Дата: 2007-12-27 17:10
????? beta-??????????????? ??? ??????? ?????????? ???????????




?.?. ????????, ?????????? ??????????? ???????? ??. ?.?.????????

C????????? ??????????? (??) ???????? ????? ?? ???????? ?????? ???? ??????????? ??????? ?????? (???). ?????????????????? ??????????? ??????? ?? ???????? ? ????. ???, ? ?????????? ?????? ????????? 45–54 ??? ??????????? ?????????? ??????????? ? 2–5% ?????? ? 0,5–1% ??????, ? ?????? 65–74 ??? – ? 11–20% ?????? ? 10–14% ??????. ?? ???????? ???????? ??????????? ?????????? ???????? ? 20% ?????????, ????? ????????????? ???????? ???????? – ? 50% ???????. ? 2000 ?. ?????????????? ??? ? ?????? ????????? 425,5 ?????? ?? 100 000 ?????????. ?????????? ?? ??? ? ??? ? ???????? ?? 65 ??? ?? ????????? 20 ??? ??????????? ?????????, ??? ??????? ??????? ? ????? "???????????" ???????? ??????? ??????? ???????? ????????, ?????? ????? ?????????? ?? ??? ????????, ? ?????????, ??????????.

?????????? ?? ??? ? ?????? ? ???????? ?? 65 ??? ? 3 ???? ????, ??? ? ??????, ? ????? ??????? ???????? ?????????? ? ????? ????? ?????????????, ? ????? 80 ??? ?????????? ? 2 ???? ???? ? ??????, ??? ? ??????. ???????????, ??? ? ????????? ?????? 40–50% ??????? ???????????? ????? ? ????? ???????????.

???????? ???????? ???????? ??????? ???????? ???????????? ?????????? ???????. ??????????? ???? ???????? ??????????? ????????? ??? ???????????? ?????????? ????????. ? ????? ????????, ?????????????? ???????? ???????, ??????? ??????? ?????????????? ?????????? ??????, ???????????????? ?????? ?????????????, ????????? ? ???????????? ? ???????????????? ???????? ?????, ????????????? ???????? ??????????????? ??????????????.

? ????? ????? ????????? ????????? ? ?????????????? ? ???????????? ? ??? ??????? ?????? ????????????, ?????????????? ?????????? ?????????? ?, ?????????????, ?????????? ??????? ?????? ??????. ????????? ??????????? ? ?????????? ???????? ??? ????????? ??????? ? ?????????????? ?????? ????????? ?????? ??????? (???), ?????????????? ?? 60 ?? 80% ??????? ???, ? ??????? (20–40% ??????? ???).

??????? ??????? ???????????? ??????????? ????????? ? ???????????? ?????????? (????? 10%) ?????????? ??? ? ????????, ? ????? ??????? ????????? ? ???????????, ??? ? ??????? ???????-???????????????? ????????? ???????????? ?????????????? ??????????????????? ? ???????????? ??????-???. ???, ???????? ? ?????????? ?????????????, ????????????? ? ????-??? ?????? ??????, ??????? ????? ???????????? b-????????? ? ???????????? ? ???????????? ??????-???. ???????????? ? ???? ??????????? ??????? ? ??? ??????-??? ????????? ? ???? ??????, ??? ? ????????????? ???.

????? ????????, ??? ???? ??? "????????" ???????? ??? ????????????? ??????? ?????????? ??????? ???, ??? ??? ??????????? ???????, ?????????? ??? ???????? ????? "???????????", ??? ??? ??????? ??? ??????????? ?????????????? ?????????? ??? ?? 10% ?????? ?????????. ?????????? ????????? ???????? ? ?????????? ??????????? ??????????????. ???????????? ?????????? ????????? ?????????????? ????? ?????????? ??????? ? ???, ?????? ?????????? ????? ????? ??????????? ?????????. ??? ?????? ??????? ???????????? ??????????????? ????? ??????????? ?????????, ???????????? ??????? ?? ???????????? ?????????????? ???????????????????, ? ????????? ? ??????, ??? ??????????? ??????????????? ??????. ?????????? ???????? ?????? ??? ?????????????? ? ???????? ?? ???? ???, ?????????? ??? ?????????? ????? ?? ????????? ??????? ? b-????????? ???.

??? ??? ???????????, ????? ???? ??????????? ??? ??????? ??????? ?????? ????????? ? ? ???????? ?????? ??????????? ????????????? ??????????. ??????? ??? ? ??????-??? ?????????? ??? ? ???????? ? ??????????? ?????????? ????????? ????????? ? ?????????????? ???????????????????. ?????????? ??? ? ?????????? ????????? ???????????? ???????? ?? ???????? ?????????????, ???????? ??? ???????.

????????? ??????, ????????? ??????? ??????????, ?????????? ??????? ??? ???????? ??????? ? ??????????????, ? ????? ? ? ????????????? ?????????? ????????, ?????????????????????? ?????????? (???????????? ? ?????????? ????? ? ? ???????? ST ?? ???) ? ???? ????? ? ????????????? ????? ? ??????? ??????. ?????? ?????????????????? ????????? ???????? ???????? "???????????? ???????". ????????, ??? ??????????? ???????????? ????? ??? ???????? ????, ?? ???? "???????? ????????", ? ????????? ???????? ????? ????????? ??-?? ????????? ???????? ????????? ??????????? ????????.

??????????? ?????????? ?? ?????????? ?????????? – ??? ??????? ???????, ??????? ????? 4 ??????????? ????????:
???? ????????? ?? ????????, ??????????? ? ????? ???? ??? ???????, ???? ???? ???????????? ????? ?? ???????;
???????? ???? ???? ????? ?????????, ???? ??????? ??? ??????, ?????? ??????? ???? ???????? ??????????? ??????? ??????????? ?? ????????;
???? ????????? ?????? ???????? ? ?????? ?? 2–3 ?? 10 ???;
?????????????? ????????????? ????? ????? ???????? ?????? ???????? ??? ???????? ? ?? ???? ??????? ?????????? ???????????? (???? ????????? ??? ?????????? ???????? ? ?????? ???????? ? ????? ?/??? ????? ?????? ??????????????, ???? ????? ????????? ??? ????????????? ??????????, ?????????? ?? ??????? ? ????????, ???????? ??????; ????, ??????????? ? ????? – ????????? ???? ????????, ??????? ? ??????????? ??????? ????????????? ??? ??????????? ?????).

? ????????????? ???????? ??????????? ????????????? ??????? ???????? ????? ??????? ????????? ?????????? (???). ?????????? ??? (??? ?????????? ????????, ?????????????????? ??????????) ????? ? ???? ?????????????? ????????: ??-??????, ?????????? ?????????? ??????????? ????????? ?????????, ??? ? ???????? ??????? ?????????? ??????? ?????????? ?????????????, ??-?????? – ????????? ???????? ? ?????????????????? ????? ???????? (??? ? ? ????? ????????? ?????? ?????????? ? ??????? ???????, ?????? ? ????????????????? ?????). ? ?????????? ??? ????? ????????? ??????? ??????????. ???, ? ????????? ????????????? ???????????? [1], ? ????? ? ??????????? ??????? [2–4] ??????????? ???????? ???? ??? ??? ?????? ?? ????????, ??????????????? ?????????? ?? ????????-?????????? ??????????? (? ??? ????? ? ?? ???).

?????? ???????????, ??? ????????????? ????????????? b-???????????????? (???) ??? ?????????? ??????? ?????? ??? ??????? ?? ????????? ??? ??????? ????????????. ??????? ????? ? ????, ??? ?? ????? ?????????? ? ???????????? ??????????? (??), ? ????? ??????????? ????????? ???????????????? (???) ? ??????????? ????? ??????. ????? ????, ?? ????? ??????????? ? ??????? ???????? ???????? (??) ???? 2, ?????????? ?????????????? ??????? ???????????????????? ?????????????, ??????????? ????????????? ???????? ??????. ??? ??? ????? ??????????? ????????? ?? ??????? ??????? ? ????? ???? ??? ????? b-???????????????.

??? ????????, ???????? ???????? ???? ?????? ??????????, ??????????? ??????????????? ?? b1-????????? ??????, ?????????? ????????????:
??????????? ?????????? ?????????? ????, ??? ????????????? ???????? ???;
??????????? ??????????????????? ????????????;
????????? ???????????? ? ???????????? ????????;
????????? ????????? ??????;
????????? ??????????? ???????? ? ?????????;
??????????? ????????????? ?????? ????????????? ??? ?????????? ? ?????????????????? ????????.

????? ???????, b-??????????????? (??? ?? ??? ??????????? ??????? ? ???????) ????????? ? ??????????????? ?????????? ????????????????? ????????. ????????????????? ??? ??? ?? ?????????? ????????????:
????????? ???????????????? ??????????, ??????????? ??????????????? ?? b1-?????????, ?? ????? ?? ?? b2-?????????;
????????? ?????????? ????????????????? ???????? (????????? II–III ?????????, ??????? ????? ???? ????????? 1–2 ???? ? ?????);
????????? ???, ?????????? ???????????????? ???????? (????????? III ?????????).

????? ??? ????????????? ??????????, ??? ????????? b-???????????????? ??????? "????????? ?????????" ? ??????? ???, ? ????????? ??, ??????? ????? ????????? ?????? ????? ??????????, ?????? ??? ???? ??? ????????????? ???????? (??? ??????????????????, ??? ? ????????????????).

??? ???????? ???????? ??????? ????????????, ?????????? ????? ??????? ???????? (??), ????????? ?? ?????? ????????????????? ????????????? ?????????????????? ??????????? ??? ??????????? ???????????? ????? ?????????. ???, ? ????????????? BHAT [5–7] ???? ????????, ??? ?????????? ???????????? (?????????????????? b-?????????????? I ?????????) ?? 5–12-? ???? ????? ????????????? ?? (? ??????? ? ??????? 25 ???) ????????? ? ???????? ????? ?????????? ?? 26%, ????????? ?????? – ?? 28%, ????????? ????????? ? ??????????? ?? – ?? 23%. ??????????? ?????????? ????????, ??? ? ?????? ??????? ???????? ????? ??????????? ?????? ????????? ?? 43%.

????????? ???????? ??????? ???????????? ??? ?? ? ???????? ?? ??????? ??????????? ?? ????????, ?????? ?????? ?????????????? ???????????? Beta-Blocker Pooling Project [8] ????????? ?? ??????????? ?????? ?????????????? ??????? ???.

??? ??????? ??????????? ???????????? ???????? ????????????????? ??? (?.?. ??????????, ??????????? b1-?????????). ???????? ?????? ??????????? ????? ?????????, ??? ???????? 50–200 ??/???, ?????????? 50–300 ??/???, ?????????? 10–40 ??/???, ?????????? 5–10 ??/??? ? ??. ??????? (??????????????????) ?????????? ??????? ????????? 2 ???? ? ????, ????? ??? ?????????? ??????, ? ????? ?????????? ???????? (?????????? ZOK) ????? ????????? 1 ??? ? ?????. ??? ?????????? ??? ??????? ?????????? ???????? ??????? ?????? ? ????? ?? 50–60 ??/???. ??? ?????????????? ????????????? ?????, ??? ??? ??????????????? ?????? ????????? ???????? ??????????? ??? ????? ???.

? ???????? ?? ????? ?? ? ????? ???????????? ????????????? ??? ??????????? ? ???? 40–200 ??/???, ?????? ?? ?????? ???? ???????????, ??????? 3–4-???????? ??????, ??? ??????? ?????????????? ??????? ? ???????. ????? ????, ??? ?? ??????? ????????? ??? ????????? ????????????? ???????????? (??, ????????????? ??????????? ??????, ??????????? ?????????????? ???????). ???? ? ???? ???????? ??????? ???????? ?????????? ????????????????? ???, ????? ??? ??????????, ??????????, ?? ??? ??????? ?????? ? ?????? ?????????????. ?? ???? ?????????? II ????????? (??????????, ??????????, ??????????, ????????) ???????? ???????????????? ??????? ???????? ???????? (? ???????????? HAPPY ? MRC-OA ??? ??????? ??????? ?? ?????????????????? ?????? ? ????????? ????????????), ???? ???????????????? ??????????? ?????? ? ?????????????.

????????? ?????????? III ????????? – ????????? – ????? ???????? ????????, ??? ??? ?????? ?????????, ????????????? ??, ??????????? ?????????? ????????? ?????????? ????????? ????? ???. ???? ? ???, ??? ????? b1-??????????? ??????? ????????? ???????? ???????????? ? ?????????????? ????????????? ?? ???? ????????? ????????????? ?????? ????? (NO) – ?????????? ??????????????. ????????? ???????? ?????????? ?????????? ???????? [9, 10]:
??? ????????????????? b1-??????????????;
???????? ???????????? ????????? ? ????????? ????????????? NO ?????????? ??????? ? ??????????? ??????????????? ??????????????.

??? ????????? ????????? ????? ? ???????????? ???????? ????????????? ???????? ? ?????????? ??????? ?????? ?????????.

? ???????????? ?? ????????????? ????????-???????? ?????????? ???? ???????? ????? ??????? ????????????? ?????????? ? ????????? ??????? b1-?????????? [11, 12] ?? ????????? ? ??????? b-???????????. ???, ?? ?????????? ?????? ? ?????????????? ??????? ?????????? ??????? ?????? ???????? ??????????? ??????? b1/b2-?????????? ??? ??????????, ?????? ???????? 288, ????? ??? ??? ??????????? ? ??????????? ???? ????? 26 [13], ??????????? – 25, ????????? – 15, ??????????? – 4,8, ???????????? – 1,9.

b1-????????????? ?????????? ???? ????? ?????????????????? ?? ??????????? ??????? ??????. ???, ???????????? ????? ??? ?????????? ????????? ????????????? ?????????? ?????????? ??????? (b1) ???? ????, ??? ??? ?????????? ?????????????? ????????????? ?????????? ????-saphena (????? ???? ??? ???? ??????? ??????????? ??????? ?????? ???c????? PGF2 ? ??????????? ??????????? (b2).

???????????? ?? ???????? ????????????? ????????? ???, ??????????? ?? ????? ???????? ????????, ????????, ??? b1-????????????? ?????????? ? 3,5 ???? ????????? ???? ?????????? ? ??????????? [14]. ?????? ??? ???????? ????????? ????????? ????????? ??? ??, ???????????? ? ???????????? ??????????? [15–17], ???????? ???????? [18–22].

?????????? ???????? ???????? ?? ?????????? ??? ? ??????? ???????????? ? ????????????? ???. ? ????? ???????? ????????????? ???????????? ????????? [23–28], ? ????? ????????????? ??? ? ????????????????? ?????????? ??????????. ????????? ??????? ? ????????? ?????? ??????????? ???????????? ?? ??????????? ? ??????? ???. ??????? ??? ??????? ???????????? ?? ???? ??? ?????? ?????????? ? ????? ??? (1,25–2,5 ??) ? ?????? ?? ???? ?????????? ??????? ???? ? ???????????, ?????? ? ?????? ????? ??????????? ??????? ?????????? ??????????? ????????? ???, ??????? ????? ????????.

??? ???????????????? ? ???????????? ????????? ???????????, ?? ????? ?????????????? ?????????? ????????????? ? ?????????? ????????. ???????? ?????? ?? ????????? ???????? ?????????? ?????????? ?????????? ???????? ?????? ????????, ??????? ?????? ?????????? ??? ???????????? ??????????????? ???.

??? ?? ???????? ???????? ??????? ??? ?????????? ?????????????? ???????, ??????? ???????? ????????? ??????, ??? ??? ????????? ???????? ???????????, ?????????? ???????????????. ????? ????, ??? ??????? ?? ??????? ?????????? ?????? ? ??????????? – 50–60 ??/??? (??? ??????? ??????? ????????????? ?? ???????).

??????? ?? – ??????????? ??????????? ???????, ????????? ??? (? ??????? ?? ????????) ???????? ???? ??? ?????????? ?????????? ?????????? ?????????. ??? ??????? ?? ??? ????? ??????? ???????????? "????????? ??????" ? ???? ??? ?????????? ?????????????? ???????, ????????????? ? ?????????: ??????? ???????? ?????? ????????, ?????????? ????????? ?????????, ?? ?????? ?? ?????????? ?? ???????????. ????? ??? ? ???????????? TIBBS [29] ????????, ??? ??? ?????? ?????????? ??????????? ???????? ???????????? ????????? ?? ??? ??????????? ??????? ??????? ? 1,5 ???? ????, ?????? ??? ???????? ?????????? ??????????? ?????????. ??????? ??????? ??????? ????? ???????? ????????????? ????? ??? ???, ?????????? ?? ????, ??? ?????, ? ?? ?????? ??? ??? ? ????? 60 ??/??? ? ?????.

???????? ???????? ??? ??????????? ? ?????????? ????????? ???????????, ???????????? ?????????, ?????????????? ? ??????????????????? ????????, ??????????? ????????? ???. ????? ????, ? ??????? ?? ??????????? ? ????????? ??????????????? ?????????????? (?????????????? ???????, ??????? ?????) ??? ???????????? (???????????? ?????, ??????????? ????????????? ??????? ??????) ????? ????????? ??? (? ??????????? ????????????, ? ????? ?????????) ????? ????????? ????????????. ??? ?????????? ???????? ??????????? ??????????. ? ???? ????????? ????????? ??????? ?????????? ?? ?????? ??????????.

???? ????????, ??? ???????? ?? ?????? ???????? ???????? ??? ?????????? ????????????: ???? ? ???, ??? ? ????????????? ??, ? ????????? ???????????? ???????????? ??????? ?????????? I ????????? (???????????) ? II ????????? (????????). ????? ????????? II ?????????, ??? ??????????, ?????????? (? ???????????, ?????????? ????????), ??????????? ????? ??????, ??? ????? ??? ????????? ? ?????????? III ?????????, ????? ??? ?????????. ??????? ?????? ?????????? ?????????? ???????? ?????????? I ????????? ? ????????? ?? ??? ?????? ??? (???, ? ?????????, ??????????? ? ??????????? ??????????).

??????????
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