. 1
( 2 .)



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oOaeCOa a aOaAeeiCe

uUUAIUE‚IOOU? E ·AAOOOIOOU?
?AIIOUAII (A??UI)
U ·OI?I?? OOUAO?U?OAOI
C.C. AOIEI
e?OUAOOO?
eaAee

noaia?o?ic i?aanoaaeyao niaie iniiaio? iicieiae- Iniiaiuie eeeie?aneeie i?iyaeaieyie IA yaey?o-
I ?aneo? oi?io aaaaia?aoeaiuo caaieaaaiee nonoa- ny aiee a nonoaaao iaoaie?aneiai oeia e aieu i?e eo
aia e oa?aeoa?ecoaony o?iie?aneei i?ia?anne?o?uei iaeuiaoee, oo?aiiyy neiaaiiinou, eioi?ay iau?ii ia
oa?aieai. A iniiaa yoiai ioeuoeoaeoi?eaeuiiai caai- i?aauoaao 30–40 ieioo, aaoeao?aoey nonoaaia ca n?ao
eaaaiey ea?eo ia?ooaiea ?aaiiaaney ia?ao aiaaiee- yennoaaoeaiiai eiiiiiaioa, eo aaoi?iaoey, ia?ea?oe-
?aneeie e eaoaaiee?aneeie i?ioannaie, e i?a?aa ana- eoey?iue o?ono e ia?aie?aiea iiaae?iinoe. A neiioi-
ai a aeaeeiiaii o?yua, eioi?ue yaeyaony iniiaiui iaoeeo inoaia?o?ica aoiayo e oaeea i?eciaee, eae eino-
ieaoaa?iii ?acaeoey iaoieiae?aneiai i?ioanna. I?e iua ?ac?anoaiey, ia?ooaiea eiia?oyioiinoe nonoaaiuo
yoii caaieaaaiee iaoieiae?aneee i?ioann eieaeecoaony iiaa?oiinoae e ?acaeoea iiaauaeoia. Aieu a nonoaaao
ia oieuei a aeaeeiiaii o?yua, ii e a neiiaeaeuiie iai- i?aanoaaeyao niaie iaeaieaa y?eee i?eciae yoiai caai-
ei?ea, noaoiia?aeuiie einoe, nonoaaiie eainoea, aioo- eaaaiey. I?e?eiu aa ?acaeoey ??acau?aeii iiiaiia?ac-
?enonoaaiuo nayceao e ieieinonoaaiuo iuooao. Ana yoi iu e iaoneiaeaiu caeioa?aniaaiiinou? a iaoieiae?a-
i?eaiaeo e ?acaeoe? a oie eee eiie noaiaie ?aoeaeae- neii i?ioanna einoe (ia?einoeo, noaoiia?aeuiua ia?a-
?o?uaai neiiaeoa, aaaaia?aoee o?yua n oiaiuoaieai eiiu, iiauoaiea aioo?eeinoiiai aaaeaiey), neiiaeaeu-
aai iauaia, einoiiio ?aiiaoee?iaaie?, neea?ico non- iie iaiei?ee (ainiaeaiea, ?aca?a?aiea ?oanoaeoaeuiuo
oaaiie eainoeu, aaaaia?aoee iaienea, ia?ea?oeeoey?- ia?aiuo ieii?aiee inoaioeoaie) e ia?ea?oeeoey?iuo
iie iuoa?iie ao?ioee. oeaiae (iuoa?iue niaci, ianoaaeeuiinou nonoaaa).
Inoaia?o?ic caieiaao ia?aia ianoi ii ?ani?i- Oa?aiey inoaia?o?ica anaaaa aie?ia auou eiiieaen-
no?aiaiiinoe n?aae a?oaeo ?aaiaoe?aneeo aieaciae iie e iai?aaeaiiie ia ono?aiaiea i?e?ei, aeey?ueo ia
e ?aoei ei??aee?oao n aic?anoii. Ii aaiiui Perrot S. ?acaeoea e i?ia?anne?iaaiea caaieaaaiey, nouanoaaiiia
e Menkes C.J. [1], ?aioaaiieiae?aneea neiioiiu yoiai oiaiuoaiea eioaineaiinoe aieae a nonoaaao e iiaaaea-
caaieaaaiey ano?a?a?ony o 50% ianaeaiey Aa?iiu iea a?oaeo neiioiiia yoiai caaieaaaiey, ii?iaeecaoe?
noa?oa 65 eao e eeeie?aneea – o 12,5%, a o eeo noa?oa aiaaiee?aneeo e eaoaaiee?aneeo i?ioannia a ii?a?ai-
80 eao inoaia?o?ic ii?aaaeyaony ii?oe o anao iaoeaioia iii o?yua, a oae?a ainnoaiiaeaiea ooieoee ii?a?aiiuo
nonoaaia. Iia aee??aao neiioii–iiaeoeoe?o?uea
[2]. I?e yoii caaieaaaiee ii?a?a?ony a ia?ao? i?a?aau
i?aia?aou, iai?aaeaiiua ia iiaaaeaiea aiee e ii?ia-
«iaa?oci?iua nonoaau», ?oi cia?eoaeuii oooaoaao ea-
eecaoe? ooieoee ii?a?aiiuo nonoaaia, e no?oeoo?-
?anoai ?ecie aieuiuo e i?aanoaaeyao na?uacio? nioe-
ii–iiaeoeoe?o?uea, niinianoao?uea ii?iaeecaoee
aeuii–yeiiiie?aneo? i?iaeaio. Inoaia?o?ic yaeyaony
iaiie ec iniiaiuo i?e?ei i?a?aaa?aiaiiie iioa?e eee noaaeeecaoee no?oeoo?iuo eciaiaiee a aeaeeiiaii
o?oainiiniaiinoe e eiaaeeaiinoe, onooiay a yoii ioii- o?yua e caiaaeaie? oaiiia i?ia?anne?iaaiey caaiea-
oaiee oieuei eoaie?aneie aieacie na?aoa. aaiey. Neiioii–iiaeoeoe?o?uay oa?aiey aee??aao
Iaoiaaiac ia?ae?iiai IA ai–iiiaii ?anoeo?iaai. i?inoua aiaeuaaoeee e ianoa?ieaiua i?ioeaiainiaee-
A aai ?acaeoee ?aoa?uaa cia?aiea i?eaaaony iaainoa- oaeuiua i?aia?aou (IIAI). Ia?aua ec ieo i?eiaiy?ony
oi?iiio neioaco oiia?ioeoaie i?ioaiaeeeaiia, a oae?a ia ia?aeuiii yoaia caaieaaaiey eee aey iioaioe?iaaiey
eiee?anoaaiiiio e ea?anoaaiiiio ia?ooaie? oi?ie- aiaeuaaoe?aneeo naienoa IIAI.
?iaaiey i?ioaiaeeeaiiauo aa?aaaoia. Aa?iia cia?aiea Eae ecaanoii, noaiaa?oiua IIAI (ai anyeii neo?aa
eiaao aeoeaaoey eieeaaaiacu, oinoieeiacu A2, aeia?- aieuoeinoai ec ieo) ?anniao?eaa?ony, eae i?aia?aou,
i?iaoeoey eioa?eaeeeia–1 (EE–1) e oaeoi?a iae?ica eioi?ua oneeeaa?o aaaaia?aoe? o?yua iin?aanoaii
iiooiee–? (OII–?), eioi?ua iai?aaeaiu ia aeoeaaoe? oi?ii?aiey iaoaaiee?aneie aeoeaiinoe oiia?iaeanoia
eaoaaiee?aneeo i?ioannia a ii?a?aiiii o?yua. Ii?a- e oaiaoaiey neioaca i?ioaiaeeeaiia oiia?ioeoaie, a
aaeaiio? ?ieu a iaoiaaiaoe?aneii eaneaaa IA i?eiaa- oae?a a?oaeo iae?iiieaeoe, iaania?eaa?ueo ii?iaeu-
ea?eo aeia?i?iaoeoee i?inoaaeaiaeia A2, noia?ienea- iia ooieoeiie?iaaiea aeaeeiiaiai o?yua. Iiyoiio
iui ?aaeeaeai, oiaiuoaie? neioaca aeeo?iiiaie een- IIAI ?aeiiaiao?o iacia?aou ei?ioeeie eo?naie e, eae
eiou neiiaeioeoaie. Iiauoaiiay yeni?anney iao?e?- i?aaeei, i?e iaee?ee aoi?e?iiai (?aaeoeaiiai) a?o?eoa
iuo iaoaeeii?ioaeiac (eieeaaaiacu, no?iiaeeceia e eee au?a?aiiuo aieae, ia eoie?o?ueony i?inouie
oinoieeiacu A2), aeoeaaoey i?iainiaeeoaeuiuo oeoi- aiaeuaaoeeaie. Iaiaei a iineaaiaa a?aiy ia?aniao?e-
eeiia (EE–1, EE–6, OII–?), nie?aiea niaa??aiey aaaony eo cia?aiea a eiiieaeniie oa?aiee inoaia?o?i-
o?ainoi?ie?o?uaai oaeoi?a ?inoa–?, a oae?a iiau- ca. Oaia?u aieacaii, ?oi iaeioi?ua IIAI niiniaiu
oaiea eiioaio?aoee ieneaa acioa e oeeeiieneaaiacu–2 naa??eaaou aiiioic eeaoie o?yua, a oae?a noeioee?i-
niinianoaoao ia?nenoe?iaaie? ainiaeaiey a oeaiyo no- aaou i?iaoeoe? eie i?ioaiaeeeaiia [3,4]. E oaeei i?a-
noaaa n ?acaeoeai oiia?eoa, inoaeoa e neiiaeoa. ia?aoai ioiineony aoaeeioaiae.

392 13, 7, 2005
Aoaeeioaiae (Ay?oae) aue neioace?iaai a 1982 a. e ca?aeiiaiaiaae naay eae i?aia?ao, iaeaaa?uee aunieie ai-
oeainiaeeoaeuiie aeoeaiinou? e oi?ioae ia?aiineiinou?. A Aa?iia ii noae oe?iei i?eiaiyouny n 1997 a., a ia-
?eiay n 2002 a. e a ?innee. Aoaeeioaiae yaeyaony i?iecaiaiui oaieeaoaoeeiaie eeneiou (2–[2,6 – aeoei?oaiee)
aieii] oaieeaoaoioenoniay eeneioa) e ii naiae no?oeoo?a aeecie e aeeeioaiaeo. Ii iaeaaaao aunieie noaiaiu?
naycuaaiey n aaeeii (99%). I?e ia?i?aeuiii i?eiaiaiee auno?i e iieiinou? aani?ae?oaony e nionoy 1,5–2 ?ana
ainoeaaao naiae iaeneiaeuiie eiioaio?aoee a e?iae. I?aia?ao ia iaeaaaao eoioeyoeaiie aeoeaiinou?, a aai oa?-
iaeieeiaoeea ia caaeneo io aic?anoa iaoeaioia.
Aoaeeioaiae iaoaaieece?oaony i?aeiouanoaaiii a ia?aie a 4’–aea?ieneaoaeeioaiae, a oae?a a a?oaea iaoa-
aieeou, aee??ay aeeeioaiae. Ia?eia iieoauaaaaiey ninoaaeyao 4 ?ana. Ii yene?aoe?oaony ec i?aaiecia i?aeio-
uanoaaiii ii?eaie. Aoaeeioaiae ia acaeiiaaenoaoao n oaeeie eaea?noaaie, eae iaoio?aenao, oeeeinii?ei, aeai-
enei, aioeeiaaoeyiou, aeo?aoeee, aioeaeioeee. I?aia?ao auioneaaony a oaaeaoeao, iie?uouo iaiei?eie. Ea?aay
oaaeaoea niaa??eo 100 ia aoaeeioaiaea. Ea?aaiay aai aica ninoaaeyao 200 ia/noo, a iiaaa??eaa?uay 100 ia/noo.
Ea?aaiue yooaeo aoaeeioaiaea, eae e a?oaeo IIAI, naycai n iiaaaeaieai neioaca iaaeaoi?ia ainiaeaiey, e
i?a?aa anaai i?inoaaeaiaeia A2 (oaae. 1). Iieacaii, ?oi o aieuiuo inoaia?o?icii n i?iyaeaieyie aoi?e?iiai a?o-
?eoa aoaeeioaiae ii n?aaiaie? n aeeeioaiaeii a aieuoae noaiaie nie?aao o?iaaiu i?inoaaeaiaeia A2 a ne-
iiaeaeuiie ?eaeinoe. Oa?aiaaoe?aneia aai aaenoaea oae?a naycaii n eiaeae?iaaieai EE–1?, EE–6 e OII–?,
nie?aieai yeni?annee iieaeoe aaaacee, iiaaaeaieai i?iaoeoee ieneaa acioa e aai aioeieneaaioiuie naienoaa-
ie [5, 6].
Aoaeeioaiae e aai iaoaaieeo – 4’–aea?ieneaoaeeioaiae i?aeiouanoaaiii iiaaaey?o oeeeiieneaaiaco–2
(OIA–2) e a iaiuoae noaiaie – OIA–1 [7]. A?oaie iaoaaieeo aoaeeioaiaea – aeeeioaiae oaiaoaao eae OIA–1, oae
e OIA–2. Ia oiia i?eaia aoaeeioaiaea niioiioaiea OIA–2 e OIA–1 auoa, ?ai i?e i?eaia oaeeo noaiaa?oiuo
IIAI, eae ie?ieneeai, eiaiiaoaoei, oaiieneeai e eaoii?ioai, ?oi e iauyniyao aunieo? aai aaciianiinou. Eioa-
?anii, ?oi naeaeoeaiia eiaeae?iaaiea OIA–2 iieacaii a eoeuoo?a ii?iaeuiuo e ii?a?aiiuo inoaia?o?icii oii-
a?ioeoao [8].
?aoeiiaeuiinou eniieuciaaiey aoaeeioaiaea o aieuiuo inoaia?o?icii iaoiaeo naia iauyniaiea ia oieuei a
aai aioeainiaeeoaeuiii e aiaeuaaoe?aneii naienoaao, ii e a aai aaenoaee ia iaoaaieeci iniiaiiai aauanoaa ae-
aeeiiaiai o?yua. Aoaeeioaiae noeioee?oao neioac i?ioaiaeeeaiia e aeaeo?iiiaie eeneiou [9,10]. Ii yen-
i?anne?oao aeeeicaieiiaeeeaiu a o?yuaaie oeaie, iieo?aiiie io aieuiuo inoaia?o?icii, a oi a?aiy eae aeeei-
oaiae e iai?ienai ia iaeaaa?o oaeeie naienoaaie. A yenia?eiaioa aoaeeioaiae aaiiino?e?oao oiia?ii?ioaeoea-
iua naienoaa, noi?anne?oy eioa?eaeeei–1–iiin?aaiaaiio? i?iaoeoe? iaoaeeii?ioaeiac, ?oi niinianoaiaoao noe-
ioeyoee neioaca i?ioaiaeeeaiia oiia?ioeoaie [11]. E?iia oiai, iaei ec iaoaaieeoia aoaeeioaiaea – 4’II–aoae-
eioaiae – oi?iiceo i?ieeoa?aoe? neiiaeioeoia.
Neiioii–iiaeoeoe?o?uea naienoaa aoaeeioaiaea i?e inoaia?o?ica auee eco?aiu a ianeieueeo aaie-
iuo–neaiuo eiio?iee?iaaiiuo enneaaiaaieyo. A ?acoeuoaoa yoeo enneaaiaaiee auei iieacaii, ?oi yooaeoeaiinou
aoaeeioaiaea a ieaia iiaaaeaiey iniiaiuo i?iyaeaiee inoaia?o?ica (oiaiuoaiea eioaineaiinoe aiee a nonoaaao,
oeo?oaiee ooieoeiiaeuiie niiniaiinoe ii?a?aiiuo nonoaaia eee aa ii?iaeecaoey) nouanoaaiii auoa ieaoaai e
yeaeaaeaioia aeeeioaiaeo, ie?ieneeaio e iai?ienaio. I?e n?aaieoaeuiie ioaiea aoaeeioaiaea e aeeeioaiaea o
397 aieuiuo n aiia?o?icii ieacaeinu, ?oi ainoiaa?iay iiei?eoaeuiay aeiaieea ioia?aia a aaoo a?oiiao (eae i?e
ea?aiee aoaeeioaiaeii, oae e aeeeioaiaeii) o?a nionoy 12 iaaaeu io ia?aea ea?aiey. Iaiiiai?aaeaiiinou ecia-
iaiee eanaeanu ia oieuei eioaineaiinoe aieae eee ooieoee nonoaaia, ii e aeiaaeuiie aeoeaiinoe aieacie ii ioai-
ea a?a?a [12]. Ii ana ?a aieu a nonoaaa ii ioaiea iaoeaioa iiaaa?aeanu aieaa y?eie aeiaieea o aieuiuo, ea?ea-
oeony aoaeeioaiaeii, a ia aeeeioaiaeii (nie?aiea ia 71% e ia 59% niioaaonoaaiii).
A a?oaii n?aaieoaeuiii enneaaiaaiee ioaieaaeenu aieu a nonoaaao ii AAO, eiaaen oy?anoe aiia?o?ica ii I.
Lequesne e ooieoey eieaiiiai nonoaaa a aaoo ia?aeeaeuiuo a?oiiao o 335 aieuiuo, ea?eaoeony aoaeeioaiaeii e
aeeeioaiaeii ia i?ioy?aiee 6 ianyoaa [13]. Nionoy 2 iaaaee io ia?aea oa?aiee eiaaen Lequesne nieceeny ia 55,3%
e 56,6% niioaaonoaaiii, a eioaineaiinou aieae ia 45,8% e 45,6%. Ainoiaa?iie iiei?eoaeuiie aeiaieea iiaaa?-
aeanu e ooieoey eieaiiiai nonoaaa, ii oieuei e eiioo 6 ianyoa ea?aiey, i?e?ai iai?aaeaiiinou e au?a?aiiinou
eciaiaiee yoiai iieacaoaey auea oae?a iaeiaeiaie a iaaeo a?oiiao.
Neiioiiaoe?aneia aaenoaea aoaeeioaiaea i?e inoaia?o?ica n?aaieaaee e n a?oaeie IIAI. A ioeuoeoaio?i-
aii aaieiii–neaiii ?aiaiiece?iaaiiii enneaaiaaiee eco?aee yooaeoeaiinou aoaeeioaiaea (200 ia/noo) e ia-
i?ienaia (1000 ia/noo) o 374 aieuiuo [14]. A iaaeo a?oiiao
Oaaeeoa 1. Iniiaiua oa?iaeieiae?aneea
i?iaiaeiay oa?aiey e eiioo 12 iaaaee i?eaaea e ainoi-
yooaeou Ay?oaea
aa?iiio nie?aie? eioaineaiinoe aiee a iieia, aiee i?e
• Oaiaoaao neioac i?inoaaeaiaeia A2
aae?aiee eee iaeuiaoee nonoaaa, a oae?a e ?ac?aoaie?
• Naeaeoeaii iiaaaeyao yeni?anne? OIA–2
yennoaaoeaiuo yaeaiee a eieaiiuo nonoaaao e oeo?oaie?
• Eiaeae?oao EE–1, EE–6, OII–?
eo ooieoee. Aiaeec aeiaieee iniiaiuo iieacaoaeae iaoi-
• Nie?aao yeni?anne? iieaeoe aaaacee
eiae?aneiai i?ioanna ia auyaee ainoiaa?iiai ?acee?ey
• Iiaaaeyao i?iaoeoe? ieneaa acioa
• Noeioee?oao neioac i?ioaiaeeeaiia e aeaeo?iiiaie eeneiou ia?ao a?oiiaie aieuiuo, i?eieia?ueo aoaeeioaiae eee
iai?ienai. Iaiaei ainoiaa?iay iiei?eoaeuiay aeiaieea
• Ono?aiyao oi?ii?aiea neioaca ae?eicaieiiaeeeaiia EE–1
auno?aa ?acaeaaeanu o aieuiuo, eioi?ua ea?eeenu aoae-
• Oaiaoaao yeni?anne? iaoaeeii?ioaeiac
• Oi?iiceo i?ieeoa?aoe? neiiaeioeoia
oOaeCOa a aOaAeeiCe
eioaiaeii. oaeuiinou i?eaia eaea?noa a iaaeo a?oiiao auea i?e-
Yooaeoeaiinou aoaeeioaiaea n?aaieaaee e n ie?i- ia?ii iaeiaeiaay e ninoaaeea aey ay?oaea 168,1 e aey
eneeaiii. A ?aiaiiece?iaaiiii eiio?iee?iaaiiii en- aeeeioaiaea – 170 aiae.
neaaiaaiee, a eioi?ii i?eiyee o?anoea 240 aieuiuo n Iauaa ?enei ia?aeaoaeuiuo yaeaiee auei ainoi-
aiia?o?icii, aoaeeioaiae iacia?aee ii 200 ia/noo. e aa?ii ie?a o aieuiuo, i?eieia?ueo aoaeeioaiae ii
ie?ieneeai ii 20 ia/noo. [15]. Ioia?aii ainoiaa?iia n?aaiaie? n aieuiuie, eioi?ua ea?eeenu aeeeioaia-
nie?aiea eioaineaiinoe aiee e oeo?oaiea ooieoee no- eii (?<0,001), ?oi a ?aaiie noaiaie ioiineony e e ?eneo
noaaia o i?aiaeaaa?uaai ?enea aieuiuo. Iaiaei anee aieuiuo, i?ae?aoeaoeo i?eai i?aia?aoa ec–ca aai ia-
aoaeeioaiae i?eaiaee e oaeiio oeo?oaie? nionoy 2 ia- ia?aiineiinoe (?<0,001). O aieuiuo 1 a?oiiu auei ain-
aaee io ia?aea oa?aiee, oi ie?ieneeai – oieuei e eiioo oiaa?ii iaiuoa ?aeoai?ii–eeoa?iuo ?aaeoee (10,6%),
ia?aiai ianyoa. ?ai o aieuiuo 2 a?oiiu (15,2%). Yoe ?aaeoee aee??aee
Oaeaniia?aciinou i?eiaiaiey oiai eee eiiai i?a- aeniaine?, aiee a ?eaioa, aea?a?, oioiioo, aieiaie?o-
ia?aoa a ea?aaiie i?aeoeea iaaicii?ia aac ananoi?ii- ?aiea, eioaeoe? (oaae. 2). I?e i?eaia aeeeioaiaea
iaai eco?aiey aai ia?aiineiinoe. Niaeo? ia?aeaoaeu- ?aua ano?a?aeenu e oaeea ia?aeaoaeuiua yaeaiey, eae
iuo yaeaiee i?e ea?aiee aoaeeioaiaeii ai iiiaii aeea?ae?aneea ?aaeoee, canoieiay na?aa?iay iaainoa-
aeecie oaeiaiio i?e ea?aiee a?oaeie IIAI, ii noua- oi?iinou, noiiaoeo, yeoeiicu e a?oaea, ii eo ?anoioa a
noaaiii ioee?aaony ii ?anoioa eo ?acaeoey. E?iia i?i- iaaeo a?oiiao ia i?aauoaea 1%.
yaeaiee ?aeoai?ii–eeoa?iie oiene?iinoe, aicii?iu A yoii enneaaiaaiee nouanoaaiii iaiuoa auei ia-
aieiaie?o?aiey, aieiaiay aieu, aai?anney, aa?iaoeo, oeaioia, i?ae?aoeaoeo ea?aiea ia oiia i?eaia aoae-
ei?iue coa. Iaiaei yoe inei?iaiey ano?a?a?ony ?aaei eioaiaea, ?ai aeeeioaiaea (?<0,001). Naiie ?anoie
e a oaeii ia?aiineiinou Ay?oaea i?eia?ii oaeay ?a, i?e?eiie ioiaiu oa?aiee yaeyeny iaainoaoi?iue oa?a-
eae e i?e i?eiaiaiee ieaoaai o aieuiuo ?aaiaoe?anee- iaaoe?aneee yooaeo, iiai?iua ?aaeoee (14,9%) e ia-
ie caaieaaaieyie [16]. Aicii?ii iiauoaiea nuai?i- aicii?iinou iaae?aaiey (10,1%). ?anoioa ?acaeoey
oi?iuo aieiio?ainoa?ac, i?e?ai yoi inei?iaiea oioiiou, aiee a ?eaioa e aea?ae, i?eaaaoea e i?ae?a-
ano?a?aaony ia ?aua, ?ai i?e ea?aiee aeeeioaiaeii, uaie? ea?aiey, auea niioaaonoaaiii ia 46%, 65% e
eiaiiaoaoeiii, iai?ienaiii, ie?ieneeaiii e oaiiene- 41% iaiuoa a a?oiia aoaeeioaiaea, ?ai a a?oiia aee-
eaiii. eioaiaea.
A ioe?uoii i?iniaeoeaiii enneaaiaaiee eco?aeanu I?aeiouanoaa aoaeeioaiaea a ieaia aai ia?aiine-
ia?aiineiinou aoaeeioaiaea o 519 aieuiuo n aiia?o?i- iinoe eee?no?e?o?o ?acoeuoaou iaae?aaiey Diaz N. n
cii, eioi?ua iieo?aee i?aia?ao ii 100 ia 2 ?aca a aaiu niaao. [13]. Aaoi?u n?aaieee ia?aiineiinou aoaeeioa-
a oa?aiea 3 ianyoaa [17]. Oy?aeuo ia?aeaoaeuiuo yaea- iaea e aeeeioaiaea o 335 aieuiuo inoaia?o?icii ei-
iee ia iaae?aaeinu. O 3,4% aieuiuo i?aia?ao aue io- eaiiuo nonoaaia. Aoaeeioaiae aucuaae ainoiaa?ii
iaiai a nayce n ?acaeoeai ?aeoai?ii–eeoa?iuo in- iaiuoa ia?aeaoaeuiuo yaeaiee, ?ai aeeeioaiae, e
ei?iaiee eaaeie e n?aaiaoy?aeie noaiaie oy?anoe. Yoe i?a?aa anaai ?aeoai?ii–eeoa?iuo. A a?oiia aieuiuo,
yaeaiey auno?i i?ioiaeee iinea ioiaiu i?aia?aoa aac i?eieia?ueo aeeeioaiae, eo auei 5,9%, a i?e ea?aiee
eaeeo–eeai aiiieieoaeuiuo iacia?aiee. O 6,4% aieu- aeeeioaiaeii 11,5%, e, e?iia oiai, iie auee iaiaa au-
iuo i?iyaeaiey ?aeoai?ii–eeoa?iie oiene?iinoe auee ?a?aiiuie, a nayce n ?ai aeeeioaiae i?eaiaee a 2 ?aca
neaai au?a?aiiuie e ia o?aaiaaee ioiaiu i?aia?aoa, ?aua e aai ioiaia, ?ai aoaeeioaiae. ?oi eanaaony aaia-
e aua o 1,1% – iaae?aaeenu ia?aeaoaeuiua yaeaiey, oioiene?iinoe, oi nouanoaaiiia iiauoaiea aieii-
eioi?ua ia auee naycaiu n ?aeoai?ii–eeoa?iui o?ae- o?ainoa?ac, eioi?ia i?eaiaeei e ioiaia oa?aiee IIAI,
oii. iaae?aaeinu o 0,6% aieuiuo ec a?oiiu aoaeeioaiaea e
I oi?ioae ia?aiineiinoe ay?oaea o aieuiuo inoai- o 3,0% – aeeeioaiaea. Aoaeeioaiae iieacae aieaa au-
a?o?icii naeaaoaeunoao?o ?acoeuoaou aieuoiai 12–ia- nieo? aaciianiinou o aieuiuo inoaia?o?icii e i?e
ny?iiai i?iniaeoeaiiai ioe?uoiai iiiaioaio?iaiai en- n?aaiaiee aai n ie?ieneeaiii [15]. A yoii 3–iany?iii
neaaiaaiey SAMM (Safety Assessment of Marketed eniuoaiee auei ca?aaeno?e?iaaii 14 ?aeoai?ii–ee-
oa?iuo inei?iaiee o 89 aieuiuo ia oiia i?eaia ie?i-
Medicines), a eioi?ii ioaieaaeanu aaciianiinou aoae-
eneeaia e oieuei 7 – ec oaeiai ?a ?enea i?eieia?ueo
eioaiaea e aeeeioaiaea o aieuiuo n ?aaiaoe?aneeie
aoaeeioaiae.
caaieaaaieyie [18]. A ?aaioa i?eiyee o?anoea 1078 a?a-
Iaoa–aiaeec aaciianiinoe aoaeeioaiaea, iniiaai-
?ae iauae i?aeoeee. A yoi enneaaiaaiea auei aee??a-
iiai ia 13 aaieiuo–neaiuo ?aiaiiece?iaaiiuo ennea-
ii 10142 aieuiuo n ?aaiaoieaiui a?o?eoii, aieeeice-
aiaaieyo, a eioi?uo i?eiyee o?anoea 3574 aieuiuo n in-
?o?uei niiiaeeia?o?eoii e inoaia?o?icii, i?e?ai o
oaia?o?icii, ?aaiaoieaiui a?o?eoii eee n aieeeice-
i?aiaeaaa?uaai aieuoeinoaa (91,4%) aue inoaia?o?ic.
?o?uei niiiaeeia?o?eoii, i?iaaiiino?e?iaae eo?oee
Aieuiua 1 a?oiiu (7890 ?aeiaae) i?eieiaee 200 ia/noo.
i?ioeeu aaciianiinoe yoiai i?aia?aoa ii n?aaiaie? n
aoaeeioaiaea e 2 a?oiiu (2252 ?aeiaaea) – 150 ia/noo.
eeanne?aneeie IIAI, aee??ay aeeeioaiae, eiaiiaoa-
aeeeioaiaea. A?oiiu auee ?aiaiiece?iaaiu ii aic-
oei, iai?ienai, ie?ieneeai e oaiieneeai [19]. I?e ea-
?anoo, iieo, iicieiae?aneei oi?iai, aeeoaeuiinoe ca-
?aiee aoaeeioaiaeii a 1,38 ?aca ?a?a ano?a?aeenu ia-
aieaaaiey e aano?iyioa?ieiae?aneiio aiaiiaco, aee?-
?aeaoaeuiua yaeaiey ii n?aaiaie? n a?oiiie aieuiuo,
?ay ycaaiio? aieaciu, ?aeoai?io? eee eeoa?io? aen-
ea?eaoeony o?aaeoeiiiuie IIAI (?<0,001). I?e yoii
iaine? e aiee a yieaano?ee. Auai?ea aieuiuo auea ?a-
ioiaia oa?aiee a nayce n aai oiene?iinou? auea oae?a
i?acaioaoeaiie e niioaaonoaiaaea iiioeyoee iaoeaioia
ainoiaa?ii ie?a (p = 0,002), ?ai o aieuiuo a?oiiu n?aa-
a iau?iie eeeie?aneie i?aeoeea. N?aaiyy i?iaie?e-

394 13, 7, 2005
oOaeCOa a aOaAeeiCe
iaiey.
A iaaaaiai ioeuoeoaio?iaii enneaaiaaiee, a eioi-
aEUA?UU?
?ii i?eiyee o?anoea 18 iaaeoeineeo oaio?ia Eniaiee e
1. Perrot S., Menkes CJ. Nonpharmacological approaches to pain in osteoarthritis.
Eoaeee, aiaeece?iaaeenu e?iaioa?aiey ec ?aeoaea e
Available options. Drugs 1996; 52: 21–6.
12–oe i.e. o 4309 aieuiuo [20]. N ea?aieai IIAI auei
2. Sangha O. Epidemiology of rheumatic disease. Rheumatology 2000; 39 (Suppl. 2):
naycaii 38% anao neo?aaa e?iaioa?aiee ec aa?oieo io- 3–12.
aaeia ieuaaa?eoaeuiiai o?aeoa, ?oi ninoaaeei 152 neo- 3. cOOIO‚ C. A. A?AIIOUAII – ·AAOOOIOOU? E ?UUAIUE‚IOOU?. eaU 2003; 11 (5):
?ay ia 1000000 ianaeaiey a aia. Iaeaieaa aunieee ?ene 3–6.
4. Murherjee P, Rachita C, Aisen PS, Pasinetti GM. Non–steroidal anti–inflammatory
e?iaioa?aiey eiae eaoi?ieae (24,7). O ?ioaeieneaa ii
drugs protect against chondrocyte apoptotic death. Clin E?p Rheumatol 2001; 19 (Suppl.
ninoaaee 7,2, iaeieneeaia 5,7, ieianoeeaa 3,2, oaeaei-
22): S7–S11.
eneaa 0,3. ?aiaa aaoi?u yoiai enneaaiaaiey iieacaee 5. Aceclofenac monografph. Almirall Prodespharma S.A. Barcelona, 2003.
aunieee ?ene oaeeo e?iaioa?aiee o iaoeaioia, i?eie- 6. Dooley M, Spencer CM, Dunn CJ. Aceclofenac. A reppraisal of its use in the manage-
ia?ueo ie?ieneeai, eaoi?ieae, eiaiiaoaoei e aoa- ment of pain and rheumatic disease. Drugs 2001; 61: 1351–78.
7. Henrotin Y., De Leval i, Mathy–Hartet M et al. In vitro effects of aceclofenac and its
oeenaeeoeeiao? eeneioo. ?ene e?iaioa?aiee o aoae-
metabolites on the production by chondrocytes of inflammatory mediators. Inflamm Res
eioaiaea ieacaeny ieceei [1,4] e caieiae n?aaiaa
2001; 50: 391–9.
iiei?aiea ia?ao ieianoeeaii e oaeaeieneaii. 8. Blanco FJ, Maneiro E, de Toro FJ et al. Effect of NSAIDs on synthesis of IL–1 receptor
Oi?ioay ia?aiineiinou, ia?yao n aai aunieie aioe- by human articular chondrocytes. Lab Invest Rheumatol 2000: THO 17.
ainiaeeoaeuiie e aiaeuaaoe?aneie aeoeaiinou?, iiau- 9. Dingle JT. The effect of NSAIDs on human articular cartilage glycosaminoglycan syn-
thesis. Eur J Rheumatol 1996; 12: 47–52.
oaao oaiaeaoai?aiiinou iaoeaioia e a?a?ae aoaeeioa-
10. Blot L, Marcelis A, Devogelaer JP, Manicourt DH. Effect diclodenac, aceclofenac and
iaeii. Yoe aaiiua iniiaaiu ia ?acoeuoaoao Aa?iiae-
melo?icam on the metabolism of proteoglecans and healuronan in osteoarthritic human
neiai iana?aaoeiiiiai eiai?oiiai enneaaiaaiey, a ei- cartilage. Br J Pharmacol 2000; 13 (17): 1413–21.
oi?ii i?iaiaeeny aiaeec ea?aiey yoei i?aia?aoii 11. Akimoto H, Yamazaki R, Hashimoto S et al. A major metabolite of aceclofenac
23 407 aieuiuo n ainiaeeoaeuiuie e aaaaia?aoeaiuie 4’hydro?y aceclofenac supresses the interleukin–1 induced production of promatri? met-
alloproteinases and release of sulfated–glycosaminoglycans from rabbit articular chon-
?aaiaoe?aneeie caaieaaaieyie a 4 no?aiao [21]. A yoii
drocytes. Eur J Pharmacol 2000; 401(3): 429–36.
enneaaiaaiee iaoeaiou ioaieaaee noaiaiu au?a?aiii-
12. Ward DE, Veys EM, Bowdler JM, Roma J. Comparison of aceclofenac with diclofenac
noe aiee ia oiia ea?aiey aoaeeioaiaeii, yooaeoea- in the treatment of osteoarthris. Clin Rheumatol 1995; 14: 656–62.
iinou ea?aiey e iauo? oaiaeaoai?aiiinou i?iaiaeiie 13. Diaz C, Rodriquez de la Serna A, Geli C, Gras i. Efficacy and tolerability of aceclofenac
oa?aieae, a oae?a o?iaaiu eiiieaaioiinoe. Noiia?iay versus diclofenac in the treatment of knee osteoarthritis. A multicenter study. Eur J
Rheumatol Inflamm 1996; 16: 17–22.
ioaiea i?iaiaeiiai ea?aiey iieacaea, ?oi i?e aoi?ii
14. Korsanoff D, Frerick H, Bowdler J, Montull E. Aceclofenac is well–tolerated alternative
aeceoa 87% iaoeaioia auee oaiaeaoai?aiu oa?aieae
to napro?en in the treatment osteoarthritis. Clin Rheumatol 1997; 16 (1): 32–8.
aoaeeioaiaeii, a e o?aouaio aeceoo oaeeo iaoeaioia 15. Perez Busquer M, Calero E, Rodriguez M. et al. Comparison of aceclofenac with
noaei aieaa 90%. Aunieay yooaeoeaiinou e aaciian- ?iro?icam in the treatment of osteoarthritis. Clin Rheumatol 1997; 16: 154–59.

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