?????????? ???????????????? ?????????? ????????????? (????) ???? ??????? ? ??????????? ???????? A.Gruentzig ? 1979 ?. [1]. ?? ????????? 20 ??? ?? ??????? ??????? ????????? ?? ???????? ?????????? ????????????? ??? ???????? ???????? (??) [2] ?????? ? ?????????????? ??????????? ????????? ????????? ??????????? ???????????? ????????. ?????? ????, ??????????? ? ????? 80-? ????? ???????????? ?????????? ??????????? [3], ???????, ??? ????????? ????????????? ? ??????? ?? – ?????? ?????????? ? ?????? ??????????? ????? ???????: ???????????? ?????????? ???????? ? ??????, ????????? ???????? ??????? ? ???????? ??, ????????? ? 90% ? ????? ???????. ? ??????? ?? ????????????, ? ?????????? ???????? ?????????? ????? ??? ????????????????, ????????????? ????? ???? ????????? ? ??????????? ??????? ??. ????????????? ? ??????????? ?????????????? ?? ?????????????? ?????????? ?????? ????????????? ? ???? (??? ???????????) ?, ????? ????, ?????? ??????????? ??????????????? ??????? ???????? ???????????????????? ????????? ?????????? ??????? ? ??????? ?????? ?????????. ?????????? ???????, ?? ??????? ???? ????????? ?????????????, ??????????, ?? ?????? ????????? ?????????????? ????? ????????, ????? ??? ? 10% ???????.
?? ?????? ??????????? ??????? [4-8] ??? ????????????? ??????? ???? ???????? (???) (??????? ????? ??? ?????????? ????????? ????, ??? ? ???? ? ??????????? ???????????????) ??????????? ?????? ???????-???????????????? ?????? ? ???????????????? ? ????????? ? ??????????????? ?????????????? ??? ??????? ???????????. ??? ? ???????? ???????? ???????????????? ? ????????? ??????????? ?????????????? ????????? ? ??? ? ????????? ? ?????? ??. ????????????, ?????????? ??????????? ????????, ???????? ????????? ??? ? ??????? ?????? ?????????, ???????????. ???? ?????? ???????? ??????? ?????? ????????????? ? ??? ? ??????????? ????????? ??????? ??, ??? ? ???????, ?? ?????????? ????????? ??????? [4, 5, 6, 9, 10], ?????? [11, 12] ?? ????? ????? ???????????, ??????? ??????? ??????? ???????????????? ? ?????????? ??? ? ????????????? ?????????? ??????? ??, ?????? ??????? ???? ???????????????? ?????????????? ????????? ? ????? ? ?????????? ???????????????? ??????????? ???????? ??? ?????????? ? ??????????? ??????????? ???? ???????? ? ????????? ???????? ??????? ??.. ?????? ?????????????????? ???? ??????? ????????? ???????? ?????????????? ???? ???????? ? 42 ??????? ?????? ????????? ????????, ??????? ???? ????????? ???? ??????? ???? ???????? ? ?????? ???? ??????????? [40]. ? ??????????? ??? ???????????? ???? ???????? ??????????? ??????? ????????? ?????????????? ?????????????? ???? ???????? ? ???????, ??????? ? ?????? ???? ??????????? ????????? ????. ? ??????????? ??????? (95%) ???????? ?????? ? ?????????????? ???? ???????? ?? ????????????. ?????????????? ???????? ??????? ? ????????? ????????? ???????????? 53% ????????? ????????. ?? ?????????? ???????? ? 53,0±4,2 ?? 60,1±4,4%. ??? ???? ?????????? ?? ?????????? ??????????? ? ?????? ??????? ? ???????? ???????????? ?? (?? 9,5%) ? ??????? ?????? ?? (????? 45%). ? ??????? ? ??????????? ?????? ??????? ??????? ??????? ? ??????? ???????? ??????? ?? ????????? ? ???????? ????? ????. ? ??????????? ?????? ?? ?? ??????????? ?????? ? 51,0±5,8 ?? 52,0±6,0%. ?? ?????? ???????, ???? ? ?????? ???? ?? ???????? ??????????? ??????? ??????????? ??????? ? ?????????? ?????? ? ?????????????? ???? ????????.
???????????? TIMI-III B [45,48] ????? ?????? ?????????????? ?????????????, ? ??????? 1473 ??????? ? ??? ???? ??????????????? ? ?????? ?????????? ? ?????? ?????????????? ??????? ???????. ???? ??????? ? ???????????????? ???????? (?????? ?/??? ??) ?? 6 ?????? ????????? 7,2% ? ?????? ??????????? ? 7,8% ? ?????? ??????????????? ??????? (?=0,69). ?????????? ??????????? ? ??????-???? ?? ???????? ??????????? ? ????? ??? ?????????? (10,8 ? 12,2% ??????????????? ??????? ??????????????). ????? ???????, ?????? ?????????? ????????? ?? ????? ?????? ???????????? ????? ?????????????? ??? ?????? ??????? ?? ???????? ?????????. ??????, ??? ??????????????? ????? ???????????????? ??????: ???????, ????????????????? ? ??????? ??????????? ???????, ???????????? ?????????? ??????. ? ?????????? – ? 2 ???? ???? ??????????????????? ? ????????? (7,8% ?????? 14,1%; ?<0,001). ????? ? ???????????? TIMI-III B ???? ???????????????? ????????????? ???????? ???????????? ?????????? ????????? ? ????? ?? ????? ??????? ???????? – ????? ??????? ?????? 65 ???. ?? ? ?????? ????????? ? 42-? ?????? ? 7,9% ??????? ???? ?????????, ????????????????? ? ??????????? ???????, ? ? 14,8% ?? ?????? ??????????????? ??????? (?=0,02).
???????????? VANQWISH [46], ??? 916 ??????? ? ????????????? ?? ??? ????? Q ???? ??????????????? ? ?????? ?????????? ? ?????? ?????????????? ??????? ???????, ???? ?????????????? ?????????. ???? ??????? ?? ???????????? ???????? ????? ??? ????? ???????????? ????????? 24 ? 19% ? ?????? ??????????? ? ??????????????? ??????? ?????????????? (?=0,05). ????? ??????? ?????????? ? ?????? ?????????? ????????? (13% ?????? 8%) ???? ??????????? ????????? ??????????? ??????? ???????????????? ??????????? ??? ?????????? ?????? ???????? ??????????? ????????????. ??? ???? ?? ???? ???????????????? ?? ?????? ?????? ?????? ??? ?????????? ?????????????. ? ????????? ???????????? (????? 23 ???) ?????????????? ??????? ?? ?????????? ??????????? ??????? ????? ?????????? (33%) ? ?????????????? (30%) ???????? ?? ???? ???????? (?=0,35).
?? ??????? ???? ????????? ??????? ?????????? ????????????????? ????????????, ? ??????? ???????????? ????????????? ???? ???????? ???????? ? ?????????????? ??????????? ????????? ??? ??: ???????????????? ? ????????????? [13-21]. ? ?????????, ???????????? PAMI-1 ???? ????????? ? ??? ? 395 ??????? [13]. ? ??????? 12 ? ? ??????? ???????? ?? 200 ??????? ???????? ???????? ????????? ???????????? (??????????), 195 ????????? ???? ????????? ????????????? ? ??????????? (? 90% ???????) ????????? ??????????????. ? ????????????, ??????????? ? ??????? ???? (???), ???? ???????? 103 ??????? ? ??????? 12 ? ? ??????? ???????? ?? [14]. ???????? ????????? ???????????? ???????? 56 ???????, 47 ????????? ???? ??????????????? ? ?????? ?????????????. ?? ???? 47 ??????? ????????????? ???? ????????? ? 45, ?.?. ? 2 ????????? ?????????? ???????????. ????????????? ??????? ?? ? ??????? ????????????? ??? ????????? ????????????? ???????????? ? ????????????, ??????????? ? 142 ??????? ? ??????????? [15]. ??????? ???? ??????????????? ? ??????? 6 ????? ? ??????? ???????? ??: 72 ??????? ????????? ?????? ????????????, 70 – ?????? ?????????????, ??????? ?????????? ???? ????????? ? 65 ?????????.
? ???? ?? ???? ???????????? ????????? ?????????? ??????????? ? ??????? ???????? ????????? ????????? ??? ?????????? ???? ? ?????? ???????, ??????? ??????????? ????????? ?????????????. ? ????????????, ??????????? ? ??????? ???? ??????? ? ????????? ???? ?????????? ???? ????????????? (??-?? ?????????????? ?????????? ??????????? ???????). ? ?????????? ?? ???? ???? ???????????? PAMI ???? ???????? ?????? ? ??????? ? ?????????? ? ????????? ??????? ? ??????? ?????? ???????????????? ?????? (???? ?????? 70 ???, ? ???????? ???????? ????????? ? ??????? ??? ??????????? ????? 100 ? ??????). ??? ??????? ??????????? ??????? ????? ??????????? ??????? ?????????, ??? ?????????????????? ?????????? ????????? 2% ????? ?????????, ??????? ???? ????????? ?????????????, ?? ????????? ? 10,4% ????? ???????, ??????? ????????? ??????????? (?=0,01). ? ???? ????????????? ??????????? ? ?????? ????????????? ?????????? ?? 2 ?? 2,6%. ??????? ????? ????????, ??? ? ???????????? PAMI-1 ???? ???????? ???????????? ???????? ? ??????? ????????????? ? ???? ????? ???????, ??????? ??????????? ????????? ?????????????, ??? ?? ???? ?? ?????? ?????? ???????????????? ????????, ? ??????? ????????????, ? ??????? ??? ?????????? ??????????? ? 4 ???????.
?? ????????? ??????, ?????????? ? ???? ?????????????, ??? ?????? ????????? ?????: ? ??????? ???????????????? ??????? ????????? ????????????? – ??? ??????????, ?????????? ? ????? ??????????? ????? ?????????????? ??????????? ????????? ??? ??, ??? ??? ????????? ???? ? ????????? ? ??? ??? ??? ?????????? ??????? ???????????? ??????????, ??????????? ? ????????? ????????????????, ?????????? ????????? ??????????????.
? ?????????? ????????????? ???? ????????? ???????? ????????? ????????? (???????? ???? ???????, ?? ???? ??????? ??????????? ???????? ?????????????? ????????????), ? ????????? GUSTO-IIb [16]. ? ??? ???????????? ???? ???????? 1138 ??????? ??, ??????????? ? ??????? 12 ? ????? ??? ????????. ????????? ????????????? ???? ????????? ? 565, ??????????? – ? 573 ???????. ?????????, ??? ????????? ????????????? ???? ?????? ?????????? ?? ????????? ? ????????????? ??? ?????? ? ??????? 30 ????. ?? ????????????? ????????? ???? ????? ???????? ?? ????????? ? ??????????? ????? ? ?????? ???????. ???, ?? ?????? GUSTO-IIb, ????????? ?????????? ??????????, ????????? (???????????) ?? ? ??????????? ????????? ???????? 13,7% ? ?????? ???????, ??????? ??? ???????? ???????????, ?? ????????? ? 9,6% ????? ?????????, ??????? ???? ????????? ????????????? (?=0,033). ????????????? ????????? ? ?????? ????????????? ???? ??????????? ??????? ??????? ???????? ????? ???????? ? ??????????? ??????? ??????????? ? 5-?? ?? 10-? ???? ? ??????? ???????? ??. ???, ?? ?????? ???????, ????????? ?? ???? ????????????? ? ???????????? ????????? ??. ??? ?????????? ? ??????? 6 ??? ??????????? ??????? ? ????????????? ???? ???? ???????? ????????, ???????? ?? ???? ???????? ????????? ? ?????? ?????????????. ????? 6 ??? ????????? ?????????? ?? ????????? ???? ??????? ???????? ?????????????? 16,1 ? 14,1%. ?? ?????? ????????? ?????? ????????????????? ???????????? ????????????? ????????????? ????????? ????? ???????????????? ?? ????????? ? ????????????? ??? ??????? ??????? ? ???????? [17], ?????? ?? ??? ????????? ???????? ST ? ???????? ??????? ?????????? [18], ? ????? ????????? ? ?????? ?????? ???????????????? ?????? [19]. ??????????? “????????????” ???????? ?????-??? (?????? ?? ??????? ?? 3-? ?????) ? ??????? ? ????????????? ????????? ????? ????????? ????????????? ??????? C.Grines ? ?????. ? ???????????? PAMI-II [20].
????????? ?????????? ?????????? 10 ????????????????? ????????????, ? ??????? ???????????? ?????? ?????????? ???????????? ? ????????? ????????????? ??? ??. ???????????? ???? ????????? ? 2606 ???????. ? ??????? ????????????? ? ???????? ????????????????? ????????? ???????????? ????????????? [15, 19, 22, 23], ? ????? – ???????? ????????? ????????????, ??????? ? ???? ????????????? ???????? ? ??????? ????????? [13, 14, 24], ? ? ????????? – “?????????”, ?.?. ? ??????? 1,5 ? [16, 17, 18].
?????????? ??? ??????? ??? ? ??????? 30 ???? ????? ?? ? ?????? ??????? ?????????? ??????????? (n=1316), ????????? 6,5% ?? ????????? ? 4,4% ????? 1290 ?????????, ??????? ???? ????????? ????????????? (?=0,02). ??????? ????????? ????????? ? ?????? ???????????? ????????? 5,4%, ? ?????? ????????? ????????????? – 2,8% (?=0,002). ????????? ?????????? ?????????? ? ??????? ????????? ?? ?? ??????? ???????? ?????????????? 11,9 ? 7,2% (?<0,001), ??????? ????????? ?? ??????? – 2 ? 0,7% (?<0,007), ?????? ??????? ? ??????? ????????????? ? ???? ???? ??? ????? ??????????: 1,1 ? 0,1% (?<0,001). ? ????????? ???????????????? ???????? ????? ???????????: ????????? ????????????? ????? ????????????.
???? ????????, ??? ??? ???????????? ??????????? ? ??????, ????? ?? ???? ?????????????? ??????????? ?????????????????? ????????, ?? ?????????????? ???????????????? ??????? (??????), ????????? IIb/IIIa-?????????? ???????????. ?????????? ??????? ??????????? ??????? ???????, ??? ? ??????????? ???????? ?????? ?????????? ???????????????? ???????????? ?????????????? ?????????? ??????????? ? ?????????? [47].
? ????????? ????? ? ???????? ?????????? ???????????????? ?????????? ????????????? ???????? ??????? ?????????? ???????????????? ????????????? ?????????? ??????????? (??????). ???? ????????????? ?????? [28]: ??????? ??????? ?????? ?????????? ??????????? ??????, ????????? ???????? ??????? ? ???????? ?? ? ?? ??????? ???? ????????? ????????? ????????????? (??????? ?????? ?????????? ?????????? ?? 7 ?? 15%); ????????? ??????? ?????????, ??????? ????????? 20-45% ? ??????? ?????? 6 ??? ????? ?????????? ????????????? [29, 30].
??? ??????????????? ??????? [31], ? ??????????????????? [32], ? ????? ? ?????????? ????????? ????????????????? ????????????? [33-36] ???? ???????? ??????????, ????????????????? ? ?????? ?????????? ??????? ??? ??. ??? ?????? ???? ???????????? ????????????????? ?????????????, ??????????? ? ??????????? ? ????????? ?????????? ???????, ?? ??????? 112 ????? ? ?????? ?????????????, 115 – ? ?????? ?????? ?????????????. ?? ?????? 6-????????? ??????????, ?????????? ???? ????????? ?????? ? ????? ??????? (? ????? ?? ???? ??????? – 2%), ? ?????????? ????????? ????????? ???? ?????????? ??????? ? ?????? ?????????????: 1 ?????? 8, ?.?. 1% ?????? 7% (?=0,036). ? ???? ???????????? ????????? IIb/IIIa- ?????????? ??????????? ?? ??????????????. ????????????? ???????????????? ???????? ? ????? ? ????????? ?????????? “????????” ?????? ????????? ??????????? ???? ? ?????? ????????????? ?? ????????? ? ??????? ?????????????: ?????????????? ? 19 (17%) ? (4%) ??????? (?=0,0016). ?? ?????????? 6-????????? ?????????? ? ???????? ????? ??????? ? ?????? ????????????? ?????????? ??????? ??????? ???????????: 95% ?????? 80% (?=0,012). ??????, ??? ?????????? ?? ??????? ??????????? ? ????? ??????? ????????????????? ???????????? Stent-PAMI [37]. ????????????? ???????? ????????? ??????? ? ?????????? ? ????????? ????????????? ?? ??????? (??? ?????????? ? ??????? 1 ???) ? ????????? ???????? ??????????? ???????????. ?????? ?????????????? ??????????? ????????? (III ??????? ?? ????????? ???????????? TIMI) ? ??????, ????????? ???????? ??????? ? ???????? ??, ???? ??????????? ? ?????? ????????????? (92,3%), ??? ? ??????, ??? ?????????????? ?????? (88,6%). ??????, ? ?????? ????????????? ???? ??????????? ????????? ???????????????? ? ????? ? ????????? ?????? ? ???????? ???????, ?? ??????? ???? ????????? ?????????????: 0,9% ?????? 3,5% (?=0,006). ??? ?????? ? ???????? ??????? ? ???????????? ???????????? ??????????????? ?????????????????? ???????????? STENTIM-2 [38]. ?????? 1 ??? ?????????? ??????????, ??????? ????????? ?????????, ?????????? ????????? ????????????? ? ???????????? ???? ??????????? ??? ? ?????? ?????????????, ??? ? ? ??????, ? ??????? ??????????? ?????????????. ????? 6 ??? ?????? ????? ????????????? ?????????? ?? ??????????? ?? ??????? ???????? ??????????? ????????? ? ?????????? ??????????, ? ????? ?? ??????? ???????? ??????? ?????????. ??? ? ??? ????????? ????? 1 ???, ???????? ???????????? ??????? ? ?????? ?????? ????????????? ???? ?? ?????? ????????? – ?? ??????? ?????????? ?????????, ????????????? ???????, ???????????????? ? ???????? ???????, ?? ??????? ???? ????????? ????????????? (7,5% ?????? 17%). ???, ?? ?????? ???????, ??????????? ??????????? ??????? ?????????? ? ?????? ?????????????. ?????? ?????? ???????????? ???????????? STENTIM-II [39] ?? 6 ??? ????? ???????????????? ? ?????? ?????????? ??????? ?????????? ??? ????????????? ??????? ??. ??????? ????????? ???? ?????????? ???? ? ?????? ????????????? ?? ????????? ? “??????” ?????????????? (25,3% ?????? 39,6%).
?????????? ??????? ?/??? ????????????? ????? ?????????????, ? ????????? ?????????? IIb/IIIa-?????????? ???????????, ????? ???????? ?????????? ????????????? ?? ???? ???????? ??????? ???????? ?????? ? ????????? ?????????? (?????????), ? ????? ??????? ?????????? [48]. ???, ? ???????????? EPIC [41] ????????, ??? ????????? ?????????? PG IIb/IIIa ??????????? ???????? ???????????????? ????????? ???? ? ???? ?????? ??????????? ??? ?????????? ??????????. ? ???????????? RAPPORT [25] ????????? ????????????? ??????????? (??????) ??? ????????? ????????????? ? ??????? ??. ? ?????? ??????????? ??????????????? 241 ????????, ? ?????? ??????? – 242 ????????, ??????????? ? ??????? 12 ? ????? ???????? ????????, ??????? ????????????? ?????????? ????????? ?????????????. ????? 6 ??? ?????????? ????????????? ?? ?????????? ???????? ? ????????? ?????????? ??????????, ??????? ???????? ????????? ????????? ? ??????? ?????????? ???????????????? ???????? (??? ? ?????????, ??? ? ? ???????? ???????) ????? ????? ????????. ???? ?????????? ???????? 28,1% ? ?????? ??????? ? 28,2% ? ?????? ??????????? (?=0,97). ????????? ?????????? (??? ????? ??????? ???????? ????????????????) ??? ?????????? ???? ? ?????? ??????????? ??? ????? 1 ??? (5,8% ?????? 11,2%; ?=0,03), ??? ? ????? 6 ??? (17,8% ?????? 11,6%; ?=0,05). ?????????? ??? ??????, ????? ???????? ? ????????????? ?????????????? ???????? ??????????? ???????????? (???????? ?????????? ???????? ????? ???????? ?? ?????????? ?????????? ? ??????? ???????? ?????????? ????????).
? ???? ???????????? ???????, ?????????? ??????????, ?? ???????, ??? ??? ???????? ? ?????????? ????????????? (? ?????????, ? EPISTENT [26,48]), ???? ????????, ??? ??????? ? ?????? ????????? ????????????? ? ?????? ??????????? (16,6% ?????? 9,5% ? ?????? ???????; ?=0,02). ? ??????????? ????????? ????? ???????????? EPILOG [27,48] ???? ????????, ??? ??????????? ???? ???????? ??? ????????????? ?? ???? ??????????? ?????????? 70 ??/?? ? ??????????? ????????? ???????? ?? ???? ????????????? ? ????? ??????? ?/??? ?????????? ?????????????? ????? ??????????? ?? ?????? ?? ???? 200 ?.
? ???????????? RESTORE [27] ???? ??????? ???????? ????????? ?????????. ??? ????????? ????????????? ? ???????? ?????????, ??? ???? ???????? ?? ?????? ?? ??????? ???????? ????????? (?? ???? ?????????????? ? ???????????? ?????????????? ??????????). ????? ????, ?? ???? ???????? ??????? ? ??? ??????? ? ????? ??????????? ???????????.
????????????? ????? ?? ?????? ? ???????????? ????????????? ? ????????????? ??????????? ??????????? ??? ?? ???? ??????????? ???????????? ADMIRAL [42, 43], ?????????????? ??????????????, ??????? ??????, ???????-??????????????, ????????????????? ???????? ?????????, ?????????????? ???? ??? ????????????? ? ?????? 12 ????? ?? ????????????? ??????? ???. ???, ?? ?????? ???????, ?????????????? ???????????? ?????????? ??????? ????????? ? 98,6% ? ?????? ???????????. ? ??????? 30 ???? ?????????? ??????????, ??????? ????????? ??, ??????? ???????????????? ???? 20,0% ? ?????? ??????? ? 10,7% ? ?????? ??????????? (?=0,03). ???? ????????, ??? ?????????? ????????????? ? ??????????? ???????? ??????? ?????? ????????? (54,6+12,3% ?????? 51,4+12,6% ? ???????, ?<0,05). ??? ?????? ???? ???????????? ????? ? Munich Study [50], ??? ???? ??????? ??????? ??????? ?? ???? ??????????? (?? ??????????????) ?? ?????????????? ????????? ?? ? ?????????????? ??????????? ????????? ? ??????? 14 ????. ?? ????????? ?? ??????????? ???????? ??????????? ???????????? ???????? ??????? ?? ? ?????? ???????????. ?? ? ???? ?????? ??????????? ? 55,7% ?? 62,2% , ? ??????????? ?????? ? 53,5% ?? 55,9% (?=0,3 ? ?=0,003).??????? ?????????? ???? ???????? ? ???????????? PURSUIT [49], ?????? ??????? ?????????? (????????????) ??? ????????????? ??????? ????????? IIb/IIIa-?????????? ??????????? ???????????? ???? ??????????? ????, ??? ???????????, ??-???????? ??? ?????????? ?????????. ????? ???? ????????, ??? ? ?????? ???? ??????????? ??????????? ????? ? ??????????? ??????? (????????? ??????? 0.8 % ? ?????? ?????? ? 1.1% ?????? ??????).
????????? ??????? ???????????? CADILLAC (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications) ??? ?? ?????????. ??????????????? ?????????? ??????? ?????? CADILLAC Trial ???? ???????????? ?? 72-?? ??????? ?????? ???????????? ????????? ?????????? ? 1999 ? [43]. 2081 ??????? ? ??? ?????????????????? ?????? 12 ????? ???? ??????????????? ? ????? ?? ??????? ????????? ???????: ????????? ?T?A (n = 517), ?T?A ???? ?????????? (????? ???? 12-??????? ???????; n = 52
, ????????? ????????????? (n = 511), ????????????? ???? ?????????? (n = 525). ????????? ???????? ?????? ? CADILLAC ???? ???????????? ??????? ??????, ?????????? ????????, ????????? ???????????????? ? ??????? 6 ???. ?? ??????? ??????? ???????????? ???????? ? ??????? ????????????? ???? ?????????? ??????? ????? ??????? ????? ????????. ????????? ???????????????? ???? ??????????? ?????? ????, ??? ? ?????? ???? ???? ?????????? (2.30 % ?????? 0.25 %; p = 0.00. ????? ???????? ????????????? ???????? ?? ???? ??????????? (0.8 % ?????? 0.2 %). ?????? ?????????????? ??????????? ????????? (III ??????? ?? ????????? ???????????? TIMI) ? ??????, ????????? ???????? ??????? ? ???????? ?? ???? ?????????? ? 94.8 % ? ?????? ????, ? 92.1 % ? ?????? ????????????? ? ? 96.7 % ? ?????? ????????????? ?? ???? ???????????.? ?????? ??????????? ????????? ???????????? ????? ??????? ?????, ??? ???? ????? ????????? ????????????? ??? ?? ???????????? ?????????????, ?? ????? ????? ????????? ? ???????????????? ????? ????????? IIb-IIIa-??????????. ???????? ???? ?????????, ??? ?????????? ???????? ??????????????? ??? ?????????? ??????? ?? ? ????????? ?? ??????????????, ? ?????????????? ???????????? ?????? ?????? ??????????? ????? ???????? ??????? ??? ?? [44].
????? ???????, ?????????? ???????????????? (????, ?????????????) ???????? ??????????? ??????? ?????????????? ??????????? ????????? ?? ???????-????????? ???????. ?????????? ???? ? ????????????? ???????-????????? ?????????? ??????? ? ?????? 6 – 12 ????? ????? ?????? ???????? ???????? ????????? ??????? ??????????? ???????????????? ???? ????????? ???????? ? ?????????? ???????????? ???? ???????. ?????????? ??????? ?????????? ???????? ??????????? ???????? ????????? ? ????? ?????????????? ?????????? ???????, ? ?????????, ?????????????? ?? ???????????????? ????????? ???????? ??????????? IIb-IIIa ??????? ????????? ????????? ?????? ???????? ????? ??????????? ?????????????.
??????????
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