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«Нейтралитет во всем», или «эндокринно-метаболический ноктюрн» комбинированного орального контрацептива на основе Е4/дроспиренона
«Нейтралитет во всем», или «эндокринно-метаболический ноктюрн» комбинированного орального контрацептива на основе Е4/дроспиренона
Оразов М.Р., Радзинский В.Е., Долгов Е.Д. «Нейтралитет во всем», или «эндокринно-метаболический ноктюрн» комбинированного орального контрацептива на основе Е4/дроспиренона. Гинекология. 2025;27(1):61–65. DOI: 10.26442/20795696.2025.1.203155
© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.
© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.
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Аннотация
Одним из наиболее контраверсионных вопросов современной гинекологии является изучение влияния комбинированных оральных контрацептивов (КОК) на эндокринно-метаболический профиль. В настоящее время в обществе, к сожалению, по-прежнему сохраняются гормонофобные предрассудки о негативном влиянии КОК на массу тела, углеводный обмен и липидный профиль, однако доказательная база у подобных суждений отсутствует. Исходя из этого целью статьи является анализ влияния КОК на основе Е4/дроспиренона на эндокринно-метаболические показатели сквозь призму доказательной медицины.
Ключевые слова: комбинированные оральные контрацептивы, эндокринно-метаболический профиль, масса тела, эстетрол, дроспиренон
Keywords: combined oral contraceptives, endocrine-metabolic profile, body weight, estetrol, drospirenone
Ключевые слова: комбинированные оральные контрацептивы, эндокринно-метаболический профиль, масса тела, эстетрол, дроспиренон
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Keywords: combined oral contraceptives, endocrine-metabolic profile, body weight, estetrol, drospirenone
Полный текст
Список литературы
1. Радзинский В.Е., Оразов М.Р., Долгов Е.Д. Доброкачественная дисплазия молочной железы и масталгия. Комбинированные оральные контрацептивы на основе эстетрола и дроспиренона. Акушерство и гинекология: новости, мнения, обучение. 2025;13(Suppl.):102-8 [Radzinskii VE, Orazov MR, Dolgov ED. Dobrokachestvennaia displaziia molochnoi zhelezy i mastalgiia. Kombinirovannye oral'nye kontratseptivy na osnove estetrola i drospirenona. Akusherstvo i ginekologiia: novosti, mneniia, obuchenie. 2025;13(Suppl.):102-8 (in Russian)]. DOI:10.33029/2303-9698-2025-13-suppl-102-108
2. Hall KS, Trussell J. Types of combined oral contraceptives used by US women. Contraception. 2012;86(6):659-65. DOI:10.1016/j.contraception.2012.05.017
3. Metz L, Isacco L, Redman LM. Effect of oral contraceptives on energy balance in women: A review of current knowledge and potential cellular mechanisms. Metabolism. 2022;126:154919. DOI:10.1016/j.metabol.2021.154919
4. San-Juan-Rodriguez A, Bes-Rastrollo M, Martinez-Gonzalez MA, et al. Oral contraceptives use and development of obesity in a Mediterranean cohort: the SUN (Seguimiento Universidad de Navarra) Project. Int J Obes (Lond). 2020;44(2):320-2. DOI:10.1038/s41366-019-0442-9
5. Bardaweel SK, Akour AA, Kilani MV. Current knowledge, attitude, and patterns of oral contraceptives utilization among women in Jordan. BMC Womens Health. 2015;15:117. DOI:10.1186/s12905-015-0275-1
6. Национальные медицинские критерии приемлемости методов контрацепции. 2023. Режим доступа: https://roag-portal.ru/materials. Ссылка активна на 10.10.2024 [Natsional'nye meditsinskie kriterii priemlemosti metodov kontratseptsii. 2023.Available at: https://roag-portal.ru/materials. Accessed: 10.10.2024 (in Russian)].
7. Schwers J, Eriksson G, Wiqvist N, Diczfalusy E. 15α-hydroxylation: A new pathway of estrogen metabolism in the human fetus and newborn. Biochimica et Biophysica Acta (BBA) – General Subjects. 2003;100(1):313-1. DOI:10.1016/0304-4165(65)90464-2
8. Schwers J, Govaerts-Videtsky M, Wiqvist N, Diczfalusy E. Metabolism of oestrone sulphate by the previable human foetus. Acta Endocrinol (Copenh). 1965;50(4):597-610. DOI:10.1530/acta.0.0500597
9. Mancuso S, Benagiano G, Dell'Acqua S, et al. Studies on the metabolism of C-19 steroids in the human foeto-placental unit. 4. Aromatisation and hydroxylation products formed by previable foetuses perfused withandrostenedione and testosterone. Acta Endocrinol (Copenh). 1968;57(2):208-27. DOI:10.1530/acta.0.0570208
10. Coelingh Bennink F, Holinka CF, Visser M, Coelingh Bennink HJ. Maternal and fetal estetrol levels during pregnancy. Climacteric. 2008;11(Suppl. 1):69-72. DOI:10.1080/13697130802056321
11. Gérard C, Arnal JF, Jost M, et al. Profile of estetrol, a promising native estrogen for oral contraception and the relief of climacteric symptoms of menopause. Expert Rev Clin Pharmacol. 2022;15(2):121-37. DOI:10.1080/17512433.2022.2054413
12. Fruzzetti F, Fidecicchi T, Montt Guevara MM, Simoncini T. Estetrol: A New Choice for Contraception. J Clin Med. 2021;10(23):5625. DOI:10.3390/jcm10235625
13. Klipping C, Duijkers I, Mawet M, et al. Endocrine and metabolic effects of an oral contraceptive containing estetrol and drospirenone. Contraception. 2021;103(4):213-21. DOI:10.1016/j.contraception.2021.01.001
14. Douxfils J, Gaspard U, Taziaux M, et al. Impact of estetrol (E4) on hemostasis, metabolism and bone turnover in postmenopausal women. Climacteric. 2023;26(1):55-63. DOI:10.1080/13697137.2022.2139599
15. Geraghty P, Taylor HS. The next generation of oral contraception: advances in estrogens. ObGyn Management, June, 2021. Available at: https://cdn.mdedge.com/files/s3fs-public/obgm_the_next_generation_of_oral_contraception_v8.pdf. Accessed: 15.01.2025.
16. Apter D, Zimmerman Y, Beekman L, et al. Estetrol combined with drospirenone: an oral contraceptive with high acceptability, user satisfaction, well-being and favourable body weight control. Eur J Contracept Reprod Health Care. 2017;22(4):260-6. DOI:10.1080/13625187.2017.1336532
17. Coelingh Bennink HJ, Heegaard AM, Visser M, et al. Oral bioavailability and bone-sparing effects of estetrol in an osteoporosis model. Climacteric. 2008;11(Suppl. 1):2-14. DOI:10.1080/13697130701798692
18. De Mello WC, Frohlich ED. Clinical perspectives and fundamental aspects of local cardiovascular and renal Renin-Angiotensin systems. Front Endocrinol (Lausanne). 2014;5:16. DOI:10.3389/fendo.2014.00016
19. De Mello WC. Chemical Communication between Heart Cells is Disrupted by Intracellular Renin and Angiotensin II: Implications for Heart Development and Disease. Front Endocrinol (Lausanne). 2015;6:72. DOI:10.3389/fendo.2015.00072
20. Bader M. ACE2, angiotensin-(1–7), and Mas: the other side of the coin. Pflugers Arch – Eur J Physiol. 2012;465(1):79-85. DOI:10.1007/s00424-012-1120-0
21. Losert W, Casals-Stenzel J, Buse M. Progestogens with antimineralocorticoid activity. Arzneimittelforschung. 1985;35(2):459-71.
22. Pérez-López FR. Clinical experiences with drospirenone: From reproductive to postmenopausal years. Maturitas. 2008;60(2):78-91. DOI:10.1016/j.maturitas.2008.03.009
23. Оразов М.Р., Ермаков В.В., Новгинов Д.С. Влияние контрацептива, содержащего эстетрол/дроспиренон, на сексуальную функцию женщин репродуктивного возраста. Гинекология. 2023;25(1):102-5 [Orazov MR, Ermakov VV, Novginov DS. Effect of an estetrol/drospirenone contraceptive on sexual function in women of reproductive age. Gynecology. 2023;25(1):102-5 (in Russian)]. DOI:10.26442/20795696.2023.1.202033
24. Оразов М.Р., Радзинский В.Е., Долгов Е.Д., Ермаков В.В. Эндокринно-метаболические эффекты оральных контрацептивов, содержащих эстетрол и дроспиренон. Вопросы гинекологии, акушерства и перинатологии. 2022;21(4):146-50 [Orazov MR, Radzinskii VE, Dolgov ED, Ermakov VV. Endokrinno-metabolicheskie effekty oral'nykh kontratseptivov, soderzhashchikh estetrol i drospirenon. Voprosy ginekologii, akusherstva i perinatologii. 2022;21(4):146-50 (in Russian)]. DOI:10.20953/1726-1678-2022-4-146-150
25. Оразов М.Р., Радзинский В.Е., Долгов Е.Д., Ермаков В.В. Риски венозных тромбоэмболий при использовании гормональных контрацептивов, содержащих эстетрол и дроспиренон. Вопросы гинекологии, акушерства и перинатологии. 2022;21(6):125-30 [Orazov MR, Radzinskii VE, Dolgov ED, Ermakov VV. Riski venoznykh tromboembolii pri ispol'zovanii gormonal'nykh kontratseptivov, soderzhashchikh estetrol i drospirenon. Voprosy ginekologii, akusherstva i perinatologii. 2022;21(6):125-30 (in Russian)]. DOI:10.20953/1726-1678-2022-6-125-130
2. Hall KS, Trussell J. Types of combined oral contraceptives used by US women. Contraception. 2012;86(6):659-65. DOI:10.1016/j.contraception.2012.05.017
3. Metz L, Isacco L, Redman LM. Effect of oral contraceptives on energy balance in women: A review of current knowledge and potential cellular mechanisms. Metabolism. 2022;126:154919. DOI:10.1016/j.metabol.2021.154919
4. San-Juan-Rodriguez A, Bes-Rastrollo M, Martinez-Gonzalez MA, et al. Oral contraceptives use and development of obesity in a Mediterranean cohort: the SUN (Seguimiento Universidad de Navarra) Project. Int J Obes (Lond). 2020;44(2):320-2. DOI:10.1038/s41366-019-0442-9
5. Bardaweel SK, Akour AA, Kilani MV. Current knowledge, attitude, and patterns of oral contraceptives utilization among women in Jordan. BMC Womens Health. 2015;15:117. DOI:10.1186/s12905-015-0275-1
6. Natsional'nye meditsinskie kriterii priemlemosti metodov kontratseptsii. 2023.Available at: https://roag-portal.ru/materials. Accessed: 10.10.2024 (in Russian).
7. Schwers J, Eriksson G, Wiqvist N, Diczfalusy E. 15α-hydroxylation: A new pathway of estrogen metabolism in the human fetus and newborn. Biochimica et Biophysica Acta (BBA) – General Subjects. 2003;100(1):313-1. DOI:10.1016/0304-4165(65)90464-2
8. Schwers J, Govaerts-Videtsky M, Wiqvist N, Diczfalusy E. Metabolism of oestrone sulphate by the previable human foetus. Acta Endocrinol (Copenh). 1965;50(4):597-610. DOI:10.1530/acta.0.0500597
9. Mancuso S, Benagiano G, Dell'Acqua S, et al. Studies on the metabolism of C-19 steroids in the human foeto-placental unit. 4. Aromatisation and hydroxylation products formed by previable foetuses perfused withandrostenedione and testosterone. Acta Endocrinol (Copenh). 1968;57(2):208-27. DOI:10.1530/acta.0.0570208
10. Coelingh Bennink F, Holinka CF, Visser M, Coelingh Bennink HJ. Maternal and fetal estetrol levels during pregnancy. Climacteric. 2008;11(Suppl. 1):69-72. DOI:10.1080/13697130802056321
11. Gérard C, Arnal JF, Jost M, et al. Profile of estetrol, a promising native estrogen for oral contraception and the relief of climacteric symptoms of menopause. Expert Rev Clin Pharmacol. 2022;15(2):121-37. DOI:10.1080/17512433.2022.2054413
12. Fruzzetti F, Fidecicchi T, Montt Guevara MM, Simoncini T. Estetrol: A New Choice for Contraception. J Clin Med. 2021;10(23):5625. DOI:10.3390/jcm10235625
13. Klipping C, Duijkers I, Mawet M, et al. Endocrine and metabolic effects of an oral contraceptive containing estetrol and drospirenone. Contraception. 2021;103(4):213-21. DOI:10.1016/j.contraception.2021.01.001
14. Douxfils J, Gaspard U, Taziaux M, et al. Impact of estetrol (E4) on hemostasis, metabolism and bone turnover in postmenopausal women. Climacteric. 2023;26(1):55-63. DOI:10.1080/13697137.2022.2139599
15. Geraghty P, Taylor HS. The next generation of oral contraception: advances in estrogens. ObGyn Management, June, 2021. Available at: https://cdn.mdedge.com/files/s3fs-public/obgm_the_next_generation_of_oral_contraception_v8.pdf. Accessed: 15.01.2025.
16. Apter D, Zimmerman Y, Beekman L, et al. Estetrol combined with drospirenone: an oral contraceptive with high acceptability, user satisfaction, well-being and favourable body weight control. Eur J Contracept Reprod Health Care. 2017;22(4):260-6. DOI:10.1080/13625187.2017.1336532
17. Coelingh Bennink HJ, Heegaard AM, Visser M, et al. Oral bioavailability and bone-sparing effects of estetrol in an osteoporosis model. Climacteric. 2008;11(Suppl. 1):2-14. DOI:10.1080/13697130701798692
18. De Mello WC, Frohlich ED. Clinical perspectives and fundamental aspects of local cardiovascular and renal Renin-Angiotensin systems. Front Endocrinol (Lausanne). 2014;5:16. DOI:10.3389/fendo.2014.00016
19. De Mello WC. Chemical Communication between Heart Cells is Disrupted by Intracellular Renin and Angiotensin II: Implications for Heart Development and Disease. Front Endocrinol (Lausanne). 2015;6:72. DOI:10.3389/fendo.2015.00072
20. Bader M. ACE2, angiotensin-(1–7), and Mas: the other side of the coin. Pflugers Arch – Eur J Physiol. 2012;465(1):79-85. DOI:10.1007/s00424-012-1120-0
21. Losert W, Casals-Stenzel J, Buse M. Progestogens with antimineralocorticoid activity. Arzneimittelforschung. 1985;35(2):459-71.
22. Pérez-López FR. Clinical experiences with drospirenone: From reproductive to postmenopausal years. Maturitas. 2008;60(2):78-91. DOI:10.1016/j.maturitas.2008.03.009
23. Orazov MR, Ermakov VV, Novginov DS. Effect of an estetrol/drospirenone contraceptive on sexual function in women of reproductive age. Gynecology. 2023;25(1):102-5 (in Russian). DOI:10.26442/20795696.2023.1.202033
24. Orazov MR, Radzinskii VE, Dolgov ED, Ermakov VV. Endokrinno-metabolicheskie effekty oral'nykh kontratseptivov, soderzhashchikh estetrol i drospirenon. Voprosy ginekologii, akusherstva i perinatologii. 2022;21(4):146-50 (in Russian). DOI:10.20953/1726-1678-2022-4-146-150
25. Orazov MR, Radzinskii VE, Dolgov ED, Ermakov VV. Riski venoznykh tromboembolii pri ispol'zovanii gormonal'nykh kontratseptivov, soderzhashchikh estetrol i drospirenon. Voprosy ginekologii, akusherstva i perinatologii. 2022;21(6):125-30 (in Russian). DOI:10.20953/1726-1678-2022-6-125-130
2. Hall KS, Trussell J. Types of combined oral contraceptives used by US women. Contraception. 2012;86(6):659-65. DOI:10.1016/j.contraception.2012.05.017
3. Metz L, Isacco L, Redman LM. Effect of oral contraceptives on energy balance in women: A review of current knowledge and potential cellular mechanisms. Metabolism. 2022;126:154919. DOI:10.1016/j.metabol.2021.154919
4. San-Juan-Rodriguez A, Bes-Rastrollo M, Martinez-Gonzalez MA, et al. Oral contraceptives use and development of obesity in a Mediterranean cohort: the SUN (Seguimiento Universidad de Navarra) Project. Int J Obes (Lond). 2020;44(2):320-2. DOI:10.1038/s41366-019-0442-9
5. Bardaweel SK, Akour AA, Kilani MV. Current knowledge, attitude, and patterns of oral contraceptives utilization among women in Jordan. BMC Womens Health. 2015;15:117. DOI:10.1186/s12905-015-0275-1
6. Национальные медицинские критерии приемлемости методов контрацепции. 2023. Режим доступа: https://roag-portal.ru/materials. Ссылка активна на 10.10.2024 [Natsional'nye meditsinskie kriterii priemlemosti metodov kontratseptsii. 2023.Available at: https://roag-portal.ru/materials. Accessed: 10.10.2024 (in Russian)].
7. Schwers J, Eriksson G, Wiqvist N, Diczfalusy E. 15α-hydroxylation: A new pathway of estrogen metabolism in the human fetus and newborn. Biochimica et Biophysica Acta (BBA) – General Subjects. 2003;100(1):313-1. DOI:10.1016/0304-4165(65)90464-2
8. Schwers J, Govaerts-Videtsky M, Wiqvist N, Diczfalusy E. Metabolism of oestrone sulphate by the previable human foetus. Acta Endocrinol (Copenh). 1965;50(4):597-610. DOI:10.1530/acta.0.0500597
9. Mancuso S, Benagiano G, Dell'Acqua S, et al. Studies on the metabolism of C-19 steroids in the human foeto-placental unit. 4. Aromatisation and hydroxylation products formed by previable foetuses perfused withandrostenedione and testosterone. Acta Endocrinol (Copenh). 1968;57(2):208-27. DOI:10.1530/acta.0.0570208
10. Coelingh Bennink F, Holinka CF, Visser M, Coelingh Bennink HJ. Maternal and fetal estetrol levels during pregnancy. Climacteric. 2008;11(Suppl. 1):69-72. DOI:10.1080/13697130802056321
11. Gérard C, Arnal JF, Jost M, et al. Profile of estetrol, a promising native estrogen for oral contraception and the relief of climacteric symptoms of menopause. Expert Rev Clin Pharmacol. 2022;15(2):121-37. DOI:10.1080/17512433.2022.2054413
12. Fruzzetti F, Fidecicchi T, Montt Guevara MM, Simoncini T. Estetrol: A New Choice for Contraception. J Clin Med. 2021;10(23):5625. DOI:10.3390/jcm10235625
13. Klipping C, Duijkers I, Mawet M, et al. Endocrine and metabolic effects of an oral contraceptive containing estetrol and drospirenone. Contraception. 2021;103(4):213-21. DOI:10.1016/j.contraception.2021.01.001
14. Douxfils J, Gaspard U, Taziaux M, et al. Impact of estetrol (E4) on hemostasis, metabolism and bone turnover in postmenopausal women. Climacteric. 2023;26(1):55-63. DOI:10.1080/13697137.2022.2139599
15. Geraghty P, Taylor HS. The next generation of oral contraception: advances in estrogens. ObGyn Management, June, 2021. Available at: https://cdn.mdedge.com/files/s3fs-public/obgm_the_next_generation_of_oral_contraception_v8.pdf. Accessed: 15.01.2025.
16. Apter D, Zimmerman Y, Beekman L, et al. Estetrol combined with drospirenone: an oral contraceptive with high acceptability, user satisfaction, well-being and favourable body weight control. Eur J Contracept Reprod Health Care. 2017;22(4):260-6. DOI:10.1080/13625187.2017.1336532
17. Coelingh Bennink HJ, Heegaard AM, Visser M, et al. Oral bioavailability and bone-sparing effects of estetrol in an osteoporosis model. Climacteric. 2008;11(Suppl. 1):2-14. DOI:10.1080/13697130701798692
18. De Mello WC, Frohlich ED. Clinical perspectives and fundamental aspects of local cardiovascular and renal Renin-Angiotensin systems. Front Endocrinol (Lausanne). 2014;5:16. DOI:10.3389/fendo.2014.00016
19. De Mello WC. Chemical Communication between Heart Cells is Disrupted by Intracellular Renin and Angiotensin II: Implications for Heart Development and Disease. Front Endocrinol (Lausanne). 2015;6:72. DOI:10.3389/fendo.2015.00072
20. Bader M. ACE2, angiotensin-(1–7), and Mas: the other side of the coin. Pflugers Arch – Eur J Physiol. 2012;465(1):79-85. DOI:10.1007/s00424-012-1120-0
21. Losert W, Casals-Stenzel J, Buse M. Progestogens with antimineralocorticoid activity. Arzneimittelforschung. 1985;35(2):459-71.
22. Pérez-López FR. Clinical experiences with drospirenone: From reproductive to postmenopausal years. Maturitas. 2008;60(2):78-91. DOI:10.1016/j.maturitas.2008.03.009
23. Оразов М.Р., Ермаков В.В., Новгинов Д.С. Влияние контрацептива, содержащего эстетрол/дроспиренон, на сексуальную функцию женщин репродуктивного возраста. Гинекология. 2023;25(1):102-5 [Orazov MR, Ermakov VV, Novginov DS. Effect of an estetrol/drospirenone contraceptive on sexual function in women of reproductive age. Gynecology. 2023;25(1):102-5 (in Russian)]. DOI:10.26442/20795696.2023.1.202033
24. Оразов М.Р., Радзинский В.Е., Долгов Е.Д., Ермаков В.В. Эндокринно-метаболические эффекты оральных контрацептивов, содержащих эстетрол и дроспиренон. Вопросы гинекологии, акушерства и перинатологии. 2022;21(4):146-50 [Orazov MR, Radzinskii VE, Dolgov ED, Ermakov VV. Endokrinno-metabolicheskie effekty oral'nykh kontratseptivov, soderzhashchikh estetrol i drospirenon. Voprosy ginekologii, akusherstva i perinatologii. 2022;21(4):146-50 (in Russian)]. DOI:10.20953/1726-1678-2022-4-146-150
25. Оразов М.Р., Радзинский В.Е., Долгов Е.Д., Ермаков В.В. Риски венозных тромбоэмболий при использовании гормональных контрацептивов, содержащих эстетрол и дроспиренон. Вопросы гинекологии, акушерства и перинатологии. 2022;21(6):125-30 [Orazov MR, Radzinskii VE, Dolgov ED, Ermakov VV. Riski venoznykh tromboembolii pri ispol'zovanii gormonal'nykh kontratseptivov, soderzhashchikh estetrol i drospirenon. Voprosy ginekologii, akusherstva i perinatologii. 2022;21(6):125-30 (in Russian)]. DOI:10.20953/1726-1678-2022-6-125-130
________________________________________________
2. Hall KS, Trussell J. Types of combined oral contraceptives used by US women. Contraception. 2012;86(6):659-65. DOI:10.1016/j.contraception.2012.05.017
3. Metz L, Isacco L, Redman LM. Effect of oral contraceptives on energy balance in women: A review of current knowledge and potential cellular mechanisms. Metabolism. 2022;126:154919. DOI:10.1016/j.metabol.2021.154919
4. San-Juan-Rodriguez A, Bes-Rastrollo M, Martinez-Gonzalez MA, et al. Oral contraceptives use and development of obesity in a Mediterranean cohort: the SUN (Seguimiento Universidad de Navarra) Project. Int J Obes (Lond). 2020;44(2):320-2. DOI:10.1038/s41366-019-0442-9
5. Bardaweel SK, Akour AA, Kilani MV. Current knowledge, attitude, and patterns of oral contraceptives utilization among women in Jordan. BMC Womens Health. 2015;15:117. DOI:10.1186/s12905-015-0275-1
6. Natsional'nye meditsinskie kriterii priemlemosti metodov kontratseptsii. 2023.Available at: https://roag-portal.ru/materials. Accessed: 10.10.2024 (in Russian).
7. Schwers J, Eriksson G, Wiqvist N, Diczfalusy E. 15α-hydroxylation: A new pathway of estrogen metabolism in the human fetus and newborn. Biochimica et Biophysica Acta (BBA) – General Subjects. 2003;100(1):313-1. DOI:10.1016/0304-4165(65)90464-2
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Авторы
М.Р. Оразов*, В.Е. Радзинский, Е.Д. Долгов
ФГАОУ ВО «Российский университет дружбы народов им. Патриса Лумумбы», Москва, Россия
*omekan@mail.ru
Patrice Lumumba People’s Friendship University of Russia (RUDN University), Moscow, Russia
*omekan@mail.ru
ФГАОУ ВО «Российский университет дружбы народов им. Патриса Лумумбы», Москва, Россия
*omekan@mail.ru
________________________________________________
Patrice Lumumba People’s Friendship University of Russia (RUDN University), Moscow, Russia
*omekan@mail.ru
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