1. No category

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A R S M E D I C AN 9 5( 1 5 )
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npil oroM ilMeor cxoAHyro lvopQonorilqecKylo
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a KThBl/ pyro u4ile MeAil aro p br Boc nafl e HAA, TaKtAe
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MofieKyfibtatrre3vtA N MarpntlHble MerannonpoTeilHagbr,Koropbre Qopvttpytor Kneroquuh unQrznurpar B Mecre BocnaneHun. llpn peBMaro152
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MOXHOpaccMarpilBarb KaKXpoHl4qecKoeBocnaflilreflbHoe ea6oreBaHile qefloBeKa [9,1 1].
Enn nporHo3r4poBaHilnpt4cKa cepAeqHo-cocyAl,lcTbrx OCnOXUeHTfi 6Ann paspa6orauut
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n p il3HaKoBce pAeqHo - cocygl/ cro fi n aro nor tAtA,
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B Bermro6pvraHtAtA 6urr npoBeAeH Mera6olesHu, BnvfraupAe Ha S-nerHtoto BbtxnBaeauanv3l 1 mccnegoeaunil, B Koropbtx nptAHnnv Mocrb. y 21o/o nar-lheHToBc PA nprunHoil
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cMepTil eBnqflacb cepAeqHo-cocyAt/cTafl nau , v r x 6 u n u B 3 n r b rn p o 6 s r K p o B l /e 1 9 7 8 - " 1 9 8 0 r r . Toflorilc. flaqreHrur co cHNXeHHbtMQyHr<qnolzlccnegoeaHVeglilnocb go 1996 roga. SaaepHaflbHbrMcrarycoM (onpegenenv c noMou1bo
wvnt ilccflegoBaHile 1531 naqrzeHl cpe,qr Ko- recra Keitel - onpegefleHile QyHrrlraonaflbHoropblx 506 nayxvr4HyMepnv ot IAEC vnn vMenn
ro cocrocHVn HVxHmx KoHeLtHocrefr),vMenv
He cMeprenuuuril rHQaprr MiloKapAa u 1025 6or uu.ryrocMeprHocru[ 14] .
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il onpe4envr;. cepgeqHo-cocyAl/crurfr pncr y
B cpaBHeHVAc rpynnoft c HtA3KtAMu
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cnoxHo. HeKoAaHHoro noKa3arenq, orHotreHile pncKoe 7l5C Topbre npenapaTbr HenocpeAcTBeHHoBrilq|oT
nocne yLreTa Tpa!,mLliloHHbtx KapAHoBacKy- Ha pa3Brrile arepocKnepo3a r areporpov6oe,
nqpHbrxQa<ropoa phcKa cocraBil.no 2,13. OrApyrre BruqroT Ha areporeHe3 onocpep,oBaHHO[UeHilepilCKOBnO ypOBHtOCb|BOpOTOT]HOrO
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KoppenellLril Mexrqy KapgroBacKynnpHoft ganprocraHoBnna BbrnycK npenapara poQe6oneeaeMocrbro r aKTLlBHocrbloHelicobacter
rorcr6 [18]. OopMafibHbtM ocHoBaHileM AnF
p y l o r i , r l 4 r p a M n l g G < C h l a m y d i a p n e u m o n i a e eroro 6ann npoMexyroqHbre pe3ynbrarbt r/c14ypoBHeM roMo4rcremHa B nra3Me. Aeropur cnepoBaHrfl APPROVe (Adenomatous Polyp
npeAnonoxvtnv, qTo BepoflTHoB pa3Bwrnv aTe- Prevention on Vioxx) [19]. Lleruro ororo rccfiepocKrepoga 6onuuyro ponb hrpaor HeranQer- AoBaHilffeBnnracb oLleHKanpoQrnarrrqecKor-lLroHHbte
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cepAeqHo-cocyAllcrbrx raracrpoQ e o6ulefi
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aenenuil, cepono3rrn BHocrkl no peBMoQa<ropy 14ypoBun CO3[3,14-17].
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HapacraH ile cepAeq Ho-cocygrcrbrx ocnoxHeuvil uacano perilcrpLlpoBarbcn rorbKo qepe3
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c nnaqe6o [20].
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K yBeflr,rr{eHro phcKa cep.4eqHo-cocyAl4cTblx PA [32].
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croBepHbrrv(Ho BecbMayMepeHHbtM)Hapacra- cHrxaercfl no Mepe yBenilqeHnn Jl.J|.nrenbHocril npileMa l-KC (c 1,7 B reqeHile nepeutx 45
HileM qacrorbr ernx ocroxHeHrfr.
TaK, no .4aHHbrMo.qHoro perpocneKTvtBHo- trueil, Ao 1 ,1 nocre 90 nHefr) [33]. Sonee ror-o,
ilMelorcc AaHHbteo roM, qro npil PA paeemrre
r-o hccreAoBaHnF y naLlileHToB,noflyqaBunx
pe3NcTeHTHOCrTlK l4HcyfirHy Koppeflilpyer c
rrr6ynpoQeH N allervncanvu]/'noByto Kl{crory,
tracrora ceprneqHo-cocypl4crbtxocnoxneHult
aKTilBHocrbroBocna neHtt+ 1341,a npormBoBoccyulecTBeHHoBbrue, qeM B rpynne, nonyqaB- nafl ilTerbHaF Tepanrfl , BKJlloqaFmoKoKopTLlqyBCTnpilBOA14T
K BOCCTaHOBTeHnlo
Kmcnory KOl4.4HylO,
uefi ToflbKo aqerilncanhllnnoByto
( O P = ' l, 7 3 ) , e r o B p e M nK a K n p n e M g m < n o Q e H a r a BilrenbHocrl4 K rzrHcynnHy
[35].
EasucHac repanrn (EflBT)
v trpyrwx H nBn (e coreraHm c aqerilaca nvLIATar KaK cilcreMHoe BocnafleHile npil PA
roeofi rncnoroil) ne accot-ll/l4poBanocbc yBenilqeH ileM cepger{Ho-cocygvtcroro phcKa 1271. yBenilqrBaer tracToTy cepAeqHo-cocyAl/cTblx
ocroxHeHril, e$QeKTrBHoe re..teHhe Moxel
AHanrs pe3ynbraroe S-nerHero AeoftHoro cnenoro nfl aqe6o-rourponil pyeMoFo t4ccflerqoBa- HaBepHoe, cHt4Strb pl4cK cep.qellHo-cocyAl4crblx sa6oneea nuhi. I.:eirtcrBnrerbHo, HeKoroHrzrn
Physician's Health Study (e rccnegoBaHile
pbre ilccneAoBaHhF noATBepxAaor ery FilnoBoLurl14
2207 1 egopoeutfr MyxttrHa, npoQnnarTnqecKvl n pil HLrMaBu-tr il aqervncanwL\vtno Byto re3y.
npneM
rrlcnory) noKa3afl, qro glnreluHutfi
"3onorsrv craHAaproM) B netleHiln PA e HacHnBn (>60.qHef ) accoqrmpyercn c yBenilLte- Tonulee BpeMe FBflnercn MerorpeKcar. BnuqHrlo MerorpeKcara Ha cepAeLlHo-cocyAl4cryto
MiloKapAa(OP=2,86), a
HneM prcKa rrrHQapKra
154
cMeprHocrb nph PA 6urno nocBFUJeHoHecKor bKo h HTepecHbrx r/ccneAoaauuil.
l-pynnofi yLleHblx Ns CUIA 6utno npoBeAeHo 18-nerHee Ha6npAeune 1240 naLlreHroB
c PA, 588 hs Hrlx npilHnuanv MerorpeKcar. B
eroil rpynne cepAeqHo-cocygilcraq cMeprHocrb yMeHblxlrflacb ua 70 o/o.flpuet't Apyrilx
6agucuurx npenaparoB He Bnvnr Ha ypoBeHb
cepAeq Ho-cocygr4croil cvreprHocrll y naumeHroB c PA. Aaropbr TrccnegoBaHtAflnpegrtarator
Bsqrb ypoBeHb cepgeqHo-cocyAl4crofi cMeprHOCT].4
npr npileMe MeTOTpeKCaTa3a eTafloH
noKa3arenqnpil npileAn9 CpaBHeHhflAaHHOTO
Me Apyrilx npenaparoe[36].
Krause D r coaer. npoBefiil perpocneKrttBHoe Ha6nloAeHme,BKrloLraB[uee256 nallneHroB c rfl)KerbrM PA. B nepiloA c 1980 no 1987
erofi rpynne 6urn Ha3HaqeH MerorpeKcar, B
cBn3tAc orcyrcrBneM eQQe<ra or npoBoAt4vofi paHee repanrr ApyrilMr 5l-lBl-1.flaqneHrbl 6unv pa3AeneHu na4 rpynnbt no orBery
Ha repanno MerorpeKcaroM, roroputfr oqeHilBancn qepe3 Fo.qnocne HaLrarane.{eF{ilq:1-c
r p y n n a y f i y q l x e H h e6 o n e e q e M H a 5 0 o / o , 2 - n ynyqueHile Ha 20-5Oo/o,3-n - Her yflytlrueHilF,
4 - n - n e q e H i l e n p e K p a u l e H o .f l o c n e 7 . 5 - 1 5 . 3
ner (e cpeAHeM 10 rer) npileMa npenapara
oueHilBanN cepAeqHo-cocyAl/cryro cMeprHocrb B rpynnax. Y naqreHToB c rnxenutu PA,
KOTOpbre
He orBerilnt Ha fieqeHre MeroTpeKcaroM (3-n rpynna), 6urno orMetleHo yBenrLteHile cMeprHocrl4 6onee qeM B 4 pasa no cpaBH e H i l o c o 6 u l n v H a c e a e H r e v r .A y n a l l r e H r o B c
PA, roropbre orBeril ntAHa neLreHhe(naqreHrut
1-oh u 2-oh rpynn)- yeenrqeHile cMeprHocrn
3HaqilTefibHoHLrxe (craH4april3oBaHHoe orHoueHhe neraflbHocrm(SMR) a 1-ofi rpynne
6 u r r o 1 , 4 7 , e o 2 - o h 1. 8 5 , e 3 - e f r - 4 . 1 1 , e 4 - o i a
- 5.56)[37].
OgHaro, cornacHo AaHHbrxLandewe RB, van
den Borne BE il coaer., MerorpeKcar yBenvqtABaer ypoBeHb roMoril4crevHa (Hesaercnvstil
Qarrop cepAeqHo-cocyAr/croro pLlcra ), roropuril cBH3aHc yBenilqeHHbrMpncKoM cMeprHocru y 6onuHurx c cyuecrByroull4M paHee
arepocKnepo3oM. [1o gaHHstMBCe rex xe aBTopoB Qonreean Kilcnora AononHilTenbHonpLl
neqeHilh MeroTpeKcaroM Moxer yMeHbuarb
ypoBeHb roMoql4cr enHa, xorfl l43onr poeaHuutfr
A R S M E D I C AN S s( 1 5 )
eQQe<r Qonueeofr Kilcrorbr Ha cepgeqHo-cocyAl/cryro narofi orillo He il3BecreH [38].
,l,ocrarovHo r.r14poKonpnMeHcorcn ceroAHn
rpynnbr npenaparoB, o6regrHnou-lrlxcq o6ulhM TepMLlHoM - "6uonorilqecKile>) areHTbl
nnu 6uonoFhqecKile voAnQrKaropbt l/MMyHHoro orBera ("bioloeics,). lAx ornw\tATerbHac
oco6eHHocrb - cefleKTNBHoeBnilFHne Ha Hav6onee Ba)KHbre3BeHbn LrMMyHonaroFeHe3a
BocnanilTerbHbrx 6oaegHefi, npn MrHilMafibHofi rurepQepeHuvtvt c HopManbHbrMrlMexavTMMyHHOTO
HL43MaMil
OTBera.
lzlveorcn .qaHHbteo roM, ttro y naureHToB
c rnxenbrrvr PA na QoHe neqeHilF ttnflnu<cnva6ov na6nroAaercn AocroBepHoe ynyqueHre eHAorenvr(AsaencutvtoiA Ba3oAt4flarawv
(vraprep paHHero arepocKrepoea), Koppenilpyroulee co cHLr)KeHreM BocnaflnrenuHoil
aKrnBHocrm 6onegHr [39]. cDHO-anuQa paccMarphBaercn He rorbKo KaK BaxHbtfr tvegnaTop BocnaneHne npm PA, Ho 14 cocy4ncroro
BocnaneHVA npv PA r arepocKfieport4qecKoM
nopaxeHLlr4cocyAoB 140,411.
Crarunur
lz1MelorccAaHHbre,qro HapffAy c rtAnonvnv4eMntrecKnMcrarilHbr o6naAaor n nport4BoBocnanilrenbHurv eQQeKroM.
HeAaeFrorpynnofi yqeHbrxKanda H, Hamasaki K, Kubo K, et al. 6urno h3yqeHaeQQerrmaHocrb cl4MBacrarnla (10 vrr/geHb B TeqeHue12
HeA.) y nar1heHroac PA (n=12) 142]. Ha QoHe
fletreHilq Ha6rogarocb AocroBepHoe yMeHblueHile qilcra 6onesHeFrHbrxcycraBoB, yny.]rxeHre o6ulero cocronHilq (no ereyanuHofi
aHano FoBofr urrane ), cn rxeH Lre KoHqeHTparIAtA
C-pearrr,rBHoro 6enrca (CPE), COe n rilrpoB
peBMaroilAHoro Qarropa. Orser no KpilrepilKonflernr peBMaroaoroB
cM Aveprrancrofr
(ACR) 2Oo/ooruaqeH 7 ns B (BB%) naqueHroe
Lfepe34 HeA.y 5 us 6 (83%) Ltepe3B HeA. vry 45
(80%) qepe3 12 nep,.B roxe BpeMff BntAAHtA Ha
il3yqaeMbre ilMMyHonorilqecKile noKa3arenh
(orHoueurrreTh 1/Th2) BbrrBfieHoHe 6stno.
Van Doornum S il coaBr. e ceoeil pa6ore
ycraHoBilrm, qro aropBacrarilH woxer 6esonacHo Llcnoflb3oBarbcn y nallreHToB c PA m
oH e$QeKruBHo yMeHbruaer xoflecrepnl nnnonporeilHoB H.!43KoilnnorHocrl4 Lt xecrKocrb
aprepilanuHoil creHKLt, Koropan FBrflercn
tcc
I/ CN/EPTHOCTb
CEPAELIHO-COCYNVICTAA
3A5OI EBAEMOCTb
SOIIbHbIXPEBMATO/N.H
bIMAPTPI/TOMO53OPIIIITEPATYPbI
MapKepoM cepAeL{Ho-cocyArcrofi naroflorilh
nepTh3a KflilHL{qecKilx cep.4eqHo-cocyAr/cTbrx
HeKoropbtx
no
aBToCrarilHbr,
AaHHbrM
[43].
Qarropoe pr4cKacpegil xeHulLrH o6enx rpynn.
poB, nMerb uMMyHoMoAynilpyloqre e$Qer<rur, Kar oragarocb, rpynnbr 6anu conocraBrMbl
a neqeHile aTopBacTaTilHoMMoxeT Aaxe npilno KoflNqecTByKypFut4x, tAHAeKcyMaccbr rena
(l/MT), peryfiqpHoMy flcnoflb3oBaHilo acnilBecTn K HeKOTOpOMyCHilXeHNo aKTLTBHOCTI4
pvHa, caxapHoMy gua6ety, aprepilanuHoil rrPA 1441. O4Haro 4ansHeilu-rve vccnegoBaHhc
npL43BaHbr
nepreH3Lrvr,ypoBHlo Qrzsmvecroil arrheHocrtA,
AOnOflHl4TbtAfitAOnpoBeprHyrb err
pe3ynbrarbr r onpeAeflqrb, AonxHbt nv crarvHacneAcreeHFrofin peApacnoro)KeH Hocrn [6] .
Hbr LrcnoflbsoBarbcnnpr PA c AeofiHurv eQero guaqnr, vro yBeflilqeHHsrfiypoeeHb cepyMeHbul4Tb
il
nporpeccvrpoBaHue
areAeqHo-cocyguctoia sa6oneeaeMocrr y nallilQerrov
pocKneposa tAaKrvBnocru PA.
eHToBc PA He o6uqcHqercn roflbKo yBenilueB nacronulee BpeMc, noIr4epxaHile eQ$erHileM KraccrqecKilx cepAeqHo-cocyAl4crbrx
TilBHOTOV AnnTenbHOr-O
HaA CyCTaB- Qarropoe phcKa.
KOHTpOAF
9BN'ICTCF
HbIM A CTCTEMHbIM
BOCNATCHilCM
Hecvorpn Ha ro, Lrro rpa4iluLroHHbreOaryMeHbuJLrrb
pilcKa He Moryr o6uncurrb yBeflrqeHhe
Bo3MoxHocrbro
Topbr
AononHilTensHofr
cepAeqHo-cocygl4cryro cMeprHocrb npil PA. cepgeqHo-cocygncrofi
ea6oneeaeMocrl4 tA
Tarofr noAXoA onpaBAaH, nocKolrbKy ecrb AocMeprHocrv nptAPA, aaxHo noHilMarb, rJToBec
croBepHbreAaHHbre,qro paHHRq,arpeccilBHaF v ervx Qarropoe ro)Ke 3HaqrrereH. lloerovy
t p\nnrenuHacSflBT 6esonacHanpv PA moqeHu BaxHo, BbrcBnffTbv Tpatrv\l4oHHbrecepAeqHoeQQerrreHa Aflq noAaBfleHhn cycraBHoil gecocyAr/crure Qarropbr pl4cKa c uenbto krx KopcTpyKr_I]414
t cepAeqHo-cocyAl/cTbrx ocno)K- peKLll4l/.
uennit [45]. OgHaKo, l4ccneAoBaHilF BntAeHtAfl
Hanpnvrep, KypeHile,He ronbKo Qarrop prcorAeflbHbrx 6agNcHurx npenaparoB cro)KHbr, Ka cepAeqHo-cocyglrcrbrx sa6oneeaHuil, Ho
n3-3a Heo6xogrrrMocrvr6onuuroro KonhqecrBa il Moxer npeApacnonararb K pa3Bnrilo PA r,r
yBefinqilBarb ero rqxecrb 146,471.
nallileHToB tAMtATenbHoro nepuoAa ilccneAoBaHVA,a rapKe roro Qarra, qro 6orulultHcreo
Y naureHToB c PA voxer Bcrpetrarbcfl vttnallileHroe c PA Hyxgaercn B 3aMeHe 6asucnpileMoM l-KC 4ra6er (qaule
Ayr-lr/poBaHHurfr
HOrO npenapaTa hnh KoppeKL\tAtA
ero rqo3br B Bcero ero orHocl4rcn K npileMy l-KC eHyrpu). B
napannenb- erofi rpynne nallreHroB ypoBeHb roulaKoeoil
xo4e neqeHre r Heo6xoE:AMocrtA
HOFOnpileMa Apyrilx neKapcrB.
FnoKo3brKpoBl/AonxeH il3MepflTbcfl exeroAHo
nnvv'aue B cflyqae 3HaqilTerbHoro yBeflilqeHrF
TPAI414414OH H bI E OAKTOPbI P]4CKA
Ao3br fKC. y nallreHroa c PA, y Koropbrx yxe
A<ryareH ceroAHe Bonpoc o ponr4 TpaAN- .qilarHocrTrpoBaHcaxapHbrx gua6e1 l-KC HyxHo
no Bo3MoxHocrr ug6eraru tAnv wcnonb3oBarb
4l4oHHbrxQarropon pilcKa B onpeAeneHril
pl4cKoB cep.qeqHo-cocyArlcrbrx ocnoxHeHmil y
ilx B MaKcrMa.nbHoBo3MoxHoil Husroil Ao3e.
AprepnanbHas rnnepreH3nq - FBrqercc nonallileHroe c PA.
KypeHne, caxapHurfi Eua6e\ aprepilanbHae
6oquurv eQQerrovr MHor-l4xfieKapcrBeHHbrx
rilnepreH3vq, fvnepnilnrAeMnF', oxvtpeHme Lr npenaparoB, ncnoflb3yeMbrxgrte neLreHnnPA,
rvnotrttr'aun+ - BaxHbre Qarropur pr4cKa l4EC,
BKfloqan HnBC, l-KC, reQnyHoMl4.q tA LI KnoKoropbre Moilr,r 6ur o6uqcnmru 6onee BbrcoKyro cnopilH. flpoQrru
aprepnanbHoro AaBneHre Aon)KeHonpe4enqrbcn y nallreHroe c PA
cepAeLrHo-cocy.qrcryo 3a6oneBaeMocrb y nauileHroB c PA. OAnaro 6orulunHcrBo LrccfleAo- nepeA HaqafloM np[eMa eTrx npenapaToB, a
B nocneAyoueM Heo6xo.qilM ero AilHaMmqeceaHniAno Ka3afio, rrro rparqmLlnoHHbre Qarropur
pilcKa o6urqHo He yBennqeHbry naqileHToB c
rnft roHrponu. HflBC, rar r3BecrHo, yMeHbuaor rNnoreH3ilBHbreeQ$e<rur MoqeroHHbrx
PA, e cpaBHeHhmc KoHrporuHoft rpynnofi. B
Nurses' Health Study 6uuo o6cregoaaHbtxeHcpeACrB, B- a.qpeHo6noraropoB vt tAHrtA6utoulvfHbr c PA u 6es aprpilTa (a raccregoBalrztr' poB aHrhoreH3h Hn peBpau{a}oulero QepveHra,
il npaKTnqecKil He Bnnr,tor Ha eQQerrrBHocrb
npvHnnv yqacrhe 6oree'114 rurcqq xeHulru)
OgHoil ta33aAaq mccfleAoBa+ttnqBflcflacb oKc- 6noraropo B Kar br.lreBbrxraHanoe [48] . f1o eroil
lcc)
npilLfhHe nallreHTaM c PA tA apTepvanbHoil rvnepTeH3ileil, KoropbtM Heo6xoAl4Mo AnilTeflbHOeret{eHile HnBC, o6bt,{Horpe6y0rcF 60flee
BbrcoKhe Ao3bt rilnoTeH3LlBHbtxnpenapaToB
nnv Bo3MoxHo BKfloqeHile B rmnoTeH3ilBHylo
cxeMy 6noraropa Kanbr-lfleBoroKaHana. OAHaKo, y naqreHToB c PA, HyxHo KoHTponhpoBarb
npreM H[|BC tA,no Bo3Mo)KHocrtAt cKarb anbrepHaruebr AnF 3aMeHbt,oco6eHHo ecnr apTepharfbHaq rilnepTeH3rlfl vnv ceptreqHae HeAocraroqHocrb nporpeccnpyor Aaxe Ha Qoue
aAeKBarHofirepan r v ervx cocrocH mlt.
Oxnpenme, oco6eHHo 6prouHoil TAn, qBflnercn QarropoM pt4cKa4.nc cepgeq Ho-cocy,qncrutx sa6oreea+tAil e o6ulell nonynellLlra.OgHaKo, npil PA cepgeqHo-cocyAVCraA cMeprHocrb
Bbrue npr hHAeKce Maccbt rena (l/MT) MeHbue 20 kg/m2. Kaxercns FBflqercn npLt3HaKoM
tqxenoro PA, il coorBercrBeHHo qeM Tflxenee PA, TeM Bbrlue sa6oneeaeMocrb t4 cMepTHocrb. flaqreHrur PA gonxHbt norsAepxmBarb
HopMarbHsrfr eec refla, 3a6orilTbcn o BocnoflHeHW 6enra tABIATaMwHoB
il eroMy Moxer noMor.f
b c6anaucvtpoBaHHoenvraHne. [49,50].
A[erearHan cocro+Ht to Ll rnxecrw QvtsuqecKaq aKTrBHocrb eule oAilH saxHurfr $arrop
cH ilxe Hil e cepgeq Ho - cocyr,t/ crbrx p klcKo e. O r 3hqecKile ynpaxHeHilq 6esonacHbt npra PA ra
Aaxe Moryr yMeHbuarb aKTTlBHocrs6onegHyr,
il noeroMy AoflxHbr BbtnoflHqrscq6oruHbtMll B
peMnccvtA. flpn nporpecct poBaHVtA3a6oneBaHVAdilshqecKile ynpaxHeHile raoKe AoJtxuut 6uttu, Ho npil oroM Qttsr.lvec<aqaKTLlBHocrb
Ha BocnaneHHbrecycraBbt AoaxHa 6urrs MVHTAvansuoil [51].
Ao6aerr K nrqe c pur6urv xrpoM, 6orarure
overofi -3 xilpHbrM14KncnoraMil, noATBeptrvnv
cBoro eQQerrneHocrb B KoMnreKCHoMreqeuurtt PA. OHr voryr cnoco6crBoBarb yMeHblueHilo rcnonb3oBaHne HnBC, a raKxe Moryr
yMeHbruarb ce p4eq Ho - cocyAl4crbt e pucru. [,nn
AOCTilXeHTq pe3ynbTaToB BaxHo nprHilMaTb
aAeKBarHbreEosbt (Aoea Ha 10-15 vn pur6uero
xnpa e cyxr) AaHHbtxnpenaparoe[52].
PAHHnT ErArHOS
14'|EL|EH]4E
.[,ononurrefl bHo K KoHTpono rpaAnLlnoHHbtx
Kaprqr4o
BacKynFp Hbrx Qarro po B pl4cKa,yMeHbluNTbcepAeqHo-cocyAt/cruril pmcr Moxer paHA R S M E D I C AN A s( 1 5 )
HAe &narHocrilKa PA u 6urcrpoe ageKBarHoe
fletreHile. Ecru vHeHne, qro nallileHTbr c PA
ypoeeHb KapgrloBacKyrMetor noBbrrxeHHurft
nnpHofi cMeprHocrl4, Bo3Mo)KHonoroMy, tlro
na4HeHT il Bpaq cocpeAoToqeHbt Ha aprpt/re [53]. Kporvreroro, cepAeqHo-cocy4t/crae
narofloriln y 6oluuurx PA Moxer nporeKarb
acrMnroMno[7]. Bpavrz AolxHbt 6ulrs HacropoxeHbr ra o6paularb BHLlMaHheHa MenKre fi
HerilnhqHbre nponB neuwil cep4eLtHo-cocyAl4croil 6one3Hr y naqneHToe c PA, noMHq o BbtcoKoM pl4cKe cocyAl4crbtx KaracrpoQ y eroil
rpynnbr.
SAKNloqEHNE
Cep.qevHo-cocyrqhcraff narofl ortAe - ocHoBHafl npnqfiHa ocIoxHeHHoro TeqeHhfl v neTaflbHocrn y naWeHToB c PA. SorulurHcreo
qro xpoHylilccneAoBarenefi npe4nonarael
LrecKoecilcreMHoe BocnaneHile cnoco6creyer
3HatfLlTenuHo 6on uu-re ft ce p6ett Ho-cocy gtttctoil
sa6oneeaeMocrr y nnL\c PA, qeM B o6uteil nonynqunv H qTo KoHTponb HaA BocnaneHileM
npr PA yMeHblxaer cMeprHocrb or cocy4l4cTbrx KaracrpoQ e eroil rpynne. KnaccrqecKre cepAeqHo-cocyAl4crbte Qarropur pytcKa
ilrpaoT ponb il MoryT, B HeKoTopbtxcrytlaFx,
6 u r r u n o r e H q n m p o B a H H bnt p e n a p a r a M n , v c nonb3yeMbrMil .qnq fleqeHhn PA. IlpoQvnaKrnKa cepgeqHo-cocyguctoil sa6oneeaeMocrt4 y
nauneHroe c PA rpe6yer rov6rHrpoBaHHoro
noAXoAa, BKn]oqa|ou-leroKoHTponb 3a ynpaBneeMbrMl4 TpaAil4roHHbrMl4 cepAetlHo-cocyAkrcrblMu QarropavtA pttcKa r eQQerrueuufr vr
AnmTenbHurfi<ourpoflb aKTrlBHocrl4PA, eurcoKyo cTeneHb HacTopoxeHHocTtAv KaK MoxHo
6onee nonHoe AilHaMrLtecKoeo6creAoeaHre
cepgeqHo-cocygncrofr
cilcreMbt y 4aHHoi
rpynnbr nauheHToB.
,Il4TEPATYPA:
1.
2.
MasypoeB.lzl.PeervarongHurilaprpt4r(<nnHilKa, ArarHOCTl,'lKa,
IeLleHue). B.lz1.
MaSypoe, A.M.llwna. Cn6.: MeA Macc Me4ra,
2000.
PincusI FerraccioliG, SokkaT et al. Evidence from cl i ni caltri al sand l ong-ter mobservationalstudiesthat disease-modifying
anti-rheumatic drugs slow radiographic
AN 3A5ON EBAEMOCTb I/ C MEPTHOCTb
CEPNE! HO- COCYAIACT
: O53OPI/TE P A TV P bI
A P TP I/TOM
s OIl b H b l xP EB M AT O/nH bl M
analyses.BMJ 2000;321: 199-204.
progressionin rheumatoidarthritis:updating a 1983 review.Rheumatology(Oxford) 14. S oderl i nMK , N i emi nenB H akal aM . Funct ionalstatus predictsmortalityin a commu2002;41: 1346-56.
nity based rheumatoidarthritispopulation.
3 . Wolfe F, MitchellDM, SibleyJT, et al. The
J R h e u m a t o1l 9 9 8 ;2 5 : 1 8 9 5 - 1 8 9 9 .
mortality of rheumatoidarthritis.Arthritis
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