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Что мы знаем о кандесартане: возможности клинического применения
Добрынина Н.В. Что мы знаем о кандесартане: возможности клинического применения. Consilium Medicum. 2016; 18 (5): 67–69. DOI: 10.26442/2075-1753_2016.5.67-69
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Dobryninа N.V. What we know about candesartan: clinical applications. Consilium Medicum. 2016; 18 (5): 67–69. DOI: 10.26442/2075-1753_2016.5.67-69
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Аннотация
Сартаны – одна из самых молодых групп антигипертензивных лекарственных препаратов, однако их эффективность во многих клинических ситуациях убедительно доказана. Кандесартан – один из самых изученных сартанов. Он обладает выраженным дозозависимым длительным антигипертензивным эффектом, органопротективными свойствами: уменьшает гипертрофию левого желудочка, защищает от мозгового инсульта, дает нефропротективный эффект, замедляет прогрессирование хронической сердечной недостаточности и предупреждает развитие пароксизмов фибрилляции предсердий. Он не только метаболически нейтрален, но и способен повышать чувствительность периферических тканей к инсулину и оказывать благоприятное действие на показатели липидного обмена. Таким образом, кандесартан соответствует всем требованиям к современным лекарственным препаратам.
Ключевые слова: ренин-ангиотензин-альдостероновая система, блокаторы рецепторов к ангиотензину II, сартаны, кандесартан, Гипосарт.
Ключевые слова: ренин-ангиотензин-альдостероновая система, блокаторы рецепторов к ангиотензину II, сартаны, кандесартан, Гипосарт.
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Sartans – one of the youngest groups of antihypertensive drugs, but their efficacy in many clinical situations convincingly proved. Candesartan – one of the most studied sartans. It has a pronounced dose-dependent long-term antihypertensive effect, reduces left ventricular hypertrophy, protects from stroke, renal protection gives effect, slows the progression of chronic heart failure and prevents the development of paroxysmal atrial fibrillation. It not only metabolically neutral but also capable of increasing the sensitivity of peripheral tissues to insulin and exert a beneficial effect on lipid metabolism. That is candesartan meets all requirements for modern medicines.
Key words: renin-angiotensin-aldosterone system, angiotensin II receptor blockers, sartans, candesartan, Giposart.
Key words: renin-angiotensin-aldosterone system, angiotensin II receptor blockers, sartans, candesartan, Giposart.
Полный текст
Список литературы
1. Гиляревский С.Р. Современные возможности блокады ренин-ангиотензиновой системы: остаются ли ингибиторы ангиотензинпревращающего фермента препаратами первого ряда? Consilium Medicum. 2010; 12 (5): 18–23. / Giliarevskii S.R. Sovremennye vozmozhnosti blokady renin-angiotenzinovoi sistemy: ostaiutsia li ingibitory angiotenzinprevrashchaiushchego fermenta preparatami pervogo riada? Consilium Medicum. 2010; 12 (5): 18–23. [in Russian]
2. Остроумова О.Д., Хорьков С.А., Копченов И.И. Возможности антагонистов рецепторов к ангиотензину II в органопротекции у больных с артериальной гипертонией. Consilium Medicum. 2009; 11 (5): 29–37. / Ostroumova O.D., Khor'kov S.A., Kopchenov I.I. Vozmozhnosti antagonistov retseptorov k angiotenzinu II v organoprotektsii u bol'nykh s arterial'noi gipertoniei. Consilium Medicum. 2009; 11 (5): 29–37. [in Russian]
3. Смирнова Е.А., Лиферов Р.А., Якушин С.С. Распространенность и оценка эффективности медикаментозной терапии артериальной гипертонии в Рязанской области. Рос. мед.-биол. вестн. им. акад. И.П.Павлова. 2008; 4: 73–9. / Smirnova E.A., Liferov R.A., Iakushin S.S. Rasprostranennost' i otsenka effektivnosti medikamentoznoi terapii arterial'noi gipertonii v Riazanskoi oblasti. Ros. med.-biol. vestn. im. akad. I.P.Pavlova. 2008; 4: 73–9. [in Russian]
4. Захарова Н.В., Кузьмина-Крутецкая С.Р. Клиническая фармакология сартанов: класс-эффект и фармакодинамические особенности препаратов. Системные гипертензии. 2011; 7 (3): 12–7. / Zakharova N.V., Kuz'mina-Krutetskaia S.R. Klinicheskaia farmakologiia sartanov: klass-effekt i farmakodinamicheskie osobennosti preparatov. Systemic Hypertension. 2011; 7 (3): 12–7. [in Russian]
5. Burnier M. Angiotensin II Type 1 Receptor Blockers. Circulation 2001; 103: 904–12.
6. Евдокимова А.Г., Ложкина М.В., Коваленко Е.В. Особенности применения кандесартана в клинической практике. Consilium Medicum. 2016; 18 (1): 68–73. / Evdokimova A.G., Lozhkina M.V., Kovalenko E.V. Osobennosti primeneniia kandesartana v klinicheskoi praktike. Consilium Medicum. 2016; 18 (1): 68–73. [in Russian]
7. Остроумова О.Д., Бондарец О.В., Гусева Т.Ф. Преимущества кандесартана в лечении артериальной гипертонии. Системные гипертензии. 2014; 10 (2): 42–6. / Ostroumova O.D., Bondarets O.V., Guseva T.F. Preimushchestva kandesartana v lechenii arterial'noi gipertonii. Systemic Hypertension. 2014; 10 (2): 42–6. [in Russian]
8. Клиническая фармакология. Под ред. В.Г.Кукеса. Изд. 4-е. М.: ГЭОТАР-Медиа, 2008; с. 392–6. / Klinicheskaia farmakologiia. Pod red. V.G.Kukesa. Izd. 4-e. M.: GEOTAR-Media, 2008; s. 392–6. [in Russian]
9. Морозова Т.Е. Сартаны в лечении больных артериальной гипертензией высокого риска: возможности кандесартана. Системные гипертензии. 2013; 9 (2): 34–9. / Morozova T.E. Sartany v lechenii bol'nykh arterial'noi gipertenziei vysokogo riska: vozmozhnosti kandesartana. Systemic Hypertension. 2013; 9 (2): 34–9. [in Russian]
10. Гиляревский С.Р., Голшмид М.В., Кузьмина И.М. Доказательная история кандесартана: прошлое, будущее и настоящее. Сердечная недостаточность. 2015; 16 (5): 303–10. / Giliarevskii S.R., Golshmid M.V., Kuz'mina I.M. Dokazatel'naia istoriia kandesartana: proshloe, budushchee i nastoiashchee. Serdechnaia nedostatochnost'. 2015; 16 (5): 303–10. [in Russian]
11. Israili ZH. Clinical of angiotensin II (AT I) receptor blockers in hypertension. J Hum Hypertens 2000; 14 (Suppl. 1): 73–86.
12. Oparll S. Newly emerging pharmacologic differences in angiotensin II receptor blockers. Am J Hypertens 2000; 13 (1 pt 2): 188–248.
13. Le MT, De Bakcer JP, Hanyady L et al. Ligand binding and functional properties of human angiotensin AT I receptors in transiently and stably expressed CHO-K1 cell. Eur J Pharmacol 2005; 513 (1–2): 35–45.
14. Minatoquchi S, Aoyama T, Kawai N et al. Comparative effect of candesartan and amlodipine, and effect of switching from valsartan, losartan, telmisartan and olmesartan to candesartan, on early morning hypertension and heart rate. Blood Press 2013; 22.
15. Weisser B, Gerwe M, Funken C. Investigation of the antihypertensive long-term action of candesartan cilexetil in different dosadges under the influence therapy-free intervals. Arzneimittelforschung 2005; 55 (9): 501–13.
16. Кобалава Ж.Д., Склизкова Л.А., Тарапата Н.П. Обоснование, опыт и перспектива применения кандесартана цилексетила. Клин. фармакология и терапия. 2001; 1: 92–6. / Kobalava Zh.D., Sklizkova L.A., Tarapata N.P. Obosnovanie, opyt i perspektiva primeneniia kandesartana tsileksetila. Klin. farmakologiia i terapiia. 2001; 1: 92–6. [in Russian]
17. Lee HY, Hong BK, Chung WJ et al. Phase IV, 8-week, multicenteral, randomized, active treatment-controlled, parallel grope, efficacy and tolerability of candesartan cilexetil combined with hydrochlorothiazide in Korean adults with stage II hypertension. Clin Ther 2011; 33 (8): 1043–56.
18. Easthope SE, Jarvis B. Candesartan cilexetil in update of its use in essential hypertension. Drugs 2002; 62: 1253–87.
19. Bakris G, Gradman A, Reif M et al and the CLAIM Study Investigators. Antihypertensive efficacy of candesartanin comparison to losartan: the CLAIM Study. J Clin Hypertens 2001; 3: 16–21.
20. Vidi DG, While WB, Ridley E et al and the CLAIM Study Investigators. A forsed titration study of antihypertensive efficacy of candesartanin cilexetil in comparison to losartan. CLAIM Study II. . J Hum Hypertens 2001; 15: 475–80.
21. Hasegawa H, Takano H, Kameda E et al. Effect of switching from telmisartan, valsartan, olmesartan or losartan, to candesartan on morning hypertension. Clin Exp Hypertens 2012; 34 (2): 86–91.
22. Escobar C, Barrios V, Calderon A et al. Electrocardiographic left ventricular hypertrophy regression induced by an angiotensin receptor blocker-based regimen in hypertensive patients with the metabolic syndrome: data from the SARA Study. J Clin Hypertens (Greenwich) 2008; 10: 208–14.
23. Penicka M, Gregor P, Kerekes R et al. Candesartan use in Hypertrophic And Non-obstructive Cardiomyopathy Estate (CHANCE) Study. The effects of candesartan on left ventricular hypertrophy and function in nonobstructive hypertrophic cardiomyopathy: a pilot, randomized study. J Mol Diagn 2009; 11: 35–41.
24. Lithell H, Hansson L, Skoog I et al. SCOPE Study Group. The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial. J Hypertens 2003; 21: 875–86.
25. Kasanuki H, Hagiwara N, Hosoda S et al. HIJ-CREATE Investigators. Angiotensin II receptor blockerbased vs. nonangiotensin II receptor blockerbased therapy in patients with angiographically documented coronary artery disease and hypertension: the Heart Institute of Japan Candesartan Randomized Trial for Evaluation in Coronary Artery Disease (HIJ-CREATE). Eur Heart J 2009; 30: 1203–12.
26. De Rosa MJ. Angiotensin II receptor blockers and cardioprotection. Vasc Health Risk Manag 2010; 6: 1047–63.
27. Burgess E, Muirhead N, Rene de Cotret P et al. SMART (Supra Maximal Atacand Renal Trial) Investigators. Supramaximal dose of candesartan in proteinuric renal disease. J Am Soc Nephrol 2009; 20: 893–900.
28. Ducharme A, Swedberg K, Pfeffer MA et al. CHARM Investigators. Prevention of atrial fibrillation in patients with symptomatic chronic heart failure by candesartan in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program. Am Heart J 2006; 152: 86–92.
29. Ogihara T, Fujimoto A, Nakao K, Saruta T. CASE-J Trial Group. ARB candesartan and CCB amlodipine in hypertensive patients: the CASE-J trial. Exp Rev Cardiovasc Ther 2008; 6 (9): 1195–201.
30. Suzuki T, Nozawa T, Fujii N et al. Combination therapy of candesartan with statin inhibits progression of atherosclerosis more than statin alone in patients with coronary artery disease. Coron Artery Dis 2011; 22: 352–35.
31. Schrader J, Lüders S, Kulschewski A et al. Acute Candesartan Cilexetil Therapy in Stroke Survivors Study Group. The ACCESS Study: evaluation of Acute Candesartan Cilexetil Therapy in Stroke Survivors. Stroke 2003; 34: 1699–703.
32. Отчет о результатах исследования CNDN-01 «Открытое, рандомизированное, перекрестное исследование сравнительной фармакокинетики и биоэквивалентности препаратов Гипосарт, таблетки 32 мг, Фармацевтический завод «Польфарма» АО (Польша), и Атаканд®, таблетки 32 мг, «АстраЗенека АБ» (Швеция), с участием здоровых добровольцев». Москва, 2013. / Otchet o rezul'tatakh issledovaniia CNDN-01 «Otkrytoe, randomizirovannoe, perekrestnoe issledovanie sravnitel'noi farmakokinetiki i biokvivalentnosti preparatov Giposart, tabletki 32 mg, Farmatsevticheskii zavod «Pol'farma» AO (Pol'sha), i Atakand®, tabletki 32 mg, «AstraZeneka AB» (Shvetsiia), s uchastiem zdorovykh dobrovol'tsev». M., 2013. [in Russian]
2. Остроумова О.Д., Хорьков С.А., Копченов И.И. Возможности антагонистов рецепторов к ангиотензину II в органопротекции у больных с артериальной гипертонией. Consilium Medicum. 2009; 11 (5): 29–37. / Ostroumova O.D., Khor'kov S.A., Kopchenov I.I. Vozmozhnosti antagonistov retseptorov k angiotenzinu II v organoprotektsii u bol'nykh s arterial'noi gipertoniei. Consilium Medicum. 2009; 11 (5): 29–37. [in Russian]
3. Смирнова Е.А., Лиферов Р.А., Якушин С.С. Распространенность и оценка эффективности медикаментозной терапии артериальной гипертонии в Рязанской области. Рос. мед.-биол. вестн. им. акад. И.П.Павлова. 2008; 4: 73–9. / Smirnova E.A., Liferov R.A., Iakushin S.S. Rasprostranennost' i otsenka effektivnosti medikamentoznoi terapii arterial'noi gipertonii v Riazanskoi oblasti. Ros. med.-biol. vestn. im. akad. I.P.Pavlova. 2008; 4: 73–9. [in Russian]
4. Захарова Н.В., Кузьмина-Крутецкая С.Р. Клиническая фармакология сартанов: класс-эффект и фармакодинамические особенности препаратов. Системные гипертензии. 2011; 7 (3): 12–7. / Zakharova N.V., Kuz'mina-Krutetskaia S.R. Klinicheskaia farmakologiia sartanov: klass-effekt i farmakodinamicheskie osobennosti preparatov. Systemic Hypertension. 2011; 7 (3): 12–7. [in Russian]
5. Burnier M. Angiotensin II Type 1 Receptor Blockers. Circulation 2001; 103: 904–12.
6. Евдокимова А.Г., Ложкина М.В., Коваленко Е.В. Особенности применения кандесартана в клинической практике. Consilium Medicum. 2016; 18 (1): 68–73. / Evdokimova A.G., Lozhkina M.V., Kovalenko E.V. Osobennosti primeneniia kandesartana v klinicheskoi praktike. Consilium Medicum. 2016; 18 (1): 68–73. [in Russian]
7. Остроумова О.Д., Бондарец О.В., Гусева Т.Ф. Преимущества кандесартана в лечении артериальной гипертонии. Системные гипертензии. 2014; 10 (2): 42–6. / Ostroumova O.D., Bondarets O.V., Guseva T.F. Preimushchestva kandesartana v lechenii arterial'noi gipertonii. Systemic Hypertension. 2014; 10 (2): 42–6. [in Russian]
8. Клиническая фармакология. Под ред. В.Г.Кукеса. Изд. 4-е. М.: ГЭОТАР-Медиа, 2008; с. 392–6. / Klinicheskaia farmakologiia. Pod red. V.G.Kukesa. Izd. 4-e. M.: GEOTAR-Media, 2008; s. 392–6. [in Russian]
9. Морозова Т.Е. Сартаны в лечении больных артериальной гипертензией высокого риска: возможности кандесартана. Системные гипертензии. 2013; 9 (2): 34–9. / Morozova T.E. Sartany v lechenii bol'nykh arterial'noi gipertenziei vysokogo riska: vozmozhnosti kandesartana. Systemic Hypertension. 2013; 9 (2): 34–9. [in Russian]
10. Гиляревский С.Р., Голшмид М.В., Кузьмина И.М. Доказательная история кандесартана: прошлое, будущее и настоящее. Сердечная недостаточность. 2015; 16 (5): 303–10. / Giliarevskii S.R., Golshmid M.V., Kuz'mina I.M. Dokazatel'naia istoriia kandesartana: proshloe, budushchee i nastoiashchee. Serdechnaia nedostatochnost'. 2015; 16 (5): 303–10. [in Russian]
11. Israili ZH. Clinical of angiotensin II (AT I) receptor blockers in hypertension. J Hum Hypertens 2000; 14 (Suppl. 1): 73–86.
12. Oparll S. Newly emerging pharmacologic differences in angiotensin II receptor blockers. Am J Hypertens 2000; 13 (1 pt 2): 188–248.
13. Le MT, De Bakcer JP, Hanyady L et al. Ligand binding and functional properties of human angiotensin AT I receptors in transiently and stably expressed CHO-K1 cell. Eur J Pharmacol 2005; 513 (1–2): 35–45.
14. Minatoquchi S, Aoyama T, Kawai N et al. Comparative effect of candesartan and amlodipine, and effect of switching from valsartan, losartan, telmisartan and olmesartan to candesartan, on early morning hypertension and heart rate. Blood Press 2013; 22.
15. Weisser B, Gerwe M, Funken C. Investigation of the antihypertensive long-term action of candesartan cilexetil in different dosadges under the influence therapy-free intervals. Arzneimittelforschung 2005; 55 (9): 501–13.
16. Кобалава Ж.Д., Склизкова Л.А., Тарапата Н.П. Обоснование, опыт и перспектива применения кандесартана цилексетила. Клин. фармакология и терапия. 2001; 1: 92–6. / Kobalava Zh.D., Sklizkova L.A., Tarapata N.P. Obosnovanie, opyt i perspektiva primeneniia kandesartana tsileksetila. Klin. farmakologiia i terapiia. 2001; 1: 92–6. [in Russian]
17. Lee HY, Hong BK, Chung WJ et al. Phase IV, 8-week, multicenteral, randomized, active treatment-controlled, parallel grope, efficacy and tolerability of candesartan cilexetil combined with hydrochlorothiazide in Korean adults with stage II hypertension. Clin Ther 2011; 33 (8): 1043–56.
18. Easthope SE, Jarvis B. Candesartan cilexetil in update of its use in essential hypertension. Drugs 2002; 62: 1253–87.
19. Bakris G, Gradman A, Reif M et al and the CLAIM Study Investigators. Antihypertensive efficacy of candesartanin comparison to losartan: the CLAIM Study. J Clin Hypertens 2001; 3: 16–21.
20. Vidi DG, While WB, Ridley E et al and the CLAIM Study Investigators. A forsed titration study of antihypertensive efficacy of candesartanin cilexetil in comparison to losartan. CLAIM Study II. . J Hum Hypertens 2001; 15: 475–80.
21. Hasegawa H, Takano H, Kameda E et al. Effect of switching from telmisartan, valsartan, olmesartan or losartan, to candesartan on morning hypertension. Clin Exp Hypertens 2012; 34 (2): 86–91.
22. Escobar C, Barrios V, Calderon A et al. Electrocardiographic left ventricular hypertrophy regression induced by an angiotensin receptor blocker-based regimen in hypertensive patients with the metabolic syndrome: data from the SARA Study. J Clin Hypertens (Greenwich) 2008; 10: 208–14.
23. Penicka M, Gregor P, Kerekes R et al. Candesartan use in Hypertrophic And Non-obstructive Cardiomyopathy Estate (CHANCE) Study. The effects of candesartan on left ventricular hypertrophy and function in nonobstructive hypertrophic cardiomyopathy: a pilot, randomized study. J Mol Diagn 2009; 11: 35–41.
24. Lithell H, Hansson L, Skoog I et al. SCOPE Study Group. The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial. J Hypertens 2003; 21: 875–86.
25. Kasanuki H, Hagiwara N, Hosoda S et al. HIJ-CREATE Investigators. Angiotensin II receptor blockerbased vs. nonangiotensin II receptor blockerbased therapy in patients with angiographically documented coronary artery disease and hypertension: the Heart Institute of Japan Candesartan Randomized Trial for Evaluation in Coronary Artery Disease (HIJ-CREATE). Eur Heart J 2009; 30: 1203–12.
26. De Rosa MJ. Angiotensin II receptor blockers and cardioprotection. Vasc Health Risk Manag 2010; 6: 1047–63.
27. Burgess E, Muirhead N, Rene de Cotret P et al. SMART (Supra Maximal Atacand Renal Trial) Investigators. Supramaximal dose of candesartan in proteinuric renal disease. J Am Soc Nephrol 2009; 20: 893–900.
28. Ducharme A, Swedberg K, Pfeffer MA et al. CHARM Investigators. Prevention of atrial fibrillation in patients with symptomatic chronic heart failure by candesartan in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program. Am Heart J 2006; 152: 86–92.
29. Ogihara T, Fujimoto A, Nakao K, Saruta T. CASE-J Trial Group. ARB candesartan and CCB amlodipine in hypertensive patients: the CASE-J trial. Exp Rev Cardiovasc Ther 2008; 6 (9): 1195–201.
30. Suzuki T, Nozawa T, Fujii N et al. Combination therapy of candesartan with statin inhibits progression of atherosclerosis more than statin alone in patients with coronary artery disease. Coron Artery Dis 2011; 22: 352–35.
31. Schrader J, Lüders S, Kulschewski A et al. Acute Candesartan Cilexetil Therapy in Stroke Survivors Study Group. The ACCESS Study: evaluation of Acute Candesartan Cilexetil Therapy in Stroke Survivors. Stroke 2003; 34: 1699–703.
32. Отчет о результатах исследования CNDN-01 «Открытое, рандомизированное, перекрестное исследование сравнительной фармакокинетики и биоэквивалентности препаратов Гипосарт, таблетки 32 мг, Фармацевтический завод «Польфарма» АО (Польша), и Атаканд®, таблетки 32 мг, «АстраЗенека АБ» (Швеция), с участием здоровых добровольцев». Москва, 2013. / Otchet o rezul'tatakh issledovaniia CNDN-01 «Otkrytoe, randomizirovannoe, perekrestnoe issledovanie sravnitel'noi farmakokinetiki i biokvivalentnosti preparatov Giposart, tabletki 32 mg, Farmatsevticheskii zavod «Pol'farma» AO (Pol'sha), i Atakand®, tabletki 32 mg, «AstraZeneka AB» (Shvetsiia), s uchastiem zdorovykh dobrovol'tsev». M., 2013. [in Russian]
________________________________________________
1. Giliarevskii S.R. Sovremennye vozmozhnosti blokady renin-angiotenzinovoi sistemy: ostaiutsia li ingibitory angiotenzinprevrashchaiushchego fermenta preparatami pervogo riada? Consilium Medicum. 2010; 12 (5): 18–23. [in Russian]
2. Ostroumova O.D., Khor'kov S.A., Kopchenov I.I. Vozmozhnosti antagonistov retseptorov k angiotenzinu II v organoprotektsii u bol'nykh s arterial'noi gipertoniei. Consilium Medicum. 2009; 11 (5): 29–37. [in Russian]
3. Smirnova E.A., Liferov R.A., Iakushin S.S. Rasprostranennost' i otsenka effektivnosti medikamentoznoi terapii arterial'noi gipertonii v Riazanskoi oblasti. Ros. med.-biol. vestn. im. akad. I.P.Pavlova. 2008; 4: 73–9. [in Russian]
4. Zakharova N.V., Kuz'mina-Krutetskaia S.R. Klinicheskaia farmakologiia sartanov: klass-effekt i farmakodinamicheskie osobennosti preparatov. Systemic Hypertension. 2011; 7 (3): 12–7. [in Russian]
5. Burnier M. Angiotensin II Type 1 Receptor Blockers. Circulation 2001; 103: 904–12.
6. Evdokimova A.G., Lozhkina M.V., Kovalenko E.V. Osobennosti primeneniia kandesartana v klinicheskoi praktike. Consilium Medicum. 2016; 18 (1): 68–73. [in Russian]
7. Ostroumova O.D., Bondarets O.V., Guseva T.F. Preimushchestva kandesartana v lechenii arterial'noi gipertonii. Systemic Hypertension. 2014; 10 (2): 42–6. [in Russian]
8. Klinicheskaia farmakologiia. Pod red. V.G.Kukesa. Izd. 4-e. M.: GEOTAR-Media, 2008; s. 392–6. [in Russian]
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Авторы
Н.В.Добрынина
ГБОУ ВПО Рязанский государственный медицинский университет им. акад. И.П.Павлова. 390026, Россия, Рязань, ул. Высоковольтная, д. 7
lec.roccd@gmail.com
ГБОУ ВПО Рязанский государственный медицинский университет им. акад. И.П.Павлова. 390026, Россия, Рязань, ул. Высоковольтная, д. 7
lec.roccd@gmail.com
________________________________________________
N.V.Dobryninа
I.P.Pavlov Ryazan State Medical University of the Ministry of Health of the Russian Federation. 390026, Russian Federation, Ryazan, ul. Vysokovol'tnaia, d. 9
lec.roccd@gmail.com
I.P.Pavlov Ryazan State Medical University of the Ministry of Health of the Russian Federation. 390026, Russian Federation, Ryazan, ul. Vysokovol'tnaia, d. 9
lec.roccd@gmail.com
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