LINEBURG


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ca 6 e 12 ian (oaae. 2) [2, 55]. Ai aoi?ii ?EE (55 aieuiuo) i?e ?aiiae ?aaaneo-
ey?ecaoee ieiea?aa auyaeaii nie?aiea nia?oiinoe ca 30 noo e 12 ian, ii ?acee-
?ea ia ainoeaei o?iaiy noaoenoe?aneie cia?eiinoe (ni. oaae. 2). EAI e AEO:
?EE, a eioi?uo n?aaieaaeanu au yooaeoeaiinou yoeo iaoiaia ea?aiey a ?aiiai
ia?eiaa EI, inei?ieaoaainy ea?aeiaaiiui oieii, ia iaeaaii.

A 1 ?EE 56 o?anoieeai auei 75 eao e aieaa; iinea ?aiiae ?aaaneo-
ey?ecaoee ieiea?aa iaae?aaeinu noaoenoe?anee iacia?eiia oaaee?aiea nia?o-

252



iinoe ca 30 noo ii n?aaiaie? n a?oiiie noaiaa?oiie oa?aiee (18 ec 24, eee 75%,
e 17 ec 32, eee 53%, aieuiuo niioa.; I?=1,41 i?e 95% AE io 0,95 ai 2,11) [2, 55].
A ?EE oae?a auyaeaii noaoenoe?anee cia?eiia oaaee?aiea ?anoiou ?acaeoey in-
o?ie ii?a?iie iaainoaoi?iinoe (n iiauoaieai o?iaiy e?aaoeieia a nuai?ioea
ai >265 ieiieu/e) o aieuiuo, iieo?aaoeo noaiaa?oio? oa?aie?, ii n?aaiaie?
n a?oiiie ?aiiae ?aaaneoey?ecaoee (o 36 ec 150, eee 24%, e 20 ec 152, eee 13%,
aieuiuo niioa.; I?=1,82 i?e 95% AE io 1,1 ai 3,0; EIA=9 i?e 95% AE io 5 ai
48). E?iia oiai, a ia?aii ?EE niiauaeinu i neaao?ueo inei?iaieyo: oy?aeia
e?iaioa?aiea, nainen, ieee?cey ia?eoa?e?aneeo ninoaia; iaiaei aaiiua i ?an-
oioa eo ?acaeoey a enneaaoaiuo a?oiiao ia oeacaiu. Ai aoi?ii ?EE inei?iaiey
ea?aiey ia iienaiu [3].

A 1 ?EE noaiaa?oiay oa?aiey aee??aea aioo?eai?oaeuio? aaeeii-
io? eiio?ioeunaoe? (ni. Neiaa?u oa?ieiia a eiioa aeaau) e o?iiaieecen [2, 55].
Ai aoi?ii ?EE iaoiau noaiaa?oiie oa?aiee ia iienaiu [3]. Aoi?ia ?EE auei
i?ae?auaii ain?i?ii aneaanoaea o?oaiinoae, aicieea?ueo i?e iaai?a o?anoie-
eia. Iaa ?EE auee i?iaaaaiu a eeeie?aneeo oaio?ao, eia?ueo aiaaoue iiuo
i?iaaaaiey ?aiiae ?aaaneoey?ecaoee ieiea?aa; aa yooaeoeaiinou a a?oaeo iaae-
oeineeo o??a?aaieyo ii?ao ieacaouny eiie [2, 3, 55].

:
A 1 ?EE ioaieaaee aeeyiea o?iiaieecena i?e ea?aeiaaiiii oiea ia oiia ino?i-
ai EI, e ia auyaeee noaoenoe?anee cia?eiiai nie?aiey nia?oiinoe ca 21 noo.

Nenoaiaoe?aneeo iaci?ia o?iiaieecena i?e ea?aeiaaiiii oiea
ia oiia ino?iai EI ia iaeaaii. Auyaeaii 1 ?EE (11 806 aieuiuo a ia?aua 12 ?
iinea ino?iai EI) o?iiaieecena no?aioieeiacie ii n?aaiaie? n ionoonoaeai
o?iiaieecena (ni. Eiiiaioa?ee) [56]. I?e aiaeeca a iiaa?oiia aieuiuo n ea?ae-
iaaiiui oieii (280 aieuiuo) ia auyaeaii noaoenoe?anee cia?eiiai aeeyiey
o?iiaieecena ia nia?oiinou a ia?aua 21 noo i?aauaaiey a noaoeiia?a (102 ec
146, eee 69%, e 94 ec 134, eee 70%, aieuiuo niioa.; I?=1,0 i?e 95% AE io 0,85
ai 1,16).

A ?EE ia i?eaiayony aaiiua i niaoeoe?aneeo inei?iaieyo o aieu-
iuo n ea?aeiaaiiui oieii [56]. A oaeii iiai?iua yooaeou ai a?aiy e iinea
aaaaaiey no?aioieeiacu iienaiu o 705 ec 5860 (12%) aieuiuo: iacia?eoaeuiia e
oy?aeia e?iaioa?aiea (3,7%), aeea?ae?aneea ?aaeoee (2,4%), a?oa?eaeuiay aeii-
oiiey (3,0%), aiaoeeaeoe?aneee oie (0,1%), iciia/eeoi?aaea (1,0%), ?aeoai?-
eiaua a?eoiee (1,2%), einoeuo (0,2%).

A ?EE ia eniieuciaaeny ?a?ei ineaieaiey [56]. I?aanoaaeaiiua
aaiiua iieo?aiu ?ao?iniaeoeaii, e ?aiaiiecaoe? i?iaiaeee aac o?aoa iaee?ey
ea?aeiaaiiiai oiea.

:
(, , , , )


253



( ,
)
?EE, iinayuaiiuo n?aaiaie? yooaeoeaiinoe ieaoaai e i?aia?aoia n iiei?e-
oaeuiui eiio?iiiui aaenoaeai eee aaciaeeaoaoi?ia i?e ea?aeiaaiiii oiea,
ia iaeaaii.

I?aia?aou n iiei?eoaeuiui eiio?iiiui aaenoaeai: nenoaiaoe-
?aneeo iaci?ia eee ?EE ii eo i?eiaiaie? ia iaeaaii. Auyaeaiu 3 ianenoaiaoe-
?aneeo iaci?a [1, 57, 58], a eioi?uo eiinoaoe?iaaeinu ionoonoaea ?EE i?aia?aoia
n iiei?eoaeuiui eiio?iiiui aaenoaeai i?e ea?aeiaaiiii oiea iinea ino?iai
EI. Aac iaeeaoaoi?u: nenoaiaoe?aneeo iaci?ia eee ?EE ia iaeaaii.

I?aia?aou n iiei?eoaeuiui eiio?iiiui aaenoaeai iiaoo oneee-
aaou eoaie? ieiea?aa e aucuaaou ?aeoai?eiaua a?eoiee [1, 57, 58]. Enneaaiaa-
iee iiai?iuo yooaeoia o aieuiuo n ea?aeiaaiiui oieii ia oiia ino?iai EI
ia iaeaaii (ni. I?eiaiaiea i?aia?aoia n iiei?eoaeuiui eiio?iiiui aaenoaeai a
aeaaa Na?aa?iay iaainoaoi?iinou).

I?eiyoi n?eoaou, ?oi i?aia?aou n iiei?eoaeuiui eiio?iiiui
aaenoaeai i?e ea?aeiaaiiii oiea ia oiia ino?iai EI yooaeoeaiu. Aieaca-
oaeunoa a iieuco eee i?ioea yoiai iiaiey ia iaeaaii. Iianiinou onoaoaeaiey
a?oa?eaeuiie aeiioiiee ia iicaieyao ?aeiiaiaiaaou eaeea-eeai aaciaeeaoaoi?u
aey ea?aiey ino?iai ea?aeiaaiiiai oiea [58].

:
?EE, iinayuaiiuo n?aaiaie? eaoaoa?ecaoee eaai?iie a?oa?ee e aa ionoonoaey,
ia iaeaaii.

Nenoaiaoe?aneeo iaci?ia e ?EE, iinayuaiiuo eaoaoa?ecaoee
eaai?iie a?oa?ee, ia iaeaaii.

A iana?aaoeiiiuo enneaaiaaieyo auyaeaia naycu ia?ao eaoaoa?eca-
oeae eaai?iie a?oa?ee e nia?oiinou?/oaaee?aieai ?anoiou ?acaeoey inei?ia-
iee, iaiaei iaynii, iaoneiaeaia ee iia iaaeaaii?eyoiui aaenoaeai eaoaoa?e-
caoee eee iaiaa aeaaii?eyoiui i?iaiicii aieuiuo, eioi?ui aa i?iaiaeee [59].
?anoioa ?acaeoey inei?iaiee (oy?aeua a?eoiee, iia?a?aaiea oeaie eaaeiai,
nainen, o?iiaiyiaieey — ni. aeaao Aaiiciua o?iiaiyiaieee) i?e eaoaoa?ecaoee
eaai?iie a?oa?ee ninoaaeyao 0,1—0,5% [59].

Eaoaoa?ecaoey eaai?iie a?oa?ee iaeaa?aao aeaaiinoeeo ea?aei-
aaiiiai oiea, ea?aiea aeiiaieaiee, iioeiecaoe? aaaeaiey iaiieiaiey i?aauo
e eaauo ioaaeia na?aoa, iiaai? aicu i?aia?aoia n iiei?eoaeuiui eiio?iiiui
aaenoaeai [1]. I?eiyoi n?eoaou, ?oi eaoaoa?ecaoey eaai?iie a?oa?ee i?e ea?aei-
aaiiii oiea ia oiia ino?iai EI yooaeoeaia [60, 61], ii aieacaoaeunoa a iieuco
eee i?ioea yoiai iiaiey ia iaeaaii.


254



:
A iaiii ?EE o?iiaieecena a ni?aoaiee n aioo?eai?oaeuiie aaeeiiiie eiio?-
ioeunaoeae e aac iaa ia auyaeaii noaoenoe?anee cia?eiiai ?acee?ey ii nia?oii-
noe ca 6 ian.

Nenoaiaoe?aneeo iaci?ia aioo?eai?oaeuiie aaeeiiiie eiio?-
ioeunaoee ia iaeaaii. Auyaeai 1 ?aoa?ao io?aoa ia ?EE (57 aieuiuo) o?iiaiee-
cena a ni?aoaiee n aioo?eai?oaeuiie aaeeiiiie eiio?ioeunaoeae (ni. Neiaa?u
oa?ieiia a eiioa aeaau) e aac iaa (ni. Eiiiaioa?ee) [62]. Noaoenoe?anee cia?e-
iiai ?acee?ey ii nia?oiinoe a oa?aiea 6 ian ia auyaeaii (22 ec 57, eee 39%, e
25 ec 57, eee 43%, aieuiuo niioa.; I?=0,9 i?e 95% AE io 0,57 ai 1,37; p=0,3).

A io?aoa ia ?EE aaiiua i iiai?iuo yooaeoao e inei?iaieyo

ea?aiey ia i?eaiayony [62].

A io?aoa ia i?eaiayony iia?iaiua aaiiua ia eniieuciaaiiuo
iaoiaao enneaaiaaiey, iiyoiio ioaiea ?acoeuoaoia cao?oaieoaeuia [58]. E?iia
oiai, auyaeaiu 2 iaaieuoeo ?EE (30 e 20 o?anoieeia) aioo?eai?oaeuiie aae-
eiiiie eiio?ioeunaoee ii n?aaiaie? ni noaiaa?oiie oa?aieae iinea ino?iai
EI [63, 64]. Ie a iaiii ec ?EE ia i?iaiaeee niaoeaeuiiai ioai?a eee aiaeeca
aaiiuo i aieuiuo n ea?aeiaaiiui oieii ia oiia ino?iai EI. Ie a iaiii ?EE
ia auyaeaii nie?aiey nia?oiinoe ia oiia i?iaaaaiey aioo?eai?oaeuiie aae-
eiiiie eiio?ioeunaoee. I?eiyoi n?eoaou, ?oi aioo?eai?oaeuiay aaeeiiiay eii-
o?ioeunaoey i?e ea?aeiaaiiii oiea ia oiia ino?iai EI yooaeoeaia. Aieaca-
oaeunoa a iieuco eee i?ioea yoiai iiaiey ia iaeaaii.

:

?EE ii i?eiaiaie? aiia?aoia aniiiiaaoaeuiiai e?iaiia?auaiey e ii o?ain-
ieaioaoee na?aoa ia iaeaaii.

Nenoaiaoe?aneeo iaci?ia e ?EE ii i?eiaiaie? aiia?aoia anii-
iiaaoaeuiiai e?iaiia?auaiey e ii o?ainieaioaoee na?aoa ia iaeaaii.

Aieacaoaeunoa iaaeaaii?eyoiiai aeeyiey aiia?aoia aniiiiaaoaeu-
iiai e?iaiia?auaiey (ni. Neiaa?u oa?ieiia a eiioa aeaau) eee o?ainieaioaoee
na?aoa i?e ea?aeiaaiiii oiea ia oiia ino?iai EI ia iaeaaii.

A iaci?ao iana?aaoeiiiuo enneaaiaaiee [1, 58, 65] e ?ao?iniae-
oeaiuo enneaaiaaieyo [66, 67] iieacaii, ?oi a iaeioi?uo neo?ayo i?eiaiaiea
aiia?aoia aniiiiaaoaeuiiai e?iaiia?auaiey eciee?iaaiii eee a ?aieao iiaai-
oiaee e o?ainieaioaoee na?aoa i?eaiaeo e oeo?oaie? eeeie?aneeo enoiaia. Ai-
ia?aou aniiiiaaoaeuiiai e?iaiia?auaiey e o?ainieaioaoey na?aoa ainooiiu eeou
a iaiiiaeo niaoeaeece?iaaiiuo eeeie?aneeo oaio?ao, iiyoiio ?acoeuoaou niio-
aaonoao?ueo enneaaiaaiee iiaoo ieacaouny iai?eiaieiuie e a?oaei oneiaeyi
iaaeoeineie iiiiue.

255




:

Ia iaeaaii ?EE, eioi?ua auee au iinayuaiu yooaeoeaiinoe yeno?aiiuo ea?-
aeioe?o?ae?aneeo aiaoaoaeunoa a nayce n ?ac?uaii ia??aeoai?eiaie ia?aai-
?iaee, ?ac?uaii na?aoa, ieo?aeuiie ?aao?aeoaoeae, i?iecaiaeiuo a ?aiiai
ia?eiaa ea?aeiaaiiiai oiea ia oiia ino?iai EI.

I?aeiouanoaa Nenoaiaoe?aneeo iaci?ia e ?EE ii aaiiiio aii?ino ia iaeaaii.
Iaainoaoee Aieacaoaeunoa iaaeaaii?eyoiiai aeeyiey yeno?aiiuo ea?aeioe?o?-
ae?aneeo aiaoaoaeunoa a ?aiiai ia?eiaa ea?aeiaaiiiai oiea, eioi?ue iaoneia-
eai aiaoiie?aneeie aaoaeoaie na?aoa ia oiia ino?iai EI, ia iaeaaii.

Aaiiua ianenoaiaoe?aneeo iaci?ia iana?aaoeiiiuo enneaaiaaiee
iieacaee, ?oi ?ac?ua na?aoa a ionoonoaea yeno?aiiuo ea?aeioe?o?ae?aneeo aia-
oaoaeunoa a ?aiiai ia?eiaa EI anaaaa i?eaiaeo e nia?oe, e ?oi iia?aoey ii
iiaiao ieo?aeuiie ?aao?aeoaoee eee ?ac?uaa ia??aeoai?eiaie ia?aai?iaee ai-
eaa yooaeoeaia i?e i?iaaaaiee a ia?aua 24—48 ? [1, 58].

Neiaa?u oa?ieiia
Na?aa?iue eiaaen — i?iecaiaiia na?aa?iiai aua?ina, ii?aaaeyaiia ii oi?ioea
na?aa?iue aua?in/ieiuaau iiaa?oiinoe oaea (e/iei/i2).
Aioo?eai?oaeuiay aaeeiiiay eiio?ioeunaoey — iaoia ea?aiey, i?e eioi?ii a
ai?oo aaiayo iaaoaiie aaeeii?ee, aai ?acaoaa?o a aeanoieo e iii?i?iy?o iaiin-
?aanoaaiii ia?aa nenoieie.
?aaaneoey?ec aoey ieiea?aa — yoei oa?ieiii iaiauaiii iacuaa?o ??anei?io?
??aci?inaaoio? ei?iia?iaiaeiieanoeeo (EAI) e ai?oiei?iia?iia ooioe?iaa-
iea (AEO).
Eeanneoeeaoey ii Eeeeeio i?aaiacia?aia aey ioaiee oy?anoe NI ii iauaain-
ooiiui eeeie?aneei iieacaoaeyi. Iniiaiua ec ieo: eeann I — ionoonoaea NI;
eeann II — iaeeiiocu??aoua aea?iua o?eiu auneooeaa?ony iaa ie?iae iiei-
aeiie eaai?iuo iieae; eeann III — iaeeiiocu??aoua aea?iua o?eiu auneooeaa-
?ony iaa anae iiaa?oiinou? eaaeeo; eeann IV — ea?aeiaaiiue oie.
Aiia?aou aniiiiaaoaeuiiai e?iaiia?auaiey — iaoaie?aneea ono?ienoaa, ia?aea-
?eaa?uea e?iau iaiia?aiaiii n ?aeoai?eaie na?aoa e i?aaiacia?aiiua aey
iiaaa??aiey na?aa?iiai aua?ina i?e NI. A nayce n oaoie?aneei ianiaa?oai-
noaii, aunieei ?eneii ?acaeoey o?iiaica e aaiieeca, aiia?aou aniiiiaaoaeu-
iiai e?iaiia?auaiey iau?ii i?eiaiy?o a oa?aiea ei?ioeiai a?aiaie i?e iia-
aioiaea e o?ainieaioaoee na?aoa.

Nouanoaaiiua eciaiaiey ii n?aaiaie? n i?aaoanoao?uei auioneii
ni?aai?ieea:
O?iiaieec en i?e ino?ii EI: iaeaaiu 2 iiauo ?EE [21, 22]; auaiau i?a?iea.
Aaoa-aeieaoi?u: iaeaaii 1 iiaia ?EE [32]; auaiau i?a?iea.


256






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Nicolas Danchin, Professor of Medicine
Universite Paris VI Hopital Europee Georges
Pompidou Paris France

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