#3

Tbilisi
2009
TBILISI
 redaqtori: giorgi CaxunaSvili
Editor in chief: GEORGE CHAKHUNASHVILI

saredaqcio kolegia:
Editorial Board:
mamanti rogava MAMANTI ROGAVA
manana RuduSauri MANANA GUDUSAURI
konstantine CaxunaSvili KONSTANTINE CAXUNASVILI
nino jobava (redaqtoris moadgile) NINO JOBAVA (CoEditor)
dito tabucaZe DITO TABUCAZE
vladimer zardaliSvili VLADIMER ZARDALISVILI
neli TofuriZe (kolegiis mdivani) NELI TOFURIZE (Secretary of Board)
neli badriaSvili NELI BADRIASHVILI
Temur miqelaZe TEMUR MIKELADZE
manana SvangiraZe MANANA SHVANGIRADZE
maia inasariZe MAIA INASARIDZE
mixeil mWedliSvili MIKHEIL MCHEDLISHVILI
merab maTiaSvili MERAB MATIASHVILI
maka ioseliani MAKA IOSELIANI
TamTa metreveli TAMTA METREVELI
nino Wanturaia NINO CHANTURAIA
lali kvezereli LALI KVEZERELI
mamuka CxaiZe MAMUKA CXAIDZE
TinaTin kutubiZe TINATIN KUTUBIDZE
zurab SaqaraSvili ZURAB SHAQARASHVILI
giorgi didava GIORGI DIDAVA
vaxtang xelaSvili VAXTANG XELASHVILI
marine xecuriani MARINE XECURIANI
sarCevi
saqarTvelos bavSvTa kardiologTa asociacia . . . . . . . . . . . . . . . . . . . . . . . 6
m.m.d. prof. akad. g.CaxunaSvili, m.d. n. jobava, m.m.d. akad. k. CaxunaSvioli
gul-sisxlZarRvTa sistemis daavadebaTa marTvis
Tanamedrove xedva bavSvTa da mozardTa asakSi . . . . . . . . . . . . . . . . . . . . . . 9
n. badriaSvili, m. moiswrafiSvili, n. TofuriZe,
n. SariqaZe, m. giorgobiani, z. SaqaraSvili
nutriciuli problemebi da maTi koreqcia kistofibrozis dros . . . . . . . . 18
m. SvangiraZe, r. ioseliani, q. cxakaia, d. TenieSvili
arteriuli hipertenzia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
z. zarnaZe, T. robaqiZe, m. inasariZe, n. Wanturaia, i. korinTeli, n. maisuraZe
ultrasonografiis, rogorc arainvaziuri informaciuli
specifikuri da mgrZnobiare radiologiuri meTodis
efeqturoba (roli) pilorostenozis adreul etapze diagnoscirebaSi . . . . . . . 23
prof. s. jaiani, prof. z. kaxabriSvili, eq. z. lominaZe, eq d. zaaliSvili.
fexburTelTa sportuli travmebis reabilitacia. kompleqsur
mkurnalobaSi mikroplazmuri samkurnalo danadgaris gamoyenebiT . . . . . . . 23
Targmani (ramaz RulaZe).
Kliegman: Nelson Textbook of Pediatrics, 18th ed. 2007.
Tavi-381.
filtvis qsovilis rekurentuli an persistulad mimdinare infiltracia . . . . . . 27
Targmani (ramaz RulaZe).
WESEZING (xmauriani sunTqva) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
d. CaxunaSvili, q. maTiaSvili, r. wivwivaZe
gul-sisxlZarRvTa sistemis dazianeba
hemoragiuli vaskulitis dros bavSvebSi . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
e. bairamovi, g. CaxunaSvili
leqtinebis gamoyenebis perspeqtiva XXI saukunis medicinaSi . . . . . . . . . . . 38
m.m.d. akad. z. kaxabriSvili, m.m.d. prof. akad. g. CaxunaSvili, m.m.d. akad. k. CaxunaSvili
maRali kvalifikaciis moWidaveebis sawvrTno procesebis marTva . . . . . . . 40
teq.m.d. prof. v. xositaSvili, m.m.d. av. koWlamaziSvili, prof. g.CaxunaSvili
parasamkurnalo preparat `menj-unis~ klinikuri kvlevis Sedegebi . . . . . . . 41
teq.m.d. prof. v. xositaSvili, prof. g.CaxunaSvili, l. xositaSvili, m.m.d. k.CaxunaSvili.
yurZnis WaWidan lipiduri bunebis naerTebis identifikacia da maTi gamoyeneba
preparatebis `menj-unisa~ da `apikoris~ miRebis teqnologiur procesSi . . . . . . 43
c. farulava. m. gordelaZe. T. goTua.
celiakiis diagnostikisa da marTvis sirTuleebi Saqriani diabetiT
daavadebul bavSvebsa da mozardebSi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
m.nanobaSvili. g.CaxunaSvili. m. Ciqovani
probiotikebisa da prebiotikebis roli meZuZuri dedebis,
axalSobilebisa da wlamde asakis bavSvTa kvebaSi
rubrika axalgazrda dedebs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

erTerTi pirveli qarTuli preparatebi . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

test-kiTxvari eqimebisaTvis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
CONTENTS
ASSOCIATION OF CHILDREN’S CARDIOLOGISTS OF GEORGIA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

PhD, Prof. Academician G.Chakhunashvili, PhD N.Jobava, PhD, Academician K.Chakhunashvili

THE MODERN VIEW OF MANAGING THE DISEASES OF
THE CARDIOVASCULAR SYSTEM IN CHILDREN AND ADOLESCENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

N.Badriashvili, M Moistsrapishvili , N.Topuridze, N.Sharikadze, M.Giorgobiani, Z.Shakarashvili

NUTRITIONAL PROBLEMS AND THEIR CORRECTION IN PATIENTS WITH CYSTIC FIBROSIS . . . . . . . . . . . . . 18

M.Shvangiradze, R.Ioseliani, K.Ckhakaia, D.Tenieshvili

ARTERIAL HYPERTENSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Z.Zarnadze, T.Robakidze, M.Inasaridze, N.Chanturaia, I.Korinteli, N.Maisuradze

THE EFFECTIVENESS OF ULTRASONOGRAPHY, AS NONINVASIVE, INFORMATIVE,
SPECIFIC AND SENSIBLE RADIOLOGICAL METHOD OF DIAGNOSTICS IN
THE EARLY STAGE OF PYLORIC STENOSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Prof. S. Jaiani, Prof. Z. Kakhabrishvili, Dr. Z. Lominadze, Dr. D. Zaalishvili

THE REHABILITATION OF FOOTBALL PLAYERS’ INJURIES, USING
THE MICROPLASMIC TREATMENT DEVICE IN THE COMPLEX TREATMENT . . . . . . . . . . . . . . . 23
Translation (Ramaz Guladze).
Kliegman: Nelson Textbook of Pediatrics, 18th ed. 2007.
Chapter381.
THE RECURRENT OR PERSISTENT COURSE OF INFILTRATION OF LUNG TISSUE . . . . . . . . . . . . . . . . 27

Translation (Ramaz Guladze).

WHEEZING (NOISY BREATHING) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

D. Chakhunashvili, Q. Matiashvili, R. Tsivtsivadze

THE INJURY OF CARDIOVASCULAR SYSTEM IN CHILDREN
WITH HEMORRHAGIC VASCULITIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

E. Bairamov, G. Chakhunashvili
THE PERSPECTIVE OF USING LECTINS IN THE 21ST CENTURY MEDICINE . . . . . . . . . . . . . . . . . . . . . . 38

PhD, Academician Z.Kakhabrishvili, PhD, Prof. Academician G. Chakhunashvili,

PhD, Academician K.Chakhunashvili
MANAGING THE TRAINING PROCESSES OF HIGH QUALIFIED WRESTLERS . . . . . . . . . . . . . . . . . . . . . 40

PhD, Prof. V.Khositashvili, PhD A.Kochlamazashvili, Prof. G.Chakhunashvili

THE RESULTS OF CLINICAL RESEARCH OF THE PARATREATING PREPARATION „MENJUNI“ . . . . . . . . . . . . . 41

PhD, Prof. V.Khositashvili, Prof. G.Chakhunashvili, L.Khositashvili, PhD K.Chakhunashvili

THE IDENTIFICATION OF LIPID NATURE ADMIXTURES FROM
THE HUSK OF GRAPES AND ITS USAGE IN THE TECHNOLOGICAL
PROCESS OF RECEIVING „MENJUNI“ AND „APICOR“ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

C.Parulava, M.Gordeladze, T.Gotua

THE DIAGNOSING THE CELIAC DISEASES AND THE TOUGHNESS
OF MANAGING DIABETES MELLITUS IN CHILDREN AND ADOLESCENTS . . . . . . . . . . . . . . . . . . . . . . . 45

M.Nanobashvili, G.Chakhunashvili, M.Chikovani

THE ROLE OF PROBIOTICS AND PREBIOTICS IN THE NOURISHMENT
OF CHILDREN IN BREASTFEEDING MOTHERS, NEWBORN CHILDREN AND INFANTS
robiotic and Prebiotic at newborns, breast feeding mothers and children of chest age
RUBRIC TO YOUNG MOTHERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

ONE OF THE 1ST GEORGIAN PREPARATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

TESTQUESTIONNAIRE FOR DOCTORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

@__) otkb
,fdidsf rfhlbjkjubf 5

@__) otkb
 6 ,fdidsf rfhlbjkjubf
saqarTvelos bavSvTa
kardiologTa asociacia
s.b.k.a. Camoyalibda Tssu-s pedklinikis bazaze
1992 wels, registrirebul iqna 1999 wlisTvis.
aRniSnuli asociacia warmoadgens kavSirs, xuTi
fizikuri piris mier Camoyalibebuls, romelic
daarsda saqarTvelos 1997 wlis samoqalaqo ko-
deqsis debulebebis Sesabamisad. `asociaciis~
saqmianobis vada ganusazRvrelia, aqvs damouki-
debeli balansi saqarTvelosa da ucxoeTis sa-
banko dawesebulebebSi. amkavSiris miznebswarmo-
adgens _ formulirebismoZeb nagul-sisxlZarR-
vTasistemisrevmatituli, revmatuli, ararevmatu-
lidazianebebis, gulis iSemuri daavadebaTa, mio-
kardiumis infarqtiT, kardiopaToebis sxvadasx-
va formebis, bavSvTa hipotenziebis, sportuli
gulis da sxva paTologiuri procesebis naad-
revi diagnostirebaSi, kardiologiis ganviTare-
ba,agreTve bavSvTa kardilogiiT dainteresebul
student-axalgazrdobisadmi yovelgvari daxma-
rebis gaweva. saqmianobis sagans warmoadgens
gulsisxlZarRvTa usisxlo instrumentuli
kvleva. e. kg. 15 ganxrSi,fag _ datvirTvisas,eleq-
trogamoTvliT velometria, pulsuri mrudebi,
kapidari skopa, reografia, eqokardiografiadasx-
va. agreTve, imunologiuri da genetikuri marke-
rebis kvleva. aRsaniSnavia, rom `asociaciis~ wev-
rebi SeiZleba iyvnen rogorc iuridiuli aseve
fizikuri pirebi,romlebic iziareben mis mizneb-
sa da saqmianobis principebs werilobiTi gan-
cxadebis safuZvelze. `asociaciis~ wevrebs akis-
riaT garkveuli ufleba-movaleobebi. monawile-
obis miReba wesdebiT gaTvaliswinebuli wesiT.
`asociaciis~ marTvaSi, isargeblon asociaciis
konsultaciebiT da rekomendaciebiT, monawile-
oba miiRon ganzraxulproeqtebze, miiRonfinan-
suri mxardaWera `asociaciis~ fondebidan, ag-
reTve _ gavidnen `asociaciidan~. `asociaciis~
marTvis organos warmoadgens `asociaciis~ wev-
rTa `saerTo kreba~, romelicmoiwveva 1 jer we-
liwadSi, an saWiroebisamebr. TiTo wels miekuT-
vneba TiTo xma. winamdebare wesdeba ZalaSia mi-
si registraciis TariRidan. amrigad, aRniSnul
asociacis kardiologiis dargSi akisria
mniSvnelovanifunqcia-movaleobebi, romelic da-
fuZnebulia eqimTa gulisxmierebasa da Semoqme-
debiT damokidebulebaze am dargis mimarT.
saqarTvelos bavSvTa
kardiologTa asociacia
saqvelmoqmedo aqciebi
1992wlidan 1998 wlamde mimdinareobda perio-
dulad mosaxleobis humanitaruli gasinjvebi.
sul 1998 wlidan socialuri pediatriis fond-
Tan erTad daiwyo saqvelmoqmedo aqciebi. aqcieb-
Si monawileoben: gamoCenili qarTveli pediatre-
bi. mimdinareobs avadmyofTa labora toriuli
da instrumentuli kvleva da sxva. urigdebaT me-
dikamentebi. CautardaT ramdenime aTeuli sasw-
rafo operacia. aTobiT avadmyofs Cautarda ufa-
so gamokvleva da mkurnaloba sxvadasxva wamyvan
klinikebSi.
07.01.98-07. 02. 99ww. Tbilisi, gaisinja 9200 bav
Svi. 23.24.01.99w. aRmosavleT saqarTvelo. centri
q. Telavi. gaisinja 3500-ze meti bavSvi. 12-13-14. 02.
99 Tbilisi televiziis muSakTa Tvis Ria karis
dRe; gaisinja 100-mde bavSvi da daurigdaT medi-
kamentebi. dedaTa da bavSvTa sadiagnostiko cen-
trSi da agreTve qalaqis sxvadasxva poliklini-
kebSi Camoyalibda maRalkvalificiur profe-
sor-maswavlebelTa ufaso konsultaciebi kvira-
Si erTjer. qalaqis wamyvan pediatriul klini-
kebSi tardeba maRalkvalificiur profesor-mas-
wavlebel Taufaso konsultaciebi TveSi erT-
jer. aqciebSi sxvadasxva profiliT monawileob-
dnen:
1. kanisa da venseneulebaTa instituti
2. parazitologiis samecniero-kvleviTi in-
stituti da sxv. dawyebulia munisa da tilis sa-
winaaRmdego profilaqtikuri RonisZiebebi dam-
kurnalobis etapi. aseve darigdeba Sesabamisi me-
dikamentebi. daibeWda da gavrcelda munisa da
tilis sawinaaRmdego Sesabamisi ufaso samaxsov-
roebi.
12-13-14.03.99w. eqspedicia foTsa da abaSaSi. 13.
03. 99w. q. foTi,gaisinja 950 bavSvi. daurigdaT me-
tikamentebi.
13-14.03.99w. q. abaSa da abaSis raioni (s. qedisi,
s. marani da sxv.)
29-30. 01-07. 08. 99w. gaisinja 4400 bavSvi,daurig-
daT medikamentebi.
23-24-25. 08. 99 w. Catarda ufaso laboratori-
uli da instrumentuli kvleva. q. xobi da q. zug-
di daurigdaT munisa da tilis sawinaaRmdego
wamlebi.
04.04.99w. eqspedicia fasanaurSi kompleqsur
ad gaisinja 400-ze meti bavSvi.
07.05.99w. eqspedicia guriis regionSi. q. lan
CxuTi CautardaT ufaso laboratoriuli da in-
strumentuli kvleva, daurigdaT medikamentebi.
18.05.99w. Catarda gasinjvebi q. rusTavSi (gai-
sinja250-zemetibavSvi, darigda medikamentebi).
22. 06. 99w. Catarda gasinjvebi sagarejoSi (ga-
isinjda250-ze meti bavSvi, darigda medikamentebi).
13-14.08.99 w Camoxatauri (gaisinja 1500-mde bav-
Svi).
15.08.99 w. baxmaro (gaisinja 2000-ze meti bavS-
vi-damsvenebeli) zRvis donidan 2050m.
16.08.99w. eqspediciagadavidabaxmarodan aWaris
maRalmTian raionebSi (sul gaisinja 750-ze meti
bavSvi) zRvis donidan 2300-2400m.
@__) otkb
,fdidsf rfhlbjkjubf
17.09.99 w. Catardakompleqsuri gamokvlevebi
Tbilisis upatrono bavSvTa saxlSi.
16.10.99w. Catarda gasinjvebi duSeTSi (gai-
sinja 200-mde bavSvi, darigda medikamentebi).
2000 weli
26.02.2000 w. q. gori gaisinja 500-ze meti bavSvi,
darigda medikamentebi
23.03.200 w. axalgori, gaisinja 30 bavSvi.
01.04.2000 w. marneulis r-ni sof. weraqvi gakeT-
da sisxlis saerTo analizi, instrumentuli ga-
mokvlevebi-eqoskopia, encefalograma da sxva.
sul gaisinja 1500 bavSvi da momvleli.
15.04.2000. w. gurjaani kompleqsuri gasinjvebi,
gaisinja 1200-mde bavSvi darigda medikamentebi.
29.04.2000 w. q. rusTavi (kostavas #6) gaisinja
300-mde bavSvi.
05-06-07. 2000 w. gasinjulia avWalis koloni is
bavSvebi.
20.07-28.07. 2000 w. wyneTis bavSvTa saxlSi ga-
sinjulia 60 bavSvi.
21-22-23.-7. 2000w. abaSis r-ni sof. sakieTisa da
samtrediis r-nis aRsazrdelTa skolis bavSvTa
gasinjvebi.
7-8.08. 2000 w. baxmaro-buSumi gaisinja 1925 bav-
Svi.
2001 w.
15.03. 2001 w. gaisinja da kompleqsuri gamokv-
leva Cautarda rusTavis azotis qarxnis TanamS-
romelTa bavSvebs.
23.06.2001w. gaisinja da kompleqsuri gamokv
levaCautarda rusTavis azotis qarxnis TanamS-
romelTa bavSvebs.
14-15-16. 09. 2001w. baRdadis r-ni sof. sairme, wi-
Telxevi, roxi, II obCa, xani, zegani, saqraula. gai-
sinja 2500 bavSvi.
2002 weli
10.03. 2002 w. axalgori gaisinja 250 bavSvi.
20-04. 2002wl. siRnaRis r-ni gaisinja 450 bavS-
vi
23-24-25-26. 2002w. xulo (aWara) sapatriarqos-
Tan erTad gaisinja 600 bavSvi da 100 mozrdili.
27-28-29. 06. 2002w. q. Tbilisi 20 mozrdilTa po-
liklinika, 10 bavSvTa poliklinika, 121 bavSv Ta-
poliklinika gaisinja 400 bavSvi.
16-17-18-19. 07. 2002w. kodoris xeoba (afxazeTi)
gaisinja 250 bavSvi.
3-4-5-6. 2002w. mTa-TuSeTi, diklo, omalo, Senaqo,
gaisinja 200 bavSvi.
2003 weli
5. 03. 2003w. samcxe-javaxeTi gaisinja 1250
bavSvi.
17.04. 2003w. werovani gaisinja 450 bavSvi.
20.05. 2003w. borjomi gaisinja 870 bavSvi.
25.06. 2003w. mTa-TuSeTi gaisinja 320 bavSvi.
30.07. 2003w. baxmaro gaisinja 630 bavSvi.
20.08. 2003 w. zestafoni gaisinja 210 bavSvi.
7.09. 2003 w. zugdidi gaisinja 290 bavSvi.
15.10. 2003 w. raWa gaisinja 170 bavSvi.
18. 10. 2003 w. dmanisi gaisinja 180 bavSvi.
@__) otkb
7
2004 weli
marti-aprili-maisi: kaspi, gurjaani, Telavi, ax-
meta, lagodexi, siRnaRi, bodbe, aspinZa, axalcixe,
borjomi, Tbilisi, zestafoni, xaragauli, WiaTura
gaisinja 1728 bavSvi. socialuripediatriis dac-
vis fondis mier saqarTvelos sapatriarqos Ta-
nadgomiT saqarTvelos sxvadasxva regionebSi:
zugdidi,xulo,xelvaCauri,qeda, lanCxuTi,ozur-
geTi, ingiri
_ Catarda saqvelmoqmedo aqciebi, sadac gai-
sinja, Sesabamisi kvalificiuri samedicino kon-
sultacia gaewia da medikamentebi daurigda 2400
bavSvs.
2005weli
mrneulis regionSi, gaisinja 700 bavSvi da 800
mozrdili.
18 ivlisi kaspi 450 bavSvi.
8 oqtomberi mcxeTis raioni 300 bavSvi.
14-15-16 oqtomberi lentexi 850 bavSvi da 200
mozardi.
2006 wlis 18 Tebervals klinikaSi Catarda
Ria karis dRe. gaisinja mxatvarTa kavSiris 20
ojaxi. martSi Ria karis dRe. gaisinja ltol-
vilTa 100-ze meti bavSvi. aprilSi saguramoSi
elCebis monawileobiT Catardaaqcia.
31 maiss q. rusTavSi gaisinja 450 bavSvi. 1-2 iv-
niss Tssu-Si Catarda Ria karis dRe.
2007 weli
_ bavSvTa kardiologia gaisinja 400 bavSvi.
maT CautardaT konsultacia da klinikolabora-
toriuli gamokvlevebi.
9-10 ivniss kaspis raionSi Catarda gasvliTi
gasinjvebi. (gaisinja 300 bavSvi.
1 ivliss cxinvalis raionSi omSi monawile-
Ta 500 bavSvi gaisinja. seqtember-oqtomberSi ga-
isinja 120 bavSvi.
noemberSi gaisinja JurnalistTa 100-200
ojaxi.
2006 wlis 18 Tebervals klinikaSi Catarda
Ria karis dRe. gaisinja mxatvarTa kavSiris 20
ojaxi.
martSi Ria karis dRe. gaisinja ltolvilTa
100-ze meti bavSvi.
aprilSi saguramoSi elCebis monawileobiT
Catarda aqcia.
31 maiss q. rusTavSi gaisinja 450 bavSvi.
1-2 ivniss Tssu-Si Catarda Ria karis dRe. ga-
isinja 400 bavSvi.
maT CautardaT konsultacia da kliniko la-
boratoriuli gamokvlevebi.
9-10 ivniss kaspis raionSi Catarda gasvliTi
gasinjvebi. (gaisinja 300 bavSvi.
1 ivliss cxinvalis raionSi omSi monawile-
Ta 500 bavSvi gaisinja. seqtember-oqtomberSi ga-
isinja 120 bavSvi.
noemberSi gaisinja JurnalistTa 100-200
ojaxi.
dRemde aqciebSi sul gasinjulia 87950 bavS-
vi da aTasobiT xanSiSesuli. saqvelmoqmedo aq-
ciebi grZeldeba.
 8 ,fdidsf rfhlbjkjubf
2007 weli
marneuli. ufaso konsultacia Cautarda 110
bavSvs. gamovlindnen sqolioziT daavadebuli
bavSvebi. gadaecaT espanderebi da meToduri re-
komendaciebi samkurnalo fizkulturis Sesaxeb.
duSeTi. kansultacia Cautarda 280 bavSvs.
axaSeni. kansultacia Cautarda 85 bavSvs
2008 weli
1 ivnisi – Ria karis DdRe (gaisinja 200
bavSvi)
2 ivnisi Teddy bear (gaisinja 300 bavSvi)
14 ivnis axmeta (qaqucoba - gaisinja 450 bavS-
vi, romelTac CautardaT Semdegi gamokvlevebi
muclis Rrus eqoskopia, ekg da sxva. darigda Se-
sabamis medikametebi
27 ivnisi – saqarTvelos seqciis aRdgena
20 agvisto – Stop Russia/ igoeTis aqcia
1 seqtemberi – Stop Russia/ Tbilisi jaWvis aqcia
4 oqtomberi Ria karis DdRe konsultacia,
gamokvlevebi: muclis Rrus eqoskopia, ekg da
sxva. Sedga mxatvrebis da xelvnebis moRvaweebis
master-klasi bavSvebisTvis
6 dekemberi bergmanis klinikaSi ufasod gai-
sinja 110 bavSvi, romelTac CautardaT Semdegi
gamokvlevebi muclis Rrus eqoskopia,ekg da sxva.
darigda Sesabamis medikametebi
dRemde aqciebSi sul gaisinja 87950 bavSvi da
aTasobiT xanSiSesuli. saqvelmoqmedo aqciebi
grZeldeba.
bavSvTa kardiologiuri asociaciis mier Ca-
tarebulia konferenciebi da simpoziumebi:
1992 w. I bavSvTa kardiologTa konferencia. I
konferencia `CvenTan erTad irwmune ukeTesi mo-
mavlis realoba~
01.VI. 99
II konferencia `janmrTeli bavSvi mSvidobia-
ni kavkasia~
25.XII. 99 III konferencia `dRevandeli ekono-
mikuri mimarTulebani pediatriaSi da misi pers-
peqtiva~ XXI saukunis pediatria _ invalidobis
profilaqtikis medicinad unda iqces.
01. VI. 2000 IVkonferencia `Canasaxidan bavSvis
ufleba unda iyos daculi~
27.III. 2001 Sexvedra saxalxo damcvelis ofis-
Si `arasrulwlovani damnaSaveebi, maTi uflebe-
bi da realoba~
01. 06. 2001 V (XIX) konferencia `miZRvnili bav-
SvTa dacvissaerTaSorisodRisadmi~
30.03. 99, 01.06. 2000, 01.06. 2001
`bavSvTa mkurnaloba XXI saukuneSi~ simpo-
ziumi 1, #2, #5
23.04.99.01. 06. 2000
`bavSvTa kveba XXI saukuneSi~ simpoziumi #1,
#2. 20. 05. 99. 01. 06. 2000
`orTopediuli skola~
simpoziumi #1, #2
17. 12. 99
`mukovis cidozis diagnostikisa da mkurna-
lobis sakiTxebi~
01. 06. 2000
axalgazrda pediatrTa XVIII konferencia
28. 02. 2001
erToblivi samecniero konferencia `respira-
torul daavadebaTa Terapiis aqtualuri sa-
kiTxebi pediatriaSi~.
01. 06. 2001
`Canasaxidan bavSvs ufleba aqvs iyos dacu-
li~
simpoziumi #1
01. 06. 2001
`bavSvi, mozardi da ojaxuri Zaladoba~
simpoziumi #1
01. 06. 2001 `Canasaxidan bavSvs ufleba aqvs
iyos daculi~
simpoziumi #1
13. 02. 2002
`adamianis genomis proeqti~
10. 03. 2002 axalgori, matonizirebuli sasmeli
`lomisis~ prezentacia.
6. 11. 2002 saerTaSoriso konferencia Temaze:
`mukovis cidoziT da nivTierebaTa cvlis kons-
tituciuri moSlilobiT daavadebulTa samedi-
cino da socialuri problemebi~.
7. 11. 2002 saerTaSorisoko nferencia Temaze:
`Tandayolili infeqciebis Tanamedrove apeqte-
bi~.
4. 04. 2003
pediatriis aqtualuri sakiTxebi. IX konfe-
rencia.
1. 06. 2003
I internet-konferencia (X samecniero-praqti-
kuli konferencia) socialuri pediatriis dac-
vis fondi ufasod uSvebs da arigebs gazeTs `so-
cialuri pediatria~ da Jurnals `socialuri pe-
diatria~ (Suqdeba socialuri, samedicino, peda-
gogiuri, fsiqologiuri, fsiqiatriuli, religiu-
ri da sxva aqtualuri da problemuri sakiTxe-
bi)
19. 12. 2003 saqarTvelos bavSvTa kardiologTa
II kongresi.
1. 06. 2004. II saerTaSoriso internet-konferen-
cia. pediatriis aqtualuri sakiTxebi
22. 10. 2004. konferencia Temaze: `pediatriis aq-
tualuri sakiTxebi~ , romelic eZRvneboda soci-
aluri pediatriis prezidentis, genetikosis viq-
tor moroSkinis naTel xsovnas.
1. 06. 2005 pediatriis aqtualuri sakiTxebi
XIV konferencia.
9. 09. 2005 Tbilisi, merioti II saerTaSoriso
konferencia `janmrTeli bavSvi mSvidobiani kav-
kasia~.
2006w. 1 ivnisi socialuri pediatris dacvis
fondis konferencia. dekemberSi axalgazrda pe-
diatrTa ligis eqim specialistTa XXIII kong-
resi.
31.05. 2007 bavSvTa kardiologiis II kongresi.
7.12. 2007 spdf me-17 konferencia.
07.10.08. konferencia `bavSvis da mozardis~
kardiologiuri seqcia (Tbilisi).
20.12.08 socialuri pediatriis dacvis fondis
da ESMNS erToblivi meore konferencia
(Tbilisi).
@__) otkb
,fdidsf rfhlbjkjubf 9

uek-cbc[k’fhqdsf cbcntvbc lffdflt,fsf vfhsdbc

sfyfvtlhjdt [tldf ,fdidsf lf vjpfhlsf fcfrib
v8v8l8 ghja8 frfl8 U8 XF{EYFIDBKB8 njpehb lfpbfyt,f !@ okbc ,bzib ~.. 
v8l8 Y8 }J<FDF8 v8v8l8 frfl8 R8 XF{EYFIDBKB8 .  1981`8 fenjacbfpt yfyf[b bmyf ~C.C.

 1915` kbgblehb kfmf fjhnfib # sdbc fcf-
rbc ,fdidsf % ghjwtynib7 * okbc fcfrbcsdbc bub
\\6 c-bc lfcfo.bcib ,fdidsf lf vjpfhlsf fcf-
fqvjfxylf ^# ghjwtync7 [jkj ( okbc ptvjs sb-
rib uek-cbc[k’fhqdsf cbcntvbc lffdflt,fsf
smvbc .dtkf ufhlfwdkbk ,fdidc8 fhbc vjyfwtvt,b
lhjek lbfuyjcnbht,fc7 cojh vrehyfkj,fcf lf
~C. Benda 1925` !# okbc ujujyfc etwfhb ufhlfwdf-
ghtdtywbekb qjybc’bt,t,bc ufnfht,fc sfyfvtl-
kt,bc itcf[t,7 fjhnbcf lf udbhudbyjdfyb fhnthb-
hjdt ,fdidsf rfhlbjkjubfib evybidytkjdfytcb
t,bc fsthjcrkthjpbc itltufl8 f8 y8 rkbvjdbc
hjkb tybzt,f8 fvltyl7 lffdflt,fsf sfyfvtlhjdt
~!)**` vjyfwtvt,bs7 cgjynfyehb kbgblehb kfmt,b
vfhsdf fewbkt,kfl s[jekj,c uek-cbc[k’f-
lf pjkt,b !_ okbc fcfrbc ,fdidt,ib bzthty fjhnbc
hqdsf cbcntvbc vwbhtjlty lfpbfyt,fsf itcf[t,
ptlfgbhbc !_ ghjwtync7 [jkj @% okbc fcfrbcsdbc
sfyfvtlhjdt [tldfcfw8 fv cfrbs[c t’qdyt,f xdtyb
#_-%_ ghjwtync8 fsthjcrkthjpbc lf vbcb v’bvt
lqtdfyltkb ihjvt,b5
rkbybrehb ufvjdkbyt,t,bc7 vfs ijhbc u8b8l-bc7
f` fsthjcrkthjpbcf lf uekbc bitvbehb lff-
uff[fkufphlfdt,bc itcf[t, erdt ,tdhb vrdktdfhb
dflt,bc gtlbfnhbekb fcgtmnt,b
vbesbst,c ~.
 1981, .    
lf
1981. ..  

   1984, ..`8
,` bveyjvjlthfnjht,bc hjkb sfyfvtlhjdt
gtlbfnht,c eylf f[cjdlts7 hjv ,fdidt,c fhf
rfhlbjkjubfib lf vfsb ufvj.tyt,bc itcf’kt,-
fmds fsthjcrkthjpb7 ufhlf utytnbrehfl ufygb-
kj,t,b ,fdidsf fcfrib8
hj,t,ekb /bgthmjktcnthbytvbbcf7 vfuhfv lffdf-
lt,bc ufydbsfht,f itb’kt,f lfbo.jc erdt ,fdidsf
FSTHJCRKTHJPBCF LF UEKBC fcfrib8 fvbnjv vybidytkjdfyb fvjwfyff fsthjut-
BITVBEHB LFFDFLT,BC GTLBFNHBEKB yekb cbnefwbbc sfdblfy fwbkt,f8
FCGTMNT,B vjhajkjut,bc evhfdktcj,f ~.. !,
lqtbcfsdbc fsthjcrkthjpb ths-thsb .dt-
, ..  
kfpt ufdhwtkt,ekb lffdflt,ff vcjakbjib8 vbcb
’bhbsflb rkbybrehb ajhvf 2 uekbc bitvbehb lf-
fdflt,f ~ubl`7 ]fylfwdbc vcjakbj jhufybpfwbbc
vbth vbxytekbf hjujhw 3cfpjufljt,bc elbltcb
tgbltvbf7 hjvtkbw vjbwfdc vcjakbjc vstk vj-
cf[ktj,fc7 serb dth bmyt,f itveifdt,ekb vbcb
ghjabkfmnbrbc tatmnehb cfiekt,t,b48
fsthjcrkthjpb fhbc mhjybrekb lffdflt,f7
hjvkbc fhcb vlujvfhtj,c fhnthbt,bc rtlkt-
,bc cbcntveh lfpbfyt,fib7 vfsib kbgblt,bc xf-
kfut,bc cf[bs7 itvfthst,tkb mcjdbkbc ufydb-
sfht,bs7 itvlujvb ufvrdhbdt,bsf lf rfkwbab-
rfwbbs7 hfcfw cf,jkjjl vbd.fdfhs vfsb cfyf-
sehbc itdbohjdt,fvlt itcf,fvbcb rkbybrehb
ufvjdkbyt,bs 2 uekbc bitvbehb lffdflt,f7 vbj-
rfhlbevbc byafhmnb7 byceknb7 [fyufvjidt,bs
rjzkj,f lf f8 i8
vhfdfkokbfyb rdktdbc vjyfwtvt,pt lf.hlyj-
,bs ~.. 
".. # 1981 .. $
1987` vbbxytdc7 hjv fsthjcrkthjpb itvltub cmt-
vbs dbsfhlt,f5 kbgblehb kfmf 2 fsthjcrkthj-
pekb ajkfmb 2 ufhsekt,ekb lfpbfyt,f ~lfo.-
kekt,f7 rfkwbyjpb7 shjv,jpb`7 vfuhfv7 fvfcsfy
thsfl7 vybidytkjdfybf cbc[k’fhqdsf fst-
hjcrkthjpekb wdkbkt,t,bc eremwtdflj,bc
afmnb ajkfmbc cnflbblfyfw rb7 hfw b’ktdf jg-
nbvbpvbc cfae’dtkc lffdflt,bc ghjabkfmnbrbcf
lf vrehyfkj,bc sdfkcfphbcbs8
lqtbcfsdbc vbxytekbf7 hjv cbc[k’fhqdt,ib
vjhajkjubehb wdkbkt,t,bc ufvjvodtdb gbhdt-
kflb ce,cnhfnbf cbc[kbc fsthjutyekb kbgjg-
hjntblt,b7 hjvkt,bw vlblfhbf mjktcnthbybs
lf itbwfdc wbkf-fgjghjntby B-c8 .dtkfpt flht lf
[ibhfl pbfylt,f fjhnf7 udbhudbyjdfyb lf ndbybc
fhnthbt,b7 vjudbfyt,bs ,fh’f.bcf lf ]jh]kbc
fhnthbt,b8 lffdflt,f vblbc nfkqbct,ehfl7 fmdc
ghjuhtcbht,bc7 cnf,bkbpfwbbcf lf htuhtcbht,bc
, 1977 ..
 1981, . afpt,b8 vbxytekbf7 hjv fsthjcrkthjpb fh fhct-

 1986` sfylfsfy w[flb [lt,f7 hjv fsthjc- ,j,c gkfpvbc kbgblt,bcf lf kbgjghjntblt,bc
rkthjpb cfsfdtc bqt,c ]th rbltd ,fdidsf lf vj- lbc,fkfycbc ufhtit8 ’bhbsflb vybidytkj,f tybzt-
pfhlsf fcfrib8 fqothbkbf fhnthbt,bc fnthjvf- ,f mjktcnthbyc7 nhbukbwblt,c lf ajcajkbgb-
@__) otkb
 10
lt,c8 rth’jl7 ght,tnfkbgjghjntblt,b fye ’fkb-
fy lf,fkb cbvrdhbdbc kbgjghjntblt,b ~’lckg`7
,tnfkbgjghjntblt,b fye lf,fkb cbvrdhbdbc kb-
gjghjntblt,b ~lckg` lf fkafkbgjghjntblt,b
fye vfqfkb cbvrdhbdbc kbgjghjntblt,b ~vckg`8
gbhdtkb jhb [fcbfslt,f fsthjutyekj,bs7 fhnt-
hbbc rtltkib itzhbcf lf xfkfut,bc eyfhbs7 [jkj
vckg ofhvjflutyty fynbfsthjutyek afmnjhc lf
gbhbmbs fath[t,ty fsthjcrkthjpbc ufydbsfht-
,fc8 fsthjutyekb [fcbfsbc lbcghjntbytvbf7 gkec
cbc[k’fhqdsf rtlkbc ufydkflj,bc vjvfnt,f7
[lt,f lffdflt,bc ufydbsfht,bc obyfgbhj,f8
fsthjcrkthjpbc ufydbsfht,f7 ptvjfqybiye-
kblfy ufvjvlbyfht7 vhfdfk afmnjhptf lfvjrb-
lt,ekb8 vfsufy vfbyw evsfdhtcbf5 !8 ubl-bcfrty
vtvrdblhtj,bsb vblhtrbkt,f7 @ lbckbgbltvbf 2
lckg-bcf lf ’vckg-bc vjvfnt,bs7 vckg-bc ljybc
lfmdtbst,bs7 #8 fhnthbekb /bgthntypbf7 $8 sfv-
,fmjc vjotdf7 %8 zfh,b ojyf7 ^8 /bgjlbyfvbf7 *8 yf[-
ibho.kt,bcflvb njkthfynj,bc lfhqdtdf8
wyj,bkbf ubl-bcf lf cbrdlbkbfyj,bc vfqfkb
vfxdtyt,tkb j]f[t,ib lf f[kj yfstcfdt,ib8 lff-
dflt,f dbsfhlt,f @_ okbs eahj flht lf @-!!-
]th eahj [ibhfl8 ,8d8 bkbycrb ~!)**` fsthjcr-
kthjpbcflvb vtvrdblhtj,bs ufyo.j,fc erfdib-
ht,c f` athvtynekb cbcntvt,bc fmnbdj,bc wd-
kbkt,fc7 ,` jhufybpvbc vjhajkjubehb cnhe-
mnehbc sfdbct,eht,fc ~vfs ijhbc cbc[k’fhq-
dt,bc`7 u` vfhtuekbht,tkb cbcntvt,bc aeymwb-
eh sfdbct,eht,t,c8 hfw eahj f[kjf yfstcfe-
hb rfdibhb7 vbs eahj [ibhbf ucc-bc fsthjcrkt-
hjpekb lfpbfyt,fw8 byafhmnuflfnfybkb vij,-
kt,bc ~$% okfvlt fcfrib` idbkt,c mjktcnthbybc
ljyt !_-!%-]th vfqfkb fmds sfyfnjkt,sfy it-
lfht,bs8
F. Friedman, S. rosental ~!)%)` fqybiyfdlyty gbhj-
dyekb sfdbct,eht,t,bc t8 o8 cnhtc-rjhjyfhekb
ghjabkbc hjkc ~A nbgb`8 tctyb fhbfy vbpfycohf-
aekb7 ihjvbcvj.dfht7 fuhtcbekb7 vfmcbvfkehfl
tvjwbehb lf abpbrehb lf’f,ekj,bc mdti vjve-
ifdt gbht,b7 hjvkt,bw dth f[th[t,ty chek.j-
abk lfcdtyt,fc veifj,bc itvltu8 fctsb nbgbc ,f-
didt,b kfgfhfrj,ty [vfvfqkf7 xmfhf7 cfrdt,cfw
zfvty lf lflbfy cohfafl7 fmds cohfadf gbhdtkj-
,bcrty ~L. Wolf at all !)(@`8
pjubthsb fdnjhb ofv.dfy hjkc frbcht,c fhf
utytnbrehc7 fhfvtl ufhtvj afmnjht,c ~%.. &'
..  1979`8 fm buekbc[vt,f rdt,bcf lf fhf-
]fycfqb w[jdht,bc otcbc gbhj,t,ib ufydbsfht,e-
kb /bgthlbckbgbltvbf lf /bgthukbrtvbf7 hfcfw
sfylfsfy vj/.dt,f fhnthbbc bynbvbcf lf shjv-
,fdidsf rfhlbjkjubf
1981`8 zfh,b w[bvjdfyb lf yf[ibho.kjdfyb rdt,f7
wbkbcf lf dbnfvbyt,bc ~C1. B6` yfrkt,j,f7 vfhbkbc
zfh,b ufvj.tyt,f lf f8 i8 mvybc fsthjcrkthjpbc
ufydbsfht,bc obyfgbhj,fc8 fmdt fqcfybiyfdbf jh-
cekj,bcfc ltlbc cjvfnehb lf tyljrhbyekb lff-
dflt,t,b7 njmcbrjpt,b7 yf.jabc vewkfl.jaybc
/bgjmcbf lf c[df7 hjvtkvfw f[fkij,bkj,bc fcfrb-
lfydt itb’kt,f ufvjbodbjc lbckbgbltvbbcflvb
vblhtrbkt,f8 c8t8 kt,tlrjdjbc vjyfwtvt,bs cf-
v[hts ehfkbc htubjyib !-lfy !^ okfvlt fcfrbc
,fdidt,ib lbckbgbltvbbc ufdhwtkt,f @^7@ ghj-
wtync fqotdc8 fqbybiyt,f vckg-bc lfmdtbst,f7 /b-
gthmjktcnthbytvbf lf /bgthnhbukbwthbltvbf8
erfyfcrytk okt,ib sfylfsfy bvfnt,c cfe,fhb
wyc-bc hjkpt lbckbgbltvbbc ufydbsfht,fib8 lfv-
nrbwt,ekbf7 hjv zfh,b tvjwbbc ajypt jhufyb-
pvib uhjdlt,f rfntmjkfvbyt,b7 bvfnt,c vbjrfh-
lbevbc vjs[jdyf ;fyu,flpt7 bo.t,f w[bvjdfyb v;f-
dt,bc vj,bkbpfwbf ltgjt,blfy7 bvfnt,c vfsb ljyt
cbc[kib ~vfs ijhbc lckg lf ’lckg`7 gfhfktke-
hfl flhtyfkbybcvfudfhb ybdsbtht,t,b vjmvtlt,ty
fhnthbbc rtlkt,pt7 vfsb vjmvtlt,bs afhsjdlt-
,f e]htlijhbcb tyljstkehb yfghfkt,b lf ce,t-
yljstkbevib bzht,bfy fsthjutyekb kbgjghj-
ntblt,b ~B Folkyer at all !)(!`8 hfw itt[t,f vck-c7 vf-
sb ljybc lfmdtbst,f7 mjktcnthbybc yjhvfkehb
ljybc lhjcfw rb7 ufyb[bkt,f hjujhw fsthjutye-
kb cbnefwbf ~B. M. Rifkind !)(@`8 vbc ljytpt efh.j-
abs ufdktyfc f[ltyc sfv,fmj7 /bgthntypbf7 yf]t-
hb w[bvjdfyb v;fdt,bs vlblfhb cfrdt,b8
lqtbcfsdbc lfvnrbwt,ekbf7 hjv fhnthbekb
/bgthntypbbc vmjyt gbht,c fsthjcrkthjpb
eahj cohfafl edbsfhlt,fs7 [jkj ubl #-$-
]th eahj [ibhbf ~rkbvjd f8 y8 !)(!`8 /bgthnty-
pbbc lhjc pbfylt,f cbc[k’fhqdsf tyljstkbe-
vb7 bvfnt,c ufvfdkj,f7 fhbc cgfcnbrehb itrevi-
dt,bcflvb vblhtrbkt,f7 bwdkt,f rjfuekfwbe-
hb cbcntvbc ojyfcojhj,f7 fqbybiyt,f lbckbgb-
ltvbf8 fmtlfy ufvjvlbyfht7 fhnthbekb /bgth-
ntypbf vbtresdyt,f 3lbl hbcrafmnjhsf4
]ueac8 ,fdidsf fcfrib fhwse bidbfsbf fhnthb-
ekb /bgthntypbbc tgbpjlt,b7 egbhfntcfl ge-
,thnfnek gthbjlib8
fctdt vybidytkjdfy afmnjhfl ufyb[bkt,f sfv-
,fmjc ufvj.tyt,f8 votdtkt,ib ubl #-]th eahj
[ibhbf8 !! okbc ,bzt,ib *7$ ghjwtynb votdtkbf ~f8
f8 fktmcfylhjd !)($`7 !% okbc fcfrib $$7# ghj-
wtync fqotdc ,bzt,ib7 @_ ghjwtync ujujyt,ib8
itltufl flubkb fmdc rfntmjkfvbyt,bc lf yf[ibh-
;fyubc vjvfnt,fc cbc[kib7 mdtbslt,f vckg-bc lj-
yt7 flubkb fmdc fhnthbekb oytdbc vjvfnt,fc7 hfw
,jwbnt,bc fuhtufwbbc wdkbkt,t,b ~.
 mvybc lffdflt,bc ufydbsfht,bc obyfgbhj,fc8
@__) otkb
,fdidsf rfhlbjkjubf 11
,fdidt,ib fhwse bidbfsbf zfh,b ojybc itvs[-
 !)^^`8 fvbnjv
dtdt,b8 cnfnbcnbrehfl * okbc fcfrib zfh,b ojyb-
cff ,fdidsf !@7( ghjwtynb8 !# okbcfsdbc @#7( ghj-
wtynb7 !^ okbcfsdbc !*7* ghjwtynb8 fvfcsfy ,f-
didt,c7 hjvtksfw fmds ufw[bvjdyt,f7 #-]th ea-
hj [ibhfl fqtybiyt,fs fhnthbekb /bgthntypbf8
fmdt eylf bsmdfc /bgjlbyfvbfptw7 hfw ufyfgbhj-
,t,c cbc[k’fhqdsf rtlkt,bc kbgjkbpehb fmnb-
dj,bc lfmdtbst,fc7 bphlt,f gthbathbekb obyff-
qvltuj,f lf cbc[k’fhqdsf ufydkflj,f ~(. pbc lfodhbkt,bs itcofdkf lf itvltub afmnj-
)*+ 1981`8 fhfcfrvfhbcb fmnbdj,f bmyf uf-
vjdktybkb * okbc fcfrib ,fdidsf @)7$ ghjwtynib7
!_ okbc fcfrib $@7% ghjwtynib7 !^ okbc fcfrib *@7(
ghjwtynib ~.. - $0   1991`
ifmhbfyb lbf,tnbc hjkb fsthjcrkthjpbc
lf ubl-bc ufydbsfht,fib fctdt tzdc fh bodtdc8
fqothbkbf itvs[dtdf ~E8 K8 Shvelhood !)($` !@
okbc ,bzbc vbjrfhlbevbc byafhmnbs ufhlfwdf-
kt,bcf7 ifmhbfyb lbf,tnbc ajypt8 byafhmnuflf-
nfybkt,c itvlujvib [ibhfl elubylt,fs lbf,t-
nbc fhct,j,f8
’bhbsflb hbcr-afmnjht,b vjmvtlt,fc bo.t,ty
,fdidsf fcfrblfydt8 jhb hbcr-afmnjhbc thsl-
hjekfl fhct,j,f bsdkt,f fsthjcrkthjpbc yf-
flhtdb ufydbsfht,bc obyfgbhj,fl8 sevwf bcbw
eylf fqbybiyjc7 hjv ubl itb’kt,f ufydbsfhltc
hbcr-afmnjht,bc fhfhct,j,bc gbhj,t,ibw8
lqtvlt fsthjcrkthjpbc gfsjutytpbc itcf-
[t, thsbfyb fphb fh fhct,j,c7 vfuhfv .dtkfpt
eahj ufdhwtkt,ekbf itvltub stjhbt,b5 f` ht-
fmwbf lfpbfyt,ek tyljstkeh e]htlpt ,` kb-
gblehb ~/bgthmjktcnthbytvbf` u` vjyjrkbyehb
~ajkfmt,b ofhvjbmvyt,f ukedreysjdfyb mcjdb-
kbc uflfudfht,ekb e]htlt,bcufy` l` dbhece-
kb gthcbcnbht,ekb byatmwbf ~tyljstkbjn-
hjgekb` a` pt;fyuehb ~kbgblt,bc sfdbceafk-
hflbrfkehb pt;fyuehb lf;fyudbc uf’kbtht,f`
d` bveyehb 2 fsthjcrkthjpek rthfib 3 2 fy-
nbc[tek-fenjbveyehb rjvgktmcbc fhct,j,f8
hjujhw ptvjfqybiyekblfy xfyc7 fsthjcrkt-
hjpb gjkbtnbjkjubehb acbmjcjvfnehb lffdf-
lt,ff8 abpbrehb7 ujyt,hbdb lf cjwbfkehb cnht-
ct,b fewbkt,tkbf ]fyvhstkj,bcfsdbc7 vfuhfv
bub fh eylf fzfh,t,ltc bylbdblefkeh itcf’kt,-
@/# itdbohjt,ekbf ~..  
fewbkt,tkbf fsthjcrkthjpbc ghtdtywbf ,fdi-
dj,bc fcfrblfydt lfbo.jc8 gtlbfnht,c eylf udf-
[cjdltc7 hjv fsthjcrkthjpbc flhtekb ufydb-
sfht,f itcf’kt,tkbf j]f[ehb /bgthmjktcnb-
hbytvbbc gbhj,t,ib8 fvbnjv bcbyb fewbkt,kfl
eylf b.dyty vtsdfk.ehtj,bc mdti bycnhevt-
ynek-,bjmbvbehb rdktdbc sfy[kt,bs8 lffdflt-
,bc lhjekb ufvjdkbyt,bcfsdbc cfzbhjf fyfvyt-
ht,bc ufsdfkbcobyt,f8 !` j]f[ehb fyfvytpb ~ucc-
bc lffdflt,t,b7 fsthjcrkthjpb7 ubl7 fhnthbe-
kb /bgthntypbf7 byceknb7 etwfhb cbrdlbkb lf
c[df` @` hbcr-afmnjht,bc fhct,j,f ~cbc[k’fhq-
dsf njyecbc lfhqdtdf7 c[tekbc zfh,b ojyf7 sf-
v,fmj7 ujyt,hbdb uflf’f,df7 fhfhfwbjyfkehb
rdt,f7 fhfcfrvfhbcb ’bkb lf c[df` #` j]f[ib ifm-
hbfyb lbf,tnbc7 /bgjsbhtjpbc7 /bgthehbrtvbbc7
yfqdtk-rtyzjdfyb lffdflt,bc fhct,j,f $` uflf-
nfybkb sfdbc ndbybc nhfdvf8 lffdflt,bc rkbyb-
reh ybiyt,c vbfresdyt,ty5 ufw[bvjdyt,fc7 mcfy-
njvt,c7 dtutnfnbehb cnfnecbc itwdkfc lf f8i8
flhtekb lbfuyjcnbrbcfsdbc vybidytkjdfybf
,bjmbvbehb fyfkbpb kbgblt,pt8 /bgthmjktcnt-
hbytvbf8 lckg-bc vjvfnt,f7 vckg-bc ljybc lfm-
dtbst,f 2 fsthjcrkthjpbc cflbfuyjcnbrj
rhbnthbevbf8 vfuhfv .jdtksdbc cfzbhjf rkbyb-
rbc ufsdfkbcobyt,f8 itb’kt,f /bgthmjktcnthb-
ytvbf fh b.jc7 vfuhfv b.jc rkbybrehb ufvjdkb-
yt,t,b8
.jdtkbdt ptvjfqybiyekbc ufsdfkbcobyt,bs
cfzbhjf ,fdidt,ib xfnfhltc vbpfyvbvfhsekb
ghjabkfmnbrf7 hfw uekbc[vj,c5 dtutnjcbc[k’f-
hqdjdfyb lbcnjybbc vrehyfkj,fc7 w[jdht,bc
]fycfqb otcbc lfvrdblht,fc ~sfv,fmjc7 zfh,b rdt-
,bc7 /bgjlbyfvbbc obyffqvltu ,h’jkfc`7 acbmj-
tvjwbehb lf’f,ekj,bc vj[cyfc lf f8i8
lfuhjdbkb vjyfwtvt,b ~Kannel W. 1982` vbe-
sbst,ty7 hjv v[jkjl cojhb7 hfwbjyfkehb rdt-
,bs itcf’kt,tkbf hfvltybvt hbcr-afmnjhbc
vj[cyf ~zfh,b ojyf7 /bgthmjktcnthbytvbf7 fh-
nthbekb /bgthntypbf`8 fvbnjv zfvbc reknehbc
lfythudf ,fdidj,blfydt vybidytkjdfybf8 ,fdidt-
,b eylf itdfxdbjs fh zfvjy cbvf’qhbc ituh’yt-
kj,t,c ~.. )
 ..
)*: !)(*`8 cnhtcbc ,fvlt7 vbbqjy yfrkt,b w[bvb7 gehb7 nr,bktekb
zfh,b ptvjmvtlt,bcufy ~hjujhw [fyuh’kbdj,bs7
bct cb’kbthbs` ,fdidbc jhufybpvib dbsfhlt,f
lbccnhtcb dtutnfwbehb lbchtuekfwbf8
fsthjcrkthjpbcfsdbc lfvf[fcbfst,tkbf
[fyuh’kbdfl vbvlbyfht afhekb gthbjlb ~rkb-
ybrfvltkb`7 gbhdtkb rkbybrehb ybiyt,b dkbylt-
,f vfiby7 hjwf erdt cbc[k’fhqdsf cfyfsehbc
@__) otkb
lf vfhbkb7 [jkj vtnb ,jcnytekb lf [bkb8 cfr-
dt,b vbbqjy $-% ]th lqtib ~vwbht ekeat,bs` lf
,jkj rdt,blfy lf’byt,fvlt @-# cffsb vfbyw ey-
lf ufdbltc8 mjktcnthbyb lf yf]thb w[bvt,b lb-
lb hfjltyj,bsff rdthw[bc uekib7 qjhbc7
w[dhbc7 ’hj[bc [jhwib7 h’bc ghjlemnt,ib8 fvb-
njv tc ghjlemnt,b hfwbjyib ,fkfycbht,ekfl
 12
eylf bmyfc xfhsekb8 [jkj mfsvbc [jhwb lf
vwtyfhtekb ptst,b itbwfdty yf]th w[bvt,c lf
fh bodtdty /bgthmjktcnthbytvbfc8 se ufdbsdf-
kbcobyt,s7 hjv vjphlbk fcfrib utytnbrehb
afmnjht,bcfufy mjktcnthbybc ljyt eahj rjy-
nhjkbht,flbf7 dblht xdbk lf flhtek fcfrib7
ufvjlbc hjv hfwbjyfkehb rdt,f xdbkj,bc fcf-
rblfydtf cfzbhj8 fv v[hbd cfertstcjf ,eyt,hbdb
rdt,bc [fyuh’kbdfl ityfhxeyt,f8
,fdidt,b flhtekb fcfrblfydt eylf itdfxdbjs
abpbreh fmnbdj,fc8 wyj,bkbf7 hjv dtutnfnbehb
ythdekb cbcntvf cbuyfkt,c qt,ekj,c vjveifdt
reyst,blfy7 fvbnjv nfydfh]bib lf abpbrehb lf-
ndbhsdf fhbc eybdthcfkehb acbmjytdhjkjub-
eh-tyljrhbyek-,bjmbvbehb ufcfqt,b7 hjvt-
kcfw ite’kbf epheydtk.jc jhufybpvbc /jvtjc-
nfpbc yjhvfkehb gfhfvtnht,b8
,fdidc eylf dfcofdkjs efh.jabsb tvjwbt-
,bc vj[cybc [tkjdyt,f8 fhfhtfkbpt,ekb
cnhtc-afmnjhb [tkc eo.j,c ytdhjpt,bc ufydb-
sfht,fc7 hbcb ghtdtywbfw itb’kt,f abpbrehb
fmnbdj,bs fy cfrvfhbcb ’bkbs7 tvjwbehb ajybc
itwdkbs lf f8i8 c[df itvs[dtdfib cfzbhjf ctlf-
wbehb lf nhfyrdbkbpfnjhekb ghtgfhfnt,bc
ufvj.tyt,f8
hfw itt[t,f sfv,fmjc vjotdfc7 vbcb vfdytj,bc
itcf[t, cfzbhjf afhsj rfvgfybbc ofhvjt,f7 eylf
xfvj.fkb,ltc efh.jabsb cfpjufljt,hbdb fphb7
fvbcfsdbc cfzbhjf cfsfyflj fubnfwbbc ofhvjt,f
ghtcbc7 ntktdbpbbc7 cfpjufljt,bc sdfkcfxbyj
otdht,bc xfhsdbs8
fhnthbekb oytdbcf lf zfh,b ojybc lf’ktdf
itcf’kt,tkbf fctdt abpbrehb fmnbdj,bs7 vfhb-
kbcf lf ukerjpbc ljybc itvwbht,bs7 ufyndb-
hsdbc lqtt,bc ufrtst,bs ~!_ lqtib !-]th` lf
c[df8
3hbcrbc ]ueabc4 ,fdidt,b eylf b.tyt,lyty
v[jkjl vwtyfhtek w[bvt,c ~fvwbht,c shjvj-
wbnt,bc fuhtufwbfc` ,jcnytekc7 pqdbc rjv,j-
cnjc7 [f[dc7 ybjhc7 ,ekufhek obofrfc ~fvfq-
kt,c gkfpvbc ab,hbyjkbpeh fmnbdj,fc`7
qdb’kc7 [bkc lf f8i8 ybiyfdty fuhtsdt C1 B1 B5 P
dbnfvbyt,c lf fcgbhbybc vbrhjljpt,c abpbrehb
fy acbmbrehb uflf’f,dbc gthbjlib8 3hbcrbc
]ueabc4 ,fdidt,ib ufhlf kbgblehb wdkbcf7 rj-
ynhjkbc mdti eylf b.jc cbc[kbc itvfltlt,tkb
cbcntvf7 vfs eylf xfenfhlts5 jasfkvjcrjgbf7
gekcehb nfkqbc cbxmfhbc ufycfpqdhf7 dtkjt-
hujvtnhbf lf f8 i8 gtlbfnhb eylf ittwfljc uf-
vjfdkbyjc hbcrbc vmjyt j]f[t,b7 ,fdidt,b7 hfsf
vfs xfenfhlts cgtwghjabkfmnbrf lf lbcgfy-
cthekb vtsdfk.ehtj,f8
,fdidsf rfhlbjkjubf
BVEYJVJLEKFNJHT<BC HJKB
SFYFVTLHJDT RFHLBJKJUBFIB LF
VFSB UFVJ>TYT<BC ITCF”KT<KJ<FYB
<FDIDSF FCFRIB
bveyehb htfmnbekj,bc velvbdb flfgnfwbehb
wdkbkt,f ofhvjflutyc wdkfl ufhtcfv.fhjib
jhufybpvbc cbwjw[kbceyfhbfyj,bc ’bhbsfl cf-
ae’dtkc8 wyj,bkbf7 hjv bveyeh cbcntvfc ufhr-
dtekb ,bjkjubehb hbnvb f[fcbfst,c8 fcfrbc vb-
[tldbs ~,fdidj,f7 jhcekj,f7 [fylfpvekj,f lf
f8i8` [lt,f bveyehb vtmfybpvt,bc fhct,bsb abpbj-
kjubehb wdkbkt,t,b8 jhufybpvbc fynbbyatmwb-
ehb htpbcntynj,bc gfhfvtnht,b lqt-qfvbc ufy-
vfdkj,fibw rb vth.tj,c8 vfufkbsfl7 afujwbnj-
pbc ljyt eahj vfqfkbf lqbcbs lf cfqfvjc7 .dt-
kfpt lf,fkb 2 qfvbs lf lbkbs7 kbvajwbnt,bc
vfmcbvfkehb vfxdtyt,tkb lfabmcbht,ekbf @$ cf-
fspt7 lf,fkb rb 2 ufqdb’t,bcfc8 fyfkjubehb nty-
ltywbff fynbc[tekt,bcf lf bveyjukj,ekbyt,bc
ufvjveifdt,bc sdfkcfphbcbs lf c[df8
itcofdkbkbf bveyehb cbcntvbc ctpjyehb hb-
nvbw8 ,fdidt,ib pfvsfhib [lt,f T 2 kbvajwbnt-
,bc7 lgG, lgm-bc lf B e]htlt,bc vfmcbvfkehb fmnb-
dfwbf8 ufpfa[ekpt fqbybiyt,f bveybntnbc T cbc-
ntvbc lfshueydf7 B 2 kbvajwbnt,bc lf lgM-bc
itvwbht,f lf ityfhxeyt,ekbf lgG-c cfrvfjl vfqf-
kb vfxdtyt,tkb8 pfa[ekib fqbybiyt,f T-cbcntvbc
fmnbdfwbf lf lgG lf B e]htlt,bc ljybc lfmdtbst-
,f8 itvjlujvfpt htubcnhbht,ekbf .dtkf lfwdb-
sb vtmfybpvt,bc vj,bkbpfwbf ~ufhlf T 2 ceghtcj-
ht,bc7 lgM lf lgG`8 ptvjfqybiyekb vbesbst,c7
hjv pfa[ekib7 itvjlujvfpt lf pfvsfhib bveye-
hb cbcntvbc thsb hujkbc lfcecnt,f rjvgtycbh-
lt,f c[dfsf fmnbdfwbbs8 v[jkjl ufpfa[ekptf
bveyehb cbcntvf lfshueyekb ~ufhlf lgG ljyb-
cf`7 hfw ,fdidbc bveyehb cbcntvbc evobahj,bs
eylf fb[cyfc8 vcufdcb ntyltywbf fqbybiyt,f fynb-
byatmwbehb htpbcntynj,bc /evjhekb afmnj-
ht,bc lbyfvbrfcsfy lfrfdibht,bs8 vtwybthsf
fvjwfyff .jdtkbdt ptvjfqybiyekbc ufsdfkbcob-
yt,f lffdflt,fsf ghtdtywbfcf lf vrehyfkj,fib8
,FDIDSF FCFRIB RKBYBREHB
BVEYJKJUBBC HJKB UEKCBC[K’FHQDSF
CBCNTVBC LFFDFLT,FSF LHJEK
VREHYFKJ,FCF LF GHTDTYWBFIB
,fdidbc bveyeh cbcntvfc7 xfcf[dblfy lfo.t,e-
kb7 f[fcbfst,c vstkb hbub bveyjvjhajkjubehb
sfdbct,eht,fyb7 hjvtkbw itcf,fvbcfl htfkbp-
lt,f bveyeh htfmwbfib8 bveyjrjhtmwbbc tatmne-
hj,f lfvjrblt,ekbf jhufybpvbc bveyehb htfm-
nbekj,bc wdkbkt,fcfsfy8
@__) otkb
,fdidsf rfhlbjkjubf
bveyehb cbcntvf xfcf[dblfydt bo.t,c lbathty-
wbht,fc8 sbvecb vewkfl.jaybc vt-@ sdtpt bo.t,c
lf # sdbcfsdbc erdt ajhvekbht,ekbf8 kbvaehb
rdfy’t,bc xfcf[df [lt,f vt-$ sdtpt lf vfsb cf,j-
kjj ajhvbht,f [lt,f gjcnyfnfkeh gthbjlib8
qthjdfyb e]htlt,b xylt,bfy tv,hbjutytpbc vt-#7
vt-( rdbhfpt8 sfdlfgbhdtkfl bcbyb ofhvjbmvyt,b-
fy qdb’kib7 vjudbfyt,bs rb ’dkbc ndbyib8 kbvaj-
wbnt,b gbhdtkfl fqvjxtybkbf vt-) rdbhfpt sbve-
cib7 !@-!% rdbhfpt tktysfib7 cbc[kib kbvajwbnt-
,bc vcufdcb e]htlt,b xylt,bfy (-!_ rdbhfpt8 lgM-
bc cbystpb bo.t,f vt-!! rdbhfpt7 [jkj lgG-c @@-t
rdbhfpt8 fmtlfy )_ ghjwtynb ]th rbltd ltlbcte-
kbf8 rjvgktvtynehb cbcntvbc xfvj.fkb,t,f cfsf-
dtc vt-( rdbhfpt bqt,c7 [jkj e]htlekb lf fhfc-
gtwbabehb htpbcntynj,bc /evjhekb afmnjht,b
dkbylt,f flhtek jynjutytpib8 T-lfvjrblt,ek
bveyeh htfmwbt,c ijhbc gbhdtkb dkbylt,f fynb-
nhfycgkfynfnehb ~vt-!# rdbhf` htfmwbf8 itytkt-
,ekb nbgbc /bgthvuh’yj,tkj,bsb htfmwbf vybi-
dytkjdyfl udbfy htfkbplt,f7 yf.jaib wjnff
gkfpvehb e]htlt,bc hfjltyj,fw7 hjvtksfw
eiefkjl ite’kbfs fynbc[tekt,bc cbystpb8 B
e]htlt,bc ufdktyf T kbvajwbnt,pt lf vfrhjaf-
ut,pt ’fkbfy itpqelekbf7 ’kbthbf mjhbjyekb
ujyfljnhjgbybc7 a- atnjghjntbybc lf a-2 ukj-
,ekbybc hjkb8 vewkfl.jaybc byabwbht,bc
lhjc fqbybiyt,f bveyehb cbcntvbc yfflhtdb fmnb-
dfwbf8 flubkj,hbdb bveybntnb jynjutytpib sb-
smvbc ufyedbsfht,tkbf8
f[fkij,bkbc gfcbehb bveybntnbc sfdbct,eht-
,fc fmdc hjujhw lflt,bsb7 bct efh.jabsb v[fht-
t,b8 ltlbcufy lgM-bc vbeqt,kj,f fvwbht,c thbs-
hjwbnek fynbutyt,sfy rjyakbmnbc hbcrc7 vtjht
v[hbd7 [lt,f uhfvefh.jabsb ,fmnthbt,bc obyff-
qvltu lf,fkb lfwdbseyfhbfyj,bc bylewbht,f8
lf,flt,bcfc f[fkij,bkc fqtybiyt,f abpbj-
kjubehb ktbrjwbnjpb ~!@-!% !_ )/k`7 hjvtksf
ijhbc #% ghjwtynb kbvajwbnt,bf8 vfsufy yf[t-
dfhpt vtnc itflutyty T 2 kbvajwbnt,b ~/tkgtht-
,b ^_ ghjwtynb7 ceghtcjht,b $_ ghjwtynb`8 B 2
e]htlt,bc hfjltyj,fw vjvfnt,ekbf7 vfs uffx-
ybfs lgM lf lgG htwtgnjht,b8 lgA lf lgE zbgkfhbc
cbc[kib bidbfsfl7 [jkj lgD cfthsjl fh ud[dlt-
,f8 lgG-bc pjvfpt vtnfl vjvfnt,f vewkfl.jaybc
byabwbht,bc vbvfybiyt,tkbf8 lgG ljyt evybidyt-
kjf lf,flt,bcfc lf *-( okfvlt sfylfsfy bvf-
nt,c8 vfnt,bc lbyfvbrf eahj vfqfkbf [tkjdyeh
rdt,fpt v.ja ,fdidt,ib7 hfw phlbc fkthubek-
fnjgbehb lffdflt,t,bc hbcrc8
eylf fqbybiyjc7 hjv ,fdidbc w[jdht,fib ufvj-
b.jaf hfvjltybvt rhbnbrekb gthbjlb7 hjwf
@__) otkb
13
bveyehb cbcntvf lf vstkb jhufybpvb itlfht,bs
cecnbf7 tctybf5 f[fkij,bkj,f7 #-^ sdbc7 @ okbc7 $-
^ okbc7 !@-!$ okbc fcfrb8 f[fkij,bkj,bc gthbj-
lib fqbybiyt,f ’kbthb ceghtcjhekb ufdktyf7
ltlbctekb gfcbehb /evjhekb bveybntnb7 T-kb-
vajwbnt,bc aeymwbehb lbc,fkfycb8 #-^ sdbc fcf-
rbcfsdbc cecnlt,f gfcbehb /evjhekb bveybnt-
nb8 rdkfd ityfhxeyt,ekbf bveyehb htfmwbbc ceg-
htcjhekb vbvfhsekt,f8 vt-@ okbcfsdbc ityfh-
xeyt,ekbf bveyehb gfce[bc gbhdtkflb [fcbfsb8
ceghtcjhekb vbvfhsekt,f bwdkt,f /tkgthe-
kbs8 flubkj,hbdb bveybntnbc cbcntvf ufyedb-
sfht,tkbf7 ,fdidt,b [ibhfl fdfllt,bfy vodfdt
htcgbhfnjhekb dbhecekb byatmwbt,bs8 $-^
okbc fcfrib lgG-c lf lgM-bc cfiefkj rjywtynhf-
wbf7 lgA-cfufy ufyc[dfdt,bs7 enjklt,f vjphlb-
kt,bcfc7 [jkj lgE-c rjywtynhfwbf fqotdc vfmcb-
vevc8 fv fcfrib [ibhbf fnjgehb7 gfhfpbnekb lf
bveyjrjvgktmcehb lffdflt,t,b8 vt[est rhbnb-
rekb gthbjlbf !#-!% otkb7 cohfab phlf lf cfcmt-
cj /jhvjyt,bc ctrhtwbbc vfnt,f7 bodtdc e]htle-
kb bveybntnbc lfmdtbst,fc lf /evjhekb bveyb-
ntnbc cnbvekfwbfc8
fhct,j,c vjyfwtvt,b bveyeh htfmnbekj,fcf
lf cbc[kbc ]ueac ijhbc rfdibhpt8 c[dflfc[df gf-
sjkjubehb ghjwtct,bc lhjc cbc[kbc c[dflf-
c[df ]ueac ite’kbf bveyehb htfmnbekj,bc lb-
athtywbht,ekb vfhrbht,f8 bmvyt,f isf,tzlbkt-
,f7 hjv A ~6 6` ]ueabc lhjc c[dflfc[df lffdflt,bc
ufydbsfht,bc hbcrb eahj vfqfkbf7 vfuhfv tc
vskfl fct fh fhbc lf eahj erfdibhlt,f gjgekf-
wbfib fv ]ueabc cbc[kbc vnfht,tksf vfqfk [dt-
lhbs obkc8 vfuhfv fhw bvbc efh.jaf itb’kt,f7
hjv fhct,j,c ufhrdtekb lfvjrblt,ekt,f cbc[-
kbc utytnbrehb vfhrtht,bc vnfht,tkcf lf ew[j
fynbutybc vbvfhs bveyjgfsjkjubehb htfmwbbc
[fcbfsc ijhbc7 hfw ufdktyfc f[ltyc gfsjkjube-
hb ghjwtcbc ufydbsfht,fpt lf vrehyfkj,bc tat-
mnehj,fpt8 bveyehb vjlekfwbf uekbc[vj,c
bveyehb cnfnecbc lfmdtbst,ekb vfxdtyt,kt,bc
cnbvekfwbfc lf vjvfnt,ekbc lfmdtbst,fc7 fye
rjhtmwbfc8 ’bhbsflfl fhct,j,c bveyjrhtmwbbc $
vbvfhsekt,f5
!8 bveyjrjhtmwbf /jhvjyt,bsf lf bveyehb cb-
cntvbc vtlbfnjht,bs ~sbvehb afmnjht,b7 vbt-
kjgtgnblt,b7 bynthathjyb7 bynthktbrbyb7 kbv-
ajwbn-vfrhjafubc ehsbthsvjmvtlt,bc afmnj-
hb lf c[df`8
@8 bveyehb by;bythbf ~bveyehb jhufyjt,bc lf
mcjdbkt,bc uflfythudf5 ’dkbc ndbyb7 sbvecb7
c[dflfc[df rkfcbc bveyjukj,ekbyt,bc lf gkf-
pvbc it.dfyf lf c[df`8
 14
#8 ,eyt,hbdb ofhvjij,bc bveyjcnbvekfnjht-
,bs rjhtmwbf ~dfmwbyt,b7 kbgjgjkbcfmfhblt,b
lf f8i8` fuhtsdt cbystpehb ghtgfhfnt,bs ~ktdf-
vbpjkb7 lbewbajyb7 bpjghtyfpbyb lf c[df`8
$8 kfpthekb lf eknhf,uthbsb lfc[bdt,bc uf-
vj.tyt,f7 gkfpvfathtpb7 c[df vtsjlt,b8
bveyjvjlekfnjht,bc hfjltyj,f cflqtbcjl
@__ lfcf[tkt,fpt vtnbf lf rdkfd bphlt,f8 bcbyb
tatmnbc vb[tldbs itb’kt,f lfd.js bveyjhtcnf-
dhfnjht,fl ~bynthathjyb`7 bveyjcnbvekfnj-
ht,fl ~nfmnbdbyb`7 bveyjceghtcjht,fl ~rjhnb-
rjcnhjblt,b` lf f8i8 fvfc itb’kt,f lfdfvfnjs
fctdt abpbrehb ptvjmvtlt,f 2 eknhf,uthf7 vfu-
ybnehb dtkb7 cbyfskbc c[bdb lf f8i8 pjubthsb fd-
njhb ~.., . )*0 !))_` fvudfh ptvj-
mvtlt,fc vjb[ctybt,ty hjujhw 3bveyjsthfgbfc48
bveyjghjgekb ybdsbtht,t,b rkbybrfib hjv
bmytc ufvj.tyt,ekb7 eylf f[fcbfst,ltc vbybvf-
kehb fmnbdj,f7 fh eylf bodtdltc e]htlsf venf-
wbfc lf cbvcbdyeh uflfudfht,fc7 jhufybpvbc cty-
cb,bkbpfwbfc8 fvfcsfy bjkfl eylf vtnf,jkbp-
lt,jltc lf ufvjb.jajltc jhufybpvblfy8 cfceh-
dtkbf fh bodtdltc vbxdtdfc7 vbbqt,jltc jhfke-
hfl7 /mjyltc bveyjvjlekfwbehb sdbct,t,b7 of-
hvjflutyltc xdtekt,hbd ghtgfhfnc8
bveyehb lfhqdtdt,b ud[dlt,f vhfdfkb lffdflt-
,bc lhjc7 vfs ijhbc7 uekcbc[k’fhqdsf cbcntvbc
lffdflt,bc lhjc8 htdvfnjblekb fhshbnbs lff-
dflt,ekt,ib bveyehb cbcntvbc vybidytkjdfyb lf-
hqdtdt,b fqbybiyt,f7 hfw ufygbhj,t,ekbf fhfche-
kafcjdfyb bveyehb gfce[bs lf bveyehb rjvgktm-
ct,bc ofhvjmvybs8 fv erfyfcrytksf ajhvbht,fib
’bhbsfl hjkc fchekt,c htdvfnjblekb afmnj-
hb7 hjvtkbw ofhvjlutybkbf fynbc[tekt,bs ~lgA
pju]th lgG lga` vbvfhsekb lgG-c obyffqvltu8 pj-
u]th fqbybiyt,f fynb,bhsdekb fynbc[tekt,b
~lyv-bc lf hyv-bc obyffqvltu` itvfthst,tkb mcjdb-
kbc c[dflfc[df itvflutytkb yfobkt,bc obyffqvltu
~rjkfutyb7 e]htlekb fynbutyt,b7 cf[chjdfyb ufh-
ct,b`8 T kbvajwbnt,bc itvwdtkj,f itvwbht,ekbf
cbc[kib lf vjvfnt,ekbf cf[chjdfy cbs[tib8 twtvf
T-ceghtcjht,bc lf K-e]htlt,bc ljyt7 bvfnt,c
kbvajwbnt,bc wbnjnjmcbehj,f8 bveyjukj,e-
kbyt,bc ljyt cbc[kib lf cfcf[cht cbs[tib vjvfnt-
,ekbf8 lfhqdtekb bveyehb htfmwbbc rjhtmwbbcf-
sdbc htdvfnjblekb fhshbnbc lhjc b.tyt,ty rjh-
nbrjcnthjblt,c7 ktdfvbpjkc7 /byufvbyc7 yfnhbe-
vbc yerktbyfnc7 sbveceh ghtgfhfnt,c lf c[df8
vbjrfhlbnbs fdflv.jat,ib flubkb fmdc vbj-
rfhlbevbc vbvfhs fenjfynbutyt,bc ofhvjmvyfc7
T-kbvajwbnt,bc aeymwbehb fmnbdj,bc lfshue-
ydfc7 T-kbvajgtybfc7 T-ceghtcjht,bc ljybc lfm-
,fdidsf rfhlbjkjubf
dtbst,fc7 bveyjukj,ekbyt,bc rjywtynhfwbbc
vjvfnt,fc8 vbjrfhlbnt,bc lhjc tnbjnhjgekb
cfiefkt,t,bc ufhlf ufvjb.tyt,f fyst,bc cfobyff-
qvltuj lf vfltctycb,bkbpt,tkb ghtgfhfnt,b 2
cbkbwbkbc v;fdf7 byljvtnfwbyb7 lbrkjatyfrb7
fynb/bcnfvbyehb ghtgfhfnt,b8 fenjbveyehb rj-
vgjytynbc ghtdfkbht,bc itvs[dtdfib 2 /bcnfu-
kj,ekbyb7 rjhnbrjcnhjblt,b7 fuhtsdt ceght-
cjht,bc cnbvekfnjht,b ~ktdfvbpjkb7 yfnhbe-
vbc yerktbyfnb`8
fsthjcrkthjpbc lhjc fqbybiyt,f egbhfnt-
cfl bveyehb cbcntvbc T yfobkbc ltabwbnb7 ceg-
htcjhekb vtmfybpvt,bc lfshueydf7 aeymwbehfl
fhfchekafcjdfyb evobafhb T-kbvajwbnt,bc vf-
nt,f8 B-kbvajwbnt,bc hfjltyj,hbdb wdkbkt,t-
,b evybidytkjf8 fsthjcrkthjpbc vrehyfkj,f-
ibw lqtbcfsdbc htrjvtylbht,ekbf sbvecehb
ghtgfhfnt,b lf yfnhbevbc yerktbyfnb8
ghtgfhfnbc sthfgbekb tatmnbc itcfafct-
,kfl vybidytkjdfybf byajhvfwbf jgnbvfkehb
ljpbc7 cbc[kbc gkfpvfib vbcb rjywtynhfwbbc
lf afhvfrjkjubehb vjmvtlt,bc vtmfybpvbc it-
cf[t,8 vtlbrfvtynsf evhfdktcj,bcfsdbc rkbyb-
rbc gbhj,t,ib lflutybkbf cfiefkj tatmnehb
ljpf lf rjywtynhfwbf7 hjvtkbw cfiefkt,fc
b’ktdf vbqt,ekb bmytc cfcehdtkb afhvfrjkj-
ubehb vjmvtlt,f8
.jdtklqbehb ghfmnbrf udbxdtyt,c7 hjv thsb
lf bubdt cfvrehyfkj cfiefkt,t,bc tatmnehj,f
lf jhufybpvbc fvnfyeyfhbfyj,f c[dflfc[df fdfl-
v.jaib c[dflfc[dfudfhbf8 lflutybkbf7 hjv evsf-
dhtcfl tc ufyc[dfdt,f ufygbhj,t,ekbf utytnbre-
hb afmnjht,bs7 vtnf,jkbpvbc ltnthvbybht,e-
kb ghjwtct,bs7 htwtgwbbs7 bveyehb gfce[bs lf
f8i8 vtlbrfvtynt,pt fhf,eyt,hbdb htfmwbf ’bhb-
sflfl ufvjodtekbf athvtynekb ltabwbnbs lf
ybdsbtht,fsf wdkbc lfhqdtdbs8 athvtynsf cby-
stpb bv.jat,f vrfwhb utytnbrehb rjynhjkbc
mdti8 venfwbbc itvs[dtdfib dbsfhlt,f athvtynj-
gfsbf7 bwdkt,f athvtynbc cbystpbc cbxmfht7 fy
cbystpbhlt,f fnbgbehb athvtynb8 fctsb lfhq-
dtdt,bc vfufkbsbf5 fnbgbehb actdljmjkbytcst-
hfpf7 ukerj-^-ajcafnlt/blhjutyfpfc ervfhb-
cj,f7 fwtnbknhfycathfpt,bc lf rfnfkfpt,bc
ervfhbcj,f lf c[df8
lffdflt,bc gfsjutytpbc ufsdfkbcobyt,bs it-
cf’kt,tkbf ufvj.tyt,ekb bmytc 2 bveyjcnbve-
kfnjht,b7 bveyjvjlekfnjht,b fy bveyjltght-
cfynt,b ~fenjbveyehb lffdflt,bc lhjc`8 gbhdt-
kb bveyjcnbvekfnjht,b b.j dfmwbyt,b7 itvltu
itbmvyf ghtgfhfnt,b7 hjvkt,bw vfcnbvekbht,tk
ufdktyfc f[ltyty e]htlekb se /evjhekb bve-
@__) otkb
,fdidsf rfhlbjkjubf
ybntnbc vfxdtyt,kt,pt8 bveyjcnbvekfnjht,b
’bhbsflfl b.jaf cfv ]ueafl5 !` vbrhjjhufybp-
vt,bc ghjlemnt,b ~,hjymjdfrcjvb7 rhtcnbyb7 ,b-
jcnbvb7 hb,jveybkb`7 @` sbvecbc gtgnblt,bc tmc-
nhfmnt,b ~sbvjcnbvekbyb7 nfmnbdbyb7 sbvjvj-
lekbyb`8 #` mbvbehb ghtgfhfnt,b ~ktdfvbpjkb7
bvghtub7 ,hjvbgbhbyb lf c[df`8
bveyjafhvfrjkjubfib f[fk /jhbpjync [cybc
bveyehb gfce[bc vtlbfnjht,bc ufvj.tyt,bc itcf’-
kt,kj,f ~bynthktbrbyt,b7 bynthathjyt,b lf c[df`8
vfs dth lfdfhmvtds bveyjcnbvekfnjht,c7 hflufy
f[fcbfst,s vhfdfkv[hbdb vjmvtlt,f7 fvbnjv eoj-
ltc bveyjvjlekfnjht,b8 vfsb tatmnb lflutybkbf
vhfdfkb lffdflt,bc lhjc7 lfo.t,ekb fkthubekb
lthvfnbnblfy lfvsfdht,ekb cbvcbdytt,bs8
bveyjvfcnbvekbht,tkb cfiefkt,t,b ufvjb.t-
yt,f vjhtwblbdt ,fmnthbekb lf dbhecekb byat-
mwbt,bc lhjc7 bveyjltghtcfynt,b fenjbveyehb
lffdflt,t,bc lhjc7 [jkj bveyjvjlekfnjht,b
fdktyty hjujhw fynbbyatmwbeh7 bct fynbcbvcb-
dyeh tatmnc8
lqtbcfsdbc erdt lfuhjdlf vjyfwtvt,b fsthj-
crkthjpbc ufydbsfht,fib bveyjgfsjkjubehb vt-
mfybpvt,bc vjyfobktj,bc itcf[t,8 ufyb[bkt,f rjy-
wtawbf7 hjv tc vtmfybpvt,b vjmvtlt,ty wyj,bk
hbcr-afmnjht,sfy cbythubekfl lf ufyfgbhj,t-
,ty fsthjcrkthjpbc ufydbsfht,fc8 fmtlfy ufvjv-
lbyfht7 fv vtmfybpvt,pt ptvjmvtlt,bs fsthjcr-
kthjpbc vrehyfkj,fib tatmnbc vbqotdf vjvf-
dkbc htpthdbf8 vtwybthsf fphbs7 fynbuty-fynbc-
[tekbc rjvgktmcbc cbc[k’fhqdsf ptlfgbhpt lf-
ktmdf ofhvjflutyc gbhdtk yf,b]c cbc[k’fhqdbc
rtltkib fyst,bcf lf gfsjkjubehb wdkbkt,t,bc
ufydbsfht,bc upfpt ~Opie`8 [ibhb fyst,bsb wdkb-
kt,t,b bodtdc fhnthbbc ibuybsf rtlkbc ufcmtkt-
,fc lf lfdbohjt,fc ~Albertini`7 [jkj fyst,fl e,yt-
15
vtmfybpvt,b vjyfobktj,ty lf c[df afmnjht,bc
sfylfhsdbcfc7 hjujhbwff vfu5 /bgthkbgbltvbf7
fxmfht,ty lf f’kbtht,ty fsthjcrkthjpbc ufydb-
sfht,fc8 ufcfsdfkbcobyt,tkbf7 hjv .jdtkb flf-
vbfyb bv.jat,f c[dflfc[df tupjutyehb fynbutyt-
,bc ptvjmvtlt,bc mdti lf vfspt cfgfce[j htfmwb-
bc itltufl cbc[k’fhqdsf rtlkt,ib dbsfhlt,f
c[dflfc[df cbv’bvbc gfsjkjubehb wdkbkt,t,b8
/bgthvuh’yj,tkj,f fynbutyt,bcflvb7 hjvtkcfw
itbwfdc7 vfu8 cbufhtnb ~Dubios E. l. Tufanelli D. L.
1964, Bonfiglio T. Botti R. Hagstrom j. 1972‘, vtlbrfvty-
nt,b ~Harvey A. Slulman L. 1954‘, h’t ~Bulkley B. H. Rob-
erts W. C. 1975‘, rdthw[b ~Heihel R. H. Curtis E. U.
1976` lf tyljutyehb ybdsbtht,f bycekbyb ~Heihel
R. H. O’Toole J. D. 1976` ufyfgbhj,t,ty gfsjkjubeh
wdkbkt,t,c cbc[k’fhqdt,ib8 B /tgfnbnbc fynb-
utybc itvwdtkb bveyehb rjvgktmct,b fqvjxtyb-
kb bmyf rdfy’jdfyb gthbfhnthbbnbc lhjc ~El-Ch-
oberey A. Grennan D. M. 1976`8 hjwf kfgfhfrbf bve-
yjkjubeh vtmfybpvt,pt7 buekbc[vt,f fhf vfhnj
/evjhekb fy e]htlekb bveybntnb7 fhfvtl fk-
nthyfnbekb upt,bc fmnbdfwbfw7 hjujhbwff rjv-
gktvtynbcf lf /futvfybc afmnjhbc fmnbdfwbf8 ,t-
dhbf bv ybdsbtht,fsf hfjltyj,f7 hjvtksf mhj-
ybrek ptvjmvtlt,fc ite’kbf fvf se bv upbc fmnb-
dfwbf7 hfw ufyfgbhj,t,c fsthjcrkthjpbc lfxmf-
ht,ek ufydbsfht,fc8
sfdbc ndbyb fhbc cfv.fhjc .dtkfpt hsekb
j,btmnb7 vf[dbkujybdhekb rjvgbenthb7 hjvt-
kbw yjhvfib jhufybpvbc bveyehb cbcntvbcfufy
bpjkbht,ekbf8 vfuhfv erfyfcrytkb fsoktekt-
,bc ufyvfdkj,fib ufxylf vjyfwtvt,b7 hjvtkbw vb-
esbst,c7 hjv sfdbc ndbyb sfdfl fhbc bveybntnt-
,bc evfqktcb jhufyj ~b8f8 vfkfi[bf7 !)*$7 @___` lf
vfc fdnjyjvbehb bveyehb cbcntvf uffxybf
~  .3. 1990 * $= >.. =
,ib [lt,f kbgblt,bcf lf rfkwbevbc xfkfut,f ~Ze-
ek`8 cbc[k’fhqdsf fsthjcrkthjpek wdkbkt,t-
,ib bveyjkjubehb vtmfybpvt,bc vjyfobktj,fc
flfcneht,c fenjacbbc itltut,bw ~Collins D. H.
Goldie W`8 fctsb wdkbkt,t,b yfyf[bf f[fkufphlf
fcfrib cntyjrfhlbekb rkbybrbc ufydbsfht,fvlt8
cbc[k’fhqdbc rtlkt,ib ofhvjbmvyt,f fshjcrkt-
hjpekb ajkfmt,b kbgblt,bc itcfvxytdb xfkfut-
,bc ufhtit8 vbrhj,ekb fynbutyt,b lf vfssfy lfrf-
dibht,ekb bveyehb rjvgktmct,b kfult,bfy lfpb-
fyt,ek ~fyst,fl` tyljstkeh e,yt,ib lf ufyfgb-
hj,t,ty fsthjcrkthjpekb ajkfmt,bc ufydbsf-
ht,fc7 vybidytkjdfybf fuhtsdt fhnthbjcrkthj-
pib e]htlekb bveyehb vtmfybpvt,bc hjkbw8
fvhbufl7 cbc[k’fhqdsf rtlkt,bc gfsjkjub-
ehb wdkbkt,t,bc ufydbsfht,fib bveyjkjubehb
@__) otkb
(.. 1989 ?* . 1984 Fontana a 1994`8 fqybiye-
kb afmnb ufycfresht,ekb fmnefkj,bs ofhvjf-
xtyc ythdekb lf bveyehb cbcntvt,bc ehsbthsm-
vtlt,bc cfrbs[c7 hjujhw stjhbekb bct rkbyb-
rehb sdfkcfphbcbs8
ef[ktcvf ufvjrdktdt,vf fxdtyf7 hjv sfd-
pehu-ndbybc cbs[t7 hjvtkbw /tvfnjtywtafke-
hb ,fhbthbc vbqvf bv.jat,f7 itbwfdc T lf B kbv-
ajwbnt,c7 hjvkt,bw cgtwbfkehb bveyehb aeym-
wbt,bc vfnfht,kt,b fhbfy lf fmds kjrfkehb
bveyehb gfce[bc xfvj.fkb,t,bc eyfhb8 tctyb fhb-
fy ’bhbsflfl5 T-/tkgtht,b7 T-ceghtcjht,b7 T-fv-
gkbabrfnjht,b7 wbnjnjmcbehb T-e]htlt,b7 B-
gkfpvjwbnt,bc obyfvjh,tlt,b ~hjvkt,bw sb-
vec-fhflfvjrblt,ek fynbutyt,pt htfubht,ty`7
B-bveyehb vf[cjdhj,bc e]htlt,b7 B-ceghtcjht-
 16 ,fdidsf rfhlbjkjubf
,b lf fctd K lf NK e]htlt,b ~= (. 1991*
@ %.. 1986`8
fqvjxylf7 hjv kbmdjhbc kbvajwbnt,b njkt-
hfynekyb fhbfy ythdekb mcjdbkbc fynbutyt,bc
vbvfhs7 vfiby7 hjwf cbc[kbc kbvajwbnt,b rjy-
nfmnbc itvs[dtdfib vfssfy bveyeh htfmwbfib it-
pvbc bveyehb gfce[bc utythfwbf-htuekfwbfib8
dabmhj,s7 hjv se ,fdidsf fcfrib c[dflfc[df lffdf-
lt,t,bc lhjc ucc-bc lfhqdtdt,b lfv.fht,ekbf
uekbc veifj,bc ytbhjtyljrhbyek ’dht,pt lf
[ibhfl jhufybpvb cfzbhjt,c /bgthrjvgtycfnjhe-
kb vtmfybpvt,bc xfhsdfc7 fewbkt,kfl ufcfsdfkb-
lbfy ~= (. 1986`7 kbmdjhib ufvjdktyb-
kb bmyf .dtkf ’bhbsflb rkfcbc bveyjukj,ekb-
yt,b ~lgM, lgA, lgG, lgD, lgE`8 ufxylf vjyfwtvt,b vfsb
ndbyib kjrfkehb cbystpbc itcf[t,8 lflutybkbf7
hjv cbc[kbcf lf ’dkbc ndbybc B-e]htlt,bc lj-
ytpt fhct,ekb ltatmnb7 fh t[t,f sfdbc ndbyc lf
bm B-kbvajwbnt,bc obyfvjh,tlt,b uflbfy bve-
yjctrhtwbek e]htlt,fl lbathtywbht,bc vstk
wbrkc8 fmtlfy ufvjvlbyfht cfdfhfeljf7 hjv tc
bveyjrjvgtntynehb e]htlt,b f[jhwbtkt,ty
rjynhjkc sfdbc ndbybc mcjdbkpt lf mvybfy ndb-
cobyt,tkbf sfdbc ndbybc7 hjujhw bveyehb jhuf-
yjc hjkb7 vbs evtntc7 se cbc[kbc vbvjmwtdbc fgf-
hfnbc ght- lf gjcnrfgbkfhekb cbcntvf xf,vekbf
gfsjkjubeh ghjwtcib lf ofhvjflutyc uekbc jh-
ufyekb lfpbfyt,bc itltuc7 hjvtkbw fhwse bidbf-
sfl cfhmdkjdfyb fgfhfnbcf lf cbc[k’fhqdsf ae-
ymwbbc lfpbfyt,bs vbvlbyfhtj,c8
hjujhw ptvjs b.j fqybiyekb uek-cbc[k’f-
hqdsf cbcntvbc lffdflt,fsf lhjc sfyfvtlhjdt
vrehyfkj,fib ufvjb.tyt,f bveyjvjlekfwbehb
cfiefkt,t,b8 ths-thsb bveyjvjlekfnjhb7 hj-
ybc bveyeh ,fhbthc ~= (. :#' .. vtkbw itcf’kjf tatmnehb fqvjxyltc7 fhbc ghtgf-
1974 = (. !)(^` 8 ufhlf fvbcf7 bveyeh gf- hfnb GA-40 ~cfhtubcnhfwbj vjovj,f 1__#_(7 !)))
ce[ib vjyfobktj,ty fuhtsdt ytbhjukbbc e]ht- okbc ( ltrtv,thb` ~]j,fdf y9 xf[eyfidbkb u8 @__$`8
lt,b5 fcnhjwblt,b7 jkbujltylhjwbnt,b lf vbr- bub ofhvjflutyc gjkbgtgnblt,bc rjvgktmcc7 hj-
hjukbf ~
 .. 1990 = .. vtkbw vbqt,ekbf trjkjubehfl ceasf ,eyt,hbdb
= (. 1995 Shrikant p/ Benveniste E.N/ 1996`8
fcnhjwbnt,sfy rjynfmnbc itvltu uffmnbdt,ekb
CD4 e]htlt,b f[ltyty bynthathjybc ghjlemwb-
fc7 hjvtkbw sfdbc v[hbd bodtdc fcnhjwbnt,bc
cnbvekfwbfc7 bynthktbrby-!-bc ufvj.jafc lf
vwtyfhtekb ytlktekblfy ufceasfdt,bc ,bjmbvb-
ehb vtsjlt,bc ufvj.tyt,bs8 bub itbwfdc mhjvfnj-
uhfabekfl ufovtylbk gjkbgtgnblt,bc cnfylfh-
nbpt,ek rjv,byfwbfc8 cfvtlbwbyj ghfmnbrfib uf-
vjb.tyt,f eathj cbs[bc cf[bs8 cfthsfijhbcj
cf,jkjjl T-e]htlt,bc fmnbdfwbfc ~?* ..
1984, Fonta na A 1985`8 sfdpehundbybc cbs[tib fq-
vjxtybkb bmyf bynthathjyb .dtkfpt vfqfkb rjy-
wtynhfwbbs7 hfw vbesbst,c7 hjv vbcb cbystpb
ndbybc mcjdbkib ofhvjt,c8 ythdek cbcntvfpt
lbl ufdktyfc f[ltyc bynthktbrbyt,b 2 bk-! lf
bk-@8 sfdbc ndbybc nhfdvt,bcf lf byceknt,bc
lhjc vfsb cbystpb ’kbthlt,f8 vfsb ’fkbfy vfqf-
kb rjywtynhfwbf ~vtybyubnb7 fkw/tbvthb7 ufafy-
nekb crkthjpb` welb ghjuyjpbc vfxdtyt,tkbf8
rkbybreh-tmcgthbvtynekb vjyfwtvt,bc
ghjuhfvbc vb[tldbs xfnfht,ekb obyfrkbybrehb
lf rkbybrehb ufvjwlbkt,bc itltufl lflutybk
bmyf hjv ghtgfhfnb GA-40 ofhvjflutyc bveyjvj-
lekfnjhc lf uffxybf hf bveyehb cbcntvbc rjhtm-
wbbc eyfhb7 vbtresyt,f bveyjrjhtmnjht,bc fye
bveyjcfhtf,bkbnfwbj nbgbc ghtgfhfnt,bc rkfcc8
fvfcsfy thsfl jhufybpvbc vbth ufvjveifdt,ekb
pjubthsb wbnjrbyt,bc vcufdcfl ~cbvcbdybc ytrhj-
pbc afmnjhb7 bynthathjyb`7 GA-40-c uffxybf gbh-
lfgbhb wbnjnjmcbrehb vjmvtlt,bc eyfhb fdsdb-
ct,bfyb cbvcbdyehb e]htlt,bc vbvfhs8
~= (. 1986, 1991, 1974, 1995, #=
>.. $= >..` vb[tldbs7 sfdbc ndbyb bveye-
hb aeymwbt,bc itchekt,fc f[jhwbtkt,c cfvb th-
svfytsbcfufy vjhajaeymwbehfl ufyc[dfdt,ekb
cbcntvbc vtidtj,bs8
gbhdtkbc cbntvf ofhvjlutybkbf kbvajblehb
e]htlt,bs ~T lf B e]htlt,b lf vfsb ce,gjgekf-
wbt,b7 vjyjwbnt,b7 vfrhjafut,b`7 vtjht 2 fhfkbv-
ajblehb e]htlt,b ~vbrhjukbf7 fcnhj lf jkbuj-
ltylhjwbnt,b7 rfgbkfhsf tyljstkbevb`7 vtcfvt 2
vtlbfnjht,b7 gtgnblt,b7 wbnjrbyt,b8 .dtkf fv cbc-
ntvbc aeymwbjybht,f ehsbthsrfdibhib [jhwbt-
klt,f8 sfdbc ndbyb7 akj,c hf ptvjfqybiyek bve-
yeh cbcntvt,c7 cfdfhfeljf7 hjv bcbyb vjyfobktj-
,ty fhf v[jkjl wyc-bc7 fhfvtl cfthsjl jhufyb-
GA-40 fqflutyc bveybntnbc B- lf T-e]htlekb
cbcntvt,bc vfxdtyt,kt,c8 rth’jl7 fqflutyc cb-
c[kib T-cfthsj7 T-fmnbehb7 T-/tgtht,bc7 T-wb-
njnjmcbrehb7 T-ceghtcjht,bc7 T-mbktht,bc ~NK
e]htlt,b` itvwdtkj,bc lfhqdtek hfjltyj-
,hbd vfxdtyt,kt,c7 yjhvfib vj/.fdc ktbrjwbnt-
,bc7 shjv,jwbnt,bc7 vjyjwbnt,bc7 tjpbyjabkt-
,bc7 ,fpjabkt,bc7 x[bh-,bhsdbfyt,bc7 ctuvtyn-
,bhsdbfyt,bc hfjltyj,hbdb vfxdtyt,kt,b7 fvwb-
ht,c thbshjwbnt,bc lfktmdbc cbxmfhtc7 yjhvfib
vj/.fdc fuhtsdt cbc[kbc bctsb ,bjmbvbehb vfxdt-
yt,kt,b7 hjujhbwff ifhljdfyf7 rhtfnbybyb7 ,b-
kbhe,byb7 ifmfhb lf c[d8
GA-40-bc ufvj.tyt,bc itltufl itbybiyt,f cb-
c[kbc bctsb ,bjmbvbehb vfxdtyt,kt,bc lflt,bsb
@__) otkb
,fdidsf rfhlbjkjubf
lbyfvbrf7 hjujhbwff5 rfywthjtv,hjutyekb fy-
nbutyt,b ~CEA`7 ghjcnfncgtwbabrehb fynbutyb
~PSA`7 fkaf-atnjghjntbyb ~AFP` lf c[d8 ghtgfhf-
nb lflt,bs ufdktyfc f[ltyc fuhtsdt cbc[kib vb-
ythfkehb yfthst,bc7 rth’jl7 yfnhbevbc7 rfkbe-
vbc lf c[dfsf itvwdtkj,fpt8
tmcgthbvtynib lflfcnehlf7 hjv ghtgfhfnb
GA-40-bc w[jdtkbc ojyfpt ! vk/ru-pt ljpbs it.-
dfybcfc vbbqt,f bveyjvjlekfwbehb tatmnb8 wd-
kbkt,t,b fqbybiyt,f egbhfntcfl rfhlbjvbjwb-
nt,bc ,bhsdekb cnhemneht,bc v[hbd8 rfhlbjvb-
17
$8 xf[eyfidbkb u8 2 pjubthsb cnhemnehekb vf-
xdtyt,tkb uekbc sfylf.jkbkb vfyrt,bc lhjc 2
rkbybrehb tmcgthbvtynekb vtlbwbyf @__! o8 1 %-^8
%8 ]j,fdf y8 2 ,fdidsf fcfrib pjubthsb sfylf-
.jkbkb7 fyst,flb lf it’tybkb fhffyst,flb lff-
dflt,t,bc lhjc uek-cbc[k’fhqdsf cbcntvbc
rkbybreh-bycnhevtynekb lf[fcbfst,f7 vfs vre-
hyfkj,fib ghtgfhfn GA-40-bc xfhsdbc itcf’kt,-
kj,fyb8 lbcthnfwbf7 vvr cfvtwybthj [fhbc[bc
vjcfgjdt,kfl8 2 s,bkbcb @__$ o8
^8 
 .. – +

# )
jwbnt,ib yfyf[b wdkbkt,t,b fqbybiyt,f fuhtsdt # // . #0, 1984  216
7. 
 .. 3#'
 .3. – Q#
fv ]ueabc rfgbkfht,bc tyljstkbevib7 byntycb- $
 #0 // . #0, 1990  352
dj,f bubdtf7 hfw rfhlbjvbjwbnt,bc itvs[dtdfib8 8. &)=
. – >= 
0
ghtgfhfn GA-40-bc vjmvtlt,f uek-cbc[k’f-  X
 $ #
+

hqdsf cbcntvfpt tmcgthbvtynib ~tru5 aru5 hgu` lf + 
'.// . “
) $ 
*: #0 2003 : "*   30-38
vbcb vjhajkjubehb lf[fcbfst,f ,jwdht,ib b’kt- 9. &)= . – 
 
 $Q
df cfae’dtkc gthcgtmnbdfib hjujhw ghtgfhfnbc #+-  )#    $ # 
itvlujvb ufvj.tyt,bc itcf’kt,kj,fc rkbybrfib8  
  +
 ) #.

-
fvltyfl7 tmcgthbvtynek vjyfwtvt,pt lf.hl-  ) $ '*, $ 
$

  *0 #. . Y... "*  1992 
yj,bs7 vbpfyitojybkbf ghtgfhfn GA-40-bc vjmvt- 419
lt,bc itvlujvb rdktdbc ufuh’tkt,f rkbybrfib7 10. &)= .. YQ* .Y. 3)#' .
. –
hfvltyflfw cfdfhfeljf fv ghtgfhfnbc ufvj.tyt- [
  *

+
 #
,bc itcf’kt,kj,f uekcbc[k’fhqdsf cbcntvbc  # #+-  )#    
$: // 3\" 2004 : 2004 : № 7-8 (112-113) . 64-
lfpbfyt,bs vbvlbyfht lffdflt,fsf rjvgktmceh 67.
vrehyfkj,fib8 11.
)*: .. – )
#  $
+

X

#: #
: '  // .
eylf fqbybiyjc7 hjv ,jkj okt,bc vjyfwtvt- #0 1983 : . 368
,bs mfhsek ghtgfhfnt,c fgbrjhc7 fgbgekvjcf
0 *' )   ':
lf fgb/tgfnc f[fcbfst,c bveyjrjhtmnekb sdbct-
,t,b fynbjmcblfyneh sdbct,t,sfy thsfl ~se
bvfcfw ufdbsdfkbcobyt,s7 hjv tc ghtgfhfnt,b it-
bwfdc htpdthfnhjkcfw7 vfiby vfsb ufvj.tyt,f
fhf vfhnj cfvrehyfkj ghjwtct,ibf vybidytkj-
dfyb7 fhfvtl ghtdtywbek rfhlbjkjubfcf7 gek-
vjyjkjubfcf lf /tgfnjkjubfibw bmyt,f rkb-
ybwbcnt,bcsdbc ufcfsdfkbcobyt,tkb8
UFVJ>TYT<EKB KBNTHFNEHF
!8 xf[eyfidbkb u89 ]j,fdf y8 2 tmjrfhlbjuhfab-
ekb vjyfwtvt,b ]fyvhstk ,fdidt,ib8 2 s,bkbcb7
!))! o8 ud8 )(8
@8 xf[eyfidbkb u89 rbkf’t l9 ]j,fdf y87 xf[eyfi-
dbkb r8 2 3cfmfhsdtkjib ,fdidsf rfhlbjkjubbc
fmnefkehb cfrbs[t,b lf vbcb ufydbsfht,bc gthc-
gtmnbdt,b \\6 cfereytib48 2 3rfhlbjkjubf lf ib-
yfufyb vtlbwbyf4 1! @__@ o8 ud8 @@-@%8
#8 xf[eyfidbkb r8 2 fsthjcrkthjpbc flhte-
kb lbfuyjcnbrbcf lf ghtdtywbbc cfrbs[t,b rkb-
ybreh-kf,jhfnjhbekb lf bycnhevtynekb
fyfkbpbc cfae’dtkpt8 lbcthnfwbf v8v8l8 s,b-
kbcb @__@ o8 ud8 @!)8
@__) otkb
12. = (. –  $# 

(*') // `. $.  $ . 1991 :.  91 № 6  14-
18.
13. S.I.Liochev and I.Fridovich, "The effects of
Superoxidedismufase on H202 formation". Free Radical
Biology and Medicine, 2007, v.42, pp.1465-1469;
14. I.G.Sava, V.Battaglia, C.A.Rossi, M.Salvi and
A.Toninelo, "Free radical scabenging action of the nat-
ural polyamine spermine in rat liver mitiochondria".
Free Radical Biology and Medicine, 2006, v.41, p.
1187;
15. Freman B.A., Crapo I.D. "Biology of
Diseases. Free radicals and tissue injury". Lab.
Invest, 1982, 47, pp. 412-426;
16. Katzitadze A., Kiladze N., Kiladze S., Chikvaidze
E., Lebanidze A., Kirikashvili I. "Photosensitization and
skin photoaging". Experimental Clinic Medicine. Int.
conference "Dermatocosmetology - XXI Centry. April
20-23, 2004, Tbilisi;
19. Katzitadze A., Kiladze N., Kiladze S.,
Chikvaidze E., Lebanidze A., Kirikashvili I. "The role
of free radicals in skin aging". Experimental Clinic
Medicine Int. conference "Dermatocosmetology - XXI
Century. April 20-23, 2004, Tbilisi;
20. Maxwell S.R., Lip G.Y. "Free radicals and
antioxidants in cardiovascular disease" Br. J.Clin,
Pharmacol, 1997, 44, pp. 307-317;
 18
nutriciuli problemebi da maTi
koreqcia kistofibrozis dros
n. badriaSvili, m. moiswrafiSvili,
n. TofuriZe, n. SariqaZe,
m. giorgobiani, z. SaqaraSvili
kistofibrozi genetikuri daavadebaa, gan-
pirobebuli kistofibrozis transmembranu-
li maregulirebeli genis mutaciiT, mimdina-
reobs upiratesad sasunTqi sistemisa da kuW-
nawlavis traqtis dazianebiT.(1,3,5). daavade-
bis paTogenezSi mniSvnelovani adgili uWi-
ravs imunuri homeostazis darRvevas. ukanas-
kneli wlebis farmakoTerapiuli miRwevebis
safuZvelze daavadebis diagnostikis SemTx-
vevaSi prognozi mniSvnelovnad aris gaumjo-
besebuli(2,4,8).
AAklinikuri suraTi vlindeba filtvis
qronikuli obstruqciuli procesis, nawlau-
ri sindromisa da fizikuri ganviTarebis Se-
ferxebiT. asakis matebasTan erTad pankrea-
sis garegani funqciis ukmarisobis niSnebis
paralelurad izrdeba sasunTqi sistemis da-
zianebis simbtomebi.
kistofibrozis Ayvelaze adreuli da mZi-
me gamovlinebaa mekonialuri ileusi, romlis
mizezia pankreasuli aqilia da wvrili naw-
lavis jirkvlebis disfunqcia.A mekonialuri
ileusi literaturis mixedviT gvxvdeba
avadmyofTa 10-15% da iTvleba daavadebis um-
Zimes formad.
malabsorbciis sindromis mkurnaloba
warmatebiT xorcieldeba pankreasuli fere-
mentebiT romelTa Soris gansakuTrebuli
adgili daimkvidra fermentma kreonma. igi ak-
mayofilebs yvela moTxovnas, romelic idea-
lur fermentul preparats waeyeneba: fermen-
tebis optimaluri, fiziologiur proporcia-
Si Semcveloba; mJavagamZleoba; swrafi da
Tanabari Sereva sakvebTan; sakvebTan erTad
gadasvla pilorusSi; fermentebis swrafi da
100 %-iT gamonTavisufleba TormetgojaSi,
sadac aqtiurad mimdinareobs sakvebis mone-
leba; amasTan igi usafrTxoa, mikrosferu-
lia, dafarulia pH mgrZnobiare kafsuliT.
kreoni® 10 000 Seicavs: 150 mg pankreatins, rac
Seesabameba 8 000 s.erT.amilazas, 10 000 s.erT.
li pazas da 600 s.erT. proteazas; kreoni® 25
000 Seicavs: 300 mg pankreatins, rac Seesabame-
ba 18 000 s.erT. amilazas, 25 000 s.erT. li pa-
zas da 1000 s. erT. proteazas; metaboluri
da cilovani cvlis koreqciisa da imunomo-
,fdidsf rfhlbjkjubf
dulaciis mizniT gamoiyeneba antioqsidanti
apikori. igi ori biologiurad aqtiuri kom-
pinentebiT mdidari produqtis futkris na-
warmisa da yurZnis wi pwis nazavia. yvavilis
mtveri mdidaria organizmis Senebis, ganviTa-
rebisa da sicocxlisaTvis aucilebeli niv-
TierebebiT: cilebiT(Seicavs aminomJavebis 22
saxeobas, maTgan 8 Seucvlels), najeri da
ujeri cximovani mJavebiT, glikozidebiT, vi-
taminebiT (A,B,C,D,PP,E,K,folis mJava), fosfote-
rinebiT, sisxlZarRvis kedlis gamamagrebeli
bioflavinoidebiT, mikro da makroelemente-
biT(Fe,Zn,Cu,F). amave dros yurZnis wi pwa imu-
nomodulatoria.
kistofibroziT daavadebulebSi malab-
sorbciis mkurnaloba grZeldeba mTeli si-
cocxlis manZilze da iTvaliswinebs kargi
nutriciuli mdgomareobis SenarCunebas, ra-
Sic udidesi mniSvneloba aqvs Tanamedrove
farmakologiur saSualebebs ekologiurad
sufTa da balansirebul sakvebi ingrediente-
bis fonze.
Sromis mizans warmoadegenda nutriciuli
statusis koreqcia kistofibroziT daavade-
bul bavSvebSi.
masala da meTodebi: Seswavlili iyo kis-
tofibroziT daavadebuli 1Tvidan 14 wlamde
asakis 26 bavSvi, maTgan 20vaJi da 22 gogona.
Mmv Sereuli forma aReniSneboda 18-s, filt-
vis forma 8 avadmyofs. sakontrolo jgufs
Seadgenda imave asakis praqtikulad janmrTe-
li 20 bavSvi. diagnozis dasabuTeba xdeboda
anamnezuri, klinikur-instrumentuli kvlevi-
sa da oflSi eleqtrolitebis siWarbis
(>60mmol/l) gansazRvris safuZvelze. imunu-
ri homeostazis SeswavlisaTvis isazRvrebo-
da CD3, CD4, CD8 limfocitebi monoklonuri
antisxeulebiT, B-limfocitebi komplementu-
ri rozetkis warmoqmnis meTodiT, sisxlis
SratSi IgG, IgA, IgM- manCinis radialuri imu-
nodifuziis meTodiT.
Sedegebis ganxilva: rogorc Cveni masa-
lis analizma gviCvena kistofibrozisaTvis
damaxasiaTebeli iyo pirveladi pnevmoniis
gaxangrZlivebuli an morecidive mimdinare-
oba. miuxedavad sworad warmarTuli mkurna-
lobisa SemdgomSi yvela SemTxvevaSi viTar-
deboda qronikuli pnevmonia ormxrivi difu-
zuri procesiT, rac emTxveva sxva avtorTa
monacemebs. Cvens SemTxvevaSi sasunTq siste-
@__) otkb
,fdidsf rfhlbjkjubf
maSi procesis gamwvaveba bronqitis ti piT
aReniSna 14(54%) avadmyofs, pnevmoniis ti piT
8(31%)-s.
Mrogorc Cveni kvlevis, aseve sxva avtor-
Ta(7,8,10) gamokvlevebis safuZvelze unda aRi-
niSnos, rom kistofibroziis dros sasunq
sistemaSi metad Taviseburi dazianebebi vi-
Tardeba, romlis safuZvelzec rig SemTxveva-
Si SeiZleba vivaraudoT kistofibrozis ar-
seboba. Cens SemTxvevaSi filtvis qsovilis
gaZliereba da deformacia gamovlinda
92%(24)-Si, sxvadasxva intensivobis emfizema
79%(21), morecidive pnevmoniebi-68%(18), myari
ateleqtazebi 16%(41), kerovani da difuzuri
pnevmosklerozi 14%(36).
Ddaavadebis mudmivi simptomi xvelaa, ro-
melic rCeba mudmivad remisiis periodSic,
xolo sasunTq sistemaSi procesis gamwvave-
bis dros mas emateba qoSini da cianozi. xve-
la mSralia, Semawuxebeli, zogjer paroqsiz-
muli, naxveli Znelad gamoiyofa. Cvens masa-
laze avadmyofTa 1/3 aReniSneboda SeteviTi
yivanaxvelasebri xvela. simptomebidan sixSi-
riT meore filtvebis emfizemaa, romelic
Cvens masalaze gamovlinda yvela SemTxveva-
Si.
sasunTq sistemaSi anTebiTi procesis aq-
tivoba kistofibrozis mimdinareobis dros
sxvadasxva intensivobisaa, rac gamovlindeba
rogorc klinikurad aseve rentgenologiu-
rad. Cvens masalaze sasunTq sistemaSi anTe-
biTi procesis aqtivoba aRiniSna 6(23%) Sem-
TxvevaSi(umniSvnelod gamoxatuli kliniku-
ri maCveneblebi, laboratoriuli maCveneble-
bi normaSi), saSualo xarisxis aqtivoba iyo
9(34,6%) SemTxvevaSi –masis daqveiTebiT, apaTi-
iT, qoSiniT, xveliT, filtvebSi auskultaciu-
ri monacemebis, rentgenologiuri cvlilebe-
bisa da sisxlis suraTis mniSvnelovani gau-
aresebiT.
mesame xarisxi gamovlinda 7(27%) SemTxve-
vaSi yivanaxvelasebri xveliT, Cirqovani nax-
veliT, wonaSi 30%-is daklebiT, gulmkerdis
kasrisebri deformaciiT, kompensirebuli
filtvismieri guliT, filtvebSi mZime anTe-
biTi procesebiT. 7(27%)SemTxvevaSi aRiniSna
qronikuli hepatiti.
kistofibrozi Sereuli formiT daavade-
bulebSi yvela SemTxvevaSi sxvadasxva xaris-
xiT gamoxatuli iyo malabsorbciis sindro-
mi. avadmyofTa 75% malabsorciis sindromi
aReniSnaT ti piuri klinikiT: polifekalia
cximiani, myrali, xSiri sagozaviseburi ganav-
liT. nawlavuri mikrofloris SeswavliT ga-
movlinda laqto da bifido baqteriebis de-
@__) otkb
19
ficiti. Cvens mier gamokvleuli kistofibro-
ziTAAdaavadebulTa 71% aReniSna disbaqteri-
ozi, 11% Segvxvda laqtozis autanloba, 3%
aRiniSneboda celiakiuri sindromisa da
laqtazuri ukmarisobis Tanaarseboba.Q ara-
iSviaTad (18%) gamovlinda swori nawlavis
gamovardna gansakuTrebiT adreuli asakis
bavSvebSi. 35%(9) aRiniSneboda infeqciis qro-
nikuli kerebi(qronikuli tonziliti, sinusi-
ti, haimoriti).
s.v. raCinskisa da n.i. kapranovis sqemis mi-
xedviT Sefasebisas avadmyofTa zogadi mdgo-
mareoba damakmayofilebeli iyo 23%(6)Si, sa-
Sualo simZimis 61,5%(16) da mZime 7,6%(2) Sem-
TxvevaSi.
kistofibroziT daavadebuli bavSebis imu-
nuri statusis Seswavlam gviCvena, rom am
dros adgili aqvs ujreduli da humoruli
imunitetis maCveneblebis daqveiTebas, gansa-
kuTrebiT CD3, CD4-limfocitebisa da sisxlis
SratSi IgG da IgA.
Cveni monacemebis analizi gviCvenebs,rom
kistofibrozi prognozi damokidebulia ara-
marto sasunTqi sistemis dazianebis xarisx-
ze, aramed imunuri sistemis mdgomareobazec.
vadmyofebs CautardaT mkurnaloba, rome-
lic eyrdnoboda saerTaSoriso simpoziumeb-
sa da SeTanxmebebis safuZvelze miRebul
praqtikul rekomendaciebs, romelic iTva-
liswinebs webovani sekretisagan bronquli
xis gasufTavebas, sasunTqi sistemis infeqci-
asTan brZolas, nutriciuli statusis Senar-
Cunebas, imunokoreqcias, kinezoTerapias, fsi-
qoemociur adaptacias.
bronquli xis webovani sekretisagan gan-
Tavisuflebis mizniT gamoiyeneboda acetil-
cisteinis da pulmozimis inhalaciebi, naxve-
lis mikrofloris Seswavlis safuZvelze
tardeboda antibiotikoTerapia (fortumi, zina-
cefi, ci probai, Mmeronemi, tienami, tobramici-
ni),
pankreasis funqciis darRvevis koreqcia
xorcieldeboda ferment kreonis gamoyene-
biT, dozis SerCeva xdeboda individualurad
da misi adeqvaturobis Sefaseba ganisazRvre-
boda sxeulis masis matebiT, zogadi mdgoma-
reobisa da gunebaganwyobis gaumjobesebiT,
defekaciis sixSiriT da ganavlovani masebis
raodenobis mixedviT.Afermentis sadReRamiso
doza nawildeboda miRebuli sakvebis raode-
nobisa da xasiaTis proporciulad.
kreonis fonze avadmyofTa kvebis racion-
Si cximebis SezRudva aRar iyo saWiro, rac
dadebiTad moqmedebda maT fizikur da goneb-
riv ganviTarebaze. NnawlavTa disfunqciis
 20
mowesrigebis mizniT gamoiyeneboda eubioti-
ki diufalaki, romelsac axasiaTebs ganavlo-
vani masis moculobis zrda,Nnawlavis moto-
rikis gaumjobeseba, airebis warmoqmnis Semci-
reba, viteminebis sinTezis stimulacia, bifi-
dogenuri aqtivoba; aseve uzrunvelyofs ana-
erobuli normofloris biomasis zrdas, mik-
robuli populaciis balansirebul aRdge-
nas. dufalakis(laqtuloza) upiratesobaa
prebiotikuri da infeqciis sawinaaRmdego
moqmedeba.
kreonisa da diufalakis erTdrouli ga-
moyenebiT malabsorbciis sindromi srulad
mowesrigda 61,5%(16)-Si, 2 SemTxvevaSi ki mox-
da mdgomareobis gaumjobeseba.
daavadebis prognozis gaumjobesebis miz-
niT tardeboda kinezoTerapia, vitamino Tera-
pia da imunokoreqcia. kinezoTerapia moicav-
da samkurnalo fizkulturas, vibraciul ma-
saJs, posturalur drenaJs. vitaminoTerapiisa
da imunokoreqciis mizniT gamoyenebuli iyo
apikori.
Catarebuli mkurnalobis fonze aRiniSna
avadmyofTa zogadi mdgomareobis gaumjobe-
seba, Tumca sasunTq sistemaSi anTebiTi pro-
cesis minimaluri aqtivoba mainc rCeboda, 2
SemTxvevaSi ver moxerxda malabsorbciis
sindromis sruli likvidacia.
amgvarad, kistofibrozis mkurnaloba unda
iyos kompleqsuri, gagrZeldes mTeli si-
cocxlis manZilze yoveldRiurad. daava-
debis drouli gamovlineba da droulad
dawyebuli mizanmimarTuli mkurnaloba aum-
jobesebs daavadebis prognozs.
,fdidsf rfhlbjkjubf
lising pilicarpine by ionoforesis” // Pediatrics- 1959- v.23-
N2-pp545-549//
8. Davis PB, Drumm M, Konstan MW: Cystic fibrosis.
Am J Respir Crit Care Med 1996 Nov; 154(5): 1229-56.
9. Johnson CA, Butler SM, Konstan MW, et al:
Estimating effectiveness in an observational study: a case
study of dornase alfa in cystic fibrosis. The Investigators
and Coordinators of the Epidemiologic Study of Cystic
Fibrosis. J Pediatr 1999 Jun; 134(6): 734-9.
10.Yankaskas JR, Mallory GB Jr: Lung transplantati-
on in cystic fibrosis: consensus conference statement.
Chest 1998 Jan; 113(1): 217-26.
Nutrition problems and treatment in patients
with cystic fibrosis
N. Badriashvili; M. Moistsrapishvili, N. Topuridze,
N. Sharikadze, M. Giorgobiani, Z. Shakarashvili
S U MA R Y
cystic fibrosis is a chronic multisystem disorder cha-
racterized by recurrent endobronchial infections, progres-
sive obstructive pulmonary disease, and pancreatic insuf-
ficiency with intestinal malabsorption. Recent studies
suggest that adenotonsillar disease appear to be more pre-
valent in patients with cystic fibrosis (Cipolli, 1993;
Halvorson, 1999).
We investigated 26 children with cystic fibrosis aged
from 1 month to 14 years who were hospitalized in pedi-
atrics clinic of TSMU . The Sweat chloride test (Chloride
concentration 60 mEq/L )were used to diagnose MV .
The investigation showed that in 26 patient 18 were
with combined and 8 with pulmonary form of MV. In
92% of patients were detected lung deformation, in 79%
emphysema, In 68% - recurrent pneumonia, in 16% -
lung atelectasis, in 14% - pneumosclerosis, in 2% - cor
"%" pulmonale, in 3% chronic hepatitis, in 79% - malabsorp-
1.   >.., 3=..
$ .. tion syndrome.

=
 .(. ,,#
- 0 * $+ The study revealed a marked depression of immunity
* )
 0#'.,,3): 2001. 11 characterized by reduction of quality of CD3, CD4, CD19-
№3 lymphocytes and the concentration of IgG, IgA, IgM .
2.
$ .. “)
 0#'” .
.

 2008 : Patients with cystic fibrosis received complex treat-
3.
3- . . "+   # )
0#' ment, which included: Enzymes, pancreatic (Creon) and
) # $  # +  Duphalac in aid of malabsorption syndrome;
*0: Y . ... #- #. )
.—., 1987 Bronchodilators (Albuterol, Proventil, Ventolin),
4.
+#' .. # .,, )
 0#') Mucolytic agents (Pulmozyme and ACC) and Antibiotics,
#,, '#. “
” "*  1990:. (Fortum, zinacef, Ciprobay, Meronem, Tienam, Tobram-
5. 3 ..  %.
. “Y  $ ycin) in treatment of bronchopulmonary disorders;

)-:+
 #: 
   Apicor for correction of immune system. Also there were
@” 3): 2001, 11, № 3 used nutrition and kinesis therapy.
6. ‚ .. # .. :* cystic fibrosis is a severe disease with progressive cur-
. “
) $* )
 0#' ) #.” rent and often with fatal outcome. But early diagnosis
"*  2001:. and right tactic of treatment and management of patients
7. Gibson L.E. cooke R.E. ,,A test for concentracion of influence on the outcome of disease and prolongs life of
eleqtrolytes in sveat in cystic fibrosis of the pancreas uti- patients.
@__) otkb
,fdidsf rfhlbjkjubf
arteriuli hipertenzia
m. SvangiraZe, r. ioseliani,
q. cxakaia, d. TenieSvili
arteriuli hi pertenzia mdgomareobaa, ro-
melsac sisxlis mimoqcevis did wreSi arte-
riuli wnevis mateba – 14/90 mg. vwy. sv-ze me-
tad axasiaTebs. mas umetes SemTxvevaSi, samiz-
ne organoebis dazianebis gamovlinebamde, da-
maxasiaTebeli Civilebi aqvs.
esenciuri hi pertenzia – ucnobi etiologi-
is arteriuli hi pertenziaa, pirveladi anu
esenciuri anu idiopaTiuri.
kanmo-s eqspertTa komitetis 1973 wlis kla-
sifikaciis mixedviT arCeven arteriuli wne-
vis Semdeg kriteriumebs (vwy. sv. mg.).
140/90 – normis zeda zRvari;
159/94 – mosazRvre arteriuli wneva;
>160/95 - arteriuli hi pertenzia.
esenciuri hi pertenziis xelSemwyobi faq-
torebi: fsiqoemociuri stresi, Tambaqo, memk-
vidruli faqtori, asaki, Saqriani diabeti, Na-
is Warbi moxmareba, simsuqne, rasa, alkoholi,
endokrinuli moSlilobebi.
esenciuri hi pertenziis paTogenezSi wamy-
vani roli atreriuli wnevis mudmivobis mre-
gulirebeli kompensatoruli meqanizmebis
darRvevas eniWeba. am TvalsazrisiT mniSvne-
lovania Tirkmlis baroreceptorebis da re-
nin-angiotenzin-aldosteronis sistemis funq-
ciuri mdgomareoba.
klinikuri gamovlineba – esenciuri hi per-
tenzia SeiZleba xangrZlivi drois manZilze
Civilebis gareSe mimdinareobdes da daavade-
bis niSnebi mxolod samizne organoebis dazi-
anebis Semdeg gamovlindes. samizne organoe-
bis mixedviT arteriuli hi pertenziis Semdeg
stadiebs gamoyofen:
I stadia – samizne organoebis dazianeba
ar aRiniSneba;
II stadia – organoebis msubuqi dazianeba
(marcxena parkuWis hi pertrofia, baduris ar-
teriebis Seviwroveba, protenuria);
III stadia – organoebis mZime dazianeba
(marcxena parkuWis ukmrisoba, encefalopTia,
sisxlCaqcevebi baduraSi, nefropaTia – glo-
merulopaTia).
calkea gamoyofili avTvisebiani hi perten-
zia – avTvisebiani nefroangiosklerozi, Tir-
kmlis arteriuli nekrozi, mZime prolifera-
ciuli endarteriti da gorglebis fibrozu-
li nekrozi, romelsac Tirkmlis ukmarisoba
axasiaTebs. paTologia gvxvdeba arteriuli
hi pertenziis SemTxvevaTa 1%-Si, ufro metad
Savkanian mosaxleobaSi, qalebSi - 30-40 wlis
asakSi, mamakacebSi ki - 40-60 wlis asakSi.
@__) otkb
21
esenciuri hi pertenziisTvis zogjer dama-
xasiaTebelia xanmokle vadiT wnevis uecari,
mkveTri momateba – hi pertenziuli krizi. hi-
pertenziuli krizis simptomebia: Semcivneba,
kankali, simxurvalis SegrZneba, oflianoba,
Tavbru, Tavis tkivili, gulisreva, Rebineba,
mxedvelobis gauareseba, smenis daqveiTeba, gu-
lis friali, gulis areSi tkivili.
hi pertenziuli krizis garTulebebia: mar-
cxena parkuWis mwvave ukmarisoba, miokardiu-
mis infarqti, Tavis tvinSi sisxlis mimoqce-
vis moSla.
diagnozi:
sistemuri hi pertenziis konstataciis Sem-
TxvevaSi esenciuri hi pertenziis diagnozi
mxolod mas Semdeg SeiZleba dadgindes, rac
gamoiricxeba simptomuri hi pertenziis yvela
SesaZlo varianti. amasTanave arteriuli wne-
vis momatebis (sistoluri 160mm vwy. sv. dias-
toluri 95 mg. vwy. sv.) faqti samjer mainc un-
da iyos dafiqsirebuli drois sxvadasxva in-
tervalSi (radgan zogierT avadmyofs eqim-
Tan kontaqtisas arteriuli wnevis momateba
aReniSneba);
diagnozi emyareba anamnezs, fizikur da
laboratoriul-instrumentuli kvlevis Se-
degebs;
kvlevis mizania arteriuli hi pertenziis
mizezis gansazRvra da samizne organoebis
funqciuri mdgomareobis Sefaseba.
diferencialuri diagnostikis mizniT re-
komendebuli gamokvlevebi:
gulmkerdis rentgenologiuri gamokvleva;
ekg;
eqokardiografia;
sisxlis da Sardis saerTo analizi;
sisxlSi narCeni azoti da kreatinini;
eleqtrolitebi sisxlSi;
Tirkmlis ultrabgeriTi gamokvleva;
sisxlSi aldosteronis, kortizolis,
reninis, kateqolaminebis kvleva;
fundoskopia – Tvalis fskeris daqveiTeba.
garTulebebi:
g.i.d. (stenokardia, miokardiumis infarqti,
gulis ukmarisoba);
insulti;
Tirkmlebis ukmarisoba;
sibrmave.
mkurnaloba – mizania arteriuli wnevis
daqveiTeba 140/90 mg. vwy. sv-is qveviT da kar-
diovaskuluri, cerebrovaskuluri da Tirkm-
lis daavadebebis ganvitarebis riskis Semci-
reba, agreTve naadrevi sikvdilis prevencia.
 22
aramedikamenturi mkurnaloba – msubuqi
da zomieri arteriuli hi pertenziis SemTx-
vevaSi medikamenturi mkurnalobis dawyebam-
de mizanSewonilia e.w. cxovrebis wesis Sec-
vla, kerZod:
wonis dakleba;
fizikuri aqtivobis momateba;
natriumis miRebis SezRudva;
alkoholis miRebis SezRudva;
specialuri dieta (li piduri cvlis mo-
wesrigebis mizniT);
Tambaqos wevis Sewyveta;
kofeinis miRebis SezRudva;
SeZlebisdagavarad stresis Tavidan aci-
leba.
medikamenturi mkurnaloba – msubuqi da
zomieri arteriuli hi pertenziiT daavade-
bulTa medikamenturi mkurnaloba im SemTxve-
vaSi, Tu cxovrebis wesis Secvla ar iwvevs
sisxlis wnevis normalizebas. mniSvnelova-
nia medikamenturi mkurnaloba daiwyos samiz-
ne organoebis dazianebis ganviTarebaze.
farmakoTerapia aucileblad aramedikamentu-
ri mkurnalobis fonze tardeba. arteriuli
hi pertenziis (samizne organoebis dazianebis
gareSe) medikamenturi mkurnaloba wamlis mi-
nimaluri efeqturi doziT xangrZliv da
uwyvet miRebas iTvaliswinebs. avadmyofma
unda icodes, rom mkurnalobis xanmokle kur-
siT esenciuri hi pertenziebisgan is ar gani-
kurneba da rom mkurnaloba SeiZleba gagr-
Zeldes wlebi da mTeli sicocxlis manZil-
zec ki.
msubuqi da zomierei hi pertenziis medika-
menturi mkurnaloba monoTerapiis saxiT mim-
dinareobs. umjobesia mkurnalobis dawyeba
SardmdenebiT, Tumca dasaSvebia ( adrenob-
lokatorebiT an kalciumis antagonistebi-
Tac. samkurnalo saSualebebis SerCeva damo-
kidebulia avadmyofis asakze, Tanmxleb daa-
vadebebsa da paTologiur procesebze (ste-
nokardia, gulis ukmarisoba, marcxena parku-
Wis hi pertrofia, Saqriani diabeti, simsuqne,
hi perli pidemia, podagra, qronospazmi da pe-
riferiuli arteriolebis dazianeba).
mZime SemTxvevaSi arteriuli hi pertenziis
samkurnalo pirveli rigis saSualebas uma-
teben sxva jgufis erT an ramdenime prepa-
rets. sarezervo hi potenziur saSualebebs
ekuTvnis centraluri moqmedebis adrenomi-
metikuri saSualebebi, periferiuli vazodi-
latatorebi, centralurad moqmedi hi poten-
ziuri saSualebebi.
aqtiuri cxovrebis wesis mqone axalgazr-
debs momatebuli aqvT simpatikuri nervis
tonusi da plazmis reninis aqtivoba. mocir-
,fdidsf rfhlbjkjubf
kulire siTxis raodenoba Seucvleli an Sem-
cirebulia. amitom maT samkurnalod pirveli
rigis preparatebs ekuTvnis antiotenzinma-
konvertirebeli fermentis inhibitorebi
(agf-inhibitorebi), seleqtiuri ( da ( adre-
noblokatorebis kombinacebi da kalciumis
antagonatebi.
xandazmul asakSi (60 wlis zeviT) arteri-
uli hi pertenzia xSirad SeuRlebulia Tanm-
xleb daavadebebTan, rc preparatis SerCevaze
did gavlenas axdens. am asakSi momatebulia
sisxlZarRvebis periferiuli winaaRmdegoba,
daqveiTebulia plazmis renonis aqtivoba da
xSirad marcxena parkuWis hi pertrofiac aRi-
niSneba. xandazmulTa pirveladi TerapiisaT-
vis mowodebulia Sardmdenebi. dadginda, rom
Sardmdenebis gamoyeneba am asakobriv jguf-
Si amcirebs insultebs, gulis ukmarisobisa
da miokardiumis infarqtis ganviTarebis six-
Sires. kalciumis antagonistebi amcireben
sisxlZarRvTa periferiul winaaRmdegobas
da ar arRveven li pidur cvlas, ris gamoc
xandazmul asakSi maTi gamoyeneba dasaSvebia.
am asakobriv jgufSi SeZlebisdagvarad unda
SeizRudos ( adrenoblokatorebis gamoyene-
bac.
gansakuTrebiT sifrTxiliTaa dasaniSni
hi potenziuri saSualebebi sxva Tanmxlebi
daavadebebis fonze. mag.: medikamentebi, rom-
lebic iniSnebian diabetis dros – agf-inhi-
bitori, Ca-is antagonisti, L1 adrenoblokato-
ri. gulis ukmarisobis dros – Sardmdeni,
agf-inhibitori, L1 adrenoblolatori. disli-
pidemia – agf-inhibitori, Ca-is antagonisti, L1
adrenoblokatori.
hi pertoniuli krizis samkurnalo perora-
luri saSualebebi:
nifti pini – enis qveS an peroralurad. 10
mg. dasawyisSi. 30 wT-is Semdeg SeiZleba do-
zis gameoreba.
klonidini – 0,1-0,2 mg. dasawyisSi, Semdeg
0,1 mg. yovel saaTSi 0,8 mg-mde.
kaptoprili – 25 mg.
preparatebi, romlebic uxSresad ixmareba
arteriuli hi pertenziis dros:
Tiazidebi da maTi msgavsi diurezuli sa-
Sualebebi. hidrolorTiazidi, bendroflua-
zidi, indapamidi.
( adrenoblokatorebi: ateneloli, karvti-
lodi, bisaprolodi, egidoki.
kalciumis arxebis mablokirebeli saSua-
lebebi: amlodi pini, verapamili, lacidi pini,
fedodi pini.
agf-inhibitorebi: kaptoprili, enalopri-
li, lizinoprili.
@__) otkb
,fdidsf rfhlbjkjubf
ultrasonografiis, rogorc arainvaziuri
informaciuli specifikuri da mgrZnobiare
radiologiuri meTodis efeqturoba (roli)
pilorostenozis adreul etapze diagnoscirebaSi
z. zarnaZe, T. robaqiZe,
m. inasariZe, n. Wanturaia,
i. korinTeli, n. maisuraZe
pilorostenozi Tanamedrove pediatriis
erT-erT aqtualur problemas warmoadgens.
msoflio jandacvis organizaciis ukanask-
neli 2005 wlis monacemebiT,misi sixSire, yo-
vel 1000 axalSobilze saSualod Seadgens
0,5-3.
saqarTveloSi 1998-2003 wlis oficialuri
statistikuri monacemebis mixedviT maRalia
ganviTarebis anomaliiT dabadebul axalSo-
bilTa xvedriTi wili
histologiuri Taviseburebebia: piloru-
li arxis mkveTri Seviwroeba,
kedlis gasqeleba (erTi mxridan SeiZleba
miaRwios 6-12 mm3arxis dagrZeleba
(30-40mm.), arxi aris qliaviseburi formis,
struqtura myife, feri-TeTri.
maRali riskis jgufs warmoadgenen:
vaJebi. (jandacvis saerTaSoriso msoflio
organizaciis uaxloesi statistikuri monace-
mebiT daavadebis gamovlinebis Tanafardoba
gogonebsa da vaJebs Soris meryeobs 1/4-dan
1/7-mde.)
memkvidruli ganwyoba vlindeba 6,9 %-Si
sisxliT naTesavTa qorwinebidan miRebul
bavSvebSi.
social-ekonomiur-biologiur maRali ri-
skis orsulTa axalSobilebi.
axalSobilebi mucladyofnis ganviTare-
bis SeferxebiT.
paraklinikuri diagnostika emyareba: gast-
roduodenoskopias, rentgenografiasa da
ultrabgeriTi kvlevas.
fexburTelTa sportuli travmebis reabilitacia.
kompleqsur mkurnalobaSi mikroplazmuri samkurnalo
danadgaris gamoyenebiT
prof. s. jaiani, prof. z. kaxabriSvili,
eq. z. lominaZe, eq d. zaaliSvili.
(kritikuli medicinis instituti, saqarT-
velos olimpiuri komitetis samedicino sam-
saxuri, safexburTo klubebis samedicino sam-
saxurebi.)
@__) otkb
23
ultrabgeriTi kvlevis SesaZleblobebi:
pilorusis dagrZelebis vizualizi-
cia.(20.mm.-ze meti.)
arxis sanaTuris Seviwroebis vizualizacia
kunTovani Sris gasqelebis vizualiza-
cia.(4mm. da meti.)
Seviwroebuli arxiT pasaJis xasiaTis Se-
faseba.
kuWis zomebis gadidebis Sefaseba.
kuWSi lorwosa da sakvebis narCenebis vi-
zualizacia
kuWSi peristaltikuri talRebis dafiqsireba.
ultrabgeriTi kvlevis SesaZleblobebis
upiratesobani sxva paraklinikur meTodeb-
Tan SedarebiT: mxolod ultrabgeriTi ga-
mokvleviT aris SesaZlebeli zemoT aRniSnu-
li oTxive niSnis erTdrouli dafiqsireba
da Sefaseba. arainvaziuroba. gamokvlevas wi-
naswari mom zadeba ar esaWiroeba. diagnos-
cireba drois xanmokle SualedSi.(5-10 wT.)
aratoqsiuroba, radiologiurad usafrTxo.
literatura
1.Poland R.L., T.S., Shankaran S. Normal values for ven-
tricular size as determined by real time sonographic techni-
ques// Pediatric Radiology. – 1985.- V. 108, #15.-P.12-14.
2.Fok T.E., Davies D.P.A studi of periventricular he-
morrhage, post-hemorragic ventricular
dilatation and periventricular leucomalacia in chinese
preterm infants// J.Paediatr. child.health.-1990.-
V.26,#10.-P.271-275.
3.Volpe J.J. of the newborn.-Philadelphia: I.B.
Lippincott Co., 1995.-876p.
4.Haddad J., Messer J., Aranda J. Periventricular he-
morrhagic infarction associated with
subependymal germinal matrix hemorrhage in the premature
newborn.Report of two cases//Eur.J.Pediatr.-1992.-V.15,#1.-P.63-65.
5.Hofmann V., Deegk H., hoyer P.F. Ultrashalldiagnostic in
Padiatrie und kinderchirurgie.-N.Y.:Verlag Stuttgart,1996.-541 p.
problemis aqtualoba.
sxvadasxva klasis fexburTelTa Soris
farTod gavrcelebuli mikrotravmebi, maTi
swrafi diagnostireba da mkurnaloba, aseve
am aspeqtSi mraval sakiTxTa gadauwyvetlo-
ba ZiriTadad gansazRvravsAarsebuli prob-
lemebis aqtualobas sportul medicinaSi
 24 ,fdidsf rfhlbjkjubf
(1;5). pleqsuri mkurnalobis arsebul tradiciul
amave dros CvenTvis xelmisawvdom samec- meTodebSi axali teqnologiebis CarTva
niero literaturaSi, romelic exeba aRniS- plazmuri nakadis gamoyenebiT, Cveni azriT
nul Tematikas, faqtiurad ar arsebobs in- uaRresad aqtualuria.
formacia sportuli travmebis adreul etap-
ze mkurnalobisa da reabilitaciis Tanamed- gamokvlevis mizani da amocanebi
rove meTodebze (6). gamokvlevis mizani gaxldaT plazmuri ga-
rogorc wesi, mikrotravmebi iwveven sayr- mosxivebiT mkurnalobis cdebis ganzogadeba
den-mamoZravebeli aparatis faruli paTolo- fexburTelTa sayrden-mamoZravebeli apara-
giebis ganviTarebas, romelic xSirad vlin- tis mikrotramvebiT miRebul moSlilobaTa
deba intensiuri varjiSebisa da sxvadasxva prevenciis mizniT; aseve mkurnalobis Sedege-
rangis sportuli Sejibrebebis dros, rac bis gaumjobeseba da fexburTelTa sportu-
bunebrivia, uaryofiT zegavlenas axdens ro- li formis swrafi aRdgena. amasTan dakavSi-
gorc sportuli maCveneblebis, aseve fexbur- rebiT wamovayeneT Semdegi amocanebi:
TelTa zogad-fizikur da fsiqologiur Cagvetarebina SedarebiTi analizi da Seg-
mdgomareobaze (3). vefasebina im Sedegebis efeqtianoba, romelic
miuxedavad imisa, rom mikrotravmebis sam- miviReT fexburTelTa tramvirebuli adgi-
kurnalo saSualebebi Zalzed farTo da lebis plazmuri nakadiT damuSavebis Sede-
mravlis momcvelia da amasTanave maTi gamo- gad.
yeneba mkurnalobisas ekonomikurad maRal- gangvesazRvra plazmis gamoyenebis pers-
xarjiani, mainc maTi intensivoba da efeqtu- peqtiva im fexburTelTa mimarT, romlebmac
roba yovelTvis ar aris sakmarisi da swraf- miiRes sxvadasxvagvari travmebi.
Sedegiani, rac ase aucilebelia fexburTe- SegvemuSavebina da samkurnalo-sareabili-
lis swrafi gamojamrTelebis da sportuli tacio programebis klinikur praqtikaSi dag-
formis sruli aRdgenisaTvis (1;5). venerga plazmuri nakadis gamoyenebis meTo-
bolo droSi travmebis samkurnalod ga- dika fexburTelTa mikrotravmebis dros.
moiyeneba aparatura, romelic dafuZnebulia
axal fizikur efeqtebze_kerZod, es gaxlavT masalebi da meTodebi
plazmuri nakadi, romelsac gaaCnia maRali 1996 wlidan dRemde Cven gamovikvli-
siTburi efeqti (12000oC). biologiur qsovi- eT plazmuri nakadis zemoqmedebis Sedegebi
lebze maRaltemperaturuli meTodebis gamo- 276 travmirebul fexburTelze. tabula 1-Si
yeneba sakmaod efeqturia da didi xnis winaa mocemulia im fexburTelTa asaki romel-
cnobili (8). Tac CautardaT plazmuri mkurnaloba:
aRniSnuli aparaturiT sxvadasxva sa- tabula #1
xeobis tramvebze Catarebulma mkurnalobis
# asaki dakvirvebis ricxvi
cdebma daadastura siTburi meTodebis ze-
moqmedebis ucilobeli perspeqtiuloba (2;4;7) absoluturi %
sportul medicinaSi - (kerZod moWi- 1 14-mde 25 9.3
daveebSi) mikroplazmuri nakadebis gamoyene- 2 15 37 13.4
ba Zireulad da srulyofilad gamoikvlia 3 16 24 8.7
prof. z. kaxabriSvilma. miRebuli Sedegebi 4 17 22 7.9
wardgenili iqna saerTaSoriso olimpiuri 5 18 36 13.3
komitetis monakoSi Catarebul IV saerTaSo- 6 19 22 7.9
riso kongressze. 7 20 20 7.2
bolo dros sportul medicinaSi plazmu- 8 21 17 6.2
ri nakadis gamoyenebis aqtualobas xeli Se- 9 22 9 3.2
uwyo moxmarebis TvalsazrisiT martivi apa-
10 23 4 1.4
raturis Seqmnam; am aparaturas gaaCnia plaz-
11 24 9 3.2
mis miwodebis moqnili konstruqcia, romelic
12 25 5 1.8
saSualebas gvaZlevs Tavisuflad vimuSaoT
13 26 9 3.2
praqtikulad sxeulis nebismier tramvire-
bul areSi. amasTanave, literaturul monace- 14 27 3 1.1
mebze dayrdnobiT, mocemul meTodikas eniWe- 15 28 4 1.4
ba maRali ekonomikuri mniSvneloba medici- 16 29 2 0.7
nis sxvadasxva sferoSi (6;7;8). 17 30 da meti 28 10.1
amdenad, fexburTelTa mikrotramvebis kom- sul 276 100
@__) otkb
,fdidsf rfhlbjkjubf
rogorc mocemuli tabula 1-dan Cans, Ziri-
Tadad mkurnaloba sWrdebodaT 20 wlamde
asakis fexburTelebs, amaTgan umetesoba gax-
ldaT 15 wlis (13.4%) da 18 wlis (13.3%). Sem-
deg modian 14 walamde (9.3%) anu sportsmene-
bi 15 wlamde jamSi Seadgenen yvela namkurna-
levi fexburTelis 31.2%-s.
miRebuli monacemebidan naTlad Cans, rom
travmebis miRebis riski ufro maRalia sru-
liad axalgazrda fexburTelebisaTvis, vid-
re mowifuli, kargad navarjiSevi sportsmene-
bisaTvis (22 wlidan zeviT).
ZiriTadad CvenTan mkurnalobas itarebd-
nen saqarTvelos respublikuri gundebis
fexburTelebi. maT garda aseve mkurnaloba
CautardaT ucxouri klubebis moTamaSeebsac.
q. Tbilisisa da saqarTvelos regionebis
gundebi:
tabula #2
gundi dakvirvebis ricxvi
#
absoluturi %
1 Tbilisi 227 88.3
2 regionebi 30 11.7
sul 257 100
rogorc tabula 2-dan Cans, CvenTan ZiriTa-
dad mkurnalobdnen Tbilisis safexburTo
gundebis sportsmenebi (88.3%); amasTanave re-
gionebidan specialurad Camodiodnen samkur-
nalod travmirebuli fexburTelebi, romleb-
mac saerTo pacientTa 11.7% Seadgina. yvela-
ze meti pacienti (185) iyo Tbilisis ,,dinamo-
dan” (33.7%) da ,,ameridan” (33.3%).
tabula 3-Si warmodgenilia is gundebi,
romlis fexburTelebmac Caitares plazmuri
nakadiT mkurnaloba:
tabula #3
# gundi dakvirvebis ricxvi
absoluturi %
1 rspublikuri 257 93.1
2 ucxouri 19 6.9
sul 276 100
rogorc tabula 3-dan Cans, fexburTel-
Ta ZiriTadi kontingenti, romelTac Cau-
tardaT plazmuri nakadiT mkurnaloba,
gaxlavT respublikuri gundebis moTamaSe-
ebi; amasTanave ucxouri gundebis fexbur-
Telebma 6.9% Seadgina. ZiriTadad eseni iy-
vnen legionerebi, romlebic TamaSobdnen
italiis, espaneTis, ruseTis, ukrainis, isra-
@__) otkb
25
elis, ajerbaijanis da sxva gundebSi. tra-
vmebis lokalizacia Zalzed mravalfero-
vani gaxldaT. es naTlad Cans tabula #4-
Si.
rogorc moyvanili tabulidan Cans, trav-
mebis umravlesoba qveda kidurebze modio-
da (98.3%); travmaTa 59.4% gvxvdeboda sxeu-
lis marjvena naxevarze, xolo 40.6% marcxe-
naze.
yvelaze xSirad ziandeboda marjvena mux-
lis saxsari (20.9%), marjvena koWwvivis saxsa-
ri (19.7%), sazardulis are (15.3%), barZayis
rbili qsovilebi (14.7%).
marcxena mxares yvelaze xSirad pacien-
tebs Soris gvxvdeboda muxlis saxsris da-
zianeba (28.9%), barZayis rbili qsovilebis
dazianeba (20.6%), xolo mesame adgilze iyo
koWwvivis saxsris dazianeba (15.7%).
moyvanili monacemebidan Cans, rom yvelaze
xSir paTologias, romelic saWiroebda
plazmuri sxivebiT mkurnalobas, iyo muxlis
saxsris da koWwvivis saxsris paTologiebi,
saintereso iyo agreTve Slateris daavade-
biT Sepyrobili avadmyofebis mkurnaloba,
lokalizaciis mxriv Slateris daavadeba
gvxvdeboda rogorc calmxrivad, aseve ormx-
rivad.
yuradReba unda mivaqcioT imasac, rom pa-
cientTa raodenoba iyo 276, xolo paTologi-
ur procesTa ricxvi Seadgenda 298_s. es gan-
pirobebuli iyo imiT, rom avdmyofTa nawils
_ (22 pacienti), erTdroulad ramdenime paTo-
logiuri procesi aReniSnebodaT.
yvela zemoT CamoTvlili travmebisa da
daavadebaTa samkurnalod gamoyenebulia
originaluri konstruqciis aparati, rome-
lic plazmur nakads argonis safuZvelze
warmoqmnis (patenti
– 2075_ 31. 03. 1998w). mkurnalobis meTodi-
ka emyareba travmirebuli adgilis ukontaq-
to dasxivebas 3-5 wuTis ganmavlobaSi. Tanax-
mad meTodikisa pacients ar esaWiroeba spe-
cialuri momzadeba. yvela SemTxvevaSi mkur-
naloba tardeba ambulatoriulad, xandaxan
ki safexburTo gundis sportuli bazis med-
punqtSi.
276 pacients Cautarda mikrotravmebis
plazmuri TerapiiT mkurnaloba. cnobilia
rom travmirebuli midamos 3-5 wuTiani dasxi-
vebisas siTbo (39o C-mde) WrilobaSi 10-12 sa-
aTs narCundeba, rac iwvevs gaZlierebul sis-
xlis mimoqcevas da amaRlebs adgilobriv
imunitets, rac TavisTavad aCqarebs Sexorce-
bis process.
 26 ,fdidsf rfhlbjkjubf
tabula #4
dazianebebis dakvirvebis ricxvi
lokalizacia marjvena mxare marcxena mxare sul
abs % abs % abs %
zemo kiduri 5 2.8 - - 5 1.6
laviwi 1 0.5 - - 1 0.3
mxari 2 1.2 - - 2 0.6
idayvis saxsari 1 0.5 - - 1 0.3
mtevani 1 0.5 - - 1 0.3
qvemo kiduri 172 97.2 121 100 293 98.3
terfi 35 19.7 19 15.7 54 18.1
aqilevsis myesi 9 5.2 2 1.6 11 3.7
wvivi 11 6.2 7 5.8 18 6.3
muxlis saxsari 37 20.9 35 38.9 72 24.2
barZayi 26 14.7 25 20.6 51 17.1
sazardulis are 27 15.3 18 14.8 45 15.1
zurgi 20 11.4 10 8.3 30 10.0
Slateris daavadeba 7 3.9 5 4.2 12 4.0
sul 177 100.0 121 100.0 298 100.0

praqtikulad Cven avadmyofs vmurnalobT _ plazmuri Terapiis meTodi martivia ga-

anTebiTi procesis me-2 fazaSi (eqsudaciis
faza) da proliferaciis procesi ufro
swraf reJimSi gadagvyavs.
muSaobis procesSi Cvens mier SerCeuli iq-
na fexburTelTa mikrotravmebis mkurnalobis
yvelaze optimaluri reJimebi, amasTanave ga-
movnaxeT da davamuSaveT aRniSnuli kategori-
is avadmyofTa mkurnalobis axali taqtika.
aucileblad unda aRvniSnoT isic, rom
yvela travmirebul avadmyofs utardeboda
ZviradRirebuli gamokvlevebi, romlebic Zi-
riTadad normalur rezultats iZleoda –
anu aseTi gamokvlevebi pacientisTvis ar iyo
aucilebeli.
bolo periodSi Cven mivmarTavT Semdeg
taqtikas: fexburTeli, romelmac miiRo mik-
rotravma, Zveleburi tradiciuli mkurnalo-
bis paralelurad mkurnalobas iwyebs plaz-
muri TerapiiT. optimalurad iTvleba 10-17
procedura (43.5% yvela pacientisa).
aRsaniSnavia isic, rom monoTerapis plaz-
muri meTodiT (yovelgvari damatebiTi mkur-
nalobis gareSe) adgili hqonda 62,3% SemTx-
vevaSi
ase, rom Catarebuli muSaobis safuZvelze
SeiZleba davaskvnaT Semdegi:
_plazmuri Terapiis meTodi warmoadgens
ubralo da efeqtur saSualebas fexburTel-
Ta mikrotravmebis mkurnalobaSi.
moyenebis dros, sakmaod ekonomiuria da ar
moiTxovs avadmyofis specialur momzadebas.
aparati SeiZleba moTavsdes gundis sameci-
dino punqtSi.
_ aRniSnuli meTodiT mkurnalobisas xde-
ba avadmyofobis xangZlivobis zRvris dawe-
va, rac fexburTels saSualebas aZlevs trav-
mis farglebSi ganagrZos rogorc varjiSi,
aseve TamaSi.
r e z i u m e
im masalebze dayrdnobiT, romlebic dag-
vigrovda plazmuri Terapos gamoyenebis cde-
biT 276 fexburTelze, romelma miiRes sxva-
dasxva saxis travmebi, avtorebi rekomendaci-
as vuwevT aRniSnuli paTologiebis ambula-
toriuli mkurnalobis axal meTodikas.
am meTodiT mkurnalobisas pacientebs
aReniSnebaT avadmyofobis ufro keTilsa-
surveli mimdinareoba, mcirdeba mkurnalobis
xangZlivoba. Cvens mier SemuSavebuli axali
samkurnalo meTodika gamoirCeva maRali eko-
nomiurobiT.
swored efeqturoba, gamoyenebis simartive,
keTilsaimedooba da ekonomiuri mniSvneloba
warmoadgens aRniSnuli meTodikis Tavisebu-
rebis mniSvnelovan maxasiaTeblebs.
ZiriTadi sityvebi: plazmuri navadi, plaz-
muri Terepia, mikrotravmebi, fexburTi.
@__) otkb
,fdidsf rfhlbjkjubf 27
Kliegman: Nelson Textbook of Pediatrics, 18th ed. 2007.
Tavi-381.
filtvis qsovilis rekurentuli an
persistulad mimdinare infiltracia.
Targmani (ramaz RulaZe). cxrili -6
neonataluri perodis Semdgom ganviTarebuli,
pnevmoniiT gamowveuli filtvis qsovio- filtvis qsovilis rekurentuli,
lis infiltraciis rendgenologiuri vizua- persistuli an migraciuli bunebis,
lizacia Sesazlebelia paTologiis dawyebi- infiltraciiT mimdinare daavadebebi
dan 1 _ 3 kviris ganmavlobaSi. pacientTa gar- asTma
kveul jgufSi, gansakuTrebiT CvilebSi, fil- ganmeorebiTi aspiraciebi.
tvis qsovilis infiltracia SeiZleba gagr- hi persensitiuri pnevmonia.
Zeldes 4 kviris manZilzec. am kontingentSi
filvis hemosiderozi.
SeiZleba gamoxatuli iyos an an ar iy- os
ucxo sxeuli.
cxeleba, xolo respiratoruli sistemis pa-
Tologiis gamomxatveli simptomatika vlin- Talasemia
debodes sxvadasxva saxiTa da xarisxiT. kistofibrozi.
filtvis qsovilis persistuli an reku- Tandayolili infeqciebi.
rentuli infiltraciis mizezebi mocemulia citomegalovirusi
6- cxrilSi. rubella.
sifilisi.
filtvis qronilul infiltraciasTan SeZenili infeqciebi.
asocirebuli simptomebi, romlebic viTarde-
citomegalovirusi.
ba si- cocxlis pirveli kviris Sedeg da
tuberkuliozi.
grZeldeba mravali kviris ganmavlibaSi (
Sidsi.
magram ar aris dakavSirebuli respirato-
rul distress sindromTan) miuTiTebs infeq- sxva virusebi
ciis arsebobaze, romelic ganviTarda an muc- Chlamydia
ladyofnis periodSi an samSobiaro gzebSi Mycoplasma, Ureaplasma
gavlis dros. qronikuli infeqciis adreuli- yivanaxvela.
gamovlineba aseve SeiZleba asocirebuli ucxo sxeuli.
iyos kistofibrozTan an sxva Tandayolil Pneumocystis carinii
paTologiasTan, romelic xels uwyobs aspi- araadeqvaturad namkurnalebi baqteriuli
raciisa da sasunTqi gzebis obstruqciis infeqciebi.
ganviTarebas. rekurentuli infiltraciis, vi-
Tandayolili anomaliebi.
zingisa da xvvelis anamnezi SeiZleba migvi-
filtvis kista.
TiTebdes asTmis arsebobaze 1 wlamde asak-
Sic ki. filtvis sekvestracia.
1 wlamde asakis bavSvebSi, filtvis qsovi- bronqis stenozi.
lis rekurentuli infiltraciis iSviaTi, sisxlZarRvovani rgoli.
Tumca mainc sayuradRebo mizezi aris filt- gulis Tandayolili PpaTologiebi
vis hemosiderozi, romlis ganviTarebac da- marcxnidan marjvnivi mimarTulebis
kavSireblia Zroxis rZis miRebasTan an ata- seriozuli SuntiT.
rebs idiopaTiur xasiaTs.. aspiracia.
bronqopulmonaluri displaziis mqone
faringialuri paTologiebi.
bavSvebSi, xSiria vizingiTa da filtvis qso-
laringo-traqeo-ezofagaluri naprali.
vilis infiltraciiT gamoxatuli respira-
traqeo-ezofagaluri fistula.
toruli disrtesis epizodebi. rekutrentu-
li pnevmoniebi, romlebic asocirebulia Sua gastro-ezofagaluri refluqsi.
yuris anTebasTan, nazofaringitTan, adeno- ucxo sxeuli.
@__) otkb
 28
cximis aspiracia.
imunodeficiti, fagocitozis deficiti.
humoruli, ujreduli da kombinirebuli
imunodeficiti.
qronikuli granulomatozuri daavadeba da
masTan dakavSirebuli granulocitebis
defeqti.
komplementis defeqti.
alergiuli zemgrZnobeloba.
filtvis hemosiderozi (Zroxis rZis
miRebasTan dakavSirebuli an sxva)..
asTma.
hi persensitiuri pnevmonia (alergiuli
alveoliti).
kistofibrozi.
pirveladi ciliaruli diskinezia (K Kartagener-
is sindromi)
sxva saxis bronqoeqtaziebi.
sarkoidozi.
neoplazma (pirveladi an metastazuri).
intersticialuri pnevmonia da fibrozi.
Cveulebrivi.
limfoiduri (Sidsi).
surfaqtantis sinTezis an sekreciis
genetikuri anomalia.
desqvamaciuri.
mwvave (Hamman-Rich-sindromi))
alveoluri proteinozi. pulmonaluri
limfangioeqtazia. α1-antitrifsinis
deficiti. medikamentozuri an radiaciuli
etiologiis anTeba da fibrozi.
kolagenozur_sisxlZarRvovani daavadebebi.
eozinofiluri pnevmonia. helminTozuri
migracia. histiocitozi. leikemia.
idditTan an dermatologiur problemebTan,
miuTiTeben komplementis an fagocitozis
defeqtiT ganpirobebuli imunodeficitebis
arsebobis SesaZleblobaze. oportunistuli
infeqciebis arseboba miuTiTrbs Sids-is ar-
sebobis SesaZlebobaze. paroqsizmuli xasia-
Tis xvelis arseboba gvafiqrebinebs yivana-
xvelas sindromis an kistofibrozis arsebo-
baze. filvis qsovilis persistuli infilt-
racia, miT ufro, Tu igi asocirebu- lia
filtvis sasicocxlo moculobis daqveiTe-
basTan, gansakuTrebiT mozrdili asakis bavS-
vebSi, gvafiqrebinebs ucxo sxeulis aspiraci-
is SesaZlebobaze.
filtvis gadaberva (overinflation) da
infiltracia, miuTiTebs kistofibrozis an
,fdidsf rfhlbjkjubf
asTmis arsebobaze. “munji filtvis” arsebo-
ba, romelsac Tan axlavs infiltracia, saeW-
vos xdis alveoluri proteinozs, neumocys-
tis carinii infeqciis, surfaqtantis sinTe-
zis an sekreciis genetikuri paTologiis da
amis Sedegad ganviTarebuli intersticiu-
li pnevmonitis an simsivnis arsebobaze.
seriozuli yuradReba unda mieqces fizi-
kuri ganviTarebis mdgomareobas, radgan Ca-
morCena fizikur ganviTarebaSi, miuTiTebs
sistemuri paTologiebis arsebobis did al-
baTobaze (kistofibrozi, an alveoluri pro-
teinozi).
kataraqta, retinopaTia an mikrocefalia
miuTiTeben intrauteraruli infeqciebis ar-
sebobaze. qronikuli rinorea, migvaniSnebs
atopiaze, Zroxis rZis autanlobaze, kisto-
fibrozze an Tandayolil sifilisze. tonzi-
lebisa da cervikaluri limfuri jirkvle-
bis ararseboba _ imunodeficitis maniSnebe-
lia.
diagnostikuri RonisZiebebi tardeba se-
leqciurad da damokidemulia anamnezisa da
sxva klinikuri monacemebis Taviseburebaze.
ZiriTadi aqcentebi keTdeba me-6 cxri- lSi
moyvanili paTologiebis arsebobaze. mniSvne-
lovani testia naxvelis an bronquli lava-
Jis citologiuri da mikrobiologiuri
kvleva. k.t. zustad asaxavs infiltratis ana-
tomiur mdebareobas. bronqoskopia aucilebe-
lia ucxo sxeulis gamoricxvisaTvis, mocu-
lobiTi procesebisa da Tanayolili anato-
miuri anomaliebis identifikaciisaTvis. Tu
aRniSnuli kvlevebi ara aris sakmarisi paTo-
logiis diagnostikisaTvis, ganixileba filt-
vis biofsiis SesaZleblobis sakiTxi.
mkurnalobis taqtika da optimaluri efeq-
ti damokidebulia zust (spercifiur) diag-
nozze. magram zogierTi qronikuli an gaxan-
grZlivebuli mimdinareobis paTologiis
(mag. gaxangrZlivebuli virusuli infeqciebi)
mkurnaloba SeiZleba warmatebiT ganxorci-
eldes simptomaturi saSualebebis gamoyene-
biTac. lorwos gaZlierebuli sekreciisa da
naxvelis dagrovebis SemTxvevaSi efeqturia
inhalaciuri Terapia da lorwos mocilebis
fizikuri saSualebebi. antibiotikebi iniSne-
ba, Tu saeWvoa baqteriuli infeqciis arsebo-
ba. efeqtur damxmare saSualebad iTvleba
oqsigenoTeapia da adeqvaturi kveba.
adreuli asakis bavSvTa filtvis qsovils
axasiaTebs aRdgenis didi potenciali da
zogjer mZimed mimdinare paTologiebic ki
filtvis funqciis sruli aRdgeniT SeiZle-
ba damTavrdes.
@__) otkb
,fdidsf rfhlbjkjubf
Wesezing
(xmauriani sunTqva)
Targmani (ramaz RulaZe).
Weezing-i aris musikaluri xmianobis, gangr-
Zobadi xmauriani sunTqva, rac sasunTqi gzebis
(bronqebis) SeviwroebiTaa gamowveuli. “vizin-
gi” upiratesad ismis amosunTqvis dros, ro-
gorc haergamtari gzebis (bronqebi, traqea) kri-
tikuli obstruqciis Sedegi.
“vizingi” _ upiratesad aris polifoniuri
xasiaTis, radgan is gamowveulia haergamtari
gzebis sxvadasxva xarisxisa da lokalizaciis
SeviwroebiT. monofoniuri “vizingi” gamowveu-
lia mxvili kalibris haergamtari gzebis Seviw-
roebiT, rogoricaa magaliTad distaluri tra-
qeomalacia an bronqomalacia.
rodesac obstruqcia exeba eqstra Toraka-
lur gzebs, inspiraciis periodSi ismis xmiano-
ba, rasac stridori ewodeba.
sasunTqi sistemis anatomiur-fiziologiuri
Taviseburebebis gamo, “vizingi” ufro advilad
viTardeba mcire asakis bavSvebSi, vidre Sedare-
biT mozrdil bavSvebsa da zrdasrulebSi.
bronqebis obstruqciis xarisxi damokidebulia
bronqebis yalibsa da filtvis tevadobaze. <
5 wlamde asakSi, mcire yalibis periferiuli
bronqebis haergamtaroba Seadgens bronqebis
saerTo haergamtarobis unaris daaxloebiT
50%-s. amitom, bronqebis marginaluri nawilis
Seviwroeba mniSvnelovnad zRudavs haeris gata-
rebas mTel sistemaSi da iwvevs “vizings”. es
mdgomareoba gansakuTrebiT mkafiod aisaxeba 1
wlamde asakis bavSvebSi.
aseve mniSvneloba aqvs imunologiur da sa-
sunTqi sistemis qsovilTa molekulur Tavise-
burebebs: CvilebSi, mozrdilebTan SedarebiT,
bronqoalveolalur lavaJSi, limfocitebisa
da neitrofilebis raodenobis Sefardeba, mas-
tocitebisa da eozinofilebis raodenobas-
Tan, ufro maRalia, rac adgilobrivi anTebiTi
reaqciis ganviTarebis met Sanss qmnis.
anTebiTi mediatorebis mravalferovneba, ma-
Ti gamoTavisuflebis xarisxi da kinetika ase-
ve gansazRvravs “vizingis” Taviseburebas.
Zalian mniSvnelovania Cvilis kvebis Tavisebu-
reba da dedis mier sigaretis moxmarebis faqti.
“vizingis” eTiologia.
axalSobilebSi “vizingi”, upiratesad gamow-
veulia bronqebSi ganviTarebuli anTebiTi pro-
cesiT (bronqitiT), Tumca SeiZleba arsebobdes
sxva mizezebic.
@__) otkb
29
cxrili 1.
“vizingis” diferencialuri diagnozi.
infeqcia:
virusuli infeqcia.
RSV)
respiratorul sincitialuri virusi (R
adamianis metapnevmovirusi.
paragripis virusi.
adeno virusi.
gripis virusi.
rino virusi.
da sxva.
sxva infeqciebi.
qlamidia.
tuberkuliozi.
histoplazmozi.
papilomatozi.
asTma. - warmavali “vizigi” (sawyisi risk-faq-
toria filtvis moculobis pirveladi Semcireba).
- persistuli “vizingi” (sawyis risk-faqto-
rebs miekuTvneba pasiuri moweva, dedis asTmis
anamnezi da bavSvis sicocxlis I wels sisxlis
SratSi IgE-s maRali done).
asTmis ganviTarebis risk faqtoria:
mogvianebiT asakSi ganviTarebuli “vizingi”.
anatomiuri paTologiebi:
centraluri bronqebis paTologia.
xorxis, traqeis an bronqis malacia.
traqeo-ezfagaluri fistula.
laringealuri naprali (aspiraciis Semdgomi).
zewoliT gamowveuli bronqebis eqstriqcia.
sisxlZarRvovani kontraqtura.
zewoliT gamowveuli bronqebis eqstriqcia.
anTebiT an sismsivniT gamowveuli mediasti-
naluri limfadenopaTia.
mediastinaluri simsivne.
bronqebis instriqtuli paTologia.
bronqebis hemangioma an sxva simsivneebi.
kistozuri adenomatozuri malformacia.
bronqo-pulmonaluri kista.
traqealur-bronquli aberacia.
sekvestracia.
gulis Tandayolili paTologia (filtvis
SeSupebiT).
ucxo sxeuli.
imunodeficitebi.
 30
IgA-deficiti.
B-ujredebis deficiti.
pirveladi ciliaruli diskinezia.
Sidsi.
bronqoeqtazia.
mukociliaruli klirensis darRveva.
kisto-fibrozi.
pirveladi ciliaruli diskinezia.
bronqoeqtazia.
bronqo-pulmonaluri displazia.
aspiraciuli sindromi.
g.e.f. refluqsi.
faringialuri da ylapvis disfunqcia.
filtvebis intersticialuri paTologia
(maT Soris maoblitirebeli bronqioliti).
gulis paTologia.
anafilaqsia.
inhalaciuri dazianeba _ damwvroba.
mwvave bronqioliti.
mwvave bronqioliti ZiriTadad virusuli
eTiologiis daavadebaa. igi ZiriTadad (50%)
gamowveulia RSV-iT. sxva agentebia: paragripis
virusi, adenovirusi, mikoplazma da iSviaTad
sxva virusebi. adamianis metapnevmovirusi xSi-
radaa pirveladi infeqciis mizezi an Tan erT-
vis xolme RSV-s. ar aris dadasturebuli
baqteriuli bronqiolitis arseboba. Tumca
baqteriuli pnevmonia zogjer diagnostirdeba,
rogorc bronqioliti an Tavad bronqioliti
rTuldeba baqteriuli pnevmoniiT.
aS.S-Si, yovelwliurad, RSV-iT gamowveuli
daavadebis diagnoziT, xdeba 50000 _ 80000 bav-
Svis hospitalizacia. aqedan 200 dan 500-made
SemTxvevaSi Sedegi fataluria.
bronqioliti ufro xSiria vaJebSi,vidre go-
gonebSi; aseve xelovnur kvebaze myof da mra-
valricxovad ojaxebSi mcxovreb bavSvebSi. in-
feqciis wyaro, umetes SemTxvevaSi, aris ujaxis
ufrosi wevri. maTSi RSV-iT, an axva agentiT,
gamowveuli infeqcia, SeiZleba minimaluri kli-
nikuri suraTiT iyos gamoxatuli.
yvela dainficirebul Cvils ar unviTardeba
qvemo sasunTqi gzebis dazianeba. anatomiuri da
imunologiuri faqtorebi mniSvnelovan gavle-
nas axdenen daavadebis ganviTarebis simZimeze.
Cvilebi _ mcire zomis bronqebiTa da filtvis
susti funqciiT _ ufro mZimed avaddebian, vid-
,fdidsf rfhlbjkjubf
re SedarebiT mozrdilebi. RSV iw-vevs kompleq-
sur imunur pasuxs _ eozinofilebis degranu-
lacias da kaTionuri cilebis mier bronqebis
lrwovanis toqsiur dazianebas. mniSvnelovania
IgE-Ti ganpirobebuli reqciis roli da LT-ebis
faqtori.
mwvave bronqioliti xasiaTdeba bronqialu-
ri obstruqciiT, bronqebis lorwovanis SeSu-
pebiT, lorwosa da ujredebis CamofcqvniT. vi-
Tardeba mcire kalibris bronqebis lorwova-
nis SeSupeba da rogorc eqspiraciuli, ise ins-
piraciuli SezRudva. Tumca eqspiracia ufro
metad izRudeba. Tu obstruqcia srulia _ vi-
Tardeba ateleqtazi.
qronikuli infeqcia.
qronikuli infeqciis arseboba xSiria kis-
to-fibrozis dros. am dros saxezea persistu-
li respiratoruli sindromi,dolis TiTebi,ma-
ladsorbcia, ganviTarebaSi CamorCena, eleqtro-
lituri balansis darRveva da rezistentuli
bronqodilatacia.
alergia da asTma
alergia da asTma aris “vizingis” uxSiresi
mizezi. asTmis dros saqme gvaqvs SeqceviTi xa-
siaTis bronqospazmTan da bronqebis hiperreaq-
tiulobasTan.
literaturuli monacemebis mixedviT, 3 wlam-
de asakis bavSTa 19,9%%-s, mwvavve respiratoru-
li virusuli infeqciiT avadobis SemTveaSi,
aReniSneba “vizingi”, romelic aRar meordeba da
bunebrivia ar SeiZleba CaiTvalos asTmad. bav-
SvTa 13,3%-s aReniSneba persistuli “vizingi”
romelic, aseve xSirad vlindeba respiratorul
infeqciasTan erTad da grZeldeba 6 wlis asa-
kamde. bavSvTa daaxloebiT 15%-s “vizingis” ga-
movlineba ewyeba 3 wlis asakis Semdeg da aqedan
mxolod 1/2-s ugrZeldeba igi 6 wlis asakis Sem-
deg. 3 wlamde asakis bavSvTa 60%-s, romelTac
persistuli “vizingi” aReniSnebaT, es sindromi
aRar aReniSnebaT 6 wlis asakis Semdeg.
aRniSnulis gamo,ioli ar aris 3 wlamde asa-
kis, Tundac persistuli “vizingis” mqone, bavS-
vebSi asTmis diagnosis dasma.
aseT SemTxvevaSe aucileblad unda iyos
gaTvaliswinebuli ojaxuri atopiuri anamnezi
(gansakuTrebiT dedis asTma) da kanis alergiu-
li gamovlinebebi bavSSi.
zogadad, adreuli “vizingis” gamovlinebaSi
aseve mniSvnelovani risk-faqtorebia dedis as-
Tma, dedis mier sigaretis moxmareba, saerTod
sigaretis moxmareba bavSvis sacxovrebel gare-
moSi, bavSSi, respiratoruli infeqciis gareSe,
ganviTarebuli xSiri riniti da egzema 1 wlam-
de asakSi.
@__) otkb
,fdidsf rfhlbjkjubf
“vizingis” sxva mizezebi.
respiratoruli traqtis malformacia SeiZ-
leba iyos “vizingis” ganviTarebis mizezi.
“vizingis”mizezi SeiZleba iyos haergamtari
gzebis sxvadasxva saxis kompresia. magaliTad:
vaskularuli kontraqtura, rodesac traqea da
saylapavi sruliad Aan nawilobriv Semoxveu-
lia sisxlZarRvebiT.
“vizingis” mizezi SeiZleba iyos kardia-
luri paTologia: mag. gulis saknebis dila-
tacia, masiuri kardiomegalia, marcxena arte-
riis gadideba, filtvis arteriis dilatacia
da sxva.
aseve _ gulis dazianebis gamo ganviTarebu-
li filtvis SeSupeba, SeiZleba “vizingis” mize-
zi gaxdes.
ucxo sxeuli.
ucxo sxeuli SeiZleba iyos mwvave an qroni-
kuli “vizingis” mizezi. am mizeziT daRupul
bavSvTa 78% aris 2 dan 4 wlamde asakis. atipi-
ur SemTxvevebSi SeiZleba daisvas bronquli as-
Tmis, obstruqciuli bronqitis an sxva diagno-
zi. “vizingis” mizezi SeiZleba gaxdes ara mxo-
lod sasunTqi gzebis, aramed saylapavis ucxo
sxeulic.
gastro-ezofagaluri refluqsi.
g.e.f. refluqsi Seizleba gaxdes “vizingis”
mizezi, rogorc am dros ganviTarebuli aspira-
ciis ise vagusis an neiro-refleqsis gziT gan-
viTarebuli bronqo spazmis gamo.
travma da simsivne.
travma da simsivne arian “vizingis” gamomwve-
vi SviaTi mizezebi.
“vizingis”klinikuri Sefaseba.
“vizingis” klinikri Sefasebisas unda Se-
fasdes am movlenis gamovlenis Tavisebure-
bebi: uecari an neli dasawyisi, xangrZlivo-
ba, uwyvetoba an piriqiT _ wyvetili xasiaTi.
asocirebuli mdgomareobebi, orsulobisa da
mSobiarobis Tavisebureba, intubaciis da Jan-
gbadiT inhalaciis anamnezi, dedis mdgomare-
oba da infeqciebi _ HSV da Sidsi. prenata-
lur periodSi sigaretis moxmareba. komorbi-
duli mdgomareobebi da sindromebi. ojaxu-
ri anamnezi _ kistofibrozze, imunodeficit-
ze, asTmaze da sxva sasunTqi sistemis reku-
rentul paTologiebze. sayuradReboa so-
cialri anamnezi _ sigaretis moxmareba sax-
lSi, movlis Tavisebureba, saxlis garemo
(mtvris arseboba, samzareulos Tavisebureba,
gaTbobis Tavisebureba, tarakanebisa da mwe-
rebis arseboba).
@__) otkb
31
cxrili 2.
“vizingis” mqone Cvil bavSvTa anamnezi.
simptomebi gamovlinda dabadebisTanave Tu
mogvianebiT ?
aqvs Tu ara bavSvs xmauriani sunTqva da ro-
dis ufroa es SesamCnevi ?
aqvs Tu ara xvela “vizingis” gareSe ?
hqonda Tu ara bavSvs manamde qvemo sasunTqi
gzebis infeqcia ?
iyo Tu ara adre, respiratoruli paTologiis
gamo, gadaudebeli Carevis epizodi ? hospitali-
zacia ? intensiuri Terapia ?
xom ar aris anamnezSi egzema ?
axlavs Tu ara tirils xvela ? an aRiniSneba
Tu ara xvela RamiT ?
rogoria fizikuri ganviTareba ?
xom ar aRiniSneba ganviTarebaSi CamorCena ?
ganviTarebaSi CamorCena ukavSirdeba kvebis
problemebs Tu ara ?
xom ar aRiniSneba eleqtrolitebis disbalan-
si ?
xom ar aRiniSneba maladsorbciis niSnebi an
diarea ?
xom ar aRiniSneba dedis genitaluri HSV-in-
feqcia ?
rogori iyo gestaciis asaki mSobiarobisas ?
xom ar iyo intubirebuli neonatalur period-
Si ?
xom ar kvebaven boTliT sxeulis horizonta-
lur mdgomareobaSi mdebareobis dros ?
xom ar aris kvebis problema _ kvebis dros
ganviTarebuli xvela, asfiqsia ? wamozideba ? Re-
bineba ?
xom ar misces ramdenime axali sakvebi erTd-
roulad ?
yavT Tu ara saxlSi sxva patara bavSvebi, rom-
lTa saSualebiTac SeiZleboda pacientis sasunTq
an saWmlis momnelebel sistemaSi moxvedriliyo
ucxo sxeuli ?
xo mar iyo travmis miRebis Sansi ?
`vizingis~ _ sindromis dros
saWiro fizikaluri kvleva.
upirvelesad saWiroa ganisazRvros sunTq-
vis sixSire da Tavisebureba, pulsis sixSire d
Tavisebureba da Jangbadis saturacia pulsoq-
simetris saSualebiT. aseve Zalian sayuradRe-
boa bavSvis zogadi ganviTarebis Sefaseba.
„vizingi“ gamoscems eqspiraciul xmianobas,
romelic SeiZleba iyos polifoniuri an mono-
foniuri. upiratesad aRiniSneba amosunTqvis
gaxangrZliveba. bifazuri „vizingi“ SeiZleba
centraluri bronqis obstruqciiT iyos gamow-
veuli. „vizingis“ mcire xmianoba ar gamo-
ricxavs seriozuli spazmis arsebobis SesaZ-
leblobas. amitom mdgomareoba unda Sefasdes
yvela arsebuli simptomebis gaTvaliswinebiT.
„vizingis“ Sesafaseblad efeqturi tetia bron-
qodilatatorebis gamoyeneba (bronqodilata-
 32
torebis, magaliTad ventolinis, inhalaciis Sem-
deg, bronqospazi unda Semcirdes). xmauriani
sunTqva, romelic ismis nikapis zemoT, gamoiyene-
ba zemo da qvemo sasunTqi gzebis dazianebis
diferencirebisaTvis. stridoris arseboba an
ararseboba unda Sefasdes inspiraciisas. unda
Sefasdes respiraciuli distresis suraTi _
taqipnea, sunTqvis ukmarisoba, qoSini, nazaluri
problemebi, traqeis pulsacia, damxmare kunTe-
bis monawileoba sunTqvaSi. zemo sasunTqi gze-
bis sistemaSi atopiis Sesafaseblad saWiroa
cxviris Rrus lorwiovanis Sefaseba _ niJare-
bis darbileba amis maCvenebelia. saWiroa kanis
kargad daTvaliereba egzemis arsebobis dasad-
genad da mravlobiTi hemangiomebis arsebobis
dafiqsireba. mniSvneovania „dolis TiTebis“ ar-
sebobis dafiqsireba.
mwvave bronqioliti.
CvilebSi ganviTarebul mwvave bronqits,
rogorc wesi, win uswrebs, mwvave respirato-
ruli daavadebis mqone mozrdilebTan kon-
taqti. amasTan, am dros, mozrdilebSi ganvi-
Tarebuli respiratoruli infeqcia SeiZleba
mimdinareobdes Zalian msubuqadac. kontaqti-
dan daaxloebiT 1 kviris Semdeg, CvilebSi vi-
Tardeba zemo sasunTqi gzebis infeqcia _
cxviris cemineba da rinorea, rasac SeiZleba
axldes cxeleba subnormaluridan 39 gradu-
samde. TandaTanobiT viTardeba respirato-
ruli distresi _ paroqsizmaluri qoSini,
xvela, dispnea da agzneba. taqi pnea imatebs
kvebis dros. diarea da Rebineba Cveulebriv
ar viTaredeba. 2 Tvemde asakis bavSvebSi an
dRenaklulebSi, apnea SeiZleba ganviTardes
ufro adre, vidre qoSini.
fizikaluri monacemebidan yvelaze TvalSi-
sacemia „vizingi“. taqipneas intensivobis kleba
yovelTvis ar korelirdeba hipoqsemiis an hi-
perkapniis klebasTan. amitom saWiroa pulsoq-
simetria an sisxlSi gazTa Semadgenlobisa da
mJava-fiZovani monacemebis kvleva. qoSini SeiZ-
leba imatebdes nazaluri problemebis gamoc.
auskulpaciiT SeiZleba ismodes mravalxmiani
musikaluri xixini an stvena, romelic gaxangr-
Zlivebulia amosunTqvis fazaSi. Znelad mosas-
meni qoSini da filtvebis eqskursiis SezRudva
gviCvenebs daavadebis seriozul simZimeze da
bronqialuri obstruqciis arsebobaze. filtve-
bis dazianebam SeiZleba gamoiwvios hepato da
splenomegalia.
diagnostikuri kvlevebi.
pirveladi gamokvlevebi damokidebulia daa-
vadebis savaraudo etiologiaze. mwvave respi-
ratoruli distresis dros unda gakeTdes
filtvebis R-grama, pirdapir da irib proeqcia-
Si. CvilebSi,romelTac pulsoqsimetriT Jangba-
dis saturaciis Semcireba aReniSnebaT < 93%-ze
da gamoxatuli aqvT qoSinis xmianobis Sesuste-
,fdidsf rfhlbjkjubf
ba da gaxangrZlivebuli aspiracia, mosalodne-
lia filtvebSi fokaluri cvlilebeis ganvi-
Tareba. filtvebis R-grafia aseve saSualebas
gvaZlevs davafiqsiroT bronqoeqtaziis arsebo-
ba, iseTi daavadebebis drosac, romlebic bron-
qebis kompresias iwvevs. bronqodilatatorebis
testi efeqturia bronquli asTmisa da bron-
qiolitis dros magram ara fiqsirebuli (myari)
bronqialuri obstruqciis SemTxvevaSi. traqeo
an bronqomalaciis dros bronqodilatatorebi
mdgomareobas auareseben da“vizingi“ ufro in-
tensiuric SeiZleba gaxdes. oflis testi da
imunuri statusis Seswavla saWiroa rekuren-
tuli da garTulebuli „vizingis“ SemTxvevaSi
da gansakuTrebiT maSi, Tu saxezea ganviTareba-
Si CamorCena da persistuli enteraluri sind-
romi. gastrointestinaluri traqtis zemo nawi-
lebis kvleva da kontrastuli R-grafia aris II
rigis kvleva
mwvave bronqiolitis dros R-grafiulad Se-
iZleba gamoxatuli iyos anTebiTi ateleqtazu-
ri da hiperanTebiTi ubnebi. periferiuli sisx-
lis suraTi, Cveulebriv, normis farglebSia. vi-
rusologiuri testireba (p.j.r.) tardeba atipi-
ur SemTxvevebSi an epidemologiuri kvlevis
mizniT.
mwvave bronqiolitis diagnozi, Cveulebriv,
damyarebulia klinikur monacemebze da ismeba
im SemTxvevaSi, roca manamde janmrTel Cvils
pirvelad ewyeba „vizingi” da saerTo mdgoma-
reoba mZimdeba.
mkurnaloba.
„vizingis“ paTogenezuri mkurnaloba damoki-
debulia gamomwvevi agentis Taviseburebaze.
bronqodilatatorebis testi ar iZleba etio-
logiuri faqtoris dadgenis saSualebas. mag-
ram gviCvenebs bronqul komponentSi hiper-reaq-
tiulobis arsebobas (am mizniT gamoiyeneba al-
buteroli,romelic < 3 wlamde asakis bavSvs eZ-
leba nebulaizeriT an speiseriT). bronqodila-
taroris gamoyeneba rekomendirebulia, rogorc
asTmis ise virusuli infeqciiT gamowveuli „vi-
zingis“ SemTxvevaSi. ipratropium bromidis ga-
moyenebis efeqturobis Sesaxeb gansxvavebuli
mosazrebebi arsebobs. igi upiratesad gamoiye-
naba bronqo an traqeomalaciiT gamowveuli
„vizingis“ SemTxvevaSi, roca B2-agonistebis ga-
moyeneba araefeqturia da piriqiT _ mosalod-
nelia mdgomareobis gauareseba (amcirebs kunT-
Ta tonuss).
sainhalacio k.s. gamoiyerneba, roca anamnezSi
fiqsirdeba atopia an klinikuradaa gamoxatu-
li egzema. aseve im SemTxvevebSi, Tu manamde Ca-
tarebulia k.s. sistemuri (peroraluri) ramde-
nime kursi. sainhalacio k.s. saukeTeso saSuale-
baa bronqebis hiperreaqtiulobiT gamowveuli
persistuli da rekurentuli „vizingis“ SemTx-
vevaSi da naklebad efeqturia epizodur da
@__) otkb
,fdidsf rfhlbjkjubf
mwvave SemTxvevebSi, romlebic araalergiul
fonze da bronqebis hiperreaqtiulobis gareSe
mimdinareoben.
oraluri k.s. gamoiyeneba maSin, Tu saxezea
atopiuri anamnezi an gamoxatulia atopiis
sxva gamovlineba (mag. egzema). an Tu bavSvs
aqvs asTma da sxva medikamentebi uefeqtoa.
oraluri k.s. ar gamoiyeneba, Tu saqme gvaqvs
„vizingis“ pirvel SemTxvevasTan an Tu mdgo-
mareoba msubuqia da pacienti ar saWiroebs
hospitalizacias.
mwvave bronqiolitis mqone Cvilebi, visac ga-
moxatuli aqvs respiratoruli diatresi, auci-
leblad unda iyvnen hospitalizirebuli.
mkurnaloba ZiriTadad simptomaturi da
damxmarea.
hipoqsemiis Sesamcireblad gamoiyneba civi,
teniani Jangbadi.
sedacia araa rekomendirebuli.
sxeulis mdebareoba sasurvelia iyos hori-
zontaluri aredan 30 gradusiT wamoweuli
kveba sasurvelia dedis rZiT da nazo-gast-
raluri zondiT, raTa Semcirdes fizikuri
datvirTva da Tavidan iqnas acilebuli aspira-
cia. mZime SemTxvevebSi saWiroa parenteraluri
kveba.
Tu saxezea respiratoruli dekompensaciis
riski, sasurvelia traqeis intubacia.
pirisa da cxviris Rru unda gaTavisufldes
lorwosagan.
bronqodilatatorebs aqvT droebiTi da ara
myari efeqti.
nebulaizeriT miwodebuli epinefrini ufro
efeqturia vidre B-agonistebi. am preparatebis
dozireba damokidebulia pacientis mdgomareo-
basa da preparatis efeqtze.
k.s. SeiZleba gamoyenebuli iyos rogirc
peroralurad da ineqciiT, ise sainhalacio
gziT. Tumca kortikosteroidebis efeqturo-
bis Sesaxeb kontrargumentebic arsebobs. k.s.
ar gamoiyeneba RSV-iT gamowveuli bronqio-
litis dros im CvilebSi, romlebic manamde
janmrTelebi iyvnen.
ribavirini gamoiyeneba sainhalacio gziT, im
CvilebSi, romelTac aReniSnebaT gulis Tanda-
yolili manki da/an filtvebis qronikuli daa-
vadebebi. Tumca dReisaTvis ar moipoveba sarw-
muno monacemebi, rom ribavirini aumjobesebs
mdgomaro-. bas an amcirebs sikvdilianobas.
antibiotiki gamoiyeneba im SemTxvevaSi, Tu
saxezea TandarTuli baqteriuli pnevmonia.
daavadebis gamovlenis Semdeg, mwvave period-
Si, anti RSV-imunolobulinis gamoyeneba ar iZ-
leva efeqts.
prognozi.
xvelisa da dipneas gamovlenidan 48 _ 72 sa-
aTSi maRalia garTulebis riski. sikvdilobis
SemTxexebi < 1%-ze. sikvdiloba gamowveulia ap-
@__) otkb
33
neiT, respiratoruli distresiT da dekompensi-
rebuli respiratoruli acidoziT an mZime deh-
drataciiT. aRniSnuli kritikuli periodis
Semdeg, simptomebi SeiZleba persistirebdes sa-
Sualod 12 dRis ganmavlobaSi.
gulis Tandayolili mankis, filtvebis dis-
plaziis an imunodeficitis mqone bavSvebSi, da-
avadeba mZimed mimdinareobs da maRalia garTu-
lebisa da sikvdilobis maCvenebeli.
«vizingis» gamovlena xSiria asTmisa da
atopiuri anamnezis da gaurkveveli xasiaTis
bronqitebis mqone pirTa ojaxebSi.
60% SemTxvevaSi «vizingi» aRar meordeba.
prevencia.
higienuri pirobebis dacva. Cvilebis moride-
ba respiratoruli viusuli infeqciis mqine pi-
rebTan.
anti-RSV hiperimunuri imunoglobulini
(RSV_IVIG). _ RESPIRGAM an PALIVIZUMAB (SINAGIS).
RSV-is sezonis win da sezonis dros.
PALIVIZUMAB rekomendirebulia < 2 wlamde asak-
Si, filtvebis qronikuli daavadebis (bronqo-
pulmonaluri displazia) an imunodeficitis
mqone bavSvebSi da dRenaklebSi.
bronqiti.
bronqiti ewodeba bronqebis araspecifiur
anTebas. mwvave bronqiti Cveulebriv virusuli
paTologiaa da misi ZiriTadi gamovlineba aris
xvela.
termini _ „mwvave traqeobronqiti“ gamoiyene-
ba maSin, Tu procesSi mniSvnelovnadaa CarTu-
li traqea. SeiZleba bronqits Tan erTvodes na-
zifaringiti da am dros arsebobs daavadebis
baqteriuli agerntisagan ( yivanaxvela, difTe-
ria) gamowvevis SesaZlebloba. naxvelSi strep-
to an atafilokoebis aRmoCena ar ar amtkicebs
maT kauzalur mniSvnelobas da ar moiTxovs an-
tibiotikiTerapias
mwvave bronqiti.
mwvave bronqiti xSirad mohyveba Tan zemo
respiratoruli gzebis virusul infeqcias.
daavadeba ufro xSirad viTardeba zamTarSi.
infeqcuri agentis gavleniT ziandeba traqe-
isa da bronqebis epiTeli. xdeba anTeboTi
ujredebis aqtivacia da citokinebis gamoTa-
visufleba. daavadebis ZiriTadi simptomia
xvela, produqciuli naxvelis an mis gareSe;
uxSiresad gamoxatveulia cxeleba, zogadi
intoqsikacia da diskomforti. traqeobronqi-
aluri epiTeli ziandeba da xdeba hi persen-
sitiuri, rac iWvevs xvelas, romelic grZel-
deba 1 _ 3 kviris ganmavlobaSi.
bavSvebSi daavadeba iwyeba, rogorc z.s.g.
araspecifiuri infeqcia _ riniti, rasac 3 _ 4
dRis Semdeg Tan erTvis mSrali, myefavi an pro-
duqciuli xvela. ramdenime dRis Semdeg proce-
 34
si SeiZleba gaxdes Cirqovani, rac gamowveulia
anTebiT areSi leikocitebis migraciiT. magram
es ar niSnavs, rom parocei aucileblad baqte-
riuli bunebisaa.
mozrdili asakis bavSvebSi xSiria mkerdis
tkivilis SegrZneba, rac xvelis garTulebas
wrmoadgens. 5 _ 10 dRis ganmavlobaSi, lorwo
TandaTan Txierdeba da xvelac iklebs. mwvave
bronqitis klinikuri suraTi Cveulebriv 1 _ 2
kvira grZeldeba. zogierT SemTxveaSi procesi
SeiZleba 3 kvira gagrZeldes. 3 kviris Semdeg
gagrZelebuli xvela ukve aRar aris mwvave
mronqitis gamoxatuleba da es uxSires SemTx-
vevaSi „postinfeqciuri xvelaa“.
mwvave bronqitis klinikuri gamovlineba da
fizikaluri monacemebi damokidebulia pacien-
tis asaksa da daavadebis xangrZlivobaze. daa-
vadebis adreul stadiaze mkveTri temoeratu-
ruli reaqcia ar aRiniSneba, saeve sustadaa ga-
moxatuli nazo-faringiti, koniuqtiviti da ri-
niti. adreul fazaSi auskulptaciuri monace-
mebi SeiZleba ar vlindbodes. mogvianebiT SeiZ-
leba gamovlindes „vizingi“ da orive mxares
simetriulad gamoxatuli sxvadasxva yalibis
(upiratesad mSrali) xixini. R-grafiulad pa-
Tologiuri cvlilebebi ar vlindeba,Tumca Se-
paTologiis kategoria
_ anTebiTi
_ qronikuli pulmonaluri procesi
_ xva qronikulidaavadebebi/Tandayolili
paTologiebi
_ infeqciuri/imunuri paToogia
_ SeZenili
,fdidsf rfhlbjkjubf
iZleba gamoixatos gaZlierebuli sisxlZarR-
vovani suraTi.
principulia pnevmoniis gamoricxva, rasac
adasturebs zogadi intoqsikacia,sunTqvis ukma-
risoba da klinikurad da rendgelogiurad ga-
moxatuli lokaluri cvlilebebi filtvis
qsovilSi.
mwvave bronqitis mkurnaloba.
mwvave bronqitis specifiuri mkurnaloba
ar arsebobs. xSirad iniSneba antibiotiki,
rac arasworia. antibiotiki ar aumjobesebs
mdgomareobas. CvilebSi, sxeulis mdebareobis
xSirma cvlam SeiZleba gaaumjobesos lo-
ewos drenireba. mozrdil bavSvebSi teniani
garemo qmnis met komforts magram ar amok-
lebs daavadebis xangrZlivobas. xvelis sup-
resantebi amcireben simpomebs. magram Sei-
Zleba aferxeben sekretis gamoyofas, ris ga-
moc gamiyenebian SerCeviT da ara rutinulad.
antihistaminuru preparatebi aseve aZneleben
sekretis sekrecias. ar aris naCvenebi eqspeq-
toratebis gamoyenebac.
rekomendirebulis temperaturis regulireba.
siTxis micema da sxva simptomaturi saSuale-
bebi.
diagnozi
asTma
bronqo-pulmonaluri displazia/filtvis
qronikuli daavadebebi.
postinfeqciuri bronqoeqtazia.
kistofibrozi.
traqeo an bronqomalacia.
ciliaruli paTologia.
laringialuri naprali an gafarToeba.
ylapvis paToloia.
gastro-ezofagaluri refluqsi.
bronqebis kompresia (mag. vaskularuli
kontraqrura an hemangioma).
gulis Tandayolili paTologia.
imunodeficiti.
tuberkuliozi.
alergia.
sinusiti.
tonziliti an adenoiditi.
qlamidia. uroplazma (CvilebSi)
yivana xvela.
mikoplazmuri pnevmonia.
ucxo sxeuli.
@__) otkb
,fdidsf rfhlbjkjubf
gul-sisxlZarRvTa sistemis dazianeba
hemoragiuli vaskulitis dros bavSvebSi
d. CaxunaSvili, q. maTiaSvili,
r. wivwivaZe
hemoragiuli vaskuliti(hv) –imunokomp-
leqsuri daavadebaa, romelsac safuZvlad
udevs mravlobiTi sistemuri mikroTrombo-
vaskuliti, kanisa da Sinagani organoebis
wvrili sisxlZarRvebis (kapilarebis, arte-
riolebis, venulebis) dazianebiT. am dros
adgili aqvs mocirkulire imunuri kompleq-
sebiT sisxlZarRvis kedlis difuzur dazi-
anebas, rac ganapirobebs sisxZlZarRvovan-
Trombocitaluri hemostazis mniSvnelovan
darRvevebs(6,7).
hemoragiuli imunuri mikroTrombovasku-
liti erT-erTi yvelaze gavrcelebuli daa-
vadebaa bavSvTa asakSi. igi Tanabari sixSi-
riT gvxvdeba gogonebSi da vaJebSi, gansakuT-
rebiT gazafxulze da Semodgomaze. igi po-
lietiologiuri daavadebaa, romlis ganviTa-
rebas ganapirobebs alergiuli faqtorebi:
streptokokuri da respiratoruli virusu-
li infeqcia, acrebi, kvebiTi da wamlismieri
alergia, WiebiT invazia da lambliozi, aseve
infeqciis qronikuli kerebi/ tonmziliti, si-
nisitebi, kbilebis kariesi, qolecistiti/.
yvela es faqtori asrulebs antigenis rols
da monawileobs antogen-antisxeulis komp-
leqsis antigenuri nawilis formireba-
Si(12,13). dadgenilia rom ara mxolod pohier
ujredebs, aramed eozinifilebsac gaaCniaT
membranuli receptorebi IgE da IgA-sadmi, ro-
melTa eqspresiac sisxlis SratSi IgE donis
zrdis paralelurad matulobs. am recepto-
rebis eqspresiis siZlieresTan mWidrodaa
dakavSirebuli eozinofilebis unari gamo-
yon sxvadasxva mediatorebi, romelTac gaaC-
niaT proteolizuri aqtivoba da azianeben
sisxlZarRvis endoTels, Tirkmlis epiTels,
endokards, perikards. daavadebis saSualo
da mZime mimdinareobisas bavSvebs xSirad
aReniSnebaT funqciuri xasiaTis sistoluri
Suili (8,9,11).
iteraturuli monacemebiT, hemoragiuli
vaskulitiT daavadebulTa 2/3-s aReniSne-
ba eozinofilia, romelic remisiis peri-
odSi mcirdeba da aqtiur fazaSi matu-
lobs. aRniSnuli cvlilebebi ganixilebo-
da rogorc araspecifiuri, romelic orga-
nizmis hi perergiuli mdgomareobaze miuTi-
@__) otkb
35
Tebda. Tumca kavSiri eozinofiliasa da
gulis dazianebas Soris ar yofila Ses-
wavlili (1,.2,10).
Cveni Sromis mizans Seadgenda Segveswav-
la Eeozinofiliis, rogorc kardiodamaziane-
beli faqtoris roli hemoragiuli vaskuli-
tis dros bavSvebSi.
masala da meTodebi:
dakvirvebis qveS imyofeboda 3-dan 15 wlam-
de asakis 85 avadmyofi: maTgan 1-5 wlisa iyo
20, 5-7 wlisa 32, 7-15 wlisa 33. sakontrolo
jgufs Seadgenda 1-dan 15 wlamde asakis 35
praqtikulad janmrTeli bavSvi.
yvela avadmyofs Cauterda klinikur-la-
boratoriuli gamokvleva, romelic moicavda
IgE koncentraciis gansazRvras radioimuno-
logiuri meTodiT(Pharmacia diagnostics” Svecia),
agreTve eleqtrokardiografias, fonokardi-
ografias, eqokardiografias.
bavSvebi dayofili iyo 2 jgufad:
I jgufi hemoragiuli vaskulitiT daava-
debuli 58 bavSvi, romelTac aReniSnebodaT
eozinofilia 5% da meti(8,5+-0,35%)
II jgufi 27 avdmyofi, eozinofilebis no-
raluri raodenobiT..
gamokvlevis Sedegebi da maTi ganxilva:
I jgufis admdmyofebidan(58) mwvave mimdi-
nareoba aReniSneboda 31(53%)-s, qvemwvave
10(17%)-s, qronikuli morecidive mimdinareoba
17(30%) pacients. maTgan 21 bavSvi iyo
7wlamde asakis, romelTac axasiaTebdaT daa-
vadebis mwvave mimdinareoba aqtivobis maRa-
li xarisxiT.
adreuli asakis bavSvebSi wvrili sisxl-
ZarRvebis anatomiur-morfologiuri Tavise-
burebisa da imunuri reaqciebis labilobi-
dan gamomdinare Warbobda eqsudaciur-SeSu-
pebiTi komponenti, gansakuTrebiT periartiku-
laruli qsovilisa, rac ganapirobebda hemo-
ragiuli vaskulitis mimdinareobis Tavisebu-
rebas bavSvebSi.
kerZod, hemoragiuli vaskuliti bavSvebSi
iRebda sistemur xasiaTs da mimdinareobda
mZimed: kanis dazianebasTan erTad avadmyo-
febs aReniSnebidaT saxsrebis tkivili, Se-
Supeba, moZraobis SezRudva, abdominalgiebi,
hepato-splenomegalia. daavadebas kidev uf-
ro amZimebda Tirkmlis dazianeba glomeru-
lonefritis saxiT, hematuriiTa da protei-
nuriiT.
 36
mimdinareoba 1- jgufi (n=58)
( eozinofilebi >N)
<6ëåò > 6 ëåò
mwvave 30% 23%
qvemwvave 6% 11%
qronikuli 12% 18%
eozinofilebis noraluri raodenobis
mqone 27 avdmyofidan(II jgufi), daavadebis
mwvave formiT hospitalizebuli iyo 7 (27%),
qvemwvaveTi 14 (50%), qronikuliT – 6 (23%). di-
agrama#1
rogorc cxrilidan Cans eozinofilebis
noraluri raodenobis mqone hemoragiuli
vaskulitiT daavadebul avadmyofebSi mwvave
mimdinareoba SedarebiT iSviaTad gvxvdeba,
ufro xSiria misi qvemwvave mimdinareoba,
hemoragiuli vaskulitis mimdinareoba
avadmyofTa I da II jgufSi
I jgufis avadmyofebSi klinikur-instru-
mentuli gamokvlevisas aRiniSneboda taqi-
kardia, auskultaciiT gulis tonebis moyru-
eba, sistoluri Suili mwvervalze da me-5
wertilze. Ee.k.g.-ze registrirdeboda P da T
kbilis cvlileba, ST segmentis cdoma izoe-
leqtruli xazis zemoT. fonokardiogramaze
aRiniSneboda gulis tonebis amplitudis
daqveiTeba, dabalamplitudiani sistoluri
Suili. Eeqokardiografiuli gamokvlevisas
orive jgufis pacientebSi gamovlinda gu-
lis dazianebis niSnebis sxvadasxva sixSire.
Eendokarditis niSnebi sarqvelebis SeSupe-
bisa da Sesqelebis saxiT, eqosignalis gaZ-
liereba aReniSneboda maTgan 26(45%) bavSvs
da eozinofilebis raodenobasTan avlendnen
Zlier korelaciur kavSirs(r=0,69; p<0,01).
Hhemoragiuli vaskulitis dros miokardiu-
misaTvis damaxasiaTebeli cvlileba iyo mi-
si akustikuri simkrivis momateba. eozinofi-
liiT mimdinare hemoragiuli vaskulitiT
daavadebuli bavSvebidan 36%(21)-s aReniSne-
boda miokardiumis dazianeba gulis kunTis
SesqelebiT, romelic eqokardiografiul su-
raTze mis SeSupebas mogvagonebda. miokar-
dis funqciuri mdgomareobis Seswavlam ga-
moavlina, rom pirvel rigSi ziandeba misi
relaqsaciuri funqcia. 23(39%) SemTxvevaSi
,fdidsf rfhlbjkjubf
2- jgufi (n=27)
( eozinofilebi =N)
âñåãî <6ëåò >6ëåò âñå
ãî
53% 17% 10% 27%
17% 20% 30% 50%
30% 8% 15% 23%
swrafi avsebis faza xangrZlivdeboda 0,088=-
0,0032wm-de(#0,06=-0,014wm;p<0,05), rac dadebi-
Tad korelirebda eozinofilebis ricxvTan
(r=0,3866;p<0,001), Tumca korelaciis koefici-
enti ufro maRali iyo perikardis RruSi
siTxis arsebobisas (r=0,532;p<0,005). avadmyof-
Ta meore jgufSi eqsudaciuri procesebi uf-
ro iSviaTad gvxvdeboda. Yhemoragiuli vas-
kulitis dros gulis dazianebis paTogenez-
Si alergiuli meqanizmebis rolis dasazus-
teblad I jgufis 30-sa da II jgufis 20 bav-
SvTan SeviswavleT IgE done.
I jgufSi IgE-s koncentracia sagrZnob-
lad hqonda momatebuli 18(60%) bavSvs, zomi-
erad 9-s(30%) da mxolod 3(10%) bavSvs hqon-
da normis farglebSi. II jgufis 20 bavSvi-
dan sagrZnoblad momatebuli IgE-s koncent-
racia hqonda 3(15%) bavSvs, zomierad 6-
s(30%), danarCen 11(55%) bavSvs ki hqonda nor-
mis farglebSi. amgvarad, pacientTa im
jgufSi, romlebsac ar aReniSnebodaT eozi-
nofilia, iSviaTad gvxvdeboda IgE-s koncen-
traciis mateba. unda aRiniSnos, rom I jgu-
fis avadmyofebSi gamovlinda sakmaod Zli-
eri pirdapiri korelaciuri kavSiri eozi-
nofilebis raodenobasa da IgE-s koncentra-
cias Soris(r=0,4257;p<0,005).
amgvarad, gulis mxriv mkveTrad gamoxatu-
li cvlilebebi endo-, mio- da perikarditis
saxiT hqondaT, periferiul sisxlSi eozino-
filebis momatebuli raodenobis mqone paci-
entebs. Aamave dros paTologiuri procesis
maRali aqtivobisa da gamoxatuli eozinofi-
liis dros, gulis dazianebis latenturi pe-
riodi mcirdeboda. Tumca eozinofilebis
zomieri momatebac garkveul rols TamaSob-
da kardialur procesSi.
perikardiumis cvlilebebi analogiuri ze-
moT aRniSnulisa, zogierTi avtoris mier aR-
werilia mZimed mimdinare alergiuli daava-
@__) otkb
,fdidsf rfhlbjkjubf 37
debebis dros, rasac isini ukavSireben eozi- 4.
)+
 ". .,,   #0 $ *
nofilias(10). es cvlilebebi aixsneba degra-   ) #,, . Y .
#! #. )
. . 1986:
nulirebuli eozinofilebis moqmedebiT, rac 5.
 .. ,,
+
 ')+ IgE $ 

ganapirobebs perikardiumis RruSi eqsudaci-  Y ) #,, . Y …
#. #.)
. –. 1998.
as. perikardiumis cvlilebebis xasiaTi da am 6 
 . . ,, . :+
 
) ) #,,
procesis dinamika ZiriTadad diagnoscirde- #0
 :'. 2001:. №11 .6-7
boda eqokardiografiulad, romelic saSua- 7.') . . @* . . :+

lebas iZleva gamovlindes umciresi perikar- 
) ?-
dialuri cvlilebebi, radgan mas axasiaTebs
Raribi araspecifiuri simptomatika, anda kli-
nikurad arc vlindeba. SeiZleba vivaraudoT,
rom zogierT SemTxvevaSi paTologiur pro-
cesSi plevris CarTva garkveul wilad aseve
dakavSirebulia degranulirebuli eozinofi-
lebis toqsiur moqmedebasTan.
Cveni varaudiT, cvlilebebi miokardSi Se-
iZleba ganpirobebuli iyos eozinofilebis
mier gulis kunTis dazianebiT. iTvleba, rom
eozinofilebs unari aqvT daazianon qsovi-
lebi biogenuri aminebis gamonTavisuflebiT
da astimulireben anTebas(2,3). Cveni gamokv-
levebiT es dadasturda gulis funciuri da
morfologiuri maCveneblebis cvlilebebiT
da garkveul wilad mogvagonebs sxva aler-
giuli da imunuri daavadebebis dros aRwe-
ril mdgomareobas, romlebic aseve mimdina-
reobdnen eozinofiliiT(3,5). gamokvlevis Se-
degad gamovlenili Eendokardis cvlilebe-
bi, aseve ar ewinaaRmdegeba eozinofiliasTan
maTematikurad gamoTvlil korelacias. eno-
dokardis eozinofiluri dazianeba aRweri-
lia mravali avtoris SromebSi, romlebic
aRniSnaven mitraluri sarqvelebis gasqele-
bas, subendokardialuri fibrozis warmoqm-
nas da gulis sarqvelebis prolabire-
bas(4,9,11).
ra Tqma unda, gulis dazianeba hemoragiu-
li vaskulitis dros ar SeiZleba mxolod
eozinofilebis damazianebel zemoqmedebas
mivaweroT. Cveni monacemebi upirveles yov-
lisa metyvelebs organizmis zogadi reaqci-
is erTianobaze sxvadasxva gamSvebi meqaniz-
mebis sapasuxod. Mmkurnalma eqimma unda ga-
iTvaliswinos aseT bavSvebSi Sinagani orga-
noebis dazianebis didi albaToba, raTa swo-
rad gansazRvros racionaluri Terapia.
". . –1996.-№5 ..-87-88.
8..Capron M. Grangrette C. Torpier G. // The second re-
ceptor for IgE in eosinophil effector function. Chem.
Immunol. 1989. 47. 128-178.
9. Olsen F. //Herz.-1995-Bd10/N1.- S.21-26.
10. Lewin R. Hor. R. et al.//Amer.Heart J. 1985 vol.110.#1-
p.116-123// )
11. Masuda M, Nakanishi K, Yoshizawa N, Iijima K,
Yoshikawa N.,,Enhanced Expression of the CD71 Mesangial
IgA1 Receptor in Berger Disease and Henoch-Schonlein
Nephritis: Association between CD71 Expression and IgA
Deposits.,,Am Soc Nephrol 2003 Feb;14(2):327-37
12. Haddad E, Moura IC, Arcos-Fajardo M, Macher MA,
Baudouin V, Alberti C, Loirat C, Monteiro RC, Peuchmaur M.
,, Group A streptococcal antigen in the glomeruli of children
with Henoch-Schonlein nephritis.,, : Am J Kidney Dis 2003
Feb;41(2):366-70
Szer I. S. Henoch-Shonlein purpura // Cur. Opin. Rheuma-
tol. –1994. – vol. 6. p. 25-31.
Eosinophilia as a possible cardiodamaging factor in
children with Henoch-Shonlein purpura
D. CHAKHUNASHVILI, K. MATIASHVILI,
R. TSIVTSIVADZE
Tbilisi State Medical University, Pediatric Clinic
Summary
By the purpose of work was the study eosinophils and
their role in pathogenesis of Henoch-shonlein purpura.
Is surveyed 85 children of the patients Henoch-Shonlein
purpura in the age of From 3 till 15 years. All patients we-
re divided into 2 groups: the first group have made 58
children with a level eosinophils 5 % and More (8,5%+-
0,35), second - 27 children with Henoch-Shonlein purpu-
ra and with a normal level eosinophils.
The heaviest current Henoch- Shonlein purpura with
fast phrogressively of disease was marked at children
with increase eosinophils. It was discovered that associa-
ted Henoch-Shonlein purpura and eosinophilia ran a co-
"%" urse marked by more well-defined exudative reaqtions,
1.  . .

-)  $
 with the heart being injured more frequently and gravely.
$:  )# $   
)  The relationshup between eosinophilia and the content

 +
 '*: . Y … of the total serum IgE in Henoch-Shonlein purpura is dis-

#. #.)
. –‰ . 1998. – 25 . scussed as is the role of age-associated and constitutional
2. =$) .Y. :# (.%. ,,X'  factors in the development of eosinophilia in Henoch-
X',,.1982 Shonlein purpura children.
3. YQ+ . . & 
 .. ,,['
    :+
 '*,,  
 Key words: Henoch-Shonlein purpura, eosinophils,
 
$:  $#.-1999.-№5.-. 42-45 IgE, children, heart .
@__) otkb
 38 ,fdidsf rfhlbjkjubf
leqtinebis gamoyenebis perspeqtiva
XXI saukunis medicinaSi.
e. bairamovi, g. CaxunaSvili
leqtinebi – es aris naxSirwyal-SemakavSi-
rebeli cilebi, romelTac gaaCniaT ujrede-
bis aglutinaciis an glikokoniugatebis Seq-
mnis unari. Ig-bi, romlebic reagireben Saqreb-
Tan ar warmoadgenen leqtinebs.Lleqtinebi
Seicaven, yvelaze mcire, or naxSirwyal-Sema-
kavSirebel bolos.
leqtinebis specifiuroba ganpirobebulia
im Saqrebze, romelTac yvelaze metad SeuZ-
liaT leqtinbis aglutinaciis da preci pi-
taciis funqciis inhibireba.
cilebi, toqsinebi da satransporto prote-
inebi SegviZlia mivakuTnod leqtinebs, Tu maT
naxSirwylebis SekavSirebis unari gaaCniaT.
mniSvnelovani leqtinebi:
konkavalin A.
ricini- citotoksiuri glikoproteini, mi-
iReba mcenareebis fesvebidan, kenkrovani mce-
nareebidan.
baqteriuli toksinebi- E.coli-s enterotok-
sini, qoleris toksini
gri pis virusis hemaglutinini.
S-ti pis leqtini – b-galactozide-SemakavSire-
beli cxoveluri warmoSobis leqtini, rome-
lic monawileobs ujredi-ujredTan an uj-
redi-matriqsi urTierTobaSi.
P-ti pis leqtini – manose-6-phosphate recep-
tori.
I-ti pis leqtini – miekuTvneba Ig-is supe-
rojaxs.
zogierT mecniers mohyavs aseTi azri, rom
virusebisTvis da baqteriuli virusebisTvis
– fagebisTvis maT zedapirze ganlagebuli
leqtinebi saWiroa imisaTvis, rom amorCevi-
Tad daukavSirdnen mikro- da makroorganiz-
mebis ijredebs da daainficiro isini. Yovel
SemTxvevaSi, gri pisa da sxva virusebisaTvis,
romlebic iwveven eqsperimentalur simsivne-
ebs, es naCvenebia sakmarisad sarwmunod.
zogierTi mikroorganizmis leqtinebi, mag.
piris RruSi mobinadre streptokokebis, iwve-
ven «kbilis qvis» warmoqmnas.
kvlevarebisTvis am leqtinebis codna
warmoadgens did Rirebulebas piris Rrus
daavadebebisagan dacvis sxvadasxva saSuale-
bebis SeqmnisaTvis.
wvrili nawlavis mikroorganizmebis leq-
tinebi warmoadgenen simbioturi Tanaarsebo-
bis formas. es Zalian mniSvnelovania k/n traq-
tis ekologiis Seswavlis TvalsazrisiT (en-
teritebis, disbaqteriozis mkurnalobaSi).
eWvgareSea agreTve leqtinebis roli hormo-
nebis ujredis receptorebTan SekavSirebis
procesSi.
70-ni wlebis dasawyisSi kvatrekasesis mier
miRebul eqsperimentuli monacemebiT WGA da
Con-A-s SeswevT unari insulinis receptorTan
dakavSirebis da amiT glukozis cvlis regula-
caze zemoqmedebis.
dadgenilia agreTve is, rom endogenur
leqtinebs SeuZliaT membranebis ionuri ar-
xebis funqcionirebis Secvla, da amiT meta-
bolur reaqciaTa seriaze zemoqmedeba.
amiT aixsneba leqtinebis maRali toqsiu-
roba., maT Soris ricinis.
leqtinebisKkidev erTi, magram naklebaT
Seswavlili funqcia. es aris maTi roli gam-
ravlebis procesSi da makroorganizmebis
ganviTarebis sawyis etapze.
eqsperimentze naCvenebia, rom spermatozoide-
bis specifiuri adgezia kvercxujredis zeda-
pirze damokidebuli specifiur naxSirwylovan-
cilovan amocnobaze,endogenuri leqtinebis mo-
nawileobiT. am mxriv sakmarisad Seswavlilia
bayayis kvercxujredis kortikaluri granule-
bis e. w. « matriqsuli leqtinebi» . naCvenebia,rom
es leqtinebi asruleben ganayofierebuli kver-
cxujredis damcvelobiT funqcias – kvercxuj-
redi muiwvdomelia sxva spermatozoidebisaTvis.
e. w. ebrionaluri leqtinebi, kvercxujredis
ganviTarebis sxvadasxva etapze – dayofa, gast-
rula,neirula,embriologebis monacemebiT – Za-
lian mniSvnelovan rols asruleben normalu-
ri an anormuli organizmis formirebaSi.
aris Tu ara adamianis genetikuri daavade-
bebis safuZveli leqtinebis warmoqmnis an
maTi funqciis defeqti.
radgan leqtinebi xasiaTdebian maRali
amorCeviTobiT, maT amCneven umcires sxvaobas
naxSirwylebis struqturaSi, romlebic ganla-
gebulia mikrobis ujredis kedelSi. magali-
Tad, eqsperimentSi isini uSecdomod amoicno-
ben azotfiqsirebad baqteriebs – rizobiebs.
cilovani molekulis erT boloSi SeiZle-
ba ganlagebuli iyos leqtinuri domeni, rome-
lic amoicnobs garkveul naxSirwyalis mole-
kulas, xolo meore boloSi – romelime sxva
domeni, romelic sxva funqcias asrulebs.
SedegadA leqtinebs SeuZliaT baqteriaze
zemoqmedebac. magaliTad, naCvenebia, rom zo-
gierTi leqtinebi aZliereben baqteria-simbi-
ontebis azotfiqsirebis funqcias.
mcenareuli warmoSobis leqtinebi agreT-
ve asruleben «imunologiur» xasiaTis funq-
cias. mag. Mmcenareebis dacvaSi sokoebsa da
inseqtebisagan, monawileoben e. w. qitinSema-
kavSirebeli leqtinebi.
@__) otkb
,fdidsf rfhlbjkjubf
zogierti leqtini TviTon aavlens fungi-
cidur da inseqticidur aqtivobas, sxvebi ami-
saTvis kooperireben fermentebTan (mag. qiti-
nazebTan). interess warmoadgens e. w. RIPs ( ri-
bosome-inactivating proteins)-cilovani kompleqse-
bi, romelTac SeswevT unari ribosomebze ze-
moqmedebis da maTi mwyobridan gamoyvanis.
maT Soris gvxvdeba maRal toqsiurebi.
leqtinebi maRalspecifiurni arian : maT ga-
narCeven erTmaneTisagan ara mxolod monosaqa-
ridebs, aramed sxvadasxva oligosaqarideb-
sac.Lleqtinebis rolis SeswavlaSi didi
wvlili miuZRvis j. aSuels – janmrTelobis
erovnuli institutidan da albert ainStai-
nis saxelobis samedicino kolejidad,romleb-
mac 1968 w. eqsperimentSi sisxlis plazmis gan-
sazRvrul glikoproteinebs (gp) fermentatu-
lad moaSores sialis mJava, Semdeg es glikop-
roteinebi Seuyvanes sacdel baWiebs. aRmoCnda,
rom sialis mJavis ar mqone glikoproteinebi
maleve qrebodnen sisxlidan, gansxvavebiT in-
taqtur molekilebisagan, romlebis garkveuli
drois ganmavlobaSi rCebodnen sisxlSi.
rogorc gvaCvenes aSuelma da morelma, gp-
ebi amTavreben TavianT arsebobas RviZlSi.si-
alis mJavis moSorebis Sedegad
- galaqtoza, normaSi miuwvdmeli qimiuri
SenaerTia, SiSvldeba da ukavSirdeba leq-
tins hepatocitebis zedapirze.
SemdgomSi aRmoCnda, rom Tu gp-is moleku-
las sialis mJavasTan erTad galaqtozasac
movaSorebT, maSin gp-is sisxlidan gaqrobis
siCqare normas ubrundeba.
am monacemebidan gamomdinare, gakeTda das-
kvna, rom cilebis gverdiTi naxSirwylovani
jaWvebi SegviZlia gamoviyenod rogorc mar-
kerebi im molekulebis, romlebic saboloo
jamSi qrebian sisxlidan da iSlebian.
zedapiruli naxSirwylebis msgavsad, zedapi-
ruli leqtinebic ganicdian cvlilebebs, uj-
redis fiziologiuri da paTologiuri mdgo-
mareobis Sesabamisad. 1981 wels r. lotani da
e. radi veismanis samecniero institutidan aR-
moaCines – adamianisa da Tagvis simsivnuri uj-
redebis zedapirze – leqtinebi, romlebic
normaluri ujredebis zedapirze ar iyo.
SemdgomSi aRmoCnda, rom es leqtinebi me-
tastazebis ganviTarebaSi monawileoben.
manoza-SemakavSirebeli leqtinebi (mSl-i)
garkveul rols asruleben mamakacebSi gulis
iSemiuri daavadebis ganviTarebaSi. SratSi mSl-
s donis momateba asocirebulia gid-is ganviTa-
rebis riskTan mamakacebSi da ara qalebSi.
rogorc cnobilia, mSl-i monawileobs
komplementis aqtivaciis reaqciaSi da mniSne-
lovan rols asrulebs organizmis imunuri
pasuxSi paTogenuri mikrobebis mimarT.
.Y., 3 !
%.., )0
39
mamakacebsa da qalebs – prospeqtuli popula-
ciuri kvlevis monawileebs Soris EPIC-Norfolk.
mSl-is sawyisi (Tavdapirveli) done 946 in-
farkt gadatanil pacientebis an 6 wlis ganmav-
lobaSi garacvlil macientebze dakvirvebiT
miRebuli monacemebi Seadares mSl-is dones
1799 pacientSi, romelTac ar ganuviTardaT gid.
mamakacebSi mSl-is done Seadgina 1.63 ng/mg-
gid mqone pirebSi da 1.2 ng/mg- pirebSi sakont-
rolo jgufidan. qalelebSi es sxvaoba iyo Za-
lian mcire 1.02 da 1.01 ng/mg Sesabamisad. C-reaq-
tiul cilaze gadaangariSebiT (gadasworebiT)
mamakacebSi gid-is ganviTrebis SefardebiTi
Sansi Seadgina 1.59 mSl-s maqsimaluri monaceme-
bisaTvis (me-4 kvartili) 1 kvartilTan Sedare-
biT. Qalebs Soris analogiuri damokidebule-
ba ar dadasturda. Avtorebi aRniSnaven: ar aris
gamoricxululi, rom miRebuli monacemebi gar-
kveul wilad xsnis gid ganviTarebis riskis
sxvaobas mamakacebsa da qalebs Soris.
Tu gadavxedavT msoflios wamyvan bioteq-
nologiur firmebs, romlebic biopreparatebis
sinTezs awarmoeben – SeiZleba Segvxdes leq-
tinebis didi CamonaTvali , maT Soris aris e.
w. moniSnuli leqtinebi da a. S. leqtinebi ga-
moiyeneba sxvadasxva genetikuri paTologiebis
diagnostikisaTvis, zogierTi mkroorganizmis
identifikaciisaTvis, kvleviT saqmianobaSi.
magram leqtinemi bioteqnologiaSi gamo-
iyeneba ufro prozaikul rolSic – specifi-
uri reagentis, romelic amorCeviTad ierTebs
ama Tu im rTul nivTierebas : glikoprotei-
debs, hormonebs, sialoproteidebs da a.S. ase
rom leqtinebis preparatebis meSveobiT Seg-
viZlia miviRoT ufro mniSvnelovani, ufro
Rirebuli nivTierebebi, romelic mZme daava-
debebis mkurnalobaSi dagvexmareba.
sakmaod prospeqtulia axali Taobis leq-
tinebis Seqmna – -leqtinebisa da antisxeule-
bis hibridebis, sxvadasxva qsovilebze zemoqme-
debisaTvis, sadac leqtinebis zemoqmedeba ar
aris mavne. erT-erTi msgavsi cda awarmoa doq-
tor andress engert-ma kiolnSi. Limfuri kvan-
Zebis kibos samkurnalod man gamoiyena antis-
xeulebTan dakavSirebuli ricini. antisxeuli
amorCeviTad miitanda ricins – simsivnesTan.
Ra Tqma unda es mxolod pirveli nabijebia
leqtinebis medicinaSi gamoyenebis, magram, zus-
tad amitom is aseTi mniSvnelovania.
literatura:
1. www.fit-area.com
2. www.medlinks.ru/article.php?sid=26720
3. www.pereplet.ru/obrazovanie/stsoros/254.html
4. bio-medicine.org
5 . w w w. c h e m n e t . r u / r u s / j o u r n a l s / m e m b r a -
nes/22/ref0058.html
6. )0
.Y.
doqtor t. keleri da misi kolegebi, ams- 
. :  =
., 1981.
terdamis samedicinoakademiur centridan, Ca- 7.
 .3. )
0 
 

 //
atares prospeqtuli kvleva : )
  
. -* $* '
-
«SemTxveva-kontroli» SearebiT janmrTel +
 *:. ., 1984. ". 1.
@__) otkb
 40 ,fdidsf rfhlbjkjubf
maRali kvalifikaciis moWidaveebis
sawvrTno procesebis marTva
m.m.d. akad. z. kaxabriSvili piriqiT, rodesac farTod moixmareba sxva-
m.m.d. prof. akad. g. CaxunaSvili dasxva farmakologiuri saSualebebi da maT
Soris iseTi preparatebic ki, romlebic Sem-
m.m.d. akad. k. CaxunaSvili dgomSi iwveven sportsmenis organizmSi mra-
val paTologiur cvlilebebs.
Tanamedrove Widaobis saxeobebisaTvis da-
1992 wlidan saqarTvelo SeuerTda saer-
maxasiaTebeli fizikuri datvirTvebis mocu-
TaSoriso olimpiur moZraobas da gaxda mi-
loba praqtikulad uaxlovdeba adamianis or-
si sruluflebiani wevri, xolo 2002 wels xe-
ganizmis SesaZleblobaTa zRvars. Aaqedan ga-
li moewera antidopingur saerTaSoriso
modinare, saWiroa ara mxolod sportsmenTa
konvencias. aRniSnuli garemoeba avaldebu-
samedicino gamokvlevebi, aramed organizmis
lebs yvela pirovnebas, romelic erTiandeba,
funqciuri mdgomareobis dinamikis mudmivi
emzadeba an raime formiT monawileobs saer-
kontroli, risTvisac saWiroa axali saimedo
TaSoriso olimpiuri komitetis (IOC) egidiT
mecnieruli meTodebis Zieba specifikuri da
Catarebul SejibrebebSi, daemorCilos msof-
araspecifikuri funqciuri sinjebis Seqmnis
lios antidopinguri saagentos (WADA) same-
mizniT, rac xels SeuwyobsAsportsmenTa saw-
dicinio kodeqs.
vrTno procesis optimizirebas.
unda aRiniSnos, rom aucilebelia Camova-
sportsmenTa Sromisunarianobis zusti
yaliboT maRali kvalifikaciis moWidaveebis
gansazRvra da masze farmakologiuri saSua-
meTodika, romelic saSualebas mogvcems Seva-
lebebis dadebiTi efeqtebis gamovlena Tana-
fasoT specifikuri da araspecifikuri Sro-
medrove sportuli medicinis erT-erTi yve-
misunarianobis sxvadasxva maCvenebeli, maT
laze aqtualur problermaTa ricxvs gane-
safuZvelze movaxdinoT sawvrTno procesis
kuTvneba.
koreqcia da sportsmenTa arsebuli funqciu-
amasTan dakavSirebiT, saWiro xdeba orga-
ri SesaZleblobebis safuZvelze ganvsazRv-
nizmis da misi calkeuli sistemebis adapta-
roT saSejibro orTabrZolebis taqtika.
ciuri reaqciebis fiziologiur Tavisebure-
_ maRali kvalifikaciis moWidaveebis funq-
baTa specifikis, sxvadasxva mimarTulebis fi-
ciuri SesaZleblobebis efeqturi Sefaseba
zikuri datvirTvebisa da farmakologiuri
mWidro urTierTkavSirSia sportsmenTa momza-
saSualebebis organizmze zegavlenis gan-
debis fazebis SinaarsTan. mosamzadebeli eta-
sazRvra.Mmravalricxovani gamokvlevebiT
pis pirvel nawilSi mizanSewonilia kompleq-
dadgenilia, rom fizikuri wvrTnis gavleniT
suri samedicino gamokvlevebi, zogadi Sromi-
matulobs moWidavis organizmis funqciuri
sunarianobisa da maqsimaluri fizikuri Zalis
SesaZleblobebi, izrdeba rogorc aerobuli
sxvadasxva maCveneblebis gansazRvris mizniT.
Sromisunarianoba, aseve anaerobuli gliko-
_ sawvrTno procesSi anaerobuli varji-
zuri da anaerobuli alaqtaturi simZlavre-
Sebis CarTvisTanave mniSvnelovnad izrdeba
ebi. amasTan erTad, Tanamedrove sportuli
im specifiuri funqciuri sinjebis gamoyene-
medicines praqtika mowmobs, rom fiziologi-
bis aucilebloba, romlebic maqsimalurad
uri normis farglebSic ki SesaZlebelia fi-
iTvaliswineben konkretuli saxeobis orTab-
zikuri datvirTvebis iseTi reJimebis gamoye-
rZolebisaTvis damaxasiaTebel fiziologi-
neba, romelic ar gamoiwvevs moWidaveTa or-
ur Taviseburebebs.
ganizmis gamofitvas da saSualebas mogvcems
_ aseve gansakuTrebuli yuradReba unda
mivaRwioT momzadebis mocemuli etapebisaT-
gamaxvildes moWidaveebis gul-sisxlZarRvTa
vis dasaxul mizans.
sistemis adaptaciisa da morfologiuri pa-
Tanamedrove maRali sportuli Sedegebis
rametrebis kontrolze, sportsmenTa asakisa
miRwevis rTul gzaze farTod gamoiyeneba
da sportuli staJis gaTvaliswinebiT.
sxvadasxva farmakologiuri saSualebebi da
_ sportis iseT saxeobaSi, rogorc aris
biologiurad aqtiuri danamatebi (bad.) am
Widaoba, warmoudgenelia raime seriozul
TvalsazrisiT arsebobs ori ukiduresad
warmatebaze fiqri, maRali teqnologoiebisa
mcdari azri. erTi _ rodesac sportsmenTa
d im kompiuteruli programebis gareSe, rom-
momzadebaSi mTlianad uaryofilia farmako-
lebic saSualebas gvaZleven Tvalyuri va-
logiur saSualebaTa gamoyeneba da meore _
devnoT sportsmenebis ara mxolod mimdinare
@__) otkb
,fdidsf rfhlbjkjubf
funqciur SesaZleblobebs, aramed vivarau-
doT organizmis energetikuli uzrunvelyo-
fis mosalodneli disbalansi.
_ maRali kvalifikaciis moWidaveebis or-
ganizmis funqcionirebis, ekonomiurobisa da
simZlavris Tvisebebis amaRlebisa da Senar-
CunebisaTvis aucilebelia gamoyenebul iqnas
kvebiTi substratebi, kvebiTi danamatebi da
biologiurad aqtiuri nivTierebebi, zogadi
da specifiuri fizikuri Sromisunarianobis
optimizaciis mizniT; Tumca moWidaveebis da-
Zabuli saSejibro ganrigis gaTvaliswine-
biT, verc farmakologiuri saSualebebis ga-
moyenebas avicilebT Tavidan. Aam SemTxvevaSi
gansakuTrebuli yuradReba unda gamaxvil-
GFHFCFVREHYFKJ GHTGFHFN 3VTY}-EYBC4
RKBYBREHB RDKTDBC ITLTUT<B
ntm8v8l87 ghja8 D8 [JCBNFIDBKB7
v8v8l8 ghja8 FD8 RJZKFVFPFIDBKB7
ghja8 U8 XF[EYFIDBKB8
cfmfhsdtkjc ihjvbc7 ]fhvhstkj,bcf lf cj-
wbfkehb lfwdbc cfvbybcnhjc cfvtlbwbyj cf[tkv-
obaj htuekbht,bc cffutynjc eahjcbc ,h’fyt,bc
sfyf[vfl ~!%8_$8 @__( 1!#)/N` ufbwf yt,fhsdf hjv
xfudtnfht,byf i8 g8 c8 3gbuvtynbc4 vbth ofhvjt,ekb
afhvfrjkjubehb cfiefkt,bc 3vty]-eybc4 rkbyb-
rehb rdktdt,b7 rfdibhb 3cfmfhsdtkjc cfpqdfhuf-
htsbc mdt.yt,bc sfyfvtuj,ht,bc4 cfthsfijhbcj
cfpjufljt,bc rfhltjkjubehb rf,bytnbc ,fpfpt8
ufdtwfybs gfhfcfvrehyfkj ghtgfhfn 3vty]-
eybc4 mbvbeh itlutybkj,fc7 vbcb vbqt,bc afhvf-
wtdnek ntmyjkjubeh cmtvt,c7 afhvfrjgtekb
cnfnbbc vjyfwtvt,c lf bv tmdcb atyjkeh yfth-
st,bs vlblfh vwtyfhtek ytlktekt,bc mbvbeh
itvwdtkj,fc7 hbcufyfw vpfllt,f gfhfcfvrehyf-
kj cfiefkt,f 3vty]-eyb48
ghtgfhfnb afhvcnfnbbc vjyfwtvt,bc vb[tldbs
ofhvjlutybkbf hjujhw uekcbc[k’fhqdsf pjub-
thsb lffdflt,t,bc cfvrehyfkj cfiefkt,f7 fctdt
bub [fcbfslt,f hflbjghjntmnjhekb sdbct,bs8
kbnthfnehekb vjyfwtvt,bc vb[tldbs at-
yjkehb yfthst,b fcrjh,by v;fdfcsfy thsfl fv-
;qfdyt,ty P dbnfvbyeh fmnbdj,fc7 fath[t,ty
athvtyn ubfkehjyblfpfc vjmvtlt,fc lf [tkc
eikbfy ubfkehjybc v;fdbc ofhvjmvyfc7 tc erf-
yfcrytkb rb fs[tkt,c cbc[k’fhqdt,c lf bodtdc
jhufybpvib /tvfnjvt,bc ofhvjmvyfc8
ufvjvlbyfht fmtlfy atyjkehb yfthst,b udtd-
kbyt,f hjujhw uekcbc[k’fhqdsf lffdflt,t,bc
c[dflfc[df cfvrehyfkj cfiefkt,f8 hfw itt[t,f
@__) otkb
41
des biologiurad aqtiuri kvebiTi danamate-
bis da farmakologiuri saSualebebis anti-
dopingur xasiaTze, maTi miRebis aucileblo-
bis urTierTkavSirze sportsmenTa momzade-
bis sxvadasxva etapTan.
da bolos mraval avtorTa gamokvlevebis
Sedegebi naTlad miuTiTebs farmakologiuri
saSualebebisa apivitis, apikoris, apipulmos,
apihepatisa da sxvaTa biologiurad aqtiuri
kvebiTi danamatebis `iveriulis~ da sxvaTa da-
debiT efeqtebze maRali kvalifikaciis moWida-
veebis zogad da specifiur Sromisunarianoba-
ze, maTi racionalurad gamoyenebis SemTxveva-
Si, WADA-s da saerTaSoriso olimpiuri komi-
tetis samedicino kodeqsis gaTvaliswinebiT.
atyjkehb yfthst,bc hflbjghjntmnjhek sdb-
ct,t,c7 wyj,bkbf7 hjv atyjkehb yfthst,b fmnb-
ehfl vjmvtlt,ty hjujhw xdtekt,hbd7 bctdt v’b-
vt vtnfkt,pt jhufybpvib7 ufvjktmfdty vfc lf if-
hlbc cfiefkt,bs ufvjbltdyt,bfy jhufybpvblfy8
ghtgfhfnb mbvbehb itvwdtkj,bcf lf ntmyjkj-
ubehb cmtvbc vjyfwtvt,bc vb[tldbs vpfllt,f ^ at-
yjkeh yfthst,bs vlblfh vwtyfhtsf yfrht,bc sf-
yf,fhb hfjltyj,bs ~/fthvihfk vlujvfhtj,fib`8
tctybf5 .eh’ybc zfzf7 ve[bc yf[th[b7 ltrf7 shbvkb7
baybcf lf abzdbc obodt,bcf lf .kjhnt,bc ]fvb8 hf-
lufy .dtkf xfvjsdkbkb vwtyfhtt,b [fcbfslt,bfy
atyjkt,bcf lf gjkbatyjkt,bc vlblfhb itvwdt-
kj,bs ~vwtyfhtsf yfrht,bc ufthsbfyt,ek tmcn-
hfmnib jhv[hbd mhjvfnjuhfvfpt xfyc @) kfmf8 vfs
ijhbc [esb ljvbyfynehb hfjltyj,bsff7 nfybye-
hb lf akfdfyjblehb ,eyt,bc`8 bcbyb fv;qfdyt,ty P
dbnfvbyeh fmnbdj,fc7 hjujhw cbc[k’fhqdt,bc
ufvfuhbkt,tk7 fctdt cbc[kxfmwtdt,bc cfobyffqv-
ltuj cfiefkt,fc lf ufvjb.tyt,f uekcbc[k’f-
hqdsf cbcntvbc lffdflt,fsf cfvrehyfkjl8
VFCFKF LF VTSJLBRF
xdtyc vbth cfpqdfhufhtsbc mdt.yt,bc sfyfvt-
uj,hj,bc cfthsfijhbcj ghjabkfmnbreh rfh-
lbjkjubeh wtynhib ufvjrdktekb bmyf #% okb-
lfy *% okfvlt fcfrbc #_ fdflv.jab8
fdflv.jat,b lbfuyjpt,bc vb[tldbs ufyfob-
klf itvltuyfbhfl5
!% 2 fdflv.jac fqtybiyf uekbc bitvbehb lf-
fdflt,f8
% 2 fdflv.jac fqtybiyf dtutnfnbehb lbcnj-
ybf /bgthcbystybehb ajhvbc8
^ 2 fdflv.jac fqtybiyf fyubjytdhjpekb
cntyjrfhlbf8
 42 ,fdidsf rfhlbjkjubf
% 2 fdflv.jac fqtybiyf fhnthbekb /bgthnt- dbkt,b7 flubkb /mjylf cntyjrfhlbekb nrbdb-
ypbf8 kt,bc ufbidbfst,fc7 [jkj bv fdflv.jasf vwbht
fvfdt lhjc cfrjynhjkj ]ueac itflutylf ]ueac7 hjvtksfw fqtybiyt,jlfs cntyjrfhlb-
@_ fdflv.jab8 ekb cf[bc nrbdbkt,b7 acbmjkjubehb lf’f,e-
b[bkts w[hbkb 1! kj,bcf lf dtutnfnbehb ythdekb cbcntvbc vji-
kbkj,f7 fye fyubjytdhjpekb cntyjrfhlbf7
lftmdtvlt,fhf xfnfht,ek vrehyfkj,fc itvs[-
dtdfsf evhfdktcj,fib8 uhfabrb 1!
cntyjrfhlbekb nrbdbkt,bc ufyfobkt,f
ofvkbc vbqt,fvlt lf vbqt,bc itvltu8

fdflv.jasf rdktdf vbvlbyfhtj,lf qhvf

rkbybrj-kf,jhfnjhbekb lf bycnhevtynekb
vtsjlt,bs ~tktmnhjrfhlbjuhfabekb7 tmjrf-
hlbjuhfabekb7 cfthsj mjktcnthbybc ufycf-
pqdhf lf cbc[kbcf lf ifhlbc cfthsj fyfkbpt-
,bc ufvjrdktdbs`8
fdflv.jat,b bqt,lyty ghtgfhfn 3vty]-eyc47
hjvtkbw ofhvjflutyc tmdcb atyjkehb yfthst-
,bs vlblfh vwtyfhtsf sfyf,fhb hfjltyj,bc yf-
rht,bc tmcnhfmnc7 hjvtkibw mhjvfnjuhfabe-
kb vtsjlt,bs itcofdkbkbf @) cf[bc kfmf ~vfs
ijhbc ljvbyfynj,c % nfybyehb lf akfdfyjble- hfw itt[t,f cbc[kib vjvfnt,ekb mjktcnt-
hb ,eyt,bc yfthst,b`8 hbybc ljytc ths]thflb !% lqbfyb vrehyfkj,bc
ufycfpqdhekbf ghtgfhfn 3vty]-eyib4 itvf- rehcbs7 vjvfnt,ekb mjktcnthbybc ljyt evyb-
dfkb sdbstekb vwtyfhbc tmcnhfmnbc7 fctdt uft- idytkjl bmyf itvwbht,ekb8 ufvjvlbyfht fmt-
hsbfyt,ekb cfthsj ]fvbc fynbjmcblfynehb lfy7 !% lqbfyb rehcb eylf uf[fyuh’kbdltc8
sdbct,t,b7 bcbyb [fcbfslt,bfy vfqfkb fynbjmcb- b[bkts uhfabrb 1@
lfynehb fmnbdj,bs8 cbc[kib mjktcnthbybc ljybc vjyfwtvt,b
ptvjs fqybiyekb atyjkehb yfthst,bc itv-
wdtkb ,bjkjubehfl fmnbehb rjvgjytynt,b vt-
lbwbyfib b[vfht,f7 hjujhw uekcbc[k’fhqdsf
lffdflt,t,bc7 fctdt fdsdbct,bfyb cbvcbdytt,bc
vrehyfkj,bcfc lf fv;qfdyt,ty hflbjghjntm-
njhek sdbct,t,c8
bv !% gfwbtynblfy lffdflt,bs uekbc bitvb-
eh * fdflv.jac fqtybiyf vbjrfhlbevbc byaf-
hmnbc itvlujvb gthbjlb8 fdflv.jasf ptvjfq-
ybiyekb rjnbutynblfy * mfkb lf @$ rfwb 3vty]-
eyc4 qt,ekj,lyty itvltub ljpt,bs5 ghtgfhf-
nbc #%-$_ vk uhfvc fdct,ty !__ vk/vlt o.kbs8
qt,ekj,lyty lqtib cfv]th zfvbc oby @_ oesbs
flht8 vrehyfkj,bc rehcbc [fyu’kbdj,f itf- fhnthbekb /bgthntypbbc lhjc xdtyb rdkt-
lutyc !%-@! lqtc8 vrehyfkj,bc ghjwtcib gfhf- dt,bc cfae’dtkpt 3vty]-eyb4 vrdtsh ptufdkt-
ktkehfl lfrdbhdt,f nfhlt,jlf cbc[kbc kb- yfc dth f[ltyc lf bub yfrkt, tatmnehbf7 hfw it-
gbleh wdkfpt8 t[t,f byafhmnbc itvlujv gthbjlc 3vty]-eyb4
hjujhw cfhtf,bkbnfwbj cfiefkt,f ofhvjf-
VBQT<EKB ITLTUT,BC FYFKBPB lutyc ths-ths cfertstcj ghtgfhfnc8 gfwbt-
bv gfwbtynt,c7 hjvtksfw fqtybiyt,jlfs ue- ynt,c vbjrfhlbjvbc vodfdt byafhmnbc itvlujv
kbc bitvbehb lffdflt,t,bs ufygbhj,t,ekb c[- gthbjlib7 hjvkt,bw exbjlyty cfthsj cbce-
dflfc[df byntycbdj,bcf lf kjrfkbpfwbbc nrb- cntc7 abpbreh e’kehj,fc7 fldbkfl lfqkbkj-
@__) otkb
,fdidsf rfhlbjkjubf
,fc7 ghtgfhfn 3vty]-eybc4 vbqt,bc !% lqbfyb re-
hcbc itvltu fqybiyekb xbdbkt,b vjt[cyfs8 b[b-
kts w[hbkb 1@
ghtgfhfn 3vty]-eybc4 rkbybrehb ybiyt,bc
lbyfvbrf
w[hbkb 1@
ghtgfhfnbc vbqt,bc itvlujvb
rkbybrehb
ybiyt,bc rkbybrehb ybiyt,bc lbyfvbrf8
lfcf[tkt,f8 lfhxf bubdt itvwbhlf vjbvfnf
cfthsj cbcecnt +++
abpbrehb
e’keht,f ++
fldbkfl lfqkf ++
LFCRDYF
xfnfht,ekb rdktdt,bc cfae’dtkpt itudb’-
kbf ufvjdbnfyjs itvltub lfcrdyt,b8
>eh’ybc zfzblfy kbgblehb ,eyt,bc
yfthst,bc bltynbabrfwbf lf vfsb
ufvj.tyt,f ghtgfhfnt,bc 3vty]-eybcf4 lf
3fgbrjhbc4 vbqt,bc ntmyjkjubeh ghjwtcib
ntm8v8l87 ghja8 D8 [JCBNFIDBKB7
ghja8 U8 XF[EYFIDBKB7 K8 {JCBNFIDBKB
v8v8l8 R8 XF{EYFIDBKB8
.eh’ybc zfzblfy kbgblehb ,eyt,bc yfthst-
,bc bltynbabrfwbf lf vbcb ufvj.tyt,f ghtgfhfn
3vty]-eybc4 lf 3fgbrjhbc4 vbqt,bc ntmyjkjub-
bc ghjwtcib
d8 [jcbnfidbkb7 u8 xf[eyfidbkb7 k8 [jcbnfi-
dbkb7 r8 xf[eyfidbkb8
.eh’ybc uflfveifdt,bc itltufl vbqt,ekb vj-
yfhxtyt,b ud[dlt,f qdbybc ktmbc 2 s[kbcf lf zf-
zbc cf[bs7 hjvtkbw itflutyc uflfveifdt,ekb
.eh’ybc !(-@_ ghjwtync8 .eh’ybc itvflutytkb
yfobkt,b ofhvjflutyty vybiydtkjdfy cfrdt, ghj-
lemnt,c lf vfsb vjyfhxtyt,blfy itb’kt,f vbqt-
,ekb bmyfc rdt,bsb qbht,ekt,bc ghjlemnt,b8
.eh’ybc zfzf ofhvjflutyc .eh’ybc lfoehdbc
itvltu ufvjyfoyt[c7 hjvtkbw itlut,f vntdybc
vtmfybrehb yfobkt,bcfufy8 zfzf itlut,f vstkb
uflfveifdt,ekb .eh’ybc !* ghjwtynbcufy8 lfe-
leqfhb zfzf itbwfdc sfdbcb ojybc %_ ghjwtyn
.eh’ybc odtyc8 f[fkb ufvjyfoyt[b zfzf ntybfyj-
,bs $(-%% ghjwtynb itbwfdc .eh’ybc rfyc %#-%)
ghjwtynb7 .eh’ybc ob,ofc @#-#) ghjwtynb7 rkt-
@__) otkb
43
!8 ghtgfhfnb 3vty]-eyb4 sfdbceakfl itb’-
kt,f ufvj.tyt,ekb bmyfc fv,ekfnjhbek fdfl-
v.jat,sfy7 hflufy vrehyfkj,bc ghjwtcib fh
bmyf itvxytekb udthlbsb vjdktyt,b lf c[dflf-
c[df cf[bc bylbdblefkehb itesfdct,kj,f8
@8 cfthsj mjktcnthbybc ljybc itcfvwbht-
,kfl ghtgfhfn 3vty]-eybc4 ufvj.tyt,bc !% lqb-
fyb rehcb ufhrdtekobkfl tatmnehbf lf cfzb-
hjt,c ljpbht,bc uf[fyu’kbdt,fc8 bubdt itt[t,f
fhnthbek /bgthntypbfc8
#8 ghtgfhfnb 3vty]-eyb4 cfuh’yj,kfl tatm-
nehbf fyubjytdhjpekb cntyjrfhlbbs lffdf-
lt,ekb gfwbtynt,bcsdbc8
$8 ghtgfhfnb 3vty]-eybc4 rkbybrehvf rdktdt-
,vf vbjrfhlbevbc vodfdt byafhmnbc itvlujv gt-
hbjlib vjudwf cfertstcj itltut,b lf vbcb tat-
mnehj,f fqtybiyt,f gfwbtynsf (_ ghjwtync8
vtlbwbybc vtwybtht,fsf ljmnjhb7 ghjat-
cjhb fdsfylbk rjzkfvfpfidbkb8
hnbc yfhxtyc !7_-#7# ghjwtync lf h,bkj,c !%-
#% ghjwtync8 ufihj,bc itvltu zfzf itlut,f vi-
hfkb ybdsbtht,t,bs @%-#* ghjwtynb7 rfyb !%-@$
ghjwtynb7 ob,of @!-@% ghjwtynb7 [jkj sdbsjy
fqvjcfdkts cfmfhsdtkjc .eh’ybc vntdfyb cf-
iefkjl itbwfdc5 rkthnc @7@-% ghjwtync7 rfyc
*-!^ ghjwtynb7 ob,ofc !7@-%7$ ghjwtync7 [jkj
lfcfdkts cfmfhsdtkjc .eh’yt,b itbwfdty5
rkthnc #-) ghjwtync7 rfyc (-!_ ghjwtync7 ob-
,ofc @-% ghjwtync8 ~kfi[b !)*_7 fdfkbfyb !)^)`
.eh’ybc ob,obc itvwdtkj,f zfzfib ’fkbfy c[-
dflfc[dfyfbhbf lf itflutyc yf.jabc vstkb vf-
cbc lff[kjt,bs @-* ghjwtync lf !-% ghjwtync
vntdybc ojybcf8 ufv[vfh zfzfib rb ofhvjflutyc
@!-#_ ghjwtync8 .eh’ybc ob,ofc qt,ekj,ty hj-
ujhw cdtkb zfzblfy7 fctdt ufvihfkb zfzblfy
cgtwbfkehb fgfhfnt,bc cfiefkt,bs8 .eh’ybc
zfzblfy kbgblehb ,eyt,bc yfthst,bc7 yf]thb
lf e]thb hbubc w[bvjdfyb v;fdt,bc bltynbabrf-
wbf vjdf[lbyts itvltub sfyvbvltdhj,bs5
!% uh8 /fthufvihfk zfzfc lfdfvfnts !%_ vk8
kbnhb tsfyjkb8 ~htmnbabmfnb` dehbts ^ cs8 @_-
@%OC-pt7 vfuybnehb cfhtdtkfc cfiefkt,bs8 it-
vltu ufdabknhts7 lfhxtybkb vfcf xfdhtw[ts %
vk8 kbnhb tsfyjkbs8 ufthsbfyt,ekb abknhf-
nt,b ufdfthsbfyts8 lfdevfnts ! vk8 kbnhb rjy-
 44
wtynhekb vfhbkv;fdf lf ufdfw[tkts # cs8 *_OC-
pt8 ufwbdt,bc itvltu vfcf ufdfytbnhfkts wfhwbs8
itvltu ufdabknhts7 abknhfnb fvjdfihts ,j-
kjvlt8 vbqt,ekb yfisb ufd[ctybs gtnhjktbybc
tsthb-tsth yfpfdib8 ~!)5!`8 [cyfhb itdbnfyts cdt-
npt lfcf.jafl7 hjvtkbw vjvpflt,ekb b.j fke-
vbybc ;fyubs8 cdtnb ufvjdhtw[ts7 ufv[cytkt,bc
yfpfdbs ~!)5!` gtnhjktbybc tsthb-tsthb8
cehfsb !
zfzbc tmcnhfmnbc w[bvjdfy v;fdfsf tsbkbc
tstht,bc ~vbqt,ekb tsfyjkbc cfiefkt,bs` uf-
peh-cbs[ehb mhjvfnjuhfvf8
!8 gbrb tsbkgfkvbnfnb @@8# ghjwtynb8
@8 gbrb tsbkcntfhfnb !_8@ ghjwtynb8
#8 gbrb tsbkjktfnb @)8( ghjwtynb8
$8 gbrb tsbkkbyjktfnb #*8_ ghjwtynb8
ahfmwbt,c dfuhjdt,lbs @_-@_ vk8 kbnh hfj-
ltyj,bs lf dcofdkj,lbs s[tkatyjdfyb mhjvf-
njuhfabbc cfiefkt,bs8 cbcntvfib gtnhjktbybc
tsthb-tsthb ~)5!` ahfmwbf @-lfy !^-vlt itbwfdlf
bylbdblefkehfl w[bvjdfy v;fdfsf tstht,c7 bub
ufdfthsbfyts lf itdfcmtkts8 vbdbqts _8@% uhfvb
ghjlemnb7 hjvtkbw itdbcofdkts ufpeh-cbs[e-
hb mhjvfnjuhfabbc cfiefkt,bs8 cehfsb #^8 xfnf-
ht,ekb rdktdt,bc itltut,b7 w[bvjdfyb v;fdt,bc
lf vfsb tstht,bc vbqt,bc vbpybs7 ~.eh’ybc zfzb-
lfy` vjwtvekbf ^ w[hbkib8 vjwtvekb w[hbkblfy
itb’kt,f ufvjdbnfyjs lfcrdyf8 jgnbvfkeh itlt-
ut,c udf’ktdc zfzbc v;fdehb vtsfyjkbpb lf tsf-
yjkbpb8 tmcnhfmnt,bc ufvjcfdfkb itflutyc $_7$
lf #*7_ uh/ru zfzfpt8 fvfcsfy thsfl ufvj.jabkb
tsbkbc tstht,b itbwfdc evfqktcb hbubc e]thb
hbubc w[bvjdfy jktbybc lf kbyjktyjkbc v;f-
dt,c7 hjvkt,bw ofhvjflutyty vtnfl ’dbhafc
ghjlemnc flfvbfybc ]fhvhstkj,bcsdbc8
.eh’ybc zfzfpt xfnfht,ekb evfqktcb hbubc
w[bvjdfy v;fdfsf vbqt,bc tmcgthbvtynt,bc itltut,b8
vfu8 !8 v;fdehb vtsfyjkbpb8 evfqktcb hbubc
w[bvjdfy v;fdfsf hfjltyj,hbdb itlutybkj,f8
!8 gfkvbnbybc v;fdf !^8^ ghjwtynb8
cnbfhbybc v;fdf %8) ghjwtynb8
jktbybc v;fdf @@8% ghjwtynb8
kbyjktybc v;fdf %%8_ ghjwtynb8
vfu8 !-ib zfzf fdbqts !% uh8 lf lfdfvfnts %_
vk8 kbnhb # ghjwtynfvlt vfhbkv;fdbs itv;f-
dt,ekb vtsfyjkb8 HCE rjywtynhekb vfhbkv-
;fdf %_ vk8 kbnhb vtsfyjkbs8
vfu8 @8 v;fdehb vtsfyjkbpb8 fdbqts !% uh8 zf-
zf lf lfdfvfnts %_ vk8 kbnhb % ghjwtynfvlt
itv;fdt,ekb vtsfyjkb8 vbqt,ekb evfqktcb hb-
ubc w[bvjdfy v;fdfsf itltut,b5
,fdidsf rfhlbjkjubf
gfkvbnbybc v;fdf !(8@ ghjwtynb8
cnbfhbybc v;fdf $8@ ghjwtynb8
jktbybc v;fdf @@8) ghjwtynb8
kbyjktybc v;fdf %#8) ghjwtynb8
vfu8 #8 v;fdehb tsfyjkbpb8 !% uh8 /fthuf-
vihfk zfzfc lfdfvfnts !__ vk8 kbnhb f,cjke-
nehb cgbhnb7 itv;fdt,ekb @ vk8 kbnhb rjywty-
nhekb ujubhlv;fdbs8 itltut,b5
gfkvbnbybc v;fdf !#8* ghjwtynb8
cnbfhbybc v;fdf %8( ghjwtynb8
jktbybc v;fdf @#8_ ghjwtynb8
kbyjktybc v;fdf %*8% ghjwtynb8
vfu8 $8 nent tsfyjkbpb8 !% uh8 zfzfc lfdfvf-
nts !__ vk8 kbnhb f,cjkenehb cgbhnb8 itv;f-
dt,ekb @ ghjwtynb ~KOH` rfkbevbc nenbs8
vbdbqts itltut,b5
gfkvbnbybc v;fdf !%8% ghjwtynb8
cnbfhbybc v;fdf (8* ghjwtynb8
jktbybc v;fdf @#8@ ghjwtynb8
kbyjktybc v;fdf %@8* ghjwtynb8
vfu8 %8 nent ublhjkbpb8 ^_ uh8 zfzfc lfdfvf-
nts @%_ vk8 kbnhb # ghjwtynbfyb KOH-bc o.f-
k[cyfhb8 itltut,b5
gfkvbnbybc v;fdf @_8^ ghjwtynb8
cnbfhbybc v;fdf !@8$ ghjwtynb8
jktbybc v;fdf @#8_ ghjwtynb8
kbyjktybc v;fdf $$8_ ghjwtynb8
vbqt,ekb vtsjlt,bc cfiefkt,bs ths ru8 /f-
thvihfk lfamdbk zfzblfy dqt,ekj,s $_ uh8
w[bvjdfy v;fdfsf tstht,c8
kbyjktybc tsthc %_ ghjwtynpt vtnc8
jktbybc @_-@% ghjwtync8
uf]tht,ek v;fdt,c @% ghjwtynpt vtnc7 vfs
ijhbc cnbfhbybc v;fdf %-( ghjwtync7 [jkj gf-
kvbnbybc v;fdfc !^-!* ghjwtync8
uf]tht,ekb v;fdt,b cfzbhjt,bc itvs[dtdfib
itb’kt,f ufvjwfkrtdt,ekb b.jc ifhljdfy v;f-
dbc cfiefkt,bs fy lf,fk ntvgthfnehfpt jhuf-
yek [cyfhib rhbcnfkbpfwbbs8
xdtyc itvs[dtdfib7 ghtgfhfn 3vty]-eybc4 lf
3fgbrjhbc4 itvflutykj,fib itcfnfyfl dfvpf-
lt,s vt-% vfufkbsib fqothbk ntmyjkjubfc7 cf-
lfw nent ublhjkbpb vbvlbyfhtj,c @-# ghj-
wtyn rfkbevbc nenbc o.fk[cyfhib8 fqybiyekb
ntmyjkjubbc ghjwtcbc itltufl vbqt,ek tmcn-
hfmnib e]thb hbubc w[bvjdfyb v;fdt,b itflutyc
#@-#% ghjwtync lf e]thb hbub w[bvjdfyb v;fdt-
,b7 jktbybc v;fdf @# ghjwtynb lf kbyjktybc
v;fdf $$ ghjwtynb7 hjvtkybw ofhvjflutyty
flfvbfybc jhufybpvbcsdbc itewdktkb e]thb
hbubc w[bvjdfy v;fdt,c7 hjvkbc yfrkt,j,bc
ghjwtcib jhufybpvib bhqdtdf [tkf[fkb e]ht-
lbc ofhvjmvybc aeymwbf8
@__) otkb
,fdidsf rfhlbjkjubf
celiakiis diagnostikisa da marTvis
sirTuleebi Saqriani diabetiT
daavadebul bavSvebsa da mozardebSi
c. farulava.
m. gordelaZe. T. goTua.
celiakia anu glutenis enteropaTia gene-
tikurad determinirebuli marcvleulis ci-
la glutenis permanentuli autanlobaa.
glutens Seicavs xorbali, Wvavi, qeri. ar Se-
icavs simindi, wiwibura, brinji (17). SvriaSi
am cilis Semcveloba mcirea da proteinebis
saerTo raodenobis mxolod 5-15%-s Seadgens
(xorbalSi igi 40%-ia), amitom Svriis toqsiu-
ri reaqcia, Tu misi moxmareba ar aRemateba 50
grams dReSi, SeiZleba wlebis manZilze arc
gamovlindes (13).
celiakiis paTogenezi bolomde ar aris
cnobili. aris azri, rom paTogenezuri kaska-
dis elementebia: 1. maspinZlis genetikuri
ganwyoba, romelic ukavSirdeba adamianis le-
ikocitis antigen HLA DQ2 da HLA-DQ8 genebs;
2. glutenis derivatebi (prolini, glutamini),
romlebic Seicaven adamianis HLA-s identur
ubnebs. maTi kompleqsi antisxeulebTan iw-
vevs nawlavis lorwovanSi CD4 ujredebis
aqtivacias, rac dasabams aZlevs autoimunur
procesebs; 3. nawlavis barieruli funqciis
daTrgunva da ganvladobis gazrda (1). hi po-
Tezis doneze SeiZleba imis mtkiceba, rom
nawlavuri infeqciebi, ZuZuTi kvebis adre
Sewyveta da glutenis Semcveli produqtebis
didi moculoba racionSi is amSvebi faqto-
rebia, romlebzec damokidebulia celiakiis
manifestaciis dro (14).
celiakiis samizne organo wvrili nawlave-
bia. imunuri reaqciis sapasuxod viTardeba
lorwovanis hi perregeneraciulia atrofia:
mikroxaoebis damokleba, kri ptebis dagrZele-
ba, epiTelis da lamina proprias infiltra-
cia limfocitebiT. hi perregeneraciuli at-
rofiis princi puli Tavisebureba celiakiis
dros aris misi Seqcevadi xasiaTi da struq-
turis aRdgenis unari glutenis racionidan
amoRebis Semdeg (4). lorwovanis atrofiul
cvlilebebs meoradad mosdevs malabsorbci-
is sindromi: iTrguneba fermentebis gamomuSa-
veba da aqtivoba, irRveva Sesabamisi ingredi-
entebis moneleba da Sewova, xdeba toqsiuri
nivTierebebis sisxlSi moxvedra, cximovani
mJavebis, qolesterinis da naRvlis mJavebis me-
tabolizmis, mikrofloris, vitaminebis da mi-
neralebis cvlis darRvevebi (1, 4).
XX saukunis 70-ian wlebamde celiakia iS-
viaT daavadebaTa ricxvs miekuTvneboda
1:6000-dan 1:1000-mde sixSiriT. XXI saukunis
dasawyisSi Catarebulma masiurma serologi-
@__) otkb
45
urma skriningma aCvena, rom celiakia farTod
gavrcelebuli daavadebaa da misi sixSire
1:80-dan 1:140-mde meryeobs (1,25_0,71%). Tanac
celiakiis SemTxvevebis ricxvi zogad popu-
laciaSi izrdeba (8). Irigis naTesavebSi his-
tologiurad dadasturebuli celiakia uv-
lindeba 4-12%, II rigis naTesavebSi 2,6_5,5%-s
(1). sad aris amdeni daavadebuli? ratom ar
xdeba maTi diagnostika? mkvlevarebis azriT
amis mizezebi SesaZlebelia iyos:
1. samedicino personalis moZvelebuli
warmodgena am daavadebaze;
2. celiakiis klinikuri manifestaciis mra-
valferovneba, ris gamoc
daavadebis simptomatika albaT aRiqmeba
da imarTeba, rogorc sxva
problema;
3. arasworad warmarTuli diagnostikis
procesi.
tradiciulad celiakia Cvilobis asakSi
gamovlenil nawlavuri disfunqciiT mimdinare
daavadebad iTvleboda. bolo monacemebiT ce-
liakia SeiZleba gamovlindes intestinuri sim-
ptomebiT,mxolod eqstraintestinaluri simpto-
mebiT an saerTod asimptomurad. manifestaciis
tipi da dro damokidebulia wvrili nawlavis
dazianebis xarisxze, romelic varirebs minima-
luridan (intraepiTeluri infiltracia lim-
focitebiT) srul vilozur atrofiamde (6). Se-
sabamisad gamohyofen klinikur variantebs:
ti piuri (klasikuri) celiakia – vlindeba
adreul asakSi sakveb racionSi marcvleu-
lis Semcveli produqtebis CarTvidan 1,5–2
Tvis Semdeg. Cveulebriv es 6-8 Tvis asaks em-
Txveva. dominirebs gastrointestinaluri
simptomatika. inicialuri simptomebia: emoci-
uri labiloba, gaRizianeba, agresiuli qceva,
cudi Zili, madis daqveiTeba, sxeulis masis
matebis tempis Seneleba. mogvianebiT vlinde-
ba defekaciis sixSiris zrda, polifekalia,
steatorea, muclis garSemowerilobis moma-
teba, kvebis qronikuli moSla, ucilo SeSupe-
ba, zrdis Seferxeba. SesaZlebelia ganviTar-
des deficituri mdgomareobebis klinikur
niSnebi.
ati piuri celiakia – manifestacia SesaZ-
lebelia nebismier asakSi. dominirebs eqtra-
intestinaluri simptomebi: herpetiformuli
dermatiti, rkinadeficituri anemia, dabali
simaRle, sqesobrivi momwifebis Seferxeba,
menstrualuri ciklis darRveva, meoradi ame-
norea, impotencia, spontanuri aborti, osteo-
porozi, hi povitaminozi, malnutricia, moreci-
dive aftozuri stomatiti, minanqris hi pop-
 46
lazia da sxva. yabzoba an Warbi wona ar ga-
moricxavs diagnozs. daavadebulTa 5-8%-s
aqvs nervul-fsiqiuri darRvevebi (depresia,
periferiuli neiropaTia, ataqsia, epilefsia,
cerebruli kalcifikacia, Sakiki).
waSlili (subklinikuri) celiakia – xang-
rZlivi subklinikuri mimdinareoba. pirveli
klinikuri niSnebi vlindeba mozrdil asakSi
an saerTod xanSiSesulebSi. klinikuri mani-
festacia klasikuri daavadebis msgavsia.
latenturi celiakia – saxezea monosimp-
tomuri klinika da es erTaderTi simptomi
SesaZlebelia iyos eqstraintestinaluri
autoimunuri genezis daavadeba.
potenciuri celiakia – gvxvdeba daavade-
bulTa axlo naTesavebSi. maT Civilebi ar
aqvT, wvrili nawlavis lorwovanis arqiteqto-
nika Secvlili ar aris, magram enterocitebSi
momatebulia intraepiTeluri limfocitebis
ricxvi, xolo sisxlSi aRiniSneba specifiuri
antisxeulebis titris zomieri mateba.
ukanasknel wlebSi yuradReba miiqcia ce-
liakiis da sxvadasxva daavadebebis xSirma
asociaciam (1). diabeti, Tireoiditi, anemia, sak-
roileiti, sarkoidozi, vaskuliti, mioziti, uve-
iti, herpetiformuli dermatiti, hepatiti, at-
rofiuli gastriti, SemaerTebeli qsovilis
sistemuri daavadebebi _ es autoimunuri daa-
vadebebis arasruli CamonaTvalia, romlebTa-
nac celiakia xSirad asocirdeba (19). amis sa-
fuZvelze gamoiTqva mosazreba, rom sakvebi an-
tigenebi garkveul rols TamaSoben autoimu-
nuri daavadebebis ganviTarebaSi. rac ufro
xangrZlivad xdeba gluteniT datvirTva, miT
metia sistemuri autoimunuri daavadebebis
ganviTarebis riski (14 ). garda amisa gaCnda in-
formacia imis Taobaze, rom pacientebs nevro-
logiuri problemebiT (idiopaTiuri ataqsia,
polineiropaTia, zurgis tvinis demieliniza-
cia, mxedvelobis nervis dazianeba da sxva)
xSirad udgindebaT glutenis autanloba. ar
aris gamoricxuli amis mizezi ara marto naw-
lavebSi Sewovis darRveviT gamowveuli B jgu-
fis vitaminebis da mineralebis deficiti, ara-
med autoimunuri procesebic iyos (12).
gansakuTrebul yuradRebas imsaxurebs ce-
liakia diabetiT daavadebul pirebSi. es ori
autoimunuri procesi msgavsi genetikuri gan-
wyobis pirebs uvlindeba. laparakia histoSe-
Tavsebis antigenebze HLA DR3 da HLA DQB1
0201 , romlebic 4-11-jer ufro xSiria am paci-
entebSi. I ti pis diabetiT daavadebul bavS-
vebSi celiakiis albaToba 20-jer maRalia
zogad populaciasTan SedarebiT da 3%-7,7%-
10% (2, 5, 7), xolo ufros asakSi 2-5%-s Seadgens
(9). II ti pis diabetis dros celiakia aseTi
xSiri ar aris, Tumca Warbi wona da simsuqne
risks zrdis. SemTxvevebis 60%-Si celiakiis
diagnoscireba xdeba diabetis gamovlenisTa-
nave, 40%-Si ki wlebis Semdeg. aris kvlevebi,
sadac dadasturebulia, rom kvebis xasiaTs
,fdidsf rfhlbjkjubf
SeuZlia gavlena iqonios diabetis gamovle-
nis albaTobaze. Seiswavles 2800 diabetis mi-
marT genetikurad ganwyobili Cvili. aRmoCn-
da, rom adre (3 Tvemde) dawyebuli fafebiT
kvebis SemTxvevaSi diabetis albaToba 8 wlam-
de asakSi 5-jer metia, anu gluteniT datvir-
Tva zrdis diabetis gamovlenis risks (5).
rogorc wesi celiakia diabetis fonze
ati piurad an saerTod usimptomod mimdina-
reobs. praqtikul endokrinologiaSi e.w.“di-
abetianebis diarea” da polineiropaTia xSi-
ri da Znelad samarTavi problemebia. bolo
wlebis kvlevebma aCvena rom, maTi mizezi ux-
Siresad celiakiaa (7).
aradiagnoscirebuli da aranamkurnalebi
celiakia SesaZlebelia diabetis kontrolis
sirTuleebis mizezi gaxdes gansakuTrebiT
adreuli asakis bavSvebSi (16). xSiria: insu-
linis dozis SerCevis problemebi, hi pergli-
kemiis da hi poglikemiis epizodebis monacv-
leoba. amis axsna albaT ase SeiZleba: malab-
sorbciis gamo adgili aqvs nutrientebis ab-
sorbciis Seferxebas. erTis mxriv pacienti
ganicdis naxSirwylovan deficits, amitom
moTxovnileba ekzogenurad miRebul insu-
linze mcirdeba (1, 2). meores mxriv, iZulebu-
lia miiRos meti martivi Saqrebi: puri, Saqa-
ri, makaroni, brinji da sxva. amas SesaZlebe-
lia mohyves sisxlSi glukozis pikebi, sapa-
suxod xdeba insulinis gamosrola, sisxlSi
Saqris donis swrafi dacema, rac klinikurad
vlindeba hi poglikemiis niSnebiT: SimSilis
grZnobiT, sisustiT, gaRizianebiT, dezorien-
taciiT, mxedvelobis problemebiT. pacienti
iZulebulia kvlav miiRos naxSirwylovani
sakvebi da yvelaferi Tavidan iwyeba.
garda amisa, aseT bavSvebs sarwmunod maRa-
li aqvT Hbt 1c –s maCvenebeli. Hbt 1c anu gli-
kozirebuli hemoglobini naxSirwylovani
cvlis kompensaciis xangrZlivi integraluri
maCvenebelia, romelic saSualebas iZleva di-
di sizustiT SevafasoT diabetis kontrolis
xarisxi. ADA-s (amerikis diabetis akademia) mo-
nacemebiT diabetian bavSvebSi dekompensaciad
iTvleba Hbt 1c < 7,6% (aradiabetianebSi norma 4-6%).
kvlevebiT dadasturebulia, rom Hbt 1c –s 1%-
iT Semcireba daaxloebiT mesamediT amcirebs
sisxlZarRvovan garTulebaTa ricxvs.
ugluteno dietis fonze diabetiT daava-
debul bavSvebs ramdenime TveSi uumjobesde-
baT zrdis parametrebi, moTxovnileba insu-
linze jdeba fiziologiur CarCoebSi, iol-
deba diabetis kontroli, iSviaTdeba hi pog-
likemiis epizodebi (11, 16).
amerikis diabetis akademia (ADA) iZleva
rekomendacias serologiuri skriningi celi-
akiaze rutinulad Cautardes yvela pacients
axlad dadgenili I ti pis diabetiT. vinaidan
serokonversia SesaZlebelia ganviTardes II
_ V dekadaSic, amitom testireba unda perio-
dulad ganmeordes, miT umetes Tu aris zrda-
@__) otkb
,fdidsf rfhlbjkjubf
Si CamorCena, wonis matebis problemebi, masis
kargva an gastroenterologiuri simptomebi
(2). aseve gasaTvaliswinebelia pacientis da
misi ojaxis anamnezuri monacemebi da celi-
akiis potenciuri riski (16).
celiakiis diagnostika unda xdebodes sa-
erTaSoriso kriteriumebis safuZvelze (14, 15):
1. serologiuri testireba _ antisxeule-
bis titris mateba qsovilovani transgluta-
minazis mimarT tTG (IgA, IgG). am testis mgrZno-
biaroba 95-98%, specifiuroba 94-95%, iafia da
amitom sxva testebTan SedarebiT meti praqti-
kuli Rirebuleba aqvs (7, 15, 17). Tu serologi-
uri markerebi pozitiuria, pacientebi miekuT-
vnebian celiakiis risk-jgufs da rekomende-

47
vis RonisZiebebis gatareba, adreuli diag-
nostika da garTulebebis prevencia.
literatura:
1. American Gastroenterological Association Institute.
Medical position Statement on the Diagnostic and
Management of Celiac Desease. Gastroenterology 2006; 131:
1977-1980
2. Barera G, Bonfanti R., viscardi M., et al. Occurence
of Celiac Desease After Onset of Type 1 Diabetes: A 6-
Year Prospective Longitudinal Study. Pediatrics 2002;109:
833-838
3. Bhadada S., Bhansuli A., Kochhar R et al. Growth
Hormone Deficiency and Celiac Disease. Gastroenterology
2007;10 (111), 1740-1746
4.  . .,   ", .,
 ..
bulia maTi referali gastroenterologTan,
:   $*. + +. 2003 6.
romelic aatarebs Rrma kvlevas (9).
2. endoskopiur kvleva duodenumis biof-
siiT da bioptatis histologiuri kvleva.
“marSis kriteriumebis” aRmoCena celiakiis
diagnozs utyuars xdis (17)
celiakiis mkurnalobis erTaderTi gza
ugluteno diatis dacvaa mTeli cxovrebis
manZilze (12). dieta diabetis kontrolis
sakvanZo momenticaa. am ori dietis Serwyma
ar aris ioli da med. muSakis specialur
momzadebas saWiroebs (11, 12). ugluteno die-
tis dacva celiakiiT da insulindamokidebu-
li diabetiT daavadebulebSi aiolebs orive
daavadebis simtomebis kontrols, axdens di-
abetis stabilizacias, rac sisxlZarRvovani
garTulebebis prevenciis sawindaria (12, 13).
amrigad, Saqriani diabeti bavSvTa da mo-
zardTa asakis erT-erTi yvelaze xSiri qro-
nikuli paTologiaa. misi socialuri mniSvne-
loba sayovelTaodaa cnobili, rac ganpirobe-
bulia naadrevi invalidobiT da rig SemTxve-
vebSi letaluri gamosavliT axalgazrda
asakSi. miuxedavad miRweuli warmatebebisa in-
sulinoTerapiis reJimebis daxvewis, adamianis
insulinebis farTo danergvis fonze, mainc
rCeba mTeli rigi subieqturi da obieqturi
faqtorebi, romlebic xels uSlian naxSirwy-
lovani cvlis kompensaciis miRwevas. erT-er-
Ti aseTi obieqturi faqtoria celiakia.
erTi SexedviT celiakia ar aris socia-
lurad mniSvnelovani daavadeba, radgan ar
moaqvs sazogadoebisaTvis didi da Seuqceva-
di ekonomiuri, socialuri da politikuri
zarali. magram Tu gaviTvaliswinebT, rom es
daavadeba ar ikurneba da problemas uqmnis
pacients mTeli cxovrebis manZilze, rom
aris maRali riski ganviTardes uSviloba, ze-
moqmedeba STamomavlobaze, osteoporozi, on-
kologiuri daavadebebi _ TvalsaCino xdeba,
rom ekonomiuri danaxarjebi droSi gaweli-
@
69-71
5. Brunilda Nazario. Cereal May Trigger Type 1
Diabetes. The journal of American Medical Association,
2003; 4: 234-236
6. Catassi C. The spectrum of celiac disease in child-
ren. Clin. Gastroenterol.1997; 11(3)
485-507
7. Gillet p, Gillet H, Israel D, et al. High Prevalence of
Celiac Desease in Patients with Type 1 Diabetes Detected
Antibodies to Endomisium and Tissue Transglutamina-
sa. Can. J. Gastroenterology, 2001; 15:197-301
8. Greco L, Romino R, Goto I, et al. The First Large
Population Based Twin Study of Celiac Desease. Gut,
2002; 50: 624-628.
9. Holmes G. Celiac Desease and Type 1 Diabetes Melitus
– the Case for Screening.Diabetic Medicine2001; 183: 169
10. Hoffenberg E., Haas J., Dresher A., et al. A Trial
of oads in children with newly diagnosed celiac disease. J
Pediatr. 2003: 137(3) 361-366
11. Kupper C., Higgins L.A. Combining Diabetes and
Gluten-Free Dietary Management Guidelines. Practical
Gastroenterology. The Celiac Diet, Series #7. 2007; 3, 68-83
12. Mohsin R. et al Celiac disease: Evaluation of the
diagnosis and Dietary Compliance in Children.
Pediatrics. 2005; 116:754-759
13. Nazim J, Starzyk J, Czerwinski E. The Evaluation
of bone mineral density in Diabetic Children with Celiac
disease and the influence of Gluten Free Diet and
Diabetes control on Bone Mineralisation. Diabetologia
2007; 50 (1) S1_S538
14. Picarelli A., Di-Tola M., Sabbatella L., et al.
Immunologic evidence of no harmful effects of oats in ce-
liac disease. Am. j Clin. Nutr. 2001; 74(1) 137-140
15. Revised criteria for diagnosis of celiac disease. Re-
port of working group of European Society of Pediatric
Gastroenterology and nutrition. Arch. Dis. Child 1990;
65(8) 909-911
16. Rensch M.J, Merenich J.A, Lieberman M. el al Gluten-
sensitive Enteropathy with Insulin-dependent Diabetes
Mellitus. Annals of Internal Medicine 1996; V, 124 (6) 564-567
17. Rossi T.M., Tjota A. Serologic indicators of celiac
disease. Clin. Lab.Med.1997; 17(3) 445- 464
18.  0 %.*  
 (.  #.
$ ) 
li, magram soliduria. iqidan gamomdinare, #0 #: 
 0
 
rom celiakiis diagnostika Zneli ar aris, :+
 X$ ) #. $ 
xolo marTva mxolod eliminaciuri dietiT  $# 20094* . 3* 5* 24-26
Semoifargleba, naTelia, rom umjobesia risk- 19. Tribole E., Kupper C., Pietzak M. Celiac sprue. N.
jgufis pacientebze fokusirebuli jandac- Engl. J. Med. 2002: 347(6) 446-448
@__) otkb
 48
he,hbrf f[fkufphlf ltlt,c
probiotikebisa da prebiotikebis roli meZuZur dedebSi,
axalSobilebsa da wlamde asakis bavSvTa kvebaSi
ROBIOTIC AND PREBIOTIC AT NEWBORNS, BREAST FEEDING MOTHERS
AND CHILDREN OF CHEST AGE
m.nanobaSvili. g.CaxunaSvili.
m. Ciqovani
neonatologebSi, am bolo periodSi, gan-
sakuTrebul interess iwvevs kuW-nawlavis tra-
qtis mikroekologiis problema. adamianis daa-
vadebaTa saerTaSoriso klasifikaciis mixed-
viT-organizmis mikroekologiuri sistema gani-
sazRvreba rogorc filogenetikurad Zalzed
rTulad awyobili, dinamiuri kompleqsi, romel-
ic Tavis TavSi moicavs rogorc xarisxobrivad,
aseve raodenobrivad mravalferovan mikroor-
ganizmebsa da maTi bioqimiuri aqtivobiT warmo-
qmnil produqtebs (metabolitebs), ganviTarebis-
Tvis saWiro saarsebo garemoTi.
arsebobs mravali mizezi, ris gamoc icv-
leba k.n.t-is normaluri mikroflora. es
cvlilebebi SeiZleba iyos moklevadiani di--
sbaqteriuli reaqcia da aseve myari e.w. dis-
baqteriozi.
e.w. disbaqteriuli reaqcia, anu dis-
biozi,Tavis TavSi moicavs ekosistemis mdgo-
mareobas, ris drosac irRveva adamianis
organizmis k.n.t.-is mTeli Semadgeneli naw-
ilis normaluri funqcionireba. mikroflo-
ris, saarsebo garemos, da maT Soris urTi-
erTqmedebis meqanizmis darRvevas mivyavarT
daavadebis Camoyalibebisken.
mcneba-disbaqteriozSi igulisxmeba moce-
muli biotipisTvis damaxasiaTebeli nor-
mofloris xarisxobrivi da raodenobrivi
cvlilebebi, rac moicavs makroorganizmis
gamoxatul klinikuri reaqciebs an gamowveu-
lia raime paTologiuri procesebis mimd-
inareobiT organizmSi. disbaqteriozi ganix-
ileba ara rogorc daavadeba, aramed simp-
tomokompleqsi. yovelTvis naTelia, rom disbaq-
teriozi meoradia da gapirobebulia ZiriTadi
daavadebiT. amiT aixsneba "disbiozis" an
"nawlavis disbaqteriozis" diagnozis ararse-
boba d.s.k-10-Si romelic gamoiyeneba rogorc
CvenTan, aseve mTels msoflioSi.
rogorc cnobilia, mucladyofnis
periodSi nayofis k.n.t-i steriluria.
dabadebis momentSi axalSobilis k.n.t-is
kolonizacia xdeba piris saSualebiT, dedis
,fdidsf rfhlbjkjubf
samSobiaro gzebis gavlisas, xolo dabade-
bidan ramdenime saaTis Semdeg, axalSobilis
k.n.t-Si ukve SeiZleba aRmovaCinoT E. Coli da
streptokokebi, romlebic vrceldebian zevi-
dan--qveviT. 10 dRis Semdeg ki-- bifidobaq-
teriebis sxvadasxva Stamebi da baqteroide-
bi.
normaluri mikroflora es aris ca-
lkeuli organoebis da sistemebis sxvadasx-
va saxis mikrobebis xarisxobrivi da raode-
nobrivi urTierTqmedeba--makroorganizmis
bioqimiuri, metaboluri da imunuri Ta-
nasworobis SenarCunebiT, rac aucilebelia
adamianis janmrTelobisaTvis.
1981 wels Hansson-ma aCvena, rom sakeisro
kveTiT dabadebul bavSvebSi, gacilebiT
dabalia laqtobaqteriebis Semadgenloba,
vidre bunebrivi gziT dabadebulebSi. 2000
wels Roberfroid-ma sabolood daamtkica,
rom mxolod bunebriv kvebaze myof bavSvebSi
Warbobs bifidobaqteriebi, riTacaa gapirobe-
buli gastrointestinaluri infeqciuri
daavadebebis ganviTarebis dabali riski
ZuZuTi kvebis dros. karga xania cnobilia,
rom xelovnur kvebaze myof bavSvebSi ar
xdeba romelime jgufis mikroorganizmebis
SedarebiT Warbi formireba. MacNelly-is 1999
wlis monacemebiT 2 wlis asakis Semdeg,
bavSvebis nawlavuri floris Semadgenloba
arafriT gansxvavdeba mozrdilTa nawlavuri
florisagan: 400-ze meti saxeobis baqteria,
romelTagan umetesoba rTulad kultivire-
badi anaerobia.
disbaqteriozis gamomwvevi mizezebi
Bangmark. S-m 200- wels Camayaliba faq-
torebi, romlebic moqmedeben axalSobilebis
k.n.t-is sxvadasxva ubnebis mikrofloris
Semadgenlobaze. esenia: nawlavis motorikis
indivdualuri Taviseburebani; Cvilis
nawlavis nerv-kunTovani aparatis aRnagobis
Tavisebureba; k.n.t-is Tandayolili daavade-
bebi (wvrili nawlavis divertikuli, ileo-
cekaluri sarqvlis defeqti, striqtura,
Sexorcebebi da a.S...); qimusis gasvlis pro-
cesis Seneleba msxvil nawlavSi (gastrodu-
deniti, sklerodermia, kronis daavadeba,
manekrozebeli enterokoliti da sxva..); PH
@__) otkb
,fdidsf rfhlbjkjubf
garemos cvlilebebi tute mxares; nawlavis
fermentuli Semadgenlobis cvlilebebi
(kuWqveSa jirkvali, RviZli); sekretoruli
IgA-s da rkinis Semcvelobis donis
darRveva; ZuZuTi kvebis dros axalSobilis
dedis araracionaluri kveba; axalSobilis
Taviseburebebi da kvebis reJimi.
n.p. Sabalovis neonatologiis saxelmZRva-
neloSi (2004?.) aRwerilia axalSobilTa
normaluri nawlavuri mikrofloris funq-
ciebi: saboloo etapze ujredSida gajir-
jveba, laqtozis, naRvlis wvenis dekoniuga-
cia da maTi gardaqmna cximovan mjavebad, vit-
aminebis sinTezi (B12, K, B1, PP, biotini, folis
mJava). pozitiur miklofloras axasiaTebs
Zlieri antagonisturi moqmedeba fermen-
tuli aqtivobis xarjze. is axdens zemo-
qmedebas nawlavis lorwovani garsis struq-
turaze da regenareciis da Sewovis
siCqareze, aseve astimulirebs adgilobriv
imunur sistemas (limfur folikulebi, lim-
focitebis produqcia, imunoglobulinebi).
axalSobilis janmrTelobasa da
ganviTarebaze normaluri mikrofloris
gavlenas aqvs kolosaluri mniSvneloba. as
aris aseve brZola avitaminozTan da fermen-
tul darRvevebTan. am dros xdeba nuk-
leotidebis, Seucvleli aminomJavebis
(tri ptofani) da peptidebis endogenuri
sinTezi; regulirdeba adaptaciis procese-
bi; qveiTdeba nawlavuri infeqciebis riski
da formirdeba nawlavis lorwovani garsis
damcavi barieri.
axalSobilebSi mikrofloris disbalan-
sis gamomwvevi mizezebi: pirvel rigSi-
ZuZusTan gvian miyvana; xelovnuri kveba;
dedis kvebis darRveva, bavSvis organizmis
reqtiulobis daqveiTeba; kuWis wvenis
mJavianobis daqveiTeba; nawlavis hi poqsia;
nawlavis gauvaloba; imunodeficituri
mdgomareoba; antibiotikebis ukontrolo da
aramiznobrivi gamoyeneba, rac iwvevs nor-
maluri mikrofloris mniSvnelovani naw-
ilis ganadgurebas da paTogenuri da
pirobiTpaTogenuri floris gamravlebas.
disbiozi-es aris nawlavuri
mikrofloris xarisxobrivi da raodeno-
brivi cvlileba gavlenis sferos
gafarToebiT.
mikrofloraze moqmedi dedis rZis faq-
torebi:
mxolod dedis rZes da ZuZuTi kvebas
SeuZlia daicvas axalSobili arasasurveli
Sedegebisgan. rZis Semadgenloba Zalian
rTulia. igi xels uwyobs baqteriebis gam-
ravlebas. erTis mxriv pasuxismgebelia
@__) otkb
49
sasurveli mikrofloris gamravlebasa da
stimulaciaze, meores mxriv-ucxo da arasas-
urveli baqteriebis daTrgunvaze. oligosa-
qaridebi (bifidus faqtori) da laqtoza
astimulirebs baqteriebis zrdas. laqtozis
fermentacia aqveiTebs nawlavis PH-s, rasac
mivyavarT baqteriebis evolucia-seleqciisa
da maTi utilizaciisaken. dedis rZe axdens
paTologiuri baqteriebis kolonizaciis
inhibirebas, rac xdeba sekretoruli IgA-s,
nutrientebis (cximovani mJavebi, laqtoferi-
ni), rTuli naxSirwylebis (glikoproteinebi,
glikozaminoglikanebi, glikoli pidebi,
mucinebi, oligosaqaridebi) meSveobiT.
rogorc zemoT iyo aRniSnuli, axalSo-
bilis biocenozis Camoyalibeba xdeba dedis
nawlavuri mikrofloris da samSobiaro gze-
bis gavleniT, ZuZuTi da Semdgomi kvebiT.
arsebuli biocenozis koreqcia xdeba 2 gziT:
pro- da prebiotikebis SeyvaniT.
klasifikacia:
dResdReobiT, biologiurad aqtiuri
nivTierebebs, romlebic monawileoben .k.n.t-is
normalur funqcionirebaSi da regulaciaSi,
zogierTi specifiuri infeqciuri daavadebis
profilaqtikasa da mkurnalobaSi, yofen:
dietur danamatebad, funqcionalur kvebad,
probiotikebad, prebiotikebad, sinbiotikebad,
baqteriofagebad da bioTerapiul agentebad.
pirveli 3 jgufi erTiandeba probiotikebSi.
probiotikebis da prebiotikebis gamoyenebas
mivyavarT erTi da igive Sedegamde-rZemjava
baqteriebis, nawlavuri floris bunebriv
Semadgenlebis ricxvis gazrdamde. ase rom
,es preparatebi, pirvel rigSi unda
daeniSnoT axalSobilebs, xandazmulebs da
stacionarul mkurnalobaze myof adamianebs.
vinaidan probiotikebi axdenen rTul, maT
Soris imunomodulaciur moqmedebas, maTi
daniSvna xdeba Cvenebis mixedviT. nawlavis
biocenozis aRdgenis da disbiozis profi-
laqtikis mizniT, ufro mizanSewonilia pre-
biotikebis gamoyeneba. prebiotikebi warmoad-
genen sakvebs obligaturi saqarolizuri
florisTvis da iyofian mono-, oligo- da
polisaqaridebad. cxovrebis pirvel wels,
bavSvebSi, bifidus floris formirebisTvis
mniSvnelovania galaqtozis Semcveli prebi-
otikebis Seyvana.
probiotikebi
gansazRvreba:
probiotikebi – es cocxali mikroorga-
nizmebia: rZemJava baqteriebi, xSirad bifi-
dobaqteriebi an laqtobacilebi, zogjer
safuarebi, romlebic "probiotikis" ganmarte-
 50 ,fdidsf rfhlbjkjubf
bidan gamomdinare, miekuTvnebian janmrTeli S.diaacetylactis
adamianis mikrofloris normalur binadrebs. S.intermedius
probiotikebis moqmedebis meqanizmi: nawla- Bifidobacteria
vuri floris zrdis mainhibirebeli antibaq- B.bifidum
teriuli nivTierebebis, organuli mJavebis,pro- B.adolescentis
teazis, sinTezi; adheziis receptorebis B.animalis
konkurentuli moqmedeba; imunuri pasuxis B.infantis
stimulacia (fagocituri aqtivobis, IgA-s da B.longum
T-kilerebis, interferonis koncentraciis B.Thermophilum
Semcvelobis zrda; antianTebiTi citokinebis preparatebis aseTi mravalferovneba met-
gamomuSavebis koreqcia; mucinis gamomuSavebis yvelebs probiotikebis warmoebis maRal
zrdis xarjze citoproteqciis gaZliereba; ganviTarebaze da masze moTxovnilebis gazr-
lorwovani garsis ganvladobis daqveiTeba. daze. gasaTvaliswinebelia, rom dasavleTis
qveynebis da yofili socbanakis qveynebis
probiotikebis klasifikacia
farmacevtuli warmoeba gansxvavdeba erTma-
actobacilli neTisgan. probiotikebSi Semavali mikroor-
L.acidophilus ganizmebi arc paTogenuria da arc toqsi-
L.casei kuri. k.n.t-is gavlisas an Senaxvisas, isini,
L.delbrueckii subsp. Bulgaricus sakmarisi raodenobiT, sicocxlisunariano-
L.reuteri bas inarCuneben.
L.brevis probiotikebi unda akmayofilebdnen Semdeg
L.cellobiosus moTxovnebs: unda Seicavdnen klinikurad damt-
L.curvatus kicebuli moqmedebis mqone mikrobebis Stamebs,
L.fermentum unda Seesabamebodnen nawlavis mikrobiocenozis
L.plantarum asakobriv Taviseburebebs, axasiaTebdeT gamZle-
Gram-positive cocci oba mJavebis, antibiotikebis mimarT da iyvnen
Lactococcus lactis subsp. Cremoris usafrTxo. isini ar iTvlebian wamlebad da
Streptococcus salivarius subsp. Thermophilus ganixilebian adamianis janmrTelobaze sasar-
Enterococcus faecium geblod moqmed saSualebebad.
sazRvargareTuli probiotikebi. ruseTis federaciis probiotikebi.
Acidophilus-Pectin bifidumbaqterini
Acidophilus-Sporogenes Oral laqtobaqterini
Attapulgite Oral bifikoli
Banana Flakes Oral kolibaqterini
Bismuth Subgallate Oral lineqsi
Bismuth Subsalicylate Oral bifilongi
Bis Subcarbonate-Kaolin-Pectin Oral trevisi
Difenoxin-Atrpine Oral flonivini BC
Kaolin-Pectin Oral biosporini
Lactobac2-Bifido1-Strep therm. nutrolin B
Lactobac Ac& Pc-S.Therm-B.Anim Oral aci poli
Lactobac Acidoph-Bifidobac Lon Oral enterol 250
actobac Acidoph-Fructooligos Oral biobaqtoni
actobac-Fructooligos-Pectin Oral sakvebis bioaqtiuri danamati
Lactobacillus Acudoph & Bulgar Oral bebilaifi
Lactobacillus Acidophilus Misc primadofilusi
Lactobacillus Acidophilus Oral multidofilusi
Lactobacillus Acidoph-Lactase Oral acidofilusi
Lactobacillus Acidoph-Pectin bebiformi
Lactobacillus Bulgaricus Oral floradofilusi
Lactobacillus Rhamnosus (GG) Oral vita balansi 3000
Loperamide Oral xilak-forte

@__) otkb
,fdidsf rfhlbjkjubf
mimoxilva
axlo warsulSi Catarda 6 Tviani kvleva
gaRizianebuli nawlavis simptomebze probi-
otikebis narevis moqmedebis Sesafaseblad.
(Lactobacillus rhamnosus GG, L.rhamnosus Lc705,
Bifidobacterium breve Bb99 da Propioibacterium frudenre-
ichii ssp. Shermanii JS). miRebul Sedegebze
dayrdnobiT avtorebs gamoaqvT daskvna, rom
mkurnalobis es forma efeqturia gaRizia-
nebuli nawlavis sindromis dros. Tu
mxedvelobaSi miviRebT imas, rom es daavade-
ba farTodaa gavrcelebuli da ar arsebobs
misi samkurnalo efeqturi preparati, simp-
tomebis Semcirebamac ki SeiZleba dadebiTi
Sedegi gamoiRos janmrTelobis SenarCunebis
TvalsazrisiT
israelis 14 pediatriul centrSi Cata-
rebuli randomizirebuli kvlevis Sedegad
Beer-Sheva-m demonstrireba gaukeTa kvebis
formulaSi Bifidobacterium lactis (BB-12)
da Lactobacillus reuteri -is xangrZlivad
miRebis efeqturobas respiratoruli daav-
adebebis mqone bavSvebSi. axalSobilebs mni-
Svnelovnad SeumcirdaT cxelebis xangrZ-
livoba, diareis epizodebi gaxda xanmokle,
aseve Semcirda antibaqteriuli mkurnalobis
Cvenebebi. am kvlevaSi naCvenebi iqna laqto-
bacilebis didi roli bifidobaqteriebTan
SedarebiT.
dabadebidan 2 kviris manZilze, dRenaklul
bavSvebSi praqtikulad ar arsebobs janmrTeli
ganviTarebisTvis da imunuri sistemis funq-
cionaluri adaptaciisaTvis saWiro bifido-da
laqtobaqteriebi. "normaluri" mikrofloris
daqveiTeba da pirobiTpaTogenuri mikrobebis
kolonizacia mcire wonis axalSobilebSi, sxva
araxelsayrel garemoebebTan erTad, warmoad-
gens manekrozebeli enterokolitis ganviTa-
rebis safuZvels. bunebriv kvebasTan erTad
probiotikebis gamoyeneba amcirebs am daavade-
bis ganviTarebis risks.
fineTSi Catarebuli randomizirebuli
kvlevebis Sedegebi aCvenebs, rom probiotike-
bis miReba dedebSi mSobiarobamde da axal-
SobilebSi dedis rZesTan erTad, dadebiTad
moqmedebs nawlavis imunitetis Camoyalibe-
baSi cxovrebis pirveli wlis manZilze. IgM,
IgA, da IgG-s saerTo done me-12-e Tveze ufro
maRali iyo im bavSvebSi, romlebic imyofebo-
dnen ZuZuTi kvebaze da Rebulobdnen probi-
otikebs. avtorebma daadgines, rom rZis zo-
gierTi komponenti (CD14) warmoadgens pro-
biotiks da astimulirebs humorul imunur
reaqcias.
turinis universitetis italieli mec-
nierebis bolo kvlevebi gviCvenebs acto-
@__) otkb
51
bacillus reuteri-s did rols axal-
Sobilebis nawlavuri kolikebis TerapiaSi.
e.w. infantiluri nawlavuri kolika xSir
problemas warmoadgens sicocxlis pirveli
Tveebis dros, Tumca 70% SemTxvevaSi gvxvde-
ba funqciuri nawlavuri kolikebi. umetesad
es kolika ar warmoadgens daavadebas. es
Cvilis k.n.t-is axal garemos Seguebadobis
Tanmdevia. infantiluri nawlavuri kolikis
winaaRmdeg brZolis 40 welze meti gam-
ocdilebis miuxedavad, mecnierebi ver
garkveulan, ra ufroa pirveladi: kolika Tu
nawlavis mikrofloris darRveva.
prebiotikebi
gansazRvreba: prebiotikebs miekuTvneba
sakvebis gadaumuSavebadi ingredientebi, rom-
lebic aumjobeseben janmrTelobas msxvil
nawlavSi mobinadre erTi an ramdenime jgu-
fis baqteriebis SerCeviTi zrdis stimu-
laciis da/an metabolur aqtivobis xarjze.
probiotikebis efeqturoba mdgomareobs
imaSi, rom: isini aqveiTeben ganavlis PH-s;
aqveiTeben amiakis produqcias; aaqtiureben
imunitets; amcireben klostridiebis, kandid-
ebis, listeriebis da a.S. zrdis potencials;
40-60%-iT zrdian sakvebidan Ca-is Sewovas;
aZliereben msxvili nawlavis epiTelis ener-
gomomaragebas da regeneracias.
prebiotikebis klasifikacia:
fruqtozo-oligosaqaridebi
inulini
galaqto-oligosaqaridebi
laqtuloza
laqtitoli
dRevandlamde cudadaa Seswavlili iseTi
prebiotikebis Tvisebebi, rogoricaa manozo,
maltozo-, qsilozo- da glikozo-oligosaqa-
ridebi. prebiotikebi warmoadgens obligatu-
ri saqarolituri floris sakvebs da iyofa
mono-, oligo- da polisaqaridebad.
prebiotikad sakvebis komponentis klasifi-
cirebisTvis, igi unda xasiaTdebodes Semdegi
TvisebebiT: ar unda iSlebodes da absorbi-
rdebodes k.n.t-is zeda nawilebSi; unda SeiZ-
lebodes sasargeblo mikroorganizmebisaTvis
misi seleqtiur substratad gamoyeneba maTi
zrdis da metaboluri aqtivobis sastimula-
ciod; unda SeeZlos nawlavuri mikrofloris
Semadgenlobis normalizeba da adgilobrivi
da sistemuri pasuxis inducireba mTliani
organizmis sakeTildReod.
oligosaqaridebi
axalSobilis nawlavuri bifidofloris
mniSvnelovan funqcias sakvebis boWkoebis-
 52
oligosaqaridebis fermentacia warmoadgens.
sakvebis boWkoebis funqciebi farToa. mas
miekuTvneba: bifidubaqteriebis da acidofil-
uri laqtobaqteriebis zrdis stimulacia;
dedis rZis "bifidus-faqtori"; toqsikuri
produqtebis adsorbcia da maTi gamodevna
fekaliebis meSveobiT; energiis moTxovnile-
bis dakmayofileba 6-9%-iT; antioqsidanturi
aqtivoba (nawlavis lorwovani garsis dacva
Tavisufali radikalebisagan); nawlavuri
mikroorganizmebisaTvis fiqsacis adgilebis
Seqmna, rac ganapirobebs sasargeblo nawla-
vuri mikrofloris ekologias; peristal-
tikis gaZliereba.
inulini
inulini-polisaqaridia, romelsac Seicavs
georginebis da babuawveras bolqvebi da fes-
vebi. igi warmoadgens fruqtozans, vinaidan
misi hidrolizisas warmoiqmneba fruqtoza.
inulini bifido- da laqto- baqteriebis
zrdis stimulaciasTan erTad amaRlebs Ca-is
Sewovas msxvil nawlavSi, e.i. aqveiTebs osteo-
porozis risks, moqmedebs li pidebis metabo-
lizmze, riTac mcirdeba gul-sisxlZarRvTa
sistemaSi aTerosklerozuli cvlilebebis
riski da SeiZleba aRkveTos II ti pis Saqriani
diabetis ganviTarebac. arsebobs winaswari
monacemebi mis antikancerogenul efeqtzec.
laqtuloza
laqtuloza-sinTezuri disaqaridia, rome-
loc ar gvxvdeba bunebaSi. masSi galaqtozis
yoveli molekula dakavSirebulia i-1,4-
kavSiriT fruqtozis molekulasTan. laqtu-
loza msxvil nawlavSi ucvleli saxiT xvde-
ba (mxolod 0,25-2,0% Seiwoveba ucvleli sa-
xiT wvril nawlavSi) da saqarolituri baq-
teriebs sakveb substratad emsaxureba. pe-
diatriaSi laqtuloza 40 welze metia
gamoiyeneba axalSobilebSi laqtobaqteri-
ebis zrdis stimulaciisTvis.
preparati "dufalaki" SeiZleba gamoyeneb-
uli iqnes nebismier asakSi prebiotikuri
doziT-3 ml. dReSi rogorc profilaqtiki-
saTvis, aseve disbiozis mkurnalobisaTvis
probiotikebTan erTad.
sxva prebiotikebi
kalciumis pantotenati monawileobs ujre-
dis SemJavebis da acetilirebis procesebSi,
naxSirwylovan da cximovan cvlaSi, ace-
tilqolinis sinTezSi, astimulirebs kortikos-
teroidebis warmoqmnas Tirkmelzeda jir-
kvalSi, axdens bifidobaqteriebis utilizacias
da xels uwyobs maTi biomasis zrdas.
,fdidsf rfhlbjkjubf
pamba--para-amino-meTil-benzoinis mjava
(analogi ambene) pirobiTpaTogenuri baq-
teriebis da sokoebis proteolituri fer-
mentebis mainhibirebeli moqmedebiT, riTac
xels uwyobs bifido- da laqtofloris
zrdis stimulacias.
lizocimi- axdens darRveuli mikrofloris
normalizebas. metad aqtiuria gramdadebiTi pa-
Togenuri da pirobiTpaTogenuri baqteriebis
mimarT. lizocims axasiaTebs bifidogenuri,
imunomodulaciuri da anTebissawinaaRmdego
moqmedeba. astimulirebs metabolur da re-
paratiul procesebs da eriTropoezs. aumjobe-
sebs saWmlis gadamuSavebas. zrdis organizmis
rezistentobas infeqciebisa da toqsinebis
mimarT. avlens antibaqteriul moqmedebas da
sinergizms mraval antibiotikTan.
mimoxilva
mozrdil moxaliseebze Catarebuli ran-
domizirebuli kvlevebi adasturebs, rom
oligosaqaridebi, gansakuTrebiT fruqtozis
SemcvelobiT, mastimulirebel gavlenas ax-
denen msxvil nawlavSi bifido- da laqto-
baqteriebis zrdaze.
oligosaqaridebi, N-acetilglukozaminis,
glukozis, galaqtozis, fukozis oligomeris
da sxva glikoproteinebis CaTvliT, rom-
lebic dedis rZis mniSvnelovan nawils
Seadgenen, warmoadgens specifiur faqtors
bifidobaqteriebis zrdisaTvis.
belgieli mecnierebis azriT, adreuli
kvebis formulaSi inulin-is da galactooligosac-
caride-s damateba proporciiT 1:9, (mTels neo-
natalur periodSi) aumjobesebs bifidoge-
nur efeqts postnatalur da amcirebs ato-
piuri diaTezis incidentebs gvian neona-
taluri periodebSi.
germaneli mecnierebis kvlevebSi dastur-
deba prebiotikuri danamatebis imunomodula-
toruli roli bavSvis postnatalur ganvi-
TarebaSi ZuZuTi da xelovnuri kvebis dros.
italieli mkvlevarebis monacemebiT, kve-
bis adreul formulaSi galacto-oligosac-
charides da fructo-oligosaccarides Car-
Tva, ganapirobebs fekalur masaSi PH-is
awevas, rasac mivyavarT paTogenuri mikro-
floris Semcirebamde.
CileSi, 140 bavSvze Catarabuli ormagi
brma randomizirebuli kvleva adasturebs pre-
biotikebis dadebiT rols antibaqteriuli Te-
rapiis fonze actobacillus da ifidobacte-
rias populaciis zrdiT. kvebis formulaSi am
dros prebiotiki eniSnebodaT 21 dRiT
antibaqteriul mkurnalobasTan erTad da
SemdgomSi.
@__) otkb
,fdidsf rfhlbjkjubf
sinbiotikebi
probiotikebis da prebiotikebis narevi
gaerTianebulia sinbiotikebis jgufSi, rom-
lebic sasargeblod moqmedeben adamianis
organizmze. aumjobeseben nawlavSi cocxali
baqteriuli danamatebis sicocxlisunari-
anobas, gamZleobas da SerCeviTad astimul-
ireben laqtobaqteriebis da bifidobaqte-
riebis zrdas maTi metabolizmis aqtivaciiT.
ruseTis federaciaSi aseTi saxis mxolod
3 preparatia daregistrirebuli: biovestin-
laqto (Seicavs bifidogenur faqtorebs
daB.bifidum, B.adolescenis, L.plantarum-os biomasas);
maltidofilusi -(Seicavs maltodeqstrins da
B.bifidum, B.adolescenis, L. bulgaricus-is biomasebs);
bifido-baki (Seicavs fruqtooligosaqari-
debs da bifidobaqteriebis da laqtobaci-
lebis kompleqss)
pro- da prebiotikebis gverdiTi efeqte-
bi miuxedavad uamravi kvlevebisa da kli-
nikur medicinaSi am preparatebis gamoyenebis
50 welze meti gamocdilebisa, mainc rCeba
Soreuli Sedegebis mxriv rigi gadauWreli
problemebi.
frangi gastroenterologebi ganixilaven
da amtkiceben probiotikebis 4 potenciur
gverdiT efeqts: infeqciuri garTulebis
ganviTareba, mavne metabolitebis produqcia,
zedmeti imunostimulacia, transgenuri reaq-
 : :, ($#. #. 
cia.
53
bilebSi, dadebiTad moqmedebs maT ganvi-
Tarebaze cxovrebis pirvel TveebSi, magram
saWiroa safuZvliani kvleva, riTac Sefa-
sdeba nawlavis imunitetze moqmedi Soreuli
Sedegebi. amitom tavi unda SevikavoT maTi
rutinuli gamoyenebisagan.
aqedan gamomdinare: bolo aTwleulebSi,
Catarebuli uamravi kvlevebis Sedegad, pre-
biotikebi, adreul kvebis formulaSi ukve
20 welze metia gamoiyeneba iaponiaSi da
mxolod axlaxan daiwyo evropaSi misi ofi-
cialuri danergva.
gasaTvaliswinebelia dRenaklul bavSve-
bSi maTi gamoyenebisas Soreuli Sedegebis
riski
dadebiTad SeiZleba CaiTvalos is faqti,
rom bolo periodSi disbiozis problema
klinicistebSi ganixileba saerTaSoriso
samedicino praqtikaSi miRebuli poziciidan.
mniSvnelovan faqtorad SeiZleba miviC-
nioT, rom nawlavis mikrofloris normal-
izaciis gzebSi, pirvel rigSi ganixileba
pro- da prebiotikebi da ara bioTerapiuli
agentebi, baqteriofagebi da antibiotikebi.
literatura
1) adamianis daavadebaTa saerTaSoriso
klasifikacia (d.s.k-10)
2) 
. 1999)
prebiotikebis mxriv aseTi efeqtebi gamor-
'

#

icxulia, vinaidan ar warmoadgenen mikrobul
'
$ ) #.2000:
agentebs. Tumca prebiotikebma SeiZleba
gamoiwvion osmosuri efeqti da msxvil
nawlavSi fermentuli darRvevebi.
otikebidan zogierTebma SeiZleba gamoiwvios
nawlavuri kolika, meteorizmi, diarea, rom-
lis kupirebac xdeba dozis gazrdiT.
daskvnebi
*ZuZuTi kveba da probiotikebis dama-
tebiTi gamoyeneba ganapirobebs axalSobilis
nawlavSi janmrTeli mikrofloris Casax-
lebas da amcirebs nawlavuri infeqciebis,
nawlavuri kolikebis da alergiuli
diaTezis ganviTarebis risks.
*probiotikebis mimzidveloba gapirobebu-
lia maTi usafrTxoebiT, ubraloebiT da
maTi aratravmatuli gziT miRebis SesaZ-
leblobiT. probiotikebi unda farTod dain-
ergos neonatologebis Terapiul praqtikaSi
da gaxdes Semdgomi kvlevebis sagani opti-
maluri Stamis, dozirebis da miRebis reJimis
dasadgenad.
*saboloodaa dadasturebuli, rom pro-
da prebiotikebis adreuli miReba axalSo-
@__) otkb
3) )0. .! Y *
'#  $
4) ?* .3. :, 2004.
5) Chen CC; Walker WA. Probiotics and prebiotics :
prebi- role in clinical disease states. Adv Pediatr. 2005;
6) Hansson HB, Barkenius G, et al. controlled compar-
ison ofnalidixc acid or laqtuloze with placebo in shigellosis.
Scand J Infect Dis 1981.
7) Shaoul R. Bamberger E. An update on probiotics
and prebiotics in children Harefuah. 2004:
PROBIOTIC AND PREBIOTIC AT NEWBORNS,
BREAST FEEDING MOTHERS AND CHILDREN OF
CHEST AGE (THE LITERATURE REVIEW)
The problem of microecology of intestines, last years
involves a great attention of neonatologists. On the inter-
national qualifier of diseases of the person ,
published in 1997, the microecological system of an
organism is defined as very difficult phylogenetical devel-
oped, dynamical complex including various on quantitative
and qualitative structure of association of microorganisms
and products of their biochemical activity and metabolies
in certain conditions of an inhabitancy.
In the textbook of Neonatologi (Shabalov N.P., 2004)
describes functions of normal microflora of intestines at
 54
newborns. This participation in final stages of digestion
(splitting cells, lactoses deconstruction bilious acids and
transformation in fat acids); synthesis of vitamins (?12, To,
B1, B2, PP, biooozes, folic acid. The positive microflore pos-
sesses powerful antagonistic action at the expense of high
fermentative activity, it influences structure of a mucous
membrane of intestines and speed of regeneration and
absorption, and also stimulate local immune system (lym-
phatic follicles, production limfotsits, antibodies).
The factors of chest milk influencing
settling of microflora
Only natural feeding can prevent intestines of the new-
born baby from undesirable consequences. The structure of
chest milk is very complex. Its factors represent the connec-
tions answering, on the one hand, for stimulation of growth
of normal microflora, and on the other hand, on suppres-
sion alien. Stimulate growth of bacteria commensals:
oligosccharids (bifidus the factor) and lactose. The lactose
fermentation reduces PH the intestinal contents leading to
evolutionary selection of bacteria, capable to utilise it.
Inhibits colonisation of pathogenic bacteria: sekretory IgA,
nutrienty (fat acids, laktoferrin), complex carbohydrate
structures (glikoproteins, glikozaminogliks, glikolipids,
mutsiny, oligosaccharids) .
As it has been found out above, formation intestinal biot-
senoza of a child occurs under the influence of microflora
of intestines and patrimonial ways of mother, chest feeding
and the further food. Correction arisen biotsenoza can be
lead by two Ways: introduction pro- and prebiotics.
PROBIOTICS
probiotics are live microorganisms: lactic bacteria, more
often bifidobakteries, or laktobatsilly, sometimes yeasts
which, as appears from the term "probiotic", concern nor-
mal inhabitants of intestines of the healthy person
The action mechanism probiotic: synthesis AB of sub-
stances, organic acids, proteaz, inhibiting of a growth of
intestinal flora; competitive action for adhesion receptors;
stimulation of the immune answer (increase fagotsitary
activity and increase in maintenance IgA, T-killers, con-
centration of interferon; correction of developmentanti-
inflammatory tsitokins; strengthening of the cytopatronage
at the expense of development increase mutsina, decrease
in permeability of a mucous membrane.
Authors RPC of research in Finland have come to a
conclusion that use of probiotics in a diet of mother before
birth giving and then at the babies who are on chest feed-
ing, positively influences process of maturing of immunity
of intestines at children of the first year of a life. The gen-
eral levels IgM, IgA, and IgG in 12 months were higher at
those babies who were exclusively on chest feeding of 8 3
months and received probiotic. Authors have shown that
some components of chest milk (CD14) are probiotic and
stimulate gumorall immune answers, and also promote
active interaction of the congenital and got immune reac-
tions at maturing of the normal immune answer in a gas-
troenteric path at children of early age.
,fdidsf rfhlbjkjubf
PREBIOTICS
To the prebiotics indigestible components of food which
promote improvement of health at the expense of selective
stimulation of growth and-or metabolic activity of one or
several groups of the bacteria living in a thick gut concern.
The effect of a prebiotic consists in the following:
they reduce pH kala; reduce ammonia production; make
active immunity; reduce growth potential klostridy, kan-
did, listery, etc.; increase absorption of Ca from food by
40-60 %; strengthen power supply and regeneration
epitelija a thick gut.
A little experiments, lead on adult volunteers, have
proved the expressed stimulating influence oligosaccharids,
especially what contain fructose, on growth bifido - and lak-
tobacteries in thick intestines.
oligosaccharids, including N-Acetylglucosamine glu-
cose galactose, oligomery fukozy or others glikoproteins
which in a considerable proportion make chest milk, are
specific factors for growth bifidobacteries.
* Feeding by a breast and additional use probiotic pro-
motes settling of intestines of babies by healthy microflora,
and also reduces risk of development of intestinal infec-
tions, NEK, intestinal gripes and an allergic diathesis.
*Appeal probiotics is caused by their safety, simplicity
and atravmatichism of applications. They should take root
widely into therapeutic practice of neonatologists and
become a subject of the further researches on revealing
optimum shtamma probiotical bacteria , dosages and
modes of their application.
* It is definitively decided that early introduction pro-
and prebiotics in a food of babies well influences their
development in the first months of a life, but the powerful
researches estimating remote results of influence of various
preparations on intestinal immunity and consequently it is
necessary to refrain from their routine appointment be
required.
The set of researches last decade is devoted improve-
ment of microecology of intestines of newborns so in Japan,
prebiotics are added to formulas of early feeding here
already more than 20 years and only recently began to be
entered officially in Europe.
However there is a potential risk of the remote conse-
quences of use of early formulas on feeding. The prolonged
introduction pro- and prebiotic to a prematurely born
babies,
Thus, positive it is necessary to consider that fact that
recently the problem disbioza has started to be considered
by clinical physicians from the positions accepted in the
international medical practice.
The important fact is also that are reconsidered and
ways of normalisation of microflora of intestines where on
the first place leave pro- and prebiotics, instead of biothera-
peutic agents, bakteriofagi or antibiotics are scientifically
proved.
@__) otkb
,fdidsf rfhlbjkjubf 55

erTerTi pirveli
qarTuli preparatebi
APININI APIPULMO apinini-apipulmo vTa sistemisa da kuWnawlavis traqtis funq-
warmoadgens ori biologiurad aqtiuri cias. 12. orsulobis da laqtaciis periodSi.
komponentebiT mdidari produqtis futkris 13. endokrinologiaSi: Saqriani diabetis da
nawarmisa da wiw- farisebri jirkvlis paTologiis dros. wina-
vovani seqstraq- aRmdeg Cvenebebi: individualuri autanloba
tis nazavs. gverdiTi movlenebi. gamovlenili ararisdo-
grZeli xorTu- zireba: 6 Tvidan 1 wlamde 1/4 abi 2-jerdRe-
misa da frenis Si; 1 wlidan 3 wlamde 1/3 abi samjer dReSi;
didi radiusis 3wlidan 6 wlamde 1 abi 3-jer dReSi. 6-dan 12
mqone qarTuli wlamde 1, 5 abi 3-jer dReSi; 12 wlidan 2 abi
futkris mier Seg- 3-jer dReSi; mkurnalobis kursi erTi Tve.
rovili yvavilis ganmeorebiTi kursi rekomendirebulia 3 Tve-
mtveri mdidaria Si erTxel. miRebis wesi: miiReba Wamamde 15
organizmis Sene- wuTiT adre, an Wamis dros. naxevari Wiqa
bis, ganviTarebisa wylis dayolebiT, an SeiZleba 13 sT-dan 15 sT-
da sicocxlisaT- mde, 17 sT-dan 19 sT-mde. eZleva eqimis daniS-
vis aucilebeli nulebiT.
nivTierebebiT: gamoSvebis forma: ori 30 tableti anif-
cilebiT (Seicavs lakoni, tabletebi Taflis aromatiT, ar aris
aminomJavebis 22 dafaruli saRebaviani garsiT.
saxeobas, maTgan 8 Senaxvis wesi: higroskopulia da inaxeba
Seucvlels), naje- mSral, gril adgilas, Senaxvis vada 1 weli.
ri da ujeri cxi-
movani mJavebiT, glikozidebiT, vitaminebiT APIKOR apikori
(A, B, C, D, PP, E, K, folismJava), fosfoterine- ori biologiurad aqtiuri komponentebiT
biT, rutiniT (sisxlZarRvis kedlis gamamag- mdidari produqtis fuktris nawarmisa da
rebeli bioflavinodi), mikro da makroele- yurZnis wi pwis nazavia. yurZnis wi pwa amci-
mentebiT (Fe, Zn, Cu, F). wiwvovani eqstraqti- rebs dabali simkvrivis li poproteidebs da
qlorofiliT. saerTod qolesterinis Semcvelobas sisxl-
gamoiyeneba: 1. mZime da xangrZlivi avadm- Si, ris Sedegadac aTe-
yofobis Semdgomi reabilitaciisaTvis. 2. go- rosklerozis prog-
nebrivi da fizikuri gadatvirTvisas, zoga- resireba ferxdeba.
domdgomareobis da nervuli sistemis gasaum- qarTuli fuktris
jobeseblad. mier Segrovili
3. parenteraluri kvebisas, vegetariane- yvavilis mtveri ki
lebisaTvis da maTTvis viskvebiT imuni- mdidaria organiz-
tets, gamoiyeneba imunodeficitis dros. ra- mis Senebis, ganviTa-
cionSic cxoveluri warmoSobis produqte- rebisa da sicocx-
bi mcirea; lisaTvis aucile-
4. aregulirebs. 5. aumjobesebs filtvebis beli nivTierebe-
ventilacias, maTSi Jangbadis miwodebas. 6. biT: cilebiT (Sei-
mwvave respiratoruli daavadebebis dros da cavs aminomJavebis
maTi profilaqtikis mizniT. 7. sasunTqi sis- 22 saxeobas, maTgan
temis 8 Seucvlels), naje-
anTebiTi daavadebebis dros: bronqitebi, ri da ujeri cximo-
pnevmoniebi, tuberkulozi. 8. qronikulidaR- vani mJavebiT, gli-
lilobissindromisdros. 9. antiradiaciuli kozidebiT, vitamine-
saSualebaa. 10. xels uwyobs mozardTa simaR- biT (A, B, C, D, PP, E,
leSi zrdas. 11. aumjobesebs gul-sisxlZarR- K, folismJava), fos-
@__) otkb
 56
foterinebiT, rutiniT (sisxlZarRvis kedlis
gamamagrebeli bioflavinoidi), mikro da mak-
roelementebiT.
aumjobesebs cximovan cvlas, sisxlZarR-
vis kedelSi amcirebs qolesterins, aumjo-
besebs mxedvelobas. xels uwyobs organiz-
mis gawmendas, wonaSi daklebas. aZlierebs
imunitets.
xsnis nervul daZabulobas stresebis
dros, organizms matebs tonuss (amagrebs
energiiT cximebis cvlis xarjze), aumjobe-
sebs Zils. gamoaqvs toqsinebi. xsnis `paxme-
lias".
aumjobesebs saWmlis monelebas, kuW-naw-
lavis traqtis, kuWis, RviZlis, elenTis funq-
cias.
gamoiyeneba: 1. bavSvebSi parenteraluri
kvebisas; maTTvis vis kvebiT racionSic cxo-
veluri warmoSobis produqtebi mcirea. 2.
imunitetis asawevad; qronikuli daRlilo-
bis sindromis dros; antiradiaciuli saSua-
lebaa. 3. gonebrivi da fizikuri gadatvirT-
visas zogadi mdgomareobis da nervuli sis-
temis gasaumjobeseblad. 4. Warbi wonis pro-
filaqtikisaTvis, wonaSi daklebis programa-
Si. 5. aTerosklerozis, gulis iSemiuri daa-
vadebebis, hi pertoniis profilaqtikisaTvis.
6. axlomxedvelobisa da mxedvelobis simax-
vilis daqveiTebis saprofilaqtikod. 7. Saq-
riani diabetis dros, rogorc damxmare saSu-
aleba. 8. vaJebis sqesobrivi momwifebis peri-
odSi, mamakacebSidaqveiTebulisqesobriviaq-
tivobisas; 9. dermatitebis, gamelotebis, cxi-
movani cvlis darRvevis, RviZlis cximovani
distrofiis, RviZlis, Tirkmlis, kuW-nawlavis
traqtis daavadebebis dros. 10. klimaqterul
periodSi.
individualuri autanloba gverdiTi mov-
lenebi gamovlenili ar aris. dozireba: 6
Tvidan 1 wlamde 1/4 abi 2-jer dReSi; 1 wli-
dan 3 wlamde 1/3 abi samjer dReSi; 3 wlidan
6 wlamde 1 abi 3-jer dReSi; 6-dan 12 wlamde
1, 5 abi 3-jer dReSi; 12 wlidan 2 abi 3-jer
dReSi; mkurnalobis kursi erTi Tve; ganmeo-
rebiTi kursi rekomendirebulia 3 TveSi er-
Txel
miRebis wesia: Wamamde 15 wuTiT adre, an Wa-
mis dros. naxevari Wiqa wylis dayolebiT, an
SeiZleba da iSvas da moeyaros Tbil sakvebs.
miRebis rekomendirebul ibiologiuri droa-
diliT9sT-10sT. 13 sT-dan 15 sT-mde, 17 sT-dan
19 sT-mde. eZlevaeqimisdaniSnulebiT.
gamoSvebis forma: ori 30 tableti anif-
lakoni. tabletebi Taflis aromatiT.
Senaxvis wesi: preparati higroskopulia
,fdidsf rfhlbjkjubf
da inaxeba mSral, gril adgilas. Senaxvis va-
da 1 weli.
APIIKNOAPIHEPATI
apipikno-apihepati
warmoadgens bunebriv naturalur mcenare-
ulkomponentTa jams: futkris nawarmi+wiw-
vovanis eqstraqti+yurZnis wi pwa. superjanm-
rTelobis eleqsi-
ri mdidaria TiTq-
mis yvela im bio-
logiurad aqtiu-
ri komponentebiT,
romlebic aucile-
belia organizmis
normaluri cxo-
vel moqmedebisaT-
vis dajanmrTelo-
bis SenarCunebi-
saTvis. esenia: ci-
lebi (Seicavs ami-
nomJavebis 22 saxe-
obas, maTgan 8 Se-
ucvlels), aqtiuri
li pidebi, maT So-
ris ujeri cximo-
vani mjavebi, gli-
kozidebi, vitaminebi (A, B, C, D, PP, E, K, folis-
mJava), rutini (sisxlZarRvis kedlis gamamag-
rebel ibioflavinoidi), fosfoterinebi _
maT Soris beta-sitosteroni, romelic gana-
pirobebs organizmSi hormonaluri nivTiere-
bebis sinTezs (meTiltest osteroni), tri-
terpenovanioqsiolianolis mJava, mikroele-
mentebi (Fe, Zn, Cu, F), wiwvovani eqstraqti -
qlorofili, yurZnis wi pwa da sxva.
gamoiyeneba: profilaqtikuri miznebisaT-
vis tonusisa da imunitetis asamaRleblad:
fizikuri da gonebrivi gadaZabvis Semdeg or-
ganizmis Sromisunarianobis aRsadgenad:
xels uwyobs mozardebis simaRleSi zrdas;
aumjobesebs organizmis cxovelmoqmedebas
da anelebs daberebis procesebs; aTeroskle-
rozis, gulis iSemiur daavadebebis, hi perto-
niis profilaqtikisaTvis.
axlomxedvelobisa da mxedvelobis simax-
vilis daqveiTe bis saprofil aqtikod; Saq-
riani diabetis dros, rogorc damxmare saSu-
aleba. vaJebis sqesobrivi momwifebis period-
Si, mamakacebSi da qveiTebuli sqesobrivi aq-
tivobisas; dermatitebis, gamelotebis, cximo-
vanicvlisdarRvevis, RviZlis cximovani dist-
rofiis, RviZlis, Tirkmlis, kuW-nawlavis
traqtis daavadebebis dros. aumjobesebs
filtvebis ventilacias, maTSi Jangbadismiwo-
@__) otkb
,fdidsf rfhlbjkjubf
debas. sasunTqisistemisanTebiTi daavadebe-
bisdros. bronqitebi, pnevmoniebi, tuberkulo-
zi. qronikulidaRlilobissindromisdros.
antiradiaciuli saSualeba.
winaaRmdeg Cvenebebi: individualuri autan-
loba. gverdiTi movlenebi: gamovlenili ar
aris. dozireba: 6 Tvidan 1 wlamde 1/4 abi 2-jer
dReSi; 2 wlidan 2 wlamde 1/3 abi samjer dReSi;
3 wlidan mozrdilTaTvis 3 abi 3-jer dReSi.
mkurnalobis kursi erTi Tve. ganmeorebi-
Ti kursi rekomendirebulia 3 TveSi erTxel.
SeiZleba daifSvnas da moeyaros Tbilsak-
vebs. miRebis rekomendirebuli biologiuri
droa diliT 9 sT-10 sT. 13 sT-dan 15 sT-mde,
17sT-dan19sT-mde. eZleva eqimis daniStable-
tis. gamoSvebis forma: ori 30 tabletiani f-
lakoni. tabletebi Taflis aromatiT.
Senaxviswesi: preparati higroskopulia-
dainaxebamSral, griladgilas. Senaxvisvada
1 weli. rekomendirebulia saqarTvelos
eqimTa asociaciismier. arisqarTuliwarmo
ebisbunebrivi, naturaluri kvebiTi dana ma-
ti, romelic akmayofilebssaerTaSoriso
standartebis yvela zemkacr kriteriumebs.
afTiaqi `parmafarmi" _ al. yazbegis gamzi-
ri #8 (trans portis saministros gverdiT)
t. 38-41-71; avlabari _ ciskris q. 7.
APIVIT apiviti
Zala da energia janmrTeli, Zlieri sul
isTvis rekomendirebulia saqarTvelos eqim-
Ta asociaciismier naturaluri
srulfasovani kompleqsi
* vitaminebi
* mineralebi
* aminomJavebi
preparati 6 Tvidan 1 wlam-
de asakis bavSvebSi miiReba 1/4
tabletis odenobiT 2-jer dRe-
Si.
1-dan 3 wlamde 1/3 table-
tis odenobiT 2-jerdReSi.
3-dan 5 wlamde 1/2 table-
tis odenobiT 2-jer dReSi.
6-dan 12 wlisasakSi 1 tab-
letis odenobiT 2-jer dReSi.
12-dan zeviT 2-3 tableti 2-
jer dReSi.
ganmeorebiTi kursis Cata-
reba rekomendirebulia 3 TveSi
erTxel, yoveli sezonis da-
sawyisSi.
orsulTaTvis 3 tableti diliT 3 Su-
adRisiT.
saWiroebis SemTxvevaSi dasaSvebia do-
zis gaormageba.
@__) otkb
57
qarTuli futkari Tavisi frenis radiusiT,
anatomiuri da fiziologiuri Taviseburebe-
biT unikaluria msoflioSi amitomac mis mier
Segrovili produqtebi: yvavilis mtveri, futk-
ris rZe,Tafli da a. S. mravalferovani da mdi-
daria organizmis Senebis, zrdis, ganviTarebis,
saerTod sicocxlisaTvis aucilebeli nivTie-
rebebiT. vitaminebiT, makro da mikro elemente-
biT, aminomJavebiT. apiviti warmoadgens swored
am bunebrivi, maRalxarisxovani Semadgenlobis
kompleqss.
Cveneba:
fizikuri da gonebrivi Sromisunariano-
bis swrafi aRdgena da aqtivacia.
mZime an xangrZlivi avadmyofobis Semd-
gomi reabilitacia.
gasaxdomi dietis sqemaSi CarTva orga-
nizmis gamofitvis da SesaZlo garTulebebis
Tavidan asacileblad.
simaRleSi zrdaSi xelis Sewyoba mo-
zardebisTvis.
kuW-nawlavis traqtis daavadebebi, dis-
baqteriozi.
RviZlis daavadebebi, gansakuTrebiT
BBda C hepatitebi.
prostatitebi, prostatis adenoma (CarT-
va kompleqsuri mkurnalobis sqemaSi).
potenciis daqveiTeba.
farisebri jirkvlis paTologiebi.
gul-sisxlZarRvTa sisgte-
mis daavadebebis kompleqsuri
mkurnalobis sqemaSi CarTva, gan-
sakuTrebiT aTerosklerozis
progresirebis SesaCereblad, mi-
si profilaqtikisTvis (rogorc
antioqsidanti, antiagreganti,
imunuri sistemis koreqtori).
pediatriuli praqtika.
orsuloba da laqtaciispe-
riodi. (apivitis miRebiT uzrun-
velyobT janmrTel momavals).
sportcmenebi (gansakuTre-
biT Zalebis swrafi aRdgenisaT-
vis, swrafi reabilitaciisaTvis).
aqvs uaryofiTi doping-testi,
ris gamoc Tavisuflad SeiZleba
gamoyeneba Sejibrebis win.
ukuCveneba:
preparatSi Semavali kompo-
nentebis mimarT momatebuli mgrZno-
beloba.
apivitis dRiuri dozis miReba umjobe-
sia diliT an SuadRisas Wamamde 10-15 wuTiT
adre, an Wamis dros.
 58 ,fdidsf rfhlbjkjubf
test-kiTxvari eqimebisaTvis
!!*^8 cnhtgnjrjrekb afhbyubnbc cfvrehyf - !!(#8 vodfdt htcgbhfwbekb byatmwbbc lhjc fy-
kjl htrjvtylt,ekbf5 nbgbhtnekb cfiefkt,t,bc ufvj.tyt,bc xdtyt,ff5
f` rjnhbvjmcfpjkb ~,fmnhbyb7 ,bctgnjkb`9 f` lf,fkb ce,at,hbkbntnb ~#* uhflecb 2
*,` gtybwbkbybc ]ueabc ghtgfhfnt,b9 #*7% uhflecb`9
u` wtafkjcgjhbyt,b9 ,` vfqfkb ce,at,hbkbntnb ~#*7% uhflecb 2
l` fvbyjukbrjpblt,b8 #( uhflecb`9
*u` vfqfkb w[tkt,f ~#(7% uhflecb lf vtnb`9
!!**8 cohfavjvmvtlb ,hjymjlbkfnfnjht,bf5 l` .dtkf xfvjsdkbkb8
f` yji-gf9
,` teabkbyb9 ! ! ($ 8 v o df dt htcg b h fwb ekb b y atm wb b c itv s[ -
u` jhfkehb cfk,enfvjkb9 dtdfib mhjybrekfl bsdkt,f [dtkf7 se bc ufuh -
*l` cfbytmwbj tgbytahbyb9 ’tklf5
t` .dtkf xfvjsdkbkb8
f` * lqt9
,` !$ lqt9
!!*(8 cohfavjvmvtlb ,hjymjlbkfnfnjht,bc
u` @! lqt9
ufvj.tyt,bc gbhflfgbhb xdtyt,ff5
f` itntdbsb [fcbfsbc [dtkf9
*l` #_ lqt8
*,` fcsvjblehb cbylhjvb ceysmdbc ervfhb-
cj,bs9 !!(%8 gytdvjybbc ufydbsfht,bc hbcr-afmnjhbf5
u` fcsvjblehb cbylhjvb ceysmdbc ervfhb- f` flhtekb fcfrb9
cj,bc ufhtit9 ,‘lqtyfrkekj,f9
l` .dtkf xfvjsdkbkb8 u` jhufybpvbc uflfwbdt,f9
l` /bgjnhjabf9
!!*)8 ,hjymjlbkfnfnjht,c fh b.tyt,ty5 *t` .dtkf xfvjsdkbkb8
*f` @ sdtvlt fcfrib9
,` @ sdblfy ! okfvlt fcfrib9 !!(^8 gytdvjybbc cflbfuyjcnbrj rkbybrehb
u` ! okblfy % okfvlt fcfrib9 ybiyt,bf5
l` [es otkpt vtn fcfrib8 f` ntvgthfnehbc vjvfnt,f7 [dtkf7 e[db vihf-
kb [b[byb8
!!(_8 rhegbc cbylhjvbc 6 6 6-6| [fhbc[bc itvs[ - ,` wbfyjpb w[dbh-nexbc fhtib7 ceysmdfib yt-
dtdfib gbhdtk hbuib ufvjb.tyt,f5 rysfijhbcb fhtt,bc vjyfobktj,f7 cdtkb vc[db-
*f` tgbytahbybc by/fkfwbf9 k,einerjdfyb [b[byb9
,` tgbytahbybc rfymdtif bytmwbf9 u` [dtkf7 w[dbhblfy e[db7 cthbjpekb ufvjyf-
u` /jhvjysthfgbf9 ltyb7 vihfkb [b[byb9
l` fynb,bjnbrsthfgbf8 *l` [dtkf7 ceysmdbc uf[ibht,f lf kjrfkehb
rhtgbnfwbf8
!!(!8 ceysmdbc ervfhbcj,bs vbvlbyfht fcs -
vjblehb ~j,cnhemwbekb` cbylhjvbc lhjc ht - !*(*8 @ oktvlt fcfrbc ,fdidt,ib ]vj-c vbth
rjvtylt,ekbf tgb ytahbybc _7!-ghjwtynbfyb [c - htrjvtylt,ekb fynbgbhtnbekb cfiefkt,ff5
yfhbc itvltub ljpbht,f5 f` fcgbhbyb9
*f` _7_! vk/ru-pt9 ,` fyfkubyb9
,` _7! vk/ru-pt9 *u` gfhfwtnfvjkb9
u` _7_! vk sbsjtek otkpt9 l` .dtkf xfvjsdkbkb8
l` _7! vk sbsjtek otkpt8
!!((8 vodfdt htcgbhfwbekb byatmwbbc lhjc @
!!(@8 cnhtgnjrjrehb afhbyubnbc gtybwbkb - sdtvlt fcfrbc ,fdidsf /jcgbnfkbpfwbbc xdtyt,ff5
ybs vrehyfkj,bc [fhuh’kbdj,f itflutyc5 f` rheyx[df9
f` % lqtc9 ,` vfqfkb w[tkt,f9
,` * lqtc9 u` rhegbc cbylhjvb9
*u` !_ lqtc9 l` fcsvjblehb cbylhjvb9
l` !$ lqtc8 *t` .dtkf xfvjsdkbkb8
@__) otkb
,fdidsf rfhlbjkjubf 59
!!()8 vodfdt htcgbhfwbekb byatmwbbc lhjc @ !!)^8 /tgfhbycf lf /bcnfvbyc ufvj.jac5
sdtpt vtnb fcfrbc ,fdidsf /jcgbnfkbpfwbbc f` ytbnhjabkb9
xdtyt,ff5 ,` kbvajwbnb9
f` rheyx[df9 *u` aj.bthb e]htlb ~vfcnjwbnb`9
,` rhegbc cbylhjvb9 l` gkfpvehb e]htlb9
u` rf[tmcbf9 t` .dtkf xfvjsdkbkb8
l` rjvehb vlujvfhtj,f9
*t` .dtkf xfvjsdkbkb8 !!)*8 kbvajwbnt,bcf lf gkfpvekb e]htlt -
,bc fmnbdj,fc shueyfdc5
! ! ) _ 8 . e hb c v o d f d t b y a t m w b b c r kb y b r e hb y b i f - f` ceghfcnbyb9
ybf5 *,` vtsbkghtlybpjkjyb ~eh,fpjyb`9
f` w[tkt,f9 u` lbujmcbyb9
,` .ehbc nrbdbkb9 l` nhtynfkb8
u` xbhmjdfyb ufvjyfltyb .ehblfy9
*l` .dtkf xfvjsdkbkb8 !!)(8 /tgfhbybc ufvj.jafc shueyfdc5
f` K dbnfvbyb9
!!)!8 .ehbc mhjybrekb byatmwbbc lbfuyjpb ,` rehfynbkb9
bcvtdf bv itvs[dtdfib7 se ufvjyfltyb .ehblfy *u` ltmcfvtnfpjyb9
uh’tklt,f5 l` nhtynfkb8
f` * lqt9
*,` !$ lqt9 !!))8 fyst,bs htfmwbfib fh vjyfobktj,c5
u` @! lqt9 f` shjv,jwbnb9
l` #_ lqt8 ,` gkfpvehb e]htlb9
u` kbvajwbnb9
UEKBCF LF CBC[KBC VBVJMWTDBC CBCNTVBC *l` vbjwbnb8
LFFDFLT,T,B8 HTDVFNBEKB LFFDFLT,T,B
!@__8 % okbc ,bzc fqtybiyt,f lfqkbkj,f7 vf -
!!)@8 rfhlbfkehb gfsjkjubbc hbcrbc ]ueac hw[tyf gfhrezbc gekcfwbbc uf’kbtht,f7 rfyrf -
fh vbtresdyt,bfy ,fdidt,b5 kb vfhw[ybd 6 6 ytrysfijhbc fhtib7 tru-pt vfhw -
f` vfhafybc cbylhjvbs9 [tyf gfhrezbc uflfndbhsdf8 htynutyjuhfvfpt 2
,` tkthc-lfykjc cbylhjvbs9 vwbht ohbc /bgthdj ktvbf7 vfhw[tyf gfhrezbc
u` lfvjrkt,ekb PQ bynthdfkbc cbylhjvbs9 /bgthnhjabf8 smdtyb obyfcofhb lbfuyjpbf5
*l` fkgjhnbc cbylhjvbs8 f` abkndbc fhnthbbc cntyjpb9
,` gfhrezsfijhbc ’ublbc ltatmnb9
!!)#8 cf[cht,bc lffdflt,t,b [ibhfl edbsfh - u` ce,fjhnekb cntyjpb9
lt,fs ,fdidt,c5 *l` qbf fhnthbekb ~,jnfkbc` cflbyfhb8
f` tmcelfwbeh-rfnfhekb lbfstpbs9
,` kbvaeh-/bgjgkfpbehb lbfstpbs9 !@_!8 fdflv.jac qbf fhnthbekb cflbyfhbs
*u` ythdek-fhshbnekb lbfstpbs9 fh f[fcbfst,c5
l` gthbyfnfkehb tywtafkjgfsbbs8 *f` gjkbwbntvbf9
,` vfhw[tyf gfhrezbc /bgthnhjabf9
!!)$8 uekbc gfsjkjubf evtntcfl dkbylt,f5 u` abkndbc fhnthbbc hrfkbc ufvjlhtrf hty-
f` ltnjyb-lt,ht-afyrjybc cbylhjvbc lhjc8 nutyjuhfvfpt9
*,` vfhafybc cbylhjvbc lhjc9 l` cbc[kbc vbvjmwtdbc vwbht ohbc /bgthdj-
u` fkgjhnbc cbylhjvbc lhjc9 ktvbf8
l` flhtyjutybnfkehb cbylhjvbc lhjc8
!@_@8 fdflv.jac qbf ufybthb fhnthbekb cf -
!!)%8 jhufybpvbc flfgnfwbbc ghjwtcib vjyf - lbyhbs ghfmnbrekfl fh edkbylt,f5
obktj,c5 f` uekbc cf’uthb ufafynekb lf uf’kbtht,ekb9
f` sbhrvtkptlf ]bhrdfkb9 ,` uekvrthlbc fvj,thdf uekbc cfghjtmwbj
,` /bgjsfkfvecb9 fhtib vfhw[ybd9
u` /bgjabpb9 u` ’hfdbcvfudfhb [vfehb9
*l` .dtkf xfvjsdkbkb8 *l` wbfyjpb lf ljkbc 3]j[bcvfudfhb sbst,b48
@__) otkb
 60
!@_#8 fdflv.jac qbf fhnthbekb cflbyhbs7
hjujhw otcb7 fh edbsfhlt,f5
f` ,fmnthbekb tyljrfhlbnb9
,` abkndbc itiegt,f9
u` uekbc ervfhbcj,f9
*l` mjiby-wbfyjpbc itntdt,b8
!@_$8 qbf fhnthbekb cflbyhbc ,fmnthbekb
lfpbfyt,bcfc dkbylt,f5
f` cgktyjvtufkbf9
,` w[tkt,f9
u` tlc-bc fxmfht,f9
l` fytvbf9
*t` .dtkf xfvjsdkbkb8
!@_%8 ufvj[fnekb pjuflb wbfyjpb f[fcbfst,c5
*f` cfvrfhbfyb cfhmdkbc fnhtpbfc9
,` fjhnbc rjfhmnfwbfc9
u` qbf fhnthbek cflbyfhc9
l` gfhrezsfijhbc ’ublbc ltatmnc9
!@_^8 abkndbcvbthb /bgthntypbf fh f[fcbfst,c5
f` qbf fhnthbek cflbyfhc9
,` obyfueksfijhbc ’ublbc ltatmnc9
u` gfhrezsfijhbc ’ublbc ltatmnc9
*l` abkndbc fhnthbbc bpjkbht,ek cntyjpc8
!@_*8 gfhrezsfijhbc ’ublbc lblb pjvbc lt -
atmnbc itvs[dtdfib # sdbc fcfrbc ,fdidc fh ed -
kbylt,f5
f` mjibyb lf abpbrehb lfndbhsdbc fenfykj,f9
,` [ibhb gytdvjybt,b9
u` abkndbc fhnthbfpt vtjht njybc fmwtynb9
*l` rheyx[df8
!@_(8 gfhrezsfijhbc ’ublbc ltatmnbc lhjc
iebkbc vfmcbvfkehb [vbfyj,f dkbylt,f5
f` uekbc vodthdfkpt9
,` abkndbc fhnthbfpt9
*u` vrthlbc ’dkbc vfhw[ybd 6 6 6-6| ytrysfijhbc
fhtib9
l` vrthlbc ’dkbc ptlf vtcfvtlpt8
!@_)8 [ibhb gytdvjybt,b fh f[fcbfst,c5
f` fnhbjdtynhbrekeh rjveybrfwbfc9
,` gfhrezsfijhbc ’ublbc ltatmnc9
*u` afkjc ntnhflfc9
l` obyfueksfijhbc ’ublbc ltatmnc8
!@!_8 afkjcntnhflbc .dtkfpt [ibhb ufhse -
kt,ff5
f` ,fmnthekb tyljrfhlbnb9
*,` cbc[k’fhqdsf shjv,jpb9
u` abkndbc itiegt,f9
l` cbc[kbc ltyf8
,fdidsf rfhlbjkjubf
!@!!8 afkjc ntnhflfc fh f[fcbfst,c5
f` b’ekt,bs vlt,fhtj,f9
,` wbfyjpbc v’bvt itntdt,b9
*u` ecbvgnjvj vbvlbyfhtj,f9
l` ~ljkbc ]j[bcvfudfhb` sbst,b9
t` gjkbwbntvbf8
!@!@8 mjiby-wbfyjpbc itntdt,b f[fcbfst,c5
f` obyfueksfijhbc ’ublbc ltatmnc9
*,` afkjc ntnhflfc9
u` qbf fhnthbek cflbyfhc9
l` gfhrezsfijhbc ’ublbc ltatmnc8
!@!#8 afkjc ntnhflbc itvs[dtdfib mjiby-
wbfyjpbc itntdbc vjcf[cytkfl fh ufvjb.tyt,f5
*f` cnhjafynbyb9
,` ;fyu,flb9
u` fyfghbkbyb ~j,pblfyb`9
l` ghjvtljkb8
!@!$8 cbcntvehb obstkb vukehfc lhjc ufvj -
yf.fhbc nbgbehb kjrfkbpfwbff5
f` .ehbc yb;fht,pt9
,` nfypt9
u` at[t,pt9
*l` w[dbhbc rt[cf lf kj.t,pt9
t` [tkt,pt8
!@!%8 cbcntveh obstk vukehfc f[fcbfst,c5
f` htbyjc cbylhjvb9
*,` cbc[kib LE-e]htlt,b9
u` gthbjh,bnekb thbstvf9
l` lbcafubf9
t` .dtkf fqybiyekb8
!@!^8 cbcntvehb obstkb vukehfc cflbfuyjc -
nb r j l . d t kf p t b y a j h v f w b e kb f u f y b c f pq d h j c 5
f` A bveyjukj,ekbyt,b9
,` M bveyjukj,ekbyt,b9
u` /tvjukj,byb9
*l` fynbc[tekt,b lyv-bc vbvfhs9
t` fhw thsb fqybiyekb8
!@!*8 cbcntvehb obstkb vukehfc lhjc uflf -
vo.dtnb lbfuyjcnbrehb vybidytkj,f tybzt,f5
f` bveyjukj,ekbyt,bc vjvfnt,fc9
,` lbcghjntbytvbfc9
*u` LE-e]htlt,bc fhct,j,fc9
l` tlc-bc vjvfnt,fc8
!@!(8 dtutythbc uhfyekjvfnjpbc lhjc bidbfsbf5
f` cfceysmb upt,bc lfpbfyt,f9
,` ytahjgfsbf9
u` w[dbh-[f[bc lfpbfyt,f9
*l` wtynhfkehb ythdekb cbcntvbc lfpbfyt,f8
@__) otkb
,fdidsf rfhlbjkjubf 61
!@!)8 crkthjlthvbfc .dtkfpt vtnfl f[fcbfst,c5 !@@*8 htdvfnbpvbc ’bhbsflb lbfuyjcnbrehb
f` qdb’kbc lfpbfyt,f9 rhbnthbevbf5
,` rfhlbjgfsbf9 f` rthjdfyb byatmwbf9
u` ytahjgfsbf9 *,` rfhlbnb9
*l` rfybc lfpbfyt,f8 u` cfthsj cbcecnt9
l` fhshfkubf8
!@@_8 lthvfnjvbjpbnc .dtkfpt vtnfl f[fcb -
fst,c5 !@@(8 htdvfnbek ghjwtcpt fh vbesbst,c5
f` htbyjc cbylhjvb9 f` ktbrjwbnjpb9
*,` reyst,bc utythfkbpt,ekb lfpbfyt,f9 ,` tlc-bc vjvfnt,f9
u` ytbhjgfsbf9 *u` kbvajwbnjpb9
l` ytahjgfsbf8 l` shjv,jwbnjpb8

!@@!8 htdvfnjblek fhshbnc f[fcbfst,c5 !@@)8 htdvfnbpvbc v’bvt itntdbc itvltu evt -
f` w[tkt,f9 ntcfl dkbylt,f5
,` gthbrfhlbnb9 f` bpjkbht,ekb vbjrfhlbnb9
u` kbvaehb ]bhrdkt,bc uflblt,f9 ,` bpjkbht,ekb gthbrfhlbnb9
l` tlc-b ^_ vv/cs9 u` bpjkbht,ekb tyljrfhlbnb9
*t` .dtkf xfvjsdkbkb8 *l` tyljvbjrfhlbnb8
!@@@8 htdvfnjbleh fhshbnc fh f[fcbfst,c5 !@#_8 htdvfnbpvbc cflbfuyjcnbrjl .dtkfpt
f` vwbht cf[cht,bc lfpbfyt,f9 lblb vybidytkj,f tybzt,f5
,` 3lbkbc it,jzbkj,f49 *f` tyljvbjrfhlbnc9
u` fhshbnbc [fyu’kbdb vbvlbyfhtj,f9 ,` uflfnfybk fyubyfc9
*l` cf[cht,bc 3vahbyfdb4 nrbdbkt,b9 u` lbcghjntbytvbfc9
t` .dtkf xfvjsdkbkb8 l` rdfy’jdfy thbstvfc8
!@@#8 htdvfnjblek fhshbnc f[fcbfst,c5
!@#!8 htdvfnbekb tyljrfhlbnbc lhjc evt -
f` tyljrfhlbnb9
ntcfl pbfylt,f5
,` cf[cht,bc 3vahbyfdb4 nrbdbkt,b9
f` fjhnekb cfhmdtkb9
u` wbrkehb vbvlbyfhtj,f chekb lf cohfab
,` cfvrfhbfyb cfhmdtkb9
ereufydbsfht,bs9
*u` jhrfhbfyb cfhmdtkb9
*l` yfhxtyb ltajhvfwbt,b9
l` abkndbc fhnthbf8
t` .dtkf xfvjsdkbkb8
!@#@8 ,fdidt,ib it’tybkb uekbc vfyrbc ajh-
!@@$8 htdvfnbpvbc ufydbsfht,f itb’kt,f uf -
vbht,bc ’bhbsflb vbptpbf5
yfgbhj,jc5
f` ab,hjtkfcnjpb9
f` gbtkjytahbnvf9
,` cbcntvehb obstkb vukehf9
,` mjktwbcnbnvf9
*u` mhjybrekvf njypbkbnvf9 *u` htdvfnbpvb9
l` dekdjdfubybnvf8 l` ctacbcehb tyljrfhlbnb8

!@@%8 htdvfnek itntdfc [ibhfl oby ecoht,c5 !@##8 fjhnekb cfhmdkbc vrdtshfl ufvj[fne-
*f` cnhtgnjrjrekb byatmwbf9 kb ervfhbcj,bc itvs[dtdfib fhnthbekb oytdf5
,` nhfdvf9 f` yjhvbc afhukt,ibf9
u` ctacbcb9 ,` vfmcbvfkehb 2 lf,fkbf7 vbybvfkehb 2 vf-
l` yfokfdehb byatmwbf8 qfkb9
*u` cbcnjkehb 2 yjhvfkehb fy vfqfkbf7 lb-
! @ @ ^ 8 ht d v f nb p v b c ’ b h b s f l b l b f u y j c n b r eh b fcnjkehb 2 lf,fkb9
rhbnthbevbf5 l` [tkt,pt 2 vfqfkb7 at[t,pt 2 lf,fkb8
f` bveyjukj,ekbyt,bc nbnhbc vjvfnt,f9
,` f,ljvbyehb cbylhjvb9 !@#$8 vbnhfkehb ervfhbcj,bc lhjc cbcnj -
*u` gjkbfhshbnb9 kehb iebkb5
l` tru-pt lf,fkb T-r,bkb9 f` yfpb7 vjrkt7 fhfvelvbdbf9
t` .dtkf xfvjsdkbkb8 ,` e[tibf7 tgbwtynhbs | othnbkib9
@__) otkb
 62
u` uf,vekbf7 v,thfdb7 lfrfdibht,ekb 6 nj-
ysfy7 | othnbkib vluhflbf7 fh mht,f9
*l` uf,vekbf7 v,thfdb7 lfrfdibht,ekb 6 nj-
ysfy7 vluhflb vfmcbvevbs uekbc vodthdfkpt8
!@#%8 htdvfnbekb itntdbc cfo.bc gthbjlib
vbpfyitojybkbf lfbybiyjc5
*f` gtybwbkbyb9
,` wtgjhbyb9
u` ktdjvbwtnbyb9
l` ,bwbkbyb8
!@#^8 htdvfnbpvbc ,bwbkbyghjabkfmnbrfc
bo.t,ty5
f` fv,ekfnjhbekfl7 cnfwbjyfhblfy ufvjot-
hbc itvltu9
,` cfyfnjhbevib9
*u` cnfwbjyfhib7 lffdflt,bc fmnbeh afpfib9
l` fv,ekfnjhbekfl7 cfyfnjhbevblfy ufvj-
othbc itvltu8
!@#*8 fhfcnthjblekb fyst,cfobyffqvltuj
ghtgfhfnt,b fh fhbc htrjvtylt,ekb5
f` htdvfnbpvbc lhjc9
,` htdvfnjblehb fhshbnbc lhjc9
*u` dthk/jabc lffdflt,bc lhjc9
l` gjcnnhfdvekb fhshbnbc lhjc8
!@#(8 gtybwbkbybc vbvfhs fkthubbc itvs[dt -
dfib eybiyfdty5
f` fvgbwbkbyc9
,` ,bwbkbyc9
u` jmcfwbkbyc9
*l` thbshjvbwbyc8
!@#)8 afkjc ntnhflfc fh f[fcbfst,c5
f` mjibyb9
*,` [dtkf mfabfyb yf[dtkbs9
u` wbfyjpb9
l` abpbreh ufydbsfht,fib xfvjhxtyf8
!@$_8 uekbc sfylf.jkbkb vfyrbc ufydbsfht,bc
[tkitvo.j, afmnjhfl fh itb’kt,f xfbsdfkjc5
f` ltlbc fyfvytpib ghjatcbekb vfdyt afmnj-
ht,bc fhct,j,f9
,` ltlbc vbth jhcekj,bc gthbjlib cfvreh-
yfkofvkj cfiefkt,t,bc vbqt,f9
*u` ltlbc ubytrjkjubehb lffdflt,t,b jh-
cekj,bc gthbjlib9
l` f[kj yfstcfdt,bc fhct,j,f7 hjvkt,cfw
fmds uekbc sfylf.jkbkb vfyrb8
!@$!8 afkjc ntnhflfc fh f[fcbfst,c5
f` abpbreh ufydbsfht,fib xfvjhxtyf9
*,` iebkbc fhfhct,j,f9
,fdidsf rfhlbjkjubf
u` mjibyb9
l` lbaepehb wbfyjpb8
!@$@8 afkjc ntnhflbc lhjc fhfnbgbehbf5
f` thbshjwbnt,bc hfjltyj,bc vjvfnt,f9
,` htynutyjuhfvfpt uekbc nbgehb rjyabue-
hfwbbc xhlbkbc fhct,j,f9
*u` vfhw[tyfuhfvf tru-pt9
l` vfh]dtyfuhfvf tru-pt8
!@$#8 vjphlbkb fcfrbc ,fdidbc fjhnbc rjfh -
mnfwbfc fh f[fcbfst,c5
f` sfdbc nrbdbkb9
,` sfd,hec[dtdf9
u` cbcecnt at[t,ib9
*l` vblhtrbkt,f cfceysmb cbcntvbc [ibhb
lffdflt,bcflvb8
!@$$8 qbf fhnthbekb cflbyfhbc fhct,j,fc fh
f[fcbfst,c5
f` abpbreh ufydbsfht,fib xfvjhxtyf9
,` rfybc cfafhdtkbc cbathvrhsfkt9
*u` fhnthbekb ~cbcnjkehb` oytdbc itvwbht,f9
l` vblhtrbkt,f cfceysmb jhufyjt,bc [ibhb
lffdflt,t,bcflvb8
!@$%8 qbf fhnthbekb cflbyfhbc fhct,j,fc
f[fcbfst,c5
f` uf[fyu’kbdt,ekb cbcnjkehb iebkb ue-
kbc vodthdfkpt9
,` lbfcnjkehb iebkb uekbc vodthdfkpt9
u` cbcnjkehb iebkb uekbc ae’tcsfy9
*l` cbcnjkeh-lbfcnjkehb iebkb 6 6 ytrysf-
ijhbc fhtib vrthlbc ’dkbc vfhw[ybd8
!@$^8 obyfueksfijhbc ’ublbc ltatmnbc lhjc
cbcnjkehb iebkb .dtkfpt erts vjbcvbyt,f5
f` uekbc vodthdfkpt9
,` | othnbkib9
u` 6 6 ytrysfijhbc fhtib vrthlbc ’dkbc vf-
h]dybd9
*l` 6 6 ytrysfijhbc fhtib vrthlbc ’dkbc vfhw[ybd8
!@$*8 gfhrezsfijhbc ’ublbc ltatmnbc lhjc
c bcnjkehb ieb kb . dtkf pt erts vjb cv b y t,f 5
f` uekbc vodthdfkpt8
*,` | othnbkib9
u` 6 6 ytrysfijhbc fhtib vrthlbc ’dkbc vfh]dybd9
l` 6 6 ytrysfijhbc fhtib vrthlbc ’dkbc vfhw[ybd8
!@$(8 ab,hjtkfcnjpbc ’bhbsfl rkbybreh
ufvjdkbyt,fc fh ofhvjflutyc5
f` rfybc cfafhdtkbc cbathvrhsfkt9
,` frhjwbfyjpb9
*u` abkndt,ib vjcvtybs odhbk,einerjdfyb
[b[byb9
l` uekbc cfpqdht,bc uflblt,f8
@__) otkb
,fdidsf rfhlbjkjubf 63
!@$)8 /bgthnjyekb nbgbc dtutnjcbc[k’fhq - u` gekcbc vrdtshb uf[ibht,bc itntdbs9
djdfyb lbcnjybbc itvs[dtdfib lbathtywbfke - l` xfceysmdbcfc gekcbc vrdtshb itvwbht,bs
hb lbfuyjpb fewb kt,kfl eylf ufnfhltc5 fy ufmhj,bs7 fvjceysmdbcfc 2 uf[ibht,bs8
f` lthvfnjvbjpbnsfy9
*,` tyljrhbyjgfsbfcsfy9 !@%*8 gekcbc ~vf]bcwtvbc` ufmhj,f f[fcbf -
u` ne,threkjpsfy9 st,c5
l` htdvfnbpvsfy8 f` tmcnhfcbcnjkbfc9
,` gfhjmcbpvek nfmbrfhlbfc9
!@%_8 mjhtfc fh f[fcbfst,c5
u` gfhfljmcek vf]bcwtvfc .bdfyf [dtkbc it-
f` mfjnehb vj’hfj,f9
ntdbc lhjc8
,` rjjhlbyfwbbc lfhqdtdf9
*u` cf[bc ythdbc gfhtpb9 *l` vjwbvwbvt ~gfhrezjdfy` fhbnvbfc8
l` [tkothbc itwdkf8
!@%(8 lbfcnjkehb rfyrfkb ~3rfnbc rheneyb4`
! @ % ! 8 h t d vj r f hlb nc f h f [ f c b f st ,c 5 uekbc vodthdfkpt f[fcbfst,c5
*f` tktysbc uflblt,f9 f` vbnhfkehb cfhmdkbc ervfhbcj,fc9
,` uekbc cfpqdht,bc uflblt,f9 *,` vbnhfkeh cntyjpc9
u` uf[fyuh’kbdt,ekb v,thfdb cbcnjkehb u` fjhnek cntyjpc9
iebkb uekbc vodthdfkpt9 l` obyfueksfijhbc ’ublbc ltatmnc9
l` uekbc njyt,bc vj.het,f8 t` fjhnbc rjfhmnfwbfc8

!@%@8 cbc[kbc vbvjmwtdbc ervfhbcj,bc cb - !@%)8 gbhdtkbc njybc uf’kbtht,f fh f[fcbf -

vgnjvc fh ofhvjflutyc5 st,c5
f` mjibyb9 *f` vbjrfhlbevbc lfpbfyt,fc ~vbjrfhlbnc7
,` qdb’kbc uflblt,f9
rfhlbjvbjgfsbfc`9
u` rbleht,bc gfcnjpehj,f9
,` obyfueksfijhbc ’ublbc ltatmnc9
*l` lbehtpbc uf’kbtht,f8
u` gfhrezsfijhbc ’ublbc ltatmnc9
!@%#8 htdvfnbpvc fh f[fcbfst,c5 l` vbnhfkehb cfhmdkbc cntyjpc9
f` pjvbthb /bgjmhjvekb fytvbf9 t` P-Q bynthdfkbc itvjrkt,fc8
*,` ktbrjgtybf9
u` ktbrjwbnjpb ajhvekbc vfhw[ybd uflf[hbs9 !@^_8 uekbc vtjht njybc ofhvjmvyfc cfae -
l` tlc-bc vjvfnt,f $_ vv/cs-vlt8 ’dkfl eltdc5
f` fnhbjdtynhbrekb cfhmdkt,bc lf[ehdf cb-
!@%$8 cbcntveh obstk vukehfc fh f[fcbfst,c5 cnjkbc lfcfo.bcib9
f` ktbrjgtybf9 *,` fjhnbcf lf abkndbc fhnthbbc cfhmdkt-
*,` ktbrjwbnjpb9 ,bc fcbymhjyekb lf[ehdf9
u` tlc-bc fxmfht,f9 u` gfhrezt,bc ufafhsjt,f cbc[kbc gbhdtkb
l` 3obstkb vukehfc4 e]htlt,bc fhct,j,f8 ekeabc uflbyt,bs lbfcnjkfib9
l` cbc[kbc uf’kbtht,ekb uflbyt,f fnhbjdt-
!@%%8 cfvb okbc ]fyvhstkb ,fdidbc gekcbc
ynhbrekeh cfhmdkt,ib8
~vf]bcwtvbc` cb[ibhtf5
f` !@_-!$_ oesib9
!@^!8 tmcelfwbehb gthbrfhlbnbc lbfuyjc -
,` !!_-!!% oesib9
nbrfib .dtkfpt byajhvfwbekbf5
*u` !_%-!!_ oesib9
l` )_-)% oesib9 f` tktmnhjrfhlbjuhfabf9
t` (_-)_ oesib8 ,` ajyjrfhlbjuhfabf9
u` htynutyjuhfabf9
!@%^8 ]fyvhstkb ,fdidbc abpbjkjubehb ~t8 o8 *l` tmjrfhlbjuhfabf8
ceysmdbsb` fhbnvbf dkbylt,f5 !@^@8 qbf fhnthbek cflbyfhc f[fcbfst,c5
*f` xfceysmdbcfc gekcbc uf[ibht,bs7 fvjcey- f` lbfcnjkehb iebkb vfmcbvevbs vtjht ytr-
smdbcfc 2 ufbidbfst,bs8 ysfijhbc fhtib vfhw[ybd9
,` lhjpt flht wfkrtekb gekcehb nfkqbc ,` e[tib cbcnjkehb iebkb vtjht ytrysfij-
ofhvjmvybsf lf itvlujvb rjvgtycfwbehb gfepbs9 hbc fhtib vfhw[ybd9
@__) otkb
 64
*u` cbcnjkeh-lbfcnjkehb iebkb vtjht yt-
rysfijhbc fhtib vfhw[ybd9
l` cbcnjkeh-lbfcnjkehb iebkb uekbc vo-
dthdfkpt8
!@^#8 qbf fhnthbekb cflbyhbc itvs[dtdfib
fh fqbybiyt,f5
f` cbcnjkeh-lbfcnjkehb 3v[th[fdb4 iebkb9
,` htynutyjuhfvfpt abkndbc fhnthbbc uf-
vjpytmf9
u` vfhw[tyf gfhrezbc uflblt,f9
l` cbc[kbc vbvjmwtdbc vwbht ohbc uflfndbhsdf9
*t` gjkbwbntvbf8
!@^$8 afhsj qbf fhnthbek ~,jnfkbc` cflb -
yfhc fh f[fcbfst,c5
f` rbchbc fhnthbt,bc gekcfwbf9
*,` lf,fkb gekcehb oytdf9
u` rfhlbjvtufkbf9
l` abpbreh ufydbsfht,fib xfvjhxtyf9
t` 3rfnbc rheneyb4 vtjht ytrysfijhbc fhtib8
!@^%8 obyfueksfijhbc ’ublbc ltatmnc ,fdi -
dj,bc fcfrib fh f[fcbfst,c5
f` mjibyb abpbrehb lfndbhsdbcfc9
*,` wbfyjpb9
u` cbcnjkehb iebkb9
l` uekbc tktmnhekb qth’bc uflf[hf vf-
h]dybd9
t` htynutyjuhfvfpt uekbc ufybdb cfpqdhbc
uflblt,f ’bhbsflfl vfh]dtyf yfobkt,bc [fh]pt8
!@^^8 uekbc hjvtkb vfyrbc lhjc fhbc obyf -
ueksfijhbc ’ublbc ltatmnbcf lf vbnhfkehb
[dhtkbc cntyjpbc rjv,bybht,f0
*f` kenty,fitc lffdflt,bc lhjc9
,` tbptyvtyuthbc rjvgktmcbc itvs[dtdfib9
u` afkjc ntnhflbc lhjc9
l` t,intbybc fyjvfkbbc itvs[dtdfib8
!@^*8 vwbht ohbc ~abkndbcvbthb` /bgthnty -
pbf fh dkbylt,f5
f` qbf fhnthbekb cflbyhbc itvs[dtdfib9
,` obyfueksfijhbc ’ublbc ltatmnbc itvs[dtdfib9
*u` abkndbc fhnthbbc bpjkbht,ekb cntyj-
pbc lhjc9
l` vbnhfkehb cfhmdkbc cntyjpbc lhjc8
!@^(8 abkndbc fhnthbbc pjvbth bpjkbht -
,ek cntyjpc fh f[fcbfst,c5
*f` wbfyjpb9
,` mjibyb lfndbhsdbcfc9
u` cbcnjkehb rfyrfkb vtjht ytrysfijhbc
fhtib vfhw[ybd9
,fdidsf rfhlbjkjubf
l` ufyltdybc nbgbc e[tib cbcnjkehb iebkb9
t` itcecnt,ekb 6 6 njyb8
!@^)8 abkndbc fhnthbbc ufvj[fnek ~v’bvt`
bpjkbht,ek cntyjpc fh f[fcbfst,c5
f` nrbdbkb vrthlbc fhtib9
,` uekbc ervfhbcj,bc htahfmnthekb7 ghju-
htcbht,flb [fcbfsb9
*u` uekbc cfpqdht,b yjhvbc afhukt,ib9
l` htynutyjkjubehfl abkndbc cehfsbc vr-
dtshb ufqfhb,t,f9
t` qhvf S r,bkb |^ ufy[hfib8
! @* _ 8 ab knd b c f h n t h b b c c f h m d kt , b c s f y l f -
.jkbkb ervfhbcj,bc lhjc fecreknfwbehb vj -
yfwtvt,bf5
f` e[tib cbcnjkeh-lbfcnjkehb iebkb ue-
kbc vodthdfkpt9
,` vtpjlbfcnjkehb iebkb uekbc vodthdf-
kpt bynthdfkbs 6 6 njysfy9
u` yjhvfkehb gbhdtkb lf vtjht njyb ab-
kndbc fhnthbfpt9
*l` ghjnjlbfcnjkehb iebkb7 itho.vekb 6 6
njysfy vtjht-vtcfvt ytrysfijhbc fhtib vf-
hw[ybd8
!@*!8 hjvtkb ufhsekt,f fh f[fcbfst,c fj -
hnbc cntyjpc0
*f` fhnthbekb /bgthntypbf9
,` vfhw[tyf gfhrezbc gbgthnhjabf9
u` rfkwbyjpb9
l` fjhnekb cfhmdkt,bc ervfhbcj,f9
t` ,fmnthbekb tyljrfhlbnb8
!@*@8 hjujhbf fhnthbekb oytdf fjhnbc rjf -
hmnfwbbc itvs[dtdfib0
f` yjhvfkehb9
,` vfmcbvfkehb 2 lf,fkb7 vbybvfkehb 2 vjvf-
nt,ekb9
u` vfmcbvfkehb 2 vfqfkb7 vbybvfkehb 2 lf,fkb9
*l` ptlf rbleht,pt 2 vfqfkb7 mdtlf rbleht-
,pt 2 lf,fkb9
t` vrdtshfl vjvfnt,ekb hjujhw ptlf7 fctdt
mdtlf rbleht,pt8
!@*#8 uekbc vfyrt,blfy hjvtkb itb’kt,f uf -
[ltc f[fkij,bk ,fdidsf cnhbljhekb ce -
ysmdbc vbptpb0
f` fjhnbc rjfhmnfwbf9
,` abkndbc fhnthbbc cntyjpb9
u` thsbfyb fhnthbekb qthj9
*l` fjhnbc hrfkbc ufjht,f8
ufuh’tkt,f b[8 itvltu yjvthib
@__) otkb