,

,
ɘɆ. ȽȺɂɇ, ȿɉ. ɄɂɋȿɅȬȼȺ
ÏÅÐÑÏÅÊÒÈÂÛ È ÂÎÇÌÎÆÍÎÑÒÈ ÊËÅÒÎ×ÍÎÉ ÒÐÀÍÑÏËÀÍÒÀÖÈÈ
ÏÐÈ ÂÎÑÑÒÀÍÎÂËÅÍÈÈ ÎÁØÈÐÍÛÕ ÄÅÔÅÊÒΠÌßÃÊÈÕ ÒÊÀÍÅÉ
ÒÐÀÂÌÀÒÈ×ÅÑÊÎÃÎ ÏÐÎÈÑÕÎÆÄÅÍÈß
ȽɍɈ «Ȼɟɥɨɪɭɫɫɤɚɹ ɦɟɞɢɰɢɧɫɤɚɹ ɚɤɚɞɟɦɢɹ ɩɨɫɥɟɞɢɩɥɨɦɧɨɝɨ ɨɛɪɚɡɨɜɚɧɢɹ»,
Ɋɟɫɩɭɛɥɢɤɚ Ȼɟɥɚɪɭɫɶ
ɐɟɥɶ. Ɉɰɟɧɢɬɶ ɷɮɮɟɤɬɢɜɧɨɫɬɶ ɫɨɜɪɟɦɟɧɧɵɯ ɦɟɬɨɞɢɤ ɤɥɟɬɨɱɧɨɣ ɬɪɚɧɫɩɥɚɧɬɚɰɢɢ, ɢɫɩɨɥɶɡɭɟɦɵɯ ɞɥɹ ɜɨɫɫɬɚɧɨɜɥɟɧɢɹ ɨɛɲɢɪɧɵɯ ɞɟɮɟɤɬɨɜ ɦɹɝɤɢɯ ɬɤɚɧɟɣ ɩɪɢ ɬɪɚɜɦɟ ɪɚɡɥɢɱɧɨɝɨ ɩɪɨɢɫɯɨɠɞɟɧɢɹ, ɢ ɨɩɪɟɞɟɥɢɬɶ ɧɚɢɛɨɥɟɟ ɩɟɪɫɩɟɤɬɢɜɧɵɟ ɧɚɩɪɚɜɥɟɧɢɹ ɞɥɹ ɪɚɡɜɢɬɢɹ ɞɚɧɧɵɯ ɬɟɯɧɨɥɨɝɢɣ
ɜ Ɋɟɫɩɭɛɥɢɤɟ Ȼɟɥɚɪɭɫɶ.
Ɇɚɬɟɪɢɚɥ ɢ ɦɟɬɨɞɵ. ɉɪɨɜɟɞɺɧ ɚɧɚɥɢɡ ɫɨɜɪɟɦɟɧɧɨɣ ɨɬɟɱɟɫɬɜɟɧɧɨɣ ɢ ɡɚɪɭɛɟɠɧɨɣ ɥɢɬɟɪɚɬɭɪɵ, ɤɚɫɚɸɳɟɣɫɹ ɬɟɨɪɟɬɢɱɟɫɤɢɯ ɚɫɩɟɤɬɨɜ ɢ ɤɥɢɧɢɱɟɫɤɨɝɨ ɨɩɵɬɚ ɩɪɢɦɟɧɟɧɢɹ ɤɥɟɬɨɱɧɵɯ ɬɟɯɧɨɥɨɝɢɣ ɪɟɝɟɧɟɪɚɬɢɜɧɨɣ ɦɟɞɢɰɢɧɵ ɜ ɜɨɫɫɬɚɧɨɜɥɟɧɢɢ ɨɛɲɢɪɧɵɯ ɞɟɮɟɤɬɨɜ ɦɹɝɤɢɯ ɬɤɚɧɟɣ ɬɪɚɜɦɚɬɢɱɟɫɤɨɝɨ ɩɪɨɢɫɯɨɠɞɟɧɢɹ.
Ɋɟɡɭɥɶɬɚɬɵ. ȼ ɫɪɚɜɧɢɬɟɥɶɧɨɦ ɚɫɩɟɤɬɟ ɩɪɨɜɟɞɺɧ ɚɧɚɥɢɡ ɨɬɟɱɟɫɬɜɟɧɧɨɣ ɢ ɡɚɪɭɛɟɠɧɨɣ ɥɢɬɟɪɚɬɭɪɵ ɫ ɨɰɟɧɤɨɣ ɷɮɮɟɤɬɢɜɧɨɫɬɢ ɢɫɩɨɥɶɡɭɟɦɵɯ ɜ ɷɤɫɩɟɪɢɦɟɧɬɟ ɢ ɤɥɢɧɢɤɟ ɫ ɥɟɱɟɛɧɨɣ ɰɟɥɶɸ
ɦɟɬɨɞɢɤ ɤɥɟɬɨɱɧɨɣ ɬɪɚɧɫɩɥɚɧɬɚɰɢɢ. ɇɚɢɛɨɥɟɟ ɩɟɪɫɩɟɤɬɢɜɧɵɦ ɧɚɩɪɚɜɥɟɧɢɟɦ ɡɚɦɟɳɟɧɢɹ ɨɛɲɢɪɧɵɯ ɬɤɚɧɟɜɵɯ ɞɟɮɟɤɬɨɜ ɬɪɚɜɦɚɬɢɱɟɫɤɨɝɨ ɢɥɢ ɞɪɭɝɨɝɨ ɩɪɨɢɫɯɨɠɞɟɧɢɹ ɫɥɟɞɭɟɬ ɩɪɢɡɧɚɬɶ ɥɟɱɟɛɧɵɟ
ɬɟɯɧɨɥɨɝɢɢ, ɨɫɧɨɜɚɧɧɵɟ ɧɚ ɢɫɩɨɥɶɡɨɜɚɧɢɢ ɦɟɡɟɧɯɢɦɚɥɶɧɵɯ ɫɬɜɨɥɨɜɵɯ ɤɥɟɬɨɤ, ɤɨɬɨɪɵɟ ɩɨɡɜɨɥɹɸɬ ɨɛɨɣɬɢ ɤɥɸɱɟɜɵɟ ɧɟɞɨɫɬɚɬɤɢ, ɫɜɹɡɚɧɧɵɟ ɫ ɩɪɨɰɟɞɭɪɨɣ ɬɪɚɧɫɩɥɚɧɬɚɰɢɢ ɚɭɬɨɥɨɝɢɱɧɵɯ ɬɤɚɧɟɣ.
ɉɪɟɢɦɭɳɟɫɬɜɚɦɢ ɷɬɨɣ ɦɟɬɨɞɢɤɢ ɹɜɥɹɸɬɫɹ: 1) ɧɟɛɨɥɶɲɨɟ ɤɨɥɢɱɟɫɬɜɨ ɚɫɩɢɪɚɬɚ, ɫɨɞɟɪɠɚɳɟɝɨ ɦɟɡɟɧɯɢɦɚɥɶɧɵɟ ɫɬɜɨɥɨɜɵɟ ɤɥɟɬɤɢ, ɩɨɥɭɱɟɧɧɨɝɨ ɢɡ ɤɨɫɬɧɨɝɨ ɦɨɡɝɚ, ɠɢɪɨɜɨɣ ɬɤɚɧɢ ɢɥɢ ɞɪɭɝɢɯ
ɢɫɬɨɱɧɢɤɨɜ, ɦɨɠɟɬ ɛɵɬɶ ɭɜɟɥɢɱɟɧɨ ɞɨ ɧɟɨɛɯɨɞɢɦɨɝɨ ɤɨɥɢɱɟɫɬɜɚ ɜ ɭɫɥɨɜɢɹɯ in vitro, ɚ ɡɚɬɟɦ ɢɫɩɨɥɶɡɨɜɚɧɨ ɞɥɹ ɥɟɱɟɧɢɹ ɰɟɥɨɝɨ ɪɹɞɚ ɡɚɛɨɥɟɜɚɧɢɣ (ɜ ɬɨɦ ɱɢɫɥɟ, ɢ ɡɚɦɟɳɟɧɢɹ ɨɛɲɢɪɧɵɯ ɬɤɚɧɟɜɵɯ
ɞɟɮɟɤɬɨɜ, ɮɨɪɦɢɪɭɸɳɢɯɫɹ ɜ ɪɟɡɭɥɶɬɚɬɟ ɬɪɚɜɦɵ ɢɥɢ ɞɪɭɝɢɯ ɩɚɬɨɥɨɝɢɱɟɫɤɢɯ ɩɪɨɰɟɫɫɨɜ); 2) ɦɟɡɟɧɯɢɦɚɥɶɧɵɟ ɫɬɜɨɥɨɜɵɟ ɤɥɟɬɤɢ ɦɨɝɭɬ ɞɢɮɮɟɪɟɧɰɢɪɨɜɚɬɶɫɹ ɜ ɧɟɫɤɨɥɶɤɨ ɤɥɟɬɨɱɧɵɯ ɩɨɤɨɥɟɧɢɣ, ɨɛɭɫɥɚɜɥɢɜɚɹ, ɬɚɤɢɦ ɨɛɪɚɡɨɦ, ɜɨɡɦɨɠɧɨɫɬɶ ɢɫɩɨɥɶɡɨɜɚɧɢɹ ɨɛɳɟɝɨ ɤɥɟɬɨɱɧɨɝɨ ɢɫɬɨɱɧɢɤɚ ɞɥɹ ɜɨɫɫɬɚɧɨɜɥɟɧɢɹ ɰɟɥɨɝɨ ɪɹɞɚ ɬɤɚɧɟɣ, ɜ ɨɬɥɢɱɢɟ ɨɬ ɩɪɢɧɰɢɩɚ ɡɚɛɨɪɚ ɡɞɨɪɨɜɵɯ ɬɤɚɧɟɣ ɞɥɹ ɜɨɫɫɬɚɧɨɜɥɟɧɢɹ ɫɟɛɟ ɩɨɞɨɛɧɵɯ ɩɪɢ ɚɭɬɨɥɨɝɢɱɧɨɣ ɩɟɪɟɫɚɞɤɟ ɬɤɚɧɢ; 3) ɦɟɡɟɧɯɢɦɚɥɶɧɵɟ ɫɬɜɨɥɨɜɵɟ ɤɥɟɬɤɢ
ɦɨɝɭɬ ɛɵɬɶ ɜɧɟɞɪɟɧɵ ɜ ɛɢɨɫɨɜɦɟɫɬɢɦɵɟ ɬɪɚɧɫɩɥɚɧɬɚɬɵ, ɩɟɪɟɫɚɠɟɧɧɵɟ ɜ ɦɟɫɬɚ ɚɧɚɬɨɦɢɱɟɫɤɢɯ
ɞɟɮɟɤɬɨɜ ɞɥɹ ɩɨɫɥɟɞɭɸɳɟɣ ɪɟɤɨɧɫɬɪɭɤɰɢɢ ɩɨɜɪɟɠɞɟɧɧɨɝɨ ɨɪɝɚɧɚ ɢɥɢ ɬɤɚɧɢ; 4) ɥɟɱɟɧɢɟ ɪɚɡɥɢɱɧɵɯ ɡɚɛɨɥɟɜɚɧɢɣ ɢ ɬɪɚɜɦ ɫ ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ ɦɟɡɟɧɯɢɦɚɥɶɧɵɯ ɫɬɜɨɥɨɜɵɯ ɤɥɟɬɨɤ ɦɨɠɟɬ ɛɵɬɶ ɚɭɬɨɥɨɝɢɱɧɨɣ ɢ ɩɪɢ ɷɬɨɦ ɪɟɲɚɬɶ ɩɪɨɛɥɟɦɵ, ɫɜɹɡɚɧɧɵɟ ɫ ɢɦɦɭɧɧɨɣ ɪɟɚɤɰɢɟɣ, ɬɪɚɧɫɦɢɫɫɢɜɧɨɣ ɩɟɪɟɞɚɱɟɣ ɜɨɡɛɭɞɢɬɟɥɟɣ, ɢɡɧɨɫɨɦ ɢ ɪɚɡɪɵɜɨɦ ɫɢɧɬɟɬɢɱɟɫɤɢɯ ɦɚɬɟɪɢɚɥɨɜ, ɚɥɥɟɪɝɢɱɟɫɤɨɣ ɪɟɚɤɰɢɟɣ ɧɚ
ɢɫɤɭɫɫɬɜɟɧɧɵɟ ɢɦɩɥɚɧɬɚɬɵ.
Ɂɚɤɥɸɱɟɧɢɟ. ɉɟɪɫɩɟɤɬɢɜɵ ɪɚɡɜɢɬɢɹ ɪɟɝɟɧɟɪɚɰɢɨɧɧɨɣ ɦɟɞɢɰɢɧɵ, ɨɫɧɨɜɚɧɧɵɟ ɧɚ ɤɥɟɬɨɱɧɵɯ ɬɟɯɧɨɥɨɝɢɹɯ, ɛɵɥɢ ɢ ɨɫɬɚɸɬɫɹ ɜɟɫɶɦɚ ɜɩɟɱɚɬɥɹɸɳɢɦɢ ɢ ɩɪɨɞɨɥɠɚɸɬ ɩɪɢɜɥɟɤɚɬɶ ɜɧɢɦɚɧɢɟ
ɭɱɟɧɵɯ ɜɫɟɝɨ ɦɢɪɚ. Ɇɨɠɧɨ ɩɪɟɞɩɨɥɚɝɚɬɶ, ɱɬɨ ɜ ɛɥɢɠɚɣɲɟɦ ɛɭɞɭɳɟɦ ɤɥɟɬɨɱɧɚɹ ɬɪɚɧɫɩɥɚɧɬɚɰɢɹ
ɡɚɣɦɟɬ ɞɨɫɬɨɣɧɨɟ ɦɟɫɬɨ ɜ ɚɪɫɟɧɚɥɟ ɫɪɟɞɫɬɜ ɥɟɱɟɧɢɹ ɪɚɧ, ɨɠɨɝɨɜ ɢ ɜɨɫɫɬɚɧɨɜɥɟɧɢɹ ɲɢɪɨɤɨɝɨ
ɫɩɟɤɬɪɚ ɬɤɚɧɟɣ ɨɪɝɚɧɢɡɦɚ ɱɟɥɨɜɟɤɚ.
Ʉɥɸɱɟɜɵɟ ɫɥɨɜɚ: ɪɟɝɟɧɟɪɚɰɢɹ, ɫɬɜɨɥɨɜɵɟ ɤɥɟɬɤɢ, ɬɤɚɧɟɜɚɹ ɢɧɠɟɧɟɪɢɹ, ɨɠɨɝɢ, ɬɪɚɧɫɩɥɚɧɬɚɰɢɹ
Objectives. To estimate the efficacy of modern treatment techniques of cell transplantation, used
to restore the extensive defects of soft tissues at a trauma of various etiology and to determine the most
perspective directions for the development of the given technologies in the Republic of Belarus.
Methods. Modern native and foreign literature was analyzed dealing with theoretical aspects as
133
” ɇɨɜɨɫɬɢ ɯɢɪɭɪɝɢɢ
well as clinical experience of application of cell technologies of the regenerative medicine in restoring soft
tissues extensive defects of the traumatic origin.
Results. The comparative analysis of native and foreign literature was carried out with the efficacy
estimation of the applied cell transplantation techniques in the experiment and in a clinic with the therapeutic
aim. One should accept the therapeutic technologies based on the application of mesenchymal stem cells
which permit to avoid the main disadvantages linked with the procedure of autologous tissues transplantation
as the most perspective direction of substitution of the extensive tissue defects of the traumatic and other
origins. The advantages of the given technique are the following: 1) small amount of aspirate containing
mesenchymal stem cells obtained from the bone marrow, adipose tissue and other sources can be increased
up to necessary amount in the vitro and then used to treat a number of diseases including the substitution
of the extensive tissue defects forming as the result of trauma and other pathologies; 2) mesenchymal stem
cells can be differentiated in several cell generations, thus giving the possibility to use total cell resource for
restoring different tissues in contrast to the principle of healthy tissue intake for restoring their own kind at
autologous tissues transplantation; 3) mesenchymal stem cells can be introduced in the biocompatible
grafts, transplanted to the places of anatomical defects for further reconstruction of the damaged organ or
tissue; 4) treatment of different diseases and traumas with application of mesenchymal stem cells can be
autologous and at the same time solve the problems dealing with the immune reaction, vector-borne
transmission of pathogens, wear and tear of synthetic materials, allergic reaction to the artificial implants.
Conclusions. Prospects of the regenerative medicine development based on the cellular technologies
were and are rather impressive and they continue to attract attention of scientists all over the world. One
may suppose that in the nearest future cell transplantation will take its rightful place in the arsenal of
treatment for wounds, burns and for restoring a wide range of tissues in the human body.
Keywords: regeneration, stem cells, tissue engineering, burns, transplantation
ɉɪɨɛɥɟɦɚ ɬɪɚɜɦɚɬɢɡɦɚ ɭ ɱɟɥɨɜɟɤɚ ɡɚɧɢɦɚɟɬ ɨɫɨɛɨɟ ɦɟɫɬɨ ɜ ɦɟɞɢɰɢɧɫɤɨɣ ɧɚɭɤɟ
ɢ ɩɪɚɤɬɢɤɟ. Ɉɛɭɫɥɨɜɥɟɧɨ ɷɬɨ ɧɟ ɬɨɥɶɤɨ ɩɨɫɬɨɹɧɧɨ ɭɜɟɥɢɱɢɜɚɸɳɟɣɫɹ ɱɚɫɬɨɬɨɣ ɥɨɤɚɥɶɧɵɯ ɜɨɟɧɧɵɯ ɤɨɧɮɥɢɤɬɨɜ, «ɨɝɪɚɧɢɱɟɧɧɵɯ ɜɨɣɧ», ɪɨɫɬɨɦ ɩɪɟɫɬɭɩɧɨɫɬɢ ɢ ɬɟɪɪɨɪɢɡɦɚ. ɋɬɪɟɦɢɬɟɥɶɧɵɣ ɪɨɫɬ ɚɜɬɨɦɨɛɢɥɟɫɬɪɨɟɧɢɹ, ɧɟɩɪɟɪɵɜɧɨɟ ɭɫɨɜɟɪɲɟɧɫɬɜɨɜɚɧɢɟ
ɫɪɟɞɫɬɜ ɩɟɪɟɞɜɢɠɟɧɢɹ, ɦɟɯɚɧɢɡɚɰɢɹ ɩɪɨɢɡɜɨɞɫɬɜɚ ɧɟ ɦɨɝɭɬ ɧɟ ɫɤɚɡɚɬɶɫɹ ɧɚ ɱɚɫɬɨɬɟ
ɬɪɚɜɦ ɢ ɭɜɟɱɢɣ. ȿɠɟɞɧɟɜɧɨ ɧɚ ɞɨɪɨɝɚɯ
ɦɢɪɚ ɬɨɥɶɤɨ ɨɬ ɚɜɬɨɦɨɛɢɥɶɧɵɯ ɚɜɚɪɢɣ ɩɨɝɢɛɚɟɬ 1000–1200 ɱɟɥɨɜɟɤ, 1 ɦɢɥɥɢɨɧ ɜ ɝɨɞ
ɫɬɚɧɨɜɹɬɫɹ ɢɧɜɚɥɢɞɚɦɢ. ȼ ɫɨɨɬɜɟɬɫɬɜɢɢ ɫ
ɞɚɧɧɵɦɢ ȼɈɁ ɟɠɟɝɨɞɧɨ ɨɬ ɪɚɡɥɢɱɧɵɯ
ɬɪɚɜɦ ɝɢɛɧɟɬ ɛɨɥɟɟ 300 ɬɵɫɹɱ ɥɸɞɟɣ ɬɪɭɞɨɫɩɨɫɨɛɧɨɝɨ ɜɨɡɪɚɫɬɚ, ɚ 7–8 ɦɢɥɥɢɨɧɨɜ
ɩɨɥɭɱɚɸɬ ɩɨɜɪɟɠɞɟɧɢɹ ɪɚɡɥɢɱɧɨɣ ɫɬɟɩɟɧɢ ɬɹɠɟɫɬɢ [1, 2, 3, 4]. ɉɪɢ ɷɬɨɦ ɧɚ ɫɨɡɞɚɧɢɟ ɢ ɮɭɧɤɰɢɨɧɢɪɨɜɚɧɢɟ ɩɨɥɧɨɰɟɧɧɵɯ
ɫɢɫɬɟɦ, ɩɨɡɜɨɥɹɸɳɢɯ ɫɧɢɡɢɬɶ ɭɪɨɜɟɧɶ ɥɟɬɚɥɶɧɨɫɬɢ ɢ ɪɟɚɛɢɥɢɬɢɪɨɜɚɬɶ ɩɨɫɬɪɚɞɚɜɲɢɯ, ɬɪɚɬɹɬɫɹ ɨɝɪɨɦɧɵɟ ɮɢɧɚɧɫɨɜɵɟ ɫɪɟɞɫɬɜɚ. ɉɪɟɞɫɬɚɜɥɟɧɧɵɟ ɮɚɤɬɵ ɫɜɢɞɟɬɟɥɶ134
ɫɬɜɭɸɬ ɨ ɜɵɫɨɤɨɣ ɫɨɰɢɚɥɶɧɨɣ ɡɧɚɱɢɦɨɫɬɢ
ɢɫɫɥɟɞɭɟɦɨɣ ɩɪɨɛɥɟɦɵ ɞɥɹ ɦɟɞɢɰɢɧɵ ɜ
ɱɚɫɬɧɨɫɬɢ ɢ ɨɛɳɟɫɬɜɚ ɜ ɰɟɥɨɦ. Ɍɪɚɜɦɵ ɫɨɫɬɚɜɥɹɟɬ ɨɤɨɥɨ 12% ɨɬ ɨɛɳɟɝɨ ɱɢɫɥɚ ɡɚɛɨɥɟɜɚɧɢɣ, ɜ ɧɚɲɟɣ ɫɬɪɚɧɟ ɨɧɢ ɫɬɨɣɤɨ ɭɞɟɪɠɢɜɚɸɬ ɬɪɟɬɶɟ ɦɟɫɬɨ (ɩɨɫɥɟ ɫɟɪɞɟɱɧɨɫɨɫɭɞɢɫɬɨɣ ɩɚɬɨɥɨɝɢɢ ɢ ɨɧɤɨɥɨɝɢɱɟɫɤɢɯ ɡɚɛɨɥɟɜɚɧɢɣ) ɜ ɫɬɪɭɤɬɭɪɟ ɫɦɟɪɬɧɨɫɬɢ ɧɚɫɟɥɟɧɢɹ, (ɚ ɜ ɜɨɡɪɚɫɬɟ 20–40 ɥɟɬ – ɡɚɧɢɦɚɸɬ
ɩɟɪɜɨɟ ɦɟɫɬɨ). Ɂɚ 1990–2005 ɝɨɞɵ ɫɦɟɪɬɧɨɫɬɶ ɨɬ ɬɪɚɜɦ ɭɜɟɥɢɱɢɥɚɫɶ ɧɚ 97,3%, ɱɬɨ
ɩɨɫɥɭɠɢɥɨ ɨɫɧɨɜɚɧɢɟɦ ɞɥɹ ɨɩɪɟɞɟɥɟɧɢɹ
ɬɪɚɜɦɚɬɢɡɦɚ ɤɚɤ ɨɞɧɨɣ ɢɡ ɜɚɠɧɟɣɲɢɯ ɫɨɫɬɚɜɥɹɸɳɢɯ Ƚɨɫɭɞɚɪɫɬɜɟɧɧɨɣ ɩɪɨɝɪɚɦɦɵ
ɞɟɦɨɝɪɚɮɢɱɟɫɤɨɣ ɛɟɡɨɩɚɫɧɨɫɬɢ Ɋɟɫɩɭɛɥɢɤɢ Ȼɟɥɚɪɭɫɶ ɧɚ 2007–2012 ɝɨɞɵ.
Ɉɫɨɛɨɟ ɦɟɫɬɨ ɜ ɫɬɪɭɤɬɭɪɟ ɬɪɚɜɦɚɬɢɡɦɚ ɩɪɢɧɚɞɥɟɠɢɬ ɬɟɪɦɢɱɟɫɤɢɦ ɩɨɜɪɟɠɞɟɧɢɹɦ [5]. ȿɠɟɦɢɧɭɬɧɨ ɜ ɦɢɪɟ ɨɞɢɧ ɱɟɥɨɜɟɤ ɫɬɚɧɨɜɢɬɫɹ ɠɟɪɬɜɨɣ ɨɠɨɝɚ. Ɍɨɥɶɤɨ ɜ
Ɋɨɫɫɢɢ ɨɠɨɝɨɜɵɟ ɩɚɰɢɟɧɬɵ ɫɨɫɬɚɜɥɹɸɬ
20% ɨɬ ɜɫɟɯ ɬɪɚɜɦɚɬɨɥɨɝɢɱɟɫɤɢɯ ɛɨɥɶɧɵɯ,
26% ɢɡ ɧɢɯ ɧɭɠɞɚɸɬɫɹ ɜ ɝɨɫɩɢɬɚɥɢɡɚɰɢɢ,
ɚ ɥɟɬɚɥɶɧɨɫɬɶ ɩɪɢ ɷɬɨɦ ɫɨɫɬɚɜɥɹɟɬ 4,7–
ʋ5x 2010 i ɬɨɦ 18
11% [6]. ȼ ɋɒȺ ɨɤɨɥɨ 2 ɦɢɥɥɢɨɧɨɜ ɱɟɥɨɜɟɤ ɩɨɥɭɱɚɸɬ ɨɠɨɝɢ ɟɠɟɝɨɞɧɨ, ɢɡ ɧɢɯ ɨɤɨɥɨ 5 ɬɵɫɹɱ ɩɚɰɢɟɧɬɨɜ ɧɭɠɞɚɸɬɫɹ ɜ ɪɟɤɨɧɫɬɪɭɤɬɢɜɧɨɜɨɫɫɬɚɧɨɜɢɬɟɥɶɧɨɦ ɯɢɪɭɪɝɢɱɟɫɤɨɦ ɥɟɱɟɧɢɢ [6]. Ɍɟɪɦɢɱɟɫɤɢɟ ɩɨɪɚɠɟɧɢɹ ɡɚɧɢɦɚɸɬ ɬɪɟɬɶɟ ɦɟɫɬɨ ɜ ɫɬɪɭɤɬɭɪɟ
ɨɛɳɟɝɨ ɬɪɚɜɦɚɬɢɡɦɚ ɜ ɦɢɪɧɨɟ ɜɪɟɦɹ ɢ
ɩɪɟɞɫɬɚɜɥɹɸɬ ɫɨɛɨɣ ɫɟɪɶɺɡɧɭɸ ɦɟɞɢɰɢɧɫɤɭɸ, ɫɨɰɢɚɥɶɧɭɸ ɢ ɷɤɨɧɨɦɢɱɟɫɤɭɸ ɩɪɨɛɥɟɦɭ [5].
ɇɟɫɦɨɬɪɹ ɧɚ ɲɢɪɨɤɢɟ ɜɨɡɦɨɠɧɨɫɬɢ ɫɨɜɪɟɦɟɧɧɨɣ ɞɢɚɝɧɨɫɬɢɤɢ, ɡɧɚɱɢɬɟɥɶɧɚɹ
ɱɚɫɬɶ ɨɧɤɨɥɨɝɢɱɟɫɤɢɯ ɛɨɥɶɧɵɯ ɧɚɱɢɧɚɸɬ
ɥɟɱɟɧɢɟ ɧɚ ɩɨɡɞɧɢɯ ɫɬɚɞɢɹɯ ɡɚɛɨɥɟɜɚɧɢɹ,
ɱɬɨ ɩɨɞɪɚɡɭɦɟɜɚɟɬ ɨɛɲɢɪɧɵɟ ɪɚɞɢɤɚɥɶɧɵɟ
ɪɟɡɟɤɰɢɢ ɫ ɨɛɪɚɡɨɜɚɧɢɟɦ ɡɧɚɱɢɬɟɥɶɧɵɯ ɞɟɮɟɤɬɨɜ ɦɹɝɤɢɯ ɬɤɚɧɟɣ, ɬɪɟɛɭɸɳɢɯ ɞɚɥɶɧɟɣɲɟɣ ɪɟɤɨɧɫɬɪɭɤɰɢɢ [7].
Ʉ ɧɚɫɬɨɹɳɟɦɭ ɜɪɟɦɟɧɢ ɩɪɟɞɥɨɠɟɧɨ ɢ
ɲɢɪɨɤɨ ɢɫɩɨɥɶɡɭɟɬɫɹ ɞɥɹ ɜɨɫɫɬɚɧɨɜɥɟɧɢɹ
ɚɧɚɬɨɦɢɱɟɫɤɢɯ ɞɟɮɟɤɬɨɜ ɦɹɝɤɢɯ ɬɤɚɧɟɣ ɨɝɪɨɦɧɨɟ ɤɨɥɢɱɟɫɬɜɨ ɪɟɤɨɧɫɬɪɭɤɬɢɜɧɨɜɨɫɫɬɚɧɨɜɢɬɟɥɶɧɵɯ ɯɢɪɭɪɝɢɱɟɫɤɢɯ ɦɟɬɨɞɢɤ ɫ
ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ ɚɭɬɨ-, ɚɥɥɨ- ɢ ɤɫɟɧɨɬɤɚɧɟɜɵɯ ɬɪɚɧɫɩɥɚɧɬɚɰɢɣ [2, 5, 8, 9]. ȼ ɩɨɫɥɟɞɧɟɟ ɜɪɟɦɹ ɧɚɱɚɥɨ ɚɤɬɢɜɧɨ ɪɚɡɜɢɜɚɬɶɫɹ
ɧɨɜɨɟ ɧɚɩɪɚɜɥɟɧɢɟ ɬɤɚɧɟɜɨɣ ɢɧɠɟɧɟɪɢɢ,
ɩɪɟɞɭɫɦɚɬɪɢɜɚɸɳɟɟ ɩɪɢɦɟɧɟɧɢɟ ɬɟɯɧɨɥɨɝɢɣ ɤɥɟɬɨɱɧɨɣ ɬɪɚɧɫɩɥɚɧɬɚɰɢɢ [2, 7, 10, 11,
12, 13, 14, 15, 16, 17].
ɐɟɥɶ. Ɉɰɟɧɢɬɶ ɷɮɮɟɤɬɢɜɧɨɫɬɶ ɫɨɜɪɟɦɟɧɧɵɯ ɦɟɬɨɞɢɤ ɤɥɟɬɨɱɧɨɣ ɬɪɚɧɫɩɥɚɧɬɚɰɢɢ, ɢɫɩɨɥɶɡɭɟɦɵɯ ɞɥɹ ɜɨɫɫɬɚɧɨɜɥɟɧɢɹ
ɨɛɲɢɪɧɵɯ ɞɟɮɟɤɬɨɜ ɦɹɝɤɢɯ ɬɤɚɧɟɣ ɩɪɢ
ɬɪɚɜɦɟ ɪɚɡɥɢɱɧɨɝɨ ɩɪɨɢɫɯɨɠɞɟɧɢɹ, ɢ ɨɩɪɟɞɟɥɢɬɶ ɧɚɢɛɨɥɟɟ ɩɟɪɫɩɟɤɬɢɜɧɵɟ ɧɚɩɪɚɜɥɟɧɢɹ ɞɥɹ ɪɚɡɜɢɬɢɹ ɞɚɧɧɵɯ ɬɟɯɧɨɥɨɝɢɣ ɜ
Ɋɟɫɩɭɛɥɢɤɟ Ȼɟɥɚɪɭɫɶ.
Ɇɚɬɟɪɢɚɥ ɢ ɦɟɬɨɞɵ
ɉɪɨɜɟɞɺɧ ɚɧɚɥɢɡ ɷɮɮɟɤɬɢɜɧɨɫɬɢ ɷɤɫɩɟɪɢɦɟɧɬɚɥɶɧɨɝɨ ɢ ɤɥɢɧɢɱɟɫɤɨɝɨ ɢɫɩɨɥɶɡɨɜɚɧɢɹ ɪɚɡɥɢɱɧɵɯ ɤɥɟɬɨɱɧɵɯ ɬɟɯɧɨɥɨɝɢɣ
ɩɪɢ ɡɚɦɟɳɟɧɢɢ ɨɛɲɢɪɧɵɯ ɬɤɚɧɟɜɵɯ ɞɟɮɟɤ-
ɬɨɜ (ɜ ɬɨɦ ɱɢɫɥɟ, ɢ ɬɪɚɜɦɚɬɢɱɟɫɤɨɝɨ ɩɪɨɢɫɯɨɠɞɟɧɢɹ) ɩɨ ɞɚɧɧɵɦ ɦɢɪɨɜɨɣ ɢ ɨɬɟɱɟɫɬɜɟɧɧɨɣ ɥɢɬɟɪɚɬɭɪɵ.
Ɋɟɡɭɥɶɬɚɬɵ ɢ ɨɛɫɭɠɞɟɧɢɟ
ɇɚ ɫɟɝɨɞɧɹɲɧɢɣ ɞɟɧɶ ɪɟɝɟɧɟɪɚɬɢɜɧɚɹ
ɦɟɞɢɰɢɧɚ ɜɤɥɸɱɚɟɬ ɱɟɬɵɪɟ ɨɫɧɨɜɧɵɯ ɧɚɩɪɚɜɥɟɧɢɹ: 1) ɜɨɫɫɬɚɧɨɜɥɟɧɢɟ ɞɟɮɟɤɬɨɜ
ɬɤɚɧɟɣ ɩɭɬɟɦ ɬɪɚɧɫɩɥɚɧɬɚɰɢɢ ɬɤɚɧɟɣ
ɚɭɬɨ-, ɚɥɥɨ- ɢɥɢ ɤɫɟɧɨɬɪɚɧɫɩɥɚɧɬɚɰɢɹ); 2)
ɜɨɫɫɬɚɧɨɜɥɟɧɢɟ ɬɤɚɧɟɣ ɩɭɬɺɦ ɫɬɢɦɭɥɹɰɢɢ
ɪɟɝɟɧɟɪɚɰɢɢ; 3) ɰɢɬɨɬɟɪɚɩɢɸ ɢɥɢ ɬɪɚɧɫɩɥɚɧɬɚɰɢɸ ɨɬɞɟɥɶɧɵɯ ɤɥɟɬɨɤ; 4) ɬɤɚɧɟɜɭɸ
ɢɧɠɟɧɟɪɢɸ [10, 13].
ȼ ɛɨɥɶɲɢɧɫɬɜɟ ɪɟɤɨɧɫɬɪɭɤɬɢɜɧɵɯ ɨɩɟɪɚɰɢɣ ɩɨ ɩɨɜɨɞɭ ɜɨɫɫɬɚɧɨɜɥɟɧɢɹ ɦɹɝɤɢɯ
ɬɤɚɧɟɣ ɝɥɚɜɧɵɦ ɩɥɚɫɬɢɱɟɫɤɢɦ ɤɨɦɩɨɧɟɧɬɨɦ ɹɜɥɹɟɬɫɹ ɠɢɪɨɜɚɹ ɬɤɚɧɶ [10, 11]. ȼ ɧɚɫɬɨɹɳɟɟ ɜɪɟɦɹ ɧɚɢɛɨɥɟɟ ɱɚɫɬɨ ɞɥɹ ɪɟɤɨɧɫɬɪɭɤɰɢɢ ɦɹɝɤɢɯ ɬɤɚɧɟɣ ɩɥɚɫɬɢɱɟɫɤɢɟ ɯɢɪɭɪɝɢ ɢɫɩɨɥɶɡɭɸɬ ɫɨɛɫɬɜɟɧɧɵɟ (ɚɭɬɨɥɨɝɢɱɧɵɟ) ɬɤɚɧɢ ɩɚɰɢɟɧɬɚ ɢɥɢ ɫɢɧɬɟɬɢɱɟɫɤɢɟ
ɢɦɩɥɚɧɬɚɬɵ [12]. Ɇɧɨɝɢɦɢ ɚɜɬɨɪɚɦɢ ɨɩɢɫɵɜɚɸɬɫɹ ɭɫɩɟɲɧɵɟ ɚɥɥɨɬɪɚɧɫɩɥɚɧɬɚɰɢɢ
ɦɹɝɤɢɯ ɬɤɚɧɟɣ (ɜ ɬɨɦ ɱɢɫɥɟ, ɢ ɜ ɚɧɚɬɨɦɢɱɟɫɤɢ ɫɥɨɠɧɵɯ ɡɨɧɚɯ) [12, 18]. Ɉɞɧɚɤɨ
ɩɪɢɧɰɢɩɢɚɥɶɧɵɦ ɧɟɞɨɫɬɚɬɤɨɦ ɥɸɛɨɣ ɚɥɥɨɬɪɚɧɫɩɥɚɧɬɚɰɢɢ ɨɫɬɚɺɬɫɹ ɛɨɥɟɜɨɣ ɫɢɧɞɪɨɦ ɜ ɨɛɥɚɫɬɢ ɞɨɧɨɪɫɤɨɣ ɩɥɨɳɚɞɤɢ [11].
ɂɫɩɨɥɶɡɨɜɚɧɢɟ ɚɥɥɨ- ɢɥɢ ɤɫɟɧɨɬɪɚɧɫɩɥɚɧɬɚɬɨɜ ɧɟɫɺɬ ɡɚ ɫɨɛɨɣ ɫɥɨɠɧɨɫɬɢ, ɫɜɹɡɚɧɧɵɟ
ɫ ɜɨɡɦɨɠɧɨɫɬɶɸ ɩɟɪɟɞɚɱɢ ɬɪɚɧɫɦɢɫɫɢɜɧɵɯ
ɢɧɮɟɤɰɢɣ. ɋɥɟɞɭɟɬ ɬɚɤɠɟ ɭɤɚɡɚɬɶ, ɱɬɨ ɬɤɚɧɟɜɵɟ ɬɪɚɧɫɩɥɚɧɬɚɬɵ ɢɦɟɸɬ ɬɟɧɞɟɧɰɢɸ ɤ
ɩɨɬɟɪɟ ɨɛɴɟɦɚ ɢɢɥɢ ɮɨɪɦɵ (ɜ ɫɪɟɞɧɟɦ ɨɬ
40 ɞɨ 60%) ɜ ɨɬɞɚɥɟɧɧɵɟ ɩɟɪɢɨɞɵ ɩɨɫɥɟ
ɢɦɩɥɚɧɬɚɰɢɢ [18, 19, 20]. ȿɳɺ ɨɞɢɧ ɬɪɚɧɫɩɥɚɧɬɚɰɢɨɧɧɵɣ ɦɟɬɨɞ ɜɨɫɫɬɚɧɨɜɢɬɟɥɶɧɨɝɨ ɥɟɱɟɧɢɹ ɨɫɧɨɜɚɧ ɧɚ ɢɫɩɨɥɶɡɨɜɚɧɢɢ ɫɢɧɬɟɬɢɱɟɫɤɢɯ ɢɦɩɥɚɧɬɚɬɨɜ (ɬɚɤɢɯ ɤɚɤ ɫɢɥɢɤɨɧ, ɩɨɥɢɩɪɨɩɢɥɟɧ ɢ ɞɪ.). Ȼɟɡɭɫɥɨɜɧɨ, ɩɨɥɨɠɢɬɟɥɶɧɨɣ ɱɟɪɬɨɣ ɢɫɩɨɥɶɡɨɜɚɧɢɹ ɫɢɧɬɟɬɢɱɟɫɤɢɯ ɢɦɩɥɚɧɬɚɬɨɜ ɹɜɥɹɟɬɫɹ ɢɯ ɧɟɨɝɪɚɧɢɱɟɧɧɵɣ ɪɟɫɭɪɫ. ɇɟɝɚɬɢɜɧɚɹ ɫɬɨɪɨɧɚ
135
” ɇɨɜɨɫɬɢ ɯɢɪɭɪɝɢɢ
ɫɜɹɡɚɧɚ ɫ ɜɨɡɦɨɠɧɨɫɬɶɸ ɪɚɡɪɵɜɚ, ɭɬɟɱɤɢ
ɢɥɢ ɫɦɟɳɟɧɢɹ, ɧɟɩɨɥɧɨɣ ɛɢɨɫɨɜɦɟɫɬɢɦɨɫɬɶɸ ɫ ɨɤɪɭɠɚɸɳɢɦɢ ɬɤɚɧɹɦɢ ɢɥɢ ɞɚɠɟ
ɪɚɡɜɢɬɢɹ ɩɨɥɧɨɣ «ɪɟɚɤɰɢɢ ɨɬɬɨɪɠɟɧɢɹ»
ɢɦɩɥɚɧɬɢɪɭɟɦɨɝɨ ɦɚɬɟɪɢɚɥɚ [19, 21]. Ȼɨɥɟɟ ɬɨɝɨ, ɜɫɟ ɩɟɪɟɱɢɫɥɟɧɧɵɟ ɜɵɲɟ ɦɟɬɨɞɢɤɢ ɧɚɩɪɚɜɥɟɧɵ ɥɢɲɶ ɧɚ ɡɚɦɟɳɟɧɢɟ ɮɨɪɦɵ ɢ ɫɬɪɭɤɬɭɪɵ ɩɨɜɪɟɠɞɺɧɧɨɣ ɬɤɚɧɢ, ɧɨ
ɧɟ ɨɛɟɫɩɟɱɢɜɚɸɬ ɩɨɥɧɨɰɟɧɧɨɝɨ ɜɨɫɫɬɚɧɨɜɥɟɧɢɹ ɮɭɧɤɰɢɢ.
Ƚɨɜɨɪɹ ɨ ɬɟɪɦɢɱɟɫɤɨɣ ɬɪɚɜɦɟ, ɧɭɠɧɨ
ɨɬɦɟɬɢɬɶ, ɱɬɨ ɡɚ ɩɨɫɥɟɞɧɢɟ ɞɟɫɹɬɢɥɟɬɢɹ ɜ
ɥɟɱɟɧɢɢ ɨɠɨɝɨɜɵɯ ɛɨɥɶɧɵɯ ɫ ɞɟɮɟɤɬɚɦɢ
ɦɹɝɤɢɯ ɬɤɚɧɟɣ ɞɨɫɬɢɝɧɭɬɵ ɨɩɪɟɞɟɥɺɧɧɵɟ
ɭɫɩɟɯɢ [2, 5]. Ɍɚɤ, ɪɚɡɪɚɛɨɬɚɧ ɪɹɞ ɩɟɪɟɜɹɡɨɱɧɵɯ ɫɪɟɞɫɬɜ ɞɥɹ ɥɟɱɟɧɢɹ ɝɥɭɛɨɤɢɯ ɨɠɨɝɨɜ, ɤɨɬɨɪɵɟ ɩɨɡɜɨɥɹɸɬ ɫɧɢɡɢɬɶ ɪɢɫɤ ɪɚɡɜɢɬɢɹ ɬɹɠɺɥɵɯ ɢɧɮɟɤɰɢɨɧɧɵɯ ɨɫɥɨɠɧɟɧɢɣ, ɩɨɬɟɪɸ ɠɢɞɤɨɫɬɢ, ɛɟɥɤɨɜ, ɷɥɟɤɬɪɨɥɢɬɨɜ ɢ ɞɪɭɝɢɯ ɠɢɡɧɟɧɧɨ ɧɟɨɛɯɨɞɢɦɵɯ ɛɢɨɥɨɝɢɱɟɫɤɢɯ ɜɟɳɟɫɬɜ. ȼɦɟɫɬɟ ɫ ɬɟɦ, ɨɛɳɟɢɡɜɟɫɬɧɨ, ɱɬɨ ɷɩɢɬɟɥɢɡɚɰɢɹ ɪɚɧ ɫ ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ ɛɢɨɥɨɝɢɱɟɫɤɢɯ ɩɨɜɹɡɨɤ ɜɨɡɦɨɠɧɚ ɬɨɥɶɤɨ ɩɪɢ ɩɨɝɪɚɧɢɱɧɵɯ (ɩɨɜɟɪɯɧɨɫɬɧɵɯ ɢ ɧɟɛɨɥɶɲɢɯ ɩɨ ɩɥɨɳɚɞɢ) ɨɠɨɝɚɯ, ɜ ɬɨ
ɜɪɟɦɹ ɤɚɤ ɩɪɢ ɝɥɭɛɨɤɢɯ ɢ ɨɛɲɢɪɧɵɯ ɬɟɪɦɢɱɟɫɤɢɯ ɩɨɪɚɠɟɧɢɹɯ ɬɪɟɛɭɟɬɫɹ ɨɛɹɡɚɬɟɥɶɧɚɹ ɩɟɪɟɫɚɞɤɚ ɤɨɠɢ [8, 13].
ɇɚɢɛɨɥɟɟ ɱɚɫɬɨ ɜɨɫɫɬɚɧɨɜɥɟɧɢɟ ɡɧɚɱɢɬɟɥɶɧɵɯ ɤɨɠɧɵɯ ɞɟɮɟɤɬɨɜ ɨɫɭɳɟɫɬɜɥɹɟɬɫɹ
ɩɭɬɺɦ ɚɭɬɨɞɟɪɦɨɩɥɚɫɬɢɤɢ – ɩɟɪɟɫɚɞɤɢ ɧɚ
ɩɨɫɬɪɚɞɚɜɲɢɟ ɭɱɚɫɬɤɢ ɥɨɫɤɭɬɨɜ ɤɨɠɢ, ɜɡɹɬɵɯ ɢɡ ɧɟɩɨɜɪɟɠɞɺɧɧɵɯ ɭɱɚɫɬɤɨɜ ɬɟɥɚ [8].
Ɉɞɧɚɤɨ ɩɪɢ ɨɛɲɢɪɧɵɯ ɝɥɭɛɨɤɢɯ ɨɠɨɝɚɯ ɛɨɥɟɟ 30–40% ɩɨɜɟɪɯɧɨɫɬɢ ɬɟɥɚ ɡɚɤɪɵɬɶ ɜɫɟ
ɪɚɧɵ ɩɪɢ ɩɨɦɨɳɢ ɥɢɲɶ ɨɞɧɢɯ ɚɭɬɨɞɟɪɦɨɬɪɚɧɫɩɥɚɧɬɚɬɨɜ (ɞɚɠɟ ɩɟɪɮɨɪɢɪɨɜɚɧɧɵɯ ɢ
ɪɚɫɬɹɧɭɬɵɯ ɫ ɩɨɦɨɳɶɸ ɫɨɜɪɟɦɟɧɧɵɯ ɬɟɯɧɢɱɟɫɤɢɯ ɜɨɡɦɨɠɧɨɫɬɟɣ) ɧɟɥɶɡɹ ɜɫɥɟɞɫɬɜɢɟ
ɞɟɮɢɰɢɬɚ ɞɨɧɨɪɫɤɢɯ ɪɟɫɭɪɫɨɜ, ɱɬɨ ɫɭɳɟɫɬɜɟɧɧɨ ɡɚɬɪɭɞɧɹɟɬ ɜɨɡɦɨɠɧɨɫɬɶ ɨɞɧɨɦɨɦɟɧɬɧɨɣ ɩɥɚɫɬɢɤɢ ɜɫɟɯ ɨɠɨɝɨɜɵɯ ɩɨɜɟɪɯɧɨɫɬɟɣ [5, 14, 22]. ɉɪɢ ɞɟɮɢɰɢɬɟ ɞɨɧɨɪɫɤɢɯ ɪɟɫɭɪɫɨɜ ɩɪɢɧɰɢɩɢɚɥɶɧɨɟ ɡɧɚɱɟɧɢɟ
ɩɪɢɨɛɪɟɬɚɸɬ ɦɚɤɫɢɦɚɥɶɧɨ ɩɨɥɧɨɟ ɩɪɢɠɢɜ136
ɥɟɧɢɟ ɩɟɪɟɫɚɠɟɧɧɵɯ ɚɭɬɨɞɟɪɦɚɥɶɧɵɯ ɥɨɫɤɭɬɨɜ ɢ ɝɥɚɞɤɨɟ ɡɚɠɢɜɥɟɧɢɟ ɞɨɧɨɪɫɤɢɯ ɪɚɧ,
ɩɨɫɤɨɥɶɤɭ ɜ ɫɥɭɱɚɟ ɨɫɥɨɠɧɺɧɧɨɝɨ ɬɟɱɟɧɢɹ
ɷɬɢɯ ɩɪɨɰɟɫɫɨɜ ɨɛɳɚɹ ɩɥɨɳɚɞɶ ɪɚɧɟɜɨɣ
ɩɨɜɟɪɯɧɨɫɬɢ (ɚ, ɫɥɟɞɨɜɚɬɟɥɶɧɨ, ɢ ɬɹɠɟɫɬɶ
ɩɨɪɚɠɟɧɢɹ) ɭɜɟɥɢɱɢɜɚɟɬɫɹ [14, 23].
Ɍɚɤɢɦ ɨɛɪɚɡɨɦ, ɬɪɚɜɦɚɬɢɱɟɫɤɢɟ ɢ ɬɟɪɦɢɱɟɫɤɢɟ ɩɨɪɚɠɟɧɢɹ ɩɪɟɞɫɬɚɜɥɹɸɬ ɫɨɛɨɣ
ɨɞɢɧ ɢɡ ɫɚɦɵɯ ɫɥɨɠɧɵɯ ɪɚɡɞɟɥɨɜ ɤɥɢɧɢɱɟɫɤɨɣ ɦɟɞɢɰɢɧɵ. ɇɚ ɫɟɝɨɞɧɹɲɧɢɣ ɞɟɧɶ
ɢɦɟɸɬ ɦɟɫɬɨ ɪɚɡɥɢɱɧɵɟ ɩɭɬɢ ɪɟɲɟɧɢɹ ɷɬɨɣ
ɩɪɨɛɥɟɦɵ.
ɉɪɢɫɭɠɞɟɧɢɟ ɜ 1990 ɝɨɞɭ ɟɞɢɧɨɣ ɇɨɛɟɥɟɜɫɤɨɣ ɩɪɟɦɢɢ ɜ ɨɛɥɚɫɬɢ ɦɟɞɢɰɢɧɵ
ɞɜɭɦ ɜɵɞɚɸɳɢɦɫɹ ɭɱɺɧɵɦɦɟɞɢɤɚɦ E.D.
Thomas (ɡɚ ɪɚɡɪɚɛɨɬɤɭ ɢ ɜɧɟɞɪɟɧɢɟ ɬɪɚɧɫɩɥɚɧɬɚɰɢɢ ɤɥɟɬɨɤ ɤɨɫɬɧɨɝɨ ɦɨɡɝɚ) ɢ G.
Murray (ɡɚ ɪɚɡɪɚɛɨɬɤɭ ɢ ɜɧɟɞɪɟɧɢɟ ɩɟɪɟɫɚɞɤɢ ɩɨɱɤɢ ɜ ɤɥɢɧɢɱɟɫɤɭɸ ɩɪɚɤɬɢɤɭ) ɹɜɢɥɨɫɶ ɩɪɢɡɧɚɧɢɟɦ ɪɚɜɧɨɣ ɡɧɚɱɢɦɨɫɬɢ ɞɥɹ
ɱɟɥɨɜɟɱɟɫɬɜɚ ɪɚɡɜɢɬɢɹ ɤɥɟɬɨɱɧɨɝɨ ɢ ɨɪɝɚɧɧɨɝɨ ɧɚɩɪɚɜɥɟɧɢɣ ɬɪɚɧɫɩɥɚɧɬɚɰɢɨɧɧɨɣ
ɦɟɞɢɰɢɧɵ.
ɇɟɨɫɩɨɪɢɦɵɦɢ ɩɪɟɢɦɭɳɟɫɬɜɚɦɢ ɤɥɟɬɨɱɧɨɣ ɬɪɚɧɫɩɥɚɧɬɚɰɢɢ ɹɜɥɹɸɬɫɹ ɞɨɫɬɚɬɨɱɧɨ ɧɢɡɤɚɹ ɫɟɛɟɫɬɨɢɦɨɫɬɶ ɦɧɨɝɢɯ ɬɟɯɧɨɥɨɝɢɣ ɢ ɜɨɡɦɨɠɧɨɫɬɶ ɢɫɩɨɥɶɡɨɜɚɧɢɹ ɫɥɚɛɵɯ
ɢɦɦɭɧɨɫɭɩɪɟɫɫɢɜɧɵɯ ɩɪɟɩɚɪɚɬɨɜ (ɞɥɹ ɩɪɨɮɢɥɚɤɬɢɤɢ ɪɟɚɤɰɢɢ ɨɬɬɨɪɠɟɧɢɹ) ɢɥɢ, ɜɨɜɫɟ, ɨɬɤɚɡ ɨɬ ɧɢɯ ɩɨɥɧɨɫɬɶɸ. ɗɬɢ ɨɫɨɛɟɧɧɨɫɬɢ ɩɨɞɞɟɪɠɢɜɚɸɬ ɩɟɪɫɩɟɤɬɢɜɧɨɟ ɪɚɡɜɢɬɢɟ ɦɟɬɨɞɚ ɜɟɞɭɳɢɦɢ ɦɢɪɨɜɵɦɢ ɫɩɟɰɢɚɥɢɫɬɚɦɢ ɧɚ ɩɪɨɬɹɠɟɧɢɢ ɩɨɫɥɟɞɧɢɯ ɬɪɺɯ
ɞɟɫɹɬɢɥɟɬɢɣ [6, 10, 12, 13, 22].
Ɋɟɡɭɥɶɬɚɬɵ ɤɥɟɬɨɱɧɨɣ ɬɪɚɧɫɩɥɚɧɬɚɰɢɢ,
ɨɫɭɳɟɫɬɜɥɹɟɦɨɣ ɤɚɤ ɩɭɬɺɦ ɬɪɚɧɫɩɥɚɧɬɚɰɢɢ
ɨɬɞɟɥɶɧɵɯ ɤɥɟɬɨɤ, ɬɚɤ ɢ ɩɭɬɺɦ ɬɪɚɧɫɩɥɚɧɬɚɰɢɢ ɠɢɜɵɯ ɷɤɜɢɜɚɥɟɧɬɨɜ ɬɤɚɧɟɣ, ɩɪɟɞɜɚɪɢɬɟɥɶɧɨ ɫɨɡɞɚɧɧɵɯ in vitro, ɜ ɥɟɱɟɧɢɢ
ɪɹɞɚ ɡɚɛɨɥɟɜɚɧɢɣ ɭɠɟ ɫɬɨɥɶ ɡɧɚɱɢɦɵ, ɱɬɨ
ɦɨɠɧɨ ɝɨɜɨɪɢɬɶ ɨ ɜɨɡɧɢɤɧɨɜɟɧɢɢ ɧɨɜɨɣ
ɨɬɪɚɫɥɢ ɧɚɭɤɢ. ɍɱɺɧɵɟ ɜ ɨɛɥɚɫɬɢ ɬɤɚɧɟɜɨɣ
ɢɧɠɟɧɟɪɢɢ ɩɪɢɦɟɧɹɸɬ ɩɪɢɧɰɢɩɵ ɤɥɟɬɨɱɧɨɣ ɬɪɚɧɫɩɥɚɧɬɚɰɢɢ ɞɥɹ ɫɨɡɞɚɧɢɹ ɛɢɨɥɨɝɢɱɟɫɤɢɯ ɡɚɦɟɫɬɢɬɟɥɟɣ, ɫɩɨɫɨɛɧɵɯ ɜɨɫɫɬɚ-
ʋ5x 2010 i ɬɨɦ 18
ɧɨɜɢɬɶ ɢ ɩɨɞɞɟɪɠɚɬɶ ɧɨɪɦɚɥɶɧɭɸ ɮɭɧɤɰɢɸ
ɜ ɛɨɥɶɧɵɯ ɢ ɩɨɜɪɟɠɞɟɧɧɵɯ ɨɪɝɚɧɚɯ ɢ ɬɤɚɧɹɯ. ȼ ɧɚɫɬɨɹɳɟɟ ɜɪɟɦɹ ɦɨɠɧɨ ɜɵɞɟɥɢɬɶ
ɞɜɚ ɨɫɧɨɜɧɵɯ ɩɨɞɯɨɞɚ ɢɫɩɨɥɶɡɨɜɚɧɢɹ ɤɥɟɬɨɱɧɵɯ ɬɟɯɧɨɥɨɝɢɣ ɜ ɦɟɞɢɰɢɧɟ. Ⱦɥɹ ɩɟɪɜɨɝɨ ɯɚɪɚɤɬɟɪɧɨ ɩɪɢɦɟɧɟɧɢɟ ɫɩɟɰɢɚɥɢɡɢɪɨɜɚɧɧɵɯ (ɞɢɮɮɟɪɟɧɰɢɪɨɜɚɧɧɵɯ) ɤɥɟɬɨɤ
ɱɟɥɨɜɟɤɚ ɢɥɢ ɠɢɜɨɬɧɵɯ. ɂ ɜɬɨɪɨɣ ɩɨɞɯɨɞ,
ɪɚɡɜɢɬɢɟ ɤɨɬɨɪɨɝɨ ɧɚɱɚɥɨɫɶ ɫɪɚɜɧɢɬɟɥɶɧɨ
ɧɟɞɚɜɧɨ (ɩɨɫɥɟɞɧɢɟ 7–10 ɥɟɬ), ɫɜɹɡɚɧ ɫ ɢɡɭɱɟɧɢɟɦ ɢ ɜɧɟɞɪɟɧɢɟɦ ɧɟɞɢɮɮɟɪɟɧɰɢɪɨɜɚɧɧɵɯ ɫɬɜɨɥɨɜɵɯ ɤɥɟɬɨɤ ɱɟɥɨɜɟɤɚ [13, 24].
Ɍɚɤ, ɩɟɪɜɵɟ ɩɨɩɵɬɤɢ ɞɥɢɬɟɥɶɧɨɝɨ ɫɨɯɪɚɧɟɧɢɹ ɠɢɡɧɟɫɩɨɫɨɛɧɨɫɬɢ ɮɪɚɝɦɟɧɬɨɜ
ɤɨɠɢ ɞɥɹ ɥɟɱɟɧɢɹ ɨɠɨɝɨɜ ɛɵɥɢ ɩɪɟɞɩɪɢɧɹɬɵ ɟɳɟ ɜ ɏ,ɏ ɜɟɤɟ A. Luinggran, ɤɨɬɨɪɵɣ
ɫɨɯɪɚɧɹɥ ɤɭɫɨɱɤɢ ɤɨɠɢ ɜ ɚɫɰɢɬɢɱɟɫɤɨɣ
ɠɢɞɤɨɫɬɢ, ɚ ɡɚɬɟɦ ɬɪɚɧɫɩɥɚɧɬɢɪɨɜɚɥ ɢɯ ɞɨɧɨɪɭ, ɨɬ ɤɨɬɨɪɨɝɨ ɨɧɢ ɛɵɥɢ ɩɨɥɭɱɟɧɵ. ɉɟɪɜɵɟ ɫɨɨɛɳɟɧɢɹ ɨ ɤɭɥɶɬɢɜɢɪɨɜɚɧɢɢ ɤɥɟɬɨɤ
ɤɨɠɢ ɩɨɹɜɢɥɢɫɶ ɜ 40-ɯ ɝɨɞɚɯ ɩɪɨɲɥɨɝɨ ɜɟɤɚ.
ȼ 70-ɵɟ ɝɨɞɵ ɛɵɥɨ ɩɪɟɞɥɨɠɟɧɨ ɢɫɩɨɥɶɡɨɜɚɬɶ ɤɭɥɶɬɢɜɢɪɭɟɦɵɟ ɤɥɟɬɤɢ ɤɨɠɢ (ɤɟɪɚɬɢɧɨɰɢɬɵ) ɜ ɥɟɱɟɧɢɢ ɨɠɨɝɨɜ [25, 26]. ɉɟɪɜɨɟ ɤɥɢɧɢɱɟɫɤɨɟ ɩɪɢɦɟɧɟɧɢɟ ɚɭɬɨɤɟɪɚɬɢɧɨɰɢɬɨɜ, ɤɭɥɶɬɢɜɢɪɨɜɚɧɧɵɯ ɩɨ ɦɟɬɨɞɭ J.
Rheinwald ɢ H. Green ɭ ɥɸɞɟɣ, ɨɫɭɳɟɫɬɜɢɥ
ɜ 1981 ɝɨɞɭ N.E. O’Connor ɫ ɫɨɚɜɬɨɪɚɦɢ.
Ƚɪɭɩɩɨɣ ɢɫɫɥɟɞɨɜɚɬɟɥɟɣ (N.E. O’Connor,
J.B. Mulletkin ɢ ɞɪ.) ɛɵɥɢ ɭɫɩɟɲɧɨ ɩɪɨɥɟɱɟɧɵ ɞɜɨɟ ɛɨɥɶɧɵɯ ɫ ɬɟɪɦɢɱɟɫɤɢɦɢ ɨɠɨɝɚɦɢ ɩɥɨɳɚɞɶɸ 80 ɢ 40% ɩɨɜɟɪɯɧɨɫɬɢ ɬɟɥɚ.
Ɇɟɬɨɞ ɥɟɱɟɧɢɹ ɡɚɤɥɸɱɚɥɫɹ ɜ ɯɢɪɭɪɝɢɱɟɫɤɨɣ ɧɟɤɪɷɤɬɨɦɢɢ, ɜɪɟɦɟɧɧɨɦ ɡɚɤɪɵɬɢɢ ɨɛɪɚɡɨɜɚɜɲɢɯɫɹ ɪɚɧ ɬɪɭɩɧɨɣ ɤɨɠɟɣ ɢ ɬɪɚɧɫɩɥɚɧɬɚɰɢɢ ɧɚ ɪɚɧɟɜɭɸ ɩɨɜɟɪɯɧɨɫɬɶ ɱɟɪɟɡ
ɬɪɢ ɧɟɞɟɥɢ ɤɭɥɶɬɢɜɢɪɨɜɚɧɧɵɯ ɚɭɬɨɤɟɪɚɬɢɧɨɰɢɬɨɜ [27]. ȼ ɞɚɥɶɧɟɣɲɟɦ ɦɟɬɨɞ ɫɬɚɥ
ɜɧɟɞɪɹɬɶɫɹ ɜ ɤɥɢɧɢɱɟɫɤɭɸ ɩɪɚɤɬɢɤɭ ɜɟɞɭɳɢɯ ɨɠɨɝɨɜɵɯ ɰɟɧɬɪɨɜ ɪɚɡɜɢɬɵɯ ɫɬɪɚɧ
ɦɢɪɚ [2, 28]. Ɉɞɧɚɤɨ, ɜ ɨɬɫɭɬɫɬɜɢɟ ɮɢɛɪɨɛɥɚɫɬɨɜ, ɤɟɪɚɬɢɧɨɰɢɬɵ, ɯɨɬɶ ɢ ɨɤɚɡɵɜɚɸɬ
ɫɬɢɦɭɥɢɪɭɸɳɟɟ ɞɟɣɫɬɜɢɟ ɧɚ ɫɨɛɫɬɜɟɧɧɵɟ
ɤɥɟɬɤɢ ɪɟɰɢɩɢɟɧɬɚ, ɩɪɚɤɬɢɱɟɫɤɢ ɧɟ ɩɪɢɠɢɜɚɸɬɫɹ ɩɪɢ ɬɪɚɧɫɩɥɚɧɬɚɰɢɢ ɧɚ ɝɪɚɧɭ-
ɥɢɪɭɸɳɢɟ ɨɠɨɝɨɜɵɟ ɪɚɧɵ [27]. Ɉɬɫɭɬɫɬɜɢɟ
ɞɟɪɦɵ ɩɪɢ ɝɥɭɛɨɤɢɯ ɨɠɨɝɚɯ ɩɨɫɥɭɠɢɥɨ ɨɫɧɨɜɚɧɢɟɦ ɞɥɹ ɪɚɡɪɚɛɨɬɤɢ ɦɟɬɨɞɨɜ ɟɺ ɜɨɫɫɬɚɧɨɜɥɟɧɢɹ. Ɉɞɧɢɦ ɢɡ ɧɚɢɛɨɥɟɟ ɩɟɪɫɩɟɤɬɢɜɧɵɯ ɩɨɞɯɨɞɨɜ ɩɪɢ ɷɬɨɦ, ɧɚ ɧɚɲ ɜɡɝɥɹɞ,
ɹɜɥɹɟɬɫɹ ɢɫɩɨɥɶɡɨɜɚɧɢɟ ɮɢɛɪɨɛɥɚɫɬɨɜ.
ɉɨɤɚɡɚɧɨ, ɱɬɨ ɬɪɚɧɫɩɥɚɧɬɚɰɢɹ ɤɭɥɶɬɢɜɢɪɨɜɚɧɧɵɯ ɮɢɛɪɨɛɥɚɫɬɨɜ ɩɪɢ ɥɟɱɟɧɢɢ ɨɠɨɝɨɜ
IIIȺ ɫɬɟɩɟɧɢ ɡɧɚɱɢɬɟɥɶɧɨ ɭɫɤɨɪɹɟɬ ɷɩɢɬɟɥɢɡɚɰɢɸ ɪɚɧ ɢ ɨɛɟɫɩɟɱɢɜɚɟɬ ɡɚɠɢɜɥɟɧɢɟ
ɩɨɝɪɚɧɢɱɧɵɯ ɨɠɨɝɨɜ. ɉɚɬɨɝɟɧɟɬɢɱɟɫɤɢɣ
ɦɟɯɚɧɢɡɦ ɞɟɣɫɬɜɢɹ ɬɚɤɨɝɨ ɩɨɞɯɨɞɚ ɡɚɤɥɸɱɚɟɬɫɹ ɜ ɫɬɢɦɭɥɹɰɢɢ ɚɥɥɨɝɟɧɧɵɦɢ ɮɢɛɪɨɛɥɚɫɬɚɦɢ ɩɪɨɥɢɮɟɪɚɰɢɢ ɢ ɞɢɮɮɟɪɟɧɰɢɪɨɜɤɢ ɩɟɪɢɜɚɫɤɭɥɨɰɢɬɨɜ ɪɟɰɢɩɢɟɧɬɨɜ, ɤɨɬɨɪɵɟ, ɬɪɚɧɫɮɨɪɦɢɪɭɹɫɶ ɜ ɮɢɛɪɨɛɥɚɫɬɵ, ɫɩɨɫɨɛɫɬɜɭɟɬ ɩɪɨɥɢɮɟɪɚɰɢɢ ɢ ɦɢɝɪɚɰɢɢ ɜ ɪɚɧɟɜɭɸ ɡɨɧɭ ɤɟɪɚɬɢɧɨɰɢɬɨɜ [29, 30]. Ɋɹɞɨɦ
ɚɜɬɨɪɨɜ ɨɩɢɫɵɜɚɸɬɫɹ ɫɥɭɱɚɢ ɩɪɢɦɟɧɟɧɢɹ
ɚɥɥɨɮɢɛɪɨɛɥɚɫɬɨɜ ɜ ɥɟɱɟɧɢɢ ɞɥɢɬɟɥɶɧɵɯ
ɧɟ ɡɚɠɢɜɚɸɳɢɯ ɞɨɧɨɪɫɤɢɯ ɪɚɧ, ɩɪɢɜɟɞɲɢɟ
ɤ ɨɛɪɚɡɨɜɚɧɢɸ ɝɢɩɟɪɬɪɨɮɢɱɟɫɤɢɯ ɢ ɤɟɥɨɢɞɧɵɯ ɪɭɛɰɨɜ [2].
ɇɚɢɛɨɥɟɟ ɩɟɪɫɩɟɤɬɢɜɧɵɦ ɧɚɩɪɚɜɥɟɧɢɟɦ ɜ ɩɥɚɫɬɢɱɟɫɤɢɣ ɯɢɪɭɪɝɢɢ ɹɜɥɹɟɬɫɹ ɩɪɨɢɡɜɨɞɫɬɜɨ ɪɚɡɥɢɱɧɵɯ «ɤɨɠɧɵɯ ɷɤɜɢɜɚɥɟɧɬɨɜ», ɜɤɥɸɱɚɸɳɢɯ ɤɚɤ ɤɭɥɶɬɢɜɢɪɨɜɚɧɧɵɟ
ɤɥɟɬɤɢ, ɬɚɤ ɢ ɞɟɪɦɚɥɶɧɵɣ ɷɤɜɢɜɚɥɟɧɬ, ɫɨɫɬɨɹɳɢɣ ɢɡ ɝɥɢɤɨɡɚɦɢɧɨɝɥɢɤɚɧɨɜ, ɤɨɥɥɚɝɟɧɚ ɢ ɞɪɭɝɢɯ ɧɨɫɢɬɟɥɟɣ. ɋɨɜɪɟɦɟɧɧɵɟ
©ɠɢɜɵɟ ɷɤɜɢɜɚɥɟɧɬɵ ɤɨɠɢ» ɩɪɟɞɫɬɚɜɥɹɸɬ
ɫɨɛɨɣ ɬɤɚɧɟɢɧɠɟɧɟɪɧɵɟ ɤɨɧɫɬɪɭɤɰɢɢ ɧɚ
ɨɫɧɨɜɟ ɤɟɪɚɬɢɧɨɰɢɬɨɜ, ɮɢɛɪɨɛɥɚɫɬɨɜ ɢ
ɤɨɥɥɚɝɟɧɨɜɨɣ ɦɚɬɪɢɰɵ [30, 31]. Ɍɚɤɢɦ ɨɛɪɚɡɨɦ, ɩɪɢɦɟɧɟɧɢɟ ɤɥɟɬɨɱɧɵɯ ɬɟɯɧɨɥɨɝɢɣ
ɜ ɥɟɱɟɧɢɢ ɬɹɠɟɥɨ ɨɛɨɠɠɺɧɧɵɯ ɭɠɟ ɤ ɧɚɫɬɨɹɳɟɦɭ ɜɪɟɦɟɧɢ ɩɪɢɜɟɥɢ ɤ ɡɧɚɱɢɬɟɥɶɧɨɦɭ ɩɪɨɝɪɟɫɫɭ ɢ ɪɚɫɲɢɪɟɧɢɸ ɜɨɡɦɨɠɧɨɫɬɟɣ
ɨɤɚɡɚɧɢɹ ɢɦ ɫɩɟɰɢɚɥɢɡɢɪɨɜɚɧɧɨɣ ɦɟɞɢɰɢɧɫɤɨɣ ɩɨɦɨɳɢ. Ɍɟɦ ɧɟ ɦɟɧɟɟ, ɩɪɨɝɧɨɡ
ɨɛɲɢɪɧɵɯ ɢ ɝɥɭɛɨɤɢɯ ɨɠɨɝɨɜ ɧɟ ɩɨɥɧɨɫɬɶɸ ɭɞɨɜɥɟɬɜɨɪɢɬɟɥɟɧ ɢɡɡɚ ɜɨɡɧɢɤɧɨɜɟɧɢɹ
ɝɪɭɛɵɯ ɪɭɛɰɨɜ ɢ ɩɨɬɟɪɢ ɧɨɪɦɚɥɶɧɨɣ ɮɭɧɤɰɢɢ ɤɨɠɢ ɢ ɟɺ ɩɪɢɞɚɬɤɨɜ, ɱɬɨ ɫɟɪɶɺɡɧɨ
ɜɥɢɹɟɬ ɧɚ ɤɚɱɟɫɬɜɨ ɠɢɡɧɢ ɩɚɰɢɟɧɬɨɜ. ɍɱɢ137
” ɇɨɜɨɫɬɢ ɯɢɪɭɪɝɢɢ
ɬɵɜɚɹ ɜɵɲɟɫɤɚɡɚɧɧɨɟ, ɭɦɟɧɶɲɟɧɢɟ ɱɚɫɬɨɬɵ ɮɨɪɦɢɪɨɜɚɧɢɹ ɨɛɟɡɨɛɪɚɠɢɜɚɸɳɢɯ,
ɚɮɭɧɤɰɢɨɧɚɥɶɧɵɯ ɪɭɛɰɨɜ ɢ ɜɨɫɫɬɚɧɨɜɥɟɧɢɟ ɧɨɪɦɚɥɶɧɨɣ ɚɧɚɬɨɦɢɢ ɢ ɮɭɧɤɰɢɢ ɤɨɠɢ
ɢ ɟɺ ɩɪɢɞɚɬɤɨɜ ɫɮɨɪɦɢɪɨɜɚɥɢ ɨɞɧɨ ɢɡ ɧɚɩɪɚɜɥɟɧɢɣ ɢɫɫɥɟɞɨɜɚɧɢɣ ɜ ɪɟɝɟɧɟɪɚɬɢɜɧɨɣ
ɦɟɞɢɰɢɧɟ. Ɇɟɠɞɭ ɬɟɦ, ɫɨɯɪɚɧɹɸɳɢɣɫɹ ɨɫɬɪɵɣ ɞɟɮɢɰɢɬ ɞɨɧɨɪɫɤɨɝɨ ɦɚɬɟɪɢɚɥɚ ɞɥɹ
ɥɟɱɟɧɢɹ ɛɨɥɶɧɵɯ ɦɟɬɨɞɚɦɢ ɤɥɟɬɨɱɧɨɣ
ɬɪɚɧɫɩɥɚɧɬɚɰɢɢ, ɨɝɪɚɧɢɱɟɧɢɟ ɢɫɩɨɥɶɡɨɜɚɧɢɹ ɤɫɟɧɨɝɟɧɧɵɯ ɢɫɬɨɱɧɢɤɨɜ ɩɨ ɩɪɢɱɢɧɟ
ɢɯ ɛɨɥɟɟ ɜɵɫɨɤɨɣ ɚɧɬɢɝɟɧɧɨɫɬɢ, ɚ ɬɚɤɠɟ
ɨɩɚɫɧɨɫɬɢ ɡɚɪɚɠɟɧɢɹ ɩɪɢɨɧɚɦɢ ɢ ɞɪɭɝɢɦɢ ɢɧɮɟɤɰɢɹɦɢ, ɩɨɛɭɠɞɚɸɬ ɭɱɺɧɵɯ ɜɫɟɝɨ
ɦɢɪɚ ɪɚɡɪɚɛɚɬɵɜɚɬɶ ɢ ɢɫɤɚɬɶ ɧɨɜɵɟ ɩɨɞɯɨɞɵ ɞɥɹ ɪɟɲɟɧɢɹ ɩɟɪɟɱɢɫɥɟɧɧɵɯ ɩɪɨɛɥɟɦ.
Ɉɞɧɢɦ ɢɡ ɩɟɪɫɩɟɤɬɢɜɧɵɯ ɢ ɧɚɢɛɨɥɟɟ
ɲɢɪɨɤɨ ɨɛɫɭɠɞɚɟɦɵɯ ɜ ɞɨɫɬɭɩɧɨɣ ɥɢɬɟɪɚɬɭɪɟ ɧɚɩɪɚɜɥɟɧɢɣ ɪɚɡɜɢɬɢɹ ɯɢɪɭɪɝɢɱɟɫɤɢɯ
ɤɥɟɬɨɱɧɵɯ ɬɟɯɧɨɥɨɝɢɣ ɹɜɥɹɟɬɫɹ ɢɡɭɱɟɧɢɟ
ɢ ɩɪɢɦɟɧɟɧɢɟ ɫɬɜɨɥɨɜɵɯ ɤɥɟɬɨɤ (ɋɄ). Ɋɟɡɭɥɶɬɚɬɵ ɷɤɫɩɟɪɢɦɟɧɬɚɥɶɧɵɯ ɢɫɫɥɟɞɨɜɚɧɢɣ
ɩɨ ɢɫɩɨɥɶɡɨɜɚɧɢɸ ɋɄ ɩɨɤɚɡɚɥɢ, ɱɬɨ ɷɬɢ
ɤɥɟɬɤɢ ɦɨɝɭɬ ɭɱɚɫɬɜɨɜɚɬɶ ɜ ɜɨɫɫɬɚɧɨɜɥɟɧɢɢ
ɬɤɚɧɟɣ ɢ ɨɪɝɚɧɨɜ ɩɪɢ ɪɚɡɥɢɱɧɵɯ ɜɚɪɢɚɧɬɚɯ ɢɯ ɩɨɪɚɠɟɧɢɹ. Ɍɚɤɢɦ ɨɛɪɚɡɨɦ, ɩɨɞɯɨɞɵ ɤ ɜɨɫɫɬɚɧɨɜɥɟɧɢɸ ɨɪɝɚɧɨɜ ɢ ɬɤɚɧɟɣ ɫ
ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ ɫɨɜɪɟɦɟɧɧɵɯ ɫɢɥ ɢ
ɫɪɟɞɫɬɜ ɪɟɝɟɧɟɪɚɬɢɜɧɨɣ ɦɟɞɢɰɢɧɵ ɦɨɝɭɬ
ɫɬɚɬɶ ɧɚɭɱɧɵɦ ɩɪɨɪɵɜɨɦ, ɷɤɜɢɜɚɥɟɧɬɧɵɦ
ɩɨ ɫɜɨɟɣ ɡɧɚɱɢɦɨɫɬɢ ɨɬɤɪɵɬɢɸ ɚɧɬɢɛɢɨɬɢɤɨɜ ɜ ɞɜɚɞɰɚɬɨɦ ɜɟɤɟ [32].
Ɍɟɪɦɢɧ «ɫɬɜɨɥɨɜɚɹ ɤɥɟɬɤɚ» ɩɪɟɞɥɨɠɟɧ
ɨɬɟɱɟɫɬɜɟɧɧɵɦ ɭɱɺɧɵɦ ȺȺ. Ɇɚɤɫɢɦɨɜɵɦ
ɜ 1908 ɝɨɞɭ ɞɥɹ ɨɛɴɹɫɧɟɧɢɹ ɦɟɯɚɧɢɡɦɚ ɛɵɫɬɪɨɝɨ ɫɚɦɨɨɛɧɨɜɥɟɧɢɹ ɤɥɟɬɨɤ ɤɪɨɜɢ. ɋ
ɧɨɜɨɣ ɬɟɨɪɢɟɣ ɤɪɨɜɟɬɜɨɪɟɧɢɹ ɢɦ ɛɵɥɨ ɫɞɟɥɚɧɨ ɫɨɨɛɳɟɧɢɟ ɧɚ ɫɴɟɡɞɟ ɝɟɦɚɬɨɥɨɝɨɜ ɜ
Ȼɟɪɥɢɧɟ (Ƚɟɪɦɚɧɢɹ). ɂɦɟɧɧɨ ɷɬɨɬ ɝɨɞ ɦɨɠɧɨ ɩɨ ɩɪɚɜɭ ɫɱɢɬɚɬɶ ɧɚɱɚɥɨɦ ɢɫɬɨɪɢɢ ɪɚɡɜɢɬɢɹ ɢɫɫɥɟɞɨɜɚɧɢɣ ɋɄ. ɍɠɟ ɬɨɝɞɚ ɭɱɺɧɵɟ
ɩɨɞɨɡɪɟɜɚɥɢ, ɱɬɨ ɜɨ ɦɧɨɝɢɯ ɬɤɚɧɹɯ ɫɭɳɟɫɬɜɭɸɬ ɤɥɟɬɤɢ, ɫɩɨɫɨɛɫɬɜɭɸɳɢɟ ɪɟɝɟɧɟɪɚɰɢɢ ɬɤɚɧɟɣ ɢ ɚɤɬɢɜɢɡɢɪɭɸɳɢɟ ɞɟɥɟɧɢɟ
ɨɛɵɱɧɵɯ ɤɥɟɬɨɤ. ȼɦɟɫɬɟ ɫ ɬɟɦ, ɩɟɪɜɵɟ ɷɤ138
ɫɩɟɪɢɦɟɧɬɵ ɩɨ ɩɪɚɤɬɢɱɟɫɤɨɦɭ ɢɫɩɨɥɶɡɨɜɚɧɢɸ ɋɄ ɛɵɥɢ ɧɚɱɚɬɵ ɥɢɲɶ ɜ ɧɚɱɚɥɟ 1950ɯ ɝɨɞɨɜ. Ȼɵɥɨ ɞɨɤɚɡɚɧɨ, ɱɬɨ ɫ ɩɨɦɨɳɶɸ
ɬɪɚɧɫɩɥɚɧɬɚɰɢɢ ɤɨɫɬɧɨɝɨ ɦɨɡɝɚ (ɨɞɧɨɝɨ ɢɡ
ɢɫɬɨɱɧɢɤɨɜ ɋɄ) ɦɨɠɧɨ ɫɩɚɫɬɢ ɠɢɜɨɬɧɵɯ,
ɩɨɥɭɱɢɜɲɢɯ ɫɦɟɪɬɟɥɶɧɭɸ ɞɨɡɭ ɪɚɞɢɨɚɤɬɢɜɧɨɝɨ ɨɛɥɭɱɟɧɢɹ. ȼ 60-ɯ ɝɨɞɚɯ ɫɨɜɟɬɫɤɢɟ ɭɱɟɧɵɟ Ⱥɥɟɤɫɚɧɞɪ Ɏɪɢɞɟɧɲɬɟɣɧ ɢ ɂɨɫɢɮ
ɑɟɪɬɤɨɜ [33] ɡɚɥɨɠɢɥɢ ɮɭɧɞɚɦɟɧɬɚɥɶɧɵɟ
ɨɫɧɨɜɵ ɧɚɭɤɢ ɨ ɋɄ ɤɨɫɬɧɨɝɨ ɦɨɡɝɚ, ɞɨɤɚɡɚɜ, ɱɬɨ ɢɦɟɧɧɨ ɬɚɦ, ɝɥɚɜɧɵɦ ɨɛɪɚɡɨɦ, ɢ
ɧɚɯɨɞɢɬɫɹ ɫɜɨɟɨɛɪɚɡɧɨɟ «ɞɟɩɨ ɤɥɟɬɨɤ».
ɉɨɡɞɧɟɟ ɫɬɚɥɨ ɢɡɜɟɫɬɧɨ, ɱɬɨ ɱɚɫɬɶ ɋɄ ɦɢɝɪɢɪɭɟɬ ɩɨ ɤɪɨɜɹɧɨɦɭ ɪɭɫɥɭ, ɢɦɟɸɬɫɹ ɨɧɢ
ɢ ɜ ɪɚɡɥɢɱɧɵɯ ɬɤɚɧɹɯ (ɜ ɱɚɫɬɧɨɫɬɢ, ɜ ɤɨɠɧɨɣ ɢ ɠɢɪɨɜɨɣ ɬɤɚɧɢ) [15].
ɋɟɝɨɞɧɹ ɩɨɞ ɬɟɪɦɢɧɨɦ «ɫɬɜɨɥɨɜɚɹ
ɤɥɟɬɤɚ» ɩɨɧɢɦɚɸɬ ɤɥɨɧɨɝɟɧɧɭɸ ɤɥɟɬɤɭ,
ɫɩɨɫɨɛɧɭɸ ɝɟɧɟɪɢɪɨɜɚɬɶ ɪɚɡɥɢɱɧɵɟ ɬɢɩɵ
ɫɩɟɰɢɚɥɢɡɢɪɨɜɚɧɧɵɯ ɬɤɚɧɟɣ, ɜɵɩɨɥɧɹɸɳɢɯ ɫɩɟɰɢɮɢɱɟɫɤɢɟ ɮɭɧɤɰɢɢ ɜ ɨɪɝɚɧɢɡɦɟ.
ɋɪɟɞɢ ɨɫɧɨɜɧɵɯ ɢɫɬɨɱɧɢɤɨɜ ɤɥɟɬɨɤ, ɤɨɬɨɪɵɟ ɦɨɝɭɬ ɛɵɬɶ ɢɫɩɨɥɶɡɨɜɚɧɵ ɞɥɹ ɜɨɫɫɬɚɧɨɜɥɟɧɢɹ ɩɨɜɪɟɠɞɟɧɧɵɯ ɬɤɚɧɟɣ ɜɵɞɟɥɹɸɬ:
ɷɦɛɪɢɨɧɚɥɶɧɵɟ ɫɬɜɨɥɨɜɵɟ ɤɥɟɬɤɢ (ɗɋɄ) ɢ
ɋɄ ɜɡɪɨɫɥɨɝɨ ɨɪɝɚɧɢɡɦɚ [15, 34].
ɂɦɟɧɧɨ ɗɋɄ ɹɜɥɹɸɬɫɹ ɢɫɬɢɧɧɵɦɢ ɋɄ.
ɉɨ ɫɩɨɫɨɛɧɨɫɬɢ ɤ ɞɢɮɮɟɪɟɧɰɢɪɨɜɤɟ ɜɵɞɟɥɹɸɬ ɬɨɬɢɩɨɬɟɧɬɧɵɟ ɋɄ, ɤɨɬɨɪɵɟ ɮɨɪɦɢɪɭɸɬɫɹ ɧɚ 2–4-ɟ ɫɭɬɤɢ ɪɚɡɜɢɬɢɹ ɡɚɪɨɞɵɲɚ.
ȼ ɭɫɥɨɜɢɹɯ in situ ɨɧɢ ɫɩɨɫɨɛɧɵ ɪɚɡɜɢɜɚɬɶɫɹ ɞɨ ɫɬɚɞɢɢ ɜɡɪɨɫɥɨɝɨ ɨɪɝɚɧɢɡɦɚ. ɉɥɸɪɢɩɨɬɟɧɬɧɵɟ ɋɄ, ɩɪɟɞɫɬɚɜɥɹɸɳɢɟ ɫɨɛɨɣ ɡɚɪɨɞɵɲɟɜɵɟ ɤɥɟɬɤɢ, ɜɵɞɟɥɟɧɧɵɟ ɧɚ ɫɬɚɞɢɢ
ɛɥɚɫɬɨɰɢɫɬɵ ɪɚɡɜɢɬɢɹ ɱɟɥɨɜɟɱɟɫɤɨɝɨ ɡɚɪɨɞɵɲɚ, ɹɜɥɹɸɬɫɹ ɡɚɱɚɬɤɨɦ ɜɫɟɯ ɛɭɞɭɳɢɯ ɜɵɫɨɤɨɫɩɟɰɢɚɥɢɡɢɪɨɜɚɧɧɵɯ ɤɥɟɬɨɤ. ɂɡɡɚ ɨɝɪɚɧɢɱɟɧɧɵɯ ɜɨɡɦɨɠɧɨɫɬɟɣ ɤ ɞɢɮɮɟɪɟɧɰɢɪɨɜɤɟ ɜ ɫɩɟɰɢɚɥɢɡɢɪɨɜɚɧɧɵɟ ɤɥɟɬɤɢ ɪɚɡɥɢɱɧɵɯ ɬɢɩɨɜ, ɚ ɬɚɤɠɟ ɫɬɟɩɟɧɢ ɡɪɟɥɨɫɬɢ
ɞɢɮɮɟɪɟɧɰɢɪɨɜɤɢ) ɋɄ, ɜɵɞɟɥɟɧɧɵɟ ɧɚ
ɩɨɡɞɧɢɯ ɫɬɚɞɢɹɯ ɪɚɡɜɢɬɢɹ ɡɚɪɨɞɵɲɚ ɮɟɬɚɥɶɧɵɟ ɫɬɜɨɥɨɜɵɟ ɤɥɟɬɤɢ ɨɬɧɨɫɹɬ ɭɠɟ ɧɟ
ɤ ɩɥɸɪɢɩɨɬɟɧɬɧɵɦ, ɚ ɤ ɦɭɥɶɬɢɩɨɬɟɧɬɧɵɦ
ɋɄ [34]. ɇɟɨɛɯɨɞɢɦɨ ɤɨɧɫɬɚɬɢɪɨɜɚɬɶ, ɱɬɨ,
ʋ5x 2010 i ɬɨɦ 18
ɧɟɫɦɨɬɪɹ ɧɚ ɛɨɥɶɲɭɸ ɩɟɪɫɩɟɤɬɢɜɭ, ɢɫɩɨɥɶɡɨɜɚɧɢɟ ɗɋɄ ɨɝɪɚɧɢɱɟɧɨ ɢɡɡɚ ɧɚɭɱɧɵɯ,
ɩɨɥɢɬɢɱɟɫɤɢɯ ɢ ɷɬɢɱɟɫɤɢɯ ɫɨɨɛɪɚɠɟɧɢɣ
[34]. ȼ ɬɨ ɠɟ ɜɪɟɦɹ, ɩɪɢɦɟɧɟɧɢɟ ɋɄ ɜɡɪɨɫɥɨɝɨ ɨɪɝɚɧɢɡɦɚ, ɨɫɨɛɟɧɧɨ ɦɟɡɟɧɯɢɦɚɥɶɧɵɯ
ɫɬɜɨɥɨɜɵɯ ɤɥɟɬɨɤ (ɆɋɄ), ɧɟ ɨɛɪɟɦɟɧɟɧɨ
ɦɧɨɝɢɦɢ ɢɡ ɧɚɡɜɚɧɧɵɯ ɜɵɲɟ ɩɪɨɛɥɟɦ.
Ⱦɥɹ ɩɨɧɢɦɚɧɢɹ ɨɫɨɛɟɧɧɨɫɬɟɣ ɢɫɩɨɥɶɡɨɜɚɧɢɹ ɆɋɄ ɫɥɟɞɭɟɬ ɛɨɥɟɟ ɩɨɞɪɨɛɧɨ ɨɫɬɚɧɨɜɢɬɶɫɹ ɧɚ ɋɄ ɜɡɪɨɫɥɨɝɨ ɨɪɝɚɧɢɡɦɚ. ȼ
ɬɤɚɧɹɯ ɜɡɪɨɫɥɨɝɨ ɨɪɝɚɧɢɡɦɚ ɨɩɪɟɞɟɥɹɸɬ
ɤɥɟɬɨɱɧɵɟ ɷɥɟɦɟɧɬɵ, ɜ ɜɢɞɟ ɪɟɞɤɢɯ ɜɤɥɸɱɟɧɢɣ, ɫɩɨɫɨɛɧɵɯ ɤ ɞɢɮɮɟɪɟɧɰɢɪɨɜɤɟ ɧɟ
ɬɨɥɶɤɨ ɜ ɬɤɚɧɟɫɩɟɰɢɮɢɱɟɫɤɢɯ ɧɚɩɪɚɜɥɟɧɢɹɯ, ɧɨ ɢ ɜ ɤɥɟɬɤɢ ɢɧɨɝɨ ɬɤɚɧɟɜɨɝɨ ɩɪɨɢɫɯɨɠɞɟɧɢɹ. ȼ ɯɨɞɟ ɞɚɧɧɨɝɨ ɩɪɨɰɟɫɫɚ ɩɪɨɢɫɯɨɞɢɬ ɩɨɬɟɪɹ ɩɟɪɜɢɱɧɵɯ ɬɤɚɧɟɜɵɯ ɦɚɪɤɟɪɨɜ ɢ ɩɪɢɨɛɪɟɬɟɧɢɟ ɦɚɪɤɟɪɨɜ ɢ ɮɭɧɤɰɢɣ
ɜɧɨɜɶ ɨɛɪɚɡɨɜɚɧɧɨɝɨ ɤɥɟɬɨɱɧɨɝɨ ɬɢɩɚ [34].
ɗɬɨ ɹɜɥɟɧɢɟ ɩɨɥɭɱɢɥɨ ɧɚɡɜɚɧɢɟ «ɬɪɚɧɫɞɢɮɮɟɪɟɧɰɢɪɨɜɤɚ». Ⱥ ɩɨɞɨɛɧɵɟ ɤɥɟɬɨɱɧɵɟ ɷɥɟɦɟɧɬɵ ɤɥɚɫɫɢɮɢɰɢɪɨɜɚɧɵ ɤɚɤ ɋɄ
ɜɡɪɨɫɥɨɝɨ ɨɪɝɚɧɢɡɦɚ. ɉɟɪɟɱɟɧɶ ɬɤɚɧɟɣ, ɫɨɞɟɪɠɚɳɢɯ ɜɡɪɨɫɥɵɟ ɋɄ, ɩɨ ɦɟɪɟ ɪɚɫɲɢɪɟɧɢɹ ɢɫɫɥɟɞɨɜɚɧɢɣ ɩɨɫɬɨɹɧɧɨ ɭɜɟɥɢɱɢɜɚɟɬɫɹ ɢ ɜɤɥɸɱɚɟɬ ɤɨɫɬɧɵɣ ɦɨɡɝ, ɠɢɪɨɜɭɸ
ɬɤɚɧɶ, ɩɟɪɢɮɟɪɢɱɟɫɤɭɸ ɤɪɨɜɶ, ɝɨɥɨɜɧɨɣ ɢ
ɫɩɢɧɧɨɣ ɦɨɡɝ, ɞɟɧɬɚɥɶɧɭɸ ɩɭɥɶɩɭ, ɤɪɨɜɟɧɨɫɧɵɟ ɫɨɫɭɞɵ, ɫɤɟɥɟɬɧɵɟ ɦɵɲɰɵ, ɷɩɢɬɟɥɢɣ ɤɨɠɢ ɢ ɩɢɳɟɜɚɪɢɬɟɥɶɧɨɝɨ ɬɪɚɤɬɚ, ɪɨɝɨɜɢɰɭ, ɫɟɬɱɚɬɤɭ, ɩɨɞɠɟɥɭɞɨɱɧɭɸ ɠɟɥɟɡɭ ɢ
ɩɟɱɟɧɶ [16, 35]. Ɇɨɪɮɨɥɨɝɢɱɟɫɤɢ ɋɄ ɜɡɪɨɫɥɨɝɨ ɨɪɝɚɧɢɡɦɚ ɫɥɨɠɧɨ ɢɞɟɧɬɢɮɢɰɢɪɨɜɚɬɶ,
ɜ ɬɨ ɠɟ ɜɪɟɦɹ ɷɬɢ ɤɥɟɬɤɢ ɷɤɫɩɪɟɫɫɢɪɭɸɬ
ɧɟɤɨɬɨɪɵɟ ɭɧɢɤɚɥɶɧɵɟ ɦɚɪɤɟɪɵ, ɤɨɬɨɪɵɟ
ɩɨɡɜɨɥɹɸɬ ɜɵɹɜɥɹɬɶ ɢɯ ɜ ɬɤɚɧɹɯ. Ɍɚɤ, ɧɚɩɪɢɦɟɪ, ɮɟɧɨɬɢɩɢɱɟɫɤɢɦ «ɩɨɪɬɪɟɬɨɦ»
ɱɢɫɬɵɯ ɩɨɩɭɥɹɰɢɣ ɝɟɦɨɩɨɷɬɢɱɟɫɤɢɯ ɫɬɜɨɥɨɜɵɯ ɤɥɟɬɨɤ (ȽɋɄ) ɫɱɢɬɚɟɬɫɹ ɩɪɢɫɭɬɫɬɜɢɟ
ɧɚ ɩɨɜɟɪɯɧɨɫɬɢ ɤɥɟɬɨɤ ɦɚɪɤɟɪɨɜ
CD34,CD133,c-kit (CD117) ɢ ɨɬɫɭɬɫɬɜɢɟ
CD38. ɇɭɠɧɨ ɨɬɦɟɬɢɬɶ, ɱɬɨ ɦɚɪɤɟɪɵ
CD133 ɢ CD117 ɯɚɪɚɤɬɟɪɧɵ ɧɟ ɬɨɥɶɤɨ ɞɥɹ
ȽɋɄ, ɨɧɢ ɧɟ ɦɨɝɭɬ ɫɱɢɬɚɬɶɫɹ ɨɫɧɨɜɧɵɦɢ
ɩɪɢɡɧɚɤɚɦɢ ɩɪɢ ɢɯ ɜɵɞɟɥɟɧɢɢ [36].
Ȼɨɥɶɲɨɟ ɜɧɢɦɚɧɢɟ ɨɬɞɟɥɶɧɵɦɢ ɢɫɫɥɟɞɨɜɚɬɟɥɹɦɢ ɭɞɟɥɟɧɨ ɢɫɩɨɥɶɡɨɜɚɧɢɸ ɋɄ
ɜɡɪɨɫɥɨɝɨ ɨɪɝɚɧɢɡɦɚ ɞɥɹ ɜɨɫɫɬɚɧɨɜɥɟɧɢɹ
ɫɟɪɞɟɱɧɨɣ ɬɤɚɧɢ. Ⱥɪɬɟɪɢɨɫɤɥɟɪɨɡ ɢ ɢɧɮɚɪɤɬ ɦɢɨɤɚɪɞɚ ɨɫɬɚɸɬɫɹ «ɩɪɢɱɢɧɨɣ ɧɨɦɟɪ ɨɞɢɧ» ɫɦɟɪɬɧɨɫɬɢ ɜɨ ɦɧɨɝɢɯ ɫɬɪɚɧɚɯ
ɦɢɪɚ. ȼ ɨɬɥɢɱɢɟ ɨɬ ɫɤɟɥɟɬɧɨɣ ɦɭɫɤɭɥɚɬɭɪɵ, ɤɚɪɞɢɨɦɢɨɰɢɬɵ ɨɝɪɚɧɢɱɢɜɚɸɬ ɩɨɬɟɧɰɢɚɥ ɜɨɫɫɬɚɧɨɜɥɟɧɢɹ ɫɟɪɞɟɱɧɨɣ ɦɵɲɰɵ.
ɇɟɤɪɨɬɢɡɢɪɨɜɚɧɧɵɟ ɤɚɪɞɢɨɦɢɨɰɢɬɵ ɜ ɩɨɜɪɟɠɞɺɧɧɨɣ ɬɤɚɧɢ ɡɚɦɟɳɚɸɬɫɹ ɮɢɛɪɨɛɥɚɫɬɚɦɢ, ɮɨɪɦɢɪɭɸɳɢɦɢ ɪɭɛɟɰ, ɤɨɬɨɪɵɣ
ɩɪɢɜɨɞɢɬ ɤ ɧɚɪɭɲɟɧɢɸ ɫɨɤɪɚɬɢɬɟɥɶɧɨɣ
ɮɭɧɤɰɢɢ ɫɟɪɞɰɚ ɢ ɩɪɨɜɟɞɟɧɢɸ ɢɦɩɭɥɶɫɨɜ.
ɇɚɱɚɥɶɧɵɟ ɢɫɫɥɟɞɨɜɚɧɢɹ ɧɚ ɦɵɲɚɯ ɩɨɤɚɡɚɥɢ, ɱɬɨ ɋɄ ɜɡɪɨɫɥɨɝɨ ɨɪɝɚɧɢɡɦɚ, ɩɨɥɭɱɟɧɧɵɟ ɢɡ ɤɨɫɬɧɨɝɨ ɦɨɡɝɚ ɢ ɜɜɟɞɟɧɧɵɟ ɜ
ɦɢɨɤɚɪɞ ɪɟɰɢɩɢɟɧɬɚ, ɫɩɨɫɨɛɧɵ ɜɨɫɫɬɚɧɨɜɢɬɶ ɦɢɨɤɚɪɞ ɦɵɲɢ ɜ ɡɨɧɟ ɩɨɜɪɟɠɞɟɧɢɹ.
D. Ortic et al. [37] ɩɭɬɺɦ ɩɟɪɟɜɹɡɤɢ ɥɟɜɨɣ
ɝɥɚɜɧɨɣ ɤɨɪɨɧɚɪɧɨɣ ɚɪɬɟɪɢɢ ɜɵɡɵɜɚɥɢ
ɢɲɟɦɢɱɟɫɤɨɟ ɩɨɜɪɟɠɞɟɧɢɟ ɤɚɪɞɢɨɦɢɨɰɢɬɨɜ ɭ ɦɵɲɟɣ. Ɂɚɬɟɦ ɜ ɩɨɪɚɠɺɧɧɭɸ ɫɬɟɧɤɭ
ɥɟɜɨɝɨ ɠɟɥɭɞɨɱɤɚ ɜɜɨɞɢɥɢ ɋɄ. ɉɨɫɥɟ ɩɪɨɜɟɞɟɧɧɨɣ ɡɚɦɟɫɬɢɬɟɥɶɧɨɣ ɤɥɟɬɨɱɧɨɣ ɬɟɪɚɩɢɢ ɜɧɨɜɶ ɨɛɪɚɡɨɜɚɧɧɵɣ ɦɢɨɤɚɪɞ ɡɚɧɢɦɚɥ
ɨɤɨɥɨ 70% ɨɬ ɦɚɫɫɵ ɫɟɪɞɰɚ. ȼɦɟɫɬɟ ɫ ɬɟɦ,
ɚɧɚɥɨɝɢɱɧɵɟ ɢɫɫɥɟɞɨɜɚɧɢɹ ɧɚ ɤɪɵɫɚɯ ɧɟ
ɩɪɨɞɟɦɨɧɫɬɪɢɪɨɜɚɥɢ ɫɬɨɥɶ ɜɵɪɚɠɟɧɧɨɝɨ
ɭɥɭɱɲɟɧɢɹ ɫɟɪɞɟɱɧɨɣ ɪɟɝɟɧɟɪɚɰɢɢ [38].
ɍɱɺɧɵɦɢ J.G. Shake et al. [39] ɞɥɹ ɨɰɟɧɤɢ
ɭɥɭɱɲɟɧɢɹ ɮɭɧɤɰɢɢ ɫɟɪɞɰɚ ɩɨɫɥɟ ɬɪɚɧɫɩɥɚɧɬɚɰɢɢ ɚɭɬɨɥɨɝɢɱɧɵɯ ɋɄ ɜɡɪɨɫɥɨɝɨ
ɨɪɝɚɧɢɡɦɚ ɛɵɥɚ ɪɚɡɪɚɛɨɬɚɧɚ ɦɨɞɟɥɶ ɢɧɮɚɪɤɬɚ ɦɢɨɤɚɪɞɚ ɭ ɫɜɢɧɶɢ. ɆɋɄ ɛɵɥɢ ɜɵɞɟɥɟɧɵ ɢɡ ɤɨɫɬɧɨɝɨ ɦɨɡɝɚ, ɤɭɥɶɬɢɜɢɪɨɜɚɧɵ ɢ, ɫɩɭɫɬɹ ɞɜɟ ɧɟɞɟɥɢ ɩɨɫɥɟ ɢɧɮɚɪɤɬɚ
ɦɢɨɤɚɪɞɚ, 60 ɦɢɥɥɢɨɧɨɜ ɆɋɄ ɛɵɥɢ ɜɧɟɞɪɟɧɵ ɜ ɡɨɧɭ ɢɧɮɚɪɤɬɚ ɢɧɴɟɤɰɢɨɧɧɨ. ɉɨ
ɞɚɧɧɵɦ ɚɜɬɨɪɨɜ ɫɬɟɩɟɧɶ ɫɨɤɪɚɬɢɬɟɥɶɧɨɣ
ɞɢɫɮɭɧɤɰɢɢ ɛɵɥɚ ɡɧɚɱɢɬɟɥɶɧɨ ɫɧɢɠɟɧɚ ɭ
ɜɫɟɯ ɠɢɜɨɬɧɵɯ [39].
Ƚɪɭɩɩɚ ɧɟɦɟɰɤɢɯ ɭɱɺɧɵɯ B.E. Strauer
et al. [40] ɫɨɨɛɳɢɥɚ ɨ ɩɟɪɜɨɦ ɩɪɚɤɬɢɱɟɫɤɨɦ ɢɫɩɨɥɶɡɨɜɚɧɢɢ ɋɄ ɜɡɪɨɫɥɨɝɨ ɨɪɝɚɧɢɡ139
” ɇɨɜɨɫɬɢ ɯɢɪɭɪɝɢɢ
ɦɚ ɞɥɹ ɥɟɱɟɧɢɹ ɢɧɮɚɪɤɬɚ ɦɢɨɤɚɪɞɚ ɭ ɱɟɥɨɜɟɤɚ. Ɇɭɠɱɢɧɟ 46 ɥɟɬ ɫ ɨɫɬɪɵɦ ɬɪɚɧɫɦɭɪɚɥɶɧɵɦ ɢɧɮɚɪɤɬɨɦ ɛɵɥɢ ɬɪɚɧɫɩɥɚɧɬɢɪɨɜɚɧɵ ɋɄ ɤɨɫɬɧɨɝɨ ɦɨɡɝɚ ɜ ɨɤɤɥɸɡɢɪɨɜɚɧɧɭɸ ɤɨɪɨɧɚɪɧɭɸ ɚɪɬɟɪɢɸ. ɑɟɪɟɡ 10 ɧɟɞɟɥɶ ɩɨɫɥɟ ɬɪɚɧɫɩɥɚɧɬɚɰɢɢ ɋɄ ɡɨɧɚ ɢɧɮɚɪɤɬɚ ɭɦɟɧɶɲɢɥɚɫɶ ɫ 24,6 ɞɨ 15,7%. ɗɬɢ
ɪɟɡɭɥɶɬɚɬɵ ɩɪɨɞɟɦɨɧɫɬɪɢɪɨɜɚɥɢ, ɱɬɨ ɫɟɥɟɤɬɢɜɧɚɹ ɢɧɬɪɨɤɨɪɨɧɚɪɧɚɹ ɬɪɚɧɫɩɥɚɧɬɚɰɢɹ
ɚɭɬɨɥɨɝɢɱɧɵɯ ɋɄ ɜɨɡɦɨɠɧɚ ɜ ɤɥɢɧɢɱɟɫɤɢɯ
ɭɫɥɨɜɢɹɯ. [39, 40]
ɆɋɄ ɜɩɟɪɜɵɟ ɛɵɥɢ ɨɩɪɟɞɟɥɟɧɵ ɤɚɤ
ɤɨɥɨɧɢɟɨɛɪɚɡɭɸɳɢɟ ɟɞɢɧɢɰɵ ɮɢɛɪɨɛɥɚɫɬɩɨɞɨɛɧɵɯ ɤɥɟɬɨɤ ɜ 1970 ɝɨɞɭ [41]. Ɇɧɨɝɨɱɢɫɥɟɧɧɵɟ ɢɫɫɥɟɞɨɜɚɧɢɹ ɩɨɤɚɡɚɥɢ, ɱɬɨ ɤɨɫɬɧɵɣ ɦɨɡɝ, ɠɢɪɨɜɚɹ ɬɤɚɧɶ, ɩɭɥɶɩɚ ɡɭɛɚ,
ɤɨɠɚ, ɝɨɥɨɜɧɨɣ ɦɨɡɝ ɢ ɧɟɤɨɬɨɪɵɟ ɞɪɭɝɢɟ
ɬɤɚɧɢ ɫɨɞɟɪɠɚɬ ɫɭɛɩɨɩɭɥɹɰɢɸ ɤɥɟɬɨɤ, ɤɨɬɨɪɚɹ ɫɩɨɫɨɛɧɚ ɧɟ ɬɨɥɶɤɨ ɤ ɫɚɦɨɪɟɩɥɢɤɚɰɢɢ ɜɨ ɦɧɨɝɢɯ ɩɚɫɫɚɠɚɯ, ɧɨ ɢ ɬɚɤɠɟ ɦɨɠɟɬ ɞɢɮɮɟɪɟɧɰɢɪɨɜɚɬɶɫɹ ɜ ɨɫɬɟɨɛɥɚɫɬɵ,
ɚɞɢɩɨɰɢɬɵ, ɯɨɧɞɪɨɰɢɬɵ ɢ ɦɢɨɛɥɚɫɬɵ [24].
ɉɪɢ ɷɬɨɦ ɆɋɄ ɢɞɟɧɬɢɮɢɰɢɪɨɜɚɧɵ ɭ ɦɧɨɝɢɯ ɩɨɡɜɨɧɨɱɧɵɯ ɠɢɜɨɬɧɵɯ, ɜɤɥɸɱɚɹ ɱɟɥɨɜɟɤɚ [17].
Ʉ ɧɚɫɬɨɹɳɟɦɭ ɦɨɦɟɧɬɭ ɢɡɜɟɫɬɟɧ ɩɨɥɧɵɣ ɫɩɢɫɨɤ ɩɨɜɟɪɯɧɨɫɬɧɵɯ ɦɚɪɤɟɪɨɜ ɆɋɄ
[42]. ɋɱɢɬɚɟɬɫɹ, ɱɬɨ ɧɚ ɩɨɜɟɪɯɧɨɫɬɢ ɆɋɄ
ɨɬɫɭɬɫɬɜɭɸɬ CD34, CD45, CD14, T- ɢɥɢ Bɤɥɟɬɨɱɧɵɟ ɦɚɪɤɟɪɵ, ɢ ɩɪɢɫɭɬɫɬɜɭɸɬ CD90,
CD105, CD106, ɚ ɬɚɤɠɟ ɪɟɰɟɩɬɨɪ ɝɢɚɥɭɪɨɧɨɜɨɣ ɤɢɫɥɨɬɵ (CD44) [43].
ɏɨɬɹ ɆɋɄ ɨɬɧɨɫɹɬɫɹ ɤ ɨɞɧɢɦ ɢɡ ɧɚɢɛɨɥɟɟ ɢɡɭɱɟɧɧɵɯ ɋɄ, ɞɚɥɶɧɟɣɲɚɹ ɢɯ ɯɚɪɚɤɬɟɪɢɫɬɢɤɚ ɨɱɟɧɶ ɜɚɠɧɚ ɢɡɡɚ ɥɟɱɟɛɧɵɯ ɫɩɨɫɨɛɧɨɫɬɟɣ, ɩɨɫɤɨɥɶɤɭ ɨɧɢ ɫɤɥɨɧɧɵ ɤ ɫɚɦɨɪɟɩɥɢɤɚɰɢɢ ɢ, ɫɥɟɞɨɜɚɬɟɥɶɧɨ, ɩɨɬɟɧɰɢɚɥɶɧɨ ɦɨɝɭɬ ɛɵɬɶ ɤɭɥɶɬɢɜɢɪɨɜɚɧɵ ɢ ɢɫɩɨɥɶɡɨɜɚɧɵ ɞɥɹ ɪɟɝɟɧɟɪɚɰɢɢ ɬɤɚɧɟɣ ɢ ɨɪɝɚɧɨɜ
[9, 43]. Ʉ ɬɨɦɭ ɠɟ, ɆɋɄ ɦɨɝɭɬ ɛɵɬɶ ɛɵɫɬɪɨ ɜɵɞɟɥɟɧɵ ɢɡ ɪɚɡɥɢɱɧɵɯ ɜɡɪɨɫɥɵɯ ɬɤɚɧɟɣ ɫ ɩɨɦɨɳɶɸ ɦɚɥɨɢɧɜɚɡɢɜɧɵɯ ɩɪɨɰɟɞɭɪ
[9, 43].
Ⱦɢɮɮɟɪɟɧɰɢɪɨɜɨɱɧɵɣ ɩɨɬɟɧɰɢɚɥ ɆɋɄ
ɩɨɡɜɨɥɢɥ ɦɧɨɝɢɦ ɢɫɫɥɟɞɨɜɚɬɟɥɹɦ ɪɚɫɫɦɚɬ140
ɪɢɜɚɬɶ ɢɯ ɤɚɤ ɨɱɟɧɶ ɩɟɪɫɩɟɤɬɢɜɧɵɣ ɦɚɬɟɪɢɚɥ ɞɥɹ ɤɥɟɬɨɱɧɨɣ ɬɟɪɚɩɢɢ ɦɧɨɝɢɯ ɡɚɛɨɥɟɜɚɧɢɣ. ȼɨɡɦɨɠɧɨɫɬɶ ɢɫɩɨɥɶɡɨɜɚɧɢɹ
ɚɭɬɨɥɨɝɢɱɧɨɝɨ ɦɚɬɟɪɢɚɥɚ ɟɳɺ ɛɨɥɟɟ ɭɜɟɥɢɱɢɥɚ ɢɧɬɟɪɟɫ ɤ ɆɋɄ [9].
ɉɨɱɟɦɭ ɆɋɄ ɜɨɫɩɪɢɧɢɦɚɸɬɫɹ ɤɚɤ ɧɚɢɥɭɱɲɢɣ ɬɪɚɧɫɩɥɚɧɬɚɬ ɚɭɬɨɥɨɝɢɱɧɵɯ ɬɤɚɧɟɣ
ɞɥɹ ɜɨɫɫɬɚɧɨɜɥɟɧɢɹ ɱɟɥɨɜɟɱɟɫɤɢɯ ɬɤɚɧɟɣ
ɢ ɨɪɝɚɧɨɜ? Ⱥɭɬɨɥɨɝɢɱɧɵɟ ɬɤɚɧɢ ɩɪɟɞɫɬɚɜɥɹɸɬ ɫɨɛɨɣ «ɡɨɥɨɬɨɣ ɫɬɚɧɞɚɪɬ» ɞɥɹ ɜɨɫɫɬɚɧɨɜɥɟɧɢɹ ɞɟɮɟɤɬɨɜ ɩɨɫɥɟ ɬɪɚɜɦɵ, ɯɪɨɧɢɱɟɫɤɢɯ ɡɚɛɨɥɟɜɚɧɢɣ, ɯɢɪɭɪɝɢɱɟɫɤɨɝɨ ɥɟɱɟɧɢɹ ɜɪɨɠɞɺɧɧɵɯ ɚɧɨɦɚɥɢɣ ɢ ɨɩɭɯɨɥɟɣ.
Ɉɞɧɚɤɨ ɚɭɬɨɥɨɝɢɱɧɚɹ ɬɪɚɧɫɩɥɚɧɬɚɰɢɹ ɬɤɚɧɟɣ ɨɫɧɨɜɵɜɚɟɬɫɹ ɧɚ ɢɞɟɢ, ɱɬɨ ɡɚɛɨɥɟɜɲɢɟ
ɢɥɢ ɩɨɜɪɟɠɞɟɧɧɵɟ ɬɤɚɧɢ ɞɨɥɠɧɵ ɛɵɬɶ ɜɨɫɫɬɚɧɨɜɥɟɧɵ ɩɨɞɨɛɧɵɦɢ ɡɞɨɪɨɜɵɦɢ ɬɤɚɧɹɦɢ. ɉɪɨɛɥɟɦɚ ɦɨɠɟɬ ɛɵɬɶ ɨɛɴɹɫɧɟɧɚ ɧɚ
ɩɪɢɦɟɪɟ ɜɨɫɫɬɚɧɨɜɥɟɧɢɹ ɤɨɫɬɧɨɣ ɬɤɚɧɢ. ȼ
ɩɨɫɥɟɞɧɢɟ ɝɨɞɵ ɜɟɞɺɬɫɹ ɩɨɢɫɤ ɧɨɜɵɯ ɢ ɫɨɜɟɪɲɟɧɫɬɜɨɜɚɧɢɟ ɢɡɜɟɫɬɧɵɯ ɦɚɬɟɪɢɚɥɨɜ
ɞɥɹ ɡɚɦɟɳɟɧɢɹ ɞɟɮɟɤɬɨɜ ɤɨɫɬɧɨɣ ɬɤɚɧɢ ɢ
ɫɬɢɦɭɥɹɰɢɢ ɟɺ ɪɨɫɬɚ [44]. ɂɫɩɨɥɶɡɨɜɚɧɢɟ
ɡɚɦɟɧɢɬɟɥɟɣ ɤɨɫɬɢ ɢɥɢ ɤɨɫɬɧɵɯ ɦɚɬɟɪɢɚɥɨɜ ɨɫɧɨɜɵɜɚɟɬɫɹ ɧɚ ɩɪɟɞɩɨɥɨɠɟɧɢɢ ɨ ɬɨɦ,
ɱɬɨ ɨɧɢ ɫɩɨɫɨɛɫɬɜɭɸɬ ɮɨɪɦɢɪɨɜɚɧɢɸ ɜ
ɦɟɫɬɟ ɢɦɩɥɚɧɬɚɰɢɢ ɧɨɜɨɣ ɤɨɫɬɢ. ɉɚɰɢɟɧɬ,
ɤɨɬɨɪɨɦɭ ɩɟɪɟɫɚɠɢɜɚɟɬɫɹ ɬɪɚɧɫɩɥɚɧɬɚɬ,
ɩɨɥɭɱɟɧɧɵɣ ɢɡ ɝɪɟɛɧɹ ɟɝɨ ɩɨɞɜɡɞɨɲɧɨɣ
ɤɨɫɬɢ, ɜɵɧɭɠɞɟɧ ɞɨɫɬɚɬɨɱɧɨ ɞɥɢɬɟɥɶɧɵɣ
ɩɪɨɦɟɠɭɬɨɤ ɜɪɟɦɟɧɢ ɧɚɯɨɞɢɬɶɫɹ ɜ ɛɨɥɶɧɢɰɟ ɢɡɡɚ ɛɨɥɟɡɧɟɧɧɨɫɬɢ ɩɪɨɰɟɞɭɪɵ, ɚ ɬɚɤɠɟ ɞɨɩɨɥɧɢɬɟɥɶɧɨɣ ɪɚɧɵ ɜ ɞɨɧɨɪɫɤɨɣ ɨɛɥɚɫɬɢ. Ɍɚɤɢɦ ɨɛɪɚɡɨɦ, ɤɥɸɱɟɜɵɦ ɧɟɞɨɫɬɚɬɤɨɦ ɬɪɚɧɫɩɥɚɧɬɚɰɢɢ ɚɭɬɨɥɨɝɢɱɧɵɯ ɬɤɚɧɟɣ
ɹɜɥɹɟɬɫɹ ɟɺ ɬɪɚɜɦɚɬɢɱɧɨɫɬɶ ɢ ɛɨɥɟɡɧɟɧɧɨɫɬɶ ɞɥɹ ɞɨɧɨɪɚ ɩɪɢ ɩɨɥɭɱɟɧɢɢ ɧɟɨɛɯɨɞɢɦɨɝɨ ɬɪɚɧɫɩɥɚɧɬɚɬɚ. ɗɬɚ ɩɪɨɛɥɟɦɚ ɨɬɫɭɬɫɬɜɭɟɬ ɩɪɢ ɢɫɩɨɥɶɡɨɜɚɧɢɢ ɆɋɄ [44].
ɋɟɝɨɞɧɹ ɛɨɥɶɲɢɟ ɧɚɞɟɠɞɵ ɜɨɡɥɚɝɚɸɬɫɹ ɧɚ ɬɤɚɧɟɜɭɸ ɢɧɠɟɧɟɪɢɸ ɫ ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ ɋɄ ɜɡɪɨɫɥɨɝɨ ɨɪɝɚɧɢɡɦɚ ɞɥɹ ɪɟɤɨɧɫɬɪɭɤɰɢɢ ɩɨɜɪɟɠɞɟɧɧɵɯ ɫɭɫɬɚɜɨɜ. Ɉɛɳɢɦ
ɧɟɞɨɫɬɚɬɤɨɦ ɡɚɦɟɧɵ ɫɭɫɬɚɜɚ ɧɚ ɚɥɥɨɝɟɧɧɵɣ
ɬɪɚɧɫɩɥɚɧɬɚɬ ɹɜɥɹɟɬɫɹ ɮɢɡɢɨɥɨɝɢɱɟɫɤɚɹ
ʋ5x 2010 i ɬɨɦ 18
ɧɟɨɛɯɨɞɢɦɨɫɬɶ ɪɟɤɨɧɫɬɪɭɤɰɢɢ ɩɨɫɥɟ ɩɪɨɜɟɞɟɧɧɵɯ ɨɩɟɪɚɰɢɢ ɜ ɫɜɹɡɢ ɫ ɢɡɧɨɲɟɧɧɨɫɬɶɸ ɢɦɩɥɚɧɬɚ [45, 46]. ɇɚɩɪɢɦɟɪ, ɨɛɳɚɹ
ɩɪɨɞɨɥɠɢɬɟɥɶɧɨɫɬɶ ɮɭɧɤɰɢɨɧɢɪɨɜɚɧɢɹ
ɫɭɫɬɚɜɚ ɩɨɫɥɟ ɟɝɨ ɯɢɪɭɪɝɢɱɟɫɤɨɣ ɡɚɦɟɧɵ ɜ
ɫɪɟɞɧɟɦ ɫɨɫɬɚɜɥɹɟɬ 8–10 ɥɟɬ – ɫɥɢɲɤɨɦ ɤɨɪɨɬɤɢɣ ɫɪɨɤ ɞɥɹ ɩɚɰɢɟɧɬɨɜ ɜ ɜɨɡɪɚɫɬɟ ɨɬ
40, 50, ɢɥɢ ɞɚɠɟ 60 ɥɟɬ. Ƚɪɭɩɩɚ ɭɱɟɧɵɯ ɩɨɞ
ɪɭɤɨɜɨɞɫɬɜɨɦ J.J. Mao ɜ 2005 ɝɨɞɭ [46] ɫɨɨɛɳɢɥɚ ɨ ɜɨɫɫɬɚɧɨɜɥɟɧɢɢ ɫ ɩɨɦɨɳɶɸ ɬɤɚɧɟɜɨɣ ɢɧɠɟɧɟɪɢɢ ɜɫɟɝɨ ɦɵɳɟɥɤɚ ɫɭɫɬɚɜɚ
ɤɚɤ ɯɪɹɳɟɜɨɣ, ɬɚɤ ɢ ɤɨɫɬɧɨɣ ɬɤɚɧɟɣ) ɩɪɢ
ɩɨɦɨɳɢ ɨɞɧɨɣ ɩɨɩɭɥɹɰɢɢ ɆɋɄ. Ȼɢɨɥɨɝɢɱɟɫɤɢ ɪɚɡɭɦɧɵɦ ɨɛɴɹɫɧɟɧɢɟɦ ɞɥɹ ɢɫɩɨɥɶɡɨɜɚɧɢɹ ɆɋɄ ɩɪɢ ɩɨɥɧɨɣ ɡɚɦɟɧɟ ɫɭɫɬɚɜɚ
ɹɜɥɹɟɬɫɹ ɬɨ, ɱɬɨ ɤɥɚɫɬɟɪɵ ɷɬɢɯ ɤɥɟɬɨɤ ɢɦɟɸɬ ɨɛɳɢɣ ɦɨɪɮɨɝɟɧɟɡ ɜɨ ɜɪɟɦɹ ɷɦɛɪɢɨɧɚɥɶɧɨɝɨ ɪɚɡɜɢɬɢɹ [47, 48].
ɉɨ ɦɧɟɧɢɸ R. Young (2009), ɤɥɸɱɟɜɵɦ
ɝɨɞɨɦ ɞɥɹ ɭɫɤɨɪɟɧɢɹ ɜɧɟɞɪɟɧɢɹ ɜ ɦɟɞɢɰɢɧɫɤɭɸ ɩɪɚɤɬɢɤɭ ɦɟɬɨɞɨɜ ɥɟɱɟɧɢɹ, ɨɫɧɨɜɚɧɧɵɯ ɧɚ ɢɫɩɨɥɶɡɨɜɚɧɢɢ ɋɄ, ɞɨɥɠɟɧ ɫɬɚɬɶ
2013 ɝɨɞ, ɤɨɝɞɚ ɜ ȿɜɪɨɩɟ, ɋɒȺ ɢ Ʉɢɬɚɟ ɛɭɞɭɬ ɩɨɥɭɱɟɧɵ ɚɞɦɢɧɢɫɬɪɚɬɢɜɧɵɟ ɪɚɡɪɟɲɟɧɢɹ ɧɚ ɲɢɪɨɤɨɟ ɤɥɢɧɢɱɟɫɤɨɟ ɩɪɢɦɟɧɟɧɢɟ
ɦɟɬɨɞɨɜ, ɨɫɧɨɜɚɧɧɵɯ ɧɚ ɢɫɩɨɥɶɡɨɜɚɧɢɢ ɞɥɹ
ɪɟɤɨɧɫɬɪɭɤɬɢɜɧɨɣ ɯɢɪɭɪɝɢɢ ɋɄ, ɚ ɬɚɤɠɟ
ɞɥɹ ɥɟɱɟɧɢɹ ɡɚɛɨɥɟɜɚɧɢɣ ɫɟɪɞɟɱɧɨɫɨɫɭɞɢɫɬɨɣ ɢ ɧɟɪɜɧɨɣ ɫɢɫɬɟɦ ɢɥɢ ɫɚɯɚɪɧɨɝɨ ɞɢɚɛɟɬɚ [49].
Ɂɚɤɥɸɱɟɧɢɟ
ɉɨɞɜɨɞɹ ɢɬɨɝ ɦɚɬɟɪɢɚɥɭ, ɢɡɥɨɠɟɧɧɨɦɭ
ɜɵɲɟ, ɫɥɟɞɭɟɬ ɨɬɦɟɬɢɬɶ, ɱɬɨ ɩɟɪɫɩɟɤɬɢɜɵ
ɪɚɡɜɢɬɢɹ ɪɟɝɟɧɟɪɚɬɢɜɧɨɣ ɦɟɞɢɰɢɧɵ, ɨɫɧɨɜɚɧɧɵɟ ɧɚ ɤɥɟɬɨɱɧɵɯ ɬɟɯɧɨɥɨɝɢɹɯ, ɛɵɥɢ ɢ
ɨɫɬɚɸɬɫɹ ɜɟɫɶɦɚ ɜɩɟɱɚɬɥɹɸɳɢɦɢ ɢ ɩɪɨɞɨɥɠɚɸɬ ɩɪɢɜɥɟɤɚɬɶ ɩɪɢɫɬɚɥɶɧɨɟ ɜɧɢɦɚɧɢɟ
ɭɱɺɧɵɯ ɜɫɟɝɨ ɦɢɪɚ. Ɇɨɠɧɨ ɩɪɟɞɩɨɥɚɝɚɬɶ,
ɱɬɨ ɜ ɛɥɢɠɚɣɲɟɦ ɛɭɞɭɳɟɦ ɤɥɟɬɨɱɧɚɹ
ɬɪɚɧɫɩɥɚɧɬɚɰɢɹ ɡɚɣɦɟɬ ɞɨɫɬɨɣɧɨɟ ɦɟɫɬɨ ɜ
ɚɪɫɟɧɚɥɟ ɫɪɟɞɫɬɜ ɥɟɱɟɧɢɹ ɪɚɧ, ɨɠɨɝɨɜ ɢ
ɜɨɫɫɬɚɧɨɜɥɟɧɢɹ ɲɢɪɨɤɨɝɨ ɫɩɟɤɬɪɚ ɬɤɚɧɟɣ
ɨɪɝɚɧɢɡɦɚ ɱɟɥɨɜɟɤɚ.
ɇɚɢɛɨɥɟɟ ɩɟɪɫɩɟɤɬɢɜɧɵɦ ɧɚɩɪɚɜɥɟɧɢɟɦ ɡɚɦɟɳɟɧɢɹ ɨɛɲɢɪɧɵɯ ɬɤɚɧɟɜɵɯ ɞɟɮɟɤɬɨɜ ɬɪɚɜɦɚɬɢɱɟɫɤɨɝɨ ɢɥɢ ɞɪɭɝɨɝɨ ɩɪɨɢɫɯɨɠɞɟɧɢɹ ɫɥɟɞɭɟɬ ɩɪɢɡɧɚɬɶ ɥɟɱɟɛɧɵɟ ɬɟɯɧɨɥɨɝɢɢ, ɨɫɧɨɜɚɧɧɵɟ ɧɚ ɢɫɩɨɥɶɡɨɜɚɧɢɢ
ɆɋɄ, ɤɨɬɨɪɵɟ ɩɨɡɜɨɥɹɸɬ ɨɛɨɣɬɢ ɤɥɸɱɟɜɵɟ ɧɟɞɨɫɬɚɬɤɢ, ɫɜɹɡɚɧɧɵɟ ɫ ɩɪɨɰɟɞɭɪɨɣ
ɬɪɚɧɫɩɥɚɧɬɚɰɢɢ ɚɭɬɨɥɨɝɢɱɧɵɯ ɬɤɚɧɟɣ.
ȼɨɩɟɪɜɵɯ, ɧɟɛɨɥɶɲɨɟ ɤɨɥɢɱɟɫɬɜɨ ɚɫɩɢɪɚɬɚ, ɫɨɞɟɪɠɚɳɟɝɨ ɆɋɄ, ɩɨɥɭɱɟɧɧɨɝɨ ɢɡ
ɤɨɫɬɧɨɝɨ ɦɨɡɝɚ, ɠɢɪɨɜɨɣ ɬɤɚɧɢ ɢɥɢ ɞɪɭɝɢɯ ɢɫɬɨɱɧɢɤɨɜ, ɦɨɠɟɬ ɛɵɬɶ ɭɜɟɥɢɱɟɧɨ ɞɨ
ɧɟɨɛɯɨɞɢɦɨɝɨ ɤɨɥɢɱɟɫɬɜɚ ɜ ɭɫɥɨɜɢɹɯ in
vitro, ɚ ɡɚɬɟɦ ɢɫɩɨɥɶɡɨɜɚɧɨ ɞɥɹ ɥɟɱɟɧɢɹ
ɰɟɥɨɝɨ ɪɹɞɚ ɡɚɛɨɥɟɜɚɧɢɣ (ɜ ɬɨɦ ɱɢɫɥɟ, ɢ
ɡɚɦɟɳɟɧɢɹ ɨɛɲɢɪɧɵɯ ɬɤɚɧɟɜɵɯ ɞɟɮɟɤɬɨɜ,
ɮɨɪɦɢɪɭɸɳɢɯɫɹ ɜ ɪɟɡɭɥɶɬɚɬɟ ɬɪɚɜɦɵ ɢɥɢ
ɞɪɭɝɢɯ ɩɚɬɨɥɨɝɢɱɟɫɤɢɯ ɩɪɨɰɟɫɫɨɜ).
ȼɨɜɬɨɪɵɯ, ɆɋɄ ɦɨɝɭɬ ɞɢɮɮɟɪɟɧɰɢɪɨɜɚɬɶɫɹ ɜ ɧɟɫɤɨɥɶɤɨ ɤɥɟɬɨɱɧɵɯ ɩɨɤɨɥɟɧɢɣ,
ɨɛɭɫɥɚɜɥɢɜɚɹ, ɬɚɤɢɦ ɨɛɪɚɡɨɦ, ɜɨɡɦɨɠɧɨɫɬɶ
ɢɫɩɨɥɶɡɨɜɚɧɢɹ ɨɛɳɟɝɨ ɤɥɟɬɨɱɧɨɝɨ ɢɫɬɨɱɧɢɤɚ ɞɥɹ ɜɨɫɫɬɚɧɨɜɥɟɧɢɹ ɰɟɥɨɝɨ ɪɹɞɚ ɬɤɚɧɟɣ, ɜ ɨɬɥɢɱɢɟ ɨɬ ɩɪɢɧɰɢɩɚ ɡɚɛɨɪɚ ɡɞɨɪɨɜɵɯ ɬɤɚɧɟɣ ɞɥɹ ɜɨɫɫɬɚɧɨɜɥɟɧɢɹ ɫɟɛɟ ɩɨɞɨɛɧɵɯ ɩɪɢ ɚɭɬɨɥɨɝɢɱɧɨɣ ɩɟɪɟɫɚɞɤɟ ɬɤɚɧɢ.
ȼ ɬɪɟɬɶɢɯ, ɆɋɄ ɦɨɝɭɬ ɛɵɬɶ ɜɧɟɞɪɟɧɵ
ɜ ɛɢɨɫɨɜɦɟɫɬɢɦɵɟ ɬɪɚɧɫɩɥɚɧɬɚɬɵ, ɩɟɪɟɫɚɠɟɧɧɵɟ ɜ ɦɟɫɬɚ ɚɧɚɬɨɦɢɱɟɫɤɢɯ ɞɟɮɟɤɬɨɜ
ɞɥɹ ɩɨɫɥɟɞɭɸɳɟɣ ɪɟɤɨɧɫɬɪɭɤɰɢɢ ɆɋɄ ɩɨɜɪɟɠɞɟɧɧɨɝɨ ɨɪɝɚɧɚ ɢɥɢ ɬɤɚɧɢ.
ȼ ɱɟɬɜɺɪɬɵɯ, ɥɟɱɟɧɢɟ ɪɚɡɥɢɱɧɵɯ ɡɚɛɨɥɟɜɚɧɢɣ ɢ ɬɪɚɜɦ ɫ ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ ɆɋɄ
ɦɨɠɟɬ ɛɵɬɶ ɚɭɬɨɥɨɝɢɱɧɨɣ ɢ ɩɪɢ ɷɬɨɦ ɪɟɲɚɬɶ ɩɪɨɛɥɟɦɵ, ɫɜɹɡɚɧɧɵɟ ɫ ɢɦɦɭɧɧɨɣ ɪɟɚɤɰɢɟɣ, ɬɪɚɧɫɦɢɫɫɢɜɧɨɣ ɩɟɪɟɞɚɱɟɣ ɜɨɡɛɭɞɢɬɟɥɟɣ, ɢɡɧɨɫɨɦ ɢ ɪɚɡɪɵɜɨɦ ɫɢɧɬɟɬɢɱɟɫɤɢɯ ɦɚɬɟɪɢɚɥɨɜ, ɚɥɥɟɪɝɢɱɟɫɤɨɣ ɪɟɚɤɰɢɟɣ
ɧɚ ɢɫɤɭɫɫɬɜɟɧɧɵɟ ɢɦɩɥɚɧɬɚɬɵ.
ɅɂɌȿɊȺɌɍɊȺ
1. Ȼɪɸɫɨɜ, ɉ. Ƚ. Ɉɤɚɡɚɧɢɟ ɫɩɟɰɢɚɥɢɡɢɪɨɜɚɧɧɨɣ ɯɢɪɭɪɝɢɱɟɫɤɨɣ ɩɨɦɨɳɢ ɩɪɢ ɬɹɠɟɥɨɣ ɦɟɯɚɧɢɱɟɫɤɨɣ
ɬɪɚɜɦɟ / ɉ. Ƚ. Ȼɪɸɫɨɜ, ɇ. Ⱥ. ȿɮɢɦɟɧɤɨ, ȼ. ȿ. Ɋɨɡɚɧɨɜ // ȼɟɫɬɧ. ɯɢɪɭɪɝɢɢ. – 2001. – Ɍ. 160, ʋ 1. –
141
” ɇɨɜɨɫɬɢ ɯɢɪɭɪɝɢɢ
ɋ. 43-47.
2. ɉɚɪɚɦɨɧɨɜ, Ȼ. Ⱥ. Ɉɠɨɝɢ: ɪɭɤɨɜɨɞɫɬɜɨ ɞɥɹ ɜɪɚɱɟɣ / Ȼ. Ⱥ. ɉɚɪɚɦɨɧɨɜ, ə. Ɉ. ɉɨɪɟɦɛɫɤɢɣ, ȼ. Ƚ. əɛɥɨɧɫɤɢɣ. – ɋɉɛ.: ɋɩɟɰɅɢɬ, 2000. – 480 ɫ.
3. Ʌɟɛɟɞɟɜ, ɇ. ȼ. Ʌɟɱɟɛɧɨɞɢɚɝɧɨɫɬɢɱɟɫɤɚɹ ɬɚɤɬɢɤɚ ɩɪɢ ɩɨɜɪɟɠɞɟɧɢɹɯ ɠɢɜɨɬɚ ɭ ɩɨɫɬɪɚɞɚɜɲɢɯ ɫɨɱɟɬɚɧɧɨɣ ɬɪɚɜɦɨɣ: ɚɜɬɨɪɟɮ. ɞɢɫ. ... ɞɪɚ ɦɟɞ. ɧɚɭɤ:
14.00.27 / Ɋ. ȼ. Ʌɟɛɟɞɟɜ. – Ɇ., 2003. – ɋ. 40.
4. Mooney, D. P. Multiple trauma: liver and spleen
injury. 19 / D. P. Mooney // Curr. Opin. Pediat. – 2002.
– Vol. 14, N 4. – Ɋ. 482-485.
5. Ʌɚɜɪɭɯɢɧ, ɘ. ɇ. Ɇɟɬɨɞɵ ɥɟɱɟɧɢɹ ɨɫɬɚɬɨɱɧɵɯ ɪɚɧ
ɭ ɨɛɨɠɠɺɧɧɵɯ / ɘ. ɇ. Ʌɚɜɪɭɯɢɧ, ȿ. ȼ. ɑɟɝɥɚɤɨɜ,
ȼ. ȼ. Ⱥɪɟɮɶɟɜ // ȼɟɫɬɧ. ɧɟɨɬɥɨɠ. ɢ ɜɨɫɫɬɚɧɨɜɢɬ.
ɦɟɞ. – 2005.– Ɍ. 6, ʋ 2. – ɋ. 386-387.
6. Brigham, P. A. Burnincidence and medical care use
in the United States: estimates, trends, and data
sources / P. A. Brigham // J. Burn Care Rehabil. –
1996. – N 17. – P. 95-107.
7. Use of breast reconstruction after mastectomy
following the Women’s Health and Cancer Rights Act
/ A. Alderman [et al.] // JAMA. – 2006. – Vol. 295. –
P. 387-388.
8. ȿɪɦɨɥɨɜ, Ⱥ. ɋ. ɉɪɢɦɟɧɟɧɢɟ ɛɢɨɥɨɝɢɱɟɫɤɢ ɚɤɬɢɜɧɵɯ ɪɚɧɟɜɵɯ ɩɨɤɪɵɬɢɣ, ɫɬɢɦɭɥɢɪɭɸɳɢɯ ɪɟɝɟɧɟɪɚɰɢɸ ɷɩɢɬɟɥɢɹ ɨɠɨɝɨɜɵɯ ɪɚɧ IIIȺ ɫɬɟɩɟɧɢ / Ⱥ. ɋ. ȿɪɦɨɥɨɜ, ɋ. ȼ. ɋɦɢɪɧɨɜ, ȼ. Ȼ. ɏɜɚɬɨɜ // Ʉɥɟɬɨɱɧɵɟ
ɬɟɯɧɨɥɨɝɢɢ ɜ ɛɢɨɥɨɝɢɢ ɢ ɦɟɞɢɰɢɧɟ. – 2008. – T. 3. –
C. 166-172.
9. Craniofacial tissue engineering / J. J. Mao [et al.] /
/ Dent. Res. In. Press. – 2006. – Vol. 15. – P. 499526.
10. Brey, E. M. Tissue engineering applied to
reconstructive surgery / E. M. Brey, C. Patrick // Eng.
Med. Biol. Mag. – 2000. – Vol. 19. – P. 122.
11. Patrick, C. W. Tissue engineering strategies for
adiposetissue repair / C. W. Patrick // Anat. Rec. –
2001. – Vol. 263. – P. 361.
12. Garfein, E. S. Clinical applicationsof tissue
engineered constructs / E. S. Garfein, D. Orgill,
J. Pribaz // Clin. Plast. Surg. – 2003. – Vol. 30. –
P. 485.
13. The impact of biomolecular medicine and tissue
engineering on plastic surgery in the 21st century /
H. P. Lorenz [et al.] // Plast. Reconstr. Surg. – 2000. –
Vol. 105. – P. 24-67.
14. Ehrlich, H. P. Understanding experimental biology
of skin equivalent: from laboratory to clinical use in
patients with burns and chronic wounds / H. P. Ehrlich
// Am. J. Surg. – 2004. – Vol. 187. – P. 29-33.
15. Isolating a pure population of epidermalstem cells
for use in tissue engineering / M. Dunnwald [et al.] //
Exp. Dermatol. – 2001. – Vol. 10. – P. 45-54.
16. Evaluation of wound healing effect on skindefect
nude mice by using human dermis-derived
mesenchymalstem cells / C. K. Perng [et al.] //
142
Transplant. Proc. – 2006. – Vol. 38. – P. 3086-3087.
17. In vitro chondrogenesis of bone marrow derived
mesenchymal stem cells in a photopolymerizing
hydrogel / C. G. Williams [et al.] // Tissue Eng. – 2003.
– Vol. 9. – P. 679-688.
18. Butler, D. L. Perspectives on cell and collagen
composites for tendon repair / D. L. Butler, H. A. Awad
// Clin. Orthop. – 1999. – Vol. 367. – P. 324-332.
19. Multilineage cells fromhuman adipose tissue:
Implications for cell-based therapies / P. A. Zuk [et
al.] // Tissue Eng. – 2001. – Vol. 7. – P. 211-228.
20. Hart, D. Overcoming complications of breast
implants / D. Hart // Plast. Surg. Nurs. – 2003. –
Vol. 23. – P. 55.
21. Long-term implantation of preadipocyte-seeded
PLGA scaffolds / C. W. Patrick [et al.] // Tissue Eng.
– 2002. – Vol. 8. – P. 283-293.
22. Takezawa, T. A strategy for the development of
tissue engineering scaffolds that regulate cell behavior
/ T. Takezawa // Biomaterials. – 2003. – Vol. 24. –
P. 22-67.
23. Valencia, I. C. Skin grafting / I. C. Valencia,
A. Falabella, W. Eaglstein // Dermatol. Clin. – 2000.
– Vol. 18, N 5. – P. 21-32.
24. Alhadlaq, A. Mesenchymal stem cells: Isolation
and therapeutics / A. Alhadlaq, J. Mao // Stem. Cells
Dev. – 2004. – Vol. 13. – P. 436-448.
25. Rheinwald, J. G. Serial cultivation of strains of
human epidermal keratinocytes: the formation of
keratinizing colonies from single cells /
J. G. Rheinwald, H. Green // Cell. – 1975. – Vol. 6,
N 3. – P. 331-343.
26. Rheinwald, J. G. Epidermal growth factor and the
multiplication of cultured human epidermal
keratinocytes / J. G. Rheinwald, H. Green // Nature. –
1977. – Vol. 265. – P. 421-424.
27. Multicentre experience in the treatment of burns
with autologous and allogenic cultured epitelium, fresh
or preserved in a frozen state / M. De Luca [et al.] //
Burns. – 1989. – Vol. 15, N 5. – P. 303-309.
28. Kumagai, M. Clinical application of autologous
cultured epithelia for the treatment of burn wounds
and burn scars / M. Kumagai // Plast. Reconstr. Surg.
– 1988. – Vol. 1. – P. 99-111.
29. Fibroblast growthfactor-2 promotes keratan
sulfate proteoglycan expression by keratocytes in
vitro / C. J. Long [et al.] // J. Biol. Chem. – 2000. –
Vol. 275, N 13. – P. 9-18.
30. Ladet, S. Multi-membrane hydrogels / S. Ladet,
L. David, A. Domard // Nature. – 2008. – Vol. 452. –
P. 76.
31. A material decoy of biological media based on
chitosan physical hydrogels: application to cartilage
tissue engineering / A. Montembault [et al.] //
Biochimie. – 2006. – Vol. 88. – P. 551.
32. Davenport, R. J. What controls organ regeneration?
ʋ5x 2010 i ɬɨɦ 18
/ R. J. Davenport // Science. – 2005. – Vol. 309. – P. 84.
33. ɉɪɟɞɲɟɫɬɜɟɧɧɢɤɢ ɤɨɫɬɧɨɣ ɢ ɝɟɦɨɩɨɷɬɢɱɟɫɤɨɣ
ɬɤɚɧɟɣ. Ⱥɧɚɥɢɡ ɝɟɬɟɪɨɬɨɩɢɱɟɫɤɢɯ ɬɪɚɧɫɩɥɚɧɬɚɰɢɣ
ɤɨɫɬɧɨɝɨ ɦɨɡɝɚ / Ⱥ. ə. Ɏɪɢɞɟɧɲɬɟɣɧ [ɢ ɞɪ.] // ɐɢɬɨɥɨɝɢɹ. – 1968. – T. 10, ʋ 5. – ɋ. 557-567.
34. Filip, S. Issues in stem cell plasticity / S. Filip,
D. English, J. Mokry // J. Cell Mol. Med. – 2004. –
Vol. 8. – P. 572-577.
35. Wound healing effect of adipose-derived stem
cells: a critical role of secretory factors on human
dermal fibroblasts / W. S. Kim [et al.] // J. Dermatol.
Sci. – 2007. – Vol. 48. – P. 15-24.
36. Prominin-1/CD133, a neural and hematopoietic
stem cell marker, is expressed in adult human
differentiated cells and certain types of kidney cancer
/ M. Florek [et al.] // Cell Tissue. Res. – 2005. – Vol.
319. – P. 15-26.
37. Bone marrow cells regenerate infarcted
myocardium / D. Orlic [et al.] // Nature. – 2001. – Vol.
410. – P. 701-705.
38. Haematopoietic stem cells adopt mature
haematopoietic fates in ischaemic myocardium /
L. B. Balsam [et al.] // Nature. – 2004. – Vol. 428. –
P. 668-673.
39. Mesenchymal stem cell implantation in a swine
myocardial infarct model: Engraftment and functional
effects / J. G. Shake [et al.] // Ann. Thorac. Surg. –
2002. – Vol. 73. – P. 1919-1925.
40. Intracoronary, h uman autologous stem cell
transplantation for myocardial regeneration following
myocardial infarction / B. E. Strauer [et al.] // Dtsch.
Med. Wochenschr. – 2001. – Vol. 126. – P. 932-938.
41. Friedenstein, A. J. The development of fibroblast
colonies in monolayer cultures of guinea pig bone
marrow and spleen cells / A. J. Friedenstein,
R. Chailakhjan, K. Lalykina // Cell Tissue Kinet. –
1970. – Vol. 3. – P. 393-403.
42. Pittenger, M. F. Mesenchymal stem cells and their
potential as cardiac therapeutics / M. F. Pittenger,
B. J. Martin // Circ. Res. – 2004. – Vol. 95. – P. 9-20.
43. Biological features of mesenchymal stem cells
from human bone arrow / Z. Guo [et al.] // Chin. Med.
J. (Engl.). – 2001. – Vol. 114. – P. 950-953.
44. Allen, M. R. Periosteum: biology, regulation, and
response to osteoporosis therapies / M. R. Allen,
J. Hock, D. Burr // Bone. – 2004. – Vol. 35. – P. 10031012.
45. Barry, F. P. Biology and clinical applications of
mesenchymal stem cells / F. P. Barry // Brith Defects
Res. C. Embryo Today. – 2003. – Vol. 69. – P. 250256.
46. Mao, J. J. Stem cell driven regeneration of synovial
joints / J. J. Mao // Biol. Cell. – 2005. – Vol. 97. –
P. 289-301.
47. Archer, C. W. Development of synovial joints /
C. W. Archer, G. Dowthwaite, F. West // Birth Defects
Res. C. Embryo Today. – 2003. – Vol. 69. – P. 144155.
48. A mechanism underlying th e movement
requirement for synovial joint cavitation /
G. Dowthwaite [et al.] // Matrix Biol. – 2003. –
Vol. 22. – P. 311-322.
49. Young, R. Stem Cell Summit. Analysis and market
forecast, 2009-2019. – Wayne: RPY Publications.
2009. – 112 ɪ.
Àäðåñ äëÿ êîððåñïîíäåíöèè
220013, Ðåñïóáëèêà Áåëàðóñü,
ã. Ìèíñê, óë. Ï. Áðîâêè, 3, êîð. 3,
ÃÓÎ «Áåëîðóññêàÿ ìåäèöèíñêàÿ
àêàäåìèÿ ïîñëåäèïëîìíîãî îáðàçîâàíèÿ»,
e-mail: gain1959@tut.by,
Ãàèí Þ.Ì.
ɉɨɫɬɭɩɢɥɚ 28.06.2010 ɝ.
143