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Вакцинопрофилактика пневмококковой инфекции как способ влияния на течение хронической обструктивной болезни легких при сочетании с бронхоэктазами
Вакцинопрофилактика пневмококковой инфекции как способ влияния на течение хронической обструктивной болезни легких при сочетании с бронхоэктазами
Игнатова Г.Л., Блинова Е.В., Антонов В.Н. Вакцинопрофилактика пневмококковой инфекции как способ влияния на течение хронической обструктивной болезни легких при сочетании с бронхоэктазами. Consilium Medicum. 2023;25(3):208–212. DOI: 10.26442/20751753.2023.3.202077
© ООО «КОНСИЛИУМ МЕДИКУМ», 2023 г.
© ООО «КОНСИЛИУМ МЕДИКУМ», 2023 г.
________________________________________________
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
В статье приводятся данные об анализе клинической эффективности вакцинопрофилактики пневмококковой инфекции (ВПИ) у пациентов с хронической обструктивной болезнью легких (ХОБЛ) в сочетании с бронхоэктазами (БЭ) на протяжении 5 лет наблюдения.
Материалы и методы. В исследование включены пациенты мужского пола (n=62) с ХОБЛ в сочетании с БЭ. Основными конечными точками наблюдения для оценки эффективности явились динамика степени тяжести одышки с использованием модифицированной шкалы одышки (Modified Medical Research Council questionnaire – mMRC), объем форсированного выдоха за 1-ю секунду (ОФВ1), частота обострений ХОБЛ, случаи пневмонии, количество госпитализаций. Также рассчитаны прогностические индексы BODE, DOSE, ADO. Для вакцинопрофилактики использовались пневмококковая конъюгированная 13-валентная вакцина.
Результаты. Установлено, что при включении вакцинопрофилактики в план ведения пациентов с ХОБЛ с БЭ уменьшается степень тяжести одышки, стабилизируются основные функциональные показатели респираторной системы не только в краткосрочный период, но и на протяжении как минимум 5 лет наблюдения. При иммунизации пневмококковой конъюгированной 13-валентной вакциной значимо сокращается число обострений ХОБЛ, количество пневмоний и госпитализаций в течение 5-летнего периода наблюдения. ВПИ позволяет улучшить качество жизни и прогноз для пациентов с ХОБЛ в сочетании с БЭ.
Заключение. Показано, что ВПИ у больных ХОБЛ и БЭ позволяет уменьшить число обострений ХОБЛ, заболеваемость пневмонией и количество госпитализаций, улучшить прогноз и выживаемость пациентов за счет сохранения эффективности в течение 5 лет наблюдения.
Ключевые слова: хроническая обструктивная болезнь легких, бронхоэктазы, вакцинопрофилактика
Materials and methods. The study included male patients (n=62) with COPD in combination with bronchiectasis. The primary endpoints were changes the severity of dyspnea using mMRS score, forced expiratory volume in 1 second (FEV1), number of exacerbations of COPD, hospitalizations, and a rate of pneumonia. The prognostic indices BODE, DOSE, ADO were also calculated. 13-valent conjugate pneumococcal vaccine PCV-13 were used for vaccination.
Results. It has been established that when vaccination is included in the management plan for COPD patients with bronchiectasis, the severity of dyspnea decreases, the lung function stabilize not only in the short-term, but also for at 5-years follow-up. Vaccination with PCV-13 significantly reduce number of exacerbations, a rate of pneumonia and hospitalizations during the 5-years follow-up. Vaccination of pneumococcal infection improves the quality of life and prognosis for COPD patients with bronchiectasis.
Conclusion. Vaccination of pneumococcal infection in patients with COPD and bronchiectasis can reduce the number of exacerbations, incidence of pneumonia and the number of hospitalizations, improve the prognosis and survival of patients using PCV-13 by maintaining efficacy for 5 years of follow-up.
Keywords: chronic obstructive pulmonary disease, bronchiectasis, vaccination
Материалы и методы. В исследование включены пациенты мужского пола (n=62) с ХОБЛ в сочетании с БЭ. Основными конечными точками наблюдения для оценки эффективности явились динамика степени тяжести одышки с использованием модифицированной шкалы одышки (Modified Medical Research Council questionnaire – mMRC), объем форсированного выдоха за 1-ю секунду (ОФВ1), частота обострений ХОБЛ, случаи пневмонии, количество госпитализаций. Также рассчитаны прогностические индексы BODE, DOSE, ADO. Для вакцинопрофилактики использовались пневмококковая конъюгированная 13-валентная вакцина.
Результаты. Установлено, что при включении вакцинопрофилактики в план ведения пациентов с ХОБЛ с БЭ уменьшается степень тяжести одышки, стабилизируются основные функциональные показатели респираторной системы не только в краткосрочный период, но и на протяжении как минимум 5 лет наблюдения. При иммунизации пневмококковой конъюгированной 13-валентной вакциной значимо сокращается число обострений ХОБЛ, количество пневмоний и госпитализаций в течение 5-летнего периода наблюдения. ВПИ позволяет улучшить качество жизни и прогноз для пациентов с ХОБЛ в сочетании с БЭ.
Заключение. Показано, что ВПИ у больных ХОБЛ и БЭ позволяет уменьшить число обострений ХОБЛ, заболеваемость пневмонией и количество госпитализаций, улучшить прогноз и выживаемость пациентов за счет сохранения эффективности в течение 5 лет наблюдения.
Ключевые слова: хроническая обструктивная болезнь легких, бронхоэктазы, вакцинопрофилактика
________________________________________________
Materials and methods. The study included male patients (n=62) with COPD in combination with bronchiectasis. The primary endpoints were changes the severity of dyspnea using mMRS score, forced expiratory volume in 1 second (FEV1), number of exacerbations of COPD, hospitalizations, and a rate of pneumonia. The prognostic indices BODE, DOSE, ADO were also calculated. 13-valent conjugate pneumococcal vaccine PCV-13 were used for vaccination.
Results. It has been established that when vaccination is included in the management plan for COPD patients with bronchiectasis, the severity of dyspnea decreases, the lung function stabilize not only in the short-term, but also for at 5-years follow-up. Vaccination with PCV-13 significantly reduce number of exacerbations, a rate of pneumonia and hospitalizations during the 5-years follow-up. Vaccination of pneumococcal infection improves the quality of life and prognosis for COPD patients with bronchiectasis.
Conclusion. Vaccination of pneumococcal infection in patients with COPD and bronchiectasis can reduce the number of exacerbations, incidence of pneumonia and the number of hospitalizations, improve the prognosis and survival of patients using PCV-13 by maintaining efficacy for 5 years of follow-up.
Keywords: chronic obstructive pulmonary disease, bronchiectasis, vaccination
Полный текст
Список литературы
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20. Игнатова Г.Л., Блинова Е.В., Антонов В.Н. Анализ клинической эффективности вакцинопрофилактики пневмококковой инфекции у пациентов с хронической обструктивной болезнью легких в сочетании с сахарным диабетом 2-го типа. Терапевтический архив. 2022;94(1):100-6 [Ignatova GL, Blinova EV, Antonov VN. Analysis of the clinical efficacy of vaccination against pneumococcal infection in patients with chronic obstructive pulmonary disease in combination with type 2 diabetes mellitus. Terapevticheskii Arkhiv (Ter. Arkh.). 2022;94(1):100-6 (in Russian)]. DOI:10.26442/00403660.2022.01.201378
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25. O’Brien C, Guest PJ, Hill SL, Stockley RA. Physiological and radiological characterization of patients diagnosed with chronic obstructive pulmonary disease in primary care. Thorax. 2000;55(8):635-42.
26. Lee J, Jung HM, Kim SK, et al. Factors associated with chronic obstructive pulmonary disease exacerbation, based on big data analysis. Sci Rep. 2019;9(1):6679. DOI:10.1038/s41598-019-43167-w
27. Alqahtani JS, Njoku CM, Bereznicki B, et al. Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis. Eur Respir Rev. 2020;29(156):190166. DOI:10.1183/16000617.0166-2019
28. Iheanacho I, Zhang S, King D, et al. Economic burden of chronic obstructive pulmonary disease (COPD): a systemic literature review. Int J Chron Obstruct Pulmon Dis. 2020;15:439-60. DOI:10.2147/COPD.S234942
29. Inghammar M, Engstom G, Kahimetar G, et al. Invasive pneumococcal disease in patients with an underlying pulmonary disorder. Clin Microbiol Infect. 2013;18:1148-54.
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31. Mao B, Lu HW, Li MH, et al. The existence of bronchiectasis predicts worse prognosis in patients with COPD. Sci Rep. 2015;5:10961. DOI:10.1038/srep10961
2. Hogg JC, McDonough JE, Suzuki M. Small airway obstruction in COPD: new insights based on micro-CT imaging and MRI imaging. Chest. 2013;143:1436-3.
3. Chuchalin AG, Khaltaev N, Antonov NS, et al. Chronic respiratory diseases and risk factors in 12 regions of the Russian Federation. Int J Chron Obstruct Pulmon Dis. 2014;9:963-74.
4. Arkhipov VV, Arkhipova DE, Stukalina EYu, Lazarev AA. COPD Phenotypes in Russia: Characteristics and Treatment. Practical Pulmonology. 2016;3:20-5 (in Russian).
5. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. 2021 Report. Available at: https://goldcopd.org/2021-gold-reports/ Accessed: 23.01.2023.
6. Soler-Cataluna J, Martinez-Garcia M, Roman S, et al. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax. 2005;60(11):925-31. DOI:10.1136/thx.2005.040527
7. Hoogendoorn M, Hoogenveen RT, Rutten-van Mölken MP, et al. Case fatality of COPD exacerbations: a meta-analysis and statistical modeling approach. Eur Respir J. 2011;37(3):508-15. DOI:10.1183/09031936.00043710
8. Martinez-Garcia MA, Miravitlles M. Bronchiectasis in COPD patients: more than a comorbidity? Int J Chron Obstruct Pulmon Dis. 2017;12:1401-11. DOI:10.2147/COPD.S132961
9. Patel IS, Vlahos I, Wilkinsin TM, et al. Bronchiectasis, exacerbations indices, and inflammation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004;170(4):400-7.
10. Martinez-Garcia MA, Soler-Cataluna JJ, Donat Sanz Y, et al. Factors associated with bronchiectasis in patients with COPD. Chest. 2011;140(5):1130-7. DOI:10.1378/chest.10-1758
11. Gatheral T, Kumar N, Sansom B, et al. COPD-related bronchiectasis: independent impact on disease course and outcomes. COPD. 2014;11(6):605-14.
12. Polverino E, Dimakou K, Hurst J, et al. The overlap between bronchiectasis and chronic airway diseases: state of the art and future directions. Eur Respir J. 2018;52:1800328. DOI:10.1183/13993003.00328-2018
13. Ni Y, Shi G, Yu Y, et al. Clinical characteristics of patients with chronic obstructive pulmonary disease with comorbid bronchiectasis: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis. 2015;10:1465-75.
14. Du Q, Jin J, Liu X, Sun Y. Bronchiectasis as a comorbidity of chronic obstructive pulmonary disease: a systematic review and meta-analysis. PLoS One. 2016;11(3):e0150532.
15. Pasteur MC, Helliwell SM, Houghton SJ, et al. An investigation into causative factors in patients with bronchiectasis. Am J of Respir and Crit Care Med. 2000;162(4):1277-84.
16. Angrill J, Augusti C, de Celis R, et al. Bacterial colonization in patients with bronchiectasis: microbiological pattern and risk factors. Thorax. 2002;57(1):15-9.
17. Harboe ZB, Dably T, Weinberger DM. Impact of 13-Valent Pneumococcal Conjugate Vaccination in Invasive Pneumococcal Disease Incidence and Mortality. Clin Infect Dis. 2014;59(8):1066-73. DOI:10.1093/cid/ciu524
18. Halpin DM, Miravitlles M, Metzdorf N, Celli B. Impact and prevention of severe exacerbations of COPD: a review of the evidence. Int J Chron Obstruct Pulmon Dis. 2017;12:2891-908. DOI:10.2147/COPD.S139470
19. Ignatova GL, Antonov VN. Efficacy analysis of five-year experience of vaccination with conjugate pneumococcal vaccine in patients with chronic obstructive pulmonary disease. Russian Pulmonology. 2018;28(2):185-92 (in Russian). DOI:10.18093/0869-0189-2018-28-2-185-192
20. Ignatova GL, Blinova EV, Antonov VN. Analysis of the clinical efficacy of vaccination against pneumococcal infection in patients with chronic obstructive pulmonary disease in combination with type 2 diabetes mellitus. Terapevticheskii Arkhiv (Ter. Arkh.). 2022;94(1):100-6 (in Russian). DOI:10.26442/00403660.2022.01.201378
21. GOLD 2013. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease. Available at: https://goldcopd.org/2018-gold-reports. Accessed: 23.01.2023.
22. GOLD 2018. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease. Available at: https://goldcopd.org/2018-gold-reports. Accessed: 23.01.2023.
23. Chuchalin AG, Aisanov ZR, Chikina SYu, et al. Federal Clinical Guidelines of Russian Respiratory Society on Spirometry. Russian Pulmonologiya. 2014;6:11-24 (in Russian).
24. Celli BR, Cote CG, Lareau SC, et al. Predictors of Survival in COPD: More than Just the FEV1. Respir Med. 2008;102(1):27-35.
25. O’Brien C, Guest PJ, Hill SL, Stockley RA. Physiological and radiological characterization of patients diagnosed with chronic obstructive pulmonary disease in primary care. Thorax. 2000;55(8):635-42.
26. Lee J, Jung HM, Kim SK, et al. Factors associated with chronic obstructive pulmonary disease exacerbation, based on big data analysis. Sci Rep. 2019;9(1):6679. DOI:10.1038/s41598-019-43167-w
27. Alqahtani JS, Njoku CM, Bereznicki B, et al. Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis. Eur Respir Rev. 2020;29(156):190166. DOI:10.1183/16000617.0166-2019
28. Iheanacho I, Zhang S, King D, et al. Economic burden of chronic obstructive pulmonary disease (COPD): a systemic literature review. Int J Chron Obstruct Pulmon Dis. 2020;15:439-60. DOI:10.2147/COPD.S234942
29. Inghammar M, Engstom G, Kahimetar G, et al. Invasive pneumococcal disease in patients with an underlying pulmonary disorder. Clin Microbiol Infect. 2013;18:1148-54.
30. Kostinov MP, Ryshov AA, Magarshak OO, et al. The clinical aspects of efficiency of the prevention of pneumococcal infection with vaccines in chronic obstructive pulmonary disease patients living in the West Siberian region. Terapevticheskii Arkhiv (Ter. Arkh.). 2014;86(3):28-33 (in Russian).
31. Mao B, Lu HW, Li MH, et al. The existence of bronchiectasis predicts worse prognosis in patients with COPD. Sci Rep. 2015;5:10961. DOI:10.1038/srep10961
2. Hogg JC, McDonough JE, Suzuki M. Small airway obstruction in COPD: new insights based on micro-CT imaging and MRI imaging. Chest. 2013;143:1436-3.
3. Chuchalin AG, Khaltaev N, Antonov NS, et al. Chronic respiratory diseases and risk factors in 12 regions of the Russian Federation. Int J Chron Obstruct Pulmon Dis. 2014;9:963-74.
4. Архипов В.В., Архипова Д.Е., Стукалина Е.Ю., Лазарев А.А. Частота встречаемости отдельных фенотипов хронической обструктивной болезни легких в Российской Федерации, их характеристики и подходы к лечению. Практическая пульмонология. 2016;3:20-5 [Arkhipov VV, Arkhipova DE, Stukalina EYu, Lazarev AA. COPD Phenotypes in Russia: Characteristics and Treatment. Practical Pulmonology. 2016;3:20-5 (in Russian)].
5. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. 2021 Report. Available at: https://goldcopd.org/2021-gold-reports/ Accessed: 23.01.2023.
6. Soler-Cataluna J, Martinez-Garcia M, Roman S, et al. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax. 2005;60(11):925-31. DOI:10.1136/thx.2005.040527
7. Hoogendoorn M, Hoogenveen RT, Rutten-van Mölken MP, et al. Case fatality of COPD exacerbations: a meta-analysis and statistical modeling approach. Eur Respir J. 2011;37(3):508-15. DOI:10.1183/09031936.00043710
8. Martinez-Garcia MA, Miravitlles M. Bronchiectasis in COPD patients: more than a comorbidity? Int J Chron Obstruct Pulmon Dis. 2017;12:1401-11. DOI:10.2147/COPD.S132961
9. Patel IS, Vlahos I, Wilkinsin TM, et al. Bronchiectasis, exacerbations indices, and inflammation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004;170(4):400-7.
10. Martinez-Garcia MA, Soler-Cataluna JJ, Donat Sanz Y, et al. Factors associated with bronchiectasis in patients with COPD. Chest. 2011;140(5):1130-7. DOI:10.1378/chest.10-1758
11. Gatheral T, Kumar N, Sansom B, et al. COPD-related bronchiectasis: independent impact on disease course and outcomes. COPD. 2014;11(6):605-14.
12. Polverino E, Dimakou K, Hurst J, et al. The overlap between bronchiectasis and chronic airway diseases: state of the art and future directions. Eur Respir J. 2018;52:1800328. DOI:10.1183/13993003.00328-2018
13. Ni Y, Shi G, Yu Y, et al. Clinical characteristics of patients with chronic obstructive pulmonary disease with comorbid bronchiectasis: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis. 2015;10:1465-75.
14. Du Q, Jin J, Liu X, Sun Y. Bronchiectasis as a comorbidity of chronic obstructive pulmonary disease: a systematic review and meta-analysis. PLoS One. 2016;11(3):e0150532.
15. Pasteur MC, Helliwell SM, Houghton SJ, et al. An investigation into causative factors in patients with bronchiectasis. Am J of Respir and Crit Care Med. 2000;162(4):1277-84.
16. Angrill J, Augusti C, de Celis R, et al. Bacterial colonization in patients with bronchiectasis: microbiological pattern and risk factors. Thorax. 2002;57(1):15-9.
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20. Игнатова Г.Л., Блинова Е.В., Антонов В.Н. Анализ клинической эффективности вакцинопрофилактики пневмококковой инфекции у пациентов с хронической обструктивной болезнью легких в сочетании с сахарным диабетом 2-го типа. Терапевтический архив. 2022;94(1):100-6 [Ignatova GL, Blinova EV, Antonov VN. Analysis of the clinical efficacy of vaccination against pneumococcal infection in patients with chronic obstructive pulmonary disease in combination with type 2 diabetes mellitus. Terapevticheskii Arkhiv (Ter. Arkh.). 2022;94(1):100-6 (in Russian)]. DOI:10.26442/00403660.2022.01.201378
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16. Angrill J, Augusti C, de Celis R, et al. Bacterial colonization in patients with bronchiectasis: microbiological pattern and risk factors. Thorax. 2002;57(1):15-9.
17. Harboe ZB, Dably T, Weinberger DM. Impact of 13-Valent Pneumococcal Conjugate Vaccination in Invasive Pneumococcal Disease Incidence and Mortality. Clin Infect Dis. 2014;59(8):1066-73. DOI:10.1093/cid/ciu524
18. Halpin DM, Miravitlles M, Metzdorf N, Celli B. Impact and prevention of severe exacerbations of COPD: a review of the evidence. Int J Chron Obstruct Pulmon Dis. 2017;12:2891-908. DOI:10.2147/COPD.S139470
19. Ignatova GL, Antonov VN. Efficacy analysis of five-year experience of vaccination with conjugate pneumococcal vaccine in patients with chronic obstructive pulmonary disease. Russian Pulmonology. 2018;28(2):185-92 (in Russian). DOI:10.18093/0869-0189-2018-28-2-185-192
20. Ignatova GL, Blinova EV, Antonov VN. Analysis of the clinical efficacy of vaccination against pneumococcal infection in patients with chronic obstructive pulmonary disease in combination with type 2 diabetes mellitus. Terapevticheskii Arkhiv (Ter. Arkh.). 2022;94(1):100-6 (in Russian). DOI:10.26442/00403660.2022.01.201378
21. GOLD 2013. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease. Available at: https://goldcopd.org/2018-gold-reports. Accessed: 23.01.2023.
22. GOLD 2018. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease. Available at: https://goldcopd.org/2018-gold-reports. Accessed: 23.01.2023.
23. Chuchalin AG, Aisanov ZR, Chikina SYu, et al. Federal Clinical Guidelines of Russian Respiratory Society on Spirometry. Russian Pulmonologiya. 2014;6:11-24 (in Russian).
24. Celli BR, Cote CG, Lareau SC, et al. Predictors of Survival in COPD: More than Just the FEV1. Respir Med. 2008;102(1):27-35.
25. O’Brien C, Guest PJ, Hill SL, Stockley RA. Physiological and radiological characterization of patients diagnosed with chronic obstructive pulmonary disease in primary care. Thorax. 2000;55(8):635-42.
26. Lee J, Jung HM, Kim SK, et al. Factors associated with chronic obstructive pulmonary disease exacerbation, based on big data analysis. Sci Rep. 2019;9(1):6679. DOI:10.1038/s41598-019-43167-w
27. Alqahtani JS, Njoku CM, Bereznicki B, et al. Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis. Eur Respir Rev. 2020;29(156):190166. DOI:10.1183/16000617.0166-2019
28. Iheanacho I, Zhang S, King D, et al. Economic burden of chronic obstructive pulmonary disease (COPD): a systemic literature review. Int J Chron Obstruct Pulmon Dis. 2020;15:439-60. DOI:10.2147/COPD.S234942
29. Inghammar M, Engstom G, Kahimetar G, et al. Invasive pneumococcal disease in patients with an underlying pulmonary disorder. Clin Microbiol Infect. 2013;18:1148-54.
30. Kostinov MP, Ryshov AA, Magarshak OO, et al. The clinical aspects of efficiency of the prevention of pneumococcal infection with vaccines in chronic obstructive pulmonary disease patients living in the West Siberian region. Terapevticheskii Arkhiv (Ter. Arkh.). 2014;86(3):28-33 (in Russian).
31. Mao B, Lu HW, Li MH, et al. The existence of bronchiectasis predicts worse prognosis in patients with COPD. Sci Rep. 2015;5:10961. DOI:10.1038/srep10961
Авторы
Г.Л. Игнатова, Е.В. Блинова*, В.Н. Антонов
ФГБОУ ВО «Южно-Уральский государственный медицинский университет» Минздрава России, Челябинск, Россия
*blinel@mail.ru
South Ural State Medical University, Chelyabinsk, Russia
*blinel@mail.ru
ФГБОУ ВО «Южно-Уральский государственный медицинский университет» Минздрава России, Челябинск, Россия
*blinel@mail.ru
________________________________________________
South Ural State Medical University, Chelyabinsk, Russia
*blinel@mail.ru
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