Анемия при беременности - витамины для беременных, при
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Анемия при беременности А çÖåàü fl‚ÎflÂÚÒfl Ó‰ÌËÏ ËÁ Ò‡Ï˚ı ˜‡ÒÚ˚ı ÓÒÎÓÊÌÂÌËÈ ·ÂÂÏÂÌÌÓÒÚË. èÓ ‡Ò˜ÂÚ‡Ï ÇÒÂÏËÌÓÈ Ó„‡ÌËÁ‡ˆËË Á‰‡‚ÓÓı‡ÌÂÌËfl [1], ‚ ‡Á‚Ë‚‡˛˘ËıÒfl Òڇ̇ı Ó̇ ̇·Î˛‰‡ÂÚÒfl Û 35-75% (‚ Ò‰ÌÂÏ 56%) ·ÂÂÏÂÌÌ˚ı ÊÂÌ˘ËÌ, ‡ ‚ ‡Á‚ËÚ˚ı Òڇ̇ı - Û 18%. ì ÏÌÓ„Ëı ËÁ ÌËı ‡ÌÂÏËfl ËÏÂÂÚÒfl ¢ ‰Ó ·ÂÂÏÂÌÌÓÒÚË. Ç ÔÓ‰‡‚Îfl˛˘ÂÏ ·Óθ¯ËÌÒÚ‚Â ÒÎÛ˜‡Â‚ (ÔËÏÂÌÓ 75%) Ô˘ËÌÓÈ ‡ÌÂÏËË fl‚Îfl˛ÚÒfl ‰ÂÙˈËÚ ÊÂÎÂÁ‡ ËÎË ÙÓÎË‚ÓÈ ÍËÒÎÓÚ˚ [2]. C.Massot Ë J.Vanderpas ÂÚÓÒÔÂÍÚË‚ÌÓ ËÁÛ˜‡ÎË ˜‡ÒÚÓÚÛ ÊÂÎÂÁÓ‰ÂÙˈËÚÌÓÈ ‡ÌÂÏËË Û ·ÂÂÏÂÌÌ˚ı Ë Ì·ÂÂÏÂÌÌ˚ı ÊÂÌ˘ËÌ ‚ ÅÂθ„ËË [3]. Ç Ô‚ÓÏ ÚËÏÂÒÚ ·ÂÂÏÂÌÌÓÒÚË ‡ÌÂÏ˲ (ÛÓ‚Â̸ „ÂÏÓ„ÎÓ·Ë̇ <11 „/‰Î) ‚˚fl‚ËÎË Û 4,3% ËÁ 887 ÊÂÌ˘ËÌ, Ô˘ÂÏ Û 35% ËÁ ÌËı ËÏÂÎËÒ¸ ÔËÁ̇ÍË ÊÂÎÂÁÓ‰ÂÙˈËÚ‡ (ÒÌËÊÂÌË ÛÓ‚Ìfl ÙÂËÚË̇ ÏÂÌ 12 ÏÍ„/Î). ç‡ ÔÓÁ‰ÌËı ÒÓ͇ı ·ÂÂÏÂÌÌÓÒÚË ˜‡ÒÚÓÚ‡ ‡ÌÂÏËË Û‚Â΢˂‡Î‡Ò¸. í‡Í, ‚ ÚÂÚ¸ÂÏ ÚËÏÂÒڠ ӷ̇ÛÊËÎË Û 31% ËÁ 1313 ÊÂÌ˘ËÌ; Û 75% ËÁ ÌËı ËÏÂÎËÒ¸ ÔËÁ̇ÍË ÊÂÎÂÁÓ‰ÂÙˈËÚ‡. ç‰ÓÒÚ‡ÚÓ˜ÌÓÒÚ¸ ÊÂÎÂÁ‡ Û ·ÂÂÏÂÌÌ˚ı ÊÂÌ˘ËÌ ‚ÒÚ˜‡ÂÚÒfl Á̇˜ËÚÂθÌÓ ˜‡˘Â, ˜ÂÏ ‡ÌÂÏËfl. ç‡ÔËÏÂ, Q.Liao Ë ÒÓ‡‚Ú. [4] ÔӇ̇ÎËÁËÓ‚‡ÎË ˜‡ÒÚÓÚÛ ËÒÚÓ˘ÂÌËfl Á‡Ô‡ÒÓ‚ ÊÂÎÂÁ‡ Ë ÊÂÎÂÁÓ‰ÂÙˈËÚÌÓÈ ‡ÌÂÏËË ‚ ‡Á΢Ì˚ı „ËÓ̇ı äËÚ‡fl Û 3591 ·ÂÂÏÂÌÌÓÈ ÊÂÌ˘ËÌ˚. ÑÂÙˈËÚ ÊÂÎÂÁ‡ Ë ‡ÌÂÏËfl ËÏÂÎËÒ¸ Û 42,6 Ë 19,1% Ô‡ˆËÂÌÚÓÍ. àı ˜‡ÒÚÓÚ‡ ·˚· Ò‡ÏÓÈ ‚˚ÒÓÍÓÈ Ì‡ ÔÓÁ‰ÌËı ÒÓ͇ı ·ÂÂÏÂÌÌÓÒÚË. ã‡ÚÂÌÚÌ˚È ‰ÂÙˈËÚ ÊÂÎÂÁ‡ ˜‡˘Â ‚˚fl‚ÎflÎË Û „ÓÓ‰ÒÍËı ÊËÚÂθÌˈ, Ӊ̇ÍÓ ËÒÍ ‡Á‚ËÚËfl ‡ÌÂÏËË ·˚Î ‚˚¯Â ‚ ÒÂθÒÍÓÈ ÏÂÒÚÌÓÒÚË. ïÓÚfl ҂‰ÂÌËfl Ó ‚ÎËflÌËË ‡ÌÂÏËË Ì‡ ËÒıÓ‰˚ ·ÂÂÏÂÌÌÓÒÚË ÌÂÓ‰ÌÓÁ̇˜Ì˚, ÚÂÏ Ì ÏÂÌÂÂ, ÏÌÓ„Ë ‡‚ÚÓ˚ ÔÓ·„‡˛Ú, ˜ÚÓ ‡ÌÂÏËfl, ÓÒÓ·ÂÌÌÓ ‚˚‡ÊÂÌ̇fl, Ó͇Á˚‚‡ÂÚ Ì··„ÓÔËflÚÌÓ ‚ÎËflÌË ̇ Á‰ÓÓ‚¸Â χÚÂË Ë ÔÎÓ‰‡, ˜ÚÓ ÓÔ‰ÂÎflÂÚ ÌÂÓ·ıÓ‰ËÏÓÒÚ¸ ‚ ˝ÙÙÂÍÚË‚ÌÓÈ ÔÓÙË·ÍÚËÍÂ Ë Î˜ÂÌËË ˝ÚÓ„Ó ÒÓÒÚÓflÌËfl. Диагноз анемии у беременных Ç ÒÓÓÚ‚ÂÚÒÚ‚ËË Ò ÂÍÓÏẨ‡ˆËflÏË Çéá [5], ÍËÚÂËÂÏ ‰Ë‡„ÌÓÒÚËÍË ‡ÌÂÏËË Û ·ÂÂÏÂÌÌ˚ı ÊÂÌ˘ËÌ fl‚ÎflÂÚÒfl ÒÌËÊÂÌË ÛÓ‚Ìfl „ÂÏÓ„ÎÓ·Ë̇ ÏÂÌ 11 „/‰Î. èÓ ÏÌÂКЛИНИЧЕСКАЯ ФАРМАКОЛОГИЯ И ТЕРАПИЯ, 2005, 14 (2 ) Ì˲ ‡ÏÂË͇ÌÒÍËı ˝ÍÒÔÂÚÓ‚ (ñÂÌÚ˚ ÔÓ ÍÓÌÚÓβ Ë ÔÓÙË·ÍÚËÍ Á‡·Ó΂‡ÌËÈ - CDC) [6], ÔË ËÌÚÂÔÂÚ‡ˆËË ÂÁÛθڇÚÓ‚ ÓÔ‰ÂÎÂÌËfl „ÂÏÓ„ÎÓ·Ë̇ ÒΉÛÂÚ Û˜ËÚ˚‚‡Ú¸ ÒÓÍ ·ÂÂÏÂÌÌÓÒÚË. Ç ÌÓÏ ÒÓ‰ÂʇÌË „ÂÏÓ„ÎÓ·Ë̇ Ë „ÂχÚÓÍËÚÌÓ ˜ËÒÎÓ Ì‡˜Ë̇˛Ú ÒÌËʇڸÒfl ‚ Ô‚ÓÏ ÚËÏÂÒÚ ·ÂÂÏÂÌÌÓÒÚË, ‰ÓÒÚË„‡˛Ú ÏËÌËχθÌ˚ı Á̇˜ÂÌËÈ ‚Ó ‚ÚÓÓÏ ÚËÏÂÒÚÂ, ‡ Á‡ÚÂÏ ÔÓÒÚÂÔÂÌÌÓ ÔÓ‚˚¯‡˛ÚÒfl. ëÓÓÚ‚ÂÚÒÚ‚ÂÌÌÓ, ‚ Ô‚ÓÏ Ë ÚÂÚ¸ÂÏ ÚËÏÂÒÚ‡ı ‡ÌÂÏËfl ÏÓÊÂÚ ·˚Ú¸ ‰Ë‡„ÌÓÒÚËÓ‚‡Ì‡ ÔË ÒÌËÊÂÌËË ÛÓ‚Ìfl „ÂÏÓ„ÎÓ·Ë̇ ÏÂÌ 11 „/‰Î, ‡ ‚Ó ‚ÚÓÓÏ - ÏÂÌ 10,5 „/‰Î. ÖÒÎË ÊÂÌ˘Ë̇ ‚˚ÍÛË‚‡ÂÚ ÔÓ 10-20 ÒË„‡ÂÚ ‚ ‰Â̸, ÚÓ Û͇Á‡ÌÌ˚ Á̇˜ÂÌËfl ÒΉÛÂÚ ÒÍÓÂÍÚËÓ‚‡Ú¸ (+0,3 „/‰Î). èË Ì‡Î˘ËË ‡ÌÂÏËË Û ·ÂÂÏÂÌÌÓÈ ÌÂÓ·ıÓ‰ËÏÓ ÔӉڂ‰ËÚ¸ ÊÂÎÂÁÓ‰ÂÙˈËÚ, Ú‡Í Í‡Í ÒÌËÊÂÌË ÛÓ‚Ìfl „ÂÏÓ„ÎÓ·Ë̇ ÏÓÊÂÚ ·˚Ú¸ Ó·ÛÒÎÓ‚ÎÂÌÓ Ë ‰Û„ËÏË Ù‡ÍÚÓ‡ÏË. ç‡Ë·ÓΠÒÔˆËÙ˘Ì˚Ï ÔÓ͇Á‡ÚÂÎÂÏ fl‚ÎflÂÚÒfl Ò˚‚ÓÓÚÓ˜Ì˚È ÛÓ‚Â̸ ÙÂËÚË̇, ÍÓÚÓ˚È ÓڇʇÂÚ Ó·˘Ë Á‡Ô‡Ò˚ ÊÂÎÂÁ‡ ‚ Ó„‡ÌËÁÏÂ. ëΉÛÂÚ Û˜ËÚ˚‚‡Ú¸, ˜ÚÓ Ò˚‚ÓÓÚÓ˜Ì˚È ‡ÔÓÙÂËÚËÌ fl‚ÎflÂÚÒfl ÓÒÚÓÙ‡ÁÌ˚Ï ·ÂÎÍÓÏ, ÒÓ‰ÂʇÌË ÍÓÚÓÓ„Ó ÔÓ‚˚¯‡ÂÚÒfl ÔË Î˛·˚ı ËÌÙÂ͈ËÓÌÌ˚ı ËÎË ‚ÓÒÔ‡ÎËÚÂθÌ˚ı ÔÓˆÂÒÒ‡ı. ëÓÓÚ‚ÂÚÒÚ‚ÂÌÌÓ, ‚ Ú‡ÍËı ÒÎÛ˜‡flı ˝ÚÓÚ ÔÓ͇Á‡ÚÂθ χÎÓ ËÌÙÓχÚË‚ÂÌ. äËÚÂËÂÏ ËÒÚÓ˘ÂÌËfl Á‡Ô‡ÒÓ‚ ÊÂÎÂÁ‡ fl‚ÎflÂÚÒfl ÒÌËÊÂÌË ÛÓ‚Ìfl ÙÂËÚË̇ ÏÂÌ 15 ÏÍ„/Î [5]. ëΉÛÂÚ Û˜ËÚ˚‚‡Ú¸, ˜ÚÓ ÛÏÂ̸¯ÂÌË ÒÓ‰ÂʇÌËfl ÙÂËÚË̇ Ò‡ÏÓ ÔÓ Ò· Ì ÔÓÁ‚ÓÎflÂÚ ÒÛ‰ËÚ¸ Ó ÙÛÌ͈ËÓ̇θÌÓÏ ‰ÂÙˈËÚ ÊÂÎÂÁ‡. àÌÙÓχÚË‚ÌÓÒÚ¸ ÔÓ͇Á‡ÚÂÎfl ÔË ·ÂÂÏÂÌÌÓÒÚË Ó„‡Ì˘Â̇, Ú‡Í Í‡Í ÓÌ ÒÌËʇÂÚÒfl ̇ ÔÓÁ‰ÌËı ÒÓ͇ı. ë ˆÂθ˛ ‚˚fl‚ÎÂÌËfl ÛÏÂÂÌÌÓ„Ó ÊÂÎÂÁÓ‰ÂÙˈËÚ‡ ÏÓÊÂÚ ·˚Ú¸ ËÒÔÓθÁÓ‚‡Ì ˝ËÚÓˆËÚ‡Ì˚È ÔÓÚÓÔÓÙËÌ, ÍÓÚÓ˚È fl‚ÎflÂÚÒfl Ô‰¯ÂÒÚ‚ÂÌÌËÍÓÏ „Âχ. èÓ‚˚¯ÂÌÌ˚È Â„Ó ÛÓ‚Â̸ ÍÓÂÎËÛÂÚ ÒÓ ÒÌËÊÂÌËÂÏ ÒÓ‰ÂʇÌËfl ÙÂËÚË̇ ‚ Ò˚‚ÓÓÚÍÂ. é‰Ì‡ÍÓ Û‚Â΢ÂÌË ÍÓ̈ÂÌÚ‡ˆËË ˝ËÚÓˆËÚ‡ÌÓ„Ó ÔÓÚÓÔÓÙË̇ ÏÓÊÂÚ Ì‡·Î˛‰‡Ú¸Òfl ÔË ËÌÙÂ͈ËË, ‚ÓÒÔ‡ÎÂÌËË, ËÌÚÓÍÒË͇ˆËË Ò‚Ë̈ÓÏ Ë „ÂÏÓÎËÚ˘ÂÒÍÓÈ ‡ÌÂÏËË. ÑÂÙˈËÚ ÊÂÎÂÁ‡ ÔË‚Ó‰ËÚ Í ÒÌËÊÂÌ˲ Â„Ó Ò˚‚ÓÓ1 èÓÚ·ÌÓÒÚ¸ ‚ ÊÂÎÂÁ (Ï„/ÒÛÚ) ÚÓ˜ÌÓ„Ó ÒÓ‰ÂʇÌËfl, Û‚Â΢ÂÌ˲ ÛÓ‚Ìfl Ú‡ÌÒÙÂË̇ (Ó·˘ÂÈ ÊÂÎÂÁÓÒ‚flÁ˚‚‡˛˘ÂÈ ÒÔÓÒÓ·ÌÓÒÚË 7 ÍÓ‚Ë) Ë ÛÏÂ̸¯ÂÌ˲ ÒÚÂÔÂÌË Ì‡Ò˚˘ÂÌËfl Ú‡ÌÒÙÂË̇. é‰Ì‡ÍÓ ˝ÚË ÔÓ͇Á‡ÚÂÎË ‚‡Ë‡·ÂθÌ˚ Ë 6 ̉ÓÒÚ‡ÚÓ˜ÌÓ ËÌÙÓχÚË‚Ì˚ ‚ ‰Ë‡„ÌÓÒÚËÍ ÊÂÎÂèÎÓ‰ Ë 5 Ô·ˆÂÌÚ‡ ÁÓ‰ÂÙˈËÚ‡. ì Ô‡ˆËÂÌÚÓ‚ Ò ·ÓΠ‚˚‡ÊÂÌÌÓÈ ÊÂÎÂÁÓ‰ÂÙˈËÚÌÓÈ ‡ÌÂÏËÂÈ ÒÚÂÔÂ̸ ̇Ò˚˘ÂÌËfl 4 Ú‡ÌÒÙÂË̇ Ó·˚˜ÌÓ ÒÓÒÚ‡‚ÎflÂÚ ÏÂÌ 16%. ê‡ÌÌËÏ Ë ‰ÓÒÚ‡ÚÓ˜ÌÓ ˜Û‚ÒÚ‚ËÚÂθÌ˚ÏË ÔËÁ̇3 ÍÓÏ Ì‰ÓÒÚ‡ÚÓ˜ÌÓÒÚË ÊÂÎÂÁ‡ fl‚ÎflÂÚÒfl ÔÓ‚˚¯ÂÌË åÂÌÒÚÛ‡ˆËË åÂÌÒÚÛ‡ˆËË ì‚Â΢ÂÌË ˜ËÒ· ÒÓ‰ÂʇÌËfl Ò˚‚ÓÓÚÓ˜Ì˚ı Ú‡ÌÒÙÂËÌÓ‚˚ı Â2 ˝ËÚÓˆËÚÓ‚ ã‡ÍÚ‡ˆËfl ˆÂÔÚÓÓ‚, ÍÓÚÓÓ Ì Á‡‚ËÒËÚ ÓÚ Ì‡Î˘Ëfl ËÌÙÂÍ1 ˆËË ËÎË ‚ÓÒÔ‡ÎÂÌËfl, ‡ Ú‡ÍÊ ‚ÓÁ‡ÒÚ‡, ÔÓ· ËÎË èÓÚÂË ÊÂÎÂÁ‡ ·ÂÂÏÂÌÌÓÒÚË [7]. é‰Ì‡ÍÓ Ëı ÛÓ‚Â̸ ÏÓÊÂÚ ÔÓ‚˚0 èÓÒÎÂÓ‰Ó‚˚È ÒËÚ¸Òfl ÔË Û‚Â΢ÂÌËË Ó·‡ÁÓ‚‡ÌËfl ˝ËÚÓˆËÚÓ‚, è‚˚È ÇÚÓÓÈ íÂÚËÈ ÔÂËÓ‰ ̇ÔËÏÂ, ÔË „ÂÏÓÎËÚ˘ÂÒÍÓÈ ‡ÌÂÏËË. äÓÏ ÚÓíËÏÂÒÚ˚ ·ÂÂÏÂÌÌÓÒÚË „Ó, ÂÁÛθڇÚ˚ ÚÂÒÚ‡ Á‡‚ËÒflÚ ÓÚ ËÒÔÓθÁÛÂÏÓ„Ó ÏÂÚÓ‰‡ ‡Ì‡ÎËÁ‡ (˜‡˘Â ‚ÒÂ„Ó ÔËÏÂÌfl˛Ú ELISA). èË ‡Ì‡ÎËÁ ҇ÏËı ˝ËÚÓˆËÚÓ‚ ÔËÁ͇̇ÏË Рис. 1. Диниамика потребности в железе во время беременности ÊÂÎÂÁÓ‰ÂÙˈËÚ‡ fl‚Îfl˛ÚÒfl ÒÌËÊÂÌË Ò‰ÌÂ„Ó Ëı Ó·˙Âχ Ë Ò‰ÌÂ„Ó ÒÓ‰ÂʇÌËfl „ÂÏÓ„ÎÓ·Ë̇. ìÏÂ̸¯Â- ÚËÏÂÒÚ‡ı ·ÂÂÏÂÌÌÓÒÚË ÒÓÒÚ‡‚ÎflÂÚ 4-6 Ï„, ‡ ‚ ÔÓÒΉÌË ÔÂ‚Ó„Ó ÔÓ͇Á‡ÚÂÎfl ÓÚϘ‡ÂÚÒfl ̇ ÔÓÁ‰ÌËı ˝Ú‡Ô‡ı ÌË 6-8 ̉Âθ ‰ÓÒÚË„‡ÂÚ 10 Ï„. ÖÒÎË ÊÂÌ˘Ë̇ ÔËÚ‡ÂÚÒfl ‡Á‚ËÚËfl ‡ÌÂÏËË. 燉ÂÊÌ˚Ï ÏÂÚÓ‰ÓÏ ‰Ë‡„ÌÓÒÚËÍË Ò˜Ë- ÔÓ‰ÛÍÚ‡ÏË, ÒÓ‰Âʇ˘ËÏË ·Óθ¯Ó ÍÓ΢ÂÒÚ‚Ó ÊÂÎÂÁ‡ Ú‡˛Ú Ú‡ÍÊ Ó͇ÒÍÛ ÍÓÒÚÌÓ„Ó ÏÓÁ„‡ ̇ ÊÂÎÂÁ‡, ıÓÚfl ÓÌ ‚ ·ËÓ‰ÓÒÚÛÔÌÓÈ ÙÓÏ (ÏflÒÓ, ÔÚˈ‡, ˚·‡), ‡ Ú‡ÍÊ ‡ÒÍÓ·ËÌÓ‚ÓÈ ÍËÒÎÓÚ˚, ÚÓ ‚ ˆÂÎÓÏ ‚Ò‡Ò˚‚‡ÌË ÊÂÎÂÁ‡ ÒÓÌ ÏÓÊÂÚ ·˚Ú¸ ËÒÔÓθÁÓ‚‡Ì ‰Îfl ÒÍËÌËÌ„‡. ê‡ÒÔÓÒÚ‡ÌÂÌÌ˚Ï ÔÓ‰ıÓ‰ÓÏ Í ‰Ë‡„ÌÓÒÚËÍ ÊÂÎÂÁÓ- ÒÚ‡‚ÎflÂÚ 3-4 Ï„/ÒÛÚ. í‡ÍËÏ Ó·‡ÁÓÏ, ‰‡Ê ‚ ÎÛ˜¯ÂÏ ‰ÂÙˈËÚÌÓÈ ‡ÌÂÏËÂÈ fl‚ÎflÂÚÒfl ËÁÛ˜ÂÌË ‰Ë̇ÏËÍË ÒÎÛ˜‡Â, Ú.Â. ÔË ‡‰ÂÍ‚‡ÚÌÓÏ ÔËÚ‡ÌËË, ·ÂÂÏÂÌ̇fl ÊÂÌÛÓ‚Ìfl „ÂÏÓ„ÎÓ·Ë̇ ËÎË „ÂχÚÓÍËÚÌÓ„Ó ˜ËÒ· ÔË ÔÂ- ˘Ë̇ ÔÓÎÛ˜‡ÂÚ ˜ÛÚ¸ ÏÂ̸¯Â ÊÂÎÂÁ‡, ˜ÂÏ ÂÈ Ú·ÛÂÚÒfl. é˜Â‚ˉÌÓ, ˜ÚÓ ‚ ˝ÚÓÈ ÒËÚÛ‡ˆËË ·‡Î‡ÌÒ ÊÂÎÂÁ‡ ‚ Ó„‡Ó‡Î¸ÌÓÏ ÔËÏÂÌÂÌËË ÔÂÔ‡‡ÚÓ‚ ÊÂÎÂÁ‡. èËÁ̇ÍÓÏ ÊÂÎÂÁÓ‰ÂÙˈËÚ‡ ÏÓÊÂÚ ÒÎÛÊËÚ¸ Û‚Â΢ÂÌË ÛÓ‚Ìfl „Â- ÌËÁÏ ÏÓÊÂÚ ÔÓ‰‰ÂÊË‚‡Ú¸Òfl ÚÓθÍÓ ÔË Ì‡Î˘ËË ‡‰ÂÍÏÓ„ÎÓ·Ë̇ ÔÓ Í‡ÈÌÂÈ Ï ̇ 1 „/‰Î ˜ÂÂÁ 1-2 ÏÂÒflˆ‡ ‚‡ÚÌ˚ı Á‡Ô‡ÒÓ‚ ÊÂÎÂÁ‡ ‰Ó ·ÂÂÏÂÌÌÓÒÚË. ÖÒÎË ·ÂÂÏÂÌ̇fl ÊÂÌ˘Ë̇ ÔËÚ‡ÂÚÒfl ÌÓχθÌÓ, ÚÓ ˝ÚË Á‡Ô‡ÔÓÒΠ̇˜‡Î‡ ΘÂÌËfl. Ò˚ ‰ÓÎÊÌ˚ ÒÓÒÚ‡‚ÎflÚ¸ ÔÓ Í‡ÈÌÂÈ Ï 300 Ï„, ÌÓ ‚ ÔÓÚË‚ÌÓÏ ÒÎÛ˜‡Â ÓÌË ‰ÓÎÊÌ˚ ·˚Ú¸ ‚˚¯Â. èÓ ‰‡ÌÌ˚Ï Обмен железа во время беременности Ç Ô‚ÓÏ ÚËÏÂÒÚ ·ÂÂÏÂÌÌÓÒÚË ÔÓÚ·ÌÓÒÚ¸ ‚ ÊÂÎÂÁ ËÒÒΉӂ‡ÌËfl, ÍÓÚÓÓ ÔÓ‚Ó‰ËÎÓÒ¸ ‚ ëòÄ [9], ωˇÒÌËʇÂÚÒfl Á‡ Ò˜ÂÚ ÔÂ͇˘ÂÌËfl Â„Ó ÔÓÚÂË ‚Ó ‚ÂÏfl ̇ ‡Ò˜ÂÚÌ˚ı Á‡Ô‡ÒÓ‚ ÊÂÎÂÁ‡ Û ÊÂÌ˘ËÌ ÒÓÒÚ‡‚Ë· 300 ÏÂÌÒÚÛ‡ˆËÈ. Ç ˝ÚÓÚ ÔÂËÓ‰ ÊÂÌ˘Ë̇ ÚÂflÂÚ ÏËÌËχθ- Ï„, ‡ Û 20% ÓÌË Ù‡ÍÚ˘ÂÒÍË ÓÚÒÛÚÒÚ‚Ó‚‡ÎË. Ç ò‚ˆËË ÌÓ ÍÓ΢ÂÒÚ‚Ó ÊÂÎÂÁ‡ - ÓÍÓÎÓ 0,8 Ï„/ÒÛÚ - ˜ÂÂÁ ÊÂÎÛ- ωˇ̇ Á‡Ô‡ÒÓ‚ ÊÂÎÂÁ‡ Û ÊÂÌ˘ËÌ ÒÓÒÚ‡‚Ë· ‚ÒÂ„Ó 150 ‰Ó˜ÌÓ-Í˯˜Ì˚È Ú‡ÍÚ, ÍÓÊÛ Ë Ò ÏÓ˜ÓÈ (Ú‡Í Ï„, ‡ Û ‰Â‚Û¯ÂÍ ÒÚ‡¯Â 15 ÎÂÚ - 70 Ï„ [10]. ã˯¸ Û 20% ̇Á˚‚‡ÂÏ˚ “·‡Á‡Î¸Ì˚” ÔÓÚÂË). é‰Ì‡ÍÓ ‚Ó ‚ÚÓÓÏ Ó·ÒΉӂ‡ÌÌ˚ı ÓÌË Ô‚˚¯‡ÎË 250 Ï„. Ç ˝ÚËı ÛÒÎÓ‚Ëflı ÚËÏÂÒÚ ÔÓÚ·ÌÓÒÚ¸ ‚ ÊÂÎÂÁ ̇˜Ë̇ÂÚÒfl Û‚Â΢Ë- ÌÂۉ˂ËÚÂθÌÓ, ˜ÚÓ ‚Ó ‚ÂÏfl ·ÂÂÏÂÌÌÓÒÚË ÛÒÛ„Û·ÎflÂÚÒfl ‚‡Ú¸Òfl Ë ÔÓ‰ÓÎʇÂÚ ‡ÒÚË ‰Ó ÍÓ̈‡ ·ÂÂÏÂÌÌÓÒÚË (ËÒ. ËÎË ‡Á‚Ë‚‡ÂÚÒfl ‰ÂÙˈËÚ ÊÂÎÂÁ‡, ˜ÚÓ ÔË‚Ó‰ËÚ Í ÔÓfl‚1) [8]. ì‚Â΢ÂÌË ÔÓÚ·ÎÂÌËfl ÍËÒÎÓÓ‰‡ χÚ¸˛ Ë ÎÂÌ˲ ‡ÌÂÏËË. ÔÎÓ‰ÓÏ ÒÓÔÓ‚Óʉ‡ÂÚÒfl Á̇˜ËÚÂθÌ˚Ï ÔÓ‚˚¯ÂÌËÂÏ Ó·˙Âχ ˆËÍÛÎËÛ˛˘ÂÈ Ô·ÁÏ˚ (ÔËÏÂÌÓ Ì‡ 50%) Ë Неблагоприятные эффекты анемии χÒÒ˚ ˝ËÚÓˆËÚÓ‚ (̇ 35%). óÚÓ·˚ Ó·ÂÒÔ˜ËÚ¸ ÔÓ‰Ó·- ÑÎfl ÌÓχθÌÓ„Ó ‡Á‚ËÚËfl Ó„‡ÌÓ‚ ÔÎÓ‰‡ Ë ÌÓ‚ÓÓÊÌ˚ ËÁÏÂÌÂÌËfl, Ó„‡ÌËÁÏÛ ÊÂÌ˘ËÌ˚ Ú·ÛÂÚÒfl ÔËÏÂ- ‰ÂÌÌÓ„Ó ÌÂÓ·ıÓ‰ËÏÓ ‰ÓÒÚ‡ÚÓ˜ÌÓ ÔÓÒÚÛÔÎÂÌË ÊÂÎÂÁ‡ ÌÓ 450 Ï„ ÊÂÎÂÁ‡. Ç ‰‡Î¸ÌÂȯÂÏ ÓÒÚ ÔÓÚ·ÌÓÒÚË ‚ [11]. ÅÓθ¯‡fl ˜‡ÒÚ¸ Â„Ó ‚ıÓ‰ËÚ ‚ ÒÓÒÚ‡‚ „ÂÏÓ„ÎÓ·Ë̇, ‡ ÊÂÎÂÁ ÔÓËÒıÓ‰ËÚ ÔÓÔÓˆËÓ̇θÌÓ Û‚Â΢ÂÌ˲ χÒ- ÏÂ̸¯‡fl ˜‡ÒÚ¸ ÔÓÒÚÛÔ‡ÂÚ ‚ ‰ÂÔÓ (ÙÂËÚËÌ) ËÎË Ò˚ ÔÎÓ‰‡. ëÓ‰ÂʇÌË ÊÂÎÂÁ‡ ‚ Ó„‡ÌËÁÏ ÔÎÓ‰‡ χÒÒÓÈ ËÒÔÓθÁÛ˛ÚÒfl ‰Îfl ÒËÌÚÂÁ‡ fl‰‡ ‡ÍÚË‚Ì˚ı ·ÂÎÍÓ‚, ‚ ˜‡ÒÚÚ· >3 Í„ ÒÓÒÚ‡‚ÎflÂÚ ÓÍÓÎÓ 270 Ï„, ‡ ‚ Ô·ˆÂÌÚ - 90 Ï„. ÌÓÒÚË ÏËÓ„ÎÓ·Ë̇ Ë ˆËÚÓıÓÏÓ‚. èË ‰ÂÙˈËÚ ÊÂÎÂÁ‡ äÓÏ ÚÓ„Ó, ÊÂÌ˘Ë̇ ÚÂflÂÚ ÓÍÓÎÓ 150 Ï„ ÊÂÎÂÁ‡ Ò ÍÓ- ÓÌÓ ÔÂËÏÛ˘ÂÒÚ‚ÂÌÌÓ ‡ÒıÓ‰ÛÂÚÒfl ̇ ÒËÌÚÂÁ „ÂÏÓ„ÎÓ·Ë‚¸˛ ‚Ó ‚ÂÏfl Ó‰Ó‚. í‡ÍËÏ Ó·‡ÁÓÏ, ‚ ˆÂÎÓÏ ÊÂÌ˘ËÌ ̇, ‚ ÚÓ ‚ÂÏfl Í‡Í ÒÍÂÎÂÚÌ˚ Ï˚¯ˆ˚, Ò‰ˆÂ Ë „ÓÎÓÁ‡ ‚ÂÏfl ·ÂÂÏÂÌÌÓÒÚË Ë Ó‰Ó‚ Ú·ÛÂÚÒfl ·ÓΠ1000 Ï„ ‚ÌÓÈ ÏÓÁ„ ËÒÔ˚Ú˚‚‡˛Ú ‰ÂÙˈËÚ ˝ÚÓ„Ó ˝ÎÂÏÂÌÚ‡ ¢ ‰Ó ÊÂÎÂÁ‡. ÔÓfl‚ÎÂÌËfl ÔËÁ̇ÍÓ‚ ÊÂÎÂÁÓ‰ÂÙˈËÚÌÓÈ ‡ÌÂÏËË. ëÛÚӘ̇fl ÔÓÚ·ÌÓÒÚ¸ ‚ ÊÂÎÂÁ ‚Ó ‚ÚÓÓÏ-ÚÂÚ¸ÂÏ í‡ÌÒÔÓÚ ÊÂÎÂÁ‡ ÓÚ Ï‡ÚÂË Í ÔÎÓ‰Û ÔÓËÒıÓ‰ËÚ ‚ 2 КЛИНИЧЕСКАЯ ФАРМАКОЛОГИЯ И ТЕРАПИЯ, 2005, 14 (2) ÓÒÌÓ‚ÌÓÏ ÔÓÒΠ30-È Ì‰ÂÎË ·ÂÂÏÂÌÌÓÒÚË, ÍÓ„‰‡ Â„Ó ‚Ò‡Ò˚‚‡ÌË ‚ Ó„‡ÌËÁÏ ÊÂÌ˘ËÌ˚ ‰ÓÒÚË„‡ÂÚ ÔË͇. í‡ÌÒÔÓÚ ÓÒÛ˘ÂÒÚ‚ÎflÂÚÒfl Ò˚‚ÓÓÚÓ˜Ì˚Ï Ú‡ÌÒÙÂËÌÓÏ, ÍÓÚÓ˚È Ò‚flÁ˚‚‡ÂÚÒfl Ò Ú‡ÌÒÙÂËÌÓ‚˚ÏË ÂˆÂÔÚÓ‡ÏË Ì‡ ÔÓ‚ÂıÌÓÒÚË Ô·ˆÂÌÚ˚ Ë ÔÓ‰‚„‡ÂÚÒfl ˝Ì‰ÓˆËÚÓÁÛ. èÓÒΠ‚˚Ò‚Ó·ÓʉÂÌËfl ÊÂÎÂÁ‡ ‡ÔÓÚ‡ÌÒÙÂËÌ ‚ÓÁ‚‡˘‡ÂÚÒfl ‚ χÚÂËÌÒÍËÈ ÍÓ‚ÓÚÓÍ, ‡ Ò‚Ó·Ó‰ÌÓ ÊÂÎÂÁÓ Ò‚flÁ˚‚‡ÂÚÒfl Ò Ú‡ÌÒÙÂËÌÓÏ ‚ ÍÎÂÚ͇ı Ô·ˆÂÌÚ˚, ‡ Á‡ÚÂÏ ÔÓÒÚÛÔ‡ÂÚ ‚ ÍÓ‚¸ ÔÎÓ‰‡. èË Ì‰ÓÒÚ‡ÚÓ˜ÌÓÏ ÒÓ‰ÂʇÌËË ÊÂÎÂÁ‡ ‚ ÍÓ‚Ë ‚ Ô·ˆÂÌÚ ۂÂ΢˂‡ÂÚÒfl ˜ËÒÎÓ Ú‡ÌÒÙÂËÌÓ‚˚ı ˆÂÔÚÓÓ‚, ˜ÚÓ Ó·ÂÒÔ˜˂‡ÂÚ ÛÒËÎÂÌÌ˚È Á‡ı‚‡Ú ÊÂÎÂÁ‡. Ç Ò‚Ó˛ Ә‰¸, ËÁ·˚ÚÓ˜ÌÓ ÔÓÒÚÛÔÎÂÌË ÊÂÎÂÁ‡ ÏÓÊÂÚ ·˚Ú¸ Ô‰ÓÚ‚‡˘ÂÌÓ ÔÛÚÂÏ ÒËÌÚÂÁ‡ ÙÂËÚË̇ ‚ Ô·ˆÂÌÚÂ. èË Ì‡Î˘ËË ÊÂÎÂÁÓ‰ÂÙˈËÚ‡ Û ÊÂÌ˘ËÌ˚ ÙÛÌ͈ËÓÌËÓ‚‡ÌË ˝ÚÓÈ ÒËÒÚÂÏ˚ ÏÓÊÂÚ Ì‡Û¯ËÚ¸Òfl. ÄÌÂÏËfl β·ÓÈ ÔËÓ‰˚ Ó͇Á˚‚‡ÂÚ ÌÂÊ·ÚÂθÌÓ ‰ÂÈÒÚ‚Ë ̇ ÔÎÓ‰ Ë fl‚ÎflÂÚÒfl Ó‰ÌÓÈ ËÁ Ô˘ËÌ Á‡‰ÂÊÍË ‚ÌÛÚËÛÚÓ·ÌÓ„Ó ‡Á‚ËÚËfl, ‡ÒÒÓˆËËÛ˛˘ÂÈÒfl Ò ÔÓ‚˚¯ÂÌÌÓÈ Á‡·Ó΂‡ÂÏÓÒÚ¸˛ Ë ÒÏÂÚÌÓÒÚ¸˛. ÅÓΠÚÓ„Ó, ‚˚Ò͇Á‡Ì‡ „ËÔÓÚÂÁ‡ Ó ÚÓÏ, ˜ÚÓ Á‡‰ÂÊ͇ ‚ÌÛÚËÛÚÓ·ÌÓ„Ó ‡Á‚ËÚËfl fl‚ÎflÂÚÒfl Ù‡ÍÚÓÓÏ ËÒ͇ ‡Á‚ËÚËfl ‡Ú¡θÌÓÈ „ËÔÂÚÓÌËË, ˯ÂÏ˘ÂÒÍÓÈ ·ÓÎÂÁÌË Ò‰ˆ‡ Ë ıÓÌ˘ÂÒÍÓÈ Ó·ÒÚÛÍÚË‚ÌÓÈ ·ÓÎÂÁÌË Î„ÍËı ‚ ÁÂÎÓÏ ‚ÓÁ‡ÒÚ („ËÔÓÚÂÁ‡ Ň͇) [12,13]. Ç ÒÓÓÚ‚ÂÚÒÚ‚ËË Ò ˝ÚÓÈ „ËÔÓÚÂÁÓÈ, ÒÚÛÍÚÛ‡ Ë ÙÛÌ͈ËË ‡ÁÌ˚ı Ó„‡ÌÓ‚ ÓÔ‰ÂÎÂÌÌ˚Ï Ó·‡ÁÓÏ ÔÓ„‡ÏÏËÛ˛ÚÒfl ‚ ÔÂËÓ‰ ˝Ï·ËÓ̇θÌÓ„Ó ‡Á‚ËÚËfl [14]. èӉӷ̇fl ÔÓ„‡Ïχ ÓÔ‰ÂÎflÂÚ Ëı ÙËÁËÓÎӄ˘ÂÒÍËÂ Ë ÏÂÚ‡·Ó΢ÂÒÍË ÓÚ‚ÂÚÌ˚ ‡͈ËË ‚ ÁÂÎÓÏ ‚ÓÁ‡ÒÚÂ. ç‡Û¯ÂÌË ÔÓÒÚÛÔÎÂÌËfl ÔËÚ‡ÚÂθÌ˚ı ‚¢ÂÒÚ‚ ‚Ó ‚ÂÏfl ·ÂÂÏÂÌÌÓÒÚË ‚˚Á˚‚‡ÂÚ ‡‰‡ÔÚË‚Ì˚È ÓÚ‚ÂÚ ÔÎÓ‰‡ (‚ ˜‡ÒÚÌÓÒÚË „ÓÏÓ̇θÌ˚È), ÍÓÚÓ˚È ÏÓÊÂÚ ·˚Ú¸ Ô˘ËÌÓÈ “ÏÂÚ‡·Ó΢ÂÒÍÓ„Ó ÍÓÌÙÎËÍÚ‡” ÔË ‚ÓÒÒÚ‡ÌÓ‚ÎÂÌËË ÌÓχθÌÓ„Ó ÔËÚ‡ÌËfl ÔÓÒΠӉӂ. ùÚÓÚ ÍÓÌÙÎËÍÚ Ô‰‡ÒÔÓ·„‡ÂÚ Í Ì‡Û¯ÂÌ˲ ‡Á΢Ì˚ı ÙËÁËÓÎӄ˘ÂÒÍËı ÙÛÌ͈ËÈ Ë ‡Á‚ËÚ˲ fl‰‡ Á‡·Ó΂‡ÌËÈ. êÂÁÛθڇÚ˚ ˝ÔˉÂÏËÓÎӄ˘ÂÒÍËı ËÒÒΉӂ‡ÌËÈ ÔÓ‰Ú‚Âʉ‡˛Ú ˝ÚÛ „ËÔÓÚÂÁÛ. ç‡ÔËÏÂ, ‚ ÇÂÎËÍÓ·ËÚ‡ÌËË ·˚· ÔÓÒÎÂÊÂ̇ ÒÛ‰¸·‡ 16000 ÏÛʘËÌ Ë ÊÂÌ˘ËÌ, Ӊ˂¯ËıÒfl ‚ 1911-1930 „„. [15]. ì‚Â΢ÂÌË χÒÒ˚ ÌÓ‚ÓÓʉÂÌÌ˚ı ‰ÂÚÂÈ (ÓÚ <2500 ‰Ó >4310 „) ‡ÒÒÓˆËËÓ‚‡ÎÓÒ¸ ÒÓ Á̇˜ËÚÂθÌ˚Ï ÒÌËÊÂÌËÂÏ Ëı ÒÏÂÚÌÓÒÚË ÓÚ ÍÓÓ̇ÌÓÈ ·ÓÎÂÁÌË Ò‰ˆ‡ ‚ ÓÚ‰‡ÎÂÌÌÓÏ ÔÂËÓ‰Â. ëıÓ‰Ì˚ ‰‡ÌÌ˚ ·˚ÎË ÔÓÎÛ˜ÂÌ˚ ÔË ‡Ì‡ÎËÁ ˜‡ÒÚÓÚ˚ ‡Ú¡θÌÓÈ „ËÔÂÚÓÌËË Ë Ò‡ı‡ÌÓ„Ó ‰Ë‡·ÂÚ‡. ó‡ÒÚÓÚ‡ Ò‡ı‡ÌÓ„Ó ‰Ë‡·ÂÚ‡ ÚËÔ‡ 2 Ë Ì‡Û¯ÂÌËfl ÚÓ·ÌÚÌÓÒÚË Í „βÍÓÁÂ Û ÏÛʘËÌ, ÍÓÚÓ˚ ‚ÂÒËÎË ÔË ÓʉÂÌËË ÏÂÌ 2500 „, ·˚· ‚ 3 ‡Á‡ ‚˚¯Â, ˜ÂÏ Û ÏÛʘËÌ, ‚ÂÒ ÍÓÚÓ˚ı ÔË ÓʉÂÌËË ÒÓÒÚ‡‚ÎflÎ ·ÓΠ4310 „ (14 Ë 40% ÒÓÓÚ‚ÂÚÒÚ‚ÂÌÌÓ [16]. åÂı‡ÌËÁÏ˚ ÔÓ‰Ó·Ì˚ı Ò‚flÁÂÈ ‰Ó ÍÓ̈‡ Ì flÒÌ˚. Ç˚Ò͇Á˚‚‡ÎÓÒ¸ Ô‰ÔÓÎÓÊÂÌËÂ Ó ÚÓÏ, ˜ÚÓ ÌËÁ͇fl χÒÒ‡ Ú· ÌÓ‚ÓÓʉÂÌÌÓ„Ó ÔÓ‚˚¯‡ÂÚ ‚ÂÓflÚÌÓÒÚ¸ ÔÓÒÎÂ‰Û˛˘Â„Ó Û‚Â΢ÂÌËfl ÛÓ‚ÌÂÈ ıÓÎÂÒÚÂË̇ ‚ ÍÓ‚Ë, Ӊ̇ÍÓ ˝Ú‡ Ò‚flÁ¸ Ì ·˚· ÔÓ‰Ú‚ÂʉÂ̇ ÔË ÏÂÚ‡-‡Ì‡ÎËÁ 79 ËÒКЛИНИЧЕСКАЯ ФАРМАКОЛОГИЯ И ТЕРАПИЯ, 2005, 14 (2) ÒΉӂ‡ÌËÈ ‚ ˆÂÎÓÏ Û 74122 Ô‡ˆËÂÌÚÓ‚ [17]. éÔ‰ÂÎÂÌÌÓ Á̇˜ÂÌË ÏÓ„ÛÚ ËÏÂÚ¸ ÒÚÓÈÍË ËÁÏÂÌÂÌËfl ÒËÒÚÂÏ˚ „ËÔÓڇ·ÏÛÒ-„ËÔÓÙËÁ, ÏÂı‡ÌËÁÏÓ‚, „ÛÎËÛ˛˘Ë ÒÂÍÂˆË˛ ËÌÒÛÎË̇ Ë ˜Û‚ÒÚ‚ËÚÂθÌÓÒÚ¸ Í ÌÂÏÛ, Ë ÒÓÒÛ‰ËÒÚÓÈ Â‡ÍÚË‚ÌÓÒÚË [18]. S.Mahajan Ë ÒÓ‡‚Ú. [19] ÔÓ͇Á‡ÎË, ˜ÚÓ ‡ÌÂÏËfl Û ·ÂÂÏÂÌÌ˚ı ÒÓÔÓ‚Óʉ‡ÂÚÒfl ·ÓΠ‚˚‡ÊÂÌÌ˚Ï Û‚Â΢ÂÌËÂÏ ÛÓ‚ÌÂÈ „ÓÏÓÌÓ‚ ÓÒÚ‡, ÔÓ·ÍÚË̇ Ë ËÌÒÛÎËÌÓÔÓ‰Ó·ÌÓ„Ó Ù‡ÍÚÓ‡ ÓÒÚ‡-1 ‚ ÍÓ‚Ë ÔÛÔÓ‚ËÌ˚. èÓ ÏÌÂÌ˲ L.Allen [20], ‡ÌÂÏËfl („ËÔÓÍÒËfl) Ë ‰ÂÙˈËÚ ÊÂÎÂÁ‡ (ÒÓÔÓ‚Óʉ‡˛˘ËÈÒfl Û‚Â΢ÂÌËÂÏ Ò˚‚ÓÓÚÓ˜ÌÓÈ ÍÓ̈ÂÌÚ‡ˆËË ÌÓ‡‰Â̇ÎË̇) ‚˚Á˚‚‡˛Ú ÒÚÂÒÒÓÌÛ˛ Â‡ÍˆË˛ Û Ï‡ÚÂË Ë ÔÎÓ‰‡, ÍÓÚÓ‡fl ÒÚËÏÛÎËÛÂÚ ÒËÌÚÂÁ ÍÓÚËÍÓÚÓÔËÌ-ËÎËÁËÌ„ „ÓÏÓ̇. èÓ‚˚¯ÂÌË ÛÓ‚Ìfl ÔÓÒΉÌÂ„Ó fl‚ÎflÂÚÒfl ÓÒÌÓ‚Ì˚Ï Ù‡ÍÚÓÓÏ ËÒ͇ ÔÂʉ‚ÂÏÂÌÌ˚ı Ó‰Ó‚, ‡Ú¡θÌÓÈ „ËÔÂÚÓÌËË Ë ˝Í·ÏÔÒËË. äÓÏ ÚÓ„Ó, ˝ÚÓÚ „ÓÏÓÌ ÒÚËÏÛÎËÛÂÚ ÔÓ‰ÛÍˆË˛ ÍÓÚËÁÓ·, ÍÓÚÓ˚È ÏÓÊÂÚ Á‡Ï‰ÎËÚ¸ ÓÒÚ ÔÎÓ‰‡. ÑÂÙˈËÚ ÊÂÎÂÁ‡ ÏÓÊÂÚ ·˚Ú¸ Ô˘ËÌÓÈ ÓÍËÒÎËÚÂθÌÓ„Ó ÒÚÂÒ‡, ‡ Ú‡ÍÊ ÔÓ‚˚¯‡ÂÚ ËÒÍ ËÌÙÂ͈ËÈ, ÍÓÚÓ˚ Ì‰ÍÓ ÒÓÔÓ‚Óʉ‡˛ÚÒfl ÔÂʉ‚ÂÏÂÌÌ˚ÏË Ó‰‡ÏË. Влияние анемии на исходы беременности èÓ ‰‡ÌÌ˚Ï Çéá [5], ‡ÌÂÏËfl Ë ‰ÂÙˈËÚ ÊÂÎÂÁ‡ Û ·ÂÂÏÂÌÌ˚ı ‡ÒÒÓˆËËÛ˛ÚÒfl Ò ÔÓ‚˚¯ÂÌËÂÏ Ï‡ÚÂËÌÒÍÓÈ ÒÏÂÚÌÓÒÚË, ÔÂË̇ڇθÌÓÈ ÒÏÂÚÌÓÒÚË Ë Û‚Â΢ÂÌËÂÏ ˜‡ÒÚÓÚ˚ ÔÂʉ‚ÂÏÂÌÌ˚ı Ó‰Ó‚. B.Brabin Ë ÒÓ‡‚Ú. [21] ÔÓ‚ÂÎË ÏÂÚ‡-‡Ì‡ÎËÁ ËÒÒΉӂ‡ÌËÈ, ‚ ÍÓÚÓ˚ı ËÁÛ˜‡ÎÓÒ¸ ‚ÎËflÌË ‡ÌÂÏËË ‚Ó ‚ÂÏfl ·ÂÂÏÂÌÌÓÒÚË Ì‡ χÚÂËÌÒÍÛ˛ ÒÏÂÚÌÓÒÚ¸. éÚÌÓÒËÚÂθÌ˚È ËÒÍ ÒÏÂÚË ÔË ÛÏÂÂÌÌÓÈ ‡ÌÂÏËË („ÂÏÓ„ÎÓ·ËÌ 4-8 „/‰Î) ÒÓÒÚ‡‚ËÎ 1,35 (95% ‰Ó‚ÂËÚÂθÌ˚È ËÌÚ‚‡Î 0,92-2,00), ‡ ÔË ÚflÊÂÎÓÈ ‡ÌÂÏËË (<4,7 „/‰Î) - 3,51 (95% ‰Ó‚ÂËÚÂθÌ˚È ËÌÚ‚‡Î 2,05-6,00). ëΉÛÂÚ ÓÚÏÂÚËÚ¸, ˜ÚÓ Ò‚flÁ¸ ÏÂÊ‰Û ‡ÌÂÏËÂÈ Ë Ï‡ÚÂËÌÒÍÓÈ ÒÏÂÚÌÓÒÚ¸˛ ‚ ÔÓÒÔÂÍÚË‚Ì˚ı ËÒÒΉӂ‡ÌËflı Ì ‰Ó͇Á‡Ì‡, ‡ ̇ ÂÁÛθڇÚ˚ Ëϲ˘ËıÒfl ËÒÒΉӂ‡ÌËÈ ÏÓ„ÎË Ó͇Á‡Ú¸ ‚ÎËflÌË ‡Á΢Ì˚ هÍÚÓ˚. ç‡ÔËÏÂ, ‚ ÍÛÔÌÓÏ Ë̉ÓÌÂÁËÈÒÍÓÏ ËÒÒΉӂ‡ÌËË ÒÏÂÚÌÓÒÚ¸ ·ÂÂÏÂÌÌ˚ı ÊÂÌ˘ËÌ, ÒÚ‡‰‡‚¯Ëı Ë Ì ÒÚ‡‰‡‚¯Ëı ‡ÌÂÏËÂÈ („ÂÏÓ„ÎÓ·ËÌ <10 „/‰Î) ÒÓÒÚ‡‚Ë· 70,0 Ë 19,7 ̇ 10000 Ó‰Ó‚ ÒÓÓÚ‚ÂÚÒÚ‚ÂÌÌÓ [22]. é‰Ì‡ÍÓ ÔÓ ÏÌÂÌ˲ ‡‚ÚÓÓ‚, Û‚Â΢ÂÌË ÒÏÂÚÌÓÒÚË ÏÓ„ÎÓ ·˚Ú¸ ÂÁÛθڇÚÓÏ ·ÓΠ‚˚‡ÊÂÌÌÓ„Ó ÍÓ‚ÓÚ˜ÂÌËfl ËÎË ÔÓÁ‰ÌÂÈ „ÓÒÔËÚ‡ÎËÁ‡ˆËË, ‡ Ì ҇ÏÓÈ ‡ÌÂÏËË. K.Rasmussen [23] Ôӂ· ÒËÒÚÂχÚËÁËÓ‚‡ÌÌ˚È 54 Ó·ÁÓ ËÒÒΉӂ‡ÌËÈ, ‚ ÍÓÚÓ˚ı ËÁÛ˜‡Î‡Ò¸ Ò‚flÁ¸ ÏÂÊ‰Û ÛÓ‚ÌÂÏ „ÂÏÓ„ÎÓ·Ë̇ ËÎË „ÂχÚÓÍËÚÓÏ Ë ËÒıÓ‰‡ÏË ·ÂÂÏÂÌÌÓÒÚË. Ç 26 ËÁ 44 ËÒÒΉӂ‡ÌËÈ ‡ÌÂÏËfl ËÎË ÌËÁ͇fl ÍÓ̈ÂÌÚ‡ˆËfl ÙÂËÚË̇ ‡ÒÒÓˆËËÓ‚‡ÎËÒ¸ Ò Û‚Â΢ÂÌËÂÏ ˜‡ÒÚÓÚ˚ ÓʉÂÌËfl ‰ÂÚÂÈ Ò ÌËÁÍÓÈ Ï‡ÒÒÓÈ Ú·. ÇÓÁÏÓÊÌÓÈ Ô˘ËÌÓÈ ˝ÚÓ„Ó Ù‡ÍÚ‡ ÏÓ„ÎË ·˚Ú¸ ÔÂʉ‚ÂÏÂÌÌ˚ Ӊ˚. í‡Í, ‚ 22 ËÁ 31 ËÒÒΉӂ‡ÌËfl ·˚· ÓÚϘÂ̇ ÓÚˈ‡ÚÂθ̇fl Á‡‚ËÒËÏÓÒÚ¸ ÏÂÊ‰Û ÛÓ‚ÌflÏË „ÂÏÓ„ÎÓ·Ë̇ ËÎË „ÂχÚÓÍËÚÌÓ„Ó ˜ËÒ· Ë ‰ÎËÚÂθÌÓÒÚ¸˛ ·ÂÂÏÂÌÌÓÒÚË. ë‚flÁ¸ ÏÂÊ‰Û ÍÓ̈ÂÌÚ‡ˆËÂÈ „ÂÏÓ„ÎÓ·Ë̇ Ë Ï‡ÒÒÓÈ Ú· ÌÓ‚ÓÓʉÂÌÌ˚ı ËÏÂÂÚ U-Ó·3 ‡ÁÌ˚È ı‡‡ÍÚÂ, Ú.Â. ˜‡ÒÚÓÚ‡ ÓʉÂÌËfl ‰ÂÚÂÈ Ò ÌËÁÍÓÈ Ï‡ÒÒÓÈ Ú· ÔÓ‚˚¯‡ÂÚÒfl Í‡Í ÔË ÌËÁÍËı, Ú‡Í Ë ‚˚ÒÓÍËı ÛÓ‚Ìfl „ÂÏÓ„ÎÓ·Ë̇ (˜ÚÓ ‚ ÔÓÒΉÌÂÏ ÒÎÛ˜‡Â, ÔÓ-‚ˉËÏÓÏÛ, ÓڇʇÂÚ Ì‰ÓÒÚ‡ÚÓ˜ÌÓ ۂÂ΢ÂÌË ӷ˙Âχ ˆËÍÛÎËÛ˛˘ÂÈ Ô·ÁÏ˚). êËÒÍ Ì··„ÓÔËflÚÌ˚ı ËÒıÓ‰Ó‚ Á‡‚ËÒËÚ ÓÚ ÚflÊÂÒÚË ‡ÌÂÏËË. ç‡ÔËÏÂ, S.Malhotra Ë ÒÓ‡‚Ú. [24] ËÁÛ˜‡ÎË ËÒıÓ‰˚ ·ÂÂÏÂÌÌÓÒÚË Û 447 ÊÂÌ˘ËÌ, ÍÓÚÓ˚ı ‡Á‰ÂÎËÎË Ì‡ 4 „ÛÔÔ˚ ‚ Á‡‚ËÒËÏÓÒÚË ÓÚ ÛÓ‚Ìfl „ÂÏÓ„ÎÓ·Ë̇ (ÓÚ <7 ‰Ó >11 „/‰Î). ë‰Ìflfl χÒÒ‡ ÌÓ‚ÓÓʉÂÌÌ˚ı ‰ÂÚÂÈ ·˚· χÍÒËχθÌÓÈ Û ÊÂÌ˘ËÌ Ò ÛÓ‚ÌÂÏ „ÂÏÓ„ÎÓ·Ë̇ 9,6-10,5 „/‰Î, ‡ ÏËÌËχθÌÓÈ - Û ÊÂÌ˘ËÌ Ò ÛÓ‚ÌÂÏ „ÂÏÓ„ÎÓ·Ë̇ <7 „/‰Î. íflÊ·fl ‡ÌÂÏËfl ‡ÒÒÓˆËËÓ‚‡Î‡Ò¸ Ú‡ÍÊÂ Ò Û‚Â΢ÂÌËÂÏ ‰ÎËÚÂθÌÓÒÚË Ó‰Ó‚ÓÈ ‰ÂflÚÂθÌÓÒÚË Ë ÌÂÓ·ıÓ‰ËÏÓÒÚË ‚ ÓÔ‡ÚË‚ÌÓÏ ‚ϯ‡ÚÂθÒÚ‚Â. èÓ ‰‡ÌÌ˚Ï K.Rasmussen [23], ÔË Ì‡Î˘ËË ‚˚‡ÊÂÌÌÓÈ ‡ÌÂÏËË (<8 „/‰Î) χÒÒ‡ Ú· ÌÓ‚ÓÓʉÂÌÌ˚ı ·˚· ‚ ˆÂÎÓÏ Ì‡ 200-400 „ ÌËÊÂ, ˜ÂÏ Û Ô‡ˆËÂÌÚÓÍ Ò ·ÓΠ‚˚ÒÓÍËÏË ÛÓ‚ÌflÏË „ÂÏÓ„ÎÓ·Ë̇ (>10 „/‰Î). Ç ÌÂÍÓÚÓ˚ı ËÒÒΉӂ‡ÌËı ÒÔˆˇθÌÓ ËÁÛ˜‡ÎËÒ¸ Ì··„ÓÔËflÚÌ˚ ÔÓÒΉÒÚ‚Ëfl ÊÂÎÂÁÓ‰ÂÙˈËÚÌÓÈ ‡ÌÂÏËË. ç‡ÔËÏÂ, ‚ ËÒÒΉӂ‡ÌËË T.Scholl Ë ÒÓ‡‚Ú. [25] ·ÓΠ˜ÂÏ Û 800 ·ÂÂÏÂÌÌ˚ı ÊÂÌ˘ËÌ Ì‡Î˘Ë ÊÂÎÂÁÓ‰ÂÙˈËÚ‡ ‡ÒÒÓˆËËÓ‚‡ÎÓÒ¸ Ò Û‚Â΢ÂÌËÂÏ ÓÚÌÓÒËÚÂθÌÓ„Ó ËÒ͇ ÓʉÂÌËfl ‰ÂÚÂÈ Ò ÌËÁÍÓÈ Ï‡ÒÒÓÈ Ú· ‚ 3 ‡Á‡ Ë ÔÂʉ‚ÂÏÂÌÌ˚ı Ó‰Ó‚ - ‚ 2 ‡Á‡, ‚ ÚÓ ‚ÂÏfl Í‡Í ‡ÌÂÏËfl ‰Û„ÓÈ ˝ÚËÓÎÓ„ËË Ì Ô˂Ӊ˷ Í ÔÓ‚˚¯ÂÌ˲ ˜‡ÒÚÓÚ˚ ÔÓ‰Ó·Ì˚ı ËÒıÓ‰Ó‚. ëıÓ‰Ì˚ ‰‡ÌÌ˚ ·˚ÎË ÔÓÎÛ˜ÂÌ˚ Ë ‚ ÌÂÍÓÚÓ˚ı ‰Û„Ëı ËÒÒΉӂ‡ÌËflı. ç‡ÔËÏÂ, ‚ ëËÌ„‡ÔÛ ·˚ÎË ÔӇ̇ÎËÁËÓ‚‡Ì˚ ËÒıÓ‰˚ ·ÂÂÏÂÌÌÓÒÚË Û ÊÂÌ˘ËÌ, ÍÓÚÓ˚ ‚ 1993 „Ó‰‡ ÓʇÎË ‚ Ó‰ÌÓÏ Î˜·ÌÓÏ Û˜ÂʉÂÌËË [26]. ÄÌÂÏËfl ·˚· ‚˚fl‚ÎÂ̇ Û 15,3% ËÁ ÌËı. Ç ÔÓ‰‡‚Îfl˛˘ÂÏ ·Óθ¯ËÌÒÚ‚Â ÒÎÛ˜‡Â‚ (81,3%) Ó̇ ·˚· ÊÂÎÂÁÓ‰ÂÙˈËÚÌÓÈ. ç‡Î˘Ë ‡ÌÂÏËË ÒÓÔÓ‚Óʉ‡ÎÓÒ¸ Û‚Â΢ÂÌËÂÏ ˜‡ÒÚÓÚ˚ ÔÂʉ‚ÂÏÂÌÌ˚ı Ó‰Ó‚, ıÓÚfl ˜‡ÒÚÓÚ‡ ‰Û„Ëı Ì··„ÓÔËflÚÌ˚ı ËÒıÓ‰Ó‚ ÒÛ˘ÂÒÚ‚ÂÌÌÓ Ì ËÁÏÂÌË·Ҹ. àÌÚÂÔÂÚËÓ‚‡Ú¸ ÂÁÛθڇÚ˚ ËÒÒΉӂ‡ÌËÈ, ‚ ÍÓÚÓ˚ı ËÁÛ˜‡ÎÓÒ¸ ‚ÎËflÌË ‡ÌÂÏËË Ì‡ ËÒıÓ‰˚ ·ÂÂÏÂÌÌÓÒÚË, ‰ÓÒÚ‡ÚÓ˜ÌÓ ÒÎÓÊÌÓ, Ú‡Í Í‡Í ÏÌÓ„Ë ËÁ ÌËı ËÏÂÎË ÒÛ˘ÂÒÚ‚ÂÌÌ˚ ӄ‡Ì˘ÂÌËfl Ò ÏÂÚÓ‰ÓÎӄ˘ÂÒÍÓÈ ÚÓ˜ÍË ÁÂÌËfl. í˜ÂÌË ·ÂÂÏÂÌÌÓÒÚË Ë Â ËÒıÓ‰˚ Á‡‚ËÒflÚ Ì ÚÓθÍÓ ÓÚ Ì‡Î˘Ëfl ‡ÌÂÏËË ËÎË ÊÂÎÂÁÓ‰ÂÙˈËÚ‡, ÌÓ Ë ÏÌÓ„Ëı Ù‡ÍÚÓÓ‚, Û˜ÂÒÚ¸ ÍÓÚÓ˚ ÒÎÓÊÌÓ. íÂÏ Ì ÏÂÌÂÂ, Ëϲ˘ËÂÒfl ‰‡ÌÌ˚ ‰ÓÒÚ‡ÚÓ˜ÌÓ Û·Â‰ËÚÂθÌÓ ‰ÂÏÓÌÒÚËÛ˛Ú ‡ÒÒӈˇˆË˛ ÏÂÊ‰Û ÍÓ̈ÂÌÚ‡ˆËÂÈ „ÂÏÓ„ÎÓ·Ë̇ Û ·ÂÂÏÂÌÌÓÈ ÊÂÌ˘ËÌ˚ Ë Ï‡ÒÒÓÈ Ú· ÌÓ‚ÓÓʉÂÌÌ˚ı, ‡ Ú‡ÍÊ ËÒÍÓÏ ÔÂʉ‚ÂÏÂÌÌ˚ı Ó‰Ó‚ [25]. Лечение и профилактика анемии у беременных èÓÒÚ˚Ï Ë ˝ÙÙÂÍÚË‚Ì˚Ï ÏÂÚÓ‰ÓÏ ÔÓÙË·ÍÚËÍË Ë Î˜ÂÌËfl ÊÂÎÂÁÓ‰ÂÙˈËÚÌÓÈ ‡ÌÂÏËË fl‚ÎflÂÚÒfl ÔÂӇθÌÓ ÔËÏÂÌÂÌË ÔÂÔ‡‡ÚÓ‚ ÊÂÎÂÁ‡. àı ËÒÔÓθÁÓ‚‡ÌË ‚Ó ‚ÂÏfl ·ÂÂÏÂÌÌÓÒÚË ÔË‚Ó‰ËÚ Í ÔÓ‚˚¯ÂÌ˲ ÛÓ‚ÌÂÈ „ÂÏÓ„ÎÓ·Ë̇ Ë Ò˚‚ÓÓÚÓ˜ÌÓ„Ó ÙÂËÚË̇ Ë, ‚ÂÓflÚÌÓ, 4 ÒÔÓÒÓ·ÒÚ‚ÛÂÚ Û‚Â΢ÂÌ˲ Á‡Ô‡ÒÓ‚ ÊÂÎÂÁ‡ Û ÌÓ‚ÓÓʉÂÌÌÓ„Ó [27]. Ç ÂÍÓÏẨ‡ˆËflı Çéá Û͇Á‡ÌÓ [5], ˜ÚÓ ÔÓÙË·ÍÚ˘ÂÒÍÓ ÔËÏÂÌÂÌË ÔÂÔ‡‡ÚÓ‚ ÊÂÎÂÁ‡ (60 Ï„) ÌÂÓ·ıÓ‰ËÏÓ ‚ÒÂÏ ·ÂÂÏÂÌÌ˚Ï ÊÂÌ˘Ë̇Ï. Ö„Ó ÌÂÓ·ıÓ‰ËÏÓ Ì‡˜Ë̇ڸ Í‡Í ÏÓÊÌÓ ‡Ì¸¯Â (Ì ÔÓÁ‰Ì ÚÂÚ¸Â„Ó ÏÂÒflˆ‡) Ë ÔÓ‰ÓÎʇڸ ‰Ó ÍÓ̈‡ ·ÂÂÏÂÌÌÓÒÚË. Ç Â„ËÓ̇ı, „‰Â ˜‡ÒÚÓÚ‡ ÊÂÎÂÁÓ‰ÂÙˈËÚÌÓÈ ‡ÌÂÏËË, Ô‚˚¯‡ÂÚ 40%, ÔÓÙË·ÍÚ˘ÂÒÍËÈ ÔËÂÏ ÔÂÔ‡‡ÚÓ‚ ÊÂÎÂÁ‡ ÒΉÛÂÚ ÔÓ‰ÓÎʇڸ ‚ Ú˜ÂÌË ÔÓ Í‡ÈÌÂÈ Ï 3 ÏÂÒflˆÂ‚ ÔÓÒΠӉӂ. ÖÒÎË Û ÊÂÌ˘ËÌ˚ ËÏÂÂÚÒfl ‡ÌÂÏËfl, ÚÓ ÔÂÔ‡‡Ú˚ ÊÂÎÂÁ‡ ˆÂÎÂÒÓÓ·‡ÁÌÓ ÔËÏÂÌflÚ¸ ‚ Θ·ÌÓÈ ‰ÓÁ (120 Ï„). ÑÓÒÚ‡ÚÓ˜ÌÓ ˝ÙÙÂÍÚË‚Ì˚ÏË, ‚ÂÓflÚÌÓ, ÏÓ„ÛÚ ·˚Ú¸ Ë ·ÓΠÌËÁÍË ÔÓÙË·ÍÚ˘ÂÒÍË ‰ÓÁ˚ ÊÂÎÂÁ‡. N.Milman Ë ÒÓ‡‚Ú. [28] ‚ ‡Ì‰ÓÏËÁËÓ‚‡ÌÌÓÏ ‰‚ÓÈÌÓÏ ÒÎÂÔÓÏ ËÒÒΉӂ‡ÌËË ÒÓÔÓÒÚ‡‚ËÎË ÂÁÛθڇÚ˚ ÔËÏÂÌÂÌËfl ÔÂÔ‡‡Ú‡ ÊÂÎÂÁ‡ ‚ ‡Á΢Ì˚ı ‰ÓÁ‡ı, ÍÓÚÓ˚ ̇Á̇˜‡ÎË ÔÓÒΠ18-È Ì‰ÂÎË ·ÂÂÏÂÌÌÓÒÚË 427 Á‰ÓÓ‚˚Ï ÊÂÌ˘Ë̇Ï. éÔÚËχθ̇fl ‰ÓÁ‡ ÒÓÒÚ‡‚Ë· 40 Ï„, Ú‡Í Í‡Í Ó̇ Ó·ÂÒÔ˜˂‡Î‡ ÔÓÙË·ÍÚËÍÛ ÊÂÎÂÁÓ‰ÂÙˈËÚ‡ Û 90% Ô‡ˆËÂÌÚÓÍ Ë ÊÂÎÂÁÓ‰ÂÙˈËÚÌÓÈ ‡ÌÂÏËË - Û 95%. èÓ ‰‡ÌÌ˚Ï ‰Û„Ó„Ó ‡Ì‰ÓÏËÁËÓ‚‡ÌÌÓ„Ó ËÒÒΉӂ‡ÌËfl Û 430 ÊÂÌ˘ËÌ [29], ‰ÓÒÚ‡ÚÓ˜Ì˚Ï ÏÓÊÂÚ ·˚Ú¸ ‰‡Ê ÔËÂÏ 20 Ï„ ÊÂÎÂÁ‡, ̇˜Ë̇fl Ò 20-È Ì‰ÂÎË ·ÂÂÏÂÌÌÓÒÚË. èÓ‰Ó·Ì˚ ËÒÒΉӂ‡ÌËfl Ô‰ÒÚ‡‚Îfl˛Ú ÌÂÒÓÏÌÂÌÌ˚È ËÌÚÂÂÒ, Ú‡Í Í‡Í ÒÌËÊÂÌË ‰ÓÁ˚ ÔÂÔ‡‡ÚÓ‚ ÊÂÎÂÁ‡ ÔÓÁ‚ÓÎflÂÚ ÛÎÛ˜¯ËÚ¸ Ëı ÔÂÂÌÓÒËÏÓÒÚ¸. ç‡Ë·ÓΠ۷‰ËÚÂθÌ˚Ï ÔÓ‰Ú‚ÂʉÂÌËÂÏ Ì··„ÓÔËflÚÌÓ„Ó ‚ÎËflÌËfl ÊÂÎÂÁÓ‰ÂÙˈËÚ‡ Ë ‡ÌÂÏËË Ì‡ Ú˜ÂÌËÂ Ë ËÒıÓ‰˚ ·ÂÂÏÂÌÌÓÒÚË ÏÓ„ÎË ·˚ ÒÎÛÊËÚ¸ ÂÁÛθڇÚ˚ ‡Ì‰ÓÏËÁËÓ‚‡ÌÌ˚ı ÍÓÌÚÓÎËÛÂÏ˚ı ËÒÒΉӂ‡ÌËÈ, ‰ÂÏÓÌÒÚËÛ˛˘Ëı ˝ÙÙÂÍÚË‚ÌÓÒÚ¸ ÔÂÔ‡‡ÚÓ‚ ÊÂÎÂÁ‡. Ç ÔÓÒΉÌË ‰ÂÒflÚËÎÂÚËfl ÔÓ‰Ó·Ì˚ ÔÓÔ˚ÚÍË Ô‰ÔËÌËχÎËÒ¸ ÌÂÓ‰ÌÓ͇ÚÌÓ. ç‡ÔËÏÂ, M.Cogswell Ë ÒÓ‡‚Ú. [30] ÒÓÔÓÒÚ‡‚ËÎË ÂÁÛθڇÚ˚ ÔËÏÂÌÂÌËfl ÔÂÔ‡‡Ú‡ ÊÂÎÂÁ‡ (30 Ï„/ÒÛÚ) Ë Ô·ˆÂ·Ó ‚ Ú˜ÂÌË Ô‚˚ı 28 ̉Âθ ·ÂÂÏÂÌÌÓÒÚË Û 275 ÊÂÌ˘ËÌ. ïÓÚfl Ôӂ‰ÂÌ̇fl Ú‡ÔËfl Ì ÔÓ‚ÎËfl· ̇ ˜‡ÒÚÓÚÛ ‡Á‚ËÚËfl ‡ÌÂÏËfl ËÎË ÔÂʉ‚ÂÏÂÌÌ˚ı Ó‰Ó‚, Ӊ̇ÍÓ Ó̇ ÒÓÔÓ‚Óʉ‡Î‡Ò¸ Á̇˜ËÚÂθÌ˚Ï ÒÌËÊÂÌËÂÏ ˜‡ÒÚÓÚ˚ ÓʉÂÌËfl ‰ÂÚÂÈ Ò ÌËÁÍÓÈ Ï‡ÒÒÓÈ Ú· (4 Ë 17%; =0,003) Ë Ì‰ÓÌÓ¯ÂÌÌ˚ı ‰ÂÚÂÈ Ò ÌËÁÍÓÈ Ï‡ÒÒÓÈ Ú· (3 Ë 10%; =0,017). K.Cuervo Ë K.Mahomed [31] ÔÓ‚ÂÎË ÒËÒÚÂχÚËÁËÓ‚‡ÌÌ˚È Ó·ÁÓ ‚ÒÂı ËÒÒΉӂ‡ÌËÈ, ‚ ÍÓÚÓ˚ı ËÁÛ˜‡Î‡Ò¸ ˝ÙÙÂÍÚË‚ÌÓÒÚ¸ ΘÂÌËfl ÊÂÎÂÁÓ‰ÂÙˈËÚÌÓÈ ‡ÌÂÏËË ‚Ó ‚ÂÏfl ·ÂÂÏÂÌÌÓÒÚË ‚ ÔÓÙË·ÍÚËÍ Á‡·Ó΂‡ÂÏÓÒÚË Ë ÒÏÂÚÌÓÒÚË Û ÊÂÌ˘ËÌ Ë ÌÓ‚ÓÓʉÂÌÌ˚ı. ÇÒÂ„Ó ·˚ÎË Ì‡È‰ÂÌ˚ 54 Ú‡ÍËı ËÒÒΉӂ‡ÌËfl, Ӊ̇ÍÓ ÚÓθÍÓ 5 ËÁ ÌËı ÒÓÓÚ‚ÂÚÒÚ‚Ó‚‡ÎË ÍËÚÂËflÏ ÓÚ·Ó‡, ‡ ÓÒڇθÌ˚ ËÏÂÎË ÒÛ˘ÂÒÚ‚ÂÌÌ˚ Ì‰ÓÒÚ‡ÚÍË. Ä‚ÚÓ˚ Ì ӷ̇ÛÊËÎË Ò‚Â‰ÂÌËÈ Ó· ÛÎÛ˜¯ÂÌËË ËÒıÓ‰Ó‚ ·ÂÂÏÂÌÌÓÒÚË. R.Rasmussen [25], ÔӇ̇ÎËÁËÓ‚‡‚¯‡fl 17 ËÒÒΉӂ‡ÌËÈ, Ú‡ÍÊ ÓÚÏÂÚË· ÌËÁÍÓ Ëı ͇˜ÂÒÚ‚Ó Ò ÏÂÚÓ‰ÓÎӄ˘ÂÒÍÓÈ ÚÓ˜ÍË ÁÂÌËfl, Ì ÔÓÁ‚ÓÎfl‚¯Â ҉·ڸ ͇ÍËÂ-ÎË·Ó ÓÔ‰ÂÎÂÌÌ˚ ‚˚‚Ó‰˚. ëΉÛÂÚ ÔÓ‰˜ÂÍÌÛÚ¸, ˜ÚÓ ıÓÚfl ‚ Û͇Á‡ÌÌ˚ı ËÒÒΉӂ‡ÌËÈ Ì ۉ‡ÎÓÒ¸ ۷‰ËÚÂθÌÓ ‰Ó͇Á‡Ú¸ ÔÓθÁÛ КЛИНИЧЕСКАЯ ФАРМАКОЛОГИЯ И ТЕРАПИЯ, 2005, 14 (2) 100 80 60 40 20 0 è·ˆÂ·Ó ÇËÚ‡ÏËÌ Ä ÜÂÎÂÁÓ ÇËÚ‡ÏËÌ Ä + ÊÂÎÂÁÓ Рис. 2. Частота нормализации уровня гемоглобина при лечении витамином А, препаратом железа и их комбинацией у беременных женщин с анемией ÔËÏÂÌÂÌËfl ÔÂÔ‡‡ÚÓ‚ ÊÂÎÂÁ‡ Ò ˆÂθ˛ ÛÎÛ˜¯ÂÌËfl ËÒıÓ‰Ó‚ ·ÂÂÏÂÌÌÓÒÚË, Ӊ̇ÍÓ Ó̇ Ë Ì ·˚· Óڂ„ÌÛÚ‡. ëÓÓÚ‚ÂÚÒÚ‚ÂÌÌÓ, Ô˂‰ÂÌÌ˚ ‰‡ÌÌ˚ Ì fl‚Îfl˛ÚÒfl ÓÒÌÓ‚‡ÌËÂÏ ‰Îfl ÓÚ͇Á‡ ÓÚ ÒÛ˘ÂÒÚ‚Û˛˘ÂÈ Ô‡ÍÚËÍË ÔÓÙË·ÍÚ˘ÂÒÍÓ„Ó ËÒÔÓθÁÓ‚‡ÌËfl ÔÓ‰Ó·Ì˚ı Ò‰ÒÚ‚ Û ·ÂÂÏÂÌÌ˚ı ÊÂÌ˘ËÌ. è˘ËÌÓÈ ‡ÌÂÏËË Û ·ÂÂÏÂÌÌÓÈ ÊÂÌ˘ËÌ˚ ÏÓÊÂÚ ·˚Ú¸ ‰ÂÙˈËÚ Ì ÚÓθÍÓ ÊÂÎÂÁ‡, ÌÓ Ë ÙÓÎË‚ÓÈ ÍËÒÎÓÚ˚. ëÓÓÚ‚ÂÚÒÚ‚ÂÌÌÓ, ‰Ó·‡‚ÎÂÌË ÙÓÎË‚ÓÈ ÍËÒÎÓÚ˚ Í ÔÂÔ‡‡ÚÛ ÊÂÎÂÁ‡ ÏÓÊÂÚ ÔÓ‚˚ÒËÚ¸ ˝ÙÙÂÍÚË‚ÌÓÒÚ¸ ΘÂÌËfl Ë ÔÓÙË·ÍÚËÍË ‡ÌÂÏËË. Ç ÏÌÓ„ÓˆÂÌÚÓ‚ÓÏ, ‰‚ÓÈÌÓÏ ÒÎÂÔÓÏ ‡Ì‰ÓÏËÁËÓ‚‡ÌÌÓÏ ËÒÒΉӂ‡ÌËË Û 371 ·ÂÂÏÂÌÌÓÈ ÊÂÌ˘ËÌ˚ Ò ÊÂÎÂÁÓ‰ÂÙˈËÚÌÓÈ ‡ÌÂÏËÂÈ ·˚· ÒÓÔÓÒÚ‡‚ÎÂ̇ ˝ÙÙÂÍÚË‚ÌÓÒÚ¸ ÏÓÌÓÚ‡ÔËË ÔÂÔ‡‡ÚÓÏ ÊÂÎÂÁ‡ (80 Ï„) Ë Â„Ó ÍÓÏ·Ë̇ˆËË Ò ÙÓÎË‚ÓÈ ÍËÒÎÓÚÓÈ (0,370 Ï„) [32]. ç‡ ÙÓÌ ÍÓÏ·ËÌËÓ‚‡ÌÌÓÈ Ú‡ÔËË ÛÓ‚Â̸ „ÂÏÓ„ÎÓ·Ë̇ Û‚Â΢ËÎÒfl ‚ ·Óθ¯ÂÈ ÒÚÂÔÂÌË, ˜ÂÏ ÔË ÔËÂÏ ÚÓθÍÓ ÔÂÔ‡‡Ú‡ ÊÂÎÂÁ‡ (p<0,001). ÅÓΠÚÓ„Ó, ÔËÏÂÌÂÌË ÙÓÎË‚ÓÈ ÍËÒÎÓÚ˚ ‚ ÔÂËÓ‰ Á‡˜‡ÚËfl ÔË Ô·ÌËÛÂÏÓÈ ·ÂÂÏÂÌÌÓÒÚË ÔË‚Ó‰ËÚ Í ‰ÓÒÚÓ‚ÂÌÓÏÛ ÒÌËÊÂÌ˲ ˜‡ÒÚÓÚ˚ ‚ÓʉÂÌÌ˚ı ÔÓÓÍÓ‚ Ì‚ÌÓÈ ÚÛ·ÍË. èÓ ‰‡ÌÌ˚Ï ÏÂÚ‡-‡Ì‡ÎËÁ‡ 4 ËÒÒΉӂ‡ÌËÈ Û 6425 ÊÂÌ˘ËÌ [33], ˜‡ÒÚÓÚ‡ Ú‡ÍËı ÔÓÓÍÓ‚ ÒÌËÁË·Ҹ ̇ 72%. èËÏÂÌÂÌË ‰Û„Ëı ‚ËÚ‡ÏËÌÓ‚ Ú‡ÍÊ ÏÓÊÂÚ ÒÔÓÒÓ·ÒÚ‚Ó‚‡Ú¸ ÛÎÛ˜¯ÂÌ˲ ÂÁÛθڇÚÓ‚ ΘÂÌËfl ‡ÌÂÏËË Û ·ÂÂÏÂÌÌ˚ı ÊÂÌ˘ËÌ. D.Suharno Ë ÒÓ‡‚Ú. [34] ‚ ‰‚ÓÈÌÓÏ ÒÎÂÔÓÏ, Ô·ˆÂ·Ó-ÍÓÌÚÓÎËÛÂÏÓÏ ËÒÒΉӂ‡ÌËË Û 251 ·ÂÂÏÂÌÌÓÈ ÊÂÌ˘ËÌ˚ Ò ‡ÌÂÏËÂÈ ÒÓÔÓÒÚ‡‚ËÎË ˝ÙÙÂÍÚË‚ÌÓÒÚ¸ Ú‡ÔËË ‚ËÚ‡ÏËÌÓÏ Ä (2,4 Ï„) Ë/ËÎË ÔÂÔ‡‡ÚÓÏ ÊÂÎÂÁ‡ (60 Ï„). ÑÓÎfl ÊÂÌ˘ËÌ, Û ÍÓÚÓ˚ı Û‰‡ÎÓÒ¸ ‰Ó·ËÚ¸Òfl ÌÓχÎËÁ‡ˆËË ÛÓ‚Ìfl „ÂÏÓ„ÎÓ·Ë̇, ·˚· χÍÒËχθÌÓÈ ÔË ÔËÏÂÌÂÌËË ÔÂÔ‡‡Ú‡ ÊÂÎÂÁ‡ ‚ ÒÓ˜ÂÚ‡ÌËË Ò ‚ËÚ‡ÏËÌÓÏ Ä (ËÒ. 2). äÓÏ ÚÓ„Ó, ‚ËÚ‡ÏËÌ˚ Ë ÏË̇Î˚ ÏÓ„ÛÚ ‰‡‚‡Ú¸ Ë ‰Û„Ë ·Î‡„ÓÔËflÚÌ˚ ˝ÙÙÂÍÚ˚ ÔË ·ÂÂÏÂÌÌÓÒÚË. ç‡ÔËÏÂ, ÔÓ ‰‡ÌÌ˚Ï ÒËÒÚÂχÚËÁËÓ‚‡ÌÌÓ„Ó Ó·ÁÓ‡ ‡Ì‰ÓÏËÁËÓ‚‡ÌÌ˚ı ÍÓÌÚÓÎËÛÂÏ˚ı ËÒÒΉӂ‡ÌËÈ [35], ÔÂÔ‡‡Ú˚ ͇θˆËfl ÒÌËʇÎË ˜‡ÒÚÓÚÛ Ô½Í·ÏÔÒËË Ë ‡Ú¡θÌÓÈ „ËÔÂКЛИНИЧЕСКАЯ ФАРМАКОЛОГИЯ И ТЕРАПИЯ, 2005, 14 (2) ÚÓÌËË, ‡ ‚ËÚ‡ÏËÌ Ä Ë ·ÂÚ‡-͇ÓÚËÌ - χÚÂËÌÒÍÛ˛ ÒÏÂÚÌÓÒÚ¸. ùÚË ‰‡ÌÌ˚ ӷÓÒÌÓ‚˚‚‡˛Ú ÒÛ˘ÂÒÚ‚Û˛˘Û˛ Ô‡ÍÚËÍÛ ¯ËÓÍÓ„Ó ÔËÏÂÌÂÌËfl ÔÓÎË‚ËÚ‡ÏËÌÌ˚ı ÔÂÔ‡‡ÚÓ‚, ÒÓ‰Âʇ˘Ëı ÏËÍÓ˝ÎÂÏÂÌÚ˚, Û ·ÂÂÏÂÌÌ˚ı ÊÂÌ˘ËÌ. ä ÒÓʇÎÂÌ˲, ˝ÙÙÂÍÚË‚ÌÓÒÚ¸ ÍÓÌÍÂÚÌ˚ı ÔÓÎË‚ËÚ‡ÏËÌÓ‚ ‰ÓÒÚ‡ÚÓ˜ÌÓ Â‰ÍÓ ËÁÛ˜‡ÂÚÒfl ‚ ÍÓÌÚÓÎËÛÂÏ˚ı ÍÎËÌ˘ÂÒÍËı ËÒÒΉӂ‡ÌËflı, ıÓÚfl ÓÌË Ô‰ÒÚ‡‚Îfl˛Ú ËÌÚÂÂÒ, Ú‡Í Í‡Í ÒÎÓÊÌÓÒÚ¸ ÒÓÒÚ‡‚‡ ÚÂÓÂÚ˘ÂÒÍË ÏÓÊÂÚ ÓÚ‡ÁËÚ¸Òfl ̇ ·ËÓ‰ÓÒÚÛÔÌÓÒÚË ÓÚ‰ÂθÌ˚ı ÍÓÏÔÓÌÂÌÚÓ‚. é‰ÌËÏ ËÁ ËÒÍβ˜ÂÌËÈ fl‚ÎflÂÚÒfl ÍÓÌÚÓÎËÛÂÏÓ ËÒÒΉӂ‡ÌËÂ, Ôӂ‰ÂÌÌÓ ‚ ÇÂÌ„ËË [36]. Ç ÌÂÏ ËÁÛ˜‡Î‡Ò¸ ˝ÙÙÂÍÚË‚ÌÓÒÚ¸ ù΂ËÚ‡ èÓ̇ڇθ, ÒÓ‰Âʇ˘Â„Ó 12 ‚ËÚ‡ÏËÌÓ‚, ‚Íβ˜‡fl 800 Ï„ ÙÓÎË‚ÓÈ ÍËÒÎÓÚ˚, 4 ÏË̇· Ë 3 ÏËÍÓ˝ÎÂÏÂÌÚ‡, ‚ ÔÓÙË·ÍÚËÍ ÔÓÓÍÓ‚ Ì‚ÌÓÈ ÚÛ·ÍË Û ÌÓ‚ÓÓʉÂÌÌ˚ı. ÜÂÌ˘Ë̇Ï, Ô·ÌËÛ˛˘ËÏ ·ÂÂÏÂÌÌÓÒÚ¸, ̇Á̇˜‡ÎË ù΂ËÚ èÓ̇ڇθ ËÎË “Ô·ˆÂ·Ó” (ÚË ÏËÍÓ˝ÎÂÏÂÌÚ‡ Ë ‚ËÚ‡ÏËÌ ë ‚ Ó˜Â̸ ÌËÁÍÓÈ ‰ÓÁÂ) ÔÓ Í‡ÈÌÂÈ Ï Á‡ 1 ÏÂÒflˆ ‰Ó Á‡˜‡ÒÚËfl. ÅÂÂÏÂÌÌÓÒÚ¸ ·˚· ÔÓ‰Ú‚ÂʉÂ̇ Û 4753 ÊÂÌ˘ËÌ. ó‡ÒÚÓÚ‡ ‚ÓʉÂÌÌ˚ı ÔÓÓÍÓ‚ ‚ ÓÒÌÓ‚ÌÓÈ „ÛÔÔ ·˚· Á̇˜ËÚÂθÌÓ ÌËÊÂ, ˜ÂÏ ‚ ÍÓÌÚÓθÌÓÈ (13,3 Ë 22,9 ̇ 1000 ÒÓÓÚ‚ÂÚÒÚ‚ÂÌÌÓ, =0,02). èÓÓÍË Ì‚ÌÓÈ ÚÛ·ÍË ·˚ÎË Á‡Â„ËÒÚËÓ‚‡Ì˚ Û 0 Ë 6 ÌÓ‚ÓÓʉÂÌÌ˚ı ÒÓÓÚ‚ÂÚÒÚ‚ÂÌÌÓ (=0,029). ëΉÛÂÚ ÓÚÏÂÚËÚ¸, ˜ÚÓ ‚ ÒÓÒÚ‡‚ ù΂ËÚ‡ èÓ̇ڇθ ‚ıÓ‰ËÚ ÊÂÎÂÁÓ ‚ ‰ÓÁÂ, ÂÍÓÏẨÛÂÏÓÈ Çéá ‰Îfl ÔÓÙË·ÍÚËÍË ‡ÌÂÏËË (60 Ï„), ‡ Ú‡ÍÊ ‚ËÚ‡ÏËÌ˚ Ä Ë ë, ÒÔÓÒÓ·ÒÚ‚Û˛˘ËÂ Â„Ó ÛÒ‚ÓÂÌ˲. ùÚÓ ÔÓÁ‚ÓÎflÂÚ ÂÍÓÏẨӂ‡Ú¸ Â„Ó ÔËÏÂÌÂÌË ‚Ó ‚ÂÏfl ·ÂÂÏÂÌÌÓÒÚË Ë ÔÓÒΠӉӂ ‰Îfl ÔÓÙË·ÍÚËÍË Ë Î˜ÂÌËfl ‡ÌÂÏËË (ÔË Ì‡Î˘ËË ‚˚‡ÊÂÌÌÓÈ ‡ÌÂÏËË ÔÓ͇Á‡Ì Ó‰ÌÓ‚ÂÏÂÌÌ˚È ÔËÂÏ ÔÂÔ‡‡ÚÓ‚ ÊÂÎÂÁ‡). Заключение ÄÌÂÏËfl fl‚ÎflÂÚÒfl ˜‡ÒÚ˚Ï Ë Ò¸ÂÁÌ˚Ï ÓÒÎÓÊÌÂÌËÂÏ ·ÂÂÏÂÌÌÓÒÚË. é̇ Ó͇Á˚‚‡ÂÚ Ì··„ÓÔËflÚÌÓ ‚ÎËflÌË ̇ ÒÓÒÚÓflÌË χÚÂË Ë ÔÎÓ‰‡ Ë ÛıÛ‰¯‡ÂÚ ËÒıÓ‰˚ ·ÂÂÏÂÌÌÓÒÚË. ó‡˘Â ‚ÒÂ„Ó Ô˘ËÌÓÈ ‡ÌÂÏËË Û ·ÂÂÏÂÌÌ˚ı ÊÂÌ˘ËÌ Ó͇Á˚‚‡ÂÚ ÊÂÎÂÁÓ‰ÂÙˈËÚ, ÔÓ˝ÚÓÏÛ ˝ÙÙÂÍÚË‚Ì˚Ï ÏÂÚÓ‰ÓÏ ÔÓÙË·ÍÚËÍË Ë Î˜ÂÌËfl ˝ÚÓ„Ó ÒÓÒÚÓflÌËfl ÒÎÛÊËÚ ÔËÏÂÌÂÌË ÔÂÔ‡‡ÚÓ‚ ÊÂÎÂÁ‡. ꇈËÓ̇θÌ˚Ï ÔÓ‰ıÓ‰ÓÏ Í ÔÓÙË·ÍÚËÍ ‡ÌÂÏËË ‚Ó ‚ÂÏfl ·ÂÂÏÂÌÌÓÒÚË fl‚ÎflÂÚÒfl ‰ÎËÚÂθÌ˚È ÔËÂÏ ÔÓÎË‚ËÚ‡ÏËÌÌ˚ı ÔÂÔ‡‡ÚÓ‚, ÒÓ‰Âʇ˘Ëı ÏË̇Î˚, ÍÓÚÓ˚È ÔÓÁ‚ÓÎflÂÚ ‚ÓÒÔÓÎÌËÚ¸ ‰ÂÙˈËÚ Ì ÚÓθÍÓ ÊÂÎÂÁ‡, ÌÓ Ë ‰Û„Ëı ‚¢ÂÒÚ‚, ÌÂÓ·ıÓ‰ËÏ˚ı ÊÂÌ˘ËÌ ‰Îfl ÌÓχθÌÓ„Ó Ú˜ÂÌËfl ·ÂÂÏÂÌÌÓÒÚË Ë ‡Á‚ËÚËfl ÔÎÓ‰‡. 1. 2. 3. 4. 5. World Health Organization. The prevalence of anaemia in women: a tabulation of available information. 2nd ed. Geneva: World Health Organization, 1992. Sifakis S., Pharmakides G. Anemia in pregnancy. Ann. N. Y. Acad. Sci., 2000, 900, 125-136. Massot C., Vanderpas J. A survey of iron deficiency anaemia during pregnancy in Belgium: analysis of routine hospital laboratory data in Mons. 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