Епідеміологічні особливості поєднаних гіперпроліферативних процесів жіночої репродуктивної системи

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ ɆȿȾɂɑɇȱ ɉȿɊɋɉȿɄɌɂȼɂ84 9. Rebrova OYu. Statisticheskiy analiz meditsinskih dannyih. Primenenie paketa prikladnyih programm STATISTICA.M: Media Sfera. 2002;312. 10. UstInov OV. Psihichne zdorov’ya yak skladova natsionalnoyi bezpeki. Ukr me d chasopis 1(93). Vidav- nitstvo «MORION»; 2013. 11. Chaban OS. Asteno-nevroticheskiy sindrom. Ru- bezhi zdorovya. 2012;1: 16-19. 12. Yureva LN. Istoriya. Kultura. Psihicheskie i povedencheskie rasstroystva. K: Sfera. 2002;224. 13. Yureva LN. Krizisnyie sosto yaniya. Dnepropet- rovsk: Art–Press. 1998;164. 14. Yureva LN. Professional noe vyigoranie u medi- tsinskih rabotnikov: form irovanie, profilaktika i kor- rektsiya. K: Sfera. 2004;272. ɍȾɄ 618.14-089.844 ȼ.Ɉ. ɉɨɬɚɩɨɜ, ɘ.ȼ. Ⱦɨɧɫɶɤɚ, ȱ.ȼ. ȱɜɚɯ, ɇ.Ƚ. Ƚɚɥɢɰɶɤɚ, Ɇ.ȼ. Ɇɟɞɜɟɞɽɜ ȿȿɉɉȱȱȾȾȿȿɆɆȱȱɈɈɅɅɈɈȽȽȱȱɑɑɇɇȱȱɈɈɋɋɈɈȻȻɅɅɂɂȼȼɈɈɋɋɌɌȱȱ ɉɉɈɈȯȯȾȾɇɇȺȺɇɇɂɂɏɏȽȽȱȱɉɉȿȿɊɊɉɉɊɊɈɈɅɅȱȱɎɎȿȿɊɊȺȺɌɌɂɂȼȼɇɇɂɂɏɏ ɉɉɊɊɈɈɐɐȿȿɋɋȱȱȼȼɀɀȱȱɇɇɈɈɑɑɈɈȲȲɊɊȿȿɉɉɊɊɈɈȾȾɍɍɄɄɌɌɂɂȼȼɇɇɈɈȲȲ ɋɋɂɂɋɋɌɌȿȿɆɆɂɂ ȾɁ «Ⱦɧɿɩɪɨɩɟɬɪɨɜɫɶɤɚ ɦɟɞɢɱɧɚ ɚɤɚɞɟɦɿɹ ɆɈɁ ɍɤɪɚʀɧɢ» ɤɚɮɟɞɪɚ ɚɤɭɲɟɪɫɬɜɚ ɿ ɝɿɧɟɤɨɥɨɝɿʀ (ɡɚɜ. – ɞ.ɦɟɞ.ɧ., ɩɪɨɮ. ȼ.Ɉ. ɉɨɬɚɩɨɜ) Ⱦɧɿɩɪɨɩɟɬɪɨɜɫɶɤ, 49044, ɍɤɪɚʀɧɚ SE "Dnipropetrovsk medical academy Ministry of Health of Ukraine" obstetrics and gynecology department Dnipropetrovsk, 49044, Ukraine e-mail: [email protected] Ʉɥɸɱɨɜɿ ɫɥɨɜɚ: ɥɟɣɨɦɿɨɦɚ ɦɚɬɤɢ, ɝɿɩɟɪɩɥɚɡɿɹ ɟɧɞɨɦɟɬɪɿɹ, ɟɧɞɨɦɟɬɪɿɨɡ, ɮɚɤɬɨɪɢ ɪɢɡɢɤɭ, ɟɩɿɞɟɦɿɨɥɨɝɿɱɧɿ ɨɫɨɛɥɢɜɨɫɬɿ Key words: uterine leiomyoma, endometrial hyperplasia, endometriosis, risk factors, epidemiologic features Ɋɟɮɟɪɚɬ. ɗɩɢɞɟɦɢɨɥɨɝɢɱɟɫɤɢɟ ɨɫɨɛɟɧɧɨɫɬɢ ɫɨɱɟɬɚɧɧɵɯ ɝɢɩɟɪɩɪɨɥɢɮɟɪɚɬɢɜɧɵɯ ɩɪɨɰɟɫɫɨɜ ɠɟɧɫɤɨɣ ɪɟɩɪɨɞɭɤɬɢɜɧɨɣ ɫɢɫɬɟɦɵ. ɉɨɬɚɩɨɜ ȼ.Ⱥ., Ⱦɨɧɫɤɚɹ ɘ.ȼ., ɂɜɚɯ ɂ.ȼ., Ƚɚɥɢɰɤɚɹ ɇ.Ƚ., Ɇɟɞɜɟɞɟɜ Ɇ.ȼ. ȼɢ ɫ ɫ ɥ ɟ- ɞɨɜɚɧɢɢ ɩɪɢɧɢɦɚɥɨ ɭɱɚɫɬɢɟ 622 ɠɟɧɳɢɧɵ ɪɟɩɪɨɞɭɤɬɢɜɧɨɝɨ ɜɨɡɪɚɫɬɚ ɫ ɬɚɤɢɦɢ ɝɢɩɟɪɩɪɨɥɢɮɟɪɚɬɢɜɧɵɦɢ ɩɪɨɰɟɫɫɚɦɢ ɨɪɝɚɧɨɜ ɦɚɥɨɝɨ ɬɚɡɚ, ɤɚɤ ɥɟɣɨɦɢɨɦɚ ɦɚɬɤɢ, ɝɢɩɟɪɩɥɚɡɢɹ ɷɧɞɨɦɟɬɪɢɹ ɢ ɷɧɞɨɦɟɬɪɢɨɡ. ȼ ɯɨɞɟ ɪɚɛɨ- ɬɵ ɢɡɭɱɟɧɵ ɨɫɧɨɜɧɵɟ ɷɩɢɞɟɦɢɨɥɨɝɢɱɟɫɤɢɟ ɮɚɤɬɨɪɵ, ɩɪɢɫɭɳɢɟ ɭɤɚɡɚɧɧɵɦ ɡɚɛɨɥɟɜɚɧɢɹɦ. ȼɵɹɜɥɟɧɨ, ɱɬɨ ɬɚɤɢɟ ɡɚɛɨɥɟɜɚɧɢɹ, ɤɚɤ ɥɟɣɨɦɢɨɦɚ ɦɚɬɤɢ, ɷɧɞɨɦɟɬɪɢɨɡ ɢ ɝɢɩɟɪɩɥɚɡɢɹ ɷɧɞɨɦɟɬɪɢɹ ɢɦɟɸɬ ɨɛɳɢɟ ɮɚɤɬɨɪɵ ɪɢɫɤɚ – ɩɨɜɵɲɟɧɧɚɹ ɦɚɫɫɚ ɬɟɥɚ, ɪɚɧɧɟɟ ɦɟɧɚɪɯɟ, ɩɨɜɵɲɟɧɧɚɹ ɱɚɫɬɨɬɚ ȼɁɈɆɌ, ɚɧɟɦɢɢ, ɝɢɩɟɪɬɨɧɢɱɟɫɤɨɣ ɛɨɥɟɡɧɢ, ɨɩɟɪɚɬɢɜɧɵɯ ɜɦɟɲɚɬɟɥɶɫɬɜ ɩɨ ɩɨɜɨɞɭ ɝɢɧɟɤɨɥɨɝɢɱɟɫɤɨɣ ɩɚɬɨɥɨɝɢɢ. ȼ ɬɨ ɠɟ ɜɪɟɦɹ ɜɵɹɜɥɟɧɵ ɫɩɟɰɢɮɢɱɟɫɤɢɟ ɱɟɪɬɵ, ɩɪɢɫɭɳɢɟ ɬɨɥɶɤɨ ɫɨɱɟɬɚɧɢɸ ɥɟɣɨɦɢɨɦɵ ɦɚɬɤɢ ɢ ɝɢɩɟɪɩɥɚɡɢɢ ɷɧɞɨɦɟɬɪɢɹ – ɩɨɜɵɲɟɧɢɟ ɱɚɫɬɨɬɵ ɋɉɄə ɢ ɫɚɯɚɪɧɨɝɨ ɞɢɚɛɟɬɚ ɜɬɨɪɨɝɨ ɬɢɩɚ, ɚ ɬɚɤɠɟ ɞɥɹ ɥɟɣɨɦɢɨɦɵ ɦɚɬɤɢ ɢ ɷɧɞɨɦɟɬɪɢɨɡɚ – ɫɨɤɪɚɳɟɧɢɟ ɩɪɨ- ɞɨɥɠɢɬɟɥɶɧɨɫɬɢ ɦɟɧɫɬɪɭɚɥɶɧɨɝɨ ɰɢɤɥɚ, ɩɨɜɵɲɟɧɢɟ ɱɚɫɬɨɬɵ ɛɟɫɩɥɨɞɢɹ. Abstract. Epidemiologic peculiarities of combined hyperproliph erative processes of female reproductive system. Potapov V.O., Donska Yu.V., Ivach I.V., Halytska V.H., Medvedyev M.V. The study involved 622 women of reproductive age with such hyperproliferative pro cesses of the pelvic organs as uterine leiomyoma, endometrial hyperplasia and endometriosis. We studied main epidemiological factors inherent in these diseases. We have found that such diseases as uterine leiomyoma, endometriosis and endometrial hyp erplasia have common risk factors: obesity, early menarche, increased frequency of PID, anemia, hypertension, surgical interventions for gynecological pathology. At the same time, specific features unique to the combination of uterine leiomyoma and endometrial hyperplasia were found: increased frequency of PCOS and type 2 diabetes, as well as for endometriosis and uterine leiomyoma – reduction of menstrual cycle length, increase of infertility frequency. 8513/ Ɍɨɦ XVIII / 2 Ʌɟɣɨɦɿɨɦɚ ɦɚɬɤɢ ( ɅɆ) ɽ ɩɨɲɢɪɟɧɨɸ ɩɭɯɥɢ- ɧɨɸ ɠɿɧɨɱɢɯ ɫɬɚɬɟɜɢɯ ɨɪɝɚɧɿɜ, ɱɚɫɬɨɬɚ ɹɤɨʀ ɭ ɠɿɧɨɤ ɪɟɩɪɨɞɭɤɬɢɜɧɨɝɨ ɜɿɤɭ ɫɬɚɧɨɜɢɬɶ 20-45%. ɍ ɤɨɠɧɨʀ ɞɪɭɝɨʀ ɯɜɨɪɨʀ ɡ ɅɆ ɫɩɨɫɬɟɪɿɝɚɸɬɶɫɹ ɝɿ- ɩɟɪɩɥɚɫɬɢɱɧɿ ɩɪɨɰɟɫɢ ɟɧɞɨɦɟɬɪɿɹ ( Ƚȿ), ɩɪɢ- ɛɥɢɡɧɨ ɭ 15-20% ɬɚɤɢɯ ɠɿɧɨɤ ɜɢɹɜɥɹɽɬɶɫɹ ɝɟɧɿ- ɬɚɥɶɧɢɣ ɟɧɞɨɦɟɬɪɿɨɡ [2]. ɇɚɹɜɧɿɫɬɶ ɩɨɽɞɧɚɧɢɯ ɝɿɩɟɪɩɪɨɥɿɮɟɪɚɬɢɜɧɢɯ ɩɪɨɰɟɫɿɜ ɜɧɭɬɪɿɲɧɿɯ ɫɬɚɬɟɜɢɯ ɨɪɝɚɧɿɜ ɭ ɠɿɧɨɤ ɫɭɬɬɽɜɨ ɜɩɥɢɜɚɽ ɧɚ ɤɥɿɧɿɱɧɢɣɩɟɪɟɛɿɝ, ɪɟɩɪɨɞɭɤ- ɬɢɜɧɭ ɮɭɧɤɰɿɸ, ɟɮɟɤɬɢɜɧɿɫɬɶ ɥɿɤɭɜɚɧɧɹ, ɳɨ ɞɢɤ- ɬɭɽ ɧɟɨɛɯɿɞɧɿɫɬɶ ɩɨɲɭɤɭ ɧɨɜɢɯ ɫɬɪɚɬɟɝɿɣ ɞɢɮɟ- ɪɟɧɰɿɣɨɜɚɧɨɝɨ ɩɿɞɯɨɞɭ ɞɨ ɥɿɤɭɜɚɧɧɹ ɰɢɯ ɡɚɯɜɨ- ɪɸɜɚɧɶ [1]. Ɇɟɬɨɸ ɞɨɫɥɿɞɠɟɧɧɹ ɛɭɥɨ ɜɢɹɜɥɟɧɧɹ ɟɩɿɞɟ- ɦɿɨɥɨɝɿɱɧɢɯ ɨɫɨɛɥɢɜɨɫɬɟɣ ɩɨɽɞɧɚɧɢɯ ɝɨɪɦɨɧɨ- ɡɚɥɟɠɧɢɯ ɝɿɩɟɪɩɪɨɥɿɮɟɪɚɬɢɜɧɢɯ ɡɚɯɜɨɪɸɜɚɧɶ ɠɿɧɨɱɨʀ ɪɟɩɪɨɞɭɤɬɢɜɧɨʀ ɫɢɫɬɟɦɢ. ɆȺɌȿɊȱȺɅɂ ɌȺ ɆȿɌɈȾɂ ȾɈɋɅȱȾɀȿɇɖ ɍ ɞɨɫɥɿɞɠɟɧɧɿ ɛɪɚɥɢ ɭɱɚɫɬɶ 542 ɠɿɧɤɢ ɪɟɩɪɨ- ɞɭɤɬɢɜɧɨɝɨ ɜɿɤɭ ɡ ɅɆ, ɹɤɚ ɩɿɞɥɹɝɚɥɚ ɨɩɟɪɚ- ɬɢɜɧɨɦɭ ɥɿɤɭɜɚɧɧɸ, ɬɚ 80 ɡɞɨɪɨɜɢɯ ɠɿɧɨɤ, ɹɤɿ ɫɤɥɚɥɢ ɤɨɧɬɪɨɥɶɧɭ ɝɪɭɩɭ ( ɄȽ). Ⱦɨɫɥɿɞɠɟɧɧɹ ɩɪɨɜɨɞɢɥɨɫɶ ɡ 2007 ɩɨ 2013 ɪɿɤ ɧɚ ɛɚɡɿ Ⱦɧɿ- ɩɪɨɩɟɬɪɨɜɫɶɤɨʀ ɨɛɥɚɫɧɨʀ ɤɥɿɧɿɱɧɨʀ ɥɿɤɚɪɧɿ ɿɦ. ȱ.ȱ. Ɇɟɱɧɢɤɨɜɚ, Ⱦɧɿɩɪɨɩɟɬɪɨɜɫɶɤɨʀ ɦɿɫɶɤɨʀ ɤɥɿ- ɧɿɱɧɨʀ ɥɿɤɚɪɧɿ ʋ9 ɬɚ ɩɪɢɜɚɬɧɨʀ ɤɥɿɧɿɤɢ «Ƚɚɪɜɿɫ». Ɂɚɥɟɠɧɨ ɜɿɞɧɚɹɜɧɨɫɬɿ ɥɟɣɨɦɿɨɦɢ ɦɚɬɤɢ ɬɚ ɿɧ- ɲɢɯ ɝɿɩɟɪɩɪɨɥɿɮɟɪɚɬɢɜɧɢɯ ɩɪɨɰɟɫɿɜ ɠɿɧɨɱɨʀ ɪɟɩɪɨɞɭɤɬɢɜɧɨʀ ɫɢɫɬɟɦɢ ɜɫɿ ɠɿɧɤɢ ɛɭɥɢ ɪɨɡɩɨ- ɞɿɥɟɧɿ ɧɚ 3 ɝɪɭɩɢ: ɝɪɭɩɭ ȱ ɫɤɥɚɥɢ 187 ɠɿɧɨɤ ɡ ɅɆ; ɞɨ ɝɪɭɩɢ ȱȱ ɭɜɿɣɲɥɢ 176 ɠɿɧɨɤ ɡ ɩɨɽɞɧɚɧɧɹɦ Ƚȿ ɬɚ ɅɆ; ɝɪɭɩɭ ȱȱȱ ɫɤɥɚɥɢ 179 ɠɿɧɨɤ ɡ ɧɚɹɜɧɿɫɬɸ ɅɆ ɬɚ ɟɧɞɨɦɟɬɪɿɨɡɭ. Ɂ ɦɟɬɨɸ ɩɿɞɜɢɳɟɧɧɹ ɪɟɩɪɟɡɟɧɬɚɬɢɜɧɨɫɬɿ ɞɚ- ɧɢɯ ɡ ɞɨɫɥɿɞɠɟɧɧɹ ɛɭɥɢ ɜɢɤɥɸɱɟɧɿ ɜɢɩɚɞɤɢ ɿɧ- ɮɿɥɶɬɪɚɬɢɜɧɨɝɨ ɟɧɞɨɦɟɬɪɿɨɡɭ, ɩɿɞɨɡɪɢ ɧɚ ɦɚɥɿɝ- ɧɿɡɚɰɿɸ, ɚɬɢɩɨɜɨʀ ɝɿɩɟɪɩɥɚɡɿʀ ɟɧɞɨɦɟɬɪɿɹ ɬɚ ɬɹɠ- ɤɨʀ ɟɤɫɬɪɚɝɟɧɿɬɚɥɶɧɨʀ ɩɚɬɨɥɨɝɿʀ. ɍ ɯɨɞɿ ɪɨɛɨɬɢ ɜɢɜɱɟɧɨ ɚɧɚɦɧɟɫɬɢɱɧɿ ɞɚɧɿ, ɳɨ ɜɤɥɸɱɚɥɢ: ɨɫɨɛɥɢɜɨɫɬɿ ɩɪɟɦɨɪɛɿɞɧɨɝɨ ɮɨɧɭ, ɫɩɚɞɤɨɜɭ ɫɯɢɥɶɧɿɫɬɶ, ɩɟɪɟɧɟɫɟɧɿ ɣ ɫɭɩɭɬɧɿ ɟɤɫ- ɬɪɚɝɟɧɿɬɚɥɶɧɿ ɬɚ ɝɿɧɟɤɨɥɨɝɿɱɧɿ ɡɚɯɜɨɪɸɜɚɧɧɹ, ɩɟɪɟɧɟɫɟɧɿ ɨɩɟɪɚɬɢɜɧɿ ɝɿɧɟɤɨɥɨɝɿɱɧɿ ɬɚ ɿɧɲɿ ɜɬɪɭ- ɱɚɧɧɹ. Ɉɫɨɛɥɢɜɚ ɭɜɚɝɚ ɩɪɢɞɿɥɹɥɚɫɹ ɜɢɜɱɟɧɧɸ ɫɩɟɰɢɮɿɱɧɢɯ ɮɭɧɤɰɿɣ ɠɿɧɨɱɨɝɨ ɨɪɝɚɧɿɡɦɭ: ɦɟɧ- ɫɬɪɭɚɥɶɧɨʀ, ɫɬɚɬɟɜɨʀ ɬɚ ɪɟɩɪɨɞɭɤɬɢɜɧɨʀ. ȼɫɿɦ ɠɿɧɤɚɦ ɛɭɥɚ ɜɢɤɨɧɚɧɚ ɦɿɨɦɟɤɬɨɦɿɹ ɥɚ- ɩɚɪɨɬɨɦɧɢɦ ɚɛɨ ɥɚɩɚɪɨɫɤɨɩɿɱɧɢɦ ɞɨɫɬɭɩɨɦ. Ɂ ɦɟɬɨɸ ɩɿɞɬɜɟɪɞɠɟɧɧɹ ɞɿɚɝɧɨɡɭ ɩɪɨɜɨɞɢɥɨɫɶ ɦɨɪ- ɮɨɥɨɝɿɱɧɟ ɞɨɫɥɿɞɠɟɧɧɹ ɜɢɞɚɥɟɧɢɯ ɩɿɞ ɱɚɫ ɯɿɪɭɪ- ɝɿɱɧɨɝɨ ɜɬɪɭɱɚɧɧɹ ɦɿɨɦɚɬɨɡɧɢɯ ɜɭɡɥɿɜ ɬɚ ɟɧɞɨ- ɦɟɬɪɿɨʀɞɧɢɯ ɟɤɫɩɥɚɧɬɿɜ. ɉɟɪɟɞ ɩɥɚɧɨɜɢɦ ɨɩɟɪɚ- ɬɢɜɧɢɦ ɥɿɤɭɜɚɧɧɹɦ ɩɪɨɜɨɞɢɥɨɫɶ ɝɿɫɬɨɥɨɝɿɱɧɟ ɞɨɫɥɿɞɠɟɧɧɹ ɡɪɚɡɤɿɜ ɟɧɞɨɦɟɬɪɿɹ, ɳɨɛɭɥɢ ɨɬɪɢ- ɦɚɧɿ ɩɿɞ ɱɚɫ ɞɿɚɝɧɨɫɬɢɱɧɨɝɨ ɜɢɲɤɪɿɛɚɧɧɹ ɚɛɨ ɚɫɩɿɪɚɰɿɣɧɨʀ ɛɿɨɩɫɿʀ ɟɧɞɨɦɟɬɪɿɹ. Ⱦɥɹ ɦɨɪɮɨɥɨɝɿɱɧɨɝɨ ɞɨɫɥɿɞɠɟɧɧɹ ɡ ɤɨɠɧɨɝɨ ɛɥɨɤɭ ɩɪɨɜɨɞɢɥɢ ɧɟ ɦɟɧɲɟ ɧɿɠ 10 ɡɪɿɡɿɜ. ɉɚ- ɪɚɮɿɧɨɜɿ ɡɪɿɡɢ ɬɨɜɳɢɧɨɸ 4-5 ɦɤɦ, ɨɬɪɢɦɚɧɿ ɧɚ ɦɿɤɪɨɬɨɦɿ Microm HM-340, ɛɭɥɢ ɞɟɩɚɪɚɮɿɧɨɜɚɧɿ ɣ ɩɨɮɚɪɛɨɜɚɧɿ ɝɟɦɚɬɨɤɫɢɥɿɧɨɦ-ɟɨɡɢɧɨɦ. ɋɜɿɬ- ɥɨɜɚ ɦɿɤɪɨɫɤɨɩɿɹ ɩɪɨɜɨɞɢɥɚɫɶ ɡɚ ɞɨɩɨɦɨɝɨɸ ɫɜɿɬɥɨɜɨɝɨ ɦɿɤɪɨɫɤɨɩɭ Le ɿca DMLS ɡ ɜɢɤɨɪɢɫ- ɬɚɧɧɹɦ ɨɛ’ɽɤɬɢɜɿɜ ×10, ×20, ×40, ×100. Ɉɬɪɢɦɚɧɿɞɚɧɿ ɨɛɪɨɛɥɹɥɢ ɡ ɜɢɤɨɪɢɫɬɚɧɧɹɦ ȿɈɆ ɡɚ ɞɨɩɨɦɨɝɨɸ ɥɿɰɟɧɡɿɣɧɨʀ ɩɪɨɝɪɚɦɢ Statistica ( ɜɟɪɫɿɹ 6.1, Statsoft, ɋɒȺ). ɇɨɪɦɚɥɶ- ɧɿɫɬɶ ɪɨɡɩɨɞɿɥɭ ɨɰɿɧɸɜɚɥɢ ɡɚ ɞɨɩɨɦɨɝɨɸ ɤɪɢ- ɬɟɪɿʀɜ ɒɚɩɿɪɨ-ɍʀɥɤɚ ɬɚ Ʉɨɥɦɨɝɨɪɨɜɚ. ɍ ɞɨɫɥɿɞ- ɠɟɧɧɿ ɛɭɥɨ ɩɪɢɣɧɹɬɨ ɪɿɜɟɧɶ ɫɬɚɬɢɫɬɢɱɧɨʀ ɡɧɚ- ɱɭɳɨɫɬɿ p<0,05. ɊȿɁɍɅɖɌȺɌɂ ɌȺ Ȳɏ ɈȻȽɈȼɈɊȿɇɇə Ⱥɧɚɥɿɡ ɨɬɪɢɦɚɧɢɯ ɞɚɧɢɯ ɩɨɤɚɡɚɜ, ɳɨ ɩɟ- ɪɟɜɚɠɧɚ ɛɿɥɶɲɿɫɬɶ ɠɿɧɨɤ ɛɭɥɢ ɜɿɤɨɦ ɜɿɞ 26 ɞɨ 40 ɪɨɤɿɜ. ɋɟɪɟɞɧɿɣ ɜɿɤ ɠɿɧɨɤ, ɳɨ ɭɜɿɣɲɥɢ ɭ ɞɨɫɥɿɞ- ɠɟɧɧɹ, ɫɬɚɧɨɜɢɜ 32,8 ± 0,85 ɪɨɤɭ. Ƚɪɭɩɢ, ɳɨ ɞɨɫɥɿɞɠɭɜɚɥɢɫɶ, ɧɟ ɜɿɞɪɿɡɧɹɥɢɫɹ ɜɿɪɨɝɿɞɧɨ ɡɚ ɜɿɤɨɦ: ɭɄ Ƚɛ ɭ ɜ 32 ± 0,97 ɪɨɤɭ; ɭ ɝɪɭɩɿ ȱ – 33,5 ± 1,3 ɪɨɤɭ; ɭ ɝɪɭɩɿ ȱȱ – 34,3 + 0,84 ɪɨɤɭ ɬɚ ɭ ɝɪɭɩɿ ȱȱȱ – 31,4 ± 1,4 ɪɨɤɭ (p>0,05). ɋɟɪɟɞɧɿɣ ɿɧɞɟɤɫ ɦɚɫɢ ɬɿɥɚ (ȱɆɌ) ɛɭɜ ɜɿɪɨɝɿɞɧɨ ɜɢɳɢɦ ɭ ɠɿɧɨɤ ɝɪɭɩɢ ȱȱȱ ɩɨɪɿɜɧɹɧɨ ɡ ɄȽ (ɬɚɛɥ.1), ɳɨ, ɨɱɟɜɢɞɧɨ, ɩɨɜ’ɹɡɚɧɨ ɡ ɛɿɥɶɲ ɱɚɫɬɢɦ ɡɚɫɬɨ- ɫɭɜɚɧɧɹ ɝɨɪɦɨɧɚɥɶɧɨʀ ɬɟɪɚɩɿʀ ɭ ɠɿɧɨɤ ɡ ɅɆ ɬɚ ɟɧɞɨɦɟɬɪɿɨɡɨɦ, ɚ ɬɚɤɨɠ ɩɿɞɜɢɳɟɧɧɹɦ ɤɨɧɰɟɧ- ɬɪɚɰɿʀ ɟɫɬɪɨɝɟɧɿɜ ɡɚ ɪɚɯɭɧɨɤ ɚɪɨɦɚɬɢɡɚɰɿʀ ɚɧɞɪɨ- ɝɟɧɿɜ ɜ ɠɢɪɨɜɿɣ ɬɤɚɧɢɧɿ. ɀɿɧɤɢ ɡ ɧɚɞɦɿɪɧɨ ɧɢɡɶɤɨɸ ɦɚɫɨɸ ɬɿɥɚ (ȱɆɌ ” 18,5 ɤɝ/ɦ 2) ɬɚ ɨɠɢɪɿɧɧɹɦ 2 ɫɬɭɩɟɧɹ ɬɚ ɜɢɳɟ ( ȱɆɌ • 35 ɤɝ/ɦ2) ɜɢɥɭɱɚɥɢɫɹ ɿɡ ɞɨɫɥɿɞ- ɠɟɧɧɹ, ɜɪɚɯɨɜɭɸɱɢ ɜɟɥɢɤɢɣ ɜɩɥɢɜ ɧɚɞɦɿɪɧɨʀ ɬɚ ɧɟɞɨɫɬɚɬɧɶɨʀ ɤɿɥɶɤɨɫɬɿ ɠɢɪɨɜɨʀ ɬɤɚɧɢɧɢ ɧɚ ɝɨɪɦɨɧɚɥɶɧɢɣ ɮɨɧ ɬɚ ɩɪɨɝɪɟɫɭɜɚɧɧɹ ɅɆ, ɱɚɫɬɨɬɭ ʀʀ ɪɟɰɢɞɢɜɿɜ. Ɉɱɿɤɭɜɚɧɨ ɠɿɧɤɢ ɨɫɧɨɜɧɢɯ ɝɪɭɩ ɯɚɪɚɤɬɟɪɢ- ɡɭɜɚɥɢɫɶ ɛɿɥɶɲ ɪɚɧɧɿɦ ɫɟɪɟɞɧɿɦ ɜɿɤɨɦ ɦɟɧɚɪɯɟ ɩɨɪɿɜɧɹɧɨ ɡ ɄȽ (p<0,05), ɳɨ ɜɤɚɡɭɽ ɧɚ ɛɿɥɶɲɭ ɟɤɫɩɨɡɢɰɿɸ ɞɨ ɟɫɬɪɨɝɟɧɿɜ ɬɚ ɛɿɥɶɲɭ ɤɿɥɶɤɿɫɬɶ ɦɟɧɫɬɪɭɚɥɶɧɢɯ ɰɢɤɥɿɜ ( Ɇɐ), ɹɤɿɩɿɞɜɢɳɭɸɬɶ ɿɦɨɜɿɪɧɿɫɬɶ ɝɿɩɟɪɩɪɨɥɿɮɟɪɚɬɢɜɧɢɯ ɡɚɯɜɨɪɸɜɚɧɶ, ɳɨ ɜɢɜɱɚɥɢɫɹ. ɋɟɪɟɞɧɹ ɬɪɢɜɚɥɿɫɬɶ Ɇɐ ɧɟ ɜɿɞ- ɪɿɡɧɹɥɚɫɹ ɜɿɞ ɡɞɨɪɨɜɢɯ ɠɿɧɨɤ ɭ ɜɫɿɯ ɝɪɭɩɚɯ ɨɤɪɿɦ ȱȱȱ, ɞɟ ɬɪɢɜɚɥɿɫɬɶ Ɇɐ ɛɭɥɚ ɫɬɚɬɢɫɬɢɱɧɨ ɡɧɚɱɭɳɨ ɦɟɧɲɨɸ, ɧɿɠ ɭ ɪɟɲɬɿ ɝɪɭɩ (p<0,05). ɉɪɢ ɨɰɿɧɰɿ ɪɨɡɩɨɜɫɸɞɠɟɧɨɫɬɿ ɡɚɩɚɥɶɧɢɯ ɡɚɯ- ɜɨɪɸɜɚɧɶ ɜɧɭɬɪɿɲɧɿɯ ɝɟɧɿɬɚɥɿɣ ( ɁɁɈɆɌ) ɛɭɥɨ ɜɢɹɜɥɟɧɨ, ɳɨ ɁɁɈɆɌ ɛɭɥɢ ɱɚɫɬɿɲɟ ɡɚɮɿɤɫɨɜɚɧɿ ɜ ɨɫɧɨɜɧɢɯ ɝɪɭɩɚɯ ɡ ɧɚɣɛɿɥɶɲɨɸ ɱɚɫɬɨɬɨɸ ɜ ɝɪɭɩɿ ȱȱȱ. ɇɚ ɧɚɲɭ ɞɭɦɤɭ, ɩɪɢɧɚɣɦɧɿ ɭ ɱɚɫɬɢɧɿ ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ ɆȿȾɂɑɇȱ ɉȿɊɋɉȿɄɌɂȼɂ86 ɜɢɩɚɞɤɿɜ, ɭ ɠɿɧɨɤ ɰɿɽʀ ɝɪɭɩɢ ɡɚ ɫɢɦɩɬɨɦɢ ɁɁɈɆɌ ɛɭɥɢ ɩɨɦɢɥɤɨɜɨ ɩɪɢɣɧɹɬɿ ɫɢɦɩɬɨɦɢ ɟɧɞɨɦɟɬ- ɪɿɨʀɞɧɨʀ ɯɜɨɪɨɛɢ. Ɋɨɡɩɨɜɫɸɞɠɟɧɿɫɬɶ ɫɢɧɞɪɨɦɭ ɩɨɥɿɤɿɫɬɨɡɧɢɯ ɹɽɱɧɢɤɿɜ (ɋɉɄə) ɛɭɥɚ ɧɚ ɪɿɜɧɿ ɡɞɨɪɨɜɢɯ ɠɿɧɨɤ ɭ ɜɫɿɯ ɨɫɧɨɜɧɢɯ ɝɪɭɩɚɯ, ɨɤɪɿɦ ɝɪɭɩɢ ȱȱ, ɞɟ ɋɉɄə ɛɭɜ ɜɢɹɜɥɟɧɢɣ ɜɿɪɨɝɿɞɧɨ ɱɚɫɬɿɲɟ, ɧɿɠ ɭ ɪɟɲɬɿ ɝɪɭɩ (p<0,05). ɐɟ ɜɤɚɡɭɽ ɧɚ ɩɟɜɧɭ ɪɨɥɶ ɋɉɄə ɜ ɝɟɧɟɡɿ Ƚȿ ɭ ɱɚɫɬɢɧɢ ɠɿɧɨɤ ɡ ɅɆ, ɨɫɤɿɥɶɤɢ ɜɿɞɨɦɨ, ɳɨ ɯɚɪɚɤɬɟɪɧɨɸ ɪɢɫɨɸ ɋɉɄə ɽ ɯɪɨɧɿɱɧɚ ɚɧɨɜɭɥɹɰɿɹ ɡ ɜɿɞɧɨɫɧɨɸ ɝɿɩɟɪɟɫɬɪɨɝɟɧɿɽɸ. ɉɪɢɦɿɬɧɢɦ ɮɚɤɬɨɦ ɛɭɥɚ ɜ 2 ɪɚɡɢ ɛɿɥɶɲɚ ɱɚɫ- ɬɨɬɚ ɨɩɟɪɚɬɢɜɧɢɯ ɜɬɪɭɱɚɧɶ ɡ ɩɪɢɜɨɞɭ ɝɿɧɟɤɨ- ɥɨɝɿɱɧɨʀ ɩɚɬɨɥɨɝɿʀ ɭ ɠɿɧɨɤ ɨɫɧɨɜɧɢɯ ɝɪɭɩ (p<0,05). ɐɟ ɳɟ ɪɚɡ ɩɿɞɬɜɟɪɞɠɭɽ ɪɨɥɶ ɦɟɯɚɧɿɱ- ɧɨɝɨ ɩɨɲɤɨɞɠɟɧɧɹ ɜ ɩɚɬɨɝɟɧɟɡɿ ɅɆ. Ɍɚɛɥɢɰɹ 1 Ɉɫɧɨɜɧɿ ɟɩɿɞɟɦɿɨɥɨɝɿɱɧɿ ɱɢɧɧɢɤɢ, ɯɚɪɚɤɬɟɪɧɿ ɞɥɹ ɝɿɩɟɪɩɪɨɥɿɮɟɪɚɬɢɜɧɢɯ ɩɪɨɰɟɫɿɜ ɉɨɤɚɡɧɢɤ ɄȽ (n=80) Ƚɪɭɩɚ ȱ (n=187) Ƚɪɭɩɚ ȱȱ (n=176) Ƚɪɭɩɚ ȱȱȱ (n=179) ȱɆɌ, ɤɝ/ɦ2 (M±m) 23,1±1,3 24,1±0,9 25,4±1,1 26,9±1,1* ɋɟɪɟɞɧɿɣ ɜɿɤ ɦɟɧɚɪɯɟ, ɪɨɤɢ (M±m) 13,2±0,5§ 11,2±0,4 10,0±0,4 11,1±0,3 ɋɟɪɟɞɧɹ ɬɪɢɜɚɥɿɫɬɶ Ɇɐ, ɞɧɿ (M±m) 29,1±1,1 28,3±0,8 30,1±1,2 25,2±0,9¥ ɁɁɈɆɌ, ɚɛɫ. (%) 5 (6,3) 21 (11,2) 22 (12,5) * 37 (20,7) * ¥ ɋɉɄə, ɚɛɫ. (%) 3 (3,8) 4 (2,1) 16 (9,1) § 6 (3,4) Ƚɿɧɟɤɨɥɨɝɿɱɧɿ ɨɩɟɪɚɰɿʀ, ɚɛɫ. (%) 11 (13,8) § 48 (25,7) 53 (30,1) 69 (38,5) Ƚɿɩɟɪɬɨɧɿɱɧɚ ɯɜɨɪɨɛɚ, ɚɛɫ. (%) 3 (3,8) § 17 (9,1) 16 (9,1) 21 (11,7) ɐɭɤɪɨɜɢɣ ɞɿɚɛɟɬ, ɚɛɫ. (%) 2 (2,5) 7 (3,7) 16 (9,1) § 8 (4,5) Ⱥɧɟɦɿɹ, ɚɛɫ. (%) 6 (7,5) § 89 (47,6) 121 (68,8) § 77 (43,0) ɉɪɢɦɿɬɤɢ: * - ɜɿɞɦɿɧɧɿɫɬɶ ɜɿɪɨɝɿɞɧɚɡɄ Ƚɩ ɪ ɢ p<0,05, § - ɜɿɞɦɿɧɧɿɫɬɶ ɡ ɪɟɲɬɨɸ ɝɪɭɩ ɜɿɪɨɝɿɞɧɚ ɩɪɢ p<0,05, ¥ - ɜɿɞɦɿɧɧɿɫɬɶ ɜɿɪɨɝɿɞɧɚ ɡ ɝɪɭɩɨɸ ȱȱ ɩɪɢ p<0,05. Ɉɫɧɨɜɧɿ ɝɪɭɩɢ ɯɚɪɚɤɬɟɪɢɡɭɜɚɥɢɫɹ ɛɿɥɶɲɟ ɧɿɠ ɜ 3 ɪɚɡɢ ɱɚɫɬɢɦ ɜɢɹɜɥɟɧɧɹɦ ɝɿɩɟɪɬɨɧɿɱɧɨʀ ɯɜɨ- ɪɨɛɢ. ɉɨɹɫɧɟɧɧɹɦ ɬɚɤɨʀ ɟɩɿɞɟɦɿɨɥɨɝɿɱɧɨʀ ɡɧɚɯɿɞ- ɤɢ ɽ ɩɨɜɿɞɨɦɥɟɧɧɹ ɩɪɨ ɫɩɿɥɶɧɿ ɥɚɧɤɢ ɩɚɬɨɝɟɧɟɡɭ ɅɆ ɬɚ ɝɿɩɟɪɬɨɧɿɱɧɨʀ ɯɜɨɪɨɛɢ [3]. ɐɿɤɚɜɢɦ ɫɩɨɫɬɟɪɟɠɟɧɧɹɦ ɽ ɫɬɚɬɢɫɬɢɱɧɨ ɡɧɚɱɭɳɟ ɩɿɞɜɢɳɟɧɧɹ ɱɚɫɬɨɬɢ ɰɭɤɪɨɜɨɝɨ ɞɿɚɛɟɬɭ ɭ ɝɪɭɩɿ ȱȱ. ɉɪɢ ɚɧɚɥɿɡɿ ɜɢɩɚɞɤɿɜ ɞɿɚɛɟɬɭ ɫɟɪɟɞ ɠɿɧɨɤ ɰɿɽʀ ɝɪɭɩɢ ɜɢɹɜɥɟɧɨ, ɳɨ 93,8% ɠɿɧɨɤɡ ɞɿɚɛɟɬɨɦ ɦɚɥɢ ɣɨɝɨ ɿɧɫɭɥɿɧ-ɧɟɡɚɥɟɠɧɢɣ ɜɚɪɿɚɧɬ, ɹɤɢɣ, ɹɤ ɿ ɋɉɄə, ɽ ɱɚɫɬɢɧɨɸ ɦɟɬɚɛɨɥɿɱɧɨɝɨ ɫɢɧɞɪɨɦɭ. Ɂɪɨɡɭɦɿɥɨɸ ɛɭɥɚ ɡɧɚɱɧɨ ɩɿɞɜɢɳɟɧɚ ɱɚɫɬɨɬɚ ɚɧɟɦɿʀ ɫɟɪɟɞ ɠɿɧɨɤ ɡ ɅɆ. ɉɪɢɱɨɦɭ ɧɚɣɛɿɥɶɲ ɜɢɫɨɤɚ ɱɚɫɬɨɬɚ ɚɧɟɦɿʀ ɛɭɥɚ ɫɟɪɟɞ ɠɿɧɨɤ ɡ ɧɚɣ- ɛɿɥɶɲ ɜɢɪɚɠɟɧɢɦ ɝɟɦɨɪɚɝɿɱɧɢɦ ɫɢɧɞɪɨɦɨɦ (ɝɪɭɩɚ ȱȱ). ɉɪɢ ɚɧɚɥɿɡɿ ɪɟɩɪɨɞɭɤɬɢɜɧɨʀ ɮɭɧɤɰɿʀ ɭ ɞɨ- ɫɥɿɞɠɭɜɚɧɢɯ ɝɪɭɩɚɯ ɛɭɥɨ ɜɢɹɜɥɟɧɨ ɩɿɞɜɢɳɟɧɭ ɱɚɫɬɨɬɭ ɛɟɡɩɥɿɞɞɹ ɫɟɪɟɞ ɠɿɧɨɤ ɡ ɅɆ ( ɬɚɛɥ. 2). Ɉɞɧɚɤ ɫɬɚɬɢɫɬɢɱɧɨ ɡɧɚɱɭɳɟ ɩɿɞɜɢɳɟɧɧɹ ɛɟɡ- ɩɥɿɞɞɹ ɫɩɨɫɬɟɪɿɝɚɥɨɫɹ ɥɢɲɟ ɭ ɠɿɧɨɤ ɝɪɭɩɢ ȱȱȱ (p<0,05), ɳɨ ɫɜɿɞɱɢɬɶ ɩɪɨ ɛɿɥɶɲɢɣ ɜɩɥɢɜ ɧɚ ɮɟɪɬɢɥɶɧɿɫɬɶ ɟɧɞɨɦɟɬɪɿɨɡɭ ɧɿɠ ɥɟɣɨɦɿɨɦɢ ɦɚɬɤɢ. ɉɪɢ ɚɧɚɥɿɡɿ ɱɚɫɬɨɬɢ ɚɛɨɪɬɿɜ ɛɭɥɨ ɜɢɹɜɥɟɧɨ ʀʀ ɩɿɞɜɢɳɟɧɧɹ ɭ ɠɿɧɨɤ ɝɪɭɩɢ ȱ ɬɚ ȱȱ. ȼɿɞɧɨɫɧɨ ɧɟɜɢɫɨɤɚ ɱɚɫɬɨɬɚ ɚɛɨɪɬɿɜ ɭ ɠɿɧɨɤ ɝɪɭɩɢ ȱȱȱ, ɹɤɚ ɛɭɥɚ ɚɧɚɥɨɝɿɱɧɚ ɞɚɧɢɦ ɭ ɡɞɨɪɨɜɢɯ ɠɿɧɨɤ, ɩɨ- ɜ’ɹɡɚɧɚ ɡ ɜɢɫɨɤɨɸ ɱɚɫɬɨɬɨɸ ɛɟɡɩɥɿɞɞɹ ɭ ɰɿɣ ɝɪɭɩɿ. ȼ ɰɿɥɨɦɭ, ɜɢɫɨɤɚ ɱɚɫɬɨɬɚ ɚɛɨɪɬɿɜ ɽ ɨɞɧɿɽɸ ɡ ɦɨɠɥɢɜɢɯ ɩɪɢɱɢɧ ɜɢɧɢɤɧɟɧɧɹ ɝɿɩɟɪɩɪɨɥɿɮɟ- ɪɚɬɢɜɧɢɯ ɩɪɨɰɟɫɿɜ ɜɧɭɬɪɿɲɧɿɯ ɠɿɧɨɱɢɯ ɝɟɧɿɬɚɥɿɣ. ɉɨɥɨɝɢ ɜ ɚɧɚɦɧɟɡɿ ɡɭɫɬɪɿɱɚɥɢɫɹ ɡ ɨɞɧɚɤɨɜɨɸ ɱɚɫɬɨɬɨɸ ɭ ɜɫɿɯ ɝɪɭɩɚɯ, ɳɨ ɞɨɫɥɿɞɠɭɜɚɥɢɫɶ, ɨɤɪɿɦɝɪɭɩɢ ȱȱȱ, ɞɟ ɜɨɧɚ ɛɭɥɚ ɜɿɪɨɝɿɞɧɨ ɧɢɠɱɨɸ (p<0,05), ɳɨ ɩɨɜ’ɹɡɚɧɨ ɡɿ ɡɝɚɞɚɧɢɦ ɜɢɳɟ ɮɚɤ- ɬɨɪɨɦ – ɜɢɫɨɤɨɸ ɪɨɡɩɨɜɫɸɞɠɟɧɿɫɬɸ ɧɟɩɥɿɞɧɨɫɬɿ ɭ ɠɿɧɨɤ ɡ ɩɨɽɞɧɚɧɧɹɦ ɅɆ ɬɚ ɟɧɞɨɦɟɬɪɿɨɡɭ. 8713/ Ɍɨɦ XVIII / 2 Ɍɚɛɥɢɰɹ 2 Ɋɟɩɪɨɞɭɤɬɢɜɧɚ ɮɭɧɤɰɿɹ ɜ ɚɧɚɦɧɟɡɿ ɉɨɤɚɡɧɢɤ ɄȽ (n=80) Ƚɪɭɩɚ ȱ (n=187) Ƚɪɭɩɚ ȱȱ (n=176) Ƚɪɭɩɚ ȱȱȱ (n=179) Ȼɟɡɩɥɿɞɞɹ, ɚɛɫ. (%) 9 (11,3) § 28 (15,0) 39 (22,2) 89 (49,7) § Ⱥɛɨɪɬɢ, ɚɛɫ. (%) 35 (43,8) * ¥ 117 (62,6) 122 (69,3) 76 (42,5) * ¥ ɉɨɥɨɝɢ, ɚɛɫ. (%) 66 (82,5) 143 (76,5) 131 (74,4) 97 (54,2) § ɉɪɢɦɿɬɤɢ: * - ɜɿɞɦɿɧɧɿɫɬɶ ɜɿɪɨɝɿɞɧɚ ɡ ɝɪɭɩɨɸ ȱ ɩɪɢ p<0,05, § - ɜɿɞɦɿɧɧɿɫɬɶ ɡ ɪɟɲɬɨɸ ɝɪɭɩ ɜɿɪɨɝɿɞɧɚ ɩɪɢ p<0,05, ¥ - ɜɿɞɦɿɧɧɿɫɬɶ ɜɿɪɨɝɿɞɧɚ ɡ ɝɪɭɩɨɸ ȱȱ ɩɪɢ p<0,05. ȼɂɋɇɈȼɄɂ 1. Ɍɚɤɢɦ ɱɢɧɨɦ, ɛɭɥɨ ɜɢɹɜɥɟɧɨ ɬɚ ɩɪɨɚɧɚ- ɥɿɡɨɜɚɧɨ ɨɫɧɨɜɧɿ ɟɩɿɞɟɦɿɨɥɨɝɿɱɧɿ ɨɫɨɛɥɢɜɨɫɬɿ ɭ ɠɿɧɨɤ ɡ ɝɿɩɟɪɩɪɨɥɿɮɟɪɚɬɢɜɧɢɦɢ ɡɚɯɜɨɪɸɜɚɧɧɹɦɢ ɜɧɭɬɪɿɲɧɿɯ ɫɬɚɬɟɜɢɯ ɨɪɝɚɧɿɜ. ȼɢɹɜɥɟɧɨ, ɳɨ ɬɚɤɿ ɡɚɯɜɨɪɸɜɚɧɧɹ, ɹɤ ɥɟɣɨɦɿɨɦɚ ɦɚɬɤɢ, ɟɧɞɨɦɟɬɪɿɨɡ ɬɚ ɝɿɩɟɪɩɥɚɡɿɹ ɟɧɞɨɦɟɬɪɿɹ ɦɚɸɬɶ ɫɩɿɥɶɧɿ ɩɚɬɨ- ɝɟɧɟɬɢɱɧɿ ɥɚɧɤɢ, ɳɨ ɩɪɨɹɜɥɹɽɬɶɫɹ ɭ ɧɚɹɜɧɨɫɬɿ ɬɚɤɢɯ ɫɩɿɥɶɧɢɯ ɞɥɹ ɰɢɯ ɡɚɯɜɨɪɸɜɚɧɶ ɮɚɤɬɨɪɿɜ ɪɢɡɢɤɭ, ɹɤ ɩɿɞɜɢɳɟɧɚ ɦɚɫɚ ɬɿɥɚ, ɪɚɧɧɽɦɟɧɚɪɯɟ, ɩɿɞɜɢɳɟɧɚ ɱɚɫɬɨɬɚ ɁɁɈɆɌ, ɚɧɟɦɿʀ, ɝɿɩɟɪɬɨɧɿɱɧɨʀ ɯɜɨɪɨɛɢ, ɨɩɟɪɚɬɢɜɧɢɯ ɜɬɪɭɱɚɧɶ ɡ ɩɪɢɜɨɞɭ ɝɿɧɟ- ɤɨɥɨɝɿɱɧɨʀ ɩɚɬɨɥɨɝɿʀ. Ɋɚɡɨɦ ɡ ɬɢɦ, ɜɢɹɜɥɟɧɿ ɫɩɟ- ɰɢɮɿɱɧɿ ɪɢɫɢ, ɩɪɢɬɚɦɚɧɧɿ ɬɿɥɶɤɢ ɩɨɽɞɧɚɧɧɸ ɅɆ ɬɚ Ƚȿ – ɩɿɞɜɢɳɟɧɧɹ ɱɚɫɬɨɬɢ ɋɉɄə ɬɚ ɰɭɤɪɨɜɨɝɨ ɞɿɚɛɟɬɭ ɞɪɭɝɨɝɨ ɬɢɩɭ, ɚ ɬɚɤɨɠ ɞɥɹ ɅɆ ɬɚ ɟɧɞɨɦɟɬɪɿɨɡɭ – ɫɤɨɪɨɱɟɧɧɹ ɬɪɢɜɚɥɨɫɬɿ ɦɟɧɫɬɪɭɚ- ɥɶɧɨɝɨ ɰɢɤɥɭ, ɩɿɞɜɢɳɟɧɧɹ ɱɚɫɬɨɬɢ ɛɟɡɩɥɿɞɞɹ. 2. Ɉɬɠɟ, ɧɚ ɨɫɧɨɜɿ ɪɟɬɟɥɶɧɨɝɨ ɜɢɜɱɟɧɧɹ ɚɧɚɦɧɟɫɬɢɱɧɢɯ ɞɚɧɢɯ ɩɚɰɿɽɧɬɤɢ ɡ ɅɆ ɦɨɠɧɚ ɩɪɨɝɧɨɡɭɜɚɬɢ ɧɚɹɜɧɿɫɬɶ ɩɨɽɞɧɚɧɧɹ ɨɫɬɚɧɧɶɨʀ ɡ ɬɚɤɢɦɢ ɝɿɩɟɪɩɪɨɥɿɮɟɪɚɬɢɜɧɢɦɢ ɩɪɨɰɟɫɚɦɢ ɹɤ ɟɧɞɨɦɟɬɪɿɨɡ ɬɚ ɝɿɩɟɪɩɥɚɡɿɹ ɟɧɞɨɦɟɬɪɿɹ, ɚ ɬɚɤɨɠ ɭɫɩɿɲɧɿɫɬɶ ɥɿɤɭɜɚɧɧɹ ɬɚ ɧɚɫɥɿɞɤɢ ɞɥɹ ɪɟɩɪɨ- ɞɭɤɬɢɜɧɨʀ ɮɭɧɤɰɿʀ, ɳɨ ɞɨɩɨɦɨɠɟ ɨɛɢɪɚɬɢ ɩɪɚ- ɜɢɥɶɧɭ ɥɿɤɭɜɚɥɶɧɭ ɫɬɪɚɬɟɝɿɸ ɧɚ ɪɚɧɧɿɯ ɟɬɚɩɚɯ. ɋɋɉɉɂɂɋɋɈɈɄɄɅɅȱȱɌɌȿȿɊɊȺȺɌɌɍɍɊɊɂɂ 1. Ɉɬ ɞɢɫɤɪɢɩɚɧɫɚ ɤ ɤɨɦɩɥɚɣɧɫɭ ɜ ɤɨɦɩɥɟɤɫɧɨɦ ɥɟɱɟɧɢɢ ɛɨɥɶɧɵɯ ɥɟɣɨɦɢɨɦɨɣ ɢ ɷɧɞɨɦɟɬɪɢɨɡɨɦ / ȼ.ɇ. ɋɟɪɨɜ, Ⱥ.Ʌ. Ɍɢɯɨɦɢɪɨɜ, Ⱦ.Ɇ. Ʌɭɛɧɢɧ, ɂ.Ⱥ. Ʉɚ- ɡɚɧɰɟɜɚ // Ⱥɤɬɭɚɥɶɧɵɟ ɜɨɩɪɨɫɵ ɤɥɢɧɢɱɟɫɤɨɣ ɠɟɥɟɡɧɨ- ɞɨɪɨɠɧɨɣ ɦɟɞɢɰɢɧɵ. – 2000. – ʋ 5. – C. 127-132. 2. Ɍɢɯɨɦɢɪɨɜɚ Ⱥ.Ʌ. Ɇɢɨɦɚ ɦɚɬɤɢ / Ⱥ.Ʌ. Ɍɢɯɨɦɢ- ɪɨɜ., Ⱦ.Ɇ. Ʌɭɛɧɢɧ – Ɇ.: ɆɂȺ, 2006. — 176 c. 3. Faerstein E. Risk factors for uterine leiomyoma: a practice-based case-control study. II. Atherogenic risk factors and potential sources of uterine irritation / E. Faer- stein, M. Szklo, N.B. Rosenshei n // Am. J. Epidemiol. — 2001. — Vol. 153, N 1. — P. 11-19. RREEFFEERREENNCCEESS 1. Serov VN, Tihomirov AL, Lubnin DM, Kazant- seva IA. Ot diskripansa k komplaynsu v kompleksnom lechenii bolnyih leyomiomoy i endometriozom. Aktual- nyie voprosyi klinicheskoy zheleznodorozhnoy meditsi- nyi. 2000;5:127-32. 2. Tihomirova AL, Lubnin DM. Mioma matki. M: MIA. 2006;176. 3. Faerstein E, Szklo M, Rosenshein NB. Risk factors for uterine leiomyoma: a practice-based case- control study. II Atherogenic risk factors and potential sources of uterine irritation. Am J Epidemiol. 2001;153(1):11-9.