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Хвороба Рейтера: імунологічні механізми розвитку та особливості діагностики: Автореф. дис… канд. мед. наук / М.Б. Джус, Ін-т фтизіатрії і пульмоноло

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?INOEOOO OOEC?AO??? ? IOEUeIIIIEIA??

?I. O.A. ssIIANUeEIAI

AEAAeAI?? IAAeE*IEO IAOE OE?A?IE

OAeE 616.72-002-022-056.3-092.19-07

Aeaeon Ia?oa Ai?en?aia

Oai?iaa ?aeoa?a: ?ioiieia?/i? iaoai?cie ?icaeoeo oa iniaeeaino?
ae?aaiinoeee

14.01.29. – ee?i?/ia ?ioiieia?y

Aaoi?aoa?ao

aeena?oaoe?? ia caeiaoooy

iaoeiaiai nooiaiy eaiaeeaeaoa iaaee/ieo iaoe

Ee?a– 1999

Aeena?oaoe??th ? ?oeiien.

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

Iaoeiaee ea??aiee:ae.i.i., aeioe. *ii’ye Aaeaioeia Aieiaeeie??aia,
Euea?anueeee aea?aeaaiee iaaee/iee oi?aa?neoao IIC Oe?a?ie, caa?aeoaa/
eaoaae?e ee?i?/ii? ?ioiieia?? oa aea?aieia??.Io?oe?ei? iiiiaioe:ae.i.i.,
i?io., *oiae Aiaoie?e Aiae??eiae/, Iaoeiaee oeaio? ?aae?aoe?eii?
iaaeeoeeie AII Oe?a?ie, caa?aeoaa/ a?aeae?eii ee?i?/ii? ?ioiieia??.

ae.i.i., i?io. Aaiaeaea ?ai? Ieoaeeiae/, Ee?anueea iaaee/ia aeaaeai?y
i?neyaeeieiiii? ina?oe ?i. I.E. Ooieea IIC Oe?a?ie, i?ioani?
eaoaae?e n?iaeii? iaaeeoeeie c eo?nii ee?i?/ii? ?ioiieia?? oa
aea?aieia??.

I?ia?aeia onoaiiaa: ?aaii-O?aie?anueea aea?aeaaia iaaee/ia aeaaeai?y IIC
Oe?a?ie,
eaoaae?a oaeoeueoaonueei? oa?ai??.

Caoeno a?aeaoaeaoueny “ 29 ” eenoiiaaea 1999 ?. i 14-00 aiaeei? ia
can?aeaii? niaoe?ae?ciaaii? a/aii? ?aaee Ae 26.552.01 i?e ?inoeooo?
ooec?ao??? ? ioeueiiiieia?? ?i. O.A. ssiianueeiai AII Oe?a?ie (03110, i.
Ee?a, INI – 03680, oca?c I?ioan?a y?, 7).

C aeena?oaoe??th iiaeia iciaeiieoenue o a?ae?ioaoe? ?inoeoooo ooec?ao???
? ioeueiiiieia?? ?i. O.A. ssiianueeiai AII Oe?a?ie (i. Ee?a, oca?c
I?ioan?a y?, 7).

Aaoi?aoa?ao ?ic?neaiee “ 25 ” aeiaoiy 1999 ?.

A/aiee nae?aoa?

niaoe?ae?ciaaii? a/aii? ?aaee Aaaioe?aa AE.A.

CAAAEUeIA OA?AEOA?ENOEEA ?IAIOE

Aeooaeuei?noue oaie

A inoaii? ?iee i?iaeai? ao?ieia??, iaoiaaiaco oa e?eoaaiith oai?iae
?aeoa?a (O?) oa ?ioeo ?aaeoeaieo a?o?eo?a o na?o? iaaeathoue aeoaea
aaeeeiai cia/aiiy a i?aeoe/i?e iaaeeoeei? (Aaaaaaiaa A.?., 1995; Eiaaeaa
TH.I., 1997; Svenungson B., 1995). Anoaiiaeaii a 90-o ?ieao cia/iee ??no
/anoioe caoai?thaaiino? ia O? (Eiaaeaiei A.I., 1996; Granfors K., 1998).
A?aeiii, ui 40% oaeeo iaoe??io?a ia? iiaoi?i? aoaee O? i?ioyaii ?ieo, a
na?eici? nenoaii? oneeaaeiaiiy (ea?ae?ieia?/i?, iaa?ieia?/i?)
niinoa??aathoueny a 3% oai?eo, nia?oi?noue – o 1% (Graham R., 1996).
Chlamydia trachomatis ? iniiaiith i?e/eiith caoai?thaaiue, o /enei yeeo
aoiaeeoue ? O?, ui aaaeooue aei aeieeiaiiy ?aaeoeaieo a?o?eo?a,
o?iaai?oaeueieo caiaeueieo i?ioean?a, o?aoiie (Aaiaeaea ?.I., 1997;
Quinn T., 1996). Oai?iaa ?aeoa?a noi?iaiaeaeo?oueny o?ii?/iei caiaeueiei
i?ioeanii, i?e yeiio /anoi ia aaea?oueny eoeueoeaoaaoe oeai?ae?? c
aiaieua caiaeaiiy. E??i oiai, i?e O? oaeiae aeyaeythoue ? ??n?i??,
eaii?eiaaeoa???, naeueiiiaee, o?aaee, no?aioieiee, noao?eieiee,
i?eiieacie oa a??one. Aea ana ae oeai?ae?eia ?ioaeoe?y ? aeii?ioth/ith
i?e O? ? ca ??cieie aeaieie ae?aaiinoo?oueny a 36 – 50% (Ianiiiaa A.I.,
1997; Granfors K., 1997; Schumacher H, 1998). Iacaaaeath/e ia oa, ui
caniae ae?aaiinoeee ? oa?ai?? oeai?ae?e oaia? noaee a?eueo aoaeoeaieie,
?iciianthaeaeai?noue oa oneeaaeiaiiy a ?acoeueoao? ?o aeoeaaoe??
i?iaeiaaeothoue ca?eueooaaoenue. O ?icaeiaieo e?a?iao /anoea
caoai?thaaiino? ia oeai?ae?ic o a?oiao ?eceeo neeaaea? ca aeaieie ??cieo
aaoi??a a?ae 11% aei 30% (Agacfidan A., 1998). Ca?oiaa noaoenoeea
?a?no?o? ui??/ii 333 iei. iiaeo aeiaaee?a caoai?thaaiue, ye?
ia?aaeathoueny noaoaaei oeyoii, ?c ieo ia oeai?ae?ic i?eiaaea? 89 iei.
(AIIC, 1995). Oae, a Oe?a?i? e?euee?noue in?a c aeyaeaiei oeai?ae?icii
noaiii ia 1998 ??e noaiiaeea 24150 oai?eo, ui a 2,8 ?ace ca?eueoeeinue
ii??aiyii c 1994 ?ieii. C?icoi?ei, ui c?inoaiiy oeai?ae?ico aaaea aei
cia/ii? caoai?thaaiino? ethaeae iieiaeiai a?eo ia O?.

Oiio aeooaeuei?noue i?iaeaie O?, iniaeeai a inoaii? aeanyoee?ooy,
coiiaeaia ye iaaee/ieie, oae ? nioe?aeueieie i?e/eiaie. Nioe?aeueiee
aniaeo iia’ycaiee c oei, ui oai??thoue, a iniiaiiio, ethaee iieiaeiai,
i?aoeacaeaoiiai a?eo, ui aaaea aei oaeaeei? ?iaae?aeecaoe?? oa coiiaeth?
?icaeoie aacie?aeaey. Iaaee/iee aniaeo i?iaeaie iieyaa? o a?aenooiino?
/?oeeo oyaeaiue i?i ao?ieia?th caoai?thaaiiy, eiai iaoiaaiac.
Oa?aeoa?ii, ui i?e O? /anoi aeyaey?oueny ?aoeeaeeaoaaiiy,
iai?iaiiciaaiee ia?aa?a, a?aenooi?noue aoaeoeaieo iaoiae?a e?eoaaiiy.

Ca’ycie ?iaioe c iaoeiaeie i?ia?aiaie, ieaiaie, oaiaie

Aeena?oaoe?y ? o?aaiaioii aea?aeaaii? iaoeiai-oaoi?/ii? i?ia?aie 02. 11
“Caoeno oa ?aaa?e?oaoe?y ?ioiii? nenoaie ianaeaiiy Oe?a?ie”. Aea?aeaaiee
?a?no?aoe?eiee iiia? – 2. 11/04102 – 97.

IAOA ? CAAAeAIIss IAOEIAIAI AeINE?AeAEAIIss

Iaoith ?iaioe aoei aea/aiiy ao?ieia?/ieo oaeoi??a oa ?ioiieo iaoai?ci?a
o ?icaeoeo O? oa ?o aca?iica’yce?a ?c ee?i?/ieie iniaeeainoyie O?.

Aeey aeinyaiaiiy iinoaaeaii? iaoe ae??ooaaeenue oae? caaaeaiiy:

1) anoaiiaeoe iniaeeaino? e?ioioeeoa?ieo, aioeo?eicaeaaeieo oa
ianiaoeeo?/ieo oaeoi??a ?ioiieia?/ii? ?aaeoeaiino? a oai?eo ia O?;

2) ii??aiyoe ?ioiieia?/i? iieacieee a oai?eo ia O? c iiceoeaiei oa
iaaaoeaiei HLA-B27 aaiioeiaie;

3) aeine?aeeoe i?noeaa? oa nenoaii? ia?ea?e ??cieo ?ioaeoe?e o oai?eo ia
O?;

4) ioe?ieoe oa?aeoa? ?ioiieia?/ieo ci?i o caeaaeiino? a?ae aeyaeaii?
?ioaeoe??, o?eaaeino?, ee?i?/ii? neiioiiaoeee, aeoeaiino? oa e?eoaaiiy
oai?eo ia O?.

IAA?OIOOAAIIss IAOEIAI? IIAECIE AeINE?AeAEAIIss, EIAI OAI?AOE*II? OA
I?AEOE*II? Oe?IIINO?

Iaoeiaa iiaecia ?iaioe iieyaa? a oiio, ui aea/aii aca?iica’ycie O? c
??cieie ?ioaeoe?eieie anioe?aoe?yie, aia?oa cai?iiiiiaaii ?icai?iooo
ee?i?ei-eaai?aoi?io ?ioiieia?/io ioe?ieo aeoeaiino? O?, aeine?aeaeaii
aieea ?ioiieia?/ieo ee?oeiieo oa aoii?aeueieo iaoai?ci?a ia ?icaeoie O?,
aeyaeaii ei?aeyoe?? ?ioiieia?/ieo iieaciee?a c o?eaae?noth oai?iae,
ee?i?/ieie i?iyaaie oa c ao?ieia?/ieie oaeoi?aie, anoaiiaeaii
iniaeeaino? ?ioiieia?/ieo iieaciee?a o HLA-B27- iiceoeaieo oa
HLA-B27-iaaaoeaieo oai?eo ia O?.

I?aeoe/ia cia/aiiy ?iaioe

Aeey i?aeoe/ieo e?ea??a ii?aoeueiaai? iieiaeaiiy aeena?oaoe??
aeicaieythoue:

1. Iie?aueoe niaoeeo?/io ae?aaiinoeeo O?.

2. Aecia/eoe aeoeai?noue O? ia iniia? ee?i?/ieo oa ia?aee?i?/ieo
?ioiieia?/ieo iieaciee?a.

3. Iaa?oiooaaoe iaoiaaiaoe/io iaiao?aei?noue canoinoaaiiy
i?ioe?ioaeoe?eii? oa ?ioiio?iiii? oa?ai?? a oai?eo ia O? ia iniia?
?iaeea?aeoaeueiiai i?aeoiaeo.

?acoeueoaoe ?iaioe ai?iaaaeaeai? a oa?aiaaoe/iiio a?aeae?eaii?
Euea?anueei? iaeanii? ee?i?/ii? e?ea?i?, Euea?anueeiio iaeaniiio
ae?aaiinoe/iiio oeaio??, a ?aaiaoieia?/ieo a?aeae?eaiiyo Aieeinueei?
iaeanii? ee?i?/ii? e?ea?i? oa Eooeueei? i?nueei? ee?i?/ii? e?ea?i?.
Aeaeai? ?ioi?iaoe?ei? eenoe: “Iaoiae aecia/aiiy aeoeaiino? oai?iae
?aeoa?a” oa “Iaoiae oi?ioethaaiiy ae?aaiico oai?iae ?aeoa?a”.

Iniaenoee aianie caeiaoaa/a a ?ic?iaee aeena?oaoe??

Ee?i?/iee i?aea?? oai?eo, ee?i?ei-eaai?aoi?i? noaie ianoaaeaiue,
eiinoeueoaoe?ei? aeniiaee oa i?ecia/aiiy niaoeeo?/ii? oa?ai?? i?iaiaeeea
naiino?eii. E??i oiai, naiino?eii eo?oaaea a?eueo?noue noaoe?iia?ieo
oai?eo, ai?iaaaeaeoaaea i?aeoe/i? ?aeiiaiaeaoe?? aeena?oaoe?? a ?iaioo
a?aeae?eaiue. Aaeeeo aeiiiiiao a iaai?? ee?i?/iiai iaoa??aeo iaaeaee
i?io. Aeaianueeee A.I., ae.i.i. aeioe. Aa?aaaiiae/ I.I., Neiaiueea
I.TH., ca ui ?i ue?i aaey/ia.

?ioiieia?/i? aeine?aeaeaiiy i?iaiaeeeenue o eaai?aoi??yo a?aeae?eaiiy
o?ii?/iiai aaiiae?ae?co oa ia?anaaeee ie?ie Euea?anueei? iaeanii?
ee?i?/ii? e?ea?i?, Euea?anueeiai iaeaniiai ae?aaiinoe/iiai oeaio?o
(?ioiioa?iaioi? oa ?ioiio?i?/i?), Euea?anueei? iaeanii? niaoe?ae?ciaaii?
aeeoy/i? e?ea?i? (oeeoioethi?iiao?e/i?, ?ioiioa?iaioi?, ?ioiio?i?/i?).
Naiino?eii aecia/aea iayai?noue oeai?ae?eiiai aioeaaio ?ioiioa?iaioiei
iaoiaeii, a?aea o/anoue o aeine?aeaeaii? noaiiioeyoe?e e?ioioeeo?a
iaoiaeii i?ioi/ii? oeeoiiao??? ca aeiiiiiaith iiiieeiiaeueieo aioeo?e.
?ioiieia?/i? aeine?aeaeaiiy aaciina?aaeiuei aeeiioaaee e.i.i. Iao?oo
A.A., e.a.i., no.i.i. Aaa?eethe A.I., e?ea?? eaai?aioe Ii?ioianueea
C.N.,*o?anueea O.I., ca ui ue?i ?i aeyeoth.

On? oai?? aoee ianoaaeai? ia aac? eaoaae?e i/ieo oai?ia Euea?anueeiai
aea?aeaaiiai iaaee/iiai oi?aa?neoaoo c iiaeaeueoei oeeoieia?/iei
aeine?aeaeaiiyi c?oe?yao c eii’thieoeae. I?e?ia?ieia?/i? aeine?aeaeaiiy
aeeiiai? ia aac? Euea?anueeiai IAe? ai?aeai?ieia?? oa a?a??ie, eaoaae?e
i?e?ia?ieia?? Euea?anueeiai aea?aeaaiiai iaaee/iiai oi?aa?neoaoo oa
Euea?anueeiai iaeaniiai ae?aaiinoe/iiai oeaio?o. Ca ni?eyiiy a
i?iaaaeaii? iaoiaeee ue?i aeyeoth ae.i.i., aeioe. Aeiia?aae I.?. oa
eieaeoeao eaai?aoi???.

Naiino?eii ii?aoeueiaoaaea aeei?enoaio e?oa?aoo?o, i?iaiaeeea
noaoenoe/i? aeine?aeaeaiiy, ?ic?iaeyea oaaeeoe? oa ?enoiee, aiae?coaaea
iaoa??ae.

On?i eieaaai, ye? aeiiiiaaaee iai? aeeiioaaoe ?iaioo, aeneiaethth naith
na?aea/io aaey/i?noue.

Ai?iaaoe?y ?acoeueoao?a aeena?oaoe??

Iniiai? iieiaeaiiy aeena?oaoe?? neooaee oa iaaiai?thaaee ia can?aeaii?
iaeaniiai oa?aiaaoe/iiai (Euea?a, 1996) oa iooaeueiieia?/iiai oiaa?enoa
(Euea?a, 1995), ia can?aeaiiyo eaoaae? oieoaeueii? oa?ai?? (Euea?a,
1997) ? ee?i?/ii? ?ioiieia?? oa aea?aieia?? (Euea?a, 1999) Euea?anueeiai
aea?aeaaiiai iaaee/iiai oi?aa?neoaoo. ?acoeueoaoe aeena?oaoe??
aeiiia?aeaeenue ia ianooiieo a?o/eciyieo ? ca?oa?aeieo c’?caeao oa
eiioa?aioe?yo: I?aeia?iaeiee Eiia?an iieiaeeo a/aieo oe?a?ioe?a
(?aaii-O?aie?anuee, 1995); 3-rd ?nternational congress on heart failure
– mechanisms and management (Geneva, Switzerland, 1995); VIII Zjazd
Polskego Towarzystwa Immunologicznego (Wroclaw, 1995); II Oe?a?inueea
iaoeiai-i?aeoe/ia eiioa?aioe?y c i?aeia?iaeiith o/anoth – Aeooaeuei?
i?iaeaie ee?i?/ii? ?ioiieia?? (Euea?a, 1996); OIV c’?cae oa?aiaao?a
Oe?a?ie (Ee?a, 1998); IUSTI European Congress 1998 on STDs and Genital
Dermatology (Goteborg, Sweden, 1998).

Ioae?eaoe??

?acoeueoaoe aeena?oaoe?? iioae?eiaai? a 12 ae?oeiaaieo aeaeaiiyo, ?c ieo
– 8 o iaoeiaeo iaaee/ieo a?o/eciyieo oa ca?oa?aeieo aeo?iaeao, 4 – a
iaoa??aeao oa oacao a?o/eciyieo oa ca?oa?aeieo eiioa?aioe?e. Aaoi?
aeionoeea aeaa ?ioi?iaoe?ei? eenoe.

Ianya oa no?oeoo?a aeena?oaoe??

Aeena?oaoe?eia ?iaioa neeaaea?oueny c? anooio, iaeyaeo e?oa?aoo?e, 5
?icae?e?a aeanieo aeine?aeaeaiue, aeniiae?a, i?aeoe/ieo ?aeiiaiaeaoe?e,
nieneo aeei?enoaii? e?oa?aoo?e. ?iaioa aeeeaaeaia ia 132 noi??ieao,
?ethno?iaaia 21 oaaeeoeyie, 17 ?enoieaie. Nienie e?oa?aoo?e ioiieth? 213
aeaea?ae.

INIIAIEE CI?NO

Iaoa??aee oa iaoiaee aeine?aeaeaiue

Iaie aoei i?iaaaeaii ee?i?ei-eaai?aoi?ia oa ?ino?oiaioaeueia ianoaaeaiiy
78 iaoe??io?a ?c O?, ye? caa?oaeenue ca iaaee/iith aeiiiiiaith a
Euea?anueeo iaeanio ee?i?/io e?ea?ith, 4-oo i?nueeo e?ea?ith i. Eueaiaa,
Euea?anueeee iaeaniee ae?aaiinoe/iee oeaio? oa a?enueeiaee oieoaeue o
ia??iae c 1993 ii 1998 ?.?. Na?aae ianoaaeaieo oai?eo aoei 63 /ieia?e?a
(81,8%) ? 15 ae?iie (18,2%). Ia?aaaaeia a?eueo?noue iaoe??io?a (62,8%)
iaea a?e a?ae 20 aei 40 ?ie?a, a o?eaae?noue caoai?thaaiiy a a?eueoino?
oai?eo (44,9%) noaiiaeea a?ae 12 aei 60 i?n. Caaaeueio eiio?ieueio a?oio
ca ?ioiieia?/ieie ia?aiao?aie neeaaeaee 30 caei?iaeo in?a a?aeiia?aeiiai
a?eo oa noao?.

O an?o iaoe??io?a cae?aany aaiaaeia?/iee aiaiiac ca ioeueiaei, ia?oei oa
ae?oaei ??aiai.

Oai?ei i?iaiaeeee oa?iia?ao?/i? aeine?aeaeaiiy ia aia?ao? “?aaeoaa – IO”
c eiii’thoa?iei aeiaeaoeii. I?ney aaciina?aaeiuei? a?coaeueii? ioe?iee
noaeia?a i?ae?aoiaoaaee /enei aoyaiaieo o caiaeueiee i?ioean noaeia?a oa
aecia/aee aaee/eio oa?iianeiao??? (??cieoey oaiia?aoo?e ciie
i?aeaeuaiiai aei?ii?iaiiy iaaeieeoi?ie oeaieiaie ? neiao?e/ieie
noaeiaaie).

Aeey anoaiiaeaiiy o?eaa?ieo oaeoi??a noaoaaeo o?aini?neaieo
caoai?thaaiue, ye? ? i?ia?aeieie /eiieeaie a aeieeiaii? oai?iae ?aeoa?a,
aoei aeei?enoaii ieceo aaeoa??ieia?/ieo, a??onieia?/ieo oa na?ieia?/ieo
iaoiae?a aeine?aeaeaiiy. Iaoa??aeii aeey aeyaeaiiy oeai?ae?e oa ?o
aioeaai?a a o?aaeaieo ee?oeiao aoee c?oe?yae c? neeciaeo iaieiiie
na/iaea?aeiiai eaiaeo, oeeee iaoee oa neeciaeo i/ae. Aeey aeyaeaiiy
oeeoiieaciaoe/ieo aeeth/aiue oeai?ae?e aeei?enoiaoaaee oa?aoaaiiy ca
iaoiaeii ?iiaiianueeiai-A?ice. Aeaoaeoe?th oeai?ae?eieo aioeaai?a
i?iaiaeeee ?ioiioa?iaioiei iaoiaeii ca aeiiiiiaith oano-nenoaie
“Surecell Chlamydia” (“Kodak”, Aiae?y), c iiiieeiiaeueieie aioeo?eaie,
niaoeeo?/ieie aei oeai?ae?eiiai LPS aioeaaio. Oeai?ae?ei? aioeo?ea eeano
IgG a ne?iaaoeao iaoe??io?a aecia/aee ca aeiiiiiaith iaai??a “Platelia
Chlamydia IgG“ (“Sanofi Paster Diagnostics”, O?aioe?y) ia iniia?
oaa?aeioaciaiai ?ioiioa?iaioiiai aiae?co oa a ?aaeoe?? iai?yii?
i?e?i?ioiioethi?anoeaioe??. ?ioiioa?iaioiei iaoiaeii oaeiae aeyaeyee
iayai?noue aioeaaio a??ona aa?iano 2 oeio iaai?aie “HerpELISA Ag”
(“Savyon Diagnostics Ltd.”, ?c?a?eue) oa iai?oaeai?noue ?ioi?oaoo aei
oeeoiiaaaeia??onii? ?ioaeoe?? ca ??aiai aioe-NIV IgG aioeo?e o
ne?iaaoeao oai?eo (“Roche”, Oaaeoea??y).

Ao?ieia?/io ?ieue eeoeiaeo iaoiaai?a (Yersinia enterocolitica, Shigella
flexneri, Shigella sonnei oa Salmonella) ioe?ithaaee ca iayai?noth
niaoeeo?/ieo aioeo?e o ne?iaaoeao oai?eo, ye? iaee a aiaiiac? ae?a?aeiee
neiae?ii, c a?aeiiaiaeieie aioeaaiieie a?eo?ioeeoa?ieie ae?aaiinoeeoiaie
a ?aaeoe?? iai?yii? aaiaaethoeiaoe?? (?IAA).

Aaeoa??aeueiee niaeo? caoaeiee?a iaaiiieieiaeo o?ao?eo?a (noao?eieiee,
no?aioieiee, eeoeiaa iaee/ea oa ?i.) anoaiiaethaaee, aeei?enoiaoth/e
caiaoaioiaaiee iaeii?aciaee i?eno??e “Diaslide” aeey aaeoa??ieia?/iiai
eoeueoeaoaaiiy iaoa??aeo, caa?aiiai c o?ao?e (“Savyon Diagnostics Ltd.”,
?c?a?eue).

Mycoplasma hominis oa Ureaplasma urealiticum aecia/aee oeyoii aianaiiy
iaoa??aeo c o?ao?e aai oea?a?eaeueiiai eaiaeo a o?ainii?oia na?aaeiaeua,
yea aoiaeeoue o neeaae oano-iaai?o “Mycoplasma DUO” (“Sanofi Pasteur”,
O?aioe?y).

Aeey ioe?iee ?ioiiiai noaoono ethaeeie aeei?enoiaoaaee iaoiaee,
?aeiiaiaeiaai? AIIC, aeey anoaiiaeaiiy ??aiy ? nooiaiy ii?ooaiiy ?ioiieo
ooieoe?e i?e aeec?aaoeyoi?ieo ?ioiiaeao?oeeoieo noaiao, aooi?ioiieo,
aea?a?/ieo oa ?ioaeoe?eieo oai?iaao, aeey i?iaiico i?io?eaiiy oa
eiio?ieth ca e?eoaaiiyi (Aai?ia A.I., 1990).

Aecia/aee oae? ee?oeii? ?ioiieia?/i? ia?aiao?e: oaaioeeoa?iee iieaciee,
“?aii?e” oa “i?ci?e” oaaioeeoic, ?iaeaen eiai aeoeaiino? (*a?iooaiei
E.O. ? ni?aaao., 1988), aaniethoio oa a?aeiinio e?euee?noue e?ioioeeo?a,
O-e?ioioeeoe (A-?OE), A-e?ioioeeoe (AAN-?OE), noaiiioeyoe?? e?ioioeeo?a
(Aa, O-, O-), a oaeiae ?iaeaene ?ioiii? a?aeiia?ae?: ?aaoeyoi?iee oa
aoaeoi?iee (*???ae??a A.I., 1976). Iaoiaeii i?ioi/ii? oeeoiiao???
aeyaeyee CD3+-, CD4+-, CD8+-, CD20+-, CD16+-e?ioioeeoe,
CD-HLA-B27+-ee?oeie. ?ioiioaiioeioaaiiy noaiiioeyoe?e e?ioioeeo?a
i?iaiaeeeiny ca aeiiiiiaith iaai?o a?aeiia?aeieo iiiieeiiaeueieo aioeo?e
(“Becton Dickenson”, NOA) oa iiiieeiiaeueieo aioeo?e aei aioeaaio
HLA-B27, i?/aieo oethi?anoea?i?cio?ioe?aiaoii (“One Lamba”, NOA).

Oee?eoethth/? ?ioii? eiiieaene aecia/aee iaoiaeii i?aoeei?oaoe?? a
iie?aoeeaiae?eie? (I=6000) c eiioeaio?aoe??th 2,75 % niaeo?ioioiiao?e/ii
(Ineiia N.A. ? ni?aaao., 1983). ?ioiiaeiaoe?ie eean?a I, G, A
aeine?aeaeoaaee iaoaeiiao?e/iei iaoiaeii o ne?iaaooe? e?ia? ca
noaiaea?oiith iaoiaeeeith c aeei?enoaiiyi iiiiniaoeeo?/ieo aioene?iaaoie
aei ?o iniiaieo eean?a, a eiiieaiaioa?io aeoeai?noue ne?iaaoee e?ia? –
oioieiei?eiao?e/ii (*a?iooaiei E.O. ? Eiainiaa E.N., 1981).

Iieacieee ianiaoeeo?/ii? ?acenoaioiino? aeeth/aee aecia/aiiy
N-?aaeoeaiiai i?ioa?io (N?I) – eaoaen oanoii, OIA – iaoiaeii
inaaeaeaiiy, i?ioa?iia?aie – iaoiaeii aeaeo?ioa?aco.

On? ianoaaeai? oai?? aoee ?icae?eai? ia oae? a?oie:

1) ca o?eaae?noth caoai?thaaiiy: aei 1 ?ieo – 22 oai?eo, 1 – 5 ?ie?a –
34 oai?eo, a?eueoa 5 ?ie?a – 21 oai?eo;

2) ca ia?aaaaeaiiyi o ee?i?oe? iaaieo neiae?ii?a O?: oao?aaea – 17
oai?eo, o??aaea – 38 oai?eo, iaiiaia O? – 23 oai?eo;

3) ca aeyaeaiiyi HLA-B27 aioeaaio ia ee?oeiao e?ia?: HLA-B27-iiceoeai? –
22 oai?eo, HLA-B27-iaaaoeai? – 30 oai?eo;

4) ca aieeaii e?eoaaiiy ia oai?eo O?: aei e?eoaaiiy – 58 oai?eo, i?ney
e?eoaaiiy – 58 oai?eo.

Oai?ei ia O? i?iaiaeeeanue ianooiia aaciaa oa?ai?y caeaaeii a?ae
ao?ieia?? O?. Aeaaaeoeyoueii oai?ei i?ecia/aee aioea?ioeee
oao?aoeeee?iiaiai ?yaeo i?ioyaii 1 i?nyoey. Iae?ie?aee canoiniaoaaee a
20 oai?eo i?ioyaii 3 i?nyoe?a, a iaoe??ioai c a??oniith ?ioaeoe??th,
e??i oiai, i?ecia/aee ??ci? aeaee aeueoa-?ioa?oa?ii?a. *anoeio oai?eo
(18 in?a), a iniiaiiio c aioa?ieie?oe/ieie i?iyaaie, e?eoaaee
naeacii??eaeaceiii. O oyaeeeo aeiaaeeao, eiee ia aeiiiiaaaea aaciaa
oa?ai?y a eiia?iaoe?? c ianoa?i?aeieie i?ioecaiaeueieie caniaaie, aei
e?eoaaiiy aeiaeaaaee ai?iiiaeuei? i?aia?aoe, a a iaeiiio – aeei?enoaii
oeeoinoaoeee.

?acoeueoaoe aeine?aeaeaiiy ii?aoeueiaoaaeeny ia IBM PC ca aeiiiiiaith
nenoaie ea?oaaiiy aacaie aeaieo 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 ? 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 e?eoa???a – iaoiae Kendall.

Iniiai? ?acoeueoaoe aeine?aeaeaiue

I?iaaaeai? i?ioyaii i’yoe ?ie?a ee?i?/i?, eaai?aoi?i? oa
?ino?oiaioaeuei? aeine?aeaeaiiy aeicaieeee aeae?eeoe 78 oai?eo, o yeeo
ae?aaiinoiaaii O? ia iniia? eeaneo?eaoe?eieo e?eoa???a Aia?eeainueei?
anioe?aoe?? ?aaiaoieia?a (1995). Aiae?c ee?i?/ieo niinoa?aaeaiue ca
oai?eie ia O? iieacaa, ui c ieo o 59 (75,6%) cono??/aeenue o?aaeaiiy
iii?ii-?ooiaiai aia?aoo: a 41% oai?eo aoei aeyaeaii a?o?eo, o 26% oai?eo
– iaeiia?/iee nae?i?ea?o, o 22% oai?eo – ao?eiaeai?o oa a 11% oai?eo –
i’yoeia? oii?e. O 61% oai?eo ia?aaaaeaee I oa II nooiai?
ooieoe?iiaeueii? iaaeinoaoiino? noaeia?a.

O 62 (80,5%) oai?eo aoei a?aei?/aii a aiaiiac? aai ia iiiaio
niinoa?aaeaiiy o?aaeaiiy na/inoaoaai? nenoaie, na?aae yeeo o?ao?eo aoa
ae?aaiinoiaaiee o 41 (66,1%) oai?iai, i?inoaoeo – o 17 (35,4%) oai?eo
/ieia?e?a, oeenoeo – o 9 (14,5%) oai?eo, aaeiaeneo – o 4 ae?iie (26,6
%).

I?e iooaeueiieia?/iiio ianoaaeaii? a 45,5% oai?eo aoei aeyaeaii
eii’thieoea?o, o 10,9 % – oaa?o, o 9,1% – ??eaeioeeee?o, a a iaeiiai
oai?iai, aiane?aeie oaeaeeiai i?ia?anoaaiiy caoai?thaaiiy, ianooieea
iiaia ao?aoa ci?o.

Aioa?ieie?o, yeee aeiee ca aeae?eueea oeaei?a ia?aae ii/aoeii
caoai?thaaiiy aai i?ney ii/aoeo oai?iae, niinoa??aaany a 26,3% oai?eo.

Oe??i? o?aaeaiiy i?e O? aoei aeyaeaii a 35 in?a (46,1%), ye?
i?iyaeyeenue ionooeueicieie, aaii?aa?/ieie aai aeaii?aa?/ieie
aeneiaiiyie, ea?aoiaea?i??th, a?ia?ea?aoicii oa e?eueoeaaei aaeai?oii. O
12,3% iaoe??io?a niinoa??aaany ae?aceiaee noiiaoeo.

Iao? aeai? a?aeiia?aeaee a?eueoino? ee?i?/ieo oa iaoeiaeo iia?aeiieaiue
?c i?eaiaeo O? (Lichtman S., 1995; Svenungson B., 1995). O oie aea /an
ee?i?/i? ?acoeueoaoe iaoeo niinoa?aaeaiue aeaui a?ae??ciythoueny a?ae
aeaieo Willkens R. et al. (1991). Oae, o iaoeo oai?eo noaeiaiaee
neiae?ii cono??/aany a 75,6%, na/inoaoaaee – 80,5 %, i/i? neiioiie –
45,5%, oe??i? i?iyae – 46,1%, aioa?aeuei? – 26,3%. Ca Willkens R. et
al., noaeiaiaee neiae?ii niinoa??aaany a 90 %, na/inoaoaaee – o 85%,
i/iee – 57%, oe??iee – 49%. Aeaye? ?ica?aeiino? a noaeiaiaiio ?
iooaeueiieia?/iiio neiae?iiao iiaeia iiynieoe aeineoue aeaoaeueieie
iaoeie ee?i?/ieie ianoaaeaiiyie noaeia?a, a oaeiae iniaeeaith
iaoiaeeeith aeine?aeaeaiiy i?aaio ci?o, cai?iiiiiaaiith eaoaae?ith
iooaeueiieia?? Euea?anueeiai aea?aeaaiiai iaaee/iiai oi?aa?neoaoo, ui
caaacia/eei iai a?eueoee a?aenioie a?aeiia?aeieo neiae?ii?a i?e O?.
Io?eiai? iaie ee?i?/i? ?acoeueoaoe a?ae??ciythoueny a?ae aeaieo Silveira
L. et al. (1993), ye? niinoa??aaee eii’thieoea?o eeoa a 29,8% oai?eo,
aeeco?e/i? yaeua – a 31,3% oa oe??i? o?aaeaiiy – a 9%. Oaeaeoa anueiai,
oeth a?aei?ii?noue iiaeia iiynieoe oei, ui a eaoaai??th “i/i? neiioiie”
ie aeeth/aee ia eeoa eii’thieoea?o, a e ??eo, ??eaeioeeee?o, oaa?o oa
ai?neea?eo, a a eaoaai??th “na/inoaoaa? i?iyae” – ia o?eueee aeeco?e/i?
yaeua, a e o?ao?eo, oeenoeo, i?inoaoeo, aaeai?o.

Oa?aeoa?ii, ui a a?eueoino? iaoe??io?a (50,1%) aoei aeyaeaii o??aaeo
oai?iae ?aeoa?a, oiae? ye oao?aaeo O? aoei ae?aaiinoiaaii a 21,7%, a
iaiiaio O? – a 28,2%. I?e aiae?c? ee?i?/ieo iieaciee?a caeaaeii a?ae
o?eaaeino? O?, neiae?iiaeueieo i?iya?a oa ae?? e?eoaaiiy aeyaeaii, ui c?
ca?eueoaiiyi o?eaaeino? caoai?thaaiiy c?inoa? e?euee?noue ee?i?/ieo
i?iya?a o?ao?eoo (?2
aiae.Aaee01234A?ia?ai?y noaeia?aiaia?iacia/iaiii??iaAe?aaeaiacia/ii
ae?aaeaiaAaee01234Noaeiaiaee ?iaeaen,
aaee0-56-1415-2526-30>31Aaee0-11234E?euee?noue i?eiooeeo
noaeia?aiaia?12-45-7>8Aaee01234O?aaeaiiy
i/aeiaia?iacia/i?iii??i?Ae?aaeai?cia/ii ae?aaeai?Aaee01234O?iaai?oaeuei?
i?iyaeiaia?iacia/i?iii??i?Ae?aaeai?cia/ii ae?aaeai?Aaee01234Oe??i?
i?iyaeiaia?iacia/i?iii??i?Ae?aaeai?cia/ii ae?aaeai?Aaee01234OIA,
ii/aiae51Aaee0-11234N-?I-++++++++++Aaee012342-aeiaoe?
ieaei 10,0%aei 12,0%aei 14,0%aei 16,0%>16,0%Aaee01234

Ioe?iea oeeo iciae o aaeao aeaea i?aenoaae aeey a?eueo /?oeiai oa
?iaeea?aeoaeueiiai aecia/aiiy nooiaith aeoeaiino? O?: aei 2 aae?a –
a?aenooiy aeoeai?noue (0 nooi?iue), 3-10 – i?i?iaeueia ( I no.aeo.), 11
– 20 – na?aaeiy (II no. aeo.), 21 – 30 – aaeeea (III no. aeo.), 30 ?
a?eueoa – iaeneiaeueia (IV no. aeo.). Ia iniia? io?eiaieo ?acoeueoao?a
iaie aoee aeae?eai? oae? a?oie oai?eo caeaaeii a?ae aeoeaiino? O?: ia?oa
a?oia – I no. aeoeaiino? (25 oai?eo), ae?oaa a?oia – 29 oai?eo c II no.
aeoeaiino? oa o?aoy a?oia – 18 oai?eo c III-IV no. aeoeaiino?.

Oaea aaeueia nenoaia aeaea iiaeeea?noue ?ic?iaeoe /?oe? e?eoa???, ye? a
oa?aeoa?ecoaaee nooi?iue aeoeaiino? O? aeey ia’?eoeaiiai aecia/aiiy
ee?i?/iiai noaoono iaoe??io?a. O iiaeaeueoiio aiia aeicaieeea
?aaeaiaiooaaoe ?ioaineai?noue oa o?eaae?noue aaciai? oa?ai??, a oaeiae
ioe?ieoe ?? aoaeoeai?noue.

A inoaii? ?iee aeoeaii aea/athoueny i?e/eie O?. O ca’yceo c oeei ie
iaiaaaeenue ioe?ieoe oeyoii niaoeeo?/ieo ?ioiieia?/ieo oa
i?e?ia?ieia?/ieo ianoaaeaiue /anoioo aeyaeaiiy oeai?ae?eii? oa ?ioeo
?ioaeoe?e ye i?e/eiieo oaeoi??a O? a ianoaaeaieo iaie oai?eo. Oae, ca
aeiiiiiaith ?ioiioa?iaioiiai iaoiaeo ie aeyaeee LPS-niaoeeo?/iee
oeai?ae?eiee aioeaai o 38% oai?eo ia O?, a aenie? ??ai? niaoeeo?/ieo
aioeoeai?ae?eieo aioeo?e o ne?iaaoeao e?ia? oai?eo ca aeiiiiiaith
?ioiioethi?anoeaioiiai oa ?ioiioa?iaioiiai iaoiae?a – o 58% oai?eo.

I?e oeeoieia?/iiio ianoaaeaii? a iaoe??io?a aeyaeaii ??ci? anioe?eiaai?
?ioaeoe?? ii?yae c oeai?ae?eiith: Neisseria gonorrhoea – a 9%,
Trichomonas vaginalis – 16%, Ureaplasma urealiticum – 22% oa Mycoplasma
hominis – 3%. Oiiaii-iaoiaaii? i?e?ii?aai?cie na/inoaoaaiai o?aeoo
oai?eo, aen?yi? a iaoiaaiieo e?eueeinoyo (oeo? 1000 EOI/ie): no?aioieiee
(17%), noao?eieiee (15%), E.coli (8%) oa Candida albicans (10%). O 34%
oai?eo caoai?thaaiiy noi?iaiaeaeoaaeinue na?ieia?/iith ?aaeoeaaoe??th
aa?iaoe/ii? ?ioaeoe?? c aenieei ??aiai niaoeeo?/ieo IgG (i?e/iio a 18%
oai?eo oea aoei i?aeoaa?aeaeaii iiceoeaieie aioeaaiieie ciao?aeeaie a
c?oe?yaao o?ao?e oa oea?a?eaeueiiai eaiaeo). Anioe?aoe?y oeai?ae?eii?
?ioaeoe?? c aa?iaoe/iith a??oniith aoea aeyaeaia a 47%. E??i oiai, a 10
oai?eo (8%) ?c neiae?iiii aioa?ieie?oo a aiaiiac? aoei aen?yii
Salmonella enteritidis, Shigella sonne?, Shigella flexneri ? ??n?i??.
Io?eiai? aeai? iaei /ei a?ae??ciythoueny a?ae iia?aeiieaiue Svenungson
B. at al. (1995). A?i niinoa??aaa aneiioiiaoe/i? o?eaa?i? ?ioaeoe?? a
10-25% oai?eo ?c iinoaioa?e/iith O? oa aei 40% – c iinoaaia?e/iith O?.
Io?eiai? iaie ?acoeueoaoe ni?aiaaeathoue ?c aeaieie Silveira L. et al.
(1993) a oiio, ui oai?? ia O? c oeai?ae?eiith ?ioaeoe??th iathoue
oyae/ee ia?aa?a oa oaeaeoo o?ii?caoe?th iaoieia?/iiai i?ioeano. Oai?? c
iayai?noth oeai?ae?eieo aioeaai?a oa i?aeaeuaieo ??ai?a aioeo?e nooo?ai
ia a?ae??ciyeenue ca a?eii, o?eaae?noth caoai?thaaiiy, e?euee?noth
o?aaeaieo noaeia?a, aeoeai?noth oai?iae oa ca ee?i?/ieie i?iyaaie ?
ianiaoeeo?/ieie iieacieeaie caiaeaiiy a?ae oai?eo c
aioa?iaaeoa??aeueieie ?ioaeoe?yie.

Aeii?ioth/eie iaoai?ciaie a ?icaeoeo O? ? ?ioiicaeaaei? i?ioeane:
?ioiiaaiaoe/i?, ?ioiicaiaeuei? oa aooi?ioii?, ye? aai noai?ththoue
ni?eyoeeaee a?oio aeey iai?oanoaoe?? niaoeeo?/ii? ?ioaeoe??, aai ?
ai?oaiiiaiii aieeao ?ioaeoe?e ia ?ioiio nenoaio oai?iai.

O iao?e ?iaio? aeoeaiooaaeany oaaaa ia ioe?ioe? e?ioioeeoa?ieo
?ioiieia?/ieo iieaciee?a oai?eo ia O?, ?o ei?aeyoe?? c o?eaae?noth,
ee?i?/ieie i?iyaaie oa aeoeai?noth i?ioeano. Anoaiiaeaii, ui a oai?eo ia
O? ca?eueoo?oueny /enei CD22+-e?ioioeeo?a (?

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