Артериальная гипертензия является доказанным фактором риска сердечно-сосудистых осложнений. С введением в схемы лечения ингибиторов кальциневрина артериальная гипертензия регистрируется у 50–80% реципиентов внутренних органов. Мы обобщили основные механизмы, участвующие в генезе индуцированной ингибиторами кальциневрина артериальной гипертензии: нарушение функции почек, эндотелиальная дисфункция, активация симпатической и ренин-ангиотензин-альдостероновой систем, усиление синтеза сосудосуживающих веществ, активация Na+/Cl-котранспортера. Акцентируется внимание на дозозависимости повышения артериального давления и необходимости дальнейшего изучения интенсивности прогипертензивного действия различных ингибиторов кальциневрина.
Arterial hypertension is an established risk factor for cardiovascular complications. Since the introduction of calcineurin inhibitors (CNI), аrterial hypertension is observed in 50–80% of transplanted patients. Arterial hypertension and transplantation are closely linked, and its association may promote impaired graft and overall survival. We summarize the main mechanisms involved in the genesis of CNI-induced hypertension as follows: impaired renal function with the sodium retaining, endothelial dysfunction, renin-angiotensin-aldosterone system and sympathetic activation, production of vasoconstrictor substances, activation the renal Na+/Cl--cotransporter. Attention is focused on the dose-dependent increase in arterial pressure and the need for further study of the intensity of the pro-hypertensive effect of various calcineurin inhibitors.
1. Mells G, Neuberger J. Reducing the risks of cardiovascular disease in liver allograft recipients. Transplantation 2007; 83 (9): 1141–50.
2. Готье С.В., Мойсюк Я.Г. Трансплантология: фармакотерапия без ошибок. М.: E-noto, 2014. / Gote S.V., Moisiuk Ia.G. Transplantologiia: farmakoterapiia bez oshibok. M.: E-noto, 2014. [in Russian]
3. Hoorn EJ, Walsh SB, McCormick JA et al. Pathogenesis of calcineurin inhibitor – induced hypertension. J Nephrol 2012; 25: 269–75. DOI: 10.5301/jn.5000174
4. Azancot MA, Ramos N, Moreso FJ et al. Hypertension in chronic kidney disease: the influence of renal transplantation. Transplantation 2014; 98 (5): 537–42. DOI: 10.1097/TP.0000000000000103
5. Kassel LE, Odum LE. Our own worst enemy: pharmacologic mechanisms of hypertension. Adv Chronic Kidney Dis 2015; 22: 245–52. DOI: 10.1053/j.ackd.2014.10.002
6. Kirilov G, Tomova A, Dakovska L et al. Elevated plasma endothelin as an additional cardiovascular risk factor in patients with Cushing’s syndrome. Eur J Endocrinol 2003; 149 (6): 549–53. DOI: http://dx.doi.org/ 10.1530%2Feje.0.1490549
7. Taler SJ, Textor SC, Canzanello VJ et al. Role of steroid dose in hypertension early after liver transplantation with tacrolimus (FK506) and cyclosporine. Transplantation 1996; 62 (11): 1588–92.
8. Трансплантация поджелудочной железы. Национальные клинические рекомендации. (Российское трансплантологическое общество). М., 2013. http://transpl.ru/images/cms/data/pdf/nacional_nye_klinicheskie_rekomendacii_po_transplantacii_podzh... / Transplantatsiia podzheludochnoi zhelezy. Natsional'nye klinicheskie rekomendatsii. (Rossiiskoe transplantologicheskoe obshchestvo). M., 2013. http://transpl.ru/images/cms/data/pdf/nacional_nye_klinicheskie_rekomendacii_po_transplantacii_podzh... [in Russian]
9. Трансплантация печени. Национальные клинические рекомендации. (Российское трансплантологическое общество). М., 2013. / Transplantatsiia pecheni. Natsional'nye klinicheskie rekomendatsii. (Rossiiskoe transplantologicheskoe obshchestvo). M., 2013. http://transpl.ru/images/cms/data/pdf/nacional_nye_klinicheskie_rekomendacii_po_transplantacii_peche... / http://transpl.ru/images/cms/data/pdf/nacional_nye_ klinicheskie_rekomendacii_po_transplantacii_pecheni.pdf [in Russian]
10. Трансплантация почки. Национальные клинические рекомендации. (Российское трансплантологическое общество). М., 2013. / Transplantatsiia pochki. Natsional'nye klinicheskie rekomendatsii. (Rossiiskoe transplantologicheskoe obshchestvo). M., 2013. http://transpl.ru/images/cms/data/pdf/nacional_nye_klinicheskie_rekomendacii_po_transplantacii_pochk... / http://transpl.ru/images/cms/data/pdf/nacional_nye_klinicheskie_rekomendacii_po_transplantacii_pochk... [in Russian]
11. Textor SC, Taler SJ, Canzanello VJ et al. Posttransplantation hypertension related to calcineurin inhibitors. Liver Transplantation 2000; 5 (6): 521–30.
12. Shiba N, Chan MC, Kwok BW et al. Analysis of survivors more than 10 years after heart transplantation in the cyclosporine era: Stanford experience. J Heart Lung Transplant 2004; 23 (2): 155–64.
13. Шумаков В.И. Трансплантология. М.: Мед. информ. агентство, 2006. / Shumakov V.I. Transplantologiia. M.: Med. inform. agentstvo, 2006. [in Russian]
14. Siddharth S, Watt KD. Long-term medical management of the liver transplant recipient: what the primary care physician needs to know. Mayo Clin Proc 2012; 87 (8): 779–90.
15. Bohlke M, Barcellos FC, Rocha M et al. Predictors of hypertension following successful renal transplantation: a population-based study. Transplant Proc 2009; 41: 3743–4632.
16. Hohage H, Bruckner D, Arlt M et al. Influence of cyclosporine A and FK506 on 24 h blood pressure monitoring in kidney transplant recipients. Clin Nephrol 1996; 45 (5): 342–4.
17. Nishi H, Hanafusa N, Kondo Y et al. Clinical outcome of thrombotic microangiopathy after living-donor liver transplantation treated with plasma exchange therapy. Clin J Am Society Nephrology 2006; 4: 811–9.
18. Gerhards U, Rudash M, Hokage U. Blood pressure controls in kidney transplant recipients: influence of immunosuppression. J A Pharmac 1999; 19 (1): 45–54.
19. Snanoudj R, Kriaa F, Arzouk N et al. Single-center experience with cyclosporine therapy for kidney transplantation: analysis of a twenty-year period in 1200 patients. Transplant Proc 2004; 36: 83–8. DOI: 10.1016/j. transproceed.2004.01.089
20. Porter GA, Bennett WM, Sheps SG. Cyclosporine-associated hypertension. National High Blood Pressure Education Program. Arch Intern Med 1990; 150: 280–3.
21. Van Buren DH, Burke JF, Lewis RM. Renal function in patients receiving long-term cyclosporine therapy. J Am Soc Nephrol 1994; 4 (Suppl. 8): 17–22.
22. Vercauteren SB, Bosmans JL, Elseviers MM et al. A meta-analysis and morphological review of cyclosporine-induced nephrotoxicity in auto-immune diseases. Kidney Int 1998; 54: 536–45.
23. Molkentin JD, Lu JR, Antos CL et al. A calcineurin-dependent transcriptional pathway for cardiac hypertrophy. Cell 1998; 93: 215–28.
24. Wadei HM, Textor SC. Hypertension in the kidney transplant recipient. Transplant Rev (Orlando) 2010; 24: 105–20.
25. Hoorn EJ, Nelson JH, McCormick JA et al. The WNK kinase network regulating sodium, potassium, and blood pressure. J Am Soc Nephrol 2011; 4: 605–14.
26. Luft FC. How calcineurin inhibitors cause hypertension. Nephrol Dial Transplant 2012; 2 (27): 473–5.
27. Hoorn EJ, Walsh SB, McCormick JA et al. The calcineurin inhibitor tacrolimus activates the renal sodium chloride cotransporter to cause hypertension. Nature Medicine 2011; 10 (17): 1304–9.
28. Melnikov S, Mayan H, Uchida S et al. Cyclosporine metabolic side effects: association with the WNK4 system. Eur J Clin Inves 2011; 10 (41): 1113–20.
29. Dbouk HA, Huang CL, Cobb MH. Hypertension: the missing WNKs. Am J Physiol Renal Physiol 2016; 311: 16–27.
30. Bhavani N. Pediatric endocrine hypertension. Indian J Endocrinol Metab 2011; 15 (Supp. l4): 361–6.
31. Маркель А.Л. Генетика артериальной гипертонии. Вестн. рос. академии наук. 2008; 3 (78): 235–46. / Markel A.L. Genetika arterial'noi gipertonii. Vestn. ros. akademii nauk. 2008; 3 (78): 235–46. [in Russian]
32. Morris ST, McMurray JJ, Rodger RS et al. Endothelial dysfunction in renal transplant recipients maintained on cyclosporine. Kidney Int 2000; 3 (57): 1100–6.
33. Roullet JB, Xue H, McCarron DA et al. Vascular mechanisms of cyclosporin-induced hypertension in the rat. J Clin Inves 1994; 5 (93): 2244–50.
34. Richards NT, Poston L, Hilton PJ. Cyclosporine A inhibits relaxation but does not induce vasoconstriction in human subcutaneous resistance vessels. J Hyperten 1989; 1 (7): 1–3.
35. Cauduro RL, Costa C, Lhulieretal F. Endothelin-1 plasma levels and hypertension in cyclosporine-treated renal transplant patients. Clin Transplant 2005; 19 (4): 470–4.
36. Forslund T, Hannonen P, Reitamo S et al. Hypertension in cyclosporin A-treated patients is independent of circulating endothelin levels. J Int Med 1995; 1 (238): 71–5.
37. Karabesheh S, Verma DR, Jain M et al. Clinical and hemodynamic effects of renin-angiotensin system blockade in cardiac transplant recipients. Am J Cardiol 2011; 108 (12): 1836–9.
38. Lee DBN. Cyclosporine and the renin-angiotensin axis. Kidney Int 1997; 1 (52): 248–60.
39. Textor SC. Hypertension and transplantation in Hypertension Primer. Lippincott Williams and Wilkins, 2003.
40. Klein IH, Abrahams AC, Van Ede T. Differential effects of acute and sustained cyclosporine and tacrolimus on sympathetic nerve activity. J Hypertens 2010; 28 (9): 1928–34.
41. Sander M, Lyson T, Thomas GD et al. Sympathetic neural mechanisms of cyclosporine-induced hypertension. Am J Hypertens 1996; 9 (11): 121–38.
42. Victor RG, Thomas GD, Marban E et al. Presynaptic modulation of cortical synaptic activity by calcineurin. Proc Nation Acad Sci USA 1995; 14 (92): 6269–73.
43. Grassi G. Assessment of sympathetic cardiovascular drive in human hypertension: achievements and perspectives. Hypertension 2009; 4 (54): 690–7.
44. Zbroch E, Małyszko J, Mysliwiec M. Hypertension in solid organ transplant recipients. Ann Transplant 2012; 17: 100–7.
45. Schlaich MP, Grassi G. Sympatho excitation in calcineurin inhibitor-induced hypertension: villain or innocent by stander? J Hypertens 2010; 9 (28): 1809–10.
46. Государственный реестр лекарственных средств. http://grls.rosminzdrav.ru / Gosudarstvennyi reestr lekarstvennykh sredstv. http://grls.rosminzdrav.ru [in Russian]
47. Robert N, Wong GW, Wright JM. Effect of cyclosporine on blood pressure. Cochrane Database Syst Rev 2010: Cd007893. DOI: 10. 1002/14651858.CD007893.pub2
48. Loughran JTP, Deeg HJ, Dahlberg S et al. Incidence of hypertension after marrow transplantation among 112 patients randomized to either cyclosporine or methotrexate as graft-versus-host disease prophylaxis. Br J Haematol 1985; 59: 547–53.
49. Grossman E, Messerli FH. High blood pressure. A side effect of drugs, poisons, and food. Arch Intern Med 1995; 155: 450–60.
50. Jensik SC. Tacrolimus (FK 506) in kidney transplantation: three-year survival results of the US Multicenter, randomized, comparative trial. Transplantation Proceedings 1998; 4 (30): 1216–8.
51. Bohlke M, Barcellos FC, Rocha M et al. Predictors of hypertension following successful renal transplantation: a population-based study. Trans Proceedings 2009; 9 (41): 3743–6.
52. Mangray M, Vella JP. Hypertension after kidney transplant. Am J Kidney Dis 2011; 2 (57): 331–41.
53. Cush JJ, Tugwell P, Weinblatt M et al. US consensus guidelines for use of cyclosporine A in rheumatoid arthritis. J Rheumatol 1999; 26: 1176–86.
54. Ekberg H, Griny J, Nashan B et al. Cyclosporine sparing with mycophenolate mofetil, daclizumab and corticosteroids in renal allograft recipients: the CAESAR study. Am J Transplant 2007; 3 (7): 560–70.
55. Pascual M, Curtis J, Delmonico FL et al. A prospective, randomized clinical trial of cyclosporine reduction in stable patients greater than 12 months after renal transplantation. Transplantation 2003; 75 (9): 1501–5.
56. Margreiter R. Efficacy and safety of tacrolimus compared with ciclosporin microemulsion in renal transplantation: a randomized multicenter study. Lancet 2002; 359 (9308): 741–6.
57. Gonwa T, Mendez R, Yang HC. Randomized trial of tacrolimus in combination with sirolimus or mycophenolate mofetil in kidney transplantation: results at 6 months. Transplantation 2003; 75 (8): 1213–20.
________________________________________________
1. Mells G, Neuberger J. Reducing the risks of cardiovascular disease in liver allograft recipients. Transplantation 2007; 83 (9): 1141–50.
2. Gote S.V., Moisiuk Ia.G. Transplantologiia: farmakoterapiia bez oshibok. M.: E-noto, 2014. [in Russian]
3. Hoorn EJ, Walsh SB, McCormick JA et al. Pathogenesis of calcineurin inhibitor – induced hypertension. J Nephrol 2012; 25: 269–75. DOI: 10.5301/jn.5000174
4. Azancot MA, Ramos N, Moreso FJ et al. Hypertension in chronic kidney disease: the influence of renal transplantation. Transplantation 2014; 98 (5): 537–42. DOI: 10.1097/TP.0000000000000103
5. Kassel LE, Odum LE. Our own worst enemy: pharmacologic mechanisms of hypertension. Adv Chronic Kidney Dis 2015; 22: 245–52. DOI: 10.1053/j.ackd.2014.10.002
6. Kirilov G, Tomova A, Dakovska L et al. Elevated plasma endothelin as an additional cardiovascular risk factor in patients with Cushing’s syndrome. Eur J Endocrinol 2003; 149 (6): 549–53. DOI: http://dx.doi.org/ 10.1530%2Feje.0.1490549
7. Taler SJ, Textor SC, Canzanello VJ et al. Role of steroid dose in hypertension early after liver transplantation with tacrolimus (FK506) and cyclosporine. Transplantation 1996; 62 (11): 1588–92.
8. Transplantatsiia podzheludochnoi zhelezy. Natsional'nye klinicheskie rekomendatsii. (Rossiiskoe transplantologicheskoe obshchestvo). M., 2013. http://transpl.ru/images/cms/data/pdf/nacional_nye_klinicheskie_rekomendacii_po_transplantacii_podzh... [in Russian]
9. Transplantatsiia pecheni. Natsional'nye klinicheskie rekomendatsii. (Rossiiskoe transplantologicheskoe obshchestvo). M., 2013. Transplantatsiia pecheni. Natsional'nye klinicheskie rekomendatsii. (Rossiiskoe transplantologicheskoe obshchestvo). M., 2013. http://transpl.ru/images/cms/data/pdf/nacional_nye_klinicheskie_rekomendacii_po_transplantacii_pecheni.pdf [in Russian]
10. Transplantatsiia pochki. Natsional'nye klinicheskie rekomendatsii. (Rossiiskoe transplantologicheskoe obshchestvo). M., 2013. http://transpl.ru/images/cms/data/pdf/nacional_nye_klinicheskie_rekomendacii_po_transplantacii_pochk... [in Russian]
11. Textor SC, Taler SJ, Canzanello VJ et al. Posttransplantation hypertension related to calcineurin inhibitors. Liver Transplantation 2000; 5 (6): 521–30.
12. Shiba N, Chan MC, Kwok BW et al. Analysis of survivors more than 10 years after heart transplantation in the cyclosporine era: Stanford experience. J Heart Lung Transplant 2004; 23 (2): 155–64.
13. Shumakov V.I. Transplantologiia. M.: Med. inform. agentstvo, 2006. [in Russian]
14. Siddharth S, Watt KD. Long-term medical management of the liver transplant recipient: what the primary care physician needs to know. Mayo Clin Proc 2012; 87 (8): 779–90.
15. Bohlke M, Barcellos FC, Rocha M et al. Predictors of hypertension following successful renal transplantation: a population-based study. Transplant Proc 2009; 41: 3743–4632.
16. Hohage H, Bruckner D, Arlt M et al. Influence of cyclosporine A and FK506 on 24 h blood pressure monitoring in kidney transplant recipients. Clin Nephrol 1996; 45 (5): 342–4.
17. Nishi H, Hanafusa N, Kondo Y et al. Clinical outcome of thrombotic microangiopathy after living-donor liver transplantation treated with plasma exchange therapy. Clin J Am Society Nephrology 2006; 4: 811–9.
18. Gerhards U, Rudash M, Hokage U. Blood pressure controls in kidney transplant recipients: influence of immunosuppression. J A Pharmac 1999; 19 (1): 45–54.
19. Snanoudj R, Kriaa F, Arzouk N et al. Single-center experience with cyclosporine therapy for kidney transplantation: analysis of a twenty-year period in 1200 patients. Transplant Proc 2004; 36: 83–8. DOI: 10.1016/j. transproceed.2004.01.089
20. Porter GA, Bennett WM, Sheps SG. Cyclosporine-associated hypertension. National High Blood Pressure Education Program. Arch Intern Med 1990; 150: 280–3.
21. Van Buren DH, Burke JF, Lewis RM. Renal function in patients receiving long-term cyclosporine therapy. J Am Soc Nephrol 1994; 4 (Suppl. 8): 17–22.
22. Vercauteren SB, Bosmans JL, Elseviers MM et al. A meta-analysis and morphological review of cyclosporine-induced nephrotoxicity in auto-immune diseases. Kidney Int 1998; 54: 536–45.
23. Molkentin JD, Lu JR, Antos CL et al. A calcineurin-dependent transcriptional pathway for cardiac hypertrophy. Cell 1998; 93: 215–28.
24. Wadei HM, Textor SC. Hypertension in the kidney transplant recipient. Transplant Rev (Orlando) 2010; 24: 105–20.
25. Hoorn EJ, Nelson JH, McCormick JA et al. The WNK kinase network regulating sodium, potassium, and blood pressure. J Am Soc Nephrol 2011; 4: 605–14.
26. Luft FC. How calcineurin inhibitors cause hypertension. Nephrol Dial Transplant 2012; 2 (27): 473–5.
27. Hoorn EJ, Walsh SB, McCormick JA et al. The calcineurin inhibitor tacrolimus activates the renal sodium chloride cotransporter to cause hypertension. Nature Medicine 2011; 10 (17): 1304–9.
28. Melnikov S, Mayan H, Uchida S et al. Cyclosporine metabolic side effects: association with the WNK4 system. Eur J Clin Inves 2011; 10 (41): 1113–20.
29. Dbouk HA, Huang CL, Cobb MH. Hypertension: the missing WNKs. Am J Physiol Renal Physiol 2016; 311: 16–27.
30. Bhavani N. Pediatric endocrine hypertension. Indian J Endocrinol Metab 2011; 15 (Supp. l4): 361–6.
31. Markel A.L. Genetika arterial'noi gipertonii. Vestn. ros. akademii nauk. 2008; 3 (78): 235–46. [in Russian]
32. Morris ST, McMurray JJ, Rodger RS et al. Endothelial dysfunction in renal transplant recipients maintained on cyclosporine. Kidney Int 2000; 3 (57): 1100–6.
33. Roullet JB, Xue H, McCarron DA et al. Vascular mechanisms of cyclosporin-induced hypertension in the rat. J Clin Inves 1994; 5 (93): 2244–50.
34. Richards NT, Poston L, Hilton PJ. Cyclosporine A inhibits relaxation but does not induce vasoconstriction in human subcutaneous resistance vessels. J Hyperten 1989; 1 (7): 1–3.
35. Cauduro RL, Costa C, Lhulieretal F. Endothelin-1 plasma levels and hypertension in cyclosporine-treated renal transplant patients. Clin Transplant 2005; 19 (4): 470–4.
36. Forslund T, Hannonen P, Reitamo S et al. Hypertension in cyclosporin A-treated patients is independent of circulating endothelin levels. J Int Med 1995; 1 (238): 71–5.
37. Karabesheh S, Verma DR, Jain M et al. Clinical and hemodynamic effects of renin-angiotensin system blockade in cardiac transplant recipients. Am J Cardiol 2011; 108 (12): 1836–9.
38. Lee DBN. Cyclosporine and the renin-angiotensin axis. Kidney Int 1997; 1 (52): 248–60.
39. Textor SC. Hypertension and transplantation in Hypertension Primer. Lippincott Williams and Wilkins, 2003.
40. Klein IH, Abrahams AC, Van Ede T. Differential effects of acute and sustained cyclosporine and tacrolimus on sympathetic nerve activity. J Hypertens 2010; 28 (9): 1928–34.
41. Sander M, Lyson T, Thomas GD et al. Sympathetic neural mechanisms of cyclosporine-induced hypertension. Am J Hypertens 1996; 9 (11): 121–38.
42. Victor RG, Thomas GD, Marban E et al. Presynaptic modulation of cortical synaptic activity by calcineurin. Proc Nation Acad Sci USA 1995; 14 (92): 6269–73.
43. Grassi G. Assessment of sympathetic cardiovascular drive in human hypertension: achievements and perspectives. Hypertension 2009; 4 (54): 690–7.
44. Zbroch E, Małyszko J, Mysliwiec M. Hypertension in solid organ transplant recipients. Ann Transplant 2012; 17: 100–7.
45. Schlaich MP, Grassi G. Sympatho excitation in calcineurin inhibitor-induced hypertension: villain or innocent by stander? J Hypertens 2010; 9 (28): 1809–10.
46. Gosudarstvennyi reestr lekarstvennykh sredstv. http://grls.rosminzdrav.ru [in Russian]
47. Robert N, Wong GW, Wright JM. Effect of cyclosporine on blood pressure. Cochrane Database Syst Rev 2010: Cd007893. DOI: 10. 1002/14651858.CD007893.pub2
48. Loughran JTP, Deeg HJ, Dahlberg S et al. Incidence of hypertension after marrow transplantation among 112 patients randomized to either cyclosporine or methotrexate as graft-versus-host disease prophylaxis. Br J Haematol 1985; 59: 547–53.
49. Grossman E, Messerli FH. High blood pressure. A side effect of drugs, poisons, and food. Arch Intern Med 1995; 155: 450–60.
50. Jensik SC. Tacrolimus (FK 506) in kidney transplantation: three-year survival results of the US Multicenter, randomized, comparative trial. Transplantation Proceedings 1998; 4 (30): 1216–8.
51. Bohlke M, Barcellos FC, Rocha M et al. Predictors of hypertension following successful renal transplantation: a population-based study. Trans Proceedings 2009; 9 (41): 3743–6.
52. Mangray M, Vella JP. Hypertension after kidney transplant. Am J Kidney Dis 2011; 2 (57): 331–41.
53. Cush JJ, Tugwell P, Weinblatt M et al. US consensus guidelines for use of cyclosporine A in rheumatoid arthritis. J Rheumatol 1999; 26: 1176–86.
54. Ekberg H, Griny J, Nashan B et al. Cyclosporine sparing with mycophenolate mofetil, daclizumab and corticosteroids in renal allograft recipients: the CAESAR study. Am J Transplant 2007; 3 (7): 560–70.
55. Pascual M, Curtis J, Delmonico FL et al. A prospective, randomized clinical trial of cyclosporine reduction in stable patients greater than 12 months after renal transplantation. Transplantation 2003; 75 (9): 1501–5.
56. Margreiter R. Efficacy and safety of tacrolimus compared with ciclosporin microemulsion in renal transplantation: a randomized multicenter study. Lancet 2002; 359 (9308): 741–6.
57. Gonwa T, Mendez R, Yang HC. Randomized trial of tacrolimus in combination with sirolimus or mycophenolate mofetil in kidney transplantation: results at 6 months. Transplantation 2003; 75 (8): 1213–20.
1 ФГБОУ ВО «Кубанский государственный медицинский университет» Минздрава России. 350063, Россия, Краснодар, ул. Седина, д. 4;
2 ГБУЗ «НИИ-Краевая клиническая больница №1 им. проф. С.В.Очаповского» Минздрава Краснодарского края. 350029, Россия, Краснодар, ул. 1 Мая, д. 16
*anna-babich1@yandex.ru
1 Kuban State Medical University of the Ministry of Health of the Russian Federation. 350063, Russian Federation, Krasnodar, ul. Sedina, d. 4;
2 Prof. S.V.Ochapovsky Clinical Hospital №1 of the Ministry of Health of the Krasnodar Region. 350029, Russian Federation, Krasnodar, ul. 1 Maya, d. 16
*anna-babich1@yandex.ru