24
I?i?noa?noai ioi?iie caei?ia”y Oe?a?ie
Ee?anueea iaaee/ia aeaaeai?y i?neyaeeieiiii? ina?oe
Nooiaeiey Aiaoie?e ?aaiiae/
OAeE 616.33-005;
616.342-002.44-02-08
OEssOE IIE?AUAIIss ?ACOEUeOAO?A I?AAIICAA??AATH*EO IIA?AOe?E I?E
AE?ACEIA?E OAI?IA? AeAAIAAeOessOEIAEI? EEOEE
(ee?i?ei-aenia?eiaioaeueia aeine?aeaeaiiy)
14.01.03 – o??o?a?y
Aaoi?aoa?ao
aeena?oaoe?? ia caeiaoooy iaoeiaiai nooiaiy
aeieoi?a iaaee/ieo iaoe
Ee?a – 1999
Aeena?oaoe??th ? ?oeiien.
?iaioa aeeiiaia a Oiaeueieoeuee?e iaeani?e ee?i?/i?e e?ea?i? IIC
Oe?a?ie, IAe? o?c?ieia?? ?iai? aeaaeai?ea Iao?a Aiaa/a Iaoe?iiaeueiiai
oi?aa?neoaoo ?iai? Oa?ana Oaa/aiea.
IAOEIAEE EIINOEUeOAIO:
aeieoi? iaaee/ieo iaoe, i?ioani?,
/eai-ei?aniiiaeaio IAI oa
AII Oe?a?ie Na?iei Aaea??e
Oaiaein??ae/, aee?aeoi? ?inoeoooo
ee?i?/ii? oa aenia?eiaioaeueii?
o??o?a?? AII Oe?a?ie.
IO?Oe?EI? IIIIAIOE:
aeieoi? iaaee/ieo iaoe, i?ioani? Oiiaooe ?aai I?ieiiiae/, aieiaiee
o??o?a E?eoaaeueiiai ia”?aeiaiiy i?e Eaa?iao? I?i?no??a Oe?a?ie,
aeieoi? iaaee/ieo iaoe, i?ioani? Ooo/aiei Ieeiea ?aaiiae/, caa?aeoth/ee
eaoaae?ith o??o?a?? noiiaoieia?/iiai oaeoeueoaoo Iaoe?iiaeueiiai
iaaee/iiai oi?aa?neoaoo ?i. I.I.Aiaiiieueoey (i.Ee?a) IIC Oe?a?ie,
aeieoi? iaaee/ieo iaoe, i?ioani? A?oai?e Aieiaeeie? Aieiaeeie?iae/,
caa?aeoth/ee eaoaae?ith aini?oaeueii? o??o?a?? Iaeanueeiai iaaee/iiai
oi?aa?neoaoo IIC Oe?a?ie.
I?IA?AeIA ONOAIIAA:
Euea?anueeee aea?aeaaiee iaaee/iee oi?aa?neoao ?i. Ae.Aaeeoeueeiai IIC
Oe?a?ie (i.Euea?a), eaoaae?a o??o?a??.
Caoeno a?aeaoaeaoueny “ 20 ” aeiaoiy 1999 ?. i _14_ aiaeei? ia
can?aeaii? niaoe?ae?ciaaii? a/aii? ?aaee Ae 26.613.02 i?e Ee?anuee?e
iaaee/i?e aeaaeai?? i?neyaeeieiiii? ina?oe IIC Oe?a?ie (254112, i.Ee?a,
aoe.Aei?iaiaeeoeueea, 9)
C aeena?oaoe??th iiaeia iciaeiieoenue o a?ae?ioaoe? Ee?anueei? iaaee/ii?
aeaaeai?? i?neyaeeieiiii? ina?oe (i.Ee?a, aoe Aei?iaiaeeoeueea, 9)
Aaoi?aoa?ao ?ic?neaiee “_20__” ___aa?aniy_ 1999 ?.
A/aiee nae?aoa?
Niaoe?ae?ciaaii? a/aii? ?aaee
e.i.i., aeioeaio
Aaicaeye I.I
CAAAEUeIA OA?AEOA?ENOEEA ?IAIOE
Aeooaeuei?noue oaie. Ae?aceiaa oai?iaa oeoieo oa aeaaiaaeoeyoeiaei?
eeoee ? iaeiei ?c naieo ?iciianthaeaeaieo caoai?thaaiue
oeoieiai-eeoeiaiai o?aeoo (OEO) ? cono??/a?oueny ia?aaaaeii a in?a
i?aoeacaeaoiiai a?eo. Aei oaia??oiueiai /ano caoai?thaaii?noue ia
ae?aceiao oai?iao aeineoue aeniea ? ia i?ine?aeaeo?oueny oaiaeaioe?? aei
?? cieaeaiiy. A oeea?e?ciaaie? e?a?iao ae?aceiaa oai?iaa cono??/a?oueny
o 4,3% ia 10 oeny/ ianaeaiiy [?unn A.N., Caa?oao Y.Y., 1998; ?unn A.N.,
Oeocii-?unn TH.E., 1994]. A iao?e e?a?i? ae?aceiaa oai?iaa neeaaea? 10%
a?ae on?o caoai?thaaiue i?aai?a o?aaeaiiy [Aaneeaiei A.O., A?aaiaa A.E.,
Oaiooeei A.A., 1987]. Nia?oi?noue a?ae ae?aceiai? oai?iae ia?aaaaeii
iia”ycaia c aeieeiaiiyi ?? oneeaaeiaiue oa iia?aoeaieie ao?o/aiiyie ?
neeaaea? 0,9% [Oeuiia?iai ss.N., 1997].
A ca”yceo c ai?iaaaeaeaiiyi a i?aeoeeo e?eoaaiiy ae?aceiai? oai?iae
iiaeo a?oi i?aia?ao?a, oaeeo ye aeieaoi?e I2-a?noai?iiaeo ?aoeaioi??a ?
?ia?a?oi??a i?ioiiii? “iiiie” a eiina?aaoeaiiio e?eoaaiiy aeinyaiooee
cia/iee i?ia?an. Aea ? i?e aeio?eioaaii? no/anieo i?eioeei?a
eiina?aaoeaiiai e?eoaaiiy ?aoeeaeea ae?aceiai? oai?iae aeieea? a 30-70%
aeiaaee?a ? o iieiaeie c ieo aoi?eiii. Oaeiae ne?ae a?aei?oeoe
iiaeeea?noue aeieeiaiiy ea?oeeii?aeo oeoieo i?e o?eaaeiio e?eoaaii?
?ia?a?oi?aie i?ioiiii? “iiiie”, ui i?aeoaa?aeaeaii a aenia?eiaio?
[Wormsley K.G., 1994].
Iaci?iiei caeeoa?oueny ? a?aenioie oneeaaeiaiue ae?aceiai? oai?iae
? neeaaea? 15-30%. Oea o? oai??, ye? iio?aaothoue iia?aoeaiiai e?eoaaiiy
[Aaoaeieia I.E. e niaao., 1989; A?aoonue A.Ae. e niaao., 1987; Aaeiooaei
N.A. e niaao., 1984; Aaneeaiei A.O. e niaao., 1987; Aaeeaioeeee I.I.,
1985; Iaioeu?aa TH.I., A?eiaa?a A.A., 1979]. I?neyiia?aoe?eia
eaoaeuei?noue i?e oneeaaeiaii? ae?aceiai? oai?iae ia?oi?aoe??th aai
e?iaioa/ath neeaaea? 5-10% [Ai?aaoei A.E., Aao/aaa I.O., 1982;
Iaioeu?aa TH.I. e niaao., 1988; Iaaa A.E., 1991; Oaeeiia A.A., Naaiei
A.O., 1987]. Oaeei /eiii, aeniea /anoioa ?aoeeaeeao caoai?thaaiiy ca
?aooiie o?ii?/iiai ia?aa?ao ae?aceiai? oai?iae, ui /anoi i?eaiaeeoue aei
aeieeiaiiy noaiico aeoiaeo ?c oeoieo, iaci?iiee a?aenioie oneeaaeiaiue ?
aeniea eaoaeuei?noue i?e ?o iia?aoeaiiio e?eoaaiiy, oei/aniaa ao?aoa
i?aoeacaeaoiino? ? ?iaae?aei?noue ?iaeoue i?iaeaio ae?aceiai? oai?iae
aeooaeueiith ia o?eueee c iaaee/ieo, aea ? nioe?aeueieo iiceoe?e.
Ia aeeaey/enue ia i?ia?an a eiina?aaoeaieo iaoiaeao e?eoaaiiy,
iia”ycaiee c ?ic?iaeith ? ai?iaaaeaeaiiyi iiaeo aenieiaoaeoeaieo
i?ioeae?aceiaeo i?aia?ao?a, aeecueei 15-30% oai?eo, ia?aaaaeii c
oneeaaeiaiei i?io?eaiiyi ae?aceiai? oai?iae, iio?aaothoue o??o?a?/iiai
e?eoaaiiy [Aeeyaei A.Ae., Aa?acia A.A., 1975; Aei?ioaaa A.E. e niaao.,
1981; Eocei I.E., Iinoieia I.I., 1976,1979; Eocei I.E. e niaao.,
1981,1982; Eo?uaei A.A., 1971; Eiaeiia A.N., Aie?ia I.O., 1985,1986;
Iaea?aiei I.E., 1988; Ieo?ioeia O.A. e niaao., 1996; Iaioeu?aa TH.I.,
A?eiaa?a A.A., 1979; Iaioeu?aa TH.I. e niaao., 1988].
Ia nueiaiaei?oi?e aeaiue ae?aceiaa oai?iaa a 90-100% anioe?eiaaia c
Helicobacter pylori (Hp) [Bayerdorffer E. et al., 1995; Bell G.D. et
al., 1996; Blaser M.I., 1990; . ?ieue Hp a o??o?a?? ? eiai aieea ia
?acoeueoaoe i?aaiicaa??aath/eo iia?aoe?e aea/aiee iaaeinoaoiuei. ?acii
c oei a?aeiii, ui aaeoa??aeueia ?iaac?y Hp i?ney iia?aoe?? ia o?eueee
a?aeiia?aea? aeiiia?aoe?eiiio ??aith, a ? iaa?oue c?inoa? [Ieo?ioeia e
niaao., 1996; Ia?eei e niaao., 1995]. Oiio aeooaeueiith ? i?iaeaia
aeine?aeaeaiiy Hp ?io?eiaaiino? aei ? i?ney iia?aoe?? oa aieeao eiai
a?aaeeeaoe?? ia ?acoeueoaoe i?aaiicaa??aath/eo iia?aoe?e.
Ia nueiaiaei?o?i?e aeaiue ?ic?iaeaii ? aeei?enoiao?oueny aaaaoi
??cieo aeae?a iia?aoeaieo ao?o/aiue, ye? a ?oeao aaoi??a a iaeaeeae/ee
i?neyiia?aoe?eiee ia??iae aeathoue iaiaae?eeea? ?acoeueoaoe, aea c /anii
?ioa?an aei ieo ao?a/a?oueny ?c-ca aaeeei? e?eueeino? oneeaaeiaiue ?
?aoeeaeea?a a a?aeaeaeaiiio i?neyiia?aoe?eiiio ia??iae?.
Aei iaaeaaiueiai /ano iniiaiei iaoiaeii o??o?a?/iiai e?eoaaiiy
ae?aceiai? oai?iae aoea ?acaeoe?y oeoieo. ? ca?ac a aeayeeo e?eoaaeueieo
caeeaaeao oeueiio iaoiaeo iia?aoeaiiai e?eoaaiiy a?aeaeathoue ia?aaaao.
Aea aenieee a?aenioie iacaaeia?eueieo ?acoeueoao?a a iaeaeeae/ee ?
a?aeaeaeaiee i?neyiia?aoe?eiee ia??iae i?eaaee aei a?eueo no?eiaiiai
a?aeiioaiiy aei ?acaeoe?? oeoieo, a c /anii aei ?ic?iaee aeoaea aocueeeo
iieac?a aei oe??? iia?aoe??. I?neyiia?aoe?eia eaoaeuei?noue i?ney
?acaeoe?? oeoieo a ieaiia?e o??o?a?? – 2-4%, i?e i?i?eaieo ae?aceao –
aei 5%, a i?e e?iaioa/ao – 10-30% [Ionoiaeo A.A., 1985; Naaiei A.O.,
1979; Oaeeiia N.A. e niaao., 1989; Oaeeiia A.A., Naaiei A.O.,
1987,1981]. Ui noino?oueny a?aeaeaeaieo ?acoeueoao?a, oi aeyaeeiny, ui o
10-40% oai?eo i?ney ?acaeoe?? oeoieo aeieeathoue ??ci? ?iceaaee
o?aaeaiiy, ye? o 10-15% i?eaiaeyoue aei ?iaae?aeiino? [Ao?aiia A.A.,
??enoaae E.Ae., 1969; Oaeeiia A.A., Naaiei A.O., 1981; Oaeeiia A.A. e
niaao., 1981, 1982]. E??i oiai a?aei?/aii, ui ?acaeoe?y oeoieo a
a?aeaeaeaiiio i?neyiia?aoe?eiiio ia??iae? iiaea i?eaiaeeoe aei ?aeo eiai
eoeueo?, ia ui aeacothoue a?o/eciyi? ? ca?oa?aei? a/ai? [Oaeeiia A.A. e
niaao., 1982].
Nueiaiaei? a ieaiia?e ? iaa?aeeeaaei?e o??o?a?? ae?aceiai? oai?iae
aeaaiaaeoeyoeiaei? eeoee (AeIE) io?eiaee ia?aaaao i?aaiicaa??aath/?
iia?aoe??. Iaea?eueo iaoiaaiaoe/ii iaoiiaeaiith iia?aoe??th i?e
ae?aceia?e oai?ia? ? naeaeoeaia i?ieneiaeueia aaaioii?y (NIA) c
ae?aioth/ith oeoiie iia?aoe??th aai aac ia?, yea aeicaiey? aeinyaoe
cieaeaiiy eeneioii-iaioe/ii? aa?an?? oeoieiaiai nieo aac cia/iiai
ii?ooaiiy iioi?ii-aaaeoaoi?ii? ooieoe?? oeoieo [Aeiie/aiei A.A., 1984;
Aeeueaeaia?aiaeo TH., 1989; Caaai?iaeiee A.A. e niaao., 1988; Eocei I.I.
e niaao., 1984; Ooo/aiei I.E., 1992; Oeeiia?iai ss.N., 1981].
Ai?iaaaeaeaiiyi i?aaiicaa??aath/eo iia?aoe?e ?, iniaeeai, NIA aoei
a?aee?eoi iiao a?o a o??o?a?/iiio e?eoaaii? ae?aceiai? oai?iae. ?acii c
oei iino?eii i?iaeiaaeothoueny iiooee aeine?aeiee?a ii oaeineiiaeaiith
oaoi?ee iia?aoe?e, ?ic?iaee iiaeo iia?aoe?e, iaoiae?a ?io?aiia?aoe?eii?
iiaiioe aaaioii??, aea/aiiy a?aeaeaeaieo ?acoeueoao?a [A?ieniai N.Ae. e
niaao., 1994; Ai?aaoei A.E., Aao/aaa I.O., 1982; Ai?aoiia A.I., Iaoiia
A.A., 1989; Caoa?ia A.I., *oaiei A.O., 1971; Coaa A.E., 1993; Iiii?eaa
A.E., 1990; Iiii?eaa A.E. e niaao. 1982].
Iaeaea an? aeine?aeieee a?aei?/athoue ia?aaaao aaaioii?? ia?aae
?acaeoe??th oeoieo caaaeyee iecuee?e i?neyiia?aoe?ei?e eaoaeueiino?,
iaeiio a?aenioeo oneeaaeiaiue, e?auei iaeaeeae/ei ? a?aeaeaeaiei
?acoeueoaoai [A?eiia O.A., Oaei N.E., 1979, 1982; Aaoaeieia I.E. e
niaao., 1989; Aeiie/aiei A.A. e niaao., 1982; Eocei I.E., 1983; Eocei
I.E., Iinoieia I.I., 1979; Eocei I.E. e niaao., 1981; Oaeeiia A.A. e
niaao., 1980].
Aea, ye iieacaa aeina?ae, ?acoeueoaoe o??o?a?/iiai e?eoaaiiy
ia caaaeaee caaeia?euei? ? i?ney aaaioii??, aieiaiei iaaeie?eii yei? ?
i?neyiia?aoe?eiee ?aoeeaeea oai?iae, yeee neeaaea? ca aeaieie ??cieo
aaoi??a 5-20% [Aaae/aa A.A., *a?iyeaae/ N.A., 1983; Aaeue E.N. e
niaao., 1986; Aa?acia TH.A., A?iieia A.N., 1970; 1974; Aeiie/aiei A.A. e
niaao., 1984; Aeeueaeaia?aiaeo TH. E niaao., 1989; Aonae A.E. e niaao.,
1989; Aeoaeaiei A.A., 1985; Aeoaeaiei A.A., Cuaei A.I., 1987;
Caii?iae/aiei A.N. e niaao., 1983; Eo?uaei A.A., 1975; Iaaaeeaa O.O. e
niaao.,1990; Iaiaae/ A.E., Oa?eoiiia E.A., 1983; Naeaciaa A.I., Nuaoeue
O.O., 1989; Oaei N.E., 1990]. Oaea cia/ia ?ica?aei?noue a a?aenioeo
i?neyiia?aoe?eiiai ?aoeeaeeao ? ae?oaeo i?neyaaaioiiieo ?iceaae?a
na?ae/eoue i?i iaaeinoaoi?e ?iaeea?aeoaeueiee i?aeo?ae c o?aooaaiiyi
iaoio?c?ieia?/ieo oaeoi??a ae?aceiooai?aiiy a eiaeiiio eiie?aoiiio
aeiaaeeo i?e aeai?? niiniao iia?aoeaiiai ao?o/aiiy [Aeioeaiei A.I. e
niaao., 1992; Aeoaeaiei A.A., 1987; Iaioeu?aa TH.I. e niaao., 1988;
Adami H.O. et al., 1980].
Aei oaia??oiueiai /ano an? oeyoe ia iie?auaiiy ?acoeueoao?a
aaaioii?? aoee iai?aaeai? ia a?eueo iiaio iaeneiaeueii iiaeeeao
aeaia?aaeoe?th eeneioii?iaeoeoth/i? ciie oeoieo. Cia/ii iaioo oaaao
i?eaeaaaee aea/aiith aieeao ia ?io? iaoai?cie ?aaoeyoe?? oeoieiai?
nae?aoe??, ye? a?ae?a?athoue cia/io ?ieue a iaoiaaiac? ae?aceiooai?aiiy
[Caoa?ia A.I. e niaao., 1971; Caa?eia E.A. e niaao., 1987; Eiienna?ia
A.A., 1990; Iuo A.A., 1987; ?aaeiiae/ I.Ae., 1986].
Iiaeaeueoa iie?auaiiy ?acoeueoao?a i?aaiicaa??aath/eo iia?aoe?e
iia”ycaii c ?iaeea?aeoaeueiei i?aeoiaeii i?e aecia/aii? aeaeo aaaioii??
c o?aooaaiiyi ??cieo iaoiaaiaoe/ieo oaeoi??a, ?ic?iaeith ?
ai?iaaaeaeaiiyi iiaeo aeae?a iia?aoe??, ye? aieeaathoue ia ae?oao oaco
oeoieiai? nae?aoe??, aeine?aeaeaiiyi I? ?io?eiaaiino? aei ? i?ney
iia?aoe?? ooa aieeao eiai a?aaeeeaoe?? ia ?acoeueoaoe i?aaiicaa??aath/eo
iia?aoe?e.
Ca’ycie oaie c iaoeiaeie i?ia?aiaie, ieaiaie, oaiaie.
Aeena?oaoeieia ?iaioa aoea aeeiiaia a neeaaei aaeocaai? iaoeiai?
i?ia?aie iinoeoooo ii caieaiiaaiie oaii “Ia?eoa?e/i? iaoai?cie
iae?i-aoii?aeueii? ?aaoeyoe?? ooieoe?e i?ieneiaeueiiai a?aeae?eo
oeoieiai-eeoeiaiai o?aeoo oa ia/?iee” ? 0197U003104 aea?aeaaii?
?a?no?aoei?, aeeiiaiie i?ioyaii 1997-1998 ??.
Iaoa oa caaaeaiiy aeine?aeaeaiiy. Iaoith ?iaioe aoei ia?aii
iie?ioaiiy ?acoeueoao?a iia?aoeaiiai e?eoaaiiy oai?eo ia ae?aceiao
oai?iao AeIE oeyoii oaeineiiaeaiiy ?nioth/eo ? ?ic?iaee iiaeo iaoiae?a
i?aaiicaa??aath/eo o??o?a?/ieo ao?o/aiue, ?ic?iaea i?eioeei?a
i?neyiia?aoe?eii? iaaeeeaiaioicii? i?io?eaeoeee ?aoeeaeeao oai?iae.
Aieiaieie caaaeaiiyie aeineiaeaeaiiy aoee:
1. ?ic?iaeoe iaoiaeeeo aeno?aaano?aeueii? aaaioii?? (AAA) ?
aenia?eiaioaeueii iaa?oiooaaoe ?? ee?i?/ia canoinoaaiiy.
2. I?iaanoe ii??aiyeuei? aeine?aeaeaiiy ??cieo aeae?a aaaioii?e ia
nae?aoi?io oa iioi?ii-aaaeoaoi?io ooieoe?? OEO o niaae.
3. Aecia/eoe ??aaiue aano?eio i?ney AAA oa ?ioeo aeae?a
i?aaiicaa??aath/eo iia?aoe?e.
4. C”ynoaaoe ?ieue I?. ye iaeiiai ?c oaeoi??a aeieeiaiiy ?aoeeaeeao
ae?acee oa aea/eoe aieea a?aaeeeaoe?? I?. i?ney iia?aoe?e ia /anoioo
?aoeeaeeao ae?aceiai? oai?iae.
5. Aeine?aeeoe nae?aoi?io ? iioi?ii-aaaeoaoi?io ooieoe?? OEO i?ney AAA
oa ?ioeo i?aaiicaa??aath/eo iia?aoe?e.
6. I?iaanoe aiae?c iaeaeeae/eo ? a?aeae?eaieo ?acoeueoao?a o??o?a?/iiai
e?eoaaiiy ae?aceiai? oai?iae AeE.
7. ?ic?iaeoe i?eioeeie o??o?a?/ii? ? oa?aiaaoe/ii? i?io?eaeoeee ae?acee
i?ney aaaioii??.
8. Oaeineiiaeeoe ? iioei?coaaoe e?eoa??? ?iaeea?aeoaeueiiai aeai?o
i?aaiicaa??aath/eo iia?aoe?e i?e ae?aceia?e oai?ia? AeIE.
9. Aea/eoe aoaeoeai?noue cai?iiiiiaaieo niinia?a i?aaiicaa??aath/eo
iia?aoe?e.
Iaoeiaa iiaecia io?eiaieo ?acoeueoao?a. ?iaioa i?noeoue iia? aeai?
i?i ?ieue eeoeiai? oace a ao?iiaoiaaiac? ae?aceiai? oai?iae. ?ic?iaeaia
eiioeaioe?y ooieoe?iiaeueii? ia?aaoaeiae ?io?aio?aeueii? ia?aiai?
nenoaie, yea iieyaa? a oiio, ui i?ney aaaaeueii? aeaia?aaoe?? aoaeue
yei? ae?eyiee oeoieiai-eeoeiaiai o?aeoo iaaea? /ooeea?noue ia???oaeueieo
ee?oei oeoieo aei aano?eio. Iaea?eueo neeueiee i?eai?/oth/ee aieea ia
a?noai?iiao oa iaioaaano?eiiao oeoieiao nae?aoe?th na?aae an?o
aeine?aeaeaieo aeae?a aaaioii?e ni?aaeyea AAA. Aeaa?o eeneioe
iaioaaano?eiiai? nae?aoe?? AAA ciaiooaaea ia 81% a ?aiiueiio
i?neyiia?aoe?eiiio ia??iae? ? ia 90% – o a?aeaeaeaiiio.
Noiaao?iaa (NoA) oa naeaeoeaia aeenoaeueia aaaioii?y (NAeA)
iineethaaee ea?aaoie?iiao oeoieiao nae?aoe?th ye a ?aiiueiio, oae ? a
i?ciueiio i?neyiia?aoe?eiiio ia??iae?. NIA a ?aiiueiio
i?neyiia?aoe?eiiio ia??iae? ia aieeaaea, a a i?ciueiio
i?neyiia?aoe?eiiio ia??iae? ca?eueooaaea ea?aaoie?iiao nae?aoe?th.
Aia?oa anoaiiaeaii, ui aeno?aaano?aeueia aaaioii?y i?eai?/o?
ea?aaoie?iiao oeoieiao nae?aoe?th. C /anii oea iiaeeaeaiiy
iiaeeaethaaeinue.
Aia?oa iieacaii, ui aaaioii?y aaeeei? e?eaecie oeoieo (AAE)
ni?aaey? i?eai?/oth/ee aieea ia oeoieiao nae?aoe?th o niaae,
noeioeueiaaio ?inoe?iii, a?noai?iii, ea?aaoie?iii ? iaioaaano?eiii.
Ia a?aei?io a?ae ?ioeo aeae?a aaaioii?? aeno?aaano?aeueia aaaioii?y
ia ca?eueoo? ??aaiue aano?eio a e?ia?.
Iieacaii, ui i?ney ia?a??cee /a?aaieo a?eie aeoeath/iai ia?aa o
niaae caa??aa?oueny ia??iaee/ia aeoeai?noue ionoiai oeoieiai-eeoeiaiai
o?aeoo oa aeaiooaci?noue oa?/iai? iioi?eee. I?e ii?iaeueieo iieacieeao
1-? oace oa?/iai? iioi?eee, i?ae /an 2-? iineaaeth?oueny iioi?ia
aeoeai?noue oiiei? eeoee. Iia? oyaeaiiy i?i ?ieue /a?aaieo a?eie
aeoeath/iai ia?aa a ?aaoeyoe?? nae?aoi?ii? oa iioi?ii-aaaeoaoi?ii?
ooieoe?? oeoieiai-eeoeiaiai o?aeoo aeicaieeee ai?iaaaeeoe a i?aeoeeo
iiaee aeae i?aaiicaa??aath/i? iia?aoe?? – aeno?aaano?aeueio.
Aia?oa iieacaia ?ieue a?eie aeoeath/eo ia?a?a, ui ?ia?aothoue
aaeeeo e?eaecio oeoieo, a ?aaoeyoe?? oeoieiai? nae?aoe??.
Anoaiiaeaia ?ieue Hp a aeieeiaii? i?neyaaaioiiieo ?aoeeaeea?a.
?ic?iaeai? e?eoa??? ?iaeea?aeoaeueiiai i?aeoiaeo aei aeai?o aeaeo
i?aaiicaa??aath/i? iia?aoe?? o oai?eo c ae?aceith aeaaiaaeoeyoeiaei?
eeoee. Ii?aeiaiiy aaeaeaaoiiai iia?aoeaiiai ao?o/aiiy c a?aaeeeaoe??th
Hp a i?neyiia?aoe?eiiio ia??iae? – iiaee iai?yiie a ee?i?/i?e
aano?iaioa?ieia??, yeee aeicaieea nooo?ai cieceoe e?euee?noue
i?neyiia?aoe?eieo oneeaaeiaiue oa ?aoeeaeeao ae?aceiai? oai?iae o
oai?eo.
I?aeoe/ia cia/aiiy io?eiaieo ?acoeueoao?a. ?acoeueoaoe
aenia?eiaioaeueieo aeine?aeaeaiue nae?aoi?ii? oa iioi?ii-aaaeoaoi?ii?
ooieoe?e OEO i?ney AAA ? iaoeiaei iaa?oiooaaiiyi canoinoaaiiy AAA a
i?aeoe/i?e aano?iaioa?ieia?? ye iaoiae e?eoaaiiy ae?aceiai? oai?iae
AeIE. Caa?aaeaiiy aaaaeueii? ?iia?aaoe?? a iaeano?
no?aaio?aeii-oeoieiaiai c”?aeiaiiy caaacia/o? eiai ii?iaeueia
ooieoe?iioaaiiy ? a?aenooi?noue i?neyaaaioiiieo ?iceaae?a o oai?eo c
aeno?aaano?aeueiith aaaioii??th.
Cai?iiiiiaaia iia?aoe?y iiaea aeei?enoiaoaaoenue i?e ?aoeeaeeaao ae?acee
i?ney i?aaiicaa??aath/eo iia?aoe?e. Aenia?eiaioaeueii oa ee?i?/ii
aeiaaaeaii iiceoeaiee aieea AAE ye aoai ?icoe?aii? NIA a i?io?eaeoeoe?
?aoeeaeeao ae?aceiai? oai?iae.
Aaeineiiaeaia iaoiaeeea NIA oeyoii ia?aaeiuei? ? caaeiuei?
na?ii?ioii?? ii iae?e e?eaeci? c a?aenaia?oaaiiyi na?icii-i”ycaaiai
eineooa ? ie?aiei aoeaaiiyi aeaoaeoa, ui aeaei ciiao oieeiooe oaeeo
?io?aiia?aoe?eieo oneeaaeiaiue oa nei?ioeoe o?eaae?noue iia?aoe?e.
Oaeineiiaeaia iaoiaeeea NIA ciaioo? o?eaae?noue iia?aoe?? ? aea?
iiaeeea?noue ?? aeei?enoaiiy a iaa?aeeeaaei?e o??o?a??. I?inoioa
aeeiiaiiy ?ic?iaeaieo iiaeo iaoiae?a iia?aoeaieo ao?o/aiue (AAA,
?icoe?aia NIA, NIA c iane??ciith na?ii?ioii??th) aeicaiey? ?o
aeei?enoiaoaaoe i?e iia?aoe?yo c i?eaiaeo e?iaioa/? ? ia?oi?aoe??.
Aia?oa anoaiiaeaii ?ieue Helicobacter pylori a aeieeiaii?
?aoeeaeeao ae?acee i?ney i?aaiicaa??aath/eo iia?aoe?e. Cai?iiiiiaai?
?aeiiaiaeaoe?? ii a?aae?eaoe?? Helicobacter pylori a i?neyiia?aoe?eiiio
ia??iae? ye iaoiae oa?aiaaoe/ii? i?io?eaeoeee ?aoeeaeeao ae?acee i?ney
i?aaiicaa??aath/eo iia?aoe?e. ?ic?iaeaii eiiieaen ae?aaiinoe/ieo
e?eoa???a, ye? aeathoue ciiao aeeoa?aioe?eiaaii ae??ooaaoe ieoaiiy
aeai?o aaeaeaaoiiai iaoiaeo i?aaiicaa??aath/eo iia?aoe?e o oai?eo c
ae?aceiaith oai?iaith AeIE, ui ? aoei iniiaith o??o?a?/ii? i?io?eaeoeee
?aoeeaeeao ae?acee.
Iniaenoee aianie caeiaoaa/a. Iaoa oa caaaeaiiy aeine?aeaeaiiy
aecia/ai? aaoi?ii. Aaoi?o iaeaaeeoue caaaeueia ?aeay. Ani aac
aeeeth/aiiy ?acoeueoaoe aeineiaeaeaiue aoee io?eiaii iniaenoi
aeena?oaioii. Aaoi? i?eeiaa aaciina?aaeith o/anoue o aeeiiaiii
ia?aaaaeii? aieueoinoi o??o?ai/ieo ao?o/aiue oa aenia?eiaioaeueieo
aeine?aeaeaiue. Aaoi?ii ?ic?iaeaia iiaa iaoiaeeea i?aaiicaa??aath/eo
iia?aoe?e – aeno?aaano?aeueia aaaioii?y. Aaoi? aenia?eiaioaeueii
iaa?oiooaaa aeioe?euei?noue ?? ee?i?/iiai canoinoaaiiy. Caeiaoaa/ai aoee
aaeineiiaeaia oa ai?iaaaeaeaia a eeiii/io i?aeoeeo iaoiaeeea
i?aaiicaa??aath/eo iia?aoe?e: naeaeoeaia i?ieneiaeueia aaaioii?y c
iane??ciith na?ii?ioii??th. Cai?iiiiiaaia ? ai?iaaaeaeaia a i?aeoeeo
iiaa iaoiaeeea iia?aoeaiiai ao?o/aiiy i?e iecueeeo iicaoeeaoeeiieo
a?eynini/eiaeo ae?aceao. Aenia?eiaioaeueii iaa?oioiaaia aeioe?euei?noue
a?eueo oe?ieiai canoinoaaiiy ?icoe?aii? i?ieneiaeueii? aaaioii??. Ia
cayaeai? niiniae iaea?aeai? 3 iaoaioa. Iniaenoi caeiaoaa/ai aoee
i?iaiaeiciaaii iaeaeeae/i oa aiaeaeaeaii ?acoeueoaoe eieoaaiiy. Aaoi?o
iaeaaeeoue iaeay i?neyiia?aoe?eii? i?io?eaeoeee ?aoeeaeeao ae?acee
oeyoii a?aaeeeaoe?? Hp. Aieiaiee iaoa?iae iaae?oeiaaieo iaoeiaeo i?aoeue
aoa iaea?aeaiee caeiaoaa/ai. Aeena?oaio iniaenoi aeeiiaa eiii”thoa?iee
noaoenoe/iee aiaeic oa ocaaaeueiea ?acoeueoaoe ?c aeei?enoaiiyi
i?eeeaaeieo i?ia?ai.
Ai?iaaoeiy ?acoeueoaoia aeena?oaoei?. Aieiaii iieiaeaiiy
aeena?oaoei? aoee aenaioeaii ia Ia?o?e Iiae?euenuee?e iaoeiai-i?aeoe/i?e
eiioa?aioe?? aano?iaioa?ieia?a “Iiaa o ae?aaiinoeoe? oa e?eoaaii?
caoai?thaaiue i?aai?a o?aaeaiiy” (A?iieoey, 1993), ia I (XVII) c”?cae?
o??o?a?a Oe?a?ie ( Euea?a, 1994), ia Ia?aie ?inneeneie
aano?iyioa?ieiae/aneie iaaeaea (Naieo-Iaoa?ao?a, 1995), ia I
oe?a?inueeiio eiia?an? aano?iaioa?ieia?a (Aei?i?iiao?ianuee, 1995), ia
III I?aeia?iaeiiio eiia?an? Anana?oiuei? Oai?nueei? iaaee/ii? aeaaeai??
(Ia/, 1996), ia Aoi?ie ?inneeneie aano?iyioa?ieiae/aneie iaaeaea
(Iineaa, 1996), ia O?aoueae ?inneeneie aano?iyioa?ieiae/aneie iaaeaea
(Iineaa, 1997), ia 37 Anana?oiueiio eiia?an? o??o?a?a (Aeaioeueei,
1997), ia can?aeaii? iaoeiaiai oiaa?enoaa o??o?a?a Oiaeueieoeueei?
iaeano?, (Oiaeueieoeueeee, 1997), ia 8 Anana?oiueiio eiia?an?
I?aeia?iaeiiai eeoao o??o?a?/ii? aano?iaioa?ieia?? (No?anao?a, 1998), ia
can?aeaii? iaoeiaiai oiaa?enoaa o??o?a?a Oiaeueieoeueei? iaeano?
(Oiaeueieoeueeee, 1998).
Ioaeieaoei?. Ca oaiith aeena?oaoei? iioaeieiaaii 29 iaoeia? ?iaioe,
c ieo a 15 noaoae o niaoeiaeueieo aeo?iaeao, 1 noaooy a iaoeiaie cai?oei
oa 13 ?iaio o aeaeyaei oac aeiiiaiaeae a iaoa?iaeao iiaeia?iaeieo
c’?caeia, eiia?ania i eiioa?aioeie. Io?eiaii o?e iaoaioa ia aeiao?ae.
No?oeoo?a aeena?oaoei?. Aeena?oaoeiy neeaaea?oueny c anooio, iaeyaeo
eioa?aoo?e, iieno iaoiaeia aeineiaeaeaiue, /ioe?ueio ?icaeieia aeanieo
aeineiaeaeaiue, aiaeico oa ocaaaeueiaiiy io?eiaieo ?acoeueoaoia,
aeniiaeia, i?aeoe/ieo ?aeiiaiaeaoeie, nieneo aeei?enoaii? eioa?aoo?e.
Aeena?oaoeieia ?iaioa aeeeaaeaia ia 267 noi?iieao iaoeiiieno,
i?iiethno?iaaia oaaeeoeyie, a?aoieaie oa noaiaie ao?o/aiue. Nienie
aeei?enoaii? eioa?aoo?e iinoeoue 298 aeaea?ae.
INIIAIEE CIINO ?IAIOE
Aenia?eiaioaeueia iaa?oiooaaiiy canoinoaaiiy aeno?aaano?aeueii? oa
?icoe?aii? aaaioii?? a o??o?a?/iiio e?eoaaii? ae?aceiai? oai?iae.
A aenia?eiaioaeueiiio ?icae?e? ?iaioe aoei aeine?aeaeaii aieea
AAA oa AAE ia oeoieiao nae?aoe?th oa iioi?ii-aaaeoaoi?io ooieoe?? OEO o
niaae oa i?iaaaeaii ii??aiyeueiee aiae?c io?eiaieo ?acoeueoao?a c
?acoeueoaoaie aieeao ??cieo aeae?a aaaioii?e ia aeacai? ooieoe?? OEO.
Aeine?aeaeaiiy i?iaiaeeeenue a oiiaao o?ii?/iiai aenia?eiaioo ia 7
a?oiao aacii?iaei?o niaae aaaith 16-20 ea c o?nooeaie ooiaeaeueiiai
a?aeae?eo oeoieo oa aeaaiaaeoeyoeiaei? eeoee. I a?oia aoea
eiio?ieueiith ? neeaaeaeanue c oaa?ei c ?ioaeoiith ia?aiaith nenoaiith
(5 niaae), II a?oia – niaaee c noiaao?iaith aaaioii??th (3 oaa?eie), III
a?oia – niaaee c naeaeoeaiith aaaioii??th (3 oaa?eie), IV a?oia – niaaee
c naeaeoeaiith i?ieneiaeueiith aaaioii??th (4 oaa?eie), Y a?oia – niaaee
c naeaeoeaiith aeenoaeueiith aaaioii??th (3 oaa?eie), YI a?oia – niaaee
c aeno?aaano?aeueiith aaaioii??th (5 oaa?ei), YII a?oia – niaaee c
aaaioii??th aaeeei? e?eaecie oeoieo (3 oaa?eie). Iia?aoeai? ao?o/aiiy
i?iaiaeeeenue i?ae iaiaooaeiaei ia?eicii (35 ia/ea, aioo??oiueiaaiii).
Iaeeaaeaiiy o?nooe ia oeoiie oa aeaaiaaeoeyoeiaeo eeoeo, a oaeiae
ia?aaeiia?aoe?eia i?aeaioiaea oa i?neyiia?aoe?eiee aeiaeyae ca oaa?eiaie
cae?enithaaeanue ca noaiaie, iienaieie a iin?aieeo N.A.Oae?iiaa ?
ni?aaao. [1989].
Aeine?aeaeaiiy oeoieiai? nae?aoe?? ii/eiaee iaouana?oea i?e
a?aenooiino? aacaeueii? nae?aoe?? oa eoaeiiio ai?noo oeoieo. Niaaeai
i?aeoe??ii aaiaeeee ?inoe?i (0,5 iae./ea), iaioaaano?ei (6 iea/ea),
ea?aaoie?i (5 iea/ea), a?noai?i (0,05 ia/ea). Ia i?ioyc? noeioethth/i?
ae?? nae?aoaaia?a (?inoe?i – 4 aiaeeie, iaioaaano?ei, ea?aaoie?i ?
a?noai?i – 1,5 aiaeeie) a i?aaiaeeiieo i?iaao aei??thaaee ia”?i
aeae?eyaoiainy oeoieiaiai nieo a i?e?e?o?ao, oeo?iiao?e/ii aecia/aee
eeneioi?noue oa eiioeaio?aoe?th iaineia ca Oaioii [1948]. I?ney /iai ie
ia/enethaaee aeaa?o eeneioe oa aeaa?o iaineio a eiaei?e i?ia? oeoieiaiai
nieo oa ca aanue aeine?ae.
Iioi?io aeoeai?noue oeoieo oa aeaaiaaeoeyoeiaei? eeoee ?a?no?oaaee
aaeiiia?ao?/iei iaoiaeii. Ia”?i iia?o?y, ui aaiaeeany a ooiaeaeueiee
aaeii, neeaaeaa 15 ie, aaeii, ?ici?uaiee a AeE, – 1,5 ie. E??i caieno
iioi?ii? aeoeaiino? ca aeiiiiiaith ieoo/iai ?aa?no?aoi?a neaiaee c
aeaeo?iiaiiiao?a iiaeaaaee ia aeaeo?iiiee ?ioaa?aoi?. Ia aeoiae?
?ioaa?aoi?a io?eioaaee aeene?aoi? neaiaee a ?ici??iino? ?iioeuena –
a/oa, ye? ?a?no?oaaeenue e?/eeueieeii O-588. ?ooeeao aeoeai?noue oeoieo
? AeE oa?aeoa?ecoaaee ii noia?iiio iioi?iiio ?iaeaeno ca eiaei?
15-oaeeeii? i?ii?aeee /ano.
Ca aeiiiiiaith aeuaiaaaaeaii? iaoiaeeee aea/aee ia??iaee/io oa
oa?/iao iioi?io aeoeai?noue OEO i?ney caiaeiaoaaiiy 75 a oe?aa,
cii/aiiai aeey iie?auaiiy niaeiaeo yeinoae 50 ie iieiea.
Aaaeoaoi?io ooieoe?th oeoieo aeine?aeaeoaaee ca aeiiiiiaith iaoiaea
aaaaoi?aciaiai ae?aioaaiiy o?nooee AeE i?e aeei?enoaii? a yeino?
ia?ea??a noa? c oa?/iai? aoie. Oaa?eiai iaoua i?ney i?iieaaiiy oeoieo
caiaeiaoaaee 100 a oe?aa, cii/aiiai 50 ie iieiea. Aeey a?aooaaiiy
e?eueeino? ?ae?, ui iieeaea? oeoiie, a ?aoe?ii aeiaaaeyee 600 aoiiaeo
noa?. Aonoeia noa? – 1,1 a/ni3, yea ? aeecueeith aei aonoeie ai?noo
oeoieo. Ae?aiao? eiaeii? noa?e ia ia?aaeuoaaa 1-1,5 ii, ui caaacia/oaaei
?o aacia?aoeiaeia i?ioiaeaeaiiy ?acii c o?ionii /a?ac i?ei?e/iee
no?ieoa? [1972]. Noia?iee ia”?i noa? ia ia?aaeuoaaa 1,5 ni3. Oaeei
/eiii, aeiaaaea ?o aei ?ae? ia ia”?i? ia iicia/aeanue.
A 5-oaeeeiieo ii?oe?yo o?iono aecia/aee eiai ia”?i, i?ae?aoiaoaaee
e?euee?noue noa? ? eiioeaio?aoe?th aiaeiaaeo ?ii?a ?iiii??ii YA-74.
Iiaiioa nii?iaeiaiiy oeoieo eiio?iethaaeanue ii ?acoeueoaoai eiai
i?iieaee a e?ioe? aenia?eiaioo.
Aeey oa?aeoa?enoeee aeeiai?ee ci?i ?I aeoiaeaiaeueiiai ai?noo i?ae
/an aaaeoaoi?iiai i?ioeano aoaeoaaee a?ao?ee a e?i?ei?e nenoai?
eii?aeeiao. Ii in? aanoeen a?aeeeaaeaee /an i?ney aiaeoaaiiy a oaeeeiao,
a ii in? i?aeeiao – aaniethoia cia/aiiy aaee/ei ?I eiaeii? i?iae o?iona.
Aaaeoaoe?th ??aeeie aecia/aee ca iaoiaeii aeine?aeaeaiiy
aaaeoaoe?? ??aeei c oeoieo. I?e aeiiiiic? ciiaeo, aaaaeaiiai /a?ac
?ioiao ii?iaeieio, a oeoiie niaaee aeeaaee 300 ie o?c?ieia?/iiai
?ic/eio, a 100 ie yeiai ?ic/eiaii 4 ie oaiieiaiai /a?aiiiai ?iaeeeaoi?a
N19I17I5NS. I?ney oeueiai aecia/aee ci?io eiioeaio?aoe?th aaaaeaiiai a
oeoiie ?ic/eio ca ?aooiie ?icaaaeaiiy eiai oeoieiaei nieii. Aaee/eio
aenoeioe?? aecia/aee ia oioieiei?eiao?? OAE-56I (eaiia NOe-98, o?eueo?
?6, =540+10 ii). Io?eioaaee a?aeiioaiiy aenoeioe?? aeine?aeaeoaaiiai
?ic/eio. Aiineee a?aeiia?aeio iii?aaeo aei ?acoeueoao?a aei??thaaiue
ia”?i?a ??aeei, yea caeeoa?oueny a oeoieo /a?ac eiaeio oaeeeio. Io?eiai?
aeai? a?aeeeaaeaee a iai?aeiaa?eoi?/i?e nenoai? eii?aeeiao ? io?eioaaee
a?ao?/ia cia?aaeaiiy aeeiai?ee aaaeoaoe?? ??aeeie. E??i oeueiai
aecia/aee aaniethoio oa a?aeiinio oaeaeeino? aaaeoaoe?? ??aeeie ca ??
e?euee?noth, ui aeoiaeeea c oeoieo eiaeio oaeeeio.
?acoeueoaoe, io?eiai? ia oaa?eiao, i?ney ??cieo aeae?a aaaioii??,
ii??aithaaee c ?acoeueoaoaie aenia?eiaio?a ia niaaeao c ?ioaeoiith
ia?aiaith nenoaiith. I?iaiaeeeo noaoenoe/io ia?iaeo ?acoeueoao?a ca
iaoiaeii Noueaeaioa-O?oa?a c aeei?enoaiiyi e?eoa??y t [1961] ia IAII
Neleron-300.
O niaae c NoA a ia?o? 6 i?nyoe?a i?ney iia?aoeaiiai ao?o/aiiy
eeneioi?noue oeoieiaiai nieo, noeioeueiaaiiai ea?aaoie?iii, aoa
ca?eueoaiei ia 208,1%. *a?ac 6 i?nyoe?a i?ney iia?aoe?? niinoa??aaeinue
ciaioaiiy aeine?aeaeoaaieo iieaciee?a ea?aaoie?iiai? nae?aoe??, ye?
/a?ac ??e noaa?e?coaaeenue. Eeneioi?noue ea?aaoie?iiaiai nieo a
i?ciueiio i?neyiia?aoe?eiiio ia??iae? aoea ca?eueoaiith ia 102,7%
(oaae.1).
A ?aiiueiio i?neyiia?aoe?eiiio ia??iae? i?ney NAeA ?ioaineai?noue
ea?aaoie?iiai? nae?aoe?? ca?eueooaaeanue ia 40,9%, aeaa?o eeneioe – ia
54,1%, aeaa?o iaineio – ia 127,1%. *a?ac ??e i?ney NAeA a ?ioaineaiino?
ea?aaoie?iiai? nae?aoe?? oa ?? eeneioiino? noaoenoe/ii a??ia?aeieo ci?i
ia niinoa??aaeiny. Ia i?ioyc? oeueiai /ano aeae?eaiiy iaineio
ciaiooaaeiny. *a?ac ??e i?ney NAeA aeaa?o iaineio aoa iaioei a
ii??aiyii? c eiio?ieai ia 46,4%.
NIA ia ni?aaeyea noaoenoe/ii a??ia?aeiiai aieeao ia aeine?aeaeoaai?
iieacieee ea?aaoie?iiai? nae?aoe?? ye a ia?o? 6 i?nyoe?a oae ? /a?ac ??e
i?ney iia?aoe??.
O niaae c AAA a ia?o? 6 i?nyoe?a i?ney iia?aoe?? noaoenoe/ii
a??ia?aeieo ci?i caciaaaei eeoa aeae?eaiiy eeneioe: aeaa?o eeneioe
ciaiooaaany ia 21,6%. *a?ac ??e oea i?eai?/aiiy iiaeeaethaaeinue ?
aeinyaaei 51,4%. A oeae aea /an iaeii/anii ciaiooaaeinue aeae?eaiiy
nieo, noeioeueiaaiiai ea?aaoie?iii, oa aeaa?o eiai iaineio. I?eai?/aiiy
ia”?io nieo oa aeaa?oo iaineio a?aeiia?aeii neeaaeaee 50,0% oa 24,5%.
*a?ac 6 i?nyoe?a i?ney iia?aoe?? an? aeaee aaaioii??, iacaeaaeii
a?ae oiai, /e caoaa/oaaea aeaia?aaoe?y ciio iaeeaaeiaeo ee?oei,
ciaiooaaee ia”?i nieo, aeaa?o eeneioe oa aeaa?o iaineio, noeioeueiaaieo
iaioaaano?eiii (oaae.2). O niaae i?ae aieeaii NoA ?ioaineai?noue
iaioaaano?eiiai? nae?aoe?? ciaiooaaeanue ia 37,1%, aeaa?o eeneioe – ia
40,0%, aeaa?o iaineio – ia 63,8%. Ia oaeiio ??ai? aeine?aeaeoaai?
iieacieee caeeoaeenue ? a iiaeaeueoiio.
A ia?o? 6 i?nyoe?a i?ney iia?aoe?? NAeA ciaiooaaea ia”?i oeoieiaiai
nieo, noeioeueiaaiiai iaioaaano?eiii, ia 55,2%, aeaa?o eeneioe – ia
57,6%, aeaa?o iaineio – ia 69,6%. A ianooii? 6 i?nyoe?a noaoenoe/ii
a??ia?aeieo ci?i a aeine?aeaeoaaieo iieacieeao iaioaaano?eiiai?
oeoieiai? nae?aoe?? ia a?aeaoaaeiny.
I?ae aieeaii NIA a ia?o? 6 i?nyoe?a ?ioaineai?noue iaioaaano?eiiai?
nae?aoe?? ciaiooaaeanue ia 51,8%, aeaa?o eeneioe – ia 68,8%, aeaa?o
iaineio – ia 56,2%. A iine?aeoth/? i?nyoe? ia”?i nieo oa aeaa?o eeneioe
ia ci?ithaaeenue, oi/a eeneioi?noue iaioaaano?eiiaiai nieo aeaui
c?inoaea. Ciaioaiiy aeaa?oo eeneioe /a?ac 7-12 i?nyoe?a i?ney iia?aoe??
NIA neeaaeaei 53,7%.
Iaea?eueo aeeaieei i?eai?/aiiy iaioaaano?eiiai? nae?aoe?? aoei i?ney
AAA. A ia?o? 6 i?nyoe?a i?ney iia?aoe?? ia”?i nieo, aeaa?o eeneioe,
aeaa?o iaineio ciaiooaaeenue a?aeiia?aeii ia 88,9%, 81,6% oa 80,4%. A
iine?aeoth/iio ia”?i nieo ? aeaa?o iaineio ia ci?ithaaeeny. Iai?ioe,
aaeueioaaiiy aeaa?oo eeneioe iiaeeaethaaeinue ? neeaaeaei 92,0%.
Aiaeia?/i? aeai? i?i neeueiee i?eai?/oth/ee aoaeo ??cieo aeae?a
aaaioii?e ia iaioaaano?eiiao nae?aoe?th, yeee i?aeoe/ii ia caeaaeeoue
a?ae oiai, yea /anoeia oeoieo aeaia?ao?oueny, io?eiai? ? ?ioeie aaoi?aie
[A?ieniai N.Ae., 1994]. Io?eiai? ?acoeueoaoe na?ae/aoue, ui i?e/eiith
oaeiai cia/iiai iaae?iiy /ooeeaino? iaeeaaeiaeo ee?oei aei aano?eio ia ?
ii?ooaiiy ?o ?ia?aaoe??. ?iaeoa ie a ia niinoa??aaee oaeiai
aoaeoo i?ney NAeA oa AAA. Iaoai?ci aeaiiai oaiiiaio ne?ae ooeaoe a cnoa?
yeiainue ?aaoeyoi?iiai iieacieea, yeee ia? i?noea i?e an?o aeaeao
aaaioii??, a naia: ii?ooothoueny ii?iaeuei? ca”ycee i?ae oeaio?aeueiith
oa ?io?aio?aeueiith ia?aiaith nenoaiaieae. A ?acoeueoao? ie
niinoa??aa?ii aaia?ae?ciaaio ?aaeoe?th ?io?aio?aeueii? ia?aiai?
nenoaie, yea i?iyaey?oueny a oiio, ui ia?a??cea a?eie aeoeath/eo ia?a?a
a aoaeue-yeiio i?noe? OEO i?eaiaeeoue aei iaae?iiy G-?aoeaioi??a
ia???oaeueieo ee?oei aei aano?eio. Aiane?aeie /iai iaioaaano?eiiaa
oeoieiaa nae?aoe?y ciaioo?oueny.
I?e aea/aii? iioi?ii-aaaeoaoi?ii? ooieoe?? OEO, ui o niaae
i?ney AAA a?aenooi? aeeaie? ii?ooaiiy iioi?ii? ooieoe??. AAA
oiia?eueith? iii?iaeiaiiy oeoieo a oae?e i???, ui a?aeiia?aea?
oiia?eueiaiith eiai i?ney i?eeiio aee?ii? ?ae? oa cia/ii iaioa a
ii??aiyii? c oiia?eueiaiiyi, ni?e/eiaiei NoA. Aeeaieee ? iacai?ioi?e
aieea AAA ia iae?i-aoii?aeueio oaco oeoieiai? nae?aoe?? oa iii??ia
niia?eueiaiiy aaaeoaoe?? c oeoieo ? a?aenooi?noue aeeaieeo ii?ooaiue
iioi?ii? ooieoe?? OEO o niaae c AAA iineoaeeei
iaoeiai-aenia?eiaioaeueiei iaa?oiooaaiiyi ai?iaaaeaeaiiy aeaiiai aeaeo
aaaioii?? a i?aeoeeo.
Eeane/ia NIA o a?aeaeaeai? n?iee i?ney iia?aoe?? aea? a?ae 5 aei 30%
?aoeeaeeao ae?aceiai? oai?iae AeIE [Aaae/aa A.A., *a?iyeaae/ N.A., 1983;
Aaeue E.N. e niaao., 1986; Aa?acia TH.A., A?iieia A.N., 1970; 1974;
Aeiie/aiei A.A. e niaao., 1984; Aeeueaeaia?aiaeo TH. E niaao., 1989;
Aonae A.E. e niaao., 1989; Aeoaeaiei A.A., 1985; Aeoaeaiei A.A., Cuaei
A.I., 1987; Caii?iae/aiei A.N. e niaao., 1983; Eo?uaei A.A., 1975;
Iaaaeeaa O.O. e niaao.,1990; Iaiaae/ A.E., Oa?eoiiia E.A., 1983;
Naeaciaa A.I., Nuaoeue O.O., 1989; Oaei N.E., 1990 ]. Ia aeoieo
aeine?aeiee?a a?eueoa /anoeia ?aoeeaeea?a iia”ycaia c oei, ui
caeeoa?oueny ?ia?aiaaiith aaeeea e?eaecia oeoiea. A ca”yceo c oeei ie
aia?oa a aenia?eiaio? aea/eee aieea ?cieueiaaii? AAE ia nae?aoi?io
ooieoe?th oeoieo o niaae. Anoaiiaeaii, ui AAE aaeueioaaea ia”?i
oeoieiaiai nieo, noeioeueiaaiiai ?inoe?iii, ia 53.4 % (oaae.3). Aeaa?o
eeneioe ciaiooaaany ia 44.9 %. AAE oaeiae i?eai?/oaaea ea?aaoie?iiao
nae?aoe?th oeoieo. Oea i?eai?/aiiy aoei i?eaeecii iaeiaeiaei a on?
ia??iaee niinoa?aaeaiiy. Ia”?i oeoieiaiai nieo, aeaa?o eeneioe oa aeaa?o
iaineio ciaiooaaeenue ia 35,2%, 50,4% ? 62,4% a?aeiia?aeii. AAE
ciaiooaaea ?ioaineai?noue oeoieiai? nae?aoe??, noeioeueiaaii?
iaioaaano?eiii, aeaa?o eeneioe oa aeaa?oo iaineio ia 44,1%, 45,3% oa
61,2%. Anoaiiaeaiee iaie oaeo i?eai?/oth/iai aieeao AAE ia oeoieiao
nae?aoe?th o niaae, noeioeueiaaio ?inoe?iii ? iaioaaano?eiii, iineoaeea
aenia?eiaioaeueiei iaa?oiooaaiiyi a?eueo oe?ieiai ai?iaaaeaeaiiy a
ee?i?/io i?aeoeeo iia?aoe?? ?icoe?aii? NIA.
Oa?aeoa?enoeea oai?eo oa iaoiaee ee?i?/ieo aeine?aeaeaiue. A
iniiao ?iaioe iieeaaeaiee aiae?c ?acoeueoao?a ianoaaeaiue ? o??o?a?/iiai
e?eoaaiiy 400 oai?eo, iia?iaaieo a o??o?a?/iiio a?aeae?eaii?
Oiaeueieoeueei? iaeanii? ee?i?/ii? e?ea?i? a 1988-1998 ?ieao.
Oai?? ia?oi? a?oie-174, iia?iaai? ca caaaeueiii?eeiyoeie
iaoiaeeeaie, ?i ia i?iaiaeeeanue aioeoae?eiaaeoa?ia oa?ai?y, aoee
eiio?ieueieie aeey ii??aiyiiy c ae?oaith – iniiaiith a?oiith – 226
oai?eo, yeei aeeiioaaeenue iia? cai?iiiiiaai? iaoiaeeee iia?aoeaieo
ao?o/aiue. ?c caaaeueii? e?eueeino? oai?eo iniiaii? a?oie /ieia?e?a
aoei 168 (74,3%), ae?iie- 58 (25,7%).
Ianoaaeaiiy oai?eo i?iaiaeeee eiiieaenii, aea/aee aiaiianoe/i? aeai? ?
ee?i?/iee ia?aa?a oai?iae. Oaeiae aeeiioaaee o?a?iaano?iaeaiineii?th,
?aiaaiieia?/ia aeine?aeaeaiiy no?aaioiaeo, oeoieo, AeIE, aecia/aee
oeoieiao na?eaoe?th o?aeoe?eiei iaoiaeii oa aeeiioaaee
aioo??oiueioeoieiao ?I-iao??th. Oaeiae aecia/aee ??aaiue aano?eio a
e?ia? oa iayai?noue Hp.
Aeaee iia?aoeaieo ao?o/aiue o oai?eo iniiaii? ? eiio?ieueii? a?oie
iaaaaeai? a oaaeeoe? 4.
O oai?eo iniiaii? a?oie aeeiioaaee oaeineiiaeai? aeaee aaaioii??
(NIA o aeaeyae? iane??cii? na?ii?ioii??, NIA c ?ic”?aeiaiiyi
aio?aeueiiai a?aeae?eo ? o?ea oeoieo) oa iiaee aeae – AAA (?en.).
Iaoiaeeea ?? aeeiiaiiy iieyaaea a ne?aeoth/iio. Iia?aoe?th aeeiioaaee c
aa?oiuei-na?aaeeiiiai aeinooio. Aeey c?o/iino? iai?ioeyoe?e ia
no?aaioiae? aaiaeeee oianoee oeoieiaee ciiae. I?ney ?aa?c?? i?aai?a
/a?aaii? ii?iaeieie ? aecia/aiiy ia”?io o??o?a?/iiai ao?o/aiiy
iia?e?coaaee e?ao aeieth ia/?iee oeyoii ia?an?/aiiy o?eeooieeiai?
ca”ycee. Ieae/a no?aaio?aeiiai ioai?o ae?ao?aaie ia i?ioyc? 2-3 ni
ia?an?eaee i/a?aaeio a iiia?a/iiio iai?yieo, yea iie?eaa?
aaaeii?iaeueiee a?aeae?e no?aaioiaeo. Aeae?eyee ? a?aee ia o?eiaeee
ia?aaei?e ? caaei?e aeoeath/? ia?ae. Ia?an?eaee oeoieiai-iaiaeiao
ca”yceo. Oeoiie ca caaeith no?ieo i?aeoyaoaaee aeiaa?oo. Iaaen?eaee
i/a?aaeio iaae iniiaieie noiaao?aie e?ai? oeoieiai? a?oa??? ? aaie.
Iioyaoth/e ca o?eiaeeo caaeiueiai noiaao?a aeoeath/iai ia?aa ? caaeith
no?ieo oeoieo iicaaeo e?ai? oeoieiai? a?oa??? ? aaie ciaoiaeeee /a?aaio
a?eeo, yea a?aeoiaeeoue a?ae caaeiueiai aeoeath/iai ia?aa. Oiaueia
/a?aaii? a?eee a a?eueoino? aeiaaee?a ??aiyeanue ae?aiao?o ia?aaeiueiai
aeoeath/iai ia?aa. *a?aaio a?eeo ia?an?eaee i?ae caaeeiaie ?
ia?aa”ycoaaee. A ae?eyioe? ii/aoeiaiai a?aeae?eo AeIE ia 1,5-2 ni ieae/a
ai?ioa?y ia?an?eaee ae?oao a?ei/eo, yea a?aeoiaeeoue a?ae ia?aaeiueiai
noiaao?a aeoeath/iai ia?aa ? ia aa?oiuei- ai?eciioaeueio /anoeio
Oaaeeoey 4
Aeaee iia?aoeaieo ao?o/aiue o oai?eo iniiaii? ? eiio?ieueii? a?oie
Iia?aoeai? ao?o/aiiyIniiaia a?oia
Eiio?ieueia a?oian%N%NIA (?cieueiaaia)2310,14727,0NIA+II aai
AeI9140,28347,0?icoe?aia NIA+ II aai AeI198,4Aeno?aaano?aeueia
aaaioii?y+II aai AeI
42
18,5NIA c iace??ciith na?ii?ioii??th+II aai AeI
22
9,7NIA c ?ic?aeiaiiyi aio?oia ? o?ea+II aai AeI
13
5,7NA c aio?oiaeoii??th167,01910,9 NOA+AAA148,0Ia?aaeiueinoiao?iaa ?
caaeiy naeaeoeaia aaaioii?y (ca Aeaeaeniiii)
11
6,3
Anueiai
226
100,0
174
100,0
AeIE ia?aoiaeeoue c ia/?ieiai-aeaaiaaeoeyoeiaei? ca”ycee. A caeaaeiino?
a?ae eieae?caoe?? ae?acee, oiiia?aoi-aiaoii?/ieo ci?i a ?? ae?eyioe?,
AAA aeiiiaithaaee iaeiei ?c aeae?a II aai AeI.
?aii? i?neyiia?aoe?ei? oneeaaeiaiiy ie a?aei?/aee o 26 (11,5%). I?ney
iia?aoe?e iiia?ei 3 oai?eo. I?e/eiith nia?o? o iaeiiai oai?iai aoea
o?iiaiaiaie?y aieiaiiai noiaao?a eaaaiaai? a?oa???, a o aeaio – aaaeea
noiooiy iaoieia?y – na?oeaai-noaeeiia iaaeinoaoi?noue a noaae?? noa- ?
aeaeiiiainaoe??. Iae/ano?oa i?neyiia?aoe?eiee ia??iae oneeaaeithaaany
aano?inoacii – 11 (4,8%) ? aeaii?ia-neiae?iiii – 4 (1,7%) oai?eo. ?io?
oneeaaeiaiiy ia aoee iia”ycai? c ?iceaaeaie ooieoe?e OEO. Ie ?icaeyaeaee
aeaii?ia-neiae?ii ? aano?inoac eeoa na?aaeiueiai ? aaaeeiai nooiaith
aaaeeino?. Aano?inoac na?aaeiueiai nooiaith aaaeeino? /ano?oa
?en. Aeno?aaano?aeueia aaaioii?y c II aai AeI
aeieeaa i?ney NIA c ?ic”?aeiaiiyi aio?aeueiiai a?aeae?eo ? o?ea oeoieo ?
AAA c II aai AeI. Ia aeieeiaiiy aano?inoaco aieeaa? aeiiia?aoe?eia
ii?ooaiiy aaaeoaoe?? ?c oeoieo. Oae, ie iia?oaaee 19 (8,4%) c yaeuaie
noa- ? aeaeiiiainiaaiiai noaiico. Oaeei oai?ei ie i?iaiaeeee ?aoaeueio
ia?aaeiia?aoe?eio i?aeaioiaeo, yea aeeth/aea aeaeiii?an?th oeoieo aea?/?
ia aeiao, aaaaeaiiy aaiciaaenii?th ? oea?oeaeo. Oai?ei, noai yeeo aoa
aaaeeee, iaia?aaeiaei? iia?aoe?? ca aeiiiiiaith aano?ineiio o AeIE
caaiaeeee ciiae aeey aioa?aeueiiai oa?/oaaiiy. I?ecia/aee
aenieieaei??ei? caaeainiaai? a?eeiai-aoaeaaiaei? noi?o?. Oaeiae oaeei
oai?ei i?iaiaeeee ia?aaeiia?aoe?eio ei?aeoe?th ii?ooaiue
aiaeii-aeaeo?ie?oiiai ? a?eeiaiai iai?io. I?iaaaeaiiy eiiieaeno
i?io?eaeoe/ieo i??ii?e?inoa c i?eaiaeo aano?inoaco aeicaieeei ciaioeoe
eiai /anoioo, a oaeiae nooi?iue aaaeeino?. Aiae?coth/e ?io?a- ?
i?neyiia?aoe?ei? oneeaaeiaiiy i?ney i?aaiicaa??aath/eo iia?aoe?e. Ie
i?eeoee aei aeniiaeo, ui a?eueo?noue ?c ieo ea?iaai? ? i?aeaeathoueny
i?io?eaeoeoe?.
Aeine?aeaeaiiy aacaeueii? oeoieiai? nae?aoe?? a
ia?aaeiia?aoe?eiiio ia??iae? o oai?eo iniiaii? a?oie (226 /ieia?e)
iieacaei, ui an? oai??, ca aeeiyoeii iaei??? a?oie c 16 /ieia?e, iaei
a?ae??ciyeenue i?ae niaith ii iieacieeai aacaeueii? nae?aoe??. A
na?aaeiueiio AIE o 210 /ieia?e neeaaeaea 5,52+0,35 iiieue/aiae., o 16 –
11,09+0,95 iiieue. Oae ye iieacieee AIE ia aoee iieaciaeie, a cia/eoue ?
ia iiaee aooe aieiaieie, o aeai?? iaoiaeo i?aaiicaa??aath/i? iia?aoe??,
o an?o oai?eo ie aea/aee iieacieee noeioeueiaaii? oeoieiai? nae?aoe??.
I?ney anoaiiaeaiiy iieaciee?a oeoieiai? nae?aoe??, noeioeueiaaii?
iaioaaano?eiii ? ?inoe?iii, oai?? aoee oiiaii ?icae?eai? ia a?oie, ?i
aeeiioaaeenue ??ci? aeaee iia?aoeaieo ao?o/aiue (oaae. ). O aeai?? aeaeo
i?aaiicaa??aath/i? iia?aoe?? i?e ae?aceia?e oai?ia? AeIE e??i
ia?aaeiia?aoe?eiiai ??aiy oeoieiai? nae?aoe?? ie oaeiae a?aoiaoaaee
nooi?iue ii?ooaiiy iioi?ii-aaaeoaoi?ii? ooieoe?? OEO, noai
aano?iaeoiaeaiaeueiiai ia?aoiaeo (noaiic), eieae?caoe?th ae?acee,
iaiao?aoe?th a non?aei? i?aaie. Cia/iee aieea ia aea??
i?aaiicaa??aath/i? iia?aoe?? ?, iniaeeai, ia aeae ae?aioth/i? iia?aoe??
ni?aaeyee aeyaeai? ?io?aiia?aoe?eii aiaoii?/i? ci?ie
aano?iaeoiaeaiaeueii? ciie.
I?ney aeeiiaiiy i?aaiicaa??aath/eo iia?aoe?e aacaeueia nae?aoe?y a
?aiiueiio i?neyiia?aoe?eiiio ia??iae? aoea ??cei cieaeaiith iacaeaaeii
a?ae aeeiiaiiai aeaeo iia?aoeaiiai ao?o/aiiy. A /a?ac ??e niinoa??aaeany
nooo?aa ??cieoey a aacaeuei?e nae?aoe?? o oai?eo ??cieo a?oi. Oae, i?ney
?cieueiaaii? NIA aacaeueia nae?aoe?y c?inoaea a ii??aiyii? c ?aii?i
i?neyiia?aoe?eiei ia??iaeii ia 47,3% ? aoea iaioith a ii??aiyii? c
aeiiia?aoe?eiei ??aiai ia 29,4%. *a?ac ??e i?ney NIA c ae?aioth/eie
iia?aoe?yie, NIA c ?ic”?aeiaiiyi aio?aeueiiai a?aeae?eo o?ea ? oeoieo,
NA c aio?oiaeoii??th ??aaiue aacaeueii? nae?aoe?? ia a?ae??ciyany a?ae
??aiy aacaeueii? nae?aoe?? a ?aiiueiio i?neyiia?aoe?eiiio ia??iae?.
I?ioeeaaeia neooaoe?y niinoa??a?eany i?ney AAA c ae?aioth/eie
iia?aoe?yie: /a?ac ??e niinoa??aaeiny iiaeaeueoa noaoenoe/ii a??ia?aeia
i?eai?/aiiy aacaeueii? nae?aoe??, yea aoea iaioith a?ae aeiiia?aoe?eiiai
??aiy ia 82,1%.
Oai??, yeei aoee aeeiiai? iia?aoe?? ?cieueiaaii? NIA, ?icoe?aii? NIA
c ae?aioth/eie iia?aoe?yie, NIA c iane??ciith na?ii?ioii??th ca ??aiai
?inoe?iiai? oeoieiai? nae?aoe?? iaei a?ae??ciyeeny i?ae niaith.
Iaeiaioee ??aaiue ?inoe?iiai? oeoieiai? nae?aoe?? a aeiiia?aoe?eiiio
ia??iae? aoa o a?oi? oai?eo, yeei aeeiioaaee AAA. I?ney a?no aeae?a
i?aaiicaa??aath/eo iia?aoe?e ?inoe?iiaa nae?aoe?y o oai?eo a ?aiiueiio
i?neyiia?aoe?eiiio ia??iae? aoea nooo?ai cieaeaiith.
An? aeaee i?aaiicaa??aath/eo iia?aoe?e a ?aiiueiio
i?neyiia?aoe?eiiio ia??iae? i?eaiaeeee aei i?eai?/aiiy iaioaaano?eiiai?
oeoieiai? nae?aoe??. O a?aeaeaeai? aea n?iee i?ney NIA niinoa??a?eany
oaiaeaioe?y aei ca?eueoaiiy nae?aoe?? oeoieo, noeioeueiaaii?
iaioaaano?eiii. Iai?ioe, i?ney NA c aio?oiaeoii??th, NIA c ?ic”?aeiaiiyi
aio?aeueiiai a?aeae?eo ? o?ea oeoieo, NIA c iane??ciith na?ii?ioii??th
oa AAA /a?ac ??e i?ney iia?aoe?? i?eai?/aiiy iaioaaano?eiiai? nae?aoe??
iiaeeaethaaeiny.
I?e ?aoaeueiiio aea/aii? aaniethoieo aaee/ei oa a?aenioeo
ciaioaiiy oeoieiai? nae?aoe??, noeioeueiaaii? iaioaaano?eiii, ie
io?eiaee iaea?eueo neeueiee i?eai?/oth/ee aieea ia ia? i?ney AAA.
Aiaeia?/i? aeai? aoee io?eiai? a o?ii?/ieo aenia?eiaioao ia niaaeao.
I?e aea/aii? ??aiy aano?eio a ne?iaaooe? e?ia? i?ney ??cieo aeae?a
i?aaiicaa??aath/eo iia?aoe?e anoaiiaeaii, ui i?ney NIA c ae?aioth/eie
iia?aoe?yie ??aaiue eiai c?inoa?. I?ney NA c aio?oiaeoii??th ??aaiue
aano?eio ciaiooaaany, ui aoei ?acoeueoaoii aeaeaeaiiy aieiaiiai
aeaea?aea aano?eio a e?ia? – aio?aeueiiai a?aeae?eo. I?ney AAA a
?aiiueiio i?neyiia?aoe?eiiio ia??iae? ??aaiue aano?eio ia ci?ithaaany.
*a?ac ??e ??aaiue aano?eio a e?ia? iia?iaaieo oai?eo ciaiooaaany, aea
oea ciaioaiiy aoei noaoenoe/ii iaa??ia?aeiei.
Aiae?coth/e aeeiai?eo i?neyiia?aoe?eieo ii?ooaiue ? oneeaaeiaiue
i?ney AAA, iiaeia c?iaeoe aeniiaie, ui aiie ? ia?aaaaeii eaaeiai ?
na?aaeiueiai nooiaith aaaeeino?, ? ?o i?iyae i?ney iia?aoe?? iinooiiai
?aa?anothoue ? ia ni?e/eiythoue iaaaoeaiiai aieeao ia ?acoeueoao AAA.
?acii c oei, iio??aii a?aei?oeoe, ui aenia?eiaioaeueii AAA i?ecaiaeeoue
aei iacia/iiai o?ia?eueiaiiy aaaeoaoe??, ui ie ee?i?/ii niinoa??aaee o
12 iaoe??io?a. Aeei?enoaiiy iaie aeiiia?aoe?eii? i?io?eaeoeee
iioi?ii-aaaeoaoi?ieo ii?ooaiue, a oaeiae ae?aaiinoeea oeo noai?a ?
oneeaaeiaiue ae?aceiai? oai?iae, ui iiaea i?ecaanoe aei oaeeo ii?ooaiue
a i?neyiia?aoe?eiiio ia??iae? ? ?o ei?aeoe?y i?ae /an iia?aoe??, a
oaeiae i?io?eaeoeea i?ney iia?aoe??, aeaei iiaeeea?noue iie?auaiiy
?acoeueoao?a AAA.
I?e ?aioaaiieia?/iiio aeine?aeaeaii? /a?ac ??e i?ney AAA o oai?eo
ee?i?/ieo i?iya?a aeaii?ia-neiae?iio aai aano?inoaco ia aoei.
Iaouana?oea oeoiie aoa ii?iaei?e, ia ca?eueoaiee, ia?enoaeueoeea oeoieo
aoea caaeia?eueiith. Aaaeoaoe?y aoea ii?oe?eiith. Iiaia aeii?iaeiaiiy
oeoieo a?aeaoaaeinue /a?ac 75+9 oa. Io?eiai? ?acoeueoaoe i?i
a?aenooi?noue iaoieia?/iiai aieeao AAA ia iioi?eeo oiieiai eeoeiaeea
ni?aiaaeathoue c aeniiaeaie A.A.Eo?ea?ia [1971,1975], yeee
i?neyiia?aoe?eiee ia?ac eeoa/ieea i?ney ??cieo aeae?a aaaioii??
?icaeyaeaa ye aeeiai?/io iai?io?aei?noue, ui niinoa??aa?oueny i?ney
aoaeue-yeiai aeaeo iia?aoeaiiai ao?o/aiiy ia i?aaiao /a?aaii?
ii?iaeieie.
Oaeei /eiii, ?ic?iaeaia AAA ? aeinoaoiuei aoaeoeaiei iia?aoeaiei
ao?o/aiiyi, a oie iacia/iee aieea, yeee aiia ni?e/eiy? ia
iioi?ii-aaaeoaoi?io ooieoe?th OEO ia ? aecia/aeueiei, aeia?a
ei?eao?oueny eiina?aaoeaieie caniaaie, a ee?i?/i? neiioiie iinooiiai
?aa?anothoue.
O oai?eo iniiaii? a?oie ie aeine?aeaeoaaee iayai?noue ?io?eoaaiiy
I?. aei iia?aoe??, i?ney iia?aoe?? /a?ac 12-14 aei?a ? /a?ac 6-12
i?nyoe?a.
Aeiiia?aoe?eia ianoaaeaiiy i?iaiaeeee ca aeiiiiiaith o?aaciiai ?
a?noieia?/iiai oano?a. I?ney iia?aoe?? ?io?eoaaiiy I?. aecia/aee ca
aeiiiiiaith ?ioiieia?/iiai oanoo.
Ianoaaeaii 79 oai?eo iniiaii? a?oie, ye? iia?iaai? c i?eaiaeo
ae?aceiai? a?oie AeIE. Oeei oai?ei aeeiioaaee
acioaaiaano?iaeoiaeaiineii?th c a?iin??th aio?aeueiiai a?aeae?eo, o?ea
oeoieo ? oeeaoeeie AeIE. O?e?aciao a?iin?th aeeiioaaee aeey a?eueoi?
a??ia?aeiino? ae?aaiinoeee, oiio ui ca aeaieie e?oa?aoo?e caa?oaeiaiiy
aaeoa??yie I?. oeoieo ia? iica?/io eieae?caoe?th [A?oei E.E., 1993].
Aei iia?aoe?? cia/ia caa?oaeiai?noue ae?aaiinoiaaia o 41 (51,9%),
iii??ia – o 27 (34,2%), neaaea – o 11 (13,9%) ianoaaeaieo oai?eo. Oiaoi,
?io?eiaai?noue oeoieo I?. ??ciiai nooiaith aaaeeino? aoea o an?o
ianoaaeaieo iaoe??io?a. ?aeaioe/i? aeai? io?eiai? aei iia?aoe?? ca
aeiiiiiaith a?noieia?/iiai oanoo.
I?e aea/aii? ii?oieia?/ieo ci?i a?iioao?a, o 74 (97,3%) oai?eo
ae?aaiinoiaaia oeoieiaa iaoaieac?y a AeIE. Ca aeaieie e?oa?aoo?e, I?. a
AeIE ciaoiaeeoueny o?eueee ia iaoaieaciaaiiio oeoieiaiio ai?oae?th. Ia
anoaiiaeaiiy iieac?a ? aeae i?aaiicaa??aath/i? iia?aoe?? iayai?noue I?.
? nooi?iue caa?oaeiaiino? ia aieeaaee. O 23 (29,1%) oai?eo aeeiiaia
NIA+II aai AeI, o 10 (12,6%) – ?cieueiaaia NIA, o 7 (8,8%) – ?icoe?aia
NIA, o 20 (27,8%) – AAA+II aai AeI, o 8 (10,1%) – NIA c iane??ciith
na?ii?ioii??th + II aai AeI, o 6 (7,5%) – NIA c ?ic”?aeiaiiyi
aio?aeueiiai a?aeae?eo ? o?ea oeoieo, o 5 (6,3%) – NA c aio?oiaeoii??th.
Oai?ei eiio?ieueii? a?oie aeeiioaaee i?aaiicaa??aath/? iia?aoe??
aac aea/aiiy iayaiino? I?. aei iia?aoe?? ? ia i?iaiaeeee oa?ai?th,
iai?aaeaio ia eiai a?aaeeeaoe?th i?ney iia?aoe??.
I?e iiaoi?iiio aecia/aii? I?. o 41 iaoe??ioa i?ney iia?aoe?? ia
12-15-e aeaiue ca aeiiiiiaith o?ueio aeua iacaaieo oano?a ie anoaiiaeee
cia/io caa?oaeiai?noue o 22 (53,7%) oai?eo ca aeiiiiiaith o?aaciiai
oanoo ? o 27 (65,8%) – ca aeiiiiiaith aaeoa??ineii??. Iayai?noue aioeo?e
aei I?. a ne?iaaooe? e?ia? ca ?ioiieia?/iei oanoii aeyaeee o 38 (92,7%)
oai?eo. O ianoaaeaieo aei ? i?ney iia?aoe?? a?noieia?/ii a?aei?/aeanue
eaeeioeeoa?ia ? e?ioioeeoa?ia ?io?eueo?aoe?y neeciai? iaieiiee oeoieo.
I?e oeueiio aoea a?aei?/aia caeaaei?noue ii?oieia?/ieo ci?i a neecia?e
iaieiioe? a?ae nooiaiy caa?oaeiaiino? I?. A?aeiii, ui I?. iioeiaeaeo?
neeciaee aa?”?? oeoieo ? eiai ai?oae?e, oei naiei noai?ththoueny oiiae
aeey i?ioaie?co no?iee ? ii/aoeo oi?ioaaiiy ae?acee, a oaeiae aeey
o?ii?/iiai i?io?eaiiy oaea ?nioth/i?. Ie a i?neyiia?aoe?eiiio ia??iae?
i?iaiaeeee eo?n aioeoae?eiaaeoa?ii? oa?ai??. C i?eaiaeo i?ecia/aiiy
aeaii? oa?ai?? ia i?ioyc? inoaii?o 5 ?ie?a ?nioaaee ??ci? i?aeoiaee.
Oae, a 1990 ?. ca ?aeiiaiaeaoe?yie I?aeia?iaeii? ?iai/i? a?oie
Anan?oiueiai Eiia?ano aano?iaioa?ieia?a a N?aeia? i?iaaaeaiiy
aioeoae?eiaaeoa?ii? oa?ai?? aoei iieacaii eeoa iaoe??ioai, ye? aaaeei
i?aeaeathoueny e?eoaaiith aai ?acenoaioi? aei cae/aeii? oa?ai??. A 1995
?. ca?aeii Iieiaeaiiy, i?eeiyoiai Iaoe?iiaeueiei ?inoeoooii NOA, oaeiio
e?eoaaiith i?aeeyaathoue an? iaoe??ioe c I?. anioe?eiaaiith ae?aceiaith
oai?iaith i?e etha?e ?? eieae?caoe??, aoaeue-oi aia?oa aeyaeaia
caoai?thaaiiy aai eiai ?aoeeaeea. A 1997 ?. oea Iieiaeaiiy i?aeo?eiaea
?in?enueea aano?iaioa?ieia?/ia a?oia, aea iaeiei ?c i?eioeei?a
iaiao?aeiino? a?aaeeeaoe?? I?. aoei cieaeaiiy /anoioe ?aoeeaeea?a
ae?aceiai? oai?iae.
*a?ac i?nyoeue i?ney iia?aoe?? (/an, iaiao?aeiee aeey noaa?e?caoe??
noaio oai?iai) o oai?eo i?iaiaeeee a?aaeeeaoe?? I?. c aeei?enoaiiyi
iio??eii? oa?ai??, yea aeeth/aea: aea-iie ii 120 ia 4 ?. ia aeaiue ca
40 oa. aei ?aee, iao?ii?aeacie ii 0,6 ia 3 ?. ia aeaiue i?ney ?aee ?
oao?aoeeee?ia a?ae?ioei?eae ii 0,5 a 4 ?. ia aeaiue i?ney ?aee. Ie
i?iaiaeeee ei?ioeioa?i?iiaee eo?n ia i?ioyc? 7-10 aei?a. I?eeii oeeo
i?aia?ao?a ia??aeei noi?iaiaeaeoaaany iia?/ieie aoaeoaie. O 12 oai?eo ?c
79 aoea ioaeioa, o 3 – ae?a?ay, o 2 – acaeoooy aeeaioa, coae oe??e.
*ano?oa oae? neiioiie aeieeaee ia 7-10-e aeaiue e?eoaaiiy. O oai?eo,
yeei aeeiioaaee ?cieueiaaio NIA, a noaio e?eoaaiiy aeiaaaeyee ?ia?a?oi?
i?ioiiii? “iiiie” iiai?acie aai iiac ii 20 ia 2 ?. ia aeiao c
iine?aeoth/ei eiai i?ecia/aiiyi ia i?ioyc? i?nyoey. C ianoaaeaii? a?oie
o 38 oai?eo i?iaiaeeee eiio?ieue ca aoaeoeai?noth a?aaeeeaoe?? i?ney
iia?aoe??. Oai?? ianoaaeoaaeenue aiaeineii?/ii, a?aee a?iioaoe c
aio?aeueiiai a?aeae?eo oeoieo, i?iaiaeeee o?aaciee ? a?noieia?/iee oano.
O 35 (89%) iaoe??io?a ca aeaieie aeaoo oano?a I?. a OEO aoa a?aenooi?e.
Iieaciee a?aaeeeaoe?? i?ney i?iaaaeaii? oa?ai?? neeaaeaa 89%. O 3-o
oai?eo ca aeaieie o?aaciiai oanoo ? aaeoa??ineii?? iieaciee ianaiai?iiy
aoa eaaeiai ? na?aaeiueiai nooiaiy. Oeei oai?ei iiaoi?ii i?iaiaeeee eo?n
aioeoae?eiaaeoa?ii? oa?ai??.
Ii??aithaaee /an caai?iiy ae?acee o oai?eo, ui ia?aianee
?cieueiaaio NIA aac aioeoae?eiaaeoa?ii? oa?ai??, c /anii caai?iiy
ae?acee o oai?eo, yeei aoea aeeiiaia oaea ae iia?aoe?y oa aoea
i?ecia/aia ?i aioeoae?eiaaeoa?ia oa?ai?y. Oae, o 19 oai?eo, ye?
io?eioaaee aioeoae?eiaaeoa?io oa?ai?th, ae?acea ?oaoethaaeanue ia
12-18-e aeaiue, a o 14 oai?eo eiio?ieueii? a?oie – ia 25-30-e aeaiue.
O oai?eo, yeei ia i?iaiaeeee a?aaeeeaoe?th I?. a i?neyiia?aoe?eiiio
ia??iae?, /a?ac ??e ?aoeeaeea aoa ae?aaiinoiaaiee o 5 iaoe??io?a. O
oai?eo, yeei a i?neyiia?aoe?eiiio i?iaiaeeee a?aaeeeaoe?th I?., /a?ac
??e ?aoeeaeeao ia aeyaeaii.
Oaeei /eiii, iaaaaeai? ?acoeueoaoe na?ae/aoue i?i iaiao?aei?noue
iaaeeeaiaioicii? oa?ai?? a i?neyiia?aoe?eiiio ia??iae?, ui aeicaieeei
cieceoe a?aenioie ?aoeeaeeao i?ney i?aaiicaa??aath/eo iia?aoe?e oa
?aeiiaiaeoaaoe aeaiee i?eioeei a ee?i?/io aano?iaioa?ieia?th.
I?e aea/aii? /anoioe oneeaaeiaiue i?ney i?aaiicaa??aath/eo
iia?aoe?e, oaeeo ye aeaii?ia-neiae?ii, aano?inoac, ae?a?ay,
?aoethen-acioaa?o ? ?i., anoaiiaeaii, ui /anoeia c ieo ia ? iane?aeeii
naiiai iia?aoeaiiai ao?o/aiiy, a ? ?acoeueoaoii oneeaaeiaiiai i?io?eaiiy
ae?aceiai? oai?iae a aeiiia?aoe?eiiio ia??iae?. Aeey i?io?eaeoeee
i?neyaaaioiiieo ii?ooaiue ? oneeaaeiaiue ie i?iaiaeeee eiiieaen
i??ii?e?inoa aei iia?aoe?? ? i?ney ia?, ye? aoee iai?aaeai? ia
ii?iae?caoe?th iioi?ii-aaaeoaoi?ii? ooieoe?? oa ia ciaioaiiy n?ie?a ??
aaeaioaoe?? aei iiaeo oiia ooieoe?iioaaiiy i?ney /anoeiai? aaaaeueii?
aeaia?aaoe?? OEO.
?ic?iaea oa ai?iaaaeaeaiiy iiaiai aeaeo i?aaiicaa??aath/i? iia?aoe??
– AAA. O??o?a?/ia oa iaaeeeaiaioicia i?io?eaeoeea?aoeeaeea?a aeicaieeea
cieceoe ?o a?aenioie aei 3,5% a iniiai?e a?oi? ia 226 iia?iaaieo i?e
6,8% ia 174 iia?iaaieo a eiio?ieuei?e a?oi?.
Io?eiai? aenia?eiaioaeuei? oa ee?i?/i? ?acoeueoaoe a?aee?eaathoue
ia?niaeoeao aei ?icoi?iiy aieeao aaaaeueii? aeaia?aaoe?? ia ??cie?
??aiyo OEO ? ?ie? I?. ye iaei??? ?c i?e/ei ?aoeeaeeaoaaiiy ae?acee, a
oiio /ene? ? i?ney i?aaiicaa??aath/eo iia?aoe?e.
Oaeei /eiii, aeua iaaaaeai? ?acoeueoaoe iiaeooue ?icaeyaeaoeny ye
iniiaa aeey iiaiai iai?aaeaiiy a ee?i?/i? aano?iaioa?ieia??, yea iieyaa?
a ia”?aeiaii? o??o?a?/iiai ? oa?aiaaoe/iiai e?eoaaiiy ae?aceiai?
oai?iae.
8. I?aaiicaa??aath/? iia?aoe?? ia iayai?noue ? nooi?iue ?io?eiaaiino?
Helicobacter pylori ia aieeaathoue.
9. ?iaeea?aeoaeueiee i?aeo?ae aei aeai?o aeaeo i?aaiicaa??aath/i?
iia?aoe??, canoinoaaiiy aeno?aaano?aeueii? aaaioii?? ? oaeineiiaeaieo
iaoiaeee naeaeoeaii? i?ieneiaeueii? aaaioii?? oa a?aaeeeaoe?y
Helicobacter pylori a i?neyiia?aoe?eiiio ia??iae? caaacia/eei cieaeaiiy
a?aenioeo ?aoeeaeeao ae?acee aei 3,5%.
I?AEOE*I? ?AEIIAIAeAOe??
1. Aeae i?aaiicaa??aath/i? iia?aoe?? iiaeiai aecia/aoeny
?iaeea?aeoaeueii. I?e oeueiio iio??aii a?aoiaoaaoe iieacieee oeoieiai?
nae?aoe?? (aacaeueia oa noeioeueiaaia iaioaaano?eiii ? ?inoe?iii) oa
noai aano?iaeoiaeaiaeueiiai ia?aoiaeo.
2. I?e iecueeeo iieacieeao ?inoe?iiai? oa aenieeo iieacieeao
iaioaaano?eiiai? nae?aoe?? iieacaii aeeiiaiiy aeno?aaano?aeueii?
aaaioii??.
3. I?e aeeiiaii? i?aaiicaa??aath/eo iia?aoe?e ia?aaaao iio??aii
iaaeaaaoe aeoiaeaiiieanoeoe? a ??cieo ?? aa??aioao.
4. Aeey i?io?eaeoeee ?io?aiia?aoe?eieo oneeaaeiaiue ? nei?i/aiiy oa?i?io
iia?aoe??, iniaeeai o oai?eo naeaeoeaio i?ieneiaeueio aaaioii?th
aeioe?eueii aeeiioaaoe a aeaeyae? iane??cii? na?ii?ioii??.
5. Iieacaie aei aeeiiaiiy naeaeoeaii? aaaioii?? c aio?oiaeoii??th ?
aenie? iieacieee aacaeueii? ? noeioeueiaaii? iaioaaano?eiii oa ?inoe?iii
oeoieiai? nae?aoe??. Ia?aaaaa iiaeiia iaaeaaaoeny
aano?iaeoiaeaiiaianoiiico e?iaoeue a e?iaoeue.
6. Aeey i?io?eaeoeee aeieeiaiiy ii?ooaiue iioi?ii-aaaeoaoi?ii? ooieoe??
oeoieiai-eeoeiaiai o?aeoo o oai?eo c ii?ooaiiyie aaaeoaoe?? iaiao?aeii
a aeiiia?aoe?eiiio ia??iae? i?iaiaeeoe eiiieaen i??ii?e?inoa, yeee
aeeth/a? aeaeiii?an?th ? aeaeo?inoeioeyoe?th oeoieo, i?eeii
aano?ie?iaoee?a.
7. Oae ye i?aaiicaa??aath/? iia?aoe?? ia aieeaathoue ia iayai?noue ?
nooi?iue ?io?eiaaiino? Helicobacter pylori, a i?neyiia?aoe?eiiio
ia??iae? iio??aii i?iaiaeeoe eo?n aioeoae?eiaaeoa?ii? oa?ai?? c
iine?aeoth/ei iiaoi?iei eiio?ieai.
8. A?aoiaoth/e oa, ui i?ney i?aaiicaa??aath/eo iia?aoe?e a a?aeaeaeaiiio
i?neyiia?aoe?eiiio ia??iae? niinoa??aa?oueny c?inoaiiy iieaciee?a
?inoe?iiai? oeoieiai? nae?aoe??, eiiieaen i??ii?e?inoa, iai?aaeaiee ia
i?io?eaeoeeo ?aoeeaeea?a, iiaeiai aeeth/aoe aioenae?aoi?i? i?aia?aoe.
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