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Хроническая болезнь почек: риски для матери и плода (обзор литературы)
Хроническая болезнь почек: риски для матери и плода (обзор литературы)
Купина А.Д., Петров Ю.А. Хроническая болезнь почек: риски для матери и плода (обзор литературы). Consilium Medicum. 2021; 23 (7): 558–562. DOI: 10.26442/20751753.2021.7.200944
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Аннотация
В статье представлен обзор современной отечественной и зарубежной научной литературы. Описаны статистические данные хронической болезни почек у женщин репродуктивного возраста, а также анатомических и физиологических изменений мочевыделительной системы у беременных. Подробно описана роль почечной патологии в патогенезе различных акушерских и перинатальных осложнений. Приведена схема оптимизации лечения данной группы пациенток в период гестации на основе современных исследований и рекомендаций.
Ключевые слова: хроническая болезнь почек, беременность, преэклампсия, артериальная гипертензия, креатинин
Keywords: chronic kidney disease, pregnancy, preeclampsia, arterial hypertension, creatinine
Ключевые слова: хроническая болезнь почек, беременность, преэклампсия, артериальная гипертензия, креатинин
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Keywords: chronic kidney disease, pregnancy, preeclampsia, arterial hypertension, creatinine
Полный текст
Список литературы
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5. Zetterström K, Lindeberg SN, Haglund B, Hanson U. Maternal complications in women with chronic hypertension: a population-based cohort study. Acta Obstet Gynecol Scand. 2005;84:419-24.
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9. Никольская И.Г., Прокопенко Е.И., Новикова С.В., и др. Осложнения и исходы беременности при хронической почечной недостаточности. Альманах клинической медицины. 2015;(37):52-69 [Nikol’skaia IG, Prokopenko EI, Novikova SV, et al. Oslozhneniia i iskhody beremennosti pri khronicheskoi pochechnoi nedostatochnosti. Al’manakh klinicheskoi meditsiny. 2015;(37):52-69 (in Russian)]. DOI:10.18786/2072-0505-2015-37-52-69
10. Никольская И.Г., Новикова С.В., Баринова И.В., и др. Хроническая болезнь почек и беременность: этиология, патогенез, классификация, клиническая картина, перинатальные осложнения. Российский вестник акушера-гинеколога. 2012;12(5):21-30 [Nikol’skaya IG, Novikova SV, Barinova IV, et al. Chronic kidney disease and pregnancy: etiology, pathophysiology, classification, clinical picture and perinatal complications. Rossiyskiy vestnik akushera-ginekologa. 2012;12(5):21-30 (in Russian)].
11. Piccoli GB, Attini R, Cabiddu G, et al. Maternal-foetal outcomes in pregnant women with glomerulonephritides. Are all glomerulonephritides alike in pregnancy? J Autoimmun. 2017;79:91-8. DOI:10.1016/j.jaut.2017.01.008
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15. Lightstone L, Hladunewich MA. Lupus Nephritis and Pregnancy: Concerns and Management. Semin Nephrol. 2017;37:347-53. DOI:10.1016/j.semnephrol.2017.05.006
16. Zhang JJ, Ma XX, Hao L, et al. A systematic review and meta-analysis of outcomes of pregnancy in CKD and CKD outcomes in pregnancy. Clin J Am Soc Nephrol. 2015;10:1964-78.
17. Никольская И.Г., Будыкина Т.С., Бочарова И.И., и др. Бактериурия у беременных с хронической болезнью почек и осложнения в перинатальном периоде. Российский вестник акушера-гинеколога. 2014;14(1):44-50 [Nikol’skaya IG, Budykina TS, Bocharova II, et al. Bacteriuriain pregnant women with chronic kidney disease and complications of the perinatal period. Rossiiskii vestnik akushera-ginekologa. 2014;14(1):44-50 (in Russian)].
18. Blom K, Odutayo A, Bramham K, Hladunewich MA. Pregnancy and Glomerular Disease: A Systematic Review of the Literature with Management Guidelines. Clin J Am Soc Nephrol. 2017;12:1862-72. DOI:10.2215/CJN.00130117
19. Piccoli GB, Fassio F, Attini R, et al. Pregnancy in CKD: whom should we follow and why? Nephrol Dial Transpl. 2012;27(Suppl. 3):iii111-8.
20. Webster P, Lightstone L, McKay DB, Josephson MA. Pregnancy in chronic kidney disease and kidney transplantation. Kidney Int. 2017;91:1047-56. DOI:10.1016/j.kint.2016.10.045
21. Kendrick J, Sharma S, Holmen J, et al. Kidney disease and maternal and fetal outcomes in pregnancy. Am J Kidney Dis. 2015;66:55-9. DOI:10.1053/j.ajkd.2014.11.019
22. Bjornstad P, Cherney DZI. Kidney Function Can Predict Pregnancy Outcomes. Clin J Am Soc Nephrol. 2017;12:102-31. DOI:10.2215/CJN.04970517
23. Jim B, Garovic VD. Acute Kidney Injury in Pregnancy. Semin Nephrol. 2017;37:378-85. DOI:10.1016/j.semnephrol.2017.05.010
24. Yamada T, Obata-Yasuoka M, Hamada H, et al. Isolated gestational proteinuria preceding the diagnosis of preeclampsia – An observational study. Acta Obstet Gynecol Scand. 2016;95:1048-54. DOI:10.1111/aogs.12915
25. Tong A, Jesudason S, Craig JC, Winkelmayer WC. Perspectives on pregnancy in women with chronic kidney disease: Systematic review of qualitative studies. Nephrol Dial Transplant. 2015;30:652-61. DOI:10.1093/ndt/gfu378
26. Shinar S, Asher-Landsberg J, Schwartz A, et al. Isolated proteinuria is a risk factor for pre-eclampsia: A retrospective analysis of the maternal and neonatal outcomes in women presenting with isolated gestational proteinuria. J Perinatol. 2016;36:25-9. DOI:10.1038/jp.2015.138
27. Bramham K, Parnell B, Nelson-Piercy C, et al. Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis. BMJ. 2014;348:g2301.
28. Piccoli GB, Cabiddu G, Attini R, et al. Hypertension in CKD Pregnancy: A Question of Cause and Effect (Cause or Effect? This Is the Question) Curr Hypertens Rep. 2016;18. DOI:10.1007/s11906-016-0644-7
29. De Castro I, Easterling TR, Bansal N, Jefferson JA. Nephrotic syndrome in pregnancy poses risks with both maternal and fetal complications. Kidney Int. 2017;91:1464-72. DOI:10.1016/j.kint.2016.12.019
30. Bramham K, Seed PT, Lightstone L, et al. Diagnostic and predictive biomarkers for pre-eclampsia in patients with established hypertension and chronic kidney disease. Kidney Int. 2016;89:874-85. DOI:10.1016/j.kint.2015.10.012
31. Magee LA, von Dadelszen P, Rey E, et al. Less-tight versus tight control of hypertension in pregnancy. N Engl J Med. 2015;372:407-17.
32. Cabiddu G, Castellino S, Gernone G, et al. A best practice position statement on pregnancy in chronic kidney disease: The Italian Study Group on Kidney and Pregnancy. J Nephrol. 2016;29:277-303. DOI:10.1007/s40620-016-0285-6
33. Петров Ю.А. Здоровье семьи – здоровье нации. 2-е изд. М., 2020 [Petrov IuA. Family health is the health of the nation. 2hd ed. Moscow, 2020 (in Russian)].
34. Rolnik DL, Wright D, Poon LC, et al. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med. 2017;377:613-22.
35. Khaing W, Vallibhakara SA, Tantrakul V, et al. Calcium and vitamin D supplementation for prevention of preeclampsia: a systematic review and network meta-analysis. Nutrients. 2017;9:E1141.
2. Piccoli GB, Alrukhaimi M, Liu ZH, et al.; World Kidney Day Steering Committee. What we do and do not know about women and kidney diseases; questions unanswered and answers unquestioned: reflection on World Kidney Day and International Woman’s Day. Physiol Int. 2018;105:1-18.
3. Piccoli GB, Cabiddu G, Attini R, et al. Risk of Adverse Pregnancy Outcomes in Women with CKD. J Am Soc Nephrol. 2015;26(8):2011-22. DOI:10.1681/ASN.2014050459
4. Piccoli GB, Attini R, Cabiddu G. Kidney diseases and pregnancy: a multidisciplinary approach for improving care by involving nephrology, obstetrics, neonatology, urology, diabetology, bioethics, and internal medicine. J Clin Med. 2018;7:E135.
5. Zetterström K, Lindeberg SN, Haglund B, Hanson U. Maternal complications in women with chronic hypertension: a population-based cohort study. Acta Obstet Gynecol Scand. 2005;84:419-24.
6. Nobles CJ, Mendola P, Mumford SL, et al. Preconception blood pressure levels and reproductive outcomes in a prospective cohort of women attempting pregnancy. Hypertension. 2018;71:904-10.
7. Kozlovskaia NL, Korotchaeva IuV, Dem’ianova KA, et al. Osobennosti vedeniia beremennosti u patsientki s khronicheskoi bolezn’iu pochek 4 stadii. Nefrologiia. 2019;23(2):109-16 (in Russian). DOI:10.24884/1561-6274-2019-23-2-109-116
8. Vialkova AA. Khronicheskaia bolezn’ pochek. Orenburgskii meditsinskii vestnik. 2015;2:42-51 (in Russian).
9. Nikol’skaia IG, Prokopenko EI, Novikova SV, et al. Oslozhneniia i iskhody beremennosti pri khronicheskoi pochechnoi nedostatochnosti. Al’manakh klinicheskoi meditsiny. 2015;(37):52-69 (in Russian). DOI:10.18786/2072-0505-2015-37-52-69
10. Nikol’skaya IG, Novikova SV, Barinova IV, et al. Chronic kidney disease and pregnancy: etiology, pathophysiology, classification, clinical picture and perinatal complications. Rossiyskiy vestnik akushera-ginekologa. 2012;12(5):21-30 (in Russian).
11. Piccoli GB, Attini R, Cabiddu G, et al. Maternal-foetal outcomes in pregnant women with glomerulonephritides. Are all glomerulonephritides alike in pregnancy? J Autoimmun. 2017;79:91-8. DOI:10.1016/j.jaut.2017.01.008
12. Su X, Lv J, Liu Y, et al. Pregnancy and Kidney Outcomes in Patients With IgA Nephropathy: A Cohort Study. Am J Kidney Dis. 2017;70:262-9. DOI:10.1053/j.ajkd.2017.01.043
13. Moroni G, Doria A, Giglio E, et al. Fetal outcome and recommendations of pregnancies in lupus nephritis in the 21st century: a prospective multicenter study. J Autoimmun. 2016;74:6-12.
14. Klemetti MM, Laivuori H, Tikkanen M, et al. Obstetric and perinatal outcome in type 1 diabetes patients with diabetic nephropathy during 1988–2011. Diabetologia. 2015;58:678-86. DOI:10.1007/s00125-014-3488-1
15. Lightstone L, Hladunewich MA. Lupus Nephritis and Pregnancy: Concerns and Management. Semin Nephrol. 2017;37:347-53. DOI:10.1016/j.semnephrol.2017.05.006
16. Zhang JJ, Ma XX, Hao L, et al. A systematic review and meta-analysis of outcomes of pregnancy in CKD and CKD outcomes in pregnancy. Clin J Am Soc Nephrol. 2015;10:1964-78.
17. Nikol’skaya IG, Budykina TS, Bocharova II, et al. Bacteriuriain pregnant women with chronic kidney disease and complications of the perinatal period. Rossiiskii vestnik akushera-ginekologa. 2014;14(1):44-50 (in Russian).
18. Blom K, Odutayo A, Bramham K, Hladunewich MA. Pregnancy and Glomerular Disease: A Systematic Review of the Literature with Management Guidelines. Clin J Am Soc Nephrol. 2017;12:1862-72. DOI:10.2215/CJN.00130117
19. Piccoli GB, Fassio F, Attini R, et al. Pregnancy in CKD: whom should we follow and why? Nephrol Dial Transpl. 2012;27(Suppl. 3):iii111-8.
20. Webster P, Lightstone L, McKay DB, Josephson MA. Pregnancy in chronic kidney disease and kidney transplantation. Kidney Int. 2017;91:1047-56. DOI:10.1016/j.kint.2016.10.045
21. Kendrick J, Sharma S, Holmen J, et al. Kidney disease and maternal and fetal outcomes in pregnancy. Am J Kidney Dis. 2015;66:55-9. DOI:10.1053/j.ajkd.2014.11.019
22. Bjornstad P, Cherney DZI. Kidney Function Can Predict Pregnancy Outcomes. Clin J Am Soc Nephrol. 2017;12:102-31. DOI:10.2215/CJN.04970517
23. Jim B, Garovic VD. Acute Kidney Injury in Pregnancy. Semin Nephrol. 2017;37:378-85. DOI:10.1016/j.semnephrol.2017.05.010
24. Yamada T, Obata-Yasuoka M, Hamada H, et al. Isolated gestational proteinuria preceding the diagnosis of preeclampsia – An observational study. Acta Obstet Gynecol Scand. 2016;95:1048-54. DOI:10.1111/aogs.12915
25. Tong A, Jesudason S, Craig JC, Winkelmayer WC. Perspectives on pregnancy in women with chronic kidney disease: Systematic review of qualitative studies. Nephrol Dial Transplant. 2015;30:652-61. DOI:10.1093/ndt/gfu378
26. Shinar S, Asher-Landsberg J, Schwartz A, et al. Isolated proteinuria is a risk factor for pre-eclampsia: A retrospective analysis of the maternal and neonatal outcomes in women presenting with isolated gestational proteinuria. J Perinatol. 2016;36:25-9. DOI:10.1038/jp.2015.138
27. Bramham K, Parnell B, Nelson-Piercy C, et al. Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis. BMJ. 2014;348:g2301.
28. Piccoli GB, Cabiddu G, Attini R, et al. Hypertension in CKD Pregnancy: A Question of Cause and Effect (Cause or Effect? This Is the Question) Curr Hypertens Rep. 2016;18. DOI:10.1007/s11906-016-0644-7
29. De Castro I, Easterling TR, Bansal N, Jefferson JA. Nephrotic syndrome in pregnancy poses risks with both maternal and fetal complications. Kidney Int. 2017;91:1464-72. DOI:10.1016/j.kint.2016.12.019
30. Bramham K, Seed PT, Lightstone L, et al. Diagnostic and predictive biomarkers for pre-eclampsia in patients with established hypertension and chronic kidney disease. Kidney Int. 2016;89:874-85. DOI:10.1016/j.kint.2015.10.012
31. Magee LA, von Dadelszen P, Rey E, et al. Less-tight versus tight control of hypertension in pregnancy. N Engl J Med. 2015;372:407-17.
32. Cabiddu G, Castellino S, Gernone G, et al. A best practice position statement on pregnancy in chronic kidney disease: The Italian Study Group on Kidney and Pregnancy. J Nephrol. 2016;29:277-303. DOI:10.1007/s40620-016-0285-6
33. Petrov IuA. Family health is the health of the nation. 2hd ed. Moscow, 2020 (in Russian).
34. Rolnik DL, Wright D, Poon LC, et al. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med. 2017;377:613-22.
35. Khaing W, Vallibhakara SA, Tantrakul V, et al. Calcium and vitamin D supplementation for prevention of preeclampsia: a systematic review and network meta-analysis. Nutrients. 2017;9:E1141.
2. Piccoli GB, Alrukhaimi M, Liu ZH, et al.; World Kidney Day Steering Committee. What we do and do not know about women and kidney diseases; questions unanswered and answers unquestioned: reflection on World Kidney Day and International Woman’s Day. Physiol Int. 2018;105:1-18.
3. Piccoli GB, Cabiddu G, Attini R, et al. Risk of Adverse Pregnancy Outcomes in Women with CKD. J Am Soc Nephrol. 2015;26(8):2011-22. DOI:10.1681/ASN.2014050459
4. Piccoli GB, Attini R, Cabiddu G. Kidney diseases and pregnancy: a multidisciplinary approach for improving care by involving nephrology, obstetrics, neonatology, urology, diabetology, bioethics, and internal medicine. J Clin Med. 2018;7:E135.
5. Zetterström K, Lindeberg SN, Haglund B, Hanson U. Maternal complications in women with chronic hypertension: a population-based cohort study. Acta Obstet Gynecol Scand. 2005;84:419-24.
6. Nobles CJ, Mendola P, Mumford SL, et al. Preconception blood pressure levels and reproductive outcomes in a prospective cohort of women attempting pregnancy. Hypertension. 2018;71:904-10.
7. Козловская Н.Л., Коротчаева Ю.В., Демьянова К.А., и др. Особенности ведения беременности у пациентки с хронической болезнью почек 4 стадии. Нефрология. 2019;23(2):109-16 [Kozlovskaia NL, Korotchaeva IuV, Dem’ianova KA, et al. Osobennosti vedeniia beremennosti u patsientki s khronicheskoi bolezn’iu pochek 4 stadii. Nefrologiia. 2019;23(2):109-16 (in Russian)]. DOI:10.24884/1561-6274-2019-23-2-109-116
8. Вялкова А.А. Хроническая болезнь почек. Оренбургский медицинский вестник. 2015;2:42-51 [Vialkova AA. Khronicheskaia bolezn’ pochek. Orenburgskii meditsinskii vestnik. 2015;2:42-51 (in Russian)].
9. Никольская И.Г., Прокопенко Е.И., Новикова С.В., и др. Осложнения и исходы беременности при хронической почечной недостаточности. Альманах клинической медицины. 2015;(37):52-69 [Nikol’skaia IG, Prokopenko EI, Novikova SV, et al. Oslozhneniia i iskhody beremennosti pri khronicheskoi pochechnoi nedostatochnosti. Al’manakh klinicheskoi meditsiny. 2015;(37):52-69 (in Russian)]. DOI:10.18786/2072-0505-2015-37-52-69
10. Никольская И.Г., Новикова С.В., Баринова И.В., и др. Хроническая болезнь почек и беременность: этиология, патогенез, классификация, клиническая картина, перинатальные осложнения. Российский вестник акушера-гинеколога. 2012;12(5):21-30 [Nikol’skaya IG, Novikova SV, Barinova IV, et al. Chronic kidney disease and pregnancy: etiology, pathophysiology, classification, clinical picture and perinatal complications. Rossiyskiy vestnik akushera-ginekologa. 2012;12(5):21-30 (in Russian)].
11. Piccoli GB, Attini R, Cabiddu G, et al. Maternal-foetal outcomes in pregnant women with glomerulonephritides. Are all glomerulonephritides alike in pregnancy? J Autoimmun. 2017;79:91-8. DOI:10.1016/j.jaut.2017.01.008
12. Su X, Lv J, Liu Y, et al. Pregnancy and Kidney Outcomes in Patients With IgA Nephropathy: A Cohort Study. Am J Kidney Dis. 2017;70:262-9. DOI:10.1053/j.ajkd.2017.01.043
13. Moroni G, Doria A, Giglio E, et al. Fetal outcome and recommendations of pregnancies in lupus nephritis in the 21st century: a prospective multicenter study. J Autoimmun. 2016;74:6-12.
14. Klemetti MM, Laivuori H, Tikkanen M, et al. Obstetric and perinatal outcome in type 1 diabetes patients with diabetic nephropathy during 1988–2011. Diabetologia. 2015;58:678-86. DOI:10.1007/s00125-014-3488-1
15. Lightstone L, Hladunewich MA. Lupus Nephritis and Pregnancy: Concerns and Management. Semin Nephrol. 2017;37:347-53. DOI:10.1016/j.semnephrol.2017.05.006
16. Zhang JJ, Ma XX, Hao L, et al. A systematic review and meta-analysis of outcomes of pregnancy in CKD and CKD outcomes in pregnancy. Clin J Am Soc Nephrol. 2015;10:1964-78.
17. Никольская И.Г., Будыкина Т.С., Бочарова И.И., и др. Бактериурия у беременных с хронической болезнью почек и осложнения в перинатальном периоде. Российский вестник акушера-гинеколога. 2014;14(1):44-50 [Nikol’skaya IG, Budykina TS, Bocharova II, et al. Bacteriuriain pregnant women with chronic kidney disease and complications of the perinatal period. Rossiiskii vestnik akushera-ginekologa. 2014;14(1):44-50 (in Russian)].
18. Blom K, Odutayo A, Bramham K, Hladunewich MA. Pregnancy and Glomerular Disease: A Systematic Review of the Literature with Management Guidelines. Clin J Am Soc Nephrol. 2017;12:1862-72. DOI:10.2215/CJN.00130117
19. Piccoli GB, Fassio F, Attini R, et al. Pregnancy in CKD: whom should we follow and why? Nephrol Dial Transpl. 2012;27(Suppl. 3):iii111-8.
20. Webster P, Lightstone L, McKay DB, Josephson MA. Pregnancy in chronic kidney disease and kidney transplantation. Kidney Int. 2017;91:1047-56. DOI:10.1016/j.kint.2016.10.045
21. Kendrick J, Sharma S, Holmen J, et al. Kidney disease and maternal and fetal outcomes in pregnancy. Am J Kidney Dis. 2015;66:55-9. DOI:10.1053/j.ajkd.2014.11.019
22. Bjornstad P, Cherney DZI. Kidney Function Can Predict Pregnancy Outcomes. Clin J Am Soc Nephrol. 2017;12:102-31. DOI:10.2215/CJN.04970517
23. Jim B, Garovic VD. Acute Kidney Injury in Pregnancy. Semin Nephrol. 2017;37:378-85. DOI:10.1016/j.semnephrol.2017.05.010
24. Yamada T, Obata-Yasuoka M, Hamada H, et al. Isolated gestational proteinuria preceding the diagnosis of preeclampsia – An observational study. Acta Obstet Gynecol Scand. 2016;95:1048-54. DOI:10.1111/aogs.12915
25. Tong A, Jesudason S, Craig JC, Winkelmayer WC. Perspectives on pregnancy in women with chronic kidney disease: Systematic review of qualitative studies. Nephrol Dial Transplant. 2015;30:652-61. DOI:10.1093/ndt/gfu378
26. Shinar S, Asher-Landsberg J, Schwartz A, et al. Isolated proteinuria is a risk factor for pre-eclampsia: A retrospective analysis of the maternal and neonatal outcomes in women presenting with isolated gestational proteinuria. J Perinatol. 2016;36:25-9. DOI:10.1038/jp.2015.138
27. Bramham K, Parnell B, Nelson-Piercy C, et al. Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis. BMJ. 2014;348:g2301.
28. Piccoli GB, Cabiddu G, Attini R, et al. Hypertension in CKD Pregnancy: A Question of Cause and Effect (Cause or Effect? This Is the Question) Curr Hypertens Rep. 2016;18. DOI:10.1007/s11906-016-0644-7
29. De Castro I, Easterling TR, Bansal N, Jefferson JA. Nephrotic syndrome in pregnancy poses risks with both maternal and fetal complications. Kidney Int. 2017;91:1464-72. DOI:10.1016/j.kint.2016.12.019
30. Bramham K, Seed PT, Lightstone L, et al. Diagnostic and predictive biomarkers for pre-eclampsia in patients with established hypertension and chronic kidney disease. Kidney Int. 2016;89:874-85. DOI:10.1016/j.kint.2015.10.012
31. Magee LA, von Dadelszen P, Rey E, et al. Less-tight versus tight control of hypertension in pregnancy. N Engl J Med. 2015;372:407-17.
32. Cabiddu G, Castellino S, Gernone G, et al. A best practice position statement on pregnancy in chronic kidney disease: The Italian Study Group on Kidney and Pregnancy. J Nephrol. 2016;29:277-303. DOI:10.1007/s40620-016-0285-6
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33. Petrov IuA. Family health is the health of the nation. 2hd ed. Moscow, 2020 (in Russian).
34. Rolnik DL, Wright D, Poon LC, et al. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med. 2017;377:613-22.
35. Khaing W, Vallibhakara SA, Tantrakul V, et al. Calcium and vitamin D supplementation for prevention of preeclampsia: a systematic review and network meta-analysis. Nutrients. 2017;9:E1141.
Авторы
А.Д. Купина*, Ю.А. Петров
ФГБОУ ВО «Ростовский государственный медицинский университет» Минздрава России, Ростов-на-Дону, Россия
*anastasya1997@bk.ru
Rostov State Medical University, Rostov-on-Don, Russia
*anastasya1997@bk.ru
ФГБОУ ВО «Ростовский государственный медицинский университет» Минздрава России, Ростов-на-Дону, Россия
*anastasya1997@bk.ru
________________________________________________
Rostov State Medical University, Rostov-on-Don, Russia
*anastasya1997@bk.ru
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