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 (P<0,001) iie?ioaiiyi oeeoia?aie iie?ioe: i?ney e?eoaaiiy aiceiio?e?th a iie?io? ca?a?no?iaaii eeoa o 22,2±8% oai?eo (ii??aiyii c 51,8±10% aei e?eoaaiiy ? 40±16% oai?eo eiio?ieueii? a?oie). E?euee?nii aiceiio?e?y iie?ioe ciaioeeany ia 34,6%. Ci?ie ?ioeo ia?aee?i?/ieo iieaciee?a (aiceiio?e?y e?ia?, ??aaiue IgA) ia aoee oe?eeii iaaieie. I?ney e?eoaaiiy iii?/aii iie?ioaiiy iieaciee?a OCAe. Iaea?eueo cia/oueie oa ?ioi?iaoeaieie iieacieeaie aeey ioe?iee aeeiai?ee caoai?thaaiiy i?e eaae?e oi?i? AA aeyaeeeny oaeaee?ni? iieacieee aeeoaiiy – ?oi? ci?ie aoee a??ia?aeieie: IIOA (c 72,3±4,4% aei 97,7±3,1% - P<0,001), aeiaiaee ?iceeae IIOA (c 26,3±3,7% aei 15,1±1,1% - P<0,01) ? IOI aeaeeoo (c 68,9±4,2% aei 81,9±3,2% - P<0,05, o eiio?ieuei?e a?oi? - 67,3±3,9% - P<0,05). Ia'?ii? ni??ia?ao?/i? iieacieee a??ia?aeii ia ci?ieeeny. I?e/eia a?aenooiino? oe?eeii iaaieo iiceoeaieo ci?i o iieacieeao ni??ia?ao?? i?e eaae?e oi?i? AA ? ca iayaiino? ae?aaeaii? iiceoeaii? ee?i?/ii? aeeiai?ee iieyaa? a oiio, ui i?e iaiaae? iaa?oue eaaei? oyaeeino? aaea aecia/a?oueny cieaeaiiy iniiaieo ni??ia?ao?/ieo ia?aiao??a aei 80% a?ae ii?ie ? ieae/a. I?e iaioeo ii?ooaiiyo a?iioii?ia?aeiino? (80%) oai?ee ee?i?/ii aoa eiiiainiaaiee, eiai noai ia o?enoaaany ye caaino?aiiy AA, ioaea, ni??ia?ao?y ia i?iaiaeeeanue ? ?acoeueoaoe aei noaoenoe/ii? ia?iaee ia a?aeeny. Aoaeoeai?noue e?eoaaiiy oai?eo ?c ia?aa?aii AA na?aaeiuei? oyaeeino? (II nooi?iue). I?ae niinoa?aaeaiiyi ciaoiaeeeiny 46 oai?eo (30 oeii/ee?a ? 16 ae?a/aoie) a?eii a?ae 5 aei 15 ?ie?a ?c AA na?aaeiuei? oyaeeino?, ye? iaea?aeoaaee e?eoaaiiy a?aeiia?aeii aei ?aeiiaiaeaoe?e I?aeia?iaeiiai Eiinainono. A?oio ii??aiyiiy neeaee 18 ae?oae (13 oeii/ee?a ? 5 ae?a/aoie). Aeine?aeaeaiiy aaaaoaoeaiiai oiiono ??cieo ooieoe?iiaeueieo nenoai aeyaeei ??ciini?yiiaaiee oa?aeoa? eiai ii?ooaiue: oae, c aieo aeeoaeueii? nenoaie ia?aaaaa ia?aneiiaoe/ieo neiioii?a iii?/aeanue o 29 (63%) ae?oae ? aeyaeyeany /anoeie i?/ieie iaiaaeaie - o 29 (63%) ae?oae, iayai?noth ae?aaeaiiai aenoaeaoeaiiai eiiiiiaioa iano?oeoe?? - a 11 (23,9%) ae?oae, caeo/aiiyi o caiaeueiee i?ioean aa?oi?o a?aeae?e?a aeeoaeueieo oeyo?a - o 4 (8,7%) ae?oae, o oie /an ye caaaeueio aaaioii?th ca?a?no?iaaii eeoa o 15 (32,6%) oai?eo. Caaaeueia aaaioii?y aai ia?aaaaa ia?aneiiaoe/ieo ?aaeoe?e o aeeoaeuei?e nenoai? noaiiaeee iieacaiiy aei i?ecia/aiiy oie?iie?oee?a – i?aia?aoa “Ao?iaaio” ii 20-40iea (1-2 aeice aa?icieth) aei 3 ?ac./ aeiao. E?eoaaiiy oai?eo iniiaii? a?oie cae?enithaaeiny a?aeiia?aeii aei aeai?eoio Nooiaiaai? oa?ai??. On? oai?? iaea?aeoaaee i?ioecaiaeueio oa?ai?th e?iiiae?eaoii iao??th a aeic? 20-40ia/aeiao (13), iaaeie?ii?eii iao??th a aeic? 4-8ia/aeiao (4) aai ?iaaeyoe?eieie aetheiei?oeei?aeaie (29). ?iaaeyoe?ei? aetheiei?oeei?aee aaeeaaeenue o aeaeyae? aaeeiiaoaciio ae?i?ii?iiaoa a aeic? 100-400iea/aeiao (18) ? oeoi?cie?aea a aeic? 500-1000 iea/aeiao (11). Aea?? naia oeeo ?iaaeyoe?eieo aetheiei?oeei?ae?a aoa iaoiiaeaiee ?oiueith iayai?noth a aioa/i?e ia?aae? i.Oa?eiaa. O?eaae?noue ?iaaeyoe?e ai?iii?a neeaea a?ae 2 aei 4 i?nyoe?a (o na?aaeiueiio 3,2 i?n.). I?e ?iaaeyoe?eiiio canoinoaaii? ai?iii?a iia?/i? ae?? o aeaeyae? ?ioiaeioeiaiai eaiaeeaeico ca?a?no?iaaii o 3 oai?eo, aea aiie oaeaeei ieioeeny i?ney canoinoaaiiy "I?noaoeio". I?ney a?aei?ie ei?oeeinoa?i?ae?a oai?ei i?ecia/aany ?ioae a aeic? 20-40ia/aeiao ia oa?i?i a?ae 4 aei 12 oeaei?a. Aiae?c ee?i?/ii? aoaeoeaiino? Nooiaiaai? oa?ai?? i?e na?aaeiueiio nooiai? oyaeeino? AA aeyaea oaea: aeia?? ?acoeueoaoe ca?a?no?iaaii o 25 (54,3±7%) oai?eo iniiaii? a?oie ? 5 (27,8±11%) ae?oae - eiio?ieueii?; caaeia?euei? - o 18 (39,1±7%) ? 9 (50±12%); iacaaeia?euei? - o 3 (6,5±4%) ? 4 (22±10%) ae?oae a?aeiia?aeii. Aeia?? ?acoeueoaoe e?eoaaiiy a iniiai?e a?oi? aeicaieeee a?aei?ieoe ?iaaeyoe?ei? aetheiei?oeei?aee o 17 c 29 oai?eo ? i?iaeiaaeoaaoe i?ioecaiaeueio oa?ai?th "Oaeeaaeii" (3aeeoeie) ? "?ioaeii" (11ae?oae), cieceoe aeiaiao aeico ai?iii?a i?e iiaoi?iiio i?ecia/aii? a 11 oai?eo, ciaioeoe iio?aao a a?iioie?oe/ieo i?aia?aoao ia 65%. Ia?aaaaeaii ia ieae/ee nooi?iue anoiioa?ai?? 18 oai?eo. Aoei i?iaiae?ciaaii aeeiai?eo o?eaaeino? caaino?aiue, /anoioe aeaiieo ? i?/ieo iaiaae?a AA o oai?eo. sseui /anoioa aeaiieo i?enooi?a AA a iniiai?e a?oi? iaea eeoa oaiaeaioe?th aei cieaeaiiy (53±7%) o ii??aiyii? c eiio?ieueiith (41±18%; P>0,05), oi /anoioa cieaeaiiy i?/ieo iaiaae?a
AA a iniiai?e a?oi? (44±7%) a??ia?aeii (?<0,01) ia?aaeuoaaea oaeo a eiio?ieuei?e a?oi? (11±8%). Oaeiae nooo?aei (?<0,05) aoei ciaioaiiy o?eaaeino? caaino?aiue (54±7% ? 24±10% a?aeiia?aeii). Iiceoeaia ee?i?/ia aeeiai?ea noi?iaiaeaeoaaeany ii?iae?caoe??th oeeoia?aie iie?ioe - aiceiio?e?y iie?ioe a?aei?/aia a 69,6±7% oai?eo aei e?eoaaiiy, o 56,5±7% - i?ney e?eoaaiiy (P>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). Ee?i?/ia iie?ioaiiy noi?iaiaeaeoaaeiny cieaeaiiyi aiceiio?e?? iie?ioe, ui aoea ca?a?no?iaaia o 72,4±8% oai?eo aei e?eoaaiiy, o 48,2±9% – i?ney e?eoaaiiy (?<0,05) e o 66,7±15% ae?oae eiio?ieueii? a?oie (?>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 (?<0,01); o a?oi? ii??aiyiiy ??aaiue IgA neeaa 598±61II/ie (?<0,01). Ia oii? Nooiaiaai? oa?ai?? a?aecia/aii a??ia?aeia iie?ioaiiy iieaciee?a OCAe (?en.4). Ii??aiyeueia ioe?iea aoaeoeaiino? Nooiaiaai? ? o?eueee a?iioie?oe/ii? oa?ai?? AA i?e ??ci?e oyaeeino? caoai?thaaiiy aeaei ciiao niinoa??aaoe iaea?eueo ae?aaeaiee aoaeo i?e oyaeeiio ia?aa?ao AA. Oae, Nooiaiaaa oa?ai?y aoea aoaeoeai?oith ca neiioiiaoe/io o 1,93 ?aca i?e oyaee?e oi?i?; o 1,20 ?aca - i?e AA na?aaeiuei? oyaeeino? oa o 1,03 ?aca - i?e eaaeiio ia?aa?ao. ??cieoey a aoaeoeaiino? e?eoaaiiy, i/aaeaeii, iia'ycaia c ??cieoeath o nee? i?ioecaiaeueiiai aoaeoo ei?oeeinoa?i?ae?a, iaaeie?ii?eo ? e?iiiae?eaoo iao??th, ui noaiiaeyoue iniiao aacenii? oa?ai??. C iaoith aeyaeaiiy iaea?eueo a??ia?aeieo iieaciee?a OCAe a ioe?ioe? aeeiai?ee caoai?thaaiiy aeey on?o oai?eo ia AA iaie aoee aecia/ai? na?aaeiueia?eoiaoe/i? cia/aiiy t-e?eoa??th iieaciee?a aeey an?o nooiai?a oai?iae. On? iciaee ii ?ioi?iaoeaiino? iiaeia oiiaii ?icae?eeoe ia 4 a?oie: ?c aenieith, iii??iith, neaaeith ?ioi?iaoeai?noth oa ia?ioi?iaoeai?. Aei a?oie c aenieith ?ioi?iaoeai?noth iaeaaeeoue eeoa iaeei iieaciee - IIOA, na?aaei? cia/aiiy eio?iai (t=4,7) a?eueo i?ae o 2 ?ace ia?aaeuo? a?aie/ia cia/aiiy a??ia?aeiino? (t=2,0; P<0,05). Aei ia?aiao??a ?c na?aaeiueith ?ioi?iaoeai?noth a?aeiinyoueny IOI (t=2,7) ? na?aaei?e aeiaiaee ?iceeae IIOA (t=2,6); c iecueeith ?ioi?iaoeai?noth - AE?E (t=2,1) ? ia?ioi?iaoeaieie aecia/ai? oae? iieacieee, ye IOA1(t=1,4) ? IOA1/OAE?E (t=1,2). AENIIAEE 1. A?iio?aeueia anoia iin?aea? cia/ia i?noea na?aae ianiaoeeo?/ieo caoai?thaaiue ?ani??aoi?ii? nenoaie, ? inoaii?ie ?ieaie (1976-1998) /anoioa aini?oae?caoe?e ae?oae, oai?eo ia AA, aei niaoe?ae?ciaaieo noaoe?iia??a ca?eueoeeanue o 3,2 ?ace. 2. Aiae?c ee?i?/ieo niinoa?aaeaiue na?ae/eoue i?i i?cith ae?aaiinoeeo AA o 38% ae?oae, iniaeeai eaaeeo oi?i, eiee a?aenooi? oeiia? iaiaaee yaeooe. 3. O ae?oae, oai?eo ia AA, anoaiiaeaii ieceo ci?i a ?ioiieia?/iiio noai?. Uiiaea?eueoiai ooeeaiiy a?ae ii?ie (t=4,4) a?aecia/aii o a?aeiioaii? ??aiy IgA. Iio?i o ii?yaeeo nooo?aeo ci?i eaeooue: e?euee?noue O-aeoeaieo e?ioioeeo?a (t=2,86); aaniethoia e?euee?noue O-e?ioioeeo?a (t=2,59); ??aaiue IgI (t=2,40); a?aeiinia e?euee?noue O-e?ioioeeo?a (t=2,19) ? O-e?ioioeeo?a (CD4) (t=2,0). 4. Ii?iaiaeie 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%. 5. Aoaeoeai?noue e?eoaaiiy ae?oae, oai?eo ia AA, ca?aeii c i?ioieieaie I?aeia?iaeiiai Eiinainono c i?iaeai ae?aaiinoeee ? e?eoaaiiy AA (GINA, 1992), aaeaioiaaieo aeey aeeoy/iai a?eo, aeua ca a?iioie?oe/io oa?ai?th, ui i?iaiaeeeany aei ai?iaaaeaeaiiy iniiaieo iieiaeaiue Eiinainono, i?e oyaee?e oi?i? – a 1,93 ?ac, i?e na?aaei?e aaaeeino? – a 1,20 ?ac, i?e eaae?e – a 1,03 ?ac. 6. Ei?ioei/ani? eo?ne ?ioaeo ia?aae eiioaeoii c aea?aaiii (ye ?aeiiaiaeiaaii Eiinainonii aeey I nooiaiy AA) – iaaoaeoeai?; iiceoeaia aeeiai?ea o oai?eo niinoa??aa?oueny i?e canoinoaaii? e?iiiae?eaoo iao??th i?ioyaii ia iaioa, /ei 3 i?nyoe?. 7. Aeei?enoaiiy a2-aaii?no?a oa oaio?e?i?a i?ieiiaiaaii? ae?? aaea ia I nooiai? AA aeicaieeei i?aeaeueoe aoaeoeai?noue e?eoaaiiy 44,4% ae?oae c eaaeith oi?iith AA. 8. Aecia/aiiy aaaaoaoeaiiai noaio ca iiaeeo?eiaaieie oaaeeoeyie Aaeia aeey aeeoa?aioe?eiaaiiai i?ecia/aiiy ?2-aaii?no?a oa oie?iie?oee?a ia II-III nooiaiyo AA aeicaieeee ciaioeoe iie?i?aaiac?th o e?eoaaii? 32,6% ae?oae, oai?eo ia AA na?aaeiuei? oyaeeino? oa 82,8% ae?oae c oyaeeei ia?aa?aii AA. 9. I?e iii?oi?eiao OCAe aeey ioe?iee aeeiai?ee oai?iae aei ia?aiao??a c aenieith ?ioi?iaoeai?noth iaeaaeeoue eeoa iaeei iieaciee – IIOA (t=4,7); c na?aaeiueith ?ioi?iaoeai?noth - IOI (t=2,7) ? aeiaiaee ?iceeae IIOA (t=2,6); c iecueeith ?ioi?iaoeai?noth - AE?E (t=2,1); ia?ioi?iaoeaieie aeyaeeenue IOA1 (t=1,4) oa IOA1/OAE?E (t=1,2). I?AEOE*I? ?AEIIAIAeAOe?? 1. Aeey nai?/anii? ae?aaiinoeee AA o ae?oae, iniaeeai i?e eaaeeo oi?iao, eiee a?aenooi? oeiia? iaiaaee yaeooe, ne?ae oe?oa aeei?enoiaoaaoe ye aeoeai? ai?aeai?ieia?/i?, oae ? no/ani? ooieoe?iiaeuei? oa aea?aieia?/i? iaoiaee aeine?aeaeaiiy. 2. I?e e?eoaaii? ae?oae, oai?eo ia AA, ne?ae canoiniaoaaoe ?aeiiaiaeaoe?? Eiinainono uiaei nooiaiaai? noaie e?eoaaiiy AA o ae?oae, ui caaacia/o? aeineoue aenieee iii?oi?eia ca noaiii caei?ia’y oai?eo ? aeicaiey? aeinyaoe iaeaaeiiai eiio?ieth ca ia?aa?aii caoai?thaaiiy. 3. I?e aecia/ai? nooiaiy oyaeeino? AA ne?ae a?aoiaoaaoe iia? ii?iaia? cia/aiiyie IIOA o ae?oae: c eaaeith oi?iith - 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%. 4. I?e aeei?enoaii? iniiaieo iieiaeaiue Eiinainono c AA, ne?ae a?aoiaoaaoe ?iaeea?aeoaeuei? iniaeeaino? ia?aa?ao caoai?thaaiiy: –o?eaae?noue e?eoaaiiy “?ioaeii” iiaeiia neeaaeaoe uiiaeiaioa 3 i?nyoe?; –ii?yae ?c ?2-aaii?noaie ei?ioei/anii? ae??, i?e iayaiino? i?/ieo iaiaae?a AA, ne?ae oaeeaaoe ?2-aaii?noe ? oaio?e?ie oiia?eueiaii? ae?? aaea i?e I nooiai? AA; –aeey ciaioaiiy iie?i?aaiac?? a e?eoaaii? oai?eo ia AA II-III nooiaiy ? aeeoa?aioe?eiaaiiai i?ecia/aiiy ?2-aaii?no?a ? oie?iie?oee?a ne?ae aeei?enoiaoaaoe aecia/aiiy aaaaoaoeaiiai noaio ca iiaeeo?eiaaiith oaaeeoeath Aaeia. 5. O yeino? aeiiii?aeieo e?eoa???a aoaeoeaiino? Nooiaiaai? oa?ai?? AA o ae?oae iiaeooue aooe aeei?enoai? aiceiio?e?y iie?ioe oa iieacieee iii?oi?eiao ooieoe?? ciai?oiueiai aeeoaiiy, c yeeo iaea?eueoa “/ooeeaei” ? IIOA, aeiaiaee ?iceeae IIOA oa IOI. 6. I?ae /an anoiaoe/iiai iaiaaeo iaaeaiiy iaa?aeeeaaeii? aeiiiiiae ?aeiiaiaeo?ii i?iaiaeeoe a?aeiia?aeii aei ianooiiiai aeai?eoio: A E A I ? E O I IAAeAIIss AeIIIIIAE Ae?OssI I?Ae *AN AINO?IAI IAIAAeO A?IIO?AEUeII? ANOIE Ee?i?/i? iciaee: Aaciaee neeaae e?ia?: *anoioa aeeoaiiy 40/oa. ?a NI2 45ii Hg *anoioa ioeueno 110/oa. ?a I2 60ii Hg IIOA 80% pI 7,35 ?io? neiioiie /aeenoaioe?ei? o?eie, ?ioa?einoaeuei? aoyae?iiy, oe?aiic, a?aaeeea?ae?y, a?iioaic?y, ii?ooaiiy iiae, i?i? eaaai?/ ? Ii/aoeiaa e?eoaaiiy: 1. ?iaaeyoe?y caieiaeaiiai eenith /eiioeaio?aoe?y 60%; aeaa?o 4e/oa./ 2. ?iaaeyoe?y oaeaeeiae?th/iai ?2-aaii?noa /naeueaooaiie, oaiioa?ie, oa?aooae?i/ - 2 ?iaaeyoe?ei? aeice /a?ac niaena? /iaaoeaeca?/ c ?ioa?aaeii 20 oaeeei. Ca iaiiaeeea?noth ?iaaeyoe?? ?2-aaii?noa aaanoe eiai ia?aioa?aeueii /naeueaooaiie aeicith 0,1ia/1,75i2 iiaa?oi? o?ea, ?ic/eiaiee o 10ie 5%aetheice/, aai ?ic/ei aae?aiae?io 1:1000 - 0,01ie/ea i?aeoe??ii. ? Ioe?iea a?aeiia?aeiino?: E?eoa??? A?aeiia?aea? Ia a?aeiia?aea? *anoioa aeeoaiiy 40/oa 40/oa *anoioa ioeueno 110/oa 110/oa ?ioa?einoaeuei? aoyae?iiy a?aenooi? i?enooi? IIOA 80% 80% Ia?aaeyae e?eoaaiiy ?ioaineaia oa?ai?y: -a2aaii?noe ca iio?aaith; -i?ioecaiaeuei? i?aia?aoe a?aeiia?aeii aei nooiaiy AA /?ioae, Oaeeaae, ?iaa- eyoe?ei? ei?oeeinoa?i?aee/; -neiioiiaoe/i? caniae /ioeie?oeee/ -?iaaeyoe?y eenith; -oie?iie?oeee ?iaaeyoe?eii (“Ao?iaaio” a aeic? 20-40iea); -ei?oeeinoa?i?aee a/a a ii/aoeia?e aeic? 1-2 ia/ea; -aoo?e?i aeicith aei 10-20ia/ea a/a; -?iooc?eia oa?ai?y ? Ioe?iea e?eoaaiiy: A?aeiia?aeath/a oi?ia Iaa?aeiia?aeath/a oi?ia Ia?aaaaeaiiy ia iiaeaeueoa e?eoaaiiy a?aeiia?aeii aei nooiaiy AA Ia?aaaaeaiiy aei a?aeae?eaiiy ?aai?iaoe?? Aeey niaoe?ae?ciaaiiai e?eoaaiiy: - ?iaaeyoe?y eenith; -aaeee? aeice ei?oeeinoa?i?ae?a a/a; -aoo?e?i aei 24ia/ea a/a; -a?iioineii?y oa OAE i?e iaaoaeoea- iino? aeeoaiiy IA?AE?E I?AOeUe, IIOAE?EIAAIEO CA OAIITH AeENA?OAOe?? 1. Eeeiaiei A.A. Yooaeoeaiinoue nia?aiaiiuo iaoiaeia ea/aiey a?iioeaeueiie anoiu o aeaoae //Aanoiee i?iaeai aeieiaee e iaaeeoeeiu. – 1998. - ?16. – N.80-82. 2. Eeeiaiei A.A. Eiaaeyoeeiiiua aetheiei?oeeieaeu a ea/aiee a?iioeaeueiie anoiu o aeaoae //Aanoiee i?iaeai aeieiaee e iaaeeoeeiu. – 1998. - ?21. – N.67-69. 3. Eiaeaiyea A.E., Eeeiaiei A.A. A?iioeaeueiay anoia o aeaoae // Iaaeaeoia?iaeiue iaaeeoeeineee aeo?iae. – 1998. – O.4, ?3. – N.38-40. 4. Eeeiaiei A.A. Ioeaiea Nooiai/aoie noaiu ea/aiey a?iioeaeueiie anoiu o aeaoae // Iaaeeoeeia naaiaeiy e caao?a. – Oa?ueeia. – 1997. – N.87-88. Aiioaoe?y Eeeiaiei A.A. Aoaeoeai?noue Nooiaiaai? oa?ai?? a?iio?aeueii? anoie o ae?oae. - ?oeiien. Aeena?oaoe?y ia caeiaoooy iaoeiaiai nooiaiy eaiaeeaeaoa iaaee/ieo iaoe ca niaoe?aeuei?noth 14.01.10 - iaae?ao??y.– Oa?e?anueeee aea?aeaaiee iaaee/iee oi?aa?neoao, Oa?e?a, 1999. Aea/aii ee?i?ei-?ioiieia?/i? iniaeeaino? a?iio?aeueii? anoie o ae?oae aaeeeiai i?iieneiaiai oeaio?o No?aeii? Oe?a?ie ia no/aniiio aoai?. Aeiaaaeaii aoaeoeai?noue e?eoaaiiy ae?oae, oai?eo ia AA, a?aeiia?aeii aei ?aeiiaiaeaoe?e I?aeia?iaeiiai Eiinainono c i?iaeai ae?aaiinoeee oa e?eoaaiiy AA (1992). C o?aooaaiiyi ?iaeea?aeoaeueieo iniaeeainoae ia?aa?ao caoai?thaaiiy, aei noaie aianaii aeiiiaiaiiy, ui aeicaieythoue i?aeaeueoe aoaeoeai?noue e?eoaaiiy AA o ae?oae: iaa?oue ia I nooiai? AA o?eaae?noue e?eoaaiiy “?ioaeii” iiaeiia neeaaeaoe uiiaeiaioa 3 i?nyoe?; ii?yae ?c ?2-aaii?noaie ei?ioei/anii? ae??, ca iayaiino? i?/ieo iaiaae?a AA, ne?ae aaeeaaoe ?2-aaii?noe ? oaio?e?ie i?ieiiaiaaii? ae?? aaea i?e I nooiai? AA; aeey ciaioaiiy iie?i?aaiac?? a e?eoaaii? oai?eo ia AA II-III nooiaiy ? aeeoa?aioe?eiaaiiai i?ecia/aiiy ?2-aaii?no?a ? oie?iie?oee?a ne?ae aeei?enoiaoaaoe iieacieee aaaaoaoeaiiai noaio ca iiaeeo?eiaaiith oaaeeoeath Aaeia. Iniiai? ?acoeueoaoe ai?iaaaeaeaii a ee?i?/io i?aeoeeo. Eeth/ia? neiaa: ae?oe, a?iio?aeueia anoia, e?eoaaiiy, Nooiaiaaa oa?ai?y, aoaeoeai?noue. Aiiioaoeey Eeeiaiei A.A. Yooaeoeaiinoue Nooiai/aoie oa?aiee a?iioeaeueiie anoiu o aeaoae. – ?oeiienue. Aeenna?oaoeey ia nieneaiea o/?iie noaiaie eaiaeeaeaoa iaaeeoeeineeo iaoe ii niaoeeaeueiinoe 14.01.10 – iaaeeao?ey.– Oa?ueeianeee ainoaea?noaaiiue iaaeeoeeineee oieaa?neoao, Oa?ueeia, 1999. Eco/aiu ?ani?ino?ai?iiinoue e eeeie/aneea iniaaiiinoe a?iioeaeueiie anoiu o aeaoae e?oiiiai i?iiuoeaiiiai oeaio?a Ainoi/iie Oe?aeiu ia nia?aiaiiii yoaia. Auyaeaiu eiioiieiae/aneea iniaaiiinoe aeaoae, no?aaeathueo AA. I?iecaaaeaii ?aiaee?iaaiea ioeeiiaiee eiioiieiae/aneeo iieacaoaeae io ii?iu aeey ii?aaeaeaiey iaeaieaa cia/eiuo iaoiaaiaoe/aneeo iaoaieciia caaieaaaiey. Auyaeai oa?aeoa? nayce iaaeaeo iniaaiiinoyie aaaaoaoeaiiai noaoona e oyaeanoueth a?iioeaeueiie anoiu. Onoaiiaeaii ianiioaaonoaea ii?iaoeaiuo aeaiiuo IINA e nooi/iiai ?aca?ina IINA, i?aaeeiaeaiiuo Eiinainonii aeey ac?ineuo aieueiuo, iieacaoaeyi o aeaoae. I?aaeeiaeaiu iao/ii iainiiaaiiua ii?iaoeaiua ia?aiao?u e aeiaa?eoaeueiua eioa?aaeu IIAN e nooi/iiai ?aca?ina IINA aeey ii?aaeaeaiey oyaeanoe AA o aeaoae. Auyaeaiu iaeaieaa eioi?iaoeaiua ia?aeeeie/aneea e eino?oiaioaeueiua iieacaoaee aeey ioeaiee aeeiaieee caaieaaaiey. I?iaaaeaia n?aaieoaeueiay ioeaiea yooaeoeaiinoe ea/aiey aeaoae, aieueiuo AA, niaeanii ?aeiiaiaeaoeeyi Iaaeaeoia?iaeiiai Eiinainona ii i?iaeaiai aeeaaiinoeee e ea/aiey AA (1992) i?e e?aeie, n?aaeiaoyae?eie e oyae?eie oi?iao caaieaaaiey. N o/?oii eiaeeaeaeoaeueiuo iniaaiiinoae oa/aiey aieacie a noaio aianaiu aeiiieiaiey, iicaieythuea iiauneoue yooaeoeaiinoue ea/aiey AA o aeaoae: i?iaeieaeeoaeueiinoue i?eiaiaiey Eioaea aeaaea i?e e?aeie noaiaie caaieaaaiey aeieaeia ninoaaeyoue ia iaiaa 3 ianyoeaa; ia?yaeo n ?2-aaiienoaie ei?ioeiai aeaenoaey, i?e iaee/ee ii/iuo i?enooiia AA iaiaoiaeeii eniieueciaaoue aae?aiiieiaoeee e oaioeeeeiu i?ieiiae?iaaiiiai aeaenoaey oaea ia I nooiaie AA; aeey oiaiueoaiey iieei?aaiacee a ea/aiee AA e aeeooa?aioee?iaaiiiai iacia/aiey aae?aiiieiaoeeia e oieeiieeoeeia ia II-III nooiaie AA ?aeiiaiaeiaaii ii?aaeaeaiea aaaaoaoeaiiai noaoona ii iiaeeoeoee?iaaiiie oaaeeoea Aaeia. I?aaeeiaeai aeai?eoi iaioeiaeiie iiiiue aeaoyi i?e i?enooia AA. Iniiaiua ?acoeueoaou aiaae?aiu a eeeie/aneoth i?aeoeeo. Eeth/aaua neiaa: aeaoe, a?iioeaeueiay anoia, ea/aiea, Nooiai/aoay oa?aiey, yooaeoeaiinoue. Abstract Klimenko V.A. Efficiency of Step’s therapy of bronchial ashtma in children. - Manuscript. Thesis for candidate’s degree by speciality 14.01.10 - pediatrics.- Kharkov State Medical University, Kharkov, 1999. Current clinical-immunological peculiar features of bronchial asthma (BA) for children in big industrial centre of East Ukraine are studied. The treatment of children ill with BA by the recommendations of the International Consensus Report on Diagnosis and Management of Asthma (1992) is proved to be effective. With due account of individual peculiarities of the course of BA, the scheme of treatment was supplemented with some essential points, permitting one to increase the effectiveness of treatment of children ill with BA: -even for slight BA the period of taking cromoglyn sodium must be 3 months as a minimum; -with night-time attacks of BA a2-agonistes and theophyllines of prolonged action should be used even in the I step of BA; -to reduce polypragmasia in treatment of BA and to prescribe differentially sympathomimetics and cholinolithics in the II-III steps of BA, one should determine vegetative status by the Wein modified table. The basic results are inculcated to clinical practice. Key words: children, bronchial ashtma , treatment, Step’s therapy, efficiency. Aeei?enoai? nei?i/aiiy AA – a?iio?aeueia anoia CI – caeeoeiaee ia’?i AE?E – aeeoo?aa ?ie?noue eaaaiue e – eaeeioeeoe eo; O-eo; A-eo; I – e?ioioeeoe oa ?o noaiiioeyoe?? IOA1 – ia’?i oi?niaaiiai aeaeeoo ca 1 nae. IIOA – i?eiaa ia’?iia oaeaee?noue aeaeeoo IOI – iiaaiioaoiiao??y OAE – oaaioeeoa?ia aeoeai?noue e?ioioeeo?a OCAe – ooieoe?y ciai?oiueiai aeeoaiiy

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