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Возрастные аспекты острого инфаркта миокарда
Возрастные аспекты острого инфаркта миокарда
Хоролец Е.В., Шлык С.В., Бычкова О.И. Возрастные аспекты острого инфаркта миокарда. Consilium Medicum. 2019; 21 (1): 31–35. DOI: 10.26442/20751753.2019.1.180087
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Аннотация
Цель. Изучить клинико-лабораторные особенности пациентов c острым инфарктом миокарда с подъемом сегмента ST (ОИМпST) в зависимости от возраста.
Материалы и методы. Включены 150 человек с диагнозом ОИМпST в 1-е сутки заболевания. Изучались клинические, лабораторные особенности пациентов. В динамике стационарного лечения при госпитализации (визит 1) и выписке (визит 2) оценивали показатели N-терминального промозгового натрийуретического пептида (NTproBNP) и ростового фактора дифференцировки 15 (GFD-15).
Результаты. Средний возраст пациентов с ОИМпST составил 61,7±2,9 года. Изложены возрастные клинико-лабораторные особенности течения ОИМпST. При сопоставимых гемодинамических данных маркеров некроза миокарда у пациентов с ОИМпST с возрастом выявлено статистически значимое увеличение уровня NTproBNP и GFD-15. Увеличение уровня GDF-15 у пациентов старше 60 лет более 1200 нг/мл отождествляется с высоким риском повторного инфаркта миокарда. В динамике стационарного лечения больных с ОИМпST до 75 лет выявлено снижение лабораторных показателей NTproBNP и GFD-15. Показатель NTproBNP имеет положительную корреляцию с функциональным классом хронической сердечной недостаточности (r=0,20; р<0,04), шкалой GRACE (r=0,38; р<0,001), отражая неблагоприятный прогноз больных с ОИМпST.
Выводы. На госпитальном этапе лечения больных с ОИМпST отмечены снижение уровня NTproBNP и GFD-15 у лиц до 75 лет, увеличение данных показателей у пациентов старше 75 лет, что определяет наиболее неблагоприятный прогноз.
Ключевые слова: острый инфаркт миокарда, сердечная недостаточность, возраст.
Материалы и методы. Включены 150 человек с диагнозом ОИМпST в 1-е сутки заболевания. Изучались клинические, лабораторные особенности пациентов. В динамике стационарного лечения при госпитализации (визит 1) и выписке (визит 2) оценивали показатели N-терминального промозгового натрийуретического пептида (NTproBNP) и ростового фактора дифференцировки 15 (GFD-15).
Результаты. Средний возраст пациентов с ОИМпST составил 61,7±2,9 года. Изложены возрастные клинико-лабораторные особенности течения ОИМпST. При сопоставимых гемодинамических данных маркеров некроза миокарда у пациентов с ОИМпST с возрастом выявлено статистически значимое увеличение уровня NTproBNP и GFD-15. Увеличение уровня GDF-15 у пациентов старше 60 лет более 1200 нг/мл отождествляется с высоким риском повторного инфаркта миокарда. В динамике стационарного лечения больных с ОИМпST до 75 лет выявлено снижение лабораторных показателей NTproBNP и GFD-15. Показатель NTproBNP имеет положительную корреляцию с функциональным классом хронической сердечной недостаточности (r=0,20; р<0,04), шкалой GRACE (r=0,38; р<0,001), отражая неблагоприятный прогноз больных с ОИМпST.
Выводы. На госпитальном этапе лечения больных с ОИМпST отмечены снижение уровня NTproBNP и GFD-15 у лиц до 75 лет, увеличение данных показателей у пациентов старше 75 лет, что определяет наиболее неблагоприятный прогноз.
Ключевые слова: острый инфаркт миокарда, сердечная недостаточность, возраст.
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Aim. To study the clinical and laboratory features of patients with acute myocardial infarction with ST segment elevation (STEMI) depending on age.
Materials and methods. Included 150 people diagnosed with STEMI in the first day of the disease. Clinical, laboratory features of patients were studied. In the dynamics of inpatient treatment, with hospitalization (visit 1) and discharge (visit 2), indicators of the N-terminal prostatic natriuretic peptide (NTproBNP) and growth differentiation factor 15 (GFD-15) were evaluated.
Results. The average age of patients with STEMI was 61.7±2.9 years. The age-related clinical and laboratory features of the course of STEMI are described. With comparable hemodynamic data, markers of myocardial necrosis in patients with STEMI with age, a statistically significant increase in the level of NTproBNP and GFD-15 was detected. An increase in GDF-15 levels in patients over 60 years old >1200 ng/ml identifies a high risk of recurrent myocardial infarction. In the dynamics of inpatient treatment of patients with STEMI up to 75 years, a decrease in laboratory parameters NTproBNP and GFD-15 was revealed. The NTproBNP indicator has a positive correlation with the functional class of chronic heart failure (r=0.20, p<0.04), the GRACE scale (r=0.38, p<0.001), reflecting the unfavorable prognosis of patients with STEMI.
Conclusions. At the hospital stage of treatment of patients with STEMI at the hospital stage of treatment, there was a decrease in the level of NTproBNP and GFD-15 in patients under 75 years of age, an increase in these indicators in patients over 75 years of age, which determines the most unfavorable prognosis.
Key words: acute myocardial infarction, heart failure, age.
Materials and methods. Included 150 people diagnosed with STEMI in the first day of the disease. Clinical, laboratory features of patients were studied. In the dynamics of inpatient treatment, with hospitalization (visit 1) and discharge (visit 2), indicators of the N-terminal prostatic natriuretic peptide (NTproBNP) and growth differentiation factor 15 (GFD-15) were evaluated.
Results. The average age of patients with STEMI was 61.7±2.9 years. The age-related clinical and laboratory features of the course of STEMI are described. With comparable hemodynamic data, markers of myocardial necrosis in patients with STEMI with age, a statistically significant increase in the level of NTproBNP and GFD-15 was detected. An increase in GDF-15 levels in patients over 60 years old >1200 ng/ml identifies a high risk of recurrent myocardial infarction. In the dynamics of inpatient treatment of patients with STEMI up to 75 years, a decrease in laboratory parameters NTproBNP and GFD-15 was revealed. The NTproBNP indicator has a positive correlation with the functional class of chronic heart failure (r=0.20, p<0.04), the GRACE scale (r=0.38, p<0.001), reflecting the unfavorable prognosis of patients with STEMI.
Conclusions. At the hospital stage of treatment of patients with STEMI at the hospital stage of treatment, there was a decrease in the level of NTproBNP and GFD-15 in patients under 75 years of age, an increase in these indicators in patients over 75 years of age, which determines the most unfavorable prognosis.
Key words: acute myocardial infarction, heart failure, age.
Полный текст
Список литературы
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12. Bonaca MP, Morrow DA, Braunwald E et al. Growth Differentiation Factor-15 And Risk Of Recurrent Events In Patients Stabilized After Acute Coronary Syndrome: Observations From PROVE IT-TIMI 22. Arterioscler Thromb Vasc Biol 2011; 31 (1): 203–10. DOI: 10.1161/atvbaha.110.213512
13. Kempf T, Sinning JM, Quint A et al. Growth differentiation factor-15 for risk stratification in patients with stable and unstable coronary heart disease: results from the AtheroGene study. Circ Cardiovasc Genet 2009; 2 (3): 286–92. DOI: 10.1161/circgenetics.108.824870
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[Balliuzek M.F., Grinenko T.N., Kvetnoi I.M. Gormony serdtsa v formirovanii serdechno-sosudistoi patologii. Klin. meditsina. 2005; 11: 4–12 (in Russian).]
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[Bugrimova M.A., Savina N.M., Vanieva O.S. et al. Mozgovoi natriiureticheskii peptid kak marker i faktor prognoza pri khronicheskoi serdechnoi nedostatochnosti. Kardiologiia. 2006; 1: 51–7 (in Russian).]
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17. Januzzi JL. Natriuretic peptide testing: A window into the diagnosis and prognosis of heart failure. Cleveland Clin J Med 2006; 73: 149–57.
18. Januzzi JL, Camargo CA, Anwaruddins S et al. The N-Terminal Pro-BNP Investigation of Dyspnea in the Emergency Department (PRIDE) Study. Am J Card 2005; 95: 948–54.
19. James SK, Lindahl B, Siegbahn A et al. N-terminal pro-brain natriuretic peptide and other risk markers for the separate prediction of mortality and subsequent myocardial infarction in patients with unstable coronary artery disease: a Global Utilization of Strategies To Open occluded arteries (GUSTO)-IV substudy. Circulation 2003; 108 (3): 275–81.
20. Remme WJ, Swedberg K. European Society of Cardiology. Comprehensive guidelines for the diagnosis and treatment of chronic heart failure. Task force for the diagnosis and treatment of chronic heart failure of the European Society of Cardiology. Eur J Heart Fail 2002; 1: 11–22.
21. Galasko GI, Lahiri A, Barnes SC et al. What is the normal range for N-terminal pro-brain natriuretic peptide? How well does this normal range screen for cardiovascular disease? Eur Heart J 2005; 26 (21): 2269–76.
22. Komajda M, Lam CS. Heart failure with preserved ejection fraction: a clinical dilemma. Eur Heart J 2014; 35 (16): 1022–32.
23. Van Veldhuisen DJ, Linssen GC, Jaarsma T et al. B-type natriuretic peptide and prognosis in heart failure patients with preserved and reduced ejection fraction. J Am Coll Cardiol 2013; 61 (14): 1498–506.
24. Schlittenhardt D, Schober A, Strelau J et al. Involvement of Growth Differentiation Factor-15. Macrophage Inhibitory Cytokine 1 (GDF-15/MIC-1) in oxLDL-induced Apoptosis of Human Macrophages in vitro and in Arteriosclerotic Lesions. Cell Tissue Res 2004; 318 (2): 325–34.
[Chazov E.I. Puti snizheniia smertnosti ot serdechno-sosudistykh zabolevanii. Therapeutic archive. 2008; 8: 6–11 (in Russian).]
2. Hjemdahl P, Eriksson SV, Held C et al. Favorable long term prognosis instable angina pectoris: an extended follow up of the angina prognosis study in Stockholm (APSIS). Heart 2006; 92: 177–82.
3. Di Angelantonio E, Chowdhury R, Sarwar N et al. Chronic kidney disease and risk of major cardiovascular disease and non-vascular mortality: prospective population based cohort study. BMJ 2010; 341: 49–86.
4. Wilson PW, Sr.D’Agostino R, Bhatt DL et al. An international model to predict recurrent cardiovascular disease. Am J Med 2012; 125: 695–703.
5. Zucker IH, Xiao L, Haack KK. The central renin-angiotensin system and sympathetic nerve activity in chronic heart failure. Clin Sci (Lond) 2014; 126 (10): 695–706.
6. Troughton R, Michael Felker G, Januzzi JLJr. Natriuretic peptide-guided heart failure management. Eur Heart J 2014; 35 (1): 16–24.
7. Argmann CA, Van Den Diepstraten CH, Sawyez CG et al. Transforming growth factor-beta 1 inhibits macrophage cholesterol ester accumulation induced by native and oxidized VLDL remnants. Arterioscler Thromb Vasc Biol 2001; 21 (12): 2011–8.
8. Kleczyński P, Legutko J, Rakowski T et al. Predictive utility of NT-pro BNP for infarct size and left ventricle function after acute myocardial infarction in long-term follow-up. Dis Markers 2013; 34 (3): 199–204.
9. Голухова Е.З., Теряева Н.Б., Алиева А.М. Натрийуретические пептиды – маркеры и факторы прогноза при хронической сердечной недостаточности. Креативная кардиология. 2007; 1–2: 126–36.
[Golukhova E.Z., Teriaeva N.B., Alieva A.M. Natriiureticheskie peptidy – markery i faktory prognoza pri khronicheskoi serdechnoi nedostatochnosti. Kreativnaia kardiologiia 2007; 1–2: 126–36 (in Russian).]
10. Kempf T, Zarbock A, Widera C et al. GDF-15 is an inhibitor of leukocyte integrin activation required for survival after myocardial infarction in mice. Nature Medicine 2011; 17 (5): 581–8. DOI: 10.1038/nm.2354
11. Xu J. GDF15/MIC-1 functions as a protective and antihypertrophic factor released from the myocardium in association with SMAD protein activation. Circulation Res 2006; 98 (3): 342–50. DOI: 10.1161/01.res.0000202804.84885.d0
12. Bonaca MP, Morrow DA, Braunwald E et al. Growth Differentiation Factor-15 And Risk Of Recurrent Events In Patients Stabilized After Acute Coronary Syndrome: Observations From PROVE IT-TIMI 22. Arterioscler Thromb Vasc Biol 2011; 31 (1): 203–10. DOI: 10.1161/atvbaha.110.213512
13. Kempf T, Sinning JM, Quint A et al. Growth differentiation factor-15 for risk stratification in patients with stable and unstable coronary heart disease: results from the AtheroGene study. Circ Cardiovasc Genet 2009; 2 (3): 286–92. DOI: 10.1161/circgenetics.108.824870
14. Баллюзек М.Ф., Гриненко Т.Н., Кветной И.М. Гормоны сердца в формировании сердечно-сосудистой патологии. Клин. медицина. 2005; 11: 4–12.
[Balliuzek M.F., Grinenko T.N., Kvetnoi I.M. Gormony serdtsa v formirovanii serdechno-sosudistoi patologii. Klin. meditsina. 2005; 11: 4–12 (in Russian).]
15. Бугримова М.А., Савина Н.М., Ваниева О.С. и др. Мозговой натрийуретический пептид как маркер и фактор прогноза при хронической сердечной недостаточности. Кардиология. 2006; 1: 51–7.
[Bugrimova M.A., Savina N.M., Vanieva O.S. et al. Mozgovoi natriiureticheskii peptid kak marker i faktor prognoza pri khronicheskoi serdechnoi nedostatochnosti. Kardiologiia. 2006; 1: 51–7 (in Russian).]
16. Kikuta K, Yasue H, Yoshimura M et al. Increased plasma levels of B-type natriuretic peptide in patients with unstable angina. Am Heart J 1996; 132 (1; Pt. 1): 101–7.
17. Januzzi JL. Natriuretic peptide testing: A window into the diagnosis and prognosis of heart failure. Cleveland Clin J Med 2006; 73: 149–57.
18. Januzzi JL, Camargo CA, Anwaruddins S et al. The N-Terminal Pro-BNP Investigation of Dyspnea in the Emergency Department (PRIDE) Study. Am J Card 2005; 95: 948–54.
19. James SK, Lindahl B, Siegbahn A et al. N-terminal pro-brain natriuretic peptide and other risk markers for the separate prediction of mortality and subsequent myocardial infarction in patients with unstable coronary artery disease: a Global Utilization of Strategies To Open occluded arteries (GUSTO)-IV substudy. Circulation 2003; 108 (3): 275–81.
20. Remme WJ, Swedberg K. European Society of Cardiology. Comprehensive guidelines for the diagnosis and treatment of chronic heart failure. Task force for the diagnosis and treatment of chronic heart failure of the European Society of Cardiology. Eur J Heart Fail 2002; 1: 11–22.
21. Galasko GI, Lahiri A, Barnes SC et al. What is the normal range for N-terminal pro-brain natriuretic peptide? How well does this normal range screen for cardiovascular disease? Eur Heart J 2005; 26 (21): 2269–76.
22. Komajda M, Lam CS. Heart failure with preserved ejection fraction: a clinical dilemma. Eur Heart J 2014; 35 (16): 1022–32.
23. Van Veldhuisen DJ, Linssen GC, Jaarsma T et al. B-type natriuretic peptide and prognosis in heart failure patients with preserved and reduced ejection fraction. J Am Coll Cardiol 2013; 61 (14): 1498–506.
24. Schlittenhardt D, Schober A, Strelau J et al. Involvement of Growth Differentiation Factor-15. Macrophage Inhibitory Cytokine 1 (GDF-15/MIC-1) in oxLDL-induced Apoptosis of Human Macrophages in vitro and in Arteriosclerotic Lesions. Cell Tissue Res 2004; 318 (2): 325–34.
________________________________________________
1. Chazov E.I. Puti snizheniia smertnosti ot serdechno-sosudistykh zabolevanii. Therapeutic archive. 2008; 8: 6–11 (in Russian).
2. Hjemdahl P, Eriksson SV, Held C et al. Favorable long term prognosis instable angina pectoris: an extended follow up of the angina prognosis study in Stockholm (APSIS). Heart 2006; 92: 177–82.
3. Di Angelantonio E, Chowdhury R, Sarwar N et al. Chronic kidney disease and risk of major cardiovascular disease and non-vascular mortality: prospective population based cohort study. BMJ 2010; 341: 49–86.
4. Wilson PW, Sr.D’Agostino R, Bhatt DL et al. An international model to predict recurrent cardiovascular disease. Am J Med 2012; 125: 695–703.
5. Zucker IH, Xiao L, Haack KK. The central renin-angiotensin system and sympathetic nerve activity in chronic heart failure. Clin Sci (Lond) 2014; 126 (10): 695–706.
6. Troughton R, Michael Felker G, Januzzi JLJr. Natriuretic peptide-guided heart failure management. Eur Heart J 2014; 35 (1): 16–24.
7. Argmann CA, Van Den Diepstraten CH, Sawyez CG et al. Transforming growth factor-beta 1 inhibits macrophage cholesterol ester accumulation induced by native and oxidized VLDL remnants. Arterioscler Thromb Vasc Biol 2001; 21 (12): 2011–8.
8. Kleczyński P, Legutko J, Rakowski T et al. Predictive utility of NT-pro BNP for infarct size and left ventricle function after acute myocardial infarction in long-term follow-up. Dis Markers 2013; 34 (3): 199–204.
9. Golukhova E.Z., Teriaeva N.B., Alieva A.M. Natriiureticheskie peptidy – markery i faktory prognoza pri khronicheskoi serdechnoi nedostatochnosti. Kreativnaia kardiologiia 2007; 1–2: 126–36 (in Russian).
10. Kempf T, Zarbock A, Widera C et al. GDF-15 is an inhibitor of leukocyte integrin activation required for survival after myocardial infarction in mice. Nature Medicine 2011; 17 (5): 581–8. DOI: 10.1038/nm.2354
11. Xu J. GDF15/MIC-1 functions as a protective and antihypertrophic factor released from the myocardium in association with SMAD protein activation. Circulation Res 2006; 98 (3): 342–50. DOI: 10.1161/01.res.0000202804.84885.d0
12. Bonaca MP, Morrow DA, Braunwald E et al. Growth Differentiation Factor-15 And Risk Of Recurrent Events In Patients Stabilized After Acute Coronary Syndrome: Observations From PROVE IT-TIMI 22. Arterioscler Thromb Vasc Biol 2011; 31 (1): 203–10. DOI: 10.1161/atvbaha.110.213512
13. Kempf T, Sinning JM, Quint A et al. Growth differentiation factor-15 for risk stratification in patients with stable and unstable coronary heart disease: results from the AtheroGene study. Circ Cardiovasc Genet 2009; 2 (3): 286–92. DOI: 10.1161/circgenetics.108.824870
14. Balliuzek M.F., Grinenko T.N., Kvetnoi I.M. Gormony serdtsa v formirovanii serdechno-sosudistoi patologii. Klin. meditsina. 2005; 11: 4–12 (in Russian).
15. Bugrimova M.A., Savina N.M., Vanieva O.S. et al. Mozgovoi natriiureticheskii peptid kak marker i faktor prognoza pri khronicheskoi serdechnoi nedostatochnosti. Kardiologiia. 2006; 1: 51–7 (in Russian).
16. Kikuta K, Yasue H, Yoshimura M et al. Increased plasma levels of B-type natriuretic peptide in patients with unstable angina. Am Heart J 1996; 132 (1; Pt. 1): 101–7.
17. Januzzi JL. Natriuretic peptide testing: A window into the diagnosis and prognosis of heart failure. Cleveland Clin J Med 2006; 73: 149–57.
18. Januzzi JL, Camargo CA, Anwaruddins S et al. The N-Terminal Pro-BNP Investigation of Dyspnea in the Emergency Department (PRIDE) Study. Am J Card 2005; 95: 948–54.
19. James SK, Lindahl B, Siegbahn A et al. N-terminal pro-brain natriuretic peptide and other risk markers for the separate prediction of mortality and subsequent myocardial infarction in patients with unstable coronary artery disease: a Global Utilization of Strategies To Open occluded arteries (GUSTO)-IV substudy. Circulation 2003; 108 (3): 275–81.
20. Remme WJ, Swedberg K. European Society of Cardiology. Comprehensive guidelines for the diagnosis and treatment of chronic heart failure. Task force for the diagnosis and treatment of chronic heart failure of the European Society of Cardiology. Eur J Heart Fail 2002; 1: 11–22.
21. Galasko GI, Lahiri A, Barnes SC et al. What is the normal range for N-terminal pro-brain natriuretic peptide? How well does this normal range screen for cardiovascular disease? Eur Heart J 2005; 26 (21): 2269–76.
22. Komajda M, Lam CS. Heart failure with preserved ejection fraction: a clinical dilemma. Eur Heart J 2014; 35 (16): 1022–32.
23. Van Veldhuisen DJ, Linssen GC, Jaarsma T et al. B-type natriuretic peptide and prognosis in heart failure patients with preserved and reduced ejection fraction. J Am Coll Cardiol 2013; 61 (14): 1498–506.
24. Schlittenhardt D, Schober A, Strelau J et al. Involvement of Growth Differentiation Factor-15. Macrophage Inhibitory Cytokine 1 (GDF-15/MIC-1) in oxLDL-induced Apoptosis of Human Macrophages in vitro and in Arteriosclerotic Lesions. Cell Tissue Res 2004; 318 (2): 325–34.
2. Hjemdahl P, Eriksson SV, Held C et al. Favorable long term prognosis instable angina pectoris: an extended follow up of the angina prognosis study in Stockholm (APSIS). Heart 2006; 92: 177–82.
3. Di Angelantonio E, Chowdhury R, Sarwar N et al. Chronic kidney disease and risk of major cardiovascular disease and non-vascular mortality: prospective population based cohort study. BMJ 2010; 341: 49–86.
4. Wilson PW, Sr.D’Agostino R, Bhatt DL et al. An international model to predict recurrent cardiovascular disease. Am J Med 2012; 125: 695–703.
5. Zucker IH, Xiao L, Haack KK. The central renin-angiotensin system and sympathetic nerve activity in chronic heart failure. Clin Sci (Lond) 2014; 126 (10): 695–706.
6. Troughton R, Michael Felker G, Januzzi JLJr. Natriuretic peptide-guided heart failure management. Eur Heart J 2014; 35 (1): 16–24.
7. Argmann CA, Van Den Diepstraten CH, Sawyez CG et al. Transforming growth factor-beta 1 inhibits macrophage cholesterol ester accumulation induced by native and oxidized VLDL remnants. Arterioscler Thromb Vasc Biol 2001; 21 (12): 2011–8.
8. Kleczyński P, Legutko J, Rakowski T et al. Predictive utility of NT-pro BNP for infarct size and left ventricle function after acute myocardial infarction in long-term follow-up. Dis Markers 2013; 34 (3): 199–204.
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Авторы
Е.В.Хоролец*1, С.В.Шлык1, О.И.Бычкова1,2
1 ФГБОУ ВО «Ростовский государственный медицинский университет» Минздрава России. 344022, Россия, Ростов-на-Дону, пер. Нахичеванский, д. 29;
2 Управление федеральной службы безопасности Российской Федерации по Волгоградской области. 400131, Россия, Волгоград, ул. Краснознаменская, д. 171 ФГБОУ ВО «Ростовский государственный медицинский университет» Минздрава России. 344022, Россия, Ростов-на-Дону, пер. Нахичеванский, д. 29;
*kata_maran@mail.ru
________________________________________________
Ekaterina V. Khorolets*1, Sergey V. Shlyk1, Olga I. Bychkova1,2
1 Rostov State Medical University of the Ministry of Health of the Russian Federation. 29, per. Nakhichevanskii, Rostov-on-Don, 344022, Russian Federation;
2 Department of the Federal Security Service in the Volgograd region. 17, Krasnoznamenskaia st., Volgograd, 400131, Russian Federation1 Rostov State Medical University of the Ministry of Health of the Russian Federation. 29, per. Nakhichevanskii, Rostov-on-Don, 344022, Russian Federation;
*kata_maran@mail.ru
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