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ue c egoilxap6orarKanbqurxopolxoBcacbrBaercn Aaxey nox[nbrx neHur ,1apavei, u naqrieHroB c noBbrueHileM pncra nauueo6pa-
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B nocle4rueforqbt nofBr4racb reHAeHqhfl K Mcnorb3oBaHho (<np[- nh3e phcKanalrueo6paroealnn B 3aBtcrlMocrt4 or cxeMbrnp[eMa
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npenaparax Kanbqhfl, B qacrHocrr4. ycrpuqHofoKanbqhr(ransqnn, H o u e H u iol 6 o a g o e a x uoRK c a r a r H b r xa u r e f t 3 H a q i l T e n b H Bb orure
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x e H h e H o p M a r H B co oB4 e p x a r n Rn p r N e c e f iK, o u r c c u e f ni o n p o - raMncuu.npn Ha3HaqeHhu 2295 6epeneHHbrM xeHU.l4HaN 2000 rqr
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npeBbr uiaoqfle pa3peueH HbreHopMarh BbrKonhqecrBanpur"recei. HacTorqeeBpeMflcr{uTaeTcfl, rrToHt43K0e norpeoreHheKanbqhfc
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npenaparoB KanbqHR y 4ereil,6epeueursrxil naxrhpyror.qr4x xeH- Hei e noqrax,B To BpeMflxax po6aa.neHnr Karbqhr K paquoHy
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r,l,r.Prcn hHroKch Kaqilh ar oMr,r H,4eM Har6oreeaKTyaneH : 13,45,61.,621.
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qeK. raqr,reilcocygoBAonoxhn P, Br,tpxos[64]. B pe:ynurareMHoroner-
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BbrpaxeHHoe cH[xeHile MllK a pauuvHbtxyqacrKaxcKenerano Macura6noeilccnegoBaHue, npoBeAeHHoe Hsjafi coaar.,srrtto-
c p a B H e H I oc n a q h e H r a M6l te t r o p o t a p u o f i6 o n e s H r .[ l p r o r o r , t 'raBUee8-lersee Ha6nrcAeHhe sa 6oree qeu 18 000 nauileHroB B
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llpr gansrefiuuxr,tccreAoBaHrnx 6uraaormeqeHa nprMaflKoppe- coaBT, Aonoxhrh,r{ronph [cnonb3oBaHHh Kanbr]un (n = 732) ape-
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oqeecf noBbrueH[eM ypoarr C-pearrilBHofo 6enrca[54]. B ro xe paqiloHy,cogepHaueMy ManoKaIbqrlr,cooTBercTBvtol4hx nilqe-
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tuua-6 u MllI ocreonopo3aI ocreonopon4'{ecKux neperoMoBt4 uareprucroil u HeoHarallbHoft cuepruocrt h npex.qeBpeMeHHbtx
ypoBHfiroi,,toqhcrehHa il ppyrr,rx6uonoruqecxilaKruBHbrx Beqecre po,qoB B fpynne,noryuaeueilnpenaparbt Kanbqufl [63]. Mexauu:u
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B nocnegunefoAbtaKrt4BHo o6cyx4aercnBonpoco ponu ocreo- 3neKTponHToB, BrraMhHaK, ocreonpororephHa, naparropMoHa ll
npororephHa B npoqeccaxKocTHof0 peMoflenhpoBaHhr li BHecKe- cBr3rMr4 c 6erraun. [entn 4annofiny6nrraqrlrHerBnrercflno4-
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npocrpaHeHHocTl4 KOpOHapHOTO arepocKnepo3a, nph groMoTMe_ norpe6neunnKanbqilff, Ho ocBeu{eHHe 3ToroBonpocaraKXe He
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nonyntqhsxy 6oree qeir,r 40% o6cre4oaaHHulx lt
[15]. VpoaeHsar- li x a n c y n a )c, y q e r o Mn p h H i l M a e Mnbet xK a p c r B e H Hnbpt xe n a p a r o hB
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rlpyercrc ocreoManRqhefi [33, 35]. c n e q u a r b H bn t xi l u { e B b A
t xo 6 a B o K[ .l p e g n o v r e u r eA o 6 a B K a Mc o, -
Ta6,rrr,rua 3 AepxaqfiMKanbqht,orflaercflno pe3ylbraTaM HecKonbKhx Mera-
aHarh3oB no oqeHKeBnuAHnn Ha pr4cK nepenoMoB, Ho ecTbh eu{e
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E nephoflbt xtrslrrr(NAS,2002]
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tffel a'ipS6-fi
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.!eru go 6 r'lec. 400 flHuexerygoqHo-KHureqHofo rpaKrah [p.) [36, 49].
6i\aec.-6rer 400
T a 6 n n t a4
llogpocrxu(or 14 go 18 rer) 200-400
Cogepxanreconefixaarqun (rurr)!l enrar,,ruxa D, (ME)
200-400 B pa3nx'{Hbtx xoru6trlupoaatHbtx npenaparax
B:pocnue25-50 ter 204-440
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t4 MyxqilHbt > 50 ner 600-800
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* xap6orar 202 ur + qilrpar 842 Mr
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(250 mr Ca'.)
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xap6ouar 7372 ur + U4rpar211 Ml
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(500 ur Ca'.) 200
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oT r4ccleAoBaHHbtx nonynflqL{1,{, TaKKaxnuqeBbte rcro+ur,lrr.r (15%)
I qr; [. Huroneg
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Q e
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Koropbre copra urocnu),a c yBenhqeHileM Bo3pacraorMeqaercfl:
. y M e H b u e H hEec a c b t B a HK[ ra n b q h B Karsqlrr'raxc +[ rilApoxchararur350 (200 r"rrCaz-) 64
f Kt,tueqHilh K3e M o n o r ] H b t x
npoAyKroB o6ycnooleuocHilxeHileM aKTilBHocrh 0creoxea xap6oHar 1000r"rr(500r'.rr Ca'z*) 100
raKTa3il 3a-
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rsa6cop6Llr,r u; Karuqnifl.-Ml,lK$oprenap6orar 4i6,3ur (766,7w Ca?-) 1.33,4
. cHilxeHHeQyHxrlnr,r nover (ra6oreeaunnnover) - yxyAuJeHhe Karuql,ri
iit ,4.-MHK xap6orar4'J.6,3rtr (766,7vr Ca'z.) 66,7
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) :e A K o e
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AepManbHoro cnot
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[33].
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Nor,r4o:0fr,o6ecne,lnaaouleil agerearrrril roMeocra3Kanbt{Hfl rl 2-ocHoBHofr 150ur + neg-
QocQar
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1200 r KanbLlufl ra400-800 ME arraruruaD,. 50 ur (50ur Ca'.
Vc Ar r/3AaHHbrx, np,.rBeAeHHbrx e :a6n.i, uoryr 6uru asr6pa- Sepoxxa xa,nu4lrfr 100MrCa2'(a Sopuexap6orara
M a r HH i * uru naHrerouara)
Hri lo6ue coorHoueHnfl co.neilxaluqnnh BnraMuHa D' cooreer-
c r B y r o r { u ep e K o M e H A y e Mcb tyM q e r o Mn o r p e 6 r e x u Rn p o A y K T o B .Co4epxargononturensxsre
4o6asnnMtrKpotneMeHToB 1,4
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nuTaqufl.
B ro xe BpeMr,Mff pa3nhqHbtx Bo3pacrHbtx nephoAoB 14cocror- LnopHbrM ocraercrBonpoc0 norb3eKoMnreKcHbtx npenaparoB
gur MflKpercoMeHAytorcr pa3JthqHbre noAXoAbt a asr6ope npenapara. c M h K p 0 3 n e M e H T ha M B ul , t T a M h H anMpihl /H t , l M a o q h M
y qi la c T r . 4
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cbr,peKoMeHAytoTct MIHhMaIbHbte aAeKBaTHbte Ao3btKanbuHt14 p o B a H i l eH. e c l r o r p nH a H a n u g v eg K c n e p h M e H T a l u uSsarrxr o a e
B h r a M H HDa( c u . r a 6 1 . 1 , 3 ) . l l o g x a r r c u e HKuoeM n r e K c H nbp t xe n a - no.0b3y KoMnJreKcHbtx npenaparoB, He cyqecreyer4ora:areluHoil
paroBB 3ror nepiloAo6ocHogaHo qelecoo6paruocrblo hcnorb3o- 6arur,nogreepxAa oqeil rSSerru enocrb hcnoJlb3oBaH ur M14 Kpo-
BaHilflpa3nhqHbtx MhKpo3neMeHroB h BUTaMfiHOB A/tffHOpMan[3a- a,neueHroB (uaruna,tlhHKa,MapraHqa, Me.qh,6opa) a MHoroqeHr-
qlrr raera6orrvecKhx npoqeccoB B ycJroBrjrx pacnpocrpaHeHHoro p0BbrxpaHAor4 143hpoBaH Hbtx Macura6H btx 14ccneAoBa Hhrx, no3To-
,qeQ[qhTaBhraMhHoB t4 MhKpoSneMeHToB. My B C0BpeMeHHbtx peKoMeHBaqhffx 3Kcneprbt Bo3rlepxfiBaficrcfl oT
Bo s:pocaou Bo3pacrenpr,tnpo$r,uaxrilKe pa3Butrr ocreono- BKnOqeHrfl KOMnneKCHbtx npenapaToB B peKoMeHAyeMbte cxeMbl
po3aB rpynnaxpilcKapexoMeH[yercfl hcnonb3oBaHue 500_1000ur reqeHuru npoSnnarruKr,l ocreonopo3a [13, 18]. Eoneeroro, no-
KarbqilflB cyrKltn 200-400 ME suraMhnaD,a nplr ero Harhqhil roxurelursril o$Sercror npileMaMafHr{r.qoxa3aH npu ucnorb3o-
.qrflreqeHhr Ha3Haqaror 1000-1500Mr Karbuhrr 800-1200 ME BaHHrefo BbtcoKhx gol (400-600 nr/cyr), npeBbtuaoqfixAo3br,
B!4TaMHHa D. 06ocHoeaHHo cqilTaerct, riroArr uHn\na4uul,,tcnorb- BKJlroqeHHbre B KoMnreKcHbte npenapaTbt. LluHttn rvarsuiluaxo-
3 o B a H r rl e q e 6 H s r xA o 3 K a n b q i l f, lt B h r a M r i H, a
QH e o 6 R r a r e l s t o flRTCfl B aHTafOHhcTt4qecKux B3ailMooTHOUeHL4tX, TaKKaKyBeth-
npe4BapilrenbHoe onpefleneuueMflK. 14ngr,rangyarruufi eul6op veure norpe6neH r,tflqr4HKaconpoBox(naercr yBelilqeHner.,r norpe6-
npenaparaAonxeH ocyu.lecrBnrrbcrB coorBercrBnuc ueo6xo4u- Hocr,rB MatHVuu r.4. llpreepeuHueSarru EfiKryorHeo6xogr,t-
u o c r l r o 6 e c n e q e H hMf fa K c h M a n b HKoof rM n n a e H T H o n c rauu h e H T a MocrbAanbHeiluero u3yqeHilfl aSSerrnauocruMuKpo3reMeHroB.

i?;

83
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tfiiilill[ilflfl
0rgenuHocneflyerocraHoBt4Tbcr Ha BrraMilHeK, xoropsri cy_
qecrByer B [Byx BHAax(K, - pacrr.lrenbHoro nporcxoxAeHr,tr, co_
Aepxrrcfl B carare laryx; K, - )l{l4BorHoro npoucxoxAeHrff,co_
flepxhrcfl B Mrce r cupax) r.lurpaer BaxHyloponb B pefynflqhrl
eyHKqt4r4 KocrHbtxnporehHoB.B ro xe Bpeilr, npil uanutnu ny6_
nuxal]]/|i'r o cHt/xeHuhpr4cKanepenoMoa6e4pa peKoMeHAaquu no
ero ucnorb3oBaHnrc (uanpur"rep, B BhAeMerarerpoHa, 45 ur/cyt)
uocRr$axyluraruisHulti xaparrep 11,3,39,40, 5gl.
K rpynneKoMnreKcHblx npenaparoBr,4oxer6utruorHeceHraK_
xe occehH-r[ApoKchanarilTHbrfi xounrexc(ocreorenou), roropslfi
cocror4r[x ru4porcuanarwa(178 Mr Kanbqurr,tg2 rur
QocQopa)r
occeilHa, BKnoqaoqeroKorrareHI runa u HeoKorJtareHoBbte nen_
ru4u (raucynr,tHosrre Qarropur pocra I r,lII, rpanc$opurapyror4r,lfi
Qarrop pocrap). CocraeoccerH-rfiApoKcilanarurHoro KoMnleKca
o6ecnequeaer n03nrnBHoeBraflHneHa peMoAenIpoBaHhe Kocr_
noit rt<auu3a cqer eucoxoil 6r,to4ocrynuocru Kalbtlhff14roKaJlbHo_
ro BnunHufr pocroBbtx Saxropoa.[oxaaareruuaa6a:a npervyqe_
c r B e H H 0 c nl /4c n o r b 3 o B a H rol cf lr e o r e H o H4al n n p o $ l l l a r r u x l ru
reqeHurocTeonopo3a B HacroflqeeBpeMflHeAocraroqHa Arf BHe_
ceHhfe f r 0 B p e K 0 M e H A a q 3h K ilCneproB oA, HaKO 3 T O rn p e n a p a r
ffBrrercflnpenaparoM esr6opanpr ueo6xo4uMocrh rcnorb3oBa_ 31. AhsorbabiLity andcosteffectivenessin calcium suppLententotion
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