Вплив несприятливих факторів середовища на респіраторну захворюваність дітей з різними фенотиповими ознаками: Автореф. дис… канд. мед. наук / С.М. В

2

I?i?noa?noai ioi?iie caei?ia’y Oe?a?ie

E?einueeee aea?aeaaiee iaaee/iee oi?aa?neoao ?i.N.?.Aai?a??anueeiai

Ai?ii?i Na?a?e Ieeieaeiae/

OAeE 616.215.4-053.2/.6:612.017.1:575.21+57.045

Aieea iani?eyoeeaeo oaeoi??a na?aaeiaeua ia

?ani??aoi?io caoai?thaai?noue ae?oae

c ??cieie oaiioeiiaeie iciaeaie

14.01.10 — iaae?ao??y

Aaoi?aoa?ao

aeena?oaoe?? ia caeiaoooy iaoeiaiai nooiaiy

eaiaeeaeaoa iaaee/ieo iaoe

N?ioa?iiieue — 1999

Aeena?oaoe??th ? ?oeiien

?iaioa aeeiiaia a E?einueeiio aea?aeaaiiio iaaee/iiio oi?aa?neoao?
?i.N.?.Aai?a??anueeiai I?i?noa?noaa ioi?iie caei?ia’y Oe?a?ie

Iaoeiaee ea??aiee — Eiaaoeue Oaoyia Aieiaeeie??aia, aeieoi? iaaee/ieo
iaoe, E?einueeee aea?aeaaiee iaaee/iee oi?aa?neoao
?i.N.?.Aai?a??anueeiai, i?ioani? eaoaae?e aini?oaeueii? iaae?ao???

Coaa??a Aaeaioei Eueaiae/, aeieoi? iaaee/ieo iaoe, i?ioani? eaoaae?e
aini?oaeueii? iaae?ao??? E?einueeiai aea?aeaaiiai iaaee/iiai
oi?aa?neoaoo ?i. N.?. Aai?a??anueeiai

Eaaaae?aa Oaoyia Aai?a??aia, aeieoi? iaaee/ieo iaoe, i?ioani?, noa?oee
iaoeiaee ni?a?ia?oiee E?einueeiai IAe? o?ce/ieo iaoiae?a e?eoaaiiy ?
iaaee/ii? ee?iaoieia?? ?i. ?.I.N?/?iiaa

I?ia?aeia onoaiiaa: Oe?a?inueeee IAe? ioi?iie caei?ia’y ae?oae oa
i?aee?oe?a, a?aeae?eaiiy aioo??oiuei? iaoieia??, IIC Oe?a?ie, i. Oa?e?a

Caoeno aeena?oaoe?? a?aeaoaeaoueny 25 n?/iy 2000 ?. ia can?aeaii?
niaoe?ae?ciaaii? a/aii? ?aaee E 52.600.01 i?e E?einueeiio aea?aeaaiiio
iaaee/iiio oi?aa?neoao? ?i. N.?. Aai?a??anueeiai Iic Oe?a?ie (
95006i.N?ioa?iiieue, aoe.Eai?ia 5/7)

C aeena?oaoe??th iiaeia iciaeiieoenue o a?ae?ioaoe? E?einueeiai
aea?aeaaiiai iaaee/iiai oi?aa?neoaoo ?i. N.?. Aai?a??anueeiai (
95006i.N?ioa?iiieue, aoe.Eai?ia 5/7)

Aaoi?aoa?ao ?ic?neaiee 22 a?oaeiy 1999 ?.

A/aiee nae?aoa?

Niaoe?ae?ciaaii? a/aii? ?aaee

Ae.i.i., i?ioani?
I.O.Iaco?aoeue

CAAAEUeIA OA?AEOA?ENOEEA ?IAIOE

Aeooaeuei?noue oaie. Noai ioi/oth/iai na?aaeiaeua a aaaaoueio e?a?iao
na?oo, a oiio /ene? a Oe?a?i?, i?iaeiaaeo? iia??ooaaoeny. Iani?eyoeeaee
noai i?e?iaeiiai na?aaeiaeua aaaaoi a /iio aecia/a? caoai?thaai?noue ?
nia?oi?noue, ia?o ca ana, na?aae ae?oae. Aeieia?y E?eio ia? nai?
iniaeeaino? ? oaeiae ia a?ae??ciy?oueny iiaiei aeaaiiieo//yi.
Caa?aaeaiiy a E?eio neeaaeiiai nioe?aeueii-aeiiii?/iiai iieiaeaiiy
ia?aoeiaeaea? ?aae?caoe?? aaaeeeaeo caoiae?a ii icaei?iaeaiith
ioi/oth/iai na?aaeiaeua. A/aieie E?eio aeae?eai? i?noa ? ?aeiie c
iaea?eueoei aeieia?/iei iaaeaaiiieo//yi oa i?aeaeuaiith caoai?thaai?noth
aeeoy/iai ianaeaiiy (Oeaaiia N.Y., Coaa?aa A.E., ?oaai A.A., Ea?iaoo
A.E., 1997). Iaeiei ?c oaeeo ?aeii?a ? N?ioa?iiieuenueeee, ui ?
iineoaeeei i?eaiaeii aeey i?iaaaeaiiy iaoiai aeine?aeaeaiiy.

Iaoai?cie ?icaeoeo aeiiaoieia?? o ae?oae a?ae??ciythoueny neeaaei?noth ?
a iiai?e i??? iaaeinoaoiuei aea/ai? aei oeueiai /ano. Aacia?a/ii, aiie
aaaaoia?aii?, iiaeooue iineoe niaoeeo?/iee ? ianiaoeeo?/iee oa?aeoa?
(Eiaaoe O.A., 1997). I?iyaey?oueny aieea iani?eyoeeaeo oaeoi??a
na?aaeiaeua ia aeeoy/ee i?aai?ci c?inoaiiyi /enea caoyaeieo,
?aoeeaeeaoth/eo caoai?thaaiue ?, ia?o ca ana, oai?ia i?aai?a aeeoaiiy,
eio?? ciaoiaeyoueny a o?niiio eiioaeo? c iiethoaioaie (aoiinoa?iei
ieeii, ae?ieneaeii n??ee, ae?ieneaeii acioo, oi?iaeueaeaa?aeii oa ?ioeie
(Aanee’aaa O.A., 1995).

Iaeiae ae?oe, ye? iaoeathoue a aeieia?/ii iani?eyoeeaeo ciiao,
ii-??ciiio ?aaaothoue ia aieea oe?aeeeaeo oaeoi??a ciai?oiueiai
na?aaeiaeua. A iaeieo ?icaeaathoueny iiaoi?i? ?ani??aoi?i?
caoai?thaaiiy, ye? i?io?eathoue c ?icaeoeii oneeaaeiaiue, oaiaeaioe??th
aei caoyaeiiai ia?aa?ao, a ?ioeo o?aaeaiiy ?ani??aoi?iiai o?aeoo
cono??/athoueny aeoaea ??aeei, i?io?eathoue aac oneeaaeiaiue. Ioaea,
?icaeoie ? ia?aa?a ?ani??aoi?ieo caoai?thaaiue aecia/a?oueny
?iaeea?aeoaeueieie iniaeeainoyie aeeoeie. Inue /iio aeooaeueiei ?
aeyaeaiiy i?ia?aeii? ?ie? a aaiac? caoai?thaaiiy aeciaaiieo aai
aiaeiaaiieo oaeoi??a o eiaeii? eiie?aoii? aeeoeie.

Iaea?eueo aenieo ?aeoeai?noue aei aieeao oe?aeeeaeo oaeoi??a na?aaeiaeua
aeyaey? nenoaia ?ioiiiai caoenoo, inue /iio iaiao?aeii aeyaeaiiy cayceo
i?ae noaiii ie?aieo eaiie ?ioi?oaoo oa aeayeeie oaiioeiiaeie
oa?aeoa?enoeeaie aeeoeie (Aioa?i’aaa A.A., 1999). Oea aeicaiey?
aecia/eoe oaeoi?e ?eceeo ii ?icaeoeo oa oneeaaeiaiiio ia?aa?ao iiaoi?ieo
?ani??aoi?ieo caoai?thaaiue, iai?oeoe oeyoe oe?eani?yiiaaieo
i?io?eaeoe/ieo caoiae?a, e?eoaaoe eiie?aoio aeeoeio, a ia oai?iao a
oe?eiio.

Caycie ?iaioe c iaoeiaeie i?ia?aiaie. Aeena?oaoe?eia ?iaioa aeeiioaaeany
a ?aieao iaoeiai? i?ia?aie E?einueeiai aea?aeaaiiai iaaee/iiai
oi?aa?neoaoo ?i.N.?. Aai?a??anueeiai: “?ic?iaeoe iia? i?aeoiaee aei
ae?aaiinoeee, i?io?eaeoeee ? e?eoaaiiy caiaeueieo caoai?thaaiue eaaaiue
o ae?oae ia i?aenoaa? aea/aiiy ooiaeaiaioaeueieo iaoai?ci?a ?o
oi?ioaaiiy, oe?eani?yiiaaii? ei?aeoe?? ooieoe?? eaaaiue” (iiia?
aea?aeaaii? ?a?no?aoe?? 01.95.U010153).

Iaoa aeine?aeaeaiiy. Aeyaeoe aieea oe?aeeeaeo oaeoi??a na?aaeiaeua ia
?icaeoie ? ia?aa?a aino?eo ?ani??aoi?ieo caoai?thaaiue o ae?oae c
o?aooaaiiyi ?o oaiioeiiaeo iniaeeainoae.

Caaea/? aeine?aeaeaiiy:

1. Aea/eoe caycie i?ae iioe?aiiyi aino?eo ?ani??aoi?ieo caoai?thaaiue
na?aae ae?oae c ??cieie oaiioeiiaeie iciaeaie oa caa?oaeiai?noth iia?o?y
iiethoaioaie.

2. Aeine?aeeoe noai ?ioiieia?/ieo iieaciee?a o ae?oae c aino?ei
a?iio?oii, iano?oeoeaiei a?iio?oii oa iiaaiii??th c o?aooaaiiyi a?eo.

3. Anoaiiaeoe caycie i?ae noaiii ie?aieo eaiie ?ioi?oaoo oa ??aiai
oa?eoeio a ne?iaaooe? e?ia?, noaooth ? a?eii.

4. Aecia/eoe i?ia?aeio ?ieue aeciaaiieo aai aiaeiaaiieo oaeoi??a o
aaiac? aino?eo ?ani??aoi?ieo caoai?thaaiue o ae?oae.

Iaoeiaa iiaecia ?acoeueoao?a aeine?aeaeaiiy. A ?iaio? cae?eniaiee
eiiieaeniee iaoiaee/iee i?aeo?ae aei aea/aiiy aino?eo ?ani??aoi?ieo
caoai?thaaiue o /anoi oai??th/eo ae?oae o ??ci? a?eia? ia??iaee, eio?ee
aeeth/a? iaeii/ania aea/aiiy ee?i?/ieo, a?io?i?/ieo, ?ioiieia?/ieo oa
oaiioeiiaeo oa?aeoa?enoee.

Aia?oa i?iaaaeaii i?iniaeoeaia nioe?aeueii-ai?aeai?ieia?/ia aea/aiiy
iioe?aiiy aino?eo ?ani??aoi?ieo caoai?thaaiue o ae?oae
N?ioa?iiieuenueeiai ?aeiio. Aeaia iaoiaeeea aeicaieeea ia o?eueee
aecia/eoe iioe?aiiy caoai?thaaiue o ?aeii?, aea e aeyaeoe ae?eyiee c
aenieith oa iecueeith ?ani??aoi?iith caoai?thaai?noth, aecia/eoe
iani?eyoeea? aiaeiaaii? oa aeciaaii? oaeoi?e, eio?? ni?eythoue ?icaeoeo
caoai?thaaiiy. I?e/iio, o?eueee o 23,8% ae?oae i?ia?aeio ?ieue o aaiac?
caoai?thaaiiy a?ae?a?aaaee aiaeiaaii? oaeoi?e, o 42,9 % ?ieue
aiaeiaaiieo oa aeciaaiieo oaeoi??a aoea iaeiaeiaa, o 33,3 % i?ia?aeia
?ieue iaeaaeaea aeciaaiiei oaeoi?ai. Anoaiiaeaii, ui iaa?oue ai?ciaee/ia
i?aeaeuaiiy i?ioyaii ?ieo ieeno aoaeaoeth oa aoiinoa?iiai ieeo a 2,5
?ace ? a?eueoa i?e ii?iaeueieo na?aaeiuei??/ieo iieacieeao, ni?ey?
aea?a?caoe?? aeeoy/iai i?aai?cio, c?inoaiith iioe?aiiy ea?eia?o?a,
iano?oeoeaieo a?iio?a o iiioeyoe??. Iiaei noaa aeieac oiai, ui c
?iaeea?aeoaeueieie iniaeeainoyie iiaycaia i?aeaeuaia /ooeea?noue ae?oae
aei aieeao iiethoaio?a. Iaea?eueo /ooeea? aei ?o aieeao oeii/eee an?o
a?eiaeo eaoaai??e c aenieei ? iecueeei ??aiai oa?eoeio a ne?iaaooe?
e?ia?. Oea ee?i?/ii i?iyaey?oueny c?inoaiiyi aea?a?/ieo ?aaeoe?e, a
aino?? ?ani??aoi?i? caoai?thaaiiy i?io?eathoue c ?icaeoeii
iano?oeoeaiiai neiae?iio.

Aia?oa aeyaeaii, ui o ae?oae ?c caiecueeei ??aiai oa?eoeio, iniaeeai o
ae?a/aoie, niinoa??aa?oueny caoyaeiee ?aoeeaeeaoth/ee ia?aa?a aino?eo
?ani??aoi?ieo caoai?thaaiue.

O oeii/ee?a c iecueeei ??aiai oa?eoeio a ne?iaaooe? e?ia? a ?aiiueiio ?
aeioe?eueiiio a?oe?, a o ae?a/aoie a oe?eueiiio a?oe? cieaeaiiy
O-e?ioioeeo?a, O-oaeia??a ? Ig A a ne?iaaooe? e?ia? ee?i?/ii
i?iyaey?oueny ?icaeoeii /anoeo aaeoa??aeueieo oneeaaeiaiue aino?eo
a??onieo ?ioaeoe?e, noeeuei?noth aei caoyaeiiai, ?aoeeaeeaoth/iai
ia?aa?ao caoai?thaaiue.

O oeii/ee?a c aenieei ??aiai oa?eoeio a ne?iaaooe? e?ia? cieaeaiiy
O-e?ioioeeo?a, i?aeaeuaiiy ??aiy Ig E i Ig G ee?i?/ii i?iyaey?oueny
?icaeoeii iiaoi?ieo ea?eia?o?a oa iano?oeoeaieo a?iio?o?a.

I?aeoe/ia cia/aiiy iaea?aeaieo ?acoeueoao?a. I?iaaaeaia aeine?aeaeaiiy
aeicaieeei aeyaeoe aeciaaii? oa aiaeiaaii? oaeoi?e ?eceeo ii ?icaeoeo
??cieo ee?i?/ieo oi?i aino?eo ?ani??aoi?ieo caoai?thaaiue o /anoi
oai??th/eo ae?oae.

Oaeoi?aie ?eceeo iiaoi?ii? ?ani??aoi?ii? caoai?thaaiino? o ae?oae ?
iaa?oue ei?ioei/ania i?aeaeuaiiy a?aie/ii aeiionoeii? eiioeaio?aoe?? a
iia?o?? ieeno aoaeaoeth, aoiinoa?iiai ieeo a 2,5 ?ace ? a?eueoa i?e
ii?iaeueieo na?aaeiuei??/ieo iieacieeao.

Iaea?eueo /ooeea? aei aieeao iiethoaio?a oeii/eee an?o a?eiaeo eaoaai??e
? ae?a/aoee oe?eueiiai a?eo c ??aiai oa?eoeio a ne?iaaooe? e?ia? iaioa
20 iea/e. Oea ee?i?/ii i?iyaey?oueny ?icaeoeii iiaoi?ieo a?iio?o?a oa
iiaaiii?e. O oeii/ee?a c ??aiai oa?eoeio a ne?iaaooe? e?ia? a?eueoa 50
iea/e aieea iiethoaio?a i?iyaey?oueny ?icaeoeii iano?oeoeaieo a?iio?o?a
oa ea?eia?o?a.

Aeyaeai? oaeoi?e ?eceeo aeicaieythoue i?aeoe/iei e?ea?yi i?ecia/aoe
aaeaeaaoio oa?ai?th ae?oyi, ye? iaoeathoue a aeieia?/ii iani?eyoeeaeo
ciiao.

Iniaenoee aianie caeiaoaa/a. O aeeiiai?e ?iaio? aia?oa aeyaeaii aieea
eiie?aoieo iani?eyoeeaeo oaeoi??a na?aaeiaeua ia ?ani??aoi?io
caoai?thaai?noue ae?oae a caeaaeiino? a?ae ?o oaiioeiiaeo iciae c
aeei?enoaiiyi iaoiaeo i?iniaeoeaiiai nioeiaeueii-yiiaeaiiieiai/iiai
aea/aiiy iioe?aiiy aino?eo ?ani??aoi?ieo caoai?thaaiue oa caeii?a
oaiiaaiaoeee.

?acoeueoaoe i?iaaaeaieo aeine?aeaeaiue iathoue nooo?aa cia/aiiy aeey
i?aeoe/ii? ioi?iie caei?iay a cayceo c oei, ui aeyaeai? aiaeiaaii?
oaeoi?e ?eceeo ?icaeoeo ? iani?eyoeeaiai ia?aa?ao iiaoi?ieo
?ani??aoi?ieo caoai?thaaiue (noaoue, a?e, ??aaiue oa?eoeio, Ig E a
ne?iaaooe? e?ia?) o ae?oae, eio?? iaoeathoue a ?aeiiao c ??ciei ??aiai
caa?oaeiaiiy ioi/oth/iai na?aaeiaeua. Oea aeicaiey? ?iaeea?aeoae?coaaoe
e?eoaaiiy ae?oae c ??cieo ?aeii?a iaoeaiiy.

Ai?iaaaeaeaiiy ?acoeueoao?a aeine?aeaeaiiy. ?acoeueoaoe aeine?aeaeaiiy
ai?iaaaeaeai? a ee?i?/io i?aeoeeo aeeoy/iai a?aeae?eaiiy Oeaio?aeueii?
?aeiiii? ee?i?/ii? e?ea?i? N?ioa?iiieuenueeiai ?aeiio oa iaa/aeueiee
i?ioean aeey nooaeaio?a E?einueeiai iaaee/iiai oi?aa?neoaoo ii.
N.I.Aai?ai?anueeiai.

Ai?iaaoe?y ?acoeueoao?a aeena?oaoe??. Iaoa??aee aeena?oaoe?eieo
aeine?aeaeaiue aeeeaaeaii ia iaoeiai-i?aeoe/i?e eiioa?aioe?? “Iiaua
aeinoeaeaiey a ?aiiae aeeaaiinoeea e oa?aiee ainiaeeoaeueiuo caaieaaaiee
i?aaiia aeuoaiey. I?aaeoi?aaeaeaiea o?iiecaoeee caaieaaaiee” (Oa?e?a,
1995), iaoeiai-i?aeoe/ieo eiioa?aioe?yo a naiaoi??yo E?eio (?aiaoi??y,
1997; sseoa, 1997), ia i?aeia?iaeiiio eiia?an? c a?iio?aeueii? anoie
(Iineaa, 1997), i?aeia?iaeiiio eiia?an? c o?c?ieia?? (Naieo-Iaoa?ao?a,
1997), i?aeia?iaeiiio eiia?an? “Aeooaeueiua aii?inu iaaeeao?ee” (Aeoooa,
1997), ia Aei? iaoee eaoaae?e aini?oaeueii? iaae?ao??? EAeIO ?i. N.?.
Aai?a??anueeiai (N?ioa?iiieue, 1998). Iniiai? ?acoeueoaoe ai?iaiaai? ia
i?aeeaoaae?aeuei?e eiioa?aioe?? EAeIO ?i. N.?.Aai?a??anueeiai
(N?ioa?iiieue, 1999).

Ca iaoa??aeaie aeine?aeaeaiue ?ic?iaeaia ?aoe?iiae?caoi?nueea
i?iiiceoe?y “Niin?a i?aiaoaeueii? ooieoe?iiaeueii? ae?aaiinoeee oaeoi??a
?eceeo i?eueoeoaeoi??aeueieo caoai?thaaiue o ae?oae” (iina?ae/aiiy ?
2162, N?ioa?iiieue, 1996).

Ioae?eaoe??. Ca iaoa??aeaie aeena?oaoe?? iioae?eiaaii 7 noaoae a
iaoeiaeo aeo?iaeao ? ca??eao iaoeiaeo i?aoeue.

Ianya ? no?oeoo?a aeena?oaoe??. Aeena?oaoe?y aeeeaaeaia ia 134
noi??ieao, i?noeoue 20 oaaeeoeue ? 7 ?enoie?a.

?iaioa neeaaea?oueny c? anooio, iaeyaeo e?oa?aoo?e, 3-o ?icae?e?a
aeanieo niinoa?aaeaiue, iaaiai?aiiy ?acoeueoao?a aeine?aeaeaiiy,
aeniiae?a, i?aeoe/ieo ?aeiiaiaeaoe?e, nieneo aeei?enoaii? e?oa?aoo?e.
A?ae?ia?ao?y aeeth/a? 113 aeaea?ae, iioae?eiaaieo a NIAe, ? 89 aeaea?ae
ca?oa?aeii? e?oa?aoo?e.

CI?NO ?IAIOE

Iaoa??aee ? iaoiaee aeine?aeaeaiiy. Aeey ae??oaiiy iinoaaeaieo caaea/
iaie aoei aeine?aeaeaii 128 ae?oae — iaoeaioe?a N?ioa?iiieuenueeiai
?aeiio, o a?oe? a?ae 1 aei 14 ?ie?a c iiaoi?ieie aino?eie ?ani??aoi?ieie
caoai?thaaiiyie. Ae?oyi c aino?ei a?iio?oii oa iano?oeoeaiei a?iio?oii,
iiaaiii??th aoee i?iaaaeai? ?ioiieia?/i? aeine?aeaeaiiy a aino?iio
ia??iae? ? ia??iae? aeaeoaeaiiy. Eiio?ieai neoaeeee aeai?, iaea?aeai?
na?aae ae?oae E?einueei? iiioeyoe??. Oe? iieacieee iaaaaeai? a oaaeeoeyo
o aeaeyae? ii??aiyiiy. Iaie oaeiae i?iaiae?ciaai? ?acoeueoaoe
eiioeaio?aoe?? iiethoaio?a a aoiinoa??, iaaaaeai? E?einueeei
?anioae?eainueeei oeaio?ii c a?ae?iiaoai?ieia??.

Aeey aecia/aiiy a?aeiinii? oa aaniethoii? e?eueeino? O-e?ioioeeo?a a
e?ia? aeei?enoaiee iaoiae niiioaiiiai ?icaoeiooai?aiiy c a?eo?ioeeoaie
aa?aia (A-?IE ii Jondal et al., 1972).

A ?iaio? canoiniaaiee iaoiae aecia/aiiy O-oaio?e?i?acenoaioieo ?
O-oaio?e?i/ooeeaeo e?ioioeeo?a ii A.Shore et al. (1978).

Aecia/aiiy aeeoa?aioe?thaaeueieo aioeaai?a iaia?aie O- ? A- e?ioioeeo?a
ia?eoa?e/ii? e?ia? i?iaiaeeee c aeei?enoaiiyi iiiieeiiaeueieo
aioee?ioioeeoa?ieo aioeo?e na??? ?EI (ae?iaieoeoai Ieaeiueiai?iaenueeiai
IAe? ai?aeai?ieia?? oa i?e?ia?ieia??). ?EI 90 aei aioeaaio (a/a) CD3
(an? O-ee?oeie), ?EI 66 aei a/a CD 72 (A-ee?oeie), ?EI 86 aei aioeaaio
CD 4 (O-oaeia?e), ?EI 31 aei a/a CD 8 (oeeoioiene/i? O-ee?oeie) a
?aaeoe?? iai?yii? ?ioiioethi?anoeaioe?? ii Remherz et al.,1979.

Ai?no iniiaieo eean?a ?ioiiaeiaoe?i?a A, I, G a ne?iaaooe? e?ia?
aecia/aee iaoiaeii ?aae?aeueii? ?ioiiaeeooc?? a aaa?? Difco ii
G.Manchini et al., 1965.

Ai?no Ig E a ne?iaaooe? e?ia? aecia/aee iaoiaeii ?ioiioa?iaioiiai
aiae?co ca aeiiiiiaith iiiieeiiaeueieo aioeo?e o??ie “Roche”.

E?euee?niee ?ioiioa?iaioiee aiae?c oa?eoeio a ne?iaaooe? e?ia? ethaeeie
i?iaiaeeee ca aeiiiiiaith ieoeieo iiiieeiiaeueieo aioeo?e aei oa?eoeio
ae?iaieoeoaa “Roche” ia oioiiao?? “Roche”.

I?iaaaeaia i?iniaeoeaia nioe?aeueii-ai?aeai?ieia?/ia aea/aiiy iioe?aiiy
?ani??aoi?ieo caoai?thaaiue o ae?oae N?ioa?iiieuenueeiai ?aeiio.
*enaeuei?noue iiioeyoe?? neeaea 29525 ae?oae. Aeine?aeaeaiiy
i?iaiaeeeeny a 5 aoai?a.

? aoai. Aea?? iaeeieoe? ? neeaaeaiiy iiioeyoe??.

?? aoai. Ne?eioth/a ianoaaeaiiy (oeyoii cae?aiiy iaoa??ae?a ii
caa?iaii? ae?oae ca iaaee/iith aeiiiiiaith a e?eoaaeueii-i?io?eaeoe/i?
caeeaaee ? ?acoeueoaoai iaeyaeo aeeoy/iai ianaeaiiy).

??? aoai. Oi?ioaaiiy a?oie i?iniaeoeaiiai niinoa?aaeaiiy (iniiaii? ?
eiio?ieueii?); aeae?eaiiy cii N?ioa?iiieuenueeiai ?aeiio ?c cieaeaiith
oa i?aeaeuaiith ?ani??aoi?iith caoai?thaai?noth.

?V aoai. Aea/aiiy ?ioiieia?/ieo oa?aeoa?enoee ae?oae, eio?? iaoeathoue a
??cieo aeieia?/ieo ?aeiiao.

V aoai. Oi?ioaaiiy a?oi ?eceeo ii ?icaeoeo iiaoi?ii? ?ani??aoi?ii?
caoai?thaaiino?.

?acoeueoaoe eaai?aoi?ieo aeine?aeaeaiue iaaaaeai? o i?aeia?iaei?e
nenoai? (N?) oa ia?iaeai? iaoiaeaie aa??aoe?eii? noaoenoeee (Eae?i A.O.,
1990).

Ioe?ieo aeinoia??iino? a?aei?iiinoae (?) i?iaiaeeee c aeei?enoaiiyi
e?eoa??th Nothaeaioa.

Io?eiai? aeai? ia?iaeai? c aeei?enoaiiyi no/anieo iaoaiaoe/ieo iaoiae?a
aa??aoe?eii? noaoenoeee ia eiii’thoa?? IBM PC Cyrix-233.

I?e iinoaiiaoe? ae?aaiico o oai?eo ae?oae ie ei?enooaaeeny
eeaneo?eaoe??th ee?i?/ieo oi?i a?iioieaaaiaaeo caoai?thaaiue o ae?oae,
yea aoea cai?iiiiiaaia a Ee?a? ia neiiic?oi? ii aaeineiiaeaiith
eeaneo?eaoe?? ianiaoeeo?/ieo oai?ia eaaaiue o ae?oae o eenoiiaae? 1998
?ioe?.

Aei /anoi oai??th/eo aoee a?aeianai? ae?oe, eio?? ia?aianee ne?aeoth/a
/enei ?ani??aoi?ieo caoai?thaaiue: o a?oe? a?ae 0 aei 12 i?nyoe?a 4 ?
a?eueoa caoai?thaaiue ia ??e, ia 2-3 ?ioe? 6 caoai?thaaiue ? a?eueoa ia
??e, ia 4-io ?ioe? 5 ? a?eueoa, ia 5-6-o ?ioe? 4 caoai?thaaiiy ?
a?eueoa, ia 7-io ?ioe? ? noa?oa 3 ? a?eueoa (Aa?aiia A.A. ?c ni?aaao.,
1986). I?e oeueiio ie a?aoiaoaaee an? ia?aianai? i?ioyaii ?ieo aino??
?ani??aoi?i? caoai?thaaiiy. Ae?oae c o?ii?/iei a?iio?oii ?
a?iio?aeueiith anoiith a a?oio /anoi oai??th/eo ae?oae ia aeeth/aee.

?acoeueoaoe aeine?aeaeaiiy oa ?o iaaiai?aiiy. Aeey ae??oaiiy iinoaaeaieo
caaea/ aoee i?iaaaeai? aeine?aeaeaiiy ee?i?/ieo, ?ioiieia?/ieo,
oaiioeiiaeo oa?aeoa?enoee. O /anoi oai??th/eo aino?eie ?ani??aoi?ieie
caoai?thaaiiyie ae?oae i?iaiae?ciaaia iioe?aiiy aino?eo ?ani??aoi?ieo
caoai?thaaiue na?aae ae?oae N?ioa?iiieuenueeiai ?aeiio, aeyaeaiee caycie
i?ae ?ani??aoi?iith caoai?thaai?noth oa caa?oaeiaiiyi iia?o?y
iiethoaioaie (aoiinoa?iei ieeii, ae?ieneaeii n??ee, ae?ieneaeii acioo,
oi?iaeueaeaa?aeii).

Oeyoii i?iniaeoeaiiai nioe?aeueii-ai?aeai?ieia?/iiai aiae?co aoei
aea/aii iioe?aiiy aino?i? ?ani??aoi?ii? caoai?thaaiino? na?aae /anoi
oai??th/eo ae?oae N?ioa?iiieuenueeiai ?aeiio. Aoee aeae?eai? o?e
ae?eyiee c iaea?eueo aenieith ?ani??aoi?iith caoai?thaai?noth: 1-o
neeaee naea: Aaa?ae?enueea, Ie?ia, ?iaeieeiaa, Oe?iiia, Iieiae?aeia,
2-onaei I??iai oa iaeaeeae/? naea, 3-th?aeii Oeaio?aeueii? ?aeiiii?
ee?i?/ii? e?ea?i?. Ae?oe, ui iaoeathoue a oeeo ciiao, neeaee
a?aeiia?aeii, 1-o, 2-o ? 3-th a?oie ii??aiyiiy. A 4-o a?oio ii??aiyiiy
aa?eoee ae?oe, ui iaoeathoue a naeao c iecueeith ?ani??aoi?iith
caoai?thaai?noth: I?iia?nueeiio, Ia?oecaiao, *enoaiueeiio.

Na?aae ae?oae 1-?, 2-? oa 3-? a?oi /ano?oa cono??/aeeny ?ani??aoi?i?
caoai?thaaiiy o aeaeyae? iano?oeoeaieo a?iio?o?a, ea?eia?o?a, a oie /an,
ye a 4-e a?oi? ia?aaaaeaee aino?? ?ani??aoi?i? ?ioaeoe?? oa aino??
a?iio?oe. Oaeei /eiii, na?aae ae?oae 1-?, 2-? oa 3-? a?oi a?aei?/aeiny
ia?aaaaeaiiy ?ani??aoi?ieo aea?a?/ieo caoai?thaaiue.

Iaie i?iaiae?ciaaiee caycie ?ani??aoi?ii? caoai?thaaiino? ?c
caa?oaeiai?noth aoiinoa?iiai iia?o?y iiethoaioaie. A ?aeiiao iaoeaiiy
ae?oae 1-? a?oie a?aei?/aeiny ai?ciaee/ia ia?aaeuaiiy a aoiinoa?iiio
iia?o?? a?aie/ii aeiionoeieo eiioeaio?aoe?e: aoiinoa?iiai ieeo a 2,4
?ace, aeaiieneaeo acioo a 1,4 ?ace; a ae?oa?e a?oi? ai?ciaee/ia
i?aeaeuaiiy ??aiy aoiinoa?iiai ieeo a 4,4 ?ace, ieeno aoaeaoeth a 2,8
?ace, aeaiieneaeo acioo a 1,4 ?ace; a 3-e a?oi? aoiinoa?iiai ieeo a
4,4 ?ace, aeaiieneaeo acioo a 1,4 ?ace, i?e ii?iaeueieo na?aaeiuei??/ieo
iieacieeao. Oea, i/aaeaeii, iaoiiaeaii ae?yeuei?noth aa?aoe?eiiai oa
aaoiiia?eueiiai o?ainii?oo a aeine?aeaeoaaieo ?aeiiao.

Ine?eueee ?inoo ?ani??aoi?ieo caoai?thaaiue ni?eythoue ia o?eueee
aeciaaii? oaeoi?e, aea e aiaeiaaii?, iaie aoee i?iaiae?ciaai? ee?i?/i?
oa ?ioiieia?/i? iniaeeaino? ae?oae.

Aeine?aeaeoaai? oai?? aoee ?iciiae?eai? ia 2 a?oie aac iciae aea?a??: c
aino?ith ?ani??aoi?iith a??oniith ?ioaeoe??th (1A), c aino?ei a?iio?oii
(2A), oa c aea?a?/ieie i?iyaaie: c ea?eia?oaie (1A) oa c iano?oeoeaieie
a?iio?oaie (2A). O?aoth a?oio neeaee oai?? ia iiaaiii?th,
i?aeoaa?aeaeaio ?aioaaiieia?/ii.

Aiae?c noiooi?o caoai?thaaiue aeicaieea aeyaeoe o ae?oae c aea?a?/ieie
i?iyaaie aaeeeo /anoioo aenoaeaoeaii-eaoa?aeueiiai ae?aoaco 14,1 %,
?<0,05, aeenoyii? ?iaac?? 4,6 %, ?<0,05. O ae?oae aac aea?a?/ieo i?iya?a /ano?oa cono??/aeeny o?ii?/i? ina?aaeee ?ioaeoe?? o aeaeyae? aaeaii?aeeoo 15,9 %, ?<0,05, aaeii?eoo 13,5 %, ?<0,001, o?ii?/iiai oiicee?oo 16,7%, ?<0,01, aiai?? – 12,3 %, ?<0,001. O ae?oae c iiaaiii??th oaeiae ia?aaaaeaee o?ii?/i? ina?aaeee ?ioaeoe?? (16,2 %, ?<0,05) iaae aiiiae?yie eiinoeoooe??. Iiaoi?ieie ?ani??aoi?ieie caoai?thaaiiyie /ano?oa oai??thoue oeii/eee, i?e/iio, iano?oeoeaiee a?iio?o cono??/a?oueny o ieo a 3 ? a?eueoa ?ac?a /ano?oa, i?ae o ae?a/aoie. Na?aae oai?eo ia iiaaiii?th a oe?eueiiio a?oe? aeinoia??ii /ano?oa cono??/athoueny ae?a/aoee (?en. 1). ?en. 1- Ni?aa?aeiioaiiy ca noaooth na?aae /anoi oai??th/eo ae?oae a?ae 4 aei 14 ?ie?a. sse aeaeii ?c ?en. 1, na?aae ae?oae, /anoi oai??th/eo aino?eie ?ani??aoi?ieie a??onieie ?ioaeoe?yie oa a?iio?oaie, aeinoia??ii ia?aaaaeathoue oeii/eee. Oaeei /eiii, aei iiaoi?ieo ?ani??aoi?ieo caoai?thaaiue a ?aiiueiio a?oe? a?eueoa noeeuei? oeii/eee, o ieo caoai?thaaiiy i?io?eathoue a?eueo oyaeei, /ano?oa ?icaeaa?oueny iiaaiii?y. O oe?eueiiio a?oe? a?iio?oe ? iiaaiii?y a?eueo aeanoea? ae?a/aoeai, oi/a na?aae oai?eo ia ea?eia?oe, iano?oeoeai? a?iio?oe /enei oeii/ee?a caeeoa?oueny aeinoia??ii aeuei, i?ae ae?a/aoie. Ine?eueee aieea oaeoi??a na?aaeiaeua ?aae?co?oueny ci?iaie a caoenieo nenoaiao ?, ia?o ca ana, a ?ioii?e o aeaeyae? aeenaaeaino i?ae iiioeyoe?yie ? noaiiioeyoe?yie ?ioiioeeo?a, cieaeaiiy ?o ooieoe?iiaeueii? aeoeaiino? ? aeeni?iii?oe?? ae?iaee ?ioiiaeiaoe?i?a, iaie aoa i?iaiae?ciaaiee noai ie?aieo eaiie ?ioi?oaoo o ianoaaeaieo ae?oae. ?ioiieia?/i? aeine?aeaeaiiy i?iaiaeeee a aino?iio ia??iae? ? i?e aeaeoaeaii? a aeaio a?eiaeo a?oiao (a?ae iaeiiai ?ieo aei 6 ?ie?a oa a?ae 7 aei 14 ?ie?a). Iaiao?aeii a?aei?oeoe, ui ae?oe, eio?? iaoeathoue a ??cieo i?noeyo N?ioa?iiieuenueeiai ?aeiio, ia a?ae??ciyeeny ca nai?ie ?ioiieia?/ieie oa?aeoa?enoeeaie a aino?iio ia??iae? caoai?thaaiiy a?iio?oii aai iiaaiii??th. Iaeiae ci?ie c aieo ee?oeiii? ? aoii?aeueii? eaiee o oai?eo ia aino?ee a?iio?o, iano?oeoeaiee a?iio?o oa iiaaiii?th, aoee ??ci?. Iaea?eueo ae?aaeai? ci?ie ?ioi?oaoo iaee i?noea o ae?oae c iiaaiii??th a iaio a?eiaeo a?oiao. O aino?iio ia??iae? a?aei?/aany eaeeioeeoic o iieiaeo?e ? noa?o?e a?eiaeo a?oiao. *enei eaeeioeeo?a ii?iae?coaaeiny i?e aeaeoaeaii? o?eueee o ae?oae noa?oa 6 ?ie?a. *enei O-e?ioioeeo?a oa ?o iiioeyoe?e aoei oaeiae cieaeaia a iaio a?eiaeo a?oiao, i?aeaeuoaaeiny i?e aeaeoaeaii?, iaeiae ia aeinyaaei eiio?ieueieo aaee/ei. Oea ii?aeioaaeiny c aenieei ??aiai Ig M a aino?iio ia??iae?, ui na?ae/eei i?i aeniea aioeaaiia iaaaioaaeaiiy. I?e aeaeoaeaii? ??aaiue Ig M ii?iae?coaaany a iaio a?eiaeo a?oiao. Iieacieee Ig G ? Ig A oaeiae aoee cieaeai? o an?o ae?oae o aino?iio ia??iae?, inoaii?e i?e aeaeoaeaii? ia a?ae??ciyany a?ae ii?ie. Ci?ie c aieo nenoaie ?ioi?oaoo o ae?oae, oai?eo ia aino?? iano?oeoeai? a?iio?oe, aoee ia iaeiicia/i?. A ?ioiia?ai? o ae?oae c iano?oeoeaiei a?iio?oii o noa?o?e a?eia?e a?oi? niinoa??aaeiny a?eueo ae?aaeaia cieaeaiiy O-noi?ani??a ye o aino?iio ia??iae? (0,110,02, ?<0,01), oae ? i?e aeaeoaeaii? (0,180,02, ?<0,05). A o ae?oae c aino?ei a?iio?oii aoei a?aei?/aii cia/ia cieaeaiiy O-oaeia??a o aino?iio ia??iae? o oai?eo iaio a?eiaeo a?oi (0,520,09, ?<0,01 a iieiaeo?e, 0,520,07, ?<0,01 a noa?o?e), ye? ia aeinyaaee eiio?ieth i?e iaeoaeaii? (0,610,06, ?<0,01 a iieiaeo?e, 0,660,07, ?<0,05 a noa?o?e). Oea ii?aeioaaeiny c iecueeei ??aiai Ig G (7,390,57, ?<0,01 a iieiaeo?e, 7,210,62, ?<0,01 a noa?o?e a?oi?), i?e/iio Ig G ii?iae?coaaany i?e aeaeoaeaii? o?eueee a iieiaeo?e a?eia?e a?oi?. O ae?oae a?ae 7 aei 14 ?ie?a aeinoia??ii cieaeoaaany Ig A, ye a aino?iio ia??iae? (1,080,09, ?<0,05), oae ? i?e aeaeoaeaii? (1,190,27, ?<0,05), ui iiaea ni?eyoe ?aoeeaeeaoaaiith aino?eo ?ani??aoi?ieo caoai?thaaiue. Iecuee? iieacieee Ig A i Ig G a iieiaeoeo a?eiaeo a?oiao iiaycai? c i?ci?i aeic??aaiiyi Ig A i Ig G-neioacoth/eo nenoai, a a?eueo aeniea /enei O-e?ioioeeo?a c o?c?ieia?/iei e?ioioeeoicii o aeaiiio a?oe?. Ioaea, caoeni? ?ioiieia?/i? ?aaeoe?? o ae?oae a?ae iaeiiai ?ieo aei 6 ?ie?a caaacia/othoueny ia?aaaaeii ca ?aooiie ee?oeiii? eaiee ?ioi?oaoo. A oe?eueiiio a?oe? (noa?oa 6 ?ie?a), ii i??? aeic??aaiiy Ig A i Ig G-neioacoth/eo nenoai oa cieaeaiiy /enea e?ioioeeo?a, caoeni? ?ioiieia?/i? ?aaeoe?? cae?eniththoueny ca ?aooiie aoii?aeueii? eaiee. Inue /iio ii?ooaiiy a aoii?aeuei?e eaioe?, aeyaeai? o ae?oae noa?oa 6 ?ie?a, ?oaeoi?ii ?eceeo ii ?icaeoeo iiaoi?ieo ?ani??aoi?ieo caoai?thaaiue, a a ?aiiueiio a?oe? oaeei oaeoi?ii ?eceeo neoaeaoue ii?ooaiiy a nenoai? O-e?ioioeeo?a. I?e aeine?aeaeaii? ??aiy Ig A o ae?oae c iano?oeoeaiei a?iio?oii o 33,3% iieacieee iaioa 50 IA/ie na?ae/aoue i?i iaeo a??ia?aei?noue aoii?/iiai caoai?thaaiiy, o 42,9% ??aaiue Ig A 51-100 IA/iena?ae/eoue i?i iiaeeeaino? iayaiino? aoii??. O 23,8% ??aaiue Ig A a?eueoa 101 IA/ie a??ia?aei?noue aoii?? aeoaea aeniea. A inoaii?e a?oi? ae?oae iiaeeeaa o?ainoi?iaoe?y iiaoi?ieo iano?oeoeaieo a?iio?o?a a a?iio?aeueio anoio. Oaeei /eiii, ?aoeeaeeaoaaiith aino?eo ?ani??aoi?ieo caoai?thaaiue o ae?oae iieiaeoi? a?eiai? a?oie ni?ey? cieaeaiiy /enea O-e?ioioeeo?a oa ?o oaeia?ii? aeoeaiino?, a oaeiae iecueeee ??aaiue Ig A. O ae?oae c iaea?eueo iecueeei /eneii O-oaeia??a aino?? ?ani??aoi?i? caoai?thaaiiy i?io?eathoue a?eueo oyaeei, c ?icaeoeii aaeoa??aeueieo oneeaaeiaiue. O ae?oae c ae?aaeaiei cieaeaiiyi O-e?ioioeeo?a ? aenieei ??aiai Ig A aino?? ?ani??aoi?i? caoai?thaaiiy i?iyaeyeeny ?icaeoeii iano?oeoeaiiai neiae?iio. Ine?eueee na?aae niinoa??aa?ieo iaie /anoi oai??th/eo ?ani??aoi?ieie caoai?thaaiiyie ae?oae o 35% iaea i?noea aiai?y, a iaaeinoaoi?noue cae?ca a i?aai?ci? aieeaa? ia oaeoi?e aoii?aeueiiai ? ee?oeiiiai ?ioi?oaoo, iiieaeoth/e ?ioiieia?/io ?acenoaioi?noue i?aai?cio (Aoaeaiia A.A. ?c ni?aaao., 1991), iecueeee ??aaiue cae?ca iiaeia aaaaeaoe oaeoi?ii ?eceeo caoai?thaaiino? ae?oae. Ia?ea?ii eaoaioiiai aeao?oeeoo cae?ca a ne?iaaooe? e?ia? iiaea neoaeeoe oa?eoei o ne?iaaooe? e?ia?. Inue /iio iaie aoa i?iaiae?ciaaiee caycie i?ae ai?noii oa?eoeio a ne?iaaooe? e?ia? ? noaiii ie?aieo eaiie ?ioi?oaoo o oai?eo iiaoi?ieie ?ani??aoi?ieie caoai?thaaiiyie. O ae?oae c iecueeei ? aenieei ??aiai oa?eoeio a ne?iaaooe? e?ia? ca aeiiiiiaith iiiieeiiaeueieo aioeo?e na??? ?EI a ?aaeoe?? iai?yii? ?ioiioethi?anoeaioe?? aoei aeyaeaii cieaeaiiy /enea CD 8 (oeeoioiene/ieo O-ee?oei), CD 3 ? CD 72 (O-? A-e?ioioeeo?a a?aeiia?aeii). Aaniethoia /enei CD 4 (O-oaeia??a) aoei cieaeaii o ae?oae c iecueeei oa?eoeiii. Anoaiiaeaii, ui iaea?eueo /ooeea? aei ae?? iiethoaio?a ae?oe c aenieei ai?noii oa?eoeio (a?eueoa 50 iea/e) a ne?iaaooe? e?ia?, a naia o ieo /ano?oa aoa iaoyaeaiee aea?a?/iee aiaiiac ? caoai?thaaiiy i?io?eaei c ?icaeoeii iano?oeoeaiiai neiae?iio, a oie /an ye o ae?oae c iecueeei ??aiai ne?iaaoeiaiai oa?eoeio (iaioa 20 iea/e) niinoa??aa?oueny cieaeaiiy ?acenoaioiino? aei a??onii? ?ioaeoe?? c ianooiiei ?icaeoeii aaeoa??aeueieo oneeaaeiaiue o aeaeyae? iiaaiii??. – – ––– –––– –– –– –– ––

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