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1 OLeHHTb OTJlaJIeHHYIO 34gtcjICKTliBlIOCTb CTeHTOB C nCKapcraeHllwM

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3 CPaBHHTb OTJlaJIeHIfYIO KJT1lmQecKYlo 3ltpcjlcKUUlIlOCTb HMnrurnraIl11lI

creRTOB C JlCKapCf seHHblM nOKpfgtlllieM I CTCHTOB 6C3 nOKpblTIrll

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v13YleHHe TeXHW-eCKHX H Me)lHl1HHCKHX CBORCTB KOpoHap ULlX CTeHTOB

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npaKTHKC rrpCI1MYlllCCTSB H He)lOCT8TKH CTeHTOB C JlCKapCTBeHHhIM

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(MocKaa 2008 ro)l) lIa COBMCCTIIOM JaccnaHfrn OTllenellHII XHpyprlflecKoro

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7

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C Tpytcrypa H 06beM lIl1cccpTamlH

JJHCCCPTauHoHHall pa60Ta H3J10 )f(CHa Ha 138 CTpaHH Uax

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JJHCCCPTaUHII IlJI IOCTpHpoBaH8 26 Ta6nHU8MH 14 Il11arpaMMaMH If 12

PHCYHK8MH oH6nHorpa4lHIeCKHH YKa3aTeJ1b BKJJlOIae-r 202 HCTOlHI1Ka Jot3

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OCHOBHOE COUEP)J(AHltE PAliOThl

Me-rOJ(hf HCCJlea068UIUI

B CCM nalUlCHTaM B n OJl1iOM o 6beMc npoBOlllUloCb KOMnJleKCIIOC

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~ a60paTopH blC MCTOllbl I1 CCJ1CllOSIUIHlI 3Kr xorrrepoBCKOC

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Heo6xolHMOCTf1 BbIl10JIHlI aCb CUI-IHTHrpaqHlI wJoK8plla TIocJle

SblflOJTHeHHlI KOMllJleKCa IICHHB83HSHbI X DliarnOCTI-IIeCKUX npollellYP

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B COOTBCTCTBHH C 3ana8MK HCCJIellOBaHHl 6blJlO 06CJlC)lOBaJlO 2 30

6orlbHbIX C HJ)C 113 HHX 168 ( 73 ) M)iKIH H 11 62 (27 ) )f(eHIllI1Hbl

B03paCT llallHeHTOB COCTaSHn 40 - 76 -lCT ( CpenHI1H s03paCT 589plusmn96 rolla)

TIauHeHTbl 6WlH P83llCJ1CHlgtl Ha lls e rpynnbl B n epB)lQ ( p a60tyiO)

rpynoy Boml lO 112 n aUHeHTOB KOTOPhlM B KA 6blnH J1MIIJlallTHpoBaJlbl

8

CTeHTbl C neKapcrBeHHblM nOKpblTHeM (311 nepJlon C 1mBap li 2005 r - M3pT

2007 r) BO STOPYIO (KOIITPOIlhHYIO) rpynny fiblIlO BKJU()LJeHO 118

IlRUHeHTOB KOTOPblM 6hIJm YCTaHOBnellbl f0J10MeTdJlJIliLJecKl1e MaTpHIHble

CTCHTbl (38 nCpHOJl c fgteBP8IU 2005 r - neKa6pb 2Q()6 r)

npoScpKa CTaTHCTlflJecKHX ntnOTe3 110 BeeM nOKa38TeIlIM

CBHLeTenbCTBYeT 0 BblCOKOM yposm OnHOponHOCTH JlBYX rpynn nRUHCHTOB

no $8K1opa1 pHcKa 0606JleIlHble n8BHble n o centalI-ropaM pHcKa B 06efix

rpyrmax npenCTaBllelibl H8 TafiJlHlte 1

rpynna I (CJlIT) rpynoa 2 (Me) pn3 118 (100 Ok)n=l12 (100 0)

55 Io IO511CT ns52711 23B031aCT lIeT

92 (78) nS 76 (678) M)K41ltHhI n () 39 (33) 35 (322) nsKypeKl1e n (~~)

71 (602) 67 (598) nsAPTCllHaT1bllWl nmeprelnlll n (Yo) 42 (356) ns i43 (384)AIICmlnllJeMIIII n () 37 (31 5)35 (312) CaxapttblR Jllla6eT n (0) ns I 39 (33) 36 (312) ns2l1llpelUte ~()

01 - piIlAHCKJI IteIlOCrtgtBeP1fW (PgtO05 n - ItOJfIJlfeCr8O nlUHeUTO

Ta(iJIllua I Xap8klepUCTHX3 JIBYX rpynn naUlfe~rroB no $alITOpal pllcKa

LVilfTenbHoCTb 3a60nellamtll H6C CpcnH nauJlCHTOB rpynnbl C CJITl

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nOlaBnJllOwce UfCJ10 nRUlietlTOB l0 BMcruaTenbCTB8 HMeno JUlIHIKY

CTellOKaplHH COOTBeTCTBYlOmylO n JI III lt1gtK OOUlee lHCJlO flaUHeHTOB (0

CH II lt1gtK OOCTaBl1JIO )03 (448 Yo) co CH III ltW - 116 (504 ) OT 06wero

1J1CJla naul1eHTOB BKJUOIeHHblX B I1CCJlenOBaIlHC ITo lt1gtK CTclloKapnHH 06e

rpynnM naUIiCHTOB B BblCOKOH CTCneHiI ODHOponHbI PH CTaTHCTIilCCKOH

06pa60TKc JlOCTOBepliblX P83JIHfHH BbUIBJleHO He 6b1J1o (PgtOOS) IToKa3aTeJlb

C2gtB JDK Konc68J1Cli OT 40 lO 62 (B cpcnHeM 473plusmn51 ) YMepefillO

CHKJ(CHlltul laquo 50 ) C2gtB JOK BbUlBlJCna y 37 (415 ) nRUHeHTOB B rpynne I

(s cpenHeM 456plusmn27 ) H Y 48 (407 ) naUi~eHTOB B rpynne 2 (B cperHleM

449plusmn51 ) (Pgt)05)

9

Auaruu JlBllllblX KopoHapol-pacJlHJJ

B pa6olfel1 rpY ll lIC y 11 2 naUHCHTOB BbJJUlJIeHO 132 CTeH038 KA B

KOImiddotrrponbHoH rpYU lle 157 CTCH030B Y 118 naJlHeHTOB LayxcocYLlHCTWC

n Op a)f(eHHll B KOH1pOJl bHOH rpynnc n aUHeHTOB BblllBnllJlHCb B cpeJlHeM B 18

p83 1aJi(C (P=O02) COoTHo lueHHe TImOB CTCH030B KA (no AHAACC) B

nBYX rpynnax n auHCWTOBlO BMewaTe1bCTBa orpIDKellO 118 nHarpaMMe 1

Pa60laquolR rpynne KOlfTpOl1bHeR rpynna

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rpyrrnax nll1lHCIITOB (no ACeAHA)

Lam~ble KOJlI11CCTBeRBoro BHaJJI138 CTCtl030B KA no BMCUlaTCnbCTBa B

LlByX rpynnax nBUHCllTOB n penCHUiJ1CHbl B Ta61U~e 2

1

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PeljtepeHTHldil IIHaMeTp aptepHH 1M 274plusmnO48 2amp4plusmnO63 nS

npoTllJllCHllOCn CTeH03a MM 193plusmn81 4 J705t5 57 0045

Cre fleHh ItCXOJlloro CTCII03a 797plusmn98 84 5plusmn84 n s

n S - p HeJlOCTOUJgtIIJoI (PgtO05)

TaMHua 2 KOrrHlCCTBCHHLIIl aHarTll3 ItCXOllHbIX CTeH030B B JlByx rpyn nax nauIlCHTOB

HenOCpellClBeHHble PClYJlb18Tbl creHTUpOOaHlfH

n pe)l1naTaUl1l BbUJOJlUella B 369 BMew aTeJlhCTB (n=85) B cnyllUlx

Tpc6YIOll11X LOnOJ1HJlTeJIIHOrO CTCIiTa I1CnOJlb30BaJICR CTellT C

aHaJJo rHIHbl M nOKphITHe~ COOTHOUleHHe TIfIlOB YCTaHOBneHHbIX CTefiTOB

CJInMC COCTaB~lJlO 1117 B pa60lcH rpynne 112 nauweHTIlM co 132

CTeH03liMH HMnJlaJlTJ1 pOBaIlO 139 CHpOJlHMYC-BblllcnllIOLUJ1X CTCHTOB B

10

KOIl-rpOJlbHOM rpyrme 118 nauHCHl8M co 157 CTetf038MI1 HMnn8HTIlpos8HO

] 63 ronOMeTaJJJJWICCKHX C1CIITa

B T86nHUc 3 rrpencTaBneHO pacnpcneyCHHC HMDnaJITHpoB8HHblX

CTClfTOB HCXOnraquo H3 )ll1aMCTpa CTCHTa a TlIKJKC CpC)l1U1H )lHaMeTp CreUTOB B

KaJKlIOH 113 rpyn n

CJfD 0=139 (JOO Y)

MC 0=163 (100 Yo)

P

25 n () 30 (2 16) 39 (239) ns

275 MM n (Yo) 76 (547) 84 (515) lLS

30 MOl n W) 21 (1 5 1) 2S (153) ns

35 M~ n (~cl) 12 (86) 15 (92) ns

Cpermn lI)lllMeTp 101M 284plusmnO28 186plusmn034 ns

n t _- pIl1UItPI tteAO108epltw ~05 D - ICMlIIecrtO CT(if18

TaMH LIlt 3 COOTHoweHHe KOnHlCCTRlI 1 JUi8MeTpOB CTelnDB 8 lIIIYX rpynnll naJJMeIffOB

Cpe1Helt 3HalCHHe JUlliHbl IfMnJlaJiTKpOBaHUblX CTeHTOB B rpynnc 1

HCCKOJlbKO npeBblwaer aJ1aJ10f1i4Ublii nOKa3aTCnb 80 STOPOH rpynne

(p=O43) CTCIITOB nmtHOH MeHee 18 MM YCTllHOsnCHO 10CTOIlCPHO 60nbwe B

KOHTpoJlbHOH rpyun c naulfCHTOB (P=O027) CTeHTOB )lnIfHOR 60J10C 23 MM

10CTOBCPHO 60nhllle yc-r8HOBJICUO B pa60leH rpynuc (P=O035) (Ta6nKua 4)

em 0=1391100)

MC Il=HIJ (100 )

P

lt18 MM n () 22 (158) 46 (282) 0027 I

18-23MM n () 68 (489) 81 (497 ns I

gt23 101M n (Yo) 49 (353) 36(22 1) 0Q3 5

CpellWllVlHHa 101M 232plusmn31 208plusmn29 0043

DI - pauMIKt MtJlOCT06epHloi (gtO05) n - KOJIRICCTBO cretflO

Ta6ru1ll8 4 COOTHollleHHe KOIlHICCTB8 If 1lIllHJl CTeHTOB BJIlIYX rpynnax nlUilleHTOB

Bee nallfeUThr 6c3 HCK1110lemtJl noJl) 4 antf ~BoliAylQ

aHTItTpOM60UlmpIlYIQ 1C3arperaHTHYIO TepanHlO lacn nSUHCHTOB

11

IlOJl)lIfJlYl I1 HrH6 1nopbl IIblllla rm1KOnp OTCH HOBblX pellCllTOPOB

TpOM60IHTOB (Ta61lJ1U8 5)

r ynna I (CJJD) rfl~nna 2 (MC) P

n~1 12 (100 ) n~118 (100 )

AcnupHH (325 Mr 3a 48 Y3C(8) 112 ( 100) 118 ( 100) ns

T HeIl OOllpIIIlHHJJ (75 Mr M lUI 1a 48 4) 85 (76) 89 (75) ns

T HCIi Oll HPUwtHbl (300 Mr3a 15 4) 27 (24) 29 (25) ns

I1nrn6HTopbl Ubfl lla (1II11p8onep) 6 (5 3) 8 (68) ns

n s - PUlUtIlamp Jte1OCTO~HhI (PgtO05) n - aonUqecna nluuem-o

TaMHua S llC3arperaH1tllll nOllroioBK8 Kp0811 B lByx rpynnax naill1eHTOB

Herrocpe~CTBeHHbrH ycn ex amiddotl rHOrrJIacrHKH COCTaBHn 973 (109

naUHeHTOB 113 112) B nepBoil rpynne 11 966 (114 n8UHeHTOB 113 118) BO

Bropoil rpynnc (PgtO05) CMep TenJHblx HCXOllOB He 6bIJlO uOCTOBepHblX

Pa3JlHlHH 8 pa3BHTHIf OCJIO)KIICIIHM Me)KJlY rpYlm aMH He OTldC4CHO (PgtO05)

KJrHtrnlecKI1 3centlcentCKlHBHOH aHTHOnnaCTlltOOi 0P3HaJi3 y 91 (81l )

n auHellTa 8 ncpBOH rpynne Ii y 95 (806 ) nauHellTOB 80 STOPOH rpyrrne

(Pgt005) (Ta6mllla 6)

rpynna 1 0=112

rpyouI2 n=1I8

p

Ycnex rrpouel1Yp n () 109 (973) 114 (966) ns I

OcnolKnemUl B c-reHTHpOnalUloii aprepHH(TVF) n () 2 (18) 2 ( 17) ns I TpoM603 CTeHTa n () 2 (J 8) 2 ( 17) lLS

Kap)(HM bHble OCnO)f(HeHH~ (MACE) n () 1(09) 2 (1 7) ns

lWcjgtaPKT M HOKllPJla n (J 1 (09) 2 (17) ns

KopoHapHoe WYHTIlposaMHe n (Vo) - - -CMepTb n () - - -LJepe6po-aacK)mtpHble ocnollUicH1Ul n (Vo ) - -

-

-

ns - PlUJllltHa HtlOC1OBepIU (PgtO05~ n - I(OJIHiCCT1M) naWICHTOI

TaMHLl8 6 HcnocpeACTIlcHHble pe3ynbT8Tbl CTelrrl1p0SllHHJI B llByx fllyn nID(

OTIUlJletltlblC PeJYJlbT3TI1 crelfTllpOB3HHH

CpCJlHHH CPOK OTJlanCII lloro Ha6molleHUI 8 JlByX rpynnax 60JthHblX

COc-raBHn 132plusmn263 Mec no HCTCgeHl1H KOTOporo 6bJJ 11 BbJnOJllleHbl

1

HarpYJOlfHIgtIe n po6w C UeJb1O BWIBJJeHHII Hwe~U1H MHOKapIla Ii IT

nOllpo6u bie lJaHlihle 110 OTJlalJCHUblM CpOKllM Ha6mltgtlIeHH51 rrpeJlCTallneHbl II

Tn6nHue 7

rpyrma I (eTTfl) n=1l2 (l00 Yo)

rpynna 2 (Me) D118 (100 0)

p

CpenHHlI CPOK HR6moJreHHi Me( 136plusmn12 129plusmn23 as

MH$OPMallHll nOCl)nHWI no 6 01lbllblM n () 102 (91) 110 (932) ns

06cneJlOB1II0 HlI OTAWleuHOM )Tane n (Yo) 91 (812) 104 (88 1) 0048

KOlllpolhlllll Kr n () 82 (732) 89 (755 ) ])e3 clenokllpolI lI n (Yo) 89 (878) 78 (71) 0Q3

1 - pulHlfftlll lttaOCTOKpUW (pgtoOS) n - mrrn~ecno IWllteHTOJ

TaMUUI 7 KOllWICCTBCHHblC JlalHlIgttC OT1UlJleHIIOrO mUTa cc~eJlOBalII1R

IlposeL1eHHWI Kr BblllBKna pecrCH031J y 29 (137 ) nallHeHTOB

y p oSeH pecreHOJa CTaTHCTIfecKH m3QHMO 6bJ1 HIf)f(e B rpynne c

HMnnaHTIlpoBaRHblMH CJIfI B cpaBHeHMH C KOHTPOfhHoit rpyrrnoH

(PltOOO 1) B rpynne 1 OCHOBHWI 18crb pecTeH0301l nplfXOL1HTClI Ha

npoKcHMaJlbHOIH Kpae CTeHlHpoB8HHOro celMellTa B rpynne 2 pecTeH03

Pa3BIIJICli npeHMymecrncHHo B rpBHHUax CTCIIT3 B 06CI1X rpynnax

H3HMeHbWIUl laCTb pecTCHOJOB COCpeJlOTOlCHa y AHCTaJlbHOro KpM

(Ta6J1l1ua 8)

rpynna I (CJID) n=102 (100 1

rpynna 2 (MC) n1I0(JOO)

p

IgtHH3PHbl A

peCTIfI03

(Yo)

Beem 6 (59) 23 (209) lt0000 1

B f1JRlfHUIIX C1effT8 2 (21) 13(118) lt0000 1

npoKCan~Hbln Kpal 3 P 9) 7 (64) ltOOOJ

IHcTWlhliMn KpRn 1 (09) 3 (27) lt0001

nOTep npocse ra MM 052plusmnO45 1 04~58 lt0001

TpOM6oI creHTll (OImoolUl) n ( ) 4 (36) - lt0001

n porpeccHjXlSaKHe aTepoCl(J1qlO3a n (o) 18(1 76) - --shy-

15 (1 36) ns

1I L - pampUINkJl HetlOCtoaephI (PgtoOS)

Ta6J11tUa 8llallllwe KonHl leCT8eHl1oll rurmorpa4Jllll H3 OTl3IleHHOM ITane

13

B KaTelOplHI nalHellTOB C Ca p eCTeH03 I3 blllBJJ eH y 15 (13 1 Bcex

60fhHbiX C Ca) 60JrbH biX cpeaH KOTOPbl X upe06J1anaml n aUHeHTbl H3

BTOpO~ rpy nnbl ljaCToTa p a3BHTHI pecrcH03a CpelH lI aUHCHTOB C CJ B

nepsoH rpynne cocra BHn a 36 (2 n ar(l~eIlTa) a BO BTOPOH Ip ynne 1S2

(9 naUHeHTOs) (PltOOOI)

HaJl6oJIbWal laCTOTa pecreHo30B B o6clix rpynn ax B03HHKJJa S

MOPIPOnOr H-IecKH CJJOlKHhIX creHo3ax 13 OC06CHHOCUI THnax B2 H C B

Cil)-lae MopcentlonOnflecRH 60nee 6 n ar OnpIHITHoro ll1Ill creli i l1pOSalHul

CTeH03a m Da A pccreHo3a B r pynne om He OTMCCIIO (JlHarpaMMa 2)

~J

~ 6 emiddot~ 4~1 I enn~ middot( -~ 1- -2-shy

gt----J - liS ~ ~~ e 2 D9J -

~

T Tn Bl TnB2 T~n C

llarpa~ma 2 PacnpellCilcHIlC yaCTOThI pecrello3a B 3aSHCl1MOC1H OT MoptKgtnOrHYCCKOrO

TMHa ~ICXOllHOro CTe l103a 8 OTllaneHJ10M nepHOAC

Ha IlHarpaMMe 3 npocnClKlIB3eTCli 06paTH31l 3aBHCHMOCTb

YMcRbm cHHlI aCTO pecTCII03a C YSeJ1HIeHIiCM IlHaMeTpa creHntpyeMoH

apTepHIt B 05CKX rpynnax lJ aCTOTn peCTeHo33 M aKCHMaJlbHa cpeIlH apTepHH

MaJlOro L1HBMeTp a 13 llHaMerpe 35 MM 1aCTOTn pa3BHTHli PCCTCH03a He

BbICOKruJ L10CTOBCptlO He p a3Jl1fQae-rclI MeJIltilY rpy n n 3MH

10 -~

-cnn~ 1-- I ~-----shy~ ~ Me

-~ - -mo

1shy25 111 27SM 30~M 35 WJ

llllarpaMMIi 3 PaClipenel CH ItC ll3CTOTI1 pecreHOJ8 B JaBHCflMOCll1 OT IHalcTpa CTeHT8

14

npll a HaJlH3C Bntll1HHlI JIl1HHbl creHTa Ha 4acrory peCTeH03a o6pmuaeT

Ha ce6l1 BHHMaHHC npM3l1 3aBMCHMOCTb a 06CliX rpynnax B

creiITHpOB3lmbIX CelMCHTax Jllll1li010 6oICC 23 MM pccrCH03bl o6HapY)f(CHbl

B 3 paJa lalUe n pH IfMnJlaHTaUHH KaJlt CM TalC Ii MC B cpaBucHlHl C

KOPOTKHMH CTeH03aMH no 18 MM (IlHarpalMa 4)

0 shya

CI1I1 ~ e 4 t ~~ 2middot1~

e lt 8 amp - 23 gt 23

1Illarp8MMa 4 PacnpellCJICHHC 18ClUfbl pecrCH033 B 3aBliCHMOCTH OT )IJlHHIgt crelmL

KOppCJUIllHORHblii aHIllTH3 aHrHOI-prupHleCKHX peCTeH030B nOKa3aJ1

LITO B rpynne C HMnJlaRTHpoBaHHblMH ClITl KOppeJUlUHOHHaJI 33SHCHMOCTL

MC)f(Jy JlHaMCTpOM CTeHTHposaHHOM apTepl1H H laCTOTO~ PaJlIHTII$

pecreHo38 npaKTHlecKH OTC)TCTByeT (r=0220) B TO BpcMlI KaK B rpvnne

MC CymecTBye-1 IlOCraTOlllO BblCOKall o6paTHaJI 33BHCHMOCTI Mellltly

YJGl3aHHbIMH napaMCTpaMI1 (r=0792) TIp aH8JT113e 3aBHCHMOCTH MC)(JIJ )]J1HHOH HCXOJlHOro nopa)f(eHHlI H

1(3CTOTOil PaJBHTHIl pccrcHOJa B rpyrme C IlMIWaHTHponlUulblMH Me 6blJ1a

Bbl1UlneHa BblCOKaJI n0J10ll(HTeJ1bHaJI KOppelUI1U1lI (r=O819) B rpynnc C CJITI

TaJOKe c)llIecTsyer IltOppcnllUHOHltaJI CB1I3b MClKllY lJ1I1HOH HCXOJlHOrO

CTeH03a 11 tacTOTOH pecrCH03a OJlllaKO pacqen1 o1p3)f(aIOT secbMa

)MepeHHblH ee xapaKTcp (r=O306) Te C TOlKH 3PCHHlI PHCKft pa3BHTHlI

pecrcno30B JlnHIiB nOplllKCItHli JIl1 l1 CJITllle HrpaeT cYlUecTJleHHoH poJ1H KlIJlt

JIl1R M C rpaqlHIeCKRe MOJleJlJ1 LltOpperullij1H JlI13gtIerp3 11 lSCTOThl peCTCII03a

1lJIHHbl Ii laCTOTbl pec-reHo33 npenCTaBJ1eHbl Ha )]HSrpaMM3X 5 11 6

i ~i

[ rp nnu cnn 1 [ipyn Me r

LIllarpsMMiI 5 KoppeJUJUMOIiIUUI 3aSI1CUMOCTh MClIOlY IlJUIMC1pOM creHlllposalllloll

ap-repllll II 18CTOTO~ pS3BIITI1I1 pccreH038

j7PYiinacnn r - rpynna Me~I

T--rmiddotl bull i ~ bull

~ ag 11 +-+1-+--1

1lIIarpaMMa 6 KOppeIlRUIIOHJ11U138SHCKMOCTb MClKIIY J1JHIIIOH UCXOllloro nopiDKellHII Ii

~lICTOTolI Pa3BIITRJI pccreHOJa

B TelCHnC )OHlPOJIMIOro nepHo)]a peKOMeHllOBaHHOLO peJKHMa

JlBOHHOH aHTHarperaHTHOA Tcpamm rrpHlle~IIMJlHCb 90 (882 )

rrSUHCIlTOB H3 rpyIIIIhJ I H 93 (845 ) n3UHeHTll H3 rpynlThl 2 (Ta6nHl3 9)

rpymUlI rpynnl2 p n=l02 =110

~OAHasr alTlll arperalfTHtllI TepaJTHll n () 90 (882) 93(84 5) ns -

98 (96) 106 (964)Acml]lIlH 150 Mrcyr n ( ) ns

THeHonHplUlIIllt 1lVtIlTerullocn TepanHTI Idee 92plusmn21 2 44gt0 11 0032

7S MrcYT I n pHlUnl a1 n n (00) 90 (882) 93 (845) ns ~ -

n ~ -- pUIIlIllHIII ttcJlOCl1VDtpKtl (pgtoOS) n - OJIIJJ~ rnunetrTOIi

Ta6J11IUamp 9 PelKHM JlIlOi1HoR3lrmarpenIJITHoArepalll1H B IlByx rpyn nax n8UHeIITOR I

16

Ha OTJlaJJeHHOM nane LIOKa38BHbJH TPOM603 CTeHTI1poB8HHOro

ccrMCHTa 3altill1KCHpOBaH y 4 (39 ) 6oJJbBblx npl1 4eM 3 m nUICHTOB fibl111113

rpyrmbI C HMrrnallTI1p OBIlH HblMJ1 C JUl OTMeTHM 410 Cp eJlH nal~HeliTOB C

YpoM6030M B nepBoi rpy nne 2 113 3 n8lHCHTOB npCpS8JII1 )lBOHHYIO

aHTHarperaHTHYlo Tepanl1lO 110 p eKOMeHllOB8HHoro CpOK3 B r pynn e CJIT1

OTMeleHO 2 CJly4W1 a B rpy n n c MC 1 CJJylJaH BCKaPJll1aJlbHbIX OCJlO)l(lIeHHH

KOTOPblC Mbl CBJJ3hl BaCM C np HcMoM LIe3arperaliToB

3a Bp eMll I tafiJlIOneHHII YMepJIO 4 (3 9 ) fiOlTbBblX B rpynne I 11 4 (3 6

) B rpyn n e 2 B pa6olei rpynnc OTMClCHO nBC HClltapJlHBJIbHble CMepTH

060 6 uleH HbiC OT)laJIeHHble p e3YJlbTaTbI aHrHOnJlacrnKll npei4CTaBJIetlbl B

Ta6mlUe 10

rpYll1l8 I n-l02

rpynna 2 n110

p

be CTeHOKllPJUIH n () 89 (878) 78 (71) 003

AKnlO rpaltj IOC K llOKll3lIllllbill pecTe1l03 n () 6 (59) 23 (209) lt000 1

PeBacKY~HpH3aI~H Ieneaom creHroa (TLR) n () 5 (49) 20 ( 182) lt000 1

PeBac~mpIf3BUIlR Ho a w CTeH030B (TVR) n () 7 (69) 5 (46) 0044

K OpoRspHoe WYIITllpoeaJfHe n (0) ) (10) 2 (1 8) 0 5

T POM603 CTelrra n () 3 (29) 1 (09) lt0001

I1111lapKT MHOKllPllB n (0) 3 (29) 4 (36) nS

KapnHaJ1bHble OCn O)f(Hflrn (MACE) n () 6 (59) 7 (63) ns

He ~llpllIl2J1bHble ocnOllltHeH Ill 0 () 2 (19) 1 (09) 004

ClotepTb (BCCro) n () 4 (3 9) 4 (36) O S

HCKaPAtlaJI b trQJI CMCpTb n () 2 (1 9) 1 (09) 004 nl_- PIlJmO(I HeJlOcro8epkW (pgtOOS) D ~ KQnUIecno ITIWteHTO

TaMH 118 10 OtQaJlCHHbJCpe3YllhTlITbl CTeIffifPOBaJi HlI B JUlyx rpynnax naUI1CHT08

K ax CJlcuyeT H3 Ta6nHlbl 10 no 1laCTOTC P83BIITHlII1M Ii KaplLHaJI b ~LbX

OClJOlKH ellHH )lOCToBepHblx p 33JJHiHA M~ rpyn nBMIi He BblJJ B11eHO

OllHaKO n o IDeTOTe HcofixonJ1MOCTFI nOBTOp lloii p esaCK)IUIJlH38lHH

npOCJTe)l(HBaeTCII llOCTOBepHoe )BCJlHlJeHHe 0 rpyrrnc C HMTIJIaRTHpOBBH NblMH

Me

I

AHaJlH3 TaKOra BIDKHOro 1I0Ka3BHJHI K8K OeJonaCHOCTb CTCIITOB no

KPHlCPHJIM TpoM603a CTeBTa KOHCOPUIi)MB no AKaneMH4ecKI1 M

HCCJIellOB3llIUlM (ARC) nOKa3aJ1 ITO Aa p aHHHX 3Tanax pamHIIIH no

laCTOTe rpoM603B MeifltlY rpyrtlHlMH He 8bllwnCHO O)lHaKO liB OTllBJICHHOM

cpoKe 38$HKCHpOBaHO HecKonbKo 6omwcc 411CJlO )IOKll3aHHbIX TpoM6030A Il

ncpBolt rpynne XOTlI KOJlHIeCTBO 1l03MO)I(Hb1X TpoM6030B MCJtillY rpyrulaMH

He )lOCTHfJJO 3HBlHMOro Pa3JTRtfHll (rB6JJHI~a 11)

rpynna 1 n1 02

rpynna 2 nUO

p

PalllluA

TpoM60J (0-30t1l1eA)

Bcuo 2 (JIJ) 2 (18) nS uOKa3llllHbIA 2 (1 9 2 ( 18) n1

BepoATItbI Ii - - -1T0000IIHn

Tpo60J pO-365 JlleR)

B~ S (49) 307) 003

JlOKa3aJIHhIA 3 (29) 1(09) 003 I

Bepomu11l 1(09) 0046

BolMOll(Hbifi 2 (19) 1(09) os

ltPieBb nOlJUIHA

TJION60J (gt365 Ulei1)

BCUI (ID) - 0046

[lOtlta38Jillhl A - - - i

BepollTHwA I (1 0) - 0046

BOlMogtKHlgtrll - - -

UTOro l0MlirooB 8 (79) i (45) ltU0l n 5 - Pl1llU I 1VI Kcnoc-roeepIlW (pgtO05) n - fCQJUf4ecno nDWtt-I-1TOt

Tawmua 11 AHaJllt31JXlM6oJa C1CIITa no ARC nllllYX rpynnax 6oJlhHhll

~ nOMOllJhlO MeTO)lHJ(1i oneHKH BblKHOaeMOCTl1 no KanJlaHy-Majjepy

Mbl paCCIIHbIBBJII ofiJUYlO Bbl)KHBaeMOCTb BbnKHBaeMOCTb 6C3 nllKCJJhLX

KapnHaJIbHblX c06bIT11H (MACE) Ii Bbl)l(HOaeMOCTb 6C3 nOBTopHblX

pcsacryJlllpl13allHH (TLR) B TeleBlie 14 MCC$lUCB Ha6molleHHJI

npH aAaJIH3e o6wefi BblJlOlBaeMOCTH B nepHOll Ra6J1lolleHHll Be Obl1l0

BblllBJICHO 3f1a4HMblX p33JIHlHA B PIICKC CMepTH M~ IlB)MlI rpynnaMH

6 0JJbHblX KpHBbl e BbllKHBaeMOCTH 6C3 TlllKeJlblX Kap)lHaJJbllblX C06blTl~H

(cepnClHaJI CMepTb HM onepauHSl Kill) HMCJJH TeRlleHllHIO K paCXO)J(llCHHIO

nOCJJe 4 MCCSlUCB Ha6 J1IOncHHJI Ol1H aKO MC)I(Jly rpynnaMH C

14

npll a HaJlH3C Bntll1HHlI JIl1HHbl creHTa Ha 4acrory peCTeH03a o6pmuaeT

Ha ce6l1 BHHMaHHC npM3l1 3aBMCHMOCTb a 06CliX rpynnax B

creiITHpOB3lmbIX CelMCHTax Jllll1li010 6oICC 23 MM pccrCH03bl o6HapY)f(CHbl

B 3 paJa lalUe n pH IfMnJlaHTaUHH KaJlt CM TalC Ii MC B cpaBucHlHl C

KOPOTKHMH CTeH03aMH no 18 MM (IlHarpalMa 4)

0 shya

CI1I1 ~ e 4 t ~~ 2middot1~

e lt 8 amp - 23 gt 23

1Illarp8MMa 4 PacnpellCJICHHC 18ClUfbl pecrCH033 B 3aBliCHMOCTH OT )IJlHHIgt crelmL

KOppCJUIllHORHblii aHIllTH3 aHrHOI-prupHleCKHX peCTeH030B nOKa3aJ1

LITO B rpynne C HMnJlaRTHpoBaHHblMH ClITl KOppeJUlUHOHHaJI 33SHCHMOCTL

MC)f(Jy JlHaMCTpOM CTeHTHposaHHOM apTepl1H H laCTOTO~ PaJlIHTII$

pecreHo38 npaKTHlecKH OTC)TCTByeT (r=0220) B TO BpcMlI KaK B rpvnne

MC CymecTBye-1 IlOCraTOlllO BblCOKall o6paTHaJI 33BHCHMOCTI Mellltly

YJGl3aHHbIMH napaMCTpaMI1 (r=0792) TIp aH8JT113e 3aBHCHMOCTH MC)(JIJ )]J1HHOH HCXOJlHOro nopa)f(eHHlI H

1(3CTOTOil PaJBHTHIl pccrcHOJa B rpyrme C IlMIWaHTHponlUulblMH Me 6blJ1a

Bbl1UlneHa BblCOKaJI n0J10ll(HTeJ1bHaJI KOppelUI1U1lI (r=O819) B rpynnc C CJITI

TaJOKe c)llIecTsyer IltOppcnllUHOHltaJI CB1I3b MClKllY lJ1I1HOH HCXOJlHOrO

CTeH03a 11 tacTOTOH pecrCH03a OJlllaKO pacqen1 o1p3)f(aIOT secbMa

)MepeHHblH ee xapaKTcp (r=O306) Te C TOlKH 3PCHHlI PHCKft pa3BHTHlI

pecrcno30B JlnHIiB nOplllKCItHli JIl1 l1 CJITllle HrpaeT cYlUecTJleHHoH poJ1H KlIJlt

JIl1R M C rpaqlHIeCKRe MOJleJlJ1 LltOpperullij1H JlI13gtIerp3 11 lSCTOThl peCTCII03a

1lJIHHbl Ii laCTOTbl pec-reHo33 npenCTaBJ1eHbl Ha )]HSrpaMM3X 5 11 6

i ~i

[ rp nnu cnn 1 [ipyn Me r

LIllarpsMMiI 5 KoppeJUJUMOIiIUUI 3aSI1CUMOCTh MClIOlY IlJUIMC1pOM creHlllposalllloll

ap-repllll II 18CTOTO~ pS3BIITI1I1 pccreH038

j7PYiinacnn r - rpynna Me~I

T--rmiddotl bull i ~ bull

~ ag 11 +-+1-+--1

1lIIarpaMMa 6 KOppeIlRUIIOHJ11U138SHCKMOCTb MClKIIY J1JHIIIOH UCXOllloro nopiDKellHII Ii

~lICTOTolI Pa3BIITRJI pccreHOJa

B TelCHnC )OHlPOJIMIOro nepHo)]a peKOMeHllOBaHHOLO peJKHMa

JlBOHHOH aHTHarperaHTHOA Tcpamm rrpHlle~IIMJlHCb 90 (882 )

rrSUHCIlTOB H3 rpyIIIIhJ I H 93 (845 ) n3UHeHTll H3 rpynlThl 2 (Ta6nHl3 9)

rpymUlI rpynnl2 p n=l02 =110

~OAHasr alTlll arperalfTHtllI TepaJTHll n () 90 (882) 93(84 5) ns -

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