Несмотря на актуальность проблемы, вопрос о влиянии миомы матки на эффективность программ вспомогательных репродуктивных технологий остается открытым. Получены данные, которые свидетельствуют о том, что при индукции суперовуляции в программе экстракорпорального оплодотворения повышается выработка факторов, способствующих пролиферации миоматозных узлов. Эти данные могут объяснить связь между миомой матки и эффективностью программ вспомогательных репродуктивных технологий, так как экспрессия тех же генов связана с имплантацией и постимплантационным развитием эмбриона. Хирургическое удаление крупных узлов перед проведением программы экстракорпорального оплодотворения в большинстве случаев расценивается как положительный прогностический фактор. Однако оперативное лечение, в свою очередь, оказывает негативное влияние на состояние маточных труб и брюшины, а также приводит к появлению рубца на матке. Данный обзор позволяет составить представление о современном состоянии проблемы и может помочь в выработке индивидуальных подходов у пациенток с бесплодием и миомой матки. Ключевые слова: миома матки, имплантация, экстракорпоральное оплодотворение, вспомогательные репродуктивные технологии.
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Despite the urgency of the problem, the impact of uterine fibroids on the effectiveness of programs assisted reproductive technology (ART) remains open. The data indicate that the induction of superovulation in vitro fertilization (IVF) increases the production of factors that contribute to the proliferation of fibroids. These data may explain the link between uterine myoma and effectiveness of ART programs, as expression of the same genes associated with implantation and post-implantation embryo development. Surgical removal of large knots prior to the IVF program in most cases, is regarded as a positive prognostic factor. However, surgical treatment, in turn, has a negative impact on the fallopian tubes and peritoneal and also leads to the appearance of the scar on the uterus. This review gives an idea of the current state of the problem and can help in the development of individual approaches in patients with infertility and uterine myoma. Key words: uterine fibroids, implantation, in vitro fertilisation, assisted reproductive technology.
1. Калинина Е.А., Широкова Д.В., Попов Г.Д. и др. Тактика ведения пациенток с миомой матки при экстракорпоральном оплодотворении. Проблемы репродукции. 2005; 1: 30–2. / Kalinina E.A., Shirokova D.V., Popov G.D. i dr. Taktika vedeniia patsientok s miomoi matki pri ekstrakorporal'nom oplodotvorenii. Problemy reproduktsii. 2005; 1: 30–2. [in Russian]
2. Мартынова А.Е., Смольникова В.Ю. Эффективность программы ЭКО у женщин с миомой матки. Проблемы репродукции. 2012; 6: 43–6. / Martynova A.E., Smol'nikova V.Iu. Effektivnost' programmy EKO u zhenshchin s miomoi matki. Problemy reproduktsii. 2012; 6: 43–6. [in Russian]
3. Мартынова А.Е., Смольникова В.Ю., Демура Т.А., Коган Е.А. Эффективность программы ЭКО у женщин с миомой матки с учетом маркеров рецептивности эндометрия – пиноподий, LIF, VEGF A, клаудина-5. Акушерство и гинекология. 2013; 8. / Martynova A.E., Smol'nikova V.Iu., Demura T.A., Kogan E.A. Effektivnost' programmy EKO u zhenshchin s miomoi matki s uchetom markerov retseptivnosti endometriia – pinopodii, LIF, VEGF-A, klaudina-5. Akusherstvo i ginekologiia. 2013; 8 [in Russian]
4. Назаренко Т.А., Мишиева Н.Г. Бесплодие и возраст. Пути решения проблемы. М.: МЕДпресс-информ, 2014. / Nazarenko T.A., Mishieva N.G. Besplodie i vozrast. Puti resheniia problemy. M.: MEDpress-inform, 2014 [in Russian]
5. Приказ Министерства здравоохранения РФ от 30.08.2012 №107н «О порядке использования вспомогательных репродуктивных технологий, противопоказаниях и ограничениях к их применению». / Prikaz Ministerstva zdravookhraneniia RF ot 30.08.2012 №107n «O poriadke ispol'zovaniia vspomogatel'nykh reproduktivnykh tekhnologii, protivopokazaniiakh i ogranicheniiakh k ikh primeneniiu». [in Russian]
6. American Society of Reproductive Medicine (ASRM). Myomas and reproductive function. Fertil Steril 2008; 90: S125–S30.
7. Arslan AA, Gold LI, Mittal K et al. Gene expression studies provide clues to the pathogenesis of uterine leiomyoma: new evidence and a systematic review. Hum Reprod 2005; 20 (4): 852–63.
8. Arthur R, Kachura J, Liu G et al. Laparoscopic myomectomy versus uterine artery embolization: long-term impact on markers of ovarian reserve J Obstet Gynaecol Can 2014; 36 (3): 240–7.
9. Benecke C, Kruger TF, Siebert TI et al. Effect of fibroids on fertility in patients undergoing assisted reproduction. A structured literature review. Gynecol Obstet Invest 2005; 59: 225–30.
10. Bosteels J, Kasius J, Weyers S et al. Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities. Cochrane Database of Systematic Reviews Issue 1. 2013. Art. No.: CD009461.
11. Bosteels J, Kasius J, Weyers S et al. Treating suspected uterine cavity abnormalities by hysteroscopy to improve reproductive outcome in women with unexplained infertility or prior to IUI, IVF, or ICSI. Gynecol Surg 2013; 10: 165–7.
12. Bulletti C, Dez D, Levi Setti P et al. Myomas, pregnancy outcome, and in vitro fertilization. Ann N Y Acad Sci 2004; 1034: 84–92.
13. Buttram VCJr, Reiter RC. Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril 1981; 36: 433–45.
14. Casini ML, Rossi F, Agostini R, Unfer V. Effect of the position of fibroids on fertility. Gynecol Endocrinol 2006; 22: 106–9.
15. Ciarmela P, Wiater E, Vale W. Activin-A in myometrium: characterization of the actions on myometrial cells. Endocrinology 2008; 149 (5): 2506–16.
16. Ciarmela P, Wiater E, Smith SM, Vale W. Presence, actions, and regulation of myostatin in rat uterus and myometrial cells. Endocrinology 2009; 150 (2): 906–14.
17. Day Baird D, Dunson DB, Hill MC et al. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 2003; 188 (1): 100–7.
18. Donnez J, Jadoul P. What are the implications of myomas on fertility? A need for a debate? Hum Reprod 2002; 17: 1424–30.
19. Eldar-Geva T, Meagher S, Healy DL et al. Effect of intramural, subserosal, and submucosal uterine fibroids on the outcome of assisted reproductive technology treatment. Fertil Steril 1998; 70: 4: 687–91.
20. Ezzati M, Norian JM, Segars JH. Management of uterine fibroids in the patient pursuing assisted reproductive technologies. Womens Health 2009; 5 (4): 413–21.
21. Farquhar C. Do uterine fibroids cause infertility and should they be removed to increase fertility? British Med J 2009; 338: b126.
22. Farrer-Brown G, Beilby JO, Tarbit MH. Venous changes in the endometrium of myomatous uteri. Obstet Gynecol 1971; 38: 743–51.
23. Gupta JK, Sinha AS, Lumsden MA, Hickey M. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev 2006; 1: CD005073.
24. Hart R, Khalaf Y, Yeong CT et al. Prospective controlled study of the effects of uterine fibroids on the outcome of assisted conception treatment. Hum Reprod 2001; 16: 2411–7.
25. Horcajadas JA, Goyri E, Higon MA et al. Endometrial receptivity and implantation are not affected by the presence of uterine intramural leiomyomas: a clinical and functional genomics analysis. J Clin Endocrinol Metab 2008; 93: 3490–8.
26. Khalaf Y, Ross C, El-Toukhy T et al. The effect of small intramural uterine fibroids on the cumulative outcome of assisted conception. Hum Reprod 2006; 21: 2640–4.
27. Klatsky PC, Lane DE, Ryan IP, Fujimoto VY. The effect of fibroids without cavity involvement on ART outcomes independent of ovarian age. Hum Reprod 2007; 22: 521–6.
28. Kuroda K, Takeuchi H, Kitade M et al. Surgery-assisted reproductive technology hybrid therapy: a reproductive procedure for an infertile woman of late reproductive age with multiple myomas. J Obstet Gynaecol Res 2009; 35 (4): 827–31.
29. Levy G, Hill MJ, Beall S et al. Leiomyoma: genetics, assisted reproduction, pregnancy and therapeutic advances. J Assist Reprod Genet 2012; 29: 703–12.
30. Mara M, Maskova J, Fucikova Z et al. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Interv Radiol 2008; 31: 73–85.
31. Matsuzaki S, Canis M, Darcha C et al. HOXA-10 expression in the mid-secretory endometrium of infertile patients with either endometriosis, uterine fibromas or unexplained infertility. Hum Reprod 2009; 24 (12): 3180–7.
32. Metwally М et al. Is another meta-analysis on the effects of intramural fibroids on reproductive outcomes needed? Reprod Biomed Online 2011; 23 (Issue 1): 2–14.
33. Narayan R, Rajat, Goswamy K. Treatment of submucous fibroids, and outcome of assisted conception. J Am Assoc Gynecol Laparosc 1994; 1: 307–11.
34. Ng EH, Ho PC. Doppler ultrasound examination of uterine arteries on the day of oocyte retrieval in patients with uterine fibroids undergoing IVF. Hum Reprod 2002; 17: 765–70.
35. Nishino M, Togashi K, Nakai A et al. Uterine contractions evaluated on cine MR imaging in patients with uterine leiomyomata. Eur J Radiol 2005; 53: 142–6.
36. Oliveira FG, Abdelmassih VG, Diamond MP et al. Impact of subserosal and intramural uterine fibroids that do not distort the endometrial cavity on the outcome of in vitro fertilization-intracytoplasmic sperm injection. Fertil Steril 2004; 81: 582–7.
37. Patterson-Keels LM, Selvaggi SM, Haefner HK, Randolph JFJr. Morphologic assessment of endometrium overlying submucosal leiomyomas. J Reprod Med 1994; 39: 579–84.
38. Pritts EA. Fibroids and infertility: a systematic review of the evidence. Obstet Gynecol Surv 2001; 56: 483–91.
39. Pritts EA, Parker WH, Olive DL. Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril 2008. Epub ahead of print.
40. Pritts EA, Parker WH, Olive DL. Fibroids and infertility: anupdated systematic review of the evidence. Fertil Steril 2009; 91: 1215–23.
41. Seoud MA, Patterson R, Muasher SJ, Coddington CC. 3rd Effects of myomas or prior myomectomy on in vitro fertilization (IVF) performance. Assist Reprod Genet 1992; 9: 217–21.
42. Shastri SM, Schattman G, Ratushny V, Rosenwaks Z. Effects of uterine Leiomyoma on outcomes of in vitro fertilization and intracytoplasmic sperm injection. ASRM abstract. 2005. Poster 8.
43. Sinclair DC, Mastroyannis A, Taylor HS. Leiomyoma simultaneously impair endometrial BMP-2-mediated decidualization and anticoagulant expression through secretion of TGF-3. J Clin Endocrinol Metab 2011; 96 (2): 412–21.
44. Somigliana E, Vercellini P, Daguati R et al. Fibroids and female reproduction: a critical analysis of the evidence. Hum Reprod Update 2007; 13: 465–76.
45. Somigliana E, Benedictis S, Vercellini P et al. Fibroids not encroaching the endometrial cavity and IVF success rate: a prospective study. Hum Reprod 2011; 26: 4: 834–9.
46. Sunkara SK, Khairy M, El-Toukhy T et al. The effect of intramural fibroids without uterine cavity involvement on the outcome of IVF treatment: a systematic review and meta-analysis. Hum Reprod 2010; 25: 418–29.
47. Surrey ES. Impact of intramural leiomyomata on in-vitro fertilization embryo transfer cycle outcome. Curr Opin Obstet Gynecol 2003; 15: 239–42.
48. Surrey ES, Minjarez DA, Stevens JM, Schoolcraft WB. Effect of myomectomyon the outcome of assisted reproductive technologies. Fertil Steril 2005; 83: 1473–9.
49. Greco TE, Ubaldi FM. Adenomyosis and endometrial-subendometrial myometrium unit disruption disease are two different entities. Reprod Biomed Online 2008; 17 (2): 285–91.
50. Verkauf BS. Myomectomy for fertility enhancement and preservation. Fertil Steril 1992; 58: 1–15.
51. Wang W, Check JH, Dietterich C, Lurie D. Effect of fibroids on cumulative probability of pregnancy in women taking follicle maturing drugs without assisted reproductive technology. Clin Exp Obstet Gynecol 2001; 28 (2): 86–8.
52. Yan L, Ding L, Li C et al. Effect of fibroids not distorting the endometrial cavity on the outcome of in vitro fertilization treatment: a retrospective cohort study. Fertil Steril 2014;101 (3): 716–21.
53. Zaher S, Lyons D, Regan L. Successful in vitro fertilization pregnancy following magnetic resonance-guided focused ultrasound surgery for uterine fibroids. J Obstet Gynaecol Res 2011; 37 (4): 370–3.
54. Rackow BW, Arici A. Fibroids and in-vitro fertilization: which comes first? Curr Opin Obstet Gynecol 2005; 17: 225–31.
55. Homer H, Saridogan E. Uterine artery embolization for fibroids is associated with an increased risk of miscarriage. Fertil Steril 2010; 94: 324–30.
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1. Kalinina E.A., Shirokova D.V., Popov G.D. i dr. Taktika vedeniia patsientok s miomoi matki pri ekstrakorporal'nom oplodotvorenii. Problemy reproduktsii. 2005; 1: 30–2. [in Russian]
2. Martynova A.E., Smol'nikova V.Iu. Effektivnost' programmy EKO u zhenshchin s miomoi matki. Problemy reproduktsii. 2012; 6: 43–6. [in Russian]
3. Martynova A.E., Smol'nikova V.Iu., Demura T.A., Kogan E.A. Effektivnost' programmy EKO u zhenshchin s miomoi matki s uchetom markerov retseptivnosti endometriia – pinopodii, LIF, VEGF-A, klaudina-5. Akusherstvo i ginekologiia. 2013; 8 [in Russian]
4. Nazarenko T.A., Mishieva N.G. Besplodie i vozrast. Puti resheniia problemy. M.: MEDpress-inform, 2014 [in Russian]
5. Prikaz Ministerstva zdravookhraneniia RF ot 30.08.2012 №107n «O poriadke ispol'zovaniia vspomogatel'nykh reproduktivnykh tekhnologii, protivopokazaniiakh i ogranicheniiakh k ikh primeneniiu». [in Russian]
6. American Society of Reproductive Medicine (ASRM). Myomas and reproductive function. Fertil Steril 2008; 90: S125–S30.
7. Arslan AA, Gold LI, Mittal K et al. Gene expression studies provide clues to the pathogenesis of uterine leiomyoma: new evidence and a systematic review. Hum Reprod 2005; 20 (4): 852–63.
8. Arthur R, Kachura J, Liu G et al. Laparoscopic myomectomy versus uterine artery embolization: long-term impact on markers of ovarian reserve J Obstet Gynaecol Can 2014; 36 (3): 240–7.
9. Benecke C, Kruger TF, Siebert TI et al. Effect of fibroids on fertility in patients undergoing assisted reproduction. A structured literature review. Gynecol Obstet Invest 2005; 59: 225–30.
10. Bosteels J, Kasius J, Weyers S et al. Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities. Cochrane Database of Systematic Reviews Issue 1. 2013. Art. No.: CD009461.
11. Bosteels J, Kasius J, Weyers S et al. Treating suspected uterine cavity abnormalities by hysteroscopy to improve reproductive outcome in women with unexplained infertility or prior to IUI, IVF, or ICSI. Gynecol Surg 2013; 10: 165–7.
12. Bulletti C, Dez D, Levi Setti P et al. Myomas, pregnancy outcome, and in vitro fertilization. Ann N Y Acad Sci 2004; 1034: 84–92.
13. Buttram VCJr, Reiter RC. Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril 1981; 36: 433–45.
14. Casini ML, Rossi F, Agostini R, Unfer V. Effect of the position of fibroids on fertility. Gynecol Endocrinol 2006; 22: 106–9.
15. Ciarmela P, Wiater E, Vale W. Activin-A in myometrium: characterization of the actions on myometrial cells. Endocrinology 2008; 149 (5): 2506–16.
16. Ciarmela P, Wiater E, Smith SM, Vale W. Presence, actions, and regulation of myostatin in rat uterus and myometrial cells. Endocrinology 2009; 150 (2): 906–14.
17. Day Baird D, Dunson DB, Hill MC et al. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 2003; 188 (1): 100–7.
18. Donnez J, Jadoul P. What are the implications of myomas on fertility? A need for a debate? Hum Reprod 2002; 17: 1424–30.
19. Eldar-Geva T, Meagher S, Healy DL et al. Effect of intramural, subserosal, and submucosal uterine fibroids on the outcome of assisted reproductive technology treatment. Fertil Steril 1998; 70: 4: 687–91.
20. Ezzati M, Norian JM, Segars JH. Management of uterine fibroids in the patient pursuing assisted reproductive technologies. Womens Health 2009; 5 (4): 413–21.
21. Farquhar C. Do uterine fibroids cause infertility and should they be removed to increase fertility? British Med J 2009; 338: b126.
22. Farrer-Brown G, Beilby JO, Tarbit MH. Venous changes in the endometrium of myomatous uteri. Obstet Gynecol 1971; 38: 743–51.
23. Gupta JK, Sinha AS, Lumsden MA, Hickey M. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev 2006; 1: CD005073.
24. Hart R, Khalaf Y, Yeong CT et al. Prospective controlled study of the effects of uterine fibroids on the outcome of assisted conception treatment. Hum Reprod 2001; 16: 2411–7.
25. Horcajadas JA, Goyri E, Higon MA et al. Endometrial receptivity and implantation are not affected by the presence of uterine intramural leiomyomas: a clinical and functional genomics analysis. J Clin Endocrinol Metab 2008; 93: 3490–8.
26. Khalaf Y, Ross C, El-Toukhy T et al. The effect of small intramural uterine fibroids on the cumulative outcome of assisted conception. Hum Reprod 2006; 21: 2640–4.
27. Klatsky PC, Lane DE, Ryan IP, Fujimoto VY. The effect of fibroids without cavity involvement on ART outcomes independent of ovarian age. Hum Reprod 2007; 22: 521–6.
28. Kuroda K, Takeuchi H, Kitade M et al. Surgery-assisted reproductive technology hybrid therapy: a reproductive procedure for an infertile woman of late reproductive age with multiple myomas. J Obstet Gynaecol Res 2009; 35 (4): 827–31.
29. Levy G, Hill MJ, Beall S et al. Leiomyoma: genetics, assisted reproduction, pregnancy and therapeutic advances. J Assist Reprod Genet 2012; 29: 703–12.
30. Mara M, Maskova J, Fucikova Z et al. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Interv Radiol 2008; 31: 73–85.
31. Matsuzaki S, Canis M, Darcha C et al. HOXA-10 expression in the mid-secretory endometrium of infertile patients with either endometriosis, uterine fibromas or unexplained infertility. Hum Reprod 2009; 24 (12): 3180–7.
32. Metwally М et al. Is another meta-analysis on the effects of intramural fibroids on reproductive outcomes needed? Reprod Biomed Online 2011; 23 (Issue 1): 2–14.
33. Narayan R, Rajat, Goswamy K. Treatment of submucous fibroids, and outcome of assisted conception. J Am Assoc Gynecol Laparosc 1994; 1: 307–11.
34. Ng EH, Ho PC. Doppler ultrasound examination of uterine arteries on the day of oocyte retrieval in patients with uterine fibroids undergoing IVF. Hum Reprod 2002; 17: 765–70.
35. Nishino M, Togashi K, Nakai A et al. Uterine contractions evaluated on cine MR imaging in patients with uterine leiomyomata. Eur J Radiol 2005; 53: 142–6.
36. Oliveira FG, Abdelmassih VG, Diamond MP et al. Impact of subserosal and intramural uterine fibroids that do not distort the endometrial cavity on the outcome of in vitro fertilization-intracytoplasmic sperm injection. Fertil Steril 2004; 81: 582–7.
37. Patterson-Keels LM, Selvaggi SM, Haefner HK, Randolph JFJr. Morphologic assessment of endometrium overlying submucosal leiomyomas. J Reprod Med 1994; 39: 579–84.
38. Pritts EA. Fibroids and infertility: a systematic review of the evidence. Obstet Gynecol Surv 2001; 56: 483–91.
39. Pritts EA, Parker WH, Olive DL. Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril 2008. Epub ahead of print.
40. Pritts EA, Parker WH, Olive DL. Fibroids and infertility: anupdated systematic review of the evidence. Fertil Steril 2009; 91: 1215–23.
41. Seoud MA, Patterson R, Muasher SJ, Coddington CC. 3rd Effects of myomas or prior myomectomy on in vitro fertilization (IVF) performance. Assist Reprod Genet 1992; 9: 217–21.
42. Shastri SM, Schattman G, Ratushny V, Rosenwaks Z. Effects of uterine Leiomyoma on outcomes of in vitro fertilization and intracytoplasmic sperm injection. ASRM abstract. 2005. Poster 8.
43. Sinclair DC, Mastroyannis A, Taylor HS. Leiomyoma simultaneously impair endometrial BMP-2-mediated decidualization and anticoagulant expression through secretion of TGF-3. J Clin Endocrinol Metab 2011; 96 (2): 412–21.
44. Somigliana E, Vercellini P, Daguati R et al. Fibroids and female reproduction: a critical analysis of the evidence. Hum Reprod Update 2007; 13: 465–76.
45. Somigliana E, Benedictis S, Vercellini P et al. Fibroids not encroaching the endometrial cavity and IVF success rate: a prospective study. Hum Reprod 2011; 26: 4: 834–9.
46. Sunkara SK, Khairy M, El-Toukhy T et al. The effect of intramural fibroids without uterine cavity involvement on the outcome of IVF treatment: a systematic review and meta-analysis. Hum Reprod 2010; 25: 418–29.
47. Surrey ES. Impact of intramural leiomyomata on in-vitro fertilization embryo transfer cycle outcome. Curr Opin Obstet Gynecol 2003; 15: 239–42.
48. Surrey ES, Minjarez DA, Stevens JM, Schoolcraft WB. Effect of myomectomyon the outcome of assisted reproductive technologies. Fertil Steril 2005; 83: 1473–9.
49. Greco TE, Ubaldi FM. Adenomyosis and endometrial-subendometrial myometrium unit disruption disease are two different entities. Reprod Biomed Online 2008; 17 (2): 285–91.
50. Verkauf BS. Myomectomy for fertility enhancement and preservation. Fertil Steril 1992; 58: 1–15.
51. Wang W, Check JH, Dietterich C, Lurie D. Effect of fibroids on cumulative probability of pregnancy in women taking follicle maturing drugs without assisted reproductive technology. Clin Exp Obstet Gynecol 2001; 28 (2): 86–8.
52. Yan L, Ding L, Li C et al. Effect of fibroids not distorting the endometrial cavity on the outcome of in vitro fertilization treatment: a retrospective cohort study. Fertil Steril 2014;101 (3): 716–21.
53. Zaher S, Lyons D, Regan L. Successful in vitro fertilization pregnancy following magnetic resonance-guided focused ultrasound surgery for uterine fibroids. J Obstet Gynaecol Res 2011; 37 (4): 370–3.
54. Rackow BW, Arici A. Fibroids and in-vitro fertilization: which comes first? Curr Opin Obstet Gynecol 2005; 17: 225–31.
55. Homer H, Saridogan E. Uterine artery embolization for fibroids is associated with an increased risk of miscarriage. Fertil Steril 2010; 94: 324–30.
ГБОУ ДПО Российская медицинская академия последипломного образования Минздрава России. 125993, Россия, Москва, ул. Баррикадная, д. 2/1
*podzolkova@gmail.com
Russian Medical Academy for Postgraduate Education of the Ministry of Health of the Russian Federation.
125993, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1
*podzolkova@gmail.com