Author: Меньшиков В.В.
Tags: патология клиническая медицина общая диагностика биохимия микробиология цитология
Year: 1999
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1'1106HH0l1a1'HH). fl.moxpoMHfI 3PHTPOl{HTOB conyTcTBYCl' H 60Jlce pCAKHM <popMaM
MaJlOKpOBHfI, HC CBSl3aHHbiM C J],CQJI1UHTOM >KCnC3a: CBHHLlOBOMY OTpaBncHHIO, Ta-
11aCCCMHH H APyrHM HacnCACTBCHHblM nOBpC>KACHHSlM 3pIITpOLlHTOB. CJlCAYCT
HMCTb B BHAY. liTO rHnoxpOMHSI' 3pHTpOl.lH1'OB MO>KCT Ha6JlIOAaTbCSI lIC T011bKO npH
CHH>KCHHH KOHLlCHTpal.l11H rCMorn06HHa H llUC11a 3pHTpOLlH1'OB B KpOBH, HO H npH
HOpMaJlbHblX KonHllCCTBCHHblX nOKa3aTC11 SIX. PC>KC BCTpC IaCTCH YCH11eHHaH OKpa-
CKa 3pHTpOLlHTOB C OTCYTCTBHCM npOCBeT11CHHH B UCHTpC - zunepXpO.MllR, CBH3aH-
METO,IJ.bl rEMATOnOrMYECKI1X MCCJJEAOBAHMM 19
HaSi C nOBblweHHblM HaCblL1l.eHHeM 3pHTpOLl,HTOB reMOrJI06HHOM H CO'-teTalOll\aSlCSI C
YBeJ1H'-ICHHbIM HX pa3McpoM - !twKpOl'llmo3o.M, !tfeZlI.IlOI{llnW30M. 3TH H3MCHCHHH
3pMTpOLlHTOB xapaKTcpHbl AnH ACq,HL{HTa TaKHX cjJaKTOpOB KpOBCTBOpeHHH, KaK
BHTaMHH 812, <lJOJ1HCRaSl KHCJ1OTa. H Ha6J11<JAaIOTCH npH aHeMHH AMHCOHa-EHpMe-
pa, AHcpHJ1J100OTpH03e, 3J10Ka'-leCTBCHHbIX OnyxOJ1HX, MHCJlOnpOJlHcfJepaTHBHblX 3a-
6oJlcnaHHSlx, MHeJ10AHCnJ1aCTWICCKOM CHHApOMC. rHnO'rMpC03C, aJ1KOr011H3Mc, 6c-
pCMCHHOCTH, 3a6011eBaHHSlX nC'-I.eHH. M3MeHcHMC OKpaCKH B BMAe nOAlapO.MamO-
ifJllAliU {3pHTpOLl,HTbl CPpoBaToro L{BeTa) 06yCJIOBJleHO OKpaCKOH KHCJ1LIMH H OC-
HORHblMH 1<paCHTc11S1MH. B HOpMC BCTpC IaIOTCSI C]J.HHH IHbIC nOJIHXpOMaTOq,M11b-
HblC 3pI1Tj)OL{H.Tbi. I1x '-IHCJ\O f10BhIWaCTCSi 111'1-1 YCI-IJ1CHHOM 3pHTpOno:;nC (nOCTrC-
f\mppanl lcCKHe aHCMHI1. I'CMOJIIITH'-ICCKl-le aHeMHH HAP.). npH Ta11aCCCMHH M APY-
I'HX rCMOrJI06HHOnaTMHX, 3a60J1cBaHHSlx nC'-ICHH. conpOBO>KAalOL1I.MXCSI A11HTeJ1bHOH
MexaHH'-ICCKOI1 )f(CJITyxol1. CBHHL{OBOH HHTOKCI-IKaL{HH BCTpC IaIOTCH TaK Ha3blBac-
MbIC .MULUeHeOUOHble 3PHTpOl-lMTbl - KJ1CTKH, HMeIOIl\He OKpaWCHHYIO ncpHcpcpHIO
M Ha cpOHC CRCT110H UeHTpaJIbHOH '-IaCTI1 Hc6011blllOrl 60JIce TeMHblH ccpepM ICCKHH
Y taCTOK. MHwenCBl'lAHbIC 3pI-lTpOL{MTbl HMCIOT YRC11H'-leHHYIO n110ll\Mb nOBcpXHO-
CTiI 3a C ICT 1-136blTKa XOJ1CCTCpHHa. nOSlBJ1CHHe 6a30ifJuAbHOli nYHKmm'llU B 3pH-
TpOL{J.'rrax CI3S-13aHO C naT0110rH'-leCKHM Kp0I3CTl30pCHHCM H xapaKTCpHO)J,JlH CBHHL{O-
BOro OTpaB11CHHSI. HO MO)!(CT RCTpC taTbCSI npH Apynlx q,opMax aHeMIIH. 3pHTp O llH-
Tbl C SlApOM - HOpM06JlGCmbl, apllnlpo6.1lGCmbi RCTpe'-IaIOTC)I B Ma3Kax KpORH npH
pa3JIH IHbIX aHCMHHX, rCM0611aCT03ax. EOJ1bIllOC K011H'-ICCTBO HopM06J1aCTOB xapa-
KTCpHO AnSI rCM011HTWICCKHX aHcMHf'I. MCTaCTa30B onyxOJ1H R KOCTHblH M03r. rH-
raHTCKHe HAcpHble 3pHTpOLlHTbi - MeulAo6JlllCnlbi - cBHACTeJ1bCTBYIOT 0 naT0110rH-
ICCKOM KpoBeTBopcHHH, CBSl3aHHOM C ]J.CcjJHLlI-ITOM BHTaMHHa 812, cfJOJlHeBOH KHC-
J101'hl. OpH 3THX >Ke COCTOHHHSlX Ha6J1IO]J.aIOTCSI.I1 3p.HTpOllHTbl C OCTaTKaMH HACp -
KOJlbLla Kc6OTa, TCJ1bLla )l(on11H. nOCIle]J.HHe cpOpMbl nOCTOSlHHO 06HapY)!(HBaIOT R
M<l3KaX KpoBH y 60JlbHbix nOCJ1e CnJ1eH3KTOMHH. lllapORHAHaSi q,opMa 3pHTpOL{H-
TOB, OTJ1H IaIOL1I.aHCH YMeHbwcHHblM J].11aMcTpoM II HHTCHCHBHOI1 6C3 npOCBeTJ1CHHf'I
oKpaCKoH, - MllKpocifJepm,llml)1 - SlBIIS1CTCH naTorHOMOHH'-IHbIM MOpcpOJlOrH ICCK"M
npHJHaKOM rCMonHTH lecKoH aHCMHI-I - Hacne]J.cTBcHHoro MHKpOCq,CpoLlMT03a. H3-
MCHCHHC COACp)!(aHHH cneKTpHHa npHBO]J.HT K HapYlllcHHIO YCTOH'-IHBOCTM MCM6pa-
Hbl 3THX 3pHTpOUHT0I3. B Hc60JlbllJOM KOJlI-I ICCTBC MHKpOCcpCpOl.\HTbI MorYT BCTpC-
'-laTbCSI H npH ApyrMx reM011HTH leCKMX aHCMHSlX. EOJ1blllOC AllarHOCTH ICCKOC 3Ha-
tlCHHC I-1MeeT o6Hapy)!(eHMC B Ma3Kax KpOBH 3pMTpOLlHTOB cepllOBUOHOit ifJOPMbl.
31'01' CHMIITOM xapaKTepcH AJ1H cepnoBHJ1,HOK11CTOLIHOH aHCMHH, OTHOCHll\Ci1CH K
rpynnc HacneACTBCHHLIX rCMor1106HHonaTI'IH. rCMor1106HH S 0611a.D,aCT cnoco6HO-
CTblO nOJIHMepM30BaTbcSI 1,1 Aeq,opMHpoBaTb MeM6paHY, OC06CHHO npH HH3KOM co-
ACp)!(aHI-IM KHCJlOpOAa B KpOBH. Ha 3TOM OCHOl3aHa "npo6a )!(rYTa", KorAa J];J1S1 YI3C-
J1H t ICHH)I cOJJ,cp)!(aHHSI cepnoBHAHLIX 3pHTpoLlIITOB ncpcA B3S1THeM KpOBl-I Ha naJleLl
naLl,UCHTa HaKJIaAbmaiOl' )f(rYT, '-IT06bl 13bl3l3aTb MecTHYIO rHnOKcmo. B COMHMTCJ1b-
Hl>IX CJ1Y'-IaSiX, KorAa IHCJlO ccpnoBH}J,HblX 3pHTpOL{HTOB B Ma3Kax HCBCJIHKO, C11CJ].Y-
CT npoBoAHTb np06LI Ha cCpnoRI-IAHOCTb 3pllTpOLlHTOB. OCHOl3aHHblC Ha Hcn011L30-
l3aUHlI BCII\CCTR (McTa6HcYJlbcfJJ.t:T HaTpHSI. SlHYCOI3LIH 3C11CHLIH, MCTH11CHOBbIH CH-
HHH), nOHH)!(alOll\HX CO]J.Cp)!(dHHC KHCJlOpOAa B npcnapaTax. A11S1 YCTaHoB11cHHSI
TO'-lHOro J1,HarH03a Tpc6yCTCH npoBcAcHHC 3ncKTpocpopc3a rCMorJ106HHa.
Ha CTeKJlC CMCWHBalOT Kanmo KpORH H Kan1110 01\HOrO H3 YKa3aHHbix BeLl.\CCTB,
HaKpblBalOT .£lOKpOBHblM CTCKnOM. npocMaTpHBalOT nOA MllKpocKonoM '-lcpe3 10-
15 MHH. 3aTCM 24-4811. B n0J10)!(HTCJlbHLIX cnY IaSix B npenapaTax K011H'-ICCTBO 3pH-
20 TOM II - 4ACfHbIE AHAJH1TJII4ECKJIIE TEXHOJIOrJIIJII
TpOLlHTOB cepnOBJ.1AHOM <pOpMI.I YBeJlHLIHBaCTCH.
JIumepamypa. CnpaAO'"IHK no KJII1HI-f"leCKHM JJa60paTopHbiM MeTOAaM HCCJle-
AOBaHHSI / noli. peA. E. A. KOCT. 2-c H3J],.- M.: MeHHLlHHa, 1975. c.17. JIIcCJleAOAa-
HHC CHCTeMhl KpOBH B KJlHHH'ICCKOM npaKTHKc. nog pCA. r.JII.Ko3HHu,a. B.A.MaKa-
pOBa. M., 1997.
:Jpumpoqumo.",empun (u3""epellUe iJuCM.empa 3PUnlpoqunloe)
Jf3""epe"ue c no. fOlqb'o oKY.Ilnp-""uKpo.'fe"'pa
npWIl ltll. J113McpcHHe AHaMcTpa 3pHTpOLll1TOB B OKpaweHHOM Ma3KC KpOBH C
nOMOU(hlO OKYJlSlp-MHKpoMcTpa.
ClleC'LtaAb1--lOe o60pyo06Gnue. l.MHKpocKon. 2. OKymlp-MHKpOMCTp - OKYJTSlP,
HaCa>KHBaeMbIH Ha Ty6yc MHKpOCKona. C KpYl'JlOH CTCKJTSlHHOH nJTaCTHHKOrf H HaHC-
CCHHOH Ha HCH lJIKaJlOH, pa31J,CJICHHOrf Ha 50 ACJTeHH t 3. 06LCKT-MHKpoMeTp -
npCAMCTHOC CTCKJTO co WKaJTOH AJlI1HOH 2 MM, pa3ACJlCHHOrf Ha 200 ACJTCHJ.1H (Ka>K-
Aoe ACJICHHe 10 MKM).
Xvi) vllpeoeilenuR. nCpCA Ha"laJlOM paooTbl onpeAeJTSlIOT LlCHY OAHoro ACJTCHHH
WKaJIbl OKYJlSlp-MHKpoMcTpa. KOTopaSi 3aBHCHT 01' AJ1HHbl Ty6yca MHKpOCKona H
YBcmfllcHHSI 06"bCKTI1Ba. OnpCACJTCHHC npoBoAHT C nOMOU(blO 06"bCKT-MHKPOMCT-
pa, KaropblH YCTaHaBJIHBalOT Ha C1'OJTHK MHKpOCKona raKI1M o6pa30M. "IT06bl WKa-
Jlbl OKYJTSlp-MHKpoMcTpa H 06'l.cKl'-MHKpoMcTpa COBnanH. 3aTCM OTC'IHTblBaIOT
"IHCJTO gCJTCHHH [uKaJlbl OKYJIHp-MHKpOMCTpa, COBnMalOlllHX C TeM HJUt HHblM KOJ1H-
"leCTBOM ACJTCHHH WKaJTbl 06"bCKT-MHKpoMeTpa, H onpcAellSiIOT LleHY OAHoro gCJTC-
HHSI. HanpHMep:40 HeJTCHHH WKaJTLI OKYJTHp-MHKpoMcTpa COBnalm C 6 IJ,CJTCHHHMH
06uCKT-MHKpoMcTpa, T.e. COOTBCTCTBYIOT 60 MKM; o.QHO ACJTeHHC 60/40=1,5 MKM.
31'0 onpCACJTCHHC npoBoASIT OAHH pa3 AJTH onpCACJTCHHOrO MHKpocKona, C nOMO-
ILlblO KOTOpOro B AaJlbHCHWCM npOH3BOASIT 3pHTpOLl.HTOMCTpHKJ.
Ha CYXOH oKpawcHHLIH Ma30K HaHOCSIT Kanmo HMMCpCHOHHOro M8CJl8, norpy-
>KafOT D HCC HMMCpCHOHHblH 06'heKTHB H MHKpocKonHpYIOT C MaKCHMarlbHO OCBC-
U(eHHbIM nOJTCM 3pCHHH. B TOHKOM MCCTe Ma3Ka (flJ,e 3PHTpOLlHTbi paCnOJIO>KeHbl
1130JlHpOB8HHO) H3McpsnoT AHaMeTp HC MCHCC 100 3pH"rpOLlHToB. OTMC"IaSl, KaKOC
KOJ1J.1"leCTBO AeJTCHH" IUKaJlbl OKYJIHp-MHKpoMcTpa YKJlMblBaeTcSI B 3PHTpOl'HT.
OTMC'IaIOT PC3YJTbTaT H3MepeHHSI Ka>KAoro 3pHTpoLlHTa (YJJ.06HO nOJlb30BaTbCSI 11-
KJ1aBHWHbIM CLleT"IHKOM, YCJlOBHO HCnOJlb3YSI pa3HblC KJ1aBHWH AJ1S1 onpeACJ1CHHO-
fO '-!HClla ACJTCHHrl WKaJTbl). 3HaSi U,CHY OAHoro ACJlCHHSI H KOJIH"ICCl'BO 3pHTpOLlH-
u
1'OB C OAHHaKOBhlM 'IHCJlOM ACJICHHH. Bblpa>K8fOT pe3YJTbT8T B npOUCHTax.
npHMCp: 3pHTpOI'HThl C J],H8MCTpor.l 4,5 MKM - 5%. 6 MKM - 10%, 7,5 MKM -
70%.9 MKM - 11 %, 10.5 MKM - 4%. PC3YJTbTaT MO>KHO npcJ],cTaAJ.1Th H B AHJW 3PH-
TpOLlHTOMCTpHLICCKOH KpHBOj:'j (KpHBaSi npaHc-,O,>KOHC8), IIPH 3TOM Ha OCH a6cLlHcc
OTKJTMblBafOT AHaMcTp n MHKpoHax. a H8 OCH 0PAHHaT - npoLlcHT 3pHTpOl'HTOB.
npH He06xoAHMOCTH PC3YJThTaT Bblpa>KafOT B AHJ],C CpCAHCro AHaMcTpa 3pllTpOl.lHTOB.
HOpMGAbHble { e.l1Hllllnbl. Y 3J],OpOAhlX milt HOpMOU,UTbl (3pHTpOUHTbIAH<1MCT-
pOM 7,5 MKM) - COCTaBJISIIOT 68 + 0,4%, MUKPOl,HTbI (HHaMcTp 5-6,5 MKM) -
15,3 + 0.42% H MaKpOLlliTbl (AHaMcTp > 8 MKM) - 16,9:t0.47%.
KAunll'leCKOe 3na 1 leJ--/Ue. Pe3YJlbTaTW 3pH"rpOUWI'OMCTpHH SlBJTSlJOTCSI Ba>KHbIMH
AJ1S1 YTOLIHCHHSI xapaKTcpa 8HCMHH. npH >KeJ1C3olJ,cqJHUHTHOt! aHeMHH, KaK npaOH-
JTO, HMeCT MCCTO MHKpOUHT03 3pHTpOLlHTOU 11.0 30-50% H, COOTBCTCTBCHHO, CIJ,BHf
METOAbl fEMAT0J10fl1l.JECKI1X I1CCJ1EAOBAHI1M 21
3plnpOUI1TOMeTpl1 ICCKOH Kpl1BOH BJ1CBO. YBeJ1I1 leHI1C npoucHTa MI1KpOUI-1TOB Ha-
6moJJ.aeTCSf TaK>f(e npl1 HaCJ1e CTBCHHOM MliKpOC<pCpOl.lI1T03e, TanaCCCMI-1I1, CBI1HUo-
BOM arpaBJ1eHI-1I1. YBeJII-1 ICHl-1e II-1CJla MaKpOl I1TOB SU3JISfeTCSf npl-13HaKOM MaKpoUI1-
TapHoi'! aHCMI1I-!, Ha6moJJ.aH)ll.lci'lcSi IIpl-1 B12- C<pI-1LlI1THbIX 11 <pOJmcBo e<pI-1LlI1THI.IX
COCTOSfHHJ!X. KOJ1WleCTBO MaKpOI HTOB npl1 3TI1X aHCMI1S1X MO>f(eT AOCTl-1raTI. 50% 11
6oJ1ee, npl1 3TOM n HCOOJlI.WOM 'IHCJle (1-3%) 06HapY>f(I1BatOT 11 Mcra.nOLlHTbl (3pl1-
TP 0 41-1Tbl C Al1aMCTpOM > 12 MKM). MaKpOLll1T03 3pHTpOUI1TOB MO>f(eT Ha6mo,IJ.aTI.CSI
HC3aBI1CHMO 01' aHCMI-U1 I1PH ,UlKoroJlI13Me, AI1<P<PY3HbIX nOpa>KCHHSfX nC'ICHI1.
J/umepamypll. r0J1bJ.l6epr A. 11.. rOJlb 6epr E. A. CnpaBO ml-1K no rCMaTOJlOrHH,
6-e 1-13).\.- TOMCK, 1980. c.72. I1CCJleAOBaHl1c CI1CTCMhl KpOBI-1 B KJlI-1HI1 'CCKOi'! npaK-
TI1Ke nOlI. pCA. r.I1.K031-1HLla, B.A.MaKapOBa. M., 1997.
Of),lIUU OOveA, 3pumporluHloO (ze.MUI1IOKpUl1man 6eAUatUlla)
reMaTOKpHTHa BCJUI"Il1Ha, HJlI-1 nOKa3aTCJlI. rc mToKpwra, AaeT npe CTaBJ1eHHC
o COOTHOWeHHI1 Me>f(AY om.cMaMI1 IIJla3Mbi H <popMeHHblx 31lCMCHTOB KpOBH (rJlaB-
HblM o6pa30M 3pHTpOLlHTOB), nOJly"'eHHoM nOCJlC ueHTpH<PyrHpoBaHHSI KpOBI-1.
npHU 1'0 rCMaTOKpI-1THOr. BCJIWIHHOH Bblpa>f(aTb 06"beM 3pI-1TpOLlI1TOB.
Memoo 0I1pe()eAeIlUJI leAtanW"pulIla c nO.ftlolll"l0 ./rIUKpolfellmpuifjyz.
npUHl{WI. UCHTpH<PyrHpOBaHl-1e KpOBI1 OlJpCACJ1CHHOe BpeMSI npH nOCTOSlHHOM
'-II1CJ1C 060pOTOB u,eHTpH<pynl C nocJle YIOIl(HM onpe,IJ.eJ1CHHeM PC3YJlbTaTa no cne-
LlI1aJ1bHOfi LUKane.
Pem<numhl. AHTI1KoarYJlSfHTbl: rCnapl1H - 5000 E.DJMJI pa:moASIT ,lJ.I1CTHJlJ1I1pO-
uaHHOH BO OH B COOTHOWCHHH 1: 5 I1JlI1 3THJlCH,lJ.Hat\-IHHTcTpaYKcycHOH KHCJlOTbl ,lJ.H-
HaTpJ1eBaSi COllI. (Nar3AT A, TpHJ10H E), 40 rlJl.
06opyoooOlme. 1. MI1KpOLleHTpH<pyra rCMaToKpHTHaSi JlH)60H MapKI1 2. KanHJ1-
JlSfpHbie Tpy6KI-1 (B KOMnJ1eKTC C 4CH1pH<fJyrofl). MO>KHO HCnOJlb30BaTb KanHJlJISlpbl
AJ1S1 onpe1\eJleHHSI C-pcaKTHBHoro 6CJlKa.
Xoo onper)e.lleHLlR. npCABapl-1TCJlbHO o6pa60TaHHblH aHTi1KOaJ YJUtHTOM 11 BbICY-
llICHHhli'! KcUTHJlJUIP 3anOJlHSlH)T KpOBhlO 113 l1aJlbL a (HJII1 BeH03HOH) Ha 7/8 1\JlI1Hbl.
YKynopl-1HatOT Ki:lI1I1J1JUIP C OAHoro KOHLla CnCLll1aJlhHof'1 nacTof'1 (MO>KHO nJ1aCTHJ1I-!-
HOM). nOMCll(alOT B pOTOp LlCHTpH<pyr"11 TaK, "IT06bl YKynopeHHble KOHUhl ynl-1pa-
J1HCb n pe31-IHonYI0 npOKJlaAKY, 11 LlCHTpH<pyrHpYIOT 5 MI1H npl1 8000 06/MHH. no 01'-
C ICTHOH WKalJe. npHJlO>f(eHHOH K UCHTpH<pyrc, onpCACJlSlIOT reMaTOKpl1THYIO BCJlH-
'IHHY.
MUKpo.rt,elllo() OIJpeOe.llelll11l1e.AWmOKpUma (MoAH<pHKaI HSI 11. ToJtopoBa)
npllHI(llll, UCHTpl-l<fJyrl-lpoBaHHc Kpoml onpeAeJleHHOe BpeMSI npH nOCTOSlHHOM
II1CJIC O(jOPOTOB LleHTpHq)YrH C nOCJlCnYIOll.lHM onpC CJlCHHeM pe3YJ1bTaTa no rpa-
A}'HpOBaHHhIM KanHJllHlpaM.
PeaKI1UtBbl TC >f(e.
06opyoooaHlie. 1. UeHTpH<fJyra. 2. nl1nCTKU OTannapaTa naH'leHKOBa (c oTpe-
3aHHbIM ACpXHl-IM KOHLlOM 11 AIIl1Hoi'1 10-11 CM).
Xo() OIlpeVe.lleHlLR. B o6paGoTaHHYI{) aHTHKoaryJlSlIiTOM H BblCOXWYI{) nl1llCTKY
Ha611pmOT KpOAI> 113 naJILLla (I11IU BCHO:JHYI{» AO BepxHef.i MCTKH (100 J,clleHHii).
nHneTKY YKynop lBal{)T. OOTSlrHAaSi cc pe3HHooLIM KOJlbUOM. H LlcHTpHq)yrHpYIOT
30-40 MUH np 1 3000 06/MUH. Pe3YJlbTaT afMetlalOT no rpaJ\)ll-lpOBKC KanHJIJlSlpa,
22 TOM II - 4ACfHbIE AHAJH1TI14ECKI1E TEXHOJIOfl111
BblLIHTaSi H3 100 ChiCOry cTOJ16HKa 3pwrpOLlHTOR,
HOp.MaJlbl--lhle aeJlll'IllHhl. Y 3AOpORbiX rCMC\TOKpHT 8CH03HOH H KamfJ11TSlpHOH
KpOB 1 panCH 40-48% (HJlH 0,40-0,48) AJ1S1 MY>KLIHH H 36-42% (HJ1H 0,36-0,42) AJ1S1
>KCHLllHH. Y AeTeH 0,5 Mec. rCMaTOKpUT 41-65%, 1 MCC. - 33-55%, 2 MCC. - 28-
42%,4 Mec. - 32-44%. 6 Mec. - 31-41 %,9 MCC. - 32-40%. 12 Mec. - 33-41 %, 1-2
rOAa - 32-40%. 3-5 JleT - 32-42%, 6-8 nCT - 33-41 %.9-11 J1eT - 34-43%, 12-14
neT - 35-45%, 15-17 JleT - 34-48%.
KALlHLl1teCKoe JHa 'I el--l lie. nOKa3aTCJlb WHpOKO HCnOJlb3yH)T AJISI cY>KAeHHSI 0
...
CTeneHH aHCMHH, npH KOTOpOH. KaK npaBHJlo. OTMCLlaeTCSI cro CHH>KCHHe, HHorAa
AO 3Ha ' IJ.1TeJlbHbIX LlJ.1cpP (20-25%). Bblpa>KeHHOC nOBblWCHHe (55-65 % )xapaKTcp-
HO AIISI 3pHTpCMHH. MCHCC pC3KOC yneJlH'ICHHe (50-55%) Ha6moAaeTcSI npH CHM-
nTOMaTH'-ICCKHX 3pHTPOLlHTo3ax. cony rCToYHULlJ.1X Bpo>KACHHbIM nopOKaM CCPALla,
JlCrOLIHOH Hc.o,OCTaTOlIHOCTH. HCKOTOpblM rCMorJlo6HHOnaTHSIM. nOKa3aTCJ1b reMa-
TOKpHTa )1.aeT npeACT3BJlCHHC 0 rCMoKoHI CHTpar(HOHHb'X C1J,BHrax, OH CHH>K3CTCSI
npH rCMOAHJlIO HH. I1cnOJ1b3YlOT rCMaToKpHT AIISI pacLlcTHbiX nOKa3aTencH, OTpa-
>KaIOWHX pa3J1HLIHble xapaKTcpHCTHKH 3pHTpOL HTOB: CpCAHHH 06"bCM, cpeAHSISI
KOHLlcHTpaLlHSI rCMorJlO6HHa, a TaK>KC AJISI pSll1a 6HOXHMH"CCKHX nOKa3aTeJlci1.
JIumepamypa. 3HI HKJ10nc.o,HSI KJ1HHHLICCKHX J1a60paTOpHhIX TCC1'08 n011 pCA.
H.THl.I,a, M.. 1997. TOJJ.OpOB 11. KIIHHHLICCKHC J1a60paTopHblC HCCJlCAOUaHHSI B I1C-
AHaTpHH. 3-e H3A. -COcpHSI, 1961, c.263.
H"oe"Cbl :JpumpollumoB
B KJlHHH'-ICCKOH npaKTHKc HCnOJlb3YIOT pa3J1H'IHbIC paC ICTHbJC xapaKTepl:1 CTH -
KH. OTpa>KaIOU\HC cpH3HKO-XHMHLICCKHC CBOHCTBa 3pHTpol(HT08. HaH60J1cC lllHpO-
KO npHMcHsnoT pacLlcT 1...IBCT080ro nOKa3aTeJlSl.
l(BemoBoii no"a3ame.tlb. I1HACKC OTpa>KaCT (yrHOCI-4TCJlJ.>Hoe cuAcp>Kam'lt: I e-
MorJlo6m a 8 3pHTpOLlHTax. B.bl l IHClIS11{)T LlBcTonof1.nOKa38'fCJlb onpCAeJ1CHHCM 01'-
HoweHUSI AUYX If(lCTHbIX, nORY'1CHHbIX 01' Ae.neHJ.1S1 KOOOlreCTHa rCMorIl06m'!a Ha Ko-
llH'.reCTBO 3pHTpOI HTOB B HOPMC H 8 HCCJ1eAYCf\.torl KpOOJ.1 no cIIe.o,YlOwcH QJOPMYJJC:
X reM X.}p
------ -----
J
N reM N;jp
rAe X reM - nartAcHHOC KOJlWICCTBO rC -IOrJl06HHa N reM - HOpMaJlbHOC KOJ1J.1 l ICCT-
80 re -IOrJl06HHa; X 3jJ - HaHAcHHOe KOJ1H l ICCTBO 3pHTpOLlI1T08; N 3p -HOpMal1bHOC KO-
JlH'ICC r80 3pHTpOl.{HTOB.
ECJIH npHHSlTb, LITO U UOpMC U 100 M1T KpOBH COACp)l{H1'CSI 16,7 r reMorJl06uHa
H 5000000 3pHTpOLlHT08 B 1 MKJ1 KPOB", TO paCCLIHTblBaiOT no QJopMYJle:
Xrc 1 X 3p
------ ----------
,
16,7 5000000
X rCM X. 5000000
lJ,8CTOBOH IIOKa3aTCJlb =
--------------------
,
X Jp x 16.7
METOJJ,bl rEMATOJIOrJ1'-IECKJ1X J1CCJIEJJ,OBAHJ111 23
X reM X 3
npH COKpall\CHHI-I :
t
neptfble 2 I(UifjPhl X'!p
B npaKTH lcCKOH pa60Te YJI,oOHO nOJlb30BaTbCH NUl no c ICTa LlBCTOBOro nOKa-
3aTCllH ncpec'lcTHblMH Ta61lHLlaMH. a TaK>t<C HOMorpaMMaMH.
HOPM(l.IlbHble oeJ1LtLlLlHbl. Y 3 OpOBbIX LlBCTOBOH nOKa33TCJlb HaXOAHTCSI B IIpC-
CJlax 0.86-1.05.
l0luHU'-leCKOe 3Ha'lelwe. no BCJlH IHHC LlBCTOBoro nOKa3aTeJ1H npHHSlTo CJlHTb
aHeMHH Ha mnoxpoMHble. HOpMOXpOMHblC H rHncpxpoMHhlC. rHnoxpoMHblC aHe-
MHH (c LlBCTOBblM nOKa3aTeJleM MCHec 0.86) WHpOKO pacnpOCTp3HCHbi H Ha6mo1J,a-
KJTCSI npc>t<flc RCCro npl! 1J,C mLll1TC >t<CJlC3a. BI.I3BantlOM pa31lH IHbIMH npHIIHHaMH.
OC06CHHO Bblpa>t<cHHoH rHnoxpoMHCfl (0.6-0.5 H HH)I(C) xapaKTcpH3YJOTCSI >t<CJlC-
301tC mLlI-ITHhlC aHCMHH. 06YCJIOBJICHHbie XpOHH'ICCKJ1MH KpOBonOTcpSlMH. MCHCC
Bblpa>t<CHH3S1 rHlloxpOMHSI 3pHTpOLlHTOB (0.7-0.8) Ha6JlKJ aeTC npH )f(CJlC30Ac m-
U"THOH aHCMHI1 6CpCMCHHI>IX. "PH J1H<pCKLlUHX. onyxoJlSlx. PeAKO BCTpClJaKJTCSI rH-
noxpOMHblC aHCMHH. HC CBSl3aHHbiC C e mLlHTOM >t<eJlC3a H 06YC1l0BJleHHbiC Hapy-
WCHHCM CI1HTC3a rcr.mrJl06HHa B pe3)lJlbTaTe C8HHI oBoro OTpaBJlCHUSlIIIJlH HaCJ1C.n.-
CTBCHHOro nORpC>t<HCHHfI CJtHTe:m nopqmpJ-lHol1 J-I Llcncfl rJlOfiHHa (J3-TIU1acCCMHH.
a-Ta.rmCCCMHH HAP.). nOBblWCHUC LlI3CTOBOro TlOKa3aTCJlfI - rHnepxpOMHSI - flBJlfI-
CTCSI xapaKTepUblM Jla60paTOpHbiM IIpH3HaKoM pa31lH'lHblX BI2- C<pHLlHTtlbIX J1 <p0-
JmCBo cq)HLlI1THbIX aHCMHH. Oc06CHHO Bblpa>t<Ctla rHncpxpOMHSI 3pHTpOLlJ1TOB
(1,2-1.3) npH pcuHAHBC aHCMHH AMHcoHa-EHpMcpa. HOpMOXpOM-HbIC aHer.UfH Ha-
6mOnaJOTcH np" HeKOTopblX rCMOJlHTl1\leCKHX q,opMax MMOKpOBJ1J1, OCTpblX KpO-
BOnOTCpSI'X. JlCHK03ax, conYTCTBYKJT LlHPP03Y nC ICHH.
Cpei>uee coi)ep:Hfa1lue zeAWlAOOU1Ia 6 3pumpolfume. nO({a3aTCllb OTpa>t<aCT
a6C0J1KYfHOC COJl,Cp>t<3HHC f'CMOrll00HHa R 0J\HOM 3pHTpOLll!TC B TlHKOrpaMMax (nr).
OnpC1J,CJ1S1JOT nYTeM JJ,CJICHHfI KOHLlCHTpaLlHII tcr.lOrJ106HH3 Ha l.fHCJlO 3pJ1TpOLlJITOB.
Hb (r/AJI) X 10
MC}; = --------------------
RBC (10'12/ J1 )
PaC ICT nOKa3aTCJ1S1 MO>t<HO npoH3BCCTJ.-I no HOMOrpaMMC (no Ma:JOHY).
HOpMaJlbHbU (1e.llU'lllflbl COCT3HJ1SnOT 27-31 nr.
K./lW-Ull/eCKOe 31-ltl l leHlle. CUH>KCHHC OTpa>KaCT I'HIlOXPOMHKJ H Ha6nKJ1J,3CTCSI
npH >KCJ1C30AC<pHLlHTHbIX aHCMHSlX. nOBblllJCHHC J1MCCTJ>.'ICCTO npH MaKpOJJ.HTapHblx
H OC06CHUO MCranOUHTapHhlX aHCMHSlX.
JIumepamypa. TOJJ,OpOB 11. KJII1HI1 I ICCKHC JJa60paTOpHble HCCllCJI,OBaHHSI B nc.n.H-
aTpHH, 3-e H3 ., PYCCK. -COq,HSI, 1961. c.272. J1cCJlC1J,OBaHHC CHCTCMbl KpOBH B KJIH-
HI1 ICCKOH npaK'IJ1KC nOJ\ pcn. r.M.K03JlIIlla. B.A.M3KapoBa. M., 1997.
Cpe()II.JlJ1 "o1l'felllnpaqU.JI le.UOlA06U1Ill 8 3p"mpolfume. nOK33aTCJlb oTpa>t<a-
eT CTcneHb HaCbHl(CHHfI 3pHTpOLlHTa rCMorJl06I1HOM B npou,cHTax. Bbl'-IHCJ1S1JOT ny-
TeM CJlCHHSI KOHU.CHTpaI HH rCMGrJ106HHa H3 rCM3ToKPHTHYlO BCJ1H'IHHY J1 YMHO-
)f(CHHSI Ha 100.
Hb (r/WI) x 100
M<:11<: = --------------------
Ht (%)
MO)f(HO J1CrKO pUCC II1TaTb. I1Cn0J1b3YSI HUMorpaMMY no Ma30HY. nOKU3UTeJ1b
BKJ1fO leH B nporpaMMY COBpCMeHHblX rCMaT0J10rI1'ICCKI1X aHaJl113aTOpOB.
HOp.Ma.nbHble (ie.llll1t.UHhf. MCIIC KOJ1c6JlCTCSI B npCACJ1aX 33-38 r/AJ1. Benl1 ll1-
Ha Hal160Jlcc KOHCTaUTHaSi. HUCbllilCHI1S1 BblWC 38% HC 6blBaCT.
K.nllHllLIeCKoe 3Ha'iCHue. CHl1>1<eHI1C nOKa3aTCJ1S1 OTpa>l<aCT a6C0J1fOTHYH) rl1no-
XpOMl1fO 11 SlBJISlCTCSI xapUKTcpHblM AJlSl .>KeJ1C30AC mu.I1THbIX aHCMI1H. l.{YBCTBI1-
l"eJlbHOCTb 3Toro I1HACKCU 3pl1TpOUI1TOB npl1 )f(CJ1C30Ac<fJMl.ll1THbIX aHCMI1S1X COCTU-
BJlSlCT 85 %. CHH)f(CHHC nOKa3aTcml UblSlBJlCHO TUK)f(C npH MaKpoLlHTapHblx 11 oco-
6CHHO MCraJIOLlHTapHblX UHCMHSlX. KorJJ,U 06,.CM 3pHTpoLlHTOB YBCJlI1 ICH HCnpOJlOp-
LlHOHaJlbHO GOJlCC 3Ha IHTCJlbHO no cpaBHCHHIO C YOCJlI1\ICHHCM HaCbllilCHI1S1 3p11T-
pOLlHTOB rCMOrJI06HHOM.
JIwl1epamypa. TOAOPOB J.1. KJlHHl1\ICCKI1C Jla60paTopHb1C I1CCJ1CJJ,OBaHI1S1 B nCAH-
aTpl1H. - CO<l)MSI. 1966. c.341, J.1cCJ1CAORaHl1c CI1CTCMbl KpORH R KJlI1HH ICCKOH npu-
KTHKC. nolJ, pCA. r.H.K03HHI a. B.A.MuKapoBa. M.. 1997.
I
J
24 TOM II - 4ACTHbIE AHAJIHTH4ECKJ.1E TEXHOJIOrJ.1J.1
CpeolluiI o6'be."., :Jpumpo14umofJ. nUKa3aTCJlb SlBJ1S1CTCSI Ba>KHbIM npH ,£\HarHO-
CTHKC pa3J1H\IHbIX <fJOPM aHc U1H. Bbl\IHCJlSlIOT I1YTCM J\CJlCHHSI rCMaToKpHTHOff BC-
JUf\II1Hbl Ha 06lilCC KOJ1H\ICCTBO 3pHTpOU.HTOB n KpOBI1. CpCAHI1f! 061>CM 3pHTpOLtH-
TUB (MCV) xapaKTcpH3YCT pa3Mcp 3pH'rpOLlI1Ta. Bblpa>KaJOT B Ky6H\ICCKHX MHKpO-
MCTpax (MKM"1) 11JH1 <fJCMl'OJ1HTpaX ( m). B aHaJ1113aTOpax H3MCpSlCTCSI no aMnmfTY-
HC l,n.mYJlbCoB. B03HHKalOlilHX npl1 npOXO)f(llCHHll KJlCTKH \ICPC3 ancpTYPY, OAHOBpC-
MCHHO C nOAC\ICTOM 3pHTpoLlHTOB. MO)f(HO pac'lcT BCCTH no HOMorpaMMc.
HOpMU./IbHble I-lC.IlU'IllHbl COCTaBmlfOT 75- 95 MKM (<1m).
J(IULHWleCKoe 3Ha'l.eHlle. nORhlWCHHC nOKa3aTCJ1S1 Hu6moJJ,acTcSI npl1 HaCJlC)J.CT-
BCHHOM MHKPOC )CpOLtHT03C, M<lKpoLtHTapHblx 11 MCraJIOLllfTapHblx aHCMHSlX, oco-
6CHHO Bb1COKOC 3Ha ICHHC (60JlcC 130 MK1l) RhISiBJ1CHO npH BI2-Ac<I)MUI1THbIX aHC-
MI1S1X. 06"bCM 3pl1TpOLtI1TOB \JaC'ro YBCJlWICH npl1 AH<fJCPY3HbIX nOpa)f(CHHSlX nC4CHI1,
aJIKOroJlH3MC. CHH)f(CHHC na6J1fOJJ,acTCSI npH MI1KpOU.HTI1pHbIX aHCMHSlX. TaJlaCCCMI1H.
JIumepllmypa. TOJJ.OpOB H. KJ1HHI1'ICCKHC Jla60paTOpHbiC 11CCJ1C)..lOBaHHSI B nCAH-
aTpl1l1.- CO )HSI, 1966, c.341. HCCJIC{.lOBaHHC CI1CTeMbl KpOBH B KJ1HHI1\ICCKOH npaK-
THKC. noJJ, pCA. r.vLK03HHLlU, B.A.MaKapoBa. M., 1997.
Cpeolluu oua.uemp :Jpump0I4Umo6. Bbl\IHCJ1S1KJT H3 PC3YJ1bTaTOB 3pHTpOLlHTO-
MCTpHH nYTeM YMHO)f(CIIHSI KmKJJ,oro npoLlcHTa KJlCTOK C Ol1pCJJ,CJ1CHHbIM JJ,l1aMCT- I
pOM Ha cro 3Ha ICHUC R MKM. CYMM...lpOBal-mCM 3THX npoI13BCJJ,CHHrl 11 ACJ1CHHCM Ha 100.
npu.«ep: npH 3pHTpOl HTOMCTpHH 100 3pHTpOLlHTOB BblSlBJICHO 10% :::IpHTpOI I1-
TOB C AuaMCTpOM 6 MKM, 70% - C HHUMCTpOM 7,5 MKM H 20% - C JJ,H<lMCTpOM 9 MKM.
CpC)..lH lrf f\l1aMCTp 3pI1TpOL HTOB (C.Q3) Bbl IHCJlSlIOT CJlCJ1.YlOlilI1M 06PU30M:
(10 x 6) + (70 x 7.5) + (20 x 9) 60 + 525 + 180 765
CJJ,3 = ------------------------------------ = ------------------ = ---- = 7.65 MKM
100 100 100
HOp.Ml1.1lbHbte (-ie.llllt/llH.bl CJJ,3 - 7.55 + 0.009 MKM.
KAllHll'leCKOC .JHlltleHlle. nOKa3aTCJ1b 3Ha t U1TCJTbHO MCHce I1H<fJopMaTHHcH, 'ICM
pa3BcpHY rble AaHHblC JpHTpOl HTOMCTpHH. Cmf)f(CHHC C.Q3 Hu6J1IOAaCTCSI npH PC3-
KO Bblpa>KCI-IHhIX )f(CJ1C30AC<fJ"I UTHbIX aHCMHSlX, nonblUICHI1C - npH pCLlHJJ,HBC aHC-
MI1H Af.lJ1.l1coHa-EHpMcpa 11 APyrHx BI2- )()JmCRoJJ,c )I1LlHTHhIX COCTOSlHI1S1X.
METOAbI rEMATOJIOrl14ECKl1X I1CCJ1EJJ.OBAHI1:M: 25
PenlllKY.flOIlUlnb'
Pemw<Y.IIOiClinlbl - MOJlO,D,bIC 3pl..rrpOl(HTbl. oGpaJYJOlllHCCSI nOCJIC nOTcpH HOp-
M06JlaCTaMH SI,D,Cp. BpCMSI C03peBaHHSI HX COCTaBJlSlCT 4,5 fJ,HSI, H3 HHX U TCt.leHHC
3 ,D,HeH OHH C03peBalOT B nepH<pcpw'lecKoH KpOBH. B HHX 06HapY>KHBaIOT BHYTpU-
KJICTO'-IHbIe CTPYKTypbl. ClUI3aHHbiC C CHHTC30M 6emmB (MHTOXOH,D,PHH, pH6ocOMbl,
annapaT rOJlhfl.>KH). MHorHC )CpMeHTbl (nHPYBaTKHHa3a, rJlloK030-6-<p oc q>aT,D,e-
rH,D,pOrCHa3a. KaTaJla3a H "p.) npHcYTCTBYIOT B peTHKYJIOl(HTax B 60JlbllJCH KOHu.eH-
Tpau,HH, '-ICM B 3PHTpou.HTax. PeTHKYJloU.HTbl cnoco6Hbi a,ncop6 lpoBaTb MOJICKynbT
>KeJleJa nocpclI,CTBOM peLlenTOpou K TpaHC )Cpp 1HY. XapaKTepHoH oco6eHHOCThI0
PCTHKYJlOLlHTOB UII CTCSI HaJlWIHC II I(HTOnJla3MC 3CpIIHCTO-HHT l IaTOH cy6cTaHLlHH.
npe)J.cTaBII I{)U eH arpcrHpomHlHhlt: pH6ocOMbi U MHTOXOHAPHH.3'Ta cy6cr aH u. HSI
BblSlBJISleTCSI npH cnCLlHaJlbHOM MeTO,nc oKpacKH - cynpaUHTaJlbHOM, T.C. 6e3 npe,nBa-
pHTeJlbHOH <pHKCal(H 1 KJleTOK. 3CpHHCTo-HH'fllaTa cy6cTaHLlHSI U pa3JIH'-IHbIX PCTH-
KYJlOUHTaX OTJlHllaCTC}1 nOJIHMop<p113MOM; lleM KJleTKa MOJIO>Ke. TeM cy6cTaHl.lHSI 60-
nce 06HIlbH<1S1. Y caMblX MOJIO,D,bIX PCTHKYJlOUHTOU OHa HMceT )opMY ryCTOro KJly6-
Ka. y 60JIce 3pCJlbiX KJleTOK BbISlBJlSlCTC U IUI,D,e CCTO'IKH, OT,D,CJIbHbIX HHTeH H 3aTeM
OT,nCJlbHbIX 3epCH. B Ma3Kax. OKpaUJeHHblX 06LI'UlLIMH rCMaTOJIOrl1 l lCCKHMH MeTO-
AaMH, peTHKYJIOU.HTLI npCJ],CTaRJ1CHbIIlOJIHXpm1aTO mIlbHhIM 1 3pHTpOLl,HTaMH.
Onpe.D.eJleHHe KOJIH'ICC'rBa peTHKYJIOU.HTOU npOH3BOAHTCSI npH MHKpOCKonHH
cneUHaJlbUO OKpaweHHblX Ma3KOB.
Menloo nooc.,ema KO.flU.,eCnlBll pemuKY.fl0IlUm06 /lOC.fle OKpaCKU UX 6pu.fl-
.flUallmOBbU. Kpe3ll.110BbIM CUllUM, u3ypo.!t11 U.flU U3ypO.!tf II IIenocpeocmBelll1O
IIa C11IeK.fle U.flU B npo6upKe
npllHl{llIl. CynpaBHTaJlbHaSi OKpaCKa KpaCHTCJ1S1MH. Bhl RJISIIOLllI1MH 3CpHHCTO-
HH r'-JaTYIO cy6cTaHLlt.1I0 peTHKYJlOLlHTon.
PeaKmLWbl. MO>KHO HCnOJIb30BaTb OJ\I1H H3 CJICHYIOII HX KpaCHTCJleH.
1. HacbllllcHHblH pacTBop 6pHJIJIHaHToBoro KpC3HJlOBOro CHHcro B a6COJ]lUrHOM
CnJ.1pTC (AJISI npHrOTOBJ1CHm1 a6cOJIIOTHoro cmlpTa HaAO BblfJ,ep>KaTb 3TaH0J1 96% B
HCCKOJIbKHX CMeHax npOKaJlCHHOrO nOpOllJKa MC)(HOro Kynopoca). Ha 100 MJ1 a6-
COJItOTHOrO cnHpTa 6CPYT 1,2 r KpaCKH.
2. PacTBop a3ypa I, npe,D,IIO>KCHHbIH n. H. KOpHKOBbIM: a3YP I - 1 r. aMMOHHSI
OKCaJl<lT - 0,4 r, HaTpHSI XJIOpHJl, - O,H r, 3THJIOUblH cnHpT 96% -10 MJ1, .D.HCTHJ1JlJ.1po-
BaHHaSi BOAa - 90 MIl. PaCTBOp KpaCKH B 3aKpbITOM <pIJaKOHe nOMClllalOT Ha 2-3 JJ,HSI
B TepMOCTaT npH 37°C J.1 ncpHO,D,HlleCKH 3HcprH l iHo B36aJITbmaIOT. 3aTeM oxna>K-
.D.alOT AO KOMH<lTHOH TeMnepaTypbl H <pHJlbTpYIOT 'ICpC3 0YMa>KHbIH <pHJlbTp. Pac-
TUOP coxpauSiIOT B nOCYAC H3 rCMHoro CTCKJJa. npH nOSlBJICIIIUI OCLVl.Ka KpaCKY CJ1e-
AyeT CHOBa npO )HI1bTpOBaTL,
3. PacTBop a3ypa II CJIeAYIOI cro COCTilBa: c!.3Yp II - 1 r, HaTpHSI UJ.1TpaT - 5 r, Ha-
TPHSI XJIOpt.lJ], - 0,4 r. AHCTHJlJ1HpOBaHHaSi BOna - 45 MIl. PaCTBOp OCTaBJ1S1JOT B TCp-
MOC raTe npH 37°C Ha 2 cy-r, nCpHoAI1'-leCKH nOMCWHBaSi. AJlSl YCKOPCHHSI pacTBope-
HJ.1S1 KpacKY MO>KHO nporpeTb na CJ1a60M orHC B Te'-leHHe 15-20 MHH, HC ,nOBO.D.SI .D.O
KHneHJ.1S1. OXJla>KfJ,<lIOT .no KOMHaTHOH TeMnepaTypLI H <PHJlbTPYIOT. XpaHSIT B nocy-
,D,e 113 TCMBOr-O CTeKJ1a.
CIlel4LllU1bHoe 060PYUO(-JaHlle. MHKpOCKon.
.
26
TOM II - YACfHbIE AHAJII1TI14ECKI1E TEXHOJIOrl111
Xoo OllpeOe.lleNltR. OKpaCKa Ha CTCKJlC. XOpOlllO RhlMblTOC U 06C3)1(HpCHHOe
npC.AMCTHOC CTCKJlO nO{\OrpCBaIOT HM n!laMCHCM rOpCJIKU. CrCKJlSlHHOif lIaJlOl.lKOH
u
HaHOCSIT Ha CTeKJlO Kanmo OAHOro 13 KpaC 1 rCJICH 1 rOTOASIT Ma30K H3 KpaCKH WJ1H-
<pOBaHHhIM CTCKIlOM. MapKHPYIOT CTOPOHY CTeKJla. Ha KOTOpYIO uaHCCCH Ma30K
KpaCKH, CTCKJIOrpaq)OM. B TaKOM IUlAC CTCKJla MO>KHO 3arOTOBHTb BnpOK H xpaHHTb
B CYXOM TCMHOM MecTC. HaHOCSIT KanmD KpOBlI Hi:\ Ma30K KpaCKH, roTOBSIT H3 HCC
TOHKH" Ma30K H TOTllaC nOMelllmOT 80 BJla)l(HYIO KaMCpy Ha 3-4 MHH (MO)l(HO nOJ1b-
30BaTbCSlI.laWKOH nCTpH C YJlO>KCHHbIMH no KpaSiM BaJlHKaf\.n1 CMOI.ICHHO" BaTbl HJlH
<pHJlbrpOBaJlbHO" 6YMarH). 3aTcM BblcYIIIHBalOT Ma3KH Ha B03AYXC. B npliroTOB-
IlCHHblX TaKHM o6pa30M Ma3Kax 3pHTpOI HThl oKpamcHbl B )l(CJlTOBaTO-3CIICHOBa-
1'1.1" l\BCT, 3CpHHCTO-HI1T'IaTaSi cy6cTaHlI,USI - B CHHHH UBCT,
OKpacKa B IlfJ0611pKe. Mel1l()() J: ncpcA ynOTpe6Jlcm1CM I'OTOBSIT B npo6HpKC
pa60 l IHH pacTBop 6pHJlIlHaHToBoro KpC3HJIOROro CHHCro U3 pacl.lcTa Ha KanJlIO 1 %
pac !'Bopa OKCaJl<lTa KaJ1HSI 4 KanIlt.1 pacTBopa KpaCKH 1. B KpaCKY Ao6aBJlSlIOT 0.04
MJl KpOBH (UBC mmCTKH AO MCTKH 0.02). CMCCh TlJlaTCJlbHO. HO OCTOpO>KHO ncpc-
MCWt.1BaJDT H OCTaBIlSlIOT Ha 30 MHH. nCpCMCWHUafUf 11 n>TORSlT TOHKHC Ma3Kt.1.
Memoo 2: B np06HpKY nOMClllalOT 0,05 MJI pac.mopa KpacKu 3 H 0,2 MIl KpOBH.
CMeCb TlllaTCJlbHO ncpCMcunmaJOT 1 OCTanJUIIOT Ha 20-30 MHH. nCpCMCWHBaJOT t.1
rOTOBSIT TOHKt.1C Ma3Kt.1.
MemO() 3: R np06HpKY nOMClllaJDT 0,3-0.5 MJl pacTBopa KpacKIl 2 H 5-6 Kancnb
Kpmm rnmC1 KO" 01' allnapaTa naHl.leHKOBa. np06HpKY 3aKpblBalOT pC3HHOBO"
npo6KoH. CMCCb TUlaTCJlbHO. HO OCTOP0)l(HO ncpCMcwHBatOT H OCTaBJISUDT Ha 1.5 '-I
(JIYI.IlUC oKpaumnalOTcSI PCTHKYJlOlll1Tbl npH 3KCn03HlI,HH 1/2-3 ll). nepcMcwHumoT
t.1 rOTOBSIT TOHKHC Ma'3KH.
nooc'lem pemllKY.llOl'1lI1100. B Ma3Kax 3pln POUHTbI oKpalllcHbl U >KeJlTOBaTO-
3cnCHOBaTblH LlBCT, 3CpHHCTO-HHT l IaTajJ cy6cTaHUI-ISI - B CHHI1i'1 HJIH CHHc.na ro-( t.10-
J1CTOBbIH UBCT.
npHroTOUJICI-IHblC OAHHM 113 YKa3aHHhiX BbltUe cnoco60B Ma3KH MHKpocKoImpy-
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MAXM. GEN-S. B aHaJ1H3aTOpax 3THX £}J11p,M nOM HMO OTHOCHTCJlbHOrO H a6co-
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B3pOCJlbiC 0,5-1,5
K.IIllNlt'/.eC1we 3fw'/.eNue. l.IHCJ10 PCTHKYJ10LtJ:lTOB B KpOBH oTpa>KaCT pcreHcpa-
THUnblC npoLtCCCbl KocTHOro M.o:,Jra, H OLtCHf<a..cro WHP<?KO HCJlOJlb3yeTcSI npH pa3-
JIH'lHbIX aHeMHS1)«- nOBG1WCHHC KoJfwlccTBa peTHKYJ101\H'tOB CJlY)l(HT Kpl-lTCpHCM
aKTHBaLJ,HH KpORCTBOpCHt1S1 H Ha6J1IOJJ.ae-:rcSi nocne.. KpoBonoTepH, npH reMOJ1HTHt.C-
CKHX aHCMl-1S1X, OC06CHl-IO B ncpHoA KpH3a (KO"J1WICCTUO peTHKYJI0LJ,HTOB MO>KCT
28 rOM II - 1.IACfHbIE AHAJII1Tl1 l lECKJIIE TEXHOJIOrMJII
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HOM B 12 (pCTHKYJ1OL{HTapHbIH KPH3 - nO}J,DC '1 llHCJla PCTHKYJIOUHTOB Ha 4 - 8-(1
J{CHb J1C l ICHHH). B Ha ' Ia11C pCMHCCHH npH rHnOlIJJaCTHllCCKOH aHCMHH. npH 3qJ<pCK-
THRHOH TcpanHH dHCMHit CHH>KCHHC K011H ' ICCT13a PCTHKYJ10UHTOB - nOKa3aTCJlb
CHH)f<CHHSI HHTCHCHBHOCTH KpOUCTBOpCHHH. Ha6J1JOAaeTc npH anJ1aCTH ' ICCKOH
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MHH. npH npJ.ICMC LtHTOCTaTH'ICCKHX npcnapaToB. J1Y"ICBoi'1 TcpanHH, :m60J1CBaHHHX
nOlICK.
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PC.fJ.. r.JII.Ko:mHu.a, B.A.MaKapoBa. M., 1997. PYKOBO,D,CTBO no rCMaTOJ10I"HH no,D,
PCA. A.I1.Bop06bcBa M.. 1985. 3HUHKJIOnC,D,H KJ1HHWICCKIIX J1a60paTOpublX TCC-
1'OB no,D, PC,D,. H.THua, M.. 1997. CnpaBo'IHHK no KJ1HHI-f'ICCKI1M J1a60paTopHblM MC-
TOAaM HCCJ1C.fJ.OBaHHH Ino)J. PCA. E. A. Koc-r. 2-c I1JA.- M.: MC,D,HlJ,HHa, 1975.
Pe3ucmelllmlOCI1Jb 3pumpOifumo6
)J.JlH OUCHKH qm3HKO-XHMH'ICCKHX CBOHCTII 3pHTpOUHTOB HCC11CAYIOT CTOHKOCTb
(pCJHCTCHTHOCTb) 3pHTpOUHTon K pa3J1H l lHblM BOJlJ.CHCT13H M. HaHooJ1bwcC pac-
npoc-rpaHCHHC B KJ1HHH l ICCKOH npaKTI1KC n0J1Y'IHJ10 HCCITC,D,onaHHC OCMOTHllCCKOfi
pC3HC rCHTHOCTH 3pHTpOlJ,I1TOB.
Memo() onpeOe.llellUH Oc."'01tlUlieCKoii pe3UCmelllnilOCltlll 3PUI1lpOllum06 tJ
AIOOUifJUKalfUU J1. H. HOe.llbCOlla (1974)
npUNl(Un KOJIH'ICCTRCHHOC onpCAeJ1CHHC CTcnCHH rCMOJTHJa 3pHTpOItHTOB B
m6yqJCpCHHbiX rHnOTOHH"ICCKI1X pacTRopax XJ10pHAa HaTpHSI.
PeaKntlUlbl. OCHOBHOH pacTBop (no CBOCft OCMOTH'ICCKOj.'1 KOHUCHTpaUHH COOT-
BCTCTBYCT 10% paCTBopy XJ10pHAa HaTpJ.I ) HMCCT pH 7.4. COCTaB pacTRopa: nBY-
3aMclllcHHblH <poc<paT HaTpH (Na2HP04)- 27.31 r (I-I11H Na2HP04 2H 2 0 - 34,23. r),
0,D,H03aMClllcHllhIH qJoc<paT HaTpu (NaH 2 P0 4 -2H 2 0) - 4.86 r. XJ10pHJ1. HaTpml - 180
r, AHCTHnJ1HpOBaHHa BOAa - no 2 J1. PacTBop MO)f<HO xpaHHTb n JaKpblTOH nocy]\c B
X0J10AHJlbHHKC R TC'ICHHC HCCKOJ1bKHX MCCHltCA. OCHOBHOH pacTlmp paJBO.fJ.HT n 10
pa3 H n011Y ' IaIOT pacTBop, COOTBCTCTBYtOlllHH no CBOCH OCMOTH'ICCKOH KOHUCHTpa-
UHH 1 % pacTBopy XJ10pHna HaTpH . J113 3Toro pacTBopa roTOB T pa60\lHc paCTRo-
pbl XJlOpl1Jta HaTpH CJ1CAYJOlllHX KOHuCHTpaltHf.i: 0.85; 0.75: 0.70: 0.65; 0.60: 0,55;
0.50; 0.45; 0,40; 0.35; 0.30; 0.20; 0.10%. MO)f<1I0 npl1rOTOBIITb no 100 MJ1 3THX pa-
60 ' IHX pacTBopoB H coxpaHHTb HX B X0110]\HJ1hHI1KC. rO,D,Hbl II TCllCHHC 2 HC})..
Cl'lel filUl"I-/Oe o6opyiJoBaNue. 1. <I>oT03JTCKTpoKOJ10pHf\-1CTp. 2. TcpMocTaT Ha 37°C.
Xoc) onpeiJe.lleNliR. B JJ.UC CTCpHJ1bHbIC npo6HpKH C npcgBapHTenbHO UHCCCHHbl-
MH 2 KanIl MI1 rCnapl1Ha 6epy,. no 1.5 MJI KpORH, nepCMCWHmHOT H O}).HY HCnOJ1LJY-
JOT AJ1 HCCJ1C.fJ.OBC\HHSI, BTOpylO - OCTaBJlSltOT HC\ CYTKH B TCpMocl'aTc. B pSI.fJ. UeHT-
PH<pY>KHbIX npo6HpoK (14 WTYK) pa3JU1BalOT no 5 MJI pa6o'lHx paCTBOpoU XJlOpHJt a
HaTpHSI C KOHlJ,CHTp3ltHci'1 OT 1 AO 0.10%. B Ka)f<J\YIO UCHl pH<pY>KHYIO np06HpKY AO-
6anJ1S1IOT no 0,02 MJI nCpCMCUIaHHoi1 rcnapuHH:mpoBaHHOH. KpOUH H oc ranJ1 IOT
npH KOMHaTHoH re lIIcpaTYpc Ha 30 MHH. lJ,cuTpH<pyrHPYIOT CMCCh KpORH C pac-
TBopmm XJlopH}J,a HaTpHSJ npH 2000 06/ n1H R TClleHHC 5 lIm. 113 Ka)f<AOH npouJ.1p-
KH C11HnaIOT Ha,D,OC£VI.0'1HYI0 )f<11}J,KOCTb J.1 H3MCpSiIOT ua qJOT03JTCKTpOKOJIOpHMCTpe
npH J],J1HHC BOJlUbl 500-560 HM (JCJICHLlrl cucToqmJ1bTp) B KJOBCl'C C TOJ1lI HHOH. CJIOSI
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METOJJ,bI fEMAT0J10fMlJECKYlX MCCJ1EJ].OBAHMI1 29
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TBOp XJIOpHALt H8TpHSI.
Pac<tem. 3a 100% rCMOJIH3 npHHHMatOT rCM0J1H3 B np06HpKC, cOACp>l<all(cfI
0,1 % pacTBop XJlOpHAa H8TpHSI. Bbl'IHCJlSlIOT npOLtCHT rcMOJH13a B Ka>l<AOH np06Hp-
KC, cpaBiumaSi BCJlJ1lIHHbl 3KCTHHKLtHH HLtJI,OCaj\O'IHOfl >KHAKOCTH C 3KCTHHKl\HCH,
npl1HSlTOH 3a 100%, no q)OPMYJlC:
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rAC E 1 - 3KCTHHKLtHSI Haj\OCLtJI,O'IHOH >KI1AKOCTH B np06HpKC C 0,1 % pacTBopoM
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np06J.1pKC C 0,1 % paCTBopOM XJlOpJ.1Aa HaTpHSL
Ha CJlCJl.YtOIl.(HH .n.CHb nOBTOpSitOT HCCJICAOBdHUC C KpOBbJO, HHKy6HpoBaHHoH 24
'I npH 37°C.
HopMaAbHble oe.nIl'IUHbl. Y 3AopOBbiX B CBC>KCH KpOBH Ha'larlO rCMOllH3a OTMC-
'latOT npH KOHllCHl paLtHH XJ10pHAa lJaTpml 0,50 - 0,45%, a nOJlHblif rCMoJ1H3 - npH
0,40 - 0,35 % pacTBopc xlIopHAa HaTpHSI.
K.nliHll'-leCKOe 3Hn r {.e1-tUe. I1CCJICAoBaHHc npOBOJlSlT npH ITOA03pCHHH Ha rCMOJ1H-
TWICCKYfO aHCMHIO. nOlm>KCHIfC OCMOTH'ICCKOH pC3HCTCHTHOCTH, T.C. nOSlBJlCHHC
rCMOJll13a 3pl1TpOllHTOB npH GOllCC BbICOKOH. 'ICM B HOpMC, KOHlICHTp8LtHJ1 XJ10PH-
Aa HaTpHSI (0,70 - 0,75%), H86JlfOAaCTCSI npH HaCJICACTBCHHOM MHKpOCcpCp O l\HT03C
H IICKOTOpblX HaCJ1C/J.CTBCHHbIX HCCq,CpOltHTaplJbIX rCMOJlHTH'ICCKHX aHCMHSlX, a
TaK>KC HHorAa npH aYToHMMYHHOH rCMOJlHTH'ICCKOrl aHCMJ.1H. B pSl.n.e CJ1Y'IaCB nOHH-
>KCHHC OCMOTH'JCCKOH pc:mCTCHTHOCTJ.1 BblSlBJUICTCSI TOllbKO npH HCCJlCAOBaHHH HH-
Ky6HpoBaHHoH KpOBH. nOBblillCHHC OCMOTHIICCKOH pC3HcTeHTHocTH xapaKTcpHO
AJiSI TaJiaCCCMHH. rC Wrn06HHonaTHH.
Jlumepamypa. PYKOBOJ1,CTBO no rCM3TOllOrJ.1H nOA pCA. A.YI.Bop06bcBa, M..
1985.
rIP06bl lIa !fiep.'IelllllOllamwo 3pUmp0'lumOB
npH HCCcpcpOLtHTapHblX rCMOJIHTH'ICCKHX aHCMHSlX B03HHKaCT Hc06xOAHMOCTb
HCCJICAOBaHHSI aKTHBHOCTH cpCpMCHTOB B 3pHTpOL HTax. B 3pHTpOLtHTaX COACp>KaT-
CSI q,CpMCHTbT rJ1HKOJH13a. nCHT030cpOcqJ8THOrO lIHKna. CHCTCMbl rJ1fOTaTHOHa, aj\C-
HHJIOBOrl CHCTCMbJ H APyrHx pCaKLtHH 06MCHa, 6J10Kaj\a KOTOpblX MO>KCT 6blTb CBSI-
3aHa C ACcpHLtHTOM cpCpMCHTOB.
HaH60JIcc pacnpOCTpaHCHHOH l-IaCIICACTBCHHOH q,CpMCHTonaTHCH 3pHTpOl J.1TOB
SlBJISlCTCSI ACcpHUHT rJIIOK030-6-cpoccpaTACnlJ porCHa3"1 (r-6-<f>J].), OTHOCSlIl.(CHCSI K
<pcpMCJrry nCHT030cpOcqJaTHOro llHKJ1a. AJ1SI AHarHOCTHKH Jl.cqmLtHTa f -6-«1> J]. Hal1-
60J1CC AOCTOBCpHblM JlBJISlCTCSI KOJlH'ICCTBCHHOC onpCACJICHHC aKTHBHOCTH <pcp-
MCUTOB B 3pHTpOLtHTax. B ycnoBHHX npaKTJ1lICCKOH pa60Tbi MorYT 6blTb BbIJ10J1HC-
Hbl Ka'ICCTBCHHbIC np06bl. HMCfOll.(HC OpI1CIITHpOBO'IHOC 3Ha'ICHHC.
Teem IIa 06paa06allue mene'l FeuII'la-:JpJlUXll "0 J(eullu
npUHlCWl. YfHKy6alll1S1 3pUTpOLtHTOB C MCTHJIORblM cpHOJICTOBblM H nOSlBJ1eHHCM
oKpallleHHblx rCJlcLt B 60J1bWOM Koml1lCCTBC B naTOJlOrH'leCKHX 3pHTpollHTax.
PeaKmlWbl. 0,5% pacTBop MCTI1J10BOI'O <pHOJJCTOBOro B H3OTOHH'ICCKOM pac-
30 TOM II - 4ACTHblE AHAnl1TI14ECKI1E TEXHOJIOfl111
TBOpC XJ10pM1J,a HaTpHSI.
Cl1e 'UaAbHOe o60pyoO(1UHlIe. MMKpOCKOn.
XOO UnpeOeAeml.R, CMeuJMBalOT B npOOMpKC paBHblC KOJ1M ICCTBa KpOBM M pac-
TBOpa MCTMJ10BOrO cpMOJICTOBOro, Tw.a'TCJlbHO ncpCMCWMoalOT M OCTaBJ1S1IOT Ha 10
MMH. fOTOBSIT Ma3KM H3 npc}J.McTHOM CTCKJ1C, HaKpblBaloT nOKpoBHblM M M iKpOCKO-
nMpYIOT C HMMCpCMOHHblM 06"bCKTMBOM.
HUpJ.taJlhHble BeAI£ iUHhl. TCJ1bu.a fCHHlla HC 06HapY>KMBaIOT B HOpMaJ1bHOH
KpOBM 3a UCKJ1IO leHHCM Hc60J1bWOrQ" KOJ1WICCTBa KJICTOK Y HOBOpO>K}J.CHHbIX MJIM
60J1bHb1X nOCJIC CnJ1CH3KTOMMH.
KflllHutteCIWe 3H(lLI-CHlte. TCJlbua fcrlHua npc}J.cTaBmtlOT COOOH npeuMnMTMpo-
l3aHHbll1 rCMOfJ106H.H, pCJiaTYPHpOl3allHblU rlpH OKHCJ1CHM i MJIM BpO>KACHHO HCCTa-
6Ml1bHbll1,. n pH n:c_cpm.lMTC f -6-<1> .o.f. ncpcA03MpOBKC cYJlhcpaHMJ1aMM}J.oB, OTpaBJ1C-
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cpaTHoro WYHTa. Y HOCWTCIICrl Hccra6wJlbHbiX rcr.1OrI106WHOB B 3PWTpOl\WTaX nOSlB-
JlSlIOTCSI TCJlbLla fCHHLla. Y J1WLl C 3TOH naTOJlorwCrl npwcM HW3KMX }J.03 OKWCJlS1lOlIUiX
npcnapaToB (acnMpwH, cpcHaLlcTwH. pC30PLlMH, CYJ1bcpaHHJlaMWAbl, CYJ1bcpOHbl M }J.p.)
MO>KCT Bbl3bIBaTb BHYTPwcocYAHCTblrl rCMOJIM3.
KallecnlfJell"blii ..'elUo() Mom}'JlbcKOlo-KeMn6eAJl
npUHt'Utl. B npHcYTcTllIm f -6-<1>.0. 06pa3ycTcSI NADPH. KOTOpblH 06CCLl8C IM-
BaCT 6pHJlJII1aHTOBblH KpC3HJIOBblH CHHMH.
PealW1U6bl. 1. PaCrBOp HaTpHCBOH C0J1HrmoK0'30-6-cpoccpaTa (825 Mr B 100 MJl
}J.HCniJ1JlMpOBaHHOl1 BOAbl). 2. PacTBop NADP (50 Mr Bl00 MJ1 AHCTHJlmipOBaHHoH
BOAbl). 3. PacTuop 6pHJJnMaHTouoro Kpc:n1J10BOrO CUHcro (32 Mr B 100 MJl A iCTMJI-
mipOBaHIH.)H BOAbl). 4. TpHc-6ycpcpHaSi CMCCb pH 8,5 (8,96 r u 97 MJl ]J.HCTHI1J1HpO-
Bal-iHOH BOJ.lbl-1-3 MJl KOHLlCIITp ipoBaHHoH HCI) . 5. napacpHH.
Xoo 011peOeJleHLLR. B np06HpKC CMCI.llHBaIOT: 0,1 MIl pCaKTltBa 1; 0,1 MJI pcaK-
THBa 2; 0,25 MJl peaKTHBa 3; 0,2 MJl pcaKTMBa 4. B APY[ YIO np06HpKY. KYAa :mpaHcc
BHCCCH 1 MJ1 AHCTMJlJlMponaHHoH BOAbl, }J.06aBJ1S1IOT 0,02 M1I KpOB i M3 naJIbu,a. CMC-
WMBalOT COACp>KHMOC 06CMX np06HpoK, CMCCb nOKpbmalOT 1-2 MJl >K i1\KOro napa-
cpltHa M CTaBSIT Ha BO}J.SlHYIO 6aHIO npH 37°C. 0 I'MC laIOT BpCMSI 06CCLI,BC'-IHBaHMSI
CMCC i.
HOpMQJlbHbte 6eAW-lUHbl. Y 3JJ.OpOBbiX pacTRop 06ecLlBc nmacTCSI. ICpC3 40-55 MMH.
lvwHltLteCKoe 3Ha'-teHue. 3aMCJIlICH iC 06cCLlBC'-IMBaHuSi 60J1CC 90 MHH CBI1AC-
TCJlbCTBYCT 0 Act1JULI,HTC f -6-<1>.0.. npH rCMOmiTWICCKOl1 3H:JHMOJ],CCPHI\HTHOH aHC-
MHH o6ccLlBe lHuaHMc HacTynacT ICpC3 3-24 [.
Kar,ecmeeHHblU AtemOo no £ep1llumeu,,}'
npUHl,u.n TOT >KC. 'ITO H B MCTOAC MOTYJ1bCKoro-Kcr.m6cJtSl, HO oKpaCKa 6pHJ1-
J1HaHTOBbIM KpC3HJ10BblM C iHHM 3aMCHCHa A IXJlOpcpCHMm'HAocpCHOJIOM.
PeaKn1LU3bt. 1. PaCTBop 2,6-AHXJ10pcpCHHJ1HHAocpcH0J1a (14,5 Mr Ha 100 MJl 6y-
cpcpHoro pacTuopa TpHC HC1,pH 8,0). EycpCpHblil paCTBOp COCTOMT H3 CJlCA)'lo-
Il.lHX KOMnOHCHTOB: 1.48 M pacrBop TpMCOKC iMCTHJ1aMUHOMeTaHa (43.27 r Ha 250
MJI DOAbl) H 1,48 M pacTBop HCI (2 ar.mYJlbl cpMKCaHaJ1a, COACp>Kall.lcro 0,1 r-3KB,
}J.OBO}J.SlT BOAOH AO 135 MJI). K 230 MIl pacTJ opa 1"p 1C A06aBIISIIOT 110 MJ1 pacTBopa
HCI H AOBOJ],SlT BOAOH AO 460 MJ1. 2. PacTBop cpcHa3HHMcTacYJlI cpaTa (2 Mr Ha 100
-
METO,QbI rEMAT0J10rI11.IECKI1X I1CCJ1E,QOBAHJ111 31
I
MJ1 BOJ].bl). 3. PacTBop NADP (2,3 Mr B 1 MJ1 BOAbl). 4. PacrBop rmoK030-6-cpoccpa-
Ta (15,2 Mr HaTpHcBoH COJ1H r-6-<l> B 1 MJ1 BOAbl). 113 3T iX paCTBOpOB rOTOB T pe-
aKTHBHYIO CMeCb CJ1eAYJOllJ,erO COCTaBa: peaKTHB 1 - 8 '-!aCTeH, pcaKTHB 2 - 1 '-IaCTb.
peaKTHB 3 - 0.5 "IaCTH H peaKTHB 4 - 0.5 "lacTIo!.
Cllel(Ua./lbHOe o60Pyc)oBllIlUe. Hc rpe6ycTCSI.
XOJ]. onpe}l,eJ1eHI1S1: B npo6HpKY C 1 MJI J].HCTHJlJlHpOnaHHoH nOAbl BHOCHT 0,02 MJ1
KpOBH H3 naJlbua. nOCJJC HacTynJ1CHHSI reM0J1H3a }l,06aBJ1S1iOT 0,5 MJ1 peaKTHBHoH
CMeCH. OCTaBJ1S1IOT Ha 15-20 MHH npH KOMHaTHOH TCMnepaType. 4epe3 15-20 M 1H
OueHHBalOT H3MCHCHHC UBCTa CMeCH.
HOp.Ma/lbHble BeJ/ll"lUHbl. 06CCUBc<U1B8miC CMCCH npOHCXOJlliT '-lcpe315-20 MHH.
f(;zuHu'-tecKoe .maLleHlle. SOJICC II03,1],HCC o{)ecUBcllHBaHHe CMCCH CBH}l,eTeJ1bCT-
ByeT 0 AecpI1U 1Te r -6-<1).0. B 3pwrpOlH1Tax. HCnOJ1HOe o6ecuBe'-umaHHe QCPC3 30 MHH
cooTBeTCTByeT YMeHbweHHlo aKTHBHOCHi r -6-<l>,Q. a OTC)'TCTBHC 06ecuBetmBaHH K
3TOMY npeMeHH CBHACTCJ1bCTBYCT 0 pe3KoM CHH>KeHH i aKTHBHOCTH cpepMeHTa.
JIumepanzypa. TOHoPOB 11. KJ1HHH'ICCKHe J1a60paTopHble HCCJ1e,l],OBaHHSI B neJ].H-
a1'pHH. 5-e H3J].. (PYCCK.) - COCPHH, 1966.
i
l(unwXILMU.,eCKfle flCCJle008allllH 3pumpolllllno8
U.HToxHMwlecK ie HCCJ1eAOllaHHSI OTJJH"lalOTCSI npOCTOTOH, He Tpe6YlOT Cllel\H-
aJIbHOro 060pYJl.onalU1H H AalOT OpHCHTHpOBO"IHUC IIpCHCTaBJICHHC 0 KOJ1H'leCTBe
HCCJ1eAYCMoro IlCLuCCTBa. I1CCJ1CJ].oBaHHSI 3pHTPOUHTOB npoBoJ].SlT C ueJ1blO BbIHBJ1e-
HHSI pa3J1M'IHbIX BHyTpHKJ1eTOtIHbJX BKJ1iO t leHHH, HaJlWIHH pa3HbiX cpOpM reMOrJ10-
6HHa. cpepMeHTHblX HapywCHHH.
CHnepOlH1ThI H cHJlep06JlaCTbi - 31'0 3pHTpOUHTbi H 3p 1Tp06J1aCTbl (HopM06J1a-
CTbl), COAep>KaLllHC B I\HTOnJ1a3Me HerCMOrJ106HHOBOC >KeJ1e30 B BHAC reMOCHACpH-
Ha i cpcppl-rnlH8.
Cfloepo6J1aCmbl fI cui)ep014ll1nbl
npUHt(LLn. OKpaCKa C nOMOI1\blO peaKI\ U1 1m 6cpmIHCKYIO J183ypb It! 06pa30Ba-
HHe BHYTpHKJ1eTO"IHbIX rpaHYJ1 CHHero UBeTa.
PeaKn1UBbi. 1. 2% pac'mop >KeJ1e1Hc'ro-eHHepoHHCTOro KalH1S1. 2.0,1 H. pacroop HCl
(8.2 MJ1 KOHUeHTpHpoBaI'lHOH HCI H J].HcHmmiponaHHoH BO,l],b1110 1 J1). 3.0,1 % pae-
TBOp cacppaHHHa. 4. MCTHJ10BbIH emip"'.
Cnel4UGJ/b/-lOe o6opy()o6aHlle. MHKpocKon.
XoO ollpeoeJ/eHIl.R. <l>HKC iPYiOT Ma3KH B MeTHJ10BOM cnHpTe 10-20 MHH H BbICY-
llumalOT H8 B03,1],YXC. nOMcLllalo'r B CMCCb p8BHbiX "laCTCrl pac !'BOpOB 1 H 2 npH TCM-
ncpaTYpc 50-56°C H8 15 -20 MHH. npOMblBalOT B npoTo IHOH BOJ].e 10-15 MHH H
OnOJ1aCKHBaIOT J].HCTHJ1J1HpOBaHHoH BOf1,OH. AOKpaulHBaiOT paCTBopoM cacppaHHHa
3-5 c.
HOpJ\UlJ/bHhle 6eJ/U 1 tUHbl. B nepHcpepl1 1 leCKO" KpOBH <II1CJ10 cHJ].epouHToB HC
npenblwaeT 1, 1 1o H COCTanJJSleT B cpej\HcM O,6i:0,04 % . B KOCTHOM M03re HX He-
CKOJ1bKO 60JJbWe - 0,2-2,1 %, KOJ1H"leCTBO cH,I],epo6J1aCTOB (SlJ].epHblx 3pHTpOUHTOB
C )t(eJ1e30COAep>KaLllI-IMH rpaHYJ1aMH) B KOCTHOM M03re 23,7i:2,4%.
KAllHLt'teCKoe 3Ha'leliue. CHH)t(eH ic CH,I],CpOUHTOB i eHAcpo6J1aCTOB xapaKTcp-
HO AJlSl >KCJ1C30fl,CcpHl\HTI'lbIX aHCMH 't nOllbI1UCI-iHC >KC11C30cOf1,Cp>KaU\HX KJ1eTOK Ha-
6J11Oj\acTCSI npH reMOJ1l1TH'-leCKHX aHeMHSlX. nOCJJe CnJ1eH3KTOMHH. npH MHeJIO}J.HC-
},
i
32 TOM II - 4ACTHblE AHAJU1TI14ECKI1E TEXH0J10rl1l1
nJ1aCni ICCKOM CHH11.pOMC (pecppaKTepHOH CHACpOOJ1aC1'HOH aHCMHH), 3pH1'pOr.me-
J103e.
JIumepllmypa. <».r.)J,>K.XeHXOY, )J,.KBar.1HHO. reMaTOJ10ni leCKaSi LlH1'OXHMHSI.
M.,1983.
tlJemaJJbllblii le.'tfOl.l106,1H. MemoiJ BemKe
npllHl.,UIl. 3J1lOLl IH reMorJ106HHa KUCJ10TOII C AOKpacKoH Ma3Kon Jl,aeT B03MO>K-
HOC1'b OTJm IHTb 3PHTpOl'H1'bl. C011.ep>Kal.l.{He cpCTaJIbHblH rcr.mrJ106nH, no coxpa-
HeHHOH OKpaCKe B OTJ1U lHe 01' 06ecLlBe leHHb1X 3pHTpOLlHTOB, cOAcp>Kaw. Hx reMO-
rJ106HH A. 31'01' Me1'01J, n03BOJISlC1' onpCJl.eJ1S11'b HbF J1HllIb B HCKOTOpblX 3pm-pOLJ,U-
Tax (MeHee 1 %) LlCJ\bHOH KpOBU ll3pOCJ1bIX.
PellKnlU6bl. 1. U. 1TpaTlio-cpoccpa1'HbIH 6ycpep (pH 3.2): 24,7 MJ1 0.2 M pacTno-
pa Na2HP04 (35.6 r Na2HP04 . 2H 2 0 H AO 1 J1 AHCTHJ1J1HpOBaHHoH BO,l],bl) H 75.3 MJ1
0,1 M pacTBopa miMoHHoH K iCJIOTbl (21.01 r J1UMOHHOH KUCJ10Thl H AO 1 J1 A iCT"J1-
J1I.-lpOBaHHoH BOAbl). 2. 1 % pac1'Bop MeTHJ10BO.-u cpHOJ1CTOBOro HJ1H 1 % pacTBop
303UHa. J1Y IWHC pe3YJlh1'a1'bi HaeT AOKpacKa MC1'HJ10nbIM <puOJ1e1'OnbIM. 3. 3rHJ10-
BblH cmip1' 80%.
Cl1el Lla.n.bHoe o60PY()ORllHue. l.M IKpocKon. 2. TepMocTaT Ha 37°C.
XOl) OIlpeOeJ1CHllll. c}>I-IKCHPYlO1' r.la3KH KpOB i B 80% an1J1000M cnHp1'e 5 MHH.
npOMblBalo1' Jl.HCTUJ1mipOnaHHoH nOJl.OH H OhlcywHBatoT. norpy)!(alOT Ma3KH Ha 5
MHH B nporpeTbl11 npH 37°C B ,.ClICHHe 30 MHH u 1TpaTHo-cpoc<paTHbIH 6y$ep (AJlSl
3J1tOLlHH reMorJ106HHa), nepH011.WleCKH nOMCUIHBaSi pac1'Bop CTeKJ1S1HHOH naJlOllKOH
AJ1S1 y,l],aJ1eHHSI nY3blpbKOU B03Ayxa. OnOJlaCKHOalOT Ma3KH AHCTHJ1J1HpOBaHHoH BO-
AOH. OhlcywmmlOT cp 1J1b1'pOnaJ1bHOrl 6YMaroH. AOKpauHmal.OT peaKTHnoM 2 B TClle-
Hue 2-3 MUH. flpoMbIBaloT ,lJ,HCTHJ1J1UpOnaHHoH nO,lJ,OH H BblcyunmalOT.
HOpltUlJlbHble lteAli1fllHbi. Y B3pOCJ1bIX llcTpe'lalOTcSI CJJJ1H" IHble oKpaUleHHble
3pHTpOI H1'bl (cOJl.ep>Kall He rcr.tOrJ106HI,1 F); YBeJ1HlleH ie llHCJIa oKpaUleHHblx 3pU-
TP0LJ,H1'OB Ha6J1to,l],ac1'cSi y HOBOP0>KACHHbIX H ,l],C1'CH AO 5-MCCSl l IHOro B03pac1'a.
KA.LlHLl',ecKoe 3HaLJeHlle. YBeJ1H"ICHHe "U1CJ1a 3p 1TpoLlH1'OB C HbF Ha6J11011.aCTCH
y 60J1bHb1X rOM03Hro1'HoH -1'aJlJ1acer.UlcH (20-100% HbF) , re1'ep03HroTHoH -
1'aJ1J1aCeMHeH (,1],0 5% B HCKOTOpblX CJ1Y'I8S1x). ccpnoBHAHOKJ1C'I"O l IHOH aHeMHH (1-
30%). J],o 10% HbF MO>KHO o6HapY>KH1'b npH napOKCl13ManbHOH HO"IHOH reMOrJlO-
6 iHypHU. pecppaKTepHof1 cH:J.cpo6J1aCTHOW m,leMHU, BpO>KACHHOM XpOHH'ICCKOM
r.IHCJI0J1CHK03e. napllHaJ1bHOfl KpaCHOKJ1CTOlIHOH altJ1a3HH. OCTpblX J1eHK03ax. CHII-
>KeHHC HhF Ha6moAac1 CSI npH I"CM0J1H"n1 l lecKoH aHeM m HOBOpO>K,IJ,CHHbIX.
JIumepamyplI. 3HlJ,HKJ10neAI'ISI KJ1UHI1lleCK iX J1a60pa1'opHblX 1'CC1'OB non peA.
Tm H., M.. 1997.
AKI1lUBIIOCl1lb r-6-tlJ,ll.r (K. (/).1.1.1.49)
npmu(wl. OKHCJ1elU1C rJ1tOK030-6-cpoccpaTa n npncYTc1'Bl-lH r -6-<1>.o.r npH y la-
C1'H i NADP, KOTOpblrl BOCCTanaBmmaeTCSI B NADP H; nOA I1J1HSlH11eM nOCJ1eAHcro
Te1'pa30m1i'1 BblSlBnSleTCH B BHAe rpaHYJ1 cpopMa3aHa.
PeUKmURbl. 1. 10% pac-fBop clJopMaJ1HHa. 2. I1HKy6auHoHHaH cpe,l],a: rn1QK030-
6-cpoccpa1' - 3 Mr B 1 MJ1, NADP - 1 Mr B 1 MJI, MarH iS1 XJ10pHJl, - 0,1 M B 0,2 MJ1. HH-
TpOC IH"" 1'eTpa30J1HH - 1 Mr B 1 MJ1, 1'pl1c-6ycpep 0,25 M (pH 7.6) - 2.3 Mn, cpeHa-
METO,l.I.bI fEMAT0J10fH4ECKHX HCCJ1E,l.I.OBAHHH 33
3HI'I-MCTaCYJlbcpaT - 0,5 MJl.
Cnel(LlallbHOe o6opyoo6aHue. 1. TcpMocTaT Ha 37"C. 2, MHKpoCKon.
XO]l, HCCJIC1J,OBaHHSI. Ha HCcpi1KcHpoBaHHbic Ma3KH KpOim HaHOCSIT 0.1-0.2 MJl
HHKy6aLJ.HOHHOH CpC,IJ,bl H nOMCLI aKYf Ma3KH B ropH30HTaJlbHOM nOJlO>KCHHH B TCp-
MOCTaT Ha 1 '115 MHH. cI>HKCHPYIOT B 10% pacTBopc cpopMa.lH1Ha 10 MHH npH KOM-
H3THOii TeMncpaTYpc. Bblcyw malOT Ha B03.n.yXC H M 1KpocKonHpYIOT.
HOp.MllJ/bHble 6e.nUI./UHbl. B 3PHTP<)LJ.HTax 06HapY>KHBaKJT 10-20 rpaHYJl cpop-
Ma3aHa.
KiJuHU(leCKOe 3Hll(lem,te. CHH>KCHHC 'IHCJ1a rpauYJI cpopMa3aHa R apHTpOLJ,HTaX
HJlH HX OTCYTCTBHC YKa3bIB3cT Ha ,l],CcpHLJ.HT r-6-<I),l.I.r. npHCM npoTHBoMaJUIPHHHblX
npcnapaToB. cpcHaLlc1'HHa, 60J1bWHX ,1],03 aCKop6HHOBOH K 1CJlOTbl, HCKOTOpblX
cYJlbcpaHHJlaMH)J.oB H CYJlbcpOHOB Y TaK 1X 60Jlbl'IbiX MO>KCT Bbl3BaTb rCMOJ1HTH"C-
CKYIO aHCM HO. CJlY'IaH rCM0J1H3a B03MO>KHbl npH OTpanJlCHHH 606aMH. ,l],Ha6cTH'IC-
CKOM aLJ.H,I],03C.
CKopOCmfJ oceoamm 3pumpoqunloB (CO.3)
HCcJlCAOBaHHc C03 SlBJlSlCTCSI OWU1M H3 caMhlX pacnpocTpaHcHHblX B Jla6opa-
TOpHOH npaKTHKc H BXOJ\HT B COCTaB 06L1..{cro KJlHH"'ICCKOro aHam13a KpOBH.
M llKpoMemoo HUI' "lellKOBa
ITPUHl(WI. CMCCb KpOB 1 C LJ. 1TpaTOM npH CTOSlH m pa3ACJlSlCTCSI Ha )J.Ba CJlOSI
(HH>KHUf1 - 3p 1TpoLU1Tbl. BCpXHl1H - r1Jla'3Ma). npH 3TOM C03. T.C. BCJIH"HHa C1'O)1-
6HKa r1Jla3Mbl, 6bIBaCT pa3JlH'IHOH B 3aBHCHMOCTH 01' H3MCHCHHH cpH3 1KO-XHMH'IC-
CK 1X CRoikTB KpOBH.
PellKmU6bl. 5% paCTBOp T)JCX::JaMCLI..{CHI'IOro L\l-1T)Ja1'a 1-taT)J 1S1 (C6Hs07Na3 ,5 H 2 0).
PacTBop cpUJlbTPYIOT (pH ]l,OJl>KCH 6blTb HCHTpaJlbUblM lum CJIa60Ll..{cJloQHbIM). np 1
nOMYTHcHHH pcaK1'HB HC roACH.
Cnel«rWJlbHOe 060pY006aHlte. AnnapaT naH(ICHKOBa. COCTOSlLl..{ 1H H3 WTa1'HBa H
KanHnnSipOB. np06HpKH H KanHnJlSlpbl ,lJ,OJl>KHbl 6blTb XHMH'ICCKH 'IHCTblMH, T. C.
Hc06xOAHMO 1X npOMblTb XpOMOBOH CMCCblO, MHoroKpaTHo nOCJ1C 31'01'0 BblMblTb
BOAOnpOB01J,Hoi1 BO,l],OH H 2-3 pa3a - ,I], 1CTHJlJlHpOBaHHoH.
Xoo onpeOeJleHuR. ncpCA HCnOJlb30BaHHCM XHMH'ICCK 1 'IHCTblH KanHnJlSlp npo-
MblBaKJT LlwrpaTOM HaTpHSI H '3.monHSlKJT 1M npo6HpKY AO MCTKH 50.
KpOlib 13 nanbl a HJlH Bellhl Ha6HpalOT ,lJ,B3>K,I],bl R KanHnnSip AO MCTKH 0 H nc-
pCHOCSIT B npo6HpKY C LJ. 1TpaTOM (ycHncHHo BblJJ.YB3S1 IiCKJ KpOBb). npH :;rfOM no-
nY'lalOT COOTHOWCHi1C Kpom1 H I HTpaTa 4:1. 3aKpblO naJIbLJ.CM BCpXHHH KOHeL\ Ka-
m11lnSipa. OCTOpO>KHO. <IT06bl KpOBb "3 Kal1l1JlnSlp3 HC Ublm1naCb, YCTaHaBJIHBalOT
cro B WTaTun CTporo nCpn1KaJlbHO. ynupaSi HU>KHUH KOHeLJ. B pC'3HHOBYIO npOKJla;,-
KY H npU>KUM3S1 BCpXHHH KOHCLJ, npoKnaAKOH HJlH np06KOH. YCpC3 'lac OTMe'lalO1'
CKOpOCTb OCC]l,aHHSI 3p 1TpOL.\I1TOB no BblCOTe OTCTOSlBwcrocSi CJlOSI nna3Mbi B MHJl-
m1MeTpax.
HOP.AfllJ/bHble ReJllll./UHbl. Y MY>K'IHH 1-10 MM/'I, Y >KCHL1l 1H 2-15 MM/'I, Y)J.eTeH
_ OT 2,5 + 0,9 MM/'I B 1 ]l,CHb H AO 4.0 :t: 2,1 MM/'-I Ha 2 IICAene. Ha npOTSI.>Kemm 1 ro-
Aa >KH31U1 C03 KOJ1e6neTcSI Me>KJ:\Y 5.0 + 2,0 MM/'-I 118.0 + 3.0 MM/,., B ,l],aJ1bHCHWCM
- Me>KJJ.Y 7,0 + 3,0 MM/<I H 9.0 :t: 3,0 M M/'1.
.
34 TOM II - '-lACfHbIE AHAJ1I1TH4ECKI1E TEXH0J10fl1l1
npH CHH>KCHHH TeMnepaTypbJ «20°C) nOMellleHHSI, 0 KOTOpoM npoooAHTCSI HC-
cne11.oBaHHe, C03 3aMcAnsleTcSI, npH nOBblUJeHHH - YBcmi'-IHBaeTCSI.
KAuHu'--tecKoe 3Ha'-lemte. YBeJ1H t leHHe C03 Ha6J1IOD,aCTCSI npH pa3JUi'-IHblX BOC-
naJ1HTeJ1bHbIX npollcccax, HHTOKC iKallHSlX, OCTpblX H XpoHHtlecKHx HH<jJeKLlHSlx,
npH HHtPapKTe M iOKapAa, onyxoJ1S1x. nOCJ1e KpoBonOTepH, onepaTHoHblx BMcwa-
TeJ1bCTB. OC06CHHO Bblpa>KeHHOe YCKopeHHe C03 (60-80 MM/tl) xapaKTepHo NUl
napanpoTeHHeMHtlccKHX reM06J1aCT030B (MHO>KCCTBeHHaSi MHCJ10Ma, 60J1C3Hb
BaJ1b11.eHCTpcMa. OCTpblH nJ1a3M06J1acTHbIH J1CHK03 HAP.) H cHMnToMaTH'-,eCKHX na-
panpOTeHHeMI1H. COnYTCrBYlOlllHX 3noKat.leCTBeHHbiM HOB006pa30BaHIUIM. XPOHH-
'-leCKOMY aKTHBHOMY renaTHTy.llHpp03y ne'-'CHH, T)'OepKyne3Y, aMHJ10H11.03Y, KOnJ1a-
rCH03aM. 3aMeAJ1eHHC C03 Ha6J1IOAaeTCSI npH apHTpCMHH H CHMnToMaTH4eCKHX
apHTpOllHT03ax.
J1umepamypa. PYKOBOACTBO no reMaTonorHH no11. peA. A.I1.Bop06beBa. M.,
1985. T011.OPOB 11, KnHHH'-leCKHe na6opaTopHbie HccneAoBaHHSI B nCAHaTpH i. 5-e
H3A. (PYCCK.) - CocfmSl, 1966.
ARQ./IU3 K.JIemOK "P06U 110 leMOmO.JIOlUlleCKUX QIIQ./IU30mopax
rrpeJ1MYlllecTBa m aBroMaTH'-ICCKOro aHaJlH3a KpOBH SlBJ1S1IOTCSI: BblCOKaSi npo-
J13BOAHTeJ1bHOCTb (AO 100 H 6oJ1ce np06 B tlac), He60J1bwoH o61,eM KpOBJ1 (12-150
MKn), OQCHKa 60J1ee 20 nOKa3areneH, BMCCTO 10-12 np i 06bl'-IHOM aHaJ1H3e KpOBH,
rpacfJHllecKoe npe]J.CTaBJ1eHHe pacnpeACJ1eHI1S1 KneTOK B BH]J.e rHcTorpaMM, CKeTO-
l'paMM, BblCOKaSi rotlHOCTb HccneAOBaHHSI.
Pa60Ta 60JlbwHHcTBa reMaTOJlOrH',eCKHX aHaJll13aTOpon OCHOBaHa Ha KOHAYK-
roMcTpH'-leCKOM MeTOAC, pa3pa60TaHHoM J.& W.Coultcr B 1947 mAY, KOropblH no-
3B0J1S1eT He TOJ1bKO nOACtlHTaTb KOnH'-ICCTBO KJ1CTOK, HO i oxapaKTCpH30BaTb 061.-
eM Ka>K]J.OH KJ1eTKH, npoXOASlllleH t.ICpC3 anepTYPY. npHHLlHn MCTOAa OCHOBaH Ha
nOACllere '-lHcna KJ1CTOK, npOXOASllllHX t.lepC3 anepTYPY, no 06c CTOpOHbl KOropOH
pacn0J10>KeHbl 3neKTpOAbl. tlepC3 KOTOpblC npOXOAHT nOCTOSlHHblH 3J1eKTpHt.leCKHH
TOK. npH npOXO>KAeHHH KJleTKH llepe3 MHKpOOTBCpCTHC COnpOTHBJ1CHHe B 3J1eKT-
pHtleCKOH QcnH B03paCTaeT H Ha npH60pc perHcTpHPyeTcSI HMnYJ1bC, KOJ1Ht'CCTBO
KOTOpblX COOTBcTCTByeT KOnH"CCTBY KnCTOK. AHaJ1 i3 aMnJ1HTYAbl HMnYJ1bCOB n03-
BOJ1S1eT H3MCpHTb o61,eM KJ1CTOK (HMnYJ1bC nponOpLlHOHaJ1eH 06DCMY KJ1CTKJ1). H
nOCTpOHTb KPHBYIO pacnpeAeneHHSI KnCTOK no HX 06veMy (rHCTorpaMMY). KOHAY-
K1'OMeTpHt'CCK iH THn C'-leTt.IHKOB npl1cnOC06J1CH AnSI TOllHOro nOD,cl,eTa apHTpoLlH-
TOB, J1eHKoQHTOB 1--1 TPOMOOQHTOB.
Ha KOHAYKToMeTpHllcCKOM npHHllHne OCl,lOBaHbl npH60pbl cfJHPMbl Coulter (ce-
pHSI M}J,-8. M}J,-10, M,lJ,-18), ACT-8, ACT-18. Sysmcx (F-520. F-820. K-800, K-
1000, K-4500). Roche (ABX-Micros), Biochcm. Immunosystcms (System
9000/9020. System 190, Spirit) H ]J.p.
B aHaJ1H3aropax nOCJ1eAYIOLLlHx nOK0J1eH d1 3TOT MeTOA COl'CTaCTCSI c HCn0J1b30-
BaHHCM AHtPcJ>epeHQHPYlOlllHX J1H3a1'OB, J1a3epHOro coeropacceHBaHHSI, paAHollac-
TOTHoro aHaJ1H3a. LlHTOXHMHllCCKOro MCTOAa (aHaJUi3aTopbl cpHPM ICN
Instruments. Roche. Coulter, Bayer. Abbott).
TaK, pa60Ta aHaJ1H3a1'Opa Sysmex SE-9000 OCHOBaHa Ha CO'leTaHHH KOHAYKro-
MCTpH4ecKoro MeTO]J.a H pa.!JJiO'lacroTHoro aHaJ1H3a. HOBoBBc]J.eHHeM n KOH YKTO-
MeTpHllecKoM MCTO]J.e 3Toro npH60pa SlBJ1S1eTCSI HaJ1H l IHC «AHHaMHtjccKOH cJ>OKYCH-
POBKH» KaHaJ1a. liTO ooecnetjHBaeT npoxO>KACHHe nOTOKa tlaCTHQ no lleHTPY anep-
-
METOAbl rEMATOJIOrHlJECKI1X HCCJ1EAOBAHI1H 35
TYpbl 101 HCKJUO'-laeT wx cnHnaH ie. TCM caMblM J.{OCTHraeTCSI BblCOKaSi TO'-IHOCTb 101
BocnpoH3BoAHMOCTb pe3ynbTaToB ( CV < 1 %). nOAc'-leT 101 AHcp4>epeHLI. ipOBKa J1eH-
KOLl.HTOB oCYll.leCTBnSleTcSI nOCJ1C }:\06aB11cHwSI J1H3HPYIOIl.lHX pcareHTOB. Ami BbISlB-
11CHI1S111 C'JeTa 303WH04>HJ10B 11 6a30clJWJ10B CHCTCMa cHa6)1(eHa OT}:\eJ1bHbIMI1 AeTeK-
TOpHblMH KaHaJlaMH. pa60Ta KOTOpblX OCHOBaHa Ha npHMeHCHHI1 CneLl.I14JH1.leCKHX
nI13aTOB. AHaJ1W3aTOp SEM9000 OCHall.lCH CnClJ.HaJlbHblM K8HaJ10M, npC}:\Ha3Ha"lCH-
HblM A11S1 AHcpclJepCHlJ.HaJlbHO" Jl,HarHOCTI1KH HC3penbiX rpaHynOLl.HTOB.
I1Cn0J1b30BaHHC O]J.HOBpeMCHHO HCCK011bKHX MCTO]J.OB amum:m 1J,aCT B03MO>K-
HOCTb 3Ha'JHTe11bHO Y11Y'-IWHTb Ka'-ICCTBO 1J,HcpclJCpCHlJ.HpOBKH KneTOK. ABTOMaTH-
'-ICCKW" aHaJlH3 KpOBH n03BOllSieT n011HOLl.CHHO oxapaKTepH30BaTb KpaCHYIO KpOBb
no CJ1CJJj'lOlllHM napaMCTpaM: RBC. HOB. HCf, MCV, MCH, MCHC, RDW.
CpeoHui't 06"beM apumpm.Cuma (MCV) - nOKa3aTe11b, xapaKTepH3YIOIl.lHH pa3-
Mep 3pHTpOLl.HTa B Ky6H'-ICCKHX MHKpoMe1"pax (MKM J ) HJ1H tPCMTOJ1HTpaX (4)11). 113-
MCpCHl1e MCV npOBoAHTCSI O]J.HOBpeMCHHO C nOAC'-ICTOM 3p iTpOQHTOB no aMnJ1l1-
1)']J.C WMnY11bCOB, B03HHKaIOU' iX npH npOXO>KJleHH i KnCTKH I.ICpe3 ancpTYPY, a pe-
3Y11bTaTbl OTpa>KaIOTCSI B BH]J.C rHCTOrpaMMbl pacnpC]J.cnCHWSI 3pHTpOLl.WTOB no I1X
06DCMY. EOJ1bWHHCTBO COBpeMCHHblX aHaJlH3aTOpOB n03BonSilOT oxapaKTCpH30-
BaTh 3pHTpOLl.HTbi 06DCMOM 01' 30]J.0 250-300 4>11.
OOKa3aTenb MCV MeHHeTCSI B Te'-ICHWC BCC" >KH3HW: y HOBOpO>K]J.CHHbIX OH }:\o-
CTHraCT 128 cpJ1, B TC'-ICHHC ncpooi1 HeAcmi CHH)I(aCTCSI AO YPOOHSI 100-112 4>11. K
wecni MCCSlQaM napaMCTp naAaCT AO 78 tPn, K roAY COCTaBnSlCT 77-794>11, B B03-
pacTe 4-5 J1eT HH)I(HSISI rpaHHLl.a HOpMbl (80 11) cTa6H11H3HpyeTcSI. MCV HI1>KC
80 cpn OQeHI1BaCTCH KaK MHKpOLl.HT03. BblWC 95 cpn - KaK MaKpoLl.HT03.
CYIl.lCCToyeT PSiA COCTOHHHH, npl1 KOTOpblX OlleHKa MCV 3aTpYAHeHa. TaK, npl1
MHKpoc4J c pOl.lHTapHoi1 reM011HTH l leCKOH aHCMHH MHKpOCcpCpOllWTbl HMeeT AHa-
MCTp MeHbWC HOpMbl, B TO BpeMSI KaK cpeAHHH 061>CM ero '-fall.lC OCTaCTCSI B npe-
]J.cnax HOpMbl. B CBSl3H C 3TWM C11CAYCT nO]J.'-,cpKHYTb Hc06xo1J,HMOCTb napaJInCJ1b-
Horo H3Y'-ICHHH Ma3Ka nepHcpcpH'-ICCKOH KpOBH C H3McpeHwcM AHaMCTpa 3pHTp O lJ. W -
TOB 11 onHcaHHeM MopcJx>11orHw KJ1CTOK. npH Bblpa>KCHHOM aHH30u.WT03C 3PHTpO-
lJ.HTOB, KorAa B KpOO i npHcYTcTBYIOT MHKpO- i MaKpOLl.HTbl, MCV, HBnSlSlCb CpeA-
HHM nOKa3aTeneM 061>CMa BCCH nonynHLlHH KnCTOK, I1MCCT 3Ha1.leH iH B npcAc11ax
HOpMbl. n03TOMY OH AOn)l(CH y'-II1TblBaTbcH B KOMnJ1eKCC C nOKa3aTeJ1CM aH1130QI1-
T03a (RDW) 11 3pH'rpOLlI1TapHOH rHCTOrpaMMoH. IlpH X01101l,0B0i1 aYToarrmOTI1Ha-
LlIUi nOKa3aTeJ1b MCV MO)l(CT 6blTb 110>KHO 3aBbIlUCH, '-11'0 YCTpaHSlcTcH npw Harpe-
BaHWH npo6bl. MCV MO)l(eT 6blTb nO>KHO 3aBblWCHHbiM npH ]J.Ha6eTH1.lcCKOM KeTO-
alJ.HJI,03C BcnCACTBHC rHnCpOCMo11S1pHOCTH nna3Mbl. OTHOCHTCJ1bHOC CHH>KeHHe
MCV MO)l(CT 6blTb cnC]J.CTBHCM nOBblWCHHoro COJlcp)l(aHHSI cpparMeHTOB 3p11TpO-
U.I1TOB B KpOBH (KoarynonaTHH nOTpc6J1CHWSI. MCXaHI1'-ICcKwi1 rCM011113 W AP.).
rCMaToKpHT pacc'-JHTblBaeTCH B C'-ICT'-IHKaX no I.lwcny 3pH'rpOllWToB 101 MCV.
CpeoHee cOOepJICaHUe zeMo2.llo6uHG B apumpol{ume (MCH) SlBnHCTCSI pac1.ICT-
HblM nOKa3aTC11CM. OH xapaKTepH3yeT cpc}:\Hec cO]J.cp)l(aHHC rCt.1Orn06wHa B 01'-
AC11bHOM 3PHTpOl....HTC B a6C011IOTHbIX eA iH ilJ.aX. Ha OCHOBaH iH MCH OCHOBaHO
pa3]J.cncHHc aHcMHH Ha HOpMO-, rHno- W rHncpxpoMHblC. MCH - 60ncc om.CKTHB-
HblH nOKa3aTe11b. '-(CM lJ.BCTOBOH nOKa3aTcnb, KOTOpblH HC 01"pa>KaeT CWHTe3 reMO-
rn06HHa 101 cra COACp)l(aHWC B 3pHTpOllHTC.
36 TOM II - 4ACTHbIE AHAJ1I1TI14ECKI1E TEXHOJIOfl111
-
Ta6mn.l,a 4
HOpMaJlLHLle nOK333TeJIH MCn B 9pHTpO HTe (Dr)
KpOBb nnOAa
18-20 HCA.
21-22 He])..
23-25 HeA.
26-30 HeA.
KpOBb H3 nynoBHHbl
0,5 Mee.
1 Mee.
2 Mec.
4 Mec.
6 Mec.
9 Mec.
12 MCC.
1-2 r.
3-5 neT
6-8 J1CT
9-11 neT
12-14 nCT
15- 17 neT
18-44 roAa
45-64 ro1J,a
65-74 roAa
.
43,14:1:2,71
41,39:1:3,32
40,48:1:2.88
37.94:1:3,67
31-37 (2 SD)
30-37
29-36
27-34
25-32
24-30
25-30
24-30
22-30
25- 31
25-31
26-32
26-32
27-32
27-34
27-35
27-34
Cpei'JHR.R KOHl(eHmpat U.R zeMo2.llo6uHG {3 apUmpOl{Ume (MCHC) OTpa>KaeT
CTeneHb HaCblll.l,eHHSl3pHTpou,HTa reMorn06HHoM H TaK>Ke paeCllHTblBaCTCSI npH6opoM.
CHH)I{eHJ.ole MCHC Ha6ntOAaeTcSI npH 3a60neBaHHHx, COnpOBO>KjJ.aIOIl.I,HXCSI Ha-
pyweHHeM CHHTe3a reMOrJ106HHa. Jho6aSl HeTOlIHOCTb, CBSl3aHHaH C onpe]).e.neHHeM
reMorno6HHa, reMaTOKpHTa. MCV npHBO,lJ,HT K ynenHllCHHfO MCHC, n03ToMY 3TOT
napaMeTp MO>KeT 6blTb Hcnonb30BaH KaK HHAHKaTop oW i6K i npH6opa, HnH OWH6-
KH, jJ.onYll.l,eHHoH npH nOJ],roTOBKe IIpo6bl K HCCJ1C,IJ,OBaHHfO. AHaJ1H3aTOpbl cepHH
«Technicon» (1-1-1, H-2, H-3) Henoepe]).CTBeHHO H3MepHlOT KOHLJ,eHTpaUHlO reMO-
rn06HHa B Ka>K]J.OM 3pHTpOl..tHTe H CTpoSiT rHcTorpaMMy pacnpeAeneHHSI KneTOK He
TOJJbKO no o6neMY, HO H no KOHLJ,eHTpaUHH reMorn06HHa, npH 3TOM BBOAHTCSI HO-
BblH nOKa3aTeJIb - wHpHHa pacnpe]J.eneHHSI 3pHTpOUHTOB no KOHLJ,eHTpal.l,HH ref\1O-
rn06HHa (HDW).
floKCl3ame.llb GHll3mCUm03Cl apllmpmCllmOf (RDW) paCClntTblBaeTcSI KaK K03ct>-
tPHu,HeHT BapHaUHH CpeJl,HCrO 06'bCMa 3pHTpOUHTOB: ROW = SO/MCV x 100 (%),
r]J.e SD - cTaHAapTHoe cpe]J.HcKnaApanillccKoe OTKnOHeHHe 06'beMa 3p iTpOl.l,HTOB
oTcpeAHer03Ha l leHHSI (HopMa 11.5 -14.5%).
npHOOpbl tPHPMbl Sysmex BblAalOT pe3ynbTaTbi KaK B BHAC RDW-SO, TaK H
ROW-CV, T.e. K03cfJQJHUHcHTa BapHauHH o6neMa 3pHTpOl.l,HTOB (%). AHH30LJ,HT03
xapaKTepH3yeT Konc6aHHSI 06'beMa 3pHTpOUHTOB H ynaBJ1HBaCTCSI npH6opoM 3Ha-
IHTenbHO 6blCTpee, "leM npH BH3yanbHoM npocMoTpe Ma3Ka KpOBH. OueHKa CTene-
HH aHH OUHT03a no]). MHKpocKonoM conpOBO>KAaeTCSll.I,CnbiM PSlAOM OWH6oK. npH
BblCblxaHHH 3PHTPOU,HTOB B Ma3Ke HX ]).HaMeTp YMCHbwaeTCSI Ha 1()-20%, B ron-
CTbJX Ma3Kax OH MCHbwe. lleM B TOHKHX. nonHoCTbto H36aBHTbcH OT apTcqJaKTOB
"
METOAbl fEMATOJIOfl1YECKI1X I1CCJ1E,IJ,OBAHI1I1 37
n03BOJlSlCT TOJlbKO aBToMaTH3HpoBaHHblH nOAC'ICT C HCn0J1b30BaHUCM KOHA}'KTO-
MCTpl1'ICCKOro MeTOAa, rJ].c coxpaHSlCTCSI cTa6uJlbHOCTb KJleTOK H BocnpOH3BOAI1-
MOCTb pC3ynbTaToB, IHcTorpaMMa rpmpH4ecKH OTpa>KaeT 'JaCTOl)' I3CTpC'JaCMocni
3pWI'pOLlHTOB pa3Horo oG'beMa.
KBanHqmLlHpoBaHHaH HHTCpnpCTaLl iSl nOJ1Y'-ICHHbIX pC3ynbTaTOB n03BonSiCT J].H-
arHOCTHpOBaTb H onpCAcnHTb xapaKTep aHCMHH, OpHCHTHpoBaTb upatla Ha npOBC-
)J,CHHC AononHHTcnbHblX HccncJ].oBaHHH, TaKHX KaK onpeACJlCHHC CbIBOpoTO'-IHoro
>KCJlC3a, cpCppHTHHa, BHTaMHHa B12. B Ha'-laJlbHOH CTa)),HH )KCJ1C30AcqmLll'lTHOH aHC-
MHI1 ()J(JJ.A) KOJ1HLICCTBO 3pHTpOU,UTOB HaXOJ].UTCSI B npeJ].cnax HOpMbl, COACp>KaHHC
rCMorno611Ha MO>KCT 61.11'1. Ha HH>KHCH rpaHHLlc HOpMbl HnH CHH)KeHHbIM, '-11'0 oTpa-
>KaCT HOpMaJlbHYK> npOJ1HcpcpaTHBHYK) aKTHBHOCTb KOCTHOro M03ra. 3TO conpoBo-
>l<J].aCTCSI HC3Ha'IHTCJlbHbIM YMcHbweHHcM MCV npH HOpMaJlbHOM RDW, 'ITO CBI1-
AeTenbcTByeT ° npeo6.na)),aHHH OAHOpOAHblX KnCTOK C MaJlblM 06DCMOM. 3pHTpO-
u,HTapHaH nicTorpaMMa HMeCT 06bl'-IHYK> <pOpMy H nHWb CMCll.{aCTCSI BnCBO. no MC-
pc AaJlbHCHWCro HapYlucHHSI npoLlcccoB rCMorn06HHoo6pa30BaHHSI npoHcxoJ].HT
CIl.{C 60nbWCC CHU>I<CHUC MCV, MCH. MCHC, YBcnH'lcHHe ROW. 3pHTpou,HTap-
HaS! rHCTorpaMMa HMCCT OAHHO'-IHbIH miK, 3Ha L IHTenbHO C}J.BHHY1'bIH BJ1CBO (pHC. 1).
Y 60J1bHb1X B rHnopcrcHcpaTopHOrl CTa)),H i )J(AA OTMC'laCTCSI CHH>I<CHHC Komi'IC-
CTBa 3pWrpOLlHTOB, MCV, 3Ha'-IHTcnbHO 60J1CC Bblpa>l<eHHOC CH i>KCHHC rCMorn06H-
Ha i MCHC. 3p 1Tpou,HTapHaSi niCTorpaMMa HMCCT UHA ynJloll.{CHHOH Kp moH, CMC-
ll.{eHHOH B nCBYK> CTOPOHY, '11'0 SlBJlSlCTCSI OTpa>l<eHHCM npHcyrcTBHSI B KpoBH re'ro-
porcHHoH nonynHl\HH 3pHTpOLl.HTOB (MHKpoU,HTOB H MaKpol\HTOB) (pHC. 2). Ha <pO-
He nC4CH iH )KAA npcnapaTaMH >l<CnC3a 3pH'rpOLlHTapHaSi rHCTorpaMMa xapaKTC-
pl13yeTCSI WHpOKHM OCHOBaHHCM 3a C4CT pa3HopOAHOCTH 3p iTpOLl iTOB no 06'bCMY
H ABYMSI nHKaMH (pHC. 3). Y 60JlbHbiX C 3pHTpC IHCH Ha <poHe 'JaCTbIX KpoBonycKa-
Hm1 pa3BHuacTcSI )J(AA C aHaJIOni'-IHbIMH U3MCHCHHSlM i nOKa3aTcncH KpacHoA
KpOBU (pHC. 4).
nOM iMO )Kene30Accp iUUTHOH aHCMHH. 3pHTpoLlHTapHaSi rHcTorpaMMa C ABYMS!
nHKaMH 3pHTpOLlHTOB MC)K]ty 50 H 140 <pJl, YKaJblBatOll.{HX Ha npHcYTcTBHC rCTcpo-
rCHHOH nonYJlSlUHH KJICTOK, MO)KCT Ha6nK>AaTbCSI nocnc rCMOTpaHccpY3 iH.
OpH B 12-ACCPHLlUTHOH aHCMH i n pC3ynbTaTc 3aMe)J,JlCHHSI npoLlcccOB CHHTC3a
AHK H ,l],cnCHHSI KneTOK 06pa3ycTCH nonynSlLlHH 3PHTPOU,UTOB C pC3KO ynCJlH'-(CH-
HblM 06'bCMOM. 3pHTpoLlHTapHaSi rHcTorpaMMa pacTSIHYTa, CMCIl.{CHa BnpaBo n 30-
HY MaKp03pHTpOU,UTOB. '11'0 COOTBeTCTBYCT BblCOKHM nOKa3aTcnSlM ROW, MCV
npH HH3KHX nOKa3aTcnSlX RBC, HOB, HCT, BblCOKOM cOACp>KaHHH MCH npu HOp-
MaJIbHOH CpCJ].HCH KOHu,eHTpau,HH reMorn06HHa (MCHC) (p iC. 5). ,IJ,HarH03 B12-Ae-
cp iU,HTHOH aHCM iH nOATBCp>KAaCTCSI nYHKu,HcH KOCTHOro M03ra, onpCJI,eJleHHCM B
CblBOpOTKC KpOBH KOHu,CHTpau,HH BHTaMHHa BI2 HnH cpOJ1HCBOH KHCnOThI, H3MeHC-
HmlMH B ncpH<pcpHLICCKOH KpoBH (MaKpoLlHTo3, rHnepxpOM iSl. TCJlbu,a )J(onnH, 6a-
30cp iJlbHaSi IIYHK1'au, iSl 3pHTpOLlHTOB. nomiccrMCHTHpOBaHHOCTb HCHTpocpHnoB).
Ou,eHKa TpoM6ou,HTapHoro 3BCHa reMorpaMMbl OCYIl.{CCTBJlSleTCSI no KOJlI1'-ICCT-
BY TPOM60u,HTOB, TpOM60u,HTapHbIM HHAeKcaM (CpCAHCMY 06'bCMY TpOM60Ll.HTOB -
MPV. nOKa3aTcntO aHH30l\HT03a TpOMGOLlHTOB - POW, TpoM60KPHTY - per) H'
TpoM60Ll napHOH rHCTOrpaMMC.
n
38 TOM II - YACTHbIE AHAJ1I1TI1YECKI1E TEXHOnOrl111
RBC RBC 4.58 (x 10 11 /1)
I , . .
" Hb 76 (g!l)
. ..- . 0 .
....
.... 0 .
. ..... MCV 60.9 (0)
......
.. :. . .
, ,
: ". 0 MCH 16.6 (pg)
, ,
"
I , I, 0 MCHC 272 (g/I)
, '"
.'
. , ," 0
'. ..
" ", RDW 18.0 (%)
I " . -. 0 I
.. ','
" I ., " . . .
250fL
PIIC, 1, 3pHTpOQ"TapHa ra1CTOrpaMMa np" >l<eJ1C3o.Qe4>J1LlI1THOH aHeM"", pez.eHepa-
mOpHa.R. tfia3a,
npUMe QI-lUe: 3AeCb M Ha ApyrMx pMCYHKax MeJ1KMMM ll1TpMXaMM YKa3aHa 30Ha HOpMaJlbHOrO
pacnpep,eJleHIHI 3pl-1TpOQMTapHOH nlCTorpaMMbl (aH8JlM3aTOp Sysmex SE-9000).
RBC
,
POC, 2, 3pH'rpOLl.J1TapHa rl1crorpaMMa npH >KeJ1e3o,Qe4>HLl.HTHOH aHeMH", wnopeze-
HepamOpHa.R. tfia3a,
RBC
o
.
. .
,
"
.... .
....
....
....1
....=.
.... I
.. r.
oo '
..: I.
o
.
I
....
-!:.
.
RBC 3.47 (x 10 11 /1)
Hb 67 (g!l)
MCV 74.1 (0)
MCH 19.3 (pg)
MCHC 261 (g/I)
RDW 28.1 (%)
I
I
0
I .
. .
0 0
. ,
.
250fL
.
RBC 4.63 (x 1011/1)
Hb 107 (g/I)
MCV 78.2 (0)
MCH 23.1 (pg)
MCHC 296 (g/l)
RDW 22.1 (%)
.
. . 0
. I I
. 0 I
I .
, .
. 0
0 I
0
250fL
PI1C, 3, 3pJ1TpoLlJ1TapHaH rJ1CTOrpaMMa npH J1ClfeHHH >l<eJ1e3o.QeqJHLlH'I1iOH aHeMHJ1
RBC RBC 6.97 (x 10 12 /1)
0 0 0 .
. . 0 . Hb 134 (g!l)
"
0 w-. . . ,
.... MCV 65.4 (0)
",
:... . I
. .....
, :1 MCH 19.2 (pg)
, . I
" ..
" I' I I
, .. MCHC 294 (g!l)
"
I " ..
I,' I
" "
" .'. 21.6 (%)
. " " I . RDW
"
. .. .
250fl
PMC, 4, 3pHTpOUJ1TapHaSl rHcrorpaMMa npH 3pHTpeMHH, conpoBO>l<.QalOllteikH >Ke-
J1e3o.Qeq)HLl 1THOH aHeMJ1ei1.
-
METO,IJ,bI fEMAT0.,110rl11..JECKI1X I1CCJ1EAOBAI-II1I1 39
RBC
.
RBC
Hb
MCV
MCH 40.8 (pg)
MCH C 330 (g/l)
2.45 (x 1012/1)
100 (g/l)
123.7 (fl)
.
.
.'
.." I
.....
: : ...
: : . : :
.. '".
.' .
:= I.
.'
.'
.'
.'
'.
'.
'.
.,
.
.
250fL
PHC. 5. 3puTpouwrapHaSl nlcTorpaMMa IIp 1 BI2-}J,C(pl1l I1TIIOU m-ICMIH1.
ABTOM£1TH l ICCKU" nOJ]pleT TpO\16onUToH npoBOnl1TC H 0JUJOM K£1HCUIC C 3PH r-
pouJ.1Tar.H1. B CBH:m C 3nlM Ba>KII""1 BJISIC rCSlLUlcp cpeHuupoBaHue npH6opoM Ma-
KpoTpOM6m\J.1ToB OT Mm:po:)p 1TpOUHTOB H cpparMeHToB 3pHTpm\l1ToB. ,lJ..nSl 3Toro
B npH60pax. rue Hcnonb3yeTcSI KOI.IJ1,YKTOMCTPU l ICCKI1Jt MCTO . CYIl.{CCTByeT CJ.ICTe-
Ma HCKpHM 1HaTopoH. 0IipCHCJI IOIIU1X BbICO-ry ::meKTpwlecKoro CHrH3J1a. nponop-
UHOHa.lhIiYIO pa:iMcpy <lacn1Ubl II lUUPHHY (AJHneJ1bl'loCTh) 11MnYJ1hCOB. Bcc UM-
nY!lbCbJ, cooTBeTcTBYlDl1lHe pa:U,1cpall'l llaCTJ.-II\ OT 1.8 .uo 30.0 Ky6wlecKHx MliKpOH
(cpeMTonHTp) nl>AClIHTblU<UOTCH KaK TpOM601 1Thl. ECJnI aMllm1TYAa HMIIY.!lhca npe-
BhlJlJaCT 30 cpCMTOJUlTp. TO BbIBO,rJ,IITCSI coo61l clIUC "Micro RBe", JH160 "Macro
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Jle!\1 POMaHOBcKoro-fr1M3bl. nCpOKC11Jl<na BhlS!BJI CTCSI B UI1TOII.la3MC KJICTOI< B LH1-
e KOpl1'lIICBblX rpaHYll.
MoollifjfJl411pmlll1l11b,ii .. le",O() P.ll.lIllP'411CCORll
flpWll(U/1 CM. J.temoo rp3xe.\W - KHn.n.n.R. AJ1S1 YMCHblllCHIIS! UHaKTUBallllU <t)ep-
\feHTa IICnOJlh30BaHhi COOTnCTCTBYIOII IIi1 <)JI1KC3TOp 11 HCOOJlbWOC KO:IJ.1tICCTBO IIC-
pCl<lICI1 BO;\OPO:l.L
PeaKnIlUfbt. 1. 60% UOjlHblH paCTBOp aLleTOHa, 2. 0.1 M pac-mop 60paTa HaTpl1S1
(MO>KHO HCIIO:lb30B<1Tb cpoccpaTHbll1 U1H1 MeJUflla.!loBhl" 6y{f)CPllhl pac-mop pH
7.6).3.5% BO]lIll>lIl pacl'nop -rpUJIOHa E. 4. HaCblw,cflHblil BOLlHblf. pacTBop 6eH3u-
}J,IW.L 5.0.003% pac-mop IICpCKllCII BO}lOpOna (pa3B()H IT ncpcn YIIOTpc6JICH ICM 13
3% pac-mopa 13 J{Ba :,nar1a). 6. I1HKy6aL IIOHHaSi cpe}J,a: 5 !\IJI 5% BO]l,HOro paCTBopa
Tpl1JlOHa E, IO 1\111 pac-mopa 60paTa ump" , 35 MJI flaCLIHlcHHOro paCTuopa OCH31-f-
]tllfta II 2 MJI paC'rBopa IICpCKUCI1 uonopo,Ua. 7. 0.5% paCTBOp Men1JIOBOrO 3eJIeHO-
54 TOM II - 1.fACTHbIE AHAJlI1TI11.IECKI1E TEXHOJlOrl111
ro Ha 6ycpepHOM pac'mopc (pH 5.0) 1J1M 0.1 % 130AUbifl paCTBOp MCTl1JleHoBoro CII-
Hcru.
Cllel(IW.IlbHOe o6oPY()O(WHue. TepMocTaT.
Xo() onper)e.lleHllJl. OJC>KCllpl1raroUJICIIHhIC 1\I<11K11 <fJIIKCllpY){JT B 60% BOJ],HOM
pac'mopc au.CTOHa II Te'ICHl1e 30 c. npOMblBatoT J.UfcTUnJHtpOBaHHoii BO/l,oii. l1uKY-
6UPYtoT B IUIKyom\ fOHH0I1 cpcnc B TC'ICIIUC 1 'I 13 TcpMocTaTc npll 37°C. npOMbl-
BalOT JHfCTI1JlJU1pomuIHoiJ Bop,oit ,lJ,oKpallHmmoT MaJKU r-.lenfJlOBhlM :ieneHblM Will
Menl'leHOBbl f CIIHHM B TC'leHIIC 1 () MUH. MO>KHO ItCCJICnOBaTb HCJlOKpaWeHHble Ma3KI-1.
l/n!7.MlI. , 1bHble ( e.nll'llll-/bl. B KpO/JIi 3J(OpOBhIX JIIOnerl aKTl1B1fOCTt. lIepoKOma:Jbl
BhISlBJUleTC}f IIpcm,'Y1u.CCTI3CHHO 13 u. ITonna3Me rpaHynou.uTOB 11 B MCHhllleH CTCIIC-
HI1 - MOHOL]JITOB. «()epMeHT nOSlBnSlCTCSI B KJICTKC\X UCI c-raHHU npOMI1Cnou.IITa. BCTpe-
'meTCS! B HCKOTOphlX Ml1eJI06JlaCTaX, ero aKTIIBHOCTb pacTcT no Mepe COJpeBaHml
KJJeTOK rpaHynOu.HTapHoro pS!}1.a, M ICJlOnCpOKCU/I,a3a SlI3JISlCTCS! MapKcpoM KJleTOK
MHCJIOI1)lH0I1 JIHHI1I1. PC3KO nOJIO>K11TCJlbHaSl peaKlUfSl Ha MI1enoncpoKcuJla3Y lIa-
6mop,aeTcSI B 3-16°,,{) HeHTpocpunoB (+++). IIOJIO)f(I1TCJlbIli:HI U 60-90% (++) U CJ1a-
60 nmIO>KWI'CJlhIlCiSI B OCT.UlbHbIX KJleTKaX (+). CUK HeHTpocpllJlOB ncpmpepl1 l lc-
CKOH KpOBH 3/.\OPOBbIX J1IoJ\ei1 paBCI! 2.56 + 0,033. B o:nmocpHJlaX BbumnSleTCS! pe3-
KO nOnO>KIITCJI!.II£lSl PC<lKLU1S1 Ha ncpoKcllwny.
K.IlllHWleCKoe 3HlPll'lllle. AKTmHlOCTb (JJCpMCHTa 13 HC(1Tpocpl1m,x CHI1>KeHa npll
l-IH(JmpKTc Ml1OKapna. pcnMaT113MC. Ty6epKYJle3c. onyxomlX. Y 60nbHbiX XpOHI1\.le-
CKUM MJ-leJIOJleHKo30M. oc06eUHO n TepMltUculhllOIl CTClJUUi, CUK Cml>KaCTCS! AO
1.63 + 0, 19 CJ . B UJlaCTHLIX KJleTKaX aKTI1BHOCTL cpepMeHTa BhlCOKaSi np ' oCTpm.t
MlIeJI06mlCTHO)\'1 Jlef1K03e. cJla6a}1 - IIpl1 OC'IPOM MOHo6m'CTHOM 11 OTCYTCTByeT -
IIpll oc-rpOM JIHMcpo6naCTHOM nei1K01e.
JIlinzepamypa. C!>.r..D.>K.Xe(.lxoy. .D..KBarmmo. reM3TOJlOl'I1 ' leCK3S1 L\IITOXI1MIUI,
M.,1983.
HECnEL\McpM'IECKME 3CTEPA3bl
rpynna <fJepMeHTOB. n'APOJHI3YIOII,Ux 3(l"ntPhl Kap6olfonhiX KI1CJTOT. JIOKaJ1H3Y-
IOTCSI n U.11TOIlJ133MC KJICTOK. I'JlaUHhlM oGpaJOM 13 JUl10COMax. Il<muonbwaSl aKTI1B-
HOCTb OUHapY>KeHa B MOHou.l1Tax KpOBH. .an}! onpe,TJ.eneHI1S1 aKHfUHOCTlf eJ>cpMCHTOB
ucnonh3Y){)T pa3JIH ' IHbIC cy6C'rpaTbl (a-Haq>TI1JJau.CTaT, HacpTon-AS-au.eTaT, Ha(jJ-
TOJJ-AS-D-x.r1opau.eTaT, p-HaeJJTl-ln-al CTaT H J.p.).
a-HAcpTMnAL\ETAT-3CTEPA3A. Memoo ReifJtfiJlepa
npUHl(llIl. CoenmleHl1e a-HaqJTHJlallCTaTCI npl1 OllpCJ CJICHHLIX pH .., TCMnepa-
Type nop, Bnl-lSlHllCM HeCneL\ feJ)I1'ICCK fX 3CTCp.l] niApOJUl3YCTCSI C 06pa3013aHUCM
CBooOJtHoro taq)TOJJa. KOTOphlt'1 C COJISlMI1 nUaJOHUSI p,aeT u.BeTHoe OKpaHlI1UaIlHC.
Pelllamlllhl. 1. <1)OpM<:lJIIHl npOMLllJIJICHllOru "p0I13BoAcTBa (40%). 2. a-Hacp-
TUJlau.eTaT. 3. Au.eToH x. 'I. 4. 0.1 M pacTBop cpoccpaTHol'o 6yeJ>cpa (pH 7.8-8.0).5.
npO'IHbIH cmmfl BB (1U1l1 npO'JlfblH KpacHblf1 TP). 6. 51AepHblJ.l KpaCI1Tenb (ret.1a-
TOKCI1J11-fH. MCTI1.'lOBbIH 3eJleHLIt'f u np.). 7. I1HKyoal\HOIlHaSi cpcna: 10 MI' a-lIa<fJTI1.!1-
au.eT£lTa. pac-rBOpeHHoro B 0.2 Mn aI\eTOlla; 40 MJI 6Y(IJcplloro pacTnopa (pcaKTHu
J\ 4). BC'IP}lXI1B<UOT ) () paCTlmpCHI1S1; 50 Mr COJIII Jtlla30HI1S1 (peaKTHB .N 5), BCTpSl-
xum'IOT p,o pac-mopeHl1S! U cp lJlI;rpYloT.
Cn.el(Lw.nhI-/Oe n6opy()oullIllle. 1. Bcc!... 2. 3KcHK<:rrop.
-
METOJJ,bl I'EMATOJIOrl1 l lECKI1X HCCJIE]J,OBAHI1M 55
Xoi) onpe()e..1cHlI.Jl. CBe)KenpUrOTOIulcHHhiC U BI>lcyweHHhle Ha BO:myxe Ma3KI1
CPHKCHPYIDT B napax < ()pM..tJII1Ha 4 MUH (cpI1Kc 'poBallllblc IIpcnapaTbl MO)f(HO co-
XpaU)lTb B XOJIO;IU:Jbm1Ke HeCKOJILKO HCnCJlb 11!H1 npH KOMHaTHof! TCJ\-IOcpcrJ'Ypc).
11 IKy6HPYIDT B IlIIKy6aUlloHHoft cpene np 1 KOMliaTuof! TCMllcpa-rypc 30 MI1U. npo-
MhmmOT B IIpOTO'IHOH BOne (2-3 Ml1l1). J],oKpaWI1BafOT paCTBopOM rel\faTOKCHJlI1Ua
B TC'leHl1e H I\HlH. I1poMJ.maIOT UlICTI1Jlm1pOBaHHoii BOHOii 15 M11II. AKTlmHOCTb
cpepMeHTa BhlSlBJISlCTCSI B Im;.l,e KOpI11IUCBO_IICpllhIX (upl1 YlloTpe6JlCHm1 npO"IHoro
cl1ucm) 11JUI KpacHo-KopllllllCBblX (npl1 YJloTpe6JlemH1 npO"IHoro KpaCUOl'o) rpa-
Hy.1l B UUTOnna31\'IC IOICTOK.
J-l()p: tlIJ1bHble (le.nll'lllllbi. B MUHOUI1T<lX nepucpepuclecKoii KpOlil-l aKnllUlOCJ'h
<pepMeHTa COHCp>KJ1TC)I B nl1ne MeJIKOii OUI1JlhHof! 3CpHUCTOCTI1. CUK B MOHOLtI1Tax
COCTaBJl eT O,95:t0,0l. Hc6oJlbWOe Koml"ICCTBO mIM<tJOlJ,WrOB (18.0:10,4 %) cOJ\ep-
>K11"I" aKTUBHOCTb cpepMeHTa B IU1JlC CJ\ 1HWIHbIX rpaHYJl B LtJITOnJJa3MC. B TpOM6o-
LtUTaX nepu(pepltllecKot"t KpOnl1 cpcpMeHT BbISlBJISleTC 1 B lut]lC MCJIKUX rpaHYJI. B ccr-
MeHTOH) CPIlLIX ICHTpOcpIlJJaX ero aKTUBIlOC J'b IH-t"ITO)f(Ha,
Cpen 1 KOCTHOM03rOBbiX KJICTO'IHbIX 3JleMeUTOB lIal1ooJII,IIIYlo aKTHBHOCTb I1Me-
101' npor.nlCJIOlJ,IITbl. t-.H1eJlUI 11Thl. MCl"ltKapUOUI1ThI. 1\'IOHOUHTbl. B MOHOUllTax nepJ-I-
cpCpWICCKOfl KpOBU U KOCTIIOI"O M03ra npu Ao6aBlleH U1 e)nOpJ1]la mnpUSI (NaF) B
KOJlH"ICCTBC 1.5 Mr/MJl peaKltUSI uHru6HpycTC . 'ITO I-fCno.11h3yeTcSI B AI1cp<f>epeHIlJ-I-
awUl KJleTOK MOHol 1Tapll()i1 JIUHI....f OT APyrl1x KJICTO"IHbIX 3!ICMCHTOB.
K.IlllHUL/eCicoe 3H(1'leHllC. CI1I1>KCIUfC ilKTUBHOCTU cpepMeHTil Ii MUHUUII'rax I yuc-
JJWleHHC B JlI1111( OIUlTaX o6I1apY)f(CHO npn J\U<p(f>Y3HbIX JlOpa>KCIHlSIX IlC'ICHU. 3Ha-
'fI1TCJlhllaSl i:lKTI-IBHOCTb cpepMeHTa BJ.ISlBJIClia B IIJI..rjMaTU'ICCKUX KnCTKax npH M11e-
JIOMIlOli 60Jle3HH, o.llac ""!.IX KJICTKaX npl-! OCTpOM MOIJo6mlCTilOM I MI1CJIOMOH06-
mlCHluM uap tallTax JlcllKo3a. n0J.\i:.lBJIHIOlJtaSlC}I (frrOpUi,oM HcrrpUSI. B TO BpeM)I KaK
npl1 OCT<UlhHhIX cpopr.IaX OCTpl>IX JldlK030B aKTl1BHOCTb cpepMeHTa B OJlaCTHhlX
K.leTKax HWITO>KmL npu xpOHU'leCKOM JlHMcpO.llcfiK03C aKTUBHOCTh cpcpMCHTa B
Jll1McpOUUTax pC3KO CHI.I)Kella. (I)CpMClnaTIIBHaSl aKnmHOCTL Hei1TpocpIUlOB npu
OCTpblX Jlcf'IKo3ax. OC06CHHO npu OCTpOM MHCJI06J1aCTHOM, CIH1)f(CHa.
JIllmepamYfJl/. <I).r.D)f(.Xcdlxoy, JJ,.KBar!UlHO. rCMaTOJIOrll'ICCKaSl lJ,11TOXJ-IMIUI.
L. 1983.
KMcnASI a",HAcpYMnALlETAT",3CTEPA3A. q)CPMCHT nOKanu3yeTc LllaB-
IILIM o6pa30M 13 nl130CmmX IlUTOllJla3Mbi KJICTOK u y'mcTl3ycT B niApOJlU3C aJUlcpa-
TlI'leCKI.IX 3cpllp<.m.
Memoi> KYJl.flell"lUtn(/ja lJ comml.
[JPUH1(1lI1. vb COC]lUlICHIUI a-HacpTI1JIaueTanl npu K 1CJIOM pH IIOH BJIHSIIH1CM
(»cpMel-rra ofipa3ycTc5I cno6oJJ.Hbln HacpTOJI. naK)U\1111ItBCTHOC OKpaUII1BmmC C cPY-
KClmOM.
PCllKf1lIWbl. 1. 2,5% paCTBOr rnYTapCUlb}\CnlHa (pll 7,2), 2. 4% pacTBop COJl -
HOKUCJIOrO eJ>YKc lIIa. 3. 4 % pac-mop HUTp..1Ta HaTplUI. 4. 0.7 M <t)Oc<paTuhli'J 6y<t)cp
(pH 5,0). 5. a-Hacp'nuJaucTaT. 6. 20ft) pac'mop MCTl1JIOUOm 3CJICH{)I"O. 7. I1HKy6a-
l UOHHaSi cpcJla: 2 Mil pcaKnma N 2, 2 !\In peaKTI1Ba N!! 3, 40 MJI pcat n1Ba K 4. 10
MI" a-HacPnJJIalJ,eTaTa. raCTIJOpClllloro u 0.4 !\IJI aUCTOll£L I1HKy6aL JIOHHa)l crena
HOJI)f(Ha UMeTb pH 5,X u roTOBIIThC 1 IICPC}\ ylJ()"rpC6Jlem1eM.
Cllel,llll.lll,HOe o6opy()omllllte. 1. XO.'IOHllJlhIHlK, 2. Becbl. 3. 3KcHKaTop,
56
TOM II - YACTHbIE AHA lI1TI1YECKI1E TEXHo.norI1M
I
Xoo 0IlpCOC.IlCHliR. BblcymcJlHhlC IIa B03Ayxe Ma3KJI <)JI1KCJ.1PYIOT B r!JY rapaJlb-
l enlp,e (peaKTUB N!! 1) "pu TCMnepa:rype 4°(' B Te lemlC 10 MUH (He<)JuKcl1poBaH-
IIhlC Ma3KI1 MO)l.:HO XpaHJITJ, B XOJIOJ\UJlhHlIKe 1-2 /\fec). Dpot.lhlBaloT }\I-ICTlIJIJII1pO-
l3aHHOH BOnOl!. MHKY0l-lpYIOT II 1HKy6aUJ.10HHOJ1 cpen,e B TC'ICIUIC 1.5 - n I. DpOMbl-
BalD... ,rJ,UCTIIJlJlllpOI3t.lHHOi"i BO.uOJ1. ,!J.OKpallUmalOT MCTUJIOl3blM 3eIleHhllli.
HOpJ l{UlhllbIC ( e.llWlllHbl. B UHTonIla3MC JH1MCPOUItTt)J3 aKTI1BHOCTh cpepMCH ra
BhlSlB;HICTOII3 BUAe TeMHO-KpaCllhIX rpaHYJ1, B Heihpocpuj]ax 1 MOlIOLl,HTax - B BU)J.e
J\11CPCPY3H0i1 OKpaCKJ.1. CJJ.K JIIIMCPOlU1TOB paBC11 0.57:t0.04. I\KTl1BHOCTb (IJcpMCH-
Ta YBeJlJ1 nlBaCTOI "pit YBCIlWleHUU BpCJ\'ICIII1 1J1Ky6aultu. TaK. "PH UHKy6aIH1I1 B TC-
ICHI1e 1.5 'I aKTUBHOCTJ, ( CpMCHTa BblSlBIleHa B 4lJ.R3:t2,75% J1UMcpOLl,I1TOB, "Pit
Y,1 J11I11Clll m cpOKa HHKy6a1 11I1 no 6 I :JCTep.l30nOJI0>101TeIII>IIbIMH CTaHOIHITCH
79.7 + 1.52(Yo JU-IM(pmUIToB. I1cnO.lh30BatHIC B Ka'lCCTBc cpJ.1KCaTOpa clmpMaJllllla ,Ua-
CT 601Jt c cTa6wJhHhiC PC3YJ1bTaTbl.
KJlltHll'lCCKOC ,ma'll I/ll(', CIIH>KeH 1e aKTlfBHOCTlt (IJepMCIITCI n JIUMcp0Ll,l1TaX xa-
paKTepHo HJ1H XpOlHl l lCCKOro JlI-tMcpoIlel1Ko3a (B-KIICTolIHoro BapmtHTa);np 1 T-
KIlCTO'll/blX npoJHtcpepm uSlx aKTlIBHOCTh HCCneLl,ucpll'lecKoit KIIC.f\Oti 3cTcpa3bl B
mIM<)JoI J1T3X 1I0BJ.lLucua, npOAYKT peaKI lm "PC.uCTdBIICH 1-3 KpynHblMIt (IJOK31lb-
ItblMU nHTHaMl1.
JIlimepmnypa. no-rallona c.r.. lllax6a3S1H r.D.. ;J,CI\HI)t(.ma 1-1.13.. Ko:mHel r.M.
}lao. HeJlo. 1981. <I) .r.,!J.>K.Xeflxoy, H. KBCI rJll1Ho. reMaTOIlOrlt l leCKa51 LlllTOXI-IM 11S1,
M.. 1983.
HACI»TOn-AS-AL-'ETA T -3CTEPA3A. Memo() neifitfi./lepa
npuIII (1lI1 u o6oPyc)oO{/Hlle TaKUC >KC. KaK .Q.'IH onpeJ],eIleHI1S1 a-Ha(lrn1JlaUCTaT-
3C rcpa3b!.
Pt'W.:JIllU1bl. 1. (1)OpMam1H npOMhlllJ.f\CIIHOrO npoI13BOp,CTB41 (40%). 2.0,1 M cpo-
ccpaTHbllt 6ycpep (pH n.R-7.0). 3. l\ueToH x. it. 4. Ha<tnoIl-AS- m CTaT (MO>KHO uc-
nO.1Jb30na..... Ha{ n)JJ-AS-D-aLl,eTaT). 5. DpOllllhlti CIUII1 1 DS. 6. 5b epHbll 1 KpaCII-
TCIlI>. 7. 11 II Ky6aUJ.10HHa51 cpeAa: 4 MI' lIa( T()JI-AS-aLl,CTaTa. paCTBopCHlIoro II 0.4 MIl
aLl,cT()Ha. 40 MJl fiY<t>cpuoro paC'rI3opa (pcaKTuB N!! 2): BCTpSlXHllaJDT U .lI.06aB.I151JDT
SO Mr npo lHoro CllllCro 1313. BCTpSlxumuDT II ( UJII.TPYIOT.
Xoc) OIlpe()eJ/eHuR,. I3blcyweHHble Ha B03JlYXC (B TC'leH 1C 1-3 II) Ma3KU <)JHKCI1-
PYKJT B Hapax cpopMa.HUHa IICCKOJlbKO MltHYT. DOMell.tatOT B IIIIKy6aU.I10IlHYK) CPCAY
Ha 60 MI1H "pI-! KOMHaTHOH TeMnepaType. DpOlllhmmoT B npoTo'IHOM Bo.ue. J].oKpa-
WltBaK)T 5IAepHbiM KpaCUTCJICM.
HOp.\UUlbllbIC l1CJll/'ltlllbl. TaK >Ke, KaK n a-uaqJTl1JI-aUCTaT3cTepa3a, q,epMcHT
IlOKaJII13yeTc 1 J"JlaBllblM 06paJOM B MOHOI IITax KpOB 1. no cpaBHemuo C aKTI1BHO-
CTbKJ a-HacpnlJlaI eTaT3c rcpa:u,1 aK nmHOCTb HacpT0J1-AS-aueTaT3cTcpa3bl B ccr-
MCHTOSll.t.ePHbIX HefrrpoclJllJlax HCCKOJ1bKO BbilHe. a B JlI1J\'I(I)OIU1TaX - CJla6cc. 13 KlleT-
Kax KOC /'HOI'O M03ra cPcpMeHT o6HapY>KCIi B McraKapHOUHTax. nIla3MaTU'-ICCKIIX
KIIeTKax. a T3K>KC HC3pC.rlbIX rpaHYIlOLl, 1Tax.
f(;zUHll'It'C/W(, 31111'ICHlte. 3Ha'nrrc.f\bHaSi aKnmHOCTI. ( CpMCHTa xapaKTepHa
lP 1 OJIaCTllblX KIICTOK npn OCTpOI\! MOH06J1aC-I'IIOM IICI1K03C. IIpU OCTPOII'I npO\Ule-
JIOLl,IITapHOM JleHK03e; npH HP}'nIX BapuaHTax OCTpOro Jlci1K03a aKTI1BHOCTb (}JCp-
MCHTa B 6JIC\CTllbiX KJICTKaX lie BbISlB.I1SleTC I.
-
METO,Qbl rEy1AT0.110rH'-IECKI1X I1CCJIE,D,OBAHHI1 57
JJwnepamypa. <]>.1' .)J.)K.Xefixoy. .0.. KlmrJJl1HO. feJ\'Ii.lTOJI0I"11'-ICCKaSi LJ,IITOXHM ISI,
M.. 19B3.
HA«PTon-As-D-xnOPAI.(ETAT-3CTEPA3A. Memo() J\10JlOlIll c COatml.
(JPllHl(llll H o60PYVOlUiHlIC raKlle )Ke, KaK A.'ISI ()npe;\eJleH IH a-Haqrn1."laueTaT-
::}CTCpa:ihL
PeW(11llWbl. 1. 10% pacnmp ctJOp 1aIH1Ha 13 MCT.-HlOJIC (xpaHHT B XOJIOH 1.1fbHUKe).
2. 6y(jJCPUblii pacTBop M lxa:JJII1ca (pH 7.4). 3, HactJTOJI-AS-D-xJlOpaLJ,CT<tT, 4.
AU,CTOH X. '-I. 5. fpaHaToBblfl IIpU'IHLI 1 GBC 111U1 CHHI1H IIpO'UlbIH BB. 6. 51.uepHLIH
Kpan1TeJlb. 7. I1HK)'6aUlloIiHaH cpe}1a: 10 Mr HactJTOJI-AS-D-xJlopau,cTaTa. pacTBo-
peHHoro B 0,5 MIl al\CToHa. 10 fl.IJl GyctJcpHoro pacTBopa (peaKnm N 2), pa:me.u eH -
HOn) IIOnOJJaM j1HCTUJlJllipOBaHHoH BO],Orl (j1,06aBJUH<H no Kan.'lSlM). 10 Mr pcaKTuBa
.N 5: 6blCTpO BCTPSlXIIBalOT no U 6e)KaHHC oGpa::mnamlSi oca.n.Ka. CMCCL ntnbTpYJOT.
Cnel(llaJlbHOC o6opydomlHlIe. He Tpe6ycTC}1.
X()() OllpeaeJletlll.Jl. CBC)KCnplln>TOIUIcIUlble 1.1 BLICYlllcllIlI.le Ha B03AYxC Ma'3K 1
cfmKcI1pYJOT B XOJI0J.l.HOM 10% pacTBope ctJopMamllla Ii MeTaHOJIC B TCllcmle 30 C H
J.1TCM BbICYlUlmaJOT. (I)HKCI1poBallllbie npenapaTbl MO)KHO coxpaHSITL HCCKOJlbKO
1ecHu,eB. nOMClllalOT B I1HKy6aLJ,II0HHYIO CMCCh npH KOMH.lTHOH TCMnepaType Ha 30
MUll. npOMbIBaKH B npOTo'IIIOi'! BOJ1,e. D.oKpaw maIOT }IJ\epHbIM Kpacu-rc...'lCM.
HOpAWJlbHble (JeJlll'IllHbl. C!>epMeHT BLIHnmlCTCSI B BUlle ClltlnX 11.111 ctmOJleTOBLIX
rpallYJI IJ IU1TOnJla3MC cerMCHTO}/J\CPUbiX HeHTpoctJ IJIOIJ. .'H1MctJOLt.I1TLI II '1OJI0I\ 1Tbl
ctJcpMeHTa HC CO.LlCp)K<1T. H MC13Kax nYHKTcrra KOCTHoro M031-a 3HOpOUbiX JUOJ\dl
H,UlOOJlbIllYK1 aKT 1BHOCTL ctJcpMCllTa 06HapY)KlmaKrr II IIpm,mcnou,lrrax. r 10 Mepe
C03peBaH11S1 rpaHYJIOI\I1TOB aKTlIBHOCTb Ha(trroJl-AS-D-xJlOpau,CTaT3CTepa3bl He-
CKOJlhKO CHI1)K<1eTCH. HO OCTaCTCSI j1,OBOJlhHO BLICOKOfi. Hau60ncc BblCOKcUI IHTeH-
CI1BHOCTb pcaKl1l111 Ha6.11O):\aeTCH np 1 ct)IIKCaUIHI B napax (jJOpM<1JlI1Ha npH KOMllaT-
HOH TCMnepaType. BpeMH ctJllKcaumi j1,O 10 MI1H IC OKa'U,lBaeT B.'II1S1HIHllla ypoBeHL
aKTI1BHU<...IH ctJcpMclITa. :U1ll1b IIpU (jJUKcaIUHI B TC'leHI1C 30 ,.,-11111 11 1l0JlbWC aKTIIB-
HOCTh cpcpMeHTa CHI1>KaCTC}1.
K.IlUHll'tecKOe 3Hll'I{ Hlle. B"'COKaH aKnmHOCTb cpepMcHTa o6l1apY)KeHa B GJla-
I CTHLIX KJICTKaX np 1 npor.meJlOLJ,UTapHOM OCTpOM JICr1K03e. HI1 t ITO)KHaH - IIpU OCT-
pml MOH06JlaCTHOM: IIpl1 HPYrwx BapHaHTax oCTporo Jler1K03a B rul3CTUbiX K.'1CTKax
aKTHBHOCTL HC BbISlBJleHa.
JJltmepamypa. ct>.r.Jl.)K.Xeitxoy. JJ,.KBarmmo. feMaTOJIOrl1l1eCKaH W1TOXI'I:'H1}I.
M.. 1983.
1
AErMAPorEHA3bl - rpynna OKUCnUTCJlhIIO-BOCCTaHOBlITCJlbllhIX 4JcpMeH-
roB. JlOKcL'1H3YIOUllIXCH B MI1TOXOH}1PUHX LJ,HTOII!laJ lbJ KneTOK. JJ,JISI HccneAoB(tHU}/
pa3JH1'lIIhlX j1,erl1.LlpOreHa3 11CJlOJlh3)'IOT MeTOll HaxJlaca C coaBT. B MOJ\uctmKaI.l.HHX.
oCHOBaHHblH Ha pCaKl\11I1 BOCCTaHOBJICIU1S1 coneH TeTpa3OJII1S1 II Bbma}J.eHl-1S1 ocaJ\Ka
)lHctJopMa3aHa B MCCTax aKTI1BHOCTU ctJepMCIITon.
CYKI.(MHATAErMAPorEHA3A (CAr; K.CI». 1.3.9.9.1)
lvlel1lf)() Ha.YflQ('a c: COUtml. (.. IOl)fJifJfJI<alfWI KtWVlllHO, Xeuxoy)
IlpllHl(liIl, AKTI1BUOCTL (pCpMeHTa OLJ,CHllBaCTCSI no peaKu,Ul-1 BOCCTaHOBJICHH}I
concH TCTpaJOJUISI B BlI):\e OCal\Ka w1cpopMa3flHa CUHcro I\BCTa.
58 TOM II - t.IACTHbIE AHJ\JU1TI1"-IECKI1E TEXHOnOrl111
PCmOlllll1bl. 1. 60% BOJlUhll"1 pacTBop ClueTOHa. 2. 0.2 M cpoccpaTHbl 1 6y<pep (pH
7,4).3.0.2 M paCT130p CYK1t1maTCI HaTpml. 4. 0,6 M pacTBop ol'1Kap60HaTa HCrrpmt.
5.0.03 M pac'mop XJTOpUna a..'IJOMmUUI. 6, 0.03 M pac mop XJIOpJ1JI,a KaJ1l LJ,USI. 7. Te-
Tpa:mnMtI mrrpo BT. 8. 0.1 % pacTBop IJpOtlHOro KpacHoro. 9. I1f1Ky6aUMoHHaH cpc-
JI,a: 10 MJJ peaKTmm 1'4 3. 2 M.1 pcaKTlma 'J 4. 0.2 M..'J peal('nma .N'!! 5, 0,2 MJI PCClK-
nlBa.N 6. 10 Mf' TeTpa30JII1Si B 10 1IIJl JlJ1CTI1JIJUlpormuu0I1130JI,bl. JtliCTHJJJlHpOBaHfloH
BOHhl JlO 40 \I.TJ.
Clln'llll.l1b/-we n6opyvoaaHue. TepMocTaT.
Xoc) OIlpeVeJleHuR. CBe>KCllpliroTonncHHble It BhlCYlllcHHble Ha m)3nyxe MCl3KII
<PMKCHPYIOT B aueTOHC IIpl! KOMHaTHOIl TCMflcpaTYpc 30-60 c. DpoMbmaJOT B J(uc-
'/'liJlllpOBaHHoi1 nonc II BblCYllllmaJOT Ha IJOJJlYXC. I1HKy61ipYfOT B IIHKyG a UUOHHOi1
cpeAe B rC'ICHue ll) npl'l 37°C. DpoMbmaJOT JI,UCTliJIJH1pOBaHHofi UOHofl. .D,oKpClIIHt-
mUOT 0.1 % pacTBopoM npo'IHoro KpaCfloro 10 MIIH.
Memoo HaXJlllCa C coao1ll. (J..W()llljjuKallllll P.TLHapI4lJcCo6a)
DpllHl ltn nn >KC.
PCm0711WlJl. 1. 60% paCTnop aLJ,eTOt1a, lIacbl eHHhli1 Tpl-IJIOHOM 13. 2. 1/15 M
<poc<paTlII.lfl oy<pep (pH 7.2). 3. CYKI(I1HaT HLnpuSi. 4. DapaHI1TpcrrcTpLBonJli1 etm-
O..'ICTOl3blit 5. Tpl1JIOH E, 6,05% paCTBOp MCn1JlOBoro 3enClloro Ha atteTClTJlO!\l Gy-
<pepe (pH 5.0). 7. I1HKyGauuoHH3S1 cpc: a: 540 Mr CYKLJ,HHLlTa HaTpI'IS1 paCTBOpSlJOT
B 10 J\-IJl .IJ,HCTIIJ1Jmp0l3aHH0I1 BO)lh), !J,06C1BflSuur 10 MJI Gyepcplloro paCTBopa (peaK-
Hm .N'!! 2) U 10 \1n pac-mopa nClpa-mrrpoTeTpa30JHISi 13 Al1cTlfnJmpouLlHHol1 BO/{C (1
Ml'h1J1), 13 Mr Tpl1JIOHLl E (pH HOI3CCTIi 11.07.2) I-I itllCT11JlJlUp0l3aHHot'1 BO.IJ,bl.IJ,O 40 MJl.
Cpc)ta MO>KeT 6blTI> IIpHro.IJ,Ha 1-2 IICJ npl! xpallcllml B XOJ10!tUllbHUKe.
Cnel lW.l1bHOe ovoPyoO(WHlle. 1. TcpMocraT HJU1 BOHSlJlaSi oalUl. 2. XOJIU IIJI"HliK.
Xor) ollper)e.l1CHliJi. <1>UKCJlPYJOT Ma::UOI aLJ,CTOHOM (pcaKHm M 1) [JP I KOM HaT-
H0I1 TeMncpaType B rC'ICHue 30 c. OJlO-TJaCKlmmoT ).{JICTlI!IJH!POB<UU10H B011.0(1 3-5 C
II BbICYWMBaJOT. I1HKy6upYloT B I1HKy6auHoIIJlori cpene B TctleH le 1 I npli 37°C.
npOMhlBClJOT JlpOTOlllfOti BO!J,OH B Te'ICHue 1 MIIII. OnonacKuBaJoT JtliCTI-f.TlnUPOBClII-
II 0 t'l BOAoft 3-5 C. .D,oKp<.HlU1lJaIOT MCTlIJIOBI.IM 3cnCHhiM 5-10 MHH. DpoMhmLlloT B
npOTO'IIH)jf uo}:\e. LI.onOJIHI1TenhHO <pHKCliPYIOT MCl3KII napaJ\UI cpOpMLUH1Ha B Te'IC-
Hlie 30 MUH (AJlSl npcHOTBpaU{eHUSI pacTBopeHHSI cpopMa3aHa HI1TpoTeTpa30JH1S1 eJ)I1-
OJleTOBoro B IIMMCpCUOHHOM MaCJle).
a-rnML-'EPocpOccpATAEn.1APorEHA3A (a-r«PAr)
Mel1loc) [JllX.lWCll c: coaum. (.uOOlJ /jr'KalJII11 P.1I.HapI4I1CCOUll)
DpllHlCllll CM. CYKI llHan1()e211apUleHl/3a.
PellKlmWbl. 1. 60% pac-mop al{eTOIIa. HaCblll(CHHhIH "'pl1JJOHm,,1 6. 2. 1/15 M
cpoceJnrrtlbli1 6yeJJcp (pH 7.2). 3. a-1J1I1ucpoeJ)Oc Ja'1' IILnpl1S1. 4. Dapa-HHTp<.rreTpa-
JOnlit'1 etHIOJICTOBblt'1. 5. TpHJIOH 6. 6. 0.5% pacTBop MCTlinOBoro 3CJICIIOf'O lIa aue-
TaTHOM 6y<pepc (pH 5,0). 7. I1HKy6a1tHOHIIClSI cpeJta: 630 MI" a-rJluuepocpocctJ<rra
HaTp11S1 pacTBopsnoT 13 10 Mjl HUCTH!1J1IIpOBaHHoH BO]1.bl, jl,06aBJISlJOT 10 MJI Gy<pep-
Horo pacTBopa (pcaKTHB .N' 2). 10 MJI pacTBopa napa-HI1TpareTpCl::JoJUISI B ]tHCTI'1JI-
JlMpOB.ilImOH BO]1.e (1 Ml'hlJl), 13 Mr Tpl1JIOHa E (pH n0I30.IJ,S1T AO 7.2) U !J,llcmnnl!po-
BallllOH BOAbl no 40 MJI. Cpena IIpU.-o!J,I1a B TCllClIIlC 1-2 He11. IIpU xpaHeHHu H XOJIO-
).!.I1JlhHHKe.
-
METOJ],bl rEMA T0J10fl1l.IECKI1X I1CCJ1E.QOBAHI1I1 59
I
06opyooamme II XO() OllpeOe.l1CHliJi CM. CYKI(llHamocuu)pozel--la3a (MOJlH(IJHKa-
lI.HS! P. I I. Hapl HccoBa).
HVp_ IlI.11hHbte He/Ill'lltl-lbl. Y : AOpOBbIX CAf II a-f<(JAf BblS!IUI HOTC B Bl1HC rpa-
HYJI II Heihpoq)HJI(tX, JH1M(I)0l 11ntx. TPOMUOI\lrraX nepucpcpwlecKoi1 KpOlU1 H Mlte-
JlooJIaCTax. rpaHYJ1Oll.HTax. MeraKapl-mll.HTaX, 3pl1TpO- H HopMo611acTax KOCTHoro
M03ra.
CUK cnf .'1I1McpOLU1TOIJ COCTaBll CT 1.1 + 0.05; a-f<I»1,f - 0,8 :t 0,08. Y Jle-refi
ClKTIH3HOCTb cpcpMeHTa Cnf oouapY>I<CHa B 46% JII1M<pOl\I1TOU. Y 3nOpOBbiX B3pOC-
JlblX B "YHKTaTC KOCTHOI'O M03ra OK0110 88% Hep,HcpcpcpClIIlHpOB<lHHbIX KlleTOK
HMClDT aKTHUHOCTb cpepMcHTa (+), Bce p,CpHbIC 3!ICMeHTbl 3pl1TpOI11l. HOro p Aa H
rpally.rt01U1Tbl npoS!BJUHOT aKTI1BHOCTb 11<\ (+) H (++).
K.I1Ul-lll'leCKOC ;Jml'leHue. CHI1>1<CHI1C aKTHBHOCTIl <t>cpMeHToB 13 JIIIM<poUHrdx
OTMC'ICIIO II nepHOJl npHcT)'lIa 6pOHXI1LlJlbHOfi acn.'lbl, npl-l XpOHl-1\leCKOM HHMcpO-
JICHK03e. nOUblWCIIHC aKTI-IBHOCTIl cpcpll'leHToB o6HapY>I<eHO Y 60JlbHhiX 3110Ka ' IC-
CTI3CHHblMI1 onYXOJI MI1 13 I'PC:UlyJIOIUITax. CHIDKCln1C aKTlII3HOCTl1 npl1 XpOHJ1 l ICCKOM
M 11CJlO!ld'IKOJC.
JIlimepamypa. Haplll1cCOB p, n. Apx. aHaT.. 1969. N!! 5, c.85-91. D,>I<.Xei1xoy,
A.Kl3arJII'IHo. feMaTOJIOrl1 ' ICCKaS! lI.l1TOXHMIUI, M" 1983.
rnMKorEH .'lOKa.11II3yCTC B Lll1TorlJla3MC K.rteTOK H HrpacT Ba>l<HYlD pOJIb B
::Hlcprenl'lecKoM MCTaOO.rtI13Me KJICTOK. OpH lI.HTOXI1MI1'ICCKOM HCCJlCHOlJaHUl1 rJIH-
KoreHa HCIIOJlh3YIOT rmmHblM o6pa30M PAS- 1111U 111I1K-pcaKUlllo (no HiHBcun1l0
peaK nmOB - IIlHcpcp-fio!lua KlicnOTa).
lWcmoiJ llla6u()uma
npllHI(llIl. non nm-IS!Hl-leM I1CpllOf.l,al'a KallllS! rm.IKoreH OKI1CJI CTC C 06pa30Ba-
HI1CM aJlh,f\enlAHblx COC1\I.IHCHIIH, nerKO pCarl1pYlOL1I.11X C peaKTHBofl.llIIl1Cl)cpa (CPYK-
CI1H-CepmlC"l'a KI1CJlOTa). B MCCTax nOKaml3a1UII1 rmtKorCHa IIblS!BJUleTC 1U1I11He-
BO-cpllUJ1eTOBOe oKpalinmaHIIC.
Pelll<nllWbl. 1. 0.03 M pacTBop IICpIlO1\aTa KanllS! 111m HaTpl1S1: 230 Mr nepHOn a -
Ta pac-rBOpS!IOT B 100 Mn UHCTI1JlmlpOBaHHofi BOAbl. rOTOI3 T nepcA ynoTpe6neHl1-
CM. 2.1 H. HC]: 82.5 M.rt KOHueHTpl1pOnaHHoi1 HCI OTII. nllOTHOCTI1 1.19 ).tomlBatOT
,f\I1CTI1J1.rtl1pOnaHHoH BOp,OH J O 1 .rt. 3. OCHOI3I10ii cpYKCI1H (:\n c}JYKCI1H-CCpHI1CTOI1
KHCJIOT!>I). 4. MeTaGHcYJlh<jJI1T KamUI. 5. PeaKTIlB 11111(1)<pa: 1 r OCHOIIHoro cpYKcmm
pacTBopmoT B 200 M.rt KIIIUHllCj:'1 nHCTll1ImlpOnaHHO 1 BO!J,bl. no Mepe OXJICI>I<1l.eHI1S1 B
pacTBop Ao6aBJl IOT 1 r MeTaol1cYJlbcpwla Kanl1 H20 \111 1 H. IICI. OCTaB.rt Krr ua
CYTKI1. HJISI nonHoro 06CCllI3C\U1RaHHSI Ao6aBnSlIoT paCTOJI'leHHYlO Ta6!ICTKY Kap6o-
.'IClla. OCTaBn IOT lIa C)'TKU, 3irrCM )ll1IhTPYIOT. PCaKTI1B coxpaHmoT B TcMIlOTe
(nYllUle HCl xOJloJ\e) B nJlOTHO 3aKphiToft noc)'nc. fOjl,eH K ymrrpc6neHi-lIO 13 TC l leHl1e
. HeCKOJlhKHX MeCSluel3 (llcrKaSi c-renCHb 1I0KpaCHeHmi CI3I11l.CTellbCTI3YCT 0 Henpl1l' O n-
!lOCTI1 peaKTI1I3a). 6. CepHIICTmI(30)la: K 10 M!I 10% paCTBopa MCTa6HcYllbcpl1'ra Ka-
-,nul Jlo6aBJlS!IOT 200 M:I J\HcTI1J1.'mponcll-lIIoi'1 BOp,b111 1011-111 1 H. HC\. fOTOB T ncpcJ\
ynoTpe6JlclUteM. 7. 0.1 % CIII1PTOBOj:'1 pac-mop CBeTnO-3CJICltoi1 KpaCKII (.'II1XTrplOH)
ilml pac'mop I"CMaTOKCI1J1I1Ha.
Cllel(lW.I1bHOC o6oPY()O(1(lI-llle. 1. fopellKI1. 2. TcpMocTaT. 3. Recbl.
-
60 rOM II - YACTI-ILIE AHAJ1J.1TI'P-JEC'KJ.1F TEXIIOnOrJ.1J.1
Xoo onper)e.lleHl'.n. npCnapaThl q)HKC 1p)'IOT (TOT'IaC nocJle npl1roTOBJICHml) n
a6COJIIOTHOf\' Cm11)TC B TC(ICHI1C 30 MI1H. npOMbIBcHOT II Hnyx CMCHax }U1CTIIJlJmpO-
BaHHof1 BO,'J,b!. norpY>KalOT R pac-rBop nepI10; aTa Ha 20 MIIH (n TCMHOTC). rJpOf\lhl-
nalOT n TpCX C 1ellax HI-fCTHJLlU1pOUaHHOIf BOnbl. 0l10JlaCKlfBaloT U CCpHIlCTOil BOnC
(II TC(!CHI1C 1-2 Mlm). OKpauHfBaJoT pcaKHmoM IlImp a B TC'ICHI1C 30-40 r.U1II (n
TCMHOTC), npO\1bIlJaIOT B TrCX CMCHax cepHllcToit nOahl no 3 MIIII. npO 1LIB<UOT U
TpCX CMCllax WICH1JIJHllxmaHHoi'1 BO,'].I> , 110 3 MIIII. OKpaullfU<uoT CUCT.'10-3ClIClmfJ
KpaCKOfJ l1J1H paCTBOpO!\'1 rCMa rOKCI1J11fHa IJ TC(ICHI1C 10-20 c. npOMhlBatoT U J1,l1C-
nUL r mpoHaHllol1 BO)1C. r.'U1KorcH oKpauumac 1'01 II BIIIIIIICBO- UOJlCTOnbl(1 UBCT Ha
3CJICIIOM OHC npcnapaTa. KpOMC rmn':OI'CIli.t, nOJIO>KIITCJJbHYIO pcaKI mo Moryl'
AaBal'b l'aKI1C llJJ.1K-IIOJIO>KI1TCJlbHbIC nCmCCl'Ba. KaK KI1CJlhlC II HdiTp<UlbllhlC MY-
KOnOJH1CaXapl1} bl, MYKonpOl'ClHlhl, rJll1KOllpOTCI1Hbi 1-' AP. rm1KorCH JICI'KO OTJ II -
4JepcHl l1pOrmTb OT Hpyn1x ucu eCTB npo60i1 co c!IIoIIOlI H-TH1 HI1aCTaJOM.
npo6a co ClIIOIIOH. npcnap<lT nO\lClIlalOT B CBC>KCcoGpaHHYH) CJlHmy If OCTan-
JlSHOT Ita 30 MI1H U TcpMOCl'aTC. 3aTCM npOlnnOH}IT OKp.tcKY 11<1 nUfKorCH nplfBC;lCII-
HblM BbllIlC \1CTOJ\OM. J.1HKyGauml npcnapaTOB co cmOllot'1 CIIOCOOCTUYCT pacu cn-
JICHIUO rm'KorCHa. II npl1 pCaKI\1U1 C pCi:tKTIIBOM llhl a HC nOJlytlacTcSI po:mBoj'j
OKpaCKI1.
J.1J!CHTIIC ItIU'lp()BaTb rJH1KOI'CH MO>KHO raK>KC "YTCM IIpCHBapll'rc.ITbIIOH IIIIKy6a-
Il 1I1 Ma:3KOB C JU1aCTa30H (cx-ar.1ICI33a: K.<]).3.2.1.1) (I MJI npocpu.IJhTpOBallHoH J\Ui:t-
CTa3bl paCrnOpl1Tb B 40 MJI H30l'OHWlCCKoro paCTBOpi:t X;IOPl1lta HaTpu ) B TC(ICHlte
30 Ml1H B TcpMOCTaTe.
J-/OfJ.'.tll.lll)Hble (W.IlIl'IIlHI,I. H MaJK<lX ncpu4JcpwlccKm1 KpOBIt r.mIKOI'CIl COjtcp-
>KUTCH n IUITOII]la3Mc HCi'lTpO ItJ10B (n BLIj:\C 00\1]11.11011 MCJIKOH 3cpm1CTOCTl1), Ll,U-
TOnJla3MC JII'lfI,UIJOIlHTOB (n IIII}W IIc6oJlhlUOrO KO-'HltleCTBa rpall)'JI). B nYIfKTaTc KO-
c-nlOro MO:3I'a 1"!I]1KOreH Dbl DJls-ICTCSi II rpaIlYJIOIUni:tX pa:moi1 crcnCHH 3pCJIOCTIl.
mIMcfJoUWl"aX 1-' McraKapHOl llTaX, Y 3J\OPOBbIX Jllo: di KOJIWICCTBO IIHTCHCIHiHO OK-
pmueHH blX HCf1TpOC}JllJI()II KlxHHf (+++) KOJIC6J1CTC B npC}(CJIaX 2-12 % . CPCl\HCH
l1HTCIICltBIiOCTH OKpaCKI1 (++) - U npe;\cJlax 72-90%. CJIaOO oKpawcHHblX (+) - OT
4 AO 18%. ClI.K pal3CH 1.71-2,04.
B mIM oUl1Tax KpOUI1 :mOpOUbIX mOJ\cll rm1KorCH COil.Cp>Kl1TC n I1l1l\C IICUO]lb-
woro 'U1CJI<l rpau}'JI U 10,4:t2,3% KJlCTOK. B MeraKapltOl frax Kocruoro "I03ra rJlH-
KorCH o6HapY>KI1BaCTCH n IniJlC rpallYJI (OT CJ I'HlftlHbIX J\O 30-50). Hanm.H1Hml CKO-
nJiCHIUI KpomlHblX I1]IaCTIIIIOK. Y 3]10pOBbIX .11{)[lci'l (IIICJIO rJIIIKOrCHI10JIO>KIITeJlb-
HblX McraKapl10UI1TOB COCTaBJlHCT 62.0 + 3,55%.
KJlW-lU',eo<oe 3lW'leHlie. YI3CJlJltICInIC COnCp>KaIHUI rmlKorClta B Hef'lTpo4JIIJlaX
Ha6J1I{)J\acTcH npl1 pa3J1WIHbIX ImCnam1TCJlbHblX npOIlcccax, 3pl1TpCMlH1, caxapHOM
; lIa6cTe, YMCHhIJIeHI1C - npl1 arpaHYJIOLlUnnax. JlY'len0l1 60JlC3Hl1, nplf xpollwre-
CKOM !\meJlOJlCrIKOJe, OC06CHIIO nplf IlporpccCI1pOnaH1111 npOl ecca. nOBbllucm1C
lH1CJIa I'JIHKOrCHnOJIO>KI1TCJlbHbIX JIIIM{ OUH'roB (1\070-80%) xapaKTcpHO HJISI m1\1-
onpom1cpepaTI1BHI.IX 3aOOJlCBamfll, ocoueHHO XpOlH1 t ICCKOro m1M OJlei'JKo:m.
npl1 TIX)M6oUlIToncHwlecKm"1 lIypnypc If CUMIITO mTJI(ICCKI1X Tpm,IOOUlITOnCHI-1S1X
'mcJlo rJlHKOrCUnOJlO>KI1TCJlhIlI,IX cpOpM Mcr<tKapl10UIHOB 3H.PH1TeJlbHO CHI1>KeUO,
nOCJIC CnJICH3KTOf\HU1 OUO nOBblwaCTCH 1\0 uopMaJlbllblX BCJIWII1IL
n pit OC rpJ,lx JldiK03ax rJll1KOrCH MO)j(HO 06HapY>KllTh n 6JlaCTllbiX I.::JICTKax: npu
OCTpOM MI1CJ100JIaCTIIOM JldiK03C - U UlIJW MCJlKOII :.JCpHI1CTOCn1 B IJ,I1TOnJla'1MC 111111
U UlI,W Hl1 y:moro CC OKpallHmalllfs-i. npll ocrpOM JIIIMqJOUJlaCTHOM JldlK03C - n
-
,
METO,IJ,bI rEMATOJlOrJ.1l.IECKJ.1X I1CCflE,IJ,OBAHI1I1 61
ul1: e KpynHblx rpaHYJI, pacnOJl{):>KCHHbIX 13 UJ1TOnJla3MC BOKpyr Hpa, np 1 oc-rpOM
MOHo6nac !'HOM 13apmlHTe 6.'JaCTHbIC KJleTK 1 COHCp:>KaT nIHKorCHa HCMHoro B BI1Ae
JI,11 Y3HOfI L'U1 HIJ{I)(IJY:Jllo-I'paHYJI pHoi1 OKpaCKII. npll 3pwrpOMI1CJI03C rmlKoreH
II IIIIJlC rpaHYJI o6HapY:>KlmaCTC}! B 3I1a'II1TCJlhHOM 'IUCJ1C 3pIlTp06JIaCTOB.
.fllllllepamypa_ ,D,)I(.Xei1xoy, D..KBar2B1Ho. ICMaTOJlOnl'ICCKa UIITOXHMHSi: M.,
LY83.
KATMOHHbl1ll &EnOK. Hc cpMcHTHbHi KaTllOHllblH 6eJIOK IIOKaJHnyeTcSI n
JHnocor-mx rpaHYIlOUl1T013 U IIrpaCT Ba:>KHYH) pOIl!. B pcalHnal Hl1 arOW-ITapHOrl
(PYUKUUl1 KnCTOK. npll IUITOXIlr-UI'ICCKOM IICCJICJI,OBamm Kan10HHhiX 6eIlKon HC-
nOJII,:j)'IOT MCTOHbl. OCHOBaHHble Ha npl1MeHCIIIU1 J I1aXpOMHbIX am10HHbiX KpaCI-ITcnetL
f
Memoo B.E.nlllupe6clwUJ (.uoomfilllfll]JOlW""bll'i).
DpUH1(1/I1. J.136 1paTCJlhH(nl OKpaCKa KaTUOHHoro 6enKa rpaHynOl 1 ron npo'l-
HhlM 3C.'ICU"IM npH pH H.l-X.2.
fhuWllWhl. 1. CJ1I1pTOnOIl pacTnop (pOpMaJll1Ha (l MJI opr-'lam1Ha II 19 MIl a6-
COJUOTHOro 3TI-1JIOBOI"O cIII1Ina). 2. 0.2 M paCTBOp 1'1)l-lca: 24.2 r Tp 1ca (OKCI1MCTl1JI)
mmum.1CTCUla paCT130pHIOT Bin UlICTIIJIJIHpOnaUIIOl1 ItOJlbl. 3. 0, I H. HC!. 4. MeTa-
HOJIOBblH Tp11C-GycIJCp (25 Mn pcaKnma J\ 2 c:'1CL/nmaHJT C 22,5 MJI pCaKTHl3a,N'!,! 3
II 52,5 Mn MCTaHOJla). 5. 3a6y cpcHHbli'1 cm'pTonoii pacTBop IIpOliHoro 3CJICHOro
(pH K 1 H.2): 100 MI" IIpO'IHoro 3CJ1eHO["() paCTBOp}1I0T I 100 MJ) pcaKnma 1\"2 4. On-
pC C:IHIOT pH 'ICpC3 cy rKU IIOCJlC np 1rlrrou:lcHU peaKTHl3a II nblpaBHllBaK)T cro
JJ,06anJICHIICM It pac'mop lIopowKa cyxoro 'qnlca (npH pH IIII:>KC .l) mill cJJa6oro
paCT130pa HC) (pH Bbllll 8,2). YCTaHounCHHiUl BeJIIl'lIIHa pH cTa6l1JlbHa IIp 1 pa-
GlHe 13 TC'ICIIIIC 4 Mce. Pac-mop xpaHIITb B CTCKn5lHHOli nocYHc C IIp 1TCI)Tm1 npo6:"
KO(I (MO:>KHO I1PH KOMH<rnwii TCMllcpirrypc). 6. 0,25% 130HHblii paCT130p a3ypa A:
250 Mr mypa A paC'rBOp}IIOT U 100 MJI JI.IICTIIJI_l 1ponaHHor. 110:1,1,1. KpaCJ1TCJlb CI'OHKI1H.
Cnel(LWJl1.Hoe o6opyiJolU1HUe. 1. pl-I-McTp. 2. Bcchl.
Xor) onpe()e.n Ul WI. BblCYWCIHlhlC Ha B03L\yXC Ma3KH IIKCIIPYH)T n cnllpToHoM
pacTBopc (I)OpM3.JIUHa 10-15 c. 130 In6c:>KaHlle (tJOHOBOIt oKpacKH MO:>KHO 11CJlOJlb-
30uaTb cnC:>KenpHrDTOIUlCUHbIC HC IIKCHpOBaHHble Ma3KII (HC n03:>KC IICM 'ICpC3 48
'I IIOCJIC npllrOT013I1CHIIH, npCllapaTbl 60JICC AJIl1TCJlbHOrO cpoKa IR 06xOLI,II/110 c1JUK-
clipoBaTb). Ma:iKII OKpaumU<.UOT :Ja6ycpepcllHhlM ClHlpTOBblM paCT BOpOM npO'IHO-
n) 3CJICHOro (pcaKTlHm N!! S) B -rC'ICIIIIC 20 MIIH. DblCTpO ononaCK 1I3atoT JJ,11CTHn-
JH1pOnaHlloii BO}lDI!. OKpaw 1I3atoT BOUHblM paC'l'Ilopm.1 a3ypa A B rClICnllC 15-20 c.
CMblBcHOT l\1a3KI1 J 11CTIIJIJHlpOBalllmf1 nOJ oH II BhICYIUl1BcHDT. npu MI-IKpOCKOJU1I1 C
:>KenTb)M HIIH OpaH:>KCBI.IM CUCTO II.lbTpOM KaTUOHHblH 6enOK B 11l-1TOnna3MC Knc-
TOK I-IMCCT UlU pKo-3encHhlx rpallYJL
l3ocnpm13BoW1MOCfb MCTO)la: Ko:)(IJ(lmUlicHT UapI-1aUIUI Cv=2,9% AJI HOp-
Mi:LlhllblX BCJIII'II1H 11 5.2% A.HI mrr0210l'WICCKIiX (IIC npCBblluaCT ) ()IIYCTI1MO 1 UCJIH-
'UlHbl).
Ilop_\W.IlbHble (je.llIl'IWlbl. Y H'3pOCJlbIX n 1303paCTC 20-30 .'ICT CIJ.K paueu AJUI
MY:>KtIHH 1 ,5X + 0,01 II JlJI"I :>KClIlllUH 1.58 + 0,03. Doncc BbICOK 1C 3HalICHH nOJlytle-
IIbJ y CTCrl u B03pacTe 1-12 \lec (1,89 :t 0,03) 11 1-3 IICT (1,96 + 0,03).
62 TOM II - I.IACTHblE AHAJU1TJ1YECKI1E TEXH0J10rl1J.1
MemO() C 6po.uifjello.rlOol,Uf CllflU.U (no M. r. my6u"lY)
npWllfltll. l136upaTCJlbmUI oKpacKa KaTHOHHoro GCJIKa opm.l<pcHO.TIOBbll...1 Cl1HHM.
PellKmUBlJi. 1. 5% paC'mop cy.'1bqJOcaJlmt 1.I0B0I1 Kl1CJ10Tbi (5 I' CYIIb )(Jcamll.I.H-
JIOBOft K 1C_'10Tbl paCI"BOpHIOT B 95 r-.w J UCTIIJIJlllpoAaHHoH BOHbl). 2.0.05 M paCT130p
6ypbl pH 9.55 (19.1 r 6YPbl pacTBopHIDT B 1 II AHCTUJI_11I1poAaHHoH UOAbl). 3.0,1 M
pacTBop OitH03aMClllcIIIIOro <JJoc<JJaTCl Ka.!IIHI (13.6 r KH 2 P0 4 pacTBOp K)T B 1 II J H-
CTllIIJIIlpOUallIIOH AO/1.bl). 4. 0,05 M 6opaTHhIi16Y<JJcp pH 8.2 (6.13 ,..111 pcaKnma.N
2 J o6aAJ1 IDT 3.87 MJI pcaKT ma N 3, a :urreM JI.OBOltHT peaKTHBoM 3 no pH X,2). 5.
0.1 % pac'mop 6pm-ICpeHOJIOBOrO OIHcro B 0.05 M 6opaTIIoM 6y<pepe (100 1\11" CY-
XOI'O opoM<pellOJI0l30ro Cl1llcro paCTAOpHI-OT 13 100 M-'1 peaKTI1I3Ll N!! 4).6. 10f0 130A-
Hblfl paCT130p ca<ppaHl'IHa IIJIH 0.05% paCrBOp OCHOIuwro <PYKc 1Ha. floCIIeitm1H 1"0-
TOB}!T nepen ynurpC6JIClmer-.,t: paCT130pHIOT 50 Mr OCHOBHoro <JJYKcmta A 100 MJI KH-
nHllJ,CM W1CTU-'JIIHpOBLlHHOfi UO)];hl.
Cnel(Ull.llbHOe o6oPy()oBaHlie. 1. pH-McTp. 2. BeCbl. 3. ra30BaH MIIM 3J1eKTpl1-
\ICCKaH I1J111TKa.
X(}() OIzpe()e.llel-lu-R. (1)HKCHpYIOT Ma3KH B 5% pac' mope CYIlb<JJocamUtlIJIOAOH
KHCJIOTbl B TC\ICHHC nO-90 c. TLllaTeIlbiio IIpoMhmalOT Al1CTHJIJmpOnaHHofi BO):{OH II
nhlCYlmmaJOT. OKpawumuoT 0.1 Ofo pacTBopoM 6pmHt)eHOJIOBOrO CHHCI'O n 6opaT-
HOM 6y<pcpc (peaKTUB .1\'"2 5) B TC'ICIIHC 1-2 ,..U1H. npOMblUatOT A Tpex CllteHaX 0.05
Y1 6opaTHora 6y<pcpa (pcaKT m N!! 4) no 1-3 M !l1. HhlcyuHlBal-OT " HOKpalllHBal-OT
1 % paCT130pOM Ca(ppaHHHa B TC'lcm1C 30-60 CHIlli 0,05 % paCTBOpO\l OCHOUHOro
<PYKCHHa B TC'ICIUIC 1-2 c. npOMblUalOT npoTo'IHOIi BouonpOBOll1lOH BO]\OMII BbICY-
WHuaIOT. KaTl10HHbIH 6CJ10K B"I BIISleTC B IITOnJ1a MC KIIeTOK B BlIJ],e CUHI1X rpallYIl.
H()p. WA1:'Hhle Be.lllllJU/-lbi. Y 3/1.0POBbIX B Hcihpo<JJ 1JJax 06HapY)l(clio 123 + 1,5
eA. HIIII CUK 1.23 + 0,015. np" 3TOM IIC OTMe\leHO pa3JIlI\lI1ti y :Jf\UPOBbIX o60cro
nO!la. flpoTeHHT10!IO>KHTCJIhllhle HeHTpoqmm.1 COCTaBJI I-OT Y MY)l('1I1II X3 + 1.4%, Y
)l(CHIJ 1111 Rfi + 0.6%.
KnllHll'teCl<OC 3Hll'ie/tlle. CmDKeHi-Ie Ka-n101I1I0ro 6eJ1Ka B HCfrrpOCpuJIax xapaK-
TepHO ]J,JISI oCTporo 130CnaJll1TCJlbHOI"O npOl\eCCa; ImomO/1.aCTCSI B p<13rapc pa3.'1 I\I-
H"IX m )eKLUIOIIHbIX Ja60JleBaJ'IUH 6aKTep 1aJ1hIl0j:j II IUIPYCHOfi 3THOIlonm. flepl1-
0)]; Bbi3AOPOUJICHHSI conpoBo)l(ALlCTCH ltopr-.m.f1Ina l1CH nOKa3aTeJI . I1 MCHCHHSI co-
l\Cp>KaJHIH I11130COMaJII,HOrO KaTI10HHOI"O 6CJIKa KOppeIlJlpYfOT co CTeneHbl-O TH)f(e-
CTH 3a6oJIel3aHHH.
.flwnepamypa. MaJllllr IO.A., CTapOCCJlhCKaH 1-'1.51. J1ao. ACJIO, 1981, .N 10.
c.582-584; BarOCB E.e. KaTlloHHblH OCJIOK J1eHKou,IITOU 11 cra :ma'ICHHe: MCTOj\U-
'ICCKHC YKa3atH-ISI.- Ha.IJb\n1K. 19R2.-67 C.; fllll'apcRcKHii RE.. Ma:mHr IO.A. flaG.
ACJlO, 1981,.Nh 10. c.579-5R2; llly6l1'1 Mr. L m'OlIonIH, 1974, K!! 10, c.1321-1322.
nlitnMAbl.l10Ka..'H13YIOTCSI U IlHTOnJIa3MC KJICTOK rJIaBHbIM o6pa:mM B MCM6pa-
IIax OpraHeJ1JI l1 06HapY)I(HAalOTCSI npenMYIu,ccTReHHo B HeHTpO )I1JlhllblX rpaHYIlo-
LU1Tax. J.1rpc\lOT Ba>KHYIO pOIlb 13 IIpOHl-lltaeMOCTH MCMupaH. L HTOX"MH'ICCKoe HC-
C-'1e]J,OBaHI'le OCHonaHO Ha npl1MeHCHHII KpaCHUlHX ueLllCCTB, paCTBOpHI-OLllIIXCH B
)f(HpaX (cYlI.aH III. cy[\aH IV. 'ICpllhlH cy[\aH II J p.). UIISI AhlHBJIeHHH HCHTpaJIhHoro
)l(Hpa nOIlb3YI-OTC c)'){aItOM [1], OKpaUUlI3cUOII'l1M )l(UP A OpaH)I(CAhlrl UBeT. flmlOH-
J1.bl I3bl l3jISlIOTCH IIY'IUIe CYAaHOM ICpllhiM ('[eplme m.:paIlHmaHl1C).
-
-
METO,Qbl fEMATOnOrl1 l IECKJ.1X J.1CCJIEJ)OI3AHJ.1I1 63
l
OKpllCKll c}'()llIw..JI 1I1 (.. 'emo() rO.1f,(tJlCllw)
nplllll(l/fl. PaC"rBOpem1C >KUpOB H OKpaCKa CY,'\cUlOIII III U OpaH>KeBblH L{BeT.
PeaKlmWI,I. 1. (I)op 1am1lloBhltl cm1pT (1 IaCTb CI)OpMaJHma II 4 'lacnl 96%
cm1pTa). 2.70% 3TJ.1JlOBbU1 CIlHpT (K 100 Mn 96% CIH1pTa npl16aBHTb 39.18 Mn J].l-I-
CTJ.mJlllpOBaHHotl BOll!.I). 3. a-Hac}JTon. 4. PacnlOp cYAalm (K 100 Mn 70% CliupTa
1\o6auJlSUDT 20 Mn AHCTJ.1JIJH1pomumOlI ROJl!> I , 1,2 r a-lIaqrrona H B H36hlTKC cYJlaH
III. Pac"mop Kumrnrr B TC l ICIH1C 10 MIIH 11 )HJIJ.TPYI-OT). 5. KpaCI1TeJlb Po:.mHonCKO-
ro-fl1M3hl.
C/l( l lllUlbHoe o(jopy()omlHlle lie TpcGYCTC .
Xo<) OllpeVeJlel-lliR. Ma3KII KpOlU1 )lJKCIIPYf{)T B cpOpMillll1HOBOM ClUlpTC U TC'IC-
Hlle 1-3 Mlm. Kpac T B paCTBopc cYJJ;aHa III B Te reHUC 1 () MI111. OOMcLllatoT B 70%
3n1JTOUbll-:'1 cnllpT lIa 1 MIIH. JJ.oKpauHmaloT KpaCHTCJICM Po:-.mHoBcKoro-nIM3r.r I1JH1
re",mTOKCHjJlHlOM B Tc'reIH1C 5-1 () IIII-tH. npOMblB.<UDT )lItCTItJlJIIlpOnaHHoll BOAoU.
Jh1JUiAbi BblSlRJ1 'OTCs-I B I31IUC OpaH>KeBhlX 3CpCII.
F [Op.M({.I1bHble ( e.f/ll'llll-ll]l. B Ma3Kax IICpUcIJcpll'ICCKoi1 KpOBH nHmlJ]."I cOJ].cp-
>KaTC}! II IlHTO/lJla3Me l1eHTpO(IH-IJIOU U UllllC 0611J1bHOH 3CpIHICTOCTH. oom",llU1HCTBO
ucihpocpHJ1OB (69-80%) Y 3JJ.0POUbIX nH);J,efi KpaC}ITCs-II1IITCHCI1BHO (+++).18-36%
HalOT oKpacKY CpCW CH HHTeH01RHOC ru (++) u 10% cnaGo OKpalllCllbl (+). CUK
JlI1011n O B B Hct1TpO JltJlax 2/i5 + 0.033. B M,13Kax KOCTlloro M()]ra B p.,u1Cno6naCTax
06HapY>KeHO Hc60JlblllOC cOJJ.ep>Kam1C JlHIU1)(On. 1\ npO\meJIOUUTax IIX 60JII,IHC l1 110
Mepe c03pcuaHmi HeI1Tpo(})IIJIOn CO Cp>KmHIC nHnll)10n YBem1'nmaCTC .
KflllHll{IeCKOe 31-UI'lCHIU!. nOBbllllCllIlC cOAep>KaHIUI nl1n11HOB R IId'rrpocpUJIax
Ha6JltoAaeTC npu oC'rp"lx JIca'1KOJaX II o60C"J'pCIIHH XpOHl1 l ICCKI1X nefiK030R. npH
OCTpl>lX JldlK03ax nHnU;J,bl D 6JJac J'HhiX KJICTKaX o6HapY>KCHhl Y (jOJIJ.llhIX IIpU f\U1e-
JlOOJ1aCTHOM l1 MOII06JlaCTHOM napmlHTax II lie B"Is-IB!ICHbl np" miMcp06nacTlwM
OCTPOM neHK03C. npl1 He;J,I'lcpcpepeHHHpoBamwM OCTpOM .'lef1K03C 6naCTflbiC KJICT-
Kl1 J1Mlllb B UCOOJIbWOM KOJIIJlICCTBC (2.2 + 0.82%) cO)J.cp>Kal' JllIfHlHbl. YMCHhwcHue
JH1IIHJJ.OD B Het'l'rpoc}H1lIaX Bhls-lUJICHO npl1 peBMaTl1:iMC, BOCmUIHTCJlbHblX npoueccax.
.flumepamypa. D.>K.XCHXOY. ,[J,.KBarmmu. re laTOJ1On1llCCKml. UHTOXIIMml, M.,
1983.
TECT BOCCTAHOBnEHIo1S1 HIo1TPOCIo1HErO TETPA30nlo1S1 (HCT-TCCT)
lJ.aeT BO:iMO>KIH)CTb CYAUTb ° cparOllllTaplloit 11 MCTa60JHl'IeCKOl1 CPYHK1Um rpaHYJIO-
IlUTOU no 06pa30RaIH-IIO B 1,I1TOIIJ1a3MC rpaHyn Q)Op\la3mJ.a.
Memoi) lIClpKll C CO(l(IIll. tJ _uoi)1l!ljIlKClI41111 10.11.6aJICop',' II COllom.
I7PW-ll(Wl. nornOlueHue rpaHYJIOIJ,I1T(lMU m1Tpocl1Hcro TCTpa30.'H1S1 U nOCCTaIlO-
BJleHUC ero B <popMa3aH, HbI5lBJI eMbli1 B BlinC rpauYJI CI1Hcr"o UBeTa.
Pemmllwbl. 1. renapHH (20-25 EHh1Jl). 2. 0,15M cIJoc aTHbl" 6y ep pH 7.2.
3. 0.2% pacTRop HllTpOCItHCrO TCTpa30JII-t5l. 4. J.130TOUI1'ICCKIIH pac'mop XJJOpHJJ.a
HaTpml. 5. :vIcTalWn. 6. 2% pacTBop MCTIt!IOBOro 3CJ1CHoro.
CnelClW.Ill,HOe 060fJYC)O(ulHIlC. 1. TcpMocTaT. 2. IIOJIHC 1"1lpOJIOnbrC IIJI<:lCTHHKH
(npHMeIUICML,IC LI,.I151 PTrA).
Xoo OllpCOe.l1CHll.fi. B !lYIiKY IlJIaCTI1UKI1 BHOC T 0.025 Mn pacTBopa rcnapmm 11
0,1 Mn KPOHl1. 0.05 MJI c1Joc aTHoro 6ycpepa U 0.05 M!I pacTnopa TCTpa30mUl. Co-
64 TOM II - 1..IACTHbIE AHAflJ.1TJ.1'-lECKJ.1E TEXHOJlOrHJ.1
Cp>Kf1MOC JIYUKI1 nCpCMCW lBcHOT C nOMow.blO mmCTKf1. nJlaCn1HKY HaKphmaKJT
HJlbTpOlm.flbHOt'1 6YMarO , CMOLICIIHOH 1130TOIH1LICCKI1M paCTBOpOI..., XJKJpUJ];a HCl-
Tpm! 1 CTCKJ1SIIIIIOi1 I1JlaCTlIIlKOl' COOTBCTCTAYiOllUIX pa:n.1cpOB. Ami CO:maIHHI
UJICl>KHOM KaMcpbl CTCKjlSlHHYIO n.lJaCTUHKY npf1>KI1MaJOT C nOMOII blO npY>KHHHbIX
:m:>Kf1"10B.I1HKy611PYHJT 13 TepMOCTaTC npH 37°C II rC lcm1C 15 I\HUI, :mTCM npu KOM-
HaTHo i TCMlIcpaT)'pc II TC ICIIIIC 15 "UUI. nOCJIC Ka>KHorO 3Tana IUIKy6mum CMeCb
nepeMCWI1BaJOT nacTcpoBCKOII mmCTKot'f (npOnYAaSi A03JJ,yX). rOTOASIT MaJKf1, Rbl-
cyunmaK)T. eJmKcHpYIOT MCTatmJIOM H HOKpau.umalOT MCTIUIOllblM 3CJlCHbIM.
H(}p_"rtaAhH.bll rleAlltlltllbl. Y 3l opoln)lx mflJ, rpaF YJlbl cJJOpM<13<um oouapY:>Klma-
I-OT B 7,2 + 1.2% HdfTpoqmJloA.
MemoiJ CmllJClpmll II coaelll. (1 _"IO()lltfilllWlfllll E. C. HmOe6G
DpllHl(WI. CM. Memod DapKa.
PeaKnlllBb/. 1. renapuH -10 EA B 1 MJI 0.9% pacTAopa XJlOpf1J\a uaTpuSi. 2. 0,1 'Yo
BOJl,HbIH pacTBop UI1TpOCm el"O rc rpaJomul. 3. 50% pacmop qmpMaJH1Ua u 0,9%
paC1'BOpc XJ10pHna Ha1'pJ1S1. 4.3,4% pac1'Rop xJlop"]l,a HaTpuSI. 5- 4(Yo <I)opMClJII1HO-
1l0-CIIHpTOBOt'1 pac'mop. 6. U,5% paCT80p Ca4)paHIfHa B O,9°,{j pacTBope XJlOpJ'fAa
Ha1'pllSi.
Cnel(llllAbH.Oe ooopya(}rlllHue. 1. UCIITpl1qJyr<1. 2. TCp 'ocTaT I1JH1 IJOJ];}IHa uall
lIa 37°C.
X oc) OJlpec)eAelill.fl. ('MCI mmaK)l' 0,1 "'111 KPOHl' 113 na 'I LLla C 0,1 MJI paCTBopa (.c-
napl1ua. Ho6anmuoT 0,1 MJI paCTBopa HH1'pocuHero 1'eTpa30JlI1S1. J.1uKy6f1PYiOT
CMeCh Ha AOl\SlHOH 6allc (J1JB1 B TcpMocTaTc) npu 37°C B TC leHHe 10 MI1H. (1)f1KCf1-
PYID1' CMeCb B paC1'BOpc cJJopMaJ1l1l1a 3 MI1H. D,ooaBmIK)1' 3 MJI 11. 'CnLIJJlI1pOHalm()H
B011.bJ Ha 20 C (Hml mnuca 3p -rrpoLlHToll). D,ouaumuDT ] MJI 3,4% paCTBopa XJlOPf1-
]J.a HaTpf1S1 (AJISI DOCC1'aUOBJlCHl1S1 u30TOIum) 1 OCTaUJlSliOT npJ.1 KOMuanloi:'1 TCMIIC-
p<\TYpc Ha 10 I\1I1H. UCHTpI14)ynIPYID1' 5 M 1H npu 1000 o6hH1H. YHa..'1 IOT nac-rcpoll-
CKofi mmeTKOH H4:t;,UC4:tHO L IUYIO :>K 1HKOCTh, In OC4:t;,Ka nrrOlnrr Ma'3KI1. <PHKCUPYJOT
Ma:iKH A <pOpMaJII11101l0-CIH1pTOIiOM pac'mopc 30 C 11 AOKpaWHBato1' cacppaHHHoM.
HOpMaJlbHhte ae 'lIl.tllfll)/. Y 3l\OPOBLIX JlID d1 IIOJIO:>Kf1TCJlbHbIH HCT -TeCT 8bl-
SlBJleH B 9.34:t 0.4% lIeft1'pocJJ fJlOB. ClI,K COC1'aAJISlCT 13.3 + 0,6.
K.llWmL,eowc 3H£NeHllC. HCT-TCC1' nOBLlWCH npH OCTpblX 6aKTepf1aJ1bUbiX
HH<IJeKl I1S1x. o6oc-rpcmm II rCIfCpaml:3aLlI1J1 O larOllblX uocna.rIllTC.llbHbIX npOlJ,CCCOU,
1'y6cpKYJle3C J1CrKf1X. xpoHwlecKf1x rcnaTH1'ax. aJ1JICprWICCKI1X :m60JlCAaHHSlx. no-
CJ1C AaKltHHaItfH1, pem.1an13 ..IC.
.flumepamypa. A.H.MaSlllcKuH. o.J.1.nl'IKY3a. KmIHH'ICCKHC ClcnCKTbl cparoLllI-
1'03a. K., 1993.
TPOM&O MTbl
Tpo. {60l(lmlbl - 6C31>Slnepllble KJICTKH. pa3MepOM 01' 1 11.0 5 MKM, SlAJlSliOTCSI
cppan1CIITaMI1 I U r<.JIUJa3Mbl McraKapIIOLlUTOIi. 1MCt{)T n1aJIOMCp f1 rpaIlYJlOMCp. rl1-
ailOMCp TpOMUOLlIITOIi OrpaHH'ICII 1'peXCJlOHHOH MCM6paHoH, mvatow.e i 60JIblllYK)
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Internet: www.glasnet.rurunimed e-mail: unimed@glasnet.ru
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1. UU11l02pa."f}.fll C Ilpeo(jJUu)aHlle..., 311llmeJlliOu(),lhIX /Ulem ()/{. B IIpenapaTax
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IIbl. HeKOTopble SI}l.pa cOJ\cp)l(aT KOMllaKTHblif XPO\lcHHH, B HItX SlAPblWKH nJIOXO
npOCMaTplwaIOTCSI. lJ,wronJlilJMa KJlCTOK 06H]11>1I" 1 11J1 1 CKY[lHaSl, pa:moi1 crCIICIUI
6a3ucpllJlIU1. Hcro 1OrCUliaH. I1H()r} a uaKYOJU1311pouaHHaSl. 113peAKa BCTpe Iak.)TCSI
MUT03bl B SlApax KElll. Kr1CTKit XO,1J,)I(KI1IIa - KPY"UbIC. C GOJlblUlIMIt CUCTJI61MH SI} -
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XOJU1. UKJIK)'laCT B ceuSi mu.tcpOlI Hble 3JICMCIITbi pa:moi"1 CTCI1Clllt 3peJIOC n1, 11J1aJ-
...,IOLlI1Tbl, 3031UIO(J)I1JlbJ. uCfiTpmfH1J161, MaKpOQ'>anl. K!leTKI1 3HAoTemiSi CIII YCOB.
.:JIJIJTCJII1011.L\lIblC K!leTKH. cpuGp06JlaCTbi.
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<po lrl'apHOC IICTO CHI-Ie. I3apuaHT JHIM<porpaHYJJCMaT03a YCTaHaBJH1Ua}{)T npll rll-
CT01l0rl1'JCCKOM I1CClICAOBaHl1H 611onTaTOB JIIIM<paTU'ICCKIIX )'3.'1013.
nlU'if1ocapKo."' 1 (HCXOA>KKIIHCKIIC 3110KatfCCTBCHHbie JUIM<P0Mbl, JICA) - CI1C-
TeMHbie 3J10Ka ' leCTBeHHble onYXOJlH I-IMMYHHOJ.I CI1CTeMbl. cy6cTpaTOM KOTOpblX }lB-
JlSUOTCSI KJICTKII UHCKOCTflOM03rOUOJ.1 JU1M<P0I-1}\IIOti TKaJH1. '11'0 OTJUllraCT IIX 0"1' JICJ.I-
K030B. Pa3B1ITl1e onYXOJIII MO>KeT conp0I30>KJ:taTbC}I 1H<p 111bTpmtl1ei1 KM If J1etiKc-
r-.UI3al{llci1, Bce COIJpCMCllllblC KJlaCC 1<pIIKa lH1 JICA SlBJISIIOTCSI MOP<P0JIOrl1'ICCKII-
MI-I U OCHOl3bma}{)TC}I Ha Mop<p0J10rWleCKOM COOTBeTCTIJIUI onYXOllel3blX KlIeTOK
CUOIIM HOpMaJlbllhlM aHaJIOraM - pOAOHa'IaJlbHUKaM onYXOJICBblX KJ10H0I3. B HaCTO-
S1Lllee I3peMSI n pa3HbiX CTpaHax IICnOJ1h3YIOTCSI pa3J1' 1lUlbIC KJraCC 'lcfJm..altlH1: KJlaC-
CI1QJIIKaUI1S-1 Lukcs U Collins (ClllA), K 'llILCKaSI (cTpaHLI El3pOnbl), B03 (POCCI1S1).
Pa60liaSi QJOPMYJII1pOnKa (ClllA), REAL (ncpCCMO'Ip EBponetlcKo-Ar-.1CpIIKaHcKoH
KJJaccu<pIIKal{1I1I J1I1McfJm1)lHbiX onyxOJICII. 1994). KJtaCCII<pIIKaUIiSI (B03. 1981)
JICA OCHomlHa Ha npe0611a.n;aHlul KJICTOllHoro Tmm C YlleTOM KlIHHll l leCKI1X II rllc-
I'OJIOrll'ICCKI1X IIpH3HaKou. Bcc .iICA ACJISlTCSI U :mm1C 1 1Ocnl 0'1' xapaKTcpa 1I0pa-
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HLIM cyue-rpaToM J\'101yr 6blTb B. T-m1M<poUI1TLI Ha pa3HbiX CTajJ,I1S1X I-IX :\U<P<PCPCH-
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lilCJI 6J10K IIX AI1<p<pCpCHUllpOI3KII. KJ1CTKII npll uccx <popMax .rICA pa3J1I1'IHbl no
pa3MepaM (MeJ1KO-, KpynHOKJICTO'IHble II CMelIIallHhle Tllm>I).
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I3blC KJ1eTKII C Mop<p0J10rl1lleCKIIMII llepT<lMIf, CBoticTl3eHHblMl1 3peJ1blM ml\1<poUI1-
TaM - J\WJlKUC KJlCTKU C nnO'nlblM TCMHOOKpallletiHhlM S1HpOM UC3 BlIHUMhlX HYKJ1eO.TI
1 C ua3o<p -lJlhtiOH L wrO[]J1a3M()H. MOp<p0JIOI'lllICCKaSI aHaIIJJa3USI Bblpa>KCHa YMe-
peHHO. MHoro ronOSlJ],cpHblX QJOpM. Ha MCUlblX JIIIM<poUI1TaX 3KcnpeccupY}{)TCSI
npel-IMYLlleCTReHHO B-KlIeTO'IHhle aHTllreHbl: C019, C020, C023, C079a. cJla6aSl
3KcnpCCC 1S1 sIgM. UlITonJla3MaTU'leCKIIC I1f Moryr (YrCYTCTI30I3aTb. OnyxOJICl3blC
B-m1MQJOIUIThl npOSIRmnOT IIhlCOKYIO aKnmHOCTh A T<I)-a3hl, KOTopaSi C'lIlTaCTC"
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XJIJI. Hc06xo]J.uMo npoBeAeHlle IIMMYHOUI1TOXIfM 1lleCKUx peaKL.{l1fi C naHellbK) MO-
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KJICTO'IHOH npUp0)\hl. B L 1TOJIOnllICCKIIX IIpcllapaTax OTMCllaCTC>1 MOHoMopcfJHasl
npoJlI1QJepm.lIISi JUIM<po6J1aCTOB - KnCTOK C KpynHblMu OKPYfJ1bIMU 11JI1-IIl0J1IIMOPQJ-
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liI1l.mhIM 1 KPYIlHbIM 1 HYKlIeOJ1aMU, 6a3or}1UJlbHOH 1 I1TOnJ1a3MO". BbIAellSlJOT MaKpo
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METO)1bI l'EMATO.IIOfl1 t IECKI1X I1CCJIEJ OHAHI1I1 87
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J10>KI1TCJILHOe Beu..teCTBO npcJlcTaBJICIIO B mme 1 rpaHYJlbl B He60JlhUlOM npOIlCHTC
KJICTOK, OTMe laeTCH ml3Ka 1 IUIII YMepeHHa)'l aKHIBHOCTh K<J>. I1MMYHoJlonl lccKI1H
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K I 3KcnpeCCllpYIOT slg II cIg. 06LI'IHO IgM npll oTcyrcTBlll1lg0. IIMCKH B-KJICTO I-
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uapliaHTe .flCA onpe1l.eJUlCTCH j-U,CIIL. npU le""1 npoueHT KJleTOK, C01l.Cp>KaIl.l,IIX CC.
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H I01' KpaCI1TCJII1, HCIlOJlb3yeMbic ]],Jl rCMa1'OJlorH'ICCKI1X I1CCJlCAOBaHI1H, B "lac I'HO-
CTI1 KpaCKI1 POMaHOBCKor'O-nlM3a. JICHIII MaHa. Maj:J -rpIOHBa.rrb/1,a. KpoMe Taro.
WHpOKO IICnOJlb3YlOTCH MeTO]],I1KI1 OKpaCKI1. rJ(C OCHOBHblM KpaCI1TCJICM SlBJISlCTC
. rC 1aTOKCI1JlI1H. a TaK>KC LlI1"rOXI1MI1 I ICCKHC MCTO]],bl.
KallecTBO OKpaWI1BalUISI 3a1U1CHT aT 81111.a 11 COCTaBa KpaCHTeJISI - ero KOHLlCH-
TpaLlHI1. KOTopaSi He BcerAa onpe.uCJ1S1CT KpaCSlll1,)'1O cnoc06HOCTb; npO]],OJl>KHTeJlb-
Hocnl OKpallJJ.malll1S1; npeMeHJ.l J.13rOTOBJleHI1 npCllapaTa (60JlbllJJ.1HC rBO npcnapa-
roB. OT MOMeHTa npHroTOBJlCHU KOTOpblX J(O OKpaI1U1BaHI1H npOWJIO 01' 6 llaCOB AO
HeCKOJlbKHX 11.Hei1, yrpa"Il1BmOT MeJIKne CTPYKTYPHblC .QcTaJlI1); pH cpe11.bl Te\11IC-
paTypbl BOJAyxa B IlPQLleCCC OKpaWI1BaHH , liTO CBH3aHO C I1CnapCUI1CM KpacSlll cro
paC1'Bopa.
,
l
.
108 TOM II - t.IACTHbIE AI-IAJU1TM YECKME TEXHO.nOII1I1
OKpaCKa no FlU1,1e II ee } IOi)uifJUKalIUlI
CnlHAap1'Hl>lH paCTBOp fl1M3I.1:
A3YP 1 - 3.772 r
30:u1H - 2.165 r
:v1CHIJICUOUblii CI-tHIfI1 - 1,563 r
MCTHJlOBhlH crmpT - 750 MJl
rJll11{CpUli - 256 MJl
Memm)uKll (}J(paCKII, npenapaT. nOJlY"leHHhlli 6 'I - 2-3 AHSI lfa:m)J,. CPHKCHPYIOT
3 /1-111 HY1'hl It MCTHJl0130M cnupTC U nepeHOCHT Ha 30 MUHYT 13 KpacSlw,Yfo >I<IIJ],KOCTb,
COCTOHW.Yf() U3 5 MJI CTC.lHAapTHoro paCTBopa ntM3bl U 20 MJI AHCTHJIJH1pOBaHHoH
BOJ],hl (pH 6,8-7,2). nOCJIC :':rroro OnOJlaCKI-lU310T uo onpOB()HH()t1IJOAOrl H BbICYIUU-
BafOT Ha B03J1.)'XC.
OKpacKa no Po.Mallo8CKo"uy-ru.",.1e
CYXHC M33KU cpHKCHp)'IOT B Me1'HJIOnOM cnup1'C (5 MHflYT) HJlH CMeCH HUKH<pO-
paBa (15 MHH)'T). 3m'CM norpY)KalOT II paGo"mH pac'mop (pa3Be.neHue 1:4) 1'01'0130-
1'0 KpaCH1'eJlSl POMaHoBcKoro-fllM3bl Ha 5-7 MHII)'T, nOCJle "lero npOMblBalOT H"'C-
THJlJlHpOBaHHoH BOJ],OH n BbIC)'UJHBatOT.
OKpacKu no llllnnelllei'h,y
rIpcABapllTeJlbH3H (fJl1KCal{IISI MaJKOn HC Tpe6ycTCSI.Ha nOACOXIJJHC ua u03Ayxe
MaJKH H3JUmaK)1' KpacK)'-qmKc3Top MaH-rpfOHBculb.na Ha 3 MHflYTbl. He CJlI-maH
KpacKY, K Hd, A06aBJlSl101' l'aKoe >Ke KOJ1H'ICCTBO JJ,J1CTHJlJlHpOlJaHHOH BOAbl. 1.JcpC3
1 IIIHH)'T)' KpacKY C Ma3Ka CmtBalOT H. IIC OnOJlaCKHBaSi crn, HamIBafOT npO()JHJlb1'-
pouaHHbli1 paoolluH pacTBop (pa3BcJteHUe 1 :4) raJ'Ouoi1 KpaCKH POMaHoBcKoro-
Im'13b' (npH pH 6.8) Ha 5 MHflYT. nOCJ1e OKpaIUHU1tHHSI npcnapaTbl npOMblBalOT HII-
CTHJlJIHpOBaHHoi1 UOAO" H BbIC)'WlmaIOT Ha 1:I03!{YXC, YCTaHaBJlJ.1BaSi HCpnlKilJlbHO II
cneLlnaJlhHo 't c)'wKe.
AJlSl npUrOTOBJleHHSI KpacKu-cpHKcaropa MaSi-rpIOHBaJlb.rW 250 MI' nopOUJKa
MaSl-rpfOHBiUlbJJ,a pac-nmpSlIOT B 100 MJI MCTlIJlOBOro CrlJ.1pTa. PacTBop nonorpcBa-
101' npH 70°C Ha BOASIHOH 6aHe JW nOJ1Horo paCTIlOpeHHH nopOIllKa, CPUJlbTPYfOT ..t
xpaHSIT B 6YTblJlKe C npHTepToH np06KoiL
MoOUrfilllW l lUll ."emO()/l lIannellzeu..Jtu
IOTOBHT 0,3% paCTBOp KpaCHTCJISI MaH-rplOllUaJlbna (300 /1-1[' nopowKa KpacH-
TeJ1S1 pacTuopHfOT n 100 MIl Me1'HJlOBoro CIIHpTa; paC'fBOp C03pCB3eT 3 AH ); pac-
TBOp a3ypa [J (1 r' paCTBOpSlf()'" BlOOD MJl KUnSiILt.e 1 BOAbl); pacTBop 303HHa KaJlml
HJlH HaTpH (1 r 303 111I a KaJlHSlI-1JlH 0,5 I" 3OJI1Ha HaTpHSI pacmopSlIOT B 1000 MIl KH-
nHllteH OOAbl).
Memo()w((l OIqJaCKU
1. BbIC)'lJIeHHbIC Ma3KH CPUKCHpYIOT 13 Men1J101J0M crmpTc 3 MHH)'Tbl.
2. OKpawHBillOT 0,3% paCTBopOM MaSl-l1JloHBaJlbI\a, Ha 1 "faCTI. KOTOpOro 1\0-
GaBJleHO 4 "laCrH cpoccpanloro 6ycpcpa (pH 6.8 - 7,2) 10 MMH)'T.
3. AOKpamHBalOT a3)'p-303HHOM (1 laCTb paCTBopa a3ypa + 1 "raCTb pacTBopa
3031111a + 5 "TaCTeH c)JoccpaTHOI'o 6ycpcpa nplf pH 6,8-7.2) 20 MHH)'T.
4. CMhlOaJOT KpaCHTeIlh npoTO l lHoi1 Bon oH .
5. BblcywHBalOT Ma3KH Ha B03A)'xe.
.
-
,
,
lJ.MTOflOfMlIECKME MCCflE,IJ,OBAHM5I 109
.
ORpaCKa .Ma3ROO no ReiimwallY
rOTOBflT KpacKY fleHUJMaHa (2.5 r cyxoro KpaCI--rreJIH Ha 1 JU1Tp MCTHJlOBOrO
Cnl1pTa; Kp3CltTCJlb C03pcnaCT 3-4 .1HfI) 33YP (1 r cyxoro KpaCl-rrCml a3YP Ha 1 JI ]\1,1-
CTI1J1JIHpOBaHHOrl H0l'bl, KpaCI1TCJl1. cOJpeBacT 3-4 HC]\CJIH); 30:il1H (1 I' cyxoro Kpa-
CJ.ITCJlfl 30311H Ha 1 JlJITp J\11CnIJlJH1poBaJ-IHO" BOJ\bl: KpaCI1TCJlb C03pCBaCT 3-4 HeAe-
JUI).
MemoouKo OK!Jac:H.:U
1. BbIC)'WCHHblrf Ha U03AYxC Ma30K ncpclmcflT Ha 3 MHHyrbl B KpaCI1TCJlb
flCM w l>1a II a.
2. npOMbmaloT n BO,lJ,onpolloJ\Hoil BOAC.
3. Y,IJ,3JUUOT (CTpflXI-fB<\K>T) 1-136b1TOK nOAbl 1-1 3<UUtHmOT Kp3CI1TCJICM. B COCT3B
KOTopom BXOJlflT 40 MJl 33ypa. 30 M.'I 30:mlla H 70 Mn AHCTHJl!lHpOnaHHOrl BO,lJ,bL
KpaCIITCJlh raTOBWr IICpC,IJ, pa60"rorl. Ma3KH oKpaUJHlJaJoT 30-40 MI'IH)'T.
4. npOMLmaKH BOAonpoooJ\HOll BOAO".
5. Bblcywl1BalOT Ha B03AYXC I1JU' npoMoKaloT cJJl-1JlbTpOBaJlbHOt1 6YMarorl.
C"po'lllan oRpacKl1 110 AJleRCee6Y
I. TOHKue Ma3KH cJJHKC'l1p)"OT II lIoJtorpcTOM ,'J.O 35-40 rpaJJ.)'coB C pacTBopc
\1afl-fpIOHUaJlbJl3 30 CCK.
2. OnOJJacKllIJaKH B BO)lC.
3. OKp3wIIBalOT 8 0,1% pacTBope (3)'p-303uHa (2: I) 2 MHHY fbl.
4. OnOJ1aCKI1BaIOT B BOnC.
5. BhICYWI1B3IOT, npOMOKaSi.
OKpacKa no nanllllUROJlay U ee ltlO()uifJUKallllll
1. BJIa>KHbIH npenapaT cJJHKCl-1p)'IOT Ii CMCCI,I J-II1KHc)JopOn<l B TC1.ICHl1e 30 MHH)'T.
ECJ1H nOCJlC (tJl1KC3UHIJ ero 3am1Th r}JJf(lCpHHOM Ha 2 'laca, TO nOTOII.' npcnapaT
MO>KHO Xp3H1fTb AO 14 AHd"1.
2. ncpc,IJ, OKpalllHuaHllCM IlpCnapaT npc.lI10ASlT 'lepe3 Cnl1pTbl HI1Cxo.Qfllltei'l KOH-
UCHTpaUI1H (100%, 95%, 80%, 50%) 11 ,lJ,HCTI1!lJlHpOBaiUlYID BOAY (B Ka>K)lOM CTa-
KaH'IJ1KC )tcp>KaT no 2 MI1HY 1"1.1).
3. OKpal.l1IIBalOT rCMaTOKCI1JHmOM U TC'leHUC 10 MI-1HYT (ncpcA I1CnOJlb30BaHI1-
eM paCTBOp KpaCl-l're.'Ifi HCOOXOHJ1t,IO c)J11J1bTpOnaTb),
4. OpOMhlBalOT B 3-x CMCHax HHCTHJLIIHpOBaHHofl HOHhl.
5. IlCpCHOCflT 13 CMCCh 113 97 MJl 70 % ClllipTa 11 3 I.'1 KOHUCUTpl1pOBalllloro pac-
TBopa aMMl-laKa( npcnapaT CTaHOIUlTCSI CIIHI1M). B ::rroH CMCCH npenapaT Heo6xo-
AHMO OnOJlOCH)'Tb HCCKOJlbKO pa3.
6. OnycKaloT B 70% cnllp'l" H 3aTCM npOMI.malOT H npoTo'IHOW BO,lJ,e.
7. OnycKalOT II paCTBOp KapooHaTa JlJtTlISI Ha 1 MI1HYT}' ( 3 KanJIH HaCLI1l..lCHHO-
ro BOHHoro paCTBopa Ha 100 IIIlI J1.IICn1JlmlpOlmmlOw llO}.J.LI).
8. OpoMbmmoT B npoTo'IHOil IIOJl.C 5 MHH)'T.
9. 06C3BO>KlfOaJ<n(W1CTI1JlJll1pOBaHHaSl BO,lJ,a II cnHpTbl BOcxoJlSmtc(l KOHUCHT-
paUl1I-1 - 50%,70%. HO°,.{). 100%).
ro. JJ,oKpaWI1B<uoT B Te'ICIlIlC 4 I1II1UY" B opaU>KCnO\1 f (roToBbli't pacTBop).
11. OnOl1aCKHB310T II .QBYX CMeHax 95% crmpTa.
12. OnycKalDT 13 Kpacl'ITem. IlanaHI-tKoJlay Ha 1-2 MHIIYTbl.
13. OnOJ1aCKlmmO"r B 3 CMeHax 95% It 2-x CMeHax 100% CnltpTa (u nOCJleAHet1
CMCIIC ]tcp>KaT 5 MHH)'T).
..
110
Tor.I II - '-IACTHbIE AHAJU1TM4ECKME TEXHOJIOrMM
I
14. npOCHcTmnoT R KCHJlOJle, 3aKJlIO'lmOT B 6aJJh3aM.
npll20nWl ./IeHiU I(IJiICllme./leii. PacTBop I: 11' KpHCTaJlJlHt.lecKoro rer-.ia1'OKCf.I-
JIHHa pacTBopHIOT B 10 MJI 1009'0 cnHp1'a.
PacTBop II: 20 r aJlIOMOKaJlUeBblX KBaCLlOI3 npH HarpeRaHHH pacTBopuTb B 200
u
MJI AHCTWIJlHpOBaHHoH BOAbl.
l-lepc3 24 t.laca pacTBopbl I 11 II CMCWHomo1' H J106aBmnoT 0,5 I' OKCHJ a PTY rH
(KpacHoro). HarpeBalQT no KJHlCHI1H H OXl!a:>K.umOT Ha BOA)!HO I 6aHC. "lepe324 tla-
ca ()"rcpl'IJIL,.rpOl aHHhlt'1 pacTBop MO:>KCT 6blTb I1cnom.:mBaH. Ka:>KAbIH pa3 ncpc]1
npHMeHeHI-lcM cro cJleAyeT QJHJlbTpOBaTb.
KpaCUme.llb nllllllHllJ(().IIay. Cr.'leWHBaIOT 45 MJI 1.5% pac1'Bopa CBeTJlOrO 3CJle-
HOro (JII1XTrploH) U 95% CmtpTe, 10 MJI 0,5% pacTBopa OCHOBHOro KOpl1 t lHeBoro
(6I1cr.mpK6paYH) 95 % cnHp1'e. 45 MJl 0,5 % pac1'Bopa 30JI1Ha R R5 % Cnl1pTe, 0.2 r
cpocqJOpIiOMOJlH6]J.eHoBoH KI1CJlOTbl H J o6aLUIHlo1' 1 KanJlIO HaCbUl(eHHOro nOAHoro
pacTBopa Kap60HaTa JlHTHH (1 I' Ha 100 MJllJJIC1'UJIJIHpOBaHHot'1 BOAbl).
OTC'ICCT13CHllhIMH 1 I-ITOJIOrar-.U1 npe]J.JIO:>KCHa MO:tl1<lmKal\HH MeTOAa, B KOTopOi1
CBe1'Jlblt'1 3eJleHblH 3aMCHCH Ha 60Jlce AocTynHblH 6pHJIJIHaHTOliblH 3eJleHblt'l.
DKpacKa no llanalluKo.JJay B A-lOoufj'JuKaijIlU KY"Uijbl
I. OpaH:>KCnblt'1 r: CMeUJHBalO1' pacTBop 0.5 r opau:>Ka G lIa 100 MJl 96% CIUlpTa
II 0,015 r QJOCQJOPHo-r.'lomI6AeHonot'1 KlICJIOThl. nonY'leHHblH paCTnop oc l'aRJlHIOT
Ha 1 C)'TKH, nOCJIC t.lero OH rOAeH AnH I-ICnOJlb OBaHI-IS1.
C LlCJlblO npm'OTOliJleHI-IH npOMe:>KYTO'IHoro KpaCllTeJlH 1-1 GpHJlJlHaHTOBoro Je-
JlCHOrO Heooxo.uIfMO 3a 1 C)'TKU npl'lroTOBl11'b CJleA)'lOlltHC BO]Ufble pacTBopbl:
1) OCHoBHOro KOpH'IHcBoro - 0.1 I' Ha 1 Jl 1l,IIC1'HJlJlHpOnaHlioH ROAbl;
2) 303HHa (:>KeJlTbIH I11IH 06hlt.IHbIH) - 0,1 r Ha 1 MJI AI1CrHJlJIHpOBaHHot'1 BOAbl:
3) 6pl1Jl.1l11aHTOlJoro 3e.rICHoro - 0.05 I' Ha 1 MJI ]J.I1CTHJlJll1poBaHHot'1 BOAbl + 1 MJI
96% cnHpTa. 31'1-1 pac1'Bopbl Heo6xoJtur.IO IIJlO1'HO 3aKpbl1'b Ha 1 cyrKH II 1'epMocTa-
1'e npH 37°C. ,D,aJlce ua HUX roTOBH1' cmlpToBblC pacTRopbl KpaCI1TeJlCH.
II. npOMC:>KYTOt.IHbIC KpaCH"I'CJIH: OCUOIJHOt'1 KopH'IHeBbIH - 1 MIl n01\Horo pac-
mopa Ha 200 MJl 96% Cnl1pTa (CCJlI1 3031-IH 06bl'IHbl" - 1 MJl BOAHoro pacTBopa lIa
260 MJ1 96% Cnl1pTa).
.IJ.JlH nOJlY l leHI1H npOMC:>KyTollHoro KpaC 1TeJlH, npenCTaBJlHIOIl'Cro C060H CMeCb,
6epyr CJleJ.tYIQIl.lIIC KOJlHt.leCTRa Bell{eCTBa Ha 100 MJI CMCCI1: 16 MJl cnl1tyronoro pac-
'mopa OCHORHOro KOpHllHcBoro, 84 MJI cnHpToBOI'O pac'mopa 30311Ha ()f(CJlTOBaTO-
ro I1Jl H 06bl l ulOro). 0.17 I' qJOCQJOPHO-MOJI H6nCHOBOt'1 KHCJlOTbl 11 .u06aBJlSIIOT 1 Ka-
nJ110 HaCbJIl.lCHHOro pac'mopa Kap60HaTa JlHTI1H. KpacH reml cpl1JlbTPYIOT nepcn
CMeunmaHHeM. OCTaTOK xpauslT HcnpoQJIIJlbTpOBaHHbIM.
III. EP 'IJlJll1aHTOBbIH JCJlellblH - 0.5 MJl BOlJ.HO-C[lI1pTOROro pacTBopa Ha 180 MJJ
96% CIlHpTa.
Memovww OKpllCKIl
1. npcnapaT )I1KCl1pYIOT B CMeCH HHKI1 )OpOBa (MHHIIMaJlbHa IlPO/tOJl:>KH-
reJ1bHOCTb cpl1KCaLllIl1 30 r.UIH).
2. npOr-.II.maKH B 96% cnHpTC, a 3aTeM AIICTIIJlJlHpomlHHot'1 BOAe.
3. OKpaWHBalOT rcr-.taTOKCHJlI1HOM 2-3 I11HUYTbl, npmlblBalO1' B BO]J.C.
4. D,l1cpcpepeHLlHpYIOT 0,5% pac-rBOpOM COJlHHOH KHCJIOTt.1 AO lIoKpacHeuHSI n
-
.
lJ,I1TOJIOrI1YECKI1E I1CCJ1ED,OBAI-H151 111
(
TC ICIH1C 2-3 IInfH)'T. CmmaKJT, npOMbinalOT B BO.o.C. KOHTpOJlI1p)'KH 1I0A MJ1Kpo-
CKonOM OKpaCK)' SI.o.ep.
5. On)'cK(\}OT Ha 1 IlHiH}.)' B CJlaObl" pacTBop KapGoHaTa JlI1TI'ISI (3 KanJlJ1 HaCbI-
l1(CHHoro BO]1,IIOro paCTBopa JlMTM lIa 100 MJ( AMCTJ1Jlm1pOnaHHo BO]].bl), npOMhl-
BalOT B BOAC.
6. TILJ,aTCJlbHO 06c::mmtOmmOT Ma30K 96% crmpToM.
7. OKpaIJIlfBalOT OpaH>KeM G B TC lcmlC 1 MMH)'Tbl, HaJlMrJaSl KpaCI1TCJlb Ha C1'C-
KJlO. CJIHBalDT KpaCMTem, M xopOWO npOMbmalOT crmpTOM /J,O )'}J,aJlCHMSI cro M36bITKa.
8. KpacSiT IIP()r.IC>K)'TO lHbIM KpaCllTCJICM 1 MMH)'T)', CJlMBaIOT, npOMblBalO1' n
CnlfpTC.
9. OKpaWI1BaIOT 6pMJlJUIaHTOBbiM 3CJICllhiM 1-2 MMH)'Tbl, CJ1MBalor, npOMblBa-
101' cnMpTOM. npOIl'IOKalO1'.
10. npoBoASIT llcpe3 KCIIJIOJI. 3aKJIIO\IaIOT n 6aJrb3aM.
OKfJUCKll n(J llunUIIUKOJlUY (J .'Wi)UifJUK1lI4I1ll Py,)elllw
BHa\laJlc rOTOBSIT BOAHblC paCTliOpbl Ll.IITOnmnMa I'WICCKJ1X KpacoK: no 0,1 I'
CBCTJlOrO 3CJlCHoro. 303Mll£1 >KeJlTOBa1"OI"O nOjJ,opacTBoplIMoro M OCHOBHoro KOPIl\I-
HCBoro pacTBopSiIOT OTHCJILHO B 1 MJl BOJlbl. BOJlIII.Ie paC-rBOpbl, XOpOUlO 3aKpbIB.
OCTaBJlSl101' HR 1 C)'TKII B TCpMOC raTC IIpM 37°C. 3m'clI.1 113 B0Jl.llbIX paCTBopOB rOTO-
BSiT cnWpTOnl.IC paCTlJOpbl KpaCl1'reJlcH:
1) CBeTJ]bl 1 3eJlelll.11i - 1 MJl BO.llHOrO pacrBopa Ha 200 MJl 96% Cnl1pTa;
2) 30311H )f(eJlTOBaTbl BOAOpaCTBOpMMbll1 - 1 MJl BO]J,HOro pac'mopa Ha 200 MJl
96% cmlpTa;
3) OCHomlOM KOpl'l"IHeBblrf - 0,25 II1Jl BOHHOro paCTBopa Ha 200 MJI 96 % cnMpTIl.
rIOCJ1C 3TOl"O I"OTOBSl1' CMCCb. KOTOp)'1O r. IlanaHHKoJIa)' Ha3naJl EA-36. OHa CO-
C roMT M3 CMCCH cnupTOBhlX paCTBopOB KpaCMTCJICH: 200 MJl CBCTJlOrO 3CJICHOrO,
168 M.I] 303Hlla )f(CJITOBilToro M 32 Mjl OCHOBHoro KOpl1 l U1CBOro, KOTOpblC ncpc]1,
CMCWI1BaHI1CI\.1 QJUjlbTP)'IOT. K CMCCII J106aB.1S1fOT O.6R -0.8 r QJOCQJOPHO-MOJII16nc-
HOlm" KIfCJIOTbl 11 4 KarlJlM HaCblweHHoro HO}IHOrO paC'rBopa Kap60HaTa JII1THSI. B
pac1'Bope KpaCIITCJHI o6pa3)'cTc IIC60JlbWOC KOJlII\ICC1'BO )'cTm1 1 IHBOrO oca/J,Ka, HC
MCIUalDll.f,cro pa6OTc. nOJlHOII J"OTOBHOCTIt KpaCK£1 AocTMracT 'lcpe3 3-12 AHCM IIpM
KOMHaTHoCf TCMllcparypc. AJlSl npMf"OTOBJlCHl-IS1 OpaH>Ka G 0.5 r c)'xoro 8Cll1CCTBa
pacTBopSifOT u 100 MJl 96% crmpTa M /J.o6£1BJlSlfDT 0,02-0,05 r <}JOCcpOpHO-MOJlM6]1,c-
HOBO I KMCJlOTbJ. nOJI)"ICHHblrf Hachlll elmbl i pac'mop rOTon K npMMCUCHli10 Ha
CJ1CnYH)ILl,M" /J,CUb. nOCJlC Taro KaK IfCnOJlb30BaH ncch pac'mop KpaCMTCJlSl, B 3TY )f(C
II0C)'AY C OCa.r KOM MO>KHO Ao6aBliTh 100 MJI 96% CflHpT<1 M )'Ka:mUHOC KOJIII'ICCTBO
cpOC<pOpHO-MOJII-IOJJ.CHOIJOI1 KIfCJIOTbJ. OCTanlllMecSi KOJIWICCTBCl cnMpTOBblX pac-
TBopon 303IHm >KCJITOUaToro It OCIiOImoro KOpl1'lHCBOro xpaH)jT M I1CnOIlb3)'IOT J],JlH
npMrOTOB,'IeHIfSi KpaCMTCJISI 3-6 MeCSlI{Cn.
Ivlemor)UKll Ol(!}(IC/(ll
1. Ma3KM cpl-fKClfp)'KJT B >KMJ],Kocnl HMKM<popoBa 30 II1MH)'T.
2. npOMblBRIOT 96% ClllfpTOM 1 MI'IHyr)'.
3. npoMbmmoT H HMCnlJIJ111pOBaHHoCI BOJlC 2-3 MMHYTbl.
4. OKpallllmal{)T B pacTBope rCMaTOKCllJIIUm 3-8 MHH)'1'.
5. OnOJlaCKI1SafDT B IJpOT01IHOii BO]].C 3-5 lI-IImy I'.
6. npOIJOJJ,SlT '(CPC3 0.5% pac"mop COJlSlHOH KJfCJlOThi 1 MMH)'ry.
7. npOMI,IBalOT 2-3 MItH)'Tbl B J'MCn1JIJIMpOB£1IIHoH BOJ],C I-f 3-5 MUH)'I - B npo-
1'O'IIIO". KouTpomfp)'SI npoLl,CCC IlOA MJ1KpOCKonOM.
I
,
'.
112 TOM II - l.JACTHbIE AHAJIHTMllECKME TEXHOJIOrHI1
8. nepcHocSlT B 0,1 % paCT BOp Kap60HaTa JlHTI,UI 1 MIIHY"Y.
9. OnOJlaCKHnalDT n /\llCTHJlJIHpOBaHHOr, BOne .., 96% crmpTe.
10. nCpCHOCHT B 100% cnHpT lIa 1 MHHYTY.
11. OKpawlmalo'r B pac'mope OpaH>K G 1 M3 MHH)'Thl.
12. npono)J.HT 'lepe3 96% cmlp'!" B Te'ICHue 2 MHHyr. KOIITpOJlUp)'st npoLlecc non
MuKpocKonm....
13. OKpaWI1BatOT B CnCTJIOI';,1 3CJ1eHOM (CMCCb EA-36) 2-5 MHHYT.
14. nponoJ\SlT l.repe3 96% cnHpT 1-3 MHHYTbl.
15. npOMOKal-OT cj)HJlhTPOBaJlbHOH 6YMarorl, npOlWAstT 'repC3 KCHJ10JI H :mKJ1tO-
'lalOT B 6aIl b3aM. I
Bapuallm OKpaCKU le...,a"'OKCUAUIlO 1 II 303UIf(}.'" (1m. ta:JK08
)J.JISI npHroTOBJleHHSI KpaCI1TCJISI 50 r aJ11OMOKaJll1CBbiX ImaCI OB paCTBOpSlI-OT B
500 f\'IJl U1cTUJ1mlp<maIlIlOrl BO,%I, }J.OBO}J.HT AO KlmCHllSI 11 BblCbmalDT n ropst l ,""
pacTBop 1 I' rCMaTOKCIIJll-IHa. 3an M } 06aRJlSl}OT 500 MJl }J.HCTI-IJ1J11lpOBaHHoii BOAb1 J.1
J1.0BOJ1.HT,[J,O KHnCIU1st (HO HC KunHTSlT). PacTilOp OCTY>KaIOT no Km.-maTlIOH TCf\tnCpa-
Typbl u n06aBJlHIOT HOJ\aT KaIlHSI. rOpJlO cocy;\a "3ilBSl3hlBalOT MapJ1CH ... DC ranmllOT
c03pcBaTh Ha CBCTY 5 HeJ1.CJ1b. 3aTCM COCYH C KpaCUTeJlCM 3aKynop..malOT ..1 y6J.1pa-
IDT n TCMHOC f\'ICCTO. nCpCJ1 J.1CnOJlh30BaHHCM KpaCHTCJlh )l-JJlbTp)'IOT.
MenlO()UKli OKpaCKU
1. Ma3K..1 ctJUKCUp)'IOT B CMeCl'1 paBHb1x 'mCTe" :JctJllpa H 96% cnHpTa I1JlJ.1 U 96%
cnHpTe 7-10 MUHYT.
2. OKpalllHBaloT B rCMaTOKCHJlHHC 5 MHH)'T.
3. npOMblBalOT B npoTo'UlOil rm/1,e 1-2 MUH}Tbl.
4. OKpawHimloT B 0.3% cmlpTOBOM pacTBopc >KCJlTOBaTOro 30:niHa 1 MJ.1HYTY.
5. npOMhmalOT B npOTo'IHOI1 nOAC 1-2 MIIHYTbl.
6. BbJCVUJIIBatOT.
J
CnEUUAJIbHLIE METOHbI OKPAmHBAHUH
UUTOJIOfU1.IECKUX nPEnAPATOB
O"pacKa flU le.uoCU()epuII llepAca
JC> lll(J'lllt( l)l:
1. )KeJlTaSl KpOBS.JHaSl COJlb.
2. 1 N pacTBop H CI.
3. MeTI1J10Bl>1H crmpT.
4. CO!ISlIlO-KHCJlbIH crmpT.
Xou pell1Cl(llll:
1. 2% paCT BOp >KCJlTOH KpOBHIIOH cOJm:
>KeJlTaH KpOBHHaSi COJlh - 2 rp.
,[J,IIC'nuumpoBaHHaSi BOna - 100 MJI.
Pac mop J\OJl>KeH 6blTb 6CCJ\BCTHhIM.
2. 06ecLlBc'lHnaHMc npcnapaTa MeTaHOJ10M I1JlI1 COJlSlHO-KJ.1CJILIM Cnl1pTOM.
3. )J,HCTI1JlJlllpOBaHHaSl BOAa.
4. 3aJlJ.1Th 1 N HCI - 30 ceK.
5. J],06aBHTb B KHC!JOT)' paHHOC KOJlH'JeCTIlO pac-mopa >KeJlTOH KponSlHoH COJllI.
6. nCpcMemaTh 11 KpaCI1Tb - 10 MI1H.
7. J],HCHtJlJlHpOUallllaSi BO/1,a.
8. BbICYIlIUTI..
-
UHTOJlOfHYECKHE HCCJlEJJ,OBAHI151 113
I
I
P.HK no (/Je.nbzellY
PeaKmUBbl:
1. MeTl1nOBbu1 cmipT.
2. 3 N HC!.
3. PeaKTI1B 11111<PcPa.
4. 1 N HC!.
npuWmOBAeHtle peaKntUB06
1. 3 N HCI.
266,4 MJ1 - KOHLI,. HC!.
AO 1 mnpa - AJ1CTHnnl1pOOaHHaSi OOAa.
rOTOBI1Tb B MepHoH Kon6e, xpaHHTb B X0J10AHJlbHHKe.
2. PeaKTJ1B lllH<PcPa (C""I. rnI1KOrcH).
3. CepHHcTaSi BOAa.
1,5 r - Na2S20S'
15 MJ1 - 1 N HCI.
300 Mn - AHcTHnm1poBaHHoH BOAbl.
Xoi) peaK ml
1. <l>I1KcaLlHSI - MeTaHOJl - 15 MHH.
2. nOAorpeTb 3 N HC) AO 37°C - 10 MI1H.
3. B nO.QorpeTblH pacTBop 3 N HC) onycTI1Tb CTCKJ10 11 nOCTaBHTb B TcpMOCTaT
"PH 37°C - 20-25 MHH.
4. npOMblTb CTeKno B OTpa6oTaHHoM pacTBope 11111<p<pa 113 XOJ1oJ],HnbHHKa.
5. nO"'.lecTHTb B paCTOOp lllH<pcpa IHCTblH. npH 37°C - 45-60 MJ1HYT.
6. npOMblTb CepHI-1CTOH BOAOH 3 pa3a no 9 MI1H.
7. npOMblTb JJ,HcTHnJ1HpOBaHHoH BOAOH.
8. BblCYWHT Ha R03Ayxe.
9. Ea.f1b3aM.
CJJU3b
PeaKmU8bl."
1. CYXOH HCMe KI-1H MYlI.l1KapMHH cpHPMbl «Kepec».
2. MeTHnoBblw cnHpT.
3. fCMaTOKCHJIHH (3THJ10BbIH cnHpT, rnHlI.epl1H. KaJ1Ht1Hble KOaCl\bl, neASIHaH YK-
CYCHaH KI1CJIOTa).
npuZOnt06AeHue peaKnllJ.80R
1. OJ],HonpOll.. paCTBOp MYLI,HKapMHHa:
MYLlHKapMHH 1.0 r + 50% CzH;OI-l - 100 MJ1.
XpaHHTb B XOnOAHJ1bHI1Ke.
ncpeJJ, ynOTpC6J1CHI1CM KpaCKY Pa3BOASIT 10 pa3:
KpaCKa - 1 laCTb, AHCTHnnl1pOOaHHaSi 1J0J].a - 9 IaCTeH.
2. re"'1aTOKCHIIHH 3pnl1xa:
reMaTOKCHJ1HH - 2 r
96° CzHsOH - 100 MJ1
AI1CTI1J1nHpOBaHHaSi BOJ].a - 100 MJ1
rm1L1,epHH - 100 Mn
KaJU1HHbJC KBaCLlbl - 3 r
J1eJ],SlHaSi YKcycHaSl KHCJJO'Ta - 10 Mn.
-
114
TOM II - llACTHblE AHAJ1I1THl.JECKI1E TEXH0J10rJ.1H
I
1
npH CMellJHOaHHH paCTBOp HMCCT CnCT!lO-KpaCHblrl LtBeT. C03peBaeT 14 JJ.HeH n
COCYAC C UlHpOKllt.'1 rOp!lOM, Ha J],HO KOToporo naCbmmOT 0 HJOblTKC TO!llICHbIC Ka-
J1HHHbIC KBaCLl.bl. rOp!lO cocy.na OOBSlJl>maIOT Map!lCH U CTaowr Ha CBeT. nepcl yno-
TpC6!lCHI1CM KpacKY qJH!lhTPYIOT. PaCT BOp AOJJ>KCH HMeTb apOt.1aTH l leCKHH 3anax H
xpOMonaTo-cjJHO!leTOObIH l\IJCT.
Xoo peaKl(WI
1. <!>I1KCal.lHSI - MeTaHO!l - 3 MHH.
2. OnycTHTb B 3<f}Hp Ha HCCKOJlbKO ceK.
3. 3aJH1Tb MyLtHKapMI1HoM Ma3KH - 10 MI1H.
4. CMbl rh J],HCTH!l!ll1pooaHHoH BOAoH.
5. J],oKpacHTb reMaTOKCH!lHHOM 3p!lHXa - 5 MI-1H.
6. Ct.'1 blTb BOAonpoBo.QHOH 1I01.l0 t
7. BblCYWI1Tb.
PBK no Eparue
PeaKmUCJbl.:
1. MeTI1JleHOBblH cnHpT.
2. MeTI1!leHOBbIH JC!lCHblrl.
3. nl-1pOHHH Y.
4. YKCYCHO-KHCJlbIH HaTpHH.
5. YKcycHaSi KHCJ10Ta.
npllZonJ(mACHUC peaKfIlUlfOlf
1. MCTH!leHOBbIH 3eJlCHbiri 2% paCTBOp.
a) OMblTb cyxylO KpaCKY XllOpOcpOpMOM.
6) 2% paCTlmp Melll111CHO!lOro 3elleHoro:
2 r - Men111CHOIJl.lrl 3CllCHhIH;
100 MJ1 - AHCTHJ111HpOBaHHoH BOAbl.
2. 5% nlipOHI1..:
5 r - m-1pOHHHa Y.
100 Mll AHCTI1J1J1HpOBaHHOH 8011.1,1.
3. Au.eTaTHblrl 6ycpep pH - 4,8:
a) CH 3 COONa - 16.4 rp;
A"CTI1!lm1pouaHuaSi BOJ1.a - ]J.O 1 Jll-rrpa.
rOTOIUITb B MCpHOH KOJ16e.
6) CH 3 COONa - 13.02 MJ1;
11.HCTHllllHpoBaHHasa 80Aa - 11.0 1 J1HTpa;
59 MJ1 (a)} + 41 Mll «6»,
1. <!>1-1KCaLtI1S1 - MCTaHOJI - 20 MHH.
2. AHCTI'IllJ1I1pOBaHHmi UOJ1.a HCCKOllbKO CCK.
3. OKpacHTb MeTUll. 3eJleH. - rmpOHl-1HOM - 2 \laca npH KOMHaTHOH TeMnepaTY-
pe. HHKyGaLtHOHHaSi cpe]J.a roTOIJHTCSI nepe]J. pa60'1'0H.
P-op (A» - 0,35 Mll 4 Kanmi - 5 npoLt. nHpOHJ1H;
0,2 Mll 2 KanJlH - 2 npoLt. MCTHJl. 3ellcHblrl;
5 M!l J],HCTH!l. BOI.lbl.
P-op «6» - 5 MJl p-op (A» + 2 Mll aLtCTaTHOro 6ycjJcpa.
4. 3 pa::m B AHCTI111. BOAe no 5 ceK.
5. BblCYIIIHTb.
-
--
.
lJ,J.1TOflOfvP-IECKJ.1E J.1CCJ1EAOBAHIUI 115
HYlCAeo.ll'"
PeaKmUBbl:
L Men-IJ10UbIH cnHpT - <In-lKC8Top.
2.0,1 % p-op MeTHJ1eHOBOro CHHero.
3. flHMOHHaSi KHCJJOTa.
4.1 N p-op NaOH.
npuzomo8AeHue pemmme08
1. 0,1 % 1'-01' MeTHJ1eH080ro CHHero:
MCTHIleHOBblH CHHHH - 100 Mr;
AHCTHJ1. OOA8 - 100 MIl.
npa<PHJ1bTp008Tb. XpaH....Tb 8 XOJJOAHJ1bHHKe.
2. IJ.HTpaTHbIH 6yIj>ep pH - 4,96.
flHMoHHaSi KHCJ10Ta - 21,01 r
1 N 1'-01' NaOH - 200 MJ1;
.n....CT. BOAa - 11.0 1 J1wrpa.
rOTOO....Tb 0 MepHoH KOJ16e. xpaHHTb B X0J10J],HJlbHHKe.
3. 1 N 1'-01' NaOH
NaOH - 40 r;
AHCTHJl. BOll.a - .0.0 1 J1HTpa.
rarORI1Tb 0 MepHoH K0J16e, XpaHHTh B X0J10JJ,....J1bHHKC.
Xo() peaKlfUtl
1. ""KcaLl.HR - MeTaHOJJ - 5 MHH.
2. OnycTHTb B 3<f>....p Ha HeCKOl1bKO ceKYH.o..
3. OKp8CI1Tb 0,1 % p-pot.-! MeTHneHoooro CHHero C KpaTKoopcMeHHblM nOJJ,orpe-
BaHHeM JJ,O JlCrKOrO napo06pa30oaHHH - 5-10 MHH.
4. CMblTb KpacKY.
5. BblCYlllHTb Ma30K.
6. nOMeCTHTb 0 LtH'rpaTHblH 6y<j)cp - 30-60 ceK.
7. BbICYlllHTb.
r.llUICOlen
Peaf<mUBbl:
1. MCTHnOOblH cn....pT - CH]OH. napbl10% <fmpMaJIHHa - 3 MI-1H.
2. MOJJ,HaSi KHCJIOTa.
3. <l>yKC....H OCHOOHOH WlSi <PYKc....HcepH....cTOH K....cnOTbl.
4. 1 N paCTDOp HC1.
5. CepHoK....CJ1bIH Na-Na2S20S'
6. AKTHB....pooaHHblfl yroJIb.
7. re 1aTOKCI-IJ1HH.
8. HOJJ,HoBaTOKHCJJbIH Na HnH K - NaIO). KIO).
9_ KanHHHble KRaCLlbl.
10. fll1MOHHaSi KHCJlOTa.
npw.onzOOJleHUe peaKmllB06
1.1 N p-op HCI.
KOHLI.. HCI - 88.8 MJ1;
AHCT. oo.o.a - JJ,O 1 JlHTpa.
L...
116 TOM II - qACTHblE AHAJIHTHt.IECKI1E TEXHOJIOrl111
rOTOBHTb B MepHOH KOJl6e, XpaHHTb B X0J10AHJlbHHKC.
2. PcaKTHB lllHcjJc}Ja:
a) c}JYKCHH - 1 r;
AHCT. Bo a - 200 MJl.
TIpoKHm1THTb HeCKOJlLKO MHH.
6) OCTY1\HTb p-op AO 50°C;
n) npoqmJlhTpOBaTb;
r) A06aBHTb 20 MJ11 N HCI;
J],) OCTYJJ.HTb;
e) JJ.OOOBHTh 1 r N a2S20S;
>K) A06aBHTb aKTHBHpOBaHHblH yrOJlb.
qepe3 CYTKH p-op 06eCLtBe'-IHBaeTCSI, xpaHHTb B XOJlOAI1JlbHI1KC.
3. CepHHcTaSi BOAa.
1 r - Na2S20.s;
200 MJl - AHCT. BOAbl;
10 MJl - 1 N HC!.
rOTODHTh nepeA pa60ToH.
4. 110J],HaSi KHCJ10Ta.
200 Mf - Ho.u.Ha KHCJlOTa:
40 MJl - AHCT. BOAa.
rOTOBHTb ncpcA pa60ToH.
llpulomo6.!Jf!IIUf! leMamOKCUJlUHa .3pJluxa
rCMaTOKCHJlHH - 1 r;
NaI0 3 - 0,2 r;
KaJ1HHHble Knaclthl - 50 r:
JlHMOHHaSi KHCJ10Ta - 1 r;
AHCT. BOAa - 1 Jlwrp.
KpacKa c03penaeT 15 AHeH B cocYJJ.e, npHKpblTOM 6YMa)KHbIM KOJlna'-IKOM, npH
'-IaCTOM B36aJ1TbJBaHHH. npH xpaHeHHH B XOPOlUO 3aKpblTOM cocYJ],e, p-op OCTaeT-
CSI B TelleHHe AJlHTeJlbHoro BpcMeHH.
CO.IUIIlO-KUCJlb'U cnupm
99 MJl - 70° C 2 H:'jOH:
1 MJ1 - KOHli.. HCI
Xoo peaKl(llll
1. <l>HKCal\HSI - MeTaHOJ1 - 20 MHH.
2. TIpOMblTb npoTo'-IHOH B01\OH - 15 MHH.
3. OnycTHTb B ac}JHp Ha HeCKOJ1bKO ceKYHJ],.
4.0.1 % p-op aMHJla3bJ pH - 7,0.
1 Mr - aMHJ1a3bl, 1 MJl - AHCT. BOJ],a.
I1HKy6HponaTb 15-30 MHH. npH to - 37°C.
5. npOMI>ITb AHCT. BOAOH - 20 MHH.
6. 110J],HaSi KHCJlOTa - 3 MHH.
7. AHCT. BOAa - 3 MHH. no 3 pa3a.
8. OnycTHTI> B peaKTI1B lllHc}Jc}Ja - 40 MHH., B TCMHOM MecTe.
9. npOMblTh cepHHcToH BOAOH - 3 MHH. 3 pa3a.
10. AHCT. BOAa - 3 MHH.
-
_..
QHTo.norMt.JECKME HCCnEAOBAHHH 117
11. AOKpacHTb reMaTOKCHJ1HHOM - 20 MI:IH.
12. npOMblTb BOAonpo80):\HoA BOAo .
13. BbICYWHTb.
llunuiJbl
PeaKmU6bt:
1. 10% napbl cfJopMaJ1HHa: <1'HKca....H .
2. CYAaH lepHbJ E.
3. 96° 3TI1J10Bblfi cnHpT.
4. KapMHH.
npUZOmOBAeHUe peaKmU80B
1. 10% napbl <PopMaJlHHa.
2. KpacKa cy,qaH 'IepHblA E.
70° CzHsOH - 100 Mr;
CYAaH t.JepHblH I) - 1130b1TOK.
npM HarpeBaHHH pacTBopSiIOT KpaCKy B 3THJ10BOM cnHpTe ):\0 COCTOSlHHSI
nepeHaCblll.\eHHSI. Ha ,qHe KOJl6b1 ):\OJDKHbl BbmaCTb KpHCTanJ1bl cy,qaHa. npo<pHJ1bT-
poBaTh, xpaHHTb B CYXOM TeMHOM MeCTe.
3. 70° H50H.
96° C 2 H s OH - 100 MJ1;
AHCT. BOAa - 391 MJ1.
4. 50° H50H.
96° H50H - 100 MJ1;
AHCT. BO,q3 96 MJ1.
5. 40° H50H.
96° H50H - 100 MJ1;
AHCT. 80Aa - 144.4 MJ1.
Cnl1pTbl xpaHHTb B XOJJO):\HJlbHHKe.
Xoo peaKu,uu
1. <1>I1KCaI.(HR - napbl 4>opMa.J1I1Ha - 3 MHH.
2. )J;I1CT. Bo,qa - HeCKOJ1bKO ceKYHA.
3. OnycTHTb KpaCKY CYJ],aH '-lepHbl B Ha t '-lac npH to - 37°C.
4. OrMblTb B 700 H50H.
5. OrMblTb B 50° H50H.
6. OTMblTb B 40° H50H.
7. AJ1CT. BOJ].3.
8. )J.oKpacHTb KapMHHoM 1 CyrKH.
llepOKCUOaaQ
PeaKmuBbl:
1. CnHpT 96° S'I'HJ10BbIA - H50H.
2. 40% cfJOPMaJ1HH.
3. 3 % nepeKHCb BOJ].opoAa - H 2 0 2 .
4. l)eH3HAHH.
npUzomo6AeHue peuKmu606
1. CnHpT - cfJOPMaJ1MH; 9:1 - <pHKcaTOp;
..
j!,.
..
iI'\
t
A'
118 TOM II - '-IACTHbIE AHAJIHTJ.1t.IECKHE TEXHOnOfJ.1H
96 0 H50H - 9 t.,acTeH;
40% 4>OpMaIUfH - 1 ',aCTb.
XpaHJtTb 13 X01l01\JtnbHJtKe.
2.40% 3TJtnOl3blH cmfpT.
96° H50H - 100 t.fJI;
J],HCT. 80M - 144,4 Mn.
XpaHHTb 11 XOlloAHnbHHKe.
Xoi) peaKl4ll11
1. 4>HKcaLlml - CnHJYf-Qx>pMaJiHH - 30 ceK.
2. OnycTHTb Ma30K Ha HeCKOJ1bKO ceKYHJJ. B 3<J>HP,
3. HHKy6aLlHH - 15 MI1H. (0_ 22°C B TeMHOM MeCTe.
J.1HKy6aLlHoHHaH cpeAa rOTOBHTCH nepeA paoOToH.
40% C 2 H s OH - 5-7 Mn;
3 % H 2 0 2 - 2 KannH
6CH3H,QHH - HeCKOJ1bKO KpHCTIl.IInOB.
CMeUlaTb, npo<J>Hl1bTpOB8Tb.
4. CMblTb BOAonpoBoAHOA 001\OH.
5. BbICYllIHTb.
HecneqU{/juliecKaJI 3cmepaJD no X eiixo
PemCml.lBbl:
1. 10% pacT BOp napbl Qx>pMaJiHHa - <j)HKcaTop.
2. a.-Hacl>THnau.eTaT.
3. XHMH",eCKH t.IHCTbIH aLleTOH.
4. CHHHft npo"lHblH B I1JIH PP.
5. TpHC.
6.0,1 N HCI.
7. NaF - HHrI10HTOp.
flpllzOnWflAeH.lle pellKmUfiOfJ
1. 10 npoLt. napbl cpopMaJ1HHa.
2. 0,1 NHCl.
3. 0,1 M TpHC - HCI - oy4>ep pH -7,8.
TpHC - 121 Mr;
AHCT. OOAa - 34 Mn;
0,1 HCI - 5 Mn.
XpaHHTb B XOJIOAHnbHHKC.
4.NaF.
NaF - 1.5 Mr;
HHKy6aLl. cpeAa - 1 Mn.
A06aoJUITb nepeA <j).1nbTpaLlHeH.
Xou peaKl'l.ll.l
1. 4>HKcau.HSI B napax cl>opMaJlHHa - 3 MHH.
2. OnycTHTb B 3<J>HP Ha HeCKOl1bKO ceKyH,Q.
3. HHKy6aL\HH - 2 'Iaca (0 - 22°C.
H HKy6aLlHoHHaSi cpeAa rOT08HTCH nepe,Q pa6oToH.
a.-Ha4>THnaL\eTaT - 5 MI';
I
I
-
IJ,I1TOJIOrl1t.IECKI1E HCCJ1E,lJ.OBAHIUI t 19
al\eTOH - 2 KanJIH pacTBopHTb;
TpHC - 6y4Jcp - 20 Mn:
CHHHH npollHblH B WJIH PP Hl1H
np01.IHI>IH KpacHblH TR - 25 MI',
PaCTI30pHTb, npoqmJlbTpOBaTb.
4. npOMI>ITb npoTo'-IIIOH HOnOH.
5. BI>ICYUlWTb.
Xoi> pellKlCltll
1. cl>HKCaLtHSI - napbl 4JopMaJlHHa - 3 MHH.
2. OnycTHTh 1m HCCKonbKO ceKYHA II 34JHp.
3. I1HKY6a....1U1 - 3 1.laea, B TeMHOM MeCTe, to -22°C.
I1HKy6 a l\HOHHaSl cpcJJ.a rOTOBHTCSI nepen pa6OToH.
a-Ha4Jntn4Joc4JaT - 1 Mr;
TpHC - 6y4Jep pH - 9.2 - 1 MIl.
CMcwaTb, npo4JHnI,fpOl3aTb.
4. npOMblTh BOJ].onpOl3oJJ.HOH BO).OH.
5. npOMhlTb JJ.HCTWJlnl1pOBaHHOH BOnO".
6, ,lJ.oKpacHTb MeTHIICHOBl>lM 3CnCHI>IM HeCKonhKO CCKYH .
7. npOMhlTI> BOAonpoBoAHOH BOnOH.
8. BbICYWHTI>.
KUCJ'Ian ifjoctfialllaaa no Rap"y
Pem{mlU3bl."
1. 10% napbl 4JopMaJIHHa IICHTpaJ1bHoro - 4JHKcaTop.
2. A30THCTOKHC1JblH HaTpHJ1 - NaN0 2 .
3. ALteTOH XHMH1.leCKH '-!HC rl>IH.
4. a-Ha4JTHn4>ocq,aT (Haq,Ton - AS - BJ, AS-TR, AS-MX - 4>oc4JaTa).
5. JIeASlHaSl YKCYCHaSi KHCJ10Ta - CH)COOH.
6. YKCYCHOKHCJlhlH HaTpHH - CH)COONa.
7. cl>YKCHH OCHOBHOH WISI 4>YKCHHCCPHHCTOH KHCJ10TI>I.
8. MeTHneHOBblJ1 3CI1CHI>IH - KpaCH'reJtb.
9. KOHLteTpHpOl3aHHaSl conSlHaSi KHCnO"la - HCl.
10. K, Na BHHHOKHcnblH - HHrH6HTOp.
n pUZOm06JIeHUe pe{1f{nlliBOO
1. 10% HeHTpaJlbHblH 4JOPMaJ1HH.
40% OpMaJlHH - 1 llaCTb:
AHcTHnm1p. Bo a - 3 'laCTH.
HanHTI> B 3KcHKaTop. 06pa3YIOTcSI napbl OpMaJ1HHa.
2. Al eTaTHI>IH 6yc}Jep pH 5.2-5,6 (5.5) H3 JJC SlHOH YKCYCHOH KHCl101'l>l.
a) 0,2 H pacTBop CH)COOH.
11,5 MIl IJCnSlHOH - AD I11HTpa,
Hm-I 12 r JleASIHOH - JJ.O 1 nHTpa.
rOTODSlT 13 MepHoH Kon6e, xpaHHTb 13 XOn01:tHnbHHKe.
6) 0,2 H pac'mop CH)COONa YKCYCHOKHC110ro Ha'rpHSI;
27.2 I' CI-I 3 COONa. 3H 2 0 Hl1H 16,4 r CH 3 COONa;
11.0 1 JIWrpa JJ.HcTHnnHp. BOnl>l.
fOTOBSlT 13 MepHOJ1 Kon6c. xpaHHTb B X0J10nHnbHHKC.
I
120 TOM II - '-:IACTHbIE AHAJH1TI:1YECKHE TEXHOJIOrHH
B) pa60'-IH" paCT BOp al eTaTHoro 6ycfJepa pH - 5,5; 8,8 Mn paCTBopa «a»; 41,2
Mn paCTuopa «6)} J],O 100 MJI J],HCTHJI. BO} hl.
EycfJep pH - 5,6.
4,8 Mn «a»; 45,2 M «6».
)],0 100 MIl JlHCTHIIJU1p. BOn"l.
rOTOBSIT B MepHOH K0J10e. xpaHI1Tb B XOJIOAHnbHHKC.
3.4% pacTuop NaN0 2 .
NaN0 2 - 200 Mr;
AHC'!'HJI. BOAa - 5 MJI.
PacTBop J\on>KCH 6bl1'b 6enbTM. XpaHH1'b U XOJIOAHjlbHHKC npl'l 4°C.
rOAeH 1 Hep,emo.
4. rCKcoa30THpoBaHHblH napapo::mHHJTHH 4% ITO Davis. OZllstcin 1959 1'.;
CPYKCHII OCHOUHOH;
WISI cfJYKCI.UlCCpIIHCTOH KHCJ10Thi - 1 rp;
2 NHC - 25 Mn.
Pac ruOpHTb npH HarpenaHHH, HO He 1\OBOp,SI AO KHneHHSI.
OxmU.\HTb. npocfJl-IlII. rpouaTh. XpalU1Th n XOJIO}{HJll.HHKC npH 4°C.
rCKCOaJOTHpOUmmc UCTp xHBaiUlcM J],O Opall>KCnO->KeIlToro qBe1'a.
5. 2 N paCT BOp HCI;
KOHcp. - HCI - 164 MIl;
.u.UCT. ImJ],a - JlO 1 Jllrrpa.
rOTOBHTb B MepHoi1 K0J16e .u.JISI napapOJaHHJIHHa.
6. O,D5 M K, Na BHHHOKHCJlbIH;
K. Na UHHHOKHCJlblH 2 - 352 Mr;
HHKy6m.lHOHHaSi cpeJ],a - 25 MIl.
7. MeTHIlclloBhli1 3enCHblH - 0,1 %
(}I'MbITb MCTHJICI.IOUbIH JCJTCHblfJ OT ITpHMCCCH xnopocpopMOM.
)J,J1S1 31'oro B CTaKaH'U1K C cyxofJ KpacKofJ ].J.o6aBHTb XIlOpo{pOpM, 3aTCM nepeMe-
waTb H ocraBHTb Ha HeCKOIlbKO MHHYT. npocfJHnbTpoBaTb. K CYXOH KpacKc. OCTau-
wei1cSI Ha cfJi1J1hTpe. Ho6mmTb XJIOpOq)opM H T.]1.. OTMhlBaTb AO Tex nop, nOKa pac- I
TBOp He CTaHeT 6eCL.J.BeTHbIM.
MCTHJICHOBblH JCJICHblfJ - 100 Mn;
AHCTHn, Bona - 100 MIl.
KpaCKY xpaHIITL B XonoAHIlbHHKC.
Xoo pe{l/a uu
1. HKCaI.lIHI. - nap!.1 cfJ0pMaJHlHa 3 MHH.
2. OnycTHTb Ma30K B 3cfJHP IHl HCCKOJlbKO CCKYII.J{ (o6e3>K11pHBaHHe).
3. HIIKy6aL HH [0 - 37°C. 4.5-5 'taCOB.
I1HKy6m.\HoHHaSi cpeAa roTOBHTCSI nepeA pa6aroH.
PacTBop «A».
Ha TOJI - AS - B7 (HJIH ASTP. AS - MX - cpoc<paT).
B 10 MI' - HacPTHJlcfJoC(}>aTa paCTl30pHTh 2 KannH AHMeTHIlcfJopMaMHAa, CMClllaTb
C 25 MIl 0.05 M paCTBopa aLleTaTHOrO 6ycpepa pH - 5,5.
PacTBop «E».
NaN0 2 - 4 KanIlH;
napap03aliHJIHH - 4 KallJlH.
BCTpSlxHBaTb 30 ceK. .no OpaH>KeBO->KeIlTOrO L.J.BeTa.
.
u,HT0J10rH1..IECKHE VlCClIEAOBAHI1}1 121
\
PaCTBopbl CJIHTb H npo HnbTpouaTb. HHl<y6 lpOBi:Hb 4,5 -5 llac. npl-i to - 37°C
B TcpMocTaTc.
4. npOMblTb npOTl)'IHOH BOAOfl.
5. r1pOMblTb AHCT. BOAoH.
6. LI.Ol<paCHTb HHpa MeTHJlCHOBblM ]CnCHbIM - HCCI<OJlbKO ceI<YHA.
7. r1pOMblTb npoTo'IHOH BOAOH.
8. BbICYWHTb.
nCCJIEJ],OBAHI1E nOJIOBOrO XPOMATl1lIA
Cocl<o6 co CJlU3HCTOH 0601101.1I<H pOTOBOH nmlOCTH nOJlY'Im-aT C BHYTpeHHeH no-
BepxHocTH UlCI<I1. CHa'laJla YTPOM lIaTOUlal< WnaTCJICM CHHMa10T nOBcpxIIOCTHblH
CJIO" 3mnemlH. HcnpHro;lHhlH AJlH I'ICCJICAoBamtH. a 3L\TCM ,'J,Pyn1M KpaeM WnaTCJISI
nOJlYl.latOT I<JICTI<U H3 CpeD.HCro C!IOH CJlJ13HCTO 1 060JIOl.II<H H al<KypaTHo pa3Ma3bl-
umOT MarepHaJl Ha CTCI<JIC.
MenlOc)llIW OKpaC/w
1. Ma301< qml<CHpYIOT B CI\.IeCH Cl1ItpTa H 3 mpa (1:1) 24 'laca.
2. npOBOASIT 'lepe3 70% 11 50% cmlpTbl no 1 tHllyre.
3. OnOJlaCKHBalOT B ]\HCHIJlJlHpOnalllloH BOAe.
4. r1epeHocHT 13 5 II. COJIHHY1O I< HCJIOTY.
5. npOMbIBalOT B AHCTHJ1JIHpOl aHI'IO" BOAe - 2 CMCHhl no 10 c.
6. Ol<paWHBalOT 5-15 c, npoMblBaJOT B nparol.lHofl BODC. UbICYUIHBa1OT.
D:JlSl npHrOTOI3JICfUlSll<paCI-iTeJlH CMCWHBalOT 9.7 r aUCT rra HaTpHSI. 14.7 r uepo-
HaJla, 500 MJl /1,HCTHJlJlHpOBmmoH BOAbI, 32 MJl 1 H. pacTBopa COJlSlHOI1 I<HCJlOTbl,40
MJl 50% cnHpTa, 1 r TOJlY"AL1HOBOrO CHlicro. r10_1Y ' leHHI>IH pacTBop QJUJlbrpYlOT
(pH I<paCHTeJlH 5,7).
OKPAlUl1BAHnE MI1KPOOprAHI13MOB B MA3KAX
OK/JacKel ...tt:mU./leIlOBbUf CUIIlUf no JIeifJififlepy
CMewHBaloT 30 MJl HaCbllll.CHHOrO cnHpToBoro pac-rHopa MCTl-iJlCHOBOro Cl-iHe-
ro co 100 MJl 0,01 % pac mapa nt11.pOI<CHJJ,a I<CUIHSI. B 3TOM I<paCHTeJle Ma3KH OKpa-
III11BalOT B Tel.lCIIHC 3-5 MHHYT, onOl1aCI<HBa1OT B np01'O'llioH BO,'J,e, Al-ic)Jc)JcpeIlUHPY-
JOT 3 C u 0.5 % pacTBope YI<CYCHOH I<HCI10TbI H onOJlaCI<HBaJOT B npOTO\IHOI1 BOAe.
flpOBOASIT 'ICpC3 C11I1pTbl. npocBCTmnoT B I<CHJIOJle H 3a1<JllO l !aJOT B 6aJlb3a 1. npc-
napaTbl MO)l(HO H3Y l li.Hb Ilp 1 MaCJ1S1HOH J.1MMCpCIUI 6e] :mI<JlI{)'lemIH B 6aJlb3aM, HO
B 3TOM CJIYllac OIUI xpaHSlTcSI HCJ],OJlro.
Pe3YJ1bmam: 6al<TepHH oKpaWUBa}OTCSI B rycTo-cHIIHH UBeT.
OKpClclm lelUlualloBbul UJlU .,;,eIllUJlOBfJUf !JjuOJlemOBbUf
CMewHBafOT 10 MJl HaChlUJ,eHHoro cnHpToBoro pac-nmpa reHLI.l1aHOBoro c)JHOJle-
'1'01301"0 co 100 M.TJ 2,5% paCTBopa c)JeHOJla (CMCCb XpaHL1TC J1.0J1ro). Ma31<H ol<pa-
WHB<tfOT B TC leHl1e 2-5 MJ.1HYT. IIpOMhIBafOT B IIPOTOllHOH BOAC, CYIiJaT H HCCIICAY-
lOT IIpl1 MaCJlHHOH l'IMMCpCI1I'\.
Pe3YJlhmam: EaI<TCpHJ.1 OKpaWlmaJOTCSI B rYCTo-c)JJ.10JICTOBbIH Ll.BeT.
OKpaCKCl OCIWOllbUf !fiYKCUHOJW llO nifJeii!fiepy
1 r OCHOBHoro ctJYI<CHHa pacTBopSiIOT B 10-15 MJl 3THJIOBOrO crmpTa H CMeWI-i-
BaJOT co 100 r-,fjI 5% paCTBopa q,cHOJ1a. 3aTeM 3 l<anml nOJlY'lcHHoro pacTBopa .[\0-
6aBJIHIOT I< 10 M.TJ ).\UCTJ.1JIJHlpOBalmOrl nOH!.1 It 3'1'0[1 CMCChlO Ol<paW.,lBafOT Ma31<H B
122 TOM II - YACTHbIE AHAJH1TI1lfECKHE TEXHOJTOfHH
TC 'CHl1e 30-40 M.-IHYT. nOCJIC 3TOro OllOJIaCKI1BCUOT BOAOH. J I1 epeHl HpYfDl'
0,1 % pac-rtJOpoM comlHOIl K11CJIOTl>1 B a6COJIIOTHOM Cnl1pTe, OllOJlaCKI1UafDT B a6co-
JlIOTHOM Cnl1pTC 11 3aKJH{) IaIOT B 6aJ11>3aM.
Pe3JlJlbmam: 6aKTCpl111 oKpauumaJol'cSi B MaJII1H060-KpaCIfI>IH ltBeT.
OKpacKD no Po.«mIfJ6cKO.My-rU.lff3e
fOTOBh.H >K11}J,KItH KpaCHTCJlb ncpcA oKpallHmall11cM Ma3KOM pa3Bo.n. T J13 pac-
leTa 1-2 KanJU1 KpaCI1TeJI Ha 1 MJI J\I1CTJUlJll-lp06aHlloH UOAI>I. Ma3KI1 OKpaWJma-
fDT 20-25 MIIHY'" npl1 37°C BO BJI3>KIf0i1 K<lMCpe (3aKpbITa JaIUK<l neTpH C YBJIa>K-
HCHHbll\'1 cpJ1Jlbl'pOM uaAlic). nOCJIC OKpaUJI1BalUJij Ma3KI1 npoMblBalDT B npoTo IHOH
BO}le, cywaT Ha B03J yxe 11 HCCJICAj'fDT npH MaCJlSIHOH H\1MepCI1H.
Kpacsu YID >KJ1).\KOCTb POM3HOBCKOI'O-fI1M31>1 B rU1AC nOpOUJKa (KoMMep leCKJ1H
KpaCI1TCJlh) paCTBopsnOT B CMeCI1 paBHl>lX 06"bCM06 MenUIOBoro Cnl1pTa 11 rJIHqe-
pl1Ha (800 M'" KpaCI1TCJIij H<1 100 MJI paCnmpI1TCml). KpaCJ1TCJII> paCTfmpflCl'C
nJIOXO, fl03TOMY JIY"IWC ero pac rcpel'b c paCTBOpltTt:IICM B KOJII1 leCT13C 300 Mr Ifa
100 Mr. a 3aTCM. nOMe UU1B.UI , J!o6aBJlijTb KpaC11TCJ.h AO nOJlY 'CHI1S1 HY>KIIOtJ KOIi-
lteHTpaltHl-L npuroTOBJlCHl1e KpaCHl'eJl l,ac-m 33HI1MaeT HCCKO}JI>KO AIfCH. Ba>KHO
B Ka ICCl'Be pac.nmpJ1"reJlei1 J1CIIOJIb30BaTh XI1MWleCKJt II1CTI>IH MeTI111013blH cnHp'" It
f"j 111 U. e P"H, TaK KaK npl1MCCIt YXYAlUatOT CBOHCTna KpaCHTemL BMCCTO MeTHJIOBOrO
cnHpTa MO>KHO npl1MCHSlTb 100% :JHI110BbIH C'U1pT. npl1J'oTOI3JleHHYlO Kpacsll YI-O
CMCCb xpauslT II CYXOM npoxm.\.! HOH MCCTC B n.!lOTHO 3aKpl>ITOM cocYAe.
Memo()w({l OKpUCf<.U
1. Ma3KH. Q>11KcnpoBalHlb.C n MeTl1JlOBOM Crll1pTC, OKpaWJ1BaI-OT paCfBOpOl\'1 (1
MJl rOToBot1 >KHAKOi1 KpacKH + 2 MJ. OCHOBHOro 6ycpepHoro pacTBopa + 47 MJ! AHC-
TI1JIJUlpOB3HHOH (30).\1,') n TC ICHue 40-120 MHHYT (npoHOmKHTeJIbHOCTb OKpaUJI1Ba-
HUH nO,'J,Ol1pmOT 3MnHpl'I"CCKH). nOJ!b3YJOTC q)Ocq)aTHI>IM 6y<fJCPOM, HO pH 6y-
epa 3aBHCI1T 0'1' BHJ1.a Ma3Ka: JI.JI Ma3Ka KOCTHOro M03ra - 5,8-6,0, AJlSl Ma3Ka KpO- I
BH - 6.4-6.5, AJISI Bb'JtCJleHJ1 npocTeJiWI1X - 6.8. MaJl pl1J1Horo nJla3M0J1.H - 7,0-7.2.
2. OJ1()JJ;lCKJJBaIOT U HHCTHJlJll-lpUBaHHoH BOJW, BI>IcYlJJI1naJOT 11 I1CCJlC}lYlOT np/.{
I1MMepCmf.
OKpClUlllollUue -mo.llcmou Kan...lll. HecpHKcHpOlJa"HYI-O TOJICT)'lO KanJlI-O cYlUaT
B Te l leHJ1C 1 '3ca Ha n03Ayxe H oKpmuHBaJoT 2-10 MlIHYT CMCCl>IO 113 4 MJI pac mo-
pa fJ1M3bl, 3 MJI'"at(CTGHa, 2 MJI 6ycpepHoro pacl'Bopa (pH 6,5) H 31 MIl J HCTI1JlJlH-
pOBaHHOH BOJj,bl; "OCTOpO>KHO npOMbmaJOT B J1.I1C ntJIJ1I1pOB3HlmH BOAe, BbICYIUHBa-
lOT 11 HCCJle.n.YIOT npll.i1MMCpCI-UI. D.Jl COXpaHeHJ1 npcnapaTOH MO>KHO JaKpblTb
TOJlCTYIO K3nJlID nOKpOBHb.M CTCKJIOM. KOTOpOC KJJaJ1.yr Ha BOJ HbIH paCTlmp nOJlI1-
I3I1HHJlOBOrO CIU1pTa HIIH paCTBOp >KCJIaHUta.
TOJlCTYI-O Kan}110 (HanpHMCp, AnSI BhISiUJICHH nJla3MOAJ1CB M VI pI1H) ue HKCH-
PYlOT. Ha Bl>ICOXWYIO KanJllO HaJlHBafDT KpaCHTCJlb rHM31>1. pa:mCJ CHHI>IH KaK OrJJ1-
caHO I3blUJe. H OKpaWHBal-OT 30-50 MI1HY". OcTOP0>KHO onOmtcKHBalOT B BOIlC (JlYl'- .
mc 13 cTaKaHc), npocYUU1BalOT OKp3lJJellllb.H Ma30K B BCpTJ1KaJIbHOM fJOJIO>KeHUJ1 H
J.1CCJlCAYIOT npH J1MMCpCJ1J1.
Pe3Y.llbnJnm: 6aKTCpJH1 OKpaJmmal{)TC n q)l1()JJCToBo-KpaCIJl>ltJ ltBeT, L\J.1TO-
II'Ja3Ma KnCTOK - 13 r0.'1y6oH, flApa - B KpaCHI>II1.
-
I
I
IU1TOJIorHQECKHE HCCJIE)J.OBAHH5I 123
(
OKpaCKa Kap6oAo6bU' muollulloJW HUKOJ1JI
CMelUHBat{)T 1 llaCTh HaCl>lIl.l,eHHoro cmlpToBoro pacTlJOpa T 10HHHa C 10 --mCTSI-
MH 1 % BO)..lHorO pacTBopa c}JeHOJla. Ma3KI1 OKpallll1BatOT 3-5 IIU1HY r. OIlOJlaCKI1BaJOT
B npoTollHOH nOJ.I,c. AJ1c}JcpepeHLlHPYIOT 30 C B 96% CnJ1pTC. CHOBa OnOJJaCKHHalDT B
nOJ\c 11 BI>ICYlUHBaIDT. npCllapaT 113Y--!aIOT npl1 MaCJlSlH0I1 UMMCpCI1U.
Pe3YJlbmam: 6aKTcpHI1 OKpmmmalOTCSI 13 TCMHO-CHHHH l.l,BeT.
OKpaCKa aKput)UlI06bU' Opall:NCeObUI no lJ,apmy-Tepllepy
1. Ma3KH cpJ1KCI1PYIOT B CMeCI1 pam-lblX (laCTeH 1I,113T11JlOB()I'O 3c}Jl1pa 11 95% 31'11-
JlOBOrO crmpTa n Te--ICHI1e 1 (mca.
2. npOBOASlT lrepc3 crlHpTbl UHcxoJJ.Slw.eH KOHL(CHTpaL.I,HH (80%, 70%, 50%) J1
AI1CTHJIJUlpormHHYlo BOJJ.Y, OKYHaSi Ma:mK 1105 pa3 B Ka>KAYJ{) nopL HIO.
3. OKYHalOT 4 pa:m B 1 % YKCYCHYIO KI1CJlOTY.
4. nepeHocSlT B AI1CTHJJJ1I-IpOl3a1IHYI{) BOAY Ha 2 MHIIYTbl.
5. nOMcw.aloT Ha 3 MI1HYTI>I B au.eTaTI-lbIl1 6y( ep (pH 3,8).
6. nepeHocSlT U 0,01 % :m6yc}JcpeHHI>If-\ pac'mop aKpl1J],uHoBoro OpaH>KCBOrO Ha
3 MI1HYTI>I.
7. J1.11( cpepeHl.l,HPYIOT 4 MHHyrbl B alJ.eTaTHOM Gyc}Jcpe (pH 3,8),
R npOTl1palOT KOHlJ.bl npeJ.tMeTHI>IX CTCKOJI, a 3aTeM oeropO>KIIO Y/J.aJlSlIOT 1136(,1-
TOK 6y( epHOro pacTBopa c}JI1JlbTpOIJaJlbHOH 6YMarofL
9. 3aKJIIO(!aI-OT nOA nOKpOl3HOC CTeKJlO B 6yc}JepHblH paC1'BOp 11 OCT.U3JUUOT Ha
2 MI-tHYTI>J. npcnapa1' I1CCJleAYJ{)T C nOMOllJ.hlD c}JJlIOOpccu.cHTHoro MI1KpOCKOna cpa-
3Y J11160, eCJlH Ma30K OCTaBJI}llOT HtUJ.0JlrO, Aep>KaT B TeMHOTe 1 napac}JmmpYIOT
KpaSl nOKpoBHoro CTCKJla. <}>JlIOOpecu.cHLlI1S1 coxpaHSleTcSI B TC"ICHHC 3 MeCSlIJ.eB.
Pe3YJlbmam: 6aKTCpI1l1. .npO>K>KI1. rpI161>1 pO]l.a Candida OKpallll1HmOTCSI B Kpac-
HI>IH U.BCT, napa311Tbi - B KpaCHl>lJl C >KCJll'btMII SlAP l\m-; JICi!K01J.l1Tbl - SlpKO-3CJICHbIC.
OKPllCK{l no I'pll.UY OAR ,M{lJK06
1, Ma3KI1 KpOLm. Llcpc6paCIH1HaIlbHof-\ >KI1)J.KOCTlI, 3KccYAaTOB 'Q:>HKCI1PYIOT HajJ,
nJl3MeHeM rOpCJIKU (61)ICTpO npOIlOASlT 3 pa:m HaJJ. nJlaMeHeM Ma3J<OM BHI13)3£1-
TeM BbICYWHlmIOT. KpoMe c}JI1KCaLlI1U HaJJ. orHeM, AJISI Ma3K013 npl1MeHl--lM£1 t:PHKcaLJ.HSI
IJ Men-IJlOBOM Cnl1pTe (5 MHH) HJlI1 B napax <J:10pMaJIHHa (B COC}'AC KOTU1Htia) B Te-
I.ICHI-fC 15 MI1HYT.
2. M33KH OKpalUl1BalOT KPHC1'aJIJlH--ICCKHM c}JHOJICTOHbIM R Te(leHI1C 1-2 MI1HYT
(I1HorAa npH 31'OM npcJJ.MeTHoe CTeKJIO nporpeBalOT 3-4 C tla1 orHeM I1JlI1 HarpcBa-
J{)T KpaCHTeJlb AO 60-80°C).
3, KpaCI1"reJlh CJ1I1BaIOT. CTCKJIO npOM lBa){)T B01.J,O", Ma30K 3aJlHBaJOT lIa 1 MI1-
HYTY pacTBopoM J1lOroml I1Jll1 J\pyrl1M ftO)J.l1CTLJM pacTBopoM. Hanpl1Mep no rpaMY
(2 r HO,ll,I1Ha Krull-fSl pacTBop IOT B 2-3 MJ1 J,JCTHJlJlI1pOBatiHOH BOAI>I, n06aUJlSll-OT 1 r
KPI1CTaJJJlI1--leCKOro fto.u.a, ,lI,OJII1BaIOT .no 300" 'MJI,- 'fIn Bei1rep-ry AO 100 MJl AI1CHI.'I-
J1l1pOBaHHoi1 BOJ.tI>I). pacTllop cmIB31OT, Ma30K npoMblBaJ{)'r £OJ'OH.
4. D.11c}Jc}JepclILJ.HpYtoT IJ 96% 3THJIOBOM crJl1pTe 2-3 pa3a no rex nop. nOKa lie
ncpecTaHeT OTXOJ.tHTI> KpaCI1TCJlb, a Ma30K He 06CCIUJe1'I1TCSI. .ECJn'1 H lecTo cnHpTa
I-fCnOJI1>30BaTb aL eTOH, TO npOMl>lBaHl1e npOAOJ1)KaeTC 30 c. MO>KHO- Auc}Jq,epeH-
IJ.l1pOBaTI> CMCCI>IO Cnl1p1'a 11 aqeTOHa (1:1) 30 c.
5. npOMl>lBatOT CTCKJla B npOTo--IHoi111JI11 J\I1CTHJlJlHpOBaHHOH BOne 1-2 MI1HY-
1'1>1. D.oKpaWlfl3alOT pac1'BopaM f c}JYKCI1tIa, cac paHHHa (0,2-0.5% BOAHMM paTuflp
. -.
I
124 TOM II - YACTHbIE AHAmlfTl1 l lECKI1E TEXHOJIOrl111
I-tnH 0.25% pac'mop B lO% CIH1pTC) OCHOBHOro KOPWUiCBOro !m60 rTHpOHHlIa J 11JUI
B 2-5 MHIIY", npOMhlllal-OT B npoTo'IHol1 nonc 5 C 1'1 BbICYIJU1BafOT.
Pe3YJlhl1wm: rpaMOIIOnmf<IiTC!lbHbIC MI1Kpo6LI OKpaWltBafOTC}! B J.1CCmUi-
v v '"
tlepHbll-l L{BCT. rpa7l100'rpl1uaTCJILHLIC - B KpaCHLIH 1-11111 KopWIHeBLIH B :mBUCU\1O-
CTI1 0'1' KpaCI1TCJJSi; SlD,pa KJlCTOK - }!pKO-KpaCHbIC. l{wronna3Ma - p030nasi.
KpllCJUiflte pllCnWOphl. PacTlJOp Kpl1CnWJJlI t lCCKoro cpnOJICTOIJOrO no 3pIlIlXY:
1. 2 r KpHCTaJl!II-1'lecKoro qmoneTonoro pacTlu>pSlI<}T B 12 M!J 96% cnupTa H o-
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'("OtICUbl B UCHTpaJTbHOH 'laCTM KnCTOK. KnC1'Ka MO)l<CT COp,ep>Ka1'b,').O 100 SI,').Cp. 011,-
HaKO "lalile l1MCCTC 20-40 Slncp. Ul1TOIIJ1a3Ma 06MJll>lIaSl, 30:J11IH><!JHJII.uaSi. fpmm-
1..ll>1 KnCTOK 'IC1'KMC, rl1rmlTCKllC KJle1'KM J1aHrxauca OTnM'IaIOTCSI 01' rMraHTCKMX
L
128 TOM II - lJACTHbIE 1\1 IAJII1TMt.IECKME TEXH0J10rl1l1
KneTOK I-UlOpOJ],HbIX TeJI rJJalUlLIM 06pc!30M nOKam13al ueH tlaCTO UCCKOJILKO RbITSI-
HYTblX 1-1 T1CpCKphlRaIOIl UX J],pyr ,!.!.pyra SI.[tep 110 flcpl-1cpcpmt KJICl'KU.
3nwne/IllOlU)llnlC' KJletllKll SlB.'HllOl'CSI ""IO IOHYKJICapUbIMU {JmroLl lTa m U pacno-
narmOTCSI l3oKpyr" o'taJ"OB HeKpo:m B Ty6epKYjlCJHLIX I-IJIU JlPyn-1X cnel ucpWICCKI-1X
rpaH)'.I)CMaX, Do Cl'pOCHItIO 0111-1 UMCIOT HCKoTopoe CXOL\Cl'I30 C 3rHIl'CJmaJIMlbiMU
KJ1CTKaMI-1. 3mrremWI-1,'lHble KnCTKU 06Ll 1 IUO BblTSlUYTOH CPOP\1bl. 3n1 KJ1Cl'KI-1 130
M lorOM CXO;:t,Hbl C 06bl'IHLIMI-1 nICTUOl ltTa\11-1 U 06HapY>KI-1BaKnCSI B KOMlIJlCKCaX
I3MeCTe C .[tpyrl-1MI-1 nmaMI-1 mCl'HOlU1TaPUbIX 3.1CMCHT0I3. Yacro BCl'pC 1 !alOl'CSI nepe-
XO;:1,HbIC (POPMbl MC)I<ny I LITSlIlY rhlMU 1-1 oKpyrJlblMlt KJlel'KaMI-1. 3rHtTCJHl0I-1J'lIble
KJICTKI-1 I-1MelOT nIlOXO Otlep11eHHYK), UC>KHO l3aKyoJlu:mpoBaHHYIO 303UHOCPI-1JIbHYI{)
LlI-1Tonna3MY. 51:J,pa I3I>1TSlHYTblC 1-1 11aCTO nepeKpY'le Ulble. OHI-1 MOI)'1' UMCTb Bepe-
rCHoo6paJuYlo, I-UlorJ],a BI-1jJ.01-13MCHe UlYK) IIOllKOBIiHIIYIO UJ1H 6060BHAuYlo (POPMY,
1!aCTO BCTpc'laKncS\ S\1J.pa rpYluclm:Uloft (lmpMbl.
TY'tHbll' KJlemKlt (.'laGpoLluTbl) - OOJlbllleti llaCTblO I-1MCIOT OKPYrJ1YlO CPOPMY.
HCpOIUlhlC KpaSl, SlJJ,pa 60raTbi XpOMaTlUIoM. 13 l'I1TOflJ1a':lMC COAep>KI-1TCSI CnCLlU(pH-
11eCKaSl 6a3mpl-1.'IbHaSl 3CpIlUCTOCTh.
n/1ll3Mllmu'H:ocuC' KJ1em/<u OKPYlAO-OOQJlbHOII fPOp.Mb/. 3Kcl eHl'pwlH0 pacno-
nO>KeHHOe SlJ],pO nmepxpoMHOC. xpm.mHm pacno.1arael'cSI pa,JUlanbHo(SlI PO HMeeT
131-11 "KO!ICCa co cmlI\ar.m"). UI1TOnm13Ma pe3Ko Ga:JO{fnLlbHaSl. C 3mlOH npOCBCl'JIC-
IHSI B61111111 SI,!.!.pa. MOJI()l LIC (f)oPMbl OOJ1ce KpyrmLlx pa3MCp0I3. xpoMaTml SlJ1,pa
paBHoMep lblll, CCT'Jal'LI i. 1-2 SlHpblllIKa. l'I-1TOnJla3Ma pe3KO Ga30c)JI-1JIbHaSi IfCIIII-1-
pOKI-1M 060.QKOM oKpY)l<acT SI}lpO.
AOC3eHl1lltl(lIl1Jlblll>le KJ1l'nll\:ll - oObiliHO UMetoT BblTSlIIYT)'IO (POPMY, OBa.1bHoe
CDCTJIOC SlAPO. 3nl KJlCTKIt npIIJICI",UOT K CTCIIK<1M KpOBeHOCHblX K,HlI-1JI.ISlpOB. II
cnoco6Hbi npcupall,aTbCSI B }l.pyruc KJ1el'011Ub1C (POpM!'I, nO::JTOMY IIX Ja3blBalOl' Ma-
J10jJ.ucpcpepCHLlI1aJlhlfbIMI1 11.I)U KaMOltanbUblMIl. 113 K<lMOl1a.JlbllblX KJleTOK Moryl'
pa3RURal'bCSI c)JuGpo6naCl'bl. MaKpoc}Jarl-1. KJICTKI1 KpOBI-1.
B npOl(CCCC cpopMuptmaHUSI KJlC'I"O'liioro IIHc)JI-1!]bl'paT<l 130cm\JICHI1S1 KaMOl1a.Jlh-
Hble MeJCHXI1MaJlbHLIC Kjlel'KIl }l.ml}(pepeHLlllpYKHCSI B (pI16po6JlaCThl, B-nm.1CpOLlI1-
Tbl HalOT ua'IaIlO KJ1el'KaM nJ1a3M,1TWICCKOI'O pSlJ],a. MOUOLlHl'bl - JJ,aKn m\tfa.Jlo nlC-
HIOLlI-1TaM 1-1 MaKpO(lmraM. MaKpocpanl Moryr OblTl. UCTO'UUIIW\1 3nl1l'eJ11-10l1AHbIX
KIICTOK, 1'1::1 KOl'OpblX CTpOSlTCSI rurallTCK te M lorOSlAcpHbiC KJlCTKI-1, KJICTKU 11HOpO}l.-
HblX TeJI (IIuporoBa-Jlar'xaHca).
Ocmpoe ROola/WHlIe - npcoGJJaualOT uci"iTpocluLIJhHble JlctiKOLlI1Tbl, 30:nUlmlm-
Jlbl. MaKpoc)Janl.
XpOHliLieCKOe (WCnl1Jlelllle - npeo6J1aAatoT JlI1Mc)JOI,tJ lIbIC 3JleMeHTbi 1-1 KJ1el'KU
nna3MaTWICCKoro pSlAa.
DPOn,YKTI1Buoe BocniUIClUlC - npoJlmlJepaTI1BHOC 130cn<U1CIIUC - 06pa::sylOl'CSI
()LlanmhlC II Huc}J{I))'3l1ble IUlc}JllnbTpaTbl. K(rropblc Moryl' 6blTb nOJHIMOp(PHOKJIC-
TOil H ble 11.'11-1 Kpyr J1 OK]I CTollllhle (JUI McpOUl-tTapHO- MOHOLlIlTap III.IC ). MaK)JocparaJ1 b-
HLIC. 3IJ1.tTCmtol-1)tHOKJICl'O'IHbIC. n1l'aHTOKJICTO IIII.le. IIIJa3 10KJlCTO'IHbIC II Hp,
DpOJJ,yKTI-1I3HOC 130cna.ICHIIC I3CTpC'!aeTCSI B .11060M opraHc. 111060" TKaHH I-t oc-
HOI3HbIe cro mqLI:
1. MeJICymo'-llloe (llllmepCflllll(tlllJlbHOC) (WClIll...Wlllie xapaKTepl1Jyel'cSI 06pa30-
niHll-lCM K:1CTOllHoro IUnpllJIbTpaTa IJ CTpOMC opraua. I1H(pl-1JlbTpaT IIpc.u.cTaB!IC 1
MOJlOAblMH (KaMGl-1aJILllbIMlI) Me: CIIXI-IMaJlbUbIMIl KJ1CTKaMU, n1CTUOI\UTaMH. \lOHO-
-
U;I1TO;10rJll1..J:ECKI1E I1CCflE.QOBAHJ;1}1 129
l I1Ta!\m, .1I1 1(pOl.tuTaMII, l;lIa3MClTI1 1 ICCKI1MI1 K11CTKaI\-UI. 11a6pOl H raMU (TY1IUbIM 1
K11eTKa!\tH). cJll1mtllHbl H1 HCi1TP0<pII.lbHhIMI.1 U 30JI1HO{JmJH:>HbIM 1 11ctiKoll lTaMH.
MOllolll1Tap lblc (parOUlITbl CTaliOBSlTCSI t.taKpo(para m: MOnOJlblC MC3eHXI1MaJlhllbiC
KJICTKI1 npenpmllatOTCSI B {Jm6p06nacTbl. a nOC.1C,11I1tC B clm6pOLlI1Tbl. npl1 HeKOTO-
pblX cpopMax IIPOAYKTHBHoro MC)f(Y1"()1IllOI"O BOClla.!lC mSl, oco6cml0 CCJlH OHO npu-
III-tMaCT xpoHwleclo1.. xapaK rcp. HaKarL'lIlBalOTCSI nna]\13TWICCKI1C ICICTKI1.
2. [jJ(luYJle.Mllt1lV.1IWe (WClIllJlelllle - xapaKTeplnycTcSI 06pa:mHarH1C t rpauYJrCM
(YJCnKoB), 003mlKalOlllIIX U pCJYJlhTaTC npoJlmJJCpallltl1 II TpaIlC{J)()pMau.mt crroc06-
HhlX K (JJan)LlIIT03Y KnCTOK. 06pcnonamlc rpmlYJICMLI npollcxO!J,I1T B Tpll CTaJ1.l1l1:
a) HaKOnJICmtC B Ollarc 1I0upe)f(!J,e mSl TK,HHt IOIII>IX MOlloll 1TapHblx aroLlIln.>B:
6) C03pCUClIIIIC :..HIIX KJleTOK 13 MaKpoeJJaI"lf I arpcrau.IfSi I1X C o6p<tJonmme\1 "ipC-
110M rpaHyneMbl:
B) !J.aJIMleilIlJce C03pCB<UHlC MOHOLlI1TapHhlX (parollUTOB II MClKpoctJanm n ::JrHne-
1111011}lllb1C KJICTKII II arpcrallml 11X C oupa:.muaHIICM 3111ITC11HOHHOti rpmIY11eMbl.
np 1 :)TOM np0l1CXO:lI1T C-'IIHIlIlfC :>m1Tcm10If)JJlbIX K.'Il:TOK (u:m MaKpml>aron). liTO
BeAeT I< 06pa30Bamno rHraHTCKllX KneTOK 1I110PO)UIr.IX Tell. KOTopLle npl1 onpe!J,c-
JICHllhlX YCJIOBI1S1X MorYT npCBpalllCl"'hCSI B mrculTCKIIC K.rJeTKH nwporoBa-JlatIl"Xallca.
rpaHYJICMbl nCTpe1ralOTCSI IIpl1 OCTpblX II HCKOTOpblX XpOHWICCK 1X IIH(PCKI HOII-
HbIX 11 HeI1HCf}CKllUOllllbIX 3a6oneBaHHSlX. O m OllC lb xapClKTcpllr.1 J(JlSI WH CKLlHOH-
HbIX 3a60nCBa1lUl1. B OCHOBC KOTOpblX '1C)f(IIT cnCUH(I)I1 ICCKOC BOCl1allC lI1e t Ty6ep-
KYJIC:J 1 HP.).
nplfMCpOM rpmlyncMaTo:moro BOCnaJICHIISI Mory r C11Y)KIITb TaK)KC l'paUYJICMbl
nplf CapKOUJ1,OJC. SlBJISIIOILlI1CCSI Bblpa)f(CHHCM n..aHcr!oil ay roCUIJICropmi. T.C. I1MCIO-
II HC OTUOIIICHlfC K 1111IMYHonaTOJlon11ICCKI1 t IlpOI CCcaM, J],JISI capKOH!J, lbIX rpaHY-
lICM. KOTopble 06pa'JYIOTCSI Ii JIIIM{JJ<tTlI'leCKIiX Y3nax If. pC)KC. no nHYTpcwUlX opra-
Hax, xapaKTcpllO IICIJUI'IIIC 3111ITeJIU(Ht:\HbIX KJ1CTOK. 06pa3YIOlllUX l'paHY:ICMY. 11 rll
l'aIlTCKlIX MHOrmj!J,ep lbIX K_'1CTOK C Hcfio:lblllotlllpllMCCblO .1If\UPOUHTOB. 01' Ty6cp-
KYJIC3 lbIX 6yropKon CapKOI1,LJ,HbIC rpmlY11eMbl OTJI llraIOTCSI OTCYTC I"IUICM IICKpOJOB.
3. Dpm)YI{!1lIll11lOe lWCIl£lJICmW C o6pa30BaHI-ICM UOJHlnOB II OCTpoKoHclmblx
KOHJ1.UJIOM Im6J11o].tacTcSI Ha C.l 13 ICTbIX 060.'IOliKax 1-1 I rp<UUlllalllCM C HHMI1 nnoc-
KOM ::JIIIITC.'1HU. Pa3paCTalU1e )f(CJIC3I1CToro ::JIIIITC!U1S1 n CTpOMbl CJ1J13I1CTOH 060no'[-
1<11 npltnoJ(l1T K o6pa30B<uIIIH} MHO)KeCTBa Me_'1KIIX COCOllKOB 111111 60JICC Kpymlblx
06pa30BaHllii. Ha:JbmaCMblX UOJllfT1aMII. TaKHe nOmfT103Hble pa3paCT<UU1S1 Ha6JIIOna-
CTCSI npl1 jIUTCnbHOM Bocn(UlcmUt CJlU311CTOI1 OOOJIO'IKII Hoca. )f(C!IYAKa, npSlMOII
K1111IKII. MaTKIL BJmramlllla If AP.
B YllacTKax nJlOCKOrO 3mnCJ1I1S1, Koropl.u1 paCIIOJIO)KCII BOJIH311 IIplf3Manl 1 le-
CKoro, HallplfMep B aHYcc. nOJlonblX oprClHax. UP!I XpmH1'ICCKOM BOCnaJlemm \J6pa-
3YH)TCS!. COCOllKOBblC o6pa30BaHI1S1, nOKpblTblC IUIOCKI1M 3IUITC:H1CM - oC'rpoKoHc11-
Hble KOH}:lI-1.10Mbl.
OCHOBllblllUi KJlCTOllltblMlf KOMnOHCHTaMI1 K!ICTO'IHbIX peaKItHH I1PH 11...,IMyllolla-
TOJIOI'I1'rCCKIlX npoLlcccax. pa:mlrnlc KOTOpblX CmBallO C HapYIUCHlleM <PYHKLlI-lll
IIMMYHoKoMueTcHTllOIf TKClIIH, SlBJISIIOTCS!. .IHIM{JJOLlI1Tbl 11 MaKpo<parl1.
C:lc!J,yeT YtICCTh, O;\HaKO. liTO IIMMplHblC pCaKL{I-fI1 IIPUCYTCTBYHJT np" Bocnane-
Him, nmCpnJla31H1 J11111t{JJm1)J,HO" TKcUII1. COIlPOBO)KJW.OT onYXOJICr!bIC npOllCCCt.I. B
lll,tTOlJ{)J"U ICCKOH KapTI-IHC 3TO U leeT OTpa)f(CIII1C B BUJlC .IaJmlm MOJlOL\LIX CpOpM
JlJIM(pmfAHOrO II IIJla3MaTI1'ICCKOro pSl}:la.
.
130 TOM II - '-IACTHbIE AHAJU1THIIECKJltE TEXllOJIOrHH
PEfF.HEP Al(I1H
PcrCUepaLlI-UI - 130CC l'aliOBneHHe CTPYKTypUblX ::JJJCMCH 1'014 TKaHl-I B3<1J\'ICH norJ16-
ImiX. caMonOCnp0l13Be CmlC >KUnOrl J\mTcpllll. BOCCTmlOI3JJClIl1e KaK CTPYKT}'pbl,
raK H CPYHKI I-IH.
BOCCTaHOBne lHe CTpYKTYPbl 11 Cp}'HKUlIII MO>KCT ocyw.CCTunSlTbCSI C nOMOIl blO
KJleTO"IHbIX Ii 1n1}'"1 pllKJJeTO'lHblX rHllcprumcnl"ICCKI-IX IIpOLleCCOI3. Iia 3TOM OCHOBa-
mUI pa3JIWIalDT KJICTO"III}'IO 11 BHYTpJ1KJJCT()IUl}'lD <pOpMl>1 pcreuepaLlHI1. ,il,JISI KJle-
TO"IIIOM CpOpM61 pcrellepm 1I11 xapaKTCpuo pa3MHO>KCtHie KneTOK MI-1TOTJ1"leCKIIM 1-1
aMHToTI'I"leCKI1M nYTeM. IlllSl BUYTPHKJICTOllIIOH CpOpMbl pcrCllepaUHl-1 - Y13C111-I'ICtHie
"IHClla (rmICpJlJJa3USI) 11 pa3McpOB (nmepTpoc}mSl) YllbTpaCTpYKTYP (SlApa. r.nITo-
XOH1 Pl1fl, pH60CO!\1 1-1 T. n.).
npe06 JJa .o.aHI1c Tofl 11-'111 I-Hloi1 CpOpMbl pcreHcpaWIII B onpe,fJ,ellCHHbIX opraHax 1,1
TKaHSlX onpCHCJISleTCSI I1X <PYUK1lHOUa.1MlbIM Ha:malJC lHeM, CTpYKTypUO-<PYHKLlUO-
HCUlbUOM cneW1aJUBaHl1cit Bcc TKalllt 11 OprmlbJ oGJlanalOT cnoco6HoCThiO K perc-
UepaLlHl-I. pa311H l 1HLI 1II-1WI. CC CpOpMl>J B 3alU1C11 MOCHI OT Cl'pYKTYPHO-CpY IlKl lI10-
HalJblt0J.1 cneLll1aJH13aLll1H TKamt HJHt opraua.
TaK, npeI1Myw.CCTHCIIIIO KlleTO"IH UI pcreHepmlHSI xapaKTep ta J\JISI. KOCTH. 3nl1-
CpJ\1Hca, CJU13I1CTbIX 060J10"ICK >KCll}'JtO t IHO-KIIIIICIUloro TpaKTa. Jl,blxaTCllbHl>IX 1-1
MO"ICBblU0JtSlLllHX n}'TCH. pblxnOM COCI\IIHI1TCnMloi:t rKallH, 3HAOTellHSI. MC30TellHSI.
KpOBeTBopllofl CI1CTeMbl, JTl1M( 0I1Jl IOH TKatll1. LlUTOnOrlt"ICCKaSl KapTI1Ha npu 3TOM
MO>KeT OTnHtlaThCSI 3 la'n-ITeJJbHbIM KO_rJJ.1lleCTBOM MOllOHblX C OpM, "11'0 He AOlJ>KIIO
paCLlCHl-maThCSI KaK npc]\onyxo.nemlSl npOJIllq>epm\HSI.
KnCTO"lUaSl 11 mIYTpI1KJICTO"lUaSl permlcpaLlIISl xapaKTcpHa nJ1S1 ne leHH. notlCK,
nO]\>KCnY OIIHOn >KCJIC:Jhl. 3HJI,OKp 1HHhJX >KeJJC3. JICrKoro. rnal KHx M!.lIm,. np 1
3TOM MO>KCT Ha6I1IOAaTbCSI. HCKOTOpOC YKpynllclUle KlleTOK. SlllCp. nOSlBIIeHI-IC IICKO-
Toporo nOJHtMopq>H3MH K.'ICTO"lIloro H Slp,epHoro. "ITO THK)f(C I OJI>KHO nonYtJaTb C()-
OTHCTCTBYIDI.U.YI{) OLlCHKY.
BHYTPilK1ICTOlIHHSI pcrCHcpat USI CBOnCTBCHlla MHOKHPAY. CKcnenlblM M!.lIIlUaM,
tlTO npOSlBnSl.CTCSI YKpymleHHeM OTJlCllhllhlX KlleTOK II J,ep.
MopcporeHC3 pcrcHeparopHoro npOllecca CKJIMhmaeTCSI 1-13 lWYX cPaJ: npOJIH-
CpCpaLlI-II-1 1-1 .n.HCpc epCHLll-lpOBKU. B clJa3Y npOnI1CpepaLlI-IU pa3MHO>KaIDTCSI MonOJl,bIC.
IC.n.H(t)CpepeHI'11pOBmUlhIC KnCTKH. 3TI1 KIIeTKII Ha3hmmOTCSI KaM6uaJ1hHbIMI-I. CTBO-
J10BbIMI-I KllCTKaMI1 H K.'ICTKaMH-npCJlWCCTBCHHUKaMII.
D,JUI Ka>KJlOH TKaHl1 xapaKTepUbl CBOU KaM6nallbHbie KllCTKI-I. K(YI"Ophle OTnI1 t la-
IOTCSI CTenCHhlO npOJll-ICt)epaTIlHIIOI1 aKTlllnlOCHI 11 ClleUl1aJUI:mUIU1. OHHaKO. CTBO-
.'louaSl K.rJeTKa MO)f(CT 6blTb pOAOlla"laJlLHIIKOM IICCKOJJbKllX BHHOB KneTOK (Kpone-
TBopHaSi TKalll" COCAmUITCJJMlaSl TKaHb).
B cp ny HucpcpepeHW1ponKU MonO.QblC KJICTKI1 C03pcna10T. np0I1CXOHI-IT l1X CTPY-
KTYP"O-Cl)YHKLlHOHaJlbIIaSl cneUl1(t'H13m uSl. Ta >KC CMCHa nmcplllJa:mH ynbTpaCTpy-
KTYP HX .QH<pcpcpeHl\HpOUKOii ("CO:ipCBamICM") JJe)f(HT B OCHOBe BHYTPHKJICTOllHOli
perCHCpatll-l H.
nPM3HAKI13ll0KAQECTBEHHOCTM
/. KAemKa:
a) pa3Mep KneTOK IIpCBOCX01 HT pa3Mcphi KJJCTOK TOri TK,UH1. KOTopaSl SlBunaCb
HCTO"IHI-IKOM onYXOJICnoro poc'ra: KJICTKH Moryr 6blTb rHraHTCKHX pa3McpOB. (,13-
Ul1TOJ10fl1YECKI1E I1CCJ1E.uOBAHI1 131
MCHcm,1C pa3Mcpa HC a6COmOTtlLIi"1 nOKa3aTcnb - pa3Mcpbl KneTOK Moryr 6blTb HC
H3MeHCHbi.
6) H3MCIICH IC OpMhl KJICTOK -mm IIC I10JIHOC'rhIO I-1nH MaJlO COOTBeTCTBYCT TOO
c}JOpMe. KOTOpa51 CBOHCTBCHHaSi KnCTKaM HOpJ\'IaJILtiOH TKaml, (l>opMa MO>KeT 6blTb
caJ\-taSi npHLIYAJlHBaSi. MO>KCT onpCACnSlTbCSI OPICTmmbifl KnCTOllHblH nOJUlI\1Op-
c}JH3M, T. C. KJICTKU pa3HhiX pa3MCpOB H <)JOpM"'.
B) H3MeHSleTCSI SlnepHO-Ll 1TOn.rJa3Manl"CCKOC COOTtlOIlICIUlC H. KaK npaBuno, B
nonh3Y SlJ1.pa(3a CLleT YBeml L leHHSI nocneAHcro).
r) nOSlBJ1CHHC MHOrOSl:lCp lbIX KnCTOK. C OT\ICTmmbIM SmCpHblM nOJIHMopc}JH3-
MOM.
A) aTHnHLIHoe pacnonmKcHHe 5IApa.
c) }J.HccoLlHaLlHSI B c03pcBmmH SI)lpa H LlHTOnna3\1bl (MonO,!.l.OC SlAPO B 3pcnot'1
KJICTKC, 3pCJlOC SI \PO B HC3pCJJOri LlHTOIIJIa3MC).
II. Hopo:
a) YBeJ1HLICHHC pa3Mcpa SlJ1.pa.
6) H3MeHeHHC (POPMbl SI)lpa. Hl-iOr}1,a SlJ1.pa npHo6pcTalOT caMYIO npwlYAmmYKJ
c}J0PMY, SI)\CPHbl" IIOJIHMOpc}JH3M.
B) Kmnyp SlJ],pa HCllparmnbHblH. lcpaBHOMcpHO 113BHnHCTbIH. Hl-lOr)la C rJly6oKH-
MH BblpC3KaMH. HCpCAKO rpy60 O"ICp"ICH.
r) SI,!.I.CpHaSi MCM6paHa HcpamlOMcpHO yrOJIIl.\CHa. pa3pbm..1.
III. CnlpoeHlIe xpo),wmww:
a) HcpaBHOMcpHOCTb. rpy6oCTb. pa3pSl>KCtI.
6) B HC) H(p<)JCpcuLlHpOnatlHhIX H HH3KO)\HCp(pepCHLlHpoBaHHblx onyxonSix MO>KCT
6bJTh TOHKo,QHcncpolbIH. pacnpcAcnc 1 paBHOMcpHO.
B) OKpaWHBaCMOCTb, "JaIl.\C Bccro - rHJlCpXpOMUSI.
IV f/()pbIWKll:
a) "lalile Bcero onpCAeJISlIOTCSI,
6) pa3Mcphi YBeJlWICHbl.
B) cpopMa HCnpam1JTbHaSl, HCpC}1,KO nOJlHMOp(PH3M.
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UI1TOJIOrl1\IECKI1E I1CCJIEHOBAHI15I 145
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1. PYKOBO CTBO no I..\HTOJIOI'H eCKOH .Ql1arHOCTHKC onYXOJleM leJlOBCKa. A.C.neT-
pona, M.n.nTOXOB, MocKl3a, «MenUI..\HHa», 1976, 304 c.
2. KHHra: «l.(HTOJIOnl lecKaSi AHarHOCTI1Ka onyxOJICM H npep,onyxOJICUblX npou. ec -
con». nop, pe/,aKIJ.weif A.c.neTpoBoif, MocKBa, «McAHI..\Hlla», 1985,300 c.
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fO.JI. nepona, MocKBa, «MefJ,Hl' lHa», 1996 r.
4. Koss L Diagnostic cytology and its histopathologic bases. London, 1961,380 p.
5. Lopes Cardozo P. Atlas of clinical cytology. The Nethcrlands. 1973, 719 p.
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BaHHOM paKC MOJIO'IHOH >KCJICJbI
-
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TaKHM 06pa30M, WHpOKOC npll1.1CHCHHe B KJIHHWICCKOH HTOJJOnm KOMnb()-
TCpHOH 1.1opcpoMeTpHH cnoco6cTByeT nOBblUJeHHtO ]J,OCTOBepHOCTIl IITOJlOnlt.le-
CKofl HHarHOCTIlKIl 3JIOKa L lCCTBCHHLIX HOBooGpa30BaHHH.
III. B03MO)KI-IOCTII II METO,[(II'-IECKHE OCHOBLI
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I1ccne]J,oBaHIUI nO]J,06Horo po::\a CCHLIaC UhUlOJ!ll}l!OTCSI lIa npu60pax: FACS,
EPICS H HPyn1x, B OCHOBe K<YrOpbIX JIe>KHT MeTOA npoToLIHOH I HT01.1eTpIlH, Bnep-
BLIC ollHcaHHLIH KpOCJIaH: OM- Td'uIOpOM u no:monSltOUJ.IIH nOJl}"laTb mU,H1HapHbIH
nOTOK oGpa3 a. 3'1'0 06ccnCt.llmaCT BhICOK}'tO TOt.1II0CTh 1'13McpeHui"1 H ]J,aCT B031.10>K-
HOCTh allaJIII311poBaTL ACCSlTKH TblCSlLI KnCTOK 3a C'IHTaHHbIC CCK}'HAbl. Ha3BaHlISI
MCTOAa nO-PyccKH Gblntt pa3HblMu: npoToLlHaSi 1 I1Tocpnyopor"'lcTpHSI, ltllmynbcHaSi
HToMeTpIlSl, npOTOLlllaSi. 1 11TOMC'lpIISl.. nCplJhli'1 11110CJlcJ\m1ti TCpMHHhl, 110 HamCM)'
MHCHIIlO, GOJICC cO(YfBeTcTBYlOT c\HrnHHcKoMY Flow cytomctry.
B K.PICCTBC HCTOLIHIlKa HJnY'ICHUSI B aHaJU13aTopax I1Cno.nhJYtOTCSI, KaK PT)'THO-
KBapl cBhlC J1aMnI.1 Bl>lCOKOro J\aUJICIII1S1. (lCP-H, ICP-22, Phywe. (}>pr; FACS.
I3cclon Dickinson, ClllA) , TaK II na3cpbl (50-H, Ortho Instruments, ClllA;
FACScan, Becton Dickinson. ClllA; EPICS-5 II EPICS Elite, CIllA-<1>pall 11S1), Ko-
TOpblC GOJlCC COBpCMCHHLI II o6naAatOT PSl} OM YHIIKclJ1bHblX CBOHCTB: MOHoxpor.m-
TH'IHOCTbtO, 60JlbllIOH nnOTHOCTbtO 3Hcpnm II BhlCOKOH KOJL1HMa HcH.
3ro AaeT B03MO>KHOCTb H3MepSlTb Ha HY>KHOU J],ntme BonH c}Jnyopec eH 1Il0
KpacH rClIctL KOJIWICCTBCHHO CBH3aHHbIX C HYKJleHHOBblMH KHCJIOT<lMH, 6CJIKOM II
HPynlM11 KOMnOHCIITaMlt KJlCTOK.
3.1. MeT01J;HK3 no."lY'IeHHH M3TepHaJl3 J1J1H HCCJle]J;OB3HHH
MaTcpMan AnSI 11CCJIel1.0BaHH I10nYL.laH)T pa3HLIMH cnocooafvU1:
1) nOCpC} CTBOM nYHKI l1H onyxoncH TOnCTbl\UI Hr11£11l1ll;
2) MCTOAOM TpcnaHo6HoncllH;
3) npH oncpaI ulI;
4) H3 napacpHHoBLIX 6JlOKOB Yl1.a11CHHbIX onyxOJICH.
Ha npOTOL.IHOM ailaJIll3aTOpc B03MO>KJlO H3yt.laTh TOJ1bKO KnCToLIHYJO cycncH-
:uno, KOI'OPYIO KaK npaBHJlO, nOJI}"I£1tOT McxaHWICCKHM ImH cpepMcHTHLIM cnoco-
6oM. .IJ,JISI 3TOH I CJIH nCTpoBa A.C. l-1 CO£1BT. [1976kRobinson I.J.P. II coaBT. [1993]
I1CIIOJIbJYIOT H3MeJlb'ICHHe GpHTBOH CBC>KeH onyxoncBoH TKaHH C noc11Cf YlOI.L{ci't
cpUKCal IICH cycllcu:mu KJICTOK ::rraIlQjI{)M (o6paJl hll1pll XpallCIHH1 B XOJlO}lH11bIlHKe
_4°C MorYT 6blTb npllroLlHblMU Ll11S1 IICCJIC OBaHiISl B Te'ICHHe HCCKOJIbKI1X MCCSlL{CB).
KncTot.IHYIO CYCIIClf3IHO o6pa6aTLII3aIOT J.(cTcprcHToM IITpllTOH X-I 00", OKpawuna-
lOT cpJI}'OpoxpOMaMH II 'ICpC3 nO.T"Placa. C nOMolllbtO npOTO'lHbiX CHCTCM. non}"laKJT
)J.HK 1,1 PHK-nICTorpaMMhl.
B 1983 r. Hedlcy D.W. IIOKa3aJi B03MO>KIIOCTh 1I0JI}'LICII11S1. KJIC1'O'-1H0i1 cycneH-
3HH It3 XpaHl1BllU1XCSI rOA£lMH n£1p£1cpuHoBblX 6110KOB.
Bcc ncpCLII1CJICHHblC cnocoGbl nO'ITI-I BcerAa A£1tOT B03MO>KHOCTb nOJ1}"IHTb aj\C-
KBaTHOC KOJIWleCTBO M<.nepmlJla A11S1 npOToLlHoH l lfToc}JnyopoMeTplm H n03TOMY,
cYUJ.Cc-ruYCT H031.10>KHOCTb npOBOAHTb HccncAoBaHHC cpa3Y 1I0cnc nonY'ICHl-1S1 KJIC-
'1'0'1110" cycncII311l1 (c nOMOUJ.blO rpitTOHa X-lOa). LICpC3 2-3 AHH "JiH I103J.(HCC (c}Jlf-
Kca l1S1 KneTOK 3TaH0J101.1) 11 Ha MaTepuanc 113 napacpHHOBbIX 6JIOKOB, xpaHHBlllHX-
Cst rOAbl, 'I 1'0 £1CT B03MO>KHOCTL post factum YCT£1HOBHTb TmOHAHOCTb II npOJU1cpc-
162 TOM II - YACTHbIE AHAflI1TI11.IECKI1E TEXHOJIOrJ111
u
pan1BHYfO aKTHBHOCTh onYXOJlCI1.
CJICAYCT T3K>KC OTMCTHTb, liTO MCTOAUKa npo I'OIIHOH I{HTOMCTpml 06Jl3):(aCT OA-
'"" '101' '101'.....
HOH B3>KHOH OTpHqaTC!lbUOH CTOpOIiOH - He n03BonHCT. 0:J,H08PC\fCHHO C H3MCpC-
tHlCM, MopcpOJlOrH'[CCKII H eHTI'lcpl'Il.lHp0831"b KnCTKH HOBo06pa30BClHHfr. D03TOt.fY,
nOJIY'ICHHhIH MaTcpHaJl (nYUK[\I'IOHHhIl1, 6110nCllltHblfl, OnCpall.HOIH-ILIH) pC>KCTCH H3
):(Ba KYCO'IKa, 0AHH p;.T1H nICTOnOnf'leCKOro dHaJ1H3a, BTOpofl - AJlH IU'ITOJlOrH'ICCKO-
fO H I\IITocpnyopOMCTpH'ICCKOro HccncAonaUHH.
DpH TBCPAOH KOHCIICTCHLI,IUI onyxoJUI ):(CJlaCTCH COCK06 C K3>K):(OH CTOpOHbi KY-
CO'IK8 1,1 Ll,wronofw-ICCKIIH MaTCpHaJl co CKaJlbnCnH HailOCHTCH Ha npejlMeTHOC CTe-
Kno. Ma3KII OKp3WlmalOTCH a3YP-303HHor...r no fleHlllMaHY. OOCJIC I{HT()JlOfll'ICCKO-
1'0 3aKJIIO'ICIIHH OHH HCnOJIb3YfOTCH Ami MOpcpOMCTpllllccKoro aHarnna.
£enH nOJlY'lcHHhli'1 onyxO!ICBblit MaTcpHan UblJl B J\OCI'3TO'IHOM OO"hCMC. TO ,[J,JlH
npOTO'UfOH I{HTOMCTpHII 6epYT TpH-'IC'tf,IPC KYCO'lKa 113 pa3HbiX Y'I<lCTKOB onyxOJU1
(ACJlafOT C Ka>KJ\Oro Ma1KH-OTne'laTKII ,[J,JlH I{UTononl'ICCKoro KmnpOJ1H) II, 3aTcr...r,
Ka>KAbIH 113 HIiX oopaoaTblBaJUI OTHCJIbHO. 3T0 CJlaCTCH AnH OOJICC OO"CKTHBflOI'O
H3Y"CIHlH COnCp>KaHHH ,IJ,HK, TaK KaK MOpcpOJIOnl'IeCK3H KapTHHa II COACp>KaHHC
,IJ,HK B KlleTKax onyxoml IIHOfna OTJlH'tafOTCH B pa3JIM'IHbiX CC Y'JaCTKax. Hat.1H B 25
Cn)l\laHX paKa nerKoro OblJ10 nponcHcHo cpaBHIITeJlbHOe 113Y'ICHI'IC cO}\Cp>Kam1H
,IJ,HK B pa3HLIX y..acTKax OAHOH onYXOJH1 (IICCJICJ\OIJaJlII HO 4-6 KYC01IKOB). B 9 cny-
llaSiX (53 %) 113 17 npu 3H3JIH3C OTJ.I,CJlhHl>lX KYCOllKOB HOBOOOp<l308aHIHI BblSlnJICIlO
OTJIH'UIC III1J..I,HK. B 5 (29%) Ha6moAcHmix pa3JIH'IIUI 6hlJ111 3Ha'IHTCJlbHbIMH H Ka-
CaJlHCb He TonbKO I1,D,HK, HO H 'lHcn3 KneTOK B S-cp<l3e. B 8 HaoJUDAcJUIHX (47%)
aHeynJIOHAHblX 11 7 (100%) lI,HnJIOHAHblX onyxO.'lei't HC Ul>IJIO nhlHBJICHO pa3JlH'II1H no
(1)J.HK, B TO BpeMH KaK 1H1cno KJICTOK U S-cpa3e He3Ha'IHTeJIbHO KOJ1COaJlOCh.
Oc060 CJleAyeT nop;'lepKHYTl>, 'ITO IIPH il,IUlnoIlAHbIX onYXOJIHX (8 Ma3Kax arne-
'laTK3X npCOOJlaA31OT KJleTKl1 paKa JlerKoro) HH n 0Hum..t H3 liCCneJ.l,OB<lHHbIX KYCO'I-
KOB He 6bl110 OOHapY>KCHO aHcynJIOHJl.HOH J1IIHIIH KnCTOK. 13 TO BpCf\-nI, KaK npH aHe- I
YllJlOI1JtHOM paKC - HBCl 113 Tpex 06pa3l1.0B. a 8 :,pyroM CJlY'IaC - 0AHH 113 TpCX oopa3-
I OB OKa3anCH AlmJIOIIAHbIM.
f10J1Y'leHHble ):(aHHLte YKa3hmmOT ua rCTeporeHHOCTL nonymll{HH KnCTOK ony-
XOJJH. D03TOMY, ,[J,JlH npCAarBpalI.{CHH U03MO>KHbIX norpelllHOCTCM npH HHK-DU"
Mbl BcerAa r01'08llJlH KneTO'IHYIO cycneH31110 113 HCCKOJlhKHX. n3HThiX B pa3HbiX Me-
CTax onyxo.I]H KYCO'IKOB, IIJlH ACJIaJJH oplrmofl TOJlCThlfl cpe3 'ICpC3 UCID onyxOJ1h, H
113 HCro nITOBHJ111 cycnCH3HfU. 06a clloc06a AaIDT KaK Obi YCpC)l.IICUHhIH KJTeTOll-
HblM COCTaB onyxoJUI, 60nce 06LeKTI1BHO OTpa>KaH)IIHIH, 'leM OJl.HH MaJleHLKHff KY-
--
CO'ICK, BCID nonYJlHUHfU KJleTOK H013000p330BaHHH.
KpOMe Taro, MO>KIIO oerpo" 6pl1TBOH CAenaTb TOJ1CThlli CpC3 no 60JlhlllCMY Ha-
MCTPY Bceti YAaJlCHHOi'1 onyxoJIII. ,IJ,aJlee 1,13 TaKoro cpe3a rOTOI\HTC KJICTO'IHaH CYC-
nCH31IH. KcrropaH n03BOJlSlCT nonY'[l.iTh CYMMapHble AaHHbie 0 n,ITOHJ.lUOCTH 11 npoml-
cpepaTlIBHOH aKTHHUOCTH KneTOK HOBooopa:J08alUl . 3TOT cnoc06 TaK>KC OU"bCK-
THBHO OTp3>KaeT pacnpeJ(eJleHHe )J.IIK U KJICTKaX onYXOJIH.
B CJIY'lae nonY'leHHH CKYJ(Horo Ma1'CpnilJJa 'IaCTb ero 06H3aTcnbHO OTlipannHeT-
CH H3 rIlCT0J10rWICCKOC HCCJIC)\OuatUlc, 113 npyrOlt n01108HHl>I, nOCllC 1'liTOJ10nf'IC-
CKoro KOHTpOJUI, rOTOBlITC KJleTO\IHaH cycncH3HH 1\JUI IIPOTO'IHOM I\HTOMCTpHH.
}J,JlH YBCPCHHOCTH B TOM, 'iTO nocne Tepamm MOpcpOJIOJ'H'leCKOMY Hccnep;OBa-
HlllO II npOTO'IUOH I\HTOMeTpIUI OYJ(CT nOJWcpmYT IIMeHHO TOT Y'taCTOK OIlYXOJlC-
I
ll,I1TOJIOrI1YECKI1E I1CCJ1E.[(OBAHIUI 163
t
BOM TKaHH, ...3 KOTOpOH AO J1C ' ICHHSI 6hIJI B3S1T OHOT1TaT H Cp,eJ1aHa npOTO'llHaSi U,...TO-
MCTpHSI, Heo6xOA...MO KaK MO>KHO TO'IHee onpe]J,enHTb MeCTO npOKona HfJIOM HJ1...
TpenaHOM. 3aTCM COOTBCTCTBeHHO npOKOJIY C]J,enaTb pa3pC3 no XOP,Y TpcnaHa (HJ1H
HfJIbl) H H3 YlJaCTKOB onyxoJIH pSlJ10M C 6bIBlllHM IIKaHaJlOM" TpenaHa Bblpe3aTb KY-
CO'IKH TKaH"']J,JlSlI1CCJIc.n.oBamUI. 31'0 AaCT n03MO)KHOCTb npe.n.n0J10)KHTb, <.ITO H3Me-
HCHHSI, nOJIY'IeHHble Ha nlc rorpaMMax, 6YAYT COOTnCTCTneHHO O'I1'a>KaTb Te H3MC-
HeHI1S1, KOTOpblC npOH30111JIH B pe3YJII>TaTe nponep,eHHoro J1C'leHHSI.
KYCO'IKH Hc06xo.n.l1fItlbIX AJISI HCCJIC}\ORaHHSI TK,mCH nOMell alOT B npOIlH"raHHbIe
4I H 3110JIOrn'leCKI1M paCT130pOM CaJlcpeTKH, KOTOpf>lC 3aTeM YKJl(lAblUaIOT R 'lalllKH
OeTpH. B TaKOM RH.n.e M3TepHaJJ TpaHcnOpTl1pyeTcH B J1a60paTopHIO.
,l],nSl aHaJll13a MaTepl1ana 113 napaqmHORbJX 6J10KOB Ha MHKparOMe .n.cnaiOT TOH-
KI1C (4 MKM) H TOJICTbIC (40 MKM) cpe3bI no CJICJtYJOlUeH TeXHOJIOrHH. .[(0 H nOCJJC
Tpex-lIcThlpCX TOJICThlX CpC3013 nape3aKJT )J,JUI I"HCTOJ10rWICCKIIX npcnapaToR
06bJ'llHbIe 4 MKM CpC3hl, KOTopble 3aTCM ncpHcpJfU,HpOBaJIHCh. Opll aTOM, Kpm.1C
CTaH}\apTHOH MOpcpOJJOrH'leCKOH xapaKTcpHC I'HKH KapTHHbl. oco60e RHI1MaHI1C 06-
pau aeTcSI H3 KJJCTO'lIHOCTb HCCJlCAOIJaHHoro MaTCpI13Jla. C'IHTaeTcSI B03MO>KHbIM B
AaJJbHCHUleM npoRccTH Ka'lccTBeHHblH npoTolIHO-I IITOcpJlYOPOMCTpl1'llecKHH aHa-
JIH3, eCIIH KlIeTKI1 p3Ka (uml 3nI1TeJII1S1) COCTa8JISIIOT Goncc 50% nJIOI.ua,tJ,H fHCTO-
JIOfWleCKOfO cpe3a. OOCJIe TaKOH mteHKH MO>KHO C ynepeHHocTbtO HCCJIe.n.OBaTb
co.n.ep)KaHHC .[(HK 13 SI.n.pax KlIeTOK 40 MKM cpe30R.
OOCJ1eAYlOllt aH 06pa60TKa 1I0JlYlJCHHOrO MaTcpmUla npoTeK3cT B HeCKOJlbKO
31'anon: npl1rOTORIICHI1C cycneH3HH KJlCTOK; ecJUI He06xoAHMO no MeTop,HKC - QJIIK-
C3I I1S1; 3aTCM oKpmmmaHHe ct>nyopoXpO 1aMH.
3.2. UpHrOTODJ1eHHe KJleTO'lIHOH cycneH3HH
B :J3BI1Cl-fMOCTI1 01' nOJlY'leHHoro MaTepHana (cRe>KHH Will TOJ1CTble cpe3b' C na-
pa4lHHOBbJX 6J10KOB) HCnOJlb3YKH l1.Ba pa3Hbix cnoc06a npHrOTOBJlCHHSI KJ1eTO'IHoM
cycneH3HIf.
B c.IIYlfae coe:HCew MamepUaAa npWrteHRemcR CJ1eoYIOU{llR J.temOouKa:
1) KYCO'ICK TK311H 113MC.fJb l JaIOT (pC>KYT 6pl-ITBOH) B llalJJKe neTpH Ii He60.%-
IIIOM 06'bCMC (0,5 MJI) npoQJHJlbTpOnaHHoro 'ICpC3 0,45 MKM MHJ1J1HnopoBblH
QJHJJbTp TPHC-HCI-oycpcpa (pH-7,4) Hml QJI13HOJIOrWleCKOI'o pacTRopa AO nOJ'Y'lle-
HHSI KJICTOtlHOH cycncH3HH.
2) KJIeTO'JHYJO cycneH3HlO Tw.aTCJlbHO ncpeMclllHBaloT B Te'ICHHH 3 MHHYT aB-
TOMaTUlJCCKOH mmeTKoH.n.o 110J1Y'ICHHH OAHOpOl'HOM R3BeCH KJICTOK, 3aTeM QJHJ1bT-
PYIOT R rpa.rtYllpOBaHHYIO I CHTPHCJ)Y>KHYIO npooHpKY, R Ha'laIlC 'lcpe'3 peAKHH
QJllJ1bTp (nopbJ 500-600 MKM), 3aTeM '-ICpC3 cT3HAapTHhlf'1 HeHJ10HOBblf'1 cfJHlIbTP C
AH3MC"'1'0M nop 100-130 MKM.
3) .[(aJlCC cycncH3HH QJHKCHpYCTCSI (CCJlH HY>KIIO OTCpOtlHTb nponep,cHHe HCCJJe-
AonaHHH) HJlH cpa3Y nOCJle OKpalllHBaHHSI no cneu,m\JIbHOH MeTop,IIKe HCCJ1eJ1.yeTcSI
Ha npoTollHOM aHaJlH3aTOpc.
llpu,Me"wHue: eCJ1U 1I0JIY'ICUHhl 1 KycolleK onyxOJlCBOH TKaHl1 O'-ICHb Man (pa3-
Mep co CIIH'IC'IHYIO r0J10RKY H lI'fCHbIllC). TO OH H3MCJlh'l(aCTCSI B MCHbllIeM 06'bCMC
6YQJcpa (0,15-0,2 MJ1). OOJIy'lcHHaSi KJ1CTO'IHaSi cycncH3HH HC ctJHlIbTpyeTcH, a cpa-
3Y oKpaIIIHRaeTCH no Cnel UaJIbHO" MeTOAHKe. 11 TonbKO nOC!Ie oKpacKH OHa npo-
nYCKaeTCSI tJepC3 100-130 MKM HeHJJOHOBblH cpHJIbTp 11 3aTeM HCCJleAYCTCH Ha npo-
TO'lHOM aHaJJH3aTOpe.
164 TOM II - LJACTllbIE AHAJII1TI1QECKI1E TEXHOnOrl1H
Dpol.{eJ].ypa npHrarOBJleHliH K.IlCI'1'lOltHOii CYCIlCH3L1U U3 nIO.l1CnIblX ll11pafPllJ-tOHhlX
CPC&Olj IlO ,wcmoOy Cmnplejonh Ii COaBT. [198516oJ1ee CJ10>KHaH Ii TpY}J,ocMKaSl:
1) L(na-TPM napaclmHoBblx cpc:m nOMelJJ.aIDT B Cnel.{naJlhHblH 3aKphllJmOll(uikH
v u
KOUTCHHCP 1-13 r-.-ICJIKOH ceTKH.
2) rOT<_)BHTCH GaTapCH peaKTHBoB (10 Jla60paTopHhlX CTaKaiJOB C npl1TCpTLJMII
KpbllllKaMM no 100 MJl): l-r, CTaKaH - KCHmm; 2-H - KCmIOJl; 3-H - 100% MeTHno-
Bhlti crmpT; 4-H - 100% MeTliJlOBblH cnHpT; 5-H - 95% MeTHnOR),J" cmlpT; 6-H -
95% MeTHJ10Bbl 1 CnilpT; 7-H - 70% MCTHJIOBblH CIU1pT; 8-H - 50% MeTHJlOBblH
cnHpT; 9-H - ]J,lICTIIJ1J11lpOBaIiHaSi BOHa 10-rt - HCTHJlJlHpOBaHHaH BOAa.
npluteWlHUe: MO>KIiO 11CIIOJlb30BaTb Ii 3THJlOBblH ClUlpT.
3) Korrrcihlcp (111111 cpa3Y HCCKOJlbKO KOHTeHHepOB) C napacpl1HOBhJMH cpC3a:o.m
nOMeU aKJT Ha 15 MHIlYT nOCJICllOBaTCJlbHO 8 KiUK]J,bIM H3 nepBblX 8 CTaKaHOB. B ]J,H-
CTHJ1J1HpOBaHHoH BO}J,e OCTaBJlHIOT na 15 r-.nmyr. ECJIlI npOBOJ],Ka MaTCpl1aT1a BbHlOIl-
HHeTCH B KOllll,C pa6o ' lcl'o :J.HH, TO KOHTeHHepbl co cpe3aMH MO>KHO OCTaBHTh Ha
HOllb B CTaKaHe C 50% CIU1pTOM.
4) DocJle nOJ1HOH npoBoJ].KU cpe3hl aKKypaTllo mlllll,CTOM ncpcHocHT B Ilp06Hp- I
KH C 1 MIl 0,5% ncnCllHa (Sigma, Poolc, Dorsct), pH 1,5.
5) Dpo6HpKH CI'amrr Ha BOHHHYIO oaHID (HJ1H B TepMocTaT) 1m 30 MHIIYT IIpll
TeMnepaType 37°C.
6) 3aTeJ>,'1 npoGHpKH 6blCTpO OXJ13>KHalOT H IIOMCll.(aJDT B l eHTplHpyry. BTe11e-
HHU 3 MHHYT I CH I'pHcpyrHpYJDT npn 2000 o6op0Tax B MI1HYTY npll KOMHaTHOrl TCM-
nepaType.
7) n ImeTKOH aKKypaTllo 3aOllpaJDT BCJD Hc1)J;OcaJJ,O'IHYID >KH}J,KOCTb.
8) K ocaJ],KY H06aHJISIIOT 2 MJI 1130TOHI-I'ICCKOro paCTBopa (Coulter Electronics,
Luton) HJlH cpoccpanlOl'O 6y<pcpa (pH 7,4) H Tll.(aTCJlbHO paJOllBalOT OCTaBllIHe '-Ia-
CTH cpe30B Ha BH6pOMeWaJlKe. I
9) <1>HJ1bTpYIOT n0J1Y 1 IeHHYro KJ1eTO'-IHYID cycneH3HH) '-lepe3 35 MKM HctLIOtIO-
BbIii <plmb Tp.
10) nponycKalOT ABa pa3a K-'leTO'-IH}'IO cycnclf3HJD '-ICpC3 TOHKYIO HHbCKI HOH-
HYIO HrJlY.
11) ,IJ,06aBJ1HIOT 5,0 M11 <PJ1YOPCClI,CHTHoro KpaCIITCJ1H DAPI (4,6-AHaMH):{HHo-2-
cpemwHH):{OJ1 rHApOXJlOPI1J , Serva).
npWtl.e[lafllle: n 15% Ha6JIJD}J,cHI1H HC YAaCTCH nOJl}"IHTb AJlH aHa r lll3a a):{eKBaT-
HYJD KOHl eHTpal.{Hto KJ1eTOIIH0I1 cycneH31UI.
3.3. IIKCaI\H" KJlCTOK
IIKcau.HIO KJleTOK OCYll.(eCTBJlHIOT }J,BYMH MeTO]J,aM I:
no J'-f.cmoj)y DarzYllkiewicz Z. II coaBT. [1975; 1977] K 1-1.5 MJI KjlCT04110ft cyc-
neH3HH }J,06aRJIHIDT no KanJlC 9 MJI XOJIl)AIIOH (4"C) CMCCH :JTaHOJ1-al.{eTOH (1:1), Bce
BpCMH TlJJ.aTenbHO nHlleTlipYIOT nOJlY'-leuuYJO KJleTO'-IHYIO H3HCCb, TCM C3MLIM IIpcnH r-
CTBYH o6pa30BaHl1JD KOHI"}IOMCpaTOB KJleTOK. H60 }J,Be CK..'lellBumecH KJleTKl1 pen1cT-
pl1PYJDTCH nparO'lHblM aHaJlH3aTOpOM KaK 0l\Ha C ynnoeHllblM KOJU1'-lccmOM .a.1IK.
no ()PYlOii. Memo()u.Ke lSteinkamp J. H coaUT., 1974] K 0,5-1 MJI KJICTO'IHOH CYC-
JlCH3H11 L\oGaBJIHJDT no KanJle 96% 3TaH0J1 npll 3TOM cycneH3IHI nOCTOHlUlO (nml
npeHoTRpa\J eIUIH CJIMnam1S1 KJICTOK) mmcn1pYCTCH C nOMOlJJ.blO aBTOMaTlltleCKOH
QI1TOnOrI1tIECKVlE VlCCflEJJ,OBAHVI$I 165
{
rumeTKH 06"hCMOM Ha 1.5 Mn. KOHI,eHTpau.IISI clIHpTa B cycneH31UI nOCTenCHHO YBe-
JIII1IMBaeTC f{0 70% (CooTHOWeHl1e B:JBeCH KTiCTOK H cllllpTa 1:2,5). TaK0I1 cnoc06
fJ)HKcm.lllH ocoGeHHo XOpOIll JVI 1I0CJ1eD,YlOlllero OKpaUlHnallHH qJJlYOPO poMoM-aK-
pHAIiHOBbIM Opall>KCBbIM.
np06HpKH nJlOTUO 3aKpbIBalOT pe311HOBblMI1 IIpooKaMl1 HnH n.rIeHKOH Parafilm
"M" (American Can. Corp., CllJA) I1I1OCJIC 48-'JaCOBOH cplIKCal\lm npll -2U J C KneT-
KH r-.mrYT 6bITh 1I0Jl.BCprHYTbl IICC.TIeAOBaHlUO C cpJlYOPOxpofvlar.m.
flpw"te'wl-lue: 3aq)HKCllpOBaHHa KJleTO'lHaH CYCIICH311S1 MO>KeT xpaHHTcSI B xo-
JlOf{l1JlbHHKC B Te'Iemm HeCKOJlbKIIX MCCHl-leB.
3.4. OopaooTKa KJICTOK ;J;eTepreHToM TpliTOH X-IOO
Traganos E H coaBT. [1977] YCTam>BmU1, 'ITO B HecpllKclipoBaHuoH KJICTO'IHOt'!
CYCIICHJIII1 nocne 06pauoTKII 0,1 % pacTBopoM rpl1TOH X-lOa (lIpH pH=4,0 I-f HH-
>Ke), Knenat cOXpaHSlJIH 1.{UTon.rm3MaTI'I'ICCKYfO OUOJlOtIKY, I-f gemUll1cb npOUlll\aC-
MblMI1 AnH m::pacKu aKpH IIHOBbIM OpaH>KCBI,IM. 3nt HYM OpOMH)..{OM H Jl.Pyrm.m
cpnyopoxpOt>1aMH. npll 3TOM He 3aTpa t lHB<:l.110Cb BpeMH Ha OTMbmaUHC KJICTOK 01'
qmKcaTopa. '1TO TaK>KC 1I0JBOJlHJlO COxpalll1"rJ. OOJlblllOe HX KOnJi'leCTBO. KpOMe 1'0-
ro, anTopbl nOf{ t lepKHBaJ1H, '-11'0 nplt oopa60TKe no aTOM MeTo"IIKC KJICTKH, Haxo SI-
LU.HCCSI B MI-fT03e. HC pa3pYIllaJoTCSI ga>Ke npl1 BCTpSlxHnallHH H JIHneTHpOBaHIII1, a
cOAep>KaHI'le B HIIX HYKneliHoBblX KIICJIOT ocraCTCH OC3 1f3MeHeHitH.
YtlllTblBaSi 3TH nOJIO>KIITCJlbHbIe oc06eHHOCTH MCTO].lHKH. OHa MO>KeT 6blTb I1C-
nO.1b30Balla J.{Jl CpOtlHOro IfCC.Tlef{OBaIlHSI ('lepe3 25 \HIHYT rOTOB OTnCT) COACp>Ka-
HIIH AHK B KJ1eTK8X onyxoJU1.
1) K 0,4 MJI KJleTOtlHOH cycneu:mH J.{o6aBJISIIOT 0,02 r-.-m IO% TeJISI'lhCH CLInO-
pOTKlt. AKKypaTHo HeCKO-'lhKO pa:J 3TY CMecb BCTpSlXltHalOT 11 tlCpC3 5 Mi1HYT K HeH
Ao6aB.THflOT 0,6 MJI O'IeHb xonOf{Horo (1-4"C) 0,1% paCTBopa Tpl'lTOH X-100 (Sigma
Chemical Co.), O.IN HCI H OJ5N NaCI (pH 1.5-2.0).
06pa601'Ka HecpllKcHpOnalUll>lX KJICTOK O,IN conHHOH Kl1cnOTOM B npl-lCYTcrUlHI
AeTepreHTa, "'pIITOH X-lOa, Yf{aJIHeT rl1CrOiILI II npyrHc KllCJIOTOpacTBOpltMble
6CJIKI1 11 YBe.'1lI ' IltBaeT B 2,4 pa3a MaKCIIJ\'fi.lnbHOe Kom-I'leCTBO I1J1TCpKaJIHPYIOLllHX
MeCT, KOTOpl>lC 3aTCM CBH3bIBaJlHCb C KpaCHTCJICM.
2) HecKonbKo pa3 CMeCb BCTpHXUBaK>T II 1I0CJIC 15-30 ceKYHA K Hd', f{06aBJl}fIOT.
1 MJI cpJlYOpoxpoMa. LjcpC3 10-15 MIIHYT oKpawe Hbll i 0(jpa3el MO>KHO I-ICCJICJ.{O-
BaTb Ha npOTOtlHOM aHa..1113aTope,
flplOAetlWlltc: 3T01' cnoc06 o6pa6oTKII OCOOCHUO XopOWO HCnOJlb30naTh npll
I1CCJIC)..{OBaHHI1 nYHKl IfOHHOI-O II UIiOnCI1HHOrO \faTepIli:Ula. KOI'Ha KYCOtlCK OIlYXO-
neBoi'1 TKaHIi O'leHb Ma. I ICUI>KI1JII1. CJleAOBaTeJ1bHO. HeJHa'II,ITC111,HO KOJIU'IeCTBO no-
J1y t ICIIHOt'1 KneTOtJHOH cycncH31111.
3.5. OKpamno3Hlle HYK.'1eIllIOObix KIICJlOT cjJJI}'OPOXPOM3MII
(I>JlyopCCl-leHTHble KpaCHTC11H «(j:J.IIYOPOXpOMbl) - 31'0 Bell\eC mel, u3a11MoAclkTBY-
IOLllI1C cne'\l1qm t lccKI1 11 CTeXHOMeTiu1lleCKI'I C BHYTPHK11CTOtlHblMH KOMnOHeHTar-.m
11 liP/! B036Y>KAeHIIIi cneTOM COOTBCTCTBYJOIl{eH HJ11111hl ROJIULI, J.{alOT H3JIY'leHlle
60JlblIleH Jl.JII1Uhl BOJIHbl. I1HTeHCI1BHOCTb KOToporo COafBeTcTByeT co"ep>KaHIHO
HCCJle yeMhlx nell\eCTB B KlICTKC.
AnSI 3TOI'O HCIIOJlb3YlOTCH pa3m-1'-IHI.IC cPJIYOPOXPOMbl: aKpl1 HHOBbIH OpaH>Ke-
BblH, 3TI1gHYM fipor-mn, MI1TpOMHl-lI1H, O.1lI1BOMH1\IIH, npOlUIHI1YM f!0AI1f{, )..{lIaMIIHO-
I
-----
166 TOM II - llACTHblE AHAJII1TI11.IECKI1E TEXHanar1111
<lJCHHJH-fHAOJ1 (DAPI). Zante J. H coaBT. [1976] MOJ],H<lJHl.J.HpomulH cnoc06 OKpaCKH
KJIeTOK Crissmann H.A. H Tobey R. 3THJ],HYM 6pOMll,l\OM (ethidum bromide), )1,0600-
nHH K KpacHTenlO qmyopecl.\HPYfO m1IIpoTHBoonyx0J1CBLIH aJf'rH6HOTHK MHTpar.m-
l\HH (mithmmycin) HJUI OJ1HBOMHl\HH, ITO cYJl.J.ecTBeHHo YJIY4lliHJIO 4YBcTBl1'rCJ1L-
HOCTb MeTOAa. Bhl60p <lJnyopoxpor.m 3aBHCHT 0'1' Toro, ITO HY>KHO I1CCJ1e,l\OBaTb -
AHK, PHK, 6eJ10K H '1'.1.1.. (oTJ],enbHo HnH BMCCTC). H 0'1' cnoc06a oKpauJHflaHHH Kne-
TOK.
3.5.1. OAlloBpeMeHHoe AH epelll(HaJlLHOe OKp3WIIB3HHe JJ;HK H PHK B
HKcHpoBaHHLlx KJleTKaX c nOMOl.l\LlO 3KpH HHoBoro opaIDKeBoro
113BecTHo. ITO IaCTb KJleTO'"IHOM PHK HaxOAHTCH B ABYC[IHpaJIbHOM KOH<lJopr.m-
l\HH. n03TOMY, '"IT06bl nOJ1Y'-IHTb AH<lJ<pcPCUUl1aJ1bHOe oKpalliHBaHHe )J,HK 11 PHK
3THM KpaCI1TeneM, J-le06xo}J,HMC? H36HpaTCJ1bHO nepeBecTH ABycnHpanbHYfO PHK B
O}J,HocnHpanbHYI-O <lJOPMY 6C3 H3MCHCHHH KOH<lJopMal.J.HH )J,HK. 3'1'0 AOC rHl'aeTCH
06pa60TKoM KJ1CTOK 1.1.0 oKpawHBaHHH xcnanlpYI-O HMH ar-CHTaMH l Darzynkicwics
Z. H coaBT.. 1975]. )J,ml :nOM [(eJ1H HCnOJ1bjYIOT Amta.TpHeBYtO com 3THneH}J,HaMH-
HOTeTpaYKcycHOH KHCnOTb[ (TpHJ10H E).
Pa3HblC napnm aKpHAI1HOBoro OpaH>KeBoro (A.a.), Aa>Ke npoH3BcACHHI>IC 0]\-
HOM <lJHPMOH, B03MO>KHO, HMCI-OT Heo}J,HHaKoBYlo CTeneHb O'UlC1'KH npcnapaTa.
Bcne}J,cTBHe 31'01-0 B KIDKJJ,OM KOHKpCTHOM cJIY'lae AcikTBHTCJ1bllaH KOHl\eHTpa1.(HH
KpaCHTCJlSI B pacTflope MO>KeT OKa3aThCR Hco}J;HHaKoBoH. n03TOMY OAHOBpCMCIUlO
roTOBHT 3Ha'U1TCJILHOe KOJ1H'IeCTBO (r.mTolIHoro) pacTBopa A.a. ("Serva") B KOH-
l\Cl-rrpal\HH 1 Mr Ha 1 MJI 1\HCTH1I1IHpOBffiIHOM BOAbl, KOTOpblM n01lL3YIOTCH fl Te'le-
HHe BceH cepHH 0111>1'1'08. MaTO'IHLIH pac'mop KpaCHTeJIH Xpmm1'CH B TeMHOTC IIpl1
2-4 CJ C H rOAeH B Te'ICHHC MHorHX MecHl.\cB.
A. npl1roTOBJleHHC pacTflopoB A H E.
PacTBop A:
8,775 r XJIOpHCTOro HaTpHH (NaCt) Ha 1 J1HTp 0,1 N HCI (pH 2,0-1,5).
3TOT paC"rBop MO>KHO xpaHHTb npH 4'c AO 2-x Hc}:\eIlb. 1.IT06bl HC npmt301U1Ia I
.u.cHaTypal.J.I1SJ )J,HK OT COJ1HHOM KHCJ10Tbl, Tcr.lIIcpaTypa IIPH HCIlOIlb30BaHHH pac-
TBopa }J,OJT>KHbI 6bITI) 1-4°C.
PaCTBOp E:
1) cI>oC<paTHO-l\HTpaTHbIH 6y<lJcp, pH 4,1-4,2.
2) 0,15 N X1l0pliCTLIH HaTpHH (NaCl).
3) 5 x 10 M }J,HHaTpHcBoti C01lH 3THJ1eHAHaMHIlOTeTpaYKcycHOH KHCJTOTbl.
4) AKPHAHHOBbl" OpaU>KCBbIH 6 MKr/Mll (0,6 MJT MaTo'IHoro pac'mopa A.a. Ha
100 MJ1 cMecH).
PaC1'BOP E 6e3 A.a. MO>KHO xpaHHTb n Te'ICHHH HeCKOJ1bKHX MCCHJJ..CB B X01l0-
AH1IbHHKe npH 2-4"C. nOCJ1e Ao6aBJICHHSI A.a. era Hc06xoJ\HMO HCn0J1b30BaTI> B TC-
CHHH 24 '-laCOB.
KaK MaTo'-IHbIH, TaK H pac rBopbl A H E <lJH1IbTpYIOT 'lepe3 0,45 MKM MHJIJIHIIO-
pOBbJe <pHJIL TPbl.
E. Henocpc}J,cTBcHHaH OKpaCKa 06pa3JJ..oB.
1. noc1Ie <lJHKCaLJ.HH K1IeTKH ABIDK,IJ.bl OTMbIBatOT. nepBblM pa3 B <poc<paTHoM
6y<lJepHoM pacTBope (pH 7,4), l.rropoH - B 0,85% <pH3H0J10rH,"lecKoM pac-mope.
IJ.I1TOJIOrl11..IECKHE I1CCJIEAOBAHI151 167
U.eHTpH£pynlpYIOT npH 1000 o60poTax B MHHYTY B TC ICHHC 5 MHHYT. Ka>KJJ,bIH pa3
KJleTo'IHYIO B3BeCI> TII aTeJlbHO rmnCTl1pYIOT.
2. n pOBO HT KOIITponb nOA MHKpocKonoM Ha HaJlH II1C J"OMorCHHOCTH. .D.OBO}J,HT
KOHl cIITpaI mo KJJCTOK AO 12 x 10 R 1 MJl.
3. 0,2 MJl K!ICTO IHOH cycncH3HH CMeIIlHB310T C 0,4 MJI xonOAHoro (1-4>C) pac-
1'Hopa A. AKKypaTHo HCCKOJ1hKO pa3 ::rry CMeCI> BCTPHXlIB3K)T H nOCJIe 15-20 cc-
KYH,'J. K HCH }J,06aB!ISlK}T 1,2 MJl pacTBopa 6.
4. Cnel 11qm'lHocTb OKpaWl1BaHHSI pl16mlyKJICHilOBOH KHCJlOTbl onpe}J,eJIHIOT B
BI>IOOpO<1HI>IX npo6ax C nOMOIUhlQ PHUOHYKJICa3I>I (0,5 Mr/MJl cycncH31111 KJICTOK,
"Serva"). BhlSlBJICtUlOC IIPH H3MCpCHHl1 YMeHhmcHHc Kpaclloi1 qmyopcCl..(eHI..(HH
(A nnx > 600 HM), npOHCl1IeAIIICe II pC3}'JlbTaTe o6pa6oTKH pH6oHYKJlCa30i1 SlBJISlCT-
CSI IIOKa3aTCJlCM cncuuqm'-ltioc I'll OKpaWHBamlSi PHK. nOCJlC TaKoi1 o6pa6oTKli
'IHCJIO KJICTOK C IIOBbllUCHHblM cO}J,cp>KaHI1CM PHK YMCtlLmaCTCSI B cycneH:mH B
CpC}J,HCM H<l 60% H npOHCXOAI11" CMCllI,CHI1C no OCM a6CI..(HCC PHK rHCTOrpaMMI>I
BJ1CBO B CpCHUCM Ha 35 Ki.lHaJ10B.
5. OKpamcHHhlH oOpa3el..( nOMCIj\3IOT B KOHTCHUCP IUHf KJICTO'-IHOi1 cycneH3HH
uui'o<tmyoporpacpa, OTKY.D,a KJlCTKH no} naBJJCHI1CM <lepe3 CMCHHhlH £pllJIbTp no co-
CAHHHTCJIhHOH TJ'>y6KC nOCT)'naIOT B npOTOKOBYIO H<leHKY, rAC OIlH nl}.\pO}\HllaMH'lc-
CKH £pOKYCHPYIOTCSI o6TCKalOIl\CH >K11}\KOCrhtO (£p113110J10I'I1'ICCKHM pacTBopoM).
3'1'0 n03Im.'IHCT nonY<IHTh YCJIOBHSI JJaMI1HapHOro nOTOKa. npH TaKHX YCJIOBI1S1X BCC
KJJCTKH nonaJ],alOT B I CtI1'P nOTOKa H ncpcccKalOT JIa3Cpubli1 JIY'-1 O} Ha :m }J,PyroM.
CKOpOCTh ABlDKCHHH KJlCTOK pcry!mpycTcSI } aBJIeHHCM o6ono'lc'IHOM >KU.D.KOCTH,
npH 3TOM YCTaliOBJICHHOC AanJICHHC 06pa31 a onpc}J,CJISlJIO cm pacxo.D, (MJl/MHH) H
}J,HaMcTp nOTOKa. c}>JlyoPCCUCIII..(11H H3MCpHCTCSI 0'1' KIDKll,OH KJICTKH 11 Bbl3bIBaCTCSI
cpOKycHpoBaHHblM AO 5 MKM aprou-llOlltlhlM Jla3CpHbiM nY'IKOM C .D,J1HHOH BonHhI
488 HM, npl1Hl Hn pa60T'" npOTO'IHblX aHaJlH3aTOpoB npocToH. OKparucmmSl cpJIY-
OpOXpOMOM K.f)CTO<lHaH cycneH3HH nOMCll aCTCH B KOHTC(jUCP AnSI. o6pa3ua. OTKY}J,<t
KJICTKH no}J, fl,3BJlCHHCM nocTynalOT B IIPOTO IHYIO KaMepy, r.D,C OHH rHApOAHHaMH'-IC-
CKll £pOKYCHPYIOTCSI, ITO n03BonHCT Bbl:JhIBaTh cpJlyopcCuetH HIO Ka:>KnOH KJleTKH,
nepCCCKalOl!l,ci'1 JIY I 01' pTymo-KBapI..(CBOH naMnbl HJII1 Jla3cpa. B03HHKII1ce £pJIYO-
pCCUCHTHOC H3JIy'wmic nOABO]1,I1TCSoI K <POTOYMHO>KnTeJlhHbIM TPy6KaM, r}J,c CBCTO-
BOH CHrHaJ1 npc06pa3YCTCSI B 3JICKTpH'ICCKHH, YCI1JlHBaCTCH. npc06pa30BhmaeTCSI H
B 3aBHCI1MOCTH OT BCJlU<II1Hhl 3anHChIBaCTCSI B Bl1J1.C I'I1CTOrpaMMhl Ha 3KpaHC .D,l1cn-
JICSI. no npHHwmy: '-ICM 60JlhlllC COACp>KaHHe D:HK, PHK HJII1 6eJlKa, rCM CI1JlhtlCC
HMn)'JJhC 11 TCM 11,aJlbwe Ha OCH a6Cll,HCC OTKJ1a)thlHaCTCSI BCJll1'll1Ha £pJIYOPOCI..(CHUI1H
KJlCTKn. Ha OCH Opfl,llHaT pCrl1CTpl1pYCTCH 'IHCJIO HMnYJlbCOB Ha KaHaJl: '-ICM BLIWC
Kpl1BaSi B mo60H rO'IKC, TCM 60nhlHC cocpe]1,arO'-ICHO KJICTOK C O]1,I1HaKOBbIM COAep-
>KaHHCM .D.HK, PHK HJIH 6CJIKa II AaliHOM KamUlC.
KpaCHOC cpJlyopCCl..(eHTHOC H3JIY<ICHUC 0'1' KOMnJleKCa A.a. C PHK (> 600 HM, B
npc]1,cJIax 625-650 HM) H 3CJICHaSi £pnYOPCCll,CHI(I1H or HHTCpKaJmpOBaHHoro B .D.HK
A.O. (B npC.D,CJlax 515-575 11M) H3MepSlCTCSI 0'1' KIDKJJ,OH KnCTKI1 11 pa3J CJISleTCSl C 110-
MOII hIO CHCTCMbl £pI1JlbTPOB, BcrpOCHllbiX B Ul1'roq)J]yor'pa£P. TaK, £pHJlbTp N300-
0281-001 nponYCKaCT KpaCtlOC H3fJY<lemlc (0'1' 625 MM AO HH£ppaKpacHoro), a
cpHJ1hTp N300-0281-001 - H3JIY<'CHHC C )J.mmoH B011HI>' OT 515 no 555 HM, 'ITa COOT-
BCTCTBYCT JCJ1CHOH CPJlYOPCCUC1IW'II1. KpaCHOC H 3eJICHOC £pJlYOPCCLJ,CHTHbIC H3JIY-
\.ICHI1S1, c06paHHblc 3J1CMCHTaMI1 BOJIOKOHtlOi'1 OIlTHKH, nOABOAHTCH K COOTnCTCTRY-
IOII HM £pOTOYMtlO>KIITCJlbHbIM TJJy6KaM, aHaJIoroBbTe Cl1ftlaJIbl KOTOpblX npco6pa-
168 TOM II - 1-IACTHbIE AHAJIH fH1-1ECKHE TEXIIOJIOrHH
30UbIBal-OTCH H 3anHCbIBalOTCH B BHAe n1CTOrpaMM Ifa 3Kpalle AHCnneSi (no OCH a6c-
LlI1CC KOToporo npeJ{CTaBJ1eHbI KaHaJlbl MHoroKaHaJ1bHOrO aH"cl!ll13aTopa). nOJIytleH-
IIble ltHTO-, )J.HK HJUI PHK-rHCTorpaMMbl aUTOMaTHLleCKH 3amfCbIBaWTCSf lIa >Ke-
CTKHi'f HCK KOMnbK)TCpa H 3aTCM aHa!1H3 IPYK)TeSf CIICltHaJlbHblMH npOrpaMM"clt\.m:
LYSIS I 11J111 II, Cell FIT, Becton Dickinson, CIlIA; MultiCyclc, Phoenix How
Systcms, CIlIA 11 T.]1,.
3.5.2. I1cc.....e;J;ooaHHc n K.....eTKax JJ:HK C nOl\lOll(bW CMeCH KpacHTcncH
Ethidium bromid It Mithram}'cin
,IJ,06aBJICHHC K mrrepKaJlHpYlOll.(eMY Kp"clCHTCJII-O Q:)]]yopeCltHpYlowcro IIpOTHBO-
ollyxOJ1eBOrO aHTH6110THK"cl Mithramicin [Zantc J. H eoaUT., 1976] ynytlWHJIO CnCLJ.H-
qmLIHocTb oKpawHBallHSI, TaK KaK Mithramycin, He SlBJIHSlCb HHTCpKa:U1pYIOI1 HM
KpaCHTCJICM (OH CBH3blBaeTC npcHMYU\eCTBeHHO C ryaHHIJ0-1 HT03HHOBbIM a30TH-
CTblMH OCHOBaHl1HMH ,fJ,HK), B CMeCH C Ethidium bromide OT.D.aeT CMY :;)Hcpn1l0 Ii
3THM YUCJII1 t lHBaeT HHTeHCHBHOCTb q)JIyopeCI{eHI I1H KOMI1JICKe"cl L(HK-HHTepKaJUl-
PYl-OlI HH KpaCHTCJlb.
3TOT cnoc06 oKpawHBaHHSI npl1roJ1.eH KaK J1.JISf lIaTHBHoro MaTep laJIa, ..aK H fJ.nSl
qmKcHpouallHoro 3TaHOJIOM. TaK >KC, KaK " npH npHI"O"romlCIH1H MaTOtlHOro pae-
Tuopa aKp"AI1HOBOro opalJ>Kenoro, O.D.HOMOMCHTHO. OTJ1.eJIbHO rOTOBSIT 3I1a t HITeJ1b-
Hoe KOJm'ICCTBO paCTBopa Ethidillm bromid (pacTBop A) II Mithramycin (pacTBop
E), KOTOpblMH MO)l(HO nOJlb30uaThCSI B Te'leH"C HCCKOJII.K"X ceplfi1 OIILiTOU.
a. npUZOm08.1leHUe pacnwvpo8 A it E
Pac'mop A:
1) 12,0 r TpHC 6ycpcpa pacTBopHTb B 1 JI"1'pc AHCTHJI!1HpOBaHHOH UOAl.>!. 0,1 N
HCI J{onCCTH pH 6yq)cpa no 7,4.
2) B 250,0 Mn nOJIY'lcHiloro 6ycpepa paCTIJOpHTh 6,25 Mr Elhidillm bromid
(Sigma Chcmical Co.). TaKHM 06PaJOM. pacTBop A: 25 MrIJI Ethidium bromid B
TpHc-HCI-6yq)epe, pH 7.4.
PacTuop E:
1) B 250,0 MJl nOJIytleHHQro 6ycpepa pacTBopHTb L2,5 Mf' Mithramycin (Scrva) "
381,0 Mr MgClz. TaK"M 06pa30M, pacTBop E: 50 Mr/JI Mithramycin U TpHC-HCI-6y-
cpepe, pH 7.4; 7,5 mM MgClz.
nOCJIe QJ 1J11.>rponaH"SI t[epe3 0,45 MKM MHJ1JIHnOpOUbIC QJHJlh1 pbl pacTBopbl A
11 6 MO>KUO xpaHHTb B TelICHH" neCKOJ1bK"X MCCHucn n X0J10J{HJIbHIIKe I1PH 2-4°C.
npHMepHo 3a 2 tmca .0.0 OKpaCK" KJICTOLIHOi1 cycneH3HH U HCllp03pa t IHoH np06Hp-
Ke rOTOR"TCSI CMeCb AUYX KpaCHTeJIeH B OTHOlliCHHI1 1 :1, KOTOpaSi 3aTCM J{O Ha l laJ1a
oKpawHuaHHSI HaXOHHTCH npH KOMU<1TIIOH TeMncpaTYpc.
6. OKpmwuwHlle (/jUKCUp06£11lHOii anWHOJlO.W KJlemO'lHOIl CYCfleH3Ull
1. MHKpo"n"neTKOff 3a6Hpal-OT R cpeJ{HcM 0.2 MJI cfJHKC lpOBd.HHOH cycneH3"H.
KJIeTK" OTMbmalO'r cfJI13HOJIOrH'ICcKHM pacTRopoM ("JIH q)l)C(paTUhIM 6ycpepoM,
pH-7,4), I CHTpHcpyrHpySl B TCllCllHC 10 M"HYT npH 1000060poTax 13 f>U1Hyry.
2. K ocaAKY .D.06aBJISlI-OT 1,0 MJI cpocQJaTHoro 6ycpcpa (pH-7,4), KJICTO'IllYIO
cyencH3HIO Tll.(aTeJIbHO mmcTHpYI-OT aBToMaTH'lccKoi'1 nHneTKoi't.
3. B np06"pKY 6epY'f IIHIIeTKoi't 0,4 MJI KJICTO'IIIOH cyeneH3ml H J,l.06anmllOT 1.0
Mn CMeCH KpaC"TCndi.
IJ,I1T0J10rl1\IECKI1E I1CCJIE)J.OBAHI151 169
4. \.lepe3 20 H1HY r HOCHC Ha'laJ1a oKpaWlmamUJ, KJleTo'IHYIO cycncI13HIO
cpHJlbTPYIOT 'lepe3 70 MKM HeHJ10HOOLIH QJHJlLTP B UJlaCTI1KOBble CT'clKaH'IHKI1 01'
npOTO'lHOrO aUaJl113aTopa.
flpu"He'wHlie: npaKTHllcCKH(1 OIiLIT nOKa3aJ1. 'ITO MO)l(HO He OTMhmaTh KJ1eTO'l-
y -
UYIO CYCIICH311tO 01' CHllpTa, a npOCTO aKKypaTHo, MI1KpOlIlIIICTKOI-1 coopaTL 'IaCTh
MClTepl1aJ1a co AHa npo6HpKI111 ncpCHCCTI1 cro B npoonpKY C 0,10 MJ1 cpoccpaTHoro
6ycpepa (pH-7.4) 11 BhllIOJIHSlTb nepe'UfCIIeHHhle 3TanblfJ;aJ1ec.
8. OKpaWUlJaHUe HecfiuKCllf)o(WHHOll KAemollHoi'i cycneU3ltll
1. K 0.4 Mil oGpa60TaHHOif 0,1 % TpHTOt-l X -1 (}() KJIC'IW!lfOH CYCIICHJIU1 A06aB-
JUIIOT 1,0 MIl CMeCl'1 KpaCllTeJleH.
2. J],JlSl OKpaUUmaHl-HI SlHCp KJlCTOK rpc6ycTCs.! 15 MI1HYT. 3aTeM KJ1CTO'IHYIO
CYCIICIIJI1KJ qUUILTPYIOT 'Iepe3 70 MKM HeHJ10HOBhIH < I1I1LTp B IIJIaCTI1KOULIC CTa-
KaH'IIIKI1 01' npOTO'lIIoro aHaJ1H3aTopa.
3.5.3. AHanH3 COAep>K8HHSI J],HK B KJleTK8X OIlYXO.III, 1I0JI}''IellllbIX H3 napa-
HHOBbIX cpe30B c nOMOU{I.IO <}JJlYOPOXPOM8 DAPI
CI1HTe311pOBaHHhiH B 1971 mAY q)JIyopCClteHTHblM KpaCI1TeJlb DAPI (4,6-
diamidino-2-phcnylindoJ-dihydrochloride) He SlBJ1S1eTCSI <f)J1YOPOXPOMOM, UltTCpKa-
I1I1PYIOIl.lI1M B MOJIeKy.TJY )J.HK (OH CBH3bmaCTCH npcI1Myw.CCTBCHHO C a)J.eHI1HO-TH-
MI1HOBblMI1 a30TI1CTblMH OCHOBaHI1S1MI1), O}J.HaKO, 06J1aJJ;aCT BhlCOKOH Cnel l1cp",.JIIO-
C rhlO 11 I1HTeHCHBHOCTblO OKpallllIBalll1H J. C30KCHpI16oIlYKJICI1HOBLIX KI1CJ10T
[Shapiro H.M., 1983].
I1ccJ1cfJ;ouaHHSI KJICTO'IHOH cycneH]HH, nOJIY'leHHoM H3 napaQJI1HOHl,lX cpe30B B
OCHORHOM RblflOJHlHIOTCH C IIOMOI.1.{LIO 3TOfO KpaCHTenSi. B HaweH COBMeCTHOH pa-
GOTe C }J.OKTOpOM Camplejohn R.S. (OT}\CJICIII1C I1CCJlCHOBal!l1H paKa HM. P..D,I1MOJICH
npH rOClIIlTaJlC CBSlTO["O Tot.1aca. PYKOBO.QHTeJ1h npocp. Nias A.H.W., r.J1oHfJ;oH)
OLI!IO HJY'ICHO cO}J.ep)l(aHHSI AHK no MCTOJ],I1Ke Hedlcy D.W. II coan"!", [1983; 1985]
C He3Ha'IIITeJlhHbIMH H3MCHeIll1HMI1 lJ,OKTOpa Camplejohn R.S. [1985]:
1) nOJlY'leHHaSi 113 TOJ1CTbIX lIapacpl1HOBLIX CpCJOB 1l0CJ1C pcn1Apl1pOBaHHSI H 00-
pa60TKH 0,5% paCTBopOM nenCIiHa KJ1eTO t IHaSi cycneH3HSI 6b1J1a pecycnCHJ],HpOBa-
Ha B 5,0 MIl H30TOHIi'ICCKOro 6ycpcpa (Coulter Electronics, Luton, England) cOJ],ep-
)l(aIl cro 1 Mr/MII DAPI (Scrva, Bochringcr Mannheim, Gcrmany).
2) CYCIICH3HH oKpaWHBiLTJaCh B Te'ICHHI1 30 MHHYT, 3aTeM cpl1J1hTpOBaJ1aCh 'lcpe3
HCMIIOHOBblH qmJ1hTp.
3) o6pa]ltbl HCCJ1C,nOBaJII1Cb Ha npoTo'IHOM aHaJ1113aTOpe FACS (Becton
Dickinson, ClllA) c PTYTHo-KBaplteBOH J1a mOH. B Ka)l(}J.OM o6pa:n.e aHaJ1113I1pOBa-
jlOCL He MeHee 50000 KIIeTOK. C nOMOIl hlO BCTpOCHIIOM B npu60p 3BM nOJly'rcH-
Hble J],aHHhle 3alll1CbrnCUIHCL Ha lJ,HCKCTbl.
3.6. HcnoJIb30naHHe CTallJl,apTOB ,:U1 onpC C_'1ClmJl D.'10HltHOl.'TH ImeTOK onyxo:m
Hawc HCCIIC.D.OBaHMe H JlHTeparypHhle }1.aHHhre CBI1JJ.eTeJlhCTBYIOT, '11'0 MHOrl1C
KJleTO'lHble cycneH31111, ITOJIY'ICHHLle 113 onYXOJIH. COlJ,ep)l(aTJH npHMeCb KIIeTOK HOp-
MaJlLHOH TKaHH, J11160 CTpOMbl 111111 3J1eMeHTOB BOCnaJ1eHI1S1, TO eCTb, IICpHblH I1I1K B
aHeynJ1011}J.HO(1 .D,HK rl1CTOrpaMMe SlB.rtSleTCSI PC3YJlLTaTOM cpJIYOPCC CHltHI1 ::rmx
KJ1CTOK 11 CBocro pOAa AIUlJrOI1AHblM CTaHAapTOM. a BTOpOM 'leTKI1H nl1K xapaKTepli-
3yeT aIlCYflJ10I11\UYIO 1l0nYJlSllJ.I1I0 KIIeTOK onYXO.TJI1.
170 TOM II - t.IACTHbIE AHAflHTHtJECKI1E TEXHOJIOrHM
AHK-rHCTOrpaMMI.I KJlCTOK onyxmIH C 0AHHM MOAcUlhflLIM nHK0\1. paCnOJlO-
)l{eHHblM B 06JlaCTH 1{HnJlOJiAHbIX CT3HnapTOIJ (KJlCTKH HOpMaJlbHblX TK3HeM, JIHM-
OI HTbI) Mbl p3C mTpmmJUI KaK ]J, mJIOHAHYIO OnYXOJlb, Ka>KAI.IH pa3 npoBOAH AJlSl
OOJII>IIICH y6eAHTeJIbHOCTH llapaJlJlCJlbllOe I HTOJlOrH1.leCKOe HCCJJC1\onalU1C Ma3KOB-
OTnellaTKOB C KYCO'-IKOB OnYXOJIH, B3S1TbIX Ami IIp01'O'-IHO" u,HToMeTpHH.
]J,JIH HaC"lpOHKJ1 npH6opoB nepeg amUUl30M lIapnm 06pa:n oB npoBOAHJIOCb HC-
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B3S1TOH H3 Toro >KC oprana BAarnl 0'1' onyxOJll1, HJH1 !HlM(t)Ol HTOB AOHOpOB. BbIACJICH-
]Jl>IX U3 I1cpH{pep llleCKO" KpOBlI llCJIOnCKa no HH>KenpHBcAcHHoi1 MCTO}\HKC.
3.6.1. MeToAHKH nplII'oTonneHlul ]J,H"JlOIIAHLIX CTatlJ.{ap-ron ) .UI H3CTpOltKH H
per:Y.1]HpOBKH npOTOQHLlX aHa:IH33TOpOB
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BHYTPCHHHM. ECJIH >KC OH BHOC!-1.1]CSI oKpawcmlbl 1 B KJICTO'-IHYIO CYCJleH3mO C qmy-
OpOXpOMOM, TO OH Ha3bmallCH BllcmHlIM. '-1'1'0 Be)\CT K YBCJIWIClU1I0 npOl.{eHTa aHe-
YJlIIOIlgHbIX onYXOJICM, 1-13-3a pa3]J,eIlbHoro OKpaWUBamUI KIIeTOK onYXOllll Ii CTaH-
.QapTa.
KOJU1 l lCCTBO .I:(HK B SI)J.pax UOJILWcli llaC ru K.rJ.CTOK HOpMaJlbHOH rKaJU1 COOT-
nCTcTByeT )J.HnJIOHWIOMY Ha60py XpOMOCOM (2c). TaK. BCC H3YlfCHHbie HaMH oupa3-
Uhl (49 60.IJbHbIX) npH CJlaOoH-YMCPcHHoi1 rHnepnJla3HH KJlCTOK 6pOHX taTlbHOro
3nHTeIlHSI (npeBaJlllponan I HJIHHAPHlleCKII" 3J1HTCJU1fl. UHor]J,a C Hc60JlbWOH npH-
MeCblO uOKanoBH HhIX H 6Cl3ClJIbHbIX KJlCTOK) 61>IJUf .n m_'IOH:J:HbIe c HCUOJlbJJU1M IUC-
JIOM KJICTOK B S (7,3:1: 0,5%) 11 Gz+M (5,5 + 0,5%) cpa3ax M ITOTH leCKoro UHKJla,
TO eCTb C IU13KOH-YMepeHHOH npOJmcpcpanmllOM aKTHBHOCTbIO (110=12.8 +
0,5%), AHK rHcTorpaMMbl KJICTOK onYXOJlH C O HHM IUIKOM, pacnOJIO>KeHHLIM B
06JlaCTlI J],I,mIlOl.f HbIX CTaH)J.apTOB. paCCMaTplmamt KaK npu:maK 1\unIlOliJJ.Horo pa-
Ka IIel'Koro.
113BCCTII0, ITO 60JlbWe 90% 1UIMcpOl wroB ncplicpepwlecKoH KpOBIi lIaXO HTCSI
B Golt qJa3e KJIeTOllHOl'O LIJ1KJIa, " Bce OHH 06pc\3YtoT AmJjIOIi HYIO nonYJISlu,HIO
KJleTOK; n03TOMY HX YA06HO licnOIlb30B3Tb B Ka<ICCTBC 3TaJ1OHa.
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nOCJlC I HTOJlOnl'-leCKoro KOH'lpO!U{, y6eJ],HBWHCb, 11'1'0 B3S1TaSf 1U13YaJlbHO HCH3-
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cycncH3HSI. laCTb H3 KOTOpOt'1 110 RblUle npHBe)J.CHHOH MCTO)tHKe cpHKCHpOBaJlH,11 B
nOCJICAYK>UJ,HX 11CCJle OBaHHSlX HCJlOJlb30BaJIH JVISI perym1poBKI1 npH60pa B KalfeCT-
ne BHeUlHero CTaHAapTa AJISI onpC]J.eIleHlm Ha 3KpaHC HHCITJleSi KOHTpOJlbHOrO no
JlO>KeHHSI IIHKa I HIIJIm1JJ.HbIX KJIeTOK. {faCTI. IlcqmKcHpoBaHHoM CYCIICH3HH CJIY>KH-
Jla AHnJlOH1{lIhIM CTaHA3pTOM B HCHb 1ccJleAoBaH 1S1.
E: 1) 15,0 M-'I renapHHH3upoBaHHoH KpOBH 20-40 e1J/ 1J1 AOIiOpOB CTaBHJlH Ha 30
f\.1Hnyr R TepMocTaT np 1 37 11 C (MO>KIIO H IleHTpHq)yrupoBaTL npH 1500 06htHH 10
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UJ1TonOrH'-IECKI1E HCCnE.QOBAHH 171
t
2) rumeTKOM3aGHpaJIH nJIa3MY, B KOTOpa" cocpeAOTO'leHO 40-50% J1HM$.)Ll.HTOll.
3) HaCJ!aHBaJlH IIJla3MY Ha rpa,IJ.HcHT Ficoll-Hcpaquc.
4) Ll,eHTpH YI'HpOBaJlH npH 1500 o6hmH B TC'ICHHe 15 MHHYT.
5) aKKypaTHo nHneTKOM 3a6HpaJIH J1HM£pOH]\HOe KOJIhI O.
6) nHM£POLl,HThl, llLIACJICHHhlC B rpa)J.HCHTC IIJIOTHOCTI1, )J.13a>K,lJ,bl OTMblDaJIH 3aGy-
cpepeHHhlM cpH:mOJlOrH'lecKHM paCTBopOM H pecycneHJ],HpOBaJIH B cpeJ],e 199. KOH-
Ll.CHTpaLl,mO HX J],OBO]\HJIH ]\0 2 x 10 B 1 MJ1 1-1 £pHKCHpOBaJlH 3TaHOJlOM.
7) '!aCTL JIHM£pOLl,HTOB OCTaBmml-1 He£pHKcHpoBaHHLIMH H HCIIOJILJOBaJlH B Ka'IC-
CTBC ]\HnJIOHAHOro CTaHJ],apTa B J],eHh HCCJIe]\OBaHHSI.
EbIJ1 COJAaH GaHK J1HM£pOLl.HTOB 01' pa3HblX AOHOpOB; C cro 1I0MOlllLIO npOBO)J.H-
JIaCh TO'IHaH KOppCKTHpOBKa 1l0JIO>KCHHSI AHIlJIOHAHOro nl-1Ka. C JlHMcpOl wraMn
YJ],06HO pa60TaTh,TaK KaK HX MO>KHO J1erKO BhlJ],eJ1S1Th H3 KpOBH, OHH Y>Ke HB1UlIOT-
CSI rOToBoi1 K ynOTpc6JICHHfO cycncII3Hci'i, H car-fOC rJ1aBHOe, 31'0 1'Ol.IHhl" ]\HnJlOHJ],-
HbiM C1'aHJ],apT. OAHaKo, TaKoi13TaJlOH, KaK cycneH3HH H3 BH3yanbHo HCH3MCHCHHOM
TKaIUi, 06"heKTHBtlo xapaKTcpH3YCT cpOIl, Ha KOTOpOM pR3BHJlaCh onYXOJIb H, n03-
1'OMY, BepoSiTHo, KorJ],a ero MO>KHO nOJIY'IHTb, SlBJIHCTCH GOJICC 1I0)J.XOJ(HlllHM KpHTe-
pHeM JJ,JIH OflpeAeJlCHHSlIUlOHJ.I,IIOC[1-1 H npOJmcpepaTI1BHOfl aKTIlBHOCTH KJ1eTOK onyxoJUI.
,QJUI Y)J.oGcma OnpCACJICHI1H IIJI0HnHOCTH onYXOJ1H, '-ITOGh! ]J;HnJIOHJ],HblM C1'aH-
]\ap1' He MeIlIaJI RhlSlBJIeHHfO ]l,ltnJ10H]\HhIX HOBoo6pa30BaHHi1, Tanncnbaum E. H CO-
aBT. [1978] IlpeJ JlO>KHJIH HCnOJlh30Ba1'h HCCKYCTBeHHhJe J1a1'eKCHhle 'IaC1'HLl.bI
(C£pepOLl.H1'hl), apHTpOLl.HTbl n1'HLI, H £popenH, K01'OpLJC, KaK H3BCCTHO, HllJ1s.1fOTCH
HnpOCO]\Cp>KaILl.HMIi KJlCTKaMH, HMefOlLI,IiMH nO'[1'H B 2,5 pa3a 60JIee HH3Koe cOJ],ep-
>KaHHe AHK, 'leM KJ1e1'KH 'leJlOBeKa H, n03TOMY, Ha rHCTOI'))aMMax I'IX Golt nHK Bce-
rJ],a HaXOTJ;HTCSI nepcf]. f].HnJIOHAHblM.
B. Memoou1<a IlpU20mORAeHUR. cycneH3lllll<.ypllHbiX 3pUmpOl.'U11l00
1. 3a6HpalO1' KpOHb KYPHLI,bI B np06HpKY C renapHHoM (20-40 cpJr-1JI). fenapH-
HH3HpoBaHHYEO KpOBI:> CTdBHT B TepMoc1'aT npH 37 11 C Ha 30 MHUY'(' (HJlH I(eIlTpH£pY-
rHpYlOT 10 MHHY1' npH 1000 06h1HH.
2. nltnC1'KOM 3a6HpalOT nJIa3MY. Oc1'aBWHCCH 3plf1'))OLl,HThI TpH>K]J;bl OTMhJBaJOT
B cpH3110JIOrl-1 ' leCKOM pacTBope, U.eHTpH£PyrHpYH KIDI<J\blM pa3 no 5 MHHYT IIPH 1000
06/MHH.
3. K 1,5-2,0 MJI CYCIICH3HH 3pH'J'))OLl,HTOB )J.o6aBJIHIOT no KanJIe SOn aTLlHOJ1; npH
3TOM AJ1S1 npe]\OTBproLl,eHHSI cnHl1aHHH KJ1e1'OK cycneH3HH nOL.OHHHO I1HllcTHpyeTcSI
C nOMOlllbfO 3BTOMaTH'lecKoi1 nHl1eTKI-1. KOHLl.CHTpaIJ,.HSI CIIHpTa B cycneH3HH YBeJIH-
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4. KypHHble 3pHTpOlJ,.HTbI BHOCSl1' B HCCJIe)J.yeMYI{) KJICTO'IHYEO cycneIl3M10, npH
:ITOM omi COCTaBJIHIOT OKOJIO 10-15% OT KOHe'[Horo KOJIHlleCTBa aHaJIH3HpyeMbix
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172 TOM II - llACTHbIE AHAJII1TI11IECKI1E TEXHOnOfl111
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) I1JII1 II, CcIlFIT. Bccton Dickinson. CiliA: MultiCycJe. Phoenix Flow Systems.
CliiA 11 T.A.
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B JUo60" K:leTOlIHOH CycllcH:nUl, I1cCJleAYe 10l1 Ha npoTollHOM aHaJ1113aTOpe,
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a BTOpOl1 - K allcYfIJIOHAHblM K.'1eTKaM onyxoJUI). nOIlYJISlU.1110 KJ1eTOK onYXOllH C OA-
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onyxonH, B3SfTOH B I1CCJleAOBaHHe.
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0,5 pq (lOg) ,lJ,HK, a llHcno XpOMOCOM paBHSfCTCSI 46.
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npc) eJlax 11 3TI1113MeHClU1S1. KaCatOTCSI KaK "'-lHcna XpOMOCOl\I. TaK I IIX CTPYKTypHhlX
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U,I1TOJIOrl1t.IECKI1E I1CCJIE,il,OHAHI151 175
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nonymfl\ IH 0AHOPOHHbIX KJleTOK J],OJJ>Kua ObITb Ha rJ.1CTOrpaMMe B BHJ],e IICpTJ.1-
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Jl,CJICIHUI, Unlp 1Ha KOTOPOM JaBlICHT 01' cneJ\yIQlltHX npulum: TCXHJ.1<leCKJ.1X, CHH3C\H-
HbJX C npm-OTOBJleH 1CM H o6pa6oTKOIJ K!leTOK, U 6HOJIOrI-I'JCCKJ.1X - O'rpa)Kalow. Hx
crpYK'rypllhlC HJMCHelUUI XP() taTJfHa H pacllpCi e.1JeHlte HYKJICUHOBblX KHC}]OT II HJJ.pC.
Ami CTilTHCTH"JeCKOfi xapaKTepltCTHKJf ,LI,HK-rHcTOrpaM\1 BbI'IHCJ1S1eTCSI (n npo-
l\eIlTax) K03Q:>QJm{HCHT BapI1a1UIH (Cv) no CJleJ\yIOw.cH Q:>opMYJle:
C v = BfAx 42,5.
rAC A - HOMCp KamL'Ja CepC}\JfHbl Goh mlKa;
B - UJHpl1Ha (B Kallallax) Goh IHIKa l-Ja 1/2 ero RhICOT"';
42,5 - K03cpQ:>I1LJ.J-feHT nepcc"lcTa AJ1S1 1I0JIY L ICHI1S1 pe3YJlhTaTa
B np0l..\eHTax [Melamed M.R. H coaBT.. 1979].
TeopeTHlICCKlt, eCJ1J-f J-fCCJICnYCMaSi nOIlYJISll\ItSi KJ1eTOK MOHoMopc1JHa. II C 0llHHa-
KOBblM COAep>KaHJ-fCM B SlApax JJ.HK. TO K03(t)(lml\J.1CHT Bapmll\J.1H rJ.1CTOrpaMMhJ
J],OJI>KCH 6hlTb panCH O. OAHaKO, npaKTJ-f'leCKJ.1 1"J.1CTOrpaMMhI 01'pa>KaJOT raYCCOR-
CKoe pacnpCJ1,CJ1eHJ-fe SlfJ,ep 11, n03TOMY, fJ,a}KC AJ1S1 TllJ,aTeJII.HO npHrOTOBJ1eHHoi1 CYC-
nCUJJ.111 HeaKT 1RJ-fpOBaHHhlx mIMcpou,HTOB ero 3Ha"ICHHC npH J.1CCJle.n.OBaHJ.1J.1 Ha npH-
6ape 50-H 6bUI0 paBHO 2-3%, aHa ICP-l1 - 3-6%.
OpJ-f UCCJIC OBaHI1 1 onyxonef1 Cv :Ufa"ICHItSi 6hlJlJ.1 60JlhWC. U Mhl npmlSlJJJ.1 YCJIO-
RI.fC, o6ll.{enpJ.1lISiTOC B CTC1THCTI.fKC, COrJlilCHO KO ropOMY Cv 11.0 10% YKaJbIBaeT H3
cJ1a60e, 01' 10% AO 20% - !fa cpeJ Hee J.1 60JIce 20% - Ha Cl1]IIt!fOC pa:moo6pa3J.1C
npJ.13IiaKR. Eo.'1bIHC 90% rI-ICTOrpaMM npJ.1 paKC .'1CrKOrO, MO_'IO"IHOH J.1 flpCJ CT"d-
TCJlhHoi1 )l(eJ1C3 6b1J1I.f MeHJ.ILlC 9%, HO 601lbmc 3%. HO .n.a;>KC C TaKJ-fM HHJKIt 1 110-
Ka3aTeJlCM Cv CCT!. UCPOSITHOCTh. "lro pSl11. T\HnnmlJlllblX 06paJI{OR !fa caMOM AeJ1e
cOJ],ep>KaJJ ABe nonYJ1S1u,ult onYXo.'IeBhIX KJICTOK: oiJ,'1Y J.1CHIHHO AUnJ10J.1HIIYIO. JlPY-
rYlo c.'Ia60 aueYIIJIOJ.1J-\HYto, TaK, COrJlaCHO )1aHHI,JM Koss L.Y. J.1 coaBT. [1989], CYC-
neHJJ.1H, COACp>KalJ{aSi AJ.1n.'IOHJ],HYIO (I1,LI,HK= 1,0) H c1m6o aHcynjIOJ.1J\IIYto
(I1AHK= 1,2) JIJ.1HHlI KJleTOK, HC MO;>KeT 61,11'1. paJ1JJ.1'IItMa BlIYTPIl nJ.1Ka. HMCBUJero
K03q)Q:>IU J-fCHT BapJ.1m J.1J.1 4% H BhIllIC. To eCTb, TeXHl1"ICCKI1C B03MO>KHOCru np 'oo-
pa, Ka"leCTBO cro HacTpoi1Ku H MCTOAH"JeCKUC 1J0rpCWHOCTJ.1 npJ.1 npHrOTODJlemm
cycneH3J.1H MorYT YMeHhlllHTb B03MO>KIIOCTJ.1 MCTOAH.
OAHaKo, MI.I C'II-fTaeM. LITO 3Ha'iCHHe Cv (x)JlbllJC 4% CBHfJ,CTCJlbcTByeT,npJ.1
npaB l1JbHOM npl1roTOBJJCHJ-f1i 06pa31\a. 0 rCTcporeHHOCTIt SlJ\CP B J-fCCIICHyeMoi1 cyc-
neH3J.1H onyxOJleBblX KJlCTOK. KpoMe 1'01'0. npu TaKHX 3Ha"ICIII1HX Cv BCerfJ,a ue06-
XOAJ.1MO 06paw.aTb BHHMaHUC lIa Q:>OPMY rncTorpaMMbl. TaK, CJ.1MMCTpIf'IHOCTb Go/t
IIJ.1Ka YKa3bJBaCT na OAHOpol1HOC 1'1. K.ICTO'IHOH nonYJJHu,HJ.1. a He60JIhlllaH nOJIOrOCTh
npaBoH "UUI JICB0I1 nOJlOBHHbl nm::a MO}KCT CBHACTeJ1hCTROBa.Tb ° npJ-fcYTcTBHlI
6JJHJKOH K fJ,JinJlml;\lIoft nonY_'ISlIWI1 KJICTOK onyxoJ1J-f (J1,LI,H K= 1,05-1,20).
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176 TOM II - '-IACTHbIE AHAJU1TI1'-IECKI1E TEXHO}10rl1I1
CrcneHb KOHp,eHCaV,HJ1 xpm.mnma B SlAPC KJICTKI1 RJlIUleT Ha HHTCl-ICI1IUIOCTb
qJJlyopeCLl.eHlllm KOMnJleKCa ,lJ,HK - HlHCpKaJH1pYIDll{HH KpaCWrCJlI,. TaK KaK c}:JJlY-
0POXPOM coej\liHSleTCSI C OCJIKaMH-n1CTOHaMI1, COC raiEISI}()Il{HMH BMCCTC C MOJleKY-
JlOH II,HK OCHOBY xpOMaTHIm. renap", H AeKCTpaH-CY!lbc}:JaT OKa3blBalOT 3aMeTHoe
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ncpcBo]J,SI KOHAeHcHpouaHllhlH xpoMaTHH B OOJICC ]J,HcnepcHYID, ,lJ,eKOH \CHCHpORaH-
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aTOM Ka leCTBO AIIK-nlcTorpaMM. nOCJle 06pa6oTKH KJleTO IHOH CYCIIC1I31H1 pac-
TBOPOM rCnapl1Ha (CnO(I>A,lIexlUl) u K(}III elnpaLl.HH 10 ME/r.L''1 (R Te leHHH 15-20
MHI YT) Ka leCTBO ,lJ,1-j K-I'HcT0rpaMM TaK>Ke YJIY'lIlIaeTcSI.
3.8. MeTo;J.ItK3 3II3JUI33 KJIeTOK B -IJ333X KJIeTO'lHoro I..{IIKJI3
B 1I0JlYlfeHHoH ,lJ,HK rHC rorpaMMe npOLl.eHT KJlCT(}'-lIThlX SlAep C pa3JllI'IHhlM co-
nep>KaHHCM il.HK BhI"II\CJlSleTCSI IIO OTIIOIIICIHUO K OOll{CMY '-IHCJIY Hccne,lJ,OBaHHblX
KJICTOK no npUHLl.Hnll::U1bHOii CXCMC OOC leTa KpIIUbIX. npe)lJlO)KeHHoi1 Rabinuvitch
P.S. 11 coaUT. [1989, 1992} B nporpaMMc \1ultiCycic (Phoenix Flow Systcms,
CiliA). npH BbISlBJlClHm aIl3}'nJI0I1]1.HOM nlIHlU1 KJICTOK '301m Me y AHlIJIOIIJ(lIhIMIl
(Golt) II allcymlUl1]lHblf\UI K:ICTKaMI1 (Goll) JJ;emlTCSI TJ(H!())IaM H, ,'J,anee, Bbl'IHCJISl-
eTCSI KOJU1'ICCTUO npOJIH<I)epuPY}()ll{HX KJICTOK (5 if G2+M) AJISI allcYIIJl0l1]J,lmH no-
nYJISl[ I1H no TOMY >KC nplllH uIIY, '11'0 H npn ,lJ,I1I1Jlm1JlHoH onyxonu (CM. pHC.3). Ta-
KOH pac'lcT IIpOJIH( epanIRHOH aKTlWHOC I'll al eynnOHJJ.Hoi1 OIlYXOlH1 npOBOHlljlCSl
nl1111b B TOM CJly"-me, eCJlU 'U1CJIO atlCYIIJI0l1AHbiX KJlCTOK no OTHOllleHl1}() K OOll{CMY
'-IHCJIY I1CC.Yfej\ouaHHbIX K.leTOK COCTaBJISI..'1O 20% H fioJlee (AH > 20%).
C nOMOll{b}{) PHK rHCTorpaMM onpC CmlJ10Cb '-ll1cno KJleTOK C 1I0RblllleHHblM
COnep)KaHl1eM PHK no MCTOJlY Stadler B.M., Dc Weck A.L. [1978]. 'ITO II03BOJlHJlO
OpJlCIITl1poRO'-IHO onpep,cmlTb '-II\CJIO KJleTOK B Gt c}:Ja3c KJleTO'IHOro L1.I1KJla. ,lJ,JISl
3Toro OT npOLl.CIHa KJ1eTOK C nOBblWCHHhlM COAep)KaHl1eM PHK HY)f(HO OblJlO OT-
HSlTb IIpol eHT K.YfeTOK B S 11 G2 + M c}:Ja:mx KneTO'-IHoro L1.HK-lIa (TO eCTb HH}J.eKC
npoJIH<I)epaLl.lUl).
3.9. TltnLl Jl.HK-rlicTorp3MM
B COOTBeTCTBI1H C IIJI0l1)lHOCTb}() 1-1 npUJH1c}:Jcpan1BHOH aKTI1BHOCTbHJ K.lIeTOK
113y t lCHHbiX onyxonefi BbJp,CJICHO 5 OCIIORHblX nmOB ,lJ,IIK-I'l1cTOrpaMM, a B 6OJlb-
WI1HCTBe 3n1X THnou U 3amlCI1MOCTl1 0'1' npOJIHc}:JcpaTHBHott aKTI1BHOC fl1 It '-Iucla
aHeYI1JIOIIJ lIbIX KJleTOK (B %) Cll{C 11 1I0JJ.THnbl (TaoJ1.1 H pHc.4).
I TlIII oGpa3013aJH1 60J1bHbie C ;J,IUlJIOlI,[\HbIM cO)lep)KaHl1eM J..I.HK U KJ1eTKaX ony-
XOJlH C HH3KI1M (no,[\TI1I1 1), YMcpeHHblM (nop-nm 2) 11 BblCOKI1M (noJ-\Tllll 3) IIOKa3a-
TeJlSlMI1 IlpoJll-lq)cpaTlllmott aKTI1BHOCTJ.t.
II _ Tim COCTaBmll1 60JIbHbie C TeTpallJlOHJlHblMH onYXOJlSlMI1, nlCTorpaMMbl KO-
TOphlX YKa'3bIBaJU1 Ha H<UH1 t Il1C lIonYJlSlLI.IUl aHeyIIJ10l1J HblX KJ1eTOK (HX 'IHCJIO npe-
BbllllaJIO 20%) C :ma'-ICHueM HHp-eKca AUK 0'1' t,XS}1o 2,15.
III THn COCTaB.IISlJ111 60J1bHb1C C allcynJIOHp,HblMI1 OIlYXOJISlMI1 (H,lJ,HK 01' 1.1 IlO
t ,84), KOTopble U 3aUHC IMOCTH OT nOKaJaTCJlcft nponHc}:JepanmHoi:1 aKTUBHOCTI1
'II1CJla aHcYIIJIOH)\HbiX KJleTOK Cll{C 1I0, pa3]\eJlSlJll-1Cb (Ta6J11l1 a 1) H 1m 7 nO,lJ,Tl1nOB:
IlI(H); III(Yl); III(Y2) III(Y3); IlI(Ml); III(M2) 11 III(M3).
-
IJ;J1TOJIOrI / P-IECKI1E HCCJ1E,D.OBAHI15I 177
IV TunOM rl-ICTOI"paMM o6JIa).l.aJn1 60JIbHbiC C pC3KO aucyruloHHHhlMI-1 onyxonSl-
MH (H,lJ,HK > 2,15), KOTopble npH J].eTaJlbHOH Ol eHKe COCTaBJISlJIH TPH nOJ].Tl-1na:
IV(l); IV(2); IV(3).
V Tun fI1CTOI-paMM 6blJl xapaKTcpcH AnSI HeMHOrO\II-1CJICI-IHOH rpymlbl 60JI.bH.bIX
C MHOrOKJIOHORhlMH onyxOJISlMH.
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I JJ: mJ1O- 1 A06 <10 IICT 1.0 III-BKOe
11J\ 113 JI 2 A012 10-15 !lCT 1.0 yr.scpell!loe
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1I.ilml/..Uta)\ 3HA tlEHllil 3IINIEIIH.H
III allcy- II IIC Rhl\IIICJJJlmICh > 20 1.1 -1.84 He Bbl'lItC-
nnmlAHaJl )I)\)[OCI:.
III Yl 13.06 dO 20-40 1.1- 1.84 H I]KOC
aucynno- Y2 AO 12 10-15 .. , yr.scpeHHoe
- - - -
Y3 > 12 >15 ,. , llblCOKOe
I1J.\HaJl - - - -
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M2 ItO 12 10-15 .. .. YMepeHHoe
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KJlOHORaJl C Ha f60JlbllmM HJU IK)
TaKHM o6pa30M, C 1I0MOlllbJO nmOB rl1CTOrpaMMbi npH CTporoM 1 I1TOJIOn1'le-
CKOM KOHTpone BblJ].eJIeHbl AHnJIOI1J].Hble l1 aHeynJIOHAHbie HOBoo6pa:JOBaHUSI., nalm
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nonYJISl.ltHii OOJJ.nm rlicTorpaMMbf JJ.aII B03MO>KHOCTh npH Ka>KJ].oM ee nme Y'IHTbl-
BaTb 'IHcno aHeynnol1JJ,HblX KJIeTOK B onyxOJIl1l1 ux npoJH1(pcpanumyJO aKnIBiIOCTh.
OJ
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IJ.HTO«bJIYOPOMETPHH B IJ.HTOJIOf'HIJECKHX
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B 50-80-c rO)J.bl Caspersson T. if npyrwMH aBTOpaMI1 6bl110 cooollleHo. 'ITO ',mo-
Ka'leCTBeHHbIe KneTKH cOJ].ep>KaT 60nhwe ,lJ,HK, 'leM HOpM,UfbHbIC KJICTKH. 3 rH 1C-
CJJCJl.0l3aHHSI npOI3CACHbf KaK C II 0 MOll.{b 10 o.t-l,lmH H] lIa 16oJlcc TlI\aTeJIhl O I13Y 1 IeH-
HblX rUCTOXUMH'-leCKI1X peaKI\I1H no enbreHY U ee MOJ].HcpuKaltm'1. TaK l1 nocpcAcT-
BOM OKpaWHBaHI1S1. cpJIYOPOXPOMOM - 3KpHAliHOUbiM Opall>KCUbIM. MeTOj1, npOTO\I-
HOH ltl1TOMeTpl1l1 3Ha\IHTenbHO OOJIer'u.1JI I1JY 1 IeHHC Co ep>KalUUI ,lJ,HK, PHK, 6CJl-
Ka, pel.\enTopoB B KJIeTKaX HOpMaJlhHblX H onYXOJIeBblX TKaHeH. Opl1 :3TOM npCCJIC-
)J.YIOTCSI TpI1 OCHOBHblC UCJII1: 1) YCT dHOBUTb pa3JII-1'II-1C MC>K!l:Y KJIeTKa 1i1 HOpMaJlb-
IIblX H 113MCHCHHbiX TKaHcH; 2) Haihu KOppCJISlHWllblC CBSl311 ft.le)KJ].Y ocooeHHOCTSI-
MH J],HK, PHK-rHcTorpaMM B KnCTOl.l1IblX TlonynSlI I1S1X U KJIHHH'-leCKUMU npoSl.BJIe-
HI1S1.MU OOJIe3HU; 3) H3YI.U1Th K 1HeTHKY cOJl,ep>KaHlUI ,lJ,HK B KneTKax onyxOJU1 IIpU
pa3JII1'IHbIX TepaneBHI'leCKI1X B03 eHCTBI1S1X.
178 TOM II - llACTHblE AHAflJ1Tltr4ECKI1E TEXHOflOrJ111
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nOJlb30BaTb MX B KJIMHMt.leCKOH I UTOJl0nn1 }lIlSI J],ManmCTU'-ICCKHX Ll.CJICH. npeJ],no-
naraTIOCb, '-ITO MeT0}l J],0mKeH CTaTh CKpHHHHroBbIM,TaK KaK C ero nOMOU\bIO
MO)KHO 6blJIO 6b! 6blC rpo H }10CTaTO'-IHO npoCTo YCTaHOBIITb 3J10Ka'ICCTBeHHoCTb
npOl.\ecca (60JIbllJMHCTBO onyxOJICH: 110 J],aHHbIM Jsaacs J. [1986], Harrison G. [1988],
Stewart c.c. [1989] MMefOT XpoMocoMHble HapYllJeHIISI, II, KaK cnCJ],CTBUC, M3MeHe-
HHC cO]J.ep)KaHHJI J],HK B SlApe KlleTIm). J],nSl 3Toi1ueJlM Hau60Jlee YAo6HOH MOJ],e-
llbfO 113-3a 06uJ1HSI MaTepliana SlBJ1J1CTCJI paK lllCHKH MaTKM. OOJlY'-IeHHble }1aHHble
nOKa3aT1M, t.ITO KlleTOf.JHaH cycneH311S1 BcerJ],a COCTmma 113 CMeCM HOpMaJlbHblX H
onYXOJlCBblX KlleT()K, npHt.ICM COOTHoUICHue I1X n UCCIleJJ,yeMOM MaTepMaTle 6bl110
pa3JIUt.IHbIM. KorJ],a npoQeHT onyxOJ1eBblX KJ1eTOK B UCCJICAYCMOH nonYJISl.Ll.UH 6bl1l
He3Hat.mTeJICH, BblJlBHTb MX MeToAoM npOTo11HOH I\HTOMeTpIiH 6blJlO I.lpe3Bblt.Iat'IHO
TpYAHO. npM 3Ha'-IlITeJIbHOM HX KOJIH'leCTBe H 60JlbllleM COACp>KaHiU1 B HUX LJ.HK,
'lleM n HOpMaJIbHblX KlleTKax. BcerAa Ha ntCTOrpaMMax 6h1J1a HMT(Ha UX T(OMUHHPYJO-
ll.\aSl CTBOJlOnasr JU1HIIH, KOTopaSi MMella J],HarHOCTH'lleCKoe 3Ha t leHHe.
3TU HCCJICJ],onaHHSI., a TaK)Ke J],aHHble o606ll.\eHHble B MOHorpa<lJHH Melamed
M.R. Ii coaBT. [1979] II J],pyntX pa6OT3x nOCTamUIH 1101\ COMHCHHe B03MO)KHOCTb HC-
nOJlb30BaHHH npOTOtlHblX CltC reM B KllUHH'lleCKOH Ll.MTOJIOrHH J],JISI. J],HarHOCTHKH 1-13-
3a CYll.\CCTBOBaHHSI. }1i1nllOJ-lAHbIX onYXOllei1, TO eCTb 3JIOKa 1 lCCTBCHHblX Houoo6pa30-
-
IJ,I1TOnOrJlP-IECKME I1CCflEAOBAHI1S1 179
8aHU" C HOpMaJ1bHbJM Kapuan-mOM.
TIo HaWHM AaHHbIM, npu A06poKa lecTBeHHblx 3a60JICBaHU X MOnOlJHoi1 >KCJIC-
3bl B 97 ,9% Ha6mO/ eHu x 06HapY>KcHhi TOJIbKO AI1nnOUAHble KJIeTKU, H TOJIbKO B
2,1 % CJlY Ja X npcppaKoBoi1npOJU1cpepaLUU-f 3nUTCJlUSI H npu CJIOHCTOii cpH6poa,qe-
HOMC Bbl BJIeHbl aHeynnOUJI,Hble J],HK-rHcTorpaMMbJ.
HaJlH IHe '-faCTO BCTpC laCMoro Jl,HnnOHJI,HorO paKa H, nYCTb pCAKO, HO BbUlBn c-
MOW aHcynJIOH).1UH IIPH JI.06poKa ICC fBCHHblX 3a6011CHaHl-1S1X (2,1 % 8CCX Ha6JIIOJ],e-
HHIi) Mono IHoi1 )Kene3b1 orpaHU n1BaCT, ]\l1arHOCnl'-ICCKHC B03MO>KHOCTH nparo'l-
HOH QHTOCPJIYOPOMCTpHH. OJ],HaKo, CJ1CJ],YCT OTMCTHTh, ITO B HaCTO ll.{ee BpeMH Y>KC
CYIl\eCTBYlOT CnO)KHbIC MCTOAbl npoTo IHOH LlJITOMCTpHU no pacn03HaBaHHIO 3JIO-
Ka'-ICCTBCHHbIX H HOpMaJIbHblX HnJIOHAHbIX KJICTOK [C.Stcwart, 1992].
npH paKC MonO IIIOH >KCJIC3bl U 57-73% cnYlJaCB MCTOJl,OM npoTOlJHOff QHTOMe-
TpHH Bbl BJI IOTCH aHcynJIOHAHbIe onYXOJ1H. TIpoBcAcHHoe HaMil HCCJIC)(OBaHHC no-
Ka3aJ10, '-11'0 npH paKC MonO'-IImH >KeJle3h1 (rpynna H3 426 60JIbHbIX) 72,2% onyxo-
Jicli - aHcymJOHAHblC H, COOTnCTCTnCHHO, 27,8% HOBOo6paJooaHHH - Jl,HnJIOHAHbIC.
,o:OJI Jl,Unnm-fj(HbJX onyxoJ1ci1 CIIH>KaJlaCh C n08hllJICHHCM CTcnCHH MCCTHo-pcnm-
HapHoro pacnpOCTpaHCHHH 60JIC3HH: npH paKC Tl NoMo ).1o.n J1.HnJIOHAHbIX onyxo-
JICW COCTaBHJIa 41 %, npJ.f paKC T2NoMo - 34%, npH paKC Tl-2NIMo - 25%, npu pa-
KC T3-4N0-2Mo H Tl-2N2Mo - 15% [nOpTHOH C.M., 1997].
OnHUM H3 OCHOUHblX rCHon, KOIiTpOJU1PYIOU(HX KJICTO'-lHhIH L1,HKJI MnCKOnHTIUO-
ll.{HX, HBnHCTC rCH 6enKa p53. COACp>Kall.{H k B SlAPC KnCTKU 6cnOK p53 8n CT-
C cpocqJOnpoTCHJI,OM C MOJ1. MaCCOH 53000,0:. OH 6bIJI OTKpblT B KOHL1,C 70-x rOAOB
B KncTKax, TpaHccpopMHp08aHHblX BHPYCOM SV-40. B 1986 r. YC1'aHOBnCHO. '11'0
rCH, KOJ],HPYIOll.{HH 31'01' 6CJIOK, pacn0J10>KCH B KOpOTKOM nJ1C'-IC XpOMOCOMbl 17
(17p 13). HaMH npUMeHCHa npOTOlJHOl(UTOMCTpH [CCKasI MCT0J],UKa AJ1 OAHOBpC-
Mct-lHoro aHaJll-13a TlJIOHAlmCTH, lJHCJla KJlCTOK R Galt, S, G2+M cpa3ax KJICTO'-IHOro
u.HKna H 3KcnpCCCHJ.f rCHa p53 B KJICTKaX HOB(X)6pa30BaHuH MOJIO IHOH )KeJ1e3bl. C
nOMOLl(bIO AaHHoH MCTOJ(HKH MO)KHO npOCJICAHTb OCHOBHYIO ponh 6CJIKa p53 B KOH-
TpOJU1pOBaHHH npOJH1cpcpaL(Uu KnCTOK U ce pcryn QHH B arBCT Ha 1l0HpC)K}(CHHC
,o:HK. TIpcABapHTCJIhHhlC PC3YJlbTaTbi CUHJ],CTCJlhCTUYIOT. ITO MYTaL(lU1 rCHa p53
UbISlBJ1 IOTCH Y 32% 6OJlbllb[X paKOM MOllO'-rHOH >KCJIC3bl.
Y 60llbHhlX C AHnJIOUJI,HblMH onYXOJlHMH npOJll1cpepaTHBHaH aKTUBHOCTb KJ1CTOK
Bblllle, 'lCM npH A06poKa'IecTBeHHbix npou.eccax H 'HH>KC, ICM IIpU aHcynJ1mlJJ,HOM
paKC MOJIO\IHOH >KCJ1C3hl.
HruIHlJUC aHCYITJIOlll\HOro paKa MOJIO IIJOH )f(eJIC3bl KOppeJ1UpYCT C HaJ1I1 mCM
MCTaCTa30B B aKCUnJ1HpHbIX JIHMcpaTH ICCKHX Y3Jlax. OTMe JeHa KOppCJISlQ 1S1 HHJ(C-
Kca ,o:HK (l1,o:HK) C pT U pN, a TaK>Ke KOJ1H ICCTROM MCTaCTa30B B nHMcpOY3JIaX.
OOpTHOH C.M. [1997] nOKa3aJ1, '-11'0 nn aHcyn.'lOHlJ.HbIX onyxOJ1CH xapaKTepHa ro-
paJAO 60!lbUiaH IaCTo...a MCTaCTaTI1'-ICCKOro nOpa)f(CHI1 pcrHOHapHblX JIHMcpaTH-
'-ICCKUX Y3JIOB. Y 60J1bHbIX, UMCBlllUX aHcynJ1011AHble HC TCTpanJ10UAHbIC onYXOJ1H,
'-IaCTOTa 1l0pa>KCtfHSI nHMcpaTH lecKHx Y3J10B 8 1,5 pa3a BblWC (p < 0,05), a y 6oJ1l>-
HblX C MHoroKJIOHOBblMU onYXOJ1 ,..m - B 2,0 pa3a BbllllC (p < 0,05) no cpaBHcHHIO
C 60J1hHI,IMH, HMC8I11HMJ.f Jl,UnJ10HJI,HhlC onYXOJ1H.
B 86,7% CJIY'IaSiX AHnnOH Horo H 78.9% aHcynJIOH HOro paKa l1,l],HK MCTaCTa-
30B COOTnCTCTnYtoT nOKa3aTCJIHM ncpUH'-IHbIX Honoo6pa308aHl1ff. B pHJ1.C cnY'IaCB
(13,3%) HI1nJ10HJ].lIbIC onYXOJIU Mono IHoi1 )f(CnC3bl MCTaCTd3HpYlOT KJICTKaMH C
180 TOM II - \.IACfHbIE AHAJIJ.1TV1YECKJ1E fEXHOJIOrJ1V1
OKOnO HnJIOH!I,HbIM I1)J,HK. KJIeTKI1 A 1nJIOI1AHbIX MeTaCTaJOD MeHbLUe 11. COOTueT-
CTBeHlm, R Imx BhlUle, ICM B IICplHl llIott ;t 1IIJIOHHllott ollyxo:m }I,tCpIfOKJICTO moc
COOTHoweHHe H COOTHOllJCH 1e nep 1'.1eTpOB, a 1X npOJIl'lc}:JepaTummH aKTHBHOCl'b
O)J,I1HaKOBa. KJIeTKH Mel'aCTaJOB aHeynJIOI1}1,HOrO paKa no OCHORHhlM MOp(J)OMeTpl1-
ICCKI1M napaMCTpaM KPYIIIICC, IIOJH1MOpc}:JHCC 11 OOJltlAalOT 60JlhWd1I1pOJIHc}:Jcpa-
l'HBHOH aKTHBHOCTbK>, 'leM KneTKH nepBH lHoft aHeynJIm1]\HOH onyxOJU1.
Amu1I-13 )J,HK napaMel'pOB KneTOK Y 47 OOJlbHblX C ann!l,epMoHJ],HblM paKO\f ner-
KHX IJOKa3aJl. 'ITO np 1 IIJIOCKOKJleTO IHOM paKC C oporOUClUlCM (13LJ,nJl; 17 HaOJIK>-
)J,eHHi1) 79,4% onyxoJlei1 - aHeynJ1m1AHble, C HCBblCOKHM CpCAHHM 3Ha leHHeM
J1Jl,HK (1,31 + 0,04) H )'MCpCHHbIM 'n1CJ10M aI c)'U.'lm1.uHblx KJ1CTlJK B onyxonH
(39,7 + 4,3%). npoJlllq}epanumaSl aKl'HBHOCTh B Cpe)1HeM no rpynne YMepcllllaSl, a
H 27.2% HaUJIK>AcHHH BbrCOK H. 3a C'ICT JHa'IHTCJlblmrO 'mCJla KJICTOK D S-c}:JaJe
KJIeTO rHoro I HKJIa (R Cpe]1,HeM no rpynnc I1n=21.8 + 1,0%).
nrH YMepeHHo/l,I1{I}{I}epeHltlrponaHiloM nJIOCKOKJIeTO'IIIOM paKe (YJ],nn; 8 lIa-
6m0}1eIU1I1) laCTOTa BC I'pC'laCMoc rn aucYlIJlol1/UlblX onyxc)JIci1 (71,1 %) C l'aTHC III IC-
CKH 3Ha'IHMO He OTJlI-l mmfCh (p>O,05) 01' 'mCTOTbl aHeynJ10H]1,IU1 npH BJ],OJI
(79,4%), npn :JTOM HC Obl110 AOCTOI3CpHOrO paJJIIl'lHH It 110 JHa'ICHI1HM l1D.l IK H J10.
OpH HHJKO!l,uc}:Jc}:JepeHLll1pOB<lHHm.1 paKe (H)J,O]]) Bce I13Y'IeHHble onyxoJlI1
aucYnJloH)tllhlC C ]tOCTOBCpIiO (p<O.OOl) GOJICC UhlCOKIIM CpC}lIlm,'1 JUa'rCllI1CM
I1IJ.HK (1,60 :t 0,07) 11 I1HTeHCI1BHOH (110=28,8 + 1,6%) npOJU1c}:JepaTJIBHott aK-
THBHOCThlO KJIeTOK. 'l(acTOTa A mJ10H)tHhIX H aHeynJ10HJl,I bIX aj1,eIiOKapItHIIO 1 :Icr-
Koro CI3HJaHa co CTCIICHblO l Itc}:Jc}:JCpCHU"POI3KIt onYXOJIU.
TaKHM OOpaJOM, CHlnKeHl1e CTellel 11 }1H CpeHl.U1pOBKI1 onYXOJIII npu nJlOCKO-
KJICTO'IHOM paKC aAcHoKapu.IHIOMC JlCrKOrO COllpOBO>K]laCTCH HOCTOUCpHblM YUCJUI-
'-leHHe\1 31-ta leHHH I1)J,HK 1 npoJU1( epanmUOH aKTHlumC1l1 K,rJeTOK paKa.
Me)l(J{Y I1UHK B nCpl3l1'lHOli onYXOJII1 11 KOHu.CHTpau.HCH P3A B CblBOpOTKC
KpOBH Y 60nbHbiX nnOCKOKJIeTO'IHbIM paKOM nerKoro HMeeTCH CTaTHCTI-I'leCKI1 AO-
C roncpHa.fl Koppemlltl1S1. CpC)tHHC ypOBlHI P3A npl1 11,11nJlOl1}1HOM paKC JlerKOrO
(I1JIHK=l,O) AOCTOUCpHO (p<0.05) HH)I(e, 'leM Y OOJlbHblX C lHCYIIJI0I1J{HbIMU OIlY-
XOJlSlMH (I1HH K > 1.05). Ilpcnc raBJICllllblC PC3Y.!lhTaThl 1I0Ka3blBalOT, '11'0 B 3a1U1-
CHMOCTH 01' CTelleHU aHal1.!JaJnH onYXOJlH (nOKc.naTt JJl-I J1)J,HK) HaomDJ{alOTcSI KO-
JUI'ICCTI3CUHI.le 13McuClmSi P3A"
I1cnoJIbJOl3aHHC Jla3epHOr1 )J,HK - npoTO'IHOrl U 1TOMC1 pl1H nOJBOJ1HJIO IIO:IY-
'JI-1Tb C nOMoUthlO KOMnhloTcpHOH IIporpaMMhl Multicycle (Phoenix Flow Systems,
ClllA) U<DKUYIO H 061>cKTJ.1m YK) I1H opMau.Hlo y OOJIMlblX CClltl1IIOMOH. rIpli TIt-
m1'IHOH ceMuHoMe (23 60JlhHbIX) onHon1m "IC onyx0-'1eBbie KJlel'KU B 60% cnYlfa-
CB 61.1111-1 j.\I-HlJlm1HHhlc 11, COOTBCTCTUCHIIO. B 400/0 CJIY JaCB aHcYIUlOU,tUt.IC. B ltl1l1-
JlOlfJ\HbIX onyxOJlSlX 'lI-1cno KJleTOK R S c}:Ja3e (5,1 + 0,2%) AocToBepHo MCHblUe. 'le\1
U aHcymlm1JlHbiX 9,3 + 0,2% (p<0,05) II01300Gpa:Jouam1S1x. rIPOUCIlT KJlCTOK B
G2+M a3e CTaTl1CTl-l'leCKI1 3Ha'II1MO He paJJllt l laJ1CSI (8,7 + 0,5 1-19.4 + 0.5%).
Y 4 60JIbHbiX UblHBneHa Jl, mnOllltHaH cnepMaTOItllTHaSi CCMHHOMa, KOTopaH xa-
paKTCpH30RaJJaCh HaJlWII1CM KJlCTO'IHOI"O 11 Sll{epliOro 1I0-'ll1 10p(lm3Ma, nmcpxpo-
MueH H]\CP 11 nOCToBepHo (p<O,05) 60_TJbl1H1M, 'leM npl-l TI1nWIHOl1 ceMUHOMe, 'IIIC-
JIOM KJ1CTOK B G2+M c}:JaJc KJleTO'IHoro UHK.'la (15.3 + 0,3%).
J],ltnJlOH}1l1hlfl lIa60p XpOMOCOM 11 Jlla IHTen)'IIOC '!HCJIO l1.enSlllt 1XCSI KJlel'OK (R
G2+M a'3e 17,8 + 0,2 %) 6blJll1 RbISlR.!IeHbl Y 71 % OOJ1bHbIX (17 CJIY'JaeB) C YCTOft-
IJ,I1TOJIOrI1YECKHE I1CCJIE,[(OBAHH5I 181
nIROH K XI-1MHO- 1-1 JIY'ICBOH Tcpamm aHanJIaCTl1'lCCKOH cjJOpMOrl CeMI1HOMbl. Y 5
60JIbHblX (29%) nblSlBJIeHbl aHeynJIOI1 HbIC on)'xmU1 C 60JIbWHM '-U1CJIOM KJIeTOK B
S (11,3 + 0,2%) 1-1 Gz+M (18.1 :f: 0,3%) cpa3ax.
B aHeynnOlI,J,HblX CCp0311hlX nOrpaHI-1'-lHblX OIlYXOJIS1X SU1 IHI-1KOB npoJ1l-1cpcpanm-
HbU1 ypollcm. ( 1 R.9 + 1.2%) 6bl11 BbILlIC. '-leM B l\l-1nJIOI-1J..1,HbIX onYXOJISlX (7,1 +
2,2%). BbICOKI1i'i npOml )CpaT 1RHblJ:'! ypoBel b (16,6 ::I:: 2,4%) BbUIUJICIl H npl-1 I1C-
CJIC OllaH m BhlCOKOT\HcpcjJepelUI,UpOllalmoro paKa SlU'IIH1KOU, npu CTaTU'leCKI-1 :ma-
'-!HMO Hearml'lI-1MOM npOl.{CHTHOM COl'ep)l(amm KJICTOK B S-cjJaJe (7.2 :f: 0.6 %) no
cpaBHeHl-11O c 3,5 + O,3(Yo II X.1 + 1.3%. AHCYIl_ 1 10I-IJ1,HblJ1 BbICOKO).{HcpcpepeHl\HpO-
uallH"IH cep03Hblii paK SlI1'IIU1KOU llCTpe'-l3eTCSI B 87.5% cnYllaeB, B TO BpCMH, KaK
AlmJIOHD,HblJ1 U 12.5 % cn)''-laen.
V. B03MOJKHOCII1 IIAPAJlJlEJILIIOrO AHAJlH3A
MOP{J)OMETPH 1 IECKHX 11 npOTOII110-QI1TOMETPHQECKI1X
nAPAMETPOB KJIETOK onYXOJII1
AnSI npCOAOJIemUI TPYJI,HoCTerl pacn03l1aBaHI-1S1 MeTO).{OM npoTO'-lHoH 1..{ 1TOMCT-
pm., Jl,l1nJIOI1J1,HbJX 3JIOKa'-ICCTBCIUI"IX onyxoJleti c'-n1TaIOT nepCneKTI1UllblM nop,xoA
OCIlODaIlH"IH Ha KOM6I-1HaL{ m al aJU13a J-\HK C O: HlmpCMCHHbIM I1CC'1eAOBalU.,CM
PYrHX napaMC "POB KJICTK 1 (PHK, 6em<a. 11JIOII aAI-1 KJIeTKl-111 H).{pa 1 T.n.).
EOJlbHblC npl., npomlcpepal..{ m :JIIHTCJUlSI no Tuny npCJ paKa, oc06eHHo IIPH co-
'-IeTaHHH aHCYnJlOHHUI-1 C 60nbliU1MI-1, 'ICM I cpel HeM no rpynllc, OCHOBHblMI1 MOp-
cjJOMCTplt'-ICCKI-1MU napaMeTpa!\.HI KJICTOK, l'0JI)I(Hbl 6bl"'b I OnOJIHHTeJIbHO 06cJIe o-
DaHhl }\J1S1 I-1CKJIto'-leHI1S1 3J10Ka l ICCTReHHOCTI1 npl)( Ccca. B CJIy'me nO)..l,TFJCp)l(JI,eHlfSl
)106pOKa\leCTBeIUloro xapaKTepa HOBo06pa30Bam1S1 MOJIO'-mOH )f(CJIC3bl 3a TaKOH
60!TbHOH IIco6xo)l, 1MO YCTaHaumwaTh Tu,aTenbHblrl j lmaMH'leCKI1H KOHTpOJIb.
Oapa!1JICJ1hHO BhIllOJlHeHHbli1 MopcjJOMeTpWleCKJ.1J1 aHamn KneTOK nOKa3aJI, ITO
nOJIJ.1MopcjJU3M KJICTOK I SI ep, pa3Mcphi SI}\ep. npH W1llJ10HJI,HOM paKC MOJIO'IHOH
>KC.IC3hl ;(OCTOBepHO MCHblilC. '-leM 13 aHeyrvloH,lHI>IX onYXOJ1S1x. OTMC'-IatOT KOppC-
JISlL{HOHHYIO CBSl3b nJIOII)l,HoCTH co CPC}\HCrt SlJI,epHOH IIJIOlllaJlbtO, YKa3bmaH lIa TO,
liTO nJlOUlaJ b SlJI,Cp J.1 K03c1JcjJHL{UCHT napllaL{lUl 1I!IOLllaJ\11 SI Cp aHeYIIJIOI1lJ.HbIX ony-
XQ.lICH 3Ha'-IHTeJ1bHO UbIlUC. lleM y ,l{lmJIOHAllbIX onYXOJ1eH. Opl1 3TOM, KaK npn allc-
YII:llU1]lHI>IX, TaK 1 HmIOHAHbIX OIlYXOJISlX He BbISlB!ICIIO KOppeJIS1l.{IUI MC y nJIO-
WaJ\hlO Slnep J.1 KOJII1'ICCTBOM K.'1eTOK B S-cpa3C,
CO'-ICTam1e MOpcjJOMCTp 1'-ICI.;Koro 1-1 npOTO'-lIIo' UHTOMeTpll'lCCKOro MeTo ou
cnoc06CTBYCT 06hCKTlml13alum 11 YJ1}/lIWCIIHIO L{UTOJIOrl1'ICCK0i1 HHarHOC"H1KH BbI-
COKoA 1cjJ(1)cpeHIU'lpoBaHHoro paKa M0J10\IHOII )I(C1IC3bl (Ta6Jl.2). I-Ie llblSlB!leHO pa3-
JllIllHSI Me)f(Jl,y ndpaMcTpar.m K-'1eTOK AHI1JIOH}{IIOrO BD. AOJlbKOBOro paKa H pC3KO
Bblpa)l(CHHOH npo.rmcjJepanllumi1 (1)opMorl MaCTOllaTm1. 06-beKTHI3H3aIlUSI OCHOB-
IIhlX napaMeTpoB KJICTOK 11 Slftep C nOMOll{hIO MopcjJoMeTp HI 11 npoTO'IHOJ:'! L{I-1TO-
MeTpl1H lIo:mOJISleT BHCCTH IIPH pa3m1 l lHbiX Bapl1aHTaX BbICOKOA 1cjJclJCpCIUll1pOBaH-
IIbJX onyxOJ1CH MOJlO'-IHOH )I(enC3bl 'ICTK 1C KOJlUlleCTBeHHblC KpllTepJ.1I1: TPH )..I,l1arHO-
C I'J.1'-ICCKHX aJIrOpUTMa C K03<p(pHl\UeHTOM 3c1JcjJcKnmHocTH pacn03HaBaHuSI KJ1eTOK
paKa (84-90,5%), KOTopbTe MO)l(HO 1CnOJIb30BaTb u KalleCTBe Ono.mmTeJ1bHbJX
IIPH npoReJl,eHm1 Jl,HcjJcjJCpCIII HaJ1bH0I1 L{I-1T0.110rH l ICCKOH JI, 1<"'IIOCTI1KJ.1 Me)f(]J,y BJJ,
paKoM 11 pe3KO Ublpa>KCHHOH npOJIHcjJcpau.Hc 1 3nUTem1S1 MOJlO'-IHOH )f(eJIC3bl C a1'H-
nHeH Slp,ep 'IaCTl1 K:leTOK.
182 TOM II - t.J.ACTHbIE AHAJUifTI1YECKI1E TEXHOJI0fl111
YCTdHOBneHO. 41'0 B 87% Ha6J110ACHMM Jl,Mnn0l11l.UOm M 79% aHeYlIJlOI1J1,HOro
paKa I1JJ.HK MeTaC'Jd30B COOTOCTCTBYIOT nOKa:mTcmlM nepBH mblX HOBooGpa30na-
HI1M. B pJlJl,e cnYllaeB (13%) AMn.'10I1J\Hble onYXOJlH MCTacTa:mpYIOT KneTKaMI1 C
oKonOAHnJl0l1AH61M M,lJ,HK. KneTKH Al1nnOHJI,HblX MCTaCTa30B I1.MelOT oW1HaKoBYIO
C JJ,HnnOHJI,HOM onYXOJlblO nprumcpcpaTIiBHYIO aKTHBHOCTb. MCTaCTa3bl 3Heynnol1.A-
Horo paKa no OCHOBHhIM Mop oMeTpHlIecKHM napaMcTpaM KpynHce. nOJU1Mop -
Hce 11. 06na.n.aIOT 60nbWCM npo.'ll-UpCpaTI1BHOH aKTHHHOCThID, leM KJICTKH nCpBH'l-
HOM aHeYnJlol1AHOH onyxonH.
Th6JUlI a 2
KOnH'IeCTBeHHLle napaMeTpLI, KOTOpLIC MO)KHO ucnonL30BaTh B Ka-.eCTBC
AOnOJlHHTenLHLIX WIll AHtjltJIepCHQHaJlLHOH QHTonorH-.ecKoH AHarHOCTHKH
BLlcoKoAHtjltjlepeHl{HpOBaHHoro paKa H pC3KO Bhlpa)KCIIHOH
nponHtjlepaTHBHOH tjlOpMLI MaCTonaTHH C aTHnHCH IIp,ep 'IaCTH KJIeTOK
XapaKTep npOl.{ecca
KOJIl1 l leCTBCHHblC napaMeTpbl
BHYTplmparOKOBblH
paK C HalIaJlOM HHBa31111.
OCHOUHLIC MOPcpoMeTpI1 ICCKl1.e napaMCTpLI
11 I1.HAeKC npoml CpaUMI1
MHcpl1.JILTpaTMBHblH npoToKoBbIH paK
1) AI1nJI0i1AHblH OCHOBHbIe MOp(IJOMcTpHtIeCKHe napaMcTpbl
2) aHcYIIJIOI1AHbIM OCHOBHbIe Mop(IJOMeTpu4ccKHe napaMeTpbl,
IIJIOI1AHOCTb, I1HJ\CKC npoJIH epaLtI1.H
I1HcpHJIbTpaTI1.BHblH AOJlbKOBblH paK
u
1) Al1nJIOHAHbJH HET OTJII1t.J1111
2) aHcynJIOMJl,HblH 51J1,epuhlc Mop oMeTpH ICCKl1e napaMcTpbl,
JlJIOI1.JI,HOCTb
nanMnnJlpHbIH paK
51nCpHbIC MOp OMCTpl1lleCKI1.C napaMCTpbl,
IIJIOI1J1,HOCTb
Ty6YJIJlpHbiM paK
nCpHMeTp KJIeTOK. MX nom1Mop H3M,
Jlp,epHLle MopcpoMeTpH l lCCKl1e napaMeTpbl.
II n 0 11 A HOC T h
5.1. HcnonL30BaHHC KOnH'IeCTBeHHLIX napaMeTpOB KnCTOK p Ka Mono-.HOH
)KeJle3LI AJUI OpHCHTHpOBO'IHOH OQCIIKII YPOBHJI pCl{enTOpOB crepoHAllLIX rop-
MOHOB
B nOCJICJ.{HI1C rop,hl IIPH paKe MOJI04HOH :>Kene3hl AJlJI oT6opa rpynn 60J1hHI>IX.
KOTOphlM nOKa3aHa ropMoHaJlbHaJi TepanHH nmpoKo HCnOJIb3yeTcH KOJm leCTBeH-
HaH OLteHKa pel enTOpOB 3cTporeHoB (P3) H nporecTepoua (pn) B LtI1T030J1J1X ony-
XOJleH MOJlO IHOH )l(ene3bl. 3CTpOl'eHHaH cTI1Myml.LtHH nepeA XHMHoTcpanHeH OCHO-
-
U:I1TOJIOrl1t.IECKME MCCJlE,lJ;OBAHI151 183
v
BblBaeTCSI Ha KOHQem.lIUf, COrJ1aCHO KOTOpOH 3C I'pOrCllbl YBeJlwU1BaIOT npoQcHT
KJICTOK n S-q,aJc KJICTOlJHorO nKJ1a H, CJ1e]J,OBaTeJ1bHO, XHMI10 IYBCTBH rCJlbHOCTb
onYXOJII-1. BblSlBneHa .CYl.I.leCTBeHHasI KoppcnSlQI1S1 ypoUH)i P3 C rnCT0J10rl1 leCK"MI1
UapltaHTaMH H CTeneHblO 3J10Ka ICCTBCHHOCTI1 paKa MOJlO IHOH )l(eJIC3bl. I1cCJIC1 O-
BaHlte KOppeJlSlQHI1 B03'pacTa. 3Ha I HHH nnOI.I.l3.A11 SI;QCp KJICTOK paKa, CTaT)'ca peru-
OHapHblX m1Mq,aTH lcc HX Y3Jlon n ypOUHSI pCI enTOpoB 3 TporCHOB nOKa3aJ10, ITO
Y naQl1eHTOB C MeTaCTa3aMH H 6eJ MCTaCTaJOB CYWeCTBYCT CB)i3h B03paCTa n nllO-
l.I.la)..\H SI)..\ep C pa3m1 IH)iMn B ypOBl C P3. Hn3Kne 3Ha IeHnSl nnOI.I.l3.AH SI)..\CP onyxone-
BbIX KJ1eTOK Ha6J110AatoTCSI B 6011bwnHCTBC CJIY IaCU B onYXOJ1S1X npl1 BbJCOKOH KOH-
QCII [-pal HeH P3. 3Ta 3aRHCHMOCTb cJ1a6ee BblpmKCHa B rpynnc OOJlbHblX C MeTa-
CTa3aMI1 B perHOHapHbIe J1I1Mq,aTwleCKlte YJJ1bl.
nJ10Il.laJ b QHTOnJ1a3Mbl KJ1eTOK paKa MOJlO IHOH )f(CJICJbl KOppcJlHpyeT C KOH-
QCHTpaQHeii P3. TIp" 3TOM at cynnm1H1 6IC onyxo.r1H 60nee tmCTO P3 OTpI1QaTeJlh-
HbIe, B TO BpeMSI, KaK cpeAn Al1nJ10HJl,HbIX onyxOJ1CH O<)J1ce BblCOK npoQeHT peQcn-
Top-no3nTHlUthiX lIono06pa30naHHtL CaMble 60Jlbllll1e JHa leHHSI OCIIORHblX MOp-
q,OMcTpH lecKHx napaMc'I-P0B KJICTOK H Sl1\CP Ha6nlOJl,a1OTCSI nplt P3-PTI- paKC MO-
J10 IHOH )f(ene3hl, a HaHMeHhlJlHe R P3+ PO+ onYXOJJ)iX (pHC. 5).
Y 60JlbHbiX MOJlO)l(C 50 J1eT, C coxpaHeHHoH MeHcTpYaTIbHOH c1JYHKI..{Hei1 n erap-
mc 60 J1eT, B rny60KoH MeHonaY3e KneTKH 11 SI)..\pa P3+pn+ HOB006paJOBaHI1H I1MC-
101' Hal1MCllblllYJO 1IJ10ma]J,b,nCpI1MeTp H nOJIUMopq,I1JM, a B P3-PD- onyxonSix Hal1-
60JlbWHC 3Ha ICHI1S1 3THX napaMeTpon. DpH aHcynlloHAHoM paKC ICTKOCTb 3THX
pa3J1l1lJHH MCHCC Bblpa)l(CHa, 'leM npl1 ;Ql1nnOI1)..\HOM. Ynm.lHeHTOK B B03paCTe 01' 50
)..\0 60 JICT 13 KJII1MaKTCpl1lJCCKOM nepl1oj.\e onpeAeJ1I1Tb, J¥l)l(C OpHCHHlpOHOlJHO, no
KOJlI1 ICCTRCHHf>lM nOKa3aTenSiM ropMOH03aBHCHMOCTb onyxoJIH TPY]J,HO.
5.2. HCnOJIL30BaHHe KOJlH-JCCTBeHHLIX nOKa1aTeJleH KJICTOK onyXO-T1H nH
o6LeKTuBu3a....uu CTcneHU BLlpa)l{CHHOCTU naTOl\lOp 03a
nYHKL.U-1S1 onyxOJICH CIICl.l"aJ1l H"IMH TOJ1CTbIMH HrJ1aMI1I1J1H TpcnalioM ]J,aeT B03-
MO)f(HOCTb nOJlY IHTb AO J1e ICHI1S1 He06xol\HMOe KOJ1w.eCTBO MaTepmUIa. B3S1THe
cro 113 HOBoo6pa301Jalll1S1 nocnc J1et.leHlUI. 130 BpCMSI oncpaUHn. n03BonSieT 113Y IaTb
13 ]J,l-maMHKC KOJ)H leCTBCHHble napaMCTpbI KJ1CTOK y 60JlbHbIX npl1 paKe MOJlOtlBOH
>Kene3bl. no AaHHblM Tanaka A.S. U coaRT. [1987, 1996] TepancB"I1 ICcKuft 3cpc}:JeKT
npc;Qonepa1.l110HHOH XI1MI10TCpamm 3Ha U1TeJ1bHO cnSl3aH C aTl1nUCH SlACp, CTcnc-
HbiO AI1c}:Jc}:JepeHLlupoBKI1 U MUTOTl-1'ICCKI1M HH,Q,CKCOM onyxonl1.
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AHaTlU3 KOnl1t.leCTBeHHbIX nOKa3aTeJICH K11CTOK onyxOJII1 AO U nOClle npc)..\ollc-
paQl-lOHHOH J1ytJCBOH TcpalUU1 (7 rp x 2=CO,lJ; 14 rp 11 5 rp x 4=CO,lJ; 20rp) 111111 ne-
-
KapcTRCHHOI1 Tepanl1H C a,o,pnaMUl..{nHOM n03BOJISleT OUbeKTHBlt3upoBaTl.., 13 OCHOfl-
HOM C nOMOIl{hlO MOpcIJoMeTPH'ICCKUX napaMeTpoB, CTcnCHb BbJpa)l(CHHOCTI1 no-
CTnY'lCBoro U nCKapcTBeHHoro naToMopcpo3a. TIpu pC3KO Bblpa>KCIIHI..IX U3MCHeHI1-
)IX MOPcIJOMcl'Pw.eCKI1C napaMCTpbl KnCTOK 11 SlAep AOCToncpHO (p<O,OOl) 60JlbWC
napaMcTpoB KJ1eTOK npl1 cna60 U YMepcHHo BLlpa)KCHHOM naToMopcIJ03e. BbUIRnc-
HO, {ITa Al1nnOI1AHblC onYXOJII-1 XY>KC, 'IeM aHcynJ10UAHble nOAU,aUa;II-1Cb nY'-jCBOH TC-
pamm. OpCHnapnTenhHblC pe3ynbTaTbI CBU;QeTenbCTBYIOT, tlTO B03paCTaHHe 11111-1
HCI13MeHeHJ.fC II1CJIa KJICTOK onYXOJ1H B S UJ1H G2+M c1Ja3ax KJIC1"O IHoro I(HKJ1a npH
npOBC CHm1 npc)..\onCpaQl10HHOH KpynHocIJpaKI..{110HHOH JIY leBOH Tepanl1l1 (COP; =
14 rp J.fnH 20 rp) C 60J1bWOH BepoSiTHoCTLIO (6oJ1ce 75%) YKaJblBatoT Ha KJIHHH-
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QCJlcc06pa:mo OI..{CHI1UaTb IIpoJ1l1cpcpaTI1BHYlO aKTI1BHOCTb onyxoJ111 npl1 BbIpa-
184 TOM II - '1ACfHbIE AHAJIMTM'1ECKI1E TEXHOJIOrl1M
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MCCneJ1.0BaJlaCb nporHocTHtlecKaSl 3Ha'II1MOCTb KOJIWICCTBCIUILIX napaMeTpoR
KJleTOK npH III CTaJ{1H1 paKa MOJlOlJlmi'f >KeJle3bl C YtlCTOM pe:mcTeHTHoCTH onyxo-
Jm H CXCMhl XHMHoTcpamm. OpH X 1MHoTepamm C aJ1.pHaMI1UJ1HOM nnoHJ1.HocTb ony-
XOJU1 He BnHSlna Ha CTeneHb Bblpa>KeHHOCTH naTOMOp(JJUJa, HO KaK 13 n 1IT;IOHJ1.HbIX.
TaK H alleynJIOI1.D.HhiX HOBoo6pa30BaHlUIX JleKapCTBeHHhle I1JMeHeHHSI 6blJlH BLlwe 13
onYXOJISlX C HI1JKHM tIHCJ10M KJIeTOK B S cJJa3e MHTOTWICCKOro LlHK:la « 7%). To
CCTL. ynCJU1 t ICHHC CTcnCHH llblpa>KCHHOCTH naToMopcpo3a conpOBO>KAaJlOCb AOCTO-
BepHblM YMeHblIJeHl1eM npOJIHcpepaTHBHoH aKTI1BHOCTI1 KJleTOK paKa MOJI011II0H
>KCJIC3bI. nOCJIC 1-2 KypCOB .:3cpcpcKHmHoH JIeKapCTBeHHor. TepanHH no CXC!\-laM
VCAF H CMFA. npH CJ1aOOH 11 YMcpeHHO" CTeneHH Ublpa>KCHHOCTH naToMopcp03a,
YMcllLwacTcSI IIJIOILla}\b I<JlCTOK onyxoJlI1, nepl1MeTp H mIOILla,u,b SI}.\Cp, nOJLHMOp-
<p113M 3THX nOKa33TeJ1er.. t[TO 06beKTHBHO CBHJ1.ereJlbcTllYC'1' 0 B03pac ralll1H CTene-
HH }.\HcJJCPCpCHLlHpoI3KH HOBOOUpaJOBaIH1i'1. I1JIOHHIIOC rh onYXO.1H He BJUfSlJla Ha CTC-
nCHh JlCKapcTBCl-mOrO naTOMop<po3a.
Van Diest P.J. H coal1T. [1989, 1992] nOnO>KHTeJIbHO OLlemmalOT :ma'ICHUC ""IOP-
cpoMeTpHH J:{J1S1 npomoJa OTBeTa Ha aJJ.blOuaHTI YIO XHMI10TCpamuo no cxeMe CMF
Y 60Jlt.llbiX paKoM MOJIO'IHOH >Ke'1e3bI H3XOASlILlHXCSI B npeMcHonaYJC C 1I0pa>KCIUI-
eM permmapHLIX lHfMcJJan11lCCKI1X YJJlOB.
J],JISI 1I0naUJlCIIHSI rUlIcp:::JKCllpeCCHI1 P-rJ1l.-u.::onpOTCHHa KJleTKaMI1 onYXO.'U1 HO-
nonmnenbHO K XI1MI-fUrcpamm Y 60JlbHbiX MCJIKOKneTO'-IHhIM paKOM J1erKOrO H MO-
JIO'lIIOH >KeJle3hl npl1MellSllOTCSI MOAHcJJHKaTopbl MHO>KeCTBcHHoi'f J1CKapC rBClIIlOH
YCTOH'U1BOCTH onYXOJ1el3blX KJ1eTOK (llcpaTlaMIfJl H 1{11KJIOCnOpHH A). Mx HcnO.'Ib30-
BaHHC 1laCTO HC npl1ROl1HT K nOnO>KHTeJlbHbIM pe3ynbTdTaM. C nOMOlI.l,blO \1tI0rona-
paMeTpOBO" npoTo'IHOH UHToMcl-pm1. M R K-16 MOHOKJlOHaJ1bHbIX aHTHTCJ1 H PO.D,O-
MHHa 123 MO>KHO nOJlY'IHTb OObCKTHBHYID I1llcpopMal IH() 0 CPYHKI,HOHaJlbHOl1 aK-
TI1BHOCTH H pC3HCTCHTHOCTI1 KJleTOK onyxo.'ut K xHMuonpenapaTa 1 (3KcnpccuSi P-
rmiKonpoTeuH3 H P0J1.0MHHa 123).
TaKH!\.1 06pa30M. aHaJlH3 KomilfeCTBeHHblX nOKcnaTeJlei1 KJICTOK onyxo.rm o H
nocnc npe}lonCpaUHoHHoH KPynHocppaKLlHoHHOH JI}/lleROH TepanHH H.'111 JlCKapCT-
BCHlmH Tcpamu1 C llApl1aMUI HHoM n03BOJlHJ1 06'bCKTI1Bl1Jl1pOBaTL. B OCHORHOM C
nOMOILlblO MOpcpOMC.I-PWICCKUX lIapaMcTpoB, CTeneHb Bblpa>KeHHOCTII noc.mytlcllo-
1'0 U JICKapC meHHoro lIaTOMopcpo3a U OLlem1Tb pe3HcTcHTHOCTb KnCTOK onyxoJlu K
XH\UmnpenapaTaM.
VI. IIPOfHOCfU'lECKOE 3HA'lEHHE OTjJ;EJlbHLIX
KOJIH'IECTBEHHLIX nAPAMETPOB KJIETOK OnYXOJIH
PI1CK YMepeTb m' paKa MOJIOllHOlf >KCJICJLI 3aIUICl-tT, C oAHon CTOpOHbl, OT CTa-
}:1HH 60JIC31m n MOMCHT }l,l1arH03a. a C APyrO" CTOpOHbl OT cc uHoJlorwlccKoH arpec-
CHBHOCTH.
B HacroSlILlee BpeMH AJ1S1 npCJ1.CKa3aHHSI npOI'HOJ3, Ii taCTHOCTU npl-I paKe MOJIO I-
.. .
HOH >KCRC3hl, HCnOJIb3YlOTCSI pa3J1H IHble KpHTepHlt: Km1HH ICCKaSJ CTllAI1S1, 1303paCT
OOJIbHLIX, MOpcpOJIOn1 1 lCCKaSi rpa)\al HSI onyxom1. ec peLlcnTopHbli1 CTa'l yc. HPyrHc
6U0J10nf'-ICCKHC II I1MMYHOJlOm'ICCKHe napaMC1-pbL }I}.\CpIiLIC MOp{t>OMeTpWICCKue
npl1JHaKH (cpeJ1.HSlSI IIJl0lU3Jlh SlJ\CP, CpCJlIntH ncpl1MeTp SlACp, MaKCI1McUlbHLIH If MII-
HHMaJlhlihlH HHaMCTpbl Sl}\Cp KJICTOK U J1.pyruc napaMC'I-pLI) HMCIOT nporHOCTWle-
CKoe 3H3 t leHHe B BbISlBJlCHI1H 1I0pa>KCHIISJ aKCI1JlJlSlpllblX JlIIMcpaTUtleCKHX YJJIOB.
186 TOM II - qACTHbIE AHAJ1I1TI1YECKI1E TEXH0J10rl1l1
Onpe eJ1eHHe nJl0l1 HOCTH OnYXOJleH MeTOAOM l.{HTOCnCKTpOcpOTOMeTlml1 AaeT
B03MO)f(HOC I'b npOrH03HpOBaTb Te\leHHe 3a60JlcUaHlUi. OJJ,HaKO, ,n,aHHb1l1 MeTOA He
1I0JIY\lI1n UlI1pOKOrO pacnpOCTpaHCIUtH, BepmITHO. Jf3-3a cm TpYJJ,oeMKOC rH.
JJ:aHHbJe. nonY\leHHble MeTo,n,OM npOTO\IHOfi I HTOMCTpHH, MO)f(HO HCnOJlb30BaTh
B Ka1.JCCTBe OT enMlhIX nporHOCTH1.JeCKHX KpHTepHeH Te'-lCHHH 3J10Ka'-leCTBCHHbIX
HOBo06pa30BaHHH. TOIIHOCTb flporH03a Ba)f(Ha AJISI oT6opa 60JlbHb1X, KOTophle
I OJI)f(HbI nonY'-IaTh paHH1010 MblOHaliTHYIO XHMHOTepamno. npeAHa3Ha\ICIfHYIO JlH
npeAOTBpall emHI AaJlbHeHlllero pOCTa onYXOJIH 11 OTAaJlCHHOro MeTaCTa3HpOBaHHH.
LIaCTOTa aHeYIIJlOHAHblX onYXOJIeH 3aBHCHT npHMonponopl HOHaJIbHO OT pa3Mepa
onYXOJlH. KpOMe TOI-O, % KneTOK B S-cpa3e KneTO'-lHOrO l.{HKna TaK)f(e YBCnl1"lI1-
HaeTCH C pa3MepOM onYXOJlH. OTMe'-leHO YBeJU1\leHHe HeAHcpcpcpeHQHponaHHoro
KOMnOHeHTa onyxonH C YBenl11.JCHHCM ee pa3Mepa, 41'0 OTpa>KaeT 113MCHCHHH 6110-
JlOrH1.JCCK"X CBOHCTB Hono06pa30BaHHs:! R TC1lCHHe ero pOCTa B CTOPOHY rHcTonaro-
JIOrH 1 1eCKOH ,n,eHHcp<pepeHI HpORKH 11 YBeJlH\leHHs:! npOJmcpepHPYlOfI CH cppaKl.{HH.
Cpe,n,H onYXOJICH 60JlblllHX pa3McpOB 3Ha 1 mTenhHO \1aLl.{e P3- HOH006p330BaHHH,
aHcynnoHAHble onYXOJB1, Bblille % KneTOK B S cpa3e KJleTO'-IHOro l.{I1Kna.
MopcpOJlOrH1.JCCKHC oc06eHHOCT" nCpBl1"lHOH onYXOJIH COAep)f(aT 3Ha'-mTenb-
HYIO npOrHOCTI14eCKYIO I1HcpopMa[ mO H oGbCKTHBHble KOJ1H\ICCTBeHHbJe MeTO bl
MorYT CYLl.{CCTBeHHO nORhlCI1Tb 3Ha 1 leHHe rHCTOnOrl1'leCKOro " l.{HTOnOrH'-leCKoro
HccneAOBaHI1s:!. no ,.aHHbIM Zajdela A. H coaBT. [lY81], ccnH 3Ha'-leHHH AHaMcTpoB
HAep KJleTOK paK3 MaJIeHbKHC (9-12 MKM 2 ),TO 5-neTus:!H Bbl)f(HBaeMOCTb IIpl1 n1060"
CTMHH flpOl.{eCca COCTaRJISJCT 89%-94%. OJJ,HaKo, eCJIH OHI1 COCTaBmllOT 12-25
MKM, TO 5-neTHHH UbI>KHBaeMOCTh IIPH Tt (AHaMeTp onYXOJII1 MeHbllle "nH paBCH 2
CM) - 73%, npH T2 (.nHaMcTp onYXOJlI1 KJImUt1lcCKH 60nbille 2 CM, HO MeHbllIe HnH
paBeH 5 CM) - 61 %; H IIPH T3-T4 (ncc APyrHe onyxOJlH) - 35%.
Wallgren A. 11 coaBT. [lY76] laK)f(C 6blJl0 OTMe4CHO, liTO 60JIee fJ,J1InCJlbHas:!
npOAOJ1)f(HTenbHocTh )f(H3HH Ha6nlO aeTcH y 60JlbHb1X, AHaMeTp KJlCTOK paKa K01'O-
pbJX MeHee 9.5 MKM. npl1 npe06JIaI aHHH 60JIee KpynHblx HAep (60nee 19 MKM B
HaMcTpc) AOJlH nal.{JfCHTOU, np0)f(HBIUHX 10 JICT, COCTaBJIs:!eT OK0110 50%. no MHe-
HHIO anTopoB, Ilc:ma 1 IHTeJ1bHOC KOJJI14CCTBO l.{HTOnJ1a3Mbl BOKpyr SlApa YKa3bmaCT
Ha 60JIce AJ1HTeJlbHbIH CpOK )f(H3HI1 60nbHhlx, HC)f(emt ee 06HJIHC.
COBpCMcHHble peTpocncKTHBHble H npocncKTHBHble "CCJleUOBaHHH nOKa3aJ1H,
liTO MOpcpOMCTpl1'lCCKHe npH3HaKH s:!BnSlIOTCH 60nce nporHOCTH4eCKHMH. IleM
KJ1aCCH'-leCKHe, TaKHC KaK nOpa)f(CHHC nHMcpaT"lleCKI1X yJHon, pa3Mep onyxonH H
COAep)f(aHHe CTCpOHAHbIX pel cnTopOB.
CI1JIb4eHKO CA. [1990] BbIH8IfJla, 111'0 no Mepc YBCJJI1'-ICHHs:! KJlJlHl1 l lCCKOlf CTa-
I HH 3a6onenaHHH YMeHbUJaeTCs:! KOJ1H'[eCTBO 0AHOrl1f1HblX HAepHblX r'Pynn C He-
60JlbllJHMH (AO 100 MKM2) HApaMH, npOHCXOAI1T CABHr BnpaRo, H YUCJlH I Il1BaeTCs:! KO-
nl1'leCTBO pa3Hopo HblX no pa3Mepy H CpHbIX rp)'lIn 3a ClleT YBenH1IeIUts:! flJIOl1.{3,!J.H
Sl1J;Cp, liTO CBHIWTCJlbcTByeT npH paKC MonO'IHO" )f(eJIe3hl 0 HapaCTaHHH rCTepOI'CH-
HOCTH KnCl'01lHblX nonYJIHl.{HH H 06 YCHneHJ1H 3JIOKa'leCTBCHHOCTH.
C nOMOl1.{blO KnacTepHoro aHaJlH3a Komitowski D. H coaRT. [1989] npOBeJIH Ha
rHCTOJlOr"\ICCKHX npenapaTax Hccne)J.OBaHHe MopcpoMeTpHIleCKHx napaMeTpOB
KnCTOK npOTOKORoro HHcpHnbTpaTI1BIIOrO paKa, H nOKa331111. 1.J 1'0 C)'Ll.{eCTByeT pa3-
nl1 l me R Ol.{CHKe CTeneHH 3JIOKa i leCTBeHHOC rH OI1YXOJ1H. onpeJleJlSlCMOH UH3YaJIbHO
H 06"beKTHBIi0. no MHeHHIO alHopoB, 60nee TOIIHa 06bCKTI-1BHaH KOnH'-leC mCI1H3H
Ol.{CHKa 3nOKa\lec rBCIIHOCTIt npOl ecca. raK KaK npH MoprfJoMeTpH'leCKH BbiAenell-
IJ:MTOJIOrl1lfECKI1E I1CCJ1E)J.OBAHI151 US?
.
HOM III CTenCHI-I 3JIOKa ICCTnCHHOCTH B 71 % CJIY laeB BbJSlBnHIOTCH MeTaCTa3bl n pe-
rHOHapJlLIC JIHM$ant'-leCKl-le Y3nbl, n TO BpeMH KaK npl-l nl-l3YaJIbHOM OU,CHKC om1
o(jHapY>Kl-lnaIOTCH TonbKO n 48%.
Watanabc T. 1-1 coanT. [1995] Ha OCHORaHl-I1-I HAepHo-Mop$oMeTpH ccKOM CTcnc-
HI-I pl-lCKa (NMRG), OllpcJ.{CJlHeMOM J.{nYMSI Mop$oMeTpl-llleCKHMI-I napaMeTpaMI1 -
CpCAHCH IJJ1011.(a.AblO HApa 1-1 cTaHJ],apTHbiM OTKnOHCHI-ICM nnolQaj1,1-I HJ.{pa - pa3J.{CJm-
nl1 60JlhtlhiX paUHI1M paKOM MOJlO'-IHOH >Kene3bI Ha J],Be rpynnbI, I1MelOll.l-le J.{OCTO-
nepHO pa3nl-l alOl,u.YIOCH o611.(YHJ 1-1 UC3PCU,HAI1HH)iHJ BLI>KI-IBaCMOCTL. AnTopbl npl1-
xOI.srr K BLIBOAY 0 TOM, '-ITO NMRG MO>KeT I-IMeTb 3Ha'-leHl-le J],JISI pemCHI1S1 0 He06-
XOAHMOCTI-I a,r.J.bIOBaHTHOH XliMI-IOTCpamm.
nOBe/1,eHHe 3J10Ka ICC mCHHOH ollyxOJm cnH3aHO He TonbKO C ce MopcpOMeTpl1-
'-ICCKI1MI1 xapaKTepHCTI-IKa UI KJleTOK, HO C HX npOJIH$cpaTHBIJOH aK mBiIOC 1'1.10 11
nnOI1J\BOCThlO. Ou,CHKa 3TI1X gnyx Kpl-lTepl1en nMeCTe. J.{enaeT nporH03 el1.(e 60nee
J.{OCTOBepHbIM. npl-l aTOM 60Jlhllll-lHC1 no J.l1nJIOHJ.HLIX on)iXOJICH 06JJaJ aCT 60JICC
HH3KI-IMI1 TCMnar..m I CJICHI-IH. '-ICM aHcyn!lol1J.{HbIC. npOJ1I-1$epaTl-lnHaH aK1'unHOCTb
KOTOpbJX 6bmaeT O'-IeHb nblcoKoH. no AaHHblM HHpperts P. H coaBT.[1993] KOM6H-
Hal\HS! KOJ1J.t'-leCTna KJICTOK II S-$a3C H % aHcYIIJIOI-IAHblX KJICTOK H onyxoJIII H8JIH-
HJTCH na>KHblMI1 $aK1'OpaMI-I nporH03a KaK J\nS! 0611.(efl, TaK " J],JIH 6e3peu,HJ\HBHOfl
Rhl>KI1RaeMOCrM y OOJILliLlX C 11-111 CT I-IHMI-I paKa MOJIO"mOH >KenC3bl. no MHCHHto
anTopon, onpeJ],eJIeHl-le '-lHcna S-$a311h1X KJleTOK, a TaK>Ke nJ10H/1,HOCTI1 onYXOJU1 R
CO'-[eTaHIUt C J],aHHI.IMH PCI\CIITOPOB CTCpOHAHhlX I'OPMOHOB J.{0JI>KHO CTaTb PYTMU-
HblM MeTogoM 06cneAonaHI1S1 60JIbHbIX.
AJIH 6()JIee TO'-lHoro onpeJ.{eJIeHI-IH nporH03a 3a6oJlenaHHH Kallionicmi D.-P. H
coaBT. [1988] npeJ],JIO>KHnH OI\eHHRaTh JJ;HK-rI-lCTOrpaMMbl R l\enOM, RhI/1,enSiSI cne-
/1,YfOU\I-IC I1X TPH I"Hlla: J - J.{IHJJIOI1J.{HbIC, C HH3KOH npOJIH$cpaTHImoH aKTl1nHOCTbHJ
KneTOK ('-,"CJlO KJICTOK n S $a3e KneTO"lHoro QI1Kna MCHbllle 7%) III - aHc)iIIJIO-
HJ.{Hble C HHAeKCOM JJ;HK 60JlMUC 2,2 H '-IHCJIOM KJICTOK II S-$a3c fioncc 12%, KO-
TopbIe CBSl3aHbi C .tal160JIee He6naronpl1THbiM nporHo30M. JJ;l1nnOI1}:(HbIe onyxonl1 C
BblCOKOH npojm$cpaTl1nHoH aKTl1nHOCThto KnCTOK 11 aHe)iI1JIOI1J.{HbIe HOBooupa30-
BaHI1S1 C HHAeKCOM JJ;HK R TlmnnOI1AHOH-OKO.TlOTeTpannoHJ],HoH 06nacTI1 H HI13KOH
npOJm$cpaQI1CH KJICTOK 06pa30naJIl1 II - npOMe>KYTOt[HbIH THrI. B 3T)i >KC l'PynllY
OTHeCCHbl aHeynnol1AHble fl1CTOrpaMMbl 60JlbHblX,n KOTOpblX Hen03MO>KHO pacc'-m-
raTh Hcno IIpOJIH$Cpl-lpytoI1.(HX KJICTOK. YKa3aHHLlc 1'11111>1 .L1.HK-ntCTOI-paMM KOp-
penl1pYfOT C n03pacToM 60JIbHblX, CTeneHhlO 3nOKa eCTReHHOCTI1 onyxQ.'IlI1 H cOJ.{ep-
>KaHI1CM pcu,erJTOpOB C1'epOI1AHhIX ropMOHOn,11 SlnnHtoTCSI TaK >Ke. KaK M CTCIICHb
3J10Ka [CC ['BCHHOCTI1 0llYXOJlI1, HC3aBI1CHMbiM $aKTopoM npOrHO:ia.
flpM peTpocneKTHnHoM 113Y'-ICHHI1 409 CJI)i'-Jacn paKa MOJ[O'-fIIO" >KeJle3h[
Fallcnius A. 11 coanT. [1986] nOKa3aJII1 OTCYTCTBl1e '-leTKOH KoppenHQl111 Me>KAY
ypOimeM pCI\cn I'OpOB cTcpmlJ.{Hblx ropMOHOB, COHCp>KaHHCM }J.HK n KJICTKaX ony-
xonH 11 xapaKTepOM npOl\eCca B nOJ],}t,-IbIlUe'-IHbiX nHMcp3TJ1IIeCKMX Y3J1ax. 3'1'11 napa-
MCTphi HBJlSnOTCS) IIC3anl1CI1MhlMI1 nporHocnl'-ICCKHMI1 q)aK'fOpar..m. rJanHcHThi C /1,11-
- nnOI1AHblM paKoM " fie3 MeTaCTa30R n nOAMbimeLIHhle nl1Mcpa1'l1'-leCKl1e Y3nbl I1Me-
10'1' HaHJly wl1l1 nporH03, 95% 113 HUX I10CJIC npoBcgcHHoro Jle leHHH )l(I1BYT 11.eCHTb
H 6OJ1ee neT, n TO npeMH KaK TOJlbKO 31 % fiOJ1bHbiX C aHeynnOI1J.{HblMI1 onyxonHMI1
Ii MCTaCra3aMI1 n m1M$alwleCKl1e Y3Jlbi J.{O>Kl1naCT AO 10 JIC'!". An"wpM ACJlafOT 11(,)-
BOA, LITO aHaJJH3 nnOUJ1,HOCTU onYXOJIU RMeCTe C Ol.eHKOM COCTOS!HI1H nI1McpaTH'-le-
CKI1X Y3nOB (eCTb Jm n HI1X MeTaCTa3bl I1JTI1 HeT) MO>KeT OUCCnC"II-ITb UblCOKYIO 1'0'-1-
.!
188 TOM 11- YACTHbIE AHAJll1TI1YECKME TEXH0J10rMI1
HOCTb npOrH03a J\ml 311a ' UlTenbHOlf rpynnbl naI HCHT()D.
,[(aHilbie Comelissc C. H coaBT. [1987J CBHHCTcnbCTBYIDT, '-11'0 Y 60JILHMX npH
aHeYIIJIOJ1HHOM paKe MO.fJOlII-IO" )f(CJICJbl 'IaCTOTa peIU1}lJ1BOB BLllllC. a Bbl)f( mae-
MOCTb HH)f(e, 'le\1 npH l1.UllJlm1}(HLIX onyxomlx. 3n1 JaHHCHMOCTb 6oJ1ee 'leTKO BI.I-
pa)f(eHa npH MCCHlopacnpOCTpaHHOM paKC. B TO BpeMst KaK np 1 HaJUI'IUH ()'r a.neH-
HblX MeTaCTa30B KOppemU{1U1 J10Ka:mTeJIeff 60nee cJIa6a . OCHOBhlB<UICb 1m AaUHblX
t.-tHOroqJaKTopHoro aHaJlH3a, mnophl J10Ka3blBaIOT, 'ITO y 60nl.HbiX B MeHOm\Y3c
IInou].{HocTb onyxolHl }IBJIHCTCSI He3aln1CHMbiM (JJaKTOpOM nponlo3a.
B 34 KnHW1Kax HU]1,CpJIall1'OB Baak J.P.A. J1 coan-I'. [1989] Ha mCTOJIOrH'ICCKI1X
npenapaTax 3000 OOJlbHblX I1CC11e.n.OBa!H1 J1pOnIOCTWICCKYID l eHHOCTh II BOCnpOlI3-
BOHHMOCTb Mop<fJoMeTpll'ICCKOro M}'JIbTHBapuaHTHoro HIIHCKca (MPI), HHp,CKca
,[(HK, ApyrHx KOJUI'lecTneHHblx. napaMCTpon B cpaBHeHHH C 113BeCTHhlMU J1pc:.WHO-
CTI1'ICCKH\1H KpHTepJUIMI1 (pa3Mcp onYXOJIu. cTaTYc pcrHoHapHblx ;IU 1$aTHqeCKHX
Y3JI0I3 H ypOBCHb pelJ,enTOpOB CTCpm1}mb1X ropMoHoB). MOpcpOMcTpl1'lecKl1if MHO-
_ u _
rOni:lpHaHTHblu npOrliOCTI1'ICCK1U1 IIH.LJ;eKC B KOMmlllal HH C HHp,eKCOM MHTOTWIC-
CKO" aKTHBIIOCTH. pa3MepOM onYXOJII., 1-1 CTa:rYCOM mIMcJ)aTH4CCKHX Y3JIOn ,((anaJI
npl16m13HTeJlbllO Ha 20% OOJIee TO'IHhIH nporm)], 'ICM npn PYTUHHOt'1 ruCTOJIOI"H-
4CCKOH OUCHKe onyxonH JI pCrHOllapl-lblX JU1McpaTH'leCKHX Y3110B. OpHMeHeHHe MPI
-
MO)f(eT cnOCOOCl'nOUaTb JIY'lweMY nelleHHIO MHOI'HX lIaQHeHTOB npH paKC MOJIO'I-
Hofl )f(CJIC3bl. npOrHOCHI'leCKH (3)f(CH TaK)f(e mll1.eKC JJ.HK, OllpcAcJISleMblH MeTO-
OM npOTollHoH I I'ITOMC rpHU.
no Halm1 1 1,alll-lhl/l1. YBem1 l lel-lUC OCUOBllhlX Mop<pOMeTpHlleCKIIX lIapaMCTpon:
1I110 3)UI (Sl>255,3 MKM2), IICpUMCTpa (P1>63,1 MKM) ollyxoncnbIX KneTOK H stJl,Cp
(S2> 170.1 MKM 2 : P2>49.2 MKM), HX nOJlln,lopctm:iMa (F2> 1, 155), CRI1}(CTClIbcTuyeT
o MCUCC 6Jlan>npmlTHoM npOrllO:iC paKa MOJIO"H-IOM )f(eJIc:,u.1. PaC'ICT Kp mbIx 06-
IL\CH nl>I)f(HnaeMOCTI1 11 fiC3PCI(IIHI'1BHOfl nbDKHBaeMOCTII IIpO[m:wnc ''''leTO OM no-
cTpoeHH Ta6mu{ HO:>I(I1TI-ISI no Kaplan E.L. U Mcicr P. P 958111 cpaBllCIHlC llOC 1'0-
ncpHOCTH pa3nH'IHH 3THX nOKa3aTf JleH C nO\10U\bIO TeCTa log rank nponol IL10Ch H
npOrpa!\1MC Survival. npe.nocTmmeHlloM OTllC.IlOI\1 CTanlCTI1KH M.D. Andcrson
Hospital (ClllA). Mllom<p3KropHblM alla11113 npOBO,(I1JICst IIYTCM EaecoRcKoff npo-
U.e.nypbl C 1I0MO blO naKeTa nporpaMM .IJ..'IH KO\1nbIDTCpHoro aH3JIH3a SAS B.1USI-
IUIC nJIOH1lHOCTH onyxOJICRhiX KJICTOK Het oO YIO Bbl)f(llBaeMOCTb 60!lbHblX 6e3 YlIC-
Td CTa1lH" paKa OT'ICTJIHBoe. Y OOJIbHblX C Jl,llIIJIOH1,HblMH (l-SI rpynna) H TCTp311-
JIOl1nHblMH OIlYXOJIHMU (2- rpynna) OTMC'laJlOCb OTHOCHTeJlhHO HoopOKa'ICCTBeH-
Hoe Te'IeHHe 6OJle31U1, IIOKi:l3aTenH o6u\eM BI>I)f( lBaCMOCTIi (OB) Ka)l(AOH U3 3THX
ABYX l-pYlm CT<\THCTlilleCKIi 3Ha'IHMO OT11I1'JaJ1HCb (p<0.05) 01' cooTncTcTBYIO HX
nOK33i:lTeneH 60nbHbix C aHcynnou,((HblMI1 onyxomlMI1 C I1JJ:IIK n HHTepRane 1,1-
1,84 11 < 1,0 (3-H rpynna) II C MIlOrOKJIOHOBblMIi aHeynnOHJ("hIMII OIlYXOJIHI\H1 (4-
rpynna). OB 60nbublx C MHorOKnOHOBblMH onyxomlMI1 (4-SI rpynna) 6bUia uauxY1l-
llICH 11 OTJIH'I£UIaCb He TOJII.KO OT COUTBeTCTnYKHl{UX 1I0Ka:iaTCJICH UOJILHblX 1 H 2
rpynnbl, HO T3K)f(C Ii OT 013 60nbHbiX 3 rpYIIIILI (p<O,05).
fIpH PM)K Tl-2NoMo Y 41 (37%) 60JlbHOti Ha6.TJIOAaJUfCb .fJ.llnJIOU;1f1bIC 11 y 71
(63%) 60JIbHOH - allCYJlJIOJ11lHble onYXOJIH, R TOM 'IHCJIC Y 8 (7%) OOJIbHbIX - Te1'-
pan11 m mHblC onyxOJm. Te l lcUl1c 60JIC3HI1 y 6U.fJbHb1X C J\lmnmIHULII\H1 UIIYXOJI MH
OTHOCHTeJIhllO llo6poKa ' lecrneHHo, nOK33aTCJII1 BPI3 U 013 31'011 rpynnhl 60JII.llh1X
CTaTHCTH'leCKH 3Ha'ntMO BblWC, llCM 60nbHbiX C aHeynJlm1HULIMI-I, HC TeTpanJIOHA-
HblMH onYXOJlSlMH (p < 0.001 .nJ1 EPn H p < 0.02 HnH DB).
-
I
I
I.JJ;ITOJ10rJlP-IECKI1E I1CCJ1E,o:OBAHI1}1 189
I
.
ThK, aHeynnmlJ.(Hbie onyXQ.TU1 HMcnH 3Ha\IHTeJlhHO Gonce BblCOKYIO (p<0,05)
nponmpcpaTHBHYIO aKTHBHOCTL, \leM AHnJIOJiAHLle, B TOM '-/HCIIC Gonee BblCOKYIO l-IO-
nI{) KneTOK, lIaXOJ\Slll.(I1XCH B S-cpa3e KneT04Horo lUIKna. Te'-Iemie 60JIC3HI1 y 60JIb-
H!>IX C J.(HnnOHAHbIMH onYXOJ1HMH 6bl110 3Ha t IHTenbHO nYlllue, '-ICM Y 60JILHblX C auc-
YIIJIOH HbIMH onyxonHMH. 5-TH H 1 O-JlCTHSISI 6e3pel(Hn 1BHaH BLDKHBaeMOCTb 60Jlb-
HblX C HH[JJIOHAHbIMH onyxomu.-m COCTalHUla 94 :t 4 % H 85 :t 7%, a y 60JIbllblX C aHe-
YnJIOHAHbIMH- 67:t 7% H 52:t 10% COOTOCTCTBeHHO (p < 0,01).5- H 10-neTHSISI 06-
ll.(aSi BbDK maCJ\'IOCTb 60nbHhix C AHnJ10H HbIMH onyxomlMH 6blnH 100% 11 96 :t 4 %,
a y UOJILHLIX C aHcY"JIOI1AHLIMU onYXOJlSlMH - 84 :t 5% H 68 :t 10% COOTBeTCToeu-
HO. Pa:mJilIHSI 6e3pC I1A 1BHOfl BhI>KIIBaCMOCTH CTaHOHHnHCh craTl1CTWleCKH 3Ha'-,"-
MblMH noeJIC 3-ro rO]la Ha6JIHJAcHI1H. Y 60jlbUhlX C A mJ10HAHbIMI1 onYXOJIHMU Ha-
6JIIO).\aJ1CH B 2,3 pa3a GOJ1ee HH3KHI1 pHCK pa3BHTHSI PCI(I1HHHC1 GOJle3HH no cprumc-
HHIO co BceH rpynnoH 6onbHblx. TaKI1M 06pa30M, nOKa:JaTCJII-f AHK-npOTOtIHOH L\H-
TOMCTpl-fH HMelOT npOn-lOCTJilleCKO 3Ha l lCHHC IIPH paHHeM paKC MonO"IHOH >KeJle3bl.
npl-f MHoro<paK ropHOM aHa.'1l13e npOrHOCTH'-leCKHX npH3HaKOB y 60JlbHbiX
PM)J( 6e3 nOpa>KCHHSI perUOHapHblX J1HMcpaTH t ICCKUX Y3JIOB (pHC. 6) mmCKC IIJIO-
I1AHOCTH (1Ul/1,eKc ]1HK) OKa3ancSJ eaMI>IM CHJ1bHbIM (l)aKTOpOM npOrH03a (nOpnlOH
CM.. 1997).
P3
pn
0,36
0,57
0,31
o 0,5 1 1,5 2 2,5 3 3,5 4 4,5 S
1,08
0,57
T
A.L\. rep<HIIUI
I1HAeKc nJJOUAIIOCTU
4,59
I'IICTOJT. (})OpMa
l
Pue. 6. BecoBble K03cp<pHllHCHTLI (no llleHi-IOIlY) npOrHOCTI1"leCKH 3Ha'-mMh1X npH-
3HaKOII y 60J1bHLIX PM)J( Tt-4NoMo C 1-13y t leHHoM nJlOI1AHOeTblD onyxonH
B03MO>KHO pa3J],eneHl1e 6D-'IbllhiX PM)J( TI-2NoMo C O}tHOUpCMCHHhlM Y"leTOM
nJ10HJ1HOCTH H I1HAeKCa npOJHHpepaTI1RHOM aKTHlUlOCH1 (I1nA) onYXOJleHblX KJIC-
TOK Ha cneAYIOIl\HC rpynnl>I: 1) C .Ql1nJIOII)tHhlMI1 onyxonHMH H I1nA HC 6()JJCC 30%;
2) C allcynJ10HAHbIMI-f, He TCTpallJ10H,QHI>IMH onYXOJISlMI1 U I1nA He 60nee 30%; 3)
C aHeymI0l1)tHbIMI1, HC TeTpamlollHublMU onYXOJ1HMI1 11 I1nA 60JICC 30%. Y 60J1b-
HLIX I-H rpynnbJ Ha6J11ogacTcH A06poKa t lecTBcHlIOC 'J"C"ICHl1e 60Jle31ut, C HblCOKllMH
nOKa3aTC.'ISlMI1 EPB HOB. Y 60JIJ,UbIX 3-H rpynnbl npoucce PCI\I'I}tHm1poBaHHH 60-
JIC3H11 HJ],eT Ol.leHh 6ypuo, 3-JleTHHH EPB COCTaUJIHCT JH1Wb 61 %, 5-neTHSIH - 43%,
10-neTHSISI - 29%. nOKa3aTem1 60nblfl.lX 2-H rpynnbl 3aHHMalOT npOMC>KyrollHoe
IIOJIO>KeHI1C Me>KHY I-fll1 3-H rpymHlMH. AoeTORCpHOCTb pa:mwlHH EPB: Me>KHY 1
11 2 rp)'lInaMH - p < 0,05; Me>KHY 1 11 3 rpynnaMI1 - p < 0,001; MC>KJij' 2 11 3 rpynna-
MH - P < 0,05. AocToBepHocTb pa3J111\nlM OB: MC>Kgy 111 2 rpynnar...m - p < 0,05; Me-
>KJ.\y 1 H 3 rpynna U1 - p < 0,001; Me>K)W 211 3 rpyullaJ\-1H - p < 0,05.
190 TOM II - "lIACTHbIE AHAJII1TltfliECKME TEXHOJIOrl111
TaKI1M 06pa30t.,t, npOI3CACmlbJi1 CTaTI-ICTWICCKl1ft aHaTm3 nOKa3aJ1, TO naI\l1eH-
rOK C Hl1nnOJ.iAHbIMH onyxomlMH YMepno :m rO}J;bl Ha6nlOAeHHH MeHbwe (p<O,OOl),
'-(eM C aHcynnOH}J;HblMI-I HOBo06pa:mnaHHHMH. ,QHI1JIOI1AHI.>IC H aHcyrulOHJ],Hble 1I0HO-
o6pa:mnaHHH (1,4<I1,[(HK<I,84) C nblCOKOH npo.'IH epaTl1nHOH aKTHI3HOCTblO
(I1IT>30%) HnnSiIOTCSI nporHocTH1.lCCKI1 Heonaronpl1HTHI>IMI1. a C01.Jc'raIlHC TaKHX
L{HTOMCTpW-ICCKHX nOKa3aTcnCH C nepC1.JHCnenHhlMH MopcfJOMeTpwiecKI1MH napa-
MeTpaMH eu\e 60nee oTSIroLL{aeT nporHo3 [B.H.EoraTblpclJ, 1991]. CJICAYCT TaK>KC
OTMCTIiTh, 1.1 ro TCTpallJlOHAllblC onYXOJUI (II THn ,QHK-rHcTorpaMM) H KapQI1HOMbl
C H,QHK 01' 1,1 AO 1,3 C HH3KOH 11 YMepeHHoM nponmpcpaTlHuloti aKTI1BHOCThlO
KJ1eTOK (III THn JJ;HK-rHCTorpaMM) HBJ1HIOTCSI 60.T1ee onaronpmlTHblMU B nporHo-
CTI1'ICCKOM IlJIaHC aHcynnol1J].HblMH HOBoo6pa30BaIUtHMH. a peJ],KHe BHAbl - MHoro-
KJIOHOHhlH paK (V THn JJ;HK-rHcTorpaMM) 11 onyxonl1 C pe3KO Bblpa>KeHHoi1 aHeyn-
JlOH HCH, I1,QHK > 2,15 (IV Tl1n JJ;HK-I'HcTorpaMM) caMblMH He6J1aronpl1S1THbIMH
C .rO l lKI1 3pCHHSI nporH03a. KOJlH'-leCTBO aHeynJlol1AHl>lX KneTOK n Honoo6pa30naHI1H
HC BJIHSlJIO Ha CKOpOCTb nporpcccHpoHaHHH 3a6oJlenaHHSI, B OTJIH1.lI1e OT nblCOKoro
yponHH npoJ]H epaQHH, KOTopaH HaGJlIO,[{aJlaCI> Y OOJILHI>IX C paHHI1M MeTacTa3l1po-
DallHCM onyxOJHi. AHaJlH3 AaHHhJX nOKa3aJ1, '-11'0 HHAeKC PHK (MPHK) HBJISIeTCH
MeHee TO'-lHbIM npOrHOCTI1'leCKHM napaMeTpOM, 'ICM 11)J,1-IK. TaK, y 60JlbHblX 6C3
nporpeccHponaHHSI H C nporpecCl1pOl3aHI1CM 3a6oJICnaHI1S1 O,[{I1HaKOHO '-!aCTO nCTpe-
'IaIOTCH MHHHMaJlhHhIC, CpCJ],HHC 11 MaKCHMaJlbHble 3Ha1.JeHHH HPHK, HO npl1 3TOM
OTMe'laeTCH TC CHL I1S1 K yncnH1.lCHHIO 1.lI1CJla nallHCHTOK C Xy.n;IIIHM nporH030M
npH I1PHK >1,1.
KOJlH eCTBeHHl>le napaMeTpbl KneTOK onyxoJlH H cc MaKpocKOIm'lccKHfl pa3-
\1Cp HC CBH3allbi MC>KJlY C060H npHMo nponopl HoHanbHo. ITpH npOrH03e 3a60Jlcna-
HHSI He06xoAHMO Y1.II1TblBaTb, 'ITO Y>Ke onyxoJlI1 no 1,0 CM 13 Al1aMCTpC 6bmalOT aHC-
ynJ10HAHbIMH, C YBCJII1QCHHI>IMH MOp OMCTpH CCKHMH nOKa3areJISlMH KneTOK,
OTAaneHHble pC3ynbTaTbl TaK>KC CBHACTCJILCTIJOnaJUI, '-11'0 IJ rpynne nal\lteHTOK
C nporpcccHpoBamlCM 3a60!lCBalH1S1 U y YMCPU1I1X 60JlI>HbIX. KneTKH perHoHapHLlx
MCTaCTil30B MeHee AH $epeHL HpOnaHI>I. "ICM ncpm14HaSi onYXOJlh, a n alleynnoHA-
HblX MCTac'ra3ax, B 60J1l.IIIHIlCTne Ha6mo.n;eHHH, KpOMe Toro C nonblweHHoi1npOJII1-
epaTHBHOH aKTHBHOCTblO (p<0.05). B TO npCMH. KaK B rpynne 60JIhHhiX 6eJ npo-
rpCCCHponaHHH 3a6onenaHHH KOJlH'leCTBeHHble napaMCTpbl KJICTOK onyxoJlI1 H MC-
TaCTa:mB npaKTH"leCKH HACHTH'IHLI (p >0,05) [B.H.EoraThipeR. 1991]. DpH lUo60f1
C ra)\HI1 npOl ecca, nHe 3aBHCHMOCTH 01' MopcfJOJlOrH'lecKoro BapHallTa onYXOJll1 H
npoBegeHHoro JIC ICHUSI nl.lHUJICII KOMI1JICKC napaMeTpon, cnHgeTenbcTnYIOLL{I1H 0
He6J1arOnpHHTHoM nporH03e paKa (Tet011.3).
CpCAH 3J10Ka'ICCTBcmll.lX onyxOJICH paK nerKoro JaHHMaeT oco60e MeCTO. 1.1'1'0
CRH3aHO, C OAHO" CTOpOHI>J, C pOCTOM :mOOJJCnaCMOCTH. a C HPyroM - C oco6eHHO-
CTHMH pa3BHTHH H Te'-ICHH}{ onyxoJlclJoro npOI\CCCa, '!aCTO C 6blCTpO n03HHKalOli.(U-
MH JUlM OrCHHhIMH H reMaTorCHHhlMH MCTaCTa3aMH. ,lJ,.nH I3Llpa6oTKH pm-l.HOHaJlb-
HOM TaKTHKH neJ],eHHSI 60JIbHblX paKOM JIerKOrO Da>KHO 3HaTb TO'lIIblW nponl03 3a-
6oJlenaml}l. Mop$OJJOn1 ICCKaH crpYKlypa H pacnpOCTpaHeHHOCTh onyxoJlcnoro
npoQecca HC ncer a SlBnSlIOTCH gocTaT01.IHblMH cpaKTopaMH R onpeAeneHHH nporHO-
3a paKa JICI'KOro.
Y 78 oom.>HLIX IIJIOCKOKOKJICTO'lIIb1M paKOM nerKoro napanne11bHO HCC11e.n;ona-
Jlbl KOJlH1.leCTHeHH bIe xapaKTepHCTHKH KnCTOK onYXOJI H (1I110I1AIIOCTh) 11 ypOReHI>
paKonoro 3MOpHOHaJlbHoro aHTHrClla (P3A) R ChIBopOTKe KponH AJISI OQCHKH HX
"
QI1TOJIOrl1QECKI1E I1CCJIE,[(OBAHI151 191
npornOCTJ14eCK0l1 3Ha'UfMOCTU. Y P3AUK3JlbHO onepupoBaHHblx 60JIbHbiX paKOM
JlerKoro C 6naronpuHTHLIM TC'ICHUCM 3a60JIeBaHuH. cpcJJ.H"e 3HaQCHUH I1)J.HK B
onYXOJ1U U P3A B KpOBU AOCTOBCpHO (p<0.05) HU>KC, 'leM y 60JIbHblX c nporpcccu-
pOBaHueM 3a6oJIeBaHuH. He BblSlBJlCHO 3aBUC"MOCTU Me)f(J!.Y AByxncTHe" 6e3peu,u-
AU8HO" Bbl>KUBaCMOCTblO U I1AHK Y Pa.AUK3JlLHO oncpupoBaHHblx 60nbHbiX I CTa-
]l,"e" IIJI0CKOKnCT01.JHOrO paKa: B TCQeHUe Bcero nepuoAa Ha6J1IOAeHUSI He YMep HU
OAIIH 6oJIbHOH OT nporpeccupOBaHUSI OCHOBHOro 3aOOJICBaHUH KaK 8 rpynne C AI1n-
nOHAHbIMU, TaK U B rpynne C allcynnouAHblM paKoM.
Ta6JIUua 3
npOl'llOCTH-IeCKH He6J1arOnpHJlTHLle KOJIHIJeCTnCHHblC napa.\feTpLJ KJleTOK
onyxo.'1H y 60JIbHblX npH paKe MOJlO-lIIOH )l(eJle3bl
CTa.A UH
KOJIWleCTBeHHble napaMeTpbl
Tl No Mo
n=64
S1 > 245 MKM 2; 52 > 160 MKM2; S > 0,653; aHCYIIJI.,
B S cfJa3e > 8 % I1.!I.HK > 1,35
T 2 No Mo
n=111
SI > 260 MKM2; SIO' > 120 MKM2; PI > 65 MKM;
S2 > 200 MKM2; 52cr > 70 MKM2; P2 > 50 MKM;
aHeynn., I1,[(HK > 1,6 l1n > 23%
T3 No Mo
n=21
51 >315MKM 2 ; aHeynn., I1.!I.HK > 1,4
TI-2 Nt Mo
n=106
aHcyml., I1AHK > 1,3
Tt-2 N 2 _ 3 Mo
n=51
S20' > 51MKM2; P2 > 42 MKM; P20' > 8MKM; F2 > 1,185MKM;
I1n> 18,5%; I1,[(HK > 1,5
1
T3_4 Nt Mo
n=44
YMepeUHO unu HU3KOAUcpcpCpCHu,upoBaHHble no AaHHblM
MopcpoMeTpuu onyxonu C I1n > 21 %
T3-4 N 2 _ 3 Mo
n=101
SI > 285 MKM 2; PI > 54 MKM; 52 > 180 MKM2; P2 > 50 MKM;
aHcynn., I1JJ;HK > 1,3; I1n > 19%.
IV
n=8
aHeynn.
OTC'IHO-UHcfJ.
cpopMa paKa
n=4
aHeynn., 110 > 21 %
l
YCJlOBHblC 060'3Ha l leHHSI: n - 'IHCJIO Ha6Jl1olJ,eHIIH; aHeynn.- aHeynnoll).\HaH onyxonb; SlO',
S2cr II T.g. - cpeAHeKBaJ1.anl',eCK1fe OTKJIOHeHlfSi napaMeTpoB (T.e. nomfMopcp1f3M nplf:JHaKa)
192 TOM II - "lIACTHbIE AHAJII1TI1"l1ECKI1E TEXHOJIOrl111
I1HaH KapTlma 06HapY>KCHa Y PCVI.HKaJILHO OnCpHpOnaHHbJX 60JJLHbIX nnOCKO-
KJICTO lHhIM paKOM nerKOrO C t.teTaCTa3at.m 80 nHYTpHrpYJlHble nHM4JaTI1 leCKl1e
Y3J1hJ Tl-3Nl-2Mo. HH ONIH 11310 60JlbHbiX C AmJJIOH]J;flbIM p3KOM He YMep 01' pCLI,H-
]l,Hna H MeTaCT3308 8 TellCHHC ]J;UYXJICTHero nepHoAa Ha6J110L CI-UIH. B TO >Ke npeMH
113 17 nm\I1CHTOB C aHcynnol1AHblM paKoM 11 (65 %) 60J1bHLIX YMepJIO OT nporpec-
cHponaHHH OCHonHoro 3a6OJICRaHI1H (p<0.05).
TaKIiM 06pa30M, Y OOJILULIX C AHnnOH]J;HbIM paKOM JICrKOI"O CpeAHH" yponeHb
P3A n Kpoml ]l,OCTORepHO (p<0.05) HM>KC. I.ICM Y 60.'lhHbIX C aHeYnJloHAHhlM paKoM
nerKoro. nporpeccMpoualU1C onYXOJ1enoro npoLl,ccca B TCl.lCHl1e nepnbIX 2-JICT 110-
cne Paj.\HKaJILIIOi1 onepal I1H Ha6mD;J,3cTcSI Ilall\C Y 60nbHbiX C aHcYIIJIOUJ\llhlM pa-
KOM. HI13KHH 11,oonepal HoHHbIH ypOBCHb P3A (HI1)Ke 10 MKrhl) IIPH npollux pan-
HblX ycnoRHHx cnHAeTenLcTuycT 0 60nee 6naronpHHTHo 1 IIponr03e nocnc p3JJ.11-
KaJ1bHOrO xHpyprwlccKoro ne leHI1H. JJ;nyxncTIHIH BLDKI1RaeMOCTb Y 60JlbHbiX IIJIO-
CKOKJIC1WIHhiM paKoM JlerKoro n CTaAl1l1 Tl-3NI-2Mo AocTonepHo (p<O,05) Bblwe C
]l,HnnOH,IJ;HbIMM onyxOJ1H 1Jf. l.leM C aHcYIJJIoUJ\Uhlt.HI. I
AHaJUl3 A<lUHIJIX 06 OTHaJlCHHblX PC3YllLTCrraX .rIel.leHUS! 114 OOJILlibIX C OCTeo-
rCHHofl capKOMO" t y 40 OOJlbHblX C capKoMoH IOHHra CBI1J CTe.1bcTRyeT, "iTO aHC-
ymIOH,rJ,Hble onyxoml IMeloT (p<0,05) XY]I,WI1H nponlo3, IleM ]l,HnJIOHA(ILIC HORo06-
pa30UamUI.
KJICTOl.(HaSi cycneH3HH Y 6WlhllbiX C onyxonbto IOmlra 8 6 cnY IaHX UbIJIa 1I0JIY-
leH3 W.i cnc>I<ero 6nonCHHHOI"O MaTcp lana, 8 34 - M3TCpl1aJi nOJlYl.leH 113 napactm-
H08bIX 6nOKOB OIlYXo.!1H nocne CTd.H]I,apTHoi1 npORO/1,KH 8 cnHpTax. AHcynnOH]I,HbIe
onYXOJlH COCTa8HnH 58%, J.\I1IIJIOI1JlUble - 42% HaOJIIDJ.\cHIIH. OI eHKa 6m1)K3HWI1X
pe3YJ1bTaTOn XUMHOJIYYCBOfl Tepanml nOK33ajia (B cpe;J,HeM n Te leHHC 6 MCC 01' Ha-
l.IaJ/a Jle1IcmlH), 1.11'0 OTMel.l3eTCH TCHACHUUH K fioJlce n03!meMY MCTac ra3Hpo8aHHto
11 pCI 1-IAUBHpo8aHHto y OOJlhUblX C wmnOHAHblM BapHaHToM onYXQ.TIH IOHHI'a. Eonee
arpcccimiloc rel.leHl1e aHCYITJIOUHIIOro RapHaHTa C3pKOMbi 1OI'IHra MO)KeT OblTb
06LSlCHeHO HnJICHHSlMH onyxoJ1enOrl nporpCCCIUI, l.(TO nO/1,Tnep)K]I,aCTCSI 60Jlee 8bl-
COKOH nponl14JepaTH8HoH 3KTUBIlOCThfO, leM npH HnJl0l1AHm1 8apl1aHTe (p<0.05),
8 TOM 'lHcnc 601ll.III11M KonU'leCTBOM KJICTOK, HaXOASlLI.lUXCH n S-<IJa3e KneTOl.lHoro
Ll,HKJI3, 3 TaK>KC 60JIblllOH Hapl-lal HCrl I1,ijHK.
OrpaHl1 t leHHOe tIMC..'1O lIa6moT\CHHH Ie n03nOJIHCT nOKa C RblCOKol1 crCnCllhKJ
/1,OCTonepHOCTH OL cm1Th l.IYRCTnI1TeJ1bHOCTb K XUMHonY1leBOMY JICtICIIIHO. OfJ,HaKO n
MaTCpl1aJIC HaIIIH,.. Ha6mOHCHHli JjHlL'lml:1Hble onYXOJHI Ka>l<YTCS! MeHee 'IYBCTBI-I-
TCJlhHbIMH K nptyrl1BOolIyxoncnoH Tcpamm. [1011lIaH perpeccml onYXO!HI. onpe]l,e-
J1S!eMaH pcmTeHO-JlOrJl t lCCKH H, B HCCKOJIhKI1X CJJYI.JaSIX - 1OP4JOJIOr"tleCKH, Haomo-
]l,anaCL n 10% IIpU }umnOH]I,HOM napltaH rc U B 50% npll aHCYIl110HHHOM, I.ITO MO)!(CT
6blT.. O1"-laCTH cnH3mlO C I1X pa:mll t lHoH npoJllupcpaTHBHoi1 aKTl1nHOCTIAO.
CCPUSI HCCJIe]l,OB3HIH1 C IIOMOlllbKJ MeTO]l,a ,ijIIK-npOTO IHO" LlI1TOMCTpml R I e-
}lOM conna.uaCT C J.\allllbJMH, nOJIY ICHHbIMH pattee C nOMOll\blD J-lpyrHx MeTO]l,on aHa-
J1U3a KJICT04HOi'1 KHHCTHKH 1-1 Komll.lCCTna JJ;HK: 3HCYIJJI0I-1]1,HblH BapHaHT capKOMhl
IOHHra Ka>l<CTCS! 60nee arpCCClIBHhlM B npOrHOCTH'leCKOM OTIlOlIleHHI1, HO O]l,HO-
BpeMeHHO, TpeOYCT HCCKOJ1bKO OT..'IH'IaIDIl\CHCH OT :1l1nnOH Hot1 onyx()j1H TaKTI1KH
Tep3nHH. ,ijHnJ10HfJ,HbIH n3pHaHT capKOMbl IOI1Hra, HCCMOTp 1 lIa HeKOTopoe OOJlce
1I0JlaronpHSlTHoe" nonCHCHHC, xY)Ke nOMaeTCH L\HTOCTaTUl.leCKOH TCpamlM 11 xapa-
KTepH3yeTcSI HCCKOJlbKO 60nee n03]J;HHM pa3B1fnleM peI HAl1nOn 11 MCTaCTa30R. 803-
MO)KHO, npl1MCHCHHC ,ijHK-npoTO'IHOrl Ill'lToMeTpHH n nepcncKnme MO)KeT CTaTb
....
LJ,11 rOJIOn,fYECKI1E J1CCJIEJJ,OBAHI15I 193
O.n;IIHM H3 3J1CMCHTOB mAUBH.n;ym>uoro nporH03upoBauHH PC3KIUUI onyxOJ1H IOHilra
Ha XHMHOJ1Y'-leBoe ne'-leHHe.
OnblT paGoTLI, HaKonneH.lblH B na6opaTopuu KJlmlWleCKOH QHTonorHU OHli.
HM. H.H.EJloXHHa PAMH, .n;aeT OCHOBaHHe nOJlaraTb, \ITO C nOMOl M() KOnH\leCT-
BCHHblX MeTUAoB ctHctJU-t3a MO)/(HO: o60eKTHl1uJHponaTb UHTOJIOrH'-ICCKHC KpHTC-
pMU, YJ1Y'-IIIIHTh .n;HanmCTUKY H NlcfJcfJepeHl\ laJlbHYIO )1,HarHOCTHKY onyxOJleH H He-
onYXOJIenblX nOpa>l<eHHH. nponeCTH KOJ1l1\leCTBeHHYIO OQeHKY HJMCHeHUH B KJICT-
Kax, npOHCXo]lHIl\HX B pe3YJ1hTaTe JTe'-leHHH, H3Y'-lHTh CO)1,ep)KaHHe ,[(HK, PHK, 3KC-
npeCCHto P-rJ1HKOnpOTeHHct HreHa p53 B KJleTKaX onYXOJlH, H IlOJIY\IHTb H3AC)KUbIC
nporHOCTWleCKHC KOJlH\leCTneHHble nOKaJ3TCJlH.
I
cnUCOKllUTEPATYPM
1. ABTaHAHJlOB r.r. Bne]J,eHHe n KOJlH'-leCTBeHHYIO naTOJlOrH'lecKYIO MOpcfJOJlO-
rHlo.-M.:MeAHQHHa,1980.-216 c.
2. AnTaH]lHJloB r.r. np06J1eMa naTOreHeJa H naTOJlOrOaH3TOMH'-ICCKOH AHarHOCTH-
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IOLLlI1X 1I0BblCUTb 'IYRcTBHTeJ1bHOCTb H cncLlHcpwlIIOC fb MCTOAa U paclliupHTb
cneK1'p BblSlBnSlCMblX (aYTo)aHTHTCJI (M anTHreHoB) npu BocnanUTCJlbHblX, ayrc)HM-
MYHllblX U HHcpeKI\HOHHbIX 60nC3HSlX 'lcnOBCKa. f1paKTH ' lcCKH 11<1)M nOl.ITH nonHO-
CTblO 3aMCHHn PI1M, nOCKOJ1hKY 06a MCTOna I1MeJOT CXOAHYIO l.IYBCTIUlTCJII.IIOCTh H
cncLl fcpwIIIOCTh, HO J.1<1)M He Tpe6YCT paUOTbl C pa; HoaKTHHHbU\'1H KOpOTKO>Klmy-
ll{I1MH 1130TOnaMH. KpoMC Toro. 6Jlarol1,apSl6oJ1ee BblCOKOH TO'UlOCTI1, nocnpm13BO-
AHMOCTH, CTaH[\apTI13al{I1H H B03MO>KHOCTH m3TOMaTH3a1\HH, I1<1>M nOCTenCHHO Bbl-
TeCHSleT Ii [\PyrHe MCTOAbl, TaKI1C KaK HMMYHO JlIOOpeCl{eHLlHSI, arrJltOTlmal\HSI. pe-
aKLlI1S1 CBSl3bmaHHSI KO mJleMCHTa.
PeaKmUl3bl O.llR lIcc.IleOOOa1ilLH.
1. EycpCpbl JVlSI HMM06HnH3aLlHH aHTHI"Clla (coating).
a) O,OlM cl>occpaTHhli'f 6ycpep. cOAep>Ka lfH 0.145 M NaCi pH 7.2.
Na2HP04, 12H 2 0 2,680 r
NaH 2 P0 4 H 2 0 0,345 r
NaCl 8,474 r
H 2 0 1 nwrp, AOBCCTH pH, xpaHHTb IIPH 4°C
6) 0,05 M Kap60HaTllhiH Gycpep pH 9,6
Na2C03 1,59 r
NaHC0 3 2,93 r
NaN
3
H 2 0 [\0 1 nl1Tpa. xpaHHTh npl1 4°C
I
-
:.-
METOAbl KJU1HMllECKOH MMMYHOnOfl111 199
B) fJll.lI l1nODbU1 6ycpep pH 10,4
D1I1lU1H 7,50 I'
MgC1 2 0,203 I'
Zn(S04)2 0,288 r
H 2 0 AO 1 JlI1Tpa, ,QOBCCTI1 pH JJ.O 10,4
2. Ey<J:>ep ]VIS! OTMblBKI1/pa3Bep;eHI1S!
0,01 M <I>OCqJaTtlblH 6ycpep, COnCp)KaLU.I1H 0,145 M XJIOpl1CTOro HaTpMSi pH 7,2
rOTOBHTCS! TaK)KC, KaK 11 6ycpcp ,[VUI I1MM06I1Jli13aLlHI1, 3aTeM B 60JlblUI11-1CTBC cny-
meB .D.06aBJlS!(OT 1 % Tween 20.
3. XpoMoreHHble cy6cTpaTbl
a) p-HI1Tpo<J:>eHwl <J:>oc<J:>aT.
5 Mr p-HI1Tpo<J:>emm <J:>occpaTa paCTDopSlJOT B 5 MJI rnl1lU1HOBoro 6ycpepa
6) OpTocpclIl1JleH-p;HaM'I1H (0<1>)),)
8 "'-II' O<1>,I::L pacTRop UOT B 12 MJI 0,1 M LlI1TpaTHo o 6y<J:>cpa pH 5,0. no .J1e pac-
TROpCfllUi }106aRJUUOT 5 MKJI 30% IICpCKI1CI1 BOnOpOna. PacTBop coxpaHS!cT CTa-
6HJlbHOCTh B TC'ICHI1I1 1 '-l R TCMHOTe. M36eraTb nOIi aHlul Ha KO)Ky 11 CJ1I13I1CTble.
B) 3,3',5 ,5' -TeTpaMeTI1JI eH3I1j1,HH (TME)
PaCTBOpl1Tb 10MI' TME B 1 MJl }1I1MeTI1JlcYJ1bcpoKCI1lJ,a. MCWICHHO CMeilJaTh B
100 MJ1 0,1 M allC raTHO-ltI1TpaTHOI"O 6ycpepa pH 6,0. )),o6aBHTb 20 MKJl 30% nepe-
KliCI1 B0}10pO}la. MCnOJlb30BaTb B Te'leHI1I1 30 MI1H. '
1') 2,2' -a311HO-JJ,I1-(3-:-;rnm6eH3TI'1a30J111 H-6-cYJ1b'cpOJiOuaSi KHCJJU-fa) (ABTS)
PaCTBOpl1!b 5 Mr ABTS B 50 MJI O,1M ltI1Tpa-r-cpocqJaTHoro 6ycpcpa pH 5,0. .0.0-
6aBI1Tb 20 MKJI 30% nCpCKI1CI1 BOnOpO}1a. I1cnoJlb30BaTb B TC ICUI1H 30 MI1H.
A) opTO-HHTp()cpeHI1Jl-f3-D-ra.JlaKT0311 a3a (ONPG).
PaCTBOpl1Tb 90 Mr ONPG 8 10 MJI cpoc<J:>aTHoro 6ycpcpa pH 7,2 (nporpcTb npH
50°C .D.JlS! pacTBOpCHI1S1). MaTO IHbIM pacrBop cTa611IIeH B Te'lemm I-ICCKOJlbKI1X
AHeH npl1 KOMHaTHOM TeMnepaT}'pe B TeMHOTe. ncpclJ, I1CnOJlb30BaHI1eM MaTot.IHbIH
paCTBOp pa3BOAS!T 1:10 PBS, COACp)KaLU.I1M 10 MM MgCI 2 11 0,1 M 2-MepKanTo3Ta-
HOlIa.
3. OCTaHaBmmalOLU.l1e paCTBopbl
a) 1 M CepHaS! KI1CJJOTa.
55 MJI 95% H 2 S0 4
900 MJl ]:1.HCTI1J1J1HpOBaHHoH BOJl,bl
Ao6aBIISlTb KI1CJlOTy O ICHb Me}J;J1eHHO K 60IIbWOMY o6"heMY jl,HC1I1IlJlHpOBaHHoH
BOAbl. OXJla} I1Tb, ]:1.oBeCTI1 .no 06"bCMa 1 mrrp }J.HCTI1IIJ1l1pOBaHHoii BOJ OH.
6) 2M CcpHaS! KI1CJ10Ta
B) 1M Na2C03
1') 2,5 M fl1ApoxJlOpHaSi KI1CJIOTa
T6ep()uR cjja3a. TBepp,aSl cpa3a, KOTopaS! I1CIIOJJb3yeTCS! JVIS! I1MM061fJIH3alum aH-
TureHa (06bI IHO 6eJ1KOBOH npl1pOAbl) Iml1 aHUITCJI, COCTOIfT 113 nOJUiCTl1pOJIa I1JUI
nOJII1BI1HI1JIXJIOpI1J1,a. HaH60J1ce pacnpOCTpaHCHlmH cpOpMOM TBep]:1.0H cpa3bl S!BJ1Sl-
IOTCS! U-06pa3HhlC JIYHKI1 MI1KpOnmn, pe)Ke npl1,Me'Hs!I{)TCSi npo6HpKI1 UJ111 Wapl1KJ.1.
B lteJ10)\,1 nOJIHCTUpon o6I1anaCT Mei-lbilleH 6eJIOK-CllSi'3bmalOLU.eJ.'r cnoco6HOCTbIO 11
CJIC)w aTeJ1bHO JJ,aCT HI13KQe cpOHOBOC IICCneltl1cpWleCKoe CHSl3hlBaHHe. nOJJUBI1-
miJIXJ10pl1)l HanpOTI1B OTJ1U IaCTCSI BblCOKOH a.n,cop6LlI10HHPH CilOco6HOCTblO. HO 3'1"0
MO)KeT npI1BO}1HTI. K BblCOKOMY HecIICu,Hcpl1'leCKOMY'CBS!3hlBaHHlO 6CJIKOB, npl1cYT-
CTBYIOILl.I1X B ucnonb3yeMbiX pacrBopax. OOnl1BlUIHJIXJIOPI1A np e nnO\JU1TCJ1btleHI1C-
.
200 TOM II - LJACTHbIE AHAJU1TI11.IECKME TEXH0J10rHI1
I10JlbJOBaTb B TOM CJIYllaC, KOrAa WUI l1MM06I1JIHJa I-UI B HaJIH'IHl1 I1MCCTCS! HC60Jlb-
1JI0e KOnH'leC1'BO aHTHreHa, ap,COp6l m:1 KOTOpOrO AOJl>KHa 6bl1'b MaKCHMaJlhHO Bhl-
COKoii KpoMe TOro. npl1 HCnOJlh30BaHl1l1 nOJ1l1Bl1Hl1nXnOpl1J],a JlS! nOCa)1Kl1 aHTl1re-
Ha Tpe6yeTCS! O'leHh HenpO[\OmKI1Te.'1hHOe BpeMSI (06b]lIHO OK0J10 60 Ml1H npl1 KOM-
HaTHOH Te mcpTYPc).
KOHvlOwmblll xpOMozeHHble cy6cmplll1Zbl (Tc\6Jm a 1). KOH"bl<JraThl, l1CnOJlb-
3YJOIl(l1eCSI R 11(1)M. 06hl'.JH0 npe[\C1'aRJ1S1JOT CooOH HMMYHorn06ym1Hhl. coe.o.l1HeH-
Hhle nocpcAcTBOM Xl1Ml1'ICCKOH peaKQl1l1 C CpMCHTOM, cnoc06HbiM pCarl1pOBaTh C
xpoMoreHHb]M cy6c1'paTOM. Pe)Ke I1Cn0J1b3yeTcSI 6eJlOK A, KOTOPb]H n03BOJlSle1' Bbl-
SlBJIH1'h aUTI1TeJIa TOJ1bKO O[lpC} CJICHHOro 1130Tlma (lgG). B nOCJlC}(lIce BpCMS!, oco-
6eHHo AJlS! l13yt.leHI1S1 KYJlhTYpanhHhlx )Kl1HKOCTeH, npl1MeHSlJOT 6eJ10K H, KOTOpbll1
He pcarl1pycT C 6bl'lbl1M 19 (npl1cyrcTByeT B CTaJlbHOH CbIUOpOTKC) 11 CUH3bmaC'f-
CSI TOJlbKO C IgG t.lenOBeKa.
Ta6nI1Qa 1
06 aJl xapaKTeplicTIiKa KOII'LIOl"aTOB II xpoMoreHHLlx cy6cTpaToB,
IICnOJIL3YIO HXCH B HclJM
Cy6cTp3T OCT3IIaBJlHB31O......I-IU
paCTBOp
He 'rpe6yeTCSI
«I>epMellT
1. ll(CJIO'lHaH
OC aTaJa
2. nepoKcHAa3a
3. f3-rarraKTo-
3J.1[\a3a
4. rJlI<JKOJa
OKCJ.fJ\aJa
5. Ypea3a
p-mf'l'pO CIIl1J]
oc aT
OpTO CHl1J]CHAl1ClMl1 H
( 0(1) LI,)
TCT(JClMCTl1JI6cHJI1Al1H
ABTS
OpTOHl1TpO eHl1Jl-
ranaKT03l1.lJ.aJa
DII<JKOJO-O<l> )J,
EpOMKpe30Jl
1 M CCpHClH KHCJIO rCl
2 M ccpuaH Kl1CJIO I'a
He Tpe6yeTcSI
1 M NaZCO)
2,5 M n1HpoXJIOpHaH
Kl1CnOTa
He 'I'pe6yeTcSI
A6cop6QIfH,
AmlHa BOJlHLI
405 HM
492 11M
450 HM
405 HM
410 HM
490 HM
Bl1JYaJlbHaSi
OI(eHKa
K xp0.AWZeHHbUf cy6cmpama.« OTHOCSIT BeLU.eCTBCl, KOTOpblC HC l1MCIOT I(BCTa B
HaTHRHOH opMe, a npH06peTaJOT oKpacKY B npoLlccce paCLU.enJlefmSl I10A BJII1HHH-
eM epMeHTa. B 60J1bWI1HCTBe CJ1Y'JaeB paJBl1TI1C OKpaCKl1 XPOMOI"CHllhIX cy6cTpa-
TOR Tpe6yeT onpe[\eJleHHOrO BpeMeHI1, a 3aTeM epMeHTHaSi peaKQl1S! OCTaHClBJ1I1-
BaeTCS! nYTeM p,06aBJ1CHl1S1 COOTBeTCTBYJOLU.l1X pcarCH"l"Ou. nOCJle[\Hee 3a1l1YAHSleT
CTaH)J,apTl13a l1JO MeTOAa. 31'0 AenaeT npeAnO'ITl1TeJ1bHbIM npUMCHCHI1C U(CJIO'ltlO-
1'0 P-Hl1Tp0<pCHHI] cpoccpaTa, KOTOPb]H l1CII0J11>3YIDTCSI B OOJ1hllll1HCTBe KOMep'le-
CKI1X TeCT-Cl1CTeM. t
b.llOKllPYlOu,lle azemnbl. )J,J1S1 6JlOKl1pOBaHI1S1 HeCnC I1<pU'lccKoro CUSlJt.maIHIH
CbIBOPOTO'IHb]X aHTl1TCJl C TBCPAOH cfJa30J1 1I0CJIC COp61 I1H aJlTnreHa cJ1eJ1.YeT I1C-
nOJlh30UaTb pacTBophl, cO}J,ep>Kall(ue 6enKJ.I, K KOTOphIM aH1'l1TCJ1Cl B CblBOpOTKClX
nJOHeJ1, KaK npaBl1nO, OTCYTC1'BYJOT: 1) 2% Ka3el1H; 2) 3% BSA; 3) 1 % Tween 20;
4) 2% FCS; 5) 2% fJll1U.epllH; 6) 1 % >KeJ1anIHa. Ee.'1Kl1 paCmOpHI<JT B 'rOM )KC pac-
TBope, KOTOPblj:'j l1CIIOJ]bJyeTcH JlSI l1MM06uJII-na ml aIlTl-U"Ctia. )J,nSl YMeHhllIeHHSI
BC:pOHTHOCTI1 JIO)KHOIIOJIO)Kl1TCJlbUt.IX pe3y.TJb raTOB. 6nOKl1pYIDIl l1e paCTBopbl HC
-
METO,D,bI KnI1HI1\lECKOM I1MMYHOJlOfl111 201
.
AOmKHb[ COACp)l(aTb Cy6CTall l1fl, C KO rOpblMI1 IIOTCHI l1arJbHO MorYT B3aI1MOAeHCT-
BOBaTb CbIBOpoT01.lHble aHTI1Tena.
TeepdoifJa3Hblu HC/JM. I1cnonb3yeTcSI AnSI onpcACHCHI1}1 ypOBII}I aIITI1Te.'1 (I1nl1
aHTl1reHOB) B 6110J10rl11.lecKl1x >KI1AKOCTSIX. Xoo lICCAeaOeal-/UR. 1) B JIYHKI1 MI1KpO-
nnaT BHOCSIT aHTl1reH (I1mf aHTI1Tena) B 6ycpcpc J.VUII1MM06I1J1I13a1{I1H B 06'beMe 50-
100 MKJI. (craHAapTHa}l KOtI CH"l'pau.l1 UC:IKOHbIX aHTHreHOB Bapbl-tpyeT 01' 1 AO 10
MKrhUI). MI1KpOmmThi A0.rI)l(Hhl 6blTb nnOTHO npHKpblTbI KPbllllKOH AJlSl H3GC)I(a-
HHSI I1CnapCHHSI pearCHTOB (3a HCKnfOtlCHJICM TCX CJIY1.IaCB, Kor.n.a aHTHreH CO}WP-
>KI1TCSI B OpraHHyeCKI1X paCTBOpl1TemlX, Hanpl1Mep KapAHOnl1nI1H). B HCKOTOpblX
CJlytlaSiX HMM06I-UIH:JaI{mO atlTHI'Clia MO>K}lO IIpOBOfJ,HTb npl1 37°C B Tellemm 111, HO
3TOT Clloc06 IICllpHCMJlCM JVISI MHOI'HX aHTI1J'eHOB. B Ka1.leCTBe 6ycpepa AmI ltMMO-
6l1nl13a l1li 06bl i lHO HCn0J1b3YfOT 0,01 M cpoccpaTHblii 6ycpcp, cOJ{ep>Kall{lfn 0.145
M X1IOPl1CTblH HaTpHl1 (pH 7,2) ItJ1I1 0,05 M Kap60HaTHblH 6ycpep (pH 9,6), pe>KC
fJll1l1.I1HOBblt"[ 6ycpep (pH 10,4). 2) MI1KponnaTbl UHKy611PYIOT B rCLICHl1It 16 1.1 npl1
4°C WIH CB}l3bmaHHSI aHTl1rClia C mcpHoM cpa30M. 3) YAMSIIOT W 6bITOK 6ycpepa, co-
ACp>KaH{CrO aHTl1rCH, lIyrcM IIcpcRopa L IHRaHHSI MllKponnaT I1I1HTeHCI1BHOrO BCTpSl-
XI1BaHHSI. 3aTCM B K<l>KAYfO JIYHKY Ao6aIJJISIfOT 110 200 MKn npOMblBafOlllero 6ycpepa
11 BHOBb nepeBOpa l [l1BafOT H I1HTeHCI1BHO BCTpSlXI1BafOT M1IKPOlllJaTbi (3TY npo eAY-
py 1I0BTOpSilOl' 3-6 pa3) 11 nocne cpHHaJlbHOH npOMblBKI1 YAMSIfOT OCTaTKI1 Gyc}Jcpa,
nOMelllaSi MI1KpOnnaTbl B nepeBepHYToM COCTO}lHHI1 Ha JIHC r cpmlbTpoRa.%HOn 6y-
Marl1. ,D,J1SlllpOMbIBKI1 H pa:mCAClUt IIpOO 06hl t IH0 IIcnO.'1b3YIOT 0,01 M cpoccpaTHblH:
6ycpep, cO)1ep>KalllI1H 0.145 M XnOpl1CToro HaTpl1S1 (pll 7,2). AnSI YMeHhUleHI1S1 He-
cnC l1cpl1'-ICCK()1"O CUSl3bIHaHmi }{06aHJI K>T 1 % Tween 20. 4) OCTaBlllnccSI cB060A-
Hble Y1.IaCTKI1 CBSl3bIBaHI1S1, npHcYTCTBYfOllll1C Ha mCPAoi'1 cpa3e, 6noKHpYKIT nYTeM
Ao6aBJICHHSI H361.1TKa IIMMyuOJlorH'-lecKu IfHepTHoro 6enKa. 06bJ t lHO 061,CM 6.'10-
Kl1pYHJlllero pac-mopa B 2 pa3a 60JII.IIIC, LICM OO'beM RHOCHMoro aHTl1rCHa. ,QJISI
nonHOH 6J10KHpOBKH MI1KpOnnaTbl I1HKy6HpYfOT npl1 KOMHaTHOH TCMnepaType
(npl1MepHO 22°C) B TCLICHHI1 2 Y. I1pH Hco6xOHI1MOCTI1 nce 3TanbJ I1HKy6au.m1 (CM.
nYHKTbl6 H 9) npOBoHSIT B TepMocTaTc. 5) Y)laJISIIOT OCTaTKI1 6noKHpYfOw,ero 6y-
cpepa (CM. nYI-IKT 3).6) rCYI"OUSIT CCpl1HHOe pa3Be}leHHe nOnO>KI1TenbHOHIi OTpl-U a-
TenbHoff CbIROpOTOK, BHOCSIT B nYHKH \fI1KporlJlaT B OITbCMe, paRHOM 06"be\iY pac-
TBopa aHTHI'eHa. I1ccJlc oBaHI1}1 CTaH}\apTOII 11 CblBOpOTOK cneAyeT nponoAHTb B
Ay6J1HKaTax. MJtKpOn.'1aTbl IfHKy611PYlOT npH KOMHaTHofl TCMncpilType H Te1.leHI1H 2
II. 7) Y.QaJ1S1fOT OCTaTKH UCCBSl3amm1XCSI 6enKOB (CM. nYHKT 3). 8) B Ka>K.JJ.YfO JlYH-
KY MI1KpOnnaT BHOCSIT pacTBop aHTJnen K UMMYHOrJI06YJIHUaM, KOHbHJrl1pOBaHHblx
C cooTBeTcTBYfOllll1M xpoMorcHHhlM cpCpMClI!'OM (CM, 1'a6J1.1), B TaKOM >KC 06"bCMC,
KaK 11 06"bCM HHeceHHOH CbIBOpOTKI1. MI1Kpon.'1aTbl UHKyGI1PYIOT IIPH KOMHaTHof,
TeMnepaTYpc B TC t lCHI1H 2 1.1. 9) YnaJISIloT OCTaTKl1' HeCBSl3aBlllerocSi K0111>l01'aTa
(CM. nYHKT 3). 10) B Ka>KJI.YfO nYHKY MI1KponnaT BHOCSIT COOTOCTCTBYfOll(l1H: cy6-
c'I"pa'l' (Ta6n.l) R 06'heMe. paRHOM 06"beMY pacTBopa KOH"bfOraTa 11 LICpC3 onpeAe-
neHHoe BpeMSI npl1 HC06XOAI1MOCTI1 OCTiluaBmmaJar peaKI\HIO. 11) OnpcAcllSIfOT
OIlTJflleCKYfO 11110 !"HOC I'b Ha MuorOKaHa.fJhHOM cpoTOMe"l'pe nJm COOTBCTCTBYJOll(eH
)\nHIIC BOJlHh[ (CM. Ta6.1.1).
"Sandwich" HC/JM. 31'0'1' MCTO.n. IfCnOJIb3yeTcSI AnSI onpCAeneHJUI ypomfSl aHTJ1-
reHa B 6110JIOfl11.lecKl1x >KI1AKOCT}lX. Xuo llcc.neOOl3WtliR. 1) B JlYHKI1 MI1Kp0l1JlaT
BHOCSIr pac'mop aHTHTCJI H 6ycpepe )1JISI HMM0611.fJ113aQI1I1 B KOHu.CHTpau.IfH 5-15
MKr/MJI If lmKy611pYlOT B Te1.leHHlf 16 II npu 4°C. 2)-11) Bcc OCTaJlbHble 3Tanbl no-
CTaUOBKI1 peaK lm TaKHC >KC KaK 11 B TBcpl ocpa:moM 1.-1 <l>M.
---
202 lb 1 II - llACTHblE AHAJlI1TH4ECKME TEXHOJIOfMI1
.
HeKOTophiC oG He peKor.1eH!\m.\HI1, KacaJOIl(l1eCSI YJ1Y lweHJ.ul Ka leCTua pCJYJlb-
TaTOIi M(I>M. CYMMl1pOnaHhI HI-I)Ke:
Opo6neMLI PeKoMeHJI;31{HH
on B KOHTpOJlbHblX .iIYHK01x YBc.IWmTb lll1CJlO OTMblBOK
C PBS >0,1 CA.onT.nJl.
on B JlYHKax C oTpHQ01TeJlhHhlM
KOHTponeM > 0,2 C .OI1T.l1JI.
on B nYHKax C nO I1THBHbIM
KOHl pOJICM <0.5 e}1..0nT.nJl.
KpaCBOH 3q){peKT
113MeHI11'h 6JlOKI1pOBKY TBep}1.0H cp013bI.
YBCJII1 II1Tb pa3Be eHl1e KOH1>lOra1'a.
I1CnOJlh300aTb aqJl1lmo-O l ll1lJ(CUHbIC O1HTIneJla.
JX06aBI11'b 1-5% HOpMaJlhHYIO ChlBOPOTKY B
6yclJcp AJ1S1 paJBe}1.eHUSI KOB bJOraTa.
IIpouepl1Th 3cpQ:>eKTHBlloCTb uMM06unl13mll111
aHTI1reHa J.1JlI1 aHTI1TeJl.
YBcmf 1 n1Th '1I1CTOTy I1MM06I1JUl30Ba'uIILlx
pearQHTOB.
YUC.'IH'II1Th BpeMH IUlKy601QI111 n03HTHUHOl'O
KOUTI)(JJISI C TBep}1.0H Q:>a30H.
YBcml II1Tb BpeMSI I1HKy6m.I1H 11 J.13MeHI1Tb
TeMnepaTYPY
EOJ1ce nu,aTCJlbHO npl1KphlTh MI1KpOnJlaThl
3. h.flOmmU"l fie.nK()(J
3JleKTpocl>opc313 1I0JllfaKpHnar.m}1.HOM rCJlc (nAr3) Ollelll. 3cpcpCKTI1BHhlH Me-
TOA pa3J{CJlCHUSI CJlO>KHoii CMCCU paJJll1'IHhlX 6eJlK0I3. AHaJ1I1TI1'-leCKl1e B03MO)l<HO-
CTH MeTO}1.a CYllI.CCTBeHHo YBenU II1JII1Cb 6Jlaron01pSl npl1MeHeHl11O TeXHI1KU 6JI01'-
Tl1Hra, IIpl1 KOTopm.f 6eJlKI1, pa3HCJleHHhle C nOMOU(hIO nAf3. 3aTeM nepeHOCSlTCSI
Ha CI1HTCTH'ICCKYJO MeM6pa1lY. nOCJle 31'oro I1HTepeCYJOllI.l1e 6eJlKI1 113Y'-laIOTCSI C
1I0MO hJO cnel{I1cpu 1 ICCKI1X aHTUTeJl I1JlI1 }1.Pyrl1x JlI1r01H)J;OB. CYllI.eCTBeUHblM npeH-
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0630pe E.M.Tan H C.L.Peebles (1993).
JIumepamypa. Charles P.J., Maini R.N. Enzyme-linkes immunosorbent a..,;say in the
rheumatological labordtory. In: Manual of Biological Markers of Disease. Ed.
W.J.van Venrooij, R.N.Maini. Kluwer Academic Publishcr. Dordrechl, Boston,
London. 1993: A5/1-A/519. Tan E.M., Peebles c.L. Immunoprecipitation of labelled
proteins. In: Manual of Biological Markers of Discase. Ed. W.J. van Vcnrooij,
R.N.Maini. Kluwer Academic Publisher. Dordrecht. Boston, London. 1993; A6/1-
A6/13. Verheijen R., Salden M., van Vcnrooij W.L. Protein blotting. In: Manual of
Biological Markers of Disea....e. Rd. W.J.Van Venrooij, R.N.Maini. Kluwer Academic
Publisher. Dordrccht, Boston, London, 1993:A411-A4/25
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JIumepamypa. Brahn E., Scoville C.D. Biochemical markers of disease activity.
Balliere's Clin. RheumatoI.1988;2:153-158.
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JI06YJHllla. C-TepMuHanhllhie y'lacTKH TSI)f(CJlhIX l cncM (Fc-cpparMeHT) cpopr-,mpy-
lOT KOIICTaHTHYK) ufumCTh MOJ1eK)'J1bl I1MMYHOfJI(6)'mmOB. 0IlpCi1.CJ1S1IOII )'1O HX
6110nOrl1 t lCCKHe cBoticTBa (C(]()COUHOC 1"1, aKTI1IUlpOnaTh CI1CTeM)' KOMfIJlCMCIlTa H
CBSl3hIBaThCH co CI1CI mtJI1'leCKHMI1 KJ1eTO'lHbIMIf pCltCnTOpa U1). IgG, IgE 11 IgD
I1MelOT MOHOMep"ylO CTPYKTYPY, IgA HIJJI CTCSI MOHOMepOM I1J111 I1MCpOM, a IgM-
nCHTaMcpOM.
IgG npI1CYTCTn)'eT B ChlBopOTKe B H3HU()J(CC IJhlCOKOM KOIIL eHTpaltm1 (8,0-1,8
r/J1), H3 cro IJ,OJIIO npI1XO I1TCJI 80% aHTHTeJ1hIlOM aKTHBHOCTH. OH BKJ1IO'JaCT B ce-
6J14 c)'6Knacca: IgG1 (60-70%), IgG2 (20-30%), IgG3 (5-8%), IgG4 (1-3%). IgA
npl1cyrcTByeT R ChlROpOTKe B KOHltellTpal(1111 0,9-4,5 r/J1 11 5IBJ1J1eTCSI OCHOBHblM ce-
Kpe1'opHblM HMMYHUrJlo6ymUloM, oOHapY>KI1BaeMbIM B CJ]IOHC. CJIC3aX, KHllle'lHhlX
1-1 UpOIIXmlJlhHhlX ceKpeTax 11 M,1TepI1HCKOM MOJIOKe. B ceKpeTax IgA lIaXOJ],I1TCSI n
Bl1Ae AI1MCp3, cO}J,cp>KaLLlCrO "J I\cm/' 11 ell e OAHII nenn1}J" Ha31.IBalOII\HHCS1 ceKpe-
TOpllhlM KOMnUllCIITOM. IgM COCTOI1T 1f3 5 MOHOMepHhlX cy6"beHI1Hl1lt. ClUI3allHblX
J.111CYJlbCPI1).\UbIMI1 MOCn1KaMI1 11 J l\enblO, 06pa3ytOLLll1X nCHTaMcp (KOHl\eHTpaltI1H B
Cl.mOp01'Ke 0,7-2.8 r/J1). IgD HaXOJ I1TCSI u CI.IBOpOTKe B CJ1e}10BbIX Kuml'ICCTuax, JI()
SlBJ1S1eTCJI OCHOBHblM nmOM I1MM)'JlOrJ106YJ1l1HOB, npl1cYI'c'mYIOll(I1M lIa MeM6paHc
B JU1McpOltIH0I3. KOHl\eHTpal\l1S1 IgE He npeuhlllJacT 100 MKr/J1. OJ],H3KO 011 I1rpaC1'
Ba)f(HYto pOJlb u pCaKl(I151X rHnep\IYBcTBlfTeJ1hHOCTl1 HCMCJJ,JICHJlOrO Tl1na.
Memoobl onpeoe.nellllJl. JJ:JIJI onpeJ],eJ1CHHSI KOHl(CHTpal HH If xapaKTepHc1'HKH
OCH()IJHbIX KnaCCOB I1MMYHOrJ106ymlHoB (IgG, IgM. IgA) UCn0J1h3yeTcSI MCTOJ], UCII-
Konoro 3J1eKTpocpope3a, I1MM)'H03JICKTpOcpOpC3, 3J1CKTpOcpOpC3 C IfMYHO(l>HKcal u-
eM, MeTO).\ Pa.AH3.%HOH UMMYlloHm <p)'3m1, HecpenoMCTpl1\ICCK3 I'CXIII1Ka. noc-
-
METOJJ,bl KJII1HI1'lJECKOI1I1MMYHOJIOfl1l1 207
KOJIbKY IgE npl1cYTcTBYCT B CblBOpOTKC B HI13KlfX KOItL(CHTpaLluslx, JISI cm onpe c-
JJCHUSI UCnOJIb3YIDT PI1M I1JIl1l1c1>M. CyoKJIacchllgG onpC eJISlIOT C nOMOLLlbfO pa-
JJ,l1aJIbHOM uMYHoJ],mpc}:JY3Hu JUlU UMMYBoc}:JepMeHTI-lOrO MCTOAa.
KAllHULf-eCKOe 3HaLf-eHue. YBCJII1l.JeHUC KOBLlCHTpaI UI1 IgM OTpa>KaeT OCTpLIH
BOCnCUUlTeJIbHblH npol.l,CCC U 3aLLluTHYlO pcaKIUuo opraHU3Ma Ha UHc}:JCKLlJ1fO. Ync-
m1"ICHI1C KOHLlcHTpm'JU1 IgG OTpa>KaCT pa3BI1TUe XPOHU"lccKoro BocncuurrcnbHoro
IlpOL CCca, algA -pcaKI'"fO Ha TOKCJ1"ICCKoe nOBpe>K eHUC UJU1 aYTouMMYUHYID na-
TOJIOn1lO. AJISI BocnamnC.'1bHbIX pCBMaTJ1"leCKHX 3a6oJICBamu1 xapaKTcpHo pa3RU-
THe nOJII1KJloHaJIbHoM nmcpUMMYHOrJIo6YJII1HeMUI1, "!aCTO KOppCJIUPYlOlI{CH C aK-
THBHOC rLfO 60nC3HI1. KpoMe Toro YRCJIJ1lleHUe KOHl\CllTp(H I1U IgA Ha6..rJfOJJ,aCTCSI
npu nOpa>KeHHSlX ne"leHU, IgA-Hcc}:JponaTJU1, rmOTCHOBOii 3HTcpOlia nm. pe>Ke npl1
pCaKTJ1BHblX ap-rpJ1TaX, XpOHJ1lICCKJ1X rllOih-lblX 3a60nCBallUSIX JICrKUX, Cnl1JJ,c;
YBem1'-1CHI1C KOm\CH1paLlUU IgM XapaKTepHO nJISI ncpm1'lHoro 611JmapHOro LlUp-
p03a, OCTpOH peBMan1"ICCKOM JlUXOpa)1.KH. B LleJIOM, onpCJ\CJICHUC CblBOpOTOlUlOii
KOHLleH1paL(HI1 OCHOBHblX KJIaCCOB HMMYHOrJIofiYJU1HOB (IgG, IgA, IgM) L(eJIcco06-
pa3HO npOBOJJ,UTb B CJICA)'fOLLlI1X CJIY"IaSiX. 1. rIpu nO[\03pemm Ha nepmf l lHf>u1 111m
HTOPU'lHbli1 HMMYHo.o.cc}:Jm\HThl. npu KOTOphlX MO)!(CT Ha6JIlOJ],aThcSI CIU1>KCHUC KOH-
L(CHTpaL(l111 OCHOBHblX KJIaCCOB HMMyuorJJ06ymlHoB. Hau60Jlec 'IaCTOH q)OPMOM SlB-
JISlCTCSI IgA )1.Cc}:JHL(I1T. 2. ,ZJ:JISI HJlarllOCTUKH MOIIOK)IOHaJlbHhlX raMMananlH (B CO"IC-
TamH1 C UMMYH03JJeKTpoc}:Jope30M CblBOpOTKU U M01.m) 11 }tHc}:Jc}:JcpeHLlJ1aJlbIlOH 1-\J1-
arHOC1HKU II}J;o6pOKa'-lccTBeHHoH" U}(110naTI1"CCKOM MOUOKJlOHaJlbllOM raMMananUi
01' napanpOTCJ1HCMJU1, CBSl3aHHOH C MUCJlOMOH (npl1 Ml1eJIOMe Ha6JIIDAaCTcSI YBCnl1-
l.JCm1C KOHLlcHTpm HI1 OJ],Horo KJIacca I1MMYHorJl06Y_'lI1HOB 11 CHH>KeHUC KOIH{CHTpa-
LlHH ]J.pyrux KJJaCCOB J1MMMYHOrJl06YJIHHOB, '-I'm HC xapaKTepHo }\JISI " ()6pOKalfecT-
BeHHoH" MOHOKJlOUCUlbHOH raMManaTI1H). 3. ,ZJ:JISI I1CCJICJJ,OBaTeJlbCKI1X I CJICH y
60nbHbix aYTOI1MMYHHblMH, JII1Mc}:JonpO!U1c}:JcpanmHbIMI1 If BOCllaJlI1TCJlbHblMH :m-
60JlCBaHHSlMJL OnpeJ],eneHl1e KOHLleHTpal(I1U IgE n03BOJlSlCT HJmrHOCTl1pOBaTb 1'11-
nep-IgE CUHApOM U IgE MuenOMY, pe>KC aTOnUl.JCCKUC 3a6oneBaHUSI, nCKOTopble
UMMYHO Cc}:JUI..{I1Tbl (CJ1HJJ,pOM BUCKOTa-OJIJJ,pWIa) U nmep303U110c}:JunbHble CUHHIJ<J-
Mbl. OnpCJJ,CJICHUe cy6KnaccOB IgG Lleneco06pa3Ho IIPH nOJ\03peHlfH na UMMYUOAC-
c}:JUL(J1T, HeCMO'I'pSI Ha HOpMaJlbllLIH ypOBeHb IgG n CLJBOpOTKC. HMMYHOJ\Cc}:JHLlUT no
O HO\1Y UJU1 HCCKonbKUM cy6KJlaCCaM IgG aCCOL(JmpyeTcSI C pa3RUTUCM CUHYCUTon,
PCLlHJU 1B I1PYIOIL(CI'O cpe Hero OTI1Ta, 6pOHXl1aJ1bHO" aCTMLI, peLlI-1AI1BHPYK) CH I1H-
c}:JeKLlUU BepXHI1X J\blxaTeJlLHblX nYTeH, MCHUHrOKOKLlCMJm.
Jlumcpamypa. UIIS/WHO Working Group. Usc and Abuse of Laburatory Tests
in Clinical Immunology: Critical Considerations or Eight Widely Used Diagnostic
Proccdurcs. Clin.lmmunol. Immunopathol. 1982;24:122-138; A Sccond lUIS/WHO
Report. Laboratory Investigations in Clinical Immunology: Methods, Pitfalls and
Clinicallndications.Clin. Exp. ImmunoL1988; 74: 494-503.
,
4. CMCTeMa KOMnneMeHTa
CI1CTCMa KOMnneMeHTa, COCTOSlIl\aSl 113 60Jlce. 'leM 20 6cnKon, urpaeT Ba>KHYIO
ponb B pa3Bu nm BOCnaJIeHUSI U UMfo,'IYHHoro OTBeTa. KOMI10HeHTbI KOMnnCMCHTa
npJ1c)'TCTBYlOT B KponSiHoM pycne B BU}1.e HeaKTUBHblX npeJ\lJIeCTneHHuKoB (3UMO-
reHOB). rIpu B03J\eHCTBI1U pa3nU IHLIX I1MMYHOJlOrJ1'-ICCKHX H HeJ1MMYHonon1 lcCKUX
CTJ1MYJlOB, OT}1.eJlhHblC KOMnOHeHTbl KOMllnCMeHTa BcrynmoT B cepHlO B3aHMoncM-
CTBUi'1 C aKTuBupYlOlI\UMU cy6cTaHLluSiMu J1 APY" C APyroM, (11'0 np 1RO)tI1T K 06pa30-
...
208 TOM II - llACTHLIE AHAJU1TI/P,IECKI1E TEXHOJIOfl111
BamHO 6U0J10n1'ICCKU aKTI1BllhlX opt.'t, o6mv.talo II \11 x M.OII\HOW npOBocnam1TCJ1b-
HOW U JH1TUtICCKOW aKTUBHOCThlO. CymecTBycT 2 OCHOBHhlX nyrn aKTI1Bi.U.t 111 KOMn-
}ICMeHTa: KJ1aCCWleCKut't 11 aJlbTcplmn1BHLU1, KOTOphiC YHKI_110HUPYIOT He3aBI1CU-
MblM pyr 01' l\pyra 06pa30M. K 6CJ1KaM KJ1aCCI1'ICCKoro nYfl1 aKTJ1BaL\UI-I KOMnJ1C-
MCHTa OTHOCJlTCJI Clq, CIs, Clr, C4, C2, C3 UCJIKU MhTcpHaTuBHom nyru HKJ1lO-
'-IalOT nponcpJ],HH, aKTopbl B. D U C3. C3 KOMI10HeHT. JlBJUIJICb O)J,HMM 113 OCHOB-
HblX r11l1KonpoTeUHOB I1J1a3Mbl (npUCYTCTBYCT B CbIHOpOTKC U KOHucHTpm.\IU1 1,3
Mrhm), 3aHUMaCT I\CHTpaJILHOe MeCTO B 06ol1x nYTJlx aKTUBaL\ m KOMnJICMeHTa.
EeJIKJ1 C5-C9 0603Ha'laiOTCJI KaK TCpMUHa.1lbHhlC KOMnOHeHTbl (MeMupalioaTaKY-
IOUtUt't KOMnJ1eKc), TaK)Ke JlBJISIlOTCJI 06U\UMI1 )J,JISI oOOUX lIyrei'1 U OCYII\CC WJIJllOT
11I13UC U nOBpC)KJ\eHue KJICTOK-MI1WCHeH. KmrrpOJlb 3a aKTI1BaL\Uci1 KOMlljlCMeHTa
ocyu cCTBJIJleTCJI 7 KOHTpmIHpYIOII\UMI1 UCJIKaMI1. OCHOBHblMI1 113 KOTOpblX JlBJISI-
lOTCSI C1JNH, I (C3bINA), H (BIH), C4BP. a TaK)KC MCM6paHHblMu 6eJIKaMU U
KJICT01.1HhIMI1 pel\enTOpaMu. AKTUBal\UJI KJlaCCU'ICCKoro nyn1l1pm1cxo)J,l1T npu U3a-
UMO)J,CHCTRlH1 Clq C 11MMYIIHhiMU KOMnJ1eKcaMI1, cO)J,cp>KaLl.tUMU aHTUTCJIa [gGl,
IgG2, IgG3, IgM. AKnmam1S1 CI MO)KCT npoucxo)J,lf'r B arcyrcTBuc aUTlnCJ1 1I0,i(
B03j1,eHCTBI1CM pa3JHt'IHhIX 1I0JU13HUOHOU, HCKaropl>lX nOJH1CaXapHAou, BUPYCHhIX
MCM6pati 11 l-{pyrux cy6cTaHl.\UH, OAHaKO 113110Jloru'lccKoe 3Ha'lCtlUe 31"(,)1'0 Tl1na
aK"nmaL\UI1 HC JlCHO. AKTI1BauUSI aJlhTcpHaTI1BHOrO nyn1 MO>l<CT npm1cxoHHTb B OT-
CyrCTBHC 3IiTUTeJI :m C'leT U03HCHCTBUSI J1l1nOnOJII1caXapUJ\OB 6aKTcpU 1, BHPYCOB U
Ul1pyc- uH £l1 m \l1pOBaHHhIX KJICTOK.
Mem()()bl Ollpei'JeJleHUR.. }1,JIJI OUCHKH COCTOSlHI1J1 CUCTeMhI KOMnJ1eMCIlTa UC-
nOJIh3YlOT pa3JII1LIHhie MCTO}J;bl, OCllOBaHHLle Ha onpCAenemm <):>YHKUUOHaJIhHOH aK-
TI1BHOCTU ucei1 CUCTCMhl KOMlIJleMeHT,L ee OTJIeJIhllhIX KOMnOHeHTOU UJ]l1 KOHlJ,CHT-
pauul1 I10cne}].HI1X R 6HOJIOnl'IeCKI1X >KHl-{KOCTSIX C 1I0MOII hlO pa3J1WlHhlX IMMYHO-
XUMI1LICCKUX MCTOI OB (paJ UaJlhHaSi tMMYHO}J;I1 Y3USI, He£l1eJIOMCTpUSI, PI1M 11
I1<1>M), CYLLlccTByeT pJl aKT()pOB, 3<npY}J,HJllOLLlJ1X I-H-ITCpnpeTaUHKJ pe3YJ1hTaTOB
HCCJlC,\OHaHUSI CUCTeMhl KOMnJ1C\1CI.IT3. Yp{mCHh KOMnOHeHTOB KOMIIJICMeHTa B
KpOBH JlBmleTCSI CTaTl1'leCKI1M nOKa3aTeJ1eM AlmaMH'ICCKOro nponecca ux CUHTC3a,
J],crpaJ\aUm1 11 yrumnaum-t, n03TOMY KOH[\eHTpaLl, IJ1 KOMlIoueHTOB KOMnJ1CMCIITa
MO)KCT cYU\eCTBCHItO He MCHSlThCJI. a>Ke HCCMOTpJl Ha SlBHoe nOTpc6J1CHUC. B HOp-
Me KOHueHTp3L1,lUi KOMIIOHeHTOU KOMnJ1Ct.1eHT3 BapLl1pyeTcSI U 1IIHpOKI1X npc}J;CJ1ax,
'-ITO 3aTpYAIISleT BhlSlUJlelmC 3K'II1BauUU KOMnJ1CMCHTa. KOMnOHeHTLI KOMIIJICMeHTa
Moryr neCTU cc6S1 KaK OCTpo a30B"le 6eJ1KI1, 'ITa BC]lCT K YBCJlH'-IeHHKJ I1X KOHl.\CH-
TPaI\I1U, HCCMOTpJl Ha aKTlmHOe nOTpCUJleHuc.
1. 06tqan le.MOAllInU"leCKllR aKlnU8IIOClnb KO]tlnJle.uemna KJlaCCU"leCKOlO ny-
mu (CIISO)
Memoo ulIpe()eJleHllR. 06LLlaSi reM0J1HTI1 L ICCKaSi aKTUBHOCTh KOMIIJleMCHTa on-
pCAenJleTCSI C nOMoLLlblO CH50 MeTO)J,a U nhIpa>K3eTCJI U YCJ10BHbIX C!.tI1HHUaX, KO-
TOphlC npc.n.cTaBJUnoT couoH KO.TJI1'ICCTBO CLIBOpOTKI1, Tpe6ye 1OH AmI JU13l1ca 50%
cycncH3m1 3pl1TpOLl,I1TOU 6apaH3. cellcuumH13uponaHHhlx Kponl1'lbH m aHTl1TCn3-
Mil. HOpMaJIMlhle PC3YJ1hT<\Tbl CH50 {rrpa)KaKJT npucy I'CTBUC YHKL\HOHaJlhHO aK-
1'l1BHhIX CI-C9 B Tccnlpyc!>1blX npo6ax. O!.tHaKo npu 3TOM a6COnKJTI.loe Komt ICCT-
uo KOMIIoueHTon KOMnJ1CMCIlTa (OC05CHHO C3 11 C4) MO)KCT UhlTh cYLLlecTBcHHO
HI1)KC HOpMhI, TaK KaK 3TU KOMIIOHeHThI IIPucYTcTnYlOT B ChlBOpOTKC B 6OJlblllOM
u36h1TKe. TaKI1M 06pa30M. CH50 MO)KIIO uHTcpnpcn1ponaTh KaK nOKa3a-rCJ1h Ll,e-
J10CTHOCTU KJ1aCCULleCKOn) IIYTU aKTImal.I1U KOMnJ1CMCHTa, HO He KaK IYHCTBl1.TCJlh-
-
METOJJ,bI KJIHHI1QECKOH HMMYHOJIOfl111 209
HblH nOKa:JaTCJ1b aKHmaJ.-l1U1 KOMnJ1eMeHTa B opram13Me lleJ10BeKa.
IVzUHlitteCJ<oe 3HatteHue. OnpeAeJ1eHHe CH50 peKoMcHA}'eTcSI npJ1 nOA03pCHIH1
Ha rCHeTl1 l leCKI-1H l\CclJl1I\I-1T KOMIIJICMCHT<l. I1CCJleAOBaHl-1c CH50 nOJ1e:mo npOBO-
AJ1Tb Y OO!lbHbIX HMMYHoKOMIIJleKCHbIMJ1 :m60neBaHJ1S1MH (oco6eHHo R ]1.J1HaMI1Ke)
AJ1S1 0l\eHK11 3cpcpeKTJ1BHOCTII JIC l ICHJ1S1. Hanpl1Mcp CHH)KCHI-1C KOHL(CHTpal-lJ1J1 CH50
aCCOL(HHPYCTCSI C nJ10XJ1M nporH030M Y 6oJ1bHb1X BOnllaHOlIHbIM HecppHT01\1 1-1 lIaCTO
KOppCJ1l-1pyeT C aKTJ1UHOCTblO IIOllCllHoro npoLlccca.
2. 06U/UR ze.tlO.fIUmU'leClWJI aKInUBlIOClnb KOJ"m.ne.ue",na a.fIbmep"amU6IIO-
lO nymu (AH50)
Memoo OIZpeOeJleHll.R. rCMOJ1l1TH ' lecKYlO aKTJ1BHOCTb MbTepHaTl1BHOrO nYTJ1
aKTJ1BaL(lH1 KOMnJ1eMeHTa J13 lepSilOT C nOMOLl\hlO AH50.
K.mtHu<IeCKOe 3HG'/.eHlle. OnpeAeJ1em1e AH50 11Cn0J1b3YlOT AnSI BbISlBJ1eHJ1S1 1'0-
M03J1rOTHoro Aecpm uTa KOMnoueH rOB aJlbTcpnaTI1UHoro IJYru. DKlIIO ' IaSl C3, cpaK-
TOp I (ubl3bmaIOLLlJ1H BTOpWIHbIJ1 AecpJ1LlJ1T C3) H RepoSiTHo cpaKTop H. )J,ecpm\IIT
cpaKTopa D accoLlI1HpyeTcSI C pellJ1]1.HRl1pYIOU CH ronoKoKKOBOH J1HcpCKI-l11CH. fOMO-
3J1rOTflbJH ACcpHLlJ1T cpaKTopa H accoLlUl1PYCTCSI C pa3BHTHeM rnoMepynoHecppHTa,
peL(HAJ1BJ1pYlOu ero McnJ1HrOKOKKODoro MCHHHI'H'ra, ('CMOJIJ1TUKOypCMJ1 l ICCKOro
CI1HApOMa J1 CKE.
3. OmOeAbllble KOAfnOlle""ll,1 KOAIn./leMe",na
Memoobl ollpeoe.neHufl. J],nSl onpeAeneHJ1S1 KOMnOHeHTOR KOMnneMeHTa J1C-
n0J1b3YIOT MCTO]\ panHaJ1I.JHOH HMMYHO:J,J1cpcpY31H1 J1 Hc<pcnoMcTpI1'lecKYlO TCXHJ1KY.
KJH1HWICCKOt'1 :ma l leHJ1e. AnSI 60nce nOJ1HOH xapaKTepJ1CTJ1KII BbIpa>KCHHOCTI1
aKTHBa1\Ul1 KOMnnCMCHTa pCKOMCHJU'CTCSI onpCnCJICUl1C OTACJlbHt.IX KOMIJOUCHTOn
(B ncpBYlO O'ICpCAb C3 H C4) C nOMow.blO UMMYHOXHMJ1 l leCKJ1X MeTO}J.OB. CmnKe-
HHe KOHI{CHTPaJ.\IH1 C3 KOppCJmpYCT C aKTHUHOC 1'1.10 npOLlccca y 60JlbHbiX CKB J1
OC06CHHO '!aCTO Ha6JlIOAaCTCSI y 60JlbHbiX BO!JtIaHO'IHbIM HC<PPHTOM. YCTOH'umoc
CHJ1)KeHJ1e KOHl\eHTpaJ.\IUI C4 TaK)I(C xapaKTcpHO JJ.JISI CKB, HO MO)KCT OTpa)KaTb He
1'OJlbKO IJOTpc6JleHJ1C KOMnJ1eMeHTa, HO J1 npHCYTCTBl1e HyncBoro tulJleml. C4, ltaC-
TOTa BC rpCllaCMOCTH KlYroporo IIpl1 CKB ULIWC, 'ICM B mmY!1SI.L(I1H. nOCKOJlhKy IIC-
lJeHb - OCHOBHoe MeCTO CI1HTe3a C3. C4, C2. cpaKTopOB B 11 D, TSI)I(enOe nopa)l(e-
HHC IIC'-ICUI-1 aCCOL(I1HPYCTCSI. co cm1)KCHI1CM KOHLlCUTPaL\Ul1 C3 H C4. npl1 MCM6pa-
H03Honpo.rm<pepan1BHOM rnOMepYJlOHccppl-1TC Ha6mo]1.aeTCSI CHl-1)1(CHHe ypOBHSI C3.
cpaKTopa B H npOnCPHI1Ha JlpH HOpMaJII.JHOr1 KOUI-lClrrpaL\1-1I1 C4, II ro CIHl3l>malOT C
CI-1HTC30M aYToaHTI1Ten (HecppHTl1'lecKoro cpaKTopa). Bbl3LIBalOLLll1X aKTH B<l1-l1-110
KOMnOHeHTOB anbTepHanmHoro nYTI1. CHH>KCHHC. KOHL(CHTpaLlHI1 KOMIIOHeHTOB
KOMlIJlCMCHTa Ha6JllOAaCTCSI U IIJleBpCUlbHOM, nCpl1KapAJ1aJlbHOM 3Kcy}:\aTax 1-1 CJ1HO-
BI1MbHO" )KI1AKOCTI1 npl1 PA H CKB.
4. llpOl)YKmbl pacU/enAellUR KOAflJOllelllllOB KOAtn.ne..Jtelllna
Memoo onpeoe.neHll.R. I1<1>M
K.mmuttecKoe 3HU'leHtte. YpoBeHb U nna3MC npOAYKTOB paCLLlCJ1JICHI1S1. KOMIIJIC-
MeHTa (C4d, Ba. C3dg) SlRJ1S1eTCSI llYBcTBl1TenbHbIM nOKa3aTeneM aKTHBaL(1U1 KOM-
IIneMCIlTa. nporpeccHpYIO Cc CHH>KCIH1C KOIIL(CtlTpaL(Ul1 npO}.YKTOB paClllenJ1eHI1S1
C4d KOppCJH1pyeT C aKn1BUOCTI.JIO CKB. KOHL(cHTpal\l151 npo}:\YKTOB aKTI1BaL\HJ1
<paKTopa B (Ba 11 Bb) nYlllJIe Koppem1pyeT C aKTI1BHOCTblO CKB, lleM KOHLleHl'pa-
LlI1S1 C4 U C3. npl1cyrc1'BJ1C Ba B CblBopoTKe accoL(I1HPYCTCSI. C JlJIOXI1M IlpoI'H030M
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poTKC B O'IeHh HI13Kl1X KOHL\CII [pal\HSI, Ami HX onpcJ.\cJ[cHI1S1 UCnOJ11.3YIOT l[YBCTBU-
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STOM nOBhlllICHHC KOIU\CH1paL\JU1 C3a orMc'JaCTCSI B cpeAHeM 3a 2 MCC )\0 Ha'Jana
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22-50 Mr%, npu H3J1WIIUI OJl.IIOro IIYJ]CBOro aJlJICJISI - 13-38 1.11"%, a npu 2x Hyne-
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accoLllUlpyeTCSI C Jl.06poKal.lecTBcIUlLIMH I1JIH 3JIOKa'-lCC ruCHHLIMH JlHMcponpOJ1ucpe-
paTHBHLIMU onYXOJISlMJ1 B Tlma. J1Hor] a OH CBSl3aH C np0Jl.)'KQllefl aHTlITeJ1 K
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npOJ1HcpepaTl1RHOrO Jlecppl1Ta (c IUlTpaMcM6paH03HblMI1 nJ10THhlMI1 Aeno3HTaMH), a
TaK)I(e npH 'mCTI1'IHOH mmOAI1CTpOcpl1l1, nocTcTpenToKoKKOBOM I"JIOMCPYJlOHCcppl1-
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npl1 MeM6paH03HOnpOnl1cpepan1BHOM HecppHTe THrm I H II. Pearl1py'" C aHTm"CnOM,
C3NeF Bhl3h1BaIOT CYII eCTBeHHoe YJl.nHHeHl1e BpeMeHI1 paClltenJ1eHHSI C3 Ii n031'O-
MY aCCOLl.mpYfOTCSI co CHI1)1(CHl1CM KOHQCHTpaQI1H C3 B C"!HOpOTKe. Onpc.n.eJ1eHl1e
3TUX aHTlITe11 I1MeeT 3Hal.leHI1e AnSI Al1(pcpepelll l1aJ1hHOfl fJ,l1arHocTHKU THnOB MeM-
6paH03HOnpQ.TIHcpepaTHBHoro rJ10MCPYJlOHCCPpl1T3 11 OQCHKC :JcpcpCKTl1BHOCTH Te-
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212 TOM II - 1.JACTHbIE AHAJII1Tll1.IECKI1E TEXHOJIOrl111
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crpenToKoKKOBhlM r.TIOMepYJlOHe<j)pHToM. CKB U XpOHH ICCKHM rJIOMepYJlOHe<j)pU-
TOM. AHTJnena K HeOaHTUrCHY 6CJIKOU CHCTeMbl KOMnJ1eMeHTa OOHapY)KHBaKrrC Y
50% OOJlbHhlX CKB, u3pc}J,Ka npu CI1HJ1POMC lllerpeHa, a TaK>KC npu 1"J10MCpYJIO-
Hc<j)pwrax TH na I (74 % ), nma II (38 %) U TJma I II (48 % ), TOJlhKO nOC]le <j)uKca-
l m1 C1q Ha TBep}J,oH <j)a3c HJIH npH CBSl3bIBaHIflf C UMMYHHbIMU KOMlIJlCKCaMU U Be-
poSiTIlO HanpaBlleHhI K Heo3mnony KOilllarcHoflo}J,06lforo Y JaCTKa Clq.
JIumepllmypa. Law S.K. A, Rcid K.B.Y. Complemem. IRL Press.Oxford.
Washington DC 1988. 73 p. Whaley K. Mcasurcment of complement activation in
clinical practice. Complcmcnt. Inflamm.1989; 6: 96-103.
S. MMMYHHble KOMnJ1eKCbI
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HblX pe3y.TIbTaTOB In-3a CUSl31JIBaHHSI C KJICTKaMU 3HTUJ1HMcpOl.{IITapHblx aHTHTeJI,
I.laC ro npHcYTcTBYfOlltUX B CblBopoTKax 60JlbHbiX CK B. 3'1'0 r "'leTOH I1HOr]\a 11C-
nO]lb3YfOT ]J,JlSI OI CIIKII aKTllBllOCTlt 60JIC3HH npH CUCTCMHblX HeKpannHpYfOlltUX
BaCKYJJHTaX n capKOHA03C.
3. Memoo ocuJlCOelluJI ILM.A-IY"llbIX KUA-tnJleKCU6 IlOJlU3111UJlelllAUKUAeJtl
(n3f -MCTOA). ,l],JlSI onpC)\CJ1CHI1S1 l..{I1K UCnOJlb3YKJT n3f (MB 6000 Oa). B BbICO-
KI1X KOHl.{CHTpal.{HSIX (GoJlce 7,5 %) n3r nO ITH nO.IIHOCTbfO OCa>KJ{aCT HMMynOrJ10-
6ym1HbI 11 }J,pyrue CbIBOp01'O IHble 6eJII(H, U IX) BpCMJ-I KaK 13 1II-13KO" KOHl.{CH1'pal.{lU1
OH npCl\lml1Tl1pYCT npcI1Myw.CCTBCHHO paCTBOpl1MblC KOMnJ1CKCbI aHTl1reH-aHTl1Te-
JIO C pa3JIU'lHot1 MOJ1CKYJ1S1pHOM MaCCOM. npc]J,nOJ1araCTCSI, I.ITO paCTBopUMOCTb
6eJ1KOB B n3f 3aBI1CIIT or crCIlCHU ux arpCn\l.{1U1 11 rl1APOcp06HOCTH, K01'opble Bbl-
pa>KCHbl B 6oJ1bUlci1 CTcnCHU y KOMnJ1eKCOB aHTI1rCH-anTl1TCJ10, '-leM y 6cnKoB, lIa-
XO}J,SllltI1XCJ-I B paCTBOpc B HanmHOH cpOpMC. Ha OCHOBe HcnO.%30Bam1S1 n3f pa3-
pa60TaHo 60nblIIOC IHCJIO MCTO OB onpC}J,ClICHUSI l..{HK, KOTOpblC YCJIOUHO 1I0.u.pa3-
HC1JSltOTCSI Ha 3 OCHOBHble rpynnbl: myp6uou.Mempu'lecKuil U Heljje.f/.OMempll"ecKlIll
.«emoc)bl, OCHOBaHHblC Ha npSlMoi1 pemcTpal.{I1H 1I0TCp 1 IIpOXOASIlltCrO CBCTa 111111
I1HTCHCHUHOCTl1 cBeTopacccSlHuSi npu ):t06aBJ1CmH1 n3f C nOMOlUbfO cneKTpocpoTO-
MeTpa 11]111 Hc£l1CJloMcTpa; /lpel(llllllf1Wt(IWHHbte Memovbl, CYTb KOTOpblX 3aKJllO l la-
CTCSI B OCa>KAeHl1H HK-no.n.06Horo MaTCpl1aJla n3f C nOCJlcAYIOlltl1M aHaJlU30M Co-
)].ep>KaHI1S1 6CJ1Ka I1JJI1 I1MMYHOXI1Ml1 l leCKoro COCTaBa npCI\"m1TaTa; KOM6w-lupORaH.-
H.ble MenWObl, lIpl1 K01'OpblX II peaKl.{I101I11YIO CMCCb lmoJun-cSi KaKOH-JU160 MCl.JeH-
HblH U30TOnaMI1 UJ111 £I1cpMcHTaMU _l}l1raH , cnCI ucpI1I.ICCKH pearupYfOlltHH C KOMn-
lleKCOM aHTI1rCH-aIiTlITCJ10 (Hallpl1Mep C1 q 11 P<1». Hal160Jlce IUl1pOKO I1CIIOJlh3YC-
MblM HBJISlCTCSI Typ6HAI1MeTpl1'leCKHt'1 MeTo)]. (Y.Haskova H coaBT.), npl1 KOTOpOM
aHamnupYCTCSI npupOCT MYI'HOCTlt CblHOpOTKU IJ npUCYTCTHI1H n3f n KmlCllHOH
KOHl.{CHTpal.{1111 3,75% no OTHOlllCHll1O K tl6J1mIKY", BKnfO t lafOlu,eMY CblBOPOTKY.
pa3BCneHHYIQ 6ycpepoM, Ha cneKTpocpOToMcTpe npl1 JVlHHC BOJlllbl 450 tlM. npu
31'01'.1 Ha 1I0.l}y mcMblc pe3YJ1bTaTbl He BJ1I1S1eT KOHlI,CHTpal.{l1S1 6eJ1KOB, gd.fOlltHX MaK-
214 TOM II - 1.JACTHbIE AHAJIJ.1Tlp.IECKHE TEXHOJIOrJ1M
C 1MaJlhHOe nornow.eHUe np 1 J1I1HC nomu.1 280 m..,J. Hau60nce nonymlpHhIM npeu.u-
nl-fTau.UOHHhIM MeTO}J,OM SlBJUICTCSI MeTO , npCnnO>KeWlhIH M.Digeon U coaBT., KO-
TOphU1 OCHOBaH Ha cneKTpocpoTOMCTpWICCKOM onpe}J,cJlemm KOHu.eHTpm HU OeJlKa
npeu.unUTaTa, nOJ1Y IClUlOro oca CHHCM n3r B KOHe IHO" KOHL\eHTpau.Hu 3.5%.
K.rtllH.l.lllecKoe 3I-la l {el-lue. YRCJlU ICIIHC KOHu.cHTpar uu LJ.HK no }J,aHllblM TI3r-
MeTOAoB KOppCJ1HPYCT C ROCnaJ1UTCJlbHOH U I-tMMYHOJlOrJ-f ICCKOH aKTHRHOC rblO
npou.ecca npH CKB, PA, cepOHeraTl1RHhlX ap1'ponaTHHx. K HC}J,OCTaTKaM \1eTOAOB
cJle yeT OTIICCTU ux HC}J,OCT3TOtIHO BblCOKYlO IYBcTBHTenhHocTh, 1'PY) HOCTII KOJIH-
\leCTBeHHOrf ou.eHKU cOJ1.ep>Kam1S1 qJ1K B IICpCC ' ICTC Ha arperupoBaHHhlM raMMar-
Jl06YJIHII, 3aBUC 1MOCTb pe3YJ1bTIiToB OT KOHu.eH1'pm H 1 IgG II ChIBOpOTKC.
4. IgA-cooep3ICawue ItlfK. 06HapY>Kellue IgA-co)\cp>Kaw.ux UMMYHHhIX KOM-
u
nneKCOR KOppeJiUpyc I' C rCMaTypHeu npu aHKun03HpYlOW.eM CnOHHUJ10apTpUTc,
npu KOTOpOM MO>KeT pa3BUBaTbCSI IgA-Hccpponan1S1. KOMnneKchl IgA-cpu6poHeK-
TUH Hau60nee xapaKTcpHbl W1H IgA-HccpponaTHu, B TO BpeMSI KaK np 1 aIlKHJI03H-
PYlOlilCM CIIOHAUJIH1'e OHH He OOHapY>KURaIOTCSI. 06pa30BaIH1C Clq-cBSl3blBaJ.ow.HX
UMMYUHLIX KOMOJICKCOU H IgA-co]J;cp>KaIu.ux UMMYHHhlX KOMnneKCOB KOppCJU1pyCT
C cepon03UTUBHOCThK>. aKTHRIlOCTblO 60JIC3HU 11 pa3BI-1TUeM BacKynHTa npH PA.
6. KpMOrJ106YJ1MHbl
KpllOl./106Y.llUHbl - rpynna CbIBOpOTO'IHbIX 6CJIKOB. o6na)1.alOw.ux aHOManhHofi
cnoc06HOCTbiO K oGpanlMoH npeu.umtTaL\HU (1]111 06p330Bam11O rcml npu IIH3KOH
TeMnepaType. Kpuorn06YJluHbl MorYT 06l1apY>KuBi1ThCSI npH wnpOKOM cneKTpe 3a-
G()]JCBaHHH UHYTpeHHHX opraHOB, BKnlO"-IaSi 3a60nCBamUI KpOlU1, BI1PYCllblC uHcpeK-
u.uu (renaTHTbl A, B, C, UlIcpCKU.HOIIHbIH MOHOHYKJIC03, u.uTOMen1J10B 1pyC), oaKTc-
pHaJlbHblC J.1HcpCKL{HH (6aKTcpU<:UlbHbJt'1 3H oKapJ],uT, nOCTcTpcnToKoKOBhllII'JIOMC-
PynoHecppHT, npoK333, cucpunuc, OOJle31'Ib JIaHMa), llapa3 1 raptlblC J.1HcpcKU.m1 (wu-
C1'030M3T03, 1'OKCOnJ1a3M03, MaJlSlpl1S1), HUCPCPY311bJC 6oJlc3m1 COCL\UHUTenbHoH 1'Ka-
Hl1 (CKB. PA. Y3CJIKOUbill no.rmapTepmn. CUHgpOM lllerpeHa, Cl1C1'eMHaSi CKJlepO-
J],epMHSI), npl1 XpoHHllecKHx 3aooneRaHuSlx nCLICItH H capKouJ{o3C. B Hc60nbwux KO-
nl1'lccmax KpuonlOuym1HhI 06HapY>KUn3lOTCSI y 3,n,OpoBbIX Jl101\eH, raw.e U u03pac-
Te C1'3pwe 60 neT. B 3aBUCl1MOCTl1 01' COCTana KpnOrJlO6ym1Hbl pa3 enSiIOTCSI Ha 3
OCHOBHhlX Tuna: 1) nm I COCTOJn 113 MOHOKnOHaJlbHhlX uMMyuorJl06YJll1HOB IgA,
IgA unu IgM, pC>KC MOHOKnOHaJlbHblX JlCrKUX u.eneii (6eJ10K ECHC-,[J,>KOHca). 2) TIm
II (cMewaHHaSi Kpuorn06ymmeMuSI) COCTOJ..1T U3 MOHOKJIOtlaJlbHblX l1MMYHOI'Jl06y-
mUlOR (06hl L lHo IgM. pC>KC IgA JUJU IgG), 06n3J.l,31Ow.Hx aUTnrn06ynHHoBoH aKT118-
HOCTblO npon-m nOJU1KJIOH3nbHoro IgG. 3) nm III (cMem3HHaSi Kpuorn06ymme-
Ml1S1). COCTOHT 13 011Horo mJU IIeCKOJlbKUX KJIaCCOB lIonUKnOHaJ1hHhiX HMMYHorJlo-
6ynHHoB, HHorAa HCHMMYHorn06YJ1I1HOBhlX MOJ1CKyn «lmopollcKTUH, mmOnpOTCl1-
J],bl, C3 KOMJlOHCHT KOMnncMcHTa). Hau60JIcc llaCTO BC1'pellaeTCSI III TIm Kp lOrno-
oynHHeMm1 (60-75%). npH 3TOM y 30% oonhHhlX pa3mnue KpHorno6ym1HCMl1U
Ha6moAaeTcSI B OTCY1'CTBJ1C uCAyw.cro :m60JJCBaHuSi. 3TOT CUHJ],pOM, nOJ1YLU1n H3-
3n3Hl1C 3cceHu.UaJlbHaSi CMcwaHHaSl Kpuorn06ymmeMuSI (3CK).
Xoo llCC.Ilej)0l311I-lUR. 1. Cmani>apmHbl" A-Iemoo OllpeOeJlelllm KpUOlJl06YJlu-
H06. J1uKy6au.mo U u.cH"ll'ucpyrHpouaHHc KpOUl1 AnSI 1I0n)"leHl1S1 ChlBOpOTKl1 CJleAY-
eT npoBoJ],HTh npu 37°C. 3aTeM B l elnpH<t>Y>KIfYIO npoGupKy lIoMcw.alOT 3 Mfl ChI-
80pOTKl1, A06aBJlSlJOT a3H]J; H3Tpl1S1 (0,01 %) U UHKYOl1PYlOT B Te L leHUl1 5 AHeii npl1
4°C. np0611pKY U.eH1'pHcpyrupYKIT (150() 06/Ml1H n Te lelUm 15 U1U) AmI. IIOJIY'IC-
METO)J,bI KJlI1HI1'4ECKOM I1MMYHOJlOrI111 215
HHSJ npCLI,HIU1TaTa, npCl\Hm1TaT OTMblBafOT u.cHTJmQJyn1poBaHHcM 3 pa::m no 15 Mini
n 10 MJ1 0,01 M PBS (pH 7.0) npH 4°C, J1.06anmlfOT 0,5 MJ1 nO]J,orpeToro 1 0 37°C
0,15 M PBS (pH 7,2) H HHKy611PYIOT B Te\leHl1I1 2 \1 npH 37°C AO nOJ1Horo paCl'BO-
pCHI1SJ. nOJlY\leIlHbIH MaTe pH all Ll,eHTpHQJyn1pYIOT B Te\lemm 15 MHH npH 37°C
(1500 06/r..-II1II), co6HpalOT cyncpnaTam- H onpeACJ1SJIOT KOHlI,eHTpau.mo 6CJ1Ka no
JlOYPH 1'1 11MMYHOxHMHLIecKHH COC1ClB MeTOl OM HMMYHOHI-1QJQJY31m B arap03C C I-1C-
nOJ]b30Bam1eM aHTI-1CblBOpOTOK K IgG, IgA, IgM, C3 H C4.
2. hb,cmp'11l1 clleKmpo!Jjomo.Mempll"leCKllU .ItIemoi) onper>eAellllJ' KpUOl.flo6y.flU-
HOB. 2 MJI CblBOpOTKI-1 CMCIIII1BaIDT C paBHblM 06'hCMOM 0,9% XJIOpHCTOro HaTpI-1H
U nOMCIJ aIOT n 2 npo6upKH, OAHY 113 KOTOpblX I1HKy611PYIOT npH 37°C, a ApyrYID
npH 4°C R TC'lemm 60 MI1H. nOCJ1C OKOH\laHHH HHKy6aLl,Im H3MCpHtOT onTlI'lccKYID
nJ10THOCTh Ha CIICKTPoQJoToMeTpc IIpl-1 AJII1He BOJ1HbI 500 HM. B Ka'ICC1UC 6J1aHKa
I-1Cn0J1b3YIDT 0,9% pacTBop XJlOpUCTOro HaTpHSJ. 0 cOJ\cp>KaHHH KpHOrJ106ym1lloB
CYAHT no pa3Hm c on (JI.CJ1bTa on500 }1M) np06, I-IHKy6HpoBaHHbix npl-1 37°C H
4°C. HopMa 0,016 Cn.OIlT.I1J1.
KpHOrJI06YJIHHCMHIO CJlC).\YCT OTJIU'IaTb 01' KPliOQJH6pI1ll0rCHCMIU1, KOTopaSJ
CBSJ3aHa C npHC)' I'CTBHCM npcu.Unl1Tl1pYIOW,Cro Ha X0J10AY qm6pHllorcna. KpHOQJH-
6pnHorcHcMHSJ MO>KeT 6blTb IICpBU'IHOi'1 H BTOPH'/lJOi'1, CUSl3aHHoi'l C onYXOJlSJMH, HC-
Kp030M, oc rpblM HJ1H XpOHI-1'ICCKItM BOCllillICHHCM. aYTOI-1MMYHHblMH 3aGOJICBaHHSI-
MH. KpUOQJH6pHHoreHcMI1S1 'laCTO p.nmmaCTCJI Y 6oJ1hllhiX IgA-HcctJponaTHcH. B
COCTaBC KpUOllpCLI,mn1THpylOw,cro 1\1a"rCpHillIa 06HapY>KlmaIOTcJI IgA-aHTHTcJIa,
pcarl1pYlOLLU1C C ctJHOpOHCKTl1HOM. IgA-pcBMaTOHJl,HhIH QJaKTop, nom1MepHblH IgA.
1G1ll/--lU'ieCKOe 3Ha l lel-Ille. OllpC).\CJICHHC KpHOrJ10oYJ1HHOn Ll,CJlccoo6pa3Ho npo-
BOAI1Tb npll nOn03pclum Ha 3CK, KOTopaSi xapaKTcpl13YCTCSI pa3BI1THCM KO>KHOJ1
BacKym1THoi'i lIypnypbl, HCQJpHTa, Hd'iponaTHH H ).\p. CHCTCMHblX npOJlBJ1CHUH It 'Ia-
CTO CBJl3aHa C HHQJCKLI,HCi'1 Bl1PYCOM renaTl1Ta C. KpOMC TOI-O. YBCJIU'ICHHC ypOBHJI
KpHOrJ106YJIIUlOB Koppcm1pYCT C RbICOKOi'1 aKTHUHOCTblO H nOpa>KeHI1CM nO'ICK npl1
CKB (MapKcp HCOJ1arOnpHSITHoro nporHo3a), paJBHTHCM CUCTCMHblX npOJlBnCHUH
npu CI-1ItJ\pOMe lllcrpcHa H P A.
JIumepllmypa. AJICllIKUH B.A., HaCOIIOB E.ll., EpcMeeBa M.B.. KOOblJ1J1HCKHH
A.r. I1cm.lJ1b30BaHuc TBcPAoctJa3Horo Clq-HMMYHoctJepMeHTHoro MCTo).\a }J.J1J1 on-
peJJ,eJ1CIIHSllU1pKym1pytOLLl.uX Uf\'IMymlblx KOMIIJICKCOB npl1 JaOOJleBaHHJlX \ICJ10ReKa.
TcpaneBT. apXI1IJ. 1989,.N 6, c.113-116. HaCOHOB E.1I. I1MMYHHblc KOMnJ1CKCbl npu
pCBMaTUtlCCKUX Ja00J1CnaHl1S1X. I1Torn HaYKU U TeXHl1KU. CCPUSI I1MMYHOJIOrJ-ISI.
TOM II, 1984. c.t 04-158. HaCOHOB E.11. MCTOAH'ICCKI1C acnCKTbI onpeAeJ1CHHJI QUP-
Kym1pYI0LLl.HX HMMYHHblX KOMIIJICKCOU C ucnO.%JOB<!HueM nOJU13TI1J1CHrJ1I-1K0J1J1. Tc-
paneBT.apxuB, 1987, N!! 4. c.38- 45. HaCOHOB £.JI., lHf\mctJccna E.E., Cypa B.B.
KJ1HHl1KO-UMMYHOJIOn1'lecKaSi ou,CHKa cncKTpo<)JoTOMCTpU'leCKoro MCTO]J.a OllpC-
ACJ1cm1J1 KpI-10fJ106YJll1HOU npu pCBMaTH'ICCKHX Ja60JICBam1SJX. PCBMaT0J10rUJI.
1988, .N 2, c.39-43. HacoHoD E.1I. EapaHaycKaHTe A.A., COJlOBbCB C.K. KpHor-
J106ym1llCMUSI npu pCBt.1aTl1 t ICCKHX 3a6oJlCBilHl1J1X. Km1ll.McAUlI,UHa. L991, .N2 6,
c.23-32.
7. AYTOaHTMTena
Aymoautnclme/la onpe CJ1SlfOTCJI KaK aHTl-ITCJla, HanpaBJ1CHllblC npOTI1R ml'ml"c-
1I0B. IIPl1CYTCTBYlOILl,IIX Ita C06CI'BCHHblX KJ1eTKaX, RHyqm KJ1CTOK 111m DO DHCKJIC-
216 TOM II - tIACTHbIE AHAJII1TI14ECKI1E TEXHOJIorl111
TOtlHOM npOCTpaHCTBe. AYTOaHTl-neJta MOrYT 6blTb Hanpal311eHbl B OTHOIllCHHU
tlpe3Bbl'IaHHO umpOl<oro CneKTpa aHTHreHOB, SlBJISlIOlI.lHXCSI KOMnOHCHTar.n1 SlJ],pa,
llHTOlllla3Mbl, K11eTO'lHhIX MeM6paH, GCJIKat.m n11a3Mbl, r'OpMOHaMH, cPCpMCHTar.m.
KJleTOtlHblMH peucrrropar.m. B Ka'iec me aYToaHTHreHOH MorYT BblcTynaTb MOJIeKY-
11b1 C pa3JIH'1HhIMH 6HOXHMH t ieCKHMH CBOlICTB3MH, BKJUO'IaSi 6ellKH, HYKJIeHHOBhlC
KHCJlOTbl, cpoccpOllHnH}J.bl, caxapa, CTepOHJ:I,bl Ap. B 3aBHCHMOCTH 01" Toro, CBSl3blBa-
IOTCSI JIH aYToaHTHTCJla C opraHOCneI.lHcpHtICCKHMH, KneTotIHOCliCIlHcpHtieCKHMI1 3H-
THreHaMH HllH opraHOHecnellHcPUtICCKHMH (l11HpOKO pacnpOCTpaHCHHblr.m) aHTHre-
Har.m, OHH nO p33J:I,eJISIIOTCSI Ha 3 OCHOBHblX rpYllllbl. OpraHocncl.lHcpH1lecKHe ay ro-
aliTHTeJIa pearHpYloT C nenTUJ:I,l-JblMH ropMoHaMU (HHCYllHH H J:I,p.), rOpMOllaTlbHblMH
pC1lcirropaMH (al.leTHlIXoJUm H J:I,p.), THpcorno6ym1HoM; KncTollHocnel.lHcpwlccKHe
aYTo3HTHTeJIa HanpaB-'IeHbI npoTHu MeM6paH pa3JIH 1 lllbiX KneTOK - 3pHTpOUHTOB,
JlHMcPoI.lHTOB, TpOM6olll1TOU; opraHoHecncllHcpullecKHe ayroaHTUTeJl3 pean1pYloT
C HYKJICHHOBhlMH KHCJIOTaMH, HYKlleonpoTcuAaMH, 6cnKaMH llHTOCKeJleTa, H Apyru-
MH KOMnOHeHTaMH, yt.mcTBYlOllI.HMH II KneTOtlHOH aK nlBallHH H MCTa60mI3Me, a
TaK)I(e GCJJKaMH nlla3Mbi (HMMYHorno6YllHHbl, KOMnOHeHTbl KOMnneMeHTa HAP.).
Ba>KHbIM CBOHCTBOM HCKOTOpblX THnou ay roaHTHTen SlBJlSlCTCSI HX cnocoGHoCTb
K IlCpCKpeCTHot'I pcaKTHBHOCTH (nOJIHCnel.lHcPlltIHOC 1"1» C pa3JIH'IHbIMI1 <:lHTHreHHbl-
MI1 J:I,eTCpMHH3HT3MII. CHUTe3 aYToaHTHTCll C onpeJ:I,enCHHot'1 CllellHcpH'IHOCThIO MO-
)l(CT Ha6mOAaTbCSI II OTC}'TCTBHC lIaTOJIOrHII (eCTCCTueHHble a}'TOaHTUTeJ1a), H pac-
CI\IaTpHUaCTCSI KaK 3alll.HTHaSl pC3KI HSI opraHl13Ma. npHHl1P','laIOJI aSl Y1JaCTHC U pcry-
nSlI.lHH HMMYHHoro OTUCTa K 3K30reHHbiM aHTHreHaM (MUKp06bl, BHPYCLI) H 3JlUMH-
HaI HH nOBpC)I( eHHbIX II CTapClOllI.HX KJleTOK.
npll aYTOHMMYHHblX 3a6011cuaHHSlX aYToaHTl1TCna IlrpalOT ua)l<HYIO pOJIb B na-
TorCHC3C 6011e3HeM. a HX onpeAeJleHHC B OHOJ10rWJeCKHX >KlfJ:I,KOCTSIX HMeeT CYllI. e -
CTBeHHOC HarHocTH'leCKoc 3Ha 1 1eHHe. Ay l'OaHTHTeJla Clloc06HbI Bb13blUaTh nOBpe-
>K)l,eHHe opraHOB nOCpeJ:I,CTUoM tlCCK011bKHX Tccno CBSI'33HHbIX MC>KJlY COGOH Mcxa-
HH3MOB: 1) KOMllneMcHT3aBHcHMbiM IlHTOJlU3 H OIlCOUH3aI lm KncToK-r.n1U1eHeH
(aHTHTella K q,opMeHHbiM 311eMCHT3M KpOBH); 2) 06pa30BaHHc llHPKYllHpYlOllI.lIX If
cpHKcHponauHblx liMMYHHhlX KOMnJleKCOU (aHTHTena K ,IJ,HK, peBMaToHlluhlH rpaK-
TOp). 3) I1HJ:I,YKI.lHSI aHTHTeJI03aBHcHMoH Kl1eTo'IHoMllHTOTOKCH t IHOCTH. 4) B:mHMo-
J:I,ellcruHc C KlleTOllHblMH peuernopaMH TV1S1 eCTeCTBCHHblX llHraHJ],on (HHrH6 m lHSI
B3aHMoAeik rBHSI aKTHBHoro I.lCHTpa pellCrlTOpHOH MOJleKYJlhl C eCTeCTBCHHblM llH-
rannOM, UMHTal.lHSI 3cpcPeKTa eCTCC rUCHHoro J1HraHJ],a, HHTepHar1l13aIlHSI H YCKope-
HHe Aerpa.r aIllfH pellerlTOpoB) HnH KaTlhl.lHCBblMH KaHallaMH. 5) MOJ:I,HClmKau,HSI 3K-
THBHOCTH CbIBOpOTO lUbIX MOJIeKyn (311THTena K cpoccpoI1HmiJ],aM). 6) AKTHBaLlHSI
KlleTOK, npHlIHr.1alOllI.IIX Y1IaCTHe B pa3BHTHH nOCnaJ1eHHSI (aHTHTena K HCHTporpU-
naM). 7) 113MeHcmlSl CPYHKllHOHaJlbHoij aKTHBHOCTH KlIeTOK pa3J1H l lHhrX opraHOB H
TKaHeM (aHTHTc.rm K Kl1eTKtir-.'1 MHOKapJ],a, 3HUOTel1H1O H J:I,p.). 8) PerynSlllHSI anonTO-
3a pa311H I IHbIX Kl1eTOK.
l..lHPKY11HPY lO llI. HC ayroaHTl-nena - OCIIOBHOH AHarHocTHt.lecKHH MapKep aYTOHM-
MYHHblX 3a6oJI Uam1H. OJ:I,HaKO TOJl1 KO 06HapY)I(eHHe aYToaH I'1l1'en He SlnmiCTCSI
J:I,OCTaTOIIHhIM J:I,J1S1 nOCT3HOBKH AlfarH03a aYTOHMMymioro 3a6oJlcUamlSi. OTMCtlCHO
napaCTaHHC 'iaCTOThI 06HapY)KCHHH aYToaHTHTCJl Y JrHI.l nO)l((.1]10rO Ii CTaptlCCKoro
B03paCTa, na cpOHe npliCMa lIeKOTopblX JICKapcTBeHHblX IIpen3paTou, npH BHPYC-
HblX H 6aKTepmUlbHhiX I1HcPeKI.lI-I X, Y 3nOpOBbiX pOJlCTBeHHHKOU UOJ1bHblX ayr0l1M-
MYHHblMH 3a6oneBmUlSlMH. B TO >Ke BpeMSI CTOHKoe nOBblWCHl1e ypOBHSI aYToaHTH-
p.
METOAbI KJII1HI1t.IECKOI1I1MMYHOJTOfl1l1 217
Tcn a>KC SlBJlSlCTCSI aKTopoM pHCKa pa3BHTHSI HC TOJlbKO ayrmlMMYHHblX 3a60nc-
BaHl'lii, HO H APymx IlIMpOKO pacnpOCTpaHCHHblX 3a60JlCBaHMM qCnOBCKa (60nc3HlI
cCPAe l lH0-cocYAHcTm1 CHCTCMbi. 3nOKaQeCTBCHHbie HOBoo6pa30naHHSI H p.). flpH
OL{eHKC KnmmllCCKoro 3Ha l leHmi aYToaHTHTen Hc06xo,1UMO Y'-UfTbmaTb CToi'IKOCTb
I Bblpa>KCHHOCTb HX np0Aj'KI.{HM. HaJlpHMCp, Ha oHe HH eKL{HH Ha6nKJAaeTCSI
YMCPCHHOC, rpaH3l1TOpHOe 06pa30BaHHe aYToaHTUTen, a npll ay fOHMMYHHblX 3a60-
JlCnaHHSlX CTOHKaSi Bblpa>KeHHaSi rHlIcpnpoAj'KL{HSI, B pSlJ],e cnY'IaeB KoppcnMpYKJ-
ll{aSi C aKTHBHOCTblO I1MMYHOJlaTOnOm l lCCKoro npOl ccca H onpeJl,eneHHblM cneKT-
pOM KnHHU'ICCKHX npOSlBJ1eHHi'f H naoopaTOpHI>IX HapymcHHi'f (nO THnbl ayroliM-
MYHHblX pCBMaTHllCCKHX 3a6oJICBaHHi'1).
MemOl)'Jl onpeOC./leHlIR. )J,JUI onpCJ],cnCHHSI L{HpKyn"pYlOlI HX ayroaHTuTcn npM-
MCHHIOT npaKTM'-ICCKH BCC CYIl{CCTBYIOIlI.HC HMMYHOJI01"H'ICCKI1e MeTOJ],bl, BKnKJlIaSI
MeTOA HenpHM0I1 HMMYHo nIOOpCCl{CHI{HH (HI1<1». MeTOJ],bl rCMarrnIOTHHaL{HH
(rA), HMMYHO 114>4>Y3mi (I1A), BCTpellHhlH HMMYH03JICKTpO OpC3 (BI13cJ».
11<I)M Ii PI1M, HMMYH06J10T'flfHr (I1E), HMMYHonpCl{HnHTaI{HtO (I1D), HCKOTOpblC
YHKL{HOHaJlbHbIC TeCTbl (Ta6mlU,a 3).
Th6nHL{a 3
Tun aYToaHTuTe."1
AHcJ>
HaTHBHaSi AHK
AC30KCHPH60HYKJICOnpOTcliH
MeTOALI onpCACJIeHUD aYToaHTHTeJl
MeToJJ,LlonpcJJ,CJICHIiJi
HH<1>
HI1cJ>, PI1M, I1A, BI13cJ>, fA. I1<l>M
PI1M, I1A, I1<1>M, naTCKC-TeCT.
4>JlOKYJISlLl.HSI C 6CHTOHlITOM.
LE-KneTolIHhIM eHoMcH
I1E, PI1M. 11 cJ>M
I1A, fA, H<1>M, I1E, I1D
VI)]" fA. l1<pM, VIE, I1D
I1A.I1E
HH<p, I1E
11.a., I1cJ>M, I1E. I1D
I1A. I1cJ>M, I1E, I1D
I1A, I1E
I1A. HE, I1cJ>M
I1D
I1cJ>M
11 (I> M
I1<1>M
JIaTcKc-arr nIOTHHaL{H SI,
HC CJIOMC1'PHSI, VI<J.>M
HHcJ>, fA, I1cJ>M
HI1<1>, I1<1>M
rMCTOH (HI. H2A. H2B. H3,H4)
Sm aHTHrCH
PHD
ScI- 70
lLcHTpoMepa
RoISS-A
LalSS- B
PMlScl
10-1
ApyrHc aMHoaLl.HnCI1HTeTa3bl TPHK
DpoTcHHa3a-3
MHenonepoKcH a3a
KapAHOJI mum
IgG - Fc
THporn06ynHH
MI1KpOCOMbl (nepoKcHAa:m)
Il{HTOBHJI,HOH >KCnC3h1
MUTOXOHAPHH
fna,!:{K3S1 MycKynaTypa
HI1cJ>, I1cJ>M
HI1<1>
218 TOM II - 1fACTHbIE AHAJH1TI1YECKI1E TEXHOnOrl111
1. PeBMamouollbie ifja"mop'JI (PiP)
P<1> - ayroaHTI1Te1la IgG t IgM 111111 IgA H30Tl1nOB, pcarl1pYIO l1x C FC-cpparMeH-
TOM IgG.
TVzuH.UllecKoe 3H.a t teltUe. Hal160J1blllee KJ1IIHH'-IeCKOe 3Ha'lleHI1C I1MCeT onpeAe-
lIeHHe IgM-PcI> (TaOJlHua 4).
TaOllHl-\a 4
IJacToTa o6l1apY.>Kelllul IgM PCJ) uP" 3aOOJIeBaUHBx qeJIOBeKa
3a6oJIeBaHIIB tJacToTa, %
PenMaTOI1AHblH apTpl1T 50-90
CHcTeMHaSi KpaCHaSi nOJl'lJaHKa 15-35
CHIi.n,pOM IllcrpcHa 75-95
CI1CTeMHaSi CKJlepoAepMHSI 20-30
nOJll1l\m03HT/.n,cpMaToMHo3I1T <10
KpHorll06Y1lHHcMMSI 40-100
CMelllaHHoc 3a60JlcnaHHe coeAHHHTCJlhHOH TKaHI1 50-60
11 HcpCKUHlI
6aKTepHaJ1bllblH 3HJ\OKapAHT
Ty6epKYlIe3
CHcpWIHC
napa:UtTapHble HHcpeK1lHH
npoKa::m
mlpYCHhie HHcpeKlll1H (KpacHyxa, KOpb. rpHI1I1)
DOJIC3HI1 JICrKHX:
capKOH}:t.03
IHTCpCTI1L'I1a.rlbHbIH JICrO'llHbl" cpH6p03
cnm1K03
ac6CCT03
nCpBlI'lHblH 6mumpHbli'r LlHpp03
3JIOKa'lleCTBeHHble HOBoo6pa30naHHSI
COlIH11.Hhie
II HM(pOnpOJutcpepantBHble
3uoponbiC 1I1011.H
M01l0)Ke 70 lIeT
cTapmc 70 JICT
25-50
<10
<13
20-90
5-58
15-65
3-33
10-50
30-50
30
45- 70
5-25
11.050
<5
AO 25 *
nplI.ue<Ill/lllC: ItMclOTCJI AaHHblC 0 TOM, <11'0 'laCTOTa It nrrphl P<I> He yocmi'lliBalOTCJI C 003-
paCTOM.
06Hapy)KeHHC IgM-P<I> y )KeH HH cpe.n,Hcro B03paCTa C l1epCHCTlIPYIO HM no-
Jll1apTpl1TOM I1PH 15% BepoSiTHoCTH PA Ha OCHOBaHHH KJIHHH'lleCKHX }:t.aHHhIX. YBC-
1I11'mBaeT nepoSiTHoCTb 3TOH naTOJIOrI1H}:t.0 74%. O}:t.HaKo, y lIHLlI10)KHlIOrO B03pac- ,
Ta, Y KOTOphiX Ha6mo}:t.aeTcSI nOBhlIlIeHHe <raCTOThI IgM-P<l>, Cl1eUHcpW.IHOCTb 31'0-
fO TeCTa J.l)ISI AHarHOcn.IKM PA CHH)KaeTCfI. npH HHTepnpCTat.lHM pe3YllhTaTOB on-
pe}:t.C1IeHHSI IgM-P<I) JJ,JlSl AHarHOCTHKH PA, Hc06xOAIiMO HMeTb B BI1AY cYll ecTBoBa-
HHC cepoHeraTHBHb1X BapHaHToB PA. nOclIe11.lIHe "lal1 C BC1'pe'lJaIOTcSI Y }KeH HH M
Y OOJlbHbrX, Y KOTOpblX PA Ha'llaJICfI B nmKHlIOM B03pacTc, 'leM Y MY)K'lIHH H Y JUII-\.
Y KcyropblX P A Ha'llaJJCSI B cpeAHeM B03pacTe. CCPOIl03"TMBHOCTb H BblCOKHe THT-
pbl IgM-PQ) KOppelIHpyJ01' C TJI)KCCT61O, 6h1CTpOTOH nporpeCCl1pOBaHI1S1 naT01l0r"-
>-.
METO,[LbI KJII1HI14ECKOH I1MMYHOJIOfl111 219
\ICCKOI'O npou.ccca Ii pa3B11THeM CHCTeMHblX npmiBJleHHH np 1 PA. B TO >Ke BpeMS!
J],HHaMHKa THTpOB IgM-PCl> HC BCer)],a SlBJIHCTCH J],OCTaT04HO 4YBCTBHTeJlhHhiM H
cneLtmtm'IHblM nOKa3aTeJleM Jl,JIH OU.CHKH 34J4JeKTHBHOCTH Jle'leHHH PA.
IgA-PcI> llaCTO o6HapY>KHBaCTCH npll IgA-Heq,ponaTHH H npH PA C nOJIHapTU-
KYJlSlpHhlM BapHaHToM HaliMa 3a6oJleBaHHSI H BHccycTal3HLIMli (cHcTeMHbJl'vUi npo-
HBJleHHHMH), a TaK>KC npH CHHAPOMC lllcrpeHa, nypnype IlleHnei'1HC\-fcHoxa Ji H1I-
4JCKllHoHHOM 3HAoKapAHTe. 06HapY>KCHHC IgA-P<1> Ii IgA-cOAep>KalllHX lIMMYHJfLIX
KOMI1JICKCOn KoppcnHpyeT C nporpeccHpoBaHHeM cycTaBHoro IIpOl ccca npli PA.
IgG-P(I) 06HapY>KHBaeTCH npH paJ.'U1\lHbIX 3a6oJICBaaHHHx. HO MeTO)], el'o onpc)],cJIC-
HHH Tpc6YCT J],aJlMtCHlLlcro concpmcHcTBoBaHHS!, a KJlHHH'ICCKOC 3Ha l lCHHC 11.0 KOH-
Lta He HCHO. P<I> KaK npaBHno He 06HapY>KHBaCTCH npH npyrHx 3a6oJlCBaHHHX, npo-
HBnHKJli.lHXCH apTpHTOM HJUf ap"'paJILrHHMJ1. C KOTOpblMH npOBO)],HT AH4J4JCpCHIJ,Ii-
MbHY}() 1I.HarHOCTJ1KY CHCTeMHblX pCBMaT 1'leCKJ1X 3a(){)JICnaHHH, TaKHMJ1 KaK OC-
Teoap'rpHT. pCBMaTIi\ICCKaSi nOJlHMliaJlbnlH, cepOHcraTHBHLIC cnoHJ],HOJlapTpona-
THH, MHKpOKpJ1CTannWIeCKliC apTponaTHH. JlaHMOnCKHH 60ppeJlH03, MCTa6oJIH'le-
CKue H 311J],OKpHllllh1C 3a60nCBaHHS! (aKpOMen.\JIHH, caxapllhlt'1 J],Ha6cT, rCMoxpOMa:-
1'03, fl.mCpnapaTJ1pC03, OXPOH03, 3a6oJICBatniH ll.lHTOBHJ],HOH >Kene3h1, 6onc3Hh
BHJlbCOHa. aMHnOHJ],03. napBOBHpYCHaH HHq,CKIJ,HH, TeHAHHHTbl, 6ypCHTbI.
MemOc)blonpeOeJleH.llR. IgM-pcp onpCncnSlIOT C nOMOll.lbKJ pcaKlUiH JIaTeKC-ar-
rnKHHHallHJ1 (.laCTHlJ,... JlaTCKca, HarpY>KCHHbIC IgO 'ICJIOnCKa) HnH peaKI.lHH Baa-
Jlep-P03C (3pHTpOLl.J1ThI6apaHa, HarpY>KeHHbiC IgG KpOJUiKa). PcaKllHH Bm\JIcp-Po-
3C MeHee IIYBCTBHTcnbHbIH, HO 60JICC CIICIJ,H4JltlIHbIH MeTO)], onpCACJICIIHSI P<1> npH
PA. ,[LnH onpc)],CJICIIHS! IgM-P<1> pa3paooTaHbi MCTO)J,LI na3epHoH Heq,cnoMeTpJ1H,
Typ6HAHMCTpHH, PI1M H 11<]>M (noCJlcAIIHH II03nO]UICT onpe)],cnHTL PCP, OTHOCH-
lllJ1HCH K pa3J1H'IHblM H30THnaM HMMYHOrJlo6YJ1HHOB. IgG. IgA. IgE). npcAnonara-
CTCH, lITO HCIIOJlb30BaHHe B I1cl>M CMCCIi IgO IICJIOBeKa H IgG KpOJlHKa II03H0J1S1eT
IIOBblCHTb llYBCTBHTCllbliOC 1'L 11 clleu.H{ IIIIHOCTb onpeUCJICHHSI IgM P<I> AJ1H )],HarHO-
CTHKH PA. (-ra6J1Hu.a 5).
Ta6J1 Hila 5
1.JYBCTBlITeJILHOCTL " clleQucl>llQHOCTL pa3JIHQllLIX MeTOjJ.OB onpCAC:ICIIUJI
IgM-P(f)
1.JYDCTDUTeJILIIOCTL, %
75
50
82
85
MCTOALI
JIaTeKc TeCT (IgG llclloBcKa)
BaaJlep-Po3e TeCT (IgG KpOJIHKa)
Heq,eJlOMCTpHH (lgG 'lcnoBcKa)
I1cJ>M (lgG 'lcnoBeKa+IgG KpOJIHKa)
CnCQl1cI>U'IIUOCTL, %
75
90
70
94
I
\
t
RameKc-mecm. Xoo OllpeOeJleHltR. PcarCIITbl nOCTaBnHIOTCSI MHornMH Ko ma-
HHHMH. B COCTan 60nbl1JHHCTBa Ha6opoll BX01l.HT 'lacTnu.bl JlaTCKCa, HarpY>KCHHbIC
IgG \ICJ10BCKa, COOTBCTCTBYIOUJ,Hi'i 6yq,ep H cneu.HaJILHOC npe)],MeTHoe CTCKJIO.
1) I1HaKTHBJ1poBaTL cbmopoTKY HarpeBaHHcM np.u 56°C B TellemUi 30 MHH, a 3aTeM
oxn HTb 11.0 KOMHaTHoi1 TeMnpaTypbl; 2) CMcwaTb 20 MKn cycncH3HH JlaKTCKca H
20 MKJI CbmopOTKH (pa3BeJJ,cHHoi"1 1 :20). 3) AKKypaTHo BCTpHXHBaTh C Te'ICHHH
1 MHH. 4) OlJ.eHHTb HaJ1H'lHe arrmoTHHau.I1H. AJ1S1 OllCHKH Tl1Tpa PeI> npHroToBHTb
CCpJiHHble pa3Be)],eHHH CblUOpOTKH Ii npoBecTH HCCJICJJ,ODaimC KaK onHcaHO B nYIIK-
Tax 2-4.
220 TOM II - YACTHbIE AHAfll1Tl1tIECKI1E TEXHOflOrl111
H.KMYlloifJepMellmHblU .uemoo (no Faith 11 coaBT., 1982). Xvi) onpe()e.AeH.tLR.
1) B nYHKH MHKponnaT H3 nOnliCTHpOna BHeCTH no 100 MKJ1 IgG 1.IenOBeKa
(5 MKrhm) B O,OlM PBS (pH 6,3): 2) I1HKy6uponaTh B Tet.leHH" 16 '-I npH KOMHaT-
HOH TeMnepaTYpc; 3) OTMl.lTb nYHKl1 MHKpOllJlaT 3 pa3a 0.01 M PBS (coAep)f<a HM
0.05% Tween-20) (PBS- T) H B Ka)f<AYI-O llYHKY A06aBuTL no 100 MKJI TecTHpyeMo(1
CbIBOpOTKH, pa3BCnCilHOH 1 :100 B PBS-T. 4) I1HKy6HpoBaTb B TelleHHH 16 '-mcoli
npH KOMHaTHO(1 TeMnepaTYpc; 5) nOBTOpUTb npOMblBKY (nYHKT 3); 6) B Ka)K)J.YI-O
nYHKY A06aBHTL no 100 MKn aHTHTen K IgM tlellOBeKa, Mel.JeHHbIX enollHo(1 £p oc -
aTa30H (pa3neJl,eHlfe 1 :500 n PBS- T) H l1HKy6uponaTb B Tellelum 2 lillpn Kor.fHaT-
HOM Ter.mepaType; 7) nocnc 2" KpaTHoli npOMblBKH PBS- T U OJl,HOKpaTHoli OTMbl8-
KH AHCTHJIJlHpOnaHHoli HOAOH, J],06aBHTb cy6cTpaTH}'K) CMeCb 11 noclIc OCTallOUKH
pCaKIU.JH H3MepHTb on Ha MHOl'OK3HaJlhHOM oToMeTpe npH AIIHHC nOllHbl 405 HM.
2. AlllllURdepllble allmume.fla (amnuIIYKIleapHble ifJaKlllOpbl)
AHTHSIAepHble aHTlfTCJla l1ml 311 nmYKJleapHble aKT()pt.l (AH<1» -reTeporeH-
HaSl rpynna aYToaHTHTen, pearHpYIOII UX C pa3J1H l 1Hb1MH KOMrTOHCHTaMH SlJI,pa.
MenWOhl onpeOe.lleHIlR. AH<j) onpCHcmUOT MeTOJ],oM HcnpSlMOH HMMYHo moo-
peC1leHLl.HH (HI1<P) C Hcnonh30B3HHeM B KallCCTBC cy6cTpaTa KpHOCTaTHLIX cpe-
'JOB MLllliHIlOH HnH KpblCHHOM IlC l IClU1 HIm HEp-2 KneTOK (3IlHTCIlHaJII.Hl.le KneTKH
p3Ka ropTaHH llcnonCKa). I1cnoJ1b30naHHe nocneJ],Hcro cy6cTpaTa npeAno l lTuTCllb-
HeM, T3K KaK 1l03BOmieT nOBblCHTb 'lyncTBHTCJILIIOCTb MeToJ],a (Ta6nHlJ.a 6),
Ta611Hlla 6
qaCTOTa oOHapy:HwIIHJI (%) AUf!)
npH CHCTeMHLlX peBM3Tu ' ICCKHX 3360.'JeBaHHJlx B 3aBllCliMOCTil OT cy6cTparn
3a6oJleBaHile KpHoCTaTHLIH cpe3 HEp-2 KJIeTKH
crB % W
CI1HJ],pOM lllcrpeHa 72 85
CHCTeMHaSi CKncpo"cpMHSI 40 88
PCBMaToHAHblli apTpHT 25 55
IOBeHHnbHblM apTpl1T 22 40
Xoi) llCC.Ilei)o6G1-1llR. 1. KynbTHBHpoBaHHc HEp-2 KneTOK. HEp-2 KJICTKH nOMe-
al-OT H3 npcgMeTHoe CTeKJIO (lxl05 KIICTOK) B 5 MJl DMEM, COTJ,ep)f<aU{eM
10% FCS H Bblpa Hl33l-OT npH 37°C B TelleHHH 40-48 '-laCOB B 5% CO2. np" TJ,0C-
TH)f<eHHH 80-90% KOmpJII-OCHTHOCTU, KneTKH £pHKCHPYI-OT CMeChtO MeTaHona C 31.lC-
TOHOM H xpaHSlT npH -20°C. 2, KOH'hJOI'HPOll3HHble aHnfTen3, I1cnonb3ytOT nonH-
BaJlCHTHhle aHTHTena (KpOJIWILH 1JlH MOpCKOli CBHHKH) uponm IgG lleJ10neKa,
KOH"btOrHpOBaHuble C ntOOpeCl.leHHHJOTHOl.lHaUaToM (COOTHOlliCHHC cpmoopecl.le-
HH/6enoK OKono 3). 3ranhl onpeAeneHHSl A I-I <1>. Ha KJleTKH. HKcHpoBaHHLlc lIa
npeAMcTHoM Cl'eKJle, HacnaHBatOT 10-20 MKJ1 pa3BeAeHHOlt CblBOpOTKH II UHKy6H-
PYI-OT BO Bna)f(HOli K3MCpC H Tel.leHHH 30 MIfH npH KOMUaTHOlt TeMneparypc. T a-
TeJ1bHO OTMbJBalOT npenapaT B p3CTBOpC PBS- Tween. 3aTeM HaHOCSlT 1 KanntO
(10-20 MKn) <I>I1Tl..l-KoHvl-OraTa H BHOBb HHKy6HPYJ{)T B TClleH 1H 30 MHH npH KOM-
HaTH0I1 TCMllcpaType. TIllaTenbHo OTMLlBalOT npenapaT B paC'rBopc PBS- Tween.
HaCJlaHBal-OT 2-3 KallJIH pac.mopa, COCTOSl ero H3 70% rm1l epHHa B PBS (pH 8,3)
H aHaJl123HpYI-OT npen3paT C Hcnonb30BaHHCM JltOMUHHcueHTHoro MUKpocKona.
CneAycT OLl.CHHTh THTP aHTUTeJI (TlfTp > 1:40 npH HCnOJlb30B3HHH KpHocTaTHhix
...
METOJ.I.bI KJ1I1HI1t.IECKOH I1MMYHOJIOrl111 221
nCpHcpepM ' leCK8101 (KpacBaH)
Kpan'laTalol
CCTlJaTaH Kpan'laTaH
J.I.HcKpcTHaH Kpan1.laTaH
HYKnCOJ1HpHaSl
cpe30n Ii >1:80 npH HCIlOJIb30BaHHH HEp-2 KnCTOK pacu,CHHBaeTCH KaK 1I0JIO>KH-
TcnbHblii pC3ynbTaT), a TaK)f(C HHTCHCHBHOCTb H THn cpmoopCCI..\CHU,H11 (rnonHl..\a 7).
Ta611 Hl..\a 7
3aBHcHMoCTL xapaKTepa HMM)'HolJJmoopeCneHQuH OT THnon AHCJ)
Tun HMMYllmlJJIIOOpeCQeHQUH Tun a)'TOaHTHTeJl
rOMorcHHaH AHTHTcna K LI,HK (JJ,BYX H OJJ,liOCIlHPaJlhHOH),
JJ,C30KCHPH6oHYKnconpoTeHHY, fHCI'OHaM (HI,
H2B, H3, H4)
AHTWrCJla K nnyxcnHpaJIbHOH J.I.HK
AHTMTena Sm, PHn, RoISS-A, LalSS- B, Jo-1
AHTHTcna ScI-70 (TonoM30Mcpa:m 1)
AHHITena K l eHTpoMcpC
AH111 rCJla K PIIK -nOJlHMepa3e 1, PM/ScI, APYI HC?
IVltlHlltteCKoe 3HatteHue. AH<)) paccMaTp1Ula10TCH KaK ccponofHllecKHx MapKcp
ayroMMMYHHblX pen 1aTH1.leCKHX :m60JleBaHHt'1 (Ta6JlHl,a 8).
Ta611Hl..\a 8
qacToTa o6I1aPY}f(CIIIUI AHcD npll 3B6o.ile031UUlx "lC.1JOOCKB
3a6oJleOBHHC
CHcTcMHaH KpacHaSl n011 l laHKa
aKTHnHaSi cpopMa
pCMHCCHIoI
J.I.HcKoH]:{HaH KpacHaH BOJ1lJaHKa
J1eKapcTBcHHaH BOJI'laHKa
CMcTcMHaH cKnepoJ],cpMHH
CI1HJJ,pOM IllcrpcHa
CMcIllaHHoc 3a6oncBaHMc
COC.Q,HHHTcnhHoH TKamt
PenMaToHJJ,lIhlM apl'}JHT
l IOncHHJlhHhlH XpoHH l lecKI1J:'i apTpHT
nOJIHMH03HT/JJ,epft.faTOMH03IiT
Y3CJIKOnbiri 1l0mmpTepliHT
3HOPOBhlC nlil..\a
J],O 40
HOCllC 40
qacTOTa, % TllTpLi
95 +++
95 ++
-40 + IinH ++
100 ++
70 ++ 1i11 M +++
-60 ++ H11M +++
100 +++
-40 + MIIH ++
20 + HnH ++
-40 +
<20 +
<5 +
Hu25 +
npl/.Uettaltue: + IfU3KIIH TI1Tp ++ cpe.L\Hlul TIITp; +++ BblCOKIIII TUTp.
4'ac'rD-ra o6HapY)f(CHHH AH(» y 3J].OpOBbIX monet'l 3atUfCHT 0'1' nOJIa Ii B03pacTa.
. Y JIHI..\ MOnO)f(C 40 neT AH(» BhlSlBJlSlIOTCIoI B 1-3% C]IYlJaCB, a y 11111..\ cTaplllc 60 neT-
n 16-25% cnYllaCB. Y )f(CH HH AHcl> BblHBJlHJOTCH n cpeJJ,HCM n 5 pa3 llaU'C, llCM Y
MY)f(tIHH. laCTOTa nblHBJIeHHSI AH<1> CY CCTBCHHO nOBblllJCHa y pO.Q,CTBeHHHKon
60JIbHblX aYTOHMMYHHblMH 3a6oneBaHHHMH, OC06CHHO peBMaTwlccKHMH: y P0JJ,CT-
nCHHHKon 60J1hHh1X CKB AHct> 06lmpY lmatoTCH B 13-57%, Y pOACTBCHHI1KOB
60nhHbiX CHHHpOMOM lllcrpcHa - n 9%, CHCTeMHOH cKnepoAepMHcH - B 17-27%,
aYToHMft,'IYHHOH TpOM60ltHTOIICHHH Ii rCMOJlHTH'ICCKOH aHCMMeH - n 18%. YnenH1.le-
HHC liaCTOTbl AI [(I> 3apcfHcTpliponaHo Ha cpoHe npHcMa IICKOTOpblX JlCKapCTBcH-
222 TOM II - LIACTHbIE AHAJH1TI1 YECKI1E TEXH0J10rl1l1
HhlX npenapaTOB, OC06CHHO rH pa.r1a:UlHa H HOBOKal1Haf\.U1Ha (50-75%). K HepeBMa-
Tl-i4CCKMM :m60nenaHHSlM, aCCOl.lHHPYtO MMCSI C A HcI>, OTHOCSlTCSI cJleAYtO He:
XpOHli'IeCKJ1H aKTMBHblH (laYToMMM}'HHbIH" HnH ntOnOlIAHbli1) l'enaTHT, nepBM4HhlH
6HnMapHblH I Hpp03. HBsAg-n03HTHBHblt'1 XpOHH'iCCKHt'1 aKTHBHblH renaTlfT, PC)KC
aJlKoronLHblH renaTHT (npM renaTHTC C AHcl> He 06HapY>KHBatOTC ), HHHOllaTHtle-
CKHH nerO..,H...i1 cJm6p03 (35%), lJa e 06HapY)KlfAalOTCst Y >KeH HH C WlHTenhllLIM
Te'iCHHCM 3aGonenaHHSI, 3KcTpanYJlbMOHMbHblMH npOSlBJleHHSlMH (cpCHOMCH Peii-
HO, apTpHT, cepono::mTHBHocTh no P<1>, AI1rHTaJlbHLlt1 uacKYlIHT), ac6eCT03 (25%),
nepBH"IHaSl JlerO'iHaSl rHlIcpTeH::JHSI (40%) (06HapY)KeHHc A I-I cI> HC xapaKTepHo AJ1S1
a.rmeprHLlecKoro aJlLuconHTa H BTOpHLJHOH nel'O'iHot'1 nmep1'eH3HH), MHcpeKLlHoH-
Hble 3a60neBaHHSI (napa3HTapHa HHcpCKI.{HSI. MaJlSlpHSI, TpMnaH030M03, UIHCT030-
Ma1'03. Ty6epKyne3, rpaMM-n0J10>KHTenbHaSl H rpaMMO"I1'HLlaTCJlbHble 6aKTepMH).
3nOKa4eCTBeHHbiC Hono06pa30BaHHSI, TaKHC KaK JlHM<ponponH<pepaTHBHhle 11 MHC-
nOnpOJ1McfJepaTHBHhle onYXOJIH (17-58%). MenaHOMa (30%), paK Mono t lHm1 >Kene-
3bl (oKono 40%), SlHLuUiKon, npOCTaTbl H nerKHX, I'CMa1'onorH'leCKHe 3a6oneBaHHSI,
a HMeHHO HAHonaTHLICCKa TpoM601{HTOneHH4ecK3S1 nypnypa (20%), aYTOHMMYH-
HaSlI"CMOJlMTHtleCKaSl aHeM11 (30%). I1HorAa AHeI> BhHlBJISlIOTCSI Y 60nbHbiX C 3H-
fl,OKpmlHoH naTonorHeH (nOJIH3HJl,OKpHHona1'mi. HHcYJlHH3aBHcHMhiH caxapHbli'1 AH-
a6eT, THpeOMAHT, TMpCOTOKCHK03), AepMaTonorw-lecKHc GOlIC3HM (ncopMa3, nY3hlp-
'iaTKa), H£\ <poHe 6epeMeHHHocTH. 1J0Clie TpaHcnnaHTal\HH (KOppCJlMpYCT C OTTOp-
)KCHMeM TpaHCnJIaHTaTa) H y 60JlLHbIX, Hax011,SlUlHXCSI Ha npm1'aMHoM I'CMOAHaJIH3e.
3. A"mumeAa " OmOe./lbllbUf uOepm,uf U llumon.naJMomUlleCKU,U allmuzelllUl
HapSl]J.Y C AHc]>, 60nbllJoe 3Ha t leHHe nITst J{Hal HOCTHKI1 aYTOMMMYHHhlX peBMaTH-
llCCKMX 3a6oneBaHm1 HMeeT onpcHeneHMe aHTHTen K onpcfI,CJlCUHbIM KJleTO\lHhlM
ayroaHTHreuaM (Ta6nHl.l3 9).
TaGll HI{a 9
1.JaCTOTa 06I1apY1KCHHJI H3H6o:Jee 'lJaCTO BCTpel.JalOIl.{HXCJI aYToaHTIITe.1J
(no JJ;aHHblM U(f)M) npll peBM3THI.JCCKHX 336oJ1eB3HHJlX
Tun 3HTHTeJI CKB C3CT CC,L\ CRES'f- CIfHJijJOM 11M/AM PA
CIfHJ\POM Werpella
AHcI>* 95% 100% 70-90% 60-90 70% 30- 50% 40%
AHTH-H,IJ,HK 60% OTp 0Tp. OT[). OTp 0'11' OTp
AHTH-Sm 30% OTp OTp Ol-p OTp OTp OTp
AIITH-PHn 30% 100% 'I aCTO OTp pefl,KO pCJ{KO OTp
(BbIC. (HH3K. (HH3K. (HHJK.
THTp) rH rp) TIITp) TLtTp)
AHTl1-
l eHTpOMepHbJe HCT HeT -15% 60-90% OTp OTp OTp
AHTM-Ro/SS-A 30% pCHKO peAKo OTp 70% 0"11' O1'p
AHTH-LalSS-B 15% peJl,KO pCJ KO O"rp 60% OTp OTp
AHTH-HYKJleo-
JlSlpHblC 'faCTO OTp \IaC 1'0 OTp 'mCTO OTp pCAKO
AHrn-Scl-70 OTp 011' 10-20% OTp 0"11' urp OTp
AHTH-Jo-1 OTp OTp O1'p OTp OTp 30-40% OTp
acI>J1 -40% 0"11' OTp OTp OTp OTp OTp
npllMelJQItUe: AH<I> onpegemlnll MCTOl\OM HI1<I> C IICIlOJIb30B,HlHCM HEp-2 K11eTOK
-
METO,I:(bI KflI1HI11fECKOM I1MMYHOJIOfl111 223
I
r
3.1. AHnlumeJla " oe30Kcupu6ollYKlleullo8oii KUCJlOme (PlIK)
AnHnena K ,I:(HK nOHpa3JJ,enslloTcH Ha 2 OCHOBHLIX nma: aHTHTeJla, pearHpyJO-
lllHe IlpeHMYllleCrBeHHO C OAHOCIlHpaJIbHOt'1 (ueHaTYPHpoBaHHot'J) ,I:(HK, H aHTHTe-
na, peanfpYIOll.lHe IlpeHMymccTueHHo C ABYXCIlHPaJIhHO(1 (HaTHBHot'J) ,I:(HK. Dep-
Bble pacIlo3naJOT nypHHonhic H JlHpHMHJ.I,HHoBble OCHOBaHHSI ,I:(HK, a DTopble - ca-
xapHo-cpocc)JaTHhIl1 OC roB ,lJ,HK.
Memool:lL onpeVCJlCHuR. ,lJ,JlH onpe}l.eJICHHH aH1wren K ,lJ,HK I-ICIlOJlh3YIOT pa3-
nH"lHhle MCTOULI, KOTophie BJ,JSlUnHIOT pa3nH"IHble THllhl aHniTCn. IIPHCYTCTBYiO-
lllHX B ChlBopoTKax OOJlbHhJX CKB. HaHooJlee l!aCTO HCIlonb3YIOTcH 4 MeTOAa:
I1<1>M. MeTO}l. HI1([> C HCIlOJlb30naHHeM Crithidia lucilia, D3f- MeTO]], H MeTOJ Farr.
B L.{CJIOM IlpH CKB Ha6mo]],aeTcSI BbJCOKaSi KoppcmuJ,HH MC)KAY pe3ynhTaTaMJf pa3-
;m"lHhJX MCTOJ(OB. 11c:I)M MeTo]J, onpeAeneHHH aHTHTen K nan-muoH ,lJ,HK o6na)J,aeT
HaH60nee BhlCOKOH tlYBcTBHTenhHocTblO, a MCTOJ( Farr Hal-,6onee CIlClJ.Hc)JHIICH JJ,JJH
J\HamOCTHKH CKB (Ta6J11H. a 10). DpH HCIlOJlh30HallHii 11<1)M B03HHKalOT MeTO]J,H-
"leCKHe Ilp06neMhl, CUH3aHHbie C HMM06HJIH3aL.{UCH lIaTHBHOH ,lJ,HK Ha TRepAot'f (118-
3e. ,lJ,JIH YUC!llflleHHSI COp61J,Uli HK nOJUfCTHpon IlpeJ],BapHTeJlhllO o6pa6m1>lUmOT
3apH)KeHHhlMH MoneKY1JatvlH: nonH-L-nH3HH, npoTa umcYJlbcpaT H,1]H HcnOllh3YiOT
KOHl.loraTLI MOJleKynbl ,lJ,H K C MCTHJIHpOuaHHblM 6bl"lbHM CbIBOpOTOllHhlM aJlb6y-
MHHOM. OJ].HaKo, B 3TOM CJIY'lae KoppeKTHaH OIJ,eHKa ypOUHH aHTHTen K ,lJ,HK MO-
)KCT OblTb 3aTpYAHeHa, 1l0CKOJlhKY CIJH3blUaHHe C 1l0JU1cTHponoM "lepe3 3apH)KCH-
IIMC MoneKynhl MO:>KCT Bbl3bmaTL KOHc)JOpMaI HOHHhle H3MeHCHlU! MOJICKYJlbl ,lJ,HK
Ii AaBaTb nO)KHOIIOJIO:>KHTCJ1hHhle pe3ynbTaTI.I, o6YCJIOUJlCHHble Hecllel HcpHtleCKHM
CDH3bma.IU1CM aHTHTCJ1 C APyrOrJ CIIClI.mJmIIHocThiO. I1MeiOTcSI AaHHbie ° roM, '11'0
06nY"leHHe nomiC mpOJIOUblX !\UfKpOllnaT ynbTpa<jmOJTCTOM npHBOAHT K ynemflJe-
HHIO HX a6cop6lJ.I-JOHHOt'J cnoco6HOCTU B OTIIOUlCHHH HaTHBHOl1 ,lJ,HK.
Ta6nm\a 10
CpaBllelluc cneQ.u4JUQHOCTII pa3JI11QllLIX MeTOAOB
onpe,QenellHJI aiiTUTcn K ,l],HK
I 3a6oJlCBaHHe qacToTa nOnO}f{UTenLHLlX pe3ynLTaTon
MeTo,Q Farr II 3 £-MCTO!l. TeCT c Critidia " M
AKTMBH3S1 CKB 98 96 96 100
PenMaToHJ HLIt'J
apTpHT 1 5 0 3
CHHApOM llIerpeHa 0 7 0 20
CKnepoUcpMUH 0 0 .0 30
AYTOHMMYHHhlt'J
renaTI1T 0 20 0 15
I MH3cTeHHH rpaOHC 0 32 0 20
4 A yrOHMMYHHblrt
THpeoHJ],HT 0 7 0 13
Eone3Hb AMHcoHa 0 0 0 0
AyroHMMYHHaH I'e-
MOllH rH"ICCKaH aHeMHH 0 10 0 0
.QOHOphi 0 0 0 0
224 TOM II - 1.IACTHbIE AHAnJ.1TJ.14ECKJ.1E TEXI-lOnOfJ.1J.1
1. Memoi> Farr (PHM). B OCHORC MCTO}W Jle>KHT HCnOllb300aHJ.fe CYllb<paTa
aMMOHHSI AJISI pa3ne1IeHHSI KOMnlIeKCOB ,IJ,1-IK-mITH ,IJ,HK OT CB060AHO 'i (MC ICHHOi'l)
,I1,HK. Xoi) ollpei)e.lleHllR. B npo6HpKe (16 x 100 MM) CMcwaTh 50 MK1I CbIBOpOTKU,
50 MKJI paCTBopa, COUCp>K3l.l.1.CrO 16 Mr/MJI IgG ICJlOBeKa, 50 MK1I PBS H 50 MKJI
paCTBopa, COHCp>Kal.l.l.ero 2 MKr/MJI [3H]-,IJ,I-lK. (B Ka leCTBe HCTO IHlfKa MC ICJmOH
,IJ,HK HCnOJlh3YIDT ,IJ,HK. BblHeJJCHHYI-O U3 THM}'"ca Te1IeHKa I1JUt lIJ1a3MHJI,HYI-O
,D,HK). J.1HKy6"'poBaTb l l lnplf 37°C. ,IJ,06aBHTb 5 MJl XOJlOHHOro 50% HaChll.l.l.eHHO-
1'0 pacTBopa cYJlb<paTa aMMOHHSI (u PBS) H UliKy6HpoBaTb 3 MHH "PH 4°C Jl.0 o6pa-
30BLtUml IIpel HnHTaTa. l(eHTpl.1CpynlponaTh IIp06HpKH B TClleHHlt 15 MHH 3000g
npH 4°C. OTMLITL npCI\11I1HTaT 2 pa3a 50% HaCLlllI,CHHblM paCTBopOM cYJIL<paTa
aMMOHHSI npH 4°C (5 MJI 1m Ka>K]J.Y1-O OTMbIBKY) lJ,CHTpHq)yrHpoBaHlfcM B TC lcmUl
15 MHli npH 3000g. PaCTBOpHTb OCaJl,OK U 1 M11 pacTBopa Solucnc-lOO. }106aBHTb
10 M11 CI\HTH1ISllJ,HOHHOH >KHAKOCTH. B Ka leCTBe KOHTpOJUI BCef1J.a BKJII-O'IaTb 2 npo-
6HPKH, COJl,Cp>Kal.l.l.lfC 50 MKJl pacnJOpa ,IJ,IIK B Soluene H CllHHTH1ISllJ,HOHHOll >KHA-
KOCrH. YpoBeHb }1HK CUSl3LIBatnUI pacc'mTaTb no <pOpl\tYJIC: [(pm 06pa:ula)/(cpm
,IJ,HK KOHTpOJISI)] x 100. YpoBeHb aHTMTCJI Bhlpa>KaeTCSI BlUhm, KOTOpblH YCTaHa- I
B1II-IBaeTCSI no MC>K]J.YHapoJJ.lmMY cTaHjJ,apry aHTHTC1I K HaTHBHofl ,IJ,HK (Wo/80). I
2. BH(/) c UCnO.llbJOfJUIIUe.AI Crithidia [lidUae (rcMocp1Iare111Ia. HMel-OwaSi 1"11-
raHTcKYIO MHTOXOIljJ,pH10, KOTopaSi cOHep>KI1T 60J1hllJoe KOJ1H leCTBO HUYCIHtpanb-
HOlt ,D,HK). Xoi) ollper)e.lle1-llIR. npCJ MC1HOe CTeKJlO, COACp>Kaw,cc Kanmo Crithidia
luciliae xpaHSIT npH -20°C 11 pa3MOpa>KHBaK)T HcnocpCjJ,CTReHHO nepeA HCClICUOBa-
HHeM. rOTOBSIT jJ,130HHbIC pa:mCjJ,eHHSI CbIBOpOTOK B PBS, Ha'UfHaSi C 1:10. 50 MKJI Ka-
>KjJ,oro pa3BCjJ,eHIHI lfHKy6MPYK)T C Crithidia lucilia B Te\leHlfH 30 M m nplf KOMHaT-
HOt.. TeMlIcpaTYpc. 3aTeM CTeK1IO OTMl.lUmOT O]1,HH pa3 Jl,HCTl-Ulnl1pOnaHHoif BOAOH H
TpCMSI CMeHaMH PBS B TC ICIIHU 30 MI1I-1. HaCJIalmalOT 20 MKJI <I)I1Tl(-Mc ICtlllhIX
aHTHTCJI H HUKy6HPYlOT 30 MHH liP" KOMliaTHOlt TeMnepaTYpc. 3aTcM CTeKJIa BHOBb
OTMl.lHalOT AHCTH1IJlHpOUaUHoH HOAO" H PBS HIIOKpbmatOT 65% caXap030" B PBS
(pH 8,2), coucp>Kalllet'1 0.5 MKrhlJllIpOIlHHHYM 110J1I1Aa 11 aHLU1H3HPytOT C I1cn011b30-
BaHHCM J1IOMHHI1CI.leHTHOI"O MI1KpOCKona.
3. If."MYllo!fiep""e1l11l11bIU ."tIenlOi) (no M.Zollali H B.D.Stollar, 1986). MI1KpO-
nJlaTbl H3 nomfC rl1pOJla 06J1Y'IaK)T YJlbTpa<pHoneTOM B Te\ICHHIf 1 8 I Ii JlaMHHapHoM
UlKacpy C HCnOlIb30llallHCM 30 w Y1IbTpacpI10JICTOROH l1aMnhI. 3aTeM B JI}'"UKH MHK-
pOlmaT UHOCSIT no 100 MKJI pacTBopa tmnmHOH D,HK 113 THMyca Te1IeHKa B TpHC-
6ycpepe (pH 7,4) B KOHI\CIITpar\HI1 5 MKrhl1l. H HIIKy6HPYl-OT (] Te l lCHl1l1 18 'I npJ.\
4°C. 3aTcM MHKpOnJ1aTbl TPH>K}'''I OTMhIBalDT Tpl1c-6y<pcpOM (no 200 MKJ1IJIYJIKa)
H 6JJOKHPYIOT HecnellH<pwlcCKOC CIUf3hlBaHl1e 100 MK.rJ 1% paCTBopa BSA B PBS
(pH 7,4) B Te'leHHl1 I l llIpl1 KOMHaTHmI Te mcpa1ype. nOC1Ie TpeXKpLtTHOH OTMhlB-
KH PBS, B JIYHKI1 BHOCSIT no 100 MKll ChlBOpOTKI1 (pa3BcAcIHfC 1:100) B PBS-BSA H
HHKy6HpYIDT B TCllCHHH 1 II npl1 KOMHaTHoll TCMHcpaType. nOC1Ie YAaJICIII1S1 ChlBO-
pOTKH H TpcxKpaTHoH OTMblBKl1 PBS. cOJ\ep>Kal.l.l.cM 0,1% Tween, A06aBJlSlK)T no
100 MK1I aHTHTCJI K IgG leJ:roBeKa, MCllCHHblX nepoKcI1Aa30H (pa3BeJl.eHHe 1:1000)
H HHKy611pYIOT B Te leHHH 1 II npl1 37°C. 3areM MI1KpOlIJlaThl TPH>KJI.bl OTMblUmOT
PBS-lWccn, UlIOCSIT pncTBop 0<1' A C IIcpeKHChl-O BOjJ,opo: a H 1I0C1Ie OCTaHOBKH pe-
aKlum onpe]],eJISIIDT on Ha MIIOI"OKaHa.%HOM q)OTOMCTpe npl1 AJ1HHe 13011HLI 492 11M.
i01wUl t teC1(()e 3H(llteHlte. AHTl1TCJIa K HaTHBHOII ,IJ,UK (oco6eHHO BbICOKoaUlfA-
HLIC aHTHTeJ1a, BblSlBJISlCMblC tCTOjJ,OM Farr), BbICOKocnel'H<plI'lHbI AJISI CKB. Y 2/3
60JlbHbiX 6C3 KJlHHI1 leCKHX npl1:maKon CKB, HO nOIlO>KltTCJlhHbIX no aHnlTCJIaM K
-
--
METOAbI KJU11-II1QECKOtII1MMYHOJIOrl1l1 225
I
I
HaTHBHot'1 AHK (MeTo]], Farr), B AaJIbHCihueM pa3BHBaeTcH CKB. YpoBeHh aHTHTeJI
K HaTHBHOH AHK KoppelmpyeT C aKHmHOCTblO CKB, a I10BbllllCHHe ypOBHH n03-
BonHeT npeACKa:mTh 060CTpCm-fC 6OJIC3HH. HH3KoaBHAHbie aHTHTena, BbIHB.'IHCMbIC
I1McI> Hl1H llEr-MeToAoM. MeHee cIleJ..{HQ:>HIIHbl AJIH CKB, 110 BhlHBmnOTCH '-1allJ.e,
IleM BLICOKOaBHJI,HblC aHTHTena. B lIaCTHOCTH, ynenWleH..le nnpOB HH3KoaBHAHhiX
aHTHTen '-lall e Ha6J11oJl,aeTCH IlPH CKB C IlOpa)l(eHHCM UCpBUOrf CHCTeMbl, IleM Bbl-
COKoaBH]],HbIX aHTUTen. AHTUTeJla K ACHaTypHpOBaHHOH AHK MeHee cneJ..{HQ:>H1IHLI
AnH CKB H BblSmmllOTC}I npH ApyrHx peBMaHI'-leCKHX 3a6oneBaHHHX.
3.2. A"mume.fla K lucmOllaM
n1CTOHbi - KOMIIOilCHTbl HApa, COCToHlu,He "3 3 cy6"heAHHuu,: 2x H2A-H2B AH-
MepOB, KOTopble naHKHpoBaHbl H3-H4 1'C'l'paMepm,111 aCCOI.lJ1I1pOBaHbi C TpCTbCU
cy6be}\HHI1UC", COCTOHU{CH H32 BHTKOB MOJleKynbl AHK. COC]lUl-lCHHC 31'0" CTPY-
Krypbl (HYKneOCO'1bl) C Jl,pyrHMH HYKJICOCoMar-."," ocYU{eCTBJIHeTCH nHHKcpHoii:
AHK, KOTopaH accoJ..{IUfPYCTCH C HI mCTOIIOM.
Memo()bt onpe()e.lleHltR. CM. Ta6J1. 3.
KAW-tlt'-ieCKOe 31-l11 l telllle. AilTHTeJ1a K H2A-H2B nfCTOHaM o6uapY)I(HBalOTCH
no'-rru Y Bcex 60nhHbiX BOn 1 laHKoH. HHAYI.{UPOBalIIIOt'1 HOBOKaH, HaMHJI,OM y 19%
60J1bHblX, 1l0JlY 1 1aIOU{HX HOBOKalmaMHA, HO He HMCIDllJ.11X CHMnTOMOB BOn'-IaHKH H y
20% 60J1LHbIX CKB. npH CKB aHTHTCJ1a pcarHpylOT C HHTaKTHblM ('HC milOM, a
npH JleKapCTHel-IHOI1 BOJJ1laHKe aHTHTena pean1pYKyr c rpI1IlCHH-pe3HcTeHTHbIMH
Q:>parMeHTaMH. llpH J1CKapC rnCHHot'1 BOJl1IaHKe, cBH3aHHoH C IlpHeMoH n1ApaJIa3HHa,
aHTHTCIIa CUH3bmalOTCSI C Y3 h Y 4 H HX TpHIlC"H-PC3HCTCHTHbIMH Q:>parMeHTaMM.
I1MCIOTCSI ]],aHHhIe 0 KoppenHI{MH MC)I(AY aKTIIBIlOCThlO CKB H ypOBHeM aHTHTCJI K
rHCTOHY no AallHblM I1<1>M.
3.3. Allmume.JJa " pun
K aHTHTeJlaM K PHll OTHOCHTCH aHTlITCJIa K 6Cl1KOBbiM KOMIlOHeHTaM (70 kd.
A U C) VI Marloro H}.!,CpHoro pH60HYKJJeOnpOTeuHa (vt MHPHn).
Memol)"l ollpe()e.llel-w.R. CM Ta6JJ. 3.
KAllHU'leCKoe 31f.{lLleHlle. AHTHTcna K V1 PHn 06HapY)I(HBaIDTCH IIP"I CMelllaH-
HOM 3a60neBaHHH COcHHHHTem)HoH TKaHH (C3CT), PC)I(C IIPH CKB H APymx dYTO-
HMMYHHhlX peBMaTH1leCKHX 3aOOJICBaHHHX. Ch180pOTKH 60IlhHbiX CKB H C3CT.
peampYIDllJ.HC C 6CJIKOUbiM KOMflOHeHTOM VI PHn, U 40% CJlY'-laHx CBSl3bIBalOTCSI
H C PHK MHPHTI. YponeHb aHTHTeJI He KOPPCJH1PYCT C aKHIBHOCTblO H pa31U1THeM
060CTpeHHSI. B 60% CIIY1laCU ChIBOpOTKH. pearHPYlOll.{HC C UI MSlPHll, COJl,Cp)l(aT
aHTwrCIIa K Sm-aHTHreHY, KaK npaBHno, U HH3KHX 'IJ-ITpaX, 1-1 paCCI\.faTpHDaloTcH KaK
PHTI/Sm n0110)l(HTenbHble. 13 CLlUopOTKax. co ep:>KallJ.HX aHTHTCJIa K Sm (CKB),
aHTHTCJla K UI MHPHn He 06HaPY:>KHBaJOTCSI. Y OOJlhUblX nepeKpeCTHblM CHIIHPO-
MOM C llepTaMH MHo3HTa, HapHHY C aH"nnenar-.1H K VI MHPI In, BhlHBl1HIOTCH aHnt-
TCIIa K U2 MHPHTI, KOTOpblH COCTOHT 1-13 V2 MSlPHn 11 8 nOJ1HnenTH) OB. ABa H3 HHX
A' H B' BCTpe'IaIOTCH TOIlbKO B U2, a 6 (B, D, E, F, G) HI3JIHIDTCH o6llJ.m,ut AJ1S1 VI H
Jl,pyrHx MHPHn.
3.4. Sill (Smith) allnlume.JJa
Sm aHTHreH COCTOHT H3 5 MaJlLIX SlJI,epHhlX (MH) PHK (VI, V2, V4, US, U6),
CBSl3aHHbiX C He MCHCC 11 nOJ1HnenTHAHMM (70 kd, A'. B'/B'. C. C'. D. E. F. G). Au-
THTCJla, cnel'HQ:>H'-IHhle AJIH CKB, pcarHpyKYr C B'/B If D nOJIHnCnTHHaMH, 06llJ.HMH
AJiSI Vl,U2 M U4/6 M}I PHll llacnll..{, npHHHMalOllJ.HX Y'-JaCTHe B cnnaHcHHrc IIpC-
226 TOM II - "lIACTHbIE AHAflI1TI1"lIECKI1E TEXHOflOrl111
MPHK. AHTHTeJIa Sm paCII03HalOT OOraTblH npOJII-IHOM AOMHHaHTHbll1 :nU1TOn B'fB
13 N 6CJIKa (MSI PHn - aCCOlumpOBaHHblH 6CnOK, pacnpCACnCHIW nCnn1AOB B KOTO-
pOM COOTBCTCTBYCT pacnpeACnCtHl10 nenntAOB, KOAltpYlDlltHXCSI reHOM KaJlbU.HTO-
mma).
MemOObl onpeOeJleHI..lR. CM. TaOJI. 3.
I01WUI'lCcKoe 3I-W'tCI-WC. AHnnCJIa Sm oOHaPY)J(nnatOTCSI npH CKB C 'IaCTOTOlt
30% npH I1CIIOJlh30namUt I1cI>M H OKono 20% no , atHlbl 1 MCTOl\a rcr-.mrrmOTlma-
lum n He RhUIBJUUOTCSI npH J1.PyrHx peRMaTW-IeCKHX 3a6D.TIeBamUIX. Omt paCCMaTpn-
BaHITCSI KaK MapKepHblC aHTWreJla AllSi CKB II IIX BbUIBJ1emle BXOAHT B 'mCJ1O Altar-
HOCTn'lCCKnx KpnTcpHcB CKB. OAHaKo. ypOBCHb aHTHTeJI Sm HC KOppCJ1ltpyeT C
aKHtnHOCTblO H onpCHCJICIIUhlMH KJIHUH'-ICCKnMn cy6nmar-.m CKB.
3.5. S5-AfRo (Robert) allnlllme.flU
S5-AfRo aHnirCH - nommennl)J,bl 60 kD H 52 kD. oopa3YtOU-U-tC KOMnJ1CKC C Ro
PHK (hYI, hY3 II hY5).
MemoObl OIlPC()CJlCIllUl. CM. Ta6n. 3.
IV1WtU.'ICCKoe 3HU'WHue. AHnfTCJIa 55-AfRo oOHapY:>KllBatOTCSI y 60-HO%
60nbHblX BTOpWlHblM CI1HAPOMOM lllcrpct-ia, Y 96% OOJlbHblX nCpmt'IHblM cnHApo-
MOM Illcrpeua H Y 35-60% 60JlbHbiX CKB B 3aBHCHMOCnt OT IIYBCTBlITeJlbHOCTn
HCnOJlh30BaHHhIX MCTOAOB. B ml3KHX Tlnpax aHTlITCJIa BblSlBJISltOTCSI Y 3AOPOBbiX
JIIO)],eM (1 %). Y 50% OOJlbHblX cnHAPOMOM IllcrpcHa H CKB aunrrcJla pcarupYIOT
C 60 kD 11 52 kD KOMnOHCHTaMII 55-AfRo 'laCTl-Iu.. KOTOpblC COCTOSIT 110 KpaHHeM
Mcpe 113 3-x 6eJIKOB H PHK. Y 40% OOJlbHblX CI1t1J POMOM lUcl"pcua all nnCJIa pC-
ampytoT TOJlI.KO C 6eJIKOM C MOJICKYJlSlpHOH MaCCOH 52 kD, a 20% CblBOpOTOK
60nbHbix CKI3 pcan1pytOT I"OJlbKO C 6CJIKOM C MOJICKYJISlpHOH MaCCOH 60 kD. AH-
UtTena 52 kD 5S-AfRo H 48 kD 5S-BfLa 6CJIKY (CM. tUDI(C) oouapY>KHBatOTCH B
60JlbIlU1HCTBe CblBOpOTOK OOJlbHblX C 1l0JIHOH 1I0IlCpC'IHOH 6JIOKRAOH CCPALJ.a (3TOT
aHTHrCH IJ 60JlblllOM KOJlHLICCTBC npHCYTCTRYCT B npoBo)],SllltCH cnCTCMC CCPALJ.a Y
nnoJ(a IICpC3 18-28 He)], nOCJIC OI1JIOAOTBopcmISl). HaJll1'mC C l'aOlUlbtlOH CTPYKTYP-
Hofl accou.uaLIJU1 RofPHD 11 LalnommcnTH.n,a n03BOJlSlCT 06-bSiCHUTb, nO'ICMY o6a
uma aHUnCJI LlaCTO BbISlR'ISltoTCSI B 0AmtX U TCX >Ke CblBopOTKax. npc nOJIaraeT-
CSI, LITO SS-AfRo aHTurCH HMCCT OTIIOIllCHHC K Ka.lJhpeufKYJUmy (KaJlhU.H(I-CBSl3bl-
BatOlltUH 6CJIOK). npH CKI3 npO.!l.YKLJ.HH aHTI'ITC,.!1 aCCOI\lUtpYCTCH C OlIpCJ(CJlCHlit.IM
Ha6opoM KJ1lmULleCKltX npOSlRnCHl1if II JIa60paTopHbiX HapYlllcHnj:'l: cfJoTOCCHCHOH-
JUl3a1\HSI, CHH pOM IllcrpcHa, nmepnpoAYKu.HSI IgM-P<l>. nOUbllllCmtC KOHLJ.Ctrrpa-
U.HH aHTHTeJl 55-AfRo U COLICTamm C rUllcpnpOA)'KI\HCif IgM-PcI> IIRCTO Ha6mol\a-
CTCSI IIpll AHc1J-oTpl1l\aTCJlbHoM nOAnmc :m60JICBaHHH (2-5% OOJlbHblX CKI3) C
KJ1ltHWICCKUMU IIpOHBJICIIUSlMH 1I0J(OCTpOH KO)l(HOH KpacHoM BOJ1 t IaHKI-I. npHCYTCT-
BUU 3THX aHUnCJI B CblBopOTKax 6CpCMCliHblX )I(CHU\HtI )'IiCJm'IHBaCT pUCK pa31U1-
THH tlCOuaTa.TIbHoro BOJI ' taHO'lHonOAo6Horo CI1HAPOM<l Y HOUOP0)l(I\CHHbIX. npH
3TOM Y MaTepcif JWTCH C tlCOuaTaJlt.UhlM Hon L laHOLlHonOJ(06Hb1M CHH pOMOM MorYT
orcyrcTuouaTb npU311aKil CKB wm J(PYrHX aYTOIIMMYHHblX 3a6OJIcuaHuil (CI1H-
ApOM IUcrpclla wm ntpCm1AUT), I1MceTCSI CBSl3b MC>KAY oomlPy)I(ctUtCM cUln1TCJIU
rCHCTWICCKI1MU ACcfJCKTRMI1 CI1CrCMbl KOMIIJICMCIlTIl. AHTUTeJIa 06_'Ia..'I.atoT cnoco6-
HOCl'btO IIcpc)].anaThCSI OT MaTCpu K nJIon.Y'-lepC3 nm.1LleHTY U HMCtOT mtTOrCHCTU-
'-ICCKOC 3Ha'-lcmm B pa3BUTUU naTOJIOnm IIpouoJ\Slu\di CUCTCMbI CCpHl\a «(lOJllIaSl
noncpC'lHaSl OJIOKRJ\a). YpOBCHb anTHTCJI RhUlIe npu nCpmt'IHOM CltH pOMC Illerpe-
Ha, '-ICM nplt BTOpWIHOM CHHAPOMC lllcrpcHa, U KOppCJmpYCT C pa3BHUIeM BaCKY-
METOAbI KJII1HI1"lJECKOM I1MMYHOJIOrl111 227
JIl1Ta. DpH nopa>Kcmm IJ.HC aHTHTeJ1a HhUlBmUOTCH B cnHHOM031'OUOH )l(H.f\KOCTH.
3.6. 5S-BILa (Lane) amnume.n.a
SS-B/La aHTllrCH - 48kd HYKJICOI(I1TOnna3MaTwlccKHH cl>occlJonpoTcHHOBhlH
KOMnneKC C Ro MaJIblM PHK (Ro hYI-hY5), HUJIHIOII Hi1CH TpaHcKpHnToM PHK no-
JHIMCpa3bl II. l1MMYHOAOMHUalrrt-l.blH 3mnon (aMI1HOKI'ICJIOTbl 88-101) SS- B/La
I1MeJOT CTPYKT}'pHYJO roM0J10rHIO C gag 6CJIKOM pCTPOBl,IPYCOB CXOAHbIC aMHHO-
KIICJIOTHLIC nOCJIC.f\onaTCJIhHOCTH H nepCKpCCTHaH pcaKTHuHoc I'L 06napY>KeHbl Me-
>KAY 70kd VI M5I PHn H pCTpOImpYCHLIM p30gag, 3nHTonOM AHK-nonHMcpa3bl I
H pa3JU1 t lHblMH penIOHaMlt 1'30 gag.
McmUObl unpCOC.JlCHUJl. CM. Ta6JI. 3.
KAllHU'IeCKOe 31w'/enIlC. AHn1TCJIa SS-A/La 06HapY>KHBaIOTCH Y 60JILHLIX nep-
UU'-lHbiM H UTOpHYUhlM CHHAPOMOM IlIcrpcHa, CO'IeTaIOU HMCSI C PA H CKB, HO He
C CJ.1CTCMHOM CKJICpOJ.(CpMHCH H IICpBJ.11UtbIM 6HmmpHOM lJ,Hpp030M. KaK H SS-AfRo
aHTHTeJ1a, aHTl-neJIa SS-B/La HBJIHIOTCSI cl>aKTopOM p"ICKa BpmKACHHOM nOJlHOH 110-
nepC1.IHOH 6JIOKaj1,hI. np"I CKB aHTHTeJIa SS-B/La LJaIl C HCTpC 1 1aJOTCSI npH Ha 1 1aJIC
60JIe3HH B nO>KllJIOM B03paCTC "I accolJ,..mpYJOTC5I C HH3KOH tIaCTOTOH pa3RHTH5I
HcclJPHTa.
3.7. Muo3um-cneqllifju'IecKue allmllme.n.a
AHTH1'cJJa, pcanIpYIOll("IC C pa3J1lf 1 lHblMH 51AepHbIMH 11/mIH 1(lfToruJa3MaTI.f t IC-
CKHMH aHTl-IrCHaf\.U1 UhlHBlIHIOTCH Y 80-90% 60JIbHblX l1AHOnaTI1 1 ICCKHMH Bocna.rUI-
Te]JhHbIM..I MHOnaTH5IMI1 (I1BM), K KOTOpblM OTllOCHTC5I nom1MH03HT (nM) H W::P-
MaToMH03HT (AM). K MH03HT-CneI(mI'H 1 IeCKl1M aHUnCJtaM OTHOC5lTC5I cncAY IO ll1. He :
1) AHTl-nena K aMHHoalJ,HJICHHTCTa3aM -rpaHCnOpTHOM PHK (anTHcHHTcTa3HbIe
aHnrrCJla): aHU1TCJIa K nICTI.fJ],HH (10-1), TpeOm1Jl (PL-7), rmIlJ,HH (El), JIH3..m, H30-
nCHlI,HH (01) H aJIamm (PL-12) TPHK-CHHTCTe3aM. 2) AHnITCJIa K ltacnU(aM C"Ir-
HaJIbHOI"O paclI03l1aBam151. 3) AHTHTena Mi-2 (5-10%) pean1pYIOT C 51AepHbIM 6CJI-
KOM C MOJ1eKYJI5IpHOH MaCCOH 220kd «(PYHKI(H5I HC H3BccTHa). 4) AUTl-ITena Fc cne-
lJ,HclJH4HLI B OTHornClum 6cnKoB, ytIaCTBYIOll1.HX II TpaHCJI5IUUH, BKJII()IIaSi cl>aK'fOp
3JlOHralJ,Ul1 (Ia). 5) AHn1 !'c.rIa MAS pcarupYJOT C 4SPHK C HCH3BecTHoH cl>YHKUH-
CM. 6) AHuncJIa Kl pcanIpyJOT C 6CJIKOM C MOJicKyml.pHoH MaCCOH 34kd. 7) AHTl1-
TeJIa MAS pcarupYIOT C 45 PHK C HCH38eCTHOH cl>YHKlI,UCH. 8) AHU1TeJIa PM-ScI
(PM -1), HanpaUJICHHhlC npoTl-1B HYKJIC0J151pHbIX n lJ,UTOIlJIa3MaTH 1 1CCK..IX 6CJIKOB.
pcal'lfpYIOT no KpaHHcM Mepc c 16 pa3JUI t lHblf\.UI 6eJIKaMH.
Memoi)hl onpe()eJlenuJl. CM. Ta6J1. 3.
Krlwul1teCKoe 3Ha'leuue. AHTl-rrcna 10-1 BbI5lBJI5IIOTC5I Y 20-40% OOJIbHblX
l1BM y U3pOCJlb1X. RKJIJOlIa51 nM/,lJ,M H ncpCKpCCl'HhlH CUHJtPOM H oc06clIUO "IaC-
TO (60 %) np"I C01.leTaHUl1 n0J1HMH03UTa C UlITCpCU1l1,UaJIbHblM nOpa>KCH"IeM ner-
K"IX. '4aCTOTIl o6HaPY>KCHUSI Apyrnx aHTlfCHHTeTIl3HbiX aHn1TC1J HC npeBbIwaeT 5%.
B lI,cnOM, aHTUTCJla K CUHTCTa3aM BblSlBJl5IIOTCSI y 40% 60nhHbiX nM, Y 54% 60J1b-
Hblx,lJ,M "I TOJIbKO Y 6% 60JIbHLIX MH03UTOM B COLleTaHun C ABCT, npH onyxone-
BOM MH03..ITC 3TH aHTnTeJ1a HC 06HaPY>KHBaIOTCH. np0I1.YKU...I5I aHU1CUHTCTa31 b]X
aHTHTCJI accourmpYCTCSI C pa3BHU1CM TaK Ha3bIBacMoro aHTUClfHTeTa3HOl"O cnH-
APO\-Ia, KOTOpbIi'1 xapaKTepH3yeTcH OCTphlM Ha1:laJIOM, HHTCpCnu.....IaJIbHbIM nopa-
>l<CHUeM JICrK"IX, JU1XOpa)J,KOH, CHMMCTplftlHbIM apTplfTOM, <l'eHOMCHOM PCHHO, n3-
MCHeHHC KO>K"I KUC rCH no umy "pYK..I MexaHHKa ll . AIITl-ITeJIa K tIaCTUlJ,aM C"IrHaJIb-
Horo paCI103UaRaHnH 06HapY>KHBaIOTCH TOJ1hKO np"I nM (4%) n TaK>KC aCCOI.(IU1-
L
228
TOM II - 1.1ACTHbIE AI IAJlI1TI1t.JECKI1E TEXHO.nOrl1l1
I
PYfOTCSI C onpcAcneHHblM Ha6opoM KJUtHWleCKHX npmIBJlemti"l, a HMCHHO OcrpblM
HatlMOM 3aOOJJenaHml. TSI>KCJIbIM Te'lemteM MH03I1Ta, IIOpa>KeHlfeM cep1\[ a, IIJIO-
XHM OTRCTOM Ha rmoKoKOpntKOH) bl. Mi-2 clHnneJla 06bl"IHO RbUIB.'ISIIOTCSI Y UOJIb-
HbIX C KJJaCCWICCKIfM cTepmt1\"lyncTBHTc.'IbHbIM )J,M. 6lIarOnpUSITHbiM B nporHo-
CnttleCKO\t OTHOllleHt1U; O"ICHb PC) KO Y 60JlbHbiX onYXOJICllblM MH031-iTOM. AHTHTe-
na KJ accOl lntpYIOTcSI C pa:muntCM MI103HTa, CHHApoMa pcrmo It UlITCpCnU.lHaJlb-
Horo nOpa>KeHHH JlerKHX. AHTlnella PM/Sci (PM-1) 06HapY>KHBCUOTCH y 8%
TIM/)J,M. 3% 60JlbHbiX CHCTeMHOH CK:ICp01\Cpr.mcH H Y 11 % 60JlbllbiX nM/CC)J,.
nOJJarafOT, "ITO 3TH aHTI1TeJla &CCOUJutpYIOTCH C OC06blM cy6TI1noM 1\H(I)< Y3I1bIX 3a-
6o..'IeIiRHHH COCAItHHTCJlbHOH TKaHH, llKJIIOtlatOLl(ItM npH3HaKH KJlaCCII"ICCKOfl CI1C-
TCMHOH CKJlepO]1CpMHIt, IIOJlHMlt0311Ta H nOpa>KC1U1C IIO"ICK.
3.8. CK/lepm)ep.TfflllleCKlle QIIIIl UlIleAG
rpynna ay roallntTCJI, C BblCOKOfl "laCTOTOH llLISIllJUICMbIX npH pa3nu t lHbiX napH-
mnax CItCTet.mOH CKJlep01\CpMlUl (CC)J,). K HItM OTIIOCSlTCSI CJ1C.uYlOlllJle: 1. AHTJf-
TeJla ScI-70 pCantpYIOT C TOn0l130MCpa3011 I (UCJIOK C MO.TICKYJlHpIlOH MRCCOH 100
kD H cra <1>parMcIlTOM (67 kD) H OTHOCHTCSI K 1130TlllJaM IgG H IgM. 2. AHTIITclla
K U.cHTpoMepe (l eHTpoMcpa-Cllcu.muIH3I-1pOBaHHblfl flOMCU XpOMOCOM 3YKapHonl- I
"leCKHX KJICTOK KHHCTOXOp-06JIaCTb l.leHTpor.1CpLI, C KuropoH 3CCOI.lHHPYIOTCSI < n-
6pHJlJILI BepeTcHa). 3. HYKJlCOJISlpHblC aHTHTeJla BKJlfOtiafOT CJICHYIOIIU'IC cncu.H-
<lmtIHocTH: 1) allnrrCJJa K HYKJIeOJ1HpHOH rnl PHO (2-7 PHK-6CJIKOBbIM "laC 1"11-
1,aM). 2) AHTHTeJIa K PHK-nomlMcpa3c I (ARIOT Kpall'mTYIO HYKJlCOJlSlPHYIO I1MMY-
HO< J1fOOpCCI(eHI(mo). 3) AHTHTCJla K < 116pHmJapHHY (34 kD 6CJJKOBblH KOl\tnO-
UCH1' U3PHO). 4) KU-aH1'I1TCJla. 5) AHTHTeJIa K U.eHTpHOJIe (pean1PYIC..H C MHTOTH-
'leCKHM BcpeTCHOM, COSlJbmalOTCH C rJIHKOJIHTH'ICCKHM <pCpMCHTOM 3HOJIa30ff).
MemOOhl onpeiJeJ/eHlm. CM. Ta6JI. 3.
KrlU1lU'teCKOe 31la'{eHlle. AIiTHTCJ1a Sci 70 'raw.e BbJHBnHfOTCSI npu \U( <fJYJHOrl
(40%), "leM npH Jn1MHntpOBaHHof1 (20%) < OpMC CCJJ, () Jl<fJ< Y3HaH <fJ0pMa Ha-
6JJ10AaCTC.s:I y 2/3 60JIbHbiX C aHTHTCJIaMH ScI-70). npl1CYTCTBHe aHTUTCll 0 COtICT3-
HI1H C UOCHTCJ1LC1'llOM HLA-DR3/DR w52 B 17 pR3 YBCJHlllaCT pHCK p33BHTH.s:I JlC-
I-OtlHoro <fJ116p03a npu CUCTe\HlOH CKJlepOp;epMHH, aCCOI(JUtpYCTCSI C IIJIOXHM npo-
rH030M Y f10JIhlfbIX C <fJCHC)MCHOM PerIHO. 06HapY>KCHHC atlTHTCJI Scl-70 Y 60JlbHbiX
C < CHOMCHOM PeHHo KOppCJlIIPYCT C paJOHTlleM CC)J,. AHTHTeJIa K I(CllTpOr.1CpC
o6HapY>KHB3IDTCSI y 20% 60JILHLIX CC,lJ., Y 60Jlbllll111CTna JtJ KOTOpLIX HMelOTC.s:I I
IIpH:maKH CREST-cllHp;pot.1a (Ka.Jlhl I1H03, <fJCHOMCH PclIHO, nOpa>KeHHe IUIII enO]\a,
CKJICpoJ{aKTlmHH, TCJlcaUnt3KTa3JUt), Y 12% 60nbUbiX IICpmt t lHLIM 6HJlJmpHbiM
1(11PP030M, y nOJlOBHHbl 113 KOTOpblX I1MClOTCSI npU3HaKH CKJlepOflepr.mu, OtlCIlL
peAKO IlpH XPOHU"ICCKOM aKTlIBHOM renaTine I-IIlCpBH'IHOH JICI'OtIHO(1 nmcpTCH3UH.
AIiTa-tTClla K U.CH1'pOMepc paCCMaTpUI aIOTCSI KaK nponlocnt'leCKUH MapKep pa:mI1-
ntH CC,lJ. Y 60JlhilLIX CI-IHI pOMOM PeHHO. npH CCJJ, B O;J,lII-tX 11 TCX >KC CLlUopOTKax
pCI KO O HOMOMeHTHO o6HapY>KlmaCTCSI oua nma CKJlepOAcpM.....lecKl1x aIlTln-CJI.
EOJlMI"IC C aliTa-rrCJH.1MH K U.eHTpoMepe t"UI e llon16mOT 01' JICrOtlHoH nmcpTeH3HII,
nOpa>KCHH.s:I )f(KT, a 60JJLIILIC C tlHTHTeJIaMIl ScI-70 - OT nOpa>KCIIIISI CCP)lUR, .'lcr-
KHX, notJeK. AIiTHTCJIa Y HYKJICOJI.s:IpHOH Th PHTI o6I1apY>KIIUalOTCSI Y 11 % CC)J" C
OrpaHH'ICHHLIM 1l0pa>KemleM KO>K11 II npl1 nCpmttlHOM CIIHAPOMC PeHllo. AIiTIITCJla
K PHK no.rmMcpa3c 1 oOHapY>KHBafOTCH y 4% 60Jlblll.IX CC)J" tlaLUC npu )J,Jf( < Y3-
HOH <fJ0PMC C nOpa>KeHHCM cCPJlua H JICrKHX. AHnnCJIa K <fJn6pl1JIJIapl-my BC"lpC"13-
fOTCSI Y 8% UOJIbHblX CC,lJ.. tmllle Y MY>KtIUU 6C3 1I0pR>KCHUSI CYCTLmOB. KpoMe 1'0-
.
...
METO)].bI KJU1HI1YECK0l1l1MMYHOJIOrl111 229
["0 HYKneOJ1S1pHbIC aHTI1TCIICl 06HapY>KHnafOTcSI npJ.I XpOHI-I\leCKOH pcaKl J.m TpaHc-
IInaHTaT npOTlIB X03S1HHa nocne nepecaAKH KOCTHoro M03ra. AHTHTena Ku aCCOLJ.H-
HPYHJTCH C ncpcKpcCTHblM CI-IHp,pOMOM CC,U,/OM. AHTHTella K LlCHTpHOJIC OlUlca-
Hbl Y 60IIbHI.IX C cKIIepop,epMonoJw6HblM :m60J1CBamtCM COCp,l1I1HTenbHoH TKaHI-I.
4. AII11lU11le.JIa " rfiocrfiO.!llmuoa.lrl
Awn1TcIIa K ( OC OmtlUtp,aM (a<l>JI) npep,cT<U3J1HKJT COOOi'1 CeMeHCTBO aYToaH-
TI-ITC.T1, pacno:maHJw,ux <1UTJ.trClUib[C nCTCpMHHaHTbl aHllOHHblX H HdrrpaJlbHhlX <}Jo-
C( OJUlnHp,oB H KOMnJlCKCHblC 3I1HTOIII.I, oopa3YI01l'HCCSI B npoLlcccC u3aHMoHcikT-
BJ.ISI ( ocQJ011lmHAOB H ( OC OnHmlp,-cB 3bma'oll'J.1X 6cnKOB. CHHTeJ acI>JI HHOI'na
ua6mO}\aeTCSI Ha (l)oHC HH )CKI HOHbIX Ja60JICBaHHit, 110 'lall C cnSl3aH C ayroHM\tyH-
HbIMH HapYlllcHHSlMH, BCAYW.HMH K pa3UJ.tTJ.tto cnoco6pa3Horo CHMnTOMOKOMIIJICK-
ca, BKJIHJ'laHJlll.CrO BCH03HbIC H!l111H apTCpHa.'lhHbIC TpOM60Jbl, pa3Jut ' iHMe OpMbI
aKYlllcpcKm'1 naTOJIOnm (B ncpBYfO O\lepeAb npHBbillHOC tlCHhlHalllHBaHHC 6epc-
MeIiHocTH), TpOM6oLJ.uTOnCHJ.tlO, a TaK>KC npyn1c pa:moo6paJHbIC HCBpOJIOl'Hlle-
CKIIC, KO>KUbIC, Cep]\e 1 1l1O-coCY1J,CTble, reMaTOIlorWICCKHC lIapywcHHSI. 3TOT CHM-
nTOMOKOMl11lCKC 060JHa'IaCTC KaK mITI1 )OC( OmmHJJ:HbIH CHHHpOM (Ac1JC), KOTO-
pblH MO>KCT 6('ITb RTOpl1 1 lHbiM (cBSl3aHHbIM C OCH013HhlM 3a60JIeBaHHCM, 06LI ' IHO
CKB) H ncpBwlHblM. K acI>Jl OTUOC TCSI C1ICJl}'KJllll-le nmbl aHTl1TeJI: 1) BOJll1aH011-
HblH aHTI1KOarYJlSlI1T (BA) - aHTHTeJla, cnoc06HbiC in vitro YJVU1HSlTb cpoc( omumJ -
3aJUtCHMbiC KoarYIISlLl.UoHHblC pCaKLl.HU (KaoJU1HOBOC Bpe lS1 cBcpTbmaHH , RpeMSI
c13cpTbmallHSI, Onpe1J,eIlSICMOH C nOMOlll.blO SlAa raJllOKH PacceJla, aKTIIBHpOmn-lllOe
'-laC'Bf1IHOC TpoM6onnacTltHo13oC 13pCMH). 2) AHTI-1TCml, pcarHpYIOw,HC C HMM06H-
nH301JaUllhlMI,I Ha TBepJ1.0H a3c KapAHonJ.uU1HOM (aKJI) J.t il.Pyn1MI1 OTpJ.tLl.aTCIILIiO
3apSl)l(CHHbIMJ.t oc omllUtHaMJ.t, HJI onpc,f\eJlcHJ.tSl KOTOpblX I1CIIOJII.3YIOT UMI\IYHO-
CpMCIITt-II.l" MCT0l\. 3) JIO>KHOnOJlO>KI'ITC.'lbH3H pcaKHHSI BacccpMaHa - aHTI'ITCJJa,
peantpYlow,J.tc co CMCCLIO KapJ J.tonlfm1Ha, XOJlCCTcpJ.tHa u OC( aTH,f\J.U1xonHHa, 011-
pCJICJISlCMblC C 1l0MOII hfO peaKLJ.HI1 arrJIHJTJ.tH3L1.UIf (JlnPB). B CblBopoTKax 60Jlb-
HblX Ac1JC MorYT 06HapY>KJ.maTbcSI ClHTI1TC.'la K VORL aHTnrcHY, 110, KaK npaBJ.lIlo.
B HJ.t3KOM niTpc, IICCMOTpSl Ha O\leHb BbICOKJ.tH YP{)(3Ctlb aKJI. B CBOIO otlCpCAI. Chl-
ROpCITKJ.I 60nbHbiX C cH( J.lJmCoM. J.1MC){)II ne BblCOKUH THTP 3HTUTcn K VORL aHTH-
rCIIY, Llac ro HC pcanlpYHJT C "lIlfCTbIM" KJI, m1Mo6J.t_ J.13oBaHHbIM Ha TBCPJlOH )a-
3C, 4) AHTJ.tTCJJa K p2-rmtKOnpOTCI-IHY (rmuwupoTeJ.1H C MOJ1eKYJISIpHOH MaCCOH
50000 kO, C BbICOKJ.tM CO]1.Cp>KaHJ.ieM yrJICU01 013 (OKO.'I0 20%), COCTOSlW,HH H3 326
aMnHOKJ.tCJ10T, COCAJ.IHCHHbIX HeCKOJlbKnMJ.1 Jl.lfcYJlb nAHbIMn MOCTlIKaMH). p2-rOI
aKTJ.tBHO C13Sl3bIBaCTCSI C pa3JlJ.tllHbIMJ.t 6110MOJICKYJJaMII, BKJlfOliaSi aHllOHHblC ( OC-
OJmmt1J,bl, renapl1H, )].HK, a TaK>KC Mct.'16palloH TPOMUOlU'ITOU 11 MI-l rOXOIIJl.pnSlMI1
1-1 paCCt.1aTpJ.1BaeTC KaK 13a>l<III.I" CCTCCTBeHHbl 1 aH:rHKOarynSlHT (nO)\aBJ1S1eT UHYT-
peHH11" IIY 1'1. KoarynSlI J.tOHHoro KaCKaJla J.t arpcralU1fO TpOM60LlJtT0(3).
MemoOhl OIlpeOeJlef-lll.R. )].nSl onpCl CJICHUSI aKJInpHMcHSlCTCSi I1c1JM, KOTOpblH
n03B0J1S1eT AaTb 1130nHlH ' ICCKYfO XapaKTepnC rHKY aHTIITCJI, a TaK)I(C nCCJICHoUa'fb
CHJIY BJmIMOp,dicTBIfH aHTJ.treHa J.t aHTJ.1TCJIa (aBl-i1J,HOCTb). XoiJ UCCJleOO{JaHltJl. B
JIYHKJ.t 1I0nJ.1CTJ.tpOJIOBbIX MIIKpOl1JlaT I3HOCSIT no 0,05 MJI KapJ.1I10I1J.tI1HHa B ClUtpTC
(Sigma) B KOHC"IHOt't KOHl eHTpm mt 50 MKr/MJI II HIIKy61-ipYfOT npJ.t 4°C u rCLICllnH
lH 11. 3aTeM JIYHKJ.t MIIKpOIlJIaT C l-iMM0611JU13<.maHllhlM lIa TBCPAOH a3C KapHIfOJm-
!IIUIOM npo...lblBalOT 3 pena 200 MKn 0,15 M PBS. 3aTcM )lJ[H 6.T1oKJ.tpoBaHI1S1 HCClle-
1 J.t J.t'lecKoro CUSlJblRaHlfSi J.t R Ka'leCT13C a(l>JI-Ko mKTopa CP2-GPI) 13 nYHKJ.t BHO-
CSiT no 100 MK!110% FCS R PBS J.t J.tHKy6J.tPYKH n TCLICHJ.Uf 1 'I npn KOMHaTlloi'l TCM-
230 TOM II - 1.fACTHbIE AI-IAJ1MTIiP,(ECKME TEXHOJIOrMI1
ncpaTYpc. JIYHKl MHKpOnJIaT npOMl>lDaIOT 3 pa3a PBS l B Ka>KAYIO nYHKY BHOCSIT
no 50 MKJI HCCJlel YCMOI1 CbIBOpOTKH B pa3BC]\CfHUt 1:50 B 10% paCTBOpc FCS B
PBS H lmKy6HPYIOT 3 [ npH KOMHaTHOI1 TCf\.mCpaTYphl. 3aTcM .IIYHKH MHKponnaT
npOMbIBalOT 5 pa3 PHS JI,ml YHancHlm HCCBH3aBl1H XCSI aHTHTCJI II BHOCSIT no 50 MKJI
KpOJ1H lbI1X atlTHTCJI K IgG 11 IgM \[CJIORCKa, MC\JCIIHbIX nCpOKCI1Aa30H. I1HKy6Hpy-
JOT R TC\ICHHH 90 MHH npH KOMHaTHOH TCMncparypc. HCCBSl3aBlIUiHCS! KOH'blOraT
OTMbJBalOT 5 pa3 PBS, nOCJIC tlcro B JIYHKI1 BHOCSIT cy6cTpaTHblI1 paCTBOp (anA C
ncpcKHcr.IO l3oAopoAa). nOCJIC OCTaHOI3KH peaKUlUi U3MCPSlJOT on ua MHlWOKa-
HaJlbHOM ct>OTOMCTpC IIpl AJ1HHC BOJlllhl 492 11M. npl1 )JtICTC pC3ynhTaToR pcaKum
l!3 cpCJ,tutX apHct>MCTWICCKHX 3Hat.ICHHH on no:mntBHOrO C l'ali/.apTa, lrrpHLI,aTCJIb-
Horo KOHTpOJIH H Tccn PYCMbIX CbJBOpOTOK I3Ll l ntTalOT CpCAHCC apmpMCTl1llCCKOC
3Ha l lCHI1C on pa3BOJ],SlII,cm paCTBopa (10% pacTBop FCS 13 PBS). nOJ1Y l ICHHbIC
nOKa3aTCJlH on IICpC130ASlT B CAHHHI,hI KOULI,CHTpaLl,mf GPL H MPL. npH 3TOM 1 CA.
GPL COOTBCTCTBYCT KapAHOmtIlHHCBSl3blBaJOUJ,C" aKTHRHoC I'H 1 MKrhm IgG aKJI, a
1 CA. MPL - ] MKr/MJI IgM aKJI, BblJI,CJICHHLIX C 1I0MOUJ,blO act>HHHOI1 xpoMaTorpa-
l\.HH. MCn0J1b3YJOT KaJlH6poI30"HYIO KprtByJO 3aRHCl Mocrn JIOrapHct>Ma on CTaH-
AapTOU OT JIOI'apmpMa KOHI CHTp<u,rUt aKJI, olUlcaHHml ypaRHcHI1CM JnmCI1HOI1 pC-
rpCCcrUt: 10gc(On) = a + b x logc(aKJ1), r}J,c 3Hat.ICtlI1C K03CP<PHl\.HCHTa "b", BbIpa-
)l(alOUJ,CI"O HaKJIOH KPlIBO" pcrpccclUf. B npCACJlax IYRCTRH rCJJr.HOC'rH MCTOAa AJISI
Ka)l(1-I,0" nOCTaHOHKH l OJ])KHO 6blTb HC MCHCC 0,4. ComacHo MC)I(AYHapoJI,HblM pc-
KOMCH}J,aLUUIM IIPH HHTCpnpCTaI HH PC3YJIbTaTOB CJlCAYcT HCnOJIh30RaTb HC TOJIbKO
aocOJIlOTHhlC 3Ha ICHHSI ypomul aKJI B GPUMPL, HO H ypoRCHh II03HfHBHOCTH ('ra6J1l1-
I\a 11).
Ta6JIHLI,a 11
['paHHI\LI CTenelieH n03HTHBHOCTH npH Ol(ellKe peJYJlLT'dTOB onpe}J,eJIeHH}I
aKJI
CTcnCHL n0311TI18HOCTH
HJOTHD aKJI
IgG aKJI (8 GPL)
60JICC 65
30-65
23-30
MCIICC 23
IgM aKJI (8 MPL)
60lICC 45
35-45
26-35
MCHCC 26
B1>ICOKO JI03HTHBHble
YMCpCHHO 1l03H1'HBUbIC
Hl!3KO IJ03HnmHblC
}-IcraTHBH blC
II. OnpC1-I,eJICHHC BA OCHORaHO Ha cro cnOC06HOCTl YAJ1HHSlTb in vitro ct>occt>o-
mmHA-3aBHCHMMC KoarYJISlLI,l!OHHblC pcaKI rUl, l303HdkmYH Ha Ca++-:mBHcHMoC
CUSl3bJBaHlfe npOTpoM6rma H ct>aKTopB Xa, Va c nOBcpxHOCTbJO QJOCct>OJnllnt).\OU, B
npoLl,CCCC C60PKH IIpOTpoM6HH-aKTltBaTOpHOro KOMOJICKca (npoTpoM6HHa3bl). AnH
onpCHCJICHI1H BA I1CnOJIh3YJOT llaHCJIb ct>YHKLI,HOHaJJbHbIX TeCTOB. AJ1S1 CKpHHltHl'a
CbIBOpOTOK PCKoMcHHyeTcH UCn0J1b30BaTb TCCT aK rnuHpoBaHHoro \JaCTH\JHoro
TpoM6011JIaCnmOBoro RpCMClUf (AYTB) H TeCT C SI}J;OM ra]1,IOKl PaCCCJI3. Ha BTO-
paM 3Tanc AJIH AHct>ct>cpCHUMaLl,mf MC)I(!\y npHCYTCTI3HeM B IlJIa3MC HHrn6wropa H nc-
ct>J.fLJ,HTOM KoarynSll\.HOHULIX ct>aKTopOB HCn0J1b3YJOT 1l0}J,TBCp>KJJ,alOUJ,nc TCCTbI, oc-
HOBaHHhlC lIa OLl,CHKC KOppCKLI,mf HapymcHI1H npn CMCllUmaHl1l (1:1lUUI 4:1) Cbmo-
pOTKH, COACp)l(aUJ,cl1 BA, H HOpMaJIbHOH bJBOpOTKH. Ha TpCTbCM ::rrallc nccJlcAO-
BalmS! l CnOJIb3YCTCSI MCT01-l, rtHrU6U1J,HH TKaHC130rO TpoM60nJIacnma, KOTOp...11 110-
3BOJJHCT nO}J,TI3CpJ1.I1Tb B3aUMOJ\C"CTBHC CbIBOpOTO IHoro rml"HUrfTOpa C ct>occt>om -
mIAaMH. B HCKOTOphlX cnY'laS!x oUHapY>KeHHC HA JIY IIIIC KOppCJJHpYCT C pa3BHTH-
. I
METO)J.bl KJII1HI1t.[ECKOI1I1MMYHOnOrl1l1 231
eM TpoM6oTl-p-leCKUX OCJIO)l(UCm1fl, 4CM ypolJcm> aKJI. BhlSlBJISIeMblX C nOMOI bJO
I1<l>M. K HC,I..I,OCTaTKaM onpe):teJlem1S1 BA CJIe):tyeT OTHeCTH HeB03MO:>KHOCTL cro
MACHTl-1 UKal\UU y 6011hHh1X, 1I0JIYllC:UOW.UX renRpUH(yrCpamuo, B03MO)l(HOC II> Jl0)l(Ho-
nOJIO)l(HTeJIbHbIX H JIO:>KHocrrpm\aTeJlhHbIX pe3ynhTaToB, TJJYAHOCTb CTaH1J,apn13aL\m1.
IGzW-W'iCCKOe 311.a'iel-llle. B LlenOM. BA 06JIaAaJOT 60Jlee BblCOKOii CneLlH H'IHO-
CTblO, a aKJI - 60JlbllJcii llync I'BHTCJll>lIOCThlO )I,lUI ]\HarHOC rHKU A<I>C. C pa3BHTU-
CM KJU1HU l ICCKUX npOSlBJICHHf1 Acl>C Jly'rwe BCen) Koppcm1pYIOT IgG aKJI, oco6cu-
HO eCJUI OHU BbISlBJlSlIOTCSI B BblCOKUX TllTpax, HO UHorAa B CbIBopOTKax 60nbHbIX
A<I>(' o611apY)I(UUalOTCSI I'OJILKO IgM IJnI IgA aK]!. YCTRHOBJleIlO, liTO CHUTe3
I1MCHHO p2-rOI-3aBHcHMbIX a c l>Jl accoLllmpyeTCS! C pa3BHTl-leM TpOM6oTH'ICCKUX
HapyweHuH B paMKax A<I>C, B TO BpeMS! KaK CTaH,IJ,apTHbIH MeTOA onpCAeJICHHS!
RKJI C I1MMo6nm130uaHHbIM Ha TBepAOH ,lJe KapAHOJIIUUmOM UbUIUJUICT KaK
p2-rOI-3aBUCI1Mhle, TaK Ii p2-rOI-IIC3RIJI1CUMl>le RHn1TeJIa, liTO CHH)I(aeT cneLlII-
11'-IHOCTb pC3y.%TaTOB. 06uapY)l(ClU1C aUnITCJI K p2-rnl JlYlJl1Ie Koppem1pYCT C
pR:mwr....CM rpoM6030n, \.ICM 06URPY)l(CHUC aKJI. OnpC)tt::neHue a(])fl CJleAyeT npo-
BOAUTb B cJle,l..l,YIOw.ux KJU1HJ1tleCKIIX CI1T}'aL\USlX: 1) OpH CKB ,l..l,JISI npOrH031lpOuam1S1
B03MO)l(I OCTH pa3BHTI1S1 A(])C. 2) Opu TpoM603e nepmpepwrecKllx COCY.JJ,OB y
60JlbHbIX MOJIO,l..l,OrO B03pacTa, pa3BlIBweMcS! B OTCYTCTBUC O'ICBlI} HbIX npOBOI\Upy-
IOn\HX cpaKTopoB. 3) fJpl1 ayrol1Mymll>lx 11 JmM£f)onpOml epaTIfBHblX 3a6o.'1eBa-
HUSIX npu HaJIH'Um Ilpl13HaKOB AcI>C. 4) Y 6CpCMCHHLIX )l(CHI I1IILr npu HaJ1Wllm
2 CIlOHTaHHblX BblKH,I..I,blWeii B aHaMt.le3e. 5) B CJIy"rae nOpa)l(eHUe lJ,HC (HweMulIc-
CKUH UIICYJlbT, XOPCSI, npHXOASlW.HC HapywcmlS1 1\1031'01101"0 KpOlI006parl\eHUS!) y
60JIbHbJX MonOAoro B03paCT'd IlpU Ham1 l IHII APYn1X npOS!BJICHHH A<I>C, r,UalX KRK
CC1 \.IRTOC JIHUCJ o, tlOpa)l(CUHC KlIanaHou Ccp} L\a, rpoM60 JIe6HT. 6) npu 3a6oJle-
BaHUSIX KopOHapHblX apTepuH y 60JlhHhiX MonOf{Oro B03paCTa. 7) Y 60J1bHb1X C no-
pOKaMli cepALla npH OTCYTCTBI1I1 peBMaTI1'IeCKOro aHaf\.1HC:Ja. 8) Opli MYJILTHOpraH-
HOM rpoM60Jc ,l..l,JISI )'H CPCpCIIIU1(UlhIlO ' HI1arliOCTl1KH C I1,RC-CliHAPOMOM 11 TPOM-
60THlJeCKOt'r TpOM6oLlliTOllelll1'IeCKOH nypllypoii. 9) Y uonbHblX C TpoM6c:)LlHTOne-
HHeH H rCMOnllT11"leCKOH aHeMueH }:\JUI AHarHOCTHKH rCMaTOJIOrWICCKHX npOSlBJIC-
HlI 1 A<I>C. 10) J],JISI Hl1(P CpCIILlHR.'lLnOH JtHar"IIOC rHKH BIlYTpHcepAellHoro TpOM6o-
3a C MHKCOMOH.
5. AnmuneulIlpo(/jU.Ilbllble 1411mOn.lla3ManllllleCKue alllllumeAll (AHl{A)
AHqA - reTeporeHHaSi nOIlYJIS!ltHSI ayToaHT....Ten, pean-tpYIOw.IIX C cpMCHTa-
Mil, JIOKaJIH30UaHHblMH U LlI1TOIlJIa3MC HcihpO I1JIOH. OCHOInlblM MeTOAOM onpe.JJ,e-
JICJIIIS1 AHUA SlB.'1S1eTCSI MeTOf{ HenpSlMOH HMMYHOCpJIJOopeCLlCHL\IU1 C HCIIOJlL30Ba-
HHeM IKCHpOBaHHbIX CIlHpTOM HeHTpocpHJIOB, C nOMow.LlO KOTOPOl"O BbUIB.'ISlJOT-
CSI 2 OCHOBlIblX uma aYl'oallTl1TeJI: HHTOIIJJa3MaTH"lecKHe AHlJ,A (uABUA). H I1C-
PUHYKJleapHbJe (I1AI-IlJ,A). B HCKOTOpblX CJlY4aSlx o6HapY)l(ImaeTcSI aTI-Hll1'lHOe
AI1 <pY3Hoe CBe\.leHl1e HeHTpo HJlOB (aAHlJ,A) (Ta6mtLlLI 12 H 13). I AHUA
06bJ l IHO cneUHCpwlHbl B lYfHOWCHl1H npUrCHtla3Lr (OP)-3, a nAHlJ,A Hal160nee lJa-
cro peampYIOT C Ml1eJIOnepOKCI1Aa30H.
Memod OIrpeOeJleHU.R. OcHOBHblM MeTOAOM onpc,IJ,C!ICt-llUI AHUA Slnn5leTCS! Me-
TO.JJ, HcnpSlMoH HMMYHO 1II00PCCI\cHltlm. R nOCJ1e.JJ,Hee BpeMS! AJISI onpe,lJ,CneHI-tSi
AHUA peKoMcHAyeTcSllICIlOJlbJOBaTb IlpOTOlIHYIO LlI1TO JII00pHMCTpHIO 1I11(])M.
232 TOM II - 'lJACTHbIE AHAJlI1TI1t.JECKI1E TEXHOJIOrl111
Ta6mu{a 12
I.IacToT'd AHU,A "PH 3a6olleBaHHJlX 'lJe.'IOBeKa (%)
3a6oJleBaHHe THn 3HTHTe:I
AHUA nAHUA
(HnH aHTH-OP-3) (mU! aHH!-
\menOnepOKCHAa3a)
rpaHynef\taT03 BercHcpa 80
KJ1accH'"lecKHH. YO 10
MOA 50
CHHAPOM t.lapra-Crpayca 10
E0J1C3Hb KauacaKH 0
OOJIHaHnmTHblH nepeKpec1'Hblfl Cl-mAPOM 40
CKB 0
CMcwaHHOC 3a6onenaHHC coeJ HmtTeJIhHOH TKaHlf 0
CHCTCt.maSi CKJICpoAept.fHSI 0
nOJ1I1MH03HT/JwpMaToMH03I1T ()
PeBMaTOHAHblH. apTpa.tT 0
PenMaToH]J,HbIH naCKYJUfT 0
CHHAPOM (l>eJITH 0
EOJIe3Hb CTHJlJIa 0
CHHHpOM UlcrpeHa 0
CHHAPOM PCHTepa 0
PeaKTI1BHblH apTpl-tT 0
AHKmJOH3HpYI011 l1l-t cnOIl]J,HJIOapTpHT 0
nCOpl-taTH'leCKHH apTpl1T 0
20
20
50
70
6-91
20
4
o
o
10
3-40
50- 75
21-100
23
27
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o
o
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Memoo HHt/J. Xoo IlCC.!Ie()o(WHIl.R. rpaHYJIoLIJtTbl AOHOpOB I3bJJl,cmIlOT U3 rcna-
pl-mH3Hpt>BaHHOH I3CHo:mOH KpOI3H C l,tCnOJtb30BaHHeM 6% pacTBopa AeKCTpaHa T-
500 (Sigma) C nOCJIellYIOIl{HM eH1'pU(l}yrHpoBaHHcM KJICTOK u rpa}1l-!eHTC IlJIOTHO-
CTH HisLopaque-l077 (Sigma). OCa}10K JIe"KOl HTOB OTMblBalOT 3 pa3a PBS, pa3Bo-
}J,SlT PBS, cO]J,ep)l(al1 I-!M 5% BSA AO KOHUCHTpaua.m KJICTOK 2x106 n 1 MJ1 H 1-IaHOCSn
no 25 MKJI Ha npCJ MCTHOC CTCKJIO. nocne BblCYlUl-maHHSI npenapaT HKCHPYIOT
99% ClU1pTOM B Te'"ICHHH 5 MHH. npl-1 4°C H ABa)l(Abl OTMLm81OT PBS. 3aTeM HaHO-
CSiT 20 MKJI HCCJIc.n,yeMoH CblBOpOTKH B pa3BellemU! 01' 1:16 AO 1 :512. nOCJIC HHKY-
6a1{l-m npl-1 KOMHaTHOM Tcr.mcpaTYpc B TC ICHHH 30 MUH npenapaT ABa)l(]J,hI OTMblBa-
lOT PBS. 3aTeM HaHOCSIT 25 MKJI KpOJ1H lbeH aHH!CLIBOpOTKI-! K HMMYHOl"Jlo6ymmm.I
'"leJIOBCKa (lgG+IgA+lgM), Me'ICHHOH <1>I1TU, H HHKy6HpYJOT B TC"lIeHHH 30 r.UtH
npl-! KOMHa-J 110" TeMneparype. OpenapaT ABa)l(AbI OTMLmalOT PBS, npocYIInlBaJOT
11 aHamnl-!PYIOT C nOMOIl{blO JlIOMHUltCI{CHTHOro MHKpocKona. I1HTepnpcTdUI1S1 pe-
:JYJIhTaToB. [{AHUA 06bI IHO AalOT rpaHYJ1S1pHYIO uHTOIU1a3Ma"It lecKYI() cpmoopec-
ueHLlHIO c G01IbUlei1 Hll1'CHCHBHOCTbJO no HanpaBnem110 K SlAPY Hci:frpOCpI1!l0n, '"leM
K nepll epl-m. nAHIJ.A AafOT ncpl-myKJICapHOe CBC'"ICHue HefITpo U1IOB I-! HeKOTO-
pbJX MOHOQUTOI3. 31'01' nm CBC'"ICHI-1S1. '"!aCTO SlBJISleTCSI KaK 6bl apTccpaKTOM, o6cy-
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eT 3a tCUKcJ.lpOBaTh KJIeTKH Ha nOBepxHocTu CTCKna U YBeJIH"lUmaCT npOHHLlae-
MOCTL KJ1CTO IHO" MCMOpaHl>1 JJ,lISI MOJIeKYJI I-!MMYHOrJIo6ymmoB. HO pac ruopSle-r lm-
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Be CKpnHltHrOBOrO rCCTa n03BOJISIeT ynCJII1"Il1Tb BbISlBJlSleMOCTt. l'p,myneMaT03a Bc-
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lOT U Te t leHll11 10 MIIH npH 4°C C nOMow.blO 1,1 % rmoTapcuibAen1Aa (100 MKJlhIYH-
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Tuope (PHS, cOAcp)l(aw.ui1 1 % BSA U 5MM 3,l..rrA), KJICTKH 11HK}'6HPYIOT 2 lllIPH
37°C 11 100% una)l(uoC'nl C 3% pacTBopoM I3SA U PBS (200 MKJlhIYHKa) An51 6no-
KI1pOUaHI151 Y'taCTKOH IIccnc HctJlJlleCKol'o CUHJbIBaHII51 aHTI1TeJI. HocJle 3Toro MO-
HocnOH KJICTOK OTMblUmOT 2 pa:.m H HHK}'6upYIOT 21..1 npll 37°C u 100% Ujla>KHO-
CTI1 co 100 MKJI IICCJlcAyeMblx CI.IL!OpOTOK, pa3BCj\CllllblX PI3S, cOAep)f(allulM 0.5%
BSA. (pa:meAeHl1e 1 :ROO). nOCJle 4-KpaTHoii OTMbmKH MOHocnmr iVIH YAaJICHI151 He-
CU513aUlllI-1XC aJlTlITCJI KJ1eTKU IIIIKy611PYIOT 1 II npu 37°C 11 100% UJ1a>KHoc-n1 co
100 MKJ1 Me'-lemlblX ncpoKclIJ\a3oi"'1 F(aW)2 ctJparMeHToB Kpoml l lLI1X aHTUTeJ1 K l1M-
M}'HOrJ106ymnraM llCJlOUeKa (IgG+IgA+IgM). U cooTBeTcTHYlOll.leM pa3ueJ\eHIHL
nOCJIC 4-KpaTHoM OTMI.IBKH MOHOCn051 KJ1eTOK U JIYHKII UHOC51T cy6cTpar (0(1>JJ;
C nepeKIfCbK.) BO)lOpol a). nOCJ1e OCTaIlOUK(1 pcaK lnl onpeJ1,CJIHIOT on Ha J\-IHoro-
KOHaJlblJOM ctJoToMeTpe npu j\!IHHC UOJ1Hbl 492 HM. PC3YJlbT<1Tbl Ublpa>KalOT U
IIH}(CKCaX CU513bIBaHlI51. KOTopble paCllllTbmalOT no cJ]eAYK.)U CH ctJopMyne:
100 x (O-H)/(f1-H), r]\e 0 - 0f1 oop<\3 a: H - 0f1 cTaJIAapTHoro HeranlBHoro
KOItTpOJI51; n - on CTaU)\apnlOrO n03ltTMBHOro KOifTpOJI51.
K,ull-Ul'leCKOe dHll'lel-lUe. npll CHCTeMHblX ImcKymlTax '-laCTara o6ImpY>KCHH51 If
TIITpbl A3KA KOppeJ1HpOBaJlU C oow.eH aKnmHOCTLIO 3<160J1eUamIH, HO He C on pC-
}J,CJICHHbIMI1 KJ1UHU l ICCKI1MI1 np051B-']eHUH H1, UKm-o t la51 nopa>KelU1C KO>KH, CYCTauou.
J1erKIIX, nO'ICK. U:HC. no uallHlM AaI-IHbiM A3KA BhIHBJUnOTC51 y 20-70% 6OJII.HLIX
CHCTeMHbl!\1I1 nacKYJUlTa!\UI, l[aII C np '1 nacKymnax. nopa>KaK.)ll(IIX COCYAbl KpynHoro
J.1 cpCAHero, tleM MeJIKOrO KaJllofopa. f1pHMe t laTCJlblio. tlTO y oonbHbIX C uaCKYJUrra-
m KpynHr.tX COC}'JWU ypoBeHb AEKA npaKTU'leCKH HC !\1eH51J1CH nOCJIC a6cop61..( UI
CblnOpCYl'OK ctJl1op06J1aCTm.m. 3TO cUHAeTCJ1bCTByeT 0 TOM, 'ITO <1HHrrCJ1a cnel llctJl1-
I.ICCKII paCn0311<UOT aHTurCHHblC ACTcpMIIHaHTbl CaMI1X 3K. Y OOjlLULIX rpaHY.'le 1a-
T030M BerCHepa, OTpm aTCJlbHbIX no AH1 A. nOULIWCHHC "HnpOU A3KA U ncpll-
OA peMUCCI1H aCCO IU1PYCTCH C pl1CKOM oGocTpemf51 3a6o!ICUaJI11H. C oco6eHHO Bbl-
COKOH tlaCTOTOll (58-88%) A3KA o6I1apY>KJ.1U<1IOTC51 npl1 CKB. npH KOTOpOll nl-
nepnpoHYK 1SI A3KA accol mIPycTC51 C K.'1UHUKO-JJa6opaTOpHbIMI1 nOKa3aTemlMH
aKTUUHOCTU 6oJ]e3U11, IIOpa>KCmleM nO'leK. cocYJlnC' 'OH 1I<\To.l0rHCH, B TOM lU1CJIC
J1erO ' IHoi1 nfllcpTcH:J 1e l, A lrHTruII.HbIM BaCKY_'JHTOM, ctJeHOMeHOM PcijHO, a TaK)f(e
CCp03 -ITOM. J1e"KOUI1TOKJIaCl'I1tlcCK I"1 BacKYJ1UTOM. Yucmlllcmle }'pOUH51 A3KA
KoppemlpycT C TH>KCCTblO nOpa>KCm1H COCY OB np 1 CC.!J. II CI1HHpOMOM lIlcrpcHa, a
npn ncpuwlHoM CI-HfJ\POMC lllcrpcHa - C ctJeHoMCIIOM Pdtuo. f1pH AepMaTo mo31lTc
A3KA BbIHI3JIHIOTC51 Y 60J1bHb1X C COllY rCTuYlOllHIM HHTCpcTlII l1aIllJIII,IM lIopa>Ke-
Hl1CM JICrKHx), a np" peBMall)u/(HOM uacKymlTe KOppeJ1l1pYloT C ULlpa>KCHHOCTblO
COC}'J\HC roro IIOBPC>KJWHI151. A3KA IgM BCTpC l mIOTC51 npn aYTollMMYHHOM nmcp-
napaTupc03e, IgA He( pOllaTl1l-1 (IICpCKpecTHO pearupYloT C HLA KJlaCCa I).
7. Dlal)KO.1Jtl "Uerlllble 11llll111llleila (rlWA)
rMA - Ce\1ei1cTBo ay-roaHTIlTen, pean1pYIOII UX C pa3J11l t lHblMH KOMnOHeHTaMM
rJ13J1.Ko 1 M}'cKyJlaTYPbl.
.
238 TOM II - "lIACTI-IbIE AHAJIHTHqECKHE TEXHOnOrHH
Memod OnpeOeJIeHU.R. MCTOJ\ I-IH<I> C HCnOJIL30Bam1CM B Ka 1 IeCTne cy6Crpa1'a
Kpl10CTa1'HbiX Cpe30D >t<CJlYJ\Ka KpblCbI.
IGwHU[leCKOe 3HQlteHUe. YBeJlH1.leHHe Tl1TpOn aHTHTeJI, CneL{HqJH1.JHbIX B O1'HO-
llICHlH1 aK1'l1Ha Ha6mOl- aeTCH Y 98% 60JIbHbiX XpOHl11.JecKHM aKTIIDHblM I'CnaTH1'OM.
rMA 06uapY>t<lmalOTcH npH YBCHTe, J1eKapCTBeHHOM rcnaTHTe. 3JIKOrOJIbHOM no-
pmKeHHH ne1.ICHH, Jler01.JHOH I'Hnep1'eH3HH. Y 3% 3J\oponblx AOHopon; Tpall3l1TOpHOe
ynenll4CHHe HX ypOBHH HaomoAacTcH npH OC1'pOM rcnaTHTC H ApyrHx BHPYCHblX HH-
cpeKqHHx, oc06eHHo 1.JaC1'O npH HH<peKLlHOHHOM MOHoHYKneo3e. TIpH 3TOM aHTHTe-
JIa K aKTHHY 60nec xapaKTepHLI AJISI XAr, a aHTH1'CJIa K npoMe>t<)'To1.IHbIM <p HJIa -
MeH1'aM - 1.IalllC nCTpet.JalOTcSI npH 13l1PYCHbiX 1I0pa>t<eHHHx ne 1 leHH.
8. MumoxO"OpUilAbllble QllmumeAa (MA)
MA HanpaBJ1CHLlllpOn1l3 HeCKOJ1bKHX KOMnOHeHTon MeMopaHLI MHTOXOHJ\PI1H 11
npeACTaDJISlIOT neCbMa re1'eporCHHYIO nonynSlL{HIO aYToaHTH rCJl.
Memoo OllpeOe.lleHU.R. ,IJ,JIH onpC)1eJleHlUI MA HCnOJIL3YIOT MeTO)], I-IH C HC-
110JlL30naHl1eM Kpl10CTaTHLIx cpe30B n01.leK KpLICLI l1JU1 HEp-2 KneTOK. a n nocnc)],-
HCC npeMH H M C HMM06HmnonaHHbIM Ha rncpAoH a3e IUlpyuaTAcrHAPoreHa30H.
KAw-twlecKoe 3HQlteHue. BbIHBJ1eHbl cJIeJJ.YlOu l1e aHTl1reHHbiC CnCL{ H <p H 1.IHOCTI1
(Ta6J1HL{8 15).
Ta6nHL{a 15
THULl If xapaKTepHCTlIKa MUTOXO pHaJIbIlLI" aHTUTeJI
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239
,
06HapY>KCHHe MA 06JlaJl.aeT 90% '-lyncTIUlTCJlbHOCTbIO U cneL.U1£lm4I1ocTb}{)
)l:-'UI ]..\HarHOCTlIKII nepBH411oro 6HnlmpHoH> IJ,Hpp03a. 'nrrp MA 60JICC 1 :40 no:mo-
JUleT 3ano]..\0:JpHTh ncpnH'-IHblff 6l1JUl3pHblH ItUpp03 a>Ke B OTc)'TcTnHe KJUlHlfIle-
CKHX npmmnellull H )'neJIH4CHIUI KOH1\CHTpaLlHlllltCnOI.IHOH £poc<lmTa3bl. THTp MA
11MceT TeHACHLlmo K KOppCJUILlIU! C npOl"peCCHpOl3aHHCM 3a60JICnaHiHI. AHnlTCJla
M2 nbUlBmilOTOI y OOJIbHblX CREST CHHApOMOM ]..\a>Ke B OTcYTcTnHe npl13H3KOn
nEtt 0AHaKO n Jt<UlbHeiiUIcM y .;ITHX 60JlbHbiX HepeAKo pa3BHBaeTcSI X01ICCTC1TWle-
CKOC nOpa>KCHUC ne'-ICHH. OnHcaHo IICCKOJlbKO 601lbHbJX co cBoco6pa3HbiM CHM-
nToMoKoMnneKcoM, llKJlIO'-IaIOLUUM ne'-JCIJ()lIHYIO rpaHYllcM)', nOpa>l<eHllC JlerKHX,
CHHAPOM lllerpcHa, rJlIOTCHon)'1O 3lfrCpOnaTlllo, CMCW<lHHOe 3a6oJICnaHHe coeJl.H-
HHTenhBoii TKaHII. R CblnOpOTKax KUroPblX 6bJJHt ooHapY>I<eHbJ UblCOKHC TlnpbI MA.
9. 1'upeollollble allmllmeAQ
B Chll30poTKax 60JIbHbIX HMMYHopenlHonaTIUlMu, K KOl'OpblM OTHOCHl'CSI TH-
pCOH,QHT XaUH1MOTO, [111(1)CI)Y3HbIH TOKCWICCKHl1 306 U I1CpnH'IHaSi MHKceAeMa, 06-
HapY>KlmaCTCSI WHpOKHH cncKTp ay roaHTlfTen K aIlTIH"CHaM IIllll'OlUIllHOlI >Kene3LI.
K HHM OTHOCSI rcSI THnhl a)' roaHTHTeJl: 1" AHTlneJ1a K Tllpeorn06ymm)' (6enoK C
MoncKY!HlpHOM MaCCOH 600 kD, KOTOpbIH CUHTc:Jl-lpyeTcSI n KllCTKax 1I\IITOm-IAHOII
>KCne3bl). 2. AHTlneJ1a K MIIKpOCO 1a"'I. KOTopble paclIo:malOT nepoKCI1A.ny LUI'ITO-
nHAHoH >Kene3bl (McM6paHo-accoUlU1pOnaHIII.IH 1".'IHKonpoTcIHI. COCTOSIlltllii 11:3 943
aMHHOKHCIIOTllblX OCTaTKOI3. KOTOpblii 3KcnpeccupycTCSI TOJlbKO Ha TllpCOLll1'raX H
npHHHMaCT Y l laCTIiC B ClIHTe3e ropMOHOB IllHTOlnll HoH >Kene3LI). 3. AHnrreJIa K
TupC011'onHbIM peLlen1'opaM.
Alemod onpe()e.n.emlR. LI,nSI onpC}\CJICHHSI THpeml,\IIl>IX aHH1 rCll HCnOIJb3}'lOT MC-
J1JA 1111(1) (B KalICCTBe cy6erpaTa Cpe3b1 LUHTOBlIHHOM >KCnC3bl lJellOBCKa HJlH
06e3bSIHbI), peaKI{I-IIO rCMarrmOTllllaLllU1 H I1cDM.
I1.M..MYl-lo(/jep.MeHlllllbul Jrtemo(). XO() llCC.!leOO(wmm. BbJ,tJ,eJICHHC mpeorJlo6y-
nl-IHa. B 50 MJl np06HpKe CMeliumaJ01' 0,1 MJl 3KcTpaKTa lI{HTOBHAHOH >l<eJleJLI (110-
nyl.JaJOT n)' I"CM rOMoreml3uponaHHSI TKalU1 LUl-ITOBHAHOfl >KCJle3bl n PBS, HHK)'GUpo-
RamlSi B Te'leHHH HOllII Ha xOl1ony. IJ,CHTpH£p)'rHponamul 64000g B TCI.JCHllI-I 50 MIUI)
C 5 M!1 pac-rHopa XJlOpHCTOro H<npHSI. TllpCOf"JI06ymlH paJI30A T AO KOHI\CHTpaLlI-IJ-i
1 MKI'/MJI n Kap60HaTHo-6uKap6ollamoM 6y epc (pH 9,6), nHOCHT 110200 MKJl n
n)'IIKH MHKpOnJlaT H3 nOJ1HBlHlH1JXJIOpUAa H HHK)'6HPYIOT B TCllCHI-fU HO'III npll 4°C.
TpH>K,tJ,bI O1'MLlI3alOT pacTBopoM PBS-Tween. CbIBOpOTKH, pa3Bel eHHblC 1:100,
nHOC T n nYHKH MHKponnaHllIeT B OOoeMe 200 MKll II HHKy6HPY10T n 1'C'-leHHH 44
I1PH 37°C. TpU>KAbl OTMhwalOT paCTRopOM PBS- Tween. 3aTeM n Ka>K1\)'lo Jl)'HKY
]..\ooan.'1S11OT aHuU1MM)'HOrJlo6YJU-IHOnhIC KOII"blOraTbl (no 200 MKJl) II HHK)'611p)'I01' n
Te'LICHHH Ho'm npH 4°C. TpH>K[1bl OTMbIBalOT paC'1'I30pOM PBS- Tween. 3aTeM B Ka-
>KJt,y1O nYHKY 1\06a1311HI01' cooTncTcTnYIOII IIM cy6cTpaT J-I nOCJle OC1'aHonKU pcaKI ml
onpeAeJ1S110T on C nm'lOUl,LIO anTOM.\TUI.ICCKoro c))OTm1cTpa.
l0zuHllliecKoe 3HQ'Ienue. AHTHTeJ1a K rHpeorn06YlIlHl)' 1-1 MHKpOCOMaM (IICpOK-
CH;\a3C) Ul,HTOnHIl1l0H >Kene3bl OOllap)'>KHBaIOTCSI y 1I0,tJ,annSIlOlItCrO 6011bWHHCTBa
60JlbHblX THpCOIIAHTOM XauIHMOTO (76-100%), aTpoq,HI.ICCKHM Tllpem.fAI-ITOM 11 y
70-90% 60nbHbIx THpCOTOKCIIK030M. AHTIlTena K MI1KpOCOMaM H non)'JlSlI..{HH 06-
HapY>KlmalOTcSI )' 7% 11 IIX lJaCTOTa )'HcmllnwaeTC C B03pacToM. '[TO aCCOlJ,lfJ,IPy-
eTCSI C 60.'1ee '-1aCTbIM pa:mUTlICM rHnampe03a y !IlH 1I0>KHnOrO l303pacTa. Onpcn c -
JleHIIC aHTIITen K MllKpOCOMaM SlUllHCTCSI aneKBaTllhlM MCTOAOM 1\JJSI UbBlI3JlemlH na-
TOnOrl-HI Ul,HTonu)J.HoH >l<CJIC3b1 n nocJlcpo.u,OI3b1M nepHOIl. Y 6011bHb1X TUPCOTOKCII-
J
.
240 TOM II - Y.ACTHbIE AHAJIl1TfP1ECKJ1E TEXHOnOrJ1J1
K030M, He m.1eWILlHX THpCOH]J;HhIX aHTl1Te!1 AO J1C eHlUI, Ha <JJOHe Tepamm fionee
BblCOKa BepmlTHOCTh pa3BHTHSI nmOTIlpe03a, \leM Y OOJlbHblX C BblCOKHM ypoBHeM
aHTHTeJI. Twrp THpeOHJ).HbIX aHTHTcn He H3MCHSleTCSI B npou.ccce ne"leHHSI THpeOH-
AliTa XaWHMoTO THpoKCHHO!\-I. Y 60J1bHb1X C BblCOKHMH THTpaMH aHTHTen MO>KCT
pa3HIITbCSI :i)HLle<JJaJlOnanISl (3HLle<JJaJlOnaTIISI XaWHM<Yro) B OTCYTCTBHC MHKceAe-
Mbl, KOTOpaJi KynHpyeTcSI Ha3Ha eHHeM rmOKOKopTHKougOB.
Jlllmepam}pa. HaCOHOB EJI.. Cypa B.B. COBpCMcHHhle nOAXOAbl K m,'IMYHOJIO-
m"leCKOH I HarHOCTHKe aYTom"fI\'IYHHbJX H HMMYHOKOMnneKCHblX 60Jle3HeH. Tcp. ap-
XHB, 1988, N!! 6, c.144-150. THU.J.eHKo B.A.. EeKeToua T.B., CeMeHKona E.1-L, KY3-
HeLlOBa T.B., HacoHoB E.JI. AHTHHerlTpO(IJHnhHhle LlHT0I1J1a3MaTH\leCK 1e .\HnrreJ1a
npH rpaHyneMaTo3c BereHepa: a",uun C nOMow.bKJ UMMYHo<JJepMeHTHoro Ii HMMY-
Ho<JJmoOPCCI\CHTHOro MCTOJ\OB. Tep. apXHB, 1994, NQ 5, c.48-50. CaJIO>KI1H K.B.,
IJJ.ep6aKoB A.E., (-laCOHOB EJI. 11 coanT. AHTI13HJ).OTCJlHaJIbHble aHTlrrCJ1a npH CH-
CTeMHOH cKJJepOAepMHH 1-1 fiOJle3HH PerIHO. Tcp. apXHB, 1995, Ng 5, c.54-57. A!leK-
caH}J,pOBa EH., HacoHoB Ell., KOBaJIeB B.10. KOJlH\leCTBCHHLIH HMMYHO<JJCp-
MCHTHblii MeToA onpcAeneHHSI aHTIITCJJ K KapAHOJlHlU11IY B ChlBopoTKe KpOBI1.
Kmm. peBMaT0J10nISl 1996, N!! 4, c.35-39. Faith A., Pontestilli 0., Unger A., eL at.
ELISA assay for IgG Rheumatoid facLors. J.ImmunoI.McLhods. 1982 55: 169-177.
Manual of Clin. Labor. Immunol. Ed. N.R.Ross, E.c. de Macario, J.L.Fahey,
H.Fcldman, a.M.Penn. Amcr. Soc. Microbial. Washington, 1995, Schwartz R.S.,
Datta S.K. Autoimmunity and autoimmune diseases. Fundamental Immunology.
Second EdiLion, ed. by W.E.Paul, Raven Press Lid., NcwYork, 1989: 819-866; Barna
L.K., Triplet D.A.: A report on the First International Workshop for Lupus
Anticoagulant Identification. Clin. Exp. Rheumatol. 1991; 9: 557-567. Shmeling I
R.(-L, Delbanco T.L. The Rheumatoid Factor: an analysis of clinical utility. Amer. J.
Med., 1991 91: 528-534. Smeenk R. Measurement of antibodies [0 DNA. In Manual
of Biological Markers of Disease. Ed. W.J. van Vcnrooij, R.N.Maini. Kluwer
Academic Publisher. Dordrecht. Boston, London, 1993; AH/1-A8/12.
8. MeToAbl M3Y'IeHMR KJ1eTOliHorO MMMYHMTeTa
1. H3y',elllle AUJ,!fiOllumo6
MemOObl OllpeOe.llCHlt.fl. CraHAapTHl>lM SlBJ1S1eTCSI MCTOJ\ npoTo'IHOii 1\ 'ITo<JJmo-
opHMeTpHH C HCIIOJlh30BamieM MOHOKJ10HaJIbHbIX aHn-ITeJ1 K nOBcpXHOCTHhlM aHTII-
rCHaM pa3J1f.11lHblX cy6nonY.'ISlI.\HH JIHMcfJ0LlUTOB. DOCKOJ1bKY C nOMOII blO npoToll-
HOH LlHT O <JJJIIOOpUMeTpl1l1 MO>KHO npOBOAI1Tb OAHOMOMCHTHYfO onpeJJ,CJJCHHe 2 n
60nce nOBepxHocTHhlX (unH BHYTpI1KJ1eTO\lHbJX) M01leKyn Ha Ka>K}10f'l 113 I1CCJ1CAYC-
MblX KJICTOK, 31'0 n03BOJISleT nOJ1Y'U1Tb 1H( OpMaI.\I1KJ 0 cy6Knaccc JH1M<JJ0U. I1TOB ,
CTa}J,J.111 I1X Jw<JJ<fJcpeH I.\UPOBKI I 11 aKTHBaLlHI-1. l1MMYHo<JJeHOTIHH1pOBaHHe npOnOHI-IT-
CSI I1JU1 H o6pa3Llax l eJ1bHoi'1 KpOBH (nocne nH3HpouaHHSI apHTpou.HTon) HnH nOCJ1e
BblAeJ1emlSl O\mU eHHoii nOIlYJlSlI\11I1 mIM<JJ01.\ 1TOB B rpaAI1CHTe nnOTHOCTl1 <1>I1KOnJ1-
renaKa. T -KJ1eTKH COCTaBJ1S1IOT 65%-80% nepl1<JJcpH ecKHx nHM<fJ0LluTOB. 061.,1'1-
lIO onpe eJIJIIOTCSl C HcnOnb30BalmeM aHnlTCJI K CD3 (peu.crrrop, accou.lUlpouall-
HblM c T-KJ1CTO\lHhIM pCLlcnTopm.I). ,il.PYrHMH peareHTaMJ.t, n03BonSllOw.HMH YCTa-
HOBUTh KOJ1I1'ICCrBO T- KJ1eTOK SlUJISlIOTCSI aHTHTCJla K CD2, CDS II CD7. O HaKo,
aHTHTC!la K CD2 pearHpYIOT C eCTeCTBCHHblMl1 K lJ1nepHhJMH (EK)-KJICTKaMu, aH-
THTCJ1a K CDS - C B-KJ1CTKaMH, a aHTlnCJ1a K CD7 - c EK-KJ1eTKaJ\-II1 II KJ1eTKaMH
mcJloJ1eiiKo3a. JJ.JI GOJlee nonHoii xapaKTepHcTuKH cyGnonYJ1S1LlIlH T -J1HM( OI.\IITOH
npHMeHSlKJT allTiITe'Ia K CD4 (cocTaBn KJT 45%-70% T -JUlM( OLl 1TOB 11 'Iacro on-
METOAbI KJ1I1I-IH'-:IECK0I1I1MMYI-I0J10rl1l1 241
pep,emnOTCSI KaK xennepHaSlhlHHYKTopHaSi cy6nonYJ1S1QHSI) 11 aHTMTeIia K C08 (20-
40% T-nm.-I4JOI HTOU. oCina mOll\I1X cYl1pCCCOpHO(I/QI1TarOKCI1 ICCKO" aKTI1UHO-
C1'bH). KpoMe Toro, C04 KJICTKI1 MorYT 3KcnpcccHpoBaTb cnel H4JI1 CCKHC CD45
113 0 4JOPMbl, xapaKTepHble AJ1S1 T.H. "HaI1BHbIX" KneTOK (CD45RA) 11 KneTOK-naMH-
1'1.1 (CD45RO). K MapKepaM, xapaKTepl13YIOIl\HM aKumaQI1H) T-KneToK, OTHOCHTCSI
CD69, CD71 (TpaHc4JcpI1HOUbIH peQeIlTop), HLA-DR (rJ1amlblH KOMnneKC rHCTO-
COUMeCTMOCTU K:lacca II), CD25 (pcQCJJTOp JVlSI I1fl-2 a QCJlu), KOTopble UhISlI:\JISI-
IOTCSI C nOMOIl bl{) COOTue1'CTBYIOUJ,HX aHTHTeJI. Onpe]"\CJICHI1C 3THX H p,pynlx aK nl-
naQI10HHbiX aHTl1reHOn MO>KCT I1MeTh 3Ha l lCHI1C }..VISI Ol\eHKI1 Uhlpa>KCHHOC1'M aKTI1-
Um I1H KJICTOK B nepl1( epH'lccKOH KpOBI1 I1JII1 n TKaHI1 npl1 uo narniTenbHblx 3a60-
JICBamlHX MIll1 pa3BHHm 3.'IOKa l IeCTBeUHoii JIMM4JonpOJ1lI£fJepaQI1I1. C APyroH CTO-
POHbl, OTCYTCTUl1e aKTl1Ual\110IlhIX MapKepou Ha KneTO'lHbiX MeM6paHax MO>KCT
CUI1]"\eTCJlbCTL!OUaTb 0 UMMYHo.o.e4JHl\I1Te. AnH onpCQcnCHl1S1 KonHlleCTIm B-JUIM£fJO-
qwrou I1cnonb3YlOT onpCACneHl1e nouepxuoC". HblX HMMYHorno6YJII1IIOU, ;:\HTliTeJI K
CD21 (peQem"Opbl ].I,JISI KOMnJIeMCHTa), a 1'aK>Ke aHTI1TCna K CR2 (pel\enTOpTOphl
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AJISI IgE). AnSI onpCAenCHHSI KOJII1 'CC'lBa EK-KneTOK IlCnOJlh3YlOT aHTl1Tena K
CD16 11 CD56.
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Hal160JICC none3HO }J;nSl )luarHOCTI1KH J1I-IM£fJonpOJJl.I4JepaTl1UHbIX 11 HMMYHoAeqm-
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ICHl1e AnSI }J;MarHOCn1KI1 M oQeHKl1 3a6oJICUaHHli KpOUl-I, B 1.laCTilOC I'M AnSI xapaKTe-
pl1CTHKM T-KneTollHoro OCTporo J1Iu.ICIJOl\llTapHOrO JlellK03a, AJlSl MJ\CUTI14JI1KaQI1l1
3nOKa ' ICCTUCHHbIX KJ1eTOK npu CI1HApoMe Sezary, B-KJICT01.IHbIX onYXOJleH (B-KJIC-
TO'IHoro XPOHW-lcCKoro J1IIM£fJ0J1eHK03a). OnpeAeneHue C04 - O ICHb XOpow11 t'l
nporHOCTwlCCKIiH nOK<\3aTeJlh npll BI11{-I1H£fJeKQm1, nOCKOJIt.KY CHI1>KeHHe 'lI1cna
3Tl1X KJICTOK cBlIAeTeJlhCTL!YC1' 0 nporpecCl1pOUalflHI u JJJIOXOM nporH03e. HMMYHO-
c eHonlmlpoBaHl1c !uu.f( OQI11'OB I1CnOJlb3YlOT AJlSl .o.l'larHOCTllKl-1 nMMYHoACC lfQIIT-
HhlX 3a6oJICUaHI1I\ TaKI-IX KaK X-TSI>KCJ10rO KOM61IIU1pOL!aHHOrO HMMY HO l1 e £fJIIQIITa
(OTCY1'C1'BMe T-KJICTOK 11 EK-KneToK), ZAP-70- AC£fJI1QI-I1'Hblii rSl>KCJlbIH KOMUUHM-
pOL!aHHbIH I1MMYHoHe£fJIIQHT (OTCYTCTBl1e CD8 -KJICTOK), X-araMMarno6ymmcMHH
(OTC}'TCTBMe B-JIl1MQJOl\I1TOB).
2 PaCmBOplLMble pelfellmopbllmmep.lle;iKllHa-2 (pHJ1-2)
AK1'Ul1pOBaHHble T-IllIMcpol ItTbl cIIH1'e3HpYfOT HHTepl1eHKlIH-2 (I1n-2) H cne-
1 114JI'I ICCKHC feM6paHfI"lc pCQcnTopbl }J;nSl 31'01"0 QUTOKlma. I1J1-2 pel(enTOp CO-
CTOH1' M3 3x nommcnTM.o.HhlX l(cnci1: a-QerU1 (p55-65, Tac), KOTopa CUSl3hlUaeT
I1J1-2 C HI13KOH a£fJ4J 'IHHOCThfO (Kd= 10-8 M), f3-I\Crm (p70-75), cBSl3bmmoll ei1
I1J1-2 C npoMc>KYT01.IHOII a£fJcpI1HHOCTblO (Kd=10-9 M), 1-1 g-Qemf (p64). AccoQl1a-
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(Kd= 10-12 M). B OTJlII IHH 01' f3-l\em1, KOTopaSi 1I0CTOSlHHO npl1cY1'c1'ByeT Ha KJIC-
1'OllHOH MeM6paHc, a-l cllb(Tac-6enoK) 3KcnpcccHpyC1'CSI 1'01lbKO U npOl.\,cccC KJIC-
ro IH()r. aKTlmal\IUI 1.1 BbICB06o>K.o.acTcSI B KpoUHHoe PYCJ10 U BH}J;C pacTDopHMOii
£fJOPMbl, K01'opaSi nOJ1Y l lIlJTa Ha3uaHue pacTRopl'IMbll1 (p) Hn-2P II Ha 10 Kd MCJJL-
rueH, '-leM MCM6paHHaSi £fJopMa. YCTaHOL!JleHO, '11'0 ypoBeHb pI1JI-2P U 6110JIorl1'-le-
CKHX >K11J\KOCT X npOnOpl\110HaneH Bblpa>KCHHOCTH 3Kcnpeccm1 3TOH MonCKYJlbl Ha
242 TOM 11- "lIACTI-IbIE AHAJlI1TI'P'IECKI1E TEXHOnOrl111
MeM6panax aKUlUl1pOBaHHblX UMMYHOKOMneTCHTHhJX KJleTOK. OCHOBHblMII KJICTKa-
MH, CeKpeTHPyIOLI UMH pI1JI-2P }!BmUOTCSI aKUIBl1p013aHHhIC T-m-IMcfJOI....HTbI, B
MCHbWCi1 CTeneHH B-nHMcfJOI I1TbI H MaKpocfJarll.
Memoo OnpeOeJlellll.R. TBepAOcfJa:mbIt1l1cI)M (Genzymc, CiliA; T cell Science,
CIlIA; Boehringer Ingelheim Bioproducts).
lVzw-/ll'leClwe 3Hu",euue. YBenlfllemw KOHI CHTpal.l,l1l1 pI1JI-2P 13 CbIBopoTKe 06-
HapY)l(eHo IIPH MHOn1X BocnamrrCJlbHbIX (PA, CKB, CHCTeMHa}! cKnepo,'\cpMml,
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UaJlIITenbHbIe 3aUOJlenaHH}! KHWC'IHI-IKa, I'>tHaCTeml}! rpamfc, paCCC)lHbIH cKnep03.
6pOHXJlaJlbilaSi aCTMf.\, JJ,UJlaTc.U{I.loHHa}! KapJJ,J.10MIIOllan1S1 H MIIOKapAlIT, CJ.fIlHpOM
n1 icHa- Bappe) 11 IIHcfJCKI I-IOlmbIX (napa3l1Tapll blC IlHcfJeKl.I,lIl1}!, BJ14 -lmcfJeKl.I,l.f}!)
3a60JIeBaHlI}!X, JIHMcfJonponHcfJcpaTIIBllhlX onyxon}!x. KO)l(HOit T -KneTO"IHoJ:i .JIIM-
cfJOMC, UpH OTTOp)l(eHlU1 TpaUCnJ1aHTaTa. Dpll PA nmepnpOJ.tYKl.I,H)I pI1JI-2P KOp-
penHpYCT C aKTHBHOCTbIO 3a6OJICBaHl.ISI. a npH CKB c aKTHBHOCTblO npoLl,CCca II
ypOBlieM aHTHTCJI K ,!],HK. CbIBopOTo'mhli1 ypOBeHb pI1Jl-2P B03paCTaeT no Mepe
nporpcccupOBaHlI}! IgA-Hc( ponaTHH OT CTa}..J,IUI I-II K CTa)J,HH III-IV. YBCJIH leHHe
ypOBH}! pI1JI-2P Koppem-lpycT C OTrop)l(eHHeM TpallClI1laHTaTa npH ncpCCa} KC
ccpJ.tl.l,a, nO"IeK H nC"ICIUI. nepcl-lcTI1PYlOl.l.(Cc nOBbJmeHHe pI1Jl-2P B nocTTpaHc-
-
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HbiM IIponw30M, oUYCJJ013JICIIHbIM nOp(1)1(CHHCM KopoHapHbIx apTcpuH. TIoc.fle nc-
pecaAKH nO"leK 1I0DblUIeHHe ypOBHSI pI1Jl-2P }!Bn}!eTC}! 60JIce paHHHM H 'IYBCrIm-
TenbHbIM nporuocTH"ICCKHM IJOKa3aTeneM nOCJleJ.tYK)Il erO pa3BHTl1}! pCaK( lnl OT-
TOp>KCHUSI TpaHCIIJIaHTaTa, '(eM YBemf'ICHue ypOBH}! KpcanUIlUla. YBemPleHHC
ypOBHSI pI1JI-2P KOppeJmpYCT C nporpeCCHpOBaHlfC\1 BI1'lI-IIH( eKl.I,IHI. B 1 eJ10M,
onpe1l.eJ1eHHC pI1JI-2P paCCMc.npllUac-rcSi KaK BeCbMC1 1I0JIC3HblH MeTOA Ol.l,CHKH aJo..-
THBal.l,HH KJleTO"lHoro HMMYUI1TeTa npl'l 3f.1UOJICBaHIfSiX 'leJ10BCKa, XOT}! H He n03BO-
-'1)leT fJ.IlcfJcfJepCHl.I,HpOBaTb aKTHBHOCTL c06CTBeHHo HMMYIlOliaT0J10rll,leCKoro IlpO-
l\eCCa OT UMMYHHoii aKTHBal.l,lut, CBSl3aHHOH C HHTcpKypeHTHoH I1HcfJCKLUtCH.
3 PaCmaOpu.Mble pe14enmopbl tfiaKlllopa lIeKp03a onyxoAu (pf/JIIO-P)
(I>HO-a II <1>HO-f3 CB}!3blUaKHCSI C 2 BblcoKoac (JmmlbIMI1 KJ1eTO'lHbIMiI nOBepx-
HOCTHbJMH pCl.I,enTOpaMI1 C t..,OJICKYJISIPHof! Mf.1ccm1 COOTBeTCTReHHO 55kd 11 75 kd,
3KcnpeccHpylOW,HMHCSI lIa MeM6paHax MIiOn-IX KJ1eTOK (T-II1-1McfJOl I1TbJ, ,.,mKpO( a-
rl1, HeHTpocfJwlbl J.1 AP). p(I>I-IO-P IIpe1l.CTaBJ1S1IDT C060l1 6eJ1KI1 (30kd), KOTopbIe
BbICB06o)l(J aIOTC}! B 6HOJIUnl'-leCKlle >KJ.1D.KOCTII B npol.l,ccce aKTl1BaI(lU1 MOHOHYKlIC-
apl bIx KneTOK.
Memoo ol1pe()eJleHllR. TBcpJ.tocJ>a'JHbIH I1(I>M (Genzyme, ClllA; T Cell Science,
CiliA; Bochringcr Ingelhaim Bioproducts).
lVzuHu.teClwe 3HG'leH.Ue. YBcll11"leHlIe ypOBlI)l p<1>HO-P 06Hap}')I(eHO B CbJI30-
pOTKe 11 CI1HOBllaJlbIiOfl >KItAKOCTII 60JlhHhJX PA H KOppeJlllpyeT C BocnaJHI reJIbHOH
aKTl1BHOC I'bID 3a60JIeBC1HHSI. IlpH oCTeoapTpo3c TaK)I(e 0 rMC"ICIlO YBenH'lcHItC
yp013HSI pcI>HO-P B CLlUopoTKe, HO He CHHOUJ.1aIlbHoii )l(HjJ,KOCTII. npe nonaraCTCSI,
t.JTO onpeAcnCHHC KOHI\eHTpaUlUl p<l>HO-P MO)l(CT IIMC"'}' 3Ha"leHI1C AJISI OI eHKH aK-
THBHOCTH IIpOl. eCca H AHarHOCTlIKII P A.
-
METOJJ:bI KJII1Hl1lJECK0l1l1MMYHOJIOfl111 243
4 Heonmepull
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pml>occpaTa B npoLlccce 6110Xl1MH leCKO" TpaHccpopMaLllUl. flpOt.-IC)I{YTOtlHbIH npo-
AYKT MCTa60nI13Ma-TCTpanIAP06IiOIlTCpHH, 5IBn5lCTC5I CCTeCTBeHblM Ko aKTopoM
n51 MOHoaMHHOOKCHJl.a3 apm.laTl1 l leCKI1X aMI1HOKI1CnOT. OKI1CJICHIISI mml1 OB I1npl1-
HI.IMaeT }'lraCTI-ie B 06pa30BaHuH pa)J;I1KaJlOB a30Ta In apnlHHHa. Hap}'llIeHlIC 6110-
Cl1HTC3a TeTparl1J.p06HonTepHHa Bbl3blBaeT ccpl>e:moe HeBpOnOrl1 l lCCKoe :m60J1C-
BaHHe (anmwlHaSi cpeHHnKcToHYPI1S1). OCliOBHblM npoHYLlCHTOM HeonTcpHHa n op-
raHl13MC 5IBJl5IIOTCSI MOHOLlHTbl/MaKpocpan1 11H,IJ,YKTOPOM Cl1HTe3a HCOIITCpl1Ha B
31'l1X KJ1eTKaX 5IB'I5ICTC51 l1IiTepcpcpoH-g, Cl1HTC3I1pYIOLUI1HCH T -JIl1M oLlI1TaMI1 R
npoLleccc HMMYHHoro OTBCTa.
Mcmon (JllpeOeJlCHlIJl. )],1151 onpeJ],eJ1eHlHI HeOnTepl1Iia B CbIBopOTKe l1CnOJlb3Y-
101' paJJ,110I1MMynOJIOrl1lleCKHH MCTOJI (IMMUtest Ncopterin, Henning-Berlin, fcp-
MaHl1S1). JJ:Jl5I onpeJl,eneHl1S1 KOHLleHTpaI\Ul1 IICOnTepl1Ha B MO IC Hcnonb3YIOT BbICO-
K03cp eKTlmHYJO xpoMaTorpacp '11O BblCOKOro J1,anJICHI151.
IG1liHU l lec/((Jc 31lQfleHlLe. YBCJll1lIeHile KOHl{CH1-paLlIU1 HeOnTCpl1Ha B CblBopoTKe
11 B MOlle lIa6JlIOAaeTCSI npl1 MHorHX 3a6OJlcnaHI151X 11J111 COC I'OSlHH5IX. xapaKTCplf3Y-
IOII{HXC5I aKTlmal l1ct1 CI1CTeMbl HMMYHI1TeTa: OTTOp)l{CHHC -rpaHCnJ1aHTaTa, aYTOHM-
MYHHble 3a6OJICBaHI151 (PA, CKB. XpOHl1 l leCKI1C BoCnanlfTeJlhHblC 3a6oJIeBaHl15l1lC-
lleliH. HHCYJIHH-3aBI1CHII'lbIH caxapHhlH "l1a6eT. aYTOHMMYHHblH TUpeOI1,IJ,HT. capK0l1-
A03, MI10KapJ1,11T. AHJ1aTIlLlI101-1113J1 KapJl,HO"'n'IOllaTHJI), 3JIOKa l ICCTBCHHI.le HOBo06pa-
30BaHiHI. l1Iul>CKLlI10HHhlC 3a60neBaHHSI (Ty6cPKYJ1C3 J1erKl1X, JlaHMOBCKI1H 6oppc-
nl103. cenclic 11 Ap.), npl1 BI1Y- m eKLllU1. OnpCnCJICHl1e HeonTepHHa l1MeeT Ba)l(-
Hoe nporuoc rWleCKoe 3Ha ICHHe )J;n51 OI{eHKI1 I1CXOAOB I1HcpeKI{l10HHbIX 11 HMMYHona-
TonorH l lCCKI1X npOl{CCCOB (HanpllMCp nporpeCCl1pOBaUUSI Bl1lI-I1HcpeKI\ml), aK-
TlmHOCTl1 3a60JleBaHHH H CKpblTO npOTeK31OLUCH I1MMYHHOH H/I1J1U I1H(peKLlHOHHOH
lIaTOJlOnUi.
Jlumepamypa. cI>YKC JJ:., CaMCOHOB M.IO., PeH6Hl1rep )1(.. HaCOHOB E.JI., Bax-
TCp X. KmIHl1 l JeCKOC 3Ha l leHl1e nCOnTCpl1Ha npH 3a6OJlem.\HH5IX leJ10BCKa. Tepa-
neBT. apxuB 1993; .J\ 5. c.80-87. Fuchs D., Werner E.R., Wachter H. Soluble
Products of immune activation: neoptcrin. In: Manual of Clinical Laboratory
Immunology. Ed. Rose N.R., Dc Macarion E.C., Fahey J.L., Friedman H., Penn G.M.
Amcr. Soc.Microb. 1994; 251-255.
9. nOKG3GTenH GKTHSGLlHH/ nOSpe)I(AeHI1R :tHAOTenHJI
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CKH aKTHnHblM MOHOCJlOCM KneTOK, I3bICTI-maJ0UJ.11X BCC COCY1 bI OpraHl13Ma leJIOI3C-
Ka. 3HAOTCJmCUlbHble KJIeTKI1 (3K), CneI{lHlm ICcKII pearl1pySl Jla pa3JIH"lHble MOJIe-
KYJIJlpHble CllrHaJlbl. I.CHCPl1pYlOlI\HCCH KaK nOKcL']hHO, raK II AHcTaHTHo, HhmOJIIUI-
lOT MHoroo6p33Hble cpYHKI\HI1. n TOM ll1cnc CC1ICKTl1BHble, TpaHClIopTHble H 6apb-
epHblC, }'lIaCTBYIOT n MeTa6oJJl13Me BHeKJICTOllHoro MaTpl1Kca. 6HoCHHTe3e pa:mo-
06pa3HblX I{HTOKl1HOB, aHrl1OrCHC3C. perynl1pylOT npOLlCCCbl CBepTbmaHHJI 11 arpe-
raLlHH TpOM6oLlIiTon, COCYAIICTblii TOHYC II HMMYHOBOCnaJIUTCJlbHble peaKI{HH. 3K
YlJaCTByeT 130 ncex a3ax oc-rporo H xpoml leCKoro nOCnaJleHHSI, TaKI1X KaK Ha'laJ1b-
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H"e 3 K.
Memoo onpec)eAeHuR. TBep octJa3HbJ" HMMYHocl>epMeHTHMH MeTO].1 (Stago,
Asniercs, France).
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paTOpHoM AHcTpecc CHHAPoMe y B3pOCJlbiX 1'1 flero lIIor. TpOM603M6oJ1I1H, Aua6eTH-
llecKoH allfllOnanU1, npC3KJ1aMnCIUI, aTepocKflcponf'lccKOM nOpa>KeHl1I1 KopoHap-
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METOL(bI KJII1HI1YECK0l1l1MMYHOJIOrl111 245
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246 TOM II - qACTHbIE AHAJU1TI1'-IECKI1E TEXHOJIOrl111
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eHHJI ypOBHSI <l>BAI- HaOJIIO aeTCJl peAKo. TIpl1 }'3e!IKOUOM 1I0JUfapTCpmfTe YBeJII1-
tIeHI1C ypoBHJI <l>BAr accm.umpYCTCH C naTOJIOrl1eM no eK. YBemf t lCUI1C KOHU,CHT-
pau,mf <l>BAr npJ..1 60Jle3HI1 Eex'leTa aCCOI\I1I1PyIOTCJI C pa3BJ..ITI1CM COCYAI1CTbIX OC-
JImf<HeHl1rf, B OCHOHHOM ueH03HblMI1 TpOM603a!l.m. TIpJ..1 rl1raUTOKJICTOtlHOM apTcpH-
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pyeTcJI C nacKymnoM, IIOpa:>KCHI1CM nO'IeK 11 TPOM60TI1'leCKHMI1 HapYlllcmfJlMI1 B
paMKax A(I)C. TIpl1 D:M/TIM YBcmf cmfc KOHL{eHTpaLl.I1I1 <l>BAr 'lall\e Ha6JIJOp;aeT-
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ro, ypOBCHb <1>BAr KOppCJlI1pYCT (II OTJII1'IHH 01' C03 H CPE) C BbIpa)KeHHOCThlO
MhJIUe'IHOfi cJ1a6oC'nf. PC3YJlbTaTbi ,[{HHaMWleCKoro onpep;eJleHJ..1S1 CBI1AeTeJIhCTBY-
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,[{ IL\HBa 1996; 74 (6), 32-34.
-
METOAbl
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MamUf - B036YAUTCJIU BUCL{CpanbHoro nCHlIIMaHH03a U TOKCOnJl33Mbl 06U1'alOT
rnaBHblM oGpa30M B TKaHCBblX MaKpOcParax U B KpOBCHOCHOM pycnc nOS1BJlHIOTCH
pC)l.KO. '-1'1'0 KacaCTCH rCJlbMJfHTOB, TO 0l\IUf 1-0 HJfX, B3pOCJ1hIC LlUfCTOCOMbl, nOCTO- I
HHHO ){(UByr H BCH03HbiX cocy ax. OTpo aH 3ACCb Sli'JL{a. Ho 3"""1 nOCJICAHJfe cpa3Y
){(c nOKJf}:\aIOT PYCJ[O KpOBJf H KOHI\CHOI PHPYIOTCH B KJfUICymfKC mm MO ICB()M IIY31>1-
pc. AJIH HX 06HapY){(CIUfH JfCCJ1CAYCTCH HC KpOHL, a 4>CKaJIHJf l-IJm MO'la (CM. pa3}J,C-
Jlbl5 Jf 7). CBoco6pa3Ha CBH3b C KpOBLIO Jf lJ.pyroH rpynnb[ rCJlbM1-JHTOB - cPUJlHpu-
.
METO.D:bI KJII1I-II1QECKOVI nAPA3MTOJIOrI1V1 251
Hp;. B3pOCJI61C <}mJISlpm1 >l<HB}'T B m1M<)JaTHl.ieCKHX cocY11.ax, a OTpO>Kp;aeMLIC HMI1
JII1IU1HKH ( mKpo<)JumlpIUl) npoHuKalOT B KpoBeHocHoc PYCJIO U J.VUlTeJIbHO nepe-
)KUBaIOT B 1IJ133Me.
.D:ml 06HapY>KCmul «KpoBenapa3uTOB» HccncHylOT U,CJILHYIO KpOBb, npuroTaB-
mmaJl In Hee «TOHKUH Ma30K» Imu «TOJICT)'IO KanJ1IO», pe>KC nOf(BcpraJl ec U,CHTPH-
<)JympoBamno HIm <)JUJlbTpaLUU-I. 3n1 npenapaT61 HCCJICJ YJOT B HaTUBHOM (Ha TpU-
naHOCOMLI U MUKpO<)JU.'ISIPJUI) mlH B OKpaLlleHHOM BUf(e.
npcnapaTbl U3 KpOBJ1 AJISI MHKpOCKOmU-l rOTOBHT 06h1'-IHO Ha npCJJ,MCTHLIX CTe-
KJ1aX, 0'1' UX KaIICCTBa U '-U1CTOThl B orpO !HOH CTenemJ 3aBUCUT 3<)J<)JCKTHBIIOCTb 06-
HapY)KCHUH U Uf(CHTH<)JuKau,HH KpoBcnapa3uToB.
CblBopoTKa U IIJIa3Ma KpOBU UCCJICgyCTCH TaK>Ke Ii ccpOJlorHIlecKux peaKL{UJlX C
L\CJ1bJO oOHapY)KCm1J1 npoTuB<mapa3UTapHbJX cnCu,u<)JwICCKUX aHTUTeJ1.
.
1.1. ManllpMMHble nna3MOAMM
MaJI5IpHMHLIC IIJla3MOp;IU-I - naH60nee UJl1pOKO pacnpoc-rpaHeHHble U HeU3MCHHO
n3TorCHHbiC npe,UcTaBl1TCJU1 Kp<.>BCnapa:mToB-npocreHIlU1x. MaTlSlpurmyJO IJH<)JCK-
QHIO Y IICIIOOCKa Bbl3bIBalOT 4 BJ1na pona Plasmodium: P.falciparum, P. vivax,
P.malariac 11 P.ovalc. nCpB61H BLl3blBaCT 3JIOKa I leCTBeHHO npOTeKafOlu,ylO TpOlIHIIC-
CKYJO MaJlSlPUfO, HCpCP;KO 3aKaH'-umalDlu.ylocSI JIC'I'aJILHO, OCT,U1bHble, COOTBCTCT-
nCHHO, 'JpCX)l,HCBHYID, 'lcTblpeX)l,HelmylO H olm.Jlc-MaJIHpUID, OTm1'IaIDIllHCC5I OTHO-
CUTeJIbHO p;06pOKaIJCC mCllHLIM Te I lcm1CM.
1.1.1. J)UOJlOzun MQ.JUlpUUHblX napaJUm08. MaJIHpUHHble nna3MO]J,IU-I napa3U-
mpYJOT nOO\lepCp;HO B ]J,BYX X03S1CB3X: B opram13MC C3MKU KO 13pa pO]J,a Anophcles,
B KOTopm,1 OCYII\CCTI3JIHCTCH nOJIOBOC pa3MHO>l<Cm1e, cnopOZOIlUR, U B opram13MC
IJeJ10nCK3 - 6ccnoJloc pa3MHO>KCHl1C, lUU30Z0IlUR. Ha\laJILH3H <)Ja3a IlU130rOHIU-I
npOUCXOP;HT B ne'-leHOIJllblX KIICTKax, renaTOL{UTaX (3K303pUTpOI..{I1TapHaJl 11U130ro-
m1H), IIOClICP;YJOlllaJl - B KpOBHHOM PYCJIe, n 3pn-rpOQl-tTax (3pl1TpmU1TapHaJl UJU30-
rOHl1H). Pa3BJmaJlCh B 3pJ.npOL{U'I'aX, nJ1a3MOp;IU-I mnalOTCH reMorJIo611HOM U pa3py-
maIO I' nOpa)KeHHble 3PUTPOQUTbl. Bce naTOJlOrI1l.iCCKUC npOSlBIICHUSI MaJIJlpHU (m1-
XOp O'-lHble npI1CTYIILI, aHCMUSI, CnJICHOMCnUUlJI, nOpa)KeHl1C I...(HC npu 'rponUIJC-
CKOM <)JOpMC MaJIHpUU) l.\Cm1KOM CBJl3aHbi C 3pJ..ITpOL{ln3pnOH UU130roHl1eH (3Ill).
1.1.2. Da6opamopHblu iJuazllo3 MaJlSlpm1 OCHOBLmaeTC Ha o6HapY>I<cmm R
npcnapaTe KpOnl1 6011bHoro J1106b1X CT I1H nJIa3MOj],I1CB, pa3RHRaIDIQI1XCSI B 3p11T-
poL{HTax: mpOfP030llm08 (MOlIOp;bIX 11 B3p0CJ1bIX), lUlt30Hm08 (He3peJ1bIX 11 3pC-
JII)IX), a TaK>KC nOJIOBblX <)JOPM, za.MenZOl(llnW8 (MY?KCKI1X 11 >KCHCKI1X). llpl1 3'1'OM
CJICAYCT Y\II1TbIB3Tb BmKHblC OTJ1H'-II1J1 3111 Y pa3JU1'-1l1bIX Bl1AOB IIJla3MOAI1ClJ.
1) Y P.falciparum I..{I1KJ1 31l1I1a\U1HaCTCJI B ncpl1<)Jcpl1 ICCKOM PycJ1e KpOBI1. 3a-
KaH'-IlmaCTCJI B l(eHmpa.llbHOM PYCJle, BCJ1CP;CTBI1C 3aJl,Cp>KKI1 nOpa>KeHHLIX 3pI1TpO-
L{I1TOB B Y3KHX Kam1J1JISIpaX BHYIPCHHI1X opraHoB (M03r, nJ1aL{eHTa 11 p;p.). no 3TOH
npl1'-1IIHC 13 HaIlane I1H<)JCKL{IU-I J1a60paHT B npenapaTax KpOBJ..I ml}.I1T TOJlbKO MOJIO-
Jl,blC Tpo(p030HThi (<<KOJIbQa»). raMCTOl..{l1TLI TaK>Ke C03pCBalOT B Kam1J1JIJlpax BHY-
TpCHHHX opraHOU H BIIcpRble BbInJ1blBalOT B nCpl1<)JepHl.iCCKOC PYCJ10 TOJIbKO C 10-
12 }..I.HH 60J1C3HH. 06HapY>KeHHC B ncpl1<)JcpWICCK0I1 KpOBI1 B3pOCJIbiX 1'pO<j)03011TOB
11J111 JIJOooro B03pacTa Llll130HTOR CRI-I)1eTCJIbCTnYCT 0 Ha\laJlC 3JIOK3'-ICCTBCHHoro
TCl.iCHI1S1 'I POIIWICCKOH MaJ1HpIU-l 11 6m13KOM J1CTaJ1bHOM I1CxoJl,e, CCJ1H JIe'-lalllI1M npa-
'-10M He 6Y1lYT npmUITLI IICOTJlO)KHbIC Mepbl. npl1 APyrl1x BI1AOBblX <)JopMax MaJ1H-
252 TOM II - 1.1ACTHbIE AHAJIMTI1l-lECKME TEXHOJIOrl1J1
pm.f 311I npOTCKaCT L{CJU1KOM B ncpml)Cp1-1'ICCKO!l.'1 PYCJ1c.
2) HCOl{CmIMOe A!fq>( epCHL{1-1aJlbHO- "arHOCnl'lccKoe JHa'ICHHC IIr-iCeT q>opt.-m
raMeTOll,HTOB y P.falciparum (pHc.lA) - OlUf He KpyrJ1blC, KaK y HPyrux m1 oB nJ1aJ-
MO.i{l-ICB, a npop,oJ1rOnaTblc (<<nOJ1YJ1YHHbIC», «6aHaHo-, COCHcK006paJHhlc»), Omf I
OTJ1I1'laIOTCJI TaK>KC I3blpa>KeHHblM OJlro)l<HTHCM: oTMHpalOT B TC'ICHHC 2-4-6 He-
ACJlb (y APyn1x BHI\OB nJ1a3MOAI1CI3 - B TC'ICHI1C 1-3 CyrOK). ITO:>TOMY oOHapY)l<clme
raMeTOI{I1TOB P.falciparnm B Te'leHHC MHOrl1X HCH nOCJIC H3J1C'ICHHJI 60J1bHOI"0
(T.C. npeKpaU\CHHJI 311I) 6J1aro,l.1.apJl ACHCTBHIO ImI30HTm{H HbIX npenapaTOI3 - JlB-
J1cmfC 06bl'lHoe, OHO He SlBJ1J1C'i'CSl nOKa3aTCJ1CM HC3<P( CKTHBHOCTH J1e'ICHl1J1.
3) lJ,HKJl 3111 nOBTOpJlCTCSI y P.fa1ciparum, P. vivax H P.ovalc Ka>KAbIC 48 \jaCOB,
y P.malariae - 72 Ilaca (3 CyrOK). MaJ1J1pI1HHIJle npHcTynbl HacrynalOT Ha TOIl cpa3e
L\HKJ1a 3ill, Kor)J,a OCHOBHaJl Macca nOpa)l(CHHblX 3plnpOl{HT0I3 paJpYlllaeTCSI H Bbl-
meAIllHC H3 HI1X AO'lepHHe oeo6H nJJa3MO,l.1.Hcn (Mep030HTbl) HHBa3HpYlOT CBC>KHC
KpaCHble KpOBJlHblC KneTKH, T.C. tlCpe3 Al3a 11.HSI Ha Tpe'mi'1 wm tlepC3 Tpl1 :I,1'ls-I Ha
tlCTBepTblH. B Me>KnpHcTynHoM (6C3JUfxopanO\IHOM) nepH01J,e B KpOBH npH BCCX
q>opMax MaJ1S1pHH KpOMC Tp01Uf'lCCKOH npe06naJ1alOT B3pOCJ1IJle TpO( OJm1Tbl H
UU130HTbl, TaK 'ITO TC HJ1H HllblC CTa]J,m1 mIa3MO HCB npllCYTCTBYWT B KpOBII no-
CTOJlHHO, nnJIOTb no n01lHoro npCKpaLl{CIU1J1 3ill. IT03TOMY paCXO>Kml peKOMCIIJ{a-
I{HSI «B3S1Tb KpOBb Ha BhlCOTC npHcTyna» OTpa)l(aeT JlHlllb npo( eCCI10IHUlbIlYIO HC-
rpaMOTHOCTb Me pa6arHl1Ka.
1.1.3. Memoobl uCCAe()(JlJUllflJl. BCJ\YLl{11M, a \IaCTO e1J,Hm::TBCHtll>IM MCTOfl.OM
1J.HarHOCT!IKH ManJlpl1U SlBJ1S1CTCSI napa3nT0J10nltICCK 1iL B OC06blX CJ1y t laSlx (HanpH-
MCp, npH Hc06xonm.,'IOCTI1 BblS1B1-1Tb 1J,OHopa, 3apa3HBlllcro MaJ1S1pHeH pC[{HnHcHTa)
npHMCHJllOTCH CCpOJIOrll\leCK!le MeT01J,bI (PI1cI>, I1<l>A).
npUIfl llIl napa31-1T0J10rH4CCKoro MeTo a '3aKmO t laCTCSI B MHKpocKomm npena-
paToB KpOBU - TOHKoro Ma3Ka 1-1 ToncToit KanJUI. OG-bCM UCCJIC11.yeMoII KpOBU BT01l-
CTOH KamlC B 20-40 pa3 60JlbWe, tleM B TOHKOM Ma3KC, B CB 3!f e '1l: 1 IIOJI0)l(HTCnb-
u u
HbUf OTBeT MO)l(HO J{ TL nOCJlC UCCJICAoBaHHJI Ma3Ka, a OTpm{i1TCJ1hHbUf - TOJlbKO
u -
nOCJ1e HCCJ1cJ{oBaHuSI TOJICTOH KallJ1U C HMMepcuoHHbIM OO"beKTHBOM U Te'leHHe MU-
mIMYM 5 f\UfHYT, C npOCMarpOM He MCHee 100 nOJlcH 3pCmlJ1 (CTaH1J.apT B03).
PeaKlrIlWbl II o6opyi'JoBal-we: CMeCL HUKm opoBa, KOMMCptlCCKl-lii MaTOtlHLIH H
pa60 t IHit pacTBop KpacKu POMaHoBcKoro-HIM3a, \U1CTble npC)(MCTHLIC CTCKJIa MOC-
u
THK HJUt KOHTCUHCP AJlJI oKpacKu C reKon, MHKpocKon.
npUWm06Jl.e1-lUe npcnapamo6 Kp06U - Ba>KHaSl npOl emrpa, npc onpC} CJ1SllOl..LI,a
3cpcpCKTHBHOCTb MUKpOCKOm1\leCKOH uarnocrJ.1KU MaJl pHU.
TOHKUU MU30K rOTOBJlT TaK:>Ke, KaK AJ1Si HCCJ1CAOBaHi-1S1 Mopcpononm 3pl-fTpOl H-
TOR (CM. CTp. 16).
TOJlcmaR Kan.n.R rOTOBUTCSI I1,BYMSI cnoc06ar-m: 1) K Kamle Kpoml Ha MCCTe npo-
KOJla (Ha naJlbl.{C, MO'IKC yxa) np!IKaCaIOTCJI npe1J.MenlblM CTeKnOM 1-1 KpyroBbIMu
1J,BU>KCmIJ1MH cro pacnpeAeJIHIOT KanJ110 o 1J.UaMCTpa 15-20 MM; I{encco06paJHO
HaHeCTU Ha npe MeTHoe CTCKJ10 2 Kannu, a TaK)I(C WTpHX KpOlU1 Me)l<AY HHMU AnSI
MapKupoBKU; 2) Ha npep;McTiloM CTCKJ1e rOTOBJlT I3Ha\I UIC Ma30K HCCKOJlhKO TOJIIUC
06bl t lHoro, 3aTCM, nOKa OH eLl{C He BblCOX, Ha Hero HaHOCSlT 1 HJ1U 2 Kannu KpOBl--f,
J<OTopble cnOHTaHHO pacTeKaloTCSI paRHoMcpHblMU nI1CKaMU. MapKHpYJOf npcna-
paT Ha CB0601J,HOM y....aCTKC Ma3Ka. BblCblxaTb TonCTblC KanJUI 1J. on )l<lIbl nOCTcneH-
lIO, 6e3 n01J.orpcna, B ycnoBuJlX 3aLl{I1Tbl HX Of nOBpC)KJ{eHHSi HaCCKOMbIMH.
.
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METOD,bl KJII1I-IJlP'IECKOI1 TIAPA3l1TOJIOrl1l1 253
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I
I
OKpaCKa /lpenapamr)8 KpOC3U npOBop;U"rc 3-5 % pa60 UfM paCTBopOM KpaCKH
Pot.faHOnCKoro-nU.13a. Pa3HbJe cepHH KOMMcpllecKHx Ma1'04UbJX pac1'Bopon KpaCKH
MorYT 3Ha IH1'CJ1LHO pa3JUI l la1'bCH 110 COACp:>KaHJHO a3ypa. I1cn0J1L3YIOT 2 cnoco6a
npoBcpK 1 cOACp:>KaHJ1H a3ypa: 1) np06HaH oKpacKa Ma3KOB U 1'OJ1C1'hIX Kane!Jb Ha
HpKOCTb BHwncBo-KpacHoro L(BeTa B I]:lpax J1CHKOI( 1TOB lum HApax MaTJHpHf1HLIX
napa3111'OB; 2)3KcrpaKL(IUI a3}'pa XJ10po( OpMOM HJ1H 3c)JHpOM: B np06 1pKY C 10 MJI
pa6o lcro pacTBopa KpacKH J{06aBmuoT 3 MIl XJIOp04>opMa HJH1 JcPHpa. co.uep:>KU-
Moe BCTpHXHBalOT U OTMc'mIDT U3MCHCHHC UBC1'a 3KCTpan1pYlOn cro SCU(CCTBa.
TIpH Hep;OCTa1'OlIHOH KOHl CUTp<lL m a3ypa, X1l0pQ( OpM (HJ1H 3cPHp) npHo6peTaID1'
CJ1a6hU1 cPJ10JICTOBO-p030BI.>IH USC1'. K TaKoH KpaCKe peKoMeHp;ye1'cH p;06aBHTb 3pe:"
J1YIO KpaCKY M3HcoHa H3 pac"lcTa 1-2 Kal1JU1 Ha 10 MJI. Pa60 l UfH pacmop Kpaqui
Pm,faHOBCKOro-n1M3a CJlCl YCT rOTOSHTh Ha 6YcPepHOH Bop;e C pH 7,2. AJ1S1 :noro
CMCWHualOT p;Ba OCHOBHblX paC1'Bopa c)JoccPa1'HblX COJ1CH:
1) NazHP04 6C3BOWlblH - 9,5 r Hd 1 J1 p;HCHlJ1mlpOBaHHof1 BOP;bl ( 1J1H NazHP04
KpHCTaJIJ1H ICCKHH - 23.7 I' Ha 1 J1 BOJl.bl) 2) KH 2 P0 4 - 9.07 r Ha 1 JI .uUCTimmlpO-
BaHHm1 BOJ LI. P"dCTBOpbl xpaHH1'OT]1.eJ1hHO U roTOBH1' 1t3 IH1X 6ycPcpuylO nOAY, CMC-
WHU<lH 73 MlI NazHP04 H 27 MJ1 KH 2 P0 4 C 900 MJ1 .n.HCH1J1Jl11pOnaHHoH BOnl.l. Pac-
TBOpbl cPoccPaTHhlx COJICH H 6Y( CPHYIO nofJ.Y xpaHH1' B nocyp;c C npHTCpTm1 np06-
KOH B 6bl1'OBOM X0J10)l.HIlhHHKC.
I1pOL(cgypy oKpacKH npOBOAH"l' U CTCKJIHHHLIX KIOUCTax (6a'IKax) C BepTHKaJIb-
H 1.>1 M...I I.HC3AaM.... lJ.JIH npeAMeTIfblX CTCKOJ1, a npH HX OTCYTCTBUC - Ha MOCTHKax 13
P;BYX napanJleJ1bHblX C1'eKJ1HHIILIX naTIOlICK, COCAJlHCHIILIX nonapHo pC3 1HOBbIMH
1'py6o l lKaMH. TOJ1CTble Kanml oKpauumalO1' B TClICHHe 15-30 MI1H, TOHK....e Ma3KH -
40-45 MUH. I1OCJ1e oKpacK.... npCnapaTl.>1 Tll(aTCJILHO npOMl.>lBalOTCH nop; CJ1a60H
C1'PYCH BOp;bl. I-IY:>KHO C06JIIOp;aTh OCTOpO:>KHOC1'b IIp 1 npoMbIBKC l'OJICThlX KaIlCJlI.,
TaK KaK npu nona)(aUm1 CWILHOH CTPYH BOJ I.>I Kanmf ""Ioryl' OTopuaTLCH 01' CTCKJ1a
J.f npCllapa1' npHp;eT B HeroAHOCTb.
1.1.4, flOpllOO" u qe.llu UCc./leOoBaIlUlI npelzapamoB "pOBU. TIp.... nepBoM 06-
CJ1Cp;OBamIH 60J1LHOrO, nO)l.03pJ1TCJ1hHOrO 11a MaTUlpmO, I'OroB T TOHKHH Ma30K 11
TOJICTYID KanJllO (J1Y'lllle 2 Kanmf Ha OCHOSC Ma3Ka). BHalJaTIC I1CCJ1ep;YIOT TOHKUf1
Ma30K, a 3aTeM rOJ1CTYIO KanJilO. J1MCCTCH 2 CP;I1HLIC UCJH1 J1 1 oco6aH, KaCalOll(aH-
CH 1'pOm1l[CCKOM cPOpMbJ Ma.nHpJ1l1. TIepuaH l(eJ1h - YCl'aHOHl-fTh ua.JH1'nte Ma.ilHpuif-
HLIX 1IJ1a3MOAJ1CU B npenapaT<lx. s1'opaSl - 1.ueH1'HcPJ1Kau."SI I1X p;o BI1p;a; oc06aH ueIlb
- onpCltCJlcH...fe ...fIITCIICHBHOCH1 napa:nfTCM nf.
061wPYJKeHlIe IlJla3.M.o()uel'l. TIpl1 BblCOKOH napa::mTeMHu HaJIUlU1C B036YP;HTCJ1H
ManHpJ1J1 A()C raTOllHO AOCTOBCpUO YCTaHflBmmacTcH npJ1 J1CCJ1C.il,Osamm TOHKoro
Ma3Ka. Op;HaKo U B :nOM CJ1)"lae L(eJ1ecoo6pa3HO HCCJ1eAOBa1'b 1'aK:>Ke TOJ1CT}'1O Ka-
I1J1IO. '-I ro MO:>KCT nOMollL 06HapY:>K 1Tb MJ1KCT-J1HcPCKUHID (CJ1Y'laH CC HCpCP;KH Y
acPP"'fKallltCn). YCTaIlOUJICHO, "rro J1CCJICAOI.mmfC 2 KallCJIL 13 TCllCHUC 2,5 MHH Ha Ka-
)KAYIO 6oJ1ce npOAYKTI1BHO, 'leM J1CCJ1Cp;OBaHHe OfJ.HOH B Te'lCHHC 5 MJ1H. TIpJ1 OTpJ1-
ua1'eJlbHOM pe3YJlbTaTe npOCfo.'IOTpa TOIiKoro Ma3Ka. HCCJlC)10UaH 1e TOJICTOff Kanm,t
CTaHOIn1 rCH a6C0J1IDTI'IO 06H3aTCJILHLIM. TIpocPcCCI.fOHaJU13M J1a60paHTa-MJ1Kpo-
CKOnl.fCTa B }lJ1arHOCTHKe MaJIHpm. onpeneJ1He1'CSI ero YMeHHeM J1CCneJ\OBaTh He
1'OHKJ11t Ma30K, a J1MCHHO TO..'ICTYID KanJllO. AOKa3aTeJILcTBOM Hamf l U1H MaJIHpm1Ho-
1'0 nJla3MO I1H CJIY:>KI1T HaxoAKa .ua:>KC 0]\1'101'0 lIapa3UTa Ha 11I060H C raJ.{ m pa3UI1THH.
OfJ.HaKO, CJ1e.n.ye1' C OCTOpO:>KHOCTblO OTHOC....TbCSI K HaXO]J.KC e)1IUICTBCHHoro 06pa-
30ualHlH, nOXO:>Kcro Ha KOJlbL(eBJ1p;IIOrO TpOcPo30l11'a 13 TOJ1CTOfl Kal1J1C, TaK KaK
BHCmHl-21t UHfJ. :=JTOH CTa,'"(UI1 lIapa3lf1'a MO:>Ke1' 61.I1'b cl'fMymfpoRall CJ1Y l JaHI1bIM COlle-
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254 TOM 11- '4ACTHbIE AHAJU1TI1'-IECKI1E TEXHOJIOrl111
TaHHCM nOCTopoHHCro a3YP- 1 303 1HOcpHnbHOrO MaTCpUa.na. npH MancihllCM CO-
MHCH 1I1 KpOBb nm.( 1eHTa p,OJ1)KHa 6blTb B3S1Ta H HCCneAoBaHa nOBTOpnO.
BUOOBa.R UOeHnJUlpUKGl{UR IlAa3.\WOUeO 06J13a1'enbHa, a B CJ1Y'lac P.falciparum
a6coJUOTno He06xOA 1Ma. Mopcponorml nna3MOAHCB pa3.'lH'lHbIX BHAOB B TOHKOM
Ma3Ke (B TaKOM npenapaTe HX eCTCCTBCHllaSi cpopMa npaKTH'ICCKH nOJ1HOCTblO CO-
xpaHCHa) It B TOnCTOH KanJle (cpopMa pe3KO UMeHeHa B npOl\eCCe AerCMOrJlo5HIfH-
3a1 HH npH OKpaCKC Hc4>HKCHpOBaHHOH npOOLI KpOBU) npeACTaBJlClla I-Ia pl1c.l A, E,
B. r. B npaKTH'IeCKOH pa60Tc MO>l<HO n0J1b30BaTb TaK:>I<C onpeAemneJleM, pa3pa-
60TaHHbJM A.E.EemleBbJM.
OnpeAenMTenb B036YAMTeneM ManRpMM* I
a) B TOHKOM Ma3KC;
1. 06pa30BaHHe, ne>Kall\CC Ha cpoHe 3pHTpol.( 1Ta, C OAHH!\'! Hnl1 HeCKOJIbKHMn
»ApaMH p030HOro. mllIlHeBOrO HnH py6mmHoro L(BeTa, C IJ,HTOnna3MoH r0J1y60ro
mm CHHero L(BeTa Plasmodium spp.
2. I1MCIOTC» 1'onbKO KOJ1bL(CBHAHI>IC Tpocp03m1Tbl (KOJlbl a) H (Hnn) nonynYH-
HLIC ra!\'feTOL( 1Tbl P.falciparum
-I1MeIOTC» TaK:>I<e 60J1ee KpynHble TpO( 030HTbl H (HnH) WH30HTbJ 3
3. nOpa>l<eHHble 3p 1TpOLU1Tbl TaKoro >Ke HnH MeHbllIcro J\HaMeTpa, 'leM HCI10-
pa>l<eHHble. 3CpHJ1CTOCTb OTCYTCTBYCT. Tpmp030l1Tbi KOMnaKTHblC
P.malariae
- DOpa>l<eHHbJe 3pHTpOl.(H1'bl YBCJ1H'IeHbl, HMeeTC» 3CpHHCTOC1'b 4
4. 3epHl1cToCTb MenKa» 11 O'leHb 06HnbHaSi. TpOcp030HTbi 06bl'UlO C »CHoBblpa-
>l<CHHbIMH nceBJ\on0Jl,H»MH. 51Apa OTHOCHTcnbHO MCJIKHC P.vivax
- 3epHHcToC'1 b OTHOCH1'eJ1bHO KpynllaSl H pe]J;Ka». Tpmpo30uThi KOMnaKTUble.
}{npa KpynHble P.ovale
6) B TOJICTOlf KaIlJIC:
1. 06pa30BaHHc Mcnb'le CCfMCHTOSIAcpHoro JleHKOl.(HTa, HMelOll\Ce OAHO mIH
HeCKOJ1bKO »Aep (06hl'lHO p030Boro, BHlUHelJQrO HnH py6HHoBoro I'BeTa) n L1,HTO-
nJ1a3MY (06bl'IHO rOJly601'o Hmf CHHero L(BeTa) Plasmodium spp.
2. I1MCIOTC» TOnbKO KOJ1bIJ,CBHAHble TpmJ)mOHTbl (KOJlhl,a) H (HJlH) nOJIYJlYH-
Hhle raMeTOLtHTbl P.falciparum
-I1MeIOTcSI 1'aK>Ke 60J1ee KpYIIHble TpOcp030HTbi H (mm) IIUf30H1'bi 3
3. TpocpmoHTbl HenpaHHnbHoH cpOpMbl 11 'laCTO pa30pBaHbi Ha MCnKI1C cppar-
MeHTbl. '-faCTO npHcYTcTBYlOT OCTaTKH nOpa>l<CHHblX 3pHTpOl.\HTOB p03oBoro I.\BeTa
P .vivax
- TpOcp030HTbi KOMnaKTHblC H HlIKorAa He pa3pbmalOTCSI Ha MeJ1KHC cppar-
MCHTbl 4
4. 06bl'lIlO HMelO1'CSI OCTaTKH nOpa>l<ellHblX 3pHTpOl.lHTOB p<130BOro L(BeTa. 51A-
pa Kpymlble P.ovale
- OCTaTKOB nOpa:>l<CllllblX 3pWrpOlJ,HTOB HC Ha6J11OJ\aeTCSI. 51Apa McnKHe
P.malariae
>+ OnpeAeJUtTem, nOCTpOCH no npMHlJ,l1l1Y 06bl'IHLIX 6110J10rWleCKI1X onpCll.CJ1I1TCJleiL ABa
yrncp>KJJ.CtnUI, oO'beAuHcHHhlC n OAHOM nYHKTe, B3311MHO JlCKnlO'J(UOT JlPYI" llPyr3. ,lJ,.:UI no-
cT3HonKI1 AuarH03a CHa'IaIl3 pemaIDT, HnIlHCTC)I Ill11l3HHoe 06pa30naul1C:: M3J1)1p"i'IHbIM napa-
311TOM (nYHKT I). npl1 n0J10>KItTeIlbHOM pCmClIl1H nepexoAHT K nYHKTy 211 Bbl611pmuT OAHO
1131l.BYX yrnep>KACHI1i1. ECIlI1 B KOHLle Bbl6p3HHoro yrnCp>KJJ.eHI1H CTOUT H33n3HI1C BMA3 - 3"1'0
-
1
METOAbI KJII1HI14ECK0I1 TIAP A3I1TOJI OrI1I1
255
H CCTI> IfCKOMbIf1 HlfarH03. eCIlt l\Hcppa - 31'0 YKa3aHJte, K KaKOMY nYHKTY onpCAC.lUlTCnH
cne]J.yeT nepei'lnl. npOl.tccc nOBTOpSIIOT, nOKa He AoilA)'T 11.0 Ha3BtUUlSI BHJ1.a.
UpIIMc..aHHe: npll peAKO Rcrpe'laJO ellcSl y mOAd'! a POCCHH npar03mfHo i l1H(I)eKI m1
300HO:JHOI"O npOHCXO}KACIUlSI. 6116c..Jl103C, a npenapaTax KpoaH 06I1apY}KHBaIOTCSI l!Hyrpl1-
3pIlTpOl\ ITapHblC napa3 1Thl CXOAHble no CBOCll cpOpMC C KO.fJbl\CHlIl\HbIMU rpo<pU301lTaMIf
P.falciparum. Ba}KHaSi UTmf'HtTCnbHaSi 'lepTa GaGe3 lo3a - 3auunCBaH1IC pa3BHaacTCSI TOnbKO
Y mu{ C ynaJ1eHHolI ceJle'jellKoit
Onpe()C//.CHlle lIHmeHC1l6HOcmll flll/Jl13UmeMUU £Ipl1 06HapY)I(eHI1M P.falciparum
- 'lpe3Bbl'lafIH0 Ba)l(UaH I1UCPOpM.iI..{UH .QnH JIe'law.ero BpaLIa npl1 Hhl60pc 11M raKTM-
KM Jle'ICIIMH, OL{CHKe ero 3<p<peKH1BI-IOC 1'11, a TaK)I(C nporH03a 3a60JIeBaHUH. AOCTa-
1'0'11I0 TO'IHbIM MeTOA CBO]J.HTI.CH K nOAC'ICTY CpCjIHerO LIMCJla napa:mTOB Ha 0NIO
none 3pel-UUI TOllCTOM KaIIJI"- ECJ1M napa3lfTOB /'.11101'0, TO IIO).1.C'ICT HCAYT B 10 n.3p.,
CCJIM MaJIO B 100. 4nCJICUI-IOCTb YKa3bIBafOT OT eJIbI-lO 1{!JH oonapY)I(CHl-lblX CT").1.m)
napa3MTa, HanplfMep, P.falciparum KOJIhL{a +++, raMeTOL{MTbI +. TIpMMel-lMTeJIhl-lO K
'IMCJ1eHHOCTM KOnCL{ B03 peKoMeHAoBaHbl C.TJenYlOlI\HC CMMlionLI:
1-10 H 100 n.3p. = +
1-10 B 10 n.3p. = ++
I-lOB £I.3p. = +++
60JICC 10 B n.3p. = ++++
60J1ee 100 B n.3p. = +++++
Jla6opal-lTbi C BbICOKMM ypOBHCM nOl\rOTOI3KM £IpHMcHHfOT GoJ1ee TOLlHbl1i Me-
1'011., d MMeI-lHO, nOACLIHTbmmOT 'IHClJCHHOCTb napa3MToB no OTHOllleHUI{) K \.IHCJIY
JICIiKOLl.HTOU. lIanpHMep. B TOJILiOM KanJIC lIa 100 nCI1KOL{HTOH HaMAeHo 20 napa:m-
TOB. AonycKaSl, '11'0 Y 6oJlbI-lOl'(> 4(x)() JIeMKOL{HTOB B 1 MKJl KpOBH, JlCrKO yc raUOHM I'L:
B MCCJIeAOBaI-IHhIX nOJIHX :ipeHMSI - 100 J1el1K0Ll.IITOB H20 napa3HToli
B 1 MKJI I1MeeTCH 4000 neHKOI\liTOB 11 X napa3H rlm
CncAOBaTeJIbHO, B 1 MKJI: 4oo0x201l00=800 napa3MTOB. TIoAcLleT 6YJl.CT ell\e
60nee 1'0'11-11.11.1, CCJ1M B <P0PMYJIY BBeCTM KOHKpCTHOC. a IIC £IpcAl10nO)l(HTC_1bl-loe
tlMCJIO JIeHKOl !1TOI3 Y AaHHOI'O £IaL{HeHTa. npM OLleHb Bb)COKOl1 napa311TeMMI1 ec MH-
TCIICMI3HOCTb MO)l(CT 6bJTb oxapaKTep!130l3alla tlMCJJOM napa3MTOB Ha 100 3pMTpO-
L{HTOB, nOAC4HTal-ll-iLIX 13 TOI-IKOM Ma3Ke.
1.1.5. l.J,e!JjeK1nbl npUWmOB.IlellUR U oKpacKu npenapa1nOO KpOOU U cnoco6bl
ux' ycmpalleHuR:
1) OTpbIB TOJICTOrl KanJl!1 0'1' HpC).\McTHoro CTeKna MO)l(CT np0l13011TM 11.0 OKpa-
CKU (KaIlJISI 6LIJ1<1 CJIHIllKOM TOJICTOrl) HJlH HO BpeMS! IIPO\1bIBKH CTCKJla HOCllC OK-
paCKM (CTPYH BOAbl 6bUla OLICIIL CHJILHOi'I). D,c<peKT HeYCTpm-lH1.1. 06Cne)10BaHHe na-
L{HCHTa Ha1l.JlC)I(MT nOBTopHTb.
2) TOJICTdH KanJISI 3a<pMKcnpoBanacb H3-3a 6!IH30CTI1 lIapOI3 clIHpTa I11IH OI'HSI.
JJ.ecpeKT l-IeYC1'pallHM, IIpcnapaT C!JCAyeT npuroTOBuTb 3aHOBO.
3) OKpameHl-lble Ma30K M TOJICTasl KanJISI MMCIOT 6JIeJI,HO-rony60H MJIM 3eJ1eHO-
BaTb)lf I\BCl'. TIpHLIHl-la: I-ICKa'ICCTBeHHaSi KpaCKa 111111 paCTBOp ee rOTOnJfJICSI Ha II C-
.'10'IHOM BOAe (pMc.2). AecpeKT HCnpa13l1M: npcnapaTLI £IorpY)I(alOT B 96° cnMpT .11.0
nOJ1HorO o6eCI Be1.IHBaIlHSI Ii 3aTCM oKpallllwalOT KatlCCTBeHHoi'l KpacKoM KaK <pMK-
Cl1pOBat-ll-lble TOUKHC Ma3KH.
4) B npcnapaTe 06HapY)l(HBmoTcSI 6aKTepHH, rpu6LI, paCTHTCJILHLIC KJlCTKI-L
01-1I-1 Mory I' HonaCTb H3 IIpcnap3T M3 3arpH3HeHHOri BOJ1.b) MJ1H H3 B03AYxa 1'1 CJ1M}'JIU-
256 TOM II - 1..J:ACTIIbIE AHAJII1TI11..J:ECKI1E TEXHOnOrl111
pOBaTb pa3JU1'4HbIe CTa]J,IU1 pa3BI1TI1S1 nJla3MOAHCB (pl1c.3). I1HOrJJ,a np"XOf\HTCH HC-
CJ1Cf\OBaTb APyrofl npcnapaT, I1CnOJlb3YH AJUi pa3I1CJ(CHI1S1 KpaCKI1 \.IMCTYIO BO Y.
npHMe"laHHe: nOJlO>KHTe.IJbHbIC np lIapaTbl HeoOXO}\IiMO xpaHIITb W1S1 B03MO>KIIOrO KOH-
TpOJlSl 3Kcnep-roM npam!JIbHOCTIi .QHarIlOCTI1KH, a TaK>Ke B u.enSix HcnOJlb30naHIISI HX n .QaJIb-
HCHll1 M AJISI Y'leOHbIX J\eJTeH.
1.2. TpMnaHocoMbl
Trypanosoma gambicnse 11 T.rhodcsicnsc BblJblBalOT, COOTUCTCTUCHHO, aHTpo-
nOB03HYK) H 300H03HYIO cpOpMbI mppl1KaHCKOro TPimaltOCOM03a 11J111 COnlWU 60-
.IIe311U. MeTo bI HX J1a60paT()pHOH f\HarHOL'T11KH BCCbMa HcnpocTblC, 110 \.lpC3Bhl-
\.mflHO Ba>KHbl, TaK KaK Ubl3bIBaCMLlC I1MH I1l1cpCKI I1H nOTcHu.HaJlbHO J1CTaJlbHLI.
1.2.1. Buo.llozUJI napa3umoB. TpmIaHOCOMbl - >KrYU1KOBhIC npoc1'cflllJl1C, pa3-
Bl1BafOTCSI noo'4epe}\BO B ABYX x03HCBax: MYXC U.c-u.c (ncpcHoc\.IHK) H opramnMc
QCJ10BeKa UJ1H )1HKHX >KHBOTHLIX, 06uTalolll.l1X B AcppHKC. no cpOpMC OHH Kpal-IHC
nOJIHMopcpHbl, pa3Mephi K0J1c6J1IOTCH B npCACJ1aX 14-33 x 1,5-3,5 MKM. T.gambicnsc
H T.rhodesicnsc MHKpOCKOIIH\.ICCKI1 HC pa3JlI1\.II1Mhl. OCHOBHblC 3nCMCHTbI CTpOC-
HI1S!.: TCJlO YAJIHIfCUUOC, HJtpO no CCpCAHHC, B 3i1,D,HCM tJaCTH HaXOl\HTCH Hc60.'1hIllOH
KHHCTOnJ1aL'T. HAOJ1b KJ1CTKH paCnOJIO>KCHa YHAymfpylOlilaSl MCM6paHa. nepcJ].I-ISlS!.
\.laCTb KOTOpOH 3aKau t lHBaCTCSI >KrYTHKOM.
Ha MCCfC YKyca MYXH IlC-I e TpHnmlOCOMbi pa3MHO>KaIOTCSI, 06pa3ycTcSI Tpl1na-
HOCOMHhlM lllaHKp, OTCK) a no JlI1McpaTl1'lCCKI1M H KpOBCHOCHhlM cOCYAa\1 napa:nrr
pa3UOCI1TCS!. no opraHaM 11 TKaHSlM, nopa>KaSl B OCHOBIIOM P3C U l HC.
Tpl1l1aHOCOMhl 06111'aK)T B nJla3MC KpOBI1 (H PyrHx 6f1OJIorWICCKUX >KH,I\KO-
CTSlX), B KJ1eTKH HC npOHI1KalO1'.
1.2.2. J1a60pamop"blu ouazll03 OCHOBbmaCTCSI Ha MHKpocKomm KpOBH, a TaK-
>Ke aCIIHpaToB J1HMcpaTH\.lccKI1X Y3J10B (CM. pa3 eJl 4), KOCTHoro M03ra (CM. pa3 CJ1
2), CM)I( (CM. pa3ACJ1 3). B cncu.l1aJlH3HporJaHHhlX na60paTOpHSlx npOB{) Sl1'CSI 6Ho-
np06bl Ha >KHBOTHbIX H npHMeHSlIOTCSI HMMYHOJlOrH'4CCKI1C MCTOfJ.bl.
1.2.3. Memoobl uCCAeooBauuR KpOBU OCHOBblBafOTCSI. Ha 06HapY>KcnHI1 B OK-
palUcHHblX no POMaHoBcKoMY npcnapaTax KpOBH TPHnaHocoM. napa311Tbl HaXO S!.T-
CSI B KpOBI-! Ha paJ-IHCM CTa,r:J.ltH HHcpCKU.I1H. 113-3a 06Ll t IHO IIH3KOH napa:UfTeMHI1 3cp-
cpeKTHBHoCTb HCCJ1C)J.OBaHHSI TOI-IKOrO Ma3Ka HnH TOJ1CTOi1 KanJ1H HeAoCTaTO\.IHO BI>I-
COKa H 1I0TOMY peKoMcH YIOTCSI MC1'OAbi KOHu.cHTPau.HH napa3H1'on.
MUKpozeMamoKpllmH1Jll1 Mcmoo KOHu.cHTpau.mf TpHnaHocoM HCCJlO>KCH H AOC-
TyncH B HCnOJIHCHHH. Heo6xo)1HMO HMCTb Kanl-!J1flSlpHYK) Tpy6KY, MHKporeMa1'oK-
PHTHYIO U.CHTpHcpyry, 2% paCl"BOp HaTpHSI nHMOHHoKHcnoro, KJICMKYIO JICHT)' H
nJIac fHJ1HH. 113 nanhl a nocne npOKOJ1a HaHOCS!.T 2 KaJlJlH KpOHI-! lIa npcf\Mc1'HOC CTC-
KJIO H npH6aBJlSllOT B Ka>K Ylo 110 1 KanJiC pac"mopa ilHMOHHOKUCJ10I'O HaTpHS!.. ne-
pCMellll-!BalOT H HanOJlJ-ISlI01' Ita 3/4 KanHJ1J1HpHYIO Tpy6KY. OTKpblT61H KOHel\ Tpy6-
KH 3aKpbIBaK)1' nJ1aC1'HJ1I1HOM, U.CHTpHcpYI'HPYIOT B MHKporc mToKpH1'HOi1 U.CHTPH-
cpyrc B TctleHHC 4 MHH. KJIaA)'T Tpy6KY Ha npeAMeTHoe CTCKJIO 11 3aKpCIIJISl.IOT ec
JlHnKOH JleH1'oM. no ManblM YBCJlI1 ICIIHCM MI-1KpOCKona (lOx) HCCJICAYIOT Y\.IaC I'OK
MC>KAY 3pwrpou.H1'aMH H nJ1a3MOM. AJ1S1 nytllllero pacllo311auaHHSI MCJlKHX H3BHnalO-
U\HXCSI 06"beKTOB I1CnOJIb3YlOT AJlHHIIOcpOKYCHhlH 06l>CKTHB 25x.
1.2.4. Hoell1nU,pUKaijUH mpunalloco.!tl fJ.0 BI1]:t,a. HC B03MO>KHa, AOCTaTO\.mo y6c-
AH1'bCSI B TOM. \.11'0 Ii OKpalllCHHblX npcnapaTax cpeAM 3PHTPOl\HTOB BHf\Hhl xapaK-
MI::TOJ{bI KJIJ1HJ11.IECKOM IlAPA3MTOJI0rJ.111 257
TepHble no QJOPMC 11 AJII1He, a TaK>Ke no pa3Mcpy KHHCTonnaCTa >KrYTI1KOBble o6pa-
30BaHHSI - TpHnaHOCOMl>1 (pJ1c.4).
I
1.3. neMwMoHMM
JIel-IWMaHHI1 - rpynna }l(rYTI1KOBbIX npOCTCHlIH1X. BhI31>IBalQw. tX pa:mH IHble
QJOPMhl Jlci'tWMaHH030B. B KpOlJl1 Mory r oUHapY)KHBaTI>CSI TOJIbKO BI1CI epOTpon-
HI>IC Jlel-IWMaHUH, B036YJ I1TCJII1 I3HCL{epaJIbHblX JIei'nuMmm030B. HaH60JIcc 'laCTO
3an03HMhli't 13 P<l> napa:nlT 3TOH rpynl1b1 - Leishmania infantum, pacnpOCTpal-leH He
TOJJLKO H cTpaHax l1.aJIbllCrO :mpyuc}I(I>SI «()paHL{I1S1. J1cnamtSl, nopTyraJll1S1, Jtha-
nHSI). HO raK>KC H IO}I(HblX pecny6mfKax CH r (TaJ1.}I(HKUCTau, TypKMt:HI1S1, Y36eKH-
CTaH, Ka3aXCTaH, rpY311S1, A3Cp6aHA>KaH). Cpel1.H3CMHOMOpCKO-cpCHllca:maTcKuH
(l1.e rCKIU1) I3I1CL{epaJIbHbn1 JIeHIIIMaUH03 - TSI>KCJI<UI IIPUro:JOHU<tSl HHQJeKL{HSI. 3aKau-
'umaJOw.aSlcSI 6e3 JIC'ICIII1H CMCpTCJIbHLIM HCXOJ],OM.
1.3.1. EUO.flOllln Bo,16yolllne.ruf. L.infantum napa311Tl1pyeT IIOO'ICpL'.ltiO U :lUYX
X03S1eBax - MOcKHTc-ncpeHoctIHKe, n KOTOpOM npoHcxoJllIT 6CCIIOJIOC pa3MHO>KC-
HHe. H B opraHH3Mc UJaK,Ula, JHfCUL{bl J1.IHI 'le.10BeKa, Bbl3bIBaSi rCIICpcUU1JOUaIlHhli'1
peTI1KYJIOrHCTHOL{HT03. B MOCKI1TC Jlciiwt\1aHI1S1 npeACTaBJleHa >KrYTI1KoBoll cpop-
M0I1 (npOf\faCTI1I"OTa). B KJIeTKaX P3C OHa 6e3}1(rYTUKOBaSi (a 1aCTI1I"(}"ra), AMaC-nt-
rOTa HMccr OB<HlbHYJO Hnl1 KpyrJIYlo QJOPMY pa3McpOM 3-5 x 1-3 MKM C Kpyr.'IbJM
HJ pOM pa3MepOM 0,7-0,8 MKM. B L{11TOJJJJa3 1C MO)KHO BH).\eTb KI1HeTOnJIaCT oKpyr-
JIOH HJ1I1 naJIO'-IKOBI1JumH 4JOpMbJ. JIel-IWMaHIIH - BHYTplfKJIeTO'UlbIC napa3l1Tbl, pa3-
\1HO>KafOTCSI npOCTblM AeJIeHl1eM.
Ha MCCTC YKyca MOCKIfTa c1J0pMIfPYCTCH nOCnaJII1TCJIbHbli'l6yropoK, 1f3 KOTOpO-
1'0 pa3MHO>KIII3WHCCSI JJCMWMHHI1I1 pa3HOCSITCH 3aTCM no oprauaM 11 TKaHSlM, JIOKa-
JI113YSlCL B cene3eHKe. KOCTHOM M03I'C 11 "POBH. Y 60JIbWI1HCTBa HHQJHL{l1pOBaf-IHhIX
B3pOC.'IbJX nel1Wtrfaf-II1HHaSi HHQJeKI I1S1 npOTeKaeT 6eCCIIMIlTm1HO. BI1CI CpaJlbHblrl
JICHWMaHI103 (BJI) KaK 60nC3f1h pa3BI1BaeTCSI Y AeTeH Mn wero B03paCTa C ue o-
CTaTO'IHO cQJOp tI1pOBaBWHMcSI I1JI1I cynpeccl1ponauflhlM I1MMYIIUTCTOM.
1.3.2. Jla6opamop"blu oualllO.l OCflOBhlBaeTCSI ua oOHapY>Kemm aMaCTlirOT B
nYHKTaTe JIHMcpaTI1 leCKl1x Y3J10U (CM. p(3).\eJI 4). ce.lJe3eHKI1 I1JII1 tlaw.e - acnHpClTe
KOCTHOro M03ra (CM. pa3 en 2). J13-3a cJIa6011 napa311TeMI111 Leishmania infanlum
B "POBH 06HapY>KUTL TPYAHO: C 60JlblUliM nOCTOSlHCTBOM OHI1 BhlSlBJUIIOTCSI B KpO-
1U1 BJ.1Y-I-fHQJI1L{I1POHaJ-IHhIX, lIa 4JOHC H 1MYfIO cQJI1L{HTa. npuMewuoTcH TClK)KC
KynbTypaJIhflhlH 11 U 1MYHo.'Ionl'lecKHjl MeTOAbl Jl.l1artIOCTltKI1.
1.3.3. Memoobl UCC.lJe006allun KpOBlJ. Ilpn HCI!03MO>KHOCTI1 nOJIy mTh aCIIH-
.... - .........
paT KOC moro M03ra, a.'JbTepHaTI1IUlbll1 I\'ICTOH ouuapY>KCIII1H JICIIWM<.HII1I1 - I1CCJIC-
AOl3aHl1e npenapaTOB KpOBI1.
nrrOBSIT 11 OKpaJUlmmOT roHKI1i"1 Ma30K H TOJ1CTYfO KanJIfO KpOBIi raK>Ke, KaK
Olll1CaUO B pa3 eJIe 1.1.3. J.1cCJICJ1.0BaHl1e 3T11X npenapaToB n03BOJISICT BLISlBHTb
net'IIIIMaHI1t'1 13 50% CJIY'laeB KO-mICI)eKI 1H1 BJ1/CnJ.1H.
npIIMC'IaHlle: EycpepllaSi Ro,na nJ1 np lrOTOB.I1eHIISI pa6o ' lcro paC"II30pa I<paCI<II POl\ta-
HOBCI<Om-nIM3C\ I OJ1)KHa I1MCTh pH 6.8 (He 7,2. KaK npn Ol<paCKC Ma.'1S1puifIlLIX nmnMo ncB).
npOBOllSiT np0L{c yPY JIel-IKOI I1TOKOIH(CIiTpaL{HH (CM. pa3J.(CJI 2.3.1.) I1I1CCJlCHY-
lOT OKpaJueHHblH npenapaT H3 JIeHKOI I1THOrf nJleHKU. 3cl)4JCKTI1BHOCTh no KO-I1I-1-
4J C Kl.I,HI1 BJI/CnJ1J], - 70-75%. MCTOA ocTyneH 11 n03BOJISIeT nonytlHTh OTBeT AO-
CTaTOlllfO 6LICTpO.
258 TOM II - YACTHbIE AHAJlHTJ1l.IECKJ1E TEXHOnOfJ1J1
.
1.3.4. l1oeIlI1lUgJUlWllllll./Jeiiw.,uulluii. npenapaTbl MCCnC}J.YfOT nOA l1MMepCM-
cti, _'IeMWMaJ-nm U IIMX pacnO]]armOTCH 06bl ' IHO Bile K]]CTOK, HO lIepcp,KO OHM 06Ha-
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capKOLlllCTa Obl'1bSl
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capKOLl tCTa COHHaH
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J1eHTeLlllJl1pOKHH
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OCTpHLla
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lleneHb KapmtKOOblfl
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nap8roHuM
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KplO'ILHMH - CB IHOI1. 6e3 KplOLlheB - 6hI L UIt't, C }J,BYMSlIl(C.IlSlMH (6m pHHMI1) - JleHTeu,
WUPOKUt'1.
5.1.2. I\-leTo OTCTaJtBallltJl
1) ct>CKaJlHl1 nOMCll(aIOT 13 UHJlI1HAP H 3aJumalOT 3-4 06-hef\taMH 130]\1.1.
2) fICpCMCWIfI3aIOT AO 06pa30BaHuSi rmlOreHHoii cycncH311H U ]lalOT OTCTOSlTL-
CSI 10-15 MHHYT.
3) Ha:\oca o'IHhIH C.llon >KH]1KOCTH C.1UBaIOT.
4) K oCaJ1.KY BHOBb jJ,06aB.'1S1IOT 3-4 061>CMa BOAhI. nCpCMCillI1BalOT, ,QalOT OTCTO-
HTbCSI.
5) K OCaJl.KY BHOBh IJ,06aB.'1HIOT 3-4 061>el\-Ia BO)1hl.
6) nCpCMCW 1BmOT I O 06pa30BaHHSI roMoreHHoi't cycneH3HU H AalOT OTCTOHTh-
CSI 10-15 MI1HYT.
7) 3aTeM BHOBL nOBTopSiIOT onepaUI1J1, YKa3aHHhie 13 nn.3-5.
8) ,IJ,aJlhHcHUJee HCCJ1e]10BaUHe TpeXKpaTHO Ol'MLITOro OCaJ.I.Ka npOBO.QHThCSI no
MeTO.QY OTMYLIHBaHHSI.
TIpH MaKpOCKonHLleCKOM HCCJle OBaHI1I1 MorYT 6hlTh o6HapY)I(eHhl re.'lbMHHTI,I,
nepeLmc.lleHHhle 13 pa3}J,CJIC 5.1.1, a TaK)I(C KpOBHHHCTO-C.IlH3I1CTLIC MaCChi - B£l>KHOe
YKa3aHI1C Ha BepOSITHoe Ha.rm IHe y 60HhHoro aMe6Horo Sl3Heltl"lOrO KOJIHT£l. B
3TI1X CJIYllaSiX MaTCpl1aJl IIO.QJIe)l(HT nepBOO lepC].l,HOMY MI1KpOCKonH L reCKOMY "C-
CJle)10RaH"IO.
5.2. MIfKpOCKOUlf'leCKlfe MeTO;\bl HCc.leJl,oualllUI
)l.uantOCTH'1CCKHC C ra.!.IJU1 napa3HTOJIOrJ1'reCKHX 06"beKTOB MorYT 6hlTh 06Hapy-
>KeHhl MHKpOCKOnl1 L leCKH 13 IwmU6I1o.t, ...ta,J"e, npHroTOBJlCUHOM "3 cpCKaJlH t per
se. OAHaKO Lmw.c npOUhl cpeKaJlHH npeABapI1Te.'1hHO "06pa6aThlBaIOTCSI" C l(eJlhlO
r
...
METOJ],bl KJU1HI1QECK0l1 nAPA3I1TOJIOrI1I1 267
I
OKpaCKH HJlH KOHL CIlTpaLlHH B HHX napa3HTOJlOrH'-leCKI1X 06"beKTOn H npHfOTOnJIe-
HHf! npenapaTon TLJIf! MHKpocKonHH H3 06orall eHHOr1 IaCTH npo6. Cnoco6hI npHI'o-
rOnJleHIUI npenapaToB Jl.Jlf! I1apa311ToJ]onl lecKoro HCCJleAOl3allHSI cYll{eCTneHHo pa3-
JlH'IaIOTCSI B 3ctnHCI1MOCTH OT l{eJlci'I aHaJlH3a, HCKOTOphlC H3 HHX IIpHMemnoTcSI AJISI
,..
oOllapY>KCHIIS1 JlHWh onpeJl.eJleHHoro BI1Aa napa311Ta, l1Pyrl1c SIRJlSIIOTCSl 01I.HHaKOno
npl-lrOAULIMH AJ1SI o6HapY>KCHI1SI pa3Hblx CT<UJ,l1l1 11 Rli,QOB napa3HTOIi. COBpcMeimaSI
napa3HTOJIOrH\IeCKaSi Ci-,.ryaL ml B pcI> XapaKTepl-13YCTCSl p J\OM OCOGCllHOCTcit lIa-
KJlaj.\l>lBalOll{HX 3aMeTHblli OTne'IaTOK Ha pa60TY Al1uruocn1'ICCKI1X JlaOOpaTOpI1H.
nCpBaSI - IIpH nce Cll C lUHpOKOM pacnpocTpaHclUlH KI1WC lHhIX nupa311T030U npo-
1130WJIO nOBCCMCCTHoe CHI1>KCHHC IlIITCHCHI3l10CTH HH<PCK1\Hll/HHna3HH. 3 ro 06CTO-
HTCJlhC1'BO rpc6ye1' "pHMcueHlul MaKCHMaJlhHO 3 )cPCKTHBHbIX MeTOAon I-iCCJIC}J.O-
BaHHSI np06 (l)eKi.uIHH. BTopaH OC06CHHOCTb - B03paCTafOll aSI \IaCTOTa 3aBo:m napa-
3H1'OD KI11lle l lHI1Ka H3 pa3BI1BalOLU.l1XCSl CTpaH A3HI1 H A(I>pHKH KaK HHocTpallL aMI1,
raK 11 pOCCI1S1Ha\m. TpeThSI OC06CHHOCTI> - B03paCTalOLLl.CC 3Ha'IcmlC n nan)JIOrHH
MHOrltX !11OACl1 cnI1A-aCCOl{HI1PYCMhIX napa311To30U. 31'11 OC06CHHOCHI napa3l1To-
_'10rH'lccKoJi cUTym l1u B Hi.UIICH cTpalie npe,QollpeAeJIHIOT HCOOXO,QI-IMOCTb H3MCHC-
HI1H TaKTltKI1 AuarHOCTJIlICCKOl1 pa60ThI: JI10VaR Ilpo6a eK(l.IILdl, 1-l(JflfJlllVle1-lll11R R
.Il11UUpllmOp1l10 d.llR llaplidUnlO.llOlll l LecKozo LlCC.IleU()(WHllR, iJO.llJKHlI IwoRepzambcR
lCO.MIIJleKCIWl..ty (OUIIORpe.MC'UltOU}' lUlU lI11pll..ll.lle.llb1-l())'1Y) llCCJler)0t a1-ll1l0 Itll BC/O
lP}'Il1Z}' 0611nlllme.llel KIWle'll-lIlKli - npocmeiiwux llze.llb},iWl11WB. nhlSlnJleHl-IC CJlY-
IaCB C\teWallHblX HH<PCK1{HftlHHua:UIH, OCU6CHHO U rpynnax pliCKa no HI1lJ-tunJ>CK-
UIH1 H COI1Ay, C raHonHTbCSI 3a,1..l,a'ICH, HMCH)II en HCIIOCpC,QCTBCIIHoe OTH01lleHHC K
3; OpOBhH) It Ka'lcC'my >KH3IUI JIIO etl, UaxOASIll ItXCSI n I pynnax plICKa. C y IC'fOM
3THX nOJIO>KCHI1H. nce MCTOf(hl, paHce npe,QJI0>KeHHbIC ,'J,J1SI 06uapY>KeHI1S1 OTACJIbH0
npocTcfi1llHX IUU1 reJlbMHHTon, paccr.1aTpUBaIOTcH HH>Ke oG"bCl1.HHeHHo, C npHMC Ia-
HUHMI1 B OTilOmCHl1I-1 Tex H3 miX, KOTopble npC11J1(nHa IaIOTCSl ClIcl\H(lm ICCKI1 ]J)IH
nhlSIBJICJIHSI TOJII.KO onpCll.CJleHHhIX IUITJ.0B npoCTeHwI1x HJlI-i rCJlhMMHTOU.
5.2.1. C6op, ;(OCT3DK3 If KOHcepnllponalllle npo6
C60p npo6 cPCKa.'1Hn nponO HTCSI 8 CYXHC AOAOHcnpOHHlJ,aCMhlC CMKOCTH - 6a-
110'IK11 H3 CTCKJla M.'1It nOJH1MCpon. napa( IUH1pOBaHHbIC CTaKall II1KH. B HHX HC
}\O_l>KHO 6hlTI> C.'IC]J,OB XHMWICCKUX I3CII\eCTU, ry61-ITCJlhllO AeHC'mYlOll nx Ha HC>Kllhle
ucrCTaTUDHblC CTaAtHl npOCTCUIIIHX 11 JIIttIllHKH renbMI1UTOB. np061>1 <peKa':lIIil
AOJ1>KHbl OblTh CBo60J\Hhl 0'1' Mo'm, II03TOMY nx 6epy r 113 nOAKml)1,1I0rO CYAHa IUU
ropwKa. B3Hl11C npo6 <pCKaJH1H IIC>KCjlaTCJlhHO npOBOAllTh y naL HCHTUU, npHHu-
MaI01l HX npOTlIBOnapa3HTaplll.le JleKapCTBeHHble npcnapaTbI, nO]J,BcpranWUXCSI
lIe3 OJlrO 11.0 06CJle,' OBmU1S1 PCH1TCHOCKUlUm C I1pHMeHcm1eM 6apusl I1JUI nOCJle
\IaCmlllhlX KJU13M.
JJ.oC'raBKa np06 cPCKlliIlIit B na60paTopHIO }J.omKHa 6LITh no U03MO)Ki!OCTH HC-
MCJ\J1CHHOll nOCJ1C 1-13 B3S1TI-I . r.e. n rCI1.IJOM BHAC (CM. IJbHue).
O<l)OpMJlCHHhle <p C I\.a.1I1H, nOJ\ne)Kaw.HC I-iCCJICJ\OBaHUIO Ha HlU\a renbMUH1UU II
L HCThl npOCTenWHX Mmyr II Te i lCHl1C pa6o ' lcro }J.HH XpaHltTbCSI n BblTH>KHOM IUKa-
cPy IIPH KOMHaTlIOH Tcr.mepi.nype I-UU1, npe,QnO ITHTCJlblleH, B XOJI0AHJlbHl1KC IIpl1
4 Q C. B CJ1Y'IaC Hel136c>KHOli 3a}lCp>KKH C l1.0CTaUKOr. npu6 B J1aOOpaTOpmo lUlU tlC-
U03MO>KlIOCTH 11CCJICl1.0mUIJ1H HX 13 I\Cllb ,QOCTaBKI1, np06hl JJ.OJI>KHbl (jblTb nOMcw.e-
HblD KOHCCPUHPYH)LLl.YIO >KII:J,KOCTh, npUMeHCHltC KOHccpnaH'lU13 06eCIIC UlnaeT 110-
J1Y leHHC J\oCTaTu'mo Ha]J,Cn<llhIX PC3YJlbTaTOU npll lICCJlel'0UaUHlI MaTcpHa. ' 1a, (\OC-
TaBJICHllOro C 3aJJ.Cp>KKOll, a TaK>KC B03MO>KIIOCTh Gonee paBlloMeplloro pacllpeAe-
..
268 TOM II - lIACrHblE AHAJIMTMlfECKME TEXHOJIOrlif11
J1CHHSI HarpY3KH na60paTopHoro nepCOUaJ1a. AJIWreJlbHOCTb COXpaHCHHSI Berera-
THBHblX CTa.r\Hi', H QHCT npocTci'IIIIHX H SlHL( rCJlbMHHTOU B KOHCCpBaHTaX n03BOJISICT
B 3aTpy.nH..'TCJ1bHbJX JVISI HarnOCTHKI-1 CJIY'IaSiX nCpCCJIaTb :mKOHCCpBl1pOBaUHbIH
MaTepHaJl Ha KOHCYJJbTUL(J.11O B CnCI H3Jm3HpOBaIlHYJO J1a60pUTOpmO. TaKoH MHTC-
PU3Jl. CO Cp>l<aw.HH TOYHO "J:{eHTl-1cpH HpouaHHbIC npOCTeHLlIHC HJTU rCJlbMHItTbl,
MO>l<eT HCn0J1b30BaTbCSI B YYCOHblX UCJ1S1X. a TaK>I<e J1S1 KOHTpOJ1H 3HaHHJI Jla6opa-
TOpHblX pa60THHKOB.
f1pe J10>l<CHO ..moro npOlIHCCH KOHccpBaHTOB. npCAHa3Ha ' leHHbJX OT CJTbHO JVISI
sm 1-1 J1WIHHOK reJlbMI-1HTOn, .nJ1S1 TpO<p030HTOIJ H U..'CT npOCTCHUJI-1X, HJ1I-1 TCX 1-1 py_
rHX BMCCTe. HCKOTOpblC KOHcepBaHTbl OTJ1U'IaIOTCSI WHPOKOi'" HeKOTopblC O'ICHb
Y3KOH 1i36I-1pUTCJlhHOCTbfO. HO ::ITa OCOOCHHOCTb I-1X .nCHCTBHSI. He Bccrna KOppCJmpy-
CT C I-1X 3cp CKTI-1BHOCTblO. Hau6oJ1ec 1-13BCCTHbiC KOHccpBaHThl C pa3Jm'IHoi', 1-1301-1-
paTeJ1btlOCTblO ,'J,CHCTBHSI npHBCACHhl B Ta6J1HL(C 3.
TaoJlHQa 3
"pOOlICH KOIlcepnallTon pa3.'IUIJHOH u3611paTeJlLIIOCTH AeHcTDlul
Ha3BamtC PeareUTbi COOTIIO- 06"beKT II J(mlTellbllOCTb
llJelmc cox pa IIC IIIUI
cpcKamm/
KOliccpnaHT
KOllccpBaHT - a30THOKI1CllbIU HilTpl1 1:1 5I.I a aCKaplIJ-\bl, BllaCOI"Jldna.
lilypetlKonoH 0.2 % paCTBOp - 1900 Mil a II KI1J10CTOM 3 TI1J-\. neHTeL(a
- paCTnop nloroml BO.l.(lIblH - Wl1pOKOro. enHH KapJJl1KoBOro.
250 Mil ARyyCTOK KOIIWl,bCiL ne'ICIIO'I-
- cpopMamlH 30% - 300 Mil IIOH. lIaUI(CTOUIIAHO.I.
- rJJl-II<lCpI1li - 25 Mn UUlCTOCUMbl MCtlCOIIII,
OIlKm: cpe P TC 11II IA. 1(0 1 mAa
)K11J-\KOCTh - nORapcllHaSi CO.'II> - 81' 1:4, To >KC
Eap6araJlJlo - OpMallllH 30% - 30 ,",,1 1:6 (3.lnI1BKa ropSl'1I1M pacTBopoM)
- BOJ\a .l.(UCT1IJ1. - 1000 M 1
AeTeprelJTbl KOMMcp'leCKl-!e. pa3l1l-!'IHb1X 1:5. To >KC + 5I11 a OCTpllL( II
( MOIo u.ule lIpM TP"XocTpOllnIJll1J.l. 1t0 () Mec.
1I0po1lJKII) 1:10 + .111'IWIKII CTpOllntllOIlAa 11
aUKlllIOCTOIIIII!l -.1.(010 CYTOK
I<ollccpnaHT - MeTJlJleUOnMI CI1Hb - 0,51' 1:3 BereTaTJlBllble 11 IJ,IfCTllble
Cacpapalll1Cl!a - CCpllOKIICllbiIt IJ,I1I1K. 2% OpMbl IlpocTet\Wl1x. AO 1 ro a
BOJ.\UblH pacTBop - 82.5 Mn
- lflopMamlH npO.l.(a)KUbl (I -
IOMn
- YKCYCHaSi K-Ta. KOH4. - 5 Mil
- <f>eHo.l KpI1CTa.'1. - 25 r
)KIIJlKOCTb - r1ll1L(Cp11H - 1,5 Mil 1 :3 BercT3TIIBHbie II UlICTHbre
EpYKa II - YKCYCH3H KIICJIOTa, cf10pMbl npoc7ci'lwUX.
rOJlbMaH3 nenSlll3S1 - 5 Mn J(III1TellbIlO
(KolicepBaHT C - >KllltKOCTb lllaymllfa -
PYA) 93.5 M!I
- nOJlIIBllHllJIOBblH a.1KOronb
(noporuoK) - 5r
-
r
METO,IJ,bI KflI1HI14ECK0I1 flAPA3I1TOJIOrl1l1
269
5.2.2. Cnoco6L1 npHrOTODJleHHJI npenapaTOD
5.2.2.1. HaTHDHLIU (cDe)KHlt IleoKpawellllLlu) J\.Ia30K. OH npenCTaBJUleT co-
60rl B3BeCb cpCKaJlHH B Kanne BOAbl, cpJ.l3paC1'Bopa. JU160 50% pac-mapa n1J.lu e pH-
Ha (nocneAHHH o6ccnC'-U1Bae1' npOCBC1'!ICHHe Ma1'epHa!Ja, 06.'1epmfl 06napY>Kemle
sn1Ll renbMHHTOB. H npeJ],oxpaHSicT npenapaT 0'1' ULlcblxaHHfI). Ba>KHOe TJ;OCTOHHC f-
BO HaTHBHoro Ma3Ka - B03MO>KHOCTh 06HapY>KeHHSI nOMHMO SlHlJ, reJlhMHHTOB, 1'aK-
>Ke BereTan1BHLIX CTa,,"\HH npocTd'lwHx (I1HorJ],a H HX 11 eHTHcpHKaLlI1S1 no xapaKTe-
PY WnI>KeHHSI).
npOlieoypa npuwnlOo/JellLlJI. Ha npeAMcTHoe CTeKJ10 HanOCSIT no 2 KallnH cP H3 -
pacTBopa. CreKmlHHoH (ACpcusHiHOit) naJ10"IKoi'l 6epYT [taCTH'-IKH J.lcCneAycMoro
MaTepHaJla, '--IYTh 60JlbUJe cm1'-le'-IHOrl roJIOHKI1 (3-5 Mr) H TII a1'eJ1hHO pa3MewHBa-
101' B KanJ1e )f(11.LtKOCH1. Cr.feCh HaKpLlBalOT nOKpOBHLIM CTeKJ10M TaK, '-IT06bl He 06-
pa30BhIBaJIOCb nY3hIphKOB B03.Ltyxa. ,IJ,J1S1 :,noro BHa'-I U1e KacalOTCSI CMeCH 01 tUfM
KOHLlOM nOKpOBHoro CTCKJta, a 3aTeM OCTopmKHO onYCKaIOT ero Ha BCIO KamllO.
Ma30K J],01I>KCH OblTb cpeAHcH TO.TIIi.lJ.lHhI, He CJll1llJKOM np03pa'-THhli'l. HO MyrHoCTh
el'o .LtOmKHa 6bJTb TaKOH, '-IT06bl CKB03L Hero MO>KHO 6blJ10 CB06o.LtHO npO'--leCTh ra-
3eTHblH TeKCT.
MJ.lKpOCKOnl1lleCKOe HCCJle OBam1e CBe>KCI-O Ma3Ka AomKHo npOBOAI1TLCSI C Co-
6JII01WHl1CM CJ1eAYIOIlI.J.lX npam1Jl:
1) OCBCllI.eHHe npenapaTa HC AomKHO 6LI1"b s:lpKHM. flpa.U1.TIbHOC OCBellJ,eHue
AOCTl1raeTCs:I COOTUCTCTBYIOIlI.HM no.TIO>KeHJ.leM KOUnCHcopa, KOTOphirl AO.TI>KCII 6blTh
onyw.CH TeM oonbwe. "ICM Cl1nhHee 11CTO"II-IHK CBeTa. Hco6xOAHMO npORepl1Tb Ha-
!1H41te cBeTocPHJILTpa.
2) flpenapaT J],on>KeH npOCMaTpl1BaTbCSI CHa"laJIa c M U1bIM ynenl1"leHHcM MHK-
pocKona, a :JaTeM C CYXOH CI1CTeMOH 60JILllJOro yne.TIH[ICmul. HMMCpCHOHHO i CHC-
u
TeMOIf npJ.l npocMoTpe CBe>KHX npenapaToB no.TIb3YlO1'CSI KpaHHe pCAKO.
D.uamocmU'leCKaR l(eH1WCmb. B HaTHUHOM Ma3Ke npOCTeHillHe KHllle'-[Hl1Ka H
HX LlHCTbl 6eCI neTHLI, OTJlH"[aSiCb 01' cfJoHa m1WL CBoeH CBCTOlIpenOMJlSleMOCTblO.
OAHaKO O'-ICHh CYUJ,eCTBCHHO, '-11'0 BereTanmHblC CT['I m1 npOSlBnSlIOT B npenapaTe,
npl1ro roB.TIeHHOM Ha cPH3paCTBope, xapaKTepHYIO gJISI AaHHoro BHAa nOAUlf>KHOCTL,
'--leM cnoc06CTBYlOT I1X 06Hapy>KeHI1IO. B Ha1'HBHOM Ma3Ke MorYT 6hITh paCn03HaHhI
rCMa1'o<parl1 E.histolytica. lJ,I1CTbI aMe6 H J1S!M6J1HH 11 SlrfLla II JIH'-mHKI1 rcnhMHHToB
(eCJ111 'mcno HX npeBblwaeT 1000 B 1 r <peKaIll1w). npl1 CJ1aOOH HHTCHCHBHOCTI1 IfH-
Ba31111 "IYBcTBI11'eJ1bHOCTL mrnmHoro Ma3Ka B OTHOWCHI1I1 SlItLlI'CJIhMI1HTOB HCAOC-
TdTO"HtO BhICOKaSi. B cOBper.feHHblx Jta60paTopl1S1X Jl.l1arHOCTI1KY npocTc 'tumx npo-
UOl1S1T napaJI.TIC1lLIIO no uaTI1BltOMY Ma3KY H Ma3KY, o6pa6oTaHIloMY pacTBopoM
JIlOrOJISI, AHarHOCTHKY SlHL renbMI1HTOB - no 6-8 HaTHBHhlM r.-ta3KaM mm no TonCTO-
MY Ma3KY Karo (CM. HI1>Ke).
5.2.2.2. HaTlIBHLIU Ma30K, o6pa6oT3HIILlH pacTDopoM JhoroJUI npeAHa3Ha-
'-IeH AnSI o6HapY>KeHI1S1 11 11J.\CHTH<pHKaUI1I1 L I1CT npocTcHIIIHX.
Heo6xouw.tbl: pacTBop lltoro.TIS!. npC.LtMeTHhIe 11 110KpOBHbiC C1'eKna, l cpeBSlH-
HhlC (CTCK.TISlHHbIC) lIaJlO'-IKI1. PacTBop JIlOronSi .'OTOBSIT no pa3.TII1"IHbIM peu..enTaM
(Ta6.TI11L a 4).
270 TOM II - '-lACTHbIE AHA.lII1Tl1tIECKME TEXlJOflOfMM
Ta6JUlI..(a 4
Pe cnTLI npUf'OToBJ"lCHHJI pacTBopa JIIOI'O."IJ1
PC3rcHTLI KO "III"CCTBO B pa3J1b1X pc cnTax
1 2 3
K pMcTilmuP'lecKMfI Hon 1 r 2 r 5 r
HOAHCThJH Kam'Ii'1 2 r 5 r lOr
HJ1Cn1.1J.fJMpOBaHllaH no a 100 M11 100 Mil 100 Mil
flpll20mOBJ1el-lUe: cua IaJ1a paCTBOpSlK)T HOJI.MCTbli'1 KaJU1H, nOTOM J1.06aBmnoT
KpMCTaJlnlftleCK IH HO . PacTBop CJICJWCT xpaHMTb no cfmaKoHc m Tel\lHOrO CTCKJIa
C npMTepn.>ii npo6K0I1. CpOK "pMroAHoc1'U )VISl pauoTbl - He 6tMCC 3 HC)J,CJ1b C MO-
MCHTa npHroTOBJ1CHHSl.
I-Ia npC}.(MCTHOM CTCKJle rcrl"OBSlT OAMH 11J1" ABa HaTHBHblX Ma3Ka Ha ()nnpaCTBO-
pc KaK Om1CalIO nblWC. EC11M Ma30K O)J,MH. TO era HCC11C/.(YlOT nHa\I U1C II IICOKpd- I
"
WeHHO\1 ml)J,C AJISI nbISlnJ1eHl-1){ nOAnM)I(HblX RCI'CTaTHBHblX CT<mJ1H npOCTCHWHX. a
3aTCM )106aB.I1HI01' KalJ.TllO paCTnopa JhOnJJlS1. npH Hil.'U1\U1H J\BYX Ma3Kon 0Aml IC-
CJIC)J,YlO1' Ha IIa.rU1 IHC nerCTaT"BllblX CTaJJ,HH npOCl'eHlIlUX H SlHLl rCJ1bMmrron. ).(PY- I
roft 06pafiaTbmalO1' pac mopOM fllOroJlS1. B 1I0CJIC).(HCM CJ1Y\lae Kall1ll0 paCTnopa Ha-
nOCSIT Y KpaH nOKpOLlUoro CTCKna, HOJI. IIPH 3TOM Jl,Hcpcl)YIIJJ,HpYCT B Ma30K, OKpaWH-
naSi CI'O C pa3HoH I1HTCHCHnHOCTblO no Mcpe npOHMKHoncm-ISI n pa3HbIC Y'IaCTKH
Ma3Ka.
J],OCTm1HCTBO Ma3Ka, 06pa6oTaHHoro paCTnopOM JhoroJ1S1- n03MO)l(IIOCTb 06Ha-
PY>KCHMSI n L\MCTax IIpOCTeifwHX Ba>KllhlX MOp 0-'10rH\ICCKJ1X ).(CTaJIeH. HeRHHu,\fbIX
B Han1BHoM IIcoKpaWCHHOM Ma3KC. I3ereTaTHBnhlC CTa;:um npOCTeHIIHIX ITO,], B.fJHSI-
tu1C/I1 Ho. :{a 6blCTpO nonfualO1', n03TO 1Y oupa60TKY paCTBopOM 11lOro11H CJ1CJI,YCT
uccrAa npOROJll1Tb HOC!le npCJ:{BapUTC.'lbHOrO npOCMOTpa CBC>KCra Han1Ruora Ma]Ka.
J1CCAel)OOLIIllle "pellapanzoo, o6pa60TaHHbiX pac ruOpOM JllOro.1JSI npmnnO)UIT
TaK >KC, KaK U CnC)I(HX HCOKpallletlllblX npenapaTOB. OKpaWUBaHHC L\J1C1' HOJ\OM
npOI1CXO _'HT tlepc3 1-2 MHU nocne npUrOTOBJICIU1H. CH l'laJ/a Beet. IIpcnapaT on1a-
rplmalOT C MaJlblM ynC11H'lelmCM. IIpU KOTOpOM Ll ICTbl IntHII!>1 B BHJI,e KPYrJlhlX U-'HI
OnaJIbllblX pC3KO Otlep\leUHhlX >KCJlTOnaTO-KopU lIlcnbIX o6pa:JOnmmH. H IH1X II3GH-
paTcnbHO OKpaweHbl Sll\CpHbIC C1'PYKTyphl, I-JU1KoreHOBbIC naKYOJU1 U JI.Pynte
BKJIKJtICHHSI. nOCJ1C OCMOTpa npcnapaTa C MaJ1blM ynem1 lcnHeM cro TLllaTeJlb!lO
npOCMaTpUUaKJT C CYXOi:'l CJ1CrCMOri U0J1b1110ro ynCJnttIBHHSI; B pCJI,t<I1X CJIY'laSlx IIpU-
u
XO]J,MTCSI nOJlb30UaTbCSI HMMCpCHOHHon CHCTCMOH.
ConOCTaUJICHUe ncex npwmaKon. nbISlnJlS1I011 UXCSI nocnc OKpaCK 1 HOJWM, n03-
BOJIHCT B 3Ha IMTe11bHoH ltaCTH CJlYLIaCn C J,\OCToncpHOCTblO onpCnCJIHTb UU;J,OBYIO
IIpI1HaJ1.JlC>KHOCTb 06HapY>KCHHbIX U,UCT.
5.2.2.3. MCTOJ1, TO.ICToro M33Ka { eKa.ll11l no K3TO
I JpUHlClln Memoua - HccneJl,onatlHC Ha SlHl.(a renbWUITOB 60JIbWerO 061>CMa Ha-
neCKM CKaJIIH1 3a C\ICT npOCBCTJ1eH"H Ma3Ka CMeCblO KaTo.
Xoo LlccAe008aIllLR. lOTonSiT He06xoHut.'fblC HHrpel HeHThl: I(CJI110 aHoBble no-
KponHble II.'TaCTHHKH, 3% nOJJ,HbIM pacTnop MaJlaXUTOnOH 3eneHH, 6% nOllnhlH pac-
TBOp cpcHOJ1a. vb nCpC\IMCJ1eIUlbIX pcareHTOn rOTOBHT 3aum,roBpeMeHHo CMeCb
KaTo, KOTOpylO MO)f(UO xpaHHTb A.fJJ11'CnbHO npH KOMHaTHOM TeMnepa'1 ypc U UYTbI-
Jm C npHTepToH np06KOr!. Opolte.o.ypa npHrcrronJICHHSl CMCCH: 500 MJl 6% paCTBO-
r
METOJ],bI KJII1Hl1lJECKOI1 nAPA3I1TOnOrl1I1 271
pa cjJCIIOJta ct.teWHua.OT C
50 MJ1 rJ1HuCpHlia H 6 M.T) 3 %
nO,[{HOI-O paCTnopa I\-ta.naXHTO-
nOH 3CJICHI-f. KYCO'-.KH rHAPO-
cjJHIIhllOro QennocpaHa pa3Me-
pOM 2 X 4 CM 3aMa 1 IHBatOT n
CMeCH KaTo Ha 24 '-taca (3anac
HX MO>KCT xpaHHTbcH B nocY1l.e
co CMeChKJ .u.mneJ1bHo). Ha
npe,[{McTlioe CTeKJlO naHOCSIT
KOMO"leK <peKaJIHH ue.1H 1 IHHOH
C roPOWHHY. 1I0KphIBaKJT 3a-
MOIICllliOi'. B CMCCli KaTo QeJ1-
Jl0cpaH0130M nnacTHHKoH. npli-
J],anmmalOT pC3HHonoH npou-
y
KOH AJIH IIOJ.y".eHliSi paBlfoMep-
Hofl 'roml HHbl Ma3Ka (pHc.7).
npcnapaT OCTanJUIiOT )J.ml
npOCBeTJ.cIUHI lIa 1 ltaC npH
KOMlmTHol1 TCMnepaTYpc.
npOCIJCTJ1CHHhlH t.ta30K MHK-
pocKonlipy.oT 1.epe3 L CJlJlO-
<PaHoBYIO nJleHKY. B TOJICTOM Ma3Ke no KaTO o6HapYJoKHBalOTCSI HHQa aCKapI1)J.bl.
BJIacorJtana, aHKlIJIOCTOMliJ]" JleHTCL OB, TpcMaTol .
OT(HHM li3 OCHOBHblX Tpc60BaJU1H, o6eCne 1 lHBa.oulHX BhICOKY.O 3cpcpCKTH8HOCTb
I-ICCJlc.u.OBallHSI MCTO,QOM TOJ1CTOrO Ma3Ka, SlBJ1S1CTCSI cTporoe CouJI101l.eHHe OIrm-
M VlhH bJX CpOKOB 3Kcn03HL IH1 TOJICToro Ma3Ka B 3anHCHMOCTH 01' KOIICHCTeHlI,Hli Ii
I\taCCbI cpeKa.r1liH H TCMnepaTypb. IIpli KOTOpoii npowmOJ],HTCH npOCBeTJ1CHHC npe-
napaTa. I1HorAa HY>KHO UbI>K1l. lTb 24-48 1 1 npe>KJ],e "ICM npenapaT npOCneTJlCeT.
npH HapywcHlil1 onnIMaJ1bHb.X CpOKOI3 BbIAcp>KliUalll1S1 TOJ1CTOI'O Ma3Ka n031U1-
KalOT smneHHSI, KOTOpbJC HanOMI1HalOT lIapYlllem1H 13 npoQeccc npOSlBJ1eHliSi cjJOTO-
n!JeHKH. npl1 «He,[{onpOSlBJICHlU1» TOJ1CTorO Ma3Ka CBCTOBOH nOTUK MliKpocKona
6YJ],eT He,QoCTaTo"leH }J)IS1 npocMoTpa npcnapaTa - BHAHa J1I1Wh TeMHaSi Macca cpcKa-
J1HH; npH «nepenpOHBJleHHH» TOJICTb.H Ma30K 6YI eT llpe3McpHo np03pa l leH, npH
3TOM ouecu,nellHBalOTcSI H Sli11 a renbMHHTon, "ITO BeCbMa 3aTpYAHHT, an pSlJ1.C CJIY-
ltacu cAenaeT HCU03MO>KHbJM HX BbIHBJ1eHHe.
I1ccJ1e,[{oua.me npoG cpeKaJIHH B Ma3Kax JIIo6oro T1111a lie BcerAa 1l.0CTaTolmo
3cpcpeKTI1I3110 H3-3a HH3KOH "IHCJ1eHHOCTli tiliCT HJlH HHU B HCCJ.C,[{YCMOM MaTcpmUle,
Hcnoc roSlHCTna liX I3b.J1.eJleHHSI H3 KHWC"IHliKa H I PYfI1x npwlHH. 31'0 06CTOs:lTeJlh-
CTUO UbWY>KAaeT npoBoAHTh oGCJICAOBaHHe naQHCHTa nOBTopHO H npliMclISlTb Me-
mO()bl 06Olaru,cUU.H. Ee3 COUJ.IO}\eHMSI 3THX YCJ10nli" HCI-aTI1BHhIH PC3YJ1hTaT O.u.HO-
ro aHaJIH3a <peK VlI-li1 Ha npOCTeHWI-IC 1-1 reJ1bMHHTbJ MeT0,QoM HaTHBHoro Ma3Ka He
MO>KeT C 1 u-r..aTbCSI mVlHAHbIM.
ITpU.Me'-l.aHue: npn HCCJ1CJ1.OIJaHI1H HanllmOro Ma3Ka no,'). Ma..'1bJM YIJem1 1 1CHMCM
o'-/eHh .ac ro MO>KHO OUHapY>KliTh MCJIKliC KPYfJlhJC, 06b. l 1HO UCCUBeTHbJe rCJIbl\a.
KOTOpl>lC HanOMliHalOT 1\I1CThJ ::>HTaMe6. ECJ1H liP" liCCne \OnaHliH nOA 60J1hWl1M
YBCJ1HlleHHeM (40x) 3TH TeJ]bl a nhJrnSl HT KOpl1 1 lHCBblMH MJ1li >KCJITbIMI1 - 31"0 He
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1 - npa6Ka pe:nIHOBaSl: 2 - LleJlnO(!JaHoBaSi
IIJleHKa; 3 - npa6a (!JeKaJIIIII; 4 - npcAMeTHoe
creKno; 5 - npcnapaT B J"OTOBM BIIAC
272 TOM 11- YACTHbIE AHAflMTI1t{ECKI1E TEXHOJIOrl111
Q 1CTbl H I-iX MO)f(HO HrHOpHpOBaTb. HC60JlblllHC Kar1J1H )f(Hpa nOA M U1hJM YBC.IJWIC-
HI1CM TaK)f(C ,.,mrYT HanOMI1HaTb I\HCThl, ol HaKo OHH KpaflHC pa:moo6paJHbl no paJ-
MCpy, a 110.0. 60JlbWHM yncnwlCHlteM BHAHa HX OCCCrpYKTYPHOCTb. Oco60 CJICM)'CT
nOJ1.4CpKHYTb, liTO MaJloe yneJ1H'IeHHC n03BOJlS:ICT BblSlBHTb J1HWb 061,CKTLI, l-IatlO-
MUHalOll{Ue Tpmp030l1Tbl 11J111 LlllCTbl 3H1'a,."tc6, H]J.CH1'HcPl1ImL USI I1X Y)f(C HCn03M())K-
Ha. fIO,Q03pHTCJlbllLJC 06"bCKTbl .Q0J1)f(Hbl 6LITb UCHTpHponaHhl H HCCJJe,t{OBaHbJ C
OOJIbllUtM YBCJlHllCHHCM (40x).
5.3. MeToALI 060rall.{eHlUi
3TH MC1'OI LI OCHOBaHbl Ha kOIlUCHTpaL IH1 SlHLl II JlHlU1UOK rCJILMHHTOB "-'lU IJ.HCT
IIPOCTCHWHX n npooc 6J1aroJI,apSi oTJ],eJlCUHIO couCTnCHHo <pCKaJILUbIX 'JaCTHLl U Ha-
KOnJlCHl11O napa311TOJlOrH l ieCKHX OU"bCKTOn n npcnapaTax. fIpOLlCJ],ype o60raw.cliH
Moryr no}\nCpraTbCSI KaK Cne)f(HC <pCKamm, TaK H MaTCPHaJl H3 KOHccpnllpYlow. 11 X
)f(H,QKOcrCH. I1cno.T1L3YIOTCSI Ana cnoc06a 060.-aW.CHI1S1: OCa)f(ACHHSI H cPJloTaLlUU.
5.3.1. MeToALI OC3}KJ.\eIIllJl
Memoi> ifjOPMO.nUlI-3ifjUPIlQW oco3ICOellUJl
06oPYUO(3{l1lLlC Ll peazeHmbt: '(CHTpHCf>yra, npooupKI1 LlclrrpH<pY)f(HbIC Ha 15 MH,
OYTblJlKH Ha 250 HJlH 500 MJI, ]J.cpcnSlHHbJC IllllaTcJU1145 x 2;0 MM, XHMlt"ICCKHH CTa-
KaH Ha 25,50 111m 100 MJI, 400-MKM lIJ1aCTUKOnbIH unH MCTaJI.'UI"ICCKHH <pHl1bTp HJut
xHpyprHllccKaSl Mapml., npC,Qt-.teTHhIC C rCK.T1a, nOKpoBHblC CTCKJIa, nacTcpoBCKHC
nHnCTKI1 C pC3HHOBOH rpYllJCH, pC3HHonbiC npooK11 AJISI QCHTPl1cPY)KHhIX IJpOUHpOK,
W1'aTHn AJISI npo6upoK; cPOPMaJIHH, 10%; 3cPHP, 3TI1J1ar(CTaT 111m 6CHJI1H; H301'OHH-
4CCKltH COJ1CnOH pac mop (0,85 %, 8,5 r/Jl); pac mop J]lOroJISI.
XVU LlCCll.eOOeaHull:
1. B QCH1'pHcPY)f(UYIO np0611pKY C 10 MIl cP0pM U111Ha ,Qo6anbTC C nOMow.LIO ]J.C-
pCBSlHHOro IImaTCJIH 1.0-1,5 r <pcKa..rmH H IIcpcMcwaHTc .0.0 06pa30na11HS!. rm1OrCH-
HOH CYCIICHJHI1.
2. TIpmJ.CJ1.HTC cycncH3HIO 'ICpC3 400-MKM <pHJ1b1'p HI1H HIla CJlOS!. U.T1a)f(HOH XH-
Pypn1 l lccKOH Mapmf npSlMO B ,QPyrylO U.CH1'PHCf>Y)f(ltYIO npoullpKY 1mH B ManellhKm1
XIiMHllCCKUH Cl'aKaH. Mapl1l0 noc.IJc IiCIIOJlb30naHHSI BbI6poCUTL.
3. JJ.o6aBbTc K cycnCHJHH Hc06xolJ,HMOC KOJlU4CC1'no 10% cf>0pManuHa TaK.
'-..ro6M 06W.HH OO.hCM COCTamm 10 M.T].
4. D,06aBb1'c K cycncH31H1 3 M.T1 :.>cf>upa (11JlH 3TU.T1aIlCTaTa. 111m 6cH3HHa) H TII(a-
TCJlbHO ncpcMcwaihc, 3a1'KHyn np06lipKY IIpo6KOH H 3Hcprli l iHO nCTpS!.XI1BaSi B 1'C-
t.lCHHe 10 ceKYHA.
5. Y,Q U1HTe npo6KY H nOMCCTIiTC IIPOUHPKY n IJ.eH1'pHcPyry; ypauHoBCCbTC npo-
6HpKH 11 UCHTJJHcPyrHpyihc co CKOpOCTblO 400-500 06/MHH B 1'CllCHHe 2-3 MUH.
6. D,ocTaHb1'e np06HpKY H3 uCH1'pHcf>yrH; COUCp)f(UMOe paCnpClJ,eHUl10Ch n 4
CJIOSl: BCpXHI1H CHOH 3<pHpa (HI1H 3THJlaQc1'aTa HI1I1 6cH3HHa), CJlOH )f(HpHbIX OCTa1'-
KOB, npHnHlIllll1X K CTCIIKC npOOHpKH, CHOH cpopMaJlHHa 11 OCa,QOK (pHc.8A).
7. CnHpaJIbHblM ]J.nH)f(CHHCM C nOMOli blO lJ,epCRS!.WIOro WnaTCJ1S1 MSirKO pa3-
pLJXJIHTC CJlOH )f(HpllblX OCTa1'Kon: nLmei'lre BcpXHHe TPH C110Sl n OJ1.HO J1.BH)f(CHHC H
AaH1'e Ha](OCa),(OIIHOH )f(ltJlKOCTI1 CTeKaTb H3 ncpcucplIY!'OH npo6HpKH KaK MHHHMYM
B TC1lCHHe 5 CCKYH,Q. ECI1H oncpaw-m npO,QC.T1aHbl TII(aTCI1LHO IICOOJILWOC KOHHlle-
crno OCl"aTO'IHOH )f(HI KOCTU co C1'eHOK npo6upKH CTCllCT nHH3 Ha OC OK (pHc.8 6. B).
8. TIepcMcwaHTe )KHAKOC1'b C OC KOM (1HIOI'J1.a Hcouxol uMO Ao6anl1Tb Kan.T11O
1130TOHH l ICCKOro pac1'nopa, llT06bl HMCTb AOCTaTO'lllo )f(UJ(KOCTl1 .LVIS!. cycncH]J.Hpo-
- - 300..,......-
.... ...
-..-
METO)J.bl KJU1HHYECK0l1 nAPA3HTOnOrl1H 273
BlliUiSi oca Ka) oAHopa30BoH CTeKJlSlHHOH mmeTKOll. HaHecHTc Kanmo cycncH31uI
Ha npe]J,MeTHoe CTeKno, HaKpof1Te nOKpoBHLIM CTeKJIOM. npenapaT. oKpameHHbIfI
pacTBopoM RlOfOJ1S1, TaK>KC MO>KeT 6blTb CAenaH (pHc.8r).
9. HccneAYllTe npenapaT C 06"bCKTH80M lOx HJut, eCJlH Hco6xo1J,m.-ta liAeHTHcpH-
Ka uSI, C 60nee CI1nbHbIM oUbeKTHBoM MHKpocKona, B CHCTeMaTl-i'-ICCKOt.f nopSiAKe,
TaK "Ho6bl BCSI nnOLU.a)\L nOKpoBHoro CTeKna 6bIna npocMarpeHa. KorAa opraHH3-
Mbl HJlU nOJ1,03pHTeJlbHbIe 06"heKTbl HaHAeHbl, HCn0J1b3YHTe 60JlbWCC Y8eml'-leHHe,
'-ITo6bl ;QeTIlJlbHee H3Y'-IHTb r-.mpcpoJlormo HccneAyer-.mro 06"heKTa.
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A. PaCllpeAeJ1eHlle CJ10eB -
E. Pa3pblxncHHe cnoSi >Kl1pHblX OCTaTKon
B. np06HpKa C OCa;:J.KOM H OCTaTO"IHOH >KngKoCTbtO (Tpn BePXHUX C.10SI YAa.leHbl)
r. HaHeCeHJ.le oca,'1,Ka Ha npenMeTHoe CTeKno
Memoi> MHf/J-Kollflell1npaquu
rOTOBSIT CMCCb MepTHOJ1aTa C cpopMaJIHHOM H rmu.{epHHoM:
PaCT80p THoMepcaJUI (MepTJ1OJlaTa N!:! 99) 1:1000 200 Mn
PaCTBOp cpOpMa.'1HHa 40% 25 MJI
H pOO 5MJl
BOAa AHCTHnnHpOUdHllaH 250 MJl
274 TOM II - YAC f'HbIE AHAfll1Tl1lIECKI1E TEXHOJI0rl.1V1
CMeCb xpaHSIT n Ter.tHoH. nJlO1'HO 3aKpbl1'OH cTcK.'1S1HIIOH nocYAe. CpOK ee xpa-
HCHJ.-I HC 60JIce 3 Mec. roronSl1' TaK>Ke 5% paC1'nop nlOl"OJISI (CM. pCHCIlT J'i1! 3 1'a6-
mll bl 4). CpOK era xpaHcHHSlllC Goncc 3-4 IICJ\. B neHh I1CCJ1e;'\OBamHI c:. eWHBaI01'
CMCCL pcaKTHBon C pac1'nopml nlOro.'U{ B np0110pu,HH 9,4 MJI 11 0.6 M]I. COO1'Be1'CT-
BeHiIO. B nOJlYtleHHYIO C ICCb BHOCSIT OKOJIO 2 r cl)eKaJuIH. 1'1I a1'e:IbHO HX paJ tCWH-
ualOT. ClmJlh'I-PYI01' llepe3 r.mpmo B U.eH1'pHcPY>KH)'1O I1p06I1PKY. n06aU:I IOT 3 MJ1
::X)H-Ipa, 3aKpbIBalOT np06KoH, :'JHCpnl t lHo UCTp XIII.mIOT B TelleHHe 30 CCKYHA. 3a-
TCM npoGKY ULIIU1MmOT. a np06l1pKY l\eH1'pJ.1( Yn1PYIOT B n:'leHlle 1 MlII-llIPH 1500
06fr...U\H. Ha)J.oCaJl,o t lHYIO )Kll)J.KOC1'L cmmalOT, llaCTL ocaHKa IICpCIIOCSIT 1m npej.\Me1'-
IIOC C1'CKJI0. HaKpbmalO1' nOKpOBHbIM CTeKJlOM H MUKpOCKOlUlpYIOT. H OCCI)\Ke 01'-
u u
tleTJUmo BHHHLI UCrCTaTJ.1UHLIC CTN\HJ.1 J.1 1\I1CTbI n!10CTeJ.111HlX J.1 SlHL a pa3HblX UI1 \OU
rClIbMIUl1'OB. CJlel1,ye1' OTMeTJ.1Tb, liTO J\.aHHblt', MeTOIJ. ()ca>l<J.\Cml Sl.BJISl.CTC 0)\110-
BpeMeHHO 11 MCTO;.\OM K()IICCpUaL J.1H (Ja CIICT q)OpMamlHa) 11 OKpaWllBaHml :m C'IC1'
MOna 11 Mep1'HOJla1'a.
Memoi> KpaCU.IlbltUlW(Ja. I1CIIOJIL3YCTCSi clloco6HOCTb nonepxHoc1'Ho-aKTHB-
noro BelI\eC1'na - CYJlb aHo.T1a, nxoASlUJ.ero B COC1'aB ]J,cTcprcHToB (CTllp UlbllbIX 110-
pOWKOB, MOIDUJ.HX pacTBopoB) 3MYJlbrHpOlJaTb cPeKam1l1 ,'),0 HHcnepcHoro COC1'OSl-
HH 11 ublCn06o)KHaTh lI3 eKaJlhll"'x Macc Slrll a reJlbMHH1'OB, K01'OpblC 3aTCM. HC-
3anHCHMO OT Y]l.e.T1hHora neca. KOHI eH1'pl1pylO1'cSi n oca,J.Ke U IIpOU,CCCC OTCTaHBalllHI
11.'111 lJ.eH1'pHcpymponaHJ.1S1.
06opydoBaf-llle Ii peaZel-lnlbl: MllKpocKon, U,CI ITpm)yra, npC)tMCTllhle cTeKna,
CTCKJISiHllblC Hjn1 )tcpemmllblc 113.'IOIIKH, lleHTpl1 Y>KHbIe npOUl1pKJ1 I1m1 CTCKmlH-
HbIe JlaKOHbI (eMKOCTblO He MeHee 20-30 MIl) C IIpoGKOII lUlU IIJIO'l"IIO IIpHJleralO-
LllCM KpbIlLlKOH, lIacrCpOnCKI1C I11-1nCTKJ1 C nblCOKO O1'JlOM.T1eHHbIM KOHI OM UInI CTC-
KJlS1HHhle TPy6o'IKJ.1. nOKponHblC CTCKJla UIIU KYCO'IKU UCJI-'IO( alla (CM. MeTO)], 1'0.'1-
C roro Ma'3Ka no KaTo, pa:qeJI 5.2.2.3), AeTepreHT. J],JISi pa60Tbi MO>KIIO J1CIIOJII. O-
naTb JUo60" CTHpaJlbHb111 nopOWOK (HJIIt >I< J1HKOC n.) OTclJeCTBeHHoro IVat 3apy-
GC)KlIoro IIpmnn011.CTlm (3a UCK.'1tOlJemlCM 611O.T10rH'leCKH aKTI-fUllblX CTl1pa:lbHblX
nopOWKOB U.T1J1 nac1').
Xod llcc.IledooaHIiR. <1>eKamtll (HC MCHCC 1 r) '.JamIH<HOT pac !"BOpOM HCTCPI'CII-
ora (1-4 %) IJ COO1'JlOIIICmUI 1: 10. ("o,.ep>I<UMOe nepeMewunalOT BPY'IHYIO CTCK!I II-
Hoft mm AcpcnSiHIloH na.llO'lKOH J.1JUI MCXallH'-ICCKJ1 C HCnOJlh30naHneM w}'rreJ1b-an-
napaTa (n nOCJlenHeM cJly'-me cp_T1aKoHbl lJ,0Jl>l<llbl 6blTh 11.1101'110 JaKpblrbl np06KOH
I-iJl11 Kpb1WKm1) AO 06pa30nmlJ.1Si rGMorCIIHO" cycnCIIJUu. CMCCb eKaJH1" C )],eTCp-
rellTOM nhlJ(ep)KHnaIOT He MeHee 24 lIaCOB. OTcnumaHHc I\'IO>KCT J JIHTLC ;'0 liC-
CKOJ1bKJ1X C}'TOK OC3 }'Ll\Cp6a HIlS! KallCcma J1ccJlC)\Onam1S1. 3a 31'0 BpeMS! 06p<nyeT-
Csf c.1']ol1 ocaJ],Ka H IIa)],oca;J.otIHOl' >K11!J.KOC1'H. naCTcpOBCKYIO mmCTKY J1JlH C1'eK.'1SiH-
HYIO Tpy60 1 1KY. Ja)Kan cnepxy naI1bu,eM, OBO).\SlT).\O AHa .T1aK()Ha (lIpOOl1pKU). JaTCM
1.ICCKOJlbKO IlpmIOJ,mlMaJOT (lla 2-3 MM) Ii OTIlYCKalO1' na.'1el\, 3a>KUMaBWHIl KOHeu.
mme1'KH (Tpy60 t IKH). nOp[ J.1S1 OCMKa 3anOJ1HSleT tlacn nHneTKH (-rpy60 t IKu).3a-
)KJ.1MalO1' mme1'KY (1'py60 1 IKY) CBCPXY naJlbu,CM, IIJR'ICKaJOT 113 ( .l1aKOIIa (npo6up-
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5.4.1.1. nepllaHa.JlbHblll cocKo6
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276 TOM II - 1.JACTHbIE AHAJIl1TM1..JECKl1E TEXHOnOrl1l1
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pac !"Hope rJlHLI,epmm. Ha npeJl.MCTHoe CTeKJ10 HaHOCSlT KanJlID )Toro >KC pacTBopa.
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:;)'1'0 YJIY'-llllHT np03pa'IHOCTb JlCHTbl.
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AO nocellleHlISI TyaneTa 11 llYllla.
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\
I
>KrYTHKOB, T3K Lrro AHcpcpepeHl..\HpoBaTb HX Hc06xOl\HMO C Pentatrichomonas (C....H.
Trichomonas) hominis. IJ.Hc1'LI l1HM6JH1ii HMelOT oBa.IJbHYIO cpOPMY C 2-4 SlJI,par.m,
OHH caMble Kp)'I1HbIC CpCAM npyrux >KrY1'I1KOBbIX H 3TO OTm1 ae1' HX 01' Hal1UOJICC
MOp(})()JlOnILlecKH CXO,[l,HblX IJ;I'1C1' Enleromonas hominis. TpO )030HTbI JISlM6mrfr 13
H3TI-lUIIOM Ma3Ke 01'1111'18101'01 xapaKTcpHbrM J\lm>KeHlreM (nO.A06HO n8j\alOw,eMY JlH-
C1'y, K0J1C6..1HCL TO I3I1CpCH, TO lIa3aj{). .D:J1S1If3Y'lelH1S1 CTPYKTyphll\lrCT )l{rY1'HKOBLIX
HaTHBHLII111pcnapaT 06pa6aTbIBalOT pac-mopOM JIloroJ1S1. .D:J1S1 ,u,eTaJILIIOH j\ lI t1J c l)e-
pCHI ltal\lm Ma3KII OKpaWliBalOT Tpl1XpOMOM (pHc.14).
17pll.ue'Ill/Hie: EMC He IIplIl'oHeH!
5.5.1.3. Balantidium coli - e,u,HHCTBCHHLlii naToreHHblu npe.ACTam11'CJlb 113
rpYlIIlbl PCCHIf'IHbIX. JIIO,i],U :m60JICl3aIOT oasraHTU.Alr030M peHKo, ::mpa>KaSiCb rJ1aB-
HblM 06pa30M 0'1' CIUIIICIi. B036YlJ,It1'CJlL 06HapY>KUnaeTCH 13 cpCKaJH1HX 13 (l)opl\le
Tpocp03mnoB umr UHCT. TpO )030UTbl Kpymlble, 50-200 x 40-70 MKM, OLleHL no,[l,-
BlDKHblc, XOPOWO 3aMcTllhi H npcnapaTax C cpl'r3pac ruOpOM n0l1. MaJlblM YOCJIJ.1LICIUI-
eM (pl1c.14). i1x 1'C_'10 1l0Kphl ru KOpOTKIlr.U1 130JIOCKaMH (peCHI1'IKaf\U1). Bo BHelll-
Hell cpe,u,e HC YCToiiLIIIBt.I, 1.1CCJlej\OBr.l1'b C1'YJ1 Ha)J,O IIC II03>Ke Llaca nOCJ1C .Acq,eKaI\Ul-I.
A mMcTp r\I'1CT Ko..'1e6J1eTCH 01' 45 ,u,o 75 MKM. KaK H TPO )030I'1Tbl. OHH nJ1OXO no,u,-
J{aIOTCH 06pa6oTKc iiOHOM, 1I03TOMY oc060e BlmMamlC l1.0J1>KHO 6bl1'L y,u,CJICHO HC-
CJICj{OH3HIH{) Ha1'UBHoro npcnapaTa.
5.5.1.4. KpltnTOCIIOpll;J.uif - na)l(HeHUUm npc,u,cT3mrrCJlh KOKI\H.A1,rH. Kllwc'nU1-
Ka. Ol Hhl3hlBaCT Jl,HapelO y eTcil MJlaJllllC 5-J1eTHero BO::Jpac-ra. 0HJlaKO ero 3Ha'Ie-
,me MlioroKpa1'Ho B03pOCJ10, KaK B036YllwreJ1S1 CnI1A-accol\HHpyeMoH.lrHcpcKUIU1
- KpmlTOCnOplr.A H03a . KpHnTOCnOpH,[I,ut'1 pa3BlmacTcSI Me>K.AY nopcHliKaMl1 31 Tepo-
ul1"l'a, IIpOXO H nOCJ1eJl.ona1'eJlLHO GCCIIOJIOe 11 n0.'10BOe pa3MHO>KCW1e. 06pa30BaB-
HmecSi OOUI1CTLI BblJ{cmHOTCSJ C CPCKcUU1S1MH. OWl MC!IKHe (5-6 MKM B JlUaMeTpe),
!\lOrYT 6blTL J1erKO nplHlSJThl 3a KpyrJlble AP0)l{)I{H.
JIa6opanlOf}f-{(lfl ()llll2liOCI1lWm OCHonaHa Ha o6I1apY>KeHIH1 OOIJ;HCT napa31-1Ta B
)HKCHplmalllloM Ma3Ke cpeKaJ1Hu. npcnapaT MO>KeT roTomITLC)11I3 (l>cKaJllU1, npe,[l,-
BapWrC!lhUO n0\1cw,eHlILIX B KOHccplmllT (TYPALlcBa, 10% ( OpMa'1HH, 2,5% pac-
Tlmp 6HxpoM<rra K,UIIHI. >KH,I\KOCTb EapGaraJlJlo) II coxpaHSlBlllUXCSI IIPl'1 4°C.
npllWl1lOUJl('{{lU' lI!1eIWf}(lIua: nrromrl' Ma30K eKaf)lUl, I3LlcYIII1H1aIDT Ha n03,[1,y-
xc, (ImKcIIPYIDT B CMCCI1 HI1KI1( OpOBa 10-15 MHII, Ha)l nJ1aMelleM l'OPCJlKH II Kpa-
CSfT no l HJlIO-I-hlJ1bceIiY.
OKpllCKll Kap6oJl-ifJYKCUIIWH 110 ItIlJlIo-Ilu '1bce")':
npll20m06 U?HUe pa60'ww paCI1WOpli Kap6oJ1-cpYKcHHa: 1 () r OCHOBHOI"O )YKCI1-
1m paCTBopSiIOT 13 100 M1I a6COJilOTIIOro ClUlpTa; 50 n eHOJla HarpcBaloT II pacrBo-
pSiIDT 13 Hc6mlhUlOM Kom1'ICCTBC AIICnUlJHlpOBallHou BO,[l,bl. flocJTe 3Toro ClUlpTO-
BOH pacTBop cpYKcHHa CMCIIII1RalO1' C <jJeH0J10M H JlOllOJl.SlT AO 1 JI WICTIUlJllipOBaH-
HOi'l BO O".
OKpllCKll. nOMCII\alOT Ma3Kl1 cpCK<lJlUii B npllroTOBJICHHLI 1 paCT BOp Ha 5-10
MI1H; IIpOMJ.lBalOT Ma3KH Bo onpouoJ{1I0" 110;:l,OU II 06CCIJ;BC'llmaIOT B no,u,KI.ICJICIIIIOM
ClUtpTe (100 MJl 95% 3T11.1IOUOro CnltpTa + 1 M.'I KOIH\CHTpUpoBaHHOn COJISIHOH KH-
c.'IO'rLr) - 20-30 CCK; npOMbIBafOT B np(TIWIIIOii BO[l,e; AOKpallllmalO1' Ma3KH B pac-
mope MaJlaXl11'OBoro :ICjICI oro - 30 CCK. MaTOLIHLl1t 3% BOAHbln pac'wop lIIaJ1aXH-
TOBoro 3CJlCHO("{) MO>KUO xpaHlI1'b ,u,O.lII"O, oxpaHSISI 01' CBCTa. .D:JlH OKpaCKH 6cpyr
1 MJI MaTo'-lIwro paC1'Bopa + 100 MJI rJ11U epltHa + 100 MIl Hl1C1'HJIJUlp013allll0l1 BO-
.
--
284 TOM II - YACTHbIE AHAJlI1TI1YECKI1E TEXHOnOrl111
)].bl. TIpoMbIBaJOT Ma3KB npOTO"IHOH BO)].OH H Bblcyw malDT lIa B03J1.yxe.
Pe3Y.l1bmam: OOI BCTbl npOCTeHWHX (KpHrlTOCIIOpIIJl,iUI. H30CnOpbl. UHKnOCnO-
pbl) OKpallIHBaK>TC B paJHble OTfCHKB SIpKO-KpaCIlOrO lI,BeTa H HMClOT IUIL\ oKpyr-
.1lbIX 06pa30UaHHr1. COnYTCTBYIDII aSI MHKpOcpnOpa OKpallnmaeTCSI B 3eneHblH uneT
(pHc.15). OTm....UlTenbHbIH npHJHaK OOo.l'lC1' KpBnTOCnOpB)J.HSI - HaJlH 1 U1C BH)'TPH
"lepHblX rpaHyn.
flpU.WC'"lllNUe: B KpaCUblJf LlBCT TaK)I(e MOlYI' OKpaUHfBaTbCH Kamm )l(UpOnOAOUHbIX He-
I.l\.CCTB, rpaHYJJbl Ae"J pUTa. J],a)l(c np 1 CJIy'raHIJOM CXOACTBC 110 pa3McpaM :;Tit 06pa30BamiH
JlCrKO OTJIlPUlTb OT OOLlltC r no OTcyrCTBlIIO y nux OT'leTJIIlBoi:i 060JIO'IKU 11 KaKOrO-Jlu60
CTPYKTypupOBalitiOrO COA<::p)l(UMoro HHyrpll. B CO IIII1TCJIbHbIX CJIY'UUIX IIpl1MCHSIIOT MOI{II-
cpl1KaLll1l0 OKpaCKI1 U IJISI-Hu.TJbCCn3 - YMCHbUlalOT KOHL(CHTpal 11I0 M3JIaXltTOHOrO 3CJleHOl'O,
liTO OGJICPI3CT BI1LlOHYI() l1p.eHTII(])I1KartmO OOltUCT Cryptosporidium sp., Cyclospora cacta-
nensis, Isospora belli.
B Ka l leCTBe aJlbTcpHanlBnoro MeTo)].y I..J,llnSI-HI1JIbCCHa IIpHMellSleTcSI oKpacKa
cacppaHI1HoM no KecTHepy.
OKpacKa clltfiPllllU1f.O.1I-f '10 Kecmllepy: 1. npnrOTOBJICHHble Ma3KH (peKa.FJHfl
CPIIKC !PYlOT 4 MIIII B peareHTe: 100 MJ1 aocoJlloTtloro MeTaHOJla + 3 MIl KOHUCIHpn-
ponaHHoJ1 conSIHoii KHCJIOTbl; 2. IIpOMhlBaK>T B nparo'lHofl BOj.tC; 3. OKpaUII1I:mIDT I
MI1H 1 % UOj.tHbIM paCTBopOM cacppaHIIH<l. npuroTOliJICUHe MaTOllHoro paCTBopa:
2,5 r cacppaHHHa ° + 100 MJI 95% ::.rraHOJIa; pa6ot.II-IH pacTBop: 10 MJI MaTO"lIIoro
pacTBopa + 90 MJI W1CTHJIJUlpOBaHHoli BO)].bl. Ha Ma30K Ha.mmaeTCSI KpacKa, nocne
'-Iero CTeKJla HarpeBatoT lIa,L{ nJlaMeHeM ropenKH AO OTXO>KHCUI1SI napOB; 4. Ma3KH
npOMLlBaJOT npoTo"u.IOH BO)].OH; 5. AOKpaWIHJalOT 30 ceK pacTBopoM Men1llCUOHOro
CHHero (1 r CYXOH KpacKH MeTHJleHoBoro cHHero COCAHlUUOT C 3 r Na2HP04 H 1 r
KH 2 P0 4 . nCC1'I1KOM nopowKl1 nepeMeWHUalOT, cyxYK> CMeCb MO)KHO j.tOJII'O xpa-
HHTb II MapKHpoBaHHoH 6YTblJIKC C IIJIOTUO npHTepTofl np06KoH. ,D,JISI. npHrOTOBJJe-
HHSI pa60"lero pacTuopa 1 r CMeCH )J.06aBJ1SIIDT K 300 MJI J:(IICTHJIJIllpOBaHHoH BOAbl,
nepCMCWHlmtOT Ha MarHHTHofl MeWaJIKC, cpmIbTpYIDT t.lepe3 ( HnbTp H COXpamltOT
B cTeKJISlHHofl nocyj.tc U TC 1 1elme 2-x neT, 06epcra}l OT cBeTa); 6. npOMbIBaJOT Ma3-
KH npoToI1UOH BOAOH 11 BblCYWllBatoT Ha u03Ayxe.
PeJ)'.I1bill llm: onpe)J.eJISIIDTCSI OlJaJlbHO-Kpyr.%IC TCJlbUa Opall>KeBO-po:30Boro
I BeTa, BHYTPH 00UI1CTblIJH / 1Hbl 4 cnop030lna, OKpaWCIIHblX B 60Jlee TeMHblC Tona.
OKpacKa mpLLqJO] WBbUt KpacumeAe.M (CM. paJAC.'I 5.5.1.1) He Bcer)J.a AaeT xo-
poWHe peJYJlbTaTbl, 1m eCJlH OOl\nCTbl ero liOCllpIlUSIJlH, TO B cnopYJmpOBaimoH
OOUHCTe JICrKO pa3JIWIaIDTCSI 4 cnop0301ITa (Aa>KHbIH AlIcpcpCpCIIUHaJlhIlO-SU tarHO -
CTH"leCKliH npH3HaK).
npH cJ1a6011 HHTcuc mIlOCTH HH( eKUI1H C YCIICXOM npHMeHSl.JOT MeTOJ:(bl o6ora-
UJ,eHlISl OOU,HCT - qJJloTaUHlo C lIaCblll,eHHblM paCTBopOM caxap03bl (MeToJ:( SC<llhcr),
NaCI HJII-1 Zn2S04 (331 r B 1 Jl BO)J.bl) 11m! ( OP\1aJ1UH-3qmpHoe oCa>KHCIII-IC.
Pe3YJlbnwm: BblSIBJlSICMOCTb OOl HCT KpHnTOCnOpl1 HSI npH OCa)KAeHI1H cpopMa-
mlH-3cpnpoM u03paCTa.'1a B 1,75 pa3 110 cpamIcmno c HaTHBHblM Ma3K0\1 [JIblceHKo
A.5J., flaBAoBcKaSI M.B.}.
5.5.1.5. Jbocnopa - u036YJ:(lne!lb H30Cnop03a, npoT030fiuOH HHcpeKUI'IU, 3Ha l 1C-
Hlle KOTOpOH B naT0J10nUl lleJIOBeKa CTallO B03pacTaTb B CBSIJH C 3mlr e,.,mell
BY1 Y/cnl1,D,.
METO)J.bI KJU1HM1-IECKOM DAPA3I1T0J10fMI1 285
OOI\HCTbI Isospora helli MorYT 6blTb 06BapY>KeHbl B Bal'HBHblX npenapaTax n11H
B npenapaTax, npHrOTOBJ1eBBhIX H3 oca Ka eKrumM, nOJ1Y'leHfIOI'O MeTOAoM op-
"'-IruIHlI-3 HpBOro OCa>K]I,CIIHSL DpH oGpa6oTKe MaJKa paCTlmpOM Ho.ua SlApa OOUJ1CT
XopOWO npOKpaIiUmaIOTC5I.
I1pu..M.e'w/me. PaCI"ROp io]].a rorOBHT, CMelmmaSi 10 M I pacrBopa nlQroJUI C 10 Mn 25%
YKCYCHOM KHCnOTLI.
Pe3YJlbf1Wm: 06 lapY>KHBmoTcSI OOl\HCTbl I.bclli OHaJlbHOH OpMhI, pa3MepoM
32 x 16 MKM. B HX l1.CHTpC BaXO HTC5I BCpa3} CJ1eHJm51 Macca l\HTOnJ1aJMbl (pHc.15).
5.5.1.6. Ll.HK:IOcllopa - R036YAHTeJlb l1.HKJIOCnOpOJa, aKTYaJlbHOCrb 3'1'0" npo-
TOJOMHOM UII CKl\HU BOJpaCTaCT B CB5I3H 3nHHcMHeM BMtj/Cnl1)J.. B HaTI-IBHhIX
npcnapaTax B 00l1.HCTaX Cyclospora caclanensis npH MrulOM YBeJIH'ICHHH XopOWO
nH, Hbl MHOrO'mCJICllllble C CpH'lccKHe TeJ1b11.a, a np 1 60JIbWOM YBem1'ICmm -
2 cnopo11.HcTbl C 2 cnop0301-fTaMH B Ka>K)J.OM. B oKpawcHublX no U:HJI,lO-H 1J1bCeHY
npenapaTax 'mCTb OOU. 'CT ;)Toro napaJHTa MO>KCT 6blTb nOJIIIOCTblO 6ec11.BenIOM
lum oKpawclUlhlMH C pa3HoH lurrCUCHBHOCTbJO (pHc.15). 31'0 CBO 'rcTBO, a "l(lK>Ke HX
60J1bUU1M pa3Mep (8-10 MKM) CJ1Y>KaT OTJ1H'IHTCJ1bIlI.IMH npH3HaKaMH npH cpauue-
HHH C OO11.l1CTaMH KpHnTocnOpHAH5I.
5.5.2. I'eJlbMUIiTbi
B CpeKaJlH5IX Mory" 6hlTb o6HapY>KCBbJ 51M11.a I1/HJ111 .'1H'IHHKH MHorHX BHAOB
reJ1bMHHTOB, 0 ruOC5IIW1XC5I K TpeM KJ1aCcar.,c UCr.,taTOna\l (Kpyr J1bJe rCJ1bI\HUlTbI),
11.CC l'O]I,aM H TpeMttTo}J.aM.
5.5.2.1. lIe:uaToT(M, 06HlrlJOllJ.UC n K 'We'IHI1KC, OTBOC5ITC5I U GOJ1hlliHHCTOC CBO-
CM K rpyrlllc n::ore11bMI1HTOIi, HX npOnm"aTMBJlble CTaAllH (51M11.a, J1WIHHKH) np1106-
pCTalOT HHBa3HUBOCTh J1Hmb HOCJIC npeGblBam1S1 U not.lBe. MCKJIlO1..[eHHeM 51UJ151eTC5I
oCTpmJ,a, SlH11.a KOTOpOM UlIBa3HRBbI npaKHr'lecKH cpa3Y HOCJ1e Ae eKaI HH.
JIa6oplllllOIJHaR j)uamocmw<o HeMaTO)( OCHOBaHa Ita o6HapY>KClUm smu. H/m1l1
JIH'JHHOK n npcnapaTax H3 CKaJIMH MCTO}J.aMH, paccMOTpCHtlhrMH B pa3ACJle 5.2.
l1()eHmutfiW(Gl{liJl 51HU. aCKapHHbl, B.'1aCOrJ1ana, aHKI1J10CTOMaTH , Tp 1XOCTpOH-
rHJ1I1A, OCTpHllbI H J1H<HmOK KHWC(IHOH yrpHl\bl npOUO]l,51T, opHeHTHpY5lCb Ha pHc.l6
H 17. HCKOTOPYIO Tp)']I,HOCTb MO>KCT npe}J.CTaBHTb H]I,eH"I1 HKal IHr onJIoAOrnOpeH-
BblX H HCOIlJIOAOTBOpCHBblX UU\ Ascaris lumbricoidcs. OcpBble HMClOT OBaJ1bHYKJ
H.'IH KPYrJlYIO OPMY. 1l0KpblTbi TOJICTOH MHOrOCJloi'1HOH 060JlO'IKOH, oKpawcHiIOM
1lI1rMCHTaMH cKrum" B TeMBO->KCJlTbIM HJIH KopwlHeBblH 11.UCT; BTOpblC - yn mmeH -
HblC no cpopMe, nOKpblTbl rpy60H 060J10'rKOH C HCpOUllblMH 3y611.aMH, Gonee npo-
3pa(IHhr, t.leM OIlJIO}J.oTBopeHBbJC (nl1]1,Hbl KpynHblc >KCJITOtUlbIC KJ1eTKH). Hanwme
B npcnapaTe TOJ1bKO BConJ10AOTBOpC HlbIX 51H11. cUHJ eTeJ1bCTBYCT 0 HH3KOM HIlTeH-
CJ.1BHOCTI1 HllBaJIH1 (OTCY "CTBHH C<\M11.on). C'IeAycT HMeTb B UHJ y, '1'1'0 SlMI\a
Ancylostoma duodenale H Necator americanus MOp<p0J10rJ"ICCKH Hepa3JI11t.IHMbl.
, JI.ua ul1J\a HeMaTo -6HOreJ1bMHHTOB, ROJ6YA ITCJICrl TOKcoKap03a H aHlnaK 1A03a,
AHarHOCTl1pYIOTCSlI1MMYHO.'1oru'lcCKUMI1 (CM. pa3J\c.'1 11) H rHCTOJ10rH'leCKHMH Me-
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HbIC. tJcJlOBCK A1151 6oJlbWI1HCTBtt IJ,CCTO]l, 51BJ151eTC5I OKOHlIaTeJlbHblM X0351HHOM (na-
pa3wrupYlOT BJpOCJlhlC OC06H), }J.JISl3XmIOKOKKOU - npOMe>Kyro'IHbIM (napa3HTHpy-
10'1' B J1U'IHHo'rHoH cTagI1H). 133pocJ1ble CTaAm1 l\eCTOA npoAYI\HPYJOT SlHI\a (AHamo-
CTlf'IeCKHC CTa,TJ,IH1), 0 HaJIIJlIlfH J1WU1HOt.IIIbIX CTa){HH 3XHHOKOKKon CYA5IT 110 pc-
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Taeniarhynchus sagimuus it JICIfTCI a lIH1pOKOro - Diphylobothrium latum) npoBo-
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arHOCTHKH TpcMaTo)J,OJOB: 13 OCTpOH CTa; I1H mma3JUf, KOTopaSi MO>KeT npOAOJ1>KaTb-
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B ta3Ke KpOBJ.t
PUC. 6. AMacTlirOTLI
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lUlTa lII. OKp<1.llICHIII.IMII II Kpacllblil LlBCT; B}l0.11,
IIII)I(IIC("O KpaS! \1IIt.:puopnuuBMa MO)l(IIO YlJlIJlCTb
HltpO: oKpacKa TpllxpollmM.
OIIIIOSt,{CpmUI LlIlCTa E.hartmanni. l."lCAa: RlIIlIII.1
r11lIKO"CIIOIliISt U:tK)'OJlb II XpO\laTOIII1HbIC TC;Ia: 01\-
p..cKa TpIIXpoMOM. Cupana: lJJl,lIIbl xpO laT0I1I1Hble
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IIII I J\IIPOM B CI)OK}'CC II xpoMaTOII'\lIbt\IU n:11a,.,m:
oKpilct.:a ;+;C11C3HbIM rCM3TOKCII."lIIllO\1.
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\IOM. Cllpmm: oKpaclm )l(C:JCJHbIM rCMaTot.:CH11H-
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PHC. 1 I. Entamoeba histolytica H Entamoeba hartmanni (opnrlman B03)
OopaTII1'C AIIIIMillUle: RCe \lacul1Hfilthle .1(IHCI'!KII (-) = 10 MK'"
..
A 3pc.la)f Ll(IC1'a Entamocba coli. CJlCBa: HeOKpaIlICII-
Hbl([ npClJapil1' C OpMaJll1HOM_ CnpclBCI: HaTliAHMII
npenapa1', OUpclOlYTaHHbifi paCTI!Opm, jlK)r01
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06pa601'3nlloM paCTBopOM JlK)rOJl . 06pa1'IITc
BHllMaHIlC Ha IIi1JIIt'JIIC B Ka>KAol\ 1,(fCTC r11lIKOreHO-
BOil BClKyom1. OKpilWCIIHO([ B KOP"'IHCI!"IH LlRC1'; 1!-
po B 1J01t06HbIX npenapaTilX OObl'IHO He IU1J!IIO.
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CJlCAa: HlIcr(l. oKpalllcHHaSi pacrcopoM JIK)ro.1A:
BIIAHbl 3 113 4 I!)(ep. CnpClBa: 3 1\lle 1 "I. B Be PXHCI1
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11011 MCMopaHc.
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110M TPHXI)()!.IOM. UilK}'OJ1b BltnHa IIC I"C1K )lCHO. KaK
cllpaca. Ha npcnapa I c. OKpaWCHHOIl1 >KC.IC'jlfhIM rc-
Ma rOKCIWHHOI\I; npu A31111hlX OKpClCKClX XOpOIIIO :m-
MC7HO O}tIIllO'JHOC RIII)() e Kp}'IIIWii KClPI!OCOM<u1
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nOJIIl)llOwaR npaKTlI'lcCKII Bce RApa. II Hc:ma'iH-
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Ha - ,'I.113rIlOC lII"IeCKIlC KplITCpllli. 1I(J"JI!OJ1RlOlI\IIC
(U!CHTlt HLtHpoB31 t. E.nanu.
PI1C. 12. AMC6hl-KOMMeHCaJ1bl (opnnmaJI B03)
OGpaTHTc DHilMaHlIC: IICC \!CIClIIl aUII..IC .IIIHd1KII (-) '" HI MK I
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CJICIJCI IIOfI Ma.I"I.\1 )iIlCJIII'ICHIIC\I. XOp01ll0 Rl1JlH3
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)iUCJ1I!'ICHIIC\1 CIIB3 BI1;tHbl HI pO \I LlIITOCTOM.
l.{B)iSlIICpllt.ltl rpO(J)0301IT DiellIamoeb,1 fmgili...
m:pamCHHbU1 GO.lee \lSlrKO. IIIIIteH \IC)I(.IY
TpOCP03011TO\I E.histol,'tica (ClICpX)' Cllpal!il)
II MCHbllJCi1 OIIlIO!lJlCPlli)i1 IUIC j'OIt E.lustoh'tic.l.
COJ\CP)l(;1II1ci1 xpmMIT0I1J1.HbIC TCJ1a. OGpaTiITC
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KpYIIIII.Ii1 MiU:POIl)iK.ICYC IHUCH K3K ''''CToe
IIpOC rpaliCTIIO II npaBoJ1 'raCTlI ItllCTbl,
E TpOCP030llT Hxuli. MCTOJI MH(f)-KOIJIIClIl'pmlllll,
BHI111bl LlIITOCTOM 11<1 IICPXYlIIKC opr3HH"JMa II
UUJlblllOC 'IIIC roc npocTp.,HCTBO II "J<1J1HCII 'lacnl -
\taKpOH)'KJ1e}'c. Iia nOBCpXHOCTII MIIKpoopnlllln H1
BIIJlHbI pecHII'IKil.
PHC. 14. KHWe'-lHhle )KrYTHKOHhle II Balantidium coli B OKparneHHhIX
npenapaTax (opI1n1Ha.T1 B03)
06paTiITc BHlI"14I11ItC: BCC MaClIlTaUHblC .IIIIICiiKII (-) = iii MK"I
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IIpClI/tpiiT C OpM,tsnIllOM- Ma.'ICHf,KllfI pa'JloIcp
(4-6 MK"') II HC1J11I'U!C III-I}'Tpli OOlUICT 'ICpllbiX
I paHYll - IUICII'IIOC l'I1'ICCKIIC npllJHaKH 1111111101"0
OpraHII"JM<I"
I) OOUIIC rI,1 C'.paTVUm. KIICllOTO}'Croii4111IbIC. TIpil
PU"JJlltlJlthiX MOAII IIKC1UIIHX OKpaCKIi Ha
KltCllOTO}'CTOi'I'IIIBble MJlKpOOpraHII3Mbi OOUllCTbl
MOr}T OKpaWIII3C111.CH OT KI'aCHoro no pOJOl\O[-U
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nensis. Blla)f(lIbIC, IIpcnapaT C Op IaJHIIWM
(ClleBd). COjlcp)f(aT MHOrO'IIICJ1Clltlble C CpIl4CCKIiC
Tella, CllpaBa, npll (jOJlhWC 1 YIJC.U\4CIII1I1. BIlAHa
CliopyrmpoBaHHcUI L(lIC'Ii\ C 2 CIlOpOIiIlCTaMIi.
HCCIIOp}'J111pOBaHHbIC Ol1LlIIC I"bl C.ca)'ctancnsis.
KIICllOTOYCTOII'"lBbl\:. n pll l1aHtlofl oKpacK\:
OOUI!CTbl oKpawllllaloTcfl pa3n11'IHO - B Kpacllblll
UBCT. rOJlyuulla"II,lflll.'111 COBce 1 He OKpllWIII!:1I0TCH.
3'1 it 'lepTa JlIIX oo.'1ce KPYUHbli'! pa:JMcp (8-10 "'KM)
no",oralOT AllqxpCpcllUllpoHaTl, I!X C OQL(lICT<lMli
KplmToCnOplllt11H.
PI1C. 15 (A-r). KmllellHblC KOKl{MJ]JUI Ii MUKpOcnOpH,[I,HH (OpHfJ.1HaJ1 B03)
()(jpaTIlTc BHII"HUllle: Bee \I,\l'llITilUllhh: .IIUII:ii,," (-) = I!J \II-. I
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1110p HIJIltIlO L OllllllC '1.1 III.!'l":JUIIO I"CII C III<:",IJIIUIMII
Hcenopy.l II po Bali 111,[\11I II JHa 'I liT.. ;11,110 flOJlhlllllX
pa:nlcpOB. 'IC.\I OOI IICTbl "pUll rocnop"'UUI 11.11I
UIlt;JlOCllnphl.
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Dupa I II 1"1: lulltMalll'c lIa IIX \I,' ICIII."II&.: p.nMLfJl.I.
XOpOlIlO IIpll)lCMOIIC I p"l)l!UallllhI&.: lIa IIpll.\ICPC
jlal1HhlX cnop \IIIKpOCnOpUjU1l1 II OC.i.,tKC "10'11I.
r
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S.lrl'ncy.;ti, 'Jl,"ci,'", B.la}Kl1blf\ IIpellapaT C
q,op\lamIllOM. TOIIKOCTl'HH,UI OOUIIC ra CO)lCp:+::11T 2
CnOplJIlIICTbl. OHa JIeI"K.' p.np 'lIIa&.:TCIi. III1J'"\lY
II IIJc"aJIIIIIX 'lac 1"0 oOllapY:+::ltllalOIOI cllouo'lllhlC
Cuopollm: 11.1 (""I-. 1,ICCb). P;:UMCpbl OOUlICT IICl X
IIIt,lOB Sarcm:y"ti.. IIplI().lll m n.'JlbIIO OII1I1W"OIlhl\:.
:1 ("!lOP'" ""'1111&.:'11I1.1' \IIIKpIJCIIOpllllllli EnlcnK}'lo.ll)UII
bicilcusi 11.111 Sept,lId inlc"lInalis II IIpCll<lpHTe
o\ipauo 1";111/10.\1 Ka.lbKO(I),lyoIK)M 6c lL,IM- KOH UOjl
.lbTP;\(I)I[o"ICTOllbl"IU JIY'I<I"III. MiI.lcnh"lIii pa }M'-'p
ooonx IIIt/lOIi "pCIIII rcmyc"I" II' CIICI IIq,II'I(,CKOII
1I)1&.:IIIIUllltKallllll II ,I.IIIIIOM IIp''lI<ipaT''.
Pue. 15 CD,-3), Kuwe'-lHLle KOKl.\l1gHlI II r\"1I1KpOCTIOpIlHmr (opunam.l B03)
06P;ITlHC 1111I1\1211111::: Bec MaCWTaOllhlC JIIIIICnKlt (-) = 25 \lKM
.
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lOT Oo.lce BbITfill)'TYIO q>oP\lY, SHill!) tlaXO,lIiTCS! B
n03l\lIcii CTa/um l p06l1elllulllpll IIpOXOJoK,UCHlIII B cpc-
KiUlIIHX.
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HOCTlipYCTCII 110 IIpIlC}'TCTBYJ() B q>CKil.IIIIIX p<IUI\II-
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20 MK\I. .:lI1'IIII1KIIIIMCIOT KOpO'lK}'IO POTOBYIO K.:1.n-
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nalOUIIiH nO.'lOlIuii ,!<I'IaTOK (nOKa'JaH CTPC:IKoi1),
PMC. 17. }J(II{a HCMaTO (OpnBmaJi B03)
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II )llla\lC I pc. rO.lcnul OUOJIO'II<.I. CO,ICP)l(ClT :,)MOPII-
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KOpll'IHcBoro LlBCT<I. C TOJlC1'OII CTCHKOil.
B <pCK,I.'IIIJ1X II MOKp<.rrc lie COIICp"'"T 3I1pO,{blwa.
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He C01ICp)KaT 3MGpIlOH<I. Ha CTCHKC npOTIiBo-
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KpocKonH"llccKOC I1CCJ1C].1.0naHHC. 13 HOpMC MOLla COJIOMCHHO->KCJITOrO U,nCTa, npo-
3pa"lJHa. J],IlSI 11."aruoC1'IKI MIIOrl1X napa:u1TapHblx nopa>KeHl1ti MO"lleBbIAemnenb-
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n01l0nOM Tpl1XOMOH03C MOlla MYTHaSl, IIpl1 cpl1J1S1pI1I1Jlo3ax B PC3YJ1bTaTC XI1J1ypHI1 -
MYTHaSi. MonO"lIHaSi. npM MO'ICnOJIOBOM 111I1CTOCOM03e - KpacHaSi I3C!lc,Ucnmc rCtvta-
rypl1H.
7.1. JIa6opamoplll)ll ()uallI03. napa311TOJIOrl-f"lICCKOe MCCJ1CAonaHI1C MOlm Ha-
npanncHo Ha BblHBnCHI1C HMO. Schistosoma hacmatobium J.I Dioctophymc renalc. Jt13-
peJu<a n ueM MO'Yf 6bl1'h 06l1apY>Kellbl Tpocpo:ml11'bl Trichomonas vaginal is, lJ,UCTbJ
Entamoeba histolytica 11 MHKpocpl-1JJSlpml Wuchereria bancrufti It Onchocerca volvulus.
CJ1C,UYCT I1MCTb n nHJ1.Y, lITO HCKOTOpbIC I3I1Jtbl npoc rci1IlUlx, 06HapY>KI1BaCMbIC n
MO"lIC, MorYT 6blTb CJ1C].1.CTBJlCM 3arpSl3HCHI1S1 CC cpCKanmlMJ.1 111111 nJlara.rII1IlJ,HbIMI1
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Ka rOTOBSIT npcnapa1'LI Ha nOKpOBllblX CTeKJ1ax. npenapaTbl I1CCJ1enYIOT n Hanm-
HOM HnH OKpalllCUHOM BI1J].e.
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1'013 npl1MCIISIIOT }\Ba MCTO,Ua: OCa>K,UCIII1C 11 cpl1J1h1'paL\ltlD. MeToA oca>KAeUI1S1 MeHee
IlyncTBI1TeJ1bHblt'l, HO 60J1ee Aelilenblt'l 11 npacToH B nJ.mOJIIICtulH. MCToJ\ cpMJIh1'pa-
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II UlLIC lIaJlOllKI1, UJTaTH13 l\JUI npo6l1poK, j\J.tCTMJ1mtpOnaHua51 BOAa, 10% pacTBop
Cj\Koro HaTpa.
Z3.2. Xoo llCcAcoooaHlIR. MOllY c0611palOT 13 IICpHO,U l.laI160Jll>lIIeH aK1'l1BHOCTU
06C11c.u.ycMoro - C 11 J],O 17 '!acon }J.H}I. B KallCCTBC np06hl J1JlSl HCCJ1eJ],OBaHI151 HC-
nOJIb3yeTcSI TCpMI1I1a.%HaSi nOpl\l151 MOIIl1 06"be1\10M AO 10 MJL KO;IH ' ICCTI10 HUll
S.hacmatobium B npo6c MO"l1H yneJlI1'II1BaCTcSl nocJlc OllpC,UCJlCIIHOH lIarpY3KU Ha
MI>IllIlJ.bl oplOumoro npccca. nO::rroMY IICPC1 n3S1TUCM MO"lU1 06CJ1eAYC\10M)' pCKO-
MCU.u.YIOT CAeJIaTL 20-25 npI1CcJ],aHI1t'1 HIII1 COBCpllll1Tb np06C>KKY Ha 100-150 M.
npM 3TOM YCJlJ1I1BaCTCSI B03ACikTBI1C MblllllJ, 6plOlilHOro npccca Ha C1'eHKY MO"lICBO-
ra nY3hIPSl, "lITO cTI1Mymtpye1' BhlX011. SlI1lJ, S.hacmatobium B npocne1' MOIIC130rO ny-
3bIpSi J.-I nonbllllaeT BCpOSITHOCTb J.tX 06HapY>KCHHSI. J.1CCJlCAYIOT TOJ1LKO Cl1e>KYlO
nopU,mo MO'II1. B TCX cnYllaSlX, KOr].1.a 31'0 HCn03MO.>KHO, B MOI.IY peKOMC I}I.YK)T ].1.06a-
BJ1S1Tb KOHcepnaH1'hl, cnOCOOCTBYlOLI\He J],J1M1'eJ1hHOMY COXpaHeHl1lO SlHU, S.hacmato-
bium (HCCKO.%KO CYTOK). HaM60JIce npOC1'blM 11 AOCT)'nHbIM KOHCCpnaltTOM SlBIISI-
CTCH cpOpMaJIMH. pa60"lIaSI KOHU,cHTpau,MSI KOToporo nOCJle J..106aBJ1CJlI1S1' B MOllY
J..lOJI>Klla Obl"l L 13 npCHCIJaX 5%. npOlJ,C.u.YPbl 13 JIaOOpaTOpl1l1:
1) ,il,oC"raBJlCHHYIO npo6y MOlll1 B36aJIThmalOT B TC l lCHl1e 30 CCK 11 1)'1' >Ke HaJlH-
BalOT no 10 MJ1 B MapKHpOBaHHhle KmUtlleCKue U,eH1VI1CPY.>KHblC np06npKu.
290 TOM 11 - YACTHbIE AHAJU1TI11.JECKI1E TEXHOJIOfl111
2) Ocnmmll<IT np06bl Ha 1 IaC HJlSI 06pa30llauHSI ocaAKa. C;ll-malOT mmOcap,Otl-
Ii)' 10 >KJ.1HKOCTh, oca;..{OK LlCHTpHcPyrl1PYfOT B TC'ICI-mc 2-5 !\-ntH np"1 1 000-2000
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CSI OCi:iJlOK KpacHoro Ll,BCTa. BI-i,lJ;J.1MbIH HeBoopY>KCHHbIM rJla30M. H3J\OC311,O IHYI0
>KI1,1J;KOCTh oCTopmKHo CJIJ.1BaJOT. nacTcpOBCKOrl nl1neTKo i 6epYT KanJifO oca]J,Ka, t
ncpcHocSiT ee Ha npe,lJ;MeTHOe CTeKJlO 11 HaKpbJBaJOT nOKpoBllhlM CTCKJIOM.
3) fOTOllLlf'I npenapaT I1CCJ1e,lJ;YfOT nOA MI1KpOCKonOM. SH11 a S.hacmatobium
TpYAHO pa,JnJ1LII1Tb Ha cjJOHC 60Jlb11l01"0 Kom1 lecTlla 3pI1TpOLl,I1TOB. Ami YJIYtllllCHHSI
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pOU.I1Tbl nOJIHOCThIO rCMOJII13HpYIOTCSI (KoHTpOnI1PycTCst no 113MCHCHI11O u.BeTa Mo- ,
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IJCpCHOCSIT cc Ha npc]],McTHOC CTCKJlO 11 HaKpbJBalOT nOKpOlUILIM C rCKlIOM. f01'O-
Bbln npcnapaT I1CCJICSAYfOT flOA MHKpocKonoM. KatlccTBO npcnapaTa 3Ha l mTeJlbHO
Y!IY'IllIaCTCSI 3a C ICT npOCBCTJlCH..1S1 cP0Ha It SJ.i'u\a S.hacmatobium 60JIcc 33MCTHLI.
06HapY>KCHUC SlI1L1, 06jICr IaCTcSI ]J,06aBJlCHI1CM K npenapary 1-2 KanCJlb Jlf06oro
KpacHTenSJ., KOTOpblt'1 I1MCCTCSJ. R Jla60pa'f(>pJ.1H (pac"mop JlJon>IIS1, MCTJ.1JJCHOllOH
CI1HbKH H T.]],.), 6J1aro,lJ;apSi IICMY COJnaCTCSJ. onpcAcncHHhlfl I\BCl'OBOfl cPOIi H oOJ]cr-
llaCTC5I Bb]SlRJICHI1C SlI1I\ rCJlLMI1HTOll.
7.3.3. npl.lHt{I_m Mcmoou ifjlUlbmpat(Wi - KOHu.eHTpal\l1S1 SlI1I\ S.haematobium
(I1JII1 MI1KpOcPl1J151pHf'I Wuchercria H Onchoccrca) nYTcM cPHJJLTpau.m-1 Mo'm 'ICpC3
qnlJlbTp, IIC IIponycK3101I(lIit SlHu.a ..1 JII1 I II11IKI1.
7.3.4. Xoo llCC.IlCOOfJQHtiR O.llR. o6/--lUpy.1KCl--llLfl R.UL{ lllllcnWCO,M:
1) nm.1Cl1\aJOT B j1,Cp>KaTCJlh cPl1J1hTpa 1I0JH1Kap60HaTHbl i mil-I Het'UJOHOBblf'l I
cPlIJu;rp (paJMCpbl SI'leeK no 12-20 MKM). MoryT 6blTb I1CnOJJh30BaHbi 6YMa>Kllhle
cPl-IJlbTpbl (BaTMaH N 54111J1H N 1). TIcpcMClIIl1BalOT IIp06y MOIIJ.1.
2) Ha611paloT R IIlllpJ.1L\ 10 MIl MO'1I1 ..t npl1KpenJlSlIOT K OCHOBaHl11O llJ,npl1Lla ACP-
)KaTC}Jb cP..1JJb Tpa.
3) D,ep>KaT nOJlY I IJ.1BIIlYJOCSI KOHCTpYKLI,J.1IO lIaJ\ JJOrKOM H cPl1J1bTpYIOT MO'IY J.13
umpm\a IICpC3 ]J,cp)KaTCJlb cjJl1J1bTpa. 1
4) OTBIUI'IHRaIOT ACp>KaTeJlb cPl1JIbTpa, BblHl1MalOT nJ.-IHU.CTOM cjJHJlbTp 11 KJla-
AYT era I3CpXHCH nOBepxHocTbJO BBCpX Ha npC}.1MCTHOC CTCKJIO.
5) HaHocm' Ha "pCAMCTlIOC CTCKJlO Kanmo paCTBopa JIlOroJiSI U >KJ1.YT 15 ceK
nSJ. OKpal1lJ.1BaHJ.1S1 51U1(.
6) TIpl1 Ma..rlOM YRc..rm l lCIIJ.1J.1 (061)cKTlm x 40) Hccnc]J,YIDT BCCb cPl1J1bTp. 51rIu.a
UHICTOCOIII OKpaI1lI1BaIDTC B OpaH>KCBbJfl UBeT I1I1X JlerKO o6HapY>KI1Th. MIiTCIICJ.1B-
HOC"'b mma3HH onpCACJlSJ.IOT 110 IIJ.1Cll}' stuu. Ha 10 f>,UJ MO'IH. AJJSI 3TOro o6llJ,ee tlllC-
!IO o6Hap}'>KCHHbIX 11U. ,lJ;eJlSlT Ha 10. ECJIH 06"beM HCCJJCJ1.ye",toH MO'1I1 6b11] MCHLWC
10 MJJ, npuMeHSJ.IOT C!ICAYIOI1(CC ypaBHCHJ.1c:
a = (n : y) x 10, r]J,c
a - ntCJlO SlJ.1L1, Ha 10 Mn MO'II1,
n - I}ItCl10 06H3PY>KCHHbIX smu.,
Y - o6-heM I1CCnCj1,OBallllot'1 npocPHJlb1'pOBaHHoH MOIIl1.
(
...
METO,lJ:bI Kfll1HJtP,lECKOI1 nAPA3l1TOJIOrl1l1
291
r
B COOTnCTCTBJ1I.I C U1C.TJOM 06uapY>KeHHblx SU1H MO>KHO onpC Cm1Tb CTcnCHb HlI-
Ba:nm: cna6as:! I1HBa3HSI - 1-49 SUIIJ, Ha 10 MJT MO'UI, TSI>KCJTa I1HBa311S1 - 50 miLl, Ha 10
MJI MO'U1
Z3.5. ffoeHmucfiuKat(llR RLU{ S.hacmatobium npOOOJ-\SlT, Opilel-lTHpYSlCb Ha HX
r.mpKepbl, nll)\I1MbIC Ha pHc.16 1-1 18.
Xoo llccileiJvaaHlIR Ha MIIKpocp11nSlp1H1 au.UIOrI1 I ICH, 3a IICKJllO ' leHHeM Hma
cpl1nbTpa: OH A{)JT>KCU 6blTb HCrmOHOBLIM C pa3MCpal\H1 nop 3-5 MKM. OCa)J,OK MO'IU
!fa Bce 06'beKTLI MO>KHO npOCMaTpl1BaTh K3K 13 HaTHOHOM Ma:u<c, TaK II 0 OKpamCI-I-
HblX npcnapaTax.
8. MOKpOTD
MOKpoTa - naTO.TJOnl l ICCKOC oTAcnSlCI\'IOC AbiXaTeJTbl-lblX 11)' ren - ncrKHX, 6pOH-
XOB, TpaXCH, ropTaHH, Bbl:I,enSlCTCSI IIpl1 K.UllJTe I1.TJU OTxapKHOaHHI1. K MOKP(HC, KaK
npammo, npHMCllIl1BaCTCSI cm13L 1-23 ropJla unu cm-OHa. n03TOMY MOKPOTY OllCnI.
oa>K-HO npaBHJ1bHO c06HpaTb. lJ,cncHanpaBJ1CHHO MOKPOTY IICC!leAYIOT Ha HaJU1tHtc
n HCH Ll,I1CT nHeBMOUI1CT 11 SlI1l\ lIaparOHI1Ma.
8.1. C60p II o6e33apa}f{IIBaHlle. CBC>KCnhmCIICHHYfO MOKpOTy C06Hp<UOT n 'm-
cryl{), CYXYID nocyAY, tlaW;C Bcero n '1aIlIKY OCTpl1. MOKpo-ry nY'lllle co6HpaTb yr-
pOM, HaTOU\aK, >KenaTeJlhHO CWC AO npl1CMa JUIW;I1. ncpc1I. c6opm." MOKpOTbl Heoo-
XOAHMO Tw;aTenbHO npononOCKaTh pOT. B cny'rac 3aTpYJ\.ICHIISIIl0.1YIICHI1 MOKpO-
I"blI1CnOnb3YloT lIaponblc I1nH Y.'1bTpa3BYKoBbIC IIHraJ1S1LllUL Omi oc06eHHo nOKa3a-
Hbl npl1 J.IccnCAonamm MOKpOThl Ha HaJII1 t ll1C IlI-1CnMOI\HCT. EonbHoro B ::rmx cnYlJa-
}!X Heo6xoT\HMO IIpeAynpe>KHaTb 0 He>KCJlaTCJlbHOCTH UCn0J1h30BaUUSI 3y6HblX naC-l",
TaK KaK BXOASlW;UC I COCTao nOCJIC)J.IH1X KOHCCpnaliTI.1 IIpCTls:!TCTOpOT XOPOIllCMY
oKpalUHnamno npenapaTOI3 MOKpOThI. C I\CJlbfO 06HapY>KCIHISI JlHCnlllOLl,HCT MOKpO-
ry H)'>KHO npocMaTpHoaTb HCMCWICHUO, 0 Kpa lIcM CJIY'lac 'lepe3 1 4 ttaca. nOMec-
1'110 ee npH 3TOM B xonOj\UJlbHI1K npll +4°C, TaK KaK npu nOJlrUM CTOSiHJ.U1 MOKpOTbl
pa3BJ.maCTCSI 6aKTepl1aJlbHaSi cPJlopa i1 p.\JpywaKJTCSI KJICTOtlHblC 3neMClIl'bt, 'ITO
llCCbMa 3aTpYHus'ICT H1KpOCKOlll1pOOaHlic. MaTCpII a!1 J nSl I1CClIe}1,0l3am1S1 Ha Harm-
'me mlCOMOLl,l1CT >KCJtaTcnbHO nonY'taTb MeTOADfI,1 6pOUXO<lJlbBeons:!pHoro .!tauC1>Ka.
Bo BpCMSI nponeAeHHSI 6POHXOCKOJlI1H, noc.!lc YCTclHoBneHuSi 6pOlIxocKona n yC"n,
O.QHOJ'O H3 cy6ccrMcHTapHhix 6pOHXOB, OCYII\CC rBJISlCTCSI I1HCTHIIJI}ILJ,USI n J I1CTanb-
Hble OT}1,CJlbl 6pOHXI-1aJlbiiOro Acpcna TCllnoro cpU3110Jl0rJ.1'ICcKoro pacTnopa C JlOC-
JleJlYlOw;erl ero acnupaUHerl. AcrmpaT MO>KCT 61.1T1, pa3J eJlCH Ha 3 nopltl1u: OPOHXH-
aJlbHblM, 6poHxoanbneonSlpHbli't 11 a.1bncOJISlpHbIM. OO.IIY1IellubIH acrmpaT (naBa)/(-
HYIO >KJ.1}{KOCTb) TaK>KC pCKoMeHAYloT J.1CCJ1eAOOaTb IICMC!VICHHO. OmicaHo Jl.rm C110-
c06a BpcMcHlloro coxpaHclHlSI r.mrepmuta: a) JlaBa>KHYKJ >KlI KOC I'b cm-malOT B CTO-
Slll{YIO no .'lbAY nocy}\y C 50 Mn pacTBopa XellKca (KOMMCp'lccKoro, pH=72-7,4); 0)
naBa>KHYKJ >KU}1,KOCTb OXna>K,' aIOT AO +4°C, nOCJle 'Iero 0 TC'ICHUC HCKOToporo npc-
MCHI1 cc MO>KHO HCII01lb300aTb )\nSl .D.onOnHI1TCJlt.HblX HccJle oB3HHH. OGc:napmKI1-
BaHI1C MOKpOTLI, J1aOa>KHoi't >KlIAKOCTI1 11 JlOCYAbl, B KOTOPO" OHI1 HaXOT\HJTlICJ., npo-
Ji3nOA}!T Kl1n}l'ICIIHCM H aBTOKJlanl1pOBaHJiCM HJU1 C J10MOW;blO ne311HcPl1LJ,IIPYfOW;UX
pacTBopoB (5% XnOpaMl1l1l1 AP.).
8.2. nOpJl OK IICC.:JeAOB3HUJI MOKpOTLI. MOKp01 Y p,nmmmOT B tlaWKI1 DCTpn
TOHKI-IM cnOCM, paCClltaTpHBafOT Ha CnCTJIOM 11 IICpHOM ( OHC. OT611paKJT 'laCTIII{J.1
113 «p>KaBbIX» 06pa30naHl1H, 06PbInKI1 TK3111111 Ap. Ha npC}1,MCTHOC CTeKno, pacnpa-
u v
DJISIIOT OCTOpO>KHO npcnapOBaJlbHOll unlOH, HClKpbIBafOT nOKpOBlfblM CTeK.TJOM H
(
{
t
292 TOM II - l.JACTHbIE AHAJIJ.1TJ.1t.IECKJ.1E TEXHOJIOrJ.1J.1
npOCMaTpHBalOT nOA MHKpOCKonoM. npH 60JlbWOM cOJWP)l(aHHH nlOH H CJTH3H MOK-
P01y JlY'-JIllC CMeWJ.1BaTb C paBHblM 061>eMOM 2% COAbl HJU1 0,5% pacTBopoM KOH
11.'1H NaOH. nepeMeWUBaTb, BCTpHXI1BaTb B Te'-ICItHC 5 MJ.myr, nOMclllaTb 13 repMo-
CTaT I1JTI1 B BOASIllYtO 6amo Ha 3 MI1ItYTbl, CHTpl1cpyrl1pol3aTb 2-3 MI1Hyrbl co CKO-
pOCTblO 1000-1500 o6hufH; J.13 oca}1.Ka npHroToBHTb npenapaT 11 HCCJ1e1l.0BaTb non
MJ.1KpOCKonoM. n pOBO]],SlT MaKpOCKOnl1'leCKHe (c LleJlblO mY'-leHHH cpl1311lfeCKI1X
CBOHCTB MOKpOTbI) 11 MI1KpOCKOnH'-leCKJ.le napa311 r0J10nl'-ICCKHC I1CCJICAOnaHJ.1H_
npH MaKpOCKOnU'IeCKOM I1CCJ1eAOBamUl MOKpm 1,1 06palllatOT I3HJ.1MaHI1C na ee
3anax. np03pa'-IHOCTb, I BeT, KOHCI1CTCH I1IO, COCTal3HLIC 'laCTI1. no KOHCJ.1CTen I1H
MOKpoTa 6bIBaCT: a) CJ1113I1CTOH; 6) CJ1113I1CTO-rHoiinoii; B) rHoflHoft; r) KpOBSlHI1-
C roti; A) KpOBSlHI1CTO-CmI3I1CToH. npl1 Onl1CaH1111 KOHCI1CTCHl_\1111 MOKpOTbl npHlISrl'O
npe06J1a;J.atOllll1ft cy6cTpaT CTIi/niTb Ha I3Topoe MCCTO. KOHcHcTeHLlI1S1 MOKpOTbi 3a-
I3I1CI1T 01' ee COCTaBa: npl1 HaJ1H'-ml1 cm13H MOKpoTa, KaK npal3l1JIO, BH3KaH ('-lalllC
Bcero lIa6J110AaCTCSI npl1 nHCBMO I1CTo3e); )l(I1AKaSi - npl1 HaJIH l ll1J.1 cep03Hofi )1(1111.-
KOCTI1 (npl1 naparoHHMo3e, aCKapH1l.03C 11 )J.p.), CJ1J.13I1CTO-I'Hot'lHaS! npl1 HaJ1If'II1H
rHOS! (npH aMc6HoM a6cLlecce J1erKoro 11 AP.). LI:BeT MOKpOTbl 3aBI1CI1T OT CC xapa-
KTepa, T.e. 01' npC06JIa)J,aHlIS! Toro HJ111 I1HOrO cy6cTpaTa, '-11'0 npHAaeT eft TOT HJ111
11 Hofl 01''TeHOK (cepOBaTO-CTeKJTOBH1l,HbIH 3a C"ICT CJH1311 npl1 nHCI3MO I1CTo3e. SlH-
TapHO-)I(eJ1TaS! npl1 HaJlI1'-IHH npl1MeCI1 )l(I1AKOCTI1 H3 3XI1HOKOKKOBOH KHCTbI, KpO-
BSlHI1CTaH npl1 naparOHI1M03e) H OT BALlxaCMb]X "taCTI1 , OKpaWl1l3alOl.U,HX MOKPOTY.
061>eKTbl, 06HapY>KHBaeMb1e npH MHKpOCKOnl1"ICCKOM I1CCJICnOl3aHI1H MOKpa!'bl
if J1aBa>KHOfl >KI1AKOCTI1, npeACTaBJ1eHbl B Ta6JTI1I. e 6.
Ta6mlila 6
06'LCKTbl, o6l1apY)l{HnaeMLIC np.. MIIKpOCKOlll.-ICCKOM IICCJlC]J;OBaHHH
MOKpOTLI .. .1anIDKHOH 1KHAKOCTH
UPOCTCUWHC
Pneumocystis carinii
Entamoeba hisrolytica (peAKo)
Entamoeba gingival is (peAKo)
Trichomonas tenax (peAKo)
Toxoplasma gondii (PCAKO)
rCJlbl\-IHHTLI
Paragonimus westermani
Echinococcus granulosus
UUCTbl
Tpo(pmoln hi
TpOcpO"JOIfThl
TpOcp0301tTbl
TpocpmOIlTbI
Strongyloides stercord.lis
Ascaris lumbricoides (peAKo)
Toxocara canis (peAKo)
Ancylostoma duodcnalc (PCAKO)
SI i:'ILla
CKOJ1eKCbl, KplO'lbSl, 06Pb1BKJ.1
HapY>KHOfi 06oJIollKI1
JII11.U1UKI1
fll1'JHlfKU
JJ If'mHKIf
fllt'IIIHKlt
JJ:J1S1 _.,UKpoCIWnU'leCKOlO HCCJ1ejJ,oBaHuSi 06"beKTOB, npeACTaBJ1eHHbIX B Ta6J1H-
e (B TOM '-1J.1CJ1e 11 SlI1 napal"OHHMa) Heo6xoJl.I1MO npOC1v1aTpHBaTb MOKpOT)' MeTO-
AOM HaTHBHoro Ma3Ka, B OTJ1I1"n1C OT 31'01"0 lVlSI BLIS!I1JICHJ.1H IIHCBMOI.\I1CT I1CCJTeAye-
Mbllt MaTepl1<1J1 nOABepralOT Cnel\ucpl11.leCKHM MeT01l,aM OKpaCKI1, paCC1vmTpl1l3ae-
MLIM III1>KC.
AJISI 06HapY>KeHI1S1 nHeBMO I1CT MOKpOT)' nOMell alOT B eHTpHcpY>KHYJO npo-
6UPKY C paBl.I.IM KOJIH ' ICCTI30M KaKOI"O-JH160 MYKomlTI1Ka (0.3% AJiTl1oTpeHTOJ1 B
r
I
METOJJ.bI KJII1HI111ECK0I:1 nAPA3J1TOJIOfI1H 293
(
0,02 M 3JJ.TA, pH=7,0; 1-2% NaOH 11J111 KOH; aLJ,CTI1J1LJ,HCTe m; 2% A 1MeKCI1]l, U
Jl.p.). nOJ1Y leIIHYIO CMeCb nepCMClllJ.1BaIOT CTCK!UlHHOM naJIO'-IKOH 11 I1HKy61-tpYJOT
npl1 37°C 13 Te leHl1e 5-15 MI1HYT. IOf\.1OrcHH:mpoBaHuYK> CMCCb pa3130:J,SlT paBHbl 1
KOJII1'ICCTBOM cpopMaJU1Ha 11 LJ,CHTpmpyrl1pYIOT 13 Te'-leHl1e 10 MI1HYT npl1 CKOpOCTJ.l
1500 06/MI1H. 113 c)'nepUaTaHTa roTOBSIT Ma3KI1 Ha HeCKOJlbKHX npCl-lMCTHbJX CTeK-
J1ax, OKpalJUmaCMblX p33J1I1 IHI.IMI1 KpaCKaMH.
8.3. OKpacK3 npenapaTOB. 06bJ'-1H0 npl1MCHSlIOT CKpl1mmrOnblC OKpaCKU, 110-
3B0J1SlI01l.lI1C YBI1:J,eTb COACp>KI1MOe 8-Sll\CPHOH LJ,I1CTbI (TaK Ha3bmaeMbie I3HYTpI1LJ,H-
CTHbJC TeJIbl{a), O,QHaKO He BbJSlI3JISIlOllll1e KJ1eTO IHYIO CTeHKY mICIIMOLJ,HCT. K HI1M
OTHOCSIT OKpaCK)' no POMaHoncKoMy-n1M3a, fpaMY, reMaTOKCI1JII1HOM-303I1HOM, no
PariTY. JJ.-'1S1 OKOH laTeJ1bHOM RCpl1cpl1KaLJ,HI1 mIC13MOLJ,I1CT npl1 1CmHOT C.'IO>KHble,
MHoro:mmHble, 3a'-IaCTYfO Tpe6YI0ll.lUC AnSI cRoero npOl3e]l,eHI1S1 Jl,OpOroCTOSlIl.lI1X
peaKTI1BOR, OKpaCKI1: oKpacKa TonYI11J,I1HOBbIM CHHI1M, MeToJ\OI\'l cepe6peHI1S1 no fo-
Mop"-fpoxOTI)', KpC311J10BbIM <lmO.'lcTOI3I,IM. C I1X nOMOll.lblO leTKO IUn}'aJ.II13npy-
eTCSI KJICTU IHaSi CTem<a LJ,UCT Pneumocysiis carinii.
OClloBHble MeTo LI oKpacKIi
8.3.1. MO.JI.11(j>HI{HpOBallllaH oKpacKa no POMaHoBcKoMy-fIl1\l33 (Walker el aI.,
1989): 1. nOCJle cpHKCaLJ,1111 13 CMCCI1 HI1KJ.lcpopoBa Ma3KH onycK3lOT Ha 10 MHHYT 13
cY J1hc l)aTHo-YKCYCHbIH pcarcHT (45 MJ1 JICAHHOM YKcycHoH KI1CJ10TbJ 11 15 f\.t:1 KOH-
UCHTpl1pOBaHHOi1 ccpHm1 KI1CJ10Tbl); 2. npoMbIBmoT Ma:iKH 5 M UIYT B IJpOTO'IHOH
BOAe; 3.oKpawHBalOT Ma3K1110% KpacHoH POMaH013CKOro-HtM3a B cpOCcp3THOM 6y-
cpcpc, pH=7,2 13 TC ' ICHl1e 30 MI1UYT.
Pe3YJlbnwm: OOOJlo'IKa U"CT OKpaWI1I3aeTCSI B Kpacuo-cpI10J1eTOBbIH L\I CT, KJIC-
TO'IHoe CO]l,Cp)f(I1MOe npJ.1 3TOM He BI13yanl13l1pYCTCSI. npOLJ,eCC OKpaCKU :mHI1MaeT
30 MI1I1.
8.3.2. OKpacK3 Kpllcra.l lHqCCKIIM (j>HOJ1eTOBbJM (J13BAoncKaSi M.B., 1994):
1. Ma KH, 3acpl1KCUpOnaHHbIC B CMeCI1 HI1Kl1cpopoBa, nOMcu alOT B pacTBop KOIU\CH-
TpHpoHallHo i cepHof'l KI1CJIOTbl (93,6-96,5%) Ha 10 MI-myr; 2. npOMbmaK>T MH:iKJ.l 13
IIpOTO'lHoti R01W 10 MHHYT. nblCYllUwalOT Ha B03Ayxe 3. CTCKJIa norpY)KalOT B 1 %
BO]l,HbIH paCTBOp KpHCTaJlJIWlecKoro cpI10JICT0130rO 4. 11361>1TOK KpaCKH YAaJ1S1lOT,
npOnOJ1aCKl1naSi OKpaweHHhlC Ma:iKH 13 20% BOAIiOM pacTBope CUS04 0 TCtlCHHe
10-20 CCKYHA; 5. npOMbmalOT Ma3KI1 B nporo'IHo i BOAe 1 II1I1H}'''}'; 6. OKpaJlJCHHble
\1a3KH nl.lCYJlJI1BalOT H3 B03J yxe.
Pe3YJlbmam: OOOJlO'-IKa LJ,I1CT OKpallll1l3aCTCH 13 cHHe-cpI10JIeTOBLI i Ul3eT. npo-
LJ,ecc OKpaWUmml1S1 3aHJ.1MHCT HC 60nee 10 MI1....
8.3.3. OKpacKa TOJlYII){lflIOBLlM CIIHHM: (WiLebsky F.e. et aI., 1988): 1. npena-
paTbi cpl1KCl1pyKYr 13 W% cpopMaJ1Ulle, CMbmaK>T 1J,I1CTI1JIJ1UpOnaHHoH B01J,OH: 2. Ma3-
KI1 onycKaK>T 13 cynbcpaTllo-YKCYCHblH pearellT (CM. Bblwe) Ha 5 MllHyr, aTCM noc-
IJC nepeMellJHBamUl pcareHTa CTCKJIHHHOH naJ10 l lKOll OCTal3JISIfOT 13 HeM ell\e lIa 10
MI-Ulyr; 3. nOAroTOBJlCU...LIC TaKI1M 06pa30M Ma:iKJ.l OKpalJJl1RafOT 0.15% TO.'IY"1J,H-
HOBhl"'l CI1HI1M (75 Mr TOJ1YJ.IAl1HOBOro CI-1Hero + 15 MJI AUCTUJ1J1HpOBamloI1 BOAbl +
0,5 MIl KOHLJ,eHTpHpOBaH.IOH COJ1S1HOH KI1CJIOTbl + 35 Mn a6COJIIOTHOro clIHpTa) 13 Te-
Ielme 3-x MI-1Hyr; 4. CMhlTb 13 IIpUTO'IHOH BO]l,e; 5. AOKpaCHTb 0,25% ROJl.lfhlM paclI3o-
pOM MeT3HI1JI0I30ro >l<C.TJTOro B Te'IClUtC 2-x MI1Hyr; 6. CMblTb 1136blTOK KpaCKU BOAOH.
Pe3YJlbmam: UHCTbI CI1He-qmOJICTOl3ble, TKaHeBbie 3JICMCHTbI 11 cpOH - :ieJle...o-
)KeJ1TbIC.
294
TOM II - l-IACTHbIE AHAJ1I1TI1LIECKI1E TEXH0J10rl1l1
I
flPUAlettll/lUe: KpaCKa MO>KCT IICn0J1h30naTbCH n TCllCHIIC rO]1a, q 1bc))aTHO-YKCYCHbl" pe-
arCHT HC fioncc tleM B TC'IeHue HeACnl1!
8.3.4. OKpacKa 110 rOl\lOpH-fpoxOTTY: L npcnapaThl GJHKCUPYlOT B 10% cP0p-
MaJII1HC - 5-10 MHHYT 2. npoMblBalOT j:\HCTJ1J1J1l1pOBaHiIOH BO.Qoti; 3. roTOBSIT 5%
paCTBOp Cr03. KOTOPhlM nOfJ,orpenaeTCSI B CTaKaHe AO 65°C, B nOfJ,orpeTbl l pac-mop
OL,ICTpO lIorp}')!(3lOT Ma3KH Ha 1 MHHYTY. CMbIBalOT J "lCT"J1JU1pOB3HHOH BOAOH;
4. Ma3KI1 onYCKalOT Ii 1 % pac'mop MeTaoHcYJ1bclu1Ta KaJutSi IIJ111 HaTpHSI Ha 1 1\1I111Y-
TY; 5. !fCLII1B<UOT paoo'HIH pac-mop ccpc6pa (25 MJI pacnmpa MCTCHaM..ma ccpc6pa,
KOTOpblU COCTOHT J.1J 100 MJ1 3% BOil,HOro MeTeHal\mHa IU" ypoTponHHa 11 5 MJ1 5% I
nOJ,Horo HlITpi.\Ta ccpe6pa) + 25 Mll fJ,I1Cn11IJIHpOUalfHOM B01l.hl + 2 MJI 5% BOfl.lIOrO
TCTpaGopan\ mrrpHSI (6YPbI) + 15 MJ1 HMeTI1J1cYJ1bcPoKcHAa). Pa60'll1li pacTBop ro-
TOIUlTCSi HCIIOCPC:,CrBCHHO IICpCA ynorpC6JICHHCM! B Hcro onYCKalOT MaJKI1. pac-
"mop lIoAorpCBaeTCSI ,0,0 90-95°C, IIOKa \ta3KH He CTaHYT TeMHO-KOpl1'meBhIMH, a
pac'mop - CBCTJIO-CCpbIM; 6. npOnOJ1aCKI1BalOT npcnapaTbl B 3-x CMCHax AI1CTJ1JTJH1-
pOB.mH0I1 BOAbl: 7. onYCKalOT Ma3KH B 0,2% BOAHblfl pacTBop XJ10pHoro 30JTOTa Ha
1 \UlIlYTY, CMblBalOT mtcTI1JlJlHpOUaHHoj:'J BOAOH; 8. onYCKalOT Ma3KH B 2% BOLl,HblH
pacTBop THOCY.'1bcPaTa HaTpHSI Ha 1 MHHYTY, CMbIBalOT ,'lucTI1.nJ1HpoBaHHoH BOJI.OH; 9.
OKpalJllmalOT CUCTJlblM 3CJlCHbiM (0,02 r J1I1XTrplOHa ::ICJleHoro 11 100 MJ1 AI1CTliJ1J1I1-
pOBa lHoM BOJI.hl H 5 KaneJ1h J1eJ\SllIot'1 YKCYCIIOt'1 KIICJ10Thl ) B TelfeHHe 5 MHIIY r, CMLI-
muo r NICTI1JlJmpOBaHHoii Bo}:(Oi:'f.
Pe;J} 'lbmam: lU1CTbi CBCT:IO- Il1nt TCMHO-KOPU'IHCBbIC (JaBHCIH OT TOJlll..ll1HbI
Ma3Ka). oKpyrnofr IUlII 6J1lOl1.1 eo6pa'-UlOrl cP0pMbl; oKpy)!(aloll,..lH CpOH II TKaHCBble
3J1CMCHTLI - JCJICHO-)!(eJlTble (pl1c.19).
.a!ISI 13bISlBJICHIISI IIOjlHcaXapll!{HOrO KOMIIOHeHTa B CTeHKC nHeBM01J,HCTLI He}J.aB-
HO 6hlna npe,'VIO)!(eHCt :\leTO,....HKa npHMeHeHIUI pe3KI..{Hli E3)-'3pa AJUI IIH!J.HKal lIIl
P.carinii D na1"OrCIIIIO!\1 !\131"CpIl3JIC (Ap.mHlkKII i P.A..1991): 1. nOMCll..lalOT 1\-1..\3-
Kl-I B 5 % pacTBop Cr03 npu 37°C Ha 30 \1HIIYT n TeMHOTe; 2. npoMblBalO'j' Ma3KH H
IIpoTo'mo i BOAC (HC MCHCC 10 MltHYT); 3.oKpaw..maIDT Ma3KU B TC'ICHl1e 45 MliHYT
peaKTl1HOM Wmpq)a. IIpl-lroTonnelille peaKnma WIf( QJa: 10 r nap03aHUJIlHIa pac-
TBOpSlIOT B 200 MJI IN HCI, MOOaBJlSlIOT 21 MJI AIICTI1JI-'lHpOBalllloft BOI bl U 10 I' MC-
Ta6ucYJlbQJ..n£t K£L1HSI. nOJ1Y ' leHHbIfi pacTBop xpaHSiT B TeMHOTC AO nOJlHoro o6ec-
UBe'lHBaHHSI (c0J10MeuHhlj:'1 OITeHOK), lITO }J.OCTl1raeTC5I B TelleHue 10-15 'laCOB; 4.
IIpoMblBmoT Ma3KII U npoTo'IHo i BOne 5 MI1HYT; 5. UOKpaWl1nalOT Ma3KIi 0,2% nou-
HblM paCTBOpOM CBe'mora JencHoro (BpeMSI nOJI.6HpaeTcSI onblTHblM nYTeM).
Pe3)lJlhmam: I\HCThl P.carinii oKpaunmaloTCSI B po:mBo-nypnypllhlfll BeT.
9. OTAenAeMoe MO"lenOnOBbIX nyreH
B MOlJCnOAOBhlX nYTHX 061lTaCT Cl\I1I1CTBCllllhIU npCfJ,CTamneJII. Prolozoa - YC-
nOBHO-I1£\TOrCHHbIl1 Trichomonas vaginalis. ABa APyrl1x BH.Qa TpI1XOMOHa,A. oG lTalO-
11 'II X B Opraml3MC (ICJIOBCKa, - T.inlcslinalis (huminis) II T.tenax (buccal is) HIUlHIOT-
CSI KOMMeHCaJ1aMI1.
9.1. Trichomonas \'aginalis y llaCTIl HllcPl1l HpOAaHHhJX I-1M UHHHBUJtOB Bbl3bma-
CT oc-rpblH 11111-1 XpOHH'ICCKHft Tp..IXOMOHOJ.
9.1.1. ElIo:lOnul. T. vaginalis - >KIYrHKOBOe npoc rCMUICC xapaKTcpHoii OB0l1J..l-
Hoil u:m rpymclulHHOH <I)()p\tbl, 4-13 MKM B 1{JIlmy II 2-9 MKM n IlUlpIlUY, IIMeeT 3-5
>KrYTIlKOB, no KpalO Te!1a pacnOJ1araeTCSI YHnYJ1l1pYlOll aSl Mer;16paHa, AOXOI Slll..laSi
u
METO,QbI KJU1HHYECKOM OAPA3MTOJIOrJ1H 295
npl1MCpHO AO nOnOnHtlbl Tena. 51J1,po O,l\HO. pacnonaraeTcS1 B nepeAHet'1 '-facnl rCJta.
Pa3MHO>KaeTcSI napa3HT npocTblM 1J,eneHl1eM, [ HCT He 06pa3yeT, npCI'CTaBneH 1'0.%-
KO Tpoq)o30HTaMI1.
PacnpOCTpaHeHHC nOBceMCCTHoe, nOpa>KCHIIOCTb T.vaginalis >KCIU.W1H COCTaB-
nSlCT B cpeAHeM 15-40%; MY>K'-II1H - CYIllCCTBCHIIO HI1>Ke.
nepeAalta B036YAI1TenSi oCYII eCTBJISlCTCSI nonOBblM "YTCM, JWTH HHOrJ1,a 3apa-
>KatOTcS1 OT MaTepl1 BO npcMSI pOAOB 11J111 '-lepC3 PYKI1, 6enbe J.1 BO UpCJ\UI TYcLTIeTa no-
nOBbiX OpraHOI3.
MCCJICAOl3aHIUO Ha HaJll1 l ll1C 3T0ro npOCTCMlllcro nOAne>KHT OTJ CJISlCMOe H3 ype-
TPhl, [ CPBHKaJlbHOrO KallaJIa, Bnaranl1l1 a, npOCTaTJ.1 l leCKI1£"1 ceKpCT. COACp>KI1MOe
napaypeTpaJ1bHhlX XOnOB, 6apTOJlHHI1CIJblX 11 CKeHeBCKHX >KCJ1C3.
9.1.2. JIa6opamopllas, i)ualllocmuKu OCHOBaHa Ha 1HKpOCKOnl1l1 HaTl1l3HblX
I3na>KHbiX npeliapaTOB 113 3KccynaTo13 nOJIOBblX OprallOI3 11J111 OCMKa MOlUj lIa lIamt-
lll1C nOABI1>KHbIX Tpmp030I1TOB, a TaK>KC OKpallleHHhlX npcnapaTOI3. B CBe>KeM Ma-
Tepl1aJ1C XOpOlllO BI1AHhl TpocfJ030l1Tbl, nCpC)'BHl'alQllll1eCSI «HepBHhIMI1», Acprmo-
IllHMI1CS1unl1 npblralOllll1MH J1,BI1>KCHI1S1MI1. l[yncTBHTcnbHOCTb 3TOro ft,-IeTOJ1,a )\OCTI1-
raCT 75-80%, cnel HQJH'mOCTh (B pYKax onblTHoro MUKpOCKofHlcTa) - 100%. Ha
3cpcpeKTHBlloCTb BbISlI3J1eHHSI rpHXOMOHa1J, Bnl1S1CT TCXHI1'ICCKI1 npaBl1nhllOC B:nrrHC
MaTCpH3J1a 11 cBoenpeMcHHblH ero npocMo ..p.
9.1.3. C60p npo6. BhIHCJICHI1S1 y >KeHII'11I! 6cpyr 130 BpeMSI fl1HeKOllonl l lCCKI1X
OCMOTpOI3 >Ken060l3aTblM 30HAOM, cfJOJIbKMaHoBcKoti JIO>KC'IKO i mll1nYTeM OTcaCbl-
B3HHSI '-lepe3 cTeKnSlHIfYlo Tpy60 l lKY C pe311ll0BblM 6aJ10H l ll1KOM }la K(mu,c (y ]\eno-
lleK C coxpaliCHHOH ,!],enCTBeIlHOH nneBOM). EcnH CYrnCJISlCMOC OlleHb CKYWIOC. TO BO
BlIaram11llC npennapllTCJlbHO I3B01J,S1T npl1lIOMOlll11 YKa3aHHbIX nbllllC HIfCTpYMeHTOB
2-3 MJI CTepHnbHoro cpu:m0J10rl1 l ICcKoro pacTBopa, KOTOpblf"t 3ilTC.\1 OTcaCbmalOT
BMeCTe c Bh1nCnCHJ.HIMI1.
v!3 IlId1KH MaTKU MaTepHaJl co6HpalOT C nOMOU hlO CTCpHllbHoro BaTuoro TaM-
1I0Ha II nepeHOCstT cro 13 KannlO TCIIJIOrO cpJ.13110J10rJllICCKOro paCTBopa IfJlH 1I0Me-
H atOT 13 np06HpKY, cOltcp>Kalll)'lO 3 MJ1 TaKOI"O paCTl30pa, eCJH1 MaTepua.'1 ; OCT<mJISI-
JOT B na6opaTopmo 113 Y'-IPC>KACHHSI 3ApaBooxpallclllm. lJ,CHTpucpyn1PYJOT np06l1p-
KY n TC l lCHl1e 2 MI1H. Yj\aJISlIOT nl1neTKOM Ha.J1ocaJ'OlIH}'KJ )KUAKOCTh. 113 oca,\Ka 1"0-
TOBSIT Han1B1lblC I1JU1 OKpaweHHhle lI1a3KI1.
Y MY>KlIJ.m I1CCJICAYIOT BblJ1,eJ1eHI1S1 HInI COCK06bI nOCJ1e MaCCa>Ka 1-13 IIcpe,!],Hero
oTHclla ypCTPbl, npOL"TaTWICCKHH COK (noCJlc MaCCa>Ka npe1J,CTaTeJIbHO" >KCJIC31.1).
l.(eHTpucpynlpYIOT MOll}'. cnepMY. .il,JISI 3a6opa Bbl.QeneHuf"t 113 ypCTPbl 13 Hee BBO:\SI1
t.1'cpl1nbUbIM 3011}:\ (6aKTCpnOJTOrH\leCKaSl IICTnSl, )1(en060BaThlH 301lA. YUJHaSi JlO-
)1(e l lKa 11 T.II.).
Opu xpOHWleCKOM 11 USlJ10TeKYII eM 3a6oJIC13aHI111 MaTepl1aT1 113 MOllCItOllOBblX
nYTeH l CJICCoo6pa:mee co6I1pa'I'b nOCJ1e npeJl,BapJ.ITCJlhllOii npOBOKaLtI1I1: am1Meli-
TapHOM (yn01'pc6JICHl1e COneHO". OCTpoii fJl1llll1. a.flKoronSl), 6I1OjlOrJ.1lICcKof"t (13I3e-
HClmc ['OHOl3aKLtHHbl), TcpMH t leCKm1. Mexam1 l lCCKOri (MaCCa>K ypeTpbl 11ml wdiKl1
MaTKII).
9.1.4. MemQ()bl UCC.IJel)o6uIIUJI. OpOCMOTp HantEUlblX npcnapaToB 'Jallle Bcero
npOH3BOASIT MCTOHOM pa3AaBJ1ef1J10H «KaIlJU1-cycneJ.13mJ» J.1 pC>KC - MCTOAOM «I3I-ICSI-
lIC"» Kamm.
296 TOM 1I- 1.IACTHbIE AHAJU1TI11..IECKI1E TEXHOnOrl111
AJH npHrOTOBJIelllHI npCnapaTa «KaIIJISI-cycneH3JUI» Ha cyxoe, 06e3)1(HpeHHOC,
nporpeToe J\O 37°C npe].l.MeTHOe CTeKJIO HaHOCSIT K UJJlID Tennoro cjJH3J.10nOrl1 le-
CKoro paCTBopa 11 CMClIJl1BalOT cc C KallJlCH I1CCJIeAYCl\mrO MaTepH3JIa. B3BeCb Ha-
KpbIBalOT nOKpoBllblM CTCKJIOM. 136eraSi 06pa30BaHI1S1 B03].1.YlUIILIX n}'3bIpbKOB B
npcnapaTC. CMbll3bl co CJII13HCTOi'i ypeTpbl, HerYCThie OCa;,KH 113 Ll,C, HTpHcjJyraTOB
nOJIY(leHHhlX Ha cPH3UOJIOI'I1 ICCKOM paCTBOpe HCCJIeAYIOTCSI B HaTI1BHblX npenapa-
Tax 6C3 ].I.OIlOJlHJ.1TC:lbHoro pa3BC].I.eHHSI.
n pH npm'OTOBJICHIII1 «BI1CSl1.leM» KannH TO IHO Ha cepenullY nOKpOBHoro CTCKJIa.
KpaSi KOToporo npCJ'BapI1TCJlbHO CMa3bll3alOT Ba3eJ1HHOM, HaHOCSIT nOJ1,OrpCTblii HO
37°C qm3l1oJlorl1 lccKUl1 pacTBOr, K KOTOpm,'IY 1I,06aBmUoT I1cCJlCnYCMblM MaTCpl1aJI
1-1 OCTUP0)l(IIO nCpCMe1lll1BatOT. nOKpoBHoe CTeKJ10 OCTOpO)l(lIO IIcpCBopa t nmalDT 11
v u
HaKJI£l..'1bmaIOT KanJlCI1 Bmn HetA Jl}'HKOH CneLl,l1aJTbHOro npe:lMeTHOro CTeKJJa Hml
npocMoTpa «BI1CSI(lei1» KanJIH. KanJHI HOJDKlla CBOOO}J.HO CBHcaTb B yrny6JIeHI111
npeJ1,MeTIiOro CTCKJIa. HC COnpl1KaCaSiCb C ero Kp3S1MH H NIOI\L
TIpcllapaTbl npOCI\1aTpJ.1BaIOT BHa'I U1e np i 06"beKTI1Be lOx, 3a'l"CM, }VISlIIOJ],TBCp-
)l(ACIH1S1, 40x. KOJll1'leL'TBO Tpoe»030HTOB MO)l(CT ULITh orpoMHblM, niK (1'1'0 Bce no-
n51' 3pCHI-HI HaX01l,SlTCSI B J,BI1)1(CHI1I1, I1JII1 naCTOJIbKO I\Ul:iepHhiM. ITO napa311T C Tp)'-
AOM oOHapY)l(l1BaeTCSI cpe H HCIIOABH)!(HbIX MaJlblX IICHKOLlI1TOB H KneTO lHoro eT-
pwra. OTJU-l'IaSiCb 01' HHX BOJIHnCTbII\U1 ].I.Bl1)!(em1S1MI1.
B : OlIomleHI1I1 K npenapaTal\l, nplirOTOBJIClIIll,lM 113 CI3C:>Kcro M rrCpl1aJJa, npl1-
rOTOBJISIIOT {fJllKCllPOHllllllble II OKpalllem-fble ILOCmO.Rl-fNble npellapanU)/. Ma3KI1
cpl1KCltPYIOT B CMCCH I h1KHcPopOBa B Te(leHUe 3-5 Mun H OKpaIlJl1BaIOT pa3JIWlllbI-
Mil MeTO] aMU. B npenapaTax. OKpalllCHHblX :>KCJIe3HbIM reMaTOKCI-IJII-fHOM. no POMa- .
UOI3CKOMy-rm.na. aKpHJ\11HOM OpaH)I(CBblM J1.f1H TpUXpOMOBhlM KpaCI1TCJlCM (CM.
pa.J].I.en 8) TP0cP030I-fTbl JICrKO pacn03HaIDTCSI 6naroAapSi HaJll1'll1lO :>KrYTIIKOB 1 KO-
pOTKOrl YHJ],ynup}'lOll efi MeM6paHbl.
J],nSl oKpalIHmaHml 0,5% paCTBopOM 6pl1.llAllaH1110B020 3eAeH020 0,5 r KpacKl1
paCTBopSiIDT B LOO MIl KJ.tnSlll.leH J1,lIcnmmlpOBaliUOH ROHbl, (tnulI, rpYIOT 13 mpSl ICM
BI1Ae llepe3 6YMa)l(IIhiri cPlIJlbTp. Ha IIpcnapaT HaHOCSIT BOJ HbIH paC-fBOp KpaCKH Ha
1 MHH, :mTeJ..f KpacKY CMblBalOT non npo ro'IHOfl BOHoi1, npcnapar BbICYlll"B UQT II
MUKpOCKOIU1PYIOT. npu J aHHOr1 OKpaCKe SI pa T.vaginalis OKpallll1BalOTCSI B lHrrCII-
CHBHO-3eJleHbIM I ReT. CCTllaTaH 1 lrrOITJm3Ma B CBCTJIO-3CJICHbIH. ICTKO npOCM rrpl1-
naeTCH OOOJIO'IKa. haKTcpuaJlbHaSi cjJJlopa OKpalllUBaCTCSI B 3eJIeHblH LlBeT pa:moM
nHTCIlCHBHOCTU.
MUKpOCKOIlUR OKpalllCI-UfblX npenapamoo SlBJISleTCSI npocTbIM 11 AellleBbIM Me-
TOAOM, He Tpe6YJOlI(I1M IICMC}VICIlIiOro npOBCMCHI1S1 UCClICAOBaHHSI, CIIClJ,l1aJlbHOI'O
OOopYMOBaHI1S1, 0AHaKO ero cneLl,l1cPl1 IHOCTb 11 IYBCTBUTeJIbHOCTb HI13KaSi. nOJIC3lfbi
nOBTopHhle 06CJICJ1,OBaHml.
9.1. S. Hoell1nuifjuKallUJI T. vagillalis ccphe3HhlX TPYJl.HOCTeH He Bbl3hIBaeT. B
HaTI1BHblX npenapaTax IIX CJlCJlYCT HJ1( q)CPCHLlupouaTb OT CBOOOHHO)l(I1BYll.lI1X )l(ry-
Tl1KOBbiX CCMdic roa OO. OHI1AOB. noncmalOll{I1X B npenapaT U3 BOAhl I1JII1 3arpSl3HeH-
HOrl nocynbl. 3TH canpO{ m'nbIC )l(rYTI1KOUbIC I1MCIOT JlI1lllb 2 )l(rYTuKa II ABl1r,UQT-
CH npSlMOJH1IICHHO. 13 oKpalllcHHblX npcnapaTax y BJIanLTnfl.1 HbIX TpI1XOMOHa,rI, 0'1'-
(leT.'1IIRO BH lIbIX 060JIO IKa, SlJWO, Lll1TOII!m3Ma, uJ1ccPapOlIJlacT. )l(I'}'TI1KU (pllc.20).
KY.IIbmYPlUlbllblll .'tfemoi) SlBJHleTC5I H£\I100JICe 'I}'BCTBI1TCJIbHhlM 11 CneLll1cPH I-
HhlM MeTO].l.OM. BJJaram1l1,lIhlC TpHxoMoHaJ.\bl MalDT XOPOlllUH pOCT Ha UCKYCCTBCH-
METO,IJ,bI KJ1I1HI1t.IECKOI1 flAPA3I1T0J10rl1l1 297
L
HblX mnaTeJ1bHblX cpeAax, co}.\ep>KallluX all'rJ--fOl1afHKH AJIH nOJ.{aBJ1eHHH pOCTa CO-
nyrcTO}'lOllleH MI1KpO<jJJ10pbl. MaTepl1M OOSJ3aTeJ1bHO AomKeH 3a6HpaTbCSJ CTe-
pl1J1bHblM 30H)J.OM 111m 6aKTepmUlbHo i neTJ1CH. MaTepHaJ1 celOT Ha cpeAY CK,IJ,C,
cpe,!],y 113 CMeCH >KHAKHX CTaH:J,apTHbIX KpOBC3aMeHHTeJ1ert, cpe11.Y crJ],c. ,IJ,J1SJ BbI-
palllHoaHHSJ TpHXOMOHa)1. lIU1pOKO HCIIOJlb3yCTCSI cpcna «Vagicult» cpllpM!>1 Orion
DiabTfloslica (<I>HHJ1S1HAUS1). MHKpocKonwlecKoe HCCJ1eAOBaHl1e KynbT)'p H HACHTH-
cpHKal\HIO T. vaginalis CJTeAYcT npOH3BOjUiTb H3 3-5 AeHb (n0J10>K1-1Te.1bHbIH pe3YJTb-
TaT - npl1)J.OHHbl(1 pOCT II llUnC [l]IOTHOrO GCJIOmlToro OCa).{Ka). TaK KaK AImTCJlb-
HOCTb pa3BHTI1S1 TpHXOMOHa)1. B KYJlbrype 3aOUCHT OT BeJTH IHHbl noceBHOH A03bl, OT-
pHl\aTcnbHblfl pC3}'JlbTaT llbICTdBJ1SJIOT nOCJIC HCCJICAOllaHI1SJ Ha 7-9 H 11-17 .u.CHb
noceBa. 113 npl111.0HIIOro OCa)1.Ka rOTOllSiT uaTHUHbl(1 npCllapaT } JIS1 MUKpOCKOIlHl1.
KYJlb rypaJlbHblfl MCTO,!], J.{oporOM 113-3a npHMCHSICMblX nUTaTCJlb.lbiX CpC)J.. B Ha-
CTOSllllee BpeMSJ nOSJmUICSJ KOMMep'-lecKutl KYJ1h rypaJlbHbli"i }\HarHOCTIIKYM «Tpuxo-
MOHaCKpUH» KOMJlaHl1H EnoccpBHC (MOCKBa) II KOTOpblM llXO)J.SlT CTCpHJlbHblC 30H-
,QbI, cyxaSi nl1TaTeJ1bHaSJ cpeJl,a B Kanc}'nax, TeCT-naKeT, MepHaSl nHneTKa. Pe3YJ1bT3T
HCCJIcJl.onalmSi - MaKCHMYM ICpC3 5 : lIcfl.
J1MMYlwAozll fecKllLl Menwu n03llOJUfCT onpCIWJU1Tb T. vaginalis B HPJ.i[ <I> C no-
MOlllbl-O HaGopa «TpHXOCJ1afIA» (AO «J1AEAHarHocTHKa», POCCI1S1). OTne JaTKI1
MaTepl1aJ1a H3 pa3JIU'-IHbIX o laron nOpa>KelH1SJ HaHOCSJT Ha npeAMeTHoe CTeKJ10 co
cnCumUlbHblMU JI}'HKi.U,m OAHopa30llbiMU 301IAa1\-111 C XopOWO COPOHPYIOIllHM llaT-
HblM TaMnOHOM. TPHXOMOHa).{bl llHAHbI B BH!{e n0J111t\-1OpcpHblX 06pa30BaHI1M C xapa-
KTCpHblM SlpKO-3CJTCllblM CBC IC.lI1eM. EaKTcpuaJlbllaSi cpJ10pa OKpaWHBaeTCSJ B
OpaH>KeBblfl UBeT, nef'tKo( 1-1Tbl. 3nl1TeJTI1aJ1bHble KJTeTKH, cnepMaT030l1Tbl - B Kpac-
HO-GYPblfl. PC3YJ1bTaT C'lwraCTCSI OTpl1uaTeJ1bHblM UpH OTCYTCTBHH KJleTO'lHbIX 3Jle-
MeHTOB co cncl(mpl1'ICCKI-1M CllC'ICHHCM.
1..JyncTHl1TCJ1bHOCTb U cncl(lIcpl1'mOCTh UMMYU0J10rl1 leCKOro MeTOAa cpamU1Ma C
TaKOBO" IIPH KYJI(1)'paJIbHOM MeTOJl,e. OH CpaBHI1TCJ1bHO ]lCWCll, upOC r B m,1I10J1HC-
Hm1, n03nonSiCT nony mTh OTOCT B Te lemlC 40-60 MUH.
.
10. &MonTaTbl TKaHeM
buonTaTbi 6epyr 113 3AOPOBbiX HJTH naT0J10rWleCKI1 H3MCHeHHblX TKi.\HCH C l\C-
nblO OOHapY>KCHHSI II IIHX napa3HTWICCKHX npOCTCI1111UX H SJHU mm nWII1HOK reJ1b-
M 1IITOB.
10.1. Cpe:l KO)l{H Ha Ha':II1 I 1C MHKpO<jJI11JSlpl1H Onchocerca volvulus nOJlY JatOT C
nOMOIu,htO I-ffJ1bJ U CKa!lbneJ1SJ 1JU1 6puToeHuoro ne::JBHSI.
npW-U(liII Atemor)a - 06HapY>KCHHe Ml-1KpocpunSlpHt'I, BbIWC}J,WHX H3 GHOIrraTa,
nOMCLU,CHHOro II cfJu3paCTl30p.
Xvo npllWmOlJAel-HlR U llcCAe008GHllR npellapama:
1) OGpaGoTKa Y lacTKa KO)l(lf cm1pToM 111IU 3cpHpOM.
2) flocne HCnapeHI1S1 Ae3HlICt)eKTaHTa BBO}.\SJT cTepHnbuylO TOHKYIO l1rJIY 13 KO>KY
cTporo nOBcpxHocTlio-ropu30llTaJlbUO H npUnoJl.Ul1MatOT KO>KY H I1rnof't.
3) Cpe3alOT Kyco',eK KO>KH, npHnoAHS1Tblt'I C nOMOlllbl-O I1I'Jlbl, GpHTBCIIHblM JIC3-
l.meM (11J1I1 OCTpt.lM CKaTlhnCJICM), ynCp>KHOaSi ero ropH30UTaTlbHO 11 ABl1raSi npOTI1B
I1fJ1bJ. TIpl1 npam1JTMIO nhlnOJ1HeHHot'l npOl\c,!],ype nOJ1Y lmOT KYCO'leK pa3McpoM
OK0J10 2 MM, 6e3 c.'IeAOll KpOBU.
4) flOMClllal-OT GHOIITaT KO>K11 B KanJilO cpIl31-10JIOrl1 JCCKOrO pacTDopa lIa npe}.\-
298 TOM II - l}ACTHbIE AHAJII1Tl1lfECKI1E TEXHOJIOrl111
MeTHOM C rCKJIC I1Jm B MI1KpOTI1TpOBaJlbHhlfl n..'IaIflUCT. OCTaBJUUOT Ha 30 MI1H npl1
KOMHaTHofi Tet\-meparype, npCAoxpaHSISI npenapaT OT BbICbJxaHI1S1.
5) I1ccJJeAYIOT npcnapaT nOA MI1KpOCKOnoM Ha HaJJI1 lI1e )l(l1l3blX nOABI1)KHbIX
MI1Kpoq)HJJSlpI-1 i:'t.
Pe3YAbmam: MI-1KpocPI1JIStpm1 Ha L U1HaIOT BblXOTl,I1Tb 113 6110nTaTa 13 paCTBOp He-
MCJ.\JJCHHO, lepe3 30 MI1H ero nOKHHaKrr OKono 70% 11 'lepe3 IaC npaKTI-1 leCKI1I3CC,
HaX01l.I1BLLH1CCSI 13 6HonTaTC. &JJI1 6110nTaT cpa' y nOCJIC cro nOJIY'ICHI-1S1 B3BeCI1Tb Ha
TOpCI10HHhiX necax, TO ICpC3 IaC MO)KHO onpeTl,eJJI1Th I1UTCnCI1BHOCTb HHBa:mH
( IHCJJO MI1KpOcpl1JJSlpl1H B Mr KO)l(I-\). n pl1 O leHb 60JlbUlOM II1CJJe MI1KP0cPI-1JJSlpHH B
npenapaTC, HX AlIH 06JICPICHI1S1 i1oAc leTa 06e3BO)l(HBalOT, JJ.o6a JJSUI Kanmo cPopMa-
JJI1Ha.
Huel-lmu(/jUKat(UR MHKP0cPI1JUlpl1fl npOBOAI1TCSI no npl13HaKaM, YKa3aUllbiM Ha
p1-1c.5 (CM. pa3AeJI 1).
10.2. EHonT3T H3 KO:H<HOii H3Dbi 113 113J1H"lHC 3M3CTilrOT ]J;ep 13TOTpOIllILlX
JIeHlUM31111II
npl.ll-lt(ltIl Mcmoua: MI1KpOCKOIUISI K!1CTOK Kpac oro I-HlcPl-1JJbTpaTa BOKpyr Sl3HbI
Ha HaJII1'IHe JJeHlllMmU1H B MaKpO( arax I1ml BHC I1X.
Xou npUlOmOfl.llel-lLLH. it UCC.IleVOlJaIfUR npenapama. EI10nTaT Ha,':jJJe>l<lI'l' li3HTb C
MHlIl1MaJlbUblM KOJII1'ICCT OM KpOBI1 H MaKCHMaJlblfblM 'mCJIOM MaKpocparOI3. J],JHI
:,)Toro Y'IaCTOK I1HqmJJbTpanmnOI"O aJUJKa aHeMw,mpylOT, C)I(HMaSi ero HUYMH
naJIbl aMI1 JIC130H PYKH UJJI1 nI1HIJ.eTOM, 1I.enatOT na1l.pC3 OCTpblM CKaJlbnCJleM 11 CO-
cKa6nl1BalOT KYCO leK TKalfl1. EI-10IlTaT MO>KHO nOJJY'II1Tb, OTKYCl1n KYCO ICK TKam1
IIHHIJ.CTOM I1JJI1 BBe):{SI 13 I1HcPl1JJbTpaT CTepllJJhHO 3y6oiipa'lc6HYK> nrJJY C Hace'IKoj:'t
(npI1MeHSleTCSI AJUI YAaJleHlUl ucpna 1-13 3y6a) II, nOBpal.llaB ee B TKaHH I1HcpMJ1bTpa-
Ta, 113BJJeKalOT nMCC rc C :mXBa ICHHbIM MaTepUaJJOM. El10nTaT nMeCTe C cYKponI-1'1-
'lOti >l<I-I)(KO("'bIO ncpclfocSiT Ha npeAMeTHoe CTeKno, pa3Ma3bmaloT nOJlY lcHHblfi
Ma30K. cpI1KCI-1pYJOT. KpacSlT no POManoBcKoMy-rl1MJa 11 UCCJICAYIOT C HMMepCI-10HHOfi
CI1CTCMOfl, KaK npll UCCJICA0l3aHl111 Ma3Ka KOCTHoro M03ra (CM. pa3HCJIbi 2.2 1-1 2.3).
10.3. EllonT3T MLlWI( H3 H3."'IH"lHC TpHXHHCJlJI
flPUl-ll'llll. J'r,emo,)a: 06HapY>KeIlHC IIIIKancYJlHpOl3aHHLIX I1JJH >KI1BbIX JU1'IHHOK
Tpl1XHHenn B MhlLLIl ax nyrcM KOMllpCCC 1I1 6110nTaTa I1JU1 ero nepeBapl1BaHuSI.
XO() npUlOmOfVle/-lltR II uCC.IleU061l1-lllR npenapal1l()(j. J],JJSI I1CCJ1eAOBaHHSI KOM-
npCCCI-IOllHbIM MCTOAOM 6epYT He6oJ1bWofl 6110nTaT ACJlbTOBUltHOII, J.\BYXrJlaI30M
I1JJH I1KpmJO>I<lIoi1 MbIUlIJ.bl. C,QaBmmaH>T ero Me>KAY ABYM5I CTeK!HlIlHbIMU IlJlaCnma-
MI1I1I1CCJJCAYJOT nOlt Ml1KpocKonoM IIpl1 MaJIOM YBe.'1WleHl1lf. TIpl1l1HTCHCHBHOH I-m-
Ba31U1 B npcnapLiTc 6C3 TpYAa o6HapY>I<HBalOT lIHKancYJU1pOlJallllbiC lIl11lHHKI1 Tpl1-
XHHeJlJJ; npl1 cJJa6m'1 UHna:nUI OUI1 06bl'IHO npocMaTpI1BaIOTcSI. ,l],IISI o6HapY>I<el uSI
)KllBhlX JUf'II1UOK TpUXI1HeJIJJ nJ){)BoJJJIT C.'Ie,QYK)u lle '1aHlmYJISlI HII: I. rOTOIUIT IICpC-
l3apl1 i.U{)IllYIO >l<11, KOCTb: 5 Mr nenCIfHa pac mopSiIOT B 1 JI I..\11CTI1JJJUlpomlHHof'l 130-
Abl, B KOTOpylO Tl,06aBJISItOT 7 M!I KOHLleHTpl1pOBLiHHOii COJlSlIIOH KI1CnOT!.I; 2. 6epY''-
1 r 6uonTaTa MblUlLlbl (CM. I3blllle). TlllaTCJILHO era paJMCJlb'latOT 11 nOMemalOT IJ 20
MJJ nepeBapHl3alOIllCH >l<I1AKOCTI1; 3. HHKy611PYlOT np06y B Te leHI1C 24 IaC npu Tet.'I-
nep<\Type 37°C. nep&10 11 leCKIl cc I3CTpSlXl1l3aSl; 4. Ao6a13JJSlIOT 60-80 MJJ nOTl,OrpeTO 1
AO 37°C BO):{bl 11 I3JJI1BaK>T pa3BeTl,eHHYl0 ncpc aplm3l0lllYIO >l<HJJ.KOCTb B BOPOHKY
EcpMaHa (CM. pa3]tCJJ 5.4.2.1). OCTan!ISlIOT >K11JJ,KOCTh B BopOHKe Ha 'laC I1JU! )(OJIL-
mc C -rCM, 'IT06bl JIH n1HKI1 nepewnll B liOCl1K BOPOIIKU: 5. BblllYCTlITb )l(I1AKOCTb 113
METOJJ;bI KJlHHH'4ECKOH nAPA3HTOJlOrHH 299
\
HOCHKa BOpOHKH H HCCJIC}J;onaTL IIO,Q MHKpOCKonOM ua Hanwmc )t(HBLIX JIH'IHHOK; 6.
B CJIY1.rac BlfJl,HMOro OTCYTCTBHH JIH1.IHHOK nO,QBcprHYTL BCI{) HMefOll YI{)Cji H BOPOH-
KC )KH,QKOCTL LlCHTpHCI}yrHpoBaHHIO B Te1.leHHC 2 Mnu npH 2000 06/MHH, H HCCJIeAO-
BaTb ocaJ\OK.
Pe3Y.llbnzanz. 06uapY)KeHHC nH1.U1HOK Tp IXUHCJ1J1 - a6comoTHblH KpHTCpHH TpU-
XHHCJIJIC3a Y oGCJleAyeMoro 60JlbHOro.
10.4. IJHonCHJI TK3HCH H3 I.\IICTlIl.\epKu. npH TCHH03e Y naLlHCHTa Mo)t(eT pa3-
BHTbCH LlHCTHLlCpK03 - napa3HTHpoBaHHe B ero TKaHSlX (rJIa3Y, KOH"biOHKTHBC. M03-
rc, nOj\KO)KHOH KnC.....IaTKe, MbliULlax) JIH'IHH01.IHOH CTa,r:{HH Taenia solium. EHorrraT
TKaHH (HanpHMcp. nOAKO>KHOro Y3na) pa3L1,BHrafOT npellapoBaJlhHhlMH HrJIaMH C
l\enblO Bhl1\CnCIUIH BHAHMoro HeBoopY>KellHblM rJIc:t30M 6enoBaToro nY3blpbKa Be-
JIH'IHHOii C ropollIHHY - CoOCTBCHHO LlHcTHLlepKa. Ero pa:J}J;anJumaHJT MC)K,QY ABYMH
npeAMeTllblMH CTCKJJaMH 11 HCCJIeJJ,yfOT IIO,Q MHKpOCKonOM. HaJlH1.lIiC B nY3blpbKe
CKoneKca C 4 npHcocKaMH H BCH1.rHKOM Kpf01.lbeB nO}J;TBCp>KJlaCT J HarH03 LlHCTHLlCP-
K03a. ECJIH LlHCTHLlCpK npOnHTaH 113BeCThIO, TO AJIH oGHapY>KCHHSI rOJlOBKH ero He-
o6xOAHMO npeABapl1Tc.'rbHo ].J.cKaJIbLluHlfpoBaTb B 4% pacTBopc a30THor1 KHCJlOTbl
H TC1.ICHHC L l.raca.
.
11. MMMYHoAMorHocTMKo
MCTOj\l>1 UMMYHOJlOrH'leCKOH J\lIartlOcnlKH B KJIHHU'lecKoH napa3HTOJlOrUH nplt-
o6peTalOT Bce 60JlbWCC 3Ha'ICHl-le. HecMoTpSl Ha TO. 1.11'0 OIiH HC Moryr H HC ,QOJI>K-
IIbIIlOj\MCHHTb TO'IHble, 06bl1.1II0 1\OC ("ynHl>rC H He oporHe napa3HTOJIOrH1.leCKHC MC-
TOAbl. OJl,HaKO 13 pH,QC CJIY'IaeB He06xo1\HMOCTL npl1MCHCHl1H 11MMYHonOrH1.ICCKUX
MCTO,QOB SlBnSleTCH I-IMnepanumoi't. TaKaH He06xo, w..tOCTb n03HIIKaCT IIpU t1CB03-
MO>KHOCTH nOJIY1.leHHSI MaTCpHaJla AJISI MHKpOCKonHH t1CHllBa3ltl3Hl>IMH cIIocoGar-m
ua npOTSI>KCHHH Bcero Te1.ICHml IUlcpCKLlI-IH/HtiBa3HH (TOKCOnm13M03. BHCKmue1.l-
HblH <1Mt::6Ha3, TpHXHHCJIJIC3. TOKCOKap03. 3XHHOKOKK03. 1 ICTI-II epK03, -'JapnClJILHLIH
naparouHM(3) HJIH B OCTpoft cpa3C, KorJ a JlHar'HOCTwICCKHC CT HH OTCYTCTBYIOT
(OIU1CTOpX03, JlCro1.IHbIH naparoHHM03. cpaCLlHOJle3). HHorna HMMYHOJIOnt1.ICCK IC
MeToAbl npHMCHHK.>T 13 J{onOJ1Hetule K napa3HTOJIOrWICCKIIM. CCJ1H 'IYBCTBHTenb-
HOCTb nOCJIt::,QHI1X B XpOHHLleCKOH cpa3C HC,QOCTaTo'IHa H3-3a CJ1aGoH HHTeHCHBHOCTH
I1Hq}CKl ltH/UH8a3HH (-rpHnaHOCOMo3bl. KpHnTocnopU}J; I03. CTpOtlrHJI0I1,Q03, WHCTOCo-
M03bl).
11.1. TOKCOnJla3MOJ. C LlCJILlO na60paTopHoH Jl,HanIOCTUKH 3TOH WHpOKO pac-
npocTpaHcHHoH npoT030MHO" UllcpCKLl.HH npHMcHHCTCH O'lCHb W lpOKHH Ha60p l1M-
MYHonor'WICCKIIX MCTOAOB: KO>KHaH np06a C T() corura3MHHOM. PCK, PHr A.
HPI1 , H(I>A, a TaK)t(e opl1rHUaJlbHaH peaKLlHSI C KpaC 1TeJ1eM (peaKqHSI Ce611Ha-
q>CJIhJl,MaHa). B nocnC)J,HUC rO}J;bl lIeJl,YIl ce MCCTO u ItMMYIIO HarHOC rHKC TOKCO-
nJla3MCHHOH uHcpeKl ml 3a1H1MaK>T I IPH(I> B nonYKOJ1lJ1reCTBeHHoM BapltaliTe (TlI'llJ
IgG) H I1(I>A B KOJU1'ICCTBeHHOM BapllaHTc (IgG H IgM B ME/M.'l).
Ht.IMYHoq}CPMCHTHhle Tec ("-cuc I"CMl>1 AJIH onpCACJICHHSI aHTltTOKCOnna3MCHHbiX
aHTHTcn np01t3UOJl,SlT 3AO «BCKTop-EecT» H «3Ko-Jla6» (pq». HCI1OJlh3YIOTCH
TaK>KC I1MnOpTHble TeCT-CHCTCMI.1 qmpMLI CaHocpH .D:uarHocTlIKC nacTep,
"Labsystcrn.s" ( UH:IHHAHH) HAp. nOCTaHOBKY T0" mU111110" TCCT-CHCTCMLI npOBO-
ASiT 13 COOTBCTCTBlIC C qmpMcHHoi1 IIHCTPYKI neiL
.
300 TOM II - \.fACTHbIE AHAJII1TI1\.fECKHE TEXH0J10rHI1
11.2. AMe6u33 BlleKHllIeQHLIH. OpMMcHsnoTcSI TeCT-CMCTCMbl HPH<I> M 11<I>A,
npOM3BOJ),HMbIC 13 CiliA.
11.3. TOKcoKapo3. npl1MCHSICTCSI TCCT-CMCTeMa «TMacKap-cTpHn» 3AO «BeK-
Top-BeCT» (PcI».
11.4. TpHXUlleJIJIe3. OpHMeHSleTCSI TeCT-CHCTeMa «THaTpI1C-CTpHn» 3AO «Be-
KTop-EeCT» (P<I».
11.5. OnHcTopx03. np IMCHSUOTCSI MMMYHOcpCpMCHTHblC TeCT-CI1CTeMbl, npOH3-
BO CTBa 3AO «BCKTOP-EcCT» H «3Ko-J1a6» (P<I».
11.6. 3XHHOKOKK03LI. TeCT';'CHCTCMa AJISI I3blSlnnCHMSI aHntTen K Echinococcus
multilocularis BbmycKaeT <lmpMa «3Ko-J1a6» (P<I». JlH0<lmJIH3Hp0l3aJIHLIH Ar
E.granulosis JlSl H3cl> H PCK - <lmpMa CaHo<lm J].HarHocTHKC OacTep (<I>paHl.{MSI).
cnUCOKnUTEPATYPM
1. AB fOX\1Jla T.I1., KmicTdHTHHo13a T.H., rOp6YHoBa 10.0. JIa60paTopHaSi ]J.Har-
HOC111Ka renbMHHT030B. l.lacTb I. HeMaTojJ,03bl: Y'lc6. noc06Mc; M., 1993.
2. BenSIeB A.E., AI3]J.lOxHHa T.H., rOp6YHoBa 10.0., <I>HJlHnnOB A.M. J1a6opaTop-
HaSl )lHarHOCTMKa MaJISlpI1H: YlleG. nocool1e; M., 1995.
3. Eepe3aHl.{CB IO.A.. ABTYLUCHKO E.r. renbMHHTOJIOrH'leCKaSi KonponOrl1\leCKaSl
]J,l1arHOCTl1Ka., J1., MelJ,uu.HHa, 1976.
4. rOp6YHo13a lO.n. J1a60paropHaSi J),HaruocTHKa KI1UJC'IHLIX npoT03003013, M.,
1989.
5. J].a 1Tcp A.E., TYMKa A.cl>. Oapa3HTapHbie 6o.ne3HM, J1., MCAHl.{HHa, 1980.
6. JIal3J),oBcKaSi M.B., JII>ICCHKO A.51., ABJ),iDXI-1Ha T.H., rOp6YHoBa 10.0. AMe6ua3:
Y'leG. nocooMe; M., 1998.
7. JlhlceHKo A.5I. (pCA.) PYKOBOACT130 no TponH'leCKMM 6onc3HSlM, M., MC]J.Ml.{MHa,
1985.
8. J1blceHKO A.51., OaBJlOBa E.A. MCTOjJ,M'ICCKUC pa3pa60TKM no JIaGopaTopHoH
AHamOCTHKe MaJlSlpMH; M., 1985.
9. MCTO]J.M\ICCKMC pa3paGOTKM K npaKTM\ICCKHM 3aHSITI1S1M no na60paTopHoH J Mar-
HOCTHKe MaJ1S1pHH I Coe-r. JIblcCHKO A.5I., DCJUlen A.E. M.: U;OJ1HYB. 1989.
10. OCHoBHble MeTO]J.1>1 JIa60paTopHoH J),MamOCTMKM napa311TIlpHbiX 60JIC3HCi1,
B03, )KeHcBa, 1994.
1 L Oa13nOBa E.A. J1a6opaTopHaSi ]J,uarHOCTI1Ka lIapa3HTapHLIx GOJle3HCH. \.facTb 1.
KMWC\lHl>le npoT03003bl, M., 1977.
12. TyMKa A.<I>. Oapa3MTOJIOI'IUI, 3I1Hp,CMI10nOrHSI H JIaGopaTopHaSI J),l1arHOCTl-IKa
KMwe'lHblX npoTo30HHbiX HH<lJeKl.{HH, J1., MenHl Mtm, 1967.
13. Bcnch Aids for the diagnosis of intestinal parasites, WHO, Geneva, 1994.
14. Bcnch Aids for the diagnosis of filarial infections, WHO, Geneva, 1997.
15. Bcnch Aids for thc diagnosis of malaria, WHO. Gcncva, 1995.
I
,
MOnEKYnSiPHO-
6MOnOrM'IECKME METOAbl
BblSlBnEHMSI M
MAEHTM<I»MKAL-'MM
MH<I»EKL-'MOHHbIX ArEHTOB
",
1. BblllBneHHe H HAeHTHtI»HKaqHII Chlamydia trachomatis,
Mycoplasma hominis, Ureaplasma urealiticum MeTOAOM
nonHMepa3HoM qenHoM peaKqHH
.
Boeoellue
Chlamydia trac:homatis - BHYTpI1KneTO"-lHbJH napa3I1T, I1Hcpl1l.(l1pYlDUJ,I1H 3nwre-
JJI1H Cnl1311CTblX nOBcpxHocreH I'CHwraJll>HOrO Tpal<Ta, np lOro KI1111e'-IHI1Ka, HOCO-
rnOTKI1 11 KOH"bJOKTI1BbJ. XnaMI1Al111 SlBnsnoTCSI npl1'IHHoH 130CllaJJI1TCJlbHbiX 3a6one-
l3aHI1H I3bllllenepe'-JI1CneHHblx opraHoB 11 TKaHcH, npl1 OCJ1O>I<HeHHOM I1nl1 XpOHI1'-le-
CKOM Te"-leHI1I1 KOTOpblX B03HI1KaJOT 6ecnJlOAl1e. npOCTdTl1Tbl, KcpaTOKOH"hIOKTI1I3I1-
Tbll1 AP. Mycoplasma hamil/is n Ureaplasma urealiticum "-faCTO SlBnsUOTCSI conYTCT-
I3YJOW.I1MI1 MeM6paHHblMI1 napa311TaMI1 3J1I1TCJJI1aJlbHbIX C11113I1CTbIX nOKpOBOB, 06y-
CJlaBnI1BalDUJ,I1MI1 BOCJlaJll1TenbHblC 113MCnCUI1S1, npI1BOASlJJ.J,l1e K nepe'UlCnCHHbJM
I3bllllC nOCJICACTBI1)1M. HC3aUI1CI1Mbie I1CCJJeAOBaHI1S1, npOBeAeHHble 13 KJUUlliKax
pa3HhiX erpaH nOKa33JJ11, "-ITO B 50-90% HapYllleHl-1S1 pcnpO)\YKTI1BHOH cpyHKL{1111 lle-
110BCKa Bbl3BaHbl cMelllaHHl>IMI1I1HcpCKUI1S1MII MO'lenonOBblX nYTeH, cpeAI1 K()T0PbIX
13 cnmo O'lepeAb "-,aCTO I3CTpe'JaIOTCSI xnaMI1AI1I1. MI1KOJlJla3MJ.1 11 ypeanna3Mbi. )J,11I1-
TCJIbHOe 6eCCI1MIITOMHOC TC l leHl1e 11 MHO>KecTBeHHble Knl1Hl1'leCKI1C HCCnCl{lIcpl1"-'e-
CKl1e npOSlBneHI1S1 3aTpYAHSlIOT CI1MnTOMaTI1'ICCKYIO AHamOCTI1KY 3TI1X 3a60nel3a-
HI1H. He Bcel'Aa 3cpcpCKTI1BHbi 11 TpaJ\m l1oHHble, I1MMYHOXI1MI1LleCKI1C 111111 cepono-
rl1yeCKI1C MeTOAbl aHa11113a, TaK KaK 3T11 I1Hq)eKUI1I1 IIpoTcKaiDT 13 naTeHTHOH cpop-
Me, L!aCTO I3bl3bmaSl e,-cpTl>I" OTBeT OpraHI13Ma 'leJlOBeKa. J],oporOBI13Ita, ){nI1Tenb-
HOCTb 11 TpYAoeMKOCTb MI1KpoGI10JIOrl1 L ICCKOro BbIAe11eHIISI AaHHblX BOJGYAI1TCJICH B
KY11bTYpC CYLl(CCTBeHtlO JaTpYAHSlIOT I1CnOnb30BaHHC :;.rroH npoueAypbl B Jla6opa-
TOpHOH Al1arHOCTI1Ke. B IJ11TCpm)'pc lIaK01l11eH 06111l1pHbIH KnI1HI1KO-JlaGopaTop-
Hbl!! on biT no I1CnOJ1b30BaHI110 MeTOAa nu.p AnSI I3bISlBJlCHI1)1 JlCpCLll1CneHHblx MI1K-
pOOprafl113MoB. OCHOBHblMI1 MI1111eHSlMI1 P.J1S1 aMIJJll1q)I1KaUI1I1 npl1 BblSlBneHl111 xna-
MI1]1.I1H TpaXOMaTI1C SlBnSliDTC)I: HYKJJCOTI1AHaSl nocneAoBaTenbHocTb I3I1AOCIJCUl1cpl-l-
"-ICCKOH KpI1I1TH"-leCKOH nJla3MI1Abl, nOCJleAOBaTCnl>HOCTh rJlaBHOrO 6e11Ka BHYTPCH-
HeH MeM6paHbl, pUGOCOMaJlblll>lC reUbl. AnSI BbJSlBneHI1S1 M.hominis I1C(1011b3Y'OTCSl
q)parMCHTbl rCIlOB-aJ\re:mHOI3, I1nl1 pl1GocOMaJlbHOH PHK. AnSI ypeanna3M - refibl
ypea3hl. HI1>Ke npl1BeAeHa MCTO) I1Ka, JJe>Kau{aSl 13 OCHOl3e paGoTbl Ha60pa pcareH-
TOB AnSI onpcAcHcHI1S1 XnaMHAl111 TpaXOMaTI1C, MI1KOnJIa3Ml>1 rOMJ1'UIC 11 ypeanJla3Mbi
ypCanl1TI1KYM MeToAoM nOnl1MCpa:moti L\cnHoii peaKI{I1I1, ymep>KACHHa)l MI1H3JJ.pa-
130M POCCJ111 1I0A (TY -9398-405-17253567-96).
302 TOM II - "lIACTHbIE AHAflMTI1'-IECKI1E TEXHOJlOfl111
AHARUTHqECKHEXAPAKTEPHCTHKH
Cnel(ucfiwtlwCmb OHOJlllJa
B nOJIO>KJ-tTeJIbHOM KOHTpOJlbHOM 06pa31 e AOJDKHa BbHIBJISlTbCSI 0AHa nOJloca
OpaIOKCnO-KpaCHOfO Ll.nCTa nOCJIe pa3HCJICHHSI peaKLl.HOJUIOH CMeCM B arap03HOM
['ene. COOTBeTCTnYlOll.{aSl no nOAHM)f(HOCrn cpparMCHTY reHOMa XJlaMM.QHH TpaXOMa-
THC HJlH ypcanJla3Mbi ypeaJIHTMKYM MJIH MHKOIlJIa3Ml>1 rOMHHHC.
B OTpMLl.aTeJlbHOM KOHTpOJlbHOM oGpa3u.e - nOJl()ca. COOTBeTCTBYIOll.{aSi cppar-
MeHT}' rCHOMa XJlaMMAMH TpaXOMaTHC, ypeanJla3Mb[ ypeaJIMTItKYM MJm MHKOnJIa3Mhi
rOMMHHC, AOJl)f(Ha OTCy rCTBonaTb.
060pyo06af-llte II pell1W1ll6bl
1) MMKponMneTKH nOJ1yaBTOMaTHl[CCKMe Ha 1-10. 5-40, 40-200,200-1000 MKJI;
2) HaKoHellHHKH K MMKponMneTKaM;
3) MHKpOllpo6HpKM nJ1aCTHKOBble Ha 1,5 M1I H 0,5 MJI;
4) lllTaTI1Bbl AJISI MHKponp06HpoK;
5) MHKpOLl.CHTpHq)yra Ha 8-12 Tblc.06/MHH }1)HI 1,5 11 0.5 MJI npo6MpoK:
6) Dpl160p AJ1S1 ropl130HTanbHoro 3JICKTpocpope3a;
7) I1porpaMMMpyeMblll TcpMocTaT (JJ.HK aM [lJlHqmKaTop );
8) TepMocTaT ua 45-55°C nOJ 1.5 MJI np06upKM;
9) YJIl>TpacpHOJIeTOBhl i TpaHCMJIJIIOMI1HaTOp;
10) BOAocTpyf1It1.>lrl HJIH naKYYMHhlH Hacoc C KOJl60H JlonywK0I1;
11) CB1..J:-IIC l ll> "JIM BOASluaSi GaHSI Ha 95-100°C;
12) BCTpSlXHBaTeJIL WISI MHKponpo6HpOK THna "BopTeKc";
13) KOJl6a KOHWleCKaSi TCpMocToHKaSi BMec nlMOCTblO 250 M11;
14) KOJ1Ga KOHHLICCKaSi nMeCTMMOCTLIO 1 JI;
15) CrCpHJIbHbie HaKOUCllHHKM 1-200 MKJI;
16) CrepUJlbHl.lC IIJIaCTHKOBble npo6HpKH 06"beMoM 1,5 MJI;
17) CI'CpHJlbHble nJIaCTHKOllLle npo6HpKM 06'bCMOM 0.5 MJI AJISI aMnJlHqmKaLl.HH;
18) CTepHJIbHblf1 qm3HOJIOfH l iecKMti p-p;
19) YHHBepcaJlbHble 30HAbi AJlSl :m6opa KJIHHMlleCKoro MaTcpMana.
PeaKmU6bl
1) Pacruop I - 6M pacTBop ryaHJ1AHH THOLl.HOHaTa, 50 MM TPUC HC1, pH 7,0
2) PacTBop II - 4M paCT BOp ryaHMAMH TMOI HaHaTa
3) PacTBop III - 50% 3TaH0J1 50MM NaCI, 25 TpMC HCI pH 7.4
4) Cop6eHT - cycneH3HSI AMaTm..loBOH 3eMJIH
5) TE 6yq)ep- 10MM TpMC HCI. IMM 3JJ.TA, pH 8.0
6) Taq-noJlHMepa3a (5 en/MJI)
7) BOAa AeHOHH30naHHaSi
8) MHHepaJll>HOe MaCJIO
9) lOx nu.p 6ycpcp - 666MM TpHC HCJ, 166 MM (NH 4 )S04' 0.1 % TBMH-20, 25MM
MgCI 2 , 0,1 % )KeJlaTHHa pH 8.8 npM 25°C
10) npaffMepbl CJlcAYlOll.{ero COCTana:
5' CACGAGCTGACGACAACCATGCA 3' - R 1
5' GGTTAGCAATAACCTAGCGGCGA3'-H
5' AAAGGGCGTGTAGGCGGAAAG 3' -Chi
5' CGTITGCGACGCTITTGGATG 3' -U
B KOHLl.CHTpaLl.HH 5 pMOJlblMKJI Ka)f(J\oro.
I
BbUIBflEHI1E I1HcI>EKUI10HHbIX ArEHTOB METOAOM nl(p 303
11) pacTl30p Ae30KcHHYKJ1eOTH/1,Tpu<}JOcq:mTOB (HT<(J) 25MM Ka>K/1,OrO H3 AT<J>,
TT<I), l(TcI>, IT<I>.
12) Arapo3a
13) 50- KpaTHblC1 TAE-6y<})ep (50xTAE) 2M TpI1C-aI..\,CTaT pH 8,2, O,05M 3J],TA
14) 6- KpaTHblff 6y<})ep AJ1 HaHeCeHHH o6pa:.u..\.a, (40% caxap03a, 0,25% 6por,1<})C-
HOJJOBblH CI1HI11-1)
15) PacTBop 6poMHcToro 3TH/1,H , 1 %
L6) nOJ1O>KHTeJ1hUhlC KOHTpOJ1bHble 06pa31..\,bl- npenapaTLI J],HK M.horninis, U.UfC-
aliticum, c.trachornalis C KOHl..\,eHTpal..\,HeH 100 <})r/MKJI
npOBEJJ:EHHE AHAJIH3A
Bb,Oe.llellUe l1.HK U3 o6pa3qa. 3a6op KAUIIU'IeCKOZO .MamepuD./la
I1ccJ1eAycMLII1 MaTepHaJ1 (COCKoo :,:mI1TeJ1HCUTLHLIX KJICTOK H3 l..\,epBHKanbHoro
KaHaJ1a, ypeTpbl, 3eBa) I1CpCHOC T B <}m3HOnOrl1 l lccKI1H pacTBop, HaXOASlIl..\.HHCH B
nOJIHllpOlIHJ1eHOBOH 1,5 MJ1 npo6l1pKe, C nOMOll.{bto OAHopa30BhlX CTepHJ1bHbIX 30H-
AOB AJ1 cocK06a :;mI1TCJ1HSI. AmI. 31'01"0, B3 TbIH Y nal..\,l1eHTa MaTepHaJ1 Ha 30H}l.e ony-
CKalOT B 100 MKJI cpH3H0J10rl1 l leCKOro pacTBopa, ncpcMewHBalOT, 30HA H3BJJeKalOT
(BbI6pacblBaIOT), a npl1ro I'OBJlclmYK> TaKI1M 06pa30M np06y HCn0J1b3YIOT AJ1S1 BhI-
ACJ1CHI1S1 ,LJ,HK MJUI xpamn npH TeMnepaTYpc - 20°C He ooJlee 2 HeAeJ1b.
06pafiolllKa KAUIIU'IeCKUX "po6 "epeo "pOfJel)ellUe"JI a.wlUluifjuKaquu (6b,oe-
JJellue l1.HK)
1) K 100 MKJ1 <})113H0J10fl1 l lecKoro pacTBopa, COI.cp>Kall.{cro KJ1HHH'leCKHH MaTe-
pmUl B £1p06 1pKe 1,5 MJ1 (nma Eppendorf). p,06aBJ1S1IOT 300 MKJI paCT BOp a I II 10
MKJI cycncH3HH cop6eHTa. np06bl HHKy611PYlO1' U -rellelUIC 10 MHHYT npli KOt.tH8T-
HUH TeMneparype, 1-2 pa3a £1epcMclUHBa lIa BOpTCKCC.
2) np06bl l eHTpHC ynipYloT 15 CCK Ha MHKpOI..\,CHTpH<})yre npH 12000-16000g
(8 - 12 TLIC. o6/MHH), cY£1epHaTaHT oT6pacblBalOT.
3) K OC8gKY l106aBJ1S1IOT 100 MKJ1 pac nmpa II H BCTpSlxHBalDT ero ua UOpTCKCC.
Cop6eHT OCa>KAaIOT L{CHTpHC})yrHpoBauHcM npH 12000-16000g (8-12 ThlC. oG/MHH),
B TCllCHHC 15 CCK. CynepH8TaHT orop8cblBalOT.
4) npOI{CAYPY OTMblBKH £1OBTOpSitoT ell..\.e ABa pa3a C HCn0J1b30BaJUleM 1,0 MJ1
pacTuopa III TaK. KaK 31'0 onHcaHO B £1.3.
5) JJ.o£1onHHTeJ1bHbIM l..\,eHTp 1cpynlpouaHHcM npH 12000-16000g (8-12 TI>IC.
06/MHH). C nocneJJ,yK>lllHM OT6pacbIBaHHeM cynepHaTaHTa y6HpalOT OCTaTKH pac-
TBopa III. npo6b1 nOAcYIUHBaloT 5 MHHYT npH TCMnepaType 45 -55°C, OCTaBJ1
£1po6HpKH 01'KpbITbIMH. -
BHHMAHHE! Ha I:Icex Cral-/.IISIX o6pa6oTKII K.ilI1IBt'leCKOro MaTcpUana YJI,ancmlC CY-
ncpHaTaHTa npmi3ROJl,SlT OHHopa30BblM lnmlcnlKOl:lblMll H3KOHC'IHlIKaMll npu nOMOllUI BOJ].O-
C1 PYHHOr-o Hacoca B Kon6Y-.'loBYWKY, COnCp>Kal.1.lyK) .QC111I1ctJm..{ lpYJOILl lfl pac-mop (3% xno-
par.nul If lll 5% nCpCKltCb nOJl.opOJl.a If T.n.).
6) B £1po6HpKH C COp6eHTOM /1,06aBJISIIOT 50 MKJ1 TE 6y<})cpa, 3aKpLIl3alOT HX.
ncpCMeWHBalOT Ha BopTeKce H HHKy611pYlOT B TelleHHe 5 MHHYT npH iet.mepaType
45-55°C.
7) np06HpKH I..\,C}iTpH<})yrHPYfOT 15 CCK npH 12000-16000g (8-12 TbIC. o6/MHH),
BOI1HYfO <})a3Y (cynepHaTaHT) HC£10J1b3YIOT II KallCC ruc HCCJICHYCMOro oGpa3L\a J],HK
AJISI nOCTaHOBKH peaKI..\,HH ar.mnHqJHKaL\HH.
304 TOM II - YACTHbIE AHAJU1TI1YECKI1E TEXHOnOrl111
06pa6OTaHHble TaKM1.1 06pa301.1 npo6bl MO>l<HO XpaHMTb npli TeMnepaTYpc 4°C
B TellCHMe HeAeJU1 HJIH npH Tef\mepaType MHHYC 20°C B TelleHHe 6 1.1eCSH.(en.
llpooeoellue nOJlUMepa311oii qenlloii peaKquu
1) DpUrOTOBliTb np06HpKM WUI nponcAcHlul aMnJIM HKaLtHH, npoHY1.1cponan HX
11 pacnOnO>l<l1B COOTBeTCTBYlOlJ.(HM 06pa30M B 1l1'raTMBe. OO)J,roToBMTb TaK>Ke npo-
6MpKH )J,JISI 1l0JlO>l<MTCnbHOI"0 H oTpMLtaTCnMmro KOHTponeH.
2) OCpCHCCTH 5 MKJI 06pa3Lta H3 06pa6OTaHHoif KJlMHWleCKolf npo6bI B COOT-
BeTCTBYlOlJ.(YIO np06MpKY )J,nSI npOBe,n,eHHSI aMnJlMqmKal.(MM.
3) J],06aBMTb B COOTBeTCTBYlOlJ.(He np06HpKM no 5 MKJI J],HK nOnO>KHTeJlbHbIX
KOHTpOJlCH, a B np06HpKH, nOMe l IeHH61e KaK OTpHl,.(aTenbHble KOHTponM, no 5 MKl1
BO)J,bI.
4) 113RJle'-Ib pacTBopbll0x nu.p- 6yq>epa, HT<l>. Taq-nonHMcpa3bI. IlpaHMepon
M3 MOp03IinbHMKa, pa31.1op03HTb COAep>l<M1.1Oe M nepeHecTH HX B neASIHYIO 6aHIO.
5) Opm"OTOBHTb C1.1eCb peaKTMBOB comaCHO npl1BeJJ,eHHoH Ta6nHLte:
KOJIU leCTDO Bo a, lOx nl{p Taq, pacTDop* HT , MKJI
npo611poK 6y4»ep, MKJI
MIU. MK."1 npauMepoB, MK."1
4 52 10 0.8 8 10
8 104 20 1.6 16 20
16 208 40 3.2 32 40
24 312 60 4.8 48 60
32 416 80 6.4 64 80
42 546 105 8.2 84 105
BHHMAHHE! OpH IIpHrOTOBJICHHM CMCCM peaKTMnoB He06xoAMMO Bce K01.1-
nOHeHTbl )J,06aBnSITb OT)J,enbHbl1.1M HaKOHe'-IHHKaMM.
*,D,ml BbUIBJ1CHIISI XHaMUlllm TpaXOManlC IICn0J1b3yeTcH napa npartMepoR Rl II ChI. Mlt-
KOnJ1a3Mbl rOMIIHIIC- Rlll H, ypeanm\3Mbl ypeaJUlnlKYM - Rl I U.
6) Oocne )J,06aBJleHMSI Taq-nonHMepa3bl, KOTopoe npOM3BO)J,MTCSI n nOCJle)J,HIOIO
oL,epeHI>, Jlco6xOAHMO TlilaTC.'T6HO ncpcMcwaT6 CMCC6 nHneTMponaHHcM.
7) J],06aBHTb 11020 MKn aMnJlMqmKal..{MOHHOH C1.1eCH n Ka>l<A)'1O np06HpKY, co-
Jj,ep)KalilYIO 5 MKn aHaJlH3Hpye1.1oro 06pa3Lta.
8) J],06aBHTb no OAHOH Kanne (OKOJIO 25 MKn) MI1HepanbHoro Macna, Hcnonb3YSI
nHneTKY OOheMOM t MJI.
9) Op06HpKM 3aKpblTb H l.(eHTpHq>yrHpoBaTh B TC'-leHHe 3-5 ceK npM 12000-
16000g (8-12 TbIC. 06/1.1HH).
10) OepeHecTM np06HpKM B nporpaMMHpyeMblfl TepMOCTaT (aMnnHqmKaTop) Ii
nponccTH aMnJlliqmKaUMIO no cneAYlOlileH nporpaMMe:
94°C - 40 ceK
58°C - 30 CCK KOJIM'-leCTBO LtHKJlOn 30
72°C - 30 ceK
BbUIBflEHI1E I1H<I>EKUI10HHbIX ArEHTOB METO,D,OM nup 305
PErUCTPAQUHPE3ynLTATOB
1) 3aJU1Tb 8 annapaT AJHI 3J1CKTpocfJopc3a 1xT AE 6yqJCp npl1roTOBJlCHllblH H3
J\I1CTI1J1J1HpOBauHoi'1 BOAC pa36al3J1CHHCM 50xT AE B 50 pa3.
2) K 1,5 r arap03bl AooaBl1Tb 2 MJI 50xTAE 6ycfJcpa 11 100 MJI I1C1'I1J1J1l1p08aH-
Hm1 80}J;bI"
3) PaCllnal3l1Th 3rapo3y Ha 3J1eKTpH'leCKOH nmnc IIm1 8 CB1.I-nC'IH. ,D,06a8111'b
K 100 Mn pacnJla8ncHHoif arap03bl 10 MKJI pacTBopa 6pOMl1cToro 3TUll.I1S1. nCpCMC-
waTh .
4) 3aJU1Th arapo:mblfl reJlL COI"JlaCHO I1I1CTpYKI Hn K annapaTY } JISI rOp1130H-
TaJIhHOrO 3ncKTpoqJOpc3a.
}J,JISI JaJUlI3KI1 arap03Horo rcnS! YI106HO I1CnOnbJ08aTb KpblWKI1 AnS! I1MMYHono-
rl1 l lCCKHX nJlaHUlCT08 nO}J;XOASlllI,lIX pa3MCp0I3. ,U.JISI 1I0JlY l ICHI1S1 KapMaHOI3 13 arapo3-
HOM j'CJlC YCTi.lHOBI1Tb rpeGcHKY Ha nnaHWCT, I1Cn0J1b3YS! 3a>K tM Tl1na "6ynbAor".
Oxna,rJ,l1Tb arap03Y .11.0 TCMncpaTypLJ 50-60°C U lIaJlHTh lIa IIJJi.lBUlCT.
nocnc 3aCTbmaHI1S1 arap03bl OCTOpO>KHO BblHYTb rpe6eHKY 113 rCJIS! H nepcllc-
CTH cro B almapaT nml npOBCUCHI1S1 3J1CK1'poqJOpeJa.
5) ,U.06a1311Tb B Ka>K.II.YIO a mnHqJHKaLl.l1oHHYIO npo611pKY no 5 MKn 6-KpaTHoro
6ycpcpa AJ1S! HaHCCCHHS! 06pa31\a.
6) HaHCCTH B KapMaHbl reJlS! no 10-15 MKn <1MIIJJHcpuKaTa. npep,Bapl1reJlbHO
CMClllaHHoro C 6yqJCpOM nJISI 06pa3L1.3 (CM. BbIHIC), B nOClICl\OBaTCJlbIiOCTU, cmyr-
BCTCTI3YlOll.{cii HYMepal-t1111 np06. HaHecTM nOJlO>KI1TCnbHblC 11 OTpl-tLl.aTenbHblC KOH-
TpOlll1.
7) nOAKnlOllHTb 3J1CKTpOqJOpCTU l ICCKYIO KaMcpy K I1CTO l lHIIKY nHTaH51S1 51 3a-
AaTb HanpSl>KCHI1C, COOTBCTCT8YIO ee HanpSl>KeHHOCTlt 3J1CKTpU'ICCKoro nonS! 10-
15 B/CM. npo8ecH1 3J1CKTpOcpopcTwlecKoc pa3}\CnCHUC npoHYKTOB aMnJlH<p"Ka-
Ll.I1H 8 HanpaBnCHHI1 01' KaTO}\a ( -) K aHony (+) B TellCHHe 30-45 MUH.
8) BbIHYTl) rC.JIb M3 qJOpMbl 11 ncpeHeCTI1 cm Ha CTeKno TpaHCHnnlOMl-maTopa.
BHUMAHUE! C rCJ1CM arapo3bl CJlCAYCT pa6araTb B nCpl.JaTKaX, T.K. 6P0P\.UlCTbUI
::ITliAlilt HBJlSlCTCSI C IJlbllbIM MYTarCHOM.
9) BKJIIOlUlTb TpallCllJlJllOMl1l1aTOp U npoallaJIH311pOBaTb pCJYJlbTaTbl a1iCL1H33.
(l>parMcHTbI aHallH3upyet.lOM J],HK npmmmnOTCSl 8 811p,C CBeTSl IIXCSl OpaH>KC80-
KpacHblX nOJloc.
AHAnU3PE3YnLTATOB "ArHOCTUKU
1) Q-l'pl1lJ,aTC!lbHbli1 KOHTponb - OTCYTCT8HC KaKI1X-!1H60 qJparMCHToB ,D,HK
2) n0J10>KI1TCJlbHblfl KOHTpOJ1b - AJ1Sl XnaMI1AIli1 BblSlBml.CTCH nO!loca pcIJMCJ){)M
501 H.II., AJ1S! ypeanna3M - 856 H.n., AJ1S! MlIKonna3M - 977 ILII.
3) AHaJll1JHpyeMblc np06bl: OTCYTCTBHe n0J10Cbl cTporo Ha ypOBHC COOTBeTCT-
DYIO cro KOHTpOJ15I cBHp,eTcnbcT8ycT 06 arpHLl.aTCJIbHOM OTBC1'C Ha npHcYTcTBIiC
}\aHHOrO 8036YJ\I1TCJlSl. HaJIII l ll1C n0J10ChI COOT8CTCTBytOlI\CH no 3JlCKTPO( OPCTH-
'ICCKOH nOA8H>KHOCTH nOJlO>KI1TCnbHoMY KOHTpOJ1fO - HaJlWII1e p,aHHoro B03GYAliTe-
JlSl B KJlI1Hl1 l ICCKOi.f np06e.
5) DOJlY'-lclfllbIC PC3YJlbTaTbi MO)l(HO P,OKYMCH rl1pOBaTb oTorpacpl1p08aHHcM
reJlCH C I-fCn0J1b308aHI1CM OpaH>KCnOrO 111111 I1HTcpqJepeHj{HOHHOro (594 HM) CBCTO-
qmJlbTpa.
306 [()\1 II - '-IACTHbIE AHAJH1TM'-IECKME TEXHOJIOfMM
2. nl-'p- AMorHOCTMKO BMPYCO renaTMTO B
Bupyc zenamllma B (HBV), OTKpblTl>lH 13 1965 r. B.S.Blumberg. B HaCTOSl ee
npcMSI CIUITaeTCSI nlaBHJ.TM 3THOJlOn1 leCKIiM arc II TOM :mOOJlCBaHHH ne ICIUf 11 rena-
TOKJ1eTO'IHOH KapLtHHOMbl. HBV - CaMbl" Me.rJKHH 1'13 M3BeCTHbiX BHPYCUB [enOBe-
Ka - npCf\CTaB.IJSleT coGorl JaCTHl'hl pa3MCpOM 42 11m, COCTOSlu,He 113 nHellIHeH 060-
.110 1 1KI1, npCACTdBneHHOH nOBepXHOCTHblMlt aHTHreHaMH npe-Sl, npe-S2. 5, H HYK-
.1ICOKanClf}T.a, npcHcTaBncliHoro IlYKJICHllOUOH KHCJIOTOJ.t, OKPY)KCIUIOH 6C.1KOM
cep;:J,uem1Hbl - Core. feHOM Bupyca npef\CTaBneH Ko.'lbLteBOI1 IlaCTl1'lHO ,!],nyXLteno-
'[e"I/IOrl MoneKYJIOH J],HK paJMCpOM OKO..'IO 3200 11.0. U IIMCCT ClIeHYIOU,UC rCllhl:
pol- KOAupyeT BHPYCHYID nO.'lIfMcpa3Y, S- KU;:J,UPYCT 6e.'lKH BHeLUHeH 060.IJO'IKIf
(HBsAg. npeSl, npeS2) C - KOf\UpyeT 6eJIOK HYKJJeoKanCUl1a (HBcAg) H ceKpenl-
pycMl>nl 6CJIOK ( HBcAg). X- KOAHPYCT 6CJlOK. Y'I<lCTBYK) HH B pcry.'ul.LtJUI lmpyc-
Hoit penm1Kal'lUl 11 3KcnpecCim BUpYCllblX 6CJ1KOB. npCl1nOJlaraCTcSI Cy",ccTBoBa-
HHC Hono..'1H ITenl>HhlX pa\lOK C 1 IHTbmaHHSI, po.1Jb KOTOpblX 13 HaCTOSlu,ee BpeMSI aK-
THBHO I1JY'ICICTCSI. KOJJ.l1pOBaHUe JHa'H1TeJIbHOrO KO!ll1'lCCTna Bl1PYCHbIX 6CJ1KOB Ii
perYJlSITopHblX 3neMeHTOB npH He3Ha"HlTeJlbllblX pa'JMepaX rmpYCHoro reHOMa
06CCIIC 1 11IBaCTCSI []{).IIIl>IM H.fIU llaCTIt'[Hl>IM IICpCKpl>lBaHIICM rCHon (pIIC, 1).
H Bc-Ag
H BeAg( -) [ 1 ]}
!1 ::F :JIllD
· COOE I: .; ;;; nnnnnnIIIIllIiIIIDP
mnmmnn
HBeAg
.LI.IIK 32001l.n.
rnJ( ::: JfID
,
PUC. 1. OpralUlJaJuul rCHm.m IHlpyca rcmrnrra B
CepOJlOrllllCCKaSi HllanlOC nlKtl BKJIIO"IaCT B cc6S1 O£lPCHClIClinC OCIlOBIIl>lX BI1-
PYCIlJ.IX allTlIl"CHOB It aHTlITC.T1 K HI1M MCTO]J,OM 11<1)A. a TaK)I(e onpCACJICmlC BlIPYC-
HO 1 .il.HK MCT0l10M nonH lepa:mOrll,enHoH pCaKI\lIU (nl p). K OCHOBHhlM I-1MMYIlO-
JI0n11ICCK IM MapKcpaM OTHOCSIT IIBsAg, IIBcAg, aHTlI-IIBc IgM. <lHTH-IIBs. aHTI1-
HBc. Pa::mUTIIC MCTOJ{OB rCHOjJ,lIamOCTlIKII. II ncpBYlo 011CpCJ\h nI p. n03BOJUIJIO
3Ha'H1TeJIl>HU }'BCnI1'IIITb I1mlJopMan1BHocTb lIa6opaTopHoH J1.J1arHOCUtKH. HaJlH-
lruc HBV-lJ,IIK B Cl>IBOpOTKC naLtneHT<l cBHj\eTCnl>c'myeT 0 pcnnnKaTHBHui1 aKTHB-
HOCTU BlIpyca. MeToA nIJ,p 0611a)l.aeT l[epe3BhJ JallHoi1 lIYBCTBJ1TeJlbHOCTblO (100 -
1000 KOlUullMJI). 'ITO O'ICHb m')KHO £lpl1 HJ13KHX TlITpaX Bllpyca. B HaCTOSl ce Bpe-
fSl nIJ,p COI3MeCTIfO C f\pyn1MJ1 JJa60pa"ropHI>IMII I'CCTaM 1 UC£lOJlb3YCTCSlllp 1110cra-
HonKe HlIarH03a BllpyCHOro renaTlfTa 11 npll nponenmum aHT£1B1lpYCHOH Tcpamm. B
.
BbHIB.nEHHE HHcI>EKUI10HHbIX ArEHTOB METO,lJ,OM BUP 307
I
npI1BO}J,I1MoI1UI1:>KC MeTOJ],I1KC I1Cn0J1b30BaHbJ npaiiMepbl K KOtlCep13aTHBHhIM yyaCT-
KaM rCHa s. npHBOAI1MaSJ HH:>Ke npo c,wpa np06onoJ,J,I"OT013KI1 11 nOCTanOBKI1 nup
JIC:>KI1T B OCHOBC HHCTPYKLlI1H K Ha60py nOJJl.1rEn-B AJ1S1 oo"apY:>KClUfSl Bupyca
renaTUTa B B CbIBOpOTKC I1JIM nJ1a31.1e Kpof31.:J TY -9398-408-17253567 -97.
AIIAJIUTUIJECKUE XAPAKTEPUCTHKH
Cnel{IUpU1tlWCmb mW.Illl3a
B nOnO:>KI1TeJlbH01.1 KOHTpOJlbUOM o6pa3Lle (JJ.HK BHpyca reJlaTUTa B) }J,OJI}I(lfa
BblSlBnSlTLCSJ O}J,Ha nOlloca OpaH:>KeBD-KpaCHOro BeTa IIOCJle 3JJeKTpoq}OpCTl1'le-
CKOI'O pa3}J,eJIeHHSJ npoAYKTOR aMIIJJI1q}HKa HH B arapo3HoM rene, COOTBeTcTBYIO-
ll.\aSl no n01\BH:>KHOCTI1 cppan,1cHTY reHOMa Bupyca renaTIiTa R pa3MepoM 307 lIap
HYK11CO mAOB.
B OTpH aTeJIbHOM KOHTpOJlbllOM oGpa:n e nOJloca OpaH:>KeBO-KpacHoro BeTa,
cOOTBeTcTBYlQlllaSi q}parMcHTy reHOMa BHpyca renaTHTa R, AOJI)KHa OTCYTC 1"U001aTb.
Heo6x()()lLMOe o6opyi>oauHue
1) nHnC1KI1 n011ya13TO mTl1'leCKl1e 01\IIOKaHaJlbHble Ha 1-20, 5-40, 40-200.200-
t 000 MKn
2) HaKoHcllHHKH C (I}l.:JJILTpa m K nHrICTKaM (ART-tips)
3) MHKponpo611pKI1 nJIaCTHKOBbIC Ha 1,5 MJI H 05 Mn
4) lllTaTHBbI )J,J1S1 MHKponp0611poK
5) MHKpo eHTpl1q}yra Ha 12 TblC. 06/MHH AJISJ 1,511 0,5 1.111 npOUl1pOK
6) npu60p AnSI ropH30llTaJlbHOrO 3JleKTpocpope3a
7) nporpaMMHpyc1.1blM TcpMocTaT (AHK aMlI!mcpl1KaTop)
8) YJlbTpacpl10JleTOBblH TpaHcHnJlloMmmTop
9) BOJ1,OCTPYMHbIH lUIH BaKYYMHblM Hacoe C KOJIGOM-J10BYUlK0f1
to) CB'lI-ne lh, 3JICKTpl1'IeCKaSi IIJIUTKa UJ1l1 BO,1S1l1aSl 6aHS! Ha 95-1000 C
11) BCTpSlXHBaTCJIb AJ1S1 MUKponp06l1pOK (THna hBopTeKc")
12) OAHOpa3013ble pe31111013b1C ll1111 nJ1aCTI1K013bIC nep JaTKH.
Peat<mlWhl
1) ACHarypHpYlOlllHH pacTBop (3 M ryaHHAHHTHO HaHaT; 50 MM TpHC-HCL;
50% CPCHOJ1; 0,3 M aJ CTaT HaTpHSI, pH 7,5);
2) 1130npOnl1n013blM cnl1pT;
3) npoMblBo IHhlf1 paCTBOp (70% 3THnOBblii cnHpT );
4) paCT130p HOCI1TeJISt ( rpaHcnopTHaSl PHK; 1 Mrhl!I) ;
5) BOAa J1C"0I1130BaHHaSl;
6) 10-KpaTHbIH 6yq}cp AnSI np013eAcHI:JS! nup (0,1 M TpI1C-I1CI, pH R,8; 25 MM
MgCI; 0,5 M KCI; 0.1 % pacTBop >KCnaTHHa, 0,5% - pacTBop Tmm-20);
7) pacTr op npaMMepoR HBV CJ1eAYIOII(ero COCTaBa:
HBV _1 S"-GAT TCC TAG GAC CCC TGC TCG TGT TAC-3"
HBY _2 5' -AAT TAG AGG ACA AAC GGG CAA CAT ACC-3'
13 KOH eHTpauHH 10 p1.1OJlh/MKJI Ka>K}J,OrO;
8) pacTBop AHT<I> (2,5 MM KIDI<J\Oro);
9) Taq-noJ1l11.1epa3a ( HO<1> "Jh1Tex"). 5 eWMKJI;
10) MaCJIO Ba3enI1UOBOC;
11) arapoJa;
12) 50-KpaTHbIM TAE-6yq}cp (2M TpHc-aJ eTaT, pH 8,2. O,05M 3.QTA);
13) 6-KpaTHLIi'1 6yq}ep i\J1S! HaHcceHHSI o6pa3 a (40% caXap03C:1, 0,25% 6pOM-
308 TOM 11- YACfHbIE AHAJII1TI1l.IECKI1E TEXHOJIOrI1I1
cpeHOJIOBblH CHHHf1);
14) pacTBop 6pOMHCTOro 3THJ\H , 1 %;
15) KOHTpOJIbHblH oGpa3eLl HBV-)],HK, C KOHLleHTpaL\HeH HC MCHCC 10 cpr\MKJI.
npOBE TJ,EHI1E AHAJUI3A
Bbloe.llellue ,aRK U3 Cb160pOmKU UJlU nAa3Mbl Kp06U
3a6op IUlUIIUII.eCKOlO AlamepUaJla
)],J1 nOJ]Y ICHH CbIHOpOTKH BeHo:myto Kpom, B KOJlH'-leCTl3e 500 MKJI co611patoT
II 110mmpOm1JIeHOBYto 1,5 MJ1 npo6upKY H gaJOT CBepHYTl>C . np0611pKY L\eHTpHq}y-
rHpYloT, nOJIY'-leHHYIO CblBOPOTKY lIepeHocSiT B CTeplfJlbHYIO IIOJIHnpOnHJIeHoBYlo
1,5 MJI npo6HpKY, I1CnOJlb3YSI HaKOHe IHHK C cl>HJlbrpoM. CblBOPOTKY KpOBl1 MO>KIJO
XpaHliTl> npl1 Te!\meparype -20"C 13 rC1lCHHC 1 1eC 1 <l.
.o:Jl nOJTY1]eHH IIJIa3Mbi BeH03HYto KpOBb B KOJII1l.JeCTBe 500 MKJI co6HpaK.rr Ii
CTCpll.!JI,UYfO nOJlHnpOmuleHoBYfO 1.5 MJ] npo6HpKY C 50 MKJJ 0,5 M pac'mopa 3)],-
T A. TlllaTcIlbHO ncpcMelllHBatoT, npo6HpKY LlcHTpHq}yrHpytoT, nonYl]CHHY]O IIJIa3-
MY nepeHOC T B C1'CpmJbHYto l1ommpOm1J1eHoBYto 1.5 MIl npo6HpKY. HCnOJIb3Y Ha-
,-
KOHC IItHK C ClmJlhTpoM. nJIa3MY KpOBH MO>KHO xpaHHTb npH TCMllcpa1ype -20"C B
Te leHl-le 1 \1CC L\a.
06pafiol1lKa CblBOpOlllKU UJlU IlJla3"'bl "pOilU Ilepeo npoeeoellue.u a.mUlu-
ifjuKalfuu (6bloe.nellue ,aHK).
1) B 'HtCrylO 1,5 MJI nOJIHnpOIlHJICHO(3)'1O np06HpKY I3HCCTH 3 MKJI paCTBopa He-
CH1'eJI H 450 MKJI J\CHarypHpytolllero pacTBopa.
2) )],o6am1Th 50 MKJl 11CCJleA}'eMOH CblBOpOTKI1 HJlH nJIa3Mbi KpOI3H. Bo H36c>Ka-
ItHe KOH1'aMHH<lL\HH 06pa31(OB ChJBOpOTKY ItJlH J]J]a3MY Kpom1 CJlep,yeT nepeHOCHTb
13 npo611pKY C neHarypHpYtolllHM pac 1130pOM, I1cno.nb3Y HaKOHctlHHKH C qmJlhTpa\U1.
3) TU a1'eJlhHO nepeMewaTb HCl BopTeKce B Te 1 leHl1e 10 ceK. I1I11<.y6HponaTh npl1
KOMHaTJWJI TCMncpa-rypc (+1 R-25 C1 C) B Te t lefU1C 10 Mllll.
4) lJ,cHTpHq}}'n1pol3aTb B TctleHHe 5 CCK npH 12 ThIC. 06/MIfH. npH KOMuaTIIOH
TCMncpaTYpc.
5) )],o6amlTb 100 MKJl XJIOpoq}OpMa, nepcMcuJ.\Tb HCl nopTcKcC n Te'leHHe 5 CCK.
6) lJ,cHTpHcl>yrnpoBaTb B TC 1 lem1e 5 MHH npH 12 TbIC. o6hUlH. npH KOMHaTHol1
TeMf1CpaT}'pc.
7) nepeHeCTI-J 300 MKJI I3cpxHcii q>a3b1 B IHCT)'to no.nHnpOnHJIeHoBYto npo6Hp-
KY. co.u.cp)Kall Ylo 300 MKJI H30npOnHJIOBoro CIIHpTa. nCpeMewClTb Ha BopTeKce B
Te leHHe 5 ceK. Bo 1136C>KaHUC KOHTaMHHaLlHH AmiHYfO npOI\C1l.YPY cneJ],yeT npol3o-
p,HTb, HcnO!Ih3YSl uaKOHetIHI-JKIi C cl>HJlbTpaMH.
8) UeHTpl1q}yrnpoBaTh n rctletiHe 15 MI1H npH 12 fl>IC. 06/MHH. npH KOMHC\THOH
TCMncpaTYpc.
9) OIOpOCHTh c)'nepHaTaHT. 1-ICI1OJlb3Y l3aKYYMHhlH acnHpaTOp, 13 K01I6Y-JIo-
BYWKY. JJ.auuYfo MmiHnYJlSl[ Hto npOBOAHTb C oco60H OCTOpO>KHOCTblO, HC p,OI1YCKaSi
JaXBaTa OCa]1,Ka.
10) .o:o6aBUTh 1 MJ1l1pOMblBo 1 1H0ro pacTBopa, nepCMCLI' TL.
11) U,CHTpHq}yrHponaTb n Te'leHHC 5 MHH IIPH 12 1'b]( 'HH. npH KOMliaTtloi1
Tct>lIlCpaTYpc.
,
BbUIBflEHJ1E J1HcI>EKU,J10HHbIX AfEI-ITOB METO,D,OM nu:p 3U9
12) YJ.\aJlH1'b cynepHaTaHT I<al< MO)KHO nOJ1HCC. HC JaXBaTHS IIPH ::ITOM ocanOK.
Oca.LJ,ol< nOJ.\cYIIIHTb B TeqeHHC 10-20 MHH.
13) ,lJ.06asHTL 30 MI<J1 ]1,CHOHHJOBaHHOH 80Abl, np06Hpl<H 3al<pbl1'b, HHKy6HpO-
BaTb B Te--ICH"C 10 MHH npH 1<0MHa1'Hoi:f TeJ\1I1CpaTYpc, 3aTeM nepeMcmaTh BCTpfl-
XHBaHHCM. PacTBop O--lHll.{eHHoi:f ,lJ.HK MO)KHO xpaHHTb npH TCMncpaT}'pe -Za'C B
TetleHHe ABYX HC.u.CJ1b .
llpoee()ellue nOJlUJJlepaJIIOU lJenllou peaKlJuu
nCpeA nponeAcHHeM TIU,P Hc06xo]1,HMO KOMnJ1CI<T pcaKTHBoB A.,'ur nponc}"tCHIUI
peaKLlHH, XpaHflII\Ht'fCSl np" TCMncpaType -2(tC. paJMOp03HTh, OCTclBHB cro np"
KOMHaTHoi:f TeMncpaTYpc Ha 15-20 MHH.
1) npHI'OTOBH1'b 0,5 MJl np06HpKH AJISI npOSe]1,CHliSi aMnmfcpHKal\lUf B KOJIH--IC-
CTBC, COOTBC1'CTBytoll\CM KOJ1H t ICC1'BY HCCJ1CA)'CMbIX 06pa31\OB, npOHYMcpOBaB JlX 11
pacnO.'JO)KHB cooTncTc1'BYIOIl.{HM 06paJOM B IUTaTIIBC. npJlrOTOBHTL raK)KC no 1
np06l1pKC JvlSI n0J10)KHTeJ1Mloro H 1 np06upl<c AIISI O1'pltl\aTCJlbHOro KOH1'pOJ1S1 11<1
Ka>K]1,bIC 20 HCCJ1eAyeMLlx o6pa3LloB.
2) npHroToBHTb CMeCb 1<0MnOHCHTOB AJ1S1 aJt.HlJIHcpHKaLlHH H3 pac--,c ra Ha O,U,HY
np06y:
I
I
lOx TIlI,P 6ycpcp 3 MKII
npai:fMepbl HBY 3 MKJ1
801\a t{CHOHH30BaHHaSl 23 MK.'1
Taq-noJUfMepa3a 0,2 MKII
3) CMCCb nCpCMCllJa1'b mmenfpoBaHHcM H BHCCTH no 27 MKJI B l<a>KJI,)'IO npo-
6HPKY AJ1S1 aft.-mJlHcpHKau.HH.
4) BHecnf no 0AHoi:f Kar1JlC (OK01I0 25 MKII) 8a3cmmonoro MaCIJa B Ka)KA)'1{)
np06l1pKY. HCn0J1h3YSl nHnCTKY C HaKOHctlHHKOM BMeCTI1MOCTLIO 1 MJl.
5) BHCC I'H no 3 MKJ1 paCTBopa aHaJUf3HPYCMOI"O 06pa3Lla n COOT8CTC"mYK)liJ.He
np06HpKH HHlI.HB"AY<UlbHbIM HaKOHC--IHHKOM C cJJHJlhTpOM. BHeCTH 3 MKJI 1\CJfOIlH30-
BaHHOH 80Abl B 1 npo6HpKY, nOMc1.lcHHYJO l<aK oTpUllaTCJlhflblH KOHTpOJlb, If 3 MKJl
HBY J],HK B 1 npo6HpKY, nOMctlcHHYIO KaK nOJIO)KHTCJ1bHbIH KOHTpOIlb.
6) TIp06HpI<H 3aKpb1TL, LlCHTpHcJJympouaTL 8 TClleHHC 5 ceK npH 3 TbIC. o6ft,um.
npH KOMHaTHOH TeMncpaType, nOMCCTHTb B nporpaMMHpycMLIH TCpMOCTa1' (a\m-
Jll-fcpHKaTop), HarpeTblH 3apaHCC AO 94°C, H npOI3Cc'l H peaKLlHto no cJleJJ..ytolltCH
nporpaMMc:
94°C.........40 CCK
60 Ll C.........60 ceK KOJlJ,:ll-JCC 1'80 LlHKJ10B 5
72 f1 C.........15 CCK
92"C.........30 eCK
60°C.........30 CCK K01IH ' ICCTBO LlHKJ10B 35
7t ' C.........45 CCK
PEfllCTPAI.{HD PE3YJIbTATOB
1) 3a)]H1'b B annapaT IVISI 3JleK1'pocpopc3a 500 MIl 1xTAF-6ycpepa, npHrOTon-
JICHHOro Ha .AHCTHJ1J1HpORaHflOH B0J.\C pa36aRJ1emfCM 50xT AE-6ycpepa B 50 pa3.
2) K 2,5 r arap03hl n06amtTb 2 MJ1 50xTAE-6ycJJcpa H 100 MIl JlHCTIIJlJmpOBaH-
HOt', BOAb!.
3) PaCnJ1aDHTb arap03Y Ha 3.'lCKTpll l leCl<oi'l nmnc H!Uf B CBlI-ne--lH. J1,o6amrn.>
310 TOM II - llACTHbIE AHAJU1TI14ECKI1E TEXHOnOrl111
K 1 00 fJ1 pacnJlaBJlCIHlOH arapOJbl 5 MKJ1 paCTBopa 6por.1HC'foro 3THAIUI. DepeMeruaTb.
4) 3a.ru1Tb arapOJHblt't reJ1b cornaCHO HIICTp)'KlJ,HI.J K annapaT)' .QJUI. ropH30H-
TaJlbHoro 3.TleKTp0<pope:m.
mf 33.'IHI3KH arapo3Horo remt )'J.l.06HO HCnOJlb3013aTb KpblWKH ml HMM)'IIOJIO-
HI'-leCKHX n.l]aIlWCTOI3 1I0.QXO.QH lIX pa3MepoB. Jl,ml nonY'fcHHSl KapM3HoB B arapo3-
G " G "
HOM reJ1e YCTalI08HTb rpc CIIKY 1m nJIaHWeT, lfCn0J1b3YSl 3a>KHM ...1-11I3 ynbAor.
OXJla; I1Tb arap03}' AO Tep\.mepaTypbl 50-60 1J C H HaJlI1Tb Ha nJlaHweT.
flOCJIC JaCTblBaHHH arap03h' OCTOpO>KHO I3blHYTb rpe6eHKY In reml H ncpcllc-
CTH cro B annapaT lVIS! IIpOI3C}.1CHUSl 3JleKTpo<pope3a.
5) J],oGamlTb B Ka>KJ YIO CI IIIJH1 )HKalJ,HOHHYIO np06HpK)' 110 5 MKJI 6-KpaTHoro
6)'( epa )l..'ISI HallCCCIUIH 06pa:nta.
6) H UlCCTH B KapMaHbl rellSl 110 10-15 MK)I af',lIIJ1u<puKaTa, npe)l.BapHTCJILIiO
CMemal-fHOrO C 6y<pcpm.r :lSl HaHecemiH 06pa31 a (CM. BbIWC), 13 nOCJ1e.a.OBaTenbHO-
cn1, COOTI3CTCTB)'lOllI.erl HYMepal 11I-1 IIpo6. HaHCCTn B Kapr..taHbl reJ1H no 10-15 MKJI
1I0.'1O>KI.JTeJlhHOrO H OTpm aTCJlbHOrO KOHTpOJIH. npeJ1BapHTCJlbHO CMcwaHHblX C
6y( epor.'l )VIS! II<UlCCCHHH 06pa31 a.
7) DO]lK!IIu'IHTb .)J)eKTpo<popenl'lecKYlo KaMcp)' K HCTO'IHHK)' mlTaHUH H 3a-
11.3Tb HanpH)I{e-HHe, COOTBC1'CTBYlO CC HanpH)I{eHHOCTlf 3J1eKTpH'-lccKor'Q nUJlSI 10-
15 B/CM. TlpOBCCTlI )J1eKTpo<popeTwlccKOC p33J CJICHl1C npO,D,)'KTOB ar.mJlHCpUKa-
lJ,HI1 B Hanpa8nel'UU1 01' Karo].l.a (-) K aHO.a.y (+) B Te'-ICIHle 30-45 MHII.
8) BbIH)'Tb renh H3 (POpMbll1 ncpCHCCTH ero Ha CTeKJ10 TpallCHJlJIIOMmraTopa.
BIIllMAHHE! C relleM ar-apmb' CJ1CAYCT pa60TaTh B nep'JaTKax. TaK KaK 6pOMII-
CTblii aTII]J,lIfl j1BJHICTOI CIL1bHhlM Myra'"CHOM.
9) BKJlIO'-IHTb Tpal-fcUJIJ1K)Ml1l-faTOp it npoauaml31'lpOlmTL pCJYJlbTaTbl aHaJ1H3a.
<Dpan.1cIITbl allCIJIIBHpyeMoi'1 J],HK npOSlBJIS!IOTCSI B BHUC CBCTSllll.UXCH OpaH>KeBO-
KpaCHhlX nonoc.
AIIAJII13 PE3YJILTATOB
]) 0 rpllu<rre.lhHhIH KOI-fTpOJ1h - 110:loca OpaH>KCBO-KpaCHoru lJ,BeTa omKJJa 01'-
C)'TcTBOl3aTh.
2) nO:IU>KlwcnhllbIH KOIHpOjlb - BblSll3JlHeTCH nOJloca Opall>KeBO-KpacHoro lJ,l3e-
Ta paJMCpOM 307 nap H)'KJleOTl-I OB.
3) AIla!1It3HPYCMbIC np06hl: OTC)'TCTBlle nOJIOCLI OpaH>KCBO-KpaCHoro LlBeTa
CTporo Ha ypOlme COOTBCTCTBYlOllI.Cro KOHTpOJ1H CBH)l.eTeJIhcTBYCT 06 o-rplllJ,aTCJlb-
HOM OTBCTC lIa "pI1C)'TCTBHC )l.<\HHoro B036Y HTeJ1S1. HarrwlHc nOJIOCbl OpaH)I{eBO-
Kpaclloro ltBCTa, COOTnCTC rnYlOm,di no 3JleKTpo<popeTH'-ICCKOn nojtBH>KIIOCTH 110-
.']())I{11TeJ1hIIOJ\lY KOIITpOJllO - HamlllHe )1aHHOrO B036YAH1'CJISI B lIpOGC CblBOpOTKH
11.'111 IIna3Mbl KpOBI1.
4) IlOSlBJleHHe n0J10Chl B OTpI1lt.aTc.'ILIIOM KOHTpOJ1e cBH eTeJIbcTByeT 0 KOHTa-
,-
MI1HalJ.HH KOMlIOHCHTOB Haoopa_
5) IIUJI)"lcHHble pe3ynb faTl,1 MO>KI-fO J OKYMCHTI-lpOm.lTb <poTorpa<pHp08aHlleM
rCJ1ci'1 C I1CnO.lb30mUII1CM Op<UI>KCBOrO 1-f.11H I1HTepcpepeHLlHoHHoro (594 11M) CBCTO-
cpHJlLTpa.
-
r
BbHIBJIEHJ1E J1HcI>EKl(lifOHHbIX AfEHTOB METO,rr,OM rrup 311
3. BblRBneHMe BMpyca rena'lM'Ia C Me'lOAOM
nonMMepa3HoH qenHoH peaK....MM
Ha lI-tHaH C 1973 ro a. KOn a 6bTI1H pa3pafioTallbl HMMYI-I.O CpMCHTllble Tec ("-cn-
CTeMbI HJIH )J.HarHOCTHKH IUlpYC08 renanlTa A H B. 6oJll,wyIO 'laCTI, noC'npal"c y-
3HOHHbTX rcnannou (OKOJlO 2/3 CJIY'lacB) CTaJH1 OTI-I.OCHTb K KI1accy 1-1.11 A. Hit B.
MHTCHCHlmLIC J1CCI1eJ\ORaHI1S1 rcnaTHTOB Ul1pYCHOt'1 3TUO-'TonUlII03B0J1JLIIII BI.ISlBI1TL
n 1989 fOAY HOB!'I" PHK-co]\ep>Kallll'lfl renaToTpollHLlft BHpyC, n n<UILHcllweM 110-
nY'IHBwHM Ha:maHHC Impyca rcnanna c. no CBOHM 6HOJIOrUClccKu/t.'1 II MOJlCKYlIHP-
IILIM xapaKTepHcTuKaM 3TI)T Impyc fiLm OTIfCCCH K ceMCHCTB}' Flaviviridac H 8"IHC-
nCH B OTJ CJJLHLIH BHA Hcpacivirus Hap JJ.Y C Y>KC H3nCCTtlbiMU BHAaMII Flavivirus H
Pcstivirus. BHpHOI-I BHpyca renanna C HMceT CcpCpH'ICCKYKJ CPOPMY It OKPY>KCH nH-
mfJ\HOM 060110 1 IKO". no 1I0CJIC1 HHM allHbiM ..ITa Jmml,lllaSi. ofio.rlOlJKa COCTonT 113
mmonpOTCHIIOB mBKOH nJlOTHOCTII Opral-l.U3Ma XO:UUUIa (1IenOBCKa) U 06nCPlaCT
-
BHPYCY npOl-lllKHOnCHIfC 'lepC3 LlHTOnJlaJMaTH'ICCKYKJ MCMOpaHY rCnaTOl(ItTa.
reNO,\{ (wpyca rcnaTH-
Ta C IIpeJ CTaB"lCH 1111-
3' NCR I-I.CT1I-1OH :>'1OJIt,;KFIOit
PHK, C KOl'Op0l1 B Xo-
HC pa3 1IiO>KeIIllH BH-
pyca CUHTC3ItpYIOT-
Cst BUPYCHWC 6eflKIt
(I1JIIOC-I CIII. PH K).
Pa3Mcp BltpycllOro r'e-
IIOMa cocnUUUICT OKO-
no 9,5 kb U nOnpa3J{e-
JISl.CTCSI I-Ia HeCKO!ILKO
Y H Ii: 11..1'1 0 H a JI h II hi X
3011: 5' HeTpaHC:UI-
PYCMblfl pcnlOli (5'
J\'CR), Core OOJlaCT.,
(C) Y'IaCTKU. KO.LJ.Upy-
10ll.(UC 6enKH OOOJIO'I-
KII Bupyca (El/E2).
nOJII-1Mepa3Y (N55) 1-1 3' HC-
5' NCR C
E1
NS5
E2 NS2 NS3 NS4
262 n_H.
1 paYHA aMnJ1l1cpl1Kalll1l1
r---1
217 n.H.
2 paYHA aMnn\i1cp\i1Kall\i111
L-..I
PHC. 2. CxcMa rCI"IOMa Bllpyca renaTHTa C C YKa3aHHeM
06nacnI, HcnOJlbJyeMou J1H 06I-1apY>KCHIlSi PHK BH-
pyca rcuaTHTa C U CLIBOpOTKC UJIlI nJIa3Me KpOlm MC-
'ro OM no.rmMcpa3HOrl l enHoH peaK UlI lIa6opoM
nOJII1TEn-C TY -9398-409-17253567-97.
npoTca3y/rCJIHKa3Y (NS3), PHK 3aBlICHMYKJ PHK
TpallCJlHpYCMYIO 06.'laCTL (puc.2).
C MOMeHTa OTKpLITIISI RHpyca l'cnaTUTa C U KI101IllpOBaIllUI Y'laCTKOB era rCHO-
Ma aKTlIBIiO pa3HBaKJTCSI MCTO"bl TccnlpOnaHJUI CI'O IIP11CYTCTBlUI B ()praIllG le xo-
3S1HHa. Tpa)..lULlHoHHO - 3'1'0 nMMYllo epMCIITllbiC MCTO]tbl BLISlB_r1l mIH <lIITItTCJI, Bbl-
pa6aTLIBaeMblX OpraHlI3Mm.l X03S1.UII(t B nepUOn KOIn;:U::r<l C UUPYCOM. 11 rCHOJlIlar-
HOCTIIKa, nOJUOJlSlKJII(aSi IICnOCpe}\CTBCIIIIO yC'raHOmrfL H..lTIWmC PHK uupyca rcna-
nlTa C B 6uonpooc. Ha CCroWIHWHI-lfl j CHI, aJlrOplt I'M JIaGopaTopllol1 ,"UanIOCTlIKH
H MomrropHHra RUpYCIlOrO rCnaTi1Ta C BKJlK)tIaCT OOWJaTCJlbllble CT<qltli OnpC}1,C-
neHHSI n ChIlK>pOTKe 60111.1101'0 CYMMapHhlX atlTllTCJI K BHPYCHblM 6CJIKaM II UbIHBJIC-
HHH Y GOJlLHOrO HCV PHK, SlBJlSllon,YIOCSI. nOKa3aTCJlC:\1 <lKHIBIIOCTII UllpYCHoro
npOLlecca. ,D,JlSI BLISlBI1CmUI PHK m"lpyca rCnaTl1Ta C WUpOKO HCnOJlb3YIOT leTOjJ.
PT nl(p, COCTOSl.ll Ht'1 B npOBe}1,CIUH1 06paTHoH TpaHcnpUULlmI MaTpllLlbl PHK BI1-
pyca H aMnJIII<jJHKaJ(1-t1l CIICLlI-t II'lecKHX y'mc I'KOB nO!IY l ICHHoi1 KJI,I-I K. Oco6eHl-I0-
CTLf() 8Hpyca rcnanlTa C SlUJIHCTCSI. ero KpaHIISISI. IIJMCH'IIIBOCTI,. I1cxo;,SI 113 cpau-
(
312 TOM II - l.IACTHbIE AI-IAJlMTM1.IECKME TEXHOJlOrl1I1
I-IHTeJIhHOrO aHaml3a pa3J1W.IHbIX ill rat-It.IOB U H30nSlTOR BHpyca. BbIHBJ1eHO 11 TIi-
1108, B CBOfO OLICpCJ{b nOApa3AenHfOlI'IIXCH na 70 cy6THnoB BHpyca l'cnaTHTa C.
OllCHb UCMHOI'He y"racTKH UHpycHoro reHOMa HBJTSlfOTCSI KOHCepBa'I11BHbIMH. K HHM
OTHOCSITCH 5' HCTpanCJH1pyeMaH H Core 06!13C rH, 06bl t iHO Hcnonb3yeMbic JJ.JTSI nOA-
60pa CnCI\H H'IHbIX npatlMcpon npH JJ.eTeKu.HH PHK Bupyca rcnaTHTa C. .D:J1H A '1ar-
I-IOCTHKI1 BHpyca renaTHTa C nOl1,o6pal-ta "rHc3AHaH n CHCTeMa npaHMcpoB. KOMnne-
:'1CIITapUhIX 5'-lleTpaHCJ1Upye 1Of'1 06JJaCTH BHPYCHOro rCHOMa. B .;;JTOM CJly"rac npo-
;{YKT ar.mmlqJHKaUI1I1 C IUICWHei1Ilapof'J npatlMcpOB CJlY)KHT MaTpHu.Cn AJISf aMnJlI1-
cpuKau.l1U C Ul-IYTPCHHCtl napol1 lpaHMcpoB (pHC. 2).
AHADUTHqECKUEXAPAKTEPHCTHKU
Ctlel{lujju t tlWC1'nb UHQ.Il1l3U
B nOJIO)l(HTCJlbHOM KOHTponbHoM o6paJu.c (PHK Bnpyca rcuaTHTa C) AOJ1)Klla
BbummfTbCH oAlla 1I0JIOCa OpaH)KCBO-KpacHoro U.BCT \ nocnc 3J1eKTpO opcnl'lc-
CKoro pa3ACJICIIHSf npoAYKToB af\.UlJm HKau.HH B arapo:moM rcne, COOTBCTC1'BYIO-
I1,aSl 110 1I0l BH>KHOCTH parMcl-ITY rCHOMa BHpyca rcnantTa C pa3McpoM 217 nap
HYKJ1COTH,l,OB.
B OTpIH\aTCJlbHOM KOHTpOJ1hHOM o6pa3u.c nOJ1oca Opall)KCBO-KpacHoro lI.Be1'a,
COCYrBCTcTBYfOll.{aSl cpparMclH)' rCHOMa Bllpyca l'cnaTi-ITa C, AOJ1>KHa oTcyrc fBOBaTb.
060PY()OlWI-I ue
1) rJlmCTKH nOJTyaBToMaTwlccKue 0AHOKaHa.rlbllbIC Ha 1-20.5-40.40-200.200-
1000 MKJl
2) HaKoHc l lIU1KU C HJTbTpar.UI K mmCTKaM
3) MHKponpo6HpKU IIJIaCTl-lKOBbIC Ha 1,5 MJI H 0,5 MJl .
4) llhanlBbl JVUJ MHKponpo611poK
5) MUKpou.cHTpmf)yra lIa 12 TbIC. 06/MHH AJISf 1.5 II 0.5 MJ1 npo6upoK
6) r1pH6op AJIH rOpl130l'rraJIMIOrO 3J1eK"rpO Opc3a
7) nporpaMMHpycMblH TcpMocTaT (D,HK aMnllllC)mKaTop)
8) TCp 10cTaT tla 45-55°C no,!]. 1,5 M:I npo6HpKU
9) YJI LTpacpHoIleToBbl ii TpallCHJlJlfOMHHaTop
10) Bo,l,ocrpyilHLIH HIU-I BaKYY!\.llIhH':i Hacoc C }(OJI6oH - JIOHYIUKOH
11) 3JICK'I1'H leCKaH OJ1l1TKa. CB4-nc ' lb HJUt BOJ].SlHaH 6aHSf Ha 95-100 fl C
12) BCTpHXHBaTCJ1h HJISI MUKponpo6HpoK (Tl1na "BopTeKc")
13) O:J.HOpa30BbIc pC3HHOBbiC 111111 nJtac rHKOBbie ncp1.taTKI1.
PeOKI1l11Hbl
1. D,eHaTypupYlouUlii pacTnop (3 1 ryaHI-1J.1,HH THou.HaHaT 50 MM Tpl1c-HCL;
50% Q:>eHOJl 0.3 M al\CTaT tlaTpnSl, pH 7,5)
2. I1JonpomfJloBblrt CIIHpT
3. npOMLIBO"IHbIl1 pacTBop (70% <)THIIOBblH cnup..- )
4. PacTBop HOCI1TCJISI ( TpaHcnopTHaSi PHK; 1 Mr/MJ1)
5. Bo/\y } CJtOHJl30BaHHYIO, o6pa6oTaHHaH DEPC
6. 10-KpaTHhlfl 6y cp ,IV)H npORCJ].emiSi PT nup (0,1 M Tpuc-HCl, pH 8,8; 25
MM MgCI; 0,5 M KCl; 0.1 % pac'l BOp :>KcJTanma, 0,5% - pacTBop 1'BHH-20)
7. PacTJ op IIpaHMcpoB HCY1 c.'leA)'K>ll.{cro COCTilBa:
IICVl_l AGA AAG CGT CTA GCC ATG GCG ITA GT
HCVl_2 AGA CCT CCC GGG GCA CTC GCA AGC A
B KOHu.cHTpal, nl 10 pMOJ1b/MKJI Ka:>KAoro
BblHBJ1EHME I1HcI>EKl(MOHHbIX AfEI-ITOB METOJ:(OM nll,p 313
L
8. PacTBop npaHMcpoB HCV2 ClIe1J,YIO e["() COCTaBa:
HCV2_1 GTG TCG TGC AGC CTC CAG GAC C;
HCV2_2 GGG CAG TCG CAA GCA CCC TAT C,
B KOHL(CHTpaL(HJI 10 pMOJ1b/MKlI Ka>l<J oro
9. PacTBop 1J,HTcl> (2,5 MM Ka>K1J,oro)
10. 06paTHaSl TpaalcKpHnTa:Ja ( HpMa Pro mega, CiliA), 200 ep/Mlol
11. I1HrH6HTop pH6oHYKlIea3 (Q:JHpMa Promega, CIlIA), 30 c)l/MKJI
12. Taq-noJ1HMcpa3a (Q:JHP""13 Pmmega, CiliA), 5 eWMKlI
13. Mac!1o Ba3CIIHHOROe
14. Arapo3a
15.50- KpaTHLIi"'1 TAE-6y ep (2M TpHC-al(eTaT, pH 8,2, O,05M 3J:(TA)
17. 6- KpaTHblM 6y ep AmI HaHeCeHH)1 o6pa:u.la (40% caxapo3a, 0,25 % 6pOM-
cpeH0J10Bblti CHHI1M)
18. PacTBop 6pOMHCToro 3THJ\HSI, 1 %
19. KOHTpOJ1LHa)J nonmKMTe.'1bHaSl CblBopoTKa. co.[],cp)l(anlaH BHPYC renanna C.
npOBE EHHE AHAJIH3A
BbldeJlellue PHK U3 CblBopomKU UAU IIAa3Mbi KpOBU
3a6op K.nUIIUqeCKOlO ",amepua.fla
.IJ:J1S1 nOJ1Y ' lemnl CbIBOpOTKH BeHo3HYlO KpoBb B KOJUf'ICCTI3C 500 MKn co6HpalOT
B nommpOnHJICHoBYIO 1,5 MIl npo6HpKY H )J.alOT KpOUl-1 CRepHYTbCH. np06HpKY LleH-
Tpmt)yrnpYIOT, nOJIY'lclmylO CblBOPOTKY ncpeHOCHT B CTepHJlbHYIO nOJ1HnpOIUfne-
HOBYIO 1.5 MIl npo6HpKY, HCnOJlb3YH HaKOHellHHK C <tJH!1bTpOM. CblBOPOTKY KpOBH
MO)l(HO xpaHHTb np" TCMnepaType -2(j'C B TC1leHHe 1 MeCSlLla.
\lIH nonY1leHHH nJla3Mbi BeH03HYIO KpOBb R KOJUflleCTBe 500 MIU1 co6HpalOT B
CTepHIlbHYIO 1I0mmpOnHJIeHOBYlO 1,5 MIl npo6HpKY C 50 MKn 0,5 M paCTBopa
3JJ.TA. TLllaTenbHo nepeMellJHBalOT, npo6HpKY L(eH11JHCPynlpYIOT, nOJIY'leHHYIO
nIla3MY nepCHOCSlT B CTepH!1bHYIO nonHnpommeHoBYlO 1,5 MlI np06HpKY, HCnOllb-
3YH lIaKOl-ie l lHHK C <pHnbTpOM. nna3MY KpOBH MO>l<HO xpaHHTL npH TeMnepaType-
20°C B TCIICllI1e 1 MeCSlL(a.
06pafiomKa CblBopomKU UAU lJ./la3/tlbl KpOBU neped "pOBeOe"UeM a.MlIAU-
ifiuKalfuu (BbldeJlellUe PHK)
1) B 'UICTYIO L,5 MIl nonHnpomUICHOUYK> npo6HpKY BI-IeCTH 3 MI<Jl pacTBopa HO-
CH1"eJlH H 450 MK!1 AeHaTypHpYIOU\ero pacTBopa.
2) ,O,o6aBHTh 50 MKn 11CCJ1CJ..lYCMOt'1 CblBOpOTKH UlIH n!1a3MLl KpOBH. Eo u36eJICa-
Hue KOHma.MltHalCtilL 06pa.3ICOB CblBopomKY It.JIU tl./la3.«Y Kp06U c.IIeoyem nepeHO-
cumb 6 npo611pKY c veHamYPUPY10LlCllM pacnwopcJ.\(, LlCIWJlb3Y..n HaKOHe'--lHUKU C
cfilt.JIbmpalrtu. TLllaTeJlLHO nepeMelllaTL Ita nopTeKCC B rcllcHHe 10 ceK. I1HKyoHpo-
BaTb npH I<OMHaTHoti Tet.mepaTypc (+18-25 fJ C) B TC1leHHe 10 MHH.
3} ll,eHTpH<pyrupoBaTb B Te'IClme 5 ceK npH 12 TLIC. 06/MHH npH KOMHaTHoH
TeMncpaType.
4) ,O,06am'ITb 100 MKJI XIlOpo<p0pMa, nepeMcw3Th Iia BOpTCKCC B TelIeHHe 5 CCI<.
5) ll,cuTp 1<pYrHpOBaTb B TCIleHue 5 MHH npH 12 TbIC. 06/MHII npH KOMHaTHOH
TCMncpaType.
6) flcpcHecTH 300 MKll BcpxHeM <pa3bl B 'IHCTYIO nOIlHnpOlll-meHoBYIO npo6Hp-
KY. cOJ],ep>KaILlYIO 300 MKJI H30npOnHJIOBoro cnHpTa. nepeMellJaTb Ha BopTcKce B
.
314 TOM II - 4ACTHblE AHAJH1TJ14ECKJ1E TEXHOJlOrJ1J1
Te1.JeIUiC 5 ceK. Bo u36eJKllHUe KOHma.M.UHat{Uli OllllllY'O npOl(eoYfJY cJ/e()yem npo-
Bo{)umh, llCflOAb3YR HQKOHe1tHllKli c cftU.Ilbmpa.Mu.
7) U;eHTpH YnfpOBaTb B Te1.lemte 15 MHH npH 12 TbIC. 06htHH I1PH KOMHaTHofl
TeMnepaType.
8) Or6pOCI1Tb cyncpHanlHT. HCnOJIh3YH 133KYYMHhIM acnHparop, H Ko.'16Y-JIo-
BYWKY. .I1.3HHYIO MaHlinYJ1HI HlO npOBOAHTb C oco6oit OCTOpO>IUIOCTblO, He ,nonYCK3H
33XBaTa OC3J K3.
9) JJ,06al3HTb 1 MI1 npOMbIB01.II-IOrO pacTBopa, nepcr.'lcwaTb, Ll,eHTpH yrllpmmTb
B TC\ICI-IHe 5 MHH npH 12 TLIC. 06/r..'IHH npH KOMII3TIIOil Ter.meparype.
10) YAaJH1Th cynepllaTaHT KaK MO)KHO nOJlUce, HC 3aXBaTi-IB npH 3TOM ocaAOK.
OCa,II,OK nOJ\CYWHTb 13 Te\leHHe 10-20 r.UUl.
11) .I1.063BHTL 30 MKJ1 )],CHOHH30B31-1I-1Oii 130)],bl, npo6HpKti :JaKpLlTb, HHKy6upo-
BaTb B TC\ICHHe 10 MHtI npll KOMHaTHofi Ter.-mcpaTYpc, 3aTCM nepeMeWa"I L BCTPH-
XHBaHHeM. Pac mop o'lHllleHHoi't PHK MO:>KHO xpaHHTh npH MHHYC 20 u C B Te1.leHHC
)],BYX HeAe.JIb.
llpooeoellue PetlK1lllU o6panllloii mpallcKpunqllll U nO.iIu.uepa3l1oii qenllou peaKllUU
nCpCA npoBe el-llleM nLI.p Hc()6xo, IIMO KOMIIJlCKT pcaKTHBoB )],JIH npoBej\clIHH
nu;p, XpaHSIILl.HHCH "PH TeMnep3Type -20<iC, pa3Mopo3HTb. OCTamm ero npH KOM-
HaTlloH TCMl1cpaType H3 15-20 MI1H.
1) flpHroTOBHTb 0,5 MJI I1po6l1pKU JVlS1 npOBCJ CIIHH aMnJIH<pHK31\1H1 B KOJIH1Ie-
CTBC, COOTBeTCTBYlDll\eM KOI1H ' ICCTBY I-ICCJ1eAyeMbIX 06P33L1,OB, npOilYMepon3U HX H
paCnOJJO:>KHB COOTBeTCTBYJOll\HM o6pa30M B WTaTi-me. npHf<Yf{)BHTb T<lK:>Ke no 1
npo6HpKe )J,JIH n0I10:>KUTCJ1bHOrO H 1 npo6upKC HJIH OTpULI,aTeJ1bHOrO KOHTpOJIH Ha
K3)Kj\hIC 20 IICCJ1CJJ.YCMbIX 06p331 OB.
2) npHrOTOBI-ITb CMCCb KOMnOl-leHTOB l ml aMnml HKau.lm In p3C ICT3 Ha OJ IIY
npo6y:
lOx nlJ,p 6ycJJepE 3 MK.'l
npaflMephl HCV1 3 MKJI
PacTBop AHT<I> 3 M KJI
B011,a ]1.eHmm30BaHH3H IX MKJI
Taq-lIoJII-lMcpa3a E.l eA
OGpaTHaH TpaHcKp IIITa3a 10 en
J1Hrll6l-rrop pH60IIYKlIea3 5 CJ.J.
3) CMeCb nepeMCIU3TL mmeTHpOBaHHeM 11 BHCCTH 110 27 MK!1 R Ka>KHYIO npo-
6HPKY AJIH a mml<pHKaI\HI1.
4) BIICCT" no O)],HO" KanJle (OKOJIO 25,1MKI1) Ba3eJIIIHoBoro MaCJ1a B Ka)KJJ.Y1D
npo6HpKY, HCn0I1b3YH IIHIICTK)' C HaKOHe1.IHI1KOM BMeCHIMOCTLIO 1 MJ1.
5) BI-ICCTH no 3 MKII paCTBopa aH3m1311pyeMoro o6pa31,a B COOTBeTCTBYIDli(He
npo6HpKI1 HHAI1BHAYCUlbllLIM HaKOHellHHKOM C <lmJII>TpoM. BHeCTH 3 MKJ1l\CHOIU!-
JOB3HUOi'1 BOAbl B 1 npo6l1pKY, IIOMClICHHYIO KaK OTpHl aTeJlbllbiti KOHTpOllb. H 3
MKJI I-ICY PHK B 1 npo6HpK)', nOMe'leHH}'1O K3K nOJIO>KUTCJIbHbIl1 KOHTpOJ1I>.
6) n p06HpKH 33KpblTb, l ellTpHcJJYl'l1pOBaTb B Te1.leHIlC 5 ceK IIPH 3 ". biC. 06/MHH
npH KOMH3TIIO" TCMnepaTYpc, nOMeCTI1Tb II nporpaMMHpycMhlH TCpMOCT<lT (ar.m-
JUI<pHKaTop), HarpeTt.IH 33paHee o 4t'C, Ii IIpOHCCTH pC3KLI,HID no cI1e)1.YI()u ci't
nporp3MMc:
I
.
. .
............ - -
BbUIBJ1EHI1E I1HcI>EK-U1101-IHbiX AfEHTOB METO,D.OM nQP 315
llpo6eoellue
npai1.MepoB
1) Dpl1fOToBMTb 0,5 MJI npo611pKI1 AmI npOBCneHI1SI at-mJII1c1mKaLlI1I1, npoHYMe-
pOBaB I1X 11 paCnO]lO}KI1B cooTBeTcTBYIOl.llI1M 06pa30M U lllTaTI1Be.
2) npl1rOTOBI1Tb CMeCb KOMnOHeHTOB AIlSI aMnJlHCpl1KaLl1111 M3 pac'lcTa Ha OAHY
np06y:
42°C......... 1 lfac KOnl1'-leCT80 lI.HKJlOB 1
94°C.........40 CCK
60°C.........60 ceK Kom1'-ICCTUO lI.HKJIOB 5
72°C.........l5 CCK
2°C......... 0 ceK
60 fl C.........30 ceK KOJIH'-ICCTBO L1,HKJlOB O
72 f1 C.........45 CCK
"zne30Hoii" peaKlJUU tum./luifjuKarluu C 6ltympelll,eu
..
napou
lOx nQP 6ycJJepE 3 MKJI
DpaHMepbl HCV2 3 MKJI
PacTBop J1,HTcI> 3 MKJI
BOAa neHOHH30BaHHaSI 18 MKJl
Taq-nomlMepa3a E.l cn
3) CMCCb nepcMemaTb mmcnlpoBamteM U IUleCTH 11027 MKJI 13 Ka>KAYIO npo-
611PKY AJISI a mJll1(pMKau.HM.
4) BHeCTH no OAHOH Kanne (OKO]]O 25 MKJl) na3eJlI1.IOBOro Macna U Ka>KAYIO
npo6HpKY, HCnOJlb3YSlIU1IICTKY C HaKOHe'-IHHKOft,'1 BMCCTHMOCTblO 1 MJI.
5) BHCCTI1 110 3 MKJI npoA}'KTa aMnJll1cJJHKaL.\,I1H C BHemHcM napoM npawMepoB B
peaKlJ,110HHYIO CMeCb.
6) np0611pKH 3aKpblTb, l.\,eHTpl1cJJYI'l1pOBaTb B Te'-ICHI1C 5 ceK IIPH 3 ThIC. 06/MI1H
npl1 KOMllaTHOW TCMneparypc, nOMCCTI1Tb B nporpaMMHpycMblH TepMocTaT (aMn-
Jlm}mKaTop), HafpcTblM 3apaHce 11.0 92 I1 C, 11 npoBecTH peaKL\.mO no CJleAYlOu eM
nporpaMMe:
92 u C.........20 CCK
60 Il C.........20 ceK
72 u C.........30 ceK
KO]]l1 l leCTBO LlHKJ10B 15
...
1
PEfMCTPAQIUI PE3YJIbTATOB
1) 3a.,TIHTh R annapaT j1,JISI 3JleKTpoQJope3a 500 MJI 1xT AE-6YQJepa, npl1fOTOB-
neHHoro Ha nHCTI1J1J1l1pOBaHHoH BOnC pa36aBJleHHeM 50xT AE-6YQJepa B 50 pa3.
2) K 2,5 f arap03bI ):J.06aBI1Th 2 MJI 50xT AE-6y<f>epa I.f 100 MJI 1l.I1CTI1J1J1HpOBaH-
HOt'1 BOAhl.
3) PaCflJlaUI1Tb arap03Y Ha 3J1CKTpWlecKoH nlllnc I1I1H B CBt.I-nc'-U1. JJ.06aBHTb
K 100 MIl paCnJlaBJIeHHOH arap031>1 5 MKJI pacTuopa 6pOMI1CTOrO 3TU)..lI1SI. DcpcMC-
maTI> .
4) 3aIII1Tb arap03HblM rCJ1b COrIlaCHO UHCTPYKLlI1H K annapaTy AIISI ropH30H-
TaJlhHOrO 3J1CKTpocJJope3a.
,D.IlSI 3aJlHBKH aJ'apo:moro renSI yn06uo HCnOJlh30naTh KpbllUKH ]J)lSI HMMYUOIlO-
rWJCCKHX JlJlaHmCTOB nOJ1,XO;\SIl.llI1X pa3MepoB. AJ1SI nOIIY l lCHI1SI Kapt-IaHOB B arapo3-
HOM rCJlC YCTaHOUHTb rpe6cHKY Ha nIIaHWeT, I1CII0J1b3YSI 3a>KHM TI-ma "6YJlbJ or".
316 TOM II - 4ACTHbIE AI-IAJII1TI1t.IECKI1E TEXHOJI or 11 11
OXJIa)],HTb arap03y AO TeMncpaTypLI 50-60°C H HaJl HTb Ha nnaHllle r.
TIOCJ1C :mCTblBaHHS! arap03bl OCTOpO>KHO BblHYTb rpe6CHKY 113 rCJlS! H ncpCHC-
CTH cro B annapaT AJ1S1 npOOCJ{CHHSI 3J1CKTpocpopc3a.
5) JJ:06aBHTb B Ka>KAYro at.mnH<p IKallHoHHYfO np06HpKY no 5 MKJI 6-Kpal'Horo
6ycpepa AIISI HaHcccmUI 06pa:m.a.
6) HaliCCTH B KapMatlbl rCIIS! no 10-15 MKII a/t.-1nIlHQJuKa-ra, npc]J.uapHTCJlbHO
CMcwaHHoro C 6ycIJCpOM 1\IlS! HaHeCCHHSI 06pa3lla (CM. BLIIIIC), B nOCJleAOBaTeI1bHO-
cnl, COOTBCTC'IBYI{)U CH HYMcpaLl.HH npo6. HaHCCl'U B KapMaHLI rCJIS! no 10-15 MKJI
nOJIO>KHTCJ1bHOI-O H oTpHllaTenbHoro KOHTpOIISI, npe1\BapHTCIlbHO CMcrnaHHbIX C
6YCPCpOM AJISI HaHCCCHHSI o6prou. a .
7) TIOJ.l,KJIlOljHTb 3J1eKTpocpopcTH l lecKYIO KaMcpy K HCTOllHHKY nlnam1S! H 3a-
J],aTb HanpSl>KCHHC, COOTBeTCTBYI{)l.ltCC HanpSl>KCHHOCl'H 3J1eKTpH l ICCKoro nonS! 10-
15 B/CM. npOBCCTH 3J1CKTpOcpOpcTH l lecKoc pa3J{CJ1ellllC npOAYKTOB aMnIIHQJHKa-
llHI1 B HanpaBIlcHHH 01' KaTOAa (-) K aHOA}' (+) n TellCHHC 30-45 MHH.
8) BLIHYI'b reJ1b 113 cpOpMbl H nepCHCCTH cro Ha crCKIlO TpaHCHIlJUDMHHaTopa.
BIII1MAHHE! C reJ1eM arap03hl cneA)'CT pa60TaTL B ncp'JaTJ<aX, TaK KaK 6pO/lut-
CThIU 3TI1J "i1 SlBJUICTCSJ CHnbHblM MyrarCHO/l1.
9) BKnfOllHl'b "paHcHnnlOMHHaTop H npoaHaJIH3HpoRaTb PC3YI1LTaTbl aHaJ1H3a.
<I>parMcHTLI allaJ1H3HpYCMoti J],HK npOSlDJUll{)TCSI B BHAC CDCl'SlU HXCSl OpaH:>KeHO-
KpacHbIx nonoe.
AHAlll13PE3YllLTATOB
1) Omplll ame.lll Hb/C.l KOHmpOJlb - nOJloca OpaH:>KCUO-KpacHoro llueTa J OJ1:>KHa
OTCYTcTBoBaTb.
2) nOJloJKume.llbHbtil KOHmpOJlb - BblSlBIlSlC rcSI 00110ca Opal-l:>KCBO-KpaCHOH)
llBCTa pa3McpOM 217 nap HYK.'ICOTHAOB.
3) AHaJlu3llpyeMble flpo61 l: urCYTCTBHC I10JIOChl OpaH:>KCBO-KpacHoro llUCT3
CTporo Ha ypoBHe COOTBCTCTBYI{)l.ltCrO KOHTpOIIS! CBHJWTCJ]bCTByel' 06 oTp H llaTCI1b-
HOM OTBere Ha npHcYTcTBHe AaHHOI'O B036YW'll'CJUI. HaJlHllHe nOIlOCbl OpaH:>KCUO- ,
KpacHon> Ll..UCTa. COOTBCTCTBYIDl.ltCti no 3JICKTpOcIJOpCTWICCKOi"J nOAUH:>KI!OCl'H no-
IlO)f(HTenbHoMY KOHTpomo - lIaJlWlHe .n.aHHoro R036Y]J.HTCJIH B CblBOpOTKC HIlH
nna3MC KpOBH. I
4) DOSlRJIcHHe nOJIOChI B OTplll.laTCJIbHOM KOHTpOJIe cBHgeTeJlbC myel' 0 KOHTa-
t.UlHaI..{HH KOMIIOHCHTOB Ha60pa.
5) nOJIYlleHHbie pC3ynbTaTLI MO:>KHO AOKYMCHTHpOBaTh QJoTorpacpHpoBaHHcM
reneti C HCnOJIb30BalIHCM OpaH:>KCBOrO HnH HIITepQJcpeHLl.HOllHoro (594 HM) CBCro-
cpHJlbTpa.
BbHIBflEHI1E MH<I>EKl..(J.10HHbIX ArEHTOB METOJJ,OM TIU,P 317
4. BblRBneHHe MHK06aKTepHM TY6epKYne3HOro KOMnneKca
MeTOAOM nonHMepa3HoM qenHoM peaKqHH
B nOCIIe]J.HHe rO/ bl npOUJICM8 Ty6epKYJle:!a I1pH06peTaeT npH()pHTCTfloe :ma1Ie-
Hile B rpynne uH4JCKLlHOHl-lbIX I1Cr0 1 IHbIX 3a6oJIeRaHldi 'leJIOUCKa. 06 aTOM CBHAe-
TenbCTBYCT CTaTHCTHKa 3a6oIleBamfSl H CMCpTHOCTH 0'1' Ty6cpKyne3a KaK B CTpaHax
3an. EBponbl, TaK H B POCCHffCKOH <I>C:WPal'J.1H. B 1994 r. 3a6oJICBaCMOcTb Ty6cp-
KYJIC30M B POCCI1H .QOCTl1rnd B CpCAHCM 50 lleIlOBeK lIa 100 TbIC. HaCCJICHl1S1. B Ha-
CTOSlll.{CC BpCMH TCIIHCHl HSI K YXYAWCI-flUO allJ.1J],cMltOIIOn1 1 IccKoft cl1TyaLlJ.1H no TY-
GCPKYJIC3Y B MHpe npoAOJI>KaCT coxpaHSlTbcSI.
TyGcpKyne3 OTliOCHTCSI K 'IHCJIY 1II10XO AJ.1arHOCl HpyeMblx H TPY.QHOI13JIC l U1Bac-
MblX 3a6oncRaHHff. n03ToMY 60JlhlllHHCTBO YCfllmH nOCJIC/ Hl1X JICT lIanpaaJJeHo Ha
pa3pa6OTKY MCTOHOB D,HK-p,HarHOCn1KH, n03BOJISIlOll.{JtX pCUlHTb CJJeAYI-OUJ,He Bon-
pOCbl:
- pa3pa60TKa 3cJJc}JCKTHBHOH AHarnOCTHKH 3a6oJICB3I1HSI, OC06CHHO Ha pal-IHHX
CTa.L\IUIX pa3UHTHSI 6oJIe:mu;
- onpCp,CJIClme UlTaMMOBOt't npIHlaj\Ile>KHOCTH Bo:!6YJ\I1TCIISI TyGepKYlle3a H, KaK
Cne]\CTBIIC, nponIO:!J.1pOBaHUC Tel[CHUH 3a6oJIeBaHilSi H 3JU1,lJ,eMHOJIOnf"[CCKHH npo-
rH03 ero pacnpOCTpaHCHHSI:
- H3Y L IeHue rCHeTH'ICCKOH npHpOJ\hl U McxallH3MOB YCT0i1 1 IHBOCTH MHK06aKTC-
PH" K Tp IIL.\.HOIHlOMY cneKTpy IIpO'n-lBoTy6epKYJ1C311blX aIJTH6HOTHKOB lVlH ycnew-
Horo npOBC1'CHf1S1 TeparulH.
)J,uarHOC'HIKa Ty6epKYIIC3a OCIJOnaHa Ha C01ICT31UIH KnHHH'ICCKHX, peHTreHOJIO-
I'H1ICCKHX H I1aGopaTopHblX MCTO/ OB Hccnep,OBaUIUI. OCHOBl-lblM KpJ.1TCpHeM I1ocra-
HOBKH Hl1arHo:!a T)'6CPKYJIC3 B Hawet't Cl-patiC HBJISlCTCH IJblSlBIIeHHC B036Y1\HTenSi
Ty6epKYIIC3a C IIOMOU'hlO Tpa HLlJ.10I-lI-lbIX na60paTopHbiX MeTO}\OB, K KOTOpblM OT-
HOCSlTCSI 6aKTepHOCKonHH (MHKpOCKonHSI Ma:!KOB. OKpaWCHllblX no UHlII.-HI1I1bCe-
IIY). JJlDMHHCCLlCllTIlaSi MHKpOCKOTU1S1, KYJlbTYPaJlhllhlH MeTOA (noceBbl Ha mrra-
TCJlhllhlC cpeAbl flCBCIIIIITefiHa-I1cHcCHa) H 6HOJIOnt 1 ICCKHJ:i MeTO]\ HccnCJ],OBaHHSI
(:mpa>K:eHHC JJa60paTopHbiX >K: J.1 BOTHbIX).
l/YBCnlOUmelll)Hocmb YKa3illlHbiX J..tem0006 llCCJleOOBaHWl Cllec)YlOu,aR:
- 6aKTcpHOCKonHSI OKpawemlblX Ma3KOB - 10eXJO-IOOOOOO Kn/Mn;
- nK)MHHCCLI,CHTH3S1 MHKpOCKOnl1S1 - 10000 Kn/Mn.
n01\06HaSi KOHLlCllTpaLlUSI MI1KpOOpraHu3Mou BCTpetlacTcH B KnHHH'ICCKOM Ma-
TCpHaJIC 01' GOJ1bHbIX Ha n03J HJ.1X CTa.D.HSlX 3a6oJICBal-lHSI.
HccJIeAOImmlc 6uonoru'lecKuM MCTOJ],OM (6Honpo6a Ha llYBcTBHTcnbHocTb na-
60paTopHhiX >KHBOTHLIX ) SmJISlCTCSI: -
1) JJ.oporocToSlILlHM H A1lHTenbHb[M O 3 MCC. C MOMCHTa 3apa>K:CHHSI;
2) He BccrAa ycncwHblM, lITO KacaCTCSI wTaMMOB, YCTOi1'IHBbIX K aHTH6aKTepH-
aJIbHblM npcnapaTaM HnH 06I1a1\al{)lllHX oCJla6JICHHot'1 nHpYIlCHTHOCTbtO.
OCI-IOBHOC MCCTO R ()llGmOCnWKe my6epKYJle311 B HacToHlllce BpCMH 3al-IHMaCT
MUKp06HOJIOl'l1LICCKaSi AHanlOCTI1Ka B03GYJ\HTeIlSl (nOCCB Ha .Ql1c}JCPCPCHI'HarIbHbIC
mlTa1'CIILHble CPCALI) H nOJIY'lcHHC Mopc}JonorHlICCK 1 pcrHCTpHpyeMhlx KOJIOHHit
l.IYBcTBHTeJIbHOCTb )laUHOro MCTOp,3 COCTaB.'ISlCT HC MCHCC 100 KJI/MII. OAHaKo, cne-
1\yeT OTJt.'fCTJ.1TL, liTO MHKOOaKTepHJI Ty6cpKYJle3HOro KOMnlleKCa OTHOCSlTCSI K MCp,-
JICHHO paCTYlIlHM MHKpoopraHH3MaM U BhISlBJICHI1C HX. a, CIICp,OB3TCJ1hHO, H IIOCTa-
HOUKa .nltarH033, l-pc6yeT BpCMCIU1 01' 6 HCJ],CJlh 11.0 3 MeCHLlCB, Hco6xoAHiltOrO AJISI
318 TOM II - '-lACTHbIE AIIAJII1TltP-IECKI1E TEXHOJIOrl1J1
CPOpM"pOBaHHSI KOnOmU1. KpOMC Taro, C/leJ /CT OTMCTI1TL, <ITa QJop UlpO(mHHC KO-
nOHHH 3aTpY;'.\JlCII0 B CJ1y'mc BLIJ],enCH"SI nal ICHTOM OCna6JICIHfbIX, MaJ10)KH3HCCno-
COOHblX H/IH MCpTBhlX MI1K06aKTcpl1fJ Ty6epKYJlc:m.
CJ1CAYCT OTMCTHTh TaK)KC, '1'1'0 MHKpoGI10J10n1'ICCK le nOCCBbl SIl3JlSIIOTCst 1U1-
QJopMaTH8HblMH H a)WKUaTHLIMH TOJ1hKO B 52-65% CJIY'IaCB aKTllImOrO Ty6cpKync-
3a JICrKHX. Dp" BlICIICrO'nlblX cpopMax 3a60JICBalUISI IIPOl{CIIT BL1S1BnCHHSI t.uIKo6a-
KTCP"" Cll{C IIH)KC. DpH ry6cpKYJIC3HLIX \'ICHUI-I1"I1TaX pOCT MIHw6aKTCpl1fJ Ha IUrra-
TCJlbllLIX cpcgax 06HapY>KHBaCTCSlllJ.1l11l. B 30/0 CJIY'lacn. lIe:ma'II-1TC/lbl-lbIM SlRII ICT-
CSI npOI{CIIT I3blCCl3aCMOCTH Y UOJlbHblX ryOt::pKYIIC30M MO'ICnOJIOBort CHCTeMbJ.
Y'IIr1'6IBaSi BCC BblrneU3J1()>KCIHlOC, MO>KUO q{CJlaTb BLIBOA, 'ITa OCHOBHhlM ItC,{O-
CTaTKOM BCCX MCTOJ{OB I Hanlocn1KH TYOCpKYJlC3a I-Ia ccro]{JU:lIllIUUI ACHL SlBJUleTCSI
AJUITCllbHOCTb JtaOOpaTOpl-lblX ICCJle/{oBamlH H HCjJ.ocTaTo'IHaSi "IYBCTBHTCJlbI-lOCTb.
B CBSl3H C 3T1IM pa3pa6oTKa 3(I)QJcKTHBuoH }{"<.u'uoc rllKU, Hcnonb3YJOll{cf't COB-
pCMCl-lllbIC nOCTl1>KCIHlSI MOJlCKymlpJjo i 6HonorHI-I, n03BOJlH1Ia c031 aTb HOBJ.IC [JO-
KOJ1CHHSI AHari-lOCT"'ICCKHX CUCTCM, OCllOBaHHblC Ha pacno3HaBaHUH H CCJlCKTI1BIIOi't
af\-UlJlHcpl'lKaWUl cpparMcHTa rCHOMa B036YAI1TcnSl Ty6cPKYJ1C3a. B nocnc}J.HHc rOAhl
npc,1 J10 )l(CHO 3ua'IHTCJlbHOC KOnl1'lCCTBO nUP-gHarHocTu'ICCKHX CHCTCM (13 HarncH
cTpaHc I 3a py6C)I(OM), no:mOJlSlIOU IIX C BblcoKoll "IYBCTBUTC.'lbHOCTbIO npouoAllTL
3Kcnpccc-AIJarHocTlIKY Ty6cpKync3a.
npCI1MYll.{CCTBa D,HK-.f\JlamoCTIIKI1, no cpaBIICIIIIIO C rpa)J.I-1l{110HHbl\nt MeTo}J.a-
MU, ClICAYI0IIU1C:
1) fIpstMoC onpCi CJICHHe HHcpeKl{HOHHoro arCIITa. CO'ICTatOlllCCCst C BJ.ICOKoti
CnCl{HcpH'IHOCTblO;
2} BblcoKaSi 'Iync nnrrCJlbllOCTL MCTO,.\a II JJaoHnbHocTb, n03BOnSlIOLltmi. B 3aBH-
CH\10CTH 01' :mJ{a(IU nbISln!1S1Tb eWII-IJI1lHblC MIIKo6aKTcplUl B UCCJlcnycl\wfJ IIp06c;
3) Dhlcrpnra IIpOlJC)\CIU1S1 aJl.UHl3<! (4-5 II) C MOMCHTd B3S!Tl1S1 npo6bl OT 60JlbHOro;
4) YHl-mCpCaJ1bHOCTh MeTona HuanIOCTI-tKH Hlist BCCX BI-IHOB KJU1HH'ICCKoro MaTC-
pHaJJa.
,lJ,J1S1 )J.l-larHOCTHKH MHKo6aKTCpI1ii Ty6cpKync3a non06patla CHCTCMa npafJMcpoB,
cncnYIOu{cro coc 1"3Ba, KOMl1nCMeHTapllbix y'JaCTKY rCHa MPB 64, n03BOJISlIOU{ml
aMJL1I1-1QJHl{lIpOmtT6 cpparMcllT. CnCl\I1CIHI<lIiblfJ TOJlbKO )\lIst MIIKooaKTcpHi'1 TYOCPKY-
J1C31-10rO KOMI1J1CKCa, H HC I3blstB.'ISIIOll.{aSi aTHnWIHbJe BH,"{bl MHKo6aKTcpuH.
lnel(lujjuLLHOCnlb aHaJ1U3a
B n0J10>KI1TClIbUOM KOIITpOJlbl-lOM 06pa3l{C \OJl)KHa BblSlBnSlTbCSI OAHa n0J10CKa
OpaH>KCUO-KpacHoro UBeTa noclIc 3J1CKTpOcpOpCTl-I I ICCKOro pa3AcnCIHlSI npoJ],YKTOII
aMIIJIHcpHKal{HI1 B arap031-10M rene, COOTBCTCTBYfOIl{aSi 110 1I0}{BH>KflOCTH cppal'MCfI-
TY rcnOMa Mycobaclcrium tubcrculosis HInI Mycobactcrium bovis pa3McpOM 357
nap HYKJICOTU.f\08.
HeovxuOu.I,we o6oPyooBaHlle
1. nl1nCTKH n01lyaBToManl 1 leCKHC O)lllOKallaJlLllblC fla 1-20,5-40, 40-200, 200-
t 000 MKJI
2. HaKOHC'IHHKH C unhTpaMH K I1HIlCTKaM (ART-lips)
3. MIIKpOJlpo6HpKl1 nIlaCTI-IKOBblC Ita 1,5 Mll 11 0,5 Mn
4. IlhanmLI AIlS! t.mKponpo6upoK I
5. MUKpoucfrrpuQJyra Ha 12 TI>IC. o6hmll aJ1S1 1,5 H 0,5 Mil np06upOK
BblSIBflEHJ.1E J.1H$EKlJ,110HHbIX AfEHTOB METO,lJ,OM nlJ,p 319
6. npl160p gml rOpI130HTaJlbHOI'O 3J1CKTpo<popc:m
7. npOrpaMMI1pycMbn1 TcpMocTaT (,IJ,HK aMnnl1qmKaTop)
8. TepMocTaT Ha 45-55 11 C nOA 1,5 MJI npoGl1pKI1
9. YJlbTpa<p110JICTOBbIH TpaHCI1JlnlOMl1l1aTOp
10. BO OCTPYHHbIM I1nl1 BaKYYMHblH Hacoc C K0J16m1 - JlOBYlUKOif
11. CBY-nc'lb, :;mCKTpI1 L leCKaSi nnl1TKa I1JII1 BOJ.l)lHaH GaHH Ha 95-100 u C
12. BCTpSlXI1BaTCJlb Ami MI1KpOnpo611poK (1'l1na uBOpTCKC")
13. O Hopa30Bblc pc:mllOllblC JlJII1 nnaCTUKOBblC nepLlaTKI1
14. Kon6a KOIlI1'ICCK3S1 repMocToHKaSi BMCCTI1MOCTblO 250 MJI
PeaKnlUB1Jt
1) PacTBop 1- 6M pac"mop l-yaHI1 HH TI10Ll,I10HaTa, 50 MM TpHC HCI. pH 7.0
2) Pac"1 BOp 11- 4M pacTBop ryaHI11J,1111 TI10Ll,I1aHaTa
3) PaCT BOp 111- 50% :yr3Hon 50MM NaC1, 25 T)mc HCI pH 7.4
4) Cop6eHT cycneH311S1 ]1,HaTOMOBoif 3CMnH
5) TE 6y<pep- 10MM Tpl1C HCI, hiM 3,1J,TA, pH 8.0,
6) Taq-noJlI1Mcpa3a (5 eAlMn)
7) BOAa ACI10HI130BaHHaSl
8) MI1HCpaJlbHOC MaCJlO
9) lOx nlJ,p 6y<pep - 666MM TpI1C HCI, 166 MM (NH 4 )S04, 0,1 % TBI1H-20.
25MM MgCI 2 , 0,1 % >KCnaTI1Ha pH 8.8 npl1 25 11 C
10) npaHMepbl cnc.QylOll.t.cro COCTdBa:
5' TGTCCGACCCCGCCTACAACATCAACA 3'
5' CTTGCACAATGGGGAAGACGACTGGCA 3'
B KOHI cHTpaLl,l1lt 5pMoJIb/MKn Ka>Kgoro.
11) pacTBop AC30KcI1HYKnCOTI11J,Tplt<poc<paToll (HT$) 25MM Ka>KAoro 113 AT$,
'IT$, l{T$. fT$.
12) Arapo3a
13) 50- KpaTHblH TAE-6y<pcp (50xTAE) (2M TP"C-al.\CTaT pH 8,2, 0,05M 3,IJ,TA)
14) 6- KpaTHhlH 6y<pcp lIaHCCCHI1S1 06pa3L1,a, (40% caxap03a, 0,25% 6pOM<pe-
HOJIOllblH CI1HI1H)
15) PaCT BOp 6pOMI1CTOI'O 3TI1AI1S1, 1 %
16) nOJlO>KI1TenbHblif KOHTpoJ1bHblif 06pa3CLI, (,IJ,HK 113 MI1K06aKTCpl1" ry6cp-
Kync3Horo KOMnnJlCKca B KOHLI,CHTpaLl,l111 100 <prlMKn)
\
npOBElI.EHUE AHAnU3A
BblOeAellue /{HK 113 o6paaqa
llOOzOIIlo8Ka KAUIIU.,eCKUX IIpo6
I1ccJleAyeMblH MaTepl-tan (MOKpO'l"a lIocnc pa3>KI1>KCHI1S1. M04a, nJlcBpanbHaSi 11
Cnl1HHOMo3roBaSl >K111\KOCTL 11 pa3JII1LIHLIC 3KccYAaTLI) I CHTpI1<pympYIOT n Te L ICHI1C
10 MI1H IIpl1 5000 OO/MI1H npl1 KOMHaTHoif TCMncpaTYpc (+ 18-2SC'C), OCagOK nonHO-
CTbJO ncpCHOCHT II 100 MKJI <p113I1OJlorwlccKol'O pacTBopa, HaXO HIl.t.CrOCSI B I10JII1-
npOnl1JleHOBOM 1,5 Mn np06l1pKe. npl1roToBncHHYIO TaKI1M o6pa30M np06y I1C-
nOJlh3YlOT WUI BbIACJlCHI1" ,lJ,HK 111111 xpaHSIT npl1 TeMnepaTYpc -20°C He oonee 2
HCAeJlb.
t
320 TOM (1- YACfHblE AHAflI1TI1Y.ECKI1E TEXHOJIOrl111
06pa6omKQ KAUUUlfeC'WX npo6 nepeo npOfle()eIlUeM a.MnAu!puKalluu (mJu)e-
.ne"ue ,l{HK)
1. A..mJUl3HpYCMbIC np06bl IIpOrpCUalOT U Te"ICUHC 20 MHU IIPH TCMncpaTYpc
+95°C.
2. K nporpcTblM aHaJIH3HpyeMbiM npoGaM Ao6aumitOT 300 MKJI pacTuopa I it
10 MK..Il cycncH3HH cop6eHTa. np06bl HUKy6HPYl-OT n Te"leHHe 10 MitH npH KOMHaT-
HOM Tcr.mepaTYpc, 1-2 pa3a ncpeMeWHBa Ha BOp1"CKCC.
3. Op06bl l.{CH1'pHcfJyrHpytOT B TC'ICHHC 15 ceK Ha MHKP0l.{CH1'pHcfJyre npH
12000 06/MHH, cyncpHaTaHT oT6pacblBalOT.
4. K OCaj\KY l\o6aBJI toT 100 MK..Il paCTBop3 II H BCTpHXHuatoT cro Ha BopTCKce.
Cop6eHT OCa>K1J,aI-OT l eH1'pH(pYrHpOnatIHCM nplf 12000 o6/MHH, B Te"leHHe 15 ceK.
CynepHaTaHT o1'6paCblBal-OT.
5. K OCap,KY .Q06aumnoT 1 MJI paC1'Bopa III H BCTpSlXl1Bat01' era H3 BopTeKC .
COp6CHT oca>KJ\al-OT I eHTpH<pyrHpoBaHl1eM nplf 12000 06/MI1H, B Te"leHHe 15 ceK.
CyncpHaTaHT oT6pacblUatoT.
6. OpOl CAYPY OTMbIHKH nOUTOpSitoT )wa pa3a C HCnOJlb30BaHI1CM 1,0 MJI paCTUO-
pa III. TaK. KaK 3T0 Onl1CaHO B n. 5.
7. ,lJ,onOnHI1TeJlbHbIM l.{eHTp"<pyntpOBamfeM npH 12000 06lMHH, C nocne)J.YIO-
I.l.\I1M orupacblBaHHeM cynepHaT3HTa, y6Hpal-OT OCTaTKH pacTBopa III. OP06bl no)J.-
cYlUI1BalOT B Te1.leHHe 5 MilH npH TeMneparype 45-55"C, OCTaB..Il np06HpKu 01'-
KpbITblMH.
8. B npo6HpKH C COp6eHTOM )J.o6aBJl toT 50 MK..Il TE GycfJepa. 3aKpbmalDT HX, nc-
peMeWHBal-OT Ha BopTeKce H ItHKy6HPYl-OT n Te"leHHC 5 MI1H npH 45-55 l1 C.
9. Op06HpKH U.eHTpucfJyntpyl-01' B Te"leHHe 15 ceK npH 12000 06/MHH npH KOM-
HaTH OM TeMncpaTYpc, UOHUYtO cfJa3Y (cyncpuaTaHT) I1CIIO..llb3ytOT B Ka"leCTBe HCC..Ile-
AyeMoro 06pa3l.{a ,lJ,HK .DJISI. nOCTaHOBKH peaKl.{H" aMnnHcpHK3l.{I1H.
06pa6oTaHHble TaKHM 06pa30M np06b1 MO>KHO Xp3HHTh npH Ter.meparype
2-8°C B Te"leHHC HCACJlH HnH npit TeMneparypc - 20"C B Te"leHl1e 6 MeC l.{eB.
llpo8eiJellue nOAlLMepa:JHou llemlOu peaK'{UU
1. OpHrOToBHTb 0,5 MJI npo6HpKH nJl I1pOnC) CHHH aMIiJUlcfJHKal.{UH II KOJ1H"ICCT-
Be, COOTBCTCTBYIOUtCM KO..llH"ICCTBY HCC..IleAYeMblX 06Pa3l.{OB, npOHYMepOBaB HX U
paCnOJIO>KI1B COOTBCTC1'Bytol.l.\HM 06pa30M B ru-ranme. OOArOTOUHTb raK>KC 110
1 npo611pKC AJI flOJIO>KHTCJlbHOf"O H OTpHl.{aTCJlbHOrO KOH1'pO..llbUJ.IX oGpa31 oB.
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n1l0I.l.t.MH (npH H<.U111 1 nll1 I1HTCrpaTopa) HJlI1 Br.ICOTC HHKOB. a TaK>KC MCTOHOM BH}'T-
pc HHero CTaH]1apTa.
AOCTOBepHOCTb pe3YJlbTaTOB KOJIH\leCTBeHlloro onpeJI.CJleHI1 OI CHI1Ba}{)T, pac-
C1.IIIThmaH TOtlHOCTb H Bocnp0l13BoAHMOCTJ. MCTOAa. MCTHHHoe cogcp>KaHIfC npena-
paTd B np06e l\OJDf(HO HaX0,l1IIThCSI LI paCC\ntTaHHhIX nOBCpl1TenbHblX l-palumax.
3 ") 6 TOM II - 'lJACTHblE AHA!II1TI-1lIECKI1E TEXHOnOrl1I1
t
PaC'ICT cpapMHKOKIIHen-ilieCKtiX napa teTpon nponoNrr C 1I0MOll..lblO p.i:nmlllHblX
npOrpaMM ,f\.'151 nCpCOtiaIlhHoro KOMllblDTCpa (HanpHMCp npOrpaM\lbl M-IND) [2]
CTaTucTUIICCKYID o6pa60TKY npouoj.\srr C nOMOlllblO nporpar.IM STATGRAF,
EXCEL MAP.
NfamepllllJlbl II o6upyvvounue. ,IJ,ml npoBCACHHSI HCCIle oBaHHft He06xoj\I1MhI:
nOCYAa AJl5I oT6opa np06 (l(eHTpmf1Y>l<lIhle IIpOUHpKII. rCnapJlHH3HpOBaHHbiC npo-
Ol-lpKH), tI'.1JJ>1 A.1H 3a60pa KponH. npOOHpKH C repMe1W'lIlhl:\1I1 KpbIWKar.fH. McpHble
mmeTKI'I. KOlllllICCK 1C KOJI6bl ,'I.JISI ynapIIBClHHSI. KOIl6a AIlSl11.era:-mponaIU1H 1I0J-lUH>K-
11011 ((>.i:HLI. . MHKporunpl1IUV1Sl XpOllIaTOrpaC})lllICCKoro i.tlla:H13a Ha 100 MK!I. GYMa)l(-
Ilble (fmm;rpbl, 1cr.'16patlH"111 cpllJIbTp HVLP 0,45 MKM N1illipor «J>palll{HH) IUIH 110-
)tOOHhlfi. po ropHbiM J-ICnapllTCJIh (ynapunaJU1c 06bfllllO npOI30)-lSiT IIPH TCMlIepaType
- 37-40 Q C), I\CIITpHcpyra. vortex, >KI1,1KOCTH0l1 xpm.mTorpacl) (Shimadzu (51110HHSI),
Hev,:letr P.tckard (CiliA). MUIlUXpOM (POCCIB ) 1/ 11P.). nKJBO'laIOLu,I1li CIICKTpOcpO-
TOMCTIHI'ICCKIIH II ( JUOOpI1MCTpH'ICCKlIi1 }!eTeKTOp, 1HTerpaTOp I1ml car.'101llICCU,.
K()}IOHK<! C o6paTHo-cl)a'ulI.IM COp6CIITOM, OCI.!OL!l-lbIM 113 KOTOpblX 51B.l51eTC5I Cop-
oeHT Ha OCUOBC CIUI1Ka('CJTSI C npHUllToi1 cpa3011 CIX (HanplfMCp 3'1'0 1"O'1'01It,IC
CTaJlhllblC KOJIOHKII .'LichrosOIh CIH" pa:u,'ICPOM 250 x 4.6 MM, "Nucleusil L20-3
Cl " pa3MepoM 125 x 4 \1M. ";r.orbax ODS" pa3Mcpm.1 150 x 4.6 MM II JJ,p.).
DP1Ufe'WHue: CneJJ,ycT 11MC'J"I, UBl1H}'. liTO 13 3aUIICI1MOCH1 OT I1CnOIlb3yeMol1 KO-
JIOIIKI1 npCMH y,lCp:>KUnaHHH I1CC.rIeHyeMoro nelllcCTna MO>KCT KOJlcuaTbC». 3TO MO-
.- U.o..J
)l(CT OulTb CKOppCKTllpOn<1HO II3Met-leIlIlC\1 COOTIIOW 1II1H UOAHOI1 l1 OpraHl-tlleCKOH
( a] n 3.;1I0CIITC.
HeCTepOHAHble npOTHBOBocnonMTenbHble npenapaTbl
AMKl10<Z>eHoK HOTpMA (BonbTapeH, opTo<Z>eH) [3. 5. 6]
:GIIOJTOrWleCKaH )l(llJlKOC 1'1. . ChlUopoTKa, n:la3Ma.
MCTo!UIKa onperre;leHI1H . Pelll>:mU6bl. AIWTOlUtTpJ1J1 WI» >K11.!lKOCTHOf't xpOMaTO-
rpacplH-l. KI1CJIOTa OpTO-()mccJ:1opHaSl.. 'I.A.a. XIloporl)OpM. 0,1 M aL{cTaTHbIH 6ycpcp
(pH 4,5). Bon.a ()11/l.I1C'I'IHI:lllpoBalllla».
DpllWlfloR.;U'Hue 06paJl(1l. H Ilp06I1PKY C rcpMcTII'IHol-'1 KphllllKOil nOMCJJ{aIOT 1
MJI OIlOJIOrwl..:cKOII )l(11J],KOCTl1. ).I.o6a13JISIIOT 200 MKJl 1M pae-mopa OPTO-(f10CQJoP-
11011 KJ-ICJIOTbl 114 M.l XJIOpoq)OpMa, rIIlClTC:lbilO IICPCMCIlHW.i:UOT 11 3KcTpanipYIDT 13
TC l lelU1C 10 MIIIIYT; :mTCM u'CHTpl1cJ:1yruPYIDT 10 MI1HYT npll 3000 o6Jr..ull-l. OpraHu-
'ICCI.a1H c.l0ft nepclloorr II KOJI6y HJI» y"apIlUaHI-H! II YllaplmalDT j.\ocyxa. Cyxoll oc-
TaTOK paCI"UOpSlJDT B 150 MK.t1 3J110CIITa. A:II1KBOTY (100 MK.1I) ItCIIOJlL3)'IDT }1,JT5I
xpoMaTOIVC1r)mpoUaHUSI. .
Ji.iwAw/1Iozpacjjll'lcCKllii llIlG.:ll/3. J],CTCKTOP - CIICKTpOC OTOMCTp 1'ICCKl1il C IIC-
pCMcHHoll JJ,JTl1HOfl BOJlllb!. A - 280 11M. ['l([> - C\ICCL au,CTomnpmm C 0.1 M au,eTaT-
Hbl 1 6ycpCpm.l (pH 4.5) n OO'hCMHOM COOTIIOIIIClU1I1 35:65. CKOpOCTh :J!IKH1pOnClHHH
1,5 fJI/MItIi. BpCMSI. Ublxo; a IIIIKa opTocpella 6 MIIH.
KO./lll'il'Cmuelllwe ollp('()e.lIeHlIe. rVlcTo,!.l, - BHYTpeHHero CTaH.n.apTa. BHYTpeHllluf
CTall apT - 11H..\OMeTaUIIH (npeMH BbIXOJ\a - 8 MUll). npCJ\CJI oUllapy>KCIII1S1. 5 IIrhu .
ThpanenTll'leCKufl I1.J1ana:lOl1 - O(jIl cllplnHalillblx TcpanCUnl'[CCKI-IX rpamll.( HeT.
MaKoKnHcTIIKa - Tm'lx 1-3 'l: 11/2 L-2 'I; PI3>99%; F 60%; C max nOCIle O}1,HO-
KpaTHoro ncpopaJlblmro IIpllcMa 50 MI" COe-ra13.IHCT U CpCl.lHCM 1134 Hr/MH. <I)apMa-
v
.nAEOPATOPHbII1 KOHTPO.nb .nEKAPCTBEHHOI1 TEPAnl111 327
KOKHHeH-IK3 OpTOq,CH3 xap3KTcpH3yeTcSI 6blCTpblM BcaCblBaHHCM H Bhl]J,CJ1CHHCM, a
raK>Ke O"leHb HHTCHCHBHblM pacnpe]J,eneHl-leM npen3paTa 110 opraHaM 11 TKaHSlM.
TIpH npHcMc opToq,eHa BMCCTC C m1UJ.cjl pCJKO YBcnwnmacTcSI BpCMH AOCTI-I>KCHHSI
MaKcHII'laJlhHOH KOHLlCHTpalJ.HH 11 CHI.I>KaCTCSI Kn1-1pCHc. a ncpMoA nOJlYBhIBCJ],eHIUI. H
nJ101lJ.8)J.b noJ], QJapMaKoKHHeTH"ICCKOH Kp IBOH IIpaKTwlccKU HC MCHSIIOTCSI.. 3a6orrc-
BaHHH nCyeHH 1-1 nOllCK 3Ha i mrenbHO yBCJ1HIIHBaHJT IICpHO no.TJYUI lBe]J,cHlISl, CJJa50
BJ1HSlIOT Ha BpeM}I. J],OCTH>KCHHSI M3KCHMaJlbHOl1 KOHIJ.eHTpaUlotH H KJ1HpeHc. Y nO>KH-
nblX mOJ],eH 3Ha"IHTeJ1bHO YBenI-lIIHBaIOTC}I. nJ101l..la.D.b no]J. q,apMaKOKJIII.CTIt'ICcKoi:i
KpHBOH lot BpeMSI AOCTH>KeHHSI MaKCIIManbHOH KOHLleHTp3Llm-l H CIUDKaCTC}I. KJUtpCHC.
B TO Bpel\UI KaK ncpHOA lIonyBblBCJ],eHHSI "P3KTI-I"ICCKH HC MCHSlCTCH.
IIPYrHC "',CTOflhl IotCCIICJJ.OH,UU1S1 . [,:>KX, TCX. K0J10pH WTpU\leCKuj"1 IC ro]).. C<l>
(QJeppHUJt3HltJI,Hbn'1 U IHlpOKCH]J,a:mbIH Clloc06bl).
MHAOMeTaL\MH (MeTMHAon) [1. 41
EHOJIOnl\leCKaSi >KHHKOCTh . CbIBopoTKa, IIna3Ma.
MCTOJlHKa onpenCJICHHSI . CM. CTaTLlo!111K.Il0fpeUliIC Hamplt.R. R Ka'leCTBC BHYT-
pCHHcro CTaH]J,apTa HCn0J1b3YCTCSI AHKnOQJCHaK HaTpml.
Th.panCBTI1\ICCKHti fll-lana30H - 0,5-3,0 MKr/MJI.
MaKoKlnleTHKa - T mdx 1-2 '-I; t ll2 1-16 'I; CI T 70-140 MnhIHH; V<\ 0,12 JI/KI'
PB>90%. I1H]J,OMeTaUHH nO'ITH nOJIIIOCTbJO a6co611pyeTcH IIpU npHeMC Bllyrpb. OH
nO]J,BcpraCTCSI 3HTCptWCllaTH l ieCKOl1 pCIJ.HPKYJ1S1LlIU-l, '1'1'0 MO>KCT BJlHSlTb 113 1t3Me-
HCHHC t 1l2 . EHoAocrynHocTb 96-98% nplot opanhHOM npHCMC H 85% npH PCKTaJlb-
HOM. lIepCJ nO'-IKH 3JIHMHHHpyeT 70% (20% B HCH3fo.feHHOM BHAC) H 30% - 'lcpe3
)KKT B BH]J.C MeTa6oJUtTOB.
lJ.pyr'Hc MeTO!l.bl (,ICCJ1CflOBaHHSI . r)KX, TCX, [,X/MC, PI1A,<1)I1A.
HanpOKceH (HcnpocMH) [1, 161
nHOJlOrWICCK3S1 >KHfiKOCTb . ChIBOpOTK3, nJ1a3Mi.\.
MCTO!lHK3 onpeflenCHHSI . PeaKmlWbl. MeTaHoJl wrSl >KHJJ.KOCTIlOfi XpOMcl'rorpa-
cpHH. KHCJlOTa oPTo-QJoC(IJOPH<.\SI, 11.]\.a. 3q,Hp MCHHLlHHCKltLI. 0,05 M (pOC( aTHLli"
6YQJcp (pH 3,7). 801.1.3 6H HCTl1JlmtpOBaHHCul.
npU20m06.lleHlIC 06pll,'I(a. B np06JtpKY C rCpMeTltllHOIt KpblWKOfl nOMcw.,UOT 1
MJI 6I1o.TJOrH'ICcKOH >KH,u,KOCTH. ]J,063HJ1S110T 200 MK!I 1 M paCTL!Opa opTo-(IJOC(JJOp-
HOH KHCIlOTbl H 5 MJI 3(pHpa MCi.\I1I,HHCKOru, Tu aTenbHO IIcpeMeWUJlalOT It :Jh.CTpa-
ntpYJOT B TC'ICHHe 10 MHHyr; 3aTeM LlCHTpl1(IJyrHpYloT 10 MIIUY" npH 3000 o6/ utH.
OpraHHllccKHH Cliotl flcpeHocSlT B Kon6y ]\JlSI ynapHBaHHH I ynapuualoT i ocyxa.
CYXOl1 OCTaTOK paCI'BOpSlI{JT L! 150 MKJ1 3JllD(;HTa. Am1KBoTY (100 MKJ1) JICnO I"3Y-
lDT JlJ1S1 xpoMaTorpacpHpoB3HHSI.
Xpo.4-taI1WZPllfJjll"iCCKllii. aHatllJ.3. }J,eTeKTop - cneKTpoQJoTOMcTpllilecKIIH C nc-
pCMCIIHOH mtHo" BO.f1Hbl. A - 240 HM. O<}) - CMCCb MCTaHOJ1a C 0,05 M (IJOC(P3THbIM
6YcP C pOM (pH 3,7) B 06"bCMIIOM COOTHOUleHlut 60:40. CKOpOCTh 3nlOHpOnaHI1S1 1
1\1.1]/MHH. BpeMSI BbIXO]J.a nHKa HanpoKceHa 7 MHII.
f KOAU.ieCm( eHHOe vllper)e.lleHlw. McTO]J, - a6comoTHot'1 KanHupoBKIl. npc)J.CJI
06HapY>KCIIHSI 5 Hrhw.
-
328 TOM II - l.IACTHbIE AHAJH1TI11.JECKI1E TEXHO.nOrl1l1
ThpaneRlwlecKIIi"i llHana30H - 30-50 r..IKr/MJI.
MaKoKI1HeTHKa - Tm.tX 1-2 lr; t l12 12-15 1.1; V d 0,1 n/Kr; CJ T 5 MJI/Ml1H;
PB>99%; F 100%; C nMx Hocnc O.ltHOKpaTlioro nepOpaJIbHoro npHcMa 250 Mr co-
CTaBJI)lCT B CpCAHCM 34 MKr/MJI. HanpoKCcu 6blCTpO llcaCbmaeTC B CllCTeMHblH
KpOUOTOK H3 )KKT. TIpenapaT Ha 90% MCTa60J1H3HpyeTcSf B netJCHH. 98 % BhIBO-
WiTCs.! l(epC3 1I0 l lKH (10 % II HCH3MCHHOM mfJ-lc) H 2 % - llepc3 )KKT. TIpu 1I0 l 1CI.I-
110M He}{OCTaTOtJHOCTJI V d H Cf T 1. KOHl-lCHTpaLlIUI HalipoKceHa B CHHOBHfulLHOH
>KHHKOCTH COCTaB!ISfCT npHMcpHO 50 % 01' IIJla3r..lellHblX KOHLleHTpaLlHH.
1J.p)THC MeTa!!,",r IICCneJlC)B,tHHSf . r)KX, qmyopHMcTpHSf.
napal.\eTaMOn (al.\eTaMMHocJ>eH) [1, 13, 14, 15]
bHOllonIL/c<':IGtSf >KII!JKOCTt. . CblBopoTKa, rIJl33Ma,CJIKJHa.
MCTollHKa onp e n e JICHl1Sf . PeOKI1lU6bl.' MeT3HOJI }l.JUI .>KIIHKOCTHOH xpoMaTol'pa-
(PHH. 0,3 II cy.'Ib(paT LlHHKa. 0,3 II rH,'-\pOKCHA 6apml. BO}l.36H,'-\HcHmJll1pOBaHHaSf.
I7pll2mn06JleHile 06p1l3l(a. B npo6HpKY C repMcTullifOH KpbllllKOH 1I0MCIl.\alOT
200 MKJI 6HOJlorW(eCKOH >KI-fHKOCTH, ,'l,06aBJlSlIOT 800 MKJI ,'J,HC1'HJInHpOlJaHHOA UOAbl,
nepCMCUllmalOT lIa vortex B TellClme 2 MI1HYT H OCTaBJlSlIOT Ha 10 MHH)'T IIPH KOM-
uaTHOH TCMnepaT)'pe. LJ,06aBJl)lKJT 1 Mll 0.3 II n1APOKCHA3 6apml H ncpcMCUHmaKJT
Ha vortex 2 MIll!; :mTeM ](06aB1'))lIOT 1 Mll 0.3 H cYllbcpaTa LlHHKa H CHOBa nepeMC-
IllHBalOT Ha vortcx 1 MHH, nacJle llcm u.cu rpH<fJyrHpYJOT 10 MHHYT npH 3000
06h1HH. HClJ-lOCajl,OlIHYIO >K11J{KOCTh CPHJlhTPYIOT llCpC3 cpHJlhTp nma MiJlipor. AJIH-
KBOTY (50 MKJl) HCnOJlb3YIOT IV1S! xpoMaTorpacpHpoBauHSf.
Xpo.'tfamozpa(/jwleClClIlI Wta.!lU3. cTeKTop - cneKTpo<fJoToMcTpWICCKHH C ne- .
peMelfHol1 }l.nHHofi BOJlHb!. A - 254 HM. £leI> - CMeCb MCTaHona C Bonoi'! B 06'bCMHOM
COOTHOUJelll1l1 HO:20. CKOpOCTb 3J110HpOBaHHSf 1,5 MJ1/MHIf. BpeM}I BblXOna nHKa
aLleTaMHHocpelia 5 MI1I1.
KO.flll<ieCI1WeHHOe onpe()eJleHlle. MCTOA - BH}'TpeHHero cTaH,'J,apTa. BHy-rpCHHHfI
cTaHAapT - 2-alI.CTal'''''I O( CHOJl (BpCMSf BLIXOj{a 8 MHII). TIpcnCJI o6HapY>KeHU}I 5 Hrlr-.fjl.
ThpaneBT!1tleCKI'liI llllana30H - 10-30 MKr/l\lJ1; TOKC.KOHl .>200 MKrhfJ1.
MaKoKHHenIKa - t 1l2 1-4 11: V d 0.95 Jl/KI'; Cf T 5,0 M.1')/MHH/Kr; PB 20-50%.
£lapaucTaMoJl BcaCblBaCTCSl 13 BCPXHHX OTAeJlax KlflllellUHKa, MCTa6oJlH3HpyeTc}I B
netJCHH H Bhll enSfeTCH B OCIIOBHOM IJOljKaMI1. 3a60JlcUaHHSf IIC 1 1CHH H nOllCK MOlY"
BLI3bIBaTb l' nCpIlO}l.H nOJlYBhlBCAeHHH H ! KJlHpCHca. £lpli i 1112 > 4 II B03MO>KHO
noUpe>KHCHHC nel(CHH. TIc l ieHOtlH3H 11 nOllC'IHaSl TOKCHllHOCTb MO>KCT TaK.>KC 1303-
HHKaTL y 3JlKOromiKOU If B TcpanCBTltlleCKlfX H03ax. Y HOBOpO>KJ-leHHhIX lIepltOl 110-
JI}'BblBeJ],CtuIH i.
Llpyn1e MCTOHhl IICC}le)\OBamISi. f)l(X, [,X/MC, 11<I)A.
Cna3MonMTM...eCKMe cpeAcTBa
Teo4»MnnMH [1, 7, 8, 9,10,11,12.13]
f)Ho.lJOnltfecKaSl >KI1UKOCTh . CI-,lBopoTKa, IIJla3Ma.CJIIOHa.
MCTO!lMK3 onpenCJICHHSf . Pemam16bl. 1 H pacTBop COJlS!HOi1 KlfCJlOTbl. XJlOPO-
cpOpM. J130npOIl3HOJI. ALlcToHlrrpllJl WHI >KHJI,KOCTHOH xpm.mTorpa<fJHlf. Xnopu}..l,
1
nAEOPATOPHblM KOHTPOnb nEKAPCTBEHHOM TEPADI1H
329
HaTpHH (nOpOlliOK). neASIHaSi YKCYCHaSi KIICJIOTa. Bop,a 6HAUCTlWJ1HpOBallHaSi.
npU20mOfMeHlle o6pa3t(a. 1. CblBOpOTKa, mJa3Ma. B np06HpKY C repMCTJ-lliHOH
KpbllliKOH nOMCll\aIOT 1 MJI 6H0J10Iw.lecKoH )f(H KOCTH, A06auJISIIOT 0,8 MJI 1H pac-
TBopa COJISIHO" KHCJ10Tbl H 10 MJI CMCCI-I XJ10P(){ OPM - H30npOliaHOJl (95:5), Tll\a-
TCJlbHO nepeMcwHBalOT H 3KcTparHpYIOT U rC'-ICHHC 20 MHHY 1'; 3aTCM L\eHTpH( ym-
PYIOT 10 t.U1HYT np" 3000 OU/M"H. OpraH"'-leCKHH CJ10ii IIcpeHocSiT B Konuy )V1S1 Yl1a-
pHBamlS1 H ynapuHalOT Aocyxa. CYXOM OCTaTOK pacTI30pSlfOT n 1 MJ1 ::mIOCHTa. AJlH-
Kum'y (50 MK11) HCnOJlb3YlOT AJUI xpo m.rorpa( l-lpOBaHI-IS1.
2. CJ1IOHa. B np06upKY C rcpMcn1 1 1Hofi KpblWKOH nOMCIl afOT 1 MJI CllfOHbl, 11.0-
6aBJ1S110T 5 MJI aItCTOHUTpHJla. UCTpSlXI-1UaIOT B TC"leHHC 10 MHHYT. 3aTeM u,CHTpl-l-
( yrHpYIOT 10 MI-IHYT npH 3000 06hu1H. PacTBop HaA OCaJ1,KOM lIepeHocSiT B Koml'-le-
CKI-IC K0116bl 1-1 ynapuBalOT JJPcyxa. CYXOfl OCTaTOK paCTUOpSiIOT U 1 MJI 3JllOeHTa.
AJUIKBOTY (50 MKJI) I-iCnOJ1b3YIOT AJISI xpoMaTorpaqmponaHI-IS1.
Xpo.Mamozpacfiu'-tecKuii aHlUlU3. ACTCKTOp - cncKlpocpOTOMCTpH'ICCKI111 C IIC-
pCMCHHOfl J.\JlHHOH BonHbl. A - 255 HM. n<l> - CMCCb au,eTOlU1Tpl-Wa H BO]J.bl U 06hCM-
nOM COOTHOlliCHI-U1 40:460 C A06al3J1CHHeM 14,5 r XJJOpli]J.a HaTpHSI H l1CfJ.SlHOH YKCYC-
HOH KHCJ10Tbl fJ.0 pH 3,0. CKOpOCTb :.>JllmlpoBaHHSI 1.5 Ml1/t.II-IH. BpeMSI BbIXO]J.a 1U1-
Ka TeO( IUlmIHa - 6 MI-1H.
KOJll-PleCn16emwe ollpeoeJlcl--lUe. MCTOJ\ - a6C0l11OTHOII Ka11l16pOBKI-I. Dpc]J.eJl
06napY)l(clU1S1 100 IIr/MJI .
ThpancBTUllCCKl-lH llHana10H - 10-20 MKrlt.w; TOKc. KOHll. >20 MKr/MJ1.
MaKOKltHCnIKa - Tn!;\X 0,5-2 '-I (6-12 "l AnSI np0J10HrHpOmlHUf,IX ( OpM); t 1l2
4-16 '1.1 (B CpC){HeM 8,7 "l Y HC KypSllll,lIX 1-14,4 "l Y KYPSlUUiX) - UpH Lll-Ipp03C H ccpn.
HCA.i fJ.0 20-30 ll; PB 40-65% (pC3KO ! npH 1\l-lpp03aX ne'lcml - 29-37%); F 70-
100%; V d 0,511/Kr; CI... 0.65 MJI/"U1H/Kr (B3pOCl1hIC HCKYPSllUUC), 1.05 MJlhum/Kr
(B3pOCJ1ble KYPSllUue), 14 MJ1/r.U1H/Kr (fJ.enl 4-17 HCT), 17 MJlhum/Kr (}\CTU 1-4 fO-
Aa). Opl-l npHcMc BHYTPb B ){O:JC 0,3 r xopowo BcaCbmaCTCSI; Cm"x B nJla3MC 4-5
MKr/MJ1 OTMctlaCTCSI tlepc3 60-90 MI-IH 1-1 coxpaHSlCTCSI Ha npOTSI)I(CHl-m 4-5 "l. npH
BHYlpl-1BCHHOM BBe]J.cmm 0.3 r 'l.lepC3 15 MI-IH (JTMelIaCTCSI KOHu,cHTpau,l-lS1 7 MKr/MJ1.
o penapaT HC oUHapY>KlmaCTCSI 13 KpoBn llCpC3 7 "l. Ha"laJlO 6pollXOm1TlI'ICCKOro
3cp( CKTa OTMC'-IaCTCSI UpI-I KOHu,CHTpau,mi 5 MKr/M:I. 85-90% npcnapaTa MCTa6oml-
3HPYCTCSI B nCtICHI-!. C MO"lO" BbIBO:J,I1TCSI 90% " BHAC MCTauoJUIToB H 10% B nCH3-
MCHHOM "HAC. Y 6011bHLIX C nO"IC"IHOH Hc.n.OCTaTO'-IHOCTblO B03MO)l(Ha KYMYJ1S1L1JISI
TCO(JmJlmma B nJm3MC KpODH. cI>ap"1aKOKI-IHCnIKa TC(}( HJlmma XapaKTepl-13yeTcSI
l(UpKa)tHbIMH pHTMaMH (11I11< fJ.HClmofl KOHl CHTpm l-m npHXOfJ.HTCSI Ha 10 \1 YTpa,
HO"IHOi't - Ha 2 tl - npl1 2-KpaTHoM npucMc npO..'loHrnpoBaHHblx upcnapaToB). Tco-
( HJlmIH npOHl-lKaCT '-ICpC3 IlJUlu,cHTapllblH 6apbep, n rpyAHoc MOJIOKO 1-1 CJIIOHY; B
.-
CJlIOHC KOHu,CHTpau,HSf npenapaTa npHOml31-ITCJlbHO HaU0J10UHHY MCHbUJe, "ICM B
rlJJa3MC. nc i KOHli,. TeO( mIJlHHa U CbIBopOTKe KpOlm: aJlJIOIIY T H HOJI , IU'IMcnl I-IH.
3pl-1TpOMIIUI- IH , OJ1CaH: OMI-IU,I1H, OpaJlLHhlC KOlpauennlBbl. nc KOHli,. TCO( HJlml-
Ha B Chi BOpO rKe KpOBH: ( cH06ap61-1TaJl, Kap6aMa3cmm, pm aMm1u,ml, , H( CHI-IH.
Ilpyruc MCTOLlbl IICCJlCnOBaIUIS1 . r)l(X, PMA, (1)I1A.
llpHMClIaHI-IC . 1. no A<lHlloil B3)1(X MCTO.n.ltKC MO>KHO O, HoupcMeHHo C TCO-
(In111mmoM onpcAcl1S1Tb rco6p0t.1H1I (BpCMH I3blXO}la 4 "U1I1) If KO( eHH (UpCMSI I3LI-
xop,a 13 MUll ).
.
\
-
330 TOM 11 - '-IACTHbIE AHAJII1TI1'-IECKME TEXHOJIOrl1M
2. C60p npo6 npoBOASIT '-ICpC3 2 '-faca nocne ncpopanbHoro np teMa mm '-lepc3
30 M tH nocne IUlYTp tBeHIJOI'o npHeMa. np06hl 06bl t lHO c06HpalOT npu YCToti'-IHBOM
COCT05lH tH.
CpeACTsa, CTMMynMpYlOlqHe HC
Ko eHH f1, 13 J
E 1OJlOrWleCKaSl )f(HJ1KOCTb . ChlUopoTKa, IJJIa3Ma,C!1I0Ha.
MCTo!UIKa onpcnencHHSI. C f. CTaTLlO Tenifju.l1Jll-lH.
ThpaneBHttlecKHt'. amma30H - 3-15 MKrhfJl rOKC. KOIH\. >50 MKr/MJl.
MaKOK tllentKa - (1/22,5-12 \1 (3aBHC tT OT 1\03bl 11 aKTHBHOCTH (pepMeHToB
nCtlcH 1) CI T 1,5 MJlhHlH/Kr; PB 15-35%: C max 1,58 - 1.76 Mr/MJI. EblCTpO H nom-Io
ncaCblBaCTCSl13 )KKT (npH i pH CO)J,Cp>KHMOro )f(CnYHKa - i a6cop6u. 1S1). Pacnp c i1 c -
J1S1CTCSI B opramnMe paBHoMcpHO. R BbiCOK0I1 KOHueHTpaLllU1 06HapY>KHUaCTCSI B
C!IIOHe. JlcrKo npmlHKacT '-lepc3 r3E. 90% MCTa601lJ.13uPYCTCSI B nC'-lcmt (6ap6 t-
TypaTLI i MCTa60JU13M, a LlI1MCTHl1J1H, 3p tTpOMHU tH J.,). '-Iepe3 24 \1 nOJ1HOCTLlO
J.TutMHmtpyeT. Y 1J0nop0)f(1\euHblx KJ1HpCHC J.., a t[n 1'.
lIpvrHc MCTonhl HCCJleIlOBaIlHSi . r)Kx. PI1A. M<I>A.
CpeACTSO, AeMcTsYlOlqHe HO
nepHcI»epM ecKHe oApeHeprM ecKHe npoqeccbl
ATeHonon [1, 11. 13,441
EHOJIOnt'-lco.::aSl >KWIKOC rb . CbmopoTKa, nJ1a3Ma.
MCTOJUtKa onpCllenel-ll1Si . CM. CTaTblO Ha nponpaHOnOJ1.
TcpancnTHtlCCKHH 13lIa30H - 200-500 Hr/M;1.
MaKoKHHeTHKa - tin 6,3 ll; V d 0,55 Jl/Kr; PB <5%; F 40-50%. Bcachlna-
HHC - 46-62%. MCTa60mnHpycTcSI 10%, aKTHBHblX MeTa6om'ToB HCT. C MOtIOi'1
BbIBO:I. tTCSI 90-100%. HCT XOpOlIICH KOppeJ1S1I\l-Ut MC)f(AY CLIBOpOTOlUJbIMH KOIII CH-
Tpm.{HSI m H Tcpancnn1 l lccKHMH :)(p(peKTClMH. CI T KOppC.'UlPYCl' C KJ1HpCHCOM Kpe-
al11H tHa.
..
na6eTonon [1, 45J
E toJIOn1'-lecKaSi >KltLlKOCTt. . Cb180pOTKa. nJ1a3Ma.
MCTo:lHKa onpClleJ1eH tS . CM. CTaTMO npnllplllw/IOJl.
Thp3I1eBTwlecK 1H l\lIamnOII - He 1\OCl"a1'O'IHO OIlPCACJ1CH.
MaKOKHHentKa - t 1l2 5,2 '-I; CI T 22 MJI/MHH/Kr; V d 10 J1/Kr; PB 50%; F 25-
40%. BcacblBaHue - 90-100%. MeTa6omt3HpycTCSI 70-75%. <l>eHOnta3 IHbl H I U- ,
MCTUT\.mf MorYT nOBhlwaTb nJ1a3McHHYIO KOHUCHTpal\UlO Jla6CTOJ1OJIa, B03MO>KIIO .
6Jlaro apSi !IX I3mtSlHmO H3 ne\leHOllHblti Mc-ra6oJIH3M.
.L1pynw MeTonbl 1CCJTCnORaHIISI . <1>JlYOPUMCTpHSI.
nponpOHonon (063MAOH, MHAepon, oHonpHnMH) [1. 11, 19.20.21]
hU(UlOnt'-lecK3S1 )f( mKOCTb . CblBopo-rKa. nJl33Ma.
-
.
,
JIAEOPATOPHbII1 KOHTPOJIb JIEKAPCTBEHHOI1 TEPAn:HI1 331
'"
MCTonuKa onQcnCJ1CIIHSI . Peal<nlLll'lbl. ALlcTomnpUJI AJISI )K 11\KOCTHOt1 xpoMaTo-
rpaqnm. KHCJIOTa OPTO( OC( OpHaSl, 'I.A.a. X110PO( OpM. 3( up MeA 1L1, mCK 1H. O,lN
n1APOKC 11\ HaTpml. Pa30aB11cHHml ccpHaSi K 1C110Ta. TpH3THJJaf\.U1H. BOAa 6HJ HCTH11-
ImpoBaHHaSi.
flpUlOm013J1eHlle o6pa31 a. B np06HpKY C repMcTw.IHOM KpbIWKO 1 nOMew.alOT 1
M11 O 10JIOnl'lecKoH )1<UtJ,KOCTn. AOOaUJ1SHOT 100 MKJI 0,1 H pacn30pa rHAPoKcuAa Ha-
Tp 1S1, 4 M11 3qmpa J.1 1 M11 X110PO( Opftla, Tw:aTCJJbHO nepcMeumBalOT J.1 :;)KCTpanipy-
lOT B Te'leHHC 10 f\.U1HYT; 3aTCM [ eHTpl-1( yruPYIOT 10 f\.UmYT np 13000 06hU1H. flpo-
6J.1pK 1 1I0MeUtalOT U MOp031UJbHYJU KaMepy Ha 20 ftU1HYT. OpraHJ.1 l leCKHH CJIOH KO-
11Ht[eCTI.lCIHlO ncpeHocS!T B np06 1pK 1 C rCpMCTH'IHl>IMII KpbIWKaMJ.1, A06aumu{)"r 150
MK1J pa36aBJ1eHHOH CCpHO 1 KnCJJOTbJ, OTKpy'umaloT 2 MHIIYl'hl Ha vOltex n Ll,eHTpll-
( yn1pYloT U Te l leHJ.1C 10 MHHYT npJ.1 3000 o6hutH. AJIl1KBOTY (100 MK11) uroupmoT
13 H 1>KHerO ClIOSI J.1 1Cn011b3YI<YI' HJISI XpoM<.\TOrpaqmpouatU1S1.
Xpo.Mlll1lOlPUfPUtlec/cuii aHlUl1l3. ,il,eTeKTop - (ImyopIlMcTpH'JCCKJ.1ft. AB036 - 265
HM, A:;)M 1C - 340 HM. 0<1> - CMCCl> al eTOm1TpJ.111a, OPTO-( OC( OPHOH KHC110TbJ. Tp l-
3n1JJaM tHa It BOJ bl U 06"heMHOM COOTHOWeHJ.1J.1 83:2:1:214. ClWpOCTb 3JI1m1pOBaHI1S1
1.5 MJl/MHH. BpeMSI Bl>JXO)l.a nllKa OpTO(peHa 8 MJ.1I1.
KO.Il11LleCl1lBeHHOe ollpe()eJlCHlie. MeTo - nHY rpeHHero CTaHHapTa. BIIY rpeHHHH
craH apT - IIpa303 1H (BpCMS! BbIXO,Qa - 10 UlH).npC \e11 06HapY)f(cHL1S110 III'/M11.
ThpaneUTWICCKJ.1H nmma3011 - 50-100 IIr/M11..
WMaKoKHllen1Ka - T max 1-2 II; tlf2 3-6 '-I (y ACTCH .1); V d 3.6 11JKr; CI T 11 ,4
MJl/MHH/KI' (i npll KYPCIUUI); PB 90-95% (i npH 6epeMeHHocn1, BOCIlaJ1eWH1 H
O)l(HpeH m); F 30%; Cm.\x IIOC.TJe oAHoKpaTHoro ncpopanbHoro npueMa 80 Ml' HaTO-
LltaK COCTaB11S1eT II cpC)l.HeM 63.1 Hr/M11, nOCJIC e.nhl - 102,4 Hr/M11. BcaCLlBaHHe npc-
napaTa - 95-100%. OponpaHonOJJ nOJ\RepraeTCSI 6110TpaHcc)JopMaLlHJ.1 U ne l Jem1,
np 11leM npcc 1cTeMHbl" MCTa60mnM ( npn nepllOM npoxmlq cmH1 llepe3 IIc l leHb)
COCT£U3mICT 60-75%. 11 ICCTCSI aKTHBllhlH MeTa6oJU1T - HI,QpoKcJ.mponaHo11, 0611a-
]J.aJULltHH TaKO 1 )I(C -G1101\.lIpYlou,elt aKTHllIlOCTh}{). OCtlCHOllHasl 3KCKpeLl,J.1S1 1 1e-
Ta60JIJ.13M npenapaToB C 3(1)( eKToM nepnoro npOXO)l(]J.CIUIH 'lepC3 IIC ' leUb MorYT
H3MellSlTbCfI ]J.a)f(C I1PH I-IOpMClJlbHOH ( YHKlumH£UlbHOJi aKTnBHOCH1 renaTOW1TOB,
liTO CBSl3auo C HaCblHLCllI1CM renaTOLl,UTa npenapaTOM H Bblpa>KaeTCSI u ucnponop-
Ll,HOIlCUlhHOM pOCTC KOIIUCHTpm'HJ.1 npOnpaHOJl011a B IJJta3MC no OTHOllleHJ.11O K npH-
HHMaCMoH 1\03e npcllapa-ra. CHH)f(Cm1e 6HOTpaUC( OpMaI\ 1H OC06CHIIO 3aMeTHO Y
[)()JlbllbIX C W1pp030M nC{leHU. 3aCTOl1HO 1 IIC]J.OCTaTO'IIIOCTbIO KpOllo06paW:CIUIS1 H
B 1I0)l(H.'10M B03paCTe. OOJTOMY Y 3TlIX rpynn 60JJbHhiX ,Q03a npOnpaHOJIOJta J],OJI>K-
Ha ObJTb CIU1>KeHa, a J.1X KOHLleHTpaLl,llSI B nJla:n,'IC KpOim pcrY11S1pHO KOHTpOIll-lpO-
BaThCSI.
1J.pymc MCTOnbJ HCC!ICHOBamISi . r)l(X, PI1A.
"'
J.
3 eAPHH [1. 31 J
DJ.10J10rWICCKaSi >KUlIKOCTh . MOlta.
MeTofiHKa Ollpene.t1eHHSI . PeoKlIllwl)l. MCnlHOJI AJIS! >K 1J KOCTIIOH xpoMcrrorpa-
cpl,m. KHCJl(rra OPTO-( OC( OpHaSl, '1.].I..a. EeH30.TJ. JJ. 13TH11a mH. 5% pacTuop rHAPO-
KCHJ a HaTpnSi. BOAa 6HJ' 1Cn1Jlm1pOnaHHaSi.
332 TOM II - T..IACTHbIE AHAJH1TI1YECKI1E TEXHOJIOrl111
[JPU20nlOfJ/l.eH.ue 06pa3l(a. B np06UpKY C repMen-i l lHot1 KpbllliKolI nUMCllJ,aIOT
10 MJI 6 lOJlOrH'.leCKOH )KHAKOCTH, Ao6aHmiIOT 5 % paCTBOp fHAPOKC fp,a HaTp 1S1 1 0
pH 11 11 10 MJI 6CH30JIa; OTKpYlIHuafOT Ha vortex 3 MHHYTL>I. 3areM l eH'lpU( yn1PY-
101' 10 MJ.1tIYT npH 3000 06/MHH. OpraHwiecKI,n1 CllOH nepeHOCSl.T B KOJI6y lJ,J1S1. yna- I
pHDaHH H ynapHBatoT .Qocyxa. CYXOH OCTaTOK paCTBOpJlIOT B 150 MKJ1 3JJ10CHTa.
AmnmoT}' (100 MKJ1) UCnOJIl>3YfOT 1 J1J1 xpot\.mTorpa( lIpOBaHHSI..
XpO.l.1.alllOZpacfiurleClCltll aHaJlll3. .D.eTeKTOp - cneKTpQ( oTOMCTpl1'lecKHi'1 C ne-
peMeHHoH p,m1Ho 1 BOJIHbl. A - 210 HM. DeI> - OPTO-( ocqJOpHaSi. KIfCJlOTa-MCTaHOJ1-
f{ 13nfJ1aMHH (75:20:1). CKOpOCTb 3.1IOupOllaH fJl 50 MKJI/t.UUI. BpCM BbIXOJ\a nHKa
3( ep,p 1Ha 7 MHII.
KOJlllrWCI1WeJUlOe onpeOeJleHlIe. MCTOA - BHYTpel-lIICrO cn1HJ{apn1. BHY rpCHHut1
CTaHf{apT - aM eTaM flI (BpCMS!. BblXOl a - 10 M fH). DpcJ{eJ1 o6HapY:>KCHml 6 Hr/MJI .
ThpaJlCnTH'lecKnH mmna30H - 0.035-0,08 MKr/M1I; TOKc. KOHL(. > 0,15 MKrh.m. I
MaKOKHHeTHKa - T mdX 2-3 'I; t l /2 3-11 II (3aDHc IT 01' 1l03L>1 11 pI I MO'IH, TaK,
npu pH 5 011 COCTaBJISl.eT 3 ll, npll pH 6 - 6 ll). XOpOlliO BcaCblBaCTCS!. IIOClle OpaJIb- I
1101-0 It B/M BBellcm1S!.. BcaCblBaeMOCTL i IIOCJle np 1eMa m1l.l u. Mep,JIeHIJO MCTa6o-
JlH3upyeTcSI. B nellCIIH, llblp,eJ1S1eTCS!. n OCIIOBHOM nOllKaMIf U HCI13MCHHOM nUi C (npu
KHCJ10H MOllC - AO 90% 3a 24 ll, npu H C.IJ01UlOH - no 30%). j JJ,ei1cTIH1C .J( c:WHlm:
a peHaJnllt, HIII"u6wroPbl MAO, pC3cpmfH. 06pa3}'eT IIcpaCTBOpl1MhlC com1 C Cy.lb-
( amfJJaMII]\aMH, a\1HJlOlII-lpHHOM, r'0,IJ.OM, OTl3apOM KOpH COli OAK!!.
lipyrHe MeToIlhi 11CCJIC!I0l3aH 1S1. . rX/MC.
IlpHMelIaHHC . JJ.aHHaSi. MeTOJUfKa MO:>KCT 6blTb HCn0J1b30naH<I jJ,JUI onpef{eJlCIH1S1.
H APynfx npmf3BOp,HbIX ( eUUJla!IKHJIaMUHa (BHYTPCIIIIHIl CTaHp,apT - 3 CAPHH).
AHTarOHMCTbl MOHOB KanbqMt:II
BepanaMMn (M30nTMH) [1. 17.43.47.48]
EH0J10rHlICcKa :>KHJ1KOCTh. CI.IUOpOTK<.l, nna3Ma.
MCTollHKa onpeneJlemul. l'eaKlnlWb/. KIfCJ1O"ra OPTO-( OC( OpmlS1, 'I.l .a. MeC .
BOJ1a 6 fJ1HCTHJlJlHpOBaHHaSi.
flpllWnlOaJleHlle o6pa.Jl(a. B np06upKY C rCpMCTH'IHoi! KpbIWKOi! IIOMCI1 alOT
100 MKn 6HOJlOrl1 1 ICCKOi! :>KHp,KOCT 1, n06al3!lS!.lOT 375 MKJ1 McCi': H 25 MKJI paCTBO-
pa BHYTpeullcm cTaHAapTa (1 Mr/M.I) 13 Del) n oTKpY"UmaJOT Ha vol1ex 13 t.H1lIYT; 3a-
TeM I CHTp 1( ymPYlOT 5 MHHY'" npH 5000 OO/MIiH. AmlKnoT)' (5 MKJI) IICIIOJ1b3YlOT
AJlSl xpoMaTOrpa( UpOUaHIIJi.
Xpo.MllnlOzpaljjurlccKuii 1lI1llJ1ll3. ACTeKTop - (Imyop 1McTpl1'lecKlIi! (AB036 - 280
HM, A3MlIC - 320 HM). Del) -CMeCh McCN C 0,07% pacTHopoM O-( OC( OPHOH KHC-
JlOTbl B 06.hCMUOM COOTHOlUemm 33:67. CKOpOCTb 3.'1I0upUUaHliSi. hLIJ!t.nul. BpCMH
UL>IXOAa IUu.:a 10 MIIII.
KOJlll'--lCCIJWeUHOe O/lpCVc.flclllle. MeToH - BllyrpcHHero crdHAapra. BHYTpeHI-IH11
CTaH]\apT - 5,6-6cH30X 1HOJlUH (BPCt..u1 Ul>lxo,a,a - 13 MI1IIyr).
ThpaJlCnTH'lecK fi! [lHana :lOU - 100-500 Hr/MJI.
MaK()KUHeTHKa - t1/2 IIpU BIB: UblCTpaSi ( a3a - 4 MUH, Mef{JleHllaSi - 2-5 'I; np" ,
nplicMe BHYTpb: 2,8-7,4 "I; np 1 KypCOUOM jle l leHHI1: 4,5-12 "l V d 4,0 J1/Kr; CI... - op,-
I
..
..
u u
J1AEOP A TOPHbII1 KOHTPOJ1b J1EKAPCTBEHHOI1 TEP AnI'Hi
333
.
f
I
IIOKpaTHb]W np 1cM 11.8 MJ1h-u1H/Kr, MHoroKpaTHb]H np 1cM > 2 KpaTHOC yneJll1\le-
H 1e; PB 90% F 25%. A6copou,uSI BbICOKa - > 90%. EHoJJ.ocTynHocTb HWJKaSi H3-
3<.1 3(pcpCKl'a nepBoro npOXO>KJJ,eHHSI '-]epeJ nC'-ICHh. I1H-reHc mUbIH MeTa6om13M B
nC'-leHU. BbUIUJIeH aKTHBHblH MeTa60Jurr - HopBepanaMHJI. BbIBOA 1TCSlllpeUMYll\e-
CTBCHHO n04Km.U1. Y nO>KmlblX CI T .1. np 1 u, 1pp03e t 1l2 u V d i, a CI T !.
l1pyrHc MeTOJ1.hl UCCJle.a.OBaHH . rX/MC, r)l(X, (pJ1YOPUMCTpHSI.
\
HM eAltnItH (KOpMH Op, aAanDT, eHltrMAMH, KOPAHnItH) [1, 17. 181
E 1OJ10n1\leCKaSi >KIHlKOCTb. CblBopoTKa, nJ1a3Ma.
MeTon 1Ka OnveIleJ1CHH . PeUl<nlllHhl. AU,CTOH 1TpHn AJISI >K 1f{KOCTHOU XpOt.1aTO-
rpa(pm1. XJ10PO(POpM. reKcaH. 2 H pacTBop n1.n;poKcHJ].a m1Tp 1S1. 0,15 H pacTBop
HaTpml .Qun1JJ.pO(pOC(p 1Ta" BOAa 6UAHCTHJ1J1HpOBaHHaSi.
npUWmOOJleUUe o6pa3lca. AHanH3 npOBOAHTCSI B TeMHOTC (npu HeSlpKOM cnC1'e
KpacHoH J1at-Inb])! Bcc npo6 1pKH JJ.OJDKHbl 6bl1'b 06CPHY1'hl (pOJlbroH. B npo6 1pKY
C rcpMCl 14HOH KpblWKOf1 nOMeU atOT 1 Mn 6 10J1m'wlccKOH >K 1.QKocn1, J o6aBJ1S1IOT
200 MKJ1 2 H pacTBopa rHf{pOKc 1:J,a lIaTpu H 4 Mn CMCCH xJ10pmpOpM - reKcaH (3:7),
1'lu,aTeJ1bHO ncpeMewHBalOT H 3KcTparHpYlOT B relleHHC 10 r.umyr; 3aTCM u,el.ITp 1-
(pyrlipYIOT 10 t.U1HYT np" 3000 o6h-Hm. np06l1pK 1 I10MClllalO1' B MOp03HJ1bHYIO Ka-
Mepy Ha 20 MHHYT. 3aTeM opraIlH'-lecK 1H CJ10f1 nepeHocSl1' B KOJl6y AJlSl ynapHBaH HI
Ii ynap 1BatOT p,ocyxa. Cyxof1 OC1'aTOK pacTBopSlIOT II 150 MKJ1 3J110CI-ITa. AJlI1KUOTY
(100 MKn) ucnOJlb3YlOT JI,..TlS1 XpOMm"Orpa(pUpOuaHHSI.
Xpo."wln02pacfillLleClmii aI-/MIl3. }J..eTeKTOp - cncKTpO(pOTOMc'rpH'-lecKHM C ne-
peMeHHof1 wumoft BOJ1Hbl. A. - 238 HM. n - CMeCb au,eToHHTp 1J1a C 0,15 H paCTBO-
paM HaTp 1S1 JJ. 1n1APO(pOC(paTa B 06'beMHOM COOTUOllleHm1 45:55. CKOpOCTb 3JItOH-
pOBaHHSI 1 MJ1/MHH. BpcMH ut.lxo]la mtKa HucpCf{Hm1Ha 8 MUll.
KOAllLleClnOeUHOe onpeiJe/leHlle. MeTOA - BHYTPeHHero CTaHf{apTa. BHYTpeHH 1H
cTdHgapT - HH'rpeHAunHH (BpCM BbIXO.Qa - 10 t.HUf). npc.o.CJI o6HapY>KCHHH 10 Hr/MJ1.
ThPanCBTl1'-leCKHH llHana30H - o6ll\Cnp 13HaHHblx TcpaneBH1\ICCKUX rpam1u, HCT.
bMaKoK 1HeTItKa - T mdx, 0,5-2 LI; t ll2 2-5 'I; V d 1,5 Jl/Kr; CI T OK0J10 10
MJ1hu1H/Kr; PB>90%; F 50%. Aocop6l\HSI - BblCOKaSi - 6oJ1ee 90%. CKOpOCTb nca-
CLlDaHml Hl-upcJUlIuma 13 Ta6J1CTOK MeHbwe, LICM H3 KancYJ1. MeTa60m13M - 1H'I"eH-
C 1BHbIW - B ne'-ICH 1. AKTHBHblX MeTa6om1TOn He BhISlBJ1CHO. BblBep,CHHC - npeHMY-
ll\eCTBCUHO nOllKaMH (HcaK1'UBHbIC MCTa6om1TbI). np" 1 1pp03e 1 OoJle3HSlX nO'-leK
i t1/2,' i V d ! PH.
llpyrHe MeTOllLI HCCne110BaHHSI . r)l(x.
IlpHMe'-IaHl1c . n penapaT OllCHL 6blCTpO pa3J1araeTCSI Ha cBeTY.
AHTMrltCTaMMHHble npenapoTbl
IIItMeTItAMH [1. 11,22.23,24]
E 1OJIOn1 leCKaSi >KHllKOCTh . CblBopoTKa, nm13 ta. MO'-la.
MeToilHKa onpeneJ1eHHH . PelllmUWht. Au,eToH 1Tpml WISI )l(HJ KocTnoH xpoMaTo-
rpa(pm1. XJ10pmpopM. 3(P 1P MegHl\HIICK 1W. nCHTaHOJ1. Pa36anJleHHaSi OPTO-(POC-
opJlaSl KUCJ10Ta. 0,05 M f{HrHJJ.pO(pOC(paT K£UU1H (pH 4,0). 0,02 M A 1n1J poclJoC(paT
334 TOM II - T..IACfHbIE AHAJII1TJ;PIECKI1E TEXHOJIOfl111
aMMOHMSI (pH 4,8). 2 H pac ruop nl poKcuHa Hc.1TpHSI. BOJ1.a 6 tA tCTIU1JmpOUaHHaSi.
npUZOm06Jle1-/Ue 06paJl{a. 1. CbJBOpm Ka. nJta3Ma. B npo6HpKY C repMc'lwlHOII
KpbIlIJKO" nOMell\<.HOT 0,3 r.m 6HonorHlfccKoW )l(HHKOCTH, Ao6aBJ1S1KJT 100 MKn 2 II
pacrBopa rIf,'J.pOKCH,lJ,CI Hc.1TpHSI H 2 Mn CMeCH 3q.mp-XJIOpocpopM-ncHTaHon (2:1:1).
Tll\aTCJlhIlO nepeMemUB<.HUT H 3KcTparupYKJT B TelleHI-tC 10 MHHYT; 3aTCM 1.\CHTpH-
(PyntpYIOT 10 fo.utHyr npl-t 3000 06/MHH. Opram1 l lccKliH CJloi"t KOJIH'leCTReHHO IICpC-
HOC SIT U np06 tpKH C rcpMCntllHblMH KpLIIllKaMH. ,\oUaUmUoT 100 MKJI p.136aBJlell-
HOH OPTO-( OC(POPHOH KHCJIOTLI, OTKpYlumaloT Ha VOrlex 2 MHIIYTbl H HCllTpHcpyn1-
PYlOT B TC'ICHHe 10 /'.umYT IIPH 3000 06lr.UtH. AmfKBo-ry (25 MK.'1) I1CnOJlbJYIOT AJlSl
Xp()MaTOrpa(pUp(>uaHHSl.
2. MOlla. B npo6HpKY nOMel1taluT 0,05 MJl MOllH, ,!.I.o6c.tBmllOT 2 MJI 10% altCTO-
HHTpllJla (u ,!.I.HCTHJlJlUpOl aHHor. BOJ e), Tll\aTenbHO IlCpCr-.'lcwlmalOT. AJlltKBOTY (25
MKn) HCnOJlh3YIUT AJISI xpoMaTOrpa( HpOBam1Sl.
XpOMamOZpalpU 1 leCKUillll--laJlU3. JJ;CTCKTOp - cneKTporpoToMeTpullecKHli c ne-
pCMeHlloH WHIHOt'1 BO.TJIILI. n - CMeCb a1.\cToHHTpl1Jla C 0,05 M paCTrmpOM JJ,HntA-
PO(pOC(paTa Kam1S1 pI I 4.0 ( JlSl mla3Mbl) Hml C 0.02 M pacTBopoM HHrH PO(poc(pa-
Ta aMMOHHSI pH 4,8 (AJlSl MOlIU) B 06'her-.UlOM COOTHowemlU 10:90. CKOpOCTt. ::)]110-
uponanml 1,5 MJlhmll. BpeMSI RhlxoAa JU1Ka I\UMCntJJ,l-tlla MHH.
KO.flll'wcnwewwe onpC()e.flellue. MeToJ - a6COJllm Hoit Karr 16p()J3KH. npeJl.cJI
o6HapY)I(CIHfSl 10 HrhuI .
ThpaneBT llleCKHft i11mna30H - 0,5-1,2 MKrhm.
MaKoKIfHcn1Ka - TIJ\.IX 1-2 LI; 1 1 /2 1,91./; V d 2.1 Jl/Kr; CI T 12 MJI/t\.H1H/Kr PB 15-
20%; F 70%; C max nOCJIC OAHOKpaTHoro ncpopa.%Horo npltCM3 400 Mr coeraUjlSl-
CT 1200-1800 HrhuL Dp" KypCOBOil MOHorepamm OCTaTOllHaSi KOHltClrrpaJ..tI-tSi 1.\H-
Menl HHa YTPOM nOCJle BCllcpHcro npHe 1a npaK IWIeCK11 He onpCJ CJISlCTCSI. npHC t
Ll,HMcn1J../,UHa nocnc Clt"l 3i.lMeTHO t3MCIUICT ero ( apMaKOKIUlen1KY, npllBOHSI K : BY-
rop6ot'! KpHBOi::f "KOHI eHTpRI ml-BpeMSI". TIpcnapaT BblB0Jl.IITCSI C MOllOil (HO% u
HCI-13MCHHOM BI1Jl.C). 3a6oJICBaJIHSI HOLICK l' t 1l2 II J., CIT' Y nO)l(HJlhlX JIIOil.eil 31-18-
llJ.1TeJlb/JO l' 1 112 , a V d 1 Cl T .1.
AMYPeTMileCKMe cpeACTSO
TpMoMTepeH [1, 22, 25,26]
DIIOJlol'HllecKaSi )f01f!KOCTb . CblBoporKa. nJ1a3Ma, MOlla.
MeToflHKa onpe]]CJ1CH tSl . PeWCml16bl. A1.\eTOHIITp 1J1 Jt1ISl )l(HJ../,KocnIO" XpOMRTO-
l"pa(pHH. KHCJIOTa OPTO-(pocej)OPIiRSI, lI.A.a. 2 M pac'mop rHJ poKcHJ{a IlaTpHSI. XJlO-
PO(popM. 3( l1p MC:J,U1.\IIHCKHiI. nCH raHOJI. Tplf31 UJlaMltH. BOAa 6 1H 1C n1JIJUlpOB<lHHaSi.
npW,OnlO6Jlefllle 06pa3l(a. I. ChlUopOTKa, nJla3Ma. B npo6HpKY C repMc n1 l lHOH
KpbIWKOi1 nOMCHtaKJT 0,2 MJI 6 10Jlont<lecKO t )KHl\KOcnl. Ao6alUIsnoT 100 ""'IKJ1 2 M
pacTuopa m poKcHJ../,a HaTpuSi If 2 MJI CMCCH 3(PHp-XJlOpO( opM-neHTaIlOJI (2:1:1),
TII\aTCJlbHO nepcMellUmatoT If 3KcTpanlpYIOT B Te l lCIH1C 10 MHHYT; oTKpYlnmalOT
Ha V0I1ex 1 Ml-mYTY II LlCIlTp 1(pyrupYIOT 5 MHHYT npH 3000 06/MHH. 1.5 MJl opraHlI-
llCCKOro CJlOS! HCpCHOCSIT 13 npo6HpKY C rcpMcTWIHOM KpbIlIlKOH, JJ,06aBJlS!KJT 100
MKJI OPTO-( OC( OPHOH KHCJlOThl (pI I 2.0), oTKpYlnmaloT Ha vot1cx 2 MIIIIY I'Ll. Aml-
KBOTY (25 MKJI) oT6upaloT H3 HU)I(lICro CJlOSIIf 1-1CnOJll.' YIOT /VISl xpot.taTorpa<l>Hpo- I
UaHl-tSi.
-
JIAEOPATOPHbII1 KOHTPOJIb nEKAPCTBEHHOI1 TEPAfIl1H 335
2. MO"-Ia. HenocpeJ{cTBcHHbli1 DBOJ{.
Xpo.MamozpaljjU'i,eCKrlii al-ta/lU3. ,lJ,e-reKTop - ( JlyopHMeTp '\leCKl1w. AB036 - 365
HM, MMUC - 470 HM. f14> - au.cToH rrpHJ1-BOAa-TpH3n'JJaM 'H (10:90:0,1). CKOpOCTb
3J1KmpOl aHH 1,5 MJ1/M 'H. BpeMSI BLlxoAa m'Ka TpmlMTcpcHa 5 nm.
KOALl l leCI1WeHHOe ollpeueAemle. MeToA - BHYTpeHHc.-o CI-aH apTa. BHYTpCHH 'i1
CTaHAapT - n'APoKc ,-3s-xmmAHH (BpeMSI BbIXOJ{a - 4 M 'H). f1pcACJI o6HaPY>Kem1Si
1 HrlMJ1 .
ThpanCUTI-'\ICcKHi1 JlHana30H - OULl\enpH3l1aHHblx TepaneBT '''-ICCKHX rpaHHl! HCT
pMaKOKHHCTl-IKa - Tma:w. 2-3 \1; tlf2 1,5-3 \1; CI T 71 MJ1hU1H; PB 50-80%: C max
nOCJ1e O}\HOKpaTHoro nepopaJlbHoro np 'et.ta 100 Mr COCTaBJ1S1eT 0,21 +0,10 MKr/MJ1.
TpHaMTepeH ULICTpO ' nomlO BcaCbmaeTCSI Ii TOHKOM K 'We\IHHKC. DOJ1ee 90% MC-
Ta60J1H3HpyeTcSI B nClICHH. MeTa60mnbi BLIBOjtSlTCSI C >KeJ1\lblO , MO"-'OH (B He n-
MCHHOM BH e 5-10%).
ClJypoceMMA (na3MKc) [1, 47]
E WJIOn1'-lccKaSi >K1-fnKOCTb. CbmopoTKa, nJ1a3Ma.
MCTollHKa onpeneJ1eHHSI. CM. CTaTblO Ha A 'rOKc m.
MaKOKHHeT 'Ka - t 1l2 0.5-0.85 '-I; TMax 20-60 MHH (U/B) 1 1-2 II (BHYlpb); CI T
166 MJ1hum/Kr; PB 95-97%. BcaCblBaH 'C - n K ,we'IH 'Ka 63-65%. OKOJIO 75%
BblBo)..{ ncSi B BHj e rmoKypoHHAOB. 3KcKpen'PycTcSI nO\IKa n' nYTCM ( l-IJlbTpau.lU1.
EOJle3lm nOllCK I13MCIISIIOT c}JapMaKoKHHcTHKY npenapaTa (lIpH nO'-le\lHof, HeAOCTa-
TO'IHOC I'll - CI T .1, npH He( pOTOKcwlecKoM CHHJ{pOMC PB !).
MMMYHOKOppeKTOpbl
HKnOCnOpHH [11,27,28,29]
DJfOllorU'leCKa >K mKOCTb . CblBopoTKa, nJla3Ma.
MeTonHKa onpenCJICtnlSi . PeaKI1lUObl. Au.eToHuTpUJI J{JISI >K11AKOCTHOH xpoMaTo-
rpac ' L K 1CJ10Ta OPTO-( OC( OpHaSl, "-1.A.a. BOJ a 6HJ\ 'Cn1J1m'pOBaIIHaSi.
flpu.20mooAcnue o6pa3l,a. B IIpo6 'PKY C repMCTI-1'lHOH KpblwKOi1 IIOMew.alOT
0,66 MJ1 6 I0J10rH'-lecKort >K1-11],KOCTI-1, 06aBJlSlIOT 0,8 MJ1 paCTBopa OPTO-( OC OPHOH
KHCJ10Tbl B au,eToHHTpl-1J1e (15 MMO.%hl). TwaTeJ1bHO nepCMeWHBalOT 11. u.cIfTJmc}Jy-
rHpYIOT 10 umYT npH 3000 o6/ n1u. AJ1HKBOTY (0,85 MJ1) HCnOJ1LJYIOT J],.T1S1 xpo m-
Torpa 'pOm1HUH.
Xpo.MamolpaljjULlccKuil aJlGA1I3. ,IJ,cTeKTop - cneKTpO( OToMeTpH'lccK 'H C ne-
peMcHHoi1 1],m'HOH BOJ1Hbl. A - 214 HM. 04> - au.eToH 1TpHJ1-B01],a B 06"beMHOM COOT-
HoweHUH 55:45 co CKOpOCTblO 3J11m'pOBaH 'SI 1,5 MJ1/MHH; B KOHl!C 3JH{)HpOm1HU
au.cToIIHTpHJ1-BoJ a (80:20) co CKOpOCTLIO 0,9 MJlhmH. BpcMSI BblXOAa IH1Ka IUIK-
JIOCnOpHHa 9 ,.,um.
KOJlU"-lecnwe/--lIwe onpeoe.f/CHlle. MeToJ{ - a6COJIIOTHoi1 KaJlHUpOnK L OpeJ{cJ1
o6uapY>KeHHSI 20 Hr/MJI .
ThpaneBTH'-lecKHH nmma30H - f1p ' IICpCCaJl.Ke nO'leK - 12 '-I nOCJ1e AOJL1100-400
Hr/MJ1, 24 \1 nOCJIC 1],031.1 100-200 Hr/MJ1; np ' nepcca Ke cep l!a - 12 \1 nOCJ1e J{OJbI
100-300 Hrl MJI, 24 \1 nocJlc 1],03hl 100-200 Hr/MJJ; npH nepeca.LI.KC KOCTHoro M03ra
336 TOM II - 1.IACfHbIE AHAflMTI11.JECKI1E TEXHOJIOrl111
12 II nOCJIC j 03LI 100-250 Hlohm. TOKC.KOHLl. > 400 Hr/MJ1.
MaKOK 1IICTHKa - Tffid.,\ 3-5 II; tll2 16+8 '-I; V d 3,5+2.7 J1/l<r; CI T 9,3+1,0
MJ1/r.u1H/Kr (60J1e3HH ne'leHU tCI T , Y ]J.eTcw CI T t) ; PB 96%; F 34+11 %. flpclla-
paT 1I0AnCp>KCH 3HTCpOITC'-ICHO'-umii PCI(UPKYJ1S1I(HH. Bbme eHHe - ne'-leHb. i Cm,lx -
aH poreHbl, [(HMenm m, ,1J. 1J1THa3eM, 3pl-1TpOMHLlI-IH, 3CTporeHbI, MHKOHa30Jl. i Cl T
- KO-TpHMaKC030J1. (peHo6ap6HTaJ1, AJ1I1TeJ1bHaS! CTcpmlAHaSl. TCpanml.
IlpyrHe MeTOJ1bl HCCJ1CJlOBaHHSI . 11<I)A (MeHCC CITCLlmpU'-ICII).
TpGHKBMnM30Topbl
OKca3enaM (TG3enaM, H03enOM) [1. 30, 31, 32, 33, 34]
EH0J10nt 1 JeCKaSi >KHJlKOCTb . CblBopoTKa, nJ1a:u..ta.
MCTOm1Ka onpene.rIemlS! . PeaKftlW3bl. MCT"dHOJ1 AJ1S! >KH KOCTHOii xpo mTorpa-
cpmt. HacblLl\eHHbJii pacTBop (pOC(paTa HcITPUS!. XJ10pmpopM. BOAa 6UHHC"n1J1JlHpO-
naHHaS!.
flpuwnzo8Ju'Hue o6pa.1l(a. B npooupKY C repMeTHllHow KPblWKOi'1 no tCLl\(U{)T 1
MJ1 O toJIOrHlleCKOW >K1t]J.KOCTH, ]J.o6aBJlSliOT HaCLILl\CHHLIi'1 paCTBOp (pOC(paTa Ha'rpHS!
no pH 13, 10 MJI XJIOpOCpOpMa, TI1\aTellbHO ncpeMclmmalOT H 3KCTparnpYIOT B TC-
lleHHe 10 p.,UtHYT; 3aTeM LlCHTpI,upyntpYIOT 10 p.,mHYT IIp 1 3000 06/MHII. Opramll.Je-
CKnlt CJ10" HCpCHOCS!T JJ KUJI6y AJIs! yuapHUaHl-lS! U ynapnHa&OT jI,ocyxa. Cyxotl OCTa-
TOK paCTBopSiIOT B 150 MKJI 3JllOeHTa. AJ1l1KBOTY (100 MKJI) 1CU0J1h3YIOT AIISI xpo-
M<rrorpa(p tpOUaIJHSI.
XpO.uUlllOzpaQjllL/ecKuii allll.ll1l3. HCTeK rap - cneKTpocpoToMeTp tllecKHn C ne-
peMCHHO" WUlHOH BOJlHb!. A - 230 HM. n<l> - MCTaHOJI-UOna H 06'hCMHOM COOTHOllie-
HHH 35:65. CKOpOCTh 3JIIOHpOUaHI1S! 1,5 p.,fjlhum. BpcMS! 13LIX0J-\a m1Ka H03enaMa 5
MHH.
KOJllllieCn16eHl-/Oe onpe()C.IIeHlle. MeToA - BHYTpeHHcro CTaH]],apTa. Huy rpeHHHM
c-raHj apT - cpeH<nenaM (13pCMH Bl>IXOAa - 7 MHH).OpejI,cJI o6HapY)l(eH ISI 4 Hrhul .
ThpaneBHI1lecKHM llHana30H - 0,2 - 1.4 MKrhIJl.
MaKoKnHCntKa - T max 2'-1; tin 7-14 'I; V d 0,6-2.0 J1/Kr; CI T 0,9-2,0 MJ1hum/Kr;
PB 90%. OKca enaM xopowo BcaCbmaeTCSI npu OpaJ1bHOM npHcMc. MCTa6oJ1l13H-
PyeTcSI B ne'lcmt nYTcM rmol<ypOmtpOuam-1S1. DOJIhllIaSi 'faCTb npHHS!ToW ]J.03b1 Bbl-
ACJISlCTCSI n01IKaMH. tin \1aJJO 3anHC tT OT (PYHKLlHOHaJlbHoro COCTOSlHJ.1.SI IIC'-ICnH H
B03paCTa.. B cpaBHeHHH C .1I'pymMH npoH3BoAHLIMH 6CII301\ I<l3CmtHa npeMSI ero ]J.cI1-
CTB tH 3Ha'-U1TCJlbHO KOpOlIC. OOJIC311H n01leK i tl/2, V d, Cl T , PB.
llpyrHc MCT{)JlbII1CCJIClIOuauuS! . f)KX, rXfMC, M(I)A.
.llpHMe'-Jamte . OKca3cnaM HHJISleTCS! 0611 tM Me-ra60mIToM )J,Ha3cnaMa, np<13ena-
Ma, MC]J.a3cnaMa, TeMa3enaMa. npHMCHCHHC 3THX 6eU30i1 ta3enHHoB MO>KHO MOHH-
TOp tpOBaTL C 1I0MOU\LW TCCHtp013aHHSI MOlU1 HMMYHmtCCJ1e OBaHucM; TCCT UOA-
TUCP>KJJ,CHUH - rXfMC. AaHHaS! B3)KX MeTOj tKa nO]J.XO]J. tT AJIH onpCACJJClUlH (pe-
Ha3enaJ\1a (B Ka1leCTBe BHYTpeHHero CTaHJ\apTa - oKca3cnaM).
.
...
f
.-- -- 1.
v v
nAEOPATOPHbII1 KOHTPOflb flEKAPCTBEHHOl1 TEPA0I111 337
npOM3BOAHbie 1,4-6eH30AMa3enMHa
rIpellapambl. - H..n pa3enaM> XnoPAHa3cnoKcHA (X) Ii ero MeTa60JH1T6L
nOOwnW(3J(Q npo6bl - K hUt nJ1a3Mbl Jl.06a13mIIOT O.1H HCl fJ,0 pH 9 H 5MJ1 UO-
ALL OepeMeW 1BaIQT> fJ,06aBJ1SIIOT no 5M!1 ]1J13H1J10130rO 3(lmpa 11 UOHbl. CMeCb Ll,eH-
Tpmpyn1PYtOT (5MHH» 3(PMPHLII1 CJ10ft nepeHOCSIT n KO!I6bl 11 YlJapl1B.<U<>T. Cyxoii
OCTaTOK pacTBOpSitOT B 100 MKJl 3JllOeHT,L AJUtKBOTY (100 MKJ1) HCIIOJlh3YIDT PiUI
XpOl\.taTOrpa(pHpOUali Ul.
YCJlOf1U.R alta.flll3ll - Y(I>-ACTCKTOp (A - 260 HM). 0(1): at..lCTOIIHTpl1J1-0,lM Kap-
60HaT aMMOHlUl (35:65). CKOpOCTh IIOTOKa - 2MJl/MHH. BpeMS! BhlXOl a X. - 8 r.umy 1',
em MeTa60J1HTbI - 4,5,11 Ml1HYT.
KO.fllt1leCnWeHHoe onpei)eAeHlle - MeTOJ1, BHYTpclmero cTau;J,apTa. BHYT.craH-
fJ,apT - HIHpa3cllaM (BpeMSl136IxOJl,a - 6,5 MHH).
rIpClIllpamlJl. - .o;m13CllaM Hero MeTa6oJIHThl.
nOowm061<a np06bt - K htJ1 CblBOpO rKH KpOBH j\o6anmllOT H3c6I11teHHLII1 p-p
Na3P04 Jl.O pH 13, 10 MJ1 X.'lOpo opMa. BCTpSixHualOT L5 1\.1IIH H LleHTpU(IJyntPYlOT
5 W1H. Opran. CJIOH nepCHOCSIT 11 ynapuBCltOT ; ocyxa. Cyxof. OCT.<nOK paCTBopS!IOT
B 100 MKJ1 XJ10PO(pOpMa H BBOASIT 13 xpoMaTorpaq).
YC.fl06llJl. G1WJl1l3a - Y(I>-AeTeKTop (A - 242 H\1) n<}): MCT3110J1-BOAa-YKcycHaSi
KHCJIOTa (56:42:2). CKOpOCTb nOTOKa - IMJ1htHH.
K()J uI't'cnlRenHOC Ollpe()eJlenlie - MeTOJt aGcOJIIOTHOH K.<lJIH6pOBKH.
npCllllplimM. - 19 6cll3o)J;mnemmoB (B TOM mC!1e OKca3enaM, HJ1Tpa3em.\M.
XJ10PAl1a3enOKCl1Jt, M CfJ,a3enaM).
noiJzomo6lw npo(ifJ/ - K 50 MKJ1 Jl,06aB!ISlIOT 300 MKJI CMeCH: aLlcTOHHTpHJI - 0,1
M KH 2 P0 4 (10:90). pH 9. CMCCh nponycKaloT '-lepC3 npel KOJIOIIKY, KOTOPY.o no-
TOM npOML>lUalOT 1 MJ1 ::rroft CMeCH.
YCJlOBWl llnaJlll3a - <1>OTol HOAHLI" cKaH 1pYIOll'Hn cncKTpo( OToMcTpn'-ICCl,J1H
AeTcKTop. DC!>-I'pa;J.l1eHT: aLlcTOHIlTpUJI-( OC(paTHL>lii 6y(pep pH 5,4 (38:62-15M m,
70:30-40 t.um).
KO/lU'tec.:mueHHoe onpeiJCJleUlle - BHYTpelumH cnlHJl.apT - npa3enaM.
CHOTBopHble cpeACTBG
CPeHo6ap6HTan (nIOMMHan) [1. 31]
DHO!10nNeCK3S1 >KUnKOCTh . CbIBOpOTK3. nJ1a3Ma.
MCTOIU1Ka onpeneJ1eHHSI . PeaKnUWbt. MeTaHOJI AJ1S1 )l(UAKOCTHOH xpOM.<rrorpa-
(PHI-i. XJ10PO( OpM. l-13ollpOnaHOJI. KHCJ10Ta OpTO-( OC(pOpHaSl! '-I.A.a.. }J.UY3aMe-
lI eHHblH (pOC(paT aMMOHUSI (0.05 M). BOl a 6Ujtl1CTJ.1JIJH1pOBaHHo)!.
npU20mOBJlellLle oGpa,Jl a. B np061ipKY C rcpMcTwlHOH KpblWKOH nOMCLl\aIOT 1
MJl 6110J10rH1.JeCKOH )l(J1J1,KOCTH. Ao6aBJ1S1lOT OPTO-( OC( OPHYlO KHCJ10TY AU pH 1-2 H
4 MJ1 CMecH XJ10PO(POpM-U30npOnmI0J1 (9:1), TlJt3TeJ1LHO nepeMCWJ.1BalOT U 3KCTp.,-
napytOT B Te'-IeHHC 10 MUHYT 3aTeM LleHTpU(pyruPYIOT 10 MHHYT npII 3000 06"'U1H.
Opram1'-lecKl1H CJ10H nepCHOCSiT B K0J16y AJ1S1 ynapHBaHHSI J.1 ynapH13alOT Aocyxa.
CYXOH OCTaTOK pacTBopSiIOT B LSD MKJ1 3J1tOCIIT3. AJIHKROTY (100 MKJI.) 11cn0J1b3Y-
101' Jl,J1S1 XpoM3TOrpa( l-I.pOBaHl1S1.
338 TOM II - t.IACTHbIE AHAJIJ1TH1..JECKI1E TEXHOJIOrJ111
Xpo.Mam02pacjjU'leCl<l1l1 aHlUlU3. ACTeKTOp - CneKTpO( OTOMClpHIICCK 1H C ne-
pCMeHlfOH HJU1HOH BOiIHbl. A - 240 HM. n<I) - 0,05 1\1 j:{BY3aMcw.eHHbIH ( OC( aT aM-
MO/uUI-MCTaHOll D 06"beMHOM COOTHOWCHHH 60:40. CKOpOCTb 3J11011pOBalIHSI 100
MKJJ!r-.U1H. BpCMSI Bblxoua nHKa npcllaparn 8 MHH.
KOJlWleCnWeHHoe onpeoelleHLle. MeTop, - a6COJUOTHOH K3J1J16pOBKH.. npcj:{eJ1
06HapY)l(cHHSI 15 HI-/MJ1.
Th.panCBTf1 t ICCKJllif JlJ1ana30H - 15-40 MKrhm; TOKC. KOHLI,. > 40 MKr/MJI.
MaKoK 1HeTHKa - T max 2-8 1I0CJle OpaJIbHOrO npueMa u 1,5 tlllOCJIC B/M; t1l2
3-4 11.11S1 Y B3pOCJlbiX " 60-1 RO II Y HOBOP0)l(j:{CHHbIX; V d 0.7 JI/Kr; CI T 0,093
M.'I/,.,u1H/Kr; PB 45-50%; F 80-100%. BcacbIBam1c np" npUCMC BHYTPb - 80%. Pa3-
PywacTcH M 1KpOCOMaJlbHbIM 1 ( CpMcIITa,.,U1 nCllCHH, B nocJ1eJ1.Yfow.eM Bbl1\CJUleTCSI
npe 1MYII CCTBeHHO C MOtlOH (10-25% B HCH3MCHHOM BH1\C H 2,5% B m1)J.e CB06oJ1,-
Horo MCTa6omna). OpH U,Upp03C nellCHl-I I t1/2 H ..!. CIT, npH 6cpCMeHHOCTH CI T I,
Y nmKH.'ILIX JIIOp,CH t1/2 i. <1>cH06ap611TaJI - HHP,YKTOP ( CPMCHTHOH C 1CTeMbl nCtlC-
HH; Bbl3bJUaeT nOUblWCHHC MeTa60JlH3Ma Jl.pynlx J1CK.apCTBCHflbIX npcnapaTOB noc-
J1C OAHOH-ABYX HCp,CJ1h JIC t ICm1S1. CIiOTBOpHOC )J.CHCTBHC ..!.: al\.U1gonHpHH, aTpomlH,
rJl}OK03a, T 1a,mH, HHKOTOHOBaSi KHCJ10Ta, allaJIenn1KH. DpOH1BOCYAOPO)l(HOC gCH-
CTBHC I: aIlU1TplmnUllm, HHaJlaMHL\, )J.Ha3cnaM; .1: pCJCpnHH.
llpyrHc MCTOTlhl 1CCJIC!.lOBaJiHSI . f)l(X, 11 <I>A , <}>HA, fX/MC.
llpHMClfaHHe . AaHmlSl MCTO)J.11Ka npHrO)..lHa AJ1S1 onpc.o.CJ1Cm1S1 H Apyn1x 6ap6 1TY-
paTOD.
6ap6tnon-HOTpMM (sepoHan-HoTpMM) [1.31]
£ 10JIOrH'.lcCKaS'l >KULIKOCTI. . CblBopoTKa, nJ1a3Ma.
MCTOIU1Ka,OnpClleJ1emUI. CM. CTaTbKJ (/JeHo6ap6wllaJl.
MaKOf(HHCTHKa - XopOWO BcaCbIBaeTCSI B )l(KT, tlaCTH{.IHO CI3S13blBaCTCSI
a.11b6YMHHa,.,m. MaJIO MCTa6OJn13 1pYCTC B nC{.ICHH. EbJCTJ?O 3KCKpeTHpYCTCSI 13
opraflH3Ma C >KCJltlbKJ B OCHOllHOM B HCH3MCHHOM IU1,QC. t 1l2 i C B03pacTOM (2,5-3.5
JlflSl). npl1 pel-YJ1S1pHOM UllCp,CHHH KYMYJlUPYCT (KYMYJ1S1nmHble CBOHCTBa I npu Ha-
pywcmm ( YHKIHH1 nOtlCK u nCtlcml).
3TOMMHOn-HaTpMM (HeM6yran) [1, 31]
bH0J10n1 t fCcKaSi >KHHKOCTb . ChmopoTKa, I1JJaJMa.
MCToJU1Ka onpCnCJ1cHHSI . CM. CTaTbfO (/)eHo6ap6wnall.
)"1aKOK 1HcTI1Ka - T m,x 0,5-2 II (i noCJlC npHCMCI nHW.H) ; t V 2 20 {.I (i IIPH
l uppo3e); PH 45-70% (.1 npJ1 nOllc HOf1 He}'(ocTClTOIIHOCTH). A6cop6HPYCTCSI U
>KKT Ha 90-100%, XopOWO BcaCLmaCTCSI npu peKnU1bHOM H B1M I3BCI CHUH. Dpc-
napaT 11 ero MCTa60miThi 3!IJ1MJ.lHUPYI{)TC B OCJfOUHOM nO'-IKaMU (OKOJlO 20% B IIC-
H3MCHHOM BHp,C). HaKanJ1HBaCTC B :>KHpoBOH TKaHU, 13 KOTOpoft MO>KCT nOllTopHO
nocTynaTh B KpOBI>. n pH nOB1UpHbIX BBCgCHHSlX HaCTYnaCT np 1BbJKam1C.
-
JIABOPATOPHbIM: KOHTPOJIb JIEKAPCTBEHHOM: TEPATIIU1 339
(
,
HapKOTH'feCKHe aHanbreTMKM
MOp4»HH [311
6H0J10rH'-leCKaSi >KUllKOCT b. MO'-la.
MeTonUKa o eJleHi-ISI . Pemmtu6bt. ALlCTOHHTpl..m A,T]SI >KHAKOCTHOf1 XpOMa-I'O-
rpaqnul. 0,01 M pacTuop au.eTaTIl aMMOHHSI. XJlOpOcpOpM. I.--bonpOnaHOJl.TucpfJ,bIH
6HKap60HaT llaTpmL KOHUCHTp 1poBaHHaSi HC!. BO)J,a 6UAI1CTllJlm1pOBaHHaSi.
nplflUmORJleltlle 06pa3t(a. B npooHpKY C repMeTu'IHofl KphlLUKOrl nOJ"'ICII alOT
20 MH 6HOJlOrW-lecKoH >K 1HKOCTII, l\06aujlSlIOT 4 MJl KOHLlCHTpupouaHHolI COJlSlHofl
KUCJlOTbl (35-39%) 1-1 BbJfl.ep>KHRalOT B Te'leH 1C 15 MllHy"1' Ha KI-IIISllllci1 ROASIHOfl 6a-
He B cocyp,e c 3aBHH ' II-IBalOLl\eHCSI KpbIWKOfl. TIoCJ1e OXJla>K,'\CHHSI )J,06aBJISUOT TBCp-
Abl" 6HKap60Ha-r HaTpllSi AO pH 9,0. IIOCJle oceAaHUSI nCHhl pac"mop nepemmalOT B
p,em1TCJlbHYJ{) BOPOIiKY H IlBa>K; bI no 10 MJ1 3KcTpanlpYKrr CMCChlO XJlOpOcpopM-
wmnpOnaHOJI (9:1). OpraHl1"leCKHc cpa3hl 06,.cJI,HHSlloT. <PHJlbTpYIOT t.lcpe3 6e3-
BO}\Hblfi Na2S04 J1 ynapHBmoT fJ,ocyxa. Cyxorl OCTa-rOK pacTBopSiIOT U 150 MKJl 3JU()-
CHTa. Am1KBoTY (100 MKJl) HCnOJlb3YlOT }lJlSl XpOM<\'rorpa<pHpoBaIlHSI.
Xp0.MamOZplUpll'leCKllillllWJ1U3. }J.eTcKTop - cneK rpo<pOTOMeTpWleCK ln C llC-
pCMeHUOH AJuuroif BOJlHbI. A - 230 HM. TI(I) - CMCCb aucToHU-rpHJla C 0.01 M alJ,CTa-
TOM aMMOHHSI B 061.eMHOM coomOlllcmUl 35:65. CKOpOCfh 3JlIOHpOUaHHSI 100
MKJI/MMH. BpeMH BhIXO:J,a rlllKa npenapaTa 4 MUH.
KO./lu'-tecmBeItH.oe onpeOe.lleHue. MeTOJ\ - a6COJlIOTHOH KaJIII6poHKH. rIpelI,cJI
06HapY>KeHHSI 10 HrhlJl.
Th.paneBH1'-1eCKl1rl Jl.Uana:iOH - 10-80 Hr/f\.UI; TOKC. KOHli.. > 200 Hrhw.
MaKoK IHeTHKa - l1/22-3 ll; V d 3-5 n/Kr; CI T 15-20 MJl/MWI/Kr; PB 35%; F
20 -33%. I1p11 BfR BBe)J,CHHH "'-tOp Hua MaKCHMaJlbHblH <papM<lKOJlOrWleCKHfI 3CP-
eKT )J,ocn1raeTCSI t.lcpe3 HCCKOJ1bKO MHHY r, npH n/K 11 HIM BUCJI,CHIUI - 'lcpe3 15 MH-
HY r. R J],aJ1bHeHWeM cO)J,ep>KaHHe MOp l-Hm R KpOAII pC3KO na,!l..acT.OKOJlO 80%
Mop HHa 01' BBe,I\CBHOfl 1\031->1 BblAenSlCTcSI C MOl.IOH B TC'leHHC 8 'laCOB. O)tHaKo
CJleAbl MOp<p HHa MO>KBO 06HapY>KUl b B MOt.le cnycTSI 72-100 '-Jacou. C >KCJ1l.lbK> Bbl-
n,enSleTcSI 11.0 10% BBeAeHHofl A03h1. TIpH MHoroKpaTHoM npHeMc Mop HHa OH Ha-
KanJlHBaeTCSI B Bonocax H HOI nix.
IlpyrHe MeTOllhl nCCJTCnOBamls:l . r)KX, PH A, H<I>A, rXiMC. JlyopHMeTpHSI.
IlrmMel.laHlie . }J.aHHaSi MeTO}\HKa npHroJ],Ha JIJls:I COBMecTHOro onpCneJ1eHml MOp-
HHa, KOfJ,elma H nananepliHa (BpeMSI BblxoAa 4, 7 U 18 MHHYT cOOTBeTCl'BeHHo).
.
.
I
I
KOAeMH [31,35]
6HOJlOrH'-leCK3H >KI-IllKOCTb. MO'-la.
MeTollHKa onpCneJ1eHI-ISI . CM. CTaThIO MOpcjJUH. BpeMSI BhlXOtJ,a KOAcHHa - 7 MUHY r.
]jaJaneBTHt.,ecKHfI nHana30H - 10-100 Hrh1Jl; TOKc. KOII . > 200 HI'/MJl.
"'taKOK"1,HcTHKa - T Olax 1'-1 (nocJle ncpopaJlbHoro npucMa); ll/2 3-4 ll; CI T 10-
15 MJlhu1H/Kr; V d 3,5 Jl/Kr; PB 7-25%. KO)J,eHH BcaCblBaeTC J],OROllbHO 6blCTpO 110-
CJ1e napeHTCpaJIbHoro BBe]J,CHHSI. MeTa6oJlH3M npoTcKaeT maBHblM oopa30M B ne-
'ICII"'. nocne OpaJlbHoro npHeMa OKOJlO 86 % J],03bl Bblp,eJISlCTCSI C MO'IOn 3a 24 '13,
ca, B TOM '-IHCJ1e CB06011HOro KOJl,eHHa 40-70%. TIpn B/M UBep,eHHH KOJIWleCTBO CBO-
340 TOM II - t.IACTHbIE AHAflJ.1TMt.IFCKME TEXHOflOfJ111
60AHoro KOAcHHa, HbIAeJJSlCt.'IOrO C MOIIOM cnycTSI 24 \laca. COCTaBJISICT 15-20%. I
llpYI'He Me rom..1 HCC IJC)jOBaHHSt f)J(X, fX/MC. PJ1A,11 cI)A.
XMMMOTeponeBTM-.eCKMe cpeACTBO. cJ),.opxMHonoHbl
04»noKCOI.IMH (TOpMBMA) [38, 39]
.6nOJJOI"l-I\leCKaSi >KHHKOCTh . CblBopoTKa, nJIa3Ma.
MeTomlKa OnpelleJJCHlHt PCmOJl1l61>l. MeTalWJI JJ,JUI >KU"KOCTHOii xpoMaTorpa-
l-IH. OC{JJaTHbli1 6ycpcp (pH 5). 0.1 H pac.i"Bop nl.LJ.pOKcHAa HaTpHSI.. XJ10pO OpM.
BOJJ,a 6I-1I.I,l'ICTMJIJ1HpOUaHHaSl..
npll20f7lVOJlelllle 06pll31(a. B np061'IPKY C repMCTIt\IHOii KpblWKOH nOMel1 c:UOl' ]
MJI UH0J101"H'leCKOH >Kl-1} KOCTH, JJ,06auJUHoT 200 MKJ1 0,1 H pac-l"Uopa rtiAPoKcHp;a Ha-
Tpm H 4 MJI XJIOpo opMa. Tl1 aTeJlbHO IICpeMCWl-maJOT H 3KcTpanlpYK>T B Te\ICHHC
10 t.-lImYT JaTeM l(eHTpu yrupYJOT 10 M1IHYT IIPH 3000 06/MHH. OprauwlecKm1
CllOH ncpeHocSiT B KOIl6y AnSI. y"apl-maHHH 11 ynapHuaJOT Aocyxa. CyXOH OCTaTOK
paCOrnOpSl.IOT H 150 MKJI 3J110CHTa. Am1KBoTY (100 \IKJI) HCn0J1b3YIOT )J.ml xpOMaTO-
rpa{JmpoBalUlS1..
XpO.MllI1102/WrP WU :ClCllli. llIW.lJll..3. eTcKTop - cneKTpo oTOMcTpwlecKHl1 C IIC-
peMcHHoti AJIHHOif BOJIHbl. A - 313 11M. nel) - CMCCh MCTaHOJIa C al.{eTaTHLIM oy e-
pm..1 (pH 5) B OU"beMHOM COOTHOIUCHlUI 35:65. CKOpOCTb 3JIJ0l1pOB<lHHSI 1,5 M.'IIt.-UIH.
Bpet.-ul BbJXOHC:l nt-IKa npenapaTa 10 MHH.
KOJlWleCnmeHlwc ollpec)e.lleHlle. MeToA - a6co.IJH.nuoti KaJm6puuKH. Ilpe,1eH
o6HapY)f(CHHH 10 Hr/MIl.
ThpancBT11\ICcKHi'1 JUmnaJOH - Tep. KOHl(. '3aBl-fCSl.T 01' MHKpOOpmm13MC:l. no 110-
OO}.{y Koroporo nep;eTCH Ile'ICHHC.
MaKOK 1HCTHKa - t1/2 5-8 'I V d 1-1,5 J1/Kr" CI T 230-280 MIlhu-tH; PB 25%; F
95-100%. C max 1I0CIlC oAHoKpaTHOI"O nepop,UlI.Horo npH Ma 200 MKI', 400 MKr, 600
IIIKr COCTaRJISJCT 1.6-2,2 MKr/MJI. 3,2-4.3 MKrh1Jl,6,7-8,1 MKr/M.'I COOTneTCTI3CHHO.
BcaCl.maeMOCTb H 611O)J.ocTynHocTb TapHBII}{a I3blCOKl-IC (6oJlee 90%). Tapl-IBUA xo-
pOUlO npOHHKaCT npaKn1\ICCKH BO Bce TKaHH 11 CPH3110JIOrWICCKl-fe )f(HJJ,KOcTl'I.TapH- l
BI1l1. o6Hap)'>KlmaCTCH B MOI[e u BbJCOKllX KOHLleHTpaUlHlx. BOIlce 90% oJ],HoKpaTHoH
IIcpopariLH0I1 H031.[ BbIACJ1SJeTCSJ C MO'IOrt B TC'leHHC 24 \1. Bhl}J.CIlSl.CTCSI. rJ1aRHhlM
06pa30M \[Cpe3 IIOtIKl-1. 60J1e311H nOllCK i t Il2 1 -1 Cil" C BcnpaCTOM 11/2 i.
ilpyrHc MCTO!lbl nCCJICnOnaHWI. B3)J(X C cpJIYOPUMCTpl1\[CCKl-IM At::.TeKT<.>poM.
llpHMe\ICIHne . JJ;aHHaSJ MeTOJ},HKa nOAXOHHT 1\JUI onpcp;cIlt::.HHSI. 11 Hpyrux "POlI3-
BO:mbIX TOpXl-lHOIloHa.
nOMe4»noKCOI.IMH r 1 ]
bl1C>JIOrHl[cCKaH >KHJlKOCTh . CbIBopoTKa, ITIla3Ma.
MCToIU1Ka OnpCIICJ1eHl-fSl. . CM. CTaTLIO OffjJIOKC£ll(llH.
MaKOKl-1IfCTHKa - T/II;!X 1,33 'I; t 1l2 7-8 \1; CI T 199 MJ1/MHH; V d 2.54 ll/Kr; C moL >;
3,47 MKrh1Jl. ,
,[lpyrHc MCTOJ1bl HCCJ1eJlOBaHHSJ . (3)J(X C JIYOPHMCTpl-lIICCKHM }WTeKTUpOM.
I
or
JIA60PATOPHbIH KOHTPOJlb JlEKAPCTBEHHOM TEPA0I111 341
..
AHTH6HOTHKH-MOKponHAW
3pHTpOMMLlHH [1, 47. 50]
DI10J10r&1 l lecKaSi )I<l1llKOC1'b. CblBopoTKa, nJ1a3Ma.
MCTo HKa onpCneJ1eHIHL PeaKlJll18b/. KHCJ10T3 opnH}JOc4JopHas-l, 'l.1(.a. MeCN.
BOAa 6H}J,HcTHnmlpoBaH Ha SI.
flpUlOm06JlCUlle 06paJI(a. B np06HpKY C repMe1'l'l l lHoi1 KpblWKOH nOMClItalOT
200 /lIKJI 6HOnOrH l ,eCKOM >KHAKOCTH, }J,06aBJISIlOT 10 MKJI pacTBopa BuyrpcHHcro
c1'aH ap1'a (10 MKrhm), 20 MKJI HaCblll eHHoro pacTBopa Kap6oH3Ta HaTpHSI H 1 MJI
f(113THJ10BOro 34JHpa, O1'KpY"IHRaIOT Ha vortex 30 CCKYHA :laTeM I eHTpll4JympylOT
2 MHHYTI,I npH 6000 06/MHH. OpraHH l lecKHi1 CJ10H ynapl1BalOT .u.ocyxa. Cyxofr oc ra-
TOK paCTBOpSl101' 13 50 MKn 0(1). Am1KB01)' (20 MKJI) Hcnonb3YlOT AJI)! Xpor-.1aTOrpa-
<)Jl-lpOBaHIHI.
Xpo.\wmozfJllifm'-iCClcuii. aUll.ll1l3. )J.cTeKTop - E. Shimad7u L-ECD-6A. n<IJ -
CMeCb McCN C 50 MM paCTBopa HHrHHpo4Joccpa1'a Ka.1Us-I (pH 10,5) B Oeh, /lIIIO\l
COO1'HOluelUU1 37:63. CKOpOC rb 3J1IOHpOBamls-l 1 MJI/MI1H. Bp nl Ublxo,u,a IUIKa IIpC-
napaTd 12 1'.11-111.
KOJlWlecnWCWtOe Ollpe()e./lClluC. MeTOf( - UIlY rpCHHero C raIlJ,apTa. BHYTpelt-
HI-I" c1'aHHapT - OJIeaHlI.OMH,-",UH (BpeM}I IIbIXO}J,a - 5 /lUIHYT).
ThpaneBTH'lccKIfi:i ilHana:mH - KOH,-",. O"lelt!> BapHa6e.l1bHa.
MaKOKHHCTl-IKa - TIpcn3paT KI1CJIOTOYC rOH'um: B llJ,eno'-IIIofi cpC}J,e npeBpa-
IItaCTCSI. B aHTH6HOTI1K WHpOKoro cnCKrpa ej:'jcTIH1}1. Xopowo npOHUKaCT B IIC-
'-leHb, JICrKlIC, KOC1'HYIO TK3Hb. MbIWL{hI. PB 60-80%. BblROJl,HTCs-I C >KeJ1 t lhIO B IIC-
H3MeHHOM BH}1e (20-30%). Tr-.tax 1,5-2 II. t 1 /2 1,2-2,61.1 (y HOBOpO>Kf(eHllhIX i). Yr-
HeTaeT aKTHUHOCTb lJ,l-ITOXpOMa P-4S0, npH 3'1'01\.1 HapywaSi 6U01-pallc<)JopMaL{111O 0}1-
HOBpeMeHHO Ha3Ha t iaeMbiX nn (nOBblwac1' KOII,-",CHTpa,-",HIO R nJla3MC KpOUH Kap6a-
Ma3cnHHa, Teo4JHJlJIltHa H YCH_I1HBae1' HX TOKCH'lecKHil 3(}JcpCK1').
f
CepAe"lHble r nHK03HAbi
HroKCHH [1, 13, 40, 46, 47]
EHOJIOrHtlecKaSi >KHnKOC rb . CblBopoTKa. IJ.IJa3Ma.
MC1'Ol1l-1Ka onpeneJIelil-lSi. PenKnlllm,l. A ,-",CTOH. 11300KTal.I. .il.I-IXJIOpMcTaH. n-
npOn3HOJl. MeTaHOJI. 31'aHOJI. nepOKCU} BOAopolla. L-acKopuHHoBaSl. KHCJlara. 80-
Aa 6HHHCTIIJ1111IpOBaHHas-l.
flpuzonw£ulcuue 06pll,Jl l/. B IIPOUHPKY C rcpMcnlllHoH KpblUIKOH 1I0MCllJ,alOT 3
MJl 6110JlOn1 t leCK0I1 )l(11}J,KOC1'U. J106aUJISilOT 20 \IKJI MKrh1J1 pacTlmpa BlIY rpCHHC-
1'0 CT"t\BHapTa B 3TallOJlC H 3 MJI al{C1'Olla, 'lu,aTeJIbHO flCpCMCllHlI.3aIOT II 3KcTparu-
PYI01' B Te t leHI1C 10 MUHYT; 3aTCM ,-",eHTpll4JyrHpYloT 5 /lU1H}'T npu 1000 O()!r.UlH. K
opl'aItl1'lccKOMY CJIOIO n06aBJISIIOT 2 /lfJI CMeCl-1 H300KTaH-HUXJIOpMeTaH (HO:20), 0"1"-
KPY"nfI33IOT Ha vorlcx 1 MHHYTY 1-1 L{CHTpH4JyrHpYloT 5 MI1IIYT IIpl-l lOOn o6/r-.u1II
YALUlSIIOT aI\CTOHOBbIH CJIO&j U ynapHBalOT no}\ TOKOM a30TLi. npl-l 370C, JJ,ooaBJISl.KJT
10 MJI CMeCI-I HHX110pMcTaH - n-npO/laHUJI (98:2). 3KCTpal'l1pYlDT B 1'e'-leHHC 10/1111-
H}'T, L{CHTpHc):Jyrl-lpYIOT 5 MHHYT npJ1 1000 u6hutH; 3KCTpaKI\t1lD IIUBTOpSiIOT, opl"a-
HH'-leCKHC CJIOH CJlHBatOT H BblJlapHBalOT /lOA TOKOM a30Ta npu 370C. Cyxofi OCTa-
TOK pac1'BopmoT B 100 MKJI CMCCl1 MeTaHOJ1-ROHa (50:50). AJIHKBOTY (100 MKJI) HC-
nonb3YIOT JJ,JISI. xpoMaTorpa<)JHpoBaHuSi.
(
,
&
342 TOM II - t.IACTHbIE AHAJU1TI1t.IECKVlE TEXHOJ10fl1l1
XpOJ..W1J102pa(jjU'ieCKlIil aH.a.llU3. ,lJ,CTCKTOp - (ImyopuMcTpWICCKJ1J1. (AB036-
360 HM.I....:JM - 425HM). n(1) - MeTaHOJI: ::rraHOJI : 130npOllaHOJI : 6yq,cp (52:3:1:45)
(6yq,cp rOTOBHTCH nYTCM CMCUJUBaHU}J 12.5 MJI 0,15% pacruopa IICPoKcuJ,a BOAO-
poga C 500 MIl 500MKr/MIl paCTBopa L-aCKop6HHOBOH KHC.'1OTbl; nepef>leWl-lBaeTCH
13 Te'-ICHUe 2 '-JaCOB). CKOpOCTb 3J1lOl-IpOBaHI-IH 0,4 MJ1Jr..UIH. BpeMSI BbIXOJ{a m-lKa npe-
lIapaTa 18,5 MHH.
Ko.lUl l tecnll3euH.uc OllpCOC.IlCHUC. MCTOA - BHY rpCllHcro CTClU}J,apTa. BHYTPCH-
HHM CTaH}J,apT - l-InITOKCl-lreHI-IH (BpeMSI BblXOAa 22,5 MI-IHYT). npeAeIl 06HapY>Ke-
H1-I}J 05 HdMJ1.
ThpaneRTH1IeCKIti'1 mmna30H - 0.8-2,0 Hrfr...JJ1; TOKc. KOHL(. > 2,5 Hr/!\-,-'1..
MaKOKI1HeTJIKa - Tmax 4-0 II; [112 30-40 II; CI T 2,29 MIlhIHH/Kr; Vd 7.3 J1/Kr:
PB 20-40%; F 70-85 %. CI T -1- npl-l 60J1e3HHX nOlieK 1-1 i y HUBOp0>Kp,eHHbIX 11 p,eTcii
IIJla3MCHliLIC KOHL(CHTpaLtJ.-m npcnapaTa i - MCKCI-IJ1l-1"nlH. npOKaI-iHaMI-IA, H6YIIPO-
q,CH. XUlUlIL
Llpyme MeTOHbl UCCJltHOR3HI-ISI. f)l(X, PI1A. I1cl>A.
Tl OO Me'-laHI-lC. O.n;nORpeMeHHO MO>KHO OnpCJI,eIlSlTb Al-iroKCl-lrCHJ-IH, .n;l-Iru.n;pOHl-lro-
KcurCHlIH, ).\llnfi p()Al1rOKCItH, q,YPOCCJ\IHA, Clll-lpOHOJJ<tKTUH.
'"
AHTMapMTMM eCKMe npenapaTbl
3TM03MH [1,41]
bHOIlorWleCKaSi >KI-I!1KOCTh . CblBopOTKa, n.'1a3Ma.
MeTOIII-IKa OnpCTIeIleHI-lH. PeaKI1U1Bbl. MeTaHOJ1 }J,J1H >K1-lp,KOCTHOH xpoMaTorpa-
q,1.fJ.L Cni-lpT 3TIUlOBbJ". 0,01 % paCTBOp KI-ICIlOTbl OpTO-q,OCq,OpHOfi. Bo)],a 61-11'"-
C n.1JIJJ HpUBaHUa}l.
IIpll201JlO6JlCIlUe 06pa31(1l. A IIpo6uPKY C rcpMcTu1llmri KphllllKOH 1I0MCII aIOT 1
MJ1 Ol-lOJI0rl1 1 leCKOH JKH.QKOCTI-I, o6aBIlSIIOT cnupT 3TUJIOBblH }J,.'1}{ OCa>KACHI-lSi 6eIl-
KOB. TI1 aTeJ1hIlO nepcMcllummoT 1-1 3KcTparupYloT R TC1leHHC 10 MI-IHY r; 3aTeM l eH-
Tpl-lq,yrHpYIOT 10 MHHYT npl-l 3000 06/MI-IH. OpraHI-I'leCKI-IH CJ10ll nepeHOCSIT B KOIl-
6y AJ1S1 ynaplmaJUIH II ynapl-lBalCYf ocyxa. CYXOH OCTaTOK pacTBopSiIOT R 150 MKJ1
3JIlOeHTa. i\JUIKBOTY (100 MK.rr) HCn0J1b3YIOT JI}{ xpoMaTorpaq,l-IpOBaHI-lH.
Xpo)'wl1I02paifJll ' leCKlUi aHaJllJ.3. ,lJ,eTeKTop - cneKTpo4>oToMeTpH 1 lecKml C ne-
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1. K:UtIIH'leCKaH c)JapMaKO..'IOrHH In.r.KYKcc. A.C.PYMHHLI,eH, E.P.A..'ILllcpomlll.
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.
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K11eTKa, pa3 iepbI 151-156
KJIOHOPX 265
KOJleHH 339
KOK HJlHH KHwe':l.HaSl. 265
KOMnJ1eMeHT. CIINH 210
- Clq 212
- C3-KoMnoHeHT 204., 209
- C4-KOMnoHeHT 20q, 209
KOQ>eHH 330
Kplfomo6YJ1JiHhI2/4
KpHnTOCnOpHJlH" 265, 283
JIa6CT3J10J1 330
JIaHxraHca- nl1poroBa mraHTCKl1e
KJIeTKH 141
JIaHrepraHca KJ1eTKI1 87
JIci1KoW1TapHaSl. <p0pMYJ1a 43
nct'lKoLlHThl, rnHKoreH 59
- (X-r11HUepoqJOcQ>aT.il.em,aporeHa3a 58
- JleruJlPOreH33bI 57
- KaTHoHHbli1 6eJ10K 61
- KHCJ1aSl Q>oc aTa3a 52
- KHCJ13S1 a-Ha<pTl1J1aUeTaT3Crepa3a 55
- m1 n HJlbl 62
- MHeJ10nepOKCHJla:m 53
- Ha(1)ToJ1-AS-aucTaT-3cTepa3a 56
- IIm})TOJ1-AS-D-XJlopaLleTaT-3CTeRa3a 57
- HccneUH<pU'fCCKHe 3crepa3bI 5'4
- CLlr 57
- Cpe.il.HHH UHTOXHMH':I.eCKHM K03<P<P H -
UHeHT .lUlfi afJleJIbHblX <pepMeHToB
(CUK) 49
- CpeJlHHH UHTOXHMH'feCKHH nOKa3a-
TCJ1h 49
- lJHCJ10 B KpOBH 41
- llleJ10lJHaSl £bOCc:pa1a3a 50
neHwMaHHH 257t 298
nCHTCU WHpOKHH 265
nHM o6J1aCTbI 77, 84
llm.utJoUHTbl 43, 47., 77, 81, 84
B-J1HMQ>OUI1TbI 80
T -J1MMQJOUHTbI 86
- cy6nonymmHH 240
JIOMe<pJ10KaUI1H 340
llSl.r.16JIHSI. 265, 281
MaKpO<pam 84
MaJUlpMHHbIe nJ1aJMO,lU111 251, 254
Mcral<apM06JlaCTbJ: 79
MCraKapHOLlI1TbJ: 47, 75, 79
MCM6p<lHOaTaKYIOwl1 i1 KOMnJ1eKC
(SC5b-9) 210
MernroHlfM 288
MeTaMHCnOLUfTbI44, 76
M I1cJ106naCTbI 76.r, 81
M HCJ10 WfTbI 44, /6, 81
MMeJIOKaplfOLlHTbI 74
MHKo6aKTcplflf Ty6cpKyne3a 317
MI1KOnna3Ma rO!\mHHC 301
MI1KPOcPHJHlp Hf 25lJ 260, 289, 297
MH03 1T-cncUH<pH'ICCKHe aHTHTCJ1a 227
MI1TOXOH.ilpmUTbHbIe aHTHTcna 238
MHoroBapl1aHTHbli:'1 MOp<p oMCT pl1l.Je-
CKlf i npOrHOCTHl.JeCKl1lf I1HACKC 188
MOHo6nacTbI 77
MOHOLU1TbI 44, 47, 77
M OP<PI1H 339
HanpoKceH 327
HcrncpHH 262
IIci'ffpo<pl1nbI 44, 47, 76, 84
HeKaTop 265f) 285
HeMaTOD.bI 2155
HCOnTCpl1H 243
HH<pcm1nHH 333
Hop\m6JlaCTbI, 6a3o<pHnbHbIc 78, 81
- nOJlHxpOM<iTmpl1J1bHbIC 81
- OKCHcPl1.'IbHbIC 78, 81
06waH re!\10JHffH'ICCKaSl aKTHBHOCTb
KOMnnCMeHTa
- KJIaCCHl.JCCKOro nyrH (CI-I50) 208
- an bTepHaTH BHOro nyrlf (AH50) 209
OKca3enaM 336
OCTPH ua 265
OqmOK3U 1H 340
lIaJ10l.JKOSlD.CQHbIC HCHTpoq>Hnbl 81
naparoHlfM 265J, 292
napm.{cTaMon 3L8
nna3M3TI-flIeCKHe K.'ICTKJf (nna3MoLU1-
TbI) 44, 81, 83, 128
n HCBMOLlI1CTa 292
nOBCpXHOCTHblX KJIeTOK HH;J,CKC 138
nOJlOBoi1: XpOMaTI1H 121
nporeCTepOH<l pcuenTopbl 182
npOD.YKTbl pacu.{cnJlCHHSI KOMnOHCH-
TOB KOM nJ1CMCHT<l 209
npOH3BOAHbIC 1,4-6cH30D.H<l3cnHHa
337
nponmbepaTHBHoH aKT 1BHOCTH I1H-
D.CKC (HnA) 172, 176
Ilpom-IWPOUHTbJ 77, 84
npOMCraKapJfOLlJfTbl 79
OPOMI1CJlOUHTbl 76
npOMOIiOLlHTbl 77
n pOHOp 106jlaCTbI 78, 8/
Oponp3Honon 330
PaCTBOpl1Mble pcucnTopbl
- HHTCpJ1CHKHH<l-2 241
- <paKTopa HCKp03a onyxoJlI1 242
PCBMaTOHjI,HblC d>aKTOPbl 218
PeTJfKynOUI1TbI 25
PCLlcnropbI,iJ,JISI KOMnJ1C\1CHTa 211
PHK JfJVI.eKC 190
PHK. cOAcp)J(aHI1C 13 H,npe KJ1eTKM 152,
166
CapKOUHCTa 6b1l.JbSl 265
- Cl3lmaSl 265
CerMeHToHllcPHblC HCMTPO<!:>lfJlbl 44,
45, 47, 76
CHJlcpo6naCTbI 31
CI11I.CPOUl1TbI 31
CKJ1ajl,l.J<iTOCTH lfH)].CKC /37
CKJ1CP O llCPMH ' ICCKHC atlHnCJIa 228
CKY'ICHHOCTH HJ1H rpynnl1pOBKH HH-
llCKC 138
C03pcBaHH 1 JfHD.CKC (MC) 136
- - l{HC.1l0BOM: {4MC) 137
C-pcaKnmHbIH 6CJ10K 204
CblROpOTO'IHbIH aMJ1Jl0I1.n.HbIH 6eJ10K A
204
C4 ailJ10ninbi 210
TCO<!:>HJ1JlHH 328
TMPCOHJlHbIC aHTHTeJIa 239
TOKcoKapa 292
TOKCOnJIa3 a 261, 292
TpcMaTOA flHU3 B ct>CKaJlHHX 287
TpHa\1TCpCH 334
TpHnaHocoMbl256
TpHXJfHej1Jla 261, 298
TPOM6oMOJlYJIHH 244
TPOM6oUl-ITbI. 0611U1H 06"bCM (TpOM6o-
KPHT, PCT) 37
- nOKtl33TC..'Ib atH130UHT03a (PDW) 37
- cpellHHH 06"bCr.1 (MPV) 37
- lHfcno B KpOI3H 65
TPO<!:>030MTbl nna3!\10JlHeB McU151pHH 251
TYllHblC KJICTKH 84, 128
YrpHLla KlIWC l IHaS1 265, 292
Ypeanna3Ma ypeanJffHKYM 301
ct>a3bl KJICT04HOro LUfKJIa, l.JHCno KJIC-
TOK H GO/I, S. G2+ M <!:>a3ax 176
CPcHo6ap6HTaJl 337
<DHopl1HOrCH 204
<DH6po6ntlCTbl 85, /27
C1>u6poUl1Tbl 85
C1>YPOCCMMJl335
Xr1aM JfD.ml TpaXOM3THC 301
XO)].)f(KHUa KJIeTKH 47 85
XpoMaTHH 1I0JIOBO" 12/ 131
Xpor.I0COMbl, ltHCJIO. Ha60p 172
L(BerouoH nOK33aTeJIb 22
u.cPynonna3MHH 204
LJ.enet'lb 6bl'IHJi 265
- KapnM KOBbl H 265
- CBHIIOfl 265
UI1KJIocnopc\ 265 285
UJfKJIOCnOpHH 3-,5
UHMeTHJlHH 333
1II1130HTbi nJla3MO,Al1eB MaJlSlp1111 251
IlIl1cTocoMa M3HcoHa 265
- smOHCKaSl 265
3HTaMe6a 265, 289, 292
3n11TCJl11011,AHble KJleTKI1 128
30311HOWI1J1bl 414 47, 76, 81
3pI1Tp06J1aCTW 1 1
3pl1-rpoKapl10UI1Tbl 78
3Pl1TPOMI1UI1H 341
3PI1TPOUI1Tbl, ,ACq,I1UI1T fJlIOK030-6-
q,ocq;aT,Aerl1I!.PorCHa3bl 29
- ,Al1aMCTp 2U
- ,-mpq,OJIorl1S1 15
- 0611\11i1 06"bCM (rcMaTOKpI1THaSl BCJlI1-
'll1lm) 21
- OCMOTI1'lCCK.:1H pC311CTeHTHOCTb 28
- nOKa3aTCJlb aHI130UI1T03a (ROW) 36
- CKOpOCTb OCC,AaHI1H 33
- Cpe,AHI1H ,Al1aMeTp (C.il3) 24
- Cpe,AHI1H 06"beM 24
- 'lI1CJlO B KpOBI1 13
3cTporcHoB peuenTopbI 182
3TaMI1HaJI-Ha!IJi1i1 338
3TaUI1311H 343
3TM031111 342
3q,C.n:PI1H 331
3XI1HOKOKK 292
$I.n:RO KJlCTKI1. ,Al1aMeTp 157 185
- 06"bCM 152 '
- nJlO11\a,D,b 155 157
- nCpl1MeTp 155
_ 51,AepHo-UI1ToillIa3MaTI1'lecKoc COOTHO-
WCHI1C 131, 157, 158
51.aepHo-Mo WOMCTI2I1'lCCKaH CTcnCHb
pMCKa (NMRG) 187
Dioctophymc rcnale 289
Fasl;iolopsis buski 265
Schistosoma hacmatobium 289
Tacnia solium 299
Trichomonas tcnax 292
Tr!chomonas vaginalis 289, 294
Tnchostrongylus spp. 265
YKa3aTeJlb aHaJlHTHQeCKHX
TeXHOJlOrHH
AKaHTaMC6bI B CM>K, MCTO,AbI o6Hapy-
>KCHI1H 262
AMe611a3a BHCKMWe'lHoro I1MMYUO-
,Al1arHOCTI1Ka 300
AHKI1JIOCTOMaTI1.A SlI1U KYJlbTI1Bl1pOBa-
HMe 277
AHTMTCJI K.ilHK onpe,ACJleHI1H MCTO,Abl
224
AHTMTCJI K Kap,A110JlMnMHY onpe,AcJlc-
IIMH I1<1>A-McTo,A 229
AH H A onpe.n-CJlCHMH I1<1>A-MeTo.n: 234
AH A onpC,ACJlCHMSI HI1<1>- fCTO,A 232
AHTM3H,llOTCJIMaJlbHbIX KJlCTO'lHbIX aH-
TMTCJlI1CDA-MCTO,A 236
30q,I1JIOB B KOCTHOM M03rc nO,AC'lCT
Ea3oq,MJlOB B KpOBI1 nO,AC'leT 44
EaJIaHTM,AMSI TpOq,030MTOB o6HapY>Ke-
HMC 283
EJlaCTOB HC,AMq,q,CPCHUMP0Bc1.HHbIX B
KOCTHOM M03rc nO,AC'lCT (MI1CJlOrpaM-
Ma) 81
- - B nYHKTaTe JlMMq,aTM'leCKMX Y3J10B
no.n-C'lCT (JlI1Mq,a,D,CHOrpaMMa) 84
EJlOTTMllr 6eJlKOB 202
BaaJIcp- P03e TeCT 219
BI1PYc renaTMTa B BblHBJlCHI1C rrup-
MCTO,A 3U7 '
BI1PYc renaTMTa C BbIHBJICHI1C rrup-
leTO,A 311 '
BOJl'JaHO'lHbli1 aHTI1KoaryJlSlHT onpe-
,ACJlCHMC 230 '
BOJl'laHO'IHble KJleTKM, MCTO,Abl I1CCJlC-
,AOBaHI1S1 48
Bc:rRC'lHbli1 I1MMYH03J1CKTPOq,OPC3
(BJI13CD) 217
rei1Hua-3pJll1xa TCJleu 06pa30BaHMH
TCCT no .ilCH'lM 29
rCJlb fI1HTOB o6HapY>KeHMC, MaKpOCKO-
nl1'.JCCKMC MCTO,Abl 266
rCJlbMMHTOB 11 npOCTCHWI1X ,Al1arHO-
CTM'leCKMX CTa,D,I1H 1I1KpOCKOnM'leCKMC
MeTO,Abl o6Hap}')KCHMH
- B,AY0,ACHaJlbHOM CO,ACp>KI1MOM M
>KCJI'l11 288
- B MOKpOTC 291-294
- B MO'IC 289
- B q,eKaJlMHX 270
rCMarrnlOTMHaU1111 MeTO,AbI 217
rCMorn06MH, CO,Aep>KaHMSI B KpOBI1
onpC,ACJlCHMC 9
- B 3pMTpOUI1TC, CpC.n:HSlSI KOHUCHTpa-
UI1S1 paC'ICT 23
- - cpe.n-Hce co.n:cp>KaHI1C paC'leT 23
reMorno611Ha q,raKUI1i1 (A2 ,F) onpc-
,ACJlCH MSI MeTO,A 11
rcmlc-rpI1'lCCKMX napaMeTpOB KJICTOK
aHaJlI13 152
rJla.LlKOMbIWC'lHbIX aHTI1TeJl HI1 <1>- MC-
TO,A 238
fnl1KOreHa B nCMKOUI1TaX onpC,!.\CnCHI1H
MCTO,!.\ 59
a- fnl1l.lCpoq,ocq,a1',!.\cm,!.\porcHa3bl B
nCMKOUl11'aX onpc,!.\cnCHI1S1 MC1'O,!.\ 58
fmoK030-6-q,ocq,a1',!.\crl1,1\pOrCHa3bI B
3pl1TpOUI11'aX ,!.\ccPl1UI11'a MCTO,!.\bl 06Ha-
PYJKCHI1S1 30, 32
JI,HK OKpaWI1BaHI1C
- ,!.\11<}Jq,CPCHI{l1aJIbHOC B q,I1KCl1pOBaH-
I-IblX KlICTKaX (aKpl1.D,I1HOBbIM OpaH)I(C-
BbIM) 166
- C 1CCblO KpaCI1TCnCM Ethidium bromid
11 Mithramycin . 168
- <}JJIIOOPOXPOM DAPI 169
IhocnopbI OOUI1C1' 1C1'Ollbl 06I1ap}')Kc-
HI1H 284
I1l\tl\!yHHblx KOMnJlCKCOB OCIDI0.lCHI1C
W31-\1cTo,!.\) 2/3
H \1MYH06J1acToB B nYHKTa1'C JlI1 \1q,a1'l1-
'JCCKI1X Y3JIOB nOJIC'JCT (JII1Mq,a,IlCHO-
maMMa) 84
I1MMYH06noTTI1Hr 217
11 1"1YHO,!.\I1q,q,Y3I1H paI!i1<UlbHaSl 209, 217
I1MMYHonQcUl1lI1lTaUI1S1 MC'JCHHbIX
6CJIKOB 203
I1MMYHOq,CpMCHTHbIH aHaJll13 /98, 2/9,
220
- rncp,!.\0q,a3HbIM MCTO.D, 20/
- "CCH,!.\BI1'I"-MCTO.D, 20/
I1MMYHoq,nlOopccueHul1H 2/7
11,,1MYH03J1CKTPOIDOpc3206,217
1111,!.\cKca)].f-lK (J;lJ],IIK) pac'JCT /75
I1H,!.\cKca nOBcpXHOC1'HbIX KlIC1'OK no.D,-
C'JC1' 138
I1H.D,cKca npoJII1q,cpaUI1I1 no,!.\c'Jcr /72,
/76
I1H.D,cKca CKlIa,Il'JaTOC1'11 nO,!.\C'IC1' /37
I1I1JJ.cKca CKY'JCHHOCTI1I1JHI Ipynm1-
pOBKI1 KlIC1'OK nO,!.\C'IC1' /38
l1H..o:cKca C03pCBaHI1H nO.D,C'JCT /36
IgA-co,!.\cp)l(aLUl1x UI1K 06HapY)l(cHI1C
214
IgM-pCnMaTOI1,!.\Horo IDaKTOpa onpc,!.\c-
JICHI1S1 I1<1>A-MCTo'!'\ 220
Kap110MCTpl1S1 /5/, /57
KapI10nI1KHOTI1'JCCKoro I1l1nCKCa (KI1)
nO,!.\C'JCT 137
Ka1'I10HHOrO 6CJIKa B JlCMKOUI1TaX on-
p .D,CJICHI1S1 MCTO,!.\bl 6/, 62
KI1CJIOM a-Haqrfl1JIaUCTa1'3cTcpa3bI on-
P JICJICHI1S1 MCTO,!.\ 55
K.I1CJIOM q,ocq,aTa3bl onpc,!.\cnCIII1S1 '-1C-
1'O,!.\ 52
KJICToK KpOBI1 aHaJII13 Ha IT"1aTOJIOm-
'JCCKI1X aHaJII13aTOpax 34
KJICTO'IHbIX 3JICMCH1'OB BOCnaJICHI1S1
nOI1CK B Ma3Kax MaTCpl1aJIa /27
KOHccpBaHTOB)JJISI np06 q,cKaJII1H
nponl1CI1 265
Kpl1orn06xnl1HOB onpC.D,CJICIII1H MC-
TO,!.\bI 2/4, 215
Kpl1nTOCnOpl1JJ:I1H OOUI1CT 06HapY)l(C-
liI1S1 MCTO,!.\bI 283
Jla1'CKC-TCCT 2/9
JleHKoKoHuCH1'paUl111 MCTO,!.\bI 46, 47
IICHKOIll1TapHol-i q,opMynbl nO,!.\C'JCT 43
JlCHKOUI1TOH KOJII1'ICC1'Ba B KpOHI1 no,!.\-
C'JCT 4/
JlcMK03PI11'p06J1aCnl'JccKoro OTIIOWC-
HI1H B MI1CJIOrpaM"1c pac'JC1' 8/
JlcMwMaHI1M aMaCTl1ro1' 06Hap}')KcHI1H
MCTOllbl 257, 259, 263
IICHW"mHI1HllCpMa rOTponHblX aMaCTI1-
roT B 6110n1'aTC 113 KO)l(HOH H3Bbi 0611a-
!2Y)I(CHI1C 298
JICK J)cTBCHHbIX CpC.aCTB onpC.D,CJICHI1S1
B3)f(X-MCTO.a 32)
nI1M( <W.cllorpaMMbl I1CCJICllOBaHI1C 83
JlI1M<}J06J1aC1'OB 11 JIlI"I<}JOUI1TOB B KpOBI1
no.ac'JC1' (J1CHKOIII1TapHaSl <}JopMYJIa) 44
JlI1"1q,06J1ac-rOB 11 JlI1Mq,OUI1TOB B nYHK-
TaTC JlI1Mq,aTI1'JcCKI1X Y3JIOB nO.D,C'JCT
(JII1McPa..o:cHorpaMMa) 83, 84
JII1McPOIII1TOB B KOCTHOM M03rc COllCp-
)l(aHI1S1 no.aC'JCT (!.-II1CJIOrpa"1Ma) 8/
JII1"Iq,OIlI11'OB CYOKJIaCCOB I1M"IYHOcpC-
HOTI1nl1pOBmIl1C 240
Jll1nI1JJ.oB B JICHKOIII1TaX onpC.D,CJICHI1H
MCTon 63
JISlM6JII1H 1'pOq,030I1TOB 06HapY)l(cHI1S1
MCTO,!.\bI281
)ClaKpoq,arOB B nYHKTaTC JlI1Mq,aTI1'IC-
CKI1X Y3JIOB nonC'JCT (mIMq,a.D,CHOrpaM-
"Ia) 83, 84
MaJISlpI1MHblX nJla3 lOJ.lI1CB 06HapY)I(c-
HI1H MCTO.D,bl 252-254
MCl'aKapI101.lI11'OB D KOCTII0"1 M03rc
nO,!.\C'ICT 75
MC1'a'-1I1CJlOUI11'OB B KpOBI1 nO.D,C'JCT
(ncHKOIll1TapHaH cpop"1YJla) 44
MCraMI1CJlOll11 roB HckrpoqJHJIbHblX CO-
,!.\cp)l(aHI1S1 B KOCTHOM M03rc nO.llC'IC1'
(MI1CJIOrpa'-1Ma) 8/
MI1cno6nacToB 11 MI1CJIOUI1TOB B KOCT-
HOM M03rc co,!.\cp)l(aHI1H nO,!.\C'JCT (MI1C-
JIOrpa"IMa) 8/
M I1cJI06J1aCTOn 11 II1CJIOUI1TOB B KpODI1
nO,J.C'JCT (JICMKOIII11'apHaH (POpMYJla) 44,
45
MI1CJIOrpaM"1a, MCTOn Apl1HKI1Ha 80
M I1CJIOKapI10UI11'OB B KOCTHOM M03re
nO,!.\C'ICT 74
MI1cJIOncpOKCI1Jm3bl D JIcflKOUI1TaX on-
pC,!.\CJICHI1S1 "1CTO.abl 53
MI1K06aK1'cpl1H -ry6CjJKYJlc3a BbISlBJIC-
HI1S1 nUP-McToll]17
MI1KOllJIa3MbI BbISlBJICHI1C nUP-\ICTOn
30/
MI1KQOIDI1JISlpl1H 06Hap}')f(CHI1C B KpOBI1
258, 259
M I1KPOIDI1JISlpl1M 06HapY)l(cHI1C B CpC3C
KO)l(I1 297
MI1TOXOHJ..\Pl1aJIbHbIX allTI1TCn onpc,!.\c-
JICIII1H MC1'OJ1bl onpc.aCJlCHI1S1 238
MOH06nacToB 11 MOHOUI1TOB B KpODJ1
nO.D,C'ICT (JICHKOUI1TapHaH q,opMYJla) 45
MOHOUI1TOB COJ1Cp)l(aHI1H B KOC1'H0'-1
\103rC nO,!.\C'JCT ("II1CJlOrpa\1Ma) 81
p
MOpQ)oMCTpl1'1CCKI1C MCTOllbI I1CCJ1CllO-
BaHI1H KJlCTOK 152
(1.- Haq,Tl1naI.(cTaT3cTcpa3bI B J1CHKOIlI1-
Tax onpCllCnCHI1H MCTOll 54
Haq,Ton-AS-aUCTIlT3cTcpa3bI B nCHKO-
!lI1TaX onpCj.!,CJ1CHI1R MCTOll 56
Haq,T0J1-AS-D-XJlopaUCTaT3cTcpa3b1 B
J1CHKOUI1TaX onp ACJ1CHI1R MCTOll 57
lIcrncJ11111 B CM)f( 06Hap}')KCHI1R MC-
TOll 263
HCHTPOq,I1J10B B nYHKTaTC nI1Mq,aTI1'IC-
CKI1X Y3J1013 nOl!C'ICT (J1I1Mq,a,n,cHorpaM-
Ma) 83, 84
HCMaToll HI1U 11 nWII1HOK B npcnajJaTax
WCKaJll1i1 MCTOJ\bI 06Hap}')KCHI1R 785
HCOnTepl1Ha onpCJ1.CJ1CHI1H 13 CbIBOpOT-
KC PJ.1A-MCTO.D- 243
HCOnTCpl1Ha onpCl!CnCHI1H B MO'IC
B3)f(X MCT01l243
HC!IPHMOi1 g,J1IOOPCCUCHUI1I1 MCTOl!
0111<1» 197,217
HCq,CllOMCTPI1H 205, 208, 213, 219
[-II1TpoCI1Hcro TCTproonl1R BOCCTIlHOB-
JlCIiI1H TeCT (HCT-TCCT) 63, 64
HOpM06J1aCTOB B KOCTHOM M03rc
nOllC'ICT (MI1CJlOrpaMMa) 81
06wci1 rC\10JlI1TI1'1CCKOH aKTI1BHOCTI1
KOMfIJ1eMCHTa KJlaCCI1'ICCKOro nyTl1 on-
\2CJ\cnCHI1C, MCTOll CH50 208
U6wci1 rCMOJlI1TI1'1CCKoi1 aKTI1BHOCTI1
KOMnnCMeHTa aJlbTCpHaTI1BHoro nyTl1
onpCllCJlCHI1C, MCTOl! AH50 209
OKpaWI1BaHI1C !\1i1KpOOpraHI13MOB B
Ma3Kax 121
- aKpl111I1HOBbIM OpaH>KCBbIM 123
- rCHUl1aHOBbiM J1Jm MCTI1J10BbIM q,110-
JlCTOBblM 121
- Kap60JlOBbIM TI10HI1HOM HI1KOnR 123
- MCTI1J1CHOBbn1 CI1HI1M no J]cq,q,JlCPY
121
- OCHOBHbl\1 q,YKCI1HOM no fIq,ci1q,cPY
121
- no fpaMY ll1IH Ma3KOB /23
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- TOJ1CTOi1 KanJ111 122
OKpalUl1BaHI1C UI1T0J10rl1'1CCKI1X npc-
napaTOB, MCTOllbI 107
- rCMaTOKCI1J1I1HOM 11 30311H0\1 112
- no AJJcKcCCBY 109
- fIO fl1M3C 108
- no J]ci1lUMaHY J09
- no fIanaHI1KOJlay 109
- no fIanaHI1Konay-KYIiI1Ue 110
- no fIanaHI1KOJIaY-PYllcHKO III
- no fIanncHrcHMY /U8
- no POMaHoBcKoMy-fI1M3C 108
OKpaWI1BaHI1C UI1TOJlOrl1'1CCKI1X npc-
ndpaTOB, CnCUl1aJ1bHbIC MCTOllbi 112
- rCMaTOKCl1nI1H 3Q.Jmxa 116
- Ha rCMOCI111CpI1HTlcpnca 112
- Ha rJJl1KOreH 115
- Ha.LI.HK no <1>cnbrcHY 113
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- Ha J1l1nI1ll.bI 717
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Xci1xo 1/8
- Ha HYKJICOJlbI 115
- Ha n pOKCI1l!a3Y 117
- Ha PHK no Epawc 114
- Ha CJ1113b 113
- COJ1HHO-KI1CJIbli1 cnl1J)T 116
Onl1CTOpX03a 11l1arHOCTI1KI1I1MMYHO-
WCPMCHTHbiC MCTOJIbI 300
OCTpl1UbI SII1U 06Hap}')KCHI1R MCTOllbI
275
TIaJ10'lKORJICPHblX Hckrpoq,l1J1ol3 13
KpOBI1 nO.D-C'ICT (J1CHKOUI1TapHaH q,op-
J1a) 44, 45
nna3MaTI1'1CCKI1X KJlCTOK 13 KOCTHOM
M03rc nOllC'ICT (MI1CJ10rpaMMa) 81
nlIa3MaTI1'1CCKI1X KJlCTOK 13 nYHKTaTC
nI1Mq,aTI1'ICCKI1X Y31l013 nO.D-C'ICT (nI1M-
c»a,n,cHorpaMMa) 84
fIJla3MOUI1TOB 13 KpOBI1 nOllC'ICT (J1CH-
KOUI1TapHaH q,opMyna) 44
fInowalll1 11 nCpl1MCTpa KJlCTKI1113\1C-
HI1H MCTO.IJ,bl 152
1 1 0.'1 OBoro XpOMaTI1Ha OnpCllCJ1CHl1e 13
KJleTKaX onyxonl1 121
npCUI1nl1Taltl10HHbIC MCTO.IJ,bI onpCJIC-
J1CHI1R UJ.1K 2/3
fIPOJlI1Mq,OUi1TOB B nYHKTaTe Jli1Mq,a-
TI1'1eCKi1X.Y3J10B nO.D-C'ICT (J1I1Mq,MCHO-
maMMa) 84
npOMi1CnOUi1TOB HCHTpoq,l1nbHbIx 13
KOCTHOM M03rc CO.IJ,Cp>KaHi1R nO.IJ,C'ICT
(Mi1CJ10rpaMMa) 81
npOMi1CnOUi1TOB 13 KpOBi1 nO.IJ,C'ICT
(nci1KOUI1TapHaH q,opMyna) 44
npoHop'\106J1aCTOB B KOCTHOM M03re
COJICp>KaIlI1H nOLlC'ICT (!\1i1CJ10rpaM'\1a)
81
fIpOCTeHWi1X KI1WC'IHI1Ka BCreTaTi1B-
(-I "IX q,OpM 06Hap}')KCHI1R MCTO.D-bl 269
fIPOCTCi1Wi1X KI1WC'IHi1Ka
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MOl3blM KpaCI1TenCM 281
fIpocTci1Wi1X Ki1WC'IHi1Ka UI1CT 13 Ha-
Ti1BHOM Ma3KC o6HapY)l(CHi1R MCTO.IJ,bl
269
fIpoTo'IHaR Ui1TOq,J1IOOPOMCTPi1H 161
fIPOTO'lHOUI1TOMCTpl1'1CCKaH MeTOJII1Ka
ll1IR OllHOBpCMCHHoro aHaJli13a nn0i111-
HOCTi1, '1i1CJla KJICTOK 13 paJJ1i1'1HblX q,a-
3ax KJlCTO'lHoro Ui1KJ1a i1 3KCnpCCCi1i1
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Pal!110I1MMYHonorl1'ICCKi1i1 aHaJli13 208
PaC"fBOpi1MbIX pcucnTopOB i1HTCplICH-
Ki1Ha-2 onpCllCnCHi1R MCT01l242
PaCTBOpi1MblX pcucnTopOB q,aKTopa HC-
Kp03a onyxonl1 onpCl!CJ1CHi1R MCTOil, 242
PCaKUi1H CBH3bIBaHI1H KOMnJ1CMCHTa 299
PCTi1KynoUI1ToB KOni1'1CCTl3a nOllC'ICT,
25,26
PcUCnTOpOI3 nporeCTcpOHa 13 Ui1T030-
nHX onyxoneH MOnO'lHOH >KCJlC3bI KOJli1-
'1CCTBCHHaR OUC(-IKa /82
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Cl1llCpoUWroB 06Hap)I)KCHl1e 31
C-pCaKTI1BHoro 6CJlKa OnpCllCJlCHI1S1
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CTPOHrHJlOl1ll.a 1II1'JI-IHOK 06l1apY)l(cHI1S1
MeTOl\bl 277
CYKUI1HaT.aCrHl pOrCHa3bl B JlCi-iKOUI1-
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TI1PC0I1.aHbIX aHTI1TCJl onpCL\CJlCHI1S1
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TOKcoKap03a L\l1arHOCTlIKIII1M\IYHOJlO-
rH'JCCKI1I1 MCTOL\ 300
TOKCOnJla3M03a L\l1arHOCTI1KH I1MMYHO-
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TOKCOnJla3Mbl B CM)K 06Hap}')KCIII1S1
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TpI1XO\IOHaD. KynbTYpaJlbHOC I1CCJICJlO-
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TPD:.160KpI1Ta paC'ICT (peT) 37
TPD:.160MOL\YJllIHa (DilCTBOPI1MOM cPop-
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TpOM60UlITOB KOJ1H'JCCTBa 13 KpOBI1
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<1>cKaJ1I1M OTMY'IHBaHI1H \1CTO.n 266
<1>CKaJll1i-i OTCTill1BilHI1H MCTOL\ 266
<1>eTaJlbHOro rCMorn0611Ha 06HilpY)l(e-
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<1>noKYJlHUI1I1 C 6CHTOHI1TOM MCT011 2/7
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nlJCTOBOro nOKil3aTCJ1H pac'JCT 22
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I ll1KJ10CnojJbl OOUI1CT MCTOL\bl 06Hapy-
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UJ.1K, MCTOllbl onpc.aCJICHI1H 2/2,213
UI1CTI1UCPKOB JII1'1I1HOK B 6110nTaTax
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UI1TOnOrH'ICCKOC HCCJ1e'IOl3aHlle 6110-
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I hrrOXI1MH'JCCKI1C I1CCJ1CL\OBaHI1H /02
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IlI,CJlO'IHOi-i <poclpilTa3bl 13 nci1KOUI1TaX
OllpCJlCJIClIl1H \1CTOllbl 50, 51
3JlCKTPOcPOPC3 6CJlKOB 202,206
3JlCKTpocpope3 C 11\IMYHocPI1KCaUl1ci-i
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