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Інтенсивна терапія ревматичних захворювань з аутоімунним та імунокомплексним механізмом розвитку: Автореф. дис… канд. мед. наук / Г.О. Проценко, Укр

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I?I?NOA?NOAI IOI?IIE CAeI?IA’ss OE?A?IE

Oe?a?inueeee iaoeiai-aeine?aeiee ?inoeooo ea?ae?ieia?? ?i. aeaae.
I.Ae.No?aaeanea

I?IOeAIEI AAEEIA IEAENAIAe??AIA

OAeE: 616-002.72-085:612.017

?IOAINEAIA OA?AI?ss ?AAIAOE*IEO CAOAI?THAAIUe C AOOI?IOIIEI OA
?IOIIEIIIEAENIEI IAOAI?CIII ?ICAEOEO

14.01.12 – ?aaiaoieia?y

AAOI?AOA?AO

aeena?oaoe?? ia caeiaoooy iaoeiaiai nooiaiy

eaiaeeaeaoa iaaee/ieo iaoe

Ee?a – 1999

Aeena?oaoe??th ? ?oeiien.

?iaioa aeeiiaia a Oe?a?inueeiio iaoeiai-aeine?aeiiio ?inoeooo?
ea?ae?ieia?? ?i.aeaae.I.Ae.No?aaeanea IIC Oe?a?ie.

Iaoeiaee ea??aiee: aeieoi? iaaee/ieo iaoe, i?ioani? Eiaaeaiei Aieiaeeie?
Ieeieaeiae/, aee?aeoi?, caa?aeoaa/ a?aeae?eaiiy ?aaiaoieia??
Oe?a?inueeiai iaoeiai-aeine?aeiiai ?inoeoooo ea?ae?ieia??
?i.aeaae.I.Ae.No?aaeanea IIC Oe?a?ie

Io?oe?ei? iiiiaioe:

aeieoi? iaaee/ieo iaoe, i?ioani? Eenaiei A?eai??e ?aaiiae/, caa?aeoaa/
eaoaae?e n?iaeii? iaaeeoeeie c eo?nii ee?i?/ii? ?ioiieia?? oa
aea?aieia?? Ee?anueei? iaaee/ii? aeaaeai?? i?neyaeeieiiii? ina?oe
?i.I.E.Ooieea IIC Oe?a?ie

aeieoi? iaaee/ieo iaoe, i?ioani? Ieeoea Oa?an Aeaieniae/, caa?aeoaa/
eaoaae?e i?iiaaeaaoeee aioo??oi?o oai?ia ?2 Iaoe?iiaeueiiai iaaee/iiai
oi?aa?neoaoo ?i.I.I.Aiaiiieueoey

I?ia?aeia onoaiiaa: Aei?i?iiao?ianueea aea?aeaaia iaaee/ia aeaaeai?y
IIC Oe?a?ie, eaoaae?a aini?oaeueii? oa?ai?? ?2

Caoeno a?aeaoaeaoueny 16 ethoiai 1999 ?ieo i ____ aiaeei? ia can?aeaii?
niaoe?ae?ciaaii? a/aii? ?aaee Ae 26.616.01 i?e Oe?a?inueeiio
iaoeiai-aeine?aeiiio ?inoeooo? ea?ae?ieia?? ?i. aeaae. I.Ae.No?aaeanea

ca aae?anith: 252151, i.Ee?a – 151, aoe.Ia?iaeiiai Iiie/aiiy, 5.

C aeena?oaoe??th iiaeia iciaeiieoeny a a?ae?ioaoe? Oe?a?inueeiai
iaoeiai-aeine?aeiiai ?inoeoooo ea?ae?ieia?? ?i.aeaae. I.Ae.No?aaeanea

ca aae?anith: i.Ee?a, aoe.Ia?iaeiiai Iiie/aiiy, 5

Aaoi?aoa?ao ?ic?neaiee 16 n?/iy 1999 ?ieo

A/aiee nae?aoa?

niaoe?ae?ciaaii? a/aii? ?aaee Aeaye N.?

CAAAEUeIA OA?AEOA?ENOEEA ?IAIOE

Aeooaeuei?noue oaie. A inoaii? aeanyoee?ooy e?ea??-?aaiaoieiae
niinoa??aathoue cia/ia i?aeaeuaiiy ??aiy ?aaiaoe/ieo caoai?thaaiue c
aooi?ioiiei oa ?ioiieiiieaeniei iaoai?ciii ?icaeoeo. A Oe?a?i? oe?
caoai?thaaiiy ? iaeiioe?ai?oei eeanii na?aae oai?ia aioo??oi?o i?aai?a,
ui ni?e/eiththoue aenieo ?iaae?aeecaoe?th ianaeaiiy i?aoeacaeaoiiai a?eo
(Eiaaeaiei A.I., 1997). Caeaa?eueoiai – oea oai?? ia nenoaiiee /a?aiiee
aia/ae (N*A), ?aaiaoi?aeiee a?o?eo (?A), nenoaii? aaneoe?oe (NA),
neea?iaea?i?th. Oe? caoai?thaaiiy oa?aeoa?ecothoueny nenoaiiei oeiii
caiaeaiiy a ??cieo i?aaiao oa nenoaiao, ye? ii?aeiai? i?ae niaith
?icaeoeii aooi?ioiiiai oa ?ioiieiiieaeniiai i?ioeano , a oaeiae
iaaei??iei o?a?iciooai?aiiyi (Ianiiiaa A.I., 1997). Uiaei ia’?aeiaiiy
oeeo oai?ia o a?oio nenoaiieo caoai?thaaiue niieo/ii? oeaieie (NCNO), oi
?nio? ni?euei?noue ie?aieo ee?i?/ieo i?iya?a, iniaeeai ia ?aii?o
noaae?yo ?icaeoeo aooi?ioiiiai i?ioeano; caaaeuei? oa oa?aeoa?i? aeey
eiaeiiai caoai?thaaiiy ?ioiieia?/i? ia?ea?e, aeecuee? i?eioeeie
i?ioecaiaeueii? oa ?ioiinoi?aneaii? oa?ai?? (Aaiaea ?.I., Eiaaeaiei
A.I., Eenaiei A.?., Na?ioeeoeueeee A.N., 1996).

Ia no/aniiio aoai? a ?aaiaoieia?? ?niothoue ??ci? iaoiaee e?eoaaiiy NCNO
?c canoinoaaiiyi ianoa?i?aeieo i?ioecaiaeueieo i?aia?ao?a (IICI),
ei?oeeinoa?i?ae?a, o?iie?iiaeo i?aia?ao?a oa oeeoinoaoee?a (Ianiiiaa
A.A., 1997). O?eaaeee, /anoi i?ia?anoth/ee ia?aa?a NCNO, iaaeinoaoiy
aoaeoeai?noue /e oneeaaeiaiiy oa?iaeioa?ai??, iniaeeai o ?ac?
ia?i?aeueiiai i?eeiio e?ea?nueeeo i?aia?ao?a, iio?aaothoue ?ic?iaeaiiy
iiaeo iaoiae?a ? i?aeoiae?a o ?o e?eoaaii?. Ee?i?/iee ia?aa?a NCNO
iiaea oneeaaeieoeny ?icaeoeii aooi?ioiieo e?ec?a ? naioe/ieo noai?a
(Eenaiei A.?., 1997). O ?ac? aooi?ioiieo e?ec?a iniiaiei iaoiaeii
e?eoaaiiy ? ?ioiinoi?aneaia oa?ai?y aetheiei?oeeinoa?i?aeaie (AEN) ?
oeeoinoaoeeaie (Aiiniaa E.I., 1997; Eenaiei A.?., 1997; Nieiaeia N.E.,
1989). Cia/io ?ieue a?ae?a?athoue ? aeno?aei?ii?aeuei? iaoiaee
aeaoieneeaoe?? — aaiini?aoe?y, ieaciaoa?ac, e?ioioeeoiieaciaoa?ac
(Ai?iaeaoeueeee A.I., 1986; Eenaiei A.?., 1996; ss?aiaiei I.A., 1997).
Oa aei oeueiai /ano iiai?noth ia ae??oaia ieoaiiy i?i aca?iica’ycie i?ae
ieaciaoa?acii (IO) oa ioeuen-oa?ai??th (IO) i?e e?eoaaii? ?aaiaoe/ieo
oai?eo. Ia aecia/ai? e?eoa??? aoaeoeaiino? oa a?aeai?o oai?eo aeey
i?iaaaeaiiy ?ioaineaiiai e?eoaaiiy iaoiaeii IO oa IO AEN a eiia?iaoe??
c IO c o?aooaaiiyi ee?i?ei-?ioiieia?/iiai noaio.

Ca’ycie ?iaioe c iaoeiaeie i?ia?aiaie, ieaiaie, oaiaie. Ia?aiee iai?yiie
aeine?aeaeaiue ni?aiaaea? c aeine?aeaeaiiyie, ye? i?iaiaeyoueny o
a?aeae?eaii? ?aaiaoieia?? Oe?a?inueeiai iaoeiai-aeine?aeiiai ?inoeoooo
ea?ae?ieia?? ?i. aeaae. I.Ae. No?aaeanea. Io?eiai? ?acoeueoaoe ?
neeaaeiaith caeeth/iiai ca?oo a?aeae?eaiiy i?i iaoeiai-aeine?aeio ?iaioo
1994–1997??. ca oaiith “?ic?iaeoe iiao iaaee/io oaoiieia?th ?ioaineaiiai
e?eoaaiiy oa caaacia/eoe ?ai?n?th ?aaiaoe/ieo caoai?thaaiue c
aooi?ioiiei oa ?ioiieiiieaeniei iaoai?ciii ?icaeoeo” (? aea?ae.
?a?no?aoe?? 0195OO).

Iaoa ? caaaeaiiy aeine?aeaeaiiy. ?ic?iaeoe e?eoa??? ioe?iee
aoaeoeaiino? ?ioaineaiiai e?eoaaiiy ?aaiaoe/ieo caoai?thaaiue c
aooi?ioiiei oa ?ioiieiiieaeniei iaoai?ciii ?icaeoeo iaoiaeii IO oa IO a
eiia?iaoe?? c IO, aecia/eoe i?eioeeie a?aeai?o oai?eo, yeei iiaeia
canoiniaoaaoe oe? iaoiaee e?eoaaiiy.

I?ae /an aeeiiaiiy ?iaioe ae??ooaaeeny ianooii? caaaeaiiy:

1. Aea/eoe ?ioi?iaoeai?noue ?ioiieia?/ieo oa ee?i?ei-a?io?i?/ieo
iieaciee?a o oai?eo ia NCNO aeey iii?oi?eiao ?o ee?i?/iiai ia?aa?ao oa
?ai?n??.

2. Aea/eoe ae?th IO ia ee?i?ei-eaai?aoi?i? oa a?io?i?/i? iieacieee e?ia?
o oai?eo ia N*A, ?aaiaoi?aeiee a?o?eo (?A), aaii?aa?/iee aaneoe?o (AA).

3. Aea/eoe noai ee?oeiiiai oa aoii?aeueiiai ?ioi?oaoo o oeeo oai?eo
aiane?aeie e?eoaaiiy IO.

4. Iaa?oiooaaoe e?eoa??? a?aeai?o oai?eo ia NCNO aeey i?iaaaeaiiy IO oa
IO c IO.

5. I?iaanoe ?ioaineaia e?eoaaiiy aooi?ioiieo e?ec?a iaoiaeii IO o
ii?aeiaii? c IO ? aeaoe ee?i?ei-?ioiieia?/io ioe?ieo aoaeoeaiino?
oeueiai iaoiaeo.

Iaoeiaa iiaecia iaea?aeaieo ?acoeueoao?a. Aia?oa aecia/aii e?eoa???
a?aeai?o oai?eo aeey ?ioaineaii? oa?ai?? caeaaeii a?ae aeo?aeiiai
?ioiiiai noaoono. Aeyaeaii iniaeeaino? noaio ?ioiii? nenoaie i?e
na?aaeiueiio oa aenieiio nooiaiyo aeoeaiino? aooi?ioiiiai i?ioeano.
?ic?iaeaii ia’?eoeai? e?eoa??? ioe?iee IO oa IO c IO c o?aooaaiiyi
?ioiia?aie oa ee?i?ei-a?io?i?/ieo iieaciee?a e?ia?.

I?aeoe/ia cia/aiiy iaea?aeaieo ?acoeueoao?a. Aeiaaaeaia iaiao?aei?noue
aeei?enoaiiy iieaciee?a ee?oeiiiai oa aoii?aeueiiai ?ioi?oaoo aeey
ioe?iee aoaeoeaiino? IO oa IO c IO, a oaeiae aecia/aii e?eoa??? a?aeai?o
oai?eo aeey canoinoaaiiy oeeo iaoiae?a e?eoaaiiy. ?ic?iaeaii
ee?i?ei-?ioiieia?/i? e?eoa??? ioe?iee ?ioaineaiiai e?eoaaiiy aooi?ioiieo
e?ec?a.

Ai?iaaaeaeaiiy ?acoeueoao?a aeine?aeaeaiiy a i?aeoeeo. ?acoeueoaoe
aeine?aeaeaiiy ai?iaaaeaeaii a i?aeoeeo ?iaioe ianooiieo a?aeae?eaiue:
ee?i?/ii? ?aaiaoieia?? i?nueei? e?ea?i? ?5 (i. E?eaee ??a),
?anioae?eainueeiai ?aaiaoieia?/iiai oeaio?o, ?aaiaoieia?/iiai
a?aeae?eaiiy ee?i?/ii? e?ea?i? ?6 (i.Ee?a), oa?aiaaoe/iiai a?aeae?eaiiy
iaeanii? ee?i?/ii? e?ea?i? ?1 oa i?nueei? ee?i?/ii? e?ea?i? ?3
(i.*a?i?aoe?), ui i?aeoaa?aeaeo?oueny aeoaie ai?iaaaeaeaiiy.

Iniaenoee aianie caeiaoaa/a. Aaoi?ii iniaenoi i?iaaaeaii ee?i?/ia
ianoaaeaiiy oai?eo oa ?o a?aea?? aeey e?eoaaiiy IO oa IO c IO.
I?iaaaeaii e?eoaaiiy oai?eo iaoiaeii IO oa IO. Aeeiiaii caa?? iaoa??aeo
aeey ?ioiieia?/iiai aeine?aeaeaiiy. Ocaaaeueiaii oa noaoenoe/ii
ia?iaeaii ?acoeueoaoe aeine?aeaeaiiy, i?aeaioiaeaii iaoeia? aeai? aei
ioae?eaoe??.

?ioiieia?/i? aeine?aeaeaiiy i?iaaaeaii ?acii ?c ni?a?ia?oieeaie
eaai?aoi??? ee?i?/ii? ?ioiieia?? Oe?a?inueeiai IAe? ea?ae?ieia?? ?i.
aeaae. I.Ae. No?aaeanea (ea??aiee — ae-? a?ie. iaoe Aaa?eeaiei O.?.).

Ai?iaaoe?y ?acoeueoao?a aeena?oaoe??. Iniiai? iieiaeaiiy aeena?oaoe??
aeiiia?aeaeeny oa iaaiai?thaaeeny ia I Eiia?an? ?aaiaoieia?a Oe?a?ie
(Oa?iii?eue, 1993); ?anioae?eainueeiio neiiic?oi? ?aaiaoieia?a (Iaeana,
1995); iaoeiai-i?aeoe/i?e eiioa?aioe?? ?aaiaoieia?a Oe?a?ie (Aeiiaoeuee,
1996); VI Eiia?an? Na?oiai? oaaea?aoe?? oe?a?inueeeo e?ea?nueeeo
oiaa?enoa (Iaeana, 1996); II Iaoe?iiaeueiiio Eiia?an? ?aaiaoieia?a
Oe?a?ie (Ee?a, 1997).

?iaioo ai?iaiaaii ia ni?eueiiio can?aeaii? a?aeae?eaiue ee?i?/ii?
?aaiaoieia??, oai?ia i?iea?aea oa aaae na?oey, ee?i?/ii? a?io?i??,
ee?i?/ii? ?ioiieia?? Oe?a?inueeiai iaoeiai-aeine?aeiiai ?inoeoooo
ea?ae?ieia?? ?i. aeaae. I.Ae.No?aaeanea oa eaoaae?e oa?ai?? ?
?aaiaoieia?? Ee?anueei? iaaee/ii? aeaaeai?? i?neyaeeieiiii? ina?oe ?i.
I.E.Ooieea.

Ioae?eaoe??. Ca iaoa??aeaie aeena?oaoe?? iioae?eiaaii 20 iaoeiaeo ?ia?o:
4 noaoo? (2 c ieo naiino?ei?) oa 16 oac?a.

No?oeoo?a aeena?oaoe??. Aeena?oaoe?y aeeeaaeaia ia 189 noi??ieao
eiii’thoa?iiai oaenoo, neeaaea?oueny c? anooio, iaeyaeo e?oa?aoo?e,
/ioe?ueio aeaa iniaenoeo aeine?aeaeaiue, aeniiae?a oa nieneo
aeei?enoiaaieo e?oa?aoo?ieo aeaea?ae. Oaeno ?ethno?iaaii 23 iaethieaie
oa 38 oaaeeoeyie, ui caeiathoue 61 noi??ieo oaenoo. Nienie e?oa?aoo?e
neeaaea?oueny c 299 aeaea?ae a?o/eciyii? oa ca?oa?aeii? e?oa?aoo?e.

INIIAIEE CI?NO ?IAIOE

Iaoa??aee oa iaoiaee aeine?aeaeaiiy

Ianoaaeaii 182 oai?eo ia NCNO a?eii a?ae 18 aei 50 ?ie?a. Ae?aaiic N*A,
?A, AA oa aoceeeiaee ia??a?oa???o (AI) anoaiiaethaaany ia iniia?
ae?aaiinoe/ieo e?eoa???a A?A (1989). O 156 oai?eo anoaiiaeaii II
nooi?iue aeoeaiino? ?aaiaoe/iiai i?ioeano, o 26 – III nooi?iue
aeoeaiino?.

An? oai?? aoee ?iciiae?eai? ia aea? a?oie: iniiaio (IA) – 106 /ieia?e oa
eiio?ieueio (EA) – 75 /ieia?e.

Aei IA oa?eoee 30 oai?eo ia N*A, 35 – ia ?A, 16 – ia AA ? 26 – c
aooi?ioiieie e?ecaie, ye? aeieeee ia oii? aenieiai nooiaiy aeoeaiino?
N*A (21 oai?ee) oa AI (5 oai?eo). Oai?ei ?c IA i?iaiaeeee eo?n IO (aeey
i?io?eaeoeee “rebound”-aoaeoo i?ae /an ieaciicai?uaiiy aaiaeeee 150 ia
nieth-ei?oaoo aai ?ioiai AEN a aea?aaeaioi?e aeic?), cie?aia oai?ei c
aooi?ioiieie e?ecaie – IO iaoeei?aaei?cieiiii o ii?aeiaii? c IO. EA
neeaaeaee 75 oai?eo a?aeiia?aeiiai a?eo, noao?, o?eaaeino? o?ii?/iiai
i?ioeano, yeei i?iaiaeeee o?eueee o?aaeeoe?eio oa?iaeioa?ai?th (IICI,
AEN).

Aeey ioe?iee aoaeoeaiino? e?eoaaiiy, e??i ee?i?/ieo aeaieo, aei oaaae
a?aee ?acoeueoaoe eaai?aoi?ieo iaoiae?a aeine?aeaeaiiy: OIA, e?euee?noue
eaeeioeeo?a e?ia?, ?aaeoe?y ia N-?aaeoeaiee a?eie (N?A), ??aaiue
o?a?eiiaaio, i?io?iia?iiaee ?iaeaen, caaaeueiee a?eie ne?iaaoee e?ia? oa
eiai o?aeoe??, n?aeiao i?iao, na?iioei?ae, aeiaoe?ie e?ia?,
?aaiaoi?aeiee oaeoi?, oano ia iayai?noue LE-ee?oei, aioeo?ea aei iAeIE
oa aeAeIE o iaoieia?/iiio oeo??. Oaeiae aecia/aee caaaeueiiee?i?/i?
iieacieee na/?: aeiaiao i?ioa?io??th, i?iao ca Ia/eii?aieii,
eiioeaio?aoe?eio caeaoi?noue ie?ie (i?iaa ca Ceiieoeueeei).

Aeey ioe?iee ee?oeiiiai ?ioi?oaoo aeei?enoai? iaoiaee aecia/aiiy
e?eueeino? Oe, Oo, On, Ae ca aeiiiiiaith iiiieeiiaeueieo aioeo?e.
Oaaioeeoa?io aeoeai?noue iaeo?io?eueieo a?aioeioeeo?a aecia/aee a oano?
?aaeoeoe?? i?o?ineiueiai oao?acie?y (INO). Aeey oa?aeoa?enoeee ?aca?aieo
iiaeeeainoae iaeo?io?eueieo a?aioeioeeo?a o INO-oano? aecia/aee
??cieoeth i?ae iieacieeaie niiioaiiiai oa ?iaeoeiaaiiai INO-oanoo o
a?aenioeao. Aeey ioe?iee aoii?aeueii? eaiee ?ioi?oaoo aecia/aee:
?ioiiaeiaoe?ie (Ig) eean?a G, M, A ca iaoiaeii Manchini (1965); ??aaiue
oee?eoethth/eo ?ioiieo eiiieaen?a (Oe?E) ca Digeon (1977);
eiiieaiaioa?io aeoeai?noue ne?iaaoee e?ia? aecia/aee ca aaiinoacii
nainea?e?ciaaieo a?eo?ioeeo?a aa?aia.

O i?ioean? ianoaaeaiiy oai?eo aeei?enoiaoaaee ?ino?oiaioaeuei? iaoiaee
aeine?aeaeaiiy: aeaeo?iea?ae?ia?ao?th, oiiiea?ae?ia?ao?th,
?aioaaiineii?th i?aai?a a?oaeii? ee?oee, ?aioaaiia?ao?th noaeia?a.

O ?ac? aeyaeaiiy II nooiaiy aeoeaiino? ?aaiaoe/iiai i?ioeano i?ecia/aee
IO, III nooiaiy aeoeaiino? c aooi?ioiieie e?ecaie – IO c IO.

IO i?iaiaeeee ca iaoiaeeeith A.I.Ai?iaeaoeueeiai oa ni?aaaoi??a (1986).
Ia eo?n e?eoaaiiy i?ecia/aee i’youe i?ioeaaeo? IO /a?ac aeaiue c
aeeo/aiiyi ia iaioa i?ae 1,5 e ieacie. IO i?iaiaeeee
iaoee-i?aaei?cieiiii ii 1000 ia uiaeaiii i?ioyaii o?ueio aei?a.
Ianoaaeoaaee oai?eo aei oa i?ney eo?no e?eoaaiiy.

?acoeueoaoe aeine?aeaeaiue ia?iaeaii ca aeiiiiiaith
iaoaiaoeei-noaoenoe/ieo iaoiae?a, ??cieoey iieaciee?a aaaaeaeany
noaoenoe/ii a??ia?aeiith o ?ac? ?

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