ȼɂ. ɆɈɊɏȺɌ, ɌɄ. ȼɈɅɄɈȼɂɑ ÎÑÎÁÅÍÍÎÑÒÈ ÒÅ×ÅÍÈß ÏÅÐÂÈ×ÍÎÉ È ÂÒÎÐÈ×ÍÎÉ ÔÎÐÌ ÁÀÊÒÅÐÈÀËÜÍÎÃÎ ÊÅÐÀÒÈÒÀ

ȼɂ. ɆɈɊɏȺɌ, ɌɄ. ȼɈɅɄɈȼɂɑ
ÎÑÎÁÅÍÍÎÑÒÈ ÒÅ×ÅÍÈß ÏÅÐÂÈ×ÍÎÉ È ÂÒÎÐÈ×ÍÎÉ ÔÎÐÌ
ÁÀÊÒÅÐÈÀËÜÍÎÃÎ ÊÅÐÀÒÈÒÀ
ɍɈ «ȼɢɬɟɛɫɤɢɣ ɝɨɫɭɞɚɪɫɬɜɟɧɧɵɣ ɦɟɞɢɰɢɧɫɤɢɣ ɭɧɢɜɟɪɫɢɬɟɬ»,
Ɋɟɫɩɭɛɥɢɤɚ Ȼɟɥɚɪɭɫɶ
ɐɟɥɶ. ɂɡɭɱɢɬɶ ɨɫɨɛɟɧɧɨɫɬɢ ɬɟɱɟɧɢɹ ɩɟɪɜɢɱɧɨɣ ɢ ɜɬɨɪɢɱɧɨɣ ɮɨɪɦ ɛɚɤɬɟɪɢɚɥɶɧɨɝɨ ɤɟɪɚɬɢɬɚ (ȻɄ).
Ɇɚɬɟɪɢɚɥ ɢ ɦɟɬɨɞɵ. ɂɫɫɥɟɞɨɜɚɧɢɟ ɩɪɨɜɟɞɟɧɨ ɭ 106 ɩɚɰɢɟɧɬɨɜ ɫ ɛɚɤɬɟɪɢɚɥɶɧɵɦ ɤɟɪɚɬɢɬɨɦ. ɉɟɪɜɭɸ ɝɪɭɩɩɭ ɫɨɫɬɚɜɢɥɢ 43 ɩɚɰɢɟɧɬɚ ɫ ɩɟɪɜɢɱɧɨɣ ɮɨɪɦɨɣ ɡɚɛɨɥɟɜɚɧɢɹ, ɜɬɨɪɭɸ – 63 ɩɚɰɢɟɧɬɚ ɫ ɜɬɨɪɢɱɧɨɣ ɮɨɪɦɨɣ. Ɇɢɤɪɨɛɢɨɥɨɝɢɱɟɫɤɨɟ ɢɫɫɥɟɞɨɜɚɧɢɟ ɫ ɨɩɪɟɞɟɥɟɧɢɟɦ ɱɭɜɫɬɜɢɬɟɥɶɧɨɫɬɢ
ɤ ɚɧɬɢɛɚɤɬɟɪɢɚɥɶɧɵɦ ɩɪɟɩɚɪɚɬɚɦ ɜɵɩɨɥɧɟɧɨ ɜ 58 ɫɥɭɱɚɹɯ. Ⱥɧɚɥɢɡ ɪɟɩɚɪɚɬɢɜɧɨɣ ɫɩɨɫɨɛɧɨɫɬɢ ɫ
ɪɚɫɱɺɬɨɦ ɤɨɷɮɮɢɰɢɟɧɬɚ ɷɩɢɬɟɥɢɡɚɰɢɢ ɪɨɝɨɜɢɰɵ (ɄɗɊ) ɩɪɨɜɟɞɺɧ ɭ 44 ɩɚɰɢɟɧɬɨɜ.
Ɋɟɡɭɥɶɬɚɬɵ. ȼɬɨɪɢɱɧɚɹ ɮɨɪɦɚ ȻɄ ɪɚɡɜɢɜɚɥɚɫɶ ɱɚɳɟ ɩɟɪɜɢɱɧɨɣ (ɪ=0,04) ɭ ɥɢɰ ɫɬɚɪɲɟ
ɬɪɭɞɨɫɩɨɫɨɛɧɨɝɨ ɜɨɡɪɚɫɬɚ. ɉɟɪɜɢɱɧɚɹ ɮɨɪɦɚ ȻɄ ɪɚɡɜɢɜɚɟɬɫɹ ɱɚɳɟ ɭ ɥɢɰ ɦɭɠɫɤɨɝɨ ɩɨɥɚ ɬɪɭɞɨɫɩɨɫɨɛɧɨɝɨ ɜɨɡɪɚɫɬɚ. ɍɫɥɨɜɧɨɩɚɬɨɝɟɧɧɚɹ ɦɢɤɪɨɮɥɨɪɚ ɩɪɟɨɛɥɚɞɚɥɚ ɜ ɨɛɟɢɯ ɝɪɭɩɩɚɯ.
Ɂɚɤɥɸɱɟɧɢɟ. ȼ ɷɬɢɨɥɨɝɢɢ ɪɚɡɜɢɬɢɹ ɩɟɪɜɢɱɧɨɣ ɢ ɜɬɨɪɢɱɧɨɣ ɮɨɪɦ ɛɚɤɬɟɪɢɚɥɶɧɨɝɨ ɤɟɪɚɬɢɬɚ ɩɪɟɨɛɥɚɞɚɟɬ St. Epidermidis, ɱɭɜɫɬɜɢɬɟɥɶɧɨɫɬɶ ɤɨɬɨɪɨɝɨ ɧɚɢɛɨɥɟɟ ɜɵɪɚɠɟɧɚ ɤ ɚɧɬɢɛɚɤɬɟɪɢɚɥɶɧɨɦɭ ɩɪɟɩɚɪɚɬɭ ɬɨɛɪɚɦɢɰɢɧ.
ɉɟɪɜɢɱɧɚɹ ɮɨɪɦɚ ɛɚɤɬɟɪɢɚɥɶɧɨɝɨ ɤɟɪɚɬɢɬɚ ɯɚɪɚɤɬɟɪɢɡɭɟɬɫɹ ɜɵɪɚɠɟɧɧɵɦɢ ɪɟɩɚɪɚɬɢɜɧɵɦɢ
ɩɪɨɰɟɫɫɚɦɢ ɜ ɫɬɚɞɢɢ ɪɟɝɪɟɫɫɢɢ ɢ ɪɭɛɰɟɜɚɧɢɹ, ɜɬɨɪɢɱɧɚɹ – ɧɢɡɤɨɣ ɢɧɬɟɧɫɢɜɧɨɫɬɶɸ ɪɟɩɚɪɚɬɢɜɧɵɯ ɩɪɨɰɟɫɫɨɜ ɜɨ ɜɫɟɯ ɫɬɚɞɢɹɯ ɜɨɫɩɚɥɢɬɟɥɶɧɨɝɨ ɩɪɨɰɟɫɫɚ, ɱɬɨ ɨɛɭɫɥɨɜɥɢɜɚɟɬ ɞɥɢɬɟɥɶɧɨɫɬɶ ɷɩɢɬɟɥɢɡɚɰɢɢ ɹɡɜɟɧɧɨɜɨɫɩɚɥɢɬɟɥɶɧɨɝɨ ɞɟɮɟɤɬɚ.
Ʉɥɸɱɟɜɵɟ ɫɥɨɜɚ: ɛɚɤɬɟɪɢɚɥɶɧɵɣ ɤɟɪɚɬɢɬ, ɩɟɪɜɢɱɧɚɹ ɮɨɪɦɚ, ɜɬɨɪɢɱɧɚɹ ɮɨɪɦɚ, ɦɢɤɪɨɮɥɨɪɚ
Objectives. To study the features of primary and secondary forms of bacterial keratitis (BK).
Methods. The investigation was performed on 106 patients with bacterial keratitis. The first group
was composed by 43 patients with the primary form of the disease, the second – by 63 patients with the
secondary form. Microbiological investigation with sensitivity definition to antibacterial preparations was
done in 58 cases. The analysis of reparative abilities with calculation of corneal epithelialization factor was
carried out in 44 patients.
Results. Secondary form of bacterial keratitis developed more often (ɪ=0,04) in persons older
those at able-bodied age. Primary form of bacterial keratitis developed more often in males of able-bodied
age. The conditional-pathogenic microflora prevailed in both groups.
Conclusions. St. Epidermidis prevails in etiology of primary and secondary forms of bacterial
keratitis development which sensitivity is most marked to an antibacterial preparation tobramycin.
The primary form of bacterial keratitis is characterized by the marked reparative processes in the
regress and scarring stage, secondary – by low intensity of reparative processes in all stages of inflammatory
process resulting in prolongation of the ulcer-inflammatory defect epithelialization.
Keywords: bacterial keratitis, primary form, secondary form, microflora
Ⱥɤɬɭɚɥɶɧɨɫɬɶ
Ȼɚɤɬɟɪɢɚɥɶɧɵɣ ɤɟɪɚɬɢɬ – ɬɹɠɺɥɨɟ ɜɨɫɩɚɥɢɬɟɥɶɧɨɟ ɡɚɛɨɥɟɜɚɧɢɟ ɪɨɝɨɜɢɰɵ. ɉɨ
ɫɤɨɪɨɫɬɢ ɪɚɡɜɢɬɢɹ ɨɧ ɩɪɟɜɨɫɯɨɞɢɬ ɞɪɭɝɢɟ
ɩɚɬɨɥɨɝɢɱɟɫɤɢɟ ɩɪɨɰɟɫɫɵ ɪɨɝɨɜɢɰɵ. Ɋɚɡɦɟɪɵ ɹɡɜɟɧɧɨɜɨɫɩɚɥɢɬɟɥɶɧɨɝɨ ɞɟɮɟɤɬɚ,
ɯɚɪɚɤɬɟɪ ɢ ɜɢɪɭɥɟɧɬɧɨɫɬɶ ɦɢɤɪɨɮɥɨɪɵ
ɨɛɭɫɥɨɜɥɢɜɚɸɬ ɟɝɨ ɬɹɠɟɫɬɶ, ɜɵɫɨɤɭɸ ɱɚɫɬɨɬɭ ɨɫɥɨɠɧɟɧɢɣ ɢ ɧɟɛɥɚɝɨɩɪɢɹɬɧɵɯ ɢɫ107
” ɇɨɜɨɫɬɢ ɯɢɪɭɪɝɢɢ
ɯɨɞɨɜ [1, 2].
ɂɫɬɨɱɧɢɤɚɦɢ ɢɧɮɟɤɰɢɢ ɹɜɥɹɸɬɫɹ ɢɧɮɢɰɢɪɨɜɚɧɧɵɟ ɢɧɨɪɨɞɧɵɟ ɬɟɥɚ, ɦɢɤɪɨɮɥɨɪɚ ɤɨɧɴɸɧɤɬɢɜɚɥɶɧɨɣ ɩɨɥɨɫɬɢ, ɫɥɺɡɧɨɝɨ
ɦɟɲɤɚ [3]. ȼ ɪɚɡɜɢɬɢɢ ɤɟɪɚɬɢɬɚ ɛɚɤɬɟɪɢɚɥɶɧɨɣ ɷɬɢɨɥɨɝɢɢ ɩɪɟɨɛɥɚɞɚɸɬ ɝɪɚɦɩɨɥɨɠɢɬɟɥɶɧɵɟ ɛɚɤɬɟɪɢɢ (63,88–87,5%), ɜ
ɦɟɧɶɲɟɣ ɫɬɟɩɟɧɢ ɝɪɚɦɨɬɪɢɰɚɬɟɥɶɧɵɟ
(12,5–35,0%), ɜ 11,1–19,2% ɫɥɭɱɚɟɜ ɨɩɪɟɞɟɥɹɟɬɫɹ ɩɨɥɢɦɢɤɪɨɛɧɚɹ ɮɥɨɪɚ [1, 2, 4].
ȼ ɷɬɢɨɥɨɝɢɢ ɛɚɤɬɟɪɢɚɥɶɧɨɝɨ ɤɟɪɚɬɢɬɚ
ɨɫɧɨɜɧɭɸ ɪɨɥɶ ɢɝɪɚɸɬ ɫɥɟɞɭɸɳɢɟ ɜɨɡɛɭɞɢɬɟɥɢ: 11,0–40,0% ɫɥɭɱɚɟɜ ɩɪɢɯɨɞɢɬɫɹ ɧɚ
Staphylococcus epidermidis, 15,2–29,4% – ɧɚ
Staphylococcus aureus, 20,0–23,5% – ɧɚ
Pseudomonas aeruginosa, 8–14% – ɧɚ
Streptococcus pneumoniae [4, 5, 6]. Ɂɧɚɱɢɬɟɥɶɧɨ ɪɟɠɟ ɟɝɨ ɜɵɡɵɜɚɸɬ Streptococcus
species (5%), Pseudomonas (9%), Moraxella
ɢ Serratia marcescens (5%), Bacillus (1%),
Corynebacterium (1%), Haemophilus influenza
(1%). ɉɪɢ ɬɪɚɜɦɟ ɪɨɝɨɜɢɰɵ ɛɚɤɬɟɪɢɚɥɶɧɵɣ ɤɟɪɚɬɢɬ ɧɚɢɛɨɥɟɟ ɱɚɫɬɨ ɪɚɡɜɢɜɚɟɬɫɹ
ɜɫɥɟɞɫɬɜɢɟ ɢɧɮɢɰɢɪɨɜɚɧɢɹ Staphylococcus
aureus – 42,7% ɢ Pseudomonas aeruginosa –
30,5%, ɚ ɩɪɢ ɪɚɡɜɢɬɢɢ ɡɚɛɨɥɟɜɚɧɢɹ ɧɚ ɮɨɧɟ
ɞɢɫɬɪɨɮɢɱɟɫɤɢ ɢɡɦɟɧɟɧɧɨɣ ɪɨɝɨɜɢɰɵ ɩɪɟɨɛɥɚɞɚɟɬ ɭɫɥɨɜɧɨɩɚɬɨɝɟɧɧɚɹ ɦɢɤɪɨɮɥɨɪɚ:
Staphylococcus epidermidis (45%),
Escherichia coli (13,1%), Streptococcus
saprophyticus (3,3%), ɚ ɬɚɤɠɟ Streptococcus
viridans (4,9%) [4, 5, 6, 7].
ɉɪɟɞɫɬɚɜɥɹɟɬɫɹ ɚɤɬɭɚɥɶɧɵɦ ɢɡɭɱɟɧɢɟ
ɱɚɫɬɨɬɵ, ɩɪɢɱɢɧ ɪɚɡɜɢɬɢɹ ɢ ɯɚɪɚɤɬɟɪɚ ɬɟɱɟɧɢɹ ɩɟɪɜɢɱɧɨɣ ɢ ɜɬɨɪɢɱɧɨɣ ɮɨɪɦ ɛɚɤɬɟɪɢɚɥɶɧɨɝɨ ɤɟɪɚɬɢɬɚ.
ɐɟɥɶ. ɂɡɭɱɢɬɶ ɨɫɨɛɟɧɧɨɫɬɢ ɬɟɱɟɧɢɹ
ɩɟɪɜɢɱɧɨɣ ɢ ɜɬɨɪɢɱɧɨɣ ɮɨɪɦ ɛɚɤɬɟɪɢɚɥɶɧɨɝɨ ɤɟɪɚɬɢɬɚ.
Ɇɚɬɟɪɢɚɥ ɢ ɦɟɬɨɞɵ
ɉɪɨɜɟɞɺɧ ɚɧɚɥɢɡ ɬɟɱɟɧɢɹ ɛɚɤɬɟɪɢɚɥɶɧɨɝɨ ɤɟɪɚɬɢɬɚ ɭ 106 ɩɚɰɢɟɧɬɨɜ, ɧɚɯɨɞɢɜɲɢɯɫɹ ɧɚ ɫɬɚɰɢɨɧɚɪɧɨɦ ɥɟɱɟɧɢɢ ɜ ɨɬɞɟɥɟ108
ɧɢɹɯ ɦɢɤɪɨɯɢɪɭɪɝɢɢ ɝɥɚɡɚ ɍɁ «ȼɢɬɟɛɫɤɚɹ
ɨɛɥɚɫɬɧɚɹ ɤɥɢɧɢɱɟɫɤɚɹ ɛɨɥɶɧɢɰɚ» ɢ ɍɁ
«10-ɚɹ ɝɨɪɨɞɫɤɚɹ ɤɥɢɧɢɱɟɫɤɚɹ ɛɨɥɶɧɢɰɚ»
ɝ. Ɇɢɧɫɤɚ ɫ 2007 ɩɨ 2010 ɝɝ.
ɉɚɰɢɟɧɬɵ ɛɵɥɢ ɪɚɡɞɟɥɟɧɵ ɧɚ ɞɜɟ ɝɪɭɩɩɵ ɜ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɮɨɪɦɵ ɛɚɤɬɟɪɢɚɥɶɧɨɝɨ ɤɟɪɚɬɢɬɚ [7]. ɉɟɪɜɭɸ ɝɪɭɩɩɭ ɫɨɫɬɚɜɢɥɢ ɩɚɰɢɟɧɬɵ ɫ ɩɟɪɜɢɱɧɨɣ ɮɨɪɦɨɣ ɛɚɤɬɟɪɢɚɥɶɧɨɝɨ ɤɟɪɚɬɢɬɚ (n=43), ɜɬɨɪɭɸ – ɫ ɜɬɨɪɢɱɧɨɣ ɮɨɪɦɨɣ ɡɚɛɨɥɟɜɚɧɢɹ (n=63).
Ɇɢɤɪɨɛɢɨɥɨɝɢɱɟɫɤɨɟ ɢɫɫɥɟɞɨɜɚɧɢɟ
ɜɵɩɨɥɧɟɧɨ ɜ 58 ɫɥɭɱɚɹɯ ɫ ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ
ɫɥɟɞɭɸɳɢɯ ɩɢɬɚɬɟɥɶɧɵɯ ɫɪɟɞ: ɤɪɨɜɹɧɨɣ
ɚɝɚɪ, ɠɟɥɬɨɱɧɨɫɨɥɟɜɨɣ ɚɝɚɪ, ɫɪɟɞɵ ɗɧɞɨ
ɢɥɢ Ʌɟɜɢɧɚ. Ɉɰɟɧɤɭ ɱɭɜɫɬɜɢɬɟɥɶɧɨɫɬɢ
ɦɢɤɪɨɨɪɝɚɧɢɡɦɨɜ ɤ ɚɧɬɢɛɚɤɬɟɪɢɚɥɶɧɵɦ
ɩɪɟɩɚɪɚɬɚɦ ɩɪɨɜɨɞɢɥɢ ɞɢɫɤɨɞɢɮɮɭɡɢɨɧɧɵɦ ɦɟɬɨɞɨɦ ɫ ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ ɞɢɫɤɨɜ
ɮɢɪɦɵ Becton Dickinson (ɋɒȺ).
ɉɚɰɢɟɧɬɚɦ, ɩɨɥɭɱɚɜɲɢɦ ɥɟɱɟɧɢɟ ɫɨɝɥɚɫɧɨ ɭɬɜɟɪɠɞɺɧɧɵɦ ɫɬɚɧɞɚɪɬɚɦ, (n=21 –
ɩɟɪɜɢɱɧɚɹ ɮɨɪɦɚ; n=23 – ɜɬɨɪɢɱɧɚɹ ɮɨɪɦɚ) ɧɚ 1-ɟ, 3-ɢ, 7-ɟ, 14-ɟ ɢ 30-ɟ ɫɭɬɤɢ ɢɫɫɥɟɞɨɜɚɧɢɹ ɜɵɩɨɥɧɹɥɢ ɢɦɩɪɟɫɫɢɨɧɧɭɸ
ɰɢɬɨɥɨɝɢɸ ɪɨɝɨɜɢɰɵ [8]. ɇɚ ɨɫɧɨɜɚɧɢɢ
ɩɨɥɭɱɟɧɧɵɯ ɪɟɡɭɥɶɬɚɬɨɜ ɩɪɨɜɨɞɢɥɢ ɚɧɚɥɢɡ
ɪɟɩɚɪɚɬɢɜɧɨɣ ɫɩɨɫɨɛɧɨɫɬɢ ɷɩɢɬɟɥɢɹ ɫ ɪɚɫɱɺɬɨɦ ɤɨɷɮɮɢɰɢɟɧɬɚ ɷɩɢɬɟɥɢɡɚɰɢɢ ɪɨɝɨɜɢɰɵ (ɄɗɊ) (ɫɭɦɦɚ ɫɨɨɬɧɨɲɟɧɢɣ ɷɩɢɬɟɥɢɚɥɶɧɵɯ ɤɥɟɬɨɤ ɛɚɡɚɥɶɧɨɝɨ ɬɢɩɚ ɤ ɷɩɢɬɟɥɢɚɥɶɧɵɦ ɤɥɟɬɤɚɦ ɫ ɩɢɤɧɨɡɨɦ ɹɞɪɚ ɩɟɪɢɮɨɤɚɥɶɧɨɣ ɢ ɩɚɪɚɥɢɦɛɚɥɶɧɨɣ ɡɨɧ ɪɨɝɨɜɢɰɵ,
ɞɟɥɺɧɧɵɯ ɧɚ ɞɜɚ).
ɋɬɚɬɢɫɬɢɱɟɫɤɭɸ ɨɛɪɚɛɨɬɤɭ ɩɨɥɭɱɟɧɧɵɯ ɞɚɧɧɵɯ ɩɪɨɜɨɞɢɥɢ ɫ ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ
ɦɟɬɨɞɨɜ ɧɟɩɚɪɚɦɟɬɪɢɱɟɫɤɨɣ ɫɬɚɬɢɫɬɢɤɢ ɫ
ɩɪɢɦɟɧɟɧɢɟɦ ɷɥɟɤɬɪɨɧɧɵɯ ɩɚɤɟɬɨɜ
«STATISTICA 6.0» ɢ «MedCalc 10.2.0.0».
ȼɵɫɱɢɬɵɜɚɥɢ ɦɟɞɢɚɧɭ (Ɇɟ), ɞɨɜɟɪɢɬɟɥɶɧɵɣ ɢɧɬɟɪɜɚɥ ɞɥɹ ɦɟɞɢɚɧɵ ɫ ɜɟɪɨɹɬɧɨɫɬɶɸ
95% (95%, Ⱦɂ ɞɥɹ Ɇɟ), ɪɚɡɦɚɯ ɦɢɧɢɦɚɥɶɧɵɯ ɢ ɦɚɤɫɢɦɚɥɶɧɵɯ ɡɧɚɱɟɧɢɣ (ɪɚɡɦɚɯ minmax), ɦɟɠɤɜɚɪɬɢɥɶɧɵɣ ɢɧɬɟɪɜɚɥ (25–75
ɩɪɨɰɟɧɬɢɥɶ). ȼɧɭɬɪɢ- ɢ ɦɟɠɝɪɭɩɩɨɜɵɟ ɪɚɡɥɢɱɢɹ ɨɩɪɟɞɟɥɹɥɢ, ɢɫɩɨɥɶɡɭɹ ɤɪɢɬɟɪɢɣ
ʋ5x 2010 i ɬɨɦ 18
Ɋɢɫ. 1. ȼɢɞɨɜɨɣ ɫɨɫɬɚɜ ɦɢɤɪɨɨɪɝɚɧɢɡɦɨɜ,
ɜɵɞɟɥɟɧɧɵɯ ɭ ɩɚɰɢɟɧɬɨɜ ɫ ɩɟɪɜɢɱɧɨɣ
ɮɨɪɦɨɣ ɛɚɤɬɟɪɢɚɥɶɧɨɝɨ ɤɟɪɚɬɢɬɚ
Ɋɢɫ. 2. ȼɢɞɨɜɨɣ ɫɨɫɬɚɜ ɦɢɤɪɨɨɪɝɚɧɢɡɦɨɜ,
ɜɵɞɟɥɟɧɧɵɯ ɭ ɩɚɰɢɟɧɬɨɜ ɫ ɜɬɨɪɢɱɧɨɣ
ɮɨɪɦɨɣ ɛɚɤɬɟɪɢɚɥɶɧɨɝɨ ɤɟɪɚɬɢɬɚ
ȼɢɥɤɨɤɫɨɧɚ, ɤɪɢɬɟɪɢɣ Ɇɚɧɧɚɍɢɬɧɢ, ɞɜɭɯɫɬɨɪɨɧɧɢɣ ɤɪɢɬɟɪɢɣ ɫɬɚɬɢɫɬɢɱɟɫɤɨɣ ɡɧɚɱɢɦɨɫɬɢ (ɭɪɨɜɟɧɶ ɞɨɫɬɨɜɟɪɧɨɫɬɢ ɪ<0,05).
ɜɨɡɪɚɫɬɚ. ɇɚɩɪɨɬɢɜ, ɜɬɨɪɢɱɧɚɹ ɮɨɪɦɚ ȻɄ
ɨɩɪɟɞɟɥɹɥɚɫɶ ɭ ɩɚɰɢɟɧɬɨɜ ɫɬɚɪɲɟ ɬɪɭɞɨɫɩɨɫɨɛɧɨɝɨ ɜɨɡɪɚɫɬɚ (Ɇɟ=65,0 ɥɟɬ, ɪ<0,001
ɞɥɹ ɥɢɰ ɦɭɠɫɤɨɝɨ ɩɨɥɚ; Ɇɟ=71,0 ɥɟɬ,
ɪ=0,007 – ɞɥɹ ɥɢɰ ɠɟɧɫɤɨɝɨ ɩɨɥɚ).
Ⱥɧɚɥɢɡ ɪɟɡɭɥɶɬɚɬɨɜ ɦɢɤɪɨɛɢɨɥɨɝɢɱɟɫɤɨɝɨ ɢɫɫɥɟɞɨɜɚɧɢɹ ɹɡɜɟɧɧɨɜɨɫɩɚɥɢɬɟɥɶɧɨɝɨ ɞɟɮɟɤɬɚ ɢ ɤɨɧɴɸɧɤɬɢɜɚɥɶɧɨɣ ɩɨɥɨɫɬɢ
ɩɨɤɚɡɚɥ ɩɪɟɨɛɥɚɞɚɧɢɟ ɭɫɥɨɜɧɨɩɚɬɨɝɟɧɧɨɣ
ɦɢɤɪɨɮɥɨɪɵ ɜ ɨɛɟɢɯ ɝɪɭɩɩɚɯ. Ɉɞɧɚɤɨ ɭ ɩɚɰɢɟɧɬɨɜ ɫ ɜɬɨɪɢɱɧɨɣ ɮɨɪɦɨɣ ɫɩɟɤɬɪ ɜɵɞɟɥɟɧɧɵɯ ɦɢɤɪɨɨɪɝɚɧɢɡɦɨɜ ɛɵɥ ɡɧɚɱɢɬɟɥɶɧɨ ɲɢɪɟ, ɧɟɠɟɥɢ ɩɪɢ ɩɟɪɜɢɱɧɨɣ ɮɨɪɦɟ ȻɄ. ɉɪɢ ɷɬɨɦ ɜ 5,75% ɫɥɭɱɚɟɜ ɨɩɪɟɞɟɥɹɥɚɫɶ ɩɨɥɢɦɢɤɪɨɛɧɚɹ ɮɥɨɪɚ. ɇɚ ɪɢɫɭɧɤɚɯ
1 ɢ 2 ɩɪɟɞɫɬɚɜɥɟɧ ɫɩɟɤɬɪ ɦɢɤɪɨɮɥɨɪɵ, ɜɵɞɟɥɟɧɧɨɣ ɩɪɢ ɩɟɪɜɢɱɧɨɣ ɢ ɜɬɨɪɢɱɧɨɣ ɮɨɪɦɚɯ ȻɄ.
Ɇɢɤɪɨɛɢɨɥɨɝɢɱɟɫɤɢɟ ɢɫɫɥɟɞɨɜɚɧɢɹ
ɩɨɤɚɡɚɥɢ ɜɵɫɨɤɭɸ ɱɭɜɫɬɜɢɬɟɥɶɧɨɫɬɶ St.
epidermidis ɤ ɧɚɢɛɨɥɟɟ ɱɚɫɬɨ ɩɪɢɦɟɧɹɟɦɵɦ
ɚɧɬɢɛɢɨɬɢɤɚɦ ɜ ɨɬɞɟɥɟɧɢɹɯ ɦɢɤɪɨɯɢɪɭɪɝɢɢ ɝɥɚɡɚ ɍɁ «ȼɈɄȻ» ɢ ɍɁ «10-ɚɹ ȽɄȻ» ɜ
ɝɪɭɩɩɟ ɩɚɰɢɟɧɬɨɜ ɫ ɩɟɪɜɢɱɧɨɣ ɮɨɪɦɨɣ ɛɚɤɬɟɪɢɚɥɶɧɨɝɨ ɤɟɪɚɬɢɬɚ (ɪɢɫ. 3).
ȼ ɝɪɭɩɩɟ ɩɚɰɢɟɧɬɨɜ ɫ ɜɬɨɪɢɱɧɨɣ ɮɨɪɦɨɣ ȻɄ St. epidermidis ɛɵɥ ɜ 100% ɫɥɭɱɚɟɜ
ɱɭɜɫɬɜɢɬɟɥɟɧ ɥɢɲɶ ɤ ɬɨɛɪɚɦɢɰɢɧɭ (ɪɢɫ. 4).
ȼ ɨɬɧɨɲɟɧɢɢ ɨɫɬɚɥɶɧɵɯ ɚɧɬɢɛɚɤɬɟɪɢɚɥɶɧɵɯ ɩɪɟɩɚɪɚɬɨɜ ɧɚɛɥɸɞɚɥɚɫɶ ɪɚɡɥɢɱɧɚɹ
ɫɬɟɩɟɧɶ ɭɫɬɨɣɱɢɜɨɫɬɢ, ɱɬɨ, ɩɨɜɢɞɢɦɨɦɭ,
ɫɜɹɡɚɧɨ ɫ ɪɟɰɢɞɢɜɢɪɭɸɳɢɦ ɯɚɪɚɤɬɟɪɨɦ ɬɟɱɟɧɢɹ ɡɚɛɨɥɟɜɚɧɢɹ ɢ ɧɟɨɞɧɨɤɪɚɬɧɨɣ ɫɦɟɧɨɣ ɥɟɤɚɪɫɬɜɟɧɧɵɯ ɫɪɟɞɫɬɜ.
Ɋɟɡɭɥɶɬɚɬɵ ɢ ɨɛɫɭɠɞɟɧɢɟ
ȼɬɨɪɢɱɧɚɹ ɮɨɪɦɚ ɛɚɤɬɟɪɢɚɥɶɧɨɝɨ ɤɟɪɚɬɢɬɚ ɜɫɬɪɟɱɚɥɚɫɶ ɞɨɫɬɨɜɟɪɧɨ ɱɚɳɟ ɩɟɪɜɢɱɧɨɣ (ɪ=0,04). ɇɚɢɛɨɥɟɟ ɱɚɫɬɨɣ ɩɪɢɱɢɧɨɣ ɪɚɡɜɢɬɢɹ ɩɟɪɜɢɱɧɨɣ ɮɨɪɦɵ ɛɚɤɬɟɪɢɚɥɶɧɨɝɨ ɤɟɪɚɬɢɬɚ (ȻɄ) ɛɵɥɚ ɧɟɩɨɫɪɟɞɫɬɜɟɧɧɨ ɬɪɚɜɦɚ ɪɨɝɨɜɢɰɵ ɛɟɡ ɢɧɨɪɨɞɧɨɝɨ ɬɟɥɚ
ɪ=0,002). ȼɬɨɪɢɱɧɚɹ ɮɨɪɦɚ ȻɄ ɪɚɡɜɢɜɚɥɚɫɶ ɨɞɢɧɚɤɨɜɨ ɱɚɫɬɨ ɤɚɤ ɜɫɥɟɞɫɬɜɢɟ ɨɮɬɚɥɶɦɨɥɨɝɢɱɟɫɤɨɣ, ɬɚɤ ɢ ɫɨɦɚɬɢɱɟɫɤɨɣ ɩɚɬɨɥɨɝɢɢ (ɪ=0,187). Ⱦɥɹ ɞɚɧɧɨɣ ɮɨɪɦɵ ȻɄ
ɜ 11,1% ɫɥɭɱɚɟɜ ɛɵɥɨ ɯɚɪɚɤɬɟɪɧɵɦ ɜɵɹɜɥɟɧɢɟ ɞɜɭɯ ɢ ɛɨɥɟɟ ɩɪɟɞɪɚɫɩɨɥɚɝɚɸɳɢɯ
ɮɚɤɬɨɪɨɜ, ɜɡɚɢɦɧɨ ɭɬɹɠɟɥɹɸɳɢɯ ɬɟɱɟɧɢɟ
ɡɚɛɨɥɟɜɚɧɢɹ.
Ʌɟɱɟɧɢɟ ɧɚ ɞɨɝɨɫɩɢɬɚɥɶɧɨɦ ɷɬɚɩɟ ɩɪɨɜɨɞɢɥɨɫɶ ɜ 46,4% ɫɥɭɱɚɟɜ ɩɪɢ ɩɟɪɜɢɱɧɨɣ
ɮɨɪɦɟ ɢ ɜ 63,8% ɩɪɢ ɜɬɨɪɢɱɧɨɣ ɮɨɪɦɟ ȻɄ.
ɂɫɫɥɟɞɭɟɦɵɟ ɝɪɭɩɩɵ ɬɚɤɠɟ ɨɬɥɢɱɚɥɢɫɶ
ɩɨ ɜɨɡɪɚɫɬɭ ɢ ɩɨɥɭ. ɉɟɪɜɢɱɧɚɹ ɮɨɪɦɚ ȻɄ
ɡɧɚɱɢɬɟɥɶɧɨ ɱɚɳɟ ɨɩɪɟɞɟɥɹɥɚɫɶ ɭ ɥɢɰ ɦɭɠɫɤɨɝɨ ɩɨɥɚ (83,7%, ɪ<0,0001), ɧɟɠɟɥɢ ɠɟɧɫɤɨɝɨ (16,3%), ɬɨɝɞɚ ɤɚɤ ɜɬɨɪɢɱɧɚɹ ɮɨɪɦɚ
ɧɚɛɥɸɞɚɥɚɫɶ ɨɞɢɧɚɤɨɜɨ ɱɚɫɬɨ ɭ ɨɛɨɢɯ ɩɨɥɨɜ (ɦɭɠɱɢɧɵ 52,4%, ɠɟɧɳɢɧɵ 47,6%,
ɪ=0,575).
ȼɨɡɪɚɫɬ ɜ ɨɛɟɢɯ ɝɪɭɩɩɚɯ ɡɧɚɱɢɬɟɥɶɧɨ
ɜɚɪɶɢɪɨɜɚɥ. Ɉɞɧɚɤɨ ɩɟɪɜɢɱɧɚɹ ɮɨɪɦɚ ȻɄ
ɱɚɳɟ ɪɚɡɜɢɜɚɥɚɫɶ ɭ ɥɢɰ ɬɪɭɞɨɫɩɨɫɨɛɧɨɝɨ
109
” ɇɨɜɨɫɬɢ ɯɢɪɭɪɝɢɢ
100
Ɍɨɛɪɚɦɢɰɢɧ
ɐɟɮɬɚɡɢɞɢɦ
72,2
0
16,7
11,1
93,3
Ʌɨɦɟɮɥɨɤɫɚɰɢɧ
ɐɟɮɬɚɡɢɞɢɦ
6,7
100
Ʌɟɜɨɮɥɨɤɫɚɰɢɧ
Ɍɨɛɪɚɦɢɰɢɧ
0
%
100
46,2
53,8
Ʌɨɦɟɮɥɨɤɫɚɰɢɧ
85,7
Ʌɟɜɨɮɥɨɤɫɚɰɢɧ
84,6
ɐɢɩɪɨɮɥɨɤɫɚɰɢɧ
100
0
ɐɢɩɪɨɮɥɨɤɫɚɰɢɧ
92,3
Ɉɮɥɨɤɫɚɰɢɧ
100
0
Ɉɮɥɨɤɫɚɰɢɧ
93,3
94,4
Ƚɟɧɬɚɦɢɰɢɧ
ɱɭɜɫɬɜɢɬɟɥɟɧ
ɭɦɟɪɟɧɧɨ ɭɫɬɨɣɱɢɜ
5,6
ɭɫɬɨɣɱɢɜ
Ƚɟ ɧɬɚɦɢɰɢɧ
0
68,75
ɱɭɜɫɬɜɢɬɟɥɟɧ
14,3
7,7
12,5
ɭɦɟ ɪɟ ɧɧɨ ɭɫɬɨɣɱɢɜ
7,7
7,7
6,7
18,75
ɭɫɬɨɣɱɢɜ
Ɋɢɫ. 3. ɍɫɬɨɣɱɢɜɨɫɬɶ ɤ ɚɧɬɢɛɚɤɬɟɪɢɚɥɶɧɵɦ
ɩɪɟɩɚɪɚɬɚɦ ɦɢɤɪɨɨɪɝɚɧɢɡɦɨɜ, ɜɵɞɟɥɟɧɧɵɯ
ɩɪɢ ɩɟɪɜɢɱɧɨɣ ɮɨɪɦɟ ɛɚɤɬɟɪɢɚɥɶɧɨɝɨ
ɤɟɪɚɬɢɬɚ
Ɋɢɫ. 4. ɍɫɬɨɣɱɢɜɨɫɬɶ ɤ ɚɧɬɢɛɚɤɬɟɪɢɚɥɶɧɵɦ
ɩɪɟɩɚɪɚɬɚɦ ɦɢɤɪɨɨɪɝɚɧɢɡɦɨɜ, ɜɵɞɟɥɟɧɧɵɯ
ɩɪɢ ɜɬɨɪɢɱɧɨɣ ɮɨɪɦɟ ɛɚɤɬɟɪɢɚɥɶɧɨɝɨ
ɤɟɪɚɬɢɬɚ
Ⱥɧɚɥɢɡ ɞɚɧɧɵɯ ɤɥɟɬɨɱɧɵɯ ɨɛɪɚɡɰɨɜ
ɪɨɝɨɜɢɰɵ ɜɵɹɜɢɥ ɩɪɟɨɛɥɚɞɚɧɢɟ ɞɢɫɬɪɨɮɢɱɟɫɤɢɯ ɢɡɦɟɧɟɧɢɣ ɜ ɝɪɭɩɩɟ ɩɚɰɢɟɧɬɨɜ ɫ
ɜɬɨɪɢɱɧɨɣ ɮɨɪɦɨɣ ɛɚɤɬɟɪɢɚɥɶɧɨɝɨ ɤɟɪɚɬɢɬɚ, ɚ ɫ ɩɟɪɜɢɱɧɨɣ – ɧɟɤɪɨɬɢɱɟɫɤɢɯ ɢ ɧɟɤɪɨɛɢɨɬɢɱɟɫɤɢɯ ɢɡɦɟɧɟɧɢɣ. ɇɚ 1-ɵɟ ɫɭɬɤɢ ɧɚɛɥɸɞɟɧɢɹ ɭ ɩɚɰɢɟɧɬɨɜ ɫ ɩɟɪɜɢɱɧɨɣ
ɮɨɪɦɨɣ ȻɄ ɤɨɷɮɮɢɰɢɟɧɬɚ ɷɩɢɬɟɥɢɡɚɰɢɢ
ɪɨɝɨɜɢɰɵ (ɄɗɊ) ɡɧɚɱɢɬɟɥɶɧɨ ɜɚɪɶɢɪɨɜɚɥ
ɨɬ ɧɢɡɤɨɣ ɞɨ ɜɵɫɨɤɨɣ ɪɟɩɚɪɚɬɢɜɧɨɣ ɫɩɨɫɨɛɧɨɫɬɢ) ɢ ɫɨɫɬɚɜɢɥ 16,25 (Ɇɟ). Ɋɟɡɭɥɶɬɚɬɵ ɩɨɫɥɟɞɭɸɳɢɯ ɫɪɨɤɨɜ ɢɫɫɥɟɞɨɜɚɧɢɹ (3ɢ, 7-ɟ, 14-ɟ ɢ 30-ɟ ɫɭɬɤɢ) ɜɵɹɜɢɥɢ ɞɨɫɬɨɜɟɪɧɨɟ ɫɧɢɠɟɧɢɟ ɪɟɩɚɪɚɬɢɜɧɨɣ ɫɩɨɫɨɛɧɨɫɬɢ ɤ 7-ɵɦ ɫɭɬɤɚɦ ɢɫɫɥɟɞɨɜɚɧɢɹ (ɪ=0,019),
ɱɬɨ, ɩɨɜɢɞɢɦɨɦɭ, ɫɜɹɡɚɧɨ ɫ ɨɬɜɟɬɧɨɣ ɪɟɚɤɰɢɟɣ ɧɚ ɚɧɬɢɛɢɨɬɢɤɨɬɟɪɚɩɢɸ, ɚ ɬɚɤɠɟ
ɚɤɬɢɜɚɰɢɸ ɩɪɨɥɢɮɟɪɚɬɢɜɧɵɯ ɩɪɨɰɟɫɫɨɜ. Ʉ
30-ɵɦ ɫɭɬɤɚɦ ɄɗɊ ɜɨɡɪɚɫɬɚɥ ɞɨ ɩɨɤɚɡɚɬɟɥɟɣ ɜɵɫɨɤɨɣ ɪɟɩɚɪɚɬɢɜɧɨɣ ɫɩɨɫɨɛɧɨɫɬɢ ɜɨ
ɜɫɟɯ ɤɥɢɧɢɱɟɫɤɢɯ ɫɥɭɱɚɹɯ (Ɇɟ=50,26).
ȼ ɝɪɭɩɩɟ ɩɚɰɢɟɧɬɨɜ ɫ ɜɬɨɪɢɱɧɨɣ ɮɨɪɦɨɣ ɛɚɤɬɟɪɢɚɥɶɧɨɝɨ ɤɟɪɚɬɢɬɚ ɩɨɤɚɡɚɬɟɥɢ
ɄɗɊ ɜɚɪɶɢɪɨɜɚɥɢ ɨɬ ɨɱɟɧɶ ɧɢɡɤɨɣ ɞɨ ɧɢɡɤɨɣ ɪɟɩɚɪɚɬɢɜɧɨɣ ɫɩɨɫɨɛɧɨɫɬɢ. ȼɨ ɜɫɟ ɫɪɨɤɢ ɢɫɫɥɟɞɨɜɚɧɢɹ ɟɝɨ ɜɵɪɚɠɟɧɧɨɣ ɞɢɧɚɦɢɤɢ ɧɟ ɧɚɛɥɸɞɚɥɨɫɶ. ɇɚ 3-ɢ ɫɭɬɤɢ ɞɚɧɧɵɣ
ɩɨɤɚɡɚɬɟɥɶ ɞɨɫɬɨɜɟɪɧɨ ɭɜɟɥɢɱɢɜɚɥɫɹ
Ɇɟ=1,96, ɪ=0,004), ɨɞɧɚɤɨ ɩɨɩɪɟɠɧɟɦɭ
ɯɚɪɚɤɬɟɪɢɡɨɜɚɥ ɨɱɟɧɶ ɧɢɡɤɢɣ ɭɪɨɜɟɧɶ ɪɟɩɚɪɚɬɢɜɧɨɣ ɫɩɨɫɨɛɧɨɫɬɢ. Ʉ 30-ɵɦ ɫɭɬɤɚɦ
ɄɗɊ ɜɨɡɪɚɫɬɚɥ (ɪ=0,016), ɧɨ, ɧɟɫɦɨɬɪɹ ɧɚ
ɩɪɨɜɨɞɢɦɨɟ ɥɟɱɟɧɢɟ, ɜɚɪɶɢɪɨɜɚɥ ɨɬ ɨɱɟɧɶ
ɧɢɡɤɨɣ ɞɨ ɧɢɡɤɨɣ ɪɟɩɚɪɚɬɢɜɧɨɣ ɫɩɨɫɨɛɧɨɫɬɢ ɪɨɝɨɜɢɰɵ (ɪɚɡɦɚɯ min-max 1,35-5,37).
Ɍɚɤɢɦ ɨɛɪɚɡɨɦ, ɞɚɧɧɵɟ ɄɗɊ ɫɜɢɞɟɬɟɥɶɫɬɜɭɸɬ ɨ ɜɵɪɚɠɟɧɧɨɫɬɢ ɪɟɩɚɪɚɬɢɜɧɵɯ
ɩɪɨɰɟɫɫɨɜ ɜ ɪɨɝɨɜɢɰɟ, ɧɚɩɪɚɜɥɟɧɧɵɯ ɧɚ
ɜɨɫɫɬɚɧɨɜɥɟɧɢɟ ɟɺ ɫɬɪɭɤɬɭɪɵ. Ⱦɢɧɚɦɢɤɚ
ɄɗɊ ɜ ɝɪɭɩɩɟ ɩɚɰɢɟɧɬɨɜ ɫ ɩɟɪɜɢɱɧɨɣ ɮɨɪɦɨɣ ȻɄ ɫɜɢɞɟɬɟɥɶɫɬɜɨɜɚɥɚ ɨɛ ɚɤɬɢɜɧɨɫɬɢ
ɪɟɩɚɪɚɬɢɜɧɵɯ ɩɪɨɰɟɫɫɨɜ, ɬɨɝɞɚ ɤɚɤ ɩɪɢ
ɜɬɨɪɢɱɧɨɣ ɮɨɪɦɟ ɨɧɢ ɛɵɥɢ ɡɧɚɱɢɬɟɥɶɧɨ
ɫɧɢɠɟɧɵ, ɱɬɨ ɨɛɭɫɥɨɜɥɢɜɚɥɨ ɛɨɥɟɟ ɩɪɨɞɨɥɠɢɬɟɥɶɧɭɸ ɷɩɢɬɟɥɢɡɚɰɢɸ ɹɡɜɟɧɧɨɜɨɫɩɚɥɢɬɟɥɶɧɨɝɨ ɞɟɮɟɤɬɚ (ɪɚɡɦɚɯ min-max 8,0–
37,0, Ɇɟ=18,0 ɫɭɬɨɤ, ɪ=0,004).
110
ȼɵɜɨɞɵ
1. ȼɬɨɪɢɱɧɚɹ ɮɨɪɦɚ ɛɚɤɬɟɪɢɚɥɶɧɨɝɨ
ɤɟɪɚɬɢɬɚ ɜɫɬɪɟɱɚɟɬɫɹ ɞɨɫɬɨɜɟɪɧɨ ɱɚɳɟ ɩɟɪɜɢɱɧɨɣ (ɪ=0,04) ɢ ɪɚɡɜɢɜɚɟɬɫɹ ɭ ɥɢɰ ɫɬɚɪɲɟ ɬɪɭɞɨɫɩɨɫɨɛɧɨɝɨ ɜɨɡɪɚɫɬɚ (ɪ<0,001 ɢ
ɪ=0,007 ɞɥɹ ɦɭɠɱɢɧ ɢ ɠɟɧɳɢɧ ɫɨɨɬɜɟɬɫɬɜɟɧɧɨ).
2. ȼ ɷɬɢɨɥɨɝɢɢ ɪɚɡɜɢɬɢɹ ɩɟɪɜɢɱɧɨɣ ɢ
ɜɬɨɪɢɱɧɨɣ ɮɨɪɦ ɛɚɤɬɟɪɢɚɥɶɧɨɝɨ ɤɟɪɚɬɢɬɚ
ɩɪɟɨɛɥɚɞɚɟɬ St. Epidermidis (72,0% ɩɪɢ ɩɟɪɜɢɱɧɨɣ, 48,6% ɩɪɢ ɜɬɨɪɢɱɧɨɣ ɮɨɪɦɚɯ),
ɱɭɜɫɬɜɢɬɟɥɶɧɨɫɬɶ ɤɨɬɨɪɨɝɨ ɧɚɢɛɨɥɟɟ ɜɵɪɚɠɟɧɚ ɤ ɚɧɬɢɛɚɤɬɟɪɢɚɥɶɧɨɦɭ ɩɪɟɩɚɪɚɬɭ ɬɨɛɪɚɦɢɰɢɧ.
3. ɉɟɪɜɢɱɧɚɹ ɮɨɪɦɚ ɛɚɤɬɟɪɢɚɥɶɧɨɝɨ
ɤɟɪɚɬɢɬɚ ɯɚɪɚɤɬɟɪɢɡɭɟɬɫɹ ɜɵɪɚɠɟɧɧɵɦɢ
ɪɟɩɚɪɚɬɢɜɧɵɦɢ ɩɪɨɰɟɫɫɚɦɢ ɜ ɫɬɚɞɢɢ ɪɟɝ-
ʋ5x 2010 i ɬɨɦ 18
ɪɟɫɫɢɢ ɢ ɪɭɛɰɟɜɚɧɢɹ, ɜɬɨɪɢɱɧɚɹ – ɧɢɡɤɨɣ
ɢɧɬɟɧɫɢɜɧɨɫɬɶɸ ɪɟɩɚɪɚɬɢɜɧɵɯ ɩɪɨɰɟɫɫɨɜ
ɜɨ ɜɫɟ ɫɬɚɞɢɢ ɜɨɫɩɚɥɢɬɟɥɶɧɨɝɨ ɩɪɨɰɟɫɫɚ,
ɱɬɨ ɨɛɭɫɥɨɜɥɢɜɚɟɬ ɞɥɢɬɟɥɶɧɨɫɬɶ ɷɩɢɬɟɥɢɡɚɰɢɢ ɹɡɜɟɧɧɨɜɨɫɩɚɥɢɬɟɥɶɧɨɝɨ ɞɟɮɟɤɬɚ
ɪɨɝɨɜɢɰɵ.
ɅɂɌȿɊȺɌɍɊȺ
1. Bacterial keratitis: predisposing factors, clinical and
microbiological review of 300 cases / T. Bourcier [et
al.] // Br. J. Ophthalmol. – 2003. – Vol. 87. – P. 834838.
2. Clinical outcomes of keratitis / M. D. Green [et al.]
// Clin. and Exper. Ophthalmol. – 2007. – Vol. 35. – P.
421-426.
3. Khurana, A. K. Ophthalmology / A. K. Khurana. –
New age international, 2007. – 603 p.
4. The efficacy and safety of topical polymyxin B,
neomycin and gramicidin for treatment of presumed
bacterial corneal ulceration / M. I. Bosscha [et al.] //
Br. J. Ophthalmol. – 2004. – Vol. 88. – P. 25-28.
5. Severe infective keratitis leading to hospital
admission in New Zealand / T. Wong [et al.] // Br. J.
Ophthalmol. – 2003. – Vol. 87. – P. 1103-1108.
6. Trends in resistance to ciprofloxacin, cefazolin, and
gentamicin in the treatment of bacterial keratitis /
N. A. Afshari [et al.] // Journal of ocular pharmacology
and therapeutics. – 2008. – Vol. 24. – P. 217-223.
7. ɒɚɢɦɨɜɚ, ȼ. Ⱥ. Ʉɥɢɧɢɤɨɷɬɢɨɥɨɝɢɱɟɫɤɢɟ ɨɫɨɛɟɧɧɨɫɬɢ ɪɚɡɥɢɱɧɵɯ ɬɢɩɨɜ ɬɟɱɟɧɢɹ ɝɧɨɣɧɨɣ ɹɡɜɵ ɪɨɝɨɜɢɰɵ / ȼ. Ⱥ. ɒɚɢɦɨɜɚ // ȼɟɫɬɧ. ɨɮɬɚɥɶɦɨɥɨɝɢɢ.
– 2002. – ʋ 1. – ɋ. 39-41.
8. ȼɨɥɤɨɜɢɱ, Ɍ. Ʉ. ɂɦɩɪɟɫɫɢɨɧɧɚɹ ɰɢɬɨɥɨɝɢɹ ɜ ɞɢɚɝɧɨɫɬɢɤɟ ɛɚɤɬɟɪɢɚɥɶɧɨɝɨ ɤɟɪɚɬɢɬɚ / Ɍ. Ʉ. ȼɨɥɤɨɜɢɱ,
Ɍ. Ⱥ. ɂɦɲɟɧɟɰɤɚɹ, ɂ. ȼ. ɋɚɦɫɨɧɨɜɚ // ARS MEDICA.
ɇɨɜɨɟ ɜ ɨɮɬɚɥɶɦɨɥɨɝɢɢ. – 2009. – ʋ 9. – ɋ. 32-37.
Àäðåñ äëÿ êîððåñïîíäåíöèè
210023, Ðåñïóáëèêà Áåëàðóñü,
ã. Âèòåáñê, ïð-ò Ôðóíçå, 27,
Âèòåáñêèé ãîñóäàðñòâåííûé
ìåäèöèíñêèé óíèâåðñèòåò,
êàôåäðà îôòàëüìîëîãèè,
e-mail: t.volkovich@rambler.ru,
Âîëêîâè÷ Ò.Ê.
ɉɨɫɬɭɩɢɥɚ 8.07.2010 ɝ.
ɑɂɌȺɃɌȿ ȼ ɋɅȿȾɍɘɓȿɆ ɇɈɆȿɊȿ:
ɂɎ. ɒɢɲɥɨ
Ɍɢɩɢɱɧɵɟ ɚɛɞɨɦɢɧɚɥɶɧɵɟ ɨɧɤɨɥɨɝɢɱɟɫɤɢɟ ɨɩɟɪɚɰɢɢ ɢ ɢɫɯɨɞ
ɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɨɝɨ ɩɟɪɢɬɨɧɢɬɚ
111