Кандесартан – один из самых «молодых», но при этом хорошо изученный представитель фармакологической группы сартанов; он обладает выраженным длительным антигипертензивным эффектом, способен уменьшать гипертрофию левого желудочка, защищать от мозгового инсульта, замедлять прогрессирование хронической сердечной недостаточности, предупреждать развитие пароксизмов фибрилляции предсердий, обладая при этом нефропротективными свойствами и благоприятными метаболическими эффектами.
Ключевые слова: ренин-ангиотензин-альдостероновая система, блокаторы рецепторов к ангиотензину II, сартаны, кандесартан, Гипосарт.
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Candesartan is one of the "youngest", but it is a well-studied representative of a pharmacological group of sartans; it has a strong long-term antihypertensive effect, can reduce left ventricular hypertrophy, and protect from stroke, to slow the progression of chronic heart failure, to prevent the development of paroxysms of atrial fibrillation, while possessing simultaneously properties and favorable metabolic effects.
Key words: the renin-angiotensin-aldosterone system, receptor blockers, angiotensin II of, sartans, candesartan, Giposart.
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. / Gilyarevsky SR. Modern possibilities of blockade of the renin-angiotensin system: stay whether ACE inhibitors first-line drugs? Consilium Mediсum. 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 Mediсum. 2009; 11 (5): 29–37. / Ostroumova OD, Khorkov SA, Kopchenov II. Features receptor antagonists of angiotensin II in the organo in patients with hypertension. Consilium Mediсum. 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. академика И.П.Павлова 2008; 4: 73–79. / Smirnova E.A., Liferov R.A., Iakushin S.S. Rasprostranennost i otsenka effektivnosti medikamentoznoi terapii arterialnoi gipertonii v Riazanskoi oblasti. Ros. med.-biol. vestn. im. akademika I.P.Pavlova 2008; 4: 73–79. [in Russian]
4. Захарова Н.В., Кузьмина-Крутецкая С.Р. Клиническая фармакология сартанов: класс-эффект и фармакодинамические особенности препаратов. Системные гипертензии. 2011; 8 (3): 12–7. / Zakharova NV, Kuzmina-Krutetskayaа SR. Clinical pharmacology sartans: their class-effect and pharmacodynamics features. Systemic Hypertension. 2011; 8 (3): 12–7. [in Russian]
5. Добрынина Н.В. Что мы знаем о кандесартане: возможности клинического применения. Consilium Mediсum. 2016; 5: 67–9. / Dobrynina N. What do we know about candesartane: clinical applications. Consilium Mediсum. 2016; 5: 67–9. [in Russian]
6. Abrahamsson Т, Karp L, Brabdl-Eliasson II el al. Candesartan causes long-last antagonism of angiotensin II receptor-mediated contractile effects in isolated vascular preparations: a comparison with irbesartan, losartan and its active metabolite (EXP-3174). Blood Pressure 2000; 9: 1–52.
7. Burnier M. Angiotensin II Type 1 Receptor Blockers. Circulation 2001; 103: 904–12.
8. Евдокимова А.Г., Ложкина М.В., Коваленко Е.В. Особенности применения кандесартана в клинической практике. Consilium Mediсum. 2016; 18 (1): 68–73. / Evdokimova AG, Lozhkina MV, Kovalenko EV. Key features of candesartan application in clinical practice. Consilium Mediсum. 2016; 18 (1): 68–73. [in Russian]
9. Остроумова О.Д., Бондарец О.В., Гусева Т.Ф. Преимущества кандесартана в лечении артериальной гипертонии. Системные гипертензии. 2014; 11 (2): 42–6. / Ostroumova OD, Bondarec OV, Guseva TF. The benefits of candesartan usage in the treatment of arterial hypertension. Systemic Hypertension. 2014; 11 (2): 42–6. [in Russian]
10. Клиническая фармакология. Под ред. В.Г.Кукеса. 4-е изд. М.: ГЭОТАР-Медиа, 2008: с. 392–6. / Klinicheskaia farmakologiia. Pod red. V.G.Kukesa. 4-e izd. M.: GEOTAR-Media, 2008: s. 392–6. [in Russian]
11. Морозова Т.Е. Сартаны в лечении больных артериальной гипертензией высокого риска: возможности кандесартана. Системные гипертензии. 2013; 10 (2): 34–9. / Morozova TE. Sartans in the treatment of patients with arterial hypertension at high risk: the possibility of candesartan. Systemic Hypertension. 2013; 10 (2): 34–9. [in Russian]
12. 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]
13. Israili ZH. Clinical of angiotensin II (AT I) receptor blockers in hypertension. J Hum Hypertens 2000; 14 (Suppl. 1): 73–86.
14. Oparll S. Newly emerging pharmacologic differences in angiotensin II receptor blockers. Am J Hypertens 2000; 13 (1 pt 2): 188–248.
15. 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.
16. Van Liefde, Vauquelin G. Sartan AT receptorinteractions: evidence for insurmountable antagonism and inverse agonism. Mol Cell Endocrinol 2009; 302 (2): 237.
17. Кравченко Е.В. Врачу-практику: место кандесартана (Кандесартан – НАН) в современной терапии артериальной гипертензии. Cardiology in Belarus 2016; 8 (2): 286–95. / Kravchenko E.V. Vrachu-praktiku: mesto kandesartana (Kandesartan – NAN) v sovremennoi terapii arterial'noi gipertenzii. Cardiology in Belarus 2016; 8 (2): 286–95.
[in Russian]
18. Minatogucbi S, Aoyama T, Kawai N et al. Comparative effect candesartan and amlodipine, and effect of switching from valsartan, losartan, telmisartan and olmesartan to candesartan, on early morning hypertension and beart rate. Blood Press 2013; 22.
19. 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.
20. 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]
21. Zheng Z, Shi H, Jia J. A systematic review and meta-analysis of candesartan and losartan in the management of essential hypertension. Journal of the Renin-Angiotensin-Aldosterone System 2011; 12 (3): 365–74.
22. 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.
23. Easthope SE, Jarvis B. Candesartan cilexetil in update of its use in essential hypertension. Drugs 2002; 62: 1253–87.
24. 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.
25. 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.
26. Hasegawa H, Takano H, Kameda E et al. Effect of swiching from telmisartan, valsartan, olmesartan or losartan, to candesartan on morning hypertension. Clin Exp Hypertens 2012; 34 (2): 86–91.
27. 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.
28. 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.
29. 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.
30. Недогода С.В., Саласюк А.С., Барыкина И.М. и др. Особенности антигипертензивной терапии. Мед. совет. 2014; 17: 42–9. / Nedogoda S.V., Salasiuk A.S., Barykina I.M. i dr. Osobennosti antigipertenzivnoi terapii. Med. sovet. 2014; 17: 42–9. [in Russian]
31. 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.
32. De Rosa MJ. Angiotensin II receptor blockers and cardioprotection. Vasc Health Risk Manag 2010; 6: 1047–63.
33. 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.
34. Yusuf S, Pfeffer MA, Swedberg K et al. for the CHARM Investigators and Committees. Effects of candesartan in patients with chronic heart failure and preserved leftventricular ejection fraction: the CHARM-Preserved Trial. Lancet 2003; 362: 777–81.
35. Щулькин А.В., Филимонова А.А., Трунина Т.П. Фармакотерапия артериальной гипертензии у пациентов на гемодиализе. Наука молодых. 2016; 3: 28–34. / Shchul'kin A.V., Filimonova A.A., Trunina T.P. Farmakoterapiia arterial'noi gipertenzii u patsientov na gemodialize. Nauka molodykh. 2016; 3: 28–34. [in Russian]
36. Бубнова М.Г. Прикладные аспекты клинического применения. Мед. совет. 2014; 12: 70–8. / Bubnova M.G. Prikladnye aspekty klinicheskogo primeneniia. Med. sovet. 2014; 12: 70–8. [in Russian]
37. 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.
38. 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.
39. Kasanuki H, Hagiwara N, Hosoda S et al. Angiotensin II receptor blocker-based vs. non-angiotensin II receptor blocker-based 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 (10): 1203–12.
40. 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.
41. Гиляревский С.Р., Голшмид М.В., Кузьмина И.М. и др. «Новейшая история» лекарственной терапии больных артериальной гипертонией: только ли антигипертензивная терапия? Consilium Mediсum. 2016; 8 (5): 36–42. / Gilyarevskyi RS, Goldshmid MV, Kuzmina IM et al. «The recent history» of drug therapy of patients with arterial hypertension: is it only antihypertensive therapy? Consilium Mediсum. 2016; 18 (5): 36–42. [in Russian]
42. Отчет о клиническом исследовании 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. М., 2013. / Otchet o klinicheskom issledovanii CNDN-01. Otkrytoe, randomizirovannoe, perekrestnoe issledovanie sravnitel'noi farmakokinetiki i bioekvivalentnosti 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. Gilyarevsky SR. Modern possibilities of blockade of the renin-angiotensin system: stay whether ACE inhibitors first-line drugs? Consilium Mediсum. 2010; 12 (5): 18–23. [in Russian]
2. Ostroumova OD, Khorkov SA, Kopchenov II. Features receptor antagonists of angiotensin II in the organo in patients with hypertension. Consilium Mediсum. 2009; 11 (5): 29–37. [in Russian]
3. Smirnova E.A., Liferov R.A., Iakushin S.S. Rasprostranennost i otsenka effektivnosti medikamentoznoi terapii arterialnoi gipertonii v Riazanskoi oblasti. Ros. med.-biol. vestn. im. akademika I.P.Pavlova 2008; 4: 73–79. [in Russian]
4. Zakharova NV, Kuzmina-Krutetskayaа SR. Clinical pharmacology sartans: their class-effect and pharmacodynamics features. Systemic Hypertension. 2011; 8 (3): 12–7. [in Russian]
5. Dobrynina N. What do we know about candesartane: clinical applications. Consilium Mediсum. 2016; 5: 67–9. [in Russian]
6. Abrahamsson Т, Karp L, Brabdl-Eliasson II el al. Candesartan causes long-last antagonism of angiotensin II receptor-mediated contractile effects in isolated vascular preparations: a comparison with irbesartan, losartan and its active metabolite (EXP-3174). Blood Pressure 2000; 9: 1–52.
7. Burnier M. Angiotensin II Type 1 Receptor Blockers. Circulation 2001; 103: 904–12.
8. Evdokimova AG, Lozhkina MV, Kovalenko EV. Key features of candesartan application in clinical practice. Consilium Mediсum. 2016; 18 (1): 68–73. [in Russian]
9. Ostroumova OD, Bondarec OV, Guseva TF. The benefits of candesartan usage in the treatment of arterial hypertension. Systemic Hypertension. 2014; 11 (2): 42–6. [in Russian]
10. Klinicheskaia farmakologiia. Pod red. V.G.Kukesa. 4-e izd. M.: GEOTAR-Media, 2008: s. 392–6. [in Russian]
11. Morozova TE. Sartans in the treatment of patients with arterial hypertension at high risk: the possibility of candesartan. Systemic Hypertension. 2013; 10 (2): 34–9. [in Russian]
12. 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]
13. Israili ZH. Clinical of angiotensin II (AT I) receptor blockers in hypertension. J Hum Hypertens 2000; 14 (Suppl. 1): 73–86.
14. Oparll S. Newly emerging pharmacologic differences in angiotensin II receptor blockers. Am J Hypertens 2000; 13 (1 pt 2): 188–248.
15. 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.
16. Van Liefde, Vauquelin G. Sartan AT receptorinteractions: evidence for insurmountable antagonism and inverse agonism. Mol Cell Endocrinol 2009; 302 (2): 237.
17. Kravchenko E.V. Vrachu-praktiku: mesto kandesartana (Kandesartan – NAN) v sovremennoi terapii arterial'noi gipertenzii. Cardiology in Belarus 2016; 8 (2): 286–95.
[in Russian]
18. Minatogucbi S, Aoyama T, Kawai N et al. Comparative effect candesartan and amlodipine, and effect of switching from valsartan, losartan, telmisartan and olmesartan to candesartan, on early morning hypertension and beart rate. Blood Press 2013; 22.
19. 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.
20. 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]
21. Zheng Z, Shi H, Jia J. A systematic review and meta-analysis of candesartan and losartan in the management of essential hypertension. Journal of the Renin-Angiotensin-Aldosterone System 2011; 12 (3): 365–74.
22. 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.
23. Easthope SE, Jarvis B. Candesartan cilexetil in update of its use in essential hypertension. Drugs 2002; 62: 1253–87.
24. 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.
25. 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.
26. Hasegawa H, Takano H, Kameda E et al. Effect of swiching from telmisartan, valsartan, olmesartan or losartan, to candesartan on morning hypertension. Clin Exp Hypertens 2012; 34 (2): 86–91.
27. 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.
28. 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.
29. 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.
30. Nedogoda S.V., Salasiuk A.S., Barykina I.M. i dr. Osobennosti antigipertenzivnoi terapii. Med. sovet. 2014; 17: 42–9. [in Russian]
31. 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.
32. De Rosa MJ. Angiotensin II receptor blockers and cardioprotection. Vasc Health Risk Manag 2010; 6: 1047–63.
33. 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.
34. Yusuf S, Pfeffer MA, Swedberg K et al. for the CHARM Investigators and Committees. Effects of candesartan in patients with chronic heart failure and preserved leftventricular ejection fraction: the CHARM-Preserved Trial. Lancet 2003; 362: 777–81.
35. Shchul'kin A.V., Filimonova A.A., Trunina T.P. Farmakoterapiia arterial'noi gipertenzii u patsientov na gemodialize. Nauka molodykh. 2016; 3: 28–34. [in Russian]
36. Bubnova M.G. Prikladnye aspekty klinicheskogo primeneniia. Med. sovet. 2014; 12: 70–8. [in Russian]
37. 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.
38. 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.
39. Kasanuki H, Hagiwara N, Hosoda S et al. Angiotensin II receptor blocker-based vs. non-angiotensin II receptor blocker-based 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 (10): 1203–12.
40. 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.
41.Gilyarevskyi RS, Goldshmid MV, Kuzmina IM et al. «The recent history» of drug therapy of patients with arterial hypertension: is it only antihypertensive therapy? Consilium Mediсum. 2016; 18 (5): 36–42. [in Russian]
42. Otchet o klinicheskom issledovanii CNDN-01. Otkrytoe, randomizirovannoe, perekrestnoe issledovanie sravnitel'noi farmakokinetiki i bioekvivalentnosti 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]
Авторы
Н.В.Добрынина
ФГБОУ ВО «Рязанский государственный медицинский университет им. акад. И.П.Павлова» Минздрава России. 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, Riazan', ul. Vysokovol'tnaia, d. 7 lec.roccd@gmail.com