EUeA?ANUeEEE AeA?AEAAIEE IAAeE*IEE OI?AA?NEOAO

?i. Aeaieea Aaeeoeueeiai

Ooiae ?ai? Ieeieaeiae/

OAeE 616.33/.34 – 002.44 – 005 – 06: 616.12 – 008.46] — 089

AINO?? AANO?IAeOIAeAIAEUeI? E?IAIOA*?

AE?ACEIAI-A?ICEAIIAI AAIACO

O OAI?EO C O?II?*IITH NA?OeAAITH IAAeINOAOI?NOTH:

INIAEEAINO? IA?AA?AO ? E?EOAAEUeII? OAEOEEE

14.01.03 — o??o?a?y

AAOI?AOA?AO

aeena?oaoe?? ia caeiaoooy iaoeiaiai nooiaiy

eaiaeeaeaoa iaaee/ieo iaoe

Euea?a — 1999

Aeena?oaoe??th ? ?oeiien.

?iaioa aeeiiaia o Euea?anueeiio aea?aeaaiiio iaaee/iiio oi?aa?neoao? ?i.
Aeaieea Aaeeoeueeiai IIC Oe?a?ie

Iaoeia? ea??aieee:

aeieoi? iaaee/ieo iaoe, i?ioani? O?eueoe I?ano Aieiaeeie?iae/

caa?aeoaa/ eaoaae?e o??o?a?? OIAeI Euea?anueeiai aea?aeaaiiai iaaee/iiai
oi?aa?neoaoo ?i. Aeaieea Aaeeoeueeiai

aeieoi? iaaee/ieo iaoe, aeioeaio AEa??iia Ieaa Eineiiae/

aeioeaio eaoaae?e ea?ae?ieia?? ? ooieoe?iiaeueii? ae?aaiinoeee
Ee?anueei? iaaee/ii? aeaaeai?? i?neyaeeieiiii? ina?oe ?i. I.E. Ooieea

Io?oe?ei? iiiiaioe:

aeieoi? iaaee/ieo iaoe, i?ioani? A?oai?e Aieiaeeie? Aieiaeeie?iae/

caa?aeoaa/ eaoaae?e o??o?a?/ieo oai?ia c i?neyaeeieiiiith i?aeaioiaeith

Iaeanueeiai aea?aeaaiiai iaaee/iiai oi?aa?neoaoo

aeieoi? iaaee/ieo iaoe, i?ioani? Aaaeye Aeieo?i ?aaaiiae/

caa?aeoaa/ eaoaae?e oieoaeueii? o??o?a?? Euea?anueeiai aea?aeaaiiai
iaaee/iiai oi?aa?neoaoo ?i. Aeaieea Aaeeoeueeiai

I?ia?aeia i?aai?caoe?y:

Aeiiaoeueeee aea?aeaaiee iaaee/iee oi?aa?neoao ?i. I. Ai?ueeiai IIC
Oe?a?ie, eaoaae?a oieoaeueii? o??o?a?? ?2

Caoeno aeena?oaoe?? a?aeaoaeaoueny 11 o?aaiy 1999 ?. i 11 aiae. 00 oa.
ia can?aeaii? niaoe?ae?ciaaii? a/aii? ?aaee Ae 35.600.01 o Euea?anueeiio
aea?aeaaiiio iaaee/iiio oi?aa?neoao? ?i. Aeaieea Aaeeoeueeiai IIC
Oe?a?ie (290010, i. Euea?a, aoe. Iaea?nueea, 69).

C aeena?oaoe??th iiaeia iciaeiieoeny a iaoeia?e a?ae?ioaoe?
Euea?anueeiai aea?aeaaiiai iaaee/iiai oi?aa?neoaoo ?i. Aeaieea
Aaeeoeueeiai IIC Oe?a?ie (290000, i. Euea?a, aoe. N?/iaeo No??eueoe?a,
6).

Aaoi?aoa?ao ?ic?neaiee 10 ea?oiy 1999 ?.

A/aiee nae?aoa? niaoe?ae?ciaaii? a/aii? ?aaee *oee?i N.I.

Caaaeueia oa?aeoa?enoeea ?iaioe

Aeooaeuei?noue oaie. Iacaaaeath/e ia cia/iee i?ia?an oa?iaeioa?ai??,
e?euee?noue ae?aceiaeo aano?iaeoiaeaiaeueieo e?iaioa/ caeeoa?oueny
i?aeoe/ii iaci?iiith [J.Macela et al. 1992, B.S.Bloom et al. 1993,
T.A.Rockall et al. 1995]. Naia oea oneeaaeiaiiy ? i?e/eiith a?eueoino?
nia?oae, iia’ycaieo c ae?aceiaith oai?iaith [L.Laine, W.L.Peterson,
1994]. Eaoaeuei?noue i?e eiai aeieeiaii? oo?eio?oueny, ca aeaieie
a?eueoino? aaoi??a, o iaaeao 6-10% [K.P.Thon et al. 1992, R.P.Walt et
al. 1992], ? eeoa a niaoe?ae?ciaaieo oeaio?ao c aaeeeei aeina?aeii
aiaeineii?/iiai ? o??o?a?/iiai e?eoaaiiy ?? cieaeaii aei 2-5%
[I.I.Aaeeaioeeee e niaao. 1989, I.Ae.Oii?i ? ni?aaao. 1997, F.Branicki
et al. 1991].

Na?aae oai?eo c ae?aceiaeie e?iaioa/aie /anoea in?a iioeeiai ? noa?a/iai
a?eo c iiiaeeiiith, ianaiia?aae na?oeaai-noaeeiiith, iaoieia??th cia/ia
? i?iaeiaaeo? c?inoaoe [I.Ae.Oii?i ? ni?aaao. 1997, B.S.Bloom et al.
1993, P.Hochain 1996]. Iayai?noue aaaeeeo na?oeaai-noaeeiieo
caoai?thaaiue, o o./. o?ii?/ii? na?oeaai? iaaeinoaoiino? (ONI) ia eeoa
iaeaaeeoue aei iniiaieo i?aaeeeoi??a iani?eyoeeaiai i?iaiico o aeiaaeeo
ye eiina?aaoeaiiai [F.Branicki et al. 1990, C.Ell et al 1995], oae ?
iia?aoeaiiai e?eoaaiiy ae?aceiaeo e?iaioa/ [B.Dousset et al. 1995], aea
e ia aeoieo aeayeeo aaoi??a [A.I.Iaoeeaiue, 1989], coiiaeth? iniaeeaino?
ae?aceiai? oai?iae ( aaeee? ?ici??e ae?acee, /ano?o? ?aoeeaeeae
e?iaioa/?. Na?oeaai-noaeeiio iaoieia?th, ye aino?o, oae ? o?ii?/io,
ca?aoiaothoue aei iniiaieo i?e/ei aino?eo a?iceaii-ae?aceiaeo o?aaeaiue
aa?oi?o a?aeae?e?a o?aaiiai o?aeoo c aaii?aa?/iei neiae?iiii
[A.O.Aaneeaiei, A.E. A?aaaiaa, 1981]. I?ioa iaaeinoaoiuei c’yniaaii
aca?iica’ycie ONI oa iaoieia?? ?ioeo i?aai?a aeeoaiiy oa nenoai
(eaaaiue, ie?ie), eio?a /anoi o?aiey?oueny iaeii/anii c
na?oeaai-noaeeiieie caoai?thaaiiyie, ye iaoiaaiaoe/ieo /eiiee?a
aano?iaeoiaeaiaeueieo e?iaioa/, caeaaei?noue iniaeeainoae ae?aceiaiai
noano?aoo ? aaii?aa?/iiai neiae?iio a?ae ao?ieia?? oa aaaeeino? ONI.

Ai?iaaaeaeaiiy a ee?i?/io i?aeoeeo naeaeoeaieo aeieaoi??a oeoieiai?
nae?aoe?? (NAON) aeicaieeei cia/ii caoceoe niaeo? iieac?a aei
o??o?a?/iiai e?eoaaiiy iaioe/ieo ae?acie [H.Paimela et al. 1991], o oiio
/ene? i?ney ia?aianaii? e?iaioa/? [T.Takahashi et al. 1994,
G.G.Jamieson, 1996]. Oea iniaeeai aaaeeeai aeey a?oie aenieiai
iia?aoe?eiiai ?eceeo, aei yei? iaeaaeaoue oai?? c ONI [ACC/AHA
Guidelines. 1996]. I?ioa aein? aeeneooaaaeueiith ? iiaeeea?noue
iaaeeeaiaioiciiai caiia?aaiiy ?aoeeaeeaai e?iaioa/? ( iaei?e c
iaeaaaeeea?oeo aeaoa?i?iaio iani?eyoeeaiai i?iaiico [I.B.Turner et al.
1991]. sseui iaei? aaoi?e oaa?aeyoue i?i nooo?aa cieaeaiiy /anoioe
?aoeeaeeaieo e?iaioa/ i?e canoinoaaii? NAON [G.Brunner et al. 1992,
J.J.Kolkman et al. 1996], oi ?io? caia?a/othoue iayai?noue oaeiai aoaeoo
[T.K.Daneshmend et al., 1992].

Oiio aeooaeueiei caeeoa?oueny ieoaiiy aeai?o i?ae eiina?aaoeaiei
e?eoaaiiyi oa aeoeaiith o??o?a?/iith oaeoeeith o oai?eo c ae?aceiaeie
e?iaioa/aie ia oii? ONI, aeai?o ia’?io ? oa?i?i?a aeeiiaiiy iia?aoe?e.
Aaaeeeaith i?iaeaiith, i?e ae??oaii? yei? ne?ae i/?eoaaoe cieaeaiiy
eaoaeueiino?, ? iioei?caoe?y aaaeaiiy iinoaaii?aa?/iiai ?
ia?eiia?aoe?eiiai ia??iaeo, iiia?aaeaeaiiy ? e?eoaaiiy na?oeaaeo
oneeaaeiaiue, ye iaei??? c iniiaieo i?e/ei nia?o? oai?eo c aino?eie
ae?aceiai-a?iceaieie e?iaioa/aie ia oii? ea?ae?iaaneoey?ii? iaoieia??
[F.Branicki et al. 1990, A.I.Iaoeeaiue 1987].

Ca’ycie c iaoeiaeie i?ia?aiaie, ieaiaie, oaiaie. Aeeiiaia ?iaioa ?
o?aaiaioii ieaiiai? i?aeeaoaae?aeueii? iaoeiai-aeine?aeii? ?iaioe
«Aaeineiiaeaiiy ae?aaiinoe/ii-e?eoaaeueii? oaeoeee i?e aino?eo
oeoieiai-eeoeiaeo e?iaioa/ao ??ciiai aaiaco» (oeo? oaie
?I.21.00.0001.96, ?a?no?aoe?eiee iiia? 0199V013955).

Iaoa ? caaea/? aeine?aeaeaiiy. Iaoa ?iaioe ( ia iniia? aea/aiiy
iniaeeainoae ia?aa?ao oa ioe?iee aoaeoeaiino? ??cieo iaoiae?a e?eoaaiiy
iioei?coaaoe oaeoeeo e?eoaaiiy oai?eo c ae?aceiai-a?iceaieie e?iaioa/aie
? ONI.

Aeey aeinyaiaiiy oe??? iaoe iinoaaeaii ianooii? caaaeaiiy:

Aecia/eoe iniaeeaino? neiioiiaoeee ? ia?aa?ao o?ii?/ieo ae?acie,
oneeaaeiaieo e?iaioa/ath, o oai?eo c ONI.

C’ynoaaoe cia/aiiy ONI ye iaoiaaiaoe/iiai /eiieea aino?eo
a?iceaii-ae?aceiaeo o?aaeaiue.

Aecia/eoe oaeoi?e, ye? anioe?eiaai? c ?eceeii ?aoeeaeeao e?iaioa/? o
oai?eo c na?oeaai-noaeeiiith iaoieia??th oa ?ic?iaeoe ?iaeaen eiai
i?iaiicoaaiiy.

C’ynoaaoe aieea naeaeoeaieo aeieaoi??a oeoieiai? nae?aoe?? ia /anoioo
?aoeeaeeaoaaiiy e?iaioa/? c iaioe/ieo ae?acie, cie?aia o oai?eo c ONI.

Anoaiiaeoe ee?i?/i? iniaeeaino? iinoaaii?aa?/iiai ? ia?eiia?aoe?eiiai
ia??iaeo o oai?eo c ONI, ?? ?ieue o oaiaoiaaiac?.

Ia??oiooaaoe aeai?eoie e?eoaaeueii? oaeoeee i?e aano?iaeoiaeaiaeueieo
e?iaioa/ao ia oii? o?ii?/ii? na?oeaai-noaeeiii? iaoieia??.

Iaoeiaa iiaecia iaea?aeaieo ?acoeueoao?a

Aeyaeaii caeaaei?noue oa?aeoa?o ae?aceiai-a?iceaieo o?aaeaiue oa
e?iaioa/? c ieo a?ae iayaiino? oa aaaeeino? ONI.

Iieacaii, ui aaaee?noue ONI ? iaeiei c iaeaaaeeea?oeo i?iaiinoe/ii
iani?eyoeeaeo e?eoa???a, a ?? aeaeiiiainaoe?y ( iaei??th c iae/ano?oeo
i?e/ei nia?o? o iinoaaii?aa?/iiio ? i?neyiia?aoe?eiiio ia??iae?.

Iaoiaeaie oi?aa??aioiiai ? ioeueoeaa??aioiiai aiae?co c a?aooaaiiyi
iayaiino? ? aaaeeino? na?oeaai-noaeeiii? iaoieia?? oa iniaeeainoae
iaaeeeaiaioicii? oa?ai?? anoaiiaeaii i?aaeeeoi?e ? ?ic?iaeaii ?iaeaene
i?iaiicoaaiiy ?aoeeaeeao ae?aceiai? e?iaioa/?, c o?aooaaiiyi iayaiino?
ONI oa oa?ai?? NAON.

Aeiaaaeaii cieaeaiiy /anoioe ?aii?o ?aoeeaeea?a ae?aceiaeo e?iaioa/ a
?acoeueoao? oa?ai?? I2-aeieaoi?aie 3-4 aaia?aoe?? oa ?ia?a?oi?aie
i?ioiiii? iiiie, a o./. aeey iaoe??io?a c ONI.

Ia iniia? oeueiai aaeineiiaeaii oaeoeeo e?eoaaiiy ae?aceiaeo e?iaioa/ o
oai?eo c na?oeaai-noaeeiiith iaoieia??th, ia??oioiaaii iaiaaeaiiy
iieac?a aei iia?aoeaiiai e?eoaaiiy, canoinoaaiiy a oe?e a?oi?
iae?aoeaieo ao?o/aiue (aen?/aiiy oa aenoa??i?ecaoe?? ae?acee) c
iiaeaeueoith iaaeeeaiaioiciith aeieaaeith nae?aoe??.

Aia?oa canoiniaaii ?ia?a?oi?e aia?ioaicei-ia?aoai?thth/iai oa?iaioo
(AIO) oa aioaaii?noe eaeueoe?th aeey oa?ai?? na?oeaai-noaeeiii?
iaoieia?? o iinoaaii?aa?/iiio ? ia?eiia?aoe?eiiio ia??iae? a in?a c
ae?aceiaeie e?iaioa/aie. I?aeoaa?aeaeaii aoaeoeai?noue ? aacia/i?noue
oaeiai e?eoaaiiy.

I?aeoe/ia cia/aiiy iaea?aeaieo ?acoeueoao?a

?acoeueoaoe aeena?oaoe?? aeicaieythoue iioei?coaaoe oaeoeeo e?eoaaiiy
oai?eo c ae?aceiai-a?iceaieie e?iaioa/aie, a o./. ia oii? ONI, ciaioeoe
eaoaeuei?noue i?e oe?e iaoieia??. Ia ?iaeaene i?iaiicoaaiiy ?aoeeaeea?a
e?iaioa/ io?eiaii 2 iina?ae/aiiy ia ?aoei?iiiceoe?th (? 711 oa 713,
aeaeai? A??A oi?aae?iiy ioi?iie caei?ia’y Euea?anueei?
iaeaea?aeaaei?i?no?aoe??), ?aeiiaiaeaoe?? ia iniia? ?acoeueoao?a
aeine?aeaeaiiy oni?oii ai?iaaaeaeaii a ?iaioo o??o?a?/ieo a?aeae?eaiue
Euea?anueei? i?nueei? e?ea?i? oaeaeei? iaaee/ii? aeiiiiiae, Euea?anueei?
iaeanii? ee?i?/ii? e?ea?i?, No?eenueei? oa Nieaeuenueei? Oe?E, ee?i?/ii?
e?ea?i? Euea?anueei? cae?cieoe?. ?acoeueoaoe aeena?oaoe?? aeei?enoaii a
i?ioean? iaa/aiiy noai?aeeiaoi??a ia eaoaae?? oaeoeueoaonueei? o??o?a??,
?ioa?i?a oa eo?naio?a ia eaoaae?? o??o?a?? OIAeI Euea?anueeiai
iaaee/iiai oi?aa?neoaoo, eo?naio?a ia eaoaae?? ea?ae?ieia?? oa
ooieoe?iiaeueii? ae?aaiinoeee Ee?anueei? aeaaeai?? i?neyaeeieiiii?
ina?oe.

Iniaenoee aianie caeiaoaa/a

Aaoi? aeena?oaoe?eii? ?iaioe ianoaaeoaaa an?o oai?eo iniiaii? a?oie ?
iniaenoi e?eoaaa cia/io /anoeio iaoe??io?a, aeeth/aieo o aeine?aeaeaiiy.
Eiio iaeaaeeoue ?aeay ?ic?iaee i?iaiinoe/ieo ?iaeaen?a. A?i naiino?eii
noai?ea eiii’thoa?i? aace aeaieo, oa i?ia?a ?o noaoenoe/iee aiae?c,
noi?ioethaaa iniiai? iieiaeaiiy oa aeniiaee ?iaioe.

Ai?iaaoe?y ?iaioe. Iaoa??aee aeena?oaoe?? i?aaenoaaeaii ia
iaoeiai-i?aeoe/i?e eiioa?aioe?? «No/ani? aniaeoe iaa?aeeeaaeii?
aeiiiiiae” (Euea?a, 1997); can?aeaii? iaeaniiai iaoeiaiai oiaa?enoaa
o??o?a?a (1999). Ai?iaaoe?y a?aeaoeanue ia a?aee?eoiio can?aeaii?
eaoaae?e o??o?a?? OIAeI.

Ioae?eaoe??. Ca iaoa??aeaie aeena?oaoe?? iioae?eiaaii 9 iaoeiaeo
i?aoeue: 4 noaoo? a iaoeiaeo aeo?iaeao, 1 ( a ca??ieeo iaoeiaeo i?aoeue,
2 ?iaioe aeaiiiiaai? a AeIOA Oe?a?ie, 2 ai?uaii a ca??ieeo iaoa??ae?a
eiioa?aioe??.

Ia’?i oa no?oeoo?a aeena?oaoe??. Aeena?oaoe?y neeaaea?oueny c anooio,
ainueie ?icae?e?a (iaeyae e?oa?aoo?e, iaoa??aee ? iaoiaee, i’youe
?icae?e?a aeanieo ?acoeueoao?a ? i?aenoiee), aeniiae?a, nieneo
aeei?enoaii? e?oa?aoo?e ? aeiaeaoeo. Oaeno aeeeaaeaii ia 152 noi??ieao,
?ethno?iaaii 62 oaaeeoeyie ? 24 ?enoieaie. Nienie e?oa?aoo?e i?noeoue
333 aeaea?aea.

Ci?no ?iaioe

Iaoa??ae oa iaoiaee aeine?aeaeaiiy

Ia’?eoii aeine?aeaeaiiy aoee oae? eiioeiaaioe oai?eo:

I?iniaeoeaia aeine?aeaeaiiy 813 iaoe??io?a c 847 aiiciaeaie
aano?iaeoiaeaiaeueieo e?iaioa/, coiiaeaieo ae?aceiai-a?iceaieie
o?aaeaiiyie, ye? aoee aini?oae?ciaai? o Euea?anueeee i?nueeee oeaio?
oeoieiai-eeoeiaeo e?iaioa/ i?ioyaii n?/iy 1995 ( aa?aciy 1997 ?.
Aaii?aa?? c o?ii?/ieo iaioe/ieo ae?acie aoee o 654 iaoe??io?a, c aino?eo
ae?aceiai-a?iceaieo o?aaeaiue (AAAO) ( o 112, coiiaeai? neiae?iiii
Iaeei??-Aaena ( o 47. O aeine?aeaeaiiy ia aeeth/aeeny oai?? c
aaii?aa?/ieie oneeaaeiaiiyie ae?aceiai-a?iceaieo aano?iaeoiaeaiaeueieo
o?aaeaiue ia oii? oee?ico ia/?iee ? ii?oaeueii? a?ia?oaic??. Iniiaiei
ia’?eoii aea/aiiy aoee 192 iniae (202 ai?ciaee e?iaioa/?), c i?iyaaie
ONI, 621 ( neeaaeaee eiio?ieueio a?oio. Ia?oo noaae?th ONI eiinoaoiaaii
o 92 oai?eo, ??A no. ( o 69, ??A no. ( o 23, ??? no. ( o 9. Na?aae
na?oeaaeo caoai?thaaiue o ieo ia?aaaaeaee a?ia?oii?/ia oai?iaa ( o 132
oai?eo oa ?oai?/ia oai?iaa na?oey (?ON) ( o 127 oai?eo, o o./. o 42 in?a
( iino?ioa?eoiee ea?ae?ineea?ic. ??aeoa o?aieyeeny o?ii?/ia eaaaiaaa
na?oea (20 iaoe??io?a), iaaoo? aaaee na?oey (8), iinoi?iea?aeeoiee
ea?ae?ineea?ic (1).

?ao?iniaeoeaia aeine?aeaeaiiy 170 iaoe??io?a c e?iaioa/aie c o?ii?/ieo
ae?acie, e?eiaaieo o 1987 ?., eiee ua iaeaea ia canoiniaoaaeeny NAON.

?ao?iniaeoeaiee aiae?c (1986-1994 ??.) ?acoeueoao?a 256 aaoiin?e oai?eo,
ye? iiia?ee o IEEOIAe, ? iaee i?eaeeoo?ai /e iinia?oii aeyaeai?
aaii?aa?/i? oneeaaeiaiiy ae?aceiai-a?iceaieo aano?iaeoiaeaiaeueieo
o?aaeaiue.

Ia i?iniaeoeaiiio iaoa??ae? aea/aeeny iniaeeaino? aaii?aa?/iiai
neiae?iio oa ?acoeueoaoe ??cieo iaoiae?a e?eoaaiiy o oai?eo c ONI a
ii??aiyii? c eiio?ieueiith a?oiith.

Aiae?c ia’?aeiaiiai i?iniaeoeaiiai oa ?ao?iniaeoeaiiai aeine?aeaeaiiy
e?iaioa/ c o?ii?/ieo ae?acie (anueiai 857 aeiaaee?a e?iaioa/?)
i?iaiaeeany c iaoith anoaiiaeaiiy oaeoi??a, anioe?eiaaieo c aenieei
?eceeii nia?o?, i?aaeeeoi??a ?aoeeaeeao e?iaioa/? oa aieeao canoinoaaiiy
NAON ia eiai /anoioo.

Aeey ioe?iee cia/aiiy na?oeaai-noaeeiii? iaoieia?? a oaiaoiaaiac? oai?eo
c aano?iaeoiaeaiaeueieie ae?aceiai-a?iceaieie e?iaioa/aie i?iaiaeeany
aiae?c ia’?aeiaiiai i?iniaeoeaiiai ? ?ao?iniaeoeaiiai
ee?i?ei-iaoieiaiaiaoii?/iiai iaoa??aeo, ui caaaeii iae?/oaaa 289
iaoe??io?a.

Iaoiaee aeine?aeaeaiiy. Aeey anoaiiaeaiiy iniaeeainoae ee?i?ee oa
ia?aa?ao caoai?thaaiiy a iniiai?e oa eiio?ieuei?e a?oiao ? i?aea?oiao
oai?eo c ONI ??cieo noaae?e ii??aithaaeeny:

Aeai? aiaiiaco, caaaeueiii?eeiyoiai o?ceeaeueiiai oa eaai?aoi?iiai
ianoaaeaiiy, ui oa?aeoa?ecoaaee ye iniaeeaino? aaii?aa?/iiai neiae?iio,
oae ? aaaee?noue oiiiai? iaoieia??.

?acoeueoaoe ?ino?oiaioaeueieo aeine?aeaeaiue, aei yeeo iaeaaeaee:

a) O?a?iacioaaiaano?iaeoiaeaiineii?y. I?e oeueiio ioe?ithaaeeny
iniaeeaino? iniiaiiai aeaea?aea e?iaioa/? (o?ii?/ia ? aino?a ae?acea,
a?ic??, o??ueia ea?ae??), iayai?noue noiooi?o ci?i o aa?oi?o a?aeae?eao
o?aaiiai o?aeoo.

a) Aoiea?ae?ia?ao?y a I- ? A-?aaeei?. Ioe?ithaaeeny e?ioeaainenoie?/iee
? e?ioeaaiae?anoie?/iee ?ici??e e?aiai oeoii/ea, ?ici??e e?aiai
ia?aaena?aey ? i?aaiai oeoii/ea, iciaee a?ia?o?io?? (oiaueia
i?aeoeoii/eiai? ia?aai?iaeee ? caaeiuei? no?iee e?aiai oeoii/ea),
?oaoeaa? ci?ie, ii?ooaiiy ooieoe?? eeaiai?a, ca oi?ioeith L.Teicholtz
ia/enethaaeeny oaea?iee ia’?i ? o?aeoe?y aeeeaeo.

a) Aeaeo?iea?ae?ia?ao?y niieith.

Iia?aoe?ei?, iaoieiaiaiaoii?/i? ? iaoia?noieia?/i? ciao?aeee.

Aaaee?noue a?ia?oii?/ii? oai?iae ioe?ithaaeany a?aeiia?aeii aei
eeaneo?eaoe?? AIIC (1962, 1978); o?ii?/ii? na?oeaai? iaaeinoaoiino? (
a?aeiia?aeii aei ?iai/i? eeaneo?eaoe?? Oe?a?inueeiai oiaa?enoaa
ea?ae?ieia?a (1996). I?e ioe?ioe? ?oai?/ii? oai?iae na?oey a?aoiaoaaeeny
ooieoe?iiaeueiee eean noaiiea?ae?? ca eeaneo?eaoe??th Eaiaaenueeiai
ea?ae?ieia?/iiai oiaa?enoaa (1968), iayai?noue aino?iai ?ioa?eoo
i?iea?aea, iino?ioa?eoiiai ea?ae?ineea?ico;

?ecee ia?eiia?aoe?eieo na?oeaaeo oneeaaeiaiue ioe?ithaaany ca?aeii c
?iaeaenaie L. Goldman et al. (1977) oa S.F. Larsen et al. (1987).

?acoeueoaoe aeine?aeaeaiiy ii?aoeueiaoaaeeny ia IBM PC ca aeiiiiiaith
NEAAe FoxPro v.2.0 (MicroSoft, USA) ? noaoenoe/ieo i?ia?ai InStat
(GraphPAD Software, USA) oa STATISTICA v. 4.3 (StatSoft, USA). Aeey
ii??aiyiiy ye?nieo iieaciee?a aeei?enoaii oi/iee oano R.Fisher o
aeiaaeeo oaaeeoeue 2(2 ? oano (2 aeey a?eueoeo oaaeeoeue, aeey
ii??aiyiiy ia?aiao?e/ieo iieaciee?a o ??cieo a?oi oai?eo ( iaia?iee
t-oano, aeey anoaiiaeaiiy ei?aeyoe?? ia?aiao?e/ieo e?eoa???a ( iaoiae
e?i?eii? ?aa?an??, ?aiaiaeo ( iaoiae Kendall. Ioeueoeaa??aioiee
(aaaaoiaei??iee) aiae?c cae?enithaaany iaoiaeii iiiaeeiii? ?aa?an??. I?e
noai?aii? ?iaeaeno i?iaiicoaaiiy ?aoeeaeeao e?iaioa/? ? ioe?ioe? ?eceeo
nia?o? aeei?enoaii iaoiae A.Wald oa ioe?ieo ?ioi?iaoeaiino? oaeoi??a ca
S.Kullback.

?acoeueoaoe aeine?aeaeaiiy

Iniaeeaino? ee?i?/ii? neiioiiaoeee ? ia?aa?ao aaii?aa?/iiai neiae?iio o
oai?eo c ONI. Na?aae oai?eo c e?iaioa/aie /anoea in?a c ONI cia/ii
ia?aaeuoaaea na?aaeiueiiiioeyoe?eio (2% ( O?ai?iaainueea
ai?aeai?ieia?/ia aeine?aeaeaiiy) ( i?e o?ii?/ieo ae?aceao, oneeaaeiaieo
aaii?aa??th, aiia nyaaea 22,6%, a i?e aino?eo ae?aceiai-a?iceaieo
o?aaeaiiyo ( 35,7%.

Aeey a?oie iaoe??io?a c ONI oa?aeoa?ia ia?aaaaeaiiy in?a iioeeiai a?eo,
/anoi c iiiaeeiiith noiooiueith iaoieia??th (i?aai?a aeeoaiiy,
na/iaeae?eueii? nenoaie oiui), ui nooo?ai a?ae??ciyei ?? a?ae
eiio?ieueii?. Oiio i?iaiaeeany ioeueoeaa??aioiee aiae?c aeey
anoaiiaeaiiy, /e iniaeeaino? aaii?aa?/iiai neiae?iio a iniiai?e a?oi?
coiiaethaaeeny naia iayai?noth ONI.

A a?oi? oai?eo c e?iaioa/ath c o?ii?/ieo ae?acie aiae?ciaaii 22
e?eoa???, ye? oa?aeoa?ecoaaee ye aeaiee ai?ciae aaii?aa??, oae ? ia?aa?a
ae?aceiai? oai?iae a ieioeiio. Ii??aiyii c eiio?ieueiith a?oiith, aeey
iaoe??io?a c ONI oa?aeoa?i? oae? a?aei?iiino? (p<0,05): a?eueo? ?ici??e ae?acie ( 21% ae?acie ae?aiao?ii 2 ni ? a?eueoa ? 37% (1-2 ni, i?ioe 15% ? 20% o eiio?ieuei?e a?oi?; /ano?oa ?o eieae?caoe?y a oeoieo (31,4% i?ioe 18,9%); /ano?oa ( iaiaeii?acia? e?iaioa/? o aiaiiac? (9,6% i?ioe 4,9%); ae?aaeai?oa iinoaaii?aa?/ia aiai?y ( ieae/ee ??aaiue aaiiaeia?io (75,79(1,78 a/e i?ioe 86,05(0,98 a/e o eiio?ie?), aaiaoie?eoo (27,51±0,67 i?ioe 32,25±0,39%), e?eueeino? a?eo?ioeeo?a (2,24±0,05 i?ioe 2,55±0,03 O/e), a?iii?ioa?iai?y (58,2±0,63 i?ioe 60,27±0,4 a/e) iniaeeaino? noaio nenoaie cn?aeaiiy e?ia?: ieae/ee i?io?iia?iiaee ?iaeaen (82,88±0,71 i?ioe 85,34±0,43 n), o?eaae?oee /an ?aeaeueoeeo?eaoe?? (62,6±0,89 i?ioe 60,16±0,49 n), iaioa e?euee?noue o?iiaioeeo?a (182,49±5,16 i?ioe 212,61±2,71 A/e) i?e aeuiio ??ai? o?a?eiiaaio (3,53±0,1 i?ioe 3,21±0,04 a/e); /ano?oa a?aenooi?noue ae?aaeaiiai aieueiaiai neiae?iio ( 79,5% i?ioe 68,4%; a?aeiiee /eiiee, yeee i?a ni?iaieoaaoe e?iaioa/o ( 40% i?ioe 19,4%. Oaeee oaeoe/ii aaaeeeaee e?eoa??e ye nooiaiue aeoeaiino? ae?aceiai? e?iaioa/? aai noaa?eueiino? aaiinoaco (ca Forrest), caeaaeaa eeoa a?ae ?ici???a ae?acee ? a?eo oai?iai (?<0,05), aac ?noioiiai ca’yceo c aaaee?noth e?iaiao?aoe oa na?oeaai-noaeeiii? iaoieia??th. Ioeueoeaa??aioiee aiae?c iieacaa, ui iayai?noue ONI iacaeaaeii anioe?thaaeany eeoa c aaaee?noth e?iaiao?aoe, /ano?oith a?aenooi?noth aieth ia?aae e?iaioa/ath, oaeiae /ano?oa aoa a?aeiiee oaeoi?, yeee ni?iaieoaaa aaii?aa?th (ianaiia?aae ( i?eeii ianoa?i?aeieo i?ioecaiaeueieo i?aia?ao?a). ?ici??e ? eieae?caoe?y o?ii?/ieo ae?acie iacaeaaeii aeaoa?i?ioaaeeny iioeeei a?eii oai?eo (oa?aeoa?iei aeey iniiaii? a?oie), a ia iayai?noth ONI. Oa?aeoa? aiaeineii?/ieo iciae o?eaath/i? /e ia?aianaii? aaii?aa?? iacaeaaeii anioe?thaaany eeoa c aaeeeeie ?ici??aie ae?acee. I?e ae?aceao ae?aiao?ii 2 ni ? a?eueoa ia?aaaaeaee a?oie Forrest 1 ? 2, ui iiaeia iiynieoe iioeiaeaeaiiyi aaeeeeo a?oa??e. Aaeee? ?ici??e ae?acie (iiiaae 2 ni), a oaeiae ?o eieae?caoe?y a oeoieo ? ia caaei?e no?ioe? aeaaiaaeoeyoeiaei? eeoee iaee iacaeaaeiee ca’ycie c a?eueoith aaaee?noth e?iaiao?aoe. Na?aae iaoe??io?a c ONI /anoea aino?eo o?aaeaiue ye i?e/ei e?iaioa/? aoea aeua (19,3% i?ioe 11,2% o eiio?ieuei?e a?oi?, p<0,01). Ni?aa?aeiioaiiy aino?eo o?aaeaiue ? o?ii?/ieo ae?acie ei?aethaaei c aaaee?noth ONI iacaeaaeii a?ae a?eo oai?iai oa ?ioi? iaoieia??. O iaoe??io?a c ONI /ano?oa cono??/aeeny iiiaeeiie? o?aaeaiiy aaeeeeo ?ici???a (70% i?ioe 40,2%), aiaeineii?/ii ?icoe?iai? ye aino?? ae?acee, c eieae?caoe??th o 75% o oeoieo, oiae? ye o eiio?ieuei?e a?oi? c iaeiaeiaith /anoioith niinoa??aaeeny o?aaeaiiy oeoiea ? aeaaiaaeoeyoeiaei? eeoee, ia?aaaaeii ( iiiaeeii? ae??ai? a?ic??. sse ? i?e o?ii?/ieo ae?aceao, i?e aino?eo ae?aceiai-a?iceaieo o?aaeaiiyo aeey iniiaii? a?oie aoea aeanoeaa a?eueoa ae?aaeai?noue iinoaaii?aa?/ii? aiai?? (aaiiaeia?i 77(3,28 i?ioe 91,13(0,44 a/e). I?ioa a aeaiiio aeiaaeeo aiia iacaeaaeii ei?aethaaea eeoa c a?eii iaoe??ioa, a ia c iayai?noth /e c aaaee?noth ONI aai iaoieia?? ?ioeo nenoai. Aaiiaeeiai?/ia ?aaeoe?y ia e?iaiao?aoo, oa?aeoa? iinoaaii?aa?/ieo oneeaaeiaiue aeaoa?i?ioaaeenue ye ia'?iii e?iaiao?aoe, oae ? aeo?aeiei noaiii na?oeaai-noaeeiii? nenoaie. Aaii?aa?/iee oie ?noioii /ano?oa niinoa??aaany eeoa na?aae iaoe??io?a c ONI ??-??? no. (33,3% i?ioe 20,4%). Ca ?acoeueoaoaie ioeueoeaa??aioiiai aiae?co, eiai /anoioa i?e aini?oae?caoe?? iacaeaaeii ei?aethaaea c oa?i?iii a?ae iiyae ia?oeo i?iya?a e?iaioa/? (cai?ioiuei), aaaee?noth e?iaiao?aoe oa iayai?noth ae?aaeaii? ONI (i?yii). Aaiiciee cano?e o /anoeie oai?eo c ONI oo?eioaaany, iacaaaeath/e ia e?iaiao?aoo ? cia/ia ciaioaiiy IOeE. Aino?a na?oeaaa ? na?oeaai-eaaaiaaa iaaeinoaoi?noue aoee iae/ano?oei oneeaaeiaiiyi o iniiai?e a?oi?, ? niinoa??aaeeny o 25 (12,4%) iaoe??io?a, o 18 oai?eo aiie aoee oaoaeueieie. O 16 (7,9%) oai?eo iniiaii? a?oie a?aecia/aeeny ee?i?/i? oa aeaeo?iea?ae?ia?ao?/i? i?iyae ?oai?? i?iea?aea (aino?ee ?ioa?eo i?iea?aea ?icaeioany o 3, i?enooie noaiiea?ae?? ( o 13). Ii?ooaiiy na?oeaaiai ?eoio e?iaioa/a ni?iaieoaaea o 13 iaoe??io?a. A?iiene/ia aioeaoaeiiao?y (16 oa.) oa aino?? ii?ooaiiy iiceiaiai e?iaiia?ao (4 oa.) niinoa??aaeeny i?e eiia?iaoe?? e?eueeio iani?eyoeeaeo oaeoi??a ( aino?i? aiai??, ONI, oea?aa?aeueiiai aoa?ineea?ico, yeo iiaeia ?icoe?ithaaoe ye i?e/eio oeueiai oneeaaeiaiiy. O eiio?ieuei?e a?oi? aeuacaaaeaieo oneeaaeiaiue ia niinoa??aaeiny. ?icaeoie aino?i? NI iiaeia aoei i?eioneaoe eeoa ye eiiiiiaio neiae?iio iie?i?aaiii? iaaeinoaoiino? caeaa?eueoiai i?e aaaee?e ai?ei?e ?ioieneeaoe?? oiui. I?ioa aaaee?noue nenoaiieo ?iceaae?a cao?oaeithaaea ?aeaioeo?eaoe?th ?? iayaiino? oa ae?aaeaiino?. Oe? oneeaaeiaiiy iinoaaii?aa?/iiai ia??iaeo i?ecaiaeeee aei a?eueoi? eaoaeueiino? na?aae oai?eo c na?oeaaith iaoieia??th ? e?iaioa/aie (7,22% i?e ONI ? no., 9,86% i?e ONI ??A no. ? 45,4% i?e ONI 2A-??? no. i?ioe 0,62% o eiio?ieuei?e a?oi?). E?eoaaeueia oaeoeea. A?aei?aoethaaiiy iioeiaeueii? e?eoaaeueii? oaeoeee aeiaaaei ae??oaiiy o?ueio aoceiaeo ieoaiue: aeai?o iaoiaeo e?eoaaiiy (eiina?aaoeaiiai /e o??o?a?/iiai); aecia/aiiy iaeni?eyoeea?oeo oa?i?i?a aeeiiaiiy iia?aoe??; aeai?o aaeaeaaoiiai ianyao o??o?a?/iiai ao?o/aiiy. Iniiaiei e?eoa???i ioe?iee i?aaeeueiino? ae??oaiiy eiaeiiai c oeeo ieoaiue aoea eaoaeuei?noue. Aeo?aeio ?ioi?iaoe?th ie io?eiaee oeyoii aea/aiiy i?e/ei nia?o? ia iniia? aaoiin?eiiai iaoa??aeo oa aecia/aiiy i?aaeeeoi??a nia?o?. Aiae?c aaoiin?eiiai iaoa??aeo iieacaa, ui 82% iiia?eeo oai?eo c aano?iaeoiaeaiaeueieie e?iaioa/aie iaee na?oeaai-noaeeiio iaoieia?th, aaaeeo cano?eio ONI eiinoaoiaaii o 26% iiia?eeo. E?iaioa/a aoea aaciina?aaeiueith i?e/eiith nia?o? eeoa o 28%, iaoii?noue na?oeaaa ? na?oeaai-eaaaiaaa iaaeinoaoi?noue ( o 47,8%, ia?aaaaeii a ?acoeueoao? aeaeiiiainaoe?? ONI (44,3% na?aae iia?iaaieo ? 49,7% na?aae iaiia?iaaieo). Na?aae ?ioeo i?e/ei nia?o? ia?aaaaeaee ai?eii-naioe/i? oneeaaeiaiiy. C on??? noeoiiino? aeaieo aiaiiaco oa ianoaaeaiiy i?e aaii?aa?? c o?ii?/ieo ae?acie (anueiai 58 e?eoa???a, 857 niinoa?aaeaiue) aeae?eaii 23 i?aaeeeoi?e iani?eyoeeaiai aeey aeeooy i?iaiico, ye? iaeaaeaoue aei o?ueio a?oi: oa?aeoa?enoeee aeaea?aea e?iaioa/?: ?ici??e ae?acee (2 ni, aeoeaia e?iaioa/a aai aiaeineii?/i? iciaee ia?aianaii?; e?ia o i?ina?o? oeoiea, iaeaia; ia?aiao?e, ye? a?aeia?aaeathoue aaaee?noue e?iaioa/? ? aeanoaa?e?caoe?? aiiainoaco: ianaiia?aae e?eoa??? aaaeeino? aiai?? (aaiiaeia?i<100 a/e, ae?aaeaia a?iii?ioa?iai?y), ae?aaeai? oao?ea?ae?y oa a?oa??aeueia a?iioaic?y, ai?ciae eieaino; oa?aeoa?enoeee oiio, ia yeiio aeieeea e?iaioa/a: aei ieo iaeaaeaoue iioeeee ? noa?a/ee a?e, iaoieia?y ??cieo i?aai?a ? nenoai ( ONI, iniaeeai ??A-??? no., a?ia?oii?/ia oai?iaa, iino?ioa?eoiee ea?ae?ineea?ic, noaiiea?ae?y OE 3-4, aeeoaeueia ? ie?eiaa iaaeinoaoi?noue, oeoe?iaee ae?aaao oiui. Iiaoi?ia e?iaioa/a aoea iaeiei c iaeaaaeeea?oeo i?aaeeeoi??a nia?o?, i?e ?? aeieeiaii? eaoaeuei?noue nyaaea 30,68% (70% a iniiai?e a?oi? ? 10,3% a eiio?ieuei?e), oiae? ye ca a?aenooiino? ( 1,73% (7,1% a iniiai?e a?oi? ? 0,17% — a eiio?ieuei?e). Iaoiaeii iiiaeeiii? ?aa?an?? anoaiiaeaii, ui iacaeaaeieie i?aaeeeoi?aie iani?eyoeeaiai aene?aeo aoee eeoa 4 oaeoi?e: ?aoeeaeea e?iaioa/?, aaeee? ?ici??e ae?acee, iayai?noue o?ii?/ii? na?oeaai? ? aeeoaeueii? iaaeinoaoiino?. Eaoaeuei?noue aoea nooo?ai aeuith na?aae iia?iaaieo oai?eo, iniaeeai i?e o?aaioieo ao?o/aiiyo (18,4% i?ioe 4% i?e ?aii?o ? ieaiiaeo iia?aoe?yo). ?acoeueoaoe o?aaioieo ao?o/aiue c i?eaiaeo e?iaioa/? o oai?eo c ONI aoee iniaeeai iani?eyoeeaeie ( eaoaeuei?noue neeaea 35,7% i?ioe 7% o eiio?ieuei?e a?oi? (p<0,05). Oiio ye iioeiaeueiee aa??aio ia?aa?ao ? e?eoaaeueii? i?ia?aie ?icaeyaea?oueny coieiea o?eaath/i? e?iaioa/? ? iiia?aaeaeaiiy ?? ?aoeeaeeao eiina?aaoeaieie caoiaeaie c iiaeaeueoei ae??oaiiyi ieoaiiy i?i aeioe?euei?noue iia?aoe?? i?ney iaeneiaeueii? eiiiainaoe?? ii?ooaiue aiiainoaco. Anueiai eiina?aaoeaia e?eoaaiiy i?ioyaii n?/iy 1995 ( aa?aciy 1997 ?? canoiniaaii ye inoaoi/iee iaoiae o 78,6% iaoe??io?a, o o./. o 79,3% oai?eo c ONI ? 78,4% ( eiio?ieueii? a?oie. O ?aooe 21,4% iaoe??io?a iaaeioe?euei?noue /e iaaoaeoeai?noue eiina?aaoeaiiai e?eoaaiiy cioneea aei aeeiiaiiy iia?aoe?e o ??ciee oa?i?i ? ca ??cieie iieacaie. O iniiai?e a?oi? iia?iaaii 32 oai?eo (19 ( c ONI ? no., 13 ( c ONI ??A no.), a eiio?ieuei?e ( 115. Ca iieacaie ie iiae?ey?ii iia?aoe?? ia oae? a?oie: O?aaioi? (aeno?ai?) iia?aoe??. ?o iniiaia iaoa ( coieiea e?iaioa/?. Aeeiiaii o 57 iaoe??io?a (14 ( iniiaii? a?oie ? 43 ( eiio?ieueii?) i?e i?ioocieo o?eaath/eo e?iaioa/ao, iaaaea/? aai iaiiaeeeaino? eiaaoeyoe?? (10 iia?aoe?e) oa i?e ?aoeeaeea? e?iaioa/? o noaoe?iia?? (47 iia?aoe?e). ?aii? iia?aoe??. ?o c?iaeaii 29 (5 ( iniiaia a?oia ? 24 ( eiio?ieueia) aeey iiia?aaeaeaiiy ?aoeeaeeao aaii?aa?? o aeiaaeeo eiai aenieiai ?eceeo i?ney a?aeiia?aeii? iaaeiaaio?eaaei? ia?aaeiia?aoe?eii? i?aeaioiaee oai?iai. I?aeaeuaiee ?ecee aiane?aeie iaiiaii? eiiiainaoe?? ii?ooaiue aiiainoaco aei?aaaeaiee iniiaiei caaaeaiiyi ( iiia?aaeaeaiiyi aeeoo?ai iaaacia/ii? iiaoi?ii? e?iaioa/?. Ieaiia? iia?aoe??. Aeeiiaii 61 ao?o/aiiy (13 oai?eo iniiaii? a?oie ? 48 ( eiio?ieueii?). Iaoith ? e?eoaaiiy aeania ae?aceiai? oai?iae, oiio aiie aeeiiothoueny eeoa o iaoe??io?a, noai yeeo aeiionea? ?aaeeeaeueio iia?aoe?th. Oa?i?i aeeiiaiiy aecia/aany noaiii oai?iai, iiaiioith ?anoeoooe?? aiiainoaco. Iieacaie aoee aaeee? ?ici??e ae?acee c iaaeinoaoi?i aoaeoii oa?ai??, o?eaaeee aiaiiac ? iaiaeii?acia? e?iaioa/? o ieioeiio, iacaaaeath/e ia iiaiioe?iia e?eoaaiiy, o o./. a?aaeeeaoe?th H. pylori, iaiiaeeea?noue aeeeth/aiiy ceiye?niiai oa?aeoa?o oeoieiai? ae?acee. Aeiaeaoeiaei iieacii aoee iaoa??aeueia iacaaacia/ai?noue ? anioe?aeueia iiaaae?iea iaoe??ioa, ye? oiaiiaeeeaethaaee iiaiioe?iio oa?ai?th. O?eaaiiy e?iaioa/? ia iiiaio aini?oae?caoe?? ?icaeyaeaeiny ianaiia?aae ye iieac aei aiaeineii?/iiai aaiinoaco, ca aeiyoeii i?ioocieo e?iaioa/. A?iiey?ia aeaeo?ieiaaoeyoe?y aoea oni?oiith o 12 oa.. Iacia/ia i?aeo?eaiiy e?ia? ca iaiiaeeeaino? eiaaoeyoe?? aeiioneaei ni?iao eiina?aaoeaiiai e?eoaaiiy i?ae eiio?ieai iino?eii? ani??aoe?? oeoieiaiai ai?noo. Oaea e?eoaaiiy caaacia/eei aaiinoac o 15 oai?eo (o o./. o 4 ca iayaiino? ONI) c iaeiei ?aoeeaeeaii e?iaioa/? o iiaeaeueoiio. O 10 oai?eo aeeiiaii aeno?ai? iia?aoe??. O 4 iaoe??io?a c aeaeeiith noaeeiith ia aei? ae?acee oni?oii i?iaaaeaii aeaeo?ieiaaoeyoe?th c iaoith i?io?eaeoeee ?aoeeaeeao. Iaoa aeine?aeaeaiiy eiina?aaoeaiiai e?eoaaiiy 840 aeiaaee?a e?iaioa/ c o?ii?/ieo ae?acie i?aeoaa?aeaeo?, ui canoinoaaiiy NAON ?noioii (p<0,05) cieaeo? e?euee?noue iiaoi?ieo e?iaioa/ iacaeaaeii a?ae i?aaeeeoi??a ?aoeeaeeao, o o./. na?aae iaoe??io?a c ONI: ?aoeeaeea?a e?iaioa/? a iniiai?e a?oi? aoei 10,5% i?e canoinoaaii? NAON ? 29,2% i?e e?eoaaii? eeoa aioaoeeaeaie ? ianaeaeoeaieie oie?iiaeieaoi?aie, a eiio?ieuei?e a?oi? ( a?aeiia?aeii 5,8% oa 18,5%. E?au? ?acoeueoaoe caaacia/othoue I2-aeieaoi?e 3 ? 4 iieie?iiy (?ai?oeaeei ? oaiioeaeei) oa ?ia?a?oi?e i?ioiiii? iiiie. I?ioa, iacaaaeath/e ia oni?o eiina?aaoeaii? oa?ai??, eeth/iaei oaeoe/iei iiiaioii i?e coieiaieo ae?aceiaeo e?iaioa/ao ? ioe?iea ?eceeo ?aoeeaeeao e?iaioa/? c iaoith a?aeai?o iaoe??io?a, yeei iieacaia ?aiiy iia?aoe?y. C iecee ee?i?/ieo e?eoa???a a?ae?a?aii 16, ye? iaee cia/ouee (p<0,05) ca’ycie c ?eceeii ?aoeeaeeao e?iaioa/? ? ?ic?iaeaii i?iaiinoe/iee ?iaeaen (oaae. 1). Oaaeeoey 1 ?iaeaen i?iaiicoaaiiy ?aoeeaeeao e?iaioa/? E?eoa??e Cia/aiiy (ae?aiacii) Aae Oa?i?i a?ae iiyae ia?oeo aei 1 aeiae +1 i?iya?a e?iaioa/? a?eueoa 1 aeiae -2 Oeoieiaee aiaiiac aei 1 ?ieo +1 1-10 ?ie?a -2 iiiaae 10 ?ie?a +2 Aieueiaee ae?aaeaiee +1 neiae?ii i? -1 Eieain aoa +2 ia aoei -1 Aeaoaeaoe?y iaeaia +1 i? -7 Oeoieiaee ai?no caonoee e?ia? +4 "eaaiaa aoua" +1 ?ioa -3 Ioeuen aei 80' -4 >80′ +1

A?oa??aeueiee oene (120 ii ?o. no. -2

(nenoie?/iee) <120 ii ?o. no. +2 I?i?iaeueiee (80 a/e -2 aaiiaeia?i <80 a/e +2 A?eie e?ia? (65 a/e -3 55-64 a/e 0 <55 a/e +3 Eieae?caoe?y aeoiaeaiaeueii? aa?oiuei-caaeiy no?iea +2 ae?acee ia?aaeiuei-ieaeiy no?iea -4 ?ici??e ae?acee iaioa 2 ni -2 2 ni ? a?eueoa +5 Aiaeineii?/i? i?aeo?eaiiy e?ia? c iiaa?oi? ae?acee -1 iciaee e?iaioa/? aeaeeia noaeeia +6 caonoie ? i?aeo?eaiiy e?ia? c-i?ae o?iiaa +10 o?iia +2 i?e?io?iiae -3 noai i?ney eiaaoeyoe?? aeaea?aea e?iaioa/? -3 ao?a aeii +2 n??a aeio -5 A?e aei 75 ?ie?a 0 75 ?ie?a ? a?eueoa +4 Na?oeaaa a?aenooiy aai ? no. -1 iaaeinoaoi?noue ??-??? no. +4 Aeeoaeueia a?aenooiy -1 iaaeinoaoi?noue iayaia +3 Noia aae?a iaioa 0 a?aeiia?aea? iecuee?e eiia??iino? ?aoeeaeeao e?iaioa/? (3,6%), a i?ii?aeeo 0-10 aae?a ( cia/ii aeu?e (19,7%), >10
aae?a ( aeoaea aenie?e (45,2%). sse aeaeii c oaaeeoe?, aei oaeoi??a
?eceeo iaeaaeeoue ONI ??-??? no., i?e ye?e /anoioa ?aoeeaeea?a e?iaioa/?
c?inoa? a?ae 9% aei 22,8%.

Iaoiaeii iiiaeeiii? ?aa?an?? aeae?eaii 4 iacaeaaei? i?aaeeeoi?e
iiiiaeaiiy e?iaioa/? ( aaaeeo e?iaiao?aoo, aaeee? ?ici??e ae?acee,
iayai?noue iciae ia?aianaii? e?iaioa/?, iaeaio i?e aeaoaeaoe??, ui aeaei
ciiao ia iniia? eiao?oe??ioo ?aa?an?? ?ic?iaeoe ua iaeei i?iaiinoe/iee
?iaeaen (oaae. 2).

Oaaeeoey 2

?iaeaen i?iaiicoaaiiy ?aoeeaeeao e?iaioa/?

E?eoa??e Aaee

Aeaoaeaoe?y iaeaiith 4

?ici?? ae?acee 2 ni ? a?eueoa 7

Aaaeea aiai?y (Hb ( 70 a/e ? iaioa) 5

Aeyaeai? i?ae /an OAAeN:

aeaeeia noaeeia. aaeee? caonoee ? i?aeo?eaiiy e?ia? c-i?ae o?iiaa 7

o?iia aai ao?a aeii ae?acee 5

Aeey oai?eo, e?eiaaieo NAON, i?e noi? aae?a 0-7 ?ecee iecueeee (0,35%
?aoeeaeea?a e?iaioa/?), 8-14 aae?a ( na?aaei?e (7.06%), iiiaae 14 aae?a
( aeoaea aenieee (36,8%). I?e canoinoaaii? oeueiai ?iaeaeno iniae c
aenieei ?eceeii ?aoeeaeeao e?iaioa/? na?aae in?a c ONI neeaaeaee 12,3%
i?ioe 7,7% o eiio?ie?, a c iecueeei 33,3% ( i?ioe 52%. Oeae ?iaeaen
c?o/i?oee, i?ioa aeei?enoaiiy eiai iaiiaeeeaa, yeui i?ae /an aiaeineii??
ia aaeaeiny iaeyiooe ae?aceo. O oeueiio aeiaaeeo iiaeia nei?enoaoeny
iiia?aaei?i ?iaeaenii, ine?eueee a?aenooi?noue ?ioi?iaoe?? i?i
yeee-iaaoaeue e?eoa??e ia aeeeth/a? iiaeeea?noue canoinoaaiiy ?iaeaeno,
oi/ ?ioi?iaoeai?noue i?e oeueiio ciaioo?oueny. *ooeea?noue ?iaeaeno ia
iniia? aiae?co Aaeueaea neeaea 83,3%, ia iniia? iiiaeeiii? ?aa?an?? (
66%, niaoeeo?/i?noue a?aeiia?aeii 85,4% ? 90,2%.

Aenieee ?ecee ?aoeeaeeao e?iaioa/? ? iieacii aei ?aiiueiai ao?o/aiiy
i?ioyaii 1 aeiae, e??i aeiaaee?a, eiee aaaeea noiooiy iaoieia?y
aeicaiey? eeoa o?aaioia iia?oaaiiy ca aeeoo?aeie iieacaie. Na?aaei?e
?ecee aeicaiey? canoiniaoaaoe o?eaae?oo i?aeaioiaeo a oiiaao
?aai?iaoe?eiiai a?aeae?eo aeey caaacia/aiiy o ?aiiueiio
iinoaaii?aa?/iiio ia??iae? ia iae?aoeaiiai, a ?aaeeeaeueiiai ao?o/aiiy,
ooo iiaeia oe?oa noaaeoe i?ioeiieace aei ?aiiuei? iia?aoe??. I?e
iecueeiio ?eceeo eiina?aaoeaia oa?ai?y ? iaoiaeii aeai?o. ?aii?
iia?aoe?? i?e iaiiai?e eiiiainaoe?? aiiainoaco, ye? iia’ycai? c
i?aeaeuaiei ?eceeii, aeioe?eueii aeeiioaaoe eeoa o ia?o? 4 aeiae,
i?ioyaii eio?eo o?aiey?oueny 3/4 an?o ?aoeeaeea?a e?iaioa/?, i?ci?oa
?ecee ?aoeeaeeao ia ia?aaeuo? 3%.

Aeey oai?eo c ONI i?eoaiaii? ye iniaeeaino?, ui niiioeothoue aei
aeoea?caoe?? o??o?a?/ii? aeoeaiino? (aeuee ?ecee ?aoeeaeeao, aeua
eaoaeuei?noue o aeiaaeeo eiai aeieeiaiiy), oae ? aei ?? iaiaaeaiiy
(aeuee o??o?a?/iee ?ecee). Iaoe??ioe c ONI ??A-??? no. oa o ?aiiueiio
iino?ioa?eoiiio ia??iae? ia iia?oaaeeny, i?ioa ?iiia?aaaeuei?noue ia
ioioiaeith?oueny c ?ieo?aaaeuei?noth, ine?eueee c oni?oii iiaeooue
canoinoaaoeny aiaeineii?/iee aaiinoac ? iaaeeeaiaioicia e?eoaaiiy. O
oai?eo c ONI ?-??A no. iia?aoeaia aeoeai?noue caaaeii iaei a?ae??ciyeany
a?ae eiio?ieueii? a?oie (24,1% i?ioe 21,6%). I?ioa, i?e aiae?c? c oi/ee
ci?o iieac?a aei ao?o/aiiy caoaaaeo?oueny, ui ca iayaiino? ae?aaeaii?
ONI /anoea ieaiiaeo ao?o/aiue ciaiooaaeany, a ia?aaaaeaee o?aaioi?
iia?aoe?? ca aeeoo?aeie iieacaie ( 53% c on?o iia?aoe?e i?e ONI ??A no.
i?ioe 36,8% i?e ONI ? no. ? 38,9% o eiio?ieuei?e a?oi?.

Aiae?c oa?aeoa?o i?neyiia?aoe?eieo oneeaaeiaiue o oai?eo c ONI iieacaa
/?oeo caeaaei?noue ?o oa?aeoa?o ? /anoioe aeieeiaiiy (53,1% o iniiai?e
a?oi? i?ioe 27,9% o eiio?ieuei?e), oa eaoaeueiino? (25% i?ioe 2,6%),
a?ae iayaiino? oa aaaeeino? ONI. Na?aae on?o oai?eo iniiaii? a?oie c
oneeaaeiaiei i?neyiia?aoe?eiei ia??iaeii o 41,2% iaee i?noea na?oeaa?
oneeaaeiaiiy, ia?aaaaeii aino?a na?oeaaa iaaeinoaoi?noue. Oea aeicaieeei
canoinoaaoe aeey ioe?iee o??o?a?/iiai ?eceeo ?nioth/? ?iaeaene
ia?eiia?aoe?eiiai na?oeaaiai ?eceeo L.Goldman et al. (1977) oa Larsen
S.F. et al. (1987). Ii??aiyiiy ?acoeueoao?a ?o canoinoaaiiy iieacaei
aeuo oi/i?noue inoaiiueiai. I?e noi? aae?a 0-7 eaoaeuei?noue ia
ia?aaeuoaaea 3,1%, 8-10 aae?a ( aoea 12,8%, 11-15 aae?a ( 40%. O oai?eo
c ioe?ieith iiiaae 10 aae?a na?aae i?e/ei nia?o? aeii?ioaaee na?oeaa?
oneeaaeiaiiy. Ie aaaaea?ii, ui aenieee iia?aoe?eiee ?ecee (10-15 aae?a)
aeiionea? eeoa i?i?iaeueia ao?o/aiiy ca aeeoo?aeie iieacaie (o?eaath/a
/e ?aoeeaeeaia e?iaioa/a), iiiaae 15 ( aecia/a? ?iiia?aaaeuei?noue
oai?iai.

Ia’?i iia?aoe?? oaeiae iae?aany c iaeyaeo ia o??o?a?/iee ?ecee, o o./.
coiiaeaiee iayai?noth na?oeaai? iaoieia??. Ca iayaiino? ONI ??A no.
?aaeeeaeuei? ao?o/aiiy neeaaeaee eeoa 30,8% a?ae on?o iia?aoe?e, a i?e
ONI 1 no. ( 52,6%, oiae? ye o eiio?ieuei?e a?oi? ( 72,2%. Iae?aoeai?
iia?aoe?? ( aen?/aiiy aai aenoa??i?ecaoe?y ae?acee aeeiioaaeeny ca
iayaiino? iaeiiai c ianooiieo oaeoi??a: aaaeeiai aaii?aa?/iiai oieo,
aiai?? Hb<80 a/e, aaaeei? noiooiuei?, ianaiia?aae na?oeaai-eaaaiaai? iaoieia??, noa?a/iai a?eo, ca oiiae a?aenooiino? i?aeic?e ia iae?ai?caoe?th ae?acee /e oaoi?/ii? iaiao?aeiino? aeeiiaiiy ?acaeoe?? oeoiea. I?ioeaaiiy o?ii?/ieo ae?acie oa noaeei ia ?o aei? ie iaeeoeee, ine?eueee aiie ia caaacia/othoue iaae?eiiai aaiinoaco. I?ney iae?aoeaieo iia?aoe?e i?ecia/aeiny aeiiiaithth/a (aae'thaaioia) e?eoaaiiy NAON ? aioeaae?eiaaeoa?ia oa?ai?y c iaoith ciaioaiiy ?eceeo i?neyiia?aoe?eieo e?iaioa/ c aino?eo ae?aceiai-a?iceaieo o?aaeaiue oa iie?auaiiy a?aeaeaeaiiai ?acoeueoaoo e?eoaaiiy. Iniiaiei ?aaeeeaeueiei ao?o/aiiyi o inoaii? ?iee i?e e?iaioa/ao c o?ii?/ieo ae?acie ye oeoiea, oae ? aeaaiaaeoeyoeiaei? eeoee noaea ?acaeoe?y oeoiea (aeeiiaii 80 c 83 ?aaeeeaeueieo iia?aoe?e) ??cea ciaioaiiy /anoee i?aaiicaa??aath/eo iia?aoe?e c aaaioii??th ie iia'yco?ii c caoaeaiiyi iieac?a aei iia?aoe?e a oe?eiio, iia?oaaiiyi ia?aaaaeii oai?eo c aaeeeeie, /anoi iaiao?oth/eie ae?aceaie, aea ?acaeoe?y ? iaoiaeii aeai?o ia eeoa i?e ieaiiaeo, aea e /anoi ueoi?ai76( i?e o?aaioieo ao?o/aiiyo; a oaeiae ?c nooo?aei iie?ioaiiyi ?acoeueoao?a aeeiiaiiy ?acaeoe?e aiane?aeie iaaoooy aeina?aeo o??o?aaie. Iiaeia i/?eoaaoe oe?oa aeeiiaiiy i?aaiicaa??aath/eo iia?aoe?e c aaaioii??th naia na?aae in?a c o?ii?/iith na?oeaaith iaoieia??th, ui ? i?iiiio? iecea aaoi??a [A.Ae.A?aoonue, 1991, A.I.Aea?iai, 1990]. I?ioa ie aeeiiaee 13 ?acaeoe?e, iaeio aaaioii?th ? 18 iae?aoeaieo ao?o/aiue o oai?eo c ONI. Iiynieoe oea iiaeia aaeeeeie ?ici??aie ae?acie, ui ?iaeei i?aaiicaa??aath/o iia?aoe?th iaaeioe?eueiith, aai e oaoi?/ii iaiiaeeeaith, a oaeiae /anoei iia?oaaiiyi ca aeeoo?aeie iieacaie ? aeeiiaiiyi eeoa i?i?iaeueiiai ao?o/aiiy ia ae?acoe?. Ii?aeiaia canoinoaaiiy ?iaeaen?a ?eceeo ?aoeeaeeao e?iaioa/? ? ia?eiia?aoe?eiiai na?oeaaiai ?eceeo aeaei ciiao noi?ioethaaoe aeai?eoi ae??oaiiy ieoaiiy i?i aeeiiaiiy iia?aoe??, ?? oa?i?i ? ia’?i. Iaaeeeaiaioicia e?eoaaiiy ae?aceiai? oai?iae. C iaeyaeo ia oa, ui eeoa iaaaeeea /anoeia e?iaioa/ (3,93%) o?eaaea ia iiiaio aini?oae?caoe??, aai aeyaeyeany aeaeeia noaeeia (4,36%), yea ? iieacii aei i?aaaioeaii? aiaeineii?/ii? oa?ai??, aeii?ioth/a cia/aiiy aeey ?acoeueoao?a e?eoaaiiy iaea iaaeeeaiaioicia oa?ai?y, iniiao yei? neeaaeaee no/ani? NAON (I2-aeieaoi?e 3-4 aaia?aoe?? oa ?ia?a?oi? i?ioiiii? iiiie iiai?acie). O ia?o? aeiae iniiaiith iaoith aoei ciaioaiiy caa?ice iiaoi?ii? e?iaioa/?. Aeey oai?eo, yeeo o iiaeaeueoiio iia?oaaee, oea aeicaieyei aea?aoe /an aeey ia?aaeiia?aoe?eii? i?aeaioiaee. Aeey ?aooe iaoe??io?a, ia?aaeon?i c iaaaeeeeie ? aia?oa aeyaeaieie ae?aceaie, iecueeei ? na?aaei?i ?eceeii ?aoeeaeeao e?iaioa/? oa aenieei iia?aoe?eiei ?eceeii, ianaiia?aae coiiaeaiei na?oeaai-noaeeiiith iaoieia??th, iaaeeeaiaioicia oa?ai?y aoea inoaoi/iei iaoiaeii e?eoaaiiy. Oaea oaeoeea i?eaaea aei nooo?aiai cieaeaiiy o??o?a?/ii? aeoeaiino? i?e o?ii?/ieo ae?aceao, oneeaaeiaieo e?iaioa/ath, ( c 52,9% o 1987 ?. aei 19,1% o 1996 ?. (o oai?eo c ONI – aei 14,9%) aiaeii/an ?c cieaeaiiyi eaoaeueiino?. I?e OAAeN /a?ac 4 oeaei? o eiio?ieuei?e a?oi? (67 oa.) ?oaaoeue aeyaeaii o 67,1%, a o?aaiaioiaaio ae?aceo ia noaae?? ?oaoethaaiiy ( o 28,4%. O iaoe??io?a c ONI (35 oa.) oe? iieacieee noaiiaeee a?aeiia?aeii 68,6% ? 17,1%, ui ia ia? ?noioii? a?aei?iiino? c eiio?ieai (p>0,05). E??i oiai,
o 78 iaoe??io?a ie i?iaiaeeee a?aaeeeaoe?th Helicobacter pylori aeey
ciaioaiiy /anoioe iiaoi?iiai ae?aceiooai?aiiy.

E?eoaaiiy aino?eo a?iceaii-ae?aceiaeo o?aaeaiue oa neiae?iio
Iaeei??-Aaena. Aoaeoeai?noue iaaeeeaiaioicii? oa?ai?? NAON o ii?aeiaii?
c aiaeineii?/iei aaiinoacii aeaea ciiao iaeaea iiai?noth oieeiooe
iia?aoeaieo ao?o/aiue c i?eaiaeo aaii?aa?e c aino?eo ae?aceiai-a?iceaieo
o?aaeaiue oa i?e neiae?ii? Iaeei??-Aaena. Ooo eiina?aaoeaia e?eoaaiiy
canoiniaoaaeinue ? i?e ?aoeeaeeaao e?iaioa/?. Iia?aoe?? aaaaeaeeny
aeioe?eueieie eeoa o iiiaeeiieeo aeiaaeeao i?ioocieo e?iaioa/ ca
a?aenooiino? aaaeei? noiooiuei? iaoieia?? (3 aeiaaeee ca /an
niinoa?aaeaiiy), ine?eueee aiie ia onoaaee i?e/eie aeieeiaiiy iiaeo
aino?eo a?ic?e oa ae?acie (no?an, oiiiaa iaoieia?y), ? ia iiaee
iiia?aaeeoe aaii?aa?e c ieo. Nooo?aei iiiaioii iaoiaaiaoe/ii? oa?ai??
aino?eo o?aaeaiue aoei aeaaaeaiiy oai?eo c aeaeiiiainaoe?? NI, e?eoaaiiy
?ioeo na?oeaaeo caoai?thaaiue, ui noi?iaiaeaeothoueny aaiiaeeiai?/iei
no?anii oa ii?ooaiiyi i?e?ioee?eoeyoe??. Oaea oaeoeea aeaea ciiao
aeinyaiooe no?eeiai aaiinoaco o 87,5% oai?eo iniiaii? a?oie ? 98,6% (
eiio?ieueii?.

E?eoaaiiy na?oeaai-noaeeiii? iaoieia?? o iinoaaii?aa?/iiio oa
ia?eiia?aoe?eiiio ia??iae?. ?noioiei iiiaioii e?eoaaiiy iniiaii? a?oie
oai?eo aoea i?io?eaeoeea ? oa?ai?y na?oeaaeo oneeaaeiaiue. Ine?eueee
a?iiaieai?th aaeaaaeiny nei?eaoaaoe aeineoue oaeaeei, ia ia?oee ieai
aeoiaeeea iaaeinoaoi?noue e?iaiia?ao aiane?aeie aeenooieoe?? i?iea?aea.
Ie oni?oii canoiniaoaaee o 53 iaoe??io?a ?ia?a?oi?e AIO ii/eiath/e c 3-5
aeiy a?ae /ano coieiee e?iaioa/?.

Iayai?noue a?ia?oii?/ii? oai?iae o a?eueoino? (65,8%) iaoe??io?a
iniiaii? a?oie oa oaeaeea a?aeiiaeaiiy a?oa??aeueii? a?ia?oaic?? o
iinoaaii?aa?/iiio ia??iae? ?iaeoue aeooaeueiei ieoaiiy ?? ei?aeoe??.
Ie??i ?ia?a?oi??a AIO, o oeueiio aeiaaeeo i?ecia/aeenue aioaaii?noe
eaeueoe?th (26 iaoe??io?a), ye? ei?eaoaaee ?oai?th i?iea?aeo oa
ii?ooaiiy ?eoio, iie?iooaaee i?e?ioee?eoeyoe?th o neecia?e iaieiioe?
oeoiea, ciaiooaaee eeneioii?iaeoeoe?th. Aaoa-aae?aiiaeieaoi?e io?eioaaee
8 oai?eo. Oa?ai?y oeeie i?aia?aoaie iaeii/anii c aaiinoaoeeaie (aeey
onoiaiiy a?iieiaaoeyoe?eiiai aoaeoo) i?e a?aooaaii? oaeoi??a ?eceeo
?aoeeaeeao e?iaioa/? aacia/ia, ui i?aeoaa?aeaeothoue ?acoeueoaoe iaoi?
?iaioe (/anoioa ?aoeeaeea?a e?iaioa/? ia iaea cia/oui? ??cieoe? c
eiio?ieueiith a?oiith).

?acoeueoaoe e?eoaaiiy. Ia iniia? iioei?caoe?? eiina?aaoeaiiai e?eoaaiiy
ae?aceiaeo o?aaeaiue oa oiiiai? iaoieia??, ii?aeiaiiai canoinoaaiiy
?iaeaen?a ioe?iee na?oeaaiai o??o?a?/iiai ?eceeo ? ?eceeo ?aoeeaeeao
e?iaioa/? noi?ioeueiaaii ?aeeiee oaeoe/iee aeai?eoi. Oaeoe/i?
?aeiiaiaeaoe??, ae?iaeai? a i?ioean? aeine?aeaeaiiy, iiaeooue
canoiniaoaaoeny ia eeoa uiaei iaoe??io?a c ONI, a aei an?o oai?eo c
ae?aceiai-a?iceaieie aano?iaeoiaeaiaeueieie e?iaioa/aie. Aeuacaaaeai?
oaeoe/i? i?aeoiaee aeaei ciiao cieceoe caaaeueio eaoaeuei?noue o 1996-97
?. na?aae oai?eo c o?ii?/ieie ae?aceaie, oneeaaeiaieie e?iaioa/ath aei
2,3%, a o./. na?aae in?a c ONI ( aei 8,5%. I?neyiia?aoe?eia
eaoaeuei?noue o oeae ia??iae neeaaeaea a?aeiia?aeii 7,5% na?aae on?o
iia?iaaieo c ae?aceiaeie e?iaioa/aie ? 25,0% na?aae in?a c ONI. Na?aae
iaoe??io?a c aino?eie ae?aceiai-a?iceaieie o?aaeaiiyie eaoaeuei?noue
aoea 7,1% (ca iayaiino? ONI ( 20%), c neiae?iiii Iaeei??-Aaena ( 2,1%
(ca iayaiino? ONI ( 14,3%), i?e/eiith nia?o? aoea aeaeiiiainaoe?y
oiiiai? iaoieia??. O eiio?ieuei?e a?oi? c AAAO oa neiae?iiii
Iaeei??-Aaena iiia?eeo ia aoei.

Aeniiaee

O iaoe??io?a c ONI ?ecee aeieeiaiiy e?iaioa/ c o?ii?/ieo
aano?iaeoiaeaiaeueieo ae?acie aeuee, aiie aaae/? ca oa?aeoa?ii. Oea
coiiaeth?oueny a?eueoeie ?ici??aie ae?acie, nenoaiieie ?iceaaeaie
aiiainoaco, oeueoea?iaaiiei aoaeoii iecee iaaeeeaiaio?a, canoiniaoaaieo
o ea?ae?ieia?/i?e i?aeoeoe?.

O?ii?/ia na?oeaaa iaaeinoaoi?noue ? iacaeaaeiei ao?ieia?/iei oaeoi?ii
aeieeiaiiy aino?eo a?iceaii-ae?aceiaeo o?aaeaiue, oneeaaeiaieo
aaii?aa??th, aecia/a? ?o oa?aeoa? (aaeee? ?ici??e oa oeoieiao
eieae?caoe?th).

O?ii?/ia na?oeaaa oa aeeoaeueia iaaeinoaoi?noue ? iacaeaaeieie
i?aaeeeoi?aie iani?eyoeeaiai i?iaiico ii?yae c ?aoeeaeeaii e?iaioa/? oa
aaeeeeie ?ici??aie ae?acee. Iniaeea?noth ia?aa?ao iinoaaii?aa?/iiai ?
i?neyiia?aoe?eiiai ia??iaeo o oai?eo c ONI ? iineeaiiy aai oaoaeueia
aeaeiiiainaoe?y na?oeaai? ? na?oeaai-eaaaiaai? iaaeinoaoiino?, ui
iaeaaeaoue aei iniiaieo i?e/ei nia?o?.

Iacaeaaeieie i?aaeeeoi?aie ?aoeeaeeao e?iaioa/? c o?ii?/ii? ae?acee ? ??
?ici??e iiiaae 2 ni, iayai?noue aeaeeii? noaeeie aai cn?aee?a e?ia? oa
o?eniaaieo o?iia?a ia iiaa?oi? ae?acee, aaaeea e?iaiao?aoa (aaiiaeia?i
<70 a/e). I?aaeeeoeaia cia/aiiy na?oeaai? iaaeinoaoiino? ??-??? no. uiaei ?aoeeaeeao e?iaioa/? iiina?aaeeiaaia /a?ac aaeee? ?ici??e ae?acee oa aaae/o e?iaiao?aoo a iaoe??io?a c oe??th iaoieia??th. Cai?iiiiiaai? iaie ?iaeaene c aenieith /ooeea?noth oa niaoeeo?/i?noth aeicaieythoue i?iaiicoaaoe ?aoeeaeea e?iaioa/?, aiie c?o/i? aeey canoinoaaiiy. Canoinoaaiiy I2-aeieaoi??a 3 ? 4 iieie?iiy oa ?ia?a?oi??a i?ioiiii? iiiie ?noioii cieaeo? /anoioo ?aoeeaeea?a e?iaioa/?, o o./. o oai?eo c ONI. Oea aea? ciiao aeio?eioaaoeny no?eiai?oi? o??o?a?/ii? oaeoeee o oai?eo c ONI i?e aenieiio iia?aoe?eiiio ?eceeo. Iaoe??io?a c ONI ??A no. aeioe?eueii iia?oaaoe ia?aaaaeii ca o?aaioieie iieacaie (o?eaath/a ? ?aoeeaeeaia e?iaioa/a) c aeeiiaiiyi iae?aoeaieo iia?aoe?e (aen?/aiiy oa aenoa??i?ecaoe?? ae?acee) ? iiaeaeueoith oa?ai??th aeieaoi?aie oeoieiai? nae?aoe?? oa a?aaeeeaoe??th H. pylori. O oai?eo c ONI I no. ?aii? ? ieaiia? ?aaeeeaeuei? iia?aoe?? ( ?acaeoe?? oeoiea iiaeia aeeiioaaoe ca oeie ae iieacaie, ui e oai?ei aac na?oeaai-noaeeiii? iaoieia?? (ca oiiae ?aoaeueii? ia?aaeiia?aoe?eii? i?aeaioiaee ? i?neyiia?aoe?eiiai aaaeaiiy). Ii?aeiaia canoinoaaiiy ?iaeaen?a i?iaiicoaaiiy ?aoeeaeeao e?iaioa/? ? ioe?iee iia?aoe?eiiai ?eceeo aeicaiey? iioei?coaaoe oaeoeeo e?eoaaiiy oai?eo c ae?aceiaeie e?iaioa/aie ia oii? na?oeaai-noaeeiii? iaoieia??. ?aii? iia?aoe?? i?e iaiiai?e eiiiainaoe?? aiiainoaco i?ioyaii ia?oeo /ioe?ueio ae?a aeeiiothoueny i?e aenieiio ?eceeo ?aoeeaeeao e?iaioa/? oa na?aaeiueiio ? iecueeiio na?oeaaiio ?eceeo. Ieaiia? iia?aoe?? i?ney iaeneiaeueii iiaeeeai? eiiiainaoe?? aiiainoaco ? ca oiiae iaaoaeoeaiino? eiina?aaoeaii? i?ioeae?aceiai? oa?ai?? ( i?e na?aaeiueiio ? iecueeiio na?oeaaiio ?eceeo. I?e e?iaioa/ao c aino?eo ae?aceiai-a?iceaieo o?aaeaiue oa neiae?ii? Iaeei??-Aaena iaoiaeii aeai?o ? eiina?aaoeaia (iaaeeeaiaioicia oa aiaeineii?/ia) oa?ai?y, iaia’yceiaei eiiiiiaioii yei? ? aieea ia iaoiaaiac ooai?aiiy aino?eo o?aaeaiue ( e?ea?aeaoe?y oeaieiii? a?iien??, o o./. oeyoii aeaaaeaiiy oai?eo c ONI ?c aeaeiiiainaoe??. Canoinoaaiiy ?ia?a?oi??a AIO ? aoaeoeaiei ? aacia/iei caniaii oa?ai?? na?oeaai? iaaeinoaoiino? oa a?oa??aeueii? a?ia?oaic?? o iinoaaii?aa?/iiio ? i?neyiia?aoe?eiiio ia??iaeao. Nienie i?aoeue, iioae?eiaaieo ca oaiith aeena?oaoe?? Ooiae ?.I. Iniaeeaino? oaeoeee e?eoaaiiy ae?aceiaeo e?iaioa/ o oai?eo c o?ii?/iith na?oeaaith iaaeinoaoi?noth. // Aeooaeuei? i?iaeaie iaaeeoeeie, a?ieia??, aaoa?eia??? oa n?euenueeiai ainiiaea?noaa. Ca. iaoe. i?aoeue.- Ei. 4. Euea?a, 1999. - N. 126-129. Ooiae ?.I., Neea/ee A.A. Na?oeaaee ?ecee a iana?oeaa?e o??o?a??. 1. Aeaoa?i?ioth/? oaeoi?e // Oe?a?inueeee ea?ae?ieia?/iee aeo?iae.- 1997.- N.2.- aei. ??.- N. 90-93. Ooiae ?.I., Neea/ee A.A. Na?oeaaee ?ecee a iana?oeaa?e o??o?a??. 2. Ae?aaiinoe/ii-oaeoe/i? aeai?eoie // Oe?a?inueeee ea?ae?ieia?/iee aeo?iae.- 1997.- N.3.- aei. ??.- N. 83-86. O?eueoe I.A., ?a/eaae/ N.E., Ooiae ?.I., Iaeo?e ?.TH., A?eee TH.Ae. Cia/aiiy i?iaiicoaaiiy ?aoeeaeeao o aeai?? oaeoeee e?eoaaiiy aano?iaeoiaeaiaeueii? e?iaioa/? ae?aceiaiai aaiaco // Ee?i. o??.- 1998.- ?.1. N. 9-11. Ooiae ?. E?eaaaey/? iaioe/i? ae?acee: no/ani? e?eoaaeuei? i?aeoiaee // Iaaeeoeeia na?oo.- 1998.- O.IV.- ?.5.- N.48 - 54. I?iaiic aeey aeeooy i?e aano?iaeoiaeaiaeueieo e?iaioa/ao: aeaoa?i?ioth/? e?eoa??? / Ooiae ?.I.; Euea?a. iaae. oi-o.- Euea?a, 1997.- 12 n. - A?ae?ia?. 19 iaca.- Oe?.- Aeai. a Oe?AeIOA // Aiio. a ?AE “Aeaiiiiaai? iaoeia? ?iaioe”, N 1, 1998. ? a/i 359. Naeaeoeai? aeieaoi?e oeoieiai? nae?aoe?? ? aaiethoe?y oaeoeee i?e ae?aceiaeo aano?iaeoiaeaiaeueieo e?iaioa/ao / O?eueoe I.A., ?a/eaae/ N.E., Ooiae ?.I., Eiienoyinueeee ?.I.; Euea?a. iaae. oi-o.- Euea?a, 1997.- 18 n. - A?ae?ia?. 53 iaca.- Oe?.- Aeai. a Oe?AeIOA // Aiio. a ?AE “Aeaiiiiaai? iaoeia? ?iaioe”, ?1, 1998. ? a/i 358. Ooiae ?.I. ?ieue na?oeaai-noaeeiii? iaoieia?? o oaiaoiaaiac? oai?eo c? oeoieiai-eeoeiaeie e?iaioa/aie // No/ani? aniaeoe iaa?aeeeaaeii? iaaee/ii? aeiiiiiae. Iao. eiio.- Ei.1.- Euea?a.- 1997.- N. 174-175. Uaiaiye ?.A., Ooiae ?.I. Ee?i?/ia ea?oeia oa e?eoaaiiy neiae?iio Iaeei??-Aaena // No/ani? aniaeoe iaa?aeeeaaeii? iaaee/ii? aeiiiiiae. Iao. eiio.- Ei.1.- Euea?a.- 1997.- N. 199-200. Aiioaoe?y Ooiae ?.I. Aino?? aano?iaeoiaeaiaeuei? e?iaioa/? ae?aceiai-a?iceaiiai aaiaco o oai?eo c o?ii?/iith na?oeaaith iaaeinoaoi?noth: iniaeeaino? ia?aa?ao ? e?eoaaeueii? oaeoeee. - ?oeiien. Aeena?oaoe?y ia caeiaoooy iaoeiaiai nooiaiy eaiaeeaeaoa iaaee/ieo iaoe ca niaoe?aeuei?noth 14.01.03. - o??o?a?y. - Euea?anueeee aea?aeaaiee iaaee/iee oi?aa?neoao IIC Oe?a?ie, Euea?a, 1999. A aeena?oaoe?? iieacaii aieea o?ii?/ii? na?oeaai? iaaeinoaoiino? (ONI) ia /anoioo aeieeiaiiy ? ia?aa?a aino?eo ae?aceiai-a?iceaieo o?aaeaiue oa o?ii?/ieo aano?iaeoiaeaiaeueieo ae?acie c aaii?aa?/ieie oneeaaeiaiiyie. Anoaiiaeaii, ui ONI, ii?o/ c ?aoeeaeeaii e?iaioa/?, aaeeeeie ?ici??aie ae?acee ? aeeoaeueiith iaaeinoaoi?noth ? iacaeaaeiei i?aaeeeoi?ii iani?eyoeeaiai aene?aeo e?eoaaiiy. Anoaiiaeaii iacaeaaei? i?aaeeeoi?e ? cai?iiiiiaaii ?iaeaene i?iaiicoaaiiy ?aoeeaeeao e?iaioa/?. Aeiaaaeaii, ui oa?ai?y I2-aeieaoi?aie oa iiai?acieii ?noioii cieaeo? /anoioo ?aoeeaeea?a e?iaioa/?, o o./. o oai?eo c ONI, ui aea? ciiao aeio?eioaaoeny iii??eiaai?oi? o??o?a?/ii? oaeoeee i?e aenieiio iia?aoe?eiiio ?eceeo. Aeiaaaeaii aeioe?euei?noue iaaeeeaiaioicii? ? aiaeineii?/ii? oa?ai?? ye iaoiaeo aeai?o i?e e?iaioa/ao c aino?eo o?aaeaiue neeciai? ? neiae?ii? Iaeei??-Aaena. ?ic?iaeaii i?aeoiaee aei i?io?eaeoeee ? oa?ai?? na?oeaaeo oneeaaeiaiue a iinoaaii?aa?/iiio ia??iae?. Ia iniia? ioe?iee ?eceeo ?aoeeaeeao e?iaioa/? oa iia?aoe?eiiai (na?oeaaiai) ?eceeo ?ic?iaeaii aeai?eoi oaeoeee e?eoaaiiy ae?aceiaeo e?iaioa/ ia oii? na?oeaai-noaeeiii? iaoieia??, ae??oaiiy ieoaiiy i?i aeioe?euei?noue iia?aoe??, ?? ia’?i ? oa?i?i aeeiiaiiy. Eeth/ia? neiaa: oeoieiai-eeoeia? e?iaioa/?, ae?aceiaa oai?iaa, aino?? ae?acee, a?iceaiee aano?eo, neiae?ii Iaeei??-Aaena, iia?aoe?eiee ?ecee, o?ii?/ia na?oeaaa iaaeinoaoi?noue Aiiioaoeey Ooiae E.I. Ino?ua aano?iaeoiaeaiaeueiua e?iaioa/aiey ycaaiii-y?iceaiiai aaiaca o aieueiuo n o?iie/aneie na?aea/iie iaaeinoaoi/iinoueth: iniaaiiinoe i?ioaeaiey e ea/aaiie oaeoeee. - ?oeiienue. Aeenna?oaoeey ia nieneaiea iao/iie noaiaie eaiaeeaeaoa iaaeeoeeineeo iaoe ii niaoeeaeueiinoe 14.01.03. - oe?o?aey. - Eueaianeee ainoaea?noaaiiue iaaeeoeeineee oieaa?neoao IC Oe?aeiu, Eueaia, 1999. A aeenna?oaoeee iieacaii aeeyiea o?iie/aneie na?aea/iie iaaeinoaoi/iinoe (ONI) ia /anoioo aicieeiiaaiey e oa/aiea ino?uo ycaaiii-y?iceaiuo ii?aaeaiee e o?iie/aneeo aano?iaeoiaeaiaeueiuo yca n aaii??aae/aneeie ineiaeiaieyie. Onoaiiaeaii, /oi ONI, eae e ?aoeeaeea e?iaioa/aiey, aieueoea ?icia?u ycau e aeuoaoaeueiay iaaeinoaoi/iinoue, yaeyaony iacaaeneiui i?aaeeeoi?ii iaaeaaii?eyoiiai enoiaea e?iaioa/aiey. Onoaiiaeaiu iacaaeneiua i?aaeeeoi?u e i?aaeeiaeaiu eiaeaenu i?iaiice?iaaiey ?aoeeaeeaa e?iaioa/aiey. Aeieacaii, /oi oa?aiey I2-aeieaoi?aie e iiai?acieii aeinoiaa?ii nieaeaao /anoioo ?aoeeaeeaiuo e?iaioa/aiee, a o./. o aieueiuo n ONI. Yoi iicaieyao i?eaea?aeeaaoueny aieaa naea?aeaiiie oe?o?ae/aneie oaeoeee i?e aunieii iia?aoeeiiiii ?enea. Aeieacaia oeaeaniia?aciinoue iaaeeeaiaioiciie e yiaeineiie/aneie oa?aiee eae iaoiaea auai?a i?e e?iaioa/aieyo ec ino?uo yca e y?icee e i?e neiae?iia Iaeei?e-Aaenna. ?ac?aaioaiu iiaeoiaeu i?ioeeaeoeee e oa?aiee na?aea/iuo ineiaeiaiee a iinoaaii??aae/aneii ia?eiaea. Ia iniiaaiee ioeaiee ?enea ?aoeeaeeaa e?iaioa/aiey e iia?aoeeiiiiai (na?aea/iiai) ?enea ?ac?aaioai aeai?eoi oaeoeee ea/aiey ycaaiiuo e?iaioa/aiee ia oiia na?aea/ii-ninoaeenoie iaoieiaee, ?aoaiey aii?ina i oeaeaniia?aciinoe iia?aoeee, aa iauaia e n?iea aeiieiaiey. Eeth/aaua neiaa: aeaeoaei/ii-eeoa/iua e?iaioa/aiey, ycaaiiay aieaciue, ino?ua ycau, y?iceaiue aano?eo, neiae?ii Iaeei?e-Aaenna, iia?aoeeiiiue ?ene, o?iie/aneay na?aea/iay iaaeinoaoi/iinoue. Summary Tumak I.M. Acute gastroduodenal bleeding in patients with chronical heart failure: features of clinical course and management.- Manuscript. Thesis for a Candidate’s Degree by Speciality 14.01.03. - Surgery. - Lviv State Danylo Halytsky Medical University of Health Ministry of Ukraine, Lviv, 1999. The thesis is devoted to problem of bleedings from peptic ulcer and acute gastroduodenal lesions in patients with chronic heart failure (CHF). The importance of this problem is linked to the fact that the persons with CHF make a large part (1/5) of all patients with bleedings from chronic ulcers, acute ulcerations, erosions, and Mallory-Weyss tears. This rate considerably exceeds prevalence of CHF in population. The patients with CHF prevail among those that have died after haemorrhages. It was established that greater volume of blood loss is characteristic for the patients with CHF. That is caused by the large ulcer size, system disturbances of homeostasis (severity of haemorrhage has independent associations with CHF presence), as well as ulcerative effect of a number of medicines used in cardiological practice. At the same time CHF is ethiological factor of acute lesions with haemorrhagic complications, determines their features: large sizes and gastric localization. Role of acute lesions among causes of bleedings in patients with CHF was significantly higher than in the control group. The carried out analysis has allowed to establish 23 significant predictors of poor prognosis for survival after bleeding. These can be divided into three groups: the characteristical features of ulcer, severity of haemorrhage and concomitant pathology, including CHF, severity of ischemic heart disease and arterial hypertension. By means of multivariate analysis it was established that only 4 predictors were independent: chronic heart and respiratory failure, rebleeding and large sizes of the ulcer. The strengthening and fatal decompensation of heart failure are the features of post-haemorrhagic and perioperative periods in the group of patients with CHF. These are the main factors of tanatogenesis in this group. By univariate analysis 16 significant predictors of rebleeding, including heart and respiratory failure, were established. Multivariate analysis has revealed independent predictors of rebleeding, among them large size of ulcer (2 cm and more), visible vessel or clot on ulcer base, severe blood loss (haemoglobin <70 g/l). Important predictive value of heart failure stages II-III (NYHA class 3-4) for rebleeding is linked to large size of ulcer and severity of bleeding in these patients. Two predictive scoring systems with sufficient sensitivity and specificity were proposed. It was proved that while majority of bleeding stopped spontaneously before hospitalisations, drug therapy and endoscopic treatment if needed are method of choice for majority of patients. Treatment with 3 and 4 generation I2-blockers and proton pump inhibitors significantly decreased rate of rebleeding, including CHF patients. This creates basis for more conservative treatment strategy in cases of high surgical risk. Except emergency operations during bleeding, the indications for surgical treatment are differentiated and take into consideration the probability of further bleeding and surgical, mostly cardiac risk. The newly developed tactical algorythm including combined usage of indexes of rebleeding prognosis and cardiac perioperative risk evaluation by Larsen score makes possible to optimize the treatment of patients with cardiac pathology and ulcer bleedings. Early operations under uncomplete homeostasis compensation are performed in case of high risk of rebleeding and moderate or low cardiac risk, elective operations after maximal homeostasis compensation and in the cases of unsatisfactory ulcer healing ( in moderate or low cardiac risk. The surgical treatment of the patients with CHF IIA stage should be performed preferably upon urgent life indications (resistant bleeding or rebleeding) by means of palliative surgery (excision or exteriorisation of ulcer) and further treatment with gastric secretion blockers and eradication of H. pylori. The indications for the surgical treatment of the patients with I stage CHF and without cardiovascular pathology don’t differ principally. Partial gastrectomy is main operation for elective surgery. Drug treatment and endoscopic treatment are methods of choice for management of patients with CHF 2B-3 (IV functional class NYHA). It was established that drug and endoscopic treatment are methods of choice for management of bleeding from acute lesions and Mallory-Weyss tear. At the same time the liquidation of tissue hypoxia and cardiac decompensation is necessary as removal of ethiological factors of acute lesions. Key words: gastroduodenal bleeding, peptic ulcer, acute ulcerations, erosive gastritis, Mellory-Weyss tear, operative risk, chronic heart failure. PAGE 1

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