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Боль в спине: проблемы выбора адекватной терапии
Боль в спине: проблемы выбора адекватной терапии
Камчатнов П.Р., Умарова Х.Я., Чугунов А.В. Боль в спине: проблемы выбора адекватной терапии. Consilium Medicum. Неврология и ревматология (Прил.). 2015; 2: 22–26.
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Аннотация
Скелетно-мышечные болевые синдромы, в частности, поясничная боль (ПБ), исключительно широко распространены в популяции, являются одной из основных причин временной утраты трудоспособности. Заболевание характеризуется склонностью к рецидивированию, что требует повторных курсов терапии, пролонгирования сроков лечения. В связи с этим возрастает лекарственная нагрузка на организм, повышается риск развития побочных эффектов. Серьезной проблемой является выбор эффективного противоболевого препарата, обладающего благоприятным профилем переносимости. Рассматривается возможность применения Налгезина (напроксен натрия) у пациентов с ПБ. Анализируются данные о его клинической эффективности, хорошей переносимости, низком риске развития кардиоваскулярных осложнений.
Ключевые слова: поясничная боль, скелетно-мышечные болевые синдромы, лечение, нестероидные противовоспалительные препараты, напроксен, Налгезин®.
Key words: back pain, musculoskeletal pain syndromes, treatment, NSAIDs, naproxen, Nalgesin.
Ключевые слова: поясничная боль, скелетно-мышечные болевые синдромы, лечение, нестероидные противовоспалительные препараты, напроксен, Налгезин®.
________________________________________________
Key words: back pain, musculoskeletal pain syndromes, treatment, NSAIDs, naproxen, Nalgesin.
Полный текст
Список литературы
1. Есин Р.Г., Есин О.Р., Ахмадеева Г.Д., Салихова Г.В. Боль в спине. Казань: Казанский полиграфкомбинат, 2010. / Esin R.G., Esin O.R., Akhmadeeva G.D., Salikhova G.V. Bol' v spine. Kazan': Kazanskii poligrafkombinat, 2010. [in Russian]
2. Van Tulder M, Becker A, Bekkering T et al. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 2006; 15 (Suppl. 2): 169–91.
3. Manchikanti L, Singh V, Datta S et al. Comprehensive review of epidemiology, scope, and impact of spinal pain. Pain Physician 2009; 12 (4): 35–70.
4. Каратеев А.Е., Насонова В.А. НПВП-ассоциированная гепатопатия. Научно-практ. ревматология. 2003; 4: 87–91. / Karateev A.E., Nasonova V.A. NPVP-assotsiirovannaia gepatopatiia. Nauchno-prakt. revmatologiia. 2003; 4: 87–91. [in Russian]
5. McGettigan P, Henry D. Use of Non-Steroidal Anti-Inflammatory Drugs That Elevate Cardiovascular Risk: An Examination of Sales and Essential Medicines Lists in Low-, Middle-, and High-Income Countries. PLoS Med 2013; 10 (2): e1001388. Doi:10.1371/journal.pmed.1001388.
6. Hagen K, Jamtvedt G, Hilde G, Winnem M. Bed rest bad for back pain, ineffective for sciatica. The updated Cochrane Review of bed rest for low back pain and sciatica. Spine 2005; 30: 542–46.
7. Runkel R, Chaplin M, Boost G et al. Absorption, distribution, metabolism, and excretion of naproxen in various laboratory animals and human subjects. J Pharm Sci 1972; 61 (5): 703–8.
8. Blechman W, Willkens R, Boncaldo G et al. Naproxen in osteoarthrosis. Doubleblind crossover trial. Ann Rheum Dis 1978; 37 (1): 80–4.
9. Castles J, Moore T, Vaughan J et al. Multicenter comparison of naproxen and indomethacin in rheumatoid arthritis. Arch Int Med 1978; 138 (3): 362–6.
10. Björkenheim J, Helland J, Peltonen J. A double-blind crossover evaluation of naproxen and piroxicam in osteoarthritis of hip or knee. J Int Med Res 1985; 13 (5): 263–9.
11. Мartinez-Lavin M, Holman K, Smyth C, Vaughan J. A comparison of naproxen, indomethacin and aspirin in osteoarthritis. J Rheum 1980; 7 (5): 711–6.
12. Code W, Yip R, Rooney M et al. Preoperative naproxen sodium reduces postoperative pain following arthroscopic knee surgery. Can J Anaesth 1994; 41 (2): 98–101.
13. Dunn T. Clark V, Jones G. Preoperative oral naproxen for pain relief after day-case laparoscopic sterilization. Br J Anaesth 1995; 75 (1): 12–4.
14. Simmons R, Owen S, Abbott C et al. Naproxen sodium and paracetamol/dextropropoxyphene in sports injuries – a multicentre comparative study. Br J Sports Med 1982; 16 (2): 91–5.
15. Bombardier C, Laine L, Reicin A et al. Comparison of Upper Gastrointestinal Toxicity of Rofecoxib and Naproxen in Patients with Rheumatoid Arthritis. N Engl J Med 2000; 343 (21): 1520–8.
16. Farkouh M, Kirshner H, Harrington R et al. Comparison of lumiracoxib with naproxen and ibuprofen in the Therapeutic Arthritis Research and Gastrointestinal Event Trial (TARGET), cardiovascular outcomes: randomized controlled trial. Lancet 2004; 364: 675–84.
17. Singh G, Fort J, Goldstein J et al. Celecoxib versus naproxen and diclofenac in osteoarthritis patients: SUCCESS-1 study. Am J Med 2006; 119: 255–66.
18. Широков В.А. Выбор нестероидных противовоспалительных препаратов в лечении болевого синдрома с позиции кардиоваскулярной безопасности. РМЖ. 2015; 12: 716–9. / Shirokov V.A. Vybor nesteroidnykh protivovospalitel'nykh preparatov v lechenii bolevogo sindroma s pozitsii kardiovaskuliarnoi bezopasnosti. RMZh. 2015; 12: 716–9. [in Russian]
19. Friedman BW, Dym AA, Davitt M et al. Naproxen With Cyclobenzaprine, оxycodone/Acetaminophen, or Placebo for Treating Acute Low Back Pain. A Randomized Clinical Trial. JAMA 2015; 314 (15): 1572–80.
20. Каратеев А.Е., Алексеева Л.И., Аникин С.Г. Комбинация напроксена и эзомепразола: обезболивающая терапия при соблюдении баланса кардиоваскулярного и желудочно-кишечного риска. Соврем. ревматология. 2013; 1: 45–9. / Karateev A.E., Alekseeva L.I., Anikin S.G. Kombinatsiia naproksena i ezomeprazola: obezbolivaiushchaia terapiia pri sobliudenii balansa kardiovaskuliarnogo i zheludochno-kishechnogo riska. Sovrem. revmatologiia. 2013; 1: 45–9. [in Russian]
21. Trelle S, Reichenbach S, Wandel S et al. Cardiovascular safety of non-steroidal antiinflammatory drugs: network meta-analysis. BMJ 2011; 342: 7086. Doi:10.1136.
22. Fosbil E, Folke F, Jacobsen S et al. Cause-Specific Cardiovascular Risk Associated with Nonsteroidal Antiinflammatory Drugs among Healthy Individuals. Circ Cardiovasc Qual Outcomes 2010; 3: 395–405.
23. Ray W, Varas-Lorenzo C, Chung C et al. Cardiovascular risks of nonsteroidal antiinflammatory drugs in patients after hospitalization for serious coronary heart disease. Circ Cardiovasc Qual Outcomes 2009; 2 (3): 155–63.
24. Capone M, Tacconelli S, Sciulli M et al. Human pharmacology of naproxen sodium. J Pharmacol Exp Ther 2007; 322 (2): 453–60.
25. Henry D, Lim L, Garcia Rodriguez L et al. Variability in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugs: results of a collaborative meta-analysis. BMJ 1996; 312: 1563–6.
2. Van Tulder M, Becker A, Bekkering T et al. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 2006; 15 (Suppl. 2): 169–91.
3. Manchikanti L, Singh V, Datta S et al. Comprehensive review of epidemiology, scope, and impact of spinal pain. Pain Physician 2009; 12 (4): 35–70.
4. Karateev A.E., Nasonova V.A. NPVP-assotsiirovannaia gepatopatiia. Nauchno-prakt. revmatologiia. 2003; 4: 87–91. [in Russian]
5. McGettigan P, Henry D. Use of Non-Steroidal Anti-Inflammatory Drugs That Elevate Cardiovascular Risk: An Examination of Sales and Essential Medicines Lists in Low-, Middle-, and High-Income Countries. PLoS Med 2013; 10 (2): e1001388. Doi:10.1371/journal.pmed.1001388.
6. Hagen K, Jamtvedt G, Hilde G, Winnem M. Bed rest bad for back pain, ineffective for sciatica. The updated Cochrane Review of bed rest for low back pain and sciatica. Spine 2005; 30: 542–46.
7. Runkel R, Chaplin M, Boost G et al. Absorption, distribution, metabolism, and excretion of naproxen in various laboratory animals and human subjects. J Pharm Sci 1972; 61 (5): 703–8.
8. Blechman W, Willkens R, Boncaldo G et al. Naproxen in osteoarthrosis. Doubleblind crossover trial. Ann Rheum Dis 1978; 37 (1): 80–4.
9. Castles J, Moore T, Vaughan J et al. Multicenter comparison of naproxen and indomethacin in rheumatoid arthritis. Arch Int Med 1978; 138 (3): 362–6.
10. Björkenheim J, Helland J, Peltonen J. A double-blind crossover evaluation of naproxen and piroxicam in osteoarthritis of hip or knee. J Int Med Res 1985; 13 (5): 263–9.
11. Мartinez-Lavin M, Holman K, Smyth C, Vaughan J. A comparison of naproxen, indomethacin and aspirin in osteoarthritis. J Rheum 1980; 7 (5): 711–6.
12. Code W, Yip R, Rooney M et al. Preoperative naproxen sodium reduces postoperative pain following arthroscopic knee surgery. Can J Anaesth 1994; 41 (2): 98–101.
13. Dunn T. Clark V, Jones G. Preoperative oral naproxen for pain relief after day-case laparoscopic sterilization. Br J Anaesth 1995; 75 (1): 12–4.
14. Simmons R, Owen S, Abbott C et al. Naproxen sodium and paracetamol/dextropropoxyphene in sports injuries – a multicentre comparative study. Br J Sports Med 1982; 16 (2): 91–5.
15. Bombardier C, Laine L, Reicin A et al. Comparison of Upper Gastrointestinal Toxicity of Rofecoxib and Naproxen in Patients with Rheumatoid Arthritis. N Engl J Med 2000; 343 (21): 1520–8.
16. Farkouh M, Kirshner H, Harrington R et al. Comparison of lumiracoxib with naproxen and ibuprofen in the Therapeutic Arthritis Research and Gastrointestinal Event Trial (TARGET), cardiovascular outcomes: randomized controlled trial. Lancet 2004; 364: 675–84.
17. Singh G, Fort J, Goldstein J et al. Celecoxib versus naproxen and diclofenac in osteoarthritis patients: SUCCESS-1 study. Am J Med 2006; 119: 255–66.
18. Shirokov V.A. Vybor nesteroidnykh protivovospalitel'nykh preparatov v lechenii bolevogo sindroma s pozitsii kardiovaskuliarnoi bezopasnosti. RMZh. 2015; 12: 716–9. [in Russian]
19. Friedman BW, Dym AA, Davitt M et al. Naproxen With Cyclobenzaprine, оxycodone/Acetaminophen, or Placebo for Treating Acute Low Back Pain. A Randomized Clinical Trial. JAMA 2015; 314 (15): 1572–80.
20. Karateev A.E., Alekseeva L.I., Anikin S.G. Kombinatsiia naproksena i ezomeprazola: obezbolivaiushchaia terapiia pri sobliudenii balansa kardiovaskuliarnogo i zheludochno-kishechnogo riska. Sovrem. revmatologiia. 2013; 1: 45–9. [in Russian]
21. Trelle S, Reichenbach S, Wandel S et al. Cardiovascular safety of non-steroidal antiinflammatory drugs: network meta-analysis. BMJ 2011; 342: 7086. Doi:10.1136.
22. Fosbil E, Folke F, Jacobsen S et al. Cause-Specific Cardiovascular Risk Associated with Nonsteroidal Antiinflammatory Drugs among Healthy Individuals. Circ Cardiovasc Qual Outcomes 2010; 3: 395–405.
23. Ray W, Varas-Lorenzo C, Chung C et al. Cardiovascular risks of nonsteroidal antiinflammatory drugs in patients after hospitalization for serious coronary heart disease. Circ Cardiovasc Qual Outcomes 2009; 2 (3): 155–63.
24. Capone M, Tacconelli S, Sciulli M et al. Human pharmacology of naproxen sodium. J Pharmacol Exp Ther 2007; 322 (2): 453–60.
25. Henry D, Lim L, Garcia Rodriguez L et al. Variability in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugs: results of a collaborative meta-analysis. BMJ 1996; 312: 1563–6.
2. Van Tulder M, Becker A, Bekkering T et al. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 2006; 15 (Suppl. 2): 169–91.
3. Manchikanti L, Singh V, Datta S et al. Comprehensive review of epidemiology, scope, and impact of spinal pain. Pain Physician 2009; 12 (4): 35–70.
4. Каратеев А.Е., Насонова В.А. НПВП-ассоциированная гепатопатия. Научно-практ. ревматология. 2003; 4: 87–91. / Karateev A.E., Nasonova V.A. NPVP-assotsiirovannaia gepatopatiia. Nauchno-prakt. revmatologiia. 2003; 4: 87–91. [in Russian]
5. McGettigan P, Henry D. Use of Non-Steroidal Anti-Inflammatory Drugs That Elevate Cardiovascular Risk: An Examination of Sales and Essential Medicines Lists in Low-, Middle-, and High-Income Countries. PLoS Med 2013; 10 (2): e1001388. Doi:10.1371/journal.pmed.1001388.
6. Hagen K, Jamtvedt G, Hilde G, Winnem M. Bed rest bad for back pain, ineffective for sciatica. The updated Cochrane Review of bed rest for low back pain and sciatica. Spine 2005; 30: 542–46.
7. Runkel R, Chaplin M, Boost G et al. Absorption, distribution, metabolism, and excretion of naproxen in various laboratory animals and human subjects. J Pharm Sci 1972; 61 (5): 703–8.
8. Blechman W, Willkens R, Boncaldo G et al. Naproxen in osteoarthrosis. Doubleblind crossover trial. Ann Rheum Dis 1978; 37 (1): 80–4.
9. Castles J, Moore T, Vaughan J et al. Multicenter comparison of naproxen and indomethacin in rheumatoid arthritis. Arch Int Med 1978; 138 (3): 362–6.
10. Björkenheim J, Helland J, Peltonen J. A double-blind crossover evaluation of naproxen and piroxicam in osteoarthritis of hip or knee. J Int Med Res 1985; 13 (5): 263–9.
11. Мartinez-Lavin M, Holman K, Smyth C, Vaughan J. A comparison of naproxen, indomethacin and aspirin in osteoarthritis. J Rheum 1980; 7 (5): 711–6.
12. Code W, Yip R, Rooney M et al. Preoperative naproxen sodium reduces postoperative pain following arthroscopic knee surgery. Can J Anaesth 1994; 41 (2): 98–101.
13. Dunn T. Clark V, Jones G. Preoperative oral naproxen for pain relief after day-case laparoscopic sterilization. Br J Anaesth 1995; 75 (1): 12–4.
14. Simmons R, Owen S, Abbott C et al. Naproxen sodium and paracetamol/dextropropoxyphene in sports injuries – a multicentre comparative study. Br J Sports Med 1982; 16 (2): 91–5.
15. Bombardier C, Laine L, Reicin A et al. Comparison of Upper Gastrointestinal Toxicity of Rofecoxib and Naproxen in Patients with Rheumatoid Arthritis. N Engl J Med 2000; 343 (21): 1520–8.
16. Farkouh M, Kirshner H, Harrington R et al. Comparison of lumiracoxib with naproxen and ibuprofen in the Therapeutic Arthritis Research and Gastrointestinal Event Trial (TARGET), cardiovascular outcomes: randomized controlled trial. Lancet 2004; 364: 675–84.
17. Singh G, Fort J, Goldstein J et al. Celecoxib versus naproxen and diclofenac in osteoarthritis patients: SUCCESS-1 study. Am J Med 2006; 119: 255–66.
18. Широков В.А. Выбор нестероидных противовоспалительных препаратов в лечении болевого синдрома с позиции кардиоваскулярной безопасности. РМЖ. 2015; 12: 716–9. / Shirokov V.A. Vybor nesteroidnykh protivovospalitel'nykh preparatov v lechenii bolevogo sindroma s pozitsii kardiovaskuliarnoi bezopasnosti. RMZh. 2015; 12: 716–9. [in Russian]
19. Friedman BW, Dym AA, Davitt M et al. Naproxen With Cyclobenzaprine, оxycodone/Acetaminophen, or Placebo for Treating Acute Low Back Pain. A Randomized Clinical Trial. JAMA 2015; 314 (15): 1572–80.
20. Каратеев А.Е., Алексеева Л.И., Аникин С.Г. Комбинация напроксена и эзомепразола: обезболивающая терапия при соблюдении баланса кардиоваскулярного и желудочно-кишечного риска. Соврем. ревматология. 2013; 1: 45–9. / Karateev A.E., Alekseeva L.I., Anikin S.G. Kombinatsiia naproksena i ezomeprazola: obezbolivaiushchaia terapiia pri sobliudenii balansa kardiovaskuliarnogo i zheludochno-kishechnogo riska. Sovrem. revmatologiia. 2013; 1: 45–9. [in Russian]
21. Trelle S, Reichenbach S, Wandel S et al. Cardiovascular safety of non-steroidal antiinflammatory drugs: network meta-analysis. BMJ 2011; 342: 7086. Doi:10.1136.
22. Fosbil E, Folke F, Jacobsen S et al. Cause-Specific Cardiovascular Risk Associated with Nonsteroidal Antiinflammatory Drugs among Healthy Individuals. Circ Cardiovasc Qual Outcomes 2010; 3: 395–405.
23. Ray W, Varas-Lorenzo C, Chung C et al. Cardiovascular risks of nonsteroidal antiinflammatory drugs in patients after hospitalization for serious coronary heart disease. Circ Cardiovasc Qual Outcomes 2009; 2 (3): 155–63.
24. Capone M, Tacconelli S, Sciulli M et al. Human pharmacology of naproxen sodium. J Pharmacol Exp Ther 2007; 322 (2): 453–60.
25. Henry D, Lim L, Garcia Rodriguez L et al. Variability in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugs: results of a collaborative meta-analysis. BMJ 1996; 312: 1563–6.
________________________________________________
2. Van Tulder M, Becker A, Bekkering T et al. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 2006; 15 (Suppl. 2): 169–91.
3. Manchikanti L, Singh V, Datta S et al. Comprehensive review of epidemiology, scope, and impact of spinal pain. Pain Physician 2009; 12 (4): 35–70.
4. Karateev A.E., Nasonova V.A. NPVP-assotsiirovannaia gepatopatiia. Nauchno-prakt. revmatologiia. 2003; 4: 87–91. [in Russian]
5. McGettigan P, Henry D. Use of Non-Steroidal Anti-Inflammatory Drugs That Elevate Cardiovascular Risk: An Examination of Sales and Essential Medicines Lists in Low-, Middle-, and High-Income Countries. PLoS Med 2013; 10 (2): e1001388. Doi:10.1371/journal.pmed.1001388.
6. Hagen K, Jamtvedt G, Hilde G, Winnem M. Bed rest bad for back pain, ineffective for sciatica. The updated Cochrane Review of bed rest for low back pain and sciatica. Spine 2005; 30: 542–46.
7. Runkel R, Chaplin M, Boost G et al. Absorption, distribution, metabolism, and excretion of naproxen in various laboratory animals and human subjects. J Pharm Sci 1972; 61 (5): 703–8.
8. Blechman W, Willkens R, Boncaldo G et al. Naproxen in osteoarthrosis. Doubleblind crossover trial. Ann Rheum Dis 1978; 37 (1): 80–4.
9. Castles J, Moore T, Vaughan J et al. Multicenter comparison of naproxen and indomethacin in rheumatoid arthritis. Arch Int Med 1978; 138 (3): 362–6.
10. Björkenheim J, Helland J, Peltonen J. A double-blind crossover evaluation of naproxen and piroxicam in osteoarthritis of hip or knee. J Int Med Res 1985; 13 (5): 263–9.
11. Мartinez-Lavin M, Holman K, Smyth C, Vaughan J. A comparison of naproxen, indomethacin and aspirin in osteoarthritis. J Rheum 1980; 7 (5): 711–6.
12. Code W, Yip R, Rooney M et al. Preoperative naproxen sodium reduces postoperative pain following arthroscopic knee surgery. Can J Anaesth 1994; 41 (2): 98–101.
13. Dunn T. Clark V, Jones G. Preoperative oral naproxen for pain relief after day-case laparoscopic sterilization. Br J Anaesth 1995; 75 (1): 12–4.
14. Simmons R, Owen S, Abbott C et al. Naproxen sodium and paracetamol/dextropropoxyphene in sports injuries – a multicentre comparative study. Br J Sports Med 1982; 16 (2): 91–5.
15. Bombardier C, Laine L, Reicin A et al. Comparison of Upper Gastrointestinal Toxicity of Rofecoxib and Naproxen in Patients with Rheumatoid Arthritis. N Engl J Med 2000; 343 (21): 1520–8.
16. Farkouh M, Kirshner H, Harrington R et al. Comparison of lumiracoxib with naproxen and ibuprofen in the Therapeutic Arthritis Research and Gastrointestinal Event Trial (TARGET), cardiovascular outcomes: randomized controlled trial. Lancet 2004; 364: 675–84.
17. Singh G, Fort J, Goldstein J et al. Celecoxib versus naproxen and diclofenac in osteoarthritis patients: SUCCESS-1 study. Am J Med 2006; 119: 255–66.
18. Shirokov V.A. Vybor nesteroidnykh protivovospalitel'nykh preparatov v lechenii bolevogo sindroma s pozitsii kardiovaskuliarnoi bezopasnosti. RMZh. 2015; 12: 716–9. [in Russian]
19. Friedman BW, Dym AA, Davitt M et al. Naproxen With Cyclobenzaprine, оxycodone/Acetaminophen, or Placebo for Treating Acute Low Back Pain. A Randomized Clinical Trial. JAMA 2015; 314 (15): 1572–80.
20. Karateev A.E., Alekseeva L.I., Anikin S.G. Kombinatsiia naproksena i ezomeprazola: obezbolivaiushchaia terapiia pri sobliudenii balansa kardiovaskuliarnogo i zheludochno-kishechnogo riska. Sovrem. revmatologiia. 2013; 1: 45–9. [in Russian]
21. Trelle S, Reichenbach S, Wandel S et al. Cardiovascular safety of non-steroidal antiinflammatory drugs: network meta-analysis. BMJ 2011; 342: 7086. Doi:10.1136.
22. Fosbil E, Folke F, Jacobsen S et al. Cause-Specific Cardiovascular Risk Associated with Nonsteroidal Antiinflammatory Drugs among Healthy Individuals. Circ Cardiovasc Qual Outcomes 2010; 3: 395–405.
23. Ray W, Varas-Lorenzo C, Chung C et al. Cardiovascular risks of nonsteroidal antiinflammatory drugs in patients after hospitalization for serious coronary heart disease. Circ Cardiovasc Qual Outcomes 2009; 2 (3): 155–63.
24. Capone M, Tacconelli S, Sciulli M et al. Human pharmacology of naproxen sodium. J Pharmacol Exp Ther 2007; 322 (2): 453–60.
25. Henry D, Lim L, Garcia Rodriguez L et al. Variability in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugs: results of a collaborative meta-analysis. BMJ 1996; 312: 1563–6.
Авторы
П.Р.Камчатнов*1, Х.Я.Умарова2, А.В.Чугунов1
1 ГБОУ ВПО Российский национальный исследовательский медицинский университет им. Н.И.Пирогова Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1;
2 ФГБОУ ВО Чеченский государственный университет. 364907, Россия, Грозный, ул. Шерипова, д. 32
*pavkam7@gmail.com
1 N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1;
2 Chechen State University. 364907, Russian Federation, Grozny, ul. Sheripova, d. 32
*pavkam7@gmail.com
1 ГБОУ ВПО Российский национальный исследовательский медицинский университет им. Н.И.Пирогова Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1;
2 ФГБОУ ВО Чеченский государственный университет. 364907, Россия, Грозный, ул. Шерипова, д. 32
*pavkam7@gmail.com
________________________________________________
1 N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1;
2 Chechen State University. 364907, Russian Federation, Grozny, ul. Sheripova, d. 32
*pavkam7@gmail.com
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