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Підвищення ефективності пренатальної діагностики хромосомної патології: Автореф. дис… канд. біол. наук / Л.А. Хлівна, Укр. наук. гігієн. центр. — К.

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OE?A?INUeEEE IAOEIAEE A?A??I?*IEE OeAIO?

OE?AIA

Ethaeieea Aiaoie??aia

OAeE 618.3: 616-053.1/-076.5

I?AeAEUAIIss AOAEOEAIINO? I?AIAOAEUeII? Ae?AAIINOEEE O?IIINIIII?
IAOIEIA??

03.00.15 – aaiaoeea

Aaoi?aoa?ao aeena?oaoe??

ia caeiaoooy iaoeiaiai nooiaiy

eaiaeeaeaoa a?ieia?/ieo iaoe

EE?A – 1998

Aeena?oaoe??th ? ?oeiien.

?iaioa aeeiiaia a Aeiiaoeueeiio i?aeiaeaniiio iaaeeei-aaiaoe/iiio
oeaio?? IIC Oe?a?ie.

Iaoeia? ea??aieee: aeieoi? iaaee/ieo iaoe

A?aociaa Na?oeaia Ai?en?aia,

Aeiiaoeueeee i?aeiaeaniee

iaaeeei-aaiaoe/iee oeaio?,

caa?aeoth/a,

aeieoi? iaaee/ieo iaoe, i?ioani?

Aa?eeye ?ai? ?iiaiiae/,

Oe?a?inueeee iaoeiaee

a?a??i?/iee oeaio?, aee?aeoi?.

Io?oe?ei? iiiiaioe: aeieoi? iaaee/ieo iaoe, no. i. n.

I?e?inueea Ia??y Aiae???aia,

?inoeooo aenia?eiaioaeueii?

?aae?ieia?? iaoeiaiai oeaio?o

AII Oe?a?ie,

caa?aeoth/a a?aeae?eii oeeoiaaiaoeee,

eaiaeeaeao a?ieia?/ieo iaoe, no. i. n.

Noaoaiiae/

Aaiia Aieiaeeie??aia

Oe?a?inueeee iaoeiaee oeaio?

iaaee/ii? aaiaoeee, caa?aeoth/a

a?aeae?eii ?aiiueiai ?icaeoeo

ethaeeie.

I?ia?aeia onoaiiaa: Iaoe?iiaeueiee Oi?aa?neoao ?i. Oa?ana Oaa/aiea,
I?i?noa?noai Ina?oe Oe?a?ie, eaoaae?a caaaeueii? oa iieaeoey?ii?
aaiaoeee, i. Ee?a.

Caoeno a?aeaoaeaoueny 28 n?/iy 1999 ?. i 10 aiaeei? ia can?aeaii?
niaoe?ae?ciaaii? a/aii? ?aaee Ae26.604.01 Oe?a?inueeiai iaoeiaiai
a?a??i?/iiai oeaio?o, 253660, i. Ee?a-94, aoe. Iiioae?aiea, 50.

C aeena?oaoe??th iiaeia iciaeiieoenue o a?ae?ioaoe? Oe?a?inueeiai
iaoeiaiai a?a??i?/iiai oeaio?o,

Ee?a-94, aoe. Iiioae?aiea, 50.

Aaoi?aoa?ao ?ic?neaiee 25 a?oaeiy 1998 ?.

A/aiee nae?aoa? niaoe?ae?ciaaii? a/aii? ?aaee ______________ Naeaciueia
A.TH.

CAAAEUeIA OA?AEOA?ENOEEA ?IAIOE

Aeooaeueiinoue oaie. Iaeiith c aaaeeeaeo caaea/ iaaee/ii? aaiaoeee
? i?ioieaeoeea o?iiiniiieo caoai?thaaiue, yei iathoue cia/io ieoiio aaao
a no?oeoo?i i?e/ei aeeoy/i? nia?oiinoi oa iiaaeiaeiinoi.

Aeooaeueiinoue i?iaeaie iineeth?oueny aenieith iiioeyoeieiith
/anoioith o?iiiniiieo neiae?iiia, yei aeyaeythoueny o 7 c 1000
aeeaiia?iaeaeaieo aeioae (Aa?eeye I.?., Aiaoaeei I.C., 1991(. *anoioa
iaeaieueo iioe?aii? iaoieiai? – neiae?iio Aeaoia (NAe) – neeaaea? a
na?aaeiueiio 1 ia 800-1100 iiaiia?iaeaeaieo (Eacthe A.E., 1979; Aa?eeye
?.?. ? ni?aaao., 1984; Eiceiaa N.E., 1987; A?aociaa N.A., 1996(.

Aoaeoeaiinoue i?aiaoaeueii? aeiaaiinoeee (IAe) o?iiiniiieo
caoai?thaaiue caeaaeeoue, aieiaiei /eiii, aiae ?ioaiiy aeaio ieoaiue –
oi?ioaaiiy a?oi ?eceeo, a yeeo i?iaiaeyoueny iiaaceaii aeineiaeaeaiiy,
oa aeai?o iaoiaeia, ui aeei?enoiaothoue aeey oeeoiaaiaoe/ii? IAe.
A?aoiaoth/e oa, ui ia?aaaaeia aieueoinoue o?iiiniiieo neiae?iiia
aiaeiinyoueny aei iooaoeie «de novo», oieueee ?ic?iaea /ioeeo e?eoa?i?a
oa ?aoaeueiee aiaeai? aaaioieo i?e i?ecia/aiii iiaaceaii? IAe iiaea
iiaeaeueoe nooiiiue aeyaeaiiy o?iiiniiii? iaoieiai? aiaeii/an ic
cieaeaiiyi ianyao aeeiioaaieo aeiaaiinoe/ieo iaiiioeyoeie.

Oi?ioaaiiy a?oi ?eceeo iiaeiii cae?enithaaoeny c o?aooaaiiyi
iniaeeainoae iiioeyoei?. Aeei?enoaiiy o?aaeeoeieiiai iieacaiiy aeey
i?iaaaeaiiy iiaaceaieo aeineiaeaeaiue – aie aeiiee aieueoa 35 ?ieia – ia
iiaea nooo?ai aieeiooe ia iiioeyoeieio /anoioo o?iiiniiieo caoai?thaaiue
a Oe?a?ii, oiio ui eieueeinoue eioiio aaaioieo ia ia?aaeuo? 9% (Arbuzova
S.B., 1997(.

I?e aeai?i iaoiaeia iiaaceaii? IAe iaiaoiaeiith oa iaia(yceiaith
oiiaith ? aacia/iinoue ? aeniea iioi?iaoeaiinoue aeineiaeaeaiiy. Oaeei
aeiiaai ia?o ca ana aiaeiiaiaea? o?ainaaaeiiiiaeueiee aiiiioeaioac (AOe)
(Tabor A., 1988; Mennuti M., 1989; Wolstenholme J., 1994(.

I?ioa, aiaeic aiiiioe/ii? ?iaeeie (A?) ia iaea?aeaa iioe?aiiai
aeei?enoaiiy a Oe?a?ii /a?ac o?oaeiiinoe?noue aeineiaeaeaiiy oa o?eaaeee
oa?i?i eoeueoeaoaaiiy, ui iiynith?oueny iaaeineiiaeinoth o?aaeeoeieii
aeei?enoiao?ieo eoeueoo?aeueieo iaoiaeee (Cieioooeia O.A.,1980; Nadler
H., 1969; Gregson N., 1970; Nelson M., 1973(.

O ca(yceo c aeuacacia/aiei, iaoith aeineiaeaeaiiy ? oaeineiiaeaiiy
iaoiaeieiai/ieo oa iaoiaee/ieo iiaeoiaeia aei aeiiieiaiai? aeiaaiinoeee
o?iiiniiii? iaoieiai?.

Caaaeaiiy aeineiaeaeaiiy.

1. Aecia/eoe iiaeeeainoi noeioeyoei? ?inoo aiiiioeeoia iaeii/anii
c? cieaeaiiyi aeo?ao oa /ano, iaiao?aeieo aeey eoeueoeaoaaiiy
aiiiioe/ii? ?iaeeie.

2.?ic?iaeoe iioeiaeueii oiiae io?eiaiiy o?iiiniiieo i?aia?aoia
aeniei? yeinoi c eoeueoo?e eeioei aiiiioe/ii? ?iaeeie.

3.Iaa?oiooaaoe aeiaaiinoe/io cia/ouinoue ia?aaaaeiiai aeei?enoaiiy
o?ainaaaeiiiiaeueiiai aiiiioeaioaco aeey IAe o?iiiniiii? iaoieiai?.

4.I?iaiaeicoaaoe aoaeoeaiinoue aeyaeaiiy o?iiiniiii? iaoieiai? a
?iciiiaiioieo a?oiao aaiaoe/iiai ?eceeo.

5.Anoaiiaeoe iaeaieueo iioi?iaoeaii e?eoa?i? oi?ioaaiiy iioieia ia
iiaaceaio i?aiaoaeueio aeiaaiinoeeo.

Iao/ia iiaecia aeineiaeaeaiue.

1. Anoaiiaeaii oaeoi?e, ye? aieeaathoue ia o?eaae?noue no?ie?a
eoeueoeaoaaiiy aii?ioeeo?a.

2. Cai?iiiiiaaii niinia io?eiaiiy aenieiyeinieo o?iiiniiieo
i?aia?aoia c 25-30 iaoaoacaie ia neei.

3. Aia?oa aeeiiaii ?iaioo c ii?iaiyeueii?e oa?aeoa?enoeee yeinoi
eoeueoo?e c ee?oei A? oa aioiaeo o?iiiniiieo i?aia?aoia, a caeaaeiinoi
aiae neeaaeo eoeueoo?aeueieo na?aaeiaeu.

4. Cai?iiiiiaaii iiaee aeeoa?aioeieiaaiee iiaeoiae aei oi?ioaaiiy
a?oi aenieiai aaiaoe/iiai ?eceeo c o?aooaaiiyi aieo aaaioieo,
aeooa?nueeiai aiaiiaco, aeaieo aiioiii/iiai oa OC-ne?eiiiaia.

Oai?aoe/ia oa i?aeoe/ia cia/ouinoue aeineiaeaeaiiy.

1. Cai?iiiiiaaii iiaeeoieiaaio iaoiaeeeo eoeueoeaoaaiiy oa
oienaoei? aiiiioeeoia, yea aeicaiey? a iaeei?iooee oa?i?i i?iaanoe
oeeoiaaiaoe/iee aiaeic.

2. I?iaaaeaii iiaeai? eoeueoo?aeueieo noiio?a c iioeiaeueiei
neeaaeii, yeee aeicaiey? cieceoe aeo?aoe ?iai/iai /ano oa ?aaeoeaia, ui
aeei?enoiaothoueny i?e eoeueoeaoaaiii oa oienaoeii aiiiioeeoia.

3. Cai?iiiiiaaii iiai i?eioeeie aei oi?ioaaiiy iioieia ia
oeeoiaaiaoe/io aeiiieiaiao aeiaaiinoeeo c ?ic?aooieii iiaeeaiaeoaeueiiai
?eceeo, yei aeicaieythoue iiaeaeueoe aoaeoeaiinoue aeyaeaiiy o?iiiniiii?
iaoieiai? iaeii/anii c? cieaeaiiyi eieueeinoi i?iaaaeaieo iiaaceaieo
aeineiaeaeaiue.

4. Oaeineiiaeaii o?aaeeoeieiee iiaeoiae aei i?ecia/aiiy iiaaceaieo
aeineiaeaeaiue aaaioiei aieii iiiaae 35 ?ieia.

Ai?iaaaeaeaiiy a i?aeoeeo.

Io?eiaii aeaii iieeaaeaii a iniiao i?ecia/aiiy oa i?iaaaeaiiy
iiaaceaieo aeineiaeaeaiue a Aeiiaoeueeiio IIAOe. Iiaeeoieiaaia iaoiaeeea
eoeueoeaoaaiiy oa oienaoei? aiiiioeeoia aeei?enoiao?oueny a ?yae?
aaiaoe/ieo eiinoeueoaoeie oa oeaio??a Oe?a?ie.

Iiai i?eioeeie oi?ioaaiiy a?oi aenieiai aaiaoe/iiai ?eceeo
a?aoiaothoue i?e ?iaioi c aaaioieie a aeiii/eo eiinoeueoaoeiyo oa
iieiaiaeiiiiiaeieo caeeaaeao.

Ia iiaenoaai ?acoeueoaoia ?iaioe aoee cai?iaaaeaeaii
?aoeiiiaeicaoi?nueei i?iiiceoei?: «Niinia iieo/aiey o?iiiniiiuo
i?aia?aoia ec eoeueoo?u eeioioeeoia ia?eoa?e/aneie e?iae»; «Niinia
iieo/aiey o?iiiniiiuo i?aia?aoia ec eoeueoo?u aiieioe/aneie aeeaeeinoe»
(?? 3416, 3417, 1996 a.).

Iniiai? iieiaeaiiy aeena?oaoe?? aoee ?ic?iaeai? a ?aieao
Iaoe?iiaeueii? I?ia?aie «Ae?oe Oe?a?ie», caoaa?aeaeaiith Oeacii
I?aceaeaioa Oe?a?ie ?63/96 a?ae 18.01.96.

Iniaenoee aianie caeiaoaa/a a i?iaaaeaiiy aeine?aeaeaiue.

Aeena?oaio iniaenoi ?ic?iaea ? cai?iaaaeea a i?aeoeeo Aeiiaoeueeiai
iiaeiaeaniiai iaaeeei-aaiaoe/iiai oeaio?o iiaeeoieiaaio iaoiaeeeo
eoeueoeaoaaiiy oa oienaoei? aiiiioeeoia. Aeena?oaioii iniaenoi
aiooaaeeny aeeaeeueii na?aaeiaeua, yei aeei?enoiaoaaeeny aeey
eoeueoo?aeueieo aeineiaeaeaiue, aeeiioaaany oeeoiaaiaoe/iee aiaeic
eeioei aiiiioe/ii? ?iaeeie, aiiioaoo ieaoeaioe oa ioiiaeiii? e?iai,
i?iaiaeeany aiaeic io?eiaieo aeaieo. Aaoi?ii naiinoieii ii?aoeueiaaii
?acoeueoaoe ?iaioe oa iiaeaioiaeaiee oaeno aeena?oaoei?.

Ai?iaaoeiy ?acoeueoaoia ?iaioe.

Iniiaii iieiaeaiiy aeena?oaoeieii? ?iaioe aeiiiaiaeaeeny ia: 2-io
c(?caei iaaee/ieo aaiaoeeia Oe?a?ie (aeiaoaiue 1995, Euea?a);
eiioa?aioeiyo ii i?aiaoaeueiie aeiaaiinoeoei a Oeaio?aeueieo oa
Noiaeii?a?iiaenueeeo e?a?iao (aa?anaiue 1996, I?aaa; /a?aaiue 1997,
Aoaeaiaoo); 1-io Eiia?ani Oe?a?inueei? Anioeiaoei? niaoeiaeinoia
oeueo?acaoeiai? aeiaaiinoeee a ia?eiaoieiai?, aaiaoeoei oa aiiaeieiai?
(o?aaaiue 1997, Oa?eia); iaeanieo, iinueeeo oa iiae?aeiiieo naiiia?ao c
iaaee/ii? aaiaoeee (1993-1998 ??.).

Ioaeieaoei?.

C oaie aeena?oaoei? iioaeieiaaii 11 ?iaio, a oiio /ene? 6
aeo?iaeueieo noaoae.

Ia(?i oa no?oeoo?a ?iaioe.

Aeena?oaoeieia ?iaioa aeeeaaeaia ia 137 noi?iieao iaoeiiieniiai
oaenoo o aeaeyae? 5 ?icae?e?a ? neeaaea?oueny c anooio, iaeyaeo
eioa?aoo?e, iieno ia’?eoo oa iaoiaeee aeine?aeaeaiiy, ?icae?e?a aeanieo
aeine?aeaeaiue, iaaiai?thaaiiy ?acoeueoao?a, aeniiaeia oa nieneo
eioa?aoo?e. Oaeno aeena?oaoei? iethno?iaaiee 15 oaaeeoeyie oa 20
iaethieaie. Nienie eioa?aoo?e iinoeoue 196 iaca.

CIINO ?IAIOE

Iaoa?iaee oa iaoiaee aeineiaeaeaiiy.

Eiiieaenia i?aiaoaeueia aeiaaiinoeea caeienithaaeany a
Aeiiaoeueeiio IIAOe. Oi?ioaaiiy iioieia ia iiaaceaii aeineiaeaeaiiy
aeeiioaaeiny ia iiaenoaai aeaieo aiaiiaco, ?acoeueoaoia oeeoiaaioe/ieo
aeineiaeaeaiue, oeueo?acaoeiaiai oa aiioiii/iiai ne?eiiiaia.

Oeueo?acaoeiaee ne?eiiia i?iaiaeeany ca noaiith, cai?iiiiiaaiith
A?a/aiiiith I.ss. (1992).

I?e aiaeici ia?ea?ia iaoa?einueei? ne?iaaoee (IN) aeei?enoiaoaaeeny
?ic?iaeaii aaciai oa a?aie/ii cia/aiiy aeueoa-oaoii?ioaiio (AOI) oa
oi?iiii/iiai aiiaaeio?iiiio (OA) aeey eiaeiiai oeaeiy aaaioiinoi oa ?o
ciiio i?e o?iiiniiieo ii?ooaiiyo o ieiaea (Ieeieaiei I.E., 1997(.
Eiiaiiiaaiee ?ecee ?ic?aoiaoaaee caiaeii i?eioeeio Wald i Cuckle (1988).

Aeey iiaaceaii? IAe ia?aaaaeii aeei?enoiaoaaany
o?ainaaaeiiiiaeueiee aiiiioeaioac. Iniiaith aeey i?iaaaeaiiy
aeineiaeaeaiue noaei oaeineiiaeaiiy o?aaeeoeieiiai niiniao io?eiaiiy
o?iiiniiieo i?aia?aoia c eoeueoo?e A?. Iiaeeoieiaaia iaoiaeeea aoea
ii?aoeueiaaia ia 150 eoeueoo?ao ia?aeaeueii c eoeueoeaoaaiiyi i
oienaoei?th A? ca eeane/iith iaoiaeeeith (Nadler, 1969; Gregson, 1970;
Nelson, 1973(.

Onueiai i?iaaaeaii 1603 aiiiioeaioaca, 104 ieaoeaioioeaioaca i 11
ei?aeioeaioacia. Anii?aoeiy iaoa?iaeo aeey iiaaceaieo aeineiaeaeaiue
i?iaiaeeeanue o oa?iiii aaaioiinoi 14-25 oeaeiia iiae eiio?ieai
oeueo?acaoeiaiai neaia?o Aloka – SSD 630.

Aeey ioeiiee o?iiiniiiiai iaai?o a eeioeiao ieaoeaioe aiaeicoaaee
i?aia?aoe, aeaioiaeaii «iaiiai?yiei» iaoiaeii (Eoeaoia I.I., 1989(.

Eoeueoeaoaaiiy ioiiaeiii? e?iai ieiaea oa ia?eoa?e/ii? e?iai
aaoueeia i?iaiaeeee ca caaaeueiiaeciaiith iaoiaeeeith (Hungerford D.,
1965(, aeei?enoiaoth/e cai?iiiiiaaiee iaie niinia neio?iiicaoei? iioicia
a eoeueoo?i – aei ii/aoeo oienaoei? eoeueoo?o eiioioeeoia aeo?eioaaee
2-2,5 aiaeeie o oa?iinoaoi c oaiia?aoo?ith 36 (N.

Aeey io?eiaiiy aeeoa?aioeieiiai caaa?aeaiiy o?iiinii, ioeiiee
?icii?ia aaoa?io?iiaoeiiaeo oa yaea?oeaooai?thth/eo ?aeiiia
aeei?enoiaoaaee G-, C- i Ag- iaoiaee (Naeaciaa TH.A., 1972; Sumner,
1971; Bloom, 1976(.

Iaoaiaoe/ia ia?iaea ?acoeueoaoia aeeiioaaeanue ia eiii(thoa?i IBM
PC/AT 486 c aeei?enoaiiyi i?ia?aie STATGRAPHICS aa?ni? 3.0; Excel 5.0;
SAS aa?ni? 6.04.

?acoeueoaoe aeineiaeaeaiue oa ?o iaaiai?aiiy

Iiaeeoieaoeiy aoaiia eoeueoeaoaaiiy aiiiioe/ii? ?iaeeie.

Aoee anoaiiaeaii /eiieee, yei aieeaathoue ia o?eaaeinoue
eoeueoeaoaaiiy aiiiioeeoia oa yeinoue o?iiiniiieo i?aia?aoia.

I?aeoe/ii a onio inioth/eo ia nueiaiaeii iaoiaeeeao ianooiiei ca
anii?aoei?th A? i?iaiaeyoue aoai oeaio?eooaoaaiiy io?eiaii? ?iaeeie c
iaoith aiaeie?aieaiiy aia?iiiaeueieo eeioei aiae iioi? noiioi. Iiae /an
oeaio?eooaoaaiiy eeioeie iiaeooue iioeiaeaeoaaoeny; e?ii oiai, i?e
aiaeie?aieaiii iaaeinaaeiai? ?iaeeie aiaeaoaa?oueny ?o /anoeiaa ao?aoa.
Oaeei /eiii, a oeie i?iai A? ia?ainii cieaeaia i?ie?oa?aoeaia
aeoeaiinoue aiiiioeeoia.

I?e onoiaiii aoaio oeaio?eooaoaaiiy A?, yeee aenooia? ia?aae
noaaeaiiyi eoeueoo?e, /a?ac 72 aiaeeie iiney ii/aoeo eoeueoeaoaaiiy ia
aeii oeaeiio aoei aiaeii/aii cia/io eieueeinoue i?ee?iieaieo aei
noano?aoo eeioei. E??i oiai, aei oeueiai /ano o 75% eoeueoo? aoee
noi?iiaaii eieiii? aeiaiao?ii 2-3 ii. A ia?aeaeueiie eoeueoo?i, aea A?
iiaeeyaaea oeaio?eooaoaaiith, ca aiaeiai/iee i?iiiaeie /ano eieueeinoue
i?ee?iieaieo aei eoeueoo?aeueii? iiaa?oii eeioei aoea cia/ii iaioith.

Aaaeeeaei /eiieeii, yeee ni?ey? nei?i/aiith /ano eoeueoeaoaaiiy, ?
aeei?enoaiiy aenia?eiaioaeueii aeia?aieo eiiieaenieo aeeaieueieo
noiioia, aei yeeo aoiaeyoue neioaoe/ii na?aaeiaeua Ham’s F-10, Ham’s
F-12, RPMI – 1640, a oaeiae aia?iiiaeueia oaey/a ne?iaaoea (AON) (80 oa
20%, aiaeiiaiaeii). I?e eoeueoeaoaaiii A? ia caaaeueiiaeciaiiio
na?aaeiaeui Chang’s, niaoeiaeueii i?ecia/aiiio aeey noeioeyoei?
a’yei?inoo/eo eeioei oa eiiie (Chang H., 1991(, i eiiieaeniie
aeeaeeueiie noiioi, /aniaeo aiaeiii ia aiaecia/aii. E?ii oeueiai,
aa?oinoue na?aaeiaeua Chang’s iaeaea a 10 ?acia ia?aaeuo? aa?oinoue
eiiieaeniiai na?aaeiaeua.

Aaaeeeaith ia?aaaaith cai?iiiiiaaii? iaoiaeeee ? oa, ui aiia ia
iio?aao? aeei?enoaiiy NI(- iieoaaoi?a aeey eoeueoeaoaaiiy eeioei A?, oae
ye iiaeia?aiee neeaae noiioia, aei yeeo aoiaeeoue HEPES, aeicaiey?
iiaeo?eioaaoe iioeiaeueiee ?iaaiue eeneioiinoi (7.2-7.4). Aiaenooiinoue
NI(-iieoaaoi?a /anoi aenooia? ia?aoeiaeith aeei?enoaiith aiiiioeeoia
aeey oeeoiaaiaoe/ii? IAe, oiio ui ani o?aaeeoeieii iaoiaeeee aaeaioiaaii
naia aei oei?? oiiai eoeueoeaoaaiiy ee?oei A?.

Ua iaeiei eoeueoo?aeueiei caoiaeii, yeee aieeaa? ia oa?i?i
eoeueoeaoaaiiy, yeinoue o?iiiniiieo i?aia?aoia oa aa?oinoue ianoaaeaiue,
? ciiia aeeaeeueii? noiioi ia ?ai?oa 5-6 aeiae. Iaoi aeineiaeaeaiiy
aeiaaee, ui, ia aiaeiiio aiae eeane/ieo iaoiaeee, iaia? iio?aae eiaeii
3-4 aeii i?iaiaeeoe ciiio aeeaeeueii? noiioi, oiio ui na?aaeiaeua
neeaaeaii c aaeeeei caianii iiaeeaieo ?a/iaei, ? ia i?ioyc? cacia/aiiai
ia?iiaeo /ano ae/a?iaiiy ?o ia aiaeaoaa?oueny. Ia?oo ciiio aeeaeeueiiai
noano?aoo i?iaiaeeee ca 16-18 aiaeei aei ii/aoeo oienaoei?,
neio?iiicoth/e iioioe/iee ?iciiaeie eeioei a eoeueoo?i. Caaaeyee
oeueiio, aaeaeiny caieueoeoe iioioe/iee iiaeaen o 2-2,5 ?ace ii?iaiyii c
aiaeiai/iith i?iaith A?, caoieniaaiith o?aaeeoeieiei niiniaii.
Aeaie?aoio ci?io aeeaeeueiiai na?aaeiaeua – ia 5 aeiao oa ca 16-18
aiaeei aei ii/aoeo o?enaoe?? – i?iaiaeeee eeoa a eoeueoo?? c iecueeith
i?ie?oa?aoeaiith aeoeai?noth.

Oaeei /eiii, aianeiaeie i?iaaaeaii? ?iaioe, aoea cai?iiiiiaaia
oaeineiiaeaia iaoiaeeea eoeueoeaoaaiiy oa oienaoei? aiiiioeeoia, ui
aeicaiey? i?ioyaii 7-9 aeia, ia aiaeiiio aiae eeane/ii?, yea iio?aao?
15-18 aeia, io?eiaoe o?iiiniiii i?aia?aoe aeniei? yeinoi c 25-30
iaoaoacaie ia neei (oaae. 1, iae.1).

Oaaeeoey 1

sse?nii-/aniaa oa?aeoa?enoeea o?aaeeoe?eii? oi iiaeeo?eiaaii? iaoiaeee

Iaoiaeeea, yea aeei?enoiao?oueny Ia??iae aaeaac??, aeiae Ia??iae
a?aeiia-eaiiy i?oioe/ii? aeoeaiino?, aeiae Ia??iae oi?io-aaiiy
aeeoa?ai-oe?eiaaiiai iiii-neith, aeiae E?euee?noue iaoaoac ia iaeiiio
nee?

O?aaeeoe?eia 5 5-8 15-18 10-15

Iiaeeo?eiaaia 3 3-5 7-9 25-30

Iae. 1. E?euee?noue iaoaoac, io?eiaia o?aaeeoe?eiei (a) iaoiaeii oa
iiaeeo?eiaaiei (a) c aeei?enoaiiyi neio?ii?caoe?? i?oic?a.

Cai?iiiiiaaia iaoiaeeea aoea ai?iaiaaia ia ia?aeaeueieo eoeueoo?ao
A?, yeo anii?oaaee a ?icieo oa?iiiao aaaioiinoi. *aniaeo aiaei?i i?e
eoeueoeaoaaiii A?, io?eiaii? c 16 ii 25 oeaeii, ia iiii/aii. A i?ioeani
?iaioe c A?, yea aoea anii?iaaia aei 16 oeaeiy, anoaiiaeaii, ui /an
eoeueoeaoaaiiy neeaaean a na?aaeiueiio 14 ae?a. Oiio, aeeiioth/e ?aiii
aiiiioeaioace, aeey nei?i/aiiy ia?iiaeo eoeueoeaoaaiiy A? i?iiiio?oueny
caaaaoeoe aeeaieueio noiio na?aaeiaeuai IMDM.

Iaa?oiooaaiiy ia?aaaaeiiai aeei?enoaiiy o?ainaaaeiiiiaeueiiai AOe
aeey oeeoiaaiaoe/ii? IAe.

Aieiaiith ia?aaaaith o?ainaaaeiiiiaeueiiai aiiiioeaioaco ? eiai
aacia/iinoue, ui i?iaeaiiino?iaaii oniia aeineiaeieeaie oa aoei iieacaii
o iaoie ?iaioi. ?ecee ia?a?eaaiiy aaaioiinoi iiney i?iaaaeaiiy oei??
iiaaceaii? iaiiioeyoei?, caiaeii c eioa?aoo?ieie aeaieie, ia ia?aaeuo?
0,5-0,7% (Ai/eia I.I., 1982; Tabor A., 1988; Mennuti M.,1989(. C 1603
aeiaaiinoe/ieo AOe, i?iaaaeaieo a IIAOe i. Aeiiaoeueea, ia?a?eaaiiyi
aaaioiinoi caeii/eeeny 4 iiaaceaii iaiiioeyoei?, ui neeaei 0,2% aiae
caaaeueii? eieueeinoi ianoaaeaieo. A iaeiiio c oeeo aeiaaeeia aoea
aeyaeaia o?iiiniiia iaoieiaiy ieiaea – o?eniiiy 21.

Canoiniaoth/e iiaeeoieiaaio iaoiaeeeo, yea aeicaiey? io?eiaoe
aenieiyeinii o?iiiniiii i?aia?aoe i?e cieaeaiii no?ieia eoeueoeaoaaiiy
A?, aeiaaiinoe/iee aiiiioeaioac aeeiioaaany ye aieiaiee iaoiae
iiaaceaii? ae?aaiinoeee o?iiiniiieo caoai?thaaiue.

sse aeiaeaoeiai iaoiaee ie aeei?enoiaoaaee ieaoeaioi- oa
ei?aeioeaioac. Aei iaoiaeo ei?aeioeaioaco caa?oaeeny a e?aei?o
aeiaaeeao, ui iiynith?oueny neeaaeiinoth aeeiiaiiy oa aenieei ?eceeii
oneeaaeiaiue iiney aeaii? iiaaceaii? iaiiioeyoei? (Eoeeaa A.I.,1990;
Nicolaides K., 1986(. A iaoeo aeineiaeaeaiiyo ei?aeioeaioac aeeiioaaany
c iaoith aa?eoieaoei? aeiaaiico, a oaeiae i?e cia/iiio iaeiaiaeaei –
eiee ani??aoe?y iaaeieiieiaeii? ?iaeeie aoea iaiiaeeeaa.

Ieaoeaioioeaioac i?iaiaeeee o aeiaaeeao iiciueiai caa?oaiiy aeiiee
aei IAOe (o oa?iiii aaaioiinoi 23-25 oeaeiia), a oiio /enei, i?e
aeyaeaiii a oeeo no?ieao OC-iciae o?iiiniiii? iaoieiai? ieiaea.
I?aeoe/ii ?aeeiith ia?aaaaith ieioeaioioeaioaco aoee iaei oa?i?ie
noaiieoaoaaiiy (2,5-3 aiaeeie) io?eiaiiai aiiioaoo. I?iaanoe yeiniee
o?iiiniiiee aiaeic o eeioeiao aiiioaoo ieaoeaioe aaeaeiny o 71%
aeiaaeeia. Iaaaea/i i?e aiaeici ea?iioeio a ?aooi aeiaaeeao aoee
coiiaeaii iayaiinoth aaeeei? eieueeinoi aiiiiei?aeieo ieanoeiie
aianeiaeie ao?aoe o?iiinii iiae /an iaoea?aoei? oeaieie ioeoiaith
eeneioith (10,6%), iecueeith yeinoth o?iiiniiieo ieanoeiie (10,7%),
aiaenooiinoth iaoaoac ia aioiaeo i?aia?aoao (4,8%) oa iaeei ia(?iii
anii?iaaii? oeaieie (2,9%). C aiaeiai/ieie i?iaeaiaie cono??/athoueny e
iioi aeineiaeieee, aiaeii/ath/e oaeiae i aieueo aenieee ?ecee
oneeaaeiaiue iiney aeaii? iaiiioeyoei? o ii?iaiyiii c
o?ainaaaeiiiiaeueiei aiiiioeaioacii (Eoeaoia I.I., Aa?oeaaa I.A., 1989;
Wapner R., Jackson L., 1988(.

Ia?aeaeueii c ieaoeaioioeaioacii aeeiioaaee aiiiioeaioace. Eeioeiio
iano, iio?iaio aeey oienaoei?, io?eioaaee /a?ac 7-9 aeia. C onio i?ia A?
aoee aeaioiaeaii aenieiyeinii o?iiiniiii i?aia?aoe.

Nooo?aith aaaeith ieaoeaioioeaioaco ? aeniea /anoioa oeaieiiiai
iica?oeecio, yeee ?a?no?othoue, aiaeicoth/e i?aia?aoe c aiiioaoo
ieaoeaioe. A iaoeo aeineiaeaeaiiyo aiia neeaaeaea 5,4%, oi/a a
eioa?aoo?i aeacothoue i aieueo cia/ia /enei aiaenioe?a. Oae, i?e
oeeoiaaiaoe/iiio aiaeici eeioei ieaoeaioe o 4 aeiaaeeao aoee aiaecia/aii
o?iiiniiii ii?ooaiiy: o?eniiiy ii o?iiiniiao 21 (2 aeiaaeee) oa
ia?ea?ieo o?iiiniiao (mar = G oa mar

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