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DIABETIC MACULOPATHY IN ADOLESCENTS AND YOUNG ADULTS WITH TYPE 1 DIABETES

Authors:
  • Republican Specialized Scientific and Practical Center of Endocrinology
  • Republican Specialized Scientific-Practical Medical Centre of Endocrinology, Tashkent, Uzbekistan

Abstract and Figures

Results of ophtalmological examination of children, adolescents and young patients with type 1 diabetes are provided in the article. Authors found out features of course of diabetic retinopathy in adolescents, such as mild hemorrhagic syndrome and formation of epiretinal fibrosis. The latter can cause poor visual outcome after laser coagulation of retina. Key words: diabetes retinopathy, adolescents, epiretinal fibrosis.
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Áèîìåäèöèíà âà àìàëè¸ò æóðíàëè / Æóðíàë áèîìåäèöèíû è ïðàêòèêè / Journal of biomedicine and practice ¹SI / 2020
1-³èñì | Ìàõñóñ ñîí
ØÊÅÍÒ-2020
ÁÈÎÌÅÄÈÖÈÍÀ ÂÀ ÀÌÀËȨÒ
ÆÓÐÍÀËÈ
ÌÀÕÑÓÑ ÑÎÍ
ÆÓÐÍÀË ÁÈÎÌÅÄÈÖÈÍÛ È
ÏÐÀÊÒÈÊÈ
ÑÏÅÖÈÀËÜÍÛÉ ÂÛÏÓÑÊ
JOURNAL OF BIOMEDICINE AND
PRACTICE
SPECIAL ISSUE
ISSN 2181-9300
Doi Journal 10.26739/2181-9300
2
Áèîìåäèöèíà âà àìàëè¸ò æóðíàëè / Æóðíàë áèîìåäèöèíû è ïðàêòèêè / Journal of biomedicine and practice ¹SI / 2020
1-³èñì | Ìàõñóñ ñîí
ÁÈÎÌÅÄÈÖÈÍÀ ÂÀ ÀÌÀËÈ¨Ò ÆÓÐÍÀËÈ
¹SI (2020) DOI http://dx.doi.org/10.26739/2181-9300-2020-SI
Ñàµèôàëîâ÷è: Õóðøèä Ìèðçàõìåäîâ
Êîíòàêò ðåäàêöèé æóðíàëîâ. www.tadqiqot.uz
ÎÎÎ Tadqiqot ãîðîä Òàøêåíò,
óëèöà Àìèðà Òåìóðà ïð.1, äîì-2.
Web: http://www.tadqiqot.uz/; E-mail: info@tadqiqot.uz
Òåë: (+998-94) 404-0000
Editorial staff of the journals of www.tadqiqot.uz
Tadqiqot LLC The city of Tashkent,
Amir Temur Street pr.1, House 2.
Web: http://www.tadqiqot.uz/; E-mail: info@tadqiqot.uz
Phone: (+998-94) 404-0000
Òàµðèðèÿò êåíãàøè
- Õàèòîâ Ðàõèì Ìóñàåâè÷ - Ðîññèÿ Ôåäåðàöèÿñè Ôàíëàð àêàäåìèÿñè àêàäåìèãè, òèááè¸ò
ôàíëàðè äîêòîðè, ïðîôåññîð, Ðîññèÿ Ôåäåðàöèÿñèäà õèçìàò ê´ðñàòãàí ôàí àðáîáè, Ðîññèÿ
ÔÒÁÀ "Èììóíîëîãèÿ èíñòèòóòè ÄÈÌ" ÔÄÁÒ èëìèé ðàõáàðè
- Jin Young Choi - Ñåóë ìèëëèé óíèâåðñèòåòè Ñòîìàòîëîãèÿ ìàêòàáè î²èç âà þç-æಠæàððîõëèãè
äåïàðòàìåíòè ïðîôåññîðè, Æàíóáèé Êîðåÿíèíã þç-æಠâà ýñòåòèê æàððîõëèê àññîöèàöèÿñè
ïðåçèäåíòè
- Àêáàðîâ Ìèðøàâêàò Ìèðîëèìîâè÷ - òèááè¸ò ôàíëàðè äîêòîðè, Â.Âàµèäîâ íîìèäàãè Ðåñïóáëèêà
èõòèñîñëàøòèðèëãàí æàððîµëèê ìàðêàçè
- Ñàèäîâ Ñàèäàìèð Àáðîðîâè÷ - òèááè¸ò ôàíëàð äîêòîðè, Òîøêåíò ôàðìàöåâòèêà èíñòèòóòè
ORCID ID: 0000-0002-6616-5428
- Òóðàåâ Ôåðóç Ôàòõóëëàåâè÷ - òèááè¸ò ôàíëàðè äîêòîðè, îðòèðèëãàí þðàê íó³ñîíëàðè
á´ëèìè, Â.Âàµèäîâ íîìèäàãè Ðåñïóáëèêà èõòèñîñëàøòèðèëãàí æàððîµëèê ìàðêàçè
ORCID ID: 0000-0002-6778-6920
- Õóäàéêóëîâà Ãóëíàðà Êàðèìîâíà - òèááè¸ò ôàíëàð äîêòîðè, Þ³óìëè âà áîëàëàð
þ³óìëè êàñàëëèêëàð êàôåäðàñè äîöåíòè, Òîøêåíò òèááè¸ò àêàäåìèÿñè
ORCID ID: 0000-0002-1119-4491
- Àáçàëîâà Øàõíîçà Ðóñòàìîâíà - ò.ô.í., äîöåíò, Òîøêåíò Ïåäèàòðèÿ òèááè¸ò èíñòèòóòè.
Èëìèé òàä³è³îòëàð, èííîâàöèÿëàð âà èëìèé ïåäàãîãëàðíè òàé¸ðëàø á´ëèìè áîøëè²è.
ORCID ID: 0000-0002-0066-3547
- Õóäàíîâ Áàõòèíóð - òèááè¸ò ôàíëàðè äîêòîðè, ¤çáåêèñòîí Ðåñïóáëèêàñè Èííîâàöèîí ðèâîæëàíèø
âàçèðëèãè á´ëèì áîøëè²è
- Ìàâëÿíîâ Ôàðõîä Øàâêàòîâè÷ - òèááèåò ôàíäàð äîêòîðè, Ñàìàð³àíä äàâëàò òèááè¸ò èíñòèòóòè
áîëàëàð æàððîµëèãè êàôåäðàñè äîöåíòè â.á.
- Ôàðìàíîâà Íîäèðà Òàõèðîâíà - ôàðìàöåâòèêà ôàíëàðè íîìçîäè, äîöåíò, Òîøêåíò ôàðìàöåâòèêà
èíñòèòóòè ôàðìàêîãíîçèÿ êàôåäðàñè äîöåíòè.
Áîø ìóµàððèð:
Ðèçàåâ Æàñóð Àëèìæàíîâè÷ - òèááè¸ò ôàíëàðè
äîêòîðè, ïðîôåññîð, Ñàìàð³àíä äàâëàò òèááè¸ò
èíñòèòóòè ðåêòîðè
ORCID ID: 0000-0001-5468-9403
Áîø ìóµàððèð ´ðèíáîñàðè:
Çèÿäóëëàåâ Øóõðàò Õóäàéáåðäèåâè÷ - òèááè¸ò
ôàíëàðè äîêòîðè, Ñàìàð³àíä äàâëàò òèááè¸ò
èíñòèòóòè Èëìèé èøëàð âà èííîâàöèÿëàð
á´éè÷à ïðîðåêòîðè
ORCID ID: 0000-0002-9309-3933
Ìàñúóë êîòèá:
Ìàìàòîâà Íîäèðà Ìóõòîðîâíà
Òîøêåíò Ïåäèàòðèÿ òèááè¸ò èíñòèòóòè «ÓÀØ òåðàïèÿ, êëèíèê ôàðìàêîëîãèÿ»
êàôåäðàñè äîöåíòè, òèááè¸ò ôàíëàðè äîêòîðè
ORCID ID: 0000-0003-2396-4905
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Áèîìåäèöèíà âà àìàëè¸ò æóðíàëè / Æóðíàë áèîìåäèöèíû è ïðàêòèêè / Journal of biomedicine and practice ¹SI / 2020
1-³èñì | Ìàõñóñ ñîí
ÆÓÐÍÀË ÁÈÎÌÅÄÈÖÈÍÛ È ÏÐÀÊÒÈÊÈ
¹SI (2020) DOI http://dx.doi.org/10.26739/2181-9300-2020-SI
Âåðñòêà: Õóðøèä Ìèðçàõìåäîâ
Êîíòàêò ðåäàêöèé æóðíàëîâ. www.tadqiqot.uz
ÎÎÎ Tadqiqot ãîðîä Òàøêåíò,
óëèöà Àìèðà Òåìóðà ïð.1, äîì-2.
Web: http://www.tadqiqot.uz/; E-mail: info@tadqiqot.uz
Òåë: (+998-94) 404-0000
Editorial staff of the journals of www.tadqiqot.uz
Tadqiqot LLC The city of Tashkent,
Amir Temur Street pr.1, House 2.
Web: http://www.tadqiqot.uz/; E-mail: info@tadqiqot.uz
Phone: (+998-94) 404-0000
Ðåäàêöèîííûé êîëëåãèÿ
- Õàèòîâ Ðàõèì Ìóñàåâè÷ - àêàäåìèê ÐÀÍ, äîêòîð ìåäèöèíñêèõ íàóê, ïðîôåññîð, çàñëóæåííûé
äåÿòåëü íàóêè Ðîññèéñêîé Ôåäåðàöèè, íàó÷íûé ðóêîâîäèòåëü ÔÃÁÓ "ÃÍÖ Èíñòèòóò èììóíîëîãèè"
ÔÌÁÀ Ðîññèè.
- Jin Young Choi - ïðîôåññîð äåïàðòàìåíòà îðàëüíîé è ÷åëþñòíî-ëèöåâîé õèðóðãèè øêîëû ñòîìàòîëîãèè
Ñòîìàòîëîãè÷åñêîãî ãîñïèòàëÿ Ñåóëüñêîãî íàöèîíàëüíîãî óíèâåðñèòåòà, Ïðåçèäåíò Êîðåéñêîãî
îáùåñòâà ÷åëþñòíî-ëèöåâîé è ýñòåòè÷åñêîé õèðóðãèè
- Àêáàðîâ Ìèðøàâêàò Ìèðîëèìîâè÷ - äîêòîð ìåäèöèíñêèõ íàóê, Ðåñïóáëèêàíñêèé ñïåöèàëèçèðîâàííûé
öåíòð õèðóðãèè èìåíè àêàäåìèêà Â.Âàõèäîâà
- Ñàèäîâ Ñàèäàìèð Àáðîðîâè÷ - äîêòîð ìåäèöèíñêèõ íàóê, Òàøêåíòñêèé ôàðìàöåâòè÷åñêèé
èíñòèòóò
ORCID ID: 0000-0002-6616-5428
- Òóðàåâ Ôåðóç Ôàòõóëëàåâè÷ - äîêòîð ìåäèöèíñêèõ íàóê, ãëàâíûé íàó÷íûé ñîòðóäíèê îòäåëåíèÿ
ïðèîáðåòåííûõ ïîðîêîâ ñåðäöà Ðåñïóáëèêàíñêîãî ñïåöèàëèçèðîâàííîãî öåíòðà õèðóðãèè èìåíè àêàäåìèêà
Â.Âàõèäîâà
ORCID ID: 0000-0002-6778-6920
- Õóäàéêóëîâà Ãóëüíàðà Êàðèìîâíà - äîêòîð ìåäèöèíñêèõ íàóê, äîöåíò êàôåäðû èíôåêöèîííûõ è
äåòñêèõ èíôåêöèîííûõ áîëåçíåé Òàøêåíòñêîé Ìåäèöèíñêîé Àêàäåìèè
ORCID ID: 0000-0002-1119-4491
- Àáçàëîâà Øàõíîçà Ðóñòàìîâíà - äîöåíò, Òàøêåíòñêèé ïåäèàòðè÷åñêèé ìåäèöèíñêèé èíñòèòóò.
Çàâåäóþùàÿ îòäåëåíèåì íàó÷íûõ èññëåäîâàíèé, èííîâàöèé è íàó÷íî-ïåäàãîãè÷åñêîé ïîäãîòîâêè.
ORCID ID: 0000-0002-0066-3547
- Ìàâëÿíîâ Ôàðõîä Øàâêàòîâè÷ - äîêòîð ìåäèöèíñêèõ íàóê, è.î. äîöåíòà êàôåäðû äåòñêîé
õèðóðãèè, Ñàìàðêàíäñêèé ãîñóäàðñòâåííûé ìåäèöèíñêèé èíñòèòóò
- Õóäàíîâ Áàõòèíóð - äîêòîð ìåäèöèíñêèõ íàóê, Ìèíèñòåðñòâî Èííîâàöèîííîãî ðàçâèòèÿ Ðåñïóáëèêè
Óçáåêèñòàí
- Ôàðìàíîâà Íîäèðà Òàõèðîâíà - êàíäèäàò ôàðìàöåâòè÷åñêèõ íàóê, äîöåíò êàôåäðû ôàðìàêîãíîçèè
Òàøêåíòñêîãî ôàðìàöåâòè÷åñêîãî èíñòèòóòà
Ãëàâíûé ðåäàêòîð:
Ðèçàåâ Æàñóð Àëèìäæàíîâè÷ - äîêòîð
ìåäèöèíñêèõ íàóê, ïðîôåññîð, Ðåêòîð
Ñàìàðêàíäñêîãî ãîñóäàðñòâåííîãî
ìåäèöèíñêîãî èíñòèòóòà
ORCID ID: 0000-0001-5468-9403
Çàìåñòèòåëü ãëàâíîãî ðåäàêòîðà:
Çèÿäóëëàåâ Øóõðàò Õóäàéáåðäèåâè÷ -äîêòîð
ìåäèöèíñêèõ íàóê, ïðîðåêòîð ïî íàó÷íîé
ðàáîòå è èííîâàöèÿì Ñàìàðêàíäñêîãî
ãîñóäàðñòâåííîãî ìåäèöèíñêîãî èíñòèòóòà
ORCID ID: 0000-0002-9309-3933
Îòâåòñâåííûé ñåêðåòàðü:
Ìàìàòîâà Íîäèðà Ìóõòîðîâíà
Äîêòîð ìåäèöèíñêèõ íàóê, Äîöåíò êàôåäðû «Êëèíè÷åñêîé ôàðìàêîëîãèè, ÂÎÏ òåðàïèè
Òàøêåíòñêîãî ïåäèàòðè÷åñêîãî ìåäèöèíñêîãî èíñòèòóòà
ORCID ID: 0000-0003-2396-4905
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Áèîìåäèöèíà âà àìàëè¸ò æóðíàëè / Æóðíàë áèîìåäèöèíû è ïðàêòèêè / Journal of biomedicine and practice ¹SI / 2020
1-³èñì | Ìàõñóñ ñîí
JOURNAL OF BIOMEDICINE AND PRACTICE
¹SI (2020) DOI http://dx.doi.org/10.26739/2181-9300-2020-SI
Pagemaker: Xurshid Mirzaxmedov
Êîíòàêò ðåäàêöèé æóðíàëîâ. www.tadqiqot.uz
ÎÎÎ Tadqiqot ãîðîä Òàøêåíò,
óëèöà Àìèðà Òåìóðà ïð.1, äîì-2.
Web: http://www.tadqiqot.uz/; E-mail: info@tadqiqot.uz
Òåë: (+998-94) 404-0000
Editorial staff of the journals of www.tadqiqot.uz
Tadqiqot LLC The city of Tashkent,
Amir Temur Street pr.1, House 2.
Web: http://www.tadqiqot.uz/; E-mail: info@tadqiqot.uz
Phone: (+998-94) 404-0000
Editorial Board
- Khaitov Rakhim Musaevich MD, DSc, Professor, Academician of the Russian Academy of
Sciences, Honored Scientist of the Russian Federation, scientific director of the FSBI «NRC Institute
of immunology» FMBA of Russia
- Jin Young Choi Professor Department of Oral and Maxillofacial Surgery School of Dentistry
Dental Hospital Seoul National University, President of the Korean Society of Maxillofacial Aesthetic
Surgery
- Akbarov Mirshavkat Mirolimovich - Doctor of Medical Sciences, Republican Specialized Center
of Surgery named after academician V.Vakhidov
- Saidamir SaidovDoctor of Medical Sciences, Tashkent Pharmaceutical Institute
ORCID ID: 0000-0002-6616-5428
- Turaev Feruz Fatkhullaevich MD, DSc, Department of Acquired Heart Diseases, V.Vakhidov
Republican Specialized Center Surgery
ORCID ID: 0000-0002-6778-6920
- Khudaykulova Gulnara Karimovna MD, DSc, Associate Professor, Department of Infectious
and Paediatric Infectious Diseases, Tashkent Medical Academy.
ORCID ID: 0000-0002-1119-4491
- Abzalova Shakhnoza Rustamovna - Associate Professor, Tashkent Pediatric Medical Institute. Head of the
department of scientific research, innovation and scientific and pedagogical training.
ORCID ID: 0000-0002-0066-3547
- Bakhtinur Khudanov Associate professor of Tashkent State Dental Institute, Ministry of Innovative
Development of the Republic of Uzbekistan
- Mavlyanov Farhod Shavkatovich MD, DSc, Department of Pediatric Surgery, Samarkand State
Medical Institute
- Farmanova Nodira Tahirovna - candidate of pharmaceutical sciences, docent, docent of the
Pharmacognosy Department of Tashkent Pharmaceutical Institute
Chief Editor:
Rizaev Jasur Alimjanovich
MD, DSc, Professor of Dental Medicine,
Rector of the Samarkand State Medical
Institute
ORCID ID: 0000-0001-5468-9403
Deputy Chief Editor:
Ziyadullaev Shukhrat Khudayberdievich
Doctor of Medical Sciences, Vice-Rector
for scientific work and Innovation,
Samarkand State Medical Institute
ORCID ID: 0000-0002-9309-3933
Responsible secretary:
Mamatova Nodira Mukhtorovna
Doctor of Medical Sciences, Associate Professor, Department of Clinical Pharmacology, Therapy
and GP, Tashkent Pediatric Medical Institute
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Áèîìåäèöèíà âà àìàëè¸ò æóðíàëè / Æóðíàë áèîìåäèöèíû è ïðàêòèêè / Journal of biomedicine and practice ¹SI / 2020
1-³èñì | Ìàõñóñ ñîí
ÌÓÍÄÀÐÈÆÀ \ ÑÎÄÅÐÆÀÍÈÅ \ CONTENT
1.Æ.À.ÐÈÇÀÅÂ, Ý.À. ÐÈÇÀÅÂ, Í.Í. ÀÕÌÀÄÀËÈÅÂ
Êîðîíàâèðóñ êàñàëëèãè (COVID-19): ìåëàòîíèííèíã ôèçèîëîãèê òàúñèðè
íó³òàè íàçàðèäàí ìóàììîíèíã çàìîíàâèé ê´ðèíèøè.........................................7
ÀÊÓØÅÐËÈÊ ÂÀ ÃÈÍÅÊÎËÎÃÈß
1.È.M.TOÆÈÅÂÀ
¤çáåêèñòîíäà âèòàìèí "D"íèíã åòèøìîâ÷èëèãè âà ãåñòàöèîí äèàáåò.................19
2.Í. Ì. ÑÈÄÈÊÎÂÀ, Í. Õ. ÐÓÇÈÅÂÀ
Ãèïåðàíäðîãåíèÿ áèëàí î²ðèãàí áåìîðëàðíè äàâîëàøíèíã êëèíèê
âà ïàòîãåíåòèê àñîñëàíèøè.................................................................................26
3.Á. Á. ÕÀÑÀÍÎÂ
Ýêñïåðèìåíòàë òîêñèê ãåïàòèò âà ëàêòàöèÿ äèíàìèêàñèäàãè
àóòîèììóí æàðà¸íëàð..........................................................................................31
ÌÎÐÔÎËÎÃÈß
1.Ì. Á.ÒÓÐÀÌÓÐÀÒÎÂÀ, Ä.Á. ÀÄÈËÁÅÊÎÂÀ
Óðãàí÷ øàµðèäà ÿøîâ÷è ñî²ëîì ³èç áîëàëàðíèíã àíòðîïîìåòðèê
ê´ðñàòêè÷ëàðèíè áàõîëàø...................................................................................36
ÝÍÄÎÊÐÈÍÎËÎÃÈß
1.Í.Ì. ÞËÄÀØÅÂÀ, Ô.Ñ. ÒÎÄÆÈÅÂÀ, À.Â. ÀËÈÅÂÀ,
Ø.Ø. ÈËÜßÑÎÂ, Ø.Ì. ÞËÄÀØÅÂ
Êàíäëè äèàáåò 1-òóð ´ñìèðëàð âà ¸ø îäàìëàðäà äèàáåòèê ìèêóëîïàòèÿñè......43
2.Ñ.X. XOÄÆÀÅÂÀ, Í.Á. ÓÁÀÉÄÓËËÀÅÂÀ, Ä. Ã. ÄÀÂËÅÒßÐÎÂ
BNP âà NT-PRO-BNP íàòðèéðåòèê ïåïòèäëàð òèðåîòîêñèêîç
ñèíäðîìèäà þðàê äèñôóíêöèÿñèíè ýðòà ê´ðñàòêè÷è
ñèôàòèäà ³´ëëàíèëèøè........................................................................................50
3.Ç.Þ. ÕÀËÈÌÎÂÀ, Ä.Ø. ÕÎËÎÂÀ, Ì.Ñ. ÑÀÔÀÐÎÂÀ
Ãèïîôèç íîôàîë àäåíîìàñèãà íàñëèé ìîéèëëèãè áîð
áåìîðëàðäà êàñàëëèê êå÷èøèíèíã âà òàøõèñîòèíèíã ´çèãà õîñëèãè................56
4.Ç.Þ. ÕÀËÈÌÎÂÀ, Ì.Ñ. ÑÀÔÀÐÎÂÀ, À.À.
ÃÓÌÀÐÎÂÀ, Ã.Ì. ÆÀÁÁÎÐÎÂÀ
Ïðîëàêòèíîìàëàðäà ãèïåðïðîëàêòèíåìèÿíè êëèíèêàñè âà êå÷èø äàâðè...........69
5.Ç.Þ. ÕÀËÈÌÎÂÀ, Ñ. Ñ. ÈÑÑÀÅÂÀ
¤ñèø ãîðìîíè èøëàá ÷è³àðóâ÷è ãèïîôèç àäåíîìàëàðèäà íóð áèëàí äàâîëàø...79
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ÌÓÍÄÀÐÈÆÀ \ ÑÎÄÅÐÆÀÍÈÅ \ CONTENT
6.Ç.Þ. ÕÀËÈÌÎÂÀ, Ã.Ì. ÆÀÁÁÎÐÎÂÀ, Ì.Ñ. ÑÀÔÀÐÎÂÀ,
Ó.À. ÌÈÐÑÀÈÄÎÂÀ, Ø.Ý. ÝÐÃÀØÅÂÀ, Î.Á. ÈÐÃÀØÅÂÀ
Áóéðàê óñòè áåçè åòèøìîâ÷èëèê âà Íåëñîí ñèíäðîìè áèëàí
àñîðàòëàíãàí ÀÊÒà ãà áî²ëèê Êóøèíã ñèíäðîìè
á´ëãàí áåìîðäà ôåðòèëëèê òèêëàíèøè...............................................................86
7.Ç.Þ. ÕÀËÈÌÎÂÀ , Ã.À.ÄÀËÈÌÎÂÀ
Áèðëàì÷è ãèïåðàëüäîñòåðîíèçìè áîð áåìîðëàðäà
öåðåáðîâàñêóëÿð êàñàëëèêëàð.............................................................................97
8.Ç.Þ. ÕÀËÈÌÎÂÀ , Ã.À.ÄÀËÈÌÎÂÀ
¤çáåêèñòîí Ðåñïóáëèêàñèäà áèðëàì÷è ãèïåðàëäîñòåðîíèçì ñêðèíèíãè............104
9.Ô.À. ÕÀÉÄÀÐÎÂÀ, Ñ. Ñ. ÔÀÕÐÓÒÄÈÍÎÂÀ, Ó.Ð. ÌÀÍÍÀÏÎÂÀ
Òóõóìäîíëàð ìóääàòèäàí àââàëãè åòèøìîâ÷èëèãè
á´ëãàí áåìîð à¸ëëàðíèíã êëèíèê-ãîðìîíàë ñòàòóñè òàñíèôè............................115
10.Ô.A. ÕÀÉÄÀÐÎÂÀ, Ç.A. ÓÌÀÐÕ¤ÆÀÅÂÀ
A¸ëëàðíè ïåðèìåíàïàóçà äàâðèäà ñàëîìàòëèãè µîëàòè âà ìåíàïàóçà
äàâðè êå÷èøèíèíã ïðîãíîçè...............................................................................126
11.Ô.À. ÕÀÉÄÀÐÎÂÀ, È.Õ. ÈÍÎßÒÕÎÄÆÀÅÂÀ
Äèàáåòèê ãàñòðîïàðåç: äèàãíîñòèêà âà äàâîëàø êèéèí÷èëèêëàðè.......................134
12.Í.Á. ÓÁÀÉÄÓËËÀÅÂÀ, Ã.È. AËËÀßÐÎÂÀ, Ô. Ô. AËÌÓÐÎÄÎÂ
Koíñåðâàòèâ äàâîäàãè Ãðåéâñ êàñàëëèãè áèëàí áåìîðëàðäà
òèðåîòîêñèêîç ³àéòàëàíèøè õàâô îìèëëàðè âà
óëàðíèíã ïðîãíîñòèê àµàìèÿòè...........................................................................149
13.Ô.À. ÒÎÕÈÐÎÂÀ, Í.Ì. ÀËÈÕÀÍÎÂÀ, Ô.À. ÕÀÉÄÀÐÎÂÀ,
À.Â. ÀËÈÌÎÂ, Ä.Ì. ÁÅÐÄÈ£ÓËÎÂÀ, Ç.Ñ. ÀÊÁÀÐÎÂ, Ã.¢.
ÀÊÐÀÌÎÂÀ, Ë.Ä. ÐÎÌÀÍÎÂÀ
£îðà³àëïî²èñòîíäà ³àíäëè äèàáåò.....................................................................156
14.X.£. ÍÀÑÈÐÎÂÀ, Ä.Ò. MÓÕÀÌÌÅÄÀÌÈÍÎÂÀ, Ç.Þ. ÕÀËÈÌÎÂÀ
Ïðîëàêòèíîìà áèëàí áåìîðëàðíè äàâîëàø ìàñàëàëàðè
âà óíèíã ýïèäåìèîëîãèÿñè.................................................................................163
15.X.£. ÍÀÑÈÐÎÂÀ, Ô.Á. MAÕÌÓÄÎÂÀ, Ç.Þ. ÕÀËÈÌÎÂÀ
Këèíèê íîôàîë ãèïîôèç àäåíîìàñè á´ëãàí áåìîðëàðíè
òàøõèñëàø âà äàâîëàø òàµëèëè..........................................................................172
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ÁÈÎÌÅÄÈÖÈÍÀ ÂÀ ÀÌÀËÈ¨Ò ÆÓÐÍÀËÈ
ÆÓÐÍÀË ÁÈÎÌÅÄÈÖÈÍÛ È ÏÐÀÊÒÈÊÈ
JOURNAL OF BIOMEDICINE AND PRACTICE
Æàñóð Àëèìäæàíîâè÷ ÐÈÇÀÅÂ
Ñàìàðêàíäñêèé ãîñóäàðñòâåííûé ìåäèöèíñêèé èíñòèòóò, Óçáåêèñòàí
Ýúçîçáåê Àëèìäæàíîâè÷ ÐÈÇÀÅÂ
Òàøêåíòñêàÿ ìåäèöèíñêàÿ àêàäåìèÿ, Óçáåêèñòàí
Íóñðàò Íóìîíîâè÷ ÀÕÌÀÄÀËÈÅÂ
Òàøêåíòñêèé ãîñóäàðñòâåííûé ñòîìàòîëîãè÷åñêèé èíñòèòóò, Óçáåêèñòàí
ÊÎÐÎÍÀÂÈÐÓÑÍÀß ÁÎËÅÇÍÜ (COVID-19): ÑÎÂÐÅÌÅÍÍÛÉ
ÂÇÃËßÄ ÍÀ ÏÐÎÁËÅÌÓ Ñ ÏÎÇÈÖÈÉ ÔÈÇÈÎËÎÃÈ×ÅÑÊÈÕ
ÝÔÔÅÊÒÎÂ ÌÅËÀÒÎÍÈÍÀ
For citation: J.A. Rizaev, E. A. Rizaev, N.N. Ahmadaliyev, Coronavirus disease (covid-
19): a modern view of the problem from the position of physiological effects of melatonin,
Journal of Biomedicine and Practice, 2020 Journal of Biomedicine and Practice 2020,
Special issue, pp.7-18
http:// dx.doi.org/10.26739/2181-9300-2020-SI-1
ÀÍÍÎÒÀÖÈß
 äàííîé ñòàòüå ïðåäñòàâëåíà èíôîðìàöèÿ îá àíòèîêñèäàíòíûõ è
èììóíîñòèìóëèðóþùèõ ýôôåêòàõ ìåëàòîíèíà è åãî ðîëè â ïîääåðæàíèè ãîìåîñòàçà
îðãàíèçìà. Ïîêàçàíî, ÷òî âñëåäñòâèå íåïðàâèëüíîãî îáðàçà æèçíè, óâåëè÷åíèÿ
âîçðàñòà, ïðèåìà íåêîòîðûõ ëåêàðñòâåííûõ ïðåïàðàòîâ è äð. ïîäàâëÿåòñÿ âûðàáîòêà
ìåëàòîíèíà. Ïðèâåäåíû ðåêîìåíäàöèè ñ ó÷åòîì âàæíûõ ôèçèîëîãè÷åñêèõ ýôôåêòîâ
ìåëàòîíèíà, êîòîðûå íåîáõîäèìî ïðèíÿòü âî âíèìàíèå ïðè ðàçðàáîòêå ñòðàòåãèè
ëå÷åíèÿ è ïðîôèëàêòèêè COVID19.
Êëþ÷åâûå ñëîâà: COVID-19, ìåëàòîíèí, ëå÷åíèå, ïðîôèëàêòèêà
Æàñóð Àëèìäæàíîâè÷ ÐÈÇÀÅÂ
Ñàìàð³àíä äàâëàò òèááè¸ò èíñòèòóòè, ¤çáåêèñòîí
Ýúçîçáåê Àëèìäæàíîâè÷ ÐÈÇÀÅÂ
Òîøêåíò òèááè¸ò Àêàäåìèÿñè, ¤çáåêèñòîí
Íóñðàò Íóìîíîâè÷ ÀÕÌÀÄÀËÈÅÂ
Òîøêåíò äàâëàò ñòîìàòîëîãèÿ èíñòèòóòè, ¤çáåêèñòîí
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ÊÎÐÎÍÀÂÈÐÓÑ ÊÀÑÀËËÈÃÈ (COVID-19):
ÌÅËÀÒÎÍÈÍÍÈÍÃ ÔÈÇÈÎËÎÃÈÊ ÒÀÚÑÈÐÈ ÍÓ£ÒÀÈ
ÍÀÇÀÐÈÄÀÍ ÌÓÀÌÌÎÍÈÍà ÇÀÌÎÍÀÂÈÉ Ê¤ÐÈÍÈØÈ
ÀÍÍÎÒÀÖÈß
Óøáó ìàêîëàäà ìåëàòîíèííèíã àíòèîêñèäàíò âà èììóíîñòèìóëëîâ÷è òàúñèðè
âà óíèíã îðãàíèçìäàãè ãîìåîñòàçíè ñàêëàøäàãè ðîëè òóãðèñèäà ìàúëóìîòëàð
êåëòèðèëãàí. Íîòóãðè òóðìóø òàðçè, ¸øíèíã îøèøè, ìàúëóì äîðè-äàðìîíëàðíè
êàáóë êèëèø âà áîøêàëàð òóôàéëè ìåëàòîíèí èøëàá ÷èêàðèëèøè ñóñàéèøè
êóðñàòèëãàí. Ìåëàòîíèííèíã ìóõèì ôèçèîëîãèê òàúñèðèíè èíîáàòãà îëãàí õîëäà
COVID-19íè äàâîëàø âà ïðîôèëàêòèêà ñòðàòåãèÿñèíè èøëàá ÷èêèøäà õèñîáãà
îëèíèøè êåðàê áóëãàí òàâñèÿëàð òàêäèì êèëèíãàí.
Êàëèò ñóçëàð: COVID-19, ìåëàòîíèí, äàâîëàø, ïðîôèëàêòèêà
Jasur Alimjanovich RIZAEV
Samarkand State Medical Institute, Uzbekistan
Ezozbek Alimjanovich RIZAEV
Tashkent Medical Academy, Uzbekistan
Nusrat Numonovich. AHMADALIYEV
Tashkent State Dental Institute, Uzbekistan
CORONAVIRUS DISEASE (COVID-19): A MODERN VIEW OF
THE PROBLEM FROM THE POSITION OF PHYSIOLOGICAL
EFFECTS OF MELATONIN
ANNOTATION
This article provides information about the antioxidant and immunostimulatory effects
of melatonin and its role in maintaining the homeostasis of the organism. It is shown that
due to improper lifestyle, increasing age, taking certain medications, etc., the production
of melatonin is suppressed. Recommendations are given taking into account the important
physiological effects of melatonin, which must be taken into account when developing
a treatment and prevention strategy for COVID19.
Key words: COVID-19, melatonin, treatment, prevention
Êîðîíàâèðóñíàÿ áîëåçíü (COVID-19). Êîðîíàâèðóñíàÿ èíôåêöèÿ COVID-19
(àááðåâèàòóðà îò àíãë. Corona Virus Disease 2019), ðàíåå êîðîíàâèðóñíàÿ
èíôåêöèÿ 2019-nCoV - ïîòåíöèàëüíî òÿæ¸ëàÿ îñòðàÿ ðåñïèðàòîðíàÿ èíôåêöèÿ,
âûçûâàåìàÿ êîðîíàâèðóñîì SARS-CoV-2 [5,16]. Ïðåäñòàâëÿåò ñîáîé îïàñíîå
çàáîëåâàíèå, êîòîðîå ìîæåò ïðîòåêàòü êàê â ôîðìå îñòðîé ðåñïèðàòîðíîé âèðóñíîé
èíôåêöèè ë¸ãêîãî òå÷åíèÿ, òàê è â òÿæ¸ëîé ôîðìå, ñïåöèôè÷åñêèå îñëîæíåíèÿ
êîòîðîé ìîãóò âêëþ÷àòü âèðóñíóþ ïíåâìîíèþ, âëåêóùóþ çà ñîáîé îñòðûé
ðåñïèðàòîðíûé äèñòðåññ-ñèíäðîì èëè äûõàòåëüíóþ íåäîñòàòî÷íîñòü ñ ðèñêîì
ñìåðòè [28].
Çàáîëåâàíèå âûçûâàåòñÿ íîâûì âèðóñîì, ó ëþäåé ê íåìó íåò ïðèîáðåò¸ííîãî
èììóíèòåòà, ïîýòîìó ê èíôåêöèè âîñïðèèì÷èâû ëþäè âñåõ âîçðàñòíûõ êàòåãîðèé.
Ðàñïðîñòðàíÿåòñÿ âèðóñ âîçäóøíî-êàïåëüíûì ïóò¸ì ÷åðåç âäûõàíèå ðàñïûë¸ííûõ
â âîçäóõå â ïðîöåññå êàøëÿ èëè ÷èõàíèÿ êàïåëü ñ âèðóñîì, à òàêæå ÷åðåç ïîïàäàíèå
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âèðóñà íà ïîâåðõíîñòè ñ ïîñëåäóþùèì çàíåñåíèåì â ãëàçà, íîñ èëè ðîò. Ê ÷èñëó
ýôôåêòèâíûõ ìåð ïðîôèëàêòèêè îòíîñèòñÿ ÷àñòîå ìûòü¸ ðóê è ñîáëþäåíèå ïðàâèë
ðåñïèðàòîðíîé ãèãèåíû [33].
Ïðèìåðíî â 15% ñëó÷àåâ çàáîëåâàíèå ïðîòåêàåò â òÿæ¸ëîé ôîðìå ñ
íåîáõîäèìîñòüþ ïðèìåíåíèÿ êèñëîðîäíîé òåðàïèè, åù¸ â 5 % ñîñòîÿíèå áîëüíûõ
êðèòè÷åñêîå. Ãëîáàëüíî ïî ñîñòîÿíèþ íà 01 àïðåëÿ ëåòàëüíîñòüçàáîëåâàíèÿ
îöåíèâàåòñÿ ïðèìåðíî â 5 %. Ñîãëàñíî àíàëèçó äàííûõ ïî 1099 ïàöèåíòàì ïî
ñîñòîÿíèþ íà 28 ôåâðàëÿ 2020 ãîäà ó 91,1 % ïàöèåíòîâ ñ COVID-19
äèàãíîñòèðîâàëàñü ïíåâìîíèÿ. Ïîêàçàòåëè ñ òå÷åíèåì âðåìåíè ìîãóò èçìåíèòüñÿ
[18].
11 ìàðòà ðàñïðîñòðàíåíèå âèðóñà áûëî ïðèçíàíî ïàíäåìèåé. Ýòà ýïèäåìèÿ
ÿâëÿåòñÿ ïåðâîé â èñòîðèè ÷åëîâå÷åñòâà ïàíäåìèåé, ïîääàþùåéñÿ êîíòðîëþ.
Ïðàâèòåëüñòâàì èìååò ñìûñë ïîäãîòîâèòü ñïèñêè îáó÷åííîãî ïåðñîíàëà, êîòîðûé
ñïîñîáåí âçÿòü ñèòóàöèþ ïîä êîíòðîëü, à òàêæå ñïèñêè ìåäèêàìåíòîâ, ñðåäñòâ
èíäèâèäóàëüíîé çàùèòû, ïðèïàñîâ è îáîðóäîâàíèÿ, íåîáõîäèìûõ äëÿ ëå÷åíèÿ.
ÂÎÇ ïðèçûâàåò ñòðàíû ê ïîäãîòîâêå áîëüíèö, îáåñïå÷åíèþ çàùèòû ìåäèöèíñêèõ
ðàáîòíèêîâ è ê ðåøåíèþ î íåîáõîäèìîñòè ïðèíÿòèÿ òåõ èëè èíûõ ìåð ñîöèàëüíîãî
äèñòàíöèðîâàíèÿ [25].
 ñâÿçè ñ ýïèäåìèåé ÂÎÇ îáúÿâëåíà ÷ðåçâû÷àéíàÿ ñèòóàöèÿ ìåæäóíàðîäíîãî
çíà÷åíèÿ â îáëàñòè çäðàâîîõðàíåíèÿ, à ðèñêè íà ãëîáàëüíîì óðîâíå îöåíèâàþòñÿ
êàê î÷åíü âûñîêèå. Ñèòóàöèÿ áûñòðî ðàçâèâàåòñÿ, åæåäíåâíî óâåëè÷èâàåòñÿ
êîëè÷åñòâî çàáîëåâøèõ è ïîãèáøèõ. Âåäóòñÿ ðàçëè÷íûå íàó÷íûå è êëèíè÷åñêèå
èññëåäîâàíèÿ.
Øòàìì 2019-nCoV âïåðâûå îáíàðóæåí â äåêàáðå 2019 ãîäà â ðåçóëüòàòå àíàëèçà
íóêëåèíîâîé êèñëîòûó ïàöèåíòà ñ ïíåâìîíèåé [28]. Òàê êàê ñîäåðæàíèå
íóêëåèíîâûõ êèñëîò áîëüøå âñåãî â ÿäðå, òî îíè ïîëó÷èëè ñâîå íàçâàíèå îò
ëàòèíñêîãî ñëîâà nucleus ("ÿäðî", ëàò.). Âïðî÷åì, íóêëåèíîâûå êèñëîòû ñîäåðæàòñÿ
íå òîëüêî â ÿäðå, ãäå, áåçóñëîâíî, èõ áîëüøå âñåãî, íî è â õëîðîïëàñòàõ è
ìèòîõîíäðèÿõ. Íóêëåèíîâûå êèñëîòû ÄÍÊ è ÐÍÊ ïðèñóòñòâóþò â êëåòêàõ âñåõ
æèâûõ îðãàíèçìîâ è âûïîëíÿþò âàæíåéøèå ôóíêöèè ïî õðàíåíèþ, ïåðåäà÷å è
ðåàëèçàöèè íàñëåäñòâåííîé èíôîðìàöèè.
Êîðîíàâèðóñíàÿ èíôåêöèÿ COVID-19 ãëóáîêî âõîäèò â êëåòêè äî óðîâíÿ
ÿäðûøêî. Ïîñëå ïðîíèêíîâåíèÿ â êëåòêó âèðóñà (èëè åãî íóêëåèíîâîé êèñëîòû)
ïðîèñõîäèò ïåðåêëþ÷åíèå ðåñóðñîâ êëåòêè íà ñèíòåç âèðóñíîé íóêëåèíîâîé
êèñëîòû è áåëêîâ. Ïðîèñõîäèò ýêñïðåññèÿ ãåíîâ. Ýêñïðåññèÿ ãåíîâ - ïðîöåññ, â
õîäå êîòîðîãî íàñëåäñòâåííàÿ èíôîðìàöèÿ îò ãåíà (ïîñëåäîâàòåëüíîñòè
íóêëåîòèäîâ ÄÍÊ) ïðåîáðàçóåòñÿ â ôóíêöèîíàëüíûé ïðîäóêò - ÐÍÊ èëè áåëîê.
Íåêîòîðûå ýòàïû ýêñïðåññèè ãåíîâ ìîãóò ðåãóëèðîâàòüñÿ: ýòî òðàíñêðèïöèÿ,
òðàíñëÿöèÿ, ñïëàéñèíã ÐÍÊ è ñòàäèÿ ïîñòòðàíñëÿöèîííûõ ìîäèôèêàöèé áåëêîâ.
Ïðîöåññ àêòèâàöèè ýêñïðåññèè ãåíîâ êîðîòêèìè äâóöåïî÷å÷íûìè ÐÍÊ íàçûâàåòñÿ
àêòèâàöèåé ÐÍÊ.
Êîãäà êëåòî÷íûå ðåñóðñû èñ÷åðïûâàþòñÿ, åå îáîëî÷êà ðàçðûâàåòñÿ è èç íåå
âûâàëèâàþòñÿ ãîòîâûå âèðóñíûå ÷àñòèöû. Òàêèì îáðàçîì, ïîðàæàþòñÿ äðóãèå
êëåòêè. Â ìåñòî ðàçâûâøåéñÿ êëåòêè ôîðìèðóåòñÿ ôèáðîçíàÿ òêàíü. Ýêñïðåññèÿ
ãåíîâ ÿâëÿåòñÿ ñóáñòðàòîì äëÿ ýâîëþöèîííûõ èçìåíåíèé, òàê êàê êîíòðîëü íàä
âðåìåíåì, ìåñòîì è êîëè÷åñòâåííûìèõàðàêòåðèñòèêàìè ýêñïðåññèè îäíîãî ãåíà
ìîæåò èìåòü âëèÿíèå íà ôóíêöèè äðóãèõ ãåíîâ â öåëîì îðãàíèçìå. Ýòî íàçûâàåòñÿ
- ìóòàöèÿ ãåíà.
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Ïðîòèâ áîëåçíè ïîêà îòñóòñòâóþò êàêèå-ëèáî ñïåöèôè÷åñêèå ïðîòèâîâèðóñíûå
ñðåäñòâà ëå÷åíèÿ èëè ïðîôèëàêòèêè. Òàê êàê, äî óðîâíÿ ÿäðûøêî ïîêà íå êàêîé
àíòèâèðóñíûé ïðåïàðàò íå äîñòèãàåò [28,33].  áîëüøèíñòâå ñëó÷àåâ (ïðèìåðíî â
80%) êàêîå-ëèáî ñïåöèôè÷åñêîå ëå÷åíèå íå òðåáóåòñÿ, à âûçäîðîâëåíèå
ïðîèñõîäèò ñàìî ïî ñåáå. Òÿæ¸ëûå ôîðìû áîëåçíè ñ áîëüøåé âåðîÿòíîñòüþ ìîãóò
ðàçâèòüñÿ ó ïîæèëûõ ëþäåé è ó ëþäåé ñ îïðåäåë¸ííûìè çàáîëåâàíèÿìè,
âêëþ÷àþùèìè àñòìó, äèàáåò è ñåðäå÷íûå çàáîëåâàíèÿ.  òÿæ¸ëûõ ñëó÷àÿõ
ïðèìåíÿþòñÿ ñðåäñòâà äëÿ ïîääåðæàíèÿ ôóíêöèé æèçíåííî âàæíûõ îðãàíîâ.
Ñåãîäíÿ ìû õîòèì ðàññêàçàòü âàì î ìåëàòîíèíå - "ãîðìîíà ñíà".
Ìåëàòîíèí - ýòî ãîðìîí, êîòîðûé åñòåñòâåííûì îáðàçîì âûäåëÿåòñÿ íàøèì
îðãàíèçìîì è ÷üè ôóíêöèè ÿâëÿþòñÿ îïðåäåëÿþùèìè äëÿ íàøåãî ôèçè÷åñêîãî
è ïñèõè÷åñêîãî áëàãîïîëó÷èÿ. Îí òåñíî ñâÿçàí ñ êîíòðîëåì öèðêàäíûõ ðèòìîâ -
íàøèõ áèîëîãè÷åñêèõ ÷àñîâ, è, òàêèì îáðàçîì, ïîìîãàåò íàì ëó÷øå ñïàòü.
Ïîìèìî âñåãî ïðî÷åãî, ýòî âåùåñòâî ó÷àñòâóåò â íåéðîýíäîêðèííûõ,
íåéðîôèçèîëîãè÷åñêèõ è èììóííûõ ïðîöåññàõ, êîòîðûå íåîáõîäèìû äëÿ
âûïîëíåíèÿ ìíîãèõ æèçíåííî âàæíûõ çàäà÷ îðãàíèçìà. Îäíàêî åãî ïðîèçâîäñòâî
ïðîèñõîäèò òîëüêî íî÷üþ è, åñëè ÷òî-òî ïðåïÿòñòâóåò ýòîìó, ÷åëîâåê èñïûòûâàåò
òðóäíîñòèñîñíîì è ïîëíîöåííûì îòäûõîì.
Ãîðìîí ìåëàòîíèí áûë îòêðûò â 1958 ãîäó À.Á. Ëåðíåðîì. Ýòî îñíîâíîé ãîðìîí
ýïèôèçà - îðãàíà, ïåðåäàþùåãî èíôîðìàöèþ î ñâåòîâîì ðåæèìå îêðóæàþùåé
ñðåäû âî âíóòðåííþþ ñðåäó îðãàíèçìà. Èçìåíåíèÿ êîíöåíòðàöèè ìåëàòîíèíà
èìåþò çàìåòíûé ñóòî÷íûé ðèòì - êàê ïðàâèëî, âûñîêèé óðîâåíü ãîðìîíà â òå÷åíèå
íî÷è è íèçêèé óðîâåíü â òå÷åíèå äíÿ. Ìàêñèìàëüíûå çíà÷åíèÿ êîíöåíòðàöèè
ìåëàòîíèíà â êðîâè ÷åëîâåêà íàáëþäàþòñÿ ìåæäó ïîëóíî÷üþ è 5 ÷àñàìè óòðà ïî
ìåñòíîìó ñîëíå÷íîìó âðåìåíè. Âûðàáàòûâàåòñÿ îñíîâíûìè ñåêðåòîðíûìè êëåòêàìè
ýïèôèçà - ïèíåàëîöèòàìè.
Âðåìÿ áèîëîãè÷åñêîãî ïîëóðàñïàäà ìåëàòîíèíà - 45 ìèíóò. Ýòî îçíà÷àåò, ÷òî
äëÿ èññëåäîâàòåëüñêèõ öåëåé îáðàçöû êðîâè äîëæíû áûòü ñîáðàíû ÷åðåç êîðîòêèå
ïðîìåæóòêè âðåìåíè äëÿ òîãî, ÷òîáû îïðåäåëèòü ïåðèîä â ïðîäóêöèè ìåëàòîíèíà.
Êðîìå òîãî, íàðóøåíèå ñíà ïàöèåíòà â òå÷åíèå íî÷è ñ öåëüþ ñáîðà îáðàçöîâ
ìîæåò ïîâëèÿòü íà óðîâåíü ìåëàòîíèíà â êðîâè. Ýòèõ ïðîáëåì ìîæíî èçáåæàòü,
åñëè îïðåäåëÿòü óðîâíè ìåòàáîëèòîâ ìåëàòîíèíà: ìåëàòîíèí ñóëüôàòà (6-
ñóëüôàòîêñèìåëàòîíèíà) è 6-ãèäðîêñèãëþêóðîíèäà â ìî÷å. 80-90 % ìåëàòîíèíà
ñåêðåòèðóåòñÿ â ìî÷ó â âèäå ìåëàòîíèí ñóëüôàòà. Êîíöåíòðàöèÿ ìåëàòîíèí ñóëüôàòà
â ìî÷å õîðîøî êîððåëèðóåò ñ îáùèì óðîâíåì ìåëàòîíèíà â êðîâè â òå÷åíèå
ïåðèîäà ñáîðà îáðàçöîâ [1,2,6].
Ñèíòåçèðîâàííûé â ýïèôèçå ìåëàòîíèí ïîñòóïàåò â êðîâü è ñïèííîìîçãîâóþ
æèäêîñòü - ëèêâîð, ïðîéäÿ ÷åðåç êîòîðóþ, íàêàïëèâàåòñÿ â ãèïîòàëàìóñå. Ïîìèìî
êðîâè è öåðåáðîñïèíàëüíîé æèäêîñòè, ìåëàòîíèí îáíàðóæåí â ìî÷å, ñëþíå,
àìíèîòè÷åñêîé æèäêîñòè.
Ìåëàòîíèí - ðåäêèé ïðèìåð ãîðìîíà, ó êîòîðîãî èìåþòñÿ êàê ìåìáðàííûå,
òàê è ÿäåðíûå ðåöåïòîðû.  îðãàíèçìå ÷åëîâåêà ìåëàòîíèí ñèíòåçèðóåòñÿ èç
àìèíîêèñëîòû òðèïòîôàíà, êîòîðàÿ ó÷àñòâóåò â ñèíòåçå íåéðîìåäèàòîðà
(íåéðîïåðåäàò÷èêà) ñåðîòîíèíà, à îí, â ñâîþ î÷åðåäü, ïîä âîçäåéñòâèåì ôåðìåíòà
N-àöåòèëòðàíñôåðàçû ïðåâðàùàåòñÿ â ìåëàòîíèí. Ïîêàçàíî, ÷òî ìåëàòîíèí ÿâëÿåòñÿ
èíäîëüíûì ïðîèçâîäíûì ñåðîòîíèíà è ñèíòåçèðóåòñÿ íî÷üþ ôåðìåíòàìè N-
àöåòèëòðàíñôåðàçîé è ãèäðîêñèèíäîë-Î-ìåòèëòðàíñôåðàçîé. Ó âçðîñëîãî ÷åëîâåêà
çà ñóòêè ñèíòåçèðóåòñÿ îêîëî 30 ìêã ìåëàòîíèíà, åãî êîíöåíòðàöèÿ â ñûâîðîòêå
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Áèîìåäèöèíà âà àìàëè¸ò æóðíàëè / Æóðíàë áèîìåäèöèíû è ïðàêòèêè / Journal of biomedicine and practice ¹SI / 2020
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êðîâè íî÷üþ â 30 ðàç áîëüøå, ÷åì äí¸ì, ïðè÷¸ì ìàêñèìóì êîíöåíòðàöèè â
ñðåäíåì ïî ìíîæåñòâó íàáëþäåíèé ïðèõîäèòñÿ ïðèáëèçèòåëüíî íà 2 ÷àñà íî÷è
ïî ìåñòíîìó ñîëíå÷íîìó âðåìåíè. Ìåëàòîíèí òðàíñïîðòèðóåòñÿ ñûâîðîòî÷íûì
àëüáóìèíîì, ïîñëå îñâîáîæäåíèÿ îò àëüáóìèíà ñâÿçûâàåòñÿ ñî ñïåöèôè÷åñêèìè
ðåöåïòîðàìè íà ìåìáðàíå êëåòîê-ìèøåíåé, ïðîíèêàåò â ÿäðî è òàì îñóùåñòâëÿåò
ñâî¸ äåéñòâèå. Ìåëàòîíèí áûñòðî ãèäðîëèçóåòñÿ â ïå÷åíè è ýêñêðåòèðóåòñÿ ñ
ìî÷îé, îñíîâíûì ìåòàáîëèòîì ÿâëÿåòñÿ 6-ãèäðîêñèìåëàòîíèí-ñóëüôàò (6-ÑÎÌÒ),
ñîäåðæàíèå êîòîðîãî ïîçâîëÿåò êîñâåííî ñóäèòü î ïðîäóêöèè ìåëàòîíèíà
ýïèôèçîì [3,4,7].
 îðãàíèçìå ïðèñóòñòâóåò è ìåëàòîíèí, îáðàçóþùèéñÿ âíå ýïèôèçà. Ýòî
îòêðûòèå â 1974 ãîäó ñäåëàëè ðîññèéñêèå ó÷¸íûå Í.Ò. Ðàéõëèí è È.Ì. Êâåòíîé
- îíè îáíàðóæèëè, ÷òî ìåëàòîíèí ñèíòåçèðóåòñÿ â êëåòêàõ ÷åðâåîáðàçíîãî îòðîñòêà
êèøå÷íèêà. Çàòåì âûÿñíèëîñü, ÷òî ìåëàòîíèí îáðàçóåòñÿ è â äðóãèõ îòäåëàõ
æåëóäî÷íî-êèøå÷íîãî òðàêòà, à òàêæå âî ìíîãèõ äðóãèõ îðãàíàõ [27].
Ñåêðåöèÿ ìåëàòîíèíà ïîä÷èíåíà ñóòî÷íîìó ðèòìó, îïðåäåëÿþùåìó, â ñâîþ
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î÷åðåäü, ðèòìè÷íîñòü ãîíàäîòðîïíûõ ýôôåêòîâ è ïîëîâîé ôóíêöèè. Ñèíòåç è
ñåêðåöèÿ ìåëàòîíèíà çàâèñÿò îò îñâåù¸ííîñòè - èçáûòîê ñâåòà ïîíèæàåò åãî
îáðàçîâàíèå, à ñíèæåíèå îñâåù¸ííîñòè óâåëè÷èâàåò ñèíòåç è ñåêðåöèþ ãîðìîíà.
Ó ÷åëîâåêà ñ íîðìàëüíûì ðàñïîðÿäêîì äíÿ (ñî ñíîì íî÷üþ) íà íî÷íûå ÷àñû
ïðèõîäèòñÿ ïðèìåðíî 70% ñóòî÷íîé ïðîäóêöèè ìåëàòîíèíà.  êëèíè÷åñêèõ
óñëîâèÿõ óñòàíîâëåíî, ÷òî äåïðèâàöèÿ ñíà â íî÷íûå ÷àñû ïðèâîäèò ê íàðóøåíèþ
ñóòî÷íîãî ðèòìà âûðàáîòêè ìåëàòîíèíà - ïðîäóêöèÿ â íî÷íîå âðåìÿ ñíèæàåòñÿ
è ïðèáëèæàåòñÿ ê äíåâíîìó óðîâíþ [7].
Ñäâèã ðèòìà ñåêðåöèè ìåëàòîíèíà ïðîèñõîäèò è ïðè ïåðåë¸òå â äðóãèå ÷àñîâûå
ïîÿñà.
Ìåëàòîíèí òàêæå èçâåñòåí êàê N-acetyl-5-methoxytryptamine and N-[2-(5-
Methoxy-1H-indol-3-yl) ethyl] acetamide.
Âûðàáîòêà ìåëàòîíèíà âñåöåëî çàâèñèò îò áèîëîãè÷åñêèõ ÷àñîâ îðãàíèçìà
÷åëîâåêà è ñìåíû íàòóðàëüíîãî öèêëà "äåíü-íî÷ü". Òàê êàê ïðîäóêöèÿ ìåëàòîíèíà
çàâèñèò îò äëèíû ñâåòîâîãî äíÿ, ìíîãèå æèâîòíûå èñïîëüçóþò å¸ êàê "ñåçîííûå
÷àñû". Ó ëþäåé, êàê è ó æèâîòíûõ, ïðîäóêöèÿ ìåëàòîíèíà ëåòîì ìåíüøå, ÷åì
çèìîé.
Òàêèì îáðàçîì, ìåëàòîíèí ìîæåò ðåãóëèðîâàòü ôóíêöèè, çàâèñÿùèå îò
ôîòîïåðèîäà - ðàçìíîæåíèå, ìèãðàöèîííîå ïîâåäåíèå, ñåçîííóþ ëèíüêó. Ó âèäîâ
ïòèö è ìëåêîïèòàþùèõ, êîòîðûå ðàçìíîæàþòñÿ ïðè äëèííîì äíå, ìåëàòîíèí
ïîäàâëÿåò ñåêðåöèþ ãîíàäîòðîïèíîâ è ñíèæàåò óðîâåíü ïîëîâîé àêòèâíîñòè. Ó
æèâîòíûõ, ðàçìíîæàþùèõñÿ ïðè êîðîòêîì ñâåòîâîì äíå, ìåëàòîíèí ñòèìóëèðóåò
ïîëîâóþ àêòèâíîñòü. Âëèÿíèå ìåëàòîíèíà íà ðåïðîäóêòèâíóþ ôóíêöèþ ó ÷åëîâåêà
íåäîñòàòî÷íî èçó÷åíî.  ïåðèîä ïîëîâîãî ñîçðåâàíèÿ ïèêîâàÿ (íî÷íàÿ)
êîíöåíòðàöèÿ ìåëàòîíèíà ðåçêî ñíèæàåòñÿ. Çèìîé ÷èñëî ìåíñòðóàëüíûõ öèêëîâ,
íå çàêàí÷èâàþùèõñÿ îâóëÿöèåé, â ñðåäíåì âûøå, ÷åì ëåòîì. Ó æåíùèí ñ
ãèïîôèçàðíîé àìåíîðååé êîíöåíòðàöèÿ ìåëàòîíèíà äîñòîâåðíî âûøå, ÷åì ó
çäîðîâûõ. Ýòè äàííûå ïîçâîëÿþò ïðåäïîëàãàòü, ÷òî ìåëàòîíèí ïîäàâëÿåò
ðåïðîäóêòèâíûå ôóíêöèè ó æåíùèí [9].
Ìåëàòîíèí - òâåðäàÿ, ïîãëîùàþùàÿ èëè ðàñòâîðÿþùàÿ æèð, âîäîíåðàñòâîðèìàÿ
ñóáñòàíöèÿ, ÿâëÿþùàÿñÿ ìîùíûì åñòåñòâåííûì àíòèîêñèäàíòîì. Îðãàíèçì,
ñèíòåçèðóÿ åþ, çàùèùàåòñÿ îò èçáûòî÷íîãî îáðàçîâàíèÿ ñâîáîäíûõ ðàäèêàëîâ -
ïðîäóêòîâ îáìåíà âåùåñòâ, âûçûâàþùèõ áûñòðîå ñòàðåíèå è ðàê. Ìåëàòîíèí
îáëàäàåò óíèêàëüíîé ñïîñîáíîñòüþ, â îòëè÷èå îò äðóãèõ àíòèîêñèäàíòîâ,
ïðîíèêàòü â ëþáóþ êëåòêó â ëþáîé ÷àñòè îðãàíèçìà è îêàçûâàòü ñïåöèôè÷åñêîå
çàùèòíîå äåéñòâèå íà ÿäðî - öåíòðàëüíóþ ñòðóêòóðó êëåòêè, ñîäåðæàùóþ ÄÍÊ,
ò.å. íà ñòðóêòóðó, ïîçâîëÿþùóþ ïîâðåæäåííîé êëåòêå âîññòàíîâèòüñÿ. Èçâåñòíî,
÷òî ìåëàòîíèí îêàç ûâ à å ò ñòèì óëèðóþùåå äåéñòâèå íà ôåðì åí ò
ãëþòàòèîíïåðîêñèäàçó, îáëàäàþùóþ àíòèîêñèäàíòíûìè ñâîéñòâàìè. Ìåëàòîíèí
ìîæåò òàêæå ñóùåñòâîâàòü â ñèíòåòè÷åñêîé ôîðìå, êîòîðàÿ ïðèìåíÿåòñÿ, êàê
äîáàâêà, îáëàäàþùàÿ ñíîòâîðíûì è àíòèîêñèäàíòíûì ñâîéñòâàìè. Ýòî ñòàíîâèòñÿ
àêòóàëüíûì ñ âîçðàñòîì ÷åëîâåêà, êîãäà àêòèâíîñòü æåëåç âíóòðåííåé ñåêðåöèè
îðãàíèçìà óãàñàåò.
Àíòèîêñèäàíòíûé ýôôåêò
Ìåëàòîíèí íåéòðàëèçóåò ðàçðóøèòåëüíûå ïîñëåäñòâèÿ îêèñëèòåëüíûõ
ïðîöåññîâ, êîòîðûå ÿâëÿþòñÿ îñíîâíîé ïðè÷èíîé ñòàðåíèÿ è óâÿäàíèÿ êîæè.
Âàæíåéøàÿ ôóíêöèÿ ìåëàòîíèíà - àíòèîêñèäàíòíàÿ àêòèâíîñòü, ïðîÿâëÿþùàÿñÿ
â îðãàíèçìå ïîâñåìåñòíî, òàê êàê ìåëàòîíèí ïðîíèêàåò âî âñå îðãàíû è òêàíè.
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Ìåõàíèçì àíòèîêñèäàíòíîãî äåéñòâèÿ ïðîÿâëÿåòñÿ â òîì, ÷òî ìåëàòîíèí îáëàäàåò
âûðàæåííîé ñïîñîáíîñòüþ ñâÿçûâàòü ñâîáîäíûå ðàäèêàëû, â òîì ÷èñëå
îáðàçóþùèåñÿ ïðè ïåðåêèñíîì îêèñëåíèè ëèïèäîâ ãèäðîêñèëüíûõ ðàäèêàëîâ, è
ýêçîãåííûå êàíöåðîãåíû, òàêæå îí àêòèâèðóåò ãëóòàòèîíïåðîêñèäàçó - ôàêòîð
çàùèòû îðãàíèçìà îò ñâîáîäíîðàäèêàëüíîãî ïîâðåæäåíèÿ. Îñíîâíûå ôóíêöèè
àíòèîêñèäàíòíîãî äåéñòâèÿ ìåëàòîíèíà íàïðàâëåíû íà çàùèòó ÄÍÊ. Â ìåíüøåé
ñòåïåíè - íà çàùèòó áåëêîâ è ëèïèäîâ [31].
Ìåëàòîíèí - ñàìûé ñèëüíûé èç èçâåñòíûõ ýíäîãåííûõ ïîãëîòèòåëåé ñâîáîäíûõ
ðàäèêàëîâ. Â ïîñëåäíèå ãîäû ïîÿâèëèñü äàííûå, ÷òî ìåëàòîíèí ìîæåò íàõîäèòüñÿ
íå òîëüêî â ïëàçìå, íî è â ÿäðàõ êëåòîê è ïðåäîõðàíÿòü ìàêðîìîëåêóëû ÿäðà îò
îêèñëèòåëüíîãî ïîâðåæäåíèÿ âî âñåõ ñóáêëåòî÷íûõ ñòðóêòóðàõ.
Èììóíîñòèìóëèðóþùèé ýôôåêò
Âàæíûì ïîñëåäñòâèåì äëèòåëüíûõ ñòðåññîâ ÿâëÿåòñÿ ñòðåññîâûé èììóíîäåôèöèò.
Ìåëàòîíèí ñïîñîáñòâóåò íîðìàëèçàöèè èììóíîëîãè÷åñêèõ ïîêàçàòåëåé. Ìåëàòîíèí
è äðóãèå ýïèôèçàðíûå ãîðìîíû ìîãóò áûòü îòíåñåíû ê ÷èñëó ãåðîïðîòåêòèâíûõ.
Óñòàíîâëåíà ñâÿçü ìåæäó ñòåïåíüþ âîçðàñòíîé èíâîëþöèè ýïèôèçà è äðÿõëåíèåì
òêàíåé. Èçâåñòíî, ÷òî ïðè ñòàðåíèè ñíèæàåòñÿ ñòåïåíü èììóíîëîãè÷åñêîé çàùèòû,
à ìåëàòîíèí, êàê óæå íåîäíîêðàòíî óêàçûâàëîñü, èìååò èììóíîìîäóëèðóþùóþ
àêòèâíîñòü. Ñ âîçðàñòîì ó ÷åëîâåêà â êðîâè êîíöåíòðàöèÿ ìåëàòîíèíà ïîíèæàåòñÿ.
Ïðè ïîíèæåíèè åãî óðîâíÿ íèæå 20% îò íîðìû ëåéêîöèòû ïåðåñòàþò ðàñïîçíàâàòü
â êðîâè ïàðàçèòîâ, è âèðóñîâ, íà÷èíàåòñÿ çàðàæåíèå îðãàíèçìà [24].
Ìåëàòîíèí ñòèìóëèðóåò èììóííóþ ñèñòåìó (èììóíîñòèìóëÿòîð), òàê êàê
ó÷àñòâóåò â ðåãóëÿöèè ôóíêöèè òèìóñà è ùèòîâèäíîé æåëåçû, ïîâûøàÿ àêòèâíîñòü
Ò-êëåòîê è ôàãîöèòîâ, ÷òî ÿâëÿåòñÿ ïðåäóïðåæäåíèåì äëÿ ðÿäà çàáîëåâàíèé è,
êàê ïîêàçûâàþò ëàáîðàòîðíûå èññëåäîâàíèÿ, çàìåäëÿåò ðîñò ñåìè âèäîâ ðàêîâûõ
êëåòîê, âêëþ÷àÿ ðàêîâûå êëåòêè ìîëî÷íîé è ïðåäñòàòåëüíîé æåëåç.
Íåäîñòàòîê ìåëàòîíèíà â îðãàíèçìå
Ýêñïåðèìåíòû íà ëàáîðàòîðíûõ æèâîòíûõ ïîêàçàëè, ÷òî ïðè íåäîñòàòêå
ìåëàòîíèíà, âûçâàííîì óäàëåíèåì ðåöåïòîðîâ, æèâîòíûå íà÷èíàëè áûñòðåå
ñòàðåòü: ðàíüøå íà÷èíàëàñü ìåíîïàóçà, íàêàïëèâàëèñü ñâîáîäíîðàäèêàëüíûå
ïîâðåæäåíèÿ êëåòîê, ñíèæàëàñü ÷óâñòâèòåëüíîñòü ê èíñóëèíó, ðàçâèâàëèñü
îæèðåíèå è ðàê [27].
Ýêñòðàïèíåàëüíûé ñèíòåç ìåëàòîíèíà
Êîëè÷åñòâà ãîðìîíà, êîòîðîå âûðàáàòûâàåòñÿ â øèøêîâèäíîé æåëåçå, íå õâàòàåò
äëÿ îáåñïå÷åíèÿ ñòîëü ìíîãî÷èñëåííûõ áèîëîãè÷åñêèõ ýôôåêòîâ ìåëàòîíèíà.
Èññëåäîâàíèÿìè áûëî ïîêàçàíî, ÷òî ïîñëå óäàëåíèÿ ïèíåàëüíîé æåëåçû ó
ýêñïåðèìåíòàëüíûõ æèâîòíûõ â êðîâè îáíàðóæèâàþòñÿ çíà÷èìûå êîëè÷åñòâà
ìåëàòîíèíà.  íàñòîÿùåå âðåìÿ òâ¸ðäî óñòàíîâëåíî, ÷òî ïèíåàëüíàÿ æåëåçà íå
ÿâëÿåòñÿ ìîíîïîëüíûì îðãàíîì âûðàáîòêè ìåëàòîíèíà. Ýêñòðàïèíåàëüíûìè
èñòî÷íèêàìè ñèíòåçà ìåëàòîíèíà ÿâëÿþòñÿ ýíòåðîõðîìàôôèííûå êëåòêè
æåëóäî÷íî-êèøå÷íîãî òðàêòà (ÅÑ-êëåòêè), îñíîâíûå êëåòêè-äåïî ñåðîòîíèíà
(ñîäåðæàò äî 95 % âñåãî ýíäîãåííîãî ñåðîòîíèíà) - ïðåäøåñòâåííèêà ìåëàòîíèíà.
Âûÿâëåí ñèíòåç ýòîãî ãîðìîíà â áîëüøîì êîëè÷åñòâå íåéðîýíäîêðèííûõ êëåòîê
âîçäóõîíîñíûõ ïóòåé, ë¸ãêèõ, â êîðêîâîì ñëîå ïî÷åê è âäîëü ãðàíèöû ìåæäó
êîðêîâûì è ìîçãîâûì ñëîåì íàäïî÷å÷íèêîâ, ïîä ïå÷¸íî÷íîé êàïñóëîé, â
ïàðàãàíãëèÿõ, ÿè÷íèêàõ, ýíäîìåòðèè, ïðåäñòàòåëüíîé æåëåçå, ïëàöåíòå, æåë÷íîì
ïóçûðå è âíóòðåííåì óõå. Ñèíòåç ìåëàòîíèíà îáíàðóæåí òàêæå è â íå ýíäîêðèííûõ
êëåòêàõ, òàêèõ êàê òó÷íûõ êëåòêàõ, ëèìôîöèòàõ, òðîìáîöèòàõ, ýîçèíîôèëüíûõ
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ëåéêîöèòàõ, â òèìóñå, ïîäæåëóäî÷íîé æåëåçå, ìîçæå÷êå, ñåò÷àòêå ãëàçà è â
íåêîòîðûõ ýíäîòåëèàëüíûõ êëåòêàõ [8,25].
Ôóíêöèîíàëüíî ìíîãèå êëåòêè, ïðîäóöèðóþùèå ìåëàòîíèí, îòíîñÿòñÿ ê òàê
íàçûâàåìîé äèôôóçíîé íåéðîýíäîêðèííîé ñèñòåìå - óíèâåðñàëüíîé ñèñòåìå
àäàïòàöèè è ïîääåðæàíèÿ ãîìåîñòàçà îðãàíèçìà.
 ïðåäåëàõ ýòîé ñèñòåìû âûäåëÿþò äâà çâåíà ìåëàòîíèí ïðîäóöèðóþùèõ êëåòîê:
- öåíòðàëüíîå (âêëþ÷àåò ïèíåàëüíóþ æåëåçó è êëåòêè çðèòåëüíîé ñèñòåìû),
â êîòîðîì ðèòì ñåêðåöèè ìåëàòîíèíà ñîâïàäàåò ñ ðèòìîì "ñâåò-òåìíîòà";
- ïåðèôåðè÷åñêîå - âñå îñòàëüíûå êëåòêè, ãäå ñåêðåöèÿ ãîðìîíà íå çàâèñèò
îò îñâåù¸ííîñòè.
Ñ âîçðàñòîì àêòèâíîñòü ýïèôèçà ñíèæàåòñÿ, ïîýòîìó êîëè÷åñòâî ìåëàòîíèíà
óìåíüøàåòñÿ, ñîí ñòàíîâèòñÿ ïîâåðõíîñòíûì è áåñïîêîéíûì, âîçìîæíà
áåññîííèöà.
Ñèìïòîìû íåõâàòêè ìåëàòîíèíà
- Áåññîííèöà è äðóãèå ðàññòðîéñòâà ñíà
- Íàðóøåíèå öèêëîâ ñíà è áîäðñòâîâàíèÿ
- Îñëàáëåíèå èììóííîé ñèñòåìû
- Êîëåáàíèÿ àðòåðèàëüíîãî äàâëåíèÿ
- Íàðóøåíèÿ ïñèõè÷åñêîé àäàïòàöèè
- Òðåâîæíî-äåïðåññèâíûå ñîñòîÿíèÿ
Îñíîâíûå ïðè÷èíû íàðóøåíèÿ åñòåñòâåííîé âûðàáîòêè ìåëàòîíèíà:
- Íàðóøåíèÿ ðåæèìà ñíà è áîäðñòâîâàíèÿ,
- Ðåãóëÿðíîå ïîòðåáëåíèå àëêîãîëÿ è íèêîòèíà
- Íåñáàëàíñèðîâàííîå ïèòàíèå
- Åñòåñòâåííîå ñíèæåíèå âûðàáîòêè ìåëàòîíèíà ñ âîçðàñòîì
- Âàõòîâûé ìåòîä ðàáîòû, íî÷íûå ñìåíû
- Ñîí â îñâåùåííîì ïîìåùåíèè
Àñïèðèí, áåòà-áëîêàòîðû ìîãóò ïðèâåñòè ê ñíèæåíèþ óðîâíÿ ìåëàòîíèíà â
îðãàíèçìå. Ñåäàòèâíûå àíòèäåïðåññàíòû, òðàíêâèëèçàòîðû è äðóãèå
óñïîêàèâàþùèå ñðåäñòâà ìîãóò ïðèâåñòè ê óìåíüøåíèþ îæèäàåìîãî ýôôåêòà.
Âîçâðàùàÿñü ê íà÷àòîìó, ïî÷òè âñå ëåòó÷èå ìûøè (êàê è âîîáùå ðóêîêðûëûå)
âåäóò íî÷íîé îáðàç æèçíè, à äí¸ì ñïÿò. Êðîìå òîãî, ëåòó÷èå ìûøè ÷àñòî óñòðàèâàþò
ñåáå óþòíûå óêðûòèÿ, çàáèâøèñü â òðåùèíû äåðåâüåâ, ñêàë èëè â ùåëè â
ïîñòðîéêàõ. Óáåæèùàìè ìîãóò ñëóæèòü ïîëîñòè â äåðåâüÿõ, ïåùåðû, ãðîòû è
ðàçëè÷íûå èñêóññòâåííûå ñîîðóæåíèÿ, êàê íàäçåìíûå, òàê è ïîäçåìíûå. Ëåòó÷èå
ìûøè ñïîñîáíû âïàäàòü â îöåïåíåíèå, ñîïðîâîæäàþùååñÿ óìåíüøåíèåì ñêîðîñòè
îáìåíà âåùåñòâ, èíòåíñèâíîñòè äûõàíèÿ è ÷àñòîòû ñåðäå÷íûõ ñîêðàùåíèé, ìíîãèå
ñïîñîáíû âïàäàòü â äëèòåëüíóþ ñåçîííóþ ñïÿ÷êó (äî 8 ìåñÿöåâ). Óñòàíîâëåíî,
÷òî ñîäåðæàíèå ðåòèíîëà è òîêîôåðîëà ó ëåòó÷èõ ìûøåé íà ïðîòÿæåíèè ñïÿ÷êè
áûëî äîñòàòî÷íî âûñîêèì è ïîçâîëèëî äëèòåëüíîå âðåìÿ âûäåðæèâàòü îòñóòñòâèå
ïîñòóïëåíèÿ îáëèãàòíûõ àíòèîêñèäàíòîâ, ñîõðàíÿÿ ïðè ýòîì ðåçåðâû,
íåîáõîäèìûå äëÿ ðåïðîäóêöèè.
Ëåòó÷èå ìûøè ÿâëÿþòñÿ åñòåñòâåííûì ðåçåðâóàðîì áåøåíñòâà è, ïî äàííûì
ÂÎÇ, âèðóñîâ Ìàðáóðã, Ýáîëà è êîðîíàâèðóñîâ, âõîäÿùèõ â ãðóïïó îñîáî îïàñíûõ
èíôåêöèé - ñïèñîê ñàìûõ îïàñíûõ äëÿ ÷åëîâåêà èçâåñòíûõ ïàòîãåííûõ âèðóñîâ,
ÿâëÿþùèõñÿ ïðè÷èíîé ñìåðòåëüíûõ çàáîëåâàíèé. Èìåþòñÿ ôàêòè÷åñêèå äàííûå
î ïðè÷àñòíîñòè ëåòó÷èõ ìûøåé ê ïåðåäà÷å èíôåêöèè.
Âûâîäû:
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1. Ñ âîçðàñòîì âûðàáîòêà ìåëàòîíèíà ñíèæàåòñÿ, ÷òî ìîæåò ïëîõî îòðàæàòüñÿ
íà êëèíè÷åñêîì òå÷åíèè êîðîíàâèðóñíîé èíôåêöèè COVID-19.
2. Íå çäîðîâûé îáðàç æèçíè ñíèæàåò âûðàáîòêó ìåëàòîíèíà
3. Ëåêàðñòâåííûå ïðåïàðàòû ñíèæàþò óðîâåíü ìåëàòîíèíà
4. Èç-çà ìåëàòîíèíà ëåòó÷èå ìûøè íå óìèðàþò, à ñòàíîâÿòñÿ íîñèòåëÿìè
èíôåêöèè.
5. Ëåòíûå ïåðèîäû ãîäà ìîæåò óâåëè÷èòüñÿ êîëè÷åñòâî çàðàæåííûõ
êîðîíàâèðóñîì çà ñ÷åò óäëèíåíèÿ ñâåòîâîãî äíÿ. Èçáûòîê ñâåòà ïîíèæàåò
îáðàçîâàíèå ìåëàòîíèíà
Ðåêîìåíäàöèè:
Ïðèìåíåíèÿ Ìåëàòîíèíà ïðè ëå÷åíèè áîëüíûõ ñ êîðîíàâèðóñîì COVID19
ìîæåò áëàãîïðèÿòíî ïîâëèÿòü íà èñõîä è ðåçóëüòàò ëå÷åíèÿ. Òàê, êàê, ýêçîãåííûé
ìåëàòîíèí àêòèâèðóåò êëåòêè-êèëëåðû è ìîíîöèòû êàê â êîñòíîì ìîçãå, òàê è â
ñåëåçåíêå ñ ëàòåíòíûì ïåðèîäîì â 7-14 äíåé. Ýòî êîìïîíåíòû íåñïåöèôè÷åñêîé
èììóííîé çàùèòû, íåêîòîðûå àâòîðû ñ÷èòàþò, ÷òî ìåëàòîíèí ñïîñîáåí
áëîêèðîâàòü îïóõîëåâûé ðîñò è óíè÷òîæàòü çàðàæåííûå âèðóñîì êëåòêè.
Óñòàíîâëåíî, ÷òî ìåëàòîíèí ñòèìóëèðóåò ñèíòåç è âûñâîáîæäåíèå îïèîèäíûõ
ïåïòèäîâ è òàêèì îáðàçîì ó÷àñòâóåò â ðåãóëÿöèè êëåòî÷íîãî ãåìîïîýçà è
ãóìîðàëüíîãî èììóíèòåòà. Ââåäåíèå ìåëàòîíèíà ïðè âàêöèíàöèè ïîòåíöèðóåò
âûðàáîòêó ñïåöèôè÷åñêèõ àíòèòåë. Èçâåñòíî, ÷òî ïðè ñòðåññîâûõ è çíà÷èòåëüíûõ
ôèçè÷åñêèõ íàãðóçêàõ ïðîèñõîäèò àêòèâàöèÿ ïðîâîñïàëèòåëüíûõ ôàêòîðîâ
(öèòîêèíîâ è ýéêîçàíîèäîâ), ðàñòåò óðîâåíü ôàêòîðà íåêðîçà îïóõîëåé àëüôà
(TNF-à), ïîâûøàåòñÿ óðîâåíü ëèìôîöèòîâ â êðîâè. Ëèïîïîëèñàõàðèäû (LPS)
ïîòåíöèðóþò ýòè ýôôåêòû - ñèòóàöèÿ, êîòîðàÿ ìîæåò èìåòü ìåñòî ïðè
íåàäåêâàòíûõ, èñòîùàþùèõ çàùèòíûå ñèëû îðãàíèçìà ôèçè÷åñêèõ íàãðóçêàõ.
Ïðè ýòîì íàðàñòàþò ïðîÿâëåíèÿ îêèñëèòåëüíîãî ñòðåññà, ïðèâîäÿùèå ê
íàðóøåíèþ öåëîñòíîñòè ãåìàòîêèøå÷íîãî áàðüåðà è âûõîäó â êðîâü LPS. Òî, ÷òî
ìåëàòîíèí ïîäàâëÿåò ïðî âîñïàëèòåëüíóþ ðåàêöèþ â îòâåò íà ôèçè÷åñêóþ
íàãðóçêó, ñëåäóåò èìåòü â âèäó ïðè ïîäãîòîâêå ñïîðòñìåíîâ è ïðè
âîññòàíîâèòåëüíûõ ìåðîïðèÿòèÿõ ó ëþäåé, çàíÿòûõ òÿæåëûì ôèçè÷åñêèì òðóäîì.
Ìåëàòîíèí áëàãîäàðÿ ñâîèì àíòèîêñèäàíòíûì è ïðîòèâîâîñïàëèòåëüíûì ñâîéñòâàì
ñïîñîáåí ñíèæàòü óðîâåíü ïîâðåæäåíèé ñëèçèñòîé æåëóäêà ïðè âîçäåéñòâèè
ìíîãèõ ïîâðåæäàþùèõ ôàêòîðîâ: ñòðåññà, àëêîãîëÿ, æåë÷è è íåñòåðîèäíûõ
ïðîòèâîâîñïàëèòåëüíûõ ïðåïàðàòîâ.
Àêòèâàöèÿ ìàêðîôàãîâ ïðè ïàòîëîãè÷åñêèõ ñîñòîÿíèÿõ ïðèâîäèò ê ïîâûøåíèþ
ïðîäóêöèè îêñèäà àçîòà (NO). Ýòîò ïðîöåññ íåáåçðàçëè÷åí äëÿ îðãàíèçìà è ìîæåò
ïðèâåñòè ê ðàçâèòèþ äåãåíåðàòèâíûõ çàáîëåâàíèé. Ìåëàòîíèí ïîäàâëÿåò ýòè
èçìåíåíèÿ, èíãèáèðóÿ ýêñïðåññèþ èíäóöèáåëüíîé NO-ñèíòàçû ìàêðîôàãîâ.
Ââåäåíèå ôàðìàêîëîãè÷åñêèõ äîç ìåëàòîíèíà ïðåäóïðåæäàëî ðàçâèòèå
ïîâðåæäåíèé in vivo, à òàêæå ïîäàâëÿëî ïåðåêèñíîå îêèñëåíèå è èíäóêöèþ NO
â êóëüòóðå êëåòîê òîëñòîãî êèøå÷íèêà.
Áëàãîäàðÿ èíòåíñèâíûì èññëåäîâàíèÿì ïîñëåäíèõ ëåò ñòàëè ïîÿâëÿòüñÿ
ñîîáùåíèÿ îá óñïåøíîì ïðèìåíåíèè ìåëàòîíèíà ïðè áàêòåðèàëüíîì ìåíèíãèòå
â êà÷åñòâå çàùèòû íåéðîíîâ ìîçãà îò ïîâðåæäåíèÿ, äëÿ íîðìàëèçàöèè ñíà è
îáùåãî ñîñòîÿíèÿ ïðè íàðóøåíèè âíèìàíèÿ è ãèïåðàêòèâíîñòè, ïðè ñèíäðîìå
íàðóøåíèé ôàç ñíà, ïðè ìèãðåíÿõ è ïðèñòóïàõ ãîëîâíîé áîëè, â êîìïëåêñíîé
òåðàïèè ðàññåÿííîãî ñêëåðîçà, ïðè ñèíäðîìå õðîíè÷åñêîé óñòàëîñòè, ïðè íî÷íûõ
ïðèñòóïàõ áðîíõèàëüíîé àñòìû, ïðè ôèáðîìèàëãèÿõ, ïðè ñèíäðîìå ðàçäðàæåííîé
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òîëñòîé êèøêè, ïðè ðåñïèðàòîðíîì äèñòðåññ ñèíäðîìå íîâîðîæäåííûõ.
Òàêèì îáðàçîì, èçó÷åíèå õèìèêî-áèîëîãè÷åñêèõ ñâîéñòâ ìåëàòîíèíà äàåò
âîçìîæíîñòü øèðîêîãî ïðèìåíåíèÿ åãî â ìåäèöèíñêîé ïðàêòèêå, ïîñêîëüêó
ýêñïåðèìåíòàëüíûå äàííûå ïîäòâåðæäàþò åãî ïîëîæèòåëüíîå âëèÿíèå íà òå÷åíèå,
êàê ôèçèîëîãè÷åñêèõ ïðîöåññîâ, òàê è íèâåëèðîâàíèå ìíîãèõ ïàòîëîãè÷åñêèõ
ñîñòîÿíèé.
Ñïèñîê ëèòåðàòóðû:
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a paracoid, and an antioxidant vitamin. Journal of pineal research, 34(1), 75-78.
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ÁÈÎÌÅÄÈÖÈÍÀ ÂÀ ÀÌÀËÈ¨Ò ÆÓÐÍÀËÈ
ÆÓÐÍÀË ÁÈÎÌÅÄÈÖÈÍÛ È ÏÐÀÊÒÈÊÈ
JOURNAL OF BIOMEDICINE AND PRACTICE
ÀÊÓØÅÐËÈÊ ÂÀ ÃÈÍÅÊÎËÎÃÈß
Iroda Mirsoli qizi TOJIEVA
Gynecologist, consultative polyclinic department,
Republiñ Specialized Scientific-Practical Medical
Centre of Endocrinology named after academician
Ya.Kh.Turakulov, Tashkent, Uzbekistan
VITAMIN D DEFICIENCY AND GESTATIONAL DIABETES
MELLITUS IN UZBEKISTAN
For citation: I.M. Tojieva. Vitamin D deficiency and gestational diabetes mellitus in
Uzbekistan. Journal of Biomedicine and Practice, 2020 Journal of Biomedicine and
Practice 2020, Special issue, pp.19-25
http:// dx.doi.org/10.26739/2181-9300-2020-SI-2
ANNOTATION
The purpose of this study was to examine the relationship between vitamin D levels
and glucose metabolism in pregnant women. This study compared serum levels of 25-
hydroxy vitamin D3 in pregnant women with gestational diabetes mellitus (GDM) and
non-GDM control subjects. We analyzed serum 25OHD concentrations in 95 pregnant
women, 75 women with diagnosed GDM and 20 women non-GDM. Maternal serum
25-hydroxy vitamin D3 concentration in GDM group at 18-32 weeks of gestation were
significantly lower than non-GDM controls, 16.76±6.88 and 21.06±9.83 respectively
(P = 0.03).Maternal 25OHD concentrations are inversely related to glucose levels and
the relationshi p between vitamin D status and glucose tolerance in pregnancy needs
further study.
Key words: gestational diabetes mellitus, vitamin D, pregnancy
Iroda Mirsoli qizi TOJIEVA
Maslahat poliklinikasi bo'limi Ginekologi,
akademik Y.X. To'raqulov nomli Respublika Ixtisoslashgan Ilmiy-Amaliy
Endokrinologia Tibbiyot Markazi, Toshkent, O'zbekiston.
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O'ZBEKISTONDA VITAMIN "D"NING YETISHMOVCHILIGI VA
GESTASION DIABET
ANNOTATSIYA
Ushbu tadqiqotning maqsadi homilador ayollarda D vitamini darajasi va glyukoza
metabolizmi o'rtasidagi bog'liqlikni o'rganish edi. Ushbu tadqiqotda homilador ayollarda
homiladorlikdagi qandli diabet kasalligi (GDM) va GDM bo'lmagan nazorat guruhidagi
sarum 25-OH-D3 vitaminini taqqoslandi. 95 homilador ayolda, GDM tashxisi qo'yilgan
75 ayolda va 20 sog'lom homilador ayollarda sarum 25OHD kontsentratsiyasini tahlil
qilindi. 18-32 xaftalik homiladorlik davrida GDM bo'lgan onalarda 25-gidroksi-D3
kontsentratsiyasi GDM holda nazorat guruhiga qaraganda 16,76 ± 6,88 va 21,06 ± 9,83
ancha pastligi aniqlandi (p = 0.03). D vitamini va glyukoza darajasi o'rtasida bog'likligi
mavjud bo'ldi . D vitamini darajasi va homiladorlik paytida glyukoza bardoshliligi o'rtasidagi
bog'liqlik qo'shimcha o'rganishni talab qiladi.
Kalit so'zlar: homiladorlik diabet, D vitamini, homiladorlik.
Èðîäà Ìèðñîëèåâíà Òîæèåâà
Ãèíåêîëîã îòäåëåíèè êîíñóëüòàòèâíîé ïîëèêëèíèêè, Ðåñïóáëèêàíñêèé
Ñïåöèàëèçèðîâàííûé Íàó÷íî-Ïðàêòè÷åñêèé Ìåäèöèíñêèé Öåíòð
Ýíäîêðèíîëîãèè èìåíè àêàäåìèêà ß.Õ. Òóðàêóëîâà, Óçáåêèñòàí
ÄÅÔÈÖÈÒ ÂÈÒÀÌÈÍÀ Ä È ÃÅÑÒÀÖÈÎÍÍÛÉ ÑÀÕÀÐÍÛÉ
ÄÈÀÁÅÒ Â ÓÇÁÅÊÈÑÒÀÍÅ
ÀÍÍÎÒÀÖÈß
Öåëüþ íàñòîÿùåãî èññëåäîâàíèÿ ÿâèëîñü èçó÷èòü âçàèìîñâÿçü óðîâíÿ
âèòàìèíà Ä ñ ìåòàáîëèçìîì ãëþêîçû ó áåðåìåííûõ. Â ýòîì èññëåäîâàíèè ìû
ñðàâíèâàëè ñûâîðîòî÷íûå óðîâíè 25-ÎÍ-âèòàìèíà D3 ó áåðåìåííûõ ñ
ãåñòàöèîííûì ñàõàðíûì äèàáåòîì (ÃÑÄ) è êîíòðîëüíîé ãðóïïîé áåç ÃÑÄ. Ìû
ïðîàíàëèçèðîâàëè êîíöåíòðàöèè 25OHD â ñûâîðîòêå êðîâè ó 95 áåðåìåííûõ
æåíùèí,75 æåíùèí ñ äèàãíîçîì ÃÑÄ è 20 çäîðîâûõ áåðåìåííûõ æåíùèí.
Êîíöåíòðàöèÿ 25-ãèäðîêñè-âèòàìèíà D3 ó ìàòåðåé ñ ÃÑÄ íà 18-32 íåäåëå
áåðåìåííîñòè áûëà çíà÷èòåëüíî íèæå, ÷åì â êîíòðîëüíîé ãðóïïå áåç ÃÑÄ, 16,76
± 6,88 è 21,06 ± 9,83 ñîîòâåòñòâåííî = 0,03). Èìåëàñü êîððåëÿöèîííàÿ çàâèñèìîñòü
óðîâíÿ âèòàìèíà Ä ñ óðîâíåì ãëþêîçû. Ñâÿçü ìåæäó óðîâíåì âèòàìèíà D è
òîëåðàíòíîñòüþ ê ãëþêîçå âî âðåìÿ áåðåìåííîñòè òðåáóåò äàëüíåéøåãî èçó÷åíèÿ.
Êëþ÷åâûå ñëîâà: ãåñòàöèîííûé äèàáåò, âèòàìèí Ä, áåðåìåííîñòü
Introduction. Gestational diabetes mellitus (GDM) is known as glucose intolerance,
with its onset or first recognition during pregnancy [1]. The prevalence of GDM is
increasing, reached almost 15% - 20% [2]. Unmanaged gestational diabetes increases
the risk of developing T2DM after pregnancy and predisposes the offspring to childhood
obesity and T2DM later in life [3]. Vitamin D deficiency is common all around the
world and has a prevalence of 26-98% in pregnancy, bringing concerns about its
consequences and need for supplementation [4,5].Compelling evidence suggests a role
of vitamin D deficiency in the pathogenesis of insulin resistance and insulin secretion
derangements. Poor Vitamin D status has also been linked with type-2 diabetes, obesity
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and other elements of metabolic syndrome [6]. Immense interest persists in vitamin D
and its potential effects on several pregnancy outcomes including gestational diabetes
mellitus (GDM) [7]. Although [1.25 (OH) D] supplementation was reported to decrease
glucose and increase insulin levels [8], other studies found no significant differences in
vitamin D status between women with GDM and NGT [9,10]. Emerging evidence
suggests that vitamin D administration can improve insulin sensitivity and glucose
tolerance, but whether vitamin D supplementation can prevent GDM is unknown [7].
Although, vitamin D deficiency is associated with a higher risk of GDM, conflicting
evidence is provided as to whether low serum 25-hydroxyvitmain D (25 (OH) D)
levels are associated with GDM. Therefore, we conducted this study for:
- Comparison of vit D status in pregnant women;
- Trying to determine the level of vitamin D associated with GDM, and its sensitivity
and specificity;
Materials and Methods. Pregnant women were screened for GDM at 18-32 weeks of
gestation using a two-hour 75 g oral glucose tolerance test (OGTT). According to the
guidelines of the international association of diabetes and pregnancy study groups
(IADPSG) 2010 , GDM was diagnosed if the OGTT results exceeded cut-offs for one
or more values: fasting plasma glucose
5.3 mmol/l, 1-h
10.0 mmol/l and 2- h
8.6
mmol/l [11].However, when risk factors such as positive family history of diabetes, age
greater than 30 years, obesity (body mass index [BMI] >30 kg/m2), previous history
of GDM, and history of macrosomia were present, the OGCT was done at the 14th
and18th week of gestation.
All the participants were subjected to:
- Full history taking including gestational age, history of previous GDM, family
history of diabetes and history of maternal and neonatal complications; Education was
categorised into 'lower' and 'higher' education (lower = lower or upper secondary or
postsecondary
non-tertiary education, higher = first or second stage of tertiary education);
- Thorough clinical examination including assessment of blood pressure, calculation
of the body mass index (BMI).Prepregnancy body mass index (BMI) (kg/m2) was
categorised into underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-
29.9) and obese (>30.0);
- Laboratory assay including fasting blood glucose, 1 hour glucose and serum 25-OH
vit D. Vitamin D sufficiency, insufficiency, and deficiency were defined as serum
25OHD concentrations 30 - 100, 10 - 29 and <10 ng/mL respectively.
Table 1. Clinical characteristics metabolic factors, 25 hydroxy vitamin D among the
study groups and their statistical significance
GDM (75) Non-GDM(20) P value
Age (years) mean ± SD 28,52±5,10 29,45±4,79 0,832
Gestational age (wk)
Mean ± SD
25,92±3,76 26,35±3,71 0,965
Gravity mean ± SD 2,62±1,15 3,15±1,22 0,319
Parity mean ± SD 2,333±0,96 2,90±,7881 0,131#
FH of DM (yes/No) % (19/56)25% (1/19)5% 0.000**
SBP (mmHg) mean ±
103,73
±8,2648
105,0
±8,8852
0,522
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Quantitative variables are expressed as mean ± SD and compared using student t test.
FH = family history; BMI = body mass index; SBP = systolic blood pressure; DBP =
diastolic blood pressure. FBS = fasting blood sugar, * = significant; ** = highly
significant; # = insignificant
Results. Ninety-five pregnant women participated in this study (75 GDM, 20 normal
GTT). The mean gestational age of the partici pants was 26.01 ± 3.74 weeks, and the
mean maternal age in the 2 groups was 28.7 ± 5.03 years.
The comparison of maternal characteristics of GDM and non-GDM mothers is
summarized in Table 1. No differences between the groups were observed in age,
weight, duration of gestation. However, there were difference in several other
characteristics, including pre-pregnancy BMI, fasting glucose, 1-hour glucose and
concentration of vitamin D3.
The mean age of the patients with GDM was 28, 52±5, 10 years; it was 29,45±4,79
in Non-GDM group (p = 0,832).The mean BMI of patients with GDM and in Non-
GDM were 24,92±5,97 and 24,06±4,68 kg/m2, respectively (p=0,265).
FBG levels were higher in-group with GDM than in Non-GDM (p= 0.00). Group
with higher glucose levels after the 75 gr OGTT (GDM) also had higher FBG levels
than the group that had normal glucose levels after the 75 gr OGTT (Non-GDM)
(p=0.00).
With regard to the serum 25-hydroxy vitamin D3 levels, deficient status (<20 ng/
mL) was present in 64.2% of patients, insufficient status (20-29 ng/mL) was present in
27.3% of patients, and sufficient status (>30 ng/mL) was present in 8.4% of all women
studied (Table 2). 25-hydroxy vitamin D3 deficiency was higher in group with GDM
SBP (mmHg) mean ±
SD
103,73±8,2648 105,0±8,8852 0,522
DBP (mmHg) mean ±
SD
67,02±10,3362 70,50±7,5915 0,383
Prepregnancy height
(cm)
160,427±6,1516 160,167±6,2332 0,556
Prepregnancy weight
(kg)
64,267±16,2109 61,333±8,0147 0,01*
Pre preg BMI (kg/m2)
mean ± SD
24,92±5,97 24,06±4,68 0,265
FBS (mmol/l) mean ±
SD
6.23±0.81 4.53±0.34 0,000**
1 hour glucose (mmol/l)
mean ± SD
10,42±0,493 4,82±0,88 0,000**
Vitamin D (ng/ml)
mean ± SD
16,76±6,88 21,06±9,83 0,036*
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than the control group, 16,76±6,88 and 21,06±9,83 respectively ( p =0,03) . The serum
levels of 25-hydroxy vitamin D3 had no significant correlation with age (r = -0.15, P
= 0.1), parity (r = -0.11, P = 0.2), BMI (r = -0.16, P = 0.11), or fasting blood
glucose level (r = -0.22, P = 0.3), but it correlated with glucose level after the 75gr
OGTT ( r=-0,22, Ð=0,02)
Table 2. Frequency (and Group Percentage) of Different Serum Levels of 25-
Hydroxy Vitamin D3 According to Groups
GDM, gestation diabetes mellitus;
P value between 2 groups
Discussion. The primary focus of this work was to determine whether 25(OH)D
concentration differs between mothers with and without GDM. There are still contradictions
about the exact role of vit. D deficiency in the pathogenesis of GDM. Many previous
studies [12,13] reported high prevalence of vitamin D deficiency that reached
approximately 95% among both pregnant and non-pregnant women. This problem also
exists in sunny Tashkent, we found a high prevalence of vitamin D deficiency during
pregnancy. This can be explained by insufficient time spent in the sun, poor diet and lack
of physical activity.
Our results showed that serum levels of 25-hydroxy-vitamin D3 were significantly
lower in GDM compared with the control group. Vitamin D is thought to play a role in
secretion and possibly in the action of insulin. There are some suggested mechanisms that
describe the relationship between vitamin D deficiency and the risk of developing
GDM.
Vitamin D can directly or indirectly regulate the function and secretion of
β
-cells by
binding their circulating active form, 1,25-hydroxy vitamin D, to the
β
-cell receptor
of vitamin D, as well as regulating the balance between extracellular and intracellular
pools of calcium
β
-cells. [14] In addition, vitamin D can increase insulin sensitivity by
stimulating the expression of insulin receptors and enhancing the response of insulin to
glucose transport [15].
There are no sufficient data to describe the relationship between GDM and vitamin
D deficiency. Our findings are in line with those of Maghbooli et al [17] in which serum
concentrations of 25-hydroxy vitamin D levels during 24-28 weeks of gestation were
significantly lower in GDM women than in groups with normal levels of vitamin D.
Clifton-Bligh et al [18] showed that maternal serum 25-hydroxy vitamin D concentrations
were significantly and inversely associated with fasting serum glucose levels. Nevertheless,
some studies could not show any relation between hypovitaminosis D and GDM. Farrant
et al [10] in the United Kingdom showed that, in total, 66% of women had hypovitaminosis
D (serum 25-hydroxy vitamin D concentrations <50 nmol/L), and 31%had levels
below 28 nmol/L. There was no significant association between maternal serum vitamin
D levels and GDM [10]. Also, another study performed in India showed no significant
Vitamin D3
Level, ng/mL
GDM
75
Non-GDM
20
Total
95
P Value
<0.05
<20 52(69,3%) 9(45%) 61(64,2%) 0,036*
20-29 19(25,3%) 7(35%) 26(27,3%)
>30 4(5,3%) 4(20%) 8(8,4%)
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association between serum 25-hydroxy vitamin D concentrations (30 weeks of gestation)
and GDM risk.[13,18].
There is a complex relationshi p between vitamin D and obesity. Our study found no
significant association between vitamin D and BMI while other many studies reported
an inverse relation between vit D levels and BMI [19,20].
Conclusion. Our results suggested that rates of vitamin D deficiency are higher
among women with GDM, and the relationship between vitamin D status and glucose
tolerance in pregnancy needs further study.
References.
1. Metzger B.E., Coustan D.R. Summary and recommendations of the Fourth
International Workshop-Conference on Gestational Diabetes Mellitus: the Organizing
Committee // Diabetes Care. - 1998. - Vol.21. - 161-167.
2. American Diabetes Association. Standards of Medical Care in Diabetes // Diabetes
Care. -2014. - Vol.37. - 14-80
3. Reece E.A., Leguizamon G., Wiznitzer A. Gestational Diabetes: The Need for a
Common Ground // The Lancet. - 2009. - Vol.373. - 1789-1797
4. Hamilton S.A., McNeil R., Hollis B.W., Davis D.J., Winkler J., Cook C. Profound
Vitamin D Deficiency in a Diverse Group of Women during Pregnancy Living in a Sun-
Rich Environment at Latitude 32 degrees // Int J Endocrinol. - 2010. - Vol.9. - 14-28.
5. Johnson D.D., Wagner C.L., Hulsey T.C., McNeil R.B., Ebeling M., Hollis
B.W. Vitamin D deficiency and insufficiency is common during pregnancy // Am J
Perinatol. - 2011. - Vol. 28 (1). - 7-12.
6.Kayaniyil S., Vieth R., Retnakaran R., Knight J.A., Qi Y., Gerstein H.C. Association
of vitamin D with insulin resistance and beta-cell dysfunction in subjects at risk for type
2 diabetes // Diabetes Care. - 2010. - Vol. 33 (6). - Vol. 13. - 79-81.
7. Burris H.H. Camargo Jr. C.A. Vitamin D and Gestational Diabetes Mellitus //
Current Diabetes Reports. - 2014. -Vol.14. - 451.
8. Rudnicki P., M?lsted-Pedersen L. Effect of 1,25-Dihydroxycholecalciferol on
Glucose Metabolism in Gestational Diabetes Mellitus. // Diabetologia. - 1997. -Vol.40.
- 40-44.
9.Baker A.M., Haeri S., Camargo Jr., C.A., Stueb, A.M., Boggess, K.A. First-
Trimester Maternal Vitamin D Status and Risk for Gestational Diabetes (GDM): A
Nested Case-Control Study // Diabetes/Metabolism Research and Reviews. - 2012. -Vol.
28. - 164-168
10. Farrant H.J., Krishnaveni G.V., Hill J.C. Vitamin D insufficiency is common in
Indian mothers but is not associated with gestational diabetes or variation in newborn
size // Eur J Clin Nutr. - 2009. - Vol.63 (5). - 646-652.
11. International Association of Diabetes and Pregnancy Study Groups International
Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis
and classification of hyperglycemia in pregnancy // Diabetes Care. - 2010. - Vol. 33. - 676-
682
12. Zhang C., Qiu C., Hu F.B., David R.M., Van Dam R.M., Bralley A., Williams,
M.A. Maternal Plasma 25-Hydroxyvitamin D Concentrations and the Risk for Gestational
Diabetes Mellitus. // PLoS ONE. - 2008. - Vol.3. - 753.
13. Holmes V.A., Barnes M.S., Alexander H.D., McFaul P., Wallace J.M.W.
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Vitamin D Deficiency and Insufficiency in Pregnant Women: A Longitudinal Study //
British Journal of Nutrition. - 2009. - Vol. 02. - 876-881.
14. Norman A.W., Frankel J.B., Heldt A.M., Grodsky G.M. Vitamin D deficiency
inhibits pancreatic secretion of insulin // Science. - 1980. - Vol. 209. - 823-825.
15. Draznin B., Sussman K.E., Eckel R.H., Kao M., Yost T., Sherman N.A. Possible
role of cytosolic free calcium concentrations in mediating insulin resistance of obesity
and hyperinsulinemia // J Clin Invest. - 1988. - Vol. 82. - 1848-1852.
16. Maghbooli Z., Hossein-Nezhad A., Karimi F., Shafaei A.R., Larijani B. Correlation
between vitamin D(3) deficiency and insulin resistance in pregnancy // Diabetes Metab
Res Rev.- 2008. - Vol. 24. - 27-32.
17. Clifton-Bligh R.J., McElduff P., McElduff A. Maternal vitamin D deficiency,
ethnicity and gestational diabetes // Diabet Med. - 2008. - Vol. 25. - 678-684.
18. Soheilykhah, S., Mojibian, M., Rashidi, M., Rahimi-Saghand, S., Jafari, F.
Maternal Vitamin D Status in Gestational Diabetes Mellitus // Nutrition in Clinical
Practice. - 2010. - Vol. 25. - 524-527.
19. Wortsman, J., Matsuoka, L.Y., Chen, T.C., Lu, Z. and Holick, M.F. Decreased
Bioavailability of Vitamin D in Obesity // The American Journal of Clinical Nutrition.
-2000. - Vol. 72. - 690-693.
20. Ford E.S., Ajani U.A., McGuire L.C., Liu, S. Concentrations of Serum Vitamin
D and the Metabolic Syndrome among US Adults // Diabetes Care. - 2005. -Vol. 28. -
1228-1230.
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ÁÈÎÌÅÄÈÖÈÍÀ ÂÀ ÀÌÀËÈ¨Ò ÆÓÐÍÀËÈ
ÆÓÐÍÀË ÁÈÎÌÅÄÈÖÈÍÛ È ÏÐÀÊÒÈÊÈ
JOURNAL OF BIOMEDICINE AND PRACTICE
Íèãîðà Ìàúðèôîâíà ÑÈÄÈÊÎÂÀ
Íîäèðà Õàêèìîâíà ÐÓÇÈÅÂÀ
Êàôåäðà Àêóøåðñòâà è ãèíåêîëîãèè, äåòñêîé ãèíåêîëîãèè,
Òàøêåíòñêèé Ïåäèàòðè÷åñêèé Ìåäèöèíñêèé èíñòèòóò, Óçáåêèñòàí.
ÊËÈÍÈÊÎ-ÏÀÒÎÃÅÍÅÒÈ×ÅÑÊÎÅ ÎÁÎÑÍÎÂÀÍÈÅ
ËÅ×ÅÍÈß ÁÎËÜÍÛÕ Ñ ÃÈÏÅÐÀÍÄÐÎÃÅÍÈÅÉ
For citation:, N.M. Sidikova, N.H. Ruzieva, clinical and pathogenetic substantiation
of treatment of patients with hyperandrogenism, Journal of Biomedicine and Practice
2020, Special issue, pp.26-30
http:// dx.doi.org/10.26739/2181-9300-2020-SI-3
ÀÍÍÎÒÀÖÈß
 ðåçóëüòàòå èçó÷åíèÿ ëèòåðàòóðû âûÿâëåíî äîñòîâåðíî âûñîêàÿ ÷àñòîòà óãðîçû
ïðåðûâàíèÿ áåðåìåííîñòè ó æåíùèí ñ ýíäîêðèííûìè ïàòîëîãèÿìè, â ÷àñòíîñòè
ãèïåðàíäðîãåíèåé. À òàêæå îáíàðóæåíî äîñòîâåðíîå íåãàòèâíîå âëèÿíèå
ãëþêîêîðòèêîèäíîé òåðàïèè íà ýìáðèîãåíåç è ðàçëè÷íûå ñèñòåìû æåíùèíû.
Êîððåêöèÿ ãèïåðàíäðîãåíèè è ïåðñîíèôèöèðîâàííàÿ òåðàïèÿ â ïðåäãðàâèäàðíîì
ïåðèîäå ó æåíùèí ñ ãèïåðàíäðîãåíèåé ïîçâîëÿþò ïðåîäîëåòü êðèòè÷åñêèå ñðîêè
ãåñòàöèè è äîáèòüñÿ áëàãîïîëó÷íîãî òå÷åíèÿ è èñõîäà áåðåìåííîñòè.
Êëþ÷åâûå ñëîâà: ãèïåðàíäðîãåíèÿ, íåêëàññè÷åñêàÿ ôîðìà âðîæäåííîé
äèñôóíêöèè êîðû íàäïî÷å÷íèêîâ, íåâûíàøèâàíèå áåðåìåííîñòè.
CLINICAL AND PATHOGENETIC SUBSTANTIATION OF
TREATMENT OF PATIENTS WITH HYPERANDROGENISM
Nigora Marifovna SIDIKOVA
Nodira Hakimovna RUZIEVA
Department of Obstetrics and Gynecology, Pediatric Gynecology,
Tashkent Pediatric Medical Institute, Uzbekistan.
ANNOTATION
A study of the literature revealed a significantly high frequency of threatened abortion
in women with endocrine pathologies, in particular hyperandrogenism. A significant
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negative effect of glucocorticoid therapy on embryogenesis and various systems of a
woman was also found. Correction of hyperandrogenism and individually selected therapy
in the pregravid period in women with hyperandrogenism can overcome the critical
periods of gestation and achieve a successful course and outcome of pregnancy.
Key words: hyperandrogenism, non-classical form of congenital dysfunction of the
adrenal cortex, miscarriage.
Íèãîðà Ìàúðèôîâíà ÑÈÄÈÊÎÂÀ
Íîäèðà Õàêèìîâíà ÐÓÇÈÅÂÀ
Àêóøåðëèê âà ãèíåêîëîãèÿ, áîëàëàð ãèíåêîëîãèÿñè êàôåäðàñè,
Òîøêåíò Ïåäèàòðèÿ Òèááè¸ò Èíñòèòóòè, ¤çáåêèñòîí.
ÃÈÏÅÐÀÍÄÐÎÃÅÍÈß ÁÈËÀÍ ÎFÐÈÃÀÍ ÁÅÌÎÐËÀÐÍÈ
ÄÀÂÎËÀØÍÈÍÃ ÊËÈÍÈÊ ÂÀ ÏÀÒÎÃÅÍÅÒÈÊ
ÀÑÎÑËÀÍÈØÈ
ÀÍÍÎÒÀÖÈß
Àäàáè¸òëàðíè ´ðãàíèø ýí ä îêðèí ïàòîëîãèÿëè ภëëàðäà, õóñóñàí
ãèïåðàíäðîãåíèçìäà µîìèëàäîðëèêíè òóãàòèø õàâôèíèíã ñåçèëàðëè äàðàæàäà
þ³îðè ÷àñòîòàñèíè àíè³ëàäè. Øóíèíãäåê, ãëþêîêîðòèêîèä òåðàïèÿñèíèíã
ýìáðèîãåíåç âà à¸ëëàðíèíã òóðëè òèçèìëàðèãà ñåçèëàðëè ñàëáèé òàúñèðèíè
ê´ðñàòäè. Ãèïåðàíäðîãåíèçì áèëàí à¸ëëàðäà îëäèíäàí ãðàâèäàð äàâðèäà
ãèïåðàíäðîãåíèçì âà ìîñëàøòèðèëãàí òåðàïèÿíè òóçàòèø ìóµèì µîìèëàäîðëèê
äàâðëàðèíè åíãèá, µîìèëàäîðëèêíèíã õàâôñèç êóðñè âà íàòèæàëàðèãà ýðèøèø
ìóìêèí.
Êàëèò ñ´çëàð: ãèïåðàíäðîãåíèçì, òó²ìà áóéðàê óñòè ï´ñòëî²è äèñôóíêñèÿñèíèíã
êëàññèê á´ëìàãàí øàêëè, òóøèøè.
Íà ñåãîäíÿøíèé äåíü íàðÿäó ñ ïîëèýòèîëîãè÷íîñòüþ äàííîé ïðîáëåìû, îäíîé
èç ïðè÷èí íåâûíàøèâàíèÿ áåðåìåííîñòè ÿâëÿåòñÿ ãèïåðàíäðîãåíèÿ (ÃÀ),
êîòîðàÿ âñòðå÷àåòñÿ ó 12-21% æåíùèí è â 21-32% ñëó÷àåâ ÿâëÿåòñÿ ïðè÷èíîé
íåâûíàøèâàíèÿ áåðåìåííîñòè [1, 2, 3]. Íàèáîëåå ÷àñòûìè ïðè÷èíàìè ÃÀ ÿâëÿþòñÿ
íåêëàññè÷åñêàÿ ôîðìà âðîæäåííîé äèñôóíêöèè êîðû íàäïî÷å÷íèêîâ (ÍÔ ÂÄÊÍ),
áîëüøèíñòâî ñëó÷àåâ êîòîðîé îáóñëîâëåíî íåäîñòàòî÷íîñòüþ ôåðìåíòà 21-
ãèäðîêñèëàçû (21-Ã), à òàêæå ñèíäðîìîì ïîëèêèñòîçíûõ ÿè÷íèêîâ (ÑÏÊß).
Êëèíè÷åñêàÿ êàðòèíà ÍÔ ÂÄÊÍ è ÑÏÊß ìîæåò áûòü ñõîæåé è òðåáóåò ïðîâåäåíèÿ
äèôôåðåíöèàëüíîé äèàãíîñòèêè [4, 5].
Íàðóøåíèå îáìåíà àíäðîãåíîâ ïðè áåðåìåííîñòè ïîâûøàåò ðèñê ðàçâèòèÿ
ïëàöåíòàðíîé íåäîñòàòî÷íîñòè ñ õàðàêòåðíûìè ìîðôîëîãè÷åñêèìè ïðèçíàêàìè:
ñíèæåíèå óäåëüíîãî îáúåìà ñîñóäèñòîãî ðóñëà è ìåæâîðñèí÷àòîãî ïðîñòðàíñòâà,
èçáûòî÷íîå îòëîæåíèå ôèáðèíîèäà, óâåëè÷åíèå îáúåìà ñêëååííûõ âîðñèí,
íàëè÷èå âûðàæåííîãî ôèáðèíîèäíîãî íåêðîçà, ãèàëèíîçà è ñêëåðîçà ñîñóäèñòîé
ñòåíêè ñ èçìåíåíèåì ïðîñâåòà ñîñóäîâ [6, 7].
Èçáûòîê àíäðîãåíîâ âî âðåìÿ áåðåìåííîñòè íåãàòèâíî âëèÿåò íà ïðîöåññû
èìïëàíòàöèè ïëîäíîãî ÿéöà, ñïîñîáñòâóåò íàðóøåíèþ êðîâîîáðàùåíèÿ â ìàòêå,
ñêëåðîçèðîâàíèþ ñîñóäîâ ìèîìåòðèÿ è õîðèîíà, ðàçðûâó ñîñóäîâ, îáðàçîâàíèþ
ðåòðîõîðèàëüíûõ ãåìàòîì, îòñëîéêè õîðèîíà, ðàçâèòèþ èñòìèêî-öåðâèêàëüíîé
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íåäîñòàòî÷íîñòè, âûçûâàåò âèðèëèçàöèþ ïëîäà æåíñêîãî ïîëà [8, 9 ].
Íà ñåãîäíÿøíèé äåíü, îñíîâíûì ïàòîãåíåòè÷åñêèì ìåòîäîì òåðàïèè
àäðåíàëîâîé ÃÀ ÿâëÿåòñÿ íàçíà÷åíèå ñóïðåññèâíîé òåðàïèè ãëþêîêîðòèêîèäíûìè
(ÃÊ) ïðåïàðàòàìè. Ïî äàííûì ëèòåðàòóðû, ðàííåå íàçíà÷åíèå âûñîêèõ äîç
äåêñàìåòàçîíà ìîæåò óìåíüøàòü ÷àñòîòó óãðîçû íåâûíàøèâàíèÿ, ïðåäîòâðàùàòü
ðèñê õðîíè÷åñêèõ ëåãî÷íûõ çàáîëåâàíèé ó íåäîíîøåííûõ íîâîðîæäåííûõ, íî
íàáëþäàþòñÿ è íåáëàãîïðèÿòíûå ýôôåêòû âêëþ÷àÿ ãèïåðòåíçèþ è ãèïåðãëèêåìèþ
ó ìëàäåíöåâ [6, 10]. Ïî äàííûì Ãóð Ñ. è ñîàâò. ïðèìåíåíèå ãëþêîêîðòèêîñòåðîèäîâ
ðåêîìåíäîâàíî áîëüíûì ÍÔ ÂÃÊÍ íà ýòàïå ïëàíèðîâàíèÿ áåðåìåííîñòè. Â
îáû÷íîé ïðàêòèêå, ìíîãèå ñïåöèàëèñòû íàçíà÷àþò ãëþêîêîðòèêîñòåðîèäû óæå
ïîñëå íàñòóïëåíèÿ áåðåìåííîñòè, íà îñíîâàíèè ïîêàçàòåëåé óðîâíÿ 17-
ãèäðîêñèïðîãåñòåðîíà è äåãèäðîýïèàíäðîñòåðîíà ñóëüôàòà â êðîâè. [11]. Ïðè ýòîì
â ðàáîòå Äðåãåð À. ñîàâòîðîâ [12] áûëî óáåäèòåëüíî äîêàçàíî, ÷òî ïðè
áåðåìåííîñòè âåðèôèêàöèÿ-äèàãíîçà ÍÔ ÂÃÊÍ âîçìîæíà òîëüêî ïóòåì
ìîëåêóëÿðíî-ãåíåòè÷åñêîãî èññëåäîâàíèÿ, à îïðåäåëåíèå óðîâíÿ àäðåíàëîâûõ
àíäðîãåíîâ â êðîâè íå ÿâëÿåòñÿ èíôîðìàòèâíûì [13].
Âëèÿíèå ãëþêîêîðòèêîèäîâ íà ðàçâèòèå ãèïåðòåíçèâíûõ íàðóøåíèé (ÃÍ) äî
ñèõ ïîð ÿâëÿåòñÿ îäíèì èç ñïîðíûõ âîïðîñîâ àêóøåðñêîé ïðàêòèêè. Íî ê
ñîæàëåíèþ, ó æåíùèí ñ ïðèâû÷íûì íåâûíàøèâàíèåì áåðåìåííîñòè, ñòðàäàþùèõ
ãèïåðàíäðîãåíèåé (ÃÀ) (íåçàâèñèìî îò ôîðìû), ëå÷åíèå ãëþêîêîðòèêîèäíûìè
ïðåïàðàòàìè (ÃÊ) äî íàñòóïëåíèÿ áåðåìåííîñòè, ñ ïîñëåäóþùèì ïðîäîëæåíèåì
ïðèåìà ëåêàðñòâåííîãî ñðåäñòâà â òå÷åíèå âñåé áåðåìåííîñòè ñ÷èòàåòñÿ
îáùåïðèíÿòîé òàêòèêîé [8,10]. Â ïîñëåäíåå âðåìÿ øèðîêî îáñóæäàåòñÿ òîò ôàêò,
÷òî äëèòåëüíûé ïðèåì ÃÊ ïðè áåðåìåííîñòè ñîïðÿæåí ñ âûñîêèì ðèñêîì äëÿ
ìàòåðè è ïëîäà. Íå ñìîòðÿ íà ïîñòåïåííîå ñíèæåíèè äîçû ñ ñåðåäèíû 2-ãî
òðèìåñòðà, ñîõðàíÿåòñÿ ðèñê ýòèõ îñëîæíåíèé[14]. Òàêæå, äëèòåëüíûé ïðèåì
ÃÊ ïðèâîäèò ê àíîìàëèÿì ðàçâèòèÿ ñîåäèíèòåëüíîé òêàíè, çàäåðæêè ðîñòà ïëîäà,
ãèïåðãëèêåìèè [15], 16 ]. Ïî äàííûì Å.À. Øóñòèêîâîé (2012) ó 1/3 æåíùèí ñ
ÃÀ, ïðèíèìàâøèõ ãëþêîêîðòèêîèäû, áåðåìåííîñòü îñëîæíÿåòñÿ ãèïåðòåíçèâíûìè
íàðóøåíèÿìè, èç íèõ ó 90% æåíùèí ñ ÃÀ ñìåøàííîãî ãåíåçà, êîòîðîå
ïîäòâåðæäàåòñÿ ïîâûøåíèåì 17-ÎÍÏ, ÄÃÝÀÑ, òåñòîñòåðîíà è êîðòèçîëà. Òàê
êàê ãèïåðêîðòèçîëåìèÿ ìîæåò ðàññìàòðèâàòüñÿ êàê àíàëîã èíñóëèíðåçèñòåíòíîñòè
è ãèïåðèíñóëèíåìèè, ó âñåõ ýòèõ æåíùèí èìååòñÿ àáäîìèíàëüíî-âèñöåðàëüíûé
òèï îæèðåíèÿ, àðòåðèàëüíàÿ ãèïåðòåíçèÿ. Ïî âèäèìîìó, ýòè ïàöèåíòêè ñ
íåäèàãíîñòèðîâàííûì ìåòàáîëè÷åñêèì ñèíäðîìîì. Êàê èçâåñòíî, â ïàòîãåíåçå
ìåòàáîëè÷åñêîãî ñèíäðîìà, êàê è ïðè ãèïåðòåíçèîííûõ íàðóøåíèÿõ, ãëàâíóþ
ðîëü èãðàåò äèñôóíêöèÿ ýíäîòåëèîöèòîâ. Ïî äàííûì Ìàêàöàðèÿ À.Ä. (2006),
ïîâðåæäåíèå ëèïîïðîòåèäîâ íèçêîé ïëîòíîñòè è áåëêîâ èç-çà âîçäåéñòâèÿ
ïîâûøåííûõ óðîâíåé ãëþêîçû è ñâîáîäíûõ ðàäèêàëîâ ïðèâîäèò ê âîñïàëèòåëüíûì
ïðîöåññàì, â ÷àñòíîñòè, â ñîñóäèñòîé ñòåíêå ðàçâèâàåòñÿ ñèíäðîì ñèñòåìíîãî
âîñïàëèòåëüíîãî îòâåòà. Èíñóëèíðåçèñòåíòíîñòü (ÈÐ) ñïîñîáñòâóåò óñèëåíèþ
ñèíòåçà àíãèîòåíçèíà-2, óñèëåíèþ îáðàòíîãî òðàíñïîðòà íàòðèÿ è âîäû â ïî÷êàõ,
ñíèæåíèþ àêòèâíîñòè ìåìáðàííîãî ôåðìåíòà Na/K-çàâèñèìîé ÀÒÔ-àçû, ÷òî
ïðèâîäèò ê ðàçâèòèþ àðòåðèàëüíîé ãèïåðòåíçèè (ÀÃ) íà ôîíå áåðåìåííîñòè è
ðèñêó ðàçâèòèÿ ïðåýêëàìïñèè. Ïî íàøèì íàáëþäåíèÿì, ó áåðåìåííûõ ñ ÎÀÀ è
ÃÀ, ïîâûøåííûå óðîâíè àíäðîãåíîâ (17-ÎÏ, ÄÃÝÀÑ è òåñòîñòåðîíà â 1-ì
òðèìåñòðå ìîãóò ñëóæèòü ïîâîäîì äëÿ íàçíà÷åíèÿ ãëþêîêîðòèêîèäîâ, ñ öåëüþ
êîððåêöèè ãèïåðàíäðîãåíèè, íî ñëåäóåò ðàññìîòðåòü âåðîÿòíûå îñëîæíåíèÿ
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íàçíà÷åíèÿ ÃÊÑ. Ó äàííîé ãðóïïû áåðåìåííûõ èìååò ìåñòî ãèïåððåàêòèâíîñòü
ãèïîòàëàìî-ïèòóèòàðíî-íàäïî÷å÷íèêîâîé ñèñòåìû è ïî ýòîìó, óæå èìåþùèéñÿ
èçáûòîê êîðòèçîëà â ñî÷åòàíèè ñ ýêçîãåííî ââîäèìûìè ãëþêîêîðòèêîèäíûìè
ïðåïàðàòàìè äëèòåëüíîãî äåéñòâèÿ (äåêñàìåòàçîí) ïðèâîäÿò ê ñíèæåíèþ
÷óâñòâèòåëüíîñòè òêàíåé ê èíñóëèíó, ÷òî ñïîñîáñòâóåò ðàçâèòèþ ÈÐ ñ
êîìïåíñàòîðíîé ãèïåðèíñóëèíåìèåé, [16]; ýíäîòåëèàëüíîé äèñôóíêöèè, ÷òî â
ñâîþ î÷åðåäü ïðèâîäèò ê ðàçâèòèþ ïðåýêëàìïñèè. [17]. Ó áåðåìåííûõ ñ ÃÀ,
ïðèíèìàâøèõ ãëþêîêîðòèêîèäû, èìååòñÿ ñîñòîÿíèå ãèïåðêîàãóëÿöèè. Òàêæå
èìåþòñÿ ïðèçíàêè ñèíäðîìà âíóòðèñîñóäèñòîãî ñâåðòûâàíèÿ (ÄÂÑ-ñèíäðîìà)
[11, 18].
Íåñìîòðÿ íà ïîáî÷íûå äåéñòâèÿ, ïðèìåíåíèå äåêñàìåòàçîíà îñòàåòñÿ
óíèâåðñàëüíûì ëå÷åíèåì ïðè ãèïåðàíäðîãåíèè âî âðåìÿ áåðåìåííîñòè, òàê êàê
òîëüêî ýòîò ãëþêîêîðòèêîèä ïðîíèêàåò ÷åðåç ïëàöåíòó áåç ïîòåðü. Ïðåäíèçîëîí,
ãèäðîêîðòèçîí íà 85% ðàçðóøàþòñÿ ïëàöåíòàðíûìè ôåðìåíòàìè è ê ïëîäó
ïðàêòè÷åñêè íå ïîñòóïàåò [10].
 ñâÿçè ñ ýòèì åñòü äàííûå ëèòåðàòóðû î òîì, ÷òî ïðåêðàùåíèå ïðèåìà
äåêñàìåòàçîíà, íå ïðåðûâàåò áåðåìåííîñòü, òàê êàê íàäïî÷å÷íèêè ïëîäà
êîìïåíñèðóþò äåôèöèò ãëþêîêîðòèêîèäîâ ó ìàòåðè. Íî ýòî ìîæåò áûòü ïðè÷èíîé
âíóòðèóòðîáíîé ãèïåðôóíêöèè êîðû íàäïî÷å÷íèêîâ ó ïëîäà è ñíèçèòü åãî
àäàïòàöèîííûå âîçìîæíîñòè ê âíåóòðîáíîé æèçíè.
Òàêèì îáðàçîì, ïðè ÃÀ è ÎÀÀ, ó áåðåìåííûõ íåöåëåñîáðàçíî îïðåäåëÿòü
óðîâåíü ÄÃÝÀ, ýñòðèîëà, ïðîãåñòåðîíà â êðîâèëþíå äëÿ ïîäáîðà
ãîðìîíàëüíîé òåðàïèè. Ó÷èòûâàÿ â àíàìíåçå íåäîñòàòî÷íîñòü ëþòåèíîâîé ôàçû
è òåõ, êîìó ïðîâîäèëè ñòèìóëÿöèþ îâóëÿöèè, öåëåñîîáðàçíî ïðåâåíòèâíî
íàçíà÷àòü. Íàäî îòìåòèòü âàæíîñòü ïðåäãðàâèäàðíîé ïîäãîòîâêè æåíùèí ñ ÃÀ è
ÎÀÀ.  ñâÿçè ñ ýòèì, ïàòîãåíåòè÷åñêè îáîñíîâàííûì ÿâëÿåòñÿ íàçíà÷åíèå
ïàöèåíòêàì ñ óæå èìåþùåéñÿ äèñôóíêöèåé ãèïîòàëàìîèïîôèçàðíî-
íàäïî÷å÷íèêîâîé ñèñòåìû è ñ ìåòàáîëè÷åñêèì ñèíäðîìîì, íàçíà÷åíèå
ãëþêîêîðòèêîèäíûõ ïðåïàðàòîâ è ìåòôîðìèíà ïàöèåíòêàì ñ ÃÀ. Ñâîåâðåìåííàÿ
äèàãíîñòèêà è ïàòîãåíåòè÷åñêè îáîñíîâàííàÿ òåðàïèÿ ÃÀ ïîçâîëèò ïðîâîäèòü
ýôôåêòèâíóþ ïðîôèëàêòèêó íåâûíàøèâàíèÿ áåðåìåííîñòè ó æåíùèí ñ ÃÀ.
Ëèòåðàòóðà:
1. Boris E.N. Covremennye podhody k differencirovannomu lecheniyu
giperandrogennyh sostoyanij u zhenshchin. Zb³rnik naukovih prac' asoc³ac³¿ akusher³v-
g³nekolog³v ukra¿ni Vi pusk 1/2 (33/34) 2014. S. 42-48.
2. Solopova A.G. Sklerozirovannie yaichniki. Sovremenniy vzglyad na problemu.
AKUSHERSTVO o GINECOLOGIYA o REPRODUKSIYA. 2017 o Tom 11 o ¹ 2. S.
57-68.
3. Suhonosova EL. Sovremennye vzgljady na patogenez, diagnostiku i lechenie sindroma
polikistoznyh jaichnikov [Modern views on the pathogenesis, diagnosis and treatment
of polycystic ovary syndrome]. Dalnevostochnyj medicinskij zhurnal [Far East Medical
Journal]. 2015;4:128-133.
4. Nikonova L.V. I soavt. Kliniko-gormonalnye variant sindroma giperandrogenii.
Journal of the Grodno State Medical University, Vol. 16, ¹ 5, 2018. S. 542-548.
5. Sidel'nikova V.M. Podgotovka i vedenie beremennosti u zhenshchin s privychnym
nevynashivaniem: metod. posobiya i klin. protokoly [Preparation and management of
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pregnancy in women with habitual miscarriage: method] / V.?M.?Sidel'nikova. - 3-e izd.
- M. : MEDpress-inform, 2013. - 224 s.
6. Shumaher A., Kosta S.D., Zenklusen A.S. Endokrinnye faktory, moduliruyushchie
immunnye reakcii pri beremennosti. [Endocrine factors that modulate immune responses
during pregnancy] Front Immunol. 2014; 5 : 196. [ PMC besplatnaya stat'ya ] [ PubMed
] [ Google Scholar.
7. Kemp M.W. Et al. The clinical use of corticosteroids in pregnancy. Human
Reproduction Update, 2016. Vol.22, No.2 pp. 240-259.
8. Dreger A., Feder E. K., Tamar-Mattis A. Prenatal'nyj deksametazon pri vrozhdennoj
giperplazii nadpochechnikov: kanarejka etiki v sovremennoj medicinskoj shahte. [Prenatal
dexamethasone for congenital adrenal hyperplasia: a canary of ethics in a modern medical
mine] J Bioeth Inq. 2012; 9 : 277-294. [ PMC besplatnaya stat'ya ] [ PubMed ] [ Google
Scholar ].
9. Trakakis E., Basios G., Trompoukis P., Labos G., Grammatikakis I., Kassanos
D. An update to 21-hydroxylase deficient congenital adrenal hyperplasia // Gynecological
Endocrinology. - Jan 2010. - Vol. 26, ¹1. - P. 63-71.
10. Hasan Namdar Ahmadabad et al. Èñõîäû áåðåìåííîñòè ïîñëå ïðèåìà âûñîêèõ
äîç äåêñàìåòàçîíà íà ðàííèõ ñðîêàõ áåðåìåííîñòè. Clinical and Experimental
Reproductive Medicine 2016;43(1):15-25. [ PubMed ] [ Google Scholar ]
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S. Lechenie prednizolonom snizhaet razvitie spiral'noj arterii endometriya u zhenshchin
s povtornym vykidyshem. [Quenby S. Treatment with prednisolone reduces the development
of the spiral endometrial artery in women with repeated miscarriage. ] Angiogenez. 2011;
14 : 523-532. [ PubMed ] [ Google Scholar ]
12. Mwansa-Kambafwile J, Cousens S, Hansen T, Lawn JE. Antenatal'nye steroidy
pri prezhdevremennyh rodah dlya profilaktiki neonatal'nyh smertej vsledstvie oslozhnenij
prezhdevremennyh rodov. Int J Epidemiol. 2010; 39 (Prilozhenie 1): i122 - i133. [ PMC
besplatnaya stat'ya ] [ PubMed ] [ Google Scholar ].
13. Shustikova E.F., Fedirko S.L. Vliyanie glyukokortikoidov, prinimaemyh pri
beremennosti, na chastotu obvitaya pupovinoj. [The effect of glucocorticoids taken during
pregnancy on the frequency entwined with the umbilical cord.] Medicina ekstrimal'nyh
situacij. ¹4 (42). 2012, str 21-25.
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Áàõòè¸ð Áóðòõàíîâè÷ ÕÀÑÀÍÎÂ
Áóõàðñêèé ãîñóäàðñòâåííûé ìåäèöèíñêèé èíñòèòóò
ÝÊÑÏÅÐÈÌÅÍÒÀËÜÍÛÉ ÒÎÊÑÈ×ÅÑÊÈÉ ÃÅÏÀÒÈÒ È
ÀÓÒÎÈÌÌÓÍÍÛÅ ÏÐÎÖÅÑÑÛ Â ÄÈÍÀÌÈÊÅ ËÀÊÒÀÖÈÈ
For citation:, B.B. Khasanov, Experimental toxic hepatitis and autoimmune processes
in the dynamics of lactation, Journal of Biomedicine and Practice 2020, Special issue,
pp.31-35
http:// dx.doi.org/10.26739/2181-9300-2020-SI-4
ÀÍÍÎÒÀÖÈß
Èññëåäîâàíî íàëè÷èå àíòèãåïàòîöèòàðíûõ àíòèòåë â ñûâîðîòêå êðîâè è ìîëîêå
ó ñ òîêñè÷åñêèì ãåïàòèòîì â ïåðèîä ãðóäíîãî âñêàðìëèâàíèÿ. Óñòàíîâëåíî íàëè÷èå
àóòîàíòèòåë â òå÷åíèå ëàêòàöèè, â îñíîâíîì â ñûâîðîòêå êðîâè, è â
íåçíà÷èòåëüíûõ êîëè÷åñòâàõ â ìîëîêå ñà ìîê ê ðûñ, ñëå äî âà òåë üíî,
ïðîòèâîïå÷åíî÷íûå àíòèòåëà ìàòåðè ïðè òîêñè÷åñêîì ãåïàòèòå íå ÿâëÿþòñÿ
ïàòîëîãè÷åñêèì àãåíòîì äëÿ ïîòîìñòâà â òå÷åíèå ãðóäíîãî âñêàðìëèâàíèÿ.
Êëþ÷åâûå ñëîâà: ãåïàòèò, àóòîèìóííûå çàáîëåâàíèÿ, ëàêòàöèÿ, ñûâîðîòêà
êðîâè, ìîëîêî.
Âakhtiyor Burtkhanovich KHASANOV
Bukhara State Medical Institute
EXPERIMENTAL TOXIC HEPÀTITIS AND AUTOIMMULOGICAL
PROCESSES IN DURING OF THE LACTATIONS
ANNOTATSION
Presence of antihepatic antibodies in whey of blood and milk at rats with toxic
hepatitis are investigated during breast-feeding. Presence autoantibodies is established in
whey of blood and scant fews in milk of rats during lactation, hence, antihepatic
antibodies of mother at a toxic hepatitis are not the pathological agent for the baby
during breast-feeding.
Key words: hepatitis, autoimmune diseases, lactation, blood serum, milk.
ÁÈÎÌÅÄÈÖÈÍÀ ÂÀ ÀÌÀËÈ¨Ò ÆÓÐÍÀËÈ
ÆÓÐÍÀË ÁÈÎÌÅÄÈÖÈÍÛ È ÏÐÀÊÒÈÊÈ
JOURNAL OF BIOMEDICINE AND PRACTICE
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Áàõòè¸ð Áóðòõàíîâè÷ ÕÀÑÀÍÎÂ
Áóõîðî äàâëàò òèááè¸ò èíñòèòóòè
ÝÊÑÏÅÐÈÌÅÍÒÀË ÒÎÊÑÈÊ ÃÅÏÀÒÈÒ ÂÀ ËÀÊÒÀÖÈß
ÄÈÍÀÌÈÊÀÑÈÄÀÃÈ ÀÓÒÎÈÌÌÓÍ ÆÀÐÀ¨ÍËÀÐ
ÀÍÍÎÒÀÖÈß
Ýêñïåðèìåíòàë òîêñèê ãåïàòèòëè óð²î÷è êàëàìóøëàðíèíã ³îíè âà ñóòèäà ýìèçèø
äàâðèäà àíòèãåïàòîöèòàð ³àðøè àíòèòàíàëàð àíè³ëàíãàí. Ýìèçèø äàâðèäà
àóòîàíòèòàíàëàð àñîñàí ³îí çàðäîáèäà âà óí÷à ê´ï á´ëìàãàí ìè³äîðäà êàëàìóøëàð
ñóòèäà àíè³ëàíãàí, äåìàê ýêñïåðèìåíòàë òîêñèê ãåïàòèò øàðîèòèäàãè îíà
àíòèãåïàòîöèòàð àíòèòàíàëàð ýìèçèø äàâðèäà àâëîä ó÷óí ïàòîëîãèê àãåíò
õèñîáëàíìàéäè.
Êàëèò ñ´çëàð: ãåïàòèò, àóòîèììóí êàñàëëèêëàð, ëàêòàöèÿ, ³îí çàðäîáè, ñóò.
Ââåäåíèå. ×àñòîòà ðàçëè÷íûõ ýêñòðàãåíèòàëüíûõ ïàòîëîãèé ó æåíùèí
äåòîðîäíîãî âîçðàñòà âñå åùå çíà÷èòåëüíà. Ïðåæäå âñåãî, óâåëè÷èâàåòñÿ
÷àñòîòà õðîíè÷åñêîãî ïîðàæåíèÿ ãåïàòîáèëèàðíîé ñèñòåìû êàê ñëåäñòâèå
ïåðåíåñåííûõ âèðóñíûõ èëè òîêñè÷åñêèõ ãåïàòèòîâ, êîòîðûå ïîä âëèÿíèåì
íåáëàãîïðèÿòíûõ ýêîëîãè÷åñêèõ óñëîâèé íåðåäêî ïðèíèìàþò õðîíè÷åñêóþ,
çàòÿæíóþ ôîðìó [3, 4].
Âîçìîæíîñòü ïåðåäà÷è âèðóñà ãåïàòèòà îò æåíùèíîñèòåëåé HbsAg
ðîäèâøèìñÿ äåòÿì, ðàçâèòèÿ ó ÷àñòè äåòåé ïåðñèñòåíöèè HbsAg, ôîðìèðîâàíèÿ
ïåðâè÷íî-õðîíè÷åñêîãî ãåïàòèòà íå âûçûâàåò ñîìíåíèé [5, 8]. Âìåñòå ñ òåì, äî
ñèõ ïîð îñòàþòñÿ ìàëîèçó÷åííûìè çíà÷åíèå àóòîèììóííûõ ïðîöåññîâ,
ðàçâîðà÷èâàþùèõñÿ â ìàòåðèíñêîì îðãàíèçìå ïðè ãåïàòèòàõ, â äèíàìèêå ëàêòàöèè
è èõ âëèÿíèå íà ðàçâèòèå ïîòîìñòâà â ïåðèîä ãðóäíîãî âñêàðìëèâàíèÿ. Òîãäà êàê
ñóùåñòâóåò çíà÷èòåëüíîå ÷èñëî èññëåäîâàíèé óêóàç³âàþùèõ, ÷òî ãåïàòèò ó ìàòåðè
ïðèâîäèò ê çàìåäëåíèþ òåìïîâ ôîðìèðîâàíèÿ èììóííûõ êîìïîíåíòîâ òîíêîãî
êèøå÷íèêà, à òàêæå è îðãàíîâ èììóííîé ñèñòåìû ïîòîìñòâà â ðàííåì
ïîñòíàòàëüíîì îíòîãåíåçå [2, 6, 11]. Îäíàêî äî ñèõ ïîð îñòàåòñÿ îòêðûòûì âîïðîñ
î ïðè÷èíàõ è ìåõàíèçìàõ ïðèâîäÿùèõ ê ýòèì èçìåíåíèÿì.
Öåëüþ íàøåãî èññëåäîâàíèÿ ÿâèëîñü èçó÷åíèå òèòðà àíòèãåïàòîöèòàðíûõ â
ñûâîðîòêå êðîâè ñ òîêñè÷åñêèì ãåïàòèòîì â äèíàìèêå ëàêòàöèè.
Ìàòåðèàë è ìåòîäû èññëåäîâàíèÿ.
Äëÿ ïðîâåäåíèÿ ýêñïåðèìåíòà áûëè èñïîëüçîâàíû 3 ìåñÿ÷íûå ïîëîâîçðåëûå
áåëûå áåñïîðîäíûå ñàìêè êðûñ (72) ìàññîé 120-140 ãðàìì. Æèâîòíûå ñîäåðæàëèñü
íà îáû÷íîì ëàáîðàòîðíîì ðàöèîíå è äî ïðîâåäåíèÿ ýêñïåðèìåíòà â òå÷åíèå äâóõ
íåäåëü íàõîäèëèñü â óñëîâèÿõ êàðàíòèíà.  êà÷åñòâå ìîäåëè ãåïàòèòà íàìè áûëà
èñïîëüçîâàíà õðîíè÷åñêàÿ ãåëèîòðèííàÿ èíòîêñèêàöèÿ [1]. Ïîñëå ñðîêà êàðàíòèíà
ñàìêàì îïûòíîé ãðóïïû (Î) ââîäèëè ãåëèîòðèí â äîçå 0,05 ìã/ãðàìì âåñà òåëà íà
0,5 ìë ôèçèîëîãè÷åñêîãî ðàñòâîðà ïîäêîæíî åæåíåäåëüíî â òå÷åíèå 6 íåäåëü,
æèâîòíûì êîíòðîëüíîé ãðóïïû (Ê) ââîäèëè òîëüêî ôèçðàñòâîð. ×åðåç 10 äíåé
ïîñëå ïîñëåäíåé èíúåêöèè ê ñàìêàì ïîäñàæèâàëè ñàìöîâ. Äëÿ èññëåäîâàíèÿ
áûëè îòîáðàíû ñàìêè îïûòíîé (40) è êîíòðîëüíîé ãðóïï (32) íà 1, 3, 7, 15, 21
è 30 ñóòêè ëàêòàöèè. Îïðåäåëåíèå àíòèãåïàòîöèòàðíûõ àíòèòåë ïðîâîäèëè ÐÏÃÀ
ïî ìåòîäó Áîéäåíà. Äëÿ ïðîâåäåíèÿ ñåðîëîãè÷åñêèõ ðåàêöèé èñïîëüçîâàëèñü
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ñûâîðîòêà êðîâè (0,5 ìë) è îáðàçöû ìîëîêà (0,2 ìë) âçÿòûå ó ñàìîê êðûñ â
âûøåóêàçàííûå ñðîêè èññëåäîâàíèÿ. Ýðèòðîöèòû áàðàíà ãîòîâèëèñü ïî
îáùåïðèíÿòîé ìåòîäèêå.  êà÷åñòâå àíòèãåíà èñïîëüçîâàëàñü íàâåñêà ïå÷åíè
èíòàêòíîé ñàìêè êðûñ â êîëè÷åñòâå 2,0 ã, ïîäãîòîâêà êîòîðîãî ïðîâîäèëàñü
âîäíî-õëîðîôîðìíûì ýêñòðàãèðîâàíèåì ïî ìåòîäó Ò.À.Àëåêñååâîé [8]. Ñîäåðæàíèå
àíòèãåíà êîíòðîëèðîâàëè ïî êîëè÷åñòâó áåëêà, êîòîðîå äîâîäèëè äî 1%. Äëÿ
áîëåå òî÷íîãî âû÷èñëåíèÿ è óäîáñòâà ïðè ñðàâíåíèè ïîëó÷åííûå ðåçóëüòàòû
âûðàæàëè â log2 [7]. Ïîëó÷åííûå äàííûå îáðàáàòûâàëèñü ïî Ôèøåðó-Ñòüþäåíòó,
äîñòîâåðíûìè ñ÷èòàëè ðàçëè÷èÿ óäîâëåòâîðÿþùèå P<0,05.
Ïîëó÷åííûå ðåçóëüòàòû è îáñóæäåíèå
 ðåçóëüòàòå íàøåãî èññëåäîâàíèÿ áûëà óñòàíîâëåíà îïðåäåëåííàÿ äèíàìèêà
èçìåíåíèé òèòðà àíòèãåïàòîöèòàðíûõ àíòèòåë êðîâè è ìîëîêà êðûñ ñ òîêñè÷åñêèì
ãåïàòèòîì â äèíàìèêå ëàêòàöèè. Â ñûâîðîòêå êðîâè ó ñàìîê îïûòíîé ãðóïïû
ñðàçó æå ïîñëå ðîäîâ îáíàðóæèâàþòñÿ àóòîàíòèòåëà äîñòèãàþùèå òèòðà 1:128,
ýòà òåíäåíöèÿ ñîõðàíÿåòñÿ äî 3 ñóòîê ëàêòàöèè, â òî âðåìÿ êàê ó êîíòðîëüíîé
ãðóïïû æèâîòíûõ òèòð àóòîàíòèòåë ðàâåí 1:8 è 1:4 íà 1 è 3 äíè ïîñëå ðîäîâ
ñîîòâåòñòâåííî. Â ïîñëåäóþùèå ñðîêè ëàêòàöèè ñåðîïîçèòèâíûìè îêàçàëèñü
ñûâîðîòêè â ðàçâåäåíèè 1:64 âïëîòü äî êîíöà ëàêòàöèîííîãî ïåðèîäà. Íàïðîòèâ,
â êîíòðîëüíîé ãðóïïå àíòèòåëà îáíàðóæèâàþòñÿ ó ñàìîê òîëüêî äî 7 ñóòîê ãðóäíîãî
âñêàðìëèâàíèÿ, íå ïðåâûøàþùèå òèòðà 1:4, â ïîñëåäóþùèå ñðîêè ëàêòàöèè
íàáëþäàëèñü òîëüêî ñëåäû.
 îòëè÷èå îò ñûâîðîòêè êðîâè ïðè ñåðîëîãè÷åñêîì èññëåäîâàíèè îáðàçöîâ
ìîëîêà ñàìîê îïûòíîé ãðóïïû íà 1 ñóòêè ïîñëå ðîäîâ, àóòîàíòèòåëà îïðåäåëÿëèñü
â ðàçâåäåíèè 1:8.  ïîñëåäóþùèå ñðîêè, ïðîòèâîïå÷åíî÷íûå àíòèòåëà íå âñåãäà
îáíàðóæèâàëèñü äàæå â ðàçâåäåíèè 1:4 . Â êîíòðîëüíîé ãðóïïå ïîêàçàòåëè
ñåðîëîãè÷åñêèõ èññëåäîâàíèé ìîëîêà â ïåðèîä ãðóäíîãî âñêàðìëèâàíèÿ
ñóùåñòâåííûõ ðàçëè÷èé îò îïûòíîé ãðóïïû íå îáíàðóæèëè.
Äëÿ ïðîâåäåíèÿ áîëåå òî÷íûõ èññëåäîâàíèé è âîçìîæíîñòè ñðàâíåíèÿ
èçìåíåíèÿ òèòðà àíòèãåïàòîöèòàðíûõ àíòèòåë â ñûâîðîòêå êðîâè è ìîëîêå ñàìîê
êðûñ â äèíàìèêå ëàêòàöèè ðåçóëüòàòû ñåðîëîãè÷åñêèõ èññëåäîâàíèé áûëè
âûðàæåíû â log2 (ñì. Òàáë.). Ñîãëàñíî ýòèì äàííûì ïðè òîêñè÷åñêîì ãåëèîòðèííîì
ãåïàòèòå ïîÿâëåíèå àóòîàíòèòåë ïðîòèâ ïå÷åíè õàðàêòåðíî òîëüêî äëÿ ñûâîðîòêè
êðîâè, êîòîðûå ïðèñóòñòâóþò âïëîòü äî êîíöà ïåðèîäà ãðóäíîãî âñêàðìëèâàíèÿ.
 òî âðåìÿ, êàê â îáðàçöàõ ìîëîêà, ïîëó÷åííûõ îò ñàìîê ñ òîêñè÷åñêèì ãåïàòèòîì
òèòð àóòîàíòèòåë ñóùåñòâåííî íå îòëè÷àëñÿ îò òàêîâûõ ó ñàìîê êîíòðîëüíîé
ãðóïïû.
Èçâåñòíî, ÷òî õðîíè÷åñêàÿ ãåëèîòðèííàÿ èíòîêñèêàöèÿ ïðèâîäèò ê
âîçíèêíîâåíèþ òîêñè÷åñêîãî ãåïàòèòà, êîòîðûé â îñíîâíîì èìååò òåíäåíöèþ ê
ïðîãðåññèðîâàíèþ, ò.å. ÿâëÿåòñÿ ìîäåëüþ àãðåññèâíîãî õðîíè÷åñêîãî ãåïàòèòà
[1]. Ïðè àêòèâíûõ ôîðìàõ ãåïàòèòîâ ïðîèñõîäèò èçìåíåíèÿ â èììóííîì ñòàòóñå,
â ÷àñòíîñòè îòìå÷àþòñÿ ãëóáîêèå èçìåíåíèÿ â Ò- è Â-ñèñòåìàõ èììóíèòåòà è
ïðîèñõîäèò íàðàñòàíèå òèòðà èììóíîãëîáóëèíîâ ðàçëè÷íûõ êëàññîâ, óâåëè÷åíèå
ãàììàðàêöèè ãëîáóëèíîâ, ÿâë ÿåòñÿ êðèòåðèÿìè îöåíêè àêòèâíîñòè
ðàçâèâàþùåãîñÿ ïàòîëîãè÷åñêîãî ïðîöåññà.  ñëó÷àÿõ ïåðåõîäà ïðîöåññà â
õðîíè÷åñêóþ ôîðìó íà ôîíå íåçíà÷èòåëüíîãî óìåíüøåíèÿ Ò-õåëïåðîâ ñóùåñòâåííî
ñíèæàåòñÿ êîëè÷åñòâî Ò-ñóïðåñññîðîâ (êèëëåðîâ), ÷òî ñïîñîáñòâóåò îáðàçîâàíèþ
ïðîòèâîïå÷åíî÷íûõ àíòèòåë è àêòèâèçàöèè ïàòîëîãè÷åñêîãî ïðîöåññà [3, 9].
Ðåçóëüòàòû íàøåãî èññëåäîâàíèÿ åùå ðàç ïîêàçàëè, ÷òî ãåëèîòðèííàÿ
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èíòîêñèêàöèÿ ñàìîê êðûñ äî áåðåìåííîñòè ÿâëÿåòñÿ ïóñêîâûì ìåõàíèçìîì
àóòîàëëåðãè÷åñêîãî ïðîöåññà, ïðîãðåññèðóþùåãî ñ òå÷åíèåì âðåìåíè. Íàðÿäó ñ
ýòèì, îòíîñèòåëüíî íåâûñîêèå òèòðû ïðîòèâîïå÷åíî÷íûõ àíòèòåë â ñûâîðîòêå
êðîâè, ïî-âèäèìîìó, ñâÿçàíû, ñ èçìåíåíèÿìè, ïðîèñõîäÿùèìè â îðãàíèçìå
ìàòåðè â äèíàìèêå áåðåìåííîñòè è ëàêòàöèè, ñòèìóëèðóþùèìè ðåãåíåðàöèîííûå
ïðîöåññû. Ïî÷òè äâóêðàòíîå ïðåâûøåíèå òèòðà àóòîàíòèòåë ñðàçó ïîñëå ðîäîâ,
îòíîñèòåëüíî äàëüíåéøåãî ïåðèîäà ëàêòàöèè (1:128 íà 1 ñóòêè è 1:64 â
ïîñëåäóþùèå ñðîêè ëàêòàöèè), âîçìîæíî, îáúÿñíÿåòñÿ âîçäåéñòâèåì ïëîäà,
÷óæåðîäíîãî äëÿ îðãàíèçìà ìàòåðè.
Òàáëèöà. Èçìåíåíèå àêòèâíîñòè ïðîòèâîïå÷åíî÷íûõ àíòèòåë â êðîâè è ìîëîêå
ñàìîê êðûñ ñ õðîíè÷åñêîé ãåëèîòðèííîé èíòîêñèêàöèåé â äèíàìèêå ëàêòàöèè
(äàííûå âûðàæåíû â log2 , ̱ì)
Ïðèìå÷àíèå: * - ðàçëè÷èÿ äîñòîâåðíû îòíîñèòåëüíî êîíòðîëÿ ïðè Ð<0,05
Íàëè÷èå íåçíà÷èòåëüíîãî êîëè÷åñòâà àíòèòåë â ìîëîêå â ïåðèîä ëàêòàöèè,
óêàçûâàåò íà òî, ÷òî ïðè÷èíîé äèñòðîôè÷åñêèõ èçìåíåíèé â ïå÷åíè êðûñÿò,
ðîæäåííûõ èíòàêòíîé êðûñû, ïðè âñêàðìëèâàíèè èõ ñàìêîé ñ ãåëèîòðèííûì
ãåïàòèòîì [4], ÿâëÿþòñÿ íå àóòîàíòèòåëà, à âîçìîæíî, ãåïàòîòîêñèíû,
îáðàçóþùèåñÿ â îðãàíèçìå ìàòåðè, âñëåäñòâèå íàðóøåíèé ôóíêöèé ïå÷åíè [10,
11, 12].
Òàêèì îáðàçîì, ïîëó÷åííûå íàìè ðåçóëüòàòû ïîçâîëÿþò ñäåëàòü âûâîä,
÷òî â êðîâè ñàìîê êðûñ ñ òîêñè÷åñêèì ãåïàòèòîì ïîñëå ðîäîâ è â äèíàìèêå
ëàêòàöèè îïðåäåëÿþòñÿ ïðîòèâîïå÷åíî÷íûå àíòèòåëà, íî â ïåðèîä ãðóäíîãî
âñêàðìëèâàíèÿ, îíè ïåðåäàþòñÿ êðûñÿòàì ÷åðåç ìîëîêî â íåçíà÷èòåëüíûõ
êîëè÷åñòâàõ è, ñêîðåå âñåãî, íå ÿâëÿþòñÿ îñíîâíîé ïðè÷èíîé îòñòàâàíèÿ
ñòàíîâëåíèÿ îðãàíîâ ïèùåâàðèòåëüíîé è èììóííîé ñèñòåì ïîòîìñòâà.
Èñïîëüçîâàííàÿ ëèòåðàòóðà:
1. Abdullayev N.KH., Karimov KH.YA. Pechen' pri intoksikatsiyakh gepatotropnymi
yadami.- Tashkent, 1988. - 96 s.
2. Azizova F.KH., Bazhakova D.KH., Akhmedova KH.YU. Vozrastnyye strukturno-
funktsional'nyye osobennosti tonkoy kishki krysyat, rozhdennykh ot samok krys s
khronicheskim toksicheskim gepatitom // Vrachebnoye delo. - 2001.- ¹ 1.- s.103-105.
Исследуемый
материал
Гр.
ж-х
С р о к и л а к т а ц и и ( в сутках)
1 3 7 14 21
Кровь
К 1,68±
0,158
0,75±
0,161
0,68±
0,149
0,48±
0,142
0,33±
0,104
О 6,03±
0,089*
5,45±
0,127*
5,10±
0,114*
4,90±
0,120*
4,73±
0,114*
Молоко
К 1,60±
0,206
1,48±
0,089
1,30±
0,082
0,83±
0,196
0,78±
0,164
О 3,75±
0,133
3,45±
0,158
3,43±
0,212
2,00±
0,199
1,95±
0,225
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3. Azizov Ye.KH. Strukturno-funktsional'nyye osnovy reaktsii mezenterial'nykh
limfaticheskikh uzlov pri eksperimental'nom tokicheskom gepatite i puti yeyo korrektsii.
Avtoref. dis. kand.med.nauk. 2-TashMI, Tashkent. - 2018. - 18 s.
4. Adilbekova D.B. Postnatal'noye stanovleniye sosudisto-tkanevykh ctruktur zheludka
i kishechnika potomstva v usloviyakh khronicheskogo toksicheskogo gepatita u materi.
Avtoref. dis. dokt.med.nauk. TMA, Tashkent. - 2018. - 26 s.
5. Golubeva M.V. i dr. Vrozhdennyye gepatity v i s u detey // Meditsinskiy vestnik
severnogo kavkaza. - ¹ 2. - 2009. - S. 94-101.
6. Dinamika antitel k otdel'nym antigenam virusa gepatita S u detey pervykh let zhizni
/ Nikolayeva L.I., Goroshanskaya M.N., Cherednichenko T.V. i dr. // Det.infektsii. 2005.
- ¹4. - S. 15-17.
7. Instruktivno-metodicheskiye materialy po primeneniyu serologicheskikh metodov
diagnostiki pri epizootologicheskom obsledovanii prirodnykh ochagov chumy. ? Moskva.
MZ SSSR GUKI. - 1983. - 135 s.
8. Nikolayev A.I., Platonova L.Ye. Metody opredeleniya autoantitel i ikh sravnitel'naya
otsenka. ? T., "Meditsina". ? 1971. ? 112 s.
9. Frolov V.M., Germanov V.T., Peresadin N.A. Funktsional'noye sostoyaniye
gepatobilliarnoy sistemy i immunnyy status beremennykh, perenesshikh virusnyy gepatit
// Akusherstvo i ginekologiya.- 1991.- ¹ 9. S 24-26.
10. Impaired monocyte-macrophage functions and defective Toll-like receptor signaling
in hepatitis E virus-infected pregnant women with acute liver failure / Sehgal R., Patra
S., David P., Vyas A., Khanam A., Hissar S., e tal. // Hepatology. - 62 (6). - 2015. -
R. 1683-1696.
11. Navaneethan U., MohajerM.A.,Shata M.T.. Hepatitis E and pregnancy: understanding
the pathogenesis, Liver. Int. . - 28 (9). - 2008 -. R. 1190-1198. 12. S. Zhang Mi,J., Zhang
W., Huang R.S. Circulating micro RNA sas biomarkers for inflammatory diseases. -
Microrna. - 2(1). - 2013. - R. 63-71.
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1-³èñì | Ìàõñóñ ñîí
ÁÈÎÌÅÄÈÖÈÍÀ ÂÀ ÀÌÀËÈ¨Ò ÆÓÐÍÀËÈ
ÆÓÐÍÀË ÁÈÎÌÅÄÈÖÈÍÛ È ÏÐÀÊÒÈÊÈ
JOURNAL OF BIOMEDICINE AND PRACTICE
ÌÎÐÔÎËÎÃÈß
Ìàíçóðà Áàòèðîâíà ÒÓÐÀÌÓÐÀÒÎÂÀ
Êàôåäðà àíàòîìèè, Óðãåí÷ñêèé ôèëèàë
Òàøêåíòñêîé ìåäèöèíñêîé àêàäåìèè, Ðåñïóáëèêà Óçáåêèñòàí
Äèëîðîì Áàõòèÿðîâíà ÀÄÈËÁÅÊÎÂÀ
Êàôåäðà àíàòîìèè è êëèíè÷åñêîé àíàòîìèè,
Òàøêåíòñêàÿ ìåäèöèíñêàÿ àêàäåìèÿ, Ðåñïóáëèêà Óçáåêèñòàí
ÎÖÅÍÊÀ ÀÍÒÐÎÏÎÌÅÒÐÈ×ÅÑÊÈÕ ÏÎÊÀÇÀÒÅËÅÉ
ÇÄÎÐÎÂÛÕ ÄÅÂÎ×ÅÊ ÏÐÎÆÈÂÀÞÙÈÕ Â ÃÎÐÎÄÅ ÓÐÃÅÍ×
For citation:, B.M. Turamurotova, D.B. Adilbekova, Evaluation of anthropometric
indicators of healthy girls residing in the city of urgench, Journal of Biomedicine and
Practice 2020, Special issue, pp.36-42
http:// dx.doi.org/10.26739/2181-9300-2020-SI-5
ÀÍÍÎÒÀÖÈß
Îáúåêòû èññëåäîâàíèÿ: çäîðîâûå äåâî÷êè îò íîâîðîæäåííîãî äî ïîäðîñòêîâîãî
ïåðèîäà ïðîæèâàþùèå â ã. Óðãåí÷à, èçó÷åíî ìåòîäîì àíòðîïîìåòðèè ïî Í.Õ.
Øîìèðçàåâó è ñîàâò. (1998), à òàêæå âàðèàöèîííî-ñòàòèñòè÷åñêèì ìåòîäîì.
Ïîêàçàòåëè ðîñòà ó äåòåé æåíñêîãî ïîëà â âîçðàñòå îò 1ãîäà äî 7 ëåò óâåëè÷èâàëèñü
â 1,64ðàçà, îò 7 äî 16 ëåò óâåëè÷èâàþòñÿ â 1,34 ðàçà; à ìàññà òåëà äî 7 ëåò â 2,26
ðàçà. Ïîêàçàòåëè ðàçìåðà îêðóæíîñòè ãðóäíîé êëåòêè â ïàóçå ñ 1 äî 16 ëåò, ó ëèö
æåíñêîãî ïîëà â 1,45 ðàçà. Íàèáîëüøèé òåìï ðîñòà ó äåâî÷åê âûÿâëÿåòñÿ â 7
ëåòíåì âîçðàñòå, îêðóæíîñòü ãðóäíîé êëåòêè ñîñòàâëÿåò 195 %, à ñ 7 äî 16 ëåò
142 % ïî ñðàâíåíèþ ñ îäíîëåòíèì ðåáåíêîì.
Êëþ÷åâûå ñëîâà: àíòðîïîìåòðèÿ, ïàðàìåòðû ðîñòà, ïîäðîñòêîâûé ïåðèîä
Manzura Batirovna TURAMURATOVA
Department of Anatomy, Urgench branch of
Tashkent medical academy,
Republic of Uzbekistan
Dilorom Bakhtiyarovna ADILBEKOVA
Department of Anatomy and Clinical Anatomy,
Tashkent Medical Academy,
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Republic of Uzbekistan
EVALUATION OF ANTHROPOMETRIC INDICATORS OF
HEALTHY GIRLS RESIDING IN THE CITY OF URGENCH
ANNOTATSION
Objects of study, healthy girls from newborn period to adolescence period. living in
the city Urgench, studied by anthropometry methods of N.H.Shomirzaev and co-
authors (1998), and by variation-statistical methods. Parameters of growth in female
children aged 1 year to 7 years, increased by 1,64 times, while the body weight of up
to 7 years at 2.26 times and from 7 to 16 years increased to 1.34 times, the mass of the
body and up to 7 years 2.26. Size measure the circumference of the chest in a pause from
1 to 16 years, in females is 1.45 times greater. The highest growth rate among girls is
detected at 7 years of age, chest circumference is 196%, compared with an annual child
and from 7 to 16 years of 142% compared to one year old child.
Keywords: anthropometry, parameters of growth, adolescence period
Ìàíçóðà Áàòèðîâíà ÒÓÐÀÌÓÐÀÒÎÂÀ
Àíàòîìèÿ êàôåäðàñè, Òîøêåíò òèááèåò àêàäåìèÿñè
Óðãàí÷ ôèëèàëè, ¤çáåêèñòîí
Äèëîðîì Áàõòèÿðîâíà ÀÄÈËÁÅÊÎÂÀ
Àíàòîìèÿ âà êëèíèê àíàòîìèÿ êàôåäðàñè,
Òîøêåíò òèááèåò àêàäåìèÿñè, ¤çáåêèñòîí
ÓÐÃÀÍ× ØÀ¥ÐÈÄÀ ßØÎÂ×È ÑÎFËÎÌ £ÈÇ
ÁÎËÀËÀÐÍÈÍà ÀÍÒÐÎÏÎÌÅÒÐÈÊ Ê¤ÐÑÀÒÊÈ×ËÀÐÈÍÈ
ÁÀ¥ÎËÀØ
ÀÍÍÎÒÀÖÈß
Òàä³è³îò îáúåêòëàðè: Óðãàí÷ øàµðèäà ÿøàéäèãàí ñî²ëîì ´ñïèðèíëèê äàâðèãà÷à
á´ëãàí ³èç áîëàëàðäà Í.Õ.Øîìèðçàåâ âà áîø³àëàð. (1998), óñóëè á´éè÷à ´òêàçèø
øóíèíãäåê, âàðèàöèîí-ñòàòèñòèê óñóë áèëàí àíòðîïîìåòðèÿ ´òêàçèø. 1 ¸øäàí 7
¸øãà÷à á´ëãàí ³èç áîëàëàðíèíã ´ñèø ñóðúàòëàðè 1,64 áàðàâàðãà, 7 ¸øäàí 16
¸øãà÷à - 1,34 áàðàâàðãà; âà 7 ¸øãà÷à á´ëãàí òàíà âàçíè 2,26 ìàðòà. 1 ¸øäàí 16
¸øãà÷à á´ëãàí ïàóçàäà ê´êðàê àòðîôèíè ´ë÷àø ê´ðñàòêè÷ëàðè, à¸ëëàðäà áó 1,45
ìàðòà. £èçëàðäà ýíã þ³îðè ´ñèø ñóðúàòè 7 ¸øäàí áîøëàá àíè³ëàíàäè, ê´êðàê
³àôàñè àòðîôëàðè 195%, 7 ¸øäàí 16 ¸øãà÷à ýñà áèð ¸øëè áîëàãà íèñáàòàí 142%.
Êàëèò ñ´çëàð: àíòðîïîìåòðèÿ, ´ñèø ê´ðñàòêè÷ëàðè,´ñïèðèíëèê äàâðè
Àêòóàëüíîñòü. Â íàøåé ñòðàíå îñóùåñòâëÿåòñÿ âåñîìàÿ ðàáîòà ïî îõðàíå çäîðîâüÿ
ìàòåðè è ðåáåíêà, ãàðìîíè÷íîìó âîñïèòàíèþ ïîäðàñòàþùåãî ïîêîëåíèÿ. 13
àïðåëÿ 2009 ãîäà Ïðåçèäåíòîì Ðåñïóáëèêè Óçáåêèñòàí ïîäïèñàíî ïîñòàíîâëåíèå
"Î äîïîëíèòåëüíûõ ìåðàõ ïî îõðàíå çäîðîâüÿ ìàòåðè è ðåáåíêà, ôîðìèðîâàíèÿ
çäîðîâîãî ïîêîëåíèÿ", à òàêæå 1 èþëÿ ýòîãî æå ãîäà ãëàâîé Ðåñïóáëèêè ïîäïèñàíî
ïîñòàíîâëåíèå ïðîãðàììå ìåð ïî äàëüíåéøåìó óñèëåíèþ è ïîâûøåíèþ
ýôôåêòèâíîñòè ïðîâîäèìîé ðàáîòû ïî óêðåïëåíèþ ðåïðîäóêòèâíîãî çäîðîâüÿ
íàñåëåíèÿ, ðîæäåíèþ çäîðîâîãî ðåáåíêà, ôîðìèðîâàíèþ ôèçè÷åñêè è äóõîâíî
ðàçâèòîãî ïîêîëåíèÿ íà 2009-2013 ãîäû". [1] Èçó÷åíèå äåòñêîãî è ïîäðîñòêîâîãî
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âîçðàñòà ÷ðåçâû÷àéíî âàæíî, òàê êàê îí îïðåäåëÿåò ôèçè÷åñêîå è íðàâñòâåííîå
ñîñòîÿíèå ÷åëîâåêà â áóäóùåì [2,3,5]. Ïîäðîñòêîâûé ïåðèîä ÿâëÿåòñÿ êðèòè÷åñêèì
ïåðèîäîì ïîñòíàòàëüíîãî ðàçâèòèÿ, äëÿ êîòîðîãî õàðàêòåðíî ìíîæåñòâî
ïñèõîëîãè÷åñêèõ îñîáåííîñòåé.[6,7,8,9].
Èçó÷åíèå ñîñòîÿíèÿ äåìîãðàôè÷åñêîé ñèòóàöèè äåòåé è ïîäðîñòêîâ â
Óçáåêèñòàíå-îäíà èç ñàìûõ îñòðûõ ñîöèàëüíî-ýêîíîìè÷åñêèõ ïðîáëåì,
çàòðàãèâàþùèõ èíòåðåñû íàöèîíàëüíîé áåçîïàñíîñòè.[10,11,12] Â ñâÿçè ñ
âûøåîïèñàííûì, îäíîé èç âàæíåéøèõ çàäà÷ ìîðôîëîãîâ ÿâëÿåòñÿ èçó÷åíèå
âîçðàñòíûõ, èíäèâèäóàëüíûõ, ïîëîâûõ è àíòðîïîìåòðè÷åñêèõ îñîáåííîñòåé
îðãàíèçìà íà ðàçëè÷íûõ ýòàïàõ îíòîãåíåçà ïðè ðàçíûõ êîíêðåòíûõ óñëîâèÿõ è íà
ýòîé îñíîâå ðàçðàáîòêè ïðîôèëàêòè÷åñêèõ ìåðîïðèÿòèé. [13,14,15]
Öåëü èññëåäîâàíèÿ: Èçó÷èòü îïðåäåëåííóþ äèíàìèêó è ïàðàìåòðû ôèçè÷åñêîãî
ðàçâèòèÿ äåòåé è ïîäðîñòêîâ â ãîðîäå Óðãåí÷å.
Ìàòåðèàë è ìåòîäû èññëåäîâàíèÿ. Ìàòåðèàëîì äëÿ èññëåäîâàíèÿ ñëóæèëè
ïðàêòè÷åñêè çäîðîâûå äåòè, èç ðîäèëüíûõ äîìîâ, âîñïèòàííèêè äåòñêèõ ñàäîâ è
ó÷àùèåñÿ øêîë ã. Óðãåí÷a. Âñåãî îáñëåäîâàíî 220 äåòåé, èç íèõ 120 ìàëü÷èêîâ è
122 äåâî÷åê â âîçðàñòå îò íîâîðîæäåííîãî ïåðèîäà äî 17 ëåò. Îáùèå
àíòðîïîìåòðè÷åñêèå ïîêàçàòåëè èçó÷åíû â ñëåäóþùåì ïîðÿäêå: ìàññà òåëà
èçìåðåíà ñ ïîìîùüþ ìåäèöèíñêèõ âåñîâ, ïðåäíàçíà÷åííûõ äëÿ íîâîðîæäåííûõ
è âçðîñëûõ (êã). Äëÿ èçìåðåíèÿ ðîñòà ñòîÿ, èñïîëüçîâàí ðîñòîìåð ñòàíäàðòíîãî
òèïà. Ïðè ýòîì òåëî ðåáåíêà íàõîäèëîñü ñâîáîäíî, íå êàñàÿñü âåðòèêàëüíîé
ïëàíêè.[16] Ïðîâåäåíû èçìåðåíèÿ äëèíû êîðïóñà èëè ðîñòà, ñèäÿ, à òàêæå
äëèíû òóëîâèùà. Îêðóæíîñòü ãðóäíîé êëåòêè èçìåðÿëè ñ ïîìîùüþ èçìåðèòåëüíîé
ëåíòû. Ïîëó÷åííûå äàííûå ïîäâåðãàëè ñòàòèñòè÷åñêîé îáðàáîòêå íà êîìïüþòåðå
ñ ïîìîùüþ ïðîãðàììíîãî ïàêåòà Microsoft office Excel 2007, âêëþ÷àÿ èñïîëüçîâàíèå
âñòðîåííûõ ôóíêöèé ñòàòèñòè÷åñêîé îáðàáîòêè.
Ðåçóëüòàòû èññëåäîâàíèÿ è èõ îáñóæäåíèå. Èññëåäîâàíèÿ ïîêàçàëè, ÷òî âåñ ó
íîâîðîæäåííûõ ïåðâûå 10 äíåé â ñðåäíåì ìåæäó 3050-3750 ã. Êàê ïîêàçàëè
ïåðâûå 3-5 äíåé ïîñëå ðîæäåíèÿ, ïðîèñõîäèò ôèçèîëîãè÷åñêàÿ ïîòåðÿ â âåñå â
ðàçìåðå îò 200 äî 245 ã îò ïåðâîíà÷àëüíîãî âåñà. Ïåðâîíà÷àëüíûé âåñ
âîññòàíàâëèâàåòñÿ â òå÷åíèå 10-12 äíåé ïîñëå ðîæäåíèÿ, â ýòî âðåìÿ äëèíà
óâåëè÷èâàåòñÿ íà 1,3- 2,1 ñì.
Ïîêàçàòåëè ðîñòà äåòåé æåíñêîãî ïîëà îò 45,0 ñì äî 54,0 ñì, â ñðåäíåì
ñîñòàâëÿÿ 49,4±2,13 ñì. Ìàññà òåëà êîëåáàëàñü îò 3,28 êã äî 3,65 êã, â ñðåäíåì
áûëà ðàâíà 3,35±0,19 êã.
Îêðóæíîñòü ãðóäè â ïàóçå íàõîäèòñÿ â ïðåäåëàõ îò 10,7 äî 13,7 ñì, â ñðåäíåì
- 12,5±0,51 ñì. Íà âûñîòå âäîõà ãðóäè êîëåáëåòñÿ îò 11,99 äî 14,6 ñì, â ñðåäíåì
13,20±0,54 ñì. Ïðè ïîëíîì âäîõå - îò 12,7 ñì äî 12,85 ñì, â ñðåäíåì 12,7±0,57 ñì,
ïîïåðå÷íûé äèàìåòð ãðóäè êîëåáëåòñÿ îò 7,19 äî 10,6 ñì, â ñðåäíåì - 8,74±0,32
ñì.
Ðîñò ó äåòåé 1 ãîäà îò 61,3 ñì äî 77,0 ñì, â ñðåäíåì ñîñòàâëÿÿ 68,3±2,72 ñì.
Ìàññà òåëà êîëåáàëàñü îò 6,6 êã äî 9,8 êã, â ñðåäíåì áûëà ðàâíà 8,20±0,41 êã.
Îêðóæíîñòü ãðóäè â ïàóçå íàõîäèòñÿ â ïðåäåëàõ îò 28,3 äî 33,3 ñì, â ñðåäíåì -
31,8±1,12 ñì. Ïîêàçàòåëè íà âûñîòå âäîõà êîëåáëåòñÿ îò 29,23 äî 35,97ñì, â ñðåäíåì
32,6±1,62 ñì. Ïðè ïîëíîì âäîõå - îò 29,9 ñì äî 33,9 ñì, â ñðåäíåì 31,6±1,12 ñì,
ïîïåðå÷íûé äèàìåòð ãðóäè êîëåáëåòñÿ îò 8.0 äî 10,9 ñì, â ñðåäíåì - 9,45± 0,67 ñì.
Ðîñò ó äåòåé 2 ãîäà îò 79,6 ñì äî 90,4ñì, â ñðåäíåì ñîñòàâëÿÿ 82,72±4,00 ñì.
Ìàññà òåëà êîëåáàëàñü îò12,7 êã äî 15,5 êã, â ñðåäíåì áûëà ðàâíà 13,33±0,54 êã.
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Îêðóæíîñòü ãðóäè â ïàóçå íàõîäèòñÿ â ïðåäåëàõ îò 34,4 äî 37,0 ñì, â ñðåäíåì
- 34,89±1,36 ñì. Ýòî ïîêàçàòåëü íà âûñîòå âäîõà êîëåáëåòñÿ îò 35 äî 37,6 ñì, â
ñðåäíåì 36,5±1,23 ñì. Ïðè ïîëíîì âäîõå - îò 34 ñì äî 38,4 ñì, â ñðåäíåì 35,8±1,37
ñì, ïîïåðå÷íûé äèàìåòð ãðóäè êîëåáëåòñÿ îò 11,0 äî 12,12 ñì, â ñðåäíåì -
11,5±0,50 ñì.
Èññëåäîâàíèÿ ïîêàçàëè, ÷òî ðîñò ó äåòåé 3 ëåò æåíñêîãî ïîëà âàðüèðîâàë îò
85,0 ñì äî 93,0 ñì, â ñðåäíåì ñîñòàâëÿÿ 88,43±4,34 ñì. Ìàññà òåëà êîëåáàëàñü îò
12,5 äî 14,6 êã, â ñðåäíåì áûëà ðàâíà 13,7±0,76 êã.
Ó äåòåé 3 ëåò æåíñêîãî ïîëà îêðóæíîñòü ãðóäè â ïàóçå íàõîäèòñÿ â ïðåäåëàõ îò
45,2 äî 53,3 ñì, â ñðåäíåì - 47,55±2,34ñì. Ýòîò ïîêàçàòåëü íà âûñîòå âäîõà
êîëåáëåòñÿ îò 46,6 äî 52,4 ñì, â ñðåäíåì 48,2±2,38ñì. Ïðè ïîëíîì âäîõå - îò 43,8
ñì äî 51 ñì â ñðåäíåì 47,4±2,04 ñì. Ó äåòåé 3 ëåò æåíñêîãî ïîëà ïîïåðå÷íûé
äèàìåòð ãðóäè êîëåáëåòñÿ îò 13,9 äî 18,0 ñì, â ñðåäíåì-15,5±0,48 ñì.
Óñòàíîâëåíî, ÷òî ðîñò ó äåòåé 4 ëåò æåíñêîãî ïîëà âàðüèðîâàë îò 89 ñì äî 103,3
ñì, â ñðåäíåì ñîñòàâëÿÿ 97±3,34 ñì. Ìàññà òåëà êîëåáàëàñü îò 12,7 äî 15,6 êã, â
ñðåäíåì áûëà ðàâíà 15,4±1,0 êã.
Ó äåòåé 4 ëåò æåíñêîãî ïîëà. Îêðóæíîñòü ãðóäè â ïàóçå íàõîäèòñÿ â ïðåäåëàõ
îò 48 äî 57ñì, â ñðåäíåì - 52,3,0±2,34 ñì. Ýòî ïîêàçàòåëü íà âûñîòå âäîõà êîëåáëåòñÿ
îò 50 äî 56ñì, â ñðåäíåì 53,4±2,12 ñì. Ïðè ïîëíîì âäîõå îò 51,8 äî 56,4, â
ñðåäíåì 52,0±2,34 ñì. Ó äåòåé 4 ëåò æåíñêîãî ïîëà ïîïåðå÷íûé äèàìåòð ãðóäè
êîëåáëåòñÿ îò 12,3 äî 18,4 ñì, â ñðåäíåì - 17,4±0,32 ñì.
Ðîñò äåòåé 5 ëåò æåíñêîãî ïîëà âàðüèðîâàë îò 101 ñì äî 108 ñì, â ñðåäíåì
ñîñòàâëÿÿ 102,0±4,67 ñì. Ìàññà òåëà êîëåáàëàñü îò 15,6 äî 17,9 êã, â ñðåäíåì áûëà
ðàâíà 15,8±0,78 êã.
Ó äåòåé 5 ëåò æåíñêîãî ïîëà. Îêðóæíîñòü ãðóäè â ïàóçå íàõîäèòñÿ â ïðåäåëàõ
îò 52 äî 57 ñì, â ñðåäíåì - 53,4±2,67 ñì. Ýòî ïîêàçàòåëü íà âûñîòå âäîõà êîëåáëåòñÿ
îò 53,2 äî 58,6 ñì, â ñðåäíåì 54,0±2,67 ñì. Ïðè ïîëíîì âäîõå îò 51,3 äî 57,7, â
ñðåäíåì- 58,2±2,56 ñì. Ó äåòåé 5 ëåò æåíñêîãî ïîëà ïîïåðå÷íûé äèàìåòð ãðóäè
êîëåáëåòñÿ îò 13,2 äî 24,6 ñì, â ñðåäíåì-18,9±0,24 ñì.
Äëèíà ðîñòà ó äåòåé 6 ëåò æåíñêîãî ïîëà âàðüèðîâàë îò 107 ñì äî 117,5 ñì, â
ñðåäíåì ñîñòàâëÿÿ - 112,0±5,12 ñì. Ìàññà òåëà êîëåáàëàñü îò 15,9 äî 22,1 êã, â
ñðåäíåì áûëà ðàâíà 19,0±1,09 êã.
Ó äåòåé 6 ëåò æåíñêîãî ïîëà, îêðóæíîñòü ãðóäè â ïàóçå íàõîäèòñÿ â ïðåäåëàõ
îò 53,4 äî 60,4 ñì, â ñðåäíåì - 55,8±0,27 ñì. Ýòî ïîêàçàòåëü íà âûñîòå âäîõà
êîëåáëåòñÿ îò 54,9 äî 62,4 ñì, â ñðåäíåì 57,0±2,67 ñì. Ïðè ïîëíîì âäîõå îò 52,9
äî 59,9 â ñðåäíåì 56,4±2,54 ñì. Ó äåòåé 6 ëåò æåíñêîãî ïîëà ïîïåðå÷íûé äèàìåòð
ãðóäè êîëåáëåòñÿ îò 14,8ñì äî19,5ñì, â ñðåäíåì-17,5 ± 0,45 ñì.
Äëèíà ðîñòà ó äåòåé 7ëåò æåíñêîãî ïîëà âàðüèðîâàë îò 117,0 ñì äî 127,0 ñì,
â ñðåäíåì ñîñòàâëÿÿ 122,0±5,12 ñì. Ìàññà òåëà êîëåáàëàñü îò 16,2 äî 21,8 êã, â
ñðåäíåì áûëà ðàâíà 19,0±1,06 êã. Ó äåòåé 7 ëåò æåíñêîãî ïîëà, îêðóæíîñòü ãðóäè
â ïàóçå íàõîäèòñÿ â ïðåäåëàõ îò 54,0 äî 64,2 ñì, â ñðåäíåì - 60,2±3,11 ñì. Ýòî
ïîêàçàòåëü íà âûñîòå âäîõà êîëåáëåòñÿ îò 56,0 äî 67,2 ñì, â ñðåäíåì 60,0±2,88 ñì.
Ïðè ïîëíîì âäîõå îò 55,0 äî 63,4 â ñðåäíåì 58,2±2,56 ñì. ïîïåðå÷íûé äèàìåòð
ãðóäè êîëåáëåòñÿ îò 16,9ñì äî19,5ñì, â ñðåäíåì-18,2 ± 0,53 ñì.
Ðîñò äåòåé 8 ëåò æåíñêîãî ïîëà âàðüèðîâàëîñü îò 117,8 ñì äî 136,4 ñì, â
ñðåäíåì ñîñòàâëÿÿ 127,1±5,45 ñì. Ìàññà òåëà êîëåáàëàñü îò 16,4 äî 32,0 êã, â
ñðåäíåì áûëà ðàâíà 24,2±1,43 êã.
Ó äåòåé 8 ëåò æåíñêîãî ïîëà îêðóæíîñòü ãðóäè â ïàóçå íàõîäèòñÿ â ïðåäåëàõ îò
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1-³èñì | Ìàõñóñ ñîí
54,4 äî 66,4 ñì, â ñðåäíåì - 60,4±3,19 ñì. Ýòîò ïîêàçàòåëü íà âûñîòå âäîõà
êîëåáëåòñÿ îò 57,0 äî 68,2 ñì, â ñðåäíåì 60,3±2,99ñì. Ïðè ïîëíîì âäîõå îò 55,2
äî 65,1 â ñðåäíåì 60,0±2,70 ñì., ïîïåðå÷íûé äèàìåòð ãðóäè êîëåáëåòñÿ îò 14,8 ñì
äî 19,5ñì, â ñðåäíåì - 19,7 ± 0,76 ñì.
Ðîñò äåòåé 9 ëåò æåíñêîãî ïîëà âàðüèðîâàëîñü îò 124,6 ñì äî 139,4 ñì, â
ñðåäíåì ñîñòàâëÿÿ 132,0±5,45 ñì. Ìàññà òåëà êîëåáàëàñü îò 18,1 äî 32,0 êã, â
ñðåäíåì áûëà ðàâíà 25,0±1,43 êã.
Ó äåòåé 9 ëåò æåíñêîãî ïîëà îêðóæíîñòü ãðóäè â ïàóçå íàõîäèòñÿ â ïðåäåëàõ îò
59,1 äî 75,0 ñì, â ñðåäíåì - 60,4,0±3,19 ñì. Ýòîò ïîêàçàòåëü íà âûñîòå âäîõà
êîëåáëåòñÿ îò 59,3 äî 76,0 ñì, â ñðåäíåì 63,7±2,99 ñì. Ïðè ïîëíîì âäîõå îò 59,0
äî 76,0 â ñðåäíåì 63,4±2,68 ñì. Ó äåòåé 9 ëåò æåíñêîãî ïîëà ïîïåðå÷íûé äèàìåòð
ãðóäè êîëåáëåòñÿ îò 18,4 äî 23,9 ñì, â ñðåäíåì - 19,5±0,78 ñì.
Ðîñò äåòåé 10 ëåò æåíñêîãî ïîëà âàðüèðîâàëîñü îò 115,8 ñì äî 139,4 ñì, â
ñðåäíåì ñîñòàâëÿÿ 136,0±3,45 ñì. Ìàññà òåëà êîëåáàëàñü îò 22,0 äî 24,0 êã, â
ñðåäíåì áûëà ðàâíà 28,23±1,37 êã.
Ó äåòåé 10 ëåò æåíñêîãî ïîëà Îêðóæíîñòü ãðóäè â ïàóçå íàõîäèòñÿ â ïðåäåëàõ
îò 57,7äî 73,0 ñì, â ñðåäíåì - 62,9±3,01 ñì. Ýòîò ïîêàçàòåëü íà âûñîòå âäîõà
êîëåáëåòñÿ îò 59,0 äî 77,0 ñì, â ñðåäíåì 63,7±2,98 ñì. Ïðè ïîëíîì âäîõå îò 56,1
äî 73,5 â ñðåäíåì 63,8±0,64 ñì.
Èññëåäîâàíèÿ ïîêàçàëè, ÷òî ðîñò ó äåòåé 11 ëåò æåíñêîãî ïîëà âàðüèðîâàë îò
134,0 ñì äî 152,0 ñì, â ñðåäíåì ñîñòàâëÿÿ 143,0±5,45ñì. Ìàññà òåëà êîëåáàëàñü
îò 24,6 äî 44,0 êã, â ñðåäíåì áûëà ðàâíà 28,0±1,67 êã.
Ó äåòåé 11 ëåò æåíñêîãî ïîëà Îêðóæíîñòü ãðóäè â ïàóçå íàõîäèòñÿ â ïðåäåëàõ
îò 60,0 äî 72,5 ñì, â ñðåäíåì - 66,0±3,23 ñì. Ýòîò ïîêàçàòåëü íà âûñîòå âäîõà
êîëåáëåòñÿ îò 61,1 äî 78,0 ñì, â ñðåäíåì 68,0±0,52 ñì. Ïðè ïîëíîì âäîõå îò 59,2
äî 75,0 â ñðåäíåì 65,8±0,49 ñì.
Èññëåäîâàíèÿ ïîêàçàëè, ÷òî ðîñò ó äåòåé 12 ëåò æåíñêîãî ïîëà âàðüèðîâàë îò
136,7 ñì äî 159,0 ñì, â ñðåäíåì ñîñòàâëÿÿ 143,0±5,34 ñì. Ìàññà òåëà êîëåáàëàñü
îò 29,2 äî 50,5 êã, â ñðåäíåì áûëà ðàâíà 30,1+1,65 êã.
Ó äåòåé 12 ëåò æåíñêîãî ïîëà Îêðóæíîñòü ãðóäè â ïàóçå íàõîäèòñÿ â ïðåäåëàõ
îò 61,6 äî 76,7 ñì, â ñðåäíåì - 68,95±2,53ñì. Ýòîò ïîêàçàòåëü íà âûñîòå âäîõà
êîëåáëåòñÿ îò 64,0 äî 77,0 ñì, â ñðåäíåì 71,0±0,48 ñì. Ïðè ïîëíîì âäîõå îò 62,9
äî 76,0 â ñðåäíåì 69,8±0,49ñì.
Ðîñò äåòåé 13 ëåò æåíñêîãî ïîëà âàðüèðîâàëîñü îò 140,8 ñì äî 156,4 ñì, â
ñðåäíåì ñîñòàâëÿÿ 148,0±6,87 ñì. Ìàññà òåëà êîëåáàëàñü îò 26,8 äî 37,0 êã, â
ñðåäíåì áûëà ðàâíà 31,9±1,77 êã.
Ó äåòåé 13 ëåò æåíñêîãî ïîëà. Îêðóæíîñòü ãðóäè â ïàóçå íàõîäèòñÿ â ïðåäåëàõ
îò 62,1 äî 77,3 ñì, â ñðåäíåì - 69,7±3,35 ñì. Ýòî ïîêàçàòåëü íà âûñîòå âäîõà
êîëåáëåòñÿ îò 65 äî 80 ñì, â ñðåäíåì 73,11±3,23 ñì. Ïðè ïîëíîì âäîõå - îò 63,9
ñì äî 75,9 ñì, â ñðåäíåì 69,9±2,94 ñì. Ó äåòåé 12 ëåò æåíñêîãî ïîëà ïîïåðå÷íûé
äèàìåòð ãðóäè êîëåáëåòñÿ îò 17,9 äî 27,6 ñì, â ñðåäíåì - 23,7±0,82 ñì.
Ðîñò äåòåé 14 ëåò æåíñêîãî ïîëà âàðüèðîâàëîñü îò 140,6 ñì äî 157,4 ñì, â
ñðåäíåì ñîñòàâëÿÿ 150,0±7,34 ñì. Ìàññà òåëà êîëåáàëàñü îò 33,0 äî 44,0 êã, â
ñðåäíåì áûëà ðàâíà 39,45±1,45 êã.
Ó äåòåé 14 ëåò æåíñêîãî ïîëà, Îêðóæíîñòü ãðóäè â ïàóçå íàõîäèòñÿ â ïðåäåëàõ
îò 65,0 äî 79 ñì, â ñðåäíåì - 70,20 ± 3,34 ñì. Ýòîò ïîêàçàòåëü íà âûñîòå äîõà
êîëåáëåòñÿ îò 63,8 äî
Ó äåòåé 14 ëåò æåíñêîãî ïîëà ïîïåðå÷íûé äèàìåòð ãðóäè êîëåáëåòñÿ îò 23,5 äî
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1-³èñì | Ìàõñóñ ñîí
27,09 ñì, â ñðåäíåì - 25,29 ±1,00ñì
Ó äåòåé 14 ëåò æåíñêîãî ïîëà, îêðóæíîñòü ãðóäè â ïàóçå íàõîäèòñÿ â ïðåäåëàõ
îò 65,4 äî 79ñì, â ñðåäíåì - 72,20 ± 3,34ñì. Ýòîò ïîêàçàòåëü íà âûñîòå äîõà
êîëåáëåòñÿ îò 63,8 äî 80,2 ñì, â ñðåäíåì 72,0±3,11 ñì. Ïðè ïîëíîì âäîõå - îò
66,4ñì äî 76,0 ñì, â ñðåäíåì 71,2±3,33 ñì
Èññëåäîâàíèÿ ïîêàçàëè, ÷òî ðîñò ó äåòåé 15 ëåò æåíñêîãî ïîëà âàðüèðîâàë îò
144,3 ñì äî 160,0 ñì, â ñðåäíåì ñîñòàâëÿÿ 152,0±7,89 ñì. Ìàññà òåëà êîëåáàëàñü
îò 25,3 äî 58,7 êã, â ñðåäíåì áûëà ðàâíà 42,0+1,65 êã.
Ó äåòåé 15 ëåò æåíñêîãî ïîëà, Îêðóæíîñòü ãðóäè â ïàóçå íàõîäèòñÿ â ïðåäåëàõ
îò 66,1 äî 80,0 ñì, â ñðåäíåì - 72,4±3,67 ñì. Ýòî ïîêàçàòåëü íà âûñîòå âäîõà
êîëåáëåòñÿ îò 69,5 äî 83,01 ñì, â ñðåäíåì 72,04±3,63 ñì. Ïðè ïîëíîì âäîõå - îò
69,5 ñì äî 83,0 ñì, â ñðåäíåì 74,0±2,78 ñì. Ó äåòåé 15 ëåò ïîïåðå÷íûé äèàìåòð
ãðóäè êîëåáëåòñÿ îò 24,0 äî 30,0 ñì, â ñðåäíåì - 28,0±1,08 ñì.
Ðîñò ó äåòåé 16 ëåò æåíñêîãî ïîëà âàðüèðîâàë îò 157,0 ñì äî 168,0 ñì, â
ñðåäíåì ñîñòàâëÿÿ 162,0±6,55 ñì. Ìàññà òåëà êîëåáàëàñü îò 40,3 äî 53,2 êã, â
ñðåäíåì áûëà ðàâíà 46,2+2,24 êã.
Ó äåòåé 16 ëåò æåíñêîãî ïîëà, Îêðóæíîñòü ãðóäè â ïàóçå íàõîäèòñÿ â ïðåäåëàõ
îò 64,1 äî 76 ñì, â ñðåäíåì - 74,0±3,70 ñì. Ýòîò ïîêàçàòåëü íà âûñîòå âäîõà
êîëåáëåòñÿ îò 67,8 äî 79,3 ñì, â ñðåäíåì 75,9±3,68 ñì. Ïðè ïîëíîì âäîõå - îò 72,7
ñì äî 77,3 ñì, â ñðåäíåì 74,4±3,67 ñì. Ó äåòåé 16 ëåò ïîïåðå÷íûé äèàìåòð ãðóäè
êîëåáëåòñÿ îò 22,4 äî 26,9 ñì, â ñðåäíåì - 28,0±1,23 ñì.
Âûâîäû.
1. Ðîñò ó äåòåé æåíñêîãî ïîëà â âîçðàñòå îò 1 ãîäà äî 7 ëåò 1,75 ðàçà, îò 7 äî.
16 ëåò óâåëè÷èâàåòñÿ 1,43 ðàç; à ìàññà òåëà äî 7 ëåò â 2,4ðàçà. È îò 7 äî 16 ëåò
óâåëè÷èâàåòñÿ 2,43 ðàçà
2. Ðàçìåðû îêðóæíîñòè ãðóäíîé êëåòêè â ïàóçå ñ 1 äî 16 ëåò, ó ëèö æåíñêîãî
ïîëà -1,46 ðàçà. Íàèáîëüøèé òåìï ó äåâî÷åê âûÿâëÿåòñÿ â 7 ëåòíåì âîçðàñòå,
îêðóæíîñòü ãðóäíîé êëåòêè ñîñòàâëÿåò 196 %, à ó 7 äî 16 ëåò 142 %
Ñïèñîê ëèòåðàòóðû
1. Lopez Sanchez GF, Gonzalez Villora S, Diaz Suarez A. Level of habitual physical
activity in children and adolescents from the Region of Murcia (Spain). SpringerPlus.
2016;5(386):1-6. https://doi.org/10.1186/S40064-016-2033-8
2. Sinha NK, Maiti S. Prevalence of undernutrition among unprivileged preschool
children (2-6 years) of Midnapore town, India. Mal J Paediatr Child Health. 2012;
18(1):58- 69. 3.
3. Ansuya, Nayak BS, Unnikrishnan B, George A, Shashidhara YN, Mundkur SC
et al. Risk factors for malnutrition among preschool children in rural Karnataka: a case-
control study. BMC Public Health. 2018; 18:283
4. International Institute for Population Sciences (IIPS) and ICF. National Family
Health Survey (NFHS-4), 2015-16: India. Mumbai: IIPS, 2017.
5. Somanwar BN, Phuljhale S. Assessment of nutritional status amongst bihor tribe
childrens residing in Dharamjaigarh block of Raigarh district (C.G.), India. Int J Res
Med Sci. 2015; 3(10):2820-25.
6. Pinneya S.M., Windhamb G.C. Perfluorooctanoate and changes in anthropometric
parameters with age in young girls in the Greater Cincinnati and San Francisco Bay
Area International Journal of Hygiene and Environmental Health Volume 222, Issue 7,
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