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Синдром раздраженного кишечника. Римские критерии IV
Синдром раздраженного кишечника. Римские критерии IV
Маев И.В., Черемушкин С.В., Кучерявый Ю.А., Черемушкина Н.В. Синдром раздраженного кишечника. Римские критерии IV. Consilium Medicum. 2016; 18 (8): 79–85.
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Аннотация
Обзор литературы посвящен выходу в свет очередных Римских критериев диагностики и лечения функциональных расстройств органов пищеварения IV пересмотра с акцентом на наиболее часто встречаемую и трудно курабельную патологию – синдром раздраженного кишечника (СРК). Приведены новые диагностические критерии, отмечены важные отличия от предшествующей редакции. Обращено внимание читателей на особенности патофизиологии СРК и связанные с недопониманием в этой области частые ошибки в ведении таких пациентов. Представлен современный взгляд на фармакотерапию СРК, основанный на доказательных клинических исследованиях, дан краткий критичный анализ наиболее частых ошибок в выборе лекарственных и иных средств в лечении данного заболевания.
Ключевые слова: синдром раздраженного кишечника, Римские критерии IV, патофизиология, диагностика, лечение.
Ключевые слова: синдром раздраженного кишечника, Римские критерии IV, патофизиология, диагностика, лечение.
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The following review of the literature is devoted to the publication of the next Rome criteria for the diagnosis and treatment of functional disorders of the digestive system. IV review focuses on the most frequently encountered and difficult curable pathology – Irritable bowel syndrome (IBS). We present the new diagnostic criteria, observed important differences from the previous version. The attention of readers to the peculiarities of the pathophysiology of IBS and related misunderstanding in this area frequent errors in the conduct of such patients. Submitted by the modern view of the IBS drug therapy based on evidence-based clinical trials, a brief critical analysis of the most common mistakes in choosing drugs and other agents in the treatment of this disease.
Key words: Irritable bowel syndrome, Rome IV criteria, pathophysiology, diagnosis, treatment.
Key words: Irritable bowel syndrome, Rome IV criteria, pathophysiology, diagnosis, treatment.
Полный текст
Список литературы
1. Маев И.В., Черемушкин С.В. Синдром раздраженного кишечника. Римские критерии III. Consilium Medicum. Гастроэнтерология (Прил.). 2007; 1: 29–33. / Maev I.V., Cheremushkin S.V. Sindrom razdrazhennogo kishechnika. Rimskie kriterii III. Consilium Medicum. Gastroenterology (Suppl.). 2007; 1: 29–33. [in Russian]
2. Маев И.В., Кучерявый Ю.А., Черемушкин С.В. Эволюция представлений о синдроме радраженного кишечника. Методическое пособие для врачей. М., 2013. / Maev I.V., Kucheriavyi Iu.A., Cheremushkin S.V. Evoliutsiia predstavlenii o sindrome radrazhennogo kishechnika. Metodicheskoe posobie dlia vrachei. M., 2013. [in Russian]
3. Маев И.В., Черемушкин С.В., Кучерявый Ю.А. и др. Многоцелевая терапия синдрома раздраженного кишечника: современный взгляд на решение проблемы. Фарматека. 2015; 10 (303): 20–5. / Maev I.V., Cheremushkin S.V., Kucheriavyi Iu.A. i dr. Mnogotselevaia terapiia sindroma razdrazhennogo kishechnika: sovremennyi vzgliad na reshenie problemy. Farmateka. 2015; 10 (303): 20–5. [in Russian]
4. Маев И.В., Черемушкин С.В., Ю.А.Кучерявый. Синдром раздраженного кишечника. Римские критерии IV. О роли висцеральной гиперчувствительности и способах ее коррекции. Методическое пособие. М., 2016. / Maev I.V., Cheremushkin S.V., Iu.A.Kucheriavyi. Sindrom razdrazhennogo kishechnika. Rimskie kriterii IV. O roli vistseral'noi giperchuvstvitel'nosti i sposobakh ee korrektsii. Metodicheskoe posobie. M., 2016. [in Russian]
5. Brandt LJ, Chey WD, Foxx-Orenstein AE et al. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol 2009; 104 (1): 1–35.
6. Lacy BE, Fermín Mearin, Lin Chang et al. Bowel Disorders. Gastroenterology 2016; 150: 1393–407.
7. Canavan C, West J, Card T. The epidemiology of irritable bowel syndrome. Clin Epidemiol 2014; 6: 71–80.
8. Chaudhary NA, Trulove SC. The irritable colon syndrome. A study of the clinical features, predisposing causes, and prognosis in 130 cases. Q J Med 1962; 31: 307–22.
9. Ford AC, Forman D, Bailey AG et al. Irritable bowel syndrome: a 10-yr natural history of symptoms and factors that influence consultation behavior. Am J Gastroenterol 2008; 103: 1229–39.
10. Ford AC et al. Systematic review and meta-analysis of the prevalence of irritable bowel syndrome in individuals with dyspepsia. Clin Gastroenterol Hepatol 2010; 8 (5): 401–9.
11. Halder SL, Locke GR 3rd, Schleck CD et al. Natural history of functional gastrointestinal disorders: a 12-year longitudinal population-based study. Gastroenterology 2007; 133: 799–807.
12. Irritable bowel syndrome. Br Med J 1972; 1 (5794): 197–8. Noauthorslisted.
13. Kim HG et al. G-Protein Beta3 Subunit C825T Polymorphism in Patients With Overlap Syndrome of Functional Dyspepsia and Irritable Bowel Syndrome. J Neurogastroenterol Motil 2012; 18 (2): 205–10.
14. Kruse FH. Functional disorders of the colon: the spastic colon, the irritable colon, and mucous colitis. Cal West Med 1933; 39 (2): 97–103.
15. Longstreth GF, Thompson WG, Chey WD et al. Functional bowel disorders. Gastroenterology 2006; 130 (5): 1480–91.
16. Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol 2012; 10: 712–21.
17. Madisch A, Holtmann G, Plein K, Hotz J. Treatment of irritable bowel syndrome with herbal preparations: results of a double-blind, randomized, placebo-controlled, multi-centre trial. Aliment Pharmacol Ther 2004; 19: 271–9.
18. Manning AP, Thompson WG, Heaton KW, Morris AF. Towards positive diagnosis of the irritable bowel. Br Med J 1978; 2 (6138): 653–4.
19. O'Donnell LJD, Virjee J, Heaton KW. Detection of pseudodiarrhoea by simple clinical assessment of intestinal transit rate. Br Med J 1990; 300: 439–40.
20. Oliver Grudmannand Saunjoo L. Yoon Complementary and alternative medicines in irritable bowel syndrome: An integrative view. World J Gastroenterol 2014; 20 (2): 346–62.
21. Palsson O, Heymen S, Whitehead WE. Abdominal pain versus abdominal discomfort: implications for diagnostic assessment of irritable bowel syndrome (IBS). United Eur Gastroenterol J 2014; 2: 405.
22. Rösch W, Vinson B, Sassin I. A randomised clinical trial comparing the efficacy of a herbal preparation STW 5 with the prokinetic drug cisapride in patients with dysmotility type of functional dyspepsia. Z Gastroenterol 2002;40: 401–8.
23. Saito YA, Locke GR, Talley NJ et al. A comparison of the Rome and Manning criteria for case identification in epidemiological investigations of irritable bowel syndrome. Am J Gastroenterol 2000; 95 (10): 2816–24.
24. Simmen U, Kelber O, Okpanyi SN et al. Binding of STW 5 (Iberogast) and its components to intestinal 5-HT, muscarinic M3, and opioid receptors. Phytomedicine 2006; 13 (Suppl. 5): 51–5.
25. Thompson WG, Longstreth GF, Drossman DA et al. Functional bowel disorders and functional abdominal pain. Gut 1999; 45 (Suppl. 2): II43–II47.
26. Von Arnim U, Peitz U, Vinson B et al. STW 5, a phytopharmacon for patients with functional dyspepsia: results of a multicenter, placebo-controlled double-blind study. Am J Gastroenterol 2007; 102: 1268–75.
2. Maev I.V., Kucheriavyi Iu.A., Cheremushkin S.V. Evoliutsiia predstavlenii o sindrome radrazhennogo kishechnika. Metodicheskoe posobie dlia vrachei. M., 2013. [in Russian]
3. Maev I.V., Cheremushkin S.V., Kucheriavyi Iu.A. i dr. Mnogotselevaia terapiia sindroma razdrazhennogo kishechnika: sovremennyi vzgliad na reshenie problemy. Farmateka. 2015; 10 (303): 20–5. [in Russian]
4. Maev I.V., Cheremushkin S.V., Iu.A.Kucheriavyi. Sindrom razdrazhennogo kishechnika. Rimskie kriterii IV. O roli vistseral'noi giperchuvstvitel'nosti i sposobakh ee korrektsii. Metodicheskoe posobie. M., 2016. [in Russian]
5. Brandt LJ, Chey WD, Foxx-Orenstein AE et al. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol 2009; 104 (1): 1–35.
6. Lacy BE, Fermín Mearin, Lin Chang et al. Bowel Disorders. Gastroenterology 2016; 150: 1393–407.
7. Canavan C, West J, Card T. The epidemiology of irritable bowel syndrome. Clin Epidemiol 2014; 6: 71–80.
8. Chaudhary NA, Trulove SC. The irritable colon syndrome. A study of the clinical features, predisposing causes, and prognosis in 130 cases. Q J Med 1962; 31: 307–22.
9. Ford AC, Forman D, Bailey AG et al. Irritable bowel syndrome: a 10-yr natural history of symptoms and factors that influence consultation behavior. Am J Gastroenterol 2008; 103: 1229–39.
10. Ford AC et al. Systematic review and meta-analysis of the prevalence of irritable bowel syndrome in individuals with dyspepsia. Clin Gastroenterol Hepatol 2010; 8 (5): 401–9.
11. Halder SL, Locke GR 3rd, Schleck CD et al. Natural history of functional gastrointestinal disorders: a 12-year longitudinal population-based study. Gastroenterology 2007; 133: 799–807.
12. Irritable bowel syndrome. Br Med J 1972; 1 (5794): 197–8. Noauthorslisted.
13. Kim HG et al. G-Protein Beta3 Subunit C825T Polymorphism in Patients With Overlap Syndrome of Functional Dyspepsia and Irritable Bowel Syndrome. J Neurogastroenterol Motil 2012; 18 (2): 205–10.
14. Kruse FH. Functional disorders of the colon: the spastic colon, the irritable colon, and mucous colitis. Cal West Med 1933; 39 (2): 97–103.
15. Longstreth GF, Thompson WG, Chey WD et al. Functional bowel disorders. Gastroenterology 2006; 130 (5): 1480–91.
16. Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol 2012; 10: 712–21.
17. Madisch A, Holtmann G, Plein K, Hotz J. Treatment of irritable bowel syndrome with herbal preparations: results of a double-blind, randomized, placebo-controlled, multi-centre trial. Aliment Pharmacol Ther 2004; 19: 271–9.
18. Manning AP, Thompson WG, Heaton KW, Morris AF. Towards positive diagnosis of the irritable bowel. Br Med J 1978; 2 (6138): 653–4.
19. O'Donnell LJD, Virjee J, Heaton KW. Detection of pseudodiarrhoea by simple clinical assessment of intestinal transit rate. Br Med J 1990; 300: 439–40.
20. Oliver Grudmannand Saunjoo L. Yoon Complementary and alternative medicines in irritable bowel syndrome: An integrative view. World J Gastroenterol 2014; 20 (2): 346–62.
21. Palsson O, Heymen S, Whitehead WE. Abdominal pain versus abdominal discomfort: implications for diagnostic assessment of irritable bowel syndrome (IBS). United Eur Gastroenterol J 2014; 2: 405.
22. Rösch W, Vinson B, Sassin I. A randomised clinical trial comparing the efficacy of a herbal preparation STW 5 with the prokinetic drug cisapride in patients with dysmotility type of functional dyspepsia. Z Gastroenterol 2002;40: 401–8.
23. Saito YA, Locke GR, Talley NJ et al. A comparison of the Rome and Manning criteria for case identification in epidemiological investigations of irritable bowel syndrome. Am J Gastroenterol 2000; 95 (10): 2816–24.
24. Simmen U, Kelber O, Okpanyi SN et al. Binding of STW 5 (Iberogast) and its components to intestinal 5-HT, muscarinic M3, and opioid receptors. Phytomedicine 2006; 13 (Suppl. 5): 51–5.
25. Thompson WG, Longstreth GF, Drossman DA et al. Functional bowel disorders and functional abdominal pain. Gut 1999; 45 (Suppl. 2): II43–II47.
26. Von Arnim U, Peitz U, Vinson B et al. STW 5, a phytopharmacon for patients with functional dyspepsia: results of a multicenter, placebo-controlled double-blind study. Am J Gastroenterol 2007; 102: 1268–75.
2. Маев И.В., Кучерявый Ю.А., Черемушкин С.В. Эволюция представлений о синдроме радраженного кишечника. Методическое пособие для врачей. М., 2013. / Maev I.V., Kucheriavyi Iu.A., Cheremushkin S.V. Evoliutsiia predstavlenii o sindrome radrazhennogo kishechnika. Metodicheskoe posobie dlia vrachei. M., 2013. [in Russian]
3. Маев И.В., Черемушкин С.В., Кучерявый Ю.А. и др. Многоцелевая терапия синдрома раздраженного кишечника: современный взгляд на решение проблемы. Фарматека. 2015; 10 (303): 20–5. / Maev I.V., Cheremushkin S.V., Kucheriavyi Iu.A. i dr. Mnogotselevaia terapiia sindroma razdrazhennogo kishechnika: sovremennyi vzgliad na reshenie problemy. Farmateka. 2015; 10 (303): 20–5. [in Russian]
4. Маев И.В., Черемушкин С.В., Ю.А.Кучерявый. Синдром раздраженного кишечника. Римские критерии IV. О роли висцеральной гиперчувствительности и способах ее коррекции. Методическое пособие. М., 2016. / Maev I.V., Cheremushkin S.V., Iu.A.Kucheriavyi. Sindrom razdrazhennogo kishechnika. Rimskie kriterii IV. O roli vistseral'noi giperchuvstvitel'nosti i sposobakh ee korrektsii. Metodicheskoe posobie. M., 2016. [in Russian]
5. Brandt LJ, Chey WD, Foxx-Orenstein AE et al. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol 2009; 104 (1): 1–35.
6. Lacy BE, Fermín Mearin, Lin Chang et al. Bowel Disorders. Gastroenterology 2016; 150: 1393–407.
7. Canavan C, West J, Card T. The epidemiology of irritable bowel syndrome. Clin Epidemiol 2014; 6: 71–80.
8. Chaudhary NA, Trulove SC. The irritable colon syndrome. A study of the clinical features, predisposing causes, and prognosis in 130 cases. Q J Med 1962; 31: 307–22.
9. Ford AC, Forman D, Bailey AG et al. Irritable bowel syndrome: a 10-yr natural history of symptoms and factors that influence consultation behavior. Am J Gastroenterol 2008; 103: 1229–39.
10. Ford AC et al. Systematic review and meta-analysis of the prevalence of irritable bowel syndrome in individuals with dyspepsia. Clin Gastroenterol Hepatol 2010; 8 (5): 401–9.
11. Halder SL, Locke GR 3rd, Schleck CD et al. Natural history of functional gastrointestinal disorders: a 12-year longitudinal population-based study. Gastroenterology 2007; 133: 799–807.
12. Irritable bowel syndrome. Br Med J 1972; 1 (5794): 197–8. Noauthorslisted.
13. Kim HG et al. G-Protein Beta3 Subunit C825T Polymorphism in Patients With Overlap Syndrome of Functional Dyspepsia and Irritable Bowel Syndrome. J Neurogastroenterol Motil 2012; 18 (2): 205–10.
14. Kruse FH. Functional disorders of the colon: the spastic colon, the irritable colon, and mucous colitis. Cal West Med 1933; 39 (2): 97–103.
15. Longstreth GF, Thompson WG, Chey WD et al. Functional bowel disorders. Gastroenterology 2006; 130 (5): 1480–91.
16. Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol 2012; 10: 712–21.
17. Madisch A, Holtmann G, Plein K, Hotz J. Treatment of irritable bowel syndrome with herbal preparations: results of a double-blind, randomized, placebo-controlled, multi-centre trial. Aliment Pharmacol Ther 2004; 19: 271–9.
18. Manning AP, Thompson WG, Heaton KW, Morris AF. Towards positive diagnosis of the irritable bowel. Br Med J 1978; 2 (6138): 653–4.
19. O'Donnell LJD, Virjee J, Heaton KW. Detection of pseudodiarrhoea by simple clinical assessment of intestinal transit rate. Br Med J 1990; 300: 439–40.
20. Oliver Grudmannand Saunjoo L. Yoon Complementary and alternative medicines in irritable bowel syndrome: An integrative view. World J Gastroenterol 2014; 20 (2): 346–62.
21. Palsson O, Heymen S, Whitehead WE. Abdominal pain versus abdominal discomfort: implications for diagnostic assessment of irritable bowel syndrome (IBS). United Eur Gastroenterol J 2014; 2: 405.
22. Rösch W, Vinson B, Sassin I. A randomised clinical trial comparing the efficacy of a herbal preparation STW 5 with the prokinetic drug cisapride in patients with dysmotility type of functional dyspepsia. Z Gastroenterol 2002;40: 401–8.
23. Saito YA, Locke GR, Talley NJ et al. A comparison of the Rome and Manning criteria for case identification in epidemiological investigations of irritable bowel syndrome. Am J Gastroenterol 2000; 95 (10): 2816–24.
24. Simmen U, Kelber O, Okpanyi SN et al. Binding of STW 5 (Iberogast) and its components to intestinal 5-HT, muscarinic M3, and opioid receptors. Phytomedicine 2006; 13 (Suppl. 5): 51–5.
25. Thompson WG, Longstreth GF, Drossman DA et al. Functional bowel disorders and functional abdominal pain. Gut 1999; 45 (Suppl. 2): II43–II47.
26. Von Arnim U, Peitz U, Vinson B et al. STW 5, a phytopharmacon for patients with functional dyspepsia: results of a multicenter, placebo-controlled double-blind study. Am J Gastroenterol 2007; 102: 1268–75.
________________________________________________
2. Maev I.V., Kucheriavyi Iu.A., Cheremushkin S.V. Evoliutsiia predstavlenii o sindrome radrazhennogo kishechnika. Metodicheskoe posobie dlia vrachei. M., 2013. [in Russian]
3. Maev I.V., Cheremushkin S.V., Kucheriavyi Iu.A. i dr. Mnogotselevaia terapiia sindroma razdrazhennogo kishechnika: sovremennyi vzgliad na reshenie problemy. Farmateka. 2015; 10 (303): 20–5. [in Russian]
4. Maev I.V., Cheremushkin S.V., Iu.A.Kucheriavyi. Sindrom razdrazhennogo kishechnika. Rimskie kriterii IV. O roli vistseral'noi giperchuvstvitel'nosti i sposobakh ee korrektsii. Metodicheskoe posobie. M., 2016. [in Russian]
5. Brandt LJ, Chey WD, Foxx-Orenstein AE et al. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol 2009; 104 (1): 1–35.
6. Lacy BE, Fermín Mearin, Lin Chang et al. Bowel Disorders. Gastroenterology 2016; 150: 1393–407.
7. Canavan C, West J, Card T. The epidemiology of irritable bowel syndrome. Clin Epidemiol 2014; 6: 71–80.
8. Chaudhary NA, Trulove SC. The irritable colon syndrome. A study of the clinical features, predisposing causes, and prognosis in 130 cases. Q J Med 1962; 31: 307–22.
9. Ford AC, Forman D, Bailey AG et al. Irritable bowel syndrome: a 10-yr natural history of symptoms and factors that influence consultation behavior. Am J Gastroenterol 2008; 103: 1229–39.
10. Ford AC et al. Systematic review and meta-analysis of the prevalence of irritable bowel syndrome in individuals with dyspepsia. Clin Gastroenterol Hepatol 2010; 8 (5): 401–9.
11. Halder SL, Locke GR 3rd, Schleck CD et al. Natural history of functional gastrointestinal disorders: a 12-year longitudinal population-based study. Gastroenterology 2007; 133: 799–807.
12. Irritable bowel syndrome. Br Med J 1972; 1 (5794): 197–8. Noauthorslisted.
13. Kim HG et al. G-Protein Beta3 Subunit C825T Polymorphism in Patients With Overlap Syndrome of Functional Dyspepsia and Irritable Bowel Syndrome. J Neurogastroenterol Motil 2012; 18 (2): 205–10.
14. Kruse FH. Functional disorders of the colon: the spastic colon, the irritable colon, and mucous colitis. Cal West Med 1933; 39 (2): 97–103.
15. Longstreth GF, Thompson WG, Chey WD et al. Functional bowel disorders. Gastroenterology 2006; 130 (5): 1480–91.
16. Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol 2012; 10: 712–21.
17. Madisch A, Holtmann G, Plein K, Hotz J. Treatment of irritable bowel syndrome with herbal preparations: results of a double-blind, randomized, placebo-controlled, multi-centre trial. Aliment Pharmacol Ther 2004; 19: 271–9.
18. Manning AP, Thompson WG, Heaton KW, Morris AF. Towards positive diagnosis of the irritable bowel. Br Med J 1978; 2 (6138): 653–4.
19. O'Donnell LJD, Virjee J, Heaton KW. Detection of pseudodiarrhoea by simple clinical assessment of intestinal transit rate. Br Med J 1990; 300: 439–40.
20. Oliver Grudmannand Saunjoo L. Yoon Complementary and alternative medicines in irritable bowel syndrome: An integrative view. World J Gastroenterol 2014; 20 (2): 346–62.
21. Palsson O, Heymen S, Whitehead WE. Abdominal pain versus abdominal discomfort: implications for diagnostic assessment of irritable bowel syndrome (IBS). United Eur Gastroenterol J 2014; 2: 405.
22. Rösch W, Vinson B, Sassin I. A randomised clinical trial comparing the efficacy of a herbal preparation STW 5 with the prokinetic drug cisapride in patients with dysmotility type of functional dyspepsia. Z Gastroenterol 2002;40: 401–8.
23. Saito YA, Locke GR, Talley NJ et al. A comparison of the Rome and Manning criteria for case identification in epidemiological investigations of irritable bowel syndrome. Am J Gastroenterol 2000; 95 (10): 2816–24.
24. Simmen U, Kelber O, Okpanyi SN et al. Binding of STW 5 (Iberogast) and its components to intestinal 5-HT, muscarinic M3, and opioid receptors. Phytomedicine 2006; 13 (Suppl. 5): 51–5.
25. Thompson WG, Longstreth GF, Drossman DA et al. Functional bowel disorders and functional abdominal pain. Gut 1999; 45 (Suppl. 2): II43–II47.
26. Von Arnim U, Peitz U, Vinson B et al. STW 5, a phytopharmacon for patients with functional dyspepsia: results of a multicenter, placebo-controlled double-blind study. Am J Gastroenterol 2007; 102: 1268–75.
Авторы
И.В.Маев1, С.В.Черемушкин*1,2, Ю.А.Кучерявый1,2, Н.В.Черемушкина1
1 ГБОУ ВПО Московский государственный медико-стоматологический университет им. А.И.Евдокимова Минздрава России. 127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1;
2 НУЗ Центральная клиническая больница №2 им. Н.А.Семашко ОАО «РЖД». 129128, Россия, Москва, ул. Будайская, д. 2
*svch555362@yandex.ru
1 ГБОУ ВПО Московский государственный медико-стоматологический университет им. А.И.Евдокимова Минздрава России. 127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1;
2 НУЗ Центральная клиническая больница №2 им. Н.А.Семашко ОАО «РЖД». 129128, Россия, Москва, ул. Будайская, д. 2
*svch555362@yandex.ru
________________________________________________
1 A.I.Evdokimov Moscow State University Medicine and Dentistry of the Ministry of Health of the Russian Federation. 127473, Russian Federation, Moscow, ul. Delegatskaia, d. 20, str. 1;
2 N.A.Semashko Central Clinical Hospital №2 of JSC "Russian Railways". 129128, Russian Federation, Mosсow, ul. Budaiskaia, d. 2
*svch555362@yandex.ru
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