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Иммунная теория сепсис

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A a?oiia iee?iaeieiae/anee aa?eoeoee?iaaiiuo eioaeoeee naiay aunieay
eaoaeueiinoue io eioaeoeee, iaoneiaeaiiuo a?aiio?eoeaoaeueiuie
aaeoa?eyie e a?eaaie I?e yoii iee?iaeieiae/aneia iiaeoaa?aeaeaiea
aiciiaeii eeoue a iieiaeia neo/aaa eioaeoeee, a onoaiiaeaiea niaeo?a
aicaoaeeoaeae e eo ?acenoaioiinoe ?anoyiooi ii a?aiaie. Iiyoiio ea/aaiay
oaeoeea eioaeoeeiiiuo ii?aaeaiee iniiauaaaony ia eeeie/anee i?i
yaeythueony neiae?iiao, oaeeo eae nainen, nii?yaeaiiuo n aunieie
eaoaeueiinoueth

I?iaeaia caeeth/aaony a oii, /oi aieioue aei naaiaeiyoiaai aeiy i?e
i?iaaaeaiee e ioeaiea ?acoeueoaoia enneaaeiaaiee ionoonoaoao aaeeiia
ii?aaeaeaiea nainena. Iai?eia?, a aeo?iaea Critical Care Medicine a 1986
a iiaeii iaeoe 5 ?acee/iuo ii?aaeaeaiee nainena. Iauei n?aaee ieo
yaeyaony oieueei iaee/ea i/aaa eioaeoeee. Iiiyoey naioeoeaiee,
aaeoa?eaiee e nainena ia?aaeei eniieuecotho, eae acaeiicaiaiyaiua iie
eiatho ?acee/ioth niuneiaoth iaa?oceo. *anoi i?eiaiytho eeeie/anee
iaii?aaeaeaiiia iiiyoea naioeoeaiee, iiae eioi?ie iiieiatho
aaeoa?eaieth, o. a. iaia?oaeaiea aicaoaeeoaeae a aaiieoeueoo?a
iaeiia?aiaiii n “naioe/aneeie” neiioiiaie. A ?acoeueoaoa iiaeiaiiai
iae?eoe/aneiai eniieueciaaiey iiiyoey naioeoeaiee aiciiaeia iaaeiioeaiea
/anoiou aicieeiiaaiey neiae?iia nainena, oae eae a 50% e aieaa anao
neo/aaa nainena aicaoaeeoaee a e?iae ia iaia?oaeeaatho. N ae?oaie
noi?iiu, ia?aioeaieaaaony yooaeoeaiinoue oa?aiaaoe/aneeo ia?ii?eyoee oae
eae iiae iiiyoea naioeoeaiee iiiaaeaao aaeoa?eaiey n ii?aaeaeaiiie
neiioiiaoeeie oaeie eae oaoeea?aeey e naioe/aneay oaiia?aoo?a

Iee?iaeieiae/aneee niaeo? nainena iaaeinoaoi/ii eco/ai. Iaaeinoaoi/ii
yooaeoeaia oaeaea oa?aiey nainena nii?iaiaeaeathuayny eaoaeueiinoueth
ieiei 40% Aunieay eaoaeueiinoue i?eienuaaaony, ii e?aeiae ia?a /anoe/ii,
iee?iaeieiae/aneei o?eaaa?ai, oaeei eae yiaeioieneiu a?aiio?eoeaoaeueiuo
aaeoa?ee, aaaeouei e aeoeaaoeee eaneaaea oeeoieeiia n iia?aaeaeathuei
ooieoeeiiaeueiui aeaenoaeai. Iiyoiio aicieeaao aii?in: iiaeao ee
iaeo?aeecaoeey oieneiia e/eee iiaeoeyoeey ainiaeeoaeueiuo ?aaeoeee,
iai?eia? n iiiiuueth eiioiiaeiaoeeiia ii aiciiaeiinoe nieceoue
eaoaeueiinoue o naioe/aneeo iaoeeaioia.

A iineaaeiea aiaeu i?iecioei nouanoaaiiia eciaiaiea o?aeoiaee
yoeiiaoiaaiaca nainena, ainiiaenoaothuaai n ia/aea aaea aei iaaeaaiaai
a?aiaie. Yoi cao?iioei oaeaea e aai oa?aieth

Iiiyoea nainena io iee?iaeieiaee e eeeie/aneie nouiinoe

Eeanne/aneia ii?aaeaeaiea nainena auei ?ac?aaioaii a ia/aea aaea. Oiaaea
nainen i?aaenoaaeyee eae iaee/ea a i?aaiecia i/aaa, ec eioi?iai
iai?a?uaii eee ia?eiaee/anee a e?iayiia ?onei iiiaaeatho iaoiaaiiua
aicaoaeeoaee. A ?acoeueoaoa yoiai aoi?aeaiey aicieeatho noauaeoeaiua e
iauaeoeaiua i?iyaeaiey aieacie. Yoi eeanne/aneia ii?aaeaeaiea, io
eioi?iai iiiaea ia ioeacaeenue e naaiaeiy, iaeiiieacii aeey eeeie/aneiai
eniieueciaaiey

Iuoaynue i?aiaeieaoue nouanoaothuea i?ioeai?a/ey a iiieiaiee iaoiaaiaca
nainena, iaicia/eoue ?acee/athueany ii oyaeanoe eeeie/aneiai oa/aiey aai
oi?iu eiinainoniay eiioa?aioeey iauanoaa e?eoe/aneie iaaeeoeeiu e
oi?aeaeueiuo a?a/ae NOA i?aaeeiaeeea noaio, i?aaenoaaeaiioth a oaae 1
Niaeanii ?aoaieth eiioa?aioeee ii?aaeaeaiea nainena iniiauaaaony ia
eeeie/aneeo e?eoa?eyo e ia o?aaoao iaia?oaeaiey aicaoaeeoaeae a
aaiieoeueoo?a Nainen ii?aaeaeytho eae nenoaiioth ?aaeoeeth ia eioaeoeeth
(ni oaae 1) Ii iaieoanoe?oao a aeaea oaoeea?aeee, oaoeiiiy, eciaiaiey
oaiia?aoo?u e eaeeioeeoica eee eaeeioeeoiiaiee Oyaeaeue nainen (eee
naioe/aneee neiae?ii) eiaaony oiaaea eiaaea nainen ioyaiuaaony
i?eciaeaie aeenooieoeee i?aaiia oaeeie eae eaeoao-aoeeaeic, ieeao?ey,
aeiienaiey eee eciaiaiea niciaiey Naioe/aneee oie ii?aaeaeytho eae
oyaeaeue nainen, ni/aoathueeny n ?ao?aeoi?iie e eiooceiiiie oa?aiee
aeiioiieae

Iioiaeay ia aaeoa?eaeueiue nainen ea?oeia iiaeao aicieeiooue aac iaee/ey
ia?ae/iie iee?iaiie eioaeoeee. I?e yoii aicieeaao i?aeoe/anee
eaeaioe/iay ea?oeia aieacie e aa oa/aiey eae aneaaenoaea iee?iaiie
eiaacee oae e a ?acoeueoaoa ia?ae/ii iaeioaeoeeiiiuo i?e/ei, oaeeo eae
o?aaia, ainiaeaiea eee eioieneeaoeey Anee ioaaoeoue a ii?aaeaeaiee
iaeioaeoeeiiiua i?e/eiu, oi yoio neiae?ii iaicia/atho eae neiae?ii
nenoaiiiai ainiaeeoaeueiiai ioaaoa (SIRS) (ni oaae 1) A ea/anoaa
naycothuaai caaia iaaeaeo iee?iaiui nainenii e iaiee?iaiui SIRS
i?aaeiieaaatho oaiiiai o?aineieaoeee aaeoa?ee e yiaeioieneia ec
eeoa/ieea aneaaenoaea eoaiee eeoa/ieea a oiaea iauaai ainiaeeoaeueiiai
i?ioeanna. Eaaeaeia ii?aaeaeaiea nainena oieueei ia?aie/aiii io?aaeaao
iiiaiia?acea eeeie/aneie ?aaeueiinoe Iiyoiio e i?aaeeaaaaiia
aia?eeaineeie a?a/aie ii?aaeaeaiea nainena oyaeaeiai nainena e
naioe/aneiai oiea ia iiaeao iieiinoueth ioaaoeoue oe?ieee niaeo?
eeeie/aneeo neiioiiia e eciaiaiee eaai?aoi?iuo ia?aiao?ia i?e
naioe/aneii neiae?iia Ii ana aea yoi aaaeiue ia?aue oaa e iauaio
eeeie/anee oe?iei i?eiaiyaiiio iiiyoeth nainena.

Eioaeoeey

iee?iaiue oaiiiai oa?aeoa?ecoaony ainiaeeoaeueiie ?aaeoeeae ia iaee/ea
iee?ii?aaieciia eee ia i?iieeiiaaiea a iau/ii noa?eeueioth oeaiue yoeo
i?aaieciia

Aaeoa?eaiey

Iaee/ea aeeauo aaeoa?ee a e?iae

Neiae?ii nenoaiiiai ainiaeeoaeueiiai ioaaoa (SIRS)

nenoaiiay ainiaeeoaeueiay ?aaeoeey ia iaeio ec iiiaeanoaa oyaeaeuo
eeeie/aneeo i?e/ei (eioaeoeey, iaie?aaoeo, iia?aaeaeaiea oeaiae o?aaia,
eoaiey yeciaaiiia aaaaeaiea ainiaeeoaeueiuo iaaeeaoi?ia, oaeeo eae
a-OII) ?aaeoeey iaieoanoe?oao a aeaea aicieeiiaaiey aeaoo eee aieaa
i?eciaeia

oaiia?aoo?a auoa,38’N eee aeiioa?iey ieaea 36’N, oaoeea?aeey (*NN aieaa
90 a ieiooo), oaoeiiiy (*Ae aieaa 20 a ieiooo eee ?^NI; iaiaa 32 ii no
no ) eaeeioeeou aieaa 12 000 a 1 iee, eee iaiaa 4000 a 1 iee eee
iac?aeua oi?iu aieaa 10%

Nainen

nenoaiiay ?aaeoeey ia eioaeoeeth ?aaeoeey iaieoanoe?oao a aeaea aeaoo
eee aieaa i?eciaeia

oaiia?aoo?a auoa 38″N eee aeiioa?iey ieaea 36 N, oaoeea?aeey (*NN aieaa
90 a I ieiooo), oaoeiiiy (*Ae aieaa 20 a 1 ie ioo> eee ?^NI; iaiaa 32 ii
no no), eaeeioeeou aieaa 12 000 a 1 iee. eee iaiaa 4000 a 1 iee eee
iac?aeua oi?iu 6oiee 10%

Oyaeaeue nainen

Nainen, naycaiiue n aeenooieoeeae i?aaiia, ia?ooaieai ia?oocee eee
aeiioiieae, ia?ooaiey ia?oocee iiaoo aeeth/aoue aicieeiiaaiea
eaeoao-aoeeaeica ieeao?ee eee ino?iai eciaiaiey iaioaeueiiai noaoona ssi
ia ia?aie/eaathony ia?a/eneaiiuie, aeiioiiey ii?aaeaeyaony eae
nenoiee/aneia e?iayiia aeaaeaiey iaiaa 90 ii ?o no eee nieaeaiea
nenoiee/aneiai aeaaeaiey aieaa 40 ii ?o no i?e ionoonoaee ae?oaeo i?e/ei
aeiioiiee

Naioe/aneee oie

nainen n aeiioiieae (ni auoa), ianiio?y ia aaeaeaaoiia aiciauaiea iauaia
aianoa n ia?ooaieai ia?oocee, aeeth/athuae iiyaeaiea eaeoao-aoeeaeica
ieeao?ee eee ino?iai eciaiaiey iaioaeueiiai noaoona, ii ia
ia?aie/eaaaony yoeie Iaoeeaiou i?e oa?aiee ninoaeinoaeeaathueie eee
eiio?iiiuie aaaioaie iiaoo oaeaea ia auoue aeiioiie/aneeie, anee
eiathony ia?ooaiey ia?oocee

Neiae?ii iieei?aaiiie aeenooieoeee

eciaiaiiay ooieoeey i?aaiia o iaoeeaioa n ino?ie oi?iie aieacie oaeiai
?iaea, /oi aiiainoac aac aiaoaoaeuenoaa ia iiaeao iiaeaea?aeeaaoueny

Iaoioeceieiaey nainena: io aicaoaeeoaey e aeoeaaoeee iaaeeaoi?ia,
aucaaiiie oieneiaie

A oeaio?a aieiaiey iaoioeceieiaee nainena oaia?ue iaoiaeeony ia
aicaoaeeoaeue a aucaaiiay aaeoa?eaeueiui oieneiii /?acia?iay
ainiaeeoaeueiay ?aaeoeey i?aaiecia. A ianoiyuaa a?aiy iieaaatho, /oi yoa
aeia?ainia/eoaeueiay ?aaeoeey eiioiiie nenoaiu niinianoaoao ?acaeoeth
naioe/aneiai oiea

A iauai neo/aa eioaeoeey iiaeao i?iyaeyoueny oiaaea eiaaea
iee?ii?aaieciu i?iieeatho /a?ac eee iaoiaeyo oaeea aa?uea?u i?aaiecia
eae eiaea eee neecenoay. Oiene/aneea aaeoa?eaeueiua i?iaeoeou iiiaaeatho
a oee?eoeyoeeth e aeoeae?otho nenoaiiua caueoiua iaoaieciu E iei
ioiinyony nenoaia eiiieaiaioa e eaneaae naa?ouaaiey, a oaeaea eeaoi/iua
eiiiiiaiou: iaeo?ioeeu, iiiioeeou, iae?ioaae e eeaoee yiaeioaeey.
Aeoeae?iaaiiua eeaoee i?iaeooee?otho iaaeeaoi?u, eioi?ua eieoeee?otho e
iiaeaea?aeeaatho ainiaeeoaeueioth ?aaeoeeth. E yoei iaaeeaoi?ai
ioiinyony oeeoieeiu (oaeoi? iae?ica iiooiee — OII), eioa?eaeeei-1 (EE-1)
e ae?., eeieiu iaoaaieeou a?a-oeaeiiiaie eeneiou, oaeoi? aeoeaaoeee
o?iiaioeeoia e ieneae acioa. Aeia?ainiaeeoaeueiay ?aaeoeey i?aaiecia
iiaeao aianoa n iee?iaiuie oieneiaie i?eaanoe e iia?aaeaeaieth eeaoie
ia?ooaieth ia?oocee e a eoiaa e oieo iieei?aaiiie iaaeinoaoi/iinoe e
nia?oe.

Oa?aiey nainena, io aioeaeica e eiioiiie iiaeoeyoeee

Eiioeaiooaeueiay niaia iaoioeceieiae/aneiai iiieiaiey naioe/aneiai
neiae?iia iaoiaeeo naia io?aaeaiea oaeaea a eciaiaiee oa?aiaaoe/aneiai
iiaeoiaea, eioi?ue oaia?ue, iiieii aioeiee?iaiuo ia?, aeeth/aao
iaeo?aeecaoeeth oieneiia e eiioiioth iiaeoeyoeeth ?ac?aaoee?iaaiiuo
caueoiuo ?aaeoeee.

E noaiaea?oiie no?aoaaee oa?aiee nainena ioiinyony ?a aaaaeaiea
aioeaeioeeia, oe?o?ae/aneia aiaoaoaeuenoai aeey naie?iaaiey i/aaa
eioaeoeee, ?aaieiaoeeiiiua ia?ii?eyoey (aeeaeec, iaoaie/aneay
aaioeeyoeey) e eniieueciaaiea aaciaeoeaiuo iaaeeeaiaioia. Ianiio?y ia
iaoiaeu oa?aiee nainen, eae e i?aaeaea, nii?yaeai n eaoaeueiinoueth
30—40%, eioi?ay i?e eeeie/aneeo i?eciaeao naioe/aneiai oiea ninoaaeyao
oaea 40—75%

A iineaaeiea aiaeu ioia/aii iiauoaiea /anoiou neo/aaa nainena *anoioa
aicieeiiaaiey oyaeaeiai nainena (naioe/aneiai neiae?iia) a aieueieoeao
NOA iiauneeanue ia 139%’ n 73,6 aei 175,9 neo/aaa ia 100 000 /aeiaae,
eioi?ua iaoiaeeeenue aieueieoeao n 1979 ii 1987 a. Yoi iiauoaiea iiaeao
n iauyniaii ?acee/iuie i?e/eiaie oeo/oaiea ?aaieiaoeeiiiuo oaoiieiaee,
iicaieythueo nio?aiyoue aeeciue iniai iiaeaa?aeaiiui eioaeoeeyi
iaoeeaioai a?oii ?enea — iiai?iaeaeaiiui e ethaeyi i?aeeiiiiai aic?anoa,
oaaee/aiea eiaaceaiuo oa?aiaaoe/aneeo iaoiaeia, i?ia?ann oeieioa?aiee e
eiioiioa?aiee ceiea/anoaaiiuo caaieaaaiee e, iaeiiaoe, oaaee/aieai /enea
aieueiuo NIEAeii. Oae, iai?eia?, 44% ec 980 iaoeeaioia n nainenii
iaaeaeo 1979 e 1989 a a Oieaa?neoaoneie eeeieea a Aa?eeia eiaee a
ea/anoaa iniiaiiai caaieaaaiey ceiea/anoaaiiua iiooiee e eaeeicu/eeioiiu
eee iiaeaa?aaeenue eiioiiiiaeaaeythuae oa?aiee

Iiauoaiiay /anoioa aicieeiiaaiey nainena e aunieay eaoaeueiinoue i?eaaee
e eioaineaiiio iieneo iiauo iaoiaeia oa?aiee ?ac?aaioea iiauo aaaioia
aeey oa?aiee nainena iniiauaaeanue /anoe/ii ia iieiaeaiee, /oi
iaeo?aeecaoeey aaeoa?eaeueiuo oieneiia eee iioaioeeaeueii
iia?aaeaeathueo iaaeeaoi?ia eiioiiie nenoaiu iiaeao inoaiiaeoue
naioe/aneee i?ioeann eee ii e?aeia ia?a caiaaeeeoue aai. Yoe iiaua aeaeu
oa?aiee iai?aaeaiu i?ioea ?acee/iuo yeaiaioia aein?ainiaeeoa1ueiiai
eaneaaea- yiaeioieneia e oeeoieeiia, oaeeo eae OII e EE-1

?ieue yiaeioieneia i?e nainena

I?eia?ii a iieiaeia neo/aaa, a eioi?uo oaeaaony iee?iaeieiae/anee
aeeaaiinoe?iaaoue aicaoaeeoaey i?e nainena, aucuaathuea aai
iee?ii?aaieciu, ieacuaathony a?aiio?eoeaoaeueiuie aaeoa?eyie *aua anaai
yoi A coli, Klebsiella spp , Enterobacter spp , Seraita spp.,
Pseudomonas aeruginosa e Proteus spp Eaoaeueiinoue i?e nainena,
aucaaiiii Pseudomonas aeruginosa, inoaaony naiie aunieie Ca yoei
aicaoaeeoaeai neaaeotho ii ienoiaeyuae Klebsiella spp., Proteus spp , A
coli, Seraita spp., Aiterobacter spp

Iieaaatho, /oi i?e a?aiio?eoeaoaeueiii aicaoaeeoaea nainena,
nii?iaiaeaeathuainy aunieie eaoaeueiinoueth, oeaio?aeueioth
iaoiaaiaoe/aneoth ?ieue, ?ieue o?eaaa?a, ea?aao aaeoa?eaeueiue
yiaeioienei eeiiiieenaoa?eae — EIN. Aaeoa?eaeueiue yiaeioienei yaeyaony
eiiieaeniui eiiiiiaioii eeaoi/iie noaiee a?aiio?eoeaoaeueiuo aaeoa?ee.
Yiaeioieneiu ioaeaeueiuo aeaeia a?aiio?eoeaoaeueiuo aaeoa?ee, oioy e
?acee/iu a aeaoaeyo, ii eiatho iauoth no?oeoo?o aioeaaiiua naoa?eaeiua
oeaie i?eaycaiu e aeae?ioiaiiio eeieaeo A, eioi?ue iaeaaeaao nianoaaiii
iia?aaeaeathuei aeaenoaeai. Yoa iauay no?oeoo?a e aa eieaeecaoeey ia
noaiea aaeoa?eaeueiie eeaoee i?eaiaeeo e oiio, /oi yiaeioienei
?aniiciaaony eiioiiie nenoaiie. ?aniiciaaaiea aioeaaia yaeyaony
iaeiia?aiaiii oaeaea eieoeeaoi?ii eaneaaea iaaeeaoi?ia e
aunaiaiaeaeaiey, i?iyaeythueo iia?aaeaeathuaa aeaenoaea oeeoieeiia

Yiaeioienei aunaiaiaeaeaaony a i?ioeanna oeceieiae/aneie aeaaee,
aucaaiiie aioeaeioeeaie, eiiieaiaioii eee oaaioeeoicii Oae, Rokke
iieacae ia ii?neeo naeieao, /oi eiaeooee?iaaiiia aaioaieoeeiii
aunaiaiaeaeaiea yiaeioieneia io?eoeaoaeueiui ia?acii neacuaaaony ia
na?aea/iii aua?ina e aeaaeaiee a eaai/iie a?oa?ee Iiaeiaiui ia?acii
oa?aiey aioeaeioeeaie eiaeooee?iaaea a iiaeaee ia e?ieeeao i?e
a?aiio?eoeaoaeueiii iaieiaeoa iiaeuai yiaeioieneia a eeeai?a e
annioeee?iaaiiia oaaee/aiea oea?aa?aeueiiai ioaea.

Ia?iiiui ?aca?aoa?ii yiaeioieneia yaeyaony eeoa/iee Aiciiaeii, /oi
?ac?ooaiea aa?uea?a neecenoie aeaeoaei/ii-eeoa/iiai o?aeoa iiaeao aac
aaeoa?eaiee i?eaanoe e yiaeioieneiaiee.

A oneiaeyo aeiiia?oocee neecenoie eeoa/ieea, ia?ooaiey ieuaaa?aiey,
eioaeoeee eee aaaeiieiaeueiuo oe?o?ae/aneeo aiaoaoaeuenoa yiaeioienei
iiaeao i?iieeaoue a nenoaio e?iaiia?auaiey e iaeiia?aiaiii n
o?aineieaoeeae aaeoa?ee eeoa/ieea Yoe i?ioeannu yaeythony i?aaeiaoii
aeoeaiuo enneaaeiaaiee.

Yiaeioieneiaiey e a?aiio?eoeaoa/ueiay aaeoa?eaiey ineiaeiytho oa/aiea
iniiaiiai caaieaaaiey oneeeaatho yooaeou yecioieneiia , iaoneiaeeaatho
iieei?aaiiioth iaaeinoaoi/iinoue Yiaeioienei naycuaaaony i?e iin?aaenoaa
EIN-naycuaathuaai i?ioaeia n CD 14-?aoeaioi?aie iae?ioaaia e
iieeii?oiiyaea?iuo a?aioeioeeoia yaeyynue o?eaaa?ii ioaaoiie ?aaeoeee
oicyeia ia iaa?oceo yiaeioieneiii Io yoiai ?aoathuei ia?acii caaeneo,
aoaeao ee aicaoaeeoaeue yeeieie?iaai eee ?aaeoeey ieaaeao
iia?aaeaeathuaa aeaenoaea ia i?aaieci oicyei aieioue aei iieei?aaiiie
iaaeinoaoi/iinoe. Eeeie/anee yoa ?aaeoeey i?iyaeyaony eae nainen

Eiaiii iiyoiio iaeo?aeecaoeey eee yeeieiaoeey yiaeioieneia iaoiaeeony a
oeaio?a enneaaeiaaiee i?e oa?aiee a?aiio?eoeaoaeueiiai nainena

Ecia?aiea yiaeioieneia

Eniieuecoaiue /aua anaai e naiue /oanoaeoaeueiue iaoiae iaia?oaeaiey
yiaeioieneia — yoi eeioethn aiaaioeeoiue eecaoiue oano (EAE oano) Yoio
oano iniiauaaaony ia neo/aeiii ioe?uoee oiai, /oi o ?a/ea Limulus
polyphemus eiuaeoeey a?aiio?eoeaoaeueiuo aaeoa?ee aaaeao e
aeennaieie?iaaiiiio aioo?eninoaeenoiio naa?ouaaieth. Iineaaeothuea
enneaaeiaaiey iieaca ee, /oi naa?ouaaiea aaiieeiou iaoneiaeeaaao iaeei
eiiiiiaio aaeoa?ee — yiaeioienei. Aeey oiai /oiau aucaaoue yoio yooaeo
aeinoaoi/ii 1 ia i/euaiiiai yiaeioieneia. Iaiaoiaeeiua aeey aeoeaaoeee
i?ioeannia naa?ouaaiey oaeoi?u iiaeii iaeoe a a?aioeao, eioi?ua eiathony
a niaoeeaeece?iaaiiuo e?iayiuo eeaoeao Limulus polyphemus — aiaaioeeoao.
N i?eiaiaieai eecaoa yoeo eeaoie aue ?ac?aaioai i?inoie oano naa?ouaaiey
aeey ecia?aiey eioe/anoaa yiaeioieneia. I?eioeei oanoa ninoieo a oii /oi
i?enoonoaea yiaeioieneia aucuaaao eaneaaeioth ?aaeoeeth a eeaoeao, a
eioi?ie o/anoaotho 3 i?ioaacu. Yoa ?aaeoeey aeoeae?oao yicei eioi?ue
?anuaieyao eeaoi/iue i?ioaei ia 3 iieeiaioeaeiua oeaii/ee 2 ec yoeo
oeaii/ae ioaa/atho ca aaee?iaaiea aaiieeiou. Yoio i?ioeann ii?aaeaeaiiui
ia?acii aiaeiae/ai /aeiaa/aneiio eaneaaeo naa?ouaaiey. A eaai?aoi?ee
niaea?aeaiea yiaeioieneia ii?aaeaeyaony oioiiao?e/anee, aeiaaaeyy e
yiceio o?iiiaaiiue noano?ao, a ea/anoaa eioi?iai eniieuecotho naycaiiue
n aeeiaioeaeii i-ieo?iaieeei Oeaaoiay ?aaeoeey i?ienoiaeeo anee yicei
iouaieyao o?aaiaio i-ieo?iaieeeia.

Iieacaii, /oi ii?aaeaeyaiua i/aiue ieceea eiioeaio?aoeee yiaeioieneia
ii?yaeea 10 ia/ie a ieacia iiaoo naeaeaoaeuenoaiaaoue i
a?aiio?eoeaoaeueiii nainena. Ia?aua ?acoeueoaou iieacaee, /oi iaee/ea e
o?iaaiue yiaeioieneiaiee ei??aee?otho n eeeie/aneei enoiaeii. Iieaaatho
/oi yoio oano iiaeii eniieueciaaoue i?e nainena aeey ioeaiee i?iaiica
Oae enneaaeiaaiey iaoeeaioia n nenoaiiie iaieiaieieeiaie eioaeoeeae
iieacaee, /oi ia/aeueiua eiioeaio?aoeee a ieacia 10 000 ia/ie annioeee?iaaiu niioaaonoaaiii n eaoaeueiinoueth
0, 14 27 e 86%. I?e yoii oeo? yiaeioieneia aieaa 700 ia/ie
annioeee?oaony noaoenoe/anee aeinoiaa?ii n ?acaeoeai oiea.

?yae oaeoi?ia iaeiaei, ineiaeiytho eioa?i?aoaoeeth eiioeaio?aoeee
yiaeioieneia a ieacia. ?acee/iua a?aiio?eoeaoaeueiua aaeoa?ee eiatho
iaiaeeiaeiaia eiee/anoai EIN e aunaiaiaeaeatho ?acee/iua eiee/anoaa
yiaeioieneia a ?acoeueoaoa iooi?aeaiey o?aaiaioia eeaoi/iie iaia?aiu ai
a?aiy oacu ?inoa Iineaaeiyy niiniaiinoue iniaaiii au?aaeaia o
iaieiaieieeiauo ooaiiia E?iia oiai yiaeioieneiu ?acee/iuo
a?aiio?eoeaoaeueiuo aaeoa?ee eiatho ?acee/ioth aeoeaiinoue ii ioiioaieth
e oanoo, /oi ia anaaaea ei??aee?oao n aeieiae/aneei aeaenoaeai Yoi
cia/eo /oi aaniethoiua eiioeaio?aoeee ia anaaaea io?aaeatho noaiaie
oyaeanoe a?aiio?eoeaoaeueiiai nainena. Iieiaeeoaeueiia iaia?oaeaiea
eiioeaio?aoeee yiaeioieneia a ieacia iiaeao auoue ?aiiei eiaeeeaoi?ii
?acaeoey nainena Io?eoeaoaeueiue ?acoeueoao ia eneeth/aao, /oi
yiaeioieneiu e iaaeeaoi?u oaea i?iyaeee naia aeaenoaea e oee?eoee?othuea
yiaeioieneiu aieueoa ia iaia?oaeeaathony. *anoi yiaeioienei i?e naiii
oyaeaeii nainena iiaeii iaia?oaeeoue a oee?eoeyoi?iii ?onea eeoue a
oa/aiea ei?ioeiai a?aiaie

Ianiio?y ia yoi ia?aie/aiea i?e iaia?oaeaiee yiaeioieneia a /aeiaa/aneie
ieacia, o?iiiaaiiue EAE-oano ieacuaaaony eae e i?aaeaea aaeeinoaaiiui
eeeie/anee i?aeoeeoaiui iaoiaeii iaia?oaeaiey e eiee/anoaaiiie ioeaiee
yiaeioieneia a ieacia.

Yiaeioienei oeaio?aeueiue eieoeeaoi? nainena eee yieoaiiiai?

Aeey iinooee?iaaiey oeaio?aeueiie ?iee yiaeioieneia i?e nainena
iaiaoiaeeii auiieiaiea neaaeothueo i?aaeiinueie 1) o?iaaiue yiaeioieneia
aeieaeai auoue ecia?yai i?e nainena,

2) aaaaeaiea yiaeioieneia aeieaeii aucaaoue iaoioeceieiae/aneia
ninoiyiea iiaeiaiia naineno,

3) iaeo?aeecaoeey yiaeioieneia aeieaeia iieiaeeoaeueiui ia?acii aeeyoue
ia oa/aiea nainena

Iiiai/eneaiiua enneaaeiaaiey iieacaee iaee/ea yiaeioieneiia a e?iae o
cia/eoaeueiiai /enea naioe/aneeo iaoeeaioia. Yiaeioieneiaiey ei??aee?oao
n ?acaeoeai ii/a/iie iaaeinoaoi/iinoe e ?anie?aoi?iiai
aeen?ann-neiae?iia. enneaaeiaaiey iieacaee, /oi yiaeioienei ia anaaaea
eiaaony a oee?eoeyoi?iii ?onea i?e nainena, ii aai i?enoonoaea
ei??aee?oao n oyaeanoueth eeeie/aneie iaieoanoaoeee e iiyaeaieai
iieei?aaiiie iaaeinoaoi/iinoe

?acoeueoaou canoaaeytho i?aaeiieiaeeoue, /oi yiaeioienei yaeyyaony ia
aaeeinoaaiiui eieoeeaoi?ii nainena. A?aiiieiaeeoaeueiua e a?eaeiaua
eioaeoeee /anoi eeeie/anee iiaoo i?ioaeaoue eae a?aiio?eoeaoaeueiue
nainen. Aiciiaeii, /oi a ?acaeoee nainena a ?iee o?eaaa?a aunooiaao
iiiaeanoai oaeoi?ia, i?e/ai yiaeioienei yaeyaony iaeaieaa /anoui e
aaaeiaeoei. Anee yiaeioienei yaeyaony oeaio?aeueiui o?eaaa?ii nainena oi
aaaaeaiea yiaeioieneia aeieaeii aucaaoue noiaeiue n nainenii neiae?ii
Aaaaeaiea yiaeioieneia iiaeiiuoiui aeeaioiui i?e aiaeeo e oyaeaeui
iaoioeceieiae/aneei eciaiaieyi. Iie caaenyo io aeaea aaeoa?ee, aeicu,
iaoiaea aaaaeaiey, enoi/ieea ec eioi?iai aue iieo/ai yiaeioienei
Oeie/iie ?aaeoeeae yaeythony aaciaeeeaoaoeey, nieaeaiea na?aea/iiai
aua?ina e ?acaeoea aeiiaeeiaie/aneiai ninoiyiey.

Suffredini aaiaeee 23 caei?iaui aeia?iaieueoeai yiaeioienei Eschenchia
coli a aeica 4 ia/ea. O anao eniuooaiuo ?acaeeny a?eiiiia?aciue neiae?ii
n oaiia?aoo?ie e iciiaii. Ecia?aiey i?e iiiiue eaoaoa?a a eaai/iie
a?oa?ee iieacaee aeia? aeeiaie/aneia ninoiyiea n iiauoaiiui na?aea/iui
eiaeaenii e oaoeea?aeeae, nieaeaiiia AAe e nii?ioeaeaiea ninoaeia. Yoe
eciaiaiey eeeie/anee niaianoeiu n eaaeie oi?iie nainena e iiaeiaiu
eciaiaieyi i?e aaaaeaiee yiaeioieneia a iiaeaee ia aeeaioiuo Iinea
nia?oaeueiie aeicu yiaeioieneia ianooiatho oie e iieei?aaiiay
iaaeinoaoi/iinoue

?aoathuei oanoii aeey auyniaiey iaiin?aaenoaaiiie ?iee yiaeioieneia
yaeyaony aeaiiino?aoeey eeeie/aneiai oeo/oaiey i?e iaeo?aeecaoeee eee
yeeieiaoeey yiaeioieneia i?e aooaioe/iii eeeie/aneii nainena. Eaaeauaa
ia iiaa?oiinoe ?aoaiea — ianneaiay eiioiecaoeey aioeoaeaie i?ioea
yiaeioieneia. E niaeaeaieth iiiieeiiaeueiua aioeoaea i?ioea eeieaea A ia
i?eaaee e eeeie/aneiio ?acoeueoaoo Eniieuecoaiua a enneaaeiaaieyo
aioeyiaeioieneiiua aioeoaea IA 1A e A5 eiaee eeoue ieceia naycuaathuaa
n?iaenoai e yiaeioieneio e ia iaeo?aeeciaaee aai yooaeou

Aa?iyoii, yiaeioienei yaeyaony aeinoaoi/iui, ii ia iaycaoaeueiui
oneiaeai eieoeee?iaaiey naioe/aneie ?aaeoeee e aai ?ieue aeieaeia auoue
aua auyniaia

Ianoi eiioiioa?aiee nainena

?ac?aaioea iiauo aaaioia aeey oa?aiee nainena iniiauaaaony ia iieiaeaiee
/oi iaeo?aeecaoeey aaeoa?eaeueiuo oieneiia eee iioaioeeaeueii
iia?aaeaeathueo iaaeeaoi?ia eiioiiie nenoaiu iiaeao ecea/eoue
naioe/aneee i?ioeann eee ii e?aeiae ia?a caiaaeeeoue aai. Yoe iiaua
oa?aiaaoe/aneea no?aoaaee iai?aaeaiu i?ioea ?acee/iuo yeaiaioia
aeia?ainiaeeoaeueiiai eaneaaea, e eioi?iio ioiinyony aaeoa?eaeueiua
oieneiu, oaeea eae yiaeioienei eee neaaeothuea ca iei iaaeeaoi?u (OII e
EE-1). Aeey yoiai a yenia?eiaioao ia aeeaioiuo e a eeeie/aneeo
enneaaeiaaieyo eniieueciaaee a ea/anoaa oa?aiaaoe/aneeo n?aaenoa
iiiieeiiaeueiua eee iieeeeiiaeueiua aioeoaea i?ioea oieneiia,
iiiieeiiaeueiua aioeoaea i?ioea iaaeeaoi?ia, aioaaiienou iaaeeaoi?ia eee
eiioiiaeiaoeeiu.

Aioiyiaeioieneiiay oa?aiey

Iniiauaaynue ia iaoiaaiaoe/aneii cia/aiee yiaeioieneia, a
yenia?eiaioaeueiuo e eeeie/aneeo enneaaeiaaieyo auee eniuoaiu e
eniuouaathony iiiai/eneaiiua aioe-yiaeioieneiiua oa?aiaaoe/aneea
n?aaenoaa. Ii aei neo ii? yoe i?aia?aou ia niiaee caiyoue naia ianoi a
eeeie/aneie i?aeoeea. Aioeoaea i?ioea iiaa?oiinoiuo aieiauo oeaii/ae
i?iyaeytho na?ioeiniaoeeoe/aneoth eiiieaiaiocaaeneioth aaeoa?eoeeaeioth
aeoeaiinoue Ana aea eeeie/aneia i?eiaiaiea yoeo aaaioia i?ioea
iiaa?oiinoiuo aieiauo oeaii/ae yiaeioieneia ia?aie/aii eo
na?ioeiniaoeeoe/iinoueth. Yoi i?eaaei e enneaaeiaaieth aioeoae,
iai?aaeaiiuo i?ioea yae?a yiaeioieneia e i?ioea eeieaea A, oae eae yoe
aioeoaea i?iyaeytho ia?ae?anoioth ?aaeoeaiinoue i?ioea ?acee/iuo
a?aiio?eoeaoaeueiuo aaeoa?ee. Iieaaatho, /oi aioeoaea i?ioea yae?a
yiaeioieneia eee i?ioea eeieaea A iaeaaeatho yooaeoii i?ioea
yiaeioieneia, iaeiaei ooieoeey e iioaioeeae yoeo aioeoae, eae e
i?aaeaea, iaecaanoiu Ianiio?y ia yoi, aioeoaea i?ioea yae?a yiaeioieneia
inoathony iaeaieaa /anoi enneaaeoaiuie aioeyiaeioieneiiauie
noanoaioeeyie.

A ia?aii eiio?iee?oaiii i?iniaeoeaiii enneaaeiaaiee n aioeoaeaie i?ioea
yiaeioieneiiaiai yae?a iaoeeaiou n a?aiio?eoeaoaeueiie aaeoa?eaieae auee
i?iea/aiu ieaoeaai (n = 100) eee aioe-J5-nuai?ioeie (n = 91).
Annioeee?iaaiiay n nainenii nia?oiinoue o iaoeeaioia n nenoaiiuie
a?aiio?eoeaoaeueiuie eioaeoeeyie, eioi?ui auea aaaaeaia
aioe-J5-nuai?ioea, ninoaaeyea 22% a n?aaiaiee n 39% a a?oiia, iieo/aaoae
eiio?ieueioth nuai?ioeo. A iiaea?oiia iaoeeaioia n naioe/aneei oieii,
eioi?ua iieo/aee ninoaeinoaeeaathuea n?aaenoaa aieaa a /, nia?oiinoue
auea 44% ii n?aaiaieth n 77% a eiio?ieueiie a?oiia. Yooaeo
aioe-J5-nuai?ioee ia iauoth nia?oiinoue ia aue i?eaaaeai
enneaaeiaaoaeyie. 5 iineaaeothueo eeeie/aneeo enneaaeiaaiee a ?aciuo
eeeieeao NOA, eioi?ua oaeaea auee i?iaaaeaiu n iieeeeiiaeueiuie
aioenuai?ioeaie, iai?aaeaiiuie i?ioea yiaeioieneiiaiai yae?a, /oiau
i?aaeioa?aoeoue nainen eee ea/eoue aai, ia iiaeoaa?aeeee yoe
iieiaeeoaeueiua ?acoeueoaou e ia iieacaee ieeaeeo i?aeiouanoa a
ioiioaiee auaeeaaaiinoe

Iiyoiio auee ?ac?aaioaiu iiiieeiiaeueiua aioeoaea i?ioea yiaeioieneia,
/oiau iaania/eoue aiciiaeiinoue niaoeeoe/aneie aioeyiaeioieneiiie
oa?aiee. Oae, iuoeiua iiiieeiiaeueiua niaoeeoe/aneea aioeeeieae
A-IgM-aioeoaea A5 caueuaee iuoae, eioi?ui auea naeaeaia eiuaeoeey
a?aiio?eoeaoaeueiuo aaeoa?ee, a /aeiaa/aneea iiiieeiiaeueiua
niaoeeoe/aneea aioeeeieae A-IgM-aioeoaea IA-1A iieacaee caueoiia
aeaenoaea o iuoae e e?un,eioi?ui aaiaeeee ?aiio?eoeaoaeueiua aaeoa?ee Ii
ana aea A5 ia aeaenoaiaae oaeei aea ia?acii o iaaoe , eioi?ui aue
aaaaeai yiaeioienei, 1 iieiaeeoaeueiua yooaeou IA-1A o iuoae e e?un
/anoe/ii ia niiaee auee auoue aini?iecaaaeaiu.

Iuoeiua iiiieeiiaeueiua niaoeeoe/aneea aioeeeieae A-lgM-aioeoaea A5 auee
i?ioanoe?iaaiu a aeaoo ioeueoeoeaio?e-/aneeo ?aiaeiiece?iaaiiuo
eiio?iee?oaiuo ieaoeaai enneaaeiaaieyo, A 1-i enneaaeiaaiee o 468
iaoeeaioia A5 ia iieacaee ieeaeiai aeinoiaa?iiai i?aeiouanoaa o
iaoeeaioia n nainenii, naioe/aneei neiae?iiii e nenoaiiie
a?aiio?eoeaoaeueiie eioaeoeeae. Aioeoaea iiauneee, iaeiaei, noaiaiue
auaeeaaaiinoe a ?ao?iniaeoeaiie iiaea?oiia, aeeth/aaoae 137 iaoeeaioia n
nenoaiiie a?aiio?eoeaoaeueiie eioaeoeeae aac i?eciaeia oiea (30% a
n?aaiaiee n 43%, ? = 0,03). Iiyoiio auei i?iaaaeaii 2-a enneaaeiaaiea
847 iaoeeaioia, /oiau aini?iecaanoe yoio iieiaeeoaeueiue ?acoeueoao. Ai
2-i enneaaeiaaiee A5 ia iiauneee noaiaiue auaeeaaaiinoe 530 iaoeeaioia,
eioi?ua eiaee nainen e nenoaiiua a?aiio?eoeaoaeueiua eioaeoeee aac
i?ecia-

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