ΠΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠ΅ Π₯ΠΠΠ: Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΎΠ΅ ΠΈ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ Π±ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ²
ΠΠ°ΡΠΊΠ΅Ρ ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π° H-FABP Π·Π½Π°ΡΠΈΠΌΠΎ ΠΏΠΎΠ²ΡΡΠ΅Π½ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Ρ Π₯ΠΠΠ ΠΏΡΠΈ ΡΠ°Π·Π²ΠΈΡΠΈΠΈ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ Π½ΠΈΠΆΠ½ΠΈΡ Π΄ΡΡ Π°ΡΠ΅Π»ΡΠ½ΡΡ ΠΏΡΡΠ΅ΠΉ. ΠΡΡΠ²Π»Π΅Π½Π½ΡΠ΅ Π·Π½Π°ΡΠΈΠΌΡΠ΅ ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ ΠΊΠΎΡΡΠ΅Π»ΡΡΠΈΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Ρ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΡΠΌ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ (Π±ΡΠΎΠ½Ρ ΠΈΡ, ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΡ) ΠΌΠ΅ΠΆΠ΄Ρ H-FABP Ρ BNP-fragment, Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΠΎΡΡΡΡ ΠΎΠ΄ΡΡΠΊΠΈ, ΠΊΠΎΠ½Π΅ΡΠ½ΠΎ-Π΄ΠΈΡΡΠΎΠ»ΠΈΡΠ΅ΡΠΊΠΈΠΌ Π΄ΠΈΠ°ΠΌΠ΅ΡΡΠΎΠΌ Π»Π΅Π²ΠΎΠ³ΠΎ ΠΆΠ΅Π»ΡΠ΄ΠΎΡΠΊΠ° ΡΠ²ΠΈΠ΄Π΅ΡΠ΅Π»ΡΡΡΠ²ΡΡΡ ΠΎ ΠΊΠ°ΡΠ΄ΠΈΠ°Π»ΡΠ½ΠΎΠΌ ΡΡΡΠ΅ΡΡΠ΅ ΠΏΡΠΈ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΈ Π₯ΠΠΠ. ΠΠΎΠ²ΡΡΠ΅Π½Π½ΡΠ΅ ΡΡΠΎΠ²Π½ΠΈ… Π§ΠΈΡΠ°ΡΡ Π΅ΡΡ >
- Π‘ΠΎΠ΄Π΅ΡΠΆΠ°Π½ΠΈΠ΅
- ΠΡΠ΄Π΅ΡΠΆΠΊΠ°
- ΠΠΈΡΠ΅ΡΠ°ΡΡΡΠ°
- ΠΡΡΠ³ΠΈΠ΅ ΡΠ°Π±ΠΎΡΡ
- ΠΠΎΠΌΠΎΡΡ Π² Π½Π°ΠΏΠΈΡΠ°Π½ΠΈΠΈ
Π‘ΠΎΠ΄Π΅ΡΠΆΠ°Π½ΠΈΠ΅
- Π‘ΠΏΠΈΡΠΎΠΊ ΡΠΎΠΊΡΠ°ΡΠ΅Π½ΠΈΠΉ
- ΠΠΠΠΠΠΠΠ
- 2. ΠΠΠΠΠ ΠΠΠ’ΠΠ ΠΠ’Π£Π Π«
- 2. 1. ΠΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΡ, ΠΊΠ°ΠΊ Π½ΠΎΠ²ΡΠΉ ΠΈΠ½ΡΡΡΡΠΌΠ΅Π½Ρ Π²Π΅Π΄Π΅Π½ΠΈΡ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ
- 2. 2. ΠΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΡ Π²ΠΎΡΠΏΠ°Π»Π΅Π½ΠΈΡ ΠΏΡΠΈ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΈ Π₯ΠΠΠ
- 2. 3. ΠΠ½Π΅Π±ΠΎΠ»ΡΠ½ΠΈΡΠ½Π°Ρ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΡ ΠΊΠ°ΠΊ ΠΏΡΠΈΡΠΈΠ½Π° ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΡ Π₯ΠΠΠ
- 2. 4. ΠΠΎΠ·ΠΎΠΊΠΎΠΌΠΈΠ°Π»ΡΠ½ΡΠ΅ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ
- 2. 5. Π‘Π΅ΡΠ΄Π΅ΡΠ½Π°Ρ Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΡ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ
- 2. 6. ΠΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΡ ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π° ΠΏΡΠΈ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΈ Π₯ΠΠΠ
- 2. 7. ΠΠ΅Π½ΠΎΠ·Π½ΡΠ΅ ΡΡΠΎΠΌΠ±ΠΎΡΠΌΠ±ΠΎΠ»ΠΈΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ
- 2. 8. ΠΠ΅ΠΏΡΠΈΠ½Π΅ΠΌΠΈΡ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ ΠΈ ΡΠΈΠ½Π΄ΡΠΎΠΌΠΎΠΌ Π°Π»ΡΠ²Π΅ΠΎΠ»ΡΡΠ½ΠΎΠΉ 48 Π³ΠΈΠΏΠΎΠ²Π΅Π½ΡΠΈΠ»ΡΡΠΈΠΈ
- 3. ΠΠΠ’ΠΠ ΠΠΠ Π ΠΠΠ’ΠΠΠ« ΠΠ‘Π‘ΠΠΠΠΠΠΠΠΠ―
- 3. 1. ΠΠ°ΡΠΈΠ΅Π½ΡΡ
- 3. 2. ΠΠ΅ΡΠΎΠ΄Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ
- 3. 3. ΠΠ·ΠΌΠ΅ΡΠ΅Π½ΠΈΠ΅ ΡΡΠΎΠ²Π½Π΅ΠΉ ΡΡΠ²ΠΎΡΠΎΡΠΎΡΠ½ΡΡ /ΠΏΠ»Π°Π·ΠΌΠ΅Π½Π½ΡΡ Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ²
- 3. 4. ΠΠΈΠ·Π°ΠΉΠ½ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ
- 3. 5. Π‘ΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈΠΉ Π°Π½Π°Π»ΠΈΠ·
- 4. Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ ΡΠΎΠ±ΡΡΠ²Π΅Π½Π½ΡΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ
- 4. 1. ΠΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΈ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠ°Ρ ΡΠΎΠ»Ρ Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² 61 Π²ΠΎΡΠΏΠ°Π»Π΅Π½ΠΈΡ ΠΏΡΠΈ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΈ Π₯ΠΠΠ
- 4. 2. ΠΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ ΡΠ΅ΡΠ΅Π½ΠΈΡ, ΠΏΡΠΎΠ³Π½ΠΎΠ· Π²Π½Π΅Π±ΠΎΠ»ΡΠ½ΠΈΡΠ½ΠΎΠΉ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ Ρ 70 Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ
- 4. 3. ΠΠΎΠ·ΠΎΠΊΠΎΠΌΠΈΠ°Π»ΡΠ½Π°Ρ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΡ ΠΈ Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΡ Π²ΠΎΡΠΏΠ°Π»Π΅Π½ΠΈΡ Ρ 76 Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ
- 4. 4. ΠΠ·ΡΡΠ΅Π½ΠΈΠ΅ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΈ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠΎΠ»ΠΈ ΠΌΠ°ΡΠΊΠ΅ΡΠ° 82 ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎΠΉ Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΠΈ β-ΡΠ³ΠΎ-Πβ ΠΏΡΠΈ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΈ Π₯ΠΠΠ
- 4. 5. ΠΠ·ΡΡΠ΅Π½ΠΈΠ΅ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΈ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠΎΠ»ΠΈ 89 Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π° (Troponin I, H-FABP) ΠΈ BNP-fragment Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ Π₯ΠΠΠ
- 4. 6. Π’ΡΠΎΠΌΠ±ΠΎΡΠΌΠ±ΠΎΠ»ΠΈΡ Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ. 96 4.7 ΠΠ·ΡΡΠ΅Π½ΠΈΠ΅ Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ ΡΡΠ²ΠΎΡΠΎΡΠΎΡΠ½ΠΎΠ³ΠΎ Π»Π΅ΠΏΡΠΈΠ½Π° Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ ΠΏΡΠΈ ΡΠΈΠ½Π΄ΡΠΎΠΌΠ΅ Π°Π»ΡΠ²Π΅ΠΎΠ»ΡΡΠ½ΠΎΠΉ Π³ΠΈΠΏΠΎΠ²Π΅Π½ΡΠΈΠ»ΡΡΠΈΠΈ ΠΈ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠΈ ΠΠΠ
- ΠΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΏΡΠΈΠΌΠ΅ΡΡ
- 5. ΠΠΠ‘Π£ΠΠΠΠΠΠ Π ΠΠΠ£ΠΠ¬Π’ΠΠ’ΠΠ
- 5. 1. Π ΠΎΠ»Ρ Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² Π²ΠΎΡΠΏΠ°Π»Π΅Π½ΠΈΡ ΠΏΡΠΈ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΈ Π₯ΠΠΠ
- 5. 2. ΠΠ½Π΅Π±ΠΎΠ»ΡΠ½ΠΈΡΠ½Π°Ρ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΡ ΠΊΠ°ΠΊ ΠΏΡΠΈΡΠΈΠ½Π° ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΡ Π₯ΠΠΠ. 119 5.3 ΠΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ Π½ΠΎΠ·ΠΎΠΊΠΎΠΌΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ
- 5. 4. ΠΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΈ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠ°Ρ Π·Π½Π°ΡΠΈΠΌΠΎΡΡΡ Nt-pro-BNP 132 ΠΏΡΠΈ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΈ Π₯ΠΠΠ
- 5. 5. ΠΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΈ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠ°Ρ ΡΠΎΠ»Ρ Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² 136 ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π° (Troponin I, H-FABP) ΠΈ BNP-fragment Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ Π₯ΠΠΠ
- 5. 6. Π’ΠΠΠ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ
ΠΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠ΅ Π₯ΠΠΠ: Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΎΠ΅ ΠΈ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ Π±ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² (ΡΠ΅ΡΠ΅ΡΠ°Ρ, ΠΊΡΡΡΠΎΠ²Π°Ρ, Π΄ΠΈΠΏΠ»ΠΎΠΌ, ΠΊΠΎΠ½ΡΡΠΎΠ»ΡΠ½Π°Ρ)
1. ΠΠΠ©ΠΠ― Π₯ΠΠ ΠΠΠ’ΠΠ ΠΠ‘Π’ΠΠΠ Π ΠΠΠΠ’Π«.
ΠΠΊΡΡΠ°Π»ΡΠ½ΠΎΡΡΡ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ.
Π₯ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΎΠ±ΡΡΡΡΠΊΡΠΈΠ²Π½Π°Ρ Π±ΠΎΠ»Π΅Π·Π½Ρ Π»Π΅Π³ΠΊΠΈΡ (Π₯ΠΠΠ) ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΎΠ΄Π½ΠΎΠΉ ΠΈΠ· Π²Π΅Π΄ΡΡΠΈΡ ΠΏΡΠΈΡΠΈΠ½ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π΅ΠΌΠΎΡΡΠΈ ΠΈ ΡΠΌΠ΅ΡΡΠ½ΠΎΡΡΠΈ Π²ΠΎ Π²ΡΠ΅ΠΌ ΠΌΠΈΡΠ΅, ΠΈ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΠ΅Ρ ΡΠΎΠ±ΠΎΠΉ Π·Π½Π°ΡΠΈΠΌΡΡ ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΡΡ ΠΈ ΡΠΎΡΠΈΠ°Π»ΡΠ½ΡΡ ΠΏΡΠΎΠ±Π»Π΅ΠΌΡ. ΠΠ΅ΡΠ°Π»ΡΠ½ΠΎΡΡΡ ΠΎΡ Π₯ΠΠΠ Π·Π°Π½ΠΈΠΌΠ°Π΅Ρ 4-Π΅ ΠΌΠ΅ΡΡΠΎ ΡΡΠ΅Π΄ΠΈ Π²ΡΠ΅Ρ ΠΏΡΠΈΡΠΈΠ½ ΡΠΌΠ΅ΡΡΠΈ Π² ΠΎΠ±ΡΠ΅ΠΉ ΠΏΠΎΠΏΡΠ»ΡΡΠΈΠΈ, ΡΡΠΎ ΡΠΎΡΡΠ°Π²Π»ΡΠ΅Ρ ΠΎΠΊΠΎΠ»ΠΎ 4% Π² ΡΡΡΡΠΊΡΡΡΠ΅ ΠΎΠ±ΡΠ΅ΠΉ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΡΡΠΈ [GOLD, 2011], ΠΈ ΠΊ 2020 Π³. ΠΎΠΆΠΈΠ΄Π°Π΅ΡΡΡ, ΡΡΠΎ ΠΎΠ½Π° Π±ΡΠ΄Π΅Ρ Π½Π°Ρ ΠΎΠ΄ΠΈΡΡΡΡ Π½Π° 3-ΠΌ ΠΌΠ΅ΡΡΠ΅ [Murray & Lopez, 1997].
ΠΠΏΠΈΠ·ΠΎΠ΄Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΉ Π₯ΠΠΠ ΠΈΠ³ΡΠ°ΡΡ ΡΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΡ ΡΠΎΠ»Ρ Π² ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π΅ΠΌΠΎΡΡΠΈ, ΡΠΌΠ΅ΡΡΠ½ΠΎΡΡΠΈ ΠΈ Π·Π°ΡΡΠ°Ρ Π½Π° Π»Π΅ΡΠ΅Π½ΠΈΠ΅ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ. Π§Π°ΡΡΠΎΠ΅ ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΉ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ ΠΏΡΠΈΠ²ΠΎΠ΄ΠΈΡ ΠΊ Π±ΠΎΠ»Π΅Π΅ Π½ΠΈΠ·ΠΊΠΎΠΌΡ ΠΊΠ°ΡΠ΅ΡΡΠ²Ρ ΠΆΠΈΠ·Π½ΠΈ [Seemungal et al., 1998], Π±ΡΡΡΡΠΎΠΌΡ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΡ ΡΡΠ½ΠΊΡΠΈΠΈ Π»Π΅Π³ΠΊΠΈΡ ΠΈ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ [Donaldson et al., 2002, Perera, et al., 2007]. Π’ΡΠΆΠ΅Π»ΠΎΠ΅ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠ΅ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ, ΠΏΡΠΈΠ²ΠΎΠ΄ΡΡΠ΅Π΅ ΠΊ ΠΎΡΡΡΠΎΠΉ Π΄ΡΡ Π°ΡΠ΅Π»ΡΠ½ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΠΈ (ΠΠΠ), ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΎΡΠ½ΠΎΠ²Π½ΠΎΠΉ ΠΏΡΠΈΡΠΈΠ½ΠΎΠΉ ΡΠΌΠ΅ΡΡΠΈ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ [Zielinski et al., 1997].
ΠΠ°ΠΊ ΠΈΠ·Π²Π΅ΡΡΠ½ΠΎ, 50−70% Π²ΡΠ΅Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΉ Π₯ΠΠΠ ΠΎΠ±ΡΡΠ»ΠΎΠ²Π»Π΅Π½Ρ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠ΅ΠΉ Π½ΠΈΠΆΠ½ΠΈΡ Π΄ΡΡ Π°ΡΠ΅Π»ΡΠ½ΡΡ ΠΏΡΡΠ΅ΠΉ [Sapey & Stockley, 2006], 10% ΡΠ°Π·Π²ΠΈΠ²Π°ΡΡΡΡ Π·Π° ΡΡΠ΅Ρ Π°ΡΠΌΠΎΡΡΠ΅ΡΠ½ΡΡ ΠΏΠΎΠ»Π»ΡΡΠ°Π½ΡΠΎΠ², Π΄ΠΎ 20−40% ΡΠΏΠΈΠ·ΠΎΠ΄ΠΎΠ² ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΡ ΠΏΡΠΈΡ ΠΎΠ΄ΠΈΡΡΡ Π½Π° ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎ-ΡΠΎΡΡΠ΄ΠΈΡΡΡΠ΅ ΡΠΎΠ±ΡΡΠΈΡ (Π’ΠΠΠ, Π΄Π΅ΠΊΠΎΠΌΠΏΠ΅Π½ΡΠ°ΡΠΈΡ Ρ ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΠΈ (Π₯Π‘Π) ΠΈ Π΄Ρ.) [Janssens, 2001, Rutten et al., 2005, Tapson, 2008]. ΠΡΠΈΠΎΠ»ΠΎΠ³ΠΈΡ 30% Π²ΡΠ΅Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΉ Π₯ΠΠΠ Π½Π΅ Π²ΡΡΡΠ½Π΅Π½Π° [Sapey & Stockley, 2006].
ΠΠ±ΠΎΡΡΡΠ΅Π½ΠΈΡ Π»ΡΠ±ΠΎΠΉ ΡΡΠΈΠΎΠ»ΠΎΠ³ΠΈΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π»ΡΠ±ΠΎΠΉ ΡΡΠ΅ΠΏΠ΅Π½ΡΡ ΡΡΠΆΠ΅ΡΡΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ ΠΌΠΎΠ³ΡΡ ΡΠ²Π»ΡΡΡΡΡ ΠΏΡΠΈΡΠΈΠ½ΠΎΠΉ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½Π½ΠΎΠ³ΠΎ ΡΠ΅ΡΠ΅Π½ΠΈΡ ΠΈ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΡΡΠΈ Π₯ΠΠΠ [Calverley et al., 2007, Wedzicha et al., 2008, Ferguson et al., 2008, Fernandez Π‘., et al., 2009, Huiart et al., 2005], Π° Π²ΡΡΠ²Π»Π΅Π½ΠΈΠ΅ ΠΏΡΠΈΡΠΈΠ½Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΡ, ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎ ΠΏΡΠΈ Π½Π°Π»ΠΈΡΠΈΠΈ ΡΠ»ΠΎΠΆΠ½ΠΎΠ³ΠΎ ΠΊΠΎΠΌΠΎΡΠ±ΠΈΠ΄Π½ΠΎΠ³ΠΎ ΡΠΎΠ½Π°, 5 ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΠ΅Ρ Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ ΡΡΡΠ΄Π½ΠΎΡΡΠΈ [Lesser et al., 1992, Hull et al., 1997, Rutten et al., 2005, Hunt et al., 2001]. Π‘Π»Π΅Π΄ΠΎΠ²Π°ΡΠ΅Π»ΡΠ½ΠΎ, ΠΈΠ΄Π΅Π½ΡΠΈΡΠΈΠΊΠ°ΡΠΈΡ ΠΏΡΠΈΡΠΈΠ½Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΡ Π±ΠΎΠ»Π΅Π·Π½ΠΈ ΡΠ²Π»ΡΠ΅ΡΡΡ Π²Π°ΠΆΠ½ΠΎΠΉ ΠΏΡΠΎΠ±Π»Π΅ΠΌΠΎΠΉ Π² Π²Π΅Π΄Π΅Π½ΠΈΠΈ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ.
ΠΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΊΡΠ»ΡΡΡΡΠ°Π»ΡΠ½ΡΡ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ² Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ Π΄Π»Ρ ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΡ ΠΏΡΠΈΡΠΈΠ½Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΡ Π₯ΠΠΠ ΠΎΡΡΠ°Π΅ΡΡΡ ΡΠΏΠΎΡΠ½ΡΠΌ ΠΈΠ·-Π·Π° Ρ ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΊΠΎΠ»ΠΎΠ½ΠΈΠ·Π°ΡΠΈΠΈ ΠΌΠΈΠΊΡΠΎΠΎΡΠ³Π°Π½ΠΈΠ·ΠΌΠ°ΠΌΠΈ Π΄ΡΡ Π°ΡΠ΅Π»ΡΠ½ΡΡ ΠΏΡΡΠ΅ΠΉ Ρ Π±ΠΎΠ»ΡΡΠΈΠ½ΡΡΠ²Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π₯ΠΠΠ [Lacoma et al., 2009]. Π’ΡΠ°Π΄ΠΈΡΠΈΠΎΠ½Π½ΡΠΉ ΠΌΠ°ΡΠΊΠ΅Ρ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ Π₯ΠΠΠ — ΠΎΠ±ΡΠ΅ΠΌ ΡΠΎΡΡΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ Π²ΡΠ΄ΠΎΡ Π° Π·Π° 1 Ρ (OOBi) -ΡΠ»Π°Π±ΠΎ ΠΊΠΎΡΡΠ΅Π»ΠΈΡΡΡΡ Ρ ΡΠΈΠΌΠΏΡΠΎΠΌΠ°ΠΌΠΈ Π±ΠΎΠ»Π΅Π·Π½ΠΈ ΠΈ Π½Π΅ ΠΎΡΡΠ°ΠΆΠ°Π΅Ρ ΡΡΡΠ΅ΠΊΡΡ Π²Π½Π΅Π»Π΅Π³ΠΎΡΠ½ΡΡ ΠΏΡΠΎΡΠ²Π»Π΅Π½ΠΈΠΉ [Jones & Agusti, 2006]. Π ΡΠ²ΡΠ·ΠΈ Ρ ΡΡΠΈΠΌ, Π½ΠΎΠ²ΡΠ΅ ΡΡΡΠ°ΡΠ΅Π³ΠΈΠΈ Π²Π΅Π΄Π΅Π½ΠΈΡ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ ΡΠ²Π»ΡΡΡΡΡ Π½Π΅ΠΎΠ±Ρ ΠΎΠ΄ΠΈΠΌΡΠΌΠΈ Π½Π΅ ΡΠΎΠ»ΡΠΊΠΎ Π΄Π»Ρ Π²ΡΡΠ²Π»Π΅Π½ΠΈΡ ΠΏΡΠΈΡΠΈΠ½Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΡ Π±ΠΎΠ»Π΅Π·Π½ΠΈ, Π½ΠΎ ΠΈ Π΄Π»Ρ ΠΎΡΠ΅Π½ΠΊΠΈ ΠΈΠ½Π΄ΠΈΠ²ΠΈΠ΄ΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° Π΄Π»Ρ ΠΊΠ°ΠΆΠ΄ΠΎΠ³ΠΎ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°.
Π Π½Π°ΡΡΠΎΡΡΠ΅Π΅ Π²ΡΠ΅ΠΌΡ ΠΎΡΠ΅Π½ΠΊΠ° Π±ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² ΡΡΠ°Π»Π° Π½ΠΎΠ²ΡΠΌ ΠΈΠ½ΡΡΡΡΠΌΠ΅Π½ΡΠΎΠΌ Π²Π΅Π΄Π΅Π½ΠΈΡ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ. ΠΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΌΠ°ΡΠΊΠ΅ΡΡ, ΠΊΠΎΡΠΎΡΡΠ΅ ΠΌΠΎΠ³ΡΡ ΠΎΡΠ΅Π½ΠΈΡΡ ΡΠ°Π·Π»ΠΈΡΠ½ΡΠ΅ Π°ΡΠΏΠ΅ΠΊΡΡ Π₯ΠΠΠ, ΡΠ°ΠΊΠΈΠ΅ ΠΊΠ°ΠΊ ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅Π·, ΡΡΠΆΠ΅ΡΡΡ, ΠΏΡΠΎΠ³Π½ΠΎΠ· Π±ΠΎΠ»Π΅Π·Π½ΠΈ ΠΈ ΠΎΡΠ²Π΅Ρ Π½Π° ΡΠ΅ΡΠ°ΠΏΠΈΡ, Π±ΡΠ»ΠΈ ΠΈΠ·ΡΡΠ΅Π½Ρ Π²ΠΎ ΠΌΠ½ΠΎΠ³ΠΈΡ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡΡ [Barnes et al., 2006, Cazzola & Novelli, 2010], ΠΎΠ΄Π½Π°ΠΊΠΎ ΠΏΠΎ ΠΌΠ΅ΡΠ΅ Π½Π°ΠΊΠΎΠΏΠ»Π΅Π½ΠΈΡ ΠΎΠ±ΡΠ΅ΠΌΠ° Π΄Π°Π½Π½ΡΡ Π²ΠΎΠ·Π½ΠΈΠΊΠ»ΠΎ ΠΌΠ½ΠΎΠ³ΠΎ ΡΠ»ΠΎΠΆΠ½ΠΎΡΡΠ΅ΠΉ ΠΏΠΎ ΠΈΡ ΠΈΠ½ΡΠ΅ΡΠΏΡΠ΅ΡΠ°ΡΠΈΠΈ, Π²ΠΎΡΠΏΡΠΎΠΈΠ·Π²ΠΎΠ΄ΠΈΠΌΠΎΡΡΠΈ ΠΈ ΠΊΠΎΡΡΠ΅Π»ΡΡΠΈΠΈ Ρ Π΄ΡΡΠ³ΠΈΠΌΠΈ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠ°ΠΌΠΈ Π₯ΠΠΠ [Ilyin 2004, Cazzola & Novelli, 2010]. Π ΡΠ²ΡΠ·ΠΈ Ρ ΡΡΠΈΠΌ, Π΄Π°Π»ΡΠ½Π΅ΠΉΡΠ΅Π΅ ΠΈΠ·ΡΡΠ΅Π½ΠΈΠ΅ ΠΏΡΠΎΡΠΈΠ»Ρ Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² ΡΠ²Π»ΡΠ΅ΡΡΡ Π½Π΅ΠΎΠ±Ρ ΠΎΠ΄ΠΈΠΌΠΎΠΉ ΠΈ Π²Π°ΠΆΠ½ΠΎΠΉ Π·Π°Π΄Π°ΡΠ΅ΠΉ Π΄Π»Ρ Π²Π΅ΡΠΈΡΠΈΠΊΠ°ΡΠΈΠΈ ΠΏΡΠΈΡΠΈΠ½ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΡ Π₯ΠΠΠ ΠΈ ΠΏΠΎΠΈΡΠΊΠ° Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΡΡ Π²Π·Π°ΠΈΠΌΠΎΡΠ²ΡΠ·Π΅ΠΉ Ρ ΠΎΡΠΈΠ΅Π½ΡΠΈΡΠΎΠ²Π°Π½Π½ΡΠΌΠΈ Π½Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ°ΠΌΠΈ.
Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ: — ΠΈΠ·ΡΡΠΈΡΡ ΠΏΡΠΈΡΠΈΠ½Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΡ, ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ ΠΈΡ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΊΠ°ΡΡΠΈΠ½Ρ, ΡΠ΅ΡΠ΅Π½ΠΈΡ, ΠΏΡΠΎΠ³Π½ΠΎΠ·Π° ΠΈ ΠΏΡΠΎΠ²Π΅ΡΡΠΈ ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡΠ½ΡΡ ΠΎΡΠ΅Π½ΠΊΡ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΈ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΎΠΉ Π·Π½Π°ΡΠΈΠΌΠΎΡΡΠΈ ΡΡΠ²ΠΎΡΠΎΡΠΎΡΠ½ΡΡ Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ Π₯ΠΠΠ.
ΠΠ°Π΄Π°ΡΠΈ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ:
1. ΠΠ·ΡΡΠΈΡΡ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ ΡΠ΅ΡΠ΅Π½ΠΈΡ, Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΡΡ ΠΈ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΡΡ ΡΠΎΠ»Ρ ΡΡΠ²ΠΎΡΠΎΡΠΎΡΠ½ΡΡ Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² Π²ΠΎΡΠΏΠ°Π»Π΅Π½ΠΈΡ (CRP, IL-6, TNF-a) ΠΏΡΠΈ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΡΡ Π₯ΠΠΠ, Π²ΡΠ·Π²Π°Π½Π½ΡΡ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΡΠΌΠΈ ΠΏΡΠΈΡΠΈΠ½Π°ΠΌΠΈ (ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ Π½ΠΈΠΆΠ½ΠΈΡ Π΄ΡΡ Π°ΡΠ΅Π»ΡΠ½ΡΡ ΠΏΡΡΠ΅ΠΉ, Π²Π½Π΅Π±ΠΎΠ»ΡΠ½ΠΈΡΠ½Π°Ρ ΠΈ Π½ΠΎΠ·ΠΎΠΊΠΎΠΌΠΈΠ°Π»ΡΠ½Π°Ρ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ).
2. ΠΡΠ΅Π½ΠΈΡΡ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΡΡ ΠΈ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΡΡ ΡΠΎΠ»Ρ Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎΠΉ Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΠΈ (Nt-pro-BNP, BNP-fragment) ΠΏΡΠΈ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΈ Π₯ΠΠΠ.
3. ΠΠ·ΡΡΠΈΡΡ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΡΡ ΠΈ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΡΡ Π·Π½Π°ΡΠΈΠΌΠΎΡΡΡ Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π° (Troponin I, H-FABP) ΠΏΡΠΈ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΈ Π₯ΠΠΠ.
4. ΠΠ·ΡΡΠΈΡΡ ΡΠ°ΡΡΠΎΡΡ, ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ ΠΈ ΠΈΡΡ ΠΎΠ΄Ρ Π’ΠΠΠ, Π° ΡΠ°ΠΊΠΆΠ΅ ΡΠΎΠ»Ρ Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² (D-Π΄ΠΈΠΌΠ΅Ρ, Nt-proBNP) Π² Π΅Π΅ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ΅ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ Π₯ΠΠΠ.
5. ΠΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°ΡΡ Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΡ Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΠ° Π»Π΅ΠΏΡΠΈΠ½Π° ΡΡΠ²ΠΎΡΠΎΡΠΊΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ Π₯ΠΠΠ ΠΏΡΠΈ ΡΠΈΠ½Π΄ΡΠΎΠΌΠ΅ Π°Π»ΡΠ²Π΅ΠΎΠ»ΡΡΠ½ΠΎΠΉ Π³ΠΈΠΏΠΎΠ²Π΅Π½ΡΠΈΠ»ΡΡΠΈΠΈ.
ΠΠ°ΡΡΠ½Π°Ρ Π½ΠΎΠ²ΠΈΠ·Π½Π°:
ΠΠΏΠ΅ΡΠ²ΡΠ΅ ΠΏΠΎΠΊΠ°Π·Π°Π½ΠΎ, ΡΡΠΎ:
— Π‘-ΡΠ΅Π°ΠΊΡΠΈΠ²Π½ΡΠΉ ΠΏΡΠΎΡΠ΅ΠΈΠ½ (CRP) ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΡΠΌ ΠΈ ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ½ΡΠΌ ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠΌ Π΄Π»Ρ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ Π±Π°ΠΊΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ ΠΈ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ: ΠΏΠΎΡΠΎΠ³ΠΎΠ²ΠΎΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ CRP Π΄Π»Ρ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ Π±Π°ΠΊΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ Π₯ΠΠΠ ΡΠΎΡΡΠ°Π²Π»ΡΠ΅Ρ >16,5 ΠΌΠ³/Π» (ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ 93%, ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ½ΠΎΡΡΡ 93%), ΠΏΠΎΡΠΎΠ³ΠΎΠ²ΠΎΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅.
CRP Π΄Π»Ρ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ ΡΠΎΡΡΠ°Π²Π»ΡΠ΅Ρ >51,5 ΠΌΠ³/Π» (ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ 87%, ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ½ΠΎΡΡΡ 91%);
— 30-Π΄Π½Π΅Π²Π½Π°Ρ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΡΡΡ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ Ρ Π²Π½Π΅Π±ΠΎΠ»ΡΠ½ΠΈΡΠ½ΠΎΠΉ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠ΅ΠΉ ΠΌΠΎΠΆΠ΅Ρ Π±ΡΡΡ ΠΏΡΠ΅Π΄ΡΠΊΠ°Π·Π°Π½Π° ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΠ΅ΠΉ CRP Π½Π° ΠΌΠΎΠΌΠ΅Π½Ρ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ ΠΈ ΠΈΠ½Π΄Π΅ΠΊΡΠΎΠΌ ΠΊΠΎΠΌΠΎΡΠ±ΠΈΠ΄Π½ΠΎΡΡΠΈ Charlson- 6 ΠΌΠ΅ΡΡΡΠ½Π°Ρ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΡΡΡ — ΠΈΠ½Π΄Π΅ΠΊΡΠΎΠΌ ΠΊΠΎΠΌΠΎΡΠ±ΠΈΠ΄Π½ΠΎΡΡΠΈ Charlson;
— ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΎΡΠ°ΠΌΠΈ ΠΏΠΎΠ²ΡΠΎΡΠ½ΠΎΠΉ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ Π±ΠΎΠ»ΡΠ½ΡΡ ΠΏΠΎΡΠ»Π΅ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΡ Π₯ΠΠΠ Π² ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ 6 ΠΌΠ΅Ρ ΡΠ²Π»ΡΡΡΡΡ ΠΈΠ½Π΄Π΅ΠΊΡ ΠΊΠΎΠΌΠΎΡΠ±ΠΈΠ΄Π½ΠΎΡΡΠΈ Charlson, ΡΠ°ΡΡΠΎΡΠ° ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΉ Π₯ΠΠΠ >3 ΡΠ°Π· Π² Π³ΠΎΠ΄ ΠΈ ΠΊΡΠ°ΠΉΠ½Π΅ ΡΡΠΆΠ΅Π»ΠΎΠ΅ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ Π₯ΠΠΠ (ΡΡ. IV ΠΏΠΎ ΠΊΠ»Π°ΡΡΠΈΡΠΈΠΊΠ°ΡΠΈΠΈ GOLD);
— ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΠΈ Nt-proBNP ΠΈ BNP-fragment ΡΠ²Π»ΡΡΡΡΡ ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΎΡΠ°ΠΌΠΈ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΡΠ½ΠΎΠΉ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΡΡΠΈ ΠΎΡ Π²ΡΠ΅Ρ ΠΏΡΠΈΡΠΈΠ½ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ Π₯ΠΠΠ;
— Π²ΡΡΠ²Π»Π΅Π½Π½ΡΠ΅ ΠΊΠΎΡΡΠ΅Π»ΡΡΠΈΠΎΠ½Π½ΡΠ΅ ΡΠ²ΡΠ·ΠΈ ΡΠΊΠ°Π·ΡΠ²Π°ΡΡ Π½Π° Π°ΡΡΠΎΡΠΈΠ°ΡΠΈΡ ΠΏΠΎΠ²ΡΡΠ΅Π½Π½ΡΡ ΡΡΠΎΠ²Π½Π΅ΠΉ Nt-proBNP ΠΈ BNP-fragment Ρ Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΠΉ ΠΏΡΠ°Π²ΠΎΠ³ΠΎ ΠΈ Π»Π΅Π²ΠΎΠ³ΠΎ ΠΆΠ΅Π»ΡΠ΄ΠΎΡΠΊΠΎΠ², Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π³ΠΈΠΏΠ΅ΡΡΠ΅Π½Π·ΠΈΠ΅ΠΉ, Ρ Π³ΠΈΠΏΠΎΠΊΡΠ΅ΠΌΠΈΠ΅ΠΉ ΠΏΡΠΈ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΈ Π₯ΠΠΠ;
— ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΠΈ Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π° (H-FABP ΠΈ Tn I) ΠΏΠΎΠ²ΡΡΠ°ΡΡΡΡ ΠΏΡΠΈ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΡΡ Π₯ΠΠΠ, Π²ΡΠ·Π²Π°Π½Π½ΡΡ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΡΠΌΠΈ ΡΠ°ΠΊΡΠΎΡΠ°ΠΌΠΈ ΠΈ Π΄Π΅ΠΊΠΎΠΌΠΏΠ΅Π½ΡΠ°ΡΠΈΠ΅ΠΉ Ρ ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΠΈ;
— ΠΏΡΠΈ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΈ Π₯ΠΠΠ ΠΏΠΎΠ²ΡΡΠ΅Π½Π½ΡΠ΅ ΡΡΠΎΠ²Π½ΠΈ Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π° (H-FABP ΠΈ Tn I) Π°ΡΡΠΎΡΠΈΠΈΡΠΎΠ²Π°Π½Ρ Ρ 30-Π΄Π½Π΅Π²Π½ΠΎΠΉ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΡΡΡΡ ΠΎΡ Π²ΡΠ΅Ρ ΠΏΡΠΈΡΠΈΠ½;
— Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΡΡΡ ΠΎΡ Π²ΡΠ΅Ρ ΠΏΡΠΈΡΠΈΠ½ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ Π² ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ 6 ΠΌΠ΅Ρ ΠΏΠΎΡΠ»Π΅ ΡΠΏΠΈΠ·ΠΎΠ΄Π° ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΡ ΠΎΠΏΡΠ΅Π΄Π΅Π»ΡΠ΅ΡΡΡ ΡΡΠΎΠ²Π½ΡΠΌΠΈ BNP-fragment Π²ΠΎ Π²ΡΠ΅ΠΌΡ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ ΠΈ ΡΠ°ΡΡΠΎΡΠΎΠΉ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΡ Π±ΠΎΠ»Π΅Π·Π½ΠΈ > 3 ΡΠ°Π· Π² Π³ΠΎΠ΄;
— Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΠ° ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΠΈ Π»Π΅ΠΏΡΠΈΠ½Π° ΡΡΠ²ΠΎΡΠΎΡΠΊΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ Π₯ΠΠΠ ΠΈ ΡΠΈΠ½Π΄ΡΠΎΠΌΠΎΠΌ Π°Π»ΡΠ²Π΅ΠΎΠ»ΡΡΠ½ΠΎΠΉ Π³ΠΈΠΏΠΎΠ²Π΅Π½ΡΠΈΠ»ΡΡΠΈΠΈ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΠΏΡΠΎΠ³Π½ΠΎΠ·ΠΈΡΠΎΠ²Π°ΡΡ ΡΡΡΠ΅ΠΊΡΡ ΡΠ΅ΡΠΏΠΈΡΠ°ΡΠΎΡΠ½ΠΎΠΉ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠΈ Π²ΠΎ Π²ΡΠ΅ΠΌΡ ΡΠΏΠΈΠ·ΠΎΠ΄Π° ΠΠΠ.
ΠΡΠ°ΠΊΡΠΈΡΠ΅ΡΠΊΠ°Ρ Π·Π½Π°ΡΠΈΠΌΠΎΡΡΡ:
ΠΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠ΅ CRP ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΠ΅Π½Π½ΡΠΌ ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠΌ Π΄Π»Ρ ΡΠΊΡΠΈΠ½ΠΈΠ½Π³Π° ΠΈ ΠΏΠΎΠ΄ΡΠ²Π΅ΡΠΆΠ΄Π΅Π½ΠΈΡ Π°ΠΊΡΠΈΠ²Π½ΠΎΠ³ΠΎ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΡ Π₯ΠΠΠ, Π²Π½Π΅Π±ΠΎΠ»ΡΠ½ΠΈΡΠ½ΠΎΠΉ ΠΈ Π½ΠΎΠ·ΠΎΠΊΠΎΠΌΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ, ΡΡΠΎ Π²Π°ΠΆΠ½ΠΎ Π΄Π»Ρ ΡΠ΅ΡΠ΅Π½ΠΈΡ ΡΠ°ΠΊΡΠΈΠΊΠΈ Π»Π΅ΡΠ΅Π½ΠΈΡ Ρ Π΄Π°Π½Π½ΠΎΠΉ ΠΊΠ°ΡΠ΅Π³ΠΎΡΠΈΠΈ Π±ΠΎΠ»ΡΠ½ΡΡ .
Π£ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ Ρ Π²Π½Π΅Π±ΠΎΠ»ΡΠ½ΠΈΡΠ½ΠΎΠΉ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠ΅ΠΉ ΠΎΡΠΌΠ΅ΡΠ΅Π½ΠΎ Π±ΠΎΠ»Π΅Π΅ Π·Π½Π°ΡΠΈΠΌΠΎΠ΅ ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΠ΅ ΡΠ΅ΠΌΠΏΠ΅ΡΠ°ΡΡΡΡ ΡΠ΅Π»Π°, Π±ΠΎΠ»Π΅Π΅ ΡΠ°ΡΡΡΠ΅ ΠΎΠ·Π½ΠΎΠ±Ρ ΠΈ Π±ΠΎΠ»ΠΈ Π² Π³ΡΡΠ΄Π½ΠΎΠΉ ΠΊΠ»Π΅ΡΠΊΠ΅, ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ Π±ΠΎΠ»ΡΠ½ΡΠΌΠΈ Π₯ΠΠΠ Π±Π΅Π· ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ. ΠΠ°Π»ΠΈΡΠΈΠ΅ Π²Π½Π΅Π±ΠΎΠ»ΡΠ½ΠΈΡΠ½ΠΎΠΉ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ ΡΡ ΡΠ΄ΡΠ°Π΅Ρ ΠΏΡΠΎΠ³Π½ΠΎΠ· Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ.
ΠΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΠΈ NT-pro-BNP ΠΈ BNP-fragment Π·Π½Π°ΡΠΈΠΌΠΎ ΠΏΠΎΠ²ΡΡΠ΅Π½Ρ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ Π₯ΠΠΠ ΠΈ Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π³ΠΈΠΏΠ΅ΡΡΠ΅Π½Π·ΠΈΠ΅ΠΉ, Π° ΡΠ°ΠΊΠΆΠ΅ Ρ ΡΠΈΡΡΠΎΠ»ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΠ΅ΠΉ Π»Π΅Π²ΠΎΠ³ΠΎ ΠΆΠ΅Π»ΡΠ΄ΠΎΡΠΊΠ°. ΠΠΎΠ²ΡΡΠ΅Π½ΠΈΠ΅ ΡΡΠΎΠ²Π½Π΅ΠΉ NT-pro-BNP ΠΈ BNP-fragment ΡΠ²Π»ΡΠ΅ΡΡΡ Π½Π΅Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΡΠΌ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΠΌ ΡΠ°ΠΊΡΠΎΡΠΎΠΌ Π΄Π»Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ Π₯ΠΠΠ. ΠΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠ΅ Π₯ΠΠΠ ΡΠΎΠΏΡΠΎΠ²ΠΎΠΆΠ΄Π°Π΅ΡΡΡ ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΠ΅ΠΌ ΡΡΠΎΠ²Π½Π΅ΠΉ Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π° (H-FABP ΠΈ Tn I), ΡΡΠΎ ΡΠ°ΠΊΠΆΠ΅ ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΎΡΠΎΠΌ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΡΠ½ΠΎΠΉ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΡΡΠΈ Π±ΠΎΠ»ΡΠ½ΡΡ Ρ Π₯ΠΠΠ.
ΠΡΠ΅Π½ΠΊΠ° Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ Π»Π΅ΠΏΡΠΈΠ½Π΅ΠΌΠΈΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Ρ Π₯ΠΠΠ ΠΈ ΡΠΈΠ½Π΄ΡΠΎΠΌΠΎΠΌ Π°Π»ΡΠ²Π΅ΠΎΠ»ΡΡΠ½ΠΎΠΉ Π³ΠΈΠΏΠΎΠ²Π΅Π½ΡΠΈΠ»ΡΡΠΈΠΈ ΠΏΡΠΈ ΡΠ°Π·Π²ΠΈΡΠΈΠΈ ΠΎΡΡΡΠΎΠΉ Π³ΠΈΠΏΠ΅ΡΠΊΠ°ΠΏΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π΄ΡΡ Π°ΡΠ΅Π»ΡΠ½ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΠΈ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΠΏΡΠΎΠ³Π½ΠΎΠ·ΠΈΡΠΎΠ²Π°ΡΡ ΡΡΡΠ΅ΠΊΡΡ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΎΠΉ Π²Π΅Π½ΡΠΈΠ»ΡΡΠΈΠΈ Π»Π΅Π³ΠΊΠΈΡ ΠΈ ΠΏΠΎΠΌΠΎΠ³Π°Π΅Ρ ΠΊΠΎΡΡΠ΅ΠΊΡΠΈΡΠΎΠ²Π°ΡΡ Π΅Π΅ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΡ.
ΠΡΠ½ΠΎΠ²Π½ΡΠ΅ ΠΏΠΎΠ»ΠΎΠΆΠ΅Π½ΠΈΡ Π΄ΠΈΡΡΠ΅ΡΡΠ°ΡΠΈΠΈ, Π²ΡΠ½ΠΎΡΠΈΠΌΡΠ΅ Π½Π° Π·Π°ΡΠΈΡΡ:
ΠΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠ΅ Π₯ΠΠΠ Ρ Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΡΠ΅ΡΡΡ ΡΡΠΈΠ»Π΅Π½ΠΈΠ΅ΠΌ Π»ΠΎΠΊΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΈ ΡΠΈΡΡΠ΅ΠΌΠ½ΠΎΠ³ΠΎ Π²ΠΎΡΠΏΠ°Π»Π΅Π½ΠΈΡ, Π° ΡΠ°ΠΊΠΆΠ΅ ΠΏΠΎΠ²ΡΡΠ΅Π½Π½ΡΠΌ ΡΠΈΡΠΊΠΎΠΌ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎΡΠΎΡΡΠ΄ΠΈΡΡΡΡ ΡΠΎΠ±ΡΡΠΈΠΉ.
ΠΠ·ΡΡΠ΅Π½Π½ΡΠΉ ΡΠΏΠ΅ΠΊΡΡ Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² ΠΎΡΡΠ°ΠΆΠ°Π΅Ρ ΡΠΎΠ»Ρ ΡΠ°Π·Π»ΠΈΡΠ½ΡΡ Π»Π΅Π³ΠΎΡΠ½ΡΡ ΠΈ Π²Π½Π΅Π»Π΅Π³ΠΎΡΠ½ΡΡ ΡΠ°ΠΊΡΠΎΡΠΎΠ² Π² ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅Π·Π΅ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΡ Π₯ΠΠΠ ΠΈ ΠΈΡ ΡΠ²ΡΠ·Ρ Ρ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ΠΌ ΠΈ ΠΏΡΠΎΠ³Π½ΠΎΠ·ΠΎΠΌ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ.
ΠΠ·ΡΡΠ΅Π½Π½ΡΠ΅ ΠΌΠ°ΡΠΊΠ΅ΡΡ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΡΡ ΠΏΡΠΎΠ³Π½ΠΎΠ·ΠΈΡΠΎΠ²Π°ΡΡ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ Π±ΠΎΠ»Π΅Π·Π½ΠΈ (CRP, Nt-proBNP, BNP-fragment, Troponin I, H-FABP, Π»Π΅ΠΏΡΠΈΠ½, D-Π΄ΠΈΠΌΠ΅Ρ), ΠΌΠΎΠ½ΠΈΡΠΎΡΠΈΡΠΎΠ²Π°ΡΡ ΡΡΡΠ΅ΠΊΡΡ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ (CRP, Π»Π΅ΠΏΡΠΈΠ½) — ΠΏΡΠΎΠ³Π½ΠΎΠ·ΠΈΡΠΎΠ²Π°ΡΡ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΈΡΡ ΠΎΠ΄Ρ (CRP, Nt-proBNP, BNP-fragment, Troponin I, H-FABP, Π»Π΅ΠΏΡΠΈΠ½) — ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΡΡ ΠΌΠΎΠ½ΠΈΡΠΎΡΠΈΠ½Π³ Π½Π΅Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΡΡ ΡΠ΅Π°ΠΊΡΠΈΠΉ (CRP, Nt-proBNP, BNP-fagment, Troponin I, H-FABP, Π»Π΅ΠΏΡΠΈΠ½), Π²ΡΡΠ²Π»ΡΡΡ Π½ΠΎΠ²ΡΠ΅ Π±ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΌΠ΅Ρ Π°Π½ΠΈΠ·ΠΌΡ, ΡΡΠ°ΡΡΠ²ΡΡΡΠΈΠ΅ Π² ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅Π·Π΅ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΡ Π₯ΠΠΠ (CRP, Nt-proBNP, BNP-fragment, Troponin I, H-FABP, Π»Π΅ΠΏΡΠΈΠ½, D-Π΄ΠΈΠΌΠ΅Ρ), ΠΈ ΡΠ°ΡΡΠΌΠ°ΡΡΠΈΠ²Π°ΡΡ Π²ΠΎΠΏΡΠΎΡΡ ΠΎ ΠΊΠΎΡΡΠ΅ΠΊΡΠΈΠΈ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ (CRP, BNP-fragment, Troponin I, H-FABP, Π»Π΅ΠΏΡΠΈΠ½).
Π‘Π²ΡΠ·Ρ ΡΠ°Π±ΠΎΡΡ Ρ Π½Π°ΡΡΠ½ΡΠΌΠΈ ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΠ°ΠΌΠΈ.
ΠΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΎ Π² ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΠΈΠΈ Ρ ΠΏΠ»Π°Π½ΠΎΠΌ Π½Π°ΡΡΠ½ΠΎ-ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°ΡΠ΅Π»ΡΡΠΊΠΎΠΉ ΡΠ°Π±ΠΎΡΡ Π€ΠΠ£ «ΠΠΠ ΠΏΡΠ»ΡΠΌΠΎΠ½ΠΎΠ»ΠΎΠ³ΠΈΠΈ» Π€ΠΠΠ Π ΠΎΡΡΠΈΠΈ (Π½ΠΎΠΌΠ΅Ρ Π³ΠΎΡΡΠ΄Π°ΡΡΡΠ²Π΅Π½Π½ΠΎΠΉ ΡΠ΅Π³ΠΈΡΡΡΠ°ΡΠΈΠΈ ΡΠ΅ΠΌΡ 1 201 180 319).
ΠΠ½Π΅Π΄ΡΠ΅Π½ΠΈΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ.
Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ, ΠΏΠΎΠ»ΡΡΠ΅Π½Π½ΡΠ΅ Π² Ρ ΠΎΠ΄Π΅ ΡΠ°Π±ΠΎΡΡ Π½Π°Π΄ Π΄ΠΈΡΡΠ΅ΡΡΠ°ΡΠΈΠ΅ΠΉ, Π²Π½Π΅Π΄ΡΠ΅Π½Ρ Π² ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΡΡ ΡΠ°Π±ΠΎΡΡ ΠΏΡΠ»ΡΠΌΠΎΠ½ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΈ 1-Π³ΠΎ ΠΈ 2-Π³ΠΎ ΡΠ΅ΡΠ°ΠΏΠ΅Π²ΡΠΈΡΠ΅ΡΠΊΠΈΡ ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΠΉ, ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΡ ΡΠ΅Π°Π½ΠΈΠΌΠ°ΡΠΈΠΈ ΠΈ ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΠΠ № 57 Π³. ΠΠΎΡΠΊΠ²Ρ. ΠΡΠ½ΠΎΠ²Π½ΡΠ΅ ΠΏΠΎΠ»ΠΎΠΆΠ΅Π½ΠΈΡ Π΄ΠΈΡΡΠ΅ΡΡΠ°ΡΠΈΠΈ Π²ΠΊΠ»ΡΡΠ΅Π½Ρ Π² ΡΡΠ΅Π±Π½ΡΡ ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΡ ΠΊΠ°ΡΠ΅Π΄ΡΡ ΠΏΡΠ»ΡΠΌΠΎΠ½ΠΎΠ»ΠΎΠ³ΠΈΠΈ ΠΠΠΠ£ ΠΠΠ Π ΠΠΠΠ£ ΠΈΠΌ Π. Π. ΠΠΈΡΠΎΠ³ΠΎΠ²Π° ΠΠΈΠ½Π·Π΄ΡΠ°Π²ΡΠΎΡΡΠ°Π·Π²ΠΈΡΠΈΡ Π ΠΎΡΡΠΈΠΈ.
ΠΠΏΡΠΎΠ±Π°ΡΠΈΡ ΡΠ°Π±ΠΎΡΡ.
ΠΡΠ½ΠΎΠ²Π½ΡΠ΅ ΠΏΠΎΠ»ΠΎΠΆΠ΅Π½ΠΈΡ ΡΠ°Π±ΠΎΡΡ Π΄ΠΎΠ»ΠΎΠΆΠ΅Π½Ρ ΠΈ ΠΎΠ±ΡΡΠΆΠ΄Π΅Π½Ρ Π½Π°:
— 16-ΠΌ, 17-ΠΌ, 18-ΠΌ, 19-ΠΌ, 20-ΠΌ ΠΠΆΠ΅Π³ΠΎΠ΄Π½ΠΎΠΌ ΠΠΎΠ½Π³ΡΠ΅ΡΡΠ΅ ΠΠ²ΡΠΎΠΏΠ΅ΠΉΡΠΊΠΎΠ³ΠΎ Π Π΅ΡΠΏΠΈΡΠ°ΡΠΎΡΠ½ΠΎΠ³ΠΎ ΠΠ±ΡΠ΅ΡΡΠ²Π° (ΠΠΎΠΏΠ΅Π½Π³Π°Π³Π΅Π½, 2007; ΠΡΠ½Ρ Π΅Π½, 2008; ΠΠ΅Π½Π°, 2009; ΠΠ°ΡΡΠ΅Π»ΠΎΠ½Π°, 2010, ΠΠΌΡΡΠ΅ΡΠ΄Π°ΠΌ, 2011 Π³Π³.);
— 16-ΠΌ, 17-ΠΌ, 18-ΠΌ, 19-ΠΌ, 20-ΠΌ, 21-ΠΌ ΠΠ°ΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΡ ΠΊΠΎΠ½Π³ΡΠ΅ΡΡΠ°Ρ ΠΏΠΎ Π±ΠΎΠ»Π΅Π·Π½ΡΠΌ ΠΎΡΠ³Π°Π½ΠΎΠ² Π΄ΡΡ Π°Π½ΠΈΡ (Π‘Π°Π½ΠΊΡ-ΠΠ΅ΡΠ΅ΡΠ±ΡΡΠ³, 2006; ΠΠ°Π·Π°Π½Ρ, 2007; ΠΠΊΠ°ΡΠ΅ΡΠΈΠ½Π±ΡΡΠ³, 2008; ΠΠΎΡΠΊΠ²Π°, 2009;10- Π£ΡΠ°, 2011 Π³Π³);
— ΠΠ°ΡΡΠ½ΡΡ ΡΠ΅ΡΡΠΈΡΡ Π€ΠΠ£ «ΠΠΠ ΠΏΡΠ»ΡΠΌΠΎΠ½ΠΎΠ»ΠΎΠ³ΠΈΠΈ» Π€ΠΠΠ Π ΠΎΡΡΠΈΠΈ (ΠΠΎΡΠΊΠ²Π° 2007, 2008, 2009, 2010, 2011 Π³Π³.);
— Π‘ΠΎΠ²ΠΌΠ΅ΡΡΠ½ΠΎΠΌ Π·Π°ΡΠ΅Π΄Π°Π½ΠΈΠΈ Π€ΠΠ£ «ΠΠΠ ΠΏΡΠ»ΡΠΌΠΎΠ½ΠΎΠ»ΠΎΠ³ΠΈΠΈ» Π€ΠΠΠ Π ΠΎΡΡΠΈΠΈ ΠΈ ΠΊΠ°ΡΠ΅Π΄ΡΡ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΏΠ΅Π΄ΠΈΠ°ΡΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠ°ΠΊΡΠ»ΡΡΠ΅ΡΠ° ΠΠΠ£ ΠΠΠ Π ΠΠΠ£ ΠΈΠΌ. Π. Π. ΠΠΈΡΠΎΠ³ΠΎΠ²Π° ΠΠΈΠ½Π·Π΄ΡΠ°Π²Π° Π Π€ (ΠΠΎΡΠΊΠ²Π°, 2009, 2010, 2011 Π³.).
ΠΡΠ±Π»ΠΈΠΊΠ°ΡΠΈΠΈ.
ΠΠΎ ΡΠ΅ΠΌΠ΅ Π΄ΠΈΡΡΠ΅ΡΡΠ°ΡΠΈΠΈ ΠΎΠΏΡΠ±Π»ΠΈΠΊΠΎΠ²Π°Π½ΠΎ 35 ΠΏΠ΅ΡΠ°ΡΠ½ΡΡ Π½Π°ΡΡΠ½ΡΡ ΡΠ°Π±ΠΎΡ Π² ΠΎΡΠ΅ΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΡ ΠΈ Π·Π°ΡΡΠ±Π΅ΠΆΠ½ΡΡ ΠΈΠ·Π΄Π°Π½ΠΈΡΡ , ΠΈΠ· ΠΊΠΎΡΠΎΡΡΡ 14 — ΡΡΠ°ΡΡΠΈ Π² ΠΆΡΡΠ½Π°Π»Π°Ρ , Π²Ρ ΠΎΠ΄ΡΡΠΈΡ Π² ΠΏΠ΅ΡΠ΅ΡΠ΅Π½Ρ Π²Π΅Π΄ΡΡΠΈΡ ΡΠ΅ΡΠ΅Π½Π·ΠΈΡΡΠ΅ΠΌΡΡ Π½Π°ΡΡΠ½ΡΡ ΠΆΡΡΠ½Π°Π»ΠΎΠ² ΠΈ ΠΈΠ·Π΄Π°Π½ΠΈΠΉ, ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄ΠΎΠ²Π°Π½Π½ΡΡ ΠΠΠ Π Π€.
ΠΠ±ΡΠ΅ΠΌ ΠΈ ΡΡΡΡΠΊΡΡΡΠ° ΡΠ°Π±ΠΎΡΡ.
ΠΠΈΡΡΠ΅ΡΡΠ°ΡΠΈΡ ΠΈΠ·Π»ΠΎΠΆΠ΅Π½Π° Π½Π° 214 ΡΡΡΠ°Π½ΠΈΡΠ°Ρ ΠΌΠ°ΡΠΈΠ½ΠΎΠΏΠΈΡΠΈ. Π‘ΠΎΡΡΠΎΠΈΡ ΠΈΠ· Π²Π²Π΅Π΄Π΅Π½ΠΈΡ, Π³Π»Π°Π²: ΠΎΠ±Π·ΠΎΡ Π»ΠΈΡΠ΅ΡΠ°ΡΡΡΡ, ΠΌΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ, ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΡΠΎΠ±ΡΡΠ²Π΅Π½Π½ΡΡ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ, ΠΎΠ±ΡΡΠΆΠ΄Π΅Π½ΠΈΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ², Π·Π°ΠΊΠ»ΡΡΠ΅Π½ΠΈΡ, Π²ΡΠ²ΠΎΠ΄ΠΎΠ², ΠΏΡΠ°ΠΊΡΠΈΡΠ΅ΡΠΊΠΈΡ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΠΉ, ΠΏΡΠΈΠ»ΠΎΠΆΠ΅Π½ΠΈΡ. ΠΠ»Π»ΡΡΡΡΠΈΡΠΎΠ²Π°Π½Π° 15 ΡΠΈΡΡΠ½ΠΊΠ°ΠΌΠΈ ΠΈ 52 ΡΠ°Π±Π»ΠΈΡΠ°ΠΌΠΈ. ΠΠΈΠ±Π»ΠΈΠΎΠ³ΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠΊΠ°Π·Π°ΡΠ΅Π»Ρ ΡΠΎΠ΄Π΅ΡΠΆΠΈΡ 26 ΠΎΡΠ΅ΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΡ ΠΈ 411 Π·Π°ΡΡΠ±Π΅ΠΆΠ½ΡΡ ΠΈΡΡΠΎΡΠ½ΠΈΠΊΠΎΠ². ΠΠΈΡΡΠ΅ΡΡΠ°ΡΠΈΡ ΠΈΠ·Π»ΠΎΠΆΠ΅Π½Π° Π½Π° ΡΡΡΡΠΊΠΎΠΌ ΡΠ·ΡΠΊΠ΅.
Π²ΡΠ²ΠΎΠ΄Ρ.
1. ΠΠ½Π΅Π±ΠΎΠ»ΡΠ½ΠΈΡΠ½Π°Ρ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΡ ΠΊΠ°ΠΊ ΠΏΡΠΈΡΠΈΠ½Π° ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΡ Π₯ΠΠΠ Π²ΡΡΡΠ΅ΡΠ°Π΅ΡΡΡ Π² -19% Π²ΡΠ΅Ρ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠΉ. ΠΠ΅Π·Π°Π²ΠΈΡΠΈΠΌΡΠΌΠΈ ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΎΡΠ°ΠΌΠΈ 30-Π΄Π½Π΅Π²Π½ΠΎΠΉ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΡΡΠΈ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ Ρ ΠΠ ΡΠ²Π»ΡΡΡΡΡ ΡΡΠΎΠ²Π½ΠΈ CRP Π½Π° ΠΌΠΎΠΌΠ΅Π½Ρ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ ΠΈ ΠΈΠ½Π΄Π΅ΠΊΡ ΠΊΠΎΠΌΠΎΡΠ±ΠΈΠ΄Π½ΠΎΡΡΠΈ Charlson. ΠΡΠ΅Π΄ΠΈΠΊΡΠΎΡΠ°ΠΌΠΈ ΠΏΠΎΠ²ΡΠΎΡΠ½ΠΎΠΉ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ Π² ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ 6 ΠΌΠ΅ΡΡΡΠ΅Π² ΡΠ²Π»ΡΡΡΡΡ ΠΈΠ½Π΄Π΅ΠΊΡ ΠΊΠΎΠΌΠΎΡΠ±ΠΈΠ΄Π½ΠΎΡΡΠΈ Charlson, ΡΠ°ΡΡΠΎΡΠ° ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΉ Π₯ΠΠΠ > 3 ΡΠ°Π· Π² Π³ΠΎΠ΄ ΠΈ ΠΊΡΠ°ΠΉΠ½Π΅ ΡΡΠΆΠ΅Π»ΠΎΠ΅ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ Π₯ΠΠΠ (ΡΡΠ°Π΄ΠΈΡ IV ΠΏΠΎ ΠΊΠ»Π°ΡΡΠΈΡΠΈΠΊΠ°ΡΠΈΠΈ GOLD).
2. ΠΠΎΠ·ΠΎΠΊΠΎΠΌΠΈΠ°Π»ΡΠ½Π°Ρ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΡ ΡΡΠ΅Π΄ΠΈ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΡΡ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ Π²ΡΡΠ²Π»Π΅Π½Π° Π² 12% Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠΉ. Π£ΡΠΎΠ²Π΅Π½Ρ ΡΡΠ²ΠΎΡΠΎΡΠΎΡΠ½ΠΎΠ³ΠΎ CRP Π·Π½Π°ΡΠΈΠΌΠΎ ΠΏΠΎΠ²ΡΡΠ°Π΅ΡΡΡ ΠΏΡΠΈ ΡΠ°Π·Π²ΠΈΡΠΈΠΈ Π½ΠΎΠ·ΠΎΠΊΠΎΠΌΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ ΠΈΡΡ ΠΎΠ΄Π½ΡΠΌΠΈ Π·Π½Π°ΡΠ΅Π½ΠΈΡΠΌΠΈ CRP Π² ΠΏΠ΅ΡΠ²ΡΠ΅ Π΄Π½ΠΈ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ. ΠΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΠΈ CRP ΠΏΡΠΈ ΡΠ°Π·Π²ΠΈΡΠΈΠΈ ΠΠ ΠΈΠΌΠ΅ΡΡ ΠΏΡΡΠΌΡΡ Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΡ ΡΠΎ ΡΠΊΠ°Π»Π°ΠΌΠΈ CPIS ΠΈ APACHE II.
3. ΠΠΎΡΠΎΠ³ΠΎΠ²ΠΎΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ CRP Π΄Π»Ρ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ Π±Π°ΠΊΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ Π₯ΠΠΠ ΡΠΎΡΡΠ°Π²Π»ΡΠ΅Ρ >16,5 ΠΌΠ³/Π» (ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ 0,931, ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ½ΠΎΡΡΡΡ 0,932).
4. ΠΠΎΡΠΎΠ³ΠΎΠ²ΡΠΉ ΡΡΠΎΠ²Π΅Π½Ρ CRP>51,5 ΠΌΠ³/Π» ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΎΡΠΎΠΌ Π½Π°Π»ΠΈΡΠΈΡ Π²Π½Π΅Π±ΠΎΠ»ΡΠ½ΠΈΡΠ½ΠΎΠΉ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ (ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ 0,870, ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ½ΠΎΡΡΡ 0,910). ΠΡΠΈ ΡΠ°Π·Π²ΠΈΡΠΈΠΈ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΠΈ ΡΡΠ²ΠΎΡΠΎΡΠΎΡΠ½ΠΎΠ³ΠΎ CRP Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΠΎ ΠΏΠΎΠ²ΡΡΠ°ΡΡΡΡ.
5. Π£ΡΠΎΠ²Π½ΠΈ NT-pro-BNP ΠΈ BNP-fragment ΠΏΠΎΠ²ΡΡΠ΅Π½Ρ Ρ Π±ΠΎΠ»ΡΡΠΈΠ½ΡΡΠ²Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ Π₯ΠΠΠ. ΠΠΎΠ²ΡΡΠ΅Π½ΠΈΠ΅ ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΠΉ NT-pro-BNP ΠΈ BNP-fragment ΠΏΡΠΈ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΈ Π₯ΠΠΠ Π½Π°Π±Π»ΡΠ΄Π°Π΅ΡΡΡ ΠΏΡΠΈ Π½Π°Π»ΠΈΡΠΈΠΈ Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π³ΠΈΠΏΠ΅ΡΡΠ΅Π½Π·ΠΈΠΈ ΠΈ ΡΠΈΡΡΠΎΠ»ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΠΈ Π»Π΅Π²ΠΎΠ³ΠΎ ΠΆΠ΅Π»ΡΠ΄ΠΎΡΠΊΠ°. ΠΠΎΠ²ΡΡΠ΅Π½ΠΈΠ΅ ΡΡΠΎΠ²Π½Π΅ΠΉ NT-pro-BNP ΠΈ BNP-fragment ΡΠ²Π»ΡΠ΅ΡΡΡ Π½Π΅Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΡΠΌ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΠΌ ΡΠ°ΠΊΡΠΎΡΠΎΠΌ Π΄Π»Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ Π₯ΠΠΠ.
6. Π£ΡΠΎΠ²Π½ΠΈ Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΠ° ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π° H-FABP ΠΏΠΎΠ²ΡΡΠ΅Π½Ρ Ρ Π±ΠΎΠ»ΡΡΠΈΠ½ΡΡΠ²Π° Π±ΠΎΠ»ΡΠ½ΡΡ Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ Π₯ΠΠΠ (92,5%). ΠΠΎΠ²ΡΡΠ΅Π½ΠΈΠ΅ Tn I (>0,5 Π½Π³/ΠΌΠ») ΠΎΡΠΌΠ΅ΡΠ΅Π½ΠΎ Π² 21,3% ΡΠ»ΡΡΠ°Π΅Π² Π²ΡΠ΅Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΉ Π₯ΠΠΠ.
7. ΠΡΠ΅Π΄ΠΈΠΊΡΠΎΡΠ°ΠΌΠΈ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΡΠ½ΠΎΠΉ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΡΡΠΈ ΠΏΡΠΈ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΈ Π₯ΠΠΠ ΡΠ²Π»ΡΡΡΡΡ ΡΡΠΎΠ²Π½ΠΈ BNP-fragment ΠΈ H-FABP.
8. ΠΠ°ΡΠΊΠ΅Ρ ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π° H-FABP Π·Π½Π°ΡΠΈΠΌΠΎ ΠΏΠΎΠ²ΡΡΠ΅Π½ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Ρ Π₯ΠΠΠ ΠΏΡΠΈ ΡΠ°Π·Π²ΠΈΡΠΈΠΈ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ Π½ΠΈΠΆΠ½ΠΈΡ Π΄ΡΡ Π°ΡΠ΅Π»ΡΠ½ΡΡ ΠΏΡΡΠ΅ΠΉ. ΠΡΡΠ²Π»Π΅Π½Π½ΡΠ΅ Π·Π½Π°ΡΠΈΠΌΡΠ΅ ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ ΠΊΠΎΡΡΠ΅Π»ΡΡΠΈΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Ρ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΡΠΌ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ (Π±ΡΠΎΠ½Ρ ΠΈΡ, ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΡ) ΠΌΠ΅ΠΆΠ΄Ρ H-FABP Ρ BNP-fragment, Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΠΎΡΡΡΡ ΠΎΠ΄ΡΡΠΊΠΈ, ΠΊΠΎΠ½Π΅ΡΠ½ΠΎ-Π΄ΠΈΡΡΠΎΠ»ΠΈΡΠ΅ΡΠΊΠΈΠΌ Π΄ΠΈΠ°ΠΌΠ΅ΡΡΠΎΠΌ Π»Π΅Π²ΠΎΠ³ΠΎ ΠΆΠ΅Π»ΡΠ΄ΠΎΡΠΊΠ° ΡΠ²ΠΈΠ΄Π΅ΡΠ΅Π»ΡΡΡΠ²ΡΡΡ ΠΎ ΠΊΠ°ΡΠ΄ΠΈΠ°Π»ΡΠ½ΠΎΠΌ ΡΡΡΠ΅ΡΡΠ΅ ΠΏΡΠΈ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΈ Π₯ΠΠΠ. ΠΠΎΠ²ΡΡΠ΅Π½Π½ΡΠ΅ ΡΡΠΎΠ²Π½ΠΈ H-FABP ΠΏΡΠΈ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ ΠΎΡΡΠ°ΠΆΠ°ΡΡ Π΅Π΅ ΡΡΠΆΠ΅ΡΡΡ. ΠΠΎΠΊΠ°Π·Π°Π½Π° ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠ°Ρ ΡΠΎΠ»Ρ H-FABP Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ Π₯ΠΠΠ.
9. ΠΡΡΠΌΡΠ΅ ΠΊΠΎΡΡΠ΅Π»ΡΡΠΈΠΈ CRP Ρ ΡΠ°Π·ΠΌΠ΅ΡΠ°ΠΌΠΈ Π»Π΅Π²ΠΎΠ³ΠΎ ΠΆΠ΅Π»ΡΠ΄ΠΎΡΠΊΠ° (ΠΊΠΎΠ½Π΅ΡΠ½ΠΎ-ΡΠΈΡΡΠΎΠ»ΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΈ ΠΊΠΎΠ½Π΅ΡΠ½ΠΎ-Π΄ΠΈΠ°ΡΡΠΎΠ»ΠΈΡΠ΅ΡΠΊΠΈΠΌ Π΄ΠΈΠ°ΠΌΠ΅ΡΡΠ°ΠΌΠΈ), ΠΎΡΡΠΈΡΠ°ΡΠ΅Π»ΡΠ½Π°Ρ ΡΠ²ΡΠ·Ρ Ρ ΡΡΠ°ΠΊΡΠΈΠ΅ΠΉ Π²ΡΠ±ΡΠΎΡΠ° Π»Π΅Π²ΠΎΠ³ΠΎ ΠΆΠ΅Π»ΡΠ΄ΠΎΡΠΊΠ° Π² Π³ΡΡΠΏΠΏΠ΅ Π±ΠΎΠ»ΡΠ½ΡΡ Ρ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠ΅ΠΉ, Π° Π² Π³ΡΡΠΏΠΏΠ΅ Π₯Π‘Π — Ρ ΡΡΠΎΠ²Π½Π΅ΠΌ BNP-fragment ΡΠ²ΠΈΠ΄Π΅ΡΠ΅Π»ΡΡΡΠ²ΡΡΡ ΠΎΠ± ΡΡΠ°ΡΡΠΈΠΈ ΡΠΈΡΡΠ΅ΠΌΠ½ΠΎΠ³ΠΎ Π²ΠΎΡΠΏΠ°Π»Π΅Π½ΠΈΡ Π² ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅Π·Π΅ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎΠΉ Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΠΈ.
10. Π§Π°ΡΡΠΎΡΠ° Π²ΡΡΡΠ΅ΡΠ°Π΅ΠΌΠΎΡΡΠΈ Π’ΠΠΠ ΠΏΡΠΈ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΈ Π₯ΠΠΠ ΡΠΎΡΡΠ°Π²Π»ΡΠ΅Ρ 3%. Π‘ΡΠΎΠΊΠΈ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ Π±ΠΎΠ»ΡΠ½ΡΡ Ρ Π’ΠΠΠ Π±ΡΠ»ΠΈ Π΄ΠΎΠ»ΡΡΠ΅, ΡΠ΅ΠΌ ΠΏΡΠΈ Π΄ΡΡΠ³ΠΈΡ ΠΏΡΠΈΡΠΈΠ½Π°Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΡ Π₯ΠΠΠ, ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΡΠ½ΠΎΠΉ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΡΡΠΈ Π½Π΅ ΡΠ°Π·Π»ΠΈΡΠ°Π»ΠΈΡΡ.
11. ΠΡΡΡΡΡΡΠ²ΠΈΠ΅ Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ Π»Π΅ΠΏΡΠΈΠ½Π΅ΠΌΠΈΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ Ρ Π°Π»ΡΠ²Π΅ΠΎΠ»ΡΡΠ½ΠΎΠΉ Π³ΠΈΠΏΠΎΠ²Π΅Π½ΡΠΈΠ»ΡΡΠΈΠ΅ΠΉ ΠΏΡΠΈ ΡΠ°Π·Π²ΠΈΡΠΈΠΈ Π³ΠΈΠΏΠ΅ΡΠΊΠ°ΠΏΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΠΠ Π°ΡΡΠΎΡΠΈΠΈΡΡΠ΅ΡΡΡ Ρ ΠΌΠ΅Π΄Π»Π΅Π½Π½ΡΠΌ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ΠΌ Π³ΠΈΠΏΠ΅ΡΠΊΠ°ΠΏΠ½ΠΈΠΈ, ΡΡΠΎ ΡΡΠ΅Π±ΡΠ΅Ρ ΠΊΠΎΡΡΠ΅ΠΊΡΠΈΠΈ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΎΠ² ΡΠ΅ΡΠΏΠΈΡΠ°ΡΠΎΡΠ½ΠΎΠΉ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠΈ.
ΠΠ ΠΠΠ’ΠΠ§ΠΠ‘ΠΠΠ Π ΠΠΠΠΠΠΠΠΠ¦ΠΠ.
1. ΠΠ»Ρ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ Π±Π°ΠΊΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ ΠΏΡΠΈ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΈ Π₯ΠΠΠ Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ CRP ΡΠΎΡΡΠ°Π²Π»ΡΠ΅Ρ >16,5 ΠΌΠ³/Π»;
2. ΠΡΠΈ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ΅ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ ΠΏΠΎΡΠΎΠ³ΠΎΠ²ΠΎΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ CRP ΡΠΎΡΡΠ°Π²Π»ΡΠ΅Ρ >51,5 ΠΌΠ³/Π».
3. ΠΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ Π΄Π»Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ Ρ ΠΠ ΠΈΠΌΠ΅ΡΡ ΡΡΠΎΠ²Π½ΠΈ CRP Π½Π° ΠΌΠΎΠΌΠ΅Π½Ρ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ ΠΈ ΠΈΠ½Π΄Π΅ΠΊΡ ΠΊΠΎΠΌΠΎΡΠ±ΠΈΠ΄Π½ΠΎΡΡΠΈ Charlson.
4. ΠΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ Π΄Π»Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ Ρ ΠΠ ΠΈΠΌΠ΅ΡΡ Π·Π½Π°ΡΠ΅Π½ΠΈΡ ΡΠΊΠ°Π»Ρ APACHE II ΠΈ ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΠΈ CRP ΠΈ IL-6 Π² ΡΡΠ²ΠΎΡΠΎΡΠΊΠ΅ ΠΊΡΠΎΠ²ΠΈ.
5. ΠΡΠΈ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ΅ Π‘Π ΠΠ ΠΏΠΎΡΠΎΠ³ΠΎΠ²ΠΎΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ ΡΡΠΎΠ²Π½Ρ Nt-proBNP ΡΠΎΡΡΠ°Π²Π»ΡΠ΅Ρ 902,1 ΡΠΌΠΎΠ»Ρ/ΠΌΠ», BNP-fragment — 943,0 ΡΠΌΠΎΠ»Ρ/ΠΌΠ».
6. ΠΡΠΈ ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΠΈ Π‘ΠΠΠ >35 ΠΌΠΌ ΡΡ ΡΡ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ ΠΏΠΎΡΠΎΠ³ΠΎΠ²ΠΎΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ ΡΡΠΎΠ²Π½Ρ Nt-proBNP ΡΠΎΡΡΠ°Π²Π»ΡΠ΅Ρ 585,2 ΡΠΌΠΎΠ»Ρ/ΠΌΠ», BNP-fragment -369,5 ΡΠΌΠΎΠ»Ρ/ΠΌΠ».
7. Π£ΡΠΎΠ²Π½ΠΈ Nt-pro-BNP >932,4 ΡΠΌΠΎΠ»Ρ/ΠΌΠ» ΠΈ BNP-fragment >1364,9 ΡΠΌΠΎΠ»Ρ/ΠΌΠ» ΡΠ²Π»ΡΡΡΡΡ Π½Π΅Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΡΠΌΠΈ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΠΌΠΈ ΡΠ°ΠΊΡΠΎΡΠ°ΠΌΠΈ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΡΡΠΈ ΠΎΡ Π²ΡΠ΅Ρ ΠΏΡΠΈΡΠΈΠ½ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ Π₯ΠΠΠ.
8. Π£ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ Π₯ΠΠΠ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈ Π½Π΅Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΡΠΌΠΈ ΡΠ°ΠΊΡΠΎΡΠ°ΠΌΠΈ ΡΠ²Π»ΡΡΡΡΡ Π·Π½Π°ΡΠ΅Π½ΠΈΡ H-FABP >6594,2 ΠΏΠ³/ΠΌΠ» ΠΈ Tn I >0,5 Π½Π³/ΠΌΠ».
9. ΠΠΈΠ½Π°ΠΌΠΈΠΊΠ° ΡΡΠ²ΠΎΡΠΎΡΠΎΡΠ½ΠΎΠ³ΠΎ Π»Π΅ΠΏΡΠΈΠ½Π° ΠΏΡΠΈ ΡΠΈΠ½Π΄ΡΠΎΠΌΠ΅ Π°Π»ΡΠ²Π΅ΠΎΠ»ΡΡΠ½ΠΎΠΉ Π³ΠΈΠΏΠΎΠ²Π΅Π½ΡΠΈΠ»ΡΡΠΈΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Π₯ΠΠΠ ΠΎΡΡΠ°ΠΆΠ°Π΅Ρ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠΌΠΎΠΉ ΡΠ΅ΡΠΏΠΈΡΠ°ΡΠΎΡΠ½ΠΎΠΉ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠΈ.
Π‘ΠΏΠΈΡΠΎΠΊ Π»ΠΈΡΠ΅ΡΠ°ΡΡΡΡ
- ΠΠ²Π΄Π΅Π΅Π² Π‘.Π., Π§ΡΡΠ°Π»ΠΈΠΈ Π. Π. ΠΠ΄ΡΡΠΊΠ°: ΠΌΠ΅Ρ Π°Π½ΠΈΠ·ΠΌΡ ΡΠ°Π·Π²ΠΈΡΠΈΡ, ΠΎΡΠ΅Π½ΠΊΠ° ΠΈ Π»Π΅ΡΠ΅Π½ΠΈΠ΅. ΠΠΎΡΠΎΠ±ΠΈΠ΅ Π΄Π»Ρ Π²ΡΠ°ΡΠ΅ΠΉ. Π., 2002- Ρ 1−25.
- ΠΠ²Π΄Π΅Π΅Π² Π‘.Π., Π§ΡΡΠ°Π»ΠΈΠ½ Π. Π. ΠΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ ΡΠΊΠ°Π» ΠΎΡΠ΅Π½ΠΊΠΈ ΡΡΠΆΠ΅ΡΡΠΈ Π² ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΈ ΠΏΡΠ»ΡΠΌΠΎΠ½ΠΎΠ»ΠΎΠ³ΠΈΠΈ. ΠΡΠ»ΡΠΌΠΎΠ½ΠΎΠ»ΠΎΠ³ΠΈΡ 2001- № 1: 84−91.
- ΠΠ²Π΄Π΅Π΅Π² Π‘.Π., Π§ΡΡΠ°Π»ΠΈΠ½ Π. Π. Π ΠΎΠ»Ρ Π±Π°ΠΊΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ ΠΈ Π²ΡΠ±ΠΎΡ Π°Π½ΡΠΈΠ±ΠΈΠΎΡΠΈΠΊΠΎΠ² ΠΏΡΠΈ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΈ Ρ ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π±ΡΠΎΠ½Ρ ΠΈΡΠ°. Consilium 2000- 2: 418−26.
- ΠΠ΅Π»ΡΡΠ°Π½Π΄ Π.Π ., ΠΠ΅Π»ΠΎΡΠ΅ΡΠΊΠΎΠ²ΡΠΊΠΈΠΉ Π. Π., ΠΡΠΎΡΠ΅Π½ΠΊΠΎ Π. Π. ΠΈ Π΄Ρ., ΠΠΎΠ·ΠΎΠΊΠΎΠΌΠΈΠ°Π»ΡΠ½Π°Ρ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΡ Π² Ρ ΠΈΡΡΡΠ³ΠΈΠΈ. ΠΠ΅ΡΠΎΠ΄ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΠΈ. ΠΠ½ΡΠ΅ΠΊΡΠΈΠΈ ΠΈ Π°Π½ΡΠΈΠΌΠΈΠΊΡΠΎΠ±Π½Π°Ρ ΡΠ΅ΡΠ°ΠΏΠΈΡ 2003- № 5−6: 124−129.
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