.

Клінічна ефективність ступеневої терапії бронхіальної астми у дітей: Автореф. дис… канд. мед. наук / В.А. Клименко, Харк. держ. мед. ун-т. — Х., 199

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OA?E?ANUeEEE AeA?AEAAIEE IAAeE*IEE OI?AA?NEOAO

EEEIAIEI A?EOI??ss AIAOIE??AIA

OAeE 616.248 – 053.2 – 08

EE?I?*IA AOAEOEAI?NOUe NOOIAIAAI? OA?AI??

A?IIO?AEUeII? ANOIE O Ae?OAE

14.01.10. – iaae?ao??y

Aaoi?aoa?ao aeena?oaoe?? ia caeiaoooy iaoeiaiai

nooiaiy eaiaeeaeaoa iaaee/ieo iaoe

OA?E?A – 1999

Aeena?oaoe??th ? ?oeiien.

?iaioo aeeiiaii a Oa?e?anueeiio aea?aeaaiiio iaaee/iiio oi?aa?neoao? IIC
Oe?a?ie.

Iaoeiaee ea??aiee – aeieoi? iaaee/ieo iaoe, i?ioani?

Eiaeai’yea Aiaoie?e ?aaiiae/

Oa?e?anueeee aea?aeaaiee iaaee/iee oi?aa?neoao

caa?aeoaa/ eaoaae?e aeeoy/eo oai?ia

Io?oe?ei? iiiiaioe: aeieoi? iaaee/ieo iaoe, i?ioani?

Iaeeiaoeue TH??e Aaneeueiae/,

Oa?e?anueeee aea?aeaaiee iaaee/iee oi?aa?neoao

caa?aeoaa/ eaoaae?e oaeoeueoaonueei? iaae?ao??? c iaaee/iith aaiaoeeith

aeieoi? iaaee/ieo iaoe, i?ioani?

Cin?iia Aiaoie?e Ieeieaeiae/

Oa?e?anueea aeaaeai?y i?neyaeeieiiii? ina?oe

i?ioani? eaoaae?e aeeoy/iai ooaa?eoeueico oa ioeueiiiieia??

I?ia?aeia onoaiiaa – ?inoeooo IAA AII Oe?a?ie, i.Ee?a

A?aeae?e caoai?thaaiiy i?aai?a aeeoaiiy

Caoeno aeena?oaoe?? a?aeaoaeaoueny “ 28 ” aeiaoiy 1999 ?. i 12-00
aiaeei? ia can?aeaii? niaoe?ae?ciaaii? a/aii? ?aaee Ae 64.600.04 i?e
Oa?e?anueeiio aea?aeaaiiio iaaee/iiio oi?aa?neoao? (310022, i.Oa?e?a,
i?. Eai?ia,4).

C aeena?oaoe??th iiaeia iciaeiieoeny o a?ae?ioaoe? Oa?e?anueeiai
aea?aeaaiiai iaaee/iiai oi?aa?neoaoo (310022, i.Oa?e?a, i?. Eai?ia,4).

Aaoi?aoa?ao ?ic?neaiee “ 27 ” aa?aniy 1999?.

A/aiee nae?aoa?

niaoe?ae?ciaaii? a/aii? ?aaee

eaiaeeaeao iaaee/ieo iaoe, aeioeaio
E.?.Ia/a?aiei

CAAAEUeIA OA?AEOA?ENOEEA ?IAIOE

Aeooaeuei?noue oaie. O no/ani?e iaae?ao??? i?iaeaia e?eoaaiiy
a?iio?aeueii? anoie (AA) caa??aa? aeiyoeiao aeooaeuei?noue.
Aeooaeuei?noue i?iaeaie iaoiiaeaia aenieei ??aiai caoai?thaaiino?,
aaeeeith ?iciianthaeaeai?noth ? c?inoaiiyi nia?oiino? a?ae AA. Iaea?eueo
a??ia?aei? aeai? ?iciianthaeaeaiiy AA a aaaaoueio e?a?iao na?oo aoee
io?eiai? inoaii?ie ?ieaie o ca’yceo c ai?iaaaeaeaiiyi ? iioe?aiiyi
i?ia?ai ECRHS (European Commission Respiratory Health Study) oa ISAAC
(International Study of Asthma and Allergy in Childhood). Oe?
ai?aeai?ieia?/i? aeine?aeaeaiiy na?ae/aoue i?i oa, ui a a?eueoino? e?a?i
na?oo a?ae 4% aei 8% ianaeaiiy no?aaeaeathoue ia AA. O aeeoy/?e
iiioeyoe?? oeae a?aenioie i?aeaeuo?oueny aei 5-10% (Aaaaeia N.I.,1997;
?o?iiaa A.A.,1992; Caeeiaa A.A.,1996; Iooeee A.I.,1997; Oauaiei
TH.?.,1997; *o/ae?i A.A.,1997; Anderson H.,1992; Sears M. R.,1997;
Succhari M.F.,1995). Ui??/ii a?ae anoie aie?a? 60 oeny/ oai?eo (Sears
M.R.,1997). ? oaiaeaioe?y aei c?inoaiiy caoai?thaaiino? oa nia?oiino?
a?ae AA caa??aa?oueny a onueiio na?o?, cie?aia e a Oe?a?i?, (Aao
E.A.,1998; Eaneoey I.?.,1996; Iooeee A.I.,1997; Ni?yi ?.N.,1995; Oauaiei
TH.?.,1997; sseeoo N.?.,1998). AA ? ia o?eueee iaaee/iith, a e
aaaeeeaith nioe?aeueiith i?iaeaiith, ine?eueee i?ecaiaeeoue aei ?aiiuei?
?iaae?aeecaoe?? oai?eo ? cieaeaiith iniiaieo iieaciee?a “yeino? aeeooy”
(The WHOQOL Group,1995,1996). ?ic?iaeaiiy aoaeoeaieo iaoiae?a e?eoaaiiy
? i?io?eaeoeee AA ia? aaeeea aeiiii?/ia cia/aiiy, ine?eueee e?eoaaiiy
iaeiiai aaaeeiai oai?iai noaiiaeoue a?ae 1800 aei 2500 aia?eeainueeeo
aeiea??a ia ??e (Iaoe. i?ia?aia ?in??,1997; *o/ae?i A.A.,1989). C iaoith
i?aeaeuaiiy aoaeoeaiino? e?eoaaiiy ? i?io?eaeoeee AA, ae?iaeaiiy
?aeeiiai i?aeoiaeo ? noaiaea?oecaoe?? oa?ai?? i?ia?aeieie
a/aieie-aea?aieiaaie a 1992 ?ioe? aoei ooai?aii I?aeia?iaeiee Eiinainon
? cai?iiiiiaaii aeai?eoi Nooiaiaai? oa?ai?? AA (National Heart, Lung and
Blood Institute,1995). Aea a iaae?ao??? oey noaia noaea iioe?thaaoeny
o?eueee inoaii?ie ?ieaie. Oae, o ?in?? Iaoe?iiaeueio i?ia?aio
“A?iio?aeueia anoia o ae?oae. No?aoaa?y e?eoaaiiy ? i?io?eaeoeee” aoei
ooaaeaii o 1996 ?ioe?, a iioae?eiaaii o?eueee o 1997?. A Oe?a?i?
?aeiiaiaeaoe?? uiaei ae?aaiinoeee oa oa?ai?? AA o ae?oae aoee noai?ai? a
1998 ?ioe? ca ?i?oe?aoeaith IIC oa anioe?aoe?? iaae?ao??a Oe?a?ie ?
caoaa?aeaeai? a aeiaoi? 1998?. ia II c’?cae? ioeueiiiieia?a ?
ooec?ao??a. Oaeei /eiii, o iaae?ao??? Nooiaiaaa noaia anoiioa?ai??
iaaeinoaoiuei ai?iaiaaia ? iio?aao? iiaeaeueoiai aea/aiiy.

Ca’ycie ?iaioe c iaoeiaeie i?ia?aiaie, ieaiaie, oaiaie. Aeena?oaoe?eio
?iaioo aeeiiaii a iaaeao iaoeiai? i?iaeaie Oa?e?anueeiai aea?aeaaiiai
iaaee/iiai oi?aa?neoaoo ca o/anoth eaoaae? iaae?ao?e/iiai i?io?eth ca
oaiith: “Ae?aaiinoeea, aeeniaina?ecaoe?y ? ?aaa?e?oaoe?y ae?oae ?c
ea?ae?aeueiith oa ?ani??aoi?iith iaoieia??th” (? Aea?aeaaii? ?a?no?aoe??
09940038041).

IAOA ? CAAeA*? IAOEIAIAI AeINE?AeAEAIIss

Iaoa ?iaioe. I?aeaeuaiiy aoaeoeaiino? Nooiaiaai? oa?ai?? AA o ae?oae.

Iniiai? caaea/? aeine?aeaeaiiy:

1. Aea/aiiy ee?i?/ieo iniaeeainoae ia?aa?ao AA o ae?oae Oa?e?anueeiai
?aa?iio ia no/aniiio aoai?.

2. Aeine?aeaeaiiy iniaeeainoae ?ioiieia?/iiai noaio ae?oae, oai?eo ia
AA.

3. Ioe?iea aoaeoeaiino? Nooiaiaai? oa?ai?? AA o ae?oae.

4. Oaeineiiaeaiiy e aaeaioaoe?y Nooiaiaai? oa?ai?? AA aeey aeeoy/iai
a?eo.

Iaoeiaa iiaecia. Aea/aii ee?i?ei-ia?aee?i?/i? iniaeeaino? AA
??ciiiai?oiiai nooiaiy oyaeeino? o ae?oae Oa?e?anueei? iaeano? ia
no/aniiio aoai?. Oia?oa a Oe?a?i? i?iaaaeaii aeiaaio?eaaea
aeine?aeaeaiiy (i?ioyaii 3 ?ie?a) uiaei ioe?iee o ae?oae ee?i?/ii?
aoaeoeaiino? Nooiaiaai? oa?ai?? AA, cai?iiiiiaaii? I?aeia?iaeiei
Eiinainonii ?c i?iaeai ae?aaiinoeee oa e?eoaaiiy AA (1992). Anoaiiaeaii
oa?aeoa? ca’yceo i?ae iniaeeainoyie aaaaoaoeaiiai noaio ? oyaee?noth
a?iio?aeueii? anoie. Aeyaeaia iaa?aeiia?aei?noue aeey ae?oae ii?iaoeaieo
iieaciee?a IIOA ? aeiaiaiai ?iceeaeo IIOA, cai?iiiiiaaieo Eiinainonii
aeey aei?ineeo oai?eo. Iaoeiai iaa?oioiaai? iia? ii?iaoeai? ia?aiao?e
IIOA ? aeiaiaiai ?iceeaeo IIOA aeey aecia/aiiy oyaeeino? AA o ae?oae.
Iiaeeo?eiaaii noaio Nooiaiaai? oa?ai?? aeey aeeoy/iai a?eo, a oaeiae
aianaii aei ia? iaai? aeiiiaiaiiy c o?aooaaiiyi ?iaeea?aeoaeueieo
iniaeeainoae caoai?thaaiiy:

–aaea ca oiia eaaeiai ia?aa?ao AA (I nooi?iue), ii?yae ?c ?2-aaii?noaie
ei?ioei/anii? ae??, i?e iayaiino? i?/ieo iaiaae?a anoie ?aeiiaiaeo?oueny
aeei?enoiaoaaoe ?2-aaii?noe ? oaio?e?ie i?ieiiaiaaii? ae??;

–o?eaae?noue e?eoaaiiy ?ioaeii iiaeiia neeaaeaoe uiiaeiaioa 3 i?nyoe?;

–aeey ciaioaiiy iie?i?aaiac?? a e?eoaaii? AA ? aeeoa?aioe?eiaaiiai
i?aeoiaeo aei i?ecia/aiiy aae?aiii?iaoee?a ? oie?iie?oee?a ia II ? III
nooiaiyo cai?iiiiiaaii aecia/aiiy aaaaoaoeaiiai noaio ca iiaeeo?eiaaiith
oaaeeoeath Aaeia.

I?iaaaeaii ?aiaoaaiiy iaea?eueo ?ioi?iaoeaieo iieaciee?a OCAe a ioe?ioe?
aeeiai?ee caoai?thaaiiy a ae?oae.

I?aeoe/ia cia/aiiy ?iaioe. I?iaaaeaii ai?iaaoe?th oa aeaii ioe?ieo
ee?i?/i?e aoaeoeaiino? Nooiaiaai? noaie e?eoaaiiy AA o ae?oae. Noaio
iiaeeo?eiaaii aeey aeeoy/iai a?eo c aianaiiyi aei ia? aeiiiaiaiue c
o?aooaaiiyi ?iaeea?aeoaeueieo iniaeeainoae caoai?thaaiiy. ?acoeueoaoe
?iaioe ai?iaaaeaeaii o i?aeoeeo Oa?e?anueei? IAeEE?1, i?nueeiai
aea?aieia?/iiai eaa?iaoo, eaoaae?e aeeoy/eo oai?ia OAII, IAeE?23,
i?nueeeo iie?ee?i?e ??1,2,14 Oa?eiaa, ui aeaei ciiao i?aeaeueoe
aoaeoeai?noue ? ciaioeoe iie?i?aaiac?th a e?eoaaii? oai?eo ia AA.

Iniaenoee aianie caeiaoaa/a. Aeena?oaoe?eio ?iaioo aeeiiaii i?ae /an
iaa/aiiy a ani??aioo?? ia eaoaae?? aeeoy/eo oai?ia Oa?e?anueeiai
aea?aeaaiiai iaaee/iiai oi?aa?neoaoo (caa. eaoaae?e – i?io. Eiaeai’yea
A.?.). Iaaaaeai? o ?iaio? iaoeia? iaoa??aee ? iniaenoei aianeii aaoi?a
aei ?ic?iaeaii? oaie. Aaoi? naiino?eii c?iaeea iaoaioii-?ioi?iaoe?eiee
iiooe, aiae?c iaoeiai? e?oa?aoo?e c aeine?aeaeaii? i?iaeaie, i?iaaea
i?aea?? oaiaoe/ieo oai?eo, cae?enithaaea ?o ianoaaeaiiy oa e?eoaaiiy.
Oaeiae naiino?eii aeeiioaaea ?ino?oiaioaeuei? aeine?aeaeaiiy ooieoe??
ciai?oiueiai aeeoaiiy – ni??ia?ao?th, iiaaiioaoiiao??th, i?eoeoiiao??th,
AEA, iiaioaaea iaoiaee ?ioiieia?/iiai aeine?aeaeaiiy. Noaoenoe/io
ia?iaeo oa aiae?c io?eiaieo aeaieo, i?aeaioiaeo aei ae?oeo ioae?eaoe?e,
ioi?ieaiiy aeena?oaoe?eii? ?iaioe aoei cae?eniaii caeiaoaa/ai
naiino?eii.

Ai?iaaoe?y ?iaioe. Iniiai? iieiaeaiiy aeena?oaoe?? aeiiia?aeaeeny ia
?icoe?aiiio Ieaioi? iaeaniiai oiaa?enoaa aeeoy/eo e?ea??a, i?enay/aiiio
iai’yo? /eai-ei?.AII N?N?, i?io.Aaeioniaa A.A. (Oa?e?a,1996) ? ia
iaoeiai-i?aeoe/i?e eiioa?aioe?? “No/ani? i?iaeaie i?aeoe/ii? iaae?ao???”
(Oa?e?a,1998).

Ioae?eaoe??. Ca oaiith aeena?oaoe?? iaae?oeiaaii 4 noaoo?, na?aae ieo 3
– o oeaio?aeueieo iaaee/ieo aeo?iaeao.

Ianya ? no?oeoo?a aeena?oaoe??. Aeena?oaoe?th iaienaii ?in?enueeith
iiaith, aeeeaaeaii ia 119 noi?. iaoeiiieniiai oaenoo. Aiia neeaaea?oueny
c? anooio, iaeyaeo e?oa?aoo?e, aeanieo niinoa?aaeaiue, caeeth/ii?
/anoeie, aeniiae?a ? i?aeoe/ieo ?aeiiaiaeaoe?e; ?ethno?iaaia 22
oaaeeoeyie ? 16 iaethieaie, ui neeaaea? 36 noi?. A?ae?ia?ao?/iee
iieaae/ee i?noeoue 215 ?ia?o a?o/eciyieo ? 160 – ca?oa?aeieo aaoi??a ui
neeaaea? 34 noi?.

CI?NO ?IAIOE

Iaoa??aee ? iaoiaee aeine?aeaeaiiy. Aeey ae??oaiiy iinoaaeaieo caaaeaiue
i?iaaaeaii eiiieaenia ianoaaeaiiy a aeeiai?oe? 102 oai?eo ia AA a?eii
a?ae 5 aei 15 ?ie?a, ye? e?eoaaeeny ca?aeii c? Nooiaiaaith noaiith.
E?aoi?noue ianoaaeaiiy neeaea 1?ac o 3i?n. (i?e I? ?a ?EE nooiaiyo AA)
oa 1?ac o 6 i?n. (i?e I nooiai? AA). Aei noaoenoe/ii? ia?iaee a?aeenue
iieacieee ia?aeiiiai ianoaaeaiiy (a?oia “aei e?eoaaiiy”) oa ?acoeueoaoe
ianoaaeaiiy oai?eo, ui io?eioaaee Nooiaiaao oa?ai?th i?ioyaii ia iaioa 2
?ie?a (a?oia “i?ney e?eoaaiiy”). A?oio ii??aiyiiy neeaee 40 ae?oae,
oai?eo ia AA, oiai ae a?eo, ye? iaea?aeoaaee eeoa a?iioie?oe/io oa?ai?th
oa aoee ianoaaeai? a eaoaiiac? aei 2 ?ie?a. Onoaiiaeaiiy ae?aaiico, eiai
aa?eo?eaoe?y cae?enithaaeeny ca?aeii c ?aeiiaiaeaoe?yie I?aeia?iaeiiai
Eiinainono c AA (1992). Ee?i?/io ioe?ieo ?acoeueoao?a e?eoaaiiy
i?iaiaeeee ca?aeii c e?eoa??yie, ?ic?iaeaieie Aaei A.Ae., Aae??aiiaith
I.A. (1976) ? iiaeeo?eiaaieie iaie noiniaii aei Eiinainono: a/ a?aei?ii?
?acoeueoaoe – cieeioee an? i?iyae caoai?thaaiiy; iaaeeeaiaioicia
e?eoaaiiy oai?ee ia iaea?aeo?; a/ aa?i? ?acoeueoaoe – neiioiie
caoai?thaaiiy caeeoeeeny, aea iai?oanoothoue ??aeoa e o a?eueo eaae?e
oi?i?; e?euee?noue i?aia?ao?a, iaiao?aeieo aeey e?eoaaiiy, ciaioeeany –
oai?ee ia?aaaaeaiee ia ieae/o nooi?iue anoiioa?ai??; a/ caaeia?euei?
?acoeueoaoe – caaino?aiiy ??aeoa ? eaaoa, aea ianya iaiao?aeiiai
oa?aiaaoe/iiai aieeao ia ciaioeany; a/ iacaaeia?euei? ?acoeueoaoe –
iie?ioaiiy ia ianooieei ? oai?ee aoa ia?aaaaeaiee ia aeuo nooi?iue
anoiioa?ai??.

Aeey ia’?eoea?caoe?? ioe?iee ooieoe?iiaeueiiai noaio nenoai i?aai?cio
canoiniaoaaeeny no/ani? ?ioi?iaoeai? iaoiaeeee:

–aecia/aiiy aaaaoaoeaiiai noaoono oai?iai ca iiaeeo?eiaaiith oaaeeoeath
Aaeia;

–ioe?iea nenoaiiiai ?ioi?oaoo (aoii?aeueii? oa ee?oeiii? eaiie) ca
aeaieie oano?a ia?oiai oa ae?oaiai ??ai?a: A-e?ioioeeoe aecia/aee ca
iaoiaeeeith Mendes (1974) o iiaeeo?eaoe?? A?eoeia O.E., Itheea? N.
(1978) iaoiaeii eiiieaiaioa?iiai ?icaoeiooai?aiiy; O-e?ioioeeoe – ca
iaoiaeeeith Iao?iaa ?.A. (1976) iaoiaeii niiioaiiiai ?icaoeiooai?aiiy c
a?eo?ioeeoaie aa?aia ii I.Jondal (1972); ?ioii?aaoeyoi?i? noaiiioeyoe??
O-e?ioioeeo?a – iaoiaeii iai?yiie iaia?aiii? ?ioiioethi?anoeaioe?? c
aeei?enoaiiyi a?o/eciyieo iiiieeiiaeueiuo aioeoae (CD4; CD8) ca
iaoiaeeeith O?eaoiaa A.A., Aa/o??ia I.N., Ia?eiaa E.A. oa ?i.(1989).
Ooieoe?iiaeueiee noai O-e?ioioeeo?a (O-aeo.) ioe?ithaaee ca iaoiaeii
Kerman (1976). ??aaiue iniiaieo o?ueio eean?a ?ioiiaeiaoeei?a IgA, IgI,
IgG a ne?iaaooe? e?ia? aecia/aee iaoiaeii i?inoi? ?aae?aeueii?
?ioiiaeeooc?? o aae? ii Mancini (1965). ??aaiue IgA caaaeueiiai o
ne?iaaooe? e?ia? aecia/aee iaoiaeii ?ioiioa?iaioiiai aiae?co ca
iaoiaeeeith III “A?ioaoiieia?y” oa AOCO “AeEAiethn” (Oeeoeeeia A.I.,
Na?aethe I.A.,1991);

–OCAe aea/aee ca aeiiiiiaith ni??ia?aoa “Iaoaoano-2”, ia’?iio
oaeaee?noue iia?o?yiiai no?oiaiy ia aaeeoo oa aeaeeoo aeine?aeaeoaaee
iiaaiioaoiiao?ii “?O-1”, a i?eiao ia’?iio oaeaee?noue aeaeeoo oa ??
aeiaia? ci?ie – i?eoeoiiao?ii o??ie “RHONE POULENC RORER”.

Aoa i?iaaaeaiee aiae?c noaoenoe/ieo aeaieo i?i e?euee?noue ae?oae,
aini?oae?ciaaieo ?c i?eaiaeo AA, ? eaoaeueiino? a?ae AA a IAeEA ?1 ca
ia??iae 1977-1997 ??. On? oeeo?ia? aoee ia?iaeai? iaoiaeii aa??aoe?eii?
noaoenoeee ia eiii’thoa?? IBM (PS)-486.

?acoeueoaoe aeine?aeaeaiiy. I?ae niinoa?aaeaiiyi ia?aaoaaei 102 aeeoeie
a?eii a?ae 5 aei 15 ?ie?a, oai?eo ia AA. O caeaaeiino? a?ae oyaeeino?
ia?aa?ao AA ?o aoei iiae?eaii ia 3 a?oie: c eaaeei ia?aa?aii (I
nooi?iue) – 27 (26,5%) oai?eo; AA na?aaeiuei? oyaeeino? (II nooi?iue) –
46 (45,1%) ae?oae; oyaeea AA (III nooi?iue) – 29 (28,4%) oai?eo. Ca?aae
oai?eo ia?aaaaeaee oeii/eee (65,7%). Aea/aeany ?ieue oaeoi??a
“ciai?oiueiai na?aaeiaeua” a ?icaeoeo AA. Na?aae oai?eo ia?aaaaeaee
i?nuee? iaoeaioe? (89%) ? iaoeaioe? ?aeii?a ?c caa?oaeiaiei iia?o?yiei
aanaeiii (I?aeaeii?e?aecaanueeee, Eii?ioa?i?anueeee, AEiaoiaaee,
O?oicainueeee ? /anoeiai Ee?anueeee ?aeiie i.Oa?eiaa) – 58%. C
ia?eiaoaeueiuo oaeoi??a iaea?eueoa cia/aiiy iaee oneeaaeiaiee ia?aa?a
aaa?oiino? (59,8%), ?aii? ooo/ia aeaiaeiaoaaiiy (65,7%) ? oneeaaeiai?
iieiae (23,5%). I?e aiae?c? aiaiiaco aeeooy aeyaeaii aenieo ieoiio aaao
ae?oae, ui /anoi oai??thoue (58%). O 31 (30,4%) aeeoeie aoee aeai? i?i
ia?aianaio iiaaiii?th; o 41 (40,2%) – a?aecia/aeeny o?ii?/i? aiaieua
?ioaeoe?? a iiniaeiooe?; o 78 (76,5%) ae?oae aeyaeaii noiooith niiaoe/io
iaoieia?th, ia?aaaaeii ii?ooaiiy ia?aiai? nenoaie (56%). I?e ioe?ioe?
aaaaoaoeaiiai noaoono oai?eo ca iiaeeo?eiaaiith oaaeeoeath Aaeia o
a?eueoino? oai?eo (46,1%) o ia??iae? ?ai?n?? aeyaeaii caaaeueio
ia?aneiiaoeeioii?th, i?e/iio oyaeea oi?ia AA oa?aeoa?ecoaaeany a?eueo
cia/ieie ii?ooaiiyie aaaaoaoeaii? ?aaoeyoe??. Oa?aeoa?enoeeo
aaaaoaoeaiiai noaoono oai?eo o caeaaeiino? a?ae oyaeeino? AA o ia??iae?
?ai?n?? iaaaaeaii a oaaeeoe? 1.

Oaaeeoey 1

Aaaaoaoeaiee noaoon oai?eo o caeaaeiinoe a?ae oyaeeino? ia?aa?ao
a?iio?aeueiie anoie aei e?eoaaiiy o ia??iae? ?ai?n??

Aaaaoaoeaiee noaiOyaee?noue a?iio?aeueii? anoieOnueiai
oai?eoEaaeaNa?aaeiyOyaeean%n%n%n%Aeoii?y1451,92860,9413,84645,1Ia?aneiia
oeeioii?y829,61532,62482,84746,1Neiiaoeeioii?y518,536,513,498,8Onueiai27
1004610029100102100

Iieacieee ?ioiieia?/iiai noaio o ae?oae, oai?eo ia AA, aei e?eoaaiiy a
ia??iae? ?ai?n?? iiaeai? ia ?en 1.

Aeey aecia/aiiy nooiaiy ooeeaiiy eiaeiiai c aiae?ciaaieo ?ioiieia?/ieo
iieaciee?a a?ae ii?ie aoei aeei?enoaii t- e?eoa??e (?en2).

I?e iii?oi?eiao OCAe anoaiiaeaii, ui o ae?oae, oai?eo ia AA, IIOA ?
aeiaiaee ?iceeae IIOA o ia??iae caaino?aiiy ia a?aeiia?aeathoue
ii?iaoeaiei aeaiei, ?aeiiaiaeiaaiei Eiinainonii aeey aei?ineeo oai?eo.
Aeey ?ic?iaee iiaeo ii?iaoeaieo a?aie/ieo ?ioa?aae?a cia/aiue aeia??/?
?ioa?aaee eieeaaiue ? na?aaei? aaee/eie IIOA ? aeiaiaiai ?iceeaeo IIOA o
ae?oae a ia??iae caaino?aiiy o caeaaeiino? a?ae oyaeeino? oai?iae
(oaae.2).

Oaaeeoey 2

Aeia??/? ?ioa?aaee cia/aiue iieaciee?a IIOA ? aeiaiaiai ?iceeaeo IIOA o
ia??iae caaino?aiiy a ae?oae, oai?eo ia AA, o caeaaeiino? a?ae oyaeeino?
oai?iae

Oyaee?noue AA IIOA (%)Aeiaiaee ?iceeae IIOA (%)Aeia??/?
?ioa?aaeeNa?aaei? cia/aiiyAeia??/? ?ioa?aaeeNa?aaei?
cia/aiiyEaaea67,9-76,772,323,0-29,626,3Na?aaeiy
45,9-58,752,329-43,636,3Oyaeea38,6-48,243,432,4-47,239,8

Aeoiaey/e c aeaieo oaae.2, a?aie/ieie cia/aiiyie IIOA o ae?oae ?c
eaaeith oi?iith AA aa?oi aaaaeaoe IIOA a?eueo 68%; ?c na?aaeiueith –
46-59%; ?c oyaeeith – iaioa 48%. A?aie/ieie cia/aiiyie aeiaiaiai
?iceeaeo IIOA aeey oai?eo ?c eaaeei ia?aa?aii AA aa?oi aaaaeaoe eiai
aaee/eio a?eueo 29%; aeey oai?eo ia AA na?aaeiuei? oyaeeino? – 29-32% ?
aeey oyaeei? – a?eueo 32%. A yeino? ?iciaaeoaaeueiiai cia/aiiy iieacieea
ocyoa eiai i?i?iaeueia aaee/eia a aeia??/iio ?ioa?aae? a?eueo oyaeeiai
ia?aa?ao oai?iae.

Aoaeoeai?noue e?eoaaiiy oai?eo ?c eaaeei ia?aa?aii a?iio?aeueii? anoie
(I nooi?iue). I?ae niinoa?aaeaiiyi ia?aaoaaei 27 ae?oae ?c eaaeei
ia?aa?aii AA (18 oeii/ee?a ? 9 ae?a/aoie). Aeey a?eueoino? (63%) oai?eo
oe??? a?oie aoea oa?aeoa?ia a?aenooi?noue ?icai?iooeo iaiaae?a yaeooe.
Naia i?e eaae?e oi?i? AA iaae?ao?e a?ae/oaaee iaea?eueo? o?oaeiiu?
ae?aaiinooaaiiy. Oae, 12 (44,4%) oai?ei ae?aaiic aoei iinoaaeaii a?eueo,
i?ae /a?ac 2 ?iee i?ney iiyaeaiiy ia?oeo ee?i?/ieo iciae oai?iae.
*anoioa i?enooi?a AA neeaea a?ae 1 aei 8 ?ac?a ia ??e – o na?aaeiueiio
4,1 ?ac/??e. A?oio ii??aiyiiy neeaee 10 oai?eo ?c eaaeei ia?aa?aii AA (8
oeii/ee?a ? 2 ae?a/eiee). O ia??iae caaino?aiiy oai?ei iniiaii? a?oie
a?iioie?oe/ia oa?ai?y i?iaiaeeeanue aae?aiii?iaoeeaie ei?ioei/anii?
ae??: naeueaooaiie iaea?aeoaaee 19 oai?eo (aeicith 100-400iea/aeiao ia
3-4 i?eeiie), oaiioa?ie – 8 (100-400iea/aeiao ia 3-4 i?eeiie).
A?iioie?oe/ia oa?ai?y aae?aiii?iaoeeaie ei?ioei/anii? ae?? aeyaeeany
iaaoaeoeaiith aeey e?eoaaiiy oai?eo ?c ia?aaaaeii i?/ieie iaiaaeaie AA.
I?ae niinoa?aaeaiiyi aoei 13 (48,1%) oaeeo oai?eo: aae?aiii?iaoee
ei?ioei/anii? ae??, io?eiaiee aeeoeiith ia?aae niii (i 21-22aiae.),
caaacia/oaaa a?iioie?oe/iee aoaeo i?ioyaii 3-6 aiae. (iaeneioi aei 4
aiae. ?aieo) ? ia i?a, oaeei /eiii, caaacia/eoe i?io?eaeoeeo i?/iiai
iaiaaeo AA. Aeiaeaaaiiy aei oa?ai?? ?i?ao?ii?oio a?ii?aeo (“Aa?iaeoae”,
“Ao?iaaio” ii 1-2 aeice aa?icieth aei 3 ?ac./aeiao) ia caiia?aaei i?/iei
caaino?aiiyi (iiceoeaiee aoaeo a?aecia/aii eeoa a 1 ?c 13 oai?eo). Uia
caaacia/eoe niie?eiee nii aeeoeie, aei e?eoaaiiy oai?eo ?c i?/ieie
iaiaaeaie caeo/aee aae?aiii?iaoeee i?ieiiaiaaii? ae?? (“Ni??iiaio”,
“Eeaiaooa?ie” a aeic? 12iea/ea/aeiao ia 2 i?eeiie – 4 oai?eo), aai
oaio?e?ie i?ieiiaiaaii? ae?? (“Oaiaeo?”, “Oaiea?”, “Oaiiae” a aeic?
10-15iea/ea/aeiao – 8 ae?oae). I?ioecaiaeueio oa?ai?th aoei
i?aaenoaaeaii e?iiiae?eaoii iao??y a aeic? a?ae 8 aei 40ia/aeiao.
O?eaae?noue aaeeaaiiy i?aia?aoo neeaaeaea a?ae 3 aei 6 i?nyoe?a (o
na?aaeiueiio 4,3 i?n.). O?ueii oai?ei “?ioae” i?ecia/aany ei?ioei/anieie
eo?naie (ia 1-2 aei?) ia?aae eiioaeoii c aea?aaiii (ye ?aeiiaiaeo?oueny
Eiinainonii i?e I nooiai? AA). Aeey an?o o?ueio oai?eo ei?ioei/ania
i?ecia/aiiy e?iiiae?eaoo iao??th aeyaeeiny iaaoaeoeaiei, ? iiceoeaio
aeeiai?eo aeinyaiooi eeoa i?ney 3-i?ny/iiai eo?no i?ioecaiaeueii?
oa?ai??. Iia?/ii? ae?? “?ioaeo”, ui ca aeaieie e?oa?aoo?e noaiiaeoue 2%
(Oaaein??a A.A., 1988), iaie cao?eniaaii ia aoei – on? ae?oe aeia?a
ia?aiineee i?aia?ao ? oaeaeei iiaiiaoaaee oaoi?eo ?iaaeyoe?e.

Ioe?iea ee?i?/ii? aoaeoeaiino? Nooiaiaai? oa?ai?? i?e eaaeiio nooiai? AA
aeicaieeea ca?a?no?oaaoe a?aei?ii? ?acoeueoaoe o 7 (25,9±9%) oai?eo
iniiaii? a?oie ? o 2 (20±13%) ae?oae – eiio?ieueii?; aeia?? – o 14
(51,9±10%) ? 4 (40+16%); caaeia?euei? – o 4 (14,8±7%) ? 3 (30±15%);
iacaaeia?euei? – o 2 (7,4±5%) ? 1 (10±10%) ae?oae a?aeiia?aeii.
Ii??aiyiiy /anoioe iiceoeaieo ?acoeueoao?a (a?aei?ii?, aeia?? e
caaeia?euei?) i?e ??cieo noaiao e?eoaaiiy, aeyaeei iacia/io ??cieoeth a
aoaeoeaiino? – Nooiaiaaa oa?ai?y aeyaeeanue aoaeoeai?oith ia 2,6%
(P>0,05), ui iiaea iiynithaaoeny iayai?noth i?ioecaiaeueiiai aoaeoo a
aoo?e?i?. Ee?i?/ia iie?ioaiiy noi?iaiaeaeoaaeiny a??ia?aeiei (P0,05), oi /anoioa cieaeaiiy i?/ieo iaiaae?a
AA a iniiai?e a?oi? (44±7%) a??ia?aeii (?0,05), o 72,3±11% – eiio?ieueii? a?oie (P>0,05).
E?euee?nii aiceiio?e?y a oeeoia?ai? iie?ioe cieceeany ia 45,5%. Iii?/aii
oaeiae ciaioaiiy aiceiio?e?? e?ia? (c 9,4±3,1% aei 7,8±4,1%; o a?oi?
ii??aiyiiy – 8,4±3,6%), aea aeyaeai? ci?ie ia aoee a??ia?aeieie. ??aaiue
IgA o ne?iaaooe? e?ia? oai?eo, ui iaea?aeoaaee Nooiaiaao oa?ai?th,
a??ia?aeii (?0,01) cieceany c 566±68II/ie aei 340±96II/ie. O a?oi?
ii??aiyiiy ??aaiue IgA neeaa 520±81II/ie (?>0,05). Ia oii? aacenii?
oa?ai?? iii?/aii a??ia?aeia iie?ioaiiy iieaciee?a OCAe (?en.3).

Aoaeoeai?noue e?eoaaiiy oai?eo ?c oyaeeei ia?aa?aii AA (III nooi?iue).
I?ae niinoa?aaeaiiyi ciaoiaeeeiny 29 oai?eo (19 oeii/ee?a ? 10
ae?a/aoie) a?eii a?ae 7 aei 15 ?ie?a, ye? iaea?aeoaaee e?eoaaiiy
a?aeiia?aeii aei ?aeiiaiaeaoe?e I?aeia?iaeiiai Eiinainono. A?oio
ii??aiyiiy neeaee 12 ae?oae (8 oeii/ee?a ? 4 ae?a/eiee). I?e aea/aii?
iniaeeainoae ee?i?/iiai ia?aa?ao oyaeei? oi?ie AA o 9 (26,4%) ae?oae
iniiaii? a?oie aoei iii?/aii oneeaaeiaiiy: anoiaoe/iee noaoon – o 4,
aio?caia eaaaiue – o 3, aoaeaeoac naaiaioa e?ai? eaaai? – o 1, o?ii?/ia
eaaaiaaa na?oea – o 1, aoi?eiia iiaaiii?y ia oii? caaino?aiiy AA -o 5
ae?oae. Aacenia i?ioecaiaeueia oa?ai?y cae?enithaaeany i?ecia/aiiyi
iii??ieo aeic ei?oeeinoa?i?ae?a aioo??oiueiaaiii (2-4ia/ea/aeia. ca
i?aaei?cieiiii) i?ioyaii 3-7 aei?a, a i?e iie?ioaii? noaio –
?iaaeyoe?eieie noa?i?aeaie a iecueeeo aeicao – 100-400iea/aeiao ca
aaeeaiaoaciiii (18 ae?oae), na?aaei?o – 400-600iea/aeiao ?, o aeiyoeiaeo
aeiaaeeao, aenieeo aeicao >600iea/aeiao – 6 ? 5 oai?eo a?aeiia?aeii. I?e
canoinoaaii? ?iaaeyoe?eieo ai?iii?a o 6 oai?eo iaie ca?a?no?iaaii
i?noeaa? oneeaaeiaiiy o aeaeyae? ?ioiaeioeiaiai eaiaeeaeico, aea aiie
oaeaeei ieioeeny i?ney canoinoaaiiy I?noaoeio iaa?oue aac a?aei?ie
ai?iii?a. Nenoaiio iia?/io ae?th aetheiei?oeei?ae?a (neiae?ii
?oeaiea-Eooeiaa) eiinoaoiaaii o aeaio oai?eo, aea ee?i?/i? i?iyae
oeueiai neiae?iio iaee i?noea o oai?eo oaea ia?aae ia?aae oei, ye aiie
aoee ocyo? i?ae niinoa?aaeaiiy. Ioe?iea ee?i?/ii? aoaeoeaiino?
Nooiaiaai? oa?ai?? i?e oyaeeiio ia?aa?ao AA iieacaea: aeia?? ?acoeueoaoe
ca?a?no?iaaii o 17 (58,6±9%) oai?eo iniiaii? a?oie ? o 2 (16,6±11%)
ae?oae – eiio?ieueii?; caaeia?euei? – o 10 (34,5±9%) ? o 5 (41,7±15%);
iacaaeia?euei? – o 2 (6,9±5%) ? o 5 (41,7±15%) ae?oae a?aeiia?aeii.
*anoioa aeaiieo iaiaae?a cieceeany a iniiai?e a?oi? ia 64±9%, o
eiio?ieuei?e – ia 46±15%; i?/ieo – ia 42±9% ? 28±13% a?aeiia?aeii.
Iio?aaa a a?iioie?oeeao ciaioeeany ia 68%. Ciaioeeany ieoiia aaaa
oyaeeeo iaiaae?a – c 23,7±4,8% aei 11±3,2% (?0,05). E?euee?nii aiceiio?e?y
ciaioeeany ia 36,5%. ??aaiue IgA cieceany o oai?eo iniiaii? a?oie c
426±48II/ie aei 240±56II/ie (?

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