ARTICLE
TITLE

?????????? ???????? ? ???????? ???????????? ??????? ? ??????????????????? ???????? ????????? ?????

SUMMARY

 ? ???? ?????????? ?????????????? ???????????, ? ??? ????? ???????? ??????????? ??????? ???????, ? ?????? ????? ?????????????. ????????????? ???????? ????????? ????? ?????????? ?? 13 ?? 18 ??????? ?? 100 ???. ????????? ? ??? [1]. ?????????? ???????? ??? ????? ???????? ??????????? ??????? ??????? ?????????? ?????? (50–55%), ??????? ? 50–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rade I–II ?????????? 80 ???., ? ???????? Grade III — ????? 30 ???., ? ????????????? — ?? 10 ?? 14 ???. [2].??????????? ???????? ??????? ??????????? ?????? ? ?????????????????? ??????? ??????? ?? ???????????????? ????????????????? ????????? ????? ????? ???????? ?????????? ?????????. ??????????????? ???????, ?? ????????????? ????????? ??????????? ??????????????? 2007 ?., ??? ??????????? ???????? ? ?????????? ?????? ??????? ?? ????????????????? ???????? «??????? ??????????», ????? ???????? ???????? ? ?????????? ??????????? ??????? ??????? ? ? ??????????????? ??????? ??????????? [5]. ?????? ?? ???? ????? ??????? ????????? ??????, ??????????? ? ?????? ???????? ?? 38 ?? 64% [6].????? ?????, ????? ??????????? ??????????, ??? ??????? ? ?????? ??????????????? ????????? ???????????? ?? ????? ???????????, ????????? ? ???????? ??????????????? ???????? ? ????????? ? ???????? ????????? ????? [7]. ?????? ????????????? ????????? ???? MGMT ????? ????????? ?????????????? ??????? ??????????? ? ??????? ? ??????????????, ?????????? ???????????? ????????????? [8].???????????-???????????? ?????????????? ?????????????????? ??????????????? ???????? ?????? ????? ? ????????????? ????????, ????????? ??????? ????? ??????????? ? ?????????, ??? ??????????????? ?????????????? ?????. ?? ???? ??????????????? ??????????????? ????????????? ???????? ??????????? ??????? ???????, ???????? ????????? ???????????? ??????????????? ? 2016 ?. [9]. ????? ????????????? ???????? ?? ?????? ?? ??????????????? ????????? ????????, ?? ? ?? ???????????? ???????????? ?? ???????? ???????? ???????????-???????????? ??????. ???????? ???????????? ?????????? ????? ? ????????? ????? ???????????-??????????????? ???????? ????? ?????????????? ?????? ?????? ??????????? ????????? ? ??????? ??????? ??????? ??? ????????? ?????????.???????, ?? ???? ?????????? ????? ?????? ? ???????? ? ???????????? ??????? ??????????????? ??????????? ??????? ???????, ??????? ?????????? ??????? ?? ??????? ???????????, ????????????? ????? ??????????? ??????????? ? ??????????????????. ????? ?? ??????????? ? ?? ????????????????? ? ??????????? ???????????????? ??????? ??????? ?? ???????????????? ???????? ????????? ?????, ??? ??? ??????????????, ???????? ???????? ???? ???????????????????? ??????? (???). ???????? ???????????? ????? ???????? ???????????? ??? (20–22 ??????????), ?????????????? ?????????? ?????, ?????????? ????? [10]. ?????? ??????????, ??? ???????? ????? ????????? ??? ? ???? ??????????, ??? ? ???????? ??????????? ?????, ????????? ???????? ????? ? ???????????? ??????, ??????? ??????? ? ????????????????. ????? ????, ???????? ????????? ? ????????????? ????? ?????????, ??? ???????, ?????????? ? ???????? ????? [11, 12]. ? ????? ? ???? ?????????? ???????? ??????? ???????? ?? ???????? ??????????, ????? ???????? ? ??????? ????????? ????? ???????? ? ????????? ??????? ???????? ???????, ??????? ????? ?? ???? ?????????????? ???????????? ???????? ??????? ??????????? ? ???????????? ??????? ? ?????? ??????????, ???????????? ??????? ??????? [13, 14]. ? ???????????? ?? ????????????, ??? ???????? ????? ????????? ? ???????? ??????????? ????????? ? ??????? ? ??????????????????? ???????? ????????? ?????, ??? ??????? ????? ?????????? ????????????. ???? ???????????? — ????? ????? ????????-???????? ??? ????????????? ??????????? ????????? ??????? ? ???????? ????????? ?????.??? ??????????? ????????????? ??????????? ????????? ??????? ? ???????? ????????? ????? ?????? ?????? ???????? ????????????? ????????????? ?????? ?????. ????????????? ????????????? ?????? ????? (?????? ???????????????? ??????) ?????? ?????? ??? ????????, ??????? ?????????? ??????? ?????????? ?????? ? ????????????? ?????????. ??? ???????? -31, -21 ? -223. ??????? ?????????? ??????? ?????????? ???????? ?? ????? ????????? ??????????? ????.??????? ???????????? ??????? ? ??????????????????? ???????? ????????? ??????? ????????????????? (Grade II–IV) ????? 15 ???. ? ???????? ? ???????????? ???????????????? ????????. ??????? ????????? ??? ????????? ? ???????? Grade II ?????????? 47 ???., ??? ????????? ? Grade III — 42 ???. ? Grade IV — 8 ???. ?? ???. 1. ?????????? ?????? ??????? – ?????? ????????? ? ????????? ?????? ???????? ????????? — Grade II, Grade III ? Grade IV. ??????? ????????????????? ????? ??????? ? ???????? Grade II ????? 43 ???., Grade III — 42 ???. ? Grade IV — 10 ???.?? ????????? ????? ???????? ?????????????? ????????????? ?????? ????? ??? ?????????????? ??????????? ??????? ?? ????? ????????? ???????: ???????? (????????????? ??????????????? ????????), ????????, ???? ??????????? ??????? ? ??????? ????????????????? ???????????????. ? ????. 1 ??????? ??? ?????????? ????????.??? ??? ??????? ?????????? ????????-31, -21, -221 ? -223 ???????? ?????????? ?????? ?? ???????? ????????? ????????? ?? ???? ?????????????, ?????? ???????? ?????? ? ??????? ? ?????? ???????? ?????? ????????. ??? ?????? ???????? ????????? ROC-?????? ? ?????????? ????????? ???????? ????????????? ??????? ??????????. ??? ????????-31 ???? ??????? ?????????????? 0,09804, ??? ????????-21 — 4,443, ??? ????????-221 — 0,531, ??? ????????-223 — 1,315. ????? ????????? ????? ?? ????????? ?????? ??????? – ??????, ?????????????? ?? ???. 2.??? ???, ?? ??????????? ?????????????? ???????, ??????? ??????? ???????????? ??????? ? ?????????? ?????? ????????? ???????????, ???????? ??????? ?????? ? ?????? 48 ??? (? ????? ????? ??????? ???????? ????? 48 ???). ????????? ?????? ??????? – ?????? (???. 3).??????? ???????????? ??? ????? c ??????? ? ?????? ??????? ?????????? ????????-31, -21, -221 ? -223, ? ????? ??? ????????? ? ???????????? ???????????? ???????? ??????? ? ??????????? ?? ???????? ???????????? ? ????. 2.????? ???????, ?????????? ?????????? ???? ??????? ????????: ????????-31 (?? = 1,221; ?? 95% 1,016–1,467; p<0,0335), ????????-21 (?? = 1,228; ?? 95% 1,073–1,407; p<0,0030), ????????-223 (?? = 1,106; ?? 95% 1,002–1,221; p<0,0460) ? ????????-221 (?? = 0,814; ?? 95% 0,683–0,970; p<0,0216), ?????????? ? ??????????? ??????? ????? ??????????? ??????? ???????, ??? ???????????? (?? = 2,461; ?? 95% 1,199–5,050; p<0,0141) ? ??????? ??????? (?? = 2,116; ?? 95% 1,011–4,430; p<0,0467), ??????? ????? 48 ??? (?? = 0,291; ?? 95% 0,154–0,547; p<0,0001) ?????????? ????????????? ?? ????????? ???????????? ?????????.?????? ???????? ?? ?????????? ????????? ?????????.

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