíî÷àñòèíîê äëÿ ë³êóâàííÿ çàë³çîäåô³öèòíî¿ àíåì³¿.

Öåé ï³äõ³ä ïðàâîì³ðíèé ³ äëÿ íàíî÷àñòèíîê íóëü-âà-

ëåíòíîãî çàë³çà (Í×Ç), àëå äàíèõ ñòîñîâíî á³îëîã³÷íî¿ àê-

òèâíîñò³, ðîçïîä³ëó â îðãàí³çì³ ³ òîêñè÷íîñò³ äàíèõ íàíî-

îá’ºêò³â íà ñüîãîäí³ íåäîñòàòíüî. Ïåðåâàæíà á³ëüø³ñòü

ïóáë³êàö³é ç á³îìåäè÷íîãî çàñòîñóâàííÿ Í×Ç ñòîñóºòüñÿ

çíåøêîäæåííÿ çàáðóäíþâà÷³â îðãàí³÷íîãî òà íåîðãàí³÷-

íîãî ïîõîäæåííÿ ó íàâêîëèøíüîìó ñåðåäîâèù³ [15]. Ïðè

öüîìó ïîð³âíÿíî íåùîäàâíî ³íòåíñèô³êóâàëèñÿ äîñë³ä-

æåííÿ çì³í, ÿê³ ìîæóòü âèíèêàòè ó íàâêîëèøíüîìó ñåðå-

äîâèù³ ïðè çàñòîñóâàíí³ öèõ íàíîðîçì³ðíèõ ìàòåð³àë³â.

Çîêðåìà âñòàíîâëåíî, ùî Í×Ç çäàòí³ îêèñíþâàòèñÿ ç óò-

ÓÄÊ 615.916:546.72:541.182:[612.084+612.087]

ÂÏËÈÂ ÍÀÍÎ×ÀÑÒÈÍÎÊ ÇÀË²ÇÀ

ÍÀ ÇÌ²ÍÓ ÌÀÑÈ Ò²ËÀ ÒÀ Â²ÄÍÎÑÍÓ ÌÀÑÓ

ÂÍÓÒÐ²ØÍ²Õ ÎÐÃÀÍ²Â Ó ÌÈØÅÉ

Äîðîøåíêî À.Ì.

Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Î. Î. Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: íàíîôàðìàêîëîã³ÿ, áåçïå÷í³ñòü, íàíî÷àñòèíêè çàë³çà, îðãàíè-ì³øåí³, ìîðôîìåòðè÷í³

ïîêàçíèêè, ìàñà ò³ëà, â³äíîñíà ìàñà âíóòð³øí³õ îðãàí³â.

âîðåííÿì Fe2+ òà Fe3+, âèêëèêàòè çíèæåííÿ âì³ñòó êèñíþ

ó ´ðóíòîâèõ âîäàõ, ³íäóêóâàòè óòâîðåííÿ ðåàêòèâíèõ ñïî-

ëóê êèñíþ ³, ÿê íàñë³äîê, ìîæóòü ïðèçâîäèòè äî ïîðóøåí-

íÿ æèòòºä³ÿëüíîñò³ ôàóíè ³ ôëîðè ´ðóíò³â ³ âîäîéì òà ïî-

òåíö³éíî çàãðîæóâàòè åêîëîã³÷íîìó ñòàíó ì³ñöåâîñòåé, â

ÿêèõ âîíè çàñòîñîâóþòüñÿ [12, 13, 17, 39, 40].

Îòæå, Í×Ç º ïîòåíö³éíîþ ñóáñòàíö³ºþ äëÿ ðîçðîáêè

îðèã³íàëüíîãî ïðîòèàíåì³÷íîãî ë³êàðñüêîãî çàñîáó. Ç

³íøîãî áîêó, äîñë³äæåíü in vivo ñòîñîâíî áåçïå÷íîñò³ òà

á³îëîã³÷íî¿ àêòèâíîñò³ Í×Ç íà ñüîãîäí³ íåäîñòàòíüî. Òàê

ÿê çàñòîñóâàííÿ áóäü-ÿêîãî íîâîãî ñèíòåçîâàíîãî ìàòå-

ð³àëó ïîòðåáóº ð³çíîñòîðîííüîãî âèð³øåííÿ êëþ÷îâèõ

ïèòàíü áåçïåêè äëÿ óíèêíåííÿ ìîæëèâèõ íåñïðèÿòëèâèõ

íàñë³äê³â ÿê äëÿ çäîðîâ’ÿ íàñåëåííÿ, òàê ³ äëÿ íàâêîëèøíüî-

ãî ñåðåäîâèùà [33, 35], âñòàíîâëåííÿ ãîñòðî¿ òîêñè÷íîñò³

Í×Ç º îäíèì ³ç ïðîâ³äíèõ åòàï³â äîêë³í³÷íîãî âèâ÷åííÿ

öèõ íàíîîá’ºêò³â. Çì³íà ìàñè ò³ëà, ÿê ³íòåãðàëüíîãî ïîêàç-

íèêà çàãàëüíîãî ñòàíó ³ ô³çè÷íîãî ðîçâèòêó, à òàêîæ âñòà-

íîâëåííÿ ïîòåíö³éíèõ îðãàí³â-ì³øåíåé ìàº âåëèêå ïðàê-

òè÷íå çíà÷åííÿ ç òî÷êè çîðó ðîçóì³ííÿ îñíîâíèõ

ïàòîô³ç³îëîã³÷íèõ ìåõàí³çì³â ³ òàêòèêè ë³êóâàííÿ ïðè

ìîæëèâèõ íàâìèñíèõ ÷è âèïàäêîâèõ îòðóºííÿõ íàíî-

÷àñòèíêàìè çàë³çà.

Ó ïîïåðåäí³õ äîñë³äæåííÿõ âñòàíîâëåíî, ùî Í×Ç, ñèí-

òåçîâàí³ â ²íñòèòóò³ á³îêîëî¿äíî¿ õ³ì³¿ ³ìåí³ Ô.Ä. Îâ÷àðåí-

êà ÍÀÍ Óêðà¿íè, íàëåæàòü äî IV êëàñó òîêñè÷íîñò³ (ìàëî-

òîêñè÷í³ ðå÷îâèíè) ïðè âíóòð³øíüîâåííîìó òà äî V

êëàñó òîêñè÷íîñò³ (ïðàêòè÷íî íåòîêñè÷í³ ðå÷îâèíè) ïðè

âíóòð³øíüîøëóíêîâîìó øëÿõàõ ââåäåííÿ çà êëàñèô³êà-

ö³ºþ Hodge H. C. ³ Sterner L. H [20]. Â ïëàí³ ïðîäîâæåííÿ

âèâ÷åííÿ òîêñè÷íîñò³ Í×Ç â äàí³é ñòàòò³ ïðåäñòàâëåí³ ðå-

çóëüòàòè äîñë³äæåííÿ ñòîñîâíî çì³íè îñíîâíèõ ìîðôî-

ìåòðè÷íèõ ïîêàçíèê³â ó ìèøåé ï³ñëÿ îäíîðàçîâîãî âíóò-

ð³øíüîâåííîãî ³ âíóòð³øíüîøëóíêîâîãî ââåäåíü Í×Ç.

Ìåòà äîñë³äæåííÿ – âñòàíîâèòè äèíàì³êó çì³íè ìàñè

ò³ëà ëàáîðàòîðíèõ òâàðèí (ìèøåé), à òàêîæ çì³íè ìàñîâèõ

êîåô³ö³ºíò³â âíóòð³øí³õ îðãàí³â äëÿ âèçíà÷åííÿ ïîòåíö³é-

íèõ îðãàí³â-ì³øåíåé çà óìîâè îäíîðàçîâîãî âíóòð³øíüî-

øëóíêîâîãî òà âíóòð³øíüîâåííîãî ââåäåíü íàíî÷àñòè-

íîê íóëü-âàëåíòíîãî çàë³çà ó òîêñè÷íèõ äîçàõ.

Ìàòåð³àëè òà ìåòîäè äîñë³äæåííÿ. Ñôåðè÷í³ íàíî-

÷àñòèíêè íóëü-âàëåíòíîãî çàë³çà (Í×Ç) ðîçì³ðîì 40 íì

îòðèìàí³ â ²íñòèòóò³ á³îêîëî¿äíî¿ õ³ì³¿ ³ìåí³ Ô. Ä. Îâ÷à-

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÒÅÎÐÅÒÈ×ÍÀ ÌÅÄÈÖÈÍÀ / THEORETICAL MEDICINE

ðåíêà ÍÀÍ Óêðà¿íè çà äîïîìîãîþ îðèã³íàëüíîãî ìåòîäó

õ³ì³÷íîãî ñèíòåçó. Äîñë³äæåííÿ ïðîâåäåí³ íà 74 ñàìêàõ ³

56 ñàìöÿõ á³ëèõ ìèøåé ë³í³¿ BALB/ñ ìàñîþ 18–22 ã ³ç äîò-

ðèìàííÿì îñíîâíèõ ïîëîæåíü Êîíâåíö³¿ Ðàäè ªâðîïè

ïðî îõîðîíó õðåáåòíèõ òâàðèí, ùî âèêîðèñòîâóþòüñÿ â

åêñïåðèìåíòàõ òà â ³íøèõ íàóêîâèõ ö³ëÿõ, â³ä 18.03.1986 ð.,

Äèðåêòèâè ªÑ ¹609 â³ä 24.11.1986 ð., Íàêàçó ÌÎÇ Óêðà¿-

íè ¹66 â³ä 13.02.2006 ð., Çàêîíó Óêðà¿íè “Ïðî çàõèñò òâà-

ðèí â³ä æîðñòîêîãî ïîâîäæåííÿ” 2006 ð. Òâàðèí óòðèìó-

âàëè ó â³âàð³¿ ÍÌÓ ³ìåí³ Î. Î. Áîãîìîëüöÿ â ñòàíäàðòíèõ

óìîâàõ çà òåìïåðàòóðè 22–24 °C òà â³äíîñíî¿ âîëîãîñò³

50–70% ç â³ëüíèì äîñòóïîì äî êîðìó òà âîäè. Ãðóïè òâà-

ðèí ôîðìóâàëè çà ìåòîäîì ðàíäîì³çàö³¿. Ïåð³îä êàðàíòè-

íó òà àêë³ìàòèçàö³¿ òðèâàâ ïðîòÿãîì 7 ä³á. Ïëàí åêñïåðè-

ìåíòó ñõâàëåíèé Êîì³òåòîì ç á³îåòèêè ÍÌÓ ³ìåí³

Î.Î. Áîãîìîëüöÿ, óñ³ ïðîöåäóðè, ïîâ’ÿçàí³ ç ãóìàííèì

ïîâîäæåííÿì ³ç òâàðèíàìè, áóëè äîòðèìàí³. Äîñë³äæåí-

íÿ ïðîâåäåíî íà áàç³ êàôåäðè ôàðìàêîëîã³¿ òà êë³í³÷íî¿

ôàðìàêîëîã³¿ òà â³âàð³þ ÍÌÓ ³ìåí³ Î.Î. Áîãîìîëüöÿ.

Ñòåðèëüíèé ïîðîøîê Í×Ç ex tempore ðîç÷èíÿëè ó

âîä³ äëÿ ³í’ºêö³é òà ââîäèëè îäíîðàçîâî ó ëàòåðàëüíó õâî-

ñòîâó âåíó äîñë³äíèõ ìèøåé àáî âíóòð³øíüîøëóíêîâî çà

äîïîìîãîþ çîíäó. Äëÿ âíóòð³øíüîøëóíêîâîãî ââåäåííÿ

Í×Ç áóëî âèêîðèñòàíî 10 ñàìîê, ç ÿêèõ ñôîðìîâàíî äîñ-

ë³äíó (5000 ìã/êã) òà êîíòðîëüíó (0 ìã/êã) ãðóïè ïî 5 òâà-

ðèí. Ïðîòÿãîì 3–4 ãîä. ïåðåä ââåäåííÿì òâàðèí óòðèìó-

âàëè áåç êîðìó ç â³ëüíèì äîñòóïîì äî âîäè. Ìèøàì

êîíòðîëüíî¿ ãðóïè ââîäèëè ÷åðåç çîíä ðîç÷èííèê – âîäó

äëÿ ³í’ºêö³é – ó òîìó æ îá’ºì³. Îá’ºì ââåäåííÿ ñòàíîâèâ

40 ìë/êã. Äëÿ âíóòð³øíüîâåííîãî ââåäåííÿ Í×Ç áóëî îá-

ðàíî 7 ð³âí³â äîç ïî 8 òâàðèí â êîæíîìó äëÿ ñàìîê (130,

155, 180, 205, 230, 255 ³ 280 ìã/êã çà ñóáñòàíö³ºþ Í×Ç) òà 6

ð³âí³â äîç ïî 8 òâàðèí â êîæíîìó äëÿ ñàìö³â (180, 205, 230,

255, 280, 305 ìã/êã çà ñóáñòàíö³ºþ Í×Ç). Òâàðèíàì ç êîíò-

ðîëüíèõ ãðóï (8 ñàìö³â ³ 8 ñàìîê) ââîäèëè òèì æå ñàìèì

ñïîñîáîì ðîç÷èííèê – âîäó äëÿ ³í’ºêö³é. Îá’ºì âíóòð³ø-

íüîâåííîãî ââåäåííÿ äëÿ âñ³õ ãðóï ñòàíîâèâ 10 ìë/êã.

Ï³ñëÿ âíóòð³øíüîâåííîãî ÷è âíóòð³øíüîøëóíêîâîãî

ââåäåííÿ ñïîñòåðåæåííÿ çà ñòàíîì òâàðèí ïðîâîäèëè

ïðîòÿãîì 14 ä³á. Ìàñó òâàðèí âèçíà÷àëè ïåðåä ââåäåííÿì

Í×Ç òà íà 3-òþ, 7-ìó ³ 14-òó äîáó â³äíîâíîãî ïåð³îäó. Íà 14

äîáó óñ³õ òâàðèí âèâîäèëè ç åêñïåðèìåíòó òà ïðè àóòîïñ³¿

âèëó÷àëè ãîëîâíèé ìîçîê, òèìóñ, ñåðöå,

ëåãåí³ ç áðîíõàìè, ïå÷³íêó, ñåëåç³íêó,

íèðêè, øëóíîê. Ï³ñëÿ â³äîêðåìëåííÿ çàé-

âî¿ æèðîâî¿ (ñïîëó÷íî¿) òêàíèí îðãàíè

ïðîìèâàëè ó ô³ç³îëîã³÷íîìó ðîç÷èí³,

çàéâó âîëîãó ïðèáèðàëè çà äîïîìîãîþ

ô³ëüòðóâàëüíîãî ïàïåðó òà çâàæóâàëè íà

åëåêòðîííèõ âàãàõ. Íà îñíîâ³ àáñîëþòíèõ

çíà÷åíü ìàñè îðãàí³â ðîçðàõîâàíî

â³äíîñí³ ìàñè øëÿõîì âèçíà÷åííÿ

ñï³ââ³äíîøåííÿ ìàñè îðãàíó äî ìàñè ãî-

ëîâíîãî ìîçêó äàíî¿ òâàðèíè. Ìàñà ãî-

ëîâíîãî ìîçêó âèêîðèñòàíà â ÿêîñò³ òî÷-

êè â³äë³êó (êîíñòàíòè) ó çâ’ÿçêó ç

ì³í³ìàëüíîþ çì³íîþ öüîãî ïîêàçíèêà

ïðè ä³¿ òîêñè÷íèõ äîç Í×Ç, ïîð³âíÿíî ³ç

àáñîëþòíîþ ìàñîþ òâàðèíè, ÿêà çíà÷íî

çì³íþâàëàñÿ â çàëåæíîñò³ â³ä ð³âíÿ äîçè òà òåðì³íó ñïîñ-

òåðåæåííÿ [32].

Ñòàòèñòè÷íó îáðîáêó äàíèõ ïðîâîäèëè çà äîïîìîãîþ

êîìï’þòåðíî¿ ïðîãðàìè BioStat 2009 for Windows (v5.8.4).

Ðîçðàõîâóâàëè çíà÷åííÿ ñåðåäí³õ àðèôìåòè÷íèõ âåëè÷èí

(Ì) ³ ñòàíäàðòíèõ ïîìèëîê ñåðåäíüî¿ (m). Äëÿ âèçíà÷åííÿ

äîñòîâ³ðíîñò³ â³äì³ííîñòåé ì³æ ñåðåäí³ìè âåëè÷èíàìè

âèêîðèñòîâóâàëè ïàðàìåòðè÷íèé êðèòåð³é Ñòüþäåíòà (t).

Çì³íè ïîêàçíèê³â ââàæàëè äîñòîâ³ðíèìè ç ð³âíåì çíà÷è-

ìîñò³ ïîíàä 95% (ð<0,05).

Ðåçóëüòàòè òà ¿õ îáãîâîðåííÿ. Ï³ñëÿ îäíîðàçîâîãî

âíóòð³øíüîøëóíêîâîãî ââåäåííÿ Í×Ç ïðîòÿãîì 14 ä³á

ñïîñòåðåæåííÿ â êîíòðîëüí³é òà äîñë³äí³é ãðóïàõ íå çàãè-

íóëà æîäíà òâàðèíà, à äèíàì³êà íàáîðó ìàñè ò³ëà áóëà

îäíàêîâîþ. Íà 14 äîáó ìàñà ò³ëà ìèøåé äîñë³äíî¿ ³ êîíò-

ðîëüíî¿ ãðóï äîñòîâ³ðíî (ð<0,05) çðîñëà íà 14,6% ³ 15,6%

â³äïîâ³äíî, ïîð³âíÿíî ³ç ïîêàçíèêîì äî ââåäåííÿ Í×Ç

(ðèñ. 1).

Ñåðåäíÿ ìàñà ãîëîâíîãî ìîçêó íà 14 äîáó ï³ñëÿ âíóòð³ø-

íüîøëóíêîâîãî ââåäåííÿ Í×Ç ñòàíîâèëà 0,43±0,02 ã òà

0,42±0,03 ã äëÿ êîíòðîëüíî¿ òà äîñë³äíî¿ ãðóï â³äïîâ³äíî.

Â³äñóòí³ñòü ñòàòèñòè÷íî¿ ð³çíèö³ ì³æ äàíèìè ïîêàçíèêàìè

äîçâîëèëî çàñòîñóâàòè ìàñó ìîçêó çà êîíñòàíòó ïðè ðîçðà-

õóíêó â³äíîñíèõ ìàñ îðãàí³â ìèøåé, ÿê³ ïðåäñòàâëåí³ íà

òàáë. 1. Âñòàíîâëåíî äîñòîâ³ðíå çìåíøåííÿ â³äíîñíèõ ìàñ

òèìóñó íà 32,1% ³ îáîõ íèðîê íà 9,4% ³ 12,9% (p<0,05) ïî-

ð³âíÿíî ³ç êîíòðîëåì. Êð³ì òîãî, ñïîñòåð³ãàºòüñÿ òåíäåíö³ÿ

äî ï³äâèùåííÿ ìàñè øëóíêà íà 17,1%. Äàí³ â³äì³ííîñò³

ìîæóòü ïîïåðåäíüî ñâ³ä÷èòè ïðî âïëèâ Í×Ç ïðè ïåðî-

ðàëüíîìó ââåäåíí³ íà âêàçàí³ îðãàíè-ì³øåí³.

Ï³ñëÿ îäíîðàçîâîãî âíóòð³øíüîâåííîãî ââåäåííÿ ìè-

øàì òîêñè÷íèõ äîç Í×Ç ñïîñòåð³ãàëàñÿ äîçîçàëåæíà çàãè-

áåëü òâàðèí ïðîòÿãîì ïåðøèõ 4 ä³á ³ çìåíøåííÿ ê³ëüêîñò³

ñïîñòåðåæåíü (n) â äîñë³äíèõ ãðóïàõ, ùî áóëî çàñòîñîâà-

íî äëÿ ðîçðàõóíêó ñåðåäíüîñìåðòåëüíî¿ äîçè (ðåçóëüòàòè

íå íàâåäåíî). Íà 3-òþ äîáó ï³ñëÿ ââåäåííÿ Í×Ç ÿê ñåðåä

ñàìö³â, òàê ³ ñåðåä ñàìîê, îêð³ì íàéíèæ÷îãî ð³âíÿ äîçè

(130 ìã/êã), ñïîñòåð³ãàëàñÿ òåíäåíö³ÿ àáî äîñòîâ³ðíå çíè-

æåííÿ (ð<0,05) ìàñè ò³ëà ïðèáëèçíî íà 2,8–10,3% ïîð³âíÿ-

íî ³ç âèõ³äíèì çíà÷åííÿì ïîêàçíèêà (ðèñ. 2, 3). Ïðè öüîìó

â êîíòðîëüíèõ ãðóïàõ íà 3-òþ äîáó ñïîñòåð³ãàëàñÿ òåíäåí-

ö³ÿ äî ï³äâèùåííÿ (ó ñàìö³â) àáî äîñòîâ³ðíå ï³äâèùåííÿ

Ðèñ. 1. Äèíàì³êà çì³íè ìàñè ò³ëà ñàìîê ìèøåé â çàëåæíîñò³ â³ä äîçè

ï³ñëÿ îäíîðàçîâîãî âíóòð³øíüîøëóíêîâîãî ââåäåííÿ Í×Ç (M±m), n=5

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

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Ðèñ. 3. Äèíàì³êà çì³íè ìàñè ò³ëà ñàìö³â ìèøåé, â çàëåæíîñò³ â³ä äîçè ï³ñëÿ îäíîðàçîâîãî

âíóòð³øíüîâåííîãî ââåäåííÿ Í×Ç, ã (M±m), n=8

Ïðèì³òêà. * – p<0,05 ïîð³âíÿíî ³ç êîíòðîëåì. Â³äñóòí³ñòü ïëàíîê ïîõèáîê ñâ³ä÷èòü ïðî çìåíøåííÿ ê³ëüêîñò³ ñïîñòåðåæåíü â ãðóïàõ

äî îäíîãî (n=1) âíàñë³äîê çàãèáåë³ ÷àñòèíè ï³ääîñë³äíèõ òâàðèí ïðîòÿãîì 14 ä³á ï³ñëÿ ââåäåííÿ òîêñè÷íèõ äîç Í×Ç.

Òàáëèöÿ 1.

Â³äíîñíà ìàñà îðãàí³â ñàìîê ìèøåé â çàëåæíîñò³ â³ä äîçè íà 14 äîáó ï³ñëÿ âíóòð³øíüîøëóíêîâîãî

îäíîðàçîâîãî ââåäåííÿ Í×Ç (M±m)

Ïðèì³òêà. * – p<0,05 ïîð³âíÿíî ³ç êîíòðîëåì.

Ðèñ. 2. Äèíàì³êà çì³íè ìàñè ò³ëà ñàìîê ìèøåé, â çàëåæíîñò³ â³ä äîçè ï³ñëÿ îäíîðàçîâîãî

âíóòð³øíüîâåííîãî ââåäåííÿ Í×Ç, ã (M±m), n=8

Ïðèì³òêà. * – p<0,05 ïîð³âíÿíî ³ç êîíòðîëåì.

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(ó ñàìîê, ð<0,05) ìàñè ò³ëà íà 6,5% òà 9,1% â³äïîâ³äíî.

Ìàñà ò³ëà äîñë³äíèõ ìèøåé îáîõ ñòàòåé, ÿê ³íòåãðàëüíèé

ïîêàçíèê ñòàíó îðãàí³çìó, íà 3-òþ äîáó ïîíèæóâàëàñÿ

ïðîïîðö³éíî äî ï³äâèùåííÿ ð³âíÿ äîçè, ùî ñâ³ä÷èòü ïðî

äîçîâó çàëåæí³ñòü òîêñè÷íîãî âïëèâó Í×Ç íà ï³ääîñë³ä-

íèõ òâàðèí. Ëèøå ó ãðóï³ ç íàéìåíøèì ð³âíåì äîçè –

130 ìã/êã – íà 3-òþ äîáó ìàñà ò³ëà ìèøåé ìàëà òåíäåíö³þ

äî ï³äâèùåííÿ ïðèáëèçíî íà 2,9% ç ïîäàëüøèì çðîñòàí-

íÿì ïîêàçíèêà ïðîòÿãîì óñüîãî â³äíîâíîãî ïåð³îäó íà 7-

ìó ³ 14-òó äîáó. Íà 7-ìó äîáó ó äîñë³äíèõ ãðóïàõ, êð³ì

ð³âíÿ äîçè 130 ìã/êã, ìàñà ò³ëà ìèøåé ìàëà òåíäåíö³þ äî

çá³ëüøåííÿ àáî äîñòîâ³ðíî ï³äâèùóâàëàñÿ (ð<0,05) ïðè-

áëèçíî äî âèõ³äíèõ çíà÷åíü. Íà 14-òó äîáó ñïîñòåð³ãàëîñÿ

ïîäàëüøå çðîñòàííÿ ìàñè ò³ëà òâàðèí â óñ³õ ãðóïàõ. Çà 14

ä³á ñïîñòåðåæåííÿ ïðèð³ñò ìàñè ò³ëà ñàìîê ìèøåé êîíò-

ðîëüíî¿ òà äîñë³äíèõ ãðóï ñêëàäàâ 16,8% ïðîòè 5,5–10,9%

â³äïîâ³äíî, à ïðèð³ñò ìàñè ò³ëà ñàìö³â êîíòðîëüíî¿ òà äîñ-

ë³äíèõ ãðóï – íà 26,0% ïðîòè 6,8–22,6% â³äïîâ³äíî. Öå

ñâ³ä÷èòü ïðî â³äñòàâàííÿ òâàðèí äîñë³äíèõ ãðóï ó ðîçâèòêó

³ çðîñòàíí³ ìàñè ò³ëà, ïîð³âíÿíî ³ç êîíòðîëåì.

Ñòàòèñòè÷íèõ â³äì³ííîñòåé çíà÷åííÿ ñåðåäíüî¿ ìàñè

ìîçêó ÿê äëÿ ñàìîê, òàê ³ äëÿ ñàìö³â ìèøåé íà 14 äîáó

ï³ñëÿ âíóòð³øíüîâåííîãî ââåäåííÿ Í×Ç ó òîêñè÷íèõ äî-

çàõ íå çàðåºñòðîâàíî, ùî äîçâîëèëî âèêîðèñòàòè äàíèé

ïîêàçíèê çà êîíñòàíòó ïðè ðîçðàõóíêó â³äíîñíèõ ìàñ

îðãàí³â (òàáë. 2 ³ 3).

Íà 14 äîáó ï³ñëÿ îäíîðàçîâîãî âíóòð³øíüîâåííîãî

ââåäåííÿ Í×Ç ó äîñë³äíèõ ãðóïàõ ñàìîê ïîð³âíÿíî ³ç êîí-

Òàáëèöÿ 2.

Â³äíîñíà ìàñà îðãàí³â ñàìîê ìèøåé â çàëåæíîñò³ â³ä äîçè íà 14 äîáó ï³ñëÿ îäíîðàçîâîãî

âíóòð³øíüîâåííîãî ââåäåííÿ Í×Ç (M±m)

Ïðèì³òêà. * – p<0,05 ïîð³âíÿíî ³ç êîíòðîëåì.

Òàáëèöÿ 3.

Â³äíîñíà ìàñà îðãàí³â ñàìö³â ìèøåé â çàëåæíîñò³ â³ä äîçè íà 14 äîáó ï³ñëÿ îäíîðàçîâîãî

âíóòð³øíüîâåííîãî ââåäåííÿ Í×Ç (M±m)

Ïðèì³òêà. * – p<0,05 ïîð³âíÿíî ³ç êîíòðîëåì.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

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òðîëåì ñïîñòåð³ãàºòüñÿ äîñòîâ³ðíå çíèæåííÿ (p<0,05) àáî

òåíäåíö³ÿ äî çíèæåííÿ â³äíîñíî¿ ìàñè ñåðöÿ íà 6,7–23,3%

³ íèðîê íà 2,9–15,6%, à òàêîæ òåíäåíö³ÿ äî çìåíøåííÿ

ìàñè òèìóñó íà 4–24% ïðè óñ³õ çàñòîñîâàíèõ ð³âíÿõ äîçè,

ïîð³âíÿíî ³ç êîíòðîëåì (òàáë. 2). Ïðè ð³âí³ äîçè 130 ìã/êã

âèçíà÷åíî äîñòîâ³ðíå çíèæåííÿ â³äíîñíî¿ ìàñè ïå÷³íêè

íà 20,1% ïîð³âíÿíî ³ç êîíòðîëåì (p<0,05). Ó äîñë³äíèõ

ãðóïàõ ñàìö³â ñïîñòåð³ãàëàñÿ òåíäåíö³ÿ äî ï³äâèùåííÿ

â³äíîñíî¿ ìàñè ïå÷³íêè íà 3,2–37,6% ïðè ð³âíÿõ äîçè â³ä

180 äî 255 ìã/êã òà ìàñè òèìóñó íà 14,3–28,6% ïðè âñ³õ

çàñòîñîâàíèõ ð³âíÿõ äîç, ïîð³âíÿíî ³ç êîíòðîëåì (òàáë. 3).

Êð³ì òîãî, âñòàíîâëåíî äîñòîâ³ðíå ï³äâèùåííÿ â³äíîñíî¿

ìàñè ñåëåç³íêè íà 28,6% ïðè ð³âí³ äîçè 230 ìã/êã (p<0,05).

²íøèõ çíà÷íèõ â³äì³ííîñòåé â³äíîñíî¿ ìàñè îðãàí³â ïî-

ð³âíÿíî ³ç êîíòðîëåì, ùî ìàëè á ñèñòåìàòè÷íèé õàðàêòåð,

íå çàðåºñòðîâàíî. Äàí³ â³äì³ííîñò³ ìîæóòü ïîïåðåäíüî

ñâ³ä÷èòè ïðî âïëèâ Í×Ç ïðè âíóòð³øíüîâåííîìó

ââåäåíí³ íà âêàçàí³ îðãàíè-ì³øåí³.

Õî÷ çàë³çî ³ º íåçàì³ííèì íóòð³ºíòîì, íåîáõ³äíèì äëÿ

òðàíñïîðòóâàííÿ êèñíþ, ïåðåíîñó åëåêòðîí³â òà êàòàë³çó,

ç ³íøîãî áîêó öåé ìåòàë ìîæå ó íàäëèøêó íàêîïè÷óâàòè-

ñÿ â îðãàí³çì³ àáî íàâìèñíî ÷è âèïàäêîâî ââîäèòèñÿ ó

òîêñè÷íèõ äîçàõ, ùî ïðèçâîäèòèìå äî îêñèäàòèâíîãî

ñòðåñó, ðîçâèòêó ãåìîõðîìàòîçó òà îíêîëîã³÷íèõ çàõâî-

ðþâàíü. Äîñë³äæåííÿ ç òîêñè÷íîñò³ íàíîçàë³çà ïåðåâàæ-

íî çîñåðåäæåí³ íà á³îëîã³÷íèõ åôåêòàõ Fe2+. Íåñïðèÿòëèâ³

á³îëîã³÷í³ åôåêòè ³îí³â Fe2+ ïîÿñíþþòü âëàñòèâ³ñòþ êàòà-

ë³çóâàòè óòâîðåííÿ ã³äðîêñèëüíèõ ðàäèêàë³â (ÎÍ>) ³ç ïå-

ðåêèñó âîäíþ ó ðåàêö³¿ Ôåíòîíà. Â³ëüí³ ðàäèêàëè º âèñî-

êîàêòèâíèìè, íåñòàá³ëüíèìè ìîëåêóëàìè, ÿê³ ìîæóòü

ïîðóøóâàòè àêòèâí³ñòü ôåðìåíò³â àíòèîêñèäàíòíî¿ ñèñ-

òåìè, ïîñèëþâàòè ïåðîêñèäàö³þ ìåìáðàííèõ ë³ï³ä³â ³ ìî-

äèô³êàö³þ íóêëå¿íîâèõ êèñëîò òà âðåøò³ ïðèçâîäèòè äî

çàãèáåë³ êë³òèí ³ ïîøêîäæåííÿ òêàíèí îðãàí³çìó [16, 18].

Òàê, â äîñë³äæåíí³ íà ìèøàõ âñòàíîâëåíî, ùî íàíî÷àñ-

òèíêè Fe3O4 ðîçì³ðîì áëèçüêî 35 íì ïðè ùîäåííîìó

³íòðàïåðèòîíåàëüíîìó ââåäåíí³ ïðîòÿãîì òèæíÿ âèêëè-

êàþòü äîçîçàëåæíå ïîðóøåííÿ àíòèîêñèäàíòíî-ïðî-

îêñèäàíòíî¿ ð³âíîâàãè â òêàíèíàõ ïå÷³íêè ³ íèðêàõ, íà

êîðèñòü ÷îãî ñâ³ä÷èòü çðîñòàííÿ ð³âíÿ ìàðêåð³â îêñèäà-

òèâíîãî ñòðåñó, à ñàìå ðåàêòèâíèõ ñïîëóê êèñíþ, ìàëî-

íîâîãî ä³àëüäåã³äó, 8-ã³äðîêñè-2-äåçîêñèãóàíîçèíó, à

òàêîæ çíèæåííÿ âì³ñòó ãëóòàò³îíó [23].

Ç ³íøîãî áîêó çà äàíèìè ë³òåðàòóðè íåäîñòàòíüî äîñ-

ë³äæåí³ îñîáëèâîñò³ òîêñè÷íîñò³ Í×Ç ñòîñîâíî îðãàí³çìó

ëþäèíè ³ òâàðèí. Àëå ó çâ’ÿçêó ³ç òèì, ùî Fe0 ó Í×Ç îêèñ-

íþºòüñÿ ç óòâîðåííÿì Fe2+ òà îêñèä³â çàë³çà, öåé ïðîöåñ

òàê ñàìî ìîæå ïðèçâîäèòè äî óòâîðåííÿ â³ëüíèõ ðàäè-

êàë³â ³ ðîçâèòêó îêñèäàòèâíîãî ñòðåñó. Òàê, Keenan C. R.

òà ñï³âàâòîðàìè â óìîâàõ in vitro âñòàíîâëåíî óòâîðåííÿ

ðåàêòèâíèõ ñïîëóê êèñíþ ³ îêèñíå ïîøêîäæåííÿ åï³òåë³-

àëüíèõ êë³òèí áðîíõ³â ëþäèíè ï³ä âïëèâîì Í×Ç òà ïðî-

äóêò³â ¿õ îêèñíåííÿ äî Fe2+ òà Fe3+ [29]. Ïðè öüîìó ÷àñòêî-

âå àáî ïîâíå îêèñíåííÿ Í×Ç ïðèçâîäèòü äî çíèæåííÿ ¿õ

îêèñíî-â³äíîâíî¿ àêòèâíîñò³, ñòóïåíÿ ñåäèìåíòàö³¿ ³ àãëî-

ìåðàö³¿, ùî, éìîâ³ðíî, çìåíøóº òîêñè÷í³ñòü ïî â³äíî-

øåííþ äî êë³òèííèõ êóëüòóð, âèä³ëåíèõ â³ä ññàâö³â. Ìîäè-

ô³êàö³ÿ ïîâåðõí³ òàêîæ ïîíèæóº òîêñè÷í³ñòü Í×Ç øëÿõîì

çìåíøåííÿ ¿õ ñåäèìåíòàö³¿ òà, ÿê íàñë³äîê, çíèæåííÿ á³î-

äîñòóïíîñò³ [30]. Êð³ì òîãî, â ïðîöåñ³ âçàºìîä³¿ Í×Ç ³ á³î-

ëîã³÷íèõ îá’ºêò³â òàêîæ ìîæóòü â³ä³ãðàâàòè ðîëü é ³íø³

ìåõàí³çìè. Çîêðåìà åêñïåðèìåíòàëüíî ïîêàçàíî, ùî â

çàëåæíîñò³ â³ä ðîçì³ðó ³ âëàñòèâîñòåé íàíî÷àñòèíîê

â³äáóâàþòüñÿ êîíôîðìàö³éí³ ïåðåòâîðåííÿ ôîñ-

ôîë³ï³ä³â, ÿê³ ìîæóòü ïðèçâîäèòè äî çì³íè ô³çèêî-

õ³ì³÷íèõ âëàñòèâîñòåé êë³òèííèõ ìåìáðàí, àáî íàâ³òü

óòâîðåííÿ ïîð [22, 28].

Çã³äíî äàíèõ ë³òåðàòóðè, ï³ñëÿ âíóòð³øíüîâåííîãî

ââåäåííÿ íàíî÷àñòèíîê îêñèä³â çàë³çà (Í×ÎÇ) – ìàãíåòè-

òó (Fe3O4) òà/àáî ìå´ãåì³òó (γ-Fe2O3) – ï³ääîñë³äíèì òâà-

ðèíàì ñïîñòåð³ãàºòüñÿ ¿õ íàêîïè÷åííÿ òà ï³äâèùåííÿ

âì³ñòó çàë³çà ó òàêèõ îðãàíàõ-ì³øåíÿõ, ÿê ïå÷³íêà ³ ñåëåç³í-

êà, ùî âñòàíîâëåíî çà äîïîìîãîþ àòîìíî-àáñîðáö³éíî¿

ñïåêòðîôîòîìåòð³¿, ðàä³îíóêë³äíèõ ìåòîä³â, íàä÷óòëèâî¿

ìàãí³òîìåòð³¿, åëåêòðîííî¿ ì³êðîñêîï³¿, ìàãí³òíî-ðåçî-

íàíñíî¿ òîìîãðàô³¿, ìîðôîëîã³÷íèõ ìåòîä³â òîùî [11, 21,

26, 36, 37, 38, 41] (òàáë. 4). Êð³ì òîãî, çàë³çî íàêîïè÷óºòüñÿ

é ó ³íøèõ îðãàíàõ-ì³øåíÿõ: ëåãåíÿõ, íèðêàõ, ë³ìôàòè÷íèõ

âóçëàõ, ê³ñòêîâîìó ìîçêó, ñåðö³ òîùî. Ïîä³áíèé îðãàííèé

ðîçïîä³ë ñïîñòåð³ãàºòüñÿ é ï³ñëÿ ïåðîðàëüíîãî ââåäåííÿ

Í×ÎÇ [14, 31] (òàáë. 4).

Í×Ç ìàþòü ïîä³áí³ ôàðìàêîëîã³÷í³ âëàñòèâîñò³, ïðî

ùî ñâ³ä÷àòü íå÷èñëåíí³ ë³òåðàòóðí³ äàí³ ñòîñîâíî ¿õ ïðî-

íèêíåííÿ ó ñò³íêó òðàâíîãî òðàêòó [6], à òàêîæ çðîñòàííÿ

âì³ñòó çàë³çà ó ïå÷³íö³ ï³ñëÿ ïåðîðàëüíîãî ââåäåííÿ Í×Ç

ëàáîðàòîðíèì òâàðèíàì [42].

Çì³íà â³äíîñíî¿ ìàñè îðãàí³â ìèøåé íà 14 äîáó ï³ñëÿ

îäíîðàçîâîãî âíóòð³øíüîøëóíêîâîãî ³ âíóòð³øíüîâåí-

íîãî ââåäåííÿ Í×Ç, ïîêàçàíà ó äàíîìó äîñë³äæåíí³,

ìîæå áóòè ïîâ’ÿçàíà ³ç íàêîïè÷åííÿì íàíî÷àñòèíîê ³

âïëèâîì íà âêàçàí³ îðãàíè-ì³øåí³. Òàê, çà ë³òåðàòóðíèìè

äàíèìè, íà 15 äîáó ï³ñëÿ îäíîðàçîâîãî âíóòð³øíüîâåí-

íîãî ââåäåííÿ ìèøàì Í×ÎÇ (Fe3O4) ðîçì³ðîì 9 íì â äî-

çàõ 102,4–250 ìã/êã âèÿâëåíî ïîøêîäæåííÿ ñòðóêòóðè

ñåðöåâîãî ì’ÿçó ³ ïîðóøåííÿ ôóíêö³¿ íèðîê, ïðî ùî

ñâ³ä÷èëè á³ëêîâ³ çë³ïêè ó êàíàëüöÿõ íåôðîí³â, åêñòðàâàçà-

òè [38]. ²íøèì àâòîðñüêèì êîëåêòèâîì ïîêàçàíî, ùî ïåðî-

ðàëüíå ââåäåííÿ íåïîêðèòèõ Í×ÎÇ (Fe3O4) ðîçì³ðîì

70±10 íì ùóðàì â äîçàõ 250–1000 ìêã/êã ïðîòÿãîì 5 äí³â

ïðèçâîäèëî äî ðîçâèòêó äîçîçàëåæíèõ çì³í ó âíóòð³øí³õ

îðãàíàõ òâàðèí ïîð³âíÿíî ³ç êîíòðîëåì. Çîêðåìà ó øëóí-

êó ñïîñòåð³ãàëîñÿ ïîâíîêðîâ’ÿ ñóäèí ï³äñëèçîâîãî øàðó,

ó íèðêàõ – îçíàêè äèñòðîô³¿ åï³òåë³þ êàíàëüö³â íåôðîíà,

ó ïå÷³íö³ – äèñòðîô³÷í³ çì³íè ãåïàòîöèò³â, îçíàêè âåíîç-

íîãî ïîâíîêðîâ’ÿ, à ó ì³îêàðä³ – çåðíèñòà äèñòðîô³ÿ êàð-

ä³îì³îöèò³â. Àëå íà äóìêó àâòîð³â, ö³ çì³íè º îáîðîòíèìè

[2]. Ïîðóøåííÿ ì³êðîñêîï³÷íî¿ áóäîâè íèðîê, à òàêîæ ïå-

÷³íêè ³ ñåëåç³íêè áóëî âñòàíîâëåíî òàêîæ ï³ñëÿ ï’ÿòèðàçî-

âîãî âíóòð³øíüîøëóíêîâîãî ââåäåííÿ äàíèõ íàíî÷àñòè-

íîê ìèøàì [27]. Â ïîäàëüøîìó àâòîðñüêèì êîëåêòèâîì

áóëî âñòàíîâëåíî, ùî ñòàá³ë³çîâàí³ öèòðàòîì íàíî÷àñ-

òèíêè Fe3O4 ðîçì³ðîì 23±6 íì ï³ñëÿ îäíîðàçîâîãî (â äîç³

700 ìã/êã) àáî ñåìèðàçîâîãî (â ðàçîâ³é äîç³ 250 ìã/êã)

âíóòð³øíüîî÷åðåâèííîãî ââåäåííÿ ùóðàì íå âèêëèêàëè

ïîðóøåíü çàãàëüíîãî ñòàíó òâàðèí òà çàãèáåë³. Çà äàíèìè

ì³êðîñêîï³÷íèõ äîñë³äæåíü íàíî÷àñòèíêè ñïðè÷èíÿëè

ìîðôîëîã³÷í³ çì³íè â ïàðåíõ³ìàòîçíèõ îðãàíàõ, ñóäèíàõ,

ÿê³, íà äóìêó àâòîð³â, º îáîðîòíèìè. Ïðè öüîìó îäíîðàçîâå

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÒÅÎÐÅÒÈ×ÍÀ ÌÅÄÈÖÈÍÀ / THEORETICAL MEDICINE

Òàáëèöÿ 4.

Îðãàíè-ì³øåí³ ïðè âíóòð³øíüîâåííîìó òà ïåðîðàëüíîìó øëÿõàõ ââåäåííÿ íàíîçàë³çà

ëàáîðàòîðíèì òâàðèíàì çã³äíî äàíèõ ë³òåðàòóðè

Ïðèì³òêè: 1 DMSA – Ì-2,3-äèìåðêàïòîñóêöèíîâà êèñëîòà; 2 – ÒÅÌ – òðàíñì³ñ³éíà åëåêòðîííà ì³êðîñêîï³ÿ; 3 – ó äóæêàõ ðîçì³ð

êðèñòàë³÷íîãî ÿäðà íàíî÷àñòèíîê; 4 PEG – ïîë³åòèëåíãë³êîëü; 5 ÐÍÅÀ – ïîë³ã³äðîêñèåòèëàñïàðòàì³ä; 6 ÐÀÀ – ïîë³àêðèëîâà êèñëîòà.

ââåäåííÿ â³äíîñíî âèñîêî¿ äîçè íàíî÷àñòèíîê ïðèçâîäèëî

äî á³ëüø âèðàæåíèõ ìîðôîëîã³÷íèõ çì³í ó îðãàíàõ äåòîê-

ñèêàö³¿ (ïå÷³íö³, íèðêàõ), à áàãàòîðàçîâå ââåäåííÿ ìåíøèõ

äîç – äî çì³í îðãàí³â ³ìóíîãåíåçó (ñåëåç³íêè, ë³ìôàòè÷-

íèõ âóçë³â) ³ ìåíøå ïîðóøóâàëî ì³êðîìîðôîëîã³þ

âíóòð³øí³õ îðãàí³â [1]. Â äîñë³äæåíí³ ³íøèõ àâòîð³â, ÷åðåç

48 ãîäèí ï³ñëÿ îäíîðàçîâîãî âíóòð³øíüîî÷åðåâèííîãî

âåäåííÿ ùóðàì íàíî÷àñòèíîê γ-Fe2O3 â äîçàõ 266–

1406 ìêìîëü Fe/êã çíà÷íèõ â³äì³ííîñòåé ìîðôîëîã³¿

ïå÷³íêè, ñåëåç³íêè, íèðîê ³ ëåãåíü ïðè ñâ³òëîâ³é ì³êðî-

ñêîï³¿ íå áóëî âèÿâëåíî, ïîð³âíÿíî ³ç êîíòðîëåì [34].

Çà äàíèìè ë³òåðàòóðè Í×ÎÇ ìàþòü çíà÷íèé âïëèâ íà

îðãàíè ³ìóíîãåíåçó. Òàê, Ñ.-Ñ. Shen òà ñï³âàâòîðàìè ïî-

êàçàíî, ùî Í×ÎÇ ³ç ñåðåäí³ì ã³äðîäèíàì³÷íèì ðîçì³ðîì

58,7 íì, ÿê³ îäíîðàçîâî âíóòð³øíüîâåííî ââîäèëè ìè-

øàì ë³í³¿ BALB/c â äîçàõ 10, 30 ³ 60 ìã Fe/êã çà îäíó ãîäèíó

ïåðåä ñåíñèá³ë³çàö³ºþ îâàëüáóì³íîì, âèêëèêàëè ïîðó-

øåííÿ ³ìóííî¿ â³äïîâ³ä³ íà äàíèé àíòèãåí [7]. Ï³çí³øå àâ-

òîðñüêèì êîëåêòèâîì ïîâ³äîìëåíî, ùî îäíîðàçîâå âíóò-

ð³øíüîâåííå ââåäåííÿ äàíèõ íàíî÷àñòèíîê ³ç ðîçðàõóíêó

0,2–10 ìã Fe/êã òàêîæ ñïðè÷èíÿëî äîçîçàëåæíå ïðè-

ãí³÷åííÿ ðåàêö³é ñïîâ³ëüíåíî¿ ã³ïåð÷óòëèâîñò³ íà ââåäåííÿ

îâàëüáóì³íó [25].

Ñèñòåìí³ åôåêòè ñïîñòåð³ãàþòüñÿ òàêîæ ïðè îäíîðà-

çîâ³é ³íòðàòðàõåàëüí³é ³íñòèëÿö³¿ Í×ÎÇ ùóðàì â äîçàõ 1 òà

5 ìã/êã. Ïðè öüîìó âñòàíîâëåíî çàòðèìêó çðîñòàííÿ ìàñè

ò³ëà òâàðèí ïîð³âíÿíî ³ç êîíòðîëåì, à òàêîæ çíà÷íå äîçî-

çàëåæíå çíèæåííÿ â³äíîñíî¿ ìàñè ëåãåíü â äîñë³äíèõ ãðó-

ïàõ ³ òðàíçèòîðíå çìåíøåííÿ â³äíîñíî¿ ìàñè ïå÷³íêè ³

íèðîê. Ââåäåííÿ íàíîçàë³çà ïðèçâîäèëî äî ôîêàëüíîãî òà

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÒÅÎÐÅÒÈ×ÍÀ ÌÅÄÈÖÈÍÀ / HEORETICAL MEDICINE

³íòåðñòèö³éíîãî çàïàëüíîãî ïðîöåñó â ëåãåíÿõ ùóð³â, ÿêå

íàïðèê³íö³ ïåðøîãî ì³ñÿöÿ ñïîñòåðåæåííÿ ïðèçâîäèòü

äî ðîçâèòêó ïîì³ðíî âèðàæåíîãî ô³áðîçó, ñòóï³íü ÿêîãî º

äîçîçàëåæíîþ [32]. Ðåçîðáòèâí³ åôåêòè ï³ñëÿ ³íãàëÿö³é-

íîãî ââåäåííÿ íàíî÷àñòèíîê Fe2O3 ùóðàì â äîç³ 8,5 ìã/êã

2 ðàçè íà äåíü ïðîòÿãîì 3 äí³â äîñë³äæåí³ Wang L. òà

ñï³âàâòîðàìè. Ïðè öüîìó âñòàíîâëåíî çðîñòàííÿ âì³ñòó

çàë³çà ó ïå÷³íö³ ³ ëåãåíåâ³é òêàíèí³ íà 36 ãîäèíó åêñïåðè-

ìåíòó, ùî ïðèçâîäèëî äî çíà÷íîãî ïîøêîäæåííÿ öèõ

îðãàí³â, à òàêîæ äî çì³íè íèçêè á³îõ³ì³÷íèõ ïîêàçíèê³â

ñèðîâàòêè êðîâ³ [8].

Âèñíîâêè:

1. Í×Ç ïðè âíóòð³øíüîøëóíêîâîìó ââåäåíí³ â äîç³

5000 ìã/êã íå âèêëèêàþòü ïîðóøåííÿ äèíàì³êè ìàñè ò³ëà

ñàìîê ìèøåé ïðîòÿãîì 14-äåííîãî òåðì³íó ñïîñòåðå-

æåííÿ, ïîð³âíÿíî ³ç êîíòðîëåì.

2. Äèíàì³êà çì³íè ìàñè ò³ëà ìèøåé ï³ñëÿ îäíîðàçî-

âîãî âíóòð³øíüîâåííîãî ââåäåííÿ Í×Ç â äîçàõ â³ä 130 äî

305 ìã/êã ìàº äîçîâó çàëåæí³ñòü òà º ïîä³áíîþ äëÿ îáîõ

ñòàòåé.

2.1.Ïðè âñ³õ çàñòîñîâàíèõ äîçàõ, îêð³ì íàéìåíøî¿ –

130 ìã/êã, ñïîñòåð³ãàºòüñÿ çíèæåííÿ ìàñè ò³ëà òâàðèí íà

3-òþ äîáó â³äíîâíîãî ïåð³îäó ç íàñòóïíèì ¿¿ â³äíîâëåí-

íÿì íà 7-ìó ³ ïîäàëüøèì çðîñòàííÿì íà 14-òó äîáó.

2.2.Â ö³ëîìó ïðè âñ³õ äîçàõ äëÿ îáîõ ñòàòåé âñòàíîâëå-

íî â³äñòàâàííÿ ó ðîçâèòêó ³ íàáîð³ ìàñè ò³ëà, ïîð³âíÿíî ³ç

êîíòðîëåì.

3. Íà îñíîâ³ çì³íè â³äíîñíî¿ ìàñè îðãàí³â âñòàíîâëå-

íî ïîòåíö³éí³ îðãàíè-ì³øåí³, à ñàìå òèìóñ, íèðêè ³ øëó-

íîê ïðè âíóòð³øíüîøëóíêîâîìó òà òèìóñ, ñåðöå, ïå÷³í-

êó, ñåëåç³íêó ³ íèðêè, ïðè âíóòð³øíüîâåííîìó øëÿõàõ

ââåäåííÿ Í×Ç ó äîçàõ 130–280 ìã/êã.

Ïåðñïåêòèâè ïîäàëüøèõ äîñë³äæåíü.

Äîö³ëüíå ïðîâåäåííÿ ïîäàëüøèõ äîñë³äæåíü ³ç âñòà-

íîâëåííÿ âïëèâó Í×Ç íà ì³êðîñêîï³÷íó ìîðôîëîã³þ

âíóòð³øí³õ îðãàí³â ëàáîðàòîðíèõ òâàðèí.

Ðåöåíçåíò: ä.ìåä.í., ïðîôåñîð Í³æåíêîâñüêà ². Â.

Ë²ÒÅÐÀÒÓÐÀ

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íàõ ëàáîðàòîðíûõ êðûñ ñ ïåðåâèâàåìûì ðàêîì ïå÷åíè ÐÑ-1 ïðè

âíóòðèáðþøèííîì ââåäåíèè öèòðàò-ñòàáèëèçèðîâàííûõ íàíî-

÷àñòèö æåëåçà / Ñ. Ì. Êóí // Ôóíäàìåíòàëüíûå èññëåäîâàíèÿ. –

2013. – Ò. 9, ¹3. – Ñ. 380–384.

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íèõ îðãàíîâ è ãîëîâíîãî ìîçãà ïðè ïðîëîíãèðîâàííîì ïåðîðàëü-

íîì ââåäåíèè íàíî÷àñòèö æåëåçà / Í. À. Íàâîëîêèí, Ñ. Ì. Êóí //

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Ñ. 760–762.

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G. N. Maslyakova, A. B. Bucharskya [et al.] // Journal of Physics:

Conference Series. – 2012. – Vol. 345. – N 012043.

28. Nanoparticle-induced surface reconstruction of phospholipid

membranes / B. Wang, L. Zhang, S. C. Bae [et al.] // PNAS. – 2008. –

Vol. 105, N 47. – P. 18171–18175.

29. Oxidative stress induced by zero-valent iron nanoparticles

and Fe(II) in human bronchial epithelial cells / C. R. Keenan,

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÒÅÎÐÅÒÈ×ÍÀ ÌÅÄÈÖÈÍÀ / THEORETICAL MEDICINE

R. Goth-Goldstein, D. Lucas [et al.] // Environ. Sci. Technol. – 2009. –

Vol. 43, N 12. – P. 4555–4560.

30 . Partial oxidation (“aging”) and surface modification decrease

the toxicity of nanosized zerovalent iron / T. Phenrat, T. C. Long,

G. V. Lowry [et al.] // Environ. Sci. Technol. – 2009. – Vol. 43, N 1. –

P. 195–200.

31. Pharmacokinetic parameters and tissue distribution of

magnetic Fe3O4 nanoparticles in mice / J. Wang, Y. Chen, B. Chen [et

al.] // Int. J. Nanomedicine. – 2010. –Vol. 5. P. 861–866.

32. Potential toxic effects of iron oxide nanoparticles in in vivo

and in vitro experiments / B. Szalay, E. T trai, G. Ny r [et al.] //

J. Appl. Toxicol. – 2012. – Vol. 32, N 6. – P. 446–453.

33. Pumera M. Nanotoxicology: the molecular science point of

view / M. Pumera // Chem. Asian. J. – 2011. – Vol. 6, N 2. – P. 340–

348.

34. Research article iron oxide magnetic nanoparticles:

characterization and toxicity evaluation by in vitro and in vivo assays

/ A. M. Prodan, S. L. Iconaru, C. S. Ciobanu [et al.] // Journal of

Nanomaterials – 2013. – Vol. 2013. – Article ID 587021. – 10 p.

http://dx.doi.org/10.1155/2013/587021

35. Santamaria A. Historical overview of nanotechnology and

nanotoxicology / A. Santamaria // Methods Mol. Biol. – 2012. – Vol.

926. – P. 1–12.

36. Superparamagnetic iron oxide polyacrylic acid coated ã-

Fe2O3 nanoparticles do not affect kidney function but cause acute

effect on the cardiovascular function in healthy mice / N. K. Iversen,

S. Frische, K. Thomsen [et al.] // Toxicol. Appl. Pharmacol. – 2013. –

Vol. 266, N 2. – P. 276–288.

37 . Superparamagnetic iron oxide: pharmacokinetics and toxicity /

R. Weissleder, D. D. Stark, B. L. Engelstad [et al.] // AJR. – 1989. – Vol.

152, N 1. – Ð. 167–173.

38 . The in vivo investigation of Fe3O4-nanoparticles acute toxicity

in mice / S. Zhao, X. Lin, L. Zhang [et al.] // Biomed. Eng. Appl. Basis

Commun. – 2012. – Vol. 24, N 3. – P. 229–236.

39. Toxicity assessments of nanoscale zerovalent iron and its

oxidation products in medaka (Oryzias latipes) fish / P. J. Chen,

C.H. Su, C. Y. Tseng [et al.] // Mar. Pollut. Bull. – 2011. – Vol. 63, N 5–

12. – P. 339–346.

40. Toxicity of nano-zero valent iron to freshwater and marine

organisms / A. A. Keller, K. Garner, R. J. Miller [et al.] // PLoS One. –

2012. – Vol. 7. N 8. – P. e43983.

41. Ultrasmall superparamagnetic iron oxide: characterization

of a new class of contrast agents for MR imaging / R. Weissleder,

G. Elizondo, J. Wittenberg [et al.] // Radiology. – 1990. – Vol. 175,

N 2. – P. 489–493.

42. Whole-body retention and distribution of orally administered

radiolabelled zerovalent iron nanoparticles in mice / Hughes M. F.,

Long T. C., Boyes W. K. [et al.] // Nanotoxicology. – 2013. – Vol. 7,

N 6. – P. 1064–1069.

43. Worldwide prevalence of anaemia 1993–2005: WHO global

database on anaemia / Ed. by B. de Benoist, E. McLean, I. Egli and

M. Cogswell. – 2008. – 48 p.

ÂËÈßÍÈÅ ÍÀÍÎ×ÀÑÒÈÖ ÆÅËÅÇÀ

ÍÀ ÈÇÌÅÍÅÍÈÅ ÌÀÑÑÛ ÒÅËÀ

È ÎÒÍÎÑÈÒÅËÜÍÓÞ ÌÀÑÑÓ

ÂÍÓÒÐÅÍÍÈÕ ÎÐÃÀÍÎÂ Ó ÌÛØÅÉ

Äîðîøåíêî À.Ì.

Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò

èìåíè À. À. Áîãîìîëüöà, Êèåâ, Óêðàèíà

Ðåçþìå. Æåëåçîäåôèöèòíàÿ àíåìèÿ ÿâëÿåòñÿ îä-

íèì èç íàèáîëåå ðàñïðîñòðàíåííûõ ïàòîëîãè÷åñêèõ ñî-

ñòîÿíèé, à òàêæå ñîöèàëüíîé ïðîáëåìîé, êîòîðàÿ ðàñ-

ïðîñòðàíåíà êàê â ðàçâèòûõ ñòðàíàõ, òàê è â ðàçâèâàþ-

ùèõñÿ, è ïðèâîäèò ê íåáëàãîïðèÿòíûì ìåäèöèíñêèì ïî-

ñëåäñòâèÿì, íàïðèìåð, ñíèæåíèþ ðàáîòîñïîñîáíîñòè ó

âçðîñëûõ, çàìåäëåííîìó êîãíèòèâíîìó ðàçâèòèþ ó äå-

òåé, à òàêæå óâåëè÷åíèþ ìàòåðèíñêîé ñìåðòíîñòè. Íà-

íî÷àñòèöû íóëü-âàëåíòíîãî æåëåçà (Í×Æ) îáëàäàþò

âûñîêèì ïîòåíöèàëîì â îáëàñòè ðàçðàáîòêè íîâûõ ïðî-

òèâîàíåìè÷åñêèõ ïðåïàðàòîâ â ñâÿçè ñ ïîâûøåííîé áèî-

ëîãè÷åñêîé àêòèâíîñòüþ íàíî÷àñòèö ìåòàëëîâ. Îäíàêî,

ïðîáëåìà òîêñè÷íîñòè íàíîìàòåðèàëîâ ÿâëÿåòñÿ êëþ-

÷åâûì ïàðàìåòðîì äëÿ îöåíêè ñîîòíîøåíèÿ “ðèñê-

ïîëüçà”. Â êà÷åñòâå îäíîãî èç ýòàïîâ èññëåäîâàíèÿ áå-

çîïàñíîñòè â äàííîé ðàáîòå îöåíåíû èçìåíåíèÿ îñíîâ-

íûõ ìîðôîìåòðè÷åñêèõ ïîêàçàòåëåé, òàêèõ êàê ìàññà

òåëà è âåñîâûå êîýôôèöèåíòû âíóòðåííèõ îðãàíîâ, ïîñ-

ëå îäíîêðàòíîãî âíóòðèæåëóäî÷íîãî èëè âíóòðèâåííîãî

ââåäåíèé Í×Æ ìûøàì. Òåêóùåå ñîñòîÿíèå èçó÷åíèå

âëèÿíèÿ íàíîæåëåçà íà âíóòðåííèå îðãàíû òàêæå îá-

ñóæäàåòñÿ â ñòàòüå.

Êëþ÷åâûå ñëîâà: íàíîôàðìàêîëîãèÿ, áåçîïàñ-

íîñòü, íàíî÷àñòèöû æåëåçà, îðãàíû-ìèøåíè, ìîðôîìåò-

ðè÷åñêèå ïîêàçàòåëè, ìàññà òåëà, îòíîñèòåëüíàÿ ìàññà

âíóòðåííèõ îðãàíîâ.

EFFECT OF IRON NANOPARTICLES

ON THE CHANGES OF BODY WEIGHT

AND INTERNAL ORGANS’ RELATIVE

WEIGHT OF MICE

A. Doroshenko

Bogomolets National Medical University, Kyiv, Ukraine

Summary. Iron deficiency anemia is one of the most

wide-spread pathological states as well as social problem,

which affects developed and developing countries and leads

to unfavourable medical consequences, such as decreased

working capacity in adults, retarded cognitive development

in children, and increase in maternal mortality etc. Zerovalent

iron nanoparticles (FeNPs) are possessed by high potential

in the area of the novel antianemic preparations’

development due to the enhanced biological activity of metal

nanoparticles. On the other hand, the problem of

nanomaterials’ toxicity is a key parameter in order to assess

“risk-benefit” ratio. As a step of biosafety evaluation changes

of main morphometric indices such as body weight and

weight coefficients of internal organs have been evaluated

after single intragastric or intravenous introduction of FeNPs

to mice. The current state of art of nanoiron influence on the

internal organs is also discussed in the study.

Key words: nanopharmacology, safety, iron

nanoparticles, target organs, morphometric parameters,

body weight, relative weight of internal organs.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÒÅÎÐÅÒÈ×ÍÀ ÌÅÄÈÖÈÍÀ / HEORETICAL MEDICINE

Âñòóïëåíèå.

Âîäà – ýòî ñàìîå èçâåñòíîå õèìè÷åñêîå ñîåäèíåíèå

âîäîðîäà è êèñëîðîäà. Íî, íà ñàìîì äåëå, ýòî óíèêàëüíîå

è ìàëîèçó÷åííîå âåùåñòâî â ïðèðîäå. Äî XIX âåêà ëþäè

ñ÷èòàëè âîäó îáû÷íûì õèìè÷åñêèì ýëåìåíòîì. Â 1805

ãîäó Àëåêñàíäð Ãóìáîëüäò è Æîçåô Ëóè Ãåé-Ëþññàê óñ-

òàíîâèëè, ÷òî âîäà ñîñòîèò èç ìîëåêóë, êàæäàÿ èç êîòîðûõ

ñîäåðæèò äâà àòîìà âîäîðîäà è îäèí àòîì êèñëîðîäà. Â

1932 ãîäó àìåðèêàíñêèå ôèçèêè Ãàðàëüä Þðè è Ýëüáåðò

Îñáîðí îáíàðóæèëè ìîëåêóëû òÿæåëîâîäîðîäíîé âîäû.

Â 1933 ãîäó àìåðèêàíåö Ãåðáåðò Ëüþèñ ñîâìåñòíî ñ Ðè-

÷àðäîì Ìàêäîíàëüäîì âïåðâûå âûäåëèëè åå â ÷èñòîì

âèäå ïðè ïîìîùè ýëåêòðîëèçà [1].

Âîäîðîä èìååò ïÿòü èçîòîïîâ ñ ìàññàìè îò 1 äî 5

àòîìíûõ åäèíèö ìàññû (à.å.ì.), òî åñòü ¹H1 – ïðîòèé, ²Í1 –

äåéòåðèé (èëè D), ³Í1 – òðèòèé (èëè Ò), 4Í1, 5Í1. Ïîñëåäíèå

èçîòîïû ñàìîñòîÿòåëüíûõ íàçâàíèé íå èìåþò, îíè ðà-

äèîàêòèâíû è êîðîòêîæèâó÷è. Â ñîåäèíåíèè ñ êèñëîðî-

äîì 16 (¹6Î) ïðîòèé (¹Í) îáðàçóåò ëåãêóþ âîäó

(Í2¹6Î), íåîáõîäèìóþ äëÿ âñåãî æèâîãî; äåéòåðèé – òÿ-

æåëóþ âîäó (D2¹6O), òðèòèé – ñâåðõòÿæåëóþ âîäó

(Ò2¹6Î). Â çåìíûõ âîäàõ ñîäåðæèòñÿ 99,73% ëåãêîé âîäû,

à òÿæåëîé âîäû – ëèøü 0,04%, òî åñòü ñîâñåì íåìíîãî.

Ñâåðõòÿæåëàÿ âîäà îáðàçóåòñÿ â ïðèðîäå â íè÷òîæíî ìà-

ëûõ êîëè÷åñòâàõ. 2/3 âåñà æèâîãî âåùåñòâà íàøåé ïëàíå-

òû ñîñòàâëÿåò âîäà. Â îðãàíèçìå âçðîñëîãî ÷åëîâåêà ñî-

äåðæèòñÿ îêîëî 70% âîäû, â îðãàíèçìå íîâîðîæäåííîãî –

80%. Íà 100 àòîìîâ âîäîðîäà â òåëå ÷åëîâåêà èìååòñÿ âñå-

ãî 58 àòîìîâ âñåõ îñòàëüíûõ ýëåìåíòîâ (êèñëîðîäà – 37,9,

óãëåðîäà – 17, àçîòà – 1,8). Ïî îòíîñèòåëüíîìó ÷èñëó àòî-

ìîâ äåéòåðèþ îòâîäèòñÿ 12-å ìåñòî, ñðàçó ïîñëå êàëèÿ è

ìàãíèÿ (0,015 àòîìîâ íà 100 àòîìîâ âîäîðîäà). Äàæå æå-

ëåçà â îðãàíèçìå ìåíüøå, ÷åì äåéòåðèÿ (0,002 àòîìîâ

æåëåçà íà 100 àòîìîâ âîäîðîäà). Ñîäåðæàíèå æå òàêèõ

ìèêðîýëåìåíòîâ, êàê ìåäü, êàäìèé, ìàðãàíåö, öèíê, ìî-

ëèáäåí è äðóãèõ â äåñÿòêè è ñîòíè ðàç ìåíüøå. Â ïèòüåâîé

ÓÄÊ 612.014.461+616-006-085

ÂËÈßÍÈÅ ËÅÃÊÎÉ ÂÎÄÛ ÍÀ ÆÈÂÛÅ

ÎÐÃÀÍÈÇÌÛ Ñ ÎÏÓÕÎËÅÂÎÉ ÏÀÒÎËÎÃÈÅÉ

È ÝÊÑÏÅÐÈÌÅÍÒÀËÜÍÀß ÏÐÎÂÅÐÊÀ

ÅÅ ÏÎËÎÆÈÒÅËÜÍÎÃÎ ÝÔÔÅÊÒÀ ÍÀ ÏÐÎÖÅÑÑÛ

ÆÈÇÍÅÄÅßÒÅËÜÍÎÑÒÈ ÍÀ ÏÐÈÌÅÐÅ

ÌÀËÎÙÅÒÈÍÊÎÂÛÕ ×ÅÐÂÅÉ ÑÅÌÅÉÑÒÂÀ

TUBIFICIDAE

Çðåëûõ Ë.Â.1, Àñååâ À.È.2

1 ÃÓ “Äíåïðîïåòðîâñêàÿ ìåäèöèíñêàÿ àêàäåìèÿ”, ã.Äíåïðîïåòðîâñê, Óêðàèíà

2 ÊÓ “×åðêàññêèé îáëàñòíîé îíêîëîãè÷åñêèé äèñïàíñåð”, ã. ×åðêàññû, Óêðàèíà

Êëþ÷åâûå ñëîâà: äåéòåðèé, ë¸ãêàÿ âîäà, òÿæ¸ëàÿ âîäà, êàðáîïëàòèí.

âîäå ñîäåðæèòñÿ 0,015 àòîìíûõ % äåéòåðèÿ [2]. Òàêèì îá-

ðàçîì, ëåãêàÿ âîäà (æèâàÿ âîäà) – ýòî âîäà ñ ïîíèæåííîé

êîíöåíòðàöèåé äåéòåðèÿ (íèæå 0,015%). Èçâåñòíî, ÷òî

êîíöåíòðàöèÿ äåéòåðèÿ â æèâûõ îðãàíèçìàõ ïðåâûøàåò

10 ììîëü/ë (93,75 ppm), â ïðèðîäíûõ âîäàõ êîíöåíòðàöèÿ

äåéòåðèÿ ñîñòàâëÿåò áîëåå 16 ììîëü/ë (150 ppm) [3].

Îïûòû ïî âëèÿíèþ ëåãêîé âîäû íà îðãàíèçì áûëè

ïðîâåäåíû â 1956-1960-õ ãîäàõ â ëàáîðàòîðèè áèîôèçèêè

Íàó÷íî-èññëåäîâàòåëüñêîãî èíñòèòóòà ïðè Òîìñêîì ïî-

ëèòåõíè÷åñêîì èíñòèòóòå Á.Í.Ðîäèìîâûì ñîâìåñòíî ñ

ñîòðóäíèêàìè êàôåäðû ïàòîëîãè÷åñêîé àíàòîìèè Òîìñ-

êîãî ìåäèöèíñêîãî èíñòèòóòà, âîçãëàâëÿåìîé È.Ï.Òîðîï-

öåâûì. Â êà÷åñòâå æèâîé âîäû èñïîëüçîâàëàñü ñíåãîâàÿ

âîäà, ñîäåðæàùàÿ äåéòåðèÿ íà 25 % ìåíüøå íîðìû; æè-

âîòíûå åå ïèëè èëè îíà ââîäèëàñü ïóòåì èíúåêöèé. Â êîí-

òðîëüíûõ ãðóïïàõ æèâîòíûå ïîëüçîâàëèñü îáû÷íîé âî-

äîé ñ 0,015 àòîìíûõ % äåéòåðèÿ. Îïûòû íà êóëüòóðàõ

êëåòîê òêàíåé ïå÷åíè êóðèíûõ çàðîäûøåé ïîêàçàëè, ÷òî

ñíåãîâàÿ âîäà òîðìîçèëà ñòàðåíèå: íà 7-8 ñóòêè íå òîëüêî

íå íàñòóïàëî äåãðàäàöèè (êàê äîëæíî áûòü), íî äàæå ïî-

ÿâëÿëèñü ïðèçíàêè ðîñòà [4].

Ïî äàííûì Ñîìëÿé Ã. è äð. (2010ã.) ïðè èñïîëüçîâàíèè

âîäû ñ êîíöåíòðàöèåé äåéòåðèÿ 30±5 ppm (parts per

million) íàáëþäàëîñü óãíåòåíèå ðîñòà in vitro ðàçëè÷íûõ

îïóõîëåâûõ êëåòî÷íûõ ëèíèé (PC-3, ïðîñòàòû ÷åëîâåêà;

MDA, ìîëî÷íîé æåëåçû ÷åëîâåêà; HT-29, òîëñòîãî êè-

øå÷íèêà ÷åëîâåêà; M 14, ìåëàíîìû ÷åëîâåêà). Ëåãêàÿ

âîäà âûçûâàëà ðåãðåññèþ îïóõîëåé MDA è MCF-7 (ðàê

ìîëî÷íîé æåëåçû) è PC-3 (ðàê ïðîñòàòû), ïðèâèòûõ ìû-

øàì, è èíäóöèðîâàëà àïîïòîç in vivo è in vitro. Òàêæå

äàííàÿ âîäà èíãèáèðîâàëà ýêñïðåññèþ îïðåäåëåííûõ ãå-

íîâ (c-myc, H-ras, COX-2), èãðàþùèõ êëþ÷åâóþ ðîëü â

êàíöåðîãåíåçå. Ó 81 ñîáàêè è 14 êîøåê ñ ðàêîì ìîëî÷íîé

æåëåçû íàáëþäàëñÿ ðåãðåññ îïóõîëè áîëåå 70% ïîä âîç-

äåéñòâèåì ëåãêîé âîäû, ïðè ýòîì áîëåå ÷åì ó 50% æèâîò-

íûõ äàííàÿ âîäà èñïîëüçîâàëàñü â êà÷åñòâå åäèíñòâåííî-

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÒÅÎÐÅÒÈ×ÍÀ ÌÅÄÈÖÈÍÀ / THEORETICAL MEDICINE

ãî ìåòîäà ëå÷åíèÿ èëè â êîìáèíàöèè ñ õèðóðãè÷åñêèìè

îïåðàöèÿìè [5] (òàáë. 1).

Ïî äàííûì Âàí Õ. è äð. (2012ã.) ëåãêàÿ âîäà ñ êîíöåí-

òðàöèåé äåéòåðèÿ 100, 75 è 50 ppm âûçûâàåò óãíåòåíèå

ïðîëèôåðàòèâíîé àêòèâíîñòè (ð<0,05), óìåíüøàåò âîç-

ìîæíîñòü êîëîíèåîáðàçîâàíèÿ è èíâàçèâíîñòü êëåòîê

íàçîôàðèíãåàëüíîé êàðöèíîìû (ð<0,01) [6].

ñòâåííî óäëèíÿåò ïðîäîëæèòåëüíîñòü æèçíè è óëó÷øàåò

êà÷åñòâî æèçíè [8].

Ïî äàííûì èññëåäîâàíèÿ Êðåìïåëñ Ê. è äð. (2008ã.) ó

ïàöèåíòîâ ñ ïåðâè÷íûì ðàêîì ëåãêèõ è ìåòàñòàòè÷åñêèì

ïîðàæåíèåì ãîëîâíîãî ìîçãà, êîòîðûõ êàæäûé äåíü íà

ïðîòÿæåíèè 3 ìåñÿöåâ íàðÿäó ñ òðàäèöèîííûìè ìåòîäà-

ìè ëå÷åíèÿ ïîèëè âîäîé ñ ïîíèæåííîé êîíöåíòðàöèåé

äåéòåðèÿ (â ïðåäåëàõ 10-20 ppm) îáùàÿ âûæèâàåìîñòü

ñîñòàâèëà 34,1 ìåñ. (òàáë. 2). Ó äâîèõ ïàöèåíòîâ ñ ìåòàñòà-

çàìè áûë îòìå÷åí ïîëíûé îòâåò íà ëå÷åíèå, ó îäíîãî ïà-

öèåíòà – ÷àñòè÷íûé îòâåò, åùå ó îäíîãî ïðîöåññ ñòàáèëè-

çèðîâàëñÿ. Â îáîèõ ñëó÷àÿõ íàáëþäàëñÿ ïîëíûé îòâåò

ïåðâè÷íîé îïóõîëè, â îñòàëüíûõ – ÷àñòè÷íûé [9].

Ïî äàííûì Êðåìïåëñ Ê. è äð. (2013 ã.) 129 ïàöèåíòîâ ñ

ìåëêî- è íåìåëêîêëåòî÷íûì ðàêîì ëåãêîãî (ñòàäèè B, Ñ

áåç ìåòàñòàçîâ è Ñ ñ ìåòàñòàçàìè ïî Äüþêó) â äîïîëíå-

íèå ê òðàäèöèîííûì ìåòîäàì õèìèîòåðàïèè è ëó÷åâîé

òåðàïèè óïîòðåáëÿëè â êà÷åñòâå ïèòüåâîé âîäû ëåãêóþ

âîäó ñ êîíöåíòðàöèåé äåéòåðèÿ 25-105 ppm. Â èòîãå ñðåä-

íÿÿ ïðîäîëæèòåëüíîñòü æèçíè ñîñòàâèëà 25,9 ìåñ ó ìóæ-

÷èí è 74,1 ìåñ ó æåíùèí. Ãåíäåðíûå ðàçëè÷èÿ áûëè ñòà-

òèñòè÷åñêè äîñòîâåðíû [10].

Èíòåðåñíûå ýêñïåðèìåíòû îòíîñèòåëüíî ðîëè ëåãêîé

âîäû â æèçíåäåÿòåëüíîñòè îðãàíèçìîâ, êëåòî÷íîì öèêëå è

ðàçâèòèè îïóõîëåé áûëè ïðîâåäåíû â Ñýììåëâåéñêîì

óíèâåðñèòåòå ìåäèöèíû, Áóäàïåøò, Âåíãðèÿ. Èíòåðåñíû

ðåçóëüòàòû II ôàçû äâîéíîãî ñëåïîãî ðàíäîìèçèðîâàííî-

ãî èññëåäîâàíèÿ, ïðîâåäåííîãî Ñîìëÿé Ã. è äð. íà áàçå

óíèâåðñèòåòà ìåäèöèíû â Áóäàïåøòå (2010 ã.). Íà ïðîòÿæå-

íèè 4 ìåñÿöåâ 22 ïàöèåíòàì, ñòðàäàþùèì ðàêîì ïðîñòà-

òû, äàâàëè ïèòü ëåãêóþ âîäó, â êà÷åñòâå êîíòðîëÿ èñïîëüçî-

âàëàñü ãðóïïà èç 22 ïàöèåíòîâ, ïîëó÷àâøèõ îáû÷íóþ

âîäó. Â ðåçóëüòàòå ó 7 ÷åëîâåê èç 22 èññëåäóåìûõ áûë âûÿâ-

ëåí ÷àñòè÷íûé îòâåò îïóõîëè ïî ñðàâíåíèþ ñ òàêèìè æå

ðåçóëüòàòàìè òîëüêî ó 1 ÷åëîâåêà èç êîíòðîëüíîé ãðóïïû

(òåñò Àðìèòàæà, p=0,027). Îäíîãîäè÷íàÿ âûæèâàåìîñòü

áûëà çíà÷èòåëüíî âûøå ó èññëåäóåìîé ãðóïïû (Ëîã-ðàíê

òåñò, p=0,029). Ê êîíöó ïåðâîãî ãîäà èññëåäîâàíèé ñóùå-

ñòâåííî ñíèçèëñÿ óðîâåíü ñìåðòíîñòè ó ïàöèåíòîâ, ïîëó-

÷àâøèõ ëåãêóþ âîäó (òåñò Ôèøåðà, p=0,034). Ó 74 æåíùèí ñ

ìåòàñòàòè÷åñêèì ðàêîì ìîëî÷íîé æåëåçû, åæåäíåâíî ïî-

ëó÷àâøèõ ëåãêóþ âîäó â êîìïëåêñå ñ òðàäèöèîííûìè ìå-

òîäàìè ëå÷åíèÿ, íàáëþäàëñÿ ðåãðåññ èëè îñòàíîâêà ïðî-

ãðåññèðîâàíèÿ îïóõîëè â 74,3% ñëó÷àåâ, óâåëè÷åíèå

ñðåäíåãî âðåìåíè âûæèâàåìîñòè äî 47,7 ìåñÿöåâ [5].

Òàáëèöà 1.

Äàííûå äîêëèíè÷åñêèõ èññëåäîâàíèé

Â ðóìûíñêîì óíèâåðñèòåòå ìåäèöèíû è ôàðìàêîëî-

ãèè, â îòäåëåíèè ôèçèîëîãèè, ó÷åíûå Áèëä Â., Ñòåôàíåñ-

êó È. (1999 ã.) ïðîâåëè èññëåäîâàíèÿ, äîêàçûâàþùèå ðà-

äèîïðîòåêòîðíûå è èììóíîñòèìóëèðóþùèå ñâîéñòâà

ëåãêîé âîäû. Äâå ãðóïïû ìûøåé, èññëåäóåìóþ (¹1) è êîí-

òðîëüíóþ (¹2), ïîäâåðãëè îáëó÷åíèþ â äîçå 8,5 Ãð. Ó ïåð-

âîé ãðóïïû, ïîëó÷àâøåé ëåãêóþ âîäó (30 ppm äåéòåðèÿ) íà

ïðîòÿæåíèè 15 äíåé, íàáëþäàëîñü çíà÷èòåëüíîå óâåëè÷å-

íèå óðîâíÿ âûæèâàåìîñòè ïî ñðàâíåíèþ ñî âòîðîé ãðóï-

ïîé, êîòîðóþ ïîèëè îáû÷íîé äèñòèëëèðîâàííîé âîäîé ñ

êîíöåíòðàöèåé äåéòåðèÿ 150 ppm (61% âûæèâàåìîñòè â

èññëåäóåìîé ãðóïïå ïðîòèâ 25% â êîíòðîëüíîé ãðóïïå). Â

ïåðâîé ãðóïïå êàðòèíà êðîâè íå èçìåíÿëàñü (íîðìàëüíûé

óðîâåíü ýðèòðîöèòîâ, ëåéêîöèòîâ, òðîìáîöèòîâ), èììó-

íîëîãè÷åñêèå ïàðàìåòðû êðîâè (îïñîíèçèðóþùèå è áàê-

òåðèöèäíûå ñâîéñòâà ñûâîðîòêè, ôàãîöèòèðóþùàÿ àêòèâ-

íîñòü ïåðèôåðè÷åñêèõ ìàêðîôàãîâ) èìåëè òåíäåíöèþ ê

óëó÷øåíèþ ïî ñðàâíåíèþ ñî çíà÷èòåëüíûì óõóäøåíèåì

äàííûõ ïàðàìåòðîâ â êîíòðîëüíîé ãðóïïå. Ïðè èñêóññò-

âåííî èíäóöèðîâàííîì âîñïàëåíèè ñ ïîìîùüþ ïîäêîæ-

íîãî ââåäåíèÿ èíîðîäíîãî òåëà ïðèåì ëåãêîé âîäû

ñïîñîáñòâóåò çíà÷èòåëüíîìó óñèëåíèþ ïðîòèâîâîñïàëè-

òåëüíîãî îòâåòà, ÷òî ïðîÿâëÿåòñÿ óâåëè÷åíèåì êîëè÷åñòâà

ëèìôîöèòîâ è ïîëèìîðôíîíóêëåàðíûõ íåéòðîôèëîâ,

óñèëåíèåì èõ ôàãîöèòèðóþùåé àêòèâíîñòè [7].

Êëèíè÷åñêèå èññëåäîâàíèÿ ïîêàçàëè, ÷òî óïîòðåáëå-

íèå ëåãêîé âîäû (10-20 ppm) âûçûâàåò ïðåêðàùåíèå ðîñòà

îïóõîëåâûõ êëåòîê â îðãàíèçìå áîëüíûõ ðàêîì, ñóùå-

Òàáëèöà 2.

Äàííûå êëèíè÷åñêèõ èññëåäîâàíèé

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÒÅÎÐÅÒÈ×ÍÀ ÌÅÄÈÖÈÍÀ / HEORETICAL MEDICINE

Ïðîôåññîð Àëåêñàíäðîâ Á.Ë. ïðåäëîæèë íîâóþ ôè-

çè÷åñêóþ (íåéòðîííî-âîäîðîäíóþ) òåîðèþ îáðàçîâàíèÿ

îíêîëîãè÷åñêîé ìàòåðèè. Äåéòåðèé îáëàäàåò âûñîêîé

ãèãðîñêîïè÷íîñòüþ, òî åñòü ñïîñîáíîñòüþ ñ æàäíîñòüþ

àäñîðáèðîâàòü íà ñåáå ìîëåêóëû ëåãêîé âîäû. Â ðåçóëü-

òàòå âîêðóã êàæäîãî àòîìà äåéòåðèÿ îáðàçóåòñÿ âîäÿíàÿ

ìèöåëëà, òî åñòü ìèêðîó÷àñòêè ñî 100% ñîäåðæàíèåì

âîäû. Âîäà îáëàäàåò âûñîêîé çàìåäëÿþùåé ñïîñîáíîñ-

òüþ íåéòðîíîâ, ïîýòîìó íà ó÷àñòêå òàêîé ìèöåëëû áóäåò

íàèáîëüøåå çàìåäëåíèå íåéòðîíîâ. Òàê êàê ïðîíèêàþ-

ùèé â íàø îðãàíèçì ïîòîê íåéòðîíîâ õàðàêòåðèçóåòñÿ

íåêîòîðûì ñïåêòðîì ýíåðãèè, òî òå íåéòðîíû, êîòîðûå

äî ïîäõîäà ê ìèöåëëå óæå äîñòàòî÷íî çàìåäëèëèñü, ìîãóò

áûòü çàõâà÷åíû â ñàìîé ìèöåëëå. Â ðåçóëüòàòå çàõâàòà

íåéòðîíà îäíèì èç àòîìîâ ëåãêîãî âîäîðîäà àäñîðáèðî-

âàâøåéñÿ ìîëåêóëû âîäû îáðàçóåòñÿ âòîðîé àòîì äåéòå-

ðèÿ, îáëàäàþùèé âûñîêîé ãèãðîñêîïè÷íîñòüþ è ñ æàä-

íîñòüþ àäñîðáèðóþùèé íà ñåáå ìîëåêóëû âîäû. Íà ýòîì

ýòàïå áóäóò ôîðìèðîâàòüñÿ ìîëåêóëû ïîëóòÿæåëîé âîäû

HDO¹v . Òàêèì îáðàçîì áóäåò ôîðìèðîâàòüñÿ ñòðóêòó-

ðà ñ âûñîêèì ñîäåðæàíèåì ïîëóòÿæåëîé âîäû, êîòîðàÿ

íà íà÷àëüíîì ýòàïå ïðåäñòàâëÿåò ñîáîé åùå íåçëîêà÷å-

ñòâåííóþ îïóõîëü ñ ðàññåÿííîé ñåòüþ ìîëåêóë ïîëóòÿ-

æåëîé âîäû. Ïîñòåïåííî, ïóòåì çàõâàòà íåéòðîíîâ ÿäðà-

ìè ëåãêîãî èçîòîïà âòîðîãî àòîìà âîäîðîäà, ìîëåêóëû

âîäû íà÷íóò ôîðìèðîâàòüñÿ â ìîëåêóëû òÿæåëîé âîäû

DO¹v. Êîíöåíòðàöèÿ ìîëåêóë òÿæåëîé âîäû â ïðåäåëàõ

îïóõîëè áóäåò âîçðàñòàòü. Íî äî òåõ ïîð, ïîêà êîíöåíòðà-

öèÿ ìîëåêóë òÿæåëîé âîäû â ïðåäåëàõ ôîðìèðóþùåéñÿ

îïóõîëè áóäåò ìåíåå 50%, åå ñòðóêòóðó è ïðåâàëèðóþ-

ùèå ñâîéñòâà áóäåò îïðåäåëÿòü ìàòåðèÿ íîðìàëüíûõ ìî-

ëåêóë âîäû HO¹v, à ôîðìèðîâàíèå îïóõîëè ïðîäîëæà-

åòñÿ â îñíîâíîì çà ñ÷åò òåõ íåéòðîíîâ, êîòîðûå

ïîãëîòèëèñü â ïðåäåëàõ ýòîé îïóõîëè. Ñ òîãî ìîìåíòà,

êîãäà êîíöåíòðàöèÿ ìîëåêóë òÿæåëîé âîäû â ôîðìèðóþ-

ùåéñÿ îïóõîëè ïåðåõîäèò ãðàíèöó 50%, ñòðóêòóðó ýòîé

îïóõîëè óæå îïðåäåëÿþò ìîëåêóëû òÿæåëîé âîäû [2].

Ñóùåñòâóåò ìíîæåñòâî òåîðèé âîçíèêíîâåíèÿ îïóõî-

ëåé: Êîíãåéìà, Âèðõîâà, “îðãàíèçàòîðîâ” Øïåìàíà, áèî-

ëîãè÷åñêîãî óêëîíåíèÿ è äðóãèå. Íà ñåãîäíÿøíèé ìîìåíò

îáùåïðèíÿòîé òåîðèåé âîçíèêíîâåíèÿ îïóõîëåé ÿâëÿåòñÿ

ïîëèýòèîëîãè÷åñêàÿ òåîðèÿ. Íàêîïèâøèåñÿ ê íàñòîÿùåìó

âðåìåíè äàííûå ñâèäåòåëüñòâóþò î òîì, ÷òî çëîêà÷å-

ñòâåííàÿ òðàíñôîðìàöèÿ íîðìàëüíûõ êëåòîê ìîæåò ïðî-

èçîéòè îò ðàçíûõ âíåøíèõ ïðè÷èí [11]. Íîâàÿ ôèçè÷åñêàÿ

(íåéòðîííî-âîäîðîäíàÿ) òåîðèÿ îáðàçîâàíèÿ îíêîëîãè-

÷åñêîé ìàòåðèè ïðîôåññîðà Àëåêñàíäðîâà Á.Ë.,ÿâëÿÿñü

î÷åðåäíîé ïîïûòêîé ïîíÿòü è îáúÿñíèòü êàíöåðîãåíåç,

ïðåäñòàâëÿåò áîëüøîé èíòåðåñ, íî îíà êàðäèíàëüíî îòëè-

÷àåòñÿ îò îáùåïðèíÿòîé ïîëèýòèîëîãè÷åñêîé òåîðèè.

Òàê êàê íàø îðãàíèçì íà 60-70% ñîñòîèò èç âîäû è çà

ñóòêè ìû äîëæíû âìåñòå ñ ïèùåé ïîòðåáëÿòü äî 2,5-3 ë

âîäû, òî ïîïàäàíèå â îðãàíèçì ìîëåêóë òÿæåëûõ âîä â

ïåðâóþ î÷åðåäü çàâèñèò îò êà÷åñòâà ïîòðåáëÿåìîé âîäû.

Ñ÷èòàåòñÿ, ÷òî ñíåãîâàÿ âîäà è âîäà òàÿùèõ ëåäíèêîâ ñî-

äåðæèò â ñåáå ìåíüøèé ïðîöåíò òÿæåëûõ âîä. Âåðîÿòíî,

ïîýòîìó ñðåäè íàðîäîâ, èñïîëüçóþùèõ âîäó ãîðíûõ ðåê,

áîëüøå äîëãîæèòåëåé. Íî äàëåêî íå âñå æèâóò â ãîðíîé

ìåñòíîñòè, ïîýòîìó ìîæíî ðåêîìåíäîâàòü ïîëó÷àòü èñ-

êóññòâåííî òàëóþ ëåäÿíóþ âîäó â äîìàøíèõ óñëîâèÿõ.

Äëÿ ýòîãî â ìîðîçèëüíóþ êàìåðó õîëîäèëüíèêà ïîìåùà-

åòñÿ æåëåçíàÿ åìêîñòü (íàïðèìåð, êàñòðþëÿ) ñ âîäîé.

Ïðèìåíÿþò äâà ñïîñîáà: ëèáî çàìåðçàåò òîëüêî ïîâåðõ-

íîñòíûé ñëîé âîäû, ïîñëå ÷åãî ïðîáèâàþòñÿ äâå äûðî÷-

êè âî ëüäó, âîäà ñëèâàåòñÿ, à ëåä âûáðàñûâàåòñÿ; ëèáî

ïîëíîñòüþ çàìåðçàåò âñÿ âîäà, ïîñëå ÷åãî åìêîñòü âûíè-

ìàåòñÿ èç ìîðîçèëüíèêà, à ëåä òàåò äî òåõ ïîð, ïîêà â åì-

êîñòè íå îñòàíåòñÿ åãî íåáîëüøîé êóñîê, ñîñòàâëÿþùèé

ïðèìåðíî 5 % îò îáùåãî îáúåìà. Âòîðîé ñïîñîá áîëåå

íàäåæíûé, òàê êàê çàìåðçàåò âåñü îáúåì âîäû, à ïðè òàÿ-

íèè ëüäà, êîòîðîå íà÷èíàåòñÿ ïðè òåìïåðàòóðå 0°Ñ, ïåðå-

õîäÿò â æèäêîå ñîñòîÿíèå òîëüêî ìîëåêóëû ëåãêîé âîäû.

Ìîëåêóëû òÿæåëîé âîäû, êîòîðûå äîëæíû ïåðåõîäèòü â

æèäêîå ñîñòîÿíèå òîëüêî ïðè ïîëîæèòåëüíîé òåìïåðàòó-

ðå (t=+3,8°Ñ), áóäóò êîíöåíòðèðîâàòüñÿ íà êóñêå åùå íå

ðàñòàÿâøåãî ëüäà [2].

Îñóùåñòâèòü ïîëíóþ î÷èñòêó âîäû îò òÿæåëûõ ìîëå-

êóë â äîìàøíèõ óñëîâèÿõ êðàéíå òÿæåëî. Ýòà çàäà÷à äîñ-

òèãàåòñÿ ñëîæíûìè ôèçèêî-õèìè÷åñêèìè ìåòîäàìè –

èçîòîïíûì îáìåíîì â ïðèñóòñòâèè ïàëëàäèÿ èëè ïëàòè-

íû, ìíîãîñòóïåí÷àòûì ýëåêòðîëèçîì âîäû â ñî÷åòàíèè ñ

êàòàëèòè÷åñêèì èçîòîïíûì îáìåíîì ìåæäó âîäîé è âî-

äîðîäîì; íèçêîòåìïåðàòóðíîé ðåêòèôèêàöèåé æèäêîãî

âîäîðîäà ñ ïîñëåäóþùèì ñæèãàíèåì Í ñ êèñëîðîäîì;

âàêóóìíîé çàìîðîçêîé âîäû ñ ïîñëåäóþùèì îòòàèâàíè-

åì, âàêóóìíîé ðåêòèôèêàöèåé è äð.[12]. Èçâåñòíû ñïîñî-

áû è óñòàíîâêè äëÿ ïîëó÷åíèÿ áèîëîãè÷åñêè àêòèâíîé

âîäû ñ ïîíèæåííûìè êîíöåíòðàöèÿìè äåéòåðèÿ è òðèòèÿ

[13, 14 15]. Àâòîðû ïîêàçàëè, ÷òî òàêàÿ âîäà, èìåþùàÿ â

ñâîåì ñîñòàâå ïîíèæåííûå (íà 8-10%) êîíöåíòðàöèè äåé-

òåðèÿ, îáëàäàåò àíòèìóòàãåííûì, ãåðîïðîòåêòîðíûì è

ðàäèîïðîòåêòîðíûì äåéñòâèåì.

Öåëü ðàáîòû: èçó÷åíèå âëèÿíèÿ âîäû ðàçíîãî êà÷å-

ñòâà (ëåãêîé, òÿæåëîé, îáû÷íîé) íà æèâûå îðãàíèçìû,

ïóòåì ñðàâíåíèÿ îñîáåííîñòåé æèçíåäåÿòåëüíîñòè â

óêàçàííûõ âèäàõ âîäû ìàëîùåòèíêîâûõ ÷åðâåé ñåìåé-

ñòâà Tubificidae ïîñëå âîçäåéñòâèÿ íà íèõ ïðîòèâîîïóõî-

ëåâûì ïðåïàðàòîì êàðáîïëàòèíîì.

Ìàòåðèàëû è ìåòîäû. Äëÿ ïðèãîòîâëåíèÿ âîäû äëÿ

ýêñïåðèìåíòà èñïîëüçîâàëàñü âîäà “Çíàìåí³âñüêà” òîð-

ãîâîé ìàðêè Áèîëà. Äëÿ îöåíêè âëèÿíèÿ ðàçëè÷íûõ ôðàê-

öèé òàëîé âîäû íà îðãàíèçì ëàáîðàòîðíûõ æèâîòíûõ

âîäà ïðèãîòàâëèâàëàñü ñëåäóþùèì îáðàçîì: âîäà â

îáúåìå 1 ëèòð ïîìåùàëàñü â ìîðîçèëüíóþ êàìåðó, çàìî-

ðàæèâàëàñü äî îáðàçîâàíèÿ ñïëîøíîé ãëûáû ëüäà. Äàëåå

ðàçìîðàæèâàëàñü äî òåõ ïîð, ïîêà â áóòûëêå íå îñòàíåòñÿ

êóñîê ëüäà, ñîñòàâëÿþùèé 5% îò îáùåãî îáúåìà. Îáðà-

çîâàâøàÿñÿ òàëàÿ âîäà ñëèâàëàñü: äàííóþ ôðàêöèþ ìîæ-

íî ñ÷èòàòü óñëîâíî “ëåãêîé” ïîñêîëüêó, ïî äàííûì ëèòåðà-

òóðû [2], â íåé èìååòñÿ ñíèæåííîå ñîäåðæàíèå äåéòåðèÿ.

Âòîðàÿ ôðàêöèÿ âîäû áûëà ïîëó÷åíà ïîñëå ðàçìîðàæèâà-

íèÿ îñòàâøèõñÿ 5% ëüäà, òàêóþ âîäó áóäåì íàçûâàòü

óñëîâíî “òÿæåëîé”, òàê êàê ñîäåðæàíèå äåéòåðèÿ â íåé

áóäåò ïîâûøåíî.

Â êà÷åñòâå ýêñïåðèìåíòàëüíîé ìîäåëè áûë âûáðàí

ïðåäñòàâèòåëü ìàëîùåòèíêîâûõ ÷åðâåé ñåìåéñòâà Òðó-

áî÷íèêè, èëè Òóáèôèöèäû (Tubificidae) – òðóáî÷íèê

îáûêíîâåííûé (Tubifex tubifex). Äàííîå ñåìåéñòâî

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÒÅÎÐÅÒÈ×ÍÀ ÌÅÄÈÖÈÍÀ / THEORETICAL MEDICINE

âêëþ÷àåò îêîëî 130 âèäîâ, ïîäàâëÿþùåå áîëüøèíñòâî

êîòîðûõ îáèòàåò íà äíå ïðåñíûõ âîäîåìîâ è ëèøü íå-

ìíîãèå âñòðå÷àþòñÿ â ïðèáðåæíîé çîíå ìîðåé. Íåêîòî-

ðûå âèäû âûäåðæèâàþò î÷åíü ñèëüíîå çàãðÿçíåíèå è

ìîãóò æèòü ïðè ìèíèìàëüíîì êîëè÷åñòâå ðàñòâîðåííî-

ãî â âîäå êèñëîðîäà, ïåðåíîñÿ â òå÷åíèå ìíîãèõ ñóòîê

äàæå ïîëíîå åãî îòñóòñòâèå [16]. Â êà÷åñòâå õèìèîòåðà-

ïåâòè÷åñêîãî àãåíòà áûë âûáðàí êàðáîïëàòèí – ïðîòè-

âîîïóõîëåâîå ñðåäñòâî àëêèëèðóþùåãî äåéñòâèÿ. Îòíî-

ñèòñÿ ê ãðóïïå ïðîèçâîäíûõ Pt, îáðàçóåò “ñøèâêè”

ìåæäó ñîñåäíèìè ïàðàìè îñíîâàíèé ãóàíèíà â ÄÍÊ,

÷òî ïðèâîäèò ê ïîäàâëåíèþ ñèíòåçà íóêëåèíîâûõ êèñ-

ëîò è ãèáåëè êëåòîê. Â îòëè÷èå îò öèñïëàòèíà îáëàäàåò

ìåíüøåé íåôðîòîêñè÷íîñòüþ è îòîòîêñè÷íîñòüþ,

ñèëüíåå óãíåòàåò ãåìîïîýç. Âûçûâàåò îñòàíîâêó ðîñòà è

îáðàòíîå ðàçâèòèå ìíîãèõ âèäîâ îïóõîëåé. Â ýêñïåðè-

ìåíòàëüíûõ èññëåäîâàíèÿõ in vivo è in vitro ïðîÿâëÿåò

ìóòàãåííûå, ýìáðèîòîêñè÷åñêèå è òåðàòîãåííûå ñâîé-

ñòâà. Êàðáîïëàòèí ìîæåò âûçûâàòü ìíîæåñòâî ïîáî÷-

íûõ ýôôåêòîâ [17].

Äëÿ ïðîâåäåíèÿ ýêñïåðèìåíòà èñïîëüçîâàëàñü “ëåã-

êàÿ” âîäà, “òÿæåëàÿ” âîäà, “îáû÷íàÿ” âîäà (íå ïîäâåðãàâ-

øàÿñÿ çàìîðàæèâàíèþ), êàðáîïëàòèí, 3 ïîïóëÿöèè ÷åð-

âåé ðîäà Òðóáî÷íèê ïî 100 îñîáåé â êàæäîé.

Îïûò çàêëþ÷àëñÿ â ñðàâíåíèè æèçíåäåÿòåëüíîñòè

òðóáî÷íèêà â “ëåãêîé” âîäå è â “òÿæåëîé” âîäå ñ äîáàâëå-

íèåì êàðáîïëàòèíà. Èñïîëüçîâàëèñü äâå ïîïóëÿöèè òðó-

áî÷íèêà ïî ñòî ÷åðâåé â êàæäîé. Ïåðâàÿ ïîïóëÿöèÿ ñî-

äåðæàëàñü â “ëåãêîé” âîäå ñ äîáàâëåíèåì êàðáîïëàòèíà,

à âòîðàÿ – â “òÿæåëîé” âîäå ñ äîáàâëåíèåì òîãî æå ïðåïà-

ðàòà. Äëÿ êîíòðîëÿ èñïîëüçîâàëàñü òðåòüÿ ïîïóëÿöèÿ òðó-

áî÷íèêà, íàõîäèâøàÿñÿ â “îáû÷íîé âîäå” ñ äîáàâëåíèåì

êàðáîïëàòèíà.

Ðàñ÷åò äîçû êàðáîïëàòèíà äëÿ ÷åðâåé ïðîâîäèëñÿ èñ-

õîäÿ èç äîçû êàðáîïëàòèíà íà ïîâåðõíîñòü òåëà ÷åëîâåêà,

êîòîðàÿ ñîñòàâëÿåò 400ìã/ì2.

Ðàñ÷åò ïëîùàäè ïîâåðõíîñòè òðóáî÷íèêà.

Òðóáî÷íèê ïî ôîðìå ñîîòâåòñòâóåò öèëèíäðó, ñëåäî-

âàòåëüíî äëÿ ðàñ÷åòà ïëîùàäè åãî ïîâåðõíîñòè èñïîëüçó-

åòñÿ ôîðìóëà äëÿ ðàñ÷åòà ïëîùàäè öèëèíäðà:

Sòð= 2

RL,

ãäå: Sòð – ïëîùàäü òðóáî÷íèêà; R – ðàäèóñ òðóáî÷íèêà; ð –

3,14; L – äëèíà òðóáî÷íèêà.

Ñðåäíèé ðàäèóñ (R) îäíîãî òðóáî÷íèêà – 0,5 ìì èëè

0,510-3ì. Ñðåäíÿÿ äëèíà (L) îäíîãî òðóáî÷íèêà – 30 ìì

èëè 310-3ì.Òàêèì îáðàçîì, ïîäñòàâëÿÿ äàííûå âåëè÷è-

íû â ôîðìóëó, ïîëó÷àåì ñëåäóþùèé ðåçóëüòàò – 2 

0,510-3ì  3,14  310-2ì=3  3,1410-5=9,4210-5ì2

(ïëîùàäü ïîâåðõíîñòè îäíîãî òðóáî÷íèêà).

Ðàñ÷åò äîçû êàðáîïëàòèíà íà ïëîùàäü ïîâåðõíîñòè 1

òðóáî÷íèêà.

Ïîñêîëüêó äîçà êàðáîïëàòèíà íà 1ì2 ïëîùàäè òåëà ÷å-

ëîâåêà ñîñòàâëÿåò 400 ìã, òî íà 9,4210-5 ì2 ïëîùàäè

òðóáî÷íèêà äîçà êàðáîïëàòèíà áóäåò ñîñòàâëÿòü –

400  9,4210-5=0,0000942  400=0,038 ìã.

Â 1 ìë ïðåïàðàòà ñîäåðæèòñÿ 10 ìã âåùåñòâà êàðáî-

ïëàòèíà, ñëåäîâàòåëüíî 0,038 ìã áóäóò ñîäåðæàòüñÿ â

0,0038 ìë ïðåïàðàòà. Ïîñêîëüêó â èññëåäóåìûõ ãðóïïàõ

ñîäåðæèòñÿ ïî ñòî ÷åðâåé, òî äîçà êàðáîïëàòèíà íà êàæ-

äóþ ãðóïïó áóäåò ñîñòàâëÿòü 0,38 ìë.

Â ïðîçðà÷íóþ åìêîñòü íàëèâàëîñü 50 ìë “ëåãêîé”

âîäû, òóäà æå ïîìåùàëîñü 100 ÷åðâåé è ââîäèëîñü èíñó-

ëèíîâûì øïðèöîì 0,38 ìë êàðáîïëàòèíà. Â äðóãóþ åì-

êîñòü íàëèâàëîñü 50 ìë “òÿæåëîé” âîäû, òóäà ïîìåùàëîñü

100 ÷åðâåé è àíàëîãè÷íî ââîäèëîñü 0,38 ìë ïðåïàðàòà.

Äëÿ êîíòðîëÿ èñïîëüçîâàëàñü òðåòüÿ åìêîñòü, êóäà íàëè-

âàëîñü 50 ìë “îáû÷íîé” âîäû, ïîìåùàëîñü 100 ÷åðâåé è

ââîäèëîñü 0,38 ìë êàðáîïëàòèíà. ×åðåç ïîë÷àñà âîäà â

òðåõ åìêîñòÿõ ñëèâàëàñü è íàëèâàëàñü íîâàÿ ïîðöèÿ óæå

áåç ââåäåíèÿ êàðáîïëàòèíà. Â ïîñëåäóþùåì çàìåíà âîäû

ïðîâîäèëàñü 1 ðàç â äåíü. Îïûò äëèëñÿ 19 äíåé.

Ðåçóëüòàòû è îáñóæäåíèå. Ïðè àíàëèçå ìàëîùåòèíêî-

âûõ ÷åðâåé ñåìåéñòâà Tubificidae, íàõîäÿùèõñÿ â “ëåãêîé”,

“òÿæåëîé” è “îáû÷íîé” âîäå ïðè âîçäåéñòâèè êàðáîïëàòè-

íà áûëî óñòàíîâëåíî, ÷òî ÷åðâè, íàõîäÿùèåñÿ â “òÿæåëîé”

è “îáû÷íîé” âîäå èìåþò ìåíüøèå ðàçìåðû, áîëåå ñâåò-

ëóþ îêðàñêó (ñíèæåíèå êîíöåíòðàöèè ãåìîãëîáèíà),

äðÿáëûé êîæíî-ìûøå÷íûé ìåøîê, ñíèæåíèå òîíóñà

ìóñêóëàòóðû, èç-çà ÷åãî ÷åðâè ìåíåå ïîäâèæíû. Ó íèõ

íàáëþäàåòñÿ óòîëùåíèå íàðóæíûõ ïîêðîâîâ (âîçíèêàåò

îòåê) è ôðàãìåíòàöèÿ êèøå÷íèêà ïî ñðàâíåíèþ ñ ÷åðâÿ-

ìè, ñîäåðæàùèìèñÿ â “ëåãêîé” âîäå. Ïðîöåññû æèçíåäå-

ÿòåëüíîñòè ÷åðâåé ïîä âîçäåéñòâèåì êàðáîïëàòèíà çà-

ìåäëÿþòñÿ, îñîáåííî ó ïîïóëÿöèè, íàõîäÿùåéñÿ â

“òÿæåëîé” âîäå, ÷òî ïðîÿâëÿåòñÿ â ñíèæåíèè ðåïðîäóê-

òèâíîé ôóíêöèè è óìåíüøåíèè êîëè÷åñòâà ÿèö ïî ñðàâ-

íåíèþ ñ ïîïóëÿöèåé, íàõîäÿùåéñÿ â “ëåãêîé” âîäå.

Âûâîäû.

1. Ïðîàíàëèçèðîâàíà èíôîðìàöèÿ î ëåãêîé âîäå èç

ðàçíûõ ëèòåðàòóðíûõ èñòî÷íèêîâ. Óñòàíîâëåíî, ÷òî áîëü-

øèíñòâî àâòîðîâ ñêëîíÿþòñÿ ê ïîëîæèòåëüíûì ýôôåê-

òàì ëåãêîé âîäû íà æèâûå îðãàíèçìû.

2. Îöåíêà âëèÿíèÿ ðàçíûõ âèäîâ âîäû íà ïðîöåññû

ðåãåíåðàöèè ïîñëå âîçäåéñòâèÿ öèòîñòàòè÷åñêèì àãåí-

Ðèñ. 2. Âíåøíèé âèä ìàëîùåòèíêîâûõ ÷åðâåé ñåìåéñòâà

Tubificidae ïîñëå íàõîæäåíèÿ â òå÷åíèå 19 äíåé â “ëåãêîé”

âîäå è âîçäåéñòâèÿ êàðáîïëàòèíîì.

Ðèñ.1. Âíåøíèé âèä ìàëîùåòèíêîâûõ ÷åðâåé ñåìåéñòâà

Tubificidae ïîñëå íàõîæäåíèÿ â òå÷åíèå 19 äíåé â “òÿæåëîé”

âîäå è âîçäåéñòâèÿ êàðáîïëàòèíîì.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÒÅÎÐÅÒÈ×ÍÀ ÌÅÄÈÖÈÍÀ / HEORETICAL MEDICINE

òîì ó ìàëîùåòèíêîâûõ ÷åðâåé ñåìåéñòâà Tubificidae ïî-

êàçàëà, ÷òî â èñïîëüçóåìîé äîçå öèòîñòàòèê îäèíàêîâî

ñíèæàåò ïðîöåññû æèçíåäåÿòåëüíîñòè ÷åðâåé âî âñåõ

ïîäãðóïïàõ. Îäíàêî, æèâîòíûå, ñîäåðæàùèåñÿ â “ëåãêîé”

âîäå, áûëè áîëåå ïîäâèæíû, àäàïòèâíûå ïðîöåññû ó íèõ

ïðîòåêàëè áîëåå àêòèâíî.

3. Íåîáõîäèìî ïðîäîëæèòü áîëåå äåòàëüíîå èçó÷åíèå

ëåãêîé âîäû ñ ïðîâåäåíèåì äîêëèíè÷åñêèõ è êëèíè÷åñ-

êèõ èññëåäîâàíèé, à òàêæå ðàññìîòðåòü â äàëüíåéøåì

ðàçðàáîòêó è ïðîèçâîäñòâî ëèíèè ëåãêîé âîäû äëÿ ïàöè-

åíòîâ ñ îíêîëîãè÷åñêîé ïàòîëîãèåé.

Ðåöåíçåíò: ä.ìåä.í., ïðîôåñîð Â.ª. ×åøóê

ËÈÒÅÐÀÒÓÐÀ:

1. Áàðìèí Ì.È., Òåìíîâ Ï.Í. Ýêîëîãèÿ âîäû: æèâàÿ âîäà

ñóùåñòâóåò!!! ÑÏá.: Êîìèëüôî, 2010. – 238 ñ.

2. Àëåêñàíäðîâ Á.Ë. Ðàê ãëàçàìè ôèçèêà: ìåõàíèçì âîçíèê-

íîâåíèÿ, ïðîôèëàêòèêà, ëå÷åíèå, çàùèòà. – ÑÏá.: ÈÃ “Âåñü”,

2010. – 272ñ.

3. Ïëèòèí Â. Í. , Áåðäûøåâ Ã. Ä., Âàðíàâñêèé È. Í., Æëàíþê

Ï. Å. , Ëåòâèíåíêî Â. Â. Òàëà âîäà. Ïèòíà âîäà. Êèåâ: Ôèòî-

ñîöèîöåíòð. 2004. – 112ñ.

4. Ìóõà÷åâ Â.Ì. “Æèâàÿ âîäà”.Ì.: Íàóêà, 1975.

5. Somlyai G., Kovács A., Guller I. et al. // EJC Supplements. –

2010. – 8, ¹ 5. – P. 208.

6. Wang H, Zhu B, Liu C, Fang W, Yang H. // Nan Fang Yi Ke Da

Xue Xue Bao. 2012 Oct; 32(10):1394-9.

7.Bild W, Stefanescu I, Haulica I. et al. // Rom J Physiol. – 1999. –

Jul-Dec; 36(3-4):205-18.

8. Wang H, Liu C, Fang W, Yang H. // Nan Fang Yi Ke Da Xue Xue

Bao. 2012 Oct;32(10):1454-6.

9. Krempels K., Somlyai I., Somlyai G. // Integr. Cancer Ther. –

2008. – 7, ¹ 3. – P.172-181.

10. Krisztina Krempels, Ildiko Somlyai, and Gabor Somlyai. //

Nutrition and Cancer. – 2013. 65(2), 240–246.

11. ×åðåçîâ À.Å. Îáùàÿ òåîðèÿ ðàêà: òêàíåâîé ïîäõîä. –

Èçä-âî Ìîñêîâñêîãî óíèâåðñèòåòà, 1997.

12. Ìîñèí Î.Â., Èãíàòîâ È. Èñòîðèÿ èññëåäîâàíèÿ òàëîé

âîäû, http://www.o8ode.ru/article/tawa/ The history of research of

melt water.

13.Âàðíàâñêèé È.Í., ×åðíèëåâñêèé Â.È., Áàðêàíîâ Â.È., Êî-

íîçåíêî È.Ä., Êóðèê Ì.Â., Ñîðîêîïóä È.À., Àíòîí÷åíêî Â.ß “Ñïî-

ñîá ïîëó÷åíèÿ öåëåáíîé ïèòüåâîé âîäû è óñòàíîâêà ÂÈÍ-4

“Íàä³ÿ” äëÿ åãî îñóùåñòâëåíèÿ”, ïàòåíò ÐÔ 2010772 îò

25.08.92.

14. Âàðíàâñêèé È.Í., Ïîíîìàðåâ Â. À., Øåñòàêîâ Â.È. “Ñïî-

ñîá ïîëó÷åíèÿ öåëåáíîé ïèòüåâîé âîäû ñ ïîíèæåííûì ñîäåðæà-

íèåì äåéòåðèÿ è òðèòèÿ”, “Ðåëèêòîâàÿ âîäà”, ïàòåíò ÐÔ

2091336, êë. Ñ 02 F 9/00 îò 19.12.95.

15. Âàðíàâñêèé È.Í. “Óñòàíîâêà ÂÈÍ-7 “Íàäèÿ” äëÿ ïîëó-

÷åíèÿ öåëåáíîé ïèòüåâîé âîäû ñ ïîíèæåííûì ñîäåðæàíèåì äåé-

òåðèÿ è òðèòèÿ”, “Ðåëèêòîâàÿ âîäà”, ïàòåíò ÐÔ 2091335,

êë. Ñ 02 F 9/00 îò 19.12.95.

16. Æèçíü æèâîòíûõ. Ýíöèêëîïåäèÿ â øåñòè òîìàõ // Ïîä

ðåäàêöèåé ïðîôåññîðîâ Í.À.Ãëàäêîâà, À.Â. Ìèõååâà. Ì.: Ïðîñâå-

ùåíèå, 1970. Ò.2.

17. Êîìïåíäèóì 2011. Ýëåêòðîííûé ñïðàâî÷íèê ëåêàðñòâåí-

íûõ ïðåïàðàòîâ.

ÂÏËÈÂ ËÅÃÊÎ¯ ÂÎÄÈ ÍÀ ÆÈÂ² ÎÐÃÀÍ²ÇÌÈ

Ç ÏÓÕËÈÍÍÎÞ ÏÀÒÎËÎÃ²ªÞ

É ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ÏÅÐÅÂ²ÐÊÀ

¯¯ ÏÎÇÈÒÈÂÍÎÃÎ ÅÔÅÊÒÀ ÍÀ ÏÐÎÖÅÑÈ

ÆÈÒÒªÄ²ßËÜÍÎÑÒ² ÍÀ ÏÐÈÊËÀÄ²

ÌÀËÎÙÅÒÈÍÊÎÂÈÕ ×ÅÐÂ²Â ÐÎÄÈÍÈ

TUBIFICIDAE

Çðºëèõ Ë.Â.1, Àñåºâ Î.².2

1ÄÓ “Äí³ïðîïåòð³âñüêà ìåäè÷íà àêàäåì³ÿ”,

ì. Äí³ïðîïåòðîâñüê, Óêðà¿íà

2ÊÇ “×åðêàñüêèé îáëàñíèé îíêîëîã³÷íèé

äèñïàíñåð”, ì. ×åðêàñè, Óêðà¿íà

Ðåçþìå. Ëåãêà âîäà – öå âîäà ç ïîíèæåíîþ êîíöåí-

òðàö³ºþ äåéòåð³þ (ìåíøå 0,015 àòîìíèõ %), ùî ìàº ïðî-

òèïóõëèííó, ïðîòèçàïàëüíó, ³ìóíîìîäóëþþ÷ó ä³þ. Çâè÷àé-

íà ³ âàæêà âîäà ì³ñòÿòü ï³äâèùåíó êîíöåíòðàö³þ äåéòå-

ð³þ, ÿêèé ÷èíèòü òîêñè÷íó ä³þ íà îðãàí³çì. Ï³ä ÷àñ àíà-

ë³çó âïëèâó ð³çíèõ âèä³â âîäè íà ïðîöåñè ðåãåíåðàö³¿ ìà-

ëîùåòèíêîâèõ ÷åðâ’ÿê³â ñ³ìåéñòâà Tubificidae ï³ñëÿ âïëèâó

íà íèõ ïðîòèïóõëèííîãî àãåíòà êàðáîïëàòèíó áóëî âñòà-

íîâëåíî, ùî ìîðôîëîã³÷í³ õàðàêòåðèñòèêè ³ ïðîöåñè æèò-

òºä³ÿëüíîñò³ ïîïóëÿö³¿ ìàëîùåòèíêîâèõ ÷åðâ’ÿê³â, ùî çíà-

õîäèëèñü â ëåãê³é âîä³, áóëè êðàùå, í³æ ó ïîïóëÿö³é, ÿê³

ïåðåáóâàëè ó çâè÷àéí³é ³ âàæê³é âîä³. Òàêèì ÷èíîì, âèâ-

÷åííÿ âïëèâó ëåãêî¿ âîäè íà æèâ³ îðãàí³çìè º ïåðñïåê-

òèâíèì íàïðÿìêîì ñó÷àñíî¿ îíêîëîã³¿.

Êëþ÷îâ³ ñëîâà: äåéòåð³é, ëåãêà âîäà, âàæêà âîäà,

êàðáîïëàòèí.

IMPACT OF DEUTERIUM DEPLETED WATER

ON THE ORGANISMS WITH CANCER PATHOLOGY

AND EXPERIMENTAL EXAMINATION OF ITS

POSITIVE EFFECT ON THE VITAL PROCESSES

ON THE EXAMPLE OF OLIGOCHAETES

OF TUBIFICIDAE FAMILY

L. Zrelykh1, A. Aseev2

1Dnipropetrovsk State Medical Academy,

Dnipropetrovsk, Ukraine

2Communal institution of “Cherkassy regional

oncology center”, Cherkassy, Ukraine

Summary. Deuterium depleted water (DDW) is a kind of

water with low concentration of deuterium (less than 0,015

atomic percent), which has antitumor, anti-inflammatory,

immunomodulating effects. Ordinary and heavy water

contains higher concentration of deuterium which has toxic

influence on organism. The analysis of the influence of

different types of water on oligochaetes’ regeneration after

the impact of antitumor agent carboplatin showed that

morphologic characteristics and vital processes of this

organisms, lived in DDW, are better than of those, lived in

ordinary and heavy water. Thus, investigation of the influence

of DDW on the organisms is a perspective direction of

modern oncology.

Key words: deuterium, deuterium depleted water, heavy

water, carboplatin.

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÒÅÎÐÅÒÈ×ÍÀ ÌÅÄÈÖÈÍÀ / THEORETICAL MEDICINE

Âñòóï.

Òåðì³í “àíòèá³îòèêè” (â³ä ãðåö. anti – ïðîòè, bios –

æèòòÿ) áóëî çàïðîïîíîâàíî Ç. Âàêñìàíîì ó 1942 ð. Öå

ðå÷îâèíè á³îëîã³÷íîãî ïîõîäæåííÿ, à òàêîæ ¿õ ïîõ³äí³

ñèíòåòè÷í³ òà íàï³âñèíòåòè÷í³ àíàëîãè, ÿê³ âèá³ðêîâî ïðè-

ãí³÷óþòü æèòòºä³ÿëüí³ñòü ì³êðîîðãàí³çì³â. Àíòèá³îòèêè

êëàñèô³êóþòü çà ñïåêòðîì ³ ñïðÿìîâàí³ñòþ á³îëîã³÷íî¿

ä³¿, õ³ì³÷íèì ñêëàäîì òà ìîëåêóëÿðíèì ìåõàí³çìîì ä³¿ íà

ì³êðîáíó êë³òèíó. Çà ñïåêòðîì ä³¿ ðîçð³çíÿþòü àíòèá³îòè-

êè âóçüêîãî é øèðîêîãî ñïåêòðà ä³¿. Çà ñïðÿìîâàí³ñòþ

á³îëîã³÷íî¿ ä³¿ àíòèá³îòèêè ïîä³ëÿþòü íà ÷îòèðè îñíîâí³

ãðóïè: àíòèáàêòåð³àëüí³, ïðîòèãðèáêîâ³, ïðîòèâ³ðóñí³,

ïðîòèïóõëèíí³.

Àíòèá³îòèêè, ÿê³ ì³ñòÿòüñÿ â ðîñëèíàõ, ó 1928 ð.

â³äêðèâ Òîê³í Ò.Ï. [1] ³ íàçâàâ ¿õ ô³òîíöèäàìè. Çà õ³ì³÷íèì

ñêëàäîì ïåðåâàæíà á³ëüø³ñòü ô³òîíöèä³â íàëåæèòü äî

ñêëàäíèõ åô³ð³â, òîìó âîíè ëåòê³ é íåñò³éê³ ³ ¿õ ñêëàäíî

âèä³ëèòè â ÷èñòîìó âèãëÿä³. Îñîáëèâ³ñòü åêñòðàêò³â ³ç

ë³êàðñüêèõ ðîñëèí ïîëÿãàº â òîìó, ùî ¿õ á³îëîã³÷íî àê-

òèâí³ ðå÷îâèíè çíàõîäÿòüñÿ ó ïåâíîìó ñï³ââ³äíîøåíí³,

ùî ñïðèÿº îïòèìàëüíîìó âïëèâó íà îðãàí³çì ëþäèíè.

Äåÿê³ ñêëàäîâ³ êîìïîíåíòè ðîñëèííèõ åêñòðàêò³â çà

õ³ì³÷íîþ ñòðóêòóðîþ ïîä³áí³ äî ô³ç³îëîã³÷íî àêòèâíèõ

ðå÷îâèí îðãàí³çìó (ãîðìîí³â, â³òàì³í³â, ôåðìåíò³â òîùî).

Òîìó òàê³ ïðèðîäí³ ë³êè á³ëüø àêòèâíî âêëþ÷àþòüñÿ â

á³îõ³ì³÷í³ ïðîöåñè ëþäñüêîãî îðãàí³çìó, í³æ ë³êè ñèíòå-

òè÷í³, ùî º ÷óæèìè äëÿ îðãàí³çìó. Äî àíòèá³îòèê³â ðîñ-

ëèííîãî ïîõîäæåííÿ íàëåæàòü: àë³öèí (÷àñíèê), ³ìàí³í

(çâ³ðîá³é), õëîðîô³ë³ïò (ëèñòÿ åâêàë³ïòó), ðàôàí³í (çåðíà

ðåäèñêè), õëîðåë³í (õëîðåëëà), óðîëåñàí (êîìá³íîâàíèé

ðîñëèííèé ïðåïàðàò).

Ïîøóê àíòèá³îòèê³â ðîñëèííîãî ïîõîäæåííÿ ñïîíó-

êàâ íàñ äî ïðîâåäåííÿ äîñë³äæåíü ñåðåä ðåë³êòîâèõ ïðåä-

ñòàâíèê³â â³ò÷èçíÿíî¿ ôëîðè. Âèá³ð ñàìå ðåë³êòîâèõ çó-

ìîâëåíî òèì, ùî â ïðîöåñ³ ³íòðîäóêö³¿ ó íèõ

ñïîñòåð³ãàºòüñÿ àêòèâàö³ÿ ñèíòåçó äåÿêèõ âòîðèííèõ ìå-

òàáîë³ò³â, çîêðåìà, ðå÷îâèí ôåíîëüíî¿ ïðèðîäè òà àì³íî-

êèñëîò, ÿê³ ðîçãëÿäàþòü ÿê àëåëîõ³ì³êàòè. Òîìó ö³ëêîì

éìîâ³ðíî, ùî â ïðîöåñ³ àäàïòàö³¿ ìàº ï³äâèùóâàòèñü ³ àëå-

ëîïàòè÷íà àêòèâí³ñòü öèõ ðîñëèí. Êð³ì òîãî, îñîáëèâî¿

óâàãè çàñëóãîâóº âèâ÷åííÿ ðå÷îâèí, ñèíòåç ÿêèõ ñïðÿæå-

íèé ç ôîðìóâàííÿì ñòðåñîâèõ ðåàêö³é ðîñëèí [2].

ÓÄÊ 577.343/579.8.012

ÀÍÒÈÁÀÊÒÅÐ²ÀËÜÍÀ ÒÀ ÀÍÒÈÔÓÍÃ²ÖÈÄÍÀ

ÀÊÒÈÂÍÎÑÒ² ÌÅÒÀÁÎË²Ò²Â ÖÈÁÓË² ÂÅÄÌÅÆÎ¯

(ALLIUM URSINUM L.)

Êà÷àëîâà Î.À.1, Äçþáà Î.².2

1 Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Î.Î. Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

2 Íàö³îíàëüíèé áîòàí³÷íèé ñàä ³ìåí³ Ì.Ì. Ãðèøêà ÍÀÍ Óêðà¿íè, ì. Êè¿â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: àíòèáàêòåð³àëüíà àêòèâí³ñòü, àíòèôóíã³öèäíà àêòèâí³ñòü, ðîñëèíí³ åêñòðàêòè,

àíòèá³îòèêè ðîñëèííîãî ïîõîäæåííÿ.

Ìåòà ðîáîòè ïîëÿãàëà â ç‘ÿñóâàíí³ àíòèáàêòåð³àëüíî¿

òà àíòèôóíã³öèäíî¿ àêòèâíîñò³ ìåòàáîë³ò³â Allium ursinum L.

ç ïåðñïåêòèâîþ ¿õ âèêîðèñòàííÿ â ìåäè÷í³é ïðàêòèö³ â

ÿêîñò³ àíòèá³îòèê³â ðîñëèííîãî ïîõîäæåííÿ.

Äëÿ äîñÿãíåííÿ ìåòè áóëè ïîñòàâëåí³ íàñòóïí³ çàâäàííÿ:

1. âèä³ëåííÿ ëåêòèí³â Allium ursinum L.;

2. äîñë³äæåííÿ àëåëîïàòè÷íèõ àêòèâíîñò³ ðîñëèííèõ

åêñòðàêò³â;

3. âèçíà÷åííÿ öèòîñòàòè÷íî¿ àêòèâí³ñò³ åêñòðàêò³â;

4. âèçíà÷åííÿ ãåìîë³òè÷íî¿ àêòèâíîñò³ åêñòðàêò³â;

5. âèçíà÷åííÿ àíòèáàêòåð³àëüíî¿ òà àíòèôóíã³öèäíî¿

àêòèâíîñò³ åêñòðàêò³â.

Ìåòîäè ³ ìàòåð³àëè.

Äîñë³äæåííÿ ïðîâîäèëèñÿ ó â³ää³ë³ àëåëîïàò³¿ ÍÁÑ

³ìåí³ Ì.Ì. Ãðèøêà ÍÀÍ Óêðà¿íè. Îá’ºêòàìè äîñë³äæåí-

íÿ áóëè ðîñëèíè Allium ursinum L., ç³áðàí³ ïðîòÿãîì âåãå-

òàö³¿ íà åêñïîçèö³éíèõ ä³ëÿíêàõ Êàðïàò. Äëÿ äîñë³äæåííÿ

áóëî âèêîðèñòàíî ð³çí³ îðãàíè ðîñëèí – íàäçåìíó ÷àñòè-

íó (ëèñòêè, êâ³òè), ï³äçåìí³ îðãàíè (öèáóëèíè).

Âèä³ëåííÿ ëåêòèí³â ïðîâîäèëè çà ìåòîäèêîþ, çàïðî-

ïîíîâàíîþ Ëóöèêîì Ì.Ä. [3]. Äëÿ âèçíà÷åííÿ àëåëîïà-

òè÷íî¿ àêòèâíîñò³ äîñë³äæóâàíèõ ñïîëóê êîðèñòóâàëèñÿ

ìåòîäîì á³îòåñòóâàííÿ, çàïðîïîíîâàíèì Ãðîäçèí-

ñüêèì À.Ì. [4]. Â ÿêîñò³ òåñò-îá’ºêòà âèêîðèñòîâóâàëè

îäíîäåíí³ ïðîðîñòêè, îã³ðêà ñîðòó “Äàëåêîñõ³äíèé”

(Cucumis sativus L.). Âèçíà÷åííÿ öèòîñòàòè÷íèõ âëàñòè-

âîñòåé ïðîâîäèëè çà ìåòîäèêîþ ²âàíîâà Â.Á. òà ³í. [5].

Ãåìîë³òè÷íó àêòèâí³ñòü ëåêòèí³â âèçíà÷àëè çà äîïî-

ìîãîþ ðåàêö³¿ ãåìàãëþòèíàö³¿ ç åðèòðîöèòàìè ìåòîäîì

ðîçâåäåííÿ åêñòðàêòó â ëóíêàõ äëÿ ì³êðîòèòðóâàííÿ [3].

Àíòèáàêòåð³àëüíó òà àíòèôóíã³öèäíó àêòèâí³ñòü åêñò-

ðàêò³â âèçíà÷àëè çà ìåòîäîì äèñê³â [6] ç âèêîðèñòàííÿì

ñòàíäàðòíèõ òåñò-øòàì³â ì³êðîîðãàí³çì³â ³ ãðèá³â:

Escher³chia coli ATCC 25922, Pseudomonas aeruginosa

ATCC 27853 òà Ñandida albicans ATCC 885-653.

Ñòàòèñòè÷íà îáðîáêà ïðîâîäèëàñü çà äîïîìîãîþ

ïðîãðàì EXÑEL 7.0 ³ Statistica 5.0, ñòàòèñòè÷í³ ïîìèëêè â

äîñë³äàõ êîëèâàëèñü â ìåæàõ 5% [7] . Ïîâòîðí³ñòü äîñë³ä³â

òðèêðàòíà. Â òàáëèöÿõ ïðèâåäåí³ ñåðåäí³ çíà÷åííÿ.

Ðåçóëüòàòè òà îáãîâîðåííÿ. Äîñë³äæåííÿ, ïðîâåäåí³

çà ìåòîäèêîþ [1] ïîêàçàëè, ùî Allium ursinum L. º ëåêòè-

íîì³ñòêîþ ðîñëèíîþ. Ëåêòèíè ÿâëÿþòü ñîáîþ á³ëêè ðîñ-

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÒÅÎÐÅÒÈ×ÍÀ ÌÅÄÈÖÈÍÀ / HEORETICAL MEDICINE

ëèííîãî àáî òâàðèííîãî ïîõîäæåííÿ, çàãàëüíîþ âëàñòè-

â³ñòþ ÿêèõ º âèá³ðêîâå çâîðîòíå çâ’ÿçóâàííÿ ç âóãëåâîäà-

ìè, â òîìó ÷èñë³ ç òèìè, ÿê³ âõîäÿòü äî ñêëàäó ãë³êîïðî-

òå¿ä³â. Âçàºìîä³ÿ ëåêòèí³â ç ãë³êîïðîòå¿äàìè íàãàäóº

ðåàêö³þ àíòèãåí-àíòèò³ëî ³ âèçíà÷àºòüñÿ âóãëåâîäíîþ äå-

òåðì³íàíòí³ñòþ, à òî÷í³øå – ñòðóêòóðîþ ñàõàðèä³â âóãëå-

âîäíîãî êîìïîíåíòó ãë³êîïðîòå¿ä³â. Îäíàê ëåêòèíè, íà

â³äì³íó â³ä àíòèò³ë, ìàþòü ìåíøó ñïîð³äíåí³ñòü ³ âèá³ð-

êîâ³ñòü âçàºìîä³¿ ç ãë³êîïðîòå¿äàìè [8, 9].

Äîñë³äæåííÿ àëåëîïàòè÷íî¿ àêòèâíîñò³ ìåòàáîë³ò³â

Allium ursinum L. ïîêàçàëè, ùî âîäí³ âèòÿæêè 1:10 ç

ëèñòê³â òà öèáóëèí ïîâí³ñòþ ïðèãí³÷óþòü ð³ñò êîðåí³â

òåñò-îá’ºêòà íàñ³ííÿ îã³ðêà (Cucumis sativus L.), ïðîðî-

ùåíîãî ó âîäíèõ åêñòðàêòàõ ð³çíî¿ êîíöåíòðàö³¿. Íàéâèùà

àëåëîïàòè÷íà àêòèâí³ñòü õàðàêòåðíà äëÿ öèáóëèí (òàáë. 1),

ñïîñòåð³ãàëîñÿ ïðèãí³÷åííÿ ðîñòó êîðåí³â íàâ³òü ïðè êîí-

öåíòðàö³¿ 1:100.

Äîñë³äæåííÿ öèòîñòàòè÷íî¿ àêòèâíîñò³ Allium

ursinum L. ëåêòèíîì³ñòêèõ åêñòðàêò³â ëèñòê³â òà öèáóëèí

ïðîâîäèëè øëÿõîì âèçíà÷åííÿ ê³ëüê³ñòü á³÷íèõ êîðåí³â

òåñò-îá’ºêòà. Âèÿâëåíî, ùî íàéá³ëüøó öèòîñòàòè÷íó

àêòèâí³ñòü ïðîÿâëÿþòü ëèñòêè (òàáë. 2.). Òàê, âîäí³ åêñò-

ðàêòè ç ëèñòê³â íàâ³òü ó êîíöåíòðàö³¿ 1:50 ïîâí³ñòþ ïðèïè-

íÿëè ïðîë³ôåðàö³þ êë³òèí á³÷íèõ êîðåí³â îã³ðêà,

à â êîíöåíòðàö³¿ 1:100 ñïîñòåð³ãàëîñü ïðèãí³÷åííÿ â

ìåæàõ 12%.

Äîñë³äæåííÿ ãåìîë³òè÷íî¿ àêòèâíîñò³ ëåêòèíîì³ñòêèõ

ñïîëóê ð³çíèõ îðãàí³â Allium ursinum L., à ñàìå öèáóëèíè,

ëèñòê³â ³ êâ³òîê âèÿâèëè , ùî âîíà äîñèòü âèñîêà. Âàæëèâî,

ùî ëåêòèíîì³ñòê³ ñïîëóêè ð³çíèõ îðãàí³â â ð³çí³é ì³ð³ âèê-

ëèêàþòü àãëþòèíàö³þ åðèòðîöèò³â, à òàêîæ âèÿâëÿþòü

ñïåöèô³÷í³ñòü åêñòðàêò³â äî ãðóï êðîâ³. Áóëî îòðèìàíî,

ùî òèòð àãëþòèíàö³¿ ëåêòèíîì³ñòêèõ åêñòðàêò³â ç ëèñòê³â

çíà÷íî âèùèé ïðè âèêîðèñòàíí³ ñóñïåíç³¿ åðèòðîöèò³â

I ãðóïè êðîâ³. Íàéâèùèé áàë àãëþòèíàö³¿ â³äïîâ³äàº åêñò-

ðàêòàì ëèñòê³â ç åêñïîçèö³éíî¿ ä³ëÿíêè Êàðïàòè (ñåðïåíü)

äëÿ ² ãðóïè êðîâ³ (òàáë. 3).

Àíàë³ç ðåçóëüòàò³â äîñë³äæåíü öèòîñòàòè÷íî¿ òà ãåìî-

ë³òè÷íî¿ àêòèâíîñòåé ëåêòèíîì³ñòêèõ ñïîëóê ëèñòê³â

Allium ursinum L. ñïîíóêàâ äî âèçíà÷åííÿ àíòèáàêòåð³-

àëüíî¿ òà àíòèôóíã³öèäíî¿ àêòèâí³ñòåé, ÿê³ ïðîâîäèëè ìå-

òîäîì äèñê³â [6]. Íàéá³ëüøó àêòèâí³ñòü âèÿâèëè åêñòðàêòè

ëåêòèí³â ç ëèñòê³â (òàáë. 4).

Ä³àìåòð ë³ç³ñó áóâ íàéá³ëüøèé íà øòàì³ Escherichia

coli – 14 ìì, à íàéìåíøèé – Pseudomonas aeruginosa –

8 ìì. Âèÿâëåíà ôóíã³öèäíà àêòèâí³ñòü ëåêòèí³â ëèñòê³â

Òàáëèöÿ 4.

Çàëåæíîñò³ ä³àìåòðàëüíèõ ðîçì³ð³â çîí ë³çèñó øòàì³â ì³êðîîðãàí³çì³â òà ãðèá³â

â çàëåæíîñò³ â³ä % ðîçâåäåííÿ åêñòðàêò³â ëèñòê³â Allium ursinum L.

Òàáëèöÿ 3.

Ãåìîë³òè÷íà àêòèâíîñò³ ëåêòèíîì³ñòêèõ åêñòðàêò³â ëèñòê³â Allium ursinum L.

Òàáëèöÿ 2.

Öèòîñòàòè÷íà àêòèâí³ñòü ëåêòèíîì³ñòêèõ åêñòðàêò³â Allium ursinum L.

Òàáëèöÿ 1.

Àëåëîïàòè÷íà àêòèâí³ñòü ìåòàáîë³ò³â

Allium ursinum L.

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÒÅÎÐÅÒÈ×ÍÀ ÌÅÄÈÖÈÍÀ / THEORETICAL MEDICINE

Allium ursinum L. íà øòàì³ Ñandida albicans – çîíà ë³çèñó

12 ìì.

Âèñíîâêè.

Â ðåçóëüòàò³ äîñë³äæåíü âèÿâëåíî, ùî Allium ursi-

num L.:

– º ëåêòèíîì³ñòêîþ ðîñëèíîþ;

– ìàº âèñîêó àëåëîïàòè÷íó àêòèâí³ñòü, ïðè÷îìó àê-

òèâí³ñòü åêñòðàêò³â öèáóëèí íàáàãàòî âèùà ïîð³âíÿ-

íî ç ëèñòêàìè;

– ì³ñòèòü öèòîñòàòèêè, ïðè÷îìó íàéá³ëüøó öèòîñòà-

òè÷íó àêòèâí³ñòü ç óñ³õ îðãàí³â ïðîÿâëÿþòü ëèñòêè;

– ëåêòèíîì³ñòê³ åêñòðàêòè ëèñòÿ ïðîÿâëÿþòü ñïå-

öèô³÷í³ñòü äî ²-¿ ãðóïè êðîâ³;

– ëåêòèíîì³ñòê³ åêñòðàêòè ëèñòê³â ïðîÿâëÿþòü àíòè-

áàêòåð³àëüíó àêòèâí³ñòü äî íàñòóïíèõ øòàì³â

ì³êðîîðãàí³çì³â – êèøêîâî¿ ïàëè÷êè (Escherichia

coli) òà ñèíåãí³éíî¿ ïàëè÷êè (Pseudomonas

aeruginosa), à òàêîæ àíòèôóíã³öèäíó àêòèâíîñòü

äî øòàì³â ãðèáà – êàíä³äè á³ë³þ÷î¿ (Ñandida

albicans). Âèçíà÷åí³ ì³í³ìàëüí³ áàêòåðèöèäí³ òà

ôóíã³öèäí³ êîíöåíòðàö³¿. Îòðèìàí³ ðåçóëüòàòè

ñâ³ä÷àòü, ùî ëåêòèíîì³ñòê³ åêñòðàêòè ëèñòê³â Allium

ursinum L. º ïåðñïåêòèâíèìè äëÿ âèêîðèñòàííÿ

ó ìåäè÷í³é ïðàêòèö³ â ÿêîñò³ àíòèá³îòèê³â ðîñëèí-

íîãî ïîõîäæåííÿ.

Ðåöåíçåíò: àêàäåì³ê ÍÀÍ òà ÍÀÌÍ Óêðà¿íè,

ä.ìåä.í., ïðîôåñîð Øèðîáîêîâ Â.Ï.

Ë²ÒÅÐÀÒÓÐÀ

1. Ãåðàñèìåíêî Â.Ã. Áèîòåõíîëîãèÿ. – Ê.: Âèùà øêîëà,

1989.- 343 ñ.

2. Ñîáêî Â.Ã., Ãàïîíåíêî Ì.Á. ²íòðîäóêö³ÿ ð³äê³ñíèõ òà çíè-

êàþ÷èõ ðîñëèí ôëîðè Óêðà¿íè. – Ê.: Íàóê. äóìêà, 1996. – 208 ñ.

3. Ëóöèê Ì.Ä., Ïàíàñþê Å.Í., Ëóöèê À.Ä. Ìåòîäû ïîèñêà

ëåêòèíîâ (ôèòîãåììàãëþòèíèíîâ) è îïðåäåëåíèå èõ èììóíî-

õèìè÷åñêîé ñïåöèôè÷íîñòè. – Ëüâîâ: Èçä-âî Ëüâîâñêîãî ìåä-

èíñòèòóòà, 1980. – 20 ñ.

4. Ãðîäçèíñêèé À. Ì. Àëëåëîïàòèÿ ðàñòåíèé è ïî÷âî-

óòîìëåíèå: Èçá. òð. – Ê.: Íàóêîâà äóìêà, 1991. – 432 ñ.

5. Èâàíîâ Â.Á., Áûñòðîâà Å.Í., Äóáðîâñêèé È.Ã. Ïðîðîñòêè

îãóðöà êàê òåñò-îáúåêò äëÿ îáíàðóæåíèÿ ýôôåêòèâíûõ öèòîñòà-

òèêîâ // Ôèçèîëîãèÿ ðàñòåíèé, – 1986. – Ò.33, âûï.1.-Ñ.195-199.

6. Íàâàøèí Ñ.Ì., Ôîìèíà È.Ï. “Ðàöèîíàëüíàÿ àíòèáèîòèêî-

òåðàïèÿ”. 4-å èçä., ïåðåðàá. è äîï. – Ì.: Ìåäèöèíà, 1982. – 496 ñ.

7. Çàéöåâ Ã.Í. Ìàòåìàòè÷åñêàÿ ñòàòèñòèêà â ýêñïåðè-

ìåíòàëüíîé áîòàíèêå. – Ì.: Íàóêà. – 423ñ.

8. Ëóöèê Ì.Ä., Ïàíàñþê Å.Í., Ëóöèê À.Ä. Ëåêòèíû. Ëüâîâ,

Âèùà øêîëà, 1981. – 154 ñ.

9. Êîðîëåâ Í.Ï. Ôóíêöèè ëåêòèíîâ â êëåòêàõ: Èòîãè íàóêè

è òåõíèêè // Îáùèå ïðîáëåìû ôèçèêî-õèìè÷åñêîé áèîëîãèè. –

Ì.: ÂÈÍÈÒÈ,1984. – Ò.1. – 349 ñ.

ÀÍÒÈÁÀÊÒÅÐÈÀËÜÍÀß ÒÀ ÀÍÒÈÔÓÍÃÈÖÈÄÍÀß

ÀÊÒÈÂÍÎÑÒÈ ÌÅÒÀÁÎËÈÒÎÂ

ALLIUM URSINUM L.

Êà÷àëîâà Î.À.1, Äçþáà Î.².2

1Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò

èìåíè À.À. Áîãîìîëüöà, ã. Êèåâ, Óêðàèíà

2Íàöèîíàëüíûé áîòàíè÷åñêèé ñàä

èìåíè Í.Í. Ãðèøêà ÍÀÍ Óêðàèíû,

ã. Êèåâ, Óêðàèíà

Ðåçþìå. Èññëåäîâàíà àíòèáèîòè÷åêàÿ è àíòèôóíãè-

öèäíàÿ àêòèâíîñòü ëåêòèñîäåðæàùèõ ýêñòðàêòîâ Allium

ursinum L. ñ ïåðñïåêòèâîé èõ èñïîëüçîâàíèÿ â ìåäèöèí-

ñêîé ïðàêòèêå â êà÷åñòâå àíòèáèîòèêîâ ðàñòèòåëüíîãî

ïðîèñõîæäåíèÿ. Ïîêàçàíî, ÷òî íàèáîëüøóþ àêòèâíîñòü

ïðîÿâëÿþò ìåòàáîëèòû ëèñòüåâ ëóêà ìåäâåæüåãî, íà

ïðèìåðå: øòàììîâ ìèêðîîðãàíèçìîâ Escherichia coli,

Pseudomonas aeruginosa è ãðèáà Ñandida albicans. Îï-

ðåäåëåíû ìèíèìàëüíûå áàêòåðèöèäíûå è ôóíãèöèäíûå

êîíöåíòðàöèè ëåêòèñîäåðæàùèõ ýêñòðàêòîâ Allium

ursinum L.

Êëþ÷åâûå ñëîâà: àíòèáàêòåðèàëüíàÿ àêòèâíîñòü,

àíòèôóíãèöèäíàÿ àêòèâíîñòü, ðàñòèòåëüíûå ýêñòðàêòû,

àíòèáèîòèêè ðàñòèòåëüíîãî ïðîèñõîæäåíèÿ.

ANTIBACTERIAL AND ANTIFUNGIC²DAL

ACTIVITIES OF THE METABOLITES OF AN ONION

BEAR (ALLIUM URSINUM L.) EXTRACTS

O. Kachalova 1, O. Dzjuba 2

1Bogomolets National Medical University,

Kyiv, Ukraine

2M.M. Gryshko National Botanic Garden, Kyiv, Ukraine

Summary. Antibacterial and anti-fungicidal activity of the

lektinous Allium ursinum L. extracts is investigated with

prospect of their use in medical practice as phytogen

antibiotics. The greatest activity is shown by metabolites of

leaves of an onion bear, on strains of microorganisms of

Escherichia coli, Pseudomonas aeruginosa and also à

fungus Candida albicans. The minimum bactericidal and

fungicidal concentration of the lektinoconous Allium ursinum

L. extracts are defined.

Key words: antibacterial activity, antifungicidal activity.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÒÅÎÐÅÒÈ×ÍÀ ÌÅÄÈÖÈÍÀ / HEORETICAL MEDICINE

Âñòóï. Îï³êîâà òðàâìà º âàæëèâîþ ìåäè÷íîþ ïðîáëå-

ìîþ, çíà÷óù³ñòü ÿêî¿ ïîâ’ÿçàíà ç ÷àñòîòîþ ³ âàæê³ñòþ óðà-

æåííÿ, äîâãîòðèâàë³ñòþ ë³êóâàííÿ, ð³çíîìàí³òí³ñòþ ³ òÿæ-

ê³ñòþ óñêëàäíåíü, âèñîêîþ ñìåðòí³ñòþ [1, 2, 5, 10].

Âèçíàíî, ùî ó ñêëàäíîìó ³ íåäîñòàòíüî âèâ÷åíîìó ïàòîãå-

íåç³ îï³êîâî¿ õâîðîáè îäíå ç ãîëîâíèõ ì³ñöü íàëåæèòü åíäî-

ãåíí³é ³íòîêñèêàö³¿, ÿêà º ðåçóëüòàòîì ïðîòåîë³çó ïîøêîä-

æåíèõ òêàíèí ³ àëüòåðàö³¿ ã³ñòîãåìàòè÷íèõ áàð’ºð³â [9]. Ó

çâ’ÿçêó ç öèì îáîâ’ÿçêîâîþ ñêëàäîâîþ êîìïëåêñíîãî ë³êó-

âàííÿ îï³êîâî¿ õâîðîáè êë³í³öèñòè ââàæàþòü [2, 9]

âíóòð³øíüîâåííó ³íôóç³þ ïðåïàðàò³â äåç³íòîêñèêàö³éíî¿,

ðåîëîã³÷íî¿, åíåðãåòè÷íî¿ òà ïðîòèøîêîâî¿ ä³¿.

Àêòóàëüí³ñòü äîñë³äæåííÿ îáóìîâëåíà òèì, ùî äî

öüîãî ÷àñó àíàë³ç òà ñï³âñòàâëåííÿ ïîêàçíèê³â åíäîãåííî¿

³íòîêñèêàö³¿ òà ñòðóêòóðíèõ çì³í îðãàí³â íåéðî³ìóíî-

åíäîêðèííî¿ ñèñòåìè ïðè îï³êîâ³é õâîðîá³ çà óìîâ ¿¿ ë³êó-

âàííÿ øëÿõîì ³íôóç³¿ êîëî¿äíî-ã³ïåðîñìîëÿðíèõ ðîç-

÷èí³â íå áóëè ïðåäìåòîì ñïåö³àëüíèõ äîñë³äæåíü.

Ìåòà äîñë³äæåííÿ: âèâ÷åííÿ ïîêàçíèê³â ëåòàëüíîñò³

òà åíäîãåííî¿ ³íòîêñèêàö³¿, à òàêîæ ñòðóêòóðíèõ çì³í àäå-

íîã³ïîô³çà, ê³ðêîâî¿ ðå÷îâèíè íàäíèðêîâî¿ çàëîçè ³ òèìó-

ñà ïðè åêñïåðèìåíòàëüí³é îï³êîâ³é õâîðîá³ ó ùóð³â çà

óìîâ ¿¿ ë³êóâàííÿ øëÿõîì âíóòð³øíüîâåííî¿ ³íôóç³¿

HAES-LX-5% òà ëàêòîïðîòå¿íó ç ñîðá³òîëîì.

Ìàòåð³àëè òà ìåòîäè. Åêñïåðèìåíòàëüíå äîñë³äæåííÿ

ìîðôîëîã³÷íèõ çì³í â àäåíîã³ïîô³ç³, íàäíèðêîâ³é çàëîç³

òà òèìóñ³ ïðè îï³êîâ³é õâîðîá³ (÷åðåç 1, 3, 7, 14, 21 òà 30 ä³á)

òà çà óìîâ ä³¿ ³íôóç³éíèõ êîëî¿äíî-ã³ïåðîñìîëÿðíèõ ïðå-

ïàðàò³â äåç³íòîêñèêàö³éíî¿, ðåîëîã³÷íî¿, åíåðãåòè÷íî¿,

ïðîòèøîêîâî¿ ä³¿ HAES-LX-5% òà ëàêòîïðîòå¿íó ç ñîðá³-

òîëîì [4,8] áóëî âèêîíàíî íà 90 ùóðàõ-ñàìöÿõ ë³í³¿ Â³ñòàð

ìàñîþ 155-160 ãðàì.

Óòðèìàííÿ òà ìàí³ïóëÿö³¿ ç òâàðèíàìè ïðîâîäèëè ó â³ä-

ïîâ³äíîñò³ äî “Çàãàëüíèõ åòè÷íèõ ïðèíöèï³â åêñïåðèìåíò³â

íà òâàðèíàõ”, óõâàëåíèõ Ïåðøèì íàö³îíàëüíèì êîíãðåñîì

ç á³îåòèêè (Êè¿â, 2001), òàêîæ êåðóâàëèñÿ ðåêîìåíäàö³ÿìè

“ªâðîïåéñüêî¿ êîíâåíö³¿ ïðî çàõèñò õðåáåòíèõ òâàðèí, ÿê³

âèêîðèñòîâóþòüñÿ äëÿ åêñïåðèìåíòàëüíèõ òà ³íøèõ íàóêî-

âèõ ö³ëåé” (Ñòðàñáóðã, 1985) ³ ïîëîæåííÿìè “Ïðàâèë äî

êë³í³÷íî¿ îö³íêè áåçïåêè ôàðìàêîëîã³÷íèõ çàñîá³â (GLP)”.

ÓÄÊ 611.814.3:611-018]:616-001.17-092.4-08

ÂÏËÈÂ ÅÍÄÎÃÅÍÍÎ¯ ²ÍÒÎÊÑÈÊÀÖ²¯ ÍÀ ÑÒÐÓÊÒÓÐÍ²

ÇÌ²ÍÈ ÎÐÃÀÍ²Â ÍÅÉÐÎ²ÌÓÍÎÅÍÄÎÊÐÈÍÍÎ¯

ÑÈÑÒÅÌÈ ÇÀ ÓÌÎÂ Ë²ÊÓÂÀÍÍß ÎÏ²ÊÎÂÎ¯ ÕÂÎÐÎÁÈ

ÊÎÌÁ²ÍÎÂÀÍÈÌÈ Ã²ÏÅÐÎÑÌÎËßÐÍÈÌÈ ÐÎÇ×ÈÍÀÌÈ

Êîâàëü÷óê Î.².1, ×åðêàñîâ Å.Â.1, Äçåâóëüñüêà ².Â.1, Ãóíàñ ².Â.2

1 Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Î.Î. Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

2 Â³ííèöüêèé íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Ì.². Ïèðîãîâà, ì. Â³ííèöÿ, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: îï³ê, åíäîãåííà ³íòîêñèêàö³ÿ, àäåíîã³ïîô³ç, íàäíèðêîâà çàëîçà, òèìóñ, ñâ³òëîâà òà

åëåêòðîííà ì³êðîñêîï³ÿ, ìîëåêóëè ñåðåäíüî¿ ìàñè, ëåéêîöèòàðíèé ³íäåêñ ³íòîêñèêàö³¿.

Òâàðèíè áóëè ðîçä³ëåí³ íà 7 ãðóï: ² – ³íòàêòí³ òâàðèíè;

²², ²²², ²V – ùóðè áåç òåðì³÷íî¿ òðàâìè, ÿêèì ïðîâîäèëàñü

îêðåìà ³íôóç³ÿ 0,9% ðîç÷èíó NaCl, HAES-LX-5% òà ëàê-

òîïðîòå¿íó ç ñîðá³òîëîì (ëàêòîïðîòå¿íó-Ñ) â³äïîâ³äíî ó

äîç³ 10 ìë/êã; V, V², V²² – òâàðèíè ç îï³êîì, ÿêèì çà àíàëî-

ã³÷íîþ ñõåìîþ òà ó òàêîìó æ äîçîâîìó ðåæèì³ ïðîâîäè-

ëè îêðåìå ââåäåííÿ äîñë³äæóâàíèõ ðå÷îâèí.

Îï³ê (ï³ñëÿ â³äïîâ³äíî¿ ïðåìåäèêàö³¿) âèêëèêàëè øëÿ-

õîì ïðèêëàäàííÿ äî á³÷íèõ ïîâåðõîíü òóëóáà òâàðèí ÷î-

òèðüîõ ì³äíèõ ïëàñòèíîê (ïî äâ³ ïëàñòèíêè ç êîæíîãî

áîêó), ÿê³ ïîïåðåäíüî òðèìàëè ïðîòÿãîì øåñòè õâèëèí ó

âîä³ ç ïîñò³éíîþ òåìïåðàòóðîþ 100 °Ñ. Çàãàëüíà ïëîùà

îï³êó ó ùóð³â çàçíà÷åíî¿ ìàñè ñêëàäàëà 21–23% ïðè åêñ-

ïîçèö³¿ 10 ñåê., ùî º äîñòàòí³ì äëÿ ôîðìóâàííÿ îï³êó ²²

ñòóïåíÿ – äåðìàëüíîãî ïîâåðõíåâîãî îï³êó òà ðîçâèòêó

øîêîâîãî ñòàíó ñåðåäíüîãî ñòóïåíÿ âàæêîñò³.

Äîñë³äæóâàí³ ðîç÷èíè ââîäèëè âíóòð³øíüîâåííî

ïðîòÿãîì 5-6 õâ. ó äîç³ 10 ìë/êã ìàñè ò³ëà. ²íôóç³þ ïðîâî-

äèëè ó íèæíþ ïîðîæíèñòó âåíó, äëÿ ÷îãî âèêîíóâàëè â

àñåïòè÷íèõ óìîâàõ ¿¿ êàòåòåðèçàö³þ ÷åðåç ñòåãíîâó âåíó.

Êàòåòåð, âñòàíîâëåíèé ó ñòåãíîâ³é âåí³, ï³äøèâàëè ï³ä

øê³ðó. Éîãî ïðîñâ³ò ïî âñ³é äîâæèí³ çàïîâíþâàëè òèòðî-

âàíèì ðîç÷èíîì ãåïàðèíó (0,1 ìë ãåïàðèíó íà 10 ìë 0,9%

ðîç÷èíó NaCl) ï³ñëÿ êîæíîãî ââåäåííÿ ðå÷îâèí. Ïåðøå

ââåäåííÿ ðîç÷èí³â çä³éñíþâàëè ÷åðåç 1 ãîäèíó ï³ñëÿ ìî-

äåëþâàííÿ ïàòîëîã³÷íîãî ñòàíó, íàñòóïí³ ³íôóç³¿ âèêîíó-

âàëè ùîäåííî çàãàëîì âïðîäîâæ 7 ä³á.

Ïðîâåäåí³ íàìè ïîïåðåäí³ äîñë³äæåííÿ ïîêàçàëè

(òàáë. 1), ùî ùóðè-ñàìö³ áåç áóäü-ÿêî¿ ôàðìàêîêîðåêö³¿ íà

ôîí³ îï³êîâî¿ òðàâìè øê³ðè ãèíóëè âñ³ íà 9-ó äîáó åêñïå-

ðèìåíòó, à íà 7-ó äîáó ëåòàëüí³ñòü ñêëàäàëà 80%, â çâ’ÿçêó

Òàáëèöÿ 1.

Ëåòàëüí³ñòü ùóð³â ï³ñëÿ îï³êîâî¿ òðàâìè

øê³ðè áåç ââåäåííÿ áóäü-ÿêèõ ôàðìàêîëîã³÷íèõ

ðîç÷èí³â

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÒÅÎÐÅÒÈ×ÍÀ ÌÅÄÈÖÈÍÀ / THEORETICAL MEDICINE

ç ÷èì (âðàõîâóþ÷è ïèòàííÿ á³îåòèêè), ïðàêòè÷íî íå ìîæ-

ëèâèì áóëî íàáðàòè êîðåêòíó, ó ê³ëüê³ñíîìó â³äíîøåíí³,

ãðóïó êîíòðîëþ ç ÷èñòèì îï³êîì øê³ðè áåç ë³êóâàííÿ.

Òîìó çàäëÿ êîíòðîëþ ë³êóâàëüíî¿ ä³¿ ã³ïåðîñìîëÿðíèõ ðîç-

÷èí³â ìè ñïèðàëèñÿ íà ãðóïó òâàðèí, ÿê³ íà ôîí³ îï³êó

øê³ðè îòðèìóâàëè 0,9 % ðîç÷èí NaCl (³çîòîí³÷íèé ðîç÷èí).

Ó ãðóï³ òâàðèí ç îï³êîâîþ òðàâìîþ øê³ðè, ÿêèì ââî-

äèëè 0,9 % ðîç÷èí NaCl, âèÿâëåíå (òàáë. 2) ïðîãðåñóþ÷å

çá³ëüøåííÿ ïîêàçíèêà ëåòàëüíîñò³ â³ä 5% ÷åðåç 1-ó äîáó

äî 11% ó ïðîì³æêó â³ä 4-¿ äî 7-¿ äîáè ç íàñòóïíèì ïîñòó-

ïîâèì çìåíøåííÿì âåëè÷èíè äàíîãî ïîêàçíèêà äî 3% ó

ïðîì³æêó â³ä 22-¿ äî 30-¿ äîáè ï³ñëÿ îï³êó øê³ðè. Çàãàëü-

íèé ïîêàçíèê ëåòàëüíîñò³ â ãðóï³ ùóð³â ñàìö³â, ÿêèì ï³ñëÿ

îï³êó øê³ðè ââîäèëè 0,9% ðîç÷èí NaCl ñêëàâ 43,5%. Îêðå-

ìà ë³êóâàëüíà êóðñîâà òåðàï³ÿ ùóð³â ç îï³êîâîþ òðàâìîþ

øê³ðè ðîç÷èíîì HAES-LX-5% ïîä³áíî äî òàêî¿ ëàêòîïðî-

òå¿íîì-Ñ ñóòòºâî ïåðåøêîäæàëà çàãèáåë³ òâàðèí óïðî-

äîâæ óñüîãî ñïîñòåðåæåííÿ.

Ñòóï³íü ³íòîêñèêàö³¿ ïðè îï³êîâ³é õâîðîá³ âèçíà÷àëè çà

ð³âíåì ìîëåêóë ñåðåäíüî¿ ìàñè [7] òà ëåéêîöèòàðíèì

³íäåêñîì ³íòîêñèêàö³¿ (Ë²²), ÿêèé ðîçðàõîâóºòüñÿ [6]

çà ôîðìóëîþ ß. Êàëüô-Êàë³ôà:

Ë²² =((4Ì+3Þ+2Ï+Ñ)õ(Ïë+1))/((Ë+Ìî)õ(Å+1)),

äå Ì – ì³ºëîöèòè, Þ – þí³, Ï – ïàëè÷êîÿäåðí³, Ñ – ñåãìåíòî-

ÿäåðí³ íåéòðîô³ëè, Ïë – ïëàçìîöèòè, Ë – ë³ìôîöèòè, Ìî – ìî-

íîöèòè, Å – åîçèíîô³ëè.

Äîñë³äæåííÿ ñòóïåíÿ ³íòîêñèêàö³¿ ïðîâîäèëè â ïðî-

áëåìí³é íàóêîâî-äîñë³äí³é ëàáîðàòîð³¿ ôóíêö³îíàëüíî¿

ìîðôîëîã³¿ òà ãåíåòèêè ðîçâèòêó íàóêîâî-äîñë³äíîãî öåí-

òðó Â³ííèöüêîãî íàö³îíàëüíîãî ìåäè÷íîãî óí³âåðñèòåòó

³ìåí³ Ì.². Ïèðîãîâà, ñåðòèô³êîâàíî¿ ÄÔÖ ÌÎÇ Óêðà¿íè

(ïîñâ³ä÷åííÿ ¹003/10 â³ä 11.01.2010 ð).

Ñòàòèñòè÷íèé àíàë³ç ðåçóëüòàò³â äîñë³äæåííÿ ïðîâåëè

â ïàêåò³ STATISTICA 5.5 (íàëåæèòü ÖÍ²Ò ÂÍÌÓ ³ìåí³

Ì.². Ïèðîãîâà. Ë³öåíç³éíèé ¹AXXR910A374605FA) ç âè-

êîðèñòàííÿì íåïàðàìåòðè÷íèõ ìåòîä³â îö³íêè îòðèìà-

íèõ ðåçóëüòàò³â. Îö³íþâàëè ïðàâèëüí³ñòü ðîçïîä³ëó îçíàê

çà êîæíèì ç îòðèìàíèõ âàð³àö³éíèõ ðÿä³â, ñåðåäí³ çíà÷åí-

íÿ çà êîæíîþ îçíàêîþ, ùî âèâ÷àëèñÿ òà ñòàíäàðòí³ â³äõè-

ëåííÿ. Äîñòîâ³ðí³ñòü ð³çíèö³ çíà÷åíü ì³æ íåçàëåæíèìè

ê³ëüê³ñíèìè âåëè÷èíàìè âèçíà÷àëè çà äîïîìîãîþ U-êðè-

òåð³ÿ Ìàíà-Ó³òí³.

Çàá³ð ìàòåð³àëó ïðîâîäèâñÿ ï³ä íàðêîçîì. Ó òâàðèí

ï³ñëÿ äåêàï³òàö³¿ ïðîâîäèëè ðîçòèí ïîðîæíèíè ÷åðåïà,

÷åðåâíî¿ òà ãðóäíî¿ ïîðîæíèíè ³ âèð³çàëè çà äîïîìîãîþ

ëåçà íåâåëèê³ øìàòî÷êè àäåíîã³ïîô³çà, ê³ðêîâî¿ ðå÷îâèíè

íàäíèðêîâî¿ çàëîçè, òèìóñà. Ìàòåð³àë äëÿ ìîðôîëîã³÷íèõ

äîñë³äæåíü îáðîáëÿëè çà çàãàëüíîïðèéíÿòîþ ìåòîäèêîþ.

Óëüòðàòîíê³ çð³çè ãîòóâàëè íà óëüòðàì³êðîòîì³ LKB,

âèâ÷àëè òà ôîòîãðàôóâàëè íà åëåêòðîííîìó ì³êðîñêîï³

ÏÅÌ-125Ê. Íàï³âòîíê³ çð³çè çàáàðâëþâàëè òîëó¿äèíîâèì

òà ìåòèëåíîâèì ñèí³ì. Ã³ñòîëîã³÷í³ çð³çè (îäåðæàí³ ç

ïàðàô³íîâèõ áëîê³â) çàáàðâëþâàëè ãåìàòîêñèë³í-ï³êðî-

ôóêñèíîì òà ãåìàòîêñèë³í-åîçèíîì. Ìîðôîìåòðè÷íå

äîñë³äæåííÿ ã³ñòîëîã³÷íèõ ïðåïàðàò³â áóëî ïðîâåäåíå ³ç

âèêîðèñòàííÿì ì³êðîñêîïó Olympus BÕ 51. Îòðèìàí³ ðå-

çóëüòàòè ñòàòèñòè÷íî îáðîáëÿëè ç âèêîðèñòàííÿì t-êðè-

òåð³þ Ñòüþäåíòà.

Åëåêòðîííîì³êðîñêîï³÷íå äîñë³äæåííÿ âèêîíàíî íà

áàç³ â³ää³ëó åëåêòðîííî¿ ì³êðîñêîï³¿ (íàóêîâèé êåð³âíèê –

ïðîôåñîð Ë.Î. Ñòå÷åíêî) ²íñòèòóòó ïðîáëåì ïàòîëîã³¿

Íàö³îíàëüíîãî ìåäè÷íîãî óí³âåðñèòåòó ³ìåí³ Î.Î. Áîãî-

ìîëüöÿ.

Ðåçóëüòàòè äîñë³äæåííÿ òà ¿õ îáãîâîðåííÿ. Äèíàì³êà

ïîêàçíèê³â ñòóïåíÿ ³íòîêñèêàö³¿ ñâ³ä÷àòü, ùî ð³âåíü ìîëå-

êóë ñåðåäíüî¿ ìàñè òà ëåéêîöèòàðíîãî ³íäåêñó ³íòîêñè-

êàö³¿ (Ë²²), ñòàòèñòè÷íî çíà÷óùå íèæ÷èé ó ùóð³â áåç îï³-

êó, í³æ ó ùóð³â ç îï³êîì óïðîäîâæ âñüîãî åêñïåðèìåíòó.

Äîñë³äæóâàí³ ïîêàçíèêè º ñòàòèñòè÷íî âèùèìè ó ùóð³â,

ÿêèì ââîäèëè 0,9% ðîç÷èí NaCl â ïîð³âíÿíí³ ç òâàðèíàìè,

ÿêèì ïðîâîäèëè îêðåìó ³íôóç³þ ëàêòîïðîòå¿íó-Ñ òà

HAES-LX-5%. Íàéâèù³ ïîêàçíèêè ð³âíÿ ìîëåêóë ñåðåä-

íüî¿ ìàñè ó ùóð³â ç îï³êîì çàô³êñîâàí³ ÷åðåç 3 äîáè ï³ñëÿ

îï³êó, ùî â³äïîâ³äàº ïåð³îäó ãîñòðîãî îï³êîâîãî øîêó.

Íàéìåíøèé ð³âåíü ìîëåêóë ñåðåäíüî¿ ìàñè ó ùóð³â ç îï³-

êîì âñòàíîâëåíèì ÷åðåç 30 ä³á ï³ñëÿ òðàâìè. Ð³âåíü Ë²²

äîñÿãàâ ñâîãî ìàêñèìóìó ó ùóð³â ç îï³êîì, ÿêèì ââîäèëè

ëàêòîïðîòå¿í-Ñ òà HAES-LX-5% ÷åðåç 3 äîáè.

Äëÿ àäåíîã³ïîô³çà, ê³ðêîâî¿ ðå÷îâèíè íàäíèðêîâî¿ çà-

ëîçè ³ òèìóñà ùóð³â ç îï³êîâîþ òðàâìîþ øê³ðè, ÿêèì ââî-

äèëè 0,9% ðîç÷èí NaCl, ÷åðåç 1, 3, 7 òà 14 ä³á åêñïåðèìåíòó

(òåðì³íè, êîëè çàðåºñòðîâàíå çá³ëüøåííÿ òà ñòàá³ë³çàö³ÿ

âåëè÷èíè ïîêàçíèê³â ëåòàëüíîñò³ òà åíäîãåííî¿ ³íòîêñè-

êàö³¿) íàéá³ëüø õàðàêòåðíèì çàãàëüíèì ïðîÿâîì ïàòî-

ìîðôîëîã³÷íèõ çì³í áóëà àëüòåðàö³ÿ ôóíêö³îíàëüíî

ð³çíèõ êë³òèí îðãàí³â òà ñò³íîê ñóäèí ãåìîì³êðîöèðêóëÿ-

òîðíîãî ðóñëà íà òë³ ìîçà¿÷íîãî, àëå, ³íêîëè âèðàçíîãî

(îñîáëèâî ÷åðåç 1 äîáó) ì³æêë³òèííîãî òà ïàðàâàçàëüíîãî

íàáðÿêó (ðèñ. 1; ðèñ. 2; ðèñ. 3).

Ó öåé ïåð³îä ó ñò³íö³ êðîâîíîñíèõ êàï³ëÿð³â ³ âåíóë

ñïîñòåð³ãàºòüñÿ íàáðÿê åíäîòåë³îöèò³â, ¿õ ïàðö³àëüíèé

³ òîòàëüíèé íåêðîç, â³äáóâàºòüñÿ ïîòîíøåííÿ òà ëîêàëüíà

Ïðèì³òêè:

1. * – äîñòîâ³ðíà ð³çíèöÿ â³äíîñíî êîíòðîëþ (îï³ê + 0,9 % NaCl);

2. # – òåíäåíö³ÿ ð³çíèö³ â³äíîñíî êîíòðîëþ (îï³ê + 0,9 % NaCl).

Òàáëèöÿ 2.

Âïëèâ ôàðìàêîòåðàï³¿ 0,9% ðîç÷èíîì NaCl, ëàêòîïðîòå¿íîì-Ñ òà HAES-LX-5%

íà ïîêàçíèêè ëåòàëüíîñò³ ùóð³â ç îï³êîâîþ òðàâìîþ øê³ðè

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÒÅÎÐÅÒÈ×ÍÀ ÌÅÄÈÖÈÍÀ / HEORETICAL MEDICINE

ðóéíàö³ÿ áàçàëüíî¿ ìåìáðàíè, óòâîðþþòüñÿ ïàðàâà-

çàëüí³ êðîâîâèëèâè.

Ó ñò³íö³ äåÿêèõ êðîâîíîñíèõ êàï³ëÿð³â ç³ çáåðåæåíîþ

ñóäèííîþ ñò³íêîþ åíäîòåë³àëüíå ïîêðèòòÿ ó öåé ïåð³îä

ñòàº òîíêèì, â ä³ëÿíêàõ ïðîñòèõ çà ôîðìîþ ³ íåâåëèêèõ çà

äîâæèíîþ ì³æäîòåë³àëüíèõ êîíòàêò³â ç‘ÿâëÿþòüñÿ ðîçøè-

ðåí³ ì³æåíäîòåë³àëüí³ ù³ëèíè àáî òðàíñåíäîòåë³àëüí³

êàíàëè, ÿê³ â çîíàõ â³äïîâ³äíèõ äî íèõ ëîêóñ³â ðóéíàö³¿ áà-

çàëüíî¿ ìåìáðàíè ìàþòü âèãëÿä íàñêð³çíèõ òðàíñìóðàëü-

íèõ äåôåêò³â (ðèñ. 4). Îïèñàí³ òðàíñìóðàëüí³ äåôåêòè ðà-

çîì ç ïðèëåãëèìè ³ ðîçøèðåíèìè (ó ðåçóëüòàò³ ðîçâèòêó

íàáðÿêó) ì³æêë³òèííèìè ïðîñòîðàìè âèâ÷åíèõ îðãàí³â º

ì³ñöÿìè “ïðîò³êàííÿ” ³ âíóòð³øíüîîðãàííîãî “ïðîíèê-

íåííÿ” ïëàçìè òà êë³òèí êðîâ³, ùî ïðèçâîäèòü äî ïðîãðå-

ñóâàííÿ íàáðÿêó òà êðîâîâèëèâ³â.

Ó ùóð³â ç îï³êîâîþ òðàâìîþ, ÿêèì çà ñõåìîþ åêñïå-

ðèìåíòó áóëè ââåäåí³ ã³ïåðîñìîëÿðí³ ðîç÷èíè (VI òà VII

ãðóïè òâàðèí), ó äîñë³äæåíèõ îðãàíàõ íåéðî³ìóíîåíäî-

êðèííî¿ ñèñòåìè íå âèÿâëåí³ ñóòòºâ³ ïîøêîäæåííÿ ñò³íêè

êðîâîíîñíèõ ñóäèí òà êðîâîâèëèâè, à òàêîæ, â³äïîâ³äíî,

íå çàðåºñòðîâàí³ ñòðóêòóðí³ îçíàêè ïàðàâàçàëüíîãî òà

ì³æêë³òèííîãî íàáðÿêó. Öå ñâ³ä÷èòü ïðî àíã³îïðîòåê-

òîðí³ âëàñòèâîñò³ çàñòîñîâàíèõ êîìá³íîâàíèõ ã³ïåðîñìî-

ëÿðíèõ ðîç÷èí³â, ÿê³ çà óìîâ çàñòîñóâàííÿ ëàêòîïðîòå¿íó-

Ñ ïîâ’ÿçàí³ ç äîâîë³ ñïåöèô³÷íîþ ìåìáðàíîïëàñòè÷íîþ

ä³ºþ öüîãî ïðåïàðàòó.

×åðåç 3 äîáè ³, îñîáëèâî, ÷åðåç 7 ä³á â äîñë³äæåíèõ

îðãàíàõ òâàðèí ç îï³êîâîþ òðàâìîþ, ÿêèì áóâ ââåäåíèé

ëàêòîïðîòå¿í-Ñ (VII åêñïåðèìåíòàëüíà ãðóïà), íàâêîëî

êðîâîíîñíèõ ñóäèí òà â çîí³ áàçàëüíî¿ ìåìáðàíè ñóäèí-

íî¿ ñò³íêè â³äçíà÷åíå íåð³âíîì³ðíå íàêîïè÷åííÿ ãåòåðî-

ìîðôíîãî åëåêòðîííîù³ëüíîãî ìàòåð³àëó (ñêëàäàºòüñÿ

ç íåîäíàêîâî ðîçïîä³ëåíèõ â àìîðôíîìó ìàòðèêñ³ äð³á-

íèõ ô³áðèë òà ãðàíóë). Çàãàëüíà åëåêòðîííà ù³ëüí³ñòü

öüîãî ìàòåð³àëó º ìåíøîþ í³æ ù³ëüí³ñòü ìàòðèêñó

åðèòðîöèò³â ó ñóäèííîìó ïðîñâ³ò³. Öåé ìàòåð³àë íà

åëåêòðîíîãðàìàõ â³äð³çíÿºòüñÿ â³ä ðîçòàøîâàíîãî ó ñó-

äèííîìó ïðîñâ³ò³ ëàêòîïðîòå¿íó-Ñ, ÿêèé â³çóàëüíî º

ãîìîãåííèì ³ àìîðôíèì.

Ïàðàâàçàëüíèé õàðàêòåð ðîçòàøóâàííÿ çàçíà÷åíîãî

åëåêòðîííîù³ëüíîãî ìàòåð³àëó ñâ³ä÷èòü, ùî éîãî ïîÿâà

Ðèñ. 3. Êðîâîâèëèâ â àäåíîã³ïîô³ç³ ùóðà ÷åðåç 7 ä³á ðîçâèòêó

îï³êîâî¿ õâîðîáè çà óìîâ ââåäåííÿ 0,9 % ðîç÷èíó NaCl.

1 – åðèòðîöèò ó ïðîñâ³ò³ íåóøêîäæåíîãî êðîâîíîñíîãî

êàï³ëÿðà; 2 – ïðîñâ³ò êðîâîíîñíîãî êàï³ëÿðà; 3 – ÿäðî

ñîìàòîòðîï³â; 4 – öèòîïëàçìà ãîíàäîòðîïà;

– åíäîòåë³îöèò; ì³æêë³òèííèé íàáðÿê;

ôåíåñòðè åíäîòåë³îöèòà. Çá. 6000.

Ðèñ. 2. Êðîâîíîñíèé êàï³ëÿð ³ç ñóáòîòàëüíî çðóéíîâàíîþ

åíäîòåë³àëüíîþ âèñò³ëêîþ â àäåíîã³ïîô³ç³ ùóðà ÷åðåç 1 äîáó

ðîçâèòêó îï³êîâî¿ õâîðîáè çà óìîâ ââåäåííÿ 0,9 % ðîç÷èíó

NaCl. 1 – åðèòðîöèò ó ïðîñâ³ò³ êðîâîíîñíîãî êàï³ëÿðà; 2 –

ÿäðî åíäîòåë³îöèòà ç³ çðóéíîâàíîþ öèòîïëàçìîþ. Çá. 12000.

Ðèñ. 1. Ïàðàâàçàëüíèé íàáðÿê ³ óòâîðåííÿ àãðåãàòó

åðèòðîöèò³â çà òèïîì “ìîíåòíîãî ñòàâï÷èêà” ó ïðîñâ³ò³

âåíóëè â ê³ðêîâ³é ðå÷îâèí³ íàäíèðêîâî¿ çàëîçè ùóðà ÷åðåç

1 äîáó ðîçâèòêó îï³êîâî¿ õâîðîáè çà óìîâ ââåäåííÿ 0,9 %

ðîç÷èíó NaCl. 1 – “ìîíåòíèé ñòîâï÷èê” åðèòðîöèò³â ó

ïðîñâ³ò³ âåíóëè; 2 – ïàðàâàçàëüí³ åðèòðîöèòè. Çá. 14000.

Ðèñ. 4. Óòâîðåííÿ íàñêð³çíèõ äåôåêò³â

(òðàíñåíäîòåë³àëüíèõ êàíàë³â òà â³äïîâ³äíèõ äî íèõ ëîêóñ³â

çíèêíåííÿ áàçàëüíî¿ ìåìáðàíè) â ñò³íö³ êðîâîíîñíîãî

êàï³ëÿðà òèìóñà ùóðà ÷åðåç 7 ä³á ðîçâèòêó îï³êîâî¿ õâîðîáè

çà óìîâ ââåäåííÿ 0,9% ðîç÷èíó NaCl. Ñòð³ëî÷êàìè â³äì³÷åí³

íàñêð³çí³ äåôåêòè êðîâîíîñíîãî êàï³ëÿðà. 1 – åðèòðîöèò

ó ïðîñâ³ò³ êðîâîíîñíîãî êàï³ëÿðà. Çá. 15000.

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÒÅÎÐÅÒÈ×ÍÀ ÌÅÄÈÖÈÍÀ / THEORETICAL MEDICINE

ïîâ’ÿçàíà ç ñïåöèô³êîþ òðàíñïîðòó ñêëàäîâèõ ëàêòîïðî-

òå¿íó-Ñ ï³ñëÿ îï³êîâî¿ òðàâìè ÷åðåç “ïðîò³êàííÿ” ñóäèí-

íî¿ ñò³íêè, ÿê³ âîíè ÷³òêî äåêîðóþòü. Çà ðàõóíîê öüîãî

êîíòóðè ì³æåíäîòåë³àëüíèõ ù³ëèí âèãëÿäàþòü í³áè íàìà-

ëüîâàíèìè ÷îðíîþ ôàðáîþ, ùî ðîçëèëàñü íàâêîëî ñó-

äèí (ðèñ. 5). Öåé “ìàëþíîê” º ñòðóêòóðíèì ìàðêåðîì

ïîòåíö³éíèõ øëÿõ³â âíóòð³øíüîîðãàííîãî ðîçïîâñþä-

æåííÿ øê³äëèâèõ ÷èííèê³â åíäîãåííî¿ ³íòîêñèêàö³¿. Ñêëà-

äîâ³ ëàêòîïðîòå¿íó-Ñ, ùî ïîòðàïèëè ó ñóäèííó ñò³íêó òà

ðîçïîâñþäèëèñÿ ÷åðåç “ïðîíèêíåííÿ” ïàðàâàçàëüíî, ìî-

äèô³êóþòüñÿ çà ðàõóíîê ôàãîöèòîçó òà ñèíòåçóþ÷î¿

ä³ÿëüíîñò³ ïðèëåãëèõ êë³òèí. Â òèìóñ³ ïðî îñòàííº

ñâ³ä÷àòü îçíàêè àêòèâàö³¿ îðãàíåë ñèíòåòè÷íîãî àïàðàòó

ïàðàâàçàëüíèõ åï³òåë³îðåòèêóëîöèò³â (á³ëüøîþ ì³ðîþ

ðîçøèðåííÿ ðîçãàëóæåíèõ êàíàëüö³â ãðàíóëÿðíî¿ åíäîï-

ëàçìàòè÷íî¿ ñ³òêè òà ¿õ çàïîâíåííÿ ïèëîïîä³áíèì âì³ñòîì

ñåðåäíüî¿ åëåêòðîííî¿ ù³ëüíîñò³).

Â³äîìî, ùî ³í³ö³àëüíà ðåàêö³ÿ íà îï³êîâó òðàâìó ìîá³-

ë³çóº çàõèñí³ ñèëè îðãàí³çìó, ÿê³ çàáåçïå÷óþòü éîãî

â³äíîñíî ñòàá³ëüíå ôóíêö³îíóâàííÿ øëÿõîì ï³äâèùåíîãî

íàïðóæåííÿ â³äïîâ³äíèõ îðãàí³â ³ ðåãóëÿòîðíèõ ìå-

õàí³çì³â [5]. Çàáåçïå÷åííÿ ãîìåîñòàçó âíóòð³øíüîãî ñå-

ðåäîâèùà îðãàí³çìó ç îï³êàìè ïåðåäáà÷àº [9] ìîá³ë³çà-

ö³þ ðåãóëÿòîðíèõ ôóíêö³é íåðâîâî¿, åíäîêðèííî¿ òà

³ìóííî¿ ñèñòåì ç ïåðåäà÷åþ ³íôîðìàö³¿ çà äîïîìîãîþ

ãîðìîí³â ³ íåéðîòðàíñì³òåð³â, à òàêîæ ïîÿâîþ ó êðîâ³

ñòðåñ-á³ëê³â (ïðîäóêò³â ïåðåêèñíîãî îêèñëåííÿ ë³ï³ä³â).

Íà êë³òèííîìó ð³âí³ ïåðåêèñíå îêèñëåííÿ ë³ï³ä³â ïîâ’ÿçà-

íå ç ìîäèô³êàö³ºþ ñòðóêòóðíî-ôóíêö³îíàëüíîãî ñòàíó

öèòîìåìáðàí òà ³îííî¿ ð³âíîâàãè â öèòîïëàçì³ êë³òèí,

îá’ºêòèâíèì â³ääçåðêàëåííÿì ÿêèõ º çì³íà ³íòåíñèâíîñò³

îêñèäàòèâíèõ ïðîöåñ³â. Âíàñë³äîê íåäîñòàòíîñò³ êîìïåí-

ñàòîðíî-ïðèñòîñóâàëüíèõ ìîæëèâîñòåé öèõ ñèñòåì ñòà-

ä³ÿ ðåçèñòåíòíîñò³ ïåðåõîäèòü â ñòàä³þ âèñíàæåííÿ [9],

ùî îáóìîâëþº íåçâîðîòí³ çì³íè îðãàí³â, ÿê³ ïðàöþþòü

íàéá³ëüø íàïðóæåíî. Ó âèïàäêó äîñë³äæåíî¿ îï³êîâî¿

õâîðîáè çàçíà÷åíå âèùå ïðîÿâëÿºòüñÿ êë³òèííîþ çàãè-

áåëëþ (íàäëèøêîâèì àïîïòîçîì òà íåêðîçîì êë³òèí) ó

âèâ÷åíèõ îðãàíàõ íåéðî³ìóíîåíäîêðèííî¿ ñèñòåìè.

Ñï³âñòàâëåííÿ êë³í³êî-ëàáîðàòîðíèõ ïîêàçíèê³â òà

ñòðóêòóðíèõ çì³í âèâ÷åíèõ îðãàí³â äîçâîëÿº ïðèïóñòèòè,

ùî â ïàòîãåíåç³ äîñë³äæåíî¿ åêñïåðèìåíòàëüíî¿ îï³êîâî¿

õâîðîáè ïðàêòè÷íî â³äñóòíÿ ôàçà â³äíîñíî¿ ðåçèñòåíòíîñò³

(ÿêà ìàëà á çàáåçïå÷èòè ìîæëèâ³ñòü åôåêòèâíî¿ àäàïòàö³¿

îðãàí³â äî çì³íåíèõ óìîâ ôóíêö³îíóâàííÿ). Óïðîäîâæ 1-7

ä³á ï³ñëÿ îï³êîâî¿ òðàâìè âèçíà÷åí³ ïîêàçíèêè øâèäøå

â³äïîâ³äàþòü ôàç³ âèñíàæåííÿ, ÿêà (çâàæàþ÷è íà òå, ùî

âèâ÷åí³ îðãàíè íàëåæàòü äî íåéðî³ìóíîåíäîêðèííî¿ ñèñ-

òåìè) õàðàêòåðèçóºòüñÿ äèñêîîðäèíàö³ºþ ðåãóëÿòîðíèõ

ìåõàí³çì³â ³ àêòèâàö³ºþ äåç³íòåãðîâàíèõ ïðîöåñ³â. Äåç-

³íòåãðàö³ÿ (ñòðóêòóðíèì ïðîÿâîì ÿêî¿ º íàäëèøêîâèé

àïîïòîç òà íåêðîç êë³òèí) ³ íåäîñòàòíÿ ïðîòèä³ÿ öüîìó ïðî-

öåñó çàõèñíèõ ñèñòåì êë³òèí îðãàí³â íåéðî³ìóíîåíäîêðèí-

íî¿ ñèñòåìè ìàþòü áóòè ðîçö³íåí³ ÿê íàéâàæëèâ³ø³

çàãàëüíîïàòîëîã³÷í³ ìåõàí³çìè ïîðóøåííÿ ãîìåîñòàçó [3].

Çàñòîñóâàííÿ âíóòð³øíüîâåííî¿ ³íôóç³¿ ëàêòîïðîòå¿-

íó-Ñ òà HAES-LX-5% çàáåçïå÷óº ãàëüìóâàííÿ ïðîöåñó

åíäîãåííî¿ ³íòîêñèêàö³¿ ³, òàêèì ÷èíîì, ïðîëîíãàö³þ

ôàçè â³äíîñíî¿ ðåçèñòåíö³¿, à òàêîæ âêëþ÷åííÿ ìåõàí³çì³â

êîìïåíñàòîðíî-ïðèñòîñóâàëüíèõ òà â³äíîâíèõ ïðîöåñ³â ó

âèâ÷åíèõ îðãàíàõ çà óìîâ äîñë³äæåíî¿ åêñïåðèìåíòàëü-

íî¿ îï³êîâî¿ õâîðîáè. Çîêðåìà, íàìè âñòàíîâëåíî, ùî

ñï³âäðóæíÿ ä³ÿëüí³ñòü êë³òèí ñóäèííî¿ ñò³íêè òà ïàðàâàçàëü-

íèõ êë³òèí ïðèçâîäèòü äî ôîðìóâàííÿ ñïåöèô³÷íèõ ìåìá-

ðàíîïîä³áíèõ ñòðóêòóð â ïàðåíõ³ì³ îðãàí³â íåéðîåíäîê-

ðèííî¿ ñèñòåìè ùóð³â VII åêñïåðèìåíòàëüíî¿ ãðóïè.

Àäàïòîãåííèé âïëèâ ëàêòîïðîòå¿íó-Ñ ïîëÿãàº ó òîìó,

ùî çà ðàõóíîê ì³æêë³òèííîãî ïðîñÿêíåííÿ êîìïîíåíò³â

ëàêòîïðîòå¿íó-Ñ ³ óòâîðåííÿ çàçíà÷åíèõ âèùå ìåìáðàíî-

ïîä³áíèõ ñòðóêòóð ñóäèííà ñò³íêà äåÿêèõ êðîâîíîñíèõ êà-

ï³ëÿð³â ñòàº áàãàòîøàðîâîþ. Çà öèõ îáñòàâèí áàð’ºðíà

ôóíêö³ÿ ñóäèííî¿ ñò³íêè çðîñòàº, ùî çàâàæàº ïðîíèêíåí-

íþ â îðãàí öèòîòîêñè÷íèõ ÷èííèê³â, çàïîá³ãàº ðîçâèòêó

íàáðÿê³â ³ êðîâîâèëèâ³â, ³, çàãàëîì, ñóòòºâî çìåíøóº

âïëèâ åíäîãåííî¿ ³íòîêñèêàö³¿ íà îðãàíè íåéðî³ìóíîåí-

äîêðèííî¿ ñèñòåìè.

Ïðîñòîðîâî-÷àñîâ³ ïàðàìåòðè ôîðìóâàííÿ óïåðøå âè-

ÿâëåíèõ ìåìáðàíîïîä³áíèõ ñòðóêòóð ñâ³ä÷àòü, ùî âîíè íå º

òèì÷àñîâèìè óòâîðàìè, ùî çíèêàþòü ÷åðåç íåâåëèêèé ïðî-

ì³æîê ÷àñó ï³ñëÿ ³íôóç³¿ ëàêòîïðîòå¿íó-Ñ (îñòàííÿ

çä³éñíþºòüñÿ ëèøå óïðîäîâæ 7 ä³á). Îêðåì³ îïèñàí³ ñïå-

öèô³÷í³ ìåìáðàíîïîä³áí³ ñòðóêòóðè îá’ºäíóþòüñÿ ó êîì³ð-

êè ³ â³äîêðåìëþþòü êë³òèíè àáî ãðóïè (êëàñòåðè) êë³òèí,

ñïðèÿþòü ¿õ ³çîëÿö³¿ â³ä ðåøòè êë³òèí òà, ìîæëèâî, çàáåçïå-

÷óþòü ¿õ çàõèñò â³ä øê³äëèâèõ âïëèâ³â öèòîòîêñè÷íèõ ÷èííè-

ê³â. Êë³òèíè, ùî îá’ºäíàí³ ó êëàñòåðè (ïî 3-30 êë³òèí), õàðàê-

òåðèçóþòüñÿ, çàçâè÷àé, çáåðåæåí³ñòþ ñòðóêòóð öèòîïëàçìè

òà ÿäðà, àëå, ³íîä³, êëàñòåðèçàö³ÿ º ïðîÿâîì ñâîºð³äíî¿ ñåêâå-

ñòðàö³¿ êë³òèí, ùî ï³äëÿãàþòü àïîïòîçó òà/àáî íåêðîçó.

×åðåç 21 òà 30 ä³á åêñïåðèìåíòó ñïåöèô³÷í³ ìåìáðà-

íîïîä³áí³ ñòðóêòóðè â ñóäèíí³é ñò³íö³ òà â ïàðåíõ³ì³ äîñ-

ë³äæåíèõ îðãàí³â íàáóâàþòü ïîäàëüøîãî ðîçâèòêó òà óò-

âîðþþòü ðîçãàëóæåíèé ìåìáðàíîïîä³áíèé êîìïëåêñ, â

êîì³ðêàõ ÿêîãî ëîêàë³çîâàí³ êë³òèíè, ùî ìàþòü òèïîâ³

îçíàêè ìîðôîëîã³÷íî¿ íîðìè.

Ïîð³âíþþ÷è ïîêàçíèêè ëåòàëüíîñò³ òà ñòóïåíÿ åíäî-

ãåííî¿ ³íòîêñèêàö³¿ ïðè åêñïåðèìåíòàëüí³é îï³êîâ³é õâî-

ðîá³ ó ùóð³â ìîæíà ïðèïóñòèòè, ùî êëàñòåð³çàö³ÿ êë³òèí

(òà ¿õ îòî÷åííÿ ñïåöèô³÷íèìè ìåìáðàíîïîä³áíèìè

ñòðóêòóðàìè) º ñóòòºâèì ÷èííèêîì îáìåæåííÿ íåãàòèâ-

Ðèñ. 5. Åëåêòðîííîù³ëüíèé âì³ñò ó ïðîñâ³ò³ êðîâîíîñíèõ

êàï³ëÿð³â (1), ùî “äåêîðóº” ðîçøèðåí³ ì³æêë³òèíí³ ù³ëèíè

ñóäèííî¿ ñò³íêè ³ í³áè “ðîçëèâàºòüñÿ” íàâêîëî ñóäèí òèìóñà

ùóðà ÷åðåç 7 ä³á ðîçâèòêó îï³êîâî¿ õâîðîáè çà óìîâ ââåäåííÿ

ëàêòîïðîòå¿íó-Ñ. Çá. 6000.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÒÅÎÐÅÒÈ×ÍÀ ÌÅÄÈÖÈÍÀ / HEORETICAL MEDICINE

íèõ âïëèâ³â åíäîãåííî¿ ³íòîêñèêàö³¿ â îðãàíàõ íåéðî³ìó-

íîåíäîêðèííî¿ ñèñòåìè, à â³äòàê ³ (ïðÿìî òà îïîñåðåäêî-

âàíî) â îðãàí³çì³ â ö³ëîìó.

Îòæå, ìîæíà ñêàçàòè, ùî òåðàïåâòè÷íà ä³ÿ çàñòîñîâà-

íèõ ã³ïåðîñìîëÿðíèõ ðîç÷èí³â â óìîâàõ ïîÿâè çîí “ïðî-

ò³êàííÿ” òà “ïðîíèêíåííÿ” â àäåíîã³ïîô³ç³, ê³ðêîâ³é ðå÷î-

âèí³ íàäíèðêîâèõ çàëîç ³ òèìóñ³ ïðè îï³êîâ³é õâîðîá³ íå

îáìåæóºòüñÿ åôåêòàìè (äåç³íòîêñèêàö³éíèì, ðåîëîã³÷-

íèì, ïðîòèøîêîâèì) ¿õ âëàñíå ³íôóç³éíîãî âïëèâó, àëå é

ïðîÿâëÿºòüñÿ àäàïòîãåííèìè (öèòîïðîòåêòîðíèì òà àíã³î-

ïðîòåêòîðíèì) åôåêòàìè, ùî îáóìîâëåí³ óòâîðåííÿì

äîáðå ñòðóêòóðîâàíèõ áàð’ºð³â.

Âèñíîâêè. Çàãàëüíèì ïðîÿâîì ïàòîìîðôîëîã³÷íèõ

çì³í â àäåíîã³ïîô³ç³, ê³ðêîâî¿ ðå÷îâèíè íàäíèðêîâî¿ çàëî-

çè òà òèìóñ³ ïðè îï³êîâ³é õâîðîá³ º àëüòåðàö³ÿ ôóíêö³î-

íàëüíî ð³çíèõ êë³òèí îðãàí³â òà ñò³íîê ñóäèí ãåìîì³êðî-

öèðêóëÿòîðíîãî ðóñëà íà òë³ óòâîðåííÿ êðîâîâèëèâ³â,

âèðàçíîãî ïàðàâàçàëüíîãî òà ì³æêë³òèííîãî íàáðÿêó.

Ïðîâ³äíèì ôàêòîðîì ðîçâèòêó íàáðÿêó â äîñë³äæåíèõ

îðãàíàõ ïðè îï³êîâ³é õâîðîá³ º óòâîðåííÿ íàñêð³çíèõ

òðàíñìóðàëüíèõ äåôåêò³â ó ñò³íö³ êðîâîíîñíèõ ñóäèí

(“ïðîò³êàíü”) ³ â³äïîâ³äíèõ âíóòð³øíüîîðãàííèõ ì³æ-

êë³òèííèõ ðîçøèðåíü (“ïðîíèêíåíü”), ìàðêåðîì ÿêèõ º

åëåêòðîííîù³ëüíèé ëàêòîïðîòå¿í-Ñ.

Ëàêòîïðîòå¿í-Ñ òà HAES-LX-5% çà óìîâ ðîçâèòêó

îï³êîâî¿ õâîðîáè ïðîÿâëÿþòü àäàïòîãåíí³ (öèòî- òà àíã³î-

ïðîòåêòîðí³) âëàñòèâîñò³, ãàëüìóþòü ðîçâèòîê êðîâîâè-

ëèâ³â, íàáðÿêó, çìåíøóþòü âïëèâ åíäîãåííî¿ ³íòîêñèêàö³¿ íà

êë³òèíè àäåíîã³ïîô³çà, ê³ðêîâî¿ ðå÷îâèíè íàäíèðêîâî¿ çàëî-

çè ³ òèìóñà ³ ñïðèÿþòü ðåïàðàö³¿ îðãàí³â. Ëàêòîïðîòå¿í-Ñ çà

óìîâ ðîçâèòêó îï³êîâî¿ õâîðîáè ïðîÿâëÿº óïåðøå îïèñà-

íèé ìåìáðàíîïëàñòè÷íèé åôåêò, ùî ïîëÿãàº â óòâîðåíí³ ó

çîíàõ “ïðîò³êàíü” òà “ïðîíèêíåíü” ñèñòåìè âçàºìî-

çâ’ÿçàíèõ ìåìáðàíîïîä³áíèõ ñòðóêòóð, ùî äîïîâíþþòü òà

ï³äâèùóþòü çàõèñí³ ôóíêö³¿ ã³ñòîãåìàòè÷íèõ áàð’ºð³â.

Ïåðñïåêòèâà ïîäàëüøèõ äîñë³äæåíü – âèâ÷åííÿ çì³í

åíäîêðèíîëîã³÷íèõ òà ³ìóíîëîã³÷íèõ ïîêàçíèê³â îðãàí³çìó

òâàðèí ïðè åêñïåðèìåíòàëüí³é îï³êîâ³é òðàâì³ øê³ðè çà

óìîâ çàñòîñóâàííÿ ³íôóç³¿ HAES-LX-5% òà ëàêòîïðîòå¿íó-Ñ.

Ðåöåíçåíò: ÷ëåí-êîð. ÍÀÌÍ Óêðà¿íè, ä.ìåä.í.,

ïðîôåñîð Þ.Á.×àéêîâñüêèé

Ë²ÒÅÐÀÒÓÐÀ

1. Àçîëîâ Â.Â. Ïðîáëåìû ñïåöèàëèçèðîâàííîé ïîìîùè îáî-

ææåííûì â Ðîññèè è ïóòè èõ ðåøåíèÿ. / Â.Â. Àçîëîâ, Â.À. Æåãà-

ëîâ, Í.À. Ïîíîìàðåâà // Ìåæäóíàðîäíûé ìåäèöèíñêèé æóðíàë. –

2009, 9. – ¹ 2. – Ñ. 102–107.

2. Èíôóçèîííàÿ òåðàïèÿ ó ïàöèåíòîâ õèðóðãè÷åñêîãî ïðî-

ôèëÿ / À.Þ. Ìàëåíêî, Ì.Â. Êîðîâêèí, Â.È. Çàëþáîâñêèé [è äð.] //

Óêð. õ³ì³îòåðàïåâò. æóðí. – 2008. – ¹1-2 (22). – Ñ. 47-49.

3. Êâåòíîé È.Ì. Íåéðîèììóíîýíäîêðèíîëîãèÿ òèìóñà /

È.Ì. Êâåòíîé, À.À. ßðûãèí, Â.Î. Ïîëÿêîâà, È.Â. Êíÿçüêèí // ÑÏÁ:

Èçäàòåëüñòâî ÄÅÀÍ, 2005. – 160 ñ.

4. Îáãðóíòóâàííÿ ðîçðîáêè á³ëêîâîãî-ñîëüîâîãî ïðåïàðàòó

“Ëàêòîïðîòå¿í ç ñîðá³òîëîì” / Á.Î. Êîíäðàöüêèé, Ì.Â. Ìèí-

äþê, Ì.É. Âèíàð÷èê [òà ³í.] // Óêðà¿íñüêèé æóðíàë ãåìàòîëîã³¿

òà òðàíñôóç³îëîã³¿. – 2004. – ¹2(4). – Ñ. 43-47.

5. Îï³êîâà òðàâìà òà ¿¿ íàñë³äêè / Ã.Ï. Êîçèíåöü, Ñ.Â. Ñëºñà-

ðåíêî, Î.Ì. Ñîðîê³íà [òà ³í.]. // Äí³ïðîïåòðîâñüê: Ïðåñà Óêðà¿-

íè, 2008. – 224 ñ.

6. Îöåíêà òÿæåñòè ýíäîãåííîé èíòîêñèêàöèè è âûáîð ìå-

òîäà äåòîêñèêàöèîííîé òåðàïèè ó îáîææåííûõ ïî äàííûì

ëåéêîöèòîãðàììû è áèîõèìè÷åñêîãî ìîíèòîðèíãà / Â.Ê. Ãóñàê,

Ý.Ö. Ôèñòàëü, È.È. Ñïåðàíñêèé [è äð.] // Êëèí. ëàá. äèàãíîñòèêà. –

2000. – ¹10. Ñ. 36.

7. Ñêðèíèíãîâûé ìåòîä îïðåäåëåíèÿ ñðåäíèõ ìîëåêóë â áèîëî-

ãè÷åñêèõ æèäêîñòÿõ. Ìåòîä. ðåêîìåíä. / Í.È. Ãàáðèýëÿí, Ý.Ð. Ëå-

âèöêèé, À.À. Äìèòðèåâ [è äð.]. // Ì.: Ìåäèöèíà, 1985. – 18 ñ.

8. Òðàíñôóç³éíèé ïðåïàðàò “Ëàêòîïðîòå¿í ç ñîðá³òîëîì” –

ôàðìàêîòîêñèêîëîã³÷íà õàðàêòåðèñòèêà / Á.Î. Êîíäðàöüêèé,

Ì.Â. Ìèíäþê, Ì.É. Âèíàð÷èê [òà ³í.] // Óêðà¿íñüêèé æóðíàë ãåìà-

òîëîã³¿ òà òðàíñôóç³îëîã³¿. – 2004. – ¹4 (4). – Ñ. 36-39.

9. Pathophysiology of burns / M. Keck, D. Herdon, L.-P. Komolz

[et al.] // Wien Med. Wochenschr. – 2009. – Vol. 159. – P. 327-336.

10. Support of the response to burn injury / Herndon D.N., Tompkins

R.G. Lancet. – 2004. Vol. 363 (9424). – P. 1895–1902.

ÂËÈßÍÈÅ ÝÍÄÎÃÅÍÍÎÉ ÈÍÒÎÊÑÈÊÀÖÈÈ

ÍÀ ÑÒÐÓÊÒÓÐÍÛÅ ÈÇÌÅÍÅÍÈß ÎÐÃÀÍÎÂ

ÍÅÉÐÎÈÌÌÓÍÎÝÍÄÎÊÐÈÍÍÎÉ ÑÈÑÒÅÌÛ

ÏÐÈ ËÅ×ÅÍÈÈ ÎÆÎÃÎÂÎÉ ÁÎËÅÇÍÈ

ÊÎÌÁÈÍÈÐÎÂÀÍÍÛÌÈ ÃÈÏÅÐÎÑÌÎËßÐÍÛÌÈ

ÐÀÑÒÂÎÐÀÌÈ

Êîâàëü÷óê À.È.1, ×åðêàñîâ Ý.Â.1,

Äçåâóëüñêàÿ È.Â.1, Ãóíàñ È.Â.2

1Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò

èìåíè À.À. Áîãîìîëüöà, ã. Êèåâ, Óêðàèíà

2Âèííèöêèé íàöèîíàëüíûé ìåäèöèíñêèé

óíèâåðñèòåò èìåíè Í.È. Ïèðîãîâà,

ã. Âèííèöà, Óêðàèíà

Ðåçþìå. Â ñòàòüå ïðèâåäåíû äàííûå î ñòðóêòóðíûõ èç-

ìåíåíèÿõ àäåíîãèïîôèçà, íàäïî÷å÷íèêà è òèìóñà ïðè ýê-

ñïåðèìåíòàëüíîé îæîãîâîé áîëåçíè ó êðûñ ïðè å¸ ëå÷å-

íèè ïóò¸ì âíóòðèâåííîé èíôóçèè êîëëîèäíî-ãèïåðîñìî-

ëÿðíûõ ðàñòâîðîâ. Âûÿñíåíî, ÷òî ëàêòîïðîòåèí-Ñ äåéñòâó-

åò êàê ïðîòåêòîð ñîñóäèñòîé ñòåíêè è îêàçûâàåò ìåìáðà-

íîïëàñòè÷åñêîå âëèÿíèå íà ñòðóêòóðó îðãàíîâ.

Êëþ÷åâûå ñëîâà: îæîãîâàÿ áîëåçíü, ýíäîãåííàÿ

èíòîêñèêàöèÿ, àäåíîãèïîôèç, íàäïî÷å÷íèê, òèìóñ, ñâå-

òîâàÿ è ýëåêòðîííàÿ ìèêðîñêîïèÿ, ìîëåêóëû ñðåäíåé

ìàññû, ëåéêîöèòàðíûé èíäåêñ èíòîêñèêàöèè.

INFLUENCE OF ENDOGENOUS INTOXICATION

ON STRUCTURAL CHANGES IN ORGANS

OF NEUROIMMUNOENDOCRINE SYSTEM UNDER

THE CONDITION OF BURN DISEASE TREATMENT

BY COMBINED HYPEROSMOLAR SOLUTIONS

O.I. Kovalchuk1, E.V. Cherkasov1,

I.V. Dzevulska1, I.V. Gunas2

1Bogomolets National Medical University,

Kyiv, Ukraine

2N.I. Pirogov National Medical University,

Vinnytsa, Ukraine

Summàry. The article presents data on the structural

changes in adenohypophysis, adrenal gland and thymus

during experimental burn disease in rat under the condition

of its treatment by the intravenosis infusion of colloid-

hyperosmolar solutions. Lactoproteinum-S protects the

damage of vessel wall and has a membranoplastic

influence on the organic structure.

Key words: burn disease, endogenous intoxication,

adenohypophysis, adrenal gland, thymus, light and

electronic microscopy, molecules of the average mass,

leucocyte index of intoxication.

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÒÅÎÐÅÒÈ×ÍÀ ÌÅÄÈÖÈÍÀ / THEORETICAL MEDICINE

Âñòóï. Ïîøèðåí³ñòü öóêðîâîãî ä³àáåòó (ÖÄ) âðàæàº

ìàñøòàáàìè, àäæå â åêîíîì³÷íî ðîçâèíåíèõ êðà¿íàõ ñâ³òó

õâîðèõ íà ÖÄ – 4 – 6 % íàñåëåííÿ [5, 7]. Çà ïðîãíîçàìè

ÂÎÎÇ, äî 2030 ðîêó ¿õ ê³ëüê³ñòü ó ñâ³ò³ ìîæå ñÿãíóòè 552

ìëí. Òîæ ÖÄ âèçíàíî ïð³îðèòåòîì äëÿ íàö³îíàëüíèõ ñèñ-

òåì îõîðîíè çäîðîâ’ÿ âñ³õ áåç âèíÿòêó êðà¿í ñâ³òó. Çà îñ-

òàííº äåñÿòèë³òòÿ ê³ëüê³ñòü õâîðèõ íà ÖÄ â Óêðà¿í³ ñòð³ìêî

çðîñëà – ç 1,8 äî 2,8 %. Îäíàê, ÿê ñâ³ä÷àòü äîñë³äæåííÿ, ¿õ

ðåàëüíà ê³ëüê³ñòü ùîíàéìåíøå âäâ³÷³ á³ëüøà, îñê³ëüêè

ïîëîâèíà õâîðèõ íàâ³òü íå çäîãàäóºòüñÿ ïðî ñâîþ íåäóãó.

Â³äîìî, ùî ó îñ³á ï³ñëÿ 65 ðîê³â çàõâîðþâàí³ñòü íà ä³àáåò

ñêëàäàº áëèçüêî 10–15% [3, 8]. Ó 2000 ðîö³ ê³ëüê³ñòü õâîðèõ

íà ä³àáåò ñòàíîâèëà 175 ìëí., çã³äíî ç ïðîãíîçîì ì³æ-

íàðîäíîãî ³íñòèòóòó ä³àáåòó (Ìåëüáóðí) íà 2010 ð³ê –

240 ìëí., à íà 2030 ð³ê öÿ öèôðà ñêëàäå 300 ìëí. ÷îë.

Íåäîñòàòíþ óâàãó äîñë³äíèê³â ïðèâåðòàþòü çì³íè

êðîâîíîñíèõ ñóäèí ïàíêðåàòè÷íèõ îñòð³âö³â (ÏÎ)

ï³äøëóíêîâî¿ çàëîçè (ÏÇ) íà ï³çí³õ åòàïàõ îíòîãåíåçó, ïî-

ðóøåííÿ ôóíêö³¿ ÿêèõ ïðèçâîäèòü äî âàæêèõ óñêëàäíåíü

ä³àáåòó [2, 6].

Ìåòîþ ðîáîòè áóëî âñòàíîâèòè îñîáëèâîñò³ êðîâîïî-

ñòà÷àííÿ îñòð³âöåâîãî àïàðàòó ï³äøëóíêîâî¿ çàëîçè

ùóð³â 24-ì³ñÿ÷íîãî â³êó, òà éîãî ïåðåáóäîâà íà ðàíí³õ

åòàïàõ ðîçâèòêó åêñïåðèìåíòàëüíîãî öóêðîâîãî ä³àáåòó.

Ìàòåð³àë òà ìåòîäè äîñë³äæåííÿ. Ðîáîòà âèêîíàíà

íà 20 á³ëèõ ùóðàõ – ñàìöÿõ ë³í³¿ Wistar ìàñîþ 340-420 ã.

24-ì³ñÿ÷íîãî â³êó, ùî óòðèìóâàëèñü â ñòàíäàðòíèõ óìî-

âàõ â³âàð³þ ç äîòðèìàííÿì âñ³õ ïðèéíÿòèõ ïðàâèë. Äëÿ

ïðîâåäåííÿ åêñïåðèìåíòó òâàðèí áóëî ïîä³ëåíî íà äâ³

ãðóïè: ïåðøà – ³íòàêòíà (6 òâàðèí), äðóãà – åêñïåðèìåí-

òàëüíà (14 òâàðèí), ó ÿêèõ ìîäåëþâàëè åêñïåðèìåíòàëü-

íèé ÖÄ [1, 4] ³ç äîñë³äæåííÿì ñòðóêòóðè òà ëàíîê ÃÌÖÐ

ÏÎ íà 2-é, òèæäåíü åêñïåðèìåíòó, ³ç íèõ 4 òâàðèíè ïîñëó-

æèëè êîíòðîëåì.

Óëüòðàñòðóêòóðí³ îñîáëèâîñò³ ñóäèí (ÏÎ) âèâ÷àëè

ï³ä åëåêòðîííèì ì³êðîñêîïîì ÏÝÌ-125 Ê ç ïðèñêîðþþ-

÷îþ íàïðóãîþ 75 êÂ. Ì³êðîôîòîãðàôóâàííÿ ïðåïàðàò³â

çä³éñíþâàëè íà òðèíîêóëÿðíîìó ì³êðîñêîï³ ÌÑ 300

(ÒÕÐ) ç ï³äêëþ÷åíîþ Digital camera for microscope DCM

900 çà äîïîìîãîþ ïðîãðàìíîãî çàáåçïå÷åííÿ Scope

Photo.

ÓÄÊ 591.413+591.437+616-092.9+616.379-008.64

ÌÎÐÔÎËÎÃ²×ÍÈÉ ÑÒÀÍ

ÃÅÌÎÌ²ÊÐÎÖÈÐÊÓËßÒÎÐÍÎÃÎ ÐÓÑËÀ

ÏÀÍÊÐÅÀÒÈ×ÍÈÕ ÎÑÒÐ²ÂÖ²Â Ó ÙÓÐ²Â 24-Ì²Ñß×ÍÎÃÎ

Â²ÊÓ ÒÀ ÉÎÃÎ ÏÅÐÅÁÓÄÎÂÀ ÍÀ 14 ÄÎÁÓ ÏÅÐÅÁ²ÃÓ

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÎÃÎ ÖÓÊÐÎÂÎÃÎ Ä²ÀÁÅÒÓ

Ì³ñüê³â Â.À.

ÄÂÍÇ “²âàíî-Ôðàíê³âñüêèé íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò”, ì. ²âàíî-Ôðàíê³âñüê, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: ï³äøëóíêîâà çàëîçà, ãåìîì³êðîöèðêóëÿòîðíîãî ðóñëî, ïàíêðåàòè÷íèé îñòð³âåöü.

Ìîðôîìåòð³þ çä³éñíþâàëè íà ì³êðîïðåïàðàòàõ çà

äîïîìîãîþ ïðîãðàìè “Bio Vision 4” â àâòîìàòè÷íîìó

àáî ðó÷íîìó ðåæèì³ ³ç âðàõóâàííÿì çá³ëüøåíü îá’ºêò³â.

Ñòðóêòóðí³ çì³íè íà êîæíîìó åòàï³ äîñë³äæåííÿ àíàë³çó-

âàëè â 50 ïîëÿõ çîðó íà ïëîù³ 0,1 ìì² ÏÎ. Îòðèìàí³ äàí³

îö³íþâàëè çà ïàðàìåòðè÷íèìè òà íåïàðàìåòðè÷íèìè

ñòàòèñòè÷íèìè ìåòîäàìè.

Ðåçóëüòàòè äîñë³äæåííÿ òà ¿õ îáãîâîðåííÿ. Âñòàíîâ-

ëåíî, ùî åíäîêðèííà ÷àñòèíà ï³äøëóíêîâî¿ çàëîçè 24-ì³-

ñÿ÷íèõ ùóð³â-ñàìö³â ë³í³¿ Â³ñòàð ïðåäñòàâëåíà ÏÎ, ÿê³

óòâîðþþòüñÿ ñêóï÷åííÿì êë³òèí, îòî÷åíèõ òîíêèìè ïðî-

øàðêàìè ñïîëó÷íî¿ òêàíèíè, ùî â³äìåæîâóþòü ¿õ â³ä åêçî-

êðèííî¿ ÷àñòèíè çàëîçè. Òàê³ îñòð³âö³ ìàþòü ïåðåâàæíî

îâàëüíó àáî îêðóãëó ôîðìó òà íåð³âí³ êîíòóðè, ñåðåäíÿ

ê³ëüê³ñòü ïàíêðåàòè÷íèõ îñòð³âö³â íà 1 ìì2 ïàðåíõ³ìè ñêëà-

äàº (9,98± 0,35), à ¿õ ä³àìåòð ó òâàðèí ö³º¿ â³êîâî¿ ãðóïè äîð³â-

íþº (96,9±2,23) ìêì, ïëîùà ñêëàäàº (11867,84±658,25) ìêì2.

Ïàíêðåàòè÷í³ îñòð³âö³ ñêëàäàþòüñÿ ç åíäîêðèííèõ

êë³òèí, ÿê³ íà ã³ñòîëîã³÷íèõ ïðåïàðàòàõ âèãëÿäàþòü ñâ³òëè-

ìè íà òë³ òåìíî¿ åêçîêðèííî¿ ïàðåíõ³ìè. Ó öèòîïëàçì³

åíäîêðèííèõ êë³òèí º äîáðå ðîçâèíåíèé á³ëîê-ñèíòåçóþ-

÷èé àïàðàò äî ñêëàäó ÿêîãî âõîäÿòü: êîìïëåêñ Ãîëüäæ³,

ãðàíóëÿðíà åíäîïëàçìàòè÷íà ñ³òêà òà ñåêðåòîðí³ ãðàíóëè.

Çà âëàñòèâîñòÿìè îñòàíí³õ åíäîêðèíí³ êë³òèíè ïîä³ëÿþòü

íà ÷îòèðè îñíîâíèõ ð³çíîâèäè: Â-êë³òèíè, À-êë³òèíè,

Ä-êë³òèíè, ÐÐ-êë³òèíè.

Êðîâîïîñòà÷àííÿ ÏÎ ÏÇ ùóð³â çä³éñíþºòüñÿ ³ç ñï³ëü-

íèõ ç åêçîêðèííîþ ÷àñòèíîþ äæåðåë.

Àðòåð³îëè ç ñåðåäí³ì çíà÷åííÿì ä³àìåòðó (20,5±0,29)

ìêì áåðóòü ïî÷àòîê â³ä àðòåð³é ³ ðîçòàøîâóþòüñÿ â ïðî-

øàðêàõ ñïîëó÷íî¿ òêàíèíè íàâêîëî îñòð³âö³â. Ðîçãàëóæó-

þ÷èñü, âîíè ôîðìóþòü ïðåêàï³ëÿðè. Âèâ÷àþ÷è ñåð³éí³

íàï³âòîíê³ çð³çè ÏÎ ÏÇ ùóð³â 24-ì³ñÿ÷íîãî â³êó, ìè

â³äì³òèëè, ùî ñóäèíè, çà ìîðôîëîã³÷íèìè îçíàêàìè

â³äíåñåí³ íàìè äî ïðåêàï³ëÿð³â, ôîðìóþòü â³äêðèò³ òà çàê-

ðèò³ ïåòë³, ÿê³ îòî÷óþòü îñòð³âö³ ³ äàþòü ïî÷àòîê êàï³ëÿ-

ðàì, ÿê³ ëåæàòü ïîì³æ åíäîêðèíîöèòàìè, àíàñòîìîçóþòü

ì³æ ñîáîþ ³ óòâîðþþòü êàï³ëÿðíó ñ³òêó.

Ïðîñâ³ò ïðåêàï³ëÿð³â º íåð³âíîì³ðíèì, ¿õ çâóæåííÿ

÷åðãóþòüñÿ ³ç ðîçøèðåíèìè ä³ëÿíêàìè, à ñåðåäí³é ä³à-

ìåòð ñêëàäàº (9,2±0,15) ìêì. Ä³àìåòð êàï³ëÿð³â äîð³âíþº

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÒÅÎÐÅÒÈ×ÍÀ ÌÅÄÈÖÈÍÀ / HEORETICAL MEDICINE

(4,9±0,52) ìêì. Êàï³ëÿðè, çëèâàþ÷èñü, ôîðìóþòü ïîñòêà-

ï³ëÿðè ä³àìåòðîì (11,6±0,15) ìêì, ÿê³ âèõîäÿòü ç ïîì³æ

åíäîêðèíîöèò³â ³ îá’ºäíàâøèñü, óòâîðþþòü âåíóëè ä³à-

ìåòðîì (32,6±0,40) ìêì, ùî ðîçòàøîâóþòüñÿ ïîðÿä ç àð-

òåð³îëàìè ó ïðîøàðêàõ ñïîëó÷íî¿ òêàíèíè íàâêîëî ïàíê-

ðåàòè÷íèõ îñòð³âö³â. Íàìè âñòàíîâëåíèé êîðåëÿö³éíèé

çâ’ÿçîê ì³æ ïëîùåþ ÏÎ òà ê³ëüê³ñòþ ñóäèí íà 0,1 ìì2 ¿õ

ïëîù³ rs=0,9; ð=0,037.

Êàï³ëÿðè ÏÎ â³äíîñÿòüñÿ äî â³ñöåðàëüíîãî òèïó ³ âèñòå-

ëÿþòüñÿ ôåíåñòðîâàíèìè åíäîòåë³îöèòàìè, ÿê³ ëåæàòü íà

íåð³âíîì³ðíî¿ òîâùèíè áàçàëüí³é ìåìáðàí³. ¯õ ëþìåíàëü-

íà ïîâåðõíÿ ôîðìóº íå÷èñëåíí³ øèðîê³ âèï’ÿ÷óâàííÿ â

ïðîñâ³ò ñóäèí (ðèñ. 1). Äî êàï³ëÿð³â ïðèëÿãàþòü ñåêðå-

òîðí³ êîìïàðòìåíòè åíäîêðèíîöèò³â, ùî ì³ñòÿòü âåëèêó

ê³ëüê³ñòü ãðàíóë, ñïîñòåð³ãàþòüñÿ îçíàêè åêçîöèòîçó.

Âæå íà 14 äîáó â³ä ïî÷àòêó ìîäåëþâàííÿ åêñïåðèìåí-

òàëüíîãî öóêðîâîãî ä³àáåòó ñåðåäíÿ ê³ëüê³ñòü ïàíêðåà-

òè÷íèõ îñòð³âö³â íà 1 ìì2 ïîð³âíÿíî ç êîíòðîëåì

çìåíøóºòüñÿ ìàéæå â 9 ðàç³â ³ ñòàíîâèòü (1,17±0,19), çìåí-

øóºòüñÿ ³ ïëîùà ÏÎ äî (4926,56±347,24) ìêì2 (ð<0,001). Â

öèòîïëàçì³ êë³òèí, ÿê³ ïåðåâàæíî ì³ñòÿòü ãðàíóëè Â-òèïó

ñïîòåð³ãàºòüñÿ ¿õ ïîë³ìîðô³çì – ð³çíîþ º îïòè÷íà

ù³ëüí³ñü ìàòðèêñó, áàãàòî ïîðîæí³õ, âèçíà÷àþòüñÿ ä³ëÿí-

êè çëèòòÿ ãðàíóë ñåêðåòîðíîãî ìàòåð³àëó, ÿêèé ðîçòàøî-

âóºòüñÿ â öèòîïëàçì³ õàîòè÷íî, êîíöåíòðàö³¿ á³ëÿ ïî-

âåðõí³ îáåðíåíî¿ äî ì³êðîñóäèí íå âèçíà÷àºòüñÿ.

Îñîáëèâ³ñòþ çì³í ñóäèí ÃÌÖÐ ÏÎ ÏÇ òâàðèí ö³º¿ â³êî-

âî¿ ãðóïè â öåé òåðì³í º: çìåíøåííÿ ïðîñâ³òó àðòåð³îë äî

(20,3±0,54) ìêì2 , ïðåêàï³ëÿð³â äî (8,7±0,07) ìêì2, êàï³-

ëÿð³â äî (4,6±0,34) ìêì2 , òà çá³ëüøåííÿ ïðîñâ³òó ïîñò êàï³-

ëÿð³â òà âåíóë â³äïîâ³äíî äî (10,9±0,12) òà (36,8±1,45) ìêì2.

Ë³ìôîöèòè â íàâêîëîñóäèíí³é ñïîëó÷í³é òêàíèí³ íå

âèçíà÷àþòüñÿ. Â ì³êðîñóäèíàõ îñòð³âö³â ñïîñòåð³ãàþòüñÿ

ÿâèùà çàïóñò³ííÿ, íàáðÿê ïåðèâàñêóëÿðíî¿ ñïîëó÷íî¿

òêàíèíè, ùî ïðîÿâëÿºòüñÿ çíèæåííÿì ¿¿ îïòè÷íî¿

ù³ëüíîñò³ òà ðîçøàðóâàííÿì êîëàãåíîâèõ âîëîêîí.

Öèòîïëàçìà åíäîòåë³àëüíèõ êë³òèí óòâîðþº “âåðâè÷-

êîïîä³áí³” ä³ëÿíêè çà ðàõóíîê íàÿâíîñò³ âåëèêî¿ ê³ëüêîñò³

Ðèñ. 2. Ñóáì³êðîñêîï³÷í³ çì³íè êàï³ëÿð³â ÏÎ ÷åðåç 2 òèæí³

â³ä ïî÷àòêó ìîäåëþâàííÿ ÑÖÄ. Çá. õ 9600. 1 – ÿäðî òåìíîãî

åíäîòåë³îöèòà, 2 – öèòîïëàçìà òåìíîãî åíäîòåë³î-öèòà,

3 – öèòîïëàçìà ñâ³òëîãî åíäîòåë³îöèòà, 4 – ôåíåñòðè.

Ðèñ. 1. Óëüòðàñòðóêòóðà êàï³ëÿðà ôåíåñòðîâàíîãî òèïó

â ñêëàä³ îñòð³âöÿ ï³äøëóíêîâî¿ çàëîçè ùóðà 24-ì³ñÿ÷íîãî â³êó.

Çá. õ 8000. 1- Â-êë³òèíà; 2 – ÿäðî; 3 – ñåêðåòîðí³ ãðàíóëè;

4 – ãåìîêàï³ëÿð ôåíåñòðîâàíîãî òèïó; 5 – âèðîñòè

ëþìåíàëüíî¿ ïëàçìîëåìè åíäîòåë³îöèòà.

ôåíåñòð, ³, ïîðÿä ç öèì, ïîòîâùåííÿ ç âèðîñòàìè íà ëþ-

ìåíàëüí³é ïîâåðõí³, îêð³ì òîãî ÷³òêî âèçíà÷àþòüñÿ ñâ³òë³ ³

òåìí³ åíäîòåë³îöèòè (ðèñ. 2). Áàçàëüíà ìåìáðàíà ïîòîâ-

ùåíà, áåç ÷³òêèõ ìåæ, ì³ñöÿìè îãîëåíà.

Âèñíîâîê. Îòæå, çì³íè åíäîêðèííî¿ ÷àñòèíè ï³äøëóí-

êîâî¿ çàëîçè ùóð³â 24-ì³ñÿ÷íîãî â³êó íà 14 äîáó ïåðåá³ãó

åêñïåðèìåíòàëüíîãî öóêðîâîãî ä³àáåòó õàðàêòåðèçóþòüñÿ

çìåíøåííÿì ê³ëüêîñò³ òà ïëîù³ ïàíêðåàòè÷íèõ îñòð³âö³â,

ñïàçìîì àðòåð³àëüíî¿ ÷àñòèíè ãåìîì³êðîöèðêóëÿòîðíî-

ãî ðóñëà, òà äèëàòàö³ºþ âåíîçíî¿ éîãî ñêëàäîâî¿.

Ïåðñïåêòèâà ïîäàëüøèõ äîñë³äæåíü.

Â³êîâ³ îñîáëèâîñò³ ïåðåá³ãó ÖÄ ïîòðåáóþòü êîìïëåê-

ñíîãî ï³äõîäó. Òîìó â íàøèõ ïîäàëüøèõ äîñë³äæåííÿõ, ìè

íàìàãàòèìåìîñü äîñë³äèòè ðåàêö³þ ïàíêðåàòè÷íèõ

îñòð³âê³â íà ïåðåá³ã åêñïåðèìåíòàëüíîãî ä³àáåòó â ³íøèõ

îíòîãåíåòè÷íèõ ãðóïàõ. Êð³ì òîãî ïåðåäáà÷àºòüñÿ âèâ-

÷åííÿ îñòð³âöåâîãî àïàðàòó ÏÇ ïðè âèêîðèñòàíí³ ôàðìà-

êîëîã³÷íî¿ ³ íå ôàðìàêîëîã³÷íî¿ êîðåêö³¿.

Ðåöåíçåíò: ä.ìåä.í., ïðîôåñîð Áîäíàð Ï.Ì.

Ë²ÒÅÐÀÒÓÐÀ

1. À.ñ. íà ðàö³îíàë³çàòîðñüêó ïðîïîçèö³þ. Ñïîñ³á ìîäåëþ-

âàííÿ öóêðîâîãî ä³àáåòó â åêñïåðèìåíò³ / Â.À.Ëåâèöüêèé, Î.ß.Æó-

ðàê³âñüêà, Â.À.Ì³ñüê³â. – ¹ 1/2585; ïîäàíî15.01.09; âèçí. ðàö.

12.02.09.

2. Áîðîâêîâà Î. Ñ. Ïèòàííÿ ïàòîãåíåçó ä³àáåòè÷íèõ àíã³î-

ïàò³é / Î.Ñ. Áîðîâêîâà, À. Ã. ²ôòîä³é // Áóêîâèíñüêèé ìåäè÷íèé

â³ñíèê. – 2006. – Ò. 10. – ¹ 2. – Ñ. 132–135.

3. Ãàãàðèí Â. È. Ñàõàðíûé äèàáåò è åãî ïîçäíèå îñëîæíåíèÿ //

Â. È. Ãàãàðèí, Ë. À. Ñûäûêîâà // Ìåæäóíàðîäíûé æóðíàë ïðèêëàä-

íûõ è ôóíäàìåíòàëüíûõ èññëåäîâàíèé. – 2010. – ¹ 11. – Ñ. 95–96.

4. Ïàò. ¹ 62966. Óêðà¿íà, ÌÏÊ 51 À 61 Â 10/00. Ñïîñ³á ìîäå-

ëþâàííÿ öóêðîâîãî ä³àáåòó 1-ãî òèïó ó òâàðèí ð³çíîãî â³êó / Â.À.

Ëåâèöüêèé, Î.ß. Æóðàê³âñüêà, Â.À. Ì³ñüê³â, Ë.Ì. Çàÿöü, Ð.Á. Ïåòð³â,

Þ.Ì. ßêèì³â, Á.Ì. Ê³ùóê, Ð.Ç. Ãíàòþê; çàÿâêà ¹ u 201101566 ;

çàÿâë. 11.02.2011 ; îïóáë. 20.09.2011, Áþë. ¹ 18. – 6 ñ.

5. Òðîíüêî Ì.Ä. Åï³äåì³îëîã³ÿ öóêðîâîãî ä³àáåòó â Óêðà¿í³/

Òðîíüêî Ì.Ä., ×åðíîáðîâ À.Ä. //Çäîðîâ’ÿ Óêðà¿íè 2005 ¹18 ñ.15

6. Aldhahi W. Inflammation and the Endothelium in Diabetes /

W. Aldhahi, O. Hamdy // Current Diabetes Reports. – 2003. – ¹ 3. –

P. 293–298.

7. Peschke E. “Classical” and “new” diabetogens-comparison of

their effects on isolated rat pancreatic islets in vitro / E. Peschke // –

Cell Mol Life Sci 2000, 57 (1).– 156-164.

8. Screening for associated autoimmunity in type 1 diabetes

mellitus with respect to diabetes control / M. Prázny, J. Škrha, Z.

Limanová [et al.] // Physiol. Res. – 2005. – ¹ 54. – P. 41–48.

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÒÅÎÐÅÒÈ×ÍÀ ÌÅÄÈÖÈÍÀ / THEORETICAL MEDICINE

ÌÎÐÔÎÔÓÍÊÖÈÎÍÀËÜÍÎÅ ÑÎÑÒÎßÍÈÅ

ÃÅÌÎÌÈÊÐÎÖÈÐÊÓËßÒÎÐÍÎÃÎ ÐÓÑËÀ

ÏÀÍÊÐÅÀÒÈ×ÅÑÊÈÕ ÎÑÒÐÎÂÊÎÂ Ó ÊÐÛÑ

24 ÌÅÑß×ÍÎÃÎ ÂÎÇÐÀÑÒÀ È ÅÃÎ ÏÅÐÅÑÒÐÎÉÊÀ

ÍÀ 14 ÑÓÒÊÈ ÒÅ×ÅÍÈß ÝÊÑÏÅÐÈÌÅÍÒÀËÜÍÎÃÎ

ÑÀÕÀÐÍÎÃÎ ÄÈÀÁÅÒÀ

Ìèñüêèâ Â.À.

Èâàíî-Ôðàíêîâñêèé íàöèîíàëüíûé ìåäèöèíñêèé

óíèâåðñèòåò, ã. Èâàíî-Ôðàíêîâñê, Óêðàèíà

Ðåçþìå. Â íîðìå êàïèëëÿðû âèñöåðàëüíîãî òèïà

âèñòåëÿþòüñÿ ôåíåñòðîâàíèìû ýíäîòåëèîöèòàìè, êî-

òîðûå ëåæàò íà íåðàâíîìåðíîé òîëùèíû áàçàëüíîé

ìåìáðàíå, à èõ ëþìåíàëüíà ïîâåðõíîñòü ôîðìèðóåò

ïàëüöåîáðàçíûå âûïÿ÷èâàíèå â ïðîñâåò ñîñóäîâ.

Íà 14 ñóòêè ðàçâèòèÿ ýêñïåðèìåíòàëüíîãî ñàõàðíî-

ãî äèàáåòà èçìåíåíèÿ â ñòðîåíèè ãåìîìèêðîöèðêóëÿ-

òîðíîãî ðóñëà ïàíêðåàòè÷åñêèõ îñòðîâêîâ ó êðûñ 24-ìå-

ñÿ÷íîãî âîçðàñòà ïðîÿâëÿþòñÿ óìåíüøåíèåì äèàìåòðà

ïðîñâåòà ìèêðîñîñóäîâ àðòåðèàëüíîãî ó÷àñòêà ãåìîìèê-

ðîöèðêóëÿòîðíîãî ðóñëà (ð < 0,05). Öèòîïëàçìà ýíäî-

òåëèàëüíûõ êëåòîê îáðàçóåò “âåðâè÷êîîáðàçíûå “ ó÷àñòêè

çà ñ÷åò íàëè÷èÿ áîëüøîãî êîëè÷åñòâà ôåíåñòð, è, íàðÿ-

äó ñ ýòèì, óòîëùåíèå ñ âûðîñòàìè íà ëþìåíàëüíèé ïî-

âåðõíîñòè, êðîìå òîãî ÷åòêî îïðåäåëÿþòñÿ ñâåòëûå è

òåìíûå ýíäîòåëèîöèòû . Áàçàëüíàÿ ìåìáðàíà óòîëùå-

íà, áåç ÷åòêèõ ãðàíèö, ìåñòàìè îáíàæåíà. Ïðîñâåò

âåíîçíûõ ñòðóêòóð ãåìîìèêðîöèðêóëÿòîðíîãî ðóñëà ðàñ-

øèðÿåòñÿ.

Êëþ÷åâûå ñëîâà: ïîäæåëóäî÷íàÿ æåëåçà, ãåìîìèêðî-

öèðêóëÿòîðíîå ðóñëî, ïàíêðåàòè÷åñêèé îñòðîâîê.

FUNCTIONAL STATE OF BLOOD VESSELS IN RAT

PANCREATIC ISLETS AT THE AGE OF 24 MONTHS

AND ITS CHANGE DURING 14 DAYS OF SUGAR

DIABETES PREFERENCE EXPERIMENT

V. Miskiv

Ivano-Frankivsk National Medical University,

Ivano-Frankivsk, Ukraine

Summary. Normally the capillaries of the visceral type

are covered via endothelial cells which lie at uneven

thickness of the basal membrane. Their surface form

similarly to the finger protrusion at the lumen of the vessels.

After 14 days of experimental diabetes changes in the

structure of blood vessels are observable. The channel in

rat pancreatic islets at 24 months of age are shown to

decrease in the diameter of the lumen of the microvessel

area of blood vessels arterial bed by (p < 0.05). The

cytoplasm of endothelial cells forming are “chain similar”

areas due to the large number of fenestra and in addition,

thickening of lyumenal surface is shown, as well as to clearly

define light and dark endothelial cells . Basal membrane is

thickened with no clear boundaries and sometimes naked.

The lumen venous structures of blood vessels channel also

widens.

Key words: pancreas, hemomicrocirculatory channel,

pancreatic islet.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÒÅÎÐÅÒÈ×ÍÀ ÌÅÄÈÖÈÍÀ / HEORETICAL MEDICINE

Âñòóï. Íàãàëüíîþ ïðîáëåìîþ íà ñó÷àñíîìó åòàï³

ðîçâèòêó ìåäèöèíè º ñòâîðåííÿ êîìá³íîâàíèõ ë³êàðñüêèõ

çàñîá³â, ôàðìàêîëîã³÷í³ åôåêòè ÿêèõ äîñÿãàþòüñÿ çàâäÿêè

ðàö³îíàëüí³é êîìá³íàö³¿ ³íãðåä³ºíò³â. Êîìá³íàö³ÿ â îäíî-

ìó ë³êàðñüêîìó ïðåïàðàò³ ê³ëüêîõ êîìïîíåíò³â ðîçøèðþº

éîãî ôàðìàêîëîã³÷íèé ñïåêòð [1]. Ïåðåâàãà êîìá³íîâàíèõ

ë³êàðñüêèõ ïðåïàðàò³â ïîð³âíÿíî ç ìîíîïðåïàðàòàìè ïî-

ëÿãàº ó òîìó, ùî âîíè åôåêòèâí³øå ë³êâ³äóþòü á³ëü, çàïà-

ëåííÿ, í³æ êîæíèé îêðåìèé êîìïîíåíò [2, 3]. Òàê³ êîìá³-

íàö³¿ äàþòü ìîæëèâ³ñòü äîäàâàòè äî ñêëàäó ë³êàðñüêèõ

çàñîá³â àêòèâí³ ðå÷îâèíè â ìåíøèõ äîçàõ, ùî çìåíøóº

òîêñè÷í³ñòü òà íåãàòèâí³ ïîá³÷í³ åôåêòè [4].

Çà îäí³ºþ ç íàéá³ëüø âèçíà÷íèõ êëàñèô³êàö³é óñ³

àíàëüãåòè÷í³ ë³êàðñüê³ çàñîáè óìîâíî ïîä³ëÿþòü íà òðè

îñíîâí³ ãðóïè, â³äïîâ³äíî äî ðåêîìåíäîâàíî¿ òåðàïåâòè÷-

íî¿ ïðàêòèêè (World Health Organization, 1986): 1 “öåíò-

ðàëüíîä³þ÷³ ïðåïàðàòè (îï³àòè), 2 – ë³êàðñüê³ çàñîáè ïå-

ðèôåðè÷íî¿ ä³¿, 3 – âòîðèíí³ àíàëüãåòèêè. Â ìåäè÷í³é

ïðàêòèö³ â ÿêîñò³ ïðîòèáîëüîâèõ ë³êàðñüêèõ çàñîá³â øèðî-

êî çàñòîñîâóþòüñÿ í³òðîãåíîâì³ñí³ îðãàí³÷í³ ñïîëóêè, ñå-

ðåä ÿêèõ â³äîìèé ë³êàðñüêèé ïðåïàðàò ïàðàöåòàìîë (íà-

ëåæèòü äî 2 ãðóïè). Ó ïàðàöåòàìîëà àíàëüãåçóþ÷à ä³ÿ

îáóìîâëåíà ãàëüìóâàííÿì ñèíòåçó ïðîñòàãëàíäèí³â. Êî-

ôå¿í (1,3,7-òðèìåòèëêñàíòèí) íàëåæèòü äî ìåäèêàìåíò³â,

ùî øèðîêî çàñòîñîâóþòüñÿ ó ìåäè÷í³é ïðàêòèö³ [5].

Çà ë³òåðàòóðíèìè äàíèìè êîôå¿í ï³äñèëþº ïðîòèáî-

ëüîâó ä³þ íåíàðêîòè÷íèõ àíàëüãåòèê³â [6]. Ìåõàí³çì ïî-

òåíö³þâàííÿ ïðîòèáîëüîâî¿ ä³¿ ïîâ’ÿçóþòü ç ïîêðàùåí-

íÿì á³îäîñòóïíîñò³ íåíàðêîòè÷íèõ àíàëüãåòèê³â ïðè

êîìá³íàö³¿ ç êîôå¿íîì [7], ³íäóêö³ºþ êîôå¿íîì öåíòðàëü-

íî¿ õîë³íåðã³÷íî¿ àíàëüãåç³¿ [8], ñòðóêòóðíîþ ñõîæîñò³

ìîëåêóë àäåíîç³íó ³ êîôå¿íó, ùî ñïðèÿº íåéðîõ³ì³÷íîìó

ìåõàí³çìó ä³¿ îñòàííüîãî ó âèãëÿä³ áëîêóâàííÿ ñïåöèô³÷-

íèõ Ð1 “ïóðèíîâèõ” ðåöåïòîð³â ìîçêó [9-11].

Ñïîëó÷åííÿ ³íãðåä³ºíò³â ó ïîë³êîìïîíåíòí³é êîìá³-

íàö³¿ âçàºìíî ï³äñèëþº ¿õ ôàðìàêîëîã³÷í³ åôåêòè [12, 13].

Ó êë³í³÷íèõ äîñë³äæåííÿõ ï³äòâåðäæåíî ïåðåâàãè êîìá³-

íàö³¿ ïåðåä ìîíîïðåïàðàòàìè ó ôàðìàêîòåðàï³¿ áîëþ.

Ìåòà ðîáîòè. Âèâ÷èòè âïëèâ í³òðîãåíîâì³ñòíèõ îðãà-

í³÷íèõ ñïîëóê (êîôå¿íó, ïàðàöåòàìîëó òà ¿õ ôàðìàêîëî-

ã³÷íî¿ êîìïîçèö³¿) íà öåíòðàëüíó íåðâîâó ñèñòåìó (ÖÍÑ)

çà åìîö³éíî-ïîâåä³íêîâèìè ðåàêö³ÿìè (ÅÏÐ) ó ùóð³â ó

òåñò³ “â³äêðèòå ïîëå” â óìîâàõ ôîðìàë³íîâîãî íàáðÿêó.

ÓÄÊ 547.857.4:547.564.4:57.084:591.51

ÅÌÎÖ²ÉÍÎ-ÏÎÂÅÄ²ÍÊÎÂ² ÐÅÀÊÖ²¯ Ó ÙÓÐ²Â:

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÅ ÄÎÑË²ÄÆÅÍÍß ÂÏËÈÂÓ

ÊÎÔÅ¯ÍÓ, ÏÀÐÀÖÅÒÀÌÎËÓ ÒÀ ¯Õ ÔÀÐÌÀÊÎËÎÃ²×ÍÎ¯

ÊÎÌÁ²ÍÀÖ²¯ Â ÒÅÑÒ² “Â²ÄÊÐÈÒÅ ÏÎËÅ”

Ôåäüêî Ê.Î., Ñèðîâà Ã.Î., Ëóê’ÿíîâà Ë.Â.

Õàðê³âñüêèé íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò, ì. Õàðê³â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: êîôå¿í, ïàðàöåòàìîë, ôàðìàêîëîã³÷íà êîìïîçèö³ÿ, “â³äêðèòå ïîëå”, ôîðìàë³íîâèé íàáðÿê.

Ìàòåð³àëè ³ ìåòîäè. Åêñïåðèìåíòàëüíå äîñë³äæåííÿ

ïðîâîäèëè íà 30 ùóðàõ ë³í³¿ WAG ñåðåäíüîþ ìàñîþ 210–

230 ã (5 ãðóï ïî 6 òâàðèí). Òâàðèíè 1-¿ ãðóïè áóëè êîíòðî-

ëåì, ¿ì îäíîêðàòíî âíóòð³øíüîøëóíêîâî (â/øë) ââîäèëè

3 % êðîõìàëüíèé ñëèç (2 ìë íà 200 ã ùóðà). Òâàðèíàì 2-¿

ãðóïè ìîäåëþâàëè ôîðìàë³íîâèé íàáðÿê øëÿõîì ñóá-

ïëàíòàðíîãî ââåäåííÿ 2 % ðîç÷èíó ôîðìàë³íó ó çàäíþ

ëàïó ùóðà òà â/øë ââîäèëè 3 % êðîõìàëüíèé ñëèç. Òâà-

ðèíàì 3-¿-5-¿ ãðóï îäíîêðàòíî â/øë ó âèãëÿä³ ñóñïåíç³¿ íà

3 % êðîõìàëüíîìó ñëèçó ââîäèëè äîñë³äí³ ïðåïàðàòè òà

¿õ êîìïîçèö³þ: òâàðèíàì 3-¿ ãðóïè ââîäèëè – êîôå¿í

(0,6 ìã/êã), 4-¿ ãðóïè – ïàðàöåòàìîë ó äîç³ 30 ìã/êã, 5-¿

ãðóïè – êîìá³íàö³þ ïàðàöåòàìîëó (30 ìã/êã) ç êîôå¿íîì

(0,6 ìã/êã). Ìàêñèìàëüíèé ðîçâèòîê ôîðìàë³íîâîãî íà-

áðÿêó ñïîñòåð³ãàºòüñÿ ÷åðåç 4 ãîäèíè ï³ñëÿ éîãî ìîäå-

ëþâàííÿ, òîìó ë³êàðñüê³ çàñîáè, à òàêîæ 3 % êðîõìàëüíèé

ñëèç ââîäèëè çà 1 ãîäèíó äî öüîãî ìîìåíòó. Îö³íêó âïëè-

âó ïðåïàðàò³â òà ¿õ êîìá³íàö³¿ íà õàðàêòåðèñòèêè ïîâåä³í-

êè òâàðèíè ïðîâîäèëè øëÿõîì ïîð³âíÿííÿ ãðóï 3-5 ç êîí-

òðîëåì (ãðóïà 1) òà ç ôîðìàë³íîâèì íàáðÿêîì (ãðóïà 2).

Ñïîñòåðåæåííÿ ïàðàìåòð³â îð³ºíòîâíî-äîñë³äíèöüêî¿

ä³ÿëüíîñò³ ùóð³â ó òåñò³ “â³äêðèòå ïîëå” [16, 17] ³ áàãàòîïà-

ðàìåòðîâîãî ìåòîäó îö³íêè òðèâîæíî-ôîá³÷íèõ ñòàí³â çà

çàãàëüíîïðèéíÿòîþ ìåòîäèêîþ ïðîâîäèëè ïðîòÿãîì

3 õâèëèí [18].

Äîñë³äæåííÿ ïðîâîäèëè â³äïîâ³äíî äî ìåòîäè÷íèõ

ðåêîìåíäàö³é Äåðæàâíîãî ôàðìàêîëîã³÷íîãî öåíòðó

ÌÎÇ Óêðà¿íè [15]. Ïðè âèáîð³ ê³ëüêîñò³ òâàðèí ³ ðîçïîä³ë³

¿õ çà ãðóïàìè âðàõîâóâàëè åêîíîìíèé ï³äõ³ä, á³îåòè÷í³

ïðàâèëà òà âèìîãè ñòàòèñòèêè. Ïåðåðàõóíîê ç äîç ëþäèíè

íà ùóð³â çä³éñíåíî ³ç âèêîðèñòàííÿì êîåô³ö³ºíòó âèäîâî¿

÷óòëèâîñò³ çà Ðèáîëîâëåâèì Þ. Ð. [20].

Ñòàòèñòè÷íó îáðîáêó îòðèìàíèõ äàíèõ ïðîâîäèëè çà-

ãàëüíîïðèéíÿòèìè ìåòîäàìè [21, 22].

Ðîáîòó âèêîíàíî íà ëàáîðàòîðíèõ òâàðèíàõ ç åêñïå-

ðèìåíòàëüíî-á³îëîã³÷íî¿ êë³í³êè ÕÍÌÓ ç óðàõóâàííÿì

íîðì çáåð³ãàííÿ, äîãëÿäó ³ ãîäóâàííÿ, çàòâåðäæåíèõ

çã³äíî ïðèíöèï³â “ªâðîïåéñüêî¿ Êîíâåíö³¿ ïðî çàõèñò õðå-

áåòíèõ òâàðèí, ÿê³ âèêîðèñòîâóþòüñÿ äëÿ åêñïåðèìåí-

òàëüíèõ òà íàóêîâèõ ö³ëåé” [23] ³ óõâàëè Ïåðøîãî íàö³î-

íàëüíîãî êîíãðåñó ç á³îåòèêè [24]. Äîñë³äè ïðîâîäèëèñÿ â

ïåðø³é ïîëîâèí³ äíÿ, ùî çà äàíèìè ë³òåðàòóðè óçãîä-

æóºòüñÿ ç çàëåæí³ñòþ îñíîâíèõ ôàðìàêîëîã³÷íèõ ïàðà-

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÒÅÎÐÅÒÈ×ÍÀ ÌÅÄÈÖÈÍÀ / THEORETICAL MEDICINE

ìåòð³â ³ ôàðìàêîëîã³÷íîþ àêòèâí³ñòþ ïðèéíÿòèõ äî äîñ-

ë³äæåííÿ ïðåïàðàò³â â³ä öèðêàäíèõ ðèòì³â [25, 26].

Ðåçóëüòàòè òà îáãîâîðåííÿ. Ïàðàìåòð îð³ºíòîâíî-

äîñë³äíèöüêî¿ ä³ÿëüíîñò³ ùóð³â ó òåñò³ “â³äêðèòå ïîëå” õà-

ðàêòåðèçóºòüñÿ ðÿäîì âåëè÷èí: ê³ëüê³ñòþ ïåðåñ³÷åíèõ

êâàäðàò³â (ãîðèçîíòàëüíà ðóõîâà àêòèâí³ñòü (ÃÐÀ)), âåðòè-

êàëüíèõ ñò³éîê (âåðòèêàëüíà ðóõîâà àêòèâí³ñòü (ÂÐÀ)), îá-

ñòåæåíèõ îòâîð³â, óìèâàíü (ãðóìèíã), óðèíàö³é òà äåôå-

êàö³é çà çàãàëüíîïðèéíÿòîþ ìåòîäèêîþ [18, 19].

Âïëèâ äîñë³äíèõ ïðåïàðàò³â ïðè ìîíîââåäåíí³ òà ¿õ

êîìïîçèö³é íà ÃÐÀ òà ÂÐÀ ùóð³â. Àíàë³ç îð³ºíòîâíî-äîñ-

ë³äíèöüêî¿ ïîâåä³íêè ùóð³â ó òåñò³ “â³äêðèòå ïîëå” çà ïî-

êàçíèêàìè ÃÐÀ ³ ÂÐÀ ðîçêðèâàº ìîòèâàö³éíó ñêëàäîâó

õàðàêòåðèñòèêè òâàðèí. Ïðè öüîìó âîíè íàìàãàþòüñÿ

ââ³éòè â íåïðÿìèé êîíòàêò ³ç ïðåäìåòàìè, ðîçòàøîâàíè-

ìè íà â³äñòàí³: ùóðè ïðèíþõóâàëèñÿ äî ïðåäìåò³â, ðîçòà-

øîâàíèõ çà ìåæàìè “â³äêðèòîãî ïîëÿ”.

Ìîäåëþâàííÿ ôîðìàë³íîâîãî íàáðÿêó (ãðóïà 2)

ñïðèÿëî ñòàòèñòè÷íî â³ðîã³äíîìó çá³ëüøåííþ ÃÐÀ ó 1,4

ðàçè òà ìàëî òåíäåíö³þ äî çá³ëüøåííÿ ÂÐÀ ó ùóð³â

â³äíîñíî êîíòðîëüíî¿ ãðóïè (òàáë. 1).

Ïðè ìîíîââåäåíí³ êîôå¿íó (ãðóïà 3) ñïîñòåð³ãàëîñÿ

çìåíøåííÿ ÃÐÀ ó 1,4 ðàçó òà ÂÐÀ ó 1,2 ðàçó â³äíîñíî ãðó-

ïè 2, ³ îòðèìàí³ äàí³ ñòàòèñòè÷íî íå â³äð³çíÿëèñü â³ä êîíò-

ðîëüíèõ âåëè÷èí (ãðóïà 1). Ìîíîââåäåííÿ â óìîâàõ ôîð-

ìàë³íîâîãî íàáðÿêó ïàðàöåòàìîëó (ãðóïà 4) ñïðèÿëî

ñòàòèñòè÷íî â³ðîã³äíîìó çìåíøåííþ ÃÐÀ ³ ÂÐÀ ó 1,5 ðàçó

â³äíîñíî òâàðèí ãðóïè 2, îòðèìàí³ äàí³ ñòàòèñòè÷íî íå

â³äð³çíÿëèñü â³ä êîíòðîëüíî¿ ãðóïè.

Ïðè ââåäåíí³ êîìïîçèö³¿ ïàðàöåòàìîëó ç êîôå¿íîì

(ãðóïà 5) ñïîñòåð³ãàëîñÿ: ñòàòèñòè÷íî â³ðîã³äíå çìåíøåí-

íÿ ÃÐÀ ó ùóð³â (ó 1,3 ðàçó) â³äíîñíî ãðóïè 2, à òàêîæ

çá³ëüøåííÿ ÂÐÀ ó ùóð³â ÿê â³äíîñíî ãðóï 1-5 (äèâ. òàáë. 1).

Ê³ëüê³ñòü îáñòåæåíèõ îòâîð³â. Ð³çíîâèäîì îð³ºí-

òîâíî-äîñë³äíèöüêî¿ ïîâåä³íêè ùóð³â º ê³ëüê³ñòü îáñòåæå-

íèõ îòâîð³â – ïîêàçíèê í³ðêîâîãî ðåôëåêñó, ÿêèé ñâ³ä÷èòü

ïðî çäàòí³ñòü òâàðèíè äîñë³äæóâàòè “â³äêðèòå ïîëå”, çîê-

ðåìà, çàãëÿäàòè â îòâîðè. Ê³ëüê³ñòü îáñòåæåíèõ îòâîð³â

õàðàêòåðèçóº ï³çíàâàëüíó àêòèâí³ñòü ùóð³â.

Ìîäåëþâàííÿ ôîðìàë³íîâîãî íàáðÿêó, ìîíîââåäåí-

íÿ êîôå¿íó (ãðóïà 3), ïàðàöåòàìîëó (ãðóïà 4) òà êîìïî-

çèö³¿ ïàðàöåòàìîëó ç êîôå¿íîì (ãðóïà 5) íå âïëèâàëî íà

ï³çíàâàëüíó àêòèâí³ñòü ùóð³â (äèâ. òàáë. 1).

Êîñìåòè÷íà ïîâåä³íêà ùóð³â. Ãðóìèíã (êîñìåòè÷íà

ïîâåä³íêà) ùóð³â º âàæëèâîþ õàðàêòåðèñòèêîþ ïîâåä³íêè

òâàðèí ó “â³äêðèòîìó ïîë³”. Òðàäèö³éíî, ùóðè á³ëüøó ÷à-

ñòèíó ÷àñó ïðèä³ëÿþòü âè÷³ñóâàííþ ñâîãî ò³ëà, ó ïî-

ð³âíÿíí³ ç ïåðåì³ùåííÿì ó ïðîñòîð³. Ãðóìèíã ò³ñíî êîðå-

ëþº ç ðóõîâîþ àêòèâí³ñòþ. Òîìó ïðè äîñë³äæåíí³ ë³êàðñü-

êèõ ïðåïàðàò³â öÿ õàðàêòåðèñòèêà ïîâåä³íêè îñîáëèâî

ö³êàâà.

Ïðè ìîäåëþâàíí³ ôîðìàë³íîâîãî íàáðÿêó ñïîñòåð³-

ãàëîñÿ çìåíøåííÿ ê³ëüêîñò³ óìèâàíü ó 1,3 ðàçó â³äíîñíî

êîíòðîëþ (ãðóïà 1). Ïðè ââåäåíí³ íà ôîí³ ôîðìàë³íîâîãî

íàáðÿêó äîñë³äíèõ ïðåïàðàò³â òà ¿õ êîìïîçèö³é (ãðóïè 3-5)

ñïîñòåð³ãàëîñÿ çá³ëüøåííÿ ãðóìèíãó â³äíîñíî ãðóïè 2 ³

êîíòðîëþ. Ââåäåííÿ ïàðàöåòàìîëó (ãðóïà 4) ñïðèÿëî ñòà-

òèñòè÷íî â³ðîã³äíîìó çá³ëüøåííþ ãðóìèíãó ÿê â³äíîñíî

ãðóïè 1 (ó 3 ðàçè), òàê ³ â³äíîñíî ãðóïè 2 (ó 3,9 ðàçó). Ââå-

äåííÿ ôàðìàêîëîã³÷íî¿ êîìá³íàö³¿ ïàðàöåòàìîëó ç êîôå¿-

íîì (ãðóïà 5) ñïðèÿëî çá³ëüøåííþ ãðóìèíãó ÿê â³äíîñíî

ãðóïè 1 (ó 2,07 ðàçó), òàê ³ â³äíîñíî ãðóïè 2 (2,7 ðàçó)

(äèâ. òàáë. 1).

Ä³óðåç, äåôåêàö³ÿ. Íåîáõ³äíî çàóâàæèòè, ùî â ÿêîñò³

ïîêàçíèêà åìîö³éíîãî ñòàòóñó ùóð³â çíà÷èì³ñòü ìàþòü

ê³ëüê³ñòü óðèíàö³é ³ äåôåêàö³é. Ð³âåíü åìîö³éíîãî ñòàíó

ùóð³â îö³íþºòüñÿ çà ê³ëüê³ñòþ óðèíàö³é ³ äåôåêàö³é.

Ìîäåëþâàííÿ ôîðìàë³íîâîãî íàáðÿêó (ãðóïà 2)

ñïðèÿëî çá³ëüøåííþ ä³óðåçó ó 1,5 ðàçó â³äíîñíî êîíò-

ðîëüíî¿ ãðóïè.

Ïðè ìîíîââåäåíí³ êîôå¿íó (ãðóïà 3) òà éîãî êîìá³-

íàö³¿ ç ïàðàöåòàìîëîì (ãðóïà 5) íå ñïîñòåð³ãàëîñÿ ñòàòèñ-

òè÷íî â³ðîã³äíèõ çì³í óðèíàö³é ó ùóð³â â³äíîñíî ãðóïè 2

(òàáë. 1).

Ìîäåëþâàííÿ ôîðìàë³íîâîãî íàáðÿêó (ãðóïà 2)

ñïðèÿëî ñòàòèñòè÷íîìó â³ðîã³äíîìó çìåíøåííþ äåôå-

êàö³é ó 1,9 ðàçó â³äíîñíî êîíòðîëüíî¿ ãðóïè.

Ââåäåííÿ â óìîâàõ ôîðìàë³íîâîãî íàáðÿêó êîôå¿íó

(ãðóïà 3), ïàðàöåòàìîëó (ãðóïà 4) íå âïëèâàëî íà ê³ëüê³ñòü

äåôåêàö³é â³äíîñíî òâàðèí ãðóïè 2.

Ïðè ìîíîââåäåíí³ ïàðàöåòàìîëó (ãðóïà 4) â³äáóâàëî-

ñÿ ñòàòèñòè÷íî â³ðîã³äíå çìåíøåííÿ ê³ëüêîñò³ äåôåêàö³é ó

1,1 ðàçó â³äíîñíî òâàðèí ãðóïè 2.

Ââåäåííÿ â óìîâàõ ôîðìàë³íîâîãî íàáðÿêó êîìá³-

íàö³¿ ïàðàöåòàìîëó ç êîôå¿íîì (ãðóïà 5) ñïðèÿëî

çá³ëüøåííþ ê³ëüêîñò³ äåôåêàö³é ó ùóð³â â³äíîñíî ãðóïè 2

ó 1,2 ðàçó (äèâ. òàáë. 1).

Âèñíîâêè. Àíàë³ç ðåçóëüòàò³â âïëèâó ïàðàöåòàìîëó,

êîôå¿íó òà ¿õ êîìïîçèö³¿ íà ÅÏÐ ùóð³â â óìîâàõ ôîðìàë³íî-

âîãî íàáðÿêó âêàçóº íà òå, ùî äîö³ëüíèì º ïðèçíà÷åííÿ

êîôå¿íó, ïàðàöåòàìîëó òà ¿õ êîìïîçèö³¿ (â³äíîñíî ÃÐÀ), êî-

ôå¿íó (â³äíîñíî ãðóìèíãó), ïàðàöåòàìîëó (â³äíîñíî ÂÐÀ).

Òàáëèöÿ 1.

Ïîêàçíèêè ïîâåä³íêîâî¿ àêòèâíîñò³ ùóð³â â óìîâàõ ôîðìàë³íîâîãî íàáðÿêó çà ìåòîäîì “â³äêðèòå ïîëå” (n=6)

Ïðèì³òêè (ñåðåäí³ ± ïîìèëêà ñåðåäíüîþ): * – â³ðîã³äí³ñòü ðåçóëüòàò³â ó â³äíîøåíí³ äî êîíòðîëüíî¿ ãðóïè, ð < 0,05; ** – äî ùóð³â

ç ôîðìàë³íîâèì íàáðÿêîì, ð < 0,05; *** – äî ùóð³â ç ìîíîâåäåííÿì êîôå¿íó, ð < 0,05; **** – äî ùóð³â ç ìîíîâåäåííÿì ïàðàöåòàìîëó,

ð < 0,05; ***** – äî ùóð³â ç âåäåííÿì ôàðìàêîëîã³÷íî¿ êîìïîçèö³¿ ïàðàöåòàìîëó ç êîôå¿íîì, ð < 0,05.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÒÅÎÐÅÒÈ×ÍÀ ÌÅÄÈÖÈÍÀ / HEORETICAL MEDICINE

Äîö³ëüíî âèâ÷èòè âïëèâ í³òðîãåíîâì³ñòíèõ îðãàí³÷-

íèõ ñïîëóê (êîôå¿íó, ïàðàöåòàìîëó òà ¿õ êîìïîçèö³¿) íà

ÅÏÐ ó ùóð³â â óìîâàõ ³íøèõ ìîäåëüíèõ ïàòîëîã³é.

Ðåöåíçåíò: ÷ëåí-êîð. ÍÀÍ òà ÍÀÌÍ Óêðà¿íè, ä.ìåä.í.,

ïðîôåñîð ×åêìàí ².Ñ.

Ë²ÒÅÐÀÒÓÐÀ

1. Ñèðîâà Ã. Î. Ïàòåíò Óêðà¿íè íà êîðèñíó ìîäåëü ¹ 51082

“Ñïîñ³á ïîòåíö³þâàííÿ ïðîòèáîëüîâî¿ ä³¿ êàë³ºâî¿ ñîë³ 2,4 – äèõ-

ëîðáåíçîéíî¿ êèñëîòè”, ÌÏÊ: À61Ê 31/00. 25.06.10. Áþë. ¹ 12.

2. Îïòèìàëüíûé âûáîð íåñòåðîèäíîãî ïðîòèâîâîñïàëè-

òåëüíîãî ïðåïàðàòà â ñîâðåìåííîé êëèíè÷åñêîé ïðàêòèêå /

Í. Í. Êîçà÷îê, Ì. Í. Ñåëþê, Ñ. À. Áû÷êîâà [è äð.] // Íîâîñòè

ìåäèöèíû è ôàðìàöèè. – 2007. – ¹ 8/218. – Ñ.3–4.

3. Ñèðîâà Ã.Î., Áà÷èíñüêèé Ð.Î., Ïåòþí³íà Â.Ì., Ñàâåëüºâà Î.Â.,

Áîéêî ª.Ï. Ïàòåíò Óêðà¿íè íà êîðèñíó ìîäåëü ¹ 56451. “Ñïîñ³á

ï³äñèëåííÿ àíàëüãåòè÷íî¿ ä³¿ ïåðèôåðè÷íîãî ãåíåçó íåñòåðî¿ä-

íèõ ïðîòèçàïàëüíèõ ³ ïðîòèðåâìàòè÷íèõ çàñîá³â, ïîõ³äíèõ îöòî-

âî¿ òà ïðîï³îíîâî¿ êèñëîò”. À61Ê31/519. 10.01.2011. Áþë. ¹ 1.

4. Äçÿê Ã. Â. Íåñòåðîèäíûå ïðîòèâîâîñïàëèòåëüíûå ñðåä-

ñòâà / Ã. Â. Äçÿê, À. Ï. Â³êòîðîâ, Å. È. Ãðèøèíà – Ê.: Ìîðèîí,

1999. – 122 ñ.

5. Christopher J Derry Caffeine as an analgesic adjuvant for

acute pain in adults / Christopher J Derry, Sheena Derry*, R Andrew

Moore // Cochrane Pain, Palliative and Supportive Care Group. – 14

MAR 2012. – 4 JAN 2012. DOI: 10.1002/14651858.CD009281.pub2

6. Ìàøêîâñêèé Ì. Ä. Ëåêàðñòâåííûå ñðåäñòâà / Ì. Ä. Ìàø-

êîâñêèé. – Ì.: ÎÎÎ “Íîâàÿ Âîëíà”, 2012. – Ñ. 1216.

7. Brune K. Safety of anti-inflammatory treatment: new ways of

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8. Morris M.B., Weinstein L. Caffeine and the fetus: is trouble

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P.607-610.

9. Êâàíòîâî-ôàðìàêîëîã³÷íå îáãðóíòóâàííÿ ïîòåíö³þâàëüíèõ

ïðîòèáîëüîâèõ âëàñòèâîñòåé êîôå¿íó / Ã.Î. Ñèðîâà, Ò.Â. Çâÿ-

ã³íöåâà, ².Ñ. ×åêìàí, Ò.Þ. Íåáåñíà // Ôàðìàö. æóðí. – 2008. –

¹ 6. – Ñ. 85-91.

10. Êîôå¿í: Ô³ç³îëîã³÷í³, á³îõ³ì³÷í³ òà êâàíòîâî-ôàðìàêîëî-

ã³÷í³ âëàñòèâîñò³ / ². ×åêìàí, Í. Ãîð÷àêîâà, Ò. Çâÿã³íöåâà, Ã. Ñè-

ðîâà, Í. Íåáåñíà // Â³ñíèê ôàðìàêîëîã³¿ òà ôàðìàö³¿. – 2009. –

¹ 6. – Ñ. 2–7.

11. Êâàíòîâî-õ³ì³÷íå äîñë³äæåííÿ êîôå¿íó /, ². Ñ. ×åêìàí,

Ò. Þ. Íåáåñíà, Ò. Â. Çâÿã³íöåâà, Ã. Î. Ñèðîâà // Àêòóàëüíûå âîïðî-

ñû òåîðåòè÷åñêîé è ïðèêëàäíîé áèîôèçèêè, ôèçèêè è õèìèè:

ìàòåðèàëû VI Ìåæäóíàð. íàó÷í.-òåõíè÷. êîíô. – ì. Ñåâàñòîï³ëü,

2010. – Ò. 1. – Ñ. 174-176.

12. Ñèðîâà Ã.Î., Ãðàáîâåöüêà ª.Ð., Øàïîâàë Ë.Ã., Íàêîíå÷íà Ñ.À.,

Âàêóëåíêî Í.Â., Áîéêî ª.Ï. Ïàòåíò Óêðà¿íè íà êîðèñíó ìîäåëü ¹

59396 “Çàñòîñóâàííÿ êîìïîçèö³é íåñòåðî¿äíèõ ïðîòèçàïàëüíèõ

çàñîá³â ç êîôå¿íîì ÿê ïðåïàðàò³â ç àíòèåêñóäàòèâíîþ àêòèâí-

³ñòþ”, ÌÏÊ: À61Ê31/00-31/80 10.05.2011. Áþë. ¹ 1.

13. Ñèðîâà Ã.Î., Ãðàáîâåöüêà ª.Ð., Øàïîâàë Ë.Ã., Áîéêî ª.Ï.

Åêñïåðèìåíòàëüíå âèâ÷åííÿ àíòèåêñóäàòèâíî¿ ä³¿ êîìïîçèö³é

äèêëîôåíàêó íàòð³þ òà ³áóïðîôåíó ç êîôå¿íîì // Åêñïåðèìåí-

òàëüíà ³ êë³í³÷íà ìåäèöèíà. – ¹ 2 (51). – 2011. – Ñ. 53–55.

14 . Èñìàéëîâà Õ. Þ. Èíäèâèäóàëüíûå îñîáåííîñòè ïîâåäåíèÿ:

(ìîíîàìèíåðãè÷åñêèå ìåõàíèçìû) / Èñìàéëîâà Õ.Þ., Àãàåâ Ò.Ì.,

Ñåìåíîâà Ò.Ï. – Áàêó: Íóðëàí, 2007. – 228 ñ.

15. Äîêë³í³÷í³ äîñë³äæåííÿ ë³êàðñüêèõ çàñîá³â : ìåòîä. ðåê. /

çà ðåä. Î. Â. Ñòåôàíîâà. – Ê., 2001. – 527 ñ.

16. Hall C. S. Emotional behavior in the rat. I., Defecation and

urination as measures of individual differences in emotionality // J.

Comp. Psychol., 1934. – P. 385-403.

17. The relationship between emotionality and ambulatory activity //

J. Comp. Psychol., 1936. – P. 22, 345-452.

18. Ðîäèíà Â.È. Íîâûé ìåòîä îöåíêè òðåâîæíî-ôîáè÷åñ-

êèõ ñîñòîÿíèé ó êðûñ / Â. È. Ðîäèíà, Í. À. Êðóïèíà, Ã. Í. Êðûæà-

íîâñêèé, Í. Á. Îêíèíà // Âûñøàÿ íåðâíàÿ äåÿòåëüíîñòü. – 1993. –

¹ 43 (5). – Ñ. 1006-1017.

19. Áóðåø ß. Ìåòîäèêè è îñíîâíûå ýêñïåðèìåíòû ïî èçó÷å-

íèþ ìîçãà è ïîâåäåíèÿ / ß. Áóðåø, Î. Áóðåøîâà, Äæ. Ï. Õüþñòîí.

Ïîä ðåä. ïðîô. À.Ñ. Áàòóåâà. – Ì., 1991. – 400 ñ.

20 . Ðûáîëîâëåâ Þ. Ð., Ðûáîëîâëåâ Ð. Ñ. Äîçèðîâàíèå âåùåñòâ

äëÿ ìëåêîïèòàþùèõ ïî êîíñòàíòàì áèîëîãè÷åñêîé àêòèâíîñò³ /

Þ.Ð. Ðûáîëîâëåâ, Ð.Ñ. Ðûáîëîâëåâ // Äîêëàäû ÀÍ ÑÑÑÐ. – 1979. –

¹ 6. – Ñ. 1513–1516.

21. Ãëàíö Ñ. Ìåäèêî–áèîëîãè÷åñêàÿ ñòàòèñòèêà / Ñ. Ãëàíö;

ïåð. ñ àíãë. – Ì.: Ïðàêòèêà, 1998. – 459 ñ.

22. Êîðîñîâ À. Â. Êîìïüþòåðíàÿ îáðàáîòêà áèîëîãè÷åñêèõ

äàííûõ: ìåòîä. ïîñîáèå / À.Â. Êîðîñîâ, Â.Â. Ãîðáà÷. – Ïåòðîçà-

âîäñê: èçä-âî ÏåòðÃÓ, 2010. – 84 ñ.

23 . European convention for the protection of vertebrate animals

used for experimental and other scientific purposes // Council of

European. – Strasbourg, 1986. – ¹ 123. – 51 p.

24 . Ñó÷àñí³ ïðîáëåìè á³îåòèêè / â³äï. ðåä. Þ.². Êóíä³ºâ. – Ê.:

“Àêàäåìïåð³îäèêà”, 2009. – 278 ñ.

25. Äîðîãîé À. Ï. Ê âîïðîñó î õðîíîïàòîëîãèè, õðîíî-

òåðàïèè è õðîíîôàðìàêîëîãèè â êàðäèîëîãèè / À.Ï. Äîðîãîé //

Àêòóàëüíûå ïðîáë. â ñîâðåì. òåðàïèè : ñá. íàó÷. òð. – Õ., 1992. –

Ñ. 22–25.

26. Çàïàäíþê È. Ï. Ëàáîðàòîðíûå æèâîòíûå: ðàçâåäåíèå,

ñîäåðæàíèå, èñïîëüçîâàíèå â ýêñïåðèìåíòå / È. Ï. Çàïàäíþê,

Â. È. Çàïàäíþê, Å.À. Çàõàðèÿ. – Ê.: Âèùà øê., 1983. – Ñ. 243–297,

342–376.

ÝÌÎÖÈÎÍÀËÜÍÎ-ÏÎÂÅÄÅÍ×ÅÑÊÈÅ ÐÅÀÊÖÈÈ

Ó ÊÐÛÑ: ÝÊÑÏÅÐÈÌÅÍÒÀËÜÍÎÅ ÈÑÑËÅÄÎÂÀÍÈÅ

ÂËÈßÍÈß ÊÎÔÅÈÍÀ, ÏÀÐÀÖÅÒÀÌÎËÀ

È ÈÕ ÔÀÐÌÀÊÎËÎÃÈ×ÅÑÊÎÉ ÊÎÌÁÈÍÀÖÈÈ

Â ÒÅÑÒÅ "ÎÒÊÐÛÒÎÅ ÏÎËÅ"

Ôåäüêî Ê. Î., Ñèðîâà Ã. Î., Ëóêüÿíîâà Ë. Â.

Õàðêîâñêèé íàöèîíàëüíèé ìåäèöèíñêèé

óíèâåðñèòåò, ã. Õàðêîâ, Óêðàèíà

Ðåçþìå. Ïðîâåäåíî èññëåäîâàíèÿ âëèÿíèÿ êîôåè-

íà, ïàðàöåòàìîëà è èõ êîìïîçèöèè íà ýìîöèîíàëüíî-

ïîâåäåí÷åñêèå ðåàêöèè êðûñ â óñëîâèÿõ ôîðìàëèíîâî-

ãî îòåêà. Àíàëèç ðåçóëüòàòîâ âëèÿíèÿ ïàðàöåòàìîëà,

êîôåèíà è èõ êîìïîçèöèè íà ýìîöèîíàëüíî-ïîâåäåí-

÷åñêèå ðåàêöèè êðûñ â óñëîâèÿõ ôîðìàëèíîâîãî îòåêà

óêàçûâàåò íà öåëåñîîáðàçíîñòü íàçíà÷åíèÿ êîôåèíà,

ïàðàöåòàìîëà è èõ êîìïîçèöèè (îòíîñèòåëüíî ãîðèçîí-

òàëüíîé äâèãàòåëüíîé àêòèâíîñòè), êîôåèíà (îòíîñè-

òåëüíî ãðóìèíãà), ïàðàöåòàìîëà (îòíîñèòåëüíî âåðòè-

êàëüíîé äâèãàòåëüíîé àêòèâíîñòè).

Êëþ÷åâûå ñëîâà: êîôåèí, ïàðàöåòàìîë, ôàðìàêî-

ëîãè÷åñêàÿ êîìáèíàöèÿ, “îòêðûòîå ïîëå”, ôîðìàëèíî-

âûé îòåê.

EMOTIONAL AND BEHAVIOURAL RESPONSES

IN RATS: EXPERIMENTAL INVESTIGATION

OF INFLUENCE OF CAFFEINE, PARACETAMOL

AND THEIR PHARMACOLOGICAL

COMPOSITION IN THE “OPEN FIELD” TEST

K. Fed’ko, A. Syrovaya, L. Lukyanova

Kharkiv National Medical University, Kharkiv, Ukraine

Summary. Experimental research of influence of

caffeine, ðaracetamol and their compositions on the

emotional and behavioral responses in rats with formalin-

induced edema was carried out. Analysis of results of

influence of caffeine, ðaracetamol and their compositions

on the emotional and behavioral responses in rats with

formalin-induced edema suggests advisability of caffeine,

paracetamol and their composition (relative to the horizontal

motive activity), caffeine (relative to grooming), paracetamol

(relative to the vertical motive activity).

Key words: caffeine, paracetamol, pharmacological

combination, “open field”, formalin edema.

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

Âñòóï. Îäí³ºþ ç àêòóàëüíèõ ïðîáëåì ñó÷àñíî¿ ïåä³-

àòð³¿ º çàõâîðþâàííÿ òðàâíîãî òðàêòó. Îñòàíí³ òðèäöÿòü

ðîê³â õàðàêòåðèçóþòüñÿ ñòð³ìêèì çðîñòàííÿì ïîøèðåí-

íÿ ãàñòðîåíòåðîëîã³÷íî¿ ïàòîëîã³¿ ñåðåä ä³òåé. Çà ïîøè-

ðåííÿì çàõâîðþâàííÿ îðãàí³â òðàâëåííÿ çàéìàþòü äðóãå

ì³ñöå ï³ñëÿ çàõâîðþâàíü îðãàí³â äèõàííÿ. Â ñòðóêòóð³ ãàñ-

òðîåíòåðîëîã³÷íèõ çàõâîðþâàíü ó ä³òåé ïåðåâàæàþòü õâî-

ðîáè îðãàí³â ãàñòðîäóîäåíàëüíî¿ çîíè. Ðîçïîâñþä-

æåí³ñòü õðîí³÷íîãî ãàñòðîäóîäåí³òó ñåðåä äèòÿ÷îãî

íàñåëåííÿ 200-220‰, à â åêîëîã³÷íî íåñïðèÿòëèâèõ ðåã³î-

íàõ – 300-400‰ [1]. Íà òåïåð³øí³é ÷àñ ó ôîðìóâàíí³ õðî-

í³÷íèõ çàïàëüíèõ çàõâîðþâàíü ãàñòðîäóîäåíàëüíî¿ çîíè

(ãàñòðèòó, ãàñòðîäóîäåí³òó) âàãîìå çíà÷åííÿ íàäàºòüñÿ

äèñáàëàíñó ì³æ ôàêòîðàìè àãðåñ³¿ òà çàõèñòó ñëèçîâî¿

îáîëîíêè øëóíêó òà äâàíàäöÿòèïàëî¿ êèøêè [2, 3].

Íà ñüîãîäí³øí³é äåíü ïðîäîâæóºòüñÿ âèâ÷åííÿ âïëè-

âó, ÷àñòîòè, ïèòîìî¿ âàãè îêðåìèõ ôàêòîð³â ó ðîçâèòêó

õðîí³÷íîãî ãàñòðîäóîäåí³òó (ÕÃÄ), çîêðåìà íåäî-

ñòàòí³ñòü ñëèçîâîãî øàðó, ùî ìàº çíà÷íó ïèòîìó âàãó ñå-

ðåä ôàêòîð³â ãàñòðîïðîòåêö³¿. Ñëèç – ìóêî¿äíèé ñåêðåò,

ùî ïðåäñòàâëåíèé äâîìà òèïàìè ðå÷îâèí – ãë³êîïðîòå¿-

íàìè òà ïðîòåîãë³êàíàìè. Ïðîòåîãë³êàíè óòâîðþþòü êëàñ

äóæå ñèëüíî ãë³êîçèëüîâàíèõ ãë³êîïðîòå¿í³â (ìàêðîìîëå-

êóëè, ÿê³ ñêëàäàþòüñÿ ç îäíîãî á³ëêà ³ îäíîãî ÷è á³ëüøå

êîâàëåíòíîçâ’ÿçàíèõ ãë³êîçàì³íîãë³êàí³â). Ö³ ãë³êîçàì³íîã-

ë³êàëüí³ ëàíöþãè º äîâãèìè, ë³í³éíèìè âóãëåâîäíèìè

ãðóïàìè, ÿê³ ñêëàäàþòüñÿ ç îë³ãîñàõàðèäíèõ çàëèøê³â, ùî

ïîâòîðþþòüñÿ [4]. Äî îë³ãîñàõàðèäíèõ ëàíöþæê³â íàëå-

æàòü ãåêñîçàì³íè, ôóêîçà, ãàëàêòîçà, ùî âèçíà÷àþòü çà-

õèñíó, òðàíñïîðòíó, áàð’ºðíó ôóíêö³¿ ñëèçîâîãî øàðó

øëóíêó [5].

Åñåíö³àëüí³ ì³êðîåëåìåíòè ÷èíÿòü çíà÷íèé âïëèâ íà

ñòàí øëóíêîâî¿ ñåêðåö³¿, ïðîäóêö³þ ôàêòîð³â çàõèñòó ñëè-

çîâî¿ îáîëîíêè øëóíêó ³ äâàíàäöÿòèïàëî¿ êèøêè, çâîðîò-

íó äèôóç³þ âîäíåâèõ ³îí³â, ô³ç³îëîã³÷íó àêòèâí³ñòü ãîð-

ìîí³â ³ â³òàì³í³â, òêàíèííå äèõàííÿ [6,7,8].

Íà ñüîãîäåííÿ äîâåäåíà íåãàòèâíó ðîëü íåàäåêâàòíî-

ãî õàð÷óâàííÿ, äåô³öèòó îêðåìèõ åññåíö³àëüíèõ ì³êðîå-

ëåìåíò³â, öèíêó çîêðåìà, â ôîðìóâàíí³ çàõâîðþâàíü

îðãàí³â òðàâëåííÿ [6, 7, 8, 9]. Ïðîòå çàëèøàºòüñÿ ìàëîâèâ-

÷åíèì âïëèâ äåô³öèòó öèíêó íà ïåðåá³ã õðîí³÷íîãî ãàñòðî-

äóîäåí³òó ó ä³òåé.

Ìåòà ðîáîòè – äîñë³äèòè îñîáëèâîñò³ êë³í³÷íîãî ïåðå-

á³ãó õðîí³÷íîãî ãàñòðîäóîäåí³òó, ñòàíó ãàñòðîïðîòåêö³¿

ÓÄÊ 616.33+616.342]-053.2-036.12

ÎÑÎÁËÈÂÎÑÒ² ÏÅÐÅÁ²ÃÓ

ÕÐÎÍ²×ÍÎÃÎ ÃÀÑÒÐÎÄÓÎÄÅÍ²ÒÓ Ó Ä²ÒÅÉ

ÍÀ ÔÎÍ² ÄÅÔ²ÖÈÒÓ ÖÈÍÊÓ

Àñîíîâ À.Î., Ìàðóøêî Þ.Â., Ã³÷êà Ñ.Ã.

Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Î.Î. Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: öèíê, ä³òè, ïàòîëîã³ÿ òðàâíîãî êàíàëó, ãàñòðîïðîòåêö³ÿ.

ïðè äåô³öèò³ öèíêó â îðãàí³çì³ ä³òåé äëÿ îá´ðóíòóâàííÿ

ë³êóâàëüííî-ðåàá³ë³òàö³éíèõ çàõîä³â.

Ìàòåð³àëè ³ ìåòîäè. Äëÿ âèð³øåííÿ ïîñòàâëåíèõ çàâ-

äàíü ó äîñë³äæåííÿ áóëî âêëþ÷åíî 189 ä³òåé ç õðîí³÷íèì

ãàñòðîäóîäåí³òîì â³êîì â³ä 6 äî 17 ðîê³â, ÿê³ ïåðåáóâàëè

íà ñòàö³îíàðíîìó ë³êóâàíí³ â äèòÿ÷³é êë³í³÷í³é ë³êàðí³ ¹8

ì. Êèºâà.

Ó ñâî¿é ðîáîò³ ìè îïèðàëèñü íà ïðîòîêîë ä³àãíîñòèêè

òà ë³êóâàííÿ çàõâîðþâàíü îðãàí³â òðàâëåííÿ ó ä³òåé

(Íàêàç ÌÎÇ â³ä 29.01.2013 ¹ 59) [1].

Îñíîâíèì êðèòåð³ºì äëÿ âêëþ÷åííÿ ä³òåé ó äîñë³ä-

æåííÿ áóëè êë³í³÷í³ ïðîÿâè õðîí³÷íîãî ãàñòðîäóîäåí³òó

(ÕÃÄ) ç óðàõóâàííÿì ñêàðã, àíàìíåçó òà íåîáõ³äí³ñòü ïðî-

âåäåííÿ ä³àãíîñòè÷íî¿ ô³áðîåçîôàãîäóîäåíîñêîï³¿

(ÔÅÃÄÑ); çãîäà áàòüê³â íà ó÷àñòü ó äîñë³äæåíí³.

Êðèòåð³¿ âèêëþ÷åííÿ ç äîñë³äæåííÿ: ïðèéîì ïðîòÿ-

ãîì 4-õ òèæí³â äî âêëþ÷åííÿ ó äîñë³äæåííÿ àíòèá³îòèê³â,

ìåòðîí³äàçîëó, ïðåïàðàò³â â³ñìóòó, ³íã³á³òîð³â ïðîòîííî¿

ïîìïè, áëîêàòîð³â Í2-ã³ñòàì³íîâèõ ðåöåïòîð³â, ñóêðàëü-

ôàòó, â³òàì³ííî-ì³íåðàëüíèõ êîìïëåêñ³â, ïðåïàðàò³â çàë³-

çà òà öèíêó, ï³äâèùåíèé âì³ñò öèíêó ó âîëîññ³.

Äîñë³äæåííÿ âèêîíàíî ç äîòðèìàííÿì îñíîâíèõ ïî-

ëîæåíü Ãåëüñ³íñüêî¿ äåêëàðàö³¿ ïðî åòè÷í³ ïðèíöèïè ïðî-

âåäåííÿ á³îìåäè÷íèõ äîñë³äæåíü çà ó÷àñòþ ëþäèíè

(1964–2000), Êîíâåíö³¿ Ðàäè ªâðîïè ïðî ïðàâà ëþäèíè òà

á³îìåäèöèíè (1997). Ìàòåð³àëè êë³í³÷íîãî äîñë³äæåííÿ

ðîçãëÿíóò³ òà çàòâåðäæåí³ êîì³ñ³ºþ ç ïèòàíü åòèêè ÍÌÓ

³ìåí³ Î.Î. Áîãîìîëüöÿ (ïðîòîêîë ¹ 75 â³ä 13.12.2013 ð ).

Îá’ºì ïðîâåäåíèõ äîñë³äæåíü âêëþ÷àâ êîìïëåêñíå

îáñòåæåííÿ: ðåòåëüíå âèâ÷åííÿ àíàìíåçó çàõâîðþâàííÿ

òà æèòòÿ; ô³çèêàëüíå îáñòåæåííÿ, ïðîâåäåííÿ çàãàëüíî-

êë³í³÷íèõ ëàáîðàòîðíèõ, ùî âêëþ÷àëè çàãàëüíèé àíàë³ç

êðîâ³, çàãàëüíèé á³ëîê ñèðîâàòêè êðîâ³, çàãàëüíèé

á³ë³ðóá³í òà éîãî ôðàêö³¿, àëàí³íàì³íîòðàíñôåðàçó, àñ-

ïàðòàòàì³íîòðàíñôåðàçó, çàãàëüíèé àíàë³ç ñå÷³, êîïðîã-

ðàìó, òà äîñë³äæåííÿ êàëó íà ïðèõîâàíó êðîâ; ³íñòðóìåí-

òàëüíèõ ìåòîä³â äîñë³äæåííÿ. Ðåçóëüòàòè îáñòåæåííÿ

çàíîñèëèñü äî ³íäèâ³äóàëüíèõ êàðò õâîðîãî, ùî áóëè

ñïåö³àëüíî ðîçðîáëåí³ íà êàôåäð³ ïåä³àòð³¿ ¹3 Íàö³î-

íàëüíîãî ìåäè÷íîãî óí³âåðñèòåòó ³ìåí³ Î.Î. Áîãîìîëüöÿ.

Ïðè ïîñòóïëåíí³ íà ë³êóâàííÿ ä³òÿì ç ÕÃÄ òà ¿õ áàòü-

êàì ìè ïðîïîíóâàëè çàïîâíèòè àíêåòó. Ïèòàííÿ â àíêåò³

ñòîñóâàëèñü äèòèíè òà ¿¿ ñ³ì’¿, àíàìíåçó çàõâîðþâàííÿ òà

àíàìíåçó æèòòÿ. Çíà÷íà óâàãà ïðèä³ëÿëàñü àíàìíåçó

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

çàõâîðþâàííÿ: êîëè ïî÷àëîñü çàõâîðþâàííÿ, ñê³ëüêè çà-

ãîñòðåíü áóëî çà îñòàíí³é ð³ê, ÿêå ïðîâîäèëîñü ë³êóâàííÿ,

÷è áóëî ïðîâåäåíî àíòèõåë³êîáàêòåðíó òåðàï³þ.

Âåðèô³êàö³ÿ ä³àãíîçó ïðîâîäèëàñü íà ï³äñòàâ³ êîìï-

ëåêñíîãî êë³í³÷íîãî òà ëàáîðàòîðíî-³íñòðóìåíòàëüíîãî

îáñòåæåííÿ.

Ïðè ïðîâåäåíí³ ô³áðîåçîôàãîãàñòðîäóîäåíîñêîï³¿

âèêîðèñòîâóâàëèñü ãíó÷ê³ ô³áðîñêîïè GIF-PQ20 òà GIF-

PQ140 ô³ðìè Olympus, ßïîí³ÿ. Äîñë³äæåííÿ ïðîâîäè-

ëîñü çà çàãàëüíîïðèéíÿòèìè ðåêîìåíäàö³ÿìè. Îö³íêà

åíäîñêîï³÷íèõ çì³í ïðîâîäèëàñü çã³äíî êëàñèô³êàö³¿

À.Â. Ìàçóðèíà (1984), ÿêà çàòâåðäæåíà äëÿ êîðèñòóâàííÿ

â ïåä³àòð³¿.

Ç ìåòîþ äîñë³äæåííÿ êèñëîòîóòâîðþþ÷î¿ ôóíêö³¿

øëóíêà çàñòîñîâóâàëàñü áàçàëüíà òîïîãðàô³÷íà ðÍ-ìåò-

ð³ÿ ç âèêîðèñòàííÿì ðÍ-ì³êðîçîíäà “ÈÊÆ-2” çà ìåòîäîì

Â.Ì. ×îðíîáðîâîãî (1991).

Äëÿ àíàë³çó á³îõ³ì³÷íîãî ñêëàäó íàòèâíîãî ñëèçó âè-

êîðèñòîâóâàëè àñï³ðàòè øëóíêîâîãî ñåêðåòó. Îö³íêà öè-

òîïðîòåêòèâíèõ âëàñòèâîñòåé ñëèçîâîãî áàð’ºðó øëóíêó

ïðîâîäèëàñü øëÿõîì âèçíà÷åííÿ ð³âíÿ ôóêîçè øëóíêîâî-

ãî ñëèçó çà ìåòîäîì Dishe (1948) òà ð³âíþ á³ëêó ó ñêëàä³

íàäåï³òåë³àëüíîãî ñëèçó øëóíêó (Áóçóí, 1982) ó 44 ä³òåé

(êë³í³êî-á³îõ³ì³÷íà ëàáîðàòîð³ÿ ÄÓ ‘’²íñòèòóò Ïåä³àòð³¿,

Àêóøåðñòâà ³ Ã³íåêîëîã³¿ ÍÀÌÍ Óêðà¿íè’’). Çà äàíèìè

Ñàëüíèêîâà À.Â. âì³ñò ôóêîçè ó ñêëàä³ ãë³êîïðòå¿í³â íà-

äåï³òåë³àëüîãî ñëèçâîãî øàðó ó ïîòåíö³éíî çäîðîâèõ îñ³á

ñêëàäàº 10,7±2,2 ìÌîëü/ë [10].

Ïðîâåäåíî ìîðôîëîã³÷íå äîñë³äæåííÿ á³îïòàò³â ñëè-

çîâî¿ îáîëîíêè øëóíêó òà äâàíàäöÿòèïàëî¿ êèøêè 35

ä³òåé â ëàáîðàòîð³¿ êàôåäðè ïàòàëîã³÷íî¿ àíàòîì³¿ Êè¿âñü-

êîãî ìåäè÷íîãî óí³âåðñèòåòó ÓÀÍÌ (çàâ. ëàáîðàòîð³¿

ïðîô. Ñ.Ã. Ãè÷êà). Á³îïñ³éíèé ìàòåð³àë ïîì³ùàëè ó 10%

ðîç÷èí³ íåéòðàëüíîãî çàáóôåðåíîãî ôîðìàë³íó (pH 7,4)

òà ô³êñóâàëè ïðîòÿãîì 24 ãîäèí. Ï³ñëÿ äåã³äðàòàö³¿ êóñî÷-

êè çàëèâàëè â ïàðàô³í çà ñòàíäàðòíîþ ìåòîäèêîþ. Ã³ñòî-

ëîã³÷í³ ïðåïàðàòè òîâùèíîþ 4-5 ìêì ôàðáóâàëè ãåìà-

òîêñèë³íîì òà åîçèíîì, à òàêîæ çà äîïîìîãîþ ìåòîäèêè

Ã³ìçå. Ã³ñòîëîã³÷í³ ïðåïàðàòè âèâ÷àëèñü ç âèêîðèñòàí-

íÿì ì³êðîñêîïà “Olympus BX 51”, öèôðîâî¿ êàìåðè

“Olympus C 5050 Z” òà ïðîãðàìíîãî çàáåçïå÷åííÿ

“Olympus DP- Soft”.

Äëÿ ³äåíòèô³êàö³¿ ãåë³êîáàêòåð³îçó âèêîðèñòîâóâàëè

ã³ñòîëîã³÷íèé ìåòîä, à òàêîæ íå³íâàçèâíó ñïåöèô³÷íó åê-

ñïðåñ ä³àãíîñòèêó çà ñêëàäîì âèäèõóâàíîãî ïîâ³òðÿ çà

äîïîìîãîþ òåñò-ñèñòåìè “ÕÅË²Ê” ç ³íäèêàòîðíîþ òðóá-

êîþ (ÎÎÎ “ÀÌÀ”, Ðîñ³ÿ).

Âèçíà÷åííÿ âì³ñòó öèíêó ñèðîâàòêè êðîâ³ ïðîâîäè-

ëîñü 72 ïàö³ºíòàì ñïåêòðàëüíèì àòîìíî-àáñîðáö³éíèì

ìåòîäîì (Kelner R., 2004) ó “Ëàáîðàòîð³¿ Äð. Ðåäãåðà,

MDI” (Ë³öåíç³ÿ ÌÎÇ Óêðà¿íè ¹ 603260 îò 23.09.211). Çà

äåô³öèò öèíêó ïðèéíÿòî çíèæåííÿ éîãî ð³âíÿ â êðîâ³ ëþ-

äèíè íèæ÷å 12,8 ìêìîëü/ë, ùî â³äïîâ³äàº 0,85 ìã/ë (çà äà-

íèìè Aggett et al., 1979 ð., Ùåïëÿã³íà, 2001ð.).

Óñ³ì ïàö³ºíòàì ïðîâîäèëîñü äîñë³äæåííÿ âì³ñòó öèí-

êó, çàë³çà, ì³ä³ òà ³íøèõ ì³êðîåëåìåíò³â ó âîëîññ³ ìåòîäîì

ðåíòãåí-ôëþîðåñöåíòíî¿ ñïåêòðîìåòð³¿ íà àïàðàò³

“ElvaX – med”. Çà äàíèìè, ùî îòðèìàí³ íàìè ïðè áàãàòî-

÷èñåëüíèõ äîñë³äæåííÿõ çà äîïîìîãîþ ðåíòãåí-ôëþî-

ðåñöåíòíî¿ ñïåêòðîìåòð³¿, íèæí³é ïîðîãîâèé âì³ñò öèíêó

ó âîëîññ³ âñòàíîâëåíèé íà ð³âí³ 100 ìêã/ã. Ïðè éîã ð³âí³

ìåíøîìó çà íèæí³é ïîð³ã êîíñòàòóâàëè äåô³öèò öèíêó.

(Ïàòåíò íà êîðèñíó ìîäåëü ¹ 6821 “Ñïîñ³á ä³àãíîñòèêè

äåô³öèòó öèíêó ó ä³òåé” â³ä 10.04.2012.)

Ñòàòèñòè÷íà îáðîáêà îòðèìàíèõ äàíèõ ïðîâåäåíà çà

çàãàëüíîïðèéíÿòèìè ìåòîäàìè âàð³àö³éíî¿ ñòàòèñòèêè.

Âèçíà÷àëèñÿ áàçîâ³ ñòàòèñòè÷í³ ïîêàçíèêè – ñåðåäíÿ

àðèôìåòè÷íà âåëè÷èíà (Ì), ñåðåäíÿ ïîõèáêà ñåðåäíüî¿

âåëè÷èíè (m), ð – äîñÿãíóòèé ð³âåíü ñòàòèñòè÷íî¿ çíà÷è-

ìîñò³, n – îáñÿã àíàë³çîâàíî¿ ãðóïè. Îö³íêó äîñòîâ³ðíîñ-

òåé â³äì³ííîñòåé â ïîð³âíþâàíèõ îáñòåæóâàíèõ ãðóïàõ

ïðîâîäèëè ñòàíäàðòíèìè ïàðàìåòðè÷íèìè ³ íåïàðàìåò-

ðè÷íèìè ìåòîäàìè çà äîïîìîãîþ êðèòåð³¿â Ñòüþäåíòà,

Â³ëêîêñîíà. Äëÿ ïîð³âíÿííÿ ÷àñòîòíèõ ïîêàçíèê³â ó âèá³ð-

êàõ çàñòîñîâóâàâñÿ êðèòåð³é Ï³ðñîíà χ2, êðèòåð³é Ô³øåðà

òà ïîïðàâêà Éåéòñà íà áåçïåðåðâí³ñòü (âèá³ð ìåòîäó îö³í-

êè áàçóâàâñÿ íà ðîçì³ð³ âèá³ðêè, ùî äîñë³äæóâàëàñü).

Ð³çíèöÿ ì³æ ãðóïàìè ââàæàëàñü ñòàòèñòè÷íî çíà÷èìîþ

ïðè â³ðîã³äíîñò³ ïîìèëêè (α) íóëüîâî¿ ã³ïîòåçè íå á³ëüøå

5% (ð<0,05).

Ðåçóëüòàòè äîñë³äæåííÿ. Íàìè áóëî ïðîâåäåíî âèç-

íà÷åííÿ âì³ñòó öèíêó ó ïðèêîðíåâ³é çîí³ âîëîññÿ ä³òåé ç

õðîí³÷íèì ãàñòðîäóîäåí³òîì ïðåäñòàâëåí³. Ðåçóëüòàòè

äîñë³äæåííÿ ïðåäñòàâëåí³ ó òàáë. 1.

Àíàë³ç îòðèìàíèõ ðåçóëüòàò³â ïîêàçàâ, ùî äåô³öèò

öèíêó âñòàíîâëåíî ó âîëîññ³ 45,5% îáñòåæóâàíèõ ä³òåé.

Íàìè áóëî ïðîâåäåíî âèçíà÷åííÿ âì³ñòó öèíêó ñèðî-

âàòêè êðîâ³ 72 ä³òåé ç ÕÃÄ. Ðåçóëüòàòè äîñë³äæåííÿ ïðåä-

ñòàâëåí³ â òàáë. 2.

ßê âèäíî ³ç òàáëèö³ 2 ó 54,2% ä³òåé ç õðîí³÷íèì ãàñòðî-

äóîäåí³òîì ñïîñòåð³ãàºòüñÿ çíèæåííÿ ð³âíÿ öèíêó ó ñè-

ðîâàòö³ êðîâ³.

Äåô³öèò öèíêó, âèÿâëåíèé ó âîëîññ³, ó ïåðåâàæí³é

á³ëüøîñò³ âèïàäê³â ï³äòâåðäæóâàâñÿ ðåçóëüòàòàìè äî ñë³ä-

æåííÿ öèíêó ñèðîâàòêè êðîâ³ (95,83%). Ñèðîâàòêà êðîâ³

â³äîáðàæàº åëåìåíòíèé ñòàòóñ êîðîòêî÷àñíèé çà åêñïî-

çèö³ºþ òà çíà÷íèé çà ñòóïåíåì â³äõèëåííÿ. Âîëîññÿ â³äîá-

ðàæàº åëåìåíòíèé ñòàòóñ, ÿêèé ôîðìóºòüñÿ íà ïðîòÿç³

òðèâàëîãî ÷àñó (ì³ñÿö³, ðîêè) ³ á³ëüø ïðèäàòíå äëÿ

êë³í³÷íî¿ îö³íêè [6].

Â çàëåæíîñò³ â³ä ð³âíÿ öèíêó ó âîëîññ³ ä³òè ç ãàñòðîäó-

îäåí³òîì áóëè ðîçïîä³ëåí³ íà 2 ãðóïè ñïîñòåðåæåííÿ:

² ãðóïà (îñíîâíà) – 86 ä³òåé ç õðîí³÷íèì ãàñòðîäóîäåí³-

òîì, ùî ìàëè äåô³öèò öèíêó ó âîëîññ³ (81,26±1,55 ìêã/ã);

²² ãðóïà (ïîð³âíÿííÿ) – 100 ä³òåé ç õðîí³÷íèì ãàñòðîäóî-

äåí³òîì òà íîðìàëüíèì âì³ñòîì öèíêó ó âîëîññ³

(131,94±2,66 ìêã/ã). Ïî â³êîâîìó, ñòàòåâîìó ñêëàäó îáèäâ³

ãðóïè äîñòîâ³ðíî íå â³äð³çíÿëèñü ì³æ ñîáîþ.

Òàáëèöÿ 1.

Âì³ñò öèíêó ó âîëîññ³ ä³òåé ç õðîí³÷íèì

ãàñòðîäóîäåí³òîì.

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

Àíàë³çóþ÷è äàí³ àíàìíåçó ìè â³äì³÷àëè, ùî âèïàäêè

çàãîñòðåííÿ ÕÃÄ äîñòîâ³ðíî ÷àñò³øå (ð<0,05) ñïîñòåð³ãà-

þòüñÿ ó ãðóï³ ïàö³ºíò³â ç äåô³öèòîì öèíêó (2,52±0,1), í³æ ó

ä³òåé ãðóïè ïîð³âíÿííÿ (1,64±0,07).

Àíàë³ç êë³í³÷íîãî îáñòåæåííÿ ïàö³ºíò³â ñâ³ä÷èòü ïðî

íàÿâí³ñòü ó äâîõ ãðóïàõ ä³òåé ç ÕÃÄ ó ïåð³îä çàãîñòðåííÿ

íàñòóïíèõ ñèíäðîì³â: áîëüîâîãî àáäîì³íàëüíîãî; äèñ-

ïåïñè÷íîãî òà ñèíäðîìó õðîí³÷íî¿ íåñïåöèô³÷íî¿ ³íòîê-

ñèêàö³¿. ×àñòîòà îêðåìèõ êë³í³÷íèõ ïðîÿâ³â ïðè ÕÃÄ ó îá-

ñòåæåíèõ ïàö³ºíò³â íàâåäåíà ó òàáë. 3.

ßê âèäíî ³ç äàíèõ òàáë. 3, ó îñíîâí³é ãðóï³ äîñòîâ³ðíî

÷àñò³øå ñïîñòåð³ãàºòüñÿ ñèíäðîì õðîí³÷íî¿ íåñïåöèô³÷-

íî¿ ³íòîêñèêàö³¿ í³æ ó ïàö³ºíò³â ãðóïè ïîð³âíÿííÿ. Áîëüî-

âèé òà äèñïåïñè÷íèé ñèíäðîìè çóñòð³÷àëèñÿ äåùî ÷àñò³-

øå, àëå äàí³ íå äîñòîâ³ðí³.

Âñ³ì õâîðèì, çà çãîäîþ áàòüê³â, áóëà ïðîâåäåíà

ÔÅÃÄÑ. Çà äàíèìè åíäîñêîï³÷íîãî îáñòåæåííÿ ïîâåðõ-

íåâèé ãàñòðîäóîäåí³ò áóâ ä³àãíîñòîâàíèé ó ² ãðóï³ â 66

(76,7%) âèïàäêàõ, à ó ãðóï³ ïîð³âíÿííÿ â 87 (87,0%) ä³òåé

â³äïîâ³äíî. Ã³ïåðòðîô³÷í³ çì³íè ñëèçîâî¿ îáîëîíêè

øëóíêó (ÑÎØ) òà äâàíàäöÿòèïàëî¿ êèøêè (ÑÎ ÄÏÊ) ñïîñ-

òåð³ãàëèñü ó 7 (8,2%) ä³òåé ç îñíîâíî¿ ãðóïè òà ó 7(7,0%)

îáñòåæåíèõ ç ãðóïè ïîð³âíÿííÿ; åðîçèâí³ ïðîöåñè â

øëóíêó òà ÄÏÊ âèÿâëåí³ 11 (12,8%) ä³òåé ² ãðóïè òà ó 4

(4,0%; ð<0,05) ä³òåé ²² ãðóïè; ñóáàòðîô³ÿ – ó 2 (2,3%) ä³òåé

ç îñíîâíî¿ ãðóïè òà ó 2(2,0%) ä³òåé ç ãðóïè ïîð³âíÿííÿ.

Çà ðåçóëüòàòàìè ïðîâåäåíîãî ìîðôîëîã³÷íîãî äîñë³-

äæåííÿ á³îïòàò³â ÑÎØ òà ÑÎ ÄÏÊ âñòàíîâëåíî á³ëüø âè-

ðàæåí³ ïðîöåñè àëüòåðàö³¿ â åï³òåë³¿ çàëîç ÑÎØ ó

ïàö³ºíò³â ç äåô³öèòîì öèíêó, á³ëüø âèðàæåí³ ïðîöåñè ñó-

áàòðîô³¿ çàëîç â ñëèçîâ³é îáîëîíö³ ó ïàö³ºíò³â ç äåô³öè-

òîì öèíêó. Â ïåðåâàæí³é á³ëüíîñò³ âèïàäê³â õðîí³÷íîãî

ãàñòðèòó íà òë³ äåô³öèòó öèíêó â á³îïòàòàõ âèÿâëåí³ îçíà-

êè ïîâíî¿ àáî íåïîâíî¿ êèøêîâî¿ ìåòàïëàç³¿ ïîâåðõíåâîãî

ïîêðèâíîãî åï³òåë³þ òà åï³òåë³þ çàëîç.

Òàêîæ íàìè ñïîñòåð³ãàëèñü â á³îïòàòàõ á³ëüø âèðà-

æåí³ ïðîöåñè ñóáàòðîô³¿ â ñëèçîâ³é îáîëîíö³ öèáóëèíè

12-ïàëî¿ êèøêè ó ãðóï³ ïàö³ºíò³â ç äåô³öèòîì öèíêó.

Àíàë³çóþ÷è ðåçóëüòàòè ïðîâåäåíîãî îáñòåæåííÿ

ä³òåé íà ãåë³êîáàêòåð³îç âèÿâëåíî, ùî ó ä³òåé ç ÕÃÄ ìàº

ì³ñöå çá³ëüøåííÿ ÷àñòîòè Í.pylori -àñîö³éîâàíèõ ÕÃÄ ç

â³êîì äèòèíè. ²íô³êóâàííÿ Helicobacter pylori âåðèô³êîâà-

íî íàìè ó 62 (72,1%) ³ç 86 õâîðèõ ² ãðóïè òà ó 61 (61,0%) ³ç

100 ä³òåé ²² ãðóïè. Äîñòîâ³ðíî¿ ð³çíèö³ çà íàÿâí³ñòþ

³íô³êóâàííÿ Í.ðylori íå âñòàíîâëåíî.

Äîñë³äæåííÿ øëóíêîâî¿ ñåêðåö³¿ ïîêàçàëî, ùî ó îáîõ

ãðóïàõ á³ëüø³ñòü ä³òåé ìàëè íîðìàëüíó êèñëîòîóòâîðþ-

þ÷ó ôóíêö³þ øëóíêà (45,4% òà 43,0% â³äïîâ³äíî). Äîñòî-

â³ðíèõ â³äì³ííîñòåé ó ð³âí³ áàçàëüíî¿ êèñëîòíîñò³ ì³æ

îáñòåæóâàíèìè ãðóïàìè íå âèÿâëåíî.

Çà ðåçóëüòàòàìè äîñë³äæåííÿ ñëèçó øëóíêîâîãî ñåê-

ðåòó áóëà âñòàíîâëåíà äîñòîâ³ðíà ð³çíèöÿ ó ïîêàçíèêàõ

öèòîïðîòåêòèâíèõ âëàñòèâîñòåé ñëèçîâîãî áàð’ºðó

øëóíêó ó ãðóïàõ ïîð³âíÿííÿ (òàáë.4).

ßê âèäíî ³ç äàíèõ òàáë. 4, ó ä³òåé ³ç çíèæåíèì âì³ñòîì

öèíêó ñïîñòåð³ãàºòüñÿ äîñòîâ³ðíî á³ëüø âèðàæåíå çíè-

æåííÿ êîíöåíòðàö³¿ ôóêîçè øëóíêîâîãî ñëèçó (2,68±0,17)

â ïîð³âíÿíí³ ç ²² ãðóïîþ (3,56 ±0,15; ð<0,05).

Òàêèì ÷èíîì, îòðèìàí³ äàí³ ïðî îñîáëèâ³ñòü ïåðåá³ãó

õðîí³÷íîãî ãàñòðîäóîäåí³òó ó ä³òåé íà ôîí³ äåô³öèòó öèíêó

Òàáëèöÿ 2.

Âì³ñò öèíêó ó ñèðîâàòö³ êðîâ³ ä³òåé ç õðîí³÷íèì ãàñòðî äóîäåí³òîì

* – ð³çíèöÿ äîñòîâ³ðíà (ð<0,05).

Òàáëèöÿ 3.

×àñòîòà êë³í³÷íèõ ñèíäðîì³â ÕÃÄ ó ä³òåé

Òàáëèöÿ 4.

Ñòàí öèòîïðîòåêòèâíèõ âëàñòèâîñòåé ñëèçîâîãî áàð’ºðó øëóíêó

* – ð³çíèöÿ äîñòîâ³ðíà ïîð³âíÿíî ç³ çäîðîâèìè (ð<0,05);

** – ð³çíèöÿ äîñòîâ³ðíà ïîð³âíÿíî ç ãðóïîþ ïîð³âíÿííÿ (ð<0,05).

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

íåîáõ³äíî âðàõîâóâàòè ïðè ðîçðîáö³ ë³êóâàëüíèõ òà

ïðîô³ëàêòè÷íèõ çàõîä³â öèì ä³òÿì. Òàêèé ï³äõ³ä ïîêðà-

ùèòü ðåçóëüòàòè òåðàïåâòè÷íèõ çàõîä³â.

Âèñíîâêè: 1. Ïåðåá³ã õðîí³÷íîãî ãàñòðîäóîäåí³òó ó

ä³òåé, ïðè çìåíøåíí³ âì³ñòó öèíêó, õàðàêòåðèçóºòüñÿ

á³ëüø ÷àñòèìè çàãîñòðåííÿìè òà âèðàæåíèìè ñèìïòîìà-

ìè ³íòîêñèêàö³¿.

2. Ó ä³òåé ³ç çíèæåíèì âì³ñòîì öèíêó ó âîëîññ³ ñïîñòå-

ð³ãàþòüñÿ á³ëüø âèðàæåí³ ïðîöåñè àëüòåðàö³¿ ñëèçîâî¿

îáîëîíêè øëóíêó òà á³ëüø âèðàæåíà ñóáàòðîô³ÿ ñëèçî-

âî¿ îáîëîíêè øëóíêó òà äâàíàäöÿòèïàëî¿ êèøêè.

3. Ó ä³òåé ³ç çíèæåíèì âì³ñòîì öèíêó ó âîëîññ³ ñïîñòå-

ð³ãàºòüñÿ á³ëüø âèðàæåíå çíèæåííÿ âì³ñòó ôóêîçè ñëèçî-

âîãî áàð’ºðó øëóíêó.

Ðåöåíçåíò: ä.ìåä.í., ïðîôåñîðÒÿæêà Î.Â.

Ë²ÒÅÐÀÒÓÐÀ:

1. Íàêàç ÌÎÇ â³ä 29.01.2013 ¹ 59 Ïðî çàòâåðäæåííÿ ïðî-

òîêîë³â ä³àãíîñòèêè òà ë³êóâàííÿ çàõâîðþâàíü îðãàí³â òðàâ-

ëåííÿ ó ä³òåé. – [Åëåêòðîííèé ðåñóðñ]. – Ðåæèì äîñòóïó äî

Íàêàçó: http://www.moz.gov.ua/ua/portal/dn_20130129_0059.html

2. Ðûëîâà Í.Â. Îñîáåííîñòè ôîðìèðîâàíèÿ çàáîëåâàíèé

âåðõíåãî îòäåëà ïèùåâàðèòåëüíîãî òðàêòà ó äåòåé (ìåäèêî-

ýêîëîãè÷åñêèå àñïåêòû): àâòîðåôåðàò äèñ. äîê. ìåä. íàóê :

ñïåö. 14.01.10 : ïåäèàòðèÿ / Í.Â. Ðûëîâà. – Ìîñêâà, 2009. –

317 ñ.

3. Cammorlinga-Ponce M. Intensity of inflammation, density

of colozation and interleukin-8 response in the gastric mucosa of

children infected with Helicobacter pylori / M. Cammorlinga-Ponce /

/ Helicobacter. – 2007. – Vol. 8, N 5. – Ð. 38-39.

4. Dovhanj J. Helicobacter Pylori, Zinc and Iron in Oxidative

Stress-Induced Injury of Gastric Mucosa / J. Dovhanj //Mini-Reviews

in Medicinal Chemistry.- 2009.- N 9.- P. 26-30

5. Êîíîíîâ À. Â. Öèòîïðîòåêöèÿ ñëèçèñòîé îáîëî÷êè æå-

ëóäêà: ìîëåêóëÿðíî-êëåòî÷íûå ìåõàíèçìû / À.Â. Êîíîíîâ // Ðîñ.

æóðí. ãàñòðîåíòåðîë., ãåïàòîë., êîëîíîïðîêòîë. – 2006. –

Ò. 16, ¹ 3. – Ñ. 12–16.

6. Ñêàëüíûé À.Â. Õèìè÷åñêèå ýëåìåíòû â ôèçèîëîãèè è ýêîëî-

ãèè ÷åëîâåêà / À.Â. Ñêàëüíûé – Ì.: ÎÍÈÊÑ 21 âåê: Ìèð, 2004. – 216 ñ.

7. Ìàðóøêî Þ.Â. Êë³í³÷íå çíà÷åííÿ äåô³öèòó öèíêó â ïàòî-

ëîã³¿ òðàâíîãî êàíàëó ó ä³òåé / Þ.Â. Ìàðóøêî , Î.Ë. Òàðèíñüêà,

À.Î. Àñîíîâ // Â³ñíèê íàóêîâèõ ïðàöü ñï³âðîá³òíèê³â ÍÌÀÏÎ

³ì. Øóïèêà.- 2010.- Âèïóñê 19, êíèãà 3 .- Ñ.796-802.

8. Prasad À.S. Zinc: Mechanisms of Host Defense /

À.S. Prasad // J. Nutr.-2007. – ¹137. – Ð.1345-1349

9. Ayad S. The Extracellular Matrix (Facts Book) / [S.Ayad,

R.P. Boot-Hanford, M.J. Humphries et al.] // Academic Press (Harcourt

Brace & Company, Publishers), Printed in Great Britain, S. 14 ff

,1998, ISBN 0-12-068911-1.

10. Ñàëüíèêîâ À.Â. Ìîðôîôóíêöèîíàëüíîå ñîñòîÿíèå ñëèçè-

ñòîé îáîëî÷êè æåëóäêà è íàäýïèòåëèàëüíîãî ñëèçèñòîãî ñëîÿ

ïðè Helicobacter pylori èíôåêöèè: Äèñ. êàíä. ìåä. íàóê: ñïåö.

14.01.10 : ïåäèàòðèÿ / À.Â. Ñàëüíèêîâ -Òîìñê, 1999. 126 ñ.

ÎÑÎÁÅÍÍÎÑÒÈ ÒÅ×ÅÍÈß ÕÐÎÍÈ×ÅÑÊÎÃÎ

ÃÀÑÒÐÎÄÓÎÄÅÍÈÒÅ ÍÀ ÔÎÍÅ ÄÅÔÈÖÈÒÀ

ÖÈÍÊÀ Ó ÄÅÒÅÉ

Àñîíîâ À.Î., Ìàðóøêî Þ.Â., Ã³÷êà Ñ.Ã.

Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò

èìåíè À.À. Áîãîìîëüöà, Óêðàèíà, ã. Êèåâ, Óêðàèíà

Ðåçþìå. Ïîëó÷åííûå äàííûå óêàçûâàþò íà âîçìîæ-

íîñòü óñîâåðøåíñòâîâàíèÿ ëå÷åíèÿ äåòåé c õðîíè÷åñêèì

ãàñòðîäîäóîäåíèòîì ó÷èòûâàÿ îáìåíà öèíêà.

Êëþ÷åâûå ñëîâà: öèíê, äåòè, õðîíè÷åñêèé ãàñòðî-

äóîäåíèò.

FEATURES OF THE CHRONIC

GASTRODUODENITIS IN CHILDREN

WITH ZINC DEFICIENCY

A. Asonov, Yu. Marushko, S. Gichka

Bogomolets National Medical University, Kyiv, Ukraine

Summary. These data suggest the possibility of impro-

ving the treatment of children with chronic gastroduodenitis

based on zinc metabolism.

Key words: zinc, children, chronic gastroduodenitis.

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

ÓÄÊ [617.711:617.764 “ 008.8]:618.173:611.847.2 “ 018.1:575.21

ÌÎÐÔÎËÎÃ²×Í² ÒÀ ÔÅÍÎÒÈÏÎÂ² ÎÑÎÁËÈÂÎÑÒ²

ÊË²ÒÈÍ ÊÎÍ’ÞÍÊÒÈÂÈ Ó ÕÂÎÐÈÕ ÍÀ ÑÈÍÄÐÎÌ

“ÑÓÕÎÃÎ ÎÊÀ” Â ÏÅÐ²ÌÅÍÎÏÀÓÇ²

Àíòîíåíêî Î.Â.1, Ñêðèïíèê Ð. Ë.1, Òèõîí÷óê Í.À.2, Þð÷åíêî Î.Â.3

1Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Î.Î. Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

2Êè¿âñüêà ì³ñüêà êë³í³÷íà ë³êàðíÿ ¹ 9, ì. Êè¿â, Óêðà¿íà

3²íñòèòóò åêñïåðèìåíòàëüíî¿ ïàòîëîã³¿, îíêîëîã³¿ òà ðàä³îá³îëîã³¿ ³ìåí³ Ð.Å. Êàâåöüêîãî ÍÀÍÓ,

ì. Êè¿â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: ãîðìîíàëüíà äèñôóíêö³ÿ, ñèíäðîì “ñóõîãî îêà”, ìîðôîëîã³÷íå, ³ìóíîöèòîõ³ì³÷íå

äîñë³äæåííÿ, êåëèõîïîä³áí³ êë³òèíè.

Ïðè öüîìó, îêðåìó ãðóïó ñêëàäàþòü ïàö³ºíòêè, ùî

çíàõîäÿòüñÿ â ñòàí³ õ³ðóðã³÷íî¿ ìåíîïàóçè. Ï³ñëÿ îâàð³åê-

òîì³¿ ó æ³íîê ðåïðîäóêòèâíîãî â³êó âèíèêàþòü áàãàòî-

÷èñëåíí³ âåãåòî-ñóäèíí³, ïñèõîåìîö³éí³ òà îáì³ííî-

åíäîêðèíí³ ðîçëàäè ó 60–80% ïàö³ºíòîê. Ïðè öüîìó,

ï³ñëÿ îïåðàö³¿, âèêîíàíî¿ ó â³ö³ 45–50 ðîê³â, ïîñòîâàð³-

åêòîì³÷íèé ñèíäðîì (ÏÎÅÑ) ðîçâèâàºòüñÿ ó êîæíî¿ äðó-

ãî¿ æ³íêè, ó 25% ïàö³ºíòîê ÏÎÅÑ ìàº âàæêèé òà äîâãèé, äî

2–5 ðîê³â, ïåðåá³ã [4, 11, 12].

Âèíèêàþ÷èé äåô³öèò ñòàòåâèõ ñòåðî¿ä³â, ÿê íàñë³äîê,

âèêëèêàº ñèñòåìí³ ïîðóøåííÿ ð³çíèõ îðãàí³â, âïëèâàº íà

ôóíêö³îíóâàííÿ ñëüîçíèõ, ìåéáîì³ºâèõ çàëîç, à òàêîæ

êåëèõîïîä³áíèõ êë³òèí êîí’þíêòèâè, ùî ëåæèòü â îñíîâ³

ïàòîãåíåçó ÑÑÎ ó æ³íîê â ïåðèìåíîïàóç³ òà ïðèçâîäèòü

äî ìîðôîëîã³÷íèõ òà ³ìóíîöèòîõ³ì³÷íèõ çðóøåííü ó

ñòðóêòóðàõ, ÿê³ ïðèéìàþòü ó÷àñòü ó ôîðìóâàíí³ ñêëàäî-

âèõ ñëüîçíî¿ ïë³âêè [20, 21, 22]. Ïðè çì³í³ ð³âíÿ ñòàòåâèõ

ñòåðî¿ä³â ó æ³íîê ç ÑÑÎ ïðè ãîðìîíàëüí³é äèñôóíêö³¿

âàæëèâà ñïåöèô³÷íà â³çóàë³çàö³ÿ â òêàíèíàõ íå ò³ëüêè

ð³çíèõ êë³òèí, à òàêîæ ãîðìîí³â òà ¿õ ðåöåïòîð³â, ùî ìîæ-

ëèâî äîñë³äèòè çà äîïîìîãîþ ìîðôîëîã³÷íèõ òà ³ìóíîöè-

òîõ³ì³÷íèõ ìåòîäèê.

Îòðèìàòè äîñòîâ³ðíó ³íôîðìàö³þ ùîäî ñòàíó êë³òèí

êîí’þíêòèâè ³ âèâ÷åííÿ ìîðôîëîã³÷íèõ çì³í î÷íî¿

ïîâåðõí³ äîçâîëÿº ìåòîä ³ìïðåñ³éíî¿ öèòîëîã³¿. Ã³ñòîëî-

ã³÷íå äîñë³äæåííÿ êîí‘þíêòèâè ïîêàçàëî ïðèñóòí³ñòü çà-

ïàëåííÿ ó õâîðèõ ç ïåðâèííèì ÑÑÎ, ÿêå ìàëî äèôóçíèé

àáî âîãíèùåâèé õàðàêòåð ç ïåðåâàæàííÿì â ³íô³ëüòðàò³

êë³òèí ë³ìôîïëàçìîöèòàðíîãî ðÿäó, ùî ñâ³ä÷èòü ïðè õðî-

í³÷íèé ñòàí çàïàëåííÿ [7, 23].

Íàÿâí³ñòü ðåöåïòîð³â åñòðîãåí³â òà ïðîãåñòåðîíó â

êë³òèíàõ êîí‘þíêòèâè îêà ñâ³ä÷èòü ïðî ÷óòëèâ³ñòü êë³òèí

äî ä³¿ öèõ ãîðìîí³â. Çàñòîñóâàííÿ ïîë³ìåðàçíî¿ ëàíöþãî-

âî¿ ðåàêö³¿ (ÏËÐ) òà Âåñòåðí-áëîò àíàë³çó âñòàíîâèëî ïðè-

ñóòí³ñòü ðåöåïòîð³â åñòðîãåí³â òà ïðîãåñòåðîíó ó êîí‘þí-

êòèâ³ îêà ó æ³íîê, ÿê³ çíàõîäÿòüñÿ ó ïðåìåíîïàóçàëüíîìó

ïåð³îä³, ùî äîçâîëÿº ïðèïóñòèòè, ùî êë³òèíè êîí’þíêòè-

âè îêà º ì³øåíÿìè äëÿ öèõ ãîðìîí³â [24, 25]. Àëå â

òåïåðèøí³é ÷àñ íåìàº ºäèíî¿ äóìêè ùîäî ôåíîòèïîâèõ

îñîáëèâîñòåé êîí’þíêòèâè ³ ðîçâèòêîì ÑÑÎ.

Ïðîáëåìà ñèíäðîìà “ñóõîãî îêà” (ÑÑÎ) çà îñòàíí³

ðîêè îáóìîâëåíà çíà÷íîþ ðîçïîâñþäæåí³ñòþ öüîãî çàõ-

âîðþâàííÿ ³ çíèæåííÿì ÿêîñò³ æèòòÿ ïàö³ºíò³â. Íà ïðîâå-

äåíîìó â 2007 ðîö³ Ì³æíàðîäíîìó ñåì³íàð³ ïî ÑÑÎ

(DEWS) áóëî âèçíà÷åíî, ùî öå áàãàòîôàêòîðíå çàõâîðþ-

âàííÿ ñëüîçíîãî àïàðàòó ³ ïîâåðõí³ îêà, ÿêå ïðîÿâëÿºòüñÿ

ñèìïòîìàìè î÷íîãî äèñêîìôîðòó, ïîðóøåííÿì çîðó ³

ñòàá³ëüíîñò³ ÑÏ ç ïîòåíö³àëüíèì óðàæåííÿì ïîâåðõí³ îêà

[1, 3, 5, 6, 8, 13, 14, 15]. Ïàòîëîã³÷í³ çì³íè ðîã³âêè, ùî âëàñ-

òèâ³ ÑÑÎ âíàñë³äîê ïîðóøåííÿ ñòàá³ëüíîñò³ ïðåêîðíåàëü-

íî¿ ñë³çíî¿ ïë³âêè, ñóïðîâîäæóþòüñÿ âèðàæåíèì ñó-

á’ºêòèâíèì äèñêîìôîðòîì ³ ðîçâèòêîì ñïåöèô³÷íèõ

êñåðîòè÷íèõ çì³í êîí’þíêòèâè ³ ðîã³âêè.

Â ñòðóêòóð³ âñ³õ õâîðèõ îôòàëüìîëîã³÷íîãî ïðîô³ëþ

ðîçïîâñþäæåí³ñòü ÑÑÎ äîñÿãàº 45%. Ñï³ââ³äíîøåííÿ

ïàö³ºíò³â â ñòîðîíó æ³íîê çá³ëüøóºòüñÿ ó â³ö³ 45-65 ðîê³â.

Îòðèìàí³ çà îñòàíí³ ðîêè äàí³ ðîçïîâñþäæåíîñò³ ÑÑÎ ñå-

ðåä æ³íîê, ñòàðøèõ 40 ðîê³â, â Óêðà¿í³ – 57,3%, çà ðåçóëüòà-

òàìè ñêðèí³íãîâîãî åï³äåì³îëîã³÷íîãî äîñë³äæåííÿ “DE-

Screen”, ñï³ââ³äíîñÿòüñÿ ç³ ñâ³òîâèìè äàíèìè – áëèçüêî

70 % [5, 9, 18, 19].

Çì³íè ãîðìîíàëüíîãî ñòàòóñó ó æ³íîê â ïåð³ìåíîïà-

óç³ çàéìàþòü îêðåìå ì³ñöå ñåðåä áàãàòî÷èñåëüíèõ îô-

òàëüìîëîã³÷íèõ ³ ñèñòåìíèõ çàõâîðþâàíü, ùî ïðèçâîäÿòü

äî ðîçâèòêó ÑÑÎ. Ïðîãðåñèâíå çá³ëüøåííÿ òðèâàëîñò³

æèòòÿ æ³íîê, âèñîêà ÷àñòîòà êë³ìàêòåðè÷íèõ ðîçëàä³â (äî

48%) ³, òèêèì ÷èíîì, çíèæåííÿ ÿêîñò³ æèòòÿ îáóìîâ-

ëþþòü àêòóàëüí³ñòü ïðîáëåìè ä³àãíîñòèêè ³ ë³êóâàííÿ

ÑÑÎ ó æ³íîê â êë³ìàêòåð³¿ [ 2, 10, 16, 17].

Ñàìîïî÷óòòÿ æ³íêè, ÿêå âèçíà÷àº íå ò³ëüêè ñòàí ô³çè÷-

íîãî òà ïñèõ³÷íîãî êîìôîðòó, à òàêîæ ïðàöåçäàòí³ñòü

æ³íîê, ìîæëèâ³ñòü âèêîíóâàòè ð³çíîìàí³òí³ ñîö³àëüí³

ôóíêö³¿, çàëåæèòü â³ä òå÷³¿ êë³ìàêòåðè÷íîãî ïåð³îäó. Âàçî-

ìîòîðí³ òà åìîö³îíàëüíî-ïñèõ³÷í³ ïîðóøåííÿ â ïåð³ìå-

íîïàóç³ ïðîÿâëÿþòüñÿ ó âèãëÿä³ êë³ìàêòåðè÷íîãî ñèíäðî-

ìó (ÊÑ) ð³çíîãî ñòóïåíþ âèðàæåíîñò³. Ïîðóøåííÿ, ùî

âèíèêàþòü íà ôîí³ â³êîâèõ ³íâîëþòèâíèõ çì³í â îðãàí³çì³

õàðàêòåðèçóþòüñÿ ïîë³ìîðô³çìîì ñêàðã ïàö³ºíò³â. Ñàìå

â öåé ïåð³îä íàäòî âàæëèâå ë³êóâàëüíå âòðó÷àííÿ äëÿ ïî-

ë³ïøåííÿ çàãàëüíîãî ñòàíó ³ ï³äâèùåííÿ ÿêîñò³ æèòòÿ.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

Ìåòà äîñë³äæåííÿ: âèâ÷åííÿ ìîðôîëîã³÷íèõ òà ³ìó-

íîöèòîõ³ì³÷íèõ îñîáëèâîñòåé êë³òèí êîí’þíêòèâè ïàö³º-

íòîê, ÿê³ ñòðàæäàþòü íà ÑÑÎ íà òë³ ÊÑ òà ÏÎÅÑ.

Ìàòåð³àëè òà ìåòîäè äîñë³äæåííÿ. Áóëî îáñòåæåíî

27 æ³íîê â³êîì â³ä 38 äî 65 ðîê³â. Ïàö³ºíòêè áóëè ïîä³ëåí³

íà 3 ãðóïè. Â ïåðøó ãðóïó ââ³éøëè 11 õâîðèõ íà ÑÑÎ ç ÊÑ,

â äðóãó – 8 ïàö³ºíòîê ç ÏÎÅÑ, â òðåòþ – 8 æ³íîê ò³º¿ æ

â³êîâî¿ ãðóïè, ÿê³ íå â³äì³÷àþòü ñêàðã ç³ ñòîðîíè î÷åé ³

ïîâ’ÿçàíèõ ç³ ñòàíîì ìåíîïàóçè. Âñ³ì îáñòåæóâàíèì

áóëî âèêîíàíî ìîðôîëîã³÷íå òà ³ìóíîöèòîõ³ì³÷íå

îáñòåæåííÿ ç âèêîðèñòàííÿì ô³ëüòð³â êîðïîðàö³¿

Millipore Millicell-CM 0,4 mn (ÑØÀ).

Ìîðôîëîã³÷íå äîñë³äæåííÿ ïðîâîäèëè çà äîïîìîãîþ

ìåòîäó ³ìïðåñ³éîíî¿ öèòîëîã³¿ êîí’þíêòèâè. Ïðåïàðàòè

ôàðáóâàëè çà ìåòîäîì Ìàé-Ãðþíâàëüäà-Ã³ìçà. Äëÿ âèç-

íà÷åííÿ åêñïðåñ³¿ ðåöåïòîð³â ñòåðî¿äíèõ ãîðìîí³â (ðå-

öåïòîð³â åñòðîãåíó, ïðîãåñòåðîí³â òà òåñòîñòåðîíó) ³ìó-

íîöèòîõ³ì³÷íèì ôëóîðåñöåíòíèì ìåòîäîì ç ïîâåðõí³

êîí’þíêòèâè âèêîðèñòîâóâàëè âòîðèíí³ àíòèò³ëà, ì³÷åíí³

FITC (Jacksonimmunoresearch, ÑØÀ). ßäðà êë³òèí

äîôàðáîâóâàëè Hoechst 33258 (Sigma, ÑØÀ). Ô³ëüòðè

óêëàäàëè â ñåðåäîâèùå Mowiol® 4-88. Àíàë³ç ïðåïàðàò³â

ïðîâîäèëè ç çàñòîñóâàííÿì ôëþîðåñöåíòíîãî ì³êðî-

ñêîïó Leica DM 1000 (Í³ìå÷÷èíà).

Ðåçóëüòàòè äîñë³äæåíü. Ïðè àíàë³ç³ ðåçóëüòàò³â

³ìïðåññ³éíî¿ öèòîëîã³¿ âðàõîâóâàëè ê³ëüê³ñòü òà ù³ëüí³ñòü

ðîçòàøóâàííÿ êåëèõîïîä³áíèõ êë³òèí â ïîë³ çîðó

ì³êðîñêîïó ïðè ñåðåäíüîìó çá³ëüøåíí³ (õ400), ôîðìó òà

öèòîëîã³÷í³ îñîáëèâîñò³ åï³òåë³àëüíèõ êë³òèí òà ¿õ

ì³æêë³òèíí³ ñïîëó÷åííÿ.

Öèòîëîã³÷íå äîñë³äæåííÿ â³äáèòê³â êîí’þíêòèâè 3-î¿

ãðóïè ïîêàçàâ, ùî åï³òåë³îöèòè ðîçòàøîâàí³ ãðóïàìè ó

âèãëÿä³ ïëàñò³â, ù³ëüíî êîíòàêòóþòü îäèí ç îäíèì. ¯õ öè-

òîïëàçìà ìàº ì³ëêîäèñïåðñíó áóäîâó, ñëàáî áàçîôèëüíà.

ßäðà áàãàòüîõ êë³òèí ìàþòü äîáðå îðãàí³çîâàíèé õðîìà-

òèí, ÿêèé ìàº ïîì³ðíó êîíäåíñîâàíó ôîðìó, ³ â ÿêîìó

ïðèñóòí³ ïåðåâàæíî ä³ëÿíêè ãåòåðîõðîìàòèíó, ñåðåä ÿêèõ

ðîçòàøîâóºòüñÿ ìåíø ù³ëüí³ ñêóï÷åííÿ äèôóçíîãî

åóõðîìàòèíó. Ì³æ ïîâåðõíåâèìè åï³òåë³àëüíèìè

êë³òèíàìè çíàõîäÿòüñÿ êåëèõîïîä³áí³ êë³òèíè, ÿê³

â³äð³çíÿþòüñÿ á³ëüøèì ðîçì³ðîì òà á³ëüø áàçîô³ëüíîþ

öèòîïëàçìîþ (ðèñ. 1).

Ó õâîðèõ 1-î¿ ãðóïè áóëî âèÿâëåíî çìåíøåííÿ

ðîçì³ðó åï³òåë³àëüíèõ êë³òèí. Çíà÷í³ ä³ëÿíêè ñêëàäàþòüñÿ

ç îêðåìî ðîçòàøîâàíèõ êë³òèí, ÿê³ íå óòâîðþþòü êîíòàêòè

ì³æ ñîáîþ. Ñåðåä ïëàñòó åï³òåë³àëüíèõ êë³òèí ùå

çíàõîäÿòüñÿ êåëèõîïîä³áí³ êë³òèíè, àëå ê³ëüê³ñòü ¿õ

çìåíøóºòüñÿ (ðèñ. 2).

Äîñë³äæåííÿ öèòîëîã³÷íèõ âëàñòèâîñòåé êîí‘þíêòèâè

õâîðèõ 2-î¿ ãðóïè äîçâîëèëî âñòàíîâèòè, ùî çíà÷íà

ê³ëüê³ñòü êë³òèí ìàº íåçíà÷í³ îçíàêè äèñòðîô³¿, ïðè öüîìó

êîíòóðè êë³òèí ñòàþòü ðîçïëèâ÷àòèìè, âèãëÿäàþòü ðîçäó-

òèìè, â³äáóâàºòüñÿ ¿õ äåñêâàìàö³ÿ. Ñïîñòåð³ãàºòüñÿ

êë³òèííèé ïîë³ìîðô³çì, à òàêîæ äåÿê³ êë³òèíè çíàõîäÿòüñÿ

ó ñòàí³ íåêðîá³îçó. Âèçíà÷åíà íàÿâí³ñòü çíà÷íî¿ ê³ëüêîñò³

åï³òåë³àëüíèõ êë³òèí, ÿê³ ìàþòü íåçíà÷í³ îçíàêè äèñòðîô³¿,

ðîçòàøîâóþòüñÿ ó âèãëÿä³ îêðåìèõ êë³òèí, áåç óòâîðåííÿ

êë³òèííèõ ïëàñò³â. Êåëèõîïîä³áí³ êë³òèíè íå ñïîñòåð³ãà-

þòüñÿ (ðèñ. 3).

Ðèñ. 1. Öèòîëîã³÷í³ îñîáëèâîñò³ êîí’þíêòèâè õâîðèõ

3-î¿ ãðóïè. Ñåðåä åï³òåë³îöèò³â ïðèñóòí³ êåëèõîïîä³áí³

êë³òèíè (Ê) á³ëüøîãî ðîçì³ðó òà áàçîô³ëüíîþ

öèòîïëàçìîþ. Çá. 200.

Ðèñ. 2. Öèòîëîã³÷í³ îñîáëèâîñò³ êîí’þíêòèâè õâîðèõ

1-î¿ ãðóïè. Îêðåìî ðîçòàøîâàí³ åï³òåë³àëüí³ êë³òèíè

êîí’þíêòèâè ìàéæå íå óòâîðþþòü ì³æêë³òèíí³

êîíòàêòè. Çá. 400.

Ðèñ. 3. Öèòîëîã³÷í³ îñîáëèâîñò³ êîí’þíêòèâè õâîðèõ 2-î¿

ãðóïè. Â³äñóòí³ñòü êåëèõîïîä³áíèõ êë³òèí â ì³ñöÿõ â³ëüíîãî

ðîçòàøóâàííÿ åï³òåë³àëüíèõ êë³òèí. Çá. 200.

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

Îñíîâí³ çì³íè â öèòîëîã³÷í³é áóäîâ³ êîí‘þíêòèâè õâî-

ðèõ ç ÑÑÎ íà òë³ ãîðìîíàëüíî¿ äèñôóíêö³¿ ñòîñóþòüñÿ íà-

ñàìïåðåä çìåíøåííÿ ðîçì³ð³â åï³òåë³îöèò³â, â³äñóòí³ñòü ¿õ

ëàòåðàëüíîãî ç‘ºäíàííÿ, ïîÿâè êë³òèí ç îçíàêàìè äèñòðî-

ô³÷íèõ ïðîöåñ³â òà çìåíøåííÿ ê³ëüêîñò³ êåëèõîïîä³áíèõ

êë³òèí.

Âèçíà÷åííÿ åêñïðåñ³¿ ðåöåïòîð³â åñòðîãåí³â òà ïðîãå-

ñòåðîíó çà äîïîìîãîþ ³ìóíîöèòîõ³ì³÷íîãî ìåòîäó

äîñë³äæåííÿ íà êë³òèíàõ êîí‘þíêòèâè æ³íîê 3-î¿ ãðóïè

äîçâîëèëî âñòàíîâèòè, ùî á³ëüø³ñòü êë³òèí â ÿäðàõ åêñï-

ðåñóþòü ðåöåïòîðè öèõ ãîðìîí³â, àëå ð³âåíü ôëóîðåñ-

öåíö³¿ áóâ â ìåæàõ ñåðåäíüî¿ ³íòåíñèâíîñò³.

Ó õâîðèõ 1-î¿ ãðóïè âèçíà÷åíà â³äñóòí³ñòü åêñïðåñ³¿

ðåöåïòîð³â åñòðîãåí³â. Ïðè ôëóîðåñöåíòíîìó äîñë³äæåí³

êë³òèíè ìàéæå íå âèçíà÷àþòüñÿ, â òîé ÷àñ ÿê ïðè

äîôàðáîâóâàíí³ Hoechst 33258 ìîæíà ñïîñòåð³ãàòè

çíà÷íó ê³ëüê³ñòü êë³òèí ó ïîë³ çîðó ôëóîðåñöåíòíîãî

ì³êðîñêîïà, ÿê³ ìàþòü áëàêèòíå îñâ³òëåííÿ ÿäðà. Ïðè

âèçíà÷åíí³ åêñïðåñ³¿ ðåöåïòîð³â ïðîãåñòåðîíó ëèøå

ïîîäèíîê³ êë³òèíè ìàþòü ñëàáî çåëåíå ñâ³ò³ííÿ ÿäåð, ùî

ñâ³ä÷èòü ïðî íåâåëèêó ê³ëüê³ñòü â ¿õ ÿäðàõ çàçíà÷åíèõ

ðåöåïòîð³â, â òîé ÷àñ ÿê â çíà÷íî¿ á³ëüøîñò³ ÿäåð êë³òèí

ôëóîðåñöåíö³ÿ íå âèçíà÷àºòüñÿ ³ òàêèì ÷èíîì ðåöåïòîðè

ïðîãåñòåðîíó íå ýêñïðåñóþòüñÿ.

²ìóíîôåíîòèïîâå äîñë³äæåííÿ êîí’þíêòèâè ó õâî-

ðèõ 2-î¿ ãðóïè âèÿâèëî â³äñóòí³ñòü ðåöåïòîð³â åñòðîãåí³â

òà ïðîãåñòåðîíó ó äàíî¿ ãðóïè ïàö³ºíò³â. Â ïðåïàðàòàõ

íå ñïîñòåð³ãàºòüñÿ ôëóîðåñöåíö³ÿ, â òîé ÷àñ ÿê ïðè

çàôàðáîâóâàíí³ Hoechst 33258 ñïîñòåð³ãàºòüñÿ çíà÷íà

ê³ëüê³ñòü êë³òèí, ÿê³ ì³ñòÿòüñÿ ó â³äáèòêó, ³ ìàþòü

áëàêèòíå ñâ³ò³ííÿ.

Çà äîïîìîãîþ ôëþîðèñöåíòíî¿ ³ìóíîöèòîõ³ì³¿ âèç-

íà÷åíî çíèêíåííÿ ç ÿäåð êë³òèí ðåöåïòîð³â ñòåðî¿äíèõ

ãîðìîí³â, ùî ìîæå ïðèçâåñòè äî ïðèïèíåííÿ ä³¿ â³äïîâ³ä-

íèõ ãîðìîí³â (åñòðîãåí³â, ïðîãåñòåðîíó), íàâ³òü ÿêùî

âîíè ñèíòåçóþòüñÿ â îðãàí³çì³ õâîðîãî.

Âèñíîâêè. Âèâ÷åííÿ ÑÑÎ íà òë³ ÊÑ òà ÏÎÅÑ ïîòðåáóº

êîìïëåêñíîãî ï³äõîäó, ç óðàõóâàííÿì ìîðôîëîã³÷íîãî òà

³ìóíîöèòîõ³ì³÷íîãî äîñë³äæåíü, ìåòîþ ÿêîãî º á³ëüø

äåòàëüíå ï³çíàííÿ ìåõàí³çì³â âèíèêíåííÿ ÑÑÎ äëÿ

ïîøóêó îïòèìàëüíèõ øëÿõ³â éîãî ïîäîëàííÿ. Íàéá³ëüø

âèðàçí³ öèòîëîã³÷í³ çì³íè ñòîñóþòüñÿ çíà÷íîãîçìåí-

øåííÿ ê³ëüêîñò³ êåëèõîïîä³áíèõ êë³òèí, ùî ïðèçâîäèòü

äî íåìîæëèâîñò³ çáåðåæåííÿ ïîñò³éíî¿ âîëîãîñò³ îêà.

Êð³ì òîãî, íåäîñòàòíÿ ê³ëüê³ñòü êåëèõîïîä³áíèõ êë³òèí

â³äïîâ³äàº çà çìåíøåííÿ ãðàíóë ìóöèíîãåíó, ÿê³ àäñîð-

áóþòü âîäó òà ïåðåòâîðþþòüñÿ íà ìóöèí, ùî º îñíîâ-

íèì êîìïîíåíòîì ñëèçó. Îòðèìàí³ äàí³ ùîäî â³äñóò-

íîñò³ ðåöåïòîð³â ãîðìîí³â íà ôîí³ çìåíøåííÿ ¿õ

ê³ëüêîñò³ ñâ³ä÷àòü ïðî âèíèêàþ÷³ çì³íè ñòàíó î÷íî¿

ïîâåðõí³, ùî º îäíèì ç ìåõàí³çì³â â ïàòîãåíåç³ çàõâîðþ-

âàííÿ íà ÑÑÎ.

Äîñë³äæåííÿ îñîáëèâîñòåé ìîðôîëîã³÷íîãî òà ôåíî-

òèïîâîãî ñêëàäó êë³òèí êîí’þíêòèâè õâîðèõ íà ÑÑÎ íà òë³

ãîðìîíàëüíî¿ äèñôóíêö³¿ º äîö³ëüíèì äëÿ âèçíà÷åííÿ

ë³êóâàëüíî¿ òàêòèêè äëÿ ï³äâèùåííÿ ÿêîñò³ æèòòÿ ö³º¿ êàòå-

ãîð³¿ ïàö³ºíòîê.

Ðåöåíçåíò: ä.ìåä.í.,ïðîôåñîð

Â³òîâñüêà Î.Ï.

Ë²ÒÅÐÀÒÓÐÀ

1. Àâåòèñîâ Ñ. Ý. Îôòàëüìîëîãèÿ: Íàöèîíàëüíîå ðóêîâîä-

ñòâî. / Ïîä ðåäàêöèåé Ñ. Ý. Àâåòèñîâà è äð. // – Ì.: “ÃÝÎÒÀÐ-

Ìåäèà” – 2008. – C. 388–399.

2. Àñòàõîâ Þ. Ñ., Ðèêñ È. À., Òêà÷åíêî Í. Â. Ìåòîäè÷åñêèå

óêàçàíèÿ ïî îáñëåäîâàíèþ ãëàçíîé ïîâåðõíîñòè. Ìåòîäè÷åñêîå

ïîñîáèå.” Ì., 2012. Ñ.4-13.

3. Áðæåñêèé Â. Â. Çàáîëåâàíèÿ ñëåçíîãî àïïàðàòà. /

Â.Â. Áðæåñêèé, Þ. Ñ. Àñòàõîâ, Í. Þ. Êóçíåöîâà. // Ïîñîáèå äëÿ

ïðàêòèêóþùèõ âðà÷åé: 2-å èçä. , èñïð. è äîï. – ÑÏá. : “Èçä-âî

Í-Ë”. -2009. – 108 c.

4. Âèõëÿåâa E. M. Ðóêîâîäñòâî ïî ýíäîêðèííîé ãèíåêîëîãèè.

/ Ïîä ðåä. Å. Ì. Âèõëÿåâîé. // Ì. : Ìåäèöèíñêîå èíôîðìàöèîííîå

àãåíòñòâî. – 1997. – Ñ. 768.

5. Ãóðîâà Ç. Ã. Ïóòè ñîâåðøåíñòâîâàíèÿ ìåäèêî-ñîöèàëüíîé

ïîìîùè æåíùèíàì ïåðèìåíîïàóçàëüíîãî âîçðàñòà : äèññåð-

òàöèÿ êàíäèäàòà ìåäèöèíñêèõ íàóê. / Ç. Ã. Ãóðîâà. M. -2006. -

P. 130c : èë.

6. Åãîðîâ Å. À. Ðàöèîíàëüíàÿ ôàðìàêîòåðàïèÿ â îôòàëü-

ìîëîãè. /ïîä ðåäàêöèåé Å. À. Åãîðîâà. // Ì. , Èçä- âî “Ëèòòåð-

ðà”. – 2004. – C. 270-275.

7. Åãîðîâà Ã. Á., À. À. Ôåäîðîâ, Ò. Ñ. Ìèòè÷êèíà Âîçìîæíîñ-

òè ìåòîäà èìïðåññèîííîé öèòîëîãèè â äèàãíîñòèêå è îöåíêå

ýôôåêòèâíîñòè ìåäèêàìåíòîçíîé êîððåêöèè ñèíäðîìà ñóõîãî

ãëàçà ïðè íîøåíèè êîíòàêòíûõ ëèíç.// Âåñòíèê îôòàëüìîëî-

ãèè, ¹ 1, 2012. Ñ. 34-36.

8. Æàáîºäîâ Ã. Ä., Ê³ðåºâ Â. Â. Ñèíäðîì “ñóõîãî îêà”: ñó÷àñ-

íèé ñòàí ïðîáëåìè. // Îôòàëüìîëîãè÷åñêèé æóðíàë, ¹ 5 2005,

Ñ. 4-14.

9. Ì³ðîâè÷ Ä. Þ. ²ìóíîëîã³÷í³ àñïåêòè ë³êóâàííÿ êë³ìàêòå-

ð³÷íîãî ñèíäðîìó / Ä. Þ. Ì³ðîâè÷, Â. Ï. Êâàøåíêî, Þ. Ï. Áîãî-

ñëàâ // Àêòóàëüí³ ïðîáëåìè àêóøåðñòâà ³ ã³íåêîëîã³¿ òà ìåäè÷íî¿

ãåíåòèêè, çá³ðíèê íàóêîâèõ ïðàöü. – 2002. - âèï 7. – Ñ. 250-253.

10. Ïàñå÷íèêîâà Í. Â. Ðåçóëüòàòû ñêðèíèíãîâîãî ýïèäåìèî-

ëîãè÷åñêîãî èññëåäîâàíèÿ (DE-Screen) ðàñïðîñòðàíåííîñòè ñèíä-

ðîìà ñóõîãî ãëàçà ñðåäè æåíùèí ñòàðøå 40 ëåò â Óêðàèíå. /

Í. Â. Ïàñå÷íèêîâà, Ã. È. Äðîææèíà, Â. À. Íàóìåíêî, [ è äð. ]. //

Îôòàëüìîëîãè÷åñêèé æóðíàë. – 2009. – ¹6, -Ñ. 68-76.

11. Òàòàð÷óê Ò. Ô. Ýíäîêðèííàÿ ãèíåêîëîãèÿ (êëèíè÷åñêèå î÷åð-

êè) Ïîëîâûå ñòåðîèäíûå ãîðìîíû è èììóííàÿ ñèñòåìà. / Ò.Ô. Òà-

òàð÷óê, Â. Ï. ×åðíûøîâ, À. Î. Èñëàìîâà. // Êèåâ. – 2003, ãëàâà 9.

12. ßðîöüêèé Ì. ª. Ïðîô³ëàêòèêà ³ êîðåêö³ÿ ñèñòåìíèõ ïî-

ðóøåíü ó æ³íîê õ õ³ðóðã³÷íîþ ìåíîïàóçîþ: Àâòîðåôåðàò äèñåð-

òàö³¿ íà çäîáóòòÿ íàóêîâîãî ñòóïåíÿ äîêòîðà ìåäè÷íèõ íàóê. /

Ì. ª. ßðîöüêèé. Ê. -2005. -C. 1-22.

13. Jerzy Szaflik Anna M. Ambroziak Diagnostyka zespo³u suchego

oka w praktyce okulistycznej, 2007, S.15-25.

14. Lemp M.A. Report of the National Eye Institute/Industry

workshop on Clinical Trials in Dry Eyes.// CLAO J. -1995.- Oct. – Vol.

21.-¹4.-P. 221-232.

15. Schaumberg D.A. Progress on the Epidemiology of Dry Eye

Syndrome ./ D.A. Schaumberg. // The Ocular Surface.-2005. – Jan.-

Vol. 3.- Suppl 1.- P. S111.

16. Schirra F. Dry eye and sex hormones: part 2. / F. Schirra,

N. Knop, E. Knop. // Ophthalmologe. – 2009 -Nov.- Vol.106.-¹11.-965.

17. Piera Versura. Menopause and dry eye. A possible relati-

onship./ Piera Versura, Emilio C. Campos // Gynecological

Endocrinology.- 2005 – May. – Vol.20- ¹5. –C. 289-298.

18. Matsui S. Associations of estrogen and testosterone with insulin

resistance in pre- and postmenopausal women with and without

hormone therapy./ Matsui, Yasui T, Tani A, [etc.]. // Int J Endocrinol

Metab. -2013. – Spring.-Vol.11. – ¹2.-P.65-70.

19. Schirra F. Using LIPCOF (lid-parallel conjunctival fold) for

assessing the degree of dry eye, it is essential to observe the exact

position of that specific fold. / F. Schirra, H. Höh, C. Kienecker. // Adv

Exp Med Biol. – 1998. – Vol. 438. – P. 853-858.

20. Schaumberg DA. Prevalence of dry eye syndrome among US

women./ DA Schaumberg, DA Sullivan , JE Buring [ etc. ]. // Am J

Ophthalmol.- 2003 – Aug.-Vol.136- ¹2. –C.318-326.

21. Stern Michael E. Inflammation in Dry Eye. / Michael E. Stern,

Stephen C. Pflugfelder // The Ocular Surface.- 2004.- April.- Vol. 2.-

Issue 2.-P.124-130.

22. Lopin Eli. Impression Cytology: Recent Advances and

Applications in Dry Eye Disease. / Eli Lopin. Tatiana Deveney, Penny A.

Asbell // The Ocular Surface.-2009,- April.- Vol. 7- Issue 2.- P.93-110.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

23. Murube J. Biopsy of the conjunctiva in dry eye patients

establishes a correlation between squamous metaplasia and dry eye

clinical severity. / J. Murube, L. Rivas. // Eur J Ophthalmol.-2003. –

Vol.13.-¹3.-P.246-256.

24. Fuchsjager-Mayrl G. Identification of estrogen and

progesterone receptor mRNA expression in the conjunctiva of

MORPHOLOGICAL AND PHENOTYPICAL

PECULIARITIES OF THE CONJUNCTIVAL CELLS

IN PATIENTS WITH “DRY EYE” SYNDROME

IN PERIMENOPAUSE

E. Antonenko1, R. Skrypnyk1,

N. Tihonchuk2, O. Yurchenko3

1Department of Ophthalmology of Bogomolets

National Medical University, Kyiv, Ukraine

2Municipal Clinical Hospital ¹ 9, Kyiv, Ukraine

3Institute of Experimental Pathology, Oncology and

Radiobiology named after R.E Kavetsky of NASU,

Kyiv, Ukraine

Summary. Changes in women hormonal status in

perimenopause hold the special place among different

ophtalmologic and system diseases, that are responsible

for “dry eye” syndrome (DES) development. Prevalence of

DES in Ukraine among women aged 40 and older is 57,3%.

There are klimakterical (KS) and postovarical (POS) “dry

eye” syndroms. The appearing lack of sexual steroids

influences upon the function of lachrymal, meibomian

glands and goblet cells of conjunctiva, that is the basis of

DES pathogenesis in perimenopause women and leads

to the morphological and imunocytochemical disorders in

structure, taking part in shaping the lachrymal film.

27 women with KS and POS underwent morphological

and imunocytochemical study. The study revealed reduction

of the epitheliocytes’ sizes, absence of its lateral adhesion,

occuring of the cells with signs of dystrofy and goblet cell

count reduction, vanishing of steroid hormone receptors

from cell nucleus.

The study of morphological and phenotypical

peculiarities of conjunctival cells at DES against the

background of hormonal dysfunctions is for determination

medical tacticians reasonable and increasing quality to lifes

to this categories patients.

Key words: hormonal dysfunction, “dry eye” syndrome,

morphological, imunocytochemical study, goblet cells.

ÌÎÐÔÎËÎÃÈ×ÅÑÊÈÅ È ÔÅÍÎÒÈÏÈ×ÅÑÊÈÅ

ÎÑÎÁÅÍÍÎÑÒÈ ÊËÅÒÎÊ ÊÎÍÚÞÍÊÒÈÂÛ

Ó ÁÎËÜÍÛÕ ÑÈÍÄÐÎÌÎÌ “ÑÓÕÎÃÎ ÃËÀÇÀ”

Â ÏÅÐÈÌÅÍÎÏÀÓÇÅ

Àíòîíåíêî Å.Â.1, Ñêðèïíèê Ð.Ë.1,

Òèõîí÷óê Í.À.2, Þð÷åíêî Î.Â.3

1Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò

èìåíè À.À. Áîãîìîëüöà,ã. Êèåâ, Óêðàèíà

2Ãîðîäñêàÿ êëèíè÷åñêàÿ áîëüíèöà ¹ 9,

ã. Êèåâ, Óêðàèíà

3Èíñòèòóò ýêñïåðèìåíòàëüíîé ïàòîëîãèè,

îíêîëîãèè è ðàäèîáèîëîãèè èì. Ð.Å. Êàâåöêîãî

ÍÀÍÓ, ã. Êèåâ, Óêðàèíà

Ðåçþìå. Èçìåíåíèÿ ãîðìîíàëüíîãî ñòàòóñà ó æåí-

ùèí â ïåðèìåíîïàóçå çàíèìàþò îòäåëüíîå ìåñòî ñðå-

äè ìíîãî÷èñëåííûõ îôòàëüìîëîãè÷åñêèõ è ñèñòåìíûõ

çàáîëåâàíèé, êîòîðûå ïðèâîäÿò ê ðàçâèòèþ ñèíäðîìà

ñóõîãî ãëàçà (ÑÑÃ). Â Óêðàèíå ðàñïðîñòðàíåííîñòü ÑÑÃ

ñðåäè æåíùèí, ñòàðøå 40 ëåò ñîñòàâëÿåò 57,3%.

Âûäåëÿþò ïîñòîâàðèýêòîìè÷åñêèé (ÏÎÝÑ) è

êëèìàêòåðè÷åñêèé (ÊÑ) ñèíäðîìû. Âîçíèêàþùèé

äåôèöèò ïîëîâûõ ñòåðîèäîâ âëèÿåò íà ôóíêöèîíèðîâà-

íèå ñëåçíûõ, ìåéáîìèåâûõ æåëåç, à òàêæå áîêàëîâèä-

íûõ êëåòîê êîíúþíêòèâû, ÷òî ëåæèò â îñíîâå ïàòîãåíå-

çà ÑÑÃ ó æåíùèí â ïåðèìåíîïàóçå è ïðèâîäèò ê

ìîðôîëîãè÷åñêèì è èììóíîöèòîõèìè÷åñêèì íàðóøåíè-

ÿì â ñòðóêòóðàõ, ïðèíèìàþùèì ó÷àñòèå â ôîðìèðîâà-

íèè ñëåçíîé ïëåíêè.

Îáñëåäóåìûì 27 æåíùèíàì ñ ÊÑ è ÏÎÝÑ âûïîë-

íåííî ìîðôîëîãè÷åñêîå èììóíîöèòîõèìè÷åñêîå èññëå-

äîâàíèÿ. Âûÿâëåíî óìåíüøåíèå ðàçìåðîâ ýïèòåëèîöè-

òîâ, îòñóòñòâèå èõ ëàòåðàëüíîãî ñîåäèíåíèÿ, ïîÿâëåíèå

êëåòîê ñ ïðèçíàêàìè äèñòðîôè÷åñêèõ ïðîöåññîâ è óìåíü-

øåíèå êîëè÷åñòâà áîêàëîâèäíûõ êëåòîê, èñ÷åçíîâåíèå

èç ÿäåð êëåòîê ðåöåïòîðîâ ñòåðîèäíûõ ãîðìîíîâ.

Èññëåäîâàíèå îñîáåííîñòåé ìîðôîëîãè÷åñêîãî è

ôåíîòèïè÷åñêîãî ñîñòàâà êëåòîê êîíúþíêòèâû áîëüíûõ

ÑÑÃ íà ôîíå ãîðìîíàëüíîé äèñôóíêöèè öåëåñîîáðàç-

íî äëÿ îïðåäåëåíèÿ ëå÷åáíîé òàêòèêè è ïîâûøåíèÿ

êà÷åñòâà æèçíè ýòîé êàòåãîðèè ïàöèåíòîê.

Êëþ÷åâûå ñëîâà: ãîðìîíàëüíàÿ äèñôóíêöèÿ, ñèíä-

ðîì “ñóõîãî ãëàçà”, ìîðôîëîãè÷åñêîå, ³ììóíîöèòî-

õèìè÷åñêîå èññëåäîâàíèå, áîêàëîâèäíûå êëåòêè.

premenopausal women./ Fuchsjager-Mayrl G, J. Nepp, C.

Schneeberger, [ etc. ]. // Invest. Ophthalmol. Vis. Sci. 2004.– Vol. 43.–

P. 2841-2844;

25. Spelsberg H. Detection of Oestrogen receptors (ER) á and â in

conjunctiva, lacrimal gland, and tarsal plates. / H. Spelsberg, M.

Klueppel, T.Reinhard, [ etc ]. // Eye.-2004. – Vol. 18. – P. 729-733.

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

Âñòóï. Ïåðåä÷àñíå íàðîäæåííÿ ä³òåé íèí³ º îäí³ºþ ç

íàéâàæëèâ³øèõ ïðîáëåì îõîðîíè çäîðîâ’ÿ â óñüîìó ñâ³ò³.

Âíóòð³øíüîøëóíî÷êîâ³ êðîâîâèëèâè (ÂØÊ) – öå íàéá³ëüø

âàæê³ ³ ÷àñò³ óðàæåííÿ ãîëîâíîãî ìîçêó ó íåäîíîøåíèõ

íîâîíàðîäæåíèõ. Çíàííÿ ÷èííèê³â ðèçèêó òà ïàòîãåíåòè÷-

íèõ ìåõàí³çì³â ÂØÊ, ðàííÿ ä³àãíîñòèêà ³ ñâîº÷àñíå ë³êó-

âàííÿ ä³òåé ç ÂØÊ äîçâîëÿòü çíèçèòè ð³âåíü ìàëþêîâî¿

ñìåðòíîñò³ ³ ïîë³ïøèòè ðåçóëüòàòè ïåðåá³ãó çàõâîðþâàííÿ.

Ìåòà ðîáîòè: ïðîâåñòè ë³òåðàòóðíèé îãëÿä ùîäî âíóò-

ð³øíüîøëóíî÷êîâèõ êðîâîâèëèâ³â ó íåäîíîøåíèõ íîâî-

íàðîäæåíèõ òà àíàë³ç ³ñòîð³é ðîçâèòêó íåäîíîøåíèõ íî-

âîíàðîäæåíèõ, ùî íàðîäèëèñü ó ÊÌÏÁ ¹6 ïðîòÿãîì

2012–2013 ðð.

Ìàòåð³àëè òà ìåòîäè: çà ïåð³îä 2012–2013 ðð. íàðîäè-

ëîñü 343 íåäîíîøåíèõ íîâîíàðîäæåíèõ. Ä³àãíîç ÂØÊ

âñòàíîâëþâàâñÿ çà äàíèìè êë³í³÷íîãî îáñòåæåííÿ òà óëü-

òðàçâóêîâîãî äîñë³äæåííÿ, ùî ïðîâîäèëîñü â ïåðø³ 3–

7 äí³â æèòòÿ äèòèíè.

Ðåçóëüòàòè òà îáãîâîðåííÿ. ×àñòîòà ÂØÊ çàëåæèòü

â³ä òåðì³íó ãåñòàö³¿: ÿêùî â³í ìåíøèé í³æ 30 òèæí³â, òî

ÂØÊ ä³àãíîñòóºòüñÿ â 42–90% âèïàäê³â; ÿêùî ïåðåâèùóº

30 òèæí³â – ó 15–40 %. Ó äîíîøåíèõ öåé ïîêàçíèê ñòàíî-

âèòü ìåíøå 5 %.

ÂØÊ àñîö³þþòüñÿ ç âèñîêîþ ñìåðòí³ñòþ ³ ìîæóòü

áóòè ïðè÷èíîþ âàæêèõ ðóõîâèõ òà êîãí³òèâíèõ ïîðóøåíü

ó ä³òåé, ÿê³ âèæèëè. Òàê, çà äàíèìè ë³òåðàòóðè, äëÿ íîâîíà-

ðîäæåíèõ ç ìàñîþ ò³ëà ïðè íàðîäæåíí³ 1000 ã ³ ìåíøå

ïåðèíàòàëüíà ñìåðòí³ñòü ìîæå äîñÿãàòè 64–85%, à ÷èñëî

ä³òåé, ùî âèæèëè – íå á³ëüøå 15–36%. Ñåðåä ä³òåé, ùî

âèæèëè, âàæê³ ³íâàë³äèçóþ÷³ ðîçëàäè ìîæóòü ïåðåâèùó-

âàòè 28%, à ìåíø ãðóá³ ïñèõîíåâðîëîã³÷í³ ïîðóøåííÿ –

44%. Ïðè÷îìó, ç 100% ä³òåé, ùî âèæèëè, çäîðîâ³ ñêëàäà-

þòü íå á³ëüøå 8–15% [6,7].

Âíóòð³øíüîøëóíî÷êîâ³ êðîâîâèëèâè ó íåäîíîøåíèõ

ìàþòü ìóëüòèôàêòîðíèé ãåíåç.

Â³äîìî, ùî îñíîâíèì ÷èííèêîì, ÿêèé ïðèçâîäèòü äî

âèíèêíåííÿ ÂØÊ, º ïåðèíàòàëüíà ã³ïîêñ³ÿ. Âîíà ³í³ö³þº

ï³äâèùåííÿ ïðîíèêëèâîñò³ êë³òèííèõ ìåìáðàí, çàãèáåëü

íåéðîí³â ³ ãë³àëüíèõ êë³òèí âíàñë³äîê íåêðîçó àáî àïîïòî-

çó, ïîðóøåííÿ ö³ë³ñíîñò³ ãåìàòîåíöåôàë³÷íîãî áàð’ºðó,

ïîòðàïëÿííÿ â ñèñòåìíèé êðîâîò³ê ìîçêîâèõ àíòèãåí³â,

ÿê³ ñòèìóëþþòü ³ìóííó ñèñòåìó íà óòâîðåííÿ àóòîìîçêî-

âèõ àíòèò³ë [13].

ÓÄÊ 616.831-38-005.1-053.32-085

ÂÍÓÒÐ²ØÍÜÎØËÓÍÎ×ÊÎÂ² ÊÐÎÂÎÂÈËÈÂÈ

Ó ÍÅÄÎÍÎØÅÍÈÕ ÍÎÂÎÍÀÐÎÄÆÅÍÈÕ: ÔÀÊÒÎÐÈ

ÐÈÇÈÊÓ, ÎÑÎÁËÈÂÎÑÒ² ÏÀÒÎÃÅÍÅÇÓ, ÎÑÍÎÂÍ²

ÌÅÒÎÄÈ Ë²ÊÓÂÀÍÍß ÒÀ ÏÐÎÔ²ËÀÊÒÈÊÈ

Äàð÷èê Þ.Â

Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Î.Î. Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: âíóòð³øíüîøëóíî÷êîâ³ êðîâîâèëèâè, íåäîíîøåí³ íîâîíàðîäæåí³.

×àñòèì íà òë³ ïåðåä÷àñíèõ ïîëîã³â º ïîºäíàííÿ òàêèõ

ôàêòîð³â, ÿê ã³ïîêñ³ÿ, âíóòð³øíüîóòðîáíà ³íôåêö³ÿ, à òà-

êîæ âïëèâ ìåõàí³÷íèõ ñèë íà ïë³ä ï³ä ÷àñ éîãî ïðîõîä-

æåííÿ ïî ïîëîãîâèõ øëÿõàõ [15]. Âñå ÷àñò³øå ó äîñë³ä-

æåííÿõ çâåðòàºòüñÿ óâàãà íà ïîñòíàòàëüí³ ðèçèêè,

îáóìîâëåí³ áåçïîñåðåäíüî ïðîâåäåííÿì ë³êóâàííÿ.

Òàê, äîâåäåíî, ùî êîëèâàííÿ àðòåð³àëüíîãî òèñêó, øâèä-

êà ³íôóç³ÿ NaHCO3 çá³ëüøóþòü ðèçèê êðîâîâèëèâó äî

64% [9]. Âàðòî â³äì³òèòè, ùî âèêîðèñòàííÿ øòó÷íî¿ âåí-

òèëÿö³¿ ëåãåíü, íåñèíõðîíí³ñòü ç ðîáîòîþ ðåñï³ðàòîðà,

ìíîæèíí³ ³íâàçèâí³ äîñë³äæåííÿ, ïîðóøåííÿ òåìïåðà-

òóðíîãî ðåæèìó òà âîëîãîñò³ ìîæóòü òàêîæ óñêëàäíþ-

âàòè ñòàí äèòèíè.

Çíà÷íó ðîëü ó âèíèêíåíí³ ÂØÊ â³ä³ãðàþòü îñîáëè-

âîñò³ àíàòîì³÷íî¿ áóäîâè íåçð³ëîãî ìîçêó íåäîíîøåíî¿

äèòèíè, à ñàìå – íàÿâí³ñòü ó ïåðèâåíòðèêóëÿðíèõ ä³ëÿíêàõ

çîí ãåðì³íàòèâíîãî (çàðîäêîâîãî) ìàòðèêñó. Ãåðì³íàòèâ-

íèé ìàòðèêñ ëîêàë³çóºòüñÿ ïîïåðåäó õâîñòàòîãî ÿäðà ³

íèæ÷å øëóíî÷êîâî¿ åïåíäèìè ³ º äîáðå âàñêóëÿðèçîâà-

íèì ñêóï÷åííÿì ãë³àëüíèõ êë³òèí òà êë³òèí-ïîïåðåäíèê³â.

Öÿ ïåðèâåíòðèêóëÿðíà çîíà íàäçâè÷àéíî óðàçëèâà ó íå-

äîíîøåíèõ ïåðåâàæíî ó ïåðø³ 48 ãîäèí æèòòÿ. Â öèõ

ä³ëÿíêàõ ó 95% íåäîíîøåíèõ ä³òåé çáåð³ãàþòüñÿ

åìáð³îíàëüí³ ñóäèíè ç ïðèì³òèâíîþ áóäîâîþ òà íèçüêîþ

ô³çè÷íîþ àêòèâí³ñòþ. Âàãîìèìè ÷èííèêàìè ó ïàòîãåíåç³

ÂØÊ º óòðóäíåííÿ âåíîçíîãî â³äòîêó ç ïåðèâåíòðè-

êóëÿðíèõ ä³ëÿíîê, ïîðóøåííÿ ãåìîñòàçó, ðåîëîã³¿ êðîâ³,

êîëèâàííÿ îñìîëÿðíîñò³ ñèðîâàòêè êðîâ³ [17].

Ïðè íåçíà÷íîìó çà îá’ºìîì êðîâîâèëèâ³ ãåìàòîìè

ë³í³éí³ òà ëîêàë³çóþòüñÿ ó çîí³ ãåðì³íàòèâíîãî ìàòðèêñó.

ßêùî êðîâîòå÷à ïðîãðåñóº, êðîâ ïðîðèâàºòüñÿ ÷åðåç

åïåíäèìó ³ ïðîíèêàº ó ïîðîæíèíè á³÷íèõ øëóíî÷ê³â, à

ïîò³ì ³ç ñïèííîìîçêîâîþ ð³äèíîþ ïîøèðþºòüñÿ ïî âñ³é

ë³êâîðîïðîâ³äí³é ñèñòåì³. Ïðîíèêíåííÿ êðîâ³ òà ïðî-

äóêò³â ¿¿ ðîçïàäó â ì’ÿê³ ìîçêîâ³ îáîëîíêè ñóïðîâîä-

æóºòüñÿ àñåïòè÷íîþ çàïàëüíîþ ðåàêö³ºþ, ùî ïðèçâî-

äèòü äî çíèæåííÿ ðåçîðáö³¿ ñïèííîìîçêîâî¿ ð³äèíè ³

ðîçâèòêó ïîâ³ëüíî ïðîãðåñóþ÷î¿ ã³äðîöåôàë³¿ [1,2].

Îáñòåæåííÿ òà ñïîñòåðåæåííÿ âêëþ÷àþòü:

1. Ìîí³òîðèíã àðòåð³àëüíîãî òèñêó, òåìïåðàòóðè ò³ëà,

×ÑÑ, ×Ä, êèñëîòíî-îñíîâíîãî ñòàíó, ðÎ2, ðÑÎ2, ãåìàòîê-

ðèòó, ãëþêîçè êðîâ³, äîñë³äæåíü ñèñòåìè ãåìîñòàçó, âèç-

íà÷åííÿ ê³ëüêîñò³ òðîìáîöèò³â.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

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ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

2. Óëüòðàñîíîãðàô³ÿ 1 ðàç íà 3-5 ä³á ïðîòÿãîì 2-õ

òèæí³â, ïîò³ì – çà ïîêàçàííÿìè, àëå íå ð³äøå í³æ 1 ðàç íà

òèæäåíü.

3. Âèì³ðþâàííÿ îáâîäó ãîëîâè 1 ðàç íà 5-7 ä³á.

4. Êîìï’þòåðíà òîìîãðàô³ÿ, ìàãí³òíèé ðåçîíàíñ – ó

ñêëàäíèõ âèïàäêàõ.

5. Ä³àãíîñòè÷íà ëþìáàëüíà ïóíêö³ÿ (ïðîâîäèòüñÿ çà

ñòðîãèìè ïîêàçàííÿìè ³ îáåðåæíî ó çâ’ÿçêó ç âèñîêèì

ðèçèêîì âêëèíåííÿ ñòîâáóðà ãîëîâíîãî ìîçêó ó âåëèêèé

ïîòèëè÷íèé îòâ³ð) [4].

Ïðàêòè÷íî ó âñ³õ äîñë³äæåííÿõ, ïðèñâÿ÷åíèõ ÂØÊ ó

íîâîíàðîäæåíèõ, òÿæê³ñòü ãåìîðàã³¿ îö³íþºòüñÿ çà øêà-

ëîþ L. Papile (1978) [10]. Çà êëàñèô³êàö³ºþ L. Papile, âèä³ëÿ-

þòü òàê³ ñòóïåí³ òÿæêîñò³ ÂØÊ:

ðåäîâèùà, ùî ïåâíîþ ì³ðîþ ³ì³òóº âíóòð³øíüîìàòêîâ³

óìîâè. Îñîáëèâî öå ñòîñóºòüñÿ ä³òåé ç äóæå íèçüêîþ ³

åêñòðåìàëüíî íèçüêîþ ìàñîþ ò³ëà. Íåîáõ³äíèé îõîðîí-

íèé ðåæèì: çìåíøåííÿ ³íòåíñèâíîñò³ çâóêîâèõ ³ ñâ³òëîâèõ

ïîäðàçíèê³â, ìàêñèìàëüíî ùàäí³ îãëÿäè, çâåäåííÿ äî

ì³í³ìóìó ïðèçíà÷åíü, ÿê³ âèêëèêàþòü á³ëü, “òåìïåðàòóð-

íèé çàõèñò”, ùî ïîïåðåäæóº ÿê îõîëîäæåííÿ, òàê ³ ïåðå-

ãð³âàííÿ, ó÷àñòü ìàòåð³ â äîãëÿä³ çà äèòèíîþ. Ó êîìïëåêñ

ë³êóâàííÿ âõîäèòü ñâîº÷àñíà ðåàí³ìàö³ÿ. Íàéá³ëüø âàæ-

ëèâèìè çàâäàííÿìè, ÿê³ âèð³øóþòüñÿ â ïðîöåñ³ ðåàí³-

ìàö³¿ òà ³íòåíñèâíî¿ òåðàï³¿ íîâîíàðîäæåíèõ ç ÂØÊ, º:

– çàáåçïå÷åííÿ àäåêâàòíî¿ ëåãåíåâî¿ âåíòèëÿö³¿;

– ï³äòðèìàííÿ ñòàá³ëüíîãî ð³âíÿ ñèñòåìíî¿ òà öåðåá-

ðàëüíî¿ ãåìîäèíàì³êè;

– ïîñò³éíèé ìîí³òîðèíã ³ îáåðåæíà êîðåêö³ÿ ð³âíÿ

ñèðîâàòêîâî¿ ãëþêîçè (ð³âåíü ãë³êåì³¿ ïîâèíåí

ï³äòðèìóâàòèñÿ íà ð³âí³ 4-6 ììîëü/ë) ³ ïîðóøåíü

âîäíî-åëåêòðîë³òíîãî áàëàíñó;

– ïðîô³ëàêòèêà òà êîíòðîëü ðîçâèòêó ñóäîì ³ íàáðÿ-

êó ìîçêó [1,2].

²ñíóº íåîáõ³äí³ñòü çàñòîñóâàííÿ ïðîô³ëàêòè÷íèõ çà-

õîä³â ó ðàç³ âèíèêíåííÿ ðèçèêó ïåðåä÷àñíèõ ïîëîã³â. Çàñ-

òîñóâàííÿ çàñîá³â, ùî ñïðÿìîâàí³ íà çìåíøåííÿ ñòóïå-

íþ âíóòð³øíüîóòðîáíî¿ òà ³íòðàíàòàëüíî¿ ã³ïîêñ³¿,

ïîêðàùóº ïðîãíîç ùîäî ðîçâèòêó òà ïðîãðåñóâàííÿ

ÂØÊ (òîêîë³òè÷íà òåðàï³ÿ, êåñàðñüêèé ðîçòèí ÿê ìåòîä

áåðåæëèâîãî ïîëîãîðîçð³øåííÿ) [6,7].

Êâàë³ô³êîâàíå âåäåííÿ ïåðåä÷àñíèõ ïîëîã³â òà àíòåíà-

òàëüíå çàñòîñóâàííÿ ãëþêîêîðòèêîñòåðî¿ä³â (ÃÊÑ) çíèæóº

ÿê ÷àñòîòó ðåñï³ðàòîðíîãî äèñòðåñ-ñèíäðîìó ïëîäà, òàê ³

ìîæëèâ³ñòü âèíèêíåííÿ ÂØÊ. ÃÊÑ ñòàá³ë³çóþòü ìåìáðà-

íó ñóäèí, â òîìó ÷èñë³ ³ ãåðì³íàòèâíîãî ìàòðèêñó [12,16].

Çàñòîñóâàííÿ ãëþêîêîðòèêîñòåðî¿ä³â åôåêòèâíî ó ïîïå-

ðåäæåíí³ ÂØÊ, îñîáëèâî, ÿêùî ìèíóëî 24 ãîäèíè ì³æ

ïî÷àòêîì ë³êóâàííÿ òà ïîëîãàìè. Çàãàëüíîïðèéíÿòèì º

âèêîðèñòàííÿ áåêëîìåòàçîíó ó äîç³ 24 ìã. Ïåðåâàãè ãëþ-

êîêîðòèêîñòåðî¿ä³â ïîâ’ÿçàí³ ç ³íäóêö³ºþ ñèíòåçó ñóðôàê-

òàíòó ³ çàïîá³ãàííÿ äèñòðåññ-ñèíäðîìó, àëå ïðèñóòí³é òà-

êîæ çàõèñò ìîçêó â³ä ï³äâèùåííÿ àðòåð³àëüíîãî òèñêó ³

ï³äòðèìàííÿ éîãî íà ñòàá³ëüíîìó ð³âí³ [11].

Çíèæåííþ ÷àñòîòè ÂØÊ ñïðèÿþòü òàêîæ âèêîðèñòàí-

íÿ íåéðîì’ÿçîâèõ áëîêàòîð³â ³íòóáîâàíèõ ä³òåé ³ íàðêî-

òè÷íèõ àíàëüãåòèê³â. Åòàìçèëàò (äèöèíîí) ³íã³áóº åôåêò

ïðîñòàöèêë³íó ³ ïîñèëþº ïîë³ìåðèçàö³þ ã³àëóðîíîâî¿

êèñëîòè â ì³æêë³òèííîìó ïðîñòîð³, çá³ëüøóþ÷è òèì ñà-

Ïðîâåäåíî ñòàòèñòè÷íèé ìîí³òîðèíã íåäîíîøåíèõ

íîâîíàðîäæåíèõ, ÿê³ íàðîäèëèñü ó 2012–2013 ðð. ó Êè¿â-

ñüêîìó ì³ñüêîìó ïîëîãîâîìó áóäèíêó ¹6. Òàê, íåäîíî-

øåí³ íîâîíàðîäæåí³ ñêëàëè 5,7% â³ä óñ³õ íîâîíàðîäæå-

íèõ ä³òåé. Ðîçïîä³ë ä³òåé çà ìàñîþ ò³ëà ïðè íàðîäæåíí³

ïðåäñòàâëåíî ó òàáë. 1.

×àñòîòà ÂØÊ ó íåäîíîøåíèõ ä³òåé çàëèøàºòüñÿ âèñî-

êîþ ³ çâîðîòíî ïðîïîðö³éíà ãåñòàö³éíîìó â³êó (òàáë. 2).

Âàæëèâî â³äì³òèòè, ùî â ãðóï³ ä³òåé ç ìàñîþ 500-999 ã

ïåðåâàæàþòü ÂØÊ III-IV ñòóïåíÿ âàæêîñò³, â ãðóï³ ä³òåé ç

ìàñîþ á³ëüøå 1000 ã – ÂØÊ I-II ñòóïåíÿ.

Òÿæê³ñòü ïåðåá³ãó ÂØÊ âèçíà÷àºòüñÿ ìàñèâí³ñòþ êðî-

âîâèëèâó, íàÿâí³ñòþ ³ âèðàæåí³ñòþ ïîñòãåìîðàã³÷íî¿

ã³äðîöåôàë³¿, à òàêîæ ñòóïåíåì çàëó÷åííÿ ó ïðîöåñ ïà-

ðåíõ³ìè ãîëîâíîãî ìîçêó.

Îñíîâíîþ îñîáëèâ³ñòþ ÂØÊ º íåñïåöèô³÷í³ñòü

êë³í³÷íî¿ êàðòèíè ³ ÷àñòèé áåçñèìïòîìíèé ïåðåá³ã íà ïî-

÷àòêó çàõâîðþâàííÿ. Çà ë³òåðàòóðíèìè äàíèìè, ðàïòîâèé

ðîçâèòîê ì’ÿçîâî¿ ã³ïîòîí³¿, çíèæåííÿ ðóõîâî¿ àêòèâíîñò³,

àïíîå, ïåð³îäè äåñàòóðàö³¿, ì³äð³àç òà ïàðåç ïîãëÿäó äîãî-

ðè ïîâ’ÿçàí³ ç ÂØÊ [2,3].

Îñíîâîþ óñï³øíîãî âèõîäæóâàííÿ íîâîíàðîäæåíèõ

ç ÂØÊ º çàáåçïå÷åííÿ êîìôîðòíîãî íàâêîëèøíüîãî ñå-

Òàáëèöÿ 1.

Ðîçïîä³ë íîâîíàðîäæåíèõ çà ìàñîþ ò³ëà ïðè íàðîäæåíí³

Òàáëèöÿ 2.

×àñòîòà ÂØÊ òà ðîçïîä³ë çà ñòóïåíåì âàæêîñò³ â çàëåæíîñò³ â³ä ìàñè íîâîíàðîäæåíîãî

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ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

ìèì àäãåç³þ òðîìáîöèò³â ³ óù³ëüíþþ÷è áàçàëüíó ìåìá-

ðàíó êàï³ëÿð³â. Ïðîâåäåí³ ðàíäîì³çîâàí³ äîñë³äæåííÿ

ï³äòâåðäæóþòü ìîæëèâ³ñòü çàñòîñóâàííÿ åòàìçèëàòó äëÿ

ïðîô³ëàêòèêè âíóòð³øíüî ìîçêîâèõ ãåìîðàã³é [8,14]. Ó

äîñë³äæåíí³ R.W. Coen âèñëîâëþºòüñÿ äóìêà, ùî êîíöåí-

òðàö³ÿ òðîìáîöèò³â íèæ÷å 200õ109/L ïðîòÿãîì ïåðøèõ

òðüîõ ä³á æèòòÿ ñòàº ï³ä´ðóíòÿì äëÿ ðîçâèòêó ÂØÊ ó íå-

çð³ëîìó ìîçêó. ßêùî ðåçóëüòàòè áóäóòü ï³äòâåðäæåí³ ïî-

äàëüøèìè äîñë³äæåííÿìè, òî ³ñíóº ìîæëèâ³ñòü çàñòîñó-

âàííÿ ïåðåëèâàííÿ òðîìáîöèòàðíî¿ ìàñè

íîâîíàðîäæåíèì ç íèçüêîþ ìàñîþ ò³ëà äëÿ ïîêðàùåííÿ

ãåìîñòàòè÷íî¿ ôóíêö³¿ ÷è â ÿêîñò³ àêòèâíîãî ë³êóâàííÿ

[11].

Âàæëèâå ïðîô³ëàêòè÷íå çíà÷åííÿ ìàº ñó÷àñíà ñòðàòåã³ÿ

ðåñï³ðàòîðíî¿ òåðàï³¿, ÿêà âêëþ÷àº â ñåáå çàì³ñíó òåðàï³þ

ñóðôàêòàíòîì (ïðîô³ëàêòè÷íå òà òåðàïåâòè÷íå ââåäåííÿ),

ðàííº çàñòîñóâàííÿ íå³íâàçèâíî¿ äèõàëüíî¿ ï³äòðèìêè –

SPAP òà âèñîêî÷àñòîòíî¿ îñöèëÿòîðíî¿ ØÂË. Ñòàá³ë³çàö³ÿ

ãåìîäèíàì³êè, ñâîº÷àñíå çàêðèòòÿ ïåðñèñòóþ÷î¿ àðòå-

ð³àëüíî¿ ïðîòîêè â ïîºäíàíí³ ç ë³êóâàëüíî-îõîðîííèì

ðåæèìîì, ìîí³òîðèíã â³òàëüíèõ ôóíêö³é ³ çàáåçïå÷åííÿì

íåïåðåðâíîãî òåïëîâîãî ëàíöþæêà º îñíîâíèìè íåñïåöè-

ô³÷íèìè íàïðÿìêàìè ó ïîïåðåäæåíí³ ÂØÊ [5].

Âèñíîâêè. Ó íîâîíàðîäæåíèõ ïðè öåðåáðàëüíèõ ïî-

øêîäæåííÿõ ³ñíóþòü ïîòåíö³éí³ êîìïåíñàòîðí³ ìîæëè-

âîñò³ ãîëîâíîãî ìîçêó, ÿê³ ïðè àäåêâàòí³é òà ñâîº÷àñí³é

ðåàá³ë³òàö³¿ ñïðèÿþòü â³äíîâëåííþ íåâðîëîã³÷íèõ

ôóíêö³é íàâ³òü ó âêðàé íåçð³ëèõ ä³òåé. Äî òàêèõ ìåõàí³çì³â

íàëåæàòü íåéðîïëàñòè÷í³ñòü òà ðå³ííåðâàö³ÿ ìîçêó,

çáåðåæåííÿ ìîæëèâîñò³ ïîäàëüøîãî ôóíêö³îíóâàííÿ

íåðâîâèõ êë³òèí, ÿê³ ïåðåíåñëè ã³ïîêñ³þ. Ðåçåðâè êîìïåí-

ñàö³¿ íàéá³ëüø âèñîê³ ïðè ïðîâåäåíí³ ðàííüî¿ ä³àãíîñòèêè

³ ñâîº÷àñíî ïî÷àòîãî ë³êóâàííÿ [3,7, 10].

Ðåöåíçåíò: ÷ëåí-êîð. ÍÀÌÍ Óêðà¿íè,

ä.ìåä.í., ïðîôåñîð Âåíöê³âñüêèé Á.Ì.

Ë²ÒÅÐÀÒÓÐÀ

1.Âíóòðèæåëóäî÷êîâûå êðîâîèçëèÿíèÿ ó íåäîíîøåííûõ íî-

âîðîæäåííûõ (ýòèîëîãèÿ, ïàòîãåíåç, äèàãíîñòèêà, ëå÷åíèå):

ó÷åáíîå ïîñîáèå / Å.Â. Ìèõàëåâ, Ñ.Ï. Åðìîëåíêî, Ã.Ï. Ôèëèïïîâ. –

Ò: CèáÃÌÓ, 2008.

2.Íåîíàòîëîã³ÿ: íàâ÷àëüíèé ïîñ³áíèê / Çà ðåä. Ò.Ê.Çíàìåí-

ñüêî¿.- Ê. : 2012.

3.Íåâðîëîãèÿ íåäîíîøåíûõ äåòåé / À.Á. Ïàëü÷èê, Ë.À. Ôåäî-

ðîâà, À. Å. Ïîíÿòèøèí. – Ì. : ÌÅÄ-ïðåññ-èíôîðì, 2010.

4.Íåîíàòîëîãèÿ: ó÷åá. ïîñîáèå: â 2 ò. – 5-å èçä., èñïð. è äîï. /

Í.Ï. Øàáàëîâ. – Ì. : ÌÅÄ ïðåññ-èíôîðì, 2009.

5.Îðëîâ Þ.Î., Êàñüÿíîâ Â.Î. Äèôôåðåíöèðîâàííîå ëå÷åíèå

ïåðèíàòàëüíîãî âíóòðè÷åðåïíîãî êðîâîèçëèÿíèÿ ó íîâîðîæäåí-

íûõ / Þ.Î. Îðëîâ, Â.Î.Êàñüÿíîâ // Óêðà¿íñüêèé íåéðîõ³ðóðã³÷íèé

æóðíàë. – 2008. – ¹1. Ñ.50-54.

6.Ïîäëåâñêèõ Ò.Ñ., Ïîïîâà È.Â., Òîêàðåâ À.Í., Áåëÿêîâ Â.À.

Êëèíèêî-äèàãíîñòè÷åñêàÿ õàðàêòåðèñòèêà âíóòðèæåëóäî÷êî-

âûõ êðîâîèçëèÿíèé â íåîíàòàëüíîì ïåðèîäå / Ò.Ñ. Ïîäëåâñêèõ,

È.Â. Ïîïîâà, À.Í. Òîêàðåâ, Â.À. Áåëÿêîâ // Äåòñêàÿ áîëüíèöà. –

2012. –¹ 1. Ñ.35-39.

7.Ôàäººâà Ó.Â., Áàóò³íà Ò.Â., Êóíºã³íà Î.Ì., Êîç³íà Ñ.Þ. Ïðî-

ãíîçóâàííÿ ðåçóëüòàò³â âíóòð³øíüîøëóíî÷êîâèõ êðîâîâèëèâ³â

ó íåäîíîøåíèõ íîâîíàðîäæåíèõ / Ó.Â. Ôàäººâà, Ò.Â. Áàóò³íà,

Î.Ì. Êóíºã³íà, Ñ.Þ. Êîç³íà // Óêðà¿íñüêèé ìåäè÷íèé àëüìàíàõ. –

2010. – Ò. 13. – ¹4. – Ñ.214-216.

8.Øóíüêî ª.ª. Âïðîâàäæåííÿ êîíöåïö³¿ ïîäàëüøîãî ðîçâèò-

êó ïåðèíàòàëüíî¿ äîïîìîãè â Óêðà¿í³ / ª.ª. Øóíüêî // Íåîíà-

òîëîã³ÿ, õ³ðóðã³ÿ òà ïåðèíàòàëüíà ìåäèöèíà. – 2011. – Ò.1. –

¹1. – Ñ.10-16.

9.Ballabh P. Intraventricular Hemorrhage in Premature Infants:

Mechanism of Disease / P. Ballabh // Pediatr Res. – 2010. – ¹ 67(1). –

P.1-8.

10.Bolisetty S., Dhawan A., Abdel-Latif M. Intraventricular he-

morrhage age and neurodevelopmental outcomes in extreme preterm

infants / S. Bolisetty, A. Dhawan, M. Abdel-Latif // Pediatrics. – 2014. –

¹ 1. – Vol. 133. – P.55-62

11.Coen R. W. Preventing germinal matrix layer rupture and

intraventricular hemorrhage / R. W. Coen // Front. Pediatr. – 2013. –

¹ 1. – P.1-4.

12.Hunt R., Hey E. Ethamsylate for the prevention of morbidity

and mortality in preterm or very low birth weight infants / R. Hunt,

E. Hey // The Cochrane Library. – 2010. – ¹ 1. – Ð.5-40.

13.Lee J.Y., Kim H.S., Jung E. Risk Factors for Periventricular-

Intraventricular Hemorrhage in Premature Infants / J.Y. Lee, H.S.

Kim, E. Jung // J. Korean Med. Sci. – 2010. – ¹ 25. – Ð.418-424.

14.Papile L.A., Burstein J., Burstein R., Koffler H. Incidence and

evolution of subependymal and intraventricular hemorrhage: a study

of infants with birth weights less than 1,500 gm / L.A Papile .,

J. Burstein , R. Burstein , H. Koffler // J. Pediatr. – 1978. – ¹ 92(4). –

P.529-534.

15.Vogtmann C., Koch R., Gmyrek D. Risk-Adjusted Intra-

ventricular Hemorrhage Rates in Very Premature Infants / C. Vog-

tmann, R. Koch, D. Gmyrek // Deutsches Ärzteblatt International. –

2012. – ¹ 109(31–32). – Ð.527-533.

16.Wang Y.C., Tseng H.I. Effects of antenatal corticosteroids on

neonatal outcomes in very-low-birth-weight preterm newborns a 10-year

retrospective study in a medical center / Y.C. Wang, H.I. Tseng //

Pediatr. Neonatol. – 2012. – ¹53(3). – Ð.178-83.

17.Whitelaw A. Core Concepts: Intraventricular Hemorrhage /

A. Whitelaw // NeoReviews. – 2011.– ¹ 2. – Vol.12. – P.1-10.

ÂÍÓÒÐÈÆÅËÓÄÎ×ÊÎÂÎÅ ÊÐÎÂÎÈÇËÈßÍÈÅ

Ó ÍÅÄÎÍÎØÅÍÍÛÕ ÍÎÂÎÐÎÆÄÅÍÍÛÕ:

ÔÀÊÒÎÐÛ ÐÈÑÊÀ, ÎÑÎÁÅÍÍÎÑÒÈ

ÏÀÒÎÃÅÍÅÇÀ, ÎÑÍÎÂÍÛÅ ÌÅÒÎÄÛ

ËÅ×ÅÍÈß È ÏÐÎÔÈËÀÊÒÈÊÈ

Äàð÷èê Þ.Â

Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò

èìåíè À.À. Áîãîìîëüöà, ã. Êèåâ, Óêðàèíà

Ðåçþìå. Â ñòàòüå ïðåäñòàâëåíû ôàêòîðû ðèñêà, îñî-

áåííîñòè ïàòîãåíåçà, îñíîâíûå ìåòîäû ëå÷åíèÿ è ïðî-

ôèëàêòèêè âíóòðèæåëóäî÷êîâûõ êðîâîèçëèÿíèé ó íåäî-

íîøåííûõ íîâîðîæäåííûõ. Ïðîâåäåí àíàëèç ñòàòèñòè-

÷åñêèõ äàííûõ Êèåâñêîãî ðîääîìà ¹ 6 ó íåäîíîøåííûõ

íîâîðîæäåííûõ.

Êëþ÷åâûå ñëîâà: âíóòðèæåëóäî÷êîâîå êðîâî-

èçëèÿíèå, íåäîíîøåííûå íîâîðîæäåííûå.

INTRAVENTRICULAR HEMORRHAGES IN

PREMATURE NEWBORNS: RISK FACTORS,

PATHOGENESIS CONCEPTS, MAIN PREVENTIVE

AND THERAPEUTIC METHODS

Y. Darchyk

Bogomolets National Medical University, Kyiv, Ukraine

Summary. This issue represents risk factors,

peculiarities of pathogenesis and principal therapeutic and

preventive methods of intraventricular hemorrhages (IVH)

in premature infants. The complex retrospective analysis of

of premature infants with IVH in Kyiv maternity hospital ¹ 6

was provided.

Key words: intraventricular hemorrhages, premature

newborns.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

Âñòóï. Õðîí³÷íèé àòðîô³÷íèé ãàñòðèò (ÕÀÃ) º îä-

í³ºþ ç íàéâàæëèâ³øèõ ïðîáëåì ñó÷àñíî¿ ãàñòðîåíòåðî-

ëîã³¿, îñê³ëüêè çã³äíî ç ðåêîìåíäàö³ÿìè ÂÎÎÇ â³äíîñèòü-

ñÿ äî ïåðåäðàêîâèõ ñòàí³â [9]. Ãîëîâíèì åò³îëîã³÷íèì

ôàêòîðîì ÕÀÃ ââàæàþòü Helicobacter pylori [9,12].

ÂÎÎÇ âèçíàëî äîñòàòí³ì íàÿâí³ äîêàçè êàíöåðîãåííîñò³

³íôåêö³¿ H.pylori ³ çà öèì êðèòåð³ºì â³äíåñëè ¿¿ äî êàíöå-

ðîãåí³â I ãðóïè. Âèçíà÷åí³ ñïåöèô³÷í³ ã³ñòîìîðôî-

ëîã³÷í³ îçíàêè õðîí³÷íî¿ õåë³êîáàêòåðíî¿ ³íôåêö³¿ – âîã-

íèùåâå ïîøêîäæåííÿ åï³òåë³àëüíèõ êë³òèí ³ çàïàëüíèé

³íô³ëüòðàò ó âëàñí³é ïëàñòèíö³ ñëèçîâî¿ îáîëîíêè, ÿêèé

ñêëàäàºòüñÿ ç ïîë³ìîðôíîíóêëåàðíèõ ëåéêîöèò³â, åîçè-

íîô³ë³â ³ ìîíîíóêëåàðíèõ êë³òèí, äî îñòàíí³õ â³äíîñÿòü-

ñÿ ë³ìôîöèòè, ìîíîöèòè ³ ïëàçìàòè÷í³ êë³òèíè [1, 2, 12].

Òàêîæ ñïåöèô³÷íîþ ã³ñòîìîðôîëîã³÷íîþ îçíàêîþ õðî-

í³÷íî¿ H.pylori ³íôåêö³¿ º ë³ìôî¿äí³ ôîë³êóëè, ÿê³, çà äà-

íèìè á³ëüøîñò³ àâòîð³â, í³êîëè íå ïðèñóòí³ ó íå³íô³êîâà-

íèõ H.pylori ïàö³ºíò³â [6, 8]. Ðîçâèòîê õðîí³÷íîãî

àòðîô³÷íîãî ãàñòðèòó ÿê ïðàâèëî ïîâ’ÿçàíèé ç ³íôåê-

ö³ºþ H.pylor³ ³ ïîðóøåííÿì àóòî³ìóííèõ ïðîöåñ³â. Ïðè

ïðîñïåêòèâíîìó äåñÿòèð³÷íîìó äîñë³äæåíí³ âñòàíîâëå-

íî, ùî ó ïàö³ºíò³â, ÿê³ ³íô³êîâàí³ H.pylori, õðîí³÷íèé

àòðîô³÷íèé ãàñòðèò ðîçâèâàºòüñÿ ó 40% âèïàäê³â ³ â

æîäíîìó âèïàäêó ïðè â³äñóòíîñò³ õåë³êîáàêòåðíî¿

³íôåêö³¿ [10].

Ïàðàäèãìà çì³í ñëèçîâî¿ îáîëîíêè øëóíêà, ùî ïî÷è-

íàþòüñÿ ³ç çàïàëüíî¿ ³íô³ëüòðàö³¿, âêëþ÷àþòü ôåíîìåí

êèøêîâî¿ ìåòàïëàç³¿, ïðèçâîäÿòü äî àòðîô³¿, äèñïëàç³¿ ³

íåîïëàç³¿ åï³òåë³þ, ìàþòü ê³íöåâèì ðåçóëüòàòîì ðàê

øëóíêà êèøêîâîãî òèïó, – îòðèìàëà íàçâó “êàñêàäà Êîð-

ðåà”[5]. Âèä³ëÿþòü äâ³ ôîðìè àòðîô³¿ – áåç ìåòàïëàç³¿

(ñïðàâæíÿ àòðîô³ÿ) ³ ç êèøêîâîþ ìåòàïëàç³ºþ, ñåðåä ÿêî¿

âèä³ëÿþòü ïîâíó ³ íåïîâíó. Íåìåòàïëàñòè÷íèé òèï õàðàê-

òåðèçóºòüñÿ âòðàòîþ çàëîç, ùî ñóïðîâîäæóºòüñÿ ô³áðî-

çîì àáî ô³áðîìóñêóëÿðíîþ ïðîë³ôåðàö³ºþ âëàñíî¿ ïëàñ-

òèíêè ñëèçîâî¿ îáîëîíêè. Ïðè ìåòàïëàñòè÷íîìó òèï³

àòðîô³¿ ñïîñòåð³ãàºòüñÿ çàì³ùåííÿ åï³òåë³þ çàëîç êë³òè-

íàìè, ùî íå âëàñòèâ³ â³ää³ëó àáî âñüîìó îðãàíó (êèøêî-

âà ìåòàïëàç³ÿ) [7].

Ïîâíà ìåòàïëàç³ÿ õàðàêòåðèçóºòüñÿ ïîÿâîþ êë³òèí

Ïàíåòà ³ êåëèõîïîä³áíèõ êë³òèí, ùî ïðîäóêóþòü ñ³àëîìó-

öèíè, õàðàêòåðí³ äëÿ ñëèçîâî¿ òîíêî¿ êèøêè. Íåïîâíà

êèøêîâà ìåòàïëàç³ÿ õàðàêòåðèçóºòüñÿ íàÿâí³ñòþ ïðèçìà-

ÓÄÊ 616.33-002.27-074-085.281.9

ÂÈÇÍÀ×ÅÍÍß ÑÒÓÏÅÍß ÊÎËÎÍ²ÇÀÖ²¯

HELICOBACTER PYLORI Â ÑËÈÇÎÂ²É ÎÁÎËÎÍÖ²

ØËÓÍÊÀ ÏÐÈ ÕÐÎÍ²×ÍÎÌÓ ÀÒÐÎÔ²×ÍÎÌÓ ÃÀÑÒÐÈÒ²

Æàêóí Í.Â., ×èðâà Î.Ñ.

Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Î.Î. Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

Ìåäè÷íèé öåíòð “Óí³âåðñàëüíà êë³í³êà “Îáåð³ã”, ì. Êè¿â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: õðîí³÷íèé àòðîô³÷íèé ãàñòðèò, Helicobacter pylori, “êàñêàäà Êîððåà”.

òè÷íîãî åï³òåë³þ ³ êåëèõîïîä³áíèõ êë³òèí, ÿê³ ïðîäóêóþòü

ñ³àëîìóöèíè ³ ñóëüôîìóöèíè. Ïðè II òèï³ êèøêîâî¿ ìåòà-

ïëàç³¿ êë³òèíè cåêðåòóþòü íåéòðàëüí³ àáî êèñë³ ñ³àëîìó-

öèíè, à ïðè III òèï³ – ñóëüôîìóöèíè [11]. Ðîçìåæóâàííÿ

òèï³â êèøêîâî¿ ìåòàïëàç³¿ ìàº ïðîãíîñòè÷íå çíà÷åííÿ –

ïðè III òèï³ êèøêîâî¿ ìåòàïëàç³¿ â³ðîã³äí³ñòü ðîçâèòêó

ðàêó øëóíêà â 4 ðàçè âèùå, í³æ ïðè I òèï³ [4].

Îñê³ëüêè H. pylori âðàæàº åï³òåë³àëüí³ êë³òèíè, íà-

ÿâí³ñòü êèøêîâî¿ ìåòàïëàç³¿ ïîâèííà ìàòè çâ’ÿçîê ç

³íô³êóâàííÿì áàêòåð³ºþ.

Ìåòîþ äîñë³äæåííÿ ñòàëî âèçíà÷åííÿ ñòóïåíÿ êîëîí³-

çàö³¿ H.ðylori ïðè ÕÀÃ ç ìåòàïëàç³ºþ ³ áåç ìåòàïëàç³¿.

Ìàòåð³àë ³ ìåòîäè. Áóëî ïðîâåäåíî ìîðôîëîã³÷íå

äîñë³äæåííÿ ãàñòðîá³îïòàò³â íà áàç³ Ìåäè÷íîãî öåíòðó

“Óí³âåðñàëüíà êë³í³êà “Îáåð³ã” â 90 âèïàäêàõ ó ïàö³ºíò³â ç

ÕÀÃ ç³ ñïðàâæíüîþ àòðîô³ºþ ñëèçîâî¿ îáîëîíêè øëóíêà

³ â 120 âèïàäêàõ ç ìåòàïëàñòè÷íîþ àòðîô³ºþ. Â ã³ñòîëîã³÷-

íèõ ïðåïàðàòàõ, çàáàðâëåíèõ ãåìàòîêñèë³íîì-åîçèíîì òà

ðåàêòèâîì Ã³ìçà, ïðîâîäèëè îö³íêó ñòóïåíÿ êîëîí³çàö³¿

áàêòåð³é, äëÿ ÷îãî âèêîðèñòîâóâàëè ñõåìó Ë.².Àðó¿íà:

ñëàáêèé ñòóï³íü – äî 20 áàêòåð³é â îêðåìèõ ïîëÿõ çîðó

ì³êðîñêîïó, ñåðåäí³é ñòóï³íü – â³ä 20 äî 50, ³ âèñîêèé

ñòóï³íü êîëîí³çàö³¿ – á³ëüøå 50 áàêòåð³é â ïîë³ çîðó ïðè

çá³ëüøåíí³ ì³êðîñêîïà 200 (Axioscop 40 (Zeiss).

Ðèñ. 1. Õðîí³÷íèé àòðîô³÷íèé ãàñòðèò – ìàëà ê³ëüê³ñòü

çàëîç ³ çíà÷í³ ô³áðîçí³ ïðîøàðêè â ñëèçîâ³é îáîëîíö³.

Çàáàðâëåííÿ ãåìàòîêñèë³íîì-åîçèíîì. Çá. 100.

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

Ðåçóëüòàòè ³ îáãîâîðåííÿ. Ïðè ÕÀÃ áåç ìåòàïëàç³¿

(ðèñ. 1) ç 90 äîñë³äæåíèõ âèïàäê³â â 48 (53,3%) â ñòðîì³

ñëèçîâî¿ â³äì³÷àëàñü íàÿâí³ñòü ë³ìôî¿äíèõ ôîë³êóë³â

(ðèñ. 2); â 36 (40%) ãàñòðèò áóâ àêòèâíèì (ðèñ. 3). Â 6

(6,7%) âèïàäêàõ áàêòåð³¿ íå áóëè çíàéäåí³, â 48 á³îïòàòàõ

(53,3%) â³äì³÷àâñÿ ñëàáêèé ñòóï³íü êîëîí³çàö³¿, â 27 (30%) –

ñåðåäí³é ³ ëèøå â 9 (10%) – âèñîêèé ñòóï³íü êîëîí³çàö³¿

H. pylori.

Â ãðóï³ ÕÀÃ ç ìåòàïëàñòè÷íîþ àòðîô³ºþ ç 120 âè-

ïàäê³â ãàñòðîá³îïòàò³â â 64 (53,3%) â³äì³÷àëàñü ïîâíà ìå-

òàïëàç³ÿ (ðèñ. 4), â 40 âèïàäêàõ (33,3%) – íåïîâíà ìåòàïëà-

ç³ÿ (ðèñ. 5) ³ ó 16 ïàö³ºíò³â (13,3:%) áóëî ïîºäíàííÿ ïîâíî¿

³ íåïîâíî¿ êèøêîâî¿ ìåòàïëàç³¿. Àêòèâíèìè áóëè 56 âè-

ïàäê³â ÕÀÃ ç ìåòàïëàç³ºþ. Ë³ìôî¿äí³ ôîë³êóëè â ñòðîì³

ñïîñòåð³ãàëèñü â 36 (30%) á³îïòàòàõ (ðèñ. 6). Â 12 âèïàäêàõ

(10%) ìåòàïëàñòè÷íîãî ÕÀÃ H. pylori íå áóëè çíàéäåí³, â

40 (33,3%) áóâ ä³àãíîñòîâàíèé ñëàáêèé ñòóï³íü êîëîí³-

çàö³¿, â 44 (36,7%) ñåðåäí³é (ðèñ. 7) ³ â 24 (20%) – âèñîêèé

ñòóï³íü êîëîí³çàö³¿ H. pylori.

Ðèñ. 2. Õðîí³÷íèé àòðîô³÷íèé ãàñòðèò ç íàÿâí³ñòþ

â ñòðîì³ ë³ìôî¿äíîãî ôîë³êóëà.

Çàáàðâëåííÿ ãåìàòîêñèë³íîì-åîçèíîì.

Çá. 100.

Ðèñ. 3. Õðîí³÷íèé àêòèâíèé ãàñòðèò.

Çàáàðâëåííÿ ãåìàòîêñèë³íîì-åîçèíîì.

Çá. 200.

Ðèñ. 4. Õðîí³÷íèé àòðîô³÷íèé ãàñòðèò ç ïîâíîþ

(òîíêîêèøêîâîþ) ìåòàïëàç³ºþ çàëîç. Çàáàðâëåííÿ

ãåìàòîêñèë³íîì – åîçèíîì. Çá. 100.

Ðèñ. 6. Õðîí³÷íèé àòðîô³÷íèé ãàñòðèò ç íåïîâíîþ

ìåòàïëàç³ºþ çàëîç, íàÿâí³ñòþ â ñòðîì³ ë³ìôî¿äíîãî

ôîë³êóëà. Çàáàðâëåííÿ ãåìàòîêñèë³íîì-åîçèíîì.

Çá. 200.

Ðèñ. 5. Õðîí³÷íèé àòðîô³÷íèé ãàñòðèò ç íåïîâíîþ

(òîâñòîêèøêîâîþ) ìåòàïëàç³ºþ çàëîç. Çàáàðâëåííÿ

ãåìàòîêñèë³íîì-åîçèíîì. Çá. 100.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

Ðèñ. 7. Õðîí³÷íèé àòðîô³÷íèé ãàñòðèò – êîëîí³çàö³ÿ

H. pylor³ (ñåðåäí³é ñòóï³íü). Çàáàðâëåííÿ ïî Ã³ìçà.

Çá. 200.

ÎÏÐÅÄÅËÅÍÈÅ ÑÒÅÏÅÍÈ ÊÎËÎÍÈÇÀÖÈÈ

HELICOBACTER PYLORI Â ÑËÈÇÈÑÒÎÉ

ÎÁÎËÎ×ÊÅ ÆÅËÓÄÊÀ ÏÐÈ ÕÐÎÍÈ×ÅÑÊÎÌ

ÀÒÐÎÔÈ×ÅÑÊÎÌ ÃÀÑÒÐÈÒÅ

Æàêóí Í.Â., ×èðâà Î.Ñ.

Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò

èìåíè À.À.Áîãîìîëüöà, ã. Êèåâ, Óêðàèíà

Ìåäèöèíñêèé öåíòð “Óíèâåðñàëüíàÿ êëèíèêà

“Îáåðèã”, ã. Êèåâ, Óêðàèíà

Ðåçþìå. Áîëåå âûñîêàÿ ñòåïåíü êîëîíèçàöèè H. ðy-

lori îòìå÷àåòñÿ ïðè õðîíè÷åñêîì àòðîôè÷åñêîì ãàñòðè-

òå ñ ìåòàïëàçèåé, ÷òî ïîäòâåðæäàåò ðîëü áàêòåðèè â

âîçíèêíîâåíèè ìåòàïëàñòè÷åñêèõ èçìåíåíèé, íà ôîíå

êîòîðûõ ìîæåò âîçíèêàòü äèñïëàçèÿ ñ ïîòåíöèàëüíûì

ðèñêîì ìàëèãíèçàöèè.

Êëþ÷åâûå ñëîâà: õðîíè÷åñêèé àòðîôè÷åñêèé ãàñò-

ðèò, Helicobacter pylori, “êàñêàäà Êîððåà”.

Âèñíîâêè. Îòæå, á³ëüø âèñîêèé ñòóï³íü êîëîí³çàö³¿

H. pylori â³äì³÷àºòüñÿ ïðè ÕÀÃ ç ìåòàïëàç³ºþ, ùî ï³äòâåð-

äæóº ðîëü áàêòåð³¿ ó âèíèêíåíí³ ìåòàïëàñòè÷íèõ çì³í, íà

ôîí³ ÿêèõ ìîæå âèíèêàòè äèñïëàç³ÿ ç ïîòåíö³éíèì ðèçè-

êîì ìàë³ãí³çàö³¿.

Ðåöåíçåíò: ä.ìåä.í., ïðîôåñîð Ëèçîãóá Â.Ã.

Ë²ÒÅÐÀÒÓÐÀ

1. Àðóèí Ë.È. Êëåòî÷íîå îáíîâëåíèå ñëèçèñòîé îáîëî÷êè

æåëóäêà â óñëîâèÿõ èíôåêöèè H.pylori / Ë.È. Àðóèí // Ïåäèàòðèÿ.

– 2002. – ¹2. – Ñ.27-33.

2. Çàê Ì.Þ. Âïëèâ òîêñèãåííèõ øòàìì³â H. Pylori íà ìîð-

ôîëîã³÷í³ çì³íè â ñëèçîâ³é îáîëîíö³ øëóíêà ó ïàö³ºíò³â ç õðîí³÷-

íèì àòðîô³÷íèì ãàñòðèòîì / Ì.Þ.Çàê // Ñó÷àñíà ãàñòðîåíòå-

ðîëîã³ÿ. – 2010. – ¹ 5(55). – Ñ. 37-42.

3. Êàøèí Ñ.Â. Àòðîôèÿ, ìåòàïëàçèÿ, äèñïëàçèÿ – ôàêòî-

ðû ðèñêà ðàçâèòèÿ ðàêà æåëóäêà: îáðàòèìûå ëè ýòè èçìåíå-

íèÿ ñëèçèñòîé îáîëî÷êè / Ñ.Â.Êàøèí, À.Ñ. Íàäåæèí, È.Î. Èâàíè-

êîâ // Êëèíè÷. ïåðñïåêòèâû ãàñòðîýíòåðîë., ãåïàòîë. – 2006. –

¹ 5. – Ñ. 13-17.

4. Êíÿçåâ Ì.Â. Àòðîôèÿ ñëèçèñòîé îáîëî÷êè æåëóäêà êàê

ïðåäðàêîâîå çàáîëåâàíèå. Ìåòîäû äèàãíîñòèêè / Ì.Â. Êíÿçåâ //

Êëèíè÷åñêàÿ ýíäîñêîïèÿ. – 2008. – ¹ 4. – Ñ. 2-12.

5. Êîíîíîâ À.Â. Àòðîôè÷åñêèé ãàñòðèò, êèøå÷íàÿ ìåòà-

ïëàçèÿ è äèñïëàçèÿ – ñóùåñòâóåò ëè ïîñëåäîâàòåëüíà çàâèñè-

ìîñòü? /À.Â.Êîíîíîâ // Ìàòåð.ñèìïîçèóìà “Õðîíè÷åñêèé ãàñò-

ðèò. Ëå÷åíèå áàíàëüíîãî çàáîëåâàíèÿ èëè ïóòü êàíöåðïðåâåí-

öèè?” – Ìîñêâà, 2008. – Ñ.8-9.

6. Êóðèê Î.Ã. Õðîí³÷íèé ãàñòðèò ³ ïåðåäðàêîâ³³ çì³íè ñëèçî-

âî¿ îáîëîíêè øëóíêà: ìîðôîëîã³÷í³ àñïåêòè / Î.Ã.Êóðèê, Ã.À.Ñî-

ëîâéîâà, Â.Î.ßêîâåíêî // Ñó÷àñíà ãàñòðîåíòåðîëîã³ÿ. – 2009. –

¹ 4/ (48). – Ñ. 88-93.

7. Ìàåâ È.Â. Êèøå÷íàÿ ìåòàïëàçèÿ ñëèçèñòîé îáîëî÷êè æå-

ëóäêà â ïðàêòèêå ãàñòðîýíòåðîëîãà: ñîâðåìåííûé âçãëÿä íà ïðîá-

ëåìó // È.Â. Ìàåâ, Î.Â. Çàéðàòüÿíö, Þ.À.Êó÷åðÿâûé // Ðîññ. æóðí.

ãàñòðîýíòåðîë., ãåïàòîë., êîëîïðîêòîë. – 2006. – ¹ 4. – Ñ. 38-47.

8. Ïàñå÷íèêîâ Â.Ä. Ìîðôîëîãè÷åñêèå ïðîÿâëåíèÿ àòðîôèè

ñëèçèñòîé îáîëî÷êè æåëóäêà ïðè Helicobacter pylori-àññîöèèðî-

âàííîì ãàñòðèòå / Â.Ä.ïàñå÷íèêîâ, Ñ.Ì.Êîòåëåâåö, Ñ.Ç.×óêîâ //

Ðîññ. æóðí. ãàñòðîýíòåðîë., ãåïàòîë., êîëîïðîêòîë. – 2004. –

Ò.1. – Ñ. 26-32.

9. Fock K.M. Gastric Cancer Consensus conference recommends

Helicobacter pylori screening and treatment in asymptomatic person

from high-risk population to prevent gastric cancer / K.M. Fock, N.J.

Talley // Am. J. Gastroenterol. – 2008. –Vol. 103. – P. 510-514.

10. Ito M. Helicobacter pylori eradication therapy improves

atrophic gastritis and intestinal metaplasia a 5-year prospective study

of patients with atrophic gastritis / M. Ito, K. Haruma, T. Kamada et

al. // Aliment. Pharmacol. Ther. – 2002. – Vol. 16, ¹ 8. – p. 1149-56.

11. Smith J.L. Is subtyping of intestinal metaplasia in the upper

gastrointestinal tract a worthwhile exercise? An evaluation of current

mucin histochemical stains/ J.L. Smith, M.F. Dixon // Br. J. Biomed.

Sci. – 2003. – Vol. 60, ¹ 4. –Ð. 180-186.

12. Tanko M.N. Relation between Helicobacter pylori,

inflammatory (neutrophil) activity,chronic gastritis, gastrc atrophy

and intestinal metaplasia / M.N. Tanko, A.N. Manasseh, G.O. Echejoh

[et al.] // Niger.J.Clin.Pract. – 2008. – Vol. 11(3). – P. 270-274.

STUDY OF EXTENT OF COLONIZATION

OF HELICOBACTER PYLORI IN GASTRIC

MUCOSA AT CHRONIC ATROPHY GASTRITIS

N. Zhakun, O.Chirva

Bogomolets National Medical University, Kyiv, Ukraine

Ìedical centre “Oberig”, Kyiv, Ukraine

Summary. Higher extent of colonization of H. ðylori is

noted at chronic atrophy gastritis with metaplasia, that

confirms a bacterium role in emergence of metaplastic

changes which potential dysplasia and potential risk of a

malignancy.

Key words: chronic atrophic gastritis, Helicobacter pylori,

“Correa cascade”.

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

Âñòóï. ßê³ñòü æèòòÿ (ßÆ) – öå ñòóï³íü êîìôîðòíîñò³

ëþäèíè, ÿê óñåðåäèí³ ñåáå, òàê ³ â ðàìêàõ ñâîãî ñóñï³ëü-

ñòâà [3]. Òàêà îö³íêà ïîâí³ñòþ çàëåæèòü â³ä ô³çè÷íîãî ³

ïñèõîåìîö³éíîãî ñòàíó, ð³âíÿ íåçàëåæíîñò³, ñóñï³ëüíîãî

ñòàíîâèùà, âïëèâó íàâêîëèøíüîãî ñåðåäîâèùà ³ îñîáèñ-

òèõ óÿâëåíü ³íäèâ³äóóìà. Â îñíîâ³ åôåêòèâíîñò³ ë³êóâàííÿ

õâîðèõ íåçàëåæíî â³ä ïàòîëîã³¿ ëåæèòü ïîêðàùàííÿ ïîêàç-

íèê³â ÿêîñò³ æèòòÿ. ×åðåç òå éîãî îö³íþâàííþ â îñòàíí³

ðîêè ïðèä³ëÿºòüñÿ ðåòåëüíà óâàãà [5].

Ìåòîþ äîñë³äæåííÿ ñòàëî âèâ÷åííÿ ðîë³ çâ’ÿçêó

³íäèâ³äóàëüíèõ îñîáëèâîñòåé õâîðîãî ç ïåðåá³ãîì

õðîí³÷íîãî îáñòðóêòèâíîãî çàõâîðþâàííÿ ëåãåíü (ÕÎÇË)

íà òë³ ñóïóòíüîãî õðîí³÷íîãî ïàíêðåàòèòó (ÕÏ) òà âïëèâ

êîìïëåêñíîãî ë³êóâàííÿ ³ç äîäàâàííÿì åñåíö³àëüíèõ

ôîñôîë³ï³ä³â òà á³îôëàâîíî¿ä³â íà äîñë³äæóâàí³

ïîêàçíèêè.

Ìàòåð³àëè ³ ìåòîäè. Äîñë³äæåííÿ ïðîâåäåí³ ó 56 õâî-

ðèõ íà ÕÎÇË Â-Ñ ãðóï, ó ÿêèõ ñòóï³íü îáñòðóêö³¿ â³äïîâ³-

äàâ GOLD 1–2 ç íèçüêèì ðèçèêîì ³ á³ëüø âèðàæåíîþ ñèì-

ïòîìàòèêîþ (Â), à òàêîæ GOLD 3 ç âèñîêèì ðèçèêîì, àëå

ìåíø âèðàæåíîþ ñèìïòîìàòèêîþ (Ñ), – ² ãðóïà, 60 õâî-

ðèõ íà ÕÎÇË ç â³äïîâ³äíîþ õàðàêòåðèñòèêîþ ãðóï ³ç ñó-

ïóòí³ì ÕÏ (²² ãðóïà) òà 19 ïðàêòè÷íî çäîðîâèõ îñ³á â

ÿêîñò³ ðåôåðåíòíî¿ ãðóïè. Äëÿ âèâ÷åííÿ ÿêîñò³ æèòòÿ âè-

ÓÄÊ 616.24-007.271:616.37-002.2

ÂÏËÈÂ “ÅÑÅÍÖ²ÀËª ÔÎÐÒÅ Í” ÒÀ ÊÂÅÐÖÅÒÈÍÓ

ÍÀ ÏÎÊÀÇÍÈÊÈ ßÊÎÑÒ² ÆÈÒÒß ÕÂÎÐÈÕ

ÍÀ ÕÐÎÍ²×ÍÅ ÎÁÑÒÐÓÊÒÈÂÍÅ ÇÀÕÂÎÐÞÂÀÍÍß

ËÅÃÅÍÜ ²Ç ÑÓÏÓÒÍ²Ì ÕÐÎÍ²×ÍÈÌ ÏÀÍÊÐÅÀÒÈÒÎÌ

Çàõàðóê Õ.Ì., Ïåòðèê ².Â., Ãàøîê Â.Â., Òåëåê³ ß.Ì.

Áóêîâèíñüêèé äåðæàâíèé ìåäè÷íèé óí³âåðñèòåò, ì. ×åðí³âö³, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: ÿê³ñòü æèòòÿ, õðîí³÷íå îáñòðóêòèâíå çàõâîðþâàííÿ ëåãåíü, õðîí³÷íèé ïàíêðåàòèò,

ë³êóâàííÿ.

êîðèñòàíî ñòâîðåíó òà àäàïòîâàíó çà ì³æíàðîäíîþ ïðî-

öåäóðîþ óêðà¿íñüêó âåðñ³þ îïèòóâàëüíèêà MOS SF-36

(Medical Outcome Study Short Form-36) [4].

Äëÿ ñóäæåííÿ ïðî ðåçóëüòàòè õâîðèõ íà ÕÎÇË ³ç ñó-

ïóòí³ì ÕÏ çã³äíî ç îòðèìàíèì ë³êóâàííÿì ðîçïîä³ëåíî

íà òðè ãðóïè: ²À (n=20) – ãðóïà ïîð³âíÿííÿ, ïàö³ºíòè ÿêî¿

îòðèìóâàëè áàçèñíå ë³êóâàííÿ çã³äíî ç Íàêàçîì ÌÎÇ

Óêðà¿íè ¹128 â³ä 19 áåðåçíÿ 2007 ð., ²Á (n=22) – îñîáàì

ö³º¿ ãðóïè äî áàçèñíèõ ïðåïàðàò³â çàëó÷åíî “Åñåíö³àëº

ôîðòå Í” ïî 2 êàïñóëè òðè÷³ íà äîáó âïðîäîâæ 1 ì³ñÿöÿ,

õâîð³ ²Â (n=18) ãðóïè äîäàòêîâî âæèâàëè êâåðöåòèí ó

äîç³ 1,0 ã 3 ðàçà íà äîáó âïðîäîâæ 14 äí³â.

Ñòàòèñòè÷íà îáðîáêà îòðèìàíèõ äàíèõ âèêîíóâàëàñÿ

íà ïåðñîíàëüíîìó êîìï’þòåð³ “ViewSonic” ç âèêîðèñòàí-

íÿì ñòàíäàðòíèõ ïàêåò³â ïðîãðàì Microsoft Excel òà çà äî-

ïîìîãîþ êîìï’þòåðíèõ ïðîãðàì “BioStat”, Statistica for

Windows âåðñ³¿ 6.0 (Stat Soft inc., ÑØÀ). Âðàõîâóâàëèñÿ:

ñåðåäíÿ àðèôìåòè÷íà âåëè÷èíà (Ì), ¿¿ ïîìèëêà (m),

êðèòåð³é Ñò’þäåíòà (t), ìîæëèâ³ñòü (p) ³ç çàáåçïå÷åííÿì

â³ðîã³äíîñò³ íå ìåíøå í³æ 95%.

Ðåçóëüòàòè òà ¿õ îáãîâîðåííÿ. Âñòàíîâëåíî, ùî ïî-

êàçíèê ô³çè÷íîãî ôóíêö³îíóâàííÿ áóâ â³ðîã³äíî íèæ÷èì

ó õâîðèõ ³ç ñóïóòí³ì óðàæåííÿì ÏÇ íà 40,8 % (ð<0,05)

(òàáë.1). Íèçüê³ ïîêàçíèêè çà ö³ºþ øêàëîþ âêàçóþòü, ùî

Òàáëèöÿ 1.

Ïîêàçíèêè ÿêîñò³ æèòòÿ ó õâîðèõ íà õðîí³÷íå îáñòðóêòèâíå çàõâîðþâàííÿ ëåãåíü

³ç ñóïóòí³ì õðîí³÷íèì ïàíêðåàòèòîì çà äàíèìè îïèòóâàëüíèêà MOS SF-36, ó áàëàõ (M±m)

Ïðèì³òêè: * – â³ðîã³äí³ñòü â³äì³ííîñòåé ïîð³âíÿíî ç ïîêàçíèêàìè ó çäîðîâèõ îñ³á ïðè p<0,05; ** – ïîêàçíèêè ² òà ²² ãðóï â³äð³çíÿ-

þòüñÿ â³ðîã³äíî (ð<0,001-0,05); Ä% – ð³çíèöÿ ïîêàçíèê³â ì³æ ãðóïàìè õâîðèõ.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

õâîð³ ²² ãðóïè ñïðîìîæí³ âèêîíàòè ìåíøå ô³çè÷íå íàâàí-

òàæåííÿ, ïîð³âíþþ÷è ç ² ãðóïîþ òà ïðàêòè÷íî çäîðîâè-

ìè îñîáàìè (p<0,05).

Îö³íþþ÷è ðîëüîâå ô³çè÷íå ôóíêö³îíóâàííÿ (ñóá’ºê-

òèâíà îö³íêà ðåñïîíäåíòîì ñòóïåíÿ îáìåæåííÿ ñâîº¿

ïîâñÿêäåííî¿ ä³ÿëüíîñò³, çóìîâëåíî ïðîáëåìàìè çäîðî-

â’ÿ çà îñòàíí³ 4 òèæí³) ó õâîðèõ çà ñóïóòíüîãî óðàæåííÿ

ÏÇ âèÿâèëî çíà÷íå îáìåæåííÿ æèòòºä³ÿëüíîñò³ âíàñë³äîê

ô³çè÷íèõ ïðîáëåì: ïîêàçíèêè ² òà ²² ãðóï ð³çíÿòüñÿ ì³æ

ñîáîþ ó 2,3 ðàçè (ð<0,05).

Ïîêàçíèê áîëþ (Á) òà éîãî âïëèâ íà ñïðîìîæí³ñòü çàé-

ìàòèñÿ ïîâñÿêäåííîþ ä³ÿëüí³ñòþ, âêëþ÷àþ÷è ðîáîòó âäî-

ìà òà çà éîãî ìåæàìè, áóâ çíèæåíèì ó ïàö³ºíò³â îáîõ ãðóï,

ïðîòå ó ²² ãðóï³ â³í áóâ íèæ÷èì ïîð³âíÿíî ç ² ãðóïîþ íà

11,23% (ð<0,05). Íèçüê³ ïîêàçíèêè çà ö³ºþ øêàëîþ çàñâ³ä-

÷óþòü, ùî àáäîì³íàëüíèé á³ëü, ÿêèé áóâ ó íåçíà÷íî¿ ÷àñòè-

íè îáñòåæåíèõ ²² ãðóïè, à çäåá³ëüøîãî, ó âèãëÿä³ äèñïåï-

ñè÷íîãî ñèíäðîìó ÿê “åêâ³âàëåíòó” áîëüîâîãî ñèíäðîìó,

çíà÷íî îáìåæèëè àêòèâí³ñòü ïàö³ºíò³â ³ç ÕÎÇË òà ÕÏ.

Ä³àãíîñòîâàíî, ùî çàãàëüíèé ñòàí ñâîãî çäîðîâ’ÿ

õâîð³ ² òà ²² ãðóï îö³íèëè íèæ÷å (ó 1,6 òà 1,8 ðàçè), í³æ

çäîðîâ³ (p<0,05). Ïðîòå ì³æ ñîáîþ ïîêàçíèêè õâîðèõ íå

â³äð³çíÿëèñü. Öå íàö³ëþº íà äóìêó, ùî õâîð³ íèçüêî îö³-

íþþòü ñâîº çäîðîâ’ÿ â ö³ëîìó, îäíàê òåíäåíö³ÿ äî ïî-

ã³ðøåííÿ ïîêàçíèêà âñå æ ñïîñòåð³ãàºòüñÿ ó ²² ãðóï³.

Ïîêàçíèê æèòòºçäàòíîñò³ ÿê ñóá’ºêòèâíà îö³íêà ðåñïîí-

äåíòîì ñâîãî æèòòºâîãî òîíóñó â ç³ñòàâëåíí³ ç àíàëîã³÷íèì

ïîêàçíèêîì ó çäîðîâèõ (p<0,05-0,001) òà õâîðèõ ² ³ ²² ãðóïè

áóâ çíèæåíèì (ó 1,9 òà ó 2,5 ðàçè). Íèçüê³ ïîêàç-íèêè ñâ³ä÷àòü

ïðî çíèæåííÿ æèòòºâî¿ àêòèâíîñò³ òà âòîìó ïàö³ºíò³â.

Ïîêàçíèê ñîö³àëüíî¿ àêòèâíîñò³ (ÑÀ) âèçíà÷àº, ó ÿê³é

ì³ð³ ô³çè÷íèé ÷è åìîö³éíèé ñòàí îáìåæóº ÑÀ, ñï³ëêóâàí-

íÿ ç äðóçÿìè, êîëåãàìè ïî ðîáîò³, ð³äíèìè çà îñòàíí³ ÷îòè-

ðè òèæí³ [2]. Îòðèìàí³ äàí³ çàñâ³ä÷óþòü ïîì³ðíó òåíäåíö³þ

(ó 1,1 ðàçè) äî îáìåæåííÿ ñîö³àëüíèõ êîíòàêò³â, çíèæåííÿ

ð³âíÿ ñï³ëêóâàííÿ ó çâ’ÿçêó ç ïîã³ðøåííÿì ô³çè÷íîãî ³

åìîö³éíîãî ñòàíó ó õâîðèõ íà ÕÎÇË ³ç ñóïóòí³ì ÕÏ ïî-

ð³âíÿíî ³ç ãðóïîþ áåç ñóïóòíüîãî óðàæåííÿ ÏÇ.

Ç’ÿñîâàíî, ùî ïîêàçíèê ðîë³ åìîö³éíèõ ïðîáëåì â

îáìåæåíí³ æèòòºä³ÿëüíîñò³ (ñóá’ºêòèâíà îö³íêà õâîðèì

ñòóïåíÿ îáìåæåííÿ ñâîº¿ áóäåííî¿ ä³ÿëüíîñò³, çóìîâëå-

íî¿ åìîö³éíèìè ïðîáëåìàìè çà îñòàíí³ ÷îòèðè òèæí³)

çíèæóâàâñÿ ó õâîðèõ íà ÕÎÇË ³ç ñóïóòí³ì ÕÏ (ð<0,05) çà

ðàõóíîê äåïðåñèâíîãî òà ³ïîõîíäðè÷íîãî ñèíäðîì³â,

ïðîòå ì³æãðóïîâî¿ â³ðîã³äíî¿ â³äì³ííîñò³ íå âèÿâëåíî

(p>0,05). Àíàë³çóþ÷è àíêåòè çäîðîâèõ îñ³á âñòàíîâëåíî,

ùî ÐÅ ó 73,7% âèïàäê³â çíàõîäèëèñü ó áàëüíîìó ³íòåðâàë³

â³ä 61 äî 100. Ñàìå öå çàñâ³ä÷óº â³äñóòí³ñòü ñòðåñîâî¿ ðîë³

åìîö³éíèõ ïðîáëåì ó ãðóï³ ÏÇÎ.

Ô³çè÷íèé êîìïîíåíò çäîðîâ’ÿ ÿê ³íòåãðàëüíèé ïîêàç-

íèê, ùî ñêëàäàºòüñÿ ç ÷îòèðüîõ ïåðøèõ ñêëàäîâèõ, âèÿ-

âèâñÿ çíà÷íî çíèæåíèì ÿê ó õâîðèõ íà ÕÎÇË, òàê ³ ó õâî-

ðèõ íà ÕÎÇË çà ñóïóòíüîãî óðàæåííÿ ÏÇ, ïðîòå â³ðîã³äíà

ì³æãðóïîâà â³äì³íí³ñòü (ð<0,05) ï³äòâåðäæóâàëà çíà÷íèé

âïëèâ ñóïóòíüî¿ ïàòîëîã³¿ íà öåé ïîêàçíèê ó ²² ãðóï³.

Îòæå, íåÿñêðàâà êë³í³÷íà êàðòèíà ìîæå çíèæóâàòè ÿê³ñòü

æèòòÿ ó õâîðèõ ²² ãðóïè òà àêöåíòóº óâàãó íà íåîáõ³äíîñò³

ðåòåëüíîãî îáñòåæåííÿ õâîðèõ ç ìåòîþ íåäîïóùåííÿ çà-

ãîñòðåííÿ ñóïóòíüîãî çàõâîðþâàííÿ.

Îö³íþþ÷è ïñèõîëîã³÷íèé êîìïîíåíò çäîðîâ’ÿ âèÿâè-

ëè ïðàêòè÷íî òàêó æ òåíäåíö³þ äî çíèæåííÿ ó ãðóï³ õâî-

ðèõ íà ÕÎÇË ³ç ñóïóòí³ì ÕÏ, ùî ï³äòâåðäæóº ò³ñíèé âçàº-

ìîçâ’ÿçîê ïñèõîëîã³÷íîãî ñòàòóñó òà êë³í³÷íî¿ êàðòèíè ó

òàêèõ õâîðèõ.

Òàêèì ÷èíîì, ó õâîðèõ íà ÕÎÇË ³ç ñóïóòí³ì õðîí³÷-

íèì ïàíêðåàòèòîì ñïîñòåð³ãàºòüñÿ çíèæåííÿ ßÆ çà ðàõó-

íîê êîìïîíåíò³â ÿê ô³çè÷íîãî, òàê ³ ïñèõ³÷íîãî ñòàòóñó.

Îòðèìàí³ äàí³ îçíà÷àþòü çìåíøåííÿ ñïðîìîæíîñò³ õâî-

ðèõ äî ô³çè÷íîãî íàâàíòàæåííÿ, îáìåæåííÿ ó ñâî¿é áó-

äåíí³é ä³ÿëüíîñò³ íà òë³ çðîñòàííÿ áîëüîâèõ â³ä÷óòò³â, ÿê³

ñóïðîâîäæóþòüñÿ çíèæåííÿì æèòòºâî¿ àêòèâíîñò³, âòî-

ìîþ ïàö³ºíò³â, îáìåæåííÿì ñï³ëêóâàííÿ ç äðóçÿìè,

ð³äíèìè, êîëåãàìè ïî ðîáîò³, ùî, â ñâîþ ÷åðãó, âèçíà÷àº

ïîÿâó äåïðåñèâíèõ, òðèâîæíèõ õâèëþâàíü òà ïñèõ³÷íîãî

íåáëàãîïîëó÷÷ÿ ³ çíèæóº ÿê³ñòü æèòòÿ.

Àíàë³ç ÿêîñò³ æèòòÿ çà äàíèìè îïèòóâàëüíèêà MOS

SF-36 ïðåäñòàâëåíèé â òàáë.2.

Òàáëèöÿ 2.

Äèíàì³êà ïîêàçíèê³â ÿêîñò³ æèòòÿ çà äàíèìè îïèòóâàëüíèêà MOS SF-36

(Medical Outcome Study Short Form-36) ï³ä âïëèâîì ë³êóâàííÿ Åñåíö³àëº ôîðòå Í òà êâåðöåòèíîì, (M±m)

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

Ïðèì³òêè: * – çì³íà ïîêàçíèêà â ïðîöåñ³ ë³êóâàííÿ â³ðîã³äíà (ð<0,001-0,05); ** – ïîêàçíèêè ²À òà ²Á ãðóï â³äð³çíÿþòüñÿ â³ðîã³äíî (ð<0,001-0,05).

Ïðîäîâæåííÿ òàáëèö³ 2.

Çàãàëüíèé ñòàí çäîðîâ’ÿ ó õâîðèõ ²À ãðóïè â³äíîñíî

ïîêàçíèê³â äî ë³êóâàííÿ ïîêðàùèâñÿ íà 14,9%, õâîð³ ²Á

ãðóïè â³äçíà÷èëè ïîêðàùàííÿ â³äïîâ³äíîãî ïîêàçíèêà íà

49,8% (ð<0,05), ó ²Â ãðóï³ – íà 35,4%, ô³çè÷íèé êîìïîíåíò

çäîðîâ’ÿ ó ãðóïàõ ïîêðàùèâñÿ íà 16,4%, 42,9% (ð<0,05), òà

18,3% â³äïîâ³äíî (ð<0,05), ïîêàçíèê ïñèõ³÷íîãî êîìïî-

íåíòó çäîðîâ’ÿ ó õâîðèõ çð³ñ íà 13,9%, 27,3% òà 18,3%,

â³äïîâ³äíî (ð<0,05).

Öå ìîæíà ïîÿñíèòè íàÿâí³ñòþ åñåíö³àëüíèõ ôîñôî-

ë³ï³ä³â ó ñêëàä³ ïðåïàðàòó, ÿê³, ÿê â³äîìî, âõîäÿòü äî ñêëà-

äó ìåìáðàí, à òàêîæ ñóðôàêòàíòó, ÿêèé ï³äòðèìóº

ïîâåðõíåâèé íàòÿã àëüâåîë, ñòâîðþþ÷è óìîâè îäíî÷àñ-

íîãî ôóíêö³îíóâàííÿ àëüâåîë ð³çíîãî ä³àìåòðó, ³íàêòè-

âóº ê³í³íè, ÿê³ ïîòðàïëÿþòü ó êðîâîíîñíå ðóñëî âíàñë³äîê

çàïàëüíîãî ïðîöåñó. Âíàñë³äîê ãàëüìóâàííÿ ô³áðî-

ãåíåçó òà ïðîòèçàïàëüíèõ öèòîê³í³â, çàõèñòó ìåìáðàí â³ä

ïîøêîäæåííÿ, ïîêðàùàííÿ ðåîëîã³÷íèõ âëàñòèâîñòåé

êðîâ³, ì³êðîöèðêóëÿö³¿, çìåíøåííÿ àãðåãàö³¿ òðîìáî-

öèò³â òà åðèòðîöèò³â, çàáåçïå÷åííÿ àíòèîêñèäàíòíèõ

âëàñòèâîñòåé ìåìáðàí, çìåíøåííÿ òîëåðàíòíîñò³ äî

õàð÷îâîãî íàâàíòàæåííÿ òà æèðîâî¿ äèñòðîô³¿ ÏÇ

“Åñåíö³àëº ôîðòå Í” ÷èíèòü ñâ³é ïîçèòèâíèé êë³í³÷íèé

åôåêò [1], ÿêèé, ó ïåðøó ÷åðãó, ïðîÿâëÿâñÿ çìåíøåííÿì

ïðîÿâ³â äèñïåïñè÷íîãî ñèíäðîìó ó 19 (86,4%) îñ³á ²Á

ãðóïè òà 11 (55,0%) ãðóïè ïîð³âíÿííÿ (²À). Íà òë³

êâåðöåòèíó ïîçèòèâíó äèíàì³êó ñïîñòåð³ãàëè ó 12

(66,7%) îáñòåæåíèõ. Ðàí³øå çíèêàëè íóäîòà, ã³ðêîòà â

ðîò³. Äèíàì³êà êë³í³÷íèõ ñèíäðîì³â ó õâîðèõ ²À òà ²Á

ãðóï â³äð³çíÿëàñÿ ç âèïåðåäæàííÿì â îñòàíí³é íà 3-4 äí³.

Ì³æ ²À òà ²Á ð³çíèöÿ ñòàíîâèëà 1-2 äí³.

Âèñíîâêè. Îòîæ, äîäàâàííÿ ÿê “Åñåíö³àëº ôîðòå Í”,

òàê ³ êâåðöåòèíó çóìîâèëî ïîêðàùàííÿ ñèíäðîìîëîã³÷-

íî¿ êàðòèíè òà ÿêîñò³ æèòòÿ. Ñë³ä çàçíà÷àòè, ùî åôåêòèâ-

í³øèì ó öüîìó ïëàí³ âèÿâèâñÿ ïðåïàðàò, ÿêèé ì³ñòèòü

åñåíö³àëüí³ ôîñôîë³ï³äè.

Ðåöåíçåíò:ä.ìåä.í., ïðîôåñîðËèçîãóá Â.Ã.

Ë²ÒÅÐÀÒÓÐÀ

1. Ãóáåðãðèö Í.Á. Ýôôåêòèâíîñòü Ýññåíöèàëå Í ïðè ëå-

÷åíèè îáîñòðåíèé õðîíè÷åñêîãî àëêîãîëüíîãî ïàíêðåàòèòà /

Í.Á. Ãóáåðãðèö, Þ.À. Çàãîðåíêî // Ñó÷àñíà ãàñòðîåíòåðîëîã³ÿ. –

2003. – ¹2 (12). – Ñ. 29-34.

2. Êèðèëþê Ê.Â. Ðîëü èçó÷åíèÿ êà÷åñòâà æèçíè äëÿ îöåíêè

âëèÿíèÿ ïñèõîñîìàòè÷åñêèõ ôàêòîðîâ ïðè õðîíè÷åñêîé îáñòðóê-

òèâíîé áîëåçíè ëåãêèõ / Ê.Â.Êèðèëþê // Ñèáèðñêèé ìåä. æóðí. –

2008. – ¹5. – Ñ.67-69.

3. Êðþê Ì. À. Êà÷åñòâî æèçíè áîëüíûõ õðîíè÷åñêèì ïàíê-

ðåàòèòîì â ñî÷åòàíèè ñ ãàñòðîýçîôàãåàëüíîé ðåôëþêñíîé

áîëåçíüþ è îæèðåíèåì / Ì. À. Êðþê // Êë³í³÷íà òà åêñïåðèìåí-

òàëüíà ïàòîëîã³ÿ. – 2008. – ¹ 3. – Ñ. 74-77.

4. Ôåùåíêî Þ.². Ïðîöåäóðà àäàïòàö³¿ ì³æíàðîäíîãî îïè-

òóâàëüíèêà îö³íêè ÿêîñò³ æèòòÿ MOS SF-36 â Óêðà¿í³. Äîñâ³ä

çàñòîñóâàííÿ ó õâîðèõ áðîíõ³àëüíîþ àñòìîþ /Þ.².Ôåùåíêî,

Þ.Ì.Ìîñòîâèé, Þ.Â.Áàá³é÷óê //Óêð. ïóëüì. æóðí. – 2002. – ¹3.

– Ñ.9-11.

5. Õðèñòè÷ Ò.Ì. ßê³ñòü æèòòÿ ó õâîðèõ íà õðîí³÷íå îá-

ñòðóêòèâíå çàõâîðþâàííÿ ëåãåíü ³ç ñóïóòí³ì õðîí³÷íèì ïàíêðå-

àòèòîì / Ò.Ì.Õðèñòè÷, ß.Ì.Òåëåê³, Ñ.Ë.Ìàðóí÷èê, Í.Ã.Ìàöêóëÿê

// Çá³ðíèê íàóêîâèõ ïðàöü ñï³âðîá³òíèê³â ÍÌÀÏÎ ³ìåí³ Ï.Ë.Øó-

ïèêà. – Âèïóñê 18. – Êíèãà 2. – Êè¿â, 2009. – Ñ.129-133.

ÂËÈßÍÈÅ “ÝÑÑÅÍÖÈÀËÅ ÔÎÐÒÅ Í”

È ÊÂÅÐÖÅÒÈÍÀ ÍÀ ÏÎÊÀÇÀÒÅËÈ ÊÀ×ÅÑÒÂÀ

ÆÈÇÍÈ ÁÎËÜÍÛÕ ÕÐÎÍÈ×ÅÑÊÈÌ

ÎÁÑÒÐÓÊÒÈÂÍÛÌ ÇÀÁÎËÅÂÀÍÈÅÌ ËÅÃÊÈÕ

Â ÑÎ×ÅÒÀÍÈÈ Ñ ÕÐÎÍÈ×ÅÑÊÈÌ

ÏÀÍÊÐÅÀÒÈÒÎÌ

Çàõàðóê Ê.Í., Ïåòðûê È.Â., Ãàøîê Â.Â., Òåëåêè ß.Ì.

Áóêîâèíñêèé ãîñóäàðñòâåííûé ìåäèöèíñêèé

óíèâåðñèòåò, ã. ×åðíîâöû, Óêðàèíà

Ðåçþìå. Ïðîâåäåíî èññëåäîâàíèå êà÷åñòâà æèçíè ó

áîëüíûõ ÕÎÁË ïðè íàëè÷èè ñîïóòñòâóþùåé ïàòîëîãèè –

õðîíè÷åñêîãî ïàíêðåàòèòà (ÕÏ). Àíàëèçèðîâàíî âëèÿíèå

êîìïëåêñíîãî ëå÷åíèÿ ñ âêëþ÷åíèåì ýññåíöèàëüíûõ

ôîñôîëèïèäîâ è áèîôëàâîíîèäîâ íà ïîêàçàòåëè êà÷å-

ñòâà æèçíè áîëüíûõ ñ ñî÷åòàííîé ïàòîëîãèåé.

Êëþ÷åâûå ñëîâà: êà÷åñòâî æèçíè, ÕÎÁË, ÕÏ.

INFLUENCE OF “ESSENTIALE FORTE N”

AND QUERCETIN ON THE QUALITY OF LIFE

OF PATIENTS WITH CHRONIC OBSTRUCTIVE

PULMONARY DISEASE COMBINED WITH

CHRONIC PANCREATITIS

K. Zaharuk, I. Petryk, V. Gashok, Ja. Teleki

Bukovinian State Medical University, Chernivtsi, Ukraine

Summary. A study of the quality of life of patients with

chronic obstructive pulmonary disease in the presence of

chronic pancreatitis was performed. The impact of integrated

treatment with essential phospholipids and bioflavonoids

on the quality of life of patients with comorbidity was analyzed.

Key words: quality of life, COPD, CP.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

Âñòóï. Â îñòàíí³ äåñÿòèð³÷÷ÿ ó á³ëüøîñò³ êðà¿í ñâ³òó

â³äì³÷àºòüñÿ íåâïèííå çðîñòàííÿ ïîêàçíèê³â çàõâîðþâàí-

íîñò³ íà êîëîðåêòàëüíèé ðàê [2]. Íàäçâè÷àéíî àêòóàëü-

íîþ º ïðîáëåìà ä³àãíîñòèêè ðàííüîãî êîëîðåêòàëüíîãî

ðàêó ³ ïåðåäðàêîâèõ çàõâîðþâàíü, íàñàìïåðåä ïîë³ïîâèä-

íèõ ³ íåïîë³ïîâèäíèõ óòâîðåíü òîâñòî¿ êèøêè. Â íàø ÷àñ

âèçíàþòü íåîáõ³äí³ñòü ñêðèí³íãîâî¿ êîëîíîñêîï³¿ (ÊÑ) ç

âèäàëåííÿì öèõ óòâîðåíü [3,4,9], ùî º ä³àãíîñòè÷íîþ ³

ë³êóâàëüíîþ ìàí³ïóëÿö³ºþ. Ìåòîäè åíäîñêîï³÷íîãî äîñ-

ë³äæåííÿ ³ç çàñòîñóâàííÿì ìåòîäèê â³äåîêîëîíîñêîï³¿,

õðîìîñêîï³¿ (ìåòèëåíîâèì ñèí³ì, ³íäèãîêàðì³íîì, îöòîâîþ

êèñëîòîþ, ãåíö³àíîâèì ô³îëåòîâèì), åíäîñêîï³¿ ç³ çá³ëüøåí-

íÿì, äîñë³äæåííÿ ó âóçüêîìó ñïåêòð³ äàþòü ìîæëèâ³ñòü îö³-

íèòè ñòàí ñëèçîâî¿ îáîëîíêè òîâñòî¿ êèøêè ³ ïðèö³ëüíî âçÿ-

òè á³îïñ³þ ç ïàòîëîã³÷íî çì³íåíèõ ä³ëÿíîê [1, 3].

Ì³êðîñêîï³÷íå äîñë³äæåííÿ äàº ìîæëèâ³ñòü âñòàíîâèòè

ã³ñòîëîã³÷íó áóäîâó óòâîðåííÿ, ùî çóìîâëþº ïîäàëüøó

òàêòèêó âåäåííÿ ïàö³ºíòà. Òàêîæ, âñå á³ëüøîãî çíà÷åííÿ

íàáóâàº âèâ÷åííÿ ïàòî- ³ ìîðôîãåíåçó êîëîðåêòàëüíèõ

íåîïëàç³é ³ç âèçíà÷åííÿì ¿õ ïîòåíö³àëó ìàë³ãí³çàö³¿ [4].

Çóá÷àñò³ àäåíîìè (ÇÀ) òîâñòî¿ êèøêè – ð³çíîâèä ïåðå-

äðàêîâèõ óòâîðåíü ñëèçîâî¿ îáîëîíêè òîâñòî¿ êèøêè, ÿê³

â³äíîñíî íåùîäàâíî ïî÷àëè ä³àãíîñòóâàòè â íàø³é êðà¿í³.

Ðàí³øå ¿õ ä³àãíîñòóâàëè ÿê àäåíîìè, ã³ïåðïëàñòè÷í³ ïî-

ë³ïè, àëå â îñòàíí³ ðîêè âèÿâèëîñü, ùî âîíè ìàþòü ñïå-

öèô³÷íèé ãåíåç, äî òîãî æ – õàðàêòåðíó ìîðôîëîã³÷íó

áóäîâó. ÇÀ ìàþòü âèñîêèé îíêîãåííèé ïîòåíö³àë ³ òîìó

ï³äëÿãàþòü õ³ðóðã³÷íîìó ë³êóâàííþ [5]. Ä³àãíîç ÇÀ ìîæ-

ÓÄÊ 616.3-091.8

ÌÎÐÔÎËÎÃ²×ÍÀ Ä²ÀÃÍÎÑÒÈÊÀ ÇÓÁ×ÀÑÒÈÕ

ÍÅÎÏËÀÇ²É ÒÎÂÑÒÎ¯ ÊÈØÊÈ

Êîñòîãëîäîâ À.Â., ßêîâåíêî Â.Î., Áîäíàð Ë.Â., Áàçäèðºâ Â.Â.

Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Î.Î. Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

Ìåäè÷íèé öåíòð “Óí³âåðñàëüíà êë³í³êà “Îáåð³ã”, ì. Êè¿â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: êîëîíîñêîï³ÿ, çóá÷àñò³ àäåíîìè, ìîðôîëîã³÷í³ îñîáëèâîñò³.

íà ïîñòàâèòè âèêëþ÷íî ïðè ìîðôîëîã³÷íîìó äîñë³ä-

æåíí³ êîëîíîá³îïòàò³â àáî îïåðàö³éíîãî ìàòåð³àëó.

Ìåòîþ íàøîãî äîñë³äæåííÿ áóëî ïðîâåñòè àíàë³ç âè-

ïàäê³â çóá÷àñòèõ àäåíîì ³ç âèçíà÷åííÿì ÷àñòîòè ¿õ âèÿâ-

ëåííÿ ³ îñîáëèâîñòåé ìîðôîëîã³÷íî¿ áóäîâè.

Ìàòåð³àëè òà ìåòîäè. Âèêîíàíèé ðåòðîñïåêòèâíèé

àíàë³ç 69 ïðîòîêîë³â ñêðèí³íãîâî¿ ÊÑ (Olympus Evis

Exera III CF- HQ190L), âèêîíàíèõ ó ãðóäí³ 2013 ðîêó íà

áàç³ Ìå-äè÷íîãî Öåíòðó “Óí³âåðñàëüíà êë³í³êà

“Îáåð³ã”, ³ â³äïîâ³äíèõ íèì ïðîòîêîë³â ïàòîìîðôîëîã³÷-

íîãî äîñë³äæåííÿ.

Ðåçóëüòàòè ³ îáãîâîðåííÿ. 47 (68%) ç 69 âèïàäê³â âèÿâ-

ëåí³ 94 ïîâåðõíåâ³ íåîïëàç³¿, ç ÿêèõ áóëî âçÿòî á³îïñ³þ àáî

âèêîíàíå åíäîñêîï³÷íå âèäàëåííÿ óòâîðåíü. Âñüîãî ó 18

(38%) ç 47 ïàö³ºíò³â áóëè ä³àãíîñòîâàí³ ÇÀ. Ïðè ìîðôîëî-

ã³÷íîìó äîñë³äæåíí³ â 44 (47%) âñ³õ âèÿâëåíèõ ïîâåðõíå-

âèõ íåîïëàç³é ä³àãíîñòîâàíî ÇÀ.

Íàçâà àäåíîì âèíèêëà âíàñë³äîê õàðàêòåðíî¿ çàçóáðå-

íî¿ ïîâåðõí³ ³ çóá÷àñòîãî ì³êðîñêîï³÷íîãî ïðîô³ëþ åï³òå-

ë³àëüíèõ ñòðóêòóð, ÿêèé äîïîâíþºòüñÿ îçíàêàìè äèñ-

ïëàç³¿ åï³òåë³îöèò³â ð³çíîãî ñòóïåíþ; äèñïëàç³ÿ çàçâè÷àé

âèçíà÷àºòüñÿ â ïîâåðõíåâèõ â³ää³ëàõ àäåíîìè [6,7].

Ó á³ëüøîñò³ çóá÷àñòà àäåíîìà ÿâëÿº ñîáîþ êîìá³íà-

ö³þ çóá÷àñòèõ óòâîðåíü ó âåðõíüîìó ñåãìåíò³ ³ àäåíîìè ó

íèæíüîìó ñåãìåíò³ (ðèñ. 1), îäíàê, ìîæå ñêëàäàòèñÿ ëèøå

³ç çóá÷àñòèõ óòâîðåíü (ðèñ. 2).

Òàêîæ, çóá÷àñò³ àäåíîìè ìîæóòü áóòè ÿê ïîë³ïîâèä-

íèìè (ðèñ. 3), òàê ³ ïëàñêèìè (ðèñ. 4).

Ðèñ. 1. Çóá÷àñòà àäåíîìà ç êîìá³íàö³¿ çóá÷àñòèõ óòâîðåíü

ó âåðõíüîìó ñåãìåíò³ ³ àäåíîìè ó íèæíüîìó ñåãìåíò³.

Çàá. ãåìàòîêñèë³íîì-åîçèíîì. Çá.200.

Ðèñ. 2. Çóá÷àñòà àäåíîìà ïåðåâàæíî ³ç çóá÷àñòèõ óòâîðåíü.

Çàá. ãåìàòîêñèë³íîì-åîçèíîì. Çá.200.

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

²íîä³ ä³àãíîñòóþòüñÿ çóá÷àñò³ ì³êðîàäåíîìè (ðèñ. 5).

Ñë³ä â³äì³òèòè, ùî ì³êðîàäåíîìè – íå âèïàäêîâà çíàõ-

³äêà ïðè ã³ñòîëîã³÷íîìó äîñë³äæåíí³, âîíè ä³àãíîñòóþòü-

ñÿ åíäîñêîï³÷íî çà íàÿâíîñò³ ñó÷àñíî¿ åíäîñêîï³÷íî¿ àïà-

ðàòóðè ³ âèêîðèñòàííÿ õðîìîñêîï³¿ ïðè ïðîâåäåíí³ ÊÑ.

Õî÷à çóá÷àñòèì àäåíîìàì íà ñüîãîäí³øí³é äåíü ³

â³äâîäÿòü çíà÷íó ðîëü ó ïðîãðåñóâàíí³ â àäåíîêàðöèíî-

ìó, îäíàê ïîòåíö³àë ìàë³ãí³çàö³¿ çàëèøàºòüñÿ âèùèì ó

íåçóá÷àñòèõ àäåíîì [8,10,11]. Êðèòåð³ºì ìàë³ãí³çàö³¿ ââà-

æàºòüñÿ ïðîðîñòàííÿ îêðåìèõ åï³òåë³àëüíèõ êîìïëåêñ³â ó

âëàñíó ì’ÿçîâó ìåìáðàíó ñëèçîâî¿ îáîëîíêè àáî êð³çü

íå¿ ó âëàñíó ï³äñëèçîâó îñíîâó. Ñåðåä äîñë³äæóâàíèõ âè-

ïàäê³â ìè òàêèõ íå ñïîñòåð³ãàëè.

Âèñíîâêè. Çóá÷àñò³ àäåíîìè º ÷àñòîþ ïàòîëîã³ºþ

ñëèçîâî¿ îáîëîíêè òîâñòî¿ êèøêè, ÿêà âèÿâëÿºòüñÿ ó 38%

âñ³õ õâîðèõ ç ïîâåðõíåâèìè íåîïëàç³ÿìè òîâñòî¿ êèøêè, ³

çàéìàº äîëþ â 47% ñåðåä âñ³õ ïîâåðõíåâèõ íåîïëàç³é ïðè

ìîðôîëîã³÷íîìó äîñë³äæåíí³.

Â ïåðñïåêòèâ³ ïëàíóþòüñÿ ïîäàëüø³ äîñë³äæåííÿ ³ç

çàëó÷åííÿì á³ëüøî¿ ê³ëüêîñò³ ïàö³ºíò³â ³ç âèâ÷åííÿì ìîð-

ôîëîã³÷íèõ îñîáëèâîñòåé çóá÷àñòèõ àäåíîì, çîêðåìà ïî-

òåíö³àëó ìàë³ãí³çàö³¿.

Ðåöåíçåíò: ÷ëåí-êîð. ÍÀÌÍ Óêðà¿íè,

ä.ìåä.í., ïðîôåñîð Çàõàðàø Ì.Ï.

Ë²ÒÅÐÀÒÓÐÀ

1. Çàõàðàø Ì.Ï. NBI ³ åíäîñêîï³ÿ ç âèñîêèì çá³ëüøåííÿì:

ñó÷àñí³ ìîæëèâîñò³ åíäîñêîï³÷íî¿ ä³àãíîñòèêè / Ì.Ï. Çàõàðàø,

Â.Î. ßêîâåíêî, Î.Ã. Êóðèê // Óêðà¿íñüêèé æóðíàë ìàëî³íâàçèâíî¿

òà åíäîñêîï³÷íî¿ õ³ðóðã³¿ – 2009. – Ò. 13, ¹ 4. – C. 12-15.

2. Çàõàðàø Ì.Ï. Ñêðèíèíã ïðåäðàêîâûõ çàáîëåâàíèé è ðàêà

òîëñòîé êèøêè /Ì.Ï. Çàõàðàø, Í.Â. Õàð÷åíêî, Ñ.Â. Ìóçûêà /

Ìåòîäè÷åñêèå ðåêîìåíäàöèè. – Êèåâ, “Ìåäèöèíà”. – 2010. – 18 ñ.

3. Êóðèê Î.Ã. Åíäîñêîï³÷íà ³ ìîðôîëîã³÷íà ä³àãíîñòèêà,

ìàëî³íâàçèâíå ë³êóâàííÿ ïîâåðõíåâèõ íåîïëàç³é òîâñòî¿ êèøêè /

Î.Ã. Êóðèê, Ì.Þ. Êîëîìîºöü, Â.Î. ßêîâåíêî, Î.Â. Êàëåíñüêà / Ìå-

òîäè÷í³ ðåêîìåíäàö³¿. – Êè¿â, 2012. - 28 ñ.

4. Íèêèøàåâ Â.È. Ýíäîñêîïè÷åñêàÿ äèàãíîñòèêà ðàííåãî

êîëîðåêòàëüíîãî ðàêà / Â.È. Íèêèøàåâ, À.Ð. Ïàòèé, È.Í. Òóìàê,

È.À.Êîëÿäà // Óêðà¿íñüêèé æóðíàë ìàëî³íâàçèâíî¿ òà åíäîñêîï³-

÷íî¿ õ³ðóðã³¿. – 2012. – Ò16, ¹ 1. – Ñ.35-55.

5. ßêîâåíêî Â.Î. Åíäîñêîï³÷íà ðåçåêö³ÿ ñëèçîâî¿ îáîëîíêè

êèøå÷íèêó ç ïðèâîäó êîëîðåêòàëüíî¿ íåîïëàç³¿ / Â.Î. ßêîâåíêî,

Î.Ã. Êóðèê // Êë³í³÷íà õ³ðóðã³ÿ. – 2013. – ¹ 12. – Ñ. 25-27.

6. Li S. C. Histopathology of serrated adenoma, its variants,

and differentiation from conventional adenomatous and hyperplastic

polyps / S. C. Li , L. Burgart // Arch. Pathol. Lab. Med. – 2007. –

¹131, vol. 3. – P. 440—445.

7. Makinen M.J. Colorectal serrated adenocarcinoma / M.J. Ma-

kinen M.J. // Histopathology. – 2007. – Vol. 50. – P. 131-150.

8. O’Brien M. The serrated polyp pathway to colorectal

carcinoma / M. O’Brien, S. Yang, C.S. Huang [et al.] // Diagn.

Histopathol. – 2008. – Vol. 14. – P. 78-93

9. Quirke P. Quality assurance in pathology in colorectal

cancer screening and diagnosis – European recommendations /

P. Quirke, M. Risio, R. Lambert // Virchows Arch. – 2011. – Vol. 458,

¹1. – P. 1-19.

10. Rubio C.A. Invasive carcinomas may arise in colorectal

adenomas with high-grade dysplasia and with carcinoma in situ /

C.A. Rubio, J.G. Delinassios // 2010. – Int. J. Clin. Exp. Med. – Vol. 3,

N1. – P. 41-47.

11. Song S.Y. Comparison of malignant potential

between serrated adenomas and traditional adenomas /

S.Y. Song, Y.H. Kim, M.K. Yu [et al.] // J. Gastroenterol. Hepatol. –

2007. – Vol.22. – P. 1786-1790.

Ðèñ. 5. Çóá÷àñòà ì³êðîàäåíîìà.

Çàá. ãåìàòîêñèë³íîì-åîçèíîì. Çá. 400.

Ðèñ. 3. Çóá÷àñòà àäåíîìà ïîë³ïîâèäíà.

Çàáàðâëåííÿ ãåìàòîêñèë³íîì – åîçèíîì. Çá. 100.

Ðèñ. 4. Çóá÷àñòà àäåíîìà ïëàñêà.

Çàáàðâëåííÿ ãåìàòîêñèë³íîì – åîçèíîì. Çá. 200.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

ÌÎÐÔÎËÎÃÈ×ÅÑÊÀß ÄÈÀÃÍÎÑÒÈÊÀ

ÇÓÁ×ÀÒÈÕ ÀÄÅÍÎÌ ÒÎËÑÒÎÉ ÊÈØÊÈ

Êîñòîãëîäîâ À.Â., ßêîâåíêî Â.À.,

Áîäíàð Ë.Â., Áàçäûðåâ Â.Â.

Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò

À.À. Áîãîìîëüöà, ã. Êèåâ, Óêðàèíà

Ìåäèöèíñêèé öåíòð “ Óíèâåðñàëüíàÿ êëèíèêà

“Îáåðèã”, ã. Êèåâ, Óêðàèíà

Ðåçþìå. Íà áàçå Ìåäèöèíñêîãî Öåíòðà “Óíèâåðñàëü-

íàÿ êëèíèêà “Îáåðèã” ïðîâåäåí àíàëèç 69 ïðîòîêîëîâ

ñêðèíèíãîâîé êîëîíîñêîïèè. Çóá÷àòûå àäåíîìû áûëè

âûÿâëåíû â 38% ñëó÷àâ âñåõ êîëîíîñêîïèé. Ïðè ìîðôî-

ëîãè÷åñêîì èññëåäîâàíèè îíè ñîñòàâèëè 47% âñåõ âû-

ÿâëåííûõ íåîïëàçèé. Ïðåäñòàâëåíû ìîðôîëîãè÷åñêèå

îñîáåííîñòè çóá÷àòûõ àäåíîì.

Êëþ÷åâûå ñëîâà: êîëîíîñêîïèÿ, çóá÷àòûå àäåíî-

ìû, ìîðôîëîãè÷åñêèå îñîáåííîñòè.

MORPHOLOGICAL DIAGNOSTIC

OF COLON SERRATUM ADENOMA

A. Kostoglodov, O.Yakovenko,

L.V. Bodnar, V.V.Bazdyrev

Bogomolets National Medical University, Kyiv, Ukraine

Ìedical centre “Oberig”, Kyiv, Ukraine

Summary. In the Medical centre “Oberig” 69 screening

colonoscopies were done. Serrated adenomas of the colon

were found in 38% of all colonoscopies cases and 47% of

all neoplasia detected on colonoscopies. The morpholo-

gical features of serrated adenomas was shown.

Key words: colonoscopy, serrated adenoma,

morphological features.

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

Â ñòðóêòóð³ çàãàëüíî¿ ñìåðòíîñò³ â Óêðà¿í³ ìîçêîâ³

³íñóëüòè çàéìàþòü äðóãå ì³ñöå, ïîñòóïàþ÷èñü ëèøå îí-

êîëîã³÷íèì çàõâîðþâàíÿì, îäíàê äèñòàíö³ÿ ì³æ íèìè

ùîð³÷íî ñêîðî÷óºòüñÿ. Çã³äíî ç îô³ö³éíîþ ñòàòèñòèêîþ

ùîðîêó âèíèêàþòü ïîíàä 100 òèñÿ÷ ìîçêîâèõ ³íñóëüò³â,

òðåòèíà ç ÿêèõ ðîçâèâàºòüñÿ â îñ³á ïðàöåçäàòíîãî â³êó, à

30-40 % õâîðèõ ïîìèðàþòü âïðîäîâæ ïåðøèõ 30 äí³â (1).

Â ïàòîãåíåç³ ³øåì³÷íîãî ³íñóëüòó âåëèêå çíà÷åííÿ ìà-

þòü çðóøåííÿ â ñèñòåì³ ãåìîñòàçó. Ïðè ïîøêîäæåíí³ ñó-

äèííî¿ ñò³íêè â çàáåçïå÷åíí³ ãåìîñòàçó âàæëèâó ðîëü

â³ä³ãðàº ôàêòîð ôîí Â³ëëåáðàíäà (vWF) — ñêëàäíèé

ìóëüòèìåðíèé àäãåçèâíèé ãë³êîïðîòå³í ïëàçìè êðîâ³,

ÿêèé ñèíòåçóºòüñÿ åíäîòåë³àëüíèìè êë³òèíàìè òà ìåãà-

êàð³îöèòàìè òà â³ä³ãðàº âàæëèâó ðîëü â ñèñòåì³ ãåìîñòà-

çó. Ïðè ïîøêîäæåíí³ ñóäèíè, vWF çâ’ÿçóº ñóáåíäîòåë³-

àëüíèé êîëëàãåíîâèé ìàòðèêñ òà òðîìáîöèòàðíèé

ðåöåïòîð GPIb-IX-V, ùî çàáåçïå÷óº ïðèêð³ïëåííÿ òðîì-

áîöèò³â äî ñóáåíäîòåë³þ ÷åðåç çâ’ÿçóâàííÿ ðåöåïòîðà

òðîìáîöèò³â ãëèêîïðîòå³íó Ib. Â³í òàêîæ ìîæå ïðèéìàòè

ó÷àñòü â òðîìáîöèò- òðîìáîöèòàðí³é âçàºìîä³¿, øëÿõîì

çâÿçóâàííÿ ãë³êîïðîòå³íó IIb/IIIa. Êð³ì òîãî, vWF º íîñ³ºì

ïðîêîàãóëÿö³éíîãî VIII ôàêòîðà çãîðòàííÿ êðîâ³, ñòàá³ë³-

çóº éîãî ñòðóêòóðó òà äîñòàâëÿº äî ì³ñöÿ ïîøêîäæåííÿ.

Âåëèêå çíà÷åííÿ äëÿ àäãåç³¿ òðîìáîöèò³â çà ó÷àñò³

vWF ìàþòü ãåìîäèíàì³÷í³ ôàêòîðè. Àäãåç³ÿ òðîìáî-

öèò³â, çóìîâëåíà vWF, íàéá³ëüø ³íòåíñèâíî ïðîõîäèòü

ïðè âèñîêèõ øâèäêîñòÿõ çñóâó, òîáòî â àðòåð³ÿõ. Ï³äâè-

ùåí³ ð³âí³ àíòèãåíî¿ vWF àêòèâíîñò³ âèñòóïàþòü ³íäèêà-

òîðîì ïîøêîäæåííÿ åíäîòåë³þ ïðè ð³çíèõ ñóäèííèõ çàõ-

âîðþâàííÿõ, âêëþ÷àþ÷è ³íôàðêò ì³îêàðäó òà ³íñóëüò,

îñîáëèâî ó õâîðèõ ç àðòåð³àëüíîþ ã³ïåðòåíç³ºþ.

Â³äîìî, ùî vWF ñåêðåòóºòüñÿ íå ëèøå ç àêòèâîâàíèõ

òðîìáîöèò³â, à é ï³äâèùóºòüñÿ â ðàç³ àêòèâàö³¿ àáî ïî-

øêîäæåííÿ åíäîòåë³àëüíèõ êë³òèí ñóäèí. Â ì³ñö³ ïîøêîä-

æåííÿ vWF âèñòóïàº ïîñåðåäíèêîì àãðåãàö³¿ òà àäãåç³¿

òðîìáîöèò³â, òîáòî ñòèìóëþº ïî÷àòîê òðîìáîóòâîðåííÿ,

çàâäÿêè ïðèêð³ïëåííþ òðîìáîöèò³â äî ä³ëÿíêè ïîøêîä-

æåíî¿ ñóäèíè. Öå â³äáóâàºòüñÿ øëÿõîì ç’ºäíàííÿ òðîìáî-

öèòàðíîãî ðåöåïòîðà GPIb-IX-V ³ç ñóáåíäîòåë³àëüíèì êî-

ëàãåíîâèì ìàòðèêñîì ÷åðåç vWF. Êð³ì öüîãî, vWF º

íîñ³ºì ôàêòîðà çãîðòàííÿ êðîâ³ VIII, ñòàá³ë³çóº éîãî

ñòðóêòóðó ³ äîñòàâëÿº äî ì³ñöÿ óøêîäæåííÿ (4).

Ìàòåð³àë òà ìåòîäè

Ó õîä³ ðîáîòè áóëî ïðîâåäåíî êîìïëåêñíå êë³í³êî-íå-

âðîëîã³÷íå îáñòåæåííÿ 113 ïàö³ºíò³â (57 æ³íîê òà 56 ÷î-

ëîâ³ê³â) ó ãîñòðèé ïåð³îä ³øåì³÷íîãî ³íñóëüòó.

Ð²ÂÅÍÜ ÔÀÊÒÎÐÀ ÔÎÍ Â²ËËÅÁÐÀÍÄÀ Ó ÕÂÎÐÈÕ

Ç ²ØÅÌ²×ÍÈÌ ²ÍÑÓËÜÒÎÌ

Êðàâ÷åíêî Í.Ê.1, Ìåëüíèê Â.Ñ.2, Ñàâ÷óê Î.Ì.1

1Êè¿âñüêèé íàöiîíàëüíèé óíiâåðñèòåò iì. Òàðàñà Øåâ÷åíêà, ÍÍÖ “²íñòèòóò Á³îëîã³¿”,

ì. Êè¿â, Óêðà¿íà

2Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Î.Î. Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: ³øåì³÷íèé ³íñóëüò, ôàêòîð ôîí Â³ëëåáðàíäà, òðîìáîöèòè.

Â³ê õâîðèõ íà ìîìåíò îãëÿäó âàð³þâàâ â³ä 43 äî 91

ðîê³â, ñêëàäàþ÷è â ñåðåäíüîìó 73,62±8,9 ðîê³â. ×îëîâ³ê³â

áóëî 56 (49,6%), æ³íîê – 57 (50,4%).

Õâîð³ ïåðåáóâàëè íà ñòàö³îíàðíîìó ë³êóâàíí³ â I òà II

íåâðîëîã³÷íèõ â³ää³ëåííÿõ Êè¿âñüêî¿ ì³ñüêî¿ êë³í³÷íî¿

ë³êàðí³ ¹4. Ä³àãíîç ³øåì³÷íîãî ³íñóëüòó áóâ ï³äòâåðäæå-

íèé íåéðîâ³çóàë³çàö³éíî (ÊÒ- àáî ÌÐÒ-ãîëîâíîãî ìîç-

êó). Âñ³ õâîð³ àáî ¿õ ðîäè÷³ áóëè ïîïåðåäæåíí³ òà äàâàëè

çãîäó íà ó÷àñòü ó êë³í³÷íîìó äîñë³äæåíí³.

Äëÿ îá’ºêòèâíî¿ îö³íêè íåâðîëîã³÷íîãî äåô³öèòó çàñ-

òîñîâóâàëèñü ñó÷àñí³ íåâðîëîã³÷í³ øêàëè. Âèðàæåí³ñòü

íåâðîëîã³÷íîãî äåô³öèòó ó õâîðèõ îö³íþâàëè çà øêàëîþ

Íàö³îíàëüíîãî ²íñòèòóòó çäîðîâ’ÿ ÑØÀ (NIHSS –

National Institute of Health Stroke Scale, USA) íà ÷àñ ãîñ-

ï³òàë³çàö³¿, íà 7-ìó òà íà 14-òó äîáó ïåðåáóâàííÿ â ñòàö³î-

íàð³. Çà ö³ºþ øêàëîþ ñóìàðíèé áàë êë³í³÷íèõ ïðîÿâ³â â³ä

3 äî 8 ñâ³ä÷èòü ïðî íåâðîëîã³÷í³ ïîðóøåííÿ ëåãêîãî ñòó-

ïåíÿ òÿæêîñò³, â³ä 9 äî 12 – ïðî ïîðóøåííÿ ñåðåäíüîãî

ñòóïåíÿ òÿæêîñò³, â³ä 13 äî 15 – òÿæê³ ïîðóøåííÿ, á³ëüøå

15 – ïðî íàäòî òÿæêèé ñòóï³íü íåâðîëîã³÷íèõ ðîçëàä³â.

Çàá³ð âåíîçíî¿ êðîâ³ ïðîâîäèëè ïóíêö³ºþ ë³êòüîâî¿

âåíè â ïåðøó äîáó ³íñóëüòó ç 8 äî 9 ãîäèíè ðàíêó íàòùå-

ñåðöå, â ïðîá³ðêó ç ðîç÷èíîì ëèìîííîêèñëîãî íàòð³þ (38

ã/ë) â ê³íöåâîìó ñï³ââ³äíîøåíí³ 9:1. Ïëàçìó êðîâ³ òà ïëàç-

ìó êðîâ³, çáàãà÷åíó òðîìáîöèòàìè îòðèìóâàëè çã³äíî

ðåêîìåíäàö³é äëÿ ðîáîòè ç ôîòîîïòè÷íèì àãðåãîìåòðîì

ÀÐ2110 “Ñîëàð” (Á³ëîðóñü). Ð³âåíü ôàêòîðà ôîí Â³ëëåá-

ðàíäà âèçíà÷àëè ó ïëàçì³ êðîâ³ ìåòîäîì ³ìóíîôåðìåíò-

íîãî àíàë³çó, ÿêèé ïðîâîäèëè çà ñòàíäàðòíîþ ìåòîäèêîþ

äëÿ ðîç÷èííèõ á³ëê³â (6).

Ïëàçìó êðîâ³ ðîçâîäèëè 50 ìÌ òðèñ-HCl áóôåðîì, pH

7,4 ó ñï³ââ³äíîøåíí³ 1:100 òà ³íêóáóâàëè ó êîì³ðêàõ ïëàí-

øåò³â çà 37°Ñ ïðîòÿãîì 60 õâ. Äëÿ âèäàëåííÿ ðåàãåíò³â, ùî

íå çâ’ÿçàëèñÿ, âèêîðèñòîâóâàëè 50 ìÌ òðèñ-HCl áóôåð,

pH 7,4. Áëîêóâàííÿ íåñïåöèô³÷íèõ ì³ñöü çâ’ÿçóâàííÿ

ïðîâîäèëè 5% ðîç÷èíîì çíåæèðåíîãî ìîëîêà ïðîòÿãîì

íî÷³. Ïåðâèíí³ (Millipore, USA) òà âòîðèíí³ (Bio-Rad,

USA) àíòèò³ëà ãîòóâàëè â³äïîâ³äíî äî ðåêîìåíäàö³é âè-

ðîáíèêà, ³íêóáàö³þ ïðîâîäèëè çà 37°Ñ ïðîòÿãîì 60 õâ.

Â³çóàë³çàö³þ ðåàêö³¿ ïðîâîäèëè ñóáñòðàòîì äëÿ ëóæíî¿

ôîñôàòàçè çà 37°Ñ ïðîòÿãîì 60 õâ. Îïòè÷íå ïîãëèíàííÿ

âèì³ðþâàëè çà äîâæèí õâèë³ 405 íì òà 492 íì íà ì³êðîðè-

äåð³ BioTek Instruments. Â³äñîòêîâèé âì³ñò vWF âèçíà÷à-

ëè çà êàë³áðóâàëüíîþ êðèâîþ.

Êîíòðîëüíà ãðóïà ñêëàäàëàñü ç 30 îñ³á, ñï³âñòàâèìèõ

çà îñíîâíèìè äåìîãðàô³÷íèìè ïîêàçíèêàìè òà ôàêòîðà-

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

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ìè ðèçèêó ³íñóëüòó ç õâîðèìè îñíîâíî¿ ãðóïè, îäíàê áåç

ãîñòðèõ ïîðóøåíü ìîçêîâîãî êðîâîîá³ãó (Ò²À, ³øåì³÷íî-

ãî àáî ãåìîðàã³÷íîãî ³íñóëüòó) â àíàìíåç³.

Ðåçóëüòàòè òà ¿õ îáãîâîðåííÿ

Ó âñ³õ îáñòåæåíèõ õâîðèõ ³øåì³÷íèé ³íñóëüò ðîçâèíó-

ñÿ íà ôîí³ ï³äâèùåíîãî ñèñòîë³÷íîãî àðòåð³àëüíîãî òèñ-

êó (ÑÀÒ). Ó á³ëüøî ñò³ õâîðèõ îñíîâíî¿ (38 (33,6%) õâîðèõ)

ð³âåíü ÑÀÒ íà ïî÷àòêó ðîçâèòêó ïåðøèõ ñèìïòîì³â çàõâî-

ðþâàííÿ ñòàíîâèâ 160-179 ìì.ðò.ñò. Ó 45 (39,8%) õâîðèõ

ä³àãíîñòîâàíà ïîñò³éíà ôîðìà ìèãîòëèâî¿ àðèòì³¿, ó 6

(5,3%) õâîðèõ – ïàðîêñèçìàëüíà ôîðìà, ó 6 (5,3%) õâîðèõ –

³íôàðêò ì³îêàðäà â àíàìíåç³. Ó 10 õâîðèõ ñïîñòåð³ãàëè

ïîºäíàííÿ ìèãîòëèâî¿ àðèòì³¿ òà ³íôàðêòó ì³îêàðäà â

àíàìíåç³. Ïðè ïðîâåäåíí³ äîïïëåðîãðàô³¿ ó 19 (16,8%)

õâîðèõ âèÿâëåí³ îçíàêè ñòåíîçóâàëüíîãî óðàæåííÿ ñîí-

íèõ àðòåð³é â åêñòðàêðàí³àëüíîìó â³ää³ë³: ó 14 õâîðèõ –

ñòåíîç ïðîñâ³òó êàðîòèä äî 75%, ó 5 – ïîíàä 75%. Ñòåíîçó-

âàëüí³ àòåðîñêëåðîòè÷í³ óðàæåííÿ ó á³ëüøîñò³ õâîðèõ

áóëè äâîá³÷íèìè. Ó 29 õâîðèõ áóâ ä³àãíîñòîâàíèé öóêðî-

âèé ä³àáåò (ÖÄ). Ä³àãíîç ÖÄ ââàæàëè äîñòîâ³ðíèì, ÿêùî

õâîð³ àáî ¿õ áëèçüê³ ïîâ³äîìëÿëè ïðî éîãî íàÿâí³ñòü â

àíàìíåç³, à êîíöåíòðàö³ÿ ãëþêîçè â êðîâ³ íàòùå áóëà âè-

ùîþ 7,0 ììîëü/ë ó ïàö³ºíò³â äî 50 ðîê³â ³ 7,2 ììîëü/ë –

ñòàðøèõ 50 ðîê³â.

Çà ñòóïåíåì òÿæêîñò³ íåâðîëîã³÷íîãî äåô³öèòó (ðèñ.

1) íàéá³ëüøà ê³ëüê³ñòü õâîðèõ ç ³øåì³÷íèì ³íñóëüòîì ìàëè

íåâðîëîã³÷í³ ïîðóøåííÿ ëåãêîãî ñòóïåíÿ (50 (44,3%)

ïàö³ºíò³â) òà ñåðåäíüîãî ñòóïåíÿ òÿæêîñò³ (33(29,2%)

ïàö³ºíò³â), ìåíøà ê³ëüê³ñòü õâîðèõ ìàëè íåâðîëîã³÷í³ ïî-

ðóøåííÿ òÿæêîãî (17(15%) ïàö³ºíò³â) òà íàäòî òÿæêîãî

ñòóïåí³â (13 (11,5%) ïàö³ºíò³â).

Ïðè äîñë³äæåíí³ òðîìáîöèòàðíî¿ ëàíêè ñèñòåìè ãå-

ìîñòàçó õâîðèõ ç ³øåì³÷íèì ³íñóëüòîì áóëî âèÿâëåíî

òåíäåíö³þ äî çðîñòàííÿ øâèäêîñò³ àãðåãàö³¿ òðîìáîöèò³â

õâîðèõ â³äíîñíî äîíîð³â, à òàêîæ òåíäåíö³þ äî çíèæåííÿ

ê³ëüêîñò³ òðîìáîöèò³â ó ïëàçì³ êðîâ³ Ìàêñèìàëüíà àìïë-

³òóäà àãðåãàö³¿ õâîðèõ ç ³øåì³÷íèì ³íñóëüòîì ïåðåâèùó-

âàëà ïîêàçíèê äîíîð³â íà 23 % (òàáë. 1.).

Òàêîæ íàìè áóëî ïîñòàâëåíî çà ìåòó äîñë³äèòè ð³âåíü

vWF ó ãîñòðîìó ïåð³îä³ ³øåì³÷íîãî ³íñóëüòó. Çã³äíî ç

ë³òåðàòóðíèìè äàíèìè ï³äâèùåííÿ ð³âíÿ vWF ó ïëàçì³

êðîâ³ ðåºñòðóºòüñÿ çà íàñòóïíèõ ïàòîëîã³é: ëåãåíåâà

ã³ïåðòåíç³ÿ (3), õðîí³÷íà ñåðöåâà íåäîñòàòí³ñòü (2), ³øåì³-

÷íà õâîðîáà ñåðöÿ (7), ì³ãðåíü (8), à òàêîæ ³øåì³÷íèé

³íñóëüò íà ôîí³ ìèãîòëèâî¿ àðèòì³¿ (5) òà ³øåì³÷íèé

³íñóëüò (9), ùî âêàçóº íà òå, ùî vWF º âàæëèâèì ìàðêå-

ðîì ó ïðîãíîçóâàíí³ òðîìáîçó.

Ïðè ïîð³âíÿíí³ ð³âíÿ ôàêòîðó ôîí Â³ëëåáðàíäà ó õâî-

ðèõ ç ³øåì³÷íèì ³íñóëüòîì ç ïàö³ºíòàìè êîíòðîëüíî¿ ãðó-

ïè, áóëî âñòàíîâëåíî äîñòîâ³ðíå ïåðåâèùåííÿ ïîêàçíèêà

íà 62,3% (p<0,05) (ðèñ. 2).

Ðèñ. 1. Âèõ³äíèé ð³âåíü íåâðîëîã³÷íîãî äåô³öèòó ó õâîðèõ

ç ³øåì³÷íèì ³íñóëüòîì çà øêàëîþ NIHSS

Òàáëèöÿ 1.

Ïîêàçíèêè òðîìáîöèòàðíî¿ ëàíêè ãåìîñòàçó ó õâîðèõ

ç ³øåì³÷íèì ³íñóëüòîì ïîð³âíÿíî ç ãðóïîþ êîíòðîëþ

* – äîñòîâ³ðí³ çì³íè â³äíîñíî êîíòðîëþ, ð ≤ 0,05.

Ðèñ. 2. Ð³âåíü ôàêòîðó ôîí Â³ëëåáðàíäà ó ïëàçì³ êðîâ³

1 – äîíîð³â

2 – õâîðèõ ç ³øåì³÷íèì ³íñóëüòîì

* – äîñòîâ³ðí³ çì³íè â³äíîñíî êîíòðîëþ, ð ≤ 0,05.

Âèñíîâêè. Íàìè âñòàíîâëåíî, ùî ïðè ³øåì³÷íîìó

³íñóëüòó ðåºñòðóºòüñÿ ï³äâèùåííÿ ïëàçìîâîãî ð³âíÿ ôà-

êóòîðó ôîí Â³ëëåáðàíäà, ÿêèé íå ëèøå âèñòóïàº ìàðêå-

ðîì àðòåð³àëüíîãî òðîìáîçó, à é ñâ³ä÷èòü ïðî ïîøêîä-

æåííÿ òà äèñôóíêö³þ åíäîòåë³àëüíèõ êë³òèí.

Ë²ÒÅÐÀÒÓÐÀ

1. Ì³ùåíêî Ò.Ñ. Ñòàí íåâðîëîã³÷íî¿ ñëóæáè Óêðà¿íè â 2009

ðîö³. — Õàðê³â, 2010. — 32 ñ.

2. Penny W.F., Weinstein M., Salzman E.W., et al. Correlation of

circulating von Willebrand factor levels with cardiovascular

hemodynamics. Circulation 1991;83:1630-1636.

3. Rabinovitch M, Andrew M, Thom H, et al. Abnormal

endothelial factor VIII associated with pulmonary hypertension and

congenital heart defects. Circulation 1987;76: 1043-1052.

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Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

4. Sadler J.E. Biochemistry and genetics of von Willebrand factor.

Annu Rev Biochem. 1998;67:395-424.

5. Sato M, Suzuki A, Nagata K, Uchiyama S. Increased

von Willebrand factor in acute stroke patients with atrial

fibrillation. J Stroke Cerebrovasc Dis. 2006 Jan-Feb;

15(1):1-7.

6. Selected methods for antibody and nucleic acid probes / Cold

Spring Harbor Laboratory Press. – USA, 1993.

7. Spiel A.O., Gilbert J.C. and Jilma B. Von Willebrand Factor in

Cardiovascular Disease: Focus on Acute Coronary Syndromes.

Circulation. 2008; 117: 1449-1459.

8. Tietjen G.E., Al-Qasmi M.M., Athanas K., et al. Increased von

Willebrand factor in migraine. Neurlogy 2001;57: 334-336.

9. Wieberdink R.G., van Schie M.C., Koudstaal P.J. et al. High

von Willebrand Factor Levels Increase the Risk of Stroke: The Rotterdam

Study. Stroke. 2010;41:2151-2156.

ÓÐÎÂÅÍÜ ÔÀÊÒÎÐÀ ÔÎÍ ÂÈËËÅÁÐÀÍÄÀ

Ó ÏÀÖÈÅÍÒÎÂ Ñ ÈØÅÌÈ×ÅÑÊÈÌ ÈÍÑÓËÜÒÎÌ

Êðàâ÷åíêî Í.Ê.1, Ìåëüíèê Â.Ñ.2, Ñàâ÷óê Î.Ì.1

1Êèåâñêèé íàöèîíàëüíûé óíèâåðñèòåò

èìåíè Òàðàñà Øåâ÷åíêî, ÍÍÖ “Èíñòèòóò

Áèîëîãèè”, ã. Êèåâ, Óêðàèíà

2Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò

èìåíè À.À. Áîãîìîëüöà, ã. Êèåâ, Óêðàèíà

Ðåçþìå. Îïðåäåëåíî, ÷òî ïðè èøåìè÷åñêîì èíñóëü-

òå ðåãèñòðèðåòñÿ ïîâûøåíèå ïëàçìåííîãî óðîâíÿ ôàê-

òîðà ôîí Âèëëåáðàíäà.

Êëþ÷åâûå ñëîâà: èøåìè÷åñêèé èíñóëüò, ôàêòîð ôîí

Âèëëåáðàíäà, òðîìáîöèòû.

VON WILLEBRAND FACTOR LEVEL

IN PATIENTS WITH ISCHEMIC STROKE

N. Kravchenko1, V. Melnyk 2, O. Savchuk 1

1Taras Shevchenko National University of Kyiv ESC

“Institut of biology”, Kyiv, Ukraine

2Bogomolets National Medical University,

Kyiv, Ukraine

Summary. Îur results may indicate that a significant

contribution to the elevation of von Willebrand factor level in

blood plasma belongs to endothelial cells, dysfunction of

which is more pronounced in patients with ischemic stroke.

Key words: ischemic stroke, von Willebrand factor,

platelets.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

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Âñòóï. Êàðöèíî¿ä – öå íîâîóòâîðåííÿ ç êë³òèí äèôóç-

íî¿ íåéðîåíäîêðèííî¿ ñèñòåìè (APUD-ñèñòåìè) ç ïåðå-

âàæíèì óðàæåííÿì êèøêîâî-øëóíêîâîãî òðàêòó (ØÊÒ)

[1, 14]. Çà äàíèìè ñòàòèñòèêè êàðöèíî¿äè ó á³ëüøîñò³ ëîêà-

ë³çóþòüñÿ â ØÊÒ (äî 85%), ðàçîì ç òèì ñåðåä óñ³õ ïóõëèí

ØÊÒ âîíè ñêëàäàþòü äî 8% [14]. Öå ïîòåíö³éíî çëîÿê³ñí³

ïóõëèí³, ÿê³ ìàþòü çäàòí³ñòü äî ãëèáîêîãî ³íô³ëüòðàòèâíî-

ãî ðîñòó, ðàçîì ç òèì õàðàêòåðèçóþòüñÿ ïîâ³ëüíèì ïðî-

ãðåñóâàííÿì ïóõëèíè, à òàêîæ íåïåðåäáà÷óâàíèì ïåðå-

á³ãîì. Äîâãèé ÷àñ ïóõëèíà íå ìàº æîäíèõ êë³í³÷íèõ

ïðîÿâ³â ïðîãðåñ³¿, êàðöèíî¿äí³ ñèìïòîìè, òà ïîäàëüøèé

êàðöèíî¿äíèé ñèíäðîì âèÿâëÿºòüñÿ íà òåðì³íàëüíèõ

ñòàä³ÿõ ðîçâèòêó ïóõëèíè, êîëè âæå º ìíîæèíí³

ìåòàñòàçè, çàçâè÷àé ó ïå÷³íö³ [3]. Òîìó ðàííÿ ä³àãíîñòèêà

º âàæëèâèì åòàïîì äëÿ ðîçï³çíàâàííÿ òà ïîïåðåäæåííÿ

ïîäàëüøîãî ðîçðîñòàííÿ çëîÿê³ñíîãî íîâîóòâîðåííÿ.

Îñòàíí³ì ÷àñîì âåëèêó óâàãó ïðèâåðòàº íåéðîåíäîê-

ðèííà ñèñòåìà ØÊÒ. Öå ïîâ’ÿçàíî ç ïðîãðåñîì â äîñë³ä-

æåíí³ ãàñòîðî³íòåñò³íàëüíèõ ãîðìîí³â òà ¿õ ôóíêö³é, ðîç-

âèòêîì ìîëåêóëÿðíî¿ ãåíåòèêè òà ïàòîô³ç³îëîã³¿

íåéðîåíäîêðèííèõ ïóõëèí, ïîÿâîþ ñó÷àñíèõ òåõíîëîã³é.

Íàéêðàù³ ðåçóëüòàòè äàº êîìïëåêñíå ë³êóâàííÿ ïðè

íàÿâíîñò³ ðîçïîâñþäæåíèõ íåéðî-åíäîêðèííèõ ïóõëèí:

“àãðåñèâíà” õ³ðóðã³÷íà òàêòèêà, ÿêà âêëþ÷àº öèòîðåäóê-

òèâí³ îïåðàö³¿, ðàä³î÷àñòîòíà àáëÿö³ÿ òà õ³ì³îåìáîë³çàö³ÿ

ìåòàñòàç³â â ïå÷³íö³, ñèñòåìíà ìåäèêàìåíòîçíà òåðàï³ÿ òà

ðàä³îíóêë³äíà òåðàï³ÿ [3].

Âïåðøå êàðöèíî¿äíó ïóõëèíó, ¿¿ ã³ñòîëîã³÷íó áóäîâó

îïèñàâ ó 1888 ðîö³ O. Lubarsch, ÿêèé âèÿâèâ ÷èñëåíí³ íî-

âîóòâîðåííÿ â äèñòàëüí³é ÷àñòèí³ êëóáîâî¿ êèøêè ïðî

ïðîâåäåíí³ àâòîïñ³¿. Òåðì³í “êàðöèíî¿ä” áóâ ââåäåíèé

S.Oberndorfer ó 1907 ðîö³, äëÿ âèçíà÷åííÿ á³ëüø íåàêòèâ-

íèõ ïóõëèí, í³æ àäåíîêàðöèíîìà. Êîíöåïö³ÿ APUD-ñèñ-

òåìè áóëà ñôîðìîâàíà ó 1968 ðîö³ àíãë³éñüêèì ã³ñòîõ³ì³-

êîì Å. Ï³ðñîì.

Êàðöèíî¿äí³ ïóõëèíè çóñòð³÷àþòüñÿ ó âñ³õ îðãàíàõ, äå

íàÿâí³ êë³òèíè APUD-ñèñòåìè. Îñê³ëüêè 90% àïóäîöèò³â

çîñåðåäæåíî â ØÊÒ, â³äì³÷àºòüñÿ íàéá³ëüøå óðàæåííÿ

ñàìå ö³º¿ ñèñòåìè; ð³äøå çóñòð³÷àþòüñÿ êàöèíî¿äè áðîí-

õîëåãåíåâî¿ ñèòåìè ³ ìîëî÷íî¿ çàëîçè [4].

Åíäîêðèíîöèòè ðîçâèâàþòüñÿ ç íåéðîáëàñò³â íåðâî-

âîãî ãðåáåíÿ. Âîíè ìàþòü âëàñòèâ³ñòü íàãðîìàäæóâàòè ³

äåêàðáîêñèëþâàòè ïîïåðåäíèê³â á³îëîã³÷íî àêòèâíèõ

àì³í³â, çâ³äñè ïîõîäèòü ¿õ íàçâà (Amine Precursors

ÓÄÊ 616. – 006.86 – 089

ÊÀÐÖÈÍÎ¯ÄÈ ØËÓÍÊÀ, ÒÎÍÊÎ¯ ÒÀ ÒÎÂÑÒÎ¯ ÊÈØÎÊ

Êðèâåøêî À.Ñ., ßêîâåíêî Â.Î., Áàçäèðºâ Â.Â.

Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Î.Î. Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

Ìåäè÷íèé öåíòð “Óí³âåðñàëüíà êë³í³êà “Îáåð³ã”, ì. Êè¿â, Óêðà¿íà

Äåðæàâíà íàóêîâà óñòàíîâà “Íàóêîâî-ïðàêòè÷íèé öåíòð ïðîô³ëàêòè÷íî¿

³ êë³í³÷íî¿ ìåäèöèíè” Äåðæàâíîãî óïðàâë³ííÿ ñïðàâàìè, ì. Êè¿â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: êàðöèíî¿äè øëóíêó òà òîíêî¿ ³ òîâñòî¿ êèøîê, ìîðôîëîã³÷íà ä³àãíîñòèêà,

åíäîñêîï³÷íà á³îïñ³ÿ, åíäîñêîï³÷íà ðåçåêö³ÿ ñëèçîâî¿ îáîëîíêè, åíäîñêîï³÷íà ï³äñëèçîâà äèññåêö³ÿ.

Uptakeand Decarboxylation). Êë³òèíè çäàòí³ óòâîðþâàòè

íåéðîàì³íè, à òàêîæ ñèíòåçóâàòè á³îëîã³÷íî àêòèâí³ ðåãó-

ëÿòîðí³ ïåïòèäè. Àïóäîöèòè îðãàí³â òðàâíîãî êàíàëó

ñèíòåçóþòü ïîíàä 20 ð³çíèõ ãîðìîí³â, ÿê³ ðåãóëþþòü íå

ëèøå ïðîöåñè òðàâëåííÿ, àëå é çàãàëüí³ ôóíêö³¿ îðãàí³ç-

ìó [1]. Êàðöèíî¿äí³ ïóõëèíè ñèíòåçóþòü çíà÷íó ê³ëüê³ñòü

á³îëîã³÷íî àêòèâíèõ ðå÷îâèí, òàêèõ ÿê íåéðîíñïåöèô³÷íà

åíäîëàçà, 5-ã³äðîêñèïåíòàì³í, 5-ã³äðîêñèòðèïòîôàí, õðî-

ìîãðàô³íè À òà Ñ, ³íñóë³í, ãëþêàãîí, ñàìàòîñòàòèí, ÀÄÃ,

ãàñòðèò, ïàíêðåàòè÷íèé ïîë³ïåïòèä, êàëüöèòîí³í, òàõ³ê³-

íèí, áîìáåçèí. Íåéðîåíäîêðèíí³ êë³òèíè ÷àñòî ïðîäóêó-

þòü äåê³ëüêà ãîðìîí³â, òîìó ä³àãíîç áàçóºòüñÿ ÿê íà íàÿâ-

íîñò³ ã³ïåðôóíêö³îíàëüíîãî ñèíäðîìó, òàê ³ íà

âèÿâëåíí³ äîì³íóþ÷î¿ ïîïóëÿö³¿ íåéðîåíäîêðèííèõ

êë³òèí [5].

Âñ³ êàðöèíî¿äè ââàæàþòüñÿ çëîÿê³ñíèìè, îäíàê

â³äð³çíÿþòüñÿ çà ñòóïåíåì äèôåðåíö³àö³¿. ²ñíóº äåê³ëüêà

êëàñèô³êàö³¿ ùîäî òèïó êàðöèíî¿ä³â [4]. Ã³ñòîëîã³÷íà òà

ã³ñòîõ³ì³÷íà õàðàêòåðèñòèêà áàçóºòüñÿ íà ïðîÿâ³ ãîðìî-

íàëüíî¿ àêòèâíîñò³ êë³òèíè. Â çàëåæíîñò³ â³ä íàÿâíîñò³ ÷è

â³äñóòíîñò³ êàðöèíî¿äíîãî ñèíäðîìó âèä³ëÿþòü: 1) ôóíê-

ö³îíóþ÷³; 2) íå ôóíêö³îíóþ÷³ êàðöèíîìè.

²íøà êëàñèô³êàö³ÿ, çàïðîïîíîâàíà E.D. Williams ³

M.Sanders ó 1963ð., â³äïîâ³äíî äî ì³ñöÿ ¿õ óðàæåííÿ:

– âåðõí³: ïóõëèíè äèõàëüíèõ øëÿõ³â, ñòðàâîõîäó, äâà-

íàäöÿòèïàëî¿ êèøêè òà ï³äøëóíêîâî¿ çàëîçè;

– ñåðåäí³: ïóõëèíè òîíêî¿ êèøêè, àïåíäèêñà, ñë³ïî¿

êèøêè, âèñõ³äíîãî â³ää³ëó òîâñòî¿ êèøêè;

– íèæí³: ïóõëèíè ïîïåðå÷íî-îáîäîâî¿ êèøêè, íèçõ³-

äíîãî, ñèãìîïîä³áíîãî â³ää³ëó òîâñòî¿ êèøêè, ïóõ-

ëèíè ïðÿìî¿ êèøêè.

Çàçâè÷àé âèñîêî äèôåðåíö³éîâàí³ ïóõëèíè ä³àìåòðîì

äî 2 ñì º äîáðîÿê³ñíèìè, ïóõëèíè ïîíàä 3 ñì êëàñèô³êó-

þòü ÿê ïóõëèíè ç ãðàíè÷íèì ïîòåíö³àëîì çëîÿê³ñíîñò³,

àáî ÿê çëîÿê³ñí³ [12]. Ìåòàñòàçóâàííÿ çàëåæèòü â³ä ñòóïåí³

äèôåðåíö³þâàííÿ òà ðîçì³ð³â íîâîóòâîðåííÿ. Ïðè ïåð-

âèííèõ ïóõëèíàõ, ä³àìåòð ÿêèõ ñòàíîâèòü ìåíøå 1 ñì,

ìåòàñòàçè âèÿâëÿþòü ëèøå â 2%, êîëè ðîçì³ðè ïóõëèíè

ñòàíîâëÿòü ïîíàä 2 ñì – ó 90% õâîðèõ [8]. Ìåòàñòàçè

ðîçïîâñþäæóþòüñÿ ãåìàòîãåííì øëÿõîì, ïåðåâàæíî

òðîïí³ äî êë³òèí ïå÷³íêè; ð³äêî çóñòð³÷àþòüñÿ â ê³ñòêàõ,

ëåãåíÿõ, ï³äøëóíêîâ³é çàëîç³, íàäíèðíèêàõ [16]. Íà ã³ñòî-

ëîã³÷íèõ çð³çàõ äëÿ çëîÿê³ñíèõ ïóõëèí ÷³òêî ïðîñòåæóºòüñÿ

ñóäèííà ³íâàç³ÿ [17].

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

Êë³òèíè äèôóçíî¿ åíäîêðèííî¿ ñèñòåìè àðãîô³ëüí³

(çäàòí³ ïðîÿâëÿòèñÿ ïðè ôàðáóâàíí³ ñîëÿìè ñð³áëà ó

ïðèñóòíîñò³ â³äíîâíèê³â). Ñàìå öåé ìåòîä øèðîêî âèêî-

ðèñòîâóºòüñÿ ó ïðàêòè÷í³é ìîðôîëîã³¿ äëÿ ³äåíòèô³êàö³¿

çëîÿê³ñíèõ íîâîóòâîðåíü APUD-ñèñòåìè. Ñåêðåòîðí³

(ãîðìîíîâì³ñí³) ãðàíóëè íàãðîìàäæóþòüñÿ íåéðîåíäî-

êðèííèìè êë³òèíàìè çàçâè÷àé â áàçàëüí³é ìåìáðàí³, íà-

áëèæåí³é äî ñóäèí ÷àñòèí³. Åêçîêðèíîöèòè êîíöåíòðóþòü

ñâî¿ ãðàíóëè â àï³êàëüí³é ÷àñòèí³. Ðîçðîáëåí³ ñïîñîáè

âèá³ðêîâî¿ ³äåíòèô³êàö³¿ çà äîïîìîãîþ åëåêòðîíî-ì³êðî-

ñêîï³÷íèõ äîñë³äæåíü íà îñíîâ³ óðàõóâàííÿ ðîçì³ð³â òà

áóäîâè ñïåöèô³÷íèõ ãðàíóë [1].

Íèí³ äëÿ âèá³ðêîâîãî âèÿâëåííÿ øëóíêîâî-êèøêîâèõ

åíäîêðèíîöèò³â øèðîêî âèêîðèñòîâóþòü ìåòîäè ³ìóíîã-

³ñòîõ³ì³¿ [6, 9, 15]. Êë³òèíè íåéðîåíäîêðèííî¿ ñèñòåìè äà-

þòü ïîçèòèâíó ðåàêö³þ ç àíòèò³ëàìè äî çàãàëüíèõ íåéðî-

åíäîêðèííèõ ìàðêåð³â – õðîìàòîãðàô³íó À (ìàðêåð

ñïåöèô³÷íèõ åíäîêðèííèõ ãðàíóë), ñèíàïòîô³çèíó (ìàð-

êåð äð³áíèõ âåçèêóë ç íåéðîòðàíñì³òåðàìè), CD56 (ìàð-

êåð ìîëåêóë àäãåç³¿), NSE òà PGP 9,5 (ìàðêåðè öèòîïëàçìà-

òè÷íèõ ïðîòå¿í³â – íåéðîñïåöèô³÷íî¿ åíäîëàçè òà

ïðîòå¿íó åíäîãåííîãî ïðîäóêòó 9,5) [5]. Äëÿ òîãî ùîá

âñòàíîâèòè òèï ÍÅÏ âèêîðèñòîâóþòü ñïåöèô³÷í³ åíäî-

êðèíí³ ìàðêåðè – ïåïòèäè, ÷è àì³íè, ÿê³ ìàþòü âëàñ-

òèâ³ñòü ãîðìîí³â (³íñóë³í, ãëþêàãîí, ñîìàòîñòàòèí, Â²Ï,

ãàñòðèò íà ³í.) [15].

Ïðîãíîç ïîâ’ÿçàíèé ç ðîçïîâñþäæåííÿì ïðîöåñó. Ïðè

íàÿâíîñò³ ëèøå ïåðâèííî¿ ïóõëèíè 5-ë³òíº âèæèâàííÿ â

ñåðåäíüîìó ñêëàäàº 94%. ßêùî æ ìåòàñòàçè ç’ÿâëÿþòüñÿ

â ðåã³îíàðíèõ ë³ìôàòè÷íèõ âóçëàõ, 5-ë³òíº âèæèâàííÿ ñòà-

íîâèòü 64% [14]. Ó ïàö³ºíò³â ç â³ääàëåíèìè ìåòàñòàçàìè

âèæèâàííÿ â ñåðåäíüîìó ñòàíîâèòü ëèøå 18% [16].Òîìó

ðàííÿ ä³àãíîñòèêà ïóõëèíè º ãîëîâíèì ôàêòîðîì äëÿ çáå-

ðåæåííÿ òà ïðîäîâæåííÿ æèòòÿ ïàö³ºíò³â.

Ïðè ïðîâåäåíí³ ñó÷àñíèõ ìåòîä³â ä³àãíîñòèêè, òàêèõ

ÿê â³äåîåçîôàãîãàñòðîäóîäåíîñêîï³ÿ (ÂÅÃÄÑ) ³ç çá³ëü-

øåííÿì, â³äåîêîëîíîñêîï³ÿ (ÂÊÑ), åíäîóëüòðàçâóêîâå

äîñë³äæåííÿ, ìîæëèâî ä³àãíîñòóâàòè êàðöèíî¿äè ó

øëóíêó, òîíê³é òà òîâñò³é êèøêàõ ïðàêòè÷íî â óñ³õ

âèïàäêàõ ¿õ íàÿâíîñò³ (çàçâè÷àé âîíè ä³àãíîñòóþòüñÿ ÿê

ï³äñëèçîâ³ óòâîðåííÿ, ÷àñòî ³ç âèðàçêóâàííÿì) ç

ïîäàëüøèì ïðîâåäåííÿì ì³í³³íâàçèâíîãî ë³êóâàííÿ –

ðåçåêö³¿ ñëèçîâî¿ îáîëîíêè ç óòâîðîì ³ ï³äñëèçîâî¿

äèñåêö³¿ [7, 10, 11, 13].

Ìåòà äîñë³äæåííÿ. Âèâ÷åííÿ åôåêòèâíîñò³ åíäî-

ñêîï³÷íî¿ ³ ìîðôîëîã³÷íî¿ ä³àãíîñòèêè ³ ì³í³³íâàçèâíèõ

åíäîñêîï³÷íèõ îïåðàòèâíèõ âòðó÷àíü ïðè êàðöèíî¿äàõ

øëóíêà ³ òîíêî¿ òà òîâñòî¿ êèøîê.

Ìàòåð³àëè òà ìåòîäè äîñë³äæåííÿ. Ïðîâåäåíèé àíàë³ç

âèïàäê³â ä³àãíîñòèêè êàðöèíî¿äíèõ ïóõëèí ïðè ÂÅÃÄÑ ³

ÂÊÑ ç ïîäàëüøèì ìîðôîëîã³÷íèì äîñë³äæåííÿì íà áàç³

Ìåäè÷íîãî Öåíòðó “Óí³âåðñàëüíà êë³í³êà “Îáåð³ã” çà 2009-

2013 ðîêè. Áóëî ïðîàíàë³çîâàí³ ïðîòîêîëè åíäîñêîï³÷íèõ

òà ìîðôîëîã³÷íèõ äîñë³äæåíü, â³äåîàðõ³â åíäîñêîï³÷íèõ

äîñë³äæåíü òà àðõ³â ã³ñòîëîã³÷íèõ ïðåïàðàò³â ïàö³ºíò³â ç

ä³àãíîñòîâàíèìè êàðöèíî¿äíèìè ïóõëèíàìè.

Ðåçóëüòàòè òà îáãîâîðåííÿ. Ä³àãíîñòîâàíî 8 âèïàäê³â

ÍÅÏ: 2 (25%) â øëóíêó, 2 (25%) – â äâàíàäöÿòèïàë³é êèøö³

(ðèñ. 1, 2), 2 (25%) – â êëóáîâ³é êèøö³ (ðèñ. 3, 4), 1 (12,5%) –

Ðèñ. 2. Êàðöèíî¿ä äâàíàäöÿòèïàëî¿ êèøêè.

Çàáàðâëåííÿ ãåìàòîêñèë³íîì-åîçèíîì. Çá. 200.

Ðèñ. 1. Êàðöèíî¿ä öèáóëèíè äâàíàäöÿòèïàëî¿ êèøêè.

Â³äåîåçîôàãîãàñòðîäóîäåñêîï³ÿ ó á³ëîìó ñâ³òë³

(Olympus GIF-160Z).

Ðèñ. 3. Êàðöèíî¿ä òåðì³íàëüíîãî â³ää³ëó êëóáîâî¿ êèøêè.

Â³äåî³ëåîêîëîíîñêîï³ÿ ó á³ëîìó ñâ³òë³ (Olympus CF-150).

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

â âèñõ³äí³é îáîäîâ³é êèøö³, 1 (12,5%) – â ïðÿì³é êèøö³. Â³ê

ïàö³ºíò³â áóâ â³ä 33 äî 67 ðîê³â.

Âñ³ì ïàö³ºíòàì ïðîâîäèëè åíäîñêîï³÷íå çîíäîâå óëü-

òðàçâóêîâå äîñë³äæåííÿ äëÿ îö³íêè ïîøèðåíîñò³ ïóõëèíè

äëÿ âèð³øåííÿ ïèòàííÿ ïðî ìîæëèâ³ñòü çàñòîñóâàííÿ

ì³í³³íâàçèâíîãî õ³ðóðã³÷íîãî âòðó÷àííÿ (ðèñ. 5).

Êàðöèíî¿äè øëóíêà ³ çäóõâèííî¿ êèøêè âèäàëåí³ øëÿ-

õîì åíäîñêîï³÷íî¿ ðåçåêö³¿ ñëèçîâî¿ îáîëîíêè, öèáóëèíè

äâàíàäöÿòèïàëî¿ êèøêè ³ ïðÿìî¿ êèøêè – åíäîñêîï³÷íî¿

ï³äñëèçîâî¿ äèñåêö³¿ (ðèñ. 6), äâàíàäöÿòèïàëî¿ êèøêè,

ïîðîæíüî¿ ³ îáîäîâî¿ êèøîê – õ³ðóðã³÷íî¿ ðåçåêö³¿.

Âñ³ ïóõëèíè âèäàëåí³ â ìåæàõ çäîðîâèõ òêàíèí, ùî

áóëî ï³äòâåðäæåíî ìîðôîëîã³÷íèì äîñë³äæåííÿì. Óòâî-

ðåííÿ ðîçòàøîâóâàëèñÿ ó ï³äñëèçîâîìó øàð³, áåç ³íâàç³¿ ó

ì’ÿçîâó, êðîâîíîñí³ ³ ë³ìôàòè÷í³ ñóäèíè. Ðîçì³ð ÍÅÏ áóâ

ä³àìåòðîì â³ä 3 ìì äî 10 ìì.

Âèñíîâêè.

1. Ìîðôîëîã³÷íà îö³íêà åíäîñêîï³÷íèõ á³îïòàò³â

ñëèçîâî¿ îáîëîíêè øëóíêà òà êèøîê º åôåêòèâíèì ñïîñî-

áîì ä³àãíîñòèêè êàðöèíî¿ä³â.

2. Åíäîñêîï³÷íà ðåçåêö³ÿ ñëèçîâî¿ îáîëîíêè òà åí-

äîñêîï³÷íà ï³äñëèçîâà äèñåêö³ÿ äîçâîëÿº îòðèìàòè ðîç-

øèðåíèé ìàòåð³àë äëÿ ìîðôîëîã³÷íî¿ ä³àãíîñòèêè ïóõëè-

íè ³ º àäåêâàòíèì ìåòîäîì âèäàëåííÿ êàðöèíî¿ä³â.

Ðåöåíçåíò: ÷ëåí-êîð. ÍÀÌÍ Óêðà¿íè,

ä.ìåä.í., ïðîôåñîð Çàõàðàø Ì.Ï.

Ë²ÒÅÐÀÒÓÐÀ

1. Áåâçà Ä.Ï. ÀÏÓÄ-êë³òèíè øëóíêîâî-êèøêîâîãî òðàêòó

òà ïðîäóêòè ¿õíüîãî ñèíòåçó (îãëÿä ë³òåðàòóðè) / Ä.Ï. Áåâçà,

Î. Ã. Êóðèê, Ì.Ä. Àíäðººâ // Â³ñíèê Â³ííèöüêîãî íàö³îíàëüíîãî

ìåäè÷íîãî óí³âåðñèòåòó. – 2005. – ¹ 9(2). – Ñ.320-326.

2. Ãóðåâè÷ Ë.Å. Ìîðôîëîãè÷åñêàÿ äèàãíîñòèêà íåéðî-

ýíäîêðèííûõ íîâîîáðàçîâàíèé æåëóäî÷íî-êèøå÷íîãî òðàêòà /

Ë.Å.Ãóðåâè÷// Ïðàêòè÷åñêèå ðåêîìåíäàöèè. – 2009. – Ìîñêâà, 30 ñ.

3. Êàáàíîâ Ì.Þ. Ýòàïíîå ëå÷åíèå áîëüíîé ñî çëîêà÷åñòâåí-

íûì êàðöèíîèäîì ïîäæåëóäî÷íîé æåëåçû ñ ìåòàñòàçàìè â

ïå÷åíü / Ì.Þ. Êàáàíîâ, Â.À.Òàðàñîâ, Ê.Â. Ñåìåíöîâ [è äð.] // Õè-

ðóðãèÿ. – 2013. – ¹10. – Ñ. 60-62.

4. Ìàðêîâñüêèé Â.Ä. Êë³í³êî-ìîðôîëîã³÷í³ îñîáëèâîñò³ êàð-

öèíî¿äíèõ ïóõëèí / Â.Ä. Ìàðêîâñüêèé, Â.Â. Çàõàðåíêî, ².Â. Ñîðî-

ê³íà [òà ³í.] // Ìîðôîëîã³ÿ. – 2013. - ¹ 3. – Ñ.10-15.

5. Õóðàí³ ².Ô. Ñó÷àñí³ àñïåêòè ìîðôîôóíêö³îíàëüíî¿ ä³àãíî-

ñòèêè êàðöèíî³äíèõ ïóõëèí /².Ô. Õóðàí³, À.Ï. Êîâàëü÷óê, Î.ß. Êà-

êàðüê³í // Â³ñíèê ìîðôîëîã³¿. – 2009. - ¹ 1(15). – Ñ. 199-202.

6. ßêîâåíêî Â.Î. Åíäîñêîï³÷íà ³ ìîðôîëîã³÷íà ä³àãíîñòèêà,

ìàëî³íâàçèâíå ë³êóâàííÿ ïåðåäðàêîâèõ çì³í ñëèçîâî¿ îáîëîíêè

øëóíêà: Ìîíîãðàô³ÿ / Â.Î. ßêîâåíêî, Ì.Ï. Çàõàðàø, Î.Ã. Êóðèê. –

Â³ííèöÿ: ÔÎÏ Êàøòåëÿíîâ Î. ², 2013. – 136 ñ.

7. Fahy B.N. Carcinoid of the rectum risk stratification (CaRRS):

a strategy for preoperative outcome assessment / B.N. Fahy, L.N.Tang,

D. Kimstra [et al.] // Am. Surg. Oncol. – 2007. – Vol. 14. – p. 396-404.

8. Grozinsky-Glasberg S. Metastatic type 1 gastric carcinoid: A

real threat or just a myth? // S. Grozinsky-Glasberg, D. Thomas,

J.R. Strosberg, [et al.] / World J. Gastroenterol. – 2013. – Vol. 19(46). –

P. 8687-8695.

9. Jamali M. Predicting prognosis in gastroenteropancreatic

neuroendocrine tumors: an overview and the value of Ki-67

immunostaining // M. Jamali, R. Chetty // Endocr. Pathol. – 2008. –

Vol. 19. – P. 282-288.

10 . Kim G.U. Clinical outcomes of rectal neuroendocrine tumors

d”10mm following endoscopic Resection // G.U. Kim, K.J. Kim,

S.M. Hong [et all.] / Endoscopy. – 2013. - Vol. 45(12). - P. 1018-23.

11. Kim S.H. Endoscopic treatment of duodenal neuroendocrine

tumors // S.H. Kim, C.H. Park, H.S. Ki [et al.] / Clin. Endosc. – 2013. –

Vo. 46(6). – P. 656-661.

12. Klimstra D.S. Pathology reporting of neuroendocrine tumors:

application of the Delphic consensus process to the development of a

Ðèñ. 4. Êàðöèíî¿ä êëóáîâî¿ êèøêè. Çàáàðâëåííÿ

ãåìàòîêñèë³íîì-åîçèíîì. Çá. 100.

Ðèñ. 6. Åíäîôîòîãðàô³ÿ. Åòàï åíäîñêîï³÷íî¿ ï³äñëèçîâî¿

äèñåêö³¿ êàðöèíî¿äà öèáóëèíè äâàíàäöÿòèïàëî¿ êèøêè.

Ï³äñëèçîâà ³í’ºêö³ÿ ðîç÷èíîì ³íäèãîêàðì³íó. Ïî÷àòîê ðîçð³çó

íàâêîëî óòâîðó. Äîñë³äæåííÿ ó á³ëîìó ñâ³òë³.

Ðèñ. 5. Åíäîñêîï³÷íà çîíäîâà óëüòðàñîíîãðàô³ÿ. Êàðöèíî¿ä

öèáóëèíè äâàíàäöÿòèïàëî¿ êóøêè ó âèãëÿä³ ã³ïîåõîãåííîãî

óòâîðåííÿ ç ÷³òêèì êîíòóðîì ó ï³äñëèçîâîìó øàð³.

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

minimum pathology data set // D.S. Klimstra, I.R.Modlin, N.V. Andrew

[et al.] // Am. J. Surg. Pathol. - 2010. – Vol. – 34. – P. 300-313.

13. Li Q.L. Endoscopic submucosal dissection for foregut neuro-

endocrine tumors: an initial Study // Q.L. Li, Y.O. Zhang, W.F. Chen

[et al.] / J. Gastroenterol. – 2012. – Vol. 18(40). – P. 5799-5806.

14. Modlin I.M. Gastroenteropancreatic neuroendorine tumors /I.M. Mod-

lin, K.Oberg, D.C. Chung [et al] // Lancet Oncol. – 2008. – Vol. 9. – P. 61-72.

15. O’Toole D. ENETS Consensus Guidelines for the Standards of

Carein Neuroendocrine Tumors: biochemical markers / D.O’Toole,

ÊÀÐÖÈÍÎÈÄÛ ÆÅËÓÄÊÀ,

ÒÎÍÊÎÉ È ÒÎËÑÒÎÉ ÊÈØÎÊ

Êðèâåøêî À.Ñ., ßêîâåíêî Â.Î., Áàçäèðåâ Â.Â.

Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò

èìåíè À.À. Áîãîìîëüöà, ã. Êèåâ, Óêðàèíà

Ìåäèöèíñêèé öåíòð “Óíèâåðñàëüíàÿ êëèíèêà

”Îáåðèã”, ã. Êèåâ, Óêðàèíà

ÃÍÓ “Íàó÷íî- ïðàêòè÷åñêèé öåíòð

ïðîôèëàêòè÷åñêîé è êëèíè÷åñêîé

ìåäèöèíû” ÃÓÄ, ã. Êèåâ, Óêðàèíà

Ðåçþìå. Â ñòàòüå ïðåäñòàâëåíû ëèòåðàòóðíûå äàí-

íûå î êëèíèêî-ìîðôîëîãè÷åñêèõ îñîáåííîñòÿõ êàðöè-

íîèäîâ, ïðèíöèïàõ èõ êëàññèôèêàöèè, ìåòîäàõ äèàãíîñ-

òèêè. Ïîêàçàíî, ÷òî ïðåìóùåñòâåííàÿ ëîêàëèçàöèÿ â æå-

ëóäî÷íî-êèøå÷íîì òðàêòå è ñëîæíîñòü äèàãíîñòèêè êàð-

öèíîèäîâ æåëóäêà è êèøå÷íèêà îáóñëîâëèâàåò àêòóàëü-

íîñòü ïðîáëåìû.

Ïðåäñòàâëåíû ñîáñòâåííûå äàííûå àíàëèçà äèàãíî-

ñòèêè è ëå÷åíèÿ êàðöèíîèäîâ æåëóäêà è êèøå÷íèêà. Íà

áàçå Ìåäèöèíñêîãî öåíòðà “Óíèâåðñàëüíàÿ êëèíèêà

“Îáåðèã” â 2009–2013 ãã. áûëî äèàãíîñòèðîâàíî 8 ñëó÷àåâ

êàðöèíîèäîâ: 2 (25%) â æåëóäêå, 2 (25%) – â äâåíàäöàòè-

ïåðñòíîé êèøêå, 2 (25%) – â òîíêîé êèøêå, 1 (12,5%) – â

âîñõîäÿùåé îáîäî÷íîé êèøêå, 1 (12,5%) – â ïðÿìîé êèø-

êå. Êàðöèíîèäû æåëóäêà è ïîäâçäîøíîé êèøêè óäàëåíû

ïóòåì ýíäîñêîïè÷åñêîé ðåçåêöèè ñëèçèñòîé îáîëî÷êè,

ëóêîâèöû äâåíàäöàòèïåðñòíîé êèøêè è ïðÿìîé êèøêè –

ýíäîñêîïè÷åñêîé ïîäñëèçèñòîé äèññåêöèè, áîëüøîãî äó-

îäåíàëüíîãî ñîñî÷êà äâåíàäöàòèïåðñòíîé êèøêè, ãîëîä-

íîé è îáîäî÷íîé êèøêè – õèðóðãè÷åñêîé ðåçåêöèè.

Ïîêàçàíî, ÷òî ìîðôîëîãè÷åñêàÿ îöåíêà ýíäîñêîïè-

÷åñêèõ áèîïòàòîâ ñëèçèñòîé îáîëî÷êè – ýôôåêòèâíûé

ñïîñîá äèàãíîñòèêè êàðöèíîèäîâ. Ýíäîñêîïè÷åñêàÿ ðå-

çåêöèÿ ñëèçèñòîé îáîëî÷êè è ýíäîñêîïè÷åñêàÿ ïîäñëè-

çèñòàÿ äèññåêöèÿ ïîçâîëÿåò ïîëó÷èòü ðàñøèðåííûé ìà-

òåðèàë äëÿ ìîðôîëîãè÷åñêîé äèàãíîñòèêè è ÿâëÿåòñÿ

àäåêâàòíûì ìåòîäîì óäàëåíèÿ êàðöèîíèäîâ.

Êëþ÷åâûå ñëîâà: êàðöèîíèäû æåëóäêà è êèøå÷íè-

êà, ìîðôîëîãè÷åñêàÿ äèàãíîñòèêà, ýíäîñêîïè÷åñêàÿ

áèîïñèÿ, ýíäîñêîïè÷åñêàÿ ðåçåêöèÿ ñëèçèñòîé îáîëî÷-

êè, ýíäîñêîïè÷åñêàÿ ïîäñëèçèñòàÿ äèññåêöèÿ.

CARCINOIDS OF THE STOMACH,

SMALL AND LARGE INTESTINES

A. Kriveshko, V. Yakovenko, V. Bazdyrev

Bogomolets National Medical University, Kyiv, Ukraine

Medical Centre “Oberig”, Kyiv, Ukraine

DNU “Scientific and Practical Centre of Preventive and

Clinical Medicine” SAD, Kyiv, Ukraine

Summary. The article presents the literature data on

clinico-morphological features, classifications and methods

of diagnostic of carcinoid tumors. The main localization in

digestive tract and difficulties of diagnostics of the ñarcinoids

of stomach and intestines causes urgency of the problem.

The own results of analysis of diagnostics and treatment

of stomach and intestines’ ñarcinoids were presented. On

the basis of Medical centre “Oberig” in 2009–2013 eight

cases of ñarcinoid tumors were diagnosed: 2 (25 %) in the

stomach, 2 (25%) – in the duodenum, 2 (25%) – in the

small intestine; 1 (12.5 %) – in the ascending colon,

1 (12.5%) – in the rectum. Carcinoids of stomach and ileum

were removed by endoscopic mucosal resection, duodenal

bulb and rectum ñarcinoids – by endoscopic submucosal

dissection, papillary duodenum, colon and jejunum

ñarcinoids – by surgical resection.

The study showed that morphological evaluation of

endoscopic mucosal biopsies is effective way to diagnose

ñarcinoids. Endoscopic mucosal resection and endoscopic

submucosal dissection allows to get advanced material for

morphological diagnosis of ñarcinoids and these methods

are adequate for surgical treatment of ñarcinoids.

Key words: ñarcinoids of stomach and intestinum,

morphological diagnosis, endoscopic biopsy, endoscopic

mucosal resection, endoscopic submucosal dissection.

A.Grossman, D. Gross [et al] //Neuroendocrinology. - 2009. – Vol. 90. –

P. 194-202.

16. Ramage J.K. Guidelines for the management of

gastroenteropancreatic neuroendocrine (including carcinoid) tumours

(NETs) / J.K. Ramage, A. Ahmed, J. Ardill [et al] // Gut. – 2012. –

Vol. 61. – P. 6-32. Doi:10.1136/gutjnl – 2011-300831.

17. Soga J. The term “carcinoid” is a misnomer: the evidence

based on local invasion / J. Soga // J. Exp. Clin. Cancer. Res. – 2009. –

Vol.28. – P.15.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

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ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

Âñòóï. Äèñïëàç³ºþ íàçèâàþòü â³äõèëåííÿ â³ä íîðìàëü-

íî¿ ñòðóêòóðè êë³òèí ³ âñüîãî òêàíüîâîãî êîìïëåêñó â

íàïðàâëåíí³ íåîïëàñòè÷íîãî ðîçâèòêó. Åêñïåðòè ÂÎÎÇ

âèçíà÷àþòü äèñïëàç³þ ÿê çì³íè, çà ÿêèõ ÷àñòèíà êë³òèí

òîâù³ åï³òåë³ÿ íàáóâàº îçíàê àòèï³¿; çì³í ñòðîìè ïðè öüîìó

íåìàº.

Íàéá³ëüø åôåêòèâíèì øëÿõîì ä³àãíîñòèêè äèñïëàç³¿ º

ãðàìîòíî âèêîíàíà åíäîñêîï³÷íà á³îïñ³ÿ ç ïîäàëüøèì

âèãîòîâëåííÿì ã³ñòîëîã³÷íèõ ïðåïàðàò³â, òîáòî ä³àãíîç

äèñïëàç³¿ ï³äòâåðäæóºòüñÿ ëèøå ìîðôîëîã³÷íî.

Çã³äíî ç ðåêîìåíäàö³ÿìè ÂÎÎÇ [17] íàéá³ëüø õàðàê-

òåðíèìè îçíàêàìè äèñïëàç³¿ º: 1) êë³òèííà àòèï³ÿ (ÿäåð-

íèé ïîë³ìîðô³çì, ã³ïåðõðîìàç³ÿ, ñòðàòèô³êàö³ÿ ÿäåð,

çá³ëüøåííÿ ÿäåðíî-öèòîïëàçìàòè÷íîãî ³íäåêñó); 2) ïî-

ðóøåííÿ äèôåðåíö³þâàííÿ (çíèêíåííÿ àáî çìåíøåííÿ

ê³ëüêîñò³ êåëèõîïîä³áíèõ êë³òèí ³ êë³òèí Ïàíåòà ó ìåòà-

ïëàçîâàíîìó åï³òåë³¿; çìåíøåííÿ àáî ïðèïèíåííÿ ïðî-

äóêö³¿ ñëèçó êë³òèíàìè åï³òåë³þ; 3) ïîðóøåííÿ àðõ³òåê-

òîí³êè ñëèçîâî¿ îáîëîíêè (³ððåãóëÿðíà ñòðóêòóðà

êðèïò, ïðîë³ôåðàö³ÿ ³ ðîçãàëóæåííÿ çàëîç ³ç ôîðìóâàí-

íÿì ïîâåðõíåâèõ ³ âíóòð³øíüîçàëîçèñòèõ ñîñî÷êîâèõ

ñòðóêòóð). Îòæå, çã³äíî ç ðåêîìåíäàö³ÿìè ÂÎÎÇ äèñïëà-

ç³ºþ ââàæàþòü çì³íè åï³òåë³þ, ùî ïåðåäóþòü ðîçâèòêó

ðàêó.

Äîíåäàâíà â ãàñòðîåíòåðîëîã³¿ íàéá³ëüøó óâàãó ïðè-

ä³ëÿëè äèñïëàç³ÿì øëóíêà, àëå íà ñüîãîäíÿøí³é äåíü ó

çâ’ÿçêó ³ç ïîøèðåí³ñòþ òàêèõ çàõâîðþâàíü, ÿê ñòðàâîõ³ä

Áàððåòòà ³ êîëîðåêòàëüíèé ðàê, äèñïëàç³¿ åï³òåë³ÿ ñòðàâî-

õîäó ³ êèøå÷íèêà ñòàþòü âñå á³ëüø àêòóàëüíèìè.

×àñòîòà âèÿâëåííÿ äèñïëàç³é, çîêðåìà øëóíêà, çà äà-

íèìè ð³çíèõ àâòîð³â, êîëèâàºòüñÿ ó çíà÷íèõ ìåæàõ. Äåÿê³

àâòîðè ãîâîðÿòü, ùî ÷àñòîòà äèñïëàç³é íà ìàòåð³àë³ ãàñò-

ðîá³îïñ³é ñÿãàº 25-30% [3]. Çàçâè÷àé äèñïëàç³þ çíàõîäÿòü

ïðè âèðàçêàõ, ïîë³ïàõ; àëå âîíà çóñòð³÷àºòüñÿ ³ â ìàêðî-

ñêîï³÷íî íåçì³íåí³é ñëèçîâ³é îáîëîíö³ [22].

Â³äòîä³ ÿê áóëî ñôîðìóëüîâàíî ÷³òêå âèçíà÷åííÿ

äèñïëàç³¿, âèä³ëÿþòü òðè ¿¿ ñòóïåíÿ çàëåæíî â³ä

âèðàæåíîñò³ ñòðóêòóðíèõ çì³í – ñëàáêèé, ïîì³ðíèé òà

âàæêèé. Á³ëüø³ñòü ìîðôîëîã³â ñüîãîäí³ êåðóþòüñÿ ö³ºþ

êëàñèô³êàö³ºþ.

Ñëàáêà äèñïëàç³ÿ (1-ãî ñòóïåíÿ) â øëóíêó ðîçãëÿäàºòü-

ñÿ ÿê ñòàí, ùî ìåæóº ³ç ã³ïåðïëàç³ºþ ³ ñïðàâæíüîþ

äèñïëàç³þ. Á³îëîã³÷íî âîíà ïîâ’ÿçàíà ç ã³ïåðïëàñòè÷íèìè

³ çàïàëüíèìè ïðîöåñàìè ³ ç ï³äñèëåíèì êë³òèííèì îíîâ-

ëåííÿì. Ñïîñòåð³ãàºòüñÿ ïîäîâæåííÿ ÿìîê, çá³ëüøåííÿ

ÓÄÊ 616.3-007.17:572.7

ÄÈÑÏËÀÇ²ß ÅÏ²ÒÅË²Þ

ØËÓÍÊÎÂÎ-ÊÈØÊÎÂÎÃÎ ÒÐÀÊÒÓ

Ëàçàð÷óê Ã.Î., Áîäíàð Ë.Â., Áàçäèðºâ Â.Â.

Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Î.Î. Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

Ìåäè÷íèé öåíòð “Óí³âåðñàëüíà êë³í³êà “Îáåð³ã”, ì. Êè¿â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: äèñïëàç³ÿ, øëóíêîâî-êèøêîâèé òðàêò, á³îïñ³ÿ, åíäîñêîï³÷íà ðåçåêö³ÿ ñëèçîâî¿ îáîëîíêè.

ä³àìåòðó ³ ã³ïåðõðîìàòîç ÿäåð, çá³ëüøåííÿ ÿäåðíî-öèòîï-

ëàçìàòè÷íîãî ñï³ââ³äíîøåííÿ.

Ïðè ïîì³ðíî âèðàæåí³é äèñïëàç³¿ (2-ãî ñòóïåíÿ)

çì³íè, õàðàêòåðí³ äëÿ ñëàáêî¿ äèñïëàç³¿, ñòàþòü á³ëüø âè-

ðàçíèìè. Çà âì³ñòîì ÄÍÊ ³ óëüòðàñòðóêòóðíèìè çì³íàìè

ïîì³ðíà äèñïëàç³ÿ íå â³äð³çíÿºòüñÿ â³ä ñëàáêî¿. ×³òêî¿ ìåæ³

ó âèçíà÷åíí³ äèñïëàç³¿ 1-ãî òà 2-ãî ñòóïåí³â íåìàº, ä³àãíî-

ñòèêà ¿õ â ïåâí³é ì³ð³ º ñóá’ºêòèâíîþ.

Âàæêà äèñïëàç³ÿ (3-ãî ñòóïåíÿ) õàðàêòåðèçóºòüñÿ

êë³òèííîþ àòèï³ºþ, ã³ïåðõðîìàòîçîì ÿäåð, àí³çîêàð³î-

çîì, çá³ëüøåííÿì ÿäåðíî-öèòîïëàçìàòè÷íîãî ñï³ââ³äíî-

øåííÿ, ïñåâäîñòðàòèô³êàö³ºþ. Ñåðåäí³é âì³ñò ÄÍÊ ³

ê³ëüê³ñòü êë³òèí â ôàç³ ñèíòåçó ÄÍÊ çíà÷íî ï³äâèùåí³.

Äèñïëàç³ÿ âèíèêàº ÿê â åï³òåë³¿ áåç ìåòàïëàç³¿, òàê ³ â

ìåòàïëàçîâàíîìó åï³òåë³¿. Ó á³ëüøîñò³ âèïàäê³â âàæêî¿

äèñïëàç³¿ âîíà âèíèêàº â åï³òåë³¿ ç ìåòàïëàç³ºþ [2].

Âèä³ëåííÿ òðüîõ ñòóïåí³â äèñïëàç³¿ – ñëàáêî¿, ïîì³ðíî¿

³ âàæêî¿ – íå äîñèòü âäàëèé ï³äõ³ä äëÿ êë³í³÷íî¿ îö³íêè öüî-

ãî òåðì³íó. Àäæå, ÿêùî êë³í³öèñòè íàëàøòîâàí³ íà òå, ùî

äèñïëàç³ÿ º ïåðåäðàêîâèì ñòàíîì, òî ñëàáêà ³ ïîì³ðíà

äèñïëàç³¿ íàâðÿä ÷è â³äïîâ³äàþòü öüîìó âèçíà÷åííþ.

ª ïóáë³êàö³¿, â ÿêèõ àâòîðè ãîâîðÿòü ïðî ìîæëèâ³ñòü

ðåãðåñ³¿ äèñïëàç³¿, îäíàê, öå ñòîñóºòüñÿ , çàçâè÷àé äèñ-

ïëàç³é ñëàáêîãî ³ ïîì³ðíîãî ñòóïåí³â [1, 3]. Cë³ä çàçíà÷èòè,

ùî îö³íèòè ìîæëèâ³ñòü ðåãðåñ³¿ äèñïëàç³¿ äîñèòü âàæêî,

òîìó ùî òàêà îö³íêà ìîæå áóòè çðîáëåíà ëèøå ï³ñëÿ ïî-

âòîðíî¿ á³îïñ³¿, à âçÿòè øìàòî÷êè ñàìå ç ì³ñöÿ ïîïåðåä-

íüî âñòàíîâëåíî¿ äèñïëàç³¿ íàâðÿä ÷è ìîæëèâî íàâ³òü çà

íàÿâíîñò³ íàéñó÷àñí³øî¿ åíäîñêîï³÷íî¿ àïàðàòóðè.

Ó 1984 ðîö³ Ì³æíàðîäíà ãðóïà ç âèâ÷åííÿ ðàêó

øëóíêó çàïðîïîíóâàëà âèä³ëÿòè äèñïëàç³¿ íèçüêîãî ³ âè-

ñîêîãî ñòóïåí³â. Ïðè äèñïëàç³¿ íèçüêîãî ñòóïåíÿ íà ôîí³

âèðàæåíîãî ãàñòðèòó ó ïàö³ºíò³â ñòàðøèõ 60 ðîê³â ðåêî-

ìåíäóþòü ïðîâåäåííÿ ïîâòîðíèõ ÅÃÄÑ ³ á³îïñ³þ êîæí³

6–12 ì³ñÿö³â [3].

Ó 2000 ðîö³ ç’ÿâèëàñÿ íîâà óçãîäæåíà Ì³æíàðîäíà

(Â³äåíñüêà) êëàñèô³êàö³ÿ åï³òåë³àëüíèõ íåîïëàç³é (äèñï-

ëàç³é) òðàâíîãî òðàêòó [16].

Ó 2004 ð. â³ò÷èçíÿíèìè ñïåö³àë³ñòàìè â ãàëóç³

åíäîñêîï³¿ áóâ îïóáë³êîâàíèé êîìåíòàð äî ö³º¿ êëàñèô³-

êàö³¿ [4]. Àâòîðè ïèøóòü, ùî ðàí³øå ó ªâðîïåéñüêèõ

êðà¿íàõ ãîëîâíèì êðèòåð³ºì ðàêó áóëà ³íâàç³ÿ âëàñíî¿ ïëà-

ñòèíêè ñëèçîâî¿ îáîëîíêè, à â ßïîí³¿ ðàê ä³àãíîñòóâàëè,

âðàõîâóþ÷è ãîëîâíèì ÷èíîì öèòîëîã³÷í³ çì³íè, òàê³ ÿê

àí³çîêàð³îç, çá³ëüøåííÿ îá’ºìó ÿäåð, íàÿâí³ñòü âèðàæå-

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

íèõ ÿäåðåöü ³ âòðàòó ïîëÿðíîñò³ êë³òèí. Ö³ ðîçá³æíîñò³

áóëè ë³êâ³äîâàí³ ïðèéíÿòòÿì óçãîäæåíî¿ Ì³æíàðîäíî¿

êëàñèô³êàö³¿ åï³òåë³àëüíèõ íåîïëàç³é òðàâíîãî òðàêòó.

Äèñïëàç³ÿ â êëàñèô³êàö³¿ âèçíà÷åíà ÿê íåîïëàç³ÿ, òîáòî

ïóõëèíà (íåîïëàçìà – êëîí êë³òèí, ùî â³äð³çíÿºòüñÿ â³ä

³íøèõ àâòîíîìíèì ðîñòîì ³ ñîìàòè÷íèìè ìóòàö³ÿìè).

Îòæå, âîíà ïîòðåáóº ç áîêó êë³í³öèñò³â â³äïîâ³äíîãî

âðàõóâàííÿ êàòåãîð³¿ (ñòàä³¿) ïðîöåñó.

Òàêîæ àâòîðè [4] çàçíà÷àþòü, ùî öåíòðàëüíîþ ô³ãó-

ðîþ â ä³àãíîñòèö äèñïëàç³¿, ùî âèçíà÷àº òàêòèêó ë³êóâàí-

íÿ ïàö³ºíò³â, º ïàòîëîãîàíàòîì, ³ äëÿ ï³äâèùåííÿ òî÷íîñò³

ïàòîìîðôîëîã³÷íîãî ä³àãíîçó ðàö³îíàëüíèì º îòðèìàí-

íÿ çàêëþ÷åííÿ â³ä äâîõ ³ á³ëüøå íåçàëåæíèõ ïàòîëîãîàíà-

òîì³â àáî çàêëþ÷åííÿ ¿õ êîíñèë³óìó.

Íà ñüîãîäí³øí³é äåíü íàéá³ëüø åôåêòèâíèì ìåòîäîì,

ùî äîçâîëÿº â³äð³çíèòè ñïðàâæíþ äèñïëàç³þ â³ä äèñðåãå-

íåðàòîðíèõ çì³í, º ³ìóíîã³ñòîõ³ì³÷íå âèçíà÷åííÿ ìàð-

êåð³â àïîïòîçó – ð53 ³ bcl-2 [14]. Á³ëîê ð53 âèÿâëåíèé â

áàãàòüîõ òðàíñôîðìîâàíèõ êë³òèíàõ, éîãî ôóíêö³ºþ º çó-

ïèíêà êë³òèííîãî öèêëó ó â³äïîâ³äü íà ïîøêîäæåííÿ

ÄÍÊ, ùî çàïîá³ãàº ïåðåíîñó ïîøêîäæåíî¿ ãåíåòè÷íî¿

³íôîðìàö³¿ â³ä îäíîãî ïîêîë³ííÿ êë³òèí íàñòóïíîìó. Ïðè

çíà÷íîìó ïîøêîäæåíí³ ÄÍÊ ð53 ³í³ö³þº àïîïòîç, ÷èì çà-

ïîá³ãàº ïðîë³ôåðàö³¿ ïîøêîäæåíèõ êë³òèí. Îòæå, ïîðó-

øåííÿ ôóíêö³¿ ãåíà ð53 º êëþ÷îâèì ó íåîïëàñòè÷íîìó

êàñêàä³.

Îñíîâíà ôóíêö³ÿ ãåíà bcl-2 – ðåãóëÿö³ÿ àïîïòîçó.

Bcl-2 ïðèãí³÷óº àïîïòîç, ïîïåðåäæàþ÷è ôðàãìåíòàö³þ

ÄÍÊ. Âèñîêèé âì³ñò bcl-2 â êë³òèí³ ñïðèÿº ¿¿ âèæèâàííþ,

çàõèùàþ÷è ¿¿ â³ä àïîïîòîçó; â òîé æå ÷àñ âèñîêà

êîíöåíòðàö³ÿ ð53 ïðèçâîäèòü äî çìåíøåííÿ êîíöåíòðàö³¿

bcl-2 â êë³òèí³ ³ âêëþ÷åííÿ ìåõàí³çì³â àïîïòîçà [21]. Òà-

êîæ ³ìóíîã³ñòîõ³ì³÷íî âèçíà÷àþòü ìàðêåð ïðîë³ôåðàö³¿

åï³òåë³àëüíèõ êë³òèí – Ê³ -67; åêñïðåñ³ÿ Ê³-67 íàñòàº ï³ä ÷àñ

ôàçè G1, ïîò³ì ïðîòÿãîì êë³òèííîãî öèêëó íàðîñòàº ³

ð³çêî çìåíøóºòüñÿ ï³ñëÿ ì³òîçó [12].

Ïðè íàÿâíîñò³ ó á³îïòàò³ îçíàê äèñïëàç³¿ âèñîêîãî

ñòóïåíÿ ðÿä àâòîð³â ðåêîìåíäóþòü ïðîâåñòè ìíîæèíí³

ïîâòîðí³ á³îïñ³¿, îñê³ëüêè òàêà äèñïëàç³ÿ ÷àñò³øå ìîæå

ñâ³ä÷èòè íå ïðî òå, ùî ó õâîðîãî ïîòåíö³éíî ìîæå âèíèê-

íóòè ðàê, à ïðî òå, ùî â³í âæå º [3]. ßêùî íàâ³òü ðàê íå

çíàéäåíèé, àâòîðè ðåêîìåíäóþòü õ³ðóðã³÷íå ë³êóâàííÿ,

îñê³ëüêè ââàæàþòü, ùî ñïîñòåðåæåííÿ ç ÷àñòèìè åíäîñ-

êîï³ÿìè ³ á³îïñ³ÿìè íå äàº ãàðàíò³¿ ä³àãíîñòèêè êóðàáåëü-

íîãî ðàêó, îñê³ëüêè çëîÿê³ñíà òðàíñôîðìàö³ÿ äèñïëàç³¿

âèñîêîãî ñòóïåíÿ â ðàê ìîæå íàñòàòè ðàïòîâî, ³ öåé ìî-

ìåíò ìîæå áóòè ïðîïóùåíèé ïðè äèíàì³÷íîìó ñïîñòå-

ðåæåíí³ [13]. Â òàêèõ âèïàäêàõ äîö³ëüíî çàñòîñîâóâàòè

åíäîñêîï³÷í³ ìåòîäè ðåçåêö³¿ àáî äèñåêö³¿ ñëèçîâî¿ îáî-

ëîíêè [7, 9].

Çðîñòàííÿ ÷àñòîòè âèÿâëåííÿ àäåíîêàðöèíîìè ñòðà-

âîõîäó çà îñòàíí³ äâà äåñÿòèð³÷÷ÿ ³ çâ’ÿçîê âèíèêíåííÿ

ö³º¿ ïóõëèíè ç ñòðàâîõîäîì Áàððåòòà çóìîâèëè

ï³äâèùåíèé ³íòåðåñ äî äàíî¿ ïàòîëîã³¿, à â³äïîâ³äíî ³ äî

ïåðåäðàêîâîãî ñòàíó – äèñïëàç³¿ ìåòàïëàçîâàíîãî

åï³òåë³þ ñòðàâîõîäó. Ñòðàâîõ³ä Áàððåòà õàðàêòåðèçóºòüñÿ

íàÿâí³ñòþ öèë³íäðè÷íîãî åï³òåë³þ â åï³òåë³àëüí³é âèñò³ëö³

ñòðàâîõîäó, à îäèí ç âàð³àíò³â ö³º¿ âèñò³ëêè – êèøêîâèé

åï³òåë³é ³ç ð³çíèì íàáîðîì êë³òèííèõ åëåìåíò³â [11]. ßê

øëóíêîâèé, òàê ³ êèøêîâèé åï³òåë³é ìîæóòü ï³äëÿãàòè äèñ-

ïëàñòè÷íèì çì³íàì, òîáòî ó âîãíèùàõ äèñïëàç³¿ öèë³íä-

ðè÷íîãî åï³òåë³þ ìîæóòü áóòè âèÿâëåí³ ìîðôîëîã³÷í³

îçíàêè, ùî õàðàêòåðèçóþòü ÿê øëóíêîâèé, òàê ³ êèøêîâèé

íàïðÿìîê äèôåðåíö³þâàííÿ [8].

Ñó÷àñí³ ï³äõîäè äî ë³êóâàííÿ äèñïëàç³¿ åï³òåë³þ âèñî-

êîãî ñòóïåíÿ ïðè ñòðàâîõîä³ Áàððåòòà íåîäíîçíà÷í³. Îäí³

àâòîðè ðåêîìåíäóþòü ðàäèêàëüíå õ³ðóðã³÷íå âòðó÷àííÿ –

ðåçåêö³þ àáî åêñòèðïàö³þ ñòðàâîõîäó, ùîá íàçàâæäè ïîç-

áóòèñÿ ðèçèêó âèíèêíåííÿ àäåíîêàðöèíîìè àáî ïîçáà-

âèòèñÿ âæå ³ñíóþ÷îãî ðàêó íà ðàíí³é ñòàä³¿. Âîíè àðãó-

ìåíòóþòü ñâîþ ïîçèö³þ òèì, ùî ïðè õ³ðóðã³÷íîìó

ë³êóâàíí³ ç ïðèâîäó äèñïëàç³¿ âèñîêîãî ñòóïåíÿ ó çíà÷íî¿

÷àñòèíè õâîðèõ ïðè ã³ñòîëîã³÷íîìó äîñë³äæåíí³ âèäàëå-

íîãî ñòðàâîõîäó çíàõîäÿòü àäåíîêàðöèíîìó [10]. ²íø³ àâ-

òîðè ââàæàþòü, ùî òàêèé ï³äõ³ä äî ë³êóâàííÿ õâîðèõ áåç

ÿâíèõ îçíàê ìàë³ãí³çàö³¿ äèñïëàñòè÷íîãî åï³òåë³þ íå º

ïðàâèëüíèì , îñê³ëüêè äóæå âèñîêèé ðèçèê ïîøèðåíîãî

îïåðàòèâíîãî âòðó÷àííÿ ç âèñîêèì â³äñîòêîì óñêëàäíåíü

³ ëåòàëüíîñò³. Êð³ì òîãî, â³ä ìîìåíòó âèÿâëåííÿ äèñïëàç³¿

âèñîêîãî ñòóïåíÿ äî ðîçâèòêó àäåíîêàðöèíîìè çàçâè÷àé

ïðîõîäèòü 3-5 ðîê³â, òîìó ìîæëèâå ³íòåíñèâíå åíäîñêî-

ï³÷íå ñïîñòåðåæåííÿ êîæí³ 3-6 ì³ñÿö³â äî òîãî ÷àñó, êîëè

áóäå ä³àãíîñòîâàíèé ðàê [8, 20].

Â òîé æå ÷àñ äëÿ ë³êóâàííÿ äèñïëàç³¿ ìîæóòü áóòè çàñ-

òîñîâàí³ ìàëî³íâàçèâí³ âòðó÷àííÿ, ùî ñóïðîâîäæóþòüñÿ

ãëèáîêèì ïîøêîäæåííÿì (ôîòîäèíàì³÷íà òåðàï³ÿ, ëàçåð-

íà äåñòðóêö³ÿ) àáî ïîâíèì âèäàëåííÿì ïîøêîäæåíî¿

ä³ëÿíêè ñëèçîâî¿ îáîëîíêè (ðåçåêö³ÿ) ó ïîºäíàíí³ ç ³íòåí-

ñèâíîþ ìåäèêàìåíòîçíîþ òåðàï³ºþ [18, 19].

Ùîäî äèñïëàç³¿ åï³òåë³þ òîâñòî¿ êèøêè, òî á³ëüø³ñòü

àâòîð³â ââàæàþòü, ùî ïðàêòè÷íî âñ³ àäåíîìè òîíêî¿ òà

òîâñòî¿ êèøîê ìàþòü òîé ÷è ³íøèé ñòóï³íü äèñïëàç³¿,

³ñíóº çàëåæí³ñòü ì³æ ñòóïåíåì äèñïëàç³¿ àäåíîì ³

÷àñòîòîþ âèíèêíåííÿ ðàêó [6, 15]. Ðàçîì ç òèì, õ³ðóðãè

çàêëèêàþòü ìîðôîëîã³â äóæå â³äïîâ³äàëüíî ï³äõîäèòè

äî âñòàíîâëåííÿ òàêèõ ä³àãíîç³â ÿê àòèï³ÿ, äèñïëàç³ÿ

âèñîêîãî ñòóïåíÿ ³ carcinoma in situ, ùîá íå äîïóñòèòè

íåïîòð³áíîãî ðàäèêàë³çìó ³ ïðîâåäåííÿ ³íâàë³äèçóþ÷èõ

îïåðàö³é [5]. Ñë³ä çàçíà÷èòè, ùî â á³îïñ³éíîìó ìàòåð³àë³

ç ïîë³ï³â òîíêî¿ òà òîâñòî¿ êèøîê ÷àñòî âèÿâëÿºòüñÿ

ïîâåðõíåâà çàëîçèñòà òêàíèíà ³ áóâàº íåìîæëèâî

âèçíà÷èòè íàÿâí³ñòü ³íâàçèâíîãî ðîñòó. Â òàêèõ âèïàäêàõ

íåîáõ³äíî ðåêîìåíäóâàòè âèñ³÷åííÿ âñüîãî ïîë³ïó ³ ðîç-

ãëÿäàòè öþ ìàí³ïóëÿö³þ ÿê ðîçøèðåíó á³îïñ³þ.

Ó âèïàäêàõ äèñïëàç³¿ âèñîêîãî ñòóïåíÿ äîö³ëüíî çàñòî-

ñîâóâàòè õ³ðóðã³÷í³ ìåòîäè ìàëî³íâàçèâíîãî ë³êóâàííÿ –

åíäîñêîï³÷í³ ìåòîäè ðåçåêö³¿ àáî äèñåêö³¿ ñëèçîâî¿ îáî-

ëîíêè ç ïîäàëüøèì ìîðôîëîã³÷íèì äîñë³äæåííÿì äëÿ

ï³äòâåðäæåííÿ ñòóïåíÿ äèñïëàç³¿ ³ ðàäèêàëüíîñò³ îïåðà-

òèâíîãî âòðó÷àííÿ [7, 9].

Ìåòîþ äîñë³äæåííÿ ñòàëî âèçíà÷åííÿ ÷àñòîòè âèÿâëåí-

íÿ äèñïëàç³é âèñîêîãî ñòóïåíÿ øëóíêîâî-êèøêîâîãî òðàê-

òó ³ îö³íèòè åôåêòèâí³ñòü ¿õ ìàëî³íâàçèâíîãî ë³êóâàííÿ.

Ìàòåð³àëè òà ìåòîäè äîñë³äæåííÿ. Ïðîâåäåíî ðåò-

ðîñïåêòèâíèé àíàë³ç âèïàäê³â åçîôàãîãàñòðîäóîäåíîñ-

êîï³¿ (ÅÃÄÑ) ³ êîëîíîñêîï³¿ (ÊÑ) (â³äåîåíäî ñêîï³÷í³ äîñë³ä-

æåííÿ, âóçüêîñìóãîâ³ äîñë³äæåííÿ, õðîìîñêîï³ÿ –

â³äåîåíäîñêîïè Olympus CF-150; Olympus GIF-160Z;

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

Olympus Optical), ïðîâåäåíèõ íà áàç³ Ìåäè÷íîãî Öåíòðó

“Óí³âåðñàëüíà êë³í³êà “Îáåð³ã”.

Ðåçóëüòàòè òà îáãîâîðåííÿ. Çà 2013 ð³ê ïðîâåäåí³ 731

ä³àãîñòè÷í³ ÅÃÄÑ ³ 499 ÊÑ. Äèñïëàç³ÿ âèñîêîãî ñòóïåíÿ,

ÿêà ïîòðåáóº õ³ðóðã³÷íîãî ë³êóâàííÿ, áóëà âèÿâëåíà â

1 âèïàäêó â ñòðàâîõîä³ íà ôîí³ ñïåö³àë³çîâàíî¿ êèøêîâî¿

ìåòàïëàç³¿ (ñòðàâîõîäó Áàððåòòà) ³ 4 âèïàäêàõ ó øëóíêó

(ðèñ. 1, 2) (ó 3 ïàö³ºíò³â íà ôîí³ õðîí³÷íîãî àòðîô³÷íîãî

ãàñòðèòó ³ ó 1 ïàö³ºíòà – â àäåíîìàòîçíîìó ïîë³ï³

øëóíêà), ùî ñêëàëî 0,7% â³ä çàãàëüíî¿ ê³ëüêîñò³ ÅÃÄÑ. Ïðè

ÊÑ äèñïëàç³ÿ âèñîêîãî ñòóïåíÿ áóëà çíàéäåíà ó 5

ïàö³ºíò³â (ðèñ. 3, 4) (1% âñ³õ ÊÑ). Ï³ñëÿ ã³ñòîëîã³÷íîãî äîñ-

ë³äæåííÿ á³îïòàò³â âñ³ íåîïëàç³¿ áóëè âèäàëåí³ øëÿõîì åí-

äîñêîï³÷íî¿ ðåçåêö³¿ ñëèçîâî¿ îáîëîíêè (EMR) ç ïîïåðåä-

íüîþ ï³äñëèçîâîþ ³í’ºêö³ºþ. Ã³ñòîëîã³÷íî ó âñ³õ âèïàäêàõ

ðåçåêö³ÿ ïðîâåäåíà â ìåæàõ çäîðîâèõ òêàíèí (R0), â³äñóò-

íÿ ³íâàç³ÿ â ë³ìôàòè÷í³ (L0) ³ êðîâîíîñí³ ñóäèíè (R0).

Âèñíîâêè. ÅÃÄÑ ³ ÊÑ ³ç çàñòîñóâàííÿ ìåòîäèê ïîêðà-

ùåííÿ åíäîñêîï³÷íîãî çîáðàæåííÿ º åôåêòèâíèìè äëÿ

ä³àãíîñòèêè äèñïëàç³¿ åï³òåë³þ ñëèçîâî¿ îáîëîíêè øëóí-

êîâî-êèøêîâîãî òðàêòó. Ë³êóâàííÿ äèñïëàç³é âèñîêîãî

ñòóïåíÿ äîö³ëüíî ïðîâîäèòè øëÿõîì åíäîñêîï³÷íî¿

ðåçåêö³¿ ñëèçîâî¿ îáîëîíêè ç âèäàëåííÿì íåîïëàç³¿ â

ìåæàõ çäîðîâèõ òêàíèí.

Ðåöåíçåíò: ÷ëåí-êîð. ÍÀÌÍ Óêðà¿íè,

ä.ìåä.í., ïðîôåñîð Çàõàðàø Ì.Ï.

Ë²ÒÅÐÀÒÓÐÀ

1. Êàøèí Ñ.Â. Àòðîôèÿ, ìåòàïëàçèÿ, äèñïëàçèÿ – ôàêòî-

ðû ðèñêà ðàçâèòèÿ ðàêà æåëóäêà: îáðàòèìûå ëè ýòè èçìåíå-

íèÿ ñëèçèñòîé îáîëî÷êè / Ñ.Â. Êàøèí, À.Ñ. Íàäåæèí, È.Î. Èâà-

íèêîâ // Êëèíè÷. ïåðñïåêòèâû ãàñòðîýíòåðîë. ãåïàòîë. – 2006. –

¹5. – Ñ.13-17.

2. Êîíîíîâ À.Â. Àòðîôè÷åñêèé ãàñòðèò, êèøå÷íàÿ ìåòàïëà-

çèÿ è äèñïëàçèÿ – ñóùåñòâóåò ëè ïîñëåäîâàòåëüíà çàâèñèìîñòü? /

À.Â.Êîíîíîâ // Ìàòåð.ñèìïîçèóìà “Õðîíè÷åñêèé ãàñòðèò. Ëå÷å-

íèå áàíàëüíîãî çàáîëåâàíèÿ èëè ïóòü êàíöåðïðåâåíöèè?”. –

Ìîñêâà, 2008. – Ñ.8-9.

3. Ìåëü÷åíêî Ä.Ñ. Ïðåäîïóõîëåâûå èçìåíåíèÿ ñëèçèñòîé îáî-

ëî÷êè æåëóäêà: ìîðôîëîãè÷åñêèå àñïåêòû èçó÷åíèÿ áèîïñèéíîãî

ìàòåðèàëà / Ä.Ñ. Ìåëü÷åíêî, Ã.Â. Áåëîâà, Ä.Â. Ñàçîíîâ, À.À. Áóä-

çèíñêèé // Êëèíè÷åñêàÿ ýíäîñêîïèÿ. – 2008. – ¹3. – Ñ. 38-45.

4. Íèêèøàåâ Â.È. Ýíäîñêîïè÷åñêèå êëàññèôèêàöèè è êîì-

ìåíòàðèè ê íèì / Â.È. Íèêèøàåâ, Å.Î. Âðóáëåâñêàÿ, È.È. Ëåì-

êî / – Êèåâ, “Ãàììà Êîë³ð”, 2004. – 32 ñ.

5. Bond J.H. Colon Polyps and Cancer /J.H. Bond // Endoscopy. –

2003. – Vol. 35. – P. 27-35.

6. Brenner H. Risk of colorectal cancer after detection and removal

of adenomas at colonoscopy: population-based case-control study //

H. Brenner, J. Chang-Claude, A. Rickert {et al.] // J. Clin. Oncol. –

2012. – Vol. 30. – P. 2969-2976.

7. Conio M. Endoscopic mucosal resection / M. Conio, T. Ponchon,

S. Blanchi, R. Filiberti //Am. J. Gastroenterol. – 2006. – Vol.101, N 3. –

P. 653-63.

8. Curves W.L. Low-grade dysplasia in Barrett’s esopha-

gus:overdiagnosed and underestimated / W.L. Curves, F.J. ten Kate,

K.K. Krishnadath // Am.J. Gastroenterol. – 2010. – Vol. 105. – P. 1523-30.

9. Ikehara H. Transcutaneous monitoring of partial pressure of

carbon dioxide during endoscopic submucosal dissection of early

colorectal neoplasia with carbon dioxide insufflation: a prospective

Ðèñ. 1. Äèñïëàç³ÿ âèñîêîãî ñòóïåíÿ â ñëèçîâ³é øëóíêà.

Çàáàðâëåííÿ ãåìàòîêñèë³íîì-åîçèíîì. Çá. 200.

Ðèñ. 3. Äèèñïëàç³ÿ âèñîêîãî ñòóïåíÿ â ñò³íö³ òîâñòî¿ êèøêè.

Çàáàðâëåííÿ ãåìàòîêñèë³íîì-åîçèíîì. Çá. 200.

Ðèñ. 2. Äèñïëàç³ÿ âèñîêîãî ñòóïåíÿ â ñëèçîâ³é øëóíêà.

Çàáàðâëåííÿ ãåìàòîêñèë³íîì-åîçèíîì. Çá. 200.

Ðèñ. 4. Àäåíîìà òîâñòî¿ êèøêè ç äèñïëàç³ºþ âèñîêîãî

ñòóïåíÿ. Çàáàðâëåííÿ ãåìàòîêñèë³íîì-åîçèíîì. Çá. 200.

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

study / H. Ikehara, K.L. Fu, T. Itoi, T.Fujii // Surg Endosc. – 2010. –

Vol. 24, N 2. – P. 343-52.

10. Gatenby P.A. Treatment modality and risk of development of

dysplasia and adenocarcinoma in columnar-lined esophagus /

P.A. Gatenby, J.R. Ramus, C.P. Caygill [et al.] // Dis. Esophagus. –

2009. – Vol 22. – P. 133-142.

11. Guindi M. Histtology of Barrett’s esophagus and dysplasia /

M. Guindi, R.H. Riddell // Gastrointest. Endosc. Clin. N. Am. – 2003/ –

Vol.3. – P. 349-368.

12. Kim Y.J. Histologic diagnosis based on forceps biopsy is not

adequate for determining endoscopic treatment ofgastric adenomatous

lesions / Y.J. Kim, J.C. Park, J.H. Kim [et al.] // Endoscopy. – 2010. –

Vol. 42. – P. 620-626.

13. Park S.Y. Long trm follow –up study of gastric intraepithelial

neoplasias: progression from low-grade dysplasia to invasive

carcinoma / S.Y.Park, S.W. Leon, M.K.Jung [et al.] // Eur.

J. Gastroenterol. Hepatol. – 2008. – Vol. 134. – P. 945-952.

14. Qiu C-Z. Relationship Between Somatostatin Receptor Subtype

Expression and Clinicopathology, Ki-67, Bcl-2 and P53 in Colorectal

Cancer / C.-Z. Qiu, C. Wang, Z.-X. Huang [et al.] // 2006. – World

J. Gastroenterol. – Vol. 12. – P. 2011-5

15. Robertson D.J. Using the resuls of a baseline and a surveillance

colonoscopy to predict recurrent adenomas with high-risk

characteristics // D.J. Robertson, C.A. Burke, H.G. Welch [et al.] //

Ann. Intern. Med. – 2009. – Vol. 151. – P. 103-109.

16. Schlemper R.J., Riddell R.H., Kato Y et al. (2000) The Vienna

classification of gastrointestinal epithelial neoplasia. Gut. 47:251-

255.

17. Sobin L.H., Greene F.L. (2004) Global TNM advisory group /

L.H. Sobin, F. L. Greene //Cancer. – 2004. – Vol.100, N5. – P.1106.

18. Virender K. Circumferential and Focal Ablation of Barrett’s

Esophagus Containing Dysplasia/ K. Virender, M.D. Sharma,

H.J. Kim [et al.] // Am. J. Gastroenterol. – 2008. – Vol. 104. –

P. 310-317.

19. Wani S. How to Manage a Barrett’s Esophagus Patient With

Low-Grade Dysplasia / S. Wani, S. Mathur, P. Sharma // Clin.

Gastroenterol. Hepatol. – 2009. – Vol. 7. – P. 27-32.

20. Wani S. Risk factors for progression of low-grade dysplasia in

patiens with Barret’s oesophagus / S. Wani, G.W. Falk, J. Post [et al.] //

Gastroenterology/ 2011. – Vol. 141. – P. 1179-86.

21. Xia H.-X. Topographic association of gastric epithelial

expression of Ki-67, Bax, and Bcl-2 with antralization in the gastric

incisura, body, and fundus / H.-X. Xia, G.-S. Zhang, N.J. Talley [et al.] //

Am. J. Gastroenterol. 2002. – Vol.97, N 12. – P. 2939-3267.

22. Yamada H. Long trm follow-up study of gastric adenoma/

dysplasia / H. Yamada, M. Ikegami, T. Shimoda [et al.] // Endoscopy. –

2004. – Vol 36. – P. 390-396.

ÄÈÑÏËÀÇÈß ÝÏÈÒÅËÈß

ÆÅËÓÄÎ×ÍÎ-ÊÈØÅ×ÍÎÃÎ ÒÐÀÊÒÀ

Ëàçàð÷óê Ã.Î., Áîäíàð Ë.Â., Áàçäûðåâ Â.Â.

Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò

èìåíè À.À.Áîãîìîëüöà, ã. Êèåâ, Óêðàèíà

Ìåäèöèíñêèé Öåíòð “Óíèâåðñàëüíàÿ êëèíèêà

“Îáåðèã”, ã. Êèåâ, Óêðàèíà

Ðåçþìå. Â ñòàòüå ïðåäñòàâëåíû ñîâðåìåííûå âçãëÿ-

äû íà äèñïëàçèþ ýïèòåëèÿ æåëóäî÷íî-êèøå÷íîãî òðàê-

òà. Ïîêàçàíà ðîëü ìîðôîëîãà â óñòàíîâëåíèè äèàãíîçà

äèñïëàçèè. Ïðåäñòàâëåíû ñîâðåìåííûå ïîäõîäû ê ëå-

÷åíèþ ïàöèåíòîâ â çàâèñèìîñòè îò ñòåïåíè äèñïëàçèè.

Â Ìåäèöèíñêîì öåíòðå “Îáåðèã” çà 2013 ãîä áûëè ïðî-

âåäåíû 731 äèàãíîñòè÷åñêàÿ ýçîôàãîãàñòðîäóîäåíîñêî-

ïèÿ (ÝÃÄÑ) è 499 êîëîíîñêîïèé (ÊÑ). Äèñïëàçèÿ âûñî-

êîé ñòåïåíè áûëà äèàãíîñòèðîâàíà â 0,7% ÝÃÄÑ è 1%

âñåõ ÊÑ. Âî âñåõ ñëó÷àÿõ áûëî ïðîèçâåäåíî ðàäèêàëü-

íîå óäàëåíèå äèñïëàçèè ïóòåì ýíäîñêîïè÷åñêîé ðåçåê-

öèè ñëèçèñòîé îáîëî÷êè.

Êëþ÷îâ³ ñëîâà: äèñïëàçèÿ, æåëóäî÷íî-êèøå÷íûé

òðàêò, áèïîñèÿ, ýíäîñêîïè÷åñêàÿ ðåçåêöèÿ ñëèçèñòîé

îáîëî÷êè.

DYSPLASIA IN GASTRO-INTESTINAL TRACT

G. Lazarchuk, L. Bodnar, V. Bazdyrev

Bogomolets National Medical University,

Kyiv, Ukraine

Medical Centre “Oberig”, Kyiv, Ukraine

Summary. The article presents the modern views for

dysplasia in gastro-intestinal tract. The main role of

morphologist in diagnosing dysplasia was shown. It was

shown that the choice of curation tactic depends on degree

of dysplasia. In the Medical centre “Oberig” 731 diagnostic

esofagogastroduodenoscopies (EGDS) and 499

colonoscopies (KS) were done in 2013. High-grade

dysplasia in 0,7% of all EGDS and 1% of all KS was found.

The endoscopic mucosal resection was successfully used

in all these cases.

Key words: dysplasia, gastro-intestinal tract, bioposy,

endoscopic mucosal resection.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

Âñòóï. Ðàê ãîðòàí³ (ÐÃ) îíêîëîã³÷íà ïàòîëîã³ÿ, ùî äî-

ñèòü ÷àñòî çóñòð³÷àºòüñÿ [1,2], òà ñêëàäàº áëèçüêî 60–70%

ïîì³æ ³íøèõ ïóõëèí ËÎÐ-îðãàí³â [6]. Íàé÷àñò³øå ó ÿêîñò³

ë³êóâàííÿ ÐÃ âèêîðèñòîâóºòüñÿ êîìá³íîâàíèé ìåòîä [6,9],

ïðè÷îìó ó 60–62% õâîðèõ ï³ñëÿ òàêîãî ë³êóâàííÿ

âèçíà÷àþòüñÿ ðåã³îíàðí³ ìåòàñòàçè, ùî, ðàçîì ³ç ï³çíüîþ

ä³àãíîñòèêîþ ðåöèäèâ³â îñíîâíîãî çàõâîðþâàííÿ òàêîæ

ïðèçâîäèòü äî âèñîêî¿ ëåòàëüíîñò³ [8,10]. Îòæå, ñâîº÷àñíå

âèÿâëåííÿ ðåã³îíàðíèõ òà â³ääàëåíèõ ìåòàñòàç³â ÐÃ ï³ñëÿ

êîìá³íîâàíîãî ë³êóâàííÿ º ãîñòðîþ ïðîáëåìîþ ñó÷àñíî¿

ðàä³îëîã³¿ òà îòîëàðèíãîëîã³¿, ùî ïîêëàäàºòüñÿ íà ìåòîäè

ðàííüî¿ íå³íâàçèâíî¿ ä³àãíîñòèêè [3]. Íàóêîâ³ ïðàö³ ïðî

ä³àãíîñòèêó ìåòàñòàç³â ÐÃ ï³ñëÿ êîìá³íîâàíîãî ë³êóâàííÿ

º íå÷èñåëüíèìè [2], òà íå çàâæäè ïåðåäáà÷àþòü îáñòå-

æåííÿ îðãàí³â, ï³äîçð³ëèõ íà â³ääàëåí³ ìåòàñòàçè (mts);

ìàéæå íåìàº äàíèõ ³ ïðî ð³äê³ñí³ ôîðìè â³ääàëåíèõ mts

(ïå÷³íêà, ê³ñòêè, ãîëîâíèé ìîçîê) ó õâîðèõ íà ÐÃ.

Ìåòà ðîáîòè: âñòàíîâèòè îñîáëèâîñò³ ðåã³îíàðíèõ òà

â³ääàëåíèõ ìåòàñòàç³â ÐÃ ï³ñëÿ êîìá³íîâàíîãî ë³êóâàííÿ

çà äàíèìè ìóëüòèäåòåêòîðíî¿ êîìï’þòåðíî¿ òîìîãðàô³¿

(ÌÄÊÒ).

Ìàòåð³àëè òà ìåòîäè äîñë³äæåííÿ. Íà áàç³ ÄÓ

“²íñòèòóò ÿäåðíî¿ ìåäèöèíè òà ïðîìåíåâî¿ ä³àãíîñòèêè

ÍÀÌÍÓ” íà 64-çð³çîâîìó êîìï’þòåðíîìó òîìîãðàô³

LightSpeed VCT, GE îáñòåæåíî 219 ïàö³ºíò³â ³ç

âñòàíîâëåíèì êë³í³÷íèì ä³àãíîçîì, âåðèô³êîâàíèì

ìîðôîëîã³÷íî. Öèì ïàö³ºíòàì ç ìåòîþ ðîçðîáëåííÿ

ñåì³îòèêè ðåã³îíàðíèõ òà â³ääàëåíèõ ìåòàñòàç³â ÐÃ ï³ñëÿ

êîìá³íîâàíîãî ë³êóâàííÿ áóëî ïðîâåäåíî êîìïëåêñíó

ÓÄÊ 616-073.756.8:681.31:611.22:611.321:616-051

ÐÎËÜ ÌÓËÜÒÈÄÅÒÅÊÒÎÐÍÎ¯ ÊÎÌÏ’ÞÒÅÐÍÎ¯

ÒÎÌÎÃÐÀÔ²¯ Ó Ä²ÀÃÍÎÑÒÈÖ² ÌÅÒÀÑÒÀÇ²Â ÐÀÊÓ

ÃÎÐÒÀÍ² Ï²ÑËß ÊÎÌÁ²ÍÎÂÀÍÎÃÎ Ë²ÊÓÂÀÍÍß

Ëîãàí³õ³íà Ê.Þ., Êîçàðåíêî Ò.Ì.

ÄÓ “²íñòèòóò ÿäåðíî¿ ìåäèöèíè òà ïðîìåíåâî¿ ä³àãíîñòèêè ÍÀÌÍ Óêðà¿íè”, ì. Êè¿â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: ðàê ãîðòàí³, ìåòàñòàçè ðàêó ãîðòàí³, êîìïëåêñíà ìóëüòèäåòåêòîðíà êîìï’þòåðíà

òîìîãðàô³ÿ, ä³àãíîñòèêà ìåòàñòàç³â ðàêó ãîðòàí³.

ÌÄÊÒ, ùî, ÿê â³äîìî, ñóòòºâî âïëèâàº íà ï³äâèùåííÿ ïî-

êàçíèê³â ä³àãíîñòè÷íî¿ åôåêòèâíîñò³ [5,7,8].

Ðåçóëüòàòè òà îáãîâîðåííÿ. Ç 219 îáñòåæåíèõ

ñôîðìóâàëè áåçðåöèäèâíó ãðóïó – 115 îñ³á (52,5%) òà

ãðóïó ³ç ì³ñöåâèìè ðåöèäèâàìè ÐÃ – 104 ïàö³ºíò³â (47,5%).

Â³ääàëåí³ mts ïðè ÐÃ ðîçâèâàþòüñÿ ó 6,5–10,5% õâîðèõ

ï³ñëÿ êîìá³íîâàíîãî ë³êóâàííÿ [4]. Çã³äíî äàíèõ

êîìïëåêñíî¿ ÌÄÊÒ, mts ï³ñëÿ êîìá³íîâàíîãî ë³êóâàííÿ ÐÃ

áóëè ä³àãíîñòîâàí³: ó 80 ïàö³ºíò³â (42,0 %) – ó ë³ìôàòè÷íèõ

âóçëàõ øè¿ (ËÂ), ó 12 (5,5 %) – â³ääàëåí³ mts ó ëåãåí³ ³ ïëåâðó,

ó 6 õâîðèõ (2,8 %) – ó ³íø³ îðãàíè (òàáë. 1), ùî º ð³äê³ñíèìè

ïðîÿâàìè â³ääàëåíîãî ìåòàñòàçóâàííÿ ÐÃ [11].

Ïðèêëàä ðåã³îíàðíîãî ìåòàñòàçóâàííÿ ó õâîðîãî ³ç

êîíòðëàòåðàëüíèì ëîêàëüíèì ðåöèäèâîì ó ä³ëÿíö³ ïðàâî¿

ãîëîñîâî¿ ñêëàäêè íàâåäåíî íà ðèñ. 1.

Ïðèêëàä ïîºäíàííÿ ëîêàëüíîãî ðåöèäèâó òà â³ääàëå-

íèõ mts ÐÃ íàâåäåíî íà ðèñ. 2, 3.

ßê âèäíî ³ç ðèñ. 3, â³ääàëåí³ mts ó ëåãåíÿõ ìàëè âèãëÿä

ìíîæèííèõ ã³ïåðäåíñíèõ ñòðóêòóð îêðóãëî¿ ôîðìè, äè-

ôóçíî ðîçïîä³ëåíèõ ó ëåãåíåâ³é ïàðåíõ³ì³, âêëþ÷àþ÷è

ñóáïëåâðàëüí³ â³ää³ëè, ³ç çàëó÷åííÿì ó ïðîöåñ äîëüîâèõ

òà ñåãìåíòàðíèõ áðîíõ³â òà âòîðèííèìè çì³íàìè ó ìåæè-

ñò³ííèõ ËÂ.

Â³ääàëåí³ mts ÐÃ ó ê³ñòêè áóëè îñòåîë³òè÷íîãî òèïó, ³ç

ïàðàîññàëüíèì ì’ÿêîòêàíèííèì êîìïîíåíòîì, ùî ïî-

ì³ðíî íàêîïè÷óâàâ ÊÐ. Òàê, ó íàñòóïíèõ õâîðèõ âèÿâèëè

mts ó ãðóäèíó òà ðåáðà ³ç âèðàæåíèì åêñòðàòîðàêàëüíèì

ì’ÿêîòêàíèííèì êîìïîíåíòîì (ðèñ. 4); ó ãîë³âêó ðåáðà

íà ð³âí³ ãðóäíîãî â³ää³ëó õðåáòà (ðèñ. 5).

Òàáëèöÿ 1.

Îñîáëèâîñò³ ìåòàñòàç³â ÐÃ ï³ñëÿ êîìá³íîâàíîãî ë³êóâàííÿ çà äàíèìè ÌÄÊÒ

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

Ðèñ. 3. À, Á. Òà ñàìà õâîðà. ÌÄÊÒ ÎÃÊ, àêñ³àëüí³ ñêàíè

(À, Á): 4 – äâîá³÷í³ mts.

Ðèñ. 4. Õâîðèé Â., 47 ðîê³â. Êë³í³÷íèé ä³àãíîç: Ñà óñ³õ

â³ää³ë³â ãîðòàí³ çïðàâà, ³ç, T4N3M0, ñòàí ÷åðåç 18 ì³ñÿö³â

ï³ñëÿ ë³êóâàííÿ. ÌÄÊÒ, àêñ³àëüíèé ñêàí (À) ÌÏÐ (Á),

VR (Â, Ã): 1,2 – óðàæåííÿ ãðóäèíè òà ãðóäèííèõ ê³íö³â

1-3-õ ðåáåð ç äâîõ áîê³â.

Ðèñ. 2. Õâîðà Ñ., 77 ðîê³â. Êë³í³÷íèé ä³àãíîç: Ñà óñ³õ â³ää³ë³â

ãîðòàí³, ñòàí ÷åðåç 6 ì³ñÿö³â ï³ñëÿ ë³êóâàííÿ, T4N2M0.

ÌÄÊÒ, àêñ³àëüí³ ñêàíè (À,Á): 1 – ðåöèäèâ ó ä³ëÿíö³ á³÷íî¿

ñò³íêè ðîòîãëîòêè òà êîðåíÿ ÿçèêà; 2 – ïðîñâ³ò

ðîòîãëîòêè çâóæåíî; 3 – ïîøèðåííÿ íà ïðàâó ÇÑÀ.

Ðèñ. 1 À, Á. Ïàö³ºíò Â, 47 ðîê³â. Êë³í³÷íèé ä³àãíîç: Ñà ë³âî¿

ãîëîñîâî¿ ñêëàäêè, T1N0M0, ñòàí ÷åðåç 3 ì³ñÿö³ ï³ñëÿ

ë³êóâàííÿ. ÌÄÊÒ, àêñ³àëüíèé ñêàí (À), ÌÏÐ (Á,Â): 1 – mts ËÂ;

2 – íåêðîç; 3 – äð³áíîãîðáèñò³ êîíòóðè.

Ðèñ. 6. Õâîðèé Ø., 67 ðîê³â. Êë³í³÷íèé ä³àãíîç: Ñà óñ³õ â³ää³ë³â

ãîðòàí³ ³ç äåñòðóêö³ºþ ¿¿ õðÿù³â, T4N0M0, ñòàí ÷åðåç

18 ì³ñÿö³ ï³ñëÿ ë³êóâàííÿ. ÌÄÊÒ, àêñ³àëüíèé ñêàí: 1 – mts

ó ë³âó ñêðîíåâî-ò³ì’ÿíó ä³ëÿíêó; 2 – ïåðèôîêàëüíèé íàáðÿê;

3 – ë³âèé á³÷íèé øëóíî÷îê êîìïðåìîâàíèé.

Ìts ÐÃ ó ãîëîâíèé ìîçîê ìàëè âèãëÿä ã³ïåðäåíñíèõ

âîãíèù îêðóãëî¿ ôîðìè, ³ç âèðàæåíèì ïåðèôîêàëüíèì

íàáðÿêîì òà äèñëîêàö³éíèì ñèíäðîìîì, ùî øèðîêî ïðè-

ëÿãàëè äî ê³ñòîê ñêëåï³ííÿ ÷åðåïà ³ç ð³çíèì ñòóïåíåì âè-

ðàæåíîñò³ ìàñ-åôåêòó ïóõëèíè ïî â³äíîøåííþ äî ê³ñòîê

ñêëåï³ííÿ òà îñíîâè ÷åðåïà – â³ä àòðîô³¿ äî ÷àñòêîâî¿/

òîòàëüíî¿ äåñòðóêö³¿.

Ð³äê³ñíèé ïðîÿâ â³ääàëåíîãî ìåòàñòàçóâàííÿ ÐÃ ó ãî-

ëîâíèé ìîçîê íàâåäåíî íà ðèñ. 6.

Áóëè âñòàíîâëåí³ ñòðîêè âèÿâëåííÿ ðåã³îíàðíèõ òà

â³ääàëåíèõ mts. Íàé÷àñò³øå ðåã³îíàðí³ mts ó øèéí³ ËÂ

ðîçâèâàëèñÿ äî 1-ãî ðîêó ï³ñëÿ êîìá³íîâàíîãî ë³êóâàííÿ

(ó 57 ïàö³ºíò³â, 71,25 %). Íàéá³ëüø ÷àñòî â³ääàëåí³ mts âè-

íèêàëè íà ²²-ìó ï³âð³÷÷³ (ó 8 ïàö³ºíò³â, 44,5%), òà âïðî-

äîâæ 1,5-2 ðîê³â ï³ñëÿ ë³êóâàííÿ (ó 4 ïàö³ºíò³â, 22,2%).

Ðèñ. 5. À,Á. Õâîðèé Ã., 57 ðîê³â. Êë³í³÷íèé ä³àãíîç: Ñà óñ³õ

â³ää³ë³â ãîðòàí³, T4N2M0, ñòàí ÷åðåç ð³ê ï³ñëÿ êîìá³íîâàíîãî

ë³êóâàííÿ. ÌÄÊÒ, àêñ³àëüí³ ñêàíè (À,Á): 1 – mts ó ãîë³âêó

ðåáðà; 2 – ïàðàîññàëüíèé ì’ÿêîòêàíèííèé êîìïîíåíò;

3,4 – mts ó ò³ëî, ïîïåðå÷íèé â³äðîñòîê IV-ãî ãðóäíîãî

õðåáöÿ â³äïîâ³äíî.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

ÐÎËÜ ÌÓËÜÒÈÄÅÒÅÊÒÎÐÍÎÉ ÊÎÌÏÜÞÒÅÐÍÎÉ

ÒÎÌÎÃÐÀÔÈÈ Â ÄÈÀÃÍÎÑÒÈÊÅ ÌÅÒÀÑÒÀÇÎÂ

ÐÀÊÀ ÃÎÐÒÀÍÈ ÏÎÑËÅ ÊÎÌÁÈÍÈÐÎÂÀÍÍÎÃÎ

ËÅ×ÅÍÈß

Ëîãàíèõèíà Ê.Þ., Êîçàðåíêî Ò.Ì.

ÃÓ “Èíñòèòóò ÿäåðíîé ìåäèöèíè è ëó÷åâîé

äèàãíîñòèêè ÍÀÌÍ Óêðàèíû” , ã. Êèåâ, Óêðàèíà

Ðåçþìå. Ðàê ãîðòàíè – îäíà èç íàèáîëåå ÷àñòî âñòðå-

÷àþùèõñÿ íîçîëîãèé, ÿâëÿåòñÿ àêòóàëüíîé ïðîáëåìîé

ñîâðåìåííîé îíêîëîãèè è îòîëàðèíãîëîãèè. Â ñâÿçè ñ

âûñîêîé ÷àñòîòîé âîçíèêíîâåíèÿ ðåãèîíàðíûõ è îòäà-

ëåííûõ ìåòàñòàçîâ ïðè ðàêå ãîðòàíè ïîñëå êîìáèíèðî-

âàííîãî ëå÷åíèÿ, àêòóàëüíûì ÿâëÿåòñÿ ñîîòâåòñò-

âóþùåå óñîâåðùåíñòîâàíèå ìåòîäîâ äèàãíîñòèêè, ñõåìû

ìîíèòîðèíãà; ðàçðàáîòêà ëó÷åâîé ñåìèîòèêè äàííîé íî-

çîëîãèè. Â äàííîé ñòàòüå ïðèâåäåíû ñîâðåìåííûå ïîä-

õîäû ê äèàãíîñòèêå ðåãèîíàðíûõ è îòäàëåííûõ ôîðì

ìåòàñòàçîâ ðàêà ãîðòàíè (âêëþ÷àÿ ðåäêèå ôîðìû); ðàç-

ðàáîòàíû èõ ñåìèîòè÷åñêèå ïðèçíàêè. Ýòî ñïîñîáñòâî-

âàëî ðàííåé äèàãíîñòèêå, ñâîåâðåìåííîé êîððåêöèè

âûáîðà ìåòîäîâ ëå÷åíèÿ òàêèõ áîëüíûõ.

Êëþ÷åâûå ñëîâà: ðàê ãîðòàíè, ìåòàñòàçû ðàêà ãîð-

òàíè, ðåãèîíàðíûå è îòäàëåííûå ìåòàñòàçû, êîìïëåêñ-

íàÿ ìóëüòèäåòåêòîðíàÿ êîìïüþòåðíàÿ òîìîãðàôèÿ,

äèàãíîñòèêà ìåòàñòàçîâ ðàêà ãîðòàíè.

ROLE OF MULTIDETECTED COMPUTER

TOMOGRAPHY IN DIAGNOSIS OF LARYNGEAL

CANCER METASTASES AFTER COMBINED

TREATMENT

Ê. Loganikhina, Ò. Kozarenko

PI “Institute of nuclear medicine and radiation

diagnostics NAMS of Ukraine” , Kyiv, Ukraine

Summary. Cancer of the larynx is one of the most

common diseases and a topical problem of modern

oncology and otolaryngology. Due to the high incidence of

regional and distant metastases of laryngeal cancer after

combined treatment, improving diagnostic methods,

monitoring scheme; elaborating radiation semiotics of this

nosology are actual problem. This article presents modern

approaches to diagnostics of regional and distant

metastases of laryngeal cancer (including rare forms);

elaboration of their semiotic signs. These approaches

contributed to the early diagnosis, timely correction of

methods of treatment of such patients.

Key words: laryngeal cancer, laryngeal cancer

metastases, complex multidetector computed tomography,

diagnosis of metastatic laryngeal cancer, regional and

distant metastases.

Òàêèì ÷èíîì, ³ç 219 îñ³á, ÿêèì áóëî ïðîâåäåíå êîìá³-

íîâàíå ë³êóâàííÿ, ó 98 ïàö³ºíòà (44,75%) âèÿâèëè mts: ó 80

ïàö³ºíò³â (42,0 %) – ðåã³îíàðí³ mts ó øèéí³ ËÂ; ó 18

ïàö³ºíò³â (8,2 %) – â³ääàëåí³ mts ó ëåãåíÿõ òà ïëåâð³, ê³ñòêàõ

ñêåëåòó, ïå÷³íö³, ãîëîâíîìó ìîçêó.

Áóëî ðîçðîáëåíî ÌÄÊÒ-ñåì³îòèêó ðåã³îíàðíèõ òà

â³ääàëåíèõ ìåòàñòàç³â ÐÃ ï³ñëÿ êîìá³íîâàíîãî ë³êóâàííÿ.

Çàñòîñóâàííÿ êîìïëåêñíî¿ ÌÄÊÒ äîçâîëèëî òî÷íî

âèçíà÷èòè íàÿâí³ñòü ðåã³îíàðíèõ òà â³ääàëåíèõ ìåòàñòàç³â

ó õâîðèõ íà ÐÃ ï³ñëÿ êîìá³íîâàíîãî ë³êóâàííÿ; ñêîðèãóâàòè

õ³ä ïîäàëüøîãî ë³êóâàííÿ òàêèõ õâîðèõ.

Âèñíîâêè.

1. Äëÿ ðàííüî¿ ä³àãíîñòèêè ì³ñöåâèõ ðåã³îíàðíèõ òà

â³ääàëåíèõ ìåòàñòàç³â ñë³ä çàñòîñîâóâàòè êîìïëåêñíó

ÌÄÊÒ.

2. Ðåã³îíàðí³ ìåòàñòàçè ï³ñëÿ êîìá³íîâàíîãî ë³êóâàí-

íÿ ðàêó ãîðòàí³ ðîçâèíóëèñÿ ó 36,5 % õâîðèõ; â³ääàëåí³ – ó

8,2 %õâîðèõ, ç ÿêèõ ó 5,5 % – ³ç ëîêàë³çàö³ºþ ó ëåãåíÿõ òà

ïëåâð³, ó 2,7 % âèïàäê³â – ó ê³ñòêàõ ñêåëåòó, ïå÷³íö³, ãîëîâ-

íîìó ìîçêó (ð³äê³ñí³ ïðîÿâè â³ääàëåíèõ ìåòàñòàç³â).

3. Ïåðåâàæíà á³ëüø³ñòü ðåã³îíàðíèõ ìåòàñòàç³â ðàêó

ãîðòàí³ ó ë³ìôàòè÷í³ âóçëè âèíèêàº ïðîòÿãîì ïåðøîãî

ðîêó ï³ñëÿ ë³êóâàííÿ (71,25 %); â³ääàëåíèõ – âïðîäîâæ

äðóãîãî ðîêó ï³ñëÿ ë³êóâàííÿ (44,5 %).

Ðåöåíçåíò: ä.ìåä.í., ïðîôåñîð Ùåïîò³í ².Á.

Ë²ÒÅÐÀÒÓÐÀ

1. 65-ð³÷÷ÿ êèñåòíîãî øâà Î.Ñ. Êîëîìèé÷åíêî: ïåðåâàãè òà

îáìåæåííÿ çàñòîñóâàííÿ / Ð.À. Àáèçîâ, Ë.Â. Ñàâ÷óê, Ñ.Î. Ëàê³çà,

Ñ.Ñ. Ñàìîéëåíêî // Æóðí. âóøíèõ, íîñîâèõ ³ ãîðëîâèõ õâîðîá. –

2008. – ¹ 3. – Ñ. 194.

2. Áàðèëÿê À.Þ. Êë³í³÷í³ òà ìîðôîëîã³÷í³ êðèòåð³¿ ïðî-

ãíîçóâàííÿ ðàíí³õ ìåòàñòàç³â ó õâîðèõ íà ðàê ãîëîñîâîãî ³ âåñ-

òèáóëÿðíîãî â³ää³ë³â ãîðòàí³ : àâòîðåô. äèñ. … êàíä. ìåä. íàóê /

À.Þ. Áàðèëÿê. – Ê., 2006. – 19 ñ.

3. Âàñèëüåâ Ï.Â. Ìóëüòèñïèðàëüíàÿ ðåíòãåíîâñêàÿ êîì-

ïüþòåðíàÿ òîìîãðàôèÿ â äèàãíîñòèêå ðàêà ãîðòàíè è ãîðòà-

íîãëîòêè : àâòîðåô. äèñ. … ä-ðà ìåä. íàóê / Ï.Â. Âàñèëüåâ. – Ì.,

2010. – 39 ñ.

4. Âåðåùàãèíà Î.Å. Äèàãíîñòè÷åñêèå âîçìîæíîñòè ýíäîñ-

êîïèè â ëàðèíãîëîãèè : àâòîðåô. äèñ. … êàíä. ìåä. íàóê /

Î.Å. Âåðåùàãèíà. – ÑÏá., 2010. – 19 ñ.

5. Äèêàí ².Ì. Ðîëü êîìïëåêñíî¿ ìóëüòèäåòåêòîðíî¿ êîìï’-

þòåðíî¿ òîìîãðàô³¿ ó ñòàä³þâàíí³ ðàêó ãîðòàí³ / ².Ì. Äèêàí,

Ò.Ì. Êîçàðåíêî, Ê.Þ. Ëîãàí³õ³íà // Îíêîëîãèÿ. – 2013. – Ò 15, ¹ 1

(55). – Ñ. 63–70.

6. Çàáîëîòíûé Ä.È. Ðîëü ìóëüòèñïèðàëüíîé ÊÒ â êîìïëåê-

ñíîé äèàãíîñòèêå ðàêà è ðåöèäèâà ðàêà ãîðòàíè / Ä.È. Çàáî-

ëîòíûé, Ô.Ä. Åâ÷åâ // Æóðí. âóøíèõ, íîñîâèõ ³ ãîðëîâèõ õâîðîá. –

2007. – ¹ 2. – Ñ. 37–40.

7. Êîçàðåíêî Ò.Ì. Ôóíêö³îíàëüí³ ïðîáè ïðè ìóëüòèäåòåê-

òîðí³é êîìï’þòåðí³é òîìîãðàô³¿ ó õâîðèõ íà ðàê ãîðòàí³ òà

ãîðòàííî¿ ÷àñòèíè ãëîòêè / Ò.Ì. Êîçàðåíêî, Ê.Þ. Ëîãàí³õ³íà,

Å.Â. Ëóêà÷ // Æóðí. âóøíèõ, íîñîâèõ òà ãîðëîâèõ õâîðîá. – 2011. –

¹ 3. – Ñ. 47–51.

8. Ëîãàí³õ³íà Ê.Þ. Ðîëü ìóëüòèäåòåêòîðíî¿ êîìï’þòåðíî¿

òîìîãðàô³¿ ó ä³àãíîñòè÷íîìó ñóïðîâîä³ êîìá³íîâàíîãî ë³êóâàí-

íÿ ðàêó ãîðòàí³ / Ê.Þ. Ëîãàí³õ³íà, Ò.Ì. Êîçàðåíêî // Óêð. íàóê.-

ìåä. ìîëîä³æíèé æóðí. – 2013. – ¹ 3. – Ñ. 27–30.

9. Íàáèåâ À.Ê. Ñðàâíèòåëüíàÿ îöåíêà ìåòîäîâ êîìáèíè-

ðîâàííîãî ëå÷åíèÿ ðàêà ãîðòàíè III ñòàäèè : àâòîðåô. äèñ. ...

êàíä. ìåä. íàóê / À.Ê. Íàáèåâ. – Óôà, 2008. – 22 ñ.

10. Òðåõìåðíàÿ ðåêîíñòðóêöèÿ è âèðòóàëüíàÿ ýíäîñêîïèÿ

çëîêà÷åñòâåííûõ îïóõîëåé ãëîòêè è ãîðòàíè / Â.Í. Ñîêîëîâ,

Ç.Í. Øàâëàäçå, Í.Â. Ïèëèïþê [è äð.] // Ïðîìåíåâà ä³àãíîñòèêà,

ïðîìåíåâà òåðàï³ÿ. – 2010. – ¹ 3–4. – Ñ. 17–22.

11. Dee S.L. Laryngeal metastasis 7 years after radical

nephrectomy / S.L. Dee, M. Eshghi, C.S. Otto // Arch. Pathol. Lab.

Med. – 2000. – V. 124, ¹ 12. – Ð. 1833–1834.

12 . Outcome prediction after surgery and chemoradiation of squ-

amous cell carcinoma in the oral cavity, oropharynx, and hypo-

pharynx: use of baseline perfusion CT microcirculatory parameters

vs. tumor volume / S. Bisdas, S.A. Nguyen, S.K. Anand [et al.] // Int.

J. Radiat. Oncol. Biol. Phys. – 2009. – V. 73, ¹ 5. – Ð. 1313–1318.

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Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

Âñòóï. Çàõâîðþâàí³ñòü íà ðàê òîâñòî¿ êèøêè çáåð³ãàº

òåíäåíö³þ äî çðîñòàííÿ ó âñüîìó ñâ³ò³. Â Óêðà¿í³, çã³äíî

äàíèõ Íàö³îíàëüíîãî êàíöåð-ðåºñòðó, ïðàêòè÷íî

ïîëîâèíà âñ³õ âèïàäê³â çàõâîðþâàííÿ âèÿâëåí³ íà III-IV

ñòàä³¿ çàõâîðþâàííÿ, ùî ïîÿñíþº âèñîêó (36,8%)

äîð³÷íó ëåòàëüí³ñòü ö³º¿ êàòåãîð³¿ õâîðèõ [1]. Âèïðàâèòè

ñèòóàö³þ ìîæå ñâîº÷àñíà ä³àãíîñòèêà ïîâåðõíåâèõ êîëî-

ðåêòàëüíèõ íåîïëàç³é (ÏÊÍ), ç ÿêèõ, ÿê ïðàâèëî, ðîçâè-

âàºòüñÿ êîëî ðåêòàëüíèé ðàê [3]. Êðàùèìè äëÿ ä³àãíîñòè-

êè ÏÊÍ º åíäîñêîï³÷í³ ìåòîäè, â òîé æå ÷àñ íåäîñòàòíüî

âèâ÷åíà ä³àãíîñòè÷íà åôåêòèâí³ñòü â³äåî³ëºîêîëîíîñêîï³¿

(Â²ÊÑ) [2, 4-7].

Ìåòà. Âèâ÷èòè ä³àãíîñòè÷íó åôåêòèâí³ñòü Â²ÊÑ ó

âóçüêîñìóãîâîìó ñïåêòð³ (narrow band imaging, NB²) ç

âèñîêèì çá³ëüøåííÿì äëÿ ä³àãíîñòèêè ÏÊÍ.

Ìàòåð³àëè òà ìåòîäè. Íàìè áóâ ïðîâåäåíèé ðåòðîñ-

ïåêòèâíèé àíàë³ç 187 ïðîòîêîë³â Â²ÊÑ, ùî áóëè âèêîíàí³

ïðîòÿãîì ñåðïíÿ–ãðóäíÿ 2013 ðîêó ó â³ää³ëåíí³

åíäîñêîï³¿ òà ìàëî³íâàçèâíî¿ õ³ðóðã³¿ ìåäè÷íîãî öåíòðó

“Óí³âåðñàëüíà êë³í³êà “Îáåð³ã”. Ó äîñë³äæåíí³ âçÿëè

ó÷àñòü âñüîãî 187 õâîðèõ ó â³ö³ 18-85 ðîê³â (ñåðåäí³é â³ê

51+13 ðîê³â) (ðèñ.1).

Â ãðóï³ ÷îëîâ³ê³â áóëî 94 (50,2%) õâîðèõ

ó â³ö³ 18-76 ðîê³â (ñåðåäí³é â³ê (51+12ðîê³â),

ó ãðóï³ æ³íîê – 93 (49,8%) ó â³ö³ 20-85 ðîê³â

(ñåðåäí³é â³ê (51+13ðîê³â). Ãðóïè ñòàòèñ-

òè÷íî íå âèð³çíÿëèñÿ ó ê³ëüê³ñíîìó ³ â³êî-

âîìó ñêëàä³ (ð>0,05). Âñ³ì õâîðèì áóëè

âèêîíàí³ Â²ÊÑ â ðåæèì³ âèñîêîãî åíäî-

ñêîï³÷íîãî çá³ëüøåííÿ (õ80) ³ NB² (â³äåî-

êîëîíîñêîï Olympus EVIS EXERA III

CF-HQ190L) ç ³íñóôëÿö³ºþ âóãëåêèñëîãî

ãàçó (Åíäîñêîï³÷íèé ³íñóôëÿòîð âóãëåêèñ-

ëîãî ãàçó Olympus UCR), ï³ä çàãàëüíîþ

àíåñòåç³ºþ (ïðîïîôîë) ³ òðàíñíàçàëüíîþ

³íñóôëÿö³ºþ êèñíþ ç ìîí³òîðèíãîì àðòå-

ð³àëüíîãî òèñêó, ïóëüñó ³ ïàðö³àëüíîãî òèñ-

êó êèñíþ â êðîâ³. Äëÿ ÿê³ñíî¿ ï³äãîòîâêè

õâîðèõ äî Â²ÊÑ âèêîðèñòîâóâàëè ñïåö³àëü-

ÓÄÊ 616.345-006-07-089

ÐÎÇÏÎÂÑÞÄÆÅÍ²ÑÒÜ ÏÎÂÅÐÕÍÅÂÈÕ

ÊÎËÎÐÅÊÒÀËÜÍÈÕ ÍÅÎÏËÀÇ²É ÇÀ ÄÀÍÈÌÈ

Â²ÄÅÎ²ËªÎÊÎËÎÍÎÑÊÎÏ²¯ Ó ÂÓÇÜÊÎÌÓ ÑÏÅÊÒÐ²

ÑÂ²ÒËÀ (NBI) Ç ÂÈÑÎÊÈÌ ÇÁ²ËÜØÅÍÍßÌ

Ëóïàðåíêî Â.À.1, ßêîâåíêî Â.Î. 2, Êóðèê Î.Ã. 1,2

1 Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Î.Î. Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

2 Ìåäè÷íèé öåíòð “Óí³âåðñàëüíà êë³í³êà “Îáåð³ã”, ì. Êè¿â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: ïîâåðõíåâ³ êîëîðåêòàëüí³ íåîïëàç³¿, ³ëºîêîëîíîñêîï³ÿ, ³íäåêñ âèÿâëåííÿ ïîâåðõíåâèõ

íåîïëàç³é.

íèé ðåæèì ï³äãîòîâêè: òðè äîáè áåçøëàêîâî¿ ä³ºòè ³ äâîõå-

òàïíèé ïðèéîì ïîë³åòèëåãë³êîëþ (2 ë ââå÷åð³ íàïåðåäîäí³

ïðîöåäóðè ³ 2 ë âðàíö³ çà 4 ãîäèíè äî ïðîöåäóðè ç 30 ìë

ðîç÷èíó ñèìåòèêîíó).

Äëÿ ï³äòâåðäæåííÿ òîòàëüíîãî îãëÿäó òîâñòî¿ êèøêè

îáîâ’ÿçêîâî âèêîíóâàëè ³íòóáàö³þ òåðì³íàëüíîãî â³ää³ëó

çäóõâèííî¿ êèøêè ç ôîòî- ³ â³äåîô³êñàö³ºþ äîñë³äæåííÿ, à

òàêîæ îòðèìóâàëè á³îïñ³éíèé ìàòåð³àë ñëèçîâî¿ îáîëîí-

êè çäóõâèííî¿ êèøêè. Ñëèçîâó îáîëîíêó òîâñòî¿ êèøêè

î÷èùàëè â³ä çàëèøê³â íåïðîçîðî¿ ð³äèíè, ï³íè çà äîïîìî-

ãîþ âèñîêîïðîäóêòèâíî¿ åíäîñêîï³÷íî¿ ïîìïè (Olympus

OFP-2) ³ øâèäê³ñíîãî â³äñìîêòóâà÷à (Olympus KV-5).

Ô³êñóâàëè âñ³ ÏÊÍ, âèÿâëåí³ ï³ä ÷àñ Â²ÊÑ, ¿õ ëîêàë³çàö³þ

³ ê³ëüê³ñòü ÏÊÍ ó îäíîãî õâîðîãî (ðèñ. 2).

Ðåçóëüòàòè òà îáãîâîðåííÿ. Ó 143 õâîðèõ ç 187 (76%;

95% äîâ³ð÷èé ³íòåðâàë, 95% Ä² 70-82%) áóëà âèÿâëåíà 531

ÏÊÍ (òàáë. 1).

Ïðè öüîìó ó ãðóï³ ÷îëîâ³ê³â áóëè âèÿâëåí³ 305 ÏÊÍ

ó 72 (77%; 95% Ä² 69-86%) õâîðèõ, ó ãðóï³ æ³íîê – 225

ÏÊÍ ó 72 (76%; 95% Ä² 67-85%). Ð³çíèöÿ ó ê³ëüêîñò³

âèïàäê³â ÏÊÍ ó ãðóïàõ ÷îëîâ³ê³â ³ æ³íîê ñòàòèñòè÷íî

íåäîñòîâ³ðíà (ð=0,9; c2=0,02; â³äíîøåííÿ øàíñ³â,

Ðèñ.1. Ðîçïîä³ë õâîðèõ çà ñòàòòþ.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

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ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

ÂØ=1,0, 95% Ä²=0,5-2,0). Òîáòî â³äñóòíÿ çàëåæí³ñòü â³ä

ñòàò³ õâîðèõ ó ê³ëüêîñò³ âèïàäê³â ÏÊÍ. ²íäåêñ âèÿâëåííÿ

ÏÊÍ (ê³ëüê³ñòü âèÿâëåíèõ ÏÊÍ ïî â³äíîøåííþ äî

çàãàëüíî¿ ê³ëüêîñò³ îáñòåæåíèõ õâîðèõ) ó âñ³õ

îáñòåæåíèõ õâîðèõ ñêëàâ 2,8. Öåé ïîêàçíèê ó ãðóï³

÷îëîâ³ê³â ñêëàâ 3,2, ó ãðóï³ æ³íîê – 2,4, ð³çíèöÿ

ñòàòèñòè÷íî äîñòîâ³ðíà (ð<0,00001; c2=22,9; ÂØ=1,8,

95% Ä²=1,4-2,3). Òîáòî, âðàõîâóþ÷è, ùî çàëåæí³ñòü â³ä

ñòàò³ õâîðèõ â³äñóòíÿ ó ê³ëüêîñò³ âèïàäê³â ÏÊÍ, ó ãðóï³

÷îëîâ³ê³â ê³ëüê³ñòü ÏÊÍ ó îäíîãî õâîðîãî â³ðîã³äíî

âèùà í³æ ó îäíîãî õâîðîãî â ãðóï³ æ³íîê.

ÏÊÍ äîñòîâ³ðíî ÷àñò³øå (76%) ëîêàë³çóâàëèñÿ ó ë³â³é

÷àñòèí³ òîâñòî¿ êèøêè (ð<0,00001; c2=282,8; ÂØ=9,9, 95%

Ä²=7,6-12,9) (ðèñ. 3).

Âèñíîâêè.

1. Â²ÊÑ ó ðåæèìàõ NBI ³ âèñîêîãî çá³ëüøåííÿ º åôåê-

òèâíîþ ó âèÿâëåíí³ ÏÊÍ. Ó 76% (95% Ä² 70-82%) õâîðèõ

âèÿâëåí³ ÏÊÍ. ²íäåêñ âèÿâëåííÿ ÏÊÍ ñêëàâ 2,84.

2. Â³äñóòíÿ çàëåæí³ñòü â³ä ñòàò³ õâîðèõ ó ê³ëüêîñò³ âè-

ïàäê³â ÏÊÍ (ð=0,9; c2=0,02). Ïðè öüîìó ê³ëüê³ñòü âèÿâëå-

íèõ ÏÊÍ ó îäíîãî õâîðîãî ó ãðóï³ ÷îëîâ³ê³â â³ðîã³äíî

âèùà í³æ ó îäíîãî õâîðîãî â ãðóï³ æ³íîê (ð<0,00001;

c2=22,9).

3. ÏÊÍ ÷àñò³øå âèÿâëÿþòüñÿ ó ë³â³é ïîëîâèí³ òîâñòî¿

êèøêè 76% (ð<0,00001; c2=282,8).

Òàáëèöÿ 1.

×àñòîòà âèÿâëåííÿ ïîâåðõíåâèõ íåîïëàç³é òîâñòî¿ êèøêè çà äàíèìè â³äåî³ëºîêîëîíîñêîï³¿

ó âóçüêîìó ñïåêòð³ ñâ³òëà (NBI) ç âèñîêèì çá³ëüøåííÿì

Ðèñ. 2. Ïîâåðõíåâà íåîïëàç³ÿ ðîçì³ðîì 1,5õ0,8ñì.

Äîñë³äæåííÿ ó á³ëîìó ñâ³òë³.

Õðîìîñêîï³ÿ 3% ðîç÷èíîì îöòîâî¿ êèñëîòè.

Ðîçïîä³ë ê³ëüêîñò³ âèÿâëåíèõ íåîïëàç³é

ïî â³ää³ëàì òîâñòî¿ êèøêè

Ðèñ.3. Ëîêàë³çàö³ÿ âèÿâëåíèõ ïîâåðõíåâèõ íåîïëàç³é

ïî â³ää³ëàõ òîâñòî¿ êèøêè.

4. Íåîáõ³äí³ ïîäàëüø³ äîñë³äæåííÿ â³êîâîãî ðîçïî-

ä³ëó ÏÊÍ, ïîð³âíÿííÿ åíäîñêîï³÷íîãî ³ ìîðôîëîã³÷íîãî

òèïó ÏÊÍ.

Ðåöåíçåíò: ÷ëåí-êîð. ÍÀÌÍ Óêðà¿íè,

ä.ìåä.í., ïðîôåñîð Çàõàðàø Ì.Ï.

Ë²ÒÅÐÀÒÓÐÀ

1. Ðàê â Óêðà¿í³, 2009–2010: çàõâîðþâàí³ñòü, ñìåðòí³ñòü,

ïîêàçíèêè ä³ÿëüíîñò³ îíêîëîã³÷íî¿ ñëóæáè /[ãîë. ðåä. ².Á. Ùåïîò³í]

//Áþë. Íàö.êàíöåð-ðåºñòðó Óêðà¿íè. – 2011. – ¹12. – 100 ñ.

2. Ýíäîñêîïè÷åñêàÿ äèàãíîñòèêà ðàííåãî êîëîðåêòàëüíîãî

ðàêà / Â. È. Íèêèøàåâ, À. Ð. Ïàòèé, È. Í. Òóìàê, È. À. Êîëÿäà //

Óêð. æ. ìàëî³íâ.¿ òà åíäîñêîï³÷íî¿ õ³ðóðã³¿. – 2012. – Ò.16, ¹ 1. –

Ñ. 35–55.

3. Endoscopic classification review group. Update on the Paris

endoscopic classification of superficial neoplastic lesions in the digestive

tract //Endoscopy. – 2005. – Vol.37. – P.570-78.

4. Endoscopic Detection of Proximal Serrated Lesions and

Pathologic Identification of Sessile Serrated Adenomas/Polyps Vary,

Based on Center / S.R. Payne, T.R. Church, M. Wandell [ea all.] // Clin.

Gastroenterol. Hepatol. – 2013. – [Epub ahead of print].

5. Gómez V. Advances in diagnostic and therapeutic colonoscopy

/ V. Gómez, M.B. Wallace // Curr. Opin. Gastroenterol. – 2014. – Vol.

30(1). – P. 63-68.

6. Image-enhanced, chromo, and cap-assisted colonoscopy for

improving adenoma/neoplasia detection rate: a systematic review

and meta-analysis / F. Omata, S. Ohde, G.A. Deshpande [ea all.] //

Scand. J. Gastroenterol. – 2013. – [Epub ahead of print].

7. Serrated and Adenomatous Polyp Detection Increases With

Longer Withdrawal Time: Results From the New Hampshire

Colonoscopy Registry / L. Butterly, C.M. Robinson, J.C. Anderson [et

all.] // Am. J. Gastroenterol. –2014. – [Epub ahead of print].

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Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

ÐÀÑÏÐÎÑÒÐÀÍÅÍÍÎÑÒÜ ÏÎÂÅÐÕÍÎÑÒÍÛÕ

ÊÎËÎÐÅÊÒÀËÜÍÛÕ ÍÅÎÏËÀÇÈÉ ÏÎ ÄÀÍÍÛÌ

ÂÈÄÅÎÈËÅÎÊÎËÎÍÎÑÊÎÏÈÈ Â ÓÇÊÎÌ ÑÏÅÊÒÐÅ

ÑÂÅÒÀ (NBI) Ñ ÂÛÑÎÊÈÌ ÓÂÅËÈ×ÅÍÈÅÌ

Ëóïàðåíêî Â.À.1 , ßêîâåíêî Â.À. 2 , Êóðèê Å.Ã. 1,2

1Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò

Î.Î. Áîãîìîëüöà, ã. Êèåâ, Óêðàèíà

2Ìåäèöèíñêèé öåíòð “Óíèâåðñàëüíàÿ êëèíèêà

“Îáåðèã”, ã. Êèåâ, Óêðàèíà

Ðåçþìå. Âèäåîèëåîêîëîíîñêîïèÿ â ðåæèìàõ NBI è

âûñîêîãî óâåëè÷åíèÿ ÿâëÿåòñÿ ýôôåêòèâíîé â

âûÿâëåíèè ïîâåðõíîñòíûõ êîëîðåêòàëüíûõ íåîïëàçèé

(ÏÊÍ). ÏÊÍ áûëè âûÿâëåíû ó 76% áîëüíûõ (95% ÄÈ 70-

82%), èíäåêñ îáíàðóæåíèÿ ñîñòàâèë 2,84. Îòñóòñòâóåò

çàâèñèìîñòü îò ïîëà áîëüíûõ â êîëè÷åñòâå ñëó÷àåâ ÏÊÍ

(ð=0,9; c2=0,02). Ïðè ýòîì êîëè÷åñòâî âûÿâëåííûõ ÏÊÍ ó

îäíîãî áîëüíîãî â ãðóïïå ìóæ÷èí äîñòîâåðíî âûøå, ÷åì

ó îäíîãî áîëüíîãî â ãðóïïå æåíùèí (ð<0,00001; c2=22,9).

ÏÊÍ ÷àùå ëîêàëèçóþòñÿ â ëåâîé ïîëîâèíå òîëñòîé

êèøêè 76 % (ð<0,00001; c2=282,8).

Íåîáõîäèìû äàëüíåéøèå èññëåäîâàíèÿ âîçðàñòíî-

ãî ðàñïðåäåëåíèÿ ÏÊÍ, ñðàâíåíèÿ ýíäîñêîïè÷åñêîãî è

ìîðôîëîãè÷åñêîãî òèïà ÏÊÍ.

Êëþ÷åâûå ñëîâà: ïîâåðõíîñòíûå êîëîðåêòàëüíûå

íåîïëàçèè, èëåîêîëîíîñêîïèÿ, èíäåêñ âûÿâëåíèÿ

ïîâåðõíîñòíûõ íåîïëàçèé.

PREVALENCE OF SUPERFICIAL COLORECTAL

NEOPLASIA ON THE RESULTS

OF VIDEOILEOCOLONOSCOPY WITH NARROW

BAND IMAGING (NBI) AND HIGH MAGNIFICATION

V.A. Luparenko1 , V.O. Yakovenko2, O.G. Kyryk1,2

1Bogomolets National Medical University,

Kyiv, Ukraine

2Ìedical centre “Oberig”, Kyiv, Ukraine

Summary. Videoileocolonoscopy with NBI and high

magnification mode is effective in identifying the superficial

colorectal neoplasia (SCN). SCN were detected in 76% of

patients (95% CI 70-82 %). SCN detection index was 2.84

No dependence on the sex of patients in the number of

SCN cases (p=0,9; c2=0.02) was revealed. The whole

number of identified SCN in one patient in the group of men

was significantly higher than in the group of women

(p<0,00001; c2=22.9). SCN is often localized in the left half

of colon 76 % (p<0,00001; c2=282.8).

Further research is needed to assess age distribution

of SCN cases and compare endoscopic and morphological

type of SCN.

Key words: superficial colorectal neoplasia, ileocolono-

scopy, superficial neoplasia detection index.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

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Âñòóï. Àðòåð³àëüíà ã³ïåðòåíç³ÿ (ÀÃ) º îäíèì ³ç íàéá³ëüø

ïîøèðåíèõ ³ òÿæêèõ çà ïðîãíîçîì çàõâîðþâàííÿì ñåðöåâî-

ñóäèííî¿ ñèñòåìè ³ âíîñèòü ñóòòºâèé âêëàä ó ðîçâèòîê ³øåì-

³÷íî¿ õâîðîáè ñåðöÿ, öåðåáðîâàñêóëÿðíî¿ ïàòîëîã³¿.

Â Óêðà¿í³ ÀÃ ä³àãíîñòîâàíî ìàéæå ó òðåòèíè äîðîñëî-

ãî íàñåëåííÿ [1]. Íåñâîº÷àñí³ ä³àãíîñòèêà ³ ë³êóâàííÿ îáó-

ìîâëþþòü òå, ùî ñìåðòí³ñòü â³ä õâîðîá ñèñòåìè êðîâî-

îá³ãó â Óêðà¿í³ ïåðåâèùóº ñåðåäíüîºâðîïåéñüêèé

ïîêàçíèê âäâ³÷³, à êðà¿í ªâðîñîþçó – â 3,6 ðàçè [2].

Íà äàíèé ÷àñ ÀÃ ïðîãðåñèâíî “ìîëîäøàº”. Òàê, äîñ-

ë³äæåííÿ ïðîâåäåí³ â ªâðîï³ òà ÑØÀ ïîêàçàëè, ùî ïîêàç-

íèê çàõâîðþâàíîñò³ ä³òåé ³ ï³äë³òê³â íà ÀÃ êîëèâàºòüñÿ â

ìåæàõ 1-4% [3].

Òåðìií “àðòåð³àëüíà ãiïåðòåíçiÿ” âæèâàºòüñÿ äëÿ ïî-

çíà÷åííÿ ñò³éêîãî ï³äâèùåííÿ àðòåðiàëüíîãî òèñêó (ÀÒ)

áóäü-ÿêîãî ïîõîäæåííÿ â îñ³á, ÿê³ íå ïðèéìàþòü àíòè-

ã³ïåðòåíçèâíîãî ë³êóâàííÿ. Äî ÀÃ òàêîæ â³äíîñÿòü ñòàíè,

êîëè “íîðìàëüíèé” ÀÒ ï³äòðèìóºòüñÿ ðåãóëÿðíèì

ïðèéîìîì àíòèã³ïåðòåíçèâíèõ ïðåïàðàò³â. Â êëàñèô³êàö³¿

ÀÃ ó ä³òåé âèä³ëÿþòü ëàá³ëüíó ÀÃ (ËÀÃ), ñòàá³ëüíó ÀÃ

(ÑÀÃ) òà ã³ïåðòîí³÷íó õâîðîáó (ÃÕ) [4].

ÀÃ ó ä³òåé ïîä³ëÿþòü íà ïåðâèííó (åñåíö³àëüíó) òà âòî-

ðèííó (ñèìïòîìàòè÷íó). Íàé÷àñò³øèìè ïðè÷èíàìè âòî-

ðèííî¿ ÀÃ ó ä³òåé º ðåíîâàñêóëÿðí³, ðåíîïàðåíõ³ìàòîçí³

çàõâîðþâàííÿ òà êîàðêòàö³ÿ àîðòè – áëèçüêî 70-90% [5].

Ó ï³äë³òê³â ïåðåâàæíî â³äì³÷àºòüñÿ ïåðâèííà ÀÃ ßê

â³äîìî, äî ôàêòîð³â ðèçèêó ïåðâèííî¿ ÀÃ â³äíîñÿòü åìî-

ö³éíå ïåðåíàïðóæåííÿ, íàäëèøêîâó ìàñó ò³ëà, íàäì³ðíå

ñïîæèâàííÿ êóõîííî¿ ñîë³, àêòèâíå êóð³ííÿ, îñîáëèâîñò³

îáì³íó ðå÷îâèí (ã³ïåðóðèêåì³þ, íèçüêó òîëåðàíòí³ñòü äî

ãëþêîçè, ïîðóøåííÿ ñï³ââ³äíîøåííÿ ôðàêö³é õîëåñòåðè-

íó), ñïàäêîâó îáóìîâëåí³ñòü [4].

Íèí³ çàãàëüíîïðèéíÿòèì êðèòåð³ºì ÀÃ ó äîðîñëèõ º

ð³âåíü ÑÀÒ >140 ìì. ðò. ñò. ³/÷è ÄÀÒ>90 ìì. ðò. ñò. Âåëè÷è-

íà ÀÒ ó ä³òåé ô³ç³îëîã³÷íî íèæ÷à, í³æ ó äîðîñëèõ. Öå çó-

ìîâëåíî ìåíøîþ ñêîðîòëèâîþ çäàòí³ñòþ ñåðöÿ, â³äíîñ-

íî á³ëüøèì ïðîñâ³òîì àðòåð³é ³ íåäîñòàòí³ì ðîçâèòêîì

åëàñòè÷íèõ âîëîêîí àðòåð³é. Òîìó, ³ ÀÃ ó ä³òåé ä³àãíîñòó-

þòü ïðè íèæ÷èõ ïîêàçíèêàõ ÀÒ. Äëÿ ïðàêòè÷íîãî çàñòî-

ñóâàííÿ ó ä³àãíîñòèö³ ñòóïåíÿ ÀÃ ó ä³òåé êîðèñòóþòüñÿ

Êðèòåð³ÿìè ªâðîïåéñüêîãî òîâàðèñòâà ã³ïåðòåíç³¿, ïðèé-

íÿòèìè ó 2009 ðîö³ [6].

Íåçâàæàþ÷è íà ñóòòºâ³ çðóøåííÿ ó âèâ÷åíí³ åò³îëîã³¿

òà ïàòîãåíåçó çàõâîðþâàííÿ, çàëèøàºòüñÿ âåëèêîþ ïðî-

áëåìîþ ðàííÿ ä³àãíîñòèêà ÀÃ. ×àñòî ä³àãíîç âñòàíîâëþ-

ÓÄÊ 616.839 008.6 053.5/.6

ÒÎÂÙÈÍÀ ÊÎÌÏËÅÊÑÓ ²ÍÒÈÌÀ-ÌÅÄ²À

ÇÀÃÀËÜÍÎ¯ ÑÎÍÍÎ¯ ÀÐÒÅÐ²¯ Ó Ä²ÒÅÉ

Ç ÀÐÒÅÐ²ÀËÜÍÎÞ Ã²ÏÅÐÒÅÍÇ²ªÞ

Ìàíäðèêà Þ.Ð., Õàéòîâè÷ Ì.Â., Òåðëåöüêèé Ð.Â., Ì³ñþðà Ë.².

Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Î.Î. Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: àðòåð³àëüíà ã³ïåðòåíç³ÿ, ä³òè, ä³àãíîñòèêà, àðòåð³àëüíèé òèñê, êàðîòèäíèé êîìïëåêñ ³íòèìà-ìåä³à

þòü ëèøå ïðè óðàæåíí³ îðãàí³â-ì³øåíåé. Ó Ðåêîìåíäà-

ö³ÿõ ç Àðòåð³àëüíî¿ ã³ïåðòåíç³¿ â³ä 2013 ðîêó, ÿê³ ðîçðîá-

ëåí³ ªâðîïåéñüêèì òîâàðèñòâîì ã³ïåðòåíç³¿ (ESH) òà

ªâðîïåéñüêèì êàðä³îëîã³÷íèì òîâàðèñòâîì (ESC), âêàçà-

íà ä³àãíîñòè÷íà ³íôîðìàòèâí³ñòü, â³äòâîðþâàí³ñòü, åêî-

íîì³÷íà äîö³ëüí³ñòü òà äîñòóïí³ñòü ðÿäó ìàðêåð³â áåç-

ñèìïòîìíîãî óðàæåííÿ îðãàí³â-ì³øåíåé ïðè ÀÃ. Ñåðåä

íèõ çâåðòàº îñîáëèâó óâàãó çà âèñîêèì çíà÷åííÿì êîæíî-

ãî ïîêàçíèêà ïðè äîñèòü íåçíà÷íèõ åêîíîì³÷íèõ âèòðàòàõ,

ïîêàçíèê òîâùèíè êîìïëåêñó ³íòèìà-ìåä³à çàãàëüíî¿ ñîí-

íî¿ àðòåð³¿ (Ê²Ì ÇÑÀ) [7].

Ìåòà ðîáîòè. Âèçíà÷èòè îñîáëèâîñò³ òîâùèíè Ê²Ì

ÇÑÀ ó ä³òåé ç ÀÃ.

Ìàòåð³àëè òà ìåòîäè. Áóëî äîñë³äæåíî 33 äèòèíè. Ñå-

ðåä îáñòåæåíèõ: 22 õëîï÷èêè â³êîì 12-18 ðîê³â (â ñåðåäíüî-

ìó 15,45±0,45 ð.) òà 11 ä³â÷àòîê â³êîì 9-17 ðîê³â (â ñåðåäíüî-

ìó 13,8±0,73 ð.). Óñ³õ äîñë³äæóâàíèõ áóëî ïîä³ëåíî íà äâ³

ãðóïè: äî 1-î¿ ãðóïè â³äíåñåíî 24 äèòèíè, äî 2-î¿ – 9 ä³òåé. Ó

âñ³õ ä³òåé 1-î¿ ãðóïè çà äàíèìè äîáîâîãî ìîí³òîðóâàííÿ ÀÒ

áóëà ä³àãíîñòîâàíî ÀÃ (ó 16 – ñòàá³ëüíó ôîðìó, ó 8 – ëà-

á³ëüíó ôîðìó). Äðóãó ãðóïó (ãðóïà êîíòðîëþ) ñêëàëè ä³òè

â³äïîâ³äíîãî â³êó ç ïîêàçíèêàìè ÀÒ â ìåæàõ íîðìè.

Îö³íêó ÀÒ ïðîâîäèëè ìåòîäàìè ðàçîâîãî âèì³ðþâàí-

íÿ òà äîáîâîãî ìîí³òîðóâàííÿ. Çàñòîñîâóâàëè ìîí³òîðè

àðòåð³àëüíîãî òèñêó “ABMP-04/M” ô³ðìè “MEDITECH”

(Óãîðùèíà).

Âèçíà÷åííÿ òîâùèíè Ê²Ì ïðîâîäèëè íà àïàðàò³

ALOKA SSD-5000 ProSound PHD (ßïîí³ÿ). Ìåòîäîì äóï-

ëåêñíîãî ñêàíóâàííÿ ë³í³éíèì äàò÷èêîì â Â-ðåæèì³ ³ç

÷àñòîòîþ â³ä 7 äî 13 ÌÃö ïî ïðàâ³é òà ë³â³é ïåðåäí³é ïî-

âåðõí³ øè¿, â ïîëîæåíí³ ïàö³ºíòà ëåæà÷è íà ñïèí³, ïðîâî-

äèëè óëüòðàñîíîãðàô³÷í³ äîñë³äæåííÿ çàãàëüíèõ ñîííèõ

(ÇÑÀ), âíóòð³øí³õ ñîííèõ àðòåð³é â åêñòðàêðàí³àëüíèõ

ñåãìåíòàõ (ÂÑÀ) ³ çîâí³øí³õ ñîííèõ àðòåð³é (ÇâÑÀ). Ó ðå-

æèì³ “online” îö³íþâàâñÿ õ³ä ñîííèõ àðòåð³é, ñòàí ïðî-

ñâ³òó, ê³ëüê³ñí³ òà ÿê³ñí³ ïîêàçíèêè êðîâîòîêó çà äàíèìè

äîïëåðîãðàô³¿ íà ä³ëÿíêàõ, äîñòóïíèõ äëÿ â³çóàë³çàö³¿.

Âèì³ðþâàííÿ òîâùèíè Ê²Ì ïðîâîäèëè â ðåæèì³

“offline” íà çîáðàæåííÿõ äîñë³äæóâàíèõ àðòåð³é. Ê²Ì âèç-

íà÷àëè íà çàäí³é, â³ääàëåí³é â³ä äàò÷èêà, ñò³íö³ ñóäèíè, ³

ðîçðàõîâóâàëè ÿê â³äñòàíü â³ä ìåæ³ ïîä³ëó ³íòèìè ç ïðî-

ñâ³òîì ñóäèíè äî ìåæ³ ì³æ ìåä³ºþ òà àäâåíòèö³ºþ [9].

Çà íîðìàòèâí³ Ê²Ì ÇÑÀ âèêîðèñòîâóâàëè ðåçóëüòàòè

îäíîìîìåíòíîãî ïîãëèáëåíîãî äîñë³äæåííÿ 247 çäîðî-

âèõ ï³äë³òê³â – 0,45 ìì äî 0,56 ìì. [8].

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

Îòðèìàí³ äàí³ îáðîáëÿëè ñòàòèñòè÷íî ç âèêîðèñòàííÿì

ïðîãðàìè Excel 2003. Çàñòîñóâàëè âàð³àö³éíó ñòàòèñòèêó, òàê

êîðåëÿö³éíèé àíàë³ç. Çíà÷åííÿ Ð<0,05 ââàæàëè äî ñòîâ³ðíèì.

Ðåçóëüòàòè òà îáãîâîðåííÿ.

Âñòàíîâëåíî, ùî ó ä³òåé, õâîðèõ íà ÀÃ, ïîêàçíèê âåëè-

÷èíè Ê²Ì áóâ â ñåðåäíüîìó äîñòîâ³ðíî âèùèé, í³æ ó ä³òåé

êîíòðîëüíî¿ ãðóïè (òàáëèöÿ 1). Òàê, òîâùèíà Ê²Ì ë³âî¿ ÇÑÀ

ó ä³àñòîë³ ó ä³òåé äîñë³äíî¿ ãðóïè ñòàíîâèëà 0,717±0,161 ìì

ïðîòè 0,422±0,044 ìì ó ä³òåé ãðóïè êîíòðîëþ; ð<0,001; ïðà-

âî¿ – â³äïîâ³äíî 0,758±0,204 ìì ïðîòè 0,478±0,067; ð<0,001.

²íø³ ïîêàçíèêè äîïïëåðîãðàô³¿ ñóäèí øè¿ ñóòòºâî ó ä³òåé

äîñë³äíî¿ òà êîíòðîëüíî¿ ãðóï íå â³äð³çíÿëèñü.

Ïðè ïîð³âíÿíí³ âåëè÷èí òîâùèíè Ê²Ì ÇÑÀ ó ä³òåé ç

ëàá³ëüíîþ ôîðìîþ ÀÃ òà ó ä³òåé ³ç ñòàá³ëüíîþ ôîðìîþ

ÀÃ îòðèìàí³ ðåçóëüòàòè ñóòòºâî íå â³äð³çíÿëèñÿ

(0,73±0,18 ìì òà 0,74±0,17 ìì).

Îòðèìàí³ ðåçóëüòàòè ó 1-é òà 2-é ãðóïàõ äîñë³äæóâàíèõ

ä³òåé òàêîæ ïîð³âíþâàëè ç ðåêîìåíäîâàíèìè íîðìàòèâ-

íèìè çíà÷åííÿìè. Ñåðåä õâîðèõ íà ÀÃ òîâùèíà Ê²Ì áóëà

â íîðì³ ó 2 ä³òåé (8,3%), ó ðåøòè 22 ä³òåé (91,7%) – çíà÷íî

ïåðåâèùóâàëà íîðìàòèâí³ çíà÷åííÿ. Çàãàëîì, òîâùèíà

Ê²Ì ó ãðóï³ ä³òåé ç ÀÃ â ñåðåäíüîìó ó 1,35 ðàçè áóëà

á³ëüøîþ çà íîðìàòèâí³ çíà÷åííÿ.

Ó ä³òåé ç ÀÃ âñòàíîâëåíî äîñòîâ³ðíèé (ð<0,05) êîðåëÿ-

ö³éíèé çâ’ÿçîê (òàáëèöÿ 2) ì³æ ñåðåäíüîí³÷íèì ñèñòîë³÷-

íèì àðòåð³àëüíèì òèñêîì ³ òîâùèíîþ ë³âîãî êàðîòèäíîãî

Ê²Ì (r=0,55; P<0,05).

Ðåçóëüòàòè íàøîãî äîñë³äæåííÿ â³äïîâ³äàþòü ðåçóëü-

òàòàì, ÿê³ îïóáë³êîâàí³ çà îñòàíí³ ðîêè. Òàê, çà ðåçóëüòàòà-

ìè 4 ïðîñïåêòèâíèõ äîñë³äæåíü ³ç çàãàëüíîþ ê³ëüê³ñòþ

ó÷àñíèê³â 4210, ïîêàçàíî, ùî ï³äâèùåíèé ÀÒ â äèòÿ÷îìó

³ ï³äë³òêîâîìó â³ö³ àñîö³þºòüñÿ ³ç ðèçèêîì ðîçâèòêó êàðî-

òèäíîãî àòåðîñêëåðîçó, ùî ñóïðîâîäæóºòüñÿ ïîòîâùåí-

íÿì ë³âîãî êàðîòèäíîãî Ê²Ì [10].

ßê âæå áóëî â³äì³÷åíî, íàäëèøêîâà ìàñà ò³ëà òà

øê³äëèâ³ çâè÷êè º ôàêòîðàìè ðèçèêó ÀÃ. Äîâåäåíî, ùî

êàðîòèäíèé Ê²Ì íåçàëåæíî â³ä àðòåð³àëüíîãî òèñêó ó

ä³òåé âèùèé ó ä³òåé ³ç îæèð³ííÿì [11] òà ó ï³äë³òê³â, ÿê³

àêòèâíî êóðÿòü [12]. Äîñë³äæåííÿ 202 ä³òåé â³êîì 4–15

ðîê³â ïîêàçàëî íåâèñîêèé, àëå äîñòîâ³ðíèé (P<0,05) êîðå-

ëÿö³éíèé çâ’ÿçîê ì³æ òîâùèíîþ êàðîòèäíîãî Ê²Ì ³ â³êîì

(r=0,229), ìàñîþ ò³ëà (r=0,265), çðîñòîì (r=0,265), ³íäåêñîì

ìàñè ò³ëà (r=0,212) [13]. Ñåðåäí³é îá’ºì òðîìáîöèò³â ³ òîâ-

ùèíà ë³âîãî êàðîòèäíîãî Ê²Ì á³ëüø³ ó ä³òåé ³ç îæè-

ð³ííÿì, í³æ ó çäîðîâîãî êîíòðîëþ. Äîâåäåíî ïîçèòèâíèé

êîðåëÿö³éíèé çâ’ÿçîê ì³æ òîâùèíîþ ë³âîãî Ê²Ì ³ ³íñóë³íî-

ðåçèñòåíòí³ñòþ, çàãàëüíèì õîëåñòåðèíîì [14].

Âèñíîâêè.

Îòæå, íåçàëåæíî â³ä õàðàêòåðó ïåðåá³ãó çàõâîðþâàí-

íÿ (ëàá³ëüíà ÷è ñòàá³ëüíà ÀÃ) ó ï³äë³òê³â ³ç ÀÃ â³äì³÷àºòü-

ñÿ ïîòîâùåííÿ êàðîòèäíîãî êîìïëåêñó ³íòèìà-ìåä³à.

Â³äì³÷åíà ïðÿìà êîðåëÿö³éíà çàëåæí³ñòü ì³æ òîâùèíîþ

êàðîòèäíîãî êîìïëåêñó ³íòèìà-ìåä³à ³ ñåðåäíüîí³÷íèì

ñèñòîë³÷íèì àðòåð³àëüíèì òèñêîì (r = 0,55, P <0,05).

Ðåöåíçåíò: ÷ëåí-êîð. ÍÀÌÍ Óêðà¿íè, ä.ìåä.í.,

ïðîôåñîð Âîëîñîâåöü Î.Ï.

Ë²ÒÅÐÀÒÓÐÀ

1. Êîðåíºâ Ì.Ì., Áîãìàò Ë.Ô. òà ³í. Ë³êóâàííÿ òà ïðîô³-

ëàêòèêà ôîðìóâàííÿ óñêëàäíåíü ó ï³äë³òê³â ³ç àðòåð³àëüíîþ ã³ïåð-

òåíç³ºþ (Ìåòîäè÷í³ ðåêîìåíäàö³¿) – Êè¿â, 2009. – 25 ñ.

2. Ãàéäàºâ Þ.Î., Êîðíàöüêèé Â.Ì. Ïðîáëåìè çäîðîâ’ÿ òà

íàïðÿìêè éîãî ïîêðàùàííÿ â ñó÷àñíèõ óìîâàõ // Óêðà¿íñüêèé êàð-

ä³îëîã³÷íèé æóðíàë. – 2007. – ¹ 5. – Ñ. 12–16.

3. Kollias A. Hypertension in children and adolescents // World

J Hypertens. 2011 December 23; 1(1): 15-19.

4. Ïåðâèííà àðòåð³àëüíà ã³ïåðòåíç³ÿ ó ä³òåé òà ï³äë³òê³â

[Òåêñò] /Çà ðåä. Â.Ã. Ìàéäàííèêà òà Â.Ô. Ìîñêàëåíêà Ê. 2007.- 390 ñ.

5. ²âàíîâ Ä.Ä., ²âàíîâà Ò.Ï. Àðòåð³àëüíà ã³ïåðòåíç³ÿ ó ä³òåé.

Êàðä³îðåíàëüí³ ñèíäðîìè // Ñîâðåìåííàÿïåäèàòðèÿ 2(36)/2011.

6. Êîíòðîëü âèñîêîãî àðòåð³àëüíîãî äàâëåíèÿ ó äåòåé è

ïîäðîñòêîâ: ðåêîìåíäàöèè Åâðîïåéñêîãî îáùåñòâà ãèïåðòåí-

çèè // Àðòåðèàëüíàÿ ãèïåðòåíçèÿ. – 2009. – 6 (8). Modeofaccess:

http://www.mif-ua.com/archive/article/11058. Titlefromthescreen.

7. 2013 ESH/ESC Guidelines for them anagementof arterial hyper-

tension. Modeofaccess:http://www.esh2013.org/wordpress/wp-content/

uploads/2013/06/ESC-ESH-Guidelines-2013.pdf. Titlefromthescreen.

8. Jourdan C, Wühl E. Normativevaluesfor intima-media thickness

and distensibility of large arteriesin healthy adolescents. J Hypertens.

2005 Sep;23(9):1707-15.

9. Pignoli P., Tremoli E. Intimalplus medial thick

nessofthearterial wall: a direct measurement with ultrasoundimaging

Circulation. 1986. V74. P.1399–1406.

10. Juhola J., Magnussen C.G., Berenson G.S. etal. Combined

effects of child and adult elevated blood pressure on subclinical

atherosclerosis: the International Childhood Cardiovascular Cohort

Consortium. Circulation. 2013 Jul 16;128(3):217-24.

11. Stabouli S., Kotsis V., Karagianni C., Zakopoulos N.,

Konstantopoulos A.Blood pressure and carotidartery intima-media

thickness in children and adolescents: the role of obesity.Hellenic

J Cardiol. 2012 Jan-Feb;53(1):41-7

12. Dratva J., Probst-Hensch N., Schmidt-Trucksäss A. etal.

Atherogenesis in youth–early consequence of adolescent smoking.

Atherosclerosis. 2013 Oct; 230 (2): 304-9.

13. deArribaMuñoz A., Domínguez Cajal M.M., Labarta Aizpún

J.I. etal. Carotid intima-media thickness; normal values from 4 years.

NutrHosp. 2013 Jul-Aug;28(4):1171-6.

14. Arslan N., Makay B., Hýzlý S. etal. Assessment of athe-

rosclerosis in obese adolescents: positive correlation of meanplatelet

volumeand carotid intima media thickness. J PaediatrChildHealth.

2013 Nov;49(11):963-8.

Òàáëèöÿ 2.

Êîðåëÿö³éíèé àíàë³ç ì³æ òîâùèíîþ ë³âîãî êàðîòèäíîãî

êîìïëåêñó ³íòèìà-ìåä³à òà ïàðàìåòðàìè äîáîâîãî

ïðîô³ëþ àðòåð³àëüíîãî òèñêó

Òàáëèöÿ 1.

Ñåðåäí³ (X±SD) ïîêàçíèêè òîâùèíè êàðîòèäíîãî

êîìïëåêñó ³íòèìà-ìåä³à ó ï³äë³òê³â

³ç ÀÃ òà ï³äë³òê³â êîíòðîëüíî¿ ãðóïè

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

ÒÎËÙÈÍÀ ÊÎÌÏËÅÊÑÀ ÈÍÒÈÌÀ-ÌÅÄÈÀ

ÎÁÙÅÉ ÑÎÍÍÎÉ ÀÐÒÅÐÈÈ Ó ÄÅÒÅÉ

Ñ ÀÐÒÅÐÈÀËÜÍÎÉ ÃÈÏÅÐÒÅÍÇÈÅÉ

Ìàíäðûêà Þ.Ð., Õàéòîâè÷ Í.Â.,

Òåðëåöüêèé Ð.Â., Ìèñþðà Ë.È.

Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò

èìåíè À.À. Áîãîìîëüöà, ã.Êèåâ, Óêðàèíà

Ðåçþìå. Ó ïîäàâëÿþùåãî áîëüøèíñòâà (91,7%) ïîä-

ðîñòêîâ ñ àðòåðèàëüíîé ãèïåðòåíçèåé íå çàâèñèìî îò

òå÷åíèÿ çàáîëåâàíèÿ (ëàáèëüíîå èëè ñòàáèëüíîå) âû-

ÿâëåíî óòîëùåíèå êàðîòèäíîãî êîìïëåêñà èíòèìà-ìå-

äèà (ÊÈÌ), â ñðåäíåì â 1,35 ðàçà ïðåâûøàþùåå íîðìà-

òèâíûå çíà÷åíèÿ. Îòìå÷åíà ïðÿìàÿ êîððåëÿöèîííàÿ

çàâèñèìîñòü ìåæäó òîëùèíîé êàðîòèäíîãî ÊÈÌ è ñðåä-

íåíî÷íûì ñèñòîëè÷åñêèì àðòåðèàëüíûì äàâëåíèåì

(r=0,55, P<0,05).

Êëþ÷åâûå ñëîâà: àðòåðèàëüíàÿ ãèïåðòåíçèÿ, äåòè,

äèàãíîñòèêà, àðòåðèàëüíîå äàâëåíèå, êàðîòèäíûé êîìï-

ëåêñ èíòèìà-ìåäèà.

THE THICKNESS OF THE CAROTID INTIMA-MEDIA

COMPLEX OF THE COMMON CAROTID ARTERY

IN CHILDREN WITH HYPERTENSION

G. Mandryka, N. Khaytovych, R Terletskyi, L. Misyura

Bogomolets National Medical University, Kyiv, Ukraine

Summary. The vast majority (91.7%) of teenagers with

hypertension regardless of the disease (stable or labile)

revealed thickening of the carotid intima-media complex

(IMC). There was a positive correlation between the

thickness of the carotid IMC and average daily blood

pressure (r = 0,55, P <0,05).

Key words: hypertension, children, diagnostics,

bloodpressure, carotid intima-media complex.

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

Âñòóï. Åíäîìåòð³îç – îäíå ç íàéá³ëüø ïîøèðåíèõ

ã³íåêîëîã³÷íèõ çàõâîðþâàíü, ÿêå çíàõîäèòüñÿ íà òðåòüîìó

ì³ñö³ ï³ñëÿ çàïàëüíèõ ïðîöåñ³â ³ ì³îìè ìàòêè. Öå çàõâîðþ-

âàííÿ âðàæàº æ³íîê ïåðåâàæíî ðåïðîäóêòèâíîãî â³êó,

ìîæå ìàòè ñåðéîçí³ óñêëàäíåííÿ, à òàêîæ áóòè äæåðåëîì

ðîçâèòêó ðàêó [1, 10]. Åíäîìåòð³îç ïðèçâîäèòü äî ôóíêö³-

îíàëüíèõ ³ ñòðóêòóðíèõ çì³í â ðåïðîäóêòèâí³é ñèñòåì³,

íåãàòèâíî âïëèâàº íà ïñèõîåìîö³éíèé ñòàí æ³íêè, ñóòòº-

âî çíèæóº ÿê³ñòü æèòòÿ. Îòæå, åíäîìåòð³îç º âàæëèâîþ

ìåäèêî-ñîö³àëüíîþ ïðîáëåìîþ, ÿêà ïîòðåáóº ïîäàëüøî-

ãî âèâ÷åííÿ.

Ñó÷àñí³ äàí³ ïðî ìîëåêóëÿðíî-ãåíåòè÷í³ îñîáëèâîñò³

ð³çíèõ âàð³àíò³â åíäîìåòð³î³äíèõ óðàæåíü äàþòü ìîæ-

ëèâ³ñòü ðîçãëÿäàòè åíäîìåòð³îç ÿê õðîí³÷íå çàõâîðþâàííÿ

ç îçíàêàìè àâòîíîìíîãî ðîñòó ãåòåðîòîï³é, ç ïîðóøåí-

íÿì á³îëîã³÷íî¿ àêòèâíîñò³ êë³òèí åíäîìåòð³ÿ [2, 3]. Àâòî-

íîìíèé ð³ñò âîãíèù åíäîìåòð³îçà îçíà÷àº â³äñóòí³ñòü

êîíòðîëþ ïðîë³ôåðàö³¿ ³ äèôåðåíö³þâàííÿ êë³òèí, ÿê³ ïå-

ðåõîäÿòü íà ³íòðà-, àóòî- ³ ïàðàêðèííèé ìåõàí³çìè ðåãó-

ëþâàííÿ ñâîãî ðîñòó [9]. Âîíè ñòàþòü áåçïîñåðåäí³ìè

ïðîäóöåíòàìè ôàêòîð³â ðîñòà, öèòîê³í³â, îíêîãåí³â ïðè

â³äñóòíîñò³ åêñïðåñ³¿ ãåíà-ñóïðåñîðà ð53, çà ðàõóíîê ÷îãî

³í³ö³þþòü ïîðóøåííÿ ãîìåîñòàçó ³ ïîãëèáëþþòü ³ìóíî-

äåô³öèò [8]. Òàêèì ÷èíîì, ôîðìóºòüñÿ ñò³éêå õèáíå êîëî

ïàòîëîã³÷íèõ ïðîöåñ³â, ÿê³ ñïðèÿþòü ïðèæèâëåííþ íîâèõ

÷àñòèíîê åíäîìåòð³î³äíî¿ òêàíèíè, ïîøèðåííþ âæå ³ñíó-

þ÷èõ åêòîï³é, ôîðìóâàííþ ãëèáîêî³íâàçèâíèõ ³ ïîøèðå-

íèõ ôîðì åíäîìåòð³îçà.

Ïðè åíäîìåòðèîç³ ôóíêö³îíàëüíî àêòèâí³ åíäîìåòð³-

àëüí³ çàëîçè ³ ñòðîìà, ùî çíàõîäÿòüñÿ ïîçà ïîðîæíèíîþ

ìàòêè, çáåð³ãàþòü ñâîþ çàëåæí³ñòü â³ä ãîðìîíàëüíîãî

âïëèâó [11]. Îäíàê, â ðåãóëÿö³¿ ïðîöåñ³â â åíäîìåòð³¿

ïðèéìàþòü ó÷àñòü íå ëèøå åñòðîãåíè, àëå é á³îãåíí³ àì³-

íè ³ ïåïòèäí³ ãîðìîíè, ùî âèðîáëÿþòüñÿ êë³òèíàìè äèôóç-

íî¿ íåéðîåíäîêðèííî¿ ñèñòåìè [5]. Íåéðîåíäîêðèíí³

êë³òèíè (ÍÅÊ) çíàéäåí³ â áàãàòüîõ îðãàíàõ ³ òêàíèíàõ â

íîðì³, ïðè ã³ïåðïëàñòè÷íèõ ïðîöåñàõ ³ ïóõëèíàõ [4, 7]. Â

åíäîìåòð³¿ ÍÅÊ ðîçì³ùóþòüñÿ ó çàëîçèñòîìó åï³òåë³¿ ³ ïðî-

äóêóþòü á³îëîã³÷íî àêòèâí³ ðå÷îâèíè, ùî ðåãóëþþòü ïðî-

öåñè êë³òèííî¿ ïðîë³ôåðàö³¿ [7]. Ïðè äîñë³äæåíí³ ð³âíÿ ñå-

ðîòîí³íó, ùî éîãî ïðîäóêóþòü ÍÅÊ, â êðîâ³ õâîðèõ íà

åíäîìåòð³îç ÿº÷íèê³â ³ ðåòðîöåðâ³êàëüíèé åíäîìåòð³îç

ÓÄÊ: 616.006: 618.145

ÍÅÉÐÎÅÍÄÎÊÐÈÍÍ² ÊË²ÒÈÍÈ Ó ÂÎÃÍÈÙÀÕ

ÀÄÅÍÎÌ²ÎÇÀ, ÐÅÒÐÎÖÅÐÂ²ÊÀËÜÍÎÃÎ

ÅÍÄÎÌÅÒÐ²ÎÇÀ ² ÅÍÄÎÌÅÒÐ²Î²ÄÍÈÕ

Ê²ÑÒÀÕ ßª×ÍÈÊ²Â

Ìåë³êñåòÿí À. Â., Ô³ëîíåíêî Ê. Â., Êóðèê Î.Ã.

Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Î.Î. Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: íåéðîåíäîêðèíí³ êë³òèíè, àäåíîì³îç, ðåòðîöåðâ³êàëüíèé åíäîìåòð³îç, åíäîìåòð³î³äí³

ê³ñòè ÿº÷íèê³â.

âèÿâëåíî, ùî ñåðåäí³ ïîêàçíèêè éîãî âì³ñòó â³ðîã³äíî

ïåðåâèùóâàëè íîðìó, à ó õâîðèõ íà åíäîìåòð³îç ìàòêè ³

øèéêè ìàòêè ð³âåíü ñåðîòîí³íó áóâ â ìåæàõ íîðìè [1].

Ìåòîþ íàøîãî äîñë³äæåííÿ ñòàëî âèâ÷åííÿ ñòàíó

ÍÅÊ ó åêòîï³÷íèõ âîãíèùàõ ïðè åíäîìåòð³îç³ ìàòêè, ÿº÷-

íèê³â ³ ðåòðîöåðâ³êàëüíîìó åíäîìåòð³îç³.

Ìàòåð³àëè òà ìåòîäè. Äëÿ äîñë³äæåííÿ áðàëè îïåðà-

ö³éíèé ìàòåð³àë 25-òè æ³íîê ç åíäîìåòð³îçîì ò³ëà ìàòêè

(â³ê ïàö³ºíòîê ñòàíîâèâ 34-52 ðîêè, ñåðåäí³é â³ê 44,2±

±1,67 ð.), 19-òè æ³íîê, õâîðèõ íà åíäîìåòð³îç ÿº÷íèê³â ( â³ê

ïàö³ºíòîê – 21–46 ðîê³â, ñåðåäí³é â³ê – 39,4±1,82 ð.) ³ 20-òè

æ³íîê ç ðåòðîöåðâ³êàëüíèì åíäîìåð³îçîì (â³ê ïàö³ºíòîê

21–42 ðîêè, ñåðåäí³é â³ê 36,2±1,78ð.). Òàêîæ ó öèõ õâîðèõ

äîñë³äæóâàëè ç³ñêîáè åíäîìåòð³ÿ, ÿê³ ïðîâîäèëèñü ïåðåä

îïåðàòèâíèì âòðó÷àííÿì. Â ãðóïó ïîð³âíÿííÿ óâ³éøëè

ôðàãìåíòè åíäîìåòð³ÿ 15 æ³íîê (ñåðåäí³é â³ê 38,6±1,54

ðîê³â ) áåç ã³íåêîëîã³÷íî¿ ïàòîëîã³¿.

Ôðàãìåíòè ì³îìåòð³ÿ ç âîãíèùàìè åíäîìåòð³îçà,

ñò³íîê åíäîìåòð³î³äíèõ ê³ñò ÿº÷íèê³â ³ ôðàãìåíòè âîãíèù

ðåòðîöåðâ³êàëüíîãî åíäîìåòð³îçà, ç³ñêîáè ³ ôðàãìåíòè

åíäîìåòð³ÿ ô³êñóâàëè ó 10% ðîç÷èí³ íåéòðàëüíîãî ôîð-

ìàë³íà, çð³çè òîâùèíîþ 4-5 ìêì çàáàðâëþâàëè ãåìàòîê-

ñèë³íîì-åîçèíîì.

Ãîëîâíîþ õàðàêòåðèñòèêîþ ÍÅÊ º íàÿâí³ñòü ñåêðå-

òîðíèõ ãðàíóë, ùî ì³ñòÿòü ãîðìîíè ³ á³îëîã³÷íî àêòèâí³

ðå÷îâèíè [6]. Äëÿ âèÿâëåííÿ ñåêðåòîðíèõ ãðàíóë â öèòî-

ïëàçì³ ÍÅÊ ïðîâåäåíî àðã³ðîô³ëüíó ðåàêö³þ, çàñíîâàíó

íà çäàòíîñò³ êë³òèí íàêîïè÷óâàòè ³îíè ñð³áëà ç ðîç÷èíó –

ìåòîä Ãðèìåë³óñà, ïðè ÿêîìó ïðîäóêò ïîçèòèâíî¿ ðåàêö³¿

â³äêëàäàºòüñÿ â öèòîïëàçì³ ó âèãëÿä³ äð³áíèõ êîðè÷íåâî-

÷îðíèõ ãðàíóë. Ï³äðàõóíîê ê³ëüêîñò³ àðã³ðîô³ëüíèõ ÍÅÊ

ïðîâîäèâñÿ â 10 ïîëÿõ çîðó ïðè çá³ëüøåíí³ ì³êðîñêîïà

200 (ñåðåäíº ÷èñëî). Ñòàòèñòè÷íó îáðîáêó ðåçóëüòàò³â

ïðîâîäèëè çà çàãàëüíîïðèéíÿòèìè ìåòîäèêàìè ç âèêîðè-

ñòàííÿì êðèòåð³þ Ñòüþäåíòà.

Ðåçóëüòàòè òà îáãîâîðåííÿ. Êë³òèíè äèôóçíî¿ ÍÅÊ

áóëè çíàéäåí³ ó 18-òè ïàö³ºíòîê ó âîãíèùàõ àäåíîì³îçó, ó

16-òè ïàö³ºíòîê â åíäîìåòð³î³äíèõ ê³ñòàõ ÿº÷íèê³â ³ ó 19-òè

âèïàäêàõ âîãíèù ðåòðîöåðâ³êàëüíîãî åíäîìåòð³îçó.

Â óñ³õ öèõ õâîðèõ ÍÅÊ òàêîæ áóëè çíàéäåí³ â åíäîìåòð³¿.

Â ãðóï³ ïîð³âíÿííÿ ÍÅÊ â åíäîìåòð³¿ ñïîñòåð³ãàëèñü ó

íåâåëèê³é ê³ëüêîñò³ (4-6 â 10 ïîëÿõ çîðó õ200), ì³ñöÿìè ïî-

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

îäèíîê³, ì³ñöÿìè ó âèãëÿä³ äð³áíèõ ñêóï÷åíü; êë³òèíè

áóëè íåâåëèêèõ ðîçì³ð³â ç äð³áíèìè íå ÷èñåëüíèìè ãðà-

íóëàìè. Â åíäîìåòð³¿ õâîðèõ íà àäåíîì³îç ê³ëüê³ñòü ÍÅÊ

òàêîæ áóëà íåâåëèêîþ – â ñåðåäíüîìó 5-6 â ïîë³ çîðó.

×àñòèíà öèõ êë³òèí áóëà ç ïîîäèíîêèìè äð³áíèìè ãðàíó-

ëàìè, ÷àñòèíà ç âåëèêîþ ê³ëüê³ñòþ ãðàíóë, ùî ðîçì³ùóâà-

ëèñü ïåðåâàæíî ïåðèíóêëåàðíî. Ó âîãíèùàõ åíäîìåòð³î-

çà â ì³îìåòð³¿ ê³ëüê³ñòü ãðàíóë äîñòîâ³ðíî íå â³äð³çíÿëàñü

â³ä ¿õ ê³ëüêîñò³ â åíäîìåòð³¿ ³ ñêëàäàëà 6-8 â ïîëÿõ çîðó. ÍÅÊ

ìàëè íåâåëèê³ ðîçì³ðè, ãðàíóëè ðîçì³ùóâàëèñü â îêðå-

ìèõ êë³òèíàõ ïåðèíóêëåàðíî, â îêðåìèõ – àï³êàëüíî, ³íîä³

çàéìàëè âñþ öèòîïëàçìó êë³òèíè.

Â åíäîìåòð³¿ õâîðèõ íà åíäîìåòð³îç ÿº÷íèê³â (åíäî-

ìåòð³î³äí³ ê³ñòè) ê³ëüê³ñòü ÍÅÊ áóëà çíà÷íî âèùîþ, í³æ ó

ãðóï³ ïîð³âíÿííÿ (ð<0,01) ³ ó ãðóï³ õâîðèõ íà àäåíîì³îç

(ð<0,01), ³ ñêëàäàëà â ñåðåäíüîìó 22,4±1,68 (â 10 ïîëÿõ

çîðó õ280). Ö³ êë³òèíè ìàëè ð³çíó ôîðìó, ïåðåâàæíî íå-

ïðàâèëüíó – âèäîâæåíó, îâàëüíó, òðàïåöåâèäíó. Ó öèòî-

ïëàçì³ âèçíà÷àëàñü âåëèêà ê³ëüê³ñòü ãðàíóë, ùî çàéìàëè

àáî àï³êàëüíó ÷àñòèíó êë³òèíè, àáî âñþ öèòîïëàçìó.

Â åíäîìåòð³¿ ïàö³ºíòîê ç ðåòðîöåðâ³êàëüíèì åíäîìåòð³î-

çîì ê³ëüê³ñòü ÍÅÊ òàêîæ áóëà äîñòîâ³ðíî á³ëüøîþ, í³æ ó

äâîõ ãðóïàõ – ïîð³âíÿííÿ ³ ãðóï³ ç àäåíîì³îçîì (ð<0,01),

³ ñêëàäàëà â ñåðåäíüîìó 20,6±1,34, ùî íåçíà÷íî ìåíøå,

í³æ ó ãðóï³ ïàö³ºíòîê ç åíäîìåòð³îçîì ÿº÷íèê³â.

Â ñò³íêàõ åíäîìåòð³î³äíèõ ê³ñò ÿº÷íèê³â òàêîæ âèçíà÷à-

ëàñü âåëèêà ê³ëüê³ñòü ÍÅÊ – 28,6±1,72, äåùî á³ëüøà í³æ â

åíäîìåòð³¿ öèõ ïàö³ºíòîê (ð>0,05), ³ â³ðîã³äíî á³ëüøà, í³æ ó

âîãíèùàõ àäåíîì³îçó (ð<0,05). ÍÅÊ ñò³íîê åíäîìåòð³î³ä-

íèõ ê³ñò ðîçì³ùóâàëèñü ïåðåâàæíî ó âèãëÿä³ ñêóï÷åíü;

ãðàíóëè â íèõ áóëè ïðåäñòàâëåí³ ó âåëèê³é ê³ëüêîñò³, çàé-

ìàëè ïðàêòè÷íî âñþ öèòîïëàçìó êë³òèíè, ùî ñâ³ä÷èëî

ïðî ôóíêö³îíàëüíó àêòèâí³ñòü êë³òèí. Ó âîãíèùàõ ðåòðî-

öåðâ³êàëüíîãî åíäîìåòð³îçà ê³ëüê³ñòü ÍÅÊ ñêëàëà

24,8±1,56. Öå áóëî äåùî á³ëüøå í³æ â åíäîìåòð³¿ öèõ

ïàö³ºíòîê ³ ãðóïè ïîð³âíÿííÿ, àëå ìåíøå, í³æ ó âîãíèùàõ

åíäîìåòð³îçó ÿº÷íèê³â (ð>0,05), ³ â³ðîã³äíî á³ëüøå, í³æ ó

âîãíèùàõ àäåíîì³îçà (ð<0,05). Ãðàíóëè â êë³òèíàõ áóëè

ïðåäñòàâëåí³ ó âåëèê³é ê³ëüêîñò³, çàéìàëè ïðàêòè÷íî

âñþ öèòîïëàçìó, ùî ñâ³ä÷èëî ïðî ôóíêö³îíàëüíó

àêòèâí³ñòü ÍÅÊ.

Îòæå, ìè â³äì³òèëè äîñòîâ³ðíå çá³ëüøåííÿ ê³ëüêîñò³

ÍÅÊ ó õâîðèõ íà åíäîìåòð³îç ÿº÷íèê³â ³ ðåòðîöåðâ³êàëü-

íèé åíäîìåòð³îç ÿê â åíäîìåòð³¿ (â³äíîñíî ãðóïè ïî-

ð³âíÿííÿ ³ ãðóïè õâîðèõ íà àäåíîì³îç), òàê ³ ó âîãíèùàõ

åíäîìåòð³îçà ÿº÷íèê³â ³ ðåòðîöåðâ³êàëüíîãî åíäîìåòð³î-

çà ó ïîð³âíÿíí³ ç âîãíèùàìè àäåíîì³îçà. Íàø³ ìîðôî-

ëîã³÷í³ äàí³ ñï³âïàäàþòü ç êë³í³÷íèìè äàíèìè ï³äâèùåííÿ

ð³âíÿ ñåðîòîí³íó, ùî éîãî ïðîäóêóþòü ÍÅÊ, â êðîâ³ õâî-

ðèõ íà åíäîìåòð³îç ÿº÷íèê³â ³ ðåòðîöåðâ³êàëüíèé åíäî-

ìåòð³îç ³ çáåðåæåííÿ íîðìàëüíîãî ð³âíÿ ñåðîòîí³íó ó

õâîðèõ íà åíäîìåòð³îç ìàòêè [1].

Çà äàíèìè ë³òåðàòóðè, ï³äâèùåííÿ ê³ëüêîñò³ ÍÅÊ ñïîñ-

òåð³ãàºòüñÿ ïðè ãîðìîíîçàëåæíèõ ïðîöåñàõ, çîêðåìà ïðè

ãîðìîíîçàëåæíîìó âàð³àíò³ ðàêà åíäîìåòð³ÿ [7].

Çá³ëüøåííÿ ê³ëüêîñò³ ÍÅÊ ïðè åíäîìåòð³îç³ ÿº÷íèê³â ³ ðåò-

ðîöåðâ³êàëüíîìó åíäîìåòð³îçó ìîæå ïåâíèì ÷èíîì

ï³äòâåðäæóâàòè ãîðìîíàëüíó òåîð³þ (ÿê îäíó ç ëàíîê)

âèíèêíåííÿ åíäîìåòð³îçó [2, 3, 5].

Âèñíîâêè òà ïåðñïåêòèâè ïîäàëüøèõ ðîçðîáîê

1. Ïðè àäåíîì³îç³ ê³ëüê³ñòü ÍÅÊ â åíäîìåòð³¿ ³ âîãíè-

ùàõ åíäîìåòð³îçà â ì³îìåòð³¿ íå çá³ëüøåíà ïî â³äíîøåí-

íþ äî åíäîìåòð³ÿ ãðóïè ïîð³âíÿííÿ.

2. Ïðè åíäîìåòð³î³ç³ ÿº÷íèê³â ê³ëüê³ñòü ÍÅÊ â³ðîã³äíî

á³ëüøà ÿê ó âîãíèùàõ åíäîìåòð³îçà òàê ³ â åíäîìåòð³¿,

â³äíîñíî ÿê ãðóïè ïîð³âíÿííÿ, òàê ³ ãðóïè ïàö³ºíòîê ç àäå-

íîì³îçîì.

3. ÍÅÊ ó âîãíèùàõ åíäîìåòð³îçó ÿº÷íèê³â ³ ðåòðî-

öåðâ³êàëüíîãî åíäîìåòð³îçó çíàõîäÿòüñÿ ó ôóíêö³îíàëüíî

àêòèâíîìó ñòàí³, îñê³ëüêè ì³ñòÿòü âåëèêó ê³ëüê³ñòü ãðàíóë.

Ðîëü ÍÅÊ ïîòðåáóº ïîäàëüøîãî âèâ÷åííÿ äëÿ îö³íêè

êë³í³÷íîãî ïåðåá³ãó åíäîìåòð³îçó, à òàêîæ ñõèëüíîñò³ âîã-

íèù åíäîìåòð³îçó äî ìàë³ãí³çàö³¿.

Ðåöåíçåíò: ÷ëåí-êîð. ÍÀÌÍ Óêðà¿íè,

ä.ìåä.í., ïðîôåñîð Âåíöê³âñüêèé Á.Ì.

Ë²ÒÅÐÀÒÓÐÀ

1. Àäàìÿí Ë.Â. Ýíäîìåòðèîçû: Ðóêîâîäñòâî äëÿ âðà÷åé /

Ë.Â. Àäàìÿí, Â.È. Êóëàêîâ, Å.Í. Àíäðååâà – Ì.: ÎÀÎ “Èçäàòåëü-

ñòâî “Ìåäèöèíà”, 2006. – 416ñ.

2. Âîëîùóê È.Í. Ìîëåêóëÿðíî-áèîëîãè÷åñêèå àñïåêòû ïà-

òîãåíåçà àäåíîìèîçà / È.Í. Âîëîùóê, Þ.À. Ðîìàäàíîâà,

À.È. Èùåíêî, À.À. Áàõâàëîâà // Àðõèâ ïàòîëîãèè. – 2007. – ¹ 3. –

Ñ. 56-61.

3. Êîãàí Å.À. Êëèíèêî-ìîðôîëîãè÷åñêèå ïàðàëëåëè è ìîëå-

êóëÿðíå àñïåêòû ìîðôîãåíåçà àäåíîìèîçà / Å.À. Êîãàí,

À.Ë. Óíàíÿí, Ò.À. Äåìóðà, Î.Ì.Ãðå÷óõèíà, È.Ñ.Ñèäîðîâà, Â.È. Êè-

ñåëåâ// Àðõèâ ïàòîëîãèè. – 2008. – Ò. 70, ¹ 5. – Ñ. 8 -12.

4. Êóðèê Î.Ã. Âïëèâ ãîðìîí³â APUD-ñèñòåìè íà ïóõëèííèé

ð³ñò / Î.Ã. Êóðèê, Ì.Ä. Àíäðººâ, Ë.Â. Áîäíàð, Ä.Ï. Áåâçà, Î.Â. Ïðî-

êîï’þê, Â.Â. Áàçäèðºâ // Ãàëèöüêèé ë³êàðñüêèé â³ñíèé. – 2005. –

Ò.12, ¹4. – Ñ.144-147.

5. Ñèäîðîâà È.Ñ. Íîâûé âçãëÿä íà ïðèðîäó ýíäîìåòðèîçà

(àäåíîìèîçà) / È.Ñ. Ñèäîðîâà, Å.À. Êîãàí, Î.Â. Çàéðàòüÿíö,

À.Ë. Óíàíÿí, Ñ.À. Ëåâàêîâ // Àêóøåðñòâî è ãèíåêîëîãèÿ. – 2002. –

¹ 3. – Ñ. 32-38.

6. Ðàéõëèí Í.Ò. Åùå ðàç ïðî àïóäîöèòû…/ Í.Ò. Ðàéõëèí,

È.Ì. Êâåòíîé, Ë.À. Áàðûøåâñêàÿ // Àðõèâ ïàòîëîãèè. – 2000. –

¹ 2. – Ñ.57-60.

7. ×åðíûøîâà À.Ë. Àïóäîöèòû ïðè ïðîëèôåðàòèâíûõ

ïðîöåññàõ ýíäîìåòðèÿ / À.Ë. ×åðíûøîâà, Ë.À. Êîëîìèåö,

Í.Ã. Êðèöêàÿ, È.Â. Ñóõîäîëî// Áþëëåòåíü ÑÎ ÐÀÌÍ. – 2005. –

¹ 3. – Ñ. 37-40.

8. Braun D. Quantitative expression of apoptosis-regulating

genes in endometrium from women with and without endometriosis /

D. Braun, J.Ding, F. Shaheen, J. Willey, N. Rana, W.P. Dmowski //

Fertil. Steril. – 2007. – V. 87. – P. 263-268.

9. Dmowski W.P. Immunology of endometriosis /

W.P. Dmowski, D.P.Braun //Obstetrics and Gynaecology. – 2004. –

V.18, N2. – 245-263.

10. Dmowski W.P. Advances in the treatment of endometriosis –

the potential of elagolix / W.P. Dmowski // Obstetrics and Gynaecology. –

2008. – N 3. – P.21-23.

11. Vinatier D. Is endometriosis an endometrial disease? /

D.Vinatier, M.Cosson, P. Dufour // Europ. J. Obstet. Gynaec. and

Reprod. Biol. – 2000. – Vol. 91, N 2. – P. 113 – 125.

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

ÍÅÉÐÎÝÍÄÎÊÐÈÍÍÛÅ ÊËÅÒÊÈ

ÏÐÈ ÀÄÅÍÎÌÈÎÇÅ, ÐÅÒÐÎÖÅÐÂÈÊÀËÜÍÎÌ

ÅÍÄÎÌÅÒÐÈÎÇÅ È ÝÍÄÎÌÅÒÐÈÎÈÄÍÛÕ

ÊÈÑÒÀÕ ßÈ×ÍÈÊÎÂ

Ìåëèêñåòÿí À. Â., Ôèëîíåíêî Å.Â., Êóðèê Å.Ã.

Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò

èìåíè À.À. Áîãîìîëüöà, ã. Êèåâ, Óêðàèíà

Ðåçþìå. Ïðîâåäåíî èññëåäîâàíèå íåéðîýíäîêèííûõ

åäåòîê ïðè ýíäîìåòðèîçå ìàòêè (àäåíîìèîçå), ðåòðöåð-

âèêàëüíîì ýíäîìåòðèîçå è ýíäîìåòðèîçå ÿè÷íèêîâ. Óñ-

òàíîâëåíî äîñòîâåðíîå óâåëè÷åíèå íåéðîýíäîêðèííûõ

êëåòîê ïðè ýíäîìåòðèîèäíûõ êèñòàõ ÿè÷íèêîâ è ðåòðî-

öåðâèêàëüíîì ýíäîìåòðèîçå êàê â î÷àãàõ ýíäîìåòðèî-

çà, òàê è â ýíäîìåòðèè ýòèõ áîëüíûõ ïî ñðàâíåíèþ êàê ñ

íîðìàëüíûì ýíäîìåòðèåì (êîíòðîëüíîé ãðóïïîé), òàê

è ñ ãðóïïîé áîëüíûõ àäåíîìèîçîì. Óñòàíîâëåíî, ÷òî

ïðåîáëàäàþùåå êîëè÷åñòâî íåéðîýíäîêðèííûõ êëåòîê

íàõîäèòñÿ â ôóíêöèîíàëüíî àêòèâíîì ñîñòîÿíèè, òàê êàê

ñîäåðæèò áîëüøîå êîëè÷åñòâî àðãèðîôèëüíûõ ãðàíóë.

Êëþ÷åâûå ñëîâà: íåéðîýíäîêðèííûå êëåòêè, àäå-

íîèîç, ðåòðîöåðâèêàëüíûé ýíäîìåòðèîç, ýíäîìåòðèî-

èäíûå êèñòû ÿè÷íèêîâ.

NEUROENDOCRINAL CELLS

IN THE ADENOMYOSIS, RETROCERVICAL

ENDOMETRIOSIS FOCUSES

AND IN ENDOMETRIOID OVARIAN CYSTS

A. Meliksetyan, K. Filonenko, O. Kyryk

Bogomolets National Medical University, Kyiv, Ukraine

Summary. The analisis of neuroendocrinal cells in

adenomyosis, retrocervical endometriosis focuses and in

endometrioid ovarian cysts was studied. The reliable

increase of neuroendocrinal cells in retrocervical

endometriosis focuses and in endometrioid ovarian cysts

as in locus of endometriosis, so and in endometrium of

this patients comparative to normal endometrium and group

with adenomyosis was found. The majority of

neuroendocrinal cells were in functionally active condition

because they contain many argyrophilic granules.

Key words: neuroendocrinal cells, adenomyosis,

retrocervical endometriosis, endometrioid ovarian cysts.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

Â íàñòîÿùåå âðåìÿ âñå áîëüøåå ìåñòî â ëå÷åíèè íå-

âðèíîì ñëóõîâîãî íåðâà çàíèìàþò ñîâðåìåííûå ìåòîäû

ðàäèîëîãè÷åñêîãî âîçäåéñòâèÿ [8]. Ðîëü ñòåðåîòàêñè÷åñ-

êîé ðàäèîõèðóðãèè (CÐÕ) è ðàäèîòåðàïèè â ëå÷åíèè

øâàííîì èçó÷àåòñÿ ïóòåì ðåòðîñïåêòèâíîãî àíàëèçà

êîíòðîëÿ íàä îïóõîëåâûì ðîñòîì è îòâåòà îïóõîëè íà

ëå÷åíèå [2,3]. Ïðåèìóùåñòâîì äàííîãî ëå÷åíèÿ, ÿâëÿåòñÿ

èçîëèðîâàííîå ïîâðåæäàþùåå âîçäåéñòâèå íà îïóõîëü ñ

ìèíèìàëüíûì âîâëå÷åíèåì â çîíó îáëó÷åíèÿ îêðóæàþ-

ùèõ çäîðîâûõ òêàíåé. Ýòî äàåò âîçìîæíîñòü â áîëüøèí-

ñòâå ñëó÷àåâ ñîõðàíèòü ñëóõ, èçáåæàòü ðàçâèòèÿ îñëîæíå-

íèé ñâÿçàííûõ ñ îïåðàöèåé. Â ñâÿçè ñ ýòèì [7,9]

ñêëîíÿþòñÿ ê ïðîâåäåíèþ ñòåðåîòàêñè÷åñêîé ðàäèîõè-

ðóðãèè ó ãðóïïû ïàöèåíòîâ ïðè íàëè÷èè ïðèçíàêîâ ðîñ-

òà îïóõîëè è íàðàñòàíèè êëèíè÷åñêîé ñèìïòîìàòèêè.

Èñïîëüçîâàíèå ÑÐÕ ïðè íåáîëüøèõ ðàçìåðàõ îïóõîëè

ìîæåò áûòü àëüòåðíàòèâîé õèðóðãè÷åñêîìó ëå÷åíèþ,

ïðè êîòîðîì ÷àñòî íàáëþäàåòñÿ çíà÷èòåëüíàÿ ïîòåðÿ ñëó-

õà, ÷òî, êîíå÷íî æå, íàðóøàåò “êà÷åñòâî” æèçíè ïàöèåí-

òîâ. Òàê ñîõðàííîñòü “àäåêâàòíîãî” ñëóõà ïðè óäàëåíèè

ðåòðîñèãìîèäíûì äîñòóïîì ïî äàííûì (6) ñîñòàâèëà 8-

57%, à ïðè ïðèìåíåíèè äîñòóïà ÷åðåç ñðåäíþþ ÷åðåï-

íóþ ÿìêó ïî ðåçóëüòàòàì [5] – 32-68 % ñëó÷àåâ. Èñïîëüçî-

âàíèå òðàñíëàáèðèíòíîãî ïîäõîäà ïðèâîäèò ê ïîëíîé

óòðàòå ñëóõà [5]. Â îòëè÷èå îò õèðóðãè÷åñêîãî âìåøàòåëü-

ñòâà âíåçàïíàÿ ïîòåðÿ ñëóõà ïðè ïðîâåäåíèè ðàäèîõè-

ðóðãè÷åñêîãî ëå÷åíèÿ íå õàðàêòåðíà. Ïî äàííûì [10,11] ó

âñåõ ïàöèåíòîâ íàáëþäàëñÿ “ïîëåçíûé” óðîâåíü ñëóõà

ïîñëå ÑÐÕ èíòðàêàíàëüíûõ ÀÍ ñ äîçîé íà êðàé îïóõîëè

14 Ãð è íèæå ïî 50-65% èçîäîçíîé êðèâîé.

Èñïîëüçîâàíèå ìåòîäîâ êëèíè÷åñêîé èììóíîëîãèè â

äèàãíîñòèêå ðàçëè÷íûõ íîâîîáðàçîâàíèé ïîëó÷àåò âñå

áîëüøåå ðàñïðîñòðàíåíèå, êàê çà ñ÷åò âûÿâëåíèÿ ìàð-

êåðíûõ îðãàíîñïåöèôè÷åñêèõ àíòèãåíîâ, òàê è ñîïðî-

âîæäàþùèõ ðàçâèòèå îïóõîëåâîãî ïðîöåññà èçìåíåíèé â

íàèáîëåå ðàñïðîñòðàíåííûõ òåñòàõ äëÿ îöåíêè èììóííî-

ãî ñîñòîÿíèÿ îðãàíèçìà [1,4].

Ó ïàöèåíòîâ ñ ïåðâè÷íîé àêóñòè÷åñêîé íåâðèíîìîé,

äîñòîâåðíî âûÿâëåíî ïîâûøåíèå óðîâíÿ ïðîâîñïàëè-

òåëüíîãî öèòîêèíà ÔÍÎ-α è ïîíèæåíèå êîëè÷åñòâà èí-

òåðôåðîíà-γ, à òàêæå âûðàæåííîå îáðàçîâàíèå ôàêòîðà

òîðìîæåíèÿ ìèãðàöèè ëèìôîöèòîâ íà àíòèãåíû ñîåäè-

íèòåëüíîé òêàíè [3].

Öåëüþ äàííîãî èññëåäîâàíèÿ ÿâëÿåòñÿ èçó÷åíèå ýô-

ôåêòèâíîñòè ëå÷åíèÿ áîëüíûõ ÀÍ ðàäèîõèðóðãè÷åñêèì

ÊËÈÍÈ×ÅÑÊÈÅ È ÈÌÌÓÍÎËÎÃÈ×ÅÑÊÈÅ ÀÑÏÅÊÒÛ

ËÅ×ÅÍÈß ÁÎËÜÍÛÕ Ñ ÀÊÓÑÒÈ×ÅÑÊÎÉ

ÍÅÂÐÈÍÎÌÎÉ ÐÀÄÈÎÕÈÐÓÐÃÈ×ÅÑÊÈÌ ÌÅÒÎÄÎÌ

Ìèíèíà À.Þ.

ÃÓ “Èíñòèòóò îòîëàðèíãîëîãèè èì.ïðîô. À.È. Êîëîìèé÷åíêî ÍÀÌÍ Óêðàèíû”, Êèåâ.

Êëþ÷åâûå ñëîâà: àêóñòè÷åñêàÿ íåâðèíîìà, ñòåðåîòàêñè÷åñêàÿ ðàäèîõèðóðãèÿ, ëå÷åíèå, ñîñòîÿíèå ñëóõà

è ðàâíîâåñèÿ.

ìåòîäîì íà îñíîâàíèè êîíòðîëÿ îïóõîëåâîãî ðîñòà ñ ïî-

ìîùüþ ÌÐÒ äèàãíîñòèêè, èçìåíåíèÿ èììóíîëîãè÷åñ-

êèõ ïîêàçàòåëåé è ÷àñòîòû âîçíèêàþùèõ ïîáî÷íûõ ÿâëå-

íèé ïîñëå ëå÷åíèÿ

Ìàòåðèàëû è ìåòîäû. Ïîä íàøèì íàáëþäåíèåì íà-

õîäèëèñü 24 áîëüíûõ ñ ÀÍ â âîçðàñòå îò 32 äî 59 ëåò, êîòî-

ðûå ïðîøëè ëå÷åíèå ïî ïðîãðàììå ÑÐÕ â ïåðèîä ñ 2010

ïî 2014 ãîäû. Ñðîêè íàáëþäåíèÿ ñîñòàâèëè îò ïîëóãîäà

äî 3 ëåò, â ñðåäíåì 2,3 ãîäà. Ðàçìåð îïóõîëè ñîñòàâëÿë îò

5 ìì äî 21 ìì, ïðè ýòîì ñðåäíèé ðàçìåð íîâîîáðàçîâàíèÿ

ðàâíÿëñÿ 16,9 ìì. Ñðåäíÿÿ ìàêñèìàëüíàÿ äîçà îáëó÷åíèÿ

îïóõîëè ñîñòàâëÿëà 18.7 Ãð, ñðåäíÿÿ êðàåâàÿ äîçà îáëó÷å-

íèÿ – 12 Ãð. Îöåíêà ðåçóëüòàòîâ äàëüíåéøåãî ðîñòà îïóõî-

ëè ïðîâîäèëàñü ñ ïîìîùüþ ÌÐÒ èññëåäîâàíèÿ ñ êîíòðà-

ñòèðîâàíèåì ìàãíåâèñòîì ÷åðåç 3-6 ìåñÿöà è ÷åðåç ãîä

ïîñëå ëå÷åíèÿ. Âñå áîëüíûå ïðîõîäèëè îòîíåâðîëîãè-

÷åñêèé îñìîòð. Îöåíêà ñëóõà áûëà ïðîâåäåíà ñ ïîìî-

ùüþ òîíàëüíîé ïîðîãîâîé àóäèîìåòðèè, ðå÷åâîé àóäèî-

ìåòðèè. Ôóíêöèþ ëèöåâîãî íåðâà îöåíèâàëè ïî øêàëå

House-Brackmann.

Ïîêàçàíèÿìè ê ïðîâåäåíèþ ÑÐÕ ó äàííûõ ïàöèåíòîâ

áûëè îòêàç ïàöèåíòà îò ïðåäëîæåííîé õèðóðãè÷åñêîé

îïåðàöèè è íàëè÷èå ïðîòèâîïîêàçàíèé ê íåé.

Ïðîâåäåííîå èììóíîëîãè÷åñêîå èññëåäîâàíèå âêëþ-

÷àëî èçó÷åíèå ñîäåðæàíèÿ àíòèòåë ðåàãèíîâîãî òèïà

(IgE,IgG4) ê òêàíåâûì àíòèãåíàì ñëóõîâîãî íåðâà – ñî-

åäèíèòåëüíîòêàííîìó (Ñole) è îñíîâíîìó áåëêó ìèåëè-

íà (ÎÁÌ) â ñûâîðîòêå êðîâè (êëàññ Å) áîëüíûõ àêóñòè÷åñ-

êîé íåâðèíîìîé äî, ÷åðåç ìåñÿö è ÷åðåç 1 ãîä ïîñëå

ðàäèîõèðóðãè÷åñêîãî ëå÷åíèÿ à òàêæå ó ïðàêòè÷åñêè çäî-

ðîâûõ äîíîðîâ. Äîïîëíèòåëüíî â êðîâè èññëåäîâàëè

óðîâíè èììóíîãëîáóëèíîâ êëàññîâ A è E, ñîäåðæàíèå

àíòèòåë ê ìèåëèíó, àññîöèèðîâàííîìó ñ ãëèêîïðîòåèíà-

ìè ïëàçìû (anti-MAG). Êðîìå òîãî îïðåäåëÿëè óðîâíè

òàêèõ ïðî- âîñïàëèòåëüíûõ öèòîêèíîâ êàê ôàêòîð íåêðî-

çà îïóõîëè (ÔÍÎ-α), èíòåðëåéêèí -1β (ÈË-1), ïðîòèâî-

âîñïàëèòåëüíîãî öèòîêèíà- èíòåðëåéêèíà -10 (ÈË-10)

è èììóíîðåãóëÿòîðíîãî öèòîêèíà- èíòåðôåðîíà-γ,

ñîäåðæàíèå êàíöåð-ýìáðèîíàëüíîãî àíòèãåíà (ÊÝÀ).

Ðåàêòèâû ôèðì Ïðî-êîí, Öèòîêèí (ÐÔ), Buhlmann,

(Øâåéöàðèÿ). Äëÿ îöåíêè ðåàêöèè ïðèìåíÿëè èììóíî-

ôåðìåíòíûé àíàëèçàòîð Stat Fax 2100 (ÑØÀ).

Ðåçóëüòàòû îáðàáîòàíû ñòàòèñòè÷åñêè ñ ïðèìåíåíè-

åì íåïàðàìåòðè÷åñêîãî êðèòåðèÿ “U” (Âèëêîêñîííà-

Ìàííà_Óèòíè, Å.Â. Ãóáëåð,1978).

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

Ðåçóëüòàòû è îáñóæäåíèå. Âñå 24 ïàöèåíòà ñ äèàãíî-

çîì îäíîñòîðîííÿÿ àêóñòè÷åñêàÿ íåâðèíîìà ïåðâîé è

âòîðîé ñòàäèè (ïî êëàññèôèêàöèè M. Portmann,1988) ïðî-

õîäèëè ñòåðåîòàêñè÷åñêóþ ðàäèîõèðóðãèþ íà àïïàðàòå

Novalis. Ïðè îáñëåäîâàíèè ïàöèåíòîâ êîíòðîëü ðîñòà

îïóõîëè áûë îñóùåñòâëåí ó 23 áîëüíûõ (95.8%).

Ó âñåõ ïàöèåíòîâ ÷åðåç 3-6 ìåñÿöåâ ïîñëå ïðîâåäåí-

íîãî ëå÷åíèÿ îòìå÷àëàñü òåíäåíöèÿ ê óâåëè÷åíèþ íîâî-

îáðàçîâàíèÿ. Òèïè÷íûå ïîñòëó÷åâûå èçìåíåíèÿ íà êîíò-

ðîëüíûõ ñíèìêàõ â âèäå öåíòðàëüíîãî íåêðîçà è

ïåðèôîêàëüíîãî îòåêà ìîãóò íàáëþäàòüñÿ äî 12 ìåñÿöåâ,

â ðåäêèõ ñëó÷àÿõ äî 18 ìåñÿöåâ, ÷òî ìîæåò îáúÿñíÿòü óâå-

ëè÷åíèå ðàçìåðîâ ÀÍ. ×åðåç ãîä ïîñëå ïðîâåäåíèÿ îáëó-

÷åíèÿ ðàçìåðû îïóõîëè íà êîíòðîëüíûõ ñíèìêàõ óìåíü-

øèëèñü ó 18 (75%) áîëüíûõ, îñòàëèñü ïðåæíèìè ó

5 (20.85%) è ó îäíîãî ïàöèåíòà (4.2%) ñîõðàíÿëñÿ ðîñò

îïóõîëè. Â ñâÿçè ñ ýòèì åìó áûëî ïðîâåäåíî õèðóðãè-

÷åñêîå óäàëåíèå îïóõîëè.

Â ðàííèå ñðîêè (3-6ìåñ.) ïîñëå ïðîâåäåíèÿ ÑÐÕ â 18

(75%) ñëó÷àÿõ íàáëþäàëèñü òîøíîòà, ãîëîâíàÿ áîëü, ãî-

ëîâîêðóæåíèå. Ó 11 (45.8%) ïàöèåíòîâ óñèëèëñÿ øóì â

óøàõ, ó 3 (12.5%) áîëüíûõ îí ïîÿâèëñÿ. Íàðóøåíèå ôóíê-

öèè òðîéíè÷íîãî íåðâà âûÿâëåíî ó 6 (25%) áîëüíûõ â

âèäå îíåìåíèÿ ëèöà íà ñòîðîíå ïîðàæåíèÿ è ïàðåñòåçèé.

Íàðóøåíèå ôóíêöèè ëèöåâîãî íåðâà ïî øêàëå House-

Brackmann íàáëþäàëîñü ó 4 (16.6%) áîëüíûõ. Ó òðåõ èç

íèõ ïàðåç ëèöåâîãî íåðâà óñóãóáèëñÿ ñî âòîðîé äî òðå-

òüåé ñòåïåíè ïîðàæåíèÿ, ó îäíîãî áîëüíîãî äèàãíîñòè-

ðîâàíî ñíèæåíèå ôóíêöèè ëèöåâîãî íåðâà äî âòîðîé

ñòåïåíè. Ôóíêöèÿ ëèöåâîãî íåðâà ó ýòèõ áîëüíûõ îñòà-

ëàñü íåèçìåííîé è ïðè ïîâòîðíûõ îñìîòðàõ â îòäàëåí-

íîì ïåðèîäå.

Àíàëèç ïîêàçàòåëåé ñòàòî-êèíåòè÷åñêîãî ðàâíîâåñèÿ

ó 19 (79 %) áîëüíûõ âûÿâèë íàðóøåíèå ôóíêöèè äèíàìè-

÷åñêîãî ðàâíîâåñèÿ 2 è 3 ñòåïåíè òÿæåñòè ïðè ïðîâåäå-

íèè ôëàíãîâîé õîäüáû è “øàãàþùåãî” òåñòà. Ñòàòè÷åñ-

êîå ðàâíîâåñèå (èíäåêñ êåôàëîãðàôèè) áûëî íàðóøåíî ó

âñåõ îáñëåäóåìûõ. Ñïîíòàííûé íèñòàãì ðåãèñòðèðîâàë-

ñÿ â 75% ñëó÷àåâ, ïðè ýòîì â çäîðîâóþ ñòîðîíó â 11.2%

íàáëþäåíèé, à â ñòîðîíó áîëüíîãî óõà â 88.8% ñëó÷àåâ.

Ñîñòîÿíèå ñëóõà ó ïàöèåíòîâ ÷åðåç 3 ìåñÿöà ïîñëå îêîí-

÷àíèÿ ëå÷åíèÿ çíà÷èòåëüíî íå èçìåíèëîñü ïî ñðàâíåíèþ

ñ èñõîäíûì óðîâíåì .

Ïðè ýòîì 50% ðàçáîð÷èâîñòü ðå÷è äîñòèãàëàñü íà

óðîâíå 61.4 ± 18.2 Äá, 100% ðàçáîð÷èâîñòü ðå÷è íå äîñòè-

ãàëàñü â 54.1% ñëó÷àåâ.

Ïðè ïðîâåäåíèè îòîíåâðîëîãè÷åñêîãî îñìîòðà ÷å-

ðåç ãîä ïîñëå ëå÷åíèÿ ãîëîâíàÿ áîëü, ïåðèîäè÷åñêèå ãî-

ëîâîêðóæåíèÿ íàáëþäàëèñü ó 5 (20.8%) áîëüíûõ. Ó 3

(12.5%) ÷åëîâåê îòìå÷åíî óìåíüøåíèå èíòåíñèâíîñòè

áîëåâîãî ñèíäðîìà ïî òèïó íåâðàëãèè íà ñòîðîíå ïîðà-

æåíèÿ. Îäíàêî, ïàðåñòåçèè íàáëþäàëèñü â 37.5% ñëó÷àåâ.

Óìåíüøåíèå èíòåíñèâíîñòè øóìà îòìå÷åíî ó 12 (50%)

÷åëîâåê. Ôóíêöèÿ ëèöåâîãî íåðâà ñòðàäàëà ó 4 (16.6%)

áîëüíûõ è ïî øêàëå House-Brackmann îñòàâàëàñü òîé æå

ñòåïåíè íàðóøåíèÿ. Íàðóøåíèå äèíàìè÷åñêîãî ðàâíî-

âåñèÿ 2 ñòåïåíè òÿæåñòè íàáëþäàëîñü ó 5 áîëüíûõ (20.8%),

à 3 ñòåïåíè ñîõðàíÿëîñü ó îäíîãî áîëüíîãî (2.4%). Ñòàòè-

÷åñêîå ðàâíîâåñèå áûëî íàðóøåíî ó 4 (16.6%) ïàöèåíòîâ.

Íàáëþäàëàñü òåíäåíöèÿ ê íîðìàëèçàöèè ïîêàçàòåëåé ýê-

ñïåðèìåíòàëüíîãî íèñòàãìà, ïðè ýòîì ñîêðàùåíèå ïðî-

äîëæèòåëüíîñòè íèñòàãìåííîé ðåàêöèè îòìå÷åíî ó 17

(70.8%) îáñëåäóåìûõ.

×åðåç ãîä ïîñëå ëå÷åíèÿ ó 5 áîëüíûõ (20.8%) íàáëþ-

äàëàñü ãëóõîòà, à ó 13 ïàöèåíòîâ (54.1 %) íàáëþäàëàñü òÿ-

æåëàÿ ñòåïåíü íàðóøåíèÿ ñëóõà. Â äàííîé ãðóïïå áîëü-

íûõ îòìå÷àëàñü òåíäåíöèÿ ê ïîâûøåíèþ ïîðîãîâ

êîñòíîé ïðîâîäèìîñòè çâóêîâ, ïðåèìóùåñòâåííî íà

ñðåäíèõ è âûñîêèõ ÷àñòîòàõ. Êîëè÷åñòâî ñëó÷àåâ ãëóõîòû

óâåëè÷èëîñü íà 4.2% (1 áîëüíîé), à ñëó÷àåâ òÿæåëîé ñòå-

ïåíè íåéðîñåíñîðíîé òóãîóõîñòè íà 4.2% (1 áîëüíîé) ïî

ñðàâíåíèþ ñ ðåçóëüòàòàìè äî ëå÷åíèÿ. Äàííûå ðå÷åâîé

àóäèîìåòðèè: 50% ðàçáîð÷èâîñòü ðå÷è äîñòèãàëàñü íà

óðîâíå 63.5±22.5Äá, 100% ðàçáîð÷èâîñòü ðå÷è íå äîñòè-

ãàëàñü â 66.6 % ñëó÷àåâ.

Ðåçóëüòàòû èññëåäîâàíèÿ ñîñòîÿíèÿ ñëóõà (ìåæäóíà-

ðîäíàÿ êëàññèôèêàöèÿ ÂÎÇ,1997ã.) ó ïàöèåíòîâ, êîòîðûì

âûïîëíåíà ÑÐÕ ïðèâåäåíû â òàá.1

Ïðè èññëåäîâàíèè èììóííîãî ñòàòóñà óñòàíîâëåíî,

÷òî ó áîëüíûõ ÀÍ èìååò ìåñòî ôëþêòóàöèè ïàðàìåòðîâ

îáùåãî IgE â ñûâîðîòêå êðîâè (ðèñ.1), õîòÿ âñå âûÿâëåí-

íûå çíà÷åíèÿ áûëè â ïðåäåëàõ íîðìû. Äîñòîâåðíûå îò-

ëè÷èÿ îò êîíòðîëÿ âûÿâëåíû òîëüêî â ãðóïïå áîëüíûõ ÀÍ

÷åðåç ìåñÿö ïîñëå ïðîâåäåííîãî îáëó÷åíèÿ. Â èñõîäíîì

ñîñòîÿíèè (äî ëå÷åíèÿ) âûÿâëåíî ïîâûøåííîå ñîäåðæà-

íèå IgE-àíòèòåë ê ÎÁÌ, àíòèãåíó Ñole è â ñèñòåìå anti-

MAG. ×åðåç ìåñÿö ó ïîëîâèíû îáñëåäîâàííûõ ñîõðàíÿ-

ëèñü ïîâûøåííûå óðîâíè àíòèòåë ê ìèåëèíó è áåëêîâûì

àíòèãåíàì ñîåäèíèòåëüíîé òêàíè. Íîðìàëèçàöèÿ óðîâíÿ

àíòèòåë ê òêàíåâûì àíòèãåíàì íåðâà íàáëþäàëàñü ÷åðåç

1 ãîä ïîñëå ðàäèî-õèðóðãè÷åñêîãî ëå÷åíèÿ (ðèñ.2 è 3).

×òî êàñàåòñÿ êîëè÷åñòâåííûõ õàðàêòåðèñòèê óðîâíÿ

ïðî- è ïðîòèâîâîñïàëèòåëüíûõ öèòîêèíîâ (ÈË-1 è ÈË-10

ñîîòâåòñòâåííî), òî èõ ñîäåðæàíèå áûëî ïîâûøåííûì

êàê äî ÑÐÕ, òàê è ÷åðåç 1 ìåñÿö ïîñëå îïåðàöèè. ×åðåç ãîä

èõ óðîâíè ïðèáëèæàëèñü ê óðîâíþ çäîðîâûõ äîíîðîâ

(ðèñ.4), ÷òî ìîæåò áûòü îáóñëîâëåíî ðàçâèòèåì àñåïòè-

÷åñêîãî âîñïàëåíèÿ â ïåðâûå íåäåëè ïîñëå ðàäèî-õèðóð-

ãè÷åñêîãî ëå÷åíèÿ.

Áîëåå âûñîêèì ïî ñðàâíåíèþ ñ êîíòðîëåì êàê â èñ-

õîäíîì ñîñòîÿíèè , òàê è íà ïðîòÿæåíèè âñåãî ñðîêà íà-

áëþäåíèé áûëî (ðèñ. 5) ñîäåðæàíèå ôàêòîðà íåêðîçà

îïóõîëè (ÔÍÎ-α), òîãäà êàê äðóãîé ðåãóëÿòîðíûé öèòî-

êèí èíòåðôåðîí-γ áûë ñíèæåí êàê äî îïåðàöèè (ð<0,02)

è ÷àñòè÷íî âîññòàíàâëèâàëñÿ ÷åðåç ãîä ïîñëå ðàäèî-õè-

ðóðãè÷åñêîãî ëå÷åíèÿ (ðèñ.6).

Òàáëèöà 1

Ñîñòîÿíèå ñëóõà ó áîëüíûõ ÀÍ ïîñëå êóðñà ÑÐÕ

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

“Íîðìàëèçàöèÿ” çíà÷åíèé êàíöåðýìáðèîíàëü-

íîãî àíòèãåíà (ÊÝÀ) òàêæå ïðîèñõîäèëà ÷åðåç ãîä

ïîñëå ëå÷åíèÿ, à â ñðîêàõ äî è ÷åðåç 1 ìåñÿö ïîñëå

ëå÷åíèÿ åãî ñîäåðæàíèå áûëî äîñòîâåðíî ïîâûøåíî

(ðèñ. 7).

Ó áîëüíûõ ÀÍ áûëî îòìå÷åíî ïîâûøåííîå ñîäåðæà-

íèå â ñûâîðîòêå êðîâè êðóïíîäèñïåðñíîãî èììóíîãëî-

áóëèíà À, êîòîðîå ïîñëå ðàäèîõèðóðãè÷åñêîãî ëå÷åíèÿ

“íîðìàëèçîâàëîñü” óæå ê ïåðâîìó ìåñÿöó ïîñëå îïåðà-

öèè (ðèñ. 8).

Ðèñ. 4. Ñîäåðæàíèå ïðîâîñïàëèòåëüíîãî (ÈË-1)

è ïðîòèâîâîñïàëèòåëüíîãî (ÈË-10) öèòîêèíîâ

â ñûâîðîòêå êðîâè áîëüíûõ ÀÍ â äèíàìèêå íàáëþäåíèé.

Ðèñ. 1. Ñîäåðæàíèå îáùåãî IgE â ñûâîðîòêå êðîâè áîëüíûõ

ÀÍ â äèíàìèêå íàáëþäåíèÿ.

Êîíòðîëü – ïðàêòè÷åñêè çäîðîâûå äîíîðû.

Ðèñ. 2. Ñîäåðæàíèå IgE –àíòèòåë ê ÎÁÌ â äèíàìèêå

íàáëþäåíèÿ.

Ðèñ. 3. Ñîäåðæàíèå IgE – àíòèòåë ê ñîåäèíèòåëüíî

òêàííîìó àíòèãåíó òèïà Cole

äî è â ðàçëè÷íûå ñðîêè ïîñëå îïåðàöèè. Ðèñ.7. Ñîäåðæàíèå ÊÝÀ â ñûâîðîòêå êðîâè áîëüíûõ ÀÍ

äî è ïîñëå ðàäèîõèðóðãè÷åñêîãî ëå÷åíèÿ.

Ðèñ. 5. Ñîäåðæàíèå ôàêòîðà íåêðîçà îïóõîëè â ñûâîðîòêå

êðîâè áîëüíûõ ÀÍ äî è ïîñëå ðàäèîõèðóðãè÷åñêîãî ëå÷åíèÿ

Ðèñ. 8. Ñîäåðæàíèå IgA â ñûâîðîòêå êðîâè áîëüíûõ ÀÍ

äî è ïîñëå ðàäèîõèðóðãè÷åñêîãî ëå÷åíèÿ.

Ðèñ. 6. Ñîäåðæàíèå èíòåðôåðîíà-

γγ

â ñûâîðîòêå êðîâè

áîëüíûõ ÀÍ äî è ïîñëå ðàäèîõèðóðãè÷åñêîãî ëå÷åíèÿ.

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

ÇÀÊËÞ×ÅÍÈÅ. Òàêèì îáðàçîì ÷åðåç ãîä ïîñëå ÑÐÕ

ïî äàííûì ÌÐÒ âûÿâëåíî óìåíüøåíèå îïóõîëè â ðàçìå-

ðàõ ó 18 (75 %) áîëüíûõ, ó 5 (20,8 %) îíà îñòàëàñü â ïðå-

æíèõ ðàçìåðàõ. Ïðè ýòîì èññëåäîâàíèå ôóíêöèîíàëüíî-

ãî ñîñòîÿíèÿ ñëóõîâîãî àíàëèçàòîðà â äèíàìèêå ëå÷åíèÿ

ó áîëüíûõ ñ ÀÍ äàëî âîçìîæíîñòü ãîâîðèòü î ñòåðåî-

òàêñè÷åñêîé õèðóðãèè, êàê î ùàäÿùåì îðãàíîñîõðàíÿþ-

ùåì ìåòîäå ëå÷åíèÿ. ×åðåç ãîä ïîñëå ëå÷åíèÿ ôóíêöèÿ

çâóêîâîñïðèÿòèÿ áûëà ñîõðàíåíà â 62,5 % ñëó÷àåâ, ïðè

ýòîì äî ëå÷åíèÿ ñëóõ áûë ñîõðàíåí ó 70,8 % áîëüíûõ.

Ðåçóëüòàòû ïðîâåäåííûõ èììóíîëîãè÷åñêèõ èññëå-

äîâàíèé ÷àñòè÷íî ïîäòâåðæäàþò ðåçóëüòàòû êîíòðîëÿ

ðîñòà îïóõîëè ïî äàííûì ñíèìêîâ ÌÐÒ äèàãíîñòèêè ó

áîëüíûõ àêóñòè÷åñêîé íåâðèíîìîé. Ïðàêòè÷åñêîå îò-

ñóòñòâèå ñòèìóëÿöèè èììóííîé ñèñòåìû áîëüíîãî òêà-

íåâûìè àíòèãåíàìè è ñíèæåíèå óðîâíÿ öèòîêèíîâ è

èììóíîãëîáóëèíîâ ÷åðåç ãîä ïîñëå îáëó÷åíèÿ ñâèäå-

òåëüñòâóåò î çíà÷èòåëüíîì ðåãðåññå îïóõîëè è (èëè) åå

îòñóòñòâèè.

Ðåöåíçåíò: àêàäåì³ê ÍÀÌÍ Óêðà¿íè,

ä.ìåä.í., ïðîôåñîð Â.².Öèìáàëþê

Ë²ÒÅÐÀÒÓÐÀ

1. Áåðåæíàÿ Í.Ì. Èììóíîëîãèÿ è èììóíîòåðàïèÿ çëîêà÷åñò-

âåííûõ íîâîîáðàçîâàíèé //Æóðí.ïðàêò.âðà÷àþ-1997.-¹4.-ñ 11-14

2. Çîëîòîâà Ñ.Â., Íèêîíîâà Í.Ã. Ñòåðåîòàêñè÷åñêàÿ ðàäèî-

õèðóðãèÿ ó áîëüíûõ ñ íåâðèíîìàìè ñëóõîâîãî íåðâà/ Âåñòíèê

íåéðîõèðóðãèè., 2009. ñ 55- 60

3. Ìåëüíèêîâ Î.Ô., Áîðèñåíêî Î.Í., Øàìðàé Å.Î. Èììóíîëî-

ãè÷åñêèå òåñòû â äèàãíîñòèêå àêóñòè÷åñêîé íåâðèíîìû / Æóð-

íàë âóøíèõ, íîñîâèõ òà ãîðëîâèõ õâîðîá., 2005. ¹2 ñ.

4. Ìåëüíèêîâ Î.Ô. Èììóíîëîãè÷åñêèé àñïåêòû ãåíåçà õðî-

íè÷åñêîãî òîíçèëëèòà è ðåãóëÿöèè ôóíêöèîíàëüíîé àêòèâíîñ-

òè íåáíûõ ìèíäàëèí. Àâòîðåô.äèñ.ä-ðà ìåä.íàóê. –Ê., 1981.-

294ñ

5. Âedavanija A.,Brieger J.,Lehr H.-A.Association of proliferative

activity and size in acoustic neuroma implications for timing of surgery

//J.Neurosurg.-2003.-Vol.98,¹4 – Ð.807-811

6. Chee G.H.,Nedzelski J.M., Rowed D.Acoustic neuroma

surgery:the results of long-term hearing preservation //Otol. Neurolog.-

2003.-Vol.24.-P.672-676

7. FriedmanW.A.,Foote K.D. Linear accelerator-based radio-

surgery for vestibular schwannoma // Neurosurg. Focus. - 2003. -

Vol.14, ¹ 5 . Ð.Å2

8. Grosh S.,GiannotaS.,Management of vestibular schwannoma //

Combined Modality Therapy of central Nervous System Tumors/ Eds

Z. Petrovich et al. -2007

9. Karpinos M.,Ten B. S.,Zeck O. Treatment of acoustic neuroma

stereotactic radiosurgery vs.microsurgery //Int. J. Radiat. Oncol. Biol.

Phis.-2002.-Vol54, ¹5.-Ð.1410-1421

10. Linskey M.E.,Lunsford L.D., Flickinger J.C. Tumor control

after stereotactic radiosurgery in neurofibromatosis patients

with bilateral acoustic tumors//Neurosurg.-1992.-Vol.3, ¹5 .-

Ð.829-839

11. Niranjian A., Lunsford L.D., Flickinger J.C. Dose reduction

improves hearing preservation rates after intracanalicular acoustic

tumor radiosurgery//Nerosurg.-1999.-Vol 45 ¹1.-Ð. 753-765

ÊË²Í²×Í² ÒÀ ²ÌÓÍÎËÎÃ²×Í² ÀÑÏÅÊÒÈ

Ë²ÊÓÂÀÍÍß ÕÂÎÐÈÕ Ç ÀÊÓÑÒÈ×ÍÎÞ

ÍÅÂÐÈÍÎÌÎÞ ÐÀÄ²ÎÕ²ÐÓÐÃ²×ÍÈÌ ÌÅÒÎÄÎÌ

Ì³í³íà À.Þ.

ÃÓ “²íñòèòóò îòîëàðèíãîëîã³¿ ³ì.ïðîô.

À.². Êîëîì³é÷åíêà ÍÀÌÍ Óêðà¿íè”, Êè¿â, Óêðà¿íà

Ðåçþìå. Â ñòàòò³ ïðåäñòàâëåíî ðåçóëüòàòè äîñë³ä-

æåííÿ åôåêòèâíîñò³ ë³êóâàííÿ õâîðèõ íà àêóñòè÷íó íå-

âðèíîìó (ÀÍ) ðàä³îõ³ðóðã³÷íèì ìåòîäîì íà îñíîâ³

êîíòðîëþ ïóõëèíîãî ðîñòó çà äîïîìîãîþ ÌÐÒ ä³àãíîñòèêè,

çì³í ³ìóíîëîã³÷íèõ ïîêàçíèê³â òà ÷àñòîòè âèíèêíåííÿ

ïîá³÷íèõ ÿâèù ï³ñëÿ ë³êóâàííÿ. Ïðîàíàë³çîâàíî äàí³

ñïîñòåðåæåííÿ 24 õâîðèõ íà ÀÍ ç 2010 ïî 2014 ðîêè.

×åðåç ð³ê ï³ñëÿ ñòåðåîòàêñè÷íî¿ ðàä³îõ³ðóðã³¿ çà äàíè-

ìè ÌÐÒ âèÿâëåíî çìåíøåííÿ ïóõëèíè â ðîçì³ðàõ ó 18 (75

%) õâîðèõ, ó 5 (20,8 %) âîíà çàëèøèëàñÿ áåç çì³í. ×åðåç

ð³ê ï³ñëÿ ë³êóâàííÿ ôóíêö³ÿ çâóêîâîñïðèÿòèÿ áóëà çáåðå-

æåíà â 62,5 % âèïàäê³â, ïðè öüîìó äî ë³êóâàííÿ ñëóõ áóâ

çáåðåæåíèé ó 70,8 % õâîðèõ. Ðåçóëüòàòè ïðîâåäåíèõ ³ìó-

íîëîã³÷íèõ äîñë³äæåíü ÷àñòêîâî ï³äòâåðäæóþòü ðåçóëü-

òàòè êîíòðîëþ ðîñòó ïóõëèíè çà äàíèìè çí³ìê³â ÌÐÒ ä³àã-

íîñòèêè. Ïðàêòè÷íà â³äñóòí³ñòü ñòèìóëÿö³¿ ³ìóííî¿ ñèñòå-

ìè õâîðîãî òêàíèííèìè àíòèãåíàìè ³ çíèæåííÿ ð³âíÿ öèòî-

ê³í³â ³ ³ìóíîãëîáóë³í³â ÷åðåç ð³ê ï³ñëÿ îïðîì³íåííÿ

ñâ³ä÷èòü ïðî çíà÷íèé ðåãðåñ ïóõëèíè ³ (÷è) ¿¿ â³äñóòí³ñòü.

Êëþ÷îâ³ ñëîâà: àêóñòè÷íà íåâðèíîìà, ñòåðåîòàê-

ñè÷íà ðàä³îõ³ðóðã³ÿ, ë³êóâàííÿ, ñòàí ñëóõó é ð³âíîâàãè.

CLINICAL AND IMMUNOLOGICAL ASPECTS

OF TREATMENT OF PATIENTS WITH ACOUSTIC

NEURINOVA BY A RADIOSURGICAL METHOD

A. Minina

SI “O.S.Kolomiychenko institute of otolaryngology

NAMS of Ukraine”, Kyiv, Ukraine

Summary. The article presents the results of the study

of treatment efficiency for patients with acoustic neurinoma

(ÀN) by a radiosurgical method on the basis of control of

tumor growth using ÌRI diagnostics, changes of

immunological indexes and side effects frequency after

treatment. 24 ÀÍ patients follow-up data from 2010 to 2014

were analysed.

One year after stereotactic radiosurgery MRI investigation

revealed diminishing of tumour in sizes at 18 (75 %)

patients, at 5 (20,8 %) it remained in former sizes. In a year

after treatment the function of hearing was present in 62,5

% cases in comparison to the 70,8 % patients before

treatment. The results of the conducted immunological study

partly confirm the results of control of tumour growth that

were obtaine by MRI data. Practical absence of stimulation

of the immune system of patient by tissue antigens and the

decline of level of cytokines and immunoproteins in a year

after radiosurgery testifies to considerable regress of tumour

and (or) its absence.

Key words: acoustic neurinoma, stereotactic

radiosurgery, treatment, state of hearing and equilibrium.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

100

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

Âñòóï. ßê ïîêàçàëè äîñë³äæåííÿ îñòàíí³õ ðîê³â, ïî-

ðóøåííÿ ìîòîðèêè æîâ÷íîãî ì³õóðà ìîæóòü áóòè ÿê

îäíèì ³ç åò³îëîã³÷íèõ, òàê ³ âåäó÷èì ïàòîãåíåòè÷íèì

ôàêòîðîì, ùî ñïðèÿº ðîçâèòêó áàãàòüîõ ðîçïîâñþäæå-

íèõ ãàñòðîåíòåðîëîã³÷íèõ çàõâîðþâàíü (æîâ÷íîêàì’ÿíà

õâîðîáà, õîëåöèñòèò, ïàíêðåàòèò òà ³íø³) [1]. Çã³äíî ç ²²²

Ðèìñüêèì êîíñåíñóñîì (2006 ð.) äèñôóíêö³ÿ æîâ÷íîãî

ì³õóðà – öå ìîòîðíî-åâàêóàòîðíèé ðîçëàä éîãî ôóíêö³¿,

ÿêèé êë³í³÷íî ìàí³ôåñòóº áîëÿìè â ïðàâîìó ï³äðåáåð’¿

³ º íàñë³äêîì áóäü-ÿêîãî ç ïî÷àòêîâèõ ìåòàáîë³÷íèõ ïî-

ðóøåíü (íàïðèêëàä, ã³ïåðñàòóðàö³¿ æîâ÷³ õîëåñòåðè-

íîì) àáî ïåðâèííîãî ðîçëàäó ìîòîðèêè æîâ÷íîãî

ì³õóðà [9]. Ó ñòðóêòóð³ á³ë³àðíî¿ ïàòîëîã³¿ ôóíêö³î-

íàëüí³ çàõâîðþâàííÿ æîâ÷íîãî ì³õóðà òà æîâ÷îâèâ³ä-

íèõ øëÿõ³â çàéìàþòü îäíå ç ïðîâ³äíèõ ì³ñöü, ñêëàäàþ-

÷è â³ä 12 äî 28% âèïàäê³â [3]. Â³äîìî, ùî äèñôóíêö³ÿ

æîâ÷íîãî ì³õóðà ñïðèÿº çàñòîþ æîâ÷³ ³ âèíèêíåííþ

á³ë³àðíîãî ñëàäæó, ïåðåäêàì’ÿíî¿ ñòàä³¿ æîâ÷î-êàì’ÿíî¿

õâîðîáè [10, 11]. Ïîðóøåíííÿ ìîòîðíî-åâàêóàòîðíî¿

ôóíêö³¿ æîâ÷íîãî ì³õóðà – íåâ³ä’ºìíà ÷àñòèíà ôîðìó-

âàííÿ ³ ïî÷àòêîâîãî ðîñòó æîâ÷íèõ êàìåí³â, îñê³ëüêè ó

âèïàäêó íîðìàëüíî¿ åâàêóàö³¿ æîâ÷³ ì³êðîêðèñòàëè

õîëåñòåðèíó ³ ñëàäæ â³ëüíî ç íüîãî âèäàëÿþòüñÿ [5].

Á³ë³àðíèé ñëàäæ â æîâ÷íîìó ì³õóð³ íå ò³ëüêè îáóìîâ-

ëþº êë³í³÷íó ñèìïòîìàòèêó, àëå é ïîã³ðøóº ÿê³ñòü æèò-

òÿ äàíèõ õâîðèõ [4].

Â³äïîâ³äíî äî ðåêîìåíäàö³é ÂÎÎÇ, ÿê³ñòü æèòòÿ (ßÆ)

âèçíà÷àºòüñÿ ÿê ³íäèâ³äóàëüíå ñï³ââ³äíîøåííÿ ëþäèíîþ

ñâîãî ñòàíîâèùà â æèòò³ ñóñï³ëüñòâà ç âëàñíèìè ö³ëÿìè,

ïëàíàìè, ìîæëèâîñòÿìè ³ ñòóïåíåì çàãàëüíî¿ íåâëàøòî-

âàíîñò³ [2, 12]. Íå âàðòî çàáóâàòè ïðî òàêèé âàæëèâèé ïî-

êàçíèê ßÆ, ÿê çäàòí³ñòü õâîðî¿ ëþäèíè àäàïòóâàòèñÿ äî

ïðîÿâ³â ñâîãî çàõâîðþâàííÿ ³ â³ä÷óâàòè ñåáå êîìôîðòíî â

ö³é ñèòóàö³¿. Òîìó, â òîé ÷àñ, êîëè äëÿ ë³êàðÿ îäíèì ç îñ-

íîâíèõ çàâäàíü ïðè ë³êóâàíí³ õâîðîãî º äîñÿãíåííÿ

êë³í³êî-ëàáîðàòîðíî¿ ðåì³ñ³¿ òà çàïîá³ãàííÿ ïðîãðåñóâàí-

íÿ çàõâîðþâàííÿ, äëÿ ïàö³ºíòà ïåðøî÷åðãîâîþ ìåòîþ º

ïîë³ïøåííÿ ñàìîïî÷óòòÿ ³ âñ³õ àñïåêò³â ßÆ, ùî, â óìîâàõ

íàÿâíîñò³ äèñôóíêö³¿ æîâ÷íîãî ì³õóðà òà á³ë³àðíîãî ñëàä-

æó, íàáóâàº îñîáëèâîãî çíà÷åííÿ.

ÓÄÊ 615.851.83:[616.366-008.6+616.36-008.811.6]-053.81

ÂÏËÈÂ ÇÀÑÎÁ²Â Ô²ÇÈ×ÍÎ¯ ÐÅÀÁ²Ë²ÒÀÖ²¯

ÍÀ ßÊ²ÑÒÜ ÆÈÒÒß ÎÑ²Á ÌÎËÎÄÎÃÎ Â²ÊÓ

Ç ÄÈÑÔÓÍÊÖ²ªÞ ÆÎÂ×ÍÎÃÎ Ì²ÕÓÐÀ

ÒÀ ÍÀßÂÍ²ÑÒÞ Á²Ë²ÀÐÍÎÃÎ ÑËÀÄÆÓ

Íàçàðêî Í.Ì.

Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Î.Î. Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: ô³çè÷íà ðåàá³ë³òàö³ÿ, ÿê³ñòü æèòòÿ, äèñôóíêö³ÿ æîâ÷íîãî ì³õóðà, á³ë³àðíèé ñëàäæ, îñîáè

ìîëîäîãî â³êó

Ìåòà ðîáîòè - ïîêðàùåííÿ ÿêîñò³ æèòòÿ â îñ³á ìîëîäî-

ãî â³êó ç äèñôóíêö³ºþ æîâ÷íîãî ì³õóðà òà íàÿâí³ñòþ

á³ë³àðíîãî ñëàäæó çà äîïîìîãîþ ð³çíèõ ïðîãðàì ô³çè÷-

íî¿ ðåàá³ë³òàö³¿.

Ìàòåð³àëè òà ìåòîäè äîñë³äæåííÿ. Äîñë³äæåíî 72

îñîáè ìîëîäîãî â³êó ç äèñôóíêö³ºþ æîâ÷íîãî ì³õóðà òà

íàÿâí³ñòþ á³ë³àðíîãî ñëàäæó ó â³ö³ â³ä 18 äî 25 ðîê³â. Âñ³õ

îáñòåæåíèõ øëÿõîì ðàíäîì³çàö³¿ ðîçïîä³ëèëè íà òðè ãðó-

ïè. Ïåðø³é ãðóï³ (n=24) ïðèçíà÷èëè çàãàëüíîâ³äîìó ïðî-

ãðàìó ðåàá³ë³òàö³¿ ç âèêîðèñòàííÿì ã³ìíàñòè÷íèõ âïðàâ

[6, 8], äðóã³é (n=25) – ïðîãðàìó ô³çè÷íèõ òðåíóâàíü íà

âåëîòðåíàæåð³ [7], òðåò³é (n=23) – ïðîãðàìó âåëîòðåíó-

âàíü â ïîºäíàíí³ ç ã³ìíàñòè÷íèìè âïðàâàìè. Ô³çè÷íà ðå-

àá³ë³òàö³ÿ òðèâàëà 30 äí³â ïðîòÿãîì 25-30 õâèëèí 5 ðàç³â íà

òèæäåíü.

ßê³ñòü æèòòÿ îñ³á îö³íþâàëè äî òà ï³ñëÿ ïðîâåäåííÿ

ô³çè÷íî¿ ðåàá³ë³òàö³¿ çà äîïîìîãîþ àíêåòè SF-36 (Medical

Outcomes Study – Short Form). Çà ðåçóëüòàòàìè àíêåòó-

âàííÿ ïðîâîäèâñÿ ðîçðàõóíîê â³ñüìîõ ïàðàìåòð³â: ô³çè÷-

íîãî ôóíêö³îíóâàííÿ (ÔÔ), ðîëüîâîãî ôóíêö³îíóâàííÿ,

îáóìîâëåíîãî ô³çè÷íèì ñòàíîì (ÐÔ), ³íòåíñèâíîñò³

áîëþ (²Á), çàãàëüíîãî ñòàíó çäîðîâ’ÿ (ÇÇ), ðîëüîâîãî ôóíê-

ö³îíóâàííÿ, îáóìîâëåíîãî åìîö³ÿìè (ÐÅ), æèòòºâî¿ àê-

òèâíîñò³ (ÆÀ), ñîö³àëüíîãî ôóíêö³îíóâàííÿ (ÑÔ), ïñèõ³-

÷íîãî çäîðîâ’ÿ (ÏÇ). Êîæåí ïàðàìåòð îö³íåíî â³äïîâ³äíî

äî øêàëè â³ä 0 äî 100 áàë³â, ïðè öüîìó, ÷èì ìåíøà

ê³ëüê³ñòü áàë³â, òèì ã³ðøà ßÆ. Ñòàòèñòè÷íà îáðîáêà îòðè-

ìàíèõ ðåçóëüòàò³â ïðîâîäèëàñÿ çà äîïîìîãîþ îäíî- ³ áà-

ãàòîôàêòîðíîãî äèñïåðñ³éíîãî àíàë³çó (ïàêåò ë³öåíç³éíèõ

ïðîãðàì “Microsoft Excel”, “Statistica 6.0”).

Ðåçóëüòàòè òà îáãîâîðåííÿ. ßê ñâ³ä÷àòü îòðèìàí³ äàí³

(òàáë. 1), äîñë³äæóâàí³ ãðóïè ¹1 îö³íþâàëè ñâîº ô³çè÷íå

ôóíêö³îíóâàííÿ íà 14,1±1,1 áàë³â êðàùå, í³æ äî ïî÷àòêó

ðåàá³ë³òàö³¿ (ð<0,01). Ï³ñëÿ ô³çè÷íî¿ ðåàá³ë³òàö³¿ ³ç çàñòîñó-

âàííÿì ã³ìíàñòè÷íèõ âïðàâ äàí³ îñîáè â³äì³òèëè ïîêðà-

ùåííÿ çàãàëüíîãî ñòàíó çäîðîâ’ÿ íà 37,3±2,5 áàë³â

(ð<0,001). Âîíè ñòàëè ââàæàòè ñåáå ìåíø õâîðîáëèâèìè,

ñõèëüíèìè äî ðîçâèòêó õâîðîá, í³æ äî ïî÷àòêó ðåàá³ë³-

òàö³¿, ïîçèòèâíî îö³íþþòü ñòàí ñâîãî çäîðîâ’ÿ. Ïîêàçíè-

êè ³íòåíñèâíîñò³ áîëþ òà ðîëüîâîãî ôóíêö³îíóâàííÿ

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îáóìîâëåíîãî ô³çè÷íèì ñòàíîì ñóòòºâî íå â³äð³çíÿëèñÿ

íà åòàïàõ ðåàá³ë³òàö³¿ (ð>0,05).

Ðîëüîâå ôóíêö³îíóâàííÿ îáóìîâëåíå åìîö³ÿìè äîñ-

òîâ³ðíî ïîêðàùèëîñÿ â îáñòåæåíèõ ãðóïè ¹1 â ñåðåäíüî-

ìó íà 18,1±2,6 áàë³â â ïîð³âíÿíí³ äî ïî÷àòêó ðåàá³ë³òàö³¿

(p<0,05).

Æèòòºâà àêòèâí³ñòü ñïî÷àòêó ñòàíîâèëà 63,4±2,5 áàë³â,

ï³ñëÿ ô³çè÷íî¿ ðåàá³ë³òàö³¿ – 77,0±3,2 áàë³â, ùî çðîñëî íà

17,7% ó ïîð³âíÿíí³ ç âèõ³äíèìè äàíèìè (p<0,01). Ïîêàçíè-

êè ïñèõ³÷íîãî çäîðîâ’ÿ çì³íèëèñÿ íà 21,6±4,2 áàëè ó ïî-

ð³âíÿíí³ äî ïî÷àòêó ðåàá³ë³òàö³¿ (p<0,05). Õâîð³ äîñèòü

ð³äêî ïî÷óâàëè ñåáå çíåâ³ðåíèìè, ñóìíèìè òà âèìó÷åíè-

ìè. Çì³íè ïîêàçíèê³â ñîö³àëüíîãî ôóíêö³îíóâàííÿ äîñ-

òîâ³ðíî íå çíà÷èì³ íà åòàïàõ ô³çè÷íî¿ ðåàá³ë³òàö³¿

(ð>0,05).

Ïîð³âíÿííÿ ïîêàçíèê³â ÿêîñò³ æèòòÿ îñ³á ãðóïè ¹1 íà

åòàïàõ ðåàá³ë³òàö³¿ ïðåäñòàâëåíî çà âñ³ìà øêàëàìè îïèòó-

âà÷à SF-36 íà ðèñ. 1.

Ó ãðóï³ ¹2 ðîëüîâå ôóíêö³îíóâàííÿ îáóìîâëåíå

ô³çè÷íèì ñòàíîì äî ïî÷àòêó ðåàá³ë³òàö³¿ áóëî 78,2±4,1

áàë³â, ï³ñëÿ – 94,6±4,1 áàë³â, òîáòî çðîñëî íà 16,4 áàë³â

(p<0,05). Âñòàíîâëåíî, ùî ïîêàçíèê ³íòåíñèâíîñò³ áîëþ

ìàâ äîñòîâ³ðíó ïîçèòèâíó äèíàì³êó ³ ñêëàäàâ çðîñòàííÿ

íà 11,0% (10,1±2,1 áàë³â) ó ïîð³âíÿíí³ ç âèõ³äíèì ñòàíîì.

Ï³ñëÿ ô³çè÷íî¿ ðåàá³ë³òàö³¿ ³ç çàñòîñóâàííÿì âåëîòðå-

íóâàííÿ ó ãðóï³ ¹2 ïîêàçíèê çàãàëüíîãî ñòàíó çäîðîâ’ÿ

ñòàâ 83,9±2,5 áàë³â, ùî íà 43,6% (37,3±2,5 áàë³â) á³ëüøå,

í³æ äî ïî÷àòêó ðåàá³ë³òàö³¿ (ð<0,001). Ïîêàçíèê ô³çè÷íîãî

ôóíêö³îíóâàííÿ ñóòòºâî íå â³äð³çíÿâñÿ íà åòàïàõ ðåàá³ë³-

òàö³¿ (ð>0,05).

Ïîð³âíÿííÿ ïîêàçíèê³â ÿêîñò³ æèòòÿ îñ³á ãðóïè ¹2 íà

åòàïàõ ô³çè÷íî¿ ðåàá³ë³òàö³¿ ç âèêîðèñòàííÿì âåëîòðåíó-

âàííÿ ïðåäñòàâëåíî çà âñ³ìà øêàëàìè îïèòóâà÷à SF-36 íà

ðèñ. 2.

Àíàë³ç äàíèõ, ïðåäñòàâëåíèõ â òàáë. 1, äîçâîëèâ âèÿâè-

òè äîñòîâ³ðíó ïîçèòèâíó äèíàì³êó âñ³õ ïîêàçíèê³â ïñèõ³÷-

íîãî êîìïîíåíòó çäîðîâ’ÿ. Ðîëüîâå ôóíêö³îíóâàííÿ

îáóìîâëåíå åìîö³ÿìè òà ïñèõ³÷íå çäîðîâ’ÿ ïîêðàùèëîñÿ

â îáñòåæåíèõ ãðóïè ¹2 â ñåðåäíüîìó â³äïîâ³äíî íà

19,8±3,9 òà 19,8±3,5 áàë³â â ïîð³âíÿíí³ äî ïî÷àòêó ðåàá³ë³-

òàö³¿ (p<0,01).

Æèòòºâà àêòèâí³ñòü ñïî÷àòêó ñòàíîâèëà 62,4±2,4 áàë³â,

ï³ñëÿ ô³çè÷íî¿ ðåàá³ë³òàö³¿ – 75,0±4,5 áàë³â, ùî çðîñëî íà

16,8% (12,6±3,5 áàë³â) ó ïîð³âíÿíí³ ç âèõ³äíèìè äàíèìè

(p<0,05). Õâîð³ ïî÷àëè ïî÷óâàòè ñåáå á³ëüø áàäüîðèìè,

ñïîê³éíèìè ³ óìèðîòâîðåíèìè, ùàñëèâèìè, ïîâíèìè

ñèë ³ åíåðã³¿ á³ëüøó ÷àñòèíó ÷àñó. Ïîêàçíèêè ñîö³àëüíîãî

ôóíêö³îíóâàííÿ äî ïî÷àòêó ðåàá³ë³òàö³¿ áóëè 75,9±3,9

áàë³â, ï³ñëÿ ô³çè÷íî¿ ðåàá³ë³òàö³¿ – 86,6±3,1 áàë³â, òîáòî

çá³ëüøèëèñÿ íà 12,3% (10,7±3,5 áàë³â) ó ïîð³âíÿíí³ ç âèõ³ä-

íèìè äàíèìè (p<0,05).

Äîñë³äæóâàí³ ãðóïè ¹3 îö³íþâàëè ñâîº ô³çè÷íå ôóí-

êö³îíóâàííÿ íà 12,1±1,1 áàë³â êðàùå, í³æ äî ïî÷àòêó ðåàá-

³ë³òàö³¿ (ð<0,01). Ðîëüîâå ôóíêö³îíóâàííÿ îáóìîâëåíå

ô³çè÷íèì ñòàíîì äî ïî÷àòêó ðåàá³ë³òàö³¿ áóëî 79,3±3,8

áàë³â, ï³ñëÿ – 96,7±3,9 áàë³â, òîáòî çðîñëî íà 17,4 áàë³â

(p<0,01). Îñîáè ãðóïè ¹3 â³äì³÷àëè ïîêðàùåííÿ ñâîãî

ô³çè÷íîãî ñòàíó, ÿêèé ðàí³øå âèêëèêàâ îáìåæåííÿ ó âè-

êîíàíí³ ïåâíî¿ ðîáîòè, äîâîäèëîñü ñêîðî÷óâàòè ÷àñ íà

âèêîíàííÿ ðîáîòè, âèíèêàëè òðóäíîù³ ïðè âèêîíàíí³

äàíî¿ ðîáîòè. Âñòàíîâëåíî, ùî ïîêàçíèê ³íòåíñèâíîñò³

áîëþ ìàâ äîñòîâ³ðíó ïîçèòèâíó äèíàì³êó ³ çðîñòàâ íà

13,4% (12,6±2,8 áàë³â) ó ïîð³âíÿíí³ ç âèõ³äíèì ñòàíîì.

Ï³ñëÿ ô³çè÷íî¿ ðåàá³ë³òàö³¿ ³ç çàñòîñóâàííÿì ã³ìíàñ-

òè÷íèõ âïðàâ òà âåëîòðåíóâàííÿ îñîáè ãðóïè ¹3 â³äì³òè-

ëè ïîêðàùåííÿ çàãàëüíîãî ñòàíó çäîðîâ’ÿ íà 41,8±2,9

áàë³â (ð<0,001).

Ïîð³âíÿííÿ ïîêàçíèê³â ÿêîñò³ æèòòÿ îñ³á ãðóïè ¹3 íà

åòàïàõ ô³çè÷íî¿ ðåàá³ë³òàö³¿ ç âèêîðèñòàííÿì âåëîòðåíó-

âàííÿ ïðåäñòàâëåíî çà âñ³ìà øêàëàìè îïèòóâà÷à SF-36 íà

ðèñ. 3.

Ðîëüîâå ôóíêö³îíóâàííÿ îáóìîâëåíå åìîö³ÿìè òà

ïñèõ³÷íå çäîðîâ’ÿ ïîêðàùèëîñÿ â îáñòåæåíèõ ãðóïè ¹3 â

ñåðåäíüîìó â³äïîâ³äíî íà 26,2±4,1 òà 23,2±3,5 áàë³â â ïî-

ð³âíÿíí³ äî ïî÷àòêó ðåàá³ë³òàö³¿ (p<0,001). Æèòòºâà àê-

òèâí³ñòü ñïî÷àòêó ñòàíîâèëà 62,6±2,8 áàë³â, ï³ñëÿ ô³çè÷íî¿

ðåàá³ë³òàö³¿ – 84,4±4,2 áàë³â, ùî çðîñëî íà 25,8% (21,8±3,5

áàë³â) ó ïîð³âíÿíí³ ç âèõ³äíèìè äàíèìè (p<0,001).

Ïîêàçíèêè ñîö³àëüíîãî ôóíêö³îíóâàííÿ äî ïî÷àòêó

ðåàá³ë³òàö³¿ áóëè 74,8±3,3 áàë³â, ï³ñëÿ ô³çè÷íî¿ ðåàá³ë³òàö³¿ –

95,5±3,5 áàë³â, òîáòî çá³ëüøèëèñÿ íà 21,7% (20,7±3,4 áàë³â)

ó ïîð³âíÿíí³ ç âèõ³äíèìè äàíèìè (p<0,001).

Âèñíîâêè:

1. Ï³ñëÿ ïðîâåäåííÿ ô³çè÷íî¿ ðåàá³ë³òàö³¿ ³ç çàñòîñó-

âàííÿì ã³ìíàñòè÷íèõ âïðàâ ÿê³ñòü æèòòÿ ïîêðàùèëàñÿ ó

äîñë³äæóâàíèõ ãðóïè ¹1 çà ïîêàçíèêàìè ô³çè÷íîãî ôóí-

êö³îíóâàííÿ, çàãàëüíîãî ñòàíó çäîðîâ’ÿ, ðîëüîâîãî ôóíê-

ö³îíóâàííÿ îáóìîâëåíîãî åìîö³ÿìè, æèòòºâî¿ àêòèâíîñò³

òà ïñèõ³÷íîãî çäîðîâ’ÿ. Çì³íè ïîêàçíèê³â ñîö³àëüíîãî

ôóíêö³îíóâàííÿ, ³íòåíñèâíîñò³ áîëþ òà ðîëüîâîãî ôóíê-

ö³îíóâàííÿ îáóìîâëåíîãî ô³çè÷íèì ñòàíîì áóëè ñòàòèñ-

òè÷íî íå çíà÷èì³ (ð>0,05).

Òàáëèöÿ 1.

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2. Ï³ñëÿ ïðîâåäåííÿ ô³çè÷íî¿ ðåàá³ë³òàö³¿ ³ç çàñòîñó-

âàííÿì âåëîòðåíóâàííÿ ÿê³ñòü æèòòÿ ïîêðàùèëàñÿ ó äîñ-

ë³äæóâàíèõ ãðóïè ¹2 çà ïîêàçíèêàìè ðîëüîâîãî ôóíêö³î-

íóâàííÿ îáóìîâëåíîãî ô³çè÷íèì ñòàíîì, ³íòåíñèâíîñò³

áîë³, çàãàëüíîãî ñòàíó çäîðîâ’ÿ, ðîëüîâîãî ôóíêö³îíó-

âàííÿ îáóìîâëåíîãî åìîö³ÿìè, æèòòºâî¿ àêòèâíîñò³, ñî-

ö³àëüíîãî ôóíêö³îíóâàííÿ òà ïñèõ³÷íîãî çäîðîâ’ÿ. Çì³íè

ïîêàçíèêà ô³çè÷íîãî ôóíêö³îíóâàííÿ áóâ ñòàòèñòè÷íî

íå çíà÷èìèì (ð>0,05).

3. Ï³ñëÿ ïðîâåäåííÿ ô³çè÷íî¿ ðåàá³ë³òàö³¿ ³ç çàñòîñóâàí-

íÿì âåëîòðåíóâàííÿ òà ã³ìíàñòè÷íèõ âïðàâ ÿê³ñòü æèòòÿ

äîñë³äæóâàíèõ ãðóïè ¹3 ïîêðàùèëàñÿ çà âñ³ìà ïîêàçíè-

êàìè ïñèõ³÷íîãî òà ô³çè÷íîãî êîìïîíåíò³â çäîðîâ’ÿ.

4. Âèêîðèñòàííÿ ïðîãðàìè ô³çè÷íî¿ ðåàá³ë³òàö³¿ îñ³á

ìîëîäîãî â³êó ç äèñôóíêö³ºþ æîâ÷íîãî ì³õóðà òà íàÿâ-

í³ñòþ á³ë³àðíîãî ñëàäæó ³ç çàñòîñóâàííÿì âåëîòðåíóâàí-

íÿ òà ã³ìíàñòè÷íèõ âïðàâ º á³ëüø äîö³ëüíèì, îñê³ëüêè âè-

ÿâëåíî ïîçèòèâíó äèíàì³êó âñ³õ ïîêàçíèê³â ÿêîñò³ æèòòÿ.

Ðåöåíçåíò:ä.ìåä.í., ïðîôåñîð Ëèçîãóá Â.Ã.

Ë²ÒÅÐÀÒÓÐÀ

1. Áàáàê Î. ß. Ñèíäðîì õîëåñòàçó (ïðè÷èíè, ìåõàí³çìè ðîç-

âèòêó, êë³í³÷í³ ïðîÿâè òà ïðèíöèïè ë³êóâàííÿ) / Î. ß. Áàáàê //

Ë³êóâàííÿ òà ä³àãíîñòèêà. – 2003. – ¹ 2. – Ñ 27-35.

2. Áîêåðèÿ Ë. À. Ïîíÿòèå “êà÷åñòâî æèçíè” è ìåòîäû åãî

îöåíêè / Ë. À. Áîêåðèÿ, Â. Ñ. Àðàêåëÿí, Å. Ã. Òóòîâ // Áþëëåòåíü

ÍÖÑÑÕ èì À.Í. Áàêóëåâà ÐÀÌÍ. – 2005. – ¹ 6 (1). – Ñ. 23-29.

3. Çâÿãèíöåâà Ò. Ä. Áèëèàðíàÿ äèñôóíêöèÿ: äèàãíîñòèêà è

ëå÷åíèå / Ò. Ä.Çâÿãèíöåâà, Ñ. Â. Ãðèäíåâà // Ñîâðåìåííàÿ ãàñòðî-

ýíòåðîëîãèÿ. – 2008. – ¹ 5 (43). – Ñ. 93-99.

4. Íîâèê À. À. Êîíöåïöèÿ èññëåäîâàíèÿ êà÷åñòâà æèçíè â

ìåäèöèíå / À. À. Íîâèê, Ò. È. Èîíîâà, Ï. Êàéíä. – ÑÏá.: Ýëáè,

1999. – 377 ñ.

5. Îõëîáûñòèí À. Â. Ðàññòðîéñòâà ìîòîðèêè æåë÷åâû-

âîäÿùèõ ïóòåé â êëèíè÷åñêîé ïðàêòèêå / À. Â. Îõëîáûñòèí //

Êëèíè÷åñêèå ïåðñïåêòèâû ãàñòðîýíòåðîëîãèè, ãåïàòîëîãèè. –

2002. – ¹ 3. – Ñ. 17-23.

6. Ïàðõîòèê È. È. Ôèçè÷åñêàÿ ðåàáèëèòàöèÿ ïðè çàáîëå-

âàíèÿõ îðãàíîâ áðþøíîé ïîëîñòè / È. È. Ïàðõîòèê. – Ê., Îëèìï.

ëèò., 2003. – 223 ñ.

Ðèñ. 2. Ãðàô³÷íå çîáðàæåííÿ ïîð³âíÿííÿ ïîêàçíèê³â ÿêîñò³

æèòòÿ îñ³á ãðóïè ¹2 íà åòàïàõ ô³çè÷íî¿ ðåàá³ë³òàö³¿ ç

âèêîðèñòàííÿì âåëîòðåíóâàííÿ

Ðèñ. 1. Ãðàô³÷íå çîáðàæåííÿ ïîð³âíÿííÿ ïîêàçíèê³â ÿêîñò³

æèòòÿ îñ³á ãðóïè ¹1 íà åòàïàõ ô³çè÷íî¿ ðåàá³ë³òàö³¿

ç âèêîðèñòàííÿì ã³ìíàñòè÷íèõ âïðàâ

Ðèñ. 3. Ãðàô³÷íå çîáðàæåííÿ ïîð³âíÿííÿ ïîêàçíèê³â ÿêîñò³

æèòòÿ îñ³á ãðóïè ¹3 íà åòàïàõ ô³çè÷íî¿ ðåàá³ë³òàö³¿ ³ç

çàñòîñóâàííÿì ã³ìíàñòè÷íèõ âïðàâ òà âåëîòðåíóâàííÿ

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ÂËÈßÍÈÅ ÑÐÅÄÑÒÂ ÔÈÇÈ×ÅÑÊÎÉ

ÐÅÀÁÈËÈÒÀÖÈÈ ÍÀ ÊÀ×ÅÑÒÂÎ ÆÈÇÍÈ ËÈÖ

ÌÎËÎÄÎÃÎ ÂÎÇÐÀÑÒÀ Ñ ÄÈÑÔÓÍÊÖÈÅÉ

ÆÅË×ÍÎÃÎ ÏÓÇÛÐß È ÍÀËÈ×ÈÅÌ

ÁÈËÈÀÐÍÎÃÎ ÑËÀÄÆÀ

Íàçàðêî Í.Í.

Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò

èìåíè À.À. Áîãîìîëüöà, ã. Êèåâ, Óêðàèíà

Ðåçþìå. Èñïîëüçîâàíèå ïðîãðàììû ôèçè÷åñêîé

ðåàáèëèòàöèè ëèö ìîëîäîãî âîçðàñòà ñ äèñôóíêöèåé

æåë÷íîãî ïóçûðÿ è íàëè÷èåì áèëèàðíîãî ñëàäæà ñ ïðè-

ìåíåíèåì âåëîòðåíèðîâêè è ãèìíàñòè÷åñêèõ óïðàæíå-

íèé ÿâëÿåòñÿ áîëåå öåëåñîîáðàçíûì, ïîñêîëüêó âû-

ÿâëåíà ïîëîæèòåëüíàÿ äèíàìèêà âñåõ ïîêàçàòåëåé

êà÷åñòâà æèçíè.

Êëþ÷åâûå ñëîâà: ôèçè÷åñêàÿ ðåàáèëèòàöèÿ, êà÷å-

ñòâî æèçíè, äèñôóíêöèÿ æåë÷íîãî ïóçûðÿ, áèëèàðíûé

ñëàäæ, ëèöà ìîëîäîãî âîçðàñòà.

EFFECT OF PHYSICAL REHABILITATION

ON QUALITY OF LIFE IN YOUNG PERSONS

WITH GALLBLADDER DYSFUNCTION

AND BILIARY SLUDGE

N. Nazarko

Bogomolets National Medical University, Kyiv, Ukraine

Summary. Using a physical rehabilitation program in

young persons with gallbladder dysfunction and biliary

sludge using bicycle training and gymnastic exercises is

more appropriate, as revealed positive changes in quality

of life of all.

Key words: physical rehabilitation, quality of life,

gallbladder dysfunction, biliary sludge, young persons.

7. Ïàò. 84200 Óêðà¿íà, ÌÏÊ À61Â10/00. Ñïîñ³á ô³çè÷íî¿

ðåàá³ë³òàö³¿ îñ³á ìîëîäîãî â³êó ç äèñôóíêö³ºþ æîâ÷íîãî ì³õóðà

òà íàÿâí³ñòþ á³ë³àðíîãî ñëàäæó / Íàçàðêî Í. Ì. (Óêðà¿íà). – ¹

u201305393; çàÿâë. 26.04.13; îïóáë. 10.10.13, Áþë. ¹19.

8. Ïºøêîâà Î. Â. Ô³çè÷íà ðåàá³ë³òàö³ÿ ïðè çàõâîðþâàííÿõ

âíóòð³øí³õ îðãàí³â / Î. Â. Ïºøêîâà. – Õàðê³â, 2000. – 215 ñ.

9. Ïèìàíîâ Ñ. È. Ðèìñêèé III Êîíñåíñóñ: èçáðàííûå ðàçäå-

ëû è êîìåíòàðèè / Ñ. È. Ïèìàíîâ, Í. Í. Ñèëèâîí÷èê. – Âèòåáñê:

Èçäàòåëüñòâî ÂÃÌÓ, 2006. – 160 ñ.

10. Ôèðñîâà Â. Ã. Æåë÷íîêàìåííàÿ áîëåçíü: âîçìîæíîñòè

äèôôåðåíöèðîâàííîãî ïîäõîäà ê ëå÷åíèþ è íåðåøåííûå âîïðîñû

/ Â. Ã. Ôèðñîâà, Â. Â. Ïàðøèêîâ, Ì. Â. Êóêîø // Ìåäèöèíñêèé

àëüìàíàõ Ãàñòðîýíòåðîëîãèÿ. – 2011. – ¹ 2 (15). – Ñ. 78-82.

11. Drossman D. A. Functional Gastrointestinal Disorders / D.A. Dros-

sman, J. E.Kicher, N. I. Talley. – USA: RC 801.F955, 1994. – 370 p.

12. Primary care physician assessment of COPD severity:

European Health-related Quality of Life in COPD study / Kardos P.,

Jones P. W., Levy M. L. et al. – Eur.Resp. J.; 2010, – 985 p.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

104

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

Âñòóï. Ñòðàâîõ³ä Áàððåòà (ÑÁ) ÿê ïðîÿâ ³ óñêëàäíåííÿ

ãàñòðîåçîôàãåàëüíî¿ ðåôëþêñíî¿ õâîðîáè, íà ñüî-

ãîäí³øí³é äåíü º îäí³ºþ ç íàéá³ëüø àêòóàëüíèõ ïðîáëåì

ñó÷àñíî¿ ãàñòðîåíòåðîëîã³¿. Íåçâàæàþ÷è íà ÷³òê³ ä³àãíîñ-

òè÷í³ êðèòåð³¿, ðîçðîáëåí³ çàâäÿêè ìîæëèâîñòÿì ñó÷àñ-

íèõ åíäîñêîï³÷íèõ ìåòîä³â ç ïðèö³ëüíèì âçÿòòÿì á³îïñ³¿ ³

ìîðôîëîã³÷íèì ï³äòâåðäæåííÿì ä³àãíîçó, ÑÁ ïðîäîâæóº

çàëèøàòèñÿ ïðåäìåòîì äèñêóñ³é. ÑÁ ÿê íàéá³ëüø âàæêèé

ïðîÿâ ãàñòðîåçîôàãåàëüíî¿ ðåôëþêñíî¿ õâîðîáè, õàðàê-

òåðèçóºòüñÿ ìåòàïëàç³ºþ åï³òåë³þ ñòðàâîõîäó ó öèë³íä-

ðè÷íèé, îäíèì ç âàð³àíò³â ÿêîãî º êèøêîâèé åï³òåë³é ³ç

ð³çíèì íàáîðîì êë³òèííèõ åëåìåíò³â [3]. Ìåòàïëàç³ÿ – öå

çàì³ùåííÿ íîðìàëüíîãî åï³òåë³ÿ, â äàíîìó âèïàäêó ïëàñ-

êîãî íåçðîãîâ³ëîãî åï³òåë³þ ñòðàâîõîäó, êë³òèíàìè ³íøî¿

áóäîâè – öè-ë³íäðè÷íèì øëóíêîâèì àáî êèøêîâèì åï³-

òåë³ºì, ÿêèé á³ëüø ñò³éêèé äî ä³¿ êèñëîãî àáî ëóæíîãî

ðåôëþêòàòà, òîáòî ìåòàïëàç³ÿ º ïðîÿâîì çàõèñíî¿ ðåàêö³¿

îðãàí³çìó [13]. Îñíîâíèìè ôàêòîðàìè, ùî ïîøêîäæóþòü

åï³òåë³é íèæíüî¿ òðåòèíè ñòðàâîõîäó ³ ïðèçâîäÿòü äî ìå-

òàïëàç³ÿ, º ÿê ñîëÿíà êèñëîòà ³ ïåïñèí, òàê ³ êîìïîíåíòè

äóîäåíàëüíîãî âì³ñòó – æîâ÷í³ êèñëîòè, ë³çîëåöèòèí ³

òðèïñèí, ïðè÷îìó ä³ÿ ãîëîâíîãî ïîøêîäæóþ÷îãî àãåíòà –

êîí’þãîâàíèõ æîâ÷íèõ êèñëîò, ðåàë³çóºòüñÿ ëèøå â óìî-

âàõ êèñëîãî ðÍ [25]. Òîìó ñàìå ïîºäíàííÿ äóîäåíîãàñò-

ðàëüíîãî ³ êèñëîòíîãî ãàñòðîåçîôàãåàëüíîãî ðåôëþêñà

ïðèçâîäèòü äî ðîçâèòêó ÑÁ.

Ç ñó÷àñíèõ ïîçèö³é ðîçâèòîê àëüòåðàö³¿ ³ ìåòàïëàç³¿

ïëàñêîãî åï³òåë³ÿ ÿê îñíîâíèõ ïðîÿâ³â ÑÁ ïîâ’ÿçóþòü ç

ä³ºþ æîâ÷íèõ êèñëîò, ÿê³ ïðè ðÍ â³ä 3 äî 6 çíàõîäÿòüñÿ â

³îí³çîâàíîìó ñòàí³ ³ çäàòí³ ïðîíèêàòè êð³çü ìåìáðàíó åï-

³òåë³àëüíèõ êë³òèí ³ ñïðè÷èíÿòè òîêñè÷íó ä³þ íà îðãàíåëè

[25]. Òàêîæ ââàæàþòü, ùî îäí³ºþ ç ïðè÷èí ³í³ö³àö³¿ äóîäå-

íî-ãàñòðî-åçîôàãåàëüíîãî ðåôëþêñà, à â ïîäàëüøîìó ³

äèñïëàñòè÷íèõ ìåõàí³çì³â â ìåòàïëàçîâàíîìó åï³òåë³¿

ñòðàâîõîäó º Helicobacter pylori [20].

ÑÁ àñîö³þºòüñÿ ç ï³äâèùåíèì ðèçèêîì ðîçâèòêó àäå-

íîêàðöèíîìè ñòðàâîõîäó, ùî ñïîñòåð³ãàºòüñÿ ó 0,5-1%

âèïàäê³â [18, 22, 26]. ²ñíóþòü òàêîæ äàí³, ùî 95% âèïàäê³â

çàëîçèñòîãî ðàêó ñòðàâîõîäó ä³àãíîñòóþòü ó õâîðèõ

³ç ÑÁ [28].

Íà ñüîãîäí³øí³é äåíü îñíîâíèì ³ îá’ºêòèâíèì êðè-

òåð³ºì âåðèô³êàö³¿ ÑÁ º ìîðôîëîã³÷íå çàêëþ÷åííÿ ï³ñëÿ

âèâ÷åííÿ á³îïòàò³â ñëèçîâî¿ îáîëîíêè äèñòàëüíîãî

ÓÄÊ: 616.329 – 007.21

ÌÎÐÔÎËÎÃ²×ÍÀ Ä²ÀÃÍÎÑÒÈÊÀ

ÑÒÐÀÂÎÕÎÄÓ ÁÀÐÐÅÒÒÀ

Íå÷â³äîâà Â.Â., Ëàçàð÷óê Ã.Î., ßêîâåíêî Â.Î.

Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Î.Î.Áîãîìîëüöÿ, ì.Êè¿â, Óêðà¿íà

Ìåäè÷íèé öåíòð “Óí³âåðñàëüíà êë³í³êà “Îáåð³ã”, ì.Êè¿â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: ñòðàâîõ³ä Áàððåòòà, åíäîñêîï³÷íà ä³àãíîñòèêà, ìîðôîëîã³÷íà ä³àãíîñòèêà, òèïè

ìåòàïëàç³¿ åï³òåë³ÿ.

â³ää³ëó ñòðàâîõîäó, âçÿòèõ ïðè åíäîñêîï³÷íîìó äîñë³ä-

æåíí³ [24]. Ïðè öüîìó ñë³ä âðàõîâóâàòè, ùî ïðîãíîñòè÷íå

çíà÷åííÿ ìàº íå ëèøå ôàêò ìåòàïëàç³¿ ñëèçîâî¿ îáîëîíêè

ñòðàâîõîäó, àëå é ïîøèðåí³ñòü öèõ çì³í [23].

Áóëî âñòàíîâëåíî, ùî â³ðîã³äí³ñòü ðîçâèòêó äèñïëàñ-

òè÷íèõ ïîðóøåíü ³ ìàë³ãí³çàö³¿ ïðîãðåñèâíî çðîñòàº ³ç

çá³ëüøåííÿì ñóìàðíî¿ ïëîù³ çîíè ìåòàïëàç³¿, òîáòî íå-

îáõ³äíî îö³íþâàòè çì³íè åï³òåë³þ íå ëèøå ó âåðòèêàëüíî-

ìó, àëå é ó ïîïåðå÷íîìó (öèðêóëÿðíîìó) íàïðÿìêó,

çã³äíî êëàñèô³êàö³¿ Ñ&M (Ïðàãà, 2004) [27]. Öÿ êëàñèô³êà-

ö³ÿ âðàõîâóº: êðèòåð³é Ñ – äîâæèíà (âåðòèêàëüíà) êðóãî-

âîãî ñåãìåíòà ìåòàïëàç³¿ (ñì); êðèòåð³é Ì – äîâæèíà ìàê-

ñèìàëüíîãî âåðòèêàëüíîãî ñåãìåíòà ìåòàïëàç³¿ (ñì).

Îñíîâíèì ìåòîäîì ä³àãíîñòèêè ÑÁ º åíäîñêîï³ÿ –

ô³áðî-, â³äåîåçîôàãîãàñòðîñêîï³ÿ ó á³ëîìó ñâ³òë³, ó âóçü-

êîïîëîñíîìó ñïåêòð³ (NBI), çá³ëüøóþ÷à åíäîñêîï³ÿ, õðî-

ìîåíäîñêîï³ÿ ç îáîâ’ÿçêîâîþ ïðèö³ëüíîþ ïîë³òîïíîþ

á³îïñ³ºþ [6, 14, 17, 29]. Âïðîâàäæåííÿ íîâèõ åíäîñêîï³÷-

íèõ òåõíîëîã³é äîçâîëèëî ï³äâèùèòè åôåêòèâí³ñòü ä³àãíîñ-

òèêè ÑÁ. Åíäîñêîï³÷íå äîñë³äæåííÿ â á³ëîìó ñâ³òë³ ìîæå

áóòè äîïîâíåíå õðîìîñêîï³ºþ, ïðè ÿê³é âèêîðèñòîâóþòü

òàê³ áàðâíèêè, ÿê ðîç÷èí Ëþãîëÿ, ³íäèãîêàðì³í, ðîç÷èí

ìåòèëåíîâîãî ñèíüîãî ³ ðîç÷èí îöòîâî¿ êèñëîòè, ãåíö³àí-

â³îëåò [6, 10. 19]. Ðîç÷èí Ëþãîëÿ âèêîðèñòîâóþòü äëÿ

óòî÷íåííÿ ãðàíèöü ðåãåíåðàö³¿ åï³òåë³þ ó ïàö³ºíò³â ³ç ÑÁ.

Ðîç÷èí ìåòèëåíîâîãî ñèíüîãî àêòèâíî ïîãëèíàºòüñÿ òêà-

íèíàìè òîíêî- ³ òîâñòîêèøêîâîãî åï³òåë³ÿ, ïðè öüîìó

ïëàñêèé åï³òåë³é ñòðàâîõîäó ³ çàëîçèñòèé øëóíêîâèé åï³-

òåë³é íå çàáàðâëþþòüñÿ. Ä³ëÿíêè åï³òåë³ÿ ç äèñïëàç³þ àáî

íåîïëàç³ºþ âèãëÿäàþòü á³ëüø ñâ³òëèìè íà ñèíüîìó ôîí³

êèøêîâî¿ ìåòàïëàç³¿ [26]. Ðîç÷èí îöòîâî¿ êèñëîòè çàáåçïå-

÷óº ï³äñèëåííÿ ñòðóêòóðè ïîâåðõí³ ñëèçîâî¿. Ïðè êîíòàêò³

ç îöòîâîþ êèñëîòîþ âèíèêàº çâîðîòíÿ äåíàòóðàö³ÿ á³ëê³â

ñëèçîâî¿ îáîëîíêè, ÿêà íàáóõàº, ä³ëÿíêè ìåòàïëàç³ÿ ñòà-

þòü á³ëüø êîíòóðíèìè [26]. ²íäèãîêàðì³í çàò³êàº ó ïðî-

ì³æêè ì³æ êë³òèíàìè, â ÿìêè, ³ ï³äêðåñëþº ìàëþíîê ñëè-

çîâî¿ îáîëîíêè [11]. Åíäîñêîï³ÿ ç âèñîêèì çá³ëüøåííÿì ³

âóçüêîñìóãîâèì äîñë³äæåííÿì äîçâîëÿº ç âèñîêîþ â³ðî-

ã³äí³ñòþ ïðèïóñòèòè òèï ìåòàïëàç³¿ íà îñíîâ³ àíàë³çó òîí-

êèõ äåòàëåé ñëèçîâî¿ îáîëîíêè ³ ñóäèííîãî ìàëþíêà ñëè-

çîâî¿ ³ ï³äñëèçîâî¿ îáîëîíîê ñòðàâîõîäó [6, 29].

Ä³àãíîñòèêà ÑÁ ïîòðåáóº ñèñòåìàòè÷íî¿ á³îïñ³¿ çì³íå-

íî¿ ñëèçîâî¿ îáîëîíêè äëÿ ï³äòâåðäæåííÿ ìåòàïëàç³¿ ³

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ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

äèñïëàç³¿. Çàá³ð ìàòåð³àëó íåîáõ³äíî ïðîâîäèòè ïðè-

ö³ëüíî ç óñ³õ ï³äîçð³ëèõ íà ìåòàïëàç³þ ä³ëÿíîê ³ ÷îòèðüîõ

êâàäðàíò³â ñò³íêè ñòðàâîõîäó ÷åðåç êîæí³ 2 ñì âçäîâæ

âñüîãî ñåãìåíòà ìåòàïëàç³ÿ [8]. Ïåðåä êîíòðîëüíîþ á³î-

ïñ³ºþ ïàö³ºíòó ³ç ÑÁ ïîâèííà áóòè ïðîâåäåíà ïðîòèçàïàëü-

íà òåðàï³ÿ, îñê³ëüêè ãîñòðå çàïàëåííÿ ìîæå ñïðè÷èíèòè

êë³òèííó àòèï³þ ³ ìîæëèâ³ñòü ìîðôîëîã³÷íî¿ ïîìèëêè [4].

Çà ã³ñòîëîã³÷íîþ êëàñèô³êàö³ºþ âèä³ëÿþòü òðè òèïè

åï³òåë³ÿ, ùî ìîæå çàì³ùóâàòè ïëàñêèé åï³òåë³é ñòðàâîõî-

äó: I – êàðä³àëüíèé òèï åï³òåë³þ, ùî ìàº ôîâåîëÿðíó ïî-

âåðõíþ ç íàÿâí³ñòþ ìóöèí-ïðîäóêóþ÷èõ êë³òèí; II – ôóí-

äàëüíèé, ïðè ÿêîìó îêð³ì ìóöèí-ïðîäóêóþ÷èõ êë³òèí

íàÿâí³ ñïåöèô³÷í³ ãîëîâí³ ³ îáêëàäî÷í³ êë³òèíè; III – öèë³-

íäðîêë³òèííèé – ç ìóöèí-ïðîäóêóþ÷èìè êë³òèíàìè, ùî

óòâîðþº âîðñèí÷àñò³ ñêëàäêè ç âêëþ÷åííÿì êåëèõîïîä³á-

íèõ êë³òèí – ñïåö³àë³çîâàíà ñòîâï÷àñòà êèøêîâà ìåòàïëà-

ç³ÿ (ÑÊÌ) – òèï, íàéá³ëüø ñõèëüíèé äî ìàë³ãí³çàö³¿ [8].

Íà ñüîãîäí³øí³é äåíü îñíîâíèì ³ îá’ºêòèâíèì êðè-

òåð³ºì âåðèô³êàö³¿ ÑÁ º ìîðôîëîã³÷íå çàêëþ÷åííÿ ï³ñëÿ

âèâ÷åííÿ á³îïòàò³â ñëèçîâî¿ îáîëîíêè äèñòàëüíîãî

â³ää³ëó ñòðàâîõîäó, âçÿòèõ ïðè åíäîñêîï³÷íîìó äîñë³ä-

æåíí³ [7, 12, 14].

Ìåòîþ äîñë³äæåííÿ ñòàëî ïðîâåñòè àíàë³ç òèï³â ìåòà-

ïëàç³¿ åï³òåë³þ ñòðàâîõîäó çà äàíèìè ÅÃÄÑ ³ ìîðôîëîã³÷-

íîãî äîñë³äæåííÿ ó ê³ëüê³ñíîìó ñï³ââ³äíîøåíí³, âèÿâèòè

÷àñòîòó äèñïëàç³¿ åï³òåë³ÿ ³ ïåðåõîäó â àäåíîêàðöèíîìó.

Ìàòåð³àëè òà ìåòîäè. Íà áàç³ Ìåäè÷íîãî öåíòðó “Óí-

³âåðñàëüíà êë³í³êà “Îáåð³ã” çà ïåð³îä 2010-2012 ðîê³â ïðî-

âåäåíî 2120 ñêðèí³íã-ÅÃÄÑ ãàñòðîñêîïîì Olympus Q160-

Z, NBI, ³ç çá³ëüøåííÿì 115. Âçÿòòÿ ìàòåð³àëó ïðîâîäèëè

çã³äíî ïðèéíÿòèì íà ñüîãîäí³øí³é äåíü ïðîòîêîëàì, à

ñàìå ïðèö³ëüíî ç óñ³õ ï³äîçð³ëèõ íà ìåòàïëàç³þ ä³ëÿíîê ³

÷îòèðüîõ êâàäðàíò³â ñò³íêè ñòðàâîõîäó ÷åðåç êîæí³ 2 ñì

âçäîâæ âñüîãî ñåãìåíòà ìåòàïëàç³¿. Á³îïòàòè ç êîæíî¿

çîíè, ïðîìàðêîâàí³ îêðåìî, ô³êñóâàëèñÿ ó 10% ðîç÷èí³

íåéòðàëüíîãî ôîðìàë³íó. Äàë³ ìàòåð³àë ïðîâîäèâñÿ ó

ã³ñòîïðîöåñîð³ êàðóñåëüíîãî òèïó STP-120, äëÿ çàëèâêè

ïàðàô³íîâèõ áëîê³â âèêîðèñòîâóâàëè ñòàíö³þ EC-350, äëÿ

ð³çêè ïàðàô³íîâèõ áëîê³â – ðîòàö³éíèé ì³êðîòîì ñåð³¿

HM – 340E, äëÿ ôàðáóâàííÿ ã³ñòîëîã³÷íèõ ïðåïàðàò³â –

àâòîìàò Robot-Stainer HMS-740 (âñ³ àïàðàòè ô³ðìè Carl

Zeiss MICROM International GmbH). Ïðåïàðàòè çàôàðáî-

âóâàëè ãåìàòîêñèë³íîì – åîçèíîì. Âèêîðèñòîâóâàëè

ì³êðîñêîï Axioskop 40 ç ôîòîêàìåðîþ Axio Cam MRc5

(Karl Zeiss).

Ðåçóëüòàòè òà îáãîâîðåííÿ. ÑÁ áóâ ä³àãíîñòîâàíèé ó

784 âèïàäêàõ , ùî ñòàíîâèëî 37% â³ä çàãàëüíî¿ ê³ëüêîñò³

ïàö³ºíò³â (2120), ÿêèì áóëà ïðîâåäåíà ÅÃÄÑ. Ñïîñòåð³ãà-

ëîñü ï’ÿòü ï³äòèï³â åíäîñêîï³÷íî¿ ìîðôîëîã³÷íî¿ êàðòèíè

ñëèçîâî¿ îáîëîíêè äèñòàëüíî¿ ÷àñòèíè ñòðàâîõîäó ïðè ÑÁ

1) êðóãë³ ÿìêè, ðåãóëÿðíà ì³êðîâàñêóëÿðèçàö³ÿ; 2) îâàëüí³

ÿìêè, ðåãóëÿðíà ì³êðîâàñêóëÿðèçàö³ÿ; 3) âîðñèí÷àñò³/

çìîðùåí³ (ìîçãîâèäí³) ÿìêè, ðåãóëÿðíà ì³êðîâàñêóëÿðè-

çàö³ÿ; 4) â³äñóòí³ñòü ÿìîê, ðåãóëÿðíà ì³êðîâàñêóëÿðèçà-

ö³ÿ; 5) çðóéíîâàí³ ÿìêè, íåðåãóëÿðíà ì³êðîâàñêóëÿðèçà-

ö³ÿ. 1 òèï â³äïîâ³äàâ ôóíäàëüíîìó òèïó åï³òåë³þ ïðè

ã³ñòîëîã³÷íîìó äîñë³äæåíí³, 2 – êàðä³àëüíîìó, 3 – ÑÊÌ, 4

³ 5 òèïè â³äïîâ³äàëè äèñïëàç³¿ åï³òåë³þ äèñòàëüíî¿ ÷àñòèíè

ñòðàâîõîäó.

Ã³ñòîëîã³÷íî êàðä³àëüíà ìåòàïëàç³ÿ (Ðèñ. 1) áóëà ä³àã-

íîñòîâàíà ó 63 (8%) ïàö³ºíò³â, ôóíäàëüíà (Ðèñ. 2) – ó 157

(20%); ñïåö³àë³çîâàíà êèøêîâà ìåòàïëàç³ÿ (Ðèñ. 3) áóëà

çíàéäåíà ó 470 (70%) ïàö³ºíò³â, çì³øàíà ìåòàïëàç³ÿ

â³äì³÷åíà ó 62 (8%) ïàö³ºíò³â. Ó 24 (3%) âèïàäêàõ áóëà

âñòàíîâëåíà äèñïëàç³ÿ íèçüêîãî ³ âèñîêîãî ñòóïåí³â; â 3

âèïàäêàõ (0,4%) áóëà ä³àãíîñòîâàíà àäåíîêàðöèíîìà.

Äî íåäàâíà ïåðø³ äâà òèïè øëóíêîâî¿ ìåòàïëàç³¿ íå

ââàæàëè ïåðåäðàêîâèìè ñòàíàìè ³ íå âêëþ÷àëè â ãðóïè

ñïîñòåðåæåííÿ. Ëèøå êèøêîâèé òèï ìåòàïëàç³¿ – ñïåö³àë³-

çîâàíèé öèë³íäðè÷íèé åï³òåë³é áóâ â³äíåñåíèé äî îáë³ãàò-

íèõ ïåðåäðàê³â [21]. Îäíàê, â îñòàíí³ ðîêè â ë³òåðàòóð³ ç’ÿ-

âèëèñü ïîâ³äîìëåííÿ, ùî ïåðø³ äâà òèïè ìåòàïëàç³ÿ

åï³òåë³þ ñòðàâîõîäó º ïåðåõ³äíîþ ôàçîþ äî ñïåö³àë³çîâà-

íîãî öèë³íäðè÷íîãî åï³òåë³þ, à â ïîäàëüøîìó äî äèñï-

ëàç³¿ ³ ðàêó ñòðàâîõîäó [9, 16]. Ïðè íàÿâíîñò³ øëóíêîâî¿

ìåòàïëàç³¿ â ñòðàâîõîä³ ³ñíóº â³ðîã³äí³ñòü ïîâíî¿ ³ íåïîâ-

íî¿ êèøêîâî¿ ìåòàïëàç³¿ øëóíêîâèõ çàëîç (Ðèñ. 4), à â ïî-

äàëüøîìó ³ äèñïëàç³¿.

Â îñòàíí³ ðîêè íåïîâíà êèøêîâà ìåòàïëàç³ÿ ðàõóºòüñÿ

ïåðåäðàêîâèì ñòàíîì; ¿¿ ä³ëÿíêè, ùî ì³ñòÿòü ñóëüôîìó-

Ðèñ. 1. Êàðä³àëüíèé òèï ìåòàïëàç³¿ åï³òåë³þ ñòðàâîõîäó.

Çàá. ãåìàòîêñèë³íîì-åîçèíîì. Çá. 200.

Ðèñ. 2. Ôóíäàëüíèé òèï ìåòàïëàç³¿ åï³òåë³þ ñòðàâîõîäó.

Çàá. ãåìàòîêñèë³íîì-åîçèíîì. Çá. 200.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

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ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

öèíè, ðîçö³íþþòü ÿê ìàðêåðè âèñîêîãî ðèçèêó ìàë³ãí³-

çàö³¿ [16]. Ðàçîì ç òèì, äåÿê³ àâòîðè ââàæàþòü, ùî ðîëü

êèøêîâî¿ ìåòàïëàç³¿ â êàíöåðîãåíåç³ âèçíà÷àºòüñÿ íå ¿¿ òè-

ïîì, à äèñïëàñòè÷íèìè çì³íàìè ìåòàïëàçîâàíîãî åï³òå-

ë³ÿ [24]. Äåÿê³ àâòîðè ââàæàþòü, ââàæàþòü, ùî ìàë³ãí³çàö³¿

ï³äëÿãàþòü íèçüêîäèôåðåíö³éîâàí³ êë³òèíè òèïó öèë³íä-

ðè÷íèõ, ùî ïðîäóêóþòü íåâåëèêó ê³ëüê³ñòü ñëèçó, àáî ò³,

ùî íå ôóíêö³îíóþòü [5, 15]. Îäíàê, â îäíîìó ç íàøèõ ñïî-

ñòåðåæåíü ï³äòâåðäæóºòüñÿ, ùî àäåíîêàðöèíîìà ñòðàâî-

õîäó ôîðìóºòüñÿ ñàìå ç ñïåö³àë³çîâàíîãî êèøêîâîãî åï³-

òåë³ÿ (Ðèñ. 5).

Ðåçóëüòàòè ã³ñòîëîã³÷íîãî äîñë³äæåííÿ á³îïòàò³â ïðè

ÑÁ âèçíà÷àþòü ïîäàëüøó òàêòèêó âåäåííÿ õâîðèõ. Çã³äíî

àëãîðèòìó âåäåííÿ ïàö³ºíò³â ³ç ÑÁ ÅÃÄÑ ç ÷îòèðüîõ êâàä-

ðàíòíîþ á³îïñ³ºþ ïðè â³äñóòíîñò³ äèñïëàç³¿ ïðîâîäèòüñÿ

1 ðàç â 2-3 ðîêè; ïðè äèñïëàç³¿ íèçüêîãî ñòóïåíþ – 1 ðàç

íà ð³ê; ïðè äèñïëàç³¿ âèñîêîãî ñòóïåíþ – 1 ðàç â 3–6

ì³ñÿö³â [2].

Â çàëåæíîñò³ â³ä ìîðôîëîã³÷íî¿ êàðòèíè ïðè ÑÁ îáèðà-

þòü ³ òàêòèêó åíäîñêîï³÷íîãî ë³êóâàííÿ. Ïðè â³äñóòíîñò³ äèñïëàç³¿ åï³òåë³þ ñòðàâîõîäó âèêîðèñòîâóþòü àðãîíîï-

ëàçìåííó êîàãóëÿö³þ, ôîòîäèíàì³÷íó òåðàï³þ, ëàçåðíó äå-

ñòðóêö³þ. Ïðè íàÿâíîñò³ äèñïëàç³¿ åï³òåë³ÿ çàñòîñîâóþòü

åíäîñêîï³÷íó ðåçåêö³þ ³ äèññåêö³þ â ï³äñëèçîâîìó øàð³. Ö³

åíäîñêîï³÷í³ òåõíîëîã³¿ âèêîðèñòîâóþòü â êîìá³íîâàíîìó

ë³êóâàíí³ ç ³íã³á³òîðàìè ïðîòîííî¿ ïîìïè [1].

Âèñíîâêè. Îòæå, ìîðôîëîã³÷íå çàêëþ÷åííÿ íà ñüî-

ãîäí³øí³é äåíü º îñíîâíèì îá’ºêòèâíèì êðèòåð³ºì âåðèô³-

êàö³¿ ÑÁ, ìàº âàæëèâå çíà÷åííÿ ó âèáîð³ òàêòèêè ë³êóâàííÿ

³ ïåâíå çíà÷åííÿ ó âèçíà÷åíí³ ïðîãíîçó çàõâîðþâàííÿ.

Ïåðñïåêòèâàìè ïîäàëüøèõ äîñë³äæåíü áà÷èìî âèâ÷åííÿ

ïîòåíö³àëó ìàë³ãí³çàö³¿ ìåòàïëàçîâàíîãî åï³òåë³þ ïðè ÑÁ.

Ðåöåíçåíò: ÷ëåí-êîð. ÍÀÌÍ Óêðà¿íè,

ä.ìåä.í., ïðîôåñîð Çàõàðàø Ì.Ï.

Ë²ÒÅÐÀÒÓÐÀ

1. Àëåêñååíêî Ñ.À. Àëãîðèòìû äèàãíîñòèêè è ëå÷åíèÿ ãàñòðî-

ýçîôàãåàëüíîé ðåôëþêñíîé áîëåçíè / Ñ.À. Àëåêñååíêî // Ôàðìà-

òåêà. – 2006. – ¹ 1. – Ñ. 40-49.

2. Áåëîâà Ã.Â. Àëãîðèòì äèàãíîñòèêè è ëå÷åíèÿ ïàöèåíòîâ

ñ ïèùåâîäîì Áàððåòòà / Ã.Â. Áåëîâà, Â.Â. Ñîêîëîâ, À.À. Áóäçèí-

ñêèé, Ä.Ñ. Ìåëü÷åíêî // Êëèíè÷åñêàÿ ýíäîñêîïèÿ. – 2008. – ¹ 1(14). –

Ñ. 33-39.

3. Áåëîóñ Ò.À. Ïèùåâîä Áàððåòòà: ìîðôîëîãè÷åñêèå îñíî-

âû ðàçâèòèÿ // Ðîññ. æóðí. ãàñòðîýíòåðîë. ãåïàòîë. êîëîïðîê-

òîë. – 2002. – Ò.12, ¹ 5. – Ñ. 63-66.

4. Âàñèëåâñêèé Ä.È. Ãàñòðîýçîôàãåàëüíàÿ ðåôëþêñíàÿ áî-

ëåçíü. Êîìáèíèðîâàííûå ìàëîèíâàçèâíûå õèðóðãè÷åñêèå òåõíî-

ëîãèè â ëå÷åíèè ïèùåâîäà Áàððåòòà ó áîëüíûõ ñ ãðûæàìè ïèùå-

âîäíîãî îòâåðñòèÿ äèàôðàãìû / Ä.È. Âàñèëåâñêèé, À.Â. Ëóôò,

Ñ.Ë. Âîðîáüåâ [è äð.] // Êëèíè÷åñêàÿ ýíäîñêîïèÿ. – 2009. – ¹ 1

(18). – Ñ. 2-19.

5. Çàéðàòüÿíö Î.Â. Ïàòîëîãè÷åñêàÿ àíàòîìèÿ ïèùåâîäà

Áàððåòòà / Î.Â. Çàéðàòüÿíö, È.Â. Ìàåâ, Â.À. Ñìîëüÿííèêîâà,

Ï.Ð. Ìîâòàåâà // Àðõèâ ïàòîëîãèè. – 2011. – ¹ 3. – Ñ. 21-26

6. Çàõàðàø Ì.Ï. NBI ³ åíäîñêîï³ÿ ç âèñîêèì çá³ëüøåííÿì:

ñó÷àñí³ ìîæëèâîñò³ åíäîñêîï³÷íî¿ ä³àãíîñòèêè / Ì.Ï. Çàõàðàø,

Â.Î. ßêîâåíêî, Î.Ã. Êóðèê //Óêðà¿íñüêèé æóðíàë ìàëî³íâàçèâíî¿

òà åíäîñêîï³÷íî¿ õ³ðóðã³¿. – 2009. – ¹4. – 12-15.

7. Êóðèê Î.Ã. Ñòðàâîõ³ä Áàððåòòà: ñó÷àñí³ ìîðôîëîã³÷í³

àñïåêòè / Î.Ã. Êóðèê , Ì.Ä. Àíäðººâ // Õ³ðóðã³ÿ Óêðà¿íè . – 2009. –

¹ 4 (32). – Ñ. 105-108.

8. Ëóêèíà À.Ñ. Ýíäîñêîïè÷åñêàÿ äèàãíîñòèêè è êëàññèôè-

êàöèÿ ïèùåâîäà Áàððåòòà. Ñîâðåìåííîå ñîñòîÿíèå è èñòîðèÿ

âîïðîñà /À.Ñ. Ëóêèíà, Â.Ã. Íåóñòðîåâ // Êëèí. ýíäîñêîïèÿ. – 2008. –

¹3 (16). – Ñ. 28-37.

Ðèñ. 3. Ñïåö³àë³çîâàíà ñòîâï÷àñòà êèøêîâà ìåòàïëàç³ÿ

åï³òåë³þ ñòðàâîõîäó. Çàá. ãåìàòîêñèë³íîì-åîçèíîì. Çá.õ200.

Ðèñ. 4. Íåïîâíà (òîâñòîêèøêîâà) ìåòàïëàç³ÿ åï³òåë³ÿ ïðè

ñòðàâîõîä³ Áàððåòà. Çàá. ãåìàòîêñèë³íîì-åîçèíîì. Çá.õ200

Ðèñ. 5. Àäåíîêàðöèíîìà ñòðàâîõîäó – çàëîçè

ç ñâ³òëèì ñòîâï÷àñòèì êèøêîâèì åï³òåë³ºì.

Çàá. ãåìàòîêñèë³íîì-åîçèíîì. Çá. 200

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9. Ìåëü÷åíêî Ä.Ñ. Ïèùåâîä Áàððåòòà: êëèíèêî-ìîðôîëî-

ãè÷åñêèå ñîïîñòàâëåíèÿ / Ä.Ñ. Ìåëü÷åíêî, Â.Ã. Áåëîâà Â. // Ìåä.

âèçóàëèçàöèÿ. – 2006. – ¹ 5. – Ñ. 74-82.

10. Íèêèøàåâ Â.È. Âèðòóàëüíàÿ õðîìîýíäîñêîïèÿ – íîâàÿ

òåõíîëîãèÿ äëÿ ïîâûøåíèÿ êà÷åñòâà ýíäîñêîïè÷åñêîãî îñìîò-

ðà. Óêðà¿íñüêèé æóðíàë ìàëî³íâàçèâíî¿ òà åíäîñêîï³÷íî¿ õ³ðóðã³¿

/ Â.È.Íèêèøàåâ // 2007. – ¹ 3. – Ñ. 12-16.

11. Ñîëîâüåâà Ã.À. Ãàñòðîýçîôàãåàëüíàÿ ðåôëþêñíàÿ áîëåçíü

è ïèùåâîä Áàððåòòà â êëèíè÷åñêîé ïðàêòèêå / Ã.À. Ñîëîâüåâà,

Â.À. ßêîâåíêî, Å.Ã. Êóðèê // Có÷àñíà ãàñòðîåíòåðîëîã³ÿ. – 2009. –

¹2. – Ñ. 88-95.

12. Ñòàðîñòèí Á.Ä. Ïèùåâîä Áàððåòòà: âûÿâëåíèå, ìî-

íèòîðèíã, ëå÷åíèå / Á.Ä.Ñòàðîñòèí // Ðîñ. æóðí. ãàñòðîºíòå-

ðîë. ãåïàòîë. êîëîïðîêòîë. – 2003. – ¹ 3. – Ñ. 74-91.

13. Ôîìèí Ï.Ä. Íåîïóõîëåâûå çàáîëåâàíèÿ ïèùåâîäà / Ï.Ä.

Ôîìèí, Â.Â. Ãðóáíèê, Â.È. Íèêèøàåâ, À.Â. Ìàëèíîâñêèé – Êèåâ:

ÎÎÎ “Áèçíåññ-Èíòåëëåêò”, 2008. – 304ñ.

14 . ßêîâåíêî Â.Î. Ñòðàâîõ³ä Áàððåòòà / Â.Î. ßêîâåíêî, Î.Ã.

Êóðèê //Óêðà¿íñüêèé æóðíàë ìàëî³íâàçè³íî¿ òà åíäîñêîï³÷íî¿

õ³ðóðã³¿. – 2012. – Ò. 16, ¹ 3. – Ñ. 17-22

15. Amano Y. Primary antibiotic resistance for cellular pro-

liferation and apoptosis in Barrett’s oesophagus with different mucin

phenotypes / Y. Amano, D. Chinuki, T. Yuki // Aliment. Pharmacol.

Ther. – 2006. – Vol. 24, Suppl. 4. – P. 41-48.

16. Buttar N.S. Extent of hight grade dysplasia in Barrett’s

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P. 1630-1639.

17 . Cadiot G. Endoscopy and surveillance of Barrett’s esophagus

/ G. Cadiot // Gastroenterol. Clin. Biol. – 2003. – Vol. 27, ¹ 8-9. –

P. 689-691.

18. Cameron A. J. Epidemiology of Barrett’s esophagus and

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19. Canto M.I. Chromoendoscopy for Barrett’s esophagus in

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21. Coad R.A. Barrett’s esophagus: definition, diagnosis and

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22. Cossentino M.J. Barrett’s esophagus and risk of esophageal

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23 . Guerlud M. Endoscopic classification of Barrett’s esophagus /

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¹ 1. – P. 58-65.

24. Guindi M. Histology of Barrett’s esophagus and dysplasia /

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Vol. 3,¹ 2. – P. 349-368.

25 . Kaur B.G. Bile salts induce blunt cell proliferation in Barrett’s

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2000. – Vol. 278, ¹ 10. – P.1000-1009.

26. Sharma P. Methylene blue chromoendoscopy for detection of

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P. 24-27.

27 . Sharma P. The Development and Validation of an Endoscopic

Grading System for Barrett’s Esophagus: The Prague C & M Criteria

/ P. Sharma, J. Dent, D. Armstrong // Gastroenterol. – 2006. – Vol.

131 (5). – P. 1392-1399.

28 . Spechler S. Barrett’s esophagus and cancer of gastrointestinal

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29. Takao E. Diagnosis of Barrett’s esophagus using NBI /

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ÌÎÐÔÎËÎÃÈ×ÅÑÊÀß ÄÈÀÃÍÎÑÒÈÊÀ

ÏÈÙÅÂÎÄÀ ÁÀÐÐÅÒÒÀ

Íå÷âèäîâà Â.Â., Ëàçàð÷óê Ã.Î., ßêîâåíêî Â.À.

Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò

èìåíè À.À. Áîãîìîëüöà, ã. Êèåâ, Óêðàèíà

Ìåäèöèíñêèé öåíòð “Óíèâåðñàëüíàÿ êëèíèêà

“Îáåðèã”, ã. Êèåâ, Óêðàèíà

Ðåçþìå. Â ñòàòüå ïðåäñòàâëåíû ýíäîñêîïè÷åñêèå è

ìîðôîëîãè÷åñêèå ïðîÿâëåíèÿ ïèùåâîäà Áàððåòòà.

Ïðåäñòàâëåíû ìîðôîëîãè÷åñêèå òèïû ìåòàïëàçèè åïè-

òåëèÿ ïðè ïèùåâîäå Áàððåòòà – êàðäèàëüíûé, ôóíäàëü-

íûé è ñïåöèàëèçèðîâàííàÿ êèøå÷íàÿ ìåòàïëàçèÿ ñ ïî-

òåíöèàëüíûì ðèñêîì ìàëèãíèçàöèè. Ðàññìîòðåíû îñ-

íîâíå ìîìåíòû òàêòèêè âåäåíèÿ ïàöèåíòîâ ñ ïèùåâî-

äîì Áàððåòòà.

Êëþ÷åâûå ñëîâà: ïèùåâîä Áàððåòòà, ýíäîñêîïè÷å-

ñêàÿ äèàãíîñòèêà, ìîðôîëîãè÷åñêàÿ äèàãíîñòèêà, òèïû

ìåòàïëàçèè ýïèòåëèÿ.

MORPHOLOGICAL DIAGNOSTIC

OF BARRET’S ESOPHAGUS

V. Nechvidova, G. Lazarchuk, O. Yakovenko

Bogomolets National Medical University, Kyiv, Ukraine

Ìedical centre “Oberig”, Kyiv, Ukraine

Summary. The article presents the endoscopic and

morphological features of Barret’s esophagus. The the main

types of metaplasia of epithelium of Barret’s esophagus –

cardial type, fundal type and speciaised intestine metaplasia

with malignancy potential was studied. The main aspects

in the choise of follow-up and treatment of patients with

Barret’s esophagus is shown.

Key words: Barret’s esophagus, endoscopic diagnostic,

morphological diagnostic, types of epithelium metaplasia.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

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Âñòóï. Ï³äòðèìêà îêñèäàíòíî-ïðîòèîêñèäàíòíîãî ãî-

ìåîñòàçó º âàæëèâèì àñïåêòîì ôóíêö³îíóâàííÿ îðãàí³ç-

ìó. Ïîðóøåííÿ âçàºìîä³¿ ì³æ ÏÎË òà ÀÎÇ ïðèçâîäèòü äî

íàêîïè÷åííÿ ïðîäóêò³â ë³ïîïåðîêñèäàö³¿ òà ïîøêîäæåí-

íÿ óñ³õ êë³òèí îðãàí³çìó [1,2]. Äîñë³äæåííþ ïðîöåñ³â îê-

ñèäàíòíî-ïðîòèîêñèäàíòíî¿ ñèñòåìè ïðèñâÿ÷åíî ÷èìàëî

ðîá³ò [3,4], ïðîòå íåäîñòàòíüî âèñâ³òëåíà ðîëü ö³º¿ ñèñòå-

ìè ó ïåðåá³ãó ÏÂ, ïîºäíàíî¿ ç ÖÄ, íå âèâ÷åíî ñïîñîáè ¿¿

êîðåêö³¿ [5,6,7,8].

Ìåòà äîñë³äæåííÿ. Âèâ÷èòè ñòàí îêñèäàíòíî-ïðîòè-

îêñèäàíòíîãî ãîìåîñòàçó, ³íòåðëåéê³íó-8 (²Ë-8) ó õâîðèõ

íà ÏÂ øëóíêà (àíòðàëüíîãî â³ää³ëó) òà äâàíàäöÿòèïàëî¿

êèøêè (ÄÏÊ), ïîºäíàíó ç ÖÄ, ó äèíàì³ö³ ë³êóâàííÿ ³íã³-

á³òîðîì àíã³îòåíçèíïåðåòâîðþþ÷îãî ôåðìåíòó (³-ÀÏÔ)

êâ³íàïðèëó (“Àêêóïðî”).

Ìàòåð³àëè òà ìåòîäè äîñë³äæåííÿ. Îáñòåæåíî

115 õâîðèõ, ÿê³ ïåðåáóâàëè íà ñòàö³îíàðíîìó ë³êóâàíí³ â

îáëàñíîìó åíäîêðèíîëîã³÷íîìó äèñïàíñåð³ òà ãàñòðî-

åíòåðîëîã³÷íîìó â³ää³ëåíí³ îáëàñíî¿ êë³í³÷íî¿ ë³êàðí³

ì. ×åðí³âö³. ² ãðóïà ñêëàäàëàñü ç 39 õâîðèõ íà ÏÂ øëóíêà

òà ÄÏÊ, Íð-àñîö³éîâàíó. Äî ²² ãðóïè óâ³éøëè 39 õâîðèõ íà

ÖÄ. ²²² ãðóïó ñêëàëè 37 õâîðèõ íà ÏÂ øëóíêà òà ÄÏÊ, Íð-

àñîö³éîâàíó, ïîºäíàíó ç ÖÄ. Êîíòðîëüíà ãðóïà ñêëàäà-

ëàñü ç 20 ïðàêòè÷íî çäîðîâèõ îñ³á (ÏÇÎ) (áåç êë³í³÷íî,

á³îõ³ì³÷íî òà ³íñòðóìåíòàëüíî ï³äòâåðäæåíèõ ä³àãíîç³â

ÏÂ òà ÖÄ).

Âñ³ì ïàö³ºíòàì ïðîâîäèëè îáñòåæåííÿ, ÿêå âêëþ÷àëî

çá³ð àíàìíåçó, îö³íêó êë³í³÷íèõ ñèìïòîì³â, ëàáîðàòîðíî-

³íñòðóìåíòàëüíå îáñòåæåííÿ, ç îáîâ‘ÿçêîâèì ïðîâåäåí-

íÿì äîñë³äæåííÿ ãëþêîçè ïëàçìè íàòùå, ïåðîðàëüíîãî

òåñòó íà òîëåðàíòí³ñòü äî ãëþêîçè, ãë³êîçèëüîâàíîãî ãåìî-

ãëîá³íó, ÓÇÄ âíóòð³øí³õ îðãàí³â, ô³áðîãàñòðîäóîäåíî-

ñêîï³¿ ç ïðèö³ëüíîþ á³îïñ³ºþ òà ïîäàëüøèì âèçíà÷åííÿì

Í. pylori ã³ñòîëîã³÷íèì ìåòîäîì òà ç äîïîìîãîþ ³ìóíîõ-

ðîìàòîãðàô³÷íî¿ òåñò-ñèñòåìè äëÿ âèÿâëåííÿ àíòèãåí³â

Í. pylori (stool-òåñòó).

Äîñë³äæóâàëè òàêîæ âì³ñò ïðîäóêò³â ïåðîêñèäíîãî

îêèñíåííÿ ë³ï³ä³â (ÏÎË) – ìàëîíîâîãî ä³àëüäåã³äó – â

ïëàçì³ êðîâ³ (ÌÄÀïë) òà åðèòðîöèòàõ (ÌÄÀåð) (Âëàäè-

ìèðîâ Þ.À., Àð÷àêîâ À.²., 1972), ³çîëüîâàíèõ ïîäâ³éíèõ

ÓÄÊ 616.33/.342-002.44:616.379-008.64]:616.15

²ÍÒÅÐËÅÉÊ²Í-8 ÒÀ ÑÒÀÍ ÎÊÑÈÄÀÍÒÍÎ-

ÏÐÎÒÈÎÊÑÈÄÀÍÒÍÎÃÎ ÃÎÌÅÎÑÒÀÇÓ

Ó ÕÂÎÐÈÕ ÍÀ ÂÈÐÀÇÊÎÂÓ ÕÂÎÐÎÁÓ ØËÓÍÊÀ

ÒÀ ÄÂÀÍÀÄÖßÒÈÏÀËÎ¯ ÊÈØÊÈ, ÏÎªÄÍÀÍÓ

Ç ÖÓÊÐÎÂÈÌ Ä²ÀÁÅÒÎÌ, Ó ÄÈÍÀÌ²Ö² Ë²ÊÓÂÀÍÍß

Îë³íèê Î.Þ.

Áóêîâèíñüêèé äåðæàâíèé ìåäè÷íèé óí³âåðñèòåò, ì.×åðí³âö³, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: ïåïòè÷íà âèðàçêà, öóêðîâèé ä³àáåò, ïåðåêèñíå îêèñíåííÿ ë³ï³ä³â, êâ³íàïðèë

çâ’ÿçê³â (²ÏÇ), ä³ºíîâèõ êîí’þãàò³â (ÄÊ), êåòîä³ºí³â ³ ñïðÿ-

æåíèõ òð³ºí³â (Ê/ÑÒ) – ó êðîâ³ (Âîë÷åãîðñüêèé ².À. òà ³í.,

1989); âì³ñò ãëóòàò³îíó â³äíîâëåíîãî (ÃÂ) (Ìåùèøåí ².Ô.,

Ïåòðîâà ².Â.,1983), àêòèâíîñò³ ãëóòàò³îíïåðîêñèäàçè (ÃÏ)

(Ìåùèøåí ².Ô., 1982), ãëóòàò³îí-S-òðàíñôåðàçè (ÃÒ) (Ìå-

ùèøåí ².Ô., 1987), êàòàëàçè (Êò) (Êîðîëþê Ì.À. òà ³í.,

1988) ó êðîâ³. Àêòèâí³ñòü çàçíà÷åíèõ ôåðìåíò³â ðîçðàõî-

âóâàëè íà 1 ã ãåìîãëîá³íó (Íâ). Âì³ñò öåðóëîïëàçì³íó

(ÖÏ) ó ñèðîâàòö³ êðîâ³ âèçíà÷àëè çà ìåòîäîì Ðåâ³íà.

Âì³ñò â ïëàçì³ êðîâ³ ²Ë-8 âèçíà÷àëè ç âèêîðèñòàííÿì

íàáîð³â ðåàêòèâ³â ô³ðìè “Âåêòîð Áåñò” (Íîâîñèá³ðñüê,

Ðîñ³ÿ).

Ñòàòèñòè÷íà îáðîáêà ðåçóëüòàò³â äîñë³äæåííÿ ïðîâî-

äèëàñü çà äîïîìîãîþ ïðîãðàìè STATISTICA 6.0. Ï³äðà-

õîâóâàëè ñåðåäíº, ñòàíäàðòíó ïîìèëêó ñåðåäíüîãî, äîâ³-

ð÷èé ³íòåðâàë (95%) òà ïîêàçíèê äîñòîâ³ðíîñò³ ð³çíèö³ ð.

Ðåçóëüòàòè äîñë³äæåííÿ òà ¿õ îáãîâîðåííÿ. Àíàë³-

çóþ÷è ñòàí ïðîöåñ³â ÏÎË (òàáë.1) â îðãàí³çì³ íàìè áóëî

â³äì³÷åíî â³ðîã³äíå çá³ëüøåííÿ âì³ñòó ²ÏÇ,ÄÊ, ÊÑÒ, ÌÄÀ

ó âñ³õ ãðóïàõ õâîðèõ ïîð³âíÿíî ç ãðóïîþ ïðàêòè÷íî çäî-

ðîâèõ îñ³á. Âñòàíîâëåíî, ùî ó õâîðèõ îñíîâíî¿ ãðóïè

ð³âåíü ²ÏÇ ñêëàäàº 6,04±0,12 [5,77-6,27], ÄÊ – 3,15±0,09

[2,97-3,33] òà ÊÑÒ – 1,2±0,03 [1,16-1,26], ùî â³ðîã³äíî âèùå,

í³æ â³äïîâ³äí³ ïîêàçíèêè â ãðóïàõ ² òà ²². Ùîäî ê³íöåâîãî

ïðîäóêòó ÏÎË ÌÄÀ, òî â îñíîâí³é ãðóï³ ìè îòðèìàëè

íàñòóïí³ ïîêàçíèêè: ÌÄÀ ïëàçìè 5,54±0,19 [5,15-5,92] òà

ÌÄÀ åðèòðîöèò³â 9,99±0,1 [9,78-10,19], ùî òàêîæ º âèùèì,

í³æ ó ãðóïàõ ïîð³âíÿííÿ. Îòæå ó õâîðèõ íà ÏÂ, ïîºäíàíó ç

ÖÄ, ñïîñòåð³ãàºòüñÿ àêòèâ³çàö³ÿ ïðîöåñ³â ÏÎË.

Âñòàíîâëåíî, ùî ó õâîðèõ íà ÏÂ, ïîºäíàíó ç ÖÄ â³äáó-

âàºòüñÿ âèñíàæåííÿ ñèñòåìè ÀÎÇ. Ïðî ùî ñâ³ä÷èòü ìåíø

âèðàæåíå ï³äâèùåííÿ àêòèâíîñò³ ãëóòàò³íîâî¿ ñèñòåìè

îðãàí³çìó, àêòèâíîñò³ êàòàëàçè òà âì³ñòó öåðóëîïëàçì³íó

ïîð³âíÿíî ç ãðóïàìè ² òà ²². À ñàìå ð³âåíü ÃÂ ñêëàäàº

0,56±0,02 [0,51-0,6], àêòèâí³ñòü ÃÏ – 157,33±1,93 [153, 36-

161, 3], ÃÒ – 129,86±0,92 [127,95-131,77], êàòàëàçè –

13,39±0,22 [12,93-13,85], âì³ñò öåðóëîïëàçì³íó – 127,6±4,9

[117,47-137,74].

Îñê³ëüêè îäíèì ³ç íàéàêòèâí³øèõ ïðîçàïàëüíèõ öè-

òîê³í³â ïðè ÏÂ º ²Ë-8, âàæëèâîþ ïðîãíîñòè÷íîþ îçíàêîþ

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

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ïåðåá³ãó ÏÂ, ïîºäíàíî¿ ç ÖÄ, ìîæå áóòè çì³íà éîãî ð³âíÿ

ó êðîâ³. Äëÿ âèâ÷åííÿ ð³âíÿ ³íòåðëåéê³íó-8 ó êðîâ³ áóëî

îáñòåæåíî 30 õâîðèõ íà ÏÂ, ïîºäíàíó ç ÖÄ, 11 õâîðèõ íà

ÏÂ, 11 õâîðèõ íà ÖÄ òà 8 ÏÇÎ. Âñòàíîâëåíî (òàáëèöÿ 2),

ùî ó õâîðèõ íà ÏÂ äîñòîâ³ðíî âèùèé (ð<0,05) ð³âåíü ²Ë-8

105,36±5,95 [92,10-118,63], í³æ ó ÏÇÎ 25,10±1,26 [22,13-

28,07] òà ó õâîðèõ íà ÖÄ 81,12±3,68 [79,91-89,32], ïðîòå äî-

ñòîâ³ðíî íèæ÷èé (ð<0,05), í³æ ó õâîðèõ íà ÏÂ, ïîºäíàíó ç

ÖÄ (181,61±6,55 [168,22-195,00]).

Îñíîâíó ãðóïó â ïðîöåñ³ ë³êóâàííÿ íàìè áóëî ðîçïî-

ä³ëåíî íà 2 ï³äãðóïè: ²²²À – õâîð³ îòðèìóâàëè áàçèñíó òå-

ðàï³þ (ðàáåïðàçîë – 20 ìã äâ³÷³ íà äåíü, àìîêñèöèë³í –

1000 ìã äâ³÷³ íà äåíü, êëàðèòðîì³öèí – 500 ìã äâ³÷³ íà äåíü

ïðîòÿãîì 14 äí³â òà ïåðîðàëüí³ öóêðîçíèæóþ÷³ àáî

³íñóë³í ó àäåêâàòí³é äîç³), ²²²Á – íà òë³ áàçèñíîãî ë³êóâàííÿ

õâîðèì áóëî ïðèçíà÷åíî ïðåïàðàò “Àêêóïðî” ó äîç³ 2,5

ìã 1 ðàç íà äîáó âðàíö³ ï³ä êîíòðîëåì ãåìîäèíàì³÷íèõ

ïîêàçíèê³â âïðîäîâæ 1 òèæíÿ, ç ïåðåõîäîì íà 5 ìã 1 ðàç íà

äîáó âðàíö³ âïðîäîâæ 3 òèæí³â.

Ï³ñëÿ ë³êóâàííÿ âèÿâëåíî (òàáëèöÿ 3) äîñòîâ³ðíå çíè-

æåííÿ óñ³õ ïîêàçíèê³â ÏÎË (á³ëüø âèðàæåíå ï³ñëÿ çàñòî-

ñóâàííÿ “Àêêóïðî”, í³æ ï³ñëÿ çàñòîñóâàííÿ áàçèñíî¿ òå-

ðàï³¿): ²ÏÇ – íà 25,3% òà 8,5%, ÄÊ – íà 19,5% òà 10 %, ÊÑÒ –

íà 20,7% òà 7,8 %, ÌÄÀ ïëàçìè – íà 30,2% òà 9,7 %, ÌÄÀ

åðèòðîöèò³â – íà 28,2 % òà 11,8 %, â³äïîâ³äíî (ð<0,05).

Ùîäî ÀÎÑ – òóò â³äì³÷åíî òåíäåíö³þ äî ïîêðàùåííÿ

ïîêàçíèê³â ãëóòàò³îíîâî¿ ñèñòåìè (á³ëüø âèðàæåíå ï³ñëÿ

çàñòîñóâàííÿ “Àêêóïðî”, í³æ ï³ñëÿ çàñòîñóâàííÿ áàçèñ-

íî¿ òåðàï³¿): ÃÂ – íà 15,6 % òà 3,4 %, ÃÒ – íà 15,1 % òà

11,2 %, ÃÏ – íà 17,3 % òà 6,5 % â³äïîâ³äíî (ð<0,05). Âîä-

íî÷àñ ð³âåíü öåðóëîïëàçì³íó çíèæóºòüñÿ – áàçèñíå

ë³êóâàííÿ íà 4,3 %, “Àêêóïðî” – íà 13,2 %, ð³âåíü êàòàëà-

çè òàêîæ çíèæóºòüñÿ – áàçèñíå ë³êóâàííÿ íà 5,6 %, “Àê-

êóïðî” – íà 19,5 % (ð<0,05). Òàêîæ âèÿâëåíî çíèæåííÿ

ÀÊÄÔÃ îñíîâíîãî òà íåéòðàëüíîãî õàðàêòåðó ï³ñëÿ

ë³êóâàííÿ ó âñ³õ ãðóïàõ îáñòåæåíèõ, ïðîòå íàé³ñòîòí³ø³

çì³íè ñïîñòåð³ãàëèñü ó õâîðèõ ãðóïè ²²²á (â 1,9 ðàçè)

(ð<0,05). Âîäíî÷àñ âñòàíîâëåíî çíèæåííÿ ë³çèñó íèçüêî-

òà âèñîêîìîëåêóëÿðíèõ á³ëê³â òà êîëàãåíîë³òè÷íî¿ àêòèâ-

íîñò³ êðîâ³ ó äèíàì³ö³ ë³êóâàííÿ. Ðåçóëüòàòè ë³çèñó àçî-

àëüáóì³íó, àçîêàçå¿íó òà àçîêîëó ï³ñëÿ çàñòîñóâàííÿ

óäîñêîíàëåíî¿ ñõåìè òåðàï³¿ äîñÿãàëè â³äïîâ³äíîãî ð³âíÿ

ó ÏÇÎ. Âì³ñò ïðîçàïàëüíîãî õåìîê³íó ²Ë-8 çìåíøóâàâñÿ

³ñòîòíî (ó 2,4 ðàçè) ïðè çàñòîñóâàíí³ êâ³íàïðèëó

(ð<0,05).

Âèñíîâêè: 1. Ïåïòè÷íà âèðàçêà òà öóêðîâèé ä³àáåò

ïåðåá³ãàþòü ç ñèíäðîìîì “âçàºìíîãî îáòÿæåííÿ”, ùî

ïðîÿâëÿºòüñÿ âèðàæåíîþ àêòèâ³çàö³ºþ ïðîöåñ³â ïåðîê-

ñèäíîãî îêèñíåííÿ ë³ï³ä³â òà ï³äâèùåííÿì ³íòåðëåéê³íó-8

ó ïëàçì³ êðîâ³.

2. ²íòåíñèô³êàö³ÿ ïðîöåñ³â ïåðîêñèäíîãî îêèñíåííÿ

ë³ï³ä³â ó õâîðèõ íà ïåïòè÷íó âèðàçêó, ïîºäíàíó ç öóêðî-

âèì ä³àáåòîì, ñóïðîâîäæóºòüñÿ âèñíàæåííÿì ñèñòåìè

àíòèîêñèäàíòíîãî çàõèñòó òà ï³äñèëåííÿì ïðîöåñ³â íåî-

áìåæåíîãî ïðîòåîë³çó, ùî ï³äòâåðäæóºòüñÿ íåàäåêâàò-

íèì ï³äâèùåííÿì ïîêàçíèê³â ãëóòàò³îíîâî¿ ñèñòåìè,

ð³âíÿ öåðóëîïëàçì³íó òà àêòèâíîñò³ êàòàëàçè.

3. Çàñòîñóâàííÿ íà òë³ àíòèõåë³êîáàêòåðíî¿ òåðàï³¿ ïðå-

ïàðàòó ³-ÀÏÔ êâ³íàïðèëó ñïðèÿº çìåíøåííþ äèñáàëàí-

ñó îêñèäàíòíî-ïðîòèîêñèäàíòíîãî ãîìåîñòàçó, çìåíøóº

ð³âåíü ïðîçàïàëüíîãî ³íòåðëåéê³íó-8 ó õâîðèõ íà ïåïòè÷íó

âèðàçêó, ïîºäíàíó ç öóêðîâèì ä³àáåòîì.

Òàáëèöÿ 2

Ð³âåíü ³íòåðëåéê³íó-8 ó õâîðèõ íà ïåïòè÷íó âèðàçêó òà öóêðîâèé ä³àáåò (M ± m)

Ïðèì³òêà.* çì³íè äîñòîâ³ðí³ ïîð³âíÿíî ç ïîêàçíèêàìè ó ÏÇÎ (ð < 0,05); ** çì³íè äîñòîâ³ðí³ ïîð³âíÿíî ç ïîêàçíèêàìè õâîðèõ íà ÏÂ

(ð < 0,05); *** çì³íè äîñòîâ³ðí³ ïîð³âíÿíî ç ïîêàçíèêàìè õâîðèõ íà ÖÄ (ð < 0,05).

Ïðèì³òêè.* Çì³íè äîñòîâ³ðí³ ïîð³âíÿíî ç ïîêàçíèêàìè ó ÏÇÎ (Ð < 0,05);** çì³íè äîñòîâ³ðí³ ïîð³âíÿíî ç ïîêàçíèêàìè õâîðèõ íà ÏÂ

(Ð < 0,05);*** çì³íè äîñòîâ³ðí³ ïîð³âíÿíî ç ïîêàçíèêàìè õâîðèõ íà ÖÄ (Ð < 0,05)

Òàáëèöÿ 1.

Ïîêàçíèêè ñòàíó îêñèäàíòíî-ïðîòèîêñèäàíòíî¿ ñèñòåìè ó õâîðèõ íà ïåïòè÷íó âèðàçêó øëóíêà

òà äâàíàäöÿòèïàëî¿ êèøêè, ïîºäíàíó ç öóêðîâèì ä³àáåòîì (M ± m)

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

110

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

Ïåðñïåêòèâè ïîäàëüøèõ äîñë³äæåíü. Äîö³ëüíî âèâ-

÷èòè âïëèâ çàïðîïîíîâàíîãî ë³êóâàííÿ íà ³íø³ ïàòîãåíå-

òè÷í³ ëàíêè ïîºäíàíîãî ïåðåá³ãó ïåïòè÷íî¿ âèðàçêè

øëóíêà òà äâàíàäöÿòèïàëî¿ êèøêè, ïîºäíàíî¿ ç öóêðîâèì

ä³àáåòîì.

Ðåöåíçåíò: ä.ìåä.í., ïðîôåñîð Áîäíàð Ï.Ì.

Ë²ÒÅÐÀÒÓÐÀ

1. Âàõíåíêî À.Â. Ñòàí ìåòàáîë³÷íî¿ ³íòîêñèêàö³¿ ó õâî-

ðèõ íà âèðàçêîâó õâîðîáó äâàíàäöÿòèïàëî¿ êèøêè ó ïîºäíàíí³

ç öóêðîâèì ä³àáåòîì 2-ãî òèïó â äèíàì³ö³ ë³êóâàííÿ /

À.Â.Âàõíåíêî // Ñâ³ò ìåäèöèíè òà á³îëîã³¿. – 2010. – ¹2. –

Ñ. 29-32

2. ²îôôå ².Â. Ïîêàçíèêè ïåðåêèñíîãî îêèñëåííÿ ë³ï³ä³â ó õâî-

ðèõ ç ÷èñëåííèìè ïåïòè÷íèìè âèðàçêàìè øëóíêà òà äâàíàäöÿ-

òèïàëî¿ êèøêè / ².Â. ²îôôå // Êë³í³÷íà õ³ðóðã³ÿ. – 2004. – ¹8. –

Ñ.11-12.

Ïðèì³òêà.* Çì³íè äîñòîâ³ðí³ ïîð³âíÿíî ç ïîêàçíèêàìè ó ÏÇÎ (ð<0,05); ** çì³íè äîñòîâ³ðí³ ïîð³âíÿíî ç ïîêàçíèêàìè ó ï³äãðóï³ äî

òà ï³ñëÿ ë³êóâàííÿ (ð<0,05); *** çì³íè äîñòîâ³ðí³ ïîð³âíÿíî ç ïîêàçíèêàìè ó ï³äãðóï³ ²²²à ï³ñëÿ ë³êóâàííÿ (ð<0,05); **** çì³íè äîñòîâ³ðí³

ïîð³âíÿíî ç ïîêàçíèêàìè ó ï³äãðóï³ ²²²á ï³ñëÿ ë³êóâàííÿ (ð<0,05).

Òàáëèöÿ 3

Ïîêàçíèêè îêñèäàíòíî-àíòèîêñèäàíòíî¿ ñèñòåìè ó õâîðèõ íà ïåïòè÷íó âèðàçêó øëóíêà

òà ÄÏÊ, ïîºäíàíó ç öóêðîâèì ä³àáåòîì, ó äèíàì³ö³ ë³êóâàííÿ (M ± m)

3. Âèñî÷èí Ì.Â. Ñòàí ñèñòåì ïåðåêèñíîãî îêèñíåííÿ ë³ï³ä³â

òà àíòèîêñèäàíòíîãî çàõèñòó ó õâîðèõ ç ïåïòè÷íîþ âèðàçêîþ

äâàíàäöÿòèïàëî¿ êèøêè ó ïîºäíàíí³ ç õðîí³÷íèì îáñòðóêòèâ-

íèì çàõâîðþâàííÿì ëåãåíü / Ì.Â. Âèñî÷èí, Ë.Ì. ²âàíîâà // Ñó-

÷àñí. ãàñòðîåíòåðîë. – 2009. – ¹2 (46). – Ñ.38-40

4. Dunlop R. A. Recent developments in the intracellular

degradation of oxidized proteins /Dunlop R. A., Rodgers K. J., Dean

R. T. // Free. Radic. Biol. Med. – 2002. – Vol. 33, Nî. 7. –P. 894–906.

5. Âäîâè÷åíêî Â.². Ïåïòè÷íà âèðàçêà ó õâîðèõ íà öóêðîâèé

ä³àáåò / Â.². Âäîâè÷åíêî, Í.Â. Ãóòâ³ðò // Ñó÷àñíà ãàñòðîåíòå-

ðîëîã³ÿ. – 2009. – ¹5 (49). – Ñ.107-110

6. Ìêðòóìÿí À.Ì. Îñîáåííîñòè òå÷åíèÿ ÿçâåííîé áîëåçíè

æåëóäêà ó áîëüíûõ ñàõàðíûì äèàáåòîì 2-ãî òèïà. / À. Ìêðòó-

ìÿí, È. Ìàåâ, Ê. Áàèðîâà // Ìåäèöèíà êðèòè÷åñêèõ ñîñòîÿíèé. –

2008. – ¹5. – Ñ.41-44

7. Dore M. Diabetes mellitus and helicobacter pylori infection /

Dore M. // Nutrition.– 2003.– Vol. 16.– P. 407–410.

8. Helicobacter pylori and diabetes mellitus / Saluja JS, Ajinkya

M, Khemani B [et al.]// Bombay Hosp J. – 2002. – 44. – Ð.57-60.

ÈÍÒÅÐËÅÉÊÈÍ-8 È ÑÎÑÒÎßÍÈÅ ÎÊÑÈÄÀÍÒÍÎ-

ÏÐÎÒÈÎÊÑÈÄÀÍÒÍÎÃÎ ÃÎÌÅÎÑÒÀÇÀ

Ó ÁÎËÜÍÛÕ ßÇÂÅÍÍÎÉ ÁÎËÅÇÍÜÞ ÆÅËÓÄÊÀ

È ÄÂÅÍÀÄÖÀÒÈÏÅÐÑÒÍÎÉ ÊÈØÊÈ

Ñ ÑÎÏÓÒÑÒÂÓÞÙÈÌ ÑÀÕÀÐÍÛÌ ÄÈÀÁÅÒÎÌ,

Â ÄÈÍÀÌÈÊÅ ËÅ×ÅÍÈß

Îëèíèê Î.Þ.

Áóêîâèíñêèé ãîñóäàðñòâåííûé ìåäèöèíñêèé

óíèâåðñèòåò, ã.×åðíîâöû, Óêðàèíà

Ðåçþìå. Â ðàáîòå èçó÷åíû ïîêàçàòåëè ïåðåêèñíîãî

îêèñëåíèÿ ëèïèäîâ è àíòèîêñèäàíòíîé ñèñòåìû.

Âûÿâëåíî, ÷òî ó áîëüíûõ ñ ïåïòè÷åñêîé ÿçâîé, ñ

ñîïóòñòâóþùèì ñàõàðíûì äèàáåòîì, èíòåíñèôèêàöèÿ

ïðîöåññîâ ïåðåêèñíîãî îêèñëåíèÿ ëèïèäîâ

ñîïðîâîæäàåòñÿ èñòîùåíèåì ñèñòåìû àíòèîêñèäàíòíîé

çàùèòû. Óñòàíîâëåíî, ÷òî êâèíàïðèë ñïîñîáñòâóåò

óìåíüøåíèþ äèñáàëàíñà îêñèäàíòíî-ïðîòèîêñèäàíò-

íîãî ãîìåîñòàçà.

Êëþ÷åâûå ñëîâà: ïåïòè÷åñêàÿ ÿçâà, ñàõàðíûé

äèàáåò, ïåðåêèñíîå îêèñëåíèå ëèïèäîâ, êâèíàïðèë.

INTRELEUKIN-8 AND THE OXIDANT-ANTIOXIDANT

HOMEOSTASIS IN PATIENTS WITH GASTRIC

AND DUODENAL ULCERS, COMBINED WITH

THE DIABETES MELLITUS, IN THE DYNAMICS

OF TREATMENT

O.J. Olinyk

Bukovian State Medical University,

Chernivtsy, Ukraine

Summary. The parameters of lipid peroxidation and

antioxidant system were studied. It was established that in

patients with peptic ulcer and diabetes mellitus,

exacerbation of the lipid peroxidation is accompanied by

the depletion of the antioxidant protection. The quinapril

reduces the imbalance of the oxidant-antioxidant

homeostasis in patients with peptic ulcer combined with

diabetes mellitus.

Key words: peptic ulcer, diabetes mellitus, lipid pero-

xidation, quinapril.

¹ 1 (79) • 2014

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Ââåäåíèå. Ðàññåÿííûé ñêëåðîç (ÐÑ) – ñåðüåçíîå íåâðî-

ëîãè÷åñêîå çàáîëåâàíèå ñ ìíîæåñòâîì íåïðåäñêàçóåìûõ

îñîáåííîñòåé, ñëîæíîé è äåéñòâåííîé ñîâîêóïíîñòüþ

íåèçâåñòíûõ ìåõàíèçìîâ, îïðåäåëÿþùèõ ïðîÿâëåíèÿ è

òå÷åíèå áîëåçíè [2]. Ìåäèêî-ñîöèàëüíàÿ çíà÷èìîñòü ðàñ-

ñåÿííîãî ñêëåðîçà îïðåäåëÿåòñÿ òåì, ÷òî ýòî çàáîëåâàíèå

ÿâëÿåòñÿ îäíîé èç ãëàâíûõ ïðè÷èí èíâàëèäèçàöèè è ñíè-

æåíèÿ êà÷åñòâà æèçíè íåâðîëîãè÷åñêèõ áîëüíûõ ìîëîäî-

ãî è ñðåäíåãî âîçðàñòà, à òàêæå âûñîêèì óðîâíåì ñâÿçàí-

íûõ ñ íèì ìåäèöèíñêèõ è íåìåäèöèíñêèõ ðàñõîäîâ [5].

Íà ñåãîäíÿ â Óêðàèíå íàñ÷èòûâàåòñÿ áîëåå 20 000

áîëüíûõ ÐÑ [3].

Ðàíåå áûëî îáùåïðèçíàííî, ÷òî ÐÑ – áîëåçíü ëþäåé

ìîëîäîãî è ñðåäíåãî âîçðàñòà. Íàèáîëåå òèïè÷íî íà÷àëî

áîëåçíè â âîçðàñòå îò 20 äî 40ëåò (70% âñåõ ñëó÷àåâ). Ê

íàñòîÿùåìó âðåìåíè âîçðàñòíûå ãðàíèöû ÐÑ çíà÷èòåëü-

íî ðàñøèðåíû – õàðàêòåðíûì ñ÷èòàåòñÿ íà÷àëî çàáîëå-

âàíèÿ â âîçðàñòå îò 10 äî 59 ëåò [6]. Ñîãëàñíî ðåçóëüòàòàì

çàðóáåæíûõ èññëåäîâàíèé, ðàñïðîñòðàíåííîñòü çàáîëå-

âàíèÿ ñ ïîçäíèì äåáþòîì êîëåáëåòñÿ îò 3,4% äî 9,4%

[8, 13]. G. Azzimondi è ñîàâò. [11] ñ÷èòàþò, ÷òî ÐÑ ñ ïîçäíèì

íà÷àëîì àññîöèèðóåòñÿ ñ ïëîõèì ïðîãíîçîì è áûñòðîé

ïðîãðåññèåé èíâàëèäíîñòè, òîãäà êàê A.D. White è ñîàâò.

[16] ïðåäïîëàãàþò îòñóòñòâèå ðàçëè÷èé â òå÷åíèå çàáîëå-

âàíèé ó áîëüíûõ ÐÑ ñ òèïè÷íûì è ïîçäíèì äåáþòîì.

Â Óêðàèíå ïðîáëåìà ÐÑ ñ ïîçäíèì íà÷àëîì çàáîëåâàíèÿ

íå äîñòàòî÷íî èçó÷åíà.

Êðîìå íàðóøåíèÿ ôèçè÷åñêîãî ñîñòîÿíèÿ áîëüíîãî,

ðàññåÿííûé ñêëåðîç, êàê õðîíè÷åñêîå çàáîëåâàíèå, ñî-

ïðîâîæäàåòñÿ íàðóøåíèÿìè â ïñèõîëîãè÷åñêîé, ýìîöè-

îíàëüíîé, ìåíòàëüíîé, äóõîâíîé è ñîöèàëüíîé ñôåðàõ

æèçíè ïàöèåíòà, ÷òî â öåëîì ñîñòàâëÿåò ïîíÿòèå “êà÷å-

ñòâî æèçíè” [7]. Èññëåäîâàòåëè îïðåäåëÿþò ñóùåñòâåí-

íûå ðàçëè÷èÿ ìåæäó îáúåêòèâíîé îöåíêîé ñîñòîÿíèÿ

ïàöèåíòà âðà÷îì è ñóáúåêòèâíîé îöåíêîé ñâîåãî ñîñòîÿ-

íèÿ áîëüíûì ðàññåÿííûì ñêëåðîçîì [12,9, 10].

Òàêèì îáðàçîì, íà ñåãîäíÿøíèé äåíü ïðîáëåìà èíâà-

ëèäèçàöèè è êà÷åñòâà æèçíè ó áîëüíûõ PC â âîçðàñòíîì

àñïåêòå îñòàåòñÿ àêòóàëüíîé è òðåáóåò áîëåå ãëóáîêîãî

èçó÷åíèÿ.

Öåëü èññëåäîâàíèÿ – îïðåäåëåíèå îñîáåííîñòåé

èíâàëèäèçàöèè è ïîêàçàòåëåé êà÷åñòâà æèçíè ó áîëüíûõ

ÐÑ ñ íà÷àëîì áîëåçíè â ìîëîäîì è ñòàðøåì âîçðàñòå.

ÓÄÊ 616.831/.832-004.2-036.8-036.86

ÑÐÀÂÍÈÒÅËÜÍÛÉ ÀÍÀËÈÇ ÓÐÎÂÍß

ÈÍÂÀËÈÄÈÇÀÖÈÈ È ÏÎÊÀÇÀÒÅËÅÉ ÊÀ×ÅÑÒÂÀ

ÆÈÇÍÈ Ó ÁÎËÜÍÛÕ Ñ ÐÀÑÑÅßÍÍÛÌ ÑÊËÅÐÎÇÎÌ

ÐÀÇÍÛÕ ÂÎÇÐÀÑÒÍÛÕ ÃÐÓÏÏ

Ñåïèõàíîâà Ì.Ì., Ñîêîëîâà Ë. È.

Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò èìåíè À.À. Áîãîìîëüöà, ã.Êèåâ, Óêðàèíà

Êëþ÷åâûå ñëîâà: ðàññåÿííûé ñêëåðîç, óðîâåíü èíâàëèäèçàöèè, êà÷åñòâî æèçíè.

Ìàòåðèàëû è ìåòîäû èññëåäîâàíèÿ. Îáñëåäîâàíî

100 ïàöèåíòîâ ñ ÐÑ â âîçðàñòå îò 20 äî 65 ëåò. Ïåðâàÿ

ãðóïïà (I) ñîñòîÿëà èç 50 áîëüíûõ ìîëîäîãî âîçðàñòà (20-

35 ëåò), äåáþò çàáîëåâàíèÿ ó êîòîðûõ â ñðåäíåì

ïðèõîäèëñÿ íà 24±3.1 ãîä. Âòîðàÿ ãðóïïà (II) – èç 50

ïàöèåíòîâ ñòàðøåãî âîçðàñòà (36-65 ëåò), äåáþò ÐÑ ó êîòî-

ðûõ ïðèõîäèëñÿ â ñðåäíåì íà 43±1.5 ãîäà. Ó âñåõ ïàöèåíòîâ

I ãðóïïû äèàãíîñòèðîâàí ðåìèòòèðóþùèé òèï òå÷åíèÿ

ÐÑ (ÐÐÑ). Âî II ãðóïïå áîëüíûõ ïåðâè÷íî-ïðîãðåññèðóþ-

ùèé òèï òå÷åíèÿ ÐÑ îïðåäåëåí ó ñåìè ÷åëîâåê, âòîðè÷íî-

ïðîãðåññèðóþùèé – ó 10, ÐÐÑ – ó 33.

Òÿæåñòü íåâðîëîãè÷åñêîãî äåôèöèòà ó áîëüíûõ ÐÑ

îöåíèâàëè ïî øêàëå EDSS â ñòàäèè ðåìèññèè ïðè ðåìèò-

òèðóþùåì òèïå òå÷åíèè. Îáùåïðèíÿòûì ÿâëÿåòñÿ âûäå-

ëåíèå òðåõ ñòåïåíåé âûðàæåííîñòè èíâàëèäèçàöèè ïî

øêàëå EDSS áîëüíûõ ÐÑ: ëåãêîé (îò 1 äî 3,5 áàëëà), ñðåä-

íåé (4–6,5 áàëëà) è òÿæåëîé (>6,5 áàëëà) [4].

Îöåíèâàëè ñðåäíþþ ñêîðîñòü ïðîãðåññèðîâàíèÿ áî-

ëåçíè (ÑÑÏ), êîòîðàÿ âûñ÷èòûâàëàñü êàê îòíîøåíèå

EDSS ê äëèòåëüíîñòè çàáîëåâàíèÿ â ãîäàõ (áàëëîâ/ãîä).

Âûäåëÿëè 3 òåìïà ïðîãðåññèðîâàíèÿ ÐÑ: ìåäëåííûé

òåìï ïðîãðåññèðîâàíèÿ (ÌÒÏ) – ìåíåå 0,25 á/ã, óìåðåí-

íûé òåìï ïðîãðåññèðîâàíèÿ (ÓÒÏ) – ≤0,25-0,75 á/ã, áûñò-

ðûé òåìï ïðîãðåññèðîâàíèÿ (ÁÒÏ) – ≥0,75á/ã. [14]. Äëÿ

îöåíêè ñòåïåíè íåâðîëîãè÷åñêîãî äåôèöèòà íàìè áûëî

ïðîàíàëèçèðîâàíî ñðåäíåå çíà÷åíèå áàëëîâ ïî øêàëå

èíâàëèäèçàöèè EDSS ó îáñëåäóåìûõ îáåèõ ãðóïï c ðàç-

íîé äëèòåëüíîñòüþ çàáîëåâàíèÿ.

Äëÿ óäîáñòâà îöåíêè óðîâíÿ âûðàæåííîñòè íåâðîëî-

ãè÷åñêîãî äåôèöèòà è àíàëèçà êà÷åñòâà æèçíè áîëüíûå

äâóõ ãðóïï â çàâèñèìîñòè îò äëèòåëüíîñòè çàáîëåâàíèÿ

(5 ëåò è ìåíåå; 6-10; 11-15 ëåò) áûëè ðàñïðåäåëåíû ïî 3

ïîäãðóïïàì. 30 ïàöèåíòîâ ìîëîäîãî âîçðàñòà ñîñòàâèëè

ïåðâóþ ïîäãðóïïó I À, âòîðóþ I Â – 15, òðåòüþ I Ñ – 5

áîëüíûõ. Ãðóïïà áîëüíûõ ñòàðøåãî âîçðàñòà ñîñòîÿëà èç

18 ïàöèåíòîâ ïîäãðóïïû II À, 21 ïîäãðóïïû II Â, è 11 ïà-

öèåíòîâ ïîäãðóïïû II Ñ (òàá. 1).

Êà÷åñòâî æèçíè (ÊÆ) èññëåäîâàëîñü ïðè ïîìîùè îá-

ùåãî îïðîñíèêà MOS SF-36, ðàçðàáîòàííîãî â Öåíòðå

èçó÷åíèÿ ìåäèöèíñêèõ ðåçóëüòàòîâ ÑØÀ â 1992 ã., êîòî-

ðûé ñîäåðæèò ñëåäóþùèå øêàëû: ôèçè÷åñêîå ôóíêöèîíè-

ðîâàíèå (ÔÔ), ðîëåâîå ôèçè÷åñêîå ôóíêöèîíèðîâàíèå

(ÐÔÔ), áîëü (Á), îáùåå çäîðîâüå (ÎÇ), æèçíåñïîñîá-

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

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íîñòü (Æ), ñîöèàëüíîå ôóíêöèîíèðîâàíèå (ÑÔ), ðîëåâîå

ýìîöèîíàëüíîå ôóíêöèîíèðîâàíèå (ÐÝÔ), ïñèõîëîãè-

÷åñêîå çäîðîâüå (ÏÇ). ×åòûðå ïåðâûå øêàëû õàðàêòåðè-

çóþò ôèçè÷åñêèé êîìïîíåíò çäîðîâüÿ (ÔÊÇ), ñëåäóþùèå

÷åòûðå – ïñèõîëîãè÷åñêèé êîìïîíåíò çäîðîâüÿ (ÏÊÇ).

Îïðîñíèê ñîäåðæèò 36 âîïðîñîâ, îõâàòûâàþùèõ âîñåìü

îñíîâíûõ õàðàêòåðèñòèê çäîðîâüÿ. Îöåíêà ïðîâîäèëàñü

ïî 100-áàëëüíîé øêàëå â óñëîâíûõ åäèíèöàõ [15].

Äëÿ îáðàáîòêè ìàòåðèàëà èñïîëüçîâàëè ïàêåòû ïðî-

ãðàìì áàçîâîé ñòàòèñòèêè Stata 12. Ñðàâíåíèå çíà÷åíèé

ïîêàçàòåëåé ïðîâîäèëîñü ñ ïîìîùüþ íåïàðàìåòðè÷åñ-

êèõ êðèòåðèåâ χ2 (êðèòåðèé Ïèðñîíà), Ìàííà-Óèòíè.

Ðåçóëüòàòû è îáñóæäåíèå. Ñðåäíÿÿ ïðîäîëæè-

òåëüíîñòü çàáîëåâàíèÿ ó áîëüíûõ ïåðâîé ãðóïïû

ñîñòàâëÿëà 5.6 ± 3.4, ó ïàöèåíòîâ âòîðîé ãðóïïû – 6.9± 3.1.

Ïðè îöåíêå ñòåïåíè âûðàæåííîñòè èíâàëèäèçàöèè ó

îáñëåäóåìûõ îáåèõ ãðóïï áûëî îïðåäåëåíî ïðåîáëàäà-

íèå ëåãêîé ñòåïåíè èíâàëèäèçàöèè – ó 40 (80%) ïàöèåíòîâ

I ãðóïïû è 33 (66%) ó áîëüíûõ II ãðóïïû, âî II ãðóïïå

èìåëàñü òåíäåíöèÿ ê óâåëè÷åíèþ ÷èñëà ïàöèåíòîâ ñ óìå-

ðåííîé è âûðàæåííîé ñòåïåíüþ èâàëèäèçàöèè (ðèñ.1).

Ñðåäíèé áàëë ïî øêàëå èíâàëèäèçàöèè EDSS äëÿ

áîëüíûõ I ãðóïïû ñîñòàâèë 3.06±1.10, ó ïàöèåíòîâ II ãðóï-

ïû – 3.34 ± 1.21.

Ïî ðåçóëüòàòàì ñðàâíèòåëüíîé îöåíêè óðîâíÿ èíâà-

ëèäèçàöèè ïî øêàëå EDSS ó áîëüíûõ ñ ðàçíîé äëèòåëüíî-

ñòüþ çàáîëåâàíèÿ, áûë âûÿâëåí áîëåå âûñîêèé áàëë

EDSS â ïîäãðóïïå ñòàðøåãî âîçðàñòà ñ äëèòåëüíîñòüþ

çàáîëåâàíèÿ 6-10 ëåò. Ó ïàöèåíòîâ ïîäãðóïïû I Â ñðåäíèé

áàëë ïî øêàëå EDSS ñîñòàâèë 2.9 ± 0.8, â ïîäãðóïïå II Â –

3.6 ± 0.9 (ð = 0,019). Â äðóãèõ ðàñïðåäåëåíèÿõ ïî ñðîêàì

çàáîëåâàíèÿ äîñòîâåðíûõ ðàçëè÷èé â ïîäãðóïïàõ íå âû-

ÿâëåíî (òàáë. 2 ).

Ïðè àíàëèçå ÑÑÏ ÐÑ ìåäëåííûé òåìï ïðîãðåññèðîâà-

íèÿ îòìå÷àëñÿ ó 7(14,0%) îáñëåäóåìûõ I ãðóïïû, óìåðåí-

íûé òåìï ó 33 ïàöèåíòîâ (66,0%) è áûñòðûì òåìïîì ïðî-

ãðåññèðîâàíèÿ õàðàêòåðèçîâàëèñü 10 ïàöèåíòîâ (20,0%).

Âî II ãðóïïå íàáëþäàëîñü 4 (8,0%) ÷åëîâåê ñ ìåäëåí-

íîé ÑÑÏ çàáîëåâàíèÿ, ñ óìåðåííîé ÑÑÏ – 27 ïàöèåíòà

(54,0 %), áûñòðûé òåìï ÑÑÏ îòìå÷åí ó 19 áîëüíûõ

(38,0%). Òàêèì îáðàçîì, II ãðóïïà áîëüíûõ îòëè÷àëàñü

ñòàòèñòè÷åñêè çíà÷èìûì áûñòðûì òåìïîì ïðîãðåññè-

ðîâàíèÿ çàáîëåâàíèÿ, â òî âðåìÿ êàê ó ïàöèåíòîâ I ãðóï-

ïû ïðåîáëàäàë óìåðåííûé òåìï ïðîãðåññèðîâàíèÿ

(ðèñ. 2).

Ïðè èçó÷åíèè ÊÆ áîëüíûõ ÐÑ íàìè îïðåäåëåíî, ÷òî

äëèòåëüíîñòü è âðåìÿ íà÷àëà çàáîëåâàíèÿ ÐÑ îêàçûâàåò

ñóùåñòâåííîå âëèÿíèå íà ïîêàçàòåëè ÊÆ – îòìå÷åíî èõ

çíà÷èòåëüíîå ñíèæåíèå â çàâèñèìîñòè îò ïðîäîëæèòåëü-

íîñòè çàáîëåâàíèÿ, îñîáåííî ôèçè÷åñêîé ñîñòàâëÿþ-

ùåé, ÷òî â ïåðâóþ î÷åðåäü îáóñëîâëåíî íàðàñòàíèåì

íåâðîëîãè÷åñêîãî äåôèöèòà.

Ñíèæåíèå ÊÆ â îáåèõ ãðóïïàõ áîëüíûõ ÐÑ íàìè íà-

áëþäàëîñü óæå â ïåðâûå ãîäû áîëåçíè (äî 5ëåò). Â áîëü-

øåé ìåðå ñíèæåíèå ïîêàçàòåëåé ÊÆ áûëè âûðàæåíû

ó ïàöèåíòîâ âòîðîé ãðóïïû, ýòî ñâèäåòåëüñòâóåò î òîì,

÷òî ïàöèåíòû ñòàðøåãî âîçðàñòà áîëåå ÷óâñòâèòåëüíû

ê èçìåíåíèÿì ñâîåãî ñîñòîÿíèÿ çäîðîâüÿ.

Íàèáîëüøèå ðàçëè÷èÿ â îöåíêå ÊÆ

áîëüíûõ ÐÑ âûÿâëåíû ïî øêàëàì ÔÔ,

ÐÔÔ, Á è ÐÝÔ, ÷òî ñâèäåòåëüñòâóåò îá

îãðàíè÷åíèè èõ ïîâñåäíåâíîé äåÿòåëü-

íîñòè (ðèñ 3, 4). Ìåíåå âñåãî ó îáñëåäó-

åìûõ ñòðàäàëî ïñèõè÷åñêîå çäîðîâüå,

ñòàòèñòè÷åñêè äîñòîâåðíàÿ ðàçíèöà

áûëà îïðåäåëåíà â ïîäãðóïïàõ áîëü-

íûõ ñòàðøåãî âîçðàñòà II À è II Â äëÿ

ïîêàçàòåëÿ ÐÝÔ.

Ó âñåõ îáñëåäóåìûõ ñ äëèòåëüíîñ-

òüþ çàáîëåâàíèÿ äî 10 ëåò îòìå÷àþòñÿ

îáùèå òåíäåíöèè èçìåíåíèÿ êà÷åñòâà

æèçíè, áîëüøå âûðàæåííûå â

ïîäãðóïïàõ ñòàðøåãî âîçðàñòà. Â äàëü-

Òàáëèöà 1.

Ðàñïðåäåëåíèå áîëüíûõ îáåèõ ãðóïï íà ïîäãðóïïû

â çàâèñèìîñòè îò äëèòåëüíîñòè çàáîëåâàíèÿ

Òàáëèöà 2.

Ñðàâíèòåëüíàÿ îöåíêà óðîâíÿ èíâàëèäèçàöèè ïî EDSS â çàâèñèìîñòè

îò äëèòåëüíîñòè çàáîëåâàíèÿ, áàëëû

Ðèñ.1 Ñòåïåíü âûðàæåííîñòè èíâàëèäèçàöèè ïî øêàëå EDSS

ó áîëüíûõ ÐÑ îáåèõ ãðóïï

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Ðèñ.2. Ñðàâíèòåëüíûé àíàëèç ÑÑÏ â îáñëåäóåìûõ ãðóïïàõ

* Ñòàòèñòè÷åñêè çíà÷èìàÿ ðàçíèöà (ð < 0,05, – êðèòåðèé χ2)

íåéøåì, ïî ìåðå íàðàñòàíèÿ íåâðîëîãè÷åñêîãî äåôèöè-

òà è óâåëè÷åíèÿ äëèòåëüíîñòè áîëåçíè áîëåå 11ëåò, ïîêà-

çàòåëè, õàðàêòåðèçóþùèå ðàçëè÷íûå ôîðìû ôóíêöèîíè-

ðîâàíèÿ, ïðîäîëæàþò ïðîãðåññèâíî óìåíüøàòüñÿ â

ïîäãðóïïàõ I Ñ è II Ñ, íå ïîêàçûâàÿ äîñòîâåð-

íî çíà÷èìûõ ðàçëè÷èé (ðèñ 5).

Âûâîäû.

Ïðè àíàëèçå ñòåïåíè èíâàëèäèçàöèè äîñ-

òîâåðíî çíà÷èìûõ ðàçëè÷èé ó áîëüíûõ ðàç-

íûõ âîçðàñòíûõ ãðóïï âûÿâëåíî íå áûëî, îä-

íàêî îïðåäåëÿåòñÿ òåíäåíöèÿ ê óâåëè÷åíèþ

÷èñëà áîëüíûõ ñ óìåðåííîé è âûðàæåííîé

ñòåïåíüþ èíâàëèäèçàöèè ñðåäè ïàöèåíòîâ

ñòàðøåãî âîçðàñòà.

Áîëüíûå ñ íà÷àëîì çàáîëåâàíèÿ â ñòàð-

øåì âîçðàñòå èìåþò äîñòîâåðíî áîëåå

áûñòðûé òåìï ïðîãðåññèðîâàíèÿ çàáî-

ëåâàíèÿ, â òî âðåìÿ êàê ó ïàöèåíòîâ, êîòîðûå

çàáîëåëè â ìîëîäîì âîçðàñòå, ïðåîáëàäàåò

óìåðåííûé òåìï ïðîãðåññèðîâàíèÿ ÐÑ.

Ïîêàçàòåëè êà÷åñòâà æèçíè ó áîëüíûõ ÐÑ ñòàðøåãî

âîçðàñòà äîñòîâåðíî íèæå ïî ñðàâíåíèþ ñ ãðóïïîé ìî-

ëîäîãî âîçðàñòà ïðè äëèòåëüíîñòè çàáîëåâàíèÿ äî 10 ëåò.

Ðèñ. 3. Ïîêàçàòåëè êà÷åñòâà æèçíè ó ïàöèåíòîâ ñ ÐÑ â ïîäãðóïïàõ IÀ, IIÀ

* Ñòàòèñòè÷åñêè çíà÷èìàÿ ðàçíèöà (ð < 0,05, – êðèòåðèé χ2)

Ðèñ. 4. Ïîêàçàòåëè êà÷åñòâà æèçíè ó ïàöèåíòîâ ñ ÐÑ â ïîäãðóïïàõ I Â, II Â

* Ñòàòèñòè÷åñêè çíà÷èìàÿ ðàçíèöà (ð < 0,05, – êðèòåðèé χ2)

Ðèñ.5. Ïîêàçàòåëè êà÷åñòâà æèçíè ó ïàöèåíòîâ ñ ÐÑ â ïîäãðóïïàõ IÑ, IIÑ

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

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Áîëåå âñåãî ñòðàäàåò ôèçè÷åñêàÿ ñîñòàâëÿþùàÿ êà÷åñòâà

æèçíè, è îäíà èç ïñèõîëîãè÷åñêèõ ñîñòàâëÿþùèõ – ðîëå-

âîå ýìîöèîíàëüíîå ôóíêöèîíèðîâàíèå.

Èçìåíåíèÿ êà÷åñòâà æèçíè íàèáîëåå âûðàæåíû íî íå

èìåþò ñòàòèñòè÷åñêè çíà÷èìûõ ðàçëè÷èé ó áîëüíûõ ðàç-

íûõ âîçðàñòíûõ ãðóïï ñ äëèòåëüíîñòüþ áîëåçíè 11-15 ëåò,

÷òî îáóñëîâëåíî çíà÷èòåëüíûìè èçìåíåíèÿìè âî âñåõ

ñôåðàõ æèçíè ïàöèåíòà âñëåäñòâèå ïðîãðåññèðîâàíèÿ

çàáîëåâàíèÿ, ïîòåðè òðóäîñïîñîáíîñòè è âûðàæåííîé

èíâàëèäèçàöèè.

Ðåöåíçåíò: ÷ëåí-êîð. ÍÀÌÍ Óêðà¿íè,

ä.ìåä.í., ïðîôåñîð Íåòÿæåíêî Â.Ç.

ËÈÒÅÐÀÒÓÐÀ

1. Áèñàãà Ã.Í. Ðàññåÿííûé ñêëåðîç. Ñîâðåìåííûå ïðåäñòàâ-

ëåíèÿ, äèàãíîñòèêà è ëå÷åíèå. – Ñàíêò-Ïåòåðáóðã: Àñïåêò ïëþñ,

2001. – 41 ñ.

2. Âîëîøèíà Í.Ï., Åãîðêèíà Î.Â. (2011) Ïðîáëåìà ðàññåÿííîãî

ñêëåðîçà â Óêðàèíå. Ôàðìàêîëîãè÷åñêîå îáîñíîâàíèå ëå÷åíèÿ ÐÑ.

Íàóêîâèé ñèìïîç³óì ç ì³æíàðîäíîþ ó÷àñòþ “Ìåäè÷í³ òà ñîö³àëüí³

àñïåêòè ðåàá³ë³òàö³¿ â íåâðîëîã³¿, ïñèõ³àòð³¿ ³ íàðêîëîã³¿”, 24–25/

ëèñòîïàäà, Êè¿â.

3. Ìàëêîâà Í.À., Èåðóñàëèìñêèé À.Ï. Ðàññåÿííûé ñêëåðîç.

Íîâîñèáèðñê, 2006;170 ñ.

4. Íîâèê À.À. Êîíöåïöèÿ èññëåäîâàíèÿ êà÷åñòâà æèçíè â íå-

âðîëîãèè/ À.À. Íîâèê, Ì.Ì. Îäèíàê, Ò.Í. Èîíîâà, Ã.Í. ÁèñàãàÏ

Íåâðîëîãè÷åñêèé æóðíàë. -2002. ¹ 6.- Ñ. 49-52.

5. Ðàññåÿííûé ñêëåðîç: ðóêîâîäñòâî / Ò.Å. Øìèäò, Í.Í. ßõíî. –

2-å èçä. – Ì. : ÌÅÄïðåññ-èíôîðì, 2010. – 146 ñ.

6. Øâàðö Ã.ß. Ôàðìàêîýêîíîìè÷åñêîå îáîñíîâàíèå ïðèìåíå-

íèÿ ëåêàðñòâåííûõ ïðåïàðàòîâ ïðåâåíòèâíîãî ðÿäà â ëå÷åíèè

áîëüíûõ ðàññåÿííûì ñêëåðîçîì / Ã.ß. Øâàðö // Íåâðîëîãè÷åñêèé

æóðíàë. 2001. – ¹ 1. – Ñ. 43-47.

7. Delalande S. et al. Late onset multiple sclerosis // Rev. Neurol. –

2002. – Vol. 158(11). – P. 1082–1087.

8. Janardhan V. Quality of life in patients with multiple sclerosis.

The impact of fatigue and depression / V. Janardhan, R. Bakshi. //

Journal of the Neurological Scienes.-2002.-Vol 205.-¹ 1. P.51-58.

9. Janssens A.C. Impact of recently diagnosed multiple sclerosis

on quality of life, anxiety, depression and distress of patients and

partners I A.C. Janssens, P A. van Doom, J.B. de Boer et all II Acta.

Neurol. Scand. 2003. – Vol. 108.6.-P. 389-395.

10. Multiple sclerosis with very late onset: report of six cases and

review of the literature / G. Azzimondi, A. Stracciari, R. Rinaldi [et al.]

// Eur. Neurol. – 1994. – Vol. 34, N 6. –P. 332–336. 125

11. Nortvedt M.W. Quality of life in multiple sclerosis: measuring

the disease effects more broadly / M. W. Nortvedt, T. Rii.se, Kjell-

Morten Myhr. et all. II Neurology.-1999. Vol.53. – P. 1098-1103.

12. Noseworthy, J. et al. Multiple sclerosis after age 50 // Neurology. –

1983. – Vol. 33. – P. 1537–1544

13. Verjans E., Theys P., Delmotte P. et al. Clinical parameters

and intrathecal IgG synthesis as prognostic features in multiple

sclerosis. Part I. J Neurol 1983; 229: 3: 155–165.

14. Ware J.E., Snow K.K., Kosinski M., Gandek B. SF-36 Health

Survey. Manual and interpretation guide. – The Health Institute, New

England Medical Center. Boston, Mass., 1993.

15. White A. D. Features of multiple sclerosis in older patients in

South Wales / A. D. White, R. J. Swingler, D. A. Compston // Gerontology. –

1990. – Vol. 36, N 3. – P. 159–164. 126.

ÏÎÐ²ÂÍßËÜÍÈÉ ÀÍÀË²Ç Ð²ÂÍß ²ÍÂÀË²ÄÈÇÀÖ²¯

ÒÀ ÏÎÊÀÇÍÈÊ²Â ßÊÎÑÒ² ÆÈÒÒß Ó ÕÂÎÐÈÕ

Ç ÐÎÇÑ²ßÍÈÌ ÑÊËÅÐÎÇÎÌ Ð²ÇÍÈÕ

Â²ÊÎÂÈÕ ÃÐÓÏ

Ñåï³õàíîâà Ì.Ì., Ñîêîëîâà Ë. È.

Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò

³ìåí³ Î.Î. Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

Ðåçþìå. Ïðîâåäåíå äîñë³äæåííÿ ïîêàçàëî, ùî õâîð³

ç ïî÷àòêîì çàõâîðþâàííÿ ó ñòàðøîìó â³ö³ ìàþòü äîñòî-

â³ðíî á³ëüø øâèäêèé òåìï ïðîãðåñóâàííÿ çàõâîðþâàí-

íÿ, â òîé ÷àñ ÿê ó ïàö³ºíò³â, ÿê³ çàõâîð³ëè â ìîëîäîìó â³ö³,

ïåðåâàæàº ïîì³ðíèé òåìï ïðîãðåñóâàííÿ ÐÑ.

Ïîêàçíèêè ÿêîñò³ æèòòÿ ó õâîðèõ ÐÑ ñòàðøîãî â³êó äî-

ñòîâ³ðíî íèæ÷å â ïîð³âíÿíí³ ç ãðóïîþ ìîëîäîãî â³êó ïðè

òðèâàëîñò³ çàõâîðþâàííÿ äî 10 ðîê³â. Íàéá³ëüøå ñòðàæ-

äàº ô³çè÷íà ñêëàäîâà ÿêîñò³ æèòòÿ, à ñàìå ðîëüîâå

ô³çè÷íå ôóíêö³îíóâàííÿ òà îäíà ç ïñèõîëîã³÷íèõ ñêëàäî-

âèõ – ðîëüîâå åìîö³éíå ôóíêö³îíóâàííÿ.

Êëþ÷îâ³ ñëîâà: ðîçñ³ÿíèé ñêëåðîç, ð³âåíü ³íâàë³äè-

çàö³¿, ÿê³ñòü æèòòÿ.

COMPARATIVE ANALYSIS OF THE LEVEL

OF DISABILITY AND QUALITY OF LIFE INDICES

IN PATIENTS WITH MULTIPLE SCLEROSIS

IN DIFFERENT AGE GROUPS

M. Sepihanova, L. Sokolova

Bogomolets National Medical University, Kyiv, Ukraine

Summary. The study showed that patients with disease

onset at an older age have a significantly faster rate of

disease progression, while in patients who fell ill at a young

age, a temperate pace of progression of MS is

predominated.

Quality of life indices in patients with MS of older age is

significantly lower compared with the group of young age

with disease duration up to 10 years. More likely physical

component of quality of life is impaired, notably, role physical

functioning and one of the psychological components – the

role emotional functioning.

Key words: multiple sclerosis, the level of disability,

quality of life.

¹ 1 (79) • 2014

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Àðòåð³àëüíà ã³ïåðòåíç³ÿ (ÀÃ) – îäíà ç íàéïîøèðåí³-

øèõ õâîðîá ñåðöåâî-ñóäèííî¿ ñèñòåìè (ÑÑC) [1,5]. Çà äà-

íèìè öåíòðó ìåäè÷íî¿ ñòàòèñòèêè, â Óêðà¿í³ çàðåºñòðîâà-

íî 11 ìëí. õâîðèõ ³ç ÀÃ. Çà ï³äðàõóíêàìè â÷åíèõ, äî 2025

ðîêó ó ñâ³ò³ áóäå 1,5 ìëðä. îñ³á ³ç ã³ïåðòåíç³ºþ, à ðèçèê ÀÃ

ìàòèìóòü 90% íàñåëåííÿ ðîçâèíåíèõ êðà¿í [2,3]. Âèñîêèé

àðòåð³àëüíèé òèñê (ÀÒ) º ÷èííèêîì ðèçèêó ùîäî áàãàòüîõ

ïàòîëîã³÷íèõ ñòàí³â: ã³ïåðòðîô³¿ ë³âîãî øëóíî÷êà, àòåðîñ-

êëåðîçó, ³øåì³÷íî¿ õâîðîáè ñåðöÿ, öåðåáðîâàñêóëÿðíèõ

õâîðîá. Íå ìåíø âàæëèâîþ ïðîáëåìîþ ñüîãîäåííÿ ÿâ-

ëÿºòüñÿ îæèð³ííÿ. Ö³ çàõâîðþâàííÿ ðàçîì ñïðè÷èíþþòü

ñìåðòü 1 ìëí. ëþäåé ùîðîêó. Îæèð³ííÿ ñïðèÿº ï³äâèùåí-

íþ ðèçèêó âèíèêíåííÿ ÑÑÇ ÷åðåç ðÿä âçàºìîïîâ’ÿçàíèõ

ìåõàí³çì³â, ÿê³ íåäîñòàòíüî âèâ÷åí³. Îêðåìî îæèð³ííÿ òà

ÀÃ º ôàêòîðàìè ðèçèêó çàãðîçëèâèõ äëÿ æèòòÿ ñòàí³â –

³íñóëüòó, ³íôàðêòó ì³îêàðäà, ïîðóøåíü ðèòìó ñåðöÿ. Â

çâ’ÿçêó ³ç çíà÷íèì ïîøèðåííÿì ÀÃ òà îæèð³ííÿ ñåðåä

ïðàöåçäàòíîãî íàñåëåííÿ öÿ ïðîáëåìà çàëèøàºòüñÿ äî-

ñèòü àêòóàëüíîþ. Äîâåäåíî, ùî ñàìå õðîí³÷íèé äèñáà-

ëàíñ íåéðîãóìîðàëüíèõ ñèñòåì º êëþ÷îâèì ÷èííèêîì

ðîçâèòêó ³ ïðîãðåñóâàííÿ ÀÃ, äèñôóíêö³¿ ë³âîãî øëóíî÷-

êà òà ñåðöåâî¿ íåäîñòàòíîñò³. Âåëèêà ðîëü â ðîçâèòêó öèõ

ïàòîëîã³÷íèõ ïðîöåñ³â íàëåæèòü äîôàì³íåðã³÷í³é ñèñ-

òåì³. Äîôàì³í (ÄÀ) çä³éñíþº ñïåöèô³÷íèé ñàìå äëÿ íüî-

ãî âïëèâ íà ÑÑÑ, ñïðè÷èíþþ÷è äèëÿòàö³þ ñóäèí íèðîê,

ï³äâèùåííÿ ä³óðåçó, íàòð³éóðåçó. Ïîðóøåíÿ â ôóíêö³î-

íóâàíí³ äîôàì³íîâèõ ðåöåïòîð³â DR1 - ðîäèíè (DR1DR5)

òà DR2- ðîäèíè (DR2DR3DR4) ïðèçâîäèòü äî ðîçâèòêó

ã³ïåðòîí³÷íî¿ õâîðîáè (ÃÕ). Îáãîâîðþºòüñÿ êîíöåïö³ÿ

âïëèâó äîôàì³íîâèõ ðåöåïòîð³â íà ôóíêö³îíóâàííÿ ðå-

öåïòîð³â äî àíã³îòåíçèíó ²² (ÀÒ²²) 1 òà 2 òèïó, ãîìåîñòàç

Na òà îêñèäàíòíèé ñòðåñ, ïåðåäñåðäíèéíàòð³éóðåòè÷íèé

ïåïòèä. [8,12,16]. Á³ëüø âèñîêèé ð³âåíü ïîêàçíèê³â

ë³ï³äíîãî îáì³íó, à ñàìå çàãàëüíîãî õîëåñòåðèíó, ãë³êîçè-

ëüîâàíèé ãåìîãëîá³í òà ³íñóë³íîðåçèñòåíòí³ñòü ïîâ’ÿçàí³

ç çíèæåííÿì öåíòðàëüíîãî äîôàì³íîâîãî òîíóñó

[9,10,11,18]. Êð³ì òîãî âñòàíîâëåíèé çâ’ÿçîê ì³æ ôóíêö³î-

íàëüíîþ àêòèâí³ñòþ DR2äîôàì³íîâèõ ðåöåïòîð³â ñòðóê-

òóð ìîçêó òà íåéðîåíäîêðèííèìè ãîðìîíàìè òàêèìè ÿê

³íñóë³í, ëåïòèí òà àöèëãðåë³í, ùî ìàº çíà÷åííÿ ïðè

îæèð³íí³ [2,14]. Ïðè îæèð³íí³ çá³ëüøóºòüñÿ óòâîðåííÿ

àíã³îòåíçèíîãåíó, ùî ïðîäóêóºòüñÿ àäèïîöèòàìè, âíàñë³-

äîê ÷îãî â³äáóâàºòüñÿ àêòèâàö³ÿ ñèíòåçó ÀÒ²² – ìàñèâíî-

ÓÄÊ616.12.– 008.331.1:616-056.52] -085.036.8

ÅÔÅÊÒÈÂÍ²ÑÒÜ ÀÃÎÍ²ÑÒ²Â ÄÎÔÀÌ²ÍÎÂÈÕ

ÐÅÖÅÏÒÎÐ²Â Ó Ë²ÊÓÂÀÍÍ² ÕÂÎÐÈÕ ÍÀ ÀÐÒÅÐ²ÀËÜÍÓ

Ã²ÏÅÐÒÅÍÇ²Þ Ç ÑÓÏÓÒÍ²Ì ÎÆÈÐ²ÍÍßÌ

Ñîáîëü Â.Î., Ëèçîãóá Â.Ã., Ìîøêîâñüêà Þ.Î., Áîíäàð÷óê Î.Ì.

Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Î.Î. Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: àðòåð³àëüíà ã³ïåðòåíç³ÿ, äîôàì³í, àëüäîñòåðîí, àíã³îòåíçèí ²², åíäîòåë³àëüíà ôóíêö³ÿ,

ì³ðàïåêñ.

ãî âàçîêîíñòðèêòîðà, ùî ñïðèÿº àêòèâàö³¿ ñèìïàòîàäðå-

íàëîâî¿ ñèñòåìè, ï³äâèùåííþ óòâîðåííÿ ñóïåðîêñèäó,

ðîçâèòêó åíäîòåë³àëüíî¿äèñôóíêö³¿, ï³äâèùåííþ òîíóñó

ñóäèí, ÀÒ ³ ðîçâèòêó ÀÃ. Òîìó ïîñèëåíà ïðîäóêö³ÿ àíã³î-

òåíçèíîãåíó ³ äàë³ ÀÒ²² ìàº âåëèêå çíà÷åííÿ â ìåõàí³çìàõ

âèíèêíåííÿ ÀÃ ó õâîðèõ ç àáäîì³íàëüíèì òèïîì îæèð³í-

íÿ. Åêñïåðèìåíòàëüí³ äîñë³äæåííÿ íà ïàöþêàõ ç îæèð³í-

íÿì ïîêàçàëè, ùî çìåíøåííÿ ê³ëüêîñò³ DR1, DR2, DR4,

DR5 âèêëèêàº ï³äâèùåíó ÷óòëèâ³ñòü äî ñîë³ òà ï³äâèùåííÿ

ÀÒ. Ï³äâèùåíà àêòèâí³ñòü ðåöåïòîð³â äî ÀÒ²² 1 òèïó ñïîñ-

òåð³ãàºòüñÿ ïðè çìåíøåíí³ åêñïðåñ³¿ DR1 òà DR2 ïðè

îæèð³íí³. Êð³ì òîãî º äóìêà ïðî òå, ùî çìåíøåííÿ åêñï-

ðåñ³¿ DR1 òà DR3 ëåæèòü â îñíîâ³ ãåíäåðíèõ îñîáëèâîñòåé

ïîðóøåíü ÀÒ [24]. ² õî÷à ÄÀ äåðèâàòè ìàþòü àíòèã³ïåð-

òåíçèâíèé åôåêò, âñå öå ùå ïîòðåáóº á³ëüø äîñêîíàëîãî

âèâ÷åííÿ. Êîæåí ³ç ï³äòèï³â ðåöåïòîð³â ÄÀ áåðóòü ó÷àñòü

â ðåãóëþâàíí³ ÀÒ ìåõàí³çìàìè, âèçíà÷åíèìè äëÿ ï³äòèïó.

Äåÿê³ ðåöåïòîðè (D2 ³ D5) âïëèâàþòü íà öåíòðàëüíó òà/÷è

ïåðèôåðè÷íó íåðâîâó ñèñòåìó, ³íø³ âïëèâàþòü íà åï³òå-

ë³àëüíèé òðàíñïîðò ³ ðåãóëþþòü ñåêðåö³þ òà ðåöåïòîðè

äåÿêèõ ãóìîðàëüíèõ àãåíò³â (íàïðèêëàä, D1,D3,D4 ðåöåï-

òîðè âçàºìîä³þòü ç ñèñòåìîþ àíã³îòåíçèíó ³ ðåí³íó).

Îñê³ëüêè îæèð³ííÿ – öå ìóëüòèôàêòîðíå çàõâîðþâàííÿ,

âèêëèêàíå âçàºìîä³ºþ ãåíîòèïó òà ñåðåäîâèùà, òî ìîæ-

ëèâî ñàìå íîñ³éñòâî À1 àëåëÿ ãåíà DRDR2 àáî 7R àëåëÿ

ãåíà DRDR4 äîôàì³íîâèõ ðåöåïòîð³â º âàæëèâèì â ôîð-

ìóâàíí³ îæèð³ííÿ [7,11,16,23]. Çà äàíèìè NeilThomas G.,

Julian A.J., DR2 ãåí ìîæå áóòè îäíèì ³ç âàæëèâèõ ãåí³â, ùî

ëåæèòü â îñíîâ³ âçàºìîçâ’ÿçêó ì³æ îæèð³ííÿì ³ ÀÃ [13,

22].Â êë³òèíàõ ïðîêñèìàëüíèõ êàíàëüö³â íèðîê çíèæåííÿ

ðåàáñîðáö³¿ íàòð³þ ïîâ’ÿçàíî ç ôóíêö³îíóâàííÿì DR1 /

DR5- ðåöåïòîð³â òà ÀÒ2-ðåöåïòîð³â, òîä³ ÿê ÀÒ1-ðåöåïòî-

ðè ï³äâèùóþòü ðåàáñîðáö³þ íàòð³þ. Á³ëüø³ñòü çíàíü ïðî

âïëèâè ÄÀ ñôîêóñîâàí³ íà DR1, ç ôóíêö³îíóâàííÿì ÿêèõ

ïîâ’ÿçàíà íèðêîâà åêñêðåö³ÿ. Îäíàê, íà â³äì³íó â³ä DR1,

ã³ïåðòåíç³ÿ, ñïðè÷èíåíà ïîðóøåííÿìè ôóíêö³¿ DR5, âè-

íèêàº âíàñë³äîê ï³äâèùåííÿ ñèìïàòè÷íîãî òîíóñó, àêòè-

âàö³¿ îêñèòîöèíó òà âàçîïðåñèíó V1. Ïîðóøåííÿ â êîíò-

ðîë³ íàä öèìè ïðîòèëåæíèìè ñèñòåìàìè ëåæèòü â îñíîâ³

ðîçâèòêó ÀÃ. Âèêîðèñòàííÿ àãîí³ñò³â DR1 òà DR5 ñïðè÷è-

íþº çìåíøåííÿ åêñïðåñ³¿ ÀÒ1- ðåöåïòîð³â. Òîìó â³äêðèò-

òÿ äèôåðåíö³àëüíîãî ðåãóëþâàííÿ DR1 òà DR5 â³äêðèâàº

íîâ³ ïåðñïåêòèâè äëÿ ðîçâèòêó ñåëåêòèâíèõ àãîí³ñò³â

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

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ï³äòèï³â äîôàì³íîâèõ ðåöåïòîð³â ÿê ö³ëüîâèõ ã³ïîòåíçèâ-

íèõ ïðåïàðàò³â, ÿê³ ìîæóòü çíèçèòè àíòèíàòð³éóðåòè÷íèé

âïëèâ ðåöåïòîð³â äî ÀÒ²² 1 òèïó. [15,27]. DR3 ðåöåïòîðè

ïðèãí³÷óþòü ñåêðåö³þ ðåí³íó. Ëîêóñè á³ëÿ DR3 ðåöåï-

òîð³â ïîâ’ÿçàí³ ç ï³äâèùåííÿì ÀÒ. Ïîðóøåííÿ DR3 ðå-

öåïòîð³â, ÿê³ ðîçì³ùåí³ íà êë³òèíàõ þêñòà-ãëîìåðóëÿðíî-

ãî àïàðàòó òà ïðîêñèìàëüíèõ êàíàëüöÿõ íèðîê, âåäå äî

ï³äâèùåííÿ ïðîäóêö³¿ ðåí³íó òà àëüäîñòåðîíó (ÀËÄ) ³

â³äïîâ³äíî âèíèêíåííþ ÀÃ [19]. B³äñóòí³ñòüD4 ðåöåï-

òîð³â ï³äâèùóº ÀÒ ÷åðåç ï³äâèùåííÿ åêñïðåñ³¿ ÀÒ1 ðå-

öåïòîð³â äî ÀÒ²². [19]. Òàêèì ÷èíîì D3- ðåöåïòîðè ³íã³áó-

þòü ðåí³íîâó ñåêðåö³þ [21], ä³ÿ ÿêèõ òàêîæ ÿê ³ D4

ðåöåïòîð³â ïîâ’ÿçàíà ç âïëèâîì íà ñèñòåìó àíã³îòåíçèíó,

ðåí³íó, âïëèâ íà ïðîöåñè íèðêîâî¿ ãåìîäèíàì³êè. Ôóíê-

ö³îíàëüíèé ñòàí äîôàì³íîâèõ ðåöåïòîð³â DR5 òåæ ïîâ’ÿ-

çàíèé ç ôóíêö³îíóâàííÿì ðåí³í-àíã³îòåíçèí-àëüäîñòåðî-

íîâîþ ñèñòåìîþ (ÐÀÀÑ) [25]. Äîñë³äæåííÿ ïîêàçóþòü,

ùî äîôàì³íîâ³ ðåöåïòîðè DR2 òà DR4 ìîäóëþþòü ÀËÄ

ñåêðåö³þ ïðîòèëåæíèìè ñïîñîáàìè. Ïðåïàðàòîì, ùî

âîëîä³º øèðîêèì ñïåêòðîì ä³¿ çà ðàõóíîê âïëèâó íà îñ-

íîâí³ â ïàòîãåíåç³ ÀÃ òà îæèð³íí³ äîôàì³íîâ³ ðåöåïòîðè

â³äíîñèòüñÿ ì³ðàïåêñ (ïðàì³ïåêñîë). ²ç âñ³õ àãîí³ñò³âäîôà-

ì³íîâèõ ðåöåïòîð³â ïðàì³ïåêñîë âîëîä³º ñàìîþ âèñîêîþ

ñïîð³äíåí³ñòþ äî D2 , D3, D4, òà D5 äîôàì³íîâèõ ðåöåï-

òîð³â, àëå íåçíà÷íî âçàºìîä³º ç ï³äòèïîì D1 ðåöåïòîð³â.

Êð³ì òîãî âñòàíîâëåíèé âçàºìîçâ’ÿçîê DR1 ³ DR3 ðåöåï-

òîð³â, à ñàìå DR1- ðåöåïòîðè ñòèìóëþþòü âàçîðåëàê-

ñàö³éí³ åôåêòè DR3 ðåöåïòîð³â ³ öåé âçàºìîçâ’ÿçîê ìàº

áóòè âêëþ÷åíèé â ðåãóëÿö³þ ÀÒ [6,26,27]. Â ôîðìóâàíí³

ã³ïåðòðîô³¿ ë³âîãî øëóíî÷êà âàæëèâó ðîëü â³ä³ãðàº ÀÒ²²,

ÀËÄ òà íîðàäðåíàë³í. ÄÀ, ä³þ÷è íà DR2 ðåöåïòîðè, ïðè-

ãí³÷óº âèâ³ëüíåííÿ íîðåï³íåôðèíó, ïðîòèä³º ÀËÄ òà

çìåíøóº åêñïðåñ³þ ÀÒ1 ðåöåïòîð³â, òîìó â³äïîâ³äíî

ì³ðàïåêñ ìîæå ïîçèòèâíî âïëèâàòè íà ðåãðåñ ã³ïåðòðîô³¿

ë³âîãî øëóíî÷êà.Îñê³ëüêè ÃÕ ïîâ’ÿçàíà ç ïîñèëåíèì

òðàíñïîðòîì Nà â íèðêîâèõ ïðîêñèìàëüíèõ êàíàëüöÿõ òà

âèñõ³äí³é ÷àñòèí³ ïåòë³ Ãåíëå, äå ïðîäóêóºòüñÿ åíäîòåë³í

òà åêñïðåñîâàí³åíäîòåë³íîâ³ ðåöåïòîðè Â, ùî ìàþòü íà-

òð³éóðåòè÷íèé åôåêò, ÿêèé ïîðóøóºòüñÿ çà ðàõóíîê ïî-

ðóøåííÿ âçàºìîçâ’ÿçê³â DR3 òà ÀÒ1 – ðåöåïòîð³â, ùî º

âàæëèâèì â ïàòîãåíåç³ ÀÃ [17]. Îñê³ëüêè ïðàì³ïåêñîë ÿâ-

ëÿºòüñÿ íååðãîë³íîâèì ñèíòåòè÷íèì ïîõ³äíèì àì³íîáåí-

çîò³àçîëó, çâ2ÿçóºòüñÿ ç D3 ðåöåïòîðàìè ç 7-ìè êðàòíî

á³ëüøîþ àô³íí³ñòþ, í³æ ç D2 ³ D4 ðåöåïòîðàìè, à òàêîæ

ìàº âïëèâ íà D5 ðåöåïòîðè, ùî â³äêðèâàº íîâ³ ïåðñïåêòè-

âè äëÿ ðîçâèòêó ñåëåêòèâíèõ àãîí³ñò³â ï³äòèï³â äîôàì³íî-

âèõ ðåöåïòîð³â ÿê ö³ëüîâèõ ã³ïîòåíçèâíèõ ïðåïàðàò³â

[15,20,27].

Ìåòà äîñë³äæåííÿ – ïîäàëüøå âèâ÷åííÿ ïàòîãåíå-

òè÷íèõ òðèãåð³â ÀÃ, à ñàìå âñòàíîâëåííÿ ðîë³ äîôàì³íî-

âîãî îáì³íó, ñóäèííî¿ ðåàêòèâíîñò³, ñòàíó ÐÀÀÑ ó ïðî-

ãðåñóâàíí³ ÀÃ ó õâîðèõ ³ç ñóïóòí³ì îæèð³ííÿì;

îñáëèâîñòåé ïîêàçíèê³â àðòåð³àëüíîãî òèñêó (ÀÒ) íà

ï³äñòàâ³ äîáîâîãî ìîí³òîðóâàííÿ ÀÒ (ÄÌÀÒ); îïòèì³çà-

ö³ÿ ë³êóâàëüíèõ çàõîä³â ó äàíî¿ êîãîðòè ïàö³ºíò³â øëÿõîì

çàñòîñóâàííÿ àãîí³ñò³âäîôàì³íîâèõ ðåöåïòîð³â.

Ìàòåð³àëè òà ìåòîäè äîñë³äæåííÿ. Áóëî îáñòåæåíî

18 ïàö³ºíò³â íà ÀÃ ç ñóïóòí³ì îæèð³ííÿì ñåðåä ÿêèõ 13

æ³íîê òà 5 ÷îëîâ³ê³â, â³ê 47–69 ðîê³â, ñåðåäí³é â³ê 59,1 ð³ê.

Âñ³ì õâîðèì ïðîâîäèëè êë³í³÷í³ ìåòîäè îáñòåæåííÿ.

Äëÿ êîíòðîëþ çì³íè ìàñè ò³ëà âèêîðèñòîâóâàëè ïîêàç-

íèê ³íäåêñó ìàñè ò³ëà (²ÌÒ). Ñåðåäí³é ²ÌÒ â êîãîðò³ äîñ-

ë³äæóâàíèõ ïàö³ºíò³â ñòàíîâèâ 33,4±3,0 êã/ì2, ùî â³äïî-

â³äàº îæèð³ííþ ² ñòóïåíÿ. Â äîñë³äæåííÿ íå âêëþ÷àëè

õâîðèõ ç ïàòîëîã³ºþ íèðîê òà åíäîêðèííèìè ïîðóøåí-

íÿìè.

Õâîðèì ïðîâîäèëè ÄÌÀÒ íà ïðèëàä³ ÒÌ-2430 (AND

Japan). Òðèâàë³ñòü ìîí³òîðóâàííÿ ÀÒ – 24 ãîä. Ð³âåíü ÄÀ

â ñå÷³ âèçíà÷àëè çà äîïîìîãîþ ôëþîðîìåòðè÷íîãî ìå-

òîäó çà ª.Ø. Ìàòë³íîþ, Ç.Ì. Êèñåëüîâîþ íà ñïåêòðî-

ôëþîìåòð³ CHITACHI ÌÏÔ-4 ç âèêîðèñòàííÿì ñïåö³àëü-

íèõ ñâ³òëîô³ëüòð³â. Êîíöåíòðàö³þ ÀËÄ âèçíà÷àëè

³ìóíîôåðìåíòíèì ìåòîäîì â ñèðîâàòö³ êðîâ³ çà äîïîìî-

ãîþ íàáîðó Aldosteronå EIA âèðîáíèöòâà Peninsula-

laboratories; êîíöåíòðàö³þ ÀÒ²² âèçíà÷àëè ³ìóíîôåðìåí-

òíèì ìåòîäîì â ïëàçì³ êðîâ³, âèêîðèñòîâóþ÷è íàá³ð

Angiotensin ²² EIA âèðîáíèöòâà Peninsulalaboratories,

ï³ñëÿ ïîïåðåäíüî¿ åêñòðàêö³¿ òà ë³îô³ë³çàö³¿ çðàçê³â; äëÿ

âèçíà÷åííÿ ñóäèíîðóõîâî¿ ôóíêö³¿ åíäîòåë³þ çàñòîñîâó-

âàâñÿ ìåòîä çàïðîïîíîâàíèé Öåëåðìàºðîì-Ñîðåíñå-

íîì. Õâîð³ íà ÀÃ ç ñóïóòí³ì îæèð³ííÿì îòðèìóâàëè â

ÿêîñò³ ë³êóâàííÿ àãîí³ñòäîôàì³íîâèõ ðåöåïòîð³â (ì³ðà-

ïåêñ â äîç³ 0,125 ìã òðè÷³ íà äåíü) âïðîäîâæ 2-îõ ì³ñÿö³â.

Êîíòðîëüíó ãðóïó ñòàíîâèëè 15 ïðàêòè÷íî çäîðîâèõ îñ³á

ðåïðåçåíòàòèâíèõ çà â³êîì.

Ðåçóëüòàòè äîñë³äæåíü òà îáãîâîðåííÿ. Ó âñ³õ õâîðèõ

ä³àãíîñòîâàíî ÀÃ ²-²² ñòóïåíÿ, 2 ñòàä³¿. Ï³ä âïëèâîì ã³ïî-

òåíçèâíî¿ òåðàï³¿ ñïîñòåð³ãàëè íîðìàë³çàö³þ àðòåð³àëüíîãî

òèñêó, à ñàìå çíèæåííÿ ÑÀÒ ñåð(äîáà) íà 8,8% (ð<0,001),

ÄÀÒ ñåð(äîáà) íà 8,9% (ð<0,01). Àíàë³çóþ÷è îòðèìàí³

ïîêàçíèêè ÄÌÀÒ âñòàíîâèëè çìåíøåííÿ íàâàíòàæåííÿ

÷àñîì ÄÀÒ (íà 30,8%) òà ÑÀÒ (íà 41,5%)à òàêîæ, âàð³à-

áåëüíîñò³ ÑÀÒ òà ÄÀÒ âïðîäîâæ äîáè (â³äïîâ³äíî íà 9,3%

òà 5,8%),àäæå ñàìå âîíè º çàãðîçëèâèìè ÷èííèêàìè ðîç-

âèòêó ñóäèííî-ìîçêîâèõ óñêëàäíåíü ó ïàö³ºíò³â ç ÀÃ.

Ó õâîðèõ íà ÀÃ ç ñóïóòí³ì îæèð³ííÿì âèõ³äíèé ð³âåíü

ÄÀ â ñå÷³ çíàõîäèâñÿ â ìåæàõ 703,1±223,2 ììîëü/ë, ùî

âêàçóº íà ïðèãí³÷åííÿ äîôàì³íåðã³÷íî¿ (ð<0,001) ñèñòåì

ó ïîð³âíÿíí³ ç êîíòðîëüíîþ ãðóïîþ, ð³âåíü ÀËÄ ³ ÀÒ²²

ñòàíîâèâ 196,8±41,3ïã/ìë (ð<0,001) òà 58,9±15,2ïã/ìë

(ð<0,01), ùo âêàçóº íà ã³ïåðàêòèâàö³þ ÐÀÀÑ. Ï³ä âïëèâîì

ë³êóâàííÿ ñïîñòåð³ãàëîñÿ ïîêðàùåííÿ ïîêàçíèê³â äîñë³ä-

æóâàíèõ ñèñòåì (òàáë.1): ï³äâèùåííÿ âì³ñòó ÄÀ â ñå÷³ íà

80,8% (ð<0,001), çìåíøåííÿ ð³âíÿ ÀËÄ íà 27,6% (ð<0,001)

òà ÀÒ²² íà 22,7% (ð<0,01).

Â äîñë³äæóâàíî¿ êîãîðòè â³äì³÷àëîñÿ ïîðóøåííÿ åí-

äîòåë³àëüíî¿ ôóíêö³¿ ïîð³âíÿíî ç êîíòðîëüíîþ ãðóïîþ,

ùî ïðîÿâëÿºòüñÿ ó çìåíøåíí³ åíäîòåë³é çàëåæíî¿ âàçîäè-

ëÿòàö³¿ (ÅÇÂÄ) (6,0±1,9% ïðîòè 13,6±3,2% ó ãðóï³ êîíòðî-

ëþ ð<0,05) òà çìåíøåííÿì åíäîòåë³éíå çàëåæíî¿ âàçîäè-

ëÿòàö³¿ (ÅÍÂÄ) íà 24,9%.

Ï³ä âïëèâîì ã³ïîòåíçèâíî¿ òåðàï³¿ ñïîñòåð³ãàëè ïîêðà-

ùåííÿ ôóíêö³¿ åíäîòåë³þ, à ñàìå ïîçèòèâ³çàö³þ ÅÇÂÄ

(6,0±1,9% ïðîòè 8,0±2,5% ï³ñëÿ ë³êóâàííÿ ( ð<0,05)íà ôîí³

çìåíøåííÿ ìàñè ò³ëà íà 9,8% (ð<0,05).

Òàêèì ÷èíîì, ë³êóâàííÿ õâîðèõ íà ÀÃ ç ñóïóòí³ì

îæèð³ííÿì íà ôîí³ ïðèãí³÷åííÿ äîôàì³íåðã³÷íî¿ ñèñòå-

ìè, ç âèêîðèñòàííÿì àãîí³ñòóäîôàì³íîâèõ ðåöåïòîð³â

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ì³ðàïåêñó, çàáåçïå÷óº îïòèì³çàö³þ ôàðìàêîòåðàï³¿ çà ðà-

õóíîê ïîçèòèâ³çàö³¿ ôóíêö³îíóâàííÿ äîôàì³íåðã³÷íî¿ òà

ÐÀÀÑ, ïîêðàùåííÿ åíäîòåë³éçàëåæíî¿âàçîäèëÿòàö³¿, ïî-

êàçíèê³â ÄÌÀÒ, çìåíøåííÿ ìàñè ò³ëà.

Âèñíîâêè

1. Íàÿâí³ñòü ó õâîðèõ ÀÃ òà ñóïóòíüîãî îæèð³ííÿ ñóï-

ðîâîäæóºòüñÿ ïðèãí³÷åííÿì ôóíêö³¿ äîôàì³íåðã³÷íî¿ òà

ã³ïåðàêòèâàö³ºþ ÐÀÀÑ â ïîºäíàíí³ ç åíäîòåë³àëüíîþäèñ-

ôóíêö³ºþ.

2. Ë³êóâàííÿ õâîðèõ íà ÀÃ ç ñóïóòí³ì îæèð³ííÿì

âïðîäîâæ 2-îõ ì³ñÿö³â ç âèêîðèñòàííÿì ì³ðàïåêñó çóìî-

âèëà ïîçèòèâíó êîðåêö³þ âì³ñòó äîôàì³íó â ñå÷³, ÀËÄ òà

ÀÒ²² â êðîâ³, ùî ñïðèÿº ïîêðàùåííþ ïîêàçíèê³â ÄÌÀÒ

òà ïàðàìåòð³â âàçîäèëÿòàö³éíî¿ ôóíêö³¿ åíäîòåë³þ íà

ôîí³ çìåíøåííÿ ìàñè ò³ëà.

3.Ó õâîðèõ íà ÀÃ òà ñóïóòí³ì îæèð³ííÿì ðåêîìåíäî-

âàíî âèçíà÷àòè ð³âåíü äîáîâî¿ åêñêðåö³¿ äîôàì³íó ³ç ñå-

÷åþ òà ïðè çíèæåíîìó éîãî âì³ñò³ äî àíòèã³ïåðòåíçèâíî¿

òåðàï³¿ âêëþ÷àòè àãîí³ñòäîôàì³íîâèõ ðåöåïòîð³â –

ì³ðàïåêñ, ùî äîçâîëèòü âïëèíóòè íà ÿêîìîãà á³ëüøó

ê³ëüê³ñòü ïàòîãåíåòè÷íèõ ìåõàí³çì³â ôîðìóâàííÿ ÀÃ.

Ðåöåíçåíò: ä.ì.í., ïðîôåñîð Ò.É.Ìàëü÷åâñüêà

Ë²ÒÅÐÀÒÓÐÀ

1. Àìîñîâà Å.Í. Êëèíè÷åñêàÿ êàðäèîëîãèÿ. – Ê.: Çäîðîâ`ÿ ,

1998.-Ò.1.-702ñ.-Ñ.400-498.

2. Áðàòóñü Â.Â., Òàëàåâà Ò.Â., Øóìàêîâ Â.À. Îæèðèíèå,

èñóëèíîðåçèñòåíòíîñòü, ìåòàáîëè÷åñêèé ñèíäðîì: ôóíäàìåí-

òàëüíå è êëèíè÷åñêèå àñïåêòû:ìîíîãðàô³ÿ.-2009.-×åòâåðòà

õâèëÿ. – 416ñ.

3. Ðàä÷åíêî Î.Ì. Ñòðàòåã³ÿ ³ òàêòèêà ã³ïîòåíçèâíî¿ òåðàï³¿

ó ïîäîëàíí³ íèçüêî¿ ïðèõèëüíîñò³ äî ë³êóâàííÿ.//Ðàöèîíàëüíàÿ

ôàðìàêîòåðàïèÿ.-2010.-¹3(16).-Ñ.5-9.

4. Ñâèùåíêî Å.Ï. Ëå÷åíèå áîëüíûõ ñ àðòåðèàëüíîé

ãèïåðòåíçèåé.//Äîêòîð.- 2000.-¹2.- Ñ.25-30.

5. Ñâèùåíêî Å.Ï., Áåçðîäíàÿ Ë.Â., Áîðòêåâè÷ Î.Ï. Ýññåí-

öèàëüíàÿ àðòåðèàëüíàÿ ãèïåðòåíçèÿ.//Óêðà¿íñüêèé ìåäè÷íèé

÷àñîïèñ.-2008.-¹2(64).-Ñ.5-34.

6. Ôåäîðîâà Í.Â. Àãîíèñòû äîôàìèíîâûõ ðåöåïòîðîâ –

ïðåïàðàòû âûáîðà òåðàïèè ðàííèõ ñòàäèé áîëåçíè Ïàðêèíñîíà /

Í.Â.Ôåäîðîâà // Consilium Medicum.- 2009.-Òîì3.-¹4.-Ñ.26-32.

7. Arisa M. Dopamine genes (DRD2/ANKK1-TaqA1 and DRD4-

7R) and executive function:their interaction with odesity / Arisa M.,

Garolera M., Jurado M.A., Garcia I., Hernan I., Sanchez- Garre C.,

Vernet M., Sender-Palacios M.J., Marques-Iturria I., Pueyo R., Segura

B., Narberhaus A. // PLoS One.-2012.-Vol.7, ¹7Ð.67.

8. Asghar M. Potential dopamine-1 receptor stimulation in

hypertension management / Asghar M., Tayebati S.K., Lokhandwala

M.F., Hussain T.//Curr. Hypertens. Rep.-2011.-Vol.13, ¹4.-P.294-302.

9. Beeler J.A. Putting desire on a budget: dopamine and energy

expenditure, reconciling reward and resources / Beeler J.A., Frazier C.R.,

Zhuang X. // Front Integr Neurosci.-2012.-Vol.6.-P.49

10. Brunerova L. Central dofaminergic activity influences

metabolic parameters in healthy men / Brunerova L., Potockova J.,

Horacek J., Suchy J., Andey M. // Neuroendocrinology .-2013.-Vol.97,

¹2.-P.132-138.

Òàáëèöÿ 1.

Çì³íè ïîêàçíèê³â äîôàì³íîâîãî îáì³íó òà ÐÀÀÑ ó õâîðèõ íà àðòåð³àëüíó ã³ïåðòåíç³þ

ç ñóïóòí³ì îæèð³ííÿì ï³ä âïëèâîì ë³êóâàííÿ

Ïðèì³òêè: Ð

1-2 – äîñòîâ³ðí³ñòü çì³í ïî â³äíîøåííþ äî ãðóïè êîíòðîëþ. Ð2-3 – äîñòîâ³ðí³ñòü çì³í ì³æ ãðóïàìè â õîä³ ë³êóâàííÿ

11. Chen A.L. Correlation of the Taq1 dopamine D2 receptor

gene and percent body fat in obese and screened control subjects: a

preliminary report / Chen A.L., Blum K., Chen T.J., Giordano J.,

Downs B.W., Han D., Barh D., Braverman E.R. // Food Funct.-2012.-

Vol.3, ¹1.-P.40-48.

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uptake in the kidney / Choi M.R., Correa A.H., Garcia F.A., Fernandez

B.E. // Nephron Physiol. – 2006.-Vol.104, ¹4.-Ð.136-143.

13. Contreras F., Fouillioux C., Bolivar A., Simonovis N.

Dopamine, hypertension and obesity/ Contreras F., Fouillioux C.,

Bolivar A., Simonovis N.//Journal of human hypertension.-2002.-

¹16.-Ð.13.

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potential with fasting neuroendocrine hormones and insulin sensitivity

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Patterson B.W., Ansari M.S., Li R., Marks- Shulman P., Abumrad N.N.

// Diabetes Care.-2012.-Vol.35, ¹5.-Ð.1105-1111.

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binding and body mass index: a multi-center European study in healthy

volunteers / Gissen E., Hesse S., Caan M.W., Zientek F., Dickson J.C.,

Tossici-Bolt L., Sera T., Asenbaum S., Guignard R., Akdemir U.O.,

Knudsen G.M., Nobili F., Pagani M., Vander Borght T., Van Leare K.,

Varrone A., Tatsch K., Booij J., Sabri O. // Neuroimage.-2013.-Vol.

64.-P.61-67.

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2011.-Vol.172.-P.63-75.

18. Li Y. Identification of two functionally distinct endosomal

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Vol.32, ¹21.-Ð.7178-7190.

19. Martin G. Angitensin-II type 1 receptor-mediated hypertension

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21. Staudacher T. Arterial blood pressure and renal sodium

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22. Thomas N. Modulation of Blood Pressure and obesity with the

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Vol. 14, ¹1.-Ð.2-18.

24. Wang X. Reduction of renal dopamine receptor expression in

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¹5.-P.1164-1170.

25. Wang X. Upregulation of renal sodium transporters in D5

dopamine receptor-deficient mice / Wang X., Luo Y., Escano C., Yang

Z., Asico L., Li H., Jones J.E., Armando I., Lu Q., Sibley D.R., Eisner

G.M., Jose P.A.// Hypertension.-2010.-Vol.55, ¹5.-P.1431-1437.

26. Zeng C. Dysregulation of dopamine- dependent mechanisms as

a determinant of hypertension: studies in dopamine receptor knockout mi-

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Am. J. Physiol. Heart Circ. Physiol.-2008.-Vol.294, ¹2.-P.551-569.

27. Zeng C. Regulation of blood pressure by D5 dopamine

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Hematol. Agents Med. Chem.-2007.-Vol.5, ¹3.-Ð.241-248.

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ÝÔÔÅÊÒÈÂÍÎÑÒÜ ÀÃÎÍÈÑÒÎÂ

ÄÎÔÀÌÈÍÎÂÛÕ ÐÅÖÅÏÒÎÐÎÂ Â ËÅ×ÅÍÈÈ

ÁÎËÜÍÛÕ ÀÐÒÅÐÈÀËÜÍÎÉ ÃÈÏÅÐÒÅÍÇÈÅÉ

Ñ ÑÎÏÓÒÑÒÂÓÞÙÈÌ ÎÆÈÐÅÍÈÅÌ

Ñîáîëü Â.Î., Ëèçîãóá Â.Ã.,

Ìîøêîâñêàÿ Þ.Î., Áîíäàð÷óê À.Í.

Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò

èìåíè À.À.Áîãîìîëüöà, ã.Êèåâ, Óêðàèíà

Ðåçþìå.Îäíèì èç çâåíüåâ ïàòîãåíåçà àðòåðèàëüíîé

ãèïåðòåíçèè è îæèðåíèÿ ÿâëÿåòñÿ íàðóøåíèå ôóíêöèî-

íàëüíîé àêòèâíîñòè äîôàìèíåðãè÷åñêîé è ðåíèí-àíãè-

îòåíçèí-àëüäîñòåðîíîâîé ñèñòåì, äåéñòâèå êîòîðûõ íà-

ïðàâëåíî íà ðåãóëÿöèþ àðòåðèàëüíîãî äàâëåíèÿ, ôîð-

ìèðîâàíèå è ïðîãðåññèðîâàíèå îæèðåíèÿ. Èçó÷åíà ýô-

ôåêòèâíîñòü àãîíèñòà äîôàìèíîâûõ ðåöåïòîðîâ ìèðà-

ïåêñà â ëå÷åíèè äàííîé êàòåãîðèè áîëüíûõ. Óñòàíîâëå-

íî, ÷òî ïðèìåíåíèå ïðåïàðàòà ïðèâîäèò ê ïîçèòèâèçà-

öèè ïîêàçàòåëåé äîôàìèíåðãè÷åñêîé è ðåíèí-àíãèîòåí-

çèí-àëüäîñòåðîíîâîé ñèñòåì, ÷òî àññîöèèðóåòñÿ ñ óëó÷-

øåíèåì ïîêàçàòåëåé âàçîäèëÿòÿöèîííîé ôóíêöèè ýí-

äîòåëèÿ è ïîêàçàòåëåé ñóòî÷íîãî ìîíèòîðèðîâàíèÿ àð-

òåðèàëüíîãî äàâëåíèÿ íà ôîíå óìåíüøåíèÿ ìàññû òåëà.

Êëþ÷åâûå ñëîâà: àðòåðèàëüíàÿ ãèïåðòåíçèÿ, äîôà-

ìèí, àëüäîñòåðîí, àíãèîòåíçèíII, ýíäîòåëèàëüíàÿ

ôóíêöèÿ, ìèðàïåêñ.

EFFICIENCY OF AGONISTS OF DOFAMINE

RECEPTORS IN THE TREATMENT OF

HYPERTENSION PATIENTS WITH CONCOMITANT

OBESITY

V. Sobol, V. Lizogub,

J.O. Ìîshkovska, A.N. Bondarchuk

Bogomolets National Medical University, Kyiv, Ukraine

Summary.One of the links of pathogenesis of arterial

hypertension and obesity is a disorders of the functional activity

of the dopaminergic and the renin-angiotensin-aldosterone

systems which action is directed at the regulation of blood

pressure and the formation and progression of obesity. We

studied the efficiency agonist dopamine receptors pramipexole

in treatment of this category of patients. It is established that

drug use leads to positive changes in indicators of

dopaminergic and the renin-angiotensin-aldosterone system,

that is associated with improved endothelial function and

indicators of daily monitoring blood pressure and a reduced

body weight.

Key words: arterial hypertension, dopamine,angiotensin

²², aldosterone, endothelial function, pramipexole.

¹ 1 (79) • 2014

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Âñòóï. Äîáðîÿê³ñíà ã³ïåðïëàç³ÿ ïåðåäì³õóðîâî¿ çàëî-

çè º îäíèì ç íàéá³ëüø ïîøèðåíèõ çàõâîðþâàíü ó ÷î-

ëîâ³ê³â ïåðåâàæíî ïîõèëîãî ³ ñòàðå÷îãî â³êó, îäíàê ³ ó â³ö³

40-49 ðîê³â 13,8% ÷îëîâ³ê³â ìàþòü ñèìïòîìè öüîãî çàõâî-

ðþâàííÿ [2].

Îäíèì ç íàéá³ëüø ïåðñïåêòèâíèõ ñó÷àñíèõ ìåòîä³â

ë³êóâàííÿ àäåíîìè ïðîñòàòè º ëàçåðíà âàïîðèçàö³ÿ [6, 7,

8], ÿêà ìàº ðÿä ñåðéîçíèõ ïåðåâàã ó ïîð³âíÿíí³ ç ³íøèìè

ìåòîäàìè õ³ðóðã³÷íîãî ë³êóâàííÿ, íàâ³òü ç òðàäèö³éíîþ

òðàíñóðåòðàëüíîþ ðåçåêö³ºþ. Ìåòîä ëàçåðíî¿ âàïîðè-

çàö³¿ ïîëÿãàº ó âèïàðîâóâàíí³ òêàíèíè çàëîçè ïîòóæíèì

ëàçåðíèì âèïðîì³íþâàííÿì ç îäíî÷àñíîþ êîàãóëÿö³ºþ

ï³äëÿãàþ÷èõ øàð³â ïàðåíõ³ìè ³ êðîâîíîñíèõ ñóäèí, âíàñë-

³äîê ÷îãî îïåðàö³ÿ º ïðàêòè÷íî áåçêðîâíîþ [4]. Âèïàðî-

âóâàííÿ ïðîâîäèòüñÿ ïîøàðîâî; ïîñò³éíà ãëèáèíà ïðî-

íèêíåííÿ ëàçåðíîãî ïðîìåíÿ äîçâîëÿº õ³ðóðãó

êîíòðîëþâàòè ïðîöåñ, çàïîá³ãàþ÷è óñêëàäíåííÿì (ïåð-

ôîðàö³ÿ êàïñóëè ïðîñòàòè, ñå÷îâîãî ì³õóðà) [9]. Òêàíèíà

ïðîñòàòè, ùî âèïàðîâóºòüñÿ, âèìèâàºòüñÿ ðàçîì ç ïðî-

ìèâíîþ ð³äèíîþ ÷åðåç óðåòðó. Ââàæàºòüñÿ, ùî ºäèíèì

ñóòòºâèì íåäîë³êîì äàíîãî ñïîñîáó ë³êóâàííÿ º íåìîæ-

ëèâ³ñòü ã³ñòîëîã³÷íîãî äîñë³äæåííÿ òêàíèíè ïðè òàê³é

îïåðàö³¿.

Îñíîâîþ åôåêòà âàïîðèçàö³¿ º ïîãëèíàííÿ ëàçåðíî¿

åíåðã³¿ á³îëîã³÷íîþ òêàíèíîþ, âèáóõîïîä³áíèì çàê³ïàí-

íÿì ð³äèíè â êë³òèíàõ ³ç øâèäêèì ðóéíóâàííÿì öèòîïëàç-

ìàòè÷íèõ ìåìáðàí, ðåçóëüòàòîì ÷îãî º âèïàðîâóâàííÿ

òêàíèí. Â òêàíèíàõ, ùî çíàõîäÿòüñÿ ãëèáøå, ñïîñòåð³-

ãàºòüñÿ ëèøå êîàãóëÿö³ÿ, òîìó ùî ïîòóæí³ñòü âïëèâó

ëàçåðíî¿ åíåðã³¿ â öèõ ä³ëÿíêàõ ïðîñòàòè çìåíøóºòüñÿ.

Âèïðîì³íþâàííÿ ëàçåðà Dornier Medilas D UroBeam ç

äîâæèíîþ õâèë³ 940 íì ìàº óí³êàëüíó ä³þ íà á³îëîã³÷í³

òêàíèíè çà ðàõóíîê òîãî, ùî ïîãëèíàºòüñÿ îäíàêîâî ³íòåí-

ñèâíî ÿê ìîëåêóëàìè îêñèãåìîãëîá³íó, òàê ³ ìîëåêóëàìè

âîäè, ùî çàáåçïå÷óº çíà÷íèé êîåô³ö³ºíò ñóìàðíîãî ïî-

ãëèíàííÿ åíåðã³¿ òêàíèíàìè [8]. Ä³ÿ ëàçåðíîãî âèïðîì³-

íþâàííÿ íà á³îëîã³÷í³ òêàíèíè çóìîâëåíà òðàíñôîðìà-

ö³ºþ ñâ³òëîâî¿ åíåðã³¿ ëàçåðíîãî ïðîìåíÿ â òåïëîâó

åíåðã³þ, íàñë³äêîì ÷îãî º âàïîðèçàö³ÿ òêàíèíè ³ êîàãóëÿ-

ö³ÿ ï³äëÿãàþ÷èõ øàð³â.

Â êë³í³÷íèõ äîñë³äæåííÿõ ï³ñëÿ çàñòîñóâàííÿ ëàçåðà

Dornier Medilas D UroBeam çà äîïîìîãîþ ÌÐÒ áóëà âèç-

ÓÄÊ: 616.65 – 006.03- 089.2: 616 – 031.8

ÌÎÐÔÎËÎÃ²×ÍÀ ÎÖ²ÍÊÀ Ä²¯ ËÀÇÅÐÀ DORNIER

MEDILAS D UROBEAM 940 ÍÌ ÍÀ ÒÊÀÍÈÍÓ

ÏÅÐÅÄÌ²ÕÓÐÎÂÎ¯ ÇÀËÎÇÈ

Òðà÷óê Ð.Ñ., Äÿ÷óê Ì.Ä., Æóðàâ÷àê À.Ç.

Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ì. Î.Î. Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

ÄÍÓ “Íàóêîâî-ïðàêòè÷íèé öåíòð ïðîô³ëàêòè÷íî¿ ³ êë³í³÷íî¿ ìåäèöèíè” ÄÓÑ, ì. Êè¿â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: ìîðôîëîã³÷íå äîñë³äæåííÿ, òêàíèíà ïðîñòàòè, ëàçåð Dornier Medilas D UroBeam,

êîàãóëÿö³éíèé íåêðîç.

íà÷åíà òîâùèíà øàðó êîàãóëÿö³¿ íàâêîëî çîíè âàïîðè-

çàö³¿, ÿêà âïðîäîâæ òèæíÿ ï³ñëÿ ë³êóâàííÿ ñòàíîâèëà 12-15

ìì. Ðàçîì ç òèì, ó 2007 ðîö³, ùå äî âïðîâàäæåííÿ àïàðàòà

Dornier Medilas D UroBeam ó êë³í³÷íó ïðàêòèêó, áóëî ïðî-

âåäåíî äîñë³äæåííÿ ïðîñòàò ñîáàê, äå òàêîæ âèì³ðÿëè

òîâùèíó øàðó êîàãóëÿö³¿ òêàíèíè. Áóëî âñòàíîâëåíî, ùî

öÿ òîâùèíà ïðè çá³ëüøåíí³ ïîòóæíîñò³ ä³¿ ëàçåðà çìåíøó-

âàëàñü. Ïðè ïîòóæíîñò³ 200Âò ïðè ïîñò³éíîìó ðåæèì³

ãëèáèíà êîàãóëÿö³¿ ñêëàëà 4 ìì [3]. Ð³çíèöþ ì³æ âåëè÷èíà-

ìè òîâùèíè øàðó êîàãóëÿö³¿ â êë³í³÷íèõ ³ åêñïåðèìåí-

òàëüíèõ äîñë³äæåííÿõ ìîæíà ïîÿñíèòè ìàëèìè ðîçì³ðàìè

îá’ºìó ïðîñòàòè åêñïåðèìåíòàëüíèõ òâàðèí ó ïîð³âíÿíí³

ç ïðîñòàòîþ ëþäèíè; ð³çíîþ ñòðóêòóðîþ çäîðîâî¿ òêàíè-

íè ïðîñòàòè ñîáàê ³ àäåíîìàòîçíî çì³íåíîþ ïåðåäì³õó-

ðîâîþ çàëîçîþ ÷îëîâ³ê³â; âèì³ðþâàííÿ òîâùèíè çîíè

êîàãóëÿö³¿ ó ñîáàê ïðîâîäèëîñü îäðàçó æ ï³ñëÿ âòðó÷àííÿ,

à ó ïðîîïåðîâàíèõ ïàö³ºíò³â âèì³ðþâàííÿ ïðîâîäèëèñü

ïðîòÿãîì òèæíÿ, êîëè â òêàíèíàõ ìîãëà ïðîõîäèòè óïî-

â³ëüíåíà ðåàêö³ÿ íà ä³þ âèñîêî¿ òåìïåðàòóðè ëàçåðíîãî

âèïðîì³íþâàííÿ.

Òîâùèíà øàðó êîàãóëÿö³¿ âàæëèâà ïðè ïîäàëüøîìó

óòâîðåíí³ ñòðóïà ³ â³äõîäæåíí³ éîãî ÷åðåç óðåòðó. Ïðè

óòâîðåíí³ òîâñòîãî øàðó êîàãóëÿö³éíîãî íåêðîçà òêàíèí

ïðè âàïîðèçàö³¿, ìàñèâíèé ñòðóï, ùî óòâîðþºòüñÿ íà

ì³ñö³ íåêðîçà ïðè â³äòîðãíåíí³ ìîæå ñïðè÷èíÿòè îáòóðà-

ö³þ óðåòðè ³ íåîáõ³äí³ñòü ïîâòîðíîãî âòðó÷àííÿ [2]. Äî-

çóâàííÿ ëàçåðíîãî âèïðîì³íþâàííÿ íà àäåíîìàòîçí³ òêà-

íèíè ïðè äîòðèìàíí³ ìåòîäèêè âòðó÷àííÿ ïîâèííî

ïðèçâîäèòè äî ìàêñèìàëüíî¿ âàïîðèçàö³¿ ³ ì³í³ìàëüíî¿

òîâùèíè êîàãóëÿö³éíîãî øàðó, ùî â ïîäàëüøîìó çàáåç-

ïå÷óº íåïîì³òíå äëÿ ïàö³ºíòà â³äòîðãíåííÿ ñòðóïà

äð³áíèìè ôðàãìåíòàìè.

Ïðè âåëèêîìó îá’ºì³ àäåíîìàòîçíî çì³íåíî¿ ïåðåä-

ì³õóðîâî¿ çàëîçè äîö³ëüíî âèêîðèñòîâóâàòè êîìá³íàö³þ

äâîõ ìåòîä³â – ëàçåðíî¿ âàïîðèçàö³¿ ³ òðàíñóðåòðàëüíî¿

ðåçåêö³¿ (ÒÓÐ), êîëè ïî÷èíàþòü îïåðàö³þ ç ëàçåðíî¿ âàïî-

ðèçàö³¿, à ïîò³ì çà äîïîìîãîþ ðåçåêòîñêîïà øâèäêî ³ áåç-

êðîâíî âèäàëÿþòü ìàñèâ êîàãóëüîâàíî¿ àäåíîìàòîçíî¿

òêàíèíè ó ê³ëüêà åòàï³â, â çàëåæíîñò³ â³ä îá’ºìó ïðîñòàòè.

Òàêà ìåòîäèêà äàº ìîæëèâ³ñòü äîñë³äèòè ã³ñòîëîã³÷íî âè-

äàëåí³ òêàíèíè ïðîñòàòè ç îö³íêîþ ðîçì³ð³â çîíè êîàãó-

ëÿö³¿ ï³ñëÿ âàïîðèçàö³¿ [1].

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

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Ìåòîþ íàøîãî äîñë³äæåííÿ ñòàëà îö³íêà ìîðôîëîã³÷-

íèõ çì³í òêàíèíè ïåðåäì³õóðîâî¿ çàëîçè ïðè âèêîðèñ-

òàíí³ ëàçåðà Dornier Medilas D UroBeam 940 íì ïðè ïðîâå-

äåíí³ âàïîðèçàö³¿ àäåíîìàòîçíî çì³íåíî¿ ïðîñòàòè.

Ìàòåð³àëè òà ìåòîäè. Ìàòåð³àëîì äëÿ äîñë³äæåííÿ

ñòàëà òêàíèíà ïåðåäì³õóðîâî¿ çàëîçè 15 ïàö³ºíò³â ç àäåíî-

ìàòîçíîþ ã³ïåðïëàç³ºþ, îá’ºì ïðîñòàò ÿêèõ áóâ á³ëüøèì

çà 130 ñì3, ³ ÿêèì áóëè ïðîâåäåíà êîìá³íàö³ÿ äâîõ ìåòîä³â

îïåðàòèâíîãî ë³êóâàííÿ – ëàçåðíà âàïîðèçàö³ÿ ³ ÒÓÐ. Ôðàã-

ìåíòè ïðîñòàòè äëÿ ã³ñòîëîã³÷íîãî äîñë³äæåííÿ ï³ä ÷àñ

îïåðàö³¿ áðàëè ç òðüîõ çîí ³ ìàðê³ðóâàëè îêðåìî: 1) ðåçåê-

òîâàíà íåêðîòè÷íà òêàíèíà ïðîñòàòè; 2) ðåçåêòîâàíà òêà-

íèíà ï³ä øàðîì íåêðîçó (ãëèáøèé çð³ç); 3) ðåçåêòîâàíà

òêàíèíà ïðîñòàòè. Øìàòî÷êè ïðîñòàòè, ô³êñóâàëè ó 10%

ðîç÷èí³ íåéòðàëüíîãî ôîðìàë³íó. Äàë³ ìàòåð³àë ïðîâîäè-

ëè ó ã³ñòîïðîöåñîð³ êàðóñåëüíîãî òèïó STP-120. Äëÿ çàëèâ-

êè ïàðàô³íîâèõ áëîê³â âèêîðèñòîâóâàëè ñòàíö³þ EC-350,

äëÿ ð³çêè ïàðàô³íîâèõ áëîê³â – ðîòàö³éíèé ì³êðîòîì ñåð³¿

HM – 340E, äëÿ ôàðáóâàííÿ ã³ñòîëîã³÷íèõ ïðåïàðàò³â –

àâòîìàò Robot-Stainer HMS-740. Ïðåïàðàòè çàôàðáîâóâàëè

ãåìàòîêñèë³íîì-åîçèíîì, Âèêîðèñòîâóâàëè ì³êðîñêîï

Axioskop 40 ç ôîòîêàìåðîþ Axio Cam MRc5 (Ñarl Zeiss).

Ðåçëüòàòè òà îáãîâîðåííÿ. Ôðàãìåíòè ðåçåêòîâàíî¿

ïðîñòàòè ïåðøî¿ çîí³ ïðåäñòàâëåí³ òêàíèíîþ ç

êîàãóëÿö³éíèì íåêðîçîì ó âèãëÿä³ îêðåìèõ ôðàãìåíò³â

äåñòðóêòèâíî çì³íåíî¿ ñòðîìè; çàëîçèñòèé êîìïîíåíò ³

ñóäèíè çðóéíîâàí³ (Ðèñ.1). Â îêðåìèõ âèïàäêàõ ìè

ñïîñòåð³ãàëè çîíó êîàãóëÿö³éíîãî íåêðîçà íà ìåæ³ ³ç

çáåðåæåíîþ òêàíèíîþ ïðîñòàòè (Ðèñ. 2).

Ùîäî òîâùèíè çîíè êîàãóëÿö³éíîãî íåêðîçó,òî â æîä-

íîìó âèïàäêó â³í íå çàéìàâ âñþ ïëîùó ïðèñëàíîãî øìà-

òî÷êà (ôðàãìåíòè ïåðøî¿ çîíè), òîâùèíà ÿêîãî áóëà íå

á³ëüøå 4-5ìì; ó á³ëüøîñò³ âèïàäê³â òîâùèíà íåêðîçó ñòà-

íîâèëà 1-2 ìì. Òàêà çîíà â íàøèõ âèïàäêàõ ñïîñòåð³ãàºòü-

ñÿ ï³ä âïëèâîì ëàçåðíîãî âèïðîì³íþâàííÿ ç âèêîðèñòà-

íîþ íàìè ïîòóæí³ñòþ 275 Âò, ùî ï³äòâåðäæóº äàí³ ïðî òå,

ùî ÷èì á³ëüøå ïîòóæí³ñòü âèïðîì³íþâàííÿ, òèì òîíøèé

øàð êîàãóëÿö³éíîãî íåêðîçà.

Ó ôðàãìåíòàõ ïðîñòàòè äðóãî¿ çîíè – ðåçåêòîâàí³é òêà-

íèí³ ï³ä øàðîì íåêðîçó – ñïîñòåð³ãàëè ïî êðàþ ñìóãó êîà-

ãóëÿö³éíîãî íåêðîçà ó âèãëÿä³ “ñâ³æîãî” êîàãóëÿö³éíîãî

ñòðóïó. Öÿ òîíêà ñìóãà êîàãóëÿö³éíîãî íåêðîçó óòâî-

ðþºòüñÿ âíàñë³äîê ä³¿ ïåòë³ ç åëåêòðè÷íèì ñòðóìîì, ÿêîþ

ïðîâîäèòüñÿ ðåçåêö³ÿ òêàíèíè ïðîñòàòè (ÒÓÐ) (Ðèñ. 3, 4).

Ðèñ. 2. Çîíà êîàãóëÿö³éíîãî íåêðîçà íà ìåæ³ ³ç çáåðåæåíîþ

òêàíèíîþ ïðîñòàòè. Çàá. ãåìàòîêñèë³íîì-åîçèíîì. Çá. 100.

Ðèñ. 1. Òêàíèíà ïðîñòàòè â çîí³ íåêðîçà.

Çàá. ãåìàòîêñèë³íîì-åîçèíîì. Çá. 100.

Ðèñ. 3. Ñìóãà êîàãóëÿö³éíîãî íåêðîçà.

Çàá. ãåìàòîêñèë³íîì-åîçèíîì. Çá. 100.

Ðèñ. 4. Ñìóãà êîàãóëÿö³éíîãî íåêðîçà.

Çàá. ãåìàòîêñèë³íîì-åîçèíîì. Çá. 200.

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Ðèñ. 6. Ñìóãà êîàãóëÿö³éíîãî íåêðîçà ïî êðàþ ðåçåêö³¿, ÿêèé

ïðîõîäèòü êð³çü ñóäèíó.Çàá. ãåìàòîêñèë³íîì-åîçèíîì. Çá. 100.

Îñê³ëüêè âèïðîì³íþâàííÿ ëàçåðà Dornier Medilas D

UroBeam ç äîâæèíîþ õâèë³ 940 íì ìàº óí³êàëüí³ âëàñòè-

âîñò³ ùîäî ïîãëèíàííÿ ìîëåêóëàìè îêñèãåìîãëîá³íó, âè-

ïàðîâóâàííþ ïåðø çà âñå ï³äëÿãàþòü äîáðå âàñêóëÿðèçî-

âàí³ ä³ëÿíêè, êîàãóëÿö³éíèé íåêðîç ÿêèõ çàïîá³ãàº

êðîâîâòðàò³. Íàâ³òü ïðè çáåðåæåí³é ñòðîì³ â³äáóâàºòüñÿ

êîàãóëÿö³ÿ âì³ñòó ñóäèí çà ðàõóíîê ä³¿ ëàçåðíîãî âèïðî-

ì³íåííÿ íà ãåìîãëîá³í åðèòðîöèò³â (Ðèñ. 5).

Êîàãóëÿö³éíèé íåêðîç âì³ñòó êðîâîíîñíèõ ñóäèí –

åðèòðîöèò³â çàïîá³ãàº êðîâîòå÷³, íàâ³òü êîëè êðàé ðåçåêö³¿

ïðîõîäèòü êð³çü ñóäèíó (Ðèñ. 6, 7).

Â òêàíèí³ çàëîçè ðåçåêòîâàíîãî äðóãîãî øàðó – ï³ä

çîíîþ íåêðîçó â ñóäèíàõ ð³äêî ñïîñòåð³ãàþòüñÿ íåçì³íåí³

åðèòðîöèòè, ÷àñò³øå – ñòàçè åðèòðîöèò³â (Ðèñ. 8) ³ çì³íè

åðèòðîöèò³â, ïîä³áí³ äî êîàãóëÿö³éíîãî íåêðîçó ïîâ’ÿçàí³

ç ä³ºþ ëàçåðíîãî âèïðîì³íþâàííÿ íà ãåìîãëîá³í åðèòðî-

öèò³â (Ðèñ. 9).

Â ÷àñòèí³ ñóäèí çì³íè ñïîñòåð³ãàþòüñÿ ó âèãëÿä³ çà-

ëèøêîâèõ íåêðîòèçîâàíèõ ìàñ åðèòðîöèò³â â ïðîñâ³ò³

ñóäèí, ùî çàïîá³ãàº êðîâîòå÷³ ïðè ðåçåêö³¿ òêàíèíè áåç

îçíàê êîàãóëÿö³éíîãî íåêðîçó (Ðèñ. 10).

Â òðåò³é çîí³ – ðåçåöèðîâàí³é òêàíèí³ ïðîñòàòè ìåòî-

äîì ÒÓÐ ñïîñòåð³ãàëàñü òêàíèíà ïåðåäì³õóðîâî¿ çàëîçè

ç àäåíîìàòîçíîþ ã³ïåðïëàç³ºþ.

Âèñíîâêè. Ðåçóëüòàòè ìîðôîëîã³÷íîãî äîñë³äæåííÿ

òêàíèíè ïåðåäì³õóðîâî¿ çàëîçè, îòðèìàíî¿ ï³ä ÷àñ îïå-

ðàòèâíèõ âòðó÷àíü – ëàçåðíî¿ âàïîðèçàö³¿ â ïîºäíàíí³ ç

ÒÓÐ ï³äòâåðäæóþòü åôåêòèâí³ñòü äàíèõ ìåòîä³â, ïðî ùî

ñâ³ä÷èòü çìåíøåííÿ çîíè êîàãóëÿö³éíîãî íåêðîçó ïðè

âèêîðèñòàíí³ ïîòóæíîñò³ ëàçåðíîãî âèïðîì³íþâàííÿ

275 Âò, à òàêîæ êîàãóëÿö³éíèé íåêðîç âì³ñòó ñóäèí –

åðèòðîöèò³â ó ä³ëÿíêàõ ç íåçì³íåíîþ ñòðîìîþ, ùî çàïî-

á³ãàº êðîâîòå÷³ ïðè ïðîâåäåíí³ ðåçåêö³¿ òêàíèíè ïðîñ-

òàòè ïðè ¿¿ âåëèêîìó îá’ºì³ ïðè ïîºäíàíí³ âàïîðèçàö³¿

ç ÒÓÐ.

Ïåðñïåêòèâîþ ïîäàëüøèõ äîñë³äæåíü º âèâ÷åííÿ ä³¿

³íøèõ ëàçåð³â íà òêàíèíó ïðîñòàòè äëÿ ïîøóêó îïòèìàëü-

íèõ ïîêàçíèê³â ëàçåðíîãî âèïðîì³íþâàííÿ ïðè âàïîðè-

çàö³¿ ïðîñòàòè ç àäåíîìàòîçíîþ ã³ïåðïëàç³ºþ äëÿ ï³äâè-

ùåííÿ åôåêòèâíîñò³ ë³êóâàííÿ.

Ðåöåíçåíò: ÷ëåí-êîð. ÍÀÌÍ Óêðà¿íè, ä.ìåä.í.,

ïðîôåñîð Þ.Á.×àéêîâñüêèé

Ðèñ. 5. Ñìóãà êîàãóëÿö³éíîãî íåêðîçà. Çì³íè åðèòðîöèò³â

â ñóäèíàõ. Çàá. ãåìàòîêñèë³íîì-åîçèíîì. Çá. 200.

Ðèñ. 7. Ñìóãà êîàãóëÿö³éíîãî íåêðîçà ïî êðàþ ðåçåêö³¿, ÿêèé

ïðîõîäèòü êð³çü ñóäèíó. Çàá. ãåìàòîêñèë³íîì-åîçèíîì. Çá. 200.

Ðèñ. 8. Òêàíèíà ïðîñòàòè ï³ä øàðîì íåêðîçó –

ñòàçè åðèòðîöèò³â â êðîâîíîñíèõ ñóäèíàõ.

Çàá. ãåìàòîêñèë³íîì-åîçèíîì. Çá. 100.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

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Ðèñ. 9. Òêàíèíà ïðîñòàòè ï³ä øàðîì íåêðîçó – çì³íè

åðèòðîöèò³â ïî òèïó êîàãóëÿö³éíîãî íåêðîçó â êðîâîíîñíèõ

ñóäèíàõ Çàá. ãåìàòîêñèë³íîì-åîçèíîì. Çá. 200.

Ðèñ. 10. Òêàíèíà ïðîñòàòè ï³ä øàðîì íåêðîçó – çàëèøêè

íåêðîòèçîâàíèõ åðèòðîöèò³â â êðîâîíîñíèõ ñóäèíàõ

Çàá. ãåìàòîêñèë³íîì-åîçèíîì. Çá. 200.

Ë²ÒÅÐÀÒÓÐÀ

1. Æóðàâ÷àê À.Ç., Ïàñº÷íèêîâ Ñ.Ï., Äÿ÷óê Ì.Ä. Ïàòåíò íà

êîðèñíó ìîäåëü ¹74938 “Ñïîñ³á çàáîðó ã³ñòîëîã³÷íîãî ìàòåð-

³àëó ç ïåðåäì³õóðîâî¿ çàëîçè”. 12.11.2012.

2. Êîãóò Â.Â. Ïåðâûå ðåçóëüòàòû ëå÷åíèÿ áîëüíûõ äîáðîêà-

÷åñòâåííîé ãèïåðïëàçèåé ïðåäñòàòåëüíîé æåëåçû äèîäíûì

ëàçåðîì Medilas D UroBeam â Óêðàèíå / Â.Â.Êîãóò, Á.Â.Äæóðàí /

/ Óðîëîãèÿ. – 2012. – ¹ 3. – Ñ. 34-37.

3. Instruction for Dornier Medilas D UroBeam laser 940. Wessling,

2012. 88p.

4. Al-Ansari A. Shokeir GreenLight HPS 120-W Laser Vaporization

Versus Transurethral Resection of the Prostate for Treatment of Benign

Prostatic Hyperplasia: A Randomized Clinical Trial with Midterm

Follow-up / A. Al-Ansari, N. Younes, V. P.Sampige [et al.] // European

Urology. – 2010. – Vol. 58, ¹ 3: – P. 349-355/

5. Bae W.J. Risk Factors for Failure of Early Catheter Removal

After Greenlight HPS Laser Photoselective Vaporization Prostatectomy in

Men With Benign Prostatic Hyperplasia / W.J.Bae, S. G. Ahn, J.H. Bang

[et al] // Korean Journal of Urology. – 2013. – Vol. 54, No. 1: 31.

6. Goh A.C. Photoselective Laser Vaporization Prostatectomy

Versus Transurethral Prostate Resection: A Cost Analysis / A. C. Goh ,

R.R. Gonzalez //The Journal of Urology. – 2010. – Vol. 183,¹ 4. –

P. 1469-1473.

7. Misraï V. Traitement de l’hyperplasie bénigne de prostate par

photovaporisation au laser Greenlight: analyse de la literature /

V. Misraï, M. Rouprêt, J. Guillotreau [et al.]// Progrès en Urologie. –

2013. – Vol. 23, ¹ 2: – P.77-87.

8. Ruszat R. GreenLight Laser Vaporization of the Prostate: Single-

Center Experience and Long-Term Results After 500 Procedures /

R. Ruszat, M.Seitz, S.F. Wyler [et al.] // European Urology. – 2008. –

Vol. 54, ¹ 4. – P. 893-901.

19. Zhang X. Photoselective Vaporization Versus Transurethral

Resection of the Prostate for Benign Prostatic Hyperplasia: A Meta-

Analysis/ X. Zhang, J. Geng, J.Zheng [et al.] //Journal of Endourology.-

2012. – Vol. 26, ¹ 9: – P.1109-1117.

ÌÎÐÔÎËÎÃÈ×ÅÑÊÀß ÎÖÅÍÊÀ ÄÅÉÑÒÂÈß

ËÀÇÅÐÀ DORNIER MEDILAS D UROBEAM 940 ÍÌ

ÍÀ ÒÊÀÍÜ ÏÐÅÄÑÒÀÒÅËÜÍÎÉ ÆÅËÅÇÛ

Òðà÷óê Ð. Ñ., Äÿ÷óê Ì.Ä., Æóðàâ÷àê À.Ç.

Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò

èìåíè À.À. Áîãîìîëüöà, Êèåâ, Óêðàèíà

ÃÍÓ “Íàó÷íî- ïðàêòè÷åñêèé öåíòð

ïðîôèëàêòè÷åñêîé è êëèíè÷åñêîé ìåäèöèíû” ÃÓÄ,

Êèåâ, Óêðàèíà

Ðåçþìå. Ïðåäñòàâëåíû ðåçóëüòàòû ìîðôîëîãè÷åñ-

êîãî èññëåäîâàíèÿ òêàíåé ïðîñòàòû, ïîëó÷åííûõ ïðè èñ-

ïîëüçîâàíèè êîìáèíàöèè äâóõ ìåòîäîâ – âàïîðèçàöèè

ëàçåðîì Dornier Medilas D UroBeam è òðàíñóðåòðàëü-

íîé ðåçåêöèè ïðîñòàòû ó ïàöèåíòîâ ñ äîáðîêà÷åñòâåí-

íîé ãèïåðïëàçèåé ïðåäñòàòåëüíîé æåëåçû. Óñòàíîâëå-

íî, ÷òî ïîñëåäîâàòåëüíîå èñïîëüçîâàíèå âàïîðèçàöèè

ëàçåðîì Dornier Medilas D UroBeam ïðè ìîùíîñòè 175-

250 Âò è òðàíñóðåòðàëüíîé ðåçåêöèè îáåñïå÷èâàåò

óìåíüøåíèå çîíû êîàãóëÿöèîííîãî íåêðîçà , ÷òî ïðå-

ïÿòñòâóåò îáðàçîâàíèþ ìàñèâíîãî ñòðóïà, à ôîòîñåëåê-

òèâíîñòü ëàçåðíîãî èçëó÷åíèÿ ê ãåìîãëîá³íó âûçûâàåò

êîàãóëÿöèîííûé íåêðîç ñîäåðæèìîãî ñîñóäîâ â î÷àãàõ ñ

íåèçìåíåííîé ñòðîìîé, ÷òî ïðåïÿòñòâóåò êðîâîòå÷åíèþ.

Êëþ÷åâûå ñëîâà: ìîðôîëîãè÷åñêîå èññëåäîâàíèå,

òêàíü ïðîñòàòû, ëàçåð Dornier Medilas D UroBeam, êîà-

ãóëÿöèîííûé íåêðîç.

MORPHOLOGICAL ESTIMATION OF LASER

DORNIER MEDILAS D UROBEAM INFLUENCE

FOR PROSTATE TISSUE

R. Trachuk, M. Dyachuk, A. Zhuravchak

National O.O. Bogomolets Medical University,

Kiev, Ukraine

DNU “Scientific and Practical Centre of Preventive

and Clinical Medicine” SAD, Kiev, Ukraine

Summary. The results of morphological ivestigation of

prostate tissue after vaporization prostatectomy by Laser

Dornier Medilas D UroBeam and transurethral prostate

resection in patients with benigh prostatic hyperplasia is

shown. We found that the successive use of laser Dornier

Medilas D Urobeam at power 175-250 W and transurethral

resectionof prostate provides diminishing of area of

coagulative necrosis which prevents formation of massive

scab. At the same time the photoselective to haemoglobin

as a result of vaporization draws coagulative necrosis of

content of vessels in areas with unchanged stroma and

prevents bleeding.

Key words: morphological research, prostate tissue,

Dornier Medilas D UroBeam laser, coagulative necrosis.

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Çà äàíèìè Âñåñâ³òíüî¿ îðãàí³çàö³¿ îõîðîíè çäîðîâ’ÿ

(ÂÎÎÇ) íà ñüîãîäí³øí³é äåíü 347 ì³ëüéîí³â ëþäåé ó âñüî-

ìó ñâ³ò³ õâîð³ íà öóêðîâèé ä³àáåò (ÖÄ), à äî 2030 ðîêó

ä³àáåò ñòàíå ñüîìîþ çà çíà÷èì³ñòþ ïðè÷èíîþ ñìåðò³

[1,2]. Çà äàíèìè åêñïåðò³â ÂÎÎÇ á³ëüøå 80% âèïàäê³â

ñìåðòåé ñåðåä õâîðèõ íà ÖÄ âèíèêàþòü âíàñë³äîê ñóäèí-

íèõ óñêëàäíåíü. Îäíèì ç íàéá³ëüø ÷àñòèõ, òÿæêèõ òà ïðîã-

íîñòè÷íî íåñïðèÿòëèâèõ óñêëàäíåíü ÖÄ º ä³àáåòè÷íà

íåôðîïàò³ÿ (ÄÍ). Ó áàãàòüîõ êðà¿íàõ ÄÍ íàéá³ëüø ïîøè-

ðåíà ïðè÷èíà òåðì³íàëüíî¿ ñòàä³¿ õðîí³÷íî¿ íèðêîâî¿ íå-

äîñòàòíîñò³ (ÕÍÍ) [3,4]. Êîæåí òðåò³é õâîðèé íà ÖÄ 1-ãî

òèïó òà êîæåí ÷åòâåðòèé õâîðèé ÖÄ 2-ãî òèïó ïîìèðàº â³ä

òåðì³íàëüíî¿ ñòàä³¿ ÕÍÍ (InternationalDiabetesFederation,

2007). Î÷³êóºòüñÿ, ùî äî 2020 ðîêó ÷èñëî õâîðèõ ç òåðì³-

íàëüíîþ íèðêîâîþ íåäîñòàòí³ñòþ âíàñë³äîê ÄÍ ïîä-

âî¿òüñÿ.

Îñíîâíèì ìîðôîëîã³÷íèì ñóáñòðàòîì äëÿ ôîðìó-

âàííÿ ñóäèííèõ óñêëàäíåíü ÖÄ íà òêàíèííîìó ð³âí³ º

ñïîëó÷íà òêàíèíà. Íåçâàæàþ÷è íà ³íòåíñèâí³ äîñë³äæåí-

íÿ, áàãàòî àñïåêò³â ôîðìóâàííÿ ÄÍ, îñîáëèâî ¿¿ äîïðîòå³-

íóðåòè÷íèõ ñòàä³é, íåäîñòàòíüî âèâ÷åí³. Ðàííº âèÿâëåííÿ

ïîðóøåíü ìåòàáîë³çìó ñïîëó÷íî¿ òêàíèíè ìîæå ñêëàñòè

îñíîâó ïðîô³ëàêòèêè ïðîãðåñóâàííÿ ÄÍ ó íàïðÿìêó

ÕÍÍ ó ïàö³ºíò³â õâîðèõ íà ÖÄ. À òàêîæ äîçâîëèòü âèçíà-

÷èòè ïðîãíîñòè÷íå çíà÷åííÿ ïîêàçíèê³â îáì³íó êîëàãåíó

ó õâîðèõ íà ÖÄ, ¿õ çâ’ÿçîê ç ìåòàáîë³÷íèìè ïîðóøåííÿìè

òà ðèçèê ðîçâèòêó ñóäèííèõ óñêëàäíåíü.

Ìåòà ðîáîòè: âèâ÷èòèîñîáëèâîñò³ îáì³íó ñïîëó÷íî¿

òêàíèíè ó ä³òåé, ùîñòðàæäàþòü íà ÖÄ 1-ãî òèïó.

Îá’ºêò ³ ìåòîäè äîñë³äæåííÿ.Îáñòåæåíî 67 ä³òåé (34

õëîï÷èêè ³ 33 ä³â÷èíêè), õâîðèõ íà ÖÄ 1-ãî òèïó â³êîì â³ä 6

äî 17 ðîê³â. Çàëåæíî â³ä òðèâàëîñò³ çàõâîðþâàííÿ, ïàö³ºí-

òè áóëè ðîçä³ëåí³ íà ãðóïè: 1-à ãðóïà (n=12, ñåðåäí³é â³ê

14,64 ± 1,63 ðîê³â) ç òðèâàë³ñòþ çàõâîðþâàííÿ äî 1 ðîêó, 2-

à ãðóïà (n=25, ñåðåäí³é â³ê 12,09 ± 0,93 ðîê³â) ç òðèâàë³ñòþ

çàõâîðþâàííÿ â³ä 1 äî 5 ðîê³â, 3-ÿ ãðóïà (n=14, ñåðåäí³é â³ê

13,21 ± 0,89 ðîê³â) ç òðèâàë³ñòþ ÖÄ ïîíàä 5 ðîê³â ³ íîðìî-

àëüáóì³íóð³ºþ, 4-à ãðóïà (n=15, ñåðåäí³é â³ê 15,46 ± 0,57

ðîê³â) ç òðèâàë³ñòþ çàõâîðþâàííÿ á³ëüøå 5 ðîê³â òà ÄÍ â

ñòàä³¿ ì³êðîàëüáóì³íóð³¿ (ÌÀÓ). Äî ãðóïè êîíòðîëþ

âêëþ÷åí³ 20 ïðàêòè÷íî çäîðîâèõ ä³òåé àíàëîã³÷íîãî â³êó,

ÿê³ íå ìàëè ñêàðã, êë³í³÷íèõ îçíàê, àíàìíåñòè÷íèõ äàíèõ,

ÿê³ á ñâ³ä÷èëè ïðî íàÿâí³ñòü ÿêîãî-íåáóäü õðîí³÷íîãî çàõ-

âîðþâàííÿ òà ïðîòÿãîì îñòàíí³õ äâîõ ì³ñÿö³â ãîñòðèõ.

Ïàö³ºíòè áóëè îáñòåæåí³ çã³äíî ç ïðîòîêîëàìè ä³àãíî-

ñòèêè òà ë³êóâàííÿ ä³òåé, õâîðèõ íà ÖÄ [5]. Âèçíà÷åííÿ

ÓÄÊ 616.61:616.379-008.64]-053.5-018.2-008.9-074

ÎÑÎÁËÈÂÎÑÒ² ÌÅÒÀÁÎË²ÇÌÓ ÑÏÎËÓ×ÍÎ¯ ÒÊÀÍÈÍÈ

Ó Ä²ÒÅÉ Ç Ä²ÀÁÅÒÈ×ÍÎ¯ ÍÅÔÐÎÏÀÒ²ªÞ

Öèìáàë Â.Ì.

Õàðê³âñüêèé íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò, ì. Õàðê³â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: ñïîëó÷íà òêàíèíà, öóêðîâèé ä³àáåò, ä³àáåòè÷íà íåôðîïàò³ÿ, ä³òè.

ð³âíÿ ÌÀÓ â äîáîâ³é ñå÷³ ïðîâîäèëè øëÿõîì îñàäó ïîë³å-

òèëåíãë³êîëþ êîìïëåêñîì “àíòèãåí-àíòèò³ëî” ìåòîäîì

ê³íöåâî¿ òî÷êè çà äîïîìîãîþ ñòàíäàðòíîãî íàáîðó âè-

ðîáíèöòâà I.S.E.S.r.l. (²òàë³ÿ). Âèçíà÷åííÿ øâèäêîñò³ êëó-

áî÷êîâî¿ ô³ëüòðàö³¿ (ØÊÔ) – ïðîâîäèëè ðîçðàõóíêîâèì

øëÿõîì çà ôîðìóëîþ Øâàðöà. Äîäàòêîâî âèçíà÷àëè

âì³ñò ãë³êîçàì³íîãë³êàí³â (ÃÀÃ), îêñèïðîë³íó (ÎÏ), â³òàì³-

íó Ñ, êîëàãåíàçè òàêîëàãåíîë³òè÷íó àêòèâí³ñòü (ÊËÀ) ó

ñå÷³. Âèçíà÷åííÿ ÊËÀ ïðîâîäèëè çà ñóìàðíîþ ê³ëüê³ñòþ

(ïðè ôåðìåíòàòèâíîìó ã³äðîë³ç³) â³ëüíîãî òà ïåïòèäíî-

çâ’ÿçàíîãî îêñèïðîë³íó â ïðîá³, ùî ä³àãíîñòóºòüñÿ; ÃÀÃ –

çà ìåòîäîì Gold (1981) ó ìîäèô³êàö³¿ (Ïàóëü, 1995) âèçíà-

÷àëè â ñèðîâàòö³ êðîâ³ ç âèêîðèñòàííÿì òðèõëîðîöòîâî¿

êèñëîòè ³ â³äîìî¿ êàðáàçîëüíî¿ ðåàêö³¿, ÿêà çàáåçïå÷óº

ô³îëåòîâî-ðîæåâå çàáàðâëåííÿ. Ôîòîìåòðóâàííÿ äîñë³ä-

æóâàíèõ çðàçê³â ïðîá çä³éñíþâàëè ïðè äîâæèí³ õâèë³

530íì. Â³òàì³í Ñ âèçíà÷àëè çà á³îõ³ì³÷íèì ìåòîäîì, ÿêèé

çàñíîâàíèé íà ñïðîìîæíîñò³ â³òàì³íó Ñ â³äíîâëþâàòè

2,6-äèõëîðôåíîë³íäîôåíîë. Ñòàòèñòè÷íèé àíàë³ç äàíèõ

ïðîâîäèëè çà äîïîìîãîþ ñòàòèñòè÷íèõ ïàêåò³â “Excell for

Windows” òà “Statistica 7.0. for Windows”. Â ÿêîñò³

õàðàêòåðèñòèêè ãðóïè äëÿ îçíàê ç ðîçïîä³ëîì â³äïîâ³ä-

íèì äî çàêîíó Ãàóññà âèçíà÷àëè ñåðåäíº àðèôìåòè÷íå

çíà÷åííÿ ( ), éîãî ñòàòèñòè÷íó ïîõèáêó (S), ñòàíäàðòíå

â³äõèëåííÿ (S).Äëÿ âèá³ðîê ç ðîçïîä³ëîì â³äì³ííèì â³ä

íîðìàëüíîãî âèçíà÷àëè ìåä³àíó (Me) òà ³íòåðêâàðòèëü-

íèé ðîçìàõ (Lq – íèæí³é êâàðòèëü; Uq – âåðõí³é

êâàðòèëü). Äëÿ ïîð³âíÿííÿ äâîõ âèá³ðîê âèêîðèñòîâóâàëè

íåïàðàìåòðè÷íèé U-êðèòåð³é Ìàííà-Ó³òí³ (MW).

Ð³çíèöþ ïàðàìåòð³â, ùî ïîð³âíþâàëè çà äâîìà òî÷êàìè,

ââàæàëè ñòàòèñòè÷íî çíà÷óùîþ ïðè ð < 0,05. Ïðè

ïîð³âíÿíí³ ïîêàçíèê³â, ÿê³ õàðàêòåðèçóâàëèñÿ ïîð³âíÿí-

íÿì á³ëüøå 2 òî÷îê, âèêîðèñòîâóâàëè Í êðèòåð³é

äèñïåðñ³éíîãî àíàë³çó Êðàñêëà-Óîëë³ñà (KW), à

â³äì³ííîñò³ ââàæàëè â³ðîã³äíèìè ç óðàõóâàííÿì ïîïðàâ-

êè Áîíôåððîí³ (ïðè ïîð³âíÿíí³ äåê³ëüêî¿ ãðóï ³ç çàãàëü-

íèì êîíòðîëåì p’=p/m-1, äå m – ê³ëüê³ñòü ãðóï â åêñïåðè-

ìåíò³). Îö³íêó çâ’ÿçêó ì³æ ðÿäàìè ïîêàçíèê³â âèçíà÷àëè

çà äîïîìîãîþ ìåòîäó ðàíãîâî¿ êîðåëÿö³¿ Ñï³ðìàíà (r).

Ðåçóëüòàòè òà ¿õ îáãîâîðåííÿ. Ó ä³òåé âñ³õ ãðóï âñòà-

íîâëåíî íàÿâí³ñòü òðèâàëî¿ ã³ïåðãë³êåì³¿, ùî ï³äòâåðäæóº

âèñîêèé ð³âåíü ãë³êîçèëüîâàíîãî ãåìîãëîá³íó (HbA1c),

áåç ãðóïîâèõ â³äì³ííîñòåé (âñ³ ð<0,05) (òàáë. 1).

Ó 20% ïàö³ºíò³â 1-¿ ãðóïè (ØÊÔ – 136±3,9 ìë/õâ) òà 32%

õâîðèõ 2-¿ ãðóïè (ØÊÔ – 143±4,75 ìë/õâ), ñïîñòåð³ãàëàñÿ

òåíäåíö³ÿ äî ã³ïåðô³ëüòðàö³¿. Ó 30% ïàö³ºíò³â 3-¿ ãðóïè òà

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

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40% õâîðèõ 4-¿ ãðóïè çàô³êñîâàíî çíèæåííÿ ØÊÔ (88±

3,4 ìë/õâ òà 85±4,8 ìë/õâ â³äïîâ³äíî). Ùî âî÷åâèäü, ïîâ’ÿ-

çàíî ç âèñíàæåííÿì ô³ç³îëîã³÷íèõ êîìïåíñàòîðíèõ

ìåõàí³çì³â òà ïðîãðåñóâàííÿì ÄÍ.

Ðåçóëüòàòè ñòàòèñòè÷íîãî àíàë³çó ïîêàçíèê³â îáì³íó

ñïîëó÷íî¿ òêàíèíè â ñå÷³ ó ä³òåé õâîðèõ íà ÖÄ 1-ãî òèïó

ïðåäñòàâëåí³ â òàáë. 2.

Ï³ñëÿ ïðîâåäåíîãî ìíîæèííîãî ïîð³âíÿííÿ ñòàòèñ-

òè÷íèõ õàðàêòåðèñòèê ïîêàçíèê³â îáì³íó ñïîëó÷íî¿ òêà-

íèíè â³äçíà÷èìî, ùî êðèòåð³é Êðàñêëà-Óîë³ññà (H) çà

âñ³ìà ïàðàìåòðàìè âèñîêî çíà÷óùèé (òàáë. 3). Öå äàº ïðà-

âî ñòâåðäæóâàòè, ùî ñòàòèñòè÷í³ õàðàêòåðèñòèêè â³äïîâ³ä-

íèõ ïîêàçíèê³â ð³çíèõ ãðóï çíà÷óùå â³äð³çíÿþòüñÿ ì³æ

ñîáîþ, à ð³âåíü ëàáîðàòîðíèõ ïîêàçíèê³â, ÿê³ äîñë³äæóâà-

ëèñÿ, çàëåæèòü â³ä ïðèíàëåæíîñò³ ïàö³ºíòà äî ò³º¿ ÷è ³íøî¿

ãðóïè.

Äîñë³äæåííÿ âì³ñòó îêñèïðîë³íó â ñå÷³ âèçíà÷èëî ñòà-

òèñòè÷íî çíà÷óùå ï³äâèùåííÿ éîãî ð³âíÿ, â ïîð³âíÿíí³ ç

êîíòðîëåì, ó ä³òåé âñ³õ ãðóï (â³äïîâ³äíî pk-1= 0,0028,

pk-2= 0,0000, pk-3 = 0,0000, pk-4=0,0000). Ïðè ïîïàðíîìó

ïîð³âíÿíí³ âèçíà÷åí³ äîñòîâ³ðí³ â³äì³ííîñò³ ì³æ â³äïîâ³ä-

íèìè ïîêàçíèêàìè ä³òåé âñ³õ ãðóï (äèâ. òàáë.3). Ïðè äîñë³-

äæåíí³ ð³âíÿ êîëàãåíàçè âèçíà÷åíî ñòàòèñòè÷íî çíà÷óùå

ï³äâèùåííÿ öüîãî ïîêàçíèêà ó õâîðèõ âñ³õ ãðóï â ïî-

ð³âíÿíí³ ç ãðóïîþ êîíòðîëþ (â³äïîâ³äíî pk-1= 0,0000,

pk-2=0,0000, pk-3 = 0,0000, pk-4=0,0000). Ïðè ïîïàðíîìó

ïîð³âíÿíí³ âèçíà÷åí³ äîñòîâ³ðí³ â³äì³ííîñò³ ì³æ â³äïîâ³ä-

íèìè ïîêàçíèêàìè ä³òåé âñ³õ ãðóï (äèâ. òàáë. 3). Ð³âí³ ÊËÀ

â ïîð³âíÿíí³ ç êîíòðîëåì, ó ïàö³ºíò³â âñ³õ ãðóï áóëè äîñòî-

â³ðíî âèùå (â³äïîâ³äíî pk-1= 0,0000, pk-2= 0,0000, pk-3 =

=0,0000, pk-4=0,0000). Ïðè ïîïàðíîìó ïîð³âíÿíí³ âèçíà-

÷åí³ äîñòîâ³ðí³ â³äì³ííîñò³ ì³æ â³äïîâ³äíèìè ïîêàçíè-

êàìè ä³òåé âñ³õ ãðóï (äèâ. òàáë. 3 ).

Ïðè äîñë³äæåíí³ ð³âí³â ÃÀÃ âèçíà÷åíî ñòàòèñòè÷íî

çíà÷óùå ï³äâèùåííÿ ð³âíÿ öüîãî ïîêàçíèêà ó ïàö³ºíò³â 2-¿

òà 4 -¿ ãðóï, ó ïîð³âíÿíí³ ç ãðóïîþ êîíòðîëþ (â³äïîâ³äíî

pk-2=0,0000,pk-4=0,0000). Ïîêàçíèê ÃÀÃ äîñòîâ³ðíî íå

â³äð³çíÿâñÿ ó ä³òåé 1-¿ òà 3-¿ ãðóïè â ïîð³âíÿíí³ ç êîíòðîëåì

(â³äïîâ³äíî pk-1=0,135 òà pk-3=0,318). Ïðè ïîïàðíîìó ïî-

ð³âíÿíí³ âèçíà÷åí³ äîñòîâ³ðí³ â³äì³ííîñò³ ì³æ â³äïîâ³äíè-

ìè ïîêàçíèêàìè ä³òåé âñ³õ ãðóï (äèâ. òàáë. 3). Ð³âí³ â³òàì³-

íó Ñ â ñå÷³, â ïîð³âíÿíí³ ç êîíòðîëåì, ó ïàö³ºíò³â âñ³õ ãðóï

áóëè äîñòîâ³ðíî íèæ÷å (â³äïîâ³äíî pk-1=0,0000,

pk-2=0,0000, pk-3=0,0000, pk-4=0,0000). Ïðè ïîïàðíîìó

ïîð³âíÿíí³ âèçíà÷åí³ â³äì³ííîñò³ (â³äïîâ³äíî p1-2=0,0000,

p1-3=0,0002, p1-4=0,0000, p2-3=0,0000, p3-4=0,0000). Ïîêàç-

íèê â³òàì³íó Ñ äîñòîâ³ðíî íå â³äð³çíÿâñÿ ó ïàö³ºíò³â 2-¿ òà

4-¿ ãðóï (p2-4=0,135).

Îáãîâîðåííÿ. Ïðîâåäåíå äîñë³äæåííÿ ïîêàçàëî, ùî

ðîçâèòîêä³àáåòè÷íî¿íåôðîïàò³¿õàðàêòåðèçóºòüñÿ ÿê³ñíè-

ìèòà ê³ëüê³ñíèìè çì³íàìè ñêëàäó êîëàãåíó íèðîê, ïîðó-

øåííÿì ð³âíîâàãè ì³æ ñèíòåçîì òà ðîçïàäîì êîëàãåíó,

ñêëàäíèìè ïîðóøåííÿìè îáì³íó ñóëüôàòîâàíèõ ãë³êî-

çàì³íîãë³êàí³â.Çàô³êñîâàíå ï³äâèùåííÿ ÊËÀ ñå÷³ â õâîðèõ

Òàáëèöÿ 1.

Ñòàòèñòè÷í³ õàðàêòåðèñòèêè äåÿêèõ ïîêàçíèê³â ïåðåá³ãó ÖÄ

Òàáëèöÿ 2.

Ñòàòèñòè÷í³ õàðàêòåðèñòèêè ïîêàçíèê³â îáì³íó ñïîëó÷íî¿ òêàíèíè ñå÷³

ó ä³òåé õâîðèõ íà ÖÄ 1-ãî òèïó

Ïðèì³òêà. * – p<0,05 ïðè ïîð³âíÿíí³ ç ïîêàçíèêàìè ãðóïè êîíòðîëþ.

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ç ÖÄ ìîæíà ðîçãëÿäàòè ç äâîõ ïîçèö³é. Â³äîìî, ùî ñóìàðíà

ÊËÀ ñêëàäàºòüñÿ ç àêòèâíîñò³ ôåðìåíò³â ë³çîñîìàëüíîãî

é íåë³çîñîìàëüíîãî ïîõîäæåííÿ, íàñàìïåðåä ìàòðè÷íèõ

ìåòàëîïðîòå¿íàç (êîëàãåíàç, æåëàòèíàç) ³ êàòåïñèí³â [6].

Âî÷åâèäü, âèñîêèé ð³âåíü ÊËÀ â ñå÷³ çâ’ÿçàíèé ³ç ï³äâè-

ùåííÿì ÊËÀ â ñèðîâàòö³ êðîâ³, ä³ÿ ÿêî¿ ñïðÿìîâàíà íà

ïîïåðåäæåííÿ åêñïàíñ³¿ åêñòðàöåëþëÿðíîãîìàòðèêñó.

Ç ³íøîãî áîêó, ÿêùî âçÿòè äî óâàãè â³ðîã³äíå çðîñòàííÿ

ð³âí³â ÃÀÃ ó ñå÷³ õâîðèõ ìîæíà ðîçö³íèòè âèñîêèé ð³âåíü

ÊËÀ ñå÷³ ÿê âòðàòó êîëàãåíîë³òè÷íèõ ôåðìåíò³â êð³çü ïî-

øêîäæåíèé íèðêîâèé áàð’ºð. Ï³äâèùåííÿ ð³âíþ ÃÀÃ

ìîæëèâå çà óìîâ ïîñèëåííÿ êàòàáîë³çìó ïðîòåîãë³êàí³â

áàçàëüíî¿ ìåìáðàíè òà ìåçàíã³ÿ êëóáî÷ê³â [7]. Òîìó â³ðî-

ã³äíå çðîñòàííÿ åêñêðåö³¿ ÃÀÃ ó ä³òåé, õâîðèõ íà ÖÄ, ìîæ-

íà ïîÿñíèòè çá³ëüøåííÿì ïðîíèêíîñò³ íèðêîâîãî áàð’º-

ðó é çìåíøåííÿì ñòóïåíÿ éîãî ñåëåêòèâíîñò³. Òàêèì

÷èíîì, ñêèäàííÿ êîëàãåíîë³òè÷íèõ ôåðìåíò³â êð³çü ïî-

øêîäæåíèé áàð’ºð ó ñå÷ó áóäå ïðèçâîäèòè äî äåô³öèòó â

ñèðîâàòö³ êðîâ³ ôåðìåíò³â, ÿê³ ðîçùåïëþþòü êîëàãåí, ùî,

â ñâîþ ÷åðãó, áóäå ñïðèÿòè íàäì³ðí³é àêóìóëÿö³¿ åêñòðà-

öåëþëÿðíîãîìàòðèêñó, ðîçâèòêó ñêëåðîçó â íèðö³[8]. Íà

ïîñèëåííÿ ñêëåðîòè÷íèõ ïðîöåñ³â ó òóáóëÿðíîìó â³ää³ë³

íèðêè ìîæå âêàçóâàòè ï³äâèùåíèé ð³âåíü â³ëüíîãî ÎÏ.

²ìîâ³ðíî, ï³äâèùåíèé âì³ñò ö³º¿ àì³íîêèñëîòè â ñå÷³ ïî-

â’ÿçàíèé ç ïîðóøåííÿì âíóòð³øíüîêë³òèííîãî ìåòàáî-

ë³çìó â ïðîêñèìàëüíîìó â³ää³ë³ íåôðîíó, ùî ïðèçâîäèòü

äî çá³ëüøåííÿ ð³âíÿ ðåàáñîðáö³¿ îêñèïðîë³íó [6,9]. Âèç-

íà÷åíèé äåô³öèò â³òàì³íó Ñ ó ñå÷³ îáñòåæåíèõ ä³òåé ç ÖÄ

ëèøå ïîãëèáëþº ïîðóøåííÿ ìåòàáîë³çìó ñïîëó÷íî¿ òêà-

íèíè. Àñêîðá³íîâà êèñëîòà âèêîíóº ðîëü â³äíîâíèêà,

ñïðèÿþ÷è ï³äòðèìö³ çàë³çà â äâóõâàëåíòíîìó ñòàí³, ùî, â

ñâîþ ÷åðãó, º óìîâîþ äëÿ ã³äðîêñèëþâàííÿ ïðîë³íó é

ë³çèíó. Ã³äðîêñèëþâàííÿ ïðîë³íó íåîáõ³äíî äëÿ ñòâîðåí-

íÿ ñòàá³ëüíî¿ òðüîõñï³ðàëüíî¿ ñòðóêòóðè êîëàãåíó, à ë³çè-

íó – äëÿ ñòâîðåííÿ êîâàëåíòíèõ çâ’ÿçê³â ì³æ ìîëåêóëàìè

êîëàãåíó ï³ä ÷àñ ïðîäóêö³¿ êîëàãåíîâèõ ñòðóêòóð. Ïðè íå-

äîñòàòíîñò³ â³òàì³íó Ñ ñèíòåç êîëàãåíó ïîðóøóºòüñÿ íà

ñòàä³¿ ã³äðîêñèëþâàííÿ. Ó ðåçóëüòàò³ öüîãî óòâîðþþòüñÿ

ìåíø ì³öí³ é ñòàá³ëüí³ êîëàãåíîâ³ âîëîêíà, ùî ïðèçâî-

äèòü äî âåëèêî¿ êðèõêîñò³ òà ëàìêîñò³ êðîâîíîñíèõ ñóäèí

[7, 10].

Òàêèì ÷èíîì, ïðîâåäåíå äîñë³äæåííÿ ç’ÿñóâàëî, ùî â

ä³òåé ³ç ÖÄ 1-ãî òèïó ñïîñòåð³ãàþòüñÿ ãëèáîê³ ïîðóøåííÿ

Ïðèì³òêà.* – Çã³äíî ïîïðàâêè Áîíôåððîí³ äîñòîâ³ðí³ñòü â³äì³ííîñòåé ïðè ð < 0,0125.

Òàáëèöÿ 3.

Ñòàòèñòè÷í³ õàðàêòåðèñòèêè ìíîæèííîãî òà ïîïàðíîãî ïîð³âíÿííÿ ïîêàçíèê³â

îáì³íó ñïîëó÷íî¿ òêàíèíè â ñå÷³ â îáñòåæåíèõ ä³òåé ç ÄÍ

ìåòàáîë³çìó ñïîëó÷íî¿ òêàíèíè. Íàÿâí³ñòü çâ’ÿçêó ì³æ

ð³âíÿìè ïîêàçíèê³â îáì³íó ñïîëó÷íî¿ òêàíèíè òà òðèâàë-

³ñòþ ÖÄ, âèñîêèé ñòóï³íü äèñêðèì³íàö³¿ çà öèìè ïîêàçíè-

êàìè äîçâîëÿþòü ö³ ïàðàìåòðè âèêîðèñòîâóâàòè â ðîë³

òåñò³â äëÿ êë³í³÷íîãî ìîí³òîðèíãó ï³ä ÷àñ îá’ºêòèâíîãî

îö³íþâàííÿ ñòðóêòóðíî-ôóíêö³îíàëüíèõ çì³í ó íèðö³,

ïðîãíîçó ïðîãðåñóâàííÿ ÄÍ ó íàïðÿìêó ÕÍÍ, çä³éñíåí-

íÿ êîíòðîëþ çà åôåêòèâí³ñòþ ïàòîãåíåòè÷íî¿ òåðàï³¿.

Ïåðñïåêòèâè ïîäàëüøèõ äîñë³äæåíü. Óðàõîâóþ÷è,

ùî ôîðìóâàííÿ òà ïðîãðåñóâàííÿ ÄÍ â³äáóâàºòüñÿ ùå äî

ïîÿâè ÌÀÓ, ïîòðåáóº ïîäàëüøèõ äîñë³äæåíü ïîøóê

ðàíí³õ á³îìàðêåð³âòóáóëî³íòåðñòèö³éíèõ ïîøêîäæåíü òà

¿õ çâ’ÿçîê ç ïîêàçíèêàìè ìåòàáîë³çìó ñïîëó÷íî¿ òêàíèíè,

ùî äîçâîëèòü âèâ÷èòè ìåõàí³çìè ôîðìóâàííÿ òà ïðîãðå-

ñóâàííÿ ÄÍ òà îá´ðóíòóâàòè çàñîáè àäåêâàòíî¿ ðåíîïðî-

òåêö³¿.

Ðåöåíçåíò: ä.ìåä.í., ïðîôåñîð Òÿæêà Î.Â.

Ë²ÒÅÐÀÒÓÐÀ

1. ²íôîðìàö³éíèéáþëåòåíü ÂÎÎÇ N°312, âåðåñåíü 2012 ð.

2. Ñåíàòîðîâà À.Ñ. Ñàõàðíûé äèàáåò îò ðåáåíêà äî âçðîñ-

ëîãî / À.Ñ. Ñåíàòîðîâà, Þ.È. Êàðà÷åíöåâ è äð. – Ìîíîãðàôèÿ. –

Õàðüêîâ: Èçä-âî ÕÍÌÓ, 2009. – Ñ. 94-96.

3. Stevens PE, Levin A. Evaluation and management of chronic

kidney disease: synopsis of the kidney disease: improving global

outcomes 2012 clinical practice guideline / PE. Stevens, A. Levin. –

Ann Intern Med. – 2013. – V. 158. – P. 825–830.

4. John Chan. Diabetic Nephropathy / Chan John. – InTech,

Published: April 20, 2012. – P. 3-5.

5. Ïðî çàòâåðäæåííÿ ïðîòîêîë³â íàäàííÿ ìåäè÷íî¿ äîïî-

ìîãè ä³òÿì çà ñïåö³àëüí³ñòþ “Äèòÿ÷à åíäîêðèíîëîã³ÿ”: ïðî-

òîêîë íàäàííÿ ìåäè÷íî¿ äîïîìîãè ä³òÿì õâîðèì íà öóêðîâèé

ä³àáåò. Íàêàçó ÌÎÇ Óêðà¿íè ¹ 254 â³ä 27.04.2006.

6. Çàé÷èê À.Ø., ×óðèëîâ Ë.Ï. Îñíîâû îáùåé ïàòîëîãèè.

Îñíîâû ïàòîõèìèè/ À.Ø. Çàé÷èê, Ë.Ï. ×óðèëîâ. – Ñàíêò-Ïåòåð-

áóðã: Èçä-âî ÝËÁÈ – 2000. – 688 ñ.

7. Êóðíèêîâà È.À., Ìàñëîâà È.Ñ.Äèñïëàçèÿ ñîåäèíèòåëüíîé

òêàíè: ïðîãíîñòè÷åñêîå çíà÷åíèå â äèàáåòîëîãèè / È.À. Êóðíè-

êîâà, È.Ñ. Ìàñëîâà. –Ìîíîãðàôèÿ. –LAMBERTAcademicPublishing. –

2011. – 116 c.

8. Tolouian R., Hernandez G. Prediction of diabetic

nephropathy: The need for a sweet biomarker / R. Tolouian, G. Her-

nandez. –Nephropathol. – 2013. – V. 2(1). – P. 4-5.

9. Ziyadeh FN, Wolf G. Pathogenesis of the podocytopathy and

proteinuria in diabetic glomerulopathy / FN.Ziyadeh, G.Wolf. – Current

Diabetes Reviews. – 2008. – V. 4(1). – P. 39–45.

10. Kanwar Y.S., Wada J. Diabetic nephropathy: mechanisms of

renal disease progression / Y.S. Kanwar, J. Wada [et al.]. – E. Biol.

Med. (Maywood). – 2008. – V. 233(1). – P. 4–11.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

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ÎÑÎÁÅÍÍÎÑÒÈ ÌÅÒÀÁÎËÈÇÌÀ

ÑÎÅÄÈÍÈÒÅËÜÍÎÉ ÒÊÀÍÈ Ó ÄÅÒÅÉ

Ñ ÄÈÀÁÅÒÈ×ÅÑÊÎÉ ÍÅÔÐÎÏÀÒÈÅÉ

Öûìáàë Â.Í.

Õàðêîâñêèé íàöèîíàëüíûé ìåäèöèíñêèé

óíèâåðñèòåò, ã. Õàðêîâ, Óêðàèíà

Ðåçþìå.Ñ öåëüþ âûÿñíåíèÿ îñîáåííîñòåé ìåòàáî-

ëèçìà ñîåäèíèòåëüíîé òêàíè îáñëåäîâàíî 67 äåòåé

áîëüíûõ ñàõàðíûì äèàáåòîì. Îïðåäåëÿëè óðîâíè êîë-

ëàãåíîëèòè÷åñêîé àêòèâíîñòè, ãëèêîçàìèíîãëèêàíîâ, îê-

ñèïðîëèíà è âèòàìèíà Ñ â ìî÷å. Âûÿâëåíû ãëóáîêèå

íàðóøåíèÿ ìåòàáîëèçìà ñîåäèíèòåëüíîé òêàíè ó äå-

òåé âñåõ ãðóïï. Óñòàíîâëåíû ñâÿçè ìåæäó óðîâíÿìè ïî-

êàçàòåëåé îáìåíà ñîåäèíèòåëüíîé òêàíè è äëèòåëüíî-

ñòüþ çàáîëåâàíèÿ. Ïðåäëîæåíî èñïîëüçîâàòü ýòè ïà-

ðàìåòðû â êà÷åñòâå òåñòîâ êëèíè÷åñêîãî ìîíèòîðèíãà

äëÿ îáúåêòèâíîé îöåíêè ñòðóêòóðíî-ôóíêöèîíàëüíûõ

èçìåíåíèé â ïî÷êå, ïðîãíîçà ïðîãðåññèðîâàíèÿ äèàáå-

òè÷åñêîé íåôðîïàòèè.

Êëþ÷åâûå ñëîâà: ñîåäèíèòåëüíàÿ òêàíü, ñàõàðíûé

äèàáåò, äèàáåòè÷åñêàÿíåôðîïàòèÿ, äåòè.

METABOLISM FEATURES OF CONNECTIVE

TISSUE AT CHILDREN WITH DIABETIC

NEPHROPATHY

V. Tsymbal

Kharkiv National Medical University, Kharkiv, Ukraine

Summary. 67 children with diabetes mellitus type 1 were

examined for finding out of metabolism features of

connective tissue. The levels of collagenolytic activity,

glycosaminoglycans, oxyproline, vitamin C in urine were

investigated. The metabolism disorders of connective tissue

were exposed for the children of all groups. Connections

between the levels of connective tissue indexes and duration

of disease were revealed. It was proposed to use these

parameters as the clinical monitoring tests for the objective

estimation of structural and functional changes in kidney,

prognosis of diabetic nephropathy progress.

Key words: metabolism of connective tissue, diabetes

mellitus, diabetic nephropathy, children.

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Introduction.The analysis of genetic associations plays

an important role in the examination of the role of genetic

factors involved in the development of polymorphic

diseases, and chronic diffuse liver disease in particular [2, 4,

5, 9]. The difference of marker allele frequency in patients

with certain pathology and healthy individuals gives the

evidence to draw a conclusion about the link between a

particular allele and corresponding pathology [3, 6]. The

information available concerning the links of chronic diffuse

liver disease pathogenesis allows detecting the range of

genes-candidates which potential relation with this

pathology needs further investigation [6, 8].

Due to recent scientific research both of Ukrainian and

foreign scientists the concept of relations between indices

of fibrinolysis and expression of various genes is beyond

any doubt [1,7,8]. Although dependence of the above

indices upon A/C polymorphism DIO1 and Pro197Leu

GPX1gene in patients with chronic diffuse liver disease

remains above the attention of researchers.

The aim of the study. To study peculiarities of the indices

of the fibrinolysis in patients with chronic diffuse liver

diseases depending on A/C polymorphism in DIO1 and

GPX1 Pro197Leu gene.

Materials and methods. 28 patients with chronic diffuse

liver disease aged from 34 to 72 were examined. Depending

on the distribution of DIO1 gene A/C polymorphism the

patients were divided into three groups: AA-genotype

carriers – 9 patients, AC-genotype – 11, CC-genotype – 8.

Depending on GPX1 gene Pro197Leu polymorphism there

were 12 homozygotes by Pro-allele, 8 – by Leu-allele and 8

ProLeu-heterozygotes.

The diagnosis of chronic diffuse liver disease was made

on the basis of anamnesis, generally accepted complex of

ÓÄÊ 616.33/.36:616.72-007.24]-085-092

ASSOCIATION OF MARKERS OF THE SYSTEM

OF FIBRINOLYSIS OF THE BLOOD PLASMA WITH

POLYMORPHISM OF SELENOENZYMES GENES

IN PATIENTS WITH CHRONIC DIFFUSE LIVER DISEASES

Chympoy K.A., Khlopan L.I., Nemish I.L., Bobyk M.V.

Bukovinian State Medical University, Chernivtsi, Ukraine

Key words: chronic diffuse liver disease, polymorphism, fibrinolysis.

clinical-laboratory and instrumental investigation methods,

USD of the abdominal organs. Patients with chronic

hepatitis and cirrhosis of a viral etiology, Wilson-Konovalov

disease, congenital insufficiency of á-antitripsin (á-inhibitor

of proteinase), idiopathic (genetic) hemochromatosis,

autoimmune hepatitis were excluded from the study.

Alleles of A/C regions in DIO1 gene and Pro197Leu in

GPX1 gene were studied by means of excretion of genome

DNA from leukocytes of the peripheral blood with further

amplification of a polymorphic region by means of

polymerase chain reaction (PCR) on the program-

med amplificatory “Amply-4L” (“Biocom”, Moscow)

with individual temperature program for the parameters of

every gene. Table 1 presents succession of oligonucleoti-

des in primers and their calculation positions on chro-

mosomes.

DNA extraction was conducted by means of “DNA-sorb-

B” reagents, variant 100 (Russian) according to the

instruction. Purified DNA was kept under the temperature of

20±20C. Samples for PCR were prepared by means of

“AmplySense – 200 – 1” set (Russian). BcI I restriction

endonuclease produced by “SibEnzyme” firm (Russian) was

used to discriminate DIO1 gene alleles.

Total non-enzymatic and enzymatic fibrinolysis of

citrated blood plasma was estimated by asofibrinolysis

(Simko Ltd., Ukraine).

The results obtained are calculated by means of Biostat

program with the use of Student t-criterion.

Results and Discussion. The indices of fibrinolysis in

patients with chronic diffuse liver disease did not experience

reliable changes depending on polymorphism of DIO1 gene

and were statistically different from the group of practically

healthy individuals (table 2).

Table 1.

Succession of oligonucleotides in primers used for polymerase chain reaction (PCR)

to identify A/C polymorphism of DIO1 gene and Pro197Leu of GPX1 gene

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Examination of fibrinolytic blood activity showed that

total fibrinolytic activity of the blood plasma in all the group

of patients was reliably lower than that of the control indices:

CC-genotype – on 19% (P1<0,001), AC-genotype and AA-

genotype – on 22,1% and 18,4% correspondingly (P1<0,001)

without reliable intergroup difference. At the same time non-

enzymatic fibrinolytic activity in all groups of patients

increases in comparison with the control on 37,3%

(P1<0,001), 33,3% and 31,4% correspondingly (P1<0,001).

Total fibrinolytic activity index in patients with AA-

genotype was reliably lower than that of the control in 1,7

times (P1<0,001), CC-genotype – in 1,8 times (P1<0,001),

while for the patients with AC-genotype a maximal inhibition

of total fibrinolytic activity was registered – in 1,9 times

(P1<0,001).

Notes: n- numbers of obseravtions;

P1 – probability of changes concerning the control

P2 – probability of changes concerning the group of patients with ProPro-genotype

P3 – probability of changes concerning the group of patients with ProLeu-genotype

Table 2.

Indices of the fibrinolysis in patients with chronic diffuse liver disease depending

on A/C polymorphism of DIO1 gene (M±m)

Notes: n-numbers of obseravtions;

P1 – probability of changes concerning the control

P2 – probability of changes concerning the group of patients with AA-genotype

P3 – probability of changes concerning the group of patients with AC-genotype

Table 3.

Indices of the fibrinolysis in patients with chronic diffuse liver diseases depending

on Pro197Leu polymorphism of GPX1 gene (M±m)

Table 3 presents the results of examination of fibrinolysis

in patients with chronic diffuse liver disease depending on

the distribution of Pro197Leu polymorphism of GPX1 gene.

Examination of fibrinolytic blood activity showed that

total fibrinolytic activity of the blood plasma in patients of all

the groups was reliably lower than that of the control values:

in patients with ProPro-genotype – on 22,1% (P<0,001), with

ProLeu-genotype and LeuLeu-genotype – on 19,6%

(P<0,001) and 18,4% (P<0,01) respectively without reliable

difference between the groups.

Non-enzymatic fibrinolytic activity in patients of all the

groups elevated, and increasing of this index in comparison

with the control group was indicative of it: on 25,5%

(P<0,001), 35,3% (P<0,001), and 41,2% (P<0,001) in the car-

riers of ProPro-, ProLeu- and LeuLeu-genotype respectively.

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Thus, A/C polymorphism of DIO1 gene and Pro197Leu

polymorphism of GPX1 gene does not influence upon the

indices of the system of fibrinolysis in patients with chronic

diffuse liver diseases.

Reviewed by: professor S.A. Dubrov

CONCLUSIONS

1. Examination of the indices of fibrinolytic blood activity in

patients with chronic diffuse liver disease showed that total fibrinolytic

activity and enzymatic fibrinolytic activity was reliably lower than that

of the control indices at the same time non-enzymatic fibrinolytic

activity increases.

2. Pro197Leu polymorphism of GPX1 gene and A/C

polymorphism of DIO1 gene does not influence upon the indices of

the system of fibrinolysis in patients with chronic diffuse liver diseases.

The prospects of proceeding investigations will be further studies

of pathogenetic peculiarities chronic diffuse liver diseases with the

aim to find the mechanisms of their occurrence and progress and

substantiation of the improved methods to correct and prevent the

given pathology.

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ÀÑÎÖ²ÀÖ²ß ÌÀÐÊÅÐ²Â ÑÈÑÒÅÌÈ Ô²ÁÐÈÍÎË²ÇÓ

ÏËÀÇÌÈ ÊÐÎÂ² Ç² ÏÎË²ÌÎÐÔ²ÇÌÎÌ ÃÅÍ²Â

ÑÅËÅÍÎÅÍÇÈÌ²Â Ó ÕÂÎÐÈÕ ÍÀ ÕÐÎÍ²×Í²

ÄÈÔÓÇÍ² ÇÀÕÂÎÐÞÂÀÍÍß ÏÅ×²ÍÊÈ

×èìïîé Ê.À., Õëîïàí Ë.²., Íåì³ø ².Ë., Áîáèê Ì.Â.

Áóêîâèíñüêèé äåðæàâíèé ìåäè÷íèé óí³âåðñèòåò,

ì. ×åðí³âö³, Óêðà¿íà

Ðåçþìå. Äèñòðèáóö³ÿ À/Ñ ïîë³ìîðô³çìó ãåíà DIO1 ³

Pro197Leu ïîë³ìîðô³çìó ãåíà GPX1 íå âïëèâàº íà ïî-

êàçíèêè ñèñòåìè ô³áðèíîë³çó ó õâîðèõ íà õðîí³÷í³ äèôóçí³

çàõâîðþâàííÿ ïå÷³íêè.

Êëþ÷îâ³ ñëîâà: õðîí³÷í³ äèôóçí³ çàõâîðþâàííÿ

ïå÷³íêè, ïîë³ìîðô³çì ãåí³â, ô³áðèíîë³ç.

ÀÑÑÎÖÈÀÖÈß ÌÀÐÊÅÐÎÂ ÑÈÑÒÅÌÛ

ÔÈÁÐÈÍÎËÈÇÀ ÏËÀÇÌÛ ÊÐÎÂÈ

Ñ ÏÎËÈÌÎÐÔÈÇÌÎÌ ÃÅÍÎÂ ÑÅËÅÍÎÝÍÇÈÌÎÂ

Ó ÁÎËÜÍÛÕ ÕÐÎÍÈ×ÅÑÊÈÌÈ ÄÈÔÔÓÇÍÛÌÈ

ÇÀÁÎËÅÂÀÍÈßÌÈ ÏÅ×ÅÍÈ

×èìïîé Ê.À., Õëîïàí Ë.È., Íåìèø È.Ë., Áîáûê Ì.Â.

Áóêîâèíñêèé ãîñóäàðñòâåííûé ìåäèöèíñêèé

óíèâåðñèòåò, ×åðíîâöû, Óêðàèíà

Summary. Äèñòðèáóöèÿ À/Ñ ïîëèìîðôèçìà ãåíà DIO1

è Pro197Leu ïîëèìîðôèçìà ãåíà GPX1 íå âëèÿåò íà ïî-

êàçàòåëè ñèñòåìû ôèáðèíîëèçà ó áîëüíûõ õðîíè÷åñêè-

ìè äèôôóçíûå çàáîëåâàíèÿ ïå÷åíè.

Êëþ÷åâûå ñëîâà: õðîíè÷åñêèå äèôôóçíûå çàáîëå-

âàíèÿ ïå÷åíè, ïîëèìîðôèçì ãåíîâ, ôèáðèíîëèç.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

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ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

Âñòóï. Ó 60-³ ðîêè ÕÕ ñòîë³òòÿ Tîìàñ Ñòàðçë âèêîíàâ

ïåðøó ó ñâ³ò³ óñï³øíó òðàíñïëàíòàö³þ ïå÷³íêè. Â Óêðà¿í³

ïåðøà ñåð³ÿ òðóïíèõ òðàíñïëàíòàö³é ïå÷³íêè áóëà ïðîâå-

äåíà ïðîòÿãîì 1994-1998 ðîê³â íà êàôåäð³ ãîñï³òàëüíî¿

õ³ðóðã³¿ Çàïîð³çüêîãî ìåäè÷íîãî óí³âåðñèòåòó [4].

Ó íàø ÷àñ òðàíñïëàíòàö³ÿ ïå÷³íêè º íàéá³ëüø åôåê-

òèâíèì ìåòîäîì ë³êóâàííÿ ïàö³ºíò³â ÿê ç ôóëüì³íàíòíîþ

ãîñòðîþ ïå÷³íêîâîþ íåäîñòàòí³ñòþ, òàê ³ ç ³íøèìè ¿¿ çàõ-

âîðþâàííÿìè ó òåðì³íàëüí³é ñòàä³¿ [1,2]. Öå ï³äòâåðäæó-

þòü äàí³ European Liver Transplant Registry: ñìåðòí³ñòü

ïàö³ºíò³â ï³ñëÿ òðàíñïëàíòàö³¿ ïå÷³íêè ó 1-é äåíü ï³ñëÿ

îïåðàö³¿ ñêëàäàº 5%, 1-é òèæäåíü 6%, 1-é ì³ñÿöü 13%, 6

ì³ñÿö³â 20%, 1 ð³ê 9%, 5 ðîê³â 9%, ï³çí³øå 5 ðîê³â 21% [13].

Ïîêðàùåííÿ òåõí³÷íî¿ ñòîðîíè õ³ðóðã³÷íîãî âòðó÷àí-

íÿ äîçâîëÿº áåçïå÷íî âèêëþ÷èòè ïå÷³íêó ç êðîâîòîêó, à

äîñÿãíåííÿ ó ñôåð³ á³îëîã³¿ äîçâîëÿþòü ï³äòðèìóâàòè

æèòòºçäàòí³ñòü îðãàíà òðèâàëèé ÷àñ [9]. Àëå ö³ íàäáàííÿ

íàóêè âñå æ òàêè íå êîìïåíñóþòü äåô³öèò îðãàí³â äëÿ

òðàíñïëàíòàö³¿, ùî îñîáëèâî ãîñòðî â³ä÷óâàºòüñÿ â íàø³é

êðà¿í³. Öå ìîæíà ï³äòâåðäèòè òèì, ùî â Óêðà¿í³ çà 1994–

2012 ðîêè áóëî âèêîíàíî ò³ëüêè 12 òðóïíèõ òðàíñïëàí-

òàö³é ïå÷³íêè, âñ³ âîíè ïðîâåäåí³ íà êàôåäð³ ãîñï³òàëüíî¿

õ³ðóðã³¿ Çàïîð³çüêîãî ìåäè÷íîãî óí³âåðñèòåòó.

Àêòóàëüíèìè çàëèøàþòüñÿ ïèòàííÿ âèáîðó êîíñåð-

âàö³¿ òðóïíî¿ ïå÷³íêè, ë³êóâàííÿ ðåïåðôóç³éíîãî ñèäðî-

ìó òà êîðåêö³¿ ³ìóíîñóïðåñèâíî¿ òåðàï³¿ â àñïåêò³ ³øåì³÷-

íîãî ïîøêîäæåííÿ ïå÷³íêè [3,7].

Ìåòà ðîáîòè – ïðîâåñòè àíàë³ç ë³êóâàííÿ ïàö³ºíò³â ç

îðòîòîï³÷íîþ òðóïíîþ òðàíñïëàíòàö³ºþ ïå÷³íêè, äîñë³-

äèòè äèíàì³êó ëàáîðàòîðíèõ äàíèõ ó ï³ñëÿîïåðàö³éíèé

ïåð³îä ³ ¿õ âçàºìîçâ’ÿçîê ç ãîñòðèì â³äòîðãíåííÿì òðàíñ-

ïëàíòàòó.

Ìàòåð³àëè òà ìåòîäè. Íàìè áóëî ïðîàíàë³çîâàíî 6

îðòîòîï³÷íèõ òðóïíèõ òðàíñïëàíòàö³é ïå÷³íêè, ùî áóëè

âèêîíàí³ ó ïåð³îä ç 2008 ïî 2012 ðîêè. Ïðîîïåðîâàí³ ïàö³-

ºíòè â³êîì 24–58 ðîê³â, ñåðåä íèõ 3 ÷îëîâ³êà ³ 3 æ³íêè,

ñåðåäí³é â³ê 38,2±3,8 ðîê³â (òàáëèöÿ 1). Çà øêàëîþ ×àéëä-

Òîðêåò ñòóï³íü öèðîçó ïå÷³íêè ó âñ³õ ïàö³ºíò³â â³äïîâ³äàº

ñòàä³¿ “Ñ”. Ïðè÷èíè öèðîòè÷íèõ çì³í ïå÷³íêè ó äîñë³äæó-

âàíèõ õâîðèõ: õâîðîáà Êàðîë³, ñêëåðîçóþ÷èé õîëàíã³ò,

òîêñè÷íå óðàæåííÿ ïå÷³íêè, â³ðóñíèé ãåïàòèò Ñ, ïåðâèí-

íèé á³ë³àðíèé öèðîç. Ä³àãíîçè áóëè ï³äòâåðäæåí³ çà äîïî-

ìîãîþ äîîïåðàö³éíî¿ á³îïñ³¿ ïå÷³íêè. Äîíîðàìè áóëè 5

÷îëîâ³ê³â ³ 1 æ³íêà ó â³ö³ 25–40 ðîê³â â ñòàí³ ñìåðò³ ãîëîâ-

íîãî ìîçêó, ïðè÷èíîþ ÿêî¿ áóëà ÷åðåïíî-ìîçêîâà òðàâ-

ìà. Ó âñ³õ äîíîð³â çàðåºñòðîâàíî íîðìàëüí³ ïîêàçíèêè

ÒÐÓÏÍÀ ÒÐÀÍÑÏËÀÍÒÀÖ²ß ÏÅ×²ÍÊÈ Ó Ë²ÊÓÂÀÍÍ²

¯¯ ÒÅÐÌ²ÍÀËÜÍÈÕ ÇÀÕÂÎÐÞÂÀÍÜ

×óäíîâåöü À.Â.1, Êîíîâàëåíêî ².À.2

1 Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Î.Î. Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

2 Çàïîð³çüêèé äåðæàâíèé ìåäè÷íèé óí³âåðñèòåò, ì. Çàïîð³ææÿ, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: òðóïíà òðàíñïëàíòàö³ÿ ïå÷³íêè, ãîñòðå â³äòîðãíåííÿ òðàíñïëàíòàòó, ³ìóíîñóïðåñèâíà

òåðàï³ÿ.

á³ë³ðóá³íó, àì³íîòðàíñôåðàç, êðåàòèí³íó, ïðîòðîìá³íî-

âîãî ³íäåêñó. Åêñïëàíòàö³ÿ äîíîðñüêî¿ ïå÷³íêè âèêîíóâà-

ëàñü â ðàìêàõ ìóëüòèîðãàííîãî çàáîðó, òðèâàë³ñòü ÿêîãî

íå ïåðåâèùóâàëà 90 õâ. Â ÿêîñò³ êîíñåðâàíòó âèêîðèñòî-

âóâàëè êóñòàä³îë. Ïðîâîäèëàñü â³çóàëüíà îö³íêà òðàíñ-

ïëàíòàòó: ïå÷³íêà áåç ìàêðîñêîï³÷íèõ çì³í. Âèêîíóâàëàñü

á³îïñ³ÿ òðàíñïëàíòàòó äî âêëþ÷åííÿ â êðîâîòîê: ó 3-õ äîñ-

ë³äæóâàíèõ ïàö³ºíò³â ñòóï³íü ³øåì³¿ òÿæêèé, ó ³íøèõ ñå-

ðåäíüî¿ òÿæêîñò³. Òðèâàë³ñòü õîëîäîâî¿ ³øåì³¿ ó ñåðåäíüî-

ìó ñêëàäàëà 2 ãîäèíè, òåïëîâî¿ ³øåì³¿ 35 õâèëèí. Åòàï

ï³äãîòîâêè äîíîðñüêî¿ ïå÷³íêè âèêîíóâàâñÿ îäíî÷àñíî ç

ãåïàòåêòîì³ºþ ó ðåöèï³ºíòà. Ïðîâîäèëàñü ïåðôóç³ÿ äî-

íîðñüêî¿ ïå÷³íêè íà åòàï³ “back table” 10% ðîç÷èíîì àëü-

áóì³íó. Ó âñ³õ ïàö³ºíò³â âèêîíóâàëàñü òðàíñïëàíòàö³ÿ

ïå÷³íêè “êëàñè÷íîþ” ìåòîäèêîþ çà Ñòàðçë áåç âåíî-

âåíîçíîãî øóíòóâàííÿ [10]. Â³äíîâëåííÿ êðîâîâòðàòè ³

êîìïåíñàö³þ âåíîçíîãî ïîâåðíåííÿ ïðîâîäèëè ñèñòå-

ìîþ øâèäêî¿ ³íôóç³¿, âèêîðèñòîâóþ÷è äëÿ öüîãî ðîëèêî-

âèé íàñîñ àïàðàòó øòó÷íîãî êðîâîîá³ãó (ÀØÊ) ô³ðìè

“Stockert” ³ îêñèãåíàòîð. Îäí³é ïàö³ºíòö³ ç ãðóïîþ êðîâ³

À (²²) Rh- áóëà ïåðåñàäæåíà ïå÷³íêà 0 (²) Rh- [11]. Äâîì

õâîðèì áóëà òðàíñïëàíòîâàíà ïå÷³íêà â³ä îñ³á ÷îëîâ³÷î¿

ñòàò³ (çà äàíèìè ë³òåðàòóðè ëèøå öåé ôàêòîð âæå ï³äâèùóº

â³ðîã³äí³ñòü â³äòîðãíåííÿ ó 5 ðàç³â) [6]. Òàêîæ ó äîíîðà

4-ãî ïàö³ºíòà ñïîñòåð³ãàâñÿ òðèâàëèé àãîíàëüíèé ïåð³îä

(7 ä³á). Ùîäî íàñë³äê³â ó ïåðøèé ì³ñÿöü ï³ñëÿîïåðàö³éíî-

ãî ïåð³îäó, òî ó 3-õ õâîðèõ áóëî ãîñòðå â³äòîðãíåííÿ

òðàíñïëàíòàòó, 2 ç ÿêèõ íå ï³ääàâàëèñü òåðàï³¿, ãîñòðà

ïå÷³íêîâîêë³òèííà íåäîñòàòí³ñòü (íàñë³äîê ³øåì³÷íîãî

óøêîäæåííÿ òðàíñïëàíòàòó), ñòðèêòóðà ãåïàòèêîºþíî-

àíàñòîìîçó, åêñóäàòèâíèé ïëåâðèò.

Ïåðåä îïåðàö³ºþ ïàö³ºíòè îòðèìóâàëè ³íäóêö³þ ñóï-

ðåñ³¿ öèêëîñïîðèíîì, ì³êîôåíîëÿòà ìîôåòèëîì, ìîíî-

êëîíàëüíèìè àíòèò³ëàìè. Óñ³ õâîð³ ï³ñëÿ îðòîòîï³÷íî¿

òðàíñïëàíòàö³¿ ïå÷³íêè îòðèìóâàëè òðüîõêîìïîíåíòíó

³ìóíîñóïðåñèâíó òåðàï³þ, ùî ñêëàäàëàñü ç ì³êðîåìóëüñ³¿

öèêëîñïîðèíó, ì³êîôåíîëÿòà ìîôåòèëó ³ êîðòèêîñòåðî¿ä³â.

Ôóíêö³þ ïå÷³íêè îö³íþâàëè çà äàíèìè êë³í³÷íîãî òà

á³îõ³ì³÷íîãî àíàë³çó.

Ðåçóëüòàòè ïðåäñòàâëåí³ ó ðîáîò³ ïîð³âíþâàëèñü ì³æ

ñîáîþ ³ îáðîáëÿëèñü çà äîïîìîãîþ ìåòîä³â íåïàðàìåò-

ðè÷íî¿ ñòàòèñòèêè. Äëÿ îö³íêè òåðì³íàëüíèõ ñòàä³é çàõâî-

ðþâàíü ïå÷³íêè òà ðîçðàõóíêó ïðîãíîñòè÷íîãî ð³âíÿ

ñìåðòíîñò³ õâîðèõ, ÿêèì íåîáõ³äíà ïåðåñàäêà ïå÷³íêè,

âèêîðèñòîâóâàëàñü ïðîãðàìà Model for end stage disease

(MELD) [12].

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Òàáëèöÿ 1.

Õàðàêòåðèñòèêà õâîðèõ, òðèâàë³ñòü îïåðàö³¿, óñêëàäíåííÿ ó ïåðøèé ì³ñÿöü ï³ñëÿ òðàíñïëàíòàö³¿

Íàìè áóëî îáðàíî äëÿ äîñë³äæåííÿ 23 äí³ ï³ñëÿîïåðà-

ö³éíîãî ïåð³îäó, àäæå ñàìå öåé ïðîì³æîê ÷àñó äîçâîëÿº

ïîâíîö³ííî ïîð³âíÿòè äèíàì³êó ëàáîðàòîðíèõ ïîêàç-

íèê³â ó äîñë³äæóâàíèõ ïàö³ºíò³â ³ äàº ìîæëèâ³ñòü âèçíà÷è-

òè, ÿê³ ëàáîðàòîðí³ äàí³ ìîæóòü ñëóãóâàòè ïðåäèêòîðàìè

ãîñòðîãî â³äòîðãíåííÿ òðàíñïëàíòàòó òà ³íøèõ æèòòºâî

íåáåçïå÷íèõ óñêëàäíåíü.

Ðåçóëüòàòè òà îáãîâîðåííÿ. Çã³äíî ïîêàçíèê³â ì³æ-

íàðîäíîãî íîðìàë³çîâàíîãî ñï³ââ³äíîøåííÿ (ÌÍÎ),

ð³âíÿ á³ë³ðóá³íó ³ êðåàòèí³íó ó ï’ÿòè ïàö³ºíò³â 11–16

áàë³â çà øêàëîþ MELD (ùî âêàçóº íà çàäîâ³ëüíó ïðîãíî-

çîâàíó 3-ì³ñÿ÷íó âèæèâàí³ñòü ïàö³ºíò³â), ó îäíîãî – 22

áàëè, ùî º ïîãàíèì ïðîãíîñòè÷íèì ÷èííèêîì ó íàé-

áëèæ÷³ 3 ì³ñÿö³.

Îö³íêà ôóíêö³¿ äîíîðñüêî¿ ïå÷³íêè â³äáóâàºòüñÿ îäðà-

çó ï³ñëÿ ¿¿ ðåïåðôóç³¿ íà îñíîâ³ êîëüîðó òà êîíñèñòåíö³¿

ïàðåíõ³ìè îðãàíà, àëå ò³ëüêè æîâ÷îóòâîðåííÿ º ãîëîâ-

íîþ îçíàêîþ ¿¿ æèòòºçäàòíîñò³ ³ êîðåëþº ç âèæèâàííÿì

ïàö³ºíòà [5,8]. Ïðîàíàë³çóºìî æ öåé ïîêàçíèê ó äàíèõ

ïàö³ºíò³â (Ãðàô³ê 1). Ó ïåðø³ äí³ ï³ñëÿ îïåðàö³¿ ó ïàö³ºíò³â

1–4 ê³ëüê³ñòü æîâ÷³ íåçíà÷íà (25–60 ìë) ó ïîð³âíÿíí³ ç ïà-

ö³ºíòàìè 5, 6, ó ÿêèõ ¿¿ îá’ºì ñÿãàº 150–200 ìë. Ó ïàö³ºíòà

2 íà 16–17 äí³ ï³ñëÿîïåðàö³éíîãî ïåð³îäó ñïîñòåð³ãàþòü-

ñÿ íàéá³ëüø³ îá’ºìè æîâ÷³ (670–635 ìë), à ó õâîðîãî 1

ìàêñèìàëüíèé îá’ºì æîâ÷³ ñêëàäàâ 320 ìë ³ ïîò³ì ïî-

ì³ðíî çìåíøèâñÿ äî 140–130 ìë. Ùîäî õâîðîãî 3, òî êðè-

âà ñåêðåö³¿ æîâ÷³ ìàº äâîôàçíèé õàðàêòåð, àäæå íà 6–7-é

äåíü ñïîñòåð³ãàºòüñÿ ð³çêå çìåíøåííÿ ñåêðåö³¿ æîâ÷³,

òîáòî íà íàñòóïíèé äåíü ä³àãíîñòîâàíîãî ãîñòðîãî

â³äòîðãíåííÿ òðàíñïëàíòàòó. Ó ïàö³ºíò³â 5, 6 ê³ëüê³ñòü

æîâ÷³ ò³ëüêè ïîñòóïîâî çìåíøóâàëàñü.

Ùîäî çì³í çàãàëüíîãî á³ë³ðóá³íó â êðîâ³, òî ó ïàö³ºíò³â

1, 2 éîãî êîíöåíòðàö³ÿ ò³ëüêè ïîñòóïîâî çìåíøóºòüñÿ, ó

õâîðîãî 3 çà äåíü äî ãîñòðîãî â³äòîðãíåííÿ òðàíñïëàíòàòó

ê³ëüê³ñòü á³ë³ðóá³íó ïî÷àëà ï³äâèùóâàòèñü ³ äîñÿãëà ìàê-

ñèìàëüíèõ çíà÷åíü íà 7-é äåíü ï³ñëÿîïåðàö³éíîãî ïåð³î-

äó, ï³ñëÿ öüîãî éîãî ê³ëüê³ñòü ïîñòóïîâî çìåíøóâàëàñü. Ó

ïàö³ºíò³â 4 – 6 ñïîñòåð³ãàëîñü ò³ëüêè ï³äâèùåííÿ ê³ëüêîñò³

á³ë³ðóá³íó ó êðîâ³ äî 312 – 430 ìêìîëü/ë (çà ðàõóíîê ïðÿ-

ìî¿ ôðàêö³¿).

Â³äîìî, ùî ëàêòàöèäîç º ïîãàíîþ ïðîãíîñòè÷íîþ îç-

íàêîþ ó ðàíí³é ï³ñëÿîïåðàö³éíèé ïåð³îä. Ùîäî ïàö³ºíò³â

2, 4, 6, òî ó ïåðøèé äåíü ï³ñëÿ îïåðàö³¿ ó íèõ ñïîñòåð³ãàâñÿ

âèñîêèé ð³âåíü ëàêòàòó â êðîâ³ 7,3 – 13 ììîëü/ë (ãðàô³ê 2),

àëå ó õâîðîãî 2 â³í øâèäêî íîðìàë³çóâàâñÿ íàñòóïíîãî

äíÿ ³ íàäàë³ éîãî ð³âåíü ò³ëüêè çìåíøóâàâñÿ, ÿê ³ ó

ïàö³ºíò³â 1, 3. Ó õâîðîãî 4 ð³âåíü ëàêòàòó áóâ ï³äâèùåíèé

âåñü ÷àñ ñïîñòåðåæåííÿ (öå ìîæíà ïîÿñíèòè ³øåì³÷íèì

óøêîäæåííÿì äîíîðñüêîãî îðãàíà). Ó ïàö³ºíò³â 5, 6

ð³âåíü ëàêòàòó çìåíøóâàâñÿ ó ï³ñëÿîïåðàö³éíèé ïåð³îä,

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

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àëå çà 2 – 3 äí³ äî ãîñòðîãî â³äòîðãíåííÿ â³í ïðîãðåñèâíî

ï³äâèùèâñÿ.

Ïîêàçíèêè àëàí³íàì³íîòðàíñôåðàçè (ÀËÒ) ³ àñïàðòà-

òàì³íîòðàíñôåðàçè (ÀÑÒ) (ãðàô³êè 3 – 4). Ó âñ³õ ïàö³ºíò³â ó

ïåðø³ äí³ ï³ñëÿ îïåðàö³¿ êîíöåíòðàö³ÿ àì³íîòðàíñôåðàç

ï³äâèùåíà, ïðè öüîìó ó íàñòóïí³ 3 – 5-é äí³ ê³ëüê³ñòü ÀËÒ ³

ÀÑÒ ùå ï³äâèùóºòüñÿ. Ó ïîäàëüøîìó êîíöåíòðàö³ÿ àì³íîò-

ðàíñôåðàç ó ïàö³ºíò³â 1, 2, 3 ïîñòóïîâî çìåíøóºòüñÿ, ùîäî

³íøèõ òðüîõ ïàö³ºíò³â, òî àì³íîòðàíñôåðàçè áóëè âåñü ÷àñ

áóëè ï³äâèùåí³ ³ ï³ä ê³íåöü ñïîñòåðåæåííÿ (îñòàíí³ 3 äí³)

äîñÿãëè òàêèõ çíà÷åíü, ÿê ³ â ïåðø³ äí³ ï³ñëÿ îïåðàö³¿ (5,5 –

5,2 ììîëü/ãîä*ë). Ó õâîðèõ 1, 2, 4 ó ïåðø³ 3 äí³ ð³âåíü ÀÑÒ

á³ëüøèé çà ê³ëüê³ñòü ÀËÒ, ùî âêàçóº íà ãåìîë³ç.

Çã³äíî ç êðèòåð³ÿìè ñòóïåí³â ³øåì³÷íîãî óøêîäæåííÿ

òðàíñïëàíòàòà (ÿê³ â ñåáå âêëþ÷àþòü îö³íêó ð³âí³â ñèðî-

âàòêîâèõ àì³íîòðàíñôåðàç ³ êîåô³ö³ºíòó äå Ð³ò³ñà) ó

ïàö³ºíò³â 1 – 5 ñïîñòåð³ãàºòüñÿ òÿæêå ³øåì³÷íå óøêîäæåí-

íÿ àëîòðàíñïëàíòàòó ïå÷³íêè, ó ïàö³ºíòà 6 – ïîì³ðíå óø-

êîäæåííÿ. Öÿ ãðàäàö³ÿ óøêîäæåíü â³äîáðàæàº ê³ëüê³ñòü

óðàæåíèõ, àëå ùå æèòòºçäàòíèõ ãåïàòîöèò³â.

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Ó äåÿê³é ì³ð³, â³äîáðàæåííÿì øâèäêîñò³ â³äíîâëåííÿ

ôóíêö³¿ ïå÷³íêè º òàêîæ êîðåëÿö³ÿ ì³æ ïðèéíÿòîþ äîçîþ

³ìóíîäåïðåñàíòó ³ éîãî êîíöåíòðàö³ºþ â êðîâ³. (òàáëèöÿ 2).

Ó íàâåäåíèõ çì³íàõ êîíöåíòðàö³¿ CsA â êðîâ³ âèÿâëåíî,

ùî ïðè ï³äâèùåíí³ äîçè ïðåïàðàòó âèçíà÷àºòüñÿ ÿñêðàâî

âèðàæåíà ãåïàòîòîêñè÷í³ñòü (ïðè ñï³âñòàâëåíí³ ç âèùåíà-

âåäåíèìè ëàáîðàòîðíèìè äàíèìè), ÿêà ó âçàºìîçâ’ÿçêó ç

ðåïåðôóç³éíèì ñèíäðîìîì ïðèçâîäèòü äî äèñôóíêö³¿

òðàíñïëàíòàòó.

Âèñíîâêè: 1. Äëÿ ïîâíîö³ííî¿ îö³íêè ìîæëèâîãî ãîñòðî-

ãî â³äòîðãíåííÿ ïå÷³íêîâîãî òðàíñïëàíòàòó íåîáõ³äíî âðà-

õîâóâàòè äàí³ ïåðåäîïåðàö³éíî¿ îö³íî÷íî¿ øêàëè MELD,

òîíêîãîëêîâî¿ á³îïñ³¿ òðàíñïëàíòàòó, äåá³ò æîâ÷³ â ï³ñëÿîïå-

ðàö³éíîìó ïåð³îä³, ïîêàçíèêè á³ë³ðóá³íó, àì³íîòðàíñôåðàç.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

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Òàáëèöÿ 2.

Àíàë³ç çì³í êîíöåíòðàö³¿ â êðîâ³ CsA â çàëåæíîñò³ â³ä äîçè ÑsA ó ï³ñëÿîïåðàö³éíîìó ïåð³îä³.

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2. Äëÿ íàéá³ëüø ³íôîðìàòèâíî¿ ä³àãíîñòèêè â³äòîðã-

íåííÿ ïå÷³íêîâîãî òðàíñïëàíòàòó íåîáõ³äíî äîñë³äèòè

³ìóíí³ ìàðêåðè â³äòîðãíåííÿ â çàëåæíîñò³ â³ä ñõåìè

³ìóíîñóïðåñ³¿.

Ðåöåíçåíò: к.мед.н., доцент Русанов І. В.

Ë²ÒÅÐÀÒÓÐÀ

1. Ãîòüå Ñ. Â., Êîíñòàíòèíîâ Á. À., Öèðóëüíèêîâà Î. Ì.

Òðàíñïëàíòàöèÿ ïå÷åíè. /Ðóêîâîäñòâî äëÿ âðà÷åé. Ì.: ÎÎÎ “Ìå-

äèöèíñêîå èíôîðìàöèîííîå àãåíòñòâî”. – 2008. -248 ñ.

2. Ãðàíîâ À. Ì., Ãðàíîâ Ä. À., Æåðåáöîâ Ô. Ê., Ïîëûñàëîâ Â. Í.,

Ãåðàñèìîâà Î. À., Áîðîâèê Â. Â., Îñîâñêèõ Â. Â., Ìàéñòðåíêî Ä. Í.,

Ðóòêèí È. Î., Öóðóïà Ñ. Ï., Òèëåóáåðãåíîâ È. È., Øàïîâàë Ñ. Â.

Îïûò 100 òðóïíûõ òðàíñïëàíòàöèé ïå÷åíè â ðîññèéñêîì íàó÷-

íîì öåíòðå ðàäèîëîãèè è õèðóðãè÷åñêèõ òåõíîëîãèé // Âåñòíèê

õèðóðãèè. - 2013.- òîì 171, ¹ 2 ñ 74-77

3. Êèñåëåâà Å. À., Óøàêîâà È. À., Êèì Ý. Ô., Ìàòâååâ Ã. Ï.,

Áèðþëèíà Í. Þ., Âàáèøåâè÷ À. Â., Ê âîïðîñó î ïðåäèêòîðàõ

ïîñòðåïåðôóçèîííîãî ñèíäðîìà ïðè îðòîòîïè÷åñêîé òðàíñ-

ïëàíòàöèè ïå÷åíè // Àíåñòåçèîëîãèÿ è ðåàíèìàòîëîãèÿ. – 2012.-

¹ 2 ñ 31-34

4. Íèêîíåíêî À.Ñ., Ãðèöåíêî Ñ.Í., Ñîáàêàðü Â.À., Ñàëåíþê Â.Â.,

Âîðîíîé À. À. Àíåñòåçèÿ è èíòðàîïåðàöèîííàÿ èíòåíñèâíàÿ

òåðàïèÿ ïðè òðàíñïëàíòàöèè ïå÷åíè // Òðàíñïëàíòîëîã³ÿ. –

2011. – ¹ 1-2- ñ 162-170

5. Íèêîíåíêî Î. Ñ., Êîâàëüîâ Î. Î., Ãðèöåíêî Ñ. Ì., Íèêîíåí-

êî Ò. Ì. Òðàíñïëàíòàöèÿ ïå÷åíè. Íàóêîâå âèäàííÿ. – Ç.: ÂÏÊ

“Çàïîð³ææÿ”, 2000. – 208 ñ.

6. Ïàâëîâ ×. Ñ., Àíäðåéöåâà Î. È., Ìóññåëèóñ Ñ. Ã., ×æàî À. Â.,

Èâàøêèí Â. Ò. ×àñòîòà è ôàêòîðû ðèñêà ðàçâèòèÿ îòòîðæå-

íèÿ ïå÷åíè ïîñëå òðàíñïëàíòàöèè // Òðàíñïëàíòîëîãèÿ. – 2003. –

¹ 1 – ñ 26-35

7. Òðàíñïëàíòîëîãèÿ. Ðóêîâîäñòâî. Ïîä ðåä. àêàä. Â.È. Øó-

ìàêîâà. – Ì.: “Ìåäèöèíà”, 2006; – 391 ñ.

8. Õóáèòèÿ Ì. Ø., Íèêóëèíà Â. Ï., Ãîäêîâ Ì. À., Ìàòâååâ Ñ. Á.,

Ñþòêèí Â. Å., ×æàî À. Â. Òðàíñïëàíòàöèÿ ïå÷åíè: èçìåíåíèå

áèîõèìè÷åñêèõ ïîêàçàòåëåé è ïàðàìåòðîâ èìóííîé ñèñòåìû ó

ïàöèåíòîâ ñ ðàçíîé ýòèîëîãèåé öèððîçà // Àííàëû õèðóðãèè. –

2010.- ¹ 2 – ñ 46-51

9. Øóìàêîâ Â. È., Ìîéñþê ß. Ã., Ïîïöîâ Â. Í. è äð. Îïûò

òðàíñïëàíòàöèè ïå÷åíè â îäíîì öåíòðå: ñîâðåìåííûå òåõíîëî-

ãèè è ïðîáëåìû óëó÷øåíèÿ ðåçóëüòàòîâ // Âåñò. Òðàíñïëàíòî-

ëîãèè è èñêóâñòâåííûõ îðãàíîâ. Ì., 2008. ¹1. Ñ. 5-13

10 . Abhinav Humar, Arthur J. Matas, William D. Payne. Atlas of

Organ Transplantation// Springer Verlag London Limited, 2006. –

348 p.

11. Gi-Won Song, Sung-Gyu Lee, Shin Hwang, Ki-Hun Kim, Chul-

Soo Ahn, Deok-Bog Moon, Tae-Young Ha, Dong-Hwan Jung. No

Immunologic failure in ABO-Incompatible Living Donor Liver

Transplantation without Splenectomy under the Anti-CD20 Antibody

Prophylaxis // The International Liver Transplantation Society 16th

Annual International Congress. – 2010 – p 94

12. P. Dutkowski, C. Oberkofler, M. Bechir, B. Mullhaupt, P.-A.

Clavien. The New MELD Allocation System for Liver Transplantation

Saves Lives but Increases Morbidity and Cost.– Prospective study //

The International Liver Transplantation Society 16th Annual

International Congress. – 2010 – p 176

13 . European Liver Transplant Registry [Åëåêòðîííèé ðåñóðñ]. –

Ðåæèì äîñòóïó : URL : http://www.eltr.org/spip.php?article188

LIVER’S CADAVERIC TRANSPLANTATION

IN THE TREATMENT OF IT’S TERMINAL

DISEASES

A. Chudnovets1, ². Konovalenko2

1Bogomolets National Medical University,

Kyiv, Ukraine

2Zaporizhzhia State Medical University,

Zaporizhzhia, Ukraine

Summary. The article presents the analysis of the

patient’s early postoperative treatment after liver’s cadaveric

transplantation. The comparative characteristic of the main

liver’s functional markers in the early postoperative period

is given.

Key words: cadaverous liver transplant, acute transplant

rejection, immunosuppressive therapy.

ÒÐÓÏÍÀß ÒÐÀÍÑÏËÀÍÒÀÖÈß ÏÅ×ÅÍÈ

Â ËÅ×ÅÍÈÈ Å¨ ÒÅÐÌÈÍÀËÜÍÛÕ ÇÀÁÎËÅÂÀÍÈÉ

×óäíîâåöü À.Â.1, Êîíîâàëåíêî ².À.2

1Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò

èìåíè À.À. Áîãîìîëüöà, ã. Êèåâ, Óêðàèíà

2Çàïîðîæñêèé ãîñóäàðñòâåííûé ìåäèöèíñêèé

óíèâåðñèòåò, ã. Çàïîðîæüå, Óêðàèíà

Ðåçþìå. Â ñòàòüå ïðåäñòàâëåí àíàëèç ðàííåãî ïîñ-

ëåîïåðàöèîííîãî ëå÷åíèÿ ïàöèåíòà ïîñëå òðóïíîé

òðàíñïëàíòàöèè ïå÷åíè. Äàíà ñðàâíèòåëüíàÿ õàðàêòå-

ðèñòèêà ãëàâíûõ ôóíêöèîíàëüíûõ ìàðêåðîâ ïå÷åíè â

ðàííåì ïîñëåîïåðàöèîííîì ïåðèîäå.

Êëþ÷åâûå ñëîâà: òðóïíàÿ ïåðåñàäêà ïå÷åíè, îñòðîå

îòòîðæåíèå òðàíñïëàíòàòà, èììóíîñóïðåññèâíàÿ

òåðàïèÿ.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

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Âñòóï. Âñåñâ³òíÿ îðãàí³çàö³ÿ îõîðîíè çäîðîâ’ÿ

(ÂÎÎÇ) îãîëîñèëà îæèð³ííÿ íîâîþ íå³íôåêö³éíîþ åï³äå-

ì³ºþ íàøîãî ÷àñó. Çà äàíèìè ÂÎÎÇ, íàäëèøêîâó ìàñó

ò³ëà íà ñüîãîäí³ ìàº 1,1 ì³ëüÿðä³â ëþäåé, ç íèõ 312 ìëí –

îæèð³ííÿ [1]. Â Óêðà¿í³, çà ðåçóëüòàòàìè ïîïóëÿö³éíîãî

äîñë³äæåííÿ ïðîâåäåíîãî â ì. Äí³ïðîïåòðîâñüê, íàäëèø-

êîâó ìàñó ò³ëà ìàþòü 39,18 %, à îæèð³ííÿ I-III ñòóïåíÿ

õàðàêòåðíå äëÿ 31,56 % [2].

Ïîøèðåí³ñòü ìîðá³äíîãî îæèð³ííÿ (²ÌÒ á³ëüøå 40 êã/

ì²), òàêîæ ñòð³ìêî çðîñòàº. Â ÑØÀ ìîðá³äíå îæèð³ííÿ

õàðàêòåðíå äëÿ 2,8 % ÷îëîâ³ê³â ³ 6,9% æ³íîê [3]. Â Óêðà¿í³

íàë³÷óºòüñÿ áëèçüêî 1,4 % äîðîñëèõ õâîðèõ íà ìîðá³äíå

îæèð³ííÿ [2].

Ïàòîëîã³ÿ ñåðöåâî-ñóäèííî¿ ñèñòåìè îäíà ç ãîëîâíèõ

ïðè÷èí ñìåðòíîñò³ òà ³íâàë³äèçàö³¿ íàñåëåííÿ â ñâ³ò³.

Ïåðøå ì³ñöå ó ñòðóêòóð³ ö³º¿ ïàòîëîã³¿ çàéìàº ã³ïåðòîí³-

÷íà õâîðîáà (ÃÕ). Â³ä ÃÕ ñòðàæäàº áëèçüêî 25% äîðîñ-

ëîãî íàñåëåííÿ ñâ³òó, ïîøèðåí³ñòü, çà ïðîãíîçàìè, ó

2025 ðîö³ çðîñòå äî 1,5 ìëðä îñ³á. Â Óêðà¿í³ ìàéæå 12 ìëí

îñ³á, õâîðèõ íà ÃÕ, ùî ñòàíîâèòü â ìåæàõ 30% äîðîñëîãî

íàñåëåííÿ [4].

Ó áàãàòüîõ êë³í³÷íèõ äîñë³äæåííÿõ âñòàíîâëåíî âçàº-

ìîçâ’ÿçîê ì³æ ï³äâèùåííÿì àðòåð³àëüíîãî òèñêó (ÀÒ) ³

çá³ëüøåííÿì ìàñè ò³ëà. Ó îäíîìó ç íàéá³ëüøèõ äîñë³ä-

æåíü (Hypertension Control Program) áóëî âèÿâëåíî, ùî

50 % ëþäåé ñåðåäíüîãî â³êó ç íàäëèøêîâîþ ìàñîþ ìàþòü

àðòåð³àëüíó ã³ïåðòåíç³þ (ÀÃ) [5]. Çà äàíèìè Ôðåì³íãåìñ-

êîãî äîñë³äæåííÿ, 78 % ÷îëîâ³ê³â ³ 65 % æ³íîê ç ÀÃ ìàþòü

îæèð³ííÿ. Ç³ çá³ëüøåííÿì ìàñè ò³ëà íà 4,5 êã ñèñòîë³÷íèé ÀÒ

ï³äâèùóºòüñÿ ïîíàä 4 ìì ðò. ñò. (ó ÷îëîâ³ê³â – íà 4,4 ìì ðò.

ñò., ó æ³íîê – íà 4,2 ìì ðò. ñò.), òîáòî çá³ëüøåííÿ ìàñè íà

1 êã ïðèçâîäèòü äî ï³äâèùåííÿ ÀÒ ïðèáëèçíî íà 1 ìì ðò. ñò.

Öþ äóìêó ï³äòâåðäæåíî ³ â áàãàòüîõ ³íøèõ äîñë³äæåííÿõ.

Çà äàíèìè Swedish Obesity Study [6], ó 44–51 % îñ³á ç

îæèð³ííÿì âèÿâëåíî ÀÃ. Ö³ êîìîðá³äí³ ñòàíè º íàéâàæëè-

â³øèìè ôàêòîðàìè ðèçèêó ðîçâèòêó ñåðöåâî-ñóäèííèõ

óñêëàäíåíü – ³íôàðêòó ì³îêàðäà, ³íñóëüòó òà ñåðöåâî¿ íå-

äîñòàòíîñò³, ÿê³ â ñâîþ ÷åðãó ïðèçâîäÿòü äî ðàííüî¿ ³íâà-

ë³äèçàö³¿ òà ïåðåä÷àñíî¿ ñìåðò³ [7, 8].

ÓÄÊ 616.12–008.331.1+616–056.52]–085–089

ÂÏËÈÂ ÌÅÄÈÊÀÌÅÍÒÎÇÍÈÕ ÒÀ Õ²ÐÓÐÃ²×ÍÈÕ

ÌÅÒÎÄ²Â Ë²ÊÓÂÀÍÍß ÍÀ ÏÐÎÔ²ËÜ ÀÐÒÅÐ²ÀËÜÍÎÃÎ

ÒÈÑÊÓ Ó ÕÂÎÐÈÕ ÍÀ ÌÎÐÁ²ÄÍÅ ÎÆÈÐ²ÍÍß

² ÀÐÒÅÐ²ÀËÜÍÓ Ã²ÏÅÐÒÅÍÇ²Þ

Øêðüîáà À.Î.1., Ì³ò÷åíêî Î.².1., Ëàâðèê À.Ñ.2., Ðîìàíîâ Â.Þ.1

1ÄÓ“ÍÍÖ “²íñòèòóò êàðä³îëîã³¿ ³ìåí³ àêàäåì³êà Ì.Ä Ñòðàæåñêà” ÍÀÌÍ Óêðà¿íè, ì. Êè¿â, Óêðà¿íà

2ÄÓ “Íàö³îíàëüíèé ³íñòèòóò õ³ðóðã³¿ òà òðàíñïëàíòîëîã³¿ ³ìåí³ Î.Î. Øàë³ìîâà” ÍÀÌÍ Óêðà¿íè,

ì. Êè¿â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: ìîðá³äíå îæèð³ííÿ, àðòåð³àëüíà ã³ïåðòåíç³ÿ, äîáîâå ìîí³òîðóâàííÿ àðòåð³àëüíîãî òèñêó,

ìåäèêàìåíòîçíå ë³êóâàííÿ, õ³ðóðã³÷íå ë³êóâàííÿ.

Äàí³ ÷èñëåííèõ äîñë³äæåíü ïîêàçàëè, ùî äëÿ õâîðèõ

íà ÀÃ òà îæèð³ííÿ, õàðàêòåðíå íåäîñòàòíº çíèæåííÿ ÀÒ

âíî÷³, ùî çíà÷íî ï³äâèùóº ðèçèê ðîçâèòêó ³íñóëüòó (24%

ïðîòè 3% ó ïàö³ºíò³â ç íîðìàëüíèì í³÷íèì çíèæåííÿì

ÀÒ), ³íôàðêòó ì³îêàðäà, à òàêîæ ñìåðòíîñòü â³ä ñåðöåâî-

ñóäèííèõ óñêëàäíåíü [9, 10].

Çà äàíèìè Îõàñàìñêîãî äîñë³äæåííÿ (1542 ïàö³ºíòà)

âñòàíîâëåíî, ùî ïîºäíàííÿ íåäîñòàòíüîãî í³÷íîãî çíè-

æåííÿ ÀÒ òà ï³äâèùåííÿ ð³âíÿ ñåðåäíüîäîáîâîãî ÀÒ º âè-

ðàæåíèì ³ íåçàëåæíèì ïðåäèêòîðîì ñìåðòíîñò³. Â³äíîñíèé

ðèçèê çàãàëüíî¿ ñìåðòíîñò³ òà ñåðöåâî-ñóäèííî¿ ñìåðòíîñò³

çá³ëüøóâàâñÿ ïðè ñåðåäíüîäîáîâîìó ÀÒ > 134/78 ìì ðò. ñò.

Ìàêñèìàëüíèé ðèçèê ñåðöåâî-ñóäèííî¿ ñìåðòíîñò³ â³äçíà-

÷àâñÿ â ãðóï³ õâîðèõ ç íåäîñòàòí³ì çíèæåííÿì ÀÒ âíî÷³ [11].

Ë³êóâàííÿ îæèð³ííÿ – áàãàòîñòóïåíåâèé ïðîöåñ, ÿêèé

âêëþ÷àº çì³íó ñòèëþ æèòòÿ, ä³ºòîòåðàï³þ, ìåäèêàìåíòîç-

íå òà õ³ðóðã³÷íå ë³êóâàííÿ.

Êîíñåðâàòèâíà òåðàï³ÿ äëÿ õâîðèõ íà îæèð³ííÿ º åôåê-

òèâíîþ ëèøå íà ïî÷àòêîâèõ ñòàä³ÿõ çàõâîðþâàííÿ. Ïðè

îæèð³íí³ II òà III ñòóïåí³â òàêå ë³êóâàííÿ ìàº íèçüêó åôåê-

òèâí³ñòü. Çà äàíèìè ð³çíèõ àâòîð³â, ó 95% ïàö³ºíò³â, ÿê³

ïðîéøëè êóðñ êîíñåðâàòèâíî¿ òåðàï³¿ ç ìåòîþ ë³êóâàííÿ

îæèð³ííÿ, â òåðì³íè â³ä 6 äî 12 ì³ñÿö³â ñïîñòåð³ãàëè ïî-

âòîðíå çá³ëüøåííÿ ÌÒ. Íåäîñòàòíÿ åôåêòèâí³ñòü êîíñåð-

âàòèâíèõ ìåòîä³â ë³êóâàííÿ ñïðèÿëà ñòð³ìêîìó ðîçâèòêó

õ³ðóðã³÷íèõ ìåòîä³â [12, 13, 14].

Áàðèàòðè÷íà õ³ðóðã³ÿ (ãð. barys – âàæêèé, iatrike – ìå-

äèöèíà) – ðîçä³ë õ³ðóðã³¿, íàïðàâëåíèé íà çíèæåííÿ ÌÒ

õâîðîãî íà ìîðá³äíå îæèð³ííÿ, øëÿõîì âèêîíàííÿ îïåðà-

òèâíîãî âòðó÷àííÿ íà øëóíêîâî-êèøêîâîìó òðàêò³.

Çã³äíî ç ðåêîìåíäàö³ÿìè IFSO (International Federation for

the Surgery of Obesity), ïîêàçàííÿìè äî õ³ðóðã³÷íîãî ë³êó-

âàííÿ îæèð³ííÿ º ìîðá³äíå îæèð³ííÿ (²ÌÒ á³ëüøå 40 êã/ì2).

Çà íàÿâíîñò³ òÿæêî¿ ñóïóòíüî¿ ïàòîëîã³¿, à ñàìå öóêðîâîãî

ä³àáåòó II òèïó, íåêîíòðîëüîâàíî¿ àðòåð³àëüíî¿ ã³ïåðòåíç³¿,

ñåðöåâî¿ íåäîñòàòíîñò³, îïåðàòèâíå ë³êóâàííÿ ìîæëèâå

ïðè ²ÌÒ 35 êã/ì2 [12, 13].

Ìåòà ðîáîòè: âèâ÷èòè ïîêàçíèêè îô³ñíîãî òà äîáîâî-

ãî ìîí³òîðóâàííÿ ÀÒ (ÄÌÀÒ) ó õâîðèõ íà ìîðá³äíå îæè-

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ð³ííÿ, äî òà ÷åðåç 6 ì³ñÿö³â ï³ñëÿ ìåäèêàìåíòîçíèõ òà

õ³ðóðã³÷íèõ ìåòîä³â ë³êóâàííÿ îæèð³ííÿ.

Ìàòåð³àëè òà ìåòîäè äîñë³äæåííÿ.. Íà áàç³ â³ää³ëåííÿ

äèñë³ï³äåì³é ÄÓ “Íàö³îíàëüíîãî Íàóêîâîãî öåíòðó

“²íñòèòóò êàðä³îëîã³¿ ³ìåí³ àêàäåì³êà Ì.Ä.Ñòðàæåñêà“

ÍÀÌÍ Óêðà¿íè ïðîâåäåíî îáñòåæåííÿ 164 ïàö³ºíò³â ç

ìîðá³äíèì îæèð³ííÿì (²ÌÒ>40 êã/ì2) òà àðòåð³àëüíîþ

ã³ïåðòåíç³ºþ, ÿê³ ñôîðìóâàëè 2 ãðóïè. Äî ïåðøî¿ ãðóïè

óâ³éøîâ 81 ïàö³ºíò (50 æ³íîê òà 31 ÷îëîâ³ê, ñåðåäí³ì â³êîì

41,1±1,6 ðîê³â, ç ñåðåäí³ì ²ÌÒ – 43,2±±0,6 êã/ì2), ÿêèì

ïðîâîäèëîñü ë³êóâàííÿ îæèð³ííÿ çà äîïîìîãîþ ä³ºòè

(ï³äâèùåíå ñïîæèâàííÿ çëàê³â, êðóï, õàð÷îâèõ âîëîêîí,

îâî÷³â ³ ôðóêò³â, çàì³íà ïðîäóêò³â ç âèñîêèì âì³ñòîì

æèð³â íà ì’ÿñî ç íèçüêèì âì³ñòîì æèð³â òà ìîðåïðîäóê-

òè, ñêîðî÷åííÿ åíåðãîñïîæèâàííÿ äî 1500 êêàë/äåíü),

ìåäèêàìåíòîçíèõ çàñîá³â (ë³êàðñüêèé çàñ³á “Ñòèô³ìîë”,

âèðîáíèöòâî Êè¿âñüêèé â³òàì³ííèé çàâîä, â äîáîâ³é äîç³

3 êàïñóëè). Äî äðóãî¿ ãðóïè óâ³éøëî 83 ïàö³ºíòè (52

æ³íêè, 31 ÷îëîâ³ê, ñåðåäí³ì â³êîì 42,2 ±1,1 ðîê³â, ç

ñåðåäí³ì ²ÌÒ – 52,1±1,2 êã/ì2), ÿêèì íà áàç³ ÄÓ “Íàö³î-

íàëüíèé ³íñòèòóò õ³ðóðã³¿ òà òðàíñïëàíòîëîã³¿

³ì. Î.Î. Øàë³ìîâà” ÍÀÌÍ Óêðà¿íè, áóëè âèêîíàí³ áàðè-

àòðè÷í³ îïåðàö³¿ (áàíäàæóâàííÿ øëóíêà àáî øóíòóâàííÿ

øëóíêà).

Áàíäàæóâàííÿ øëóíêà, öå îïåðàö³ÿ, ÿêà äàº çìîãó äî-

ñÿãíóòè çìåíøåííÿ îá’ºìó øëóíêà áåç ïîðóøåííÿ éîãî

ö³ë³ñíîñò³, ç îáìåæåííÿì ê³ëüêîñò³ ¿æ³, ÿêó ìîæå ñïîæèòè

ïàö³ºíò çà îäèí ïðèéîì, òà øâèäêèì íàñè÷åííÿì. Øëó-

íîê çà äîïîìîãîþ ñèë³êîíîâîãî áàíäàæó ïåðåòÿãóºòüñÿ

òàê, ùîá â³í áóâ ïîä³ëåíèé íà äâ³ ÷àñòèíè – âåðõíþ òà

íèæíþ, ïðè÷îìó âåðõíÿ (òàê çâàíèé “ìàëèé“ øëóíîê)

ìåíøà çà îá’ºìîì (íå á³ëüøå 50-60 ìë), à ñïîëó÷åííÿ ì³æ

äâîìà ÷àñòèíàìè øëóíêó, òàê çâàíå ñï³âóñòÿ, ñêëàäàº

ïðèáëèçíî 15 ìì â ä³àìåòð³ [15,16].

Øóíòóâàííÿ øëóíêà – îïåðàö³ÿ, ÿêà ìàº ðåñòðèêòèâ-

íèé êîìïîíåíò ³ ïåðåäáà÷àº ðåêîíñòðóêö³þ òîíêî¿ êèøêè,

ñïðÿìîâàíó íà îáìåæåííÿ âñìîêòóâàííÿ êîìïîíåíò³â

¿æ³. Ê³ëüê³ñòü ¿æ³ îáìåæóºòüñÿ øëÿõîì ñòâîðåííÿ ó

âåðõí³é ÷àñòèí³ øëóíêà “ìàëîãî” øëóíêà îá’ºìîì äî 20–

30 ìë, ÿêèé ç’ºäíóºòüñÿ áåçïîñåðåäíüî ç òîíêîþ êèøêîþ.

²íøà ÷àñòèíà øëóíêà ïðè öüîìó íå âèäàëÿºòüñÿ, àëå ïî-

âí³ñòþ âèêëþ÷àºòüñÿ ç ïàñàæó ¿æ³ ðàçîì ³ç äâàíàäöÿòèïà-

ëîþ òà ïîðîæíüîþ êèøêàìè. Øëóíêîâèé ñ³ê, æîâ÷ òà

ïàíêðåàòè÷íèé ñ³ê çì³øóþòüñÿ ðàçîì ³ç ¿æåþ áåçïîñå-

ðåäíüî â ïîðîæí³é êèøö³ [17,18].

Ïàö³ºíòè îáîõ ãðóï, áóëè îáñòåæåí³ äî òà ÷åðåç 6

ì³ñÿö³â ï³ñëÿ ë³êóâàííÿ îæèð³ííÿ. Íà ïåðøîìó òà äðóãî-

ìó åòàïàõ äîñë³äæåííÿ âñ³ì ïàö³ºíòàì ïðîâîäèëîñü çà-

ãàëüíîêë³í³÷íå îáñòåæåííÿ, âèçíà÷åííÿ ìàñè ò³ëà (ó êã) òà

çð³ñò (ó ì). Íàÿâí³ñòü ³ ñòóï³íü îæèð³ííÿ îö³íþâàëè çà âå-

ëè÷èíîþ: ²ÌÒ (êã/ì2) = ìàñà ò³ëà (êã)/çð³ñò (ì2) (òàá.1).

Âñ³ì ïàö³ºíòàì ïðîâîäèëîñü âèì³ðþâàííÿ îô³ñíîãî

ÑÀÒ ³ ÄÀÒ òà ÄÌÀÒ (ÀÂÐÌ-04 “Ìåäèòåê”, Óãîðùèíà) ç

îö³íêîþ ð³âíÿ ñèñòîë³÷íîãî ³ ä³àñòîë³÷íîãî ÀÒ, âàð³àáåëü-

Òàáëèöÿ 1.

Êàòåãîð³¿ ²ÌÒ (ÂÎÇ, 1997)

Ðèñ 1. Áàíäàæóâàííÿ øëóíêà. Ðèñ 2. Øóíòóâàííÿ øëóíêà.

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íîñò³ ÀÒ â äåíí³ òà í³÷í³ ãîäèíè, ñòóïåíÿ í³÷íîãî çíèæåí-

íÿ ÀÒ. Äîñë³äæåííÿ âêëþ÷àëîñÿ â ðîçðàõóíêè çà íàÿâ-

íîñò³ íå ìåíøå í³æ 85 % â³ðîã³äíèõ ðåçóëüòàò³â. Çàëåæíî

â³ä âåëè÷èíè äîáîâîãî ³íäåêñó ÑÀÒ òà ÄÀÒ âèä³ëÿëè ÷îòè-

ðè òèïè äîáîâèõ êðèâèõ ÀÒ: “Over dipper” – äîáîâèé

³íäåêñ á³ëüøå 20 %, “Dipper” – äîáîâèé ³íäåêñ â³ä 10 % äî

20 %, “Non-dipper”- äîáîâèé ³íäåêñ â³ä 0 % äî 10 % òà

“Night piker” – äîáîâèé ³íäåêñ ìåíøèé 0 %.

Íà ïåðøîìó åòàï³ âñ³ì ïàö³ºíòàì ïðèçíà÷àëàñü ñòàí-

äàðòíà àíòèã³ïåðòåíçèâíà òåðàï³ÿ çã³äíî ç ðåêîìåíäàö³ÿ-

ìè ó 2013 ðîö³ ªâðîïåéñüêîãî òîâàðèñòâà ç âèâ÷åííÿ

ã³ïåðòåíç³¿ (ESH)/ªâðîïåéñüêîãî òîâàðèñòâà êàðä³îëîã³â

(ESC) [19], òà ðåêîìåíäàö³ÿìè Óêðà¿íñüêî¿ àñîö³àö³¿ êàðä³î-

ëîã³â (2008), ç ïåðåãëÿäîì êë³í³÷íî¿ íàñòàíîâè ó 2012 ð. [20].

Ñòàòèñòè÷íó îáðîáêó îòðèìàíèõ ðåçóëüòàò³â ïðîâåäå-

íî ñòàíäàðòíèìè ìåòîäàìè âàð³àö³éíî¿ ñòàòèñòèêè ç âèêî-

ðèñòàííÿì ïàêåòà ñòàòèñòè÷íèõ ïðîãðàì Statistica 6.0. Ðå-

çóëüòàòè íàâåäåí³ ÿê (M±m), äå Ì – ñåðåäíº çíà÷åííÿ

ïîêàçíèêà, m – ñòàíäàðòíà ïîìèëêà. Äîñòîâ³ðí³ñòü

â³äì³ííîñòåé ì³æ ïîêàçíèêàìè, ùî âèâ÷àþòüñÿ, âèçíà÷à-

ëàñÿ çà äîïîìîãîþ äâîâèá³ðêîâîãî êðèòåð³þ Ñòüþäåíòà.

Ðåçóëüòàòè òà îáãîâîðåííÿ. Ïàö³ºíòè îáîõ ãðóï ïåð-

âèííî áóëè ñï³âñòàâí³ çà àíòðîïîìåòðè÷íèìè äàíèìè

(òàáë.2). ×åðåç 6 ì³ñÿö³â ï³ñëÿ ë³êóâàííÿ, ÿê â ² òàê ³ â ²²

ãðóïàõ ñïîñòåð³ãàëîñü äîñòîâ³ðíå çíèæåííÿ ìàñè ò³ëà òà

²ÌÒ ïîð³âíÿíî ç âèõ³äíèìè ïîêàçíèêàìè. Äî ïî÷àòêó

ë³êóâàííÿ ñåðåäíÿ âàãà ó ïàö³ºíò³â ² ãðóïè ñêëàäàëà 120,5 ±

±2,06 êã (²ÌÒ 43,2 ± 0,6 êã/ì2), ÷åðåç 6 ì³ñÿö³â ï³ñëÿ ë³êó-

âàííÿ – 115 ± 1,77 êã (²ÌÒ 41,2±0,5êã/ì2), òîáòî ñïîñòåð³ãà-

ëîñü çìåíøåííÿ ìàñè ò³ëà íà 5,5 êã (4,6%). Ó ïàö³ºíò³â ²²

ãðóïè, ÿê³ ë³êóâàëèñü çà äîïîìîãîþ õ³ðóðã³÷íèõ îïå-

ðàö³é, ïî÷àòêîâà âàãà ñêëàäàëà 153,9 ± 3,75 êã (²ÌÒ – 52,1 ±

±1,2), ÷åðåç 6 ì³ñÿö³â ï³ñëÿ ë³êóâàííÿ – 118,9 ± 3,39 êã

(²ÌÒ – 40,2 ± 1,0), òîáòî ñåðåäíÿ âòðàòà ìàñè ò³ëà ñêëàëà

35 êã (22,8 %).

Òàêèì ÷èíîì, á³ëüø ñóòòºâå çíèæåííÿ ìàñè ò³ëà ñïîñ-

òåð³ãàëîñü ó ïàö³ºíò³â ²² ãðóïè, ÿê³ ë³êóâàëèñü çà äîïîìî-

ãîþ õ³ðóðã³÷íèõ îïåðàö³é.

Íà ïåðøîìó åòàï³ äîñë³äæåííÿ ó âñ³õ ïàö³ºíò³â ÿê ² òàê

³ ²² ãðóïè áóëà âèÿâëåíà àðòåð³àëüíà ã³ïåðòåíç³ÿ (Âåðèô³-

êàö³ÿ ä³àãíîçó ïðîâîäèëàñü çã³äíî ç êðèòåð³ÿìè, ðåêîìåí-

äîâàíèìè ó 2013 ðîö³ ªâðîïåéñüêèì òîâàðèñòâîì ç âèâ-

÷åííÿ ã³ïåðòåíç³¿ (ESH)/ªâðîïåéñüêèì òîâàðèñòâîì

êàðä³îëîã³â (ESC) [19], òà ðåêîìåíäàö³ÿìè Óêðà¿íñüêî¿

àñîö³àö³¿ êàðä³îëîã³â (2008), ç ïåðåãëÿäîì êë³í³÷íî¿ íàñòà-

íîâè ó 2012 ð. [20].

Íà ïî÷àòêó äîñë³äæåííÿ ñåðåäí³é îô³ñíèé ÀÒ ó

ïàö³ºíò³â ² ãðóïè ñêëàäàâ 142/88,8 ìì ðò ñò., ó ïàö³ºíò³â ²²

ãðóïè 158,7/ 98,4 ìì ðò ñò..

×åðåç 6 ì³ñÿö³â ï³ñëÿ ë³êóâàííÿ îæèð³ííÿ ñïîñòåð³ãà-

ëîñü çíèæåííÿ ïîêàçíèê³â îô³ñíîãî ÀÒ. Ó ïàö³ºíò³â ²

ãðóïè ÑÀÒ çíèçèâñÿ íà 2,9 %, ÄÀÒ íà 4 %. Ó ïàö³ºíò³â ²²

ãðóïè ñïîñòåð³ãàëîñü çíèæåííÿ ÑÀÒ íà 18 %, ÄÀÒ íà 21 %

(òàáë. 3).

Òàêèì ÷èíîì, äëÿ ïàö³ºíò³â ²² ãðóïè, ÿê³ ë³êóâàëèñü çà

äîïîìîãîþ õ³ðóðã³÷íèõ îïåðàö³é, áóëî õàðàêòåðíå á³ëüø

ñóòòºâå çíèæåííÿ, ÿê ÑÀÒ òàê ³ ÄÀÒ, ùî áóëî ïîâ’ÿçàíî ç

á³ëüøîþ âòðàòîþ ìàñè ò³ëà.

Ïðè àíàë³ç³ ÄÌÀÒ, ïðè âèçíà÷åíí³ äîáîâîãî ³íäåêñó

ÑÀÒ òà ÄÀÒ, ó ïàö³ºíò³â îáîõ ãðóï áóëî âèÿâëåíî ïîðóøåí-

íÿ äîáîâîãî ðèòìó ÀÒ, â ñòðóêòóð³ ÿêîãî ïåðåâàæàëè ïàö³-

ºíòè ç íåäîñòàòí³ì çíèæåííÿì ÑÀÒ ³ ÄÀÒ âíî÷³ (“Non-

dipper”) òà ï³äâèùåííÿì ÑÀÒ ³ ÄÀÒ âíî÷³ (“Night piker”).

Ñåðåä ïàö³ºíò³â ² ãðóïè áóëî âèÿâëåíî 44 % ïàö³ºíò³â

ç ðèòìîì “Non-dipper” ÑÀÒ ³ 31% ÄÀÒ òà 27 % ïàö³ºíò³â ç

ðèòìîì “Night piker” ÑÀÒ ³ 17 % ÄÀÒ.

Òàáëèöÿ 2.

Äèíàì³êà àíòðîïîìåòðè÷íèõ äàíèõ

Ïðèì³òêà:*ð1-2<0,05; **ð3-4<0,05

Òàáëèöÿ 3.

Äèíàì³êà ïîêàçíèê³â îô³ñíîãî òà äîáîâîãî ìîí³òîðóâàííÿ àðòåð³àëüíîãî òèñêó

äî òà ÷åðåç 6 ì³ñÿö³â ï³ñëÿ ë³êóâàííÿ

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Ñåðåä ïàö³ºíò³â ²² ãðóïè áóëî âèÿâëåíî 44 % ïàö³ºíò³â

ç ðèòìîì “Non-dipper” ÑÀÒ ³ 54% ÄÀÒ òà 34 % ïàö³ºíò³â ç

ðèòìîì “Night piker” ÑÀÒ ³ 14 % ÄÀÒ (ðèñ.3,4,5,6).

Ïîä³áíå çá³ëüøåííÿ â³äñîòêà îñ³á ³ç íåäîñòàòí³ì çíè-

æåííÿì ÀÒ ó ïàñèâíèé ïåð³îä ìîí³òîðóâàííÿ ÀÒ ìîæíà

ïîÿñíèòè ïðèãí³÷åííÿì ïàðàñèìïàòè÷íî¿ ðåãóëÿö³¿, ùî

â³äïîâ³äàº çà çíèæåííÿ ÿê íîðìàëüíîãî, òàê ³ ï³äâèùåíîãî

ÀÒ â í³÷í³ ãîäèíè. ßê â³äîìî, ïðè îæèð³íí³ òà ã³ïåð³íñóë³-

íåì³¿ öÿ çàêîíîì³ðí³ñòü âòðà÷àºòüñÿ òà çì³íþºòüñÿ õðîí³÷-

íîþ ã³ïåðàêòèâàö³ºþ ñèìïàòè÷íî¿ íåðâîâî¿ ñèñòåìè.

Á³ëüø³ñòü äîñë³äíèê³â ââàæàº, ùî äîñë³äæåííÿ òà

çì³íè ÀÒ â í³÷íèé ÷àñ º á³ëüø âàæëèâèìè òà ³íôîðìàòèâ-

íèìè, í³æ ÀÒ ó äåííèé ÷àñ, äëÿ ïðîãíîçó ðîçâèòêó êàðä³-

îâàñêóëÿðíèõ óñêëàäíåíü òà ôàòàëüíèõ ïîä³é [21]. Òàê,

ïðè ïðîâåäåíí³ Dublin Outcome Study áóëî âèÿâëåíî, ùî

ïðè ï³äâèùåíí³ â í³÷íèé ÷àñ ÑÀÒ íà 10 ìì ðò.ñò. ðèçèê

ñìåðòíîñò³ çá³ëüøèâñÿ íà 21 % [22]. Íåñïðèÿòëèâèìè ó

ïðîãíîñòè÷íîìó â³äíîøåíí³ ââàæàþòüñÿ òàê³ òèïè äîáî-

âîãî ïðîô³ëþ: ôåíîìåíè non-dipper òà night-peakers, îñ-

ê³ëüêè íåäîñòàòíº çíèæåííÿ ÀÒ ó í³÷íèé ïåð³îä àñîö³-

Ðèñ 3. Ñòðóêòóðà äîáîâîãî ïðîô³ëþ ÑÀÒ ó ïàö³ºíò³â ² ãðóïè äî òà ÷åðåç 6 ì³ñÿö³â ï³ñëÿ ë³êóâàííÿ.

Ðèñ 4. Ñòðóêòóðà äîáîâîãî ïðîô³ëþ ÄÀÒ ó ïàö³ºíò³â ² ãðóïè äî òà ÷åðåç 6 ì³ñÿö³â ï³ñëÿ ë³êóâàííÿ.

Ðèñ. 6 Ñòðóêòóðà äîáîâîãî ïðîô³ëþ ÄÀÒ ó ïàö³ºíò³â ²² ãðóïè äî òà ÷åðåç 6 ì³ñÿö³â ï³ñëÿ ë³êóâàííÿ.

Ðèñ 5. Ñòðóêòóðà äîáîâîãî ïðîô³ëþ ÑÀÒ ó ïàö³ºíò³â ²² ãðóïè äî òà ÷åðåç 6 ì³ñÿö³â ï³ñëÿ ë³êóâàííÿ.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

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þºòüñÿ ç âåëèêîþ ÷àñòîòîþ ïåðåíåñåíîãî ³íñóëüòó, á³ëüø

÷àñòèì ðîçâèòêîì ã³ïåðòðîô³¿ ì³îêàðäó ë³âîãî øëóíî÷êà,

÷àñòîòîþ òà ñòóïåíåì ì³êðîàëüáóì³íóð³¿ [23, 24], à ðîçâè-

òîê ôåíîìåíó over-dipper ñóïðîâîäæóºòüñÿ ã³ïîïåðôóç-

³éíèìè óñêëàäíåííÿìè, çîêðåìà â³äçíà÷àºòüñÿ âèñîêèé

ðèçèê ðîçâèòêó ³øåì³÷íîãî ³íñóëüòó ÷è òðîìáîåìáîë³¿

ëåãåíåâî¿ àðòåð³¿, ùî îñîáëèâî íåáåçïå÷íî ïðè ñóïóòí³é

êîðîíàðí³é ïàòîëîã³¿ òà óðàæåíí³ ñîííî¿ àðòåð³¿.

×åðåç 6 ì³ñÿö³â ï³ñëÿ ë³êóâàííÿ äîáîâèé ïðîô³ëü ÀÒ ó

õâîðèõ ² ãðóïè ôàêòè÷íî íå çì³íèâñÿ, ñïîñòåð³ãàëîñü ïåðå-

âàæàííÿ ïàö³ºíò³â ç äîáîâèì ïðîô³ëåì “Non-dipper”

(47% CÀÒ, 31 % ÄÀÒ) òà “Night piker” (20 % ÑÀÒ, 15 % ÄÀÄ).

Ùî ñòîñóºòüñÿ ïàö³ºíò³â ²² ãðóïè, òî ÷åðåç 6 ì³ñÿö³â

ï³ñëÿ ë³êóâàííÿ â ñòðóêòóð³ äîáîâîãî ïðîô³ëþ ÀÒ ïåðå-

âàæàëè ïàö³ºíòè ç ïðîô³ëåì “Dipper” (54 % CÀÒ, 77 %

ÄÀÒ), â³äáóëîñÿ çíà÷íå çìåíøåííÿ ïàö³ºíò³â ç ïðîô³ëåì

“Non-dipper” òà “Night piker”. Òàêèì ÷èíîì, çíèæåííÿ

ìàñè ò³ëà ñóïðîâîäæóâàëîñü ïîêðàùåííÿì öèðêàäíîãî

ðèòìó äîáîâîãî ïðîô³ëþ ÀÒ.

Âèñíîâêè

1. Ó õâîðèõ íà àðòåð³àëüíó ã³ïåðòåíç³þ òà ìîðá³äíå

îæèð³ííÿ äîáîâèé ïðîô³ëü ÀÒ õàðàêòåðèçóâàâñÿ ï³äâè-

ùåííÿì ÑÀÒ ³ ÄÀÒ ïðîòÿãîì äîáè òà ïîºäíóâàâñÿ ç ïîðó-

øåííÿìè öèðêàäíîãî ðèòìó ÀÒ ó âèãëÿä³ íåäîñòàòíüîãî

éîãî çíèæåííÿ â í³÷í³ ãîäèíè (non-dipper, night-piker), ùî

äîçâîëÿº â³äíåñòè öèõ õâîðèõ äî ãðóïè âèñîêîãî ðèçèêó

âèíèêíåííÿ ñåðöåâî-ñóäèííèõ óñêëàäíåíü.

2. Çàñòîñóâàííÿ ìåäèêàìåíòîçíèõ òà õ³ðóðã³÷íèõ ìå-

òîä³â ë³êóâàííÿ îæèð³ííÿ ñóïðîâîäæóâàëîñü çíèæåííÿì

ìàñè ò³ëà. Á³ëüø ñóòòºâå çíèæåííÿ ìàñè ò³ëà ñïîñòåð³ãà-

ëîñü ó ïàö³ºíò³â ²² ãðóïè (íà 22,8%), ÿê³ ë³êóâàëèñü çà äîïî-

ìîãîþ õ³ðóðã³÷íèõ îïåðàö³é â ïîð³âíÿíí³ ïàö³ºíòàìè

² ãðóïè (íà 4,6%).

3. Çíèæåííÿ ìàñè ò³ëà ñóïðîâîäæóâàëîñü çíèæåí-

íÿì ÑÀÒ ³ ÄÀÒ ó ïàö³ºíò³â ² òà ²² ãðóïè. Á³ëüø ñóòòºâå

çíèæåííÿ ÀÒ (íà 18 % ÑÀÒ òà íà 21 % ÄÀÄ) ñïîñòåð³ãà-

ëîñü ó ïàö³ºíò³â ²² ãðóïè, ùî áóëî ïîâ’ÿçàíî ç á³ëüøîþ

âòðàòîþ ìàñè ò³ëà.

4. Çíèæåííÿ ìàñè ò³ëà ñóïðîâîäæóâàëîñü ïîêðà-

ùåííÿì öèðêàäíîãî ðèòìó äîáîâîãî ïðîô³ëþ ÀÒ ó

ïàö³ºíò³â ²² ãðóïè, òîáòî ñïîñòåð³ãàëîñü çìåíøåííÿ

ïàö³ºíò³â ç äîáîâèì ïðîô³ëåì “Non-dipper” òà “Night

piker” òà çá³ëüøåííÿì ïàö³ºíò³â ç ô³ç³îëîã³÷íèì äâîôàç-

íèì ðèòìîì “Dipper”. Ùî ñòîñóºòüñÿ ïàö³ºíò³â ² ãðóïè, òî

çíà÷èìèõ çì³í äîáîâîãî ïðîô³ëþ ÀÒ íå áóëî âèÿâëåíî.

Ðåöåíçåíò:ä.ìåä.í., ïðîôåñîð Ëèçîãóá Â.Ã.

Ë²ÒÅÐÀÒÓÐÀ

1. Âëàñåíêî Ì.Â., Ñåìåíþê ².Â., Ñëîáîäÿíþê Ã.Ã. Öóêðîâèé

ä³àáåò ³ îæèð³ííÿ – åï³äåì³ÿ XXI ñòîë³òòÿ: ñó÷àñíèé ï³äõ³ä äî

ïðîáëåìè // Óêðà¿íñüêèé òåðàïåâòè÷íèé æóðíàë. – 2011. – ¹ 2.

– Ñ. 50-55.

2. Ìèò÷åíêî Å.È, Ìàìåäîâ Ì.Í., Êîëåñíèê Ò.Â, Äååâ À.Ä.

Ñîâðåìåííûé ïðîôèëü ôàêòîðîâ ðèñêà ñåðäå÷íî-ñîñóäèñòûõ

çàáîëåâàíèé â ãîðîäñêîé ïîïóëÿöèè Óêðàèíû//Óêðà¿íñüêèé êàðä-

³îëîã³÷íèé æóðíàë. – 2013.- ¹ 4 Äîäàòêîâèé. – Ñ. 76–83.

3. Bray G.A.; Bellanger T. Pennington Biomedical Research

Center, Baton Rouge, LA, USA. Epidemiology, trends, and morbidities

of obesity and the metabolic syndrome. Endocrine. 2006; 29(1):109-

17 (ISSN: 0969-711X).

4. Êîâàëåíêî Â.Ì., Êîðíàöüêèé Â.Ì. (ðåä.) (2013) Õâîðîáè

ñèñòåìè êðîâîîá³ãó: äèíàì³êà òà àíàë³ç. (àíàë³òè÷íî-ñòàòèñ-

òè÷íèé ïîñ³áíèê). Êè¿â, ñ. 26–29.

5. Bae S, Kim J, Min K, Kwon S, Han D. Patient Compliance

and Associated Factors in the Community-based Hypertension Control

Program. Korean J Prev Med. 1999 Jun; 32(2):215-227.

6. Sjöström L. Surgical treatment of obesity. An overview and

results from the SOS study. In: Bray GA, Bouchard C, ed. Handbook

of obesity clinical applications. 2nd ed. New York: Marcel Dekker,

2004:359-89.

7. Kario K., Pickering T.G., Matsuo T. et al. Stroke prognosis

and abnormal nocturnal blood pressure falls in older hypertensives /

/ Hypertension.– 2001. – Vol. 38 (4). – P. 852-857.

8. Lewington S., Clarke R., Qizilbash N. Age-specific relevance

of usual blood pressure to vascular mortality // The Lancet. – 2003. –

Vol. 361, Issue 9366. – Ð. 1391-1392.

9. O’Brien E. Sleepers versus nonsleepers, another twist to the

dipper/nondipper concept // Hypertension. – 2007. – Vol. 49. – P.

769-770.

10 . Mancia G., Parati G. Ambulatory Blood Pressure Monitoring

and Organ Damage // Hypertension. – 2000. – Vol. 36. – P. 894.

11. Kikuya M., O. Takayoshi, Kei A. et al. Ambulatory blood

pressure and 10 – year risk of cardiovascular and noncardiovascular

mortality. The Ohasama study //Hypertension. -2005. – Vol.45. – P.

240-245.

12. AHA/ACC/TOS Guideline for the Management of

Overweight and Obesity in Adults: A Report of the American College

of Cardiology/American Heart Association Task Force on Prac-

tice Guidelines and The Obesity SocietyNovember 12, 2013; Cir-

culation.

13. WJ Pories et al. “Beyond the BMI: The Search for Better

Guidelines for Bariatric Surgery.” Obesity. 2010. 18:865-871

14. Salem, V. and Bloom S. Approaches to the Pharmacological

Treatment of Obesity: What are the Current Treatment Options? Expert

Review of Clinical Pharmacology (2010)

15 . Ëàâðèê À. Ñ., Òûâîí÷óê À. Ñ., Ëàâðèê Î. À. Âëèÿíèå îïåðà-

öèè áàíäàæèðîâàíèÿ æåëóäêà íà êà÷åñòâî æèçíè áîëüíûõ ìîð-

áèäíûì // Îæèðåíèå è ìåòàáîëèçì. 2011. ¹4.

16. Nadler EP, Reddy S, Isenalumhe A, et al. Laparoscopic

adjustable gastric banding for morbidly obese adolescents affects

android fat loss, resolution of co-morbidities, and improved metabolic

status. J Am Coll Surg. 2009 Nov;209(5):638-44. Epub 2009

Aug 29.

17 . Ëàâðèê À.Ñ., Ñàåíêî Â.Ô., Òûâîí÷óê À.Ñ., Àíäðååùåâ Ñ. À.,

Ôóðìàíåíêî Å.Ä. Øóíòèðîâàíèå æåëóäêà â õèðóðãè÷åñêîì ëå÷å-

íèè ïàòîëîãè÷åñêîãî îæèðåíèÿ //Êë³í. Õ³ðóðã³ÿ. – 2002. – ¹ 3. –

Ñ.14–17.

18 . Boza, C. et al. Laparoscopic Roux-en-Y gastric bypass versus

laparoscopic adjustable gastric banding: five years of follow-up,

(2010).

19. Mancia G., Fagard R., Narkiewicz K. et al. 2013 ESH/ESC

Guidelines for the management of arterial hypertension: The Task

Force for the management of arterial hypertension of the European

Society of Hypertension (ESH) and of the European Society of

Cardiology (ESC) // Journal of Hypertension. –2013. – Vol. 31, Iss. 7. –

P. 1281-1357.

20. Àðòåð³àëüíà ã³ïåðòåíç³ÿ. Îíîâëåíà òà àäàïòîâàíà

êë³í³÷íà íàñòàíîâà, çàñíîâàíà íà äîêàçàõ (2012 ð³ê): ïðàêòè÷í³

ðåêîìåíäàö³¿; ïðîåêò / Ðîáî÷à ãðóïà ç àðòåð³àëüíî¿ ã³ïåðòåíç³¿

Óêð. àñîö. êàðä³îëîã³â // Àðòåðèàëüíàÿ ãèïåðòåíçèÿ. – 2012. – ¹

1. – Ñ. 96-152.

21 . Collins R., Peto R., MacMahon S. et al. Blood pressure, stroke,

and coronary heart disease–Part 2, short-term reductions in blood

pressure: overview of randomised drug trials in their epidemiological

context // Lancet. – 1990. – Vol. 335. – Ð. 827-838.

22 . Dolan E., Stanton A., Thijs L. et al. Superiority of ambulatory

over clinic blood pressure measurement in predicting mortality:

the Dublin Outcome Study // Hypertension. – 2005. – Vol. 46. –

P. 156-161.

23. Kario K. Stroke prognosis and abnormal nocturnal blood

pressure falls in older hypertensive // Hypertension. – 2001. – ¹ 38

(4). – Ð. 852-857.

24. O’Brien E. Use and interpretation of ambulatory blood

pressure monitoring: recommendations of the British Hypertension

Society // BMJ. – 2000. – ¹ 320. – P. 1128-1134.

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ÂËÈßÍÈÅ ÌÅÄÈÊÀÌÅÍÒÎÇÍÛÕ

È ÕÈÐÓÐÃÈ×ÅÑÊÈÕ ÌÅÒÎÄÎÂ ËÅ×ÅÍÈß

ÍÀ ÏÐÎÔÈËÜ ÀÐÒÅÐÈÀËÜÍÎÃÎ ÄÀÂËÅÍÈß

Ó ÁÎËÜÍÛÕ ÌÎÐÁÈÄÍÛÌ ÎÆÈÐÅÍÈÅÌ

È ÀÐÒÅÐÈÀËÜÍÎÉ ÃÈÏÅÐÒÅÍÇÈÅÉ

Øêð¸áà À.À.1, Ìèò÷åíêî Å.È.1,

Ëàâðèê À.Ñ.2, Ðîìàíîâ Â.Þ.1

1ÃÓ “ÍÍÖ “Èíñòèòóò êàðäèîëîãèè

èìåíè àêàäåìèêà Ì.Ä. Ñòðàæåñêî” ÍÀÌÍ

Óêðàèíû, ã. Êèåâ, Óêðàèíà

2ÃÓ “Íàöèîíàëüíûé èíñòèòóò õèðóðãèè

è òðàíñïëàíòîëîãèè èìåíè À.À.Øàëèìîâà”

ÍÀÌÍ Óêðàèíû, ã. Êèåâ, Óêðàèíà

Ðåçþìå. Ïðèìåíåíèå ìåäèêàìåíòîçíûõ è õèðóðãè-

÷åñêèõ ìåòîäîâ ñîïðîâîæäàëîñü ñíèæåíèåì ìàññû

òåëà. Áîëåå çíà÷èòåëüíîå ñíèæåíèå ìàññû òåëà íàáëþ-

äàëîñü ó ïàöèåíòîâ II ãðóïïû, ÷òî ñîïðîâîæäàëîñü ñíè-

æåíèåì îôèñíîãî ÀÄ è óëó÷øåíèåì öèðêàäíîãî ðèòìà

ñóòî÷íîãî ïðîôèëÿ ÀÄ.

Êëþ÷åâûå ñëîâà: ìîðáèäíîå îæèðåíèå, àðòåðèàëü-

íàÿ ãèïåðòåíçèÿ, ñóòî÷íîå ìîíèòîðèðîâàíèå àðòåðè-

àëüíîãî äàâëåíèÿ, ìåäèêàìåíòîçíîå ëå÷åíèå, õèðóðãè-

÷åñêîå ëå÷åíèå.

EFFECT OF MEDICAL AND SURGICAL

TREATMENTS FOR BLOOD PRESSURE PROFILE

IN PATIENTS WITH MORBID OBESITY

AND HYPERTENSION

A.A. Shkroba1, O.I. Mitchenko1,

A.S. Lavrik2, V.Y. Romanov1

1State Institution “NSC “M.D. Strazhesko institute

of cardiology” MAS of Ukraine, Kyiv, Ukraine

2State Institution “National Institute of Surgery

and Transplantation A.A.Shalimova” MAS of Ukraine,

Kyiv, Ukraine

Summary. Using medication and surgical methods was

accompanied by the weight loss. A significant reduction in

body weight was observed in patients of the second group

that was associated with decreased office BP and improved

circadian rhythm of blood pressure profile.

Key words: morbid obesity, hypertension, ambulatory

blood pressure monitoring, medication treatment, surgical

treatment.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

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Âñòóï. Ðàê ãîðòàí³ – íàéá³ëüø ÷àñòà çëîÿê³ñíà ïóõëèíà

âåðõí³õ äèõàëüíèõ øëÿõ³â ³ ïîñ³äàº 8-ìå ì³ñöå â ñòðóêòóð³

çàõâîðþâàíîñò³ íà çëîÿê³ñí³ íîâîóòâîðåííÿ. Ùîð³÷íî

âèÿâëÿºòüñÿ 12-14 õâîðèõ íà ðàê ãîðòàí³ íà 100 000

íàñåëåííÿ. Åò³îëîã³ÿ çàõâîðþâàííÿ íåâèâ÷åíà. Çà äàíèìè

äîñë³äæåíü ñïðèÿòëèâèìè ôàêòîðàìè º â³ê (40-70 ðîê³â),

ñòàòü (÷îëîâ³êè õâîð³þòü ÷àñò³øå í³æ æ³íêè), àëêîãîëüíà

òà í³êîòèíîâà ³íòîêñèêàö³ÿ. Äîáðîÿê³ñí³ ïóõëèíè,

ëåéêîïëàê³¿, õðîí³÷íèé ëàðèíã³ò òàêîæ ñïðèÿþòü ðîçâèòêó

çëîÿê³ñíèõ íîâîóòâîðåíü.

Âèä³ëÿþòü äâ³ ãðóïè ïåðåäðàêîâèõ çàõâîðþâàíü. Äî

ïåðøî¿ â³äíîñÿòüñÿ çàõâîðþâàííÿ ç âèñîêîþ ÷àñòîòîþ

ìàë³ãí³çàö³¿ (îáë³ãàòí³): ïàï³ëîìà, ïàï³ëîìàòîç. Äðóãà

îá’ºäíóº çàõâîðþâàííÿ ç ìàëîþ ÷àñòîòîþ ìàë³ãí³çàö³¿

(ôàêóëüòàòèâí³): ô³áðîìà, ê³ñòè. Çà ã³ñòîëîã³÷íîþ áóäî-

âîþ çëîÿê³ñíèõ ïóõëèíè ãîðòàí³ ÷àñò³øå çóñòð³÷àºòüñÿ

ïëîñêîêë³òèííèé ðàê. Çíà÷íî ð³äøå – áàçàëüíîêë³òèííèé

ðàê, àäåíîêàðöèíîìà.

Íà ðàíí³õ ñòàä³ÿõ ðàê ãîðòàí³ óñï³øíî ë³êóºòüñÿ ïðîìå-

íåâîþ òåðàï³ºþ, à íà á³ëüø ï³çí³õ ñòàä³ÿõ – ë³êóâàííÿ ïîëÿ-

ãàº â ïîºäíàíí³ õ³ðóðã³÷íî¿, ïðîìåíåâî¿ òà õ³ì³îòåðàï³¿.

Ìåòà äîñë³äæåííÿ: äîñë³äèòè ìåòîäè ë³êóâàííÿ õâî-

ðèõ ðàêîì ãîðòàí³ III ñòàä³¿ íà îñíîâ³ ðåòðîñïåêòèâíîãî

àíàë³çó ìåäè÷íèõ êàðò õâîðèõ, âèçíà÷èòè íàéá³ëüø ðàö³î-

íàëüíèé ìåòîä.

Ìàòåð³àëè òà ìåòîäè: â õîä³ âèêîíàíî¿ ðîáîòè áóëè

âèâ÷åí³ ìàòåð³àëè ³ñòîð³é õâîðîáè òà êàðòî÷êè 52 õâîðèõ,

ùî ïðîõîäèëè ë³êóâàííÿ ç ïðèâîäó ðàêà ãîðòàí³ â

²íñòèòóò³ îòîëàðèíãîëîã³¿ ³ì. ïðîô. Î.Ñ.Êîëîì³é÷åíêà

ÍÀÌÍ Óêðà¿íè ó â³ää³ë³ îíêîïàòîëîã³¿ ËÎÐ-îðãàí³â ç

êâ³òíÿ 2000 ðîêó ïî âåðåñåíü 2008 ðîêó.

Ðåçóëüòàòè òà îáãîâîðåííÿ. Áóëî âèâ÷åíî äàíí³ 52

õâîðèõ. Âñ³ õâîð³ áóëè ÷îëîâ³÷î¿ ñòàò³ (â³ä 46 äî 64 ðîê³â).

Âñ³ì õâîðèì áóëî ïðîâåäåíî îáñòåæåííÿ: çîâí³øí³é

îãëÿä ³ ïàëüïàö³ÿ øè¿ òà ðåã³îíàðíèõ ë³ìôîâóçë³â;

ëàðèíãîñêîï³ÿ, (ïðè óòðóäíåíîìó îãëÿä³ âîíà äîïîâ-

íþâàëàñü ëàðèíãîô³áðîñêîï³ºþ ³ êîìï’þòåðíîþ òîìî-

ãðàô³ºþ). Îáñòåæåííÿ ãîðòàí³ çàâåðøèëîñü á³îïñ³ºþ

ïóõëèíè.

Ã³ñòîëîã³÷íå äîñë³äæåííÿ ïîêàçàëî, ùî ïðåâàëþâàëè

ïëîñêî êë³òèíí³ ôîðìè ðàêà, â òîìó ÷èñë³ îðîãîâ³âàþ÷³ ó

49 õâîðèõ, íåîðîãîâ³âàþ÷³ ó 2, íåäèôåðåíö³éîâàíèé ðàê ó

1 õâîðîãî.

Ó âñ³õ 52 õâîðèõ íà ðàê ãîðòàí³ ñòóï³íü ïîøèðåíîñò³

çëîÿê³ñíîãî ïðîöåñó â³äðîâ³äàëà Ò3NxM0. Âñ³ õâîð³ áóëè

÷îëîâ³÷î¿ ñòàò³ ó â³ö³ â³ä 46 äî 64 ðîê³â. Öå â³äïîâ³äàº åï³äå-

ÓÄÊ 616

ÏÎÐ²ÂÍßËÜÍÀ ÎÖ²ÍÊÀ ÌÅÒÎÄ²Â ÊÎÌÁ²ÍÎÂÀÍÎÃÎ

Ë²ÊÓÂÀÍÍß ÕÂÎÐÈÕ ÍÀ ÐÀÊ ÃÎÐÒÀÍ² ²²² ÑÒÀÄ²¯

Øîâêîâàÿ Î.Â.

²íñòèòóò îòîëàðèíãîëîã³¿ ³ìåí³ ïðîôåñîðà Î.Ñ.Êîëîì³é÷åíêà ÍÀÌÍ Óêðà¿íè, ì. Êè¿â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: ðàê ãîðòàí³, êîìá³íîâàíå ë³êóâàííÿ, ïðîìåíåâà òåðàï³ÿ, õ³ì³îòåðàï³ÿ.

ì³îëîã³÷íèì äàíèì ïðî ñòàòåâ³ òà â³êîâ³ îñîáëèâîñò³ ïî-

øèðåíîñò³ ðàêó ãîðòàí³ â Óêðà³í³.

Êë³í³÷í³ ïðîÿâè ðàêà ãîðòàí³ çàëåæàëè, â ïåðøó ÷åðãó,

â³ä ëîêàë³çàö³¿ ³ ïîøèðåíîñò³ óðàæåííÿ, à òàêîæ ôîðìè

ðîñòó ïóõëèíè, ñóïóòí³õ çàïàëüíèõ ÿâèù.

Ó 16 (30,7%) ïàö³ºíò³â ïóõëèííèé ïðîöåñ îáìåæåíèé

çâ’ÿçêîâèì â³ää³ëîì ãîðòàí³. Óðàæåííÿ äâóõ â³ää³ë³â ãîð-

òàí³ (çâ’ÿçêîâîãî ³ íàäçâ’ÿçêîâîãî) â³äì³÷åíî ó 25 (48,0%)

õâîðèõ. Ó 11 (21,3%) õâîðèõ â³äì³÷àëèñü óðàæåííÿ âñ³õ

â³ää³ë³â ãîðòàí³.

Ó 29 (55,7%) õâîðèõ â³äì³÷åíèé çì³øàíèé òèï ðîñòó

ïóõëèí, ó 15 (28,8%) õâîðèõ – åêçîô³òíèé, ó 6 (15,5%) –

åíäîô³òíèé.

Ã³ñòîëîã³÷íå äîñë³äæåííÿ ïîêàçàëî, ùî îñíîâíó

äîëþ õâîðèõ ñêëàäàëè âèïàäêè ïëîñêîêë³òèííîãî ðàêó

ãîðòàí³. ²íø³ ã³ñòîòèïè ïóõëèí áóëè îäèíè÷íèìè. Ç 52

õâîðèõ ðàêîì ãîðòàí³ III ñòàä³¿ ó 10 (19,2%) âèÿâëåí³ îäè-

íî÷í³ ìåòàñòàçè â ðåã³íîíàðí³ ë³ìôîâóçëè (Ò3N1M0), ó

³íøèõ 42 (80,8%) ¿õ íå áóëî (Ò3N0M0). Ó 6 õâîðèõ ìåòàñòà-

òè÷í³ ë³ìôîâóçëè çíàõîäèëèñü â îáëàñò³ ñîííîãî òðèêóò-

íèêà, ó 3 – â íàäêëþ÷è÷í³é îáëàñò³ ³ ó 1 – â ï³äùåëåïíîìó

òðèêóòíèêó. Âñ³ì õâîðèì îêð³ì çàãàëüíî êë³í³÷íîãî äîñ-

ë³äæåííÿ ïðîâîäèëèñü ³íñòðóìåíòàëüí³ ìåòîäè äîñë³ä-

æåííÿ – íåïðÿìà ³ ïðÿìà ëàðèíãîñêîï³ÿ, á³÷íà ðåíòãåíî-

ãðàô³ÿ øè¿ ïî Çåìöîâó, ïðè íåîáõ³äíîñò³ ïîøàðîâà ÊÒ

ãîðòàí³, îãëÿä äèõàëüíèõ øëÿõ³â çà äîïîìîãîþ ãíó÷êîãî

ô³áðîîïòè÷íîãî åíäîñêîïó, à òàêîæ öèòîëîã³÷íå ³ ã³ñòî-

ëîã³÷íå äîñë³äæåííÿ á³îïòàò³â ïóõëèí. Âñ³ 52 ïàö³ºíòè

ï³ñëÿ êîìïëåêñíîãî äîñë³äæåííÿ áóëè ï³ääàí³ ïðîòèïóõ-

ëèííîìó ë³êóâàííþ ïî ðàäèêàëüí³é ïðîãðàì³. Â çàëåæ-

íîñò³ â³ä ìåòàñòàç³â ïðîâåäåíîãî ë³êóâàííÿ õâîðèõ ðîç-

ä³ëèëè íà 4 ãðóïè.

I ãðóïà ñêëàäàëàñü ç 22 (42,3%) õâîðèõ, ùî îòðèìàëè

ðîçùåïëåíèé êóðñ äèñòàíö³éíî¿ òåëåãàììàòåðàï³¿ â ðà-

çîâ³é äîç³ (ÐÂÄ) 2 Ãð äî ñóìàðíî¿ âîãíèùåâî¿ äîçè (ÑÌÄ)

60 Ãð â ðåæèì³ äâîõ çóñòð³÷íèõ ïîë³â.

II ãðóïà ñêëàäàëàñü ç 13 (25,0%) õâîðèõ, ÿêèì áóëà âè-

êîíàíà îïåðàö³ÿ ëàðèíãîåêòîì³¿ ï³ñëÿ ïðîâåäåííÿ ðàäè-

êàëüíîãî êóðñó äèñòàíö³éíî¿ òåëåãàììàòåðàï³¿ â ðàçîâ³é

âîãíèùåâ³é äîç³ – 2 Ãð äî ñóìàðíî¿ âîãíèùåâî¿ äîçè 60 Ãð

â ðåæèì³ ç äâîõ çóñòð³÷íèõ ïîë³â.

III ãðóïà ñêëàäàëàñü ç 9 (17,3%) õâîðèõ, ÿê³ îòðèìàëè

êîìá³íîâàíå ë³êóâàííÿ: 2 êóðñó íåîàä’þâàíòíî¿ ïîë³-

õ³ì³îòåðàï³¿ ïî ñõåì³ Öèñïëàòèí 80 ìã/ì2 â 1-é äåíü ³ Ôòî-

ðóðàöèë 750 ìã/ì2 â 1-5-é äåíü, ÐÂÄ 2 Ãð äî ÑÂÄ 4 Ãð

³ àä‘þâàíòíó õ³ì³îòåðàï³þ 2 êóðñà ïî ò³é æå ñõåì³.

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IV ãðóïà ñêëàäàëàñü ç 8 (15,4%) õâîðèõ, ÿê³ îòðèìàëè

êîìá³íîâàíå ë³êóâàííÿ : 2 êóðñà íåîàä`þâàíòíî¿ âíóòð³ø-

íüîàðòåð³àëüíî¿ õ³ì³îòåðàï³¿ ïî ñõåì³ Òàêñîòåð 75 ìã/ì2 ³

Öèñïëàòèí 80 ìã/ì2 â 1é äåíü, ëàðèíãåêòîì³ÿ, äèñòàíö³éíà

òåëåãàìàòåðàï³ÿ ÐÂÄ 2 Ãð äî ÑÂÄ 40 Ãð.

Áåçïîñåðåäí³ ðåçóëüòàòè ë³êóâàííÿ â I ³ II ãðóïàõ õâî-

ðèõ â òàáëèö³ 1.

ßê âèäíî ç òàáëèö³ 1, õâîðèõ ç ïîâíîþ ðåãðåñ³ºþ ïóõ-

ëèíè ï³ñëÿ ïðîâåäåíî¿ ïðîìåíåâî¿ òåðàï³¿ áóëà ïðèáëèç-

íî îäíàêîâà ê³ëüê³ñòü â îáîõ ãðóïàõ. Õâîðèõ ç ÷àñòêîâîþ

ðåãðåñ³ºþ â ïåðø³é ãðóï³ áóëî òðîõè á³ëüøå, í³æ â

äðóã³é. Ó âñ³õ õâîðèõ ç äðóãî¿ ãðóïè ÷åðåç 1,5 – 2 ðîêè

ðîçâèâàâñÿ ðåöèäèâ, ó çâ‘ÿçêó ç ÷èì ¿ì, òà õâîðèì ç ÷àñ-

òêîâîþ ðåãðåñ³ºþ ³ áåç ðåãðåñ³¿ ïóõëèíè ïðîâîäèëàñü

ëàðèíãåêòîì³ÿ.

×àñòîòà ³ ñòðîêè ðîçâèòêó ðåöèäèâ³â ³ ìåòàñòàç³â â I ³ II

ãðóïàõ õâîðèõ íà ðàê ãîðòàí³ ïðèâåäåí³ â òàáë. 2.

Ç íàâåäåíèõ ó òàáëèö³ 2 äàíèõ, âèäíî, ùî íàé÷àñò³øå

ðåöèäèâè ³ ìåòàñòàçè ç‘ÿâëÿëèñÿ ï³ñëÿ äèñòàíö³éíî¿ òåëå-

ãàìàòåðàï³¿ (48,6%), í³æ ï³ñëÿ äèñòàíö³éíî¿ òåëåãàìà-

òåðàï³¿ ç ëàðèíãåêòîì³ºþ (40,8%).

Ïðè öüîìó ï³ñëÿ äèñòàíö³éíî¿ òåëåãàìàòåðàï³¿ (ÄÒÃÒ)

ðåöèäèâè ðîçâèâàëèñÿ ó 12 (54,5%), ³ ìåòàñòàçè ó 4 (18,0%)

õâîðèõ, à ï³ñëÿ äèñòàíö³éíî¿ òåëåãàìàòåðàï³¿ ç ëàðèíãåêòî-

ì³ºþ (ÄÒÃÒ ç ËÅ) â³äïîâ³äíî ó 1 (7,6%), ³ 3 (22,%) õâîðèõ.

Àíàë³ç îòðèìàíèõ äàíèõ çà ñòðîêàìè âèíèêíåííÿ ðå-

öèäèâ³â ³ ìåòàñòàç³â ïîêàçàâ, ùî ï³ñëÿ ÄÒÃÒ ðåöèäèâè ³

ìåòàñòàçè ÷àñò³øå ðîçâèâàëèñÿ â ïåð³îä â³ä 1 äî 3 ðîê³â

(â³äïîâ³äíî 4,5% ³ 9,0%), ïðè÷îìó âîíè ïðîÿâëÿëèñÿ óæå

â ïåðøèé ð³ê ï³ñëÿ ïî÷àòêó ë³êóâàííÿ â 9,0% ³ 4,5% âè-

ïàäê³â, äîñÿãàþ÷è ìàêñèìóìà äî 3 ðîêó ³ çìåíøóþ÷èñü

äî 5 ðîêó äî 41,0% ³ 4,5%. Â ãðóï³ õâîðèõ, ùî îòðèìàëè

êîìá³íîâàíå ë³êóâàííÿ, íàéá³ëüøà ê³ëüê³ñòü õâîðèõ ç ðå-

öèäèâàìè ³ ìåòàñòàçàìè â³äì³÷åíà ïðîòÿãîì ïåðøîãî

ðîêó ï³ñëÿ ïî÷àòêó ë³êóâàííÿ (â³äïîâ³äíî 9,0% ³ 4,5%), â

ñòðîêè â³ä 1-3 ³ 3-5 ðîê³â ðîçâèâàëèñÿ ëèøå ìåòàñòàçè, ðå-

öèäèâ³â íå áóëî.

Ïðè àíàë³ç³ ïî ðîêàõ áóëî â³äì³÷åíî, ùî â II ãðóï³ áóëî

ìåíøå ðåöèäèâ³â ³ ìåòàñòàç³. Òàêèì ÷èíîì êîìá³íîâàíå

ë³êóâàííÿ ç âêëþ÷åííÿì ËÅ äîçâîëÿº ñóòòºâî çíèçèòè

ðîçâèòîê ðåöèäèâ³â ³ ìåòàñòàç³â ðàêà ãîðòàí³ ïðîòÿãîì 5

ðîê³â ï³ñëÿ ïî÷àòêó ë³êóâàííÿ.

Ðåçóëüòàòè äîñë³äæåííÿ ïîêàçàëè, ùî ÷àñòîòà ³ ñòðîêè

ðîçâèòêó ðåöèäèâ³â ³ ìåòàñòàç³â ï³ñëÿ ïðîâåäåííÿ êîìá³-

íîâàíîãî ë³êóâàííÿ â III ³ IV ãðóïàõ õâîðèõ íà ðàê ãîðòàí³

ð³çíÿòüñÿ â çàëåæíîñò³ â³ä ìåòîäà ïðîâåäåíîãî ë³êóâàííÿ

(òàáë. 3).

Ïðîàíàë³çóâàâøè äàí³ çà ñòðîêàìè ïðîÿâëåííÿ ðåöè-

äèâ³â ³ ìåòàñòàç³â ìè ïðèéøëè äî âèñíîâêó, ùî ï³ñëÿ ïîë³-

õ³ì³îòåðàï³¿ ç äèñòàíö³éíîþ òåëåãàìàòåðàï³ºþ ðåöèäèâè ³

ìåòàñòàçè ÷àñò³øå ðîçâèâàëèñü ïðîòÿãîì ïåðøîãî ðîêó.

Íà ïåðøîìó ðîö³ ðåöèäèâè âèÿâëåíî ó 1 (11,1%) õâîðîãî,

â ïîäàëüø³ ðîêè íå áóëî. Ó 2 (22,2%) õâîðèõ áóëè

ìåòàñòàçè â ñòðîê äî 1 ðîêó, 1 (11,1%) â ñòðîê 1–3 ðîêè, â

ñòðîêè 3-5 ðîê³â íå áóëî.

Â IV ãðóï³ õâîðèõ ðåöèäèâè â³äì³÷åí³ ëèøå ó 1 (12,5%)

õâîðîãî â 1 ð³ê, â ïîäàëüø³ ðîêè ðåöèäèâ³â íå âèÿâëåíî.

Ìåòàñòàçè áóëè ó 1 (12,5%) õâîðîãî â ïåð³îä 3–5 ðîê³â

Òàáëèöÿ 1.

Òàáëèöÿ 3.

Òàáëèöÿ 2.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

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ï³ñëÿ ë³êóâàííÿ. Îòðèìàí³ äàí³ äîçâîëÿþòü çðîáèòè âèñ-

íîâê, ùî ïðîâåäåííÿ êîìá³íîâàíîãî ë³êóâàííÿ ç âèêîðèñ-

òàííÿì òàêèõ ìåòîä³â ÿê âíóòð³øíüîàðòåð³àëüíà õ³ì³îòå-

ðàï³ÿ, ëàðèíãîåêòîì³ÿ, äèñòàíö³éíà òåëåãàìàòåðàï³ÿ

äîçâîëÿº çíà÷íî çíèçèòè ð³âåíü âèíèêíåííÿ ðåöèäèâ³â òà

ìåòàñòàç³â.

Âèñíîâêè. Ï³ñëÿ àíàë³çó îòðèìàíèõ äàíèõ ìè ïðèéø-

ëè äî âèñíîâêó, ùî çàñòîñóâàííÿ êîìá³íîâàíîãî ìåòîäó

òàêîãî ÿê âíóòð³øíüîàðòåð³àëüíà õ³ì³îòåðàï³ÿ, ëàðèíãî-

åêòîì³ÿ, äèñòàíö³éíà òåëåãàìàòåðàï³ÿ, â ë³êóâàíí³ ðàêó

ãîðòàí³ III ñòàä³¿ çíà÷íî çíèæóº ðîçâèòîê ðåöèäèâ³â ³ ìåòà-

ñòàç³â, çìåíøóº ñìåðòí³ñòü ³ çá³ëüøóº âèæèâàºì³ñòü

á³ëüøîñò³ õâîðèõ â ïîð³âíÿíí³ ç ³íøèìè ìåòîäàìè ë³êó-

âàííÿ. Òîìó çàñòîñîâóâàííÿ äàíîãî ìåòîäó ë³êóâàííÿ

ìîæíà ââàæàòè ìåòîäîì âèáîðó â ë³êóâàíí³ õâîðèõ íà ðàê

ãîðòàí³ III ñòàä³¿.

Ðåöåíçåíò: ä.ìåä.í., ïðîôåñîð Ùåïîò³í ².Á.

Ë²ÒÅÐÀÒÓÐÀ

1. Àáäóðàõèìîâ, Î.Í. Ñðàâíèòåëüíàÿ îöåíêà ýôôåêòèâ-

íîñòè ðàçëè÷íûõ ìåòîäîâ ëå÷åíèÿ ðàêà ãîðòàíè: àâòîðåô. äèñ.

. êàíä. ìåä. íàê. – Òàøêåíò, 2002. – 20 ñ.

2. Ãàíöåâ, Ê.Ø. Ñðàâíèòåëüíàÿ îöåíêà ãåìîðåîëîãèè ïðè

ðàêå îñíîâíûõ ëîêàëèçàöèé è ïóòè åå êîððåêöèè: àâòîðåô. äèñ.

. êàíä. ìåä. íàóê. – Óôà, 2000. 25 ñ.

3. Ãàíöåâ, Ê.Ø. Óëó÷øåíèå ðåçóëüòàòîâ íåñòàíäàðòíûõ

îïåðàöèé â àáäîìèíàëüíîé îíêîëîãèè: àâòîðåô. äèñ. ä-ðà ìåä.

íàóê. Óôà, 2005. – 50 ñ.

4. Ãàíöåâ, Ø.Õ. Àìáóëàòîðíàÿ îíêîëîãèÿ: ìîíîãðàôèÿ /

Ø.Õ. Ãàíöåâ, È.Ð. Ðàõìàòóëëèíà, Å.Â. Ìàëûøåâà. Óôà: Çäðàâî-

îõðàíåíèå Áàøêîðòîñòàíà, 2005.- 151 ñ.

5. Ãàíöåâ, Ø.Õ. Îíêîëîãèÿ / Ø.Õ.Ãàíöåâ; Áàøêèðñêèé ãîñ.

ìåä. óí-ò. Ì.: ÌÈÀ, 2004.-516 ñ.

6. Ãàíöåâ, Ø.Õ. Ïàòîëîãèÿ è ìîðôîëîãè÷åñêàÿ õàðàêòå-

ðèñòèêà îïóõîëåâîãî ðîñòà / Ø.Õ. Ãàíöåâ, Ø.Ì. Õóñíóòäèíîâ;

Áàøêèðñêèé ãîñ. ìåä. óí-ò. -Ì.: ÌÈÀ, 2003.-208 ñ.

7. Ìàòÿêèí, Å.Ã. Ñîâðåìåííûå ïîäõîäû ê ëå÷åíèþ áîëüíûõ

ðàêîì ãîðòàíè / Å.Ã. Ìàòÿêèí, P.M. Àçèçÿí, Ñ.Î. Ïîäâÿçíèêîâ //

Âåñòí. Ìîñê. îíêîë. Îá-âà. 2001. – ¹ 2. – Ñ. 56-59.

8. Íàáèåâ, À. Ê. Âíóòðèàðòåðèàëüíàÿ õèìèîòåðàïèÿ ïðè

ðàêå ãîðòàíè Ó À. Ê. Íàáèåâ, Ä.Ò. Àðûáæàíîâ // Àêòóàëüíûå âîï-

ðîñû ýêñïåðèìåíòàëüíîé è êëèíè÷åñêîé îíêîëîãèè: ñá. 2-é ðåãèî-

íàëüíîé êîíôåðåíöèè ìîëîäûõ ó÷åíûõ. – Òîìñê, 2007. – Ñ. 67-68.

9. Íàáèåâ, À. Ê. Ðåãèîíàðíàÿ õèìèîòåðàïèÿ ðàêà ãîðòàíè /

À. Ê. Íàáèåâ, Î. Ê. Êóëàêååâ, Ä. Ò. Àðûáæàíîâ [è äð.] // Âåñòíèê

ÞÊÃÌÀ. – 2007. -¹ 1 (34).-Ñ. 112-113.

10. Íàáèåâ, À. Ê. Ðåçóëüòàòû êîìáèíèðîâàííîãî ëå÷åíèÿ

ðàêà ãîðòàíè / À. Ê. Íàáèåâ Î. Ê. Êóëàêååâ, Ä. Ò. Àðûáæàíîâ [è

äð.] // Âåñòíèê ÞÊÃÌÀ. -2007. – ¹ 3 (36). – Ñ. 90-93.

11. Îñíîâû îáùåé òåîðèè îïóõîëåâîãî ïðîöåññà / Î.Ñ. Êî-

öàðåâ, È.Â. Áåëåíüêèé, Â.È. Ïîëåòàåâà, Ñ.Â. Àíòîíþê // Ýêñïåðè-

ìåíòàëüíàÿ îíêîëîãèÿ: òåç. äîêë. 2-ãî ñúåçäà îíêîëîãîâ ñòðàí

ÑÍÃ (23-26 ìàÿ, 2000 ã., Êèåâ).-Êèåâ, 2000.-Ñ. 137.

12. ×èæîâà, À.Â. Âîññòàíîâëåíèå çâó÷íîé ðå÷è ïîñëå îïåðà-

öèé ïî ïîâîäó ðàêà ãîðòàíè / À.Â. ×èæîâà // Âåñòí. Ìîñêîâ.

îíêîë. Îá-âà. 2001. – ¹ 2. – Ñ. 65-67.

ÑÐÀÂÍÈÒÅËÜÍÀß ÎÖÅÍÊÀ ÌÅÒÎÄÎÂ

ÊÎÌÁÈÍÈÐÎÂÀÍÍÎÃÎ ËÅ×ÅÍÈß ÁÎËÜÍÛÕ

ÍÀ ÐÀÊ ÃÎÐÒÀÍÈ ²²² ÑÒÀÄÈÈ

Øîâêîâàÿ Î.Â.

Èíñòèòóò îòîëàðèíãîëîãèè

èì. ïðîô. À.Ñ.Êîëîìèé÷åíêà ÍÀÌÍ Óêðàèíû,

ã. Êèåâ, Óêðàèíà

Ðåçþìå. Ïðîâåäåí ðåòðîñïåêòèâíûé àíàëèç èñòîðèé

áîëåçíè è ìåäèöèíñêèõ êàðò 52 áîëüíûõ, êîòîðûå ïðî-

õîäèëè ëå÷åíèå ïî ïîâîäó ðàêà ãîðòàíè â Èíñòèòóòå

îòîëàðèíãîëîãèè èì. ïðîô. À.Ñ. Êîëîìèé÷åíêà ÍÀÌÍ

Óêðàèíû â îòäåëå îíêîïàòîëîãèè ËÎÐ-îðãàíîâ ñ àïðåëÿ

2000 ãîäà äî ñåíòÿáðÿ 2008 ãîäà. Ïðîèçâåäåíà ñðàâíè-

òåëüíàÿ îöåíêà ýôôåêòèâíîñòè ðàçëè÷íûõ ìåòîäîâ ëå-

÷åíèÿ ðàêà ãîðòàíè.

Êëþ÷åûå ñëîâà: ðàê ãîðòàíè, êîìáèíèðîâàíîå

ëå÷åíèå, ëó÷åâàÿ òåðàïèÿ, õèìèîòåðàïèÿ.

COMPARATIVE ASSESSMENT OF METHODS

OF COMBINED TREATMENT LARYNGEAL

CANCER III STAGE

O. Shovkovaya

Otolaryngology Institute A. Kolomyichenko NAMS

of Ukraine, Kyiv, Ukraine

Summary. The study presents a retrospective analysis

of case histories and medical records of 52 patients who

were treated for laryngeal cancer at the Otolaryngology

Institute A. Kolomiychenko NAMS of Ukraine in the

department of otolaryngological oncopathology from April

2000 to September 2008. The comparative evaluation of

the effectiveness of various treatments for cancer of the

larynx.

Key words: laryngeal cancer, combination treatment,

radiation therapy, chemotherapy.

¹ 1 (79) • 2014

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145

ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

Çàõâîðþâàííÿ ïàðîäîíòó â íàø ÷àñ º íàäçâè÷àéíî

ïîøèðåíèìè, íåçâàæàþ÷è íà êîìïëåêñíèé ï³äõ³ä ó ë³êó-

âàíí³ òà ïîñò³éíå óäîñêîíàëåííÿ ïðîô³ëàêòè÷íèõ çàõîä³â.

Ïðîò³êàííÿ ¿õ ñóïðîâîäæóþòüñÿ ðÿäîì îçíàê ïîðóøåíü

îêëþç³éíèõ ñï³ââ³äíîøåíü ùåëåï âíàñë³äîê ñêóï÷åííÿ,

íàõèë³â, ïîâîðîò³â, òà çì³ùåíü çóá³â ³ çì³íàìè ð³âíÿ ðîçòà-

øóâàííÿ òà ôîðìè îêëþç³éíî¿ ïëîùèíè. Âíàñë³äîê öüîãî

âèíèêàþòü íåòèïîâ³ çà íàïðÿìêàìè òà âåëè÷èíîþ çóñèë-

ëÿ, ÿê³ ä³þòü íà ïàðîäîíò çóá³â â ìåæàõ ³ ïîçà ìîæëèâîñòÿ-

ìè éîãî àäàïòàö³¿. Îêëþç³éíà òðàâìà âèçíà÷àºòüñÿ ÿê ïî-

øêîäæåííÿ ïàðîäîíòó âíàñë³äîê íàäì³ðíèõ çóñèëü ÿê³

ïåðåâèùóþòü éîãî ðåïàðàòèâí³ ìîæëèâîñò³. Âïëèâ òðàâ-

ìàòè÷íî¿ îêëþç³¿ íà ñòàí ïàðîäîíòó ÿê òðàâìóþ÷îãî ôàê-

òîðà íåçàïåðå÷íèé, õî÷à ³ íå ââàæàºòüñÿ îñíîâíîþ

ïðè÷èíîþ âèíèêíåííÿ ïàðîäîíòèòà [2,5,8,12,13,18].

Êë³í³÷íèìè îçíàêàìè îêëþç³éíî¿ òðàâìè º ï³äâèùåííÿ

ð³âíÿ ðóõëèâîñò³, çì³ùåííÿ çóá³â ³ ïåð³îäè÷íèé äèñêîìôîðò

ïðè çìèêàíí³, ÿê³ âèçíà÷àþòüñÿ âæå íà ïî÷àòêîâèõ ñòàä³ÿõ

çàõâîðþâàííÿ ïàðîäîíòó. Ïàòîëîã³÷í³ çì³íè îêëþç³éíî¿ ïî-

âåðõí³ â ñòàòè÷í³é òà äèíàì³÷í³é îêëþç³¿ ôîðìóþòü íå-

ñòàá³ëüí³ êîíòàêòè, áëîêóþ÷è ðóõè íèæíüî¿ ùåëåïè òà ïðî-

âîêóþ÷è ¿¿ çñóâè â íåô³ç³îëîã³÷íèõ íàïðÿìêàõ, â³äïîâ³äíî

ïîñèëþþ÷è íàâàíòàæåííÿ íà çóáè, à òàêîæ íà æóâàëüí³ ì’ÿ-

çè òà ñêðîíåâî-íèæíüîùåëåïí³ ñóãëîáè [5,6,7,18,21].

Îêëþç³éí³ øèíè ìîæóòü áóòè åôåêòèâíî âèêîðèñòàí³

äëÿ âèð³øåííÿ íàñòóïíèõ çàâäàíü: ïîêðàùåííÿ íåéðî-

ì’ÿçåâî¿ êîîðäèíàö³¿, ë³êóâàííÿ ì’ÿçåâî-ñóãëîáîâèõ äèñ-

ôóíêö³é, ï³äâèùåííÿ âåðòèêàëüíî¿ âèñîòè, ñòàá³ë³çàö³¿ ïî-

ëîæåííÿ íèæíüî¿ ùåëåïè, çì³íè òðàåêòîð³é ðóõ³â íèæíüî¿

ùåëåïè, òåñòóâàííÿ çàïëàíîâàíî¿ îêëþç³éíî¿ ñõåìè â öåíò-

ðè÷íîìó òà åêñöåíòðè÷íîìó ïîëîæåííÿõ, ïåðåðîçïîä³ëó

íàâàíòàæåííÿ ïðè áðóêñèçì³, óòî÷íåííÿ îêëþç³éíèõ åò³î-

ëîã³÷íèõ ôàêòîð³â ï³ä ÷àñ âñòàíîâëåííÿ ä³àãíîçó. Â îñ-

òàíí³é ÷àñ çíà÷íî ïîøèðèëèñü ðåêîìåíäàö³¿ ùîäî çàñòîñó-

âàííÿ ðåëàêñàö³éíèõ øèí ïðè îêëþç³éíèõ ïîðóøåííÿõ òà

íàÿâíîñò³ îçíàê áðóêñèçìà [1, 3, 6, 7, 9, 10, 14, 15, 16, 22].

Äëÿ åôåêòèâíî¿ îö³íêè ðåçóëüòàò³â øèíîòåðàï³¿ çàïðî-

ïîíîâàíî çàñòîñóâàííÿ åëåêòðîì³îãðàô³¿, ïàëüïàö³ÿ æó-

âàëüíèõ ì’ÿç³â ç óðàõóâàííÿì ÷óòëèâîñò³ äî áîëþ. Âèêî-

ðèñòîâóþòü òàêîæ ñóá’ºêòèâí³ îçíàêè çíèæåííÿ ñòóïåíÿ

áîëüîâîãî ñèíäðîìó äèñôóíêö³¿, ÿê³ îö³íþþòü çà ñïå-

ö³àëüíîþ øêàëîþ [2, 3]. Çà äàíèìè ë³òåðàòóðíèõ äæåðåë

óñ³ ö³ êðèòåð³¿ ïîêàçóþòü âèñîêèé ñòóï³íü êîðåëÿö³¿ ì³æ

ïî÷àòêîì òà çàâåðøåííÿì ë³êóâàííÿ ðåëàêñóþ÷îþ øè-

íîþ [17, 19, 20].

ÓÄÊ – 616.314.17-008.1-031.81-092:616.314.26

ÇÌ²ÍÈ ÊË²Í²×ÍÈÕ ÏÐÎßÂ²Â ÃÅÍÅÐÀË²ÇÎÂÀÍÎÃÎ

ÏÀÐÎÄÎÍÒÈÒÓ ÏÐÈ ÇÀÑÒÎÑÓÂÀÍÍ²

ÎÊËÞÇ²ÉÍÈÕ ØÈÍ

Þðêîâñüêà ª.Ã. , Æåãóëîâè÷ Ç.ª.

Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Î.Î. Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: ðåëàêñóþ÷à øèíà, ñòàá³ë³çóþ÷à øèíà, òðàâìàòè÷íà îêëþç³ÿ, ì`ÿçåâî-ñóãëîáîâ³ äèñôóíêö³¿.

Ó çâ’ÿçêó ç ïîøèðåííÿì îêëþç³éíèõ øèí ó ñó÷àñí³é

ñòîìàòîëîã³¿ òà âåëèêîþ ê³ëüê³ñòþ ñï³ðíèõ ðåêîìåíäàö³é

ùîäî âèêîðèñòàííÿ îêðåìèõ âèä³â îêëþç³éíèõ øèí,

òåðì³í³â òà åôåêòèâíîñò³ ¿õ çàñòîñóâàííÿ ó ïàö³ºíò³â ç îê-

ëþç³éíèìè ïîðóøåííÿìè æóâàëüíîãî àïàðàòó àíàë³ç ðå-

çóëüòàò³â ë³êóâàííÿ îêëþç³éíèìè øèíàìè íà ï³äãîòîâ÷îìó

äî ïðîòåçóâàííÿ åòàï³ º àêòóàëüíèì.

Ìåòîþ íàøîãî äîñë³äæåííÿ áóâ àíàë³ç çì³íè ñèìï-

òîì³â îêëþç³éíî¿ òðàâìè ïðè çàñòîñóâàíí³ ðåëàêñóþ÷î¿

ñòàá³ë³çóþ÷î¿ øèíè ó ïàö³ºíò³â ç îêëþç³éíèìè ïîðóøåí-

íÿìè íà ðàíí³õ ñòàä³ÿõ çàõâîðþâàííÿ ïàðîäîíòó.

Äëÿ âèêîíàííÿ ïîñòàâëåíèõ çàâäàíü ïðîâåäåíî àíàë³ç

êë³í³÷íèõ ïðîÿâ³â îêëþç³éíèõ ïîðóøåíü ó ïàö³ºíò³â, ÿê³

îáñòåæóâàëèñÿ òà ë³êóâàëèñü íà êàôåäð³ îðòîïåäè÷íî¿

ñòîìàòîëîã³¿ ÍÌÓ ïðîòÿãîì 2005–2013 ðîê³â ç ïðèâîäó

òðàâìàòè÷íî¿ îêëþç³¿ íà ðàíí³õ ñòàä³ÿõ çàõâîðþâàííÿ

ïàðîäîíòó.

Ïàö³ºíòè, ÿêèõ áóëî âêëþ÷åíî â äîñë³äæåííÿ, îö³íþ-

âàëèñü çà íàñòóïíèìè êðèòåð³ÿìè: ïî÷àòêîâà ñòàä³ÿ ãåíå-

ðàë³çîâàíîãî ïàðîäîíòèòó, îðòîãíàòè÷íèé ïðèêóñ, áåçïå-

ðåðâí³ çóáí³ ðÿäè ³ ìàë³ äåôåêòè çóáíèõ ðÿä³â, íàÿâí³ñòü

ïîîäèíîêèõ øòó÷íèõ êîðîíîê, ðåñòàâðàö³é ³ íåâåëèêèõ

ìîñòîâèäíèõ ïðîòåç³â. Êðèòåð³ÿìè âèêëþ÷åííÿ ç äîñë³ä-

æåííÿ áóëè äåôåêòè çóáíèõ ðÿä³â ñåðåäíüîãî òà âåëèêîãî

ðîçì³ðó, íàÿâí³ñòü çí³ìíèõ çóáíèõ ïðîòåç³â òà âåëèêèõ

ìîñòîâèäíèõ ïðîòåç³â, ñèíäðîì Êîñòåíà. Ç ÷èñëà îáñòå-

æåíèõ ïàö³ºíò³â áåçñèñòåìíî âèä³ëåíî ãðóïó 20 îñ³á, ÿê³

â³äïîâ³äàëè îáðàíèì êðèòåð³ÿì ³ äîòðèìóâàëèñü óñ³õ ðå-

êîìåíäàö³é ïðè êîðèñòóââàíí³ îêëþç³éíèìè øèíàìè.

Ñåðåäí³é â³ê äîñë³äæóâàíèõ îñ³á ñòàíîâèâ 39,6±1,4 ðîê³â.

Îáñòåæåííÿ ïàö³ºíò³â ïðîâîäèëîñÿ çà çàãàëüíîïðèé-

íÿòîþ ñõåìîþ ç âèêîðèñòàííÿì àëãîðèòìó êë³í³÷íîãî

ôóíêö³îíàëüíîãî àíàë³çó çà Ñëàâ³÷åêîì [4], ÿêèé âêëþ÷àº

ñóá`ºêòèâíó òà îá’ºêòèâíó îö³íêó ñòàíó æóâàëüíîãî àïà-

ðàòó (çàãàëüíîñîìàòè÷íèé ñòàí, äåíòàëüíèé ñòàòóñ, ïàðî-

äîíòîëîã³÷íå îáñòåæåííÿ, êë³í³÷íå äîñë³äæåííÿ ì’ÿç³â,

íåðâ³â, ñêðîíåâî-íèæíüîùåëåïîâèõ ñóãëîá³â, äèíàì³êó

ðóõ³â íèæíüî¿ ùåëåïè, îêëþç³éí³ êîíòàêòè). Äëÿ âèçíà÷åí-

íÿ íàÿâíîñò³ ðåçîðáö³¿ àëüâåîëÿðíî¿ ê³ñòêè ïðîâîäèëè

àíàë³ç îðòîïàíòîìîãðàì.

Ïàö³ºíòè ñêàðæèëèñü íà ïîðóøåííÿ æóâàííÿ, äèñ-

êîìôîðò ïðè çìèêàíí³ çóá³â, íàäì³ðíó ÷óòëèâ³ñòü çóá³â.

Ó ìåíø³é ì³ð³ ïàö³ºíòè â³äì³÷àëè ôîíåòè÷í³ ïîðóøåííÿ.

Îçíà÷åí³ õàðàêòåðèñòèêè ïîêàçóþòü íàÿâí³ñòü ñóòòºâèõ

ïàòîëîã³÷íèõ çì³í îêëþç³éíèõ ñï³ââ³äíîøåíü ùåëåï ïðè

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

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çìèêàíí³ òà ôóíêö³îíàëüíèõ ðóõàõ. Ïåâíà ê³ëüê³ñòü

ïàö³ºíò³â âêàçóâàëà íà óù³ëüíåííÿ, íåïðèºìí³ â³ä÷óòòÿ ³

á³ëü ó æóâàëüíèõ ì’ÿçàõ òà ó ä³ëÿíö³ ñêðîíåâî-íèæíüîùå-

ëåïíèõ ñóãëîá³â. Òàêîæ äåÿê³ ç íèõ â³äì³÷àëè õðóñê³ò òà

êëàöàííÿ ó ñóãëîáàõ, ñêóò³ñòü ïðè ðóõàõ íèæíüî¿ ùåëåïè.

Çàãàëîì ö³ îçíàêè ï³äêðåñëþþòü íàÿâí³ñòü ïîðóøåíü

âçàºìîä³¿ êîìïîíåíò³â æóâàëüíîãî àïàðàòó ³, â ïåðøó

÷åðãó, ì’ÿçåâîãî ³ ñóãëîáîâîãî êîìïîíåíò³â. Ïåðåë³ê âè-

ùåïåðåðàõîâàíèõ ñóá’ºêòèâíèõ ñèìïòîì³â âêëþ÷åíî äî

ñõåìè îáñòåæåííÿ – îêëþç³éíîãî ³íäåêñó (Î²). Î² – öå

àëãîðèòì îïèòóâàííÿ, ùî äîçâîëÿº âèçíà÷èòè ïîðó-

øåííÿ ôóíêö³¿ æóâàëüíîãî àïàðàòó çà ñóá’ºêòèâíèìè

â³ä÷óòòÿìè ïàö³ºíòà. Äàíà ñõåìà âèçíà÷àº íå ò³ëüêè

íàÿâí³ñòü ñèìïòîì³â, àëå é ð³âåíü ¿õ ïðîÿâ³â â áàëàõ çà

â³ä÷óòòÿìè ïàö³ºíò³â (òàáë. 1). Ñóìà áàë³â, ïîä³ëåíà íà

ê³ëüê³ñòü ñèìïòîì³â, ôîðìóº îö³íêó ïðîÿâ³â ïîðóøåíü

(êîåô³ö³ºíò â³ä 1 äî 3). Â äàí³é ðîáîò³ ìè ïðîàíàë³çóâàëè

ò³ëüêè íàÿâí³ ñèìïòîìè ó ïàö³ºíò³â áåç óðàõóâàííÿ

ñòóïåíþ ¿õ ïðîÿâ³â.

Äëÿ óñóíåííÿ âèÿâëåíèõ îçíàê çàñòîñóâàëàñü ðåëàê-

ñóþ÷à ñòàá³ë³çóþ÷à øèíà ç ïðîòðóç³éíèì òà ðåòðóç³éíèì

êîíòðîëåì íà íèæíþ ùåëåïó. Øèíó âèãîòîâëÿëèëè â àðòè-

êóëÿòîð³ íà ìîäåëÿõ, ñï³âñòàâëåíèõ â ïîëîæåíí³ öåíòðàëü-

íîãî ñï³ââ³äíîøåííÿ ùåëåï. Îêëþç³éí³ êîíòàêòè íà í³é

êîðåãóâàëè ï³ä ÷àñ íàêëàäàííÿ òà â òåðì³íè 3, 7, 14 ä³á,

1 ì³ñÿöü. Ñïî÷àòêó ïëîùèííà ïîâåðõíÿ ¿¿ ïðîòÿãîì ïåðøîãî

ì³ñÿöÿ ñòâîðþâàëà óìîâè äëÿ ðåëàêñàö³¿ æóâàëüíèõ ì’ÿç³â ³

ïðîñòîðîâîãî ïîçèö³îíóâàííÿ íèæíüî¿ ùåëåïè. Ï³ñëÿ

ïåðøîãî ì³ñÿöÿ ðåëàêñàö³¿ áóëî ñôîðìîâàíî ïåðåäíþ

íàïðàâëÿþ÷ó, ùî çàáåçïå÷óâàëà óäîñêîíàëåííÿ äèíàì³÷-

íî¿ îêëþç³¿. Ï³ñëÿ äðóãîãî ì³ñÿöÿ êîðèñòóâàííÿ ñôîðìî-

âàíî ðåòðóç³éíèé êîíòðîëü ó ä³ëÿíêàõ ïðåìîëÿð³â, âíàñ-

ë³äîê ÷îãî áëîêóâàâñÿ çñóâ íèæíüî¿ ùåëåïè äèñòàëüíî.

Çàâåðøóâàëîñü ë³êóâàííÿ øèíîþ ó 3 ì³ñÿö³ (ðèñ. 1).

Ó ãðóï³ ïàö³ºíò³â ïðîÿâè òðàâìàòè÷íî¿ îêëþç³¿ âèÿâëåíî ó

ôðîíòàëüíèõ ³ áîêîâèõ ä³ëÿíêàõ çóáíèõ ðÿä³â. Âèçíà÷åíî

òàêîæ ïàðàôóíêö³îíàëüí³ ôàñåòêè ñòèðàííÿ, ðîçòàøîâàí³

ïåðåâàæíî íà ïðåìîëÿðàõ òà ìîëÿðàõ, áàëàíñóþ÷³ òà ã³ïåð-

áàëàíñóþ÷³ îêëþç³éí³ êîíòàêòè íà ìîëÿðàõ, ó ÷àñòèíè

ïàö³ºíò³â çìåíøåíå âåðòèêàëüíå ïåðåêðèòòÿ ôðîíòàëüíèõ

çóá³â ³ ó äåê³ëüêîõ îáñòåæåíèõ – ãëèáîêå ïåðåêðèòòÿ ôðîí-

òàëüíèõ çóá³â. Ðóõëèâ³ñòü çóá³â, íåçíà÷íà êðîâîòî÷èâ³ñòü òà

â³áðàö³¿ çóá³â ñïîñòåð³ãàëàñü ëîêàëüíî, àëå ïåðåâàæíî ó

ôðîíòàëüíèõ ä³ëÿíêàõ çóáíèõ ðÿä³â (öåíòðàëüí³ ð³çö³, ëàòå-

ðàëüí³ ð³çö³, ³êëà) ³ á³ëÿ äèñòàëüíèõ ìîëÿð³â. Ïàðîäîíòàëüí³

êèøåí³ òàêîæ âèÿâëÿëèñü ïåðåâàæíî â áîêîâèõ ä³ëÿíêàõ

á³ëÿ ìîëÿð³â ³ â íåçíà÷í³é ê³ëüêîñò³ á³ëÿ ôðîíòàëüíèõ çóá³â.

Íàÿâí³ñòü êèøåíü ñï³âïàäàëà ç ï³äâèùåíîþ ðóõîì³ñòþ,

êðîâîòî÷èâ³ñòþ, ðåöåñ³ÿìè ÿñåí ³ çì³íàìè ïîëîæåíü çóá³â.

Ë³êóâàëüíèé åôåêò øèíè âèçíà÷àâñÿ çà îçíàêàìè ðå-

ëàêñàö³¿ ì’ÿç³â. Îö³íêà ñòàíó æóâàëüíèõ ì’ÿç³â ïðîâîäè-

ëàñü ç óðàõóâàííÿì ³íäèâ³äóàëüíî¿ ÷óòëèâîñò³ äî áîëþ.

Ïàëüïàö³ÿ ì’ÿç³â çä³éñíþâàëàñü çã³äíî ç ðåêîìåíäàö³ÿìè

[4, 10] ó òåðì³íè êîðåêö³¿ øèíè. Â íàø³é ïðàêòèö³ ìè çàñ-

òîñóâàëè ïðîñòèé òà äîñòóïíèé ìåòîä ñèñòåìíî¿ ïàëü-

ïàö³¿ ì’ÿç³â, ùî âõîäèòü â ñõåìó êë³í³÷íîãî ôóíêö³îíàëü-

íîãî àíàë³çó ñòàíó æóâàëüíîãî îðãàíó [4]. Â ïåðøó ÷åðãó

ñë³ä â³äì³òèòè, ùî ó çíà÷íî¿ ê³ëüêîñò³ ïàö³ºíò³â ç îêëþç³é-

íèìè ïîðóøåííÿìè íà ïî÷àòêîâèõ ñòàä³ÿõ ãåíåðàë³çîâà-

íîãî ïàðîäîíòèòó ïðè îáñòåæåíí³ âèÿâëåíî íàïðóæåííÿ

òà áîë³ñí³ñòü ãëèáîêî¿ ãîëîâêè æóâàëüíîãî ì’ÿçó, ëàòå-

ðàëüíîãî êðèëîâèäíîãî ì’ÿçó (âåðõíüî¿ òà íèæíüî¿ ãîëîâ-

êè), äâî÷åðåâöåâîãî (ïåðåäíº ÷åðåâöå), ùåëåïíî-ï³ä’ÿçè-

êîâîãî. Ó çíà÷íî ìåíøîìó ñï³ââ³äíîøåíí³ âèçíà÷àëàñü

ðåàêö³ÿ íàñòóïíèõ ì’ÿç³â: ñêðîíåâîãî (ïåðåäíüî¿ òà çàä-

íüî¿ ÷àñòèíè), ìåä³àëüíîãî êðèëîïîä³áíîãî. Ó ïåðø³ äí³

ñïîñòåðåæåííÿ äåÿê³ ãðóïè ì’ÿç³â ïîêàçóâàëè íàâ³òü ï³äâè-

ùåíó àêòèâí³ñòü, àëå âæå íàïðèê³íö³ ïåðøîãî ì³ñÿöÿ âèç-

íà÷åíî ñóòòºâå ïîêðàøåííÿ ¿õ ñòàíó. Äî ê³íöÿ ë³êóâàííÿ â

îñíîâíèõ ãðóïàõ æóâàëüíèõ ì’ÿç³â (ï³äí³ìà÷³â, îïóñêà÷³â

íèæíüî¿ ùåëåïè, ïðîòðàêòîð³â) ïðè ïàëüïàö³¿ íå âèçíà÷à-

ëîñü íàïðóæåíü òà áîë³ñíîñò³. Ó òîé-æå ÷àñ ì’ÿçè, ÿê³ çà-

áåçïå÷óþòü ïîñòàâó, íå äîñÿãëè áàæàíîãî ð³âíÿ ðåëàêñàö³¿

(ðèñ. 4).

Ðåçóëüòàòè òà îáãîâîðåííÿ. Ïîð³âíÿííÿ ñèìïòîì³â Î²

äî òà ï³ñëÿ ë³êóâàííÿ äîçâîëèëî âèçíà÷èòè ñóòòºâå

ïîêðàùåííÿ ¿õ ó ãðóï³ çà ðÿäîì îçíàê. Òàê ñêàðãè íà

ïðîáëåìè ç æóâàííÿì áóëî óñóíóòî ó çíà÷íî¿ ê³ëüêîñò³

ïàö³ºíò³â (75% äî ïî÷àòêó ë³êóâàííÿ ³ 45 % ï³ñëÿ øèíî-

òåðàï³¿). Äèñêîìôîðò ïðè ìàêñèìàëüíîìó çìèêàíí³ çóá³â

áóëî óñóíóòî ó êîæíîãî äðóãîãî ïàö³ºíòà (100% – 50%) ,

Íàäì³ðíà ÷óòëèâ³ñòü çóá³â çìåíøèëàñü ñóòòºâî (â³ä 80%

ñêàðã äî ïî÷àòêó ë³êóâàííÿ äî 20% ï³ñëÿ çàâåðøåííÿ ë³êó-

Òàáëèöÿ 1.

Âèçíà÷åííÿ Îêëþç³éíîãî ²íäåêñó (Î²)

Ðèñ.1. Ðåëàêñóþ÷à ñòàá³ë³çóþ÷à øèíà

ç ïðîòðóç³éíèì òà ðåòðóç³éíèì êîíòðîëåì.

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Ðèñ. 4. Ïîð³âíÿëüíèé àíàë³ç ñòàíó ì’ÿç³â ãîëîâè òà ø³¿ ï³ñëÿ

ë³êóâàííÿ îêëþç³éíèìè øèíàìè (%). (1 – ïëå÷³ òà øèÿ;

2 – àòëàíòî-ïîòèëè÷íà ä³ëÿíêà; 3 – ñêðîíåâèé ì’ÿç,

ïåðåäíÿ ÷àñòèíà; 4 – ñêðîíåâèé ì’ÿç, ñåðåäíÿ ÷àñòèíà;

5 – ñêðîíåâèé ì’ÿç, çàäíÿ ÷àñòèíà; 6 – æóâàëüíèé ì’ÿç,

ïîâåðõíåâà ÷àñòèíà; 7 – æóâàëüíèé ì’ÿç, ãëèáîêà ÷àñòèíà;

8-ãðóäíèíî-êëþ÷è÷íî-ñîñêîïîä³áíèéì’ÿç; 9 – ëîïàòî÷íî-

ï³ä’ÿçèêîâèé ì’ÿç; 10 – íàäï³ä’ÿçèêîâ³ ì’ÿçè;

11 – íàäï³ä’ÿçèêîâ³ ì’ÿçè; 12 – ãîðòàíü: 13 – á³÷íèé

êðèëîâèäíèé ì’ÿç, âåðõíÿ ãîëîâêà; 14 – äâî÷åðåâöåâèé ì’ÿç,

ïåðåäíº áðþøêî; 15 – ùåëåïíî-ï³ä’ÿçèêîâèé ì’ÿç;

16 – ïðèñåðåäí³é êðèëîâèäíèé ì’ÿç; 17 – á³÷íèé êðèëîâèäíèé

ì’ÿç, íèæíÿ ãîëîâêà; 18 – ÿçèê).

Ïîð³âíÿëüíèé àíàë³ç ñòàíó ì’ÿç³â ãîëîâè òà øè¿

ï³ñëÿ 3-õ ì³ñÿö³â ë³êóâàííÿ øèíîþ (%)

âàííÿ). Ì’ÿçåâî-ñóãëîáîâ³ ñèìïòîìè ïàö³ºíò³â, äëÿ óñó-

íåííÿ ÿêèõ ³ çàñòîñîâóâàëè ë³êóâàííÿ îêëþç³éíîþ øè-

íîþ, òàêîæ ñóòòºâî çìåíøèëèñü (ïóíêòè 6, 8, 9 – ðèñ. 2),

àáî áóëè ïîâí³ñòþ óñóíóòî (ïóíêò 5 – ðèñ. 2). Ó çâ’ÿçêó ç

îòðèìàíèìè ðåçóëüòàòàìè ìîæíà ââàæàòè çàïðîïîíîâà-

íó ñõåìó îáñòåæåííÿ ïàö³ºíò³â ïîêàçîâîþ íå ò³ëüêè äëÿ

îö³íêè ð³âíÿ ïàòîëîã³÷íèõ çì³í ó æóâàëüíîìó îðãàí³, àëå

é äëÿ âèçíà÷åííÿ äèíàì³êè ïîçèòèâíèõ çì³í ó ë³êóâàíí³.

Çóáí³, ì’ÿçåâ³, ñóãëîáîâ³ îçíàêè ïîðóøåíü æóâàëüíîãî

àïàðàòó, ùî ñóïðîâîäæóþòü çàõâîðþâàííÿ ïàðîäîíòó,

ìîæóòü áóòè íàñë³äêîì çì³íè ïîëîæåííÿ íèæíüî¿ ùåëå-

ïè ï³ä âïëèâîì íåñòàá³ëüíèõ ñòàòè÷íèõ êîíòàêò³â òà çì³íå-

íèõ íàïðàâëÿþ÷èõ ïîâåðõîíü çóá³â âíàñë³äîê ä³¿ òðàâìà-

òè÷íî¿ îêëþç³¿, íà ùî âêàçóþòü äåÿê³ ë³òåðàòóðí³ äæåðåëà

[5, 8, 12, 21].

Çã³äíî ïðîâåäåíîãî àíàë³çó ïàðîäîíòàëüíèõ ñèìï-

òîì³â ëîêàëüíà êðîâîòî÷èâ³ñòü áóëà ïðèñóòíÿ ó 80 %

ïàö³ºíò³â ³ ï³ñëÿ ë³êóâàííÿ îêëþç³éíèìè øèíàìè âîíà âè-

ÿâëÿëàñü ó 30 % îñ³á. Ðóõîì³ñòü ïîîäèíîêèõ çóá³â àáî

ãðóï çóá³â âèÿâëåíî ó 75 % îáñòåæåíèõ äî ë³êóâàííÿ ³ çíè-

æåííÿ öüîãî ïîêàçíèêà â³äì³÷åíî äî 20%. ×óòëèâ³ñòü

çóá³â âèçíà÷àëàñü ó 80 % îñ³á ³ ïðîÿâëÿëàñü ïîñò³éíî àáî

÷àñ â³ä ÷àñó. ×óòëèâ³ñòü â³äì³÷àëàñü íà ïîîäèíîêèõ çóáàõ ³

íà ãðóïàõ çóá³â. ×àñò³øå ïàö³ºíòè â³äì³÷àëè ÷óòëèâ³ñòü â

ä³ëÿíêàõ ïðåìîëÿð³â ³ ìîëÿð³â ³ ¿¿ ñèìïòîìè ó ïðèø³éêî-

âèõ ä³ëÿíêàõ ñï³âïàäàëà ç íàÿâí³ñòþ ðåöåñ³é ³ àáôðàêö³é, à

íà îêëþç³éíèõ ïîâåðíÿõ ç ôàñåòêàìè ñòèðàííÿ òà òð³ùè-

íàìè åìàë³ àáî ñêîëàìè êîðîíêîâî¿ ÷àñòèíè çóá³â. Ï³ñëÿ

çàñòîñóâàííÿ îêëþç³éíî¿ øèíè ð³âåíü ÷óòëèâîñò³ ó ãðóï³

çíèçèâñÿ äî 20 %. Ñóòòºâèõ çì³í ñòàíó ðåöåñ³é, ð³âíÿ ðå-

çîðáö³¿ àëüâåîëÿðíî¿ ê³ñòêè òà çì³í ïîëîæåííÿ çóá³â ï³ñëÿ

øèíîòåðàï³¿ íå âèÿâëåíî. Â³áðàö³¿ çóá³â ïðè çìèêàíí³ âèç-

íà÷àëèñü ó 100% îñ³á äî ïðîâåäåííÿ øèíîòåðàï³¿ ³ äàíèé

ïîêàçíèê çíèçèâñÿ äî 40% ï³ñëÿ ë³êóâàííÿ. Á³ëüø³ñòü

ïàö³ºíò³â ï³ñëÿ ë³êóâàííÿ øèíîþ â³äì³÷àëè çì³íè îêëþ-

ç³éíèõ êîíòàêò³â ïðè çìèêàíí³ çóá³â, ùî ìîæå áóòè íà-

ñë³äêîì ñòàá³ë³çàö³¿ ðóõîìèõ çóá³â (ðèñ.3). Òàêîæ, ÿê ïîêà-

çàëè áàãàòî÷èñåëüí³ äîñë³äæåííÿ, êîðåêö³ÿ øèíè ï³ä ÷àñ

ë³êóâàííÿ ïîâ’ÿçàíà ç³ çì³íàìè ðîçòàøóâàííÿ êîíòàêò³â

çóá³â íà ¿¿ ïîâåðõí³ â ðåçóëüòàò³ íîðìàë³çàö³¿ ïðîñòîðî-

âîãî ïîëîæåííÿ íèæíüî¿ ùåëåïè [1,5,12,18].

Çàñòîñóâàííÿ îêëþç³éíî¿ øèíè ç ìåòîþ óñóíåííÿ

ì’ÿçåâèõ ñèìïòîì³â òà íîðìàë³çàö³¿ ïîëîæåííÿ íèæíüî¿

ùåëåïè ñóòòºâî ïîêðàùóº còàí îêëþç³éíîãî êîìïîíåíòó

æóâàëüíîãî àïàðàòó, ùî ï³äòâåðäæóºòüñÿ ñóá’ºêòèâíèìè

â³ä÷óòòÿìè ïàö³ºíò³â: çìåíøåííÿì ñêàðã íà ïðîáëåìè ç

æóâàííÿì, äèñêîìôîðò ïðè ìàêñèìàëüíîìó çìèêàíí³

çóá³â, çíèæåííÿì ð³âíÿ ÷óòëèâîñò³ çóá³â.

Ïî çàê³í÷åíí³ ë³êóâàííÿ â îñíîâíèõ ãðóïàõ æóâàëüíèõ

ì’ÿç³â (ï³äí³ìà÷³â, îïóñêà÷³â íèæíüî¿ ùåëåïè, ïðîòðàê-

òîð³â) ïðè ïàëüïàö³¿ íå âèçíà÷àëîñü íàïðóæåíü òà áîë³ñ-

íîñò³. Öå ñâ³ä÷èòü ïðî åôåêòèâí³ñòü ãàðìîí³çàö³¿ êîìïî-

íåíò³â æóâàëüíîãî àïàðàòó ³ ï³äòâåðäæóºòüñÿ âåëèêîþ

ê³ëüê³ñòþ äîñë³äæåíü [6, 9, 14, 17, 22]. Ó òîé-æå ÷àñ ì’ÿçè,

ÿê³ çàáåçïå÷óþòü ïîñòàâó, íå äîñÿãëè áàæàíîãî ð³âíÿ

ðåëàêñàö³¿ (ðèñ. 4). Äëÿ ïîêðàùåííÿ äîñÿãíóòîãî ðåçóëü-

òàòó âàðòî êîìá³íóâàòè øèíîòåðàï³þ ç ïîñòóðîëîã³÷-

íèìè ìåòîäàìè êîðåêö³¿ ñòàíó ì’ÿç³â.

Âèêîðèñòàííÿ ðåëàêñàö³éíî¿ øèíè ìîæå ñòàòè ìåòî-

äîì ïîïåðåäíüîãî ë³êóâàííÿ ç êîìïëåêñíîþ ä³ºþ íà îê-

Ðèñ. 3. Çì³íè ïàðîäîíòàëüíèõ ñèìïòîì³â ï³ñëÿ ë³êóâàííÿ

îêëþç³éíèìè øèíàìè.

Ðèñ. 2. Çì³íè ñèìïòîì³â îêëþç³éíîãî ³íäåêñó ó ïàö³ºíò³â ï³ñëÿ

ë³êóâàííÿ øèíîþ. (%). (²íäåêñàö³ÿ ñèìïòîì³â çã³äíî òàáë.1)

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ÊË²Í²×ÍÀ ÌÅÄÈÖÈÍÀ / CLINICAL MEDICINE

ÈÇÌÅÍÅÍÈß ÊËÈÍÈ×ÅÑÊÈÕ ÏÐÎßÂËÅÍÈÉ

ÃÅÍÅÐÀËÈÇÎÂÀÍÍÎÃÎ ÏÀÐÎÄÎÍÒÈÒÀ

ÏÐÈ ÏÐÈÌÅÍÅÍÈÈ ÎÊÊËÞÇÈÎÍÍÛÕ ØÈÍ

Þðêîâñêàÿ Å.Ã. , Æåãóëîâè÷ Ç.Å.

Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò

èìåíè À.À. Áîãîìîëüöà, ã. Êèåâ, Óêðàèíà

Ðåçþìå. Çàáîëåâàíèÿ ïàðîäîíòà ñîïðîâîæäàþòñÿ

òðàâìàòè÷åñêîé îêêëþçèåé, êîòîðàÿ ñóùåñòâåííî óõóä-

øàåò ñîñòîÿíèå çóáîâ è óñòðàíåíèå å¸ ÿâëÿåòñÿ âåäó-

ùèì óñëîâèåì ëå÷åíèÿ íà ìåñòíîì óðîâíå. Ïðîâåäåí

àíàëèç èçìåíåíèÿ ñèìïòîìîâ îêëþçèîííîé òðàâìû ïðè

ïðèìåíåíèè ðåëàêñèðóþùåé ñòàáèëèçèðóþùåé øèíû ó

ïàöèåíòîâ ñ îêêëþçèîííûìè íàðóøåíèÿìè íà íà÷àëü-

íûõ ñòàäèÿõ çàáîëåâàíèÿ ïàðîäîíòà. Âûÿâëåíî ñóùå-

ñòâåííîå óëó÷øåíèå ñîñòîÿíèÿ ñóñòàâîâ, ìûøö, çóáîâ è

ïàðîäîíòà ïîñëå ïðèìåíåíèÿ øèíû.

Êëþ÷åâûå ñëîâà: ðåëàêñèðóþùàÿ øèíà, ñòàáèëèçè-

ðóþùàÿ øèíà, òðàâìàòè÷åñêàÿ îêêëþçèÿ, ìûøå÷íî-ñóñ-

òàâíûå äèñôóíêöèè.

CHANGES OF CLINICAL MANIFESTATION

OF GENERALIZED PERIODONTITIS UNDER

OCCLUSAL SPLINTS TREATMENT

E. Yurkivska, Z. Zhegulovich

Bogomolets National Medical University, Kyiv, Ukraine

Summary. Periodontal disease is accompanied by

traumatic occlusion, which significantly worsens the

condition of the teeth and improving this state is a

prerequisite for treatment at the local level. The analysis of

trauma from occlusion symptoms after applying a relaxed

stabilizing splint in patients with occlusal disorders on early

stages of periodontal disease was made. A significant

improvement in the condition of the joints, muscles, teeth

and periodontium after the splint therapy was revealed.

Key words: relaxing splint, stabilizing splint, trauma from

occlusion, muscular-joint dysfunction.

ëþç³éíèé, íåéðîì’ÿçåâèé ³ ñóãëîáîâèé êîìïîíåíòè æó-

âàëüíîãî àïàðàòó, ðåçóëüòàòîì ÷îãî º âñòàíîâëåííÿ ïðî-

ñòîðîâîãî ïîëîæåííÿ íèæíüî¿ ùåëåïè, íîðìàë³çàö³ÿ

âíóòð³øíüîñóãëîáîâèõ âçàºìîâ³äíîñèí, ãàðìîí³çàö³ÿ

ôóíêö³îíàëüíîãî ñòàíó æóâàëüíèõ ì’ÿç³â òà ñòàá³ë³çàö³ÿ

çóá³â â çóáíèõ ðÿäàõ. Äàíèé âèä øèíóâàííÿ äîçâîëÿº

ñòâîðèòè ðîçâàíòàæóþ÷³ îêëþç³éí³ êîíòàêòè, óñóíóòè

òðàâìàòè÷íó îêëþç³þ, ïåðåðîçïîä³ëèòè òèñê íà çóáè ³

ï³äòâåðäæóº íåîáõ³äí³ñòü ñòâîðåííÿ íîâî¿ îêëþç³éíî¿ ñõå-

ìè. Çìåíøåííÿ ê³ëüêîñò³ ðóõîìèõ çóá³â òà ñòóïåíÿ ðóõî-

ìîñò³ ïðè âèêîðèñòàíí³ äàíîãî ìåòîäó ë³êóâàííÿ º ïåðå-

äóìîâîþ äî ïðîâåäåííÿ ê³íöåâîãî åòàïó îêëþç³éíî¿

êîðåêö³¿ – îïòèì³çàö³¿ îêëþç³¿.

Ðåöåíçåíò: ä.ìåä.í., ïðîôåñîð Â.Ï.Íåñïðÿäüêî

Ë²ÒÅÐÀÒÓÐÀ

1. Êëèìîâà Ò.Í., Øåìîíàåâ Â.È., Ñàðãñÿí Ê.À., Áîðùåâà Å.Ñ.

Êîìïëåêñíûé ïîäõîä ê ñòîìàòîëîãè÷åñêîé ðåàáèëèòàöèè ïà-

öèåíòîâ ñ ïàðàôóíêöèåé æåâàòåëüíûõ ìûøö.// Âîëãîãðàäñêèé

íàó÷íî-ìåäèöèíñêèé æóðíàë.-2011.-¹3.- ñ.41-44.

2. Îêêëþçèÿ è êëèíè÷åñêàÿ ïðàêòèêà. Ïîä ðåä. Êëèíåíáåð-

ãà È, Äæàãåðà Ð. Ìîñêâà, ÌÅÄïðåññ-èíôîðì- 2006- 200ñ.

3. Ðîíêèí Ê. Èñïîëüçîâàíèå ïðèíöèïîâ íåéðîìûøå÷íîé

ñòîìàòîëîãèè ïðè ðåêîíñòðóêòèâíîì ïðîòåçèðîâàíèè ïàöè-

åíòà ñ ïàòîëîãèåé ïðèêóñà è äèñôóíêöèåé âèñî÷íî-íèæíå÷åëþ-

ñòíîãî ñóñòàâà. // Dåíòàë Êàëåéäîñêîï. – 2007.- ÿíâ-àïð.-

ñòð.18-27.

4. Ñëàâè÷åê Ð. Æåâàòåëüíûé îðãàí. Ôóíêöèè è äèñôóíêöèè.

Ìîñêâà “Àçáóêà”.- 2008. – 543ñ.

5. Ñìóêëåð Õ. Íîðìàëèçàöèÿ îêêëþçèè ïðè íàëè÷èè èíòàê-

òíûõ è âîññòàíîâëåííûõ çóáîâ. Ìîñêâà, “Àçáóêà”.- 2006.-136 ñ.

6. Ñòàòîâñêàÿ Å.Å. Îñîáåííîñòè ïðèìåíåíèÿ îêêëþçèîí-

íûõ êàïï.//LAB. -2007. – 4. – còð.3-6.

7. Õâàòîâà Â.À. Êëèíè÷åñêàÿ ãíàòîëîãèÿ. Ìîñêâà “ Ìåäè-

öèíà”.- 2005,- 295 ñ.

8. ßíóøåâè÷ Î.Î., Ðóíîâà Ã.Ñ., Ãîí÷àðåíêî À.Ä. Âëèÿíèå îêê-

ëþçèîííîé òðàâìû íà ðàçâèòèå çàáîëåâàíèé ïàðîäîíòà. // Ðîñ-

ñèéñêàÿÿ ñòîìàòîëîãèÿ. - 2009. – ¹3. – ñòð.16-19.

9. Alencar F.J., Becker A. Evaluation of different occlusal splints

and counseling in the management of myofacial pain disfunction. //

Journal of Oral Rehabilitation. -2009. -36. – p.79-85.

10. Bumann A, Lozmann U. TMJ Disorders and Orofacial Pain.

The role of Dentistry in Multidisciplinary Diagnostic Approach. Stuttgart

“Theme”. -2002. -p.306-332.

11. Capp N.J. Occlusion and splint Therapy. ||In: Ibbertson R., Eder

A. Tooth Surface Loss. The authoritative reference for dental practitioners

and students. BDJ Books, London, Dennis Barker Ltd. – 2002. -p.15-20.

12 . Davies S.J., Gray R.J.M. A clinical Guide to Occlusion. BDJ

books, London Dennis Barker Ltd. – 2003. -103 p.

13. Dimitresku A.L. Etiology and Pathogeneses of Periodontal

Deseases. Springer, – 2000-360p.

14 . Hamata M.M., Zuim P.E., Garcia A.R. Comparative evaluation

of the efficacy of occlusal splint fabricated in centric relation or

maximum intercuspation in temporomandibular disorder patients. //

Journal of Applied Oral Science.-2009.-17(1). – p.32-38.

15 . Harrel S.K., Nunn M.E., Hallmon W.W. Is There an Association

Between Occlusion and Periodontal Destruction? Yes – Occlusal Forces

can Contribute to Periodontal Destruction. // JADA. – 2006. – 137. –

ð.1380-1392.

16. Hiroshi Ueda, Fernanda R.Almeida, Alan A. Lowe, N.Dorin

Ruse. Changes in Occlusal Contact Area during Oral Appliance

Therapy Assessed on Study Models. // Angle Orhodontist. -2008. –

Vol.72. -5. – p.866-872.

17. Nilsson H., Limchaichana N., Nilner M., Ekberg E.C. Short-

term treatment of a resilient appliance in TMD pain patients: a

randomized controlled trial. // Journal of Oral Rehabilitation. – 2009. –

36. – p. 547-553.

18. Re J.-P., Perez C., Darmouni L., CarlierJ.F., Orthlieb J.-D.

The occlusal splint Therapy. //International Journal of Stomatology

and Occlusion Medicine. – 2009. – 2. – p. 82-86.

19 . Santos J.Jr. Occlusion. Principles and Treatment. Quintessence

Publ.Inc. – 2007. – 220p.

20 . Sforza C, Montagna S., Rosati R., De Menezes M. Immediate

effect of an elastomeric oral appliance on the neuromuscular

coordination of masticatory muscles: a pilot study in healthy subjects.

// Journal of Oral Rehabilitation. -2010. -37. – p.840-847.

21. Thurman MM, Huang GJ. Insufficient Evidence to Support

the Use of Stubilization Splint Therapy over other Active Intervention

in the treatment of Temporomandibular Myofascial Pain. // JADA-

2009 – 140 – ð.1524-1525.

22. Ruprecht R. Trauma from Occlusion. A review. // Clinical

Update. – 2004. – V.26. – 3. – ð. 1.

23 . Viveli C., Slavicek G., Slavicek R. Arbitrary versus exact mounting

procedure during fabrication of intraoral splints: an exploratory

randomized controlled clinical trial. // International Journal of

Stomatology and Occlusion Medicine. – 2009. – 3. – p. 99-105.

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

149

²ÑÒÎÐ²ß ÌÅÄÈÖÈÍÈ / HISTORY OF MEDICINE

Â 2014 ðîö³ âèïîâíþºòüñÿ 140 ðîê³â ç äíÿ íàðîäæåííÿ

ïðîôåñîðà Àðñåí³ÿ Â³êòîðîâè÷à Ñòàðêîâà – çàâ³äóâà÷à

êàôåäð îïåðàòèâíî¿ õ³ðóðã³¿ òà òîïîãðàô³÷íî¿ àíàòîì³¿

Ìîñêîâñüêîãî òà íîð-

ìàëüíî¿ àíàòîì³¿ Êè¿âñü-

êîãî é Ëàòâ³éñüêîãî óí³-

âåðñèòåò³â. Éîãî æèòòÿ òà

íàóêîâà ä³ÿëüí³ñòü äî íå-

äàâíüîãî ÷àñó ëèøàëèñÿ

ïîçà óâàãîþ. Çîêðåìà öå

ïîâ`ÿçàíî ç òèì, ùî ñâîãî

÷àñó â³í íàáóâ ñòàòóñó

ïîë³òè÷íîãî åì³ãðàíòà.

Àðñåí³é Â³êòîðîâè÷

Ñòàðêîâ íàðîäèâñÿ 8 ëþ-

òîãî 1874 ðîêó ó ì. Òîð-

æîê Òâåðñüêî¿ ãóáåðí³¿

(ÐÔ) â ñ³ì’¿ â³éñüêîâîãî

ë³êàðÿ. Â 1892 ðîö³ ï³ñëÿ

çàê³í÷åííÿ Òâåðñüêî¿ êëà-

ñè÷íî¿ ã³ìíàç³¿ áóâ çàðàõîâàíèé íà ìåäè÷íèé ôàêóëüòåò

Ìîñêîâñüêîãî óí³âåðñèòåòó, ÿêèé çàê³í÷èâ ç â³äçíàêîþ.

Â ïåð³îä íàâ÷àííÿ â óí³âåðñèòåò³ îäíèì ç â÷èòåë³â

À.Â. Ñòàðêîâà áóâ êåð³âíèê êàôåäðè îïåðàòèâíî¿ õ³ðóðã³¿

òà òîïîãðàô³÷íî¿ àíàòîì³¿ ïðîôåñîð Ï.². Ä’ÿêîíîâ. Â 1898

ðîö³ Ä’ÿêîíîâ âçÿâ ìîëîäîãî ë³êàðÿ íà êàôåäðó â ÿêîñò³

ïîçàøòàòíîãî ïîì³÷íèêà ïðîçåêòîðà, à ï³çí³øå – øòàòíî-

ãî ïîì³÷íèêà ïðîçåêòîðà [1]. Àðñåí³é Â³êòîðîâè÷ ñâîþ

ðîáîòó â óí³âåðñèòåò³ ïîºäíóâàâ ç ìåäè÷íîþ ïðàêòèêîþ:

â 1897–1898 ðîêàõ. ïðàöþâàâ â õ³ðóðã³÷í³é êë³í³ö³ ²âåð-

ñüêî¿ ñï³ëüíîòè ñåñòåð ìèëîñåðäÿ, äå ðîçðîáèâ ìåòîäèêó

àðòðîòîì³¿ êîë³ííîãî ñóãëîáà. Öå â³äêðèòòÿ óâ³éøëî â ë³òå-

ðàòóðó ï³ä íàçâîþ “ðîçð³ç Á³ëüðîòà-Îëëüº-Ñòàðêîâà” [2] –

ñåðåäèííèé äîñòóï ïðè àðòðîòîì³¿ êîë³ííîãî ñóãëîáà ç

ïîçäîâæí³ì ðîçð³çîì ñóõîæèëêà ÷îòèðèãîëîâîãî ì’ÿçà,

íàêîë³íêà, âëàñíî¿ çâ’ÿçêè íàêîë³íêà ³ ãîðáèñòîñò³ âåëèêî-

ãîì³ëêîâî¿ ê³ñòêè.

Â 1899–1908 ðîêàõ îá³éìàâ ïîñàäó àñèñòåíòà – ³íòåðíà

õ³ðóðã³÷íîãî â³ää³ëåííÿ Ãîë³öèíñüêî¿ ë³êàðí³ â Ìîñêâ³. Â

²íñòèòóò³ òîïîãðàô³÷íî¿ àíàòîì³¿ òà îïåðàòèâíî¿ õ³ðóðã³¿

Ìîñêîâñüêîãî óí³âåðñèòåòó À.Â. Ñòàðêîâ âèêîíàâ, à â

1900 ðîö³ – çàõèñòèâ äîêòîðñüêó äèñåðòàö³þ “Åò³îëîã³ÿ ³

ïàòîëîã³÷íà àíàòîì³ÿ ì’ÿçîâî¿ êðèâîøè¿” [3]. Íàïåðå-

äîäí³, ó âåðåñí³ 1900 ðîêó, â³í áóâ îáðàíèé Ðàäîþ Æ³íî-

÷îãî ìåäè÷íîãî ³íñòèòóòó â Ìîñêâ³ íà ïîñàäó ïðîôåñîðà

îïèñîâî¿ òà ïîð³âíÿëüíî¿ àíàòîì³¿ òà äèðåêòîðîì Àíàòî-

ÓÄÊ 611.13/16-654

ÂÈÄÀÒÍÈÉ ÀÍÀÒÎÌ

ÏÐÎÔÅÑÎÐ ÀÐÑÅÍ²É Â²ÊÒÎÐÎÂÈ× ÑÒÀÐÊÎÂ

Ìàë³êîâ Î.Â., Äçåâóëüñüêà ².Â., ²ãíàò³ùåâ Ì.Ð., Ãîí÷àðîâ Â.Ë., Âèäåðêî Ð.Â., Êîâàëü÷óê À.Â.

Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Î.Î. Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: àíàòîì³ÿ, õ³ðóðã³ÿ, àíàòîì³÷íà øêîëà, äîñë³äæåííÿ, ïðåïàðàòè.

ì³÷íîãî ³íñòèòóòó. Ñàìå òàì À.Â. Ñòàðêîâ çàñíóâàâ ìóçåé

îïèñîâî¿ òà ïîð³âíÿëüíî¿ àíàòîì³¿, ùî äî 1918 ðîêó íà-

ë³÷óâàâ á³ëüø í³æ 1500 ïðåïàðàò³â, ïåðåâàæíà ê³ëüê³ñòü

ÿêèõ áóëà âèãîòîâëåíà íèì âëàñíîðó÷.

Â 1906 ðîö³ À.Â. Ñòàðêîâ áóâ â³äïðàâëåíèé ó â³äðÿä-

æåííÿ íà äâà ðîêè ìåäè÷íèì ôàêóëüòåòîì äî àíàòîì³÷-

íèõ ³íñòèòóò³â Áåðë³íà òà Â³äíÿ. Ç ìåòîþ ïîãëèáëåíîãî

âèâ÷åííÿ àíàòîì³¿ òà õ³ðóðã³¿ â³í äîäàòêîâî ïðàöþâàâ íà

çîîëîã³÷í³é ñòàíö³¿ â Íåàïîë³.

Ï³ñëÿ ïîâåðíåííÿ â Ðîñ³þ â 1908 ðîö³ À.Â. Ñòàðêîâ áóâ

îáðàíèé ïðîçåêòîðîì íà êàôåäðó òîïîãðàô³÷íî¿ àíà-

òîì³¿ òà îïåðàòèâíî¿ õ³ðóðã³¿ Ìîñêîâñüêîãî óí³âåðñèòåòó,

äå ÷èòàâ îáîâ’ÿçêîâèé êóðñ. Ç 1915 ð. çàâ³äóâàâ ²íñòèòóòîì

òîïîãðàô³÷íî¿ àíàòîì³¿ òà îïåðàòèâíî¿ õ³ðóðã³¿. Íàóêîâ³

ðîáîòè À.Â. Ñòàðêîâà òîãî ïåð³îäó ÿâëÿëè ñîáîþ ôóíäà-

ìåíòàëüí³ äîñë³äæåííÿ: “Àíàòîì³ÿ ïðÿìî¿ êèøêè

³ ì’ÿç³â, ùî ìàþòü â³äíîøåííÿ äî íå¿. Ë³òåðàòóðíå é àíà-

òîì³÷íå äîñë³äæåííÿ” (Ì., 1912, ò. 1, 519 ñ.) [4] ³ “Àíàòîì³ÿ

ôàñö³é òà êë³òêîâèíè ìàëîãî òàçó. Ïîøèðåííÿ íàãíîºííÿ.

Ë³òåðàòóðíå ³ àíàòîì³÷íå äîñë³äæåííÿ” (Ì., ò. 2, 781 ñ.) [5].

Çà îñòàííþ ðîáîòó À.Â. Ñòàðêîâ íà êîíôåðåíö³¿ Â³éñüêîâî-

ìåäè÷íî¿ àêàäåì³¿ çäîáóâ Ïðåì³þ ³ìåí³ Ï.À. Çàãîðñüêîãî.

Â ðîêè Ïåðøî¿ ñâ³òîâî¿ â³éíè çàéìàâ ïîñàäó ãîëîâ-

íîãî õ³ðóðãà ëàçàðåòó ³ìïåðàòîðñüêî¿ ôàì³ë³¿ â Ïåòðîâ-

ñüêîìó ïàëàö³, äå ïðîâ³â ïîíàä 1 òèñ. îïåðàö³é.

Ó 1917 ðîö³ ï³ñëÿ ñìåðò³ ïðîôåñîðà Ô.À. Ñòåôàí³ñà,

À.Â. Ñòàðêîâ ñòàâ ïðîôåñîðîì, çàâ³äóâà÷åì êàôåäðè àíà-

òîì³¿ Óí³âåðñèòåòó Ñâ. Âîëîäèìèðà. Ï³çí³øå â³í î÷îëèâ

êàôåäðó àíàòîì³¿ Óêðà¿íñüêîãî äåðæàâíîãî óí³âåðñèòåòó

òà óêðà¿íñüêî¿ ëåêòóðè. Êàôåäðîþ àíàòîì³¿ ç ðîñ³éñüêîþ

ìîâîþ âèêëàäàííÿ íà òîé ÷àñ êåðóâàâ ïðîôåñîð Ï.². Ìî-

ðîçîâ, âèïóñêíèê Õàðê³âñüêîãî óí³âåðñèòåòó, çãîäîì äå-

êàí ³ ïðîðåêòîð Êè¿âñüêîãî ìåäè÷íîãî ³íñòèòóòó.

Çàâ³äóâà÷ êàôåäðè àíàòîì³¿ ëþäèíè (ç 1930 ïî 1971 ð³ê)

Ì.Ñ. Ñï³ðîâ ïèñàâ: “Ïðîôåñîð À.Â. Ñòàðêîâ áóâ áëèñêó-

÷èì ëåêòîðîì, ³ éîãî çàõîïëþþ÷³ ëåêö³¿ áóëè ïðèêëàäîì

òî÷íîãî ³ êàðòèííîãî âèêëàäåííÿ àíàòîì³÷íèõ ôàêò³â, ùî

ïðèâàáëþâàëè âåëè÷åçíó àóäèòîð³þ ñëóõà÷³â”. Íà òîé ÷àñ

ó÷íÿìè ³ ïîì³÷íèêàìè ïðîôåñîðà À.Â. Ñòàðêîâà áóëè

ïðîçåêòîðè Ì. Âîëêîáîé, Ô. Öåøê³âñüêèé, Ì. Ñï³ðîâ, à

ïîì³÷íèêàìè ïðîçåêòîðà – Â. Îâåí, Ë. Êðàóçå, Â. Êèáàëü-

÷è÷ òà Ì. Ñàóëÿê-Ñàâèöüêà. À.Â. Ñòàðêîâ ï³äãîòóâàâ ÷è-

ìàëî â÷åíèõ-àíàòîì³â, â³äòàê ôîðìóþ÷è ñâîþ óêðà¿í-

ñüêó íàóêîâó øêîëó[6].

Â. Ïëþù íàçèâàâ ïðîôåñîðà À.Â. Ñòàðêîâà îäíèì ³ç

ñâî¿õ íåçàáóòí³õ â÷èòåë³â ³ õàðàêòåðèçóâàâ éîãî, ÿê âèäàò-

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

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íîãî â÷åíîãî Óêðà¿íè, òàëàíîâèòîãî àíàòîìà ³ áëèñêó÷î-

ãî ïåäàãîãà [7].

Ï³ñëÿ ñòâîðåííÿ ó 1918 ðîö³ Óêðà¿íñüêî¿ àêàäåì³¿

íàóê (çãîäîì ÂÓÀÍ), ïðîôåñîð Ñòàðêîâ ñòàâ îäíèì ³ç

ïåðøèõ ¿¿ ä³éñíèõ ÷ëåí³â ó ãàëóç³ ìåäè÷íî¿ á³îëîã³¿, àêà-

äåì³êîì êàôåäðè àíàòîì³¿ Ô³çèêî-ìàòåìàòè÷íîãî

â³ää³ëó ÂÓÀÍ. Â³í, à òàêîæ Î. Êîð÷àê-×åïóðê³âñüêèé

(7 áåðåçíÿ 1921 ðîêó íà ñï³ëüíîìó çàñ³äàíí³ ÓÀÍ îáðàíî

àêàäåì³êîì ðàçîì ç³ À.Â. Ñòàðêîâèì) òà Ô. Îìåëü÷åíêî é

áóëè, âëàñíå, ïåðøèìè óêðà¿íñüêèìè ë³êàðÿìè-àêàäåì³-

êàìè. Òîãî æ ðîêó À.Â. Ñòàðêîâ îðãàí³çîâóº â àêàäåì³¿

ëàáîðàòîð³þ äëÿ äîñë³äæåííÿ öåíòðàëüíî¿ íåðâîâî¿ ñèñ-

òåìè. 1 ëèïíÿ 1921 ðîêó â àêàäåì³¿ ñòâîðåíî Êîì³ñ³þ ç

âèâ÷åííÿ öåíòðàëüíî¿ íåðâîâî¿ ñèñòåìè ï³ä êåð³âíèöò-

âîì àêàäåì³êà À.Â. Ñòàðêîâà. Äî ñêëàäó êîì³ñ³¿ âõîäèëè

äâà íàóêîâ³ ñï³âðîá³òíèêè. Âîíà ðîçòàøîâóâàëàñü â áó-

äèíêó Àíàòîì³÷íîãî òåàòðó [8].

Â ëèïí³ 1922 ðîêó À.Â. Ñòàðêîâ áóâ çìóøåíèé çàëè-

øèòè Óêðà¿íó ÷åðåç äðàìàòè÷í³ ïîä³¿: éîãî òåñòü, ³íæå-

íåð-ìåõàí³ê Êèºâî-Âîðîíåçüêî¿ çàë³çíèö³, áóâ çààðåøòî-

âàíèé ó Âîðîíåæ³ çà çâèíóâà÷åííÿì ó ïîñîáíèöòâ³

Äîáðîâîëü÷³é àðì³¿ ³ çãîäîì ñòðà÷åíèé. Ç ÷àñîì ñòàëî

â³äîìî, ùî âîðîíåçüêèé ÍÊ “âèéøîâ íà ñë³ä” Ñòàðêîâèõ.

Íàéáëèæ÷èì ÷àñîì î÷³êóâàâñÿ àðåøò ³ À.Â. Ñòàðêîâ áóâ

çìóøåíèé íåãàéíî çàëèøèòè Êè¿â òà ðóøèòè ³ç ñ³ì’ºþ

äî Êîðîñòåíÿ, à çâ³äòè ë³ñàìè òà áîëîòàìè, ç äâîìà ìà-

ëåíüêèìè ä³òüìè íà ðóêàõ, áëèçüêî òðüîõ òèæí³â ïðîáè-

ðàòèñÿ äî Ïîëüù³. Âïðîäîâæ ï‘ÿòè ì³ñÿö³â ñ³ì’ÿ æèëà â

Ï³íñüêó, äå À.Â. Ñòàðêîâ çàéìàâñÿ ïðèâàòíîþ ìåäè÷-

íîþ ïðàêòèêîþ, íà ùî â ñ³÷í³ 1923 ðîêó îòðèìàâ çàáî-

ðîíó ³ áóâ âèìóøåíèé øóêàòè ³íøå ïîìåøêàííÿ òà

ðîáîòó [9].

Íà ïî÷àòêó 1923 ðîêó â÷åíèé ïåðå¿õàâ äî Ïðàãè, äå

âïðîäîâæ äâîõ ðîê³â î÷îëþâàâ êàôåäðó á³îëîã³¿ Óêðà¿í-

ñüêîãî ïåäàãîã³÷íîãî ³íñòèòóòó. 11 ÷åðâíÿ 1923 ðîêó íà

ñï³ëüíîìó ç³áðàíí³ Ðàäè ÂÓÀÍ ó â³äïîâ³äü íà ïèñüìîâó

ïðîïîçèö³þ àêàäåì³êà À.Â. Ñòàðêîâà áóëî óõâàëåíî

ð³øåííÿ âèäàòè éîìó ìàíäàò ïîñåðåäíèêà ì³æ ÂÓÀÍ òà

ãðîìàäñüêèìè îðãàí³çàö³ÿìè ×åõîñëîâà÷÷èíè. Ó 1923

ðîö³ ïðî À.Â. Ñòàðêîâà ïèøóòü, ÿê ïðî ïîçàøòàòíîãî àêà-

äåì³êà ÂÓÀÍ (ó Ïðàç³). Çãîäîì, â³í äåÿêèé ÷àñ ïðàöþâàâ

íà ïîñàä³ ïðîôåñîðà Ðèçüêîãî óí³âåðñèòåòó â Ëàòâ³¿. Íå-

â³äîìî ç ÿêèõ ì³ðêóâàíü ïðîôåñîð À.Â. Ñòàðêîâ íå ïðèé-

íÿâ ëàòâ³éñüêîãî ãðîìàäÿíñòâà.Â Ðèçüêîìó óí³âåðñèòåò³,

â³í ³ ïðîâ³â ñâî¿ îñòàíí³ ðîêè æèòòÿ.

Ó 1925 ðîö³ Óêðà¿íñüêèé ãðîìàäñüêèé âèäàâíè÷èé

ôîíä ó Ïðàç³ âèäàâ êíèãó ÷ëåíà Óêðà¿íñüêî¿ àêàäåì³¿ íàóê

ïðîôåñîðà À.Â. Ñòàðêîâà “Çàãàëüíà á³îëîã³ÿ (Åëåìåíòè

æèòòÿ. Õ³ì³÷íèé òà ô³çè÷íèé ñóáñòðàò æèòòÿ. Çàãàëüí³ ïî-

íÿòòÿ ïðî êë³òèíó)” [10]. Öå áóâ ïåðøèé óêðà¿íñüêèé

ï³äðó÷íèê ç á³îëîã³¿.

Ó òîìó æ ðîö³ ó Ïðàç³ âèéøëà êíèãà Ì. Ïàâë³÷óêà “Êî-

ðîòêà àíàòîì³ÿ äëÿ ñòóäåíò³â ìåäèöèíè” (×.1, 213 ñ.), ïå-

ðåäìîâó äî ÿêî¿ íàïèñàâ àêàäåì³ê À.Â. Ñòàðêîâ. Ó ñâî¿é

ðåöåíç³¿ ïðîô. Î. ×åðíÿõ³âñüêèé â³äçíà÷àâ, ùî öÿ êíèãà º

ïåðøèì óêðà¿íñüêèì ï³äðó÷íèêîì ç àíàòîì³¿, ÿêèé ðîç-

ðàõîâàíèé íà ñòóäåíò³â-ìåäèê³â.

Â 1946 ðîö³ ó Ïðàç³ À.Â. Ñòàðêîâ îïóáë³êóâàâ ïðàöþ

“Äîñë³äæåííÿ íåðâ³â ñåðöÿ” [11].

Ïîìåð àêàäåì³ê À.Â. Ñòàðêîâ â í³÷ íà 19 ãðóäíÿ 1927

ðîêó ó ïî¿çä³ Â³äåíü – Ðèì ÷åðåç ðàïòîâó çóïèíêó ñåðöÿ.

“Ïðîôåñîð Ñòàðêîâ îäèí ïðîïðàöþâàâ ðîê³â òðèä-

öÿòü ñåðåä òðóï³â äëÿ òîãî, ùîá ïîëåãøèòèæèòòÿ æèâèì

ëþäÿì. Òðèäöÿòü ðîê³â íåâïèííî¿ ïðàö³, çàâæäè ïîâ’ÿçà-

íî¿ ç íåáåçïåêîþ äëÿ æèòòÿ. Ï³ä ÷àñ â³éíè â³í, äîñâ³ä÷åíèé

õ³ðóðã, âðÿòóâàâ íå îäíå ëþäñüêå æèòòÿ. ² îñü â³í ðàïòîâî

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ïîìèðàº ó âàãîí³ äåñü á³ëÿ Â³äíÿ. Òóò äðóæèíà éîãî, ÿêà

ùîéíî ïîõîâàëà ìàò³ð, ÷åêàëà éîãî ç äâîìà ñèíàìè òà

íàãîòîâëþâàëà ïîäàðóíêè, à ä³òè – ÷åêàëè, ùî ïîêàæóòü

áàòüêîâ³, ùî çà éîãî â³äñóòí³ñòü äå÷îìó ³ íàâ÷èëèñÿ. Òå-

ïåð â ïîíåä³ëîê ïðèáóäå ïðàõ ÷îëîâ³êà ³ áàòüêà” – ïèñàëà

³ñòîðèê Ò.Ñ. Âàðøåð [12], ñï³â÷óâàþ÷è äîë³ â÷åíîãî òà

éîãî ñ³ì’¿.

Ïîõîâàëè À.Â. Ñòàðêîâà â Ðèì³ íà êëàäîâèù³ Òåñòà÷÷î.

Â Óêðà¿íñüê³é ðàäÿíñüê³é åíöèêëîïåä³¿ òà âèäàííÿõ

ÀÍ ÓÐÑÐ ïðîôåñîð À.Â. Ñòàðêîâ íå áóâ ïðåäñòàâ-ëå-

íèé, éîãî ³ì’ÿ âèêðåñëèëè ç ³ñòîð³¿ Êè¿âñüêîãî ìåäè÷íî-

ãî óí³âåðñèòåòó òà ÀÍ ÓÐÑÐ ç ôîðìóëþâàííÿì “çà ñìåð-

òþ”. Ò³ëüêè ó ïóáë³êàö³ÿõ Ì.Ñ. Ñï³ðîâà íàâåäåí³ êîðîòê³

â³äîìîñò³ ïðî â÷åíîãî òà éîãî ó÷í³â.

Ïîïðè òå, ùî íàóêîâî-ïåäàãîã³÷íà ä³ÿëüí³ñòü À.Â. Ñòàð-

êîâà â Óêðà¿í³ íå áóëà äîâãîòðèâàëîþ, â³í âñå æ òàêè çì³ã

çàïî÷àòêóâàòè ðîçâèòîê ñâîº¿ àíàòîì³÷íî¿ øêîëè. Íà ñüî-

ãîäí³ íåìàº ñóìí³âó, ùî éîãî âíåñîê â íàóêó òà ñëàâåòíå

³ì’ÿ îäíîãî ñåðåä ïåðøèõ óêðà¿íñüêèõ àêàäåì³ê³â, íå-

îäì³ííî ïîòðåáóþòü ïîâåðíåííÿ äî ³ñòîðè÷íî¿ ñêàðá-

íèö³ óêðà¿íñüêî¿ ìåäèöèíè.

Ðåöåíçåíò: ä.ìåä.í., ïðîôåñîð ×åðêàñîâ Â.Ã.

Ë²ÒÅÐÀÒÓÐÀ

1. Âàñèëüåâ Ê.Ê. Ïðîôåññîð À.Â.Ñòàðêîâ (ê 125-ëåòèþ ñî

äíÿ ðîæäåíèÿ) // Ìîðôîëîãèÿ. 1999. Ò.115, ¹3.

2. Ýíöèêëîïåäè÷åñêèé ñëîâàðü ìåäèöèíñêèõ òåðìèíîâ. Ì.:

Ñîâ. ýíöèêëîïåäèÿ. 1982, Ò.1, Ñ.135.

3. Ýòèîëîãèÿ è ïàòîëîãè÷åñêàÿ àíàòîìèÿ ìûøå÷íîé êðè-

âîøåè: Äèññåðòàöèÿ. – Ì.: 1900. – 135 ñ.

4. Àíàòîìèÿ ïðÿìîé êèøêè è ìûøö, èìåþùèõ ê íåé îòíî-

øåíèå. Ëèòåðàòóðíîå è àíàòîìè÷åñêîå èññëåäîâàíèå. – Ì.: 1912. –

Ò.1. – 519 ñ.

5. Àíàòîìèÿ ôàñöèé è êëåò÷àòêè ìàëîãî òàçà. – Ì.:

1912. – Ò.2.

6. Ñï³ðîâ Ì.Ñ. Êè¿âñüêà àíàòîì³÷íà øêîëà. – Êè¿â: Çäîðîâ’ÿ

1965. – Ñ.90-91.

7. Â. Ïëþù. Ìåäè÷íà íàóêà â Óêðà¿í³ ó ïåðø³é ïîëîâèí³ XX

ñòîð³÷÷ÿ // Ìàòåð³àëè äî ³ñòîð³¿ óêðà¿íñüêî¿ ìåäèöèíè. – Íüþ-

Éîðê; Ìþíõåí, 1975. – Ò.1. – Ñ. 75, 96, 102, 104, 114.

8. Ìàêàðåíêî ².Ì. Ïîëÿêîâà ².Ì. Áèîãðàôè÷åñêèé ñëîâàðü

çàâåäóþùèõ êàôåäðàìè è ïðîôåññîðîâ Êèåâñêîãî ìåäèöèíñêîãî

èíñòèòóòà (1841-1991). – Êèåâ: Çäîðîâüÿ, 1991. – Ñ. 105.

9. Ãàí³òêåâè÷ ß. Óêðà¿íñüê³ ë³êàð³-â÷åí³ ïåðøî¿ ïîëîâèíè ÕÕ

ñòîë³òòÿ òà ¿õ íàóêîâ³ øêîëè. Á³îãðàô³÷í³ íàðèñè òà á³áë³îãðà-

ô³ÿ. – Ë.: 2002. – Ñ.111-113.

10. Âîëêîâ Â.À., Êóëèêîâà Ì.Â. Ðîññèéñêàÿ ïðîôåññóðà XVIII-

XX ââ. Áèîãðàôè÷åñêîå è ìåäèêî-áèîëîãè÷åñêèå íàóêè. Ì.: 2003.

Ñ.224-225.

11. Çàãàëüíà á³îëîã³ÿ. – Ïðàãà, 1925.

12. Äîñë³äæåííÿ ïðî íåðâè ñåðöÿ. – Ïðàãà, 1946.

13. ËÃÈÀ. Ô.7131. Îï.1. ¹58. Ë.: Àâòîãðàô.Ñ.63-69.

ÂÛÄÀÞÙÈÉÑß ÀÍÀÒÎÌ

ÏÐÎÔÅÑÑÎÐ ÀÐÑÅÍÈÉ ÂÈÊÒÎÐÎÂÈ× ÑÒÀÐÊÎÂ

Ìàëèêîâ À.Â., Äçåâóëüñüêàÿ È.Â., Èãíàòèùåâ Ì.Ð.,

Ãîí÷àðîâ Â.Ë., Âèäåðêî Ð.Â., Êîâàëü÷óê À.Â.

Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò

èìåíè À.À. Áîãîìîëüöà, ã. Êèåâ, Óêðàèíà

Ðåçþìå. Ñòàòüÿ ïîñâÿùàåòñÿ 140-ëåòíåìó þáèëåþ

îòå÷åñòâåííîãî ó÷åíîãî Àðñåíèÿ Âèêòîðîâè÷à Ñòàðêî-

âà. Ïîêàçàíà åãî íàó÷íàÿ è ïðåïîäàâàòåëüñêàÿ ðàáîòà

â êà÷åñòâå çàâåäóþùåãî êàôåäðîé àíàòîìèè ÷åëîâåêà

Êèåâñêîãî óíèâåðñèòåòà Ñâÿòîãî Âëàäèìèðà. Òàêæå îñ-

âåùàþòñÿ ñòðàíèöû åãî áèîãðàôèè â òÿæåëûå ãîäû ïåð-

âîé ïîëîâèíû ÕÕ âåêà.

Íàó÷íî-ïåäàãîãè÷åñêàÿ äåÿòåëüíîñòü À.Â. Ñòàðêîâà

òåñíî ñâÿçàíà ñ ôîðìèðîâàíèåì îòå÷åñòâåííîé øêîëû

àíàòîìîâ.

Êëþ÷åâûå ñëîâà: àíàòîìèÿ, õèðóðãèÿ, àíàòîìè÷å-

ñêàÿ øêîëà, èññëåäîâàíèÿ, ïðåïàðàòû.

THE GREAT ANATOMY

PROFESSOR ARSENIY VIKTOROVYCH STARKOV

A. Malikov, I. Dzevulska, M. Ignatischev,

V. Honcharov, R. Viderko, A. Kovalchuk

Bogomolets National Medical University, Kiev, Ukraine

Summary. This article is devoted to the 140th anniversary

of native scientist Arseniy Victorovich Starkov. His scientific

and pedagogical work is shown as dean of the anatomy

department at Kiev st. Volodimyr University. Also the facts of

his biography during those hard years in the first half of XX

century are hughlighted.

A.V. Starkov’s scientific and pedagogical work is closely

related to the formation of the native school of anatomy.

Key words: anatomy, surgery, school of anatomy,

researches, preparations.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

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ÓÄÊ 616–006.441–07:606.72

ÏÐÎÁËÅÌÛ ÄÈÀÃÍÎÑÒÈÊÈ È ÊËÀÑÑÈÔÈÊÀÖÈÈ

ÍÅÕÎÄÆÊÈÍÑÊÈÕ ËÈÌÔÎÌ

Áóñëåíêî Þ.À.

Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò èìåíè À.À. Áîãîìîëüöà, ã. Êèåâ, Óêðàèíà

Êëþ÷åâûå ñëîâà: ÍÕË, êëèíè÷åñêàÿ êëàññèôèêàöèÿ, ìîðôîëîãè÷åñêèå êëàññèôèêàöèè, äèàãíîñòèêà ÍÕË,

ïðîãíîçèðîâàíèå èñõîäà.

Íåõîäæêèíñêèå ëèìôîìû (ÍÕË) – îäíî èç ñàìûõ

ðàñïðîñòðàíåííûõ ëèìôîïðîëèôåðàòèâíûõ çàáîëåâà-

íèé êðîâè, ðèñê âîçíèêíîâåíèÿ êîòîðîãî óâåëè÷èâàåòñÿ

ñ âîçðàñòîì. Çàáîëåâàåìîñòü ÍÕË è ñìåðòíîñòü îò íèõ âî

âñåì ìèðå åæåãîäíî óâåëè÷èâàþòñÿ [2]. Ïåðâè÷íûé îïó-

õîëåâûé î÷àã ìîæåò ëîêàëèçîâàòüñÿ ïåðâè÷íî â ëèìôà-

òè÷åñêèõ óçëàõ (íîäàëüíîå ïîðàæåíèå) èëè â äðóãèõ îðãà-

íàõ è òêàíÿõ (ýêñòðàíîäàëüíîå ïîðàæåíèå). Êëèíè÷åñêèå

ïðîÿâëåíèÿ îïðåäåëÿþòñÿ ðàñïîëîæåíèåì îïóõîëåâûõ

î÷àãîâ. Îòìå÷àåòñÿ îò÷åòëèâàÿ ðàçíèöà â ÷àñòîòå ïîðà-

æåíèÿ ðàçíûõ îðãàíîâ è òêàíåé. Ïîðàæåíèå ìåäèàñòè-

íàëüíûõ ëèìôàòè÷åñêèõ óçëîâ âîçíèêàåò ðåæå, ÷åì ïðè

ëèìôîìå Õîäæêèíà, ñîñòàâëÿÿ 15–25%. Ïàðåíõèìàòîç-

íûå ëåãî÷íûå ïîðàæåíèÿ âñòðå÷àåòñÿ â 3–6% ñëó÷àåâ,

âîâëå÷åíèå â ïðîöåññ ñåëåçåíêè è êîñòíîãî ìîçãà ñîñòàâ-

ëÿåò 30–40%, ïå÷åíè – 15–50%, æåëóäî÷íî-êèøå÷íîãî

òðàêòà – 10–24%, êîñòåé – 5–15%. Äèàãíîñòèêà çàáîëåâàå-

ìîñòè è ñìåðòíîñòü îò ÍÕË â ïîñëåäíèå 2–3 äåñÿòèëåòèÿ

ïðîäîëæàåò íåóêëîííî ðàñòè [4].

Àêòóàëüíîñòü: 5-ëåòíÿÿ âûæèâàåìîñòü âçðîñëûõ

áîëüíûõ ñ ÍÕË, ïî äàííûì Íàöèîíàëüíîãî èíñòèòóòà

ðàêà ÑØÀ (NCI) çà 2003-2009 ãîä, ñîñòàâëÿåò 69%. Ñìåðò-

íîñòü â òå÷åíèå ãîäà ïîñëå ïîñòàíîâêè äèàãíîçà ÍÕË â

ÑØÀ, ñîñòàâëÿåò 27,3%[3]. Ïî äàííûì Íàöèîíàëüíîãî

êàíöåð-ðåãèñòðà Óêðàèíû, â 2011 ãîäó äèàãíîç ÍÕË áûë

âïåðâûå óñòàíîâëåí ó 2465 ÷åëîâåê. Ñìåðòíîñòü íà ïðî-

òÿæåíèè ïåðâîãî ãîäà ïîñëå óñòàíîâëåíèÿ äèàãíîçà ñî-

ñòàâèëà 33.7%[1].

Êëèíè÷åñêàÿ êëàññèôèêàöèÿ Ann Arbor. Äëÿ îïðåäå-

ëåíèÿ êëèíè÷åñêîãî ðàñïðîñòðàíåíèÿ ÇÍ èñïîëüçóþò

ïðåäëîæåííóþ â Ann Arbor (1971 ã.) êëàññèôèêàöèþ ëèì-

ôîãðàíóëåìàòîçà. Êàê êëèíè÷åñêàÿ êëàññèôèêàöèÿ ïî

ñòàäèÿì Ann Arbor íå ñîâåðøåííà. Çàòî – ëåãêî âûïîëíè-

ìà è ìîæåò ïðèìåíÿòüñÿ â ðàçëè÷íûõ ó÷ðåæäåíèÿõ äëÿ

ïîëó÷åíèÿ ñîïîñòàâèìûõ äàííûõ. Ýòà êëàññèôèêàöèÿ

áàçèðóåòñÿ íà äàííûõ àíàìíåçà, êëèíè÷åñêîãî îáñëåäî-

âàíèÿ, ìåòîäîâ âèçóàëèçàöèè è áèîïñèè [4].

Ñòàäèÿ I. Ïîðàæåíèå îäíîé ëèìôàòè÷åñêîé çîíû (I),

èëè ëîêàëèçîâàííîå ïîðàæåíèå îäíîãî ýêñòðàëèìôàòè-

÷åñêîãî îðãàíà èëè òêàíè (IÅ).

Ñòàäèÿ II. Ïîðàæåíèå äâóõ èëè áîëåå ëèìôàòè÷åñêèõ

îáëàñòåé ïî îäíó ñòîðîíó äèàôðàãìû (II) èëè ëîêàëèçî-

âàííîå ïîðàæåíèå îäíîãî ýêñòðàëèìôàòè÷åñêîãî îðãàíà

èëè òêàíè è èõ ðåãèîíàðíûõ ëèìôàòè÷åñêèõ óçëîâ(à) â

ñî÷åòàíèè èëè áåç ïîðàæåíèÿ äðóãèõ ëèìôàòè÷åñêèõ îá-

ëàñòåé ïî òó æå ñòîðîíó äèàôðàãìû (IIÅ). Êîëè÷åñòâî

ïîðàæåííûõ ëèìôàòè÷åñêèõ îáëàñòåé ìîæåò óêàçû-

âàòüñÿ ñëåäóþùèì îáðàçîì (II3).

Ñòàäèÿ III. Ïîðàæåíèå ëèìôàòè÷åñêèõ óçëîâ ïî îáå

ñòîðîíû äèàôðàãìû (III), êîòîðîå ìîæåò ñî÷åòàòüñÿ ñ ëî-

êàëèçîâàííûì ïîðàæåíèåì îäíîãî ýêñòðàëèìôàòè÷åñ-

êîãî îðãàíà èëè òêàíè (IIIÅ) èëè ñ ïîðàæåíèåì ñåëåçåíêè

(IIIS), èëè ïîðàæåíèåì òîãî è äðóãîãî (IIIE+S).

Ñòàäèÿ IV. Äèññåìèíèðîâàííîå (ìíîãîôîêóñíîå)

ïîðàæåíèå îäíîãî èëè íåñêîëüêèõ ýêñòðàëèìôàòè÷åñêèõ

îðãàíîâ â ñî÷åòàíèè èëè áåç ïîðàæåíèÿ ëèìôàòè÷åñêèõ

óçëîâ èëè èçîëèðîâàííîå ïîðàæåíèå ýêñòðàëèìôàòè÷åñ-

êîãî îðãàíà ñ ïîðàæåíèåì îòäàëåííûõ (íå ðåãèîíàðíûõ)

ëèìôàòè÷åñêèõ óçëîâ.

Êàæäàÿ ñòàäèÿ äîëæíà áûòü ðàçäåëåíà íà À è Á ïîäñòà-

äèè âçàâèñèìîñòè îò îòñóòñòâèÿ (À) èëè íàëè÷èÿ (Á)

ñèìïòîìîâ èíòîêñèêàöèè, ê êîòîðûì îòíîñÿòñÿ:

1) íåîáúÿñíèìàÿ ïîòåðÿ ìàññû òåëà áîëåå ÷åì íà 10%

çà 6 ïîñëåäíèõ ìåñÿöåâ äî îáðàùåíèÿ ê âðà÷ó;

2) íåîáúÿñíèìûå ïîäúåìû òåìïåðàòóðû òåëà âûøå

38°Ñ;

3) íî÷íàÿ ïîòëèâîñòü.

Êîíñòàòàöèÿ äàæå îäíîãî èç ïåðå÷èñëåííûõ ñèìïòî-

ìîâ äàåò îñíîâàíèå äëÿ îïðåäåëåíèÿ ïîäñòàäèè Á.

Áîëåå èíôîðìàòèâíîé äëÿ âûáîðà òàêòèêè ëå÷åíèÿ è

ïðîãíîçà ÿâëÿåòñÿ ïàòîìîðôîëîãè÷åñêàÿ êëàññèôèêàöèÿ

ÍÕË [4-5].

Ïàòîìîðôîëîãèÿ ÍÕË: ÍÕË – ãåòåðîãåííàÿ ãðóïïà

ëèìôîïðîëèôåðàòèâíûõ çàáîëåâàíèé. Ïîäòèïû ÍÕË îò-

ëè÷àþòñÿ ìåæäó ñîáîé ïî ìîðôîëîãè÷åñêèì, ìîëåêó-

ëÿðíî-áèîëîãè÷åñêèì, èììóíîôåíîòèïè÷åñêèì õàðàê-

òåðèñòèêàì, ïî ñòåïåíè àãðåññèâíîñòè, òî åñòü è ïî

ïðîãíîçó [2,6].

Áëàãîäàðÿ èñïîëüçîâàíèþ ïåðåäîâûõ òåõíîëîãèé äèàã-

íîñòèêè, ïîíèìàíèå ãèñòîïàòîëîãèè îïóõîëåé ðàñòåò. Áûëè

îïèñàíû íîâûå ìîðôîëîãè÷åñêèå âàðèàíòû ÍÕË. Êëàñ-

ñèôèêàöèÿ ëèìôîì çà ïîñëåäíèå 40 ëåò çíà÷èòåëüíî èçìå-

íåíà, ïîñòîÿííî ðàñøèðÿåòñÿ è ñîâåðøåíñòâóåòñÿ [5].

Ïåðâàÿ ìîðôîëîãè÷åñêàÿ êëàññèôèêàöèÿ çëîêà÷å-

ñòâåííûõ ëèìôîì áûëà ðàçðàáîòàíà E.A. Gall è T.B. Mal-

lory â 1942 ã. Â 60–70-õ ãã. XX âåêà ñîâåðøåíû îòêðûòèÿ

ðåâîëþöèîííîãî õàðàêòåðà, óãëóáèâøèå çíàíèÿ î ïðèðîäå

è ôóíêöèÿõ êëåòîê èììóííîé ñèñòåìû [5].

Â íà÷àëå 70-õ óñòàíîâëåíî íàëè÷èå íà ïîâåðõíîñòíûõ

ìåìáðàíàõ ëèìôîöèòîâ àíòèãåíîâ è ðåöåïòîðîâ. Èõ âû-

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ÿâëåíèå ïîçâîëèëî èäåíòèôèöèðîâàòü ëèíåéíóþ ïðè-

íàäëåæíîñòü (ñóáïîïóëÿöèè Â- èëè Ò-/ÅÊ-êëåòîê) è óðî-

âåíü äèôôåðåíöèðîâêè íåîïëàñòè÷åñêèõ ëèìôîèäíûõ

êëåòîê. Â 1979 ãîäó ïîëó÷åíû ïåðâûå ÌêÀÒ (ìîíî-

êëîíàëüíûå àíòèòåëà) ïðîòèâ äèôôåðåíöèðîâî÷íûõ

àíòèãåíîâ ëèìôîöèòîâ ÷åëîâåêà. Â äàëüíåéøåì áûëà

ïðåäëîæåíà ñèñòåìà, ïîäðàçäåëåííàÿ íà êëàñòåðû äèô-

ôåðåíöèðîâêè (CD) âêëþ÷àâøàÿ àíòèãåíû ìåìáðàí, öè-

òîïëàçìû è ÿäåð êëåòîê ðàçëè÷íûõ îðãàíîâ è òêàíåé. Íà

ñåãîäíÿøíèé äåíü, äàííàÿ ñèñòåìà ïåðåèìåíîâàíà â

HCDM (Äèôôåðåíöèðîâî÷íûå ìîëåêóëû êëåòîê ÷åëîâå-

êà), âêëþ÷àåò áîëåå 350 êëàñòåðîâ. Ýòè îòêðûòèÿ ïîçâîëè-

ëè îõàðàêòåðèçîâàòü èììóíîôåíîòèï ìíîãèõ ÍÕË Â- è

Ò-êëåòî÷íîãî ïðîèñõîæäåíèÿ. Îäíîâðåìåííî áûë äîñ-

òèãíóò çíà÷èòåëüíûé ïðîãðåññ â ïîíèìàíèè ìîëåêóëÿð-

íî-ãåíåòè÷åñêèõ ìåõàíèçìîâ ðàçâèòèÿ ËÍ. Ïåðâûìè âû-

ÿâëåíû öèòîãåíåòè÷åñêèå èçìåíåíèÿ â âèäå t (14;18)

(q32;q21) ïðè ôîëëèêóëÿðíîé ëèìôîìå è t (8;14) (q24; q32)

ïðè ëèìôîìå Áåðêèòòà.

Ðàçðàáîòêà íîâûõ ìåòîäîâ – ïîëèìåðàçíîé öåïíîé

ðåàêöèè (ÏÖÐ) è ôëóîðåñöåíòíîé ãèáðèäèçàöèè in situ

(FISH) ïîçâîëèëà èçó÷àòü ãåí ðåöåïòîðà è ðåàðàíæèðîâ-

êó îíêîãåíîâ, íà óðîâíå îäíîé êëåòêè, èñïîëüçóÿ ïàðà-

ôèíîâûå ñðåçû [5].

Ïåðâîé ïîïûòêîé ñîçäàíèÿ ñîâðåìåííîé êëàññèôè-

êàöèè ëèìôîì íà îñíîâå íîâûõ ãèñòîìîðôîëîãè÷åñêèõ

äàííûõ è ìîëåêóëÿðíî-ãåíåòè÷åñêîãî àíàëèçà, ñëåäóåò

ñ÷èòàòü Ïåðåñìîòðåííóþ (ïîäâåðãøóþñÿ ðåâèçèè)

Åâðîïåéñêî-Àìåðèêàíñêóþ êëàññèôèêàöèþ ëèìôîèäíûõ

íåîïëàçèé (REAL classification) 1994 ãîäà [6].

Â 2008 ã. îïóáëèêîâàíà íîâåéøàÿ êëàññèôèêàöèÿ ÂÎÇ

(4-ãî ïåðåñìîòðà), â ñîçäàíèè êîòîðîé ïðèíèìàëè ó÷àñ-

òèå 130 ïàòîëîãîâ èç 22 ñòðàí. Íîâàÿ êëàññèôèêàöèÿ ñòðî-

èëàñü íà äîñòèãíóòûõ ðàíåå ðåçóëüòàòàõ è îäíîâðåìåííî

ñîäåðæèò íîâûå ïîëîæåíèÿ, îòêðûâàþùèå ïóòè ê ëó÷-

øåìó îïðåäåëåíèþ ãåòåðîãåííûõ èëè íåÿñíûõ íîçîëîãè-

÷åñêèõ ôîðì [6]. Êëàññèôèêàöèÿ âêëþ÷àåò âðåìåííóþ

ãðóïïó ïîãðàíè÷íûõ ëèìôîì. Ïîãðàíè÷íûå ÍÕË èìåþò

ïðèçíàêè, ïðîìåæóòî÷íûå ìåæäó ðàçíûìè âèäàìè ëèì-

ôîì [7]. Îáðàùåíî âíèìàíèå íà àíàòîìè÷åñêóþ ëîêàëè-

çàöèþ íîâîîáðàçîâàíèÿ, à òàêæå âîçðàñò áîëüíîãî. Ïðåä-

ëîæåíî ïðîãíîñòè÷åñêîå ðàñïðåäåëåíèå Â-êëåòî÷íûõ

ëèìôîì.

Âûäåëÿþò èíäîëåíòíûå, àãðåññèâíûå è âûñîêî àãðåñ-

ñèâíûå ËÍ [6].

Ïðîãíîçèðîâàíèå èñõîäà ÍÕË: ïî îäíîìó îïðåäåëå-

íèþ âèäó ëèìôîìû ïðîãíîç âûæèâàåìîñòè ñîñòàâèòü

çàòðóäíèòåëüíî. Ñîçäàíî íåñêîëüêî ïðîãíîñòè÷åñêèõ ìî-

äåëåé äëÿ íàèáîëåå ðàñïðîñòðàíåííûõ ïîäòèïîâ ÍÕË. Èõ

èñïîëüçóþ äëÿ ïðîãíîçèðîâàíèÿ èñõîäà çàáîëåâàíèÿ íà

îñíîâå êëèíè÷åñêèõ äàííûõ áîëüíîãî äî ëå÷åíèÿ. Äëÿ àã-

ðåññèâíûõ Ë – Ìåæäóíàðîäíûé ïðîãíîñòè÷åñêèé

èíäåêñ (Revised IPI (R-IPI) 2005). Ñðåäè àãðåññèâíûõ ëèì-

ôîì íàèáîëåå ÷àñòî âñòðå÷àåòñÿ äèôôóçíàÿ êðóïíîêëå-

òî÷íàÿ Â-êëåòî÷íàÿ ëèìôîìà. Äëÿ ôîëëèêóëÿðíûõ ëèì-

ôîì èñïîëüçóþò Ìåæäóíàðîäíûé ïðîãíîñòè÷åñêèé

Òàáëèöà 1.

Òàáëèöà 2.

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èíäåêñ ôîëëèêóëÿðíûõ ëèìôîì (Follicular Lymphoma

International Prognostic Index (FLIPI2)) [6,8].

Ñîãëàñíî äàííûì Armitage è ñîàâòîðîâ, ê ãðóïïå ñ

íàèëó÷øèì ïðîãíîçîì, ãäå 5-ëåòíÿÿ âûæèâàåìîñòü ñî-

ñòàâëÿåò áîëåå 70%, îòíîñÿòñÿ áîëüíûå ñ ôîëëèêóëÿðíîé,

àíàïëàñòè÷åñêîé êðóïíîêëåòî÷íîé è MALT-ëèìôîìà-

ìè. Âòîðóþ ãðóïïó ñîñòàâëÿþò ïàöèåíòû ñî ÇË èç ìàëûõ

ëèìôîöèòîâ, ëèìôîïëàçìîöèòàðíîé Ë, îïóõîëÿìè èç

êëåòîê ìàðãèíàëüíîé çîíû, ïðè êîòîðûõ 5-ëåòíÿÿ âûæè-

âàåìîñòü ñîñòàâëÿåò îò 50 äî 70%. Ê ãðóïïå ïàöèåíòîâ ñî

ÇË, ïðè êîòîðûõ 5-ëåòíÿÿ âûæèâàåìîñòü êîëåáëåòñÿ â

ïðåäåëàõ 30–50%, îòíîñÿòñÿ áîëüíûå ñ ëèìôîìîé Áåð-

êèòòà è Â-êðóïíîêëåòî÷íîé Ë. Â ãðóïïó ñ íàèõóäøèì

ïðîãíîçîì âõîäÿò ïàöèåíòû ñ Ë èç êëåòîê ìàíòèéíîé

çîíû, Ò-ëèìôîáëàñòíûìè è èç çðåëûõ ïåðèôåðè÷åñêèõ

Ò-êëåòîê [9]. Îäèí èç âàðèàíòîâ èñõîäà ëèìôîìû – ëåéêå-

ìèçàöèÿ, â ñëó÷àå ïîðàæåíèå êîñòíîãî ìîçãà [6].

Çàêëþ÷åíèå: ñîâðåìåííàÿ äèàãíîñòèêà çëîêà÷åñòâåí-

íûõ ëèìôîïðîëèôåðàòèíûõ çàáîëåâàíèé îñóùåñòâëÿåò-

ñÿ ïàòîëîãàìè è îíêî-ãåìàòîëîãàìè ñ ó÷åòîì Êëàññèôè-

êàöèÿ ÂÎÇ 2008 ãîäà [6]. Äèàãíîç äîëæåí îñíîâûâàòüñÿ íà

ðåçóëüòàòàõ

1. Êëèíè÷åñêèõ äàííûõ;

2. Ïàòîãèñòîëîãè÷åñêèõ äàííûõ;

3. ÈÃÕ èññëåäîâàíèÿõ;

4. Ðåçóëüòàòàõ öèòîìîðôîëîãè÷åñêèõ èññëåäîâàíèé

ïåðèôåðè÷åñêîé êðîâè è ïóíêòàòîâ ÊÌ, äîïîëíåííûå

äàííûìè èììóíîôåíîòèïèðîâàíèÿ êëåòîê;

5. Äàííûå ìîëåêóëÿðíî-ãåíåòè÷åñêîãî àíàëèçà (äëÿ

óòî÷íåíèÿ äèàãíîçà, â ðÿäå ñîìíèòåëüíûõ ñëó÷àåâ).

Ðåöåíçåíò: ä.ìåä.í., ïðîôåñîð Â.ª. ×åøóê

ËÈÒÅÐÀÒÓÐÀ

1. Ðàê â Óêðà¿í³, 2011-2012: Çàõâîðþâàí³ñòü, ñìåðòí³ñòü,

ïîêàçíèêè ä³ÿëüíîñò³ îíêîëîã³÷íî¿ ñëóæáè â Óêðà¿í³/ [Ôåäîðåíêî Ç.Ï.,

Ìèõàéëîâè÷ Þ.É., Ãóëàê Ë.Î., òà ³íø³.]; ï³ä ðåä. Ùåïîò³íà ².Á. –

Ê.: Íàö³îíàëüíèé ³íñòèòóòðàêó, 2013. – (Áþëåòåíü Íàö³îíàëü-

íîãî êàíöåð-ðåºñòðó Óêðà¿íè, ¹14).

2. Ñòàíäàðòû äèàãíîñòèêè è ëå÷åíèÿ íåõîäæêèíñêèõ ëèì-

ôîì â ìèðå è â Óêðàèíå: êîììåíòàðèè ñïåöèàëèñòîâ / È.À. Êðÿ-

÷îê, Î.Â. Ïîíîìàðåâà//Çäîðîâüå Óêðàèíû. – ¹ 13-14. – 2008.

3. SEER Cancer Statistics Fact sheets: Non-Hodgkin Lymphoma.

National Cancer Institute 2013 .Bethesda, MD, http://seer.cancer.gov/

statfacts/html/nhl.html.

4. Äèàãíîñòèêà è îïðåäåëåíèå ðàñïðîñòðàíåííîñòè (ñòà-

äèðîâàíèå) Íåõîäæêèíñêèõ ëèìôîì/ È.Â. Ïîääóáíàÿ, Å.À. Ä¸-

ìèíà // Ïðàêòè÷åñêàÿ îíêîëîãèÿ.–¹ 3.–Òîì 5.–2004.– ñ.176-184

5. Î ïðèðîäå è íîâîé êëàññèôèêàöèè ëèìôîèäíûõ îïóõî-

ëåé / Ä.Ô. Ãëóçìàí [è äð.]// Îíêîëîãèÿ. – ¹2. –Òîì 14.–2012. –

ñ.117-125.

6. Genentech USA/ Non-Hodgkin’s Lymphoma a histo-

pathologic and prognostic evaluation/ Biooncology. – 2010.

7. Cabanillas F. Non-Hodgkin’s lymphoma: the old and the

new. Elsevier Inc.2011.

8. Sarkozy C, Baseggio L, and oth.Peripheral blood involvement

in patients with follicular lymphoma: a rare disease manifestation

associated with poor prognosis. Hospices Civils de Lyon (HCL)/Pierre

Benite Cedex, France.2013.

9. William BM, Armitage JO. International analysis of the

frequency and outcomes of NK/T-cell lymphomas. Best Pract Res Clin

Haematol. 2013.

ÏÐÎÁËÅÌÈ Ä²ÀÃÍÎÑÒÈÊÈ ÒÀ ÊËÀÑÈÔ²ÊÀÖ²¯

ÍÅÕÎÄÆÊÈÍÑÜÊÈÕ Ë²ÌÔÎÌ

Áóñëåíêî Þ.À.

Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò

³ìåí³ Î.Î. Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

Ðåçþìå. Ïðåäñòàâëåíî àíàë³ç ë³òåðàòóðè, ïðèñâÿ÷å-

íî¿ ïèòàííþ îïòèì³çàö³¿ àëãîðèòì³â êëàñèô³êàö³¿ òà ä³àã-

íîñòèêè õâîðèõ íà Íåõîäæê³íñüê³ ë³ìôîìè. Ðîçãëÿäàþòü-

ñÿ êëþ÷îâ³ ìîìåíòè ó ðîçâèòêó òåõíîëîã³é ä³àãíîñòèêè ³

ñïðîá êëàñèô³êóâàòè ïóõëèíè ë³ìôî¿äíî¿ òêàíèíè. Ïðåä-

ñòàâëåí³ íîâ³ àñïåêòè ïîêëàäåí³ â íîâ³òíþ êëàñèô³êàö³þ

ÂÎÎÇ 2008 ðîêó. Âèâ÷åíî äàí³ ë³òåðàòóðè ç êë³í³÷íèõ äîñ-

ë³äæåíü ³ç çàñòîñóâàííÿì ïðîãíîñòè÷íèõ ³íäåêñ³â.

Êëþ÷îâ³ ñëîâà: ÍÕË, êë³í³÷íà êëàñèô³êàö³ÿ, ìîðôî-

ëîã³÷í³ êëàñèô³êàö³¿, ä³àãíîñòèêà ÍÕË, ïðîãíîçóâàííÿ

íàñë³äê³â.

PROBLEMS OF DIAGNOSIS AND CLASSIFICATION

OF NON-HODGKIN’S LYMPHOMA

I. Buslenko

Bogomolets National Medical University, Kyiv, Ukraine

Summary. Presents an analysis of the literature on the

optimization algorithms of classification and diagnosis of

patients with non-Hodgkin lymphomas. Examines the key

stages in the development of diagnostic technologies and

attempts to classify tumors of lymphoid tissue. Presented

new aspects put in the latest WHO classification 2008.

Explored the literature on clinical studies using prognostic

indices.

Key words: NHL, clinical classification, morphological

classifications, diagnostics of NHL, prognosis.

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ÎÃËßÄÈ / SURVEYS

ÓÄÊ 618.19.–006.6-033.2(048)+616.71-006.6-033.2-085(048)

ÌÅÒÀÑÒÀÇÈ ÐÀÊÓ ÌÎËÎ×ÍÎ¯ ÇÀËÎÇÈ (ÐÌÇ)

Ó Ê²ÑÒÊÈ: ÌÅÕÀÍ²ÇÌ Ê²ÑÒÊÎÂÎ¯ ÄÅÑÒÐÓÊÖ²¯

ÒÀ ¯Õ Ë²ÊÓÂÀÍÍß

Âèñîöüêèé À.Î.

Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Î.Î. Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: ê³ñòêîâ³ ìåòàñòàçè, á³ôîñôîíàòè, RANKL, äåíîñóìàá.

Ïðîáëåìà ë³êóâàííÿ ìåòàñòàòè÷íîãî óðàæåííÿì

ê³ñòîê ñêåëåòó º äîñèòü àêòóàëüíîþ ñüîãîäí³, òîìó ùî òàê³

õâîð³ ñòðàæäàþòü â³ä ñò³éêîãî áîëüîâîãî ñèíäðîìó, ïàòî-

ëîã³÷íèõ ïåðåëîì³â, ïîðóøåíü ðóõó, ùî çíà÷íî ïîã³ðøóº

ÿê³ñòü æèòòÿ òà ñêîðî÷óº éîãî òðèâàë³ñòü.

Ïðè ìåòàñòàçóâàíí³ ÐÌÇ, îñòåîë³òè÷í³ ïðîöåñè âèç-

íà÷àþòüñÿ ó 80% ïàö³ºíòîê, à ó 20% - îñòåîáëàñòè÷í³ àáî

çì³øàí³. Óðàæåííÿ õàðàêòåðèçóºòüñÿ ï³äâèùåíîþ àêòèâ-

í³ñòþ îñòåîêëàñò³â, äåñòðóêö³ºþ ê³ñòêîâî¿ òêàíèíè ³ ïî-

ÿâîþ áîëþ, ã³ïåðêàëüö³éåì³¿, êîìïðåñ³¿ ñïèííîãî ìîçêó

àáî íåðâ³â, ïàòîëîã³÷íèõ ïåðåëîì³â (SREs, skeletal-related

events). Öåíòðàëüíèì ìåõàí³çìîì ï³äâèùåííÿ àêòèâíîñò³

îñòåîêëàñò³â º íàäì³ðíà àêòèâàö³ÿ ¿õ ðåöåïòîð³â RANKL.

Â íîðì³ îñòåîêëàñòè àêòèâóþòüñÿ îñòåîáëàñòàìè. Îñ-

òàíí³ ïðîäóêóþòü ìàêðîôàãàëüíèé êîëîí³ºñòèìóëþþ-

÷èé ôàêòîð (M-CSF) ³ àêòèâàòîðè ðåöåïòîð³â RANK, ÿê³

ïåðåäàþòü ³íôîðìàö³þ ïðî äèôåðåíö³àö³þ ³ àêòèâàö³þ

îñòåîêëàñò³â. Òàêîæ îñòåîáëàñòè âèä³ëÿþòü îñòåîïðîòå-

ãåðèí (OPG), ÿêèé áëîêóº ðåöåïòîðè RANK. Ï³äâèùóþòü

ð³âåíü RANKL òàê³ àãåíòè ÿê PTHrP, TNF-α, PGE2, IL-1,

IL-11, FGF-2, IGF-1, NF-κB/MAP-kinase, ³íã³á³òîðè ÖÎÃ 2

(³íäîìåòàöèí) òà ³íø³ ðå÷îâèíè [3, 2].

Ñåðåä ê³ñòîê íàé÷àñò³øå ìåòàñòàçóâàííÿ â³äáóâàºòüñÿ

ó àêñ³àëüíèé ñêåëåò. Àíàòîì³÷íà ïðè÷èíà öüîãî òà, ùî

âåíîçíà êðîâ â³ä ãðóäåé ³ òàçîâèõ îðãàí³â âïàäàº íå ëèøå ó

íèæíþ ïîðîæíèñòó âåíó, à é âåðòåáðàëüíå âåíîçíå ñïëå-

òåííÿ. Çá³ëüøåííÿ ãë³êîë³çó â ïóõëèí³ ³ ïðîäóêö³ÿ ìîëî÷-

íî¿ êèñëîòè ïðèçâîäèòü äî ì³ñöåâîãî àöèäîçó, ùî

çá³ëüøóº îñòåîêëàñòíó ðåçîðáö³þ, ïðîâîêóº âèêèä ³ àêòè-

âàö³þ êàòåïñèí³â B, D, ³ L òà MMPs, ÿê³ ñïðèÿþòü äåãðà-

äàö³¿ åêñòðàöåëþëÿðíîãî ìàòðèêñó. Âåëèêó ðîëü â³ä³ãðà-

þòü ì³êðîîòî÷åííÿ ê³ñòêîâî¿ òêàíèíè (ã³ïîêñ³ÿ, âèñîêèé

âì³ñò êàëüö³þ), ùî ñïðèÿþòü ïóõëèíí³é ïðîãðåñ³¿, à òàêîæ

íàÿâí³ñòü ôàêòîð³â ðîñòó (òàêèõ ÿê TGF-β, IGFs), ÿê³

ï³äòðèìóþòü ïîðî÷íå êîëî ìåòàñòàçóâàííÿ â ê³ñòêè. Ìå-

õàí³çì éîãî óòâîðåííÿ ïî÷èíàºòüñÿ ç òîãî, ùî ìåòàñòà-

òè÷í³ ïóõëèíí³ êë³òèíè ïðîäóêóþòü ð³çíîìàí³òí³ ôàêòîðè

ðîñòó, íàéá³ëüøå çíà÷åííÿ ñåðåä ÿêèõ ìàº PTHrP

(parathyroid hormone-related protein). Â³í ñïðè÷èíþº íàä-

ì³ðíó àêòèâàö³þ RANKL ³ çìåíøóº âì³ñò OPG, çá³ëüøóþ-

÷è àêòèâí³ñòü îñòåîêëàñò³â. Ïðè öüîìó, ôàêòîðè ðîñòó,

ùî íàêîïè÷åí³ ó ìàòðèêñó (TGF-β, VEGF, IGFs, bone

morphogenic proteins, fibroblast-derived factors), à òàêîæ

éîíè êàëüö³þ âèâ³ëüíÿþòüñÿ â ì³êðîîòî÷åííÿ ê³ñòêè.

Äàí³ ðå÷îâèíè ñòèìóëþþòü ïîäàëüøó ïðîë³ôåðàö³þ ïóõ-

ëèííèõ êë³òèí ³ ïðîäóêóâàííÿ íèìè ùå á³ëüøå ôàêòîð³â

ðîñòó ³ PTHrP. Òàêîæ ïðîâîêóþòü äèôåðåíö³àö³þ îñòåîê-

ëàñò³â ³ ðåçîðáö³þ ê³ñòêè ²Ë-6, ²Ë-8, ²Ë-11, ÿê³ ïðîäóêóþòü

êë³òèíè ÐÌÇ. Àêòèâí³ñòü äàíèõ öèòîê³í³â òàêîæ ñòèìó-

ëþºòüñÿ TGF-β. Ïðè öüîìó ²Ë-8 ìîæå íàâ³òü ñàì àêòèâó-

âàòè RANK. Âåëèêå çíà÷åííÿ ïðèä³ëÿºòüñÿ ³ îñòåîì³ì³ê-

ðè÷íèì ôàêòîðàì, ÿê³ âèä³ëÿþòü ïóõëèíí³ êë³òèíè –

îñòåîïîíò³í, îñòåîêàëüöèí, îñòåîíåêòèí, ê³ñòêîâ³ ñ³àëîï-

ðîòå¿íè. Íàïðèêëàä, îñòåîïîíò³í ïðîäóêóºòüñÿ ó áàãàòüîõ

âèïàäêàõ êë³òèíàìè ÐÌÇ, ñòèìóëþº äèôåðåíö³àö³þ ³ àê-

òèâí³ñòü îñòåîêëàñò³â, ïîðóøåííÿ â³äêëàäàííÿ ì³íåðàë³â â

îñòåî¿ä. Åêñïðåñóþòü êë³òèíè â íàäì³ðí³é ê³ëüêîñò³ òàêîæ

ôàêòîð òðàíñêðèïö³¿ Runx2, ÿêèé íåîáõ³äíèé äëÿ äèôå-

ðåíö³àö³¿ îñòåîáëàñò³â ç ìåçåíõ³ìàëüíèõ ñòîâáóðîâèõ

êë³òèí [3, 8].

Ñó÷àñí³ ï³äõîäè äî ë³êóâàííÿ ìåòàñòàç³â â ê³ñòêè âèç-

íà÷àþòüñÿ áàãàòüìà ïàðàìåòðàìè, ãîëîâíèìè ç ÿêèõ º

ëîêàë³çàö³ÿ ³ ã³ñòîëîã³÷íà ôîðìè ïåðâèííî¿ ïóõëèíè. Îñ-

íîâíèìè êîìïîíåíòàìè êîìïëåêñíîãî ë³êóâàííÿ ìåòà-

ñòàòè÷íîãî â ê³ñòêè ÐÌÇ º ïðîìåíåâà òåðàï³ÿ, ãîðìîíîòå-

ðàï³ÿ, õ³ì³îòåðàï³ÿ. Ãîðìîíîòåðàï³ÿ ìåòàñòàç³â ïîâ’ÿçàíà

³ç çàñòîñóâàííÿì àíòèåñòðîãåíó, ³íã³á³òîð³â àðîìàòàçè,

ïðîãåñòèí³â, à òàêîæ àãîí³ñò³â ðèë³çèíã-ãîðìîíó ëþòå¿í³-

çóþ÷îãî ãîðìîíó.

Ïðè ìåòàñòàòè÷íîìó óðàæåííÿ ê³ñòîê ïîòð³áíî ðîç³ð-

âàòè ïîðî÷íå êîëî àêòèâàö³¿ îñòåîêëàñò³â. Ç ö³ºþ ìåòîþ

óæå áàãàòî ðîê³â âèêîðèñòîâóþòüñÿ á³ôîñôîíàòè. Âîíè

ïîêðàùóþòü ÿê³ñòü æèòòÿ, ïîïåðåäæóþ÷è ïåðåëîìè òà

³íø³ SREs. Ïðèêð³ïëþþ÷èñü äî ã³äðîêñèàïàòèò³â ê³ñòêî-

âîãî ìàòðèêñó äàí³ ïðåïàðàòè ïîãëèíàþòüñÿ îñòåîêëàñòà-

ìè, ùî ïðèçâîäèòü äî ¿õíüîãî àïîïòîçó [7]. Á³ôîñôîíàòè

ïåðøî¿ ãåíåðàö³¿ (íàïðèêëàä, êëîäðîíàò) íå ì³ñòèëè àòîì

àçîòó, òîä³ ÿê ï³çí³øî¿ ãåíåðàö³¿ (ïàì³äðîíàò, çîëåäðîíîâà

êèñëîòà) éîãî ì³ñòÿòü ³ ¿õíÿ ä³ÿ áàçóºòüñÿ íà ³íã³áóâàíí³

ôàðíåñèëôäèôîñôîíàòñèíòàçè, ÿêà ðåãóëþº àêòèâí³ñòü

êëþ÷îâîãî ôåðìåíòó - ãóàíîçèí òðèôîñôàòàçè, ùî íåîá-

õ³äíèé äëÿ ôóíêö³îíóâàííÿ îñòåîêëàñò³â [10]. Ó äîñë³ä-

æåííÿ Paterson A. òà ³í. (1993) â³äáóëîñÿ çìåíøåííÿ ã³ïåð-

êàëüöåì³÷íèõ åï³çîä³â (28 ïðîòè 52 áåç ë³êóâàííÿ),

ïåðåëîì³â õðåáö³â (84 ïðîòè 124), äåôîðìàö³¿ õðåáö³â (168

ïðîòè 304) ïðè âèêîðèñòàíí³ á³ôîñôîíàò³â [11]. Òàêîæ

ïîºäíàííÿ ïàì³äðîíàòó ç õ³ì³îòåðàï³ºþ ïðèçâîäèòü äî

ïðîëîíãàö³¿ ñåðåäíüîãî ÷àñó ïðîãðåñ³¿ ìåòàñòàç³â (244

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

156

ÎÃËßÄÈ / SURVEYS

ïðîòè 180 äí³â) ³ çíà÷íîãî çíèæåííÿ áîëþ ïîð³âíÿíî ç

ïàö³ºíòàìè, ÿêèì áóëà ïðèçíà÷åíà ëèøå õ³ì³îòåðàï³ÿ.

Êðàù³ ðåçóëüòàòè äàº âèêîðèñòàííÿ á³ôîñôîíàò³â 3 ïîêî-

ë³ííÿ. Íàïðèêëàä, ïðè âèêîðèñòàíí³ çîëåäðîíîâî¿ êèñëî-

òè ó ïîð³âíÿíí³ ç ïàì³äðîíàòîì ÷àñ âèíèêíåííÿ ïåðøèõ

îçíàê SREs ïðîäîâæèâñÿ äî 310 äí³â ³ 174 â³äïîâ³äíî [10].

Çà äàíèìè Paterson A. H. et al. (1993), âèêîðèñòàííÿ çîëåä-

ðîíîâî¿ êèñëîòè çìåíøèëî íà 39% ð³âåíü SREs ïîð³âíÿíî

ç ïëàöåáî ó ïàö³ºíòîê ç ê³ñòêîâèìè ìåòàñòàçàìè ÐÌÇ [9].

American Society of Clinical Oncology ðåêîìåíäóº

³í³ö³àëüíå ë³êóâàííÿ á³ôîñôîíàòàìè ïðè ÐÌÇ ó ïàö³ºíò³â

ç îçíàêàìè äåñòðóêö³¿ ê³ñòîê íà îãëÿäîâ³é ðåíòãåíîãðàì³.

Àëå ÷åðåç íåôðîòîêñè÷í³ñòü, çîëåäðîíîâà êèñëîòà ïðî-

òèïîêàçàíà ïàö³ºíòàì ç íèðêîâîþ íåäîñòàòí³ñòþ.

²íøèé ïðåïàðàò, ùî ìîæå áóòè çàñòîñîâàíèé ïðè

äàí³é ïàòîëîã³¿ – äåíîñóìàá (ÄÍ), ìîíîêëîíàëüíå àíòè-

ò³ëî äî RANKL [2]. Ñüîãîäí³ éîãî âèêîðèñòàííÿ ðåêîìåí-

äîâàíå FDA äëÿ ë³êóâàííÿ æ³íîê â ïîñòìåíîïàóç³ ç âèñî-

êèì ðèçèêîì ðîçâèòêó îñòåîïîðîòè÷íèõ ïåðåëîì³â ³

äîñë³äæóºòüñÿ çàñòîñóâàííÿ ó ïàö³ºíò³â ç ê³ñòêîâèìè ìå-

òàñòàçàìè. Ïîð³âíÿëè åôåêòèâí³ñòü ÇÊ ³ ÄÍ Stopeck A. T.

et al. (2005). Çà ¿õ ðåçóëüòàòàìè ùîì³ñÿ÷íå ï³äøê³ðíå ââå-

äåííÿ 120 ìã äåíîñóìàáó ìàº á³ëüøó åôåêòèâí³ñòü ó

â³äñòðî÷åíí³ òà ïðîô³ëàêòèö³ SREs ïîð³âíÿíî ç ÇÊ ó ïàö³-

ºíòîê ç ìåòàñòàçàìè ÐÌÇ ó ê³ñòêè. Åë³ì³íàö³ÿ éîãî â³äáó-

âàºòüñÿ ÷åðåç êàòàáîë³çì â ðåòèêóëîåíäîòåë³àëüí³é òêà-

íèí³ (ÿê ³ ³íøèõ ìîíîêëîíàëüíèõ àíòèò³ë), íå âïëèâàþ÷è

íà ôóíêö³þ íèðîê. Òîìó ÄÍ ìîæå áóòè ïðåïàðàòîì âè-

áîðó äëÿ ïàö³ºíòîê ç ê³ñòêîâèìè ìåòàñòàçàìè ³ õðîí³÷íîþ

íèðêîâîþ íåäîñòàòí³ñòþ, àáî ÿêèì ïðèçíà÷åíî íåôðî-

òîêñè÷íèé ðåæèì õ³ì³îòåðàï³¿. Âòðè÷³ ÷àñò³øå âèíèêàþòü

ðåàêö³¿ ãîñòðî¿ ôàçè (flu-like symptoms) ïðè âèêîðèñòàíí³

çîëåäðîíîâî¿ êèñëîòè, àëå äåíîñóìàá ÷àñò³øå âèêëèêàº

ã³ïîêàëüö³éåì³þ [12].

²íøèé ïðåïàðàò – òåð³ïàðàòèä âèêîðèñòîâóºòüñÿ óæå

áàãàòî ðîê³â äëÿ ë³êóâàííÿ îñòåîïîðîçó. Â³í, íà â³äì³íó

â³ä á³ôîñôîíàò³â ³ äåíîñóìàáó, ä³º íà îñòåîáëàñòè ³ ñòè-

ìóëþº ïðîë³ôåðàö³þ ê³ñòêîâî¿ òêàíèíè. Òîìó â³í ÷àñòî

àñîö³éîâàíèé ç îñòåîñàðêîìàìè ³ ïðîãðåñ³ºþ ê³ñòêîâèõ

ìåòàñòàç³â [3]. Nimali P Withana et al. (2012) òàêîæ äîñë³äè-

ëè ðîëü êàòåïñèí³â ó ðîçâèòêó ìåòàñòàç³â ÐÌÇ â ê³ñòêè.

²íã³áóâàííÿ êàòåïñèíó B â ïóõëèííèõ êë³òèíàõ çìåíøóâà-

ëî äåãðàäàö³þ êîëàãåíó 1 òèïó in vitro ³ ìåòàñòàçóâàííÿ â

ê³ñòêè in vivo. Òàêîæ ïðîâîäèòüñÿ äîñë³äæåííÿ ïðåïà-

ðàò³â, ùî ³íã³áóþòü Src, CXCR4 [6].

Õ³ðóðã³÷íå ë³êóâàííÿ, ùî º ïàë³àòèâíèì ìåòîäîì ó

êîìá³íîâàí³é òåðàï³¿ ìåòàñòàç³â ó ê³ñòêè, â³ä³ãðàº âàæëèâó

ðîëü â àäàïòàö³¿ õâîðèõ òà ïîëåãøóº ïðîâåäåííÿ ¿ì ðÿäó

ìàí³ïóëÿö³é. Íà ñüîãîäí³ õ³ðóðã³÷í³ ìåòîäè ïðåäñòàâëåí³

åíäîïðîòåçóâàííÿì, ³íòðàìåäóëÿðíèì ³ íàê³ñòêîâèì îñ-

òåîñèíòåçîì, êþðåòàæåì ïóõëèíè ç âèêîðèñòàííÿì

ê³ñòêîâîãî öåìåíòó, ÷åðåçê³ñòêîâèì ïîçàâîãíèùåâèì îñ-

òåîñèíòåçîì [1]. Âèêîðèñòàííÿ ðàä³î³çîòîïíîãî ìåòîäó

ë³êóâàííÿ åôåêòèâíå ïðè îñòåîáëàñòè÷í³é àêòèâíîñò³

ïóõëèííèõ êë³òèí (ùî çóñòð³÷àºòüñÿ ÷àñò³øå, íàïðèêëàä,

ïðè ìåòàñòàçóâàíí³ ðàêó ïåðåäì³õóðîâî¿ çàëîçè, í³æ

ÐÌÇ) [5, 13].

Âèñíîâîê. Àíàë³ç ë³òåðàòóðè ñâ³ä÷èòü ïðî ïåâí³ óñï³-

õè ó ë³êóâàíí³ ê³ñòêîâèõ ìåòàñòàç³â ïðè ÐÌÇ. Àëå âèêîðè-

ñòàííÿ á³ôîñôîíàò³â, à òàêîæ ìîíîêëîíàëüíèõ àíòèò³ë äî

RANKL íå âïëèâàº íà ðåãðåñ³þ ìåòàñòàç³â, òîìó ïîøóê

íîâèõ òàðãåòíèõ ïðåïàðàò³â º íåîáõ³äíèì.

Ðåöåíçåíò: ä.ìåä.í., ïðîôåñîð Ùåïîò³í ².Á.

Ë²ÒÅÐÀÒÓÐÀ

1. Áóð’ÿíîâ Î.À., Ïðîöåíêî Â.Â., ×îðíèé Â.Ñ. Íàø äîñâ³ä

ë³êóâàííÿ õâîðèõ ç ìåòàñòàòè÷íèì óðàæåííÿì ê³ñòîê // Òðàâ-

ìà.- 2011.- Òîì 12.

2. Aapro S. M. Denosumab for bone metastases from breast cancer:

a new therapy option? // Journal of clinical oncology.-2011.-¹ 14.-

p.1419-1420.

3. Chen Y.-C., Sosnoski D. M., Mastro A. M. Breast cancer metastasis

to the bone: mechanisms of bone loss // Breast cancer research.-

2010.- ¹ 12.-p. 215-225.

4. Guise T. A. Breaking down bone: new insight into site-specific

mechanisms of breast cancer osteolysis mediated by metalloproteinases

// Genes Dev. -2009.- ¹ 23.- p. 2117-2123.

5. Hillegonds D. J., Franklin S., Shelton D. K., Vijayakumar S.,

Vijayakumar V. The management of painful bone metastases with an

emphasis on radionuclide therapy // J. Natl. Med. Assoc. – 2007. –

¹ 99(7).- p.785–794.

6. Hussein O., Komarova S. V. Breast cancer at bone metastatic

sites: recent discoveries and treatment targets // J. Cell. Commun.

Signal. – 2011.- ¹ 5(2).- p.85–99.

7. Keller E. T., Dai J., Escara-Wilke J., Hall C. L., Ignatoski K.,

Taichman R. S., Keller J. New trends in the treatment of bone meta-

stasis // Journal of cellular biochemistry.- 2007.- ¹ 102.- p. 1095–

1102.

8. Kingsley L. A., Fournier P. G.J., Chirgwin, J. M. et al. Molecular

biology of bone metastasis // Mol. Cancer Ther.- 2007.- ¹6.- p. 2609-

2617.

9. Kohno N., Aogi K., Minami H. et al. Zoledronic acid significantly

reduces skeletal complications compared with placebo in japanese

women with bone metastases from breast cancer: a randomized,

placebo-controlled trial // J. Clin. Oncol. -2005.- ¹ 23.-p. 3314–21.

10. Lipton A. Implications of bone metastases and the benefits of

bone-targeted therapy // Seminars in oncology.- 2010.- Vol. 37, ¹ 5.-

pp. S15-S29.

11. Paterson A.H., Powles T.J., Kanis J.A., McCloskey E., Hanson J.,

Ashley S.. Double-blind controlled trial of oral clodronate in patients

with bone metastases from breast cancer // J. Clin. Oncol. -1993.-

¹11.- p. 59–65.

12. Stopeck A. T., Lipton A., Body J.-J., Steger G. G., Tonkin K.,

de Boer R. H., Lichinitser M., Fujiwara Y., Yardley D. A., Viniegra M.,

Fan M., Jiang Q., Dansey R., Jun S., Braun A. Denosumab compared

with zoledronic acid for the treatment of bone metastases in patients

with advanced breast cancer: a randomized, double-blind study //

Journal of clinical oncology.- 2010.-¹35.-5132-5139.

13. Yaneva M. P., Semerdjieva M., Radev L.R., Ivanova E.K.,

Geiman M., Vlaikova M.I., Mihova L.S. Radionuclide therapy of cancer

patients with bone metastases // Folia Med. (Plovdiv). -2005.- ¹47(3-

4).-p.63-9.

¹ 1 (79) • 2014

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157

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ÌÅÒÀÑÒÀÇÛ ÐÀÊÀ ÌÎËÎ×ÍÎÉ ÆÅËÅÇÛ (ÐÌÆ)

Â ÊÎÑÒÈ: ÌÅÕÀÍÈÇÌ ÊÎÑÒÍÎÉ ÄÅÑÒÐÓÊÖÈÈ

È ÈÕ ËÅ×ÅÍÈÅ

Âûñîöêèé À.Î.

Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò

èìåíè À.À. Áîãîìîëüöà, ã. Êèåâ, Óêðàèíà

Ðåçþìå. Äî 80% ïàöèåíòîê ñ ìåòàñòàòè÷åñêèì ðàêîì

ìîëî÷íîé æåëåçû ðàçâèâàþòñÿ ìåòàñòàçû â êîñòè ïî

îñòåîêëàñòè÷åñêîìó òèïó, â ðåçóëüòàòå ÷åãî íàáëþäàåò-

ñÿ ëîêàëüíàÿ äåñòðóêöèÿ êîñòåé è ñêåëåòíûå îñëîæíå-

íèÿ, âêëþ÷àÿ áîëü, ãèïåðêàëüöèåìèþ è äðóãèå. Êîñòíûé

ìàòðèêñ áîãàò íà òàêèå ôàêòîðû, êàê òðàíñôîðìèðóþ-

ùèé ôàêòîð ðîñòà- Â è èíñóëèíîïîäîáíûé ôàêòîð ðîñòà,

êîòîðûå ïîïàäàþò â ìèêðîîêðóæåíèå îïóõîëè ïðè îñòå-

îëèçå. Ýòè ôàêòîðû ñòèìóëèðóþò ðîñò îïóõîëåâûõ êëåòîê,

èçìåíÿþò èõ ôåíîòèï, ñïîñîáñòâóÿ òåì ñàìûì îáðàçî-

âàíèþ ïîðî÷íîãî êðóãà. Áèñôîñôîíàòû, êëàññ àíòèðå-

çîðáòèâíûìè ïðåïàðàòîâ, ñåãîäíÿ ÿâëÿþòñÿ îñíîâîé ëå-

÷åíèÿ äàííûõ êîñòíûõ îñëîæíåíèé. Ïîíèìàíèå ïàòîãå-

íåçà êîñòíûõ ìåòàñòàçîâ ñòèìóëèðîâàëî ðàçðàáîòêó

íåñêîëüêèõ ìåòîäîâ òàðãåòíîé òåðàïèè, â òîì ÷èñëå

ìîíîêëîíàëüíûõ àíòèòåë ê àêòèâàòîðà ðåöåïòîðà ÿäåð-

íîãî ôàêòîðà ( NF ) – B ëèãàíäà (RANK) (äåíîñóìàá).

Êëþ÷åâûå ñëîâà: êîñòíûå ìåòàñòàçû, áèôîñôî-

íàòû, RANKL, äåíîñóìàá.

BREAST CANCER METASTASIS TO THE BONE:

MECHANISMS OF BONE LOSS AND TREATMENT

A. Vysotskyi

Bogomolets National Medical University, Kyiv, Ukraine

Summary. Up to 80% of patients with metastatic breast

cancer develop bone metastases that induce increased

osteoclast activity resulting in local bone destruction and

skeletal complications, including pain, hypercalcemia, and

skeletal-related events (SREs). The bone matrix is rich in

factors, such as transforming growth factor-B and insulin-

like growth factors, which are released into the tumor

microenvironment by osteolysis. These factors stimulate

the growth of tumor cells and alter their phenotype, thus

promoting a vicious cycle of metastasis and bone pathology.

Bisphosphonates, a class of antiresorptive drugs, are now

the mainstay of the treatment of skeletal-related events. In

addition, increased understanding of the pathogenesis of

bone metastasis has resulted in the development of several

bone-targeted therapies including a monoclonal antibody

targeting the receptor activator of nuclear factor (NF)-B ligand

(RANKL).

Key words: bone metastasis, bisphosphonates,

RANKL, denosumab.

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ÓÄÊ: 616.921.5(Í1N1) – 036.21 – 037

ÄÅßÊ² ÎÑÎÁËÈÂÎÑÒ² ÏÅÐÅÁ²ÃÓ ÏÀÍÄÅÌ²¯ ÃÐÈÏÓ À

(H1N1) 2009 ÐÎÊÓ ÍÀ ÒÅÐÈÒÎÐ²¯ ÓÊÐÀ¯ÍÈ

Âîäÿíèê À.À., Ä³áðîâà Þ.Â.

Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Î.Î. Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: Ãðèï À (Í1N1), ïàíäåì³ÿ ñâèíÿ÷îãî ãðèïó, ñèìïòîìàòèêà.

Òàáëèöÿ 1.

Â³êîâà ñòðóêòóðà õâîðèõ íà ãðèï A (H1N1)

Âñòóï. ²íôåêö³éí³ õâîðîáè íå âòðà÷àþòü àêòóàëüíîñò³

÷åðåç ¿õíþ çäàòí³ñòü øâèäêî ïîøèðþâàòèñü ó ëþäñüê³é

ïîïóëÿö³¿ [1]. Ãðèï º îäí³ºþ ç àêòóàëüíèõ ïðîáëåì îõî-

ðîíè çäîðîâ’ÿ ÷åðåç øèðîêå ðîçïîâñþäæåííÿ òà çíà÷í³

ñîö³àëüíî-ìåäè÷í³ íàñë³äêè [2].

Çà òåîðåòè÷íèìè ðîçðàõóíêàìè, åï³äåì³ÿ ñï³ââ³äíîñíà

çà ðîçì³ðàìè äî ïàíäåì³¿ “³ñïàíêè” 1918 ðîêó, ïðè ÿê³é ìîæå

çàõâîð³òè 30% ðîáî÷îãî íàñåëåííÿ ³ç âòðàòîþ ïðàöåçäàò-

íîñò³ ïðîòÿãîì 3 òèæí³â, çàâäàñòü çáèòê³â ó 700 ì³ëüÿðä³â

äîëàð³â [3]. Íà òåïåð³øí³é ÷àñ óðÿä ÑØÀ âèòðà÷àº áëèçüêî

10 ì³ëüÿðä³â äîëàð³â ùîðîêó íà áîðîòüáó ç ñåçîííèì ãðè-

ïîì, ñìåðòí³ñòü â³ä ÿêîãî äîñ³ ëèøàºòüñÿ íà âèñîêîìó ð³âí³.

Ïàíäåì³ÿ “ñâèíÿ÷îãî ãðèïó” À (Í1N1) 2009 ðîêó,

çáóäíèêîì ÿêî¿ ñòàâ øòàì A/California/04/2009, çàáðàëà

æèòòÿ 18 òèñÿ÷ ëþäåé. 622 òèñÿ÷³ âèïàäê³â ³íô³êóâàííÿ äà-

íèì â³ðóñîì áóëè ëàáîðàòîðíî ï³äòâåðäæåí³ ïðîòÿãîì

2009-2010 ðîê³â [4]. Â³ðóñ ïîøèðèâñÿ íà âñ³ êîíòèíåíòè

ïëàíåòè, à ð³âåíü ñìåðòíîñò³ ñêëàâ 0,03%.

Â³äîìî, ùî â³ðóñó ãðèïó ïðèòàìàííà øèôòîâà

ì³íëèâ³ñòü òà àíòèãåííèé äðåéô, ùî îáóìîâëþº éîãî ïî-

ñò³éíó àíòèãåííó ð³çíîìàí³òí³ñòü [5]. Òàêà îñîáëèâ³ñòü

â³ðóñó ïðèçâîäèòü äî òîãî, ùî âàêöèíè øâèäêî çàñòàð³âà-

þòü, òîìó ³ñíóº ïîñò³éíèé ðèçèê ñåçîííèõ åï³äåì³é ç íå-

ïåðåäáà÷óâàíèìè íàñë³äêàìè [1].

Ìåòà äîñë³äæåííÿ – âèçíà÷èòè îñîáëèâîñò³ ïåðåá³ãó

ïàíäåì³¿ ãðèïó À (H1N1) 2009 ðîêó íà òåðèòîð³¿ Óêðà¿íè çà

ðåçóëüòàòàìè àíàë³çó ìåäè÷íî¿ äîêóìåíòàö³¿ ùîäî ïîìåð-

ëèõ, ³íô³êîâàíèõ êàë³ôîðí³éñüêèì øòàìîì â³ðóñó ãðèïó.

Ìàòåð³àëè ³ ìåòîäè. Çàãàëîì ïðîàíàë³çîâàíî 50 óí³ô³-

êîâàíèõ ôîðì çáîðó êë³í³÷íèõ äàíèõ õâîðèõ ç òð³àäîþ

ñèìïòîì³â â àíàìíåç³ – ï³äâèùåííÿì òåìïåðàòóðè ò³ëà >

38,5î C, êàøëåì (àáî áîëåì â ãîðë³) òà çàäèøêîþ (àáî äè-

õàëüíèìè ðîçëàäàìè), ÿê³ ë³êóâàëèñÿ ó â³ää³ëåííÿõ ³íòåí-

ñèâíî¿ òåðàï³¿ ³ ïîìåðëè ó çàêëàäàõ îõîðîíè çäîðîâ’ÿ óñ³õ

ôîðì âëàñíîñò³ òà â³äîì÷î¿ ï³äïîðÿäêîâàíîñò³.

Óí³ô³êîâàí³ ôîðìè çáîðó êë³í³÷íèõ äàíèõ (ÓÔÇ) äîñ-

ë³äæåíî çà 86 ïàðàìåòðàìè ó âèì³ð³: ëàáîðàòîðíî¿ ä³àãíîñ-

òèêè, äàíèõ ïðî çáóäíèêà çàõâîðþâàííÿ; ñèìïòîì³â, ùî

ñóïðîâîäæóâàëè õâîðîáó; íàÿâíîñò³ ñóïóòí³õ çàõâîðþ-

âàíü é óñêëàäíåíü îñíîâíîãî çàõâîðþâàííÿ.

Ðåçóëüòàòè òà ¿õ îáãîâîðåííÿ. 27 õâîðèì ç ãðèïîì A

(H1N1), âèêëèêàíèì êàë³ôîðí³éñüêèì øòàìîì, ä³àãíîç

áóâ ï³äòâåðäæåíèé ëàáîðàòîðíî ³ ïîñòàâëåíèé ïðèæèòòºâî.

Ó 26 âèïàäêàõ â³ðóñ áóâ âèä³ëåíèé ç íîñîãëîòêè, â 67% –

äîäàòêîâî ç ðîòîãëîòêè ³ â îäíîìó âèïàäêó – ³çîëüîâàíî

ç ðîòîãëîòêè. 13 ïàö³ºíòàì ä³àãíîç “ñâèíÿ÷èé ãðèï” áóâ

ëàáîðàòîðíî ï³äòâåðäæåíèé ï³ñëÿ äîñë³äæåííÿ àóòîïñ³é-

íîãî ìàòåð³àëó. Äåñÿòüîì õâîðèì ëàáîðàòîðíà ä³àãíîñòèêà

çáóäíèêà çàõâîðþâàííÿ ïðèæèòòºâî òà ï³ñëÿ ñìåðò³ íå

ïðîâîäèëàñÿ.

Æîäåí ³ç ïîìåðëèõ íå îòðèìóâàâ âàêöèíàö³¿ ïðîòè

â³ðóñó À (H1N1), òðîº ïàö³ºíò³â ïðîâîäèëè ïðîô³ëàêòèêó

ãðèïó ïðîòèâîâ³ðóñíèìè ïðåïàðàòàìè çà 14 ä³á äî ïî÷àòêó

çàõâîðþâàííÿ.

Ï³ä ÷àñ åï³äåì³¿ ñåçîííîãî ãðèïó áëèçüêî 90% âèïàäê³â

ñìåðòåé ïðèïàäàº íà îñ³á ïîõèëîãî â³êó, ÿê³ ÷àñòî îñëàá-

ëåíí³ ÷åðåç ðÿä õðîí³÷íèõ çàõâîðþâàíü. Äàí³ íàøîãî äîñ-

ë³äæåííÿ ïîêàçàëè, ùî â ñòðóêòóð³ õâîðèõ, ÿê³ ïîìåðëè ï³ä

÷àñ åï³äåì³ÿ ãðèïó A (H1N1) 2009 ðîêó íà òåðèòîð³¿ Óêðà¿íè,

ïåðåâàæàëè ëþäè ìîëîäîãî òà ñåðåäíüîãî â³êó (òàáë. 1).

Ïåðåá³ã çàõâîðþâàííÿ ïðîòÿãîì åï³äåì³¿ ãðèïó À

(H1N1) áóâ íàäçâè÷àéíî ñòð³ìêèì. Òàê ó 50% ïðîàíàë³çî-

âàíèõ âèïàäê³â õâîð³ ïîìåðëè âïðîäîâæ ïåðøèõ äåñÿòè

ä³á ç ÷àñó ïîÿâè ñèìïòîì³â õâîðîáè, 36% – ïðîòÿãîì 11–

16 äîáè çàõâîðþâàííÿ ³ ëèøå ó 14% âèïàäêàõ õâîðîáà òðè-

âàëà á³ëüøå äâîõ òèæí³â. Çâàæàþ÷è íà øâèäêå ïîã³ðøåííÿ

ñòàíó õâîðîãî íà “ñâèíÿ÷èé ãðèï” äóæå âàæëèâîþ º ñâîº-

÷àñíà ä³àãíîñòèêà, ùî ïåðøî÷åðãîâî ´ðóíòóºòüñÿ íà ðîç-

ï³çíàâàíí³ îñíîâíèõ ñèìïòîì³â çàõâîðþâàííÿ, õàðàêòåðíèõ

äëÿ åï³äåì³¿ êàë³ôîðí³éñüêîãî øòàìó â³ðóñó ãðèïó (òàáë. 2).

Íåïðîäóêòèâíèé êàøåëü ñóïðîâîäæóâàâ ïåðåá³ã çàõ-

âîðþâàííÿ ìàéæå óäâ³÷³ ÷àñò³øå, í³æ ïðîäóêòèâíèé. Õà-

ðàêòåðíèì áóâ ïåðåõ³ä íåïðîäóêòèâíîãî êàøëþ â ïðî-

äóêòèâíèé ïðîòÿãîì çàõâîðþâàííÿ ó 20% õâîðèõ. Êðîâ â

ìîêðîòèíí³ áóëà âèÿâëåíà ó 86% ïàö³ºíò³â ³ç ïðîäóêòèâ-

íèì êàøëåì. Ñèìïòîìè, õàðàêòåðí³ äëÿ ÃÐÂ² (à ñàìå: á³ëü

ó ãîðë³, á³ëü ó ñóãëîáàõ) çóñòð³÷àëèñÿ ïîð³âíÿíî ð³äêî.

Ó ìàéæå ïîëîâèíè ïðîàíàë³çîâàíèõ âèïàäê³â êîíñòà-

òóâàëè íàäëèøêîâó âàãó. Ó 45 % ç öüîãî ÷èñëà ³íäåêñ ìàñè

ò³ëà (²ÌÒ) áóâ ïîíàä 30, à ó 55% – á³ëüøå 40 (òàáë. 3).

Íàé÷àñò³øèìè óñêëàäíåííÿìè ó õâîðèõ íà ãðèï À

(H1N1) áóëè ãîñòðèé ðåñï³ðàòîðíèé äèñòðåñ-ñèíäðîì

(72%), ïîë³îðãàííà íåäîñòàòí³ñòü (72%), óðàæåííÿ öåíò-

ðàëüíî¿ íåðâîâî¿ ñèñòåìè (ÖÍÑ) (32%), ÿê³ âèíèêàëè â

êîìá³íàö³¿ ÷è îêðåìî (òàáë. 4).

Âèñíîâêè. Ïîìåðë³ íà ãðèï A (H1N1) (êàë³ôîðí³é-

ñüêèé øòàì) ³ç ÷èñëà óêðà¿íö³â áóëè ìîëîäîãî òà ñåðåäíüîãî

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Òàáëèöÿ 4.

Óñêëàäíåííÿ, ùî ñóïðîâîäæóâàëè ïåðåá³ã

ãðèïó A (H1N1)

Òàáëèöÿ 2.

Ïîøèðåí³ñòü êë³í³÷íèõ ñèìïòîì³â ïðè ãðèï³,

ñïðè÷èíåíîìó â³ðóñîì A (H1N1)

Òàáëèöÿ 3.

Ñóïóòí³ çàõâîðþâàííÿ ó õâîðèõ íà ãðèï A (H1N1)

â³êó, ùî â³äð³çíÿº “ñâèíÿ÷èé ãðèï” â³ä ñåçîííîãî, íà ÿêèé

õâîð³þòü ïåðåâàæíî îñëàáëåí³ ëþäè ïîõèëîãî â³êó.

Ïåðåá³ã ãðèïó A (H1N1) ìàâ òåíäåíö³þ äî øâèäêîãî

ïîã³ðøåííÿ ñòàíó õâîðîãî. Ó 86% õâîðèõ ñìåðòü íàñòóïà-

ëà äî 16 äîáè ç ÷àñó ïîÿâè ïåðøèõ ñèìïòîì³â íåäóãè.

Òð³àäó ñèìïòîì³â, ùî íàé÷àñò³øå çóñòð³÷àëèñÿ ïðè

åï³äåì³¿ ãðèïó 2009 ðîêó, ñêëàëè: ëèõîìàíêà > 38,5 (98%),

çàäèøêà (82%), íåïðîäóêòèâíèé êàøåëü (76%). Õàðàêòåð-

íîþ äëÿ ãðèïó À (H1N1) áóëà ïîÿâà êðîâ³ ó ìîêðîòèíí³

á³ëüøå, í³æ ó 80% ïàö³ºíò³â ç ïðîäóêòèâíèì êàøëåì.

Íàäëèøêîâà âàãà âèÿâëÿëàñÿ ÿê ñóïóòíÿ ïàòîëîã³ÿ ó

44% õâîðèõ, ùî ïîìåðëè â³ä êàë³ôîðí³éñüêîãî øòàìó

â³ðóñó À (H1N1).

Òð³àäó íàé÷àñò³øèõ óñêëàäíåíü ãðèïó ñêëàëè: ãîñòðèé

ðåñï³ðàòîðíèé äèñòðåñ-ñèíäðîì (72%), ïîë³îðãàííà íå-

äîñòàòí³ñòü (72%), óðàæåííÿ ÖÍÑ (36%), ùî âèíèêàëè îê-

ðåìî àáî îäíî÷àñíî ó ð³çíèõ êîìá³íàö³ÿõ.

Ðåöåíçåíò: ä.ìåä.í., ïðîôåñîð Êîëåñí³êîâà ².Ï.

Ë²ÒÅÐÀÒÓÐÀ

1. Êàçàêîâ Â.Ì., Ãðèï A (H1N1) 2009, “Ñâèíÿ÷èé ãðèï”:

Ïàíäåì³ÿ (ïåðø³ ï³äñóìêè é ïåðñïåêòèâè ðîçâèòêó)/ Êàçàêîâ

Â.Ì., Øëîïîâ Â.Ã. – Ä.: “Êàøòàí”, 2009 – 108 ñ

2. Äîàí Ñ.². Ïîð³âíÿëüíà õàðàêòåðèñòèêà ñåçîííèõ åï³äåì³é

ãðèïó îñòàííüîãî äåñÿòèë³òòÿ òà ïàíäåì³÷íîãî ï³äéîìó 2009-

2010 ðð. â Óêðà¿í³ / Ñ.². Äîàí, À.Ï. Ì³ðîíåíêî, Î.Ñ. Ãîëóáêà òà ³í.

// Ïðîô³ëàêòè÷íà ìåäèöèíà . – 2010. – ¹ 4 (12). – Ñ. 19-22.

3. Poland G “Vaccines against avian influenza—a race against

time” N. Engl J Red – 2006. 354

4. “Pandemic (H1N1) 2009 – update 100”. Disease Outbreak

News (World Health Organization (WHO)). 14 May 2010.

5. Ìåäè÷íà ì³êðîá³îëîã³ÿ, â³ðóñîëîã³ÿ òà ³ìóíîëîã³ÿ / [Àäð³-

àíîâà Ò.Â., Áîáèð Â.Â., Âèíîãðàä Í.Î., Âîéöåõ³âñüêèé Â.Ã.] ; ï³ä

ðåä. Â.Ï. Øèðîáîêîâà – [2 âèä.] – Â. : Íîâà Êíèãà, 2011. – 951 ñ.

ÍÅÊÎÒÎÐÛÅ ÎÑÎÁÅÍÍÎÑÒÈ ÏÐÎÒÅÊÀÍÈß

ÏÀÍÄÅÌÈÈ ÃÐÈÏÏÀ À (H1N1) 2009 ÃÎÄÀ

ÍÀ ÒÅÐÐÈÒÎÐÈÈ ÓÊÐÀÈÍÛ

Âîäÿíèê À.À., Äèáðîâà Þ.Â.

Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò

èìåíè À.À. Áîãîìîëüöà, ã. Êèåâ, Óêðàèíà

Ðåçþìå. Ïðîàíàëèçèðîâàíî 50 óíèôèöèðîâàííûõ

ôîðì ñáîðà êëèíè÷åñêèõ äàííûõ óìåðøèõ îò ãðèïïà A

(H1N1). Óñòàíîâëåíî, ÷òî â âîçðàñòíîé ñòðóêòóðå áîëü-

íûõ íà “ñâèííîé ãðèïï” ïðåîáëàäàþò ëþäè ìîëîäîãî è

ñðåäíåãî âîçðàñòà. Òå÷åíèå ãðèïïà, âûçâàííîãî êàëè-

ôîðíèéñêèì øòàììîì âèðóñà, èìåëî òåíäåíöèþ ê áûñò-

ðîìó óõóäøåíèþ ñîñòîÿíèÿ áîëüíîãî. Òðèàäó ñèìïòîìîâ,

êîòîðûå ÷àùå âñåãî âñòðå÷àëèñü ïðè ýïèäåìèè ãðèïïà

2009 ãîäà, ñîñòàâèëè: ëèõîðàäêà > 38,5, îäûøêà, íåïðî-

äóêòèâíûé êàøåëü. Èçáûòî÷íûé âåñ êàê ñîïóòñòâóþùàÿ

ïàòîëîãèÿ ïðè ãðèïïå îáíàðóæèâàëñÿ ó 44% áîëüíûõ.

Òðèàäó íàèáîëåå ðàñïðîñòðàí¸ííûõ îñëîæíåíèé ñîñòà-

âèëè: îñòðûé ðåñïèðàòîðíûé äèñòðåññ-ñèíäðîì, ïîëè-

îðãàííàÿ íåäîñòàòî÷íîñòü, ïîðàæåíèå ÖÍÑ.

Êëþ÷åâûå ñëîâà: Ãðèïï À (Í1N1), ïàíäåìèÿ ñâèíîãî

ãðèïïà, ñèìïòîìàòèêà.

PECULIARITIES OF THE PANDEMIC

OF INFLUENZA A (H1N1) 2009 IN UKRAINE

A. Vodynik, U. Dibrova

Bogomolets National Medical University, Kyiv, Ukraine

Summary. 50 standardized clinical data collection forms

in patients with suspected influenza A (H1N1) were analyzed.

It is established that young and middle aged patients were

affected by swine flu the most often. The disease leads to

the rapid deterioration of the patient. The triad of symptoms

that are often encountered during the flu epidemic of 2009

were: fever> 38.5, dyspnea, nonproductive cough. Excess

weight was detected in 44% of patients with swine flu. The

triad of frequent complications of influenza were: acute

respiratory distress syndrome, multiple organ failure, CNS.

Key words: Influenza A (H1N1), pandemic of swine flu,

symptomatology.

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Ñ íåçàïàìÿòíûõ âðåìåí íàèáîëåå âîñòðåáîâàííûìè â

ìåäèöèíñêîé ïðàêòèêå ÿâëÿþòñÿ îáåçáîëèâàþùèå è ïðîòè-

âîâîñïàëèòåëüíûå ëåêàðñòâåííûå ïðåïàðàòû. Âåäü áîëü,

ñâÿçàííàÿ ñ ìåñòíûì âîñïàëåíèåì èëè ïîâðåæäåíèåì òêà-

íè, à òàêæå ëèõîðàäêà – íàèáîëåå ìó÷èòåëüíûå ïðîÿâëå-

íèÿ áîëåçíåé ÷åëîâåêà; îíè ñîïðîâîæäàþò òðàâìû, ðàíå-

íèÿ, îñòðûå è õðîíè÷åñêèå èíôåêöèîííûå ïðîöåññû, à

òàêæå àóòîèììóííûå è îíêîëîãè÷åñêèå çàáîëåâàíèÿ [10].

Íåñòåðîèäíûå ïðîòèâîâîñïàëèòåëüíûå ïðåïàðàòû

(ÍÏÂÏ) – îäíà èç íàèáîëåå õîðîøî èçó÷åííûõ ãðóïï ëå-

êàðñòâåííûõ ñðåäñòâ. Ðàñòåíèÿ, â ñîñòàâ êîòîðûõ âõîäÿò

ñàëèöèëàòû, îáëàäàþùèå æàðîïîíèæàþùèìè ñâîéñòâà-

ìè, èñïîëüçîâàëèñü ñ äðåâíåéøèõ âðåìåí. Îäíàêî íà÷à-

ëîì øèðîêîãî ïðèìåíåíèÿ ÍÏÂÏ êàê ëåêàðñòâ ñ íàó÷íî

äîêàçàííîé ýôôåêòèâíîñòüþ, âåðîÿòíî, ñëåäóåò ñ÷èòàòü

1876 ã., êîãäà â “Lancet” áûëà îïóáëèêîâàíà ñòàòüÿ

A. Mayers, ïîñâÿùåííàÿ ýôôåêòèâíîñòè ýêñòðàêòà êîðû

èâû (ñàëèöèíà) ïðè îñòðîé ðåâìàòè÷åñêîé ëèõîðàäêå

[24]. Ñïóñòÿ áîëåå 130 ëåò ãðàíèöû êëèíè÷åñêîãî ïðèìå-

íåíèÿ çíà÷èòåëüíî ðàñøèðèëèñü è ñåãîäíÿ ÍÏÂÏ – íàè-

áîëåå ïîïóëÿðíàÿ ãðóïïà ïðåïàðàòîâ [3].

Äîìèíèðóþùàÿ ãðóïïà ïîòðåáèòåëåé ÍÏÂÏ ïðåä-

ñòàâëåíà ïàöèåíòàìè ñ âîñïàëèòåëüíûìè èëè äåãåíåðà-

òèâíûìè çàáîëåâàíèÿìè îïîðíî-äâèãàòåëüíîãî àïïàðà-

òà. Ñåãîäíÿ âî âñåì ìèðå åæåäíåâíî ïðèíèìàþò ÍÏÂÏ

áîëåå 30 ìèëëèîíîâ ëþäåé [29]. Òàêàÿ ïîïóëÿðíîñòü

îáúÿñíÿåòñÿ îñîáûì ñïåêòðîì ôàðìàêîëîãè÷åñêîé àê-

òèâíîñòè ÍÏÂÏ – ïðîòèâîâîñïàëèòåëüíûì, àíàëãåçèðó-

þùèì è æàðîïîíèæàþùèì ýôôåêòàìè. Â ýòîé ñèòóàöèè

âîïðîñû áåçîïàñíîñòè ÍÏÂÏ èìåþò îñîáîå çíà÷åíèå,

ïîñêîëüêó ýòè ñðåäñòâà ïðèìåíÿþòñÿ äëèòåëüíî, â àìáó-

ëàòîðíîé ïðàêòèêå, ÷àñòî ïðè ñàìîëå÷åíèè. Îñîáåííî

àêòóàëüíà ïðîáëåìà êîíòðîëÿ õðîíè÷åñêîãî áîëåâîãî

ñèíäðîìà ó áîëüíûõ ïîæèëîãî âîçðàñòà ñ çàáîëåâàíèÿìè

îïîðíî-äâèãàòåëüíîãî àïïàðàòà, ïîñêîëüêó áîëüøèíñòâî

èç íèõ èìåþò ñîïóòñòâóþùóþ ïàòîëîãèþ ñåðäå÷íî-ñî-

ñóäèñòîé ñèñòåìû. Òàê, àíàëèç ÷àñòîòû êîìîðáèäíûõ çà-

áîëåâàíèé ó 15 òûñ. æèòåëåé ÑØÀ â âîçðàñòå 65 ëåò è

ñòàðøå, ñòðàäàþùèõ îñòåîàðòðîçîì, ïîêàçàë, ÷òî 80% èç

íèõ èìåþò àðòåðèàëüíóþ ãèïåðòåíçèþ (ÀÃ), 31,3% – ñà-

õàðíûé äèàáåò (ÑÄ), 38% – ïðèçíàêè ñåðäå÷íîé íåäîñòà-

òî÷íîñòè, 16,9% – èøåìè÷åñêóþ áîëåçíü ñåðäöà (ÈÁÑ), à

17,3% – öåðåáðîâàñêóëÿðíûå íàðóøåíèÿ [23]

Çà ïîñëåäíèå ãîäû ñïåêòð ÍÏÂÏ çíà÷èòåëüíî ðàñøè-

ðèëñÿ, è ñåãîäíÿ îíè ðàçëè÷àþòñÿ ìåæäó ñîáîé îñîáåí-

ÓÄÊ 615.276; 616.12-008.331.1

ÍÅÑÒÅÐÎÈÄÍÛÅ ÏÐÎÒÈÂÎÂÎÑÏÀËÈÒÅËÜÍÛÅ

ÏÐÅÏÀÐÀÒÛ È ÀÐÒÅÐÈÀËÜÍÀß ÃÈÏÅÐÒÅÍÇÈß –

ÏÐÎÁËÅÌÀ ÑÎÂÐÅÌÅÍÍÎÉ ÊÀÐÄÈÎËÎÃÈÈ

Êàðïåíêî Å.À., Êîíäðàòþê Â.Å.

Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò èìåíè À.À. Áîãîìîëüöà, ã. Êèåâ, Óêðàèíà

Êëþ÷åâûå ñëîâà: êëèíè÷åñêàÿ ôàðìàêîëîãèÿ, íåñòåðîèäíûå ïðîòèâîâîñïàëèòåëüíûå ïðåïàðàòû,

àðòåðèàëüíàÿ ãèïåðòåíçèÿ, ïîáî÷íûå ýôôåêòû.

íîñòÿìè äåéñòâèÿ è ïðèìåíåíèÿ. Â êëàññ ÍÏÂÏ âõîäÿò

îêîëî 20 îðèãèíàëüíûõ ëåêàðñòâåííûõ ñðåäñòâ. Íà îñíî-

âå èõ õèìè÷åñêîé ñòðóêòóðû ïðåïàðàòû áûëè êëàññèôè-

öèðîâàíû êàê [6]:

1) ïðîèçâîäíûå ñàëèöèëîâîé êèñëîòû: àöåòèëñàëèöè-

ëîâàÿ êèñëîòà (àñïèðèí),

ñóëüôàñàëàçèí;

2) ïðîèçâîäíûå ïàðààìèíîôåíîëà: àöåòàìèíîôåí

(ïàðàöåòàìîë);

3) èíäîë- è èíäåíóêñóñíûå êèñëîòû: èíäîìåòàöèí,

ýòîäîëàê, ñóëèíäàê;

4) ãåòåðî-àðèë óêñóñíûå êèñëîòû: äèêëîôåíàê, êåòî-

ðîëàê, òîëìåòèí;

5) àðèë-ïðîïèîíîâûå êèñëîòû: èáóïðîôåí, êåòîïðî-

ôåí, ôëóðáèïðîôåí,

íàïðîêñåí, ôåíîïðîôåí, îêñàïðîçèí àöåêëîôåíàê,

ôåíêëîôåíàê;

6) àíòðàíèëîâûå êèñëîòû (ôåíàìàòû): ìåôåíàìèíî-

âàÿ êèñëîòà;

7) åíîëüíûå êèñëîòû (îêñèêàìû): ïèðîêñèêàì, òåíîê-

ñèêàì, ìåëîêñèêàì;

8) àëêàíîíû: íàáóìåòîí;

9) ïèðàçîëèäèíû: ôåíèëáóòàçîí, îêñèôåíèëáóòàçîí;

10) äèàðèëãåòåðîöèêëû (ñåëåêòèâíûå èíãèáèòîðû

ÖÎÃ-2): öåëåêîêñèá, ðîôåêîêñèá, âàëäåêîêñèá, ëóìèðà-

êîêñèá, ïàðåêîêñèá, ýòåðîêîêñèá.

Ïðåïàðàòû âñåõ ýòèõ ãðóïï èìåþò îáùèå õèìè÷åñêèå

è ôàðìàêîëîãè÷åñêèå ñâîéñòâà. Óñëîâíî èõ ìîæíî ðàçäå-

ëèòü íà “êîðîòêîæèâóùèå” ñ ïåðèîäîì ïîëóâûâåäåíèÿ

äî 6 ÷àñîâ (àöåòèëñàëèöèëîâàÿ êèñëîòà, äèêëîôåíàê,

èáóïðîôåí, èíäîìåòàöèí, êåòîïðîôåí, íèìåñóëèä, ýòî-

äîëàê, öåëåêîêñèá è äð.) è “äëèòåëüíîæèâóùèå” ñ ïåðèî-

äîì ïîëóâûâåäåíèÿ áîëåå 6 ÷àñîâ (ìåëîêñèêàì, íàïðîê-

ñåí, ïèðîêñèêàì, àöåêëîôåíàê, ëîðíîêñèêàì è äð).

Ýôôåêòèâíîñòü è áåçîïàñíîñòü ÍÏÂÏ ñâÿçàíû ñ èç-

áèðàòåëüíûì ïîäàâëåíèåì àêòèâíîñòè öèêëîîêñèãåíàçû

(ÖÎÃ) – êëþ÷åâîãî ôåðìåíòà, ðåãóëèðóþùåãî ïðåâðà-

ùåíèå àðàõèäîíîâîé êèñëîòû â ïðîñòàãëàíäèíû (ÏÃ),

ïðîñòàöèêëèí (ÏÃI2) è òðîìáîêñàí (ÒõÀ2).

Èäåíòèôèöèðîâàíî òðè îñíîâíûå èçîôîðìû ÖÎÃ,

êîòîðûå îáîçíà÷àþòñÿ êàê ÖÎÃ-1, ÖÎÃ-2 è ÖÎÃ-3. Ïåð-

âàÿ (ÖÎÃ-1) ïîñòîÿííî ïðèñóòñòâóåò â áîëüøèíñòâå òêàíåé

(õîòÿ è â ðàçëè÷íîì êîëè÷åñòâå), îòíîñèòñÿ ê êàòåãîðèè

“ñòðóêòóðíûõ” ôåðìåíòîâ, ðåãóëèðóþùèõ ôèçèîëîãè-

÷åñêèå ýôôåêòû ÏÃ. ×åðåç ÖÎÃ-1 îïîñðåäóåòñÿ ñèíòåç

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òðîìáîêñàíà À2 òðîìáîöèòàìè, èíäóêòîðà àäãåçèè è àã-

ðåãàöèè òðîìáîöèòîâ. Íàïðîòèâ, ÖÎÃ-2 â íîðìå â áîëü-

øèíñòâå òêàíåé íå îáíàðóæèâàåòñÿ, íî åå óðîâåíü ñóùå-

ñòâåííî óâåëè÷èâàåòñÿ íà ôîíå ðàçâèòèÿ âîñïàëåíèÿ [3].

Ïîäîáíî äðóãèì ôåðìåíòàì ÖÎÃ, ÖÎÃ-3 òîæå ó÷àñòâóåò

â ñèíòåçå ïðîñòàãëàíäèíîâ è èãðàåò ðîëü â ðàçâèòèè áîëè

è ëèõîðàäêè. Îäíàêî â îòëè÷èå îò ÖÎÃ-1 è ÖÎÃ-2, ÖÎÃ-3

íå ïðèíèìàåò ó÷àñòèÿ â ðàçâèòèè âîñïàëåíèÿ. Àêòèâ-

íîñòü ÖÎÃ-3 èíãèáèðóåòñÿ ïàðàöåòàìîëîì, êîòîðûé îêà-

çûâàåò ñëàáîå âëèÿíèå íà ÖÎÃ-1 è ÖÎÃ-2. Îäíàêî, ñòîèò

çàìåòèòü, ÷òî ÖÎÃ-3 îáíàðóæåí â òêàíÿõ ýêñïåðèìåí-

òàëüíûõ æèâîòíûõ, è ñóùåñòâîâàíèå äàííîé èçîôîðìû

ÖÎÃ â îðãàíèçìå ÷åëîâåêà òðåáóåò äîêàçàòåëüñòâà, êàê è

òðåáóåò äàëüíåéøåãî èçó÷åíèÿ è äîêàçàòåëüñòâà ñâÿçàí-

íûé ñ èíãèáèðîâàíèåì ÖÎÃ-3 ìåõàíèçì äåéñòâèÿ ïàðà-

öåòàìîëà [11,12]. Ïîäàâëåíèå ÖÎÃ-2 ÿâëÿåòñÿ îäíèì èç

íàèáîëåå âàæíûõ ìåõàíèçìîâ ïðîòèâîâîñïàëèòåëüíîãî

äåéñòâèÿ ÍÏÂÏ, à èíãèáèöèÿ ÖÎÃ-1 ñâÿçàíà ñ ðàçâèòèåì

ïîáî÷íûõ ýôôåêòîâ. Ïîýòîìó ýôôåêòèâíîñòü è òîêñè÷-

íîñòü “ñòàíäàðòíûõ” íåñåëåêòèâíûõ ÍÏÂÏ ñâÿçûâàþò ñ

èõ ñïîñîáíîñòüþ â îäèíàêîâîé ñòåïåíè ïîäàâëÿòü àêòèâ-

íîñòü îáåèõ èçîôîðì ÖÎÃ. Ýòî ïîñëóæèëî òîë÷êîì ê ñî-

çäàíèþ íîâîé ãðóïïû ÍÏÂÏ, èçáèðàòåëüíî èíãèáèðóþ-

ùèõ ÖÎÃ-2 (ñåëåêòèâíûå ÍÏÂÏ).

Îáðàòíîé ñòîðîíîé âûñîêîãî ëå÷åáíîãî ïîòåíöèàëà

ÍÏÂÏ ÿâëÿåòñÿ ïîâûøåíèå ðèñêà “êëàññ-ñïåöèôè÷å-

ñêèõ” íåæåëàòåëüíûõ ýôôåêòîâ, íàèáîëåå ÷àñòûå èç êîòî-

ðûõ – ïîðàæåíèå æåëóäî÷íî-êèøå÷íîãî òðàêòà (ÆÊÒ),

ïîâûøåíèå àãðåãàöèè òðîìáîöèòîâ, ôóíêöèè ïî÷åê,

íåãàòèâíîå âëèÿíèå íà ñèñòåìó êðîâîîáðàùåíèÿ [31].

ÍÏÂÏ ïîêàçàëè ýôôåêòèâíîñòü â óïðàâëåíèè áîëüþ

[8], âñëåäñòâèå ÷åãî îíè ðåêîìåíäóþòñÿ äëÿ ïàöèåíòîâ ñ

ðåâìàòîèäíûì àðòðèòîì (ÐA). Âåäü îñíîâíûì êëèíè÷å-

ñêèì ïðîÿâëåíèåì îñòðûõ è õðîíè÷åñêèõ ðåâìàòè÷åñêèõ

çàáîëåâàíèé (ÐÇ) ÿâëÿåòñÿ áîëåâîé ñèíäðîì, ïàòîãåíåç

êîòîðîãî òåñíî ñâÿçàí ñ ïðîöåññàìè òêàíåâîãî âîñïàëå-

íèÿ è âûáðîñîì ïðîâîñïàëèòåëüíûõ ìåäèàòîðîâ. Ðàöèî-

íàëüíàÿ ñèìïòîìàòè÷åñêàÿ òåðàïèÿ ñóùåñòâåííî óëó÷-

øàåò ñîñòîÿíèå áîëüíîãî, äåëàåò áîëåå êîìôîðòíûì

ïåðèîä îæèäàíèÿ äî íà÷àëà äåéñòâèÿ áàçèñíûõ ïðîòèâî-

âîñïàëèòåëüíûõ ïðåïàðàòîâ, äàåò âîçìîæíîñòü èçáåæàòü

ñèñòåìíîãî è ëîêàëüíîãî ïðèìåíåíèÿ ãëþêîêîðòèêîè-

äîâ, ïîâûñèòü êà÷åñòâî æèçíè ïàöèåíòîâ. È êàê ñðåäñòâî

ñèìïòîìàòè÷åñêîé òåðàïèè ÍÏÂÏ ïðè ÐÇ ïðàêòè÷åñêè

íå èìååò àëüòåðíàòèâû [1].

Èõ èñïîëüçîâàíèå (â ÷àñòíîñòè, õðîíè÷åñêîå) óâåëè-

÷èâàåòñÿ ñ âîçðàñòîì, è ïðèáëèçèòåëüíî 10-40% ëþäåé â

âîçðàñòå ñòàðøå 65 ëåò åæåäíåâíî ïðèíèìàþò ÍÏÂÏ [19].

Ïðèåì ÍÏÂÏ ñïîñîáåí îêàçûâàòü îòðèöàòåëüíîå

âëèÿíèå íà ñåðäå÷íî-ñîñóäèñòóþ ñèñòåìó, ïðè÷åì ìåäè-

öèíñêîå è ñîöèàëüíîå çíà÷åíèå ýòîé ïàòîëîãèè íå ìåíü-

øå, ÷åì îñëîæíåíèé ñî ñòîðîíû ÆÊÒ. Ñïåêòð âîçìîæ-

íûõ íåæåëàòåëüíûõ ýôôåêòîâ äîñòàòî÷íî øèðîê,

ðàçëè÷íûå ïðîÿâëåíèÿ êàðäèîâàñêóëÿðíîé ïàòîëîãèè

íåðåäêî ñî÷åòàþòñÿ, âçàèìíî îòÿãîùàÿ äðóã äðóãà,

íàïðèìåð ÀÃ è ÈÁÑ. Òåì íå ìåíåå, ïðåäñòàâëÿåòñÿ öåëå-

ñîîáðàçíûì âûäåëÿòü 3 îñíîâíûå ãðóïïû ÍÏÂÏ-àññîöè-

èðîâàííûõ îñëîæíåíèé: äåñòàáèëèçàöèÿ ÀÃ; êàðäèî-

âàñêóëÿðíûå êàòàñòðîôû; äåñòàáèëèçàöèÿ ñåðäå÷íîé

íåäîñòàòî÷íîñòè [2].

Áûë ïðîâåäåí àíàëèç âëèÿíèÿ ÍÏÂÏ íà òå÷åíèå ñî-

ïóòñòâóþùèõ çàáîëåâàíèé ïðè ÐÀ. Íàèáîëåå ðàñïðîñò-

ðàíåííûìè èç íèõ ÿâëÿþòñÿ ñëåäóþùèå: ÀÃ (35,9%), ÑÄ 2

òèïà (30,9%), îñòåîïîðîç (25,8%), à òàêæå äèñëèïèäåìèè

(19,4%) [5]. Ïîâûøåíèå ðèñêà ñåðäå÷íî-ñîñóäèñòûõ ñî-

áûòèé ñâÿçàíî ñ ìíîãî÷èñëåííûìè ìåõàíèçìàìè, ñðåäè

êîòîðûõ ïðåâàëèðóþùåå çíà÷åíèå èìåþò ýíäîòåëèàëüíàÿ

äèñôóíêöèÿ, íàðóøåíèå ñèíòåçà îêñèäà àçîòà [20], óðî-

âåíü îêñèäàíòíîãî ñòðåññà [4], ñòåïåíü ïîâûøåíèÿ àðòå-

ðèàëüíîãî äàâëåíèÿ (ÀÄ) [30] è çàäåðæêè æèäêîñòè [33].

Íàëè÷èå õðîíè÷åñêîãî âîñïàëåíèÿ ïðè ÐÀ ÿâëÿåòñÿ

óñòàíîâëåííûì ôàêòîðîì ðèñêà äëÿ ðàçâèòèÿ ïîâûøåí-

íîé æåñòêîñòè àðòåðèé è ïðîãðåññèðîâàíèÿ ÀÃ, ÷òî

îáóñëîâëåíî êàê íàðóøåíèåì ìèêðîöèðêóëÿòîðíîé ðå-

àêòèâíîñòè è äèñôóíêöèåé ýíäîòåëèÿ, òàê è èçìåíåíèÿìè

íåìèîöèòàðíûõ ýëåìåíòîâ ñåðäöà. Ëå÷åíèå ÀÃ ó áîëü-

íûõ ÐA ÿâëÿåòñÿ îñîáåííî ñëîæíîé çàäà÷åé. Ìíîæåñòâî

ôàêòîðîâ, âêëþ÷àÿ ñòåïåíü âîñïàëåíèÿ, ñîïóòñòâóþùèå

çàáîëåâàíèÿ, îòñóòñòâèå ôèçè÷åñêîé àêòèâíîñòè è ïðèåì

ïðîòèâîðåâìàòè÷åñêèõ ïðåïàðàòîâ ñ “ãèïåðòîíè÷åñ-

êèì” ïîòåíöèàëîì, ìîæåò âëèÿòü êàê íà óðîâåíü ÀÄ, òàê

è íà ýôôåêòèâíîñòü àíòèãèïåðòåíçèâíîé òåðàïèè [25].

ÖÎÃ-1/ÖÎÃ-2 çàâèñèìûé ñèíòåç ÏÃ èãðàþò âàæíóþ

ðîëü â ôèçèîëîãè÷åñêîé ðåãóëÿöèè ñîñóäèñòîãî òîíóñà è

ôóíêöèè ïî÷åê. ÏÃ âçàèìîäåéñòâóþò ñ ðåíèí-àíãèî-

òåíçèíîâîé ñèñòåìîé, ìîäåëèðóÿ âàçîêîíñòðèêòîðíûé è

àíòèíàòðèéóðåòè÷åñêèé ýôôåêò àíãèîòåíçèíà II. Îáñóæ-

äàåòñÿ íåñêîëüêî âçàèìîñâÿçàííûõ ìåõàíèçìîâ, îïðåäå-

ëÿþùèõ ïðîãèïåðòåíçèâíûé ýôôåêò ÍÏÂÏ [18]: ñíèæå-

íèå íàòðèéóðåçà çà ñ÷åò ïîäàâëåíèÿ ôèëüòðàöèè è

óñèëåíèÿ ïðîêñèìàëüíîé êàíàëüöåâîé ðåàáñîðáöèè íàò-

ðèÿ; óâåëè÷åíèå âíåïî÷å÷íîé è âíóòðèïî÷å÷íîé ñîñó-

äèñòîé ðåçèñòåíòíîñòè çà ñ÷åò èíãèáèöèè ñèíòåçà ÏÃ ñ

âàçîäèëàòàòîðíîé àêòèâíîñòüþ (ÏÃÅ2 è ÏÃI2) è/èëè çà

ñ÷åò óñèëåíèÿ âûñâîáîæäåíèÿ íîðàäðåíàëèíà èç íåðâ-

íûõ îêîí÷àíèé è óâåëè÷åíèå ÷óâñòâèòåëüíîñòè ñîñóäèñ-

òîé ñòåíêè ê äåéñòâèþ öèðêóëèðóþùèõ âàçîêîíñòðèêòîð-

íûõ ñóáñòàíöèé; ñíèæåíèå ïî÷å÷íîãî êðîâîòîêà è

êëóáî÷êîâîé ôèëüòðàöèè, óâåëè÷åíèå ñåêðåöèè ýíäî-

òåëèíà-1; òîêñè÷åñêîå äåéñòâèå ÍÏÂÏ íà ïî÷êè (ëåêàð-

ñòâåííàÿ íåôðîïàòèÿ ñ ôîðìèðîâàíèåì òóáóëîèíòåð-

ñòèöèàëüíîãî íåôðèòà). Ïðèíöèïèàëüíî âàæíî, ÷òî

ïî÷å÷íàÿ ðåãóëÿöèÿ àðòåðèàëüíîãî äàâëåíèÿ âî ìíîãîì

îïðåäåëÿåòñÿ àêòèâíîñòüþ ÖÎÃ-2, âûïîëíÿþùåãî â äàí-

íîé ñèòóàöèè ôóíêöèþ “ñòðóêòóðíîãî” ôåðìåíòà. Ïî-

ýòîìó êàê ñåëåêòèâíûå èíãèáèòîðû ÖÎÃ-2 (ñÍÏÂÏ), òàê

è íåñåëåêòèâíûå (íÍÏÂÏ), ñïîñîáíû îêàçûâàòü “ïðîãè-

ïåðòåíçèâíîå” äåéñòâèå.

Îöåíèòü ðåàëüíóþ ÷àñòîòó äàííîé ïàòîëîãèè äîñòà-

òî÷íî ñëîæíî, ïîñêîëüêó õðîíè÷åñêèå çàáîëåâàíèÿ îïîð-

íî-äâèãàòåëüíîé ñèñòåìû (êàê ïðè÷èíà íàçíà÷åíèÿ ÍÏÂÏ)

è ÀÃ ÿâëÿåòñÿ íàèáîëåå ðàñïðîñòðàíåííîé, ÷àñòî ñî÷åòà-

þùåéñÿ ïàòîëîãèåé, îñîáåííî ó ëèö ïîæèëîãî âîçðàñòà.

Ïî äàííûì ýïèäåìèîëîãè÷åñêèõ èññëåäîâàíèé ÑØÀ,

ïðèìåðíî 12-20 ìëí. ÷åëîâåê ïðèíèìàþò îäíîâðåìåííî

ÍÏÂÏ è àíòèãèïåðòåíçèâíûå ïðåïàðàòû. ÍÏÂÏ íàçíà÷à-

þòñÿ áîëåå ÷åì òðåòè áîëüíûõ ñ ÀÃ [17, 28].

Äàííûå î ñïîñîáíîñòè ÍÏÂÏ âëèÿòü íà ðàçâèòèå ÀÃ ó

ëèö, ðàíåå íå ñòðàäàâøèõ äàííîé ïàòîëîãèåé, äîñòàòî÷íî

ïðîòèâîðå÷èâû. Òàê, ïî äàííûì J. Gurwitz è ñîàâò. [16],

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

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îöåíèâøèõ ïîòðåáíîñòü â àíòèãèïåðòåíçèâíîé òåðàïèè ó

ïðèáëèçèòåëüíî 100000 ïàöèåíòîâ (íàáëþäåíèå > 2ëåò),

ïðèåì ÍÏÂÏ âûñòóïàë íåçàâèñèìûì ôàêòîðîì ðàçâèòèÿ

ÀÃ. Àíàëîãè÷íûå ðåçóëüòàòû ïîëó÷åíû â ðåòðîñïåêòèâ-

íîì èññëåäîâàíèè NHS (Nurses’ Health Study) II. Ïðè ýòîì

êîãîðòà îáñëåäóåìûõ ñîñòàâèëè 80020 æåíùèí â âîçðàñòå

31-50 ëåò – îòíîñèòåëüíûé ðèñê (ÎÐ) ðàçâèòèÿ ÀÃ ñðåäè

ïðèíèìàâøèõ ÍÏÂÏ ñîñòàâèë 1,68 [13]. Ñõîäíûå äàííûå

ïîëó÷åíû J.Dedier [14], êîòîðûé îáíàðóæèë óâåëè÷åíèå

ðèñêà ðàçâèòèÿ ÀÃ ó óñëîâíî çäîðîâûõ æåíùèí, ïîëó÷àâ-

øèõ ÍÏÂÏ (ÎÐ=1,35). Îäíàêî ðåçóëüòàòû ïðîãðàììû

PHS – Physicians’ Health Study (êîãîðòà 8229 óñëîâíî çäî-

ðîâûõ ìóæ÷èí, íàáëþäåíèå – 5 ëåò) íå ïîêàçàë ñâÿçè ìåæ-

äó ïðèåìîì ÍÏÂÏ è ðàçâèòèåì ÀÃ (ÎÐ=1,08). D.Solomon è

ñîàâò., îöåíèâ ÷àñòîòó ðàçâèòèÿ ðàçâèòèÿ ÀÃ ó 17844 ëèö >

65 ëåò çà ïåðèîä íå ìåíåå 2 ëåò, íå âûÿâèëè ðàçíèöû ïî ýòîé

ïàòîëîãèè ó ïðèíèìàâøèõ íÍÏÂÏ èëè öåëåêîêñèá ïî

ñðàâíåíèþ ñ íå ïðèíèìàâøèìè êàêèå-ëèáî ÍÏÂÏ.

Ïðîñïåêòèâíîå íàáëþäåíèå ãðóïï æåíùèí â âîçðàñòå

51-70 ãîä (NHS I, n=1903) è 34-53 ëåò (NHS II, n=3220) ïîêà-

çàëî óâåëè÷åíèå ðèñêà ðàçâèòèÿ ÀÃ ó ïðèíèìàþùèõ

ÍÏÂÏ (ÎÐ=1,78; 1,21-2,6 è ÎÐ=1,60; 1,10 – 2,32) [15]. Îäíà-

êî ïðèåì àöåòàìèíîôåíà â äîçå > 500 ìã/ñóòêè àññîöèè-

ðîâàëñÿ ñ íåñêîëüêî áîëüøèì ðèñêîì ðàçâèòèÿ ýòîé ïàòî-

ëîãèè (ÎÐ=1,93; 1,30-2,88). Àíàëîãè÷íûå äàííûå ïî

àöåòàìèíîôåíó áûëè ïîëó÷åíû â õîäå ðåòðîñïåêòèâíîãî

NHS II. Âåðîÿòíî, ýòî ñëóæèò óêàçàíèåì íà âëèÿíèå ïðè-

÷èíû íàçíà÷åíèÿ àíàëüãåòèêîâ (õðîíè÷åñêîé áîëè), à íå

ñàìèõ àíàëüãåòèêîâ íà ðàçâèòèå ÀÃ.

Íåêîíòðîëèðóåìàÿ ÀÃ – îáùåïðèçíàííûé ôàêòîð

ðèñêà êàðäèîâàñêóëÿðíûõ êàòàñòðîô, ïîýòîìó äàæå íå-

çíà÷èòåëüíîå ïîâûøåíèå ñðåäíèõ öèôð ÀÄ ìîæåò àññî-

öèèðîâàòüñÿ ñ ñåðüåçíîé îïàñíîñòüþ ðàçâèòèÿ ïîòåíöè-

àëüíî ôàòàëüíûõ îñëîæíåíèé.

×àñòîòà ðàçâèòèÿ èëè äåñòàáèëèçàöèè ÀÃ, ôèêñèðóå-

ìàÿ â õîäå äëèòåëüíûõ ÐÊÈ, êîëåáëåòñÿ â øèðîêèõ ïðåäå-

ëàõ, îäíàêî íå ïðåâûøàåò 5-7%. Ïî äàííûì J.Pope è ñîàâò.

[26], îñíîâàííûõ íà ðåçóëüòàòàõ 54 ÐÊÈ, ïðèåì íÍÏÂÏ

ïðèâîäèò ê óâåëè÷åíèþ ÀÄ â ñðåäíåì íà 3,2 ìì ðò.ñò. ó

ïàöèåíòîâ, ñòðàäàþùèõ ÀÃ, íî íå âëèÿåò íà ÀÄ ó ïàöèåí-

òîâ, íå èìåâøèõ èñõîäíî ýòîé ïàòîëîãèè. Ñîãëàñíî ðå-

çóëüòàòàì ìåòààíàëèçà A. Johnson è ñîàâò. [21], îáîáùèâ-

øèõ äàííûå 50 ÐÊÈ, ïðèåì ÍÏÂÏ ïðèâîäèò ê ðîñòó ÀÄ â

ñðåäíåì íà 5 ìì ðò.ñò.

Ïî äàííûì ìåòààíàëèçà [7], ñÍÏÂÏ (“êîêñèáû”) ñïî-

ñîáíû èíäóöèðîâàòü óâåëè÷åíèå ñèñòîëè÷åñêîãî (íà 3,85

ìì ðò.ñò.) è äèàñòîëè÷åñêîãî (íà 1,06 ìì ðò.ñò.) ÀÄ, à

íÍÏÂÏ ñîîòâåòñòâåííî íà 2,83/1,34 ìì ðò.ñò. Â öåëîì,

ïðèåì ñÍÏÂÏ àññîöèèðóåòñÿ ñ íåäîñòîâåðíûì óâåëè÷å-

íèåì ðèñêà ðàçâèòèÿ ÀÃ ïî ñðàâíåíèþ ñ ïëàöåáî

(ÎÐ=1,65; 0,91-2,84; ð=0,1) è íÍÏÂÏ (ÎÐ=1,25; 0,87-1,78).

Ïðè ýòîì ïðèåì ðîôåêîêñèáà âûçâàë áîëåå âûðàæåííîå

óâåëè÷åíèå ñèñòîëè÷åñêîãî ÀÄ è ðèñê ðàçâèòèÿ êëèíè-

÷åñêè çíà÷èìîé ñèñòîëè÷åñêîé ÀÃ (ÎÐ=1,5; 1,00 – 2,26;

ð=0,05) ïî ñðàâíåíèþ ñ öåëåêîêñèáîì [9].

Ñðåäè íÍÏÂÏ, ïî äàííûì J.Gurwitz è ñîàâò. [17], íàè-

ìåíüøèé ðèñê ðàçâèòèÿ èëè äåñòàáèëèçàöèè ÀÃ îòìå÷åí â

îòíîøåíèè êåòîïðîôåíà è èáóïðîôåíà, íàèáîëüøèé – ïè-

ðîêñèêàìà, ôåíèëáóòàçîíà, èíäîìåòàöèíà. Ðåçóëüòàòû êëè-

íè÷åñêèõ èññëåäîâàíèé ñâèäåòåëüñòâóþò î òîì, ÷òî ÍÏÂÏ –

èíäîìåòàöèí, ïèðîêñèêàì è íàïðîêñåí â ñðåäíèõ òåðàïåâ-

òè÷åñêèõ äîçàõ è èáóïðîôåí â âûñîêîé äîçå – îáëàäàþò ñïî-

ñîáíîñòüþ ñíèæàòü ýôôåêòèâíîñòü áåòà-áëîêàòîðîâ, äèó-

ðåòèêîâ, èíãèáèòîðîâ ÀÏÔ, íî â ñóùåñòâåííî ìåíüøåé

ñòåïåíè âëèÿþò íà àíòèãèïåðòåíçèâíîå äåéñòâèå àíòàãîíèñ-

òîâ êàëüöèÿ [9]. Òàêæå ñÍÏÂÏ ñïîñîáíû ñíèæàòü ýôôåêòèâ-

íîñòü àíòèãèïåðòåíçèâíûõ ïðåïàðàòîâ. Èìåþòñÿ äàííûå,

÷òî öåëåêîêñèá è íèìåñóëèä â ìåíüøåé ñòåïåíè âëèÿþò íà

äåñòàáèëèçàöèþ ÀÃ ïî ñðàâíåíèþ ñ äèêëîôåíàêîì.

Ôàêòîðû ðèñêà ðàçâèòèÿ è äåñòàáèëèçàöèè ÀÃ íà

ôîíå ïðèåìà ÍÏÂÏ îïðåäåëåíû íåäîñòàòî÷íî ÷åòêî.

Òåì íå ìåíåå, îðèåíòèðóÿñü íà äàííûå ïîïóëÿöèîííûõ è

ïðîñïåêòèâíûõ èññëåäîâàíèé, ñëåäóåò ñ÷èòàòü ðèñê íàè-

áîëüøèì äëÿ ëèö ïîæèëîãî âîçðàñòà, ñòðàäàþùèõ ÀÃ

(îñîáåííî ïðè íåäîñòàòî÷íî ýôôåêòèâíîì êîíòðîëå ÀÄ)

è çàáîëåâàíèÿìè ïî÷åê. Ïîâûøåíèå ÀÄ ÷àùå îòìå÷àåò-

ñÿ íà ôîíå äëèòåëüíîãî ïðèåìà ÍÏÂÏ â âûñîêèõ äîçàõ, èç

êîòîðûõ íàèáîëåå îïàñåí èíäîìåòàöèí. Äîïîëíèòåëüíû-

ìè ôàêòîðàìè ðèñêà ìîãóò ñ÷èòàòüñÿ êóðåíèå è ïðèåì

ïðåïàðàòîâ, îáëàäàþùèõ ïðîãèïåðòåíçèâíûì äåéñòâè-

åì, íàïðèìåð ãëþêîêîðòèêîèäîâ.

Îñíîâíûìè ìåòîäàìè ïðîôèëàêòèêè äåñòàáèëèçàöèè

ÀÃ ñëåäóåò ñ÷èòàòü àäåêâàòíûé êîíòðîëü ÀÄ ó áîëüíûõ,

ïðèíèìàþùèõ ÍÏÂÏ, è ñâîåâðåìåííîå íàçíà÷åíèå èëè

êîððåêöèþ àíòèãèïåðòåíçèâíîé òåðàïèè (óñèëåíèå çà ñ÷åò

óâåëè÷åíèÿ äîçû ñóùåñòâóþùèõ èëè æå äîáàâëåíèå àíòè-

ãèïåðòåíçèâíûõ ïðåïàðàòîâ èç äðóãèõ ãðóïï ñ ó÷åòîì èõ

ïåðåíîñèìîñòè, à òàêæå ñòðóêòóðíî-ôóíêöèîíàëüíîãî ñî-

ñòîÿíèÿ æèçíåííî âàæíûõ îðãàíîâ). Ê ïðåïàðàòàì âûáîðà

äëÿ ëå÷åíèÿ ÀÃ ó áîëüíûõ, íóæäàþùèõñÿ â äëèòåëüíîé òå-

ðàïèè ÍÏÂÏ, ñëåäóåò îòíîñèòü áëîêàòîðû êàëüöèåâûõ êà-

íàëîâ (â ÷àñòíîñòè, àìëîäèïèí), èíãèáèòîðû ÀÏÔ, îáëà-

äàþùèå øèðîêèì ñïåêòðîì ïëåéîòðîïíûõ ýôôåêòîâ, ïðè

îòñóòñòâèè íåãàòèâíîãî ìåòàáîëè÷åñêîãî âëèÿíèÿ. Ñðåäè

ÍÏÂÏ äëÿ áîëüíûõ ÀÃ öåëåñîîáðàçíî îòäàòü ïðåäïî÷òå-

íèå ïðåïàðàòàì, â íàèìåíüøåé ñòåïåíè âëèÿþùèì íà ÀÄ,

òàêèì êàê íàïðîêñåí è ñÍÏÂÏ (ìåëîêñèêàì, öåëåêîêñèá).

Âðà÷ äîëæåí ïîìíèòü, ÷òî, åñëè àíòèãèïåðòåíçèâíóþ

òåðàïèþ áîëüíîé äîëæåí ïîëó÷àòü ïîæèçíåííî, òî ïðåïà-

ðàòû èç ãðóïïû ÍÏÂÏ – òîëüêî ïðè íàëè÷èè âîñïàëåíèÿ

èëè áîëè – êàê ìîæíî êîðîòêèé ïåðèîä âðåìåíè, ñ ó÷åòîì

ðèñêà ðàçâèòèÿ êàðäèî-âàñêóëÿðíûõ è ãàñòðýíòåðîëîãè-

÷åñêèõ ñîáûòèé è, â áîëüøèíñòâå ñëó÷àåâ (ÿçâåííûé àíàì-

íåç èëè íàëè÷èå äèñïåïñè÷åñêîãî ñèíäðîìà), îáÿçàòåëüíî

ïîä “ïðèêðûòèåì” ïðåïàðàòîâ èç ãðóïïû èíãèáèòîðîâ

ïðîòîííîé ïîìïû, ïîñëå êîíñóëüòàöèè ãàñòðîýíòåðîëîãà.

Ðåöåíçåíò: ÷ëåí-êîð. ÍÀÌÍ Óêðà¿íè, ä.ìåä.í.,

ïðîôåñîð Íåòÿæåíêî Â.Ç.

ËÈÒÅÐÀÒÓÐÀ

1. Êàðàòååâ À.Å. Íåñòåðîèäíûå ïðîòèâîâîñïàëèòåëü-

íûå ïðåïàðàòû â ñîâðåìåííîé êëèíè÷åñêîé ïðàêòèêå: “çà”

áîëüøå, ÷åì “ïðîòèâ”. Ñîâðåìåííàÿ ðåâìàòîëîãèÿ ¹1, 2008,

ñ.70-78;

2. Êàðàòååâ À.Å., è ñîàâò. Ïðèìåíåíèå íåñòåðîèäíûõ ïðîòè-

âîâîñïàëèòåëüíûõ ïðåïàðàòîâ. Êëèíè÷åñêèå ðåêîìåíäàöèè. –

Ì.:ÈÌÀ-ÏÐÅÑÑ, 2009. – ñ.63-66;

3. Íàñîíîâ Å.Ë., Ëàçåáíèê Ë.Á., Ìàðååâ Â.Þ.è äð. Ïðèìåíå-

íèå íåñòåðîèäíûõ ïðîòèâîâîñïàëèòåëüíûõ ïðåïàðàòîâ. Êëè-

íè÷åñêèå ðåêîìåíäàöèè. Ì., 2006;

4. Adderley, S.R.; FitzGerald, D.J. Oxidative damage of

cardiomyocytes is limited by extracellular regulated kinases 1/2

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Hamed Qutbuddeen, Salma Al-Harthi, Sarah Subahi. Comorbidity

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Prescriptions Trend, Clin Med Insights Arthritis Musculoskelet Disord.

2013; 6: 11–18. Published online 2013 April 4;

6. Antman, E.M.; Bennett J.S.; Daugherty A.; Furberg, C.;

Roberts, H.; Taubert, K.A. Use of nonsteroidal antiinflammatory drugs.

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7. Aw T.-J., Haas S., Liew D. Meta-analysis of cyclooxygenase-2

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8. Bjordal, J.M.; Ljunggren, A.E.; Klovning , A.; Slordal, L.

Nonsteroidal anti-inflammatory drugs, including cyclo-oxygenase-2

inhibitors, in osteoarthritic knee pain: Meta analysis of randomised

placebo controlled trials. B.M.J., 2004, 329, 1317;

9. Brown J., Dollery C., Valdes G. Interaction of nonsteroidal

anti-inflammatory drugs with antihypertensive and diuretic agents.

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10. Brune K. The early history of non-opioid analgesics. Acute

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11. Chandrasekharan N.V., Hu Dai, Lamar Turepu Roos K.,

Nathan K. Evanson, Joshua Tomsik, Terry S. Elton, Daniel L. Simmons.

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PNAS published September 19, 2002, 10.1073/pnas.162468699;

12. Chen C., Bazan N.G. Acetaminophen modifies hippocampal

synaptic plasticity via a presynaptic 5-HT2 receptor. Neuroreport.

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13 . Curhan G.C., Willet W.C., Rosner B., Stamfer M.J. Frequency_f

analgetic use and risk of hypertension in younger woman. Arch Intern

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14. Dedier J., Stamfer M.J., Hankinson S.E. et al. Nonnarcotic

analgetic use and risk of hypertension in US women. Hypertension

2002; 40: 604-8;

15. Formam J., Stamfer M., Curhan G. Non-narcotic analgetic

dose and risk of incident hypertension in US women. Hypertension

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16. Gurwitz J.H., Avonn J., Bohn R.L. et al. Initiation of

antihypertensive treatment deny nonsteroidal anti-inflammatory

therapy. JAMA 1994; 272; 781-6;

17. Harley C., Wagner S. The prevalence of cardiovascular risk

factors in patients prescribing anti-inflammatory drugs; data from

managed care. Clin Ther 2003; 25: 139-49;

18. Harris C., Breyer M. Update on Cyclooxygenase-2 Inhibitors. Clin

J Am Soc Nephrol 2006; 1:236-45, Cheng H.-F., Harris R. Cyclooxy-

genases, the kidney, and hypertension. Hypertension 2004; 43:525-30;

19. Hawkey, C.J.; Cullen, D.J.E.; Pearson, G.; Holmes, S.;

Doherty, S.; Wilson, J.V.; Garrud, P.; Garner, S.; Maynard, A.; Logan,

R.F.A. Pharmacoepidemiology of non-steroidal antinflammatory drug

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2 inhibitors on endothelial function in salt-induced hypertension.

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21. Jonson A., Nguyen T., Day R. Do nonsteroidal anti-

inflammatory drugs affect blood pressure? A meta-analysis. Ann Intern

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27. Singh, G.; Fort, J.G.; Goldstein, J.L.; Levy, R.A.; Hanrahan,

P.S.; Bello, A.E.; Andrade-Ortega, L.; Wallemark, C.; Agrawal, N.M.;

Eisen, G.M.; Stenson, W.F.; Triadafilopoulos, G. For the SUCCESS-

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29. Singh, G. Gastrointestinal complications of prescription and

overthe-counter nonsteroidal anti-inflammatory drugs: a view from

the ARAMIS database. Arthritis, rheumatism, and aging medical

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30 . Sowers, J.R.; White, W.B.; Pitt, B.; Whelton, A.; Simon, L.S.;

Winer, N. The effects of cyclooxygenase-2 inhibitors and nonsteroidal

anti-inflammatory therapy on 24-hour blood pressure in patients with

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Med., 2005, 165, 161-8;

31 . Sturkenboom M., Burke T., Dieleman J.et al. Underutilization

of preventive strategies in patients receiving NSAIDs. Rheumatology

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32. Wang P.S. et al. // Hypertension. 2005. V. 46. P. 273;

33. Zhang, J.; Ding, E.L.; Song, Y. Adverse effects of

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ÍÅÑÒÅÐÎ¯ÄÍ² ÏÐÎÒÈÇÀÏÀËÜÍ² ÏÐÅÏÀÐÀÒÈ

ÒÀ ÀÐÒÅÐ²ÀËÜÍÀ Ã²ÏÅÐÒÅÍÇ²ß – ÏÐÎÁËÅÌÀ

ÑÓ×ÀÑÍÎ¯ ÊÀÐÄ²ÎËÎÃ²¯

Êàðïåíêî Î.Î., Êîíäðàòþê Â.ª.

Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñ³òåò

³ìåí³ Î.Î.Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

Ðåçþìå. Íåñòåðî¿äí³ ïðîòèçàïàëüí³ ïðåïàðàòè

(ÍÏÇÏ) ïðèçíà÷àþòüñÿ á³ëüø í³æ òðåòèí³ õâîðèõ ç àðòå-

ð³àëüíîþ ã³ïåðòåíç³ºþ (ÀÃ). Îäíèì ç ìîæëèâèõ íåáàæà-

íèõ åôåêò³â ÍÏÇÏ º ³í³ö³àö³ÿ ÀÃ ç äåñòàá³ë³çàö³ºþ ¿¿ ïåðå-

á³ãó: ðîçâèòîê ³íôàðêòó ì³îêàðäà, ³íñóëüòó, ñåðöåâî¿ íå-

äîñòàòíîñò³. Ï³äâèùåííÿ ðèçèêó ñåðöåâî-ñóäèííèõ ïîä³é

âèçíà÷àºòüñÿ åíäîòåë³àëüíîþ äèñôóíêö³ºþ, ïîðóøåí-

íÿì ñèíòåçó îêñèäó àçîòó, ð³âíåì îêñèäàíòíîãî ñòðåñó ³

ñòóïåíåì ï³äâèùåííÿ àðòåð³àëüíîãî òèñêó. Äëÿ ïðîô³ëàê-

òèêè äåñòàá³ë³çàö³¿ ÀÃ ñë³ä çä³éñíþâàòè àäåêâàòíèé êîí-

òðîëü àðòåð³àëüíîãî òèñêó ³ ñâîº÷àñíî êîðåãóâàòè àíòè-

ã³ïåðòåíçèâíó òåðàï³þ.

Êëþ÷îâ³ ñëîâà: êë³í³÷íà ôàðìàêîëîã³ÿ, íåñòåðî¿äí³

ïðîòèçàïàëüí³ ïðåïàðàòè, àðòåð³àëüíà ã³ïåðòåíç³ÿ,

ïîá³÷í³ åôåêòè.

NON-STEROIDAL ANTI-INFLAMMATORY DRUG

AND ARTERIAL HYPERTENSION – PROBLEM

OF MODERN CARDIOLOGY

O. Karpenko, V. Kondratiuk

Bogomolets National Medical University, Kyiv, Ukraine

Summary. Nonsteroidal anti-inflammatory drugs

(NSAIDs) are assigned more than one third of patients with

hypertension (H). One of the possible adverse effects of

NSAIDs is to initiate H destabilization of its course:

myocardial infarction, stroke, heart failure. Increased risk of

cardiovascular events is determined by endothelial

dysfunction, impaired synthesis of nitric oxide, oxidative

stress level and the degree of increase in blood pressure.

For the prevention of destabilization we should implement

adequate control of blood pressure and timely corrected

antihypertensive therapy. For patients with hypertension are

advisable to use naproxen, celecoxib, and meloxicam.

Key words: clinical pharmacology, non-steroidal anti-

inflammatory drugs, hypertension, side effects.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

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ÓÄÊ 616-006:615.2(045)

ÈÑÏÎËÜÇÎÂÀÍÈÅ ÎÍÊÎÌÀÐÊÅÐÎÂ

Â ÄÈÀÃÍÎÑÒÈÊÅ ÎÍÊÎËÎÃÈ×ÅÑÊÎÉ ÏÀÒÎËÎÃÈÈ

Ìàëÿð÷óê Å.À.

Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò èìåíè À.À. Áîãîìîëüöà, ã. Êèåâ, Óêðàèíà

Êëþ÷åâûå ñëîâà: îíêîëîãèÿ, îíêîìàðêåðû, êàíöåðîãåíåç, ñêðèíèíã, îïóõîëåâûé ðîñò, äèàãíîñòèêà îïóõîëåé.

Çëîêà÷åñòâåííûå íîâîîáðàçîâàíèÿ – îäíà èç íàèáî-

ëåå îïàñíûõ ïðîáëåì ñîâðåìåííîñòè. Åæåãîäíî îò ðàêà

óìèðàþò 837 òûñÿ÷ åâðîïåéöåâ, â òî âðåìÿ êàê â ìèðå

ðåãèñòðèðóåòñÿ îêîëî 4 ìèëëèîíîâ íîâûõ ñëó÷àåâ îíêî-

ëîãè÷åñêèõ çàáîëåâàíèé.

Ïî÷òè 90 òûñÿ÷ æèòåëåé Óêðàèíû óìèðàþò îò ðàêà

åæåãîäíî, ïðè÷åì 35 ïðîöåíòîâ óìåðøèõ – ëèöà òðóäî-

ñïîñîáíîãî âîçðàñòà. Ïî ðàñ÷åòàì ñïåöèàëèñòîâ, ê 2020

ãîäó êîëè÷åñòâî âïåðâûå çàáîëåâøèõ ðàêîì â Óêðàèíå

ìîæåò âûðàñòè äî 200 òûñÿ÷. [4]

Îäíàêî èçâåñòíî, ÷òî ðàê, äèàãíîñòèðîâàííûé íà ðàí-

íåé ñòàäèè, ÿâëÿåòñÿ ïîëíîñòüþ èçëå÷èìûì è íå ïðèâî-

äèò íè ê èíâàëèäíîñòè, íè ê íàðóøåíèþ êà÷åñòâà æèçíè.

Òàêèì îáðàçîì, àêòóàëüíîé ñòàíîâèòñÿ ïðîáëåìà èçó÷å-

íèÿ îíêîìàðêåðîâ äëÿ ðàííåé è òî÷íîé äèàãíîñòèêè,

ñêðèíèãîâûõ ïðîãðàìì è ìîíèòîðèíãà ñîñòîÿíèÿ ïàöè-

åíòà âî âðåìÿ ëå÷åíèÿ è ïîñëå íåãî ñ ïîìîùüþ áèîëîãè-

÷åñêèõ ìàðêåðîâ, êîòîðûå çà ïîñëåäíåå äåñÿòèëåòèå ñòà-

ëè âàæíåéøèì äèàãíîñòè÷åñêèì è ïðîãíîñòè÷åñêèì

êðèòåðèåì â îíêîëîãèè. Îíè èñïîëüçóþòñÿ â êà÷åñòâå:

– ñêðèíèíãà (ïðîñòàò-ñïåöåôè÷åñêèé àíòèãåí )

– ìîíèòîðèíãà (óðîâåíü ÀÒÔ â êðîâè ïîñëå èçëå÷å-

íèÿ òåðàòîìû)

– â íåéðîîíêîëîãèè (êîãäà ïðîáëåìàòè÷íî ïîñòàâèòü

äèàãíîç äðóãèì ñïîñîáîì)

Îíêîìàðêåðû (ÎÌ) – âåùåñòâà, ñîäåðæàíèå êîòîðûõ

â áèîëîãè÷åñêèõ æèäêîñòÿõ êîððåëèðóåò ñ íàëè÷èåì èëè

ïðîãðåññèðóþùèì ðîñòîì çëîêà÷åñòâåííîé îïóõîëè.

Èçâåñòíî áîëåå 200 îïóõîëåâûõ ìàðêåðîâ, îäíàêî “èäå-

àëüíîãî ìàðêåðà”, êîòîðûé áû ñîîòâåòñòâîâàë âñåì êðè-

òåðèÿì, åùå íå âûÿâëåíî. Â êëèíè÷åñêîé ïðàêòèêå

èñïîëüçóþò îêîëî 20 ìàðêåðîâ. Âñå ÎÌ äîëæíû ïðîäó-

öèðîâàòüñÿ òîëüêî çëîêà÷åñòâåííûìè êëåòêàìè, áûòü

îðãàíîñïåöèôè÷íûìè, âûÿâëÿòüñÿ â âûñîêèõ êîíöåíòðà-

öèÿõ. Èõ êîíöåíòðàöèÿ äîëæíà êîððåëèðîâàòü ñ ðàç-

ìåðîì îïóõîëè, ñî ñòàäèåé çàáîëåâàíèÿ, ñ ïðîãíîçîì è

ýôôåêòèâíîñòüþ ëå÷åíèÿ.[1, 2]

Â ñîîòâåòñòâèè ñ ýòèì îíè êëàññèôèöèðóþòñÿ:

I. Ïî õèìè÷åñêîé ñòðóêòóðå: ãëèêîïðîòåèäû, ëèïîï-

ðîòåèäû, ïîëèïåïòèäû, ãëèêîëèïèäû è ò.ä.

II. Ïî áèîëîãè÷åñêîé ôóíêöèè:

1. Îíêîôåòàëüíûå àíòèãåíû – ÐÝÀ, ÀÔÏ, ÕÃ×,

ÑÀ-125, ÑÀ-15-3, ÑÀ-19-9, ÑÀ-72-4.

2. Ôåðìåíòû – ÍÑÅ, ÏÑÀ, ÖÎÃ-2

3. Ãîðìîíû – êàëüöèòîíèí, ÀÊÒÃ

4. Äðóãèå – CYFRA21 -1, β-2-ì

III. Ïî çíà÷åíèþ äëÿ äèàãíîñòèêè

–Ãëàâíûé ìàðêåð – îáëàäàåò ìàêñèìàëüíîé

÷óâñòâèòåëüíîñòüþ è ñïåöèôè÷íîñòüþ äëÿ îï-

ðåäåëåííîãî òèïà îïóõîëè.

–Âòîðè÷íûé ìàðêåð – èìååò áîëåå íèçêóþ ÷óâ-

ñòâèòåëüíîñòü/ñïåöèôè÷íîñòü, íî â êîìáèíà-

öèè ñ ãëàâíûì ïîâûøàåò òî÷íîñòü äèàãíîñòèêè.

–Äîïîëíèòåëüíûé ìàðêåð – ìîæåò áûòü îðãà-

íîñïåöèôè÷íûì [1, 3].

Ïîêàçàíèÿìè äëÿ îïðåäåëåíèÿ îíêîëîãè÷åñêèõ ìàð-

êåðîâ ÿâëÿþòñÿ:

1. Ñêðèíèíã îíêîëîãè÷åñêèõ çàáîëåâàíèé. Äëÿ ñêðè-

íèíãà èñïîëüçóþò â îñíîâíîì ÏÑÀ (ðàê ïðåäñòàòåëüíîé

æåëåçû) è êàëüöèòîíèí (êàðöèíîìà ùèòîâèäíîé æåëåçû)

2. Äèàãíîñòèêà è äèôôåðåíöèàëüíàÿ äèàãíîñòèêà

çëîêà÷åñòâåííûõ è äîáðîêà÷åñòâåííûõ ïðîöåññîâ. Îíà

ýôôåêòèâíà, òî÷íà è âûñîêîñïåöèôè÷íàÿ, îäíàêî ìîæíî

ñòîëêíóòüñÿ ñ Ïðîáëåìîé “Ñåðîé” çîíû – ãðàíèöû çíà-

÷åíèé êîíöåíòðàöèè ÎÌ, õàðàêòåðíûå êàê äëÿ çëîêà÷å-

ñòâåííîãî, òàê è äîáðîêà÷åñòâåííîãî ïðîöåññà.

3. Ïðîãíîç. ×åì âûøå óðîâíè ÎÌ, òåì áîëåå ðàñ-

ïðîñòðàíåí îïóõîëåâûé ïðîöåññ, áîëåå ïîçäíÿÿ ñòàäèÿ

çàáîëåâàíèÿ è õóäøèé ïðîãíîç, êðîìå òîãî, íåêîòîðûå

ìàðêåðû, òàêèå êàê BRAF, NRAF è KRAF èìåþò òàêæå

çíà÷åíèå è äëÿ âûáîðà ëå÷åíèÿ.

4. Îöåíêà ðàäèêàëüíîñòè òåðàïèè: Ñíèæåíèå êîí-

öåíòðàöèè ÎÌ – ïîêàçàòåëü óñïåøíîãî ëå÷åíèÿ. Íåîáõî-

äèìî ó÷èòûâàòü ïåðèîä ïîëóæèçíè ÎÌ.

5. Ìîíèòîðèíã áîëüíûõ. Ïîâòîðíîå ïîâûøåíèå

êîíöåíòðàöèè ÎÌ ñâèäåòåëüñòâóåò î ðåöèäèâå èëè/è ìå-

òàñòàçèðîâàíèè.

Ñõåìà âçÿòèÿ ïðîá (ñîãëàñíî ÂÎÇ äëÿ âñåõ ÎÌ):

– 1 ð. â ìåñ. – â òå÷åíèå 1-ãî ãîäà ïîñëå ëå÷åíèÿ.

– 1 ð. â 2 ìåñ. – â òå÷åíèå 2-ãî.

– 1 ð. â 3 ìåñ. – â òå÷åíèå 3-ãî ãîäà íàáëþäåíèÿ. [2]

Êëàññèôèêàöèþ îíêîëîãè÷åñêèõ ìàðêåðîâ óäîáíî

áóäåò ïðåäñòàâèòü â òàáëèöå:

Â íàñòîÿùåå âðåìÿ íàèáîëåå èíôîðìàòèâíûìè è

âàæíûìè ÿâëÿþòñÿ îíêîëîãè÷åñêèå ìàðêåðû äëÿ ñëåäóþ-

ùèõ îïóõîëåé:

I. Àäåíîêàðöèíîìà ïðåäñòàòåëüíîé æåëåçû

Ïðîñòàòîñïåöèôè÷åñêèå ìàðêåðû (PSA è ÐÀÐ)

1) Ïðîñòàòîñïåöèôè÷åñêèé àíòèãåí (PSA) – ôèçèîëî-

ãè÷åñêèé ýêñêðåòîðíûé ïðîäóêò ïðîñòàòû, óìåíüøàþ-

ùåé âÿçêîñòü ñïåðìû (ãëèêîïðîòåàçà). ßâëÿåòñÿ ãëàâíûì

äèàãíîñòè÷åñêèì ìàðêåðîì êàðöèíîìû ïðîñòàòû.

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Òàáëèöà 1.

Â íîðìå íèæå 4 ìã/ë ó çäîðîâûõ ìóæ÷èí áåç ãèïåðòðî-

ôèè ïðîñòàòû. Ôèçèîëîãè÷åñêîå óâåëè÷åíèå êîíöåíòðà-

öèè ìàðêåðà ïðîèñõîäèò ó ìóæ÷èí ïîæèëîãî âîçðàñòà è

ïîñëå äèàãíîñòè÷åñêèõ ïðîöåäóð (ïàëüöåâîãî ðåêòàëüíî-

ãî èññëåäîâàíèÿ, öèñòîñêîïèè, êîëîíîñêîïèè, òðàíñóðåò-

ðàëüíîé áèîïñèè, ëàçåðíîé òåðàïèè). Ïîýòîìó çàáîð

ïðîá ïðîâîäÿò äî èëè ÷åðåç 5 äíåé ïîñëå ïðîöåäóð. Èñ-

ïîëüçóåòñÿ äëÿ äèàãíîñòèêè êàê ìàðêåð êàðöèíîìû ïðî-

ñòàòû. Èìååò âûñîêóþ ñïåöèôè÷íîñòü.

2) Ïðîñòàòàñïåöèôè÷åñêàÿ êèñëàÿ ôîñôàòàçà (ÐÀÐ) –

ãëèêîïðîòåèí, êîíöåíòðàöèÿ êîòîðîãî â íîðìå íèæå 4 íã/

ìë ó çäîðîâûõ ìóæ÷èí áåç ãèïåðòðîôèè ïðîñòàòû. ×óâ-

ñòâèòåëüíîñòü ýòîãî ìàðêåðà íèæå, ÷åì PSA. Ïîýòîìó

ïåðâûé èç ìàðêåðîâ ïðåäïî÷òèòåëüíåå. [7]

II. Ðàê ìîëî÷íîé æåëåçû

Â ïëàíå îíêîëîãè÷åñêèõ ìàðêåðîâ äîñòàòî÷íî õîðî-

øî èçó÷åí ðàê ìîëî÷íîé æåëåçû. Äëÿ äèàãíîñòèêè ýòîãî

çàáîëåâàíèÿ èñïîëüçóåòñÿ ïîðÿäêà 10 ìàðêåðîâ – îò íå-

ñïåöèôè÷åñêîãî CEA, ýêñïðåññèðóåìîãî, òàêæå ïðè

ðàêå ïîäæåëóäî÷íîé æåëåçû, êèøå÷íèêà, ÿè÷íèêîâ è ïò.,

äî î÷åíü òî÷íîãî HER-2, êîòîðûé ïîçâîëÿåò íå òîëüêî

ïîñòàâèòü äèàãíîçà è îöåíèòü îòâåò îïóõîëè íà áèîëîãè-

÷åñêóþ òåðàïèþ, íî îïðåäåëèòü âàðèàíò îïóõîëè, íàèáî-

ëåå ÷óâñòâèòåëüíûé ê îïðåäåëåííîé òàðãåòíîé òåðàïèè, â

÷àñòíîñòè ê òðàñòóçóìàáó. Êðîìå òîãî, àêòèâíî ïðèìåíÿ-

åòñÿ òàêîé ìàðêåð êàê ðàñòâîðèìàÿ ôîðìà MUC-1. Ïî-

ñêîëüêó åãî ÷óâñòâèòåëüíîñòü ñîñòàâëÿåò 10-15 % íà ïåð-

âîé ñòàäèè è 30-35% íà 3 è 4 ñòàäèÿõ, åãî ïðèìåíÿþò

èñêëþ÷èòåëüíî êàê äîïîëíèòåëüíûé ìåòîä äèàãíîñòèêè.

Òàêæå ñòîèò îòìåòèòü, ÷òî îäíî èç ïåðâûõ ìåñò ïî çà-

áîëåâàåìîñòè è ñìåðòíîñòè âî âñåì ìèðå çàíèìàåò ðàê

ëåãêîãî. Ê ñîæàëåíèþ, äëÿ íåãî íå ñóùåñòâóåò ìàðêåðîâ,

îïðåäåëÿþùèõñÿ â ìî÷å èëè êðîâè. Íî öåëåñîîáðàçíûì

ÿâëÿåòñÿ ìîëåêóëÿðíîå îïðåäåëåíèå ìóòàöèé áèîïòàòà

îïóõîëè èëè ìîêðîòû. Ïðè ðàêå ëåãêèõ ïðîèñõîäÿò ìóòà-

öèè íåñêîëüêèõ ãåíîâ, â òîì ÷èñëå EGFR, ALK, KRAS,

BRAF è HER2. Ðåçóëüòàòû òåñòèðîâàíèÿ ïîìîãàþò òî÷íåå

ïîñòàâèòü äèàãíîç, âûáðàòü ñõåìó ñèñòåìíîé è òàðãåòíîé

òåðàïèè è ïðåäïîëîæèòü, íàñêîëüêî ýôôåêòèâíûì áóäåò

ëå÷åíèå [5,6].

Âûâîäû: Íà ñåãîäíÿøíèé äåíü â ìèðå èçó÷åíî è ïðè-

ìåíÿåòñÿ áîëüøîå êîëè÷åñòâî îíêîëîãè÷åñêèõ ìàðêåðîâ

äëÿ äèàãíîñòèêè ðàçëè÷íûõ îïóõîëåé, à òàêæå äëÿ óòî÷íå-

íèÿ ñòàäèè çàáîëåâàíèÿ, îñîáåííîñòåé ìîëåêóëÿðíîé

ñòðóêòóðû îïóõîëè è îòâåòà íà ëó÷åâóþ è õèìèîòåðàïèþ.

Òàê êàê, îíêîìàðêåðû ÿâëÿþòñÿ äèàãíîñòè÷åñêè çíà÷èìû-

ìè íà ðàííèõ ñòàäèÿõ îïóõîëåâûõ çàáîëåâàíèé, öåëåñî-

îáðàçíî ïðèìåíÿòü èõ äëÿ îáñëåäîâàíèÿ áîëüøîãî êîëè-

÷åñòâà íàñåëåíèÿ â êà÷åñòâå ñêðèíèíãîâûõ ïðîãðàìì.

Ê ñîæàëåíèþ, â Óêðàèíå íå ñóùåñòâóåò áåñïëàòíûõ ãîñó-

äàðñòâåííûõ ïðîãðàìì íà îïðåäåëåíèå ÎÌ â êðîâè. Îïðå-

äåëåíèå ÎÌ ðåêîìåíäóåòñÿ äëÿ ñêðèíèãîâîãî èññëåäîâà-

íèÿ êðîâè íà îïðåäåëåíèå PSA ó ìóæ÷èí ñòàðøå 60 ëåò, à

òàêæå ïðîâåäåíèå ìàììîãðàôèè ìîëî÷íîé æåëåçû ó æåí-

ùèí ñòàðøå 45 ëåò è îïðåäåëåíèå â êðîâè HER-2 ó æåíùèí,

áîëüíûõ ðàêîì ìîëî÷íîé æåëåçû äëÿ îïðåäåëåíèÿ ïðà-

âèëüíîé ñòðàòåãèè ëå÷åíèÿ. Òàêèå ìåðû çíà÷èòåëüíî

ïîìîãëè áû ñíèçèòü ñìåðòíîñòü îò ýòèõ 2 îïóõîëåé.

Ðåöåíçåíò: ä.ìåä.í., ïðîôåñîð Ùåïîò³í ².Á.

ËÈÒÅÐÀÒÓÐÀ

1. Êîìëåâà Å.Î. Ìîëåêóëÿðíûå è ãåíåòè÷åñêèå ìàðêåðû

îïóõîëåâîãî ðîñòà [Òåêñò] / Î. Å. Êîìëåâà ÑÏá.: Ãîðîäñêîé êëè-

íè÷åñêèé îíêîëîãè÷åñêèé äèñïàíñåð, 2010. – 148 ñ.

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ÂÈÊÎÐÈÑÒÀÍÍß ÎÍÊÎÌÀÐÊÅÐ²Â

Â Ä²ÀÃÍÎÑÒÈÖ² ÎÍÊÎËÎÃ²×ÍÎ¯ ÏÀÒÎËÎÃ²¯

Ìàëÿð÷óê Ê. À.

Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò

³ìåí³ Î.Î. Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

Ðåçþìå. Íà ñüîãîäí³øí³é äåíü â ñâ³ò³ âèâ÷åíî ³ çàñòî-

ñîâóºòüñÿ âåëèêà ê³ëüê³ñòü îíêîëîã³÷íèõ ìàðêåð³â äëÿ

ä³àãíîñòèêè ð³çíèõ ïóõëèí, à òàêîæ äëÿ óòî÷íåííÿ ñòàä³¿

çàõâîðþâàííÿ, îñîáëèâîñòåé ìîëåêóëÿðíî¿ ñòðóêòóðè

ïóõëèíè ³ â³äïîâ³ä³ íà ïðîìåíåâó ³ õ³ì³îòåðàï³þ. Òàê ÿê,

îíêîìàðêåðè º ä³àãíîñòè÷íî çíà÷óùèìè íà ðàíí³õ ñòà-

ä³ÿõ ïóõëèííèõ çàõâîðþâàíü, äîö³ëüíî çàñòîñîâóâàòè ¿õ

äëÿ îáñòåæåííÿ âåëèêî¿ ê³ëüêîñò³ íàñåëåííÿ â ÿêîñò³

ñêðèí³íãîâèõ ïðîãðàì. Íà æàëü, â Óêðà¿í³ íå ³ñíóº áåç-

êîøòîâíèõ äåðæàâíèõ ïðîãðàì íà âèçíà÷åííÿ OÌ â êðîâ³.

Âèçíà÷åííÿ ÎÌ ðåêîìåíäóºòüñÿ äëÿ ñêðèíèãîâîãî äîñ-

ë³äæåííÿ êðîâ³ íà âèçíà÷åííÿ PSA ó ÷îëîâ³ê³â ñòàðøå 60

ðîê³â, à òàêîæ ïðîâåäåííÿ ìàìîãðàô³¿ ìîëî÷íî¿ çàëîçè

ó æ³íîê ñòàðøå 45 ðîê³â ³ âèçíà÷åííÿ â êðîâ³ HER-2 ó

æ³íîê, õâîðèõ íà ðàê ìîëî÷íî¿ çàëîçè äëÿ âèçíà÷åííÿ

ïðàâèëüíî¿ ñòðàòåã³¿ ë³êóâàííÿ. Òàê³ çàõîäè çíà÷íî äîïî-

ìîãëè á çíèçèòè ñìåðòí³ñòü â³ä öèõ 2 ïóõëèí.

Êëþ÷îâ³ ñëîâà: îíêîëîã³ÿ, îíêîìàðêåðè, êàíöåðî-

ãåíåç, ñêðèí³íã, ïóõëèííå çðîñòàííÿ, ä³àãíîñòèêà ïóõëèí.

USAGE OF TUMOR MARKERS

IN THE DIAGNOSIS OF CANCER

K. Malyarchuk

Bogomolets National Medical University, Kyiv, Ukraine

Summary. At present time a considerable amount of

oncology markers for different tumor diagnostics have been

researched and applied, and also to define the stage of

disease, tumor molecular structure character and response

to radio and chemotherapy. As, oncology markers are

resulted to be diagnostically considerable at the early

stages of oncology diseases, it is reasonable to apply them

for a big amount of people as screening programmes.

Unfortunately, in Ukraine there are not free government

programmes to define oncology markers in blood.

Diagnosis of oncology markers is recommended for

screening blood testing for diagnosis PSA of men who are

older than 60 years, and also mammography of breasts of

women who are older than 45 and diagnosis in blood HER-

2 of women, who have breast cancer for diagnosis the right

treatment strategy. Such measures could considerably

decrease death rate from these two tumors.

Key words: oncology, tumor markers, cancerogenesis,

screening, tumor growth, diagnostic of tumors.

2. Ùåïîòèí È. Á. Îíêîëîãèÿ [Òåêñò] // È. Á. Ùåïîòèí,

Â. Ë. Ãàíóë, È. Î. Êëèìåíêî, Î. ß. ßðåì÷óê, Â. Ä. Ðîçóìåíêî,

Ã. Î. Âàêóëåíêî, Â. Å. ×åøóê.- Ê.: Êíèãà ïëþñ, 2006.- 495 ñ.

3. Ñåðãååâà Í. Ñ., Ìàðøóòèíà Í. Â. Îáùèå ïðåäñòàâëåíèÿ

î ñåðîëîãè÷åñêèõ áèîìàðêåðàõ è èõ ìåñòå â îíêîëîãèè // Ïðàê-

òè÷åñêàÿ îíêîëîãèÿ. – 2011.- Ò.12, ¹4. – Ñ.147-154.

4. Íàöèîíàëüíûé êàíöåð-ðååñòð Óêðàèíû 2009[Åëåêòðîí-

íèé ðåñóðñ]: ñàéò http://www.gs.com.ua/dovida9/index.htm. (äàòà

îáðàùåíèÿ: 20.12.13). – íàçâàíèå ñ ýêðàíà.

5. (CEA) in the follow-up of disease-free breast cancer patients

// Tumori.– 1982; 68: 477–480.Voge C., Cobleigh M., Tripathy D. et

al. Efficacy and safety of trastuzumab

6. As a single agent in first-line treatment of HER2 – overexpressing

metastatic breast cancer // J. Clin. Oncol.– 2002; 20: 719–726.

7. Wolff A., Hammond M., Schwartz J. et al. American Society of

Clinical Zigeuner R.E., Lipsky K., Riedlerl. Et al. Did the rate of incidental

prostate cancer change in the era of PSA testing? A retrospective study

of 1127 patients // J. Urol. 2003. – Vol. 62, ¹3. – P. 451-455.

¹ 1 (79) • 2014

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ÓÄÊ 617.55-089-06(048.8)

ÏÐÈÌÅÍÅÍÈÅ ÒÀÊÒÈÊÈ FASTTRACKSURGERY

ÊÀÊ ÏÐÎÔÈËÀÊÒÈÊÀ ÏÎÑËÅÎÏÅÐÀÖÈÎÍÍÛÕ

ÎÑËÎÆÍÅÍÈÉ ÏÐÈ ÎÏÅÐÀÖÈßÕ

ÍÀ ÁÐÞØÍÎÉ ÏÎËÎÑÒÈ

Ôèðñîâà À.Â.

Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò èìåíè À.À. Áîãîìîëüöà, ã. Êèåâ, Óêðàèíà

Êëþ÷åâûå ñëîâà: òåõíîëîãèÿ áûñòðîãî âîññòàíîâëåíèÿ, îïóõîëè áðþøíîé ïîëîñòè, ïîñëåîïåðàöèîííûé ïåðèîä.

Ââåäåíèå. Â ïîñëåäíåå âðåìÿ â ìåäèöèíå è õèðóðãèè

â ÷àñòíîñòè (â îíêîëîãèè â òîì ÷èñëå) íàáèðàåò ñèëó íà-

ïðàâëåíèå êîìïëåêñíîãî ëå÷åíèÿ, îïèðàþùååñÿ íà êîí-

öåïöèþ “áûñòðîãî (óñêîðåííîãî) âûçäîðîâëåíèÿ” –

fasttracksurgery (FTS) èëè enhancedrecoveryaftersurgery

(ERAS – óñêîðåíèå âûçäîðîâëåíèÿ ïîñëå õèðóðãèè), êî-

òîðîå âïåðâûå áûëî ïðåäëîæåíî â 90-å ãîäû ïðîøëîãî

âåêà äàòñêèì àíåñòåçèîëîãîì HenricKehlet [2].

Öåëü äàííîé ïðîãðàììû – ìàêñèìàëüíîå îãðàíè÷å-

íèå ôèçè÷åñêîé òðàâìû, îáóñëîâëåííîé õèðóðãè÷åñêèì

âìåøàòåëüñòâîì, áîðüáà ñ ïîñëåîïåðàöèîííîé áîëüþ è

îáåñïå÷åíèå âûçäîðîâëåíèÿ áåç îñëîæíåíèé â âîçìîæ-

íî êîðîòêèé ñðîê ãîñïèòàëèçàöèè [1].

Öåëü ðàáîòû. Èçó÷èòü îïûò ïðîãðàììû FTS â ðàçâè-

òûõ ñòðàíàõ.

Ìàòåðèàëû è ìåòîäû. Ïðîâåäåí áèáëèîãðàôè÷åñêèé

àíàëèç ïóáëèêàöèé, äåïîíèðîâàííûõ â ñåòè PUBMED,

MEDLINE, íàó÷íûõ ñòàòåé ñïåöèàëèçèðîâàííûõ ïåðèî-

äè÷åñêèõ èçäàíèé (êëþ÷åâûå ñëîâà: òåõíîëîãèÿ áûñòðîãî

âîññòàíîâëåíèÿ, îïóõîëè áðþøíîé ïîëîñòè, ïîñëåîïå-

ðàöèîííûé ïåðèîä).

Ðåçóëüòàòû è îáñóæäåíèå. Ïðîãðàììà FTS îõâàòûâà-

åò âîïðîñû ïðåäîïåðàöèîííîé ïîäãîòîâêè, îïåðàòèâíîé

òåõíèêè, âåäåíèå ïîñëåîïåðàöèîííîãî ïåðèîäà ó áîëü-

íûõ, ïîäëåæàùèõ îïåðàòèâíûì âìåøàòåëüñòâàì íà îðãà-

íàõ áðþøíîé ïîëîñòè [1].

Ïðîãðàììà FTS áàçèðóåòñÿ íà ïàòîôèçèîëîãè÷åñêèõ

ïðèíöèïàõ, îñíîâíûì èç êîòîðûõ ÿâëÿåòñÿ ïðèíöèï ðå-

äóêöèè ñòðåññîðíîãî îòâåòà îðãàíèçìà íà õèðóðãè÷åñ-

êóþ òðàâìó [1].

Ïî îïðåäåëåíèþ H. Kehlet [2], ïðîãðàììà FTS “…ïðå-

äóñìàòðèâàåò ïðèìåíåíèå ýïèäóðàëüíîé èëè ðåãèîíàð-

íîé àíåñòåçèè, ìèíèèíâàçèâíûõ îïåðàòèâíûõ âìåøà-

òåëüñòâ è òåõíèêè àãðåññèâíîé ïîñëåîïåðàöèîííîé

ðåàáèëèòàöèè, âêëþ÷àþùèõ ðàííåå ýíòåðàëüíîå ïèòàíèå

ðàííþþ àêòèâèçàöèþ. Â êîìáèíàöèè ýòè ìåðû ïîçâîëÿ-

þò ñíèçèòü ñòðåññîðíûå ðåàêöèè îðãàíèçìà è çíà÷èòåëü-

íî ñîêðàòèòü âðåìÿ, íåîáõîäèìîå äëÿ ïîëíîãî âîññòà-

íîâëåíèÿ (äëèòåëüíîå íàëè÷èå â îðãàíèçì èíîðîäíûõ

òåë, òàêèõ êàê äðåíàæè, êàòåòåðû è çîíäû)”.

Ìàêñèìàëüíî ïðèíöèïàì FTS ñîîòâåòñòâóåò ïðèìå-

íåíèå ëàïàðîñêîïè÷åñêèõ òåõíîëîãèé, íî òàêæå óñïåøíî

ïðèìåíÿåòñÿ ïðè îòêðûòûõ îïåðàöèÿõ íà îðãàíàõ áðþø-

íîé ïîëîñòè. Â ðàáîòåJ. Wind [3] , áûëè ñóììèðîâàíû è

èäåíòèôèöèðîâàíû ôàêòîðû, âõîäÿùèå â ñîñòàâ ìóëüòè-

ìîäàëüíîé ïðîãðàììû FTS â ðàíäîìèçèðîâàííûõ èññëå-

äîâàíèÿõ è ìåòààíàëèçå:

– Äîîïåðàöèîííîå èíôîðìèðîâàíèå ïàöèåíòà.

– Îòêàç îò ïðåìåäèêàöèè.

– Ïðèìåíåíèå ïðîáèîòèêîâ ïåðåä îïåðàöèåé.

– Îòêàç îò ïîëíîãî ãîëîäàíèÿ ïåðåä îïåðàòèâíûì

âìåøàòåëüñòâîì.

– Ðåãèîíàðíàÿ àíåñòåçèÿ, êîðîòêîäåéñòâóþùèå àíå-

ñòåòèêè.

– Êîðîòêèå ðàçðåçû (ìèíèèíâàçèâíûé äîñòóï, ïî-

ïåðå÷íûå ðàçðåçû).

– Ïðîôèëàêòèêà äîîïåðàöèîííîé ãèïîòåðìèè.

– Ïðèìåíåíèå âûñîêèõ êîíöåíòðàöèé êèñëîðîäà

ïåðèîïåðàöèîííî.

– Íåîïèîèäíàÿ àíàëãåçèÿ.

– Îòêàç îò ðóòèííîãî èñïîëüçîâàíèÿ äðåíàæåé è íà-

çîãàñòàëüíûõ çîíäîâ.

– Ðàííåå óäàëåíèå ìî÷åâîãî êàòåòåðà.

– Ïðîêèíåòèêè.

– Ðàííåå íà÷àëî ïîñëåîïåðàöèîííîãî ïåðîðàëüíîãî

ïèòàíèÿ.

– Ðàííÿÿ ìîáèëèçàöèÿ.

Áîëüøèíñòâî àâòîðîâ ðåêîìåíäóþò èñïîëüçîâàíèå

9-12 ôàêòîðîâ èç ïåðå÷èñëåííûõ [4].

Ïîäàâëÿþùåå áîëüøèíñòâî êîìïîíåíòîâ ïðîãðàììû

FTS èìåþò âûñîêóþ ñòåïåíü äîñòîâåðíîñòè ñ ïîçèöèé äî-

êàçàòåëüíîé ìåäèöèíû. Íàèáîëåå âûñîêóþ ñòåïåíü äîêà-

çàòåëüñòâ (1À) èìåþò ïîëîæåíèÿ îá îòêàçå îò ìåõàíè÷åñ-

êîé î÷èñòêè òîëñòîé êèøêè, ïðèìåíåíèå ìàëîèíâàçèâíûõ

îïåðàòèâíûõ äîñòóïîâ, îòêàç îò ðóòèííîé óñòàíîâêè

äðåíàæåé â áðþøíóþ ïîëîñòü, îòêàç îò èñïîëüçîâàíèÿ

èëè ðàííåå óäàëåíèå íàçîãàñòðàëüíîãî çîíäà [5].

Îäíèì èç ýëåìåíòîâ ïðîãðàììû FTS ÿâëÿåòñÿ àäåêâàò-

íàÿ àíàëãåçèÿ. Âñå õèðóðãè÷åñêèå îïåðàöèè ñîïðîâîæäà-

þòñÿ áîëüþ. Â ñâÿçè ñ ýòèì â êëèíè÷åñêîé ïðàêòèêå øèðîêî

ïðèìåíÿþò íàðêîòè÷åñêèå àíàëüãåòèêè, êàê ýôôåêòèâíûå

ñðåäñòâà äëÿ êîíòðîëÿ áîëè. Íî íàçíà÷åíèå ýòèõ ñðåäñòâ

ïðèâîäèò ê óâåëè÷åíèþ ïðîäîëæèòåëüíîñòè ïîñëåîïåðà-

öèîííîãî ïàðåçà êèøå÷íèêà è ìîæåò âûçâàòü ïîñëåîïåðà-

öèîííóþ äèíàìè÷åñêóþ êèøå÷íóþ íåïðîõîäèìîñòü [6].

Äëÿ ñíÿòèÿ áîëåâîãî ñèíäðîìà â ïîñëåîïåðàöèîííûé ïå-

ðèîä èñïîëüçóþò äâå òàêòèêè: ïåðâàÿ (áîëåå ýôôåêòèâíàÿ) –

ïðèìåíåíèå äëèòåëüíîé ýïèäóðàëüíîé àíåñòåçèè âìåñòå ñ

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

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íàçíà÷åíèåì íåñòåðîèäíûõ ïðîòèâîâîñïàëèòåëüíûõ ïðå-

ïàðàòîâ [9], âòîðàÿ – ââåäåíèå â êëèíè÷åñêóþ ïðàêòèêó

ïðèìåíåíèÿ àíòàãîíèñòîâ îïèîèäíûõ ðåöåïòîðîâ (ìåòèë-

íàëòðåêñîí)[8]. Êðîìå âëèÿíèÿ íà áîëåâîé ñèíäðîì ïðè-

ìåíåíèå ðåãèîíàðíîé ýïèäóðàëüíîé è ñïèíàëüíîé àíåñ-

òåçèè ñîïðâîæäàåòñÿ óëó÷øåíèåì ôóíêöèé ëåãêèõ,

ñíèæåíèåì íàãðóçêè íà ñåðäå÷íî-ñîñóäèñòóþ ñèñòåìó,

ìåíüøèì ïàðåçîì êèøå÷íèêà [10].

Ðàçâèòèå èíòðàîïåðàöèîííîé ãèïîòåðìèè âëå÷åò çà

ñîáîé óõóäøåíèå ãåìîñòàçà ñ óâåëè÷åíèåì âíóòðè- è

ïîñëåîïåðàöèîííîé êðîâîïîòåðè, óñèëåíèå ïîñëåîïå-

ðàöèîííîé äðîæè ñ ïîâûøåííûì ïîòðåáëåíèåì êèñëî-

ðîäà è ïîâûøåíèåì ðèñêà èøåìèè ìèîêàðäà. Àêòèâíîå

ñîãðåâàíèå ïàöèåíòà, óêðûâàíèå íåîïåðèðóåìûõ ÷àñòåé

òåëà è íàçíà÷åíèå ïîäîãðåòûõ èíôóçèîííûõ ñðåä ïîìî-

ãàþò ïîääåðæèâàòü íîðìîòåðìèþ [11].

Òðàäèöèîííî áîëüíûì ïîñëå îïåðàöèé íà îðãàíàõ

áðþøíîé ïîëîñòè ðåêîìåíäóþò äëèòåëüíûé ïîñòåëüíûé

ðåæèì ñ îãðàíè÷åíèåì äâèãàòåëüíîé àêòèâíîñòè [1]. Îäíà-

êî äîêàçàíî, ÷òî äëèòåëüíàÿ èììîáèëèçàöèÿ óñóãóáëÿåò ïî-

òåðþ ìûøå÷íîé ìàññû è ñëàáîñòü, óõóäøàåò ëåãî÷íûå

ôóíêöèè, ïðåäðàñïîëàãàåò ê âåíîçíîìó çàñòîþ è òðîìáî-

ýìáîëèè, à òàêæå ñïîñîáñòâóåò ïîñëåîïåðàöèîííîìó îáðà-

çîâàíèþ ñïàåê [10]. Ïîýòîìó ðàííÿÿ àêòèâèçàöèÿ áîëüíîãî

íàïðàâëåíà íà òî, ÷òîáû èçáåæàòü äàííûõ îñëîæíåíèé.

Ïî äàííûì P. Lindgren è ñîàâò., ïðåèìóùåñòâî ïîïå-

ðå÷íîé ëàïàðîòîìèè íàä ñðåäèííîé çàêëþ÷àåòñÿ â òîì,

÷òî ïðè ïîñëåäíåé áîëåâîé èìïóëüñ ðàñïðîñòðàíÿåòñÿ

ïî áîëüøåìó êîëè÷åñòâó ÷óâñòâèòåëüíûõ íåðâîâ, ÷åì

ïðè ïîïåðå÷íîì äîñòóïå, ïîñêîëüêó äàííûé ðàçðåç ïðî-

õîäèò â ðàìêàõ îäíîãî äåðìàòîìà [12].

Ïî äàííûì H. Kehlet è ñîàâò. [2], ðóòèííîå íàçíà÷åíèå

êèñëîðîäíîé ìàñêè ðåêîìåíäîâàíî âñåì ïîñëåîïåðàöè-

îííûì áîëüíûì ñ ïîâûøåííîé ñòåïåíüþ àíåñ-òåçèîëî-

ãè÷åñêîãî ðèñêà (ASAIII-IV), à òàêæå ïàöèåíòàì ñ SpO2<

93%. Ýòî ñâÿçàíî ñâÿçàíî ñ òåì, ÷òî ãèïîêñèÿ ÿâëÿåòñÿ

ôàêòîðîì ðèñêà èíôåêöèîííûõ îñëîæíåíèé, â ïåðâóþ

î÷åðåäü ñî ñòîðîíû ïîñëåîïåðàöèîííîé ðàíû, ïîñêîëü-

êó íåäîñòàòî÷íîå ñíàáæåíèå êèñëîðîäîì çíà÷èòåëüíî

óõóäøàåò ðåãåíåðàöèþ è óìåíüøàåò óñòîé÷èâîñòü ïðî-

òèâ ãíîåðîäíûõ ìèêðîîðãàíèçìîâ [13].

Â ïîñëåäíèå ãîäû ïîÿâèëèñü ñîîáùåíèÿ îá îòñóò-

ñòâèè íåîáõîäèìîñòè ðóòèííîéíàçîãàñòðàëüíîé äåêîìï-

ðåññèè â ïëàíîâîé õèðóðãèè. C. Hafner è ñîàâò. ñîîáùàþò

î òàêèõ îñëîæíåíèÿõ íàçîãàñòðàëüíîé èíòóáàöèè, êàê ãè-

ïåðòåðìèÿ, ïíåâìîíèè, ïîâðåæäåíèÿ ïîëîñòè íîñà è íî-

ñîãëîòêè [14], à åå ïðèìåíåíèå îïðàâäàíî è èìååò îáúåê-

òèâíûå ïîêàçàíèÿ òîëüêî â 5% ñëó÷àåâ [7].

Âûâîäû. Ìíîãîîáåùàþùèåíà÷àëüíûåðåçóëüòàòû,

ïîëó÷åííûå ïðè èñïîëüçîâàíèèïðîãðàììûFTS, ïîäíè-

ìàþò âîïðîñ î íåîáõîäèìîñòè èçìåíåíèÿ òðàäèöèîííîé

õèðóðãè÷åñêîé ïîìîùè äëÿ óëó÷øåíèÿ ïîñëåîïåðàöèîí-

íûõ ðåçóëüòàòîâ è ïîñëåäóþùåãî èçó÷åíèÿ êàæäîãî èç

êîìïîíåíòîâ ïðîãðàììû.

Ðåöåíçåíò: ä.ìåä.í., ïðîôåñîð Äðîíîâ Î.².

ËÈÒÅÐÀÒÓÐÀ

1. Ùåïîòèí È.Á. Ïåðñïåêòèâû èñïîëüçîâàíèÿ ìóëüòè-

ìîäàëüíîé ïðîãðàììû FTS â õèðóðãè÷åñêîì ëå÷åíèè îïóõîëåé

îðãàíîâ áðþøíîé ïîëîñòè / Ùåïîòèí È.Á., Êîëåñíèê Å.À., Ëóêà-

øåíêî À.Â., Ðàçóìåé Ä.À., Ìàõìóäîâ Ä.Ý., Íàóì÷óê Ã.Â. // Êëèíè-

÷åñêàÿ îíîëîãèÿ. – 2012. – ¹5 (1). – ñòð. 22-32.

2. Kehlet H. Multimodal approach to control postoperative pa-

thophysiology and rehabilitation. // Br. J. Anaesth. – 1997. – Vol.78. –

P. 606–617.

3. Wind J., Pollc S.V., Fung Kon Jin H.P. et al. Systematic review

of enhanced recovery programmes in colonic surgery // Brit. J. Surg. –

2006. — Vol. 93. – P. 800-809.

4. Zonea P., Stigler J., Maly T. et al. Do we really apply fast

track surgery? // Bratisl. LekListy. – 2008. – Vol. 109, N 2. –

P. 61-65.

5. Êîòåíêî Ê.À. ÌóëüòèìîäàëüíàÿïðîãðàììàFTS – ñìåíà

ïàðàäèãìû â õèðóðãè÷åñêîì ëå÷åíèè ðàêà // Çäîðîâ’ÿÓêðà¿íè. –

2012. – ¹ 4 (23). – ñò. 10-12.

6. Delaney C.P. Clinical perspective on postoperative ileus and

the effect of opiates // Neurogastroenterol. Motil. – 2009. – Vol.16. –

P. 61–66.

7. Cheatham M.L., Chapman W.C., Key S.P. et al. A meta-ana-

lysis of selective versus routine nasogastric decompression after elective

laparotomy // Ann. Surg.- 1995. – Vol. 221. – P. 469–476.

8. P. Sipos, PálOndrejka “Fast-Track” Colo-Rectal Surgery //

HMJ. – 2007, – Vol. 2. – P. 165–174.

9. Meakins, J.L. Innovations in surgery: the rules of evidence /

/ Am. J. Surg.2002. – Vol.183. – P. 399–405.

10 . Ìàçèòîâà Ì.È., Ìóñòàôèí Ý.Ð. Fasttrack õèðóðãèÿ – ìóëü-

òèìîäàëüíàÿ ñòðàòåãèÿ âåäåíèÿ õèðóðãè÷åñêèõ áîëüíûõ // Êà-

çàíñêèé ìåäèöèíñêèé æóðíàë. – 2012. – ¹ 5.

11. Sessler D.I. Mild perioperative hypothermia //

N. Engl. J. Med. – 1997. – Vol. 336. – P. 1730–1737.

12. Lindgren P.G., Nordgren S.R., Oresland T. et al. Midline or

transverse abdominal incision for right-sided colon cancer – a

randomized trial // Colorectal Dis.2001. – ¹ 3. P. 46–50.

13 . Rosenberg J. Late postoperative hypoxemia. Mechanisms and

clinical implications // Danish medical bulletin. – 2005. – Vol. 42. – P.

40–46.

14 . Hafner C.D., Wylie J.H., Brush B.E. Complications of gastro-

intestinal intubation// Arch. Surg. – 1961. – Vol. 83. – P.163–176.

ÇÀÑÒÎÑÓÂÀÍÍß ÒÀÊÒÈÊÈ FASTTRACKSURGERY

ßÊ ÏÐÎÔ²ËÀÊÒÈÊÀ Ï²ÑËßÎÏÅÐÀÖ²ÉÍÈÕ

ÓÑÊËÀÄÍÅÍÜ ÏÐÈ ÎÏÅÐÀÖ²ßÕ ÍÀ ×ÅÐÅÂÍ²É

ÏÎÐÎÆÍÈÍ² (ÎÃËßÄ Ë²ÒÅÐÀÒÓÐÈ)

Ô³ðñîâà À.Â.

Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò

³ìåíè Î.Î. Áîãîìîëüöÿ, ì. Êè¿â, Óêðà¿íà

Ðåçþìå. Óñï³øí³ ïî÷àòêîâ³ ðåçóëüòàòè, îòðèìàí³ ïðè

âèêîðèñòàíí³ ïðîãðàìè FTS, ï³ä³éìàþòü ïèòàííÿ ïðî

íåîáõ³äí³ñòü çì³íè òðàäèö³éíî¿ õ³ðóðã³÷íî¿ äîïîìîãè äëÿ

ïîêðàùåííÿ ï³ñëÿîïåðàö³éíèõ ðåçóëüòàò³â ³ ïîäàëüøî-

ãî âèâ÷åííÿ êîæíîãî ³ç êîìïîíåíò³â ïðîãðàìè.

Êëþ÷îâ³ ñëîâà:òåõíîëîã³ÿ øâèäêîãî â³äíîâëåííÿ, ïóõ-

ëèíè ÷åðåâíî¿ ïîðîæíèíè, ï³ñëÿîïåðàö³éíèé ïåð³îä.

THE USAGE OF FAST TRACK SURGERY TACTIC

AS A PROPHYLAXIS OF POST-OPERATIVE

COMPLICATIONS AFTER ABDOMINAL

CAVITY SURGERIES (REVIEW)

A. Firsova

Bogomolets National Medical University, Kyiv, Ukraine

Summary. Promising initial results, received by FTS

program usage, give rise to the question of the necessity of

changing traditional surgical help for improving post-

operative results and further learning each program

component.

Key words: technology of fast recovery, abdominal

tumors, postoperative period.

¹ 1 (79) • 2014

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

169

ÂÈÙÀ ÌÅÄÈ×ÍÀ ÎÑÂ²ÒÀ / HIGHER MEDICAL EDUCATION

Âñòóï. Ìîçêîâèé øòóðì – òåõí³êà ïðîâåäåííÿ çàíÿòòÿ,

ïðè ÿê³é ãðóïà ïðàãíå çíàéòè âèð³øåííÿ êîíêðåòíî¿ ïðî-

áëåìè çà äîïîìîãîþ àêóìóëþâàííÿ âñ³õ ³äåé, ñïîíòàííî

ïðîïîíîâàíèõ ñòóäåíòàìè [5].

“Ìîçêîâèé øòóðì” (àíãë. brainstorming) – îäèí ç

íàéá³ëüø ïîïóëÿðíèõ ³ ÷àñòî âèêîðèñòîâóâàíèõ ìåòîä³â

ñòèìóëþâàííÿ òâîð÷î¿ àêòèâíîñò³, ÿêèé äîçâîëÿº øâèäêî

çíàéòè ð³øåííÿ ñêëàäíèõ ïðîáëåì øëÿõîì çàñòîñóâàííÿ

ñïåö³àëüíèõ ïðàâèë îáãîâîðåííÿ. ª ìåòîäîì åêñïåðòíî-

ãî îö³íþâàííÿ [2].

Ìåòîä “ìîçêîâîãî øòóðìó” ÿâëÿº ñîáîþ äâîåòàïíó

ïðîöåäóðó âèð³øåííÿ çàâäàííÿ: íà ïåðøîìó åòàï³ ãåíå-

ðóþòüñÿ ³äå¿, à íà äðóãîìó – àíàë³çóþòüñÿ, ðîçâèâàþòüñÿ.

Â îñíîâ³ ³äå¿ öüîãî ìåòîäó ëåæèòü ïðîòèñòàâëåííÿ òâîð-

÷îãî ³ êðèòè÷íîãî ìèñëåííÿ. Ïðè îðãàí³çàö³¿ “ìîçêîâîãî

øòóðìó” âèõîäÿòü ç ïðîïîçèö³¿, ùî ïðè çâè÷àéíèõ ïðèéî-

ìàõ îáãîâîðåííÿ òà âèð³øåííÿ ïðîáëåì âèíèêíåííÿ íîâà-

òîðñüêèõ ³äåé ïåðåøêîäæàþòü êîíòðîëüí³ ìåõàí³çìè ñâ³äî-

ìîñò³, ÿê³ ñêîâóþòü ïîò³ê öèõ ³äåé ïðèäóøåííÿì çâè÷íèõ,

ñòåðåîòèïíèõ ôîðì ïðèéíÿòòÿ ð³øåíü. Ãàëüì³âíèé âïëèâ

÷èíÿòü òàê ñàìî ñòðàõ íåâäà÷³, ñòðàõ âèãëÿäàòè ñì³øíèì ³ ò.ï.

Äàíà òåõíîëîã³ÿ â òàêîìó âèïàäêó ïðåäñòàâëÿºòüñÿ ÿê çàñ³á

ñòèìóëþâàííÿ ³íòåëåêòóàëüíèõ òâîð÷èõ çä³áíîñòåé, ïðè ÿêî-

ìó ó÷àñíèêàì ïðîïîíóºòüñÿ âèñëîâëþâàòè ÿêîìîãà á³ëüøå

âàð³àíò³â ð³øåííÿ, â ò.÷. íàéôàíòàñòè÷í³øèõ [8,9].

Ìåòà äîñë³äæåííÿ – ðîçâèòîê òâîð÷èõ íàâè÷îê òà

³íòó¿òèâíîãî êë³í³÷íîãî ìèñëåííÿ ó íàóêîâî-äîñë³äí³é ðî-

áîò³ ñòóäåíò³â, âì³ííÿ ïðàöþâàòè â êîëåêòèâ³, íàâ÷àííÿ ¿õ

øâèäêîìó, ³ ìîæëèâî íåïðîãíîçîâàíîìó ð³øåííþ çàäà-

íî¿ çàäà÷³, ³íòåãðóâàííÿ çíàíü â ìåäèöèí³, ï³äâèùåííÿ

ð³âíÿ êâàë³ô³êàö³¿.

Â óìîâàõ ñó÷àñíîãî íàâ÷àííÿ, öå îäèí ³ç íàéåôåêòèâ-

í³øèõ ìåòîä³â óñíîãî îïèòóâàííÿ ñòóäåíò³â, äîçâîëÿº

“í³âåëþâàòè” åôåêò âãàäóâàííÿ ï³ä ÷àñ ïðîâåäåííÿ ÷àñòè-

íè çàíÿòòÿ ³ç òåñòóâàííÿì. Îñîáëèâî åôåêòèâíèé öåé

ìåòîä äëÿ ñòóäåíò³â ìåäèê³â ïðè ïîñòàíîâö³ ä³àãíîçó íåÿñ-

íèì õâîðèì. Ãîëîâíà ôóíêö³ÿ ö³º¿ òåõíîëîã³¿ – çàáåçïå-

÷åííÿ ïðîöåñó ãåíåðóâàííÿ ³äåé, áåç ¿õ êðèòè÷íîãî àíà-

ë³çó òà îáãîâîðåííÿ ó÷àñíèêàìè [3,4].

Ìîçêîâèé øòóðì º, ïî ñóò³, íàéá³ëüø â³ëüíîþ ôîðìîþ

äèñêóñ³¿. Åâðèñòè÷íèé ä³àëîã “ìîçêîâîãî øòóðìó” áàçóºòü-

ñÿ íà ðÿä³ ïñèõîëîã³÷íèõ è ïåäàãîã³÷íèõ çàêîíîì³ðíîñòåé.

Ìåòîä “ìîçêîâîãî øòóðìó” ç’ÿâèâñÿ ó Ñïîëó÷åíèõ

Øòàòàõ Àìåðèêè â ê³íö³ 30-õ ðîê³â, êîëè ñï³ââëàñíèê âåëèêî¿

ðåêëàìíî¿ ô³ðìè Àëåêñ Ô. Îñáîðí ïî÷àâ ïðàêòèêóâàòè ñå-

ðåä ñâî¿õ ñï³âðîá³òíèê³â íîâèé ï³äõ³ä äî ïîøóêó ³äåé. Ìåòîä

îñòàòî÷íî îôîðìèâñÿ ³ ñòàâ â³äîìèé øèðîêîìó êîëó ñïå-

ÓÄÊ 61:378(477.84)

ÌÎÇÊÎÂÈÉ ØÒÓÐÌ ßÊ ÌÅÒÎÄ ÐÅÀË²ÇÀÖ²¯

²ÍÒÅÐÅÀÊÒÈÂÍÎÃÎ ÍÀÂ×ÀÍÍß

Òåëåìóõà Ñ.Á.

²âàíî-Ôðàíê³âñüêèé íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò, ì. ²âàíî-Ôðàíê³âñüê, Óêðà¿íà

Êëþ÷îâ³ ñëîâà: ìîçêîâèé øòóðì, òâîð÷å ìèñëåííÿ, ãåíåðóâàííÿ ³äåé, íàóêîâî-äîñë³äíà ðîáîòà.

ö³àë³ñò³â ç âèõîäîì â 1963 ðîö³ êíèãè À. Îñáîðíà “Êåðîâàíå

óÿâëåííÿ: ïðèíöèïè ³ ïðîöåäóðè òâîð÷îãî ìèñëåííÿ” [1].

Îñáîðí ñòâåðäæóâàâ, ùî ³ñíóþòü äâà ïðèíöèïè ñâ³äî-

ìîãî óïðàâë³ííÿ ê³ëüê³ñòþ ãåíåðîâàíèõ ³äåé, à ñàìå: ïðèí-

öèï â³äñòðî÷åíî¿ êðèòè÷íî¿ îö³íêè ³ ïðèíöèï, çà ÿêèì

çá³ëüøåííÿ ê³ëüêîñò³ ³äåé òÿãíå çà ñîáîþ çðîñòàííÿ ¿õ ÿêîñò³.

Ãîëîâíà ³äåÿ “ìîçêîâîãî øòóðìó” ïîëÿãàº â òîìó, ùî

í³õòî íå ïîâèíåí âèñëîâëþâàòè îö³íêó ÷è êðèòèêó íà àä-

ðåñó áóäü-ÿêî¿ ³äå¿, ùî âèíèêëà â õîä³ îáãîâîðåííÿ. Ìåòîä

“ìîçêîâîãî øòóðìó” ïðèïóñêàº, ùî êîæíà ëþäèíà â

ÿê³éñü ì³ð³ âîëîä³º òâîð÷èìè çä³áíîñòÿìè, àëå ïåâí³

âíóòð³øí³ òà ñîö³àëüí³ ôàêòîðè íå äîçâîëÿþòü éîìó

ïîâíîþ ì³ðîþ âèêîðèñòîâóâàòè ñâ³é òâîð÷èé ïîòåíö³àë.

Â õîä³ “ìîçêîâîãî øòóðìó” âñ³ îáìåæåííÿ ïðèáèðàþòüñÿ,

³ ïîòåíö³àë ìîæå áóòè âèêîðèñòàíèé â ïîâí³é ì³ð³.

Ðîçðîáëåíèé Îñáîðíîì ìåòîä ïðîâåäåííÿ “ìîçêîâîãî

øòóðìó” âîëîä³º íàñòóïíèìè ïåðåâàãàìè:

– ìàòåð³àë “ìîçêîâîãî øòóðìó” ÿâëÿº ñîáîþ ðåçóëü-

òàò ñï³ëüíèõ çóñèëü äåê³ëüêîõ ïðàêòèê³â. Â³í ï³äñó-

ìîâóº äîñâ³ä, íàâè÷êè, ³íôîðìàö³þ, ÿêèìè âîëî-

ä³þòü ó÷àñíèêè ãðóïîâî¿ ðîáîòè.

– ç’ÿâëÿºòüñÿ ³ìîâ³ðí³ñòü ãåíåðàö³¿ á³ëüøî¿ ê³ëüêîñò³

ð³çíîìàí³òíèõ ³äåé.

– îñê³ëüêè â ïðîöåñ³ îïèòóâàííÿ ñòóäåíò³â áåðå ó÷àñòü

äåê³ëüêà ÷îëîâ³ê, òî çá³ëüøóºòüñÿ øàíñ âèÿâëåííÿ

ïîìèëêè.

– ñàì ôàêò ó÷àñò³ îêðåìèõ ÷ëåí³â êîìàíäè â “ìîçêî-

âîìó øòóðì³” çá³ëüøóº ñòóï³íü ¿õ â³äïîâ³äàëüíîñò³

çà ïðèéíÿò³ çãîäîì ð³øåííÿ.

– çàñòîñóâàííÿ “ìîçêîâî¿ øòóðìó” äîçâîëÿº óíèê-

íóòè “ñèíäðîìó òåïëóâàòîþ âîäè” (ðàí³øå íàçâà-

íîãî “ìèñëåííÿì â òüìÿíèõ òîíàõ”).

Àëåêñ Îñáîðí ñôîðìóëþâàâ íàñòóïí³ ïðàâèëà ïðîâå-

äåííÿ “ìîçêîâîãî øòóðìó”:

I. Çàõ³ä ìàº ïðîâîäèòèñÿ â íåôîðìàëüí³é îáñòàíîâö³.

II. Ñë³ä ñïîíóêàòè ó÷àñíèê³â äî â³ëüíîãî ³íòåëåêòó-

àëüíîãî ñàìîâèðàæåííÿ.

III. Í³õòî íå ïîâèíåí êðèòèêóâàòè ³äå¿ ³íøèõ.

IV. ×èì íåçâè÷í³øà àáî áåçãëóçä³øà ïðîïîíîâàíà

³äåÿ, òèì êðàùå.

V. ×èì á³ëüøå íàäõîäèòü ïðîïîçèö³é, òèì êðàùå.

VI. ²äå¿ ìîæíà êîìïîíóâàòè ïî-ð³çíîìó.

VII. Ãðóïó ö³êàâëÿòü äóìêè âñ³õ ó÷àñíèê³â “ìîçêîâîãî

øòóðìó”.

VIII. Âñ³ ó÷àñíèêè ìàþòü ð³âíèé ñòàòóñ.

²ñòîòíèì º ïîëîæåííÿ ïðî òå, ùî ìîçêîâèé øòóðì º

ìåòîäîì ïîøóêó àëüòåðíàòèâíèõ íàïðÿì³â ðîçâ’ÿçàííÿ

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 1 (79) • 2014

170

ÂÈÙÀ ÌÅÄÈ×ÍÀ ÎÑÂ²ÒÀ / HIGHER MEDICAL EDUCATION

ïðîáëåìè. Ïîä³áíèé ïîøóê ïðîâîäèòüñÿ íà ïî÷àòêîâîìó

åòàï³ âèð³øåííÿ, â ìîìåíò, êîëè íåìàº äàíèõ ïðî ìîæëèâ³

øëÿõè ³ çàñîáè âèð³øåííÿ [6].

Áóëè ïðîâåäåí³ ÷èñëåíí³ åêñïåðèìåíòàëüí³ äîñë³ä-

æåííÿ, ç ìåòîþ ïîð³âíÿííÿ ê³ëüêîñò³ ³ ÿêîñò³ ³äåé, ñòâîðå-

íèõ ãðóïàìè â ïðîöåñ³ ìîçêîâîãî øòóðìó ³ ëþäüìè, ùî

ïðàöþþòü ³íäèâ³äóàëüíî. Ðåçóëüòàòè ¿õ ñâ³ä÷àòü ïðî òå,

ùî çà óìîâè ïðàâèëüíîãî çàñòîñóâàííÿ äàíî¿ òåõí³êè

³íòåðàêòèâí³ ãðóïè íåð³äêî ãåíåðóþòü á³ëüøó ê³ëüê³ñòü

çíà÷óùèõ ³äåé, í³æ îêðåì³ ³íäèâ³äè [7].

Â³äîìî çíà÷íà ê³ëüê³ñòü åôåêòèâíèõ ìîäèô³êàö³é ìåòîäó

“ìîçêîâîãî øòóðìó”. Â îñòàíí³ ðîêè øèðîêå ïîøèðåííÿ

îäåðæàâ “åëåêòðîííèé ìîçêîâèé øòóðì” (online brain-

storming), ùî âèêîðèñòîâóº ³íòåðíåò-òåõíîëîã³¿. Â³í äîçâî-

ëÿº ìàéæå ïîâí³ñòþ óñóíóòè “ñòðàõ îö³íêè”, òîìó ùî çà-

áåçïå÷óº àíîí³ìí³ñòü ó÷àñíèê³â, à òàêîæ äàº ìîæëèâ³ñòü

âèð³øèòè ðÿä ïðîáëåì òðàäèö³éíîãî ìîçêîâîãî øòóðìó.

Ìîçêîâèé øòóðì äàº ìîæëèâ³ñòü îá’ºäíàòè â ïðîöåñ³

ïîøóêó ð³øåíü äóæå ð³çíèõ ëþäåé, à ÿêùî ãðóï³ âäàºòüñÿ

çíàéòè ð³øåííÿ, òî ¿¿ ó÷àñíèêè çàçâè÷àé ñòàþòü ñò³éêèìè

ïðèõèëüíèêàìè éîãî ðåàë³çàö³¿.

Ê³ëüê³ñòü ó÷àñíèê³â: âñòàíîâëåíî, ùî îïòèìàëüíèé ñêëàä

ãðóïè â³ä 6 äî 12 îñ³á. Îïòèìàëüíå ÷èñëî – 7. Îòî÷åííÿ,

ì³ñöå ïðîâåäåííÿ: çàãàëüíîïðèéíÿòèì º òå, ùî äëÿ ïðîâå-

äåííÿ ìîçêîâîãî øòóðìó äîö³ëüíî âèêîðèñòîâóâàòè àóäèòî-

ð³þ àáî îêðåìó ê³ìíàòó, äàëåêî â³ä ñòîðîííüîãî øóìó. Íà

ñò³í³ ðåêîìåíäóºòüñÿ ïîâ³ñèòè ïëàêàò ç îñíîâíèìè ïðàâèëà-

ìè ïðîâåäåííÿ ìîçêîâîãî øòóðìó. Áàæàíî ìàòè äîøêó, ÿêó

ó÷àñíèêè ìîæóòü âèêîðèñòîâóâàòè äëÿ â³äîáðàæåííÿ ñâî¿õ

³äåé. Ñòîëè òà ñò³ëüö³ ðåêîìåíäóºìî ðîçòàøóâàòè ó âèãëÿä³

áóêâè Ï, Î, êîëà àáî íàï³âåë³ïñà. Öå ïîëåãøóº êîíòàêò ó÷àñ-

íèê³â ³ ï³äâèùóº êîìóí³êàáåëüí³ñòü. ßêùî ãðóïà íåâåëèêà

(5–6 îñ³á) – íàéá³ëüø çðó÷íèé êðóãëèé ñò³ë [7,8].

Òðèâàë³ñòü ³ ÷àñ: á³ëüø³ñòþ äîñë³äæåíü ïîêàçàíî. ùî

ÿê ïðàâèëî, òðèâàë³ñòü ïðîâåäåííÿ ìîçêîâîãî øòóðìó

êîëèâàºòüñÿ â ìåæàõ 40–60 õâèëèí, – öå íàéá³ëüø åôåê-

òèâíèé ïðîì³æîê ÷àñó.

Çàãàëüíîïðèéíÿòà ïðîöåäóðà ïðîâåäåííÿ çàíÿòü çà

ìåòîäîì “ìîçêîâîãî øòóðìó” ñêëàäàºòüñÿ ç íàñòóïíèõ

åòàï³â:

1. Ôîðìóëþâàííÿ ïðîáëåìè, ÿêó íåîáõ³äíî âèð³øèòè,

îáãðóíòóâàííÿ çàäà÷³ äëÿ ïîøóêó ð³øåííÿ. Âèçíà÷åííÿ

óìîâ ãðóïîâî¿ ðîáîòè, çíàéîìñòâî ç ïðàâèëàìè ïîâåä³íêè â

ïðîöåñ³ “ìîçêîâîãî øòóðìó”. Ôîðìóâàííÿ ðîáî÷èõ ãðóï

ïî 5–7 ÷îëîâ³ê ³ îêðåìî åêñïåðòíî¿ ãðóïè “êðèòèê³â”, â îáî-

â’ÿçêè ÿêî¿ íà íàñòóïíîìó åòàï³ áóäóòü âõîäèòè ðîçðîáêà

êðèòåð³¿â, îö³íêà ³ â³äá³ð êðàùèõ ³ç âèñóíóòèõ ³äåé. Ïðè íåâå-

ëèêèõ ðîçì³ðàõ ãðóï, ìîæëèâà â³äñóòí³ñòü òàêîãî ðîçä³ëó.

2. Ðîçìèíî÷íà ñåñ³ÿ, òîáòî âïðàâè íà øâèäêèé ïîøóê

â³äïîâ³äåé íà ïèòàííÿ. Çàâäàííÿ öüîãî åòàïó – äîïîìîãòè

ó÷àñíèêàì ìàêñèìàëüíî çâ³ëüíèòèñÿ â³ä âïëèâó ïñèõîëî-

ã³÷íèõ áàð’ºð³â (í³ÿêîâîñò³, ñîðîì’ÿçëèâîñò³, çàìêíóòîñò³,

ñêóòîñò³ é ò.ï.).

3. Ðîáî÷à ñåñ³ÿ, òîáòî ñàì “øòóðì” ïîñòàâëåíî¿ ïðîá-

ëåìè. Ùå ðàç óòî÷íþþòüñÿ çàâäàííÿ, íàãàäóþòüñÿ ïðàâè-

ëà ïîâåä³íêè â õîä³ ðîáîòè. Ãåíåðóâàííÿ ³äåé ïî÷èíàºòüñÿ

çà ñèãíàëîì êåð³âíèêà (âèêëàäà÷à) â óñ³õ ðîáî÷èõ ãðóïàõ.

Äî êîæíî¿ ãðóïè ïðèêð³ïëþºòüñÿ îäèí åêñïåðò, ó çàâäàí-

íÿ ÿêîãî âõîäèòü ô³êñóâàííÿ íà äîøö³ àáî âåëèêîìó

àðêóø³ ïàïåðó âñ³ âèñóíóò³ ³äå¿.

4. Åêñïåðòèçà – îö³íêà ç³áðàíèõ ³äåé ³ â³äá³ð êðàùèõ ³ç

íèõ íà îñíîâ³ ïîïåðåäíüî ðîçðîáëåíèõ êðèòåð³¿â.

5. Ï³äâåäåííÿ ï³äñóìê³â – çàãàëüíå îáãîâîðåííÿ ðå-

çóëüòàò³â ðîáîòè ãðóï, ïðåäñòàâëåííÿ êðàùèõ ³äåé, ¿õ îá-

´ðóíòóâàííÿ òà ïóáë³÷íèé çàõèñò. Ïðèéíÿòòÿ çàãàëüíîãî

ãðóïîâîãî ð³øåííÿ, éîãî ô³êñàö³ÿ.

Ïðèíöèïîâèì º òå, ùî áóäü-ÿêèé ó÷àñíèê íà êîæíîìó

åòàï³ “ìîçêîâîãî øòóðìó” ìàº ìîæëèâ³ñòü äëÿ âèñëîâëþ-

âàííÿ â ñòðîãî ë³ì³òîâàíèé ÷àñ, çâè÷àéíî â ìåæàõ â³ä

îäí³º¿ äî òðüîõ õâèëèí.

Ðîëü êåð³âíèêà (ë³äåðà): Îñíîâí³ ôóíêö³¿ êåð³âíèêà

ïîëÿãàþòü â ³íôîðìóâàíí³ âñ³õ ó÷àñíèê³â ïðî ïðàâèëà

“ìîçêîâîãî øòóðìó”, ó êîíòðîë³ çà ¿õ äîòðèìàííÿì, à òà-

êîæ â çàãàëüíîìó êîíòðîë³ çà äèñêóñ³ºþ, ùîá âîíà çàëè-

øàëàñÿ â ðàìêàõ àáî ìåæàõ îáãîâîðþâàíî¿ òåìè àáî

ïðîáëåìè. Âåäó÷èé “ìîçêîâîãî øòóðìó” íå ìàº ïðàâà

êîìåíòóâàòè àáî îö³íþâàòè âèñëîâëþâàííÿ ó÷àñíèê³â,

àëå ìîæå ïåðåðâàòè ó÷àñíèêà, ÿêùî â³í âèñëîâëþºòüñÿ

íå ïî òåì³ àáî âè÷åðïàâ ë³ì³ò ÷àñó, à òàêîæ ç ìåòîþ óòî÷-

íåííÿ ñóò³ âèñëîâëåíèõ ïðîïîçèö³é.

Âàæëèâî, ùîá êåð³âíèê ñàì áðàâ ó÷àñòü â ãåíåðóâàíí³

³äåé. Â³í îäíî÷àñíî ïîâèíåí âèêîíóâàòè ðîëü ñòèìóëÿòîðà

àáî êàòàë³çàòîðà ó ðàç³ óïîâ³ëüíåííÿ òåìïó ãåíåðóâàííÿ

³äåé. Ãàðíèé êåð³âíèê, ÿê ïðàâèëî, ïîâèíåí çàçäàëåã³äü

ìàòè ñïèñîê ìîæëèâèõ ð³øåíü ïðîáëåìè. Ðîëü êåð³âíèêà

(âèêëàäà÷à) ïîëÿãàº òàêîæ ó ï³äáîð³ ó÷àñíèê³â “ìîçêîâîãî

øòóðìó” ÿê ì³í³ìóì çà 2 äí³ äî ¿¿ ïðîâåäåííÿ. Åôåêòèâíèé

êåð³âíèê ïîñò³éíî ï³äêèäàº “äèê³” é áåçðîçñóäí³ ³äå¿ òà ïðî-

ïîçèö³¿, ùîá ïðîäåìîíñòðóâàòè, ùî âîíè çàîõî÷óþòüñÿ.

²íîä³ áóâàº, ùî ãðóï³ ó÷àñíèê³â âàæêî ïîçáóòèñÿ â³ä

òðàäèö³éíèõ ï³äõîä³â, ñòåðåîòèï³â ó âèð³øåíí³ ïðîáëåìè.

Ó öüîìó âèïàäêó ðåêîìåíäóºìî âèêîðèñòîâóâàòè ìà-

ëåíüêó õèòð³ñòü: êåð³âíèê çóïèíÿº õ³ä “ìîçêîâîãî øòóð-

ìó” ³ ââîäèòü îáìåæåííÿ: ïðîòÿãîì 2–3 õâèëèí ïðîïîíó-

âàòè ò³ëüêè íåïðàêòè÷í³, ñàì³ íåçâè÷àéí³ ³äå¿.

×àñòî áóâàº, ùî ó÷àñíèêè ïðîäîâæóþòü ãåíåðóâàòè

ö³êàâ³ ³äå¿ òà ï³ñëÿ ïðîâåäåííÿ çáîð³â. Ó öüîìó âèïàäêó

çàâäàííÿ êåð³âíèêà – ç³áðàòè ãðóïó ÷åðåç ê³ëüêà äí³â ³

çàô³êñóâàòè ö³ ³äå¿. Ìåòîþ âåäó÷îãî íà åòàï³ îö³íêè ³äåé ³

ðîáîòè ç íèìè º ìàêñèìàëüíå ñïðèÿííÿ ðîçâèòêó â³ä³áðà-

íèõ íàïðÿìê³â, ¿õ îôîðìëåííÿ, ùî äîçâîëÿº ñóäèòè ïðî

ìîæëèâîñò³ ïðàêòè÷íî¿ ðåàë³çàö³¿ âèáðàíèõ ð³øåíü. Àíàë³-

çóâàòè ³äå¿ ìîæíà íåñê³í÷åííî äîâãî, ³ òîìó îäíå ç îñíîâ-

íèõ çàâäàíü âåäó÷îãî – óòðèìàòè ãðóïó â³ä çàéâî¿ çàõîïëå-

íîñò³ ïðîöåñîì îáãîâîðåííÿ. Íà öüîìó åòàï³ íåîáõ³äíà

âæå êîíêðåòèçàö³ÿ çàïðîïîíîâàíèõ ðàí³øå ³äåé.

Îñíîâíà óìîâà ðåçóëüòàòèâíîãî ïðîâåäåííÿ çàíÿòü çà

òèïîì “ìîçêîâîãî øòóðìó” ïîâ’ÿçàíå ç ãîòîâí³ñòþ ñòó-

äåíò³â â³ëüíî âèñëîâëþâàòè íåñòàíäàðòí³ ð³øåííÿ. Êðàù³

ðåçóëüòàòè äîñÿãàþòüñÿ ïðè ïåâíèõ íàâè÷êàõ ó÷àñò³ â

“ìîçêîâîìó øòóðì³”. Òîìó íàâ÷àëüí³ “ìîçêîâ³ øòóðìè”

êîðèñí³, îñê³ëüêè âèðîáëÿþòü ó ñòóäåíò³â ïðàâèëà ¿õ ïðî-

âåäåííÿ ³ ôîðìóþòü íàâè÷êè äëÿ ðåàëüíèõ “ìîçêîâèõ

àòàê” (ÿê ³ ³íøèõ ôîðì íàâ÷àííÿ).

Àêòóàëüí³ñòü ðîçãëÿíóòîãî ïèòàííÿ ïîÿñíþºòüñÿ òèì,

ùî ìîçêîâèé øòóðì, ÿê êðåàòèâíèé ìåòîä âèð³øåííÿ

çàâäàíü ñòèìóëþº àêòèâí³ñòü òà ³íòó¿òèâíå ìèñëåííÿ ëþäåé

â ïðîöåñ³ ïîøóêó ³äåé, ïðîïîçèö³é; ñïðèÿº ³íòåãðóâàííþ

íàêîïè÷åíî¿ ³íôîðìàö³¿, ÷èì çíà÷íî ï³äâèùóþòü

åôåêòèâí³ñòü ïðèéíÿòèõ ð³øåíü, ùî îñîáëèâî âàæëèâî â

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ÂÈÙÀ ÌÅÄÈ×ÍÀ ÎÑÂ²ÒÀ / HIGHER MEDICAL EDUCATION

ÌÎÇÃÎÂÎÉ ØÒÓÐÌ ÊÀÊ ÌÅÒÎÄ ÐÅÀËÈÇÀÖÈÈ

ÈÍÒÅÐÀÊÒÈÂÍÎÃÎ ÎÁÓ×ÅÍÈß

Òåëåìóõà Ñ.Á.

Èâàíî-Ôðàíêîâñêèé íàöèîíàëüíûé ìåäèöèíñêèé

óíèâåðñèòåò, ã. Èâàíî-Ôðàíêîâñê, Óêðàèíà

Ðåçþìå. Ìîçãîâîé øòóðì – òåõíèêà ïðîâåäåíèÿ çàíÿ-

òèÿ, ïðè êîòîðîé ãðóïïà ñòðåìèòñÿ íàéòè ðåøåíèå êîíê-

ðåòíîé ïðîáëåìû ñ ïîìîùüþ àêêóìóëèðîâàíèÿ âñåõ èäåé,

ñïîíòàííî ïðåäëàãàåìûõ ñòóäåíòàìè. Ìåòîä “ìîçãîâîãî

øòóðìà” ïðåäñòàâëÿåò ñîáîé äâóõ ýòàïíóþ ïðîöåäóðó ðå-

øåíèÿ çàäà÷è: íà ïåðâîì ýòàïå ãåíåðèðóþòñÿ èäåè, à íà

âòîðîì – àíàëèçèðóþòñÿ, ðàçâèâàþòñÿ. Óñòàíîâëåíî, ÷òî

îïòèìàëüíûé ñîñòàâ ãðóïïû – îò 6 äî 12 ÷åëîâåê. Îïòè-

ìàëüíîå ÷èñëî – 7. Îáùåïðèíÿòàÿ ïðîöåäóðà ïðîâåäå-

íèÿ çàíÿòèé ïî ìåòîäó “ìîçãîâîãî øòóðìà” ñîñòîèò èç ñëå-

äóþùèõ ýòàïîâ: 1) ôîðìóëèðîâàíèå ïðîáëåìû; 2) ðàçìè-

íî÷íàÿ ñåññèÿ; 3) ðàáî÷àÿ ñåññèÿ; 4) ýêñïåðòèçà – îöåí-

êà ñîáðàííûõ èäåé è îòáîð ëó÷øèõ èç íèõ ïî ïðåäâàðè-

òåëüíî ðàçðàáîòàííûì êðèòåðèÿì; 5) ïîäâåäåíèå èòî-

ãîâ. Âíåäðåíèå ìåòîäà “ìîçãîâîãî øòóðìà” â ïðàêòèêó

ïðåïîäàâàíèÿ êëèíè÷åñêèõ äèñöèïëèí â âûñøèõ ó÷åáíûõ

ìåäèöèíñêèõ çàâåäåíèÿõ äàåò âîçìîæíîñòü óëó÷øèòü

êà÷åñòâî óñâîåíèÿ çíàíèé (íà òðåòüåì óðîâíå), îáåñïå-

÷èâàåò àêòèâèçàöèþ ìûñëèòåëüíîé äåÿòåëüíîñòè ó÷àùèõ-

ñÿ, ïîîùðÿåòñÿ òâîð÷åñêîå ìûøëåíèå è ïðåîäîëåâàåò-

ñÿ çàâèñèìîñòü îò ñòåðåîòèïîâ.

Êëþ÷åâûå ñëîâà: ìîçãîâîé øòóðì, òâîð÷åñêîå ìûø-

ëåíèå, ãåíåðèðîâàíèå èäåé, íàó÷íî-èññëåäîâàòåëüñêàÿ

ðàáîòà.

BRAINSTORM AS A METHOD

OF IBRAINSTORMING AS A METHOD

OF IMPLEMENTATION OF INTERACTIVE

LEARNING

S. Telemukha

Ivano-Frankivsk National Medical University,

Kyiv, Ukraine

Summary. Brainstorming is a teaching method when a

group seeks to find a solution to a specific problem by storing

all spontaneously offered ideas. The method of

“brainstorming” is a two phase procedure for solving the

problem: in the first stage ideas are generated, and the

second – are analyzed and developed. The optimum

number of participants of the group is 6-12 students.

Optimal number is 7. The common procedure for conducting

“brainstorming” consists of the following stages: 1) the

problem formulation, 2) lead-in, 3) working session,

4) assessment – evaluation and selection of collected ideas,

using previously defined criteria, 5) summarizing.

Implementation of “brainstorming” into the teaching practice

for clinical disciplines in higher education medical

establishments provides an opportunity to improve the

quality of learning (the third level), activates the mental activity

of students, encouraged creative thinking of students and

overcoming dependence on stereotypes.

Key words: brainstorming, creative thinking, idea

generation, research work.

óìîâàõ æîðñòêî¿ êîíêóðåíö³¿ , êîëè íåîáõ³äí³ ³ííîâàö³éí³

ñòðàòåã³¿, íåîðäèíàðí³ ³äå¿ òà ä³¿, íîâ³ ñïîñîáè ïîâåä³íêè.

Êðèòåð³¿ îö³íþâàííÿ ðîáîòè.

Çàãàëüíà îö³íêà ðîáîòè ãðóïè: 1) ââàæàºòüñÿ çà íîð-

ìó, ÿêùî ïðîòÿãîì çàíÿòòÿ ãðóïà ïðîäóêóº äî ñîòí³ ³äåé;

2) äîòðèìàííÿ ïðàâèë ðîáîòè, ïðèíöèï³â òà ìåòîäèêè

ïðîâåäåííÿ “ìîçêîâîãî øòóðìó”, äîñòàòíÿ àêòèâí³ñòü

âñ³õ ÷ëåí³â ãðóïè; 3) âèð³øåííÿ çàïðîïîíîâàíî¿ çàäà÷³ –

íàçâàíî âñ³ â³äîì³ øëÿõè ¿¿ âèð³øåííÿ òà çàïðîïîíîâàíî

îðèã³íàëüí³ íåñòåðåîòèïí³ øëÿõè òà ìåòîäè âèð³øåííÿ

âñòàíîâëåíî¿ ïðîáëåìè.

²íäèâ³äóàëüíà îö³íêà ðîáîòè ñòóäåíò³â: 1) äîòðèìàííÿ

ïðàâèë ðîáîòè, ïðèíöèï³â òà ìåòîäèêè ïðîâåäåííÿ “ìîç-

êîâîãî øòóðìó”; 2) äîñòàòíÿ àêòèâí³ñòü â ïðîäóêóâàíí³

³äåé òà ¿õ åêñïåðòèç³; 3) çíàííÿ â³äîìèõ øëÿõ³â âèð³øåííÿ

âñòàíîâëåíî¿ ïðîáëåìè, ïðîïîíóâàííÿ îðèã³íàëüíèõ íå-

ñòåðåîòèïíèõ øëÿõ³â òà ìåòîä³â ¿¿ âèð³øåííÿ (àáî ³äåé, ùî

ñòàëè ï³äãðóíòòÿì äî ðîçðîáêè òàêèõ øëÿõ³â òà ìåòîä³â); 4)

âì³ííÿ äî ³íòåãðàö³¿ (ì³æäèñöèïë³íàðíî¿ ³íòåãðàö³¿) îòðè-

ìàíèõ çíàíü.

Âèñíîâêè. Âïðîâàäæåííÿ ìåòîäó “ìîçêîâîãî øòóð-

ìó” â ïðàêòèêó âèêëàäàííÿ êë³í³÷íèõ äèñöèïë³í ó âèùèõ

íàâ÷àëüíèõ ìåäè÷íèõ çàêëàäàõ äàº ìîæëèâ³ñòü ïîêðàùèòè

ÿê³ñòü çàñâîºííÿ çíàíü (íà òðåòüîìó ð³âí³), çàáåçïå÷óº àê-

òèâ³çàö³þ ðîçóìîâî¿ ä³ÿëüíîñò³ ó÷í³â, çàîõî÷óºòüñÿ òâîð÷å

ìèñëåííÿ ó÷í³â òà äîëàºòüñÿ çàëåæí³ñòü â³ä ñòåðåîòèï³â.

“Ìîçêîâèé øòóðì” – öå ïðîñòèé ìåòîä, ÿêèé ëåãêî çðî-

çóì³òè ³ ëåãêî çàñòî ñîâóâàòè íà çàíÿòò³. Äëÿ éîãî ïðîâåäåííÿ

íå ïîòð³áíî ñêëàäíå óñòàòêóâàííÿ, òåõí³êà ³ áàãàòî ÷àñó.

Ðåöåíçåíò: äîö. Êîâàëü÷óê Î.².

Ë²ÒÅÐÀÒÓÐÀ

1. Osborn A. F. Applied imagination: Principles and procedures

of creative problem solving. 3 rd ed. – New York: Charles Scribner’s

Sons, 1963. – 417 Ð.

2. Äè÷ê³âñüêà ².Ì. ²ííîâàö³éí³ ïåäàãîã³÷í³ òåõíîëîã³¿: Íàâ÷.

Ïîñ³á. – Ê.: Àêàäåìâèäàâ, 2004.

3. ²íòåðàêòèâí³ ìåòîäè íàâ÷àííÿ: íàâ÷. ïîñ³áíèê / çà ðåä.

Ï. Øåâ÷óêà ³ Ï.Ôåíðèõà. – Ùåö³í: Âèä-âî WSAP, 2005. – 170 ñ.

4. Ì³ëåðÿí Â.ª. Ìåòîäè÷í³ îñíîâè ï³äãîòîâêè òà ïðîâå-

äåííÿ íàâ÷àëüíèõ çàíÿòü â ìåäè÷íèõ âóçàõ: Ìåòîäè÷íèé ïîñ³áíèê. –

Ê.: Õðåùàòèê, 2004. – 80 ñ.

5. Íàãîðíîâ È. Â. Èíòåðàêòèâíîå îáó÷åíèå â ó÷åáíî-âîñïèòà-

òåëüíîì ïðîöåññå êàôåäðû âîåííî-ïîëåâîé òåðàïèè / È. Â. Íà-

ãîðíîâ, À. Í. ßíóëü // Âîåííàÿ ìåäèöèíà. – 2012. – ¹ 2. – Ñ. 15-20.

6. Íàêàç ÌÎÇ Óêðà¿íè ¹522/51 â³ä 12.09.2008 ðîêó “Ïðî

çàòâåðäæåííÿ Êîíöåïö³¿ ðîçâèòêó âèùî¿ ìåäè÷íî¿ îñâ³òè

Óêðà¿íè”.

7. Ïàíôèëîâà À.Ï. Èãðîâîå ìîäåëèðîâàíèå â äåÿòåëüíîñòè

ïåäàãîãà. Ìîñêâà: Èçä. Öåíòð “Àêàäåìèÿ”, 3-å èçäàíèå, 2008 ã. –

368 ñ.

8. Ñàôîíîâà Å. È. Ðåêîìåíäàöèè ïî èñïîëüçîâàíèþ èííîâà-

öèîííûõ îáðàçîâàòåëüíûõ òåõíîëîãèé â ó÷åáíîì ïðîöåññå. Ó÷åá-

íîå ïîñîáèå. – Ì.: ÐÃÃÓ, 2011. – 71 ñ.

9. Ñòóïèíà Ñ. Á. Òåõíîëîãèè èíòåðàêòèâíîãî îáó÷åíèÿ

â âûñøåé øêîëå: Ó÷åáíî-ìåòîäè÷åñêîå ïîñîáèå. – Ñàðàòîâ:

Èçäàòåëüñêèé öåíòð “Íàóêà”, 2009. – 52 ñ.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 2 • 2009

172

ÀÍÎÍÑ / ÀÍÎÍÑ / ANNOUNCEMENT

ÓÊÐÀ¯ÍÑÜÊÈÉ ÍÀÓÊÎÂÎ-ÌÅÄÈ×ÍÈÉ ÌÎËÎÄ²ÆÍÈÉ ÆÓÐÍÀË

ÓÌÎÂÈ ÏÓÁË²ÊÀÖ²¯

1. Ñòàòò³ ïóáë³êóþòüñÿ óêðà¿íñüêîþ, àíãë³éñüêîþ òà ðîñ³éñüêîþ ìîâàìè.

2. Â³ê àâòîðà, ïð³çâèùå ÿêîãî ñòî¿òü ïåðøèì, íå ïîâèíåí ïåðåâèùóâàòè 35 ðîê³â.

3. Àâòîðñüêèé îðèã³íàë ñêëàäàºòüñÿ ç äâîõ ïðèì³ðíèê³â, íàäðóêîâàíèõ íà á³ëîìó ïàïåð³ ôîðìàòó À4 íà îäíîìó

áîö³ àðêóøà, òà åëåêòðîííî¿ âåðñ³¿ ìàòåð³àëó íà äèñêåò³ 3,5 äþéìà àáî êîìïàêò-äèñêó, íàáðàíèõ â ðåäàêòîð³ Word for

Windows (áóäü-ÿêî¿ âåðñ³¿) ãàðí³òóðîþ “Times New Roman”, 12 ïóíêò³â, áåç òàáóëÿòîð³â, ÷åðåç ï³âòîðà ³íòåðâàëè,

ç ïîëÿìè ç óñ³õ áîê³â ïî 20 ìì. Ó òåêñò³ òà çàãîëîâêàõ íå ìàº áóòè ñë³â, íàáðàíèõ âåëèêèìè ë³òåðàìè. Äëÿ íàä³éíîñò³

çáåðåæåííÿ ìàòåð³àëó ïðîñèìî ïîäàâàòè äâ³ êîï³¿ ìàòåð³àë³â íà îäíîìó åëåêòðîííîìó íîñ³¿. Äèñêåòó àáî êîìïàêò-

äèñê ïåðåñèëàòè ó òâåðäîìó êîíâåðò³.

4. Ñòðóêòóðà îñíîâíîãî òåêñòó ñòàòò³ ìàº â³äïîâ³äàòè çàãàëüíîïðèéíÿò³é ñòðóêòóð³ äëÿ íàóêîâèõ ñòàòåé. Îáñÿã íå

ïîâèíåí ïåðåâèùóâàòè: ñòàòò³ – äî 9 ñ.; îãëÿäó, ïðîáëåìíî¿ ñòàòò³ – äî 12 ñ.; êîðîòêî¿ ³íôîðìàö³¿ – äî 3 ñ.

Óâàãà! Ïèòàííÿ ïðî ïóáë³êàö³þ â æóðíàë³ âåëèêî¿ çà îáñÿãîì ³íôîðìàö³¿ âèð³øóºòüñÿ ³íäèâ³äóàëüíî, ÿêùî, íà äóìêó

ðåäêîëåã³¿, âîíà ñòàíîâèòü îñîáëèâèé ³íòåðåñ äëÿ ÷èòà÷³â.

5. Ñòàòò³, ùî ì³ñòÿòü ðåçóëüòàòè åêñïåðèìåíòàëüíèõ äîñë³äæåíü, ó òîìó ÷èñë³ äèñåðòàö³éíèõ, ñêëàäàþòüñÿ ç

òàêèõ ðîçä³ë³â: “Âñòóï”, “Ìåòà ðîáîòè”, “Ìàòåð³àëè òà ìåòîäè”, “Ðåçóëüòàòè òà îáãîâîðåííÿ”, “Âèñíîâêè”. Ö³ ïóáë³êàö³¿

ìàþòü âêëþ÷àòè òàê³ íåîáõ³äí³ åëåìåíòè: ïîñòàíîâêà ïðîáëåìè ó çàãàëüíîìó âèãëÿä³ òà ¿¿ çâ’ÿçîê ³ç âàæëèâèìè

íàóêîâèìè ÷è ïðàêòè÷íèìè çàâäàííÿìè; àíàë³ç îñòàíí³õ äîñë³äæåíü ³ ïóáë³êàö³é, â ÿêèõ çàïî÷àòêîâàíî ðîçâ’ÿçàííÿ

äàíî¿ ïðîáëåìè ³ íà ÿê³ ñïèðàºòüñÿ àâòîð, âèä³ëåííÿ íåðîçâ’ÿçàíèõ ðàí³øå ÷àñòèí çàãàëüíî¿ ïðîáëåìè, êîòðèì

ïðèñâÿ÷óºòüñÿ çàçíà÷åíà ñòàòòÿ; ôîðìóëþâàííÿ ö³ëåé ñòàòò³; âèêëàä îñíîâíîãî ìàòåð³àëó äîñë³äæåííÿ ç ïîâíèì

îá ðóíòóâàííÿì îòðèìàíèõ íàóêîâèõ ðåçóëüòàò³â; âèñíîâêè ç öüîãî äîñë³äæåííÿ ³ ïåðñïåêòèâè ïîäàëüøèõ ðîçâ³äîê

ó äàíîìó íàïðÿìêó.

6. Ðåçþìå ìàº äîïîâíþâàòè ìîâó òåêñòó ñòàòò³ (íàïðèêëàä, ÿêùî ñòàòòÿ íàïèñàíà óêðà¿íñüêîþ ìîâîþ, òî ðåçþìå

ìàº áóòè ðîñ³éñüêîþ òà àíãë³éñüêîþ ìîâàìè), ïåðåêëàä ìàº áóòè ÿê³ñíèé ³ òî÷íèé.

7. Íà 1-é ñòîð³íö³ òåêñòó çàçíà÷àþòü: 1) ³íäåêñ ÓÄÊ òà íàçâó ñòàòò³; 2) ïð³çâèùà òà ³í³ö³àëè àâòîð³â; 3) óñòàíîâó, äå

ïðàöþþòü àâòîðè, ì³ñòî, êðà¿íó (äëÿ ³íîçåìö³â); 4) êëþ÷îâ³ ñëîâà – 5–10 ñë³â ÷è ñëîâîñïîëó÷åíü, ùî ðîçêðèâàþòü

çì³ñò ñòàòò³.

8. Íà îñòàíí³é ñòîð³íö³ òåêñòó âì³ùóþòü: 1) âëàñíîðó÷í³ ï³äïèñè âñ³õ àâòîð³â; 2) ïå÷àòêó òà ï³äïèñ â³äïîâ³äàëüíî¿

îñîáè óñòàíîâè, â³ä ÿêî¿ ïîäàºòüñÿ ìàòåð³àë; 3) ïð³çâèùå, ³ì’ÿ òà ïî áàòüêîâ³, ïîøòîâó àäðåñó, íîìåðè òåëåôîí³â

(ñëóæáîâèé òà äîìàøí³é) àâòîðà, ç ÿêèì ðåäàêö³ÿ ìàº ñï³ëêóâàòèñÿ.

9. Òàáëèö³ ìàþòü áóòè âèêîíàí³ ãàðí³òóðîþ “Times New Roman”, 10 ïóíêò³â, áåç ñëóæáîâèõ ñèìâîë³â óñåðåäèí³.

Ïóáë³êàö³¿, ùî ì³ñòÿòü òàáëèö³, âèêîíàí³ çà äîïîìîãîþ òàáóëÿòîðà, ðîçãëÿäàòèñÿ íå áóäóòü. Íàçâè ïðåïàðàò³â ñë³ä

ïîäàâàòè ç ìàëî¿ ë³òåðè.

10. Óñ³ âåëè÷èíè íàâîäÿòüñÿ â îäèíèöÿõ CI.

11. Ñïèñîê ë³òåðàòóðè îôîðìëþºòüñÿ íà îêðåìèõ ñòîð³íêàõ. Äæåðåëà ïîäàþòüñÿ â àëôàâ³òíîìó ïîðÿäêó (³íî-

çåìí³ – îêðåìî) àáî çà ïîðÿäêîì öèòóâàííÿ ó òåêñò³. ¯õ çàãàëüíà ê³ëüê³ñòü íå ïîâèííà ïåðåâèùóâàòè 50, ïðè öüîìó

50% ç íèõ ìàþòü áóòè ìåíø í³æ ï’ÿòèð³÷íî¿ äàâíîñò³. Ïîñèëàííÿ â òåêñò³ çàçíà÷àþòüñÿ öèôðàìè â êâàäðàòíèõ

äóæêàõ (íàïðèêëàä: [7]). Ïîðÿäîê îôîðìëåííÿ ìàº â³äïîâ³äàòè ÄÑÒÓ 7.1:2006 “Ñèñòåìà ñòàíäàðò³â ç ³íôîðìàö³¿,

á³áë³îòå÷íî¿ òà âèäàâíè÷î¿ ñïðàâè. Á³áë³îãðàô³÷íèé çàïèñ. Á³áë³îãðàô³÷íèé îïèñ. Çàãàëüí³ âèìîãè òà ïðàâèëà ñêëà-

äàííÿ”.

12. Ñòàòòÿ ïîâèííà ñóïðîâîäæóâàòèñÿ ðåöåíç³ºþ ôàõ³âöÿ â³äïîâ³äíîãî ïðîô³ëþ, ÿê ïðàâèëî, äîêòîðà íàóê òà

íàïðàâëåííÿì äî äðóêó, çàâ³ðåíèìè ïå÷àòêîþ óñòàíîâè, â ÿê³é âèêîíàíî ðîáîòó.

13. Àâòîðè íåñóòü â³äïîâ³äàëüí³ñòü çà íàóêîâå òà ë³òåðàòóðíå ðåäàãóâàííÿ ïîäàíîãî ìàòåð³àëó, öèòàò òà ïîñè-

ëàíü, àëå ðåäàêö³ÿ çàëèøàº çà ñîáîþ ïðàâî íà âëàñíå ðåäàãóâàííÿ ñòàòò³ ÷è â³äìîâó àâòîðîâ³ â ïóáë³êàö³¿, ÿêùî

ïîäàíèé ìàòåð³àë íå â³äïîâ³äàº çà ôîðìîþ àáî çì³ñòîì çãàäàíèì âèùå âèìîãàì.

14. Ìàòåð³àëè, ùî íå â³äïîâ³äàþòü íàâåäåíèì ñòàíäàðòàì ïóáë³êàö³é ó æóðíàë³, ðåäàêö³ºþ íå ðîçãëÿäàþòüñÿ òà

íå ïîâåðòàþòüñÿ.

15. Äèñêè, äèñêåòè, ðóêîïèñè, ìàëþíêè, ôîòîãðàô³¿ òà ³íø³ ìàòåð³àëè, íàä³ñëàí³ â ðåäàêö³þ, íå ïîâåðòàþòüñÿ.

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Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

173

²ÑÒÎÐ²ß ÌÅÄÈÖÈÍÈ / ÈÑÒÎÐÈß ÌÅÄÈÖÈÍÛ / HISTORY OF MEDICINE

ÓÊÐÀÈÍÑÊÈÉ ÍÀÓ×ÍÎ-ÌÅÄÈÖÈÍÑÊÈÉ ÌÎËÎÄÅÆÍÛÉ ÆÓÐÍÀË

ÓÑËÎÂÈß ÏÓÁËÈÊÀÖÈÈ

1. Ñòàòüè ïóáëèêóþòñÿ íà óêðàèíñêîì, àíãëèéñêîì è ðóññêîì ÿçûêàõ.

2. Âîçðàñò àâòîðà, ôàìèëèÿ êîòîðîãî ñòîèò ïåðâîé, íå äîëæåí ïðåâûøàòü 35 ëåò.

3. Àâòîðñêèé îðèãèíàë ñîñòîèò èç äâóõ ýêçåìïëÿðîâ, íàïå÷àòàííûõ íà áåëîé áóìàãå ôîðìàòà À4 íà îäíîé

ñòîðîíå ëèñòà, è ýëåêòðîííîé âåðñèè ìàòåðèàëà íà äèñêåòå 3,5 äþéìà èëè êîìïàêò-äèñêå, íàáðàííûõ â ðåäàêòîðå

Word for Windows (ëþáîé âåðñèè) ãàðíèòóðîé “Times New Roman”, 12 ïóíêòîâ, áåç òàáóëÿòîðîâ, ÷åðåç ïîëòîðà

èíòåðâàëà, ñ ïîëÿìè ñî âñåõ ñòîðîí ïî 20 ìì. Â òåêñòå è çàãîëîâêàõ íå äîëæíî áûòü ñëîâ, íàáðàííûõ çàãëàâíûìè

áóêâàìè. Äëÿ íàäåæíîñòè ñîõðàíåíèÿ ìàòåðèàëà ïðîñèì ïîäàâàòü äâå êîïèè ìàòåðèàëîâ íà îäíîì ýëåêòðîííîì

íîñèòåëå. Äèñêåòó èëè êîìïàêò-äèñê ïåðåñûëàòü â òâåðäîì êîíâåðòå.

4. Ñòðóêòóðà îñíîâíîãî òåêñòà ñòàòüè äîëæíà ñîîòâåòñòâîâàòü îáùåïðèíÿòîé ñòðóêòóðå äëÿ íàó÷íûõ ñòàòåé.

Îáúåì íå äîëæåí ïðåâûøàòü: ñòàòüè – äî 9 ñ.; îáçîðà, ïðîáëåìíîé ñòàòüè – äî 12 ñ.; êðàòêîé èíôîðìàöèè – äî 3 ñ.

Âíèìàíèå! Âîïðîñ î ïóáëèêàöèè â æóðíàëå áîëüøîé ïî îáúåìó èíôîðìàöèè ðåøàåòñÿ èíäèâèäóàëüíî, åñëè,

ïî ìíåíèþ ðåäêîëëåãèè, îíà ïðåäñòàâëÿåò îñîáûé èíòåðåñ äëÿ ÷èòàòåëåé.

5. Ñòàòüè, ñîäåðæàùèå ðåçóëüòàòû ýêñïåðèìåíòàëüíûõ èññëåäîâàíèé, â òîì ÷èñëå äèññåðòàöèîííûõ, ñîñòîÿò

èç ñëåäóþùèõ ðàçäåëîâ: “Ââåäåíèå”, “Öåëü ðàáîòû”, “Ìàòåðèàëû è ìåòîäû”, “Ðåçóëüòàòû è îáñóæäåíèå”, “Âûâîäû”.

Ýòè ïóáëèêàöèè äîëæíû âêëþ÷àòü òàêèå íåîáõîäèìûå ýëåìåíòû: ïîñòàíîâêà ïðîáëåìû â îáùåì âèäå è åå ñâÿçü ñ

âàæíûìè íàó÷íûìè èëè ïðàêòè÷åñêèìè çàäà÷àìè; àíàëèç ïîñëåäíèõ èññëåäîâàíèé è ïóáëèêàöèé, â êîòîðûõ íà÷à-

òî ðåøåíèå äàííîé ïðîáëåìû è íà êîòîðûå îïèðàåòñÿ àâòîð, âûäåëåíèå íåðåøåííûõ ðàíåå ÷àñòåé îáùåé ïðîáëå-

ìû, êîòîðûì ïîñâÿùàåòñÿ äàííàÿ ñòàòüÿ; ôîðìóëèðîâêà öåëåé ñòàòüè, èçëîæåíèå îñíîâíîãî ìàòåðèàëà èññëåäî-

âàíèÿ ñ ïîëíûì îáîñíîâàíèåì ïîëó÷åííûõ íàó÷íûõ ðåçóëüòàòîâ, âûâîäû èç ýòîãî èññëåäîâàíèÿ è ïåðñïåêòèâû

äàëüíåéøèõ èññëåäîâàíèé â äàííîì íàïðàâëåíèè.

6. Ðåçþìå äîëæíî äîïîëíÿòü ÿçûê òåêñòà ñòàòüè (íàïðèìåð, åñëè ñòàòüÿ íàïèñàíà íà óêðàèíñêîì ÿçûêå, òî

ðåçþìå äîëæíî áûòü íà ðóññêîì è àíãëèéñêîì ÿçûêàõ), ïåðåâîä äîëæåí áûòü êà÷åñòâåííûì è òî÷íûì.

7. Íà 1-é ñòðàíèöå òåêñòà óêàçûâàþò: 1) èíäåêñ ÓÄÊ è íàçâàíèå ñòàòüè; 2) ôàìèëèè è èíèöèàëû àâòîðîâ;

3) ó÷ðåæäåíèå, ãäå ðàáîòàþò àâòîðû, ãîðîä, ñòðàíó (äëÿ èíîñòðàíöåâ); 4) êëþ÷åâûå ñëîâà – 5–10 ñëîâ èëè ñëîâî-

ñî÷åòàíèé, ðàñêðûâàþùèõ ñîäåðæàíèå ñòàòüè.

8. Íà ïîñëåäíåé ñòðàíèöå òåêñòà ïîìåùàþò: 1) ñîáñòâåííîðó÷íûå ïîäïèñè âñåõ àâòîðîâ; 2) ïå÷àòü è ïîäïèñü

îòâåòñòâåííîãî ëèöà ó÷ðåæäåíèÿ, îò êîòîðîãî ïîäàåòñÿ ìàòåðèàë; 3) ôàìèëèÿ, èìÿ è îò÷åñòâî, ïî÷òîâûé àäðåñ,

íîìåðà òåëåôîíîâ (ñëóæåáíûé è äîìàøíèé) àâòîðà, ñ êîòîðûì ðåäàêöèÿ äîëæíà îáùàòüñÿ.

9. Òàáëèöû äîëæíû áûòü âûïîëíåíû ãàðíèòóðîé “Times New Roman”, 10 ïóíêòîâ, áåç ñëóæåáíûõ ñèìâîëîâ

âíóòðè. Ïóáëèêàöèè, ñîäåðæàùèå òàáëèöû, âûïîëíåííûå ñ ïîìîùüþ òàáóëÿòîðà, ðàññìàòðèâàòüñÿ íå áóäóò. Íàçâà-

íèÿ ïðåïàðàòîâ ñëåäóåò ïîäàâàòü ñî ñòðî÷íîé áóêâû.

10. Âñå âåëè÷èíû ïðèâîäÿòñÿ â åäèíèöàõ CI.

11. Ñïèñîê ëèòåðàòóðû îôîðìëÿåòñÿ íà îòäåëüíûõ ñòðàíèöàõ. Èñòî÷íèêè ïîäàþòñÿ â àëôàâèòíîì ïîðÿäêå

(èíîñòðàííûå – îòäåëüíî) èëè â ïîðÿäêå öèòèðîâàíèÿ â òåêñòå. Èõ îáùåå êîëè÷åñòâî íå äîëæíî ïðåâûøàòü 50, ïðè

ýòîì 50% èç íèõ äîëæíû áûòü ìåíåå ïÿòèëåòíåé äàâíîñòè. Ññûëêè â òåêñòå óêàçûâàþòñÿ öèôðàìè â êâàäðàòíûõ

ñêîáêàõ (íàïðèìåð: [7]). Ïîðÿäîê îôîðìëåíèÿ äîëæåí ñîîòâåòñòâîâàòü ÃÎÑÒó 7.1:2006 “Ñèñòåìà ñòàíäàðòîâ ïî

èíôîðìàöèè, áèáëèîòå÷íîìó è èçäàòåëüñêîìó äåëó. Áèáëèîãðàôè÷åñêàÿ çàïèñü. Áèáëèîãðàôè÷åñêîå îïèñàíèå.

Îáùèå òðåáîâàíèÿ è ïðàâèëà ñîñòàâëåíèÿ”.

12. Ñòàòüÿ äîëæíà ñîïðîâîæäàòüñÿ ðåöåíçèåé ñïåöèàëèñòà ñîîòâåòñòâóþùåãî ïðîôèëÿ, êàê ïðàâèëî, äîêòîðà

íàóê è íàïðàâëåíèåì ê ïå÷àòè, çàâåðåííûì ïå÷àòüþ ó÷ðåæäåíèÿ, â êîòîðîì âûïîëíåíà ðàáîòà.

13. Àâòîðû íåñóò îòâåòñòâåííîñòü çà íàó÷íîå è ëèòåðàòóðíîå ðåäàêòèðîâàíèå ïðåäñòàâëåííîãî ìàòåðèàëà,

öèòàò è ññûëîê, íî ðåäàêöèÿ îñòàâëÿåò çà ñîáîé ïðàâî íà ñîáñòâåííîå ðåäàêòèðîâàíèå ñòàòüè èëè îòêàç àâòîðó

â ïóáëèêàöèè, åñëè ýòè ìàòåðèàëû íå ñîîòâåòñòâóþò ïî ôîðìå èëè ñîäåðæàíèþ âûøåóïîìÿíóòûì òðåáîâàíèÿì.

14. Ìàòåðèàëû, íå ñîîòâåòñòâóþùèå ïðèâåäåííûì ñòàíäàðòàì ïóáëèêàöèé â æóðíàëå, ðåäàêöèåé íå ðàññìàòðè-

âàþòüñÿ è íå âîçâðàùàþòñÿ.

15. Äèñêè, äèñêåòû, ðóêîïèñè, ðèñóíêè, ôîòîãðàôèè è äðóãèå ìàòåðèàëû, îòïðàâëåííûå â ðåäàêöèþ, íå âîçâðà-

ùàþòñÿ.

Óêðà¿íñüêèé íàóêîâî-ìåäè÷íèé ìîëîä³æíèé æóðíàë

¹ 2 • 2013

174

²ÑÒÎÐ²ß ÌÅÄÈÖÈÍÈ / ÈÑÒÎÐÈß ÌÅÄÈÖÈÍÛ / HISTORY OF MEDICINE

UKRAINIAN SCIENTIFIC MEDICAL YOUTH JOURNAL

PUBLICATION REQUIREMENTS

1. Articles are published in English, Ukrainian and Russian.

2. Age of the author, whose name stands first, should not exceed 35 years.

3. The author’s original consists of two copies printed on one side of A4 white paper, and the electronic version of the

material on the 3,5-inch diskette or CD-R, typed in Microsoft Word (any version), typeface “Times New Roman”, font size 12,

without tabulators, with 1,5 line spacing, with all the margins of 20 mm. The text and titles should not contain words, typed

in capital letters. To ensure reliable preservation of materials, please, submit two copies of materials on a single electronic

carrier. Diskette or CD-R should be sent in a solid envelope.

4. The structure of the main text of the article should correspond the generally assepted structure of scientific articles.

The volume should not exceed: article – up to 9 p.; review, problematic article – up to 12 p., short information – up to 3 p.

Attention! The decision about publication of lengthy articles in the journal is taken individually if, in the opinion of the

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The list of reference sources should be arranged according the State Standarts 7.1:2006 “System of informational, library

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ResearchGate has not been able to resolve any citations for this publication.

Comorbidity Profile Among Patients with Rheumatoid Arthritis and the Impact on Prescriptions Trend

Article

Full-text available

Apr 2013

Comorbid conditions play a pivotal role in rheumatoid arthritis management and outcomes. We estimated the percentage of comorbid illness among rheumatoid arthritis patients and explored the relationship between this comorbidity and different prescriptions. A cross-sectional study of patients with rheumatoid arthritis in three centers in Saudi Arabia was carried out. Comorbidity and antirheumatoid medication regimens prescribed were recorded on a specially designed Performa. The association between comorbidity and different drugs was analyzed. A total of 340 patients were included. The most comorbidities were hypertension 122 (35.9%), diabetes 105 (30.9%), osteoporosis 88 (25.8%), and dyslipidemia in 66 (19.4). The most common drug prescribed was prednisolone in 275 (80.8%) patients followed by methotrexate in 253 (74.4%) and biological therapy in 142 (41.5%) patients. Glucocorticoids were prescribed considerably more frequently in hypertensive and diabetic patients as well as in patients with osteoporosis and dyslipidemia. Most patients with rheumatoid arthritis suffered from comorbid diseases.

2013 ESH/ESC guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)

Article

Jan 2013

Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin Outcome Study

Article

Jan 2005

“Fast-Track” Colo-Rectal Surgery

Article

Jun 2007

The early history of non-opioid analgesics

Article

Dec 1997

Kay Brune

The late 19th century gave rise to the discovery of the three prototypes of modern non-opioid antipyretic analgesics: acetaminophen (acetanilide), aspirin and salicylic acid, and phenazone. At three different sites at almost the same time in Germany the zest for finding substitutes for quinine, ie antipyretic drugs, led to synthetic efforts culminating at Erlangen in the synthesis of phenazone (antipyrine), at Strasbourg of acetanilide (antifebrin), and at Wuppertal of aspirin (acetylsalicylic acid). The rationales for synthesising these drugs were not stringent, but proved, nonetheless, successful. Thereafter chemists concentrated their attempts merely on modifying the drugs discovered with the help of the rapidly expanding and improving organic chemistry. Although no new principles were discovered, the ‘relatives’ of the originals, namely aspirin and its modifications, acetaminophen and propyphenazone, as well as dipyrone, still make up for about 50% of the market of the antipyretic analgesics worldwide.

A Meta-Analysis of Selective Versus Routine Nasogastric Decompression After Elective Laparotomy

Article

Jun 1995

A meta-analysis of all published clinical trials comparing selective versus routine nasogastric decompression was performed in an attempt to evaluate the need for nasogastric decompression after elective laparotomy. Many studies have suggested that routine nasogastric decompression is unnecessary after elective laparotomy and may be associated with an increased incidence of complications. Despite these reports, many surgeons continue to practice routine nasogastric decompression, believing that its use significantly decreases the risk of postoperative nausea, vomiting, aspiration, wound dehiscence, and anastomotic leak. A comprehensive search of the English language medical literature was performed to identify all published clinical trials evaluating nasogastric decompression. Twenty-six trials (3964 patients) met inclusion criteria. The outcome data extracted from each trial were subsequently "pooled" and analyzed for significant differences using the Mantel-Haenszel estimation of combined relative risk. Fever, atelectasis, and pneumonia were significantly less common and days to first oral intake were significantly fewer in patients managed without nasogastric tubes. Meta-analysis based on study quality revealed significantly fewer pulmonary complications, but significantly greater abdominal distension and vomiting in patients managed without nasogastric tubes. Routine nasogastric decompression did not decrease the incidence of any other complication. Although patients may develop abdominal distension or vomiting without a nasogastric tube, this is not associated with an increase in complications or length of stay. For every patient requiring insertion of a nasogastric tube in the postoperative period, at least 20 patients will not require nasogastric decompression. Routine nasogastric decompression is not supported by meta-analysis of the literature.

Initiation of antihypertensive treatment during nonsteroidal anti-inflammatory drug therapy

Article

Oct 1994

To determine whether there is an increased risk for the initiation of antihypertensive therapy in older persons prescribed nonaspirin, nonsteroidal anti-inflammatory drugs (NSAIDs). Case-control study. New Jersey Medicaid program. Medicaid enrollees aged 65 years and older. The 9411 case patients were newly started on an antihypertensive medication between November 1981 and February 1990. A similar number of controls were randomly selected among other enrollees. We used logistic regression to determine the odds ratio for the initiation of antihypertensive therapy in patients using NSAIDs relative to nonusers, after adjusting for age, sex, race, nursing home residence, number of prescriptions filled, intensity of physician utilization, and days hospitalized. The adjusted odds ratio for the initiation of antihypertensive therapy for recent NSAID users compared with nonusers was 1.66 (95% confidence interval, 1.54 to 1.80). The odds ratio increased with increasing daily NSAID dose: the adjusted odds ratio for users of low average daily doses relative to nonusers was 1.55 (95% CI, 1.38 to 1.74), that for medium-dose users was 1.64 (95% CI, 1.44 to 1.87), and that for high-dose users was 1.82 (95% CI, 1.62 to 2.05). Use of NSAIDs may increase the risk for initiation of antihypertensive therapy in older persons. Given the high prevalence of NSAID use by elderly persons, this association may have important public health implications for the management of hypertension in the older population.

Multimodal Approach to Control Postoperative Pathophysiology and Rehabilitation

Article

Jun 1997

H Kehlet

Major surgery is still associated with undesirable sequelae such as pain, cardiopulmonary, infective and thromboembolic complications, cerebral dysfunction, nausea and gastrointestinal paralysis, fatigue and prolonged convalescence. The key pathogenic factor in postoperative morbidity, excluding failures of surgical and anaesthetic technique, is the surgical stress response with subsequent increased demands on organ function. These changes in organ function are thought to be mediated by trauma-induced endocrine metabolic changes and activation of several biological cascade systems (cytokines, complement, arachidonic acid metabolites, nitric oxide, free oxygen radicals, etc). To understand postoperative morbidity it is therefore necessary to understand the pathophysiological role of the various components of the surgical stress response and to determine if modification of such responses may improve surgical outcome. While no single technique or drug regimen has been shown to eliminate postoperative morbidity and mortality, multimodal interventions may lead to a major reduction in the undesirable sequelae of surgical injury with improved recovery and reduction in postoperative morbidity and overall costs.

Bile salts induce or blunt cell proliferation in Barrett's esophagus in an acid-dependent fashion

Article

Jun 2000

Barrett's esophagus (BE) results from acid and bile reflux and predisposes to cancer. We investigated the effect of bile salts, with or without acid, on cell proliferation in BE and assessed mechanism(s) involved. To mimic physiological conditions, biopsies of esophagus, BE, and duodenum were exposed to a bile salt mixture, either continuously or as a 1-h pulse, and were compared with control media without bile salts (pH 7.4) for < or =24 h. Similar experiments were also performed with acidified media (pH 3.5) combined with the bile salt mixture as a 1-h pulse. Cell proliferation was assessed by a [(3)H]thymidine incorporation assay with or without bisindolylmaleimide (BIM), a selective protein kinase C inhibitor. Bile salt pulses enhanced cell proliferation in BE without affecting cell proliferation in esophageal or duodenal epithelia. In the presence of BIM, there was complete obliteration of the bile salt-induced BE hyperproliferation. In contrast, 1-h pulses of bile salts in combination with acid significantly inhibited proliferation in BE but had no effect on esophagus or duodenum. We conclude that in BE explants, brief exposure to bile salts, in the absence of acid, increases proliferation, whereas exposure to a combination of bile salts and acid together inhibits proliferation.

Endoscopic ablation of Barrett's esophagus

Article

Jul 1999

M. Brian Fennerty

Barrett's esophagus is a premalignant lesion of the esophagus that arises as an abnormal tissue response to epithelial injury from gastroesophageal reflux. Barrett's esophagus has previously been considered an irreversible lesion that required life-long surveillance to prevent malignant transformation. Recently, combination therapy with pharmacologic or surgical control of acid reflux combined with endoscopic delivery of a mucosal injury appears to have the capability of reversing superficial Barrett's tissue, and perhaps deeper tissue as well. Whether Barrett's esophagus is cured and cancer/dysplasia prevented by these techniques will require long-term follow-up of these patients.

THE THICKNESS OF THE CAROTID INTIMA-MEDIA COMPLEX OF THE COMMON CAROTID ARTERY IN CHILDREN WITH HYPERTENSION

Abstract

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