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64 ɍȾɄ 616.379-008.64 ȀdzǾǮǽdzǰȀǶȅdzǿǸǼdz ǼǯȁȅdzǻǶdz ǹǶȄ DZǾȁǽǽȉ ǾǶǿǸǮ ǿǮȃǮǾǻǼDZǼ DzǶǮǯdzȀǮ 2 ȀǶǽǮ ɂ. Ⱥ. Ɋɨɦɚɧɟɧɤɨ1*, ɞɨɤɬɨɪ ɦɟɞɢɰɢɧɫɤɢɯ ɧɚɭɤ, ɇ. ȼ. Ɇɚɜɪɵɱɟɜɚ2, ȼ. Ȼ. Ƚɪɢɧɲɬɟɣɧ1, ɤɚɧɞɢɞɚɬ ɦɟɞɢɰɢɧɫɤɢɯ ɧɚɭɤ, Ɉ. ȼ. ȼɚɥɚɬɢɧɚ3 ȽȻɈɍ ȼɉɈ «ɂɜɚɧɨɜɫɤɚɹ ɝɨɫɭɞɚɪɫɬɜɟɧɧɚɹ ɦɟɞɢɰɢɧɫɤɚɹ ɚɤɚɞɟɦɢɹ» Ɇɢɧɡɞɪɚɜɚ Ɋɨɫɫɢɢ, 153012, Ɋɨɫɫɢɹ, ɝ. ɂɜɚɧɨɜɨ, ɒɟɪɟɦɟɬɟɜɫɤɢɣ ɩɪɨɫɩ., ɞ. 8. 2 ɆȻɍɁ «Ƚɨɪɨɞɫɤɚɹ ɤɥɢɧɢɱɟɫɤɚɹ ɛɨɥɶɧɢɰɚ ʋ 5», 600031, Ɋɨɫɫɢɹ, ɝ. ȼɥɚɞɢɦɢɪ, ɭɥ. Ⱦɨɛɪɨɫɟɥɶɫɤɚɹ, ɞ. 38ɚ 3 ɈȻɍɁ «ɂɜɚɧɨɜɫɤɚɹ ɨɛɥɚɫɬɧɚɹ ɤɥɢɧɢɱɟɫɤɚɹ ɛɨɥɶɧɢɰɚ», 153040, ɂɜɚɧɨɜɨ, ɭɥ. Ʌɸɛɢɦɨɜɚ, 1 1 Ʉɥɸɱɟɜɵɟ ɫɥɨɜɚ: ɨɠɢɪɟɧɢɟ, ɩɪɟɞɢɚɛɟɬ, ɧɚɪɭɲɟɧɧɚɹ ɬɨɥɟɪɚɧɬɧɨɫɬɶ ɤ ɝɥɸɤɨɡɟ, ɩɪɨɝɪɚɦɦɚ ɬɟɪɚɩɟɜɬɢɱɟɫɤɨɝɨ ɨɛɭɱɟɧɢɹ, ɤɥɚɫɫ ɩɪɨɮɢɥɚɤɬɢɤɢ ɫɚɯɚɪɧɨɝɨ ɞɢɚɛɟɬɚ, ɝɪɭɩɩɚ ɪɢɫɤɚ ɪɚɡɜɢɬɢɹ ɫɚɯɚɪɧɨɝɨ ɞɢɚɛɟɬɚ 2 ɬɢɩɚ. * Ɉɬɜɟɬɫɬɜɟɧɧɵɣ ɡɚ ɩɟɪɟɩɢɫɤɭ (corresponding author): e-mail: [email protected]. Ɋɨɫɬ ɡɚɛɨɥɟɜɚɟɦɨɫɬɢ ɢ ɪɚɫɩɪɨɫɬɪɚɧɟɧɧɨɫɬɢ ɫɚɯɚɪɧɨɝɨ ɞɢɚɛɟɬɚ (ɋȾ) 2 ɬɢɩɚ ɜɨ ɜɫɟɦ ɦɢɪɟ ɨɩɪɚɜɞɵɜɚɟɬ ɫɚɦɵɟ ɩɟɫɫɢɦɢɫɬɢɱɟɫɤɢɟ ɩɪɨɝɧɨɡɵ ɭɱɟɧɵɯ. ɇɟɫɦɨɬɪɹ ɧɚ ɪɚɡɪɚɛɨɬɤɭ ɷɮɮɟɤɬɢɜɧɵɯ ɥɟɤɚɪɫɬɜɟɧɧɵɯ ɩɪɟɩɚɪɚɬɨɜ, ɧɚ ɫɟɝɨɞɧɹɲɧɢɣ ɞɟɧɶ ɨɧ ɨɫɬɚɟɬɫɹ ɧɟɢɡɥɟɱɢɦɵɦ ɡɚɛɨɥɟɜɚɧɢɟɦ. Ʌɢɰɚ, ɢɦɟɸɳɢɟ ɮɚɤɬɨɪɵ ɪɢɫɤɚ ɪɚɡɜɢɬɢɹ ɋȾ, ɨɛɪɚɳɚɸɬɫɹ ɡɚ ɦɟɞɢɰɢɧɫɤɨɣ ɩɨɦɨɳɶɸ ɱɚɳɟ ɜɫɟɝɨ ɥɢɲɶ ɜ ɷɤɫɬɪɟɧɧɵɯ ɫɢɬɭɚɰɢɹɯ (ɝɢɩɟɪɬɨɧɢɱɟɫɤɢɣ ɤɪɢɡ, ɫɨɫɭɞɢɫɬɵɟ ɤɚɬɚɫɬɪɨɮɵ), ɚ ɦɧɨɝɢɟ ɢɡ ɧɢɯ ɧɟ ɡɧɚɸɬ ɨ ɩɨɜɵɲɟɧɧɨɣ ɨɩɚɫɧɨɫɬɢ ɪɚɡɜɢɬɢɹ ɭ ɧɢɯ ɋȾ ɢ ɫɱɢɬɚɸɬ ɫɟɛɹ ɩɪɚɤɬɢɱɟɫɤɢ ɡɞɨɪɨɜɵɦɢ. Ɇɟɠɞɭ ɬɟɦ ɞɢɚɝɧɨɫɬɢɪɨɜɚɧɧɵɣ ɋȾ – ɜɟɪɯɭɲɤɚ ɚɣɫɛɟɪɝɚ: ɧɟ ɞɢɚɝɧɨɫɬɢɪɭɸɬɫɹ ɩɪɟɞɲɟɫɬɜɭɸɳɢɟ ɟɦɭ ɞɨɤɥɢɧɢɱɟɫɤɢɟ ɧɚɪɭɲɟɧɢɹ ɭɝɥɟɜɨɞɧɨɝɨ ɨɛɦɟɧɚ, ɤɨɬɨɪɵɟ ɹɜɥɹɸɬɫɹ ɨɛɪɚɬɢɦɵɦɢ. ȼ ɋɒȺ, ȿɜɪɨɩɟ, Ɋɨɫɫɢɢ ɛɵɥɢ ɩɪɨɜɟɞɟɧɵ ɤɪɭɩɧɵɟ ɢɫɫɥɟɞɨɜɚɧɢɹ ɞɥɹ ɩɪɨɮɢɥɚɤɬɢɤɢ ɋȾ ɭ ɥɢɰ ɫ ɩɪɟɞɢɚɛɟɬɨɦ: FDPS (2001), DPP (2002), STOP-NIDDM (2003), ȺɉɊȿɅɖ (2004), DREAM (2006), ORIGIN (2012), ɢɯ ɪɟɡɭɥɶɬɚɬɵ ɧɟ ɛɵɥɢ ɨɩɬɢɦɚɥɶɧɵɦɢ, ɩɪɢɱɟɦ ɷɬɨ ɨɛɴɹɫɧɹɥɨɫɶ ɱɪɟɡɜɵɱɚɣɧɨ ɧɢɡɤɨɣ ɤɨɦɩɥɚɟɧɬɧɨɫɬɶɸ ɥɢɰ ɫ ɩɪɟɞɢɚɛɟɬɨɦ, ɩɪɢɬɨɦ ɱɬɨ ɩɪɨɮɢɥɚɤɬɢɤɚ ɨɫɧɨɜɚɧɚ ɧɚ ɨɫɨɡɧɚɧɧɨɦ ɢɡɦɟɧɟɧɢɢ ɫɬɢɥɹ ɠɢɡɧɢ ɢ ɜɵɩɨɥɧɟɧɢɢ ɧɚɡɧɚɱɟɧɢɣ ɜɪɚɱɚ ɜ ɬɟɱɟɧɢɟ ɞɥɢɬɟɥɶɧɨɝɨ ɜɪɟɦɟɧɢ. ɂɦɟɧɧɨ ɜ ɞɢɚɛɟɬɨɥɨɝɢɢ ɜ ɩɪɨɲɥɨɦ ɜɟɤɟ ɜɩɟɪɜɵɟ ɛɵɥɨ ɩɪɨɜɟɞɟɧɨ ɬɟɪɚɩɟɜɬɢɱɟɫɤɨɟ ɨɛɭɱɟɧɢɟ ɛɨɥɶɧɵɯ. ɋ ɬɟɯ ɩɨɪ ɦɟɬɨɞɵ ɩɪɟɩɨɞɚɜɚɧɢɹ ɧɟɩɪɟɪɵɜ- ɧɨ ɫɨɜɟɪɲɟɧɫɬɜɭɸɬɫɹ. Ɍɟɦ ɧɟ ɦɟɧɟɟ ɜ ɞɨɫɬɭɩɧɨɣ ɧɚɦ ɥɢɬɟɪɚɬɭɪɟ ɦɵ ɧɟ ɨɛɧɚɪɭɠɢɥɢ ɨɩɢɫɚɧɢɣ ɬɟɪɚɩɟɜɬɢɱɟɫɤɨɝɨ ɨɛɭɱɟɧɢɹ ɥɢɰ ɢɡ ɝɪɭɩɩɵ ɪɢɫɤɚ ɋȾ 2 ɬɢɩɚ. Ⱦɥɹ ɷɬɨɝɨ ɤɨɧɬɢɧɝɟɧɬɚ ɩɚɰɢɟɧɬɨɜ ɧɟɨɛɯɨɞɢɦɨ ɮɨɪɦɢɪɨɜɚɧɢɟ ɦɨɬɢɜɚɰɢɨɧɧɨɝɨ ɫɨɫɬɨɹɧɢɹ, ɨɬɥɢɱɧɨɝɨ ɨɬ ɬɚɤɨɜɨɝɨ ɩɪɢ ɤɥɢɧɢɱɟɫɤɨɣ ɦɚɧɢɮɟɫɬɚɰɢɢ ɋȾ, ɩɪɢ ɤɨɬɨɪɨɦ ɛɨɥɶɧɵɟ ɨɛɭɱɚɸɬɫɹ ɤɨɧɬɪɨɥɸ ɦɟɬɚɛɨɥɢɱɟɫɤɢɯ ɩɨɤɚɡɚɬɟɥɟɣ ɫ ɰɟɥɶɸ ɭɥɭɱɲɟɧɢɹ ɤɚɱɟɫɬɜɚ ɠɢɡɧɢ. ɗɬɨ ɨɩɪɟɞɟɥɢɥɨ ɚɤɬɭɚɥɶɧɨɫɬɶ ɪɚɡɪɚɛɨɬɤɢ ɫɩɟɰɢɚɥɶɧɨɣ ɩɪɨɝɪɚɦɦɵ ɬɟɪɚɩɟɜɬɢɱɟɫɤɨɝɨ ɨɛɭɱɟɧɢɹ ɞɥɹ ɥɢɰ ɢɡ ɝɪɭɩɩɵ ɪɢɫɤɚ ɋȾ. ɇɚɦɢ ɛɵɥ ɨɪɝɚɧɢɡɨɜɚɧ «ɤɥɚɫɫ ɩɪɨɮɢɥɚɤɬɢɤɢ ɫɚɯɚɪɧɨɝɨ ɞɢɚɛɟɬɚ» ɞɥɹ ɥɢɰ ɫ ɫɨɱɟɬɚɧɢɟɦ ɨɫɧɨɜɧɵɯ ɮɚɤɬɨɪɨɜ ɪɢɫɤɚ ɡɚɛɨɥɟɜɚɧɢɹ: ɨɠɢɪɟɧɢɹ, ɧɚɪɭɲɟɧɧɨɣ ɬɨɥɟɪɚɧɬɧɨɫɬɢ ɤ ɝɥɸɤɨɡɟ, ɚɪɬɟɪɢɚɥɶɧɨɣ ɝɢɩɟɪɬɨɧɢɢ. Ɉɛɭɱɟɧɢɟ ɩɪɨɲɥɢ 80 ɱɟɥɨɜɟɤ (46 ɠɟɧɳɢɧ ɢ 34 ɦɭɠɱɢɧɵ, ɫɪɟɞɧɢɣ ɜɨɡɪɚɫɬ – 58,7 ± 4,8 ɝɨɞɚ). Ɉɠɢɪɟɧɢɟ 1-ɣ ɫɬɟɩɟɧɢ ɜɵɹɜɥɟɧɨ ɭ 52 ɱɟɥɨɜɟɤ, 2-ɣ – ɭ 23, 3-ɣ – ɭ 5. Ⱥɪɬɟɪɢɚɥɶɧɚɹ ɝɢɩɟɪɬɨɧɢɹ, ɫɨɨɬɜɟɬɫɬɜɭɸɳɚɹ 1-2 ɫɬɟɩɟɧɢ ɩɨɜɵɲɟɧɢɹ ȺȾ, ɜɵɹɜɥɟɧɚ ɜ 94% ɧɚɛɥɸɞɟɧɢɣ. ɉɟɪɟɞ ɧɚɱɚɥɨɦ ɡɚɧɹɬɢɣ ɩɪɨɜɨɞɢɥɨɫɶ ɚɧɤɟɬɢɪɨɜɚɧɢɟ ɩɚɰɢɟɧɬɨɜ ɩɨ ɪɚɡɪɚɛɨɬɚɧɧɨɦɭ ɧɚɦɢ ɨɩɪɨɫɧɢɤɭ ɞɥɹ ɨɩɪɟɞɟɥɟɧɢɹ ɭɪɨɜɧɹ ɨɫɜɟɞɨɦɥɟɧɧɨɫɬɢ ɨ ɧɨɪɦɚɥɶɧɵɯ ɮɢɡɢɨɥɨɝɢɱɟɫɤɢɯ ɩɚɪɚɦɟɬɪɚɯ ɨɪɝɚɧɢɡɦɚ, ɨ ɦɨɞɢɮɢɰɢɪɭɟɦɵɯ ɢ ɧɟɦɨɞɢɮɢɰɢɪɭɟɦɵɯ ɮɚɤɬɨɪɚɯ ɪɢɫɤɚ, ɨɛ ɨɫɥɨɠɧɟɧɢɹɯ ɋȾ, ɨ ɧɟɨɛɯɨɞɢɦɨɫɬɢ ɩɪɢɞɟɪɠɢɜɚɬɶɫɹ ɡɞɨɪɨɜɨɝɨ ɨɛɪɚɡɚ ɠɢɡɧɢ ɞɥɹ ɩɪɨ- Romanenko I. A., Mavrycheva N. V., Greenstein V. B., Valatina O. V. THERAPEUTICAL TRAINING IN PATIENTS FROM RISK GROUPS FOR DIABETES MELLITUS 2 TYPE Key words: obesity, prediabetes, impaired glucose tolerance, therapeutic training program, group for diabetes mellitus prophylaxis, risk group for diabetes mellitus 2 type development. Ɍ. 18, ʋ 4, 2013 ȼɟɫɬɧɢɤ ɂɜɚɧɨɜɫɤɨɣ ɦɟɞɢɰɢɧɫɤɨɣ ɚɤɚɞɟɦɢɢ ɮɢɥɚɤɬɢɤɢ ɡɚɛɨɥɟɜɚɧɢɹ. Ⱦɥɹ ɨɰɟɧɤɢ ɪɟɡɭɥɶɬɚɬɨɜ ɨɩɪɨɫɚ ɫɭɦɦɢɪɨɜɚɥɢɫɶ ɛɚɥɥɵ, ɩɪɢɫɜɨɟɧɧɵɟ ɡɚ ɤɚɠɞɵɣ ɩɪɚɜɢɥɶɧɵɣ ɨɬɜɟɬ; ɦɚɤɫɢɦɚɥɶɧɨɟ ɤɨɥɢɱɟɫɬɜɨ ɛɚɥɥɨɜ – 48. ɂɫɯɨɞɧɵɣ ɩɨɤɚɡɚɬɟɥɶ ɢɧɮɨɪɦɢɪɨɜɚɧɧɨɫɬɢ ɨɛɫɥɟɞɨɜɚɧɧɵɯ ɫɨɫɬɚɜɢɥ 7,9 ± 3,2 ɛɚɥɥɚ. Ⱦɥɹ ɩɪɨɜɟɞɟɧɢɹ ɡɚɧɹɬɢɣ ɛɵɥɢ ɫɮɨɪɦɢɪɨɜɚɧɵ ɝɪɭɩɩɵ ɩɨ 5–7 ɱɟɥɨɜɟɤ; ɩɪɨɝɪɚɦɦɚ ɨɛɭɱɟɧɢɹ ɪɚɫɫɱɢɬɚɧɚ ɧɚ 5 ɡɚɧɹɬɢɣ ɩɨ 60 ɦɢɧɭɬ ɢ ɜɤɥɸɱɚɥɚ ɢɡɭɱɟɧɢɟ ɬɟɨɪɟɬɢɱɟɫɤɨɝɨ ɦɚɬɟɪɢɚɥɚ (ɜ ɫɨɨɬɜɟɬɫɬɜɢɢ ɫ ɩɪɢɧɰɢɩɨɦ «ɪɚɡɭɦɧɨɣ ɞɨɫɬɚɬɨɱɧɨɫɬɢ») ɢ ɨɫɜɨɟɧɢɟ ɩɪɚɤɬɢɱɟɫɤɢɯ ɧɚɜɵɤɨɜ ɤɨɧɬɪɨɥɹ ɜɵɹɜɥɟɧɧɵɯ ɧɚɪɭɲɟɧɢɣ: ɚɪɬɟɪɢɚɥɶɧɨɣ ɝɢɩɟɪɬɨɧɢɢ, ɨɠɢɪɟɧɢɹ, ɝɥɢɤɟɦɢɢ ɢ ɩɪ. Ɂɚɧɹɬɢɹ ɩɪɨɜɨɞɢɥɢɫɶ ɜ ɜɢɞɟ ɞɟɥɨɜɵɯ ɢɝɪ, ɞɢɫɤɭɫɫɢɣ, ɤɨɧɤɭɪɫɨɜ. ɇɚ 1-ɦ ɡɚɧɹɬɢɢ ɩɚɰɢɟɧɬɵ ɩɨɥɭɱɚɸɬ ɢɧɮɨɪɦɚɰɢɸ ɨ ɪɨɥɢ ɢɧɫɭɥɢɧɚ ɜ ɭɫɜɨɟɧɢɢ ɨɪɝɚɧɢɡɦɨɦ ɝɥɸɤɨɡɵ, ɨ ɪɚɛɨɬɟ ȕ-ɤɥɟɬɨɤ ɩɨɞɠɟɥɭɞɨɱɧɨɣ ɠɟɥɟɡɵ ɩɪɢ ɨɠɢɪɟɧɢɢ, ɨ ɩɪɢɱɢɧɚɯ ɮɨɪɦɢɪɨɜɚɧɢɹ ɞɨɤɥɢɧɢɱɟɫɤɢɯ ɧɚɪɭɲɟɧɢɣ ɭɝɥɟɜɨɞɧɨɝɨ ɨɛɦɟɧɚ, ɨ ɰɟɥɟɜɵɯ ɩɨɤɚɡɚɬɟɥɹɯ ɝɥɢɤɟɦɢɢ, ɯɨɥɟɫɬɟɪɢɧɚ, ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɞɚɜɥɟɧɢɹ, ɨ ɪɢɫɤɟ ɪɚɡɜɢɬɢɹ ɋȾ. ɉɪɚɤɬɢɱɟɫɤɢɟ ɧɚɜɵɤɢ ɜɤɥɸɱɚɥɢ ɢɡɦɟɪɟɧɢɟ ȺȾ, ɭɪɨɜɧɹ ɝɥɢɤɟɦɢɢ ɧɚɬɨɳɚɤ ɢ ɩɨɫɥɟ ɩɪɢɟɦɚ ɩɢɳɢ. ɇɚ 2-ɦ ɡɚɧɹɬɢɢ ɩɚɰɢɟɧɬɚɦ ɪɚɫɫɤɚɡɵɜɚɥɢ ɨɛ ɢɡɛɵɬɨɱɧɨɣ ɦɚɫɫɟ ɬɟɥɚ ɢ ɨɠɢɪɟɧɢɢ, ɢɯ ɩɪɢɱɢɧɚɯ, ɨ ɪɨɥɢ ɨɠɢɪɟɧɢɹ ɜ ɮɨɪɦɢɪɨɜɚɧɢɢ ɮɟɧɨɦɟɧɚ ɢɧɫɭɥɢɧɨɪɟɡɢɫɬɟɧɬɧɨɫɬɢ. ɉɪɚɤɬɢɱɟɫɤɢɟ ɧɚɜɵɤɢ ɜɤɥɸɱɚɥɢ ɢɡɦɟɪɟɧɢɟ ɨɤɪɭɠɧɨɫɬɢ ɛɟɞɟɪ ɢ ɬɚɥɢɢ, ɩɨɞɫɱɟɬ ɢɧɞɟɤɫɚ ɦɚɫɫɵ ɬɟɥɚ ɫ ɨɩɪɟɞɟɥɟɧɢɟɦ ɫɬɟɩɟɧɢ ɨɠɢɪɟɧɢɹ, ɤɨɧɬɪɨɥɶ ɤɚɥɨɪɢɣɧɨɫɬɢ ɞɧɟɜɧɨɝɨ 65 ɩɢɳɟɜɨɝɨ ɪɚɰɢɨɧɚ ɩɨ ɬɚɛɥɢɰɚɦ ɤɚɥɨɪɢɣɧɨɫɬɢ ɩɢɬɚɧɢɹ ɢ ɷɬɢɤɟɬɤɚɦ ɧɚ ɩɪɨɞɭɤɬɚɯ. ɇɚ 3-ɦ ɡɚɧɹɬɢɢ ɪɚɫɫɦɚɬɪɢɜɚɥɢɫɶ ɩɪɚɜɢɥɚ ɫɧɢɠɟɧɢɹ ɦɚɫɫɵ ɬɟɥɚ, ɩɪɢɜɨɞɢɥɢɫɶ ɞɚɧɧɵɟ ɨ ɞɜɨɣɧɨɦ ɥɟɱɟɛɧɨɦ ɞɟɣɫɬɜɢɢ ɮɢɡɢɱɟɫɤɢɯ ɧɚɝɪɭɡɨɤ – ɧɚ ɭɪɨɜɟɧɶ ɝɥɸɤɨɡɵ ɜ ɤɪɨɜɢ ɢ ɧɚ ɫɨɞɟɪɠɚɧɢɟ ɠɢɪɨɜɨɣ ɬɤɚɧɢ. ɉɪɚɤɬɢɱɟɫɤɢɟ ɧɚɜɵɤɢ ɜɤɥɸɱɚɥɢ ɫɨɫɬɚɜɥɟɧɢɟ ɞɧɟɜɧɨɝɨ ɦɟɧɸ ɢɡ ɩɪɨɞɭɤɬɨɜ ɧɢɡɤɨɣ ɢ ɭɦɟɪɟɧɧɨɣ ɤɚɥɨɪɢɣɧɨɫɬɢ, ɩɨɞɛɨɪ ɨɩɬɢɦɚɥɶɧɨɣ ɢɧɬɟɧɫɢɜɧɨɫɬɢ ɮɢɡɢɱɟɫɤɨɣ ɧɚɝɪɭɡɤɢ. ɇɚ 4-ɦ ɢ 5-ɦ ɡɚɧɹɬɢɹɯ ɨɫɜɟɳɚɥɢɫɶ ɜɨɩɪɨɫɵ ɨ ɦɨɞɢɮɢɰɢɪɭɟɦɵɯ ɢ ɧɟɦɨɞɢɮɢɰɢɪɭɟɦɵɯ ɮɚɤɬɨɪɚɯ ɪɢɫɤɚ ɪɚɡɜɢɬɢɹ ɋȾ 2 ɬɢɩɚ, ɨ ɦɟɯɚɧɢɡɦɚɯ ɜɪɟɞɧɨɝɨ ɜɨɡɞɟɣɫɬɜɢɹ ɬɚɛɚɤɨɤɭɪɟɧɢɹ ɢ ɩɨɬɪɟɛɥɟɧɢɹ ɚɥɤɨɝɨɥɹ. ɉɚɰɢɟɧɬɚɦ ɪɚɡɴɹɫɧɹɥɨɫɶ, ɤɚɤ ɩɪɨɜɟɫɬɢ ɨɰɟɧɤɭ ɢɧɞɢɜɢɞɭɚɥɶɧɨɝɨ ɪɢɫɤɚ ɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɵɯ ɡɚɛɨɥɟɜɚɧɢɣ ɫ ɧɟɛɥɚɝɨɩɪɢɹɬɧɵɦ ɢɫɯɨɞɨɦ ɜ ɬɟɱɟɧɢɟ 10 ɛɥɢɠɚɣɲɢɯ ɥɟɬ ɩɨ systemic coronary risk evaluation, ɢ ɩɪɟɞɥɚɝɚɥɨɫɶ ɧɚɣɬɢ ɞɥɹ ɫɟɛɹ ɫɩɨɫɨɛɵ ɫɧɢɠɟɧɢɹ ɷɬɨɝɨ ɪɢɫɤɚ. ɉɨɜɬɨɪɧɨɟ ɚɧɤɟɬɢɪɨɜɚɧɢɟ ɩɚɰɢɟɧɬɨɜ ɩɨɫɥɟ ɨɤɨɧɱɚɧɢɹ ɬɟɪɚɩɟɜɬɢɱɟɫɤɨɝɨ ɨɛɭɱɟɧɢɹ ɡɚɪɟɝɢɫɬɪɢɪɨɜɚɥɨ ɪɨɫɬ ɢɧɮɨɪɦɢɪɨɜɚɧɧɨɫɬɢ ɨ ɰɟɥɟɜɵɯ ɩɨɤɚɡɚɬɟɥɹɯ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɞɚɜɥɟɧɢɹ, ɢɧɞɟɤɫɚ ɦɚɫɫɵ ɬɟɥɚ, ɭɪɨɜɧɹɯ ɝɥɢɤɟɦɢɢ ɢ ɯɨɥɟɫɬɟɪɢɧɚ (ɫɭɦɦɚɪɧɵɣ ɪɟɡɭɥɶɬɚɬ – ɜ ɫɪɟɞɧɟɦ 41,8 ± 3,9 ɛɚɥɥɚ), ɩɨɜɵɫɢɥɚɫɶ ɢɯ ɨɬɜɟɬɫɬɜɟɧɧɨɫɬɶ ɡɚ ɫɨɯɪɚɧɟɧɢɟ ɫɜɨɟɝɨ ɡɞɨɪɨɜɶɹ; ɤɨɦɩɥɚɟɧɬɧɨɫɬɶ ɧɚɡɧɚɱɟɧɢɹɦ ɜɪɚɱɚ ɜɨɡɪɨɫɥɚ ɜ ɫɪɟɞɧɟɦ ɜ 2,5 ɪɚɡɚ.
