Ãàð÷èã -...

ÌÎÍÃÎËÛÍ ÀÍÀÃÀÀÕ ÓÕÀÀÍ, 2014, 2 (168) 1

Ãàð÷èã

Ñóäàëãàà, øèíæèëãýýÁèîàíàãààõ

1. ß.Ìºíõäýëãýð, Ñ.Äàâààñ¿ðýí, Á.Äîëãîðæàâ, À.Ãýðýëýý, Ð.Îþóí÷èìýã, Æ.Ñàðàíòóÿà Øýýñíèé çàìûí õàëäâàð ¿¿ñãýã÷ Escherichia coli-èéí àäãåçèéí õîðóó øèíæèéã èëð¿¿ëñýí ä¿í

2. Á.Öýðýííàäìèä, Á.Îäìàà, À.Àâèðìýä, Ä.ÀìãàëàíáààòàðÍàñàíä õ¿ðñýí õ¿íèé òàðõèíû õîâäëûí ñóäñàí áèåèéí ¿ëýìæ áîëîí áè÷èë á¿òöèéã ñóäàëñàí ä¿í

3. Ä.Áààñàíæàâ, ß.Ýðäýíý÷èìýã, Á.×èìýãëõàì, Ò.Ñàðàíöýöýã, Á.Îþóíãýðýë, Ä.ÁîëîðìààÌîíãîë îðíû ç¿¿í áà òºâèéí á¿ñèéí çàðèì àéìãèéí õ¿í àìûí äóíäàõ ìýäðýëèéí óäàìøëûí ºâ÷íèé (ÌÓª) á¿òýö, òàðõàëòûí òºâøèí

4. Í.Áààñàíæàâ, Ë.Ñîäíîìöîãò, Ä.Ï¿ðýâñ¿ðýí, Ö.Áàäàìñýä, Á.Ñîäãýðýë, ×.Òºâæàðãàë, Ì.À÷èòìàà Ç¿ðõíèé ýëáýã òîõèîëääîã òºðºëõèéí ãàæãóóäûã õàðèóöäàã ãåí¿¿äèéí ÄÍÊ-èéí íóêëåîòèäèéí äàðààëëûã ìîëåêóë ãåíåòèêèéí íàðèéí àðãûã àøèãëàí òàéëæ óíøèí, ãåíåòèêèéí øàëòãààíòàé ç¿ðõíèé ãàæèã ¿¿ñýõ ìàãàäëàëûã ñóäàëñàí ä¿í

5. Á.Ñóâä, Á.Áóðìààæàâ10 õ¿ðòýëõ íàñíû õ¿¿õäèéí äóíäàõ õºõ òîëáîíû òàðõàëò, Ìîíãîë óëñ, 2014 îí

6. Ã.Óÿíãà, Æ.Çàíäàðàà,Ñ.Ãàíáîëä, Ñ.ªíºðñàéõàí, Ä.ÑóâäGSTT1, GSTM1 ãåíèéí äåëåöèéã èëð¿¿ëýõ øèíæèëãýýíèé àðãà

Ýìíýëç¿é7. Ö.Áàäàìñýä, Í.Áèëã¿¿í, Ì.Óÿíãà

Íîéð áóë÷èðõàéí ¿ðýâñëèéí ðåíòãåí øèíæ òýìäã¿¿ä 8. Ò.Ãàíöýöýã, Ñ.Îäîíãýðýë, Ó.Öýðýíäîëãîð, Ñ.Òóÿà, Ë.Áàòò¿âøèí, Ç.Õèøèãñ¿ðýí

Ñýòãýë õºäëºëèéí õî¸ð òóéëò ýìãýãèéí óäàìøèõ õàíäëàãûí îíöëîãèéã ñóäàëñàí ä¿íãýýñ

9. Ð. Óðàí÷èìýã, Ð. Ãàíáààòàð, Ë. Áàÿðìàà, Æ. Ëõàãâàñ¿ðýíÓìàéí áóë÷èíãèéí õîðã¿é õàâäðûí òýæýýã÷ àðòåðèéí ñóäñûã áºãëºæ ýì÷èëñíèé äàðààõ æèðýìñëýëòèéí áàéäàëä õèéñýí ñóäàëãàà

10. Ö.Ñîëîíãî, Ç.Ãýðýëìàà, Á.ÁóðìààæàâÌîíãîë óëñûí áàðóóí á¿ñèéí ïåðèíàòàëü ýíäýãäëèéí ºíººãèéí áàéäàë

11. Î.Áàÿíæàðãàë, Ã.Ìýíäñàéõàí, Ö.ÝðäýìáèëýãÆèðýìñíèé òýýëòèéí ýðò õóãàöààíä ìîíãîë óðãèéí çóëàé, àõàð ñ¿¿ëíèé óðòûí õýâèéí õýìæýýã òîãòîîñîí íü

Íèéãìèéí ýð¿¿ë ìýíä12. Ó.×èìýäöýðýí, Ã.Ñ¿õáàò, Á.Áààñàíæàðãàë

Óëààíáààòàð õîòûí õ¿í àìûí äóíä óëèðëûí ÷àíàðòàé ñýòãýë ãóòðàëûã ñóäàëñàí ä¿í

13. Ì.Ï¿ðýâæàâ, Ç.Àðèóíàà, Î.×èìýäñ¿ðýí, Ä.Öýíä-Àþóø, Á.ÁóðìààæàâÌîíãîëûí óëàìæëàëò àíàãààõ óõààíû ñóäàëãààíû çàðèì àñóóäàë

14. À.Áàðõàñ, ×.Öîëìîí, Ö.Ìóõàð, Ï.ÓâøÝìíýëãèéí ìåíåæìåíòèéí çàðèì àñóóäàëä

15. Á.Ýíõòóíãàëàã, Á.Ãýðýëæàðãàë, Á.Ò¿âøèíáàÿð, Ä.Îþóíäýëãýð, ×.ªíºðöýöýã, Á.Äàâààäóëàì, Ä.Öýðýíëõàì, Ä.Õèøèãòîãòîõ, Á.Ñîäíîìöýðýí, Ý.Ýíõæàðãàë, Î.ÁàòõèøèãÌîíãîëûí õ¿í àìûí ºðãºí õýðýãëýýíèé èìïîðòûí çàðèì õ¿íñíèé á¿òýýãäýõ¿¿íèé õàð òóãàëãàíû ¿ëäýãäýë, ýð¿¿ë ìýíäèéí ýðñäýë

Ëåêö, Òîéì, Çºâëºãºº

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16. Ó.ÖýðýíäîëãîðÃàäààäûí çàðèì óëñ îðíû õ¿í àìûí öóñàí äàõü ñåëåíèé ò¿âøèí

17. Æ.Ãàíç¿ã, ª.Îþóí÷èìýã, Ï.Ýðõýìáóëãàí, È.Ï¿ðýâäîðæ Æèðýìñýí ¿åä òºðºëõèéí õºãæëèéí ãàæãèéã èëð¿¿ëýõ áèîõèìèéí ñêðèíèíã øèíæèëãýý

18. È.Ï¿ðýâäîðæ, Ï.Ýðõýìáóëãàí, ª.Îþóí÷èìýã, Æ.Ãàíç¿ã, Ã.ÌýíäñàéõàíÄàóíû õàìøèíæèéã æèðýìñíèé ýðò ¿åä èë¿¿ëýõ, îíîøèëîõ

19. Ñ.ªíºðñàéõàí, Ã.ÑóâäààÝìíýëãèéí íàíîá¿òýýãäýõ¿¿íèé õîðîí ÷àíàðûã ýñèéí ò¿âøèíä ñóäëàõ îð÷èí ¿åèéí àðãóóä

20. Ý.Á¿æèí, Í.Ëõààñ¿ðýí, Á.Áàò÷èìýã, Ä.Öýëìýí, Ã.Îþóíãýðýë, Í.Ìºíõò¿âøèí, Á.ÌºíõáàòÌîíãîë õºõ òîëáîíû òóõàé

Ø¿¿ìæ, áîäîë, ýðãýö¿¿ëýë21. Ï.Íÿìäàâàà

“Ìîíãîëûí ¿íäýñíèé íýâòýðõèé òîëü” ãýý÷èéí òóõàé

Ìýäýýëýë, ñóðòàë÷èëãàà22. 2013 îíä àíàãààõ óõààíû äîêòîðûí çýðýã õàìãààëñàí ýðäýìòýä (¯ðãýëæëýë)

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Content

Original articles

Biomedicine

1. The detection of adherence factorsby Escherichia coli cause of urinary tractinfectionsMunkhdelger.Ya, Davaasuren.S, Dolgorjav.B, Gerelee.A, Oyunchimeg.R, Sarantuya.J

2. The study of macro and micro structure of choroid plexus of adult brain ventriclesTserennadmid B, Odmaa B, Avirmed A, Amgalanbaatar D

3. Epidemiology of neurohereditary diseases in the population of some provinces(aimags) existence in south and central part of MongoliaD.Baasanjav, Ya.Erdenechimeg, B.Chimeglkham, T.Sarantsetseg, B.Oyungerel, D.Bolormaa

4. To determine the probability of developing heart defect seguence method that degects seguence in dna nucleotide of responsible genes for most common heart defectsN.Baasanjav, L.Sodnomtsogt, D.Purevsuren, Ts.Badamsed, B.Sodgerel, Ch.Tuvjargal, M.Achitmaa

5. Prevalence of Mongolian blue spots among 1-10 years old children, Mongolia, 2014B.Suvd, B.Burmaajav

6. Detection of GSTM1, GSTT1 deletion variantsG.Uyanga, J.Zandaraa, S. Gandbold, S.Unursaikhan, D.Suvd

Clinical medicine

7. X-ray symptoms of pancreatitis Ts.Badamsed, N.Bilguun, M.Uynga

8. Heritabilityof patients with bipolar disorders T.Gantsetseg, S.Odongerel, U.Tserendolgor, L.Battuvshin, Z.Khishigsuren

9. Pregnancy cases after embolization of uterine fibroidsUranchimeg R, Ganbaatar R, Bayarmaa L, Lkhagvasuren J

10. Current situation of perinatal mortality in west region of MongoliaTs.Solongo, Z.Gerelmaa, B.Burmaajav

11. Estimation of nomograms according to Crown-Rump Length in Mongolian populationO.Bayanjargal, G.Mendsaikhan, Ts.Erdembileg

Public Health

12. A study result of the seasonal affective disorder in the population of Ulaanbaatar cityChimedtseren U, Sukhbat G, Baasanjargal B

13. Some aspects of traditional Mongolian medicine research statusPurevjav.M, Ariunaa.Z, Chimedsuren.O, Tsend-Ayush.D, Burmaajav.B

14. Some problems of hospital managementA.Barhas, Ch.Tsolmon, Ts.Mukhar, P.Uvsh

15. Lead residue and health risk in some commonly consumed imported food products among Mongolian populationB.Enkhtungalag, B.Gereljargal, B.Tuvshinbayar, D.Oyundelger, Ch.Unurtsetseg, B.Davaadulam, B.Tserenlkham, D.Khishigtogtokh, B.Sodnomtseren, E.Jargal, Î.Batkhishig

Lecture, Review and Consultation 16. Serum selenium concentration in population in some countries

U.Tserendolgor

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34-38

39-42

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77-91


17. Prenatal Screening for Congenital Defects birthJ.Ganzug, P.Erkhembulgan, U.Ouynchimeg, I.Purevdorj, G.Mendsaikhan

18. Early diagnosis and screening of Down syndrome I.Purevdorj, P.Erkhembulgan, U.Oyunchimeg, J.Ganzug, G.Mendsaikhan

19. Modern cells methods of the toxicity for Nano medicalS.Unursaikhan. G.Suvdaa

20. Blue spot review article E.Bujin, N.Lkhaasuren, B.Batchimeg, D.Tselmen, G.Oyungerel, N.Munkhtuvshin, B.Munkhbat

Critiques, thoughts and reflections21. About the “Mongolian National Encyclopedia”

P.Nymadawa

Information and Advertisement22. Scientists îbtained scientific degree in Medicine in 2013, Mongolia (Cont.)

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101-105

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Øýýñíèé çàìûí õàëäâàð ¿¿ñãýã÷ Escherichia coli-èéíàäãåçèéí õîðóó øèíæèéã èëð¿¿ëñýí ä¿í

ß.Ìºíõäýëãýð1, Ñ.Äàâààñ¿ðýí1, Á.Äîëãîðæàâ2, À.Ãýðýëýý3,Ð.Îþóí÷èìýã3, Æ.Ñàðàíòóÿà1

1ÀØÓ¯ÈÑ, 2Øàñòèíû íýðýìæèò óëñûí ãóðàâäóãààð òºâ ýìíýëýã, 3Óëñûí íýãä¿ãýýð òºâ ýìíýëýãE-mail: [email protected]

The detection of adherence factorsby Escherichia coli cause of urinarytract infectionsin Ulaanbaatar, Mongolia

Munkhdelger.Ya1, Davaasuren.S1, Dolgorjav.B2, Gerelee.A3,Oyunchimeg.R3, Sarantuya.J1

1MNUMS, 2State Third Central Hospital, 3State First Central HospitalE-mail: [email protected]

IntroductionUrinary tract infections among the most common bacterial infectious diseases encountered at all ages. Escherichia coli are being the etiologic agent in 50–80%. Therefore, it is an important public health problem. E.coli causing urinary tract infections express pilli, fimbriae and others adherence virulence factors.

GoalTo detect the some adherence virulence factors of Uropathogenic Escherichia coli (UPEC) in Ulaanbaatar, Mongolia

Materials and Methods A total of 76E.colisampleswere collected. These samples were positive bacteriological examination of urine, performed at the bacteriological laboratory of the State Central Third Hospital and State Central First Hospital, Ulaanbaatar, Mongolia. The biofilm formation was evaluated by the growth rate of E.coli on plastic surface.The detection of the virulence factors type 1 fimbriae (fimA gene) and P-fimbriae (papC) was performed by multiplex PCR using gene specific primers.Curli expression was determined by using congo red agar.

ResultsThe evaluation of bacterial biofilm formation using 96 well plates showed 40 negative (52.6%), 32 weak biofilm (42.1%) and 4 moderate biofilm (5.3%) formation for E.coli and no strong biofilm forming strain was detected. The cell surface protein (curli) was detected by Congo red agar. The result was 71% positive for studied E.coli strains. The detection result of pili genes by multiplex PCR showed that fimH gene detected for 73 (96.1%) and papC gene detected for 18 (23.7%) E.coli cultures.

Conclusion: Almost half of surveyed Uropathogenic E.coli isolated in Ulaanbaatar, Mongolia had ability of biofilm formation and it has been determined by the bacterial surface protein (curli), which is one of bacterial adherence factors, may cause biofilm formation.

Keywords: biofilm formation, cell surface protein (curli), UPEC (uropathogenic E.coli)Pp. 5-8, Table 1, Figures 3, References 14

ÑÓÄÀËÃÀÀ, ØÈÍÆÈËÃÝÝ

ÁÈÎÀÍÀÃÀÀÕ


¯íäýñëýë:

Õ¿íèé õýâèéí áè÷èë áèåòýí E.coli íü ãàäíû õ¿÷èí ç¿éëèéí ¿éë÷ëýëýýð áàéðøëàà ñýëãýâýë íºõöºëò ýìãýã òºðºã÷ øèíæ ÷àíàðòàé áîëíî.

Íºõöºëò ýìãýãòºðºã÷ øèíæòýé E.coli øýýñ ÿëãàðóóëàõ ýðõòýíèé ýä ýñèéã ýìãýãø¿¿ëýõ øèíæ ÷àíàðòàé áîëñíîîð èëýð÷ áóé ºâ÷íèéã E.coli-èéí øàëòãààíò îïïîðòóíèñò õàëäâàð ãýäýã.1

Øýýñíèé çàìûí õàëäâàð ¿¿ñãýã÷ E. coli (UPEC) íü öèñòèò, íåôðèò çýðýã øýýñíèé çàìûí õàëäâàð (ØÇÕ)-ûí àíõäàã÷ øàëòãààí áîëäîã áºãººä ØÇÕ-ûí 70–95%-èéã ¿¿ñãýäýã.2 ØÇÕ íü á¿õ íàñíû õ¿íä, ºíäºð õóâüòàé òîõèîëääîã õàëäâàðò ºâ÷èí þì.3,4 Íàñàíä õ¿ðñýí ýìýãòýé÷¿¿äèéí 40-50%, ýðýãòýé÷¿¿äèéí 20% îð÷èì íü öèñòèò, íåôðèò áîëîí áàêòåðèóðèãààð ºâääºã áà õ¿í àìûí íàñ õ¿éñíýýñ õàìààðààä òîäîðõîé õóâü íü øèíæ òýìäýãã¿é áàêòåðóðèáîëæ áàéäàã.5,6 ÀÍÓ-ä æèë á¿ð E.coli-ààð ¿¿ñãýãäñýí ØÇÕ 6-7 ñàÿ á¿ðòãýãääýã.7

UPEC íü øýýñíèé çàìûí õó÷óóð ýñýä Ð áîëîí type 1ñîðìóóñ, ýñèéí ãàäàðãóóãèéí óóðàã ãýõ ìýò àäãåçèéí ýðõòýíöýð¿¿äèéí òóñëàìæòàéãààð õîëáîãäîí áèîôèëüìèéã ¿¿ñãýæ, ¿ðýâñëèéí óðâàëûã ºðí¿¿ëäýã.2 Íÿíãóóä íü õîðóó ÷àíàðûí îëîí õ¿÷èí ç¿éë¿¿äèéí òóñëàìæòàéãààð ýñèéí ãàäàðãóóä àäãåçè áîëæ ººð õîîðîíäîî õîëáîãäîí ýñèéí ãàäíàõ ìàòðèêñèéí ïîëèìåðèéã íèéëýãæ¿¿ëýí ãàäàðãóóä á¿ðõ¿¿ë ¿¿ñãýõ ¿éë ÿâöûã áèîôèëüì ãýíý.8 Íÿíãóóä íü áèîôèëüì ¿¿ñãýñíýýðýý àíòèáèîòèê òýñâýðò ÷àíàð íü 10-1000 äàõèí íýìýãäýæ íÿíãèéí ýñðýã àíòèáèîòèê ýì÷èëãýý ¿ð ä¿í ìóóòàé áîëäîã áàéíà.2,9

Çîðèëãî: Øýýñíèé çàìûí õàëäâàð ¿¿ñãýã÷ E.coli-èéí çàðèì àäãåçèéí õîðóó ÷àíàðûí õ¿÷èí ç¿éëèéã èëð¿¿ëýõ

Ìàòåðèàë, àðãà ç¿é:

ÓÍÒÝ áîëîí Øàñòèíû íýðýìæèò óëñûí ãóðàâäóãààð òºâ ýìíýëãèéí íÿí ñóäëàëûí ëàáîðàòîðò 2013 îíû 11 ñàðààñ 2014 îíû 2 ñàðûí õóãàöààíä õèéãäñýí øýýñíèé àðèóí ÷àíàð òîäîðõîéëîõ øèíæèëãýýãýýðèëýðñýí 76 E.coli-èéí ºñãºâðèéã öóãëóóëñàí.

Áèîôèëüì ¿¿ñãýõýä îðîëöäîã ýñèéí ãàäàðãóóãèéí óóðãèéã (curli) èëð¿¿ëýõäýý êîíãî óëààí áóäàã áîëîí ñàõàðîçûã íýìýëòýýð àãóóëñàí òàðõè-ç¿ðõíèé øºë á¿õèé òýæýýëò îð÷èí áýëòãýí íÿíã òàðüæ ºñãºâºðëºí êîëîíèéã õ¿ðýýëýí òîä õàð ºíãº ºãñíèéã ýåðýã ãýæ ¿íýëýâ.8

Íÿíãèéí õóâàíöàð ãàäàðãóóä àäãåçè áîëæ áèîôèëüì ¿¿ñãýõ øèíæèéã òîäîðõîéëîõäîî 96 õîíîãòîé,õàâòãàé ¸ðîîëòîé, áè÷èë óðâàëûí ñàìáàðò 0,45%-èéí ãëþêîç á¿õèé DMEM àãóóëñàí îð÷èíä íÿíãèéí áóëèíãààñ õèéæ 18-24 öàãèéí òóðø 370Ñ õýìä ºñãºâºðëºí 0,5%-èéí êðèñòàë âèîëåòîîð áóäààä ELISA àïïàðàòàä óíøóóëæ ä¿ãíýñýí.10

E.coli íÿíãèéí ÄÍÕ-ã õàëààæ áóöàëãàõ àðãààð ÿëãàæ fimH F:TGCAGAACGGATAAGCCGTGG, R:GCAGTCACCTGCCCTCCGGTA; papC F: GTGGCAGTATGAGTAATGACCGTTA, R:ATATCCTTTCTGCAGGGATGCAATA äàðààëàë á¿õèé ºâºðìºö ïðàéìåðóóäûã (COSMO GENETECH) àøèãëàí 508 õ.í (fimH) áîëîí 200 õ.í (papC) óðòòàé õýð÷ì¿¿äèéã äàðààõ íºõöëººð îëøðóóëëàà (Table1).11

Table 1.Condition of Multiplex PCR

Temperature Time Total cycle

94 5 min

35 cycleDenaturation 94 1 min

Annealing 60 1 minExtension 72 2 min

72 10 min

¯ð ä¿í:96 õóäàãòàé õàâòãàé ¸ðîîëò òàâãèéã àøèãëàí íÿíãèéíáèîôèëüì ¿¿ñãýõ øèíæèéã ¿íýëýõäýý ñîðüö òóñ á¿ðèéã òóñ á¿ð 3 õóäàãò õèéæ äóíäàæ óòãûã òîîöîí ñºðºã õÿíàëòòàé õàðüöóóëàí ¿íýëñýí. Ñºðºã õÿíàëò á¿õèé 3 õóäàãíû äóíäàæ óòãûã (OD

meannegative) òîîöîí ñòàíäàðò õàçàéëòûã

(SD) íýìæ áîñãî õýìæýýã òîîöîõîä 0,12 áàéëàà. Íÿíãèéí áèîôèëüì ¿¿ñãýõ øèíæèéã Ñºðºã <0.12, Áàãà áèîôèëüì 0.12-0.24, Äóíä áèîôèëüì 0.24-0.48, Õ¿÷òýé áèîôèëüì >0.48ãýæ ¿íýëýâ (Table 2).

Table 2.Biofilm formation in Uropathogenic E.coli

Biofi lm formation OD E.coli (UPEC)Negative <0.12 40 52,6%

Weak 0.12-0.24 32 42,1%Moderate 0.24-0.48 4 5,3%

Total 76 100%

Øèíæèëãýýãýýð øýýñíèé çàìûí õàëäâàð ¿¿ñãýã÷ E.coli (76)-èéí 40 (52.6%)ñºðºã,32(42.1%) áàãà çýðãèéí áèîôèëüì ¿¿ñãýõ èäýâõèòýé, 4(5.3%) äóíä çýðãèéí áèîôèëüì ¿¿ñãýõ ÷àäâàðòàé áàéñàí áºãººä õ¿÷òýé áèîôèëüì ¿¿ñãýõ øèíæòýé íÿí èëýðñýíã¿é.


Ýñèéí ãàäàðãóóãèéí óòàñëàã óóðàã (curli)–èéã èëð¿¿ëýõäýý Êîíãî óëààí àãàð áýëòãýí ºñãºâðºº ºñãºâºðëºæ õàð ºíãº ºãñíèéã ýåðýã, ºíãº ººð÷ëºãäººã¿é áîë ñºðºã (çóðàã 1) ãýæ ¿íýëýõýä ØÇÕ ¿¿ñãýã÷ E.coli íÿíãèéí 54 (71%) íü ýñèéí ãàäàðãóóãèéí óòàñëàã óóðàã (curli) ýåðýã, 22 (29%) íü ñºðºã áàéíà.

Figure 1. Detection of curli fiber

Figure 2. The investigation of the biofilm production by the Congo Red agar

A) positive B) negative

Áèîôèëüì øèíæ ýåðýã (40) òîäîðõîéëîãäñîí íèéò íÿíãèéí 80%-ä ýñèéí ãàäàðãóóãèéí óòàñëàã óóðàã (curli) èëýð÷ áàéñàí áºãººä ýíý íü áèîôèëüì ¿¿ñãýõ øèíæòýé õàìààðàëòàé áàéíà (p=0,04).

E.coli íÿíãèéí õàìãèéí ºíäºð õóâüòàé òîäîðõîéëîãääîã typeIñîðìóóñûã êîäëîã÷ fimH, PAPñîðìóóñûã êîäëîã÷ papC ãåí¿¿äèéã ìóëüòèïëåêñ ÏÃÓ–ààð îëøðóóëæ, îëøèðñîí á¿òýýãäýõ¿¿íèéã 1.5%-èéí ãåëü àøèãëàí õýâòýý ãåëèéí ýëåêòðîôîðåçèéí àïïàðàòàä 135V 30 ìèíóòã¿éëãýæ UVI ìèêðîñêîïò çóðãèéã àâ÷ òîäîðõîéëñîí.

Figure 3. Agarose gel-electrophoresis of Multiplex PCR. Sm-size marker, nc-negative control, 2643-

2684 samples.

E.coli íÿíãèéí fimH, papC ãåí¿¿äèéã ìóëüòèïëåêñ ÏÃÓ–ààð èëð¿¿ëýõýä fimH ãåí 73(96,1%), papC ãåí 18(23,7%) ñîðüöîíä ýåðýã èëýðñýí.Áèîôèëüì øèíæ ýåðýã (40) òîäîðõîéëîãäñîí íèéò íÿíãèéí 95%-ä fimH, 25%-ä papCãåí èëýðñýí áºãººä E.coli íÿíãèéí fimH, papC ãåí¿¿ä ýåðýã áàéõ íü áèîôèëüì ¿¿ñãýõ øèíæòýé õàìààðàëã¿é áàéíà (p=0,645; p=0,746).

Õýëöýìæ:Ýìíýëãýýñ øàëòãààëàõ õàëäâàð íü äýëõèé äàõèíä ýð¿¿ë ìýíäèéí ñàëáàðò òóëãàìäñàí àñóóäëûí íýã áîëæ áàéãàà ÷ ìàíàé îðîíä 1998-2007 îíû õîîðîíä ýìíýëãýýñ øàëòãààëàõ õàëäâàðûí íèéò 2141 òîõèîëäîë (íèéò õýâòýí ýì÷ë¿¿ëýã÷äèéí 0.02%) á¿ðòãýãäñýí íü áîäèò áàéäàëòàé ¿ë íèéöñýí òîî áèëýý. Ýíý òîî áàðèìò íü ìàíàé îðîíä óã íÿíãèéí õàëäâàðûí òàðõàëò áàãà áàéãàà áóñ óã õàëäâàðûã èëð¿¿ëýõ, îíîøëîõ, á¿ðòãýõ, òàíäàëò ìýäýýëëèéí òîãòîëöîî ñóë áàéãààã õàðóóëæ áàéíà.12Áèä ìàíàé îðîíä òîõèîëäîæ áóé øýýñíèé àðèóí ÷àíàð òîäîðõîéëîéëîõ øèíæèëãýýíä ýåðýã òîäîðõîéëîãäñîí E.coli-èéã öóãëóóëæ áèîôèëüì ¿¿ñãýõ øèíæèéã ¿íýëýõýä 48%ýåðýã òîäîðõîéëîãäñîí íü Niveditha.S (2012) Hancock.V (2007) íàðûí ñóäàëãààíû ä¿íòýé îéðîëöîî áàéãàà þì.6,8

Øýýñíèé çàìûí õàëäâàð ¿¿ñãýã÷ E.coli-èéí õîðóó ÷àíàðûí õ¿÷èí ç¿éë¿¿äèéã êîäîëñîí ãåí¿¿äèéã ýíãèéí áîëîí ìóëüòèïëåêñ ÏÃÓ-ààð èëð¿¿ëýõ øèíæèëãýý áîëîí ñóäàëãààíóóä äýëõèé äàõèíä õèéãäñýýð áàéíà. Õýäèéãýýð áóñàä óëñ îðíóóäàä èõýýð õèéãäñýí ñóäàëãàà áîëîâ÷ ìàíàé îðíû õóâüä õèéãäýæ áàéãààã¿é ó÷ðààñ ýìíýë ç¿éí ñîðüöíîîñ èëýð÷ áàéãàà E.coli-èéí õîðóó ÷àíàð ÿìàð áàéãàà, àëü ôèëîãåíåòèê á¿ëãèéí áîëîõ, ÿìàð õýâ øèíæ íü èõ òàðõàëòòàé áàéãàà çýðýã îëîí àñóóäëóóä òîäîðõîéã¿é áàéíà.

Áèä E.coli íÿíãèéí õàìãèéí ºíäºð õóâüòàé òîäîðõîéëîãääîã type I ñîðìóóñûã êîäëîã÷ fimH, PAP ñîðìóóñûã êîäëîã÷ papC ãåí¿¿äèéã ìóëüòèïëåêñ ÏÃÓ–ààð îëøðóóëæ èëð¿¿ëýõýä fimH ãåí 96,1%, papCãåí 23,7% ñîðüöîíä ýåðýã áàéñàí áîë MounaTarchouna (2013)3 áîëîí Ki WookYun (2013)13 íàðûí ñóäàëãààãààð fimHãåí 83%, 96.9%; papC ãåí 20%, 3,1%-ä òóñ òóñ èëýðñýí áàéíà. Ýäãýýð ñîðìóóñíû òóñëàìæòàéãààð íÿí ýñèéí ãàäàðãóóä àäãåçè áîëîõûã õàëäâàðûí ýõíèé øàò ãýæ ¿çäýã. Áèäíèé ñóäàëãààãààð E.coli íÿíãèéí fimH, papC ãåí¿¿ä ýåðýã áàéõ íü áèîôèëüì ¿¿ñãýõ øèíæòýé õàìààðàëã¿é áàéãàà íü ìàãàäã¿é ñóäàëãààíä õàìðóóëñàí ñîðüöíû òîî õàðüöàíãóé öººí áàéãààòàé õîëáîîòîé áàéæ ìàãàäã¿é þì. Ñ¿¿ëèéí ¿åä E.coli íÿíãèéí

A) B)


ýäãýýð ñîðìóóñíû ýñðýã ¿éë÷ëýõ ìåõàíèçìòàé áàéõààð øýýñíèé çàìûí õàëäâàðààñ ñýðãèéëýõ àíõíû âàêöèíûã ãàðãàõýìíýë ç¿éí òóðøèëò ñóäàëãààíóóä ÷ õèéãäýæ áàéíà.14

Ä¿ãíýëò: Ñóäàëãààíä õàìðóóëñàí ØÇÕ ¿¿ñãýã÷ E.coli-èéí òàë õóâü íü áèîôèëüì ¿¿ñãýõ ÷àäâàðòàé áàéñàí áºãººä íÿíãèéí àäãåçèéí õ¿÷èí ç¿éëèéí íýã áîëîõ ýñèéí ãàäàðãóóãèéí óòàñëàã óóðàã (curli) íü áèîôèëüì ¿¿ñãýõýä îðîëöîæ áàéãàà íü òîäîðõîéëîãäîâ.

Íîì ç¿é:1. Johnson JR. Virulence factors in

Escherichia coli urinary tract infection. Clinical microbiology reviews. Jan 1991;4(1):80-128.

2. Wiles TJ, Kulesus RR, Mulvey MA. Origins and virulence mechanisms of uropathogenic Escherichia coli. Experimental and molecular pathology. Aug 2008;85(1):11-19.

3. Tarchouna M, Ferjani A, Ben-Selma W, Boukadida J. Distribution of uropathogenic virulence genes in Escherichia coli isolated from patients with urinary tract infection. Int J Infect Dis. Jun 2013;17(6):e450-453.

4. Nazemi A, Mirinargasi M, Merikhi N, Sharifi SH. Distribution of Pathogenic Genes aatA, aap, aggR, among Uropathogenic Escherichia coli (UPEC) and Their Linkage with StbA Gene. Indian J Microbiol. Jul 2011;51(3):355-358.

5. Mabbett AN, Ulett GC, Watts RE, et al. Virulence properties of asymptomatic bacteriuria Escherichia coli. International journal of medical microbiology : IJMM. Jan 2009;299(1):53-63.

6. Hancock V, Ferrieres L, Klemm P. Biofilm formation by asymptomatic and virulent urinary tract infectious Escherichia coli strains. FEMS Microbiol Lett. Feb 2007;267(1):30-37.

7. Reuter BM. Cloning and mutational analysis of the FimB promoters in uropathogenic escherichia coli, University of WISCONSIN- LA CROSSE; 2012: 3-4

8. Niveditha S, Pramodhini S, Umadevi S, Kumar S, Stephen S. The Isolation and the Biofilm Formation of Uropathogens in the Patients with Catheter Associated Urinary Tract Infections (UTIs). Journal of clinical and diagnostic research : JCDR. Nov 2012;6(9):1478-1482.

9. Mah TF, O’Toole GA. Mechanisms of biofilm resistance to antimicrobial agents. Trends in microbiology. Jan 2001;9(1):34-39.

10. Wakimoto N, Nishi J, Sheikh J, et al. Quantitative biofilm assay using a microtiter plate to screen for enteroaggregative Escherichia coli. Am J Trop Med Hyg. Nov 2004;71(5):687-690.

11. Johnson JR, Stell AL. Extended virulence genotypes of Escherichia coli strains from patients with urosepsis in relation to phylogeny and host compromise. The Journal of infectious diseases. Jan 2000;181(1):261-272.

12. Äàøèéìàà Ë, Ìºíõòóÿà Ø, ÕîñáàÿðÒ, Ãýëýãæàìö Õ, Ìàë÷èíõ¿¿ ×. Õ¿¿õäèéí ïèåëîíåôðèò ºâ÷íèé øàëòãààí, ýìíýë ç¿é áîëîí ¿¿ñãýã÷èéí àíòèáèîòèêò äàñëûí ñóäàëãàà. Ìîíãîëûí àíàãààõ óõààí. 2010;3(153)

13. Yun KW, Kim HY, Park HK, Kim W, Lim IS. Virulence factors of uropathogenic Escherichia coli of urinary tract infections and asymptomatic bacteriuria in children. Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi. Sep 21 2013.

14. Johnson JR, Russo TA. Extraintestinal pathogenic Escherichia coli: “the other bad E coli”. The Journal of laboratory and clinical medicine. Mar 2002;139(3):155-162.

Òàíèëöàæ, íèéòëýõ ñàíàë ºãñºí: Àêàäåìè÷ Ï.Íÿìäàâàà


Íàñàíä õ¿ðñýí õ¿íèé òàðõèíû õîâäëûí ñóäñàí áèåèéí ¿ëýìæ áîëîíáè÷èë á¿òöèéã ñóäàëñàí ä¿í

Á.Öýðýííàäìèä1, Á.Îäìàà1, À.Àâèðìýä2, Ä.Àìãàëàíáààòàð2

1ÀØÓ¯ÈÑ-èéí Ñóâèëàõóéí ñóðãóóëü àíàòîìè-ôèçèîëîãèéí òýíõèì2ÀØÓ¯ÈÑ-èéí Áèî-àíàãààõûí ñóðãóóëü àíàòîìèéí òýíõèì

e-mail: [email protected]

The study of macro and micro structure of choroid plexus of adult brain ventricles

Tserennadmid B1, Odmaa B1, Avirmed A2, Amgalanbaatar D2

1HSUM, School of nursing department of anatomy and physiology2HSUM, School of biomedicine department of anatomy


IntroductionIn Mongolia, The anatomists researched morphometric measurements and blood supply of heart in adult’s liver pancreas, spleen, Ren and spinal cord and etc... The study of morphometric measurements of the choroid plexus is not being taught in Mongolia.

Goal To determine the structure of the choroid plexus of adult brain ventricle.

Materials and ÌethodsThis study obtained choroid plexus size in 84 dead bodies, which is between the adult and children from cadavers. To determine the choroid plexus morphometric measurements, the total 336 specimens were evaluated. The standards deviation of choroid plexus length and thickness were computed in different ages.

Result In present study, the maximum length and thickness were determined in ages from 22-60. In present study, the minimum length and thickness were determined in ages 0-10day. In adult, the mean choroid plexus length was 8.61±0.15 cm of the lateral ventricles and 4.47±0.02 cm of the fourth ventricles and 0.56±0.140 cm of the third ventricle and the choroid plexus thickness was 0.5±0.03 cm of the lateral ventricles and 0.29±0.01 cm of the fourth ventricles and 0.28±0.01 cm of the third ventricle.

Conclusions: In adult, the mean choroid plexus length was 8.61±0.15 cm of the lateral ventricles and 4.47±0.02 cm of the fourth ventricles and 0.56±0.140 cm of the third ventricle and the choroid plexus thickness was 0.5±0.03 cm of the lateral ventricles and 0.29±0.01 cm of the fourth ventricles and 0.28±0.01 cm of the third ventricle.

The choroid plexus weight was 0.51±0.01 gm in the lateral ventricles and 0.42±0.014 gm in the fourth ventricle.

Key words: Choroid plexus, adult, children, brain ventricle, sizePp. 9-11, Tables 2, Figure 1, References 10

¯íäýñëýëÄýëõèéí èõýíõ óëñ îðíóóä ººðèéí ¿íäýñòýíèé áèå ýðõòýíèé á¿òýö, õýìæýý, öóñàí õàíãàìæèéí õýëáýðèéã ãàçàð ç¿é ¿íäýñòýíèé îíöëîãòîé íü óÿëäóóëàí ñóäàëñàí áàéäàã. Íàñàíä õ¿ðñýí Ìîíãîë õ¿íèé ç¿ðõ, óóøãè, ýëýã, áººð, íîéð

áóë÷èðõàé, äýë¿¿, íóãàñ ãýõ ìýò ýðõòýí¿¿äèéí ¿ëýìæ áîëîí áè÷èë á¿òýö, öóñàí õàíãàìæèéí áàéäëûã ñóäëàí òîãòîîñîí [1].

Òàðõè, ìýäðýëèéí ºâ÷èí, ýìãýã¿¿ä èõñýæ áàéãàà ºíºº ¿åä òàðõèíû õîâäëûí ñóäñàí


õîëáîîãîîð õîëáîãäñîí áàéëàà. Õàðèí ýñèéí ñóóðü õýñãèéí á¿ðõ¿¿ë íü äîòîãøîî ò¿ðñýí îëîí õóíèàñ òºñò áàéãàà íü àæèãëàãäëàà (Çóðàã1).

áèåèéí õàðüöàíãóé ýð¿¿ë ¿åèéí õýìæýýñ¿¿äèéã, ò¿¿íèé öóñàí õàíãàìæèéí îíöëîãèéã ñóäëàõ çàìààð òîãòîîõ íü ìàíàé îðíû íºõöºëä öààøèä òàðõè, ìýäðýëèéí ýìãýãèéã îíîøëîõ, ýì÷ëýõ, òàðõèíû ñóäàñíû ðåíòãåí îíîøëîãîî, ìýñ àæèëáàð õèéõýä ñóóðü ñóäàëãàà áîëîõ ÷óõàë à÷ õîëáîãäîëòîé þì.

ÇîðèëãîÍàñàíä õ¿ðñýí õ¿íèé òàðõèíû õîâäëûí ñóäñàí áèåèéí õàðüöàíãóé ýð¿¿ë ¿åèéí ¿ëýìæ áîëîí áè÷èë á¿òöèéã ñóäëàõ

Ìàòåðèàë, àðãà ç¿éÁèä ñóäàëãààíû àæëûã ÀØÓ¯ÈÑ-èéí Àíàãààõ óõààíû ¸ñ ç¿éí õÿíàëòûí ñàëáàð õîðîîíû 2010 îíû 3 äóãààð ñàðûí 4-íèé ºäðèéí 76/4 òîîò õóðëààð çºâøººðñºíèé äàãóó 2010 îíû 3 äóãààð ñàðààñ 2014 îíû 2 äóãààð ñàð õ¿ðòýë õóãàöààíä ÀØÓ¯ÈÑ-èéí Áèî-Àíàãààõûí ñóðãóóëèéí Àíàòîìèéí òýíõèìèéí ñóðãàëòûí ìàòåðèàëëàã áààçûã ò¿øèãëýí õèéæ ã¿éöýòãýâ. Ñóäàëãààíä ìîðôîëîãèéí íàñíû àíãèëëààð 18-

74 íàñíû íèéò 54 íàñàíä õ¿ðñýí õ¿íèé öîãöîñíû òàðõèíû õîâäëûí ñóäñàí áèåèéã ñóäàëãààíû ìàòåðèàë áîëãîí àâ÷ ìîðôîìåòðèéí ñóäàëãààã Ã.Ã.Àâòàíäèëîâ (1990) íàðûí õýìæèë ç¿éí àðãà, ýä ñóäëàëûí àðãûã àøèãëàí õèéñýí. Ñóäàëãààíä àâñàí äýýæ ìàòåðèàëóóäûã á¿ðä¿¿ëýõäýý çîðèóäûí áèø ò¿¿âýðëýëòèéí àðãààð, àãøèíãèéí ñóäàëãàà õèéæ ñòàòèñòèê áîëîâñðóóëàëòûã SPSS 21.0 ïðîãðàìì àøèãëàí ã¿éöýòãýñýí.

¯ð ä¿í: Íàñàíä õ¿ðñýí õ¿íèé ñóäñàí áèåèéí óðò áîëîí çóçààíû õýìæýýã íàñíû á¿ëýã òóñ á¿ðýýð õàðüöóóëæ ¿çýõýä íàñíû á¿ëýã òóñ á¿ðò óðò áîëîí çóçààíû õýìæýý õîîðîíäîî ÿëãààòàé áàéãàà íü ñòàòèñòèêèéí ¿íýí ìàãàäòàé (P< 0.05) áàéíà. Íàñàíä õ¿ðñýí õ¿íèé ñóäñàí áèåèéí óðò áîëîí çóçààíû õýìæýýã õîâäîë òóñ á¿ðýýð òîäîðõîéëæ ¿çýõýä èäýð íàñíû á¿ëýã áóþó 22-60 íàñàíä õàìãèéí óðò áºãººä çóçààí áàéíà. Òàðõèíû õàæóóãèéí õîâäëûí ñóäñàí áèåèéí æèí 0.51±0.01 ãðàìì, äºðºâä¿ãýýð õîâäëûí ñóäñàí áèåèéí æèí 0.42±0.014 ãðàìì áàéíà.

Table 1. Size of the choroid plexus of the adult and children (M±Std.D)

Age (year) Size (cm) Choroid plexus of brain ventricles (n=54)Choroid plexus of lateral ventricle

Choroid plexus of fourth ventricle

Choroid plexus of third ventricle

18-21 length 9.35 ±0.69 4.46±0.13 0.58±0.17

thickness 0.5±0.16 0.3±0.06 0.29±0.08

22-65 length 9.57±0.69 4.51±0.11 0.59±0.17

thickness 0.53±0.19 0.31±0.08 0.29±0.07

66-74 length 9.31±0.45 4.46±0.10 0.53±0.14

thickness 0.47±0.20 0.28±0.07 0.27±0.07

Òàðõèíû õîâäëûí ñóäñàí á¿ðõ¿¿ëèéí õàíûí õó÷óóð ýäýí äàâõðàãà íýã äàí øîî äºðâºëæèí õó÷óóð ýñýýñ á¿òñýí, ýñ õàæóó ãàäàðãóóãààðàà çýðãýëäýýõ ýñòýéãýý ñàëààâ÷ëàí çºðñºí

AFigure 1. À. Choroid plexus of the third ventricle, B. Choroid plexus of the fourth ventricle, C.

Choroid plexus of the lateral ventricle hematoxylin-eosin 40õ10

Õýëöýìæ: Ñóäëàà÷ Ìîòòè íàðûí íàñàíä õ¿ðýãñäèéí ñóäñàí áèåèéã èä¿¿ëýõ àðãààð ñóäàëñàí ñóäàëãààíû ¿ð ä¿í íü áèäíèéõòýé òààð÷ áàéãàà ÷ çàðèì íýã çºðºëäºõ ç¿éë¿¿ä áàéñàí. Íàâ÷ òºñò õýëáýðòýé, ò¿¿äãýíöýðèéí á¿òýöòýé

õÿëãàñàí ñóäàñíóóä öýëìýíò õ¿ðýýíä áàéæ áè÷èë ò¿¿äãýíöýð¿¿ä áîëîí òîì äèàìåòðòýé á¿òö¿¿ä àëü àëü ñóäàëãààíä èæèë áàéñàí. Ìºí Ìîòòè íàð íü ñóäñàí òîðûí ìîðôîëîãèéí á¿òöèéí õóâüä õî¸ð ººð á¿ñèéã òîäîðõîéëñîí. Íýãä¿ãýýðò òºâ


íü òýãø, öýëìýí á¿õèé ÷ºëººò èðìýãòýé çàõûí õýñýã. Õî¸ðäóãààðò íàðèéí õÿëãàñàí ñóäñóóä íü òîìîîõîí ñóäñóóäûã îðîîæ áàéðëàñàí áàéäàã íü áèäíèé ñóäàëãààòàé ä¿éæ áàéíà [3-5].

Íàñàíä õ¿ðýãñäèéí ñóäñàí òîðûã èä¿¿ëýõ áîëîí öóòãàõ àðãààð ñóäëàõàä àðòåðè âåíèéí øóíò öýëìýíò õÿëãàñàí ñóäñàíä áàéñàí áà öýëìýíãèéí öóñíû óðñãàëûã çîõèöóóëàõ ¿¿ðýãòýé áàéäàã áàéíà [2].

Ãëîìóñò áàéðëàäàã õàðüöàíãóé òîì,

ñóäàñæèëòã¿é á¿ñ íü íàñàíä õ¿ðýã÷äýä áàéäàãã¿é. Ãëîìóñ íü õîëáîã÷ ýäèéí õóðèìòëàëûí òàëáàéòàé áàéäàã íü òóõàéí õýñýãò öóñíû óðñãàë ñààòäàãòàé õîëáîîòîé ãýæ çàðèì ñóäëàà÷èä òýìäýãëýæýý [7].

Zagorska-Swiezy K, Litwin JA, Gorczyca J, Pitynski K, Miodonski AJ íàðûí ñóäàëãààãààð 20 äîëîî õîíîãòîé óðãèéí ñóäñàí òîðûí á¿òýö íü õî¸ðäîã÷ æèíõýíý öýëìýíã ýñ òîîöâîë íàñ áèå ã¿éöñýí õ¿íèé ñóäñàí òîðûí á¿òýöòýé èæèë áàéäãèéã õàðóóëñàí áàéëàà [10].

Table 2. Thickness of the choroid plexus of brain ventricles

Thickness of thechoroid plexus

By our study, 2014 (cm)Madhukar M, Choudhary AK et al,

2012 (cm)In lateral ventricle 0.34±0.02 0.32

In fourth ventricle 0.29±0.01 0.25

Ñóäàëãààíû ¿ð ä¿íãýýñ òàðõèíû õàæóóãèéí õîâäîë áîëîí äºðºâä¿ãýýð õîâäëûí ñóäñàí áèåèéí çóçààíûã áóñàä ñóäëàà÷äûíõòàé õàðüöóóëæ ¿çýõýä ñóäëàà÷ Madhukar M, Choudhary AK íàðûíõòàé îéðîëöîî áàéíà [6].

Ä¿ãíýëò:Íàñàíä õ¿ðñýí õ¿íèé òàðõèíû õàæóóãèéí õîâäëûí ñóäñàí áèåèéí óðò 9.41±0.14, äºðºâä¿ãýýð õîâäëûí ñóäñàí áèåèéí óðò 4.47±0.02, ãóðàâäóãààð õîâäëûí ñóäñàí áèåèéí óðò 0.56±0.140 áàéíà. Íàñàíä õ¿ðñýí õ¿íèé òàðõèíû õàæóóãèéí õîâäëûí ñóäñàí áèåèéí çóçààí 0.5±0.03, äºðºâä¿ãýýð õîâäëûí ñóäñàí áèåèéí çóçààí 0.29±0.01, ãóðàâäóãààð õîâäëûí ñóäñàí áèåèéí çóçààí 0.28±0.01 áàéíà. Òàðõèíû õàæóóãèéí õîâäëûí ñóäñàí áèåèéí æèí 0.51±0.01 ãðàìì, äºðºâä¿ãýýð õîâäëûí ñóäñàí áèåèéí æèí 0.42±0.014 ãðàìì áàéíà.

Íàñàíä õ¿ðñýí õ¿íèé òàðõèíû õîâäëûí ñóäñàí ñ¿ëæýýíèé õàíûí õó÷óóð ýäýí äàâõðàãà íü äàí øîî äºðâºëæèí õó÷óóð ýäýýñ òîãòñîí, ñóóðèéí õýñýã íü îëîí íóãàëàà õóíèàñ òºñò á¿òýö ¿¿ñãýñýí áàéíà.

Íîì ç¿é1. Áÿìáàñ¿ðýí Ã, Ò¿ìýíæèí Ý, Óðàí÷èìýã Ä,

Ò¿íäýâðýíöýí Ñ, Àìãàëàíáààòàð Ä. Íàñàíä õ¿ðñýí õ¿íèé íóãàñíû ìîðôîìåòðèéí ¿ç¿¿ëýëò¿¿ä, “Îíîø ñýò¿¿ë”, 2013, №2, õ.58-64

2. Babik TM. Morphometric characteristics of epitheliocytes in the choroid plexus of the cerebral ventricles in humans during aging, “Neurosci Behav Physiol”, 2007, vol 37(2), p.107-9

3. Lametschwandtner A, Lametschwandtner U, Weiger T. Scanning electron microscopy

of vascular corrosion casts – techniques and applications: updated review, “Scanning Microsc”, 1990, vol 4, p.889–941

4. Miodonski A, Poborowska J, Friedhuber de Grubenthal A. SEM study of the choroid plexus of the lateral ventricle in the cat. “Anat Embryol”, 1979, Vol 155, p.407–416

5. Motti EDF, Imhof HG, Janzer RC, Marquardt K, Yasargil GM. The capillary bed in the choroid plexus of the lateral ventricles: a study of luminal casts, “Scanning Electron Microsc”, 1986, vol IV, p.1501–1513

6. Madhukar M, Choudhary AK, Boal DK, Dias MS, Iantosca MR. Choroid plexus: normal size criteria on neuroimaging, “Surg Radiol Anat”, 2012, vol 34(10), p.887-95

7. Pedget DH. The development of the central arteries in the human embryo. “Contrib Embryol”, 1948, vol 32, p.205–262

8. Sharifi M, Ciolkowski M, Krajewski P, Ciszek B. The choroid plexus of the fourth ventricle and its arteries, “Folia Morphol”, 2005, vol 64(3), p.194-8

9. Weiger T, Lametchwandtner A, Hodde CK, Adam H. The angioarchitecture of the choroid plexus of the lateral ventricle of the rabbit. A scanning electron microscopic study of vascular corrosion casts, “Brain Res”, 1986, vol 378, p.285–296

10. Zagorska-Swiezy K, Litwin JA, Gorczyca J, Pitynski K and Miodonski AJ. The microvascular architecture of the choroid plexus in fetal human brain lateral ventricle: a scanning electron microscopy study of corrosion casts, “J. Anat”, 2008, 213, p.259–265

Òàíèëöàæ, íèéòëýõ ñàíàë ºãñºí: Àíàãààõûí øèíæëýõ óõààíû äîêòîð,

ïðîôåññîð Á.Äàãâàöýðýí


Ìîíãîë îðíû ç¿¿í áà òºâèéí á¿ñèéí çàðèì àéìãèéí õ¿í àìûí äóíä ìýäðýëèéí óäàìøëûí ºâ÷íèé (ÌÓª) á¿òýö, òàðõàëòûí òºâøèí

Ä.Áààñàíæàâ, ß.Ýðäýíý÷èìýã, Á.×èìýãëõàì, Ò.Ñàðàíöýöýã, Á.Îþóíãýðýë, Ä.ÁîëîðìààÀíàãààõ óõààíû õ¿ðýýëýí


Abstract

Epidemiology of neurohereditary diseases in the population of some provinces(aimags) existence in south and central part of Mongolia

D.Baasanjav, Ya.Erdenechimeg, B.Chimeglkham, T.Sarantsetseg, B.Oyungerel, D.BolormaaMedical Research Institute


BackgroundOur previous study has shown that the prevalence and structure of the neurohereditary diseases were different by provinces and some form of these diseases as “indigenous” in some isolated population. There are some scientific results of our researches–genetics about consanguineous, which is more potential factor of community is some area of Mongolia. All these circumstance is giving to carry out this study.

Materials and MethodsWe used descriptive epidemiological method for revealing hereditary neurological diseases in the population of 6 provinces (aimags) of Mongolia: Dornogobi (Easth-gobi), Sukhbaatar, Gobisumber, Central aimag, Bulgan, and Darkhan-Uul. Total population of these provinces is 363072. The number of population in 6 provinces was fluctuated in the range from 15.000 (Govisumber) to 88.875 (Darkhan-Uul). Prevalence was accounted for 100.000 populations.

ResultsThe prevalence of neurohereditary diseases makes up 17.08 cases per 100.000 populations among these 6 provinces. 79% of these are hereditary neuromuscular diseases i.e 49 patients from 29 families. Myotonic dystrophia and genetic neuropathies Charcot-Marie-Tooth have comparative high prevalence over test forms of disease.

The high rate neurohereditary diseases was established in the population of Bulgan (35.80•10-5), Sukhbaatar (31.17•10-5), and Dornogobi (21.33•10-5) provinces. Their prevalence’s prevailed in the 7-10 times over rates Darkhan-Uul, 3-5 times over rates of Gobisumber aimags.

No neuromuscular forms of neurohereditary diseases i.e spastic paraplegia (11.3%) and spinocerebeller ataxia (9.68%) accounts for 21% among all forms of neurohereditary diseases. The prevalence of neuromuscular diseases in the population of these six provinces is two times high then the average rate of the population of Russia (1980 years). First reason is may be associated with high predisposition of based on consanguineous through reproductive way in some of these provinces of Mongolia.

Key words: neurohereditary diseases, myotonic dystrophia, hereditary muscular diseasesPp.12-17, Tables 2, References 16

¯íäýñëýëÌýäðýëèéí óäàìøëûí ºâ÷í¿¿ä (ÌÓª) õ¿íèé óäàìøëûí ºâ÷í¿¿äèéí äîòîð òýðã¿¿ëýõ áàéðóóäàä îðäîã áºãººä èõýíõ íü ààæìààð äààìæðàí õ¿íä õýëáýðèéí òàõèð äóòóóæèëòûã ¿¿ñãýí ãýð îðîí, íèéãýìä õ¿íä äàðàìò ó÷ðóóëäàã áºãººä íºõºí ¿ðæèõ¿éí çàìààð òàðõàæ, óäìûí öýâýð àðèóí áàéäàëä õîð õºíººë ó÷ðóóëäãààðàà èë¿¿ õºíººëòýé ºâ÷èí þì. Ãýâ÷ õ¿í àìûí äóíä ýíý ºâ÷íèéã èëð¿¿ëýõ óëìààð

óðüä÷èëàí ñýðãèéëýõ àñóóäàë óëñ îðîí á¿ðò õàðèëöàí àäèëã¿é òºâøèíä ÿâàãäàæ áàéãààã ñóäëàà÷èä òýìäýãëýäýã. ßëàíãóÿà Àçè, Àôðèê, Ëàòèí Àìåðèêèéí îëîí îðîíä ýíý òàëààðõ ñóäàëãàà, ìýäýýëýë õîìñ áàéãààã òýìäýãëýäýã (Å.Ä.Ìàðêîâà, Ð.Â.Ìàãæàíîâ,1990 îí).ªâ÷íèé ¿¿ñýõ õºãæèõºä íºëººëäºã õ¿ðýýëýí áóé îð÷íû õ¿÷èí ç¿éëñ (õàëäâàðò ºâ÷èí, ºëñãºëºí, ãýìòýë ã.ì)-èéã áóóðóóëàõ áîëîìæ äýýøèëæ áàéãààòàé õîëáîãäîí ýð¿¿ë ìýíäýä ñºðãººð


íºëººëäºã óäìûí õ¿÷èí ç¿éëñèéí ýçëýõ õóâü ºññººð áàéíà ãýæ ÄÝÌÁ-ûí ýêñïåðò¿¿ä 1966 îíä òýìäýãëýæ áàéñàí.

...Õºãæèëòýé îðíóóäàä ãåíåòèêèéí ºâ÷í¿¿ä íÿðàéí íàñ áàðàëò, õ¿¿õäèéí òàõèð äóòóóæèëòàíä ºíäºð õóâèéã ýçýëäýã áîëæ áàéíà. Ãåíåòèêèéí ñóóðü ººð÷ëºëò íü òèéì õ¿ì¿¿ñò íàñàíä õ¿ðýõýä íü ÿíç á¿ðèéí åðºíõèé ºâ÷í¿¿ä òóõàéëáàë, äèàáåò, õàâäàð, ãèïåðòîíè, ç¿ðõíèé èøåìèéí ºâ÷èí, òýíýãøèðýë çýðýã ºâ÷í¿¿ä, ýðò ýõýëäýã íºõöºë íü áîëäîã (Control of hereditary diseases ÄÝÌÁ-ûí òåõíèê èëòãýë¿¿ä, 865, p1,1996).

Ìîíãîë îðíû õ¿í àìûí äóíä ÌÓª-íèé á¿òýö, òàðõàëòûí òàíäàëò ñóäàëãààã áèä óðüä îíóóäàä õ¿í àìûí äóíä ÿâóóëæ, 14 àéìàã, ÓÁ õîòûã õàìðààä áàéñàí. Ýíý ñóäàëãààíû ä¿íã¿¿äýýñ ¿çýõýä ÌÓª-íèé á¿òýö, òàðõàëòûí òºâøèí àéìãóóäààð èõýýõýí ÿëãààòàé áàéãàà áºãººä çàðèì àéìàã ñóìàíä çàðèì íýã ºâ÷èí, “íóòàãøìàë” áàéäàëòàé ò¿ãýí òàðõàæ áàéãààã òîãòîîãîîä áàéãàà áèëýý.

Çîðèëãî: ÌÓª-íèé ýïèäåìèîëîãèéí òàíäàëò ñóäàëãààíä õàìðàãäààã¿é ¿ëäñýí çóðãààí àéìàã ¿¿íä, Ñ¿õáààòàð, Äîðíîãîâü, Ãîâüñ¿ìáýð, Òºâ,

Áóëãàí, Äàðõàí-Óóë àéìãèéí á¿õ õ¿í àìûã õàìàð÷, çîíõèëîí òîõèîëääîã ÌÓª-èéã èëð¿¿ëýõ, òàðõàëòûí äàâòàìæèéã ñóäàëãààíä õàìðàãäñàí àéìàã á¿ðýýð áîëîí íýãòãýí ä¿ãíýõ, óëìààð óðüä ÿâóóëñàí àéìãóóäûí áîëîí îëîí óëñûí ñóäàëãààíû ä¿íòýé õàðüöóóëàí ä¿ãíýõ, çàðèì îíöëîãòîé ýñýõèéã òîãòîîõ çîðèëãî òàâüñàí.

Ìàòåðèàë, àðãà ç¿éÌÓª-íèéã èëð¿¿ëýõ ñóäàëãààã ýìíýëãèéí ¿éë÷èëãýýíèé 3 øàòíû ¿¿íä, áàã, ñóìûí, àéìãèéí áîëîí ñóäëàà÷ ýì÷ íàðûí ò¿âøèíä ÿâóóëæ, ºâ÷òýé áà ñýæèãòýé õ¿ì¿¿ñèéã íèéò õ¿í àìûí äóíäààñ èëð¿¿ëýí á¿ðòãýæ, îíîøëîãîîã íàðèéí ìýðãýæëèéí ñóäëàà÷ ýì÷ íàðûí õÿíàëò ¿çëýãýýð áàòàëãààæóóëñàí. Îíîøëîãîîíä ãýð á¿ë, óäìûí àñóóìæ àðãà, ìýäðýëèéí ýìíýëç¿éí àðãóóäûã õýðýãëýñýí. ªâ÷òýé õ¿ì¿¿ñ, ãýð á¿ëèéí òîîã àéìàã á¿ðýýð ãàðãàæ, òàðõàëòûí äàâòàìæèéã 100.000 õ¿í àìä òîîöîæ ãàðãàñàí. Ñóäàëãààíä õàìðàãäñàí àéìãóóäûí õ¿í àìûí òîîã 2012 îíû 12-ð ñàðûí áàéäëààð àâ÷, òàðõàëòûí äàâòàìæèéã òîãòîîõîä àøèãëàâ. Íèéò 6 àéìãèéí õ¿í àìûí òîî 363072 áàéâ. Ñóäàëãààíä õàìðàãäñàí õ¿í àìûí òîîã àéìàã á¿ðýýð äîîð õàðóóëàâ (Table 1).

Table 1. Sample number of the study among 6 provinces (by provinces and total number)

ProvincesBulgan Sukhbaatar Dornogobi Gobisumber Tuv Darkhan Total

Sample number(in 2012)

58651 51334 60935 15000 88277 88875 363072

Ñóäàëãààíû ¿ç¿¿ëýëò¿¿äèéí áîëîâñðóóëàëòûí èíòåíñèâ ¿ç¿¿ëýëò¿¿äèéã ºâ÷íèé íýðøëýýð (100.000 àìä) ãàðãàñàí. Ñòàòèñòèê áîëîâñðóóëàëòàä “t” “p” øàëãóóðûã àøèãëàâ.

¯ð ä¿íÑóäàëãààíä õàìðàãäñàí àéìãóóäûí õ¿í àìûí

äóíä èëýðñýí ìýäðýëèéí óäàìøëûí ºâ÷í¿¿äèéã ºâ÷íèé íýðøëýýð, èëýðñýí ºâ÷í¿¿äèéí òàðõàëòûí äàâòàìæèéã 100.000 õ¿í àìä íîãäîõ òîõèîëäëûí òîîíû äàâòàìæ áîëîí ºâ÷òýé õ¿ì¿¿ñòýé ãýð á¿ëèéí òîîã äîîðõ õ¿ñíýãòýä õàðóóëàâ (Table 2).

Table 2. Prevalence of neurological hereditary diseases among population of 6 provinces

№ Diseases Prevalence Provinces TotalBulgan Sukhbaatar Dornogobi Gobisumber Tuv Darkhan-

Uul1 Ìyotonic

DystrophyIncidence 8 3 6 - 2 1 20Frequency 13.64 5.84 9.85 - 2.26 1.12 5.51Family number

3 1 3 - 2 1 10

Charcot-Marie-Tooth disease(Polyneuropathy)

Incidence 4 10 1 1 16Frequency 6.82 19.48 1.64 1.13 4.41Family number

4 3 1 1 9

2 Spastic Paraplegia

Incidence 2 - 2 - 2 1 7Frequency 3.41 - 3.28 - 2.26 1.12 1.93Family number

1 - 1 - 2 1 5


3 Myodystrophy Duchenne

Incidence - 2 3 1 - 1 7Frequency - 3.90 4.92 6.66 - 1.12 1.93Family number

- 1 2 1 - 1 5

4 Myodystrophy (Erba-Rota and etc)

Incidence 2 1 1 - 1 - 5Frequency 3.41 1.95 1.64 - 1.13 - 1.38Family number

1 1 1 - 1 - 4

5 Spinocerebellar ataxia

Incidence 4 - - 2 6Frequency 6.82 - - 2.26 1.65Family number

2 - - 1 3

6 Paroxysmal myoplegia

Incidence 1 - - - 1Frequency 1.70 - - - 0.27Family number

1 - - - 1

7 Total Incidence 21 16 13 1 8 3 62Frequency 35.80 31.17 21.33 6.66 9.06 3.37 17.08

Family number

12 6 8 1 7 3 37

(100.000) (by provinces and total number)

Õ¿ñíýãòýä õàðóóëñíààð ñóäàëãààíä õàìðàãäñàí íèéò 6 àéìãèéí õ¿í àìûí äóíä ìýäðýëèéí óäàìøëûí ºâ÷èíòýé 37 ãýð á¿ëèéí 62 ºâ÷òºí èëýðñýí íü àéìãóóäûí äóíäæààð 100.000 õ¿í àìä 17.08 òîõèîëäëûí äàâòàìæòàé áàéíà.

Àéìãóóäààð òàðõàëòûí ¿ç¿¿ëýëò èõýýõýí ÿëãààòàé áàéëàà. Òàðõàëòûí ¿ç¿¿ëýëòèéí õýëáýëçýë 100.000 õ¿í àìä 3.37(Äàðõàí-óóë àéìàã)-ààñ 35.80 (Áóëãàí àéìàã) äîòîð õýëáýëçñýí. Õàðüöàíãóé ºíäºð òàðõàëòòàé àéìàãò Áóëãàí äàðàà íü Ñ¿õáààòàð (31.17 äàâòàìæ), Äîðíîãîâü (21.33 äàâòàìæòàé) áàéãàà áîë õàðüöàíãóé áàãà äàâòàìæòàé àéìãóóäàä Äàðõàí-Óóë àéìãààñ ãàäíà Ãîâüñ¿ìáýð (6.66), Òºâ àéìàã (9.06) òóñ òóñ îðæ áàéíà.

Õ¿í àì íü ñóóðüøìàë, óäòàë òýð íóòàãòàà îðøèí ñóóãàà óóãóóë õ¿í àìòàé àéìãóóäûí (Áóëãàí, Ñ¿õáààòàð, Äîðíîãîâü) äîòîð òàðõàëòûí ¿ç¿¿ëýëò ºíäºð áàéãàà áîë õàðüöàíãóé øèíýýð áàéãóóëàãäñàí àéìãóóäûí (Äàðõàí-Óóë, Ãîâüñ¿ìáýð) õ¿í àìûí äóíä áîëîí ÓÁ õîòòîé îéðõîí õºðø îðøäîã õ¿í àìûí äóíä ìýäðýëèéí óäàìøëûí ºâ÷èí õàðüöàíãóé áàãà õýìæýýíèé òàðõàëòòàé áàéíà.

ªâ÷íèé á¿òöèéí íýðøëýýð íèéòäýý 7 òºðëèéí íýðøèë á¿õèé ºâ÷èí èëýðñíýýñ, õàðüöàíãóé õàìãèéí èõ äàâòàìæòàé ºâ÷èí óäàìøëûí ìèîòîíèéí äèñòðîôè, äàðàà íü ØÌÒ ºâ÷èí áàéëàà. ªâ÷íèé íýðøèë á¿ðýýð òàðõàëòûí äàâòàìæèéã àéìãóóäààð áîëîí àéìãóóäûí íýãòãýñýí ä¿íãýýð àâ÷ ¿çüå.

Ìèîòîíèéí äèñòðîôè ºâ÷èí ñóäàëãààíä õàìðàãäñàí 6 àéìãààñ 5-ä íü ¿¿íä, Áóëãàí, Ñ¿õáààòàð, Äîðíîãîâü, Òºâ, Äàðõàí-Óóë àéìãèéí õ¿í àìûí äóíä 100.000-ä 13.64 òîõèîëäëûí äàâòàìæ (Áóëãàíä)-ààñ 1.12 (Äàðõàí-Óóë) òîõèîëäëûí äàâòàìæ äîòîð õýëáýëçýëòýé áàéñàí áîë Ãîâüñ¿ìáýð àéìãèéí õ¿í àìûí äîòîð ýíý ºâ÷íèé òîõèîëäîë áàéõã¿é áàéëàà. Õàìðàãäñàí íèéò 6 àéìãèéí äóíäæààð ýíý ºâ÷íèé òàðõàëòûí äàâòàìæ 100.000 õ¿í àìä 5.51 òîõèîëäëûí äàâòàìæòàé áàéëàà. Õàìãèéí îëîí ºâ÷òºí èëýðñýí àéìàã áîëîõ Áóëãàíä 8 òîõèîëäîë 3 ãýð á¿ëä, Ñ¿õáààòàð 3 ºâ÷òºí 1 ãýð á¿ëä, Äîðíîãîâü àéìàãò 6 òîõèîëäîë 3 ãýð á¿ëä òóñ òóñ èëýðñýí. Ñóäàëãààíû íèéò 6 àéìãèéí õýìæýýíä 20 ºâ÷òºí 9 ãýð á¿ëä èëýðñýí.

Øàðêî-Ìàðè-Òóò (ØÌÒ) ºâ÷èí òàðõàëòûí òºâøíººð ìèîòîíèéí äèñòðîôè ºâ÷íèé äàðàà II áàéðò îðæ áàéíà. Ñóäàëãààíû íèéò àéìãóóäûí ä¿íãýýð ýíý ºâ÷íèé 16 òîõèîëäîë 9 ãýð á¿ëä èëýð÷, òàðõàëòûí òºâøèí íü 100.000 õ¿í àìä 4.41 òîõèîëäëûí äàâòàìæòàé áàéëàà. Ýíý ºâ÷èí Ãîâüñ¿ìáýð, Äàðõàí-óóë àéìãèéí õ¿í àì äóíä èëðýýã¿é. Õàìãèéí îëîí òîõèîëäîë èëýðñýí àéìàã Ñ¿õáààòàð. Ýíä 10 òîõèîëäîë 3 ãýð á¿ëä èëýðñýí íü àéìãèéíõàà õ¿í àìä õàðüöóóëàõàä 100.000 õ¿í àìä 19.48 òîõèîëäëûí äàâòàìæòàéãààð õàìãèéí ºíäºð ºâ÷ëºëòýé áàéâ. II áàéðò íü Áóëãàí àéìàã. Ýíä 100.000 õ¿í àìä 6.82 òîõèîëäëûí äàâòàìæòàé áóþó 4 òîõèîëäîë 4 ãýð á¿ëä èëýðñýí.

Ìº÷-á¿ñë¿¿ðèéí ìèîäèñòðîôè (Ýðáà-Ðîòûí õýâøèíæ) Ñóäàëãààíû àéìãóóäàä íèéòäýý 5


òîõèîëäîë á¿ðòãýãäýæ, íèéò àéìãèéí äóíäæààð 100.000 õ¿í àìä 1.38 òîõèîëäëûí äàâòàìæòàé òàðõàëòòàé áàéíà. Ýíý ºâ÷èí Ãîâüñ¿ìáýð, Äàðõàí-Óóë àéìàãò á¿ðòãýãäýýã¿é áóþó áàéõã¿é ãýæ òýìäýãëýñýí. Àéìãóóäààð õàðüöàíãóé îëîíòàà òîõèîëäîë Áóëãàí àéìàãò 2 òîõèîëäîë áàéëàà. Ñ¿õáààòàð, Äîðíîãîâü, Òºâ àéìãóóäàä íýã íýã òîõèîëäîë á¿ðòãýãäñýí íü ýíý àéìãóóäàä 100.000 õ¿í àìä 1.13-ààñ 1.95 òîõèîëäëûí äàâòàìæ á¿õèé òàðõàëòòàé áàéíà.

Äþøåí ìèîäèñòðîôè ºâ÷èí íèéòäýý 7 òîõèîëäîë 5 ãýð á¿ëä èëýðñýí íü àéìãóóäûí äóíäæààð 100.000 õ¿í àìä 1.93 òîõèîëäëûí äàâòàìæòàé áàéíà. Àéìãóóäààð Ñ¿õáààòàðò 2 òîõèîëäîë, Äîðíîãîâüä 3 òîõèîëäîë, Ãîâüñ¿ìáýð, Äàðõàíä òóñ á¿ð 1 òîõèîëäîë èëðýâ. Òàðõàëòûí äàâòàìæ íü àéìãóóäààð 0.00-ààñ (Áóëãàí,Òºâ àéìàã)-ààñ 6.66(Ãîâü-Ñ¿ìáýð) òîõèîëäëûí äîòîð õýëáýëçýâ.

Ïàðîêñèçìàëü ìèîïëåãè ºâ÷èí çºâõºí Áóëãàí àéìàãò íýã òîõèîëäîë èëýðñýí, õàðèí áóñàä àéìãóóäàä èëðýýã¿é.

Äýýð äóðüäñàí 5 íýðøëèéí ºâ÷èí íü á¿ãä ìýäðýë áóë÷èíãèéí á¿ëãèéí áºãººä íèéò ä¿íãýýð 49 ºâ÷òºí áàéãàà íü íèéò èëýðñýí ìýäðýëèéí óäàìøëûí ºâ÷íèé 62 òîõèîëäëûí äîòîð 79%-èéã ýçýëæ ¿íýìëýõ¿é äàâàìãàéëæ áàéíà (ð<0.05). ¯ëäñýí 21%-èéã ìýäðýë áóë÷èíãèéí áóñ ìýäðýëèéí óäàìøëûí ºâ÷í¿¿ä, ¿¿íä, ñïàñòèê ïàðàïëåãè, íóãàñ áàãà òàðõèíû àòàêñè ºâ÷í¿¿ä ýçëýâ.

Óäàìøëûí ñïàñòèê ïàðàïëåãè ºâ÷èí ñóäàëãààíû àéìãóóäûí íèéò õ¿í àìûí äóíä 7 òîõèîëäîë èëýðñýí íü 100.000 õ¿í àìä 1.93 òîõèîëäëûí äàâòàìæòàé áàéíà. Àéìãóóäààð 0,00 (Ñ¿õáààòàð, Ãîâüñ¿ìáýð)-ààñ 3.41(Áóëãàí) òîõèîëäëûí äàâòàìæ äîòîð õýëáýëçýæ áàéíà. Áóëãàí, Äîðíîãîâü, Òºâ àéìãóóäàä òóñ á¿ð 2 òîõèîëäîë, Äàðõàíä 1 òîõèîëäîë òóñ òóñ èëðýâ. Ýäãýýð 7 òîõèîëäîë 5 ãýð á¿ëýýñ èëðýâ.

Óäàìøëûí íóãàñ-áàãà òàðõèíû àòàêñè ñóäàëãààíû íèéò àéìãóóäûí õ¿í àì äóíä 6 òîõèîëäîë 3 ãýð á¿ëä èëýðñýí íü àéìãóóäûí äóíäæààð 100.000 õ¿í àìä 1.65 òîõèîëäëûí äàâòàìæòàé áàéíà. Àéìãóóäààð 0.00 (Ñ¿õáààòàð, Äîðíîãîâü, Ãîâüñ¿ìáýð, Äàðõàí-Óóë)-ààñ 6.82 òîõèîëäëûí (Áóëãàí) äàâòàìæ äîòîð õýëáýëçýëòýé áàéâ. Òºâ àéìàãò 2 òîõèîëäîë èëýðñýí íü 100.000 õ¿í àìä 2.26 òîõèîëäëûí äàâòàìæòàé áàéâ. Ýíý ºâ÷èí ñóäàëãààíû 6 àéìãèéí çºâõºí 2-ò íü (Òºâ, Áóëãàí) èëýðñýí íü

áóñàä àéìãóóäàä õàðààõàí òàðõààã¿é áàéíà ãýæ ¿çýõýýð áàéíà.

Ñóäàëãààíû 6 àéìãèéí õ¿í àìûí äîòîð èëýðñýí ìýäðýëèéí óäàìøëûí íèéò ºâ÷íèé òàðõàëòûí äàâòàìæààð çýðýãëýæ ¿çâýë I áàéðàíä Áóëãàí àéìàã 100.000 õ¿í àìä 35.80, II-Ñ¿õáààòàð 31.17, III-Äîðíîãîâü 21.33, IV-Òºâ àéìàã 9,06 òîõèîëäëûí äàâòàìæààð òóñ òóñ îðæ Äàðõàí, Ãîâüñ¿ìáýð àéìãóóä õàðüöàíãóé áàãà ºâ÷ëºëòýé (3.37-Äàðõàí-Óóë, 6.66-Ãîâüñ¿ìáýð) áàéíà.

Õýëöýìæ ªíãºðñºí õóãàöààíä ìîíãîë îðíû õ¿í àìûí äóíä ìýäðýëèéí óäàìøëûí çîíõèëîõ ºâ÷í¿¿äèéí á¿òýö, òàðõàëòûí ñóäàëãààã 15 àéìàã, ÓÁ õîòûã õàìàðñàí ñóäàëãààíû ¿ç¿¿ëýëò¿¿äòýé õàðüöóóëàõàä:Ìèîòîíèéí äèñòðîôè ºâ÷íèé òàðõàëòàíä 1997-2005 îíû 7 àéìãèéí äóíäæààð ýíý ºâ÷èí 5.76∙10-5; 2005-2007 îíû 8 àéìãèéí äóíäæààð 5.41∙10-5 áàéñàíòàé îéðîëöîî. Ýíýõ¿¿ 6 àéìãèéí ñóäàëãààíû ä¿íãýýð 5.51∙10-5 õîîðîíäîî èæèëä¿¿, ãýõäýý ãàäààäûíõààñ áàãà äàâòàìæòàé (ð<0.05). Ñóäàëãààíä õàìðàãäñàí àéìãóóäààð äýýðõ ºâ÷íèé òàðõàëò 0.00∙10-5-îîñ 27.05∙10-5 õýìæýýòýé áàéíà. Ýíý íü ãàäààäûí ñóäëàà÷äûí ñóäàëãààãààð äóíäàæ ãýæ ¿çýõ õýìæýý þì. Øâåéöàðò õèéãäñýí ñóäàëãààãààð 4.9∙10-

5òîõèîëäëûí äàâòàìæòàé áàéãààòàé îéðîëöîî áàéíà. Ãýâ÷ ñóäàëãààíä õàìðàãäñàí ãàçàð îðíóóä èõ ÿëãààòàé áóþó õýëáýëçýëòýé. ¯¿íä: 0.6∙10-5-ààñ 149∙10-5òîõèîëäëûí äàâòàìæòàé áàéíà.

Øàðêî-Ìàðè-Òóò ºâ÷èí áóþó óäàìøëûí ïîëèíåâðîïàòè ºâ÷íèé òàðõàëò ýíýõ¿¿ 6 àéìãèéí äóíäæààð 4.41∙10-5 äàâòàìæòàé óðüäàõ ñóäàëãààíû ä¿íã¿¿äòýé õàðüöóóëàõàä çàðèì àéìãèéí ä¿íãýýñ òóõàéëáàë, Àðõàíãàé (48.30∙10-

5), Äîðíîäîä (32.26∙10-5) äàõèàñ èõýýõýí áàãà. Ìºí ãàäààäûí ºíäºð ¿ç¿¿ëýëòòýé ãàçðóóäààñ òóõàéëáàë, Áàðóóí Íîðâåãè, Ãóàìûí áîëîí õîéä Åëåíàãèéí àðëóóä äàõü ¿ç¿¿ëýëò (72.7∙10-

5)-¿¿ä, ìºí ÎÕÓ-ûí Àìóð ìóæèéí çàðèì ºíäºð ¿ç¿¿ëýëòòýé ãàçðóóäààñ èõýýõýí áàãà. Ãàäààäûí äóíäàæ ¿ç¿¿ëýëò¿¿äòýé îéðîëöîî ãýæ ¿çìýýð õýìæýýòýé.

Óäàìøëûí ñïàñòèê ïàðàïëåãè (Øòðþìïåëü) ºâ÷íèé òàðõàëò ýíýõ¿¿ 6 àéìãèéí ñóäàëãààíû äóíäæààð 1.93∙10-5 áàéãàà íü óðüä íü ÿâóóëñàí 15 àéìãèéí äóíäàæ áîëîõ 2.70∙10-5 òîõèîëäëûí äàâòàìæààñ áàãà áàéíà. Ýíý ºâ÷èí ìàíàé îðíû Óâñ (13.48òõë), Õîâä (6.55 òõë), Áàÿíõîíãîð (5.41òõë), àéìãóóä òîõèîëäëûí äàâòàìæààð òýðã¿¿ëäýã. Ìîíãîëûí 9 àéìàãò ýíý ºâ÷èí îäîîãîîð èëðýýã¿é áàéãàà þì. Ãàäààäûí


ñóäëàà÷äûíõààð ýíý ºâ÷íèé òàðõàëò 1.40∙10-

5–ààñ 4.3∙10-5 òîõèîëäëûí äàâòàìæòàé ãýäýã çýðãýýñ ¿çýõýä ýíý ºâ÷èí ìîíãîëûí õ¿í àìä õàðüöàíãóé áàãà òàðõàëòòàé áîëîâ÷ çàðèì ãàçàðò Óâñ ã.ì íóòàãøìàë áàéäàëòàé òàðõàí äýëãýðýõ õàíäëàãàòàé áàéíà.

Ìº÷ á¿ñë¿¿ðèéí ìèîäèñòðîôè ºâ÷èí, ìèîäèñòðîôè Äþøåí, ïàðîêñèçìàëü ìèîïëåãè çýðýã ìýäðýë áóë÷èíãèéí ºâ÷í¿¿ä ýíý 6 àéìãèéí äóíäæààð 100.000 õ¿í àìä 1.38 (ìº÷ á¿ñë¿¿ðèéí ìèîïëåãè)-ààñ 1.93∙10-5 òõë (ìèîäèñòðîôè Äþøåí) äîòîð õýëáýëçñýí íü ãàäààäûí ñóäëàà÷äûíõààñ áàãà áàéíà. Ìèîäèñòðîôè Äþøåí íü ýðò íàñ áàðäàã, èõýâ÷ëýí õ¿¿õýä íàñíû õ¿í àì äîòîð òàðõàëò íü ºíäºð áàéäàã, õ¿¿õäèéí óäàìøëûí ºâ÷íèé á¿ëýãò õàðüÿàëàãääàã çýðýã íü åðºíõèé õ¿í àìûí äîòîð áàãà äàâòàìæòàé; öààøèä øèíæèëãýýã ñàéæðóóëàõ øààðäëàãàòàé. Ïàðîêñèçìàëü ìèîïëåãè ºâ÷íèé òàðõàëòûí ñóäàëãàà ìàø öººí áîëîëòîé. Áèäýíä ýíý òàëààð ñóäàëãààíû àæèë òààðàëäñàíã¿é.

Íóãàñ áàãà òàðõèíû àòàêñèéí òàðõàëò ñóäàëãààíû àéìãóóäûí äóíäæààð 1.65∙10-5

äàâòàìæòàé èëýðñýí íü ò¿ð¿¿÷èéí áèäíèé çàðèì àéìàãò õèéñýí ñóäàëãààíû ¿ç¿¿ëýëò¿¿äýýñ 0.47∙10-5(Çàâõàí) ºíäºð áàéíà. Ãàäààäûí ñóäëàà÷äûí ñóäàëãààãààð (Å.Ä.Ìàðêîâà, Ð.Â.Ìàãæàíîâ íàð, 1990) 0.21∙10-5-ààñ 4.7∙10-5 ã.ì õýìæýýíä õýëáýëçýæ áàéñàí. Ñ.Í.Èëëàðèîøêèí, Ã.Å.Ðóäÿíñêàÿ, È.À.Èâàíîâà, Ñìîëåíñêàÿ, Å.Ä.Ìàðêîâà, Ñ.Ä.Êëþøíèêîâ íàð, 2006-ûí òýìäýãëýñíýýð ýíý ºâ÷íèé òàðõàëò èõýýõýí õýëáýëçýëòýé, ýíý íü ýíý á¿ëýãò õàìààðàõ á¿ëýã ºâ÷í¿¿äèéã õýð õàìàð÷ ñóäàëñàí çýðýã íºõöëººñ õàìààðäàã. ªíäºð òàðõàëòûí ¿ç¿¿ëýëò Èñïàíè, Íèãåðè, Õîéä Èðëàíä, ßïîíû Òîòòîðè-ä 100.000 õ¿í àìä 10-ààñ 17.8 òîõèîëäëûí äàâòàìæòàéã èøëýë àâ÷ òýìäýãëýñýí. Ýíý á¿ëãèéí óäàìøëûí ºâ÷íèé òàðõàëòûã ìîíãîëä öààøèä òîäðóóëàõ øààðäëàãàòàé áàéíà.

Ýíýõ¿¿ 6 àéìãèéí äóíäæààð ìýäðýë áóë÷èíãèéí á¿ëýã ºâ÷íèé ìèîòîíèéí äèñòðîôè, ØÌÒ ºâ÷èí, Äþøåíí ìèîäèñòðîôè, ìº÷ á¿ñë¿¿ðèéí ïðîêñèçìàëü ìèîïëåãè òàðõàëòûí òºâøèí 13.5∙10-5 (42 ºâ÷òºí) áàéãàà íü Óçáåêñòàíä õèéñýí ñóäàëãààíû ä¿íòýé (Õàííàêîâà Ô.Ê. 1988, 12.4∙10-5)-òàé îéðîëöîî, õàðèí ÷ áàãà çýðýã èë¿¿ ¿ç¿¿ëýëòòýé. Ýíý íü ÎÕÓ-ûí äóíäæààñ (6.9∙10-

5) 2 äàõèí ºíäºð áàéãàà þì. Óçáåêñòàíä ñàäàí òºðëèéí õ¿ì¿¿ñèéí õîîðîíäûí ãýðëýëò 22-28% õ¿ð÷ áàéãààòàé ºâ÷ëºëèéí ºíäºð òºâøèí õîëáîîòîé ãýñýí äýýðõ ñóäëàà÷èéí äýâø¿¿ëæ áàéñàí òààìàãëàëûã áèä õóâààëöâàë çîõèíî.

Ìàíàéä öóñ îéðòîëòûí ýðñäýë ºíäºð áàéãààã òýìäýãëýäýã (Æ.Áàòñóóðü, 2004 îí) ñóäàëãààíû ä¿ãíýëòèéã àíõààðàëäàà àâàõ øààðäëàãàòàé. Äóðüäñàíààñ ¿çýõýä îí óäààí æèë àéìàãòàà òîãòìîë îðøèí ñóóãàà óóãóóë õ¿í àìòàé àéìãóóäàä ìýäðýëèéí óäàìøëûí ºâ÷èí õàðüöàíãóé ºíäºð äàâòàìæ á¿õèé òàðõàëòòàé áàéãàà íü àíõààðàë òàòàõ ó÷èðòàé. Äàðõàí-Óóë, Ãîâüñ¿ìáýð àéìãóóä õàðüöàíãóé ñ¿¿ëä áàéãóóëàãäñàí õ¿í àìûí á¿òöýýð ÿëàíãóÿà Äàðõàí-Óóë àéìàã 1970-ààä îíû ¿åä õàìãèéí çàëóó õ¿í àìòàé áàéñàí áºãººä óëñûí àæ ¿éëäâýðèéí øèíý òºâèéí ¿¿ðýã á¿õèé øèíý õîò áîëîí áàéãóóëàãäàæ, ààæìààð õ¿í àìûí òºâëºðºë èõñýæ, áèå äààñàí àéìàã áîëñîí ò¿¿õòýé áèëýý.

Ä¿ãíýëò:1. Ñóäàëãààíä õàìðàãäñàí ýíýõ¿¿ 6 àéìãèéí

õ¿í àìûí äóíä ìýäðýëèéí óäàìøëûí äàðààõ ºâ÷í¿¿ä èëðýâ. ¯¿íä, ìèîòîíèéí äèñòðîôè, óäàìøëûí ïîëèíåâðîïàòè Øàðêî-Ìàðè-Òóò, ìº÷ á¿ñë¿¿ðèéí ìèîäèñòðîôè (Ýðáà-Ðîòàãèéí õýâøèíæ), ìèîäèñòðîôè Äþøåí, ïàðîêñèçìàëü ìèîïëåãè, ñïàñòèê ïàðàïëåãè, íóãàñ áàãà òàðõèíû àòàêñè ºâ÷í¿¿ä þì.

2. ªâ÷èí òóñ á¿ðèéí òàðõàëòûí äàâòàìæèéã 100.000 õ¿í àìä ãàðãàõàä äîîðõè äàðààëëààð òîãòîîãäîâ. ¯¿íä: ìèîòîíèéí äèñòðîôè-5.51 òîõèîëäîë (òõë), Øàðêî-Ìàðè–Òóò ºâ÷èí -4.41 òõë, ìèîäèñòðîôè Äþøåíí-1.93 òõë, ñïàñòèê ïàðàïëåãè-1.93 òõë, íóãàñ áàãà òàðõèíû àòàêñè-1.65 òõë, ìº÷ á¿ñë¿¿ðèéí ìèîäèñòðîôè (Ýðáà-Ðîòàãèéí õýâøèíæ) 1.38 òõë, ¿å ¿å èëýðäýã ìèîïëåãè-0.27 òõë òóñ òóñ áîëíî.

3. Èëýðñýí ìýäðýëèéí óäàìøëûí ºâ÷íèé íèéò ä¿íãýýð òàðõàëòûí äàâòàìæ àéìãóóäûí íýãòãýñýí ä¿íãýýð 100.000 õ¿í àìä 17.06 òõë-ûí äàâòàìæòàé áîëîâ÷ àéìãóóäààð èõýýõýí ÿëãààòàé áàéíà. Õàìãèéí ºíäºð äàâòàìæ Áóëãàí àéìàãò 35.80 òõë I áàéð, äàðàà íü Ñ¿õáààòàð 31.17 òõë-îîð II áàéð, III áàéð Äîðíîãîâü-21.33 òõë áàéñàí áîë õàìãèéí áàãà äàâòàìæ Äàðõàí-Óóëä 3.37, Ãîâüñ¿ìáýðò 6.66 ã.ì òõë òóñ òóñ äàâòàìæòàé áàéíà.

4. Íèéò èëýðñýí ÌÓª-íèé (62 ìýäðýëèéí ºâ÷òºí) ìýäðýë áóë÷èíãèéí á¿ëãèéí ºâ÷í¿¿ä çîíõèëæ (49 òõë) 79%-èéã ýçýëæ áàéãàà îíöëîãòîé áàéíà.

5. Ìýäðýë áóë÷èíãèéí óäàìøëûí ºâ÷íèé òàðõàëò Ìîíãîëä ÎÕÓ-ûí äóíäæààñ 2 äàõèí èõ, õàðèí Óçáåêñòàí, Àìóð ìóæ çýðýã ºíäºð ¿ç¿¿ëýëòòýé ãàçðóóäûí õýìæýýíä áàéíà.

6. Íóòãèéí óóãóóë ñóóðüøìàë, õÿçãààðëàãäìàë(èçîëÿò) õ¿í àìûí äóíä ºâ÷ëºë ºíäºð äàâòàìæòàé áàéãàà íü ýìãýã


ãåí íºõºí ¿ðæèõ¿éí çàìààð ò¿ãýí äýëãýðýõ áîëîí õ¿í àìûí öóñ îéðòîëò áîëîõ áîëîìæ ºíäºð áàéõ íü ãýæ ÌÓª ¿¿ñýõ íýã ýðñäýëò õ¿÷èí ç¿éë áîëîõ ¿íäýñëýëòýé áàéíà.

Íîì ç¿é

1. Ä.Áààñàíæàâ,ß.Ýðäýíý÷èìýã, Á.Îþóíãýðýë, Ò.Ñàðàíöýöýã, Ï.Ñî¸ëìàà, Ä.Áîëîðìàà, Ýðäýíýöýöýã, Íÿìààõ¿¿.“ÓÁ õîòûí õ¿í àìûí äóíäàõ ÌÓª-íèé á¿òýö òàðõàëò” //ÌÀÓ ñýòã¿¿ë, 2005, №4, õ.11-13

2. Ä.Áààñàíæàâ. ß.Ýðäýíý÷èìýã, Á.Îþóíãýðýë, Ò.Ñàðàíöýöýã, Ï.Ñî¸ëìàà, Ä.Áîëîðìàà.Ö.Îþóíãýðýë. “Äîðíîä àéìãèéí õ¿í àìûí äóíäàõ ÌÓª-í¿¿ä, òýäãýýðèéí òàðõàëò, á¿òýö, çàðèì îíöëîã” //ÌÀÓ ñýòã¿¿ë, 2006, №2, (136) õ.10-13

3. Ä.Áààñàíæàâ, ß.Ýðäýíý÷èìýã, Á.Îþóíãýðýë, Ò.Ñàðàíöýöýã, Ï.Ñî¸ëìàà, Ä.Áîëîðìàà, Ýðäýíýöýöýã, Íÿìààõ¿¿. “Õîâä àéìãèéí õ¿í àìûí äóíäàõ ÌÓª, áîëîí óäàìøëûí çàðèì õàìøèíæ¿¿ä òýäãýýðèéí òàðõàëò” //ÌÀÓ ñýòã¿¿ë, 2005, №4, (134) õ.14-17

4. Ä.Áààñàíæàâ, ß.Ýðäýíý÷èìýã, Á.Îþóíãýðýë, Ò.Ñàðàíöýöýã, Ï.Ñî¸ëìàà, Ä.Áóìàþóø, Ä.Îþóí÷óëóóí, Á.ªíºðöýöýã, Á.È÷èíõîðëîî. “Õºâñãºë, ªìíºãîâü, Óâñ àéìãóóäûí õ¿í àìûí äóíä ÌÓª-íèé á¿òýö, òàðõàëò” //ÌÀÓ ñýòã¿¿ë, 2008, №4, (146) õ.36-42

5. Ä.Áààñàíæàâ, ß.Ýðäýíý÷èìýã, Á.Îþóíãýðýë, Ò.Ñàðàíöýöýã, Á.×èìýãëõàì, Á.Õàíäñ¿ðýí “Ìîíãîë îðíû õ¿í àìûí äóíäàõ ãýð á¿ëèéí áóþó óäàìøëûí äîîä ìº÷íèé õºø¿¿í õîñ ñàà ºâ÷íèé òàðõàëòûí áàéäàë” //ÌÀÓ ñýòã¿¿ë, 2011, №1, (155) õ.23-26

6. Ä.Áààñàíæàâ, ß.Ýðäýíý÷èìýã, Á.Îþóíãýðýë, Ò.Ñàðàíöýöýã, Á.×èìýãëõàì, Á.Õàíäñ¿ðýí. “Ìîíãîë îðíû õ¿í àìûí äóíäàõ óäàìøëûí ìèîòîíèéí äèñòðîôè ºâ÷íèé òàðõàëòûí òºâøèí, ýìíýëç¿éí çàðèì îíöëîã” //ÌÀÓ ñýòã¿¿ë, 2011, №1, (155),õ.19-22

7. Ä.Áààñàíæàâ, ß.Ýðäýíý÷èìýã, Á.Îþóíãýðýë, Ò.Ñàðàíöýöýã, Á.×èìýãëõàì, Á.Õàíäñ¿ðýí. “Ìîíãîë îðíû õºäººãèéí õ¿í àìûí äóíäàõ ìýäðýëèéí óäàìøëûí ºâ÷íèé (ÌÓª) á¿òýö, òàðõàëò” //ÌÀÓ ñýòã¿¿ë, 2010, №2, (154) õ.24-30

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16. European Federation of neurological societies. Paris, September 4-7, 2004,V 11, supplem.2 p 1510, p165

Òàíèëöàæ, íèéòëýõ ñàíàë ºãñºí: Àíàãààõ óõààíû äîêòîð, ïðîôåññîð

Ã.Öàãààíõ¿¿


Ç¿ðõíèé ýëáýã òîõèîëääîã òºðºëõèéí ãàæãóóäûã õàðèóöäàã ãåí¿¿äèéí äíê-èéí íóêëåîòèäèéí äàðààëëûã ìîëåêóë ãåíåòèêèéí íàðèéí àðãûã àøèãëàí òàéëæ óíøèí,

ãåíåòèêèéí øàëòãààíòàé ç¿ðõíèé ãàæèã ¿¿ñýõ ìàãàäëàëûã ñóäàëñàí ä¿í

Í.Áààñàíæàâ, Ë.Ñîäíîìöîãò, Ä.Ï¿ðýâñ¿ðýí, Ö.Áàäàìñýä,Á.Ñîäãýðýë, ×.Òºâæàðãàë, Ì.À÷èòìàà

Àêàäåìè÷ Ò.Øàãäàðñ¿ðýíãèéí íýðýìæèò Àíàãààõ óõààíû õ¿ðýýëýí

To determine the probability of developing heart defect seguence method that degects seguence in dna nucleotide of responsible genes for most common heart defects

N.Baasanjav, L.Sodnomtsogt, D.Purevsuren, Ts.Badamsed,B.Sodgerel, Ch.Tuvjargal, M.Achitmaa

Institute of Medical Sciences T.Shagdarsuren

BackgroundCongenital heart defects (CHD) turn out to be the leading cause of infant mortality in their first year after infectious diseases. Per 1,000 infants, born with CHD, about 19-75 failed to survive. It reveals the fact that CHD is a major cause of childhood mortality in worldwide. Beyond the progress of medicine and surgery, the cause of CHD is not fully defined. The majority of studies reveal that CHD is triggered by many factors, such as the genetic and environmental factors.

Based on the evidences of the sequence of the human genome and advances in molecular technology, genetic factors play a major role. Per 100 newborninfants, they’re found one child, born with a CHD is concerned as a highly frequent incident for birth anomaly. Only 0.5% of these congenital defects enable to be inherited in accordance with Mendel’s genetic laws, which is associated with the change and mutation of a single gene. Many found that most congenital anomalies depend upon mutation or change in multiple genes and other relevant factors. As a result of the progressive development of molecular biology in the past 20 years discovered a range of genes involved in fetus formation, development, growth and control of processes. In our country case, corrective surgery for CHD dominates among all cardiovascular surgery in Mongolia. Particularly, for all incidents done some corrective surgery of congenital heart defects, atrial septal defect operation occupies 42.44%, in other word it is a substantial part of the CHDoperation (D.Tsegeenjav, 2009). Molecular genetics study of infant born with heart defects and simultaneous anomaly of other organ system research still has not been done for Mongolian population. In many cases the diagnosis of CHD is delayed until their adulthood, which is a research gap to address without further delay and the finding must be applied in practice in the near future.

GoalThe aim of the research is to conduct a molecular genetic study of children, born with CHD and combined abnormalities of other organs and systems, identify gene lesion, location and characteristics of mutations, pathogenetic mechanism of congenital defects and anomalies among the Mongolian population.

ResultFor this study, there are 118 patients, with congenital heart disease, received surgical treatment in the cardiovascular department of III central state hospital named P.N. Shastin, involved after confirmed diagnosis through objective and instrumental investigations (ECG, Fluoroscopy, EchoKG). The 118 healthy family members of patients sampled as a control group. According to the diagnosis of patients with congenital heart defect, such as atrial septal defects-95 (81.2% ± 3.6), ventricular septal defects-17 (14.5% ± 3.3), patent ductusarteriosus- 2 (1.7± 0 .0%) have combined severe defects - 4 (3.3% ± 1.0). Out of 118 patients with congenital heart defects, 32.2% (38 patients) was male, whereas women accounted for 67.8% (80 patients) with average age of 22, 3 ± 12.9 (minimum 1.0 year, maximum 51 year). These comprised 42.4% in 1-17 years old (average age 10 ± 5.27) and 57.6% in 18-51 years old (average age 31 ± 9.54). The 33.9% ± 4.4 (40 patients) of


operated patients responded the questionnaire that they have a hereditary heart defect. Shortness of breath, heart pain, and recurrent pneumonia were the main complaints of patients with CHD that significantly authentic to statistical probability. From the taken 118 blood samples, 95 were diagnosed ASD, in 7 diagnosed VSD, in 2 diagnosed PDA, in 4 diagnosed combined defects. For the 95 samples, we decided to examine the ASD associated GATA4, TBX5gene. It draws attention to the fact that 81.2% of all congenital heart defects found only ASD. To examine the ASD genes in the sample, the following changes have occurred. The study found 8 variants of mutations forming ASD. It includes on exon 1 Gly 93 Ala (c.278G> C), on exon 1 P163S (c.487C>T).

Conclusions:1. Patients with ASD alone occupy 81,2% of all heart defects in our study. 2. For the samples of ASD, the study found 8 different mutations of GATA4.3. In the sample of blood not found TBX5 gene mutation. 4. In the samples, one patient with dextrocardiasitusinvertus was combined with congenital heart defects found E359Xfs (c.1075delG) deletion variation on exon3.

Key words: ASD, GATA4, heart, defects, congenital

Pp.18-24, Figures 15, References 20

ÎðøèëÇ¿ðõíèé òºðºëõèéí ãàæèã (ÇÒÃ) íü òºðñíèé äàðààõ ýõíèé æèëä õàëäâàðò ºâ÷í¿¿äýýñ ãàäíà õ¿¿õäèéí íàñ áàðàëòûí òýðã¿¿ëýõ øàëòãààí áîëäîã (J.I.Hoffman áà áóñàä., 2002). Òîõèîëäîë íü àìüä òºðñºí 1000 õ¿¿õýä òóòàìä 19 - 75 áàéãàà áà ¿ð çóëáàëòûí èõýíõ õóâèéã ýçýëæ áàéãàà íü ÇÒÃ äýëõèé äàõèíä õ¿¿õýä íàñíû ºâ÷ëºë, ýíäýãäëèéí ãîëëîõ øàëòãààí ãýäãèéã õàðóóëæ áàéíà (B.G.Bruneau áà áóñàä, 2008).Àíàãààõ óõààíû îëîëò áà ìýñ çàñëûí äýâøèëòýò àõèöààñ ¿ë õàìààðàí ÇÒÃ-èéí øàëòãààí îäîîã õ¿ðòýë á¿ðýí òàéëáàðëàãäààã¿é áàéíà. Õ¿íèé ãåíîìûí äàðààëàë áà ìîëåêóë òåõíîëîãèéí îëîëò àìæèëò íü ÇÒÃ-ò óäàìøëûí õ¿÷èí ç¿éë ãîëëîõ áàéð ñóóðü ýçýëæ áàéãààã õàðóóëñààð áàéíà. Èõýíõ ñóäëàà÷èä ÇÒÃ íü ãåíåòèêèéí áîëîîä õ¿ðýýëýí áóé îð÷íû íºëºº çýðýã îëîí õ¿÷èí ç¿éëýýñ õàìààðàëòàé ãýæ ¿çäýã. ÇÒÃ íü óäàìøëûí, õ¿ðýýëýí áàéãàà îð÷íû íºëººëºë çýðýã îëîí õ¿÷èí ç¿éëýýñ õàìààðäàã áîëîõûã Áàëòèìîð-Âàøèíãòîíû íÿðàé ñóäëàë áîëîí áóñàä ñîíãîäîã ñóäàëãààíóóä îëæ òîãòîîãîîä áàéãàà þì (C.Ferencz áà áóñàä,1993). ªíãºðñºí õàãàñ çóóíä õ¿¿õäèéí ç¿ðõíèé ºâ÷íèé òîõèîëäîëä óäàìøëûí ¿ð íºëººëëèéí ýðñäýë ºíäºð áàéñíûã îëîí òîîíû æèøýýãýýð õàðóóëñàí. ÇÒÃ-òàé òºðñºí èõýíõ õ¿¿õä¿¿äýä áóñàä ãàæ õºãæèë áàéäàãã¿é áàéõàä õàðèí ÇÒÃ áóñàä ãàæ õºãæèëòýé õàâñàðñàí áóþó õàì øèíæ òàíèãäñàí õýñýã íü 25-40%-èéã ýçýëäýã (D.Bernstein áà áóñàä, 2004). Ñóäàëãààãààð NKX2.5 ìóòàöè òîñãóóð-õîâäëûí äàìæóóëàëòûí óðòñàëòòàé äàí òîñãóóðûí òàñëàâ÷èéí ãàæèã ¿¿ñãýäýã áîëîõûã õàðóóëñàí (Schott J.J. et al.,1998). GATA4 ìóòàöè NKX2.5-

òàé õàðèëöàí ¿éë÷ëýëöýæ ÀÂ äàìæóóëàëòûí óðòñàëòã¿é äàí òîñãóóðûí òàñëàâ÷èéí ãàæèã ¿¿ñãýäýã. Ìºí GATA4 ìóòàöè TBX5-òàé õàðèëöàí ¿éë÷ëýëöýæ ÇÒÃ ¿¿ñãýäýã. MYH6 ìóòàöè òîñãóóðûí òàñëàâ÷èéí ãàæãèéí áàñ íýã øàëòãààí áîëæ áàéäàã (Y.H.Ching áà áóñàä, 2005). MYH6 íü TBX5 áà GATA4-ð èäýâõæèæ, ç¿ðõíèé òàñëàâ÷èéí ãàæãèéí øàëòãààí áîëäîã.

ÇîðèëãîÇ¿ðõíèé ýëáýã òîõèîëääîã òºðºëõèéí ãàãóóäûã õàðèóöäàã ãåí¿¿äèéí ÄÕÊ-èéí íóêëåîòèäèéí äàðààëëûã ìîëåêóëü ãåíåòèêèéí íàðèéí àðãûã àøèãëàí òàéëæ óíøèí, ãåíåòèêèéí øàëòãààíòàé ç¿ðõíèé ãàæèã ¿¿ñýõ ìàãàäëàëûã ñóäëàõàä ñóäàëãààíû àæëûí çîðèëãî îðøèíî.

Ìàòåðèàë, àðãà ç¿é Íèéò ç¿ðõíèé òºðºëõèéí ãàæèãòàé 118 ºâ÷òºí áîëîí òýäíèé ãýð á¿ëèéí ýð¿¿ë 118 ãèø¿¿äèéã õÿíàëòûí á¿ëýã áîëãîí ñóäàëãààíä õàìðóóëñàí. Õÿíàëòûí á¿ëýã áîëîõ ãýð á¿ëèéí 662 ãèø¿¿äèéã ç¿ðõíèé òºðºëõèéí ãàæèã èëð¿¿ëýõ ç¿ðõíèé öàõèëãààí áè÷ëýã, ç¿ðõíèé ÝÕÎÊÃ, ðåíòãåí øèíæèëãýý, ç¿ðõ ñóäàñíû ýì÷èéí ¿çëýãò õàìðóóëñàí.

ÀÓÕ áîëîí ÕÁÍÃÓ-í Ëåéïöåã, Õàëëå õîòûí Óäàìç¿éí õ¿ðýýëýí õàìòûí àæèëëàãààíû ãýðýýíèé õ¿ðýýíä òóñ õ¿ðýýëýíãèéí ìîëåêóë áèîëîãèéí ëàáîðàòîðèä íèéò 236 õ¿íèéã ñîíãîí àâ÷ ¸ñ ç¿éí çºâøººðºë àâñíû ¿íäñýí äýýð òóñ á¿ð 4.0 ìë –ýýð 2 óäàà íèéò 8.0 ìë öóñ àâ÷ ÄÍÕ-ã ÿëãàæ óóðãèéí äàðààëëûã òîãòîîõ øèíæèëãýýã õèéñýí.


¯ð ä¿íÇÒÃ-òàé ºâ÷òí¿¿äèéã îíîøîîð íü àâ÷ ¿çâýë òîñãóóð õîîðîíäûí òàñëàâ÷èéí õî¸ðäîã÷ öîîðõîé 95 (81.2%±3.6), õîâäîë õîîðîíäûí òàñëàâ÷èéí öîîðõîé 17(14.5%±3.3), àðòåðèéí áèò¿¿ðýýã¿é öîðãî 2 ( 1,7 % ± 0 .0), õàâñàðñàí õ¿íä ãàæèã 4 (3.3 % ± 1,0 ) áàéëàà .

ÇÒÃ-òàé 118 ºâ÷òí¿¿äýýñ ýðýãòýé íü 32.2% (38 õ¿í), ýìýãòýé íü 67.8% (80 õ¿í) áàéëàà ( Çóðàã 3). Äóíäàæ íàñ íü 22,3 ±12.9 (õàìãèéí áàãà íü 1.0 íàñòàé, õàìãèéí àõìàä íü 51.0 íàñòàé áàéëàà). ¯¿íýýñ, 42.4 % íü 1-17 íàñòàé (äóíäàæ íàñ 10 ± 5.27 ), 57.6 % íü 18-51 íàñ (äóíäàæ íàñ 31± 9.54)

Ñóäàëãààíä õàìðàãñäûã ãàçàð ç¿éí áàéðøëààð íü ñóäëaõàä Óëààíáààòàð õîòîîñ 36.4%, áàðóóí á¿ñ - 20%, òºâèéí á¿ñ - 20%, ç¿¿í á¿ñ - 8%, õàíãàéí á¿ñ - 16% ýçëýæ áàéíà. ÇÒÃ-òàé ºâ÷òí¿¿äèéí àìüñãààäàõ, ç¿ðõýýð ºâäºõ áà óóøèãíû ¿ðýâñëýýð äàâòàí ºâäºõ ãýñýí çîâèóð äàâàìãàéëæ áàéñàí (p< 0.05).

Ç¿ðõíèé õýò àâèàí øèíæèëãýý (äîïïëåð). Ç¿ðõíèé õýò àâèàí øèíæèëãýýãýýð òàñëàâ÷èéí öîîðõîéí 29.3% íü 1.1 ñì-ýýñ áàãà, 40,2% íü 1.1- 2.0 ñì, 2.1-3.0 ñì íü 25.6%, 3.1-4.0 ñì íü 4.9% òóñ òóñ áàéíà. Öîîðõîéí äóíäàæ õýìæýý íü 2.1 ± 0.75 ñì (0.5-3.5 ñì).

Ç¿ðõíèé õýò àâèàí äîïëëåð øèíæèëãýýãýýð óóøèãíû àðòåðèéí äàðàëòûí (SPAP) äóíäàæ íü 43.3±15.3 ì.ó.á (15.5–75 ì.ó.á.) áàéñàí. ¯¿íýýñ, õºíãºí çýðãèéí óóøèãíû àðòåðèéí ãèïåðòåíçè íü 27.8 %, äóíä çýðãèéí–55.6%, õ¿íä çýðãèéí–16.7% ýçëýæ áàéíà.

Ìýñ çàñëûí ýì÷èëãýý:Á¿õ ºâ÷òºí¿¿ä öóñíû çîõèîìîë ýðãýëòèéí íºõöºëä öîîðõîéã íºõºõ ìýñ çàñëûí ýì÷èëãýý õèéëãýñýí. Ìýñ çàñëûí ýì÷èëãýý õèéëãýñýí ºâ÷òíèé33.9% ± 4.4 íü (40 õ¿í) ãàæãèéí óäàìøèëòàé ãýæ õàðèóëñàí. Ñîðüö 169: GATA 4 ãåíèéí 1-ð ýêçîíû 487-ð ëîêóñûí ÒÀÄ2 õýñãèéí 163 äàõü àìèíõ¿÷ëèéí áàéðëàë äàõü òóéëæààã¿é Ïðîëèí àìèíõ¿÷èë íü òóéëæñàí Ñåðèí àìèíõ¿÷ëýýð ñîëèãäñîíîîñ òðàíñêðèïöèéí ïðîöåññ ñààòñàíòàé õîëáîîòîé òàñëàâ÷ õîîðîíäûí öîîðõîé ¿¿ñýõ íºõöºë á¿ðääýã áàéíà. Ïðîëèí íü ýññåíöåëü áèø, ãèäðîôîá øèíæ ÷àíàðòàé, ôåíîëûí öàãèðàã àãóóëñàí àìèíõ¿÷èë áºãººä õàðèí ñåðèí íü ýññåíöåëü áèø àììîíèéí ãðóïï á¿õèé àìèí õ¿÷èë þì. Á¿òöèéí õóâüä ººð àìèí õ¿÷ë¿¿ä ñîëèãäîæ ººð÷ëºãäñºíººñ ¿¿äýí äýýðõ ãàæèã ¿¿ññýí. Ýíý

ÇÒÃ íü òðàíñêðèïöèéí ïðîöåññèéí èäýõæ¿¿ëýã÷ ôàêòîðûí ¿éë àæèëëãààíû ººð÷ëºëòòýé õîëáîîòîé. Ìàíàé îðîíä òîõèîëäîæ áàéãàà ÒÕÒÖ íü çºâõºí GATA4 ãåíèéí ººð÷ëºëòèéí ä¿íä èëýð÷ áàéãàà íü ºâºðìºö þì.

Ñîðüö 0013: CATA4 ãåíèéí 1 ýêñîíû ÒÀÄ1 õýñãèéí 278 äàõü ëîêóñûí 93 äàõü áàéðëàëä ãëèöèí íü àëàíèí àìèíõ¿÷ëýýð ñîëèãäñîíîîñ òðàíñêðèïöèéí ïðîöåññèéã èäýâõæ¿¿ëýã÷ äîìåíèé ¿éë àæèëëãàà ñààòñíààñ ÇÒÃ ¿¿ñýõ íºõöºë á¿ðäñýí áàéíà. Ãëèöèí àìèí õ¿÷èë íü ýññåíöåëü áèø, õèìèéí á¿òöèéí õóâüä ýíãèéí áèåìàõáîäèä íèéëýãæäýã, óóðãèéí á¿òöýä ÷óõàë ¿¿ðýãòýé õèðàë á¿òýö àãóóëààã¿é, ãèäðîôèëü øèíæ ÷àíàðòàé àìèíõ¿÷èë þì. Àëàíèí íü õèéí á¿òöèéí õóâüä õèðàë á¿òýöòýé ýññåöåëü, ãèäðîôîá àìèíõ¿÷èë þì

Figure 1. Prolin and Serin aminoacid

Subject ¹169

ASD

Blood sample taken

Figure 2. Pedigree chart of patient with ASD

Figure 3. Glycin and Alanin aminoacid



Ñîðüö 113: Áàðóóí òàëäàà ç¿ðõòýé ºâ÷òºíä E359X (c.1075delG) äåëåöè èëýðñýí áºãººä ýíýõ¿¿ ººð÷ëºëò íü ãàòà 4 ãåíèéí 3 ýêçîíû Ñ òåðìèíàëü öèíê ôèíãåð äîìåíèéí 1075 äàõü ëîêóñò ãóàíèíû ºìíºõ òðèïëåò õàÿãäñàíààñ ìýäýýäýë àãóóëñàí ìýäýýëëèéí ìÐÍÕ á¿ðýí áèø ìýäýýëýë õóóëáàðëàãäàæ ýñèéí áººìä äàìæñàíòàé õîëáîãäîí ýìáðèîãåíåçèéí ¿åä áóðóó áàéðëàëä ¿¿äýë ýñ¿¿ä áàéðøèõ áîëîí ç¿ðõíèé áóñàä õàâñàðñàí ãàæãóóä ¿¿ñýõ ìàãàäëàëòàé þì. ¯¿íèéã öààø íàðèéâ÷ëàí ñóäëàõ øààðäëàãàòàé.

Ñîðüö 110: GATA 4 ãåíèéí 3 ýêçîí äýýð Ñ òåðìèíàëü öèíê ôèíãåð äîìåíèéí 886ëîêóñûí 296 äàõü àìèíõ¿÷èë áàéðëàëä ãëèöèí íü öèñòåéíýýð ñîëèãäñîí áàéíà. Äýýð äóðäñàí÷ëàí ãëèöèí íü ýññåíöåëü áèø, õèìèéí á¿òöèéí õóâüä ýíãèéí áèåìàõáîäèä íèéëýãæäýã, óóðãèéí á¿òöýä ÷óõàë ¿¿ðýãòýé õèðàë á¿òýö àãóóëààã¿é, ãèäðîôèëü øèíæ ÷àíàðòàé àìèíõ¿÷èë þì. Öèñòåéí íü õàæóóãèéí õýëõýýíäýý õ¿õýð àãóóëñàí áà èñýëäýëòèéí ¿åä äèñóëüôèäèéí ã¿¿ðèéã ¿¿ñãýí õîëáîãääîã ýëãýíä íèéëýãæäýã, ãèäðîôèëü àìèí õ¿÷èë þì. ªºð õîîðîíäîî ÿëãààòàé àìèí õ¿÷èë ñîëèãäñîíîîñ òðàíñêðèïöèéí (õóóëáàðëàõ) òºãñãºë øàòàíä íºëººëºõ ôàêòîðóóäûí ººð÷ëºëòººñ ¿¿äýí äýýðõ ÇÒÃ ¿¿ñýõ áîëîìæòîé

Ñîðüö 145: GATA 4 ãåíèéí 3 ýêçîí äýýð Ñ òåðìèíàëü öèíê ôèíãåð äîìåíèéí 886ëîêóñûí 296 äàõü àìèíõ¿÷èë áàéðëàëä ãëèöèí íü àëàíèí àìèí õ¿÷ëýýð ñîëèãäñîíòîé õîëáîîòîéãîîð ÇÒÃ ¿¿ññýí. Ñîëèãäñîí àëàíèí íü õèéí á¿òöèéí õóâüä õèðàë á¿òýöòýé ýññåíöåëü, ãèäðîôîá àìèíõ¿÷èë. Öèñòåéí íü õàæóóãèéí õýëõýýíäýý õ¿õýð àãóóëñàí áà èñýëäýëòèéí ¿åä äèñóëüôèäèéí ã¿¿ðèéã ¿¿ñãýí õîëáîãääîã ýëãýíä íèéëýãæäýã, ãèäðîôèëü àìèí õ¿÷èë þì. ªºð õîîðîíäîî ÿëãààòàé àìèí õ¿÷èë ñîëèãäñîíîîñ òðàíñêðèïöèéí (õóóëáàðëàõ) òºãñãºë øàòàíä íºëººëºõ ôàêòîðóóäûí ººð÷ëºëòººñ ¿¿äýí äýýðõ ÇÒÃ ¿¿ñýõ áîëîìæòîé.

Ñîðüö 122: GATA 4 ãåíèéí 4 ýêçîí äýýð áººì ð¿¿ òºâëºðñºí äîìåíèéí õýñãèéí 946 äàõü ëîêóñ äàõü 316 àìèíõ¿÷ëèéí áàéðëàëä ãëþòàìèí íü ãëþòàìèíû õ¿÷ëýýð ñîëèãäñîí. Ãëþòàìèí íü ýññåíöåëü áèø, àìèíîãðóïïèéí äîíîðûí ¿¿ðãèéã ã¿éöýòãýäýã, ãèäðîôèëü àìèí õ¿÷èë áºãººä ãëþòàìèíû õ¿÷èë íü ýíàíòèîìåð á¿òýöòýé ãèäðîêñèë ãðóïïèéí àãóóëàìæ ºíäºð, õ¿÷èëëýã àìèíõ¿÷èë þì. Ýíý õýñýãò àìèíõ¿÷èë ñîëèãäñîíîîñ óóðãèéí ìýäýýëýë àãóóëñàí ìÐÍÕ-èéí áººì ð¿¿ øèëæèõ ïðîöåññ ñààòñàíòàé õîëáîòîéãîîð ÇÒÃ ¿¿ñýõ ìàãàäëàë ºíäºð þì.

Subject ¹113

1 y dead

DEXTROCARDIA. CHD

blood sample taken

Figure 5. Pedigree chart of patient with Dextrocardia CHD

Figure 6. Glycin and Cystein aminoacid

Subject ¹110

ASD

Blood sample taken


Figure 8. Glycin and Alanin aminoacid

Subject ¹145

ASD

Blood sample taken


Fugure 10. Glutamin and Glutamat aminoacid

Subject ¹122

ASD

Blood sample taken



Ñîðüö 161: ÃÀÒÀ4 ãåíèéí 6 ýêçîíû 1232 ëîêóñä àëàíèí âàëèíààð ñîëèãäñîí ººð÷ëºëòèéã òîãòîîñîí. Àëàíèí íü õèéí á¿òöèéí õóâüä õèðàë á¿òýöòýé ýññåíöåëü, àìèíõ¿÷èë, âàëèí íü ýññåíöåëü ãèäðîôîá àìèí õ¿÷èë.

Ñîðüö 140: 6 ýêçîí äýýð 1273 äàõü ëîêóñûí 425 áàéðëàëä àñïàðãèíû õ¿÷èë íü àñïàðãèíààð ñîëèãäñîíûã îëæ òîãòîîñîí.

Õýëöýìæ: GATA4 áîëîí TBX5 ãåíèéí òðàíñôàêòîðûí õîîðîíäûí õàðèëöàí ¿éë÷ëýëèéã G296S ìóòàöè íü òàñëàí çîãñîîäîã. TBX5 ãåíèé ìóòàöè íü GATA4, TBX5 ãåí¿¿äèéí õîîðîíäûí õàðèëöàí ¿éë÷ëýëèéã ñààòóóëæ äàí ç¿ðõíèé òàñëàâ÷èéí öîîðõîé ¿¿ñãýõ øàëòãààí áîëäîã (Garg et al., 2003). Õ¿íä ÇÒÃ-òàé 16 íàñòàé îõèíû öóñàíä GATA4 ãåíèéí ººð÷ëºëò 8p23.1 õðîìîñîìä èëýðñýí. Ýöýãò íü ìºí ãåíèéí ººð÷ëºëò èëýðñýí áîëîâ÷ õºíãºí ÿâöòàé

ÇÒÃ îíîøëîãäñîí (Kennedy et al., 2001). ÇÒÃ îíîøëîãäñîí íýã ãýð á¿ëèéí 5 ¿åèéí 16 ãèø¿¿íä GATA4 ãåíèéí G296S ìóòàöè íºëººëñºí áîëîõûã òîäîðóóëñàí.Á¿õ ãèø¿¿äýä ÒÕÒÖ èëýðñýí. Ìºí 8 ãèø¿¿íä õàâñàðñàí ÕÕÒÖ, àíõäàã÷ ÒÕÒÖ, óóøèãíû õàâõëàãûí íàðèéñàë, ç¿ðõíèé õàâõëàãûí äóòàãäàë èëýðñýí. Õàðèí ç¿ðõíèé äàìæóóëàõ ñèñòåìèéí áîëîí áóñàä ýðõòýíèé ãàæèã èëðýýã¿é. Ç¿ðõíèé òàñëàâ÷èéí öîîðõîé áîëîí õàâõëàãûí ãàæèãòàé 628 ºâ÷òºíèé 5-ä íü GATA4 ãåíèéã 4 òºðëèéí õîîðîíäûí õàìààðàëã¿é äàðààëëóóäûã èëð¿¿ëñýí. Òýäíèé íýã íü Ôàëëîãèéí äºðâºëòýé áàéñàí. Ñóäàëãààíû ä¿íä GATA4 ãåíèéí ìóòàöè òàñëàâ÷èéí ãàæèãòàé ºâ÷òºí¿¿äýä õîâîð èëýðäãèéã òîäîðõîéëñîí (Tomita-Mitchell et al., 2007). GATA4 ãåíèéí ìóòàöèòàé 107 õóëãàíûã õàìðóóëñàí ñóäàëãààíä ãåòåðîçèãîò õîîðîíäîî õàìààã¿é 4 ºâ÷òºíã òîäðóóëñàí. ÒÕÒÖ-òîé 8 ºâ÷òºíèé 1(12,5%), ç¿ðõíèé õàâõëàãûí ãàæèãòàé 43 ºâ÷òºíèé 2 (4.8%), ç¿ðõíèé áàðóóí õîâäëûí ãèïîïëàçèòàé 9 ºâ÷òºíèé 1 (11.1%) îíîøëîãäñîí. Ç¿ðõíèé êàðäèîìèîïàòèòàé 48 ºâ÷òºíä ìóòàöè èëðýýã¿é áàéíà (Rajagopal et al.,2007). ÇÒÃ-òàé 486 õÿòàä ºâ÷òºíèé öóñàíä GATA4 ãåíèéí øèíæèëãýý õèéõýä 12 ºâ÷òºíä 9 ãåòåðîçèãîò ìóòàöè èëýðñýí. ¯¿íä: ÕÕÒÖ-òîé 319 ºâ÷òºíèé 9 (2.8%), Ôàëëîãèéí äºðâºëòýé 64 ºâ÷òºíèé 2 (3.1%), õàâõëàãûí ãàæèãòàé 11 ºâ÷òºíèé 1 (9.1%) áàéñàí. Òýäýíä äàìæóóëàõ ñèñòåìèéí ººð÷ëºëò èëðýýã¿é ( Zhang et al., 2008).

Óäàìøëûí áóñ ÇÒÃ-òàé 135 õÿòàä õ¿¿õä¿¿äýä GATA4 ãåíèéí ìóòàöèéí øèíæèëãýýã õèéõýä 2 ãåòåðîçèãîò ìóòàöè èëýðñýí. ¯¿íä: 1 Ôàëëîãèéí äºðâºëñºí ãàæèã, 1 ÕÕÒÖ-òîé ºâ÷òºí áàéñàí (Peng et al., 2010).

Õÿòàäûí íýã ãýð á¿ëèéí 3 ¿åèéã õàìðóóëàí GATA4 ãåíèéã ñóäëàõàä ãåòåðîçèãîò ìóòàöè èëýðñýí. Òýäíèé äóíä àóòîñîì äîìèíàíò ÒÕÒÖ áîëîí óóøèãíû àðòåðèéí íàðèéñàëò òîäîðõîéëîãäîíî. Ñóäàëãààíä ÇÒÃ-òàé 30 (10 ÒÕÒÖ, 10 ÕÕÒÖ, 8 ÒÕÒÖ áîëîí ÕÕÒÖ õàâñàðñàí, 2 àíõäàã÷ ÒÕÒÖ)-òîé ºâ÷òºíä GATA4 ãåíèéí øèíæèëãýý õèéõýä ìóòàöè èëðýýã¿é (Chen et al., 2010). Õî¸ðäîã÷ ÒÕÒÖ îíîøëîãäñîí Õÿòàä ãýð á¿ëèéí 8 ãèø¿¿íä GATA4 ãåíèéã øèíæëýõýä ãåòåðîçèãîò ìóòàöè èëýðñýí. Ãýõäýý òîõèîëäëûí ÇÒÃ-òàé 70 ºâ÷òºíä GATA4 ãåíèéí ìóòàöè èëðýýã¿é. Òýäíèé 20 íü ÒÕÒÖ-òîé áàéñàí. Öóñàí òºðëèéí õàìààðàëã¿é ÕÕÒÖ-òîé 210 Õÿòàä ºâò÷ºíä GATA4 ãåíèéã ñóäàëñàí. Òýäíèé 45 íü õàâñàðñàí ç¿ðõíèé ãàæèãòàé áàéñàí. Õàðèí 1 ºâ÷òºíä ãåòåðîçèãîò ìóòàöè èëýðñýí. Ñóäëàà÷äûí òýìäýãëýñíýýð

Figure 12. Alanin and Valin aminoacid

Subject ¹161

ASD

Blood sample taken


Figure 14. Aspartat and Aspargin aminoacid

Subject ¹161

ASD

Blood sample taken



GATA4 ãåíèéí êîäîí 296 ìóòàöèéã ÕÕÒÖ, áóñàä ç¿ðõíèé ãàæèã, õî¸ðäîã÷ ÒÕÒÖ, óóøèãíû àðòåðèéí íàðèéñàëòàé ºâ÷òºí¿¿äýä øèíæëýõýä, gly296 íü ìóòàöè ¿¿ñãýõ ÷óõàë õ¿÷èí ç¿éë áîëäîã ãýäãèéã òîäîðõîéëñîí ( Wang et al., 2011). Õÿòàäûí ÕÕÒÖ-òîé 160 öóñàí òºðëèéí áóñ ºâ÷òºíä GATA4 ãåíèéí ýêçîí, èíòðîíû êîäûí äàðààëëûã òîäîðõîéëîõîä, 1 ºâ÷òºíä ãåòåðîçèãîò ìóòàöè èëýðñýí. 160 ºâ÷òºíèé 200 öóñàí òºðëèéí õàìààòàíã ñóäàëãààíä õàìðóóëñíààñ ìóòàöè èëðýýã¿é (Yang et al., 2012). ÒÕÒÖ îíîøòîé 95 ñîðüöîíä òîñãóóð õîîðîíäûí òàñëàâ÷èéí ãàæãèéã íºõöºëä¿¿ëýã÷ GATA4, TBX5 ãåí¿¿äèéí ñóäëàõàä çºâõºí GATA4 ãåí äýýð 8 òºðëèéí ìóòàöè ººð÷ëºëò èëýðñýí áºãººä TBX5 ãåíèéí ººð÷ëºëò îãò èëðýýã¿é. Îëîí óëñûí õýâëýëä íèéòëýãäñýíýýñ õàðàõàä ÒÕÒÖ ãàæãèéí 20-25% íü GATA4, TBX5 ãåíèéí õàâñàðñàí ººð÷ëºëòèéí ä¿íä èëýðäýã áîëîõûã òýìäýãëýñýí áàéäàã. Ìàíàé îðîíä òîõèîëäîæ áàéãàà ÒÕÒÖ íü çºâõºí GATA4 ãåíèéí ººð÷ëºëòèéí ä¿íä èëýð÷ áàéãàà íü ºâºðìºö þì. Àíõààðàë òàòñàí íýã òîõèîëäîë íü áàðóóí òàëäàà ç¿ðõòýé õàâñàðñàí òºðºëõèéí ãàæèãòàé íýã ºâ÷òºíèé ñîðüöîä GATA4 ãåíèéí ýêçîí 3 äýýð E359X (c.1075delG) äåëåöè ººð÷ëºëò èëýðñýí. Ýíý ººð÷ëºëò íü ìàø õîâîð òîõèîëääîã áºãººä ºíººãèéí áàéäëààð õýâëýëä íèéòëýãäñýíýýð 3 òîõèîëäîë Õÿòàä, ßïîí, Òàéâàíüä èëýðñýí áºãººä áàðóóí òàëäàà áàéðëàñàí ç¿ðõ, õàâñàðñàí ãàæãèéí ìîëåêóëãåíåòèêèéí ñóäàëãààã çàéëøã¿é õèéõ øààðäëàãàòàé áàéãàà þì.

Ä¿ãíýëò:

1. Ç¿ðõíèé òºðºëõèéí ãàæãèéí 81.2 õóâèéã ç¿ðõíèé òîñãóóð õîîðîíäûí òàñëàâ÷èéí öîîðõîé äàíãààðàà ýçýëæ áàéíà.

2. Ç¿ðõíèé òîñãóóð õîîðîíäûí òàñëàâ÷èéí öîîðõîé ãàæèã îíîøòîé 8 ºâ÷òºíèé ñîðüöîä GATA4 ãåíèéí 8 òºðëèéí ìóòàöè èëýðñýí.

3. Ñóäàëãààíä àâñàí ñîðüöîä TBX5 ãåíèéí ººð÷ëºëò èëðýýã¿é.

4. Áàðóóí òàëäàà ç¿ðõòýé òºðºëõèéí õàâñàðñàí ãàæèãòàé ºâ÷òºíèé ñîðüöîä GATA4 ãåíèéã ¿çýõýä ýêçîí 3 äýýð E359Xfs (c.1075delG) äåëåöè ººð÷ëºëò èëýðñýí.

Àøèãëàñàí íîì

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6. Ýðäýíý÷óëóóí Ä. ×àñòîòà ñòðóêòóðà ÂÏÑ ó äåòåé â ÌÍÐ è ïîòðåáíîñòü â ñòàöèîíàðíî-êàðäèîõèðóðãè÷åñêîé ïîìîùè. – Àâòîðåô. äèññ.êàíä.ìåä.íàóê. -ÓÁ. -1990. -21ñ.

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11. Chen, Y., Han, Z.-Q., Yan, W.-D., Tang, C.-Z., Xie, J.-Y., Chen, H., Hu, D.-Y.A novel mutation in GATA4 gene associated with dominant inherited familial atrial septal defect.J. Thorac. Cardiovasc. Surg. 140: 684-687, 2010. [PubMed: 20347099, related citations] [Full Text: HighWire Press]

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Òàíèëöàæ, íèéòëýõ ñàíàë ºãñºí: Áèîëîãèéí øèíæëýõ óõààíû äîêòîð,

äýä ïðîôåññîð Æ.Îþóíáèëýã


10 õ¿ðòýëõ íàñíû õ¿¿õäèéí äóíäàõ õºõ òîëáîíû òàðõàëò, Ìîíãîë óëñ, 2014 îí

Á.Ñóâä1, Á.Áóðìààæàâ2

1Íèéãìèéí ýð¿¿ë ìýíäèéí ¿íäýñíèé òºâ, ÀØÓ¯ÈÑ-èéí äîêòîðàíò2Ìîíãîëûí àíàãààõ óõààíû àêàäåìè, ÝÌßÝëåêòðîí øóóäàí: [email protected]

AbstractPrevalence of blue spots among

1-10 years old children, Mongolia, 2014

B.Suvd1, B.Burmaajav2

1National Center for Public Health2Mongolian Academy of Medical Sciences, MOH

E-mail: [email protected], [email protected]

BackgroundMongolian spots (MS) are congenital birthmarks seen most commonly over the lumbosacral area. They are bluish-green to black in color and oval to irregular in shape. Dermal pigmentation appears gray, greyish-blue or greyish black because these colors have a shorter wavelength and are reflected to the skin surface. The amount of melanin in the dermal melanocytes, the number of dermal melanocytes and their depth in the dermis are also important determinants of color. The Mongolian blue spots often fade in a few years and are almost always gone by adolescence.

AimThe aim of this study was to determine the frequency and characteristics of Mongolian spots in 1-10-years-old children.

Material and MethodThe study was carried out on 1000 children who were lived in Ulaanbaatar during 2013-2014. Children were carefully examined for the presence of Mongolian spots, including the hairy skin, during the systematic physical examination. If a spot was observed, localization, size, color and shape were recorded. Statistical analysis was done using SPSS-21.

Result96.8% (95%CI 95.7-97.8) of the children’s was residents of Ulaanbaatar city, 49.2% [95%CI 46.1-52.5] of boys. The color of the Mongolian spots varied from pale blue to grayish blue. The most frequently involved sites were the lumbosacral areas. There was a disappearance in the incidence of Mongolian spots with advancing age.

ConclusionThe study shows that prevalence of blue spot among children aged 1-10 years old decreased with age and blue spot tended to disappear after the age of 10.

Key words: Mongolian blue spot, birthmark, Congenital dermal melanocytosis, Mongolia

Pp.25-28, Tables 4, Figures 3, References 14

Îðøèë. A.D.A.M. Medical Encyclopedia-ä Ìîíãîë õºõ òîëáî íü àçè, ç¿¿í ýíýòõýã, àôðèê ãàðàëòàé áàðààí àðüñòàé õ¿ì¿¿ñò ò¿ãýýìýë òîõèîëääîã ãýæýý [1-5].

Ìîíãîë õºõ òîëáî íü àðüñíû ìåëàíîöèò ýñèéí áººãíºðëèéí õàìãèéí ò¿ãýýìýë õýëáýðèéí íýã þì [6].

“Ìîíãîë õ¿¿õýä ýõýýñ òºðºõäºº óóö, íóðóóíûõàà àðüñàíä õºõ òîëáîòîé òºðäºã. Õºõ òîëáî áàãà íàñíû õ¿¿õäýä àæèãëàãääàã, òºðñíèé äàðààõ õî¸ð áà ãóðàâ äàõü õîíîãîîñ èëýðäýã. 12-24 ñàðûí äàðàà àðèëæ, ìàø õîâîð òîõèîëäîëä íàñàíä õ¿ðñýí õ¿íä á¿äýãõýí ¿ëäñýí áàéäàã”

ãýæýý [7].


Ìîíãîë õºõ òîëáî íü òºðºëõèéí òýìäýã áºãººä áèåèéí óóö á¿ñýëõèé õýñãýýð áàéðëàäàã. Áèåèéí òàëáàéí < 5 õóâèéã ýçëýí íýã ò¿¿íýýñ îëîí õýñýãòýé, õýìæýýíèé õóâüä ìàø áàãààñ 20 ñì õ¿ðòýë óðò õýìæýýòýé áàéäàã. ßìàð íýãýí ýì÷èëãýý õýðýãã¿é ÷ ñ¿¿ëèéí ¿åä áîäèñûí ñîëèëöîîíû ýìãýãòýé õîëáîîòîé áàéæ áîëîõûã ñóäàëñàí áàéíà [8].

“Ìîíãîë õºõ òîëáî” íü õÿçãààðëàãäìàë äóãóé áà çóóâàí õýëáýðòýé, óóö-á¿ñýëõèé áîëîí íóðóó-ãóÿ îð÷èìä áàéõ æèãäõýí õºõºëáèé ñààðàë áóþó õ¿ðýí ºíãºòýé òîëáî áºãººä ýíý íü 1-2 ñì áà ¿¿íýýñ ÷ áàãà õýìæýýòýéãýýð èëýðäýã” ãýæ Braun-Falco O, Plewig G, Wolff HH, Burgdorf WH íàðûí ñóäëàà÷èä ¿çñýí áàéíà [9]. Ãýòýë ýðäýìòýí Silengo M, Battistoni G, Spada M íàð “Òºðºõºä ìààíü áàéäàã õºõ òîëáî àðèëàí àëãà áîëäîã áóñ àðâàí íàñ õ¿ðýõýä áèäíèé öóñàíä øèíãýæ, áèåýð òàðæ ýð÷ õ¿÷, ýð çîðèã, îþóí óõààíû ýð÷èì õ¿÷ ýíåðãè áîëäîã. Ýíý òîëáî íü òºðñíèé äàðàà ãàðàõ, ýñâýë ãàðñíû äàðàà òîìðîõ íü ìàø õîâîð, àðàâ þì óó àðâàí íýãýí íàñàíä íü æèë îðîõ, àðâàí ãóðàâíû àãò àðàà óðãàõààñ ºìíºõºí àðèë÷èõäàã òóë áàéíãûí òýìäýã ãýõýä õýö¿¿” ãýñýí áàéíà [10].

Çîðèëãî. Ìîíãîë õºõ òîëáîíû òàðõàëòûã 1-10 íàñíû õ¿¿õäèéí äóíä òîãòîîæ óëìààð òîëáî õýäýí íàñàíäàà àðèëæ áàéãààã òîäîðõîéëîõ

Ìàòåðèàë àðãàç¿é. Ñóäàëãààã íýãýí àãøèíãèéí çàãâàðààð óðüä÷èëàí áîëîâñðóóëñàí àñóóìæ áîëîí àðüñíû ¿çëýã õèéæ ñóäàëñàí. Ñóäàëãààíû çîðèëòîò õ¿í àì 1-10 íàñíû õ¿¿õýä áºãººä íàñíû á¿ëýã òóñ á¿ðýýñ 100, íèéò 1000 õ¿¿õäèéã ñàíàìñàðã¿éãýýð ñîíãîñîí. Ò¿¿âðèéí õ¿ðýý íü Óëààíáààòàð õîòûí Áàÿíãîë ä¿¿ðãèéí õýìæýýíä ¿éë àæèëëàãàà ÿâóóëæ áóé 30 öýöýðëýã, 45 ÅÁÑ, 21 ºðõèéí ýð¿¿ë ìýíäèéí òºâèéã “ñàíàìñàðã¿é òîîí õ¿ñíýãò” àøèãëàí ãóðâàí öýöýðëýã, õî¸ð ñóðãóóëü, íýã ºðõèéí ýð¿¿ë ìýíäèéí òºâèéã ñîíãîæ õèéâ. 1-2 íàñíû õ¿¿õäèéã ºðõèéí ýð¿¿ë ìýíäèéí òºâººñ, 3-5 íàñíû õ¿¿õäèéã öýöýðëýãýýñ, 6-10 íàñíû õ¿¿õäèéã ñóðãóóëèàñ ñîíãîí ñóäàëãààíä õàìðóóëëàà. Áîëîâñðóóëàëòûã SPSS 21.0 ïðîãðàì äýýð ã¿éöýòãýæ ¿ð ä¿íä äåñêðèïòèâ áîëîí íàðèéâ÷èëñàí ñòàòèñòèê øèíæèëãýý õèéæ ¿ç¿¿ëýëò¿¿äèéã õ¿ñíýãòëýõ áîëîí çóðàã, ä¿ðñëýëèéí àðãààð èëýðõèéëëýý. Òàðõàëòûã õóâèàð èëýðõèéëæ 95.0 õóâèéí èòãýõ èíòåðâàë [CI:]-ûã íýãæèéí ñóäàëãààíû àðãàä òîõèðóóëàí òîîöñîí.

¯ð ä¿í. Íèéò õ¿¿õäèéí 96.8 õóâü [95%CI 95.7-97.8] íü Óëààíáààòàð õîòîä òºðñºí, 49.2 õóâü [95%CI

46.1-52.5] íü ýðýãòýé áàéëàà. Ýöýã ýõ÷¿¿äèéí äèéëýíõ íü (90.7%CI 88.9-92.5) ãýðëýñýí, õàëõ (ýõ: 91.6%CI 89.7-93.3 ýöýã: 87.7%CI 85.7-89.7) ¿íäýñòýí áàéâ. Ìîíãîë íýã íàñòàé õ¿¿õäèéí äóíäàõ õºõ òîëáîíû òàðõàëò 87.0 õóâü (795%CI 81.3-90.6), õî¸ð íàñòàéä 77.0 õóâü (95%CI 70.0-82.5), ãóðâàí íàñòàéä 71.0 õóâü (95%CI 63.5-77.2) áàéíà. Íàñíû á¿ëýã äýýøëýõýä ìîíãîë õºõ òîëáîíû òàðõàëò áóóð÷ 10 íàñòàé õ¿¿õäèéí äóíä 4.0 õóâüòàé áîëñîí áàéâ (p=0.0001). 1-10 õ¿ðòýëõ íàñíû ìîíãîë õºõ òîëáîòîé õ¿¿õäèéí äóíäàæ íàñ 3.8, ãîë÷ íàñ 4, õàìãèéí îëîí äàâòàãäñàí íü 1 íàñ áàéëàà (Figure 1).

Figure 1. Distribution age of children with “Mongolian blue spot”

Ìîíãîë õºõ òîëáîíû àðèëàõ íü õ¿¿õäèéí íàñíààñ õàìààðàõ õàìààðàë íü 95.0 õóâü áóþó õ¿÷òýé õàìààðàëòàé áàéíà.

Figure 2. Ìîíãîë õºõ òîëáîòîé õ¿¿õäèéí õóâü, íàñààð

Ìîíãîë õºõ òîëáîíû òàðõàëòûí õóâèéã òîîöîîëîõ ðåãðåññèéí òýãøèòãýëèéã òîîöîîëîí ãàðãàëàà. Ìîíãîë õºõ òîëáîíû òàðõàëòûí õóâü= -0.545 íàñ2 – 3.745 íàñ + 89.6 ýíýõ¿¿ ðåãðåññèéí çàãâàð àøèãëàí 95.0 õóâèéí èòãýõ ìàãàäëàëûí èíòåðâàëòàé ¿ç¿¿ëýëò¿¿äèéí òîîí óòãûã òîîöîí ãàðãàâ (Table 1).

y = -0.5455x2 - 3.7455x + 89.6 R² = 0.9581

0102030405060708090

100

1 2 3 4 5 6 7 8 9 10

Perc

ent

Age


Table 1. Ìîíãîë õºõ òîëáîòîé õ¿¿õäèéí íàñíû ðåãðåññèéí òýãøèòãýëèéí òààìàãëàñàí óòãà, èòãýõ èíòåðâàë

Age Frequency of Mongolian blue

spot

95%CIMin Max

1 85.31 80.80 88.572 79.93 73.93 83.673 73.46 67.34 78.524 65.90 58.88 71.365 57.25 50.71 63.926 47.51 40.86 54.267 36.68 30.48 43.188 24.76 19.74 30.499 11.75 9.107 15.6210 2.35 1.001 5.446

Õ¿¿õäèéí íàñ íýìýãäýõýä ìîíãîë õºõ òîëáîíû òîî, õýìæýý áàãàñàæ, ºíãº á¿äãýð÷ áàéëàà. 1-10 íàñíû õ¿¿õäèéí õàìãèéí áàãà íü íýã, õàìãèéí èõ íü 10 õýñýã òîëáîòîé áàéâ. Õ¿¿õäèéí íàñ áàãà áàéõàä òîëáîíû òîî èõ, íàñ íýìýãäýõýä áàðàã á¿õ õ¿¿õýä íýã õýñýã òîëáîòîé áîëñîí áàéâ. Ñóäàëãààíä õàìðàãäñàí õ¿¿õäèéí äèéëýíõ íü óóöàíäàà, çóóâàí õýëáýðèéí ìîíãîë õºõ òîëáîòîé áàéëàà (Table 2).

Table 2. Ñóäàëãààíä õàìðàãäñàí õ¿¿õäèéí õóâèéí æèí, ìîíãîë õºõ òîëáîíû

òîî, ºíãº, õýëáýð, áàéðøëààð

Child-ren’sage

Percentage of children Number of

children with blue

spot

Part: Spot

Color:Blue

Shape:Oval

Site: Lum-bosacral

1 41.4 23.0 90.8 86.0 86

2 44.2 18.2 89.6 87.0 77

3 56.3 12.8 81.7 82.1 71

4 73.4 4.7 84.4 85.5 64

5 73.0 3.2 84.1 98.4 63

6 76.3 2.5 89.8 93.2 59

7 74.2 - 90.3 83.9 31

8 100.0 - 75.0 100.0 16

9 100.0 - 100.0 100.0 8

10 100.0 - 87.1 100.0 4

Ìîíãîë õºõ òîëáîíû ºðãºíèé õýìæýý áà õ¿¿õäèéí íàñàíä õàðãàëçàõ òîîí óòãûí ¿ð ä¿íã òîäîðõîéëæ õ¿ñíýãòýýð õàðóóëàâ (Table 3).

Table 3. Ìîíãîë õºõ òîëáîíû ºðãºíèé õýìæýý, õ¿¿õäèéí íàñààð

Age Median95%CI

ModeStd.error

mean

Std. devia-tion

Min MaxMin Max

1 4.0 3 4 4.0 0.33 3.4 1 23

2 4.0 3 4 4.0 0.33 3.4 1 23

3 2.0 2 3 2.0 0.31 2.6 0.5 12

4 2.0 2 3 2.0 0.52 4.2 0.5 21

5 2.0 2 3 2.0 0.42 3.38 0.5 18

6 2.0 1 3 1.0 0.21 1.67 0.5 8

7 2.0 1 2.5 1.0 0.22 1.25 0.5 6

8 0.75 0.3 1.2 0.3 0.17 0.71 0.2 3.0

9 0.75 0.3 1.0 1.0 0.19 0.56 0.3 2.0

10 1.1 0.2 1.2 0.3 0.25 0.51 0.3 1.5

Ìîíãîë õºõ òîëáîíû ºðãºíèé äóíäàæ õýìæýý 1 íàñòàéä 4 ñì áàéñíàà 10 íàñòàéä 1.1 ñì áîëæ áàãàññàí áàéíà.

Ìîíãîë õºõ òîëáîíû óðòûí õýìæýý áà õ¿¿õäèéí íàñàíä õàðãàëçàõ òîîí óòãûí ¿ð ä¿íã òîäîðõîéëæ õ¿ñíýãò 4-ººð õàðóóëàâ (Table 4).

Table 4. Ìîíãîë õºõ òîëáîíû óðòûí õýìæýý, õ¿¿õäèéí íàñààð

Age Median95%CI

ModeStd.error

meanStd.

deviationMin Max

Min Max

1 6.5 5 7 5.0 0.44 4.1 1 30

2 5.0 5 7 5.0 0.44 4.1 1 30

3 4.0 3 5 3.0 0.50 4.2 1 20

4 4.5 3.5 5.5 5.0 0.85 6.7 1 43

5 4.0 3 5 1.0 0.50 3.9 1 22

6 3.5 3 4 1.0 0.32 2.5 1 13

7 3.0 3 4 3.0 0.36 2.0 1 10

8 0.5 0.5 1 1.0 0.23 0.9 0.5 4

9 1.1 0.5 2 1.0 0.29 0.8 1 2

10 1.2 0.5 2. - - 1.1 0.5 1.7

Õ¿¿õýä 1 íàñòàé áàéõàä ìîíãîë õºõ òîëáîíû óðò 6.5 ñì áàéñàí áîë 5 íàñòàéä 4.0 ñì, 10 íàñòàéä 1.2 ñì áîëæ áàãàññàí áàéâ.

Õýëöýìæ. Êàíàäûí Êàëãàðò Õÿòàä-Êàíàäûí 92 íÿðàé (49 ýìýãòýé, 43 ýìýãòýé), 1633 Õÿòàä-Êàíàäûí õ¿¿õäèéã õàìðóóëàí Ìîíãîë òîëáî èëð¿¿ëýõ ñóäàëãàà õèéæýý. Á¿õ íÿðàéä õºõ òîëáî èëýðñýí áºãººä 6 õ¿ðòýë íàñàíäàà ààæèì àðèëæ, 10 íàñòàéä òîëáîòîé õ¿¿õýä èëðýýã¿é. Õºõ òîëáîíû ºíãº ñààðàë, áàðààí ñààðàë õ¿ðòýë ÿíç á¿ð áàéâ. Åðºíõèéäºº õ¿¿õýä áàãà áàéõ òóñàì Ìîíãîë òîëáî íü òîä ºíãºòýé áàéâ [11].

Íèãåðò íýã ñàðòàéãààñ 14 íàñ õ¿ðòýëõ 484 õ¿¿õäèéã Ìîíãîë õºõ òîëáî èëð¿¿ëýõ ñóäàëãààíä õàìðóóëæýý. Ñóäàëãààãààð õºõ òîëáî ñóðãóóëèéí ºìíºõ íàñíû õ¿¿õäèéí 13.6 õóâüä èëýðñýí, çóðãààãààñ äýýø íàñíû õ¿¿õäýä àæèãëàãäààã¿é, òîëáî ãîëäóó óóö, íóðóó, ãóÿ õýñãýýð, õºõ, ñààðàë ºíãºòýé áàéñàí áàéíà [12]. Áèäíèé ñóäàëãààãààð ìîíãîë õ¿¿õäèéí õºõ òîëáî áóñàä


îðîíä õèéãäñýí ñóäàëãààòàé õàðüöóóëàõàä èë¿¿ òàðõàëòòàé áàéâ.

Ä¿ãíýëò. Ñóäàëãààíä õàìðàãäñàí 1-10 íàñíû õ¿¿õäèéí äóíäàõ ìîíãîë õºõ òîëáîíû òàðõàëò õ¿¿õäèéí íàñ àõèõàä áàãàñ÷ 10 ò¿¿íýýñ äýýø íàñàíäàà àðèëàõ ìàãàäëàëòàé áàéíà.

Íîì ç¿é

1. Tanyasiri K, Kono T, Groff WF, Higashimori T, Petrovska I, Sakurai H, Nozaki M. Mongolian spots with involvement of mandibular area. J Dermatol. 2007 Jun;34(6):381-4. PMID: 17535403

2. Larralde M, Santos-Muñoz A, Rodríguez Cáceres M, Ciardiullo A. Phacomatosis pigmentovascularis type Va in a 3-month old. Pediatr Dermatol. 2008 Mar-Apr;25(2):198-200

3. A.D.A.M. Medical Encyclopedia. Mongolian blue spots

4. Wolf R, Wolf D, Davidovici B. Phacomatosis pigmentopigmentalis: aberrant Mongolian spots and segmental café au lait macules. Pediatr Dermatol. 2009 Mar-Apr;26(2):228-9. PMID: 19419484

5. Egemen A, �kizo�lu T, Ergör S, Mete Asar G, Y�lmaz Ö. Frequency and characteristics of mongolian spots among Turkish children in Aegean region. Turk J Pediatr 2006; 48: 232-236

6. Sanghoon Lee, M.D., Dae-Hyun Kim, M.D., Gunhong Lee, M.D., Kyu-Uang Whang, M.D., Jong Suk Lee, M.D., and Young-Lip Park, M.D. An Unusual Case of Congenital Dermal Melanocytosis Ann Dermatol. 2010 November; 22(4): 460–462. PMCID: PMC2991728.

7. Wateff S: Taches pigmentaires chez les enfants bulgares. Bull Mem Soc Anthrop 1907;8:231-249.

8. Gupta D, Thappa DM. Mongolian spots. Indian J Dermatol Venereol Leprol. 2013 Jul-Aug;79(4):469-78. doi: 10.4103/0378-6323.113074.

9. Braun-Falco O, Plewig G, Wolff HH, Burgdorf WH. Dermatology (2nd ed). New York: Springer-Verlag;2000:1518-1519

10. Silengo M, Battistoni G, Spada M. Is there a relationship between extensive Mongolian spots and inborn error of metabolism. Am J Med Genet 1999;87: 276-7.

11. Leung AK. Mongolian spots in Chinese children. Int J Dermatol. 1988 Mar; 27(2):106-8. PMID: 3360547. http://www.ncbi.nlm.nih.gov/pubmed/3360547, 2014. Jan

12. Onayemi O, Adejuyigbe EA, Torimiro SE, Oyelami O, Jegede OA Prevalence of Mongolian spots in Nigerian children in Ile-Ife, Nigeria. Niger J Med. 2001 Jul-Sep;10(3):121-3.

Òàíèëöàæ, íèéòëýõ ñàíàë ºãñºí:Áèîëîãèéí óõààíû äîêòîð, ïðîôåññîð

Ñ.Ýíýáèø


GSTT1, GSTM1 ãåíèéí äåëåöèéã Taq 2x Dual master mix àøèãëàí èëð¿¿ëýõ øèíæèëãýýíèé àðãà

Ã.Óÿíãà1, Æ.Çàíäðàà2, Ñ.Ãàíáîëä3, Ñ.ªíºðñàéõàí1, Ä.Ñóâä1*1Íèéãìèéí ýð¿¿ë ìýíäèéí ¿íäýñíèé òºâ, 2×îðîñ-Îíîø ëàáîðàòîðè

3Ø¿¿õèéí øèíæèëãýýíèé ¿íäýñíèé õ¿ðýýëýí*Õîëáîî áàðèõ õàÿã: [email protected]

AbstractMethod for detection of GSTM1, GSTT1 deletion variantsusing

Taq 2x Dual master mix

G.Uyanga1, J.Zandaraa2, S. Gandbold3, S.Unursaikhan1, D.Suvd1

1National Center of Public Health, 2Choros-Onosh Laboratory 3National Institute for forensic sciences

Corresponding author: [email protected]

IntroductionGSTs are a family of antioxidant enzymes that responsible for the detoxification of many carcinogens. Glutathione S-transferases are polymorphic in humans and the null genotypes are results in lack of enzyme activity.In many studies the polymorphisms of GSTM1, GSTT1 have been associated with cancers of the lung, bladder, breast and colon.

GoalIn this research we aimed to establish PCR condition for obtaining “long” PCR product for detection of deletions in GSTT1, GSTM1 genes using various master mixes, which would help us further to detect heterozygous variants for these two genes in Mongolian population.

Materials and MethodsThree kinds of commercial master mixes as Go Taq PCR master mix (USA), Taq 2x Dual master mix (Mongolia), and DyNAzyme EXT buffer were tested at various PCR conditions on 117 DNA samples, isolated in three ways such as phenol chloroform extraction method, guanidine hydrochloride method and using Promega Wizard Genomic Fragment DNA Extraction Kit from fresh blood lymphocytes, buccal swabs and dried blood spots.

ResultsThree types of samples were used for DNA extraction such as buccal swabs, dried onto soft tissue blood spots and fresh peripheral blood lymphocytes, using three kind extraction methods from which DNA template obtained from fresh blood isolated by guanidine chloride method had best quality. Combination as template DNA from fresh blood, guanidine chloride DNA extraction method and Taq 2x Dual master mix (Mongolia) resulted in all four band, whereas other combination did not display desired results.

Conclusions:Out of three kinds commercial master mixes tested in this study for various PCR template DNApreparation and PCR conditions we observed that:1. PCR with Taq 2x Dual master mix (Mongolia) resulted in all four initially desiredPCR products as 625bp for GSTM1, 969bp for GSTT1 genes and 4748bp for GSTM1, 3106bp for GSTT1 gene deletions correspondingly;2. Template genome DNA prepared from fresh peripheral blood lymphocytes by guanidine hydrochloride extraction methods suited best for “long” PCR reaction;3. Using Taq 2x Dual master mix produced in Mongolia saved us time and was cheaper. 4. Multplex primer mix is excellent tool in research of GST gene polymorphism.

Key words: GSTM1, GSTT1, Long PCR product

Pp.29-33, Tables 3, Images 4, References19


¯íäýñëýëÕ¿íèé áèå ìàõáîä õîðòîé áîäèñûã õîðã¿éæ¿¿ëýõ òîãòîëöîîòîé áàéäàã. Òýäíèé íýã áîëîõ ãëóòàòèîí-S-òðàíñôåðàçà á¿ëãèéí ôåðìåíò¿¿ä ìàø îëîí òºðëèéí õèìèéí áîäèñûã õîðã¿éæ¿¿ëýõýä îðîëöäîã áºãººä äîòðîî õýä õýäýí á¿ëýãò õóâààãääàã. Õ¿íèé ïîïóëÿöèä GSTT1, GSTM1, GSTP1 á¿ëãèéí ôåðìåíòèéí ìýäýýëëèéã íºõöºëä¿¿ëäýã ãåíèéí îëîí õýëáýðøèë ò¿ãýýìýë òîõèîëääîã áàéíà [1-6]. Ìóòàöèä îðñîí GSTT1, GSTM1 ãåíèéí õóâèëáàðûã ãîìîçèãîò õýëáýðýýð àãóóëñàí õýâ øèíæèä ýäãýýð ôåðìåíòèéí èäýâõè á¿ðýí àëäàãäñàí áàéäàã, èéìýýñ ýäãýýð õóâèëáàðóóäûã îð÷íû áîëîí àæèë ìýðãýæëýýñ øàëòãààëñàí áîõèðäëîîñ õàìààðñàí ýìãýãèéí ýðñäëèéã èëð¿¿ëýõýä ãåíåòèê ìàðêåð áîëãîí àøèãëàõàä íýí òîõèðîìæòîé, ó÷èð íü ñóäëàãäàõóóí ïîïóëÿöèéã ýìãýã ¿¿ñãýã÷ - ýìãýã øèíæèéí õàìààðëûã òîãòîîõ áîëîìæòîé ìàø òîäîðõîé õî¸ð á¿ëýãò àíãèëæ àæèãëàõ áîëîìæèéã îëãîäîã [7-9]. Ìºí ò¿¿í÷ëýí äàâñàã, òºìñºã, ò¿ð¿¿ áóë÷èðõàé, óóøãè, ã¿éëñýí áóë÷èðõàé, õºõíèé ºìºíòýé õîëáîæ ñóäàëñàí ñóäàëãàà øèíæèëãýýíèé àæèë èõýýõýí õèéãäñýí áàéíà [10-17]. Óã áîëîìæèíä ¿íäýñëýí GSTT1, GSTM1 ãåíèéí îëîí õýëáýðøëèéã ìàø îëîí ñóäàëãààíä ºðãºíººð àøèãëàñàí áàéäàã. Îëîí óëñàä GST ãåíèéí îëîí õýëáýðøëèéã õýä õýäýí àðãààð, òóõàéëáàë Multiplex ïîëèìåðàçûí ãèíæèí óðâàë(ÏÃÓ)-ûí àðãààð ñóäëàí òîãòîîäîã áàéíà [1, 4]. Ìîíãîëä GST ãåíèéí îëîí õýëáýðøëèéã óóë óóðõàé, óìàéí õ¿ç¿¿íèé ºìºíòýé õîëáîí ñóäàëñàí ñóäàëãàà áàéäàã áà òýäãýýð ñóäàëãààãààð çºâõºí ãýýãäýõ ìóòàöèä îðñîí GSTT1, GSTM1 ãåíèéí õóâèëáàðûã ãîìîçèãîò õýëáýðýýð àãóóëñàí õýâ øèíæèéí äàâòàìæèéã òîãòîîõ äýýð ¿íäýñëýñýí áàéíà [18]. Áèä ñóäàëãààíäàà GSTT1, GSTM1 ãåíèéí õýâèéí áîëîí ãýýãäýõ ìóòàöèä îðñîí õóâèëáàðóóäûã àãóóëñàí ãåòåðîçèãîò õýâøëèéí äàâòàìæèéã òîãòîîõ,ººðººð õýëáýë ÏÃÓ-ààð “Long” áóþó “Óðò” á¿òýýãäýõ¿¿í ãàðãàí àâàõ øèíæèëãýýíèé àðãà áîëîâñðóóëàõ çîðèëãî òàâüñàí.

Çîðèëãî:ÏÃÓ ÿâóóëæ GSTT1, GSTM1 ãåíèéí “Long” áóþó “Óðò” á¿òýýãäýõ¿¿í ãàðãàí àâàõ àðãà áîëîâñðóóëàõ

Çîðèëò:1. Ãåíîìûí ÄÍÕ ÿëãàõ 2. GSTT1, GSTM1 ãåíèéí õýâèéí áîëîí

ìóòàöèä îðñîí õóâèëáàðûã ÏÃÓ-ûã àøèãëàí ãàðãàí àâàõ

Ìàòåðèàë, àðãà ç¿éÑóäàëãààíû ò¿¿âýð: Ñóäàëãààíä îëîí æèë áè÷èë óóë óóðõàéí îëáîðëîëò õèéãäýæ áàéñàí Òºâ àéìãèéí Æàðãàëàíò, Áîðíóóð ñóì, ìºí óóë óóðõàéí ¿éë àæèëëàãàà õèéãäýýã¿é çýðãýëäýýõ Áàÿí÷àíäìàíü ñóìûí îðøèí ñóóã÷äààñ ñàéí äóðûí ¿íäñýí äýýð, òàíèóëñàí çºâøººðëèéí äàãóó 2013, 2014 îíóóäàä öóãëóóëñàí 117 áèîëîãèéí ñîðüöûã àøèãëàâ.

Ãåíîìûí ÄÍÕ ÿëãàëò: Ñóäàëãààíä öóñ, çàâüæíû àð÷äàñíû ñîðüö öóãëóóëñàí áà çàõûí ñóäàñíû öóñíààñ ãóàíèäèí-ãèäðîõëîðèäûí àðãà, çàâüæíû àð÷äàñíû ñîðüöîîñ ôåíîë-õëîðîôîðìûí àðãààð ãåíîìûí ÄÍÕ ÿëãàâ.

ÄÍÕ-èéí àãóóëàìæèéã òîîöîõ: ÄÍÕ-èéí àãóóëàìæèéã ñòàíäàðò Ê562 DNA High Molecular Weight, 2800 M Control DNA (10ng/μl)-òàé õàðüöóóëàí 0,8 %-èéí àãàðîçûí ãåëüä ýëåêòðîôîðåç ÿâóóëæ ¿íýëýâ.

ÏÃÓ:Ñóäàëãààíä Bioneer ôèðìèéí “Mygene32 thermal block” òºõººðºìæ àøèãëàñàí. Multiplex ÏÃÓ-ûí àðãààð GSTT1, GSTM1 ãåíèéã ºâºðìºöººð òàíèõ ïðàéìåðíàéðóóëàõ: Ïðàéìåðèéã õî¸ð õóâèëáàðààð áýëäýâ. ¯¿íä: ¯éëäâýðëýã÷ýýñ ñàâëàñàí 100 ïèêîìîëü/ìêë ýõ óóñìàëààñ 1-ð õ¿ñíýãòýíä õàðóóëñàí ïðàéìåð á¿ðò õàðãàëçàõ àãóóëàìæòàé ïðàéìåðûí õîëèìîã áýëäýâ. Ïðàéìåð òóñ á¿ðèéã 10 äàõèí øèíãýëæ (ïðàéìåð òóñ á¿ðýýñ 5 ìêë äýýð íü 45 ìêë óñ õîëèâ) àæëûí óóñìàë áýëòãýâ.

Table 1. Multiplex PCR primers

Amplicon Primers μmol/LAmpliconsize (bp)

GSTT1 geneForward:5’-TCTTTTGCATAGAGACCATGACCAG-3’Reverse: 5’-CTCCCTACTCCAGTAACTCCCGACT-3’

0,30 969

GSTT1 deletion Forward: 5’-GAAGCCCAAGAATGGGTGTGTGTG-3’Reverse: 5’-TGTCCCCATGGCCTCCAACATT-3’

0,04 3106

GSTÌ1 geneForward: 5’-CAAATTCTGGATTGTAGCAGATCATGC-3’Reverse: 5’-CACAGCTCCTGATTATGACAGAAGCC-3’

0,22 625

GSTÌ1 deletion Forward: 5’-AAGACAGAGGAAGGGTGCATTTGATA-3’Reverse: 5’-ACAGACATTCATTCCCAAAGCGACCA-3’

0,40 4748


Ìàñòåð õîëèìîã ãàðãàí àâàõ, ÏÃÓ ÿâóóëàõ íºõöºë: Ìàñòåð õîëèìîã áýëòãýõäýý Taq 2x Dual ìàñòåð õîëèìîã àøèãëàñàí (2õ ÏÃÓ-ûí áóôåð pH=8.5, dNTPòóñ á¿ð 500 ìêìîëü, 2.5 ìêìîëü MgCl2, Taq ÄÍÕ ïîëèìåðàçà) áà óðâàëûí íèéò ýçýëõ¿¿í 25 ìêë áàéõààð áýëòãýâ. ÏÃÓ-ûí ýõíèé äåíóòðàöèéã 940Ñ-3 ìèíóò äàðààãèéí äåíóòðàöèéã 940Ñ-30 ñåêóíä, õîñëóóëàõ 680Ñ-7 ìèíóò, óðòàñãàõ 680Ñ-7 ìèíóò, 720Ñ-10 ìèíóò ÿâóóëàõ ïðîãðàììûã îðóóëæ, 35 öèêë ÿâàãäàæ äóóñìàãö ñîðüöûã ÏÃÓ-ûí ìàøèíààñ ãàðãàí àâ÷ ãåëü ýëåêòðîôîðåç ã¿éëãýâ.

Àãàðîç ãåëü ýëåêòðîôîðåç: ÏÃÓ-ûí á¿òýýãäýõ¿¿íèéã ¿íýëýõäýý 0.8%, 1.5%-èéí àãàðîçûí ãåëüä 1õTBE áóôåðèéí îð÷èíä ã¿éëãýæ Bioneer ôèðìèéí 100 õ.í. óðòòàé ìîëåêóë æèíãèéí ñòàíäàðò õýìæýý òîãòîîã÷òîé õàðüöóóëàí ¿íýëýâ. Ýëåêòðîôîðåçûã 100 B-ûí õ¿÷äýëä çàëãàí 25 ìèíóòûí òóðø ã¿éëãýæ ãåëèéí çóðãèéã “BioSens Imaging systems” òºõººðºìæººð àâàâ. ¯ð ä¿íÃåíîìûí ÄÍÕ-ã ÿëãàñàí ¿ð ä¿í: ÄÍÕ-èéí àãóóëàìæèéã ñòàíäàðò Ê562 DNA High Molecular Weight, 2800M Control DNA (10ng/μl)–òàé õàðüöóóëàí, 0.8%-ûí àãàðîçûí ãåëüä ýëåêòðîôîðåç ÿâóóëæ ¿íýëýâ (Çóðàã1).

Figure 1. Result of extraction genomic DNA with Guanidine-Hydrochloride

ÌultiPlex ÏÃÓ-ààð GSTT1, GSTM1 ãåíèéã èëð¿¿ëñýí ä¿í: 2013 îíä öóãëóóëñàí 79 ñîðüöîíä GSTT1, GSTM1 ãåíèéí îëîí õýëáýðøëèéã òîãòîîõ øèíæèëãýýã õèéõýä 8 ñîðüöîä GSTM1 ãåíèé õýâèéí õóâèëáàð áóþó ÏÃÓ-ûí áîãèíî á¿òýýãäýõ¿¿í (625 õ.í), 18 ñîðüöîíä GSTT1 ãåíèéí õýâèéí õóâèëáàð áóþó ÏÃÓ-ûí áîãèíî á¿òýýãäýõ¿¿í (969 õ.í) òóñ òóñ èëðýâ, 14 ñîðüöîä GSTT1/GSTM1 ãåí õî¸óëàà, õàðèí 11 ñîðüöîä ÿìàð íýãýí ÄÍÕ-èéí õýð÷èì èëðýýã¿é áîëíî (Çóðàã 2, 3).

Figure 2. Results for PCR with Taq 2x Dual master mix (Mongolia), where genome DNA is extracted by phenol chloroform

methodused as template

Çóðàã 3-ààð multiplex ÏÃÓ ÿâóóëñàí ¿ð ä¿íã 1,5%-ûí àãàðîç ãåëü ýëåêòðîôîðåç ã¿éëãýí ¿íýëñýí áàéäëûã æèøýýãýýð õàðóóëàâ. Ãåëèéí çóðãààñ õàðàõàä íèéò 17 ñîðüö ã¿éëãýæ ¿íýëñýí áà ýäãýýðèéí 1, 4, 8, 11, 15-ð ñîðüöîä 625 õ.í.á¿õèé ÄÍÕ-èéí õýð÷èì áóþó GSTM1 ãåíèé õýâèéí õóâèëáàð îëøèðñîí áîëîõ íü õàðàãäàæ áàéíà. Õàðèí 2, 5, 9-ð ñîðüöîíä 969 õ.í á¿õèé ÄÍÕ-èéí õýð÷èì áóþó GSTÒ1 ãåíèé õýâèéí õóâèëáàð, ñîðüö 3, 5, 6, 10, 12, 13, 14, 16, 17-ð ñîðüöîíä ÄÍÕ-èéí õýð÷èì ¿¿ñýýã¿é áîëîõ íü õàðàãäàæ áàéíà. Ýíý õ¿ðòýëõ ñóäàëãààíä àøèãëàñàí àðãà, ÏÃÓ ÿâóóëàõ íºõöëººð ÏÃÓ-ûí “Óðò” á¿òýýãäýõ¿¿í èëðýýã¿é òóë ãýýãäýõ ìóòàöè èëð¿¿ëýõ íºõöëèéã òîãòîîõ øààðäëàãà ¿¿ñýâ.

Figure 3. Result of determination of GSTT1 and GSTM1 gene usingÌultiPlex PCR

ÌultiPlex ÏÃÓ-ààð GSTT1, GSTM1 ãåíèéí ãýýãäýõ ìóòàöè îðñîí õóâèëáàð áóþó äåëåöè èëð¿¿ëñýí ä¿í: Äýýð ºã¿¿ëñýíýýð ÏÃÓ-ûí “Óðò” á¿òýýãäýõ¿¿í áóþó GSTM1 - èéí õóâüä (4738 õ.í), GSTÒ1-èéí õóâüä (3106 õ.í.) óðòòàé ÄÍÕ-èéí õýð÷ì¿¿ä íü òóñ òóñ ýäãýýð ãåí¿¿äèéí äåëåöèéí ìàðêåðóóä þì. Òóðøèëòààð ôåíîë õëîðîôîðìûí àðãààð ÿëãàñàí ÄÍÕ-èéã ÏÃÓ-ä à÷ààëëàæ “Óðò” á¿òýýãäýõ¿¿íèéã ãàðãàí àâàõ òóðøèëòûã 26 ñîðüöîíäººð ººð õóâèëáàðààð ÿâóóëàâ. Çóðàã 4-ò Ìultiplex ÏÃÓ-ààð GSTT1, GSTM1 ãåí¿¿äèéí äåëåöèéã èëð¿¿ëñýí ä¿íã õàðóóëàâ. Ãåëèéí çóðãààñ õàðàõàä íèéò 6ñîðüöíû1, 2, 4, 5-ð ñîðüöîä 4738 õ.í.á¿õèé


ÄÍÕ-èéí õýð÷èì áóþó GSTM1 ãåíèéí äåëåöè îëøèðñîí áîëîõ íü õàðàãäàæ áàéíà. Õàðèí 1, 2, 3, 4, 5, 6-ð ñîðüöîíä 3106 õ.íá¿õèé ÄÍÕ-èéí õýð÷èì áóþó GSTT1 ãåíèéí äåëåöè, 2, 3, 4, 5, 6-ð ñîðüöîíä 969 õ.í. óðòòàé ÄÍÕ-èéí õýð÷èì áóþó GSTÒ1 ãåí, 2, 6-ð ñîðüöîä 625 õ.í.á¿õèé GSTM1 ãåí îëøèðñîí áîëîõ íü õàðàãäàæ áàéíà.

ÕýëöýìæÑóäàëãààíû ¿ð ä¿íã 2, 3-ð õ¿ñýãòýíä íýãòãýæ õàðóóëàâ. Ãåíîìûí ÄÍÕ ÿëãàõàä øèíý øèíãýí öóñ áóñàä òºðëèéí ñîðüíîîñ èë¿¿ ¿ð ä¿í ºã÷ áàéâ (Õ¿ñíýãò 2).

Table 2. Lon g PCR template DNA preparation methods

Reagent used for DNA extraction

Sample type Liquid blood Blood spots Saliva

Phenol-Chloroform extraction Not fuitable for long PCR due to cutting long length DNA Guanidine Hydrochloride extraction

Best fuitable - -

Promega Wizard Genomic Fragment DNA Extraction Kit

Resulted in less template amount

- -

3-ð õ¿ñíýãòýýñ õàðàõàä øèíãýí öóñíààñ ãóàíèäèí-ãèäðîõëîðèäûí àðãààð ÿëãàñàí ãåíîìûí ÄÍÕ-èéã ÏÃÓ ÿâóóëàõàä àøèãëàñàí òîõèîëäîëä àëü ÷ êîìïàíèé ¿éëäâýðëýñýí óðâàëûí ìàñòåð õîëèìîãèéã àøèãëàñàí ÷ “Óðò” á¿òýýãäýõ¿¿í èëýðýõ õàíäëàãàòàé áàéâ. Õàðèí

óðâàëûí ìàñòåð õîëèìîãèéã êîìïàíèóäààð íü õàðüöóóëáàë Ìîíãîëûí “×îðîñ-Îíîø” ëàáîðàòîðèä ¿éëäâýðëýñýí ìàñòåð õîëèìîã õàìãèéí ñàéí ¿ð ä¿í ºã÷ áàéâ.

Table 3. Long PCR efficiency

PCR mix

Extraction total genomic DNA

Phenol-Chloroform extractionGuanidine

Hydrochloride extraction

Promega Wizard Genomic Fragment DNA Extraction Kit

Go Taq PCR (USA) +

Taq 2x Dual master mix (Mongolia)

MgCl2-1,5 μl ++ ++++ +++

MgCl2-2,5 μl ++ ++++

DyNAzyme EXT buffer (germany) +++ ++

- 625 bpÄÍÕ-èéí õýð÷èì ¿¿ññýí+

- 625, 969bpÄÍÕ-èéí õýð÷èì ¿¿ññýí++

- 625, 969, 3106bpÄÍÕ-èéí õýð÷èì ¿¿ññýí+++

- 625, 969, 3106, 4748bpÄÍÕ-èéí õýð÷èì ¿¿ññýí++++

Figure 4. Result of determined GSTT1 and GSTM1 deletion by ÌultiPlex PCR


Ä¿ãíýëò:1. Áèä ÏÃÓ–ûí “Óðò” á¿òýýãäýõ¿¿í ãàðãàí

àâàõûí òóëä ÏÃÓ-ûí 3 ººð òºðëèéí íºõöëººð òóðøèëòûã õèéæ 625, 969, 3106, 4748 õ.í.óðòòàé ÄÍÕ-ûí õýð÷ìèéã ãàðãàí àâàâ.

2. ÏÃÓ - ûí “Óðò” á¿òýýãäýõ¿¿í ãàðãàí àâàõûí òóëä ãåíîìûí ÄÍÕ ÿëãàõ àðãà èõ à÷ õîëáîãäîëòîé áèäíèé ñóäàëãààãààð ôåíîë-õëîðîôîðìûí àðãààð ÿëãàõ íü òîõèðîìæã¿é õàðèí ãóàíèäèí-ãèäõîðëîðèäûí àðãààð ÿëãàõ íü èë¿¿ ¿ð ä¿íòýé áàéíà.

3. Öààøèä äýýðõè àðãààð Ìîíãîëä ãàðãàí àâñàí Taq ïîëèìåðàçà ôåðìåíòèéã ñóäàëãàà øèíæèëãýýíä àøèãëàõ íü öàã õóãàöàà áîëîí, õºðºíãº ìºíãº õýìíýõ áîëîìæòîé ãýæ ¿çýæ áàéíà.

4. Ãåíîìûí ò¿âøèíä Multiplex ïðàéìåðûí õîëèìîã àøèãëàí GST ãåíèéí ñóäàëãàà õèéõ á¿ðýí áîëîìæòîé áàéíà.

Íîì ç¿é: 1. Anders Buchard, Juan J. Sanchez, Kim Dalhoff

and NielsMorling. Multiplex PCR Detection of GSTM1, GSTT1, and GSTP1 Gene VariantsJournal of Molecular Diagnostics, Vol. 9, No. 5, November 2007

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13. Strange RC, Fryer AA. The glutathione S-transferases: influence of polymorphism on cancer susceptibility. In: Ryder W, ed. Metabolic Polymorphisms and Susceptibility to Cancer. Lyon, France: International Agency for Research in Cancer;1999(148):231–249.

14. Moyer, A.M., Salavaggione, O.E., Hebbring, S.J., Moon, I., Hildebrandt, M.A.T., Eckloff, B.W., et al., 2007. Glutathione s-transferase T1 and M1: Gene sequence variation and functional genomics. Clinic Cancer Res. 13, 7207-7216.

15. Cote ML, Kardia SL, Wenzlaff AS, Land SJ, Schwartz AG: Combinations of glutathione S-transferase genotypes and risk of early-onset lung cancer in Caucasians and African Americans: a populationbased study. Carcinogenesis 2005, 26:811–819

16. Ye Z, Song H, Higgins JP, Pharoah P, Danesh J: Five glutathione S-transferase gene variants in 23,452 cases of lung cancer and 30,397 controls: meta-analysis of 130 studies. PLoS Med 2006, 3:e91

17. Zhang H, Ahmadi A, Arbman G, Zdolsek J, Carstensen J, Nordenskjold B, Soderkvist P, Sun XF. Glutathione S-transferase T1 and M1 genotypes in normal mucosa, transitional mucosa and colorectal adenocarcinoma. Int. J. Cancer 1999, 84:135–138

18. Á.È÷èíõîðëîî, Ä.Îðõîíñýëýíãý. GSTT1, GSTM1 ãåí¿¿äèéí òàðõàëò áà äåëåöèéí ñóäàëãàà. Ýð¿¿ë àõóé÷, òàðõàâàð ñóäëàà÷äûí ¿íäýñíèé çºâëºëèéí õî¸ðäóãààð çºâëºãººí. Ýðäýì øèíæèëãýýíèé áàãà õóðëûí ýìõýòãýë. ÓÁ, 2013 îí. õ.233

Òàíèëöàæ, íèéòëýõ ñàíàë ºãñºí:Àêàäåìè÷ Ë.Ëõàãâà


Íîéð áóë÷èðõàéí ¿ðýâñëèéí ðåíòãåí øèíæ òýìäã¿¿ä

Ö.Áàäàìñýä1, Í.Áèëã¿¿í2, Ì.Óÿíãà3

1Àêàäåìè÷ Ò.Øàãäàðñ¿ðýíãèéí íýðýìæèò àíàãààõ óõààíû õ¿ðýýëýí2Óëààíáààòàð òºìºð çàìûí òºâ ýìíýëýã

3.Óëàìæëàëò àíàãààõ óõààíû ýëýã ñóäëàëûí êëèíèê òºâ

AbstractX-ray symptoms of pancreatitis

Ts.Badamsed1, N.Bilguun2, M.Uynga3

1Medical Research Institute named after Academician T.Shagdarsuren2Central Clinic of Ulaanbaatar railway

3Hepatological clinic centre of traditional medicine

BackgroundAbdominal X-ray findings of destructive acute pancreatitis are usually similar with intestinal obstruction x-ray sign.

CoalThe main goal of this study is detecting X-ray findings of pancreatitis depend on type of pancreatitis and location of the pathological abnormality.

Objectives:1. Determining pancreatitis x-ray findings depend on types of pancreatitis and pathologic abnormalities location.2. Determining radiologic features of chronic pancreatitis

Material and Methods

From2012 to 2014, 45 patients’ x-ray finding of pancreatitis have been analysed (31 patients with acute pancreatitis and 14 patients with chronic pancreatitis). All patients have diagnosis by clinical symptom, laboratory tests, ultrasound, celiacography, CT, MRI, ERCP, MRCP,citology and biopsy.

ResultsX-ray findings of pancreatitis are associated with type of acute pancreatitis and location of pathologic abnormalities in the pancreas.

Conclusion:

1. Patients with pancreatic tail swelling and deformity (acute pancreatitis), whose chest radiograph shows elevation of left hemi-diaphragm. Arka signs are seen level of L

2 ,right side of the L

2-L

3, and

stomach and upper part of the small intestine filled with gas, these recognized radiographic signs are associated with head of the pancreas destruction, which is caused by acute pancreatitis.

2. In our study, commonly recognized radiographic signs associated with chronic pancreatitis include with ascending colon and hepatic flexure are filled with gas, right part of transverse colon spasms, stomach and upper part of the small intestine filled with gas and small calcification in the pancreas

Key words: pancreatitis, location, acute, chronic, radiographic

Pp.34-38, Tables 2, Image 7, References 9

ÓäèðòãàëÐåíòãåí øèíæèëãýýãýýð äýýä ãýäýñíèé òýëýãäýëò, õîäîîä áà á¿ä¿¿í ãýäýñíèé õºíäëºí õýñãèéí õîîðîíäûí çàé èõñýõ, íîéð áóë÷èðõàéí îð÷èì õèéí áºìáºëºã òîäîðõîéëîãäîõ øóóä áóñ øèíæ òýìäã¿¿ä íîéð áóë÷èðõàéí ýìãýã¿¿äèéí ¿åä

èëýðäýã. Ðåíòãåí øèíæèëãýýã (öýýæ áà õýâëèéí õºíäèéí òîéì ðåíòãåí õàðàëò áà çóðàã àâàëòûã) áîñîî, õýâòýý áà õàæóó áàéðëàëä ã¿éöýòãýõýýñ ýõýëíý [6, 9]. Íîéð áóë÷èðõàéí öî÷ìîã ¿ðýâñýë ýõýëñýíýýñ

ÝÌÍÝËÇ¯É


5-6 öàãèéí äàðàà ðåíòãåí øóóä áóñ, 12-24 öàãèéí äàðàà ðåíòãåí øóóä øèíæ òýìäã¿¿ä èëýðíý. ¯¿íä: Ýðò èëðýõ òîãòìîë øèíæ íü ç¿¿í ºðöíèé òºâãºð äýýð áàéðëàæ õºäºëãººí õÿçãààðëàãäàõ, õîæóó ¿åä ºðöíèé áàðóóí òºâãºðèéí ¿éë àæèëëàãàà àëäàãäàæ, ºðöíèé õèë õÿçãààð òîä áóñ (ºðö äýýð ôèáðèí ñóóñíààñ) áîëíî. Óóøãèíû äîîä õýñýãò ÿëàíãóÿà ç¿¿íä íàðèéí øàë÷èéëò (àòåëåêòàç) ¿¿ñíý. Ïëåâðèéí õºíäèéä øèíãýí õóðèìòëàãäàíà [1-9]. ¯ðýâñýëò áà ýâäðýëò ïðîöåññ íîéð áóë÷èðõàéí ñ¿¿ë õýñýãò áàéðëàñàí áîë öýýæ áà õýâëèéí õºíäèéí òîéì ðåíòãåí õàðàëò áà çóðãààð ç¿¿í ºðöíèé òºâãºð, óóøãè áà ïëåâðèä ººð÷ëºëò èëýð÷, õýâëèéí õºíäèéä á¿ñýëõèéí II-III-ð íóãàëìàéí ç¿¿í òàëä íàðèéí ãýäýñíèé ãîãöîî õèéãýýð ä¿¿ðãýãäñýí (Àðêà) øèíæ òýìäýã (æèæ¿¿ðëýñýí íàðèéí ãýäýñíèé ãîãöîîíóóä øèíæ òýìäýã) èëýðíý. Íîéð áóë÷èðõàéí öîöìîã ¿ðýâñëèéí õ¿íä õýëáýðèéí ¿åä õ¿ðýý ãýäýñíèé äýë¿¿ áà ýëýãíèé ºíöºã ìýäýãäýõ¿éö òýëýãäýæ, õºíäëºí ãýäýñ õÿçãààðëàãäìàë íàðèéñíà (á¿ä¿¿í ãýäýñ òàñàðõàéäàõ øèíæ òýìäýã). Íîéð áóë÷èðõàéí öî÷ìîã ¿ðýâñëèéí ýâäðýëò õýëáýðèéí ¿åä õýâëèéí õºíäèéí òîéì ðåíòãåí õàðàëò áà çóðãààð ãýäýñíèé ò¿ãæðýëèéí ¿éë àæèëëàãààíû øèíæ òýìäã¿¿ä èë¿¿òýé èëýðíý. ̄ ¿íä: Õîäîîä-ãýäýñíèé çàìûí òîäîðõîé õýñã¿¿ä íàðèéñ÷, òýëýãäëýýð ñîëèãäîíî. Õîäîîä áà íàðèéí ãýäýñíèé äýýä õýñã¿¿ä õèéãýýð ä¿¿ðãýãäýíý. Õîäîîä äýýø áà áàðóóí òèéø øèëæèæ, õîäîîäíû òîì òàõèð ÿëãàðàí õàðàãäàõã¿é. Íîéð áóë÷èðõàéí òîëãîé õýñýã òîìîðñîí áîë äýýä ãýäýñ íýëýíõ¿éäýý áà õýñýã÷èëýí õèéãýýð ä¿¿ðãýãäýæ, äýýä ãýäýñíèé äîòîð ãàäàðãûí õýëáýð àëäàãääàíà. Äýýä ãýäýñíèé äîòîð ãàäàðãûí õýëáýð àëäàãäàëò íü ç¿¿í õàæóó áàéðëàëä èë¿¿ òîä èëýðäýã. Íàðèéí ãýäýñíèé õèéãýýð ä¿¿ðãýãäñýí ãîãöîî äîõü øèíãýíèé ò¿âøèí èõýñ÷, íàðèéí ãýäýñíèé øèíãýí áà õèéãýýð ä¿¿ðãýãäñýí ãîãöîîíóóä áèå áèå äýýðýý äàâõàðëàæ æèæèã øàò ìýò õàðàãäàíà. Õ¿ðýý ãýäýñíèé õºíäëºí õýñýã õèéãýýð ä¿¿ðãýãäýíý [1-9].

Íîéð áóë÷èðõàéí àðõàã ¿ðýâñëèéí ýõíèé ¿å øàò áà äàõèëò ºãñºí ¿åä íîéð áóë÷èðõàé

òîìîðäîã ó÷èð ðåíòãåí øèíæèëãýýãýýð õîäîîä óðàãø øèëæèæ, äýýä ãýäýñíèé ãîãöîî òýëýãäýæ, äýýä ãýäýñíèé äîòîð õàíà òýãøèðýõ áóþó äýýä ãýäýñíèé äýýä áà äîîä òîì õºõºíöºð äîòîð õàíûí ò¿âøèíä äàðàãäàæ áóðóó õàðñàí 3 òîî (Ôðîñòáåðãèéí øèíæ òýìäýã) èëýðäýã [3].

Àðõàã ïàíêðåàòèòòàé ºâ÷òºíèé 35%-ä øîõîéæèëò ýñâýë ÷óëóó, 33%-ä õîäîîäíû ðåëüåô ººð÷ëºãäºõ øèíæ òýìäã¿¿ä èëýðíý [8].

ÇîðèëãîÏàíêðåàòèòûí õýëáýð áà ýìãýã ººð÷ëºëòèéí áàéðëàëààñ õàìààð÷ ðåíòãåí øèíæ òýìäã¿¿ä èëýðäãèéã ñóäëàõàä ñóäàëãààíû àæëûí çîðèëãî îðøèíî.

Çîðèëòóóä:1. Ðåíòãåí øèíæ òýìäã¿¿ä íü öî÷ìîã ïàíêðåàòèòûí õýëáýð áà ýìãýã ººð÷ëºëòèéí áàéðëàëòàé õýðõýí õàìààðàëòàéã òîãòîîõ2. Àðõàã ïàíêðåàòèòûí ðåíòãåí îíöëîã øèíæ òýìäã¿¿äèéã èëð¿¿ëýõ

Ìàòåðèàë, àðãàç¿é2012-2014 îíû õîîðîíä áèä öî÷ìîã ïàíêðåàòèòòàé-31, àðõàã ïàíêðåàòèòòàé 14 ºâ÷òºíèé ðåíòãåí øèíæ òýìäã¿¿äýä ñóäàëãààíû òóñãàé êàðòóóäûã òóñ òóñ áîëîâñðóóëæ, òýäãýýðò ä¿ãíýëò õèéñýí.

Ýäãýýð øèíæë¿¿ëýã÷äèéí îíîøèéã êëèíèê, ëàáîðàòîðè, õýò àâèàí, öåëèàêîãðàôè, ÊÒÃ, MRI, ERCP, MRCP, öèòîëîãè áà áèîïñèéí øèíæèëãýý, ìýñ àæèëáàð çýðãýýð áàòàëñàí.

Ñóäàëãààíû ¿ð ä¿íã ñòàòèñòèêèéí ò¿ãýýìýë õýðýãëýãäýõ äóíäàæ ¿ç¿¿ëýëò, ¿ç¿¿ëýëòèéí àëäàà çýðãèéã òîäîðõîéëæ, Ñòüþäåíòèéí øàëãóóðààð ¿ç¿¿ëýëòèéí ìàãàäëàëûã øàëãàñàí.

¯ð ä¿íÁèä öî÷ìîã ïàíêðåàòèò îíîø áàòëàãäñàí 31 ºâ÷òºíèé ðåíòãåí øèíæ òýìäã¿¿äèéã àâ÷ ¿çñýí (Õ¿ñíýãò 1).

Table 1. Acute pancreatitis radiographic signs

№ Radiographic signs number % ±m1 Elevated left hemi-diaphragm 16 56.1 8.92 Restricted movements of left hemi-diaphragm 12 38.7 8.73 Elevated right hemi-diaphragm 7 22.6 7.54 Restricted movements of right hemi-diaphragm 5 16.1 6.65 Left hemi-diaphragm counter is invisible (silhouette sign) 8 25.8 7.96 Small atelectasis seen in lover part of the left lung 3 9.7 5.37 Left sided pleural effusion 2 6.5 4.4


8 1-2 Arka sign are seen left side of the L2-L

3 6 19.4 7.1

9 Right hepatic and left splenic flexures are filled with air and transverse colon spasms

9 29.0 8.2

10 Air and fluid level seen in the duodenal bulb (duodenostasis) 5 16.1 6.611 Several Arka sign seen L

2level and right side of L

2-L

3 16 56.1 8.9

12 Ascending colon and hepatic flexure are filled with gas, right part of transverse colon spasms,

11 35.5 8.6

13 Right kidney counter is unable to determine 9 29.0 8.214 Right m.psoas counter is not seen 8 25.8 7.915 Stomach and upper part of the small intestine are filled with air 21 67.7 8.416 Dislocation of stomach 13 41.9 8.917 Widened and dilated duodenum 12 38.7 8.818 Stairs like Arka sign 13 41.9 8.919 Air-filled transverse colon 5 16.1 6.620 Small pancreatic cysts 3 9.7 5.321 Small intestine spasms, fluid in the small intestine and peritoneal

cavity 5 16.1 6.6

Äýýðõè ðåíòãåí øèíæ òýìäýã íü öî÷ìîã ïàíêðåàòèòûí õýëáýð áà ýìãýã ººð÷ëºëòèéí áàéðëàëòàé õàìààðàëòàé áàéíà.

Àðõàã ïàíêðåàòèò îíîø áàòëàãäñàí 14 ºâ÷òºíèé ðåíòãåí øèíæ òýìäã¿¿äèéã àâ÷ ¿çñýí. (Õ¿ñíýãò 2).

Table 2. Chronic pancreatitis radiographic signs

№ Radiographic signs number % ±m1 Elevated left hemi-diaphragm 6 42.9 13.72 Restricted movements of left hemi-diaphragm 5 35.7 13.33 Elevated right hemi-diaphragm 3 21.4 11.44 Restricted movements of right hemi-diaphragm 2 14.3 9.75 Right hepatic and left splenic flexures are filled with air and

transverse colon spasms 9 64.3 13.3

6 Ascending colon and hepatic flexure are filled with gas right part of transverse colon spasms,

11 78.6 11.4

7 Stomach and upper part of the small intestine are filled with air 10 71.4 12.58 Dislocation of stomach 3 21.4 11.49 Widened and dilated duodenum 5 38.7 8.810 Stairs like Arka sign 6 42.9 13.711 Air-filled transverse colon 4 28.6 12.520 Small calcification in the pancreas /Small pancreatic calcifications / 1 7.1 7.1

Õýëöýìæ: Áèäíèéõýýð öî÷ìîã ïàíêðåàòèòûí ¿åä 16(56,1%±8,9)-ä ºðöíèé ç¿¿í òºâãºðèéí áàéðëàë äýýøèëñýí, 12(38,7%±8,7)-ä ºðöíèé ç¿¿í òºâãºðèéí õºäºëãººí õÿçãààðëàãäìàë, 8(25,8%±7,9)-ä ºðöíèé òºâãºðèéí õèë õÿçãààð òîä áóñ, 3(9,7%±5,3)-ä ç¿¿í óóøãèíû äîîä õýñýãò æèæèã àòåëåêòàç ¿¿ñýõ, 2(6,5%±4,4)-ä ç¿¿í ïëåâðèéí õºíäèéä øèíãýí õóðèìòëàãäàõ, 6(19,4%±7,1)-ä L

2-L

3-í ç¿¿í òàëä 1-2 øèðõýã Àðêà

øèíæ òýìäýã èëýð÷ áàéíà. ¯ðýâñýëò áà ýâäðýëò ïðîöåññ íîéð áóë÷èðõàéí ñ¿¿ë õýñýãò áàéðëàñàí

áîë öýýæ áà õýâëèéí õºíäèéí òîéì ðåíòãåí õàðàëò áà çóðãààð ç¿¿í ºðö, óóøãè áà ïëåâðèä ººð÷ëºëò èëýð÷, õýâëèéí õºíäèéä á¿ñýëõèéí II-III-ð íóãàëìàéí ç¿¿í òàëä íàðèéí ãýäýñíèé ãîãöîî õèéãýýð ä¿¿ðãýãäñýí (Àðêà øèíæ òýìäýã) øèíæ òýìäýã (æèæ¿¿ðëýñýí íàðèéí ãýäýñíèé ãîãöîîíóóä øèíæ òýìäýã) èëýðíý (Çóðàã 1-2) ãýñýí Ì.Ê.Ùåðáàòåíêî., Ý.À.Áåðåñíåâà.,1977 íàðûí ä¿ãíýëòèéã áèäíèé ñóäàëãàà áàòàëæ áàéíà.


Image 1. AP abdominal radiogramm.Pancreatic tail swelling associated with acute

pancreatitis. Air-filled small intestine loops are seen, Arka sign is visible in left side of abdomen.

Image 2. AP abdominal radiogramm.Acute pancreatitis of tail of the pancreas.

Air-filled small intestine loops located left side of abdomen (Sentinel loop sign).

78,6%-ä ºãñºõ ãýäýñ áà á¿ä¿¿í ãýäýñíèé ýëýãíèé ºíöºã õèéãýýð ä¿¿ðãýãäýõ áîëîâ÷ õºíäëºí ãýäýñíèé áàðóóí õýñýã õèéãýýð ä¿¿ðãýãäýõã¿é áóþó àãøèëòûí áàéäàëòàé (Çóðàã 3), 71,4%-ä õîäîîä áà íàðèéí ãýäýñíèé äýýä õýñýã õèéãýýð ä¿¿ðãýãäýõ, 21,4%-ä õîäîîäíû áàéðëàë ººð÷ëºãäºõ (Çóðàã 4), 35,7%-ä äýýä ãýäýñ ºðãºñ÷, òýëýãäýõ, 42,9%-ä øàòàëñàí áàéðëàëòàé Àðêà èëðýõ, 28,6%-ä õºíäëºí ãýäýñ õèéãýýð ä¿¿ðãýãäýõ, 7,1%-ä íîéð áóë÷èðõàéí áàéðëàëûí ôîí äýýð æèæèã øîõîéæèëòóóä (Çóðàã 5-7) òîäðîõ íü àðõàã ïàíêðåàòèòûí ¿åä èë¿¿òýé äàâàìãàéëæ áóé íü Ë.Ä.Ëèíäåíáðàòåí, (1983); Pistolesiáà áóñàä, (1975) íàðûí ñóäàëãààòàé ä¿éæ áàéíà.

Image 3. AP abdominal radiogramm.Destructive type of acute pancreatitis.

Air-filled right hepatic and left splenic flexures, transverse colon spasms.

Small air-filled cysts are seen same location of pancreas (Small air-filled pancreatic cysts)

Image 4. AP abdominal radiogramm.Barium study of the Upper GI.

Destructive type of acute pancreatitis.Dislocation of stomach, antrum of the stomach is elevated like arch, duodenum is widened and

dilated


Image 5. Left anterior oblique abdominal radiogram. Chronic pancreatitis

Calcifications presented in the head of the pancreas.

Image 6. AP abdominal radiogramm.Chronic pancreatitis.

Calcification presented in the body and tail of the pancreas.

Image 7. AP abdominal radiogramm.Chronic pancreatitis

Calcifications presented in the head of the pancreas.

Ä¿ãíýëò1. Ðåíòãåí øèíæèëãýýãýýð ºðöíèé ç¿¿í

òºâãºðèéí áàéðëàë äýýøèëñýí íü íîéð áóë÷èðõàéí ñ¿¿ë õýñãèéí öî÷ìîã ïàíêðåàòèòûí õàâàãíàëò áà ýâäðýëò õýëáýðèéí ¿åä, L

2-í èõ áèåèéí ò¿âøèíä áà L

2-

L3-í áàðóóí òàëä õýä õýäýí Àðêà øèíæ òýìäýã

èëðýõ, õîäîîä áà íàðèéí ãýäýñíèé äýýä õýñýã õèéãýýð ä¿¿ðãýãäýõ íü íîéð áóë÷èðõàéí òîëãîéí öî÷ìîã ïàíêðåàòèòûí ýâäðýëò õýëáýðèéí ¿åä èëýðäãèéã òîãòîîñîí.

2. ªãñºõ ãýäýñ áà á¿ä¿¿í ãýäýñíèé ýëýãíèé ºíöºã õèéãýýð ä¿¿ðãýãäýõ áîëîâ÷ õºíäëºí ãýäýñíèé áàðóóí õýñýã õèéãýýð ä¿¿ðãýãäýõã¿é áóþó àãøèëòûí áàéäàëòàé, õîäîîä áà íàðèéí ãýäýñíèé äýýä õýñýã õèéãýýð ä¿¿ðãýãäýõ, íîéð áóë÷èðõàéí áàéðëàëûí ôîí äýýð æèæèã øîõîéæèëòóóä òîäðîõ íü àðõàã ïàíêðåàòèòûí ¿åä äàâàìãàéëæ áàéíà.

Íîì ç¿é1. Àêêåðìàí Ã.À., Õîðåâ Ã.Í.

Ðåíòãåíîäèàãíîñòèêà îñòðîãî ïàíêðåàòèòà. –Ñîâ.ìåä. 1965. №10. Ñ.86-89.

2. Âàðíîâèöêèé Ã.È.,Âèíîãðàäîâ Â.Â. Î ðåíòãåíîëîãè÷åñêèõ ïðîÿâëåíèÿõ îñòðîãî ïàíêðåàòèòà //Âåñòí.ðåíòãåíîë. è ðàäèîë.-1969.-№1.-ñ.29-33.

3. Ëèíäåíáðàòåí Ë.Ä. Çàáîëåâàíèÿ ïîäæåëóäî÷íîé æåëåçû// Êëèíè÷åñêàÿ ðåíòãåíîðàäèîëîãèÿ (ðóêîâîäñòâî). Ò.2. Ðåíòãåíäèàãíîñòèêà çàáîëåâàíèé îðãàíîâ ïèùåâàðåíèÿ.-Ì.:Ìåäèöèíà.-1983.-ñ.367-374.

4. Ùåðáàòåíêî Ì.Ê., Áåðåñíåâà Ý.À. Íåîòëîæíàÿ ðåíòãåíîäèàãíîñòèêà îñòðûõ çàáîëåâàíèé è ïîâðåæäåíèé îðãàíîâ áðþøíîé ïîëîñòè.-Ìåäèöèíà.-1977. -ñ.162-173.

5. Balthazar E.J.,FreenyP.V.,vanSonnenbeerg E. Imaging and intervention in acute panvreatitis. Radiology. 193: 297-306. 1994.

6. Kohler R. Radiological diagnosis of pancreatitis. 1972. v.616 p.269-272.

7. Miller I.,Irving M. The value of the Plain abdominal Roentgenogram in the Diagnosis of acute Pancreatitis.-“Am.J.surg.”.-1972.-v.123.-p.671-673.

8. Pistolesiáà áóñàä.Radiological diagnosis of pancreatitis. 1972. v.512 p.28-31.

9. Swart B., Meyer G. Diagnoctic des akuten abdomens beirh Erwavhseheneinneuesklinsc

hontgenologischeskonzept.-Radiologe. 1974.№1.1-57.


ïðîôåññîð Ï.Í Îíõóóäàé


Ñýòãýë õºäëºëèéí õî¸ð òóéëò ýìãýãèéí óäàìøèõ õàíäëàãûíîíöëîãèéã ñóäàëñàí ä¿íãýýñ

Ò.Ãàíöýöýã1, Ñ.Îäîíãýðýë2, Ó.Öýðýíäîëãîð3, Ñ.Òóÿà2, Ë.Áàòò¿âøèí1, Ç.Õèøèãñ¿ðýí1

1ÀØÓ¯ÈÑ, ÀÓÑ, Ñýòãýöèéí Ýð¿¿ë Ìýíäèéí òýíõèì,2Ñýòãýöèéí Ýð¿¿ë Ìýíäèéí ¯íäýñíèé Òºâ

3ÀØÓ¯ÈÑ, Äîðíîãîâü àéìãèéí ñàëáàð ñóðãóóëüe-mail: [email protected]

AbstractHeritability of patients with bipolar disorders

T.Gantsetseg1, S.Odongerel2, U.Tserendolgor3, L.Battuvshin1, Z.Khishigsuren1

1School of Medicine, NUMS2National Center for Mental Health

3School of Dornogobi, NUMS

IntroductionIt has been suggested that most of the patients with bipolar disorders (BD) have either parent side which is mentally ill. Furthermore, 25-27% of the children have been affected by BD if either parent side has BD, or 50-75% is affected if theboth sides of parents have BD, respectively. Heritability of BD in monozygotic twins is 40-70%, and it is 20% in dizygotic twins. Therefore we aimed to study hereditary issues of patients with bipolar disorders.

PurposeTo assess hereditary issues of patients with bipolar disorders.

Materials and MethodsThe study sample comprises 31 male, 81 female patients referred to the inpatient settings of the National Center for Mental Health. The participiants were examined by psychiatric interviews including objective and subjective anamnesis to assess hereditary history of bipolar disorders. Pearson’s x2 test was used for the analysis between categorical variables, whereas simple logistic regression was used for the regression analysis.

ResultsWe covered 31 male (24.8%), 81 female (75.2%) participants between 14-62 years old, mean age: 42.05±0.97. Among the participants, 60 (53.6%) of them were with the hereditary history of mental disorders whose father (11.6%), mother (25%), a sibling (21.7%),close relatives (38.3%), and a child (3.3%) were mentally ill. 46.7% of the relatives were diagnosed with mood disorders and 36.7% of them were diagnosed with schizophrenia and its spectrum disorders. Furthermore,there was an association between mental illness of a sibling and bipolar disorders. Also, the number of patients with BD whose mother was diagnosed with BD (13%) is more prevalent than the patients with BD whose mother or father or other relatives were diagnosed with any mental disorders (x2 test, P value = 0.012).

Conclusion Heritability of BD might be associated with autosomal dominant inheritance with incomplete phenotype, and mostly relevant if the patient’s sibling is diagnosed with mental disorders. Keywords: bipolar disorders, depression,mania, heredity, risk factors.

Pp.39-42, Table-1, Figures-2, References-7


ÎðøèëÑýòãýë õºäëºëèéí õî¸ð òóéëò ýìãýã (ÑÕÕÒÝ) íü ¿å ¿å äàõèäàã, äàõèõ ¿åäýý ñýòãýë ãóòðàõ áà ñýòãýë õººðºõ õàìøèíæèéí àëü íýãýýð ýñâýë äýýðõ 2 õàìøèíæ íü õîëèìîã áàéäëààð èëýðäýã, íàìæìàë ¿åäýý ºâ÷òºí á¿ðýí ýð¿¿ëæäýã äîòîîä øàëòãààíòàé, óäàìøèõ õàíäëàãàòàé ñýòãýöèéí ýìãýã þì.1-3 Ñýòãýë õºäëºëèéí õî¸ð òóéëò ýìãýãèéí óäàìøèõ õàíäëàãûã õýâëýëèéí òîéìîîñ ñóäàëæ ¿çýõýä óã ýìãýãòýé ºâ÷òºí¿¿äèéí íèëýýä õóâüä ýöýã, ýõèéí àëü íýã íü ñýòãýöèéí ýìãýãòýé áàéñàí íü òîãòîîãäæýý. Ñóäëàà÷äûí ñóäàëãààíû ä¿íãýýñ ¿çâýë ºâ÷òºíèé ýöýã ýõèéí õýí íýã íü ýíý ýìãýãýýð ºâ÷èëñºí áîë õ¿¿õä¿¿äèéíõ íü 25-27%, ýöýã ýõ õî¸óëàà ºâ÷èëñºí òîõèîëäîëä 50-75% íü ñýòãýë õºäëºëèéí õî¸ð òóéëò ýìãýãýýð ºâ÷ëºõ ìàãàäëàëòàé ãýæ ¿çýæ áàéíà. Ìºí íýã ºíäãºí ýñèéí èõð¿¿äèéí 40%-ä, õî¸ð ºíäãºí ýñèéí èõð¿¿äèéí 20%-ä óã ºâ÷èí èëýð÷ áàéãààã òîãòîîæýý.1, 4 Ñýòãýë õºäëºëèéí õî¸ð òóéëò ýìãýãèéí óäàìç¿éí áàéäëûã ñóäàëñàí çàðèì íýã ñóäàëãààíû ä¿íãýýñ ¿çýõýä áèåèéí 11 ä¿ãýýð õðîìîñîì äýýð ºâºðìºö ãåí áàéðëàñàí áàéäàã íü òîãòîîãäñîí ó÷ðààñ ñýòãýë õºäëºëèéí õî¸ð òóéëò ýìãýãèéã ãåòåðîãåííûé á¿ëýãò õàìààðàõ ºâ÷èí ãýæ ¿çäýã àæýý. Èéìýýñ áèä ñýòãýë õºäëºëèéí õî¸ð òóéëò ýìãýãòýé ºâ÷òºí¿¿äèéí óäàì ç¿éí áàéäëûã ñóäàëñàí.

Ìàòåðèàë, àðãà ç¿éÑýòãýöèéí ýð¿¿ë ìýíäèéí ¿íäýñíèé òºâèéí õýâò¿¿ëýí ýì÷ëýõ òàñãóóäàä ñýòãýë õºäëºëèéí õî¸ð òóéëò ýìãýãèéí óëìààñ õýâòýí ýì÷ë¿¿ëñýí ýðýãòýé 31, ýìýãòýé 81, íèéò 112 ºâ÷òºíèéã ñóäàëãààíä õàìðóóëæ îáúåêòèâ áà ñóáúåêòèâ àíàìíåçûí àðãûã àøèãëàí ýìíýëç¿éí ÿðèëöëàãà õèéõ, ñóäàëãààíä õàìðàãäàãñäûí ºâ÷íèé ò¿¿õ, õÿíàëòûí êàðòûã àøèãëàí ðåòðîñïåêòèâ àðãààð áàðèìòûí ñóäàëãààã õèéñýí. Ñóäàëãààíä îðîëöîõ ¸ñ ç¿éí çºâøººðëèéã ºâ÷òºí áîëîí ºâ÷òºí á¿ðèéí àñðàìæëàã÷ààñ àâñàí. Ìºí óäàìäàà 2 áà ò¿¿íýýñ äýýø ñýòãýöèéí ºâ÷òýé õ¿íòýé áàéâàë ýìíýëç¿éí ãåíåàëîãèéí àðãûã àøèãëàí óäìûí çóðãèéã çóðæ ¿íýëýëãýý ºãñºí. Ñóäàëãààíû áîëîâñðóóëàëòûã SPSS 21.0 ïðîãðàììûã àøèãëàí êàòåãîðèéí õóâüñàã÷óóäûí õîîðîíä äàõü ÿëãààã Ïèéðñîíû õ2 òåñòýýð, òýäãýýðèéí õîîðîíäûí õàìààðëûã ýíãèéí ëîãèñòèê ðåãðåññèéí àðãààð òîîöîâ. Õóâüñàã÷óóäûí äóíäàæ òîî áà ñòàíäàðò àëäààíû äóíäæààð èëýðõèéëñýí.

¯ð ä¿íÁèäíèé ñóäàëãààíä 14-62 íàñíû (äóíäàæ íàñ 42.05±0.97) ýðýãòýé 31 (27.7%), ýìýãòýé 81 (72.3%) íèéò 112 ºâ÷òºí õàìðàãäñàíû 53.6% (n=60) íü óäàìäàà ñýòãýöèéí ýìãýãòýé õ¿íòýé áàéâ. Ñóäàëãààíä õàìðàãäñàí óäàìäàà

ñýòãýöèéí ýìãýãòýé õ¿íòýé íèéò ºâ÷òºíèé 40 (35.7%) íü óäàìäàà ñýòãýöèéí ºâ÷òýé íýã õ¿íòýé, 15 (13.4%) íü 2 õ¿íòýé, 2 (1.8%) íü 3 õ¿íòýé, 1 (0.9%) íü 4 õ¿íòýé, 2 (1.8%) íü 5 õ¿íòýé áàéñàí áºãººä äóíäàæ íü 0.8±0.09 áàéâ. Òýäíèé òºðñºí ýöýã ýõ áîëîí òýäíèé õàìààòíóóäûã ñóäàëæ ¿çýõýä 7 (11.6%) íü ºâ÷òºíèé òºðñºí ýöýã, 15 (25%) íü ºâ÷òºíèé òºðñºí ýõ, 13 (21.7%) íü ºâ÷òºíèé òºðñºí àõ, ýã÷, ä¿¿ãèéí õýí íýã, 2 (3.3%) òîõèîëäîëä òºðñºí õ¿¿õýä, 23 (38.4%) íü ºâ÷òºíèé ýöýã ýõèéí îéðûí òºðºë ñàäàíãèéí õ¿í íü ñýòãýöèéí ºâ÷òýé áàéñàí. Áèä óäàì äàõü ñýòãýöèéí ýìãýãòýé òºðºë ñàäàíãèéí ýçëýõ õóâèéã ñóäàëæ ¿çýõýä çºâõºí ýöýã ýõèéí õàìààòàí ñýòãýöèéí ýìãýãòýé áàéõ íü õàìãèéí èõ (21.4%) õóâèéã ýçýëæ áàéëàà. Èéìýýñ ýöýã ýõèéí õàìààòíûã íàðèéâ÷ëàí ñóäëàõàä ýöýã ýõ áîëîí òºðñºí àõ ýã÷ ä¿¿ íàðòàé äàâõàðäñàí òîîãîîð íèéò 31 (27.7%) íü ºâ÷òºíèé ýöýã ýõèéí àëü íýã íü óäàìä ñýòãýöèéí ºâ÷òýé õ¿íòýé áàéëàà. ¯¿íýýñ ýöãèéí òàëä 15 (13.4%), ýõèéí òàëä 15 (13.4%), ýöýã, ýõèéí õî¸óëàíä íü ñýòãýöèéí ºâ÷òýé 1(0.9%) òîõèîëäîë áàéâ.

Table1. Diagnosis of relatives with mental

disorders

Relatives

Mood disorders (n=28)

Schizophrenia and schizoaffective disorders (n=22)

Other mental disorders(n=10) to

tal

n n n nFathers 4 2 1 7Mothers 6 3 6 15Siblings 7 5 1 13child 0 2 0 2other relatives

11 10 2 23

Total 28 (46.7%)

22 (36.7%) 10 (16.6)

*

* Pearson’s x2 P value >0.012

Õ¿ñíýãò 1-ýýñ õàðàõàä ñýòãýë õºäëºëèéí õî¸ð òóéëò ýìãýãòýé ºâ÷òºí¿¿äèéí óäàìä ñýòãýë õºäëºëèéí õ¿ðýýíèé (28 õ¿í áóþó 46.7), øèçîôðåíè áîëîí øèçîàôôåêòèâ ýìãýã (22 õ¿í áóþó 36.7%)-òýé ºâ÷òºí¿¿ä èõýíõ õóâèéã ýçýëæ

áàéâ.

Ýìíýëç¿éí òîõèîëäîë: Áèäíèé ñóäàëãààíä óäàìäàà ñýòãýöèéí ýìãýãòýé 5 õ¿íòýé 2 ºâ÷òºí õàìðàãäñàí áºãººä ò¿¿íèé óäìûí çóðãèéã äàðààõ

çóðãóóäààð õàðóóëàâ.


Figure 1. The pedigree chart of a patient with

bipolar disorder

Çóðàã 1-ýýñ õàðàõàä óäìûí I ¿åèéí ýýæèéí ààâ (ºâºº), ýýæ (ýìýý) 2 íü ýð¿¿ë áàéõàä óäìûí II ¿åä òºðñºí ýýæ íü ñýòãýë ãóòðàõ äàõèëòàò ýìãýã (F33)-òýé áàéñàí áºãººä áèåèéí ºâ÷íèé óëìààñ 2012 îíû 7 ñàðä 76 íàñàíäàà íàñ áàðñàí áàéâ. Õàðèí III ¿åä íýã ýõèéí 2 ýðýãòýé, íýã ýìýãòýé õ¿¿õýä íü ñýòãýë õºäëºëèéí ýìãýãýýð ºâ÷èëñºí áàéãàà íü ÿìàð ÷ õ¿éñíèé õ¿í ñýòãýë õºäëºëèéí õî¸ð òóéëò ýìãýãýýð õ¿éñíýýñ õàìààðàõã¿é ºâäºæ áàéãààã õàðóóëæ áàéíà. Ìºí óäìûí IY ¿åä íü ýýæèéí òºðñºí àõûí òîì õ¿¿ íü ñýòãýë õºäëºëèéí 2 òóéëò ýìãýãèéí óëìààñ ñýòãýöèéí ýì÷èéí õÿíàëòàíä ýì÷ëýãäýæ áàéãààä àìèà åã¿¿òãýæ íàñ áàðñàí áàéâ. Äýýðõ óäìûí çóðãààñ õàðàõàä ñóäàëãààíä îðîëöîã÷ ºâ÷òºí (F34)-èé ãýð á¿ëèéí óäìûí çóðàãò íü àóòîñîìíû á¿ðýí áóñ èëðýëòýé äàâàìãàéëàã÷ ãåíýýð óäàìøñàí

áàéõ ìàãàäëàëòàé áàéíà.

Figure 2. The pedigree chart of a patient with

bipolar disorder

Çóðàã 2-îîñ õàðàõàä óäìûí I ¿åä íü ààâûí ààâ íü (ºâºº) íü, II ¿åä ààâûí òºðñºí ýðýãòýé ä¿¿, III ¿åä íü ñóäàëãààíä îðîëöîã÷èéí òºðñºí àõ, ýã÷ õî¸ð íü ñýòãýë õºäëºëèéí ýìãýãòýé áàéíà. Ìºí òóñ çóðãàíä ñóäàëãààíä îðîëöîã÷ ºâ÷òºí (F31)-èé òºðñºí ýöýã ýõ 2 ýð¿¿ë õ¿ì¿¿ñ áàéãàà ÷ ºâºº íü àðõàã ñîëèîðîõ ýìãýãòýé (F20) áàéñàí íü á¿ðýí áóñ èëðýëòýé àóòîñîìíû äàâàìãàéëàã÷ ãåíýýð óäàìøñàí áàéõ ìàãàäëàëòàéã õàðóóëëàà.

Ìºí ñóäàëãààíä îðîëöîã÷èéí óäìûí I ¿åä ºâºº àðõàã ñîëèîðîõ ýìãýãòýé áàéãàà íü ñýòãýë õºäëºëèéí ýìãýãèéí õýâøèíæèò áóñ õýëáýð áàéæ áîëîõîîñ ãàäíà ñýòãýë õºäëºëèéí õ¿ðýýíèé ýìãýã, øèçîôðåíè ò¿¿íèé õ¿ðýýíèé ýìãýã¿¿ä íü óäàìøèìòãàé, äîòîîä øàëòãààíòàé ºâ÷èí¿¿ä ó÷èð óäìûí õ¿÷èí ç¿éëèéí õóâüä õîëáîîòîé áàéæ áîëîõ þì.

ÕýëöýìæÕýâëýëèéí òîéìîîñ ¿çýõýä ñýòãýë õºäëºëèéí õî¸ð òóéëò ýìãýãòýé ºâ÷òºí¿¿äèéí íèëýýä õóâüä íü ýöýã, ýõèéí àëü íýã íü ñýòãýë õºäëºëèéí ýìãýãòýé áàéñàí íü òîãòîîãäæýý. ÀÍÓ-ûí Æîí Õîïêèíñèéí èõ ñóðãóóëüä 1995 îíä õèéãäñýí ñóäàëãààíä ñýòãýë õºäëºëèéí õî¸ð òóéëò ýìãýãýýð òºðñºí ýõ ºâäºõ íü òºðñºí ýöãýýñ èë¿¿ óäàìøèõ õàíäëàãàòàé áàéäàã ãýñýí áîë ººð íýã ñóäàëãààíä ñýòãýë õºäëºëèéí õî¸ð òóéëò ýìãýãýýð ºâäñºí ýõèéí õ¿¿õä¿¿ä óã ýìãýãýýð ºâäºõ ýðñäýë 2.5 äàõèí èõ (P>0.017) áîë ýõèéí òàëûí õàìààòàí ñàäàí óã ýìãýãýýð ºâäñºí áàéõ íü ýðñäëèéã 2.3-2.8 äàõèí (P>0.017) íýìýãä¿¿ëäýã ãýæýý.5 Õàðèí áèäíèé ñóäàëãààíä òºðñºí ýõ íü ñýòãýë õºäëºëèéí ýìãýãòýé áàéõàä ºâ÷èí óäàìøèõ õàíäëàãà ýöýã íü ºâ÷òýé áàéõààñ èë¿¿ áàéñàí íü äýýðõ ñóäàëãààíû ä¿íòýé îéðîëöîî ãàðñàí þì. Ñóäëàà÷ Kidd.K.K (1987) íàðûí ñóäàëãààíààñ ¿çýõýä ñýòãýë õºäëºëèéí õî¸ð òóéëò ýìãýãòýé ºâ÷òºí¿¿äèéí 22%-ä ýöýã ýõ íü ºâ÷òýé áàéõ ìàãàäëàë ºíäºð áàéäàã. Ìºí 25%-ä íü òºðñºí àõ, ýã÷, ä¿¿ íàðûí õýí íýã íü, 39%-ä íü òºðñºí õ¿¿õýä íü óã ýìãýãýýð ºâäºõ ýðñäýëòýé áàéäàã áîë ýöýã ýõèéí õàìààòíóóä ºâ÷òýé áàéõ íü äýýðõ ýðñäëèéã èë¿¿ èõ íýìýãä¿¿ëäýã áîëîõûã òîãòîîæýý6.

Áèäíèé ñóäàëãààíä òºðñºí ýöýã ýõèéí õàìààòàíóóä (n=23), òºðñºí àõ, ýã÷, ä¿¿ íàðûí õýí íýã íü (n=13) õàìãèéí èõ õóâèéã ýçýëæ áàéñàí íü äýýðõ ñóäàëãààíû ä¿íòýé îéðîëöîî áàéëàà. Õýâëýëèéí òîéìóóäàä ñýòãýë õºäëºëèéí õî¸ð òóéëòýìãýã íü õî¸ð ºíäãºí ýñèéí èõð¿¿äèéí 20%-ä, íýã ºíäãºí ýñèéí èõð¿¿äèéí 67%-ä óäàìøäàã ãýæýý.1, 4 Ìàíàé ñóäàëãààíä èõýð ºâ÷òºí íýã õàìðàãäñàí áîëîâ÷ èõðèéí ºðººñºí íü áàãà íàñàíäàà íàñ áàðñàí áàéñàí òóë áèä èõð¿¿äèéí òàëààð ìýäýýëýõ áîëîìæã¿é áàéëàà. Õàðèí áèäíèé ñóäàëãààíä õàìðàãäñàí ñýòãýë õºäëºëèéí õî¸ð òóéëò ýìãýãòýé ºâ÷òºí¿¿äèéí óäàìä ñýòãýë õºäëºëèéí õ¿ðýýíèé (28 õ¿í áóþó 46.7%) áà øèçîôðåíè áîëîí ò¿¿íèé õ¿ðýýíèé ýìãýã (22 õ¿í áóþó 36.7%)-òýé ºâ÷òºí¿¿ä èõýíõè õóâèéã ýçëýæ áàéñàí. Îëîí ãåíèéí îðîëöîîòîé ¿¿ñýõ óäàìøèìòãàé ºâ÷íèé òîîíä ñýòãýöèéí ºâ÷í¿¿äýýñ ñýòãýë õºäëºëèéí õî¸ð òóéëò ýìãýã,


øèçîôðåíè 2 ãîë òºëººëºã÷ áàéäëààð îðäîã.7 Òèéìýýñ áèä ñýòãýë õºäëºëèéí õî¸ð òóéëò ýìãýãèéí óäàìøèë íü ÿìàð õýëáýðýýð äàìæèæ áàéãààã óäìûí çóðãààð çóðàõàä çóðàã 2-îîð õàðóóëñàí ºâ÷òºí ªâ÷òºíèé ºâºº íü ñýòãýöèéí ýìãýãòýé áàéñàí õýäèé ÷ ýöýã ýõ íü ýð¿¿ë áàéñàí íü õýâëýëèéí òîéìä ìýäýýëñýí á¿ðýí áóñ èëðýëòýé àóòîñîìíû äàâàìãàéëàã÷ ãåíýýð óäàìøèõ ãýäýã íü óã ºâ÷èí ¿å àëãàñàí èëýð÷ áàéæ áîëäîã7 ãýñýí ìýäýýëýëòýé ñóäàëãààíû ä¿í îéðîëöîî ãàðñàí þì. Ýíý ºâ÷èí íü óäàìøèõ õàíäëàãàòàé äîòîîä øàëòãààíä ñýòãýöèéí ýìãýã áîëîõûã õàðóóëæ áàéíà. 1, 2

Ä¿ãíýëò:

Ñóäàëãààíä õàìðàãäàãñäûí óäàì ç¿éí áàéäëûã ñóäàëæ ¿çýõýä ñýòãýë õºäëºëèéí õî¸ð òóéëò ýìãýã íü õ¿éñ õàìààðàëã¿é á¿ðýí áóñ èëðýëòýé àóòîñîìíû äàâàìãàéëàã÷ ãåíýýð óäàìøñàí áàéõ ìàãàäëàëòàé áàéëàà. Ìºí ºâ÷òºí¿¿äèéí òºðñºí ýõ íü ñýòãýöèéí óäàìøèõ õàíäëàãàòàé ýìãýãòýé áàéõàä ºâ÷èí óäàìøèõ õàíäëàãà ýöýã íü ºâ÷òýé áàéõààñ èë¿¿ íºëººëæ áîëîõ þì.

Íîì ç¿é:

1. Harold LKaplan BJS. Pocket handbook of clinical psychiatry of america. 1990, p. 88-89.

2. Ïîïîâ Þ.Â ÂÂÄ. Ñîâðåìåííàÿ êëèíè÷åñêàÿ ïñèõèàòðèÿ. Ì, ñ.110-14 1997

3. Ãåëüäåð Ì. ÃÄ, Ìåéî Ð. . Îêñôîðäñêîå ðóêîâîäñòâî ïî ïñèõèàòðèè i òîì, êèâå., ñ. 1990-1998 1997

4. Mondimore. FM. Bipolar disorder second edition., a johns hopkins press health book of america 2006, p.198-202.

5. Francis J. McMahon CS, Deborah A. Meyers, Sylvia G. Simpson, and, DePaulo JR. Patterns of maternal transmission in bipolar affective disorder. Am. J. Hum. Genet. 56:1277-1286. 1995

6. Kidd KK. Genetic research in affective disorders: Current problems and future directions. Inaffective disorders: Recent research and related developments (eds. S.M.Chanabasavanna & s.A.Saleem). Bangalore: Nimhans. 1987

7. Ï¿ðýâäîðæ.È Óäàìøèìòãàé ºâ÷í¿¿ä. Àíàãààõ óõààíû óäàì ç¿é. 2003: õ.59-79

Òàíèëöàæ, íèéòëýõ ñàíàë ºãñºí: Àíàãààõ óõààíû äîêòîð Ë.Íàñàíöýíãýë


Óìàéí áóë÷èíãèéí õîðã¿é õàâäðûí òýæýýã÷ àðòåðèéí ñóäñûã áºãëºæ ýì÷èëñíèé äàðààõ æèðýìñëýëòèéí áàéäàëä õèéñýí ñóäàëãàà

Ð.Óðàí÷èìýã1, Ð.Ãàíáààòàð, Ë.Áàÿðìàà1, Æ.Ëõàãâàñ¿ðýí1Êëèíèêèéí íýãä¿ãýýð àìàðæèõ ãàçàð, Óëñûí ãóðàâäóãààð òºâ ýìíýëýã,

Àíàãààõûí øèíæëýõ óõààíû ¿íäýñíèé èõ ñóðãóóëü

Abstract

Pregnancy cases after embolization of uterine fibroids

Uranchimeg R1, Ganbaatar R2, Bayarmaa L, Lkhagvasuren J3

1First ìaternity Íospital, Third state central hospital, Mongolian National University of Medical Scienes

Introduction

Uterine leiomyoma occurs with broad range of 20-50% among reproductive aged women. It takes second place of all women’s genital diseases that cause abnormal menstrual bleeding. Leiomyoma dependent surgical frequency such as hysterectomy is around up to 80, 6%. Lately uterine fibroid embolization treatment is highly effective, less painful, and more rapid recovery, most importantly keeping organ while maintaining the reproductivity, is successfully entered in practice. We successfully performed 40 cases first time in Mongolia and 8 of them conceived naturally after treatment.

GoalTo determine if arterial embolization in women with uterine fibroids (leiomyomata) is an effective method to keep their reproductive organ intact.

Objectives:

• To study pregnancy cases in women who had uterine fibroid embolization• To monitor and determine the features of course of pregnancy and childbirth.• To evaluate uterine fibroids.

Materials and MethodsThe study was conducted in 2009-2012. A total of forty women between 23-50 years of age, diagnosed with symptomatic uterine fibroid that received embolization treatment of dominating arterial blood vessel feeding the uterine fibroids were involved in the study. Eight of the forty women who conceived naturally were selected for the study. The study focused on monitoring the course of their pregnancy and delivery and its outcome.

ResultsAmong 40 women who underwent bilateral uterine artery embolization, 31 (75.5%) were seeking to become pregnant, and 8 of the 31 (25, 8%) became pregnant, four having been nulliparous. One patient had two pregnancies. All 8 pregnancies were spontaneous. The mean time from embolization to conception was 12±3, 5 months (range, 6-27 months). Three medical terminations occurred. The other 5 pregnancies went to term; one pregnancy had to be terminated pre-term due to placenta praevia. 60% experienced threatened abortion and 1 case with advanced age mother complicated with mild preeclampsia. 62,5% of the women’s pregnancy ended with childbirth, of which one woman (20%) had vaginal delivery and the remaining four pregnancies (80%) ended with C-section. On an average, post-treated uterine fibroids decreased in volume by 94% in comparison to pre-treated uterine fibroids in the patients who became pregnant. All of the neonates were healthy with Apgar scores greater than8. The mean weight of the neonates was 3,189± 200 g (range, 2,100–3,800 g). One neonate was preterm due to placenta praevia (2,100 g).


Conclusion: 1. Of the forty women that received arterial embolization treatment with uterine fibroid, thirty one (75, 5%) women desired to keep their uterine for further reproduction, of which eight women (25, 8% of the patients) between the ages of 23-42 years (mean age=35) conceived naturally. Arterial embolization to treat women with uterine fibroids is an effective method for women who wish to keep their reproductive organ intact to conceive and reproduce. 2. 60 percent of the women who conceived experienced threatened abortion and 20 percent of the women’s pregnancy had to be terminated pre-term due to placenta praevia. 62,5 percent of the women’s pregnancy ended with childbirth, of which one woman (20%) had vaginal delivery and the remaining four pregnancies (80%) ended with C-section. 3. On an average, post-treated uterine fibroids decreased in volume by 94% in comparison to pre-treated uterine fibroids.

Key words: Bilateral uterine artery embolization; uterine fibroid embolization; Uterine fibroids (leiomyomata); Pregnancy after uterine fibroid embolization.

Pp.43-48, Tables-3; References-22

¯íäýñëýëÓìàéí ëåéîìèîì õàâäàð íü íºõºí ¿ðæèõ¿éí íàñíû ýìýãòýé÷¿¿äèéí äóíä ºðãºí õýëáýëçýëòýé 20-50% òîõèîëääîã, ýìýãòýé÷¿¿äèéí áýëýã ýðõòýíèé ºâ÷ëºëèéí äîòîð õî¸ðäóãààð áàéð ýçýëäýã [5, 8].

Ìîíãîë ýìýãòýé÷¿¿äèéí äóíä óìàéí ëåéîìèîì õàâäðûí ºâ÷ëºë õ¿¿õýä òºð¿¿ëýõ íàñíû ýìýãòýé÷¿¿äèéí 20%, 40-ººñ äýýø íàñíû ýìýãòýé÷¿¿äèéí 25% [3], ýìýãòýé÷¿¿äèéí çºâëºãºº ºãºõ ãàçàðò óã ºâ÷íèé ó÷èð ¿ç¿¿ëýãñýä áîëîí ýìíýëýãò õýâòýæ ýì÷ë¿¿ëýãñäèéí 3-15%, ýìýãòýé÷¿¿äèéí ºâ÷íèé óëìààñ ìýñ àæèëáàð õèéëãýãñäèéí 40%-èéã óìàéí õîðã¿é õàâäàðòàé ºâ÷òºí¿¿ä ýçýëæ [1], 1986-1990 îíä ÊÍÀÃ-ûí ýìýãòýé÷¿¿äèéí òàñàãò õýâòýæ ýì÷ë¿¿ëýãñäèéí 1,3% ëåéîìèîì õàâäàðòàé, ìýñ çàñàë õèéëãýñýí ºâ÷òºí¿¿äèéí 32,6% óã õàâäðûí óëìààñ óìàé òàéðàõ ìýñ çàñàë õèéëãýæ áàéæýý [2]. Ýð¿¿ë Ìýíäèéí Õºãæëèéí ¯íäýñíèé Òºâèéí ñóäàëãààãààð 2000-2004 îíóóäàä íèéò 1372 ýìýãòýéä ëåéîìèîì îíîøëîãäñîí áàéíà. Ãýòýë óã õàâäðûí ºâ÷ëºë æèë òóòàì íýìýãäýæ 2006-2011 îíä çºâõºí ÊÍÀÃ-ûí ýìýãòýé÷¿¿äèéí òàñàãò íèéò 10579 ýìýãòýé õýâòýí ýì÷ëýãäñýíèé 1824 áóþó 17,3% ëåéîìèîì îíîøòîé, á¿ãä 4131 ìýñ çàñàë õèéãäñýíèé 1415 áóþó 34,5% ýíý ºâ÷íèé óëìààñ õèéãäñýí áàéíà. Ýäãýýð ìýñ çàñàë õèéãäñýí ýìýãòýé÷¿¿äèéí äîòîð 36-50 íàñàíä ºâ÷ëºëèéí òîõèîëäîë èõ á¿ðòãýãäæýý. 2012-2013 îíä äýýðõ òîî áàðèìò 869 òîõèîëäîë áóþó 19,9% áîëæ íýìýãäñýí áà íèéò ìýñ çàñëûí 40,8%-èéã ëåéîìèîì õàâäðûí óëìààñ õèéãäñýí ìýñ çàñàë ýçýëæ áàéãàà þì. Ëåéîìèîì õàâäàð îíîøëîãäñîí ýìýãòýé÷¿¿äèéí 80,6% ìýñ çàñàë ýì÷èëãýý õèéëãýæýý.

Ñ¿¿ëèéí10 ãàðóé æèëèéí õóãàöààíä äýëõèéí áóñàä óëñ îðíóóäàä ëåéîìèîì õàâäðûã ýì÷ëýõ ºíäºð ¿ð ä¿íòýé, çîâèóð áàãàòàé, ºâ÷òºí ýðãýí ñýðãýõ õóãàöàà áîãèíî, õàìãèéí ãîë íü ýðõòýí õàäãàëæ, ýìýãòýéí íºõºí ¿ðæèõ ÷àäâàðûã õýâýýð ¿ëäýýõ äàâóó òàë á¿õèé ëåéîìèîì õàâäðûí òýæýýã÷ àðòåðèéí ñóäñûã áºãëºæ ýì÷ëýõ ýì÷èëãýýíèé àðãûã ïðàêòèêò àìæèëòòàé õýðýãëýæ áàéíà [4, 8, 9, 10, 11, 13, 14]. Óã àðãààð áèä 40 ýìýãòýéí ëåéîìèîì õàâäðûã ýì÷èëñíèé äàðàà 8 ýìýãòýé æèðýìñýëñýí áºãººä ýíý òàëààð Ìîíãîë Óëñàä õèéãäýæ áóé àíõíû ñóäàëãàà áîëæ áàéãàà þì.

ÇîðèëãîÓìàéí ëåéîìèîì õàâäðûí òýæýýã÷ àðòåðèéí ñóäñûã áºãëºæ ýì÷ëýõ ýì÷èëãýý íü ýìýãòýéí íºõºí ¿ðæèõ¿éí ÷àäâàðûã õàäãàëàõ ¿ð ä¿íòýé àðãà áîëîõûã øèíæëýõ óõààíû ¿íäýñëýëòýé òîãòîîõ

Çîðèëò: 1. Óìàéí ëåéîìèîì õàâäðûí òýæýýã÷

àðòåðèéí ñóäñûã áºãëºõ ýì÷èëãýýíèé äàðàà æèðýìñýí áîëñîí òîõèîëäëóóäûã ò¿¿âýðëýí ñóäëàõ

2. Æèðýìñýí áîëîí òºðºëòèéí ÿâöûã õÿíàæ, îíöëîãèéã òîäîðõîéëîõ

3. Ëåéîìèîì õàâäðûí áàéäàëä ¿íýëãýý ºãºõ

Ìàòåðèàë, aðãà ç¿é Ñóäàëãààã 2009-2012 îíû õóãàöààíä Óëààíáààòàð õîòîä Êëèíèêèéí Íýãä¿ãýýð àìàðæèõ ãàçðûí ýìýãòýé÷¿¿äèéí òàñàã, Îíîø ç¿éí òàñàã, Øàñòèíû íýðýìæèò III Íýãäñýí


ýìíýëãèéí Àíãèîãðàôèéí òàñàã, ÀØÓ¯ÈÑ- èéí ÀÓÑ-èéí Ýõ áàðèõ Ýìýãòýé÷¿¿ä ñóäëàëûí òýíõèì äýýð õèéñýí. Ñóäàëãààíä õàìðàãäñàí õ¿ì¿¿ñýýñ ÀØÓ¯ÈÑ-èéí Àíàãààõ Óõààíû ¨ñ Ç¿éí Õÿíàëòûí Õîðîîíû 2010 îíû 6 ñàðûí 4-íèé №81/19òîãòîîëûí äàãóó ”Òàíèóëñàí çºâøººðëèéí õóóäàñ”-ààð çºâøººðºë àâ÷ ñóäàëãààã ýõë¿¿ëñýí. Ñóäàëãààíä áèä 2009-2012 îíä øèíæ òýìäýã á¿õèé ëåéîìèîì õàâäàðòàé 23-50 íàñíû (40,89±2,00) 40 ýìýãòýéä õàâäðûí òýæýýã÷ ñóäñûã áºãëºæ ýì÷èëñýíèé äàðàà æèðýìñýëñýí 8 òîõèîëäëûã õàìðóóëæ òýäãýýð ýõ÷¿¿äèéí æèðýìñíèé ÿâö, òºãñãºë áîëîí òºðºëòèéí ÿâöûã äàãàæ õÿíàí ¿ð ä¿íã òîîöñîí áîëíî. Ëåéîìèîì õàâäðûí òýæýýã÷ àðòåðèéí ñóäñûã áºãëºõ ýì÷èëãýý õèéõýýñ ºìíº íèéò 40 ýìýãòýéä áèä ªìíºä Ñîëîíãîñ Óëñàä ¿éëäâýðëýñýí MedisonX8 ºíãºò Äîïïëåðòîé ¿òðýýíèé ÅÑ 4-9 Ìãö ¿¿ñãýí á¿ðòãýã÷ýýð óìàéí õýìæýý áîëîí õàâäðûí çàíãèëààíû áàéðøèë, õýìæýý, ñóäàñæèëò ìºí ýìýãòýé÷¿¿äèéí áóñàä õàâñàðñàí ýìãýã áèé ýñýõèéã õýò àâèàí øèíæèëãýý õèéæ òîäîðõîéëñíû äàðàà àðòåðèéí ñóäàñ áºãëºõ ýì÷èëãýýã õèéñýí. Ëåéîìèîì õàâäðûí òýæýýã÷ àðòåðèéí ñóäàñ áºãëºõ ýì÷èëãýýã ðåíòãåí ìýñ çàñëûí òóñãàéëàí òîíîãëîãäñîí ºðººíä Philips ôèðìèéí digital subtraction ä¿ðñëýë ïðîãðàììòàé Polydiagnost C-2 àíãèîãðàôèéí àïïàðàò äýýð ºâ÷òºíèé áàðóóí õºëèéí ãóÿíû ºíãºö àðòåðèéí õ¿ðöýýð óìàéí õî¸ð òàëûí àðòåðèéí ñóäñààð Cobra 4Fr áîëîí Roberts Uterine curve (COOK ôèðì, ÀÍÓ) êàòåòåðûã àøèãëàí óñàíä óóñäàã, îñìîñûí áàãà æèíòýé, ðåíòãåí òîäðóóëàã÷ (óëüòðàâèñò-300, Ãåðìàí) óóñìàëààð àðòåðèîãðàôè õèéí õàâäðûí òýæýýã÷ àðòåðèéí ñóäñûã òîäðóóëàí âèäåî áè÷ëýã õèéæ ðåíòãåí õÿíàëòûí äîð PVA-300, 500 íì (COOK ôèðì, ÀÍÓ) áºãëºã÷ áîäèñîîð

áºãëºí ñòàíäàðò àðãà÷ëàëûí äàãóó àìæèëòòàé õèéæ ã¿éöýòãýñýí.Ýì÷èëãýý õèéñíýýñ õîéø 6,9,12,24 ñàðûí äàðàà äàâòàí õýò àâèàí øèíæèëãýý õèéæ õàâäðûí õýìæýýíèé áàãàñàëòûã òîäîðõîéëæ, òóñãàé áîëîâñðóóëñàí àñóóìæààð ñýòãýë õàíàìæèéí áàéäëûã ñóäàëñíààñ ãàäíà áèä ýìýãòýé÷¿¿äýä ýì÷èëãýýíýýñ õîéø 6 ñàðààñ äýýø õóãàöààíû äàðàà æèðýìñëýõ òàëààð çºâëºëãºº ºãñºí. Ëåéîìèîì õàâäðûí òýæýýã÷ ñóäàñ áºãëºõ ýì÷èëãýý õèéëãýñýí íèéò 40 ýìýãòýéãýýñ æèðýìñýí áîëîõûã õ¿ññýí 31 (77.5%) ýìýãòýéí 8 (25,8%) íü õýâèéí áàéäëààð æèðýìñýëñýí.

¯ð ä¿í

Ëåéîìèîì õàâäðûí òýæýýã÷ ñóäàñ áºãëºõ ýì÷èëãýý õèéãäñýí 23-50 íàñíû (äóíäàæ íàñ 40,65) íèéò 40 ýìýãòýéí 31 (77,5%) íü íºõºí ¿ðæèõ¿éí ÷àäâàðàà õýâýýð õàäãàëæ ¿ëäýõ õ¿ñýëòýé áàéñàí áºãººä ¿¿íýýñ 23-42 (äóíäàæ íàñ 35) íàñíû 8 (25,8%) ýìýãòýé áºãëºõ ýì÷èëãýý õèéëãýñíýýñ õîéø 6-27 ñàðûí äàðàà õýâèéí áàéäëààð àÿíäàà æèðýìñýëæ 5 ýìýãòýé òºðæ 3 ýìýãòýé òóñ á¿ð 1-2 óäàà ººðèéí õ¿ñýëòýýð ¿ð õºíä¿¿ëñýí áàéíà.

Ëåéîìèîì õàâäàðòàé ãýñýí îíîøòîé ýì÷ë¿¿ëæ áàéñàí õóãàöààã àæèãëàõàä 3 ñàðààñ 8 æèë ¿ðãýëæèëæ, äýýðõ õóãàöààíä 2 ýìýãòýé ìèîìýêòîìè ìýñ çàñàë õèéëãýæ áàéæýý.

Ñóäàëãààíä õàìðàãäñàí 8 ýõèéí íýã íü îãò æèðýìñýëæ áàéãààã¿é, 2 íü íýã óäàà æèðýìñýëæ ¿ð õºíä¿¿ëñýí, 5 ýõ õî¸ð áîëîí çóðãàà ò¿¿íýýñ îëîí æèðýìñýëæ áàéñàí, 4 ýìýãòýé äàâòàí òºðºã÷, 4 ýìýãòýé àíõíû òóëãàð òºðºã÷ áàéëàà. Äýýðõ 8 ýìýãòýéí 60 õóâü óðüä íü ¿ð õºíä¿¿ëæ áàéñàí áàéíà. Áèåèéí æèíãèéí õóâüä ýìýãòýé÷¿¿äèéí 65 õóâü íü õýâèéí (ÁÆÈ=18,9-24,9) áàéñàí (Õ¿ñíýãò 1).

Table 1. Basical characteristics all subjects (n=8)

Age(years)

Education No of Pregnancy

No ofParity

Previousabortion

BMI(kg/m2)

Duration of fibroid(months)

Prior treatment

42 High 2-3 2-3 - 24,4 18 Hormone33 High 4-5 2-3 2-3 22.0 7 None23 High - - - 20,2 12 None26 Second 1 - 1 18,6 18 None39 High 2 - 1 23,4 3 None39 High 6 and

above2-3 2-3 25,4 60 Myomectomy

38 High 1 - 1 25 96 Myomectomy40 Second 4-5 2-3 2-3 24,3 12 Hormone


Æèðýìñëýñýí 8 ýìýãòýéí 6 òîõèîëäîëä ºâäºëò, ñàðûí òýìäýã èõ èðýõ, öóñ áàãàäàëò çýðýã çîâèóðòàé áàéñàí áîë 2 ýìýãòýé íü çîâèóðã¿é áàéëàà. Ìèîìûí çàíãèëààã áàéðøëààð íü ¿çâýë ñàëñòûí äîð 2, áóë÷èí äóíä 2, ãÿëòàíãèéí äîð 3, áóë÷èí äóíäààñ ãàäàãø óðãàëòòàé 1 áàéñàí áîë òîî øèðõýãèéí õóâüä õàìãèéí îëîí íü 8 øèðõýã, ¿ëäñýí íü 1-2 øèðõýã, õàìãèéí òîì äîìèíàíò çàíãèëàà 88ñì3 õàìãèéí æèæèã çàíãèëàà íü 14ñì3

õýìæýýòýé (äóíäàæ 50cm3) áàéñàí áàéíà.

2 òîõèîëäîëä ñàëñòûí äîîðõ ìèîìûí çàíãèëàà òîäîðõîéëîãäñîí áàéñíààñ 1 òîõèîëäîë íü õýìæýýãýýð æèæãýð÷ àðèëñàí áà íºãºº íü ¿òðýýãýýð ò¿ðæ ãàðñàí. Ýì÷èëãýýíèé äàðàà ýìýãòýé÷¿¿äèéí ñýòãýë õàíàìæ ñàéí ¿ç¿¿ëýëòòýé áàéñíààñ ãàäíà ºâäºëò áîëîí ñàðûí òýìäýã èõ èðýõ çîâèóðóóä 98-100 õóâü àðèëñàí, óìàé äóíäæààð 60 õóâèàð (158ñì3-63cm3) áàãàññàí, õàâäðûí õýìæýý ýì÷èëãýýíèé ºìíºõººñ äóíäæààð 94 õóâèàð (50ñì3-3ñì3) æèæãýðñýí áàéíà (Õ¿ñíýãò 2).

Table 2. Clinical characteristics of fibroids before and after UAE (n=8)

Localizationof fibroids

No of fibroids

Complicationsof patients

Size of fibroids cm3

(before)

Size of fibroids

cm3

(after6m)

Size of fibroids cm3

(after12m)

Size of fibroidscm3

(after24m)

Intramural 8 Pain 88 31 26 6Intramural 1 Pain and

hyperpolymen57 4 1 -

Subserosalintramural

2 Anaemia andhyperpolymen

58 8 3 -

Subserosal 2 No 48 6 2 -Subserosal 1 No 54 35 21 20Subserosal 3 Pain and

hyperpolymen27 17 8 5

Submucosal 1 Pain andhyperpolymen

54 Expulsion - -

Submucosal 1 Hyperpolymen 14 2 - -

Æèðýìñíèé ÿâöàä 2 ýõýä ýðò ¿åä óðàã çóëáàõààð çàâäàõ çîâèóð èëýð÷, 1 ýõ æèðýìñíèé õîæóó õóãàöààíä äóòóó òºðºõººð çàâäàí ýì÷èëãýý õèéãäñýí áºãººä 1 òîõèîëäîëä èõýñ ò¿ð¿¿ëýõ ýìãýã ¿¿ññýí áàéíà. Õîæóó àíõàí òºðºã÷ íýã ýõýä æèðýìñíèé õîæóó õîðäëîãî õºíãºí õýëáýðýýð èëýðñýí.

Table 3. Characteristics of women who became pregnant after UAE Age at conception

End of Pregnancy

Neonate(weight and Apgar score)

Complication of Pregnancy

Complication of Labor

The way of Labor

42 Twice abortion - - - -33 Abortion

and labor3600gr, boy,7-8 score

None None Csection

23 Labor 2100gr,girl5-6 score

Threatened abortion, placenta praevia

HaemorragePreterm labor

Csection

26 Labor 3400gr,boy7-8 score

Threatened abortion,

None Vaginal delivery

39 Labor 3800gr,boy7-8 score

Threatened preterm delivery

None Csection

39 Abortion - - - -38 Labor 3000gr,boy

7-8 scoreMild preeclapmcia None Csection

40 Abortion - - - -

Æèðýìñëýëò íü òºðºëòººð òºãññºí 5 ýõèéã íàñíû õóâüä àâ÷ ¿çâýë 23-26 íàñíû òóëãàð òºðºã÷ áîëîí õîæóó íàñíû (38-39 íàñ) òóëãàð òºðºã÷ ýõ òóñ òóñ 2, îëîí æèëèéí äàðàà äàâòàí òºðºã÷ ýõ

1 áàéñàí áàéíà. 5 òºðºëòèéí 1 òîõèîëäîëä èõýñ ò¿ð¿¿ëýëòòýé öóñ àëäñàíû óëìààñ äóòóó òºðñºí áîë ¿ëäñýí 4 ýìýãòýéí æèðýìñëýëò ã¿éöýä òýýãäýæ 2500-3800 ãð (äóíäàæ 3,180±200ãð)


æèíòýé Àïãàðûí 7-9 áàëëòàé íÿðàé òºð¿¿ëñýí. Äóòóó òºðñºí íÿðàéí æèí 2100ãð áàéëàà (Õ¿ñíýãò 3). Õýëöýìæ Pron G et al Ontario UFE Colloborative Group ñóäàëñíààð 18-59 íàñíû 555 ýìýãòýéä ëåéîìèîì õàâäðûí òýæýýã÷ ñóäñûã áºãëºõ ýì÷èëãýý õèéñíèé äàðàà 24-42 íàñíû 24 ýìýãòýé æèðýìñýëñíèé 6 íü æèðýìñíèé ýðò ¿åä òàñàëäàæ 18 íü òºðñºí áàéíà. Òºðºëòèéí 9 òîõèîëäîëä òºðºõ çàìààð, 9 òîõèîëäîëä êåñàð ìýñ çàñëààð òºðæ 2 òîõèîëäîëä èõýñ ò¿ð¿¿ëýëò, 2 òîõèîëäîëä æèðýìñíèé àðòåðèéí äàðàëò èõäýëò, 4 íÿðàé áàãà æèíòýé òºðñºí ãýæ òýìäýãëýæýý.

Áèä õýäèéãýýð õàðüöàíãóé öººí õ¿íèéã õàìðóóëñàí áîëîâ÷ ýì÷èëãýý àìæèëòòàé ¿ð ä¿íòýé áîëñîí áà ýì÷èëãýýíèé äàðàà 25,5 õóâü (äóíäàæ íàñ 35) æèðýìñýëæ; 37,5 õóâü (äóíäàæ íàñ 40) ¿ð õºíä¿¿ëæ; 62,5 õóâü (äóíäàæ íàñ 31,8) òºðñºí áà æèðýìñíèé õóãàöààíä èõýñ ò¿ð¿¿ëæ öóñ àëäñàí 1 (20%) òîõèîëäñîí íü ýõ áàðèõûí åðäèéí îëîíëîãò òîõèîëääîã ò¿âøèíòýé (èõýñ ò¿ð¿¿ëýëò 5%, öóñ àëäàëò 17,6%) õàðüöóóëàõàä ºíäºð áàéñàí áîë àðòåðèéí äàðàëò èõäýõ, õàâàãíàõ çîâèóð 20% áàéãàà íü (8-18%) îéðîëöîî áàéâ. Æèðýìñíèé ýðò õóãàöààíä çóëáàõààð çàâäàõ (40%) áîëîí äóòóó òºðºõººð çàâäàõ (20%) õ¿íäðýë òîõèîëäñîí áàéíà. Áºãëºõ ýì÷èëãýýíèé äàðàà õàìãèéí îéðõîí íü 6 ñàð ò¿¿íýýñ õîéø 2 æèë 3 ñàðûí äàðàà æèðýìñýëñýí áà 1 ýìýãòýé îëîí æèëèéí äàðàà äàâòàí òºðºëò áàéñàí áîë áóñàä 4 ýìýãòýéí õóâüä àíõíû òºðºëò, 2 íü õîæóó àíõàí òºðºã÷èä (äóíäàæ íàñ 38,5) áàéëàà. Ãàäààäûí îðíû ñóäëàà÷äûíõààð áºãëºõ ýì÷èëãýýíèé äàðààõ æèðýìñëýëòèéí äóíäàæ íàñ 34 ò¿¿íýýñ äýýø áàéíà [15,16,17,18, 20]. Ýì÷èëãýýíèé äàðàà ºâäºëò áîëîí ñàðûí òýìäýã èõ èðýõ çîâèóðóóä 98-100 õóâü àðèëñàí, óìàé äóíäæààð 60 õóâèàð (158ñì3-63cm3) áàãàñ÷, õàâäðûí õýìæýý ýì÷èëãýýíèé ºìíºõººñ äóíäæààð 94 õóâèàð (50ñì3-3ñì3) æèæãýðñýí áàéíà. Robert L.Worthington-Kirsch íàðûí ñóäàëãààíä öóñ àëäàëò áîëîí ýðõòýí äàðàãäàë, ºâäºëòèéí çîâèóð 85-90 õóâü, áºãëºñíèé äàðààõ 3-6 ñàðûí õóãàöààíä óìàéí õýìæýý 60 õóâü, õàâäðûí õýìæýý 50-75 õóâü òóñ òóñ áàãàññàí òóõàé òýìäýãëýãäæýý. Ñóäàëãààíä õàìðàãäàãñàí ýõ÷¿¿äèéí 80 õóâü íü êåñàð ìýñ çàñëààð òºðñºí áºãººä ñóäëàà÷èä óã ýì÷èëãýýíèé äàðààõ òºðºëò êåñàð ìýñ çàñëààð òºãñºõ íü íèéò òºðºëòèéí êåñàðûí ò¿âøèíãýýñ èë¿¿ ºíäºð áàéäàã ãýæ ä¿ãíýñýí íü áèäíèé ñóäàëãààíû ¿ð ä¿íòýé èæèë áàéíà [20, 21, 22].

Ä¿ãíýëò:1. Ëåéîìèîì õàâäðûí òýæýýã÷ ñóäñûã áºãëºõ ýì÷èëãýý õèéãäñýí íèéò 40 ýìýãòýéí 31 (75,5%) íü íºõºí ¿ðæèõ¿éí ÷àäâàðàà õýâýýð õàäãàëæ ¿ëäýõ õ¿ñýëòýé áàéñàí áºãººä òýäãýýðýýñ 23-42 íàñíû (äóíäàæ íàñ 35) 8 ýìýãòýé (25,8%) æèðýìñýëñýí íü óìàéí ëåéîìèîì õàâäðûí ¿åä õàâäðûã òýæýýã÷ ñóäñûã áºãëºõ ýì÷èëãýý ¿ð ä¿íòýé áºãººä ýðõòýí õàäãàëàõ õ¿ñýëòýé öààøèä æèðýìñýëæ õ¿¿õýä òºð¿¿ëýõ ñîíèðõîëòîé ýìýãòýé÷¿¿ä óã àðãûã ñîíãîí õýðýãëýõ áîëîìæòîé áàéíà. 2. Æèðýìñëýñýí ýõ÷¿¿äèéí 60 õóâüä æèðýìñíèé ÿâöàä óðàã çóëáàõààð çàâäñàí, 20 õóâüä èõýñ ò¿ð¿¿ëñíèé óëìààñ òºðºëòèéã õóãàöààíààñ ºìíº øèéäñýí áàéíà. Æèðýìñýëñýí òîõèîëäëóóäûí 62.5 õóâüä òºðºëòººð òºãñºæ íýã (20%) ýõ òºðºõ çàìààð ººðºº òºðñºí áà áóñàä äºðâºí òîõèîëäîëä (80%) êåñàð ìýñ çàñëààð òºðºëò øèéäýãäñýí áàéíà. 3. Ëåéîìèîì õàâäðûí çàíãèëààíóóäûí õýìæýý ýì÷èëãýýíèé ºìíºõººñ äóíäàæààð 94 õóâèàð æèæãýðñýí áàéëàà.

Íîì ç¿é 1. Æàâ Á. Ýìýãòýé÷¿¿äèéí ºâ÷èí ñóäëàë.1998,

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2. ßíæèíñ¿ðýí Ä. Óìàéí õîðã¿é õàâäðûí ýì÷èëãýýíèé àñóóäàë. Ìàãèñòðèéí á¿òýýýëèéí õóðààíãóé,1993, õ.4

3. Íýðã¿é Á. Óìàéí õîðã¿é õàâäðûã õýò àâèàí øèíæèëãýýíèé àðãààð îíîøëîõóé. Ìàãèñòðèéí á¿òýýëèéí õóðààíãóé, 2006, õ. 3

4. Áîáðîâ Á.Þ, Àëèåâà À.À. Ýìáîëèçàöèÿ ìàòî÷íûõ àðòåðèé â ëå÷åíèè ìîèì ìàòêè (îáçîð ëèòåðàòóðû) 2003, ñ.1-3

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7. Oliver J. Selective embolization to control of massive hemorrhage following pelvic surgery. Am J Obstet Gynecol, 1979, №135, p.431-432

8. Ravina J, Merland J, Herbreteau D et al., Preoperative embolization of uterine fibroma. Preliminary results(10 cases) Letter in French. Presse Med.,1994, №23 ð.1540

9. Ravina J.H, Ciraru-Vigneron N, Aymard A, Ledre O, Herbreteau D, Merland J. Arterial Embolization of Uterine Myomata: Results of 184 cases. presentation at 10th anniversary


international conference for the society for minimally invasive therapy. 1998, MITAT, 7:26

10. Stewart E.A. Uterine fibroids, “Lancet”, 2001, 357:293-8

11. Robert L. Worthington-Kirsch, Uterine Artery Embolization: State of the Art. Semin Intervent Radiol. Mar 2004; 21(1): 37-42.

12. Jerzy A. Walocha, Adam J. Miodoński, Wojciech Szczepański, Janusz Skrzat,Jerzy Stachura. Two types of vascularisation of intramural uterine leiomyomata revealed by corrosion Folia Morphol. Vol. 63, No.1, p. 37-41

13. Sampson J. The blood supply of uterine myomata. Surg. Gynecol. Obstet. 1912, XIV, p. 215-234

14. Êavous Firouznia, Hossein Ghanaati. Pregnancy After Uterine Artey Embolization for Symptomatic Fibroids: A Series of 15 Pregnancies. AJR 2009;192: 1588-1592

15. Carpenter TT, Walker WJ. Pregnancy following uterine artery embolization for symptomatic fibroids: a series of 26 completed pregnancies. BJOG 2005; 112:321-325

16. Holub Z, Mara M, Kuzel D, Jabor A, Maskova J, Eim J. Pregnancy outcomes after uterine artery occlusion: prospective multicentric study. Fertil Steril 2008; 90:1886 -1891

17. Spies JB, Ascher SA, Roth AR, et al. Uterine artery embolization for leiomyomata. Obstet Gynecol 2001; 98:29-34

18. Pinto Pabón I, Magret JP, Unzurrunzaga EA, García IM, Catalán IB, Cano Vieco ML. Pregnancy after uterine fibroid embolization:follow-up of 100 patients embolized using tris-acryl gelatin microspheres. Fertil Steril. 2008 Dec;90(6):2356-60. Epub 2008, Mar

19. Tulandi T, Salamah K. Fertility and uterine artery embolization.Obstet.Gynecol. 2010 Apr; 115(4): 857-60.

20. Pron G, Mocarski E, Bennet J, Vilos G, Vanderburgh L, Ontario UFE Collaborative Group. Pregnancy after uterine embolization for leiomyomata: the Ontario multicenter trial. Obstet Gynecol. 2005; 105(1):67-76

21. Goldberg J, Pereira L, Berghella V. Pregnancy after uterine embolization. Obstet Gynecol. 2002; 100(5Pt1):869-72

Òàíèëöàæ íèéòëýõ ñàíàë ºãñºí:Àíàãààõûí øèíæëýõ óõààíû äîêòîð,

ïðîôåññîð Ò.Ýðõýìáààòàð


Ìîíãîë óëñûí áàðóóí á¿ñèéí ïåðèíàòàëü ýíäýãäëèéí ºíººãèéí áàéäàë

Ö.Ñîëîíãî1,Ç.Ãýðýëìàà2, Á.Áóðìààæàâ3

1 Õîâä ÁÎÝÒ, 2 ÀØÓ¯ÈÑ, 3ÝÌß, ÌÀÓÀ[email protected]

Abstract

Current situation of perinatal mortality inWest region of Mongolia

Ts.Solongo1, Z.Gerelmaa2, B.Burmaajav3

1Khovd Regional Diagnostic and treatment Center, 2National University of Medical Sciences, 3Ministry of Health, Mongolian Academy of Medical Sciences

[email protected]

BackgroundOne of the confronted problems of health branch of Mongolia is to confirm pregnancy and delivery to health of mother and baby and to decrease early neonatal mortality and stillbirth. Rate of perinatal mortality becomes real index of health and quality of health care. In the world more than 6 million perinatal mortality and 2.6 million stillbirths occur in 1000 birth every year. In Mongolia last year’s birth increases and perinatal mortality hasn’t been decreased yet. By 2013 perinatal mortality of country and aimag 14.4 per 1000 birth, in eastern and khangai and central regions and Ulaanbaatar (UB) city it is fewer than the above mentioned average, but the western region it is 17.5 or 3.1 î/

îî

higher than average rate.

Goal To study current situation of perinatal mortality in western region of Mongolia

Material and Methods On the base of statistical dates of perinatal mortality of Health indicators and dates of health authorities of western region of Mongolia in 2004-2013 we considered indications of stillbirth from 22 weeks of gestation and early neonatal mortality by trend criteria.

Results In the period of last 10 years in the western region of Mongolia totally 94810 mothers gave a birth, perinatal mortality is 2347 or 24.7 per 1000 birth. 57.7% of total perinatal mortality is stillbirth and 42.3% is early neonatal mortality. Among 5 aimags of region in Bayn-Ulgii stillbirth is the highest (77.2%), in Gobi-Altai aimag early neonatal mortality is the highest (70.3%). Dates show that perinatal mortality rate is different among western region’s aimags. Trends of Mongolian western region’s perinatal mortality rate till 2016 years will increase in Zavkhan aimag by 8.6, and in Khovd aimag by 0.9; and in other aimags will decrease.

Conclusion Although perinatal mortality decreases in western region of Mongolia, it is always higher than average rate of country. Therefore it is necessary to improve quality of antenatal and prenatal care. By doing this trend of increasing and decreasing will become stable and further it will be decreased.

Key words: Ðerinatal mortality, stillbirth, early neonatal mortality, trend, western region, Mongolia

Pp.49-52, Figures 4, References 12


Óäèðòãàë

Ìîíãîë óëñûí ýð¿¿ë ìýíäèéí ñàëáàðûí òóëãàìäñàí àñóóäàë, áîäëîãûí íýã íü æèðýìñëýëò, òºðºëòèéã ýõ õ¿¿õäèéí ýð¿¿ë ìýíäýä ¿ëýìæ íèéöñýí áàéäëààð òºãñãºõ, óðãèéí áà ýðò íÿðàé ¿åèéí ýíäýãäëèéã áóóðóóëàõ ÿâäàë þì. Ïåðèíàòàëü ýíäýãäëèéí ò¿âøèí íü àëèâàà óëñûí ýð¿¿ë ìýíäèéí òóñëàìæ, ¿éë÷èëãýýíèé ÷àíàðûí áîäèò ¿ç¿¿ëýëò áîëäîã.1 Äýëõèéä æèë òóòàìä 6 ñàÿ ãàðóé ïåðèíàòàëü ýíäýãäýë òîõèîëäîæ áàéãààãèéí 2.6 ñàÿ íü àìüã¿é òºðºëò áàéíà.2,3 Ìîíãîë óëñàä ñ¿¿ëèéí æèë¿¿äýä òºðºëò íýìýãäýæ, ïåðèíàòàëü ýíäýãäýë òóóøòàé áóóðàõã¿é áàéíà. 2013 îíû áàéäëààð ïåðèíàòàëü ýíäýãäëèéí óëñûí äóíäàæ ò¿âøèí 1000 íèéò òºðºëòºä 14.4 áàéãàà áà ç¿¿í, õàíãàéí, òºâèéí á¿ñýä äýýðõ äóíäæààñ äîîãóóð áàéõàä áàðóóí á¿ñýä 17.5 áóþó óëñûí äóíäàæ ¿ç¿¿ëýëòýýñ 3.1 ïðîìèëîîð ºíäºð áàéíà [4].

Ìàòåðèàë, àðãà ç¿é

Ñóäëàãààã ðåòðîñïåêòèâ çàãâàðààð ã¿éöýòãýñýí. Ìîíãîë óëñûí áàðóóí á¿ñèéí Áàÿí-ªëãèé, Ãîâü-Àëòàé, Çàâõàí, Óâñ, Õîâä àéìãèéí òºðºëòèéí áà ïåðèíàòàëü ýíäýãäëèéí 2004-2013 îíû ñòàòèñòèê òîîí ìýäýýëëèéã ÝÌß, òóõàéí àéìãèéí ìýäýýëëèéí íýãäñýí ñàíãààñ àâ÷ àøèãëàâ. Èíãýõäýý ÄÝÌÁ-ààñ ãàðãàñàí òîäîðõîéëîëòûã ¿íäýñëýí æèðýìñíèé 22 äîëîî õîíîãòîéãîîñ õîéø õóãàöààíä àìüã¿é òºðñºí áîëîí òºðñíèé äàðààõ ýõíèé 7 õîíîã õ¿ðòýëõ õóãàöààíä íàñ áàðñàí íÿðàéí ¿ç¿¿ëýëòèéã ò¿¿âýðëýæ, öóãëóóëñàí ìýäýýëëèéã excel, SPSS 19 ïðîãðàììóóäûã àøèãëàí ïåðèíàòàëü ýíäýãäëèéí ò¿âøèíã 1000 òºðºëòºä òîîöîæ, ïðîìèëîîð èëýðõèéëæ ãàðãàñàí áîëíî [5, 6, 7]

¯ð ä¿í

Ìîíãîë óëñûã ãàçàð ç¿éí á¿ñ÷ëýëýýð áàðóóí, òºâ, õàíãàéí, ç¿¿í á¿ñ, íèéñëýë ãýæ õóâààäàã áºãººä 100 000 õ¿í àìä íîîãäîõ òºðºëòèéí òîî Óëààíáààòàð õîòîä 2909, áàðóóí á¿ñýä 2757, õàíãàéí á¿ñýä 2703, òºâèéí á¿ñýä 2180, ç¿¿í á¿ñýä 2500 òóñ òóñ áàéíà. ¯¿íýýñ õàðàõàä áàðóóí á¿ñ òºðºëò ºíäºðòýé, òºðºëòèéí òîîãîîðîî íèéñëýëèéí äàðàà õî¸ðäóãààðò îðæ áàéíà (Çóðàã 1).

Figure 1. Comparison of perinatal mortality in western region with other regions of Mongolia,

2004-2013

Ïåðèíàòàëü ýíäýãäëèéí õàðüöóóëñàí ä¿íãýýð õóãàöààíû ýõíýýñ 2009 îí õ¿ðòýë áóóð÷ áàéñíàà 2009 îíîîñ äàõèí íýìýãäýæ, ñ¿¿ëèéí 2 æèëä áóóðàõ õàíäëàãàòàé ÷, 2013 îíä óëñ àéìãóóäûí äóíäàæ 14,4 áàéõàä áàðóóí á¿ñýä 17,5 áóþó áóñàä á¿ñýýñ ºíäºð áàéñààð áàéãàà íü òºâººñ õýò àëñëàãäñàí, äýä á¿òýö ìóó õºãæñºí ãýõ ìýò íèéãýì, ýäèéí çàñãèéí îëîí àñóóäàëòàé õîëáîîòîé áàéæ áîëîõ þì (Çóðàã 2).

Figure 2. Perinatal mortality Mongolia, by region, 2004-2013

Ìîíãîë óëñûí áàðóóí á¿ñýä 2004-2013 îíä íèéò 94810 ýõ òºðñíººñ ïåðèíàòàëü ýíäýãäýë 2347 òîõèîëäîë áóþó 1000 òºðºëòºä 24,75î/

îî áàéíà.

Íèéò ïåðèíàòàëü ýíäýãäëèéí 57,7%-èéã àìüã¿é òºðºëò, 42,3%-èéã ýðò íÿðàéí íàñ áàðàëò ýçýëæ áàéíà.

Áàðóóí á¿ñèéí àéìãóóäûí ïåðèíàòàëü ýíäýãäëèéí ò¿âøèí ñ¿¿ëèéí 10 æèëèéí äóíäàæ ¿ç¿¿ëýëòýýð á¿ñèéí õýìæýýíä áóóð÷ áàéãàà áîëîâ÷ á¿ñèéí àéìãóóäàä ÿëãààòàé áàéãàà íü àíõààðàë òàòàæ áàéíà. Òóõàéëáàë Áàÿí-ªëãèé àéìàãò àìüã¿é òºðºëò õàìãèéí ºíäºð 18,4% áóþó àéìãèéíõàà ïåðèíàòàëü ýíäýãäëèéí 77,2%-èéã ýçýëæ áàéõàä, Ãîâü-Àëòàé àéìàãò ýðò íÿðàéí ýíäýãäýë õàìãèéí ºíäºð 11,4î/

îî áóþó

àéìãèéíõàà ïåðèíàòàëü ýíäýãäëèéí 70,3%-èéã òóñ òóñ ýçýëæ áàéíà (Çóðàã 3).

2013201220112010200920082007200620052004

3000

2750

2500

2250

2000

1750

1500

Date

Birt

h ra

te

WesternCentralKhangaiEastern


Figure 3. Comparative result of perinatal mortality (PM), stillbirth (SB), early neonatal mortality

(ENM) in western region (2004-2013)

ÕýëöýìæÑóäàëãààãààð Ìîíãîë óëñûí áàðóóí á¿ñèéí 5 àéìãèéí ñ¿¿ëèéí 10 æèëèéí òºðºëòèéí íèéò òîî 94810 áàéãàà áºãººä ¿¿íýýñ 2347 ïåðèíàòàëü ýíäýãäýë òîõèîëäñîí áàéíà. Ïåðèíàòàëü ýíäýãäëèéí 54,7%-èéã àìüã¿é òºðºëò ýçýëæ áàéíà. ªºðººð õýëáýë 1000 òºðºëòèéí 13,6 íü àìüã¿é òºðæ áàéíà. Õàðèí ýðò íÿðàéí ýíäýãäýë ïåðèíàòàëü ýíäýãäëèéí 42.3%-èéã ýçýëæ, 1000 àìüä òºðºëòºä 9,4 òîõèîëäîë áàéãàà áà ñ¿¿ëèéí æèë¿¿äýä áàãà áàãààð áóóð÷ áàéãàà áîëîâ÷ òààòàé ¿ð ä¿í áèø þì[8].

Ñóäëàà÷ Merina Shrestha íàð (2012) Íåïàë äàõü Òðèáõóâàí èõ ñóðãóóëèéí ýìíýëýãò ºíãºðñºí 13 æèëèéí òóðø ãàðñàí ïåðèíàòàëü ýíäýãäëèéã ñóäëàõàä, íèéò 42746 òºðºëò á¿ðòãýãäñýíýýñ 921 ïåðèíàòàëü ýíäýãäýë ãàð÷ áàéñíû 50% íü àìüã¿é òºðºëò áàéæýý. Ìºí àìüã¿é òºðºëò 1000 òºðºëòºä 21.5 òîõèîëäîë, õàðèí ýðò íÿðàéí ýíäýãäýë 1000 àìüä òºðºëòºä 31 áàéñíàà 18 áîëòëîî áóóðñíûã ñóäëàæ ãàðãàñàí íü íÿðàéí ýðò ¿åä ¿ç¿¿ëýõ òóñëàìæèéí ÷àíàðò èõýýõýí àðãà õýìæýý àâñàí áàéæ áîëîõ þì. Äýýðõ ñóäàëãààíû ä¿íòýé õàðüöóóëàõàä áèäíèé ñóäàëãàà áîäèò òîîíû õóâüä ºíäºð ìýò áîëîâ÷, 1000 òºðºëòºä õàðüöóóëñàí ä¿íãýýðýý õàðüöàíãóé áàãà ýíäýãäýëòýé ãýæ ¿çýæ áîëîõîîð áàéíà. Ýíý íü õàíãàëòòàé ç¿éë áèø òóë áàðóóí á¿ñ íóòàãò ýõèéí æèðýìñíèé õÿíàëò, òºðëºã óäèðäàõ, òºðºõ ¿åä ¿ç¿¿ëýõ ýðò íÿðàéí íýí øààðäëàãàòàé òóñëàìæèéí ÷àíàðûã ýðc ñàéæðóóëàõ íü ç¿éòýé. Ó÷èð íü áàðóóí á¿ñ íóòàãò àìüã¿é òºðºëò ºíäºð áàéãàà íü òóõàéí àéìàãò õÿíàëòûí òîãòîëöîî õàíãàëòã¿é, õàðèí òºðñíèé äàðààõ ýðò íÿðàéí ýíäýãäýëä õ¿ðãýäýã ýðñäýë íü òºðëºã óäèðäàõ, ýðò íÿðàéä çàéëøã¿é ¿ç¿¿ëýõ òóñëàìæèéí ÷àíàðààñ øóóä õàìààðäãèéã ÄÝÌÁ-ûí çºâëºìæèä çààæ ºãñºí íü ¿¿íèé íîòîëãîî ãýæ ¿çýæ áàéíà.

Ýíýòõýã óëñûí Îðèññà ýìíýëýãò ÿâóóëñàí ñóäàëãààãààð òýä 10 æèëèéí õóãàöààíä ïåðèíàòàëü ýíäýãäýë 2002 îíä 70.2%-èéã ýçýëæ

áàéñàí áà ýíý ¿ç¿¿ëýëòèéã 43%-èàð áóóðóóëæ ÷àäñàí áàéíà. ¯¿íèé ó÷èð íü àìüã¿é òºðºõ, ýðò ýíäýõýýñ óðäü÷èëàí ñýðãèéëýõ àæëûã ñàéí ¿ð ä¿íòýé õèéñýí áàéíà. ¯¿íýýñ ¿çýõýä áèäíèé ñóäàëãààíû ä¿íãýýñ õàìãèéí ºíäºð ýíäýãäëèéí ó÷èð øàëòãààí, íºëººëëèéã äàðóé ñóäëàæ, ãîëëîí õýðýãæ¿¿ëýõ àðãà õýìæýý þó áîëîõûã òîãòîîõ íü äýýðõ ñóäëàà÷äûí ¿ð ä¿íä õ¿ðòýë áóóðóóëàõ ãàðö ãýæ ¿çëýý.

Êîñîâîãèéí õ¿¿õäèéí áîëîí èõ ñóðãóóëèéí ýìíýëýãò Mehmedali A., íàð (2012)-ûí õèéñýí ñóäàëãààãààð ïåðèíàòàëü ýíäýãäýë 1000 òºðºëò òóòàìä 2000 îíä 29,1 áàéñàí áîë 2011 îíä 14.8 áîëæ áóóðñàí, àìüã¿é òºðºëò 2000 îíä 14.5 %î, áàéñíàà 2011 îíä 11 áîëæ áóóðñàí ä¿íòýé áàéãàà íü áèäíèé ñóäàëãààãààð ãàðñàí áàðóóí á¿ñèéí Áàÿí-ªëãèé àéìãèéí ïåðèíàòàëü ýíäýãäýë 1000 òºðºëòºä 2004 îíä 49,6 áàéñíàà 2013 îíä 22.8 áîëæ áóóðñàí ñàéí ¿ð ä¿íòýé ä¿éæ áàéãàà áîëîâ÷ Ãîâü-Àëòàé àéìàãò ýðò íÿðàéí ýíäýãäýë õàìãèéí ºíäºð 11,4î/îî áóþó àéìãèéíõàà ïåðèíàòàëü ýíäýãäëèéí 70,3% áàéãàà íü Mîíãîë óëñ, áàðóóí á¿ñ äîòðîî õàìãèéí ºíäºð ýíäýãäýëòýé àéìàã õýâýýð áàéãààã õàðóóëëàà[10,11].

Ñóäëàà÷ Á.Ëóâñàí-¨íäîí íàðûí ýðäýìäèéí ñóäàëñíààð 1978 îíä Óëààíáààòàð õîòûí àìàðæèõ ãàçðóóäûí ïåðèíàòàëü íàñ áàðàëò 1000 òºðºëòºä 29, ¿¿íýýñ àìüã¿é òºðºëò 44.5%, ýðò íÿðàéí íàñ áàðàëò 55.5% òîõèîëäîæ12 áàéñíûã òîãòîîæýý. Ýíý ¿åä ýõèéí æèðýìñíèé òýýëòèéí òàëààñ ýðñäýë áàãàòàé, õàðèí òºðñíèé äàðààõ ýðò ¿åèéí òóñëàìæèéã ñàéæðóóëàõ àñóóäàë òóëãàìäàæ áàéñàí áàéíà. Õàðèí îð÷èí ¿åä ìàíàé óëñ, òýð òóñìàà áàðóóí á¿ñ íóòàãò àìüã¿é òºðºëòèéí ýçëýõ õóâü ïåðèíàòàëü ýíäýãäëèéí äèéëýíõ õóâèéã ýçýëæ áàéãàà íü òààã¿é ¿ð ä¿í þì. Ñóäëàãààíû ýíý ñýäâýýð ¿íäýñíèé õýìæýýíä õèéãäñýí ñóäàëãàà õàðààõàí áàéõã¿é áàéãààãààñ õàðàõàä öààøèä ïåðèíàòàëü ýíäýãäëèéí øàëòãààí, íºëººëºõ õ¿÷èí ç¿éëñèéã ¿íäýñíèé õýìæýýíä ñóäëàõ øààðäëàãàòàé áàéíà.

Ä¿ãíýëò: Ìîíãîë óëñûí áàðóóí á¿ñèéí ïåðèíàòàëü ýíäýãäýë áóóð÷ áàéãàà áîëîâ÷ óëñ àéìãèéí äóíäàæ ¿ç¿¿ëýëòýýñ ºíäºð áàéãàà ó÷èð æèðýìñíèé õÿíàëò áà ïåðèíàòàëü òóñëàìæèéí ÷àíàðûã ñàéæðóóëàõàä îíöãîé àíõààðàõ øààðäëàãàòàé áàéíà. Èíãýñíýýð áàãà ÷ ãýñýí ºñ÷, áóóðàõ õàíäëàãûã òîãòâîðòîé õàäãàëæ, óëìààð áóóðóóëàõ íºõöºë áîëíî.


Íîì ç¿é

1. Ýð¿¿ë ìýíäèéí Ñàéäûí 456 òîîò òóøààë “Ýõ, íÿðàéí ýð¿¿ë ìýíä” 2011-2015 îíû ñòðàòåãè, ÓÁ. 2010.

2. 2,6 million babies stillborn in 2009,WHO-lancet report “The Lancet” The Free Library 14 april 2011. 03 Lune 2012.

3. Ìºíõçóë Ñ. Àìüã¿é òºðºëòèéí øàëòãààí, õ¿÷èí ç¿éëñèéã ñóäëàõ àñóóäàëä, íýã ñýäýâò çîõèîë, ÓÁ, 2012. www.stf.mn/index.php?option=com_content&view=article ìàãèñòðûí çýðýã ãîðèëñîí á¿òýýë

4. Ýð¿¿ë ìýíäèéí ¿ç¿¿ëýëò¿¿ä. 2013. ÓÁ. x.15, 63-64

5. ×èìýäñ¿ðýí Î. Ýïèäåìèîëîãè. ÓÁ, 2008. õ.49-57.

6. Áàòçîðèã Á. Áèîñòàòèñòèê. ÓÁ 2011. õ.233-245.

7. Ýõ áàðèõûí ÿàðàëòàé, íÿðàéí íýí øààðäëàãàòàé òóñëàìæèéí ºíººãèéí áàéäàë, õýðýãöýýíèé ¿íýëãýý. 2010. õ.24; 32.

8. Ýð¿¿ë ìýíäèéí ¿ç¿¿ëýëò¿¿ä. 2004-2013. ÓÁ. õ.15, 63-64.

9. Shrectha M.,Shrectha L., Basnet S., Shrectha PS. Trends in Perinatal Mortality in Tribhuvan University Teaching Hospital: 13 Years Review, J. Nepal Paediatr.Soc, 2012. 32(2): 150-153.

10. Azemi, M.et al, Rate and time trend of perinatal, infant, maternal mortality, natality and natural population growth in kosovo, Mater Sociomed, 2012, 24(4): 238-241.

11. WHO Neonatal and perinatal mortality; country, regional and global estimates 2004. WHO Press; 2007. www.who.int/health info/morttables.

12. Ëóâñàí-¨íäîí,Á Óëààíáààòàð õîòûí àìàðæèõ ãàçðóóäûí ïåðèíàòàëü ¿åèéí íàñ áàðàëò, íýã ñýäýâò çîõèîë, ÓÁ, 1978. http://mongolmed.mn/uploads/editions/pdf/


Ã.Ýðäýíýòóÿà


Æèðýìñíèé òýýëòèéí ýðò õóãàöààíä ìîíãîë óðãèéí çóëàé, àõàð ñ¿¿ëíèé óðòûí õýâèéí õýìæýýã òîãòîîñîí íü

Î.Áàÿíæàðãàë, Ã.Ìýíäñàéõàí, Ö.ÝðäýìáèëýãÝð¿¿ë ìýíäèéí øèíæëýõ óõààíû ¿íäýñíèé èõ ñóðãóóëü

E-mail:[email protected]

Abstract

Estimation of nomograms according to Crown-Rump Lengthin Mongolian population

O.Bayanjargal, G.Mendsaikhan, Ts.ErdembilegHealth Sciences National University of Mongolia

E-mail:[email protected]

GoalThis study was performed to construct Mongolian ethnic specific crown-rump length (CRL) nomogram and to compare its ability to predict gestational age with previously published widely used nomograms in the world.

Materials and Methods A regression model was developed for estimation of gestational age using CRL measurements of 1170 singleton fetuses in the Mongolian population. Measurements were obtained by placing the calipers of the ultrasound machine from the crown to the rump. The appropriateness of previously established widespread CRL nomograms for predicting the gestational age was assessed in the Mongolian population to determine comparability between nomograms. ResultsCRL corresponds to other nomograms up to 9 weeks of gestational age. There is a 4-5mm difference of Robinson Hadlock; 7mm of Osaka at 10-12 weeks but the same with Campbell, 4 mm long of Campbell at 13 weeks.

Conclusions: CRL measurements are used as a reliable method for estimation of the gestational age as well as a baseline for comparing gestational ages later. CRL corresponds to other widely used nomogram up to 9 weeks gestational age. There is a 3mm differences of M.A.Esetov, 4-5mm Robinson, and Hadlock; 7mm of Osaka at 10-12 weeks but the same with Campbell, 4 mm long of Campbell at 13 weeks. Difference with the established nomograms may be due to ethnic differences of the Mongolian fetal development. After 13 weeks, CRL measurement is unreliable due to flexion of the fetus.

Keywords: Ultrasound, Gestational Age, Nomogram, Crown-Rump Length

Pp.53-56, Tables 2, Figure 1, Referneces 7

¯íäýñëýë1973 îíä ñóäëàà÷ Ðîáèíñîí æèðýìñíèé ýðò õóãàöààíä óðãèéí çóëàé àõàð ñ¿¿ëíèé óðòûã, 1975 îíä Êàìïâåë, Âèëêèí íàð óðãèéí õýâëèéí á¿ñë¿¿ðèéí õýìæýýãýýð óðãèéí áèîìåòðèéã òîäîðõîéëñîí íü æèðýìñíèé õóãàöàà, óðãèéí æèí, ºñºëòèéã ¿íýëýõ àíõíû àëõàìóóä áàéëàà. 1981-1984 îíû õîîðîíä Õýäëîê, áóñàä.. ñóäëàà÷èä óðãèéí áèîìåòðèéí õýìæýýñ¿¿äýä ñóóðèëàí óðãèéí æèíã òîîöîîëîí ãàðãàñàí íü îäîî õ¿ðòýë äýëõèé íèéòýä ºðãºí õýðýãëýãääýã

ëàâëàãàà õýìæýý áîëñîîð áàéíà. Ãýõäýý Õýäëîê áîëîí áóñàä ñóäëàà÷äûí ãàðãàñàí ºñºëòèéí ìóðóé íü Åâðîï æèðýìñýí ýìýãòýé÷¿¿äèéí óðãèéí õýìæýýñò ñóóðèëñàí ëàâëàãàà òóë áóñàä óëñ îðîíä õýðýãëýõ áîëîìæ áàãàòàé, óãñàà ç¿éí õóâüä óðãèéí æèí õîîðîíäîî ÿëãààòàé áàéäàã íü ñóäàëãààãààð áàòëàãäñàí áàéíà [1].

Äýëõèéí ýð¿¿ë ìýíäèéí áàéãóóëëàãààñ ãàðàãñàí çºâëºìæèä óðãèéí ºñºëò íü ¿íäýñòýí ÿñòàí, òóõàéí àðä ò¿ìíèé óãñàà ç¿é, àìüäðàõ ãàçàð


íóòàã, õýðýãëýäýã õîîë òýæýýëýýñ õàìààðàí ÿëãààòàé áàéäàã òóë óðãèéí ºñºëò, õºãæèëòèéã õýò àâèàí øèíæèëãýýãýýð ¿íýëýõäýý òóõàéí ¿íäýñòíèé ñòàíäàðò õýìæýýñèéã àøèãëàæ áàéõûã çºâëºæýý [2-5].

Ñóäëàà÷ Ã.Ìýíäñàéõàí (2011) æèðýìñíèé òýýëòèéí 15-40 äîëîî õîíîãòîé óðãèéí áèîìåòðèéí ºðãºòãºñºí õýìæýýñ¿¿äèéã òîãòîîñîí íü ìîíãîë õ¿íèé áèîëîãèéí ìýäýýëëèéí ñàíä ¿íýòýé õóâü íýìýð áîëñîí òºäèéã¿é ýìíýë ç¿éí ïðàêòèêò óðãèéí õºãæëèéí õîæóó õóãàöààíû ýìãýãèéã èëð¿¿ëæ îíîøëîõîä ñóóðü ìýäýýëýë áîëîí àøèãëàãäàæ áàéíà.

Æèðýìñíèé òýýëòèéí ýðò õóãàöààíä îíîøëîãäîõ áîëîìæòîé óðãèéí õºãæëèéí òºðºëõèéí ýìãýã¿¿ä (18 äóãààð õðîìîñîìûí ãóðâàëä 30%, 13 äóãààð õðîìîñîìûí ãóðâàëä 40%)-èéã ýðò èëð¿¿ëýõ, óðãèéí àìüäðàõ ÷àäâàðûã ¿íýëýõ, 15 äîëîî õîíîãîîñ ºìíºõ óðãèéí õºãæèë áàðèãäàõ õàì øèíæèéã îíîøëîõ, æèðýìñíèé òýýëòèéí õóãàöààã íàðèéâ÷ëàëòàé òîãòîîõ, èõýð æèðýìñíèé èõýñ, àìíèîí á¿ðõ¿¿ëèéí òîîã íàðèéâ÷ëàí òîãòîîõîä Ìîíãîë óðãèéí áèîìåòðèéí õýâèéí ñóóðü ¿ç¿¿ëýëòèéã òîãòîîõ íü ýõ áàðèõûí ïðàêòèêò ÷óõàë à÷ õîëáîãäîëòîé áàéíà [1, 6-7].

ÇîðèëãîÝð¿¿ë Ìîíãîë ýìýãòýéí æèðýìñíèé òýýëòèéí ýðò ¿åä óðãèéí çóëàé àõàð ñ¿¿ëíèé óðò (ÓÇÀÑÓ)-ûí õýâèéí õýìæýýã òîãòîîõ

Ìàòåðèàë, àðãà ç¿éÑóäàëãààã àíàëèòèê ñóäàëãààíû íýã àãøèíãèéí àðãààð çîðèëãî, õ¿ëýýãäýæ áóé ¿ð ä¿íòýé óÿëäóóëàí 2012 îíû 12 äóãààð ñàðààñ 2014 îíû 4 ñàð õ¿ðòýë ÊÍÀÃ-ûí àìàðæèõ ãàçðûí àìáóëàòîðè, Ãóðâàí ãàë, Ñîðîãçîí ýìíýëýãò õýò àâèàí øèíæèëãýý õèéëãýõýýð èðñýí, òºðºõ (15-49) íàñíû 1170 ýìýãòýéã õàìðóóëëàà.

Õýò àâèàí øèíæèëãýýã ªìíºä Ñîëîíãîñ óëñàä ¿éëäâýðëýñýí Sonoace Õ8 3/4D, Accuvix V20, Accuvix A30, ßïîí, Ãåðìàí óëñûí õàìòàðñàí ¿éëäâýðèéí Ìî÷èäà Ñèåìåíñ Ñîíîâèñòà Õ500 4D àïïàðàò áîëîí C6-2 õýâëèéí, áîëîí EC 4-9 ¿òðýýíèé, C7F2 4D ¿¿ñãýí á¿ðòãýã÷èéí òóñëàìæòàéãààð õèéæ ã¿éöýòãýâ.

Óðãèéí çóëàé-àõàð ñ¿¿ëíèé óðò (ÓÇÀÑÓ)-ûã õýìæèõäýý õýâëèéí áîëîí ¿òðýýí ìýäð¿¿ëýýð ¿ð õºâðºëèéã îëæ, óðãèéí ç¿ðõíèé ëóãøèëò õàðàãäàõ õ¿ðòýë ààæèì ãóëñóóëàí, ç¿ðõíèé ëóãøèëòûã õàäãàëàí ¿¿ñãýí á¿ðòãýã÷èéã ààæèì ýðã¿¿ëýí óðãèéí äàãóó ç¿ñëýãò õàìãèéí óðò õýìæýý ãàðñàí ¿åä ä¿ðñèéã äýëãýö äýýð çîãñîîí õýìæèëòèéí òýìäãèéã óã ä¿ðñèéí õî¸ð òàëûí àëñëàãäñàí öýãò áàéðëóóëàí õýìæèëòèéã õèéëýý. Õýìæèëòèéí àëäààíààñ çàéëñõèéõèéí òóëä ñóäàëãààã ýõ áàðèõ, ýìýãòýé÷¿¿äèéí õýò àâèàí ÷èãëýëýýð ìýðãýøñýí ýì÷ õýìæèëòèéã ãóðàâ áà ò¿¿íýýñ äýýø õèéæ äóíäàæààð íü òîîöëîî. Õýìæèëò, àñóóëãà ñóäàëãààíû ä¿íã ñóäëàà÷ áà õºíäëºíãèéí ñóäëàà÷ äàâõàð õÿíàæ òîîí ìýäýýã áîëîâñðóóëàõäàà ñòàòèñòèêèéí õýðýãëýýíèé “SPSS-21”, Å-views áîëîí “Windows Excel ïðîãðàììóóäûã àøèãëàí òîîöîî, øèíæèëãýýã õèéëýý. Óðãèéí çóëàé-àõàð ñ¿¿ëíèé óðòûí õýìæýýã ðåãðåññèéí çàãâàðò îðóóëàí ¿ç¿¿ëýëòèéã òîîöëîî.

¯ð ä¿í Ñóäàëãààíä íèéò 1170 õàðüöàíãóé ýð¿¿ë 17-41 íàñíû æèðýìñýí ýõ÷¿¿ä õàìðàãäñàí. Ýõ÷¿¿äèéí äóíäàæ íàñ 29±6.4, 80.2% íü õàëõ ìîíãîë, 44.3% íü Óëààíáààòàð õîòûí óóãóóë èðãýä áàéâ. Æèðýìñýí ýõ÷¿¿äèéí 51.0 % íü äýýä, 48.0% íü äóíä áîëîâñðîëòîé, 96.0% íü ýíãèéí íºõöºëä àæèëëàäàã áàéëàà.

Ñóäàëãààãààð òîãòîîñîí ÓÇÀÑÓ-ûã æèðýìñíèé òýýëòèéí 5+5-13+6 äîëîî õîíîãèéí õîîðîíä ºäºð á¿ðýýð áóþó íèéò 58 õîíîãîîð òîîöîí 5, 50, 95 äàõü ïðîöåíòèëîîð ¿íýëæ, äîëîî õîíîã òóòàìä íýãòãýñíèéã 1-ð õ¿ñíýãòýýð õàðóóëàâ (Table 1).

Table 1. Important Percentile Values of CRL in Different Gestational Weeks

Gestational age Percentile

5 50 95

5.5-5.6 3 3 56-6.6 3 7 87-7.6 8 12 148-8.6 12 19 289-9.6 20 27 3810-10.6 28 36 4711-11.6 41 52 6612-12.6 57 65 8713-13.6 68 80 95


Æèðýìñíèé òýýëòèéí 5+5-9+6 äîëîî õîíîãò óðãèéí çóëàé àõàð ñ¿¿ëíèé óðò äîëîî õîíîã òóòàìä îéðîëöîî õóðäòàé, 10 äîëîî õîíîãòîéãîîñ õîéø îãöîì íýìýãäýõ õàíäëàãàòàé áàéëàà. ¯ð ä¿íã ðåãðåññèéí çàãâàð àøèãëàí 95%-èéí èòãýõ ìàãàäëàëààð øàëãàõàä R2=94.0-96.7% áóþó õ¿÷òýé õàìààðàëòàé áàéíà (Figure 1).

y = 1.301x - 9.754 R² = 0.94

y = 1.473x - 7.555 R² = 0.964

y = 1.829x - 7.785 R² = 0.967

0

10

20

30

40

50

60

70

80

90

100

Cro

wn

rum

ph le

ight

(CR

L), m

m

Gestation age

5th percentile

50th percentile

95th percentile

Õýëöýìæ

Áèäíèé ñóäàëãààíààñ ãàðñàí ¿ð ä¿íã óãñàà ç¿éí õóâüä ÿëãààòàé óðãóóäûí ÓÇÀÑÓ –òàé õàðüöóóëëàà (Table 2). ÓÇÀÑÓ-ûã Àçè òèâèéã òºëººë¿¿ëýí ßïîíû Îñàêà, ãàçàð íóòãèéí îéðîëöîîõ áàéäëûã õàðãàëçàí Ñèáèðü îð÷ìûí Ýðõ¿¿ãèéí á¿ñ, Àìåðèêèéí ñóäëàà÷ Ðîáèíñîí, Ôëåìèíã ìºí äýëõèéä òàðõìàë õýðýãëýãääýã Õýäëîê, Àâñòðàëèéí Êàìïâåë íàðûí ãàðãàñàí ñóäàëãààíû ¿ð ä¿íòýé õàðüöóóëæ ñóäàëëàà..

Table 2. Comparison of CRL in Correlation with GA in Different Studies

Gestationalage

CRL 50th Percentile [mm] Gestational age

CRL 50th Percentile [mm]

1 2 3 4 5 6 1 2 3 4 5 65.5 2.8 2 3 10 32 31 31 30 32 345.6 3.2 3 4 10.1 33.6 32 32 32 34 366 3.9 5 4 10.2 34.4 33 34 33 35 37

6.1 5.1 4 6 5 10.3 35.6 35 35 35 37 386.2 5.6 6 5 6 6 10.4 37.2 36 36 37 34 396.3 6.2 6 6 7 7 10.5 40.2 37 38 38 40 396.4 6.8 7 7 8 8 10.6 40.8 39 40 40 41 406.5 8.7 8 8 8 9 11 42.4 40 41 42 43 446.6 9.3 8 9 9 10 11.1 47.8 42 42 43 44 457 9.5 9 10 10 11 11.2 50.8 44 43 45 46 47

7.1 9.5 10 11 9 10 11 11.3 53.5 45 46 47 48 487.2 10.9 10 11 11 12 11.4 54.2 47 47 48 49 527.3 12.6 11 12 10 12 12 11.5 55.4 48 49 49 51 557.4 12.7 12 13 11 13 13 11.6 56.6 50 51 51 53 567.5 13.5 13 14 14 14 12 57.6 54 53 577.6 14.3 14 15 12 15 15 12.1 63.1 55 55 588 16.2 15 16 13 16 17 12.2 64.1 56 57 60

8.1 17.4 16 17 14 17 18 12.3 64.8 59 59 618.2 18.3 17 18 15 18 19 12.4 65.7 62 60 638.3 18.3 18 19 16 19 20 12.5 68.3 63 62 648.4 19.1 19 20 17 20 21 12.6 70.9 66 63 658.5 21.4 20 21 18 21 22 13 74.5 67 688.6 21.9 21 22 19 22 22 13.1 77 68 709 22.7 22 23 21 23 23 13.2 79.1 70 72

9.1 23.9 23 24 22 24 24 13.3 79.9 71 749.2 25.3 24 25 23 26 26 13.4 81.6 73 769.3 27.8 25 26 25 27 27 13.5 83.4 76 779.4 28 27 27 26 28 28 13.6 84.5 79 809.5 29.3 28 28 27 30 299.6 30 29 29 31 31

1-Current study, 2-Robinson, 3- Hadlock, 4-Osaka, 5-M.A.Esetov, 6-ASUM, Campbell

Figure 1. Regression Model for Predicting Fetal CRL Parameters from Gestational Age


Áèäíèé ñóäàëãààíä ÓÇÀÑÓ íü æèðýìñíèé òýýëòèéí 9 äîëîî õîíîã õ¿ðòýë áóñàä ñóäëàà÷äûíõòàé àäèë, 10-12 äîëîî õîíîãòîéä Àâñðàëèéí Êàìïâåëèéíõòýé îéðîëöîî; Õýäëîê, Ðîáèíñîí íàðûíõààñ 4-5ìì, Ì.À.Ýñåòîâûíõààñ 3ìì õàðèí Îñàêà-èéíõààñ 7ìì óðò; 13 äîëîî õîíîãòîéä Êàìïâåëèéíõýýñ 4ìì, Õýäëîêèéíõîîñ 5 ìì-ýýð óðò áóþó ñòàòèñòèêèéí ÿëãààòàé áàéãàà íü áàòëàãäëàà (p=0.0001).

Áèäíèé ñóäàëãààãààð ãàðãàñàí æèðýìñíèé òýýëòèéí ýðò ¿åèéí óðãèéí çóëàé àõàð ñ¿¿ëíèé óðò íü Àâñòðàëè óëñûí ýõîíû íèéãýìëýã (ASUM)-ýýñ ãàðãàñàí ºñºëòèéí ìóðóéòàé îéðîëöîî áàéãàà òóë Êàìïâåëèéí õ¿ñíýãòèéã õýðýãëýõ íü æèðýìñíèé õóãàöààã íàðèéâ÷ëàë ñàéòàé òîäîðõîéëîõîä õàðüöàíãóé àëäàà áàãàòàé õýìæèãäýõ¿¿íä òîîöîãäîæ áàéíà.

Ä¿ãíýëòÆèðýìñíèé òýýëòèéí 5+5-13+6 äîëîî õîíîãòîé óðãèéí çóëàé àõàð ñ¿¿ëíèé óðòûã äîëîî õîíîã á¿ðýýð òîäîðõîéëîâ. Æèðýìñíèé òýýëòèéí 9 äîëîî õîíîã õ¿ðòýë õóãàöààíä Ìîíãîë óðãèéí çóëàé àõàð ñ¿¿ëíèé óðò áóñàä ¿íäýñòýíòýé îéðîëöîî áîëîâ÷ ¿¿íýýñ äýýø õóãàöààíä õàðüöàíãóé óðò áàéãàà íü òîãòîîãäëîî.

Íîì ç¿é 1. Graham Keith Parry, Ethnic and Maternal

Determinants of Fetal Growth in Normal Pregnancies, Thesis for the degree of MD at the University of Auckland 2011, õ.1-50

2. Ìýíäñàéõàí Ã, Ýð¿¿ë æèðýìñýí ýõ÷¿¿äèéí èõýñ-óðãèéí òîãòîëöîîíû õýò àâèàí øèíæèëãýýíèé õýâèéí ¿ç¿¿ëýëò, ÀÓ äîêòîðûí çýðýã (Ðh.D) ãîðèëñîí íýã ñýäýâò á¿òýýë, 2011, õ. 21-24

3. Kypros H. Nicolaides, The 11-13+6 weeks scan. Fetal Medicine Foundation, London 2004, õ.7-58

4. F. Gary Cunningham. et al. Williams Obstetrics 21st Edition, 2002, õ.745-757

5. De Mucio B., Martinez G. CLAP/WR-PAHO/WHO, Monitoring fetal growth, 2011, õ. 9-11

6. Ï.Äåìèäîâ Â.Í. Óëüòðàçâóêîâàÿ äèàãíîñòèêà ãàñòðîøèçèñà â ðàííèå ñðîêè áåðåìåííîñòè, Ïðåíàò. Äèàãí. 2004, õ.257-260.

7. Ýñåòîâ Ì.À. Îïûò ðàçðàáîòêè ðåãèîíàëüíûõ ïðîöåíòèëüíûõ ïîêàçàòåëåé êîï÷èêî-òåìåííîãî ðàçìåðà ýìáðèîíà/ïëîäà, Ïðåíàòàëüíàÿ äèàãíîñòèêà, 2003, 2, õ.125-129

Òàíèëöàæ, íèéòëýõ ñàíàë ºãñºí:

Àíàãààõ óõààíû äîêòîð, ïðîôåññîð

Ä.Ìºíõöýöýã


Óëààíáààòàð õîòûí õ¿í àìûí äóíä óëèðëûí ÷àíàðòàéñýòãýë ãóòðàëûã ñóäàëñàí ä¿í

Ó.×èìýäöýðýí1, Ã.Ñ¿õáàò2, Á.Áààñàíæàðãàë2

1Õàâäàð ñóäëàëûí ¿íäýñíèé òºâ, 2 ÀØÓ¯ÈÑ, Áèî-Àíàãààõûí ñóðãóóëüe-mail: [email protected]

Abstract

A study result of the seasonal affective disorder in the population of Ulaanbaatar city

Chimedtseren U1, Sukhbat G2, Baasanjargal B2, 1National Cancer Center, 2Mongolian Natioanal University of Medical Sciences, School of Bio-Medicine

e-mail: [email protected] IntroductionThe degree to which the change of season influences mood, energy, sleep, appetite, food preference, and the wish to socialize has been called “seasonality” [1]. In 1984 Rosenthal and associates described the syndrome of “seasonal affective disorder” (SAD), a condition where depressions in fall and winter alternate with non-depressed periods in the spring and summer [5]. Seasonal Affective Disorder (SAD) is supposed to be caused by lack of daylight in winter [6]. Ulaanbaatar city is the coldest capital in compared with medium temperature of the world. That’s why, it is an idea that we supposed to there might be a seasonal affective disorder in this city. There is nothing to be studied before related to this topic and that is our goal of the study.

GoalTo determine a seasonal affective disorder in the adults of Ulaanbaatar city

Materials and MethodsIn this study, we examined 560 healthy people between 20-60 aged livings in the Ulaanbaatar city using by Seasonal Pattern Assessment Questionnaire. ResultGender distribution showed an increased incidence of females (56.1%, 314 cases) compared with male (43.9%, 246 cases). Distribution by age groups shows that 20-29 years were 237 (42.3%), 30-39 years were 99 (17.6%), 40-49 years were 132 (23.5%), and 50-59 years were 92 (16.4%). According to the Seasonal Pattern Assessment Questionnaire, below 8 score was 323 (57.6%), 9-10 score 53 (9.4%), over the 11 score 184 (33%).

ConclusionAccording to the questionnaire of Seasonal pattern assessment, 33 percent were seasonal affective disorder. It means Mongolian people of Ulaanbaatar have Seasonal affective disorder.

Keywords. Behavior, climate, seasonal pattern assessment questionnaire, latitude, mood, Pp.57-60, Table –1, Figures- 2, References -15

¯íäýñëýëÓëèðàë ñîëèãäîõ ¿åèéí öàã àãààðûí ººð÷ëºëò íü õ¿íèé ààø çàí, ýíåðãè, íîéð, õîîëíû áàéäàëä íºëººëºõ áºãººä íèéãýìä ¿¿íèéã óëèðàëøèõ ãýæ íýðëýæ èðæýý [1]. Ýðò äýýð ¿åýñ õ¿ì¿¿ñ óëèðàë ñîëèãäîõ ¿åèéí çàí òºëºâ áà ñýòãýöèéí áàéäëûã ìýääýã áàéñàí áà 1845 îíä Esquirol, 1921 îíä Kraepelin íàð óëèðëûí ñîëèãäîõ ¿åèéí çàí òºëºâèéí ººð÷ëºëòèéí òàëààð ñóäàëæ áàéñàí [2-4]. 1984 îíä Rozenthal íàð “Óëèðëûí

÷àíàðòàé ñýòãýë ãóòðàõ” õàì øèíæèéã ºâëèéí óëèðàëä ñýòãýë ãóòðàë ¿¿ñ÷, çóí áîëîí õàâàð õýâèéí áàéäàëä ýðãýí îðîõ ãýæ òîäîðõîéëæýý [5]. Óëèðëûí ÷àíàðòàé ñýòãýë ãóòðàë íü ºâëèéí óëèðàëä ºäðèéí ãýðýë äóòàãäñàíòàé õîëáîîòîé ãýæ òààìàãëàäàã [6]. Óëèðëûí ÷àíàðòàé ñýòãýë ãóòðàë íü ºíäºð ºðãºðãèéí íóòàã äýâñãýðò èë¿¿òýé òîõèîëääîã ÷ öàã óóðûí õ¿÷èí ç¿éë, óäàìøèë, íèéãýì ñî¸ëûí áàéäàë çýðýã áóñàä ÷óõàë íºëººòýé õ¿÷èí ç¿éëòýé õàðüöóóëàõàä

ÍÈÉÃÌÈÉÍ ÝÐ¯¯Ë ÌÝÍÄ


íºëººëºë áàãàòàé áàéäàã [7]. Àìåðèêèéí íýãäñýí óëñûí Ñýòãýöèéí ýð¿¿ë ìýíäèéí õ¿ðýýëýíãèéí Norman Rozenthal íàð 1987 îíä Óëèðëûí õýâ øèíæèéí ¿íýëãýýíèé àñóóìæèéã áîëîâñðóóëñàí áºãººä ¿¿ãýýð óëèðëûí ÷àíàðòàé ñýòãýë ãóòðàëûí òàðõàëòûí òóõàé èõýíõ ñóäàëãàà õèéãääýã [8]. Çàðèì ñóäëàà÷äûí ñóäàëãààíû ¿ð ä¿íãýýñ ¿çýõýä Àìåðèêèéí íýãäñýí óëñ áîëîí õîéä Åâðîïûí íàñàíä õ¿ðñýí 10 õ¿í òóòìûí 1-ä, Õîéä Àìåðèêò 1,4 -9,7%, Åâðîïò 1,3 - 3%, Àçèä 0,9 -1% -èéí òàðõàëòòàé áàéíà [9].

Ìàíàé îðîí äýëõèéí õîéä õàãàñûí ñýð¿¿í á¿ñèéí äóíäàä ºðãºðºãò îðøäîã (ºðãºðºãèéí 41°35-52°09) áºãººä òóñ îðíû íóòãààð äýëõèéí õîéä õàãàñûí ìºíõ öýâäãèéí óðä çàõ äàéð÷ ãàðäàã. Èéìýýñ õóóðàé áîãèíî çóí 6-ð ñàðààñ 8-ð ñàð, óðò õ¿éòýí ºâºë 11-ð ñàðààñ 4-ð ñàð, õàâàð 4-ð ñàðààñ 6-ð ñàð, íàìàð 8-ð ñàðûí ñ¿¿ë÷ýýñ 10-ð ñàð ãýñýí 4 óëèðàëòàé áºãººä ºâëèéí óëèðàë óðò, õ¿éòýí, çóí äóëààí áîëîâ÷ áîãèíîõîí, õàâàð íàìðûí óëèðàë øèëæèìòãèé, õàëóóí õ¿éòíèé çºð¿¿ æèëèéí äîòîð òºäèéã¿é õîíîãèéí äîòîð ÷ ýðñ ººð÷ëºãäºæ óëèðëûí ÿëãàà òîä èëýðäýã áàéíà. Óëààíáààòàð õîò äýëõèéí äóíäàæ òåìïåðàòóðààð õàìãèéí õ¿éòýí íèéñëýëä òîîöîãääîã çýðãýýñ óëèðëûí ÷àíàðòàé ñýòãýë ãóòðàë áàéõ ìàãàäëàëòàé áà ºìíº íü óëèðàëòàé õîëáîæ ñýòãýë ãóòðàëûã ñóäàëñàí äîðâèòîé àæèë õèéãäýýã¿é áàéãàà íü áèäíèé ñóäàëãààíû ¿íäýñëýë áîëîâ.

Çîðèëãî Óëààíáààòàð õîòûí íàñàíä õ¿ðýã÷äèéí äóíä óëèðëûí ÷àíàðòàé ñýòãýë ãóòðàëûã èëð¿¿ëýõ

Çîðèëò:1. Óëèðëûí õýâ øèíæèéí ¿íýëãýýíèé

àñóóìæààð õ¿í àìûí äóíä óëèðëûí ÷àíàðòàé ñýòãýë ãóòðàëûí òàðõàëòûã òîãòîîõ, õ¿í àìç¿é áîëîí ºâºë õàâðûí óëèðàëä õàðüöóóëàí ñóäëàõ

2. Óëèðëûí ÷àíàðòàé ñýòãýë ãóòðàë ò¿¿íä íºëººëæ áàéãàà çàðèì õ¿÷èí ç¿éëèéí õîîðîíäîõ õàìààðëûã ñóäëàõ

3. Óã ýìãýãèéí ¿åä èëýðäýã íåéðîâåãåòàòèâ áîëîí çàí òºëºâèéí øèíæ òýìäã¿¿äèéã õàðüöóóëàõ

¨ñ ç¿éí çºâøººðºë ÝÌØÓÈÑ-ûí Áèî-Àíàãààõûí ¸ñ ç¿éí õÿíàëòûí ñàëáàð õîðîîíû 2013 îíû 4 ä¿ãýýð ñàðûí 25-íû ºäðèéí õóðëààð ñóäàëãààíû ¸ñ ç¿éã õýëýëö¿¿ëýí, çºâøººðºãäñºíèé äàãóó ñóäàëãààã õèéæ ã¿éöýòãýâ (№ 13-12/1À Óëààíáààòàð õîò). Ñóäàëãààã àâàõûí ºìíº ñóäàëãààíä îðëöîã÷äîîñ òàíèóëñàí çºâøººðëèéí õóóäñààð çºâøººðºë àâñàí. Ìàòåðèàë, àðãà ç¿éÁèä ñóäàëãààã ºâëèéí óëèðàëä 1-2 äóãààð ñàð, õàâðûí óëèðàëä 3 äóãààð ñàðä íèéò 2 óäàà Óëààíáààòàð õîòûí 20-60 íàñíû ýð¿¿ë 560 õ¿íèéã õàìðóóëàí àãøèíãèéí àðãààð Óëèðëûí õýâ øèíæèéí ¿íýëãýýíèé àñóóìæûã àøèãëàí àâñàí.

Õ¿í àìç¿éí õóâüñàãäàõóóí: Ýíý õýñãèéí ìýäýýëýëä íàñ, õ¿éñ, áîëîâñðîë, ãýð á¿ëèéí áàéäàë, àìüäàð÷ áàéãàà ãàçàð, áèåèéí ºíäºð, æèíã àñóóñàí.

Óëèðëûí õóâüñàãäàõóóí: Óëèðëûí ÷àíàðòàé ñýòãýë ãóòðàëûã Óëèðëûí õýâ øèíæèéí ¿íýëãýýíèé àñóóìæààð ¿íýëñýí (1987îíä Àìåðèêèéí íýãäñýí óëñûí Ñýòãýöèéí ýð¿¿ë ìýíäèéí õ¿ðýýëýíãýýñ ãàðãàñàí Norman Rozenthal áà áóñàä ñóäëàà÷äûí áîëîâñðóóëñàí). Àñóóìæ 3 õýñãýýñ á¿ðäýõ áà àíãëè õýëýýð áýëòãýãäñýí ýõ õóâèëáàðûã ìîíãîë õýë ð¿¿ îð÷óóëàí, àñóóëòûí óòãà ñàíàà, àãóóëãà á¿ðýí õàäãàëàãäñàí ýñýõèéã õÿíàæ, íÿãòëàí øàëãàñíû ýöýñò ñóäàëãààíä àøèãëàñàí.

1-ð õýñýãò: Äýëõèéí óëèðëûí îíîî- áîë 6 ÿíçûí óëèðëûí äàãóóõ ººð÷ëºëòèéã àñóóñàí íèéëìýë õýìæèãäýõ¿¿í þì. ¯¿íä: õîîëíû äóðøèë, íîéð, íèéãìèéí èäýâõè, çàí ààø, ýð÷ õ¿÷íèé ò¿âøèí, áèåèéí æèí. Ç¿éë á¿ð íü îíîîíîîñ á¿ðäýõ áà 0 áóþó ººð÷ëºëòã¿éãýýñ 4 áóþó ìàø èëýðõèé ººð÷ëºëòòýé. Íèéò îíîîíû õÿçãààð 0- 24 áàéõ áà 11-ñ äýýø îíîî àâñàí áîë óëèðëûí ÷àíàðòàé ñýòãýë ãóòðàõ ýìãýã áàéíà ãýæ ¿çíý.

Table 1. Global Seasonality (GS) score- The total scale ranges from 0 to 24

No Change Slight Change

Moderate Change

Marked Change

Extremely Marked Change

À. Sleep length 0 1 2 3 4Á. Social activity 0 1 2 3 4Â. Mood (overall being

Of well-being)0 1 2 3 4

C. Weight 0 1 2 3 4E. Appetite 0 1 2 3 4F. Energy level 0 1 2 3 4


2-ð õýñýãò: Óëèðëûí àñóóäëûí îíîî – Ýíý áîë óëèðëààñ øàëòãààëæ çàí òºëºâèéí ººð÷ëºëò èëýðäýã áîë òýð àñóóäàë íü õýð çýðýã èëýð÷ áàéãààã àñóóõ áà äàðààõ õàðèóëòòàé.

0= àñóóäàëã¿é

1= Áàãà

2= Äóíä

3= Èëýðõèé

4= Õ¿íä

5=ªâ÷èëñºí ìýò

Äóíä áóþó 2 ýñâýë ò¿¿íýýñ äýýø îíîî àâñàí áîë óëèðëûí ÷àíàðòàé ñýòãýë ãóòðàë ãýæ ¿çíý.

3-ð õýñýãò: Óëèðëûí àñóóäëûí õóãàöàà áîë öàãòàé õîëáîîòîéãîîð æèëèéí àëü óëèðàëä èë¿¿ ìóó ìýäðýìæ èëýðäãèéã òîäîðõîéëîõ áà ¿¿íèéã öîíõ ãýæ íýðëýíý. Ñóäàëãààíä îðîëöîã÷ 12 äóãààð ñàðä (ýñâýë 1 ä¿ãýýð ñàð) ýñâýë 2 äóãààð ñàðä èë¿¿ ìóó ìýäðýìæòýé áàéãàà íü ºâëèéí óëèðëûí ÷àíàðòàé ñýòãýë ãóòðàëûí øàëãóóð áîëíî. Çóíû óëèðëûí ÷àíàðòàé ñýòãýë ãóòðàëûí øàëãóóð áîë 6 äóãààð ýñâýë 7 äóãààð ýñâýë 8 äóãààð ñàðä èë¿¿ ìóóõàé ìýäðýìæòýé áàéäàã.

¯ð ä¿í: Áèäíèé ñóäàëãààíä Óëààíáààòàð õîòûí 20-60 íàñíû ýð¿¿ë ýðýãòýé 246 (48.3%), ýìýãòýé 314 (51.7%) íèéò 560 õ¿í õàìðàãäñàíààñ äóíäàæ íàñëàëò 32±0.84 áàéâ. Ñóäàëãààíä õàìðàãäàãñäûã íàñíû á¿ëãýýð àíãèëáàë 20-29 íàñíûõàí 237 (42.3%), 30-39 -99 (17.6%), 40-49 -132 (23.5%), 50-59- 92 (16.4%). Ãýðëýëòèéí áàéäëûí õóâüä ãàíö áèå 219 (39.1%), ãýðëýñýí 310 (55.3%), ñàëñàí 21 (3.7%), áýëýâñýí 10 (1.7%) áàéñàí.

Óëààíáààòàðò 1 æèëýýñ áàãà õóãàöààãààð àìüäàðñàí 64 (11.4%), 1-2 æèë àìüäàðñàí 37 (6.6 %), 3-5 æèë àìüäàðñàí 71 (12.6%), 5-ñ äýýø æèë àìüäàðñàí 388 (69.2) % áàéñàí. Áîëîâñðîëûí õóâüä áîëîâñðîëã¿é 13 (2.3 %), áàãà áîëîâñðîëòîé 40 ( 7.1%), á¿ðýí äóíä 184 (32.8%), òóñãàé äóíä 82 (14.6%), äýýä áîëîâñðîëòîé 242 (43.2%).

Äýëõèéí óëèðëûí îíîî íü 8-ñ äîîø áàéñàí 323 (57.6%), 9-10 îíîîòîé 53 (9.4%), 11-ñ äýýø áóþó óëèðëûí ÷àíàðòàé ñýòãýë ãóòðàëòàé 184 (33%) áàéñàí (Çóðàã 1). 560 îðîëöîã÷äûí 390 (69.6%) íü óëèðëûí àñóóäàëã¿é áàéñàí áîë 170 (30.5%) óëèðàëûí àñóóäàëòàé õîëáîîòîéãîîð

çàí òºëâèéí ººð÷ëºëòºä äàñàí çîõèöäîã ãýæ õàðèóëñàí. ßëàíãóÿà 170 îðîëöîã÷ûí 65 (38.2%) áàãà çýðãèéí àñóóäàëòàé, 60 (35.2%) äóíä çýðãèéí àñóóäàëòàé, 26 (15.2%) èëýðõèé, 11 (6.4%) õ¿íä, 8 (4.7%) íü óëèðëààñ õàìààð÷ ºâ÷èëñºí ìýò áàéäàã ãýæ õàðèóëæýý (Çóðàã 2).

Figure 1. Global Seasonality (GS) score

Figure 2. Seasonal problems score

Õàìãèéí ºíäºð îíîî àâñàí 23. Õàìãèéí áàãà îíîî 0. Äýëõèéí óëèðëûí äóíäàæ îíîî íü ýìýãòýéä 5.55, ýðýãòýéä 6.52 áàéñàí.

Õýëöýìæ

Mersch áîëîí Nanette íàðûí ñóäàëãààãààð Óëèðëûí õýâ øèíæèéí ¿íýëãýýíèé àñóóìæûã óëèðëûí ÷àíàðòàé ñýòãýë ãóòðàëûí îíîøëîãîîíä õýðýãëýõýä ìýäðýã ÷àíàð 44%, ºâºðìºö ÷àíàð 94% áàéñàí [10]. Èõýíõ ñóäàëãààíä èæèë àðãà áîëîõ óëèðëûí õýâ øèíæèéí ¿íýëãýýíèé àñóóìæèéã õýðýãëýäýã [11] áà èæèë òºðëèéí øàëãóóðûí õýðýãëýý íü ñóäàëãààíóóäûí ¿ð ä¿íã õàðüöóóëàõàä äºõºì áîëäîã [1].

Áèäíèé ñóäàëãààíä óëèðëûí ÷àíàðòàé ñýòãýë ãóòðàëûã èëð¿¿ëýõýä õýðýãëýäýã, ¿íäñýí øàëãóóðûí íýã áîëîõ äýëõèéí óëèðëûí äóíäàæ îíîî íü ýìýãòýéä 5.55, ýðýãòýéä 6.52 áàéãàà íü Ling Han, Keqin Wang íàðûí 2000 îíä õèéñýí ñóäàëãààíààñ íèëýýä áàãà áàéíà. Ýäãýýð ýðäýìòýäèéí ñóäàëãààãààð äýëõèéí óëèðëûí îíîî ýðýãòýéä 8.4 ýìýãòýéä 8.2 áà õ¿éñèéí õóâüä

58% 9%

33%

below 8 score 9-10 score

over the 11 score


õàìààðàëã¿é áàéñàí áîë áèäíèé ñóäàëãààíä ýðýãòýé÷¿¿äýä äýëõèéí óëèðëûí îíîî èë¿¿ à÷ õîëáîãäîëòîé ñòàòèñòèê ¿íýí ìàãàäòàé ¿ç¿¿ëýëò áàéëàà [13].

Àôðèêèéí Àìåðèê Êîëëåæèéí îþóòíóóäûí äóíä Óëèðëûí õýâ øèíæèéí ¿íýëãýýíèé àñóóìæààð ºðãºðãèéí 35˚-45˚-ä îðøèõ íóòàã äýâñãýðò õèéãäñýí 2004 îíû Agumadu, Samina íàðûí ñóäàëãààãààð äýëõèéí óëèðëûí äóíäàæ îíîî ýìýãòýéä 8,6, ýðýãòýéä 7,9 áàéñàí [14] íü ýäãýýð ñóäëàà÷èä áîëîí ºðãºðºãèéí 47°-ä áàéðëàõ Øâåéöàðò õèéãäñýí Wirz- Justize, Grew íàðûí ñóäëàà÷äûí [15] ¿ð ä¿íòýé õàðüöóóëàõàä ìàíàé îðîíòîé ºðãºðºãèéí õóâüä îéðîëöîî ãàçàð íóòàãò áàéðëàñàí áîëîâ÷ ýìýãòýé÷¿¿äýä äýëõèéí óëèðëûí äóíäàæ îíîî ºíäºð áàéãàà íü áèäíèé ñóäàëãààíààñ ÿëãààòàé áàéíà.

Ñóäàëãààíä îðîëöîã÷äûí 123 (24.3%) íü óëèðëûí ººð÷ëºëòºíä çàðèìäàà äàñàí çîõèöîõîä õ¿íäðýëòýé áàéñàí ãýæ õàðèóëñàí íü Mersch, Middendorp íàðûí óëèðëûí õýâ øèíæèéí ¿íýëãýýíèé àñóóìæèéã áóñàä àñóóìæèéí àðãàòàé õîñëóóëàí õèéñýí 1999 îíû ñóäàëãààíû ¿ð ä¿íòýé õàðüöóóëàõàä óëèðëûí àñóóäàëòàé õ¿íèé ýçëýõ õóâü íèëýýä áàãà áàéíà [9].

Kurata, Nomura íàðûí 2012 îíû Èõ Áðèòàíä àìüäàð÷ áàéãàà ßïîí÷óóäûí äóíä óëèðëûí õàìààðàëò çàí àðàíøèíãèéí ººð÷ëºëòèéí òàëààðõ ñóäàëãààíä äýëõèéí óëèðëûí îíîî 5,73 [16] áàéãàà íü áèäíèé ñóäàëãààíû ¿ð ä¿í íèëýýä îéðîëöîî áàéíà.

Ä¿ãíýëò:

Áèä Óëèðëûí õýâ øèíæèéí ¿íýëãýýíèé àñóóìæûí äàãóó ¿íýëýõýä 33% íü óëèðëûí ÷àíàðòàé ñýòãýë ãóòðàëòàé áàéâ. Ýíý íü Óëààíáààòàð õîòîä îðøèí ñóóæ áàéãàà Ìîíãîë÷óóäàä óëèðëûí ÷àíàðòàé ñýòãýë ãóòðàë áàéãààã õàðóóëæ áàéíà.

Íîìç¿é 1. Kasper S, Wehr TA, Bartko JJ, Gaist PA,

Rosenthal NE. Epidemiological findings of seasonal changes in mood and behavior. A telephone survey of Montgomery Country. Maryland Arch Gen Psychiatry 1989; 46: 823-833

2. Wher TA. Seasonal affective disorder, historical overwiev, in Seasonal Affective Disorder and Phototherapy. Edited by Rosenthal NE, Blehar MC, New-York, Guilford , 1989, 11-32

3. Esquirol E, Mental Maladies: Treatise on insanity. E.K Hunt (Ed) Lea and Blanchard, 1945

4. Kraepelin E. Manic Depressive Illness and Paranoia. R.M, Barklay (Trans) Robertson

GM, Livingstone M (Eds), Livingstone E and S, Edinburgh, 1921

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6. Hansen V, Skre I, Lund E. What is this thing called “SAD” ? A critique of the concept of seasonal affective disorder. 2008

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Òàíèëöàæ, íèéòëýõ ñàíàë ºãñºí: Àíàãààõ Óõààíû äîêòîð, äýä ïðîôåññîð

Ë.Íàñàíöýíãýë


Ìîíãîëûí óëàìæëàëò àíàãààõ óõààíû ñóäàëãààíû çàðèì àñóóäàë

Ì.Ï¿ðýâæàâ1, Ç.Àðèóíàà2, Î.×èìýäñ¿ðýí3, Ä.Öýíä-Àþóø3, Á.Áóðìààæàâ4

1Ýì÷èëãýý, ñóäàëãàà, ¿éëäâýðëýëèéí “Ìîíã-Ýì” ýìíýëýã2Óëàìæëàëò àíàãààõûí øèíæëýõ óõààí, òåõíîëîãè, ¿éëäâýðëýëèéí êîðïîðàöè

3Àíàãààõûí øèíæëýõ óõààíû ¿íäýñíèé èõ ñóðãóóëü4Ýð¿¿ë ìýíäèéí ÿàì

Abstract

Some aspects of traditional Mongolian medicine research

Ì. Purevjav1, Z.Ariunaa2, Î.Chimedsuren3, D.Tsend-Ayush3, B.Burmaajav4

1”Mong-Em” Research&Production Clinic2TMM Science&Technology Corporation 3Health Science University of Mongolia

4Ministry of Health

Mail: [email protected]@[email protected]

[email protected]@yahoo.com

BackgroundTraditional Mongolian Medicine has a history of over 5000 years. Scientific development of TM has started in 1959. Since 1999 Mongolia was categorized by WHO as a country having an Integrative system of TM- officially recognized and incorporated into all areas of health care provision, TMM research has been following key objectives of National R&D programs.

AimIn order to assess the situation of TMM development we have conducted this study based on last 10 years’ research done.

Ìaterial and MethodsDocument study- we have selected key TMM’s R&D project implementers’ archive and human resources documents.Descriptive and Analytic methods- a survey of 32 questions evaluating participation of TMM professionals in R&D work were conducted. Also, to clarify the point of view about TMM’s R&D 6 focus group meetings with different level participants, such as professional committee, policy makers and research workers as well as health care providers, were organized.

ResultsFrom 2004-2013, there are 28 projects implemented on TMM, 43% accomplished by TMMRTC, 32.8% of which is resulting in raw materials standardization and technology study, related clinical studies standing 20% out of all studies done on TMM matter. These numbers are confirmed by survey and focus group interviews, more than 50% of participants willing to conduct a clinical study and expressing difficulties such as lack of knowledge of methodology, policy support and revenue.

Conclusions:1. TMM R&D has a potential growth due to human resources capacity. Practitioners are least

involved in R&D, due to lack of knowledge of methodology and revenue. 2. There were 28 projects implemented on TMM matter, most of these are basic studies, fewer

clinical studies done, resulting in pharmacopeia monographs and technological guidelines.

Keywords: Traditional Mongolian Medicine, Research status, TM clinical study.

Pp.61-66, Tables-3, Figures-8, References 15


¯íäýñëýëÌîíãîëûí óëàìæëàëò àíàãààõ óõààí 5000 æèëèéí ò¿¿õòýé áºãººä øèíæëýõ óõààíû ¿¿äíýýñ ñóäëàõ, õºãæ¿¿ëýõ àñóóäàë 55 æèëèéí ºìíººñ ýõëýëòýé. Ýíý õóãàöààíä óëàìæëàëò àíàãààõ óõààíû ñóäëàà÷ ýðäýìòäèéí õèéñýí ç¿éë áàãàã¿é áºãººä ÿëàíãóÿà ìîíãîëûí óëàìæëàëò àíàãààõ óõààíûã õºãæ¿¿ëýõ òºðººñ áàðèìòëàõ áîäëîãî õýðýãæèõ ýðõ ç¿éí îð÷èí ¿¿ñýí áèé áîëñîí 1999 îíîîñ õîéø ñóäàëãààíû îëîí àæèë õèéãäæýý. Íîòîëãîîíä ñóóðèëñàí óëàìæëàëò àíàãààõ óõààíû õºãæëèéí ÷èãëýëèéã òîäîðõîéëîõ ¿¿äíýýñ ñ¿¿ëèéí 10 æèëä (2004-2013) óëàìæëàëò àíàãààõ óõààíû ñóäàëãààíû ÷èãëýë, õ¿ðñýí ¿ð ä¿íã òîäîðõîéëîõ øààðäëàãà òóëãàð÷ áàéíà.

ÇîðèëãîÓëàìæëàëò àíàãààõ óõààíû ñóäàëãààíû ºíººãèéí áàéäëûã ñóäëàõ.

Çîðèëò:1. Óëàìæëàëò àíàãààõûí ñóäàëãààíû õ¿íèé

íººöèéí áàéäàë, óëàìæëàëò àíàãààõûí ìýðãýæèëòí¿¿äèéí ñóäàëãààíû àæëûí îðîëöîîã ñóäëàõ

2. Óëàìæëàëò àíàãààõûí ÷èãëýëýýð õýðýãæ¿¿ëñýí òºñëèéí ÷èãëýë, ¿ð ä¿íã ñóäëà

Ìàòåðèàë, àðãà ç¿é:

Áàðèìòûí ñóäàëãààíä: Óëàìæëàëò àíàãààõ óõààíû ñóäàëãààíû òºâ áàéãóóëëàãà áîëîõ ÓÀØÓÒ¯Ê, ñóðãàëòûí òºâ áàéãóóëëàãà áîëîõ ÝÌØÓÈÑ-ÓÀÑ, õóâèéí õýâøëèéí óëàìæëàëò àíàãààõ óõààíû ñóðãàëòûí áàéãóóëëàãà áîëîõ Îòî÷ Ìàíðàìáà Äýýä Ñóðãóóëü, Øèíý Àíàãààõ Äýýä Ñóðãóóëü, À÷ ÀÓÄýÑ, Ýò¿ãýí ÀÓÄýÑ, ÓÀÓ-û ýì÷èëãýý, ¿éëäâýðëýë, ñóäàëãààíû Ìîíã-Ýì ýìíýëãèéí òºñºëò ñóäàëãààíû àæëûí ìýäýýëýë áîëîí õ¿íèé íººöèéí ìýäýýëëèéã àøèãëàñàí.

Àãøèíãèéí áîëîí äåñêðèïòèâ ñóäàëãààíä: Óëàìæëàëò àíàãààõ óõààíû ñóäàëãàà øèíæèëãýýíä îðîëöîã÷ á¿õ øàòíû áàéãóóëëàãóóä áóþó ÝÌß, ÓÀØÓÒ¯Ê, ÀØÓ¯ÈÑ-ÓÀÑ, “Øèíý àíàãààõ” äýýä ñóðãóóëü, “Îòî÷ Ìàíðàìáà” Äýýä ñóðãóóëü, ò¿¿íèé äýðãýäýõ “Ìàíáàäàöàí” ýìíýëýã, ýìèéí ¿éëäâýð, “Ýò¿ãýí” ÀÓÄýÑ, “À÷” ÀÓÄýÑ, 1, 2, 3-ð øàòëàëûí óëñûí ýìíýëãèéí áîëîí óëàìæëàëò àíàãààõ óõààíû ÷èãëýëèéí õóâèéí õýâøëèéí ýìíýëýã ñóâèëàë çýðýã 20 áàéãóóëëàãûí óëàìæëàëò àíàãààõ óõààíû ýì÷, ñóäëàà÷, ìýðãýæèëòí¿¿äèéã îðîëöóóëàí ñóäàëãààíû ìýäýýëëèéã öóãëóóëàõäàà àñóóìæ áà ÿðèëöëàãûí àðãûã õîñëóóëàí õýðýãëýâ.

Ñóäàëãààíû àæëûí ¿ð ä¿íãèéí áîëîâñðóóëàëò

Áàðèìòûí ñóäàëãààíä àøèãëàñàí ìýäýý ìýäýýëëèéã êîäëîõ, êîìïüþòåðò îðóóëàõäàà “Excel” ïðîãðàììûã àøèãëàæ, SPSS-18

ïðîãðàììààð ¿ð ä¿íã áîëîâñðóóëàí íýãòãýæ, ¿ð ä¿íä äåñêðèïòèâ øèíæèëãýý õèéâ. Ìýäýýíä øèíæèëãýý õèéí, õóâüñóóðóóäûí õîîðîíäûí ÿëãàà, õàìààðëûã Õè êâàäðàò, t òåñò çýðãýýð òîîöîîëîâ. ×àíàðûí ñóäàëãààíû ìýäýýëëèéã ÷èãë¿¿ëýõ àñóóëòûí äàãóó á¿ëýãëýí, ìýäýýëëèéí àãóóëãà, óòãà ñàíààã íýãòãýí, îíöëîõ ¿ð ä¿í, ñàíàë áîäîë, àñóóäàë õºíäñºí ìýäýýëëèéã øèãòãýý áàéäëààð ¿ð ä¿íä îðóóëàâ.

Ñóäàëãààíû àæëûí ¸ñ ç¿éÑóäàëãààíû àæëûí àðãà ç¿éã ÝÌß-íû Àíàãààõ óõààíû ¸ñ ç¿éí õÿíàëòûí õîðîîíû õóðëààð 2014 îíû 3 äóãààð ñàðûí 7-íû ºäºð õýëýëö¿¿ëæ ñóäàëãàà ÿâóóëàõ ¸ñ ç¿éí çºâøººðºë àâñàí (№03).ÝÌØÓÈÑ-èéí 2014 îíû 5 äóãààð ñàðûí 23-íû ºäðèéí ¨ñ ç¿éí õîðîîíû õóðëààð ñóäàëãààíû àæëûí ¸ñ ç¿éí ä¿ãíýëòèéã ãàðãóóëñàí (№ 14-12/2À).

¯ð ä¿íÓëàìæëàëò àíàãààõ óõààíû ñóäàëãààíû áàéãóóëëàãóóäûí õ¿íèé íººöèéí áàéäàë

Óëàìæëàëò àíàãààõ óõààíû ÷èãëýëýýð ñóäàëãààíû òºñºë õýðýãæ¿¿ëäýã 5 áàéãóóëëàãûí õ¿íèé íººöèéí áàéäëûã ñ¿¿ëèéí 10 æèëèéí áàéäëààð ãàðãàæ ¿ç¿¿ëýâ.

Çóðàã 1-ñ õàðàõàä ñóäàëãààíä õàìðàãäñàí 5 áàéãóóëëàãûí õ¿íèé íººö 2004 îíîîñ ºìíºõòýé õàðüöóóëàõàä 44.3% íýìýãäñýí áàéíà. Íèéò ìýðãýæèëòí¿¿äèéí äîòðîîñ ¿íäñýí ñóäëàà÷èéí íººöèéã òîãòîîâ.


ÝÌß-íû àíàãààõûí õ¿íèé íººöèéí ñóäàëãààãààð àíàãààõûí øèíæëýõ óõààíû äîêòîð (DSc)-ûí çýðýãòýé ýðäýìòýäèéí 9,2 õóâèéã, àíàãààõ óõààíû äîêòîð (PhD) ûí çýðýãòýé ýðäýìòýäèéí 5,4 õóâèéã óëàìæëàëò àíàãààõûí ñóäëàà÷èä ýçëýæ áàéíà. Ýíý ÷èãëýëýýð ýðäìèéí çýðýã õàìãààëñàí ýðäýìòäèéí òîî 1990-ýýä îíîîñ íýìýãäñýí áàéíà (Çóðàã 3).

Ìýðãýæèëòí¿¿äèéí ñóäàëãààíû îðîëöîî

Óëàìæëàëò àíàãààõ óõààíû ìýðãýæèëòí¿¿äèéí ñóäàëãààíû îðîëöîîã ¿íýëýõ ¿¿äíýýñ òóñ ÷èãëýëýýð ¿éë àæèëëàãàà ÿâóóëäàã óëñûí 1, 2, 3 äóãààð øàòëàëûí ýìíýëãèéí ýì÷ íàð, ÓÀØÓÒ¯Ê-èéí ìýðãýæèëòí¿¿ä, õóâèéí õýâøëèéí ýìíýëýã ñóâèëàë, ñóðãàëòûí áàéãóóëëàãûí àæèëëàãñäààñ àâñàí àñóóìæèéí ä¿íãýýñ ¿çýõýä ýì÷ íàðûí ñóäàëãààíû îðîëöîî õàìãèéí ñóë áóþó íèéò àñóóìæ ñóäàëãààíä îðîëöñîí 69 ýì÷èéí 56% ñóäàëãààíä îðîëöäîã áàéíà. Õàðèí áàãø, ñóäëàà÷ íàðûí ýðäýì øèíæèëãýýíèé àæëûí èäýâõ ºíäºð áàéäàã íü õàðàãäàæ áàéíà (Õ¿ñíýãò 1).

Table1. Participation in research and profession exercised

Àæèëëàäàã áàéãóóëëàãààñ õàìààðàí ýðäýì øèíæèëãýýíèé àæëûí îðîëöîîíû áàéäëûã ñóäàëæ ¿çõýä õóâèéí õýâøëèéí ýìíýëýã, ñóâèëëûí ìýðãýæèëòí¿¿ä ñóäàëãààíä õàìãèéí áàãà îðîëöäîã áàéíà (Õ¿ñíýãò 2). Óã àñóóìæèä îðîëöñîí ñóðãàëò, ýðäýì øèíæèëãýýíèé áàéãóóëëàãûí 35 àæèëëàãñäûí 33 íü ñóäàëãàà ÿâóóëäàã ãýæ õàðèóëæýý.

Óëàìæëàëò àíàãààõûí ÷èãëýëýýð ñóäàëãààíû òºñºë õýðýãæ¿¿ëñýí áàéäàë

Óëàìæëàëò àíàãààõ óõààíû ÷èãëýëýýð ñóäàëãààíû òºñºë õýðýãæ¿¿ëñýí 5 áàéãóóëëàãûí òºñºë õýðýãæ¿¿ëñýí áàéäëûã íýãòãýí õàðóóëàâ.

Áèäíèé ñóäàëãààíä õàìðàãäñàí 5 áàéãóóëëàãàä øèíæëýõ óõààí òåõíîëîãèéí òºñºë, èííîâàöè, öºì òåõíîëîãè, çýõýö àæèë, ãàäààäòàé õàìòàðñàí çýðýã ñóäàëãààíû 28 òºñºë õýðýãæ¿¿ëñíýýñ 42.9 õóâèéã ÓÀØÓÒ¯Ê, 42.9 õóâèéã ÝÌØÓÈÑ-ÓÀÑ-ä õýðýãæ¿¿ëñýí áàéíà. “Øèíý-Àíàãààõ” ÀÓÄýÑ “Áàéãàëèéí ãàðàëòàé çàðèì ýìèéí áýëäìýëèéã ýìíýë ç¿éí ïðàêòèêò á¿ðýí íýâòð¿¿ëýõ”òºñºëò ñóäàëãààíä äýä òºñºë õýðýãæ¿¿ëýã÷èéí ¿¿ðãýýð õàìòðàí àæèëëàæ áàãàã¿é ¿ð ä¿íã õ¿ëýýëãýí ºãñºí.

Ìºí äýýðõ áàéãóóëëàãóóäûí çàõèàëãàò òºñëèéã ñàíõ¿¿æ¿¿ëñýí áàéäëûã ñàíõ¿¿æ¿¿ëýã÷ òóñ á¿ðýýð õàðóóëàâ.

Do you participate in research

Profession yes no

тоо % Судлаачдын дунд % тоо %

Р value 0,001

Teacher 26 89.7% 28.6% 3 10.3% Researcher 15 93.8% 16.5% 1 6.3% Doctor 38 55.1% 41.8% 31 44.9% Research-doctor 7 70% 7.7% 3 30%

Assistant 5 100% 5.5% 0 0%

Total 91 70.5% 100% 38 29.5%

Ñóäàëãààíä õàìðàãäñàí áàéãóóëëàãóóäàä ñ¿¿ëèéí 10 æèëä õýðýãæ¿¿ëñýí 28 òºñëèéã íèéòäýý 7 áàéãóóëëàãà ñàíõ¿¿æ¿¿ëæýý. ¯¿íýýñ, ØÓÒÑ 20 (71.4%) òºñºë, ÌÌÑÑ 2(7.1%), ÝÌß

Table 2. Participation in research and workplace

Do you participate in research

Р value 0.001

Workplace yes no N % N %

Governmental organizations 4 4.3 0 .0 Education&research organizations 33 35.9 2 5.1 Public hospitals 35 38.0 16 41.0 Private hospitals 20 21.7 21 53.8 Total 92 100.0 39 100.0

Ñóäàëãààíû òºñºë õýðýãæ¿¿ëæ, ñóäàëãàà ÿâóóëäàã 5 áàéãóóëëàãàä àæèëëàäàã íèéò ìýðãýæèëòíèé äîòîðõ ¿íäñýí ñóäëàà÷èéí òîîã ñ¿¿ëèéí 10 æèëèéí áàéäëààð àâ÷ ¿çýõýä ºñºõ õàíäëàãà àæèãëàãäàæ áàéíà.


3 (10.7%), ÁÑØÓß 1(3.6%), ñàëáàðûí áóñ ÿàì (¯ÕÀÀß) 1 (3.6%), Øèíæëýõ óõààíû àêàäåìè 1(3.6%), ãàäààäûí áàéãóóëëàãà 1 (3.6%) òºñëèéã òóñ òóñ ñàíõ¿¿æ¿¿ëñýí áàéíà.

Ñóäàëãààíä õàìðàãäñàí 5 áàéãóóëëàãà 8 ÷èãëýëýýð íèéò 221 ¿ð ä¿íã ñóäàëãààíû òºñëèéí õ¿ðýýíä õ¿ëýýëãýí ºãñíººñ ýìèéí ò¿¿õèé ýä, øèíý ýì, áýëäìýë, æîðûí õèìè, ñòàíäàðò÷èëàë, òåõíîëîãèéí ñóäàëãàà õàìãèéí èõ õèéãääýã áîë àìüòàí ãàðøóóëàõ, íóòàãøóóëàõ ñóäàëãàà íýã õèéãäñýí áàéíà. Ò¿¿í÷ëýí, óëàìæëàëò áîëîí øèíý ýìèéí ýìíýë ç¿éí ñóäàëãàà öººí õèéãääýã áîëîõ íü àæèãëàãäàæ áàéíà.

Àñóóìæ ñóäàëãààíä îðîëöîãñäûí ýðäýì ñóäëàëûí àæëûí ÷èãëýëýýñ õàðàõàä ýìèéí ò¿¿õèé ýä áîëîí óðãàìëûí ñóäàëãàà ò¿ëõ¿¿ õèéãääýã áà ýìíýëç¿é áîëîí óëàìæëàëò àíàãààõ óõààíû ýì÷èëãýýíèé àðãóóäûí ñóäàëãàà áàãà õèéãääýã áàéíà (Çóðàã 7).

Óëàìæëàëò àíàãààõ óõààíû ÷èãëýëýýð õèéãäñýí ñóäàëãàà øèíæèëãýýíèé àæëóóäûí 58.6% íü äîîðõ õ¿ñíýãò-3 äàõü ¿ð ä¿íä õ¿ðäýã áîë ¿ëäñýí 41.4%-èéí ¿ð ä¿íä òàéëàí ãàðäàã áàéíà. Õàðèí ýìèéí øèíý õýëáýð, øèíý á¿òýýãäýõ¿¿í 22.7% áàéíà.

Õèéãäñýí ñóäàëãààíû 22.7 õóâü íü øèíý á¿òýýãäõ¿¿í, 5 õóâü íü øèíý òåõíîëîãè, 16 õóâü íü ýìíýë ç¿éí óäèðäàìæ, ýì÷èëãýýíèé ñòàíäàðò áàéäëààð áàòàëãààæñàí áàéíà (Õ¿ñíýãò 3).

Àñóóìæ ñóäàëãààíä îðîëöñîãñäîîñ óëàìæëàëò àíàãààõ óõààíû ÷èãëýëýýð ýðäýì øèíæèëãýýíèé àæèë õèéõýä òóëãàðäàã áýðõøýýëèéí òàëààð ñóäàëñàí ¿ð ä¿íã õàðóóëàâ (Çóðàã 8).

Àñóóìæ ñóäàëãààíä îðîëöîãñäûí 46.3% ýðäýì øèíæèëãýýíèé á¿òýýë áè÷èõ, áîëîâñðóóëàõ òóðøëàãà äóòìàã, 45% íü ãàäààä õýëíèé ìýäëýã äóòìàã ãýæ õàðèóëñàí áàéâ. Ýíý áàéäàëòàé óÿëäààä ýðäýì øèíæèëãýýíèé á¿òýýë òóóðâèõ, õýâë¿¿ëýõ, ÿëàíãóÿà îëîí óëñûí ñýòã¿¿ëä õýâë¿¿ëñýí ºã¿¿ëýë öººí áàéõ ìàãàäëàëòàé áàéíà. Ò¿¿í÷ëýí ñóäàëãààíû ÷àíàð, ¿ð ä¿íä íºëººëæ áóé äàðààãèéí õ¿÷èí ç¿éë íü ñóäàëãààíû óäèðäëàãà, çîõèîí áàéãóóëàëò äóòìàã (32%), ñóäëàà÷äûí öàëèí õºëñ (55.7%) õàíãàëòã¿é áàéäàãòàé õîëáîîòîé áàéíà.

Õýëöýìæ

Ìîíãîëûí óëàìæëàëò àíàãààõ óõààí 5000 æèëèéí ò¿¿õòýé áºãººä ìîíãîë÷óóäûí àìüäðàëûí õýâ ìàÿã, öàã óóðûí îíöëîãò òîõèðñîí ýíý ñî¸ëûí ºâèéã øèíæëýõ óõààíû ¿¿äíýýñ òàéëáàðëàõ, íîòîëãîîíä ñóóðèëñàí àíàãààõ óõààíû õýðýãëýýã ºðãºæ¿¿ëýõ ¿¿äíýýñ ýðäýì øèíæèëãýýíèé àæëóóä îëíîîð õèéãäýæ èðñýí áèëýý [1,2].

Óëàìæëàëò àíàãààõ óõààíä ìîíãîë÷óóäûí îðóóëñàí ã¿í óõààí÷ ñýòãýëãýýíèé ºâ ñî¸ëûí ¿íýò õýñýã íü ººðñäèéí áèé áîëãîñîí ìýäëýã, òóðøëàãàäàà òóëãóóðëàí àþóðâåäèéí àíàãààõ óõààí, öààøèëáàë äîðíûí áîëîí ºðíèéí àíàãààõ óõààíòàé õîñëóóëàí ã¿íçãèéð¿¿ëýí õºãæ¿¿ëæ èðñýí ÿâäàë þì [3].

Ìîíãîëûí óëàìæëàëò ýìíýëãèéí îíîëûí ¿íäñýí çàð÷èì ýìíýë ç¿éí åðºíõèé îéëãîëòûã àâ÷ ¿çýõã¿éãýýð ýìò áîäèñûã òóõàéí ¿åä õýðýãëýæ áàéñàí ó÷èð õîëáîãäëûã îð÷èí ¿åèéí øèíæëýõ óõààíû ¿¿äíýýñ ñóäàëõàä áýðõøýýëòýé

Table 3. Results of studies

N % New product, new formula of traditional medicine 17 22.7 New technology, methodology, guideline 5 6.7 Clinical guideline, treatment standard 12 16 Patent 6 8 State standard 4 5.3 Research report 31 41.3 Total 75 100


àñóóäëóóä ç¿é ¸ñîîð ãàðäàã [4].

Óëàìæëàëò àíàãààõ óõààíû îíîë àðãàç¿éí ¿íäñýí îéëãîëòóóä, ¿çýë áàðèìòëàë, àðãà áàðèë íü øèíæëýõ óõààíû ¿çýë, îíîë àðãà ç¿é áîëîâñðîãäîí òºëºâøèõººñ õýäýí àðâàí çóóí æèëèéí òýðòýýä ãîë òºëºâ òóõàéí ¿åèéíõýý ã¿í óõààí, ó÷èð ç¿éí óõààíû ¿çýë, àðãà áàðèëä ¿íäýñëýãäýí áèé áîëñîíòîé õîëáîîòîéãîîð ò¿¿õýí ººð ººð íºõöºë áàéäàëä á¿ðýëäýí òºëºâøñºí àíàãààõ óõààíû õàðüöàíãóé áèå äààí õºãæñºí õî¸ð ººð òîãòîëöîî òóë çýðýãö¿¿ëýí õºãæ¿¿ëýõ àñóóäëûã á¿òýýë÷ ¿ð ä¿íòýé áîëãîõîä àðãà ç¿é áîëîí òàíèí ìýäýõ¿éí îëîí àñóóäëûã ñóäëàí øèéäâýðëýõ ÿâäàë ÷óõàë [5].

Ìîíãîë óëñûí óëàìæëàëò àíàãààõ óõààíûã øèíæëýõ óõààí÷ààð ñóäëàõ 55 æèëä 70-ààä îâãèéí 900 ãàðóé ýìèéí ò¿¿õèé ýäýýñ 200 ãàðóé óðãàìëûí ôèòîõèìèéí ñóäàëãààã õèéæ áèîëîãèéí èäýâõèéã íü òîãòîîæýý [6].

ÓÀØÓÒ¯Ê íü àìüòàí, óðãàìàë, ýðäñèéí ãàðàëòàé 100-ãààä ç¿éëèéí ýìèéí ò¿¿õèé ýäýýñ 50 îð÷èì øèíý áîäèñûã íýýí èëð¿¿ëæýý. Òóñ áàéãóóëëàãà íü äýýðõ õóãàöàààíä íèéòäýý 100-ãààä ýìèéí ò¿¿õèé ýäýä ñóäàëãàà ÿâóóëæ, 77 îð÷èìä íü ñòàíäàðò (ôàðìàêîïåéí ºã¿¿ëýë), òåõíîëîãèéí çààâàð, íèéëìýë æîðûí ÷àíàðûí ñåðòèôèêàò 100 ãàðóé, òàí, òàëõ, ¿ðýë ýìýíä òàâèãäàõ ñòàíäàðòûã áîëîâñðóóëàí 50-èàä îð÷èì øèíý ýìèéã áàòàëãààæóóëñíû 75 îð÷èì õóâü íü 70-90-ýýä îíóóäàä á¿òýýãäæýý. Ìîíãîë óëñûí ýìèéí ¿íäýñíèé ôàðìàêîïåéä îðñîí æàãñààëòûí 78 íü óðãàìëûíõ áàéäàã [6].

Ìîíãîë Óëñûí õýìæýýíä ýðäýìòýí ñóäëàà÷èä 2004-2009 îíä ñóäàëãààíû àæëûí 6327 ¿ð ä¿íã áîëîâñðóóëàí çàõèàëàã÷èä õ¿ëýýëãýí ºãñíèé äîòîð òåõíîëîãè 569 (9%), áèåò á¿òýýãäýõ¿¿íèé çàãâàð 663 áàéíà. Ýíý õóãàöààíä øèíý á¿òýýëèéí ïàòåíò 284, àøèãòàé çàãâàðûí ãýð÷èëãýý 241(3,8%), çîõèîã÷èéí ýðõèéí ãýð÷èëãýý 108-èéã òóñ òóñ àâñàí áàéíà[7]. Áèäíèé ñóäàëãààíààñ õàðàõàä Óëàìæëàëò àíàãààõ óõààíû ýðäýì øèíæèëãýýíèé òºâ áàéãóóëëàãà áîëîõ ÓÀØÓÒ¯Ê ñ¿¿ëèéí 10 æèëä õèéãäñýí íèéò òºñºëò ñóäàëãààíû 50%-èéã, èõ äýýä ñóðãóóëèóä 44%-èéã ã¿éöýòãýæ, ýäãýýð òºñëèéí õ¿ðýýíä õ¿ëýýëãýí ºãñºí íèéò ¿ð ä¿íãèéí 65%-èéã ÓÀØÓÒ¯Ê, 34%-èéã èõ äýýä ñóðãóóëèóä õ¿ëýýëãýí ºãñºí áàéíà. Òºñºëò àæëûí ñóäàëãààíû 263 ¿ð ä¿íã ãîëëîõ äîëîîí õýëáýðýýð áàòàëãààæóóëñàí áàéäëààñ õàðàõàä ñòàíäàðò, ôàðìàêîïåéí ºã¿¿ëýë 23.6%, òåõíîëîãèéí çààâàð 22% áóþó íèéò áàòàëãààæèëòûí äîòîð äèéëýíõ ¿ç¿¿ëýëòòýé áàéãàà áîë á¿òýýãäýõ¿¿íèé çàãâàð, Àøèãòàé çàãâàðûí ãýð÷èëãýý (AÇÃ) 2.7%, çîõèîí áàéãóóëñàí õóðàë, ñåìèíàð 6%-èéã ýçýëæ áàéíà.

Æèëä äýëõèéí õýìæýýíä 60 òýðáóì äîëëàðûí óëàìæëàëò àíàãààõ óõààíû á¿òýýãäýõ¿¿í

õýðýãëýäýã áàéíà[8]. Äýëõèé íèéòèéí õýìæýýíä ÓÀÓ-ûã õºãæ¿¿ëýí, ýð¿¿ë ìýíäèéí òîãòîëöîîíäîî àìæèëòòàé íýâòð¿¿ëýõ àñóóäàëä èõýýõýí à÷ õîëáîãäîë ºã÷ áàéãààãààñ èéíõ¿¿ ºñºí íýìýãäñýýð áóé Óëàìæëàëò/Äîðíî äàõèí/àëüòåðíàòèâ àíàãààõ óõààíû õýðýãëýýã çºâ çîõèîí áàéãóóëàõ, àþóëã¿é, ¿ð ä¿íòýé îíîøëîãîî ýì÷èëãýýíèé áàéäàëä õÿíàëò òàâèõ àñóóäàë ç¿é ¸ñîîð óðãàí ãàð÷ áàéíà. Àçè íîìõîí äàëàéí á¿ñýä 900 ñàÿ õ¿í ºäºðò 2 àì äîëëàð õ¿ðýõã¿é ìºíãººð àìüäàð÷ áàéãàà ýíý ¿åä ýð¿¿ë ìýíäèéí ýäèéí çàñãèéí àøèãòàé õýëáýðèéã ñîíãîõ íü õ¿í àìûã ºâ÷íººñ óðüä÷èëàí ñýðãèéëýõ, ýð¿¿ë ìýíäèéí òóñëàìæ ¿éë÷èëãýýã õ¿ðòýýìæòýé áîëãîõ íèéãìèéí ýð¿¿ë ìýíäèéí íýí ÷óõàë àñóóäëóóäûí íýã þì [9]

Ò¿¿í÷ëýí, óëàìæëàëò àíàãààõ óõààíû ìýäëýã ºâèéã íèéãìèéí ýð¿¿ë ìýíäèéí ñàëáàðò àøèãëàõ ñóäàëãààíóóä õèéãäñýýð áàéíà. 2003 îíä Õÿòàä óëñ SARS-èéí ¿åä óëàìæëàëò æîðûí ýì òàíãààð óðüä÷èëàí ñýðãèéëýõ áîëîí ýì÷ëýõ ñòðàòåãèéã õýðýãëýæ áàéñàí [10] áîë Àôðèêèéí çàðèì îðíóóäàä ÄÎÕ ºâ÷íèé óðõàãòàé òýìöýõ ¿¿äíýýñ óëàìæëàëò àíàãààõûí óðãàìëûã õýðýãëýæ áàéíà [11]. Ýíý íü îð÷èí ¿åèéí àíàãààõûí ¸ñ ç¿éòýé íèéöýõã¿é ãýæ çàðèì íýãýí áèîàíàãààõûí ñóäëàà÷èä ¿çäý [11, 12]. Ãýâ÷ îëîí çóóí æèëýýð õýðýãëýí, õ¿íèé àìü àìüäðàë äýýð òóðøèãäñààð èðñýí ìýäëýãèéã îð÷èí ¿åèéí àðãààð áàòàëòàë äýýð õýëñýí÷ëýí îëîí àðâàí æèë, õ¿÷ õºðºíãº çàðöóóëäàã áºãººä õàìãèéí ãîë íü õ¿íèéã ºâ÷íººñ àíãèæðóóëàõ áîëîìæ àëäàãäàõ ºíäºð ìàãàäëàëòàéã çàðèì ñóäëàà÷èä òýìäýãëýí, íèéãìèéí ýð¿¿ë ìýíäèéí òóëãàìäñàí àñóóäëóóäàä óëàìæëàëò àíàãààõ óõààíû àðãûã õýðýãëýõèéã èë¿¿òýé äýìæèæ áàéíà [13].

2002-2007 îíóóäûí õîîðîíä äýëõèé äýýðõ ñóäëàà÷äûí òîî 5.8 ñàÿ áàéñíààñ 7.1 ñàÿ áîëæ ýðñ íýìýãäýæýý, õºãæèæ áóé îðíóóäûí ñóäëàà÷äûí òîî 1,8 ñàÿààñ 2,7 ñàÿ áîëæ íýìýãäñýí íü äýëõèéí ñóäëàà÷äûí 38,4%-èéã ýçýëæ áàéíà. ¯¿íòýé çýðýãöýí ñóäàëãààíû çàðäàë ìºí ºññººð èðñýí áàéíà. Æèøýý íü, 2002 îíä îíä äýëõèéí íèéò ÄÍÁ-èéí 1.71%èéã ñóäàëãààíä çàðöóóëæ áàéñàí áîë 2007 îíä 1.74% íü ñóäàëãàà øèíæèëãýýíä çàðöóóëàãäñàí áàéíà. ÁÍÕÀÓ (1.5%), Òóíèñ (1%) çýðýã óëñóóäûã ýñ òîîöâîë õºãæèæ áóé îðíóóä ÄÍÁ 1%-ýýñ áàãà õóâèéã ñóäàëãààíä çàðöóóëäàã áàéíà. Àçèéí óëñ îðíóóäûí ñóäàëãààíû çàðäëûí äóíäàæ íü 2007 îíû áàéäëààð 1.6% áàéñàí, ¿¿íýýñ ýðäýì øèíæèëãýýíèé çàðäëààð òýðã¿¿ëýã÷ íü ßïîí óëñ (3.4%), Ñîëîíãîñ óëñ (3.5%), Ñèíãàïóð (2.6%) áàéíà. Eâðîïä 2007 îíû áàéäëààð 0.2%- 3.7% áóþó ñóäàëãàà øèíæèëãýýíä õàìãèéí áàãà çàðöóóëäàã íü Ìàêåäîíè, õàìãèéí èõ õºðºíãº çàðöóóëäàã íü Øâåä óëñ áàéíà. Àâñòðè, Äàíè, Ôðàíö, Ãåðìàí, Èñëàíä áîëîí Øâåéöàðü çýðýã óëñóóä ÄÍÁ-èéí 2-3% -èéã ñóäàëãàà øèíæèëãýýíä çàðöóóëäàã áàéíà[14]. Ìàíàé óëñàä 2008 îíû


áàéäëààð ñóäàëãàà øèíæèëãýýíä ÄÍÁ-èéí 0.28%-èéã áóþó 15 ñàÿ àì.äîëëàð çàðöóóëñàí ¿ç¿¿ëýëòýýðýý õàðüöóóëñàí îðíóóäààñ õàìãèéí ñ¿¿ëä îðñîí áàéíà. Ïåðó óëñ ãýõýä 2008 îíä 104 ñàÿ àì.äîëëàð Ìîíãîë Óëñûí ¿ç¿¿ëýëòýýñ äàðóé äîëîî äàõèí èõ ¿ç¿¿ëýëò çàðöóóëñàí áîò ªìíºä Ñîëîíãîñ 33686 ñàÿ àì.äîëëàð. (Ìîíãîë Óëñûí ¿ç¿¿ëýëòýýñ äàðóé 2245 äàõèí èõ ¿ç¿¿ëýëò) çàðöóóëäàã áàéíà[15].

Àçèéí óëñ îðíóóäàä ýìýãòýé ñóäëàà÷èä íèéò ñóäëàà÷äûí 18%-èéã ýçýëæ áàéãàà íü ÞÍÅÑÊÎ-èéí ¿çýæ áàéãààãààð ÷àìëàëòòàé ¿ç¿¿ëýëò þì[14]. Õàðèí ìàíàé óëñûí õóâüä ýìýãòýé÷¿¿ä íèéò ñóäëàà÷äûí 50-ñ èë¿¿ õóâèéã ýçýëæ áàéíà[15]. Óëàìæëàëò àíàãààõ óõààíû ñàëáàðûí ñóäëàà÷äûí õ¿íèé íººöèéí á¿òöèéã ñóäàëñàí áèäíèé ¿ð ä¿íãýýñ ìºí ë ýìýãòýé÷¿¿ä äàâàìãàéëäàã áàéäàë õàðàãäàæ áàéíà. Óëàìæëàëò àíàãààõ óõààíû õºãæëººðºº òýðã¿¿ëýã÷ ÁÍÕÀÓ, ßïîí, ÁÍÑÓ çýðýã óëñóóäòàé õàðüöóóëõàä ìàíàé óëñàä óëàìæëàëò àíàãààõ óõààíû ýì, ýì÷èëãýý îíîøèëãîîíû àðãà áàðèëûí ýìíýë ç¿éí ñóäàëãàà äóòìàã õèéãääýã íü áèäíèé ñóäàëãààíààñ õàðàãäàæ áàéíà.

Ä¿ãíýëò:1. Óëàìæëàëò àíàãààõ óõààíû õ¿íèé

íººö áîëîí ìýðãýøñýí ñóäëàà÷äûí òîî ñ¿¿ëèéí 10 æèëä ºñºõ õàíäëàãàòàé áàéíà. Ýìíýëç¿é÷ ýì÷ íàðûí øèíæëýõ óõààíû ñóäàëãààíû îðîëöîî îëîí òàëààð äóòìàã áàéäàã áà öàëèí õàíãàìæ, ñóäàëãààíû àðãà ç¿éí ìýäëýã, óð ÷àäâàð äóòìàã áàéäàãòàé õîëáîîòîé ãýæ ¿çýæ áàéíà.

2. Ñ¿¿ëèéí àðâàí æèëä õýðýãæñýí ñóäàëãààíû òºñëèéí äèéëýíõèéã ÓÀØÓÒ¯Ê ã¿éöýòãýñýí áà òºñëèéí õ¿ðýýíä õàâñðàãà ñóäàëãàà çîíõèëîí õèéãäýæ, ýìíýëç¿é, ýõ ñóðâàëæ ñóäëàëûí ñóäàëãàà õîöðîíãóé áàéíà. Ýäãýýð ñóäàëãààíû ¿ð ä¿íã ôàðìàêîïåéí ºã¿¿ëýë, òåõíîëîãèéí çààâàð áàéäëààð áàòàëãààæóóëàõ íü ò¿ëõ¿¿ áàéíà.

Íîì ç¿é1. Bold Sharav, Historical stages of traditional

mongolian medicine, History and development of traditional Mongolian medicine,Ulaanbaatar, 2009, p.20

2. Ø.Áîëä, Ìîíãîë÷óóäûí ýð¿¿ë àìüäðàõ óõààí, Óëààíáààòàð õîò, 2009, õ.13

3. Ò.À.Àñååâà, Ê.Ô.Áëèíîâà, Ã.Ï.ßêîâëåâ Ëåêàðñòâåííûå ðàñòåíèÿ òèáåòñêîé ìåäèöèíû, Èçä “Íàóêà” 1985, ñ.6-17

4. Ö.Õàéäàâ, Öýðýí÷èìýä, Î ñòàðîé ìîíãîëüñêîé ìåäèöèíñêîé ëèòåðàòóðå, Òºâ àçèéí èðãýíøèëä í¿¿äýë÷äèéí ðîëü,

Îëîí óëñûí ñèìïîçèóìûí õýðýãëýãäýõ¿¿í, Óëààíáààòàð õîò, 1974 îí, õ.289

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6. ÓÀØÓÒ¯Ê, Óëàìæëàëò àíàãààõûí øèíæëýõ óõààí òåõíîëîãè, ¿éëäâýðëýëèéí êîðïîðàöèéí ýðäýì ñóäëàëûí á¿òýýëèéí òîéì, õ.19

7. ÁÑØß, Ýðäýì øèíæèëãýýíèé àæëûí ¿ð ä¿í, öàõèì õóóäàñ: http://www.meds.gov.mn

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Òàíèëöàæ, íèéòëýõ ñàíàë ºãñºí:Àêàäåìè÷ Ø.Áîëä


Ýìíýëãèéí ìåíåæìåíòèéí çàðèì àñóóäàëä

À.Áàðõàñ1, ×.Öîëìîí2, Ö.Ìóõàð3, Ï.Óâø4

1Ýð¿¿ë ìýíäèéí ÿàì 2Àíàãààõûí øèíæëýõ óõààíû ¿íäýñíèé èõ ñóðãóóëü, ÍÝÌÑ

3À÷òàí-Ýëèò Ýìíýëýã 4Óäèðäëàãûí àêàäåìè

AbstractSome problems of hospital management

A.Barhas1, Ch.Tsolmon2, Ts.Mukhar3, P.Uvsh4

1Ministry of Health2National University of Medical Sciences

3Àchtan Elite” Hospital4Academy of Management

BackgroundThe Mongolian Government is regularly concerned on the hospital development and the improvement of hospital structure and function at the health sectors’ policy level. Therefore, there is a need of evidence based survey that is determine possible ways in improving hospital management through the management function (organization, planning, decision making, leadership-motivation, monitoring and evaluation management) and management component (human resources, information, marketing, finance, foreign relationship and cooperation).

Objective To outline possible approaches in improving clinical hospital management upon reviewing of its current setting

Materials and MethodsThe study was conducted by qualitative method and data was collected through applying discussions and participatory approaches. In total, 155 participants were enrolled in the study, from which 72 were covered by the Focus Group Discussions, and the remained 83 were studied for Organizational Diagnostic Analysis.

ResultsThe Clinical hospital management aspects are reasonably unsatisfactory (61.4%). As a result of survey, clinical hospital structure, organization and coordination (76%), monitoring and evaluation management (72.8%), planning (71.6%) encompass comparatively predominant advantages whereas decision making management (67.5%), motivation (59.6%), human resources management (62.4%), information management (57.8%), financial management (52.9%), and hospital marketing (30%) enclose prevailing disadvantages. According to the hospital policy analysis, there were hospital priority issues such as inappropriate hospital structure, the weak hospital governance, monitoring and responsibility, financial system is separate and it could not the right financial lever, do not have hospital capacity planning and repairing system, private sector’s role is indefinite and coordination is limited. There recommended 4 hospital policy approaches.

Conclusion: Advantages and Disadvantages of the Clinical hospital management levels, although they vary, management aspects are reasonably unsatisfactory. If to view in an isolation by each key role and direction of the management functions, organization, planning, monitoring and evaluation management encompass comparatively predominant advantages whereas human resources, information, finance, motivation, and decision making management enclose prevailing disadvantages. In terms of hospital marketing, it is extremely poor. Therefore, there are needed for improving of hospital management and marketing through the hospital 4 policy approaches by phase.

Key words: Hospital management, Hospital policy, Health management, Health policy

Pp.67-70, Table -1, References -25


¯íäýñëýë

Ìîíãîë Óëñûí Çàñãèéí ãàçàð áîëîí Ýð¿¿ë ìýíäèéí ñàëáàðûí áîäëîãûí ò¿âøèíä ýìíýëãèéã õºãæ¿¿ëýõ, óäèðäëàãà çîõèîí áàéãóóëàëòûã áîëîâñðîíãóé áîëãîõîä àíõààðëàà áàéíãà õàíäóóëæ áàéíà. Èéìä íîòîëãîîíä òóëãóóðëàí, óäèðäàõ àæèëòíû ¿íäñýí ¿¿ðýã (çîõèîí áàéãóóëàëò, òºëºâëºëò, øèéäâýð ãàðãàëò, ìàíëàéëàë-èäýâõèæ¿¿ëýëò, õÿíàëò-øèíæèëãýý, ¿íýëãýý) áîëîí ìåíåæìåíòèéí ¿íäñýí á¿ðýëäýõ¿¿í (õ¿íèé íººö, ìýäýýëýë, ìàðêåòèíã, ñàíõ¿¿, ãàäààä õàðèëöàà) õýñãèéí ¿éë àæèëëàãààã áîëîâñðîíãóé áîëãîõ àðãà çàìûã òîäîðõîéëîõ íü ýíýõ¿¿ ñóäàëãààíû ¿íäýñëýë áîëæ áàéíà.

Çîðèëãî

Êëèíèêèéí ýìíýëãèéí ìåíåæìåíòèéí ºíººãèéí áàéäëûã ñóäëàí, áîëîâñðîíãóé áîëãîõ àðãà çàìûã òîäîðõîéëîõ

Çîðèëò: Êëèíèêèéí ýìíýëãèéí ìåíåæìåíòèéí á¿òýö, çîõèîí áàéãóóëàëò, ¿íäñýí ÷èã ¿¿ðãèéí ºíººãèéí áàéäëûã ¿íýëýõ, ñàëáàðûí õýìæýýíèé õàíäëàãàä òóëãóóðëàñàí õàðèóöëàãàòàé, èë òîä, øóóðõàé ìåíåæìåíòèéí òîãòîëöîî, ÷èã ¿¿ðãèéã ñàéæðóóëàõ àðãà çàìûã òîäîðõîéëîõ

Màòåðèàë, àðãà ç¿é

Ñóäàëãààíä Óëààíáààòàð õîòûí êëèíèêèéí ýìíýëýã, òºðºëæñºí íàðèéí ìýðãýæëèéí òºâ¿¿äèéí 53.3%, õóâèéí õýâøëèéí êëèíèêèéí ýìíýëãèéí 20.0% áóþó íèéò 12 ýìíýëýã, 155 îðîëöîãñîä õàìðàãäàâ. Ñóäàëãààã îð÷íû øèíæèëãýý, áàéãóóëëàãûí îíîøëîãîîíä òóëãóóðëàí ÷àíàðûí ñóäàëãààíû àðãààð õèéëýý.

¯ð ä¿í

Êëèíèêèéí ýìíýëãèéí óäèðäëàãà, á¿òýö çîõèîí áàéãóóëàëò: Êëèíèêèéí ýìíýëã¿¿ä íü óëñûí õýìæýýíä òºðºëæñºí íàðèéí ìýðãýæëèéí òóñëàìæ ¿éë÷èëãýýã ¿ç¿¿ëæ, àíàãààõ óõààíû ñóðãàëò, ñóäàëãàà ÿâóóëàõ, ýðäýì øèíæèëãýýíèé àæèë ýðõëýõ, ìýðãýæèë àðãà ç¿éí çºâëºãºº ºãºõ ¿íäñýí ÷èã ¿¿ðýãòýé àæèëëàäàã. Ýìíýëã¿¿äýä 2004-2007 îíóóäàä 2 óäàà Ýð¿¿ë ìýíäèéí ñàéäûí òóøààëààð á¿òöèéí ººð÷ëºëò õèéñýí áàéíà. Ñ¿¿ëèéí æèë¿¿äýä á¿òýö çîõèîí áàéãóóëàëò ñàéæèð÷ áàéãàà áîëîâ÷ ýìíýëýã á¿õýí ººðèéí îíöëîãîîñ õàìààðàí äàâóó áà ñóë òàëòàé áàéíà. SWOT øèíæèëãýýíèé ¿ð ä¿íãýýñ õàðàõàä ýìíýëãèéí ¿éë àæèëëàãààíû óÿëäàà õîëáîî, äîòîîä çîõèöóóëãà, ä¿ðýì æóðàì, õàìòûí àæèëëàãàà õàðüöàíãóé áîëîìæòîé, õàðèí óäèðäëàãûí á¿òýö çîõèîí áàéãóóëàëò

îíîâ÷òîé áóñ, ýìíýëãèéí îäîîãèéí á¿òýö çîõèîí áàéãóóëàëò òåõíèê òåõíîëîãèéí äýâøèëä íèéöýæ ÷àäàõã¿é áàéãàà ñóë òàë õàðàãäàæ áàéíà.

Òºëºâëºëòèéí óäèðäëàãà: Êëèíèêèéí ýìíýëã¿¿ä íü ýð¿¿ë ìýíäèéí ñàëáàðûí ìàñòåð òºëºâëºãººíèé ¿íäñýí ÷èãëýëä òóëãóóðëàí, ñòðàòåãèéí òºëºâëºãººã, àæëûí ã¿éöýòãýë, ¿íýëãýýíä òóëãóóðëàí æèëèéí áîëîí îéðûí òºëºâëºãººã áîëîâñðóóëäàã áàéíà. Òºëºâëºëòèéã øààðäàãäàõ íººöèéã òóñãàäàã áîëîâ÷, áîäèò áóñ, ýñâýë òºñºâòºº òààðóóëàí òºëºâëºäºã ó÷ðààñ õýðýãæèëòèéí øàòàíäàà äîãîëäîæ, áèåëýõã¿é áàéõ ¿íäñýí øàëòãààí áîëæ áàéíà. Ñòðàòåãèéí òºëºâëºãºº íü ñàëáàðûí áîäëîãî, øèéäâýð, ýðõ ç¿éí îð÷èíòîé óÿëäàæ òóñëàìæ, ¿éë÷èëãýýíèé ÷àíàð õ¿ðòýýìæèéã äýýøë¿¿ëýõýä ÷èãëýæ áàéãààãààðàà äàâóó òàëòàé áàéíà. Òºëºâëºñºí ¿éë àæèëëàãàà õýðýãæ¿¿ëýõ ñàíõ¿¿ãèéí íººöèéã òîîöîõ, òåõíèê, òåõíîëîãèéí äýâøëèéã íýâòð¿¿ëýõ, ýìçýã á¿ëãèéí õ¿í àìä ¿ç¿¿ëýõ òóñëàìæ ¿éë÷èëãýýã íýìýãä¿¿ëýõ òàëààð õàíãàëòã¿é áàéíà.

Óäèðäëàãûí øèéäâýð ãàðãàëò áà õàìò îëíû îðîëöîî: Êëèíèêèéí ýìíýëãèéí óäèðäàõ çºâëºë íü øèéäâýðèéã áàãààð ãàðãàõ áîëîìæòîé áàéäàã áà ãàðãàñàí øèéäâýðèéã ãèø¿¿ä, àæèëòàí õàðèëöàí àäèëã¿é õ¿ëýýæ àâäàã áîëîâ÷ èõýâ÷ëýí õ¿ëýýí çºâøººð÷, õýðýãæèëòèéã õàíãàæ àæèëëàäàã áàéíà. Øèéäâýð ãàðãàëòàä õàìò îëîí îðîëöîõäîî èõýâ÷ëýí òàñàã íýãæäýý àñóóäëàà õýëýëöýí, òàñãèéí ýðõëýã÷, óäèðäëàãààð äàìæóóëàí óäèðäëàãà, óäèðäàõ çºâëºëä õ¿ðã¿¿ëýõ çàìààð îðîëöäîã. Òºâëºðëèéã ñààðóóëæ, øèéäâýð ãàðãàõ ýðõ ìýäëèéã äîîä ò¿âøèíä øèëæ¿¿ëýõ, íýýëòòýé áîäëîãî áàðèìòëàõ çýðýã àðä÷èëñàí äýâøèë ãàð÷ áàéãàà, ò¿¿í÷ëýí áàéãóóëëàãûí äîòîîä æóðàìä õàìò îëíû ñàíàëûã òóñãàõ, óäèðäàõ àæèëòíû øèéäâýðèéã àæèëòíóóä äýìæèí õ¿ëýýæ àâäàã äàâóó òàëòàé, øèéäâýðò õàìò îëíû çºâëºëèéí òºëººëºë îðîëöîõ, óäèðäëàãààñ àæèëòàíòàé õàðèëöàí ÿðèëöàõ, àæëûã ¿íýëýõ çýðýã äýìæëýãò óäèðäëàãà õàíãàëòã¿é ñóë òàëòàé áàéíà.

Óäèðäëàãûí ìàíëàéëàë áà èäýâõèæ¿¿ëýëò: Ñóäàëãààíä îðîëöîãñîäûí äèéëýíõ íü óäèðäàõ àæèëòíû ìàíëàéëàëä ñýòãýë õàíãàëóóí, “ñàéí ìàíëàéëæ àæèëëàäàã, ìàíëàéëàë ñàéí áàéõã¿é áîë àæèë óðàãøëàõã¿é, áàéãóóëëàãà õºãæèõã¿é” ãýñýí çºâ ¿çýë áîäîëòîé áàéíà. Õàðèí óäèðäëàãûí ìàíëàéëàë, ¿éë àæèëëàãààíä óëñ òºðèéí ñºðºã íºëººëºë èõòýé, óäèðäàã÷ ¿ð á¿òýýëòýé àæèëëàæ ýõýëìýãö ººð÷èëäºã, äàðààãèéí õ¿í çàëãàìæ áîëæ ÷àääàãã¿é ãýæ ¿çýæ áàéíà. Óäèðäëàãûí ìàíëàéëàëä ñàéí òàë áàéãàà ÷ óðàìøóóëàë, èäýâõèæ¿¿ëýëò õàíãàëòã¿é


áàéãàà íü ¿ç¿¿ëýëò áóóðàõàä íºëººëæ, ýíý òàëààð ñóäàëãààíä îðîëöîãñîä õàðèëöàí àäèëã¿é áîäîëòîé áàéíà.

Õÿíàëò ¿íýëãýý áà ¿¿ðýã õàðèóöëàãà: ×àíàðûí ìåíåæåð, õ¿íèé íººöèéí ìåíåæåð çýðýã 3-5 õ¿íèé á¿ðýëäýõ¿¿íòýé “õÿíàëò ¿íýëãýýíèé áàã” òîäîðõîé òºëºâëºãººòýé àæèëëàäàã áà àñóóäëûã óäèðäàõ çºâëºëä õýëýëö¿¿ëýí øèéäâýðë¿¿ëäýã áàéíà. Ñóäàëãààíä îðîëöîãñîä õÿíàëò-¿íýëãýýíèé òîãòîëöîî íü áàéãóóëëàãûí óðàãøëàõ ¿éë ÿâö ãýñýí çºâ ¿çýë áîäîëòîé, ñ¿¿ëèéí æèë¿¿äýä ñàéæèð÷ áàéíà ãýñýí ¿íýëãýýòýé áàéíà. Õàðúÿà äýýä øàòíû áàéãóóëëàãàòàé õÿíàëò ¿íýëãýýíèé òàëààð õàìòðàí àæèëëàõ, ÷àíàðûí õÿíàëòûã á¿õ ò¿âøèíä õèéõ, ãîìäëûí ìºðººð àðãà õýìæýý àâ÷ ìýäýýëýõ òàëààð õàíãàëòã¿é áàéíà.

Õ¿íèé íººöèéí óäèðäëàãà: Êëèíèêèéí ýìíýëã¿¿ä íü ýð¿¿ë ìýíäèéí ñàëáàðûí ìàñòåð òºëºâëºãººíä òóëãóóðëàñàí, õ¿íèé íººöèéã õºãæ¿¿ëýõ õýòèéí áîëîí îéðûí òºëºâëºãººòýé áàéíà. Òºëºâëºãºº íü òàñðàëòã¿é ñóðãàëòûí òîãòîëöîîã õàíãàõàä ò¿ëõ¿¿ ÷èãëýñýí áàéíà. Ñóäàëãààíä îðîëöîãñîä øèíý òåõíîëîãè íýâòðýõýä áàãààð àæèëëàõ ÷àäàâõè ñóë áàéãàà íü õ¿íèé íººöèéí áîäëîãî äóòàãäàëòàé áàéãààã õàðóóëæ áàéíà. Êëèíèêèéí ýìíýëã¿¿äèéí ýðäýì øèíæèëãýý, ñóäàëãààíû àæèë õÿçãààðëàãäìàë õ¿ðýýíä, ñóäàëãààíû ¿ð ä¿íã áîëîâñðóóëàõ, ä¿ãíýëò ãàðãàõ, íîòîëãîîíä àøèãëàõ ÷àäàâõè ñóë áàéíà.

Ìýäýýëýë, ìàðêåòèíãèéí óäèðäëàãà: Êëèíèêèéí ýìíýëã¿¿äèéí ìýäýýëëèéí óðñãàë íü èõýâ÷ëýí äýýðýýñ äîîø ÷èãëýñýí, íýã òàëò õàðèëöàà äàâàìãàéëæ áàéíà. Êëèíèêèéí ýìíýëã¿¿ä íü ìýäýýëëèéí íýýëòòýé áàéäëûã õàíãàõ, äîòîîä ñ¿ëæýýíä õîëáîãäîõ, øóóðõàé áàéäëûã õàíãàõ òàëààð äàâóó òàëòàé áàéíà. Öàõèì ìýäýýëëèéí àþóëã¿é áàéäëûã õàíãàõ, ìýäýýëëèéã àøèãëàõ, öàãèéí ìåíåæìåíò õàíãàëòã¿é, ñóë òàë èõòýé áàéíà. Êëèíèêèéí ýìíýëã¿¿äèéí ìàðêåòèíãèéí óäèðäëàãà, çàõ çýýëèéí áîäëîãî ìàø õàíãàëòã¿é, äàâóó òàë áàéõã¿é áàéíà. ßëàíãóÿà ýðýëò, íèéë¿¿ëýëò, ºðñºëäºã÷èéí òàëààð ñóäëàõ, áàéãóóëëàãûí ¿éë àæèëëàãààíû òàëààð òàíèëöóóëãà, ñóðòàë÷èëãàà õèéõ, îëîí íèéòýä ìýäýýëýõ, ¿ð íºëººã ¿íýëýõ áàéäàë ìàø õàíãàëòã¿é, ñóë òàë èõòýé áàéíà.

Ñàíõ¿¿ãèéí óäèðäëàãà: Ýìíýëãèéí ñàíõ¿¿, íÿãòëàí áîäîõ á¿ðòãýë òîîöîîíä îëîí óëñûí ñòàíäàðòûí øààðäëàãà õàíãàñàí ïðîãðàìì õàíãàìæ íýâòð¿¿ëñýí ñàéí òàë áàéãàà ÷ ñàíõ¿¿ãèéí óäèðäëàãà, íººöèéí çîõèöóóëàëòàä ñóë òàë èõ áàéíà. Ñàíõ¿¿ãèéí óäèðäëàãûí ñóë

òàë íü íººö, òºñâèéí õÿçãààðëàãäìàë áàéäàëòàé èë¿¿ õîëáîîòîé, ÿëàíãóÿà ýðñäëèéã òîîöîîëæ, áîëçîøã¿é ¿åèéí çàðäëûã íººöëºõ, øèíý òåõíîëîãè íýâòð¿¿ëýõ, ýìíýëãýý ºðãºæ¿¿ëýõýä øààðäàãäàõ õºðºíãº ãàðãàõ áîëîìæ áàãà áàéíà.

Table 1. Main indicators (Indicators’ average)

№ Indicator Percentage, %Management function1 Structure 76.02 Planning 71.63 Decision making 67.54 Leadership and motivation 59.65 Monitoring and evaluation

management72.8

6 Responsibility 64.0Management component7 Human resource

management 62.4

8 Information management 57.89 Financial management 52.910 Hospital Marketing 30.0

Ýìíýëãèéí ìåíåæìåíòèéí ºíººãèéí áàéäëûã óäèðäëàãûí ¿íäñýí 5 ¿¿ðýã, ¿íäñýí 5 á¿ðýëäýõ¿¿í õýñãèéí õ¿ðýýíä ñóäëàõàä ýìíýëãèéí ìåíåæìåíò õàíãàëòã¿é (61.4%) áàéíà. Ýìíýëãèéí á¿òýö, çîõèîí áàéãóóëàëò áà çîõèöóóëàëò (76%), õÿíàëò-øèíæèëãýý, ¿íýëãýý (72.8%), òºëºâëºëò (71.6%) õàíãàëòòàé áàéíà. Õàðèí øèéäâýð ãàðãàëò áà õàìò îëíû îðîëöîî (67.5%), óäèðäëàãûí ìàíëàéëàë áà èäýâõèæ¿¿ëýëò (59.6%) ñóë áàéíà. Ýìíýëãèéí õ¿íèé íººöèéí óäèðäëàãà (62.4%), ìýäýýëëèéí óäèðäëàãà (57.8%), ñàíõ¿¿ãèéí óäèðäëàãà (52.9%), ýìíýëãèéí ìàðêåòèíã (30%) õàíãàëòã¿é áàéíà.

Ä¿ãíýëò: 1. Ýìíýëãèéí ìåíåæìåíòèéí ºíººãèéí

áàéäëûã óäèðäëàãûí ¿íäñýí 5 ¿¿ðýã, ¿íäñýí5 á¿ðýëäýõ¿¿í õýñãèéí õ¿ðýýíä ñóäëàõàä ýìíýëãèéí ìåíåæìåíò õàíãàëòã¿é (61.4%) áàéíà. Ýìíýëãèéí á¿òýö, çîõèîí áàéãóóëàëò áà çîõèöóóëàëò (76%), õÿíàëò-øèíæèëãýý, ¿íýëãýý (72.8%), òºëºâëºëòèéí óäèðäëàãà (71.6%) õàíãàëòòàé áàéíà. Õàðèí øèéäâýð ãàðãàëò áà õàìò îëíû îðîëöîî (67.5%), óäèðäëàãûí ìàíëàéëàë áà èäýâõèæ¿¿ëýëò (59.6%) ñóë áàéíà. Ýìíýëãèéí õ¿íèé íººöèéí óäèðäëàãà (62.4%), ìýäýýëëèéí óäèðäëàãà (57.8%), ñàíõ¿¿ãèéí óäèðäëàãà (52.9%), ýìíýëãèéí ìàðêåòèíã (30%) õàíãàëòã¿é áàéíà.

2. Ýìíýëãèéí ìåíåæìåíòèéã áîëîâñðîíãóé áîëãîõ äàðààõ àðãà çàìóóä:


a. Ýìíýëãèéí ñàëáàðûí á¿òýö çîõèîí áàéãóóëàëòûã õ¿í àìûí õýðýãöýý, òóëãàìäñàí àñóóäëûã øèéäâýðëýõýä íèéö¿¿ëýí îíîâ÷òîé, ¿ð àøèãòàéãààð ººð÷ëºí çîõèîí áàéãóóëàõ

b. Ýìíýëãèéí ñàëáàðûí çîõèöóóëàëò, óäèðäëàãûí áèå äààñàí áàéäàë, ¿ð ä¿íä ÷èãëýñýí õàðèóöëàãûí òîãòîëöîîã ñàéæðóóëàõûí òóëä ñàëáàðûí áà ýìíýëãèéí ò¿âøèíä çàñàãëàëûã ñàéæðóóëàõ

c. Ýìíýëãèéí ã¿éöýòãýëä çîõèñòîé óðàìøóóëàë áèé áîëãîõ, ñàíõ¿¿æèëòèéí ýõ ¿¿ñâýð õîîðîíäûí çîõèöóóëàëòûã ñàéæðóóëàõ, ñàíõ¿¿æèëòèéí òîãòâîðòîé áàéäëûã õàíãàõûí òóëä ñàíõ¿¿æèëòèéí áà òºëáºðèéí ìåõàíèçìûã øèíý÷ëýõ

d. Õóâèéí ñàëáàðûã äýìæèõ, çîõèöóóëàëòûã ñàéæðóóëàõ, òºð áà õóâèéí õýâøëèéí õàìòûí àæèëëàãààã õºãæ¿¿ëýõèéí òóëä õóâèéí ýìíýëãèéí ñàëáàðûí áîäëîãûí íàðèéí çîõèöóóëàëòûã áèé áîëãîõ

Íîì ç¿é1. Ñîäíîìïèë Ö. Ýð¿¿ë ìýíäèéí óäèðäëàãà,

áàéãóóëëàãûí ¿éë àæèëëàãààã òîãòâîðòîé áîëãîõ íü. Óëààíáààòàð: 1986.

2. ßíñàí Ï. Õºäººãèéí õ¿í àìä ¿ç¿¿ëýõ òóñëàìæ, ¿éë÷èëãýýíèé çîõèîí áàéãóóëàëò. Óëààíáààòàð: 1992.

3. Äàø-ßíäàã Á. Ìåíåæìåíòèéí óõààíààð ýìíýëãèéã óäèðäàõóé, Áàÿíç¿ðõ ä¿¿ðãèéí íýãäñýí ýìíýëãèéí æèøýýí äýýð. Óëààíáààòàð: 2009.

4. Ñîíèí Ñ. Ýìíýëãèéí áàéãóóëëàãûã ººð÷ëºí çîõèîí áàéãóóëàõ íü. Óëààíáààòàð: 2011. õ.5

5. Áóëãàí÷èìýã Á. Ýìíýëãèéí óäèðäëàãûí ¿íäýñ. Óëààíáààòàð: 2004. õ. 81, 110

6. Õàíäìàà À. Áàéãóóëëàãûí õ¿íèé íººöèéí ìåíåæìåíòèéí øèíý÷ëýëèéí çàðèì àñóóäàë. Óëààíáààòàð: 2010. õ. 6

7. Óäâàë Í. Ýð¿¿ë ìýíäèéí àíõíû òóñëàìæèéí õàðüöóóëñàí ñóäàëãàà áà óäèðäëàãà çîõèîí áàéãóóëàëòûí ìîíãîë çàãâàð. Á¿òýýëèéí õóðààíãóé. Óëààíáààòàð: 2002. õ. 16.

8. Áàäðàëìàà Ð., Ýð¿¿ë ìýíäèéí ñàëáàðûí ñòðàòåãèéí óäèðäëàãûí øèíæèëãýý, Óëààíáààòàð, 2011

9. Äîðæñ¿ðýí Ï., Çàñàãëàëûí îíîøëîãîîíèé àðãà ç¿éí àñóóäàë, Óëààíáààòàð, 2010

10. Æàðãàë Ã., Áàéãóóëëàãûí îíîøëîãîî òºëºâëºëò õèéõ àðãà÷ëàë, Óëààíáààòàð, 2004

11. Êåéíñ È., Áàéãóóëëàãûí õºãæëèéí óäèðäëàãà áà ñî¸ë, Óëààíáààòàð, 2006

12. Íàðàí÷èìýã Í., Óâø Ï., Âîëãèí Í.À., Íèéãìèéí áîäëîãî, Óëààíáààòàð, 2009

13. Îòãîíòóÿà Ë., Òºñâèéí çàðëàãûí óäèðäëàãà, òºëºâëºëò, Óëààíáààòàð, 2007

14. Ñîäíîìïèë Ö. Ýð¿¿ë ìýíäèéí óäèðäëàãà. Óëààíáààòàð: 2003.

15. Øóóðàâ ß., Ìåíåæìåíò, Óëààíáààòàð, 200916. Ýíõáàÿð Ã., Îòãîíòóÿà Ë., Òºðèéí ñàíõ¿¿ãèéí

óäèðäëàãà, Óëààíáààòàð, 200917. Ýð¿¿ë ìýíäèéí ñàëáàðûí óäèðäëàãà

ìýäýýëëèéí òîãòîëöîî, Óëààíáààòàð, 201018. Óäèðäàõóéí îíîë, ïðàêòèêèéí àñóóäëóóä:

ÝØÁ №10, Óëààíáààòàð, 201119. Handbook of leadership: Research and

management applications, third edition, 200820. Hospital management, New York, 2009 21. Açèéí õºãæëèéí áàíê – Ýð¿¿ë ìýíäèéí

ñàëáàðûí õºãæèë-4 òºñºë, 2010 îíû 5 ñàð: Ñàëáàðûí çàñàãëàëûã ñàéæðóóëàõ – Ñòðàòåãèéí ä¿í øèíæèëãýý. Òºñºë áîëîâñðóóëàõ òåõíèê òóñëàëöààíû òºñºë TA 7309-MON

22. Açèéí õºãæëèéí áàíê – Ýð¿¿ë ìýíäèéí ñàëáàðûí õºãæèë-4 òºñºë, Ýìíýëãèéí äýä ñàëáàðûí ä¿í øèíæèëãýý

23. Áààñàíæàâ, Í, 2011: Êëèíèêèéí 3 äóãààð ýìíýëãèéí òóñëàìæ ¿éë÷èëãýýã ¿íýëýõ íü (èëòãýë).

24. La Forgia GM and Couttolenc BF, 2008: Hospital Performance in Brazil: In search of Excellence. The World Bank, Washington DC.

25. World Bank, 2010: Enhancing Policies and Practices for Ger Area Development in Ulaanbaatar. The World Bank, Cities Alliance.

Òàëàðõàë: Ñóäàëãàà õèéõýä ñàíõ¿¿ãèéí äýìæëýã ¿ç¿¿ëñýí ÝÌß, ÄÝÌÁ, ÀÕÁ, õàìòðàí àæèëëàæ, ¿íýòýé õóâü íýìðýý îðóóëñàí òºñëèéí áàãèéí àõëàã÷ Àíàãààõ óõààíû äîêòîð Ñ.Äóëàìñ¿ðýí, òºñëèéí çºâëºõ Àíàãààõ óõààíû äîêòîð, ýð¿¿ëèéã õàìãààëàõûí ãàâúÿàò àæèëòàí Ö.Ñîäíîìïèë, òºñëèéí áàãèéí ãèø¿¿í Àíàãààõ óõààíû ìàãèñòð Ë.Øèðíýí áîëîí áàãèéí áóñàä ãèø¿¿ä, ÝÌØÓÈÑ-èéí ÍÝÌÑ, ÇÃÕÀ, ÝÌÃ, Óäèðäëàãûí àêàäåìè, ñóäàëãààíä îðîëöñîí êëèíèêèéí ýìíýëã¿¿äèéí óäèðäëàãà, õàìò îëîíä ã¿í òàëàðõàë èëýðõèéëüå.


ïðîôåññîð Á.Îðãèë


Ìîíãîëûí õ¿í àìûí ºðãºí õýðýãëýýíèé èìïîðòûí çàðèì õ¿íñíèé á¿òýýãäýõ¿¿íèé õàð òóãàëãàíû ¿ëäýãäýë,

ýð¿¿ë ìýíäèéí ýðñäýë

Á.Ýíõòóíãàëàã1, Á.Ãýðýëæàðãàë1, Á.Ò¿âøèíáàÿð1, Ä.Îþóíäýëãýð1, ×.ªíºðöýöýã2, Á.Äàâààäóëàì1, Ä.Öýðýíëõàì1, Ä.Õèøèãòîãòîõ,

Á.Ñîäíîìöýðýí1, Ý.Ýíõæàðãàë1, Î.Áàòõèøèã3, e-mail:[email protected]

1Íèéãìèéí ýð¿¿ë ìýíäèéí ¿íäýñíèé òºâ2Àíàãààõûí øèíæëýõ óõààíû ¿íäýñíèé èõ ñóðãóóëü

3Øèíæëýõ óõààíû àêàäåìèéí Õºðñ ñóäëàëûí ëàáîðàòîðè

Abstract

Lead residue and health risk in some commonly consumed imported food products among Mongolian population

B.Enkhtungalag1, B.Gereljargal1, B.Tuvshinbayar1, D.Oyundelger1, Ch.Unurtsetseg2, B.Davaadulam1, B.Tserenlkham1, D.Khishigtogtokh1,

B.Sodnomtseren1, E.Jargal 1, Î.Batkhishig3,

1National center for public health2National University of Medical Sciences

3Soil analyzed laboratory, Science Academy

IntroductionThe imported food products are more than 60 percent of total food consumption of Mongolia. The lead residue in food products causes chronic and acute poisoning to the human health when exceeds maximum residues limits, and human exposure and significant public health problems in many parts of the world.

GoalTo assess lead residues and health risk of some commonly consumed imported food products among Mongolian population.

Objectives: 1. To determine consumption of some imported food products of Mongolian population;2. To investigate lead residue in some commonly consumed imported food products;3. To assess potential health risk related lead residue.

Materials and Methods The research used analytic study of cross-sectional study design. Randomly selected 1290 people’s imports food consumption was analyzed by questionnaire and body weight measurements. Took samples from 145 import products, identified lead residue with Academy of Sciences Soil Research Laboratory`s, ASS (USA, 2002) equipment.

Results

60.7% of imported food samples were lead residues exceeded to Maximum Residues Limits, such us mean lead residues in meat product were 1.55 mg/kg, in milk product 1.22 mg/kg, in cereal products 1.15 mg/kg, in vegetables 1.57 mg/kg, in fruit and fruit juice 1.03 mg/kg, in alcohols drink 1.31 mg/kg, and in tea 1.93 mg/kg (p=0.001). Estimated Provisional Tolerable Weekly Intake (PTWI) of lead exposure for survey responses was 0.079mg/kg body weight.


Conclusions:1. 60.7% of imported food samples were lead residues exceeded to Maximum Residues Limits,

such us mean lead residues in meat product, milk products, fruits and vegetables.

2. Imported vegetables (54.0%), cereal 8.4% products (15.5%), fruit and fruit juice (11.8%), and milk products (8.4%) is main contributing to lead residues in imported food.

3. Estimated Provisional Tolerable Weekly Intake (PTWI) of lead exposure for survey responses was 0.079mg/kg body weight, which is 3.2 times higher than toxicological guidance (PTWI 0.025 mg/kg per 1 kg human body weight) and the high health risk level.

Pp.71-76, Tables 2, Figure 1, References 16

ÎðøèëÕ¿íñýí äýõ õîðò áîëîí áîõèðäóóëàã÷ áîäèñûí ¿ëäýãäëèéã áàãàñãàõ, õýðýãëýã÷äèéí ýð¿¿ë ìýíäèéã õàìãààëàõ, äýëõèéí õóäàëäààã øóäàðãà ÿâóóëàõ ¿¿äíýýñ Í¯Á-ûí ÕÕÀÀÁ, ÄÝÌÁ-ûí õàìòàðñàí Õ¿íñíèé Ýðõ Ç¿éí Êîìèññ (ÕÝÇÊ) õàð òóãàëãà çýðýã õ¿íä ìåòàëëûí õ¿íñýí äýõ ¿ëäýãäëèéí çºâøººðºãäºõ äýýä õýìæýý (ÇÄÕ), õ¿íèé áèåèéí 1 êã æèíä îíîãäîõ õîíîãèéí õ¿ëöýõ òóí (ÕÕÒ), äîëîî õîíîãèéí ò¿ð çºâøººðºãäºõ õýðýãëýý (ÄÕÒÇÕ)-ã òîãòîîäîã [1, 2, 5].

Õ¿íèé áèåä õîîë óíäààð îðñîí õàð òóãàëãà öóñààð çººâºðëºãäºæ ÿñ, áººð, ýëýã, äýë¿¿, ç¿ðõ çýðýã öóëëàã ýðõòýíä õóðèìòëàãäàõ áà ìýäðýë, ç¿ðõ ñóäàñ, áººð, õîäîîä ãýäýñ, öóñ òºëæ¿¿ëýõ, íºõºí ¿ðæèõ¿é, äàðõëààíû ýðõòýíã ãýìòýýõ, õóðö áîëîí àðõàã õîðäëîãî, õàâäàð ¿¿ñãýíý. Õàð òóãàëãà èõñèéí öóñààð ìàø ñàéí øèìýãäýæ, ¿ð õºâðºëèéí ¿åýñ ýõëýí áèåä õóðèìòëàãäàõ òóë óðàãò ìàø àþóëòàé [1, 5, 17, 10, 16]. Õàð òóãàëãàíû òàëààðõ øèíæëýõ óõààíû íîòîëãîîã íýìýãä¿¿ëýõ, õóó÷èí ìýäýýëëèéã øèíý÷ëýõ, õ¿íèé ýð¿¿ë ìýíäýä ¿ç¿¿ëýõ ýðñäëèéã ¿íýëýõ íü äýëõèé äàõèíàà íèéãìèéí ýð¿¿ë ìýíäèéí òóëãàìäñàí àñóóäàë õýâýýð áàéíà.

Ìàòåðèàë, àðãà ç¿éÑóäàëãààíä àíàëòèê áîëîí àãøèíãèéí çàãâàðûã àøèãëàñàí áà ýäèéí çàñãèéí á¿ñèéã òºëººëºõ 4 àéìàã, Óëààíáààòàð õîòîîñ ñàíàìñàðã¿é ò¿¿âðèéí àðãààð ñîíãîãäñîí 1290 õ¿íèé èìïîðòûí õ¿íñíèé á¿òýýãäýõ¿¿íèé õýðýãëýýã àñóóìæ, áèåèéí æèíã õýìæèëòèéí àðãààð ñóäàëñàí. Àëòàíáóëàã, Çàìûí ¯¿ä õèëèéí

áîîìò, “Íàðàíòóóë”, “Õ¿÷èò øîíõîð”, “Áàðñ-1” áººíèé õóäàëäààíû òºâ, “Íîìèí”, “Ìèíèé äýëã¿¿ð”-ò õóäàëäààëæ áóé èìïîðòûí õ¿íñíèé á¿òýýãäýõ¿¿íýýñ 145 äýýæ àâ÷, ØÓÀ-èéí Õºðñ ñóäëàëûí ëàáîðàòîðèä àòîìûí øèíãýýëòèéí ñïåêòðîôîòîìåòð (ÀÑÑ, ÀÍÓ 2002) áàãàæààð õàð òóãàëãàíû ¿ëäýãäëèéã òîäîðõîéëóóëñàí.

Ñóäàëãààíû ñòàòèñòèê áîëîâñðóóëàëòûã SPSS-18.5 ïðîãðàìì äýýð ã¿éöýòãýæ, õ¿íñíèé á¿òýýãäýõ¿¿íèé õîíîãèéí äóíäàæ õýðýãëýý, õàð òóãàëãàíû ¿ëäýãäëèéí äóíäàæ õýìæýý, ñóäàëãààíû õ¿í àìûí áèåèéí æèíãèéí äóíäàæ, 1êã æèíä îíîãäîæ áóé õàð òóãàëãàíû ÄÕÒÇÕ-ã òóñ òóñ òîîöîæ, ñòàíäàðò ¿ç¿¿ëýëòòýé õàðüöóóëæ, ýðñäëèéí ¿íýëãýý õèéñýí. Ñóäàëãààíû ¸ñ ç¿éí àñóóäëûã ÝÌß-íû äýðãýäýõ Àíàãààõ óõààíû ¨ñ ç¿éí õÿíàëòûí õîðîîíû 2010 îíû 8 äóãààð ñàðûí 05-íû ºäðèéí õóðëààð õýëýëö¿¿ëæ, 11 ä¿ãýýð òîãòîîëîîð ñóäàëãààã ÿâóóëàõ çºâøººðºë àâñàí áîëíî.

¯ð ä¿íÑóäàëãààíä 15-25 íàñíû 309 (24.0%), 25-35 íàñíû 304 (23.6%), 35-45 íàñíû 258 (20.0%), 45-55 íàñíû 247 (19.1%), 55-ñ äýýø íàñíû 172 (13.3%), íèéò 1290 õ¿í õàìðàãäñàí. Ñóäàëãààíû õ¿í àìûí áèåèéí æèíãèéí äóíäàæ 65.0±16.6êã áàéâ (p=0.000). ªðãºí õýðýãëýýíèé èìïîðòûí õ¿íñíèé á¿òýýãäýõ¿¿íèé äàâòàìæûã ñóäëàõàä ñîíãèíî, òºìñ, ñàðìèñ, ëóóâàí, áàéöàà, êåò÷óï, ñàõàð, áàéõóó öàéã 7 õîíîãò 4-6 ºäºð, áóñàä á¿òýýãäýõ¿¿íèéã 7 õîíîãò 1-3 ºäºð õýðýãëýæ áàéíà (p=0.000, Õ¿ñíýãò 1).

Table 1. Estimated intake for adults of some imported foods

No

Food itemsFood frequency

(day/week)

Mean serving size intake (gram, ml)

Mean daily intake(gram, ml)

Total intake per week (gram, ml)

1 Rice 2.8 56.8 22.7 159.02 Mullet 1 51.5 7.4 51.5


3 Barley 0.8 48.9 5.6 39.14 Buckwheat 1.1 53.1 8.3 58.4

5 Noodles 1.6 60.2 13.8 96.36 Apple 1.6 175.2 40.0 280.37 Banana 1 157.1 22.4 157.18 Orange 1 133 19.0 133.09 Grapefruit 0.8 135.6 15.5 108.5

10 Raise 1.2 115.5 19.8 138.611 Plum 0.8 89.1 10.2 71.312 Compote 0.6 197.5 16.9 118.513 Kiwi 0.8 88.5 10.1 70.814 Apricot 0.7 83 8.3 58.115 Cabbage 4.2 43.3 26.0 181.916 Broccoli 1.7 29.5 7.2 50.217 Carrot 5.3 47.6 36.0 252.318 Onion 5.9 10.6 8.9 62.519 Garlic 4.1 5.6 3.3 23.020 Pepper 2 46.7 13.3 93.421 Cucumber 1.4 71.5 14.3 100.122 Tomato 1.3 86.5 16.1 112.523 Sea cabbage/temple 1.7 4.1 1.0 7.024 Potato 5.6 73.8 59.0 413.325 Canned fish 0.6 90.9 7.79 54.5

26 Nuts 1.1 101.9 16.0 112.127 Ketchup 4.3 11.4 7.0 49.028 Tea with package 4.9 - - -

29 Instant coffee 3.7 8 4.2 15.030 Sugar 4.5 12.4 8.0 55.831 Candy 2.6 39.3 14.6 102.2

Äýýðõ õ¿ñíýãòýýñ õàðàõàä ºðãºí õýðýãëýýíèé èìïîðòûí çàðèì õ¿íñíèé á¿òýýãäýõ¿¿íèé õýðýãëýý õàðèëöàí àäèëã¿é, õîíîãèéí äóíäàæ õýðýãëýý òºìñ 59.9 ãð (äîëîî õîíîãò 413.3 ãð), ëóóâàí 36.0 ãð (äîëîî õîíîãò 413.3 ãð) ëóóâàí, àëèì 40.0 ãð (äîëîî õîíîãò 280 ãð), öàãààí áóäàà 22.4ãð (äîëîî õîíîãò 159 ãð) òóñ òóñ áàéãàà íü áóñàä á¿òýýãäýõ¿¿íýýñ ºíäºð áàéíà (p=0.000).

Íèéò äýýæèéí 60.7%-ä õàð òóãàëãàíû ¿ëäýãäýë “Õ¿íñíèé á¿òýýãäýõ¿¿í äýõ õ¿íä ìåòàëëûí ¿ëäýãäëèéí çºâøººðºãäºõ äýýä õýìæýý” MNS 4504:2008, “Õ¿íñíèé á¿òýýãäýõ¿¿í äýõ õîðò áîëîí áîõèðäóóëàã÷ áîäèñûí åðºíõèé ñòàíäàðò” MNS CAC 193:2007 çýðýã ñòàíäàðòàä çààñàí ÇÄÕ-íýýñ õýòýðñýí áàéíà (p=0.001). Ìàõ, ìàõàí á¿òýýãäýõ¿¿íèé õàð òóãàëãàíû ¿ëäýãäýë äóíäæààð 1.65 ìã/êã, òàõèàíû ìàõàíä 0.54 ìã/êã (ÇÄÕ 0.1 ìã/êã), êèëüêèä 1.73 ìã/êã (ÇÄÕ 0.3 ìã/êã), øïðîòîä 3.30 ìã/êã (ÇÄÕ 0.3 ìã/êã), íººøèëñºí “Ñàéðà” çàãàñàíä 0.19 ìã/êã (ÇÄÕ 0.3 ìã/êã), “Òóíà” çàãàñàíä 2.88 ìã/êã (ÇÄÕ 0.3 ìã/êã), ¿õðèéí æèãíýñýí ìàõàíä 1.28 ìã/êã (ÇÄÕ 0.3 ìã/êã) òóñ òóñ áàéíà (p=0.000).

Ñ¿¿í, ñ¿¿í á¿òýýãäýõ¿¿íèé õàð òóãàëãàíû

¿ëäýãäýë äóíäæààð 1.22 ìã/êã áàéãàà íü ÇÄÕ-ñ õýò ºíäºð áàéíà (p=0.001, Çóðàã 1).

Note: MRL* - Maximum residues limits

¯ð, òàðèàí á¿òýýãäýõ¿¿íèé õàð òóãàëãàíû ¿ëäýãäýë äóíäæààð 1.15 ìã/êã áóþó ÇÄÕ (0.2 ìã/êã)-íýýñ 5.6 äàõèí èõ, ãóðâàëæèí áóäààíä 1.59 ìã/êã (OR=7.95), ãóðèëàíä 1.44 ìã/êã (OR=7.20), ãîéìîíä 0.55 ìã/êã (OR=2.75), øàð áóäààíä 1.17 ìã/êã (OR=8.05), õºö áóäààíä 0.92 ìã/êã (OR=4.60), õóóðñàí áóäààíä 0.51 ìã/êã (OR=2.55), öàãààí áóäààíä 0.48 ìã/êã (OR=2.40) òóñ òóñ áàéíà (p=0.000).

Èìïîðòûí õ¿íñíèé íîãîîíû õàð òóãàëãàíû ¿ëäýãäýë äóíäæààð 1.57 ìã/êã, òóõàéëáàë,

1.40 1.38

1.00 1.16 1.15 1.22

0.000.200.400.600.801.001.201.401.60

Butter Coffee milk Dry milk Ice cream Cheese Average

Lead

(mg/

kg)

Product name Figure 1. Lead residues in some imported milk products (mg/kg)


òºìñ 3.9 ìã/êã (ÇÄÕ 0.1 ìã/êã), áàéöàà 0.62 ìã/êã (ÇÄÕ 0.3 ìã/êã), ëóóâàí 1.24 ìã/êã (ÇÄÕ 0.1 ìã/êã), ñàðìèñ, ñîíãèíîä 1.46 ìã/êã (ÇÄÕ 0.1 ìã/êã), øèíý ºðãºñò õýìõ 2.21 ìã/êã (ÇÄÕ 0.1 ìã/êã), óëààí ëîîëü 1.73 ìã/êã (ÇÄÕ 0.1 ìã/êã), àìòàò ÷èíæ¿¿ 2.83 ìã/êã (ÇÄÕ 0.1 ìã/êã), ñàëàòíû íàâ÷ 0.54 ìã/êã (ÇÄÕ 0.3 ìã/êã), øèíý ìººã 1.06 ìã/êã (ÇÄÕ 0.3 ìã/êã), âàíäóé 1.44 ìã/êã (ÇÄÕ 1.0

ìã/êã), íººøèëñºí ºðãºñò õýìõ 0.18 ìã/êã (ÇÄÕ 1.0 ìã/êã), àëàã ñàëàò 2.08 ìã/êã (ÇÄÕ 1.0 ìã/êã), íººøèëñºí ìººã 1.08 ìã/êã (ÇÄÕ 1.0 ìã/êã) òóñ òóñ áàéíà (p=0.001). Èìïîðòûí æèìñ, æèìñíèé ø¿¿ñíèé õàð òóãàëãàíû ¿ëäýãäýë äóíäæààð 1.03 ìã/êã áóþó ÇÄÕ-íýýñ 4.1 äàõèí èõ áàéâ (p<0.002, Õ¿ñíýãò 2).

Table 2. Lead residues in some imported fruits and fruit juice (mg/kg)

No Food itemsNumber of samples

Lead residues MRL*(mg/kg)

Mean (mg/kg) St.Dev (mg/kg)1. Apple 10 2.31 1.50 0.12. Banana 14 0.80 0.31 0.13. Orange 7 0.55 0.30 0.14. Raise 8 1.54 0.70 0.25. Nuts 8 0.99 0.57 0.36. Ground nuts 2 1.33 0.98 0.27. Salted nuts 4 0.91 0.54 0.28. Dried fruits 2 0.54 0.38 1.09. Fruit juice 5 1.23 0.90 0.05

Total 60 1.03 0.67 0.25

Note: MRL* - Maximum residues limits

Äýýðõ õ¿ñíýãòýýñ õàðàõàä õàð òóãàëãàíû ¿ëäýãäýë àëèì, ¿çýì, ãàçðûí ñàìàð, æèìñíèé ø¿¿ñýíä õàìãèéí ºíäºð áàéíà.

Áóñàä á¿òýýãäýõ¿¿íèé õóâüä “Heineken” øàð àéðàã 2.86 ìã/ë, “Hite” øàð àéðàã 2.44 ìã/ë, “Áàëòèêà” øàð àéðàã 1.0 ìã/ë, “Ñèáåðüñêàÿ êðîíàÿ” øàð àéðàã 0.4 ìã/ë, “Cass” øàð àéðàã 0.23 ìã/ë, äàðñ áîëîí ëèê¸ð 0.92 ìã/ë, “Ahmad” öàé 36.96 ìã/êã, “Lipton” öàé 2.17 ìã/êã, “Ã¿ðæ íîãîîí” öàé 1.01 ìã/êã, “×åðíàÿ ñìîðäèíà” öàé 0.6 ìã/êã, ýëñýí ÷èõýð áîëîí ¸îòîí 2.17 ìã/êã õàð òóãàëãà àãóóëæ áàéãàà íü ÇÄÕ-íýýñ õýòýðñýí (p=0.0001), õàðèí õîîëíû äàâñàíä 0.91ìã/êã (ÇÄÕ 2ìã/êã), êåò÷óïò 1.05 ìã/êã (ÇÄÕ 1.5 ìã/êã) òóñ òóñ áàéâ (p=0.0001).

Õ¿íñíèé á¿òýýãäýõ¿¿í òóñ á¿ðèéí äîëîî õîíîãèéí äóíäàæ õýðýãëýý (õ¿ñíýãò 1-ä äóðüäñàí), õ¿íñíèé á¿òýýãäýõ¿¿í òóñ á¿ðèéí õàð òóãàëãàíû ¿ëäýãäýë, ñóäàëãààíû õ¿í àìûí áèåèéí äóíäàæ æèí çýðýã ¿ç¿¿ëýëòèéã ¿íäýñëýí ºðãºí õýðýãëýýíèé èìïîðòûí çàðèì õ¿íñíèé á¿òýýãäýõ¿¿íýýñ äîëîî õîíîãò àâ÷ áóé õàð òóãàëãàíû íèéò õýìæýý, ÄÕÒÇÕ-ã òîîöîõîä ñóäàëãààíû õ¿í àìûí áèåèéí 1êã æèíä 0.079 ìã/êã áàéíà.

ªðãºí õýðýãëýýíèé èìïîðòûí çàðèì õ¿íñíèé á¿òýýãäýõ¿¿íýýð àâ÷ áóé õàð òóãàëãàíû 54.0%-

èéã õ¿íñíèé íîãîî, 15.5%-èéã ¿ð òàðèàí á¿òýýãäýõ¿¿í, 11.8%-èéã æèìñ áîëîí æèìñíèé ø¿¿ñ, 8.4%-èéã ñ¿¿í á¿òýýãäýõ¿¿í, 6.2%-èéã öàé, äàâñ, ñàõàð, êåò÷óï, 2.9%-èéã ñîãòóóðóóëàõ óíäàà, 1.3%-èéã òàõàéíû ìàõ, íººøèëñºí çàãàñ ýçýëæ áàéíà (p=0.000).

Õýëöýìæ Èìïîðòûí õ¿íñíèé á¿òýýãäýõ¿¿íèé çýñ, õàð òóãàëãàíû àãóóëàìæèéã ñóäàëñàí ä¿í, ýð¿¿ë àõóéí ¿íýëãýý” ñóäàëãààãààð 317 äýýæèéí 3.1%, òóõàéëâàë íººøèëñºí ìàõàí á¿òýýãäýõ¿¿í 0.01 ìê/êã, ¿ð òàðèàí á¿òýýãäýõ¿¿í 0.01 ìê/êã, ýëñýí ÷èõýðò 0.26 ìê/êã, áîëîâñðóóëñàí íîãîî æèìñ 0.01 ìê/êã, òºðºë á¿ðèéí æèìñ 0.2 ìê/êã, æèìñíèé ø¿¿ñ 0.009 ìê/êã, àðõè, äàðñ, ëèê¸ð 0.09 ìê/êã áàéñàí (Á.Áóðìàà, Ø.Ýíõöýöýã, ×.Íÿìðàã÷àà, Ä.×èìýääóëàì áà áóñàä, 1999) [6]. Áèäíèé ñóäàëãààãààð íººøèëñºí ìàõàí á¿òýýãäýõ¿¿íä 0.19-3.30 ìã/êã õ¿ðòýë, ¿ð òàðèàí á¿òýýãäýõ¿¿íä 1.15 ìã/êã, ýëñýí ÷èõýðò 2.17 ìã/êã, àëàã ñàëàò 2.08 ìã/êã, íººøèëñºí ºðãºñò õýìõýíä 0.18 ìã/êã, òºðºë á¿ðèéí æèìñýíä 0.8-2.31 ìê/êã õ¿ðòýë, æèìñíèé ø¿¿ñýíä 1.23 ìê/êã, äàðñ, ëèê¸ðò 0.92 ìê/êã õàð òóãàëãàíû ¿ëäýãäýë èëýðñýí íü áîõèðäîëò áóóðààã¿é, ýðñ íýìýãäñýíèéã õàðóóëæ áàéíà.

“Õ¿íñíèé á¿òýýãäýõ¿¿íèé áîõèðäëûí ò¿âøèí” ñóäàëãààãààð ÁÍÕÀÓ-ä ¿éëäâýðëýñýí ãóðèë, öàãààí áóäàà, õóóðàé ñ¿¿, àëèì, ýëñýí ÷èõðèéí


10 äýýæèéí 38.6%-ä õàð òóãàëãàíû ¿ëäýãäýë ÇÕÄ-ýýñ õýòýðñýí áàéñàí (¯ÕÀÀß, ÝÌß, ÍÝÌÕ, ÌÕÅÃ, 2007) [4]. Áèäíèé ñóäàëãààãààð ÁÍÕÀÓ-ä òàðèàëñàí òºìñ, àìòàò ÷èíæ¿¿, áàéöàà, ëóóâàí, ºðãºñò õýìõ, óëààí ëîîëü, íàâ÷èò íîãîî, õàð ìººã, àëèì, ãàäèë, ¿çýì, öàãààí áóäàà, õºö áóäàà, øàð áóäàà, õóóðàé ñ¿¿ çýðýã á¿òýýãäýõ¿¿íä õàð òóãàëãàíû ¿ëäýãäýë ÇÄÕ-íýýñ õýòýðñýí áàéñàí íü äýýðõ ñóäàëãààíû ä¿íòýé ä¿éöýæ áàéíà.

Í¯Á-ûí ÕÕÀÀÁ, ÄÝÌÁ-ûí õàìòàðñàí ÕÝÇÊ-ûí Õ¿íñíèé íýìýëòèéí àñóóäëààðõ õîðîîíû 41, 42, 43 äóãààð ÷óóëãàíààð íü õàð òóãàëãàíû ò¿ð õ¿ëöýõ òóí 50 êã æèíòýé õ¿íýýð òîîöîõîä áèåèéí 1 êã æèíä õîíîãò 0.007 ìã/êã, ÄÕÒÇÕ 0.025 ìã/êã áàéõààð òóñ òóñ òîãòîîñîí. Íàñàíä õ¿ðñýí õ¿íèé áèåèéí 1 êã æèíä îíîãäîõ õàð òóãàëãàíû ºðòºëòèéí òóí Êàíàä óëñàä 0.11 ìã/êã, ÁÍÕÀÓ-ä 0.9 ìã/êã, Ýíýòõýã óëñàä 0.44 ìã/êã, ÀÍÓ-ä 0.03 ìã/êã, Øèíý Çåëàíä óëñàä 0.13 ìã/êã, Àâñòðàëè óëñûí ýðýãòýé÷¿¿äýä 0.06-0.40ìã/êã, ýìýãòýé÷¿¿äýä 0.02-0.36ìã/êã áàéãààã 2011 îíä òóñ òóñ òîãòîîñîí áàéäàã [1, 5, 10, 12-16].

Áèäíèé ñóäàëãààãààð õàð òóãàëãàíû ÄÕÒÇÕ ñóäàëãààíû õ¿í àìûí áèåèéí æèíä 0.079 ìã/êã îíîãäîæ áàéãàà íü Í¯Á-ûí ÕÕÀÀÁ, ÄÝÌÁ-ûí õàìòàðñàí ÕÝÇÊ-ûí Õ¿íñíèé íýìýëòèéí àñóóäëààðõ õîðîîíû òîãòîîñîí õîð ñóäëàëûí ÇÄÕ (áèåèéí 1 êã æèíä 0.025 ìã/êã)-ààñ 3.2 äàõèí ºíäºð, ýð¿¿ë ìýíäýä ýðñäýë ó÷ðóóëàõ õýìæýýíä, áóñàä îðîíä õèéãäñýí ñóäàëãààíû ä¿íòýé õàðüöóóëàõàä Êàíàä (1.4 äàõèí), ÁÍÕÀÓ (11.4 äàõèí), Ýíýòõýã (5.5 äàõèí), Øèíý Çåëàíä óëñûíõààñ (1.6 äàõèí) òóñ òóñ áàãà, ÀÍÓ-ûíõààñ 2.3 äàõèí ºíäºð áàéíà.

Áèäíèé ñóäàëãààíû àæëûí çîðèëãî, ëàáîðàòîðèéí ÷àäàìæ, ñàíõ¿¿ãèéí áîëîìæ íü èìïîðòûí õ¿íñíèé á¿òýýãäýõ¿¿í äýõ õàð òóãàëãàíû ¿ëäýãäýë, õ¿íèé ýð¿¿ë ìýíäýä ýðñäýë ó÷ðóóëàõ ò¿âøèíä õ¿ðñýí ýñýõýä ¿íýëãýý ºãºõººð õÿçãààðëàãäñàí òóë õ¿íñíèé ñ¿ëæýýíèé àëü øàòàíä èìïîðòûí õ¿íñíèé á¿òýýãäýõ¿¿í õàð òóãàëãààð áîõèðäîæ, ÿìàð õ¿÷èí ç¿éë íºëººëæ áóéã öààøèä íàðèéâ÷ëàí ñóäëàõ íü àæèë ÌÓ-ûí çàñãèéí ãàçàð, îëîí óëñûí áîëîí ¿íäýñíèé ýðäýì øèíæèëãýýíèé áàéãóóëëàãóóäûí ºìíº íýýëòòýé ¿ëäýæ áàéíà. Ä¿ãíýëò: 1. Õ¿í àìûí ºðãºí õýðýãëýýíèé èìïîðòûí

çàðèì õ¿íñíèé á¿òýýãäýõ¿¿íèé 145 äýýæèéí 60.7% íü õàð òóãàëãàíû ¿ëäýãäýë ÇÄÕ-íýýñ õýòýðñýí, ñ¿¿í á¿òýýãäýõ¿¿í, æèìñ, õ¿íñíèé íîãîî õàìãèéí èõ áîõèðäîëòòîé áàéâ.

1. Õ¿íñíèé íîãîî (54.0%), ¿ð òàðèàí á¿òýýãäýõ¿¿í (15.5%), æèìñ, æèìñãýíý áîëîí æèìñíèé ø¿¿ñ (11.8%), ñ¿¿í á¿òýýãäýõ¿¿í (8.4%) íü ºðãºí õýðýãëýýíèé èìïîðòûí çàðèì õ¿íñíèé á¿òýýãäýõ¿¿íèé õàð òóãàëãàíû áîõèðäëûí ãîë ¿¿ñâýð áîëæ áàéíà.

2. Õàð òóãàëãàíû áîõèðäîëä ºðòºëòèéí äîëîî õîíîãèéí ò¿ð çºâøººðºãäºõ õýðýãëýý ñóäàëãààíû õ¿í àìûí áèåèéí 1 êã æèíä 0.079 ìã/êã îíîãäîæ áàéãàà íü ñòàíäàðò (áèåèéí 1êã æèíä 0.025ìã/êã)-ààñ 3.2 äàõèí ºíäºð, ýð¿¿ë ìýíäýä ýðñäýë ó÷ðóóëàõ ò¿âøèíä áàéíà.

Çºâëºìæ- Öààøèä ñóäàëãààíû àæëûã ã¿íçãèéð¿¿ëæ,

õ¿íñíèé ñ¿ëæýýíèé àëü øàòàíä èìïîðòûí õ¿íñíèé á¿òýýãäýõ¿¿í õàð òóãàëãààð áîõèðäîæ áàéãàà áîëîõ, áîõèðäëûí ýõ ¿¿ñâýð, íºëººëæ áóé õ¿÷èí ç¿éëñèéã òîãòîîõ, áóóðóóëàõ àðãà õýìæýý àâàõ øààðäëàãàòàé òóë ýíý ÷èãëýëýýð õîëáîãäîõ áàéãóóëëàãóóä õàìòðàí àæèëëàõ;

- Õ¿íñíèé á¿òýýãäýõ¿¿íèé õàð òóãàëãàíû ¿ëäýãäëèéã õ¿í àìûí íèéò õ¿íñíèé õýðýãëýý (Total Diet Study), õºðñ, óñ àãààð äýõ õàð òóãàëãàíû ¿ëäýãäýë õ¿í àìûí ºâ÷ëºë, íàñ áàðàëòòàé õîëáîí ñóäëàõ àæèëä Çàñãèéí ãàçàð, îëîí óëñûí áàéãóóëëàãûí ç¿ãýýñ äýìæëýã ¿ç¿¿ëýõ;

- Èìïîðòûí õ¿íñíèé á¿òýýãäýõ¿¿íèé õàð òóãàëãàíû ¿ëäýãäëèéã äîòîîäûí ¿éëäâýðèéí õ¿íñíèé á¿òýýãäýõ¿¿íèéõòýé õàðüöóóëàí ñóäàëæ, õàð òóãàëãàíû ¿ëäýãäýë èõòýé õ¿íñíèé á¿òýýãäýõ¿¿íèé èìïîðòîä õîðèã òàâèõ ýðõ ç¿éí îð÷èíã áèé áîëãîõ;.

- Ìîíãîë óëñàä îäîî ìºðäºæ áóé ñòàíäàðòóóäûã õÿíàí, øèíý÷èëýõ;

- Ò¿ðãýâ÷èëñýí øèíæèëãýýíèé áàãàæ, õýðýãñëýëýýð õèëèéí õÿíàëòûí áîîìòóóäûã õàíãàõ;

- Íèéò õ¿í àì áîëîí õ¿íñ èìïîðòëîã÷ íàðò çîðèóëñàí ñóðãàëò, ñóðòàë÷èëãààíû ìàòåðèàë áîëîâñðóóëàõ, ò¿ãýýõ àæëûã òºð, õóâèéí õýâøëèéí áàéãóóëëàãóóä õàìòðàí õèéõ;

- Èìïîðòûí õ¿íñíèé á¿òýýãäýõ¿¿íèéã çîðèóëàëòûí òýýâðèéí õýðýãñëýëýýð òýýâýðëýõ, çîðèóëàëòûí ñàâàíä õàäãàëàõ, áîðëóóëàëòûí ÿâöàä áîõèðäóóëàõã¿é áàéõ øààðäëàãûã õ¿íñíèé ¿éëäâýðëýë, ¿éë÷èëãýý ýðõëýã÷èä ÷àíä ìºðäºí àæèëëàõ.


Íîì ç¿é1. ÑÕÇÃ, Ìîíãîë Óëñûí Ñòàíäàðò.Õ¿íñíèé

á¿òýýãäýõ¿¿í äýõ õîðò áîëîí áîõèðäóóëàã÷ áîäèñûí åðºíõèé ñòàíäàðò. MNS CAC 193:2007:22-23, 31-39

2. ÑÕÇÃ, Ìîíãîë Óëñûí Ñòàíäàðò. Õ¿íñíèé á¿òýýãäýõ¿¿í äýõ õ¿íä ìåòàëëûí ¿ëäýãäëèéí çºâøººðºãäºõ äýýä õýìæýý. MNS 4504:2008

3. ÑÕÇÃ, Ìîíãîë Óëñûí Ñòàíäàðò. Õ¿íñíèé äàâñ. Òåõíèêèéí øààðäëàãà. MNS CAC 150:2007

4. ¯ÕÀÀß, ÝÌß, ÍÝÌÕ, ÌÕÅÃ, 2007. Õ¿íñíèé á¿òýýãäýõ¿¿íèé áîõèðäëûí ò¿âøèí. ÓÁ;2007:26-27

5. ÝÌß, ÍÝÌ¯Ò.Ìîíãîëûí õ¿í àìûí ºðãºí õýðýãëýýíèé èìïîðòûí çàðèì õ¿íñíèé á¿òýýãäýõ¿¿íèé õ¿íä ìåòàëë, ïåñòèöèäèéí ¿ëäýãäýë, ýð¿¿ë ìýíäèéí ýðñäëèéí ¿íýëãýý.ØÓÒÑ-ãèéí òºñëèéí äóóññàí àæëûí òàéëàí.ÓÁ;2013:22-26, 50-63

6. ×.Íÿìðàã÷àà, Ä.×èìýääóëàì, Ç.Àðèóíáèëýã, Ë.Íàðàíòóÿà, Õ.Æàìáàëìàà, Ä.Áàòäýëãýð, Æ.Õàëçàíõ¿¿. Èìïîðòûí õ¿íñíèé á¿òýýãäýõ¿¿íèé çýñ, õàð òóãàëãàíû àãóóëàìæèéã ñóäàëñàí ä¿í, ýð¿¿ë àõóéí ¿íýëãýý. Ýðäýì øèíæèëãýýíèé á¿òýýëèéí ýìõòãýë -1 1999. ÝÌß, ÍÝÌÕ, ÓÁ; 2001:28-33

7. CAC. Codex General Standard for Contaminants and toxins in Food. CAC 193-1995 (Rev.2-2006)

8. ÑÀÑ, Codex standard for grade salt (Codex standard 150-1985, 2012)

9. ÑÀÑ, Lead: Maximum levels (Codex standard 230-2001)

10. Commission Regulation (EC) No 333/2007 of 28 March 2007 laying down the methods of sampling and analysis for the official control of the levels of lead, cadmium, mercury, inorganic tin, 3-MCPD and benz (a) Pyrenees in foodstuffs

11. Ministry of Health Malaysia. Food ACT 1993 (ACT 281) and Regulations. Laws of Malaysia. AS AT 15th APRIL;2010

12. Lead and cadmium: Need for International action? Guideline. 22 Feb 2008

13. Food Safety Authority of Ireland. Mercury, Lead, Cadmium, Tin and Arsenic in Food Issue (1);2009:1-14

14. George E, Raiment. Australian and Some International Food Standards for Heavy Metals. Journal of Physical Environmental. Queensland Department of Primary Industries.2010:156-162

15. WHO, FAO. Evaluation of Certain Contaminants in Food, Seventy-second report of the Joint FAO/WHO Expert Committee on Food Additives. Technical Report Series World Health Organization 2011(960)

16. WHO-Europe, Exposure of children to chemical hazards in food. Fact Sheet 4.4 December 2009; RPG4:4-5

Òàíèëöàæ, íèéòëýõ ñàíàë ºãñºí: àíàãààõûí øèíæëýõ óõààíû äîêòîð, ïðîôåññîð

Á.Áóðìààæàâ


Ãàäààäûí çàðèì óëñ îðíû õ¿í àìûí öóñàí äàõü ñåëåíèé ò¿âøèí (Òîéì ºã¿¿ëýë)

Ó.ÖýðýíäîëãîðÍÝÌ¯Ò

AbstractSerum selenium concentration in poulation in some contries

U.TserendolgorNational Center for Public Health, Ministry of Health Mongolia

Selenium is a major antioxidant in the form of selenoproteins to mitigate the cytotoxic effects of reactive oxygen species [1-2). Also selenium an essential trace element, is vital for human normal development, growth, and thyroid hormone metabolism, and immune function [3]. A number of studies have been reported on selenium level [4-8]. Selenium concentration in the biological fluids varies considerably inside the global population, and normal ranges for typical population are different [9].

Selenium levels in the serum of populations throughout the world vary from 41.7 μg/l In Finland to 158.2 μg/l in Canada [10,11] reflect the profound influence of the natural environment on the selenium contents of soils, crops, and human tissues (11, 31). In some regions of the world such as Finland, New Zealand, the East coast of the United Stated America and China the content of Selenum in soil is remarkably low [12]. Thus, this article aimed to reviwer on serum selenium concentration in population in some countries.

KeyWords: Concentration, mean level, selenium, serum, environment, soil, dietary intake.

Pp.77-91, Tables 4, References 50

Ñåëåí íü áèå ìàõáîäîä ÿâàãäàõ èñýëäýëòèéí õîðòîé íºëººíººñ ýñèéã õàìãààëàõ [1, 2-3], äàðõëààíû ñèñòåìèéí ¿éë àæèëëàãààã äýìæèæ [1], õàëäâàðààñ ñýðãèéëýõ, áèå ìàõáîäûí ýä ýñèéí õýâèéí ºñºëò õºãæèëòèéã õàíãàõ ¿¿ðýã ã¿éöýòãýäýã [3].

Õ¿í àìûí öóñàí äàõü ñåëåíèé ò¿âøèíã òîãòîîõ ñóäàëãàà äýëõèéí çàðèì óëñ îðîíä õèéãäýæ [4-8), õ¿í àìûí öóñàí äàõü ñåëåíèé ò¿âøèí íü îëîí õ¿÷èí ç¿éëýýñ õàìààð÷, ººð õîîðîíäîî ÿëãààòàé áàéãààã òîãòîîñîí áàéíà [9]. Ãàçðûí õºðñíèé ñåëåíèé àãóóëàìæààñ øàëòãààëàí óðãàìàë áà àìüòíû ãàðàëòàé õ¿íñýíä àãóóëàãäàõ ñåëåíèé õýìæýý õàðèëöàí àäèëã¿é áàéõ áºãººä ýíý íü õ¿íèé öóñàí äàõü ñåëåíèé ò¿âøèíä íºëººëäºã áàéíà [11, 31]. Òóõàéëáàë Ôèíëàíä, Øèíý Çåëàíä, ÀÍÓ-ûí ç¿¿í ýðýã áîëîí ÁÍÕÀÓ-ûí çàðèì á¿ñ íóòãèéí ãàçðûí õºðñ íü ñåëåíèé àãóóëàìæ áàãàòàé àæ [12]. Ãàçðûí õºðñºí äýõ ñåëåíèé àãóóëàìæààñ õàìààðààä äýëõèéí óëñ îðíóóäûí õ¿í àìûí öóñàí äàõü ñåëåíèé ò¿âøèí íü õàðèëöàí àäèëã¿é áºãººä òóõàéëáàë Ôèíëàíä óëñûí õ¿í àìûí öóñàí äàõü ñåëåíèé ò¿âøèí íü 41,7 ìèêðîãðàìì/ë áàéõàä Êàíàäûí õ¿í àìûí öóñàí äàõü ñåëåíèé ò¿âøèí íü 158,2

ìèêðîãðàìì/ë áàéñàí àæ [10, 11]. Ãàçðûí õºðñ áîëîí õ¿í àìûí ºðãºí õýðýãëýýíèé õ¿íñíèé á¿òýýãäýõ¿¿í äýõ ñåëåíèé àãóóëàìæ, õîîë õ¿íñýýð àâ÷ áóé ñåëåíèé õýìæýý áîëîí çàðèì ºâ÷èí ýìãýãýýñ øàëòãààëàí, õ¿í àìûí öóñàí äàõü ñåëåíèé ò¿âøèí õàðèëöàí àäèëã¿é áàéäàã íü ñóäàëãààãààð íîòëîãäñîí áàéíà. Òóõàéëáàë ÀÍÓ-ä 1988-1994 îíä õèéãäñýí “Ýð¿¿ë ìýíä, øèì ñóäëàëûí òàíàäàëòûí ¿íäýñíèé 3-ð ñóäàëãàà“ áîëîí 2003-2004 îíä õèéãäñýí “Ýð¿¿ë ìýíä, øèì ñóäëàëûí òàíàäàëòûí ¿íäýñíèé ñóäàëãàà“- íû õ¿ðýýíä õ¿í àìûí öóñàí äàõü ñåëåíèé ò¿âøèíã ñóäëàõ òîìîîõîí ñóäàëãààíóóä õèéãäýæ, “ÀÍÓ-ûí õ¿í àìûí öóñàí äàõü ñåëåíèé ò¿âøèí”, “ÀÍÓ-ûí íàñàíä õ¿ðñýí õ¿í àìûí öóñàí äàõü ñåëåíèé ò¿âøèí áà ÷èõðèéí øèæèí”, “ÀÍÓ äàõü ÷èõðèéí øèæèíòýé áà ÷èõðèéí øèæèíã¿é íàñàíä õ¿ðñýí õ¿í àìûí öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí“, “ÀÍÓ-ûí íàñàíä õ¿ðñýí õ¿í àìûí äóíäàõ õàâäàð, ç¿ðõ ñóäàñíû ºâ÷íººð íàñ áàðàãñàäûí òîõèîëäîë áà öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí“, “ÀÍÓ- ûí õ¿í àìûí äóíäàõ öóñíû äàðàëò èõñýõ ýìãýã áà öóñàí äàõü ñåëåíèé ò¿âøèí“ ãýñýí 5 ÷èãëýëýýð ýðäýì øèíæèëãýýíèé ºã¿¿ëýë õýâëýãäýæ, õýâëýë, íîì ç¿éí ýðãýëòýíä îðñîí áàéíà (Õ¿ñíýãò 1) [13-17].

ËÅÊÖ, ÒÎÉÌ, ÇªÂËªÃªª


Table 1 Mean Serum Selenium Concentration in US Population, and in Other Population in Some Countries

№ Countries Author Date of survey

Title of research

Research design

Number of participants

Serum Selenum Concentration (Ranges of means or mean ± standart error)

1 USA Niskar AS, Paschal DC, Kieszak SM, et all., 2003.

1988-1994

Serum selenium levels in the US population: /Third National Health and Nutrition Examination Survey, 1988-1994/.

It is a national population-based cross-sectional survey with an in-person interview and serum selenium measurements.

18,597 persons for whom serum selenium values were available in NHANES III.

The mean concentration of selenium was 1.58 nmol/L and the median concentration was 1.56 nmol/L. Mean serum selenium levels differed by age group, sex, race ethnicity, PIR, and geographic region. The US population has slight differences in serum selenium levels by demographic factors.

2 USA Laclaustra M; Navas-Acien A; Stranges S; Ordovas JM; Gluallar E.

2003-2004

Serum Selenium Concentrations and Diabetes in U.S. Adults: National Health and Nutrition Examination Survey (NHANES) 2003–2004

Cross-sectional survey

A cross-sectional analysis of 917 adults >or = 40 years

Mean serum selenium was 137.1 microg/l. In spline regression models, the prevalence of diabetes as well as glucose and glucosylated hemoglobin levels increased with increasing selenum concentrations up to 160 microg/l.

3 USA Joachim Bleys, MD,MPH, Ana Navas-Acien, MD, PHD, Eliseo Guallar,MD, DRPH

1988-1994

Serum Selenium and Diabetes in U.S. Adults /Third National Health and Nutrition Examination Survey/

A cross-sectional analysis of adults �20 years of age who participated in the Third National Health and Nutrition Examination Survey.

8,876 adults �20 years of age who participated in the Third National Health and Nutrition Examination Survey.

Mean serum selenium levels in participants with and without diabetes were 126.5 and 125.7 ng/ml, respectively. Authors suggested that the association between high serum selenium and the prevalence of diabetes was nonlinear.


4 USA Joachim Bleys, MD, MPH; Ana Navas-Acien, MD, Ph.D; Eliseo Guallar, MD, DrPH

1988-1994

Serum Selenum Levels and All-Cause, Cancer, and Cardiovascular Mortality Among US Adults/Third National Health and Nutrition Examination Survey/

A Prospective Cohort Study

Serum selenium level meased in 13.887 adult participants in the Third National Health and Nutrition Examination Survey, and were recruited from 1988 to 1994 and followed up for mortality for up to 12 years.

The mean serum selenum level was 125.6 ng/ml. There was no association between serum selenium levels and cardiovascular mortality. Increasing serum selenium levels were associated with decreased mortality up to 130 ng/ml.

5 USA Laclaustra, Martin, Navas-Acien, Ana, Stranges, Saverio, Ordovas, J.M. and Guallar, Eliseo. 2009.

2003-2004

Serum Selenum Concentrations andHypertentionIn the US population/National Health and Nutrition Examination Survey, 2003-2004/

A cross-sectional analysis of adults ≥40 years of age who participated in the National Health and Nutrition Examination Survey, 2003-2004

2638 adults ≥40 years old who participated in the 2003 to 2004 National Health and Nutrition Examination Survey.

The mean serum selenum level was 137.1 mu g/l. In spline regression models, blood pressure levels and the prevalence of hypertension increased with increasing selenium concentration up to 160 mu g/l. Authors concluded that the high serum selenium concentrations were associated with higher prevalence of hypertension.

6 Greece Alexios Sotiropoulos, Stavroula A Papadodima, Athanasia K Papazafiropoulou et al., 2011

2009-2010

Serum selenium levels do not differ in type 2 diabetic subjects with and without coronary artery disease

A cross-sectional study

A total of 200 subjects with type 2 diabetes (100 with CAD and 100 without CAD), consecutively selected from the outpatient clinic were entrolled into the study.

Serum selenium levels did not differ between diabetic subjects with and without CAD (102.40±30-31.10 vs. 108.86±33.88 microg/L, p= 0.16).


7 Taiwan Kuen-Chen Yang, Long-Teng Lee, Yow-Shan Lee et al., 2010

2007 Sereum selenium concentration is associated with metabolic factors in the elderly: a cross-sectional study

A cross-sectional study

200 males and females aged 65-85 years old.

The mean serum selenium concentration was 1.14 μmol/l, without significant difference between sexes. Total cholesterol, triglycerides, and LDL cholesterol increased significantly with serum selenium concentration p<0.001, p<0.05, p<0.001). Furthermore, there was a significantly positive association between serum selenium and serum fasting glucose concentrations (p<0.05).

8 Korea Young-Jae Kim, Oyunbileg Galindev, Jun Han Sei, Su-Mi Bae, Hosub Im, Lanying Wen, Young Rok Seo, Woong Shick Ahn

2006 Serum SelenumLevel in Healthy Koreans

Cross-sectionalstudy

Total of 100 person (50 males and 50 females) were participated in this study.

The mean serum selenium level in healthy subjects was 112.05±30.42 μg/l. For jender, it was 120.81±27.37 μg/l for females and 103.29±31.05 μg/l for males. There was a significant difference between the mean selenium concentration of gender group (p=0.0035).


9 Iran R Safaralizadeh, GA Kardar, Z Pourpak, M Moin, A Zare and S Teimourian, 2005

2004 Serum concentration of Selenium in healthy individuals living in Tehran

Cross-sectionalstudy

184 healthy subjects

The mean serum Selenium concentration was in children (1-16 years) 84.3±11.0 μg/l and there was no significant difference between gender in this group. In adults (older than 16 years) the mean serum Selenium concentration was1100.6±13 SD μg/l; among women the mean was 93.9± 14SD μg/l and among men it was 100.2± 12SD μg/l. The mean selenium level in men was higher than in women (p<0.005), There was a positive correlation between higher selenium serum concentration and age in men (p<0.001).

Õ¿ñíýãò 1. ÀÍÓ áîëîí áóñàä óëñ îðíóóäûí íàñàíä õ¿ðñýí õ¿í àìûí öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿âøèí

№ Ñóäàëãàà õèéãäñýí óëñ îðíóóä

Õýâëýí íèéòëýëò õèéñýí çîõèîã÷èä

Ñóäàëãàà õèéñýí îí

Ñýäâèéí íýð Ñóäàëãààíû äåçàéí

Ñóäàëãààíä õàìðàãäñàí õ¿íèé òîî

Öóñàí äàõü ñåëåíèé äóíäàæ ò¿âøèí (Äóíäàæ õýìæèãäýõ¿¿íèé õýëáýëçýë áà äóíäàæ ± ñòàíàðò àëäàà)

1 ÀÍÓ

Niskar AS, Paschal DC, Kieszak SM, et all., 2003.

1988-1994

ÀÍÓ-ûí õ¿í àìûí öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí /Ýð¿¿ë ìýíä, Øèì ñóäëàëûí òàíàäàëòûí ¿íäýñíèé 3-ð ñóäàëãàà,1988-1994/.

¯íäýñíèé õýìæýýíèé õ¿í àìä ñóóðèëñàí cross-sectional ñóäàëãàà, Ñóäàëãààíû õ¿í àìààñ àñóóìæ àâ÷, öóñàíä ñåëåí òîäîðõîéëñîí

Ýð¿¿ë ìýíä, Øèì ñóäëàëûí òàíàäàëòûí ¿íäýñíèé 3-ð ñóäàëãààíä õàìðàãäàæ, öóñàíä ñåëåí òîäîðõîéëîãäñîí 18597 õ¿í

Öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿âøèí íü 1.58 ìèêðîìîëü/ë, ìåäèàí êîíöåíòðàö íü 1.56 íìîëü/ë áàéñàí áºãººä ñåëåíèé äóíäàæ ò¿âøèí íü íàñ, õ¿éñ, ¿íäýñ óãñàà, õ¿í àìûí îðëîãî, ãàçàð ç¿éí áàéðøëààñ õàìààðàí áàãà çýðýã ÿëãààòàé òîãòîîãäñîí áàéíà.

2 ÀÍÓ

Laclaustra M; Navas-Acien A; Stranges S; Ordovas JM; Gluallar E.

2003-2004

ÀÍÓ- ûí íàñàíä õ¿ðñýí õ¿í àìûí öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí áà ÷èõðèéí øèæèí/Ýð¿¿ë ìýíä, øèì ñóäëàëûí òàíàäàëòûí ¿íäýñíèé ñóäàëãàà,2003-2004/.

Cross-sectional ñóäàëãàà

40 áà ò¿¿íýýñ äýýø íàñíû 917 õ¿íèéã õàìðóóëñàí ñross-sectional ñóäàëãàà

Öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿âøèí íü 137.1 ìèêðîãðàìì/ë áàéñàí áºãººä ºëºí öóñàí äàõü ñàõàðûí õýìæýý áà ãëþêîçèæñàí ãåìîãëîáèíû ò¿âøèí èõñýõ áîëîí ÷èõðèéí øèæèíãèéí òàðõàëò èõñýõ òóòàì öóñàí äàõü ñåëåíèé õýìæýý íü 160 μ/ë õ¿ðòýë èõñýæ áàéñàí àæ.


3 ÀÍÓ

Joachim Bleys, MD,MPH, Ana Navas-Acien, MD, PHD, Eliseo Guallar,MD, DRPH

1988-1994

ÀÍÓ- ûí íàñàíä õ¿ðñýí õ¿í àìûí öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí áà ÷èõðèéí øèæèí /Ýð¿¿ë ìýíä, Øèì ñóäëàëûí òàíäàëòûí ¿íäýñíèé 3-ð ñóäàëãàà,1988-1994/.

20 áà ò¿¿íýýñ äýýø íàñíû õ¿ì¿¿ñèéã cross-sectional àðãààð Ýð¿¿ë ìýíä, Øèì ñóäëàëûí òàíàäàëòûí ¿íäýñíèé 3-ð ñóäàëãààíä õàìðóóëñàí.

20 áà ò¿¿íýýñ äýýø íàñíû 8876 õ¿íèéã Ýð¿¿ë ìýíä, Øèì ñóäëàëûí òàíàäàëòûí ¿íäýñíèé 3-ð ñóäàëãààíä õàìðóóëñàí.

Öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿âøèí íü ÷èõðèéí øèæèíòýé õ¿í àìûí á¿ëýãò 126.5 íã/ìë, ÷èõðèéí øèæèíã¿é õ¿í àìûí á¿ëýãò 125.7 íã/ìë áàéñàí áºãººä ÷èõðèéí øèæèíòýé áà ÷èõðèéí øèæèíã¿é õ¿í àìûí á¿ëãèéí öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèíä ÿëãàà ãàðààã¿é áàéíà.

4 ÀÍÓ

Joachim Bleys, MD, MPH; Ana Navas-Acien, MD, Ph.D; Eliseo Guallar, MD, DrPH

1988-1994

ÀÍÓ-ûí íàñàíä õ¿ðñýí õ¿í àìûí äóíäàõü õàâäàð, ç¿ðõ ñóäàñíû ºâ÷íººð íàñ áàðàãñàäûíá¿õ òîõèîëäîë áà öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí /Ýð¿¿ë ìýíä, Øèì ñóäëàëûí òàíàäàëòûí ¿íäýñíèé 3-ð ñóäàëãàà,1988-1994/

Ïðîëñïåêòèâ Êîãàðò ñóäàëãàà

1988-1994 îíäÝð¿¿ë ìýíä, Øèì ñóäëàëûí òàíàäàëòûí ¿íäýñíèé 3-ð ñóäàëãààíä õàìðàãäñàí 13887 õ¿íèé öóñàíä ñåëåí òîäîðõîéëñîí ìàòåðèàëûã àøèãëàñàí áà ñóäàëãààíä õàðàãäñàíààñ õîéø 12 æèë õ¿ðòýëõ õóãàöààíä íàñ áàðñàí õ¿ì¿¿ñèéí ìàòåðèàëûã õàìðóóëñàí.

Öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿âøèí íü 125.6 íã/ìë áàéñàí áºãººä öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿âøèí áà ç¿ðõ ñóäàñíû ºâ÷ººð íàñ áàðàëòûí òîõèîëäîë õîîðîíäîî õàìààðàëã¿é áàéñàí. Ãýâ÷ öóñàí äàõü ñåëåíèé ò¿âøèí 130 íã/ìë õ¿ðòýëõ èõýññýí òîõèîëäîëä íàñ áàðàëòûí òîõèîëäîë áóóð÷ áàéñàí àæ.

5 ÀÍÓ

Laclaustra, Martin, Navas-Acien, Ana, Stranges, Saverio, Ordovas, J.M. and Guallar, Eliseo. 2009.

2003-2004

ÀÍÓ- ûí õ¿í àìûí öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí áà öóñíû äàðàëò èõñýõ ºâ÷èí /Ýð¿¿ë ìýíä, øèì ñóäëàëûí òàíàäàëòûí ¿íäýñíèé ñóäàëãàà,2003-2004/

2003-2004 îíû Ýð¿¿ë ìýíä, øèì ñóäëàëûí òàíàäàëòûí¿íäýñíèé cross-sectional ñóäàëãààíä 40 áà ò¿¿íýýñ äýýø íàñíû õ¿ì¿¿ñèéã õàìðóóëñàí.

40 áà ò¿¿íýýñ äýýø íàñíû 2638 õ¿íèéã 2003-2004 îíä õèéãäñýí Ýð¿¿ë ìýíä, øèì ñóäëàëûí òàíàäàëòûí¿íäýñíèé ñóäàëãààíä õàìðóóëñàí.

Öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿âøèí íü 137 mu ã/ë áàéñàí áà öóñàí äàõü ñåëåíèé ò¿âøèí 160 mu ã/ë õ¿ðòýë èõñýõ òîõèîëäîëä öóñíû äàðàëòûí õýìæýý áîëîí öóñíû äàðàëò èõñýõ ºâíèé òàðõàëò èõñýæ áàéãàà íü øóãàìàí ðåãðåññèéí çàãâàðààð áàòëàãäñàí áàéíà.

6 Ãðåê

Alexios Sotiropoulos, Stavroula A Papadodima, Athanasia K Papaza-firopoulou et al., 2011

2009-2010

Ç¿ðõíèé òèòýì ñóäàñûí ýìãýãòýé áîëîí ýìãýããã¿é, ÷èõðèéí øèæèí ýìíýë ç¿éí 2 äàõü õýâ øèíæòýé ºâ÷òºíèé öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí ÿëãààã¿é áîëîõ íü

Ñross-sectional ñóäàëãàà

×èõðèéí øèæèí ýìíýë ç¿éí 2 äàõü õýâ øèíæòýé 200 ºâ÷òºíèéã (ç¿ðõíèé òèòýì ñóäàñíû ýìãýãòýé 100, ýìãýãã¿é 100 ºâ÷òºí) õÿíàëòûí ºâ÷òºíººñ ñîíãîæ, ñóäàëãààíä õàìðóóëñàí.

Öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿âøèí íü 102.40±30-31.10 μã/ë áà108.86±33.88 μã/ë áàéñàí áºãººä ÷èõðèéí øèæèí 2 äàõü õýâ øèíæòýé, ç¿ðõíèé òèòýì ñóäàñíû ýìãýãòýé áà ýìãýããã¿é ºâ÷òºíèé öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèíä ÿëãàà ãàðààã¿é.


7 Òàéâàíü

Kuen-Chen Yang, Long-Teng Lee, Yow-Shan Lee et al., 2010

2007 ªíäºð íàñòàí õ¿ì¿¿ñèéí öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí íü áîäèñûí ñîëèëöîîíû õ¿÷èí ç¿éëòýé õàìààðàëòàé áîëîõ íü

Ñross-sectional ñóäàëãàà

65-85 íàñíû ýðýãòýé, ýìýãòýé 200 õ¿íèéã ñóäàëãààíä õàìðóóëñàí.

Öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿âøèí íü 1.14 μmol/l áàéñàí áºãººä õ¿éñèéí ÿëãàà ãàðààã¿é áàéíà. Íèéò õîëåñòðîë, òðèãëèöåðèä, áàãà íÿãòðàëòàé ëèïîïðîòåèä èõñýõ òóòàì öóñàí äàõü ñåëåíèé ò¿âøèí èõñýæ áàéñàí àæ (p<0.001, p<0.05, p<0.001). Ò¿¿í÷ëýí ºëºí ¿åèéí öóñàí äàõü ãëþêîç áîëîí ñåëåíèé ò¿âøèí õîîðîíäîî õàìààðàëòàé áàéñàí (p<0.05) àæ.

8 ªìíºä Ñîëîíãîñ

Young-Jae Kim, Oyunbileg Galindev, Jun Han Sei, Su-Mi Bae, Hosub Im, Lanying Wen, Young Rok Seo, Woong Shick Ahn

2006 ªìíºä Ñîëîíãîñ óëñûí ýð¿¿ë õ¿íèé öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí

Cross-sectionalñóäàëãàà

Ýðýãòýé 50, ýìýãòýé 50, íèéò 100 õ¿íèéã ñóäàëãààíä õàìðóóëñàí.

Öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿øèí íü ñóäàëãààíû íèéò õ¿í àìä 112.05±30.42 μã/ë, ýìýãòýéä 120.81±27.37 μã/ë, ýðýãòýéä 103.29±31.05 μã/ë áàéñàí áºãººä ýìýãòýé÷¿¿äèéí öóñàí äàõü ñåëåíèé ò¿âøèí íü ýðýãòýé÷¿¿äèéíõýýñ ºíäºð áàéñàí (p=0.0035) àæ.

9 Èðàí

R Safara-lizadeh, GA Kardar, Z Pourpak, M Moin, A Zare and S Teimourian, 2005

2004

Òåãðàí õîòûí ýð¿¿ë õ¿íèé öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí

Cross-sectionalñóäàëãàà

184 ýð¿¿ë õ¿ì¿¿ñ

Öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿øèí íü 1-16 íàñíû õ¿¿õäýä 84.3±11.0 μã/ë, 16-ñ äýýø íàñíû õ¿í àìä 100.6±13 SD μã/ë áàéñàí áàýìýãòýéä 93.9± 14SD μã/ë, ýðýãòýéä 100.2± 12SD μã/ë áàéñàí àæ. Ýðýãòýé÷¿¿äèéí öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿âøèí íü ýìýãòýé÷¿¿äèéíõýýñ ºíäºð (p<0.005), ìºí ýðýãòýé÷¿¿äèéí öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí íü íàñíààñ õàìààðàí èõñýæ áàéñàí (p<0.001) àæ.

Äýýðõ õ¿ñíýãòýýñ õàðâàë ÀÍÓ-ä 18597 íàñàíä õ¿ðñýí ýð¿¿ë õ¿íèéã õàìðóóëàí õèéñýí ñóäàëãààíû ä¿íãýýð öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ õýìæýý íü 1.58 íìîëü/ë áàéñàí áºãººä ñóäàëãààíä õàìðàãäñàí õ¿íèé öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí íü íàñ, õ¿éñ, ¿íäýñ óãñàà, õ¿í àìûí îðëîãî, ãàçàð ç¿éí á¿ñýýñ õàìààð÷ áàãà çýðýã ÿëãààòàé òîãòîîãäñîí áàéíà [13]. Õàðèí 40 áà ò¿¿íýýñ äýýø íàñíû 917 õ¿íèéã õàìðóóëàí õèéñýí ñóäàëãààíû ä¿íãýýð öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí íü 124 ìèêðîãðàì/ë-ñ 147 ìèêðîãðàì/ë, äóíäàæ ò¿âøèí íü 137.1 ìèêðîãðàìì/ë áàéñàí áºãººä öóñíû ñèéâýí äýõ íèéò õîëåñòðîë, áàãà íÿãòðàëòàé ëèïîïðîòåèäûí ò¿âøèí èõñýí òóòàì ñåëåíèé ò¿âøèí èõñýæ

áàéñàí àæ [14]. Ìºí 20 áà ò¿¿íýýñ äýýø íàñíû ÷èõðèéí øèæèíòýé áà ÷èõðèéí øèæèíã¿é 8876 õ¿íèéã õàìðóóëàí õèéñýí ñóäàëãààíû ä¿íãýýð ÷èõðèéí øèæèíòýé õ¿í àìûí á¿ëãèéí öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿âøèí íü 126.8 íã/ìë, ÷èõðèéí øèæèíã¿é õ¿í àìûí á¿ëèéí öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿âøèí íü 124.7 íã/ìë áàéñàí áºãººä ÷èõðèéí øèæèíòýé õ¿í àìûí á¿ëãèéí öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿âøèí íü ÷èõðèéí øèæèíã¿é õ¿í àìûí á¿ëãèéí öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿âøèíãýýñ ºíäºð áàéñàí àæ [15]. Ò¿¿í÷ëýí 1988-1994 îíä ÀÍÓ-ä õèéãäñýí “Ýð¿¿ë ìýíä, øèì ñóäëàëûí òàíàäàëòûí ¿íäýñíèé 3-ð ñóäàëãàà“-íû õ¿ðýýíä 13887 õ¿íèéã õàìðóóëàí õèéñýí “ÀÍÓ- ûí


íàñàíä õ¿ðñýí õ¿í àìûí äóíäàõ õàâäàð, ç¿ðõ ñóäàñíû ºâ÷íººð íàñ áàðàãñàäûí òîõèîëäîë áà öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí“ ñýäýâò ñóäàëãààíû ä¿íãýýð õ¿í àìûí öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿âøèí íü 125.6 íã/ìë áàéñàí áºãººä ç¿ðõ ñóäàñíû ºâ÷íººð íàñ áàðàãñàäûí òîõèîëäîëòîé õàìààðàëã¿é áàéñàí áîëîâ÷ öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí èõñýõ òóòàì íèéò ºâ÷ëºëèéí òîõèîëäîë áàãàñ÷ áàéñàí àæ [16]. Ìºí 2003-2004 îíä ÀÍÓ- ä õèéãäñýí “Ýð¿¿ë ìýíä, õîîë òýæýýëèéí áàéäëûã òàíàäàõ ¿íäýñíèé ñóäàëãàà”- íû õ¿ðýýíä 40 áà ò¿¿íýýñ äýýø íàñíû 2638 õ¿íèéã õàìðóóëàí õèéñýí “ÀÍÓ- ûí õ¿í àìûí äóíäàõ öóñíû äàðàëò èõñýõ ýìãýã, õ¿í àìûí öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí“ ñóäàëãààíû ä¿íãýýð öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿âøèí íü 137 mu ã/ë áàéñàí áºãººä öóñíû äàðàëòûí õýìæýý èõñýõ áîëîí öóñíû äàðàëò èõñýõ ýìãýãèéí òàðõàëò íýìýãäýõ òóòàì öóñàí äàõü ñåëåíèé ò¿âøèí íü 160 mu ã/ë õ¿ðòýë èõñýæ áàéãàà íü òîãòîîãäñîí áàéíà [17]. Ìºí Òàéâàíü óëñàä 65-85 íàñíû 200 õ¿íèéã õàìðóóëàí õèéñýí “ªíäºð íàñòàí õ¿ì¿¿ñèéí öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèíã áîäèñûí ñîëèëöîîíû õ¿÷èí ç¿éëòýé õîëáîí ñóäëàõ“ ñóäàëãààíû ä¿íãýýð öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿âøèí íü 1.14 μmol/l áàéñàí áºãººä õ¿éñèéí ÿëãàà ãàðààã¿é [18] áîëîâ÷ íèéò õîëåñòðîë, òðèãëèöåðèä, áàãà íÿãòðàëòàé ëèïîïðîòåèä èõñýõ òóòàì öóñàí äàõü ñåëåíèé ò¿âøèí èõñýæ (p<0.001, p<0.05, p<0.001) áàéãàà íü òîãòîîãäñîí áàéíà [18]. Ò¿¿í÷ëýí ºëºí ¿åèéí öóñàí äàõü ãëþêîç áîëîí ñåëåíèé ò¿âøèí õîîðîíäîî õàìààðàëòàé (p<0.05) áàéñàí àæ [18]. Õàðèí Ãðåê óëñàä Ç¿ðõíèé òèòýì ñóäàñíû ýìãýãòýé áîëîí ýìãýãã¿é, ÷èõðèéí øèæèí ýìíýë ç¿éí 2-ð õýâ øèíæòýé 200 ºâ÷òºíèéã õàìðóóëàí õèéñýí ñóäàëãààíû ä¿íãýýð öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿âøèí íü ç¿ðõíèé òèòýì ñóäàñíû ýìãýãòýé, ÷èõðèéí øèæèí ýìíýë ç¿éí 2-ð õýâ øèíæòýé ºâ÷òºíä 108.86±33.88 μã/ë áàéñàí áîë ç¿ðõíèé òèòýì ñóäàñíû ýìãýãã¿é, ÷èõðèéí øèæèí ýìíýë ç¿éí 2-ð õýâ øèíæòýé ºâ÷òºíä 102.40±30-31.10 μã/ë áàéñàí áºãººä ç¿ðõíèé òèòýì ñóäàñíû ýìãýãòýé áîëîí ýìãýãã¿é, ÷èõðèéí øèæèíãèéí ýìíýë ç¿éí 2-ð õýâ øèíæòýé ºâ÷òºí¿¿äèéí öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿âøèíä ñòàòèñòèê à÷ õîëáîãäîë á¿õèé

ÿëãàà ãàðààã¿é àæ [19]. Òýãâýë ªìíºä Ñîëîíãîñ óëñàä 100 ýð¿¿ë õ¿íèéã õàìðóóëàí õèéñýí ñóäàëãààíû ä¿íãýýð öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿øèí íü ñóäàëãààíû íèéò õ¿í àìä 112.05±30.42 μã/ë, ýìýãòýéä 120.81±27.37 μã/ë, ýðýãòýéä 103.29±31.05 μã/ë áàéñàí áºãººä ýìýãòýé÷¿¿äèéí öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿âøèí íü ýðýãòýé÷¿¿äèéíõýýñ ºíäºð áàéñàí àæ (p=0.0035). Ìºí Èðàí óëñàä 184 ýð¿¿ë õ¿íèéã õàìðóóëàí õèéñýí ñóäàëãààíû ä¿íãýýð õ¿í àìûí öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿øèí íü 1-16 íàñíû õ¿¿õäýä 84.3±11.0 μã/ë, 16-ñ äýýø íàñíû õ¿í àìä 100.6±13 SD μã/ë áàéñàí àæ. Õ¿éñýýð àíãèëæ ¿çâýë ýìýãòýéä 93.9± 14SD μã/ë, ýðýãòýéä 100.2± 12SD μã/ë áàéñàí áºãººä ýðýãòýé÷¿¿äèéí öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿âøèí íü ýìýãòýé÷¿¿äèéíõýýñ ºíäºð áàéñàí (p<0.005) àæ. Ìºí ýðýãòýé÷¿¿äèéí öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí íü íàñíààñ õàìààðàí èõñýæ áàéñàí (p<0.001) àæ [20]. Ò¿¿í÷ëýí ýð¿¿ë õ¿ì¿¿ñèéí öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèíã ñóäàëñàí ººð ñóäàëãààíóóäûí 36 òàéëàíä õèéñýí ø¿¿í õýëýëö¿¿ëãýýñ ¿çâýë Ñåðá óëñûí ýð¿¿ë õ¿í àìûí á¿ëãèéí öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿âøèí íü 0.52 ìèêðîìîëü/ë áóþó õàìãèéí áàãà, ÀÍÓ-ûí Wyoming áîëîí ºìíºä Äîêàòà ìóæ óëñûí õ¿í àìûí öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí íü 2.5 ìèêðîìîëü/ë áóþó õàìãèéí ºíäºð ò¿âøèíòýé áàéñàí àæ [21, 22]. Äýýðõ ñóäàëãààíóóäàä 7502 ýð¿¿ë õ¿íèéã õàìðóóëàí, “öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ õýìæýý“-ã òîãòîîæ, ýð¿¿ë õ¿í àìûí á¿ëãèéí öóñàí äàõü ñåëåíèé ñòàíäàðò íîðì õýìæýýã òîãòîîñîí áàéíà [21, 28], (Õ¿ñíýãò 2). Ìºí ãàçðûí õºðñºí äýõ ñåëåíèé àãóóëàìæ íü áàãà áàéäàã Ôèíëàíä, Øèíý Çåëàíä [4] çýðýã óëñ îðîíä, ¿ð òàðèàíä õýðýãëýõ áîðäîîã ñåëåíýýð áàÿæóóëæ õýðýãëýí, öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí íü 0,6-ñ 1,5 ìèêðîìîëü/ë õ¿ðòýë íýìýãäñýíèéã äýýðõ ñóäàëãààãààð òîãòîîñîí áàéíà [21, 22]. Ò¿¿í÷ëýí ñåëåíèé äóòàëòàé õîëáîîòîé ¿¿ñäýã Êåøàí áà Êàñ÷èíû ºâ÷èíòýé õ¿ì¿¿ñ áîëîí, áàìáàéí äààâðûí äóòàë, õ¿íèé äàðõëàë õîìñäîëûí âèðóñ òýýã÷èä áîëîí äàðõëàà äóòëûí îëäìîë õàì øèíæòýé õ¿ì¿¿ñèéí öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèíã [23.24.25.26.27-29] äýýðõ ñóäàëãààíû ¿ð ä¿íãèéí ø¿¿í õýëýëö¿¿ëãýä õàìðóóëàí àâ÷ ¿çñýí áàéíà (Õ¿ñíýãò 2).

Table 2 Representative mean serum selenium concentration (μmol/l) in specific studies

№ Specific studies Ranges of mean or mean ± standard error of selenium concentration (μmol/l)

Pathologic investigation 1 Keshan disease (China) 0.15-0.252 Kaschin-Beck disease (China) 0.22 ± 0.03


3 Myxoedematous cretins (Zaire) 0.26 ± 0.124 HIV and AIDSc 0.36-0.54

Data for normal subjects5 Serbia and Croatia 0.63-0.856 Bulgaria 0.66-0.727 New Zealand 0.698 Hungary 0.71 ± 0.139 Norway 1.52-1.6910 United States, Maryland 1.69-2.1511 United States, South Dakota 2.17-2.5012 Proposed reference ranges for healthy subjects 0.5-2.5, 0.67- 2.04

Õ¿ñíýãò 2. Õ¿í àìûí öóñàí äàõü ñåëåíèé äóíäàæ ò¿âøèíã (μìîëü/ë/) òóñãàé ñóäàëãààãààð òîãòîîñîí áàéäàë

№ Ñóäàëãàà õèéãäñýí óëñ îðíóóä Öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿âøèí (êîíöåíòðàö)

ìèêðîìîëü/ëÊåøàí, Êàñ÷èí, áàìáàéí äààâðûí äóòàë áîëîí õ¿íèé äàðõëàë õîìñäîëûí âèðóñ òýýã÷èä áîëîí

äàðõëàà äóòëûí îëäìîë õàì øèíæòýé õ¿í àìûí á¿ëãèéí öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí1 ÁÍÕÀÓ- ûí Êåøàíû ýìãýãòýé á¿ñ íóòãèéí õ¿í àìûí öóñíû

ñèéâýí äýõ ñåëåíèé ò¿âøèí (Êèøàíû ºâ÷íèé ñóäàëãàà)0.15-0.25

2 ÁÍÕÀÓ-ûí Êàñ÷èíû ýìãýã áóþó íóðóó, ¿å ìº÷íèé ýìãýãòýé õ¿í àìûí á¿ëãèéí öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿âøèí (Êàñ÷èíû ºâ÷íèé ñóäàëãàà)

0.22 ± 0.03

3 Çàèð óëñûí áàìáàé äààâðûí äóòàë áóþó ìåêñèäåì ýìãýãòýé õ¿í àìûí öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿âøèí

0.26 ± 0.12

4 Õ¿íèé äàðõëàë õîìñäîëûí âèðóñ òýýã÷èä áîëîí äàðõëàà äóòëûí îëäìîë õàì øèíæòýé õ¿í àìûí á¿ëãèéí öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí

0.36-0.54

Ýð¿¿ë õ¿í àìûí á¿ëãèéí öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿âøèí 5 Ñåðáå áà Õîðâàò óëñûí ýð¿¿ë õ¿í àìûí á¿ëãèéí öóñíû ñèéâýí

äýõ ñåëåíèé ò¿âøèí0.63-0.85

6 Áîëãàð óëñûí õ¿í àìûí öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí 0.66-0.727 Øèíý Çåëàíä óëñûí õ¿í àìûí öóñíû ñèéâýí äýõ ñåëåíèé

ò¿âøèí0.69

8 Óíãåð óëñûí õ¿í àìûí öóñíû ñèéâýí äýõ ñåëåíèé äóíäàæ ò¿âøèí

0.71 ± 0.13

9 Íîðâåãè óëñûí õ¿í àìûí öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí 1.52-1.6910 ÀÍÓ- ûí Ìàðóëàíä ìóæ óëñûí õ¿í àìûí öóñíû ñèéâýí äýõ

ñåëåíèé ò¿âøèí1.69-2.15

11 ÀÍÓ-ûí ªìíºä Äîêàòà ìóæ óëñûí õ¿í àìûí öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí

2.17-2.50

12 Ñóäàëãààíû ¿ð ä¿íã ¿íäýñëýí ñàíàë áîëãîñîí “Ýð¿¿ë õ¿í àìûí á¿ëãèéí öóñàí äàõü ñåëåíèé ëàâëàãàà õýìæýý”

0.5-2.5, 0.67- 2.04

Äýýðõ õ¿ñíýãòýýñ õàðõàä ÁÍÕÀÓ- ûí õ¿í àìûí äóíäàõ Êåøàí, Êàñ÷èíû ºâ÷èí, Çàèð óëñûí õ¿í àìûí äóíäàõ áàìáàéí äààâðûí äóòàë áîëîí õ¿íèé äàðõëàë õîìñäîëûí âèðóñ òýýã÷èä áîëîí äàðõëàà äóòëûí îëäìîë õàì øèíæòýé õ¿í àìûí á¿ëãèéí öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí íü 0.15-0.55 ììîëü/ë- èéí äóíä õýëáýëçýæ [23.24.25.26-27], ýð¿¿ë õ¿í àìûí á¿ëãèéí öóñíû ñèéâýíä òîãòîîãäñîí ñåëåíèé ëàâëàãàà õýìæýý áîëîõ 0.5-2.5 ììîëü/ë áà 0.67- 2.04 ììîëü/ë-ñ äîîãóóð áàéíà. Ìºí Ñåðáå, Õîðâàò, Áîëãàð, Øèíý Çåëàíä, Óíãåð çýðýã óëñ îðíû õ¿í àìûí

öóñàí äàõü ñåëåíèé äóíäàæ ò¿âøèí íü ýð¿¿ë õ¿í àìûí á¿ëãèéí öóñíû ñèéâýíä òîãòîîãäñîí ñåëåíèé ëàâëàãàà õýìæýýíèé äîîä õÿçãààðòàé îéðîëöîî ò¿âøèíä áàéãàà áîëîâ÷ Íîðâåãè, ÀÍÓ-ûí Ìàðóëàíä áîëîí ºìíºä Äîêàòà ìóæ óëñûí õ¿í àìûí öóñíû ñèéâýíä òîãòîîãäñîí ñåëåíèé äóíäàæ ò¿âøèíãýýñ áàãà áàéíà. Èéíõ¿¿ äýýðõ óëñ îðíóóäûí õ¿í àìûí öóñàí äàõü ñåëåíèé õýìæýý õàðèëöàí àäèëã¿é áàéãàà íü òóõàéí óëñ îðíû îðøèí áàéðëàõ ãàçàð ç¿éí á¿ñ íóòãèéí ãàçðûí õºðñíèé öýâäýãò àãóóëàãäàõ ñåëåíèé õýìæýý áîëîí óðãàìàë, àìüòíû ãàðàëòàé õ¿íñýíä áàéõ


ñåëåíèé õýìæýýíýýñ õàìààðàëòàé àæ [22.26]. Òóõàéëáàë íýã ãð àìóó òàðèàíä àãóóëàãäàõ ñåëåíèé õýìæýý 10 íã- ñ áàãà, ãàçðûí õºðñºíä àãóóëàãäàõ, óñàíä óóñäàã ñåëåíèé õýìæýý 3 íã-ñ áàãà áàéâàë ñåëåíèé äóòàëòàé á¿ñ íóòàãò õàìààðàãääàã áàéíà [30]. Ãàçðûí õºðñíèé ñåëåíèé àãóóëàìæ íü áàãà áàéäàã ÁÍÕÀÓ- ûí çàðèì á¿ñ íóòàãò öàãààí áóäàà, ýðäýíý øèø, óëààí áóóäàé çýðýã õ¿íñíèé á¿òýýãäýõ¿¿í áîëîí ìàëûí òýæýýëä àãóóëàãäàõ ñåëåíèé õýìæýý áàãà áàéäãààñ øàëòãààëàí õ¿í àìûíõ íü äóíä ñåëåíèé äóòàëòàé õîëáîîòîé Êåøàíû ºâ÷èí, Êàñ÷èíû íóðóó, ¿å ìº÷íèé ýìãýã òîõèîëääîã áàéíà [30-34]. Ò¿¿í÷ëýí Áàðóóí ¨âðîïûí îëîí óëñ îðîíä, ãàçðûí õºðñíèé ñåëåíèé àãóóëàìæ íü ýðñ õýëáýëçýëòýé áàéäàã áºãººä ãàçðûí õºðñºí äýõ ñåëåíèé àãóóëàìæ íü õàíãàëòã¿é áàéäàã Ôèíëàíä, Øèíý Çåëàíä, Àíãëè çýðýã óëñ

îðíóóä ãàçàð òàðèàëàíãèéí áîðäîîã ñåëåíýýð áàÿæóóëñàí íü àìóó òàðèà, ñ¿¿ áîëîí áóñàä àìüòíû ãàðàëòàé á¿òýýãäýõ¿¿íä äýõ ñåëåíèé àãóóëàìæèéã íýìýãä¿¿ëñýí [31] áºãººä õ¿í àìûí öóñàí äàõü ñåëåíèé ò¿âøèí áàãàòàé Ôèíëàíä, Øèíý Çåëàíä, Àíãëè çýðýã óëñ îðíóóä íü ãàçðûí õºðñíèé ñåëåíèé àãóóëàìæ ºíäºðòýé á¿ñ íóòãààñ àìóó òàðèà èìïîðòëîõ áîäëîãî áàðèìòàëñàí áàéíà [31]. Èéíõ¿¿ ãàçðûí õºðñ áîëîí õ¿íñýíä àãóóëàãäàõ ñåëåíèé õýìæýý íü õ¿í àìûí öóñàí äàõü ñåëåíèé ò¿âøèíä îíöãîé íºëººòýé áîëîõûã äýýðõ ñóäàëãààíû ä¿íã¿¿ä õàðóóëæ áàéíà. Ìºí õ¿í àìûí ºðãºí õýðýãëýýíèé õîîë õ¿íñýýð àâ÷ áóé ñåëåíèé õýìæýý íü ãàçðûí õºðñíèé ñåëåíèé àãóóëàìæ áîëîí õ¿í àìûí õîîëëîõ çàí ¿éëýýñ õàìààð÷, óëñ îðíóóäàä ÿëãààòàé áàéäàã íü (Õ¿ñíýãò 3,4) õ¿í àìûí öóñàí äàõü ñåëåíèé ò¿øèíä íºëººëäºã àæ [31].

Table 3 Typical distribution of selenium in dietary constituents (μg/day) in selected countries

China China India India Finland United Kingdom

Keshan disease area

Disease-free area

Low-income vegetarian diets

Low-income conventional diets

Total diet 7.7 16.4 27.4 52.5 30 31Food groupCereals and cereal products

5.4 11.6 15.7 21.1 2.8 7

Ìeat and eggs >0.6 >2.2 3.7 9.2 10Fish 18.4 9.5 4Dairy products 6.9 4.8 6.5 3Fruits and vegetables

1.7 2.6 0.9 0.9 0.5 6

Other - - - - 1.1 3

Õ¿ñíýãò 3. Ñóäàëãààíä ñîíãîãäñîí óëñ îðíóóäûí õ¿í àìûí õîíîãèéí õýðýãëýýíèé õ¿íñýíä àãóóëàãäàõ ñåëåíèé õýìæýý (μã/õîíîã)

ÁÍÕÀÓ ÁÍÕÀÓ Ýíýòõýã Ýíýòõýã Ôèíëàíä Àíãëè

Êåøàíû ºâ÷íèé á¿ñ íóòàã

Êåøàíû ºâ÷èíã¿é á¿ñ íóòàã

Áàãà îðëîãîòîé, öàãààí õîîë õýðýãëýäýã õ¿í àì

Áàãà îðëîãîòîéåðäèéí õîîë õ¿íñ õýðýãëýäýã õ¿í àì

Õîíîãèéí á¿õ õ¿íñýýð

7.7 16.4 27.4 52.5 30 31

Õ¿íñíèé á¿ëýã¯ð òàðèà, ¿ð òàðèàíû á¿òýýãäýõ¿¿í

5.4 11.6 15.7 21.1 2.8 7

Ìàõ, ºíäºã >0.6 >2.2 3.7 9.2 10

Çàãàñ 18.4 9.5 4

Ñ¿¿, öàãààí èäýý 6.9 4.8 6.5 3

Æèìñ, õ¿íñíèé íîãîî

1.7 2.6 0.9 0.9 0.5 6

Áóñàä - - - - 1.1 3


Äýýðõ õ¿ñíýãòýýñ õàðâàë ÁÍÕÀÓ-ûí êèñ÷àíû ºâ÷íèé òàðõàëòòàé á¿ñ íóòãèéí õ¿í àìûí õîíîãò õýðýãëýæ áàéãàà á¿õ õ¿íñ áîëîí ¿ð òàðèàíû á¿òýýãäýõ¿¿í, ìàõ, ºíäºã, æèìñ, õ¿íñíèé íîãîîãîîð õîíîãò àâàõ ñåëåíèé õýìæýý íü êèñ÷àíû ºâ÷èíã¿é á¿ñ íóòãèéí õ¿í àìûí õîíîãò õýðýãëýæ áàéãàà á¿õ õ¿íñ áîëîí áîëîí ¿ð òàðèàíû á¿òýýãäýõ¿¿í, ìàõ, ºíäºã, æèìñ, õ¿íñíèé íîãîîãîîð õîíîãò àâàõ ñåëåíèé õýìæýýíýýñ áàãà áàéíà. Ìºí Ýíýòõýã óëñûí öàãààí õîîë õýðýãëýäýã õ¿í àìûí õîíîãèéí á¿õ õ¿íñ áîëîí ¿ð òàðèàíû á¿òýýãäýõ¿¿íýýñ àâàõ ñåëåíèé õýìæýý íü áàãà îðëîãîòîé, åðäèéí õîîë õ¿íñ õýðýãëýäýã õ¿í àìûí á¿ëãèéí õîíîãèéí á¿õ õ¿íñ áîëîí ¿ð òàðèàíû á¿òýýãäýõ¿¿íýýñ àâàõ ñåëåíèé õýìæýýíýýñ áàãà áàéíà. Ýíýòõýã óëñûí áàãà îðëîãîòîé, åðäèéí õîîë õ¿íñ

õýðýãëýäýã õ¿í àìûí á¿ëýã íü ìàõ, ºíäºã, çàãàñ çýðýã á¿òýýãäýõ¿¿íýýñ ñåëåíèéã àâ÷ áàéãàà íü öàãààí õîîë õýðýãëýäýã õ¿í àìûí á¿ëãýýñ äàâóó òàëòàé áàéíà. Õàðèí ãàçðûí õºðñíèé ñåëåíèé àãóóëàìæ áàãàòàé Ôèíëàíäûí õ¿í àìûí ¿ð òàðèàíû á¿òýýãäýõ¿¿í, æèìñ, õ¿íñíèé íîãîîãîîð àâàõ áîëîìæòîé ñåëåíèé õýìæýý íü êèñ÷àíû ºâ÷èíã¿é ÁÍÕÀÓ-ûí á¿ñ íóòàã áîëîí äýýðõ õ¿ñíýãòýä ýìõýòãýãäñýí áóñàä óëñ îðíû õ¿í àìûí ¿ð òàðèàíû á¿òýýãäýõ¿¿í, æèìñ, õ¿íñíèé íîãîîãîîð àâàõ áîëîìæòîé ñåëåíèé õýìæýýòýé õàðüöóóëàõàä áàãà áàéíà.

Íàñàíä õ¿ðýãñýäèéí õîíîãèéí õîîë õ¿íñýýð àâ÷ áóé ñåëåíèé õýìæýýã óëñ îðíóóäààð àíãèëàí, 4-ð õ¿ñíýãòýä õàðóóëàâ.

Table 4. Selenium intakes of adults in some countries

Region or country Selenium intake (Mean ± standart deviation (SD) or range, (μg/day)

Reference

China, Keshan disease area 3-11 32,33

China, Kaschin-Beck disease area 2.6-5.0 34

Sweden, vegans 10 35

New Zealand, Low-selenium area 11±3 35,36

China, Disease –free area 13.3±3.1 23

South Sweden, conventional diets 40±4 38

India, vegan low income 27 39

Finland, before selenium fertilization 26 40-42

Finland, after selenium fertilization 56 40-42

Slovakia 27±8 43

United Kingdom, 1974 60 44




Italy 41 35

Germany 38-48 46

France 47 47

India, conventional diet 48 39

United States, all 80±37 48

Males 90±14 48

Females 74±12 48

Canada 98-224 49

United States, seleniferous area 216 35

Venezuela 80-500 50

China, seleniferous area 1338 35


Õ¿ñíýãò 4. Íàñàíä õ¿ðýãñäèéí õîíîãèéí õîîë õ¿íñýýð àâ÷ áóé ñåëåíèé õýìæýý óëñ îðíóóäààð áîëîí á¿ñ íóòãààð

Óëñ îðíóóä áà á¿ñ íóòàã Õîíîãèéí õîîë õ¿íñýýð àâàõ ñåëåíèé õýìæýý (äóíäàæ

õýìæýý ± ñòàíäàðò àëäàà áà õýëáýëçýë) (μã/õîíîã)

Õýâëýëèéí ýõ ¿¿ñâýð

ÁÍÕÀÓ- ûí Êåøàíû ºâ÷èíèé á¿ñ íóòãèéí õ¿í àì 3-11 32, 33ÁÍÕÀÓ- ûí Êàñ÷èíû ºâ÷íèé á¿ñ íóòãèéí õ¿í àì 2.6-5.0 34Øâåä óëñûí öàãààí õîîëòîí 10 35Øèíý Çåëàíä óëñûí ãàçðûí õºðñºí äýõ ñåëåíèé àãóóëàìæ áàãàòàé á¿ñ íóòãèéí õ¿í àì

11±3 35, 36

ÁÍÕÀÓ- ûí Êåøàí áîëîí Êàñ÷èíû ºâ÷èíã¿é á¿ñ íóòãèéí õ¿í àì

13.3±3.1 23

Øâåäèéí ºìíºä õýñãèéí åðäèéí õîîëòîé õ¿í àìûí á¿ëýã 40±4 38Ýíýòõýãèéí îðëîãî áàãàòàé, öàãààí õîîëòîí 27 39Áîðäîîã ñåëåíýýð áàÿæóóëàõûí ºìíºõ ¿åèéí Ôèíëàíäûí õ¿í àì

26 40-42

Áîðäîîã ñåëåíýýð áàÿæóóëñàíû äàðààõ ¿åèéí Ôèíëàíäûí õ¿í àì

56 40-42

Ñëîâàê óëñûí õ¿í àì 27±8 43Àíãëèéí Íýãäñýí Âàíò Óëñ, 1974 60 44Àíãëèéí Íýãäñýí Âàíò Óëñ, 1985 43 44Àíãëèéí Íýãäñýí Âàíò Óëñ, 1994 32 44Àíãëèéí Íýãäñýí Âàíò Óëñ, 1995 33 44Èòàë óëñûí õ¿í àì 41 35Ãåðìàí óëñûí õ¿í àì 38-48 46Ôðàíö óëñûí õ¿í àì 47 47Ýíýòõýãèéí åðäèéí õîîë õ¿íñ õýðýãëýäýã õ¿í àì 48 39ÀÍÓ- ûí íèéò õ¿í àì 80±37 48Ýðýãòýé 90±14 48Ýìýãòýé 74±12 48Êàíàä óëñûí õ¿í àì 98-224 49Ãàçðûí õºðñºí äýõ ñåëåí, òºìðèéí àãóóëàìæ ºíäºðòýé ÀÍÓ- ûí á¿ñ íóòãèéí õ¿í àì

216 35

Âåíåñóàëü óëñûí õ¿í àì 80-500 50Ãàçðûí õºðñºí äýõ ñåëåí, òºìðèéí àãóóëàìæ ºíäºðòýé Õÿòàä óëñûí á¿ñ íóòãèéí õ¿í àì

1338 35

Äýýðõ õ¿ñíýãòýýñ õàðâàë ÁÍÕÀÓ-ûí Êåøàí, Êàñ÷èíû ºâ÷èíèé òàðõàëòòàé áîëîí ºâ÷èíã¿é á¿ñ íóòàã, Øâåä óëñûí öàãààí õîîëòîí, ãàçðûí õºðñºí äýõ ñåëåíèé àãóóëàìæ áàãàòàé Øâåä óëñûí á¿ñ íóòãèéí õ¿í àìûí õîíîãèéí õîîë õ¿íñýýð àâ÷ áàéãàà ñåëåíèé õýìæýý íü äýýðõ õ¿ñíýãòýä ýìõýòãýãäñýí áóñàä óëñ îðíû õ¿í àìûí ñåëåíèé õîíîãèéí õýðýãëýýíýýñ áàãà áàéíà. Õàðèí ãàçðûí õºðñºí äýõ ñåëåí, òºìðèéí àãóóëàìæ èõòýé á¿ñ íóòàãò áàéðëàæ áàéãàà ÀÍÓ, ÁÍÕÀÓ- ûí õ¿í àìûí õîíîãèéí õîîë õ¿íñýýð àâ÷ áàéãàà ñåëåíèé õýìæýý íü äýýðõ õ¿ñíýãòýä ýìõýòãýãäñýí áóñàä óëñ îðíû õ¿í àìûí ñåëåíèé õîíîãèéí õýðýãëýýíýýñ ýðñ ºíäºð áàéíà.

Ä¿ãíýëò:Õýâëýí íèéòëýãäñýí ñóäàëãààíû ¿ð ä¿íã¿¿äèéã íýãòãýí ä¿ãíýæ, äàðààõ ä¿ãíýëòèéã õèéâ.

1. Ýð¿¿ë õ¿í àìûí á¿ëãèéí öóñíû ñèéâýí äýõ ñåëåíèé ëàâëàãàà õýìæýýã 0.5-2.5 ììîëü/ë áà 0.67- 2.04 ììîëü/ë-ýýð òîãòîîñîí áàéíà.

2. Õ¿í àìûí öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí íü ãàçðûí õºðñºí äýõ ñåëåíèé àãóóëàìæ, õ¿í àìûí ºðãºí õýðýãëýýíèé õ¿íñýí äýõ ñåëåíèé àãóóëàìæ áîëîí õ¿í àìûí õîîëëîõ çàí ¿éëýýñ õàìààð÷, õàðèëöàí àäèëã¿é áàéíà.

3. Öóñàí äàõü íèéò õîëåñòðîë, òðèãëèöåðèä, áàãà íÿãòðàëòàé ëèïîïðîòåèä èõñýõ òóòàì öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí èõ ãàðñàí áàéíà p<0.001, p<0.05, p<0.001). Ìºí ºëºí ¿åèéí öóñàí äàõü ãëþêîç áîëîí ãëþêîçèæñîí ãåìîãëîáèí èõñýõèéí õèðýýð öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí èõýññýí áàéíà (p<0.05).

4. Öóñíû äàðàëò èõñýõ áîëîí öóñíû


äàðàëò èõñýõ ýìãýãèéí òàðõàëò íýìýãäýõ òóòàì öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí èõýññýí áàéíà.

5. Êåøàí, Êàñ÷èíû ºâ÷èí, áàìáàéí äààâðûí äóòàë áîëîí õ¿íèé äàðõëàë õîìñäîëûí âèðóñ òýýã÷èä, äàðõëàà äóòëûí îëäìîë õàì øèíæòýé õ¿í àìûí á¿ëãèéí öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèí íü 0.15-0.55 ììîëü/ë- èéí äóíä õýëáýëçýæ, ýð¿¿ë õ¿í àìûí á¿ëãèéí öóñíû ñèéâýíä òîãòîîãäñîí ñåëåíèé ëàâëàãàà õýìæýý áîëîõ 0.5-2.5 ììîëü/ë áà 0.67- 2.04 ììîëü/ë-ñ äîîãóóð áàéíà.

Çºâëºìæ• Ìîíãîëûí ýð¿¿ë õ¿í àìûí öóñíû ñèéâýí

äýõ ñåëåíèé õýìæýýã íàñ, õ¿éñýýð àíãèëàí, á¿ñ íóòàã, àéìàã, ñóìäûí ãàçðûí õºðñºí äýõ ñåëåíèé àãóóëàìæ, ºðãºí õýðýãëýíèé õ¿íñýíä àãóóëàãäàõ ñåëåíèé àãóóëàìæ áîëîí õîíîãèéí õîîë õ¿íñýýð àâàõ ñåëåíèé õýðýãëýýòýé õîëáîí ñóäëàæ, ¿íýëãýý ä¿ãíýëò ãàðãàõ.

• Ìîíãîëûí õ¿í àìûí öóñíû ñèéâýí äýõ ñåëåíèé ò¿âøèíã õàëäâàðò áîëîí õàëäâàðûí áóñ ºâ÷èíòýé õîëáîí ñóäëàõ.

Íîì ç¿é

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[41] Mutanen, M. 1985.Comparison of chemical analysis and calculation emthod in estimating selenium content of Finnish diets. Nutr.Res., 5: 693-697.[42] Mutanen, M. 1984.Dietary intake and sources of selenium in young Finnish women. Hum. Nutr: Appl. Nutr., 38A: 265-269.[43] Kadrabova, J., Madaric, A. & Ginter, E. 1998.Determination of the daily selenium intake in Slovakia. Biol. Trace Elem. Res., 61: 277-286.[44] MacPherson, A., Barclay, M.N.J., Scotts, R. & Yates, R.W.S. 1997. Loss of Canadian wheat imports lowers selenium intake and status of the Scottish population. In: Trace Elements in Man and Animals -Proceedings of 9th International

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Òàíèëöàæ, íèéòëýõ ñàíàë ºãñºí: àíàãààõûí

øèíæëýõ óõààíû äîêòîð, ïðîôåññîð

Á.Áóðìààæàâ


Æèðýìñýí ¿åä òºðºëõèéí õºãæëèéí ãàæãèéã èëð¿¿ëýõáèîõèìèéí ñêðèíèíã øèíæèëãýý

Æ.Ãàíç¿ã1, ª.Îþóí÷èìýã2, Ï.Ýðõýìáóëãàí3, È.Ï¿ðýâäîðæ4

1ÝÌØÓÈÑ-èéí Ìîëåêóë áèîëîãè, óäàì ç¿éí òýíõìèéí äîêòîðàíò4ÝÌØÓÈÑ-èéí Ìîëåêóë áèîëîãè, óäàì ç¿éí òýíõìèéí áàãø, ïðîôåññîð

2ÝÕÝÌ¯Ò-èéíÀíàãààõûíóäàìç¿éíëàáîðàòîðè, ÀÓ-íû äîêòîð3ÁØÓß-íû Äýýä áîëîâñðîë õàðèóöñàí õýëòýñ,äýä ïðîôåññîð

Prenatal Screening for Congenital Defects birth(Review article)

J.Ganzug1, P.Erkhembulgan2, U.Ouynchimeg3, I.Purevdorj4, G.Mendsaikhan5

1,4,5National University of Medical Sciences2Ministry of Education and Science

3The National Center for Maternal and Child Health

Abstract

The double and triple test is a prenatal screening used to identify those pregnant women who should be offered a diagnostic test to identify whether their fetus has an aneuploidy. It was first described in 1988, but has largely been superseded by newer tests either conducted earlier in the first trimester (ie, the combined test, using ultrasound measurement of nuchal translucency, pregnancy-associated plasma protein A, and human chorionic gonadotrophin [hCG]) or in the second trimester (ie, the triple and quadruple test, using α-fetoprotein, hCG, uE3, and inhibin).

These newer tests have been introduced because they offer greater detection and lower screen positive results thereby enhancing diagnosis rates, while decreasing the risk of iatrogenic harm caused by the invasive testing required when collecting suitable sample tissue. Both first and second trimester screening programs have been expanded to include risk assignment for trisomy 18. Targeted screening algorithms have not been developed for chromosomal abnormalities other than Down syndrome and trisomy 18, although it has been suggested that a trisomy13 risk might be calculated. The construction of such algorithms would require recognition of a characteristic pattern for each condition using the appropriate combination of markers. It is likely, therefore, that the double and triple test will continue to be used in routine antenatal care for the foreseeable future.

Keywords: Congenital Defects birth, Double and triple test, Down syndrome, Prenatal screening

Pp.92-97, Tables -2, Figure-1, References-40

Ò¿ëõ¿¿ð ¿ã: Ïðåíàòàë îíîøèëãîî, Õîéìñîí òåñò, Ãóðâàë òåñò, Òºðºëõèéí õºãæëèéí ãàæèã

ÓäèðòãàëÄýëõèéä îéðîëöîîãîîð æèë á¿ð íèéò òºðæ áàéãàà õ¿¿õäèéí 6 õóâü áóþó 7.9 ñàÿ òºðºëõèéí õºãæëèéí ãàæèã(ÒÕÃ)-òàé õ¿¿õýä òºðæ, òýäíèé 3.3 ñàÿ íü áàãà íàñàíäàà ýíäýæ, 3.2 ñàÿ íü õºãæëèéí áýðõøýýëòýé èðãýí áîëäîã1. ÒÕÃ-èéí 6%-èéã õðîìîñîìûí, 8%-èéã ãåíèéí, 25%-èéã óäàìøèìòãàé ýìãýã ýçýëäýã ãýñýí ñóäàëãàà áèé [March of Dimes, Global report on birth defects, 2006].Òºðºëõèéí õºãæëèéí ãàæèã, óäàìøëûí áà õðîìîñîìûí ºâ÷òýé õ¿¿õýä òºðºõººñ ñýðãèéëýõ çîðèëãîîðæèðýìñíèé õÿíàëòàíäõàìãèéí ºðãºí õýðýãëýãääýã áèîõèìèéí ñêðèíèíã áóþó õîéìñîí-ãóðâàë òåñò áîëîíïðåíàòàë îíîøèëãîîíû èíâàçèâ áà õýò àâèàí õÿíàëòûã öîãöîîð íü

á¿ðýí íýâòð¿¿ëæ ÷àäñàí óëñ îðîíä õ¿¿õýä íÿðàéí ýíäýãäýë1000:15-ààñ õýòýðäýãã¿é àæýý2-5 Æèøýý íü Íèäåðëàíä óëñ 50 æèëèéí õóãàöààíä ïðåíàòàë îíîøèëãîîíû àðãóóäûã ¿å øàòòàé õýðýãæ¿¿ëñíýýð õðîìîñîìûí àíåóïëîèä, òàðõè íóãàñ, õ¿éíèé èâýðõèéáîëîí òºðºëõèéíõºãæëèéí ãàæèãòàé õ¿¿õýä òºðºõ ýðñäëèéã 87.5-90 %-èàðáóóðóóëæ ÷àäæýý (Çóðàã 1)6-9.

Figure 1. The stepwise evolution prenatal screening in the Netherlands (Woltelbor et al.,2010)

Prenatal screening in the Netherlands ScreeningIndroductionFirstFull Implemented Screening for for NTD triple test trimester testProgramm Trisomy 13 and 18

1977 1990 2002 2007 2010 1988 1996 2004 2007 2013 AFP for Population Permission to 20 weeksScreening for screeningscreening inform all anomaly more than DS act women scanDown


Èéìä õðîìîñîìûí áîëîí òºðºëõèéí õºãæëèéí ãàæèãòàé õ¿¿õýä òºð¿¿ëýõ ºíäºð ýðñäýëòýé ýìýãòýé÷¿¿ä òóõàéëáàë õîæóó íàñàíäàà æèðýìñýëæ áàéãàà á¿ñã¿é÷¿¿äýä æèðýìñíèé õÿíàëòûí àðãóóäûã öîãöîîð íü íýâòð¿¿ëýõ íü îíöãîé à÷ õîëáîãäîëòîé.

1. Æèðýìñíèé áèîõèìèéí ñêðèíèíã (èëð¿¿ëýã)

Ýõèéí öóñíû èéëäýñ äýõü óðàã-èõñýýñ ÿëãàðàõ AFP, βhCG, uE3, PAPP-A, inhibin-A óóðãóóäààð ýõèéí õýâëèé äýõü õºâðºë, óðãèéí õºãæëèéí ÿâö, õðîìîñîìûí àíåóïëîèä áîëîí òºðºëõèéí õºãæëèéí ãàæãèéã õÿíàõ áîëîìæòîé6,8,10,27.

Æèðýìñíèé áèîõèìèéí ñêðèíèíãíü æèðýìñíèé ýðò ¿åä óðàãò òºðºëõèéí áà óäàìøëûí ýìãýãèéã èëð¿¿ëýõ, ýðñäýë òîäîðõîéëîõ øèíæèëãýý þì. Ýíýõ¿¿ øèíæèëãýýã æèðýìñíèé çààãäñàí õóãàöààíä áóþó æèðýìñíèé I, II õàãàñò òîäîðõîéëíî. ¯¿íä:a. Æèðýìñíèé áèîõèìèéí èëð¿¿ëýã

øèíæèëãýý:- Æèðýìñëýëòòýé õàìààò ïëàçìûí À-

óóðàã-Pregnancy associated plasma A-protein (PAPP-A)

- Àëüôàôåòîïðîòåèí-Alpha-fetoprotein (AFP)

- Õîðèîíû ãîíàäîòðîïèí -human chorionic gonadotropin(βhCG, HCG)

- ×ºëººò ýñòðèîë-unconjugated estriol(uE3)

b. Ìýñ àæèëáàðã¿é àðãà- Õýò àâèàí øèíæèëãýý Óðãèéíøèëýíõ¿ç¿¿íèéàðûí çàé

õýìæèõ-Nuchal translucency(NT)c. Ìýñ àæèëáàðò àðãà

- Àìíèîöåíòåç- Õîðèîíû áèîïñûí øèíæèëãýý

Ýõèéí öóñíû èéëäýñ äýõü æèðýìñíèé áèîõèìèéí äààâðóóäûí õýìæýý íü ýõèéí íàñ, æèðýìñíèé òýýëòèéí õóãàöàà, øèíæëýõ àðãà îíîøëóóð çýðãýýñ õàìààð÷ ò¿¿íèé äóíäàæ ¿ç¿¿ëýëò õýëáýëçäýã ó÷ðààñ îëîí óòãûí äóíäàæ (MOM-multiple of the median)-ààð èëýðõèéëæ ä¿ãíýëò ãàðãàõàä àøèãëàäàã áîëæýý1-5.

2. Æèðýìñíèé ýõíèé 3 ñàðûí áèîõèìèéí ñêðèíèíã áóþó “Õîéìñîí òåñò”

Æèðýìñíèé 9-13 äîëîî õîíîãò æèðýìñýí ýõèéí öóñíû èéëäñýíä PAPP-A, βhCG-ûã òîäîðõîéëîõûã “õîéìñîí òåñò” ãýíý. Ýíýõ¿¿ ñîðèë äýýð íýìæ õýò àâèàí øèíæèëãýýãýýð óðãèéí NT-ã õýìæèí, ýõèéí íàñûã õàìòàòãàí ýðñäýëèéã ¿íýëäýã áîëæýý30.

ÐÀÐÐ-À íü æèðýìñíèé òóðøèä òðîôîáëàñòààñ íèéëýãæäýã ãëèêîïðîòåèí áºãººä æèðýìñíèé õóãàöààãàà äàãàí õýìæýý íü ºñºí íýìýãäýæ áàéäàã. Èíñóëèí òºñò ºñºëòèéí õ¿÷èí ç¿éë 4-èéã çàäëàã÷ ïðîòåàçûí ¿¿ðýãòýé9. ÐÀÐÐ-À-èéí îíîøèéí à÷ õîëáîãäîëòîé õýìæýýñ íü æèðýìñíèé 9-10 äàõü äîëîî õîíîãîîñ ýõëýõ áºãººä õàðèí 14 äýõü äîëîî õîíîãîîñ îíîøèéí à÷ õîëáîãäëîî àëääàã36.

Ñóäëàà÷äûí òîãòîîñíîîð æèðýìñíèé 8-13 äàõü äîëîî õîíîãò ÐÀÐÐ-À-èéí õýìæýý íîðìîîñîî 2.5 äàõèí áóóðàõ íü Äàóíû õàìøèíæòýé óðàã òýýæ áóéí áàòàëãàà áîëäîã12.

Õ¿íèé õîðèîíû ãîíàäîòðîïèí(HCG) èõñèéí öèòîòðîôîáëàñòààñ íèéëýãæäýã, ãëèêîïðîòåèä áºãººä àëüôà áà áåòà ãýñýí õî¸ð õýñãýýñ òîãòäîã. Ò¿¿íèé β õýñýã èë¿¿ ºâºðìºö øèíæ ÷àíàðòàéãààñ ãàäíà öóñàíä ÷ºëººò áàéäëààð îðøäîã11. Ñ¿¿ëèéí ¿åèéí ñóäàëãààãààð õðîìîñîìûí ãàæèãòàé õ¿¿õýä òýýæ áàéãàà ýõèéí öóñàíä βhCG-íû õýìæýý íýìýãääýã áîëîõ íü òîãòîîãäñîí21ó÷ðààñ ïðåíàòàë ñêðèíèíã-ä àøèãëàõ áîëñîí. βhCG-èéã ÐÀÐÐ-À áîëîí õýò àâèàí øèíæèëãýýíèé NÒ¿ç¿¿ëýëò¿¿äòýé õàìòàòãàí æèðýìñíèé ýõíèé 3 ñàðûí õÿíàëòàíä õýðýãëýõ áîëñíîîð Äàóí, Ýäâàðäñ, Ïàòàóãèéíõàìøèíæ çýðýã õðîìîñîìûí ãàæãèéã 75-80%-èàð èëð¿¿ëýõ áîëîìæòîé áîëñîí áàéíà6,13,34.

Àíãëè, Øâåéöàðè, ÀÍÓ áîëîí áóñàä îëîí óëñõîæóó æèðýìñýëñýí ýìýãòýé÷¿¿äýä ÐÀÐÐ-À, βhCG-ûãòîäîðõîéëîõ ïðåíàòàë ñêðèíèíã-ä õàìðóóëñíààð æèðýìñíèé ýõíèé 3 ñàðä Äàóíû õàì øèíæèéã 75-85%-èàð èëð¿¿ëäýã áîëæýý.Ìºí13,18-ð õðîìîñîìûí ãóðâàëòàé õ¿¿õýä òýýæ áàéãàà ýõèéí öóñíû èéëäýñ äýõü hCG, ÐÀÐÐ-À íü õýâèéí ¿ç¿¿ëýëòýýñýý ýðñ áàãàñäàã áàéíà34,39.Õàðèí áýëãèéí õðîìîñîìûí ãàæèãòàé õ¿¿õýä òýýæ áóé òîõèîëäîëä ýõèéí öóñíû èéëäýñ äýõü βhCG-èéí õýìæýý õýâèéí ÐÀÐÐ-À íü áóóðàõ ç¿é òîãòîëòîéã ñóäàëñàí áàéíà39.

“Õîéìñîí òåñò”-èéí á¿ðýëä¿¿í äààâðóóä íü 13, 18, 21-ð õðîìîñîìûí àíõäàã÷ ýðñäëèéã òîäîðõîéëæ, áóñàä òºðºëõèéí õºãæëèéí ãàæãèéã ýðò èëð¿¿ëýõ áîëîìæèéã îëãîäîã.

Ñ¿¿ëèéí ¿åä ñóäëàà÷èä æèðýìñíèé ýõíèé ãóðâàí ñàðûí õÿíàëòàíä øèíýýðA Disintegrin and Metalloprotease12-S (ADAM12) äààâðûã íü æèðýìñýí ýõèéí öóñíû èéëäñýíä òîäîðõîéëîí “õîéìñîí òåñò”-èéí ¿ç¿¿ëýëò¿¿äòýé õàìòàòãàí 13,18,21 õðîìîñîìûí áîëîí áóñàä òºðëèéí àíåóïëîèäèéã á¿ðýí èëð¿¿ëýõ áîëîìæèéã íýýæýý24-26.ADAM12 äààâàð íü òðîôîáëàñòààñ íèéëýãæäýã ãëèêîïðîòåèí15.


Ñóäëàà÷ Woltelboer íü æèðýìñíèé 8-9 äîëîî õîíîãò ADAM12, PAPP-A äààâðûã õýò àâèàí NT ¿ç¿¿ëýëòòýé õàìòàòãàí óëìààð 12 äîëîî õîíîãò βhCG-ûã çàõûí öóñíû èéëäñýíä òîäîðõîéëîõ çàìààð õðîìîñîìûí àíåóïëîèäè ãàæãèéã èëð¿¿ëýõ ÷àäàìæèéã íü 97% õ¿ðòýë ºñãºæ ÷àäñàí áºãººä ýíý ¿åä õóóðàì÷ ýåðýã ¿ð ä¿í íü 5% -òàé áàéâ. Ñóäëàà÷ ADAM12 äààâðûã 21 õðîìîñîìûí ãóðâàëûã ãàðöààã¿é èëð¿¿ëýã÷ äààâàð ãýæ îíöëîí òýìäýãëýñýí áàéíà24.

Æèðýìñíèé ýõíèé 3 ñàðûí äààâðóóäûí èõñýë, áàãàñàë íü öààøèä æèðýìñíèé õî¸ðäóãààð õàãàñò æèðýìñíèé õîðäëîãî, òºðºõ õ¿÷íèé ñóëðàë, öàãààñ ºìíº òºðºõ, óìàéí äîòîðõ áóþó òºðºõ òîéðíû ýíäýãäýë, èõñèéí ýìãýã áîëîõ, èõýñ ò¿ð¿¿ëýõ, èõýñ óðàãäàõ,õ¿íäðýë¿¿äèéã èëòãýäýã7.

Õýò àâèàí ñêðèíèíã (Nuchal translucency-NT øèëýíõ¿ç¿¿íèéàðûí çàé õýìæèõ)Ñ¿¿ëèéí 20 ãàðóé æèëèéí òóðøæèðýìñíèé ýðò ¿åä Äàóíû õàìøèíæ áîëîí ÒÕÃ-òàé õ¿¿õýä òºðºõ ýðñäýëèéã ¿íýëýõýäõýò àâèàí øèíæèëãýý õ¿÷ ò¿ðýí îðæ èðëýý. Óðãèéí øèëýí õ¿ç¿¿íèé àðûí çàé (NT), õàìàð ÿñ, çóëàé àõàð ñ¿¿ëíèé õýìæýýñ(CRL)¿ç¿¿ëýëò¿¿äèéã òîäîðõîéëæýý29,36.

Õðîìîñîìûí áîëîí òºðºëõèéí õºãæëèéí ãàæèã, óðãèéí ç¿ðõíèé ãàæãèéí ¿åä óðãèéí øèëýíõ¿ç¿¿íèéàðûí çàé (NT) èõýñäýã20,32.

11 äîëîî õîíîãòîéä óðãèéí èëýðõèé õºãæëèéí ãàæãóóäûã (àêðàíèÿ, àíýíöåôàëè, ç¿ðõíèé õºíäèéí ãàæèã, õýâëèéí õàíûí äóòìàã õºãæèëã.ì) õýò àâèàí øèíæèëãýýãýýð îíîøëîõ áîëîìæòîé32.

Õýò àâèàí ñêðèíèíãèéã æèðýìñíèé 11-136äîëîî õîíîãò óðãèéí øèëýíõ¿ç¿¿íèéàðûí çàé (NT)-ã õýìæèõ íü îíîøèéí õàìãèéí çºâ à÷ õîëáîãäîë á¿õèé õóãàöàà þì.

11-13 äîëîîõîíîãòîéäóðãèéíõàìàðÿñíû õýìæýýñ íü 21õðîìîñîìûíãóðâàë-60%, 18 õðîìîñîìûíãóðâàë-50%, 13 õðîìîñîìûíãóðâàë-40%-ä õàðàãäàãã¿é. Ãýòýëõýâèéíõðîìîñîìòîéóðãèéí äºíãºæ2%-ä õàìðûí ÿñõàðàãäàõã¿é áàéõ òîõèîëäîë áèé. Òèéìýýñóðãèéíõàìàðÿñíû õàðàãäàõ ç¿é òîãòîëíüÄàóíû õàìøèíæèéíýðñäëèéã¿íýëýõýä à÷ õîëáîãäîëòîé¿ç¿¿ëýëò áîëäîã áàéíà.Óðãèéíõàìàðÿñõýâèéíáóñáàéõíüýõèéíÿñ¿íäýñòýé÷óõàëõàìààðàëòàé29.

Æèðýìñíèé ýõíèé 3 ñàðûí õÿíàëòàíä Äàóíû õàìøèíæ áîëîí òºðºëõèéí õºãæëèéí ãàæãèéí ýðñäýëèéã ¿íýëýõýä çºâõºí óðãèéí NT-ã äàíãààð íü õýìæèõýä èëð¿¿ëýëò61% áàéäàã áîë Muller íàð(2003), áèîõèìèéí βhCG, PAPP-A, AFP äààâðóóäòàé õàìòàòãàíýðñäëèéã òîîöîõîäSpencer íàð (2000)-ûíõààð 86%; Krantz íàð(2000)-ûíõààð 91%; Schuchter íàð (2002)-ûíõààð 92%;Muller íàð (2003)-ûíõààð82%, Crossley íàð (2002)-ûíõààð80%õ¿ð÷ èëð¿¿ëýõ ÷àäàìæ ýðñ ºñºæ áàéãàà òóõàé òýìäýãëýñýí áàéíà.

Õýâèéí æèðýìñíèéÿìàð õóãàöààíä ¿åä NT áîëîíCRL õýâèéí õýìæýý íü 2.0 ìì áàéäàã áîë Äàóí, Ýäâàðäñ, Ïàòàó,Òåðíåðèéí õàìøèíæèéí ¿åä 3.4; 5.5; 4.0; 7.8ìì-ýýð ºñºõ ç¿é òîãòîë àæèãëàãääàã áàéíà28,29,32.

Table 1. Pregnancy biomarkers and ultrasound scan Copyright@ KyprosNicolaides

Pregnancy biochemical test and ultrasound scan

Normal pregnancy

Trisomy21

Trisomy18

Trisomy13

Crown rump lengthCRL (%) 5 95 70 85

Median CRLand NT (mm) 2.0 3.4 5.5 4.0

Median βhCG (MoM) 1.0 2.0 0.2 0.5

Median PAPP-A (MoM) 1.0 0.5 0.2 0.3

Nasal bone (%) 2.5 60 53 45

CRL crown rump length, MOM multiple of the median

Ýíý íü ýðñäýëòýé æèðýìñýí ýìýãòýé÷¿¿äèéí óðãèéí øèëýí õ¿ç¿¿íèé àðûí çàéä ¿¿ñýõ øèíãýíèéã õýìæèæ, æèðýìñíèé äààâðóóäòàé õàâñðàí øèíæëýõýä õðîìîñîìûí áîëîí òºðºëõèéí õºãæëèéí ãàæèã, óðãèéí ç¿ðõíèé ãàæèã áóñàä ýìãýã¿¿äèéí èëðýõ ìàãàäëàë íýìýãääýã áîëîõûã íîòîëæ áàéíà.

Æèðýìñíèé õî¸ðäàõü 3 ñàðûí áèîõèìèéí ñêðèíèíã áóþó “Ãóðâàë òåñò”Æèðýìñíèé 16-21 äîëîî õîíîãò ýõèéí öóñàíä AFP, HCG. uE3-ûã òîäîðõîéëîõûã “ãóðâàë òåñò” ãýíý1,4.

“Ãóðâàë òåñò” íü ýõèéí õýâëèé äýõ õºâðºë, óðãèéí õºãæëèéí ÿâö ñààòàõ, çîãñîõ, àíýíöåôàëè,


ãèäðîöåôàëè, òàðõè íóãàñíû èâýðõèé, õýâëèéí õàíûí öîîðõîé, õ¿éí ãàæèã, õîîë áîëîâñðóóëàõ çàìûí áèò¿¿ðýëòýé, Äàóí, Ýäâàðäñ, Ïàòàó, Òåðíåðèéí õàì øèíæ çýðýã õðîìîñîìûí ýìãýãòýé õºâðºë òýýæ áóéã èëòãýäýã1-5,12.

BarthaB (2006) íàðûí ñóäàëãààãààð AFP, HCG õî¸ð äààâðûí ò¿âøèí èõñýõ íü 19-23 äîëîî õîíîãèéí õóãàöààí äàõü èõñèéí õ¿íä ýìãýãèéã óðüä÷èëàí îíîøèëîõîä à÷ õîëáîãäîëòîéã òîäîðõîéëæýý7.

Ýõèéí öóñíû èéëäýñ äýõü AFP, HCG, uE3 äààâðóóäûí ò¿âøèíãèéí õýëáýëçëèéí õàìààðàë íü æèðýìñíèé ¿åèéí ýìãýã¿¿äèéí áàéäàëä ¿íýëãýý ºã÷ óðãèéí ìýäðýëèéí ñóâãèéí ãàæãèéã èëð¿¿ëýõ áîëîìæèéí àðãûí íýã þì27.

Àíãëèéí ñóäëàà÷äûíõààð ýðñäýëòýé æèðýìñýí ýõ÷¿¿äèéí AFP-ûã òîäîðõîéëñîí ä¿íãýýñ ¿çýõýä ò¿¿íèé ò¿âøèí èõýññýí òîõèîëäëóóäûí 88%-ä àíýíöåôàëè, 79%-ä íü õ¿éí áà íóðóó íóãàñíû èâýðõèéèëýð÷ áàéñàí áàéíà10,31.

ÎÕÓ-ûí òîìîîõîí õîòóóäàä æèðýìñýëñýí á¿õ ýìýãòýé÷¿¿äýý ãóðâàë òåñòèéí øèíæèëãýýíä õàìðóóëäàã áîëñíîîð õðîìîñîìûíáîëîíÒÕÃ-òàé õ¿¿õýä òºðºõ ÿâöûã òîäîðõîé õýìæýýãýýð áóóðóóëñàí áàéäàã29.

ÁÍÑÓ íü æèðýìñýëñýí á¿õ ýìýãòýé÷¿¿äýä “Ïðåíàòàë ºâºðìºö öîãö çàãâàð”-ûã áîëîâñðóóëàí Ýð¿¿ë ìýíäèéí äààòãàëûí ñàíòàéãàà õàìòðàí Äàóíû õàìøèíæ áîëîí áóñàä òºðºëõèéí õºãæëèéí ãàæèéã ýðò èëð¿¿ëýõ çîðèëãîîð æèðýìñíèé õî¸ðäàõü 3 ñàðä íü AFP, HCG, uE3 äààâðóóä äýýð íýìýëò áîëãîí inhibin A äààâðûã òîäîðõîéëñíîîð Äàóíû õàìøèíæèéã èëð¿¿ëýõ ÷àäàìæ íü 81.8-95%-ä õ¿ð÷ ñàéæèð÷ýý38.

Æèðýìñíèé õÿíàëòàíä “õîéìñîí áîëîí ãóðâàëòåñò”-èéí îíîøèëãîîíû ÷àäàìæèéã ñàéæðóóëàõ íü òºðºëõèéí õºãæëèéí ãàæèã, õðîìîñîìûí áîëîí óäàìøëûí ºâ÷òýé õ¿¿õýä òºðºõººñ óðüä÷èëàí ñýðãèéëýõ àñóóäàëä èõýýõýí à÷ õîëáîãäîëòîé íü îëîí îðíû òóðøëàãààñ õàðàãäàæ áàéíà.

Biomarkers of pregnancy screening

Screening for fetal chromosomal and abnormalities

Risk %

Reference(Detection rate DR)

(False-positive

rate-FPR)

Maternal age Down syndrome and other aneuploidy 30 5 Down1866; Morris 1999;

DOUBLE ÒÅÑÒ

MA+ fetalNT Down syndrome and other aneuploidy 75-80 5 Sinjders 1998; Wald 2003; Nicolaides 2004

MA + βhCG, PAPP-A Edwards &Patau’ssyndrome congenital defect birth

60-70 5 Tul 1999; Cuckle, 1999; Spencer 2000a

MA+ NT + βhCG, PAPP-A Trisomychromosome abnormalities 85-95 5 Krantz 2000; Schuchter 2002; Kagan 2008;

MA+NT+CRL+ βhCG, PAPP-A Aneuploidy and congenital heart defects and malformations

93-95 2.5 Aitken 2007; Wrightet 2010; Nicolaides 2011;

TRIPLE ÒÅÑÒ

MA+AFP, hCG(doubletest)Neural tube defects , anencephaly, hydrocephaly other anatomical defects of brain

55-60 5 Merkatz 1984;Canick 1988; Van Lith1993;

MA+AFP, βhCG (double test) 60-65 5 Brambati 1993; Aitken 1996; Wald 2003a;

MA+AFP, hCG+uE3 60-65 5 Spencer 2000; Wald 2003b;Cuckle 2005;

MA+AFP, βhCG+uE3Other brain malformations, spine bifida, chromosome abnormalities and congenital defects.

70-75 5 Malkne 2005; Cuckle&Ben 2009;

MA+AFP, βhCG+uE3+inhibinA (quadruple test) Early pregnancy preeclampsia,

diabetes, chromosome abnormalities, multiple pregnancy and fetal diet

80-85 5Wright 2004; Nicolaides 1996; Cuckle 2008; Moratalla 2010; Kagan 2010

MA+NT+PAPP-A (11 week)AFP, βhCG+uE3+inhibinA

90-95 5 Kagan 2008; Cuckle&Maymon 2010; Wright 2011

MA+NT+ADAM12s+PAPP-A (8-9 weeks)+ βhCG (12 weeks)

Turner and Klinefelter syndrome and triploidy, trisomy13, 18, 21 and congenital heart defects and malformations

97 5Wortelboer 2009; Poon 2009; Christainsen 2010;

Table 2. Prenatal screening

Maternal age-MA; nuchal translucency-NT; human chorionic gonadotropin βhCG, HCG; pregnancy associated plasma A-protein PAPP-A; alpha-fetoprotein-AFP; unconjugated estriol uE3; A Disintegrin and Metalloproteinase12-S-ADAM12; inhibin A.


“Õîéìñîí áîëîí ãóðâàë òåñò“-èéí øèíæèëãýý “ýåðýã” áóþó “ýðñäýëòýé” õàðèó ãàðñàí òîõèîëäîëä ïðåíàòàë îíîøëîãîîíû èíâàçèâ àðãûã ñîíãîõ øààðäëàãà ãàðäàã. Æèðýìñíèé ýðò ¿åèéí èëð¿¿ëýã øèíæèëãýýíèé ¿ð ä¿í “ýåðýã” áóþó õðîìîñîìûí ººð÷ëºëòòýé õ¿¿õýä òºðºõ ýðñäýëòýé òîõèîëäîëä óðãèéí óñ ýñâýë õîðèîíîîñ øèíæèëãýý àâ÷ êàðèîòèïûã òîäîðõîéëäîã.

Ìàíàé ñóäëàà÷äààñ æèðýìñíèé õî¸ðäàõü 3 ñàðûí õÿíàëòûí áèîõèìèéí äààâðóóäûí íýã áîëîõ AFP-íû õýìæýýã ìîíãîë æèðýìñýí ýìýãòýé÷¿¿äýä íàñ áà òýýëòèéí õóãàöààíû õàìààðëààð ñóäàëãàà õèéñýí1 áîë Ä. Ñàíñàðìàà íàð (2010) æèðýìñíèé õî¸ðäàõü 3 ñàðûí õÿíàëòûí ãóðâàë òåñòèéí äààâàð (AFP, HCG. uE3)-ûí õýìæýýã òîäîðõîéëñîí áàéíà. Ãýâ÷ ýäãýýð ñóäàëãàà íü õàðüöàíãóé öººí òîõèîëäëûã õàìàðñàí ó÷ðààñ òóõàéí äààâðóóäûí ìîíãîë õ¿íä áàéõ õýâèéí õýìæýý ãýæ ¿çýõýä ó÷èð äóòàãäàëòàé.

Ïðåíàòàëñêðèíèíãèéí äàâóó òàë íü þóíû óðüä õðîìîñîìûí ýìãýãèéí äàâòàìæèéã íýã ãýð á¿ëä òºäèéã¿é ïîïóëÿöèä áóóðóóëäàãòáàéãàà þì.

Õðîìîñîìûí ýìãýã îëîí ýðõòýí òîãòîëöîîíû õàâñàðñàí ãàæèã ¿¿ñãýäýã òºäèéã¿é ¿ð çóëáàëòûí 40-60%, àìüã¿é òºðºõ øàëòãààíû 7%, îþóíû õîìñäîëûí øàëòãààíû èõýýõýí õóâèéã ýçýëäýã3.5.

Õðîìîñîìûí ãàæãèéí ïîïóëÿöèä èëðýõ òîî íÿðàéä 0,6-0,8%, îëîí ýðõòýí òîãòîëöîîíûõàâñàðñàí ãàæèãòàé íÿðàéä 40% õ¿ðòýë ºñäºã. Íºãººòýéã¿¿ð õðîìîñîìûí ºâ÷íèé ýì÷èëãýýíèé ¿ð ä¿í áàãà òàâèëàí ìóó áàéäàã íü ïðåíàòàë îíîøèëãîî õèéõ ãàðöààã¿é çààëò áîëäîã1-5,40.Ýíý á¿õíýýñ ¿¿äýí æèðýìñíèé õÿíàëòàíä ïðåíàòàë óðüä÷èëàí ñýðãèéëýëòèéí àðãà òåõíîëîãèéã íýâòð¿¿ëýõ íü îíöãîé øààðäëàãàòàéáàéíà.

Íîì ç¿é1. Ãàíç¿ã Æ íàð. Æèðýìñíèé õÿíàëòàíä ãóðâàë

òåñòèéã íýâòð¿¿ëýõèéí à÷ õîëáîãäîë. 2008. Ýð¿¿ë ìýíäèéí øèíæëýõ óõààí ñýòã¿¿ë- 50. №10

2. Ãàíç¿ã Æ íàð. Æèðýìñíèé ýõíèé 3 ñàðûí õÿíàëòûí ñêðèíèíã øèíæèëãýýã íýâòð¿¿ëýõ àñóóäàëä. Õ¿ðýë òîãîîò-2011 (149)

3. Ï¿ðýâäîðæ È. Òºðºëõèéí õºãæëèéí ãàæãààñ ñýðãèéëýõ àðãà çàì. 2010

4. ÑàíñàðìààÄ íàð. Ïðåíàòàëîíîøèëãîîíû áèîõèìèéí ñêðèíèíã íýâòð¿¿ëýõ àñóóäàëä. 2010. Ýð¿¿ë ìýíäèéí øèíæëýõ óõààí ñýòã¿¿ë- 52. №12

5. Îþóí÷èìýã. ªíàð “Íèéñëýëèéí õýìæýýíä

òºðñºí íÿðàéí äóíäàõ òºðºëõèéí õºãæëèéí ãàæãèéí òîõèîëäëûí ä¿íãýýñ” Èëòãýë-ñóäàëãàà. Õ¿ðýë òîãîîò-2012 (67)

6. Aitken DA, Wallace EM, Crossley JA et al. DimericinhibinA as a marker for Down’s syndrome in early pregnancy. 1996. NEngl J Med 334:1231-1236

7. Bartha JL, Illanes S, Abdel-Fattah SA, Harrison G, SoothillPW . Maternal serum alpha-fetoprotein, fetal middle cerebral artery blood flow velocity and fetal haemoglobin in pregnancies at risk of fetal anaemia. 2006.PrenatDiagn , 26:101–104.[Medline]

8. Brambai B, MacintostMCM,TeiserB et al. Low maternal serum level of pregnancy assiocaited plasma protein (PAPP-A) in the first trimester in association with abnormal fetal karyotype.1993.BJOG100;324-326

9. Bischof, P. Purification and characterization of pregnancy associated plasma protein A (PAPP-A). 1979.ArchGynecol, 227(4), 315-326.

10. Canick J, Knight G, Palomaki et al. Low second trimester maternal serum unconjugated estriol in pregnancies with Down’s syndrome.1988. BJOG. 95;330-333

11. Cole LA: Immunoassay of hCG, its Free Subunits and Metabolies. ClinChem 1997,43:2233-2243

12. Cuckle H, BennPMultianalyte maternal serum screening for chromosomal defects. In Genetic Disorders and the fetus:2009. Diagnosis Prevention and Treatment (6thedn), Milunsky A (ed). Johns Hopkins University; Baltimore.

13. Cuckle H, Van Lith JM Appropriate biochemical parameters in first trimester screening for Down’s syndrome. 1999. PrenatDiagn 19: 505-512.

14. Crossley JA, Aitken DA, Cameron AD et al. Combined ultrasound and biochemical screening for Down’s syndrome in the first trimester; a Scottish milticentre study.2002. BIOG109(6); 667-676.

15. Gilpin, B. J., Loechel, F., Mattei, M. G., Engvall, E., Albrechtsen, R., &Wewer, U. M. A novel, secreted form ofhuman ADAM 12 (meltrin alpha) provokes myogenesis in vivo. 1998.JBiolChem273:(157-166).

16. Health Council of the Netherlands. Heredity: society and knowledge. The Hague. Health Council of theNetherlands: 1989; publication no. 31/89 (In Dutch).

17. Health Council of the Netherlands. Genetic screening. The Hague. Health Council of the Netherlands, 1994;publication no. 1994/22 (In Dutch).

18. Health Council of the Netherlands. Prenatal screening; Down’s syndrome, neural tube defects, routineultrasonography.The Hague:


Health Council of the Netherlands, 2001; publication no. 2001/11 (In Dutch).

19. Health Council of the Netherlands. Prenatal screening (2); Down’s syndrome, neural tube defects. The Hague:Healthe Council of the Netherlands, 2004; publication no. 2004/06 (In Dutch).

20. Hyett JA, Noble PL, SnijdersRJ, Nicolaides. Fetal heart rate in trisomy 21 and other chromosomal abnormalities at 10-14 weeks of gestation. 1996. Ultrasound ObstetGynecol 7;239-244.

21. Kagan KO, Wright D, Spencer K, Molina FS, Nicolaides KH. First trimester screening for trisomy 21 by free beta human chorionic gonadotropinand pregnancy assiociated plasma protein A; impact of maternal and pregnancy characteristics. Ultrasound ObstetGynecol 31;493-502.

22. Krantz DA, Hallahan TW et al. First trimester Down’s syndrome screening using dried blood biochemistry and nuchal translucency. 2000. ObstetGynecol 96:207-213.

23. Langdon Down J. Observations on an ethnic classificationof idiots. LondHosp Rep 3:259-262.

24. Laigaard, J., Sorensen, T., Frohlich, C., Pedersen, B. N., Christiansen, M., Schiott, K., Uldbjerg, N., Albrechtsen, R.,Clausen, H. V., Ottesen, B., &Wewer, U. M. ADAM12: a novel first-trimester maternal serum marker for Down

syndrome. 2003.PrenatDiagn23:(1086-1091).25. Laigaard, J., Christiansen, M., Frohlich, C.,

Pedersen, B. N., Ottesen, B., &Wewer, U. M. 2005a. The level of ADAM12-Sin maternal serum is an early first-trimester marker of fetal trisomy 18. PrenatDiagn25:(45-46).

26. Laigaard, J., Spencer, K., Christiansen, M., Cowans, N. J., Larsen, S. O., Pedersen, B. N., &Wewer, U. M. 2006b. ADAM12 as a first-trimester maternal serum marker in screening for Down syndrome. PrenatDiagn26:(973-979).

27. Merkatz IR, Nitowsky HM An association between low maternal serum alpha-fetoprotein and fetal chromosomal abnormalities. 1984. Am J ObstetGynecol 148;886-894.

28. Muller F, Benattar C. First trimester screening for Down syndrome in France combining fetal nuchal translucency measurement and biochemical marker. 2003.PrenatDiagn 23;833-836.

29. Nicolaides KH. Nuchal translucency and other first trimester sonographic markers of

chromosomal abnormalities. Am J Obstet. Gynecol 191; 45-67.

30. Pennings LA, Koster PH. Discovery of novel serum biomarkers for prenatal Down syndrome screening by integrative data mining.2009.

31. Prenatal Test-AFP. Journal.Pre.Diag. 2005. Medline. p-9

32. Souka AP, Snidjers RJM. Novakov A. Nicolaides KH. Defects and syndromes in chromosomally normal fetuses with increased nuchal translucency thickness at 10-14 weeks of gestation.1998.Ultrasound ObstetGynecol 11;391-400.

33. Schucher K, Hafner E et al. The first trimester combined test for the detection of Down syndrome pregnanciesin 4939 unselected pregnancies.2002. PrenatDiagn 22(3); 211-215

34. Spencer, K. &Cowans, N. J. 2007. ADAM12 as a marker of trisomy 18 in the first and second trimester of pregnancy.JMatern Fetal Neonatal Med 20:(645-650).

35. Spencer K,Cowans N. J., &Stamatopoulou, A. 2007. Maternal serum ADAM12s as a marker of rare aneuploidies in the first or second trimester of pregnancy. PrenatDiagn27:(1233-1237).

36. Wald, N., Rudnicka,A., &Bestwick, J.Sequential and contingent prenatal screening for Down syndrome.2006.Prenat Diagn, 26(9), 769-777

37. Wortelboer EJ, Linskens IH, Koster MPH et al. ADAM12s a first-trimester screening marker of trisomy.2009.Prenat Diagn 29(9); 866-9.

38. Young Kwon et al.,201139. Tul N, Spencer K, Noble P, Chan C, Nicolaides

KH. Screening for trisomy 18 by fetal nuchal translucency and maternal serum free beta hCG and PAPP-A at 10-14 weeks gestation. 1999;PrenatDiagn 19;1035-1042.

40. Odibo AO, Sehdev HM, Stamilio DM, Macones GA. 2006. Evaluating the thresholds of abnormal second trimester multiple marker screening tests associated with intra-uterine growth restriction. Am J Perinatol 2, 3:363–367.[Medline]

Òàíèëöàæ, íèòëýõ ñàíàë ºãñºí: Àíàãààõ óõààíû äîêòîð Æ.Ýíõöýöýã


Äàóíû õàìøèíæèéã æèðýìñíèé ýðò ¿åä èëð¿¿ëýõ, îíîøèëîõÀëãîðèòì

Ýõ áàðèõ, æèðýìñíèé õÿíàëò, ýìýãòýé÷¿¿äèéí ýì÷, ýìíýëãèéí àæèëòàí íàðò çîðèóëàâ.

2014 îí

È.Ï¿ðýâäîðæ1, Ï.Ýðõýìáóëãàí2, ª.Îþóí÷èìýã3, Æ.Ãàíç¿ã4, Ã.Ìýíäñàéõàí5

1,4,5Àíàãààõûí Øèíæëýõ Óõààíû ¯íäýñíèé Èõ Ñóðãóóëü 2Áîëîâñðîë Øèíæëýõ Óõààíû ßàì

3Ýõ Õ¿¿õäèéí Ýð¿¿ë Ìýíäèéí ¯íäýñíèé Òºâ email: [email protected]

Àãóóëãà

A.1. ÇîðèëãîA.2. Õýðýãëýã÷èäÀ.3. Àæëûí õýñýãA.4. Íýð òîìü¸î, òîäîðõîéëîëò, ýõ ñóðâàëæÀ.5. Äàóíû õàìøèíæ, îëîí óëñûí ºâ÷íèé àíãèëàëÁ.1. Äàóíû õàìøèíæèéí ýðñäýë òîäîðõîéëîõ øèíæèëãýýíèé àëãîðèòì

Á.2. ×àíä àâèàí îíîøèëãîîÁ.3. Æèðýìñíèé ýðò ¿åä äàóíû õàìøèíæèéã áàòëàõ øèíæèëãýýíèé àëãîðèòì

À.1.çîðèëãî

Æèðýìñíèé õÿíàëòûí ýì÷èéí Äàóíû õàìøèíæòýé õ¿¿õýä òºðºõººñ óðüä÷èëàí ñýðãèéëýõ ¿éë àæèëëàãààíû ìåíåæìåíòûã ñàéæðóóëàõ.

Äàóíû õàìøèíæèéã æèðýìñíèé ýðò ¿åä èëð¿¿ëýõ, îíîøèëîõ øèíæèëãýýã ïðàêòèêò íýâòð¿¿ëýõ, ýì÷ íàðûí ÷àäàìæèéã äýýøë¿¿ëýõ.

À.2.Õýðýãëýã÷èä Ýõ áàðèõ, ýìýãòýé÷¿¿äèéí ýì÷ Æèðýìñíèé õÿíàëòûí ýì÷ Ëàáîðàòîðèéí ýì÷ íàð Áóñàä íàðèéí ìýðãýæëèéí ýì÷ íàð Ñóäëàà÷èä Ðåçèäåíò

À.3. Áîëîâñðóóëñàí àæëûí õýñýã

1. È.Ï¿ðýâäîðæ - ÌÀÓÀêàäåèéí ãèø¿¿í, ÝÌß-íû Óäàì ç¿éí ìýðãýæëèéí çºâëºëèéí äàðãà, ïðîôåññîð

2. Ï.Ýðõýìáóëãàí - ÁØÓß-íû Äýýä áîëîâñðîë õàðèóöñàí õýëòñèéí äàðãà, ÀÓ-íû äîêòîð 3. ª.Îþóí÷èìýã -ÝÕÝÌ¯Ò-èéí ÀÓ-íû

Óäàì ç¿éí ëàáîðàòîðèéí ýðõëýã÷, ÝÌß-íû Óäàì ç¿éí ìýðãýæëèéí çºâëºëèéí

ãèø¿¿í, ÀÓ-íû äîêòîð 4. Æ.Ãàíç¿ã - ÀØÓ¯ÈÑ-èéí Ýì ç¿é-ÁèîÀÑ-èéí äîêòîðàíò, ÀÓ-íû ìàãèñòð 5. Ã. Ìýíäñàéõàí - ÀØÓ¯ÈÑ, ÀÓ-íû äîêòîð

À.4. Ýõ ñóðâàëæ

Çºâëºìæèéí èëð¿¿ëýã øèíæèëãýýíèé õýñãèéã

îëîí óëñûí íîòîëãîîíä ñóóðèëñàí ìåíåæìåíò

á¿õèé óäèðäàìæèéí ñòðàòåãèò ñóóðèëàí

áîëîâñðóóëñàí. ¯¿íä:o Global report on birth defects, March of

Dimes, 2006. o Birth defect prevention center in Canada,

2008o National Center for Environmental Health,

Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3724, USA.

o ÄÝÌÁ, ÀÍÓ, Òàéâàí, Àâñòðè, Èçðèàëü, ßïîí óëñ îðíû ìýðãýæèëòýíòýé õàìòàðñàí ñóäàëãàà øèíæèëãýý

o Antenatal Screening for DownSyndrome and Conditions. Ministry of Health, New Zealand

À.5 . Îëîí óëñûí ºâ÷íèé 10-ð àíãèëàë

Q90 Down’s syndrome Ñèíäðîì Äàóíà Äàóíû õàìøèíæ

Q90.0 Trisomy 21, meiotic nondisjunction

Òðèñîìèÿ 21, Ìåéîòè÷åñêîå íåðàñõîæäåíèå

21-ð õðîìîñîìûí ãóðâàë, ìåéîç õóâààãäëûí ¿åèéí ¿ë ñàëàëò

Q90.1 Trisomy21,mosaicism (mitotic nondisjunctoin)

Òðèñîìè ÿ 21 (ìèòîòè÷èñêîå ìîçàèöèçì íåðàõîæäåíèå)

21-ð õðîìîñîìûí ãóðâàë, ìèòîç õóâààãäàëûí ¿åèéí ¿ë ñàëàëò

Q90.2 Trisomy21, translokcatoin

Òðèñîìèÿ 21,òðàíñëîêàö èÿ

21-ð õðîìîñîìûí ãóðâàë , òðàíñëîêàöè

Q90.9 Down’ s syndromy, unspecified

Ñèíäðîì Äàóíà íåóòî÷íåííûè

Äàóíû õàì øèíæ , òîäîðõîéã¿é


Á.1. Äàóíû õàìøèíæèéí ýðñäýë òîäîðõîéëîõ ñêðèíèíã øèíæèëãýýíèé àëãîðèòì

Õ¿ñíýãò 1. Äàóíû õàìøèíæòýé õ¿¿õýä òºðºõ ýðñäýëòýé ¿åèéí ñêðèíèíã

øèíæèëãýýíä ãàðàõ ººð÷ëºëò

Æèðýìñíèé ýõíèé 3 ñàðä

21-ðõðîìîñîìûí

ãóðâàë

ÐÀÐÐ-

À

×ºëººò

β-HCG

Äàãçíû àðûí çàé (NT)

↓ ↑ ↑Æèðýìñíèé 2 äàõü 3 ñàðä

21-ð õðîìîñîìûí

ãóðâàë

HCG ×ºëººò

ýñòðèîë

Àëüôàôå-

òîïðîòåéí

Èíãèáèí

À

↑ ↓ ↓ ↑

NT-(Nuchal translucency), hCG-(human chorionic gonadotropin), PAPP-A –( Pregnancy-associated plasma protein A), ÀÔÏ-(Àëüôàôåòîïðîòåéí)

Øèíæèëãýýíèé ìýäðýã ÷àíàðÆèðýìñíèé 11-13 äîëîî õîíîã 6 õîíîãòîéä óðãèéí øèëýí õ¿ç¿¿íèé àðûí çàéí õýìæýýñèéã ýõèéí íàñòàé õàðüöóóëàí òîîöîõîä óðãèéí õðîìîñîìûí ýìãýãèéã èëð¿¿ëýõ õóâü 75% áàéäàã. Õàðèí óðãèéí øèëýí õ¿ç¿¿íèé àðûí çàéí õýìæýýñèéã áèîõèìèéí ìàðêåð áîëîõ æèðýìñýíòýé õàìààò ñèéâýíãèéí À óóðàã (ÐÀÐÐ-À), õ¿íèé öýëìýíãèéí ãîíàäîòðîïèí äààâðûí ò¿âøèíã õàâñàðãàí òîäîðõîéëîõîä îíîøèëãîî 85-90% áîëíî. Ýäãýýð øèíæèëãýýòýé õàìòàòãàí óðãèéí õàìàð ÿñ òîäîðõîéëîõ øèíæèëãýý õèéõýä õðîìîñîìûí ýìãýãèéã èëð¿¿ëýõ õóâü 95% áîëæ íýìýãääýã.

Á.2. ×àíä àâèàí îíîøèëãîî

Äàóíû õàìøèíæèéã èëð¿¿ëýõýä îíîøèëãîîíû à÷ õîáîãäîë á¿õèé õýò àâèàí øèíæèëãýýíèé ¿ç¿¿ëýëò¿¿ä:Äàóíû õàìøèíæòýé õ¿¿õýä òºðºõ ýðñäýëèéã òîäîðõîéëîõîä õýò àâèàí ¿ç¿¿ëýëò¿¿äèéã õàðãàëçàí òîîöîõ íü øààðäëàãàòàé.

Жирэмсний хяналтын эмч ДАУНЫ ХАМШИНЖ илрүүлэх скрининг шинжилгээ санал болгох

Скрининг шинжилгээнээс “татгалзах”

Скрининг шинжилгээнд хамрагдахыг “зөвшөөрөх”

Чанд авиан илрүүлэг шинжилгээнд: NT - хэмжих

Чанд авиан оношилгоо: Бүтцийн илэрхий хөгжлийн

гажиг

Скрининг шинжилгээнд: Хоймсон тест: Гурвал тест:

Жирэмсний хугацаа: 10-13 долоо хоног ; 16-21 долоо

Эрсдэл тодорхойлох

Óðãèéí õàìàð ÿñ, øèëýí õ¿ç¿¿íèé øèíãýí, ýõèéí öóñàíä öýëìýíãèéí ãîíàäîòðîïèí, æèðýìñýíòýé õàìààò À óóðàã òîäîðõîéëîõîä Äàóíû õàìøèíæèéí èëð¿¿ëýëòèéí õóâü 95% áàéäàã.

Øèëýí õ¿ç¿¿íèé àðûí çàé õýìæèõ (Nuchal translucency-NT):Æèðýìñíèé ýõíèé ñàðä õýò àâèàí èëð¿¿ëýã øèíæèëãýýã æèðýìñíèé 11-13 äîëîî õîíîã 6 õîíîãòîéä óðãèéí øèëíèé àðûí çàé (NT) õýìæèíý. Øèëýí õ¿ç¿¿íèé àðûí çàéä ¿¿ñýõ øèíãýíèéã õýìæèæ, æèðýìñíèé áèîõèìèéí öóñíû øèíæèëãýýòýé õàâñðàí õèéõýä ýäãýýð ýìãýã¿¿äèéí èëðýõ ìàãàäëàë íýìýãääýã. 11 äîëîî õîíîã 2 õîíîãòîéãîîñ 13 äîëîî õîíîã 2 õîíîãòîé õóãàöààíä øèëýí õ¿ç¿¿íèé àðûí çàé 1,2-2,7 ìì áàéäàã. 3,5 ìì áà ò¿¿íýýñ äýýø íýìýãäýõ íü Äàóíû õàìøèíæèéí ýðñäýëòýéã èëýðõèéëíý.

×àíä àâèàí èëð¿¿ëýã øèíæèëãýýíä àøèãëàæ áîëîõ ºâºðìºö áèø òóñëàõ øèíæ¿¿ä:

Èõñèéí ýçýëõ¿¿í: Æèðýìñíèé 11-14 äîëîî õîíîãòîéä èõñèéí ýçýëõ¿¿íèéã òîäîðõîéëîõ áà äàóíû õàìøèíæèéí ¿åä èõñèéí ýçýëõ¿¿í áóóðñàí áàéäàã. Óðãèéí ç¿ðõíèé öîõèëò: 21-ð õðîìîñîìûí ãóðâàëûí ¿åä óðãèéí ç¿ðõíèé öîõèëò ÿëèõã¿é èõýññýí áàéäàã. Ýð¿¿ë, 5 äîëîî õîíîãòîé óðãèéí ç¿ðõíèé öîõèëò 100 áàéñíàà 10 äîëîî õîíîãòîéä 170 áîëæ èõýñäýã äàóíû õàì øèíæèéí ¿åä ÓÇÖ áàãà çýðýã áóóðäàã ÷ áàñ ÷àíä àâèàí øèíæèëãýýíèé ¿åä ãàðàõ ºâºðìºö øèíæ áèø ó÷ðààñ áóñàä èëðýõ øèíæ òýìäýãòýé õàðüöóóëàí ¿çýõ íü ÷óõàë þì. Ductus venosus-ûí äîïïëåð: Æèðýìñíèé 10-136 äîëîî õîíîãòîéä øèíæëýõ áîëîìæòîé áºãººä ç¿ðõíèé äàóíû õàìøèíæòýé óðàãò 80%, ýð¿¿ë óðàãò 5% èëýðäýã. Óðãèéí õ¿éí âåíýýñ õ¿÷èëòºðºã÷ººð õàíãàãäñàí öóñ ç¿ðõíèé òèòýì ñóäàñ áîëîí òàðõèíû öóñíû ýðãýëò ð¿¿ äàìæóóëäàã öîðûí ãàíö øóíò þì.

Á.3. Æèðýìñíèé ýðò ¿åä äàóíû õàìøèíæèéã áàòëàõ øèíæèëãýýíèé àëãîðèòì

Ïðåíàòàë îíîøèëãîî íü æèðýìñíèé ýðò ¿åèéí èëð¿¿ëýã øèíæèëãýý ¿ð ä¿í “ýåðýã” áóþó õðîìîñîìûí ººð÷ëºëòòýé õ¿¿õýä ãàðàõ ýðñäýëòýé òîõèîëäîëä óðüä÷èëàí òàâèñàí îíîøèéã áàòëàõ çîðèëãîîð õèéãäýõ øèíæèëãýý þì.


Хромосомын шинжилгээнээс “татгалзах”

Жирэмслэлт, төрөлтийг шийдэх

Жирэмсний

хяналты

н эмч

Скрининг шинжилгээний үр дүн “сөрөг” ба “эерэг” тохиолдолд

“Эрсдэлгүй”

Хромосомын шинжилгээг санал болгох

“Эрсдэлтэй”

Ураг хэвийн

Ураг 21-р хромосом дээр өөрчлөлттэй

Эцэг, эхийн шийдвэр

Мэргэжлийн эмч нарын комиссын шийдвэр

Хромосомын шинжилгээнд хамрагдахыг “зөвшөөрөх”

Íîì ç¿é

1. Ýð¿¿ë ìýíäèéí òåõíîëîãèéí ¿íýëãýýíèé æóðàì, 2009

2. ÄÝÌÁ-ûí óäàìøëûí ýìãýãèéí îíîøëîãîîíû òàëààð áàðèìòàëæ áóé ñòðàòåãè ÄÝÌÁ, 2009 îí

3. Àíàãààõ óõààíû óäàì ç¿é, 2010

4. Òºðºëõèéí õºãæëèéí ãàæãààñ óðüä÷èëàí ñýðãèéëýõ àðãà çàì, 2010

5. Æèðýìñíèé 16-21 äîëîî õîíîã äàõü öóñíû èéëäñèéí ÀÏÔ-íû õýâèéí õýìæýýã òîäîðõîéëñîí íü. Ìàãèñòðûí íýã ñýäýâò á¿òýýë, 2008

6. Ïðåíàòàë îíîøëîãîîíû áèîõèìèéí ñêðèíèíã íýâòð¿¿ëýõ àñóóäàëä. Ìàãèñòðûí íýã ñýäýâò á¿òýýë, 2010

7. ICD-10 Congenital malformations and chromosomal abnormalities.

8. Discovery of Novel Serum Biomarkers for Prenatal DownSyndrome Screening by Integrative Data Mining. Laboratory for Health Protection Research (GBO), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands, 2 Laboratory for InMedical Genetic in developing countries, 2005

9. Essential in Down’s syndrome screening going straight, 2011

10. Wright D, Kagan KO, Molina FS, Gazzoni A, Nicolaides KH. A mixture model of nuchal translucency thickness in screening for chromosomal defects. Ultrasound Obstet Gynecol. 2008;31:376-83.

11. Joint Commission on Accreditation of Healthcare Organizations. Accreditation manual for hospitals. Vol 1, Standards. Joint Commission of Accreditation of Healthcare Organizations, Oakbrook Terrace, IL 1992. p. 21.

12. American College of Obstetricians and Gynecologists. The obstetrician gynecologist and primary preventive health care. ACOG, Washington, DC 1993.

13. American College of Obstetricians and Gynecologists. Psychosocial risk factors: perinatal screening and intervention. Educational bulletin No. 255. ACOG, Washington, DC 1999.


Ýìíýëãèéí íàíî á¿òýýãäýõ¿¿íèé õîðîí ÷àíàðûã ýñèéí ò¿âøèíä ñóäëàõîð÷èí ¿åèéí àðãóóä

(Õýâëýëèéí òîéì)

Ñ.ªíºðñàéõàí, Ã.ÑóâäààÍèéãìèéí ýð¿¿ë ìýíäèéí ¿íäýñíèé òºâ

[email protected]

AbstractModern cells methods of the toxicity for nano medical products

S.Unursaikhan, G.SuvdaaNational center of Public Health

With the development of nanotechnology, nanomaterials are being widely used in manyindustries as well as in medicine and pharmacology. Despite the many proposed advantages of nanomaterials, increasing concerns have been expressed on their potential adverse human health effects. In recent years, application of nanotechnology in medicine has been defined as nanomedicine. Techniques in nanomedicine make it possible to deliver therapeutic agents into targeted specific cells, cellular compartments, tissues, and organs by using nanoparticulate carriers. Because nanoparticles possess different physicochemical properties than their fine-sized analogues due to their extremely small size and large surface area, they need to be evaluated separately for toxicity and adverse health effects. In addition, in the field of nanomedicine, intravenous and subcutaneous injections of nanoparticulate carriers deliver exogenous nanoparticles directly into the human body without passing through thenormal absorption process. These nanoparticulate carriers themselves may be responsible for toxicity and interaction with biological macromolecules within the human body. Second, insoluble nanoparticulate carriers may accumulate in human tissues or organs. Therefore, it is necessary to address the potential health and safety implications of nanomaterials used in nanomedicine. Toxicological studies for biosafety evaluation of these nanomaterials will be important for the continuous development of nanomedical science. This review summarizes the current knowledge on toxicology of nanomaterials, particularly on those used in nanomedicine.Kew words: cytotoxicity, in vivo, in vitro, nanomaterial, Nano medicine, nanoparticle

Pp.101-105, References 48

¯íäýñëýëÍàíî øèíæëýõ óõààí íü ñ¿¿ëèéí õîðèí æèëèéí òóðø ýð÷èìòýé õºãæèæ áàéãàà áàéãàà øèíý ñàëáàð þì. Îäîîãîîð íàíîìàòåðèàëûã ýëåêòðîíèêèéí ñàëáàð áîëîí ñïîðòûí òîíîã òºõººðºìæ, ãîî ñàéõíû á¿òýýãäýõ¿¿í, õ¿íñíèé áóäàã, ýìèéí áîäèñûí ¿éëäâýðëýëä ºðãºíººð õýðýãëýæ áàéíà. Íàíî àíàãààõ óõààí íü íàíî øèðõýãëýëèéí øèíæ ÷àíàðò ¿íäýñëýñýí øèíæëýõ óõààíû øèíý ñàëáàð þì. Íàíî õýìæýýñ íü ýñèéã ñýðãýýæ øèíý÷ëýõýä, àøèãëàãäàõ áºãººä ýðõòí¿¿äèéã õîëáîæ, òýäãýýðèéí õóðäàí èëààðøèõ, ýäãýðýõ ¿éë àæèëëàãààíä îðîëöäîã áºãººä ïîëèìåð áîëîí óóðàã àãóóëñàí òîì ãàäàðãóó á¿õèé òàëáàéã ýçýëæ, ýíý íü ýñèéí ¿ðæëèéã äýìæäýã [1-3]. Ýäãýýð øèíæèéã íü àíàãààõ óõààíû ñàëáàðò øàðõ àíàãààõ, ÿñ îðëóóëàõ, ýïèòåëü ñóóëãàõ áîëîí ýìèéã çººâºðëºõ çýðýãò àøèãëàäàã áàéíà. Ýð¿¿ë ìýíäèéí ñàëáàðò íàíî ìàòåðèàëûí õýðýãëýý íýìýãäýõòýé õîëáîãäîí ò¿¿íèé àþóëã¿é áàéäàë, ºðòºëòèéí ýðñäëèéã

ñóäëàõ øààðäëàãà ç¿é ¸ñîîð òàâèãäàæ áàéíà. Íàíî ìàòåðèàë áîëîí áèîëîãèéí òîãòîëöîîíû õàðèëöàí õàìààðëûã àìüä áèå äýýð in vivo îð÷èíä òóðøñàí òîõèîëäëóóä ìàø öººí, õàðèí õóðóó øèëíèé in vitro òóðøèëòóóä èõýýð õèéãäýæ áàéíà. Ýðäýìòäèéí òîãòîîñíîîð ýñýä ¿ç¿¿ëýõ õîðóó ÷àíàðûí øèíæèëãýýíèé àðãà÷ëàë áîëîí áóñàä àðãóóäûí òóñëàìæòàéãààð íàíî õýìæýýñò ìàòåðèàëûí ýðñäëèéí ¿íýëãýýã ëàáîðàòîðèéí ò¿âøèíä òîãòîîõ áîëîìæòîé þì.Íàíî ìàòåðèàëûí õ¿ðýýëýí áóé îð÷èí áîëîí õ¿íèé áèå ìàõáîäîä ó÷ðóóëàõ ýðñäëèéí òàëààðõ ñóäàëãààíû ìàòåðèàë õîìñ áàéãàà áºãººä Àìåðèêèéí ýðäýìòýíVicki Colvin íàíî õýñãèéã ávðävvëýã÷ ôóëëåðåí (Fullerene) ãýæ íýðëýãääýã áºìáºëºã õýëáýðò ìîëåêóë íü õvðýýëýí áóé îð÷èíä õîð õºíººë ó÷ðóóëæ, òýð ÷ ávv õýë ºâ÷èí vvñãýõ ÷àäâàðòàé áîëîõûã òîãòîîñîí áàéíà [4].

Õîðîí ÷àíàðûí ìåõàíèçìÕýä õýäýí ìåõàíèçìààð äàìæèí íàíî õýìæýýñ


íü õ¿íèé áèå ìàõáîäîä íýâòðýõ áîëîâ÷ ãîëöóó ýñèéí ò¿âøèíä èäýâõòýé õ¿÷èëòºðºã÷èéí ðàäèêàë(ROS)-ä õîëáîãäîí îðäîã áàéíà [5-8].Ôåíòîíû óðâàëûí äàãóó áóþó H

2O

2-

îîñ OH, OOH á¿ëýã áîëîí õ¿÷èëòºðºã÷èéí ðàäèêàë çàäðàõ óðâàëûí ÿâöàä íàíîõýìæýýñ äàìæèæ áîëíî. Öààøèëáàë çàðèì èäýâõã¿é íàíîìàòåðèàë íü àÿíäàà èäýâõòýé õ¿÷èëòºðºã÷èéí ðàäèêàëûã íèéëýãæ¿¿ëäýãã¿é ÷ áèîëîãèéí õ¿÷èí ç¿éëèéí äîð íàíîõýìæýýñ íü òóõàéí áàé ìèòîõîíäîðòîî õ¿ð÷ ¿éë÷èëäýã áàéíà. Èäýâõòýé õ¿÷èëòºðºã÷èéí ðàäèêàëíü ôèçèîëîãèéí õóâüä ÷óõàë øààðäëàãàòàé ç¿éë áîëîâ÷ õîð õºíººë ó÷ðóóëàõ ýðñäýëòýé áàéäàã. Äóíä çýðãèéí ò¿âøíèé èäýâõòýé õ¿÷èëòºðºã÷èéí ðàäèêàë íü ýñèéí ò¿âøèíä ãåíåòèê ìàòåðèàëûí øèëæèëò, óóðãèéí íèéëýãæèëò çýðýãò ¿¿ðýã ¿ç¿¿ëäýã [9]. ªíäºð èäýâõòýé õ¿÷èëòºðºã÷èéí ðàäèêàë íü ýñèéí ëèïèäèéí èñýë, á¿òýö íü àëäàãäñàí óóðàã [10], ÄÍÕ-èéí ãýìòýë çýðãèéã ¿¿ñãýõ áºãººä ýíý íü õàâäàð, áººð, ìýäðýë, ç¿ðõ ñóäàñ áîëîí óóøãèíû ºâ÷íèé øàëòãààí áîëäîã. Ìºí èäýâõòýé õ¿÷èëòºðºã÷èéí ðàäèêàëíü áèå ìàõáîäûí á¿òöýä ººð÷ëºëò îðóóëæ, ýñèéã ìºõºëä õ¿ðãýäýã [11]. Òóõàéëáàë: Òèòàíû îêñèäûí íàíî õýìæýýñ íü õ¿íèé ýíäîòåëü ýñèéã ºäººõ ¿éë÷èëãýý ¿ç¿¿ëäýã áîë í¿¿ðñíèé íàíî õýìæýýñ íü õàðõàíä óóøãèíû ¿ðýâñýë áîëîí çàãàñàíä òàðõèíû õ¿÷èëòºðºã÷èéí äóòàãäàëä õ¿ðãýõ çýðýã ñºðºã òàëòàé [12,13]. Èäýâõòýé õ¿÷èëòºðºã÷èéí ðàäèêàëûí õîðîí ÷àíàð íü òºâ ìýäðýëèéí òîãòîëöîîíä èë¿¿òýé íºëººëäºãèéí ãîë øàëòãààí íü íàéðëàãàíäàà õàíààã¿é ººõíèé õ¿÷èë àãóóëäàãò áàéäàã áàéíà [17]. Èäýâõòýé õ¿÷èëòºðºã÷èéí ðàäèêàë íü òàðõèíû ñóäàñíû õàòóóðàë, öóñíû äàðàëò èõñýëòýíä ñºðãººð íºëººëäºã [18] áºãººä ÄÍÕ-èéã ãýìòýýñíýýð ìýäðýëèéí áóë÷èíãèéí ñóëðàë, í¿äíèé òîðëîã á¿ðõýâ÷ ¿ðýâñýõ, ìèòîõîíäð ýíöåôàëîôàòè, ñ¿¿íèé õ¿÷ëèéí äóòàë, õàðâàëò, ç¿ðõíèé ºâ÷èí áîëîí áóñàä òºðëèéí ãýìòýë áîëîí òàðõè íóãàñíû øèíãýíèé äóòàãäàë çýðýã êëèíèê øèíæ òýìäã¿¿ä èëýðäýã [19].

Íàíî ìàòåðèàëûí õîðîí ÷àíàðûã òîãòîîõ øèíæèëãýýíèé àðãóóäIn vitro áîëîí in vivo òóðøèëòIn vitro àðãà íü àìüòàí äýýð òóðøèëò õèéõýýñ çàéëñõèéñýí, õÿìä ºðòºãòýé áºãººä íàíî õîðîí ÷àíàðûã òîäîðõîéëîõ ñóäàëãààíû ¿íäñýí àðãà þì [20].Óã àðãà íü øèíýýð ãàðãàí àâ÷ áàéãàà íàíî õýìæýýñèéí áèîëîãèéí èäýâõèéã ¿íýëýõýä ÷óõàë ¿¿ðýãòýé. Ìºí òóõàéí ýñèéí õîðóó ÷àíàð, ìºõëèéí øàëòãààíûã òîäîðõîéëîõ áîëîìæòîé þì.Õîðîí ÷àíàðûã in vitro àðãààð ¿íýëýõ íü áîãèíî õóãàöààíû ò¿ðãýâ÷èëñýí àðãà áîëîâ÷ ýíý íü óðò õóãàöààíû ôèçèîëîãèéí ¿ð ä¿íãèéí

õýòèéí òààìàãëàëûã òîäîðõîéëîõ áîëîìæã¿é áàéäàã. In vivo àðãàä àìüòäûã õýðýãëýäýã áºãººä ýíý íü òóõàéí áîäèñûí õ¿íèé áèåä íýâ÷èí îðîõ çàì, òàðõàëò, áîäèñûí ñîëèëöîî áîëîí áèåýñ ÿëãàðàõ çàì çýðãèéã òîäîðõîéëîõîä ÷óõàë à÷ õîëáîãäîëòîé áîëîâ÷ öàã èõ çàðöóóëäàã, ºðòºã ¿íýòýé áîëîí àìüòíû ¸ñ ç¿éã õºíäñºí çýðýã ñóë òàëòàé þì. Õýäèé òèéì ÷ ýíý àðãûí ¿ð ä¿íä ÿìàð çàìààð íàíî ìàòåðèàë íü õ¿íèé áèå ìàõáîäîä îðæ õàâäàð, àìüñãàëûí çàì, àðüñ ñàëñò áîëîí õîäîîä ãýäñýíä õîðîí ÷àíàð ¿ç¿¿ëæ áàéãààã íü íàðèéâ÷ëàí òîäîðõîéëîõ áîëîìæòîé þì [21]. Îð÷èí ¿åä íàíî ìàòåðèàëûí õýðýãëýý ºðãºí íýâòðýõ áîëñîí ó÷èð òýäãýðèéí ýð¿¿ë àþóëã¿é áàéäàë, ò¿¿í÷ëýí áèîëîãèéí ñèñòåìä õýðõýí òàðõäàã òàëààðõ ìýäýýëëýë çàéëøã¿é øààðäëàãàòàé áàéíà.

Íàíî õýìæýýñèéí ôèçèê, õèìèéí øèíæ ÷àíàð õîðîí ÷àíàðò íºëººëºõ íüÍàíîìàòåðèàëûí õîðîí ÷àíàðûã òîäîðõîéëîõîä íàíî õýìæýýñ, ãàäàðãóóãèéí õèìèéí íàéðëàãà, õýëáýð, óóðãèéí íýâ÷èëò áîëîí ãàäàðãóóãèéí òýãø áîëîí òýãø áèø áàéäàë çýðýã íü ÷óõàë ¿¿ðýãòýé.

Õýìæýýíèé íºëººëºë: Íàíî õýìæýýñ áàãàñàõàä ãàäàðãóóãèéí õýìæýý òºäèé ÷èíýýãýýð èõýñäýã áàéíà. Òèéìýýñ íàíî ìàòåðèàëûí ãàäàðãóó íü ò¿¿íèé õýìæýý áàãàñàõ, íàéðëàãà áîëîí õèìèéí óðâàëûí èäýâõ çýðãýýñ èõýýõýí õàìààðäàã áàéíà.Íàíî õýìæýýñ íü ôèçèîëîãèéí õàðèó ¿éëäýë, òàðõàëò áîëîí ÿëãàðàëòàíä èõýýõýí íºëºº ¿ç¿¿ëäýã [22, 23]. In vitro ñóäàëãààãààð ÿíç á¿ðèéí íàíî õýìæýýñèéã ÿíç á¿ðèéí ýñýä, èæèë íºõöºë áîëîí èæèë öàãààð ¿éë÷ëýõýä õîðîí ÷àíàð íü ÿëãààòàé ãàðñàí áàéíà [24-28]. In vitro àðãààð íàíî õýìæýýñèéã òîäîðõîéëîõ ¿åä ò¿¿íèé õîðîí ÷àíàðûí òàëààð ìýäýýëýë õàíãàëòòàé àâ÷ ÷àäàõã¿é áàéäàã áîë in vivo àðãààð òóõàéí íàíî õýìæýýñèéí õîðîí ÷àíàð áîëîí òîêñèêî êèíåòèêèéí òàëààðõ á¿ðýí îéëãîëò àâàõ áîëîìæòîé þì [29-32].Àìüñãàëûí çàì íü õ¿íèé áèåä íàíî õýìæýýñ íýâòðýí îðîõ ãîë çàì áºãººä in vivo àðãààð íàíî õýìæýýñèéí ýðò ¿åèéí õîðîí ÷àíàðûã òîäîðõîéëæ áîëíî. ¯¿íýýñ ¿çýõýä íàíîõýìæýýñ áàãàñàõ òóñàì óóøãèíû öóëöàíä î÷èõ áîëîìæòîé áîëîõ áºãººä èë¿¿ õîðîí ÷àíàð ¿ç¿¿ëäýã áàéíà.Òóõàéëáàë: Òèòàíèéí èñýëèéí íàíî õýìæýýñ 25íì ¿åä õ¿íèé óóøãèíû ýñýä ¿éë÷èëäýã áîë 250íì áîëîí ò¿¿íýýñ äýýø ¿åä ¿ðýâñ¿¿ëýõ ¿éë÷èëãýý ¿ç¿¿ëíý.Ìºí çýñèéí íàíî õýìæýýñ 17 íì ¿åä õ¿íèé áèåä õîðîí ÷àíàðòàé áîë 23,5 íì áóþó ò¿¿íýýñ äýýø õýìæýýòýé íºõöºëä õ¿íèé áèåä õîðîí ÷àíàð ¿ç¿¿ëäýãã¿é áàéíà.


Íàíî õýìæýýñèéí õýëáýðèéí íºëººëºë: Íàíî õýìæýýñèéí õýëáýð íü õîðîí ÷àíàðûã òîäîðõîéëîõ õî¸ð äàõü ãîë õ¿÷èí ç¿éë þì. Íàíîìàòåðèàë íü øèðõýãëýã, áºìáºðöºã, õîîëîé, öàãèðàã áîëîí õàâòãàé çýðýã îëîí òºðëèéí õýëáýðòýé áàéäàã. Èõýíõ íàíî õýìæýýñèéí õýëáýð ä¿ðñíýýñ õàìààðñàí õîðîí ÷àíàðûí òàëààðõ ñóäàëãààã in vitro àðãààð ã¿éöýòãýñýí áàéäàã. In vivo àðãààð ýíäåöèòîç áîëîí ôàãîöèòîçûí ÿâöàä ìåìáðàíä òóõàéí õýëáýð ä¿ðñ íü õýðõýí íºëººëæ áàéãààã ñóäàëäàã [33-38]. Æèøýýëáýë: Áºìáºðöºã õýëáýðòýé íàíî õýìæýýñ íü øèðõýãëýã áîëîí áóñàä õýëáýð¿¿äèéã áîäâîë ýíäîöèòîçîä èë¿¿ àìàð, õÿëáàð íýâ÷äýã áàéíà. Óðò õýìæýýñòýé øèðõýãëýã õýëáýðòýé íàíî õýìæýýñ¿¿äæèøýýëáýë í¿¿ðñíèé íàíî õýìæýýñ íü ìèçîòåëü áîëîí ýíäîòåëü ýñèéã ãýìòýýäýã çýðýã ñºðºã ¿ð äàãàâàðòàé áàéäàã.Õýëáýðýýñ õàìààðàëòàé õîðîí ÷àíàðûí ñóäàëãààíóóä ãîëöóó àëò áîëîí òèòàí íàíîìàòåðèàë äýýð õèéãääýã. Ñàâàà õýëáýðòýé, 74x14 íì àëòíû íàíî õýìæýýñ íü öàãèðàã õýëáýðòýé ìºí èæèë õýìæýýòýé àëòíààñ õîðîí ÷àíàð áàãà áàéäàã áàéíà.

Ãàäàðãóóãèéí öýíýãèéí íºëººëºë: Ãàäàðãóóãèéí öýíýã íü õîðîí ÷àíàðûã èëòãýõ íýã ¿ç¿¿ëýëò áºãººä ýíý íü òóõàéí èîí áîëîí áèîìîëåêóëûí íýâ÷èëòýíä íºëººëäºã áàéíà. Åðºíõèéäºº õàñàõ öýíýãòýé êàòèîí ãàäàðãóó íü íýìýõ öýíýãòýé àíèîí ãàäàðãóóã áîäîõîä èë¿¿ õîðîí ÷àíàðòàé ãýæ ¿çäýã [39-43]. Íàíî õýìæýýñèéí ãàäàðãóóãèéí öýíýã íü òàðõè- íóãàñíû õîðèãèéã íýâòðýõýä ìºí ñºðãººð íºëººëäºã [44]. Æèøýýëáýë: ªíäºð êîíöåíòðàöèòàé àíèîí áîëîí êàòèîí íàíî õýìæýýñ íü òàðõè-íóãàñíû õîðèãèéã äàâàõàä ñààä ó÷ðóóëäàã áàéíà.Ìºí ñºðºã öýíýãòýé 50 áîëîí 500 íì õýìæýýòýé íàíî õýìæýýñ íü àðüñûã íýâòýðäýã áîë ýåðýã áîëîí öýíýãã¿é áººì íü ÿìàð ÷ õýìæýýñòýé áàéñàí íýâòýð÷ ÷àääàãã¿é áàéíà [45-47].

Íàéðëàãûí íºëººëºë:Çàðèì ñóäëàà÷äûí ¿çýæ áàéãààãààð íàíîìºíãº, íàíîçýñ áîëîí ìåòàëëûí óóñäàã íýãäë¿¿ä íü áèå ìàõáîäîä õîðóó ÷àíàð ¿ç¿¿ëäýã ãýæ ¿çñýí áàéíà. Èõýíõ íàíî õýìæýýñ¿¿ä íü õèìèéí íàéðëàãà, ãàäàðãóóãèéí öýíýã, õýìæýý, õýëáýð çýðýã õàâñàðñàí îëîí õ¿÷èí ç¿éëñýýñ øàëòãààëàí õîðîí ÷àíàð ¿¿ñãýäýã áàéíà.

Ãàäàðãóóãèéí íºëººëºë: Ãàäàðãóóãèéí íºëººëºë íü ãàäàðãóóãèéí öýíýã ýñâýë ãàäàðãóóãèéí íàéðëàãûã òîäîðõîéëîõ áîëîìæèéã îëãîäîã. Ãàäàðãóóãèéí áººãíºðºë áîëîí á¿òýö íü in vivo òóðøèëòàíä í¿¿ðñíèé íàíî õîîëîéí õîðîí ÷àíàðûã áàãàñãàæ áàéãààã òîãòîîñîí áàéíà [48]. Èõýíõ ñóäàëãààãààð ãàäàðãóóãèéí íºëºº íü íàíî

õýìæýýñèéí õîðîí ÷àíàð, õóðèìòëàë, òàðõàëò, øèíãýëòýíä íºëººëäºã áîëîõûã òîãòîîñîí áàéíà.

Ãàäàðãóóãèéí òýãø áóñ áàéäëûí íºëººëºë: Íàíîìàòåðèàëûí ãàäàðãóóãèéí ôèçèêèéí ¿ç¿¿ëýëò¿¿ä íü ýñýä ¿ç¿¿ëýõ íºëººëëèéí ¿ð äàãàâðûã òîäîðõîéëîõ ãîë õ¿÷èí ç¿éë áîëäîã.

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Ñ.Öîãòñàéõàí


Ìîíãîë õºõ òîëáîíû òóõàé(Õýâëýëèéí òîéì)

Ý.Á¿æèí, Í.Ëõààñ¿ðýí, Á.Áàò÷èìýã, Ä.Öýëìýí,Ã.Îþóíãýðýë, Í.Ìºíõò¿âøèí, Á.Ìºíõáàò

Àíàãààõ óõààíû õ¿ðýýëýí[email protected]

Abstract

A bout Mongolian blue spot

E.Bujin, N.Lkhaasuren, B.Batchimeg, D.Tselmen, G.Oyungerel, N.Munkhtuvshin, B.Munkhbat

Medical Research [email protected]

Mongolian blue spots are birthmarks that are present at birth and their most common location is sacrococcygeal or lumbar area. There are macular and round, oval or irregular in shape. Lesions may be single or multiple. They usually spontaneously regress and disappear during childhood. The prevalence of Mongolian blue spots varies among different ethnic groups according to the overall depth of pigmentation. Mongolian blue spots are common among Asian, East Indian, and African races, but rare among Caucasian and other races. Mongolian blue spot is a congenital, developmental condition exclusively involving the skin. Mongolian blue spot results from entrapment of melanocytes in the dermis during their migration from the neural crest into the epidermis. This migration is regulated by exogenous peptide growth factors that work by the activation of tyrosine kinase receptors. It is postulated that accumulated metabolites such as GM1and heparin sulfate bind to this tyrosine kinase receptor and lead to severe neurologic manifestations and aberrant neural crest migration.

Pp.106-111, Table-1, Figures- 2, References -51

Ìîíãîë õºõ òîëáîíû òóõàé åðºíõèé îéëãîëò

Íÿðàé õ¿¿õäèéí óóö íóðóó õýñýãò áàéðëàñàí ìåëàíîöèò ýñ¿¿äýýñ ¿¿ñýëòýé òîäîðõîé õýëáýð ä¿ðñã¿é, õºõ, ñààðàë, áàðààí ºíãèéí òºðºëõèéí òîëáûã Ìîíãîë õºõ òîëáî (àíãë. Mongolian blue spot) ãýíý.1,2Àíõ Ìîíãîë õºõ òîëáî ãýñýí íýð òîìú¸îã1885 îíä Ãåðìàíû ýðäýìòýí BaelzE ßïîí óëñàä àæèëëàæ áàéõäààÌîíãîë÷óóäàäáàéäàãõºõòîëáûãßïîíõ¿¿õä¿¿äýäáàéãààã àíçààð÷ “Ìîíãîë õºõ òîëáî”ãýæ áàðèìòæóóëñíààð äýëõèé äàÿàð “Ìîíãîë õºõ òîëáî”õýìýýí íýðëýæ çàíøæýý.3Ò¿¿íýýñ õîéø ñóäëàà÷èä Ìîíãîë õºõ òîëáûã “Mongolian blue spot, blue spot, child fleck, sacral fleck, newborn blue fleck, newborn sacral blue fleck, semitic mark, semitic stain, congenital dermal melanocytosis, dermal melanocytosis”ãýõ ìýòýýð òýìäýãëýñýí áàéäàã.4

Ìîíãîë õºõ òîëáî íü íÿðàé õ¿¿õäýä òîä èëýð÷ ºíãº, õýëáýð, õýìæýý íü ººð÷ëºãäºõã¿é ÿâñààð 2-4 íàñ õ¿ðýõýä ààæìààð á¿äãýðýí àðèëäàã áºãººäõîâîð òîõèîëäîëäíàñàí òóðøèä õàäãàëàãäàí ¿ëääýã áàéíà.1 Áàéðøëûí õóâüä èõýâ÷ëýí óóö íóðóó õýñýãò èëðýõ áà ìºð, õºë, ãàðíû îð÷ìîîð íýã ýñâýë îëîí òîîòîé èëýð÷ áîëíî.Ìîíãîë õºõ òîëáîíû ñîíãîìîë áàéðøèë

íü óóö íóðóóíû õýñýã þì.1,5-9 Ñóäëàà÷ Wateff S íàð “Ìîíãîë õ¿¿õýä ýõýýñ òºðºõäºº óóö, íóðóóíäàà õºõ òîëáîòîé òºðäºã áºãººä èõýâ÷ëýí áàãà íàñíû õ¿¿õä¿¿äýä àæèãëàãääàã. Ìîíãîë õºõ òîëáî íü òºðñíèé äàðàà 2-3 äàõü õîíîãîîñ èëýð÷ 12-24 ñàðûí äàðàà àðèëàõ áà ìàø õîâîð òîõèîëäîëä íàñàíä õ¿ðñýí õ¿íä á¿äýãõýí ¿ëäñýí áàéäàã” ãýæýý.10

Ò¿¿í÷ëýí ñóäëàà÷ Braun-Falco O íàð Ìîíãîë õºõ òîëáî íü äóãóé áà çóóâàí õýëáýðòýé, óóö á¿ñýëõèé áîëîí íóðóó ãóÿ îð÷èìä áàéõ æèãäõýí õºõºëáºð ñààðàë áóþó õ¿ðýí ºíãºòýé òîëáî áºãººä ýíý íü ÿíç á¿ðèéí õýìæýýòýéãýýð èëýðäýã ãýæ òýìäýãëýæýý.11

Õàðâàðäûí èõ ñóðãóóëèéí àðüñ ñóäëàà÷ ýì÷ Thomas BFitzpatrickõ¿íèé àðüñíû ºíãèéã õýò ÿãààí òóÿàíä ¿ç¿¿ëæ áóé õàðèó óðâàëä ¿íäýñëýí äàðààõ 6 õýëáýðò õóâààí ¿çñýíèéã Fitzpatrick-èéí àíãèëàë ãýäýã.Ýíý àíãèëàëààð:

I. Çýâõèé öàãààí ºíãºòýé àðüñII. Öàãààí ºíãºòýé àðüñIII. Øàðãàë öàãààí ºíãºòýé àðüñIV. Öàéâàð áîð ºíãºòýé àðüñV. Áîð ºíãºòýé àðüñVI. Õàð áîð ºíãºòýé àðüñ ãýæ 6 àíãèëäàã

áàéíà.


Ñóäëàà÷äûí òýìäýãëýëä Ìîíãîë õºõ òîëáîíû ºíãèéã õàð, õàð õºõ, õàð ñààðàë, ñààðàë, õàð áîð ãýõ ìýò îëîí ÿíçûí ºíãººð èëýðõèéëýí áè÷ñýí áàéäãèéãFitzpatrick-èéí àíãèëàëààð òàéëáàðëàäàã áàéíà.12Òóõàéëáàë äýýðõ àíãèëàëààð Àôðèê áîëîí Ýíýòõýã õ¿ì¿¿ñèéí àðüñ V, VI õýëáýðò îðäîã òóë Ìîíãîë õºõ òîëáî íü íîãîîí-õºõ ºíãºòýé, Àçè ãàðàëòàé õ¿ì¿¿ñèéí àðüñ III, IV õýëáýðò îðäîã òóë õàð ñààðàë, õàð õºõ ºíãºòýé õàðàãääàã áàéíà.1,13,14

Ìîíãîë õºõ òîëáîíû îíöëîã øèíæ Óðãèéí õºãæëèéí ¿åä ìåëàíîöèò ýñ¿¿ä ìýäðýëèéí äàëàíãààñ äåðì-ýïèäåðìèñèéí õîëáîîñîíä í¿¿í øèëæäýã áàéíà.Òîäðóóëáàë ¿ð õºâðºëèéí 10 äàõü äîëîî õîíîãîîñ äåðìèñèéí äàâõàðãàä ìåëàíîöèò ýñ¿¿ä ¿¿ñ÷, 11-14 äýõü äîëîî õîíîãòîéä ýïèäåðìèñèéí äàâõàðãà ðóó øèëæäýã áàéíà.15 Óëìààð ¿ð õºâðºëèéí 20 äàõü äîëîî õîíîãòîéäìåëàíîöèò ýñ¿¿ä äåðìèñèéí äàâõàðãààñ á¿ðýí øèëæèæ äóóñäàã áîëîâ÷ýíý ÿâöò¿ð ñààòñàíààñ Ìîíãîë õºõ òîëáî ¿¿ñäýã áàéíà.5,15,16Ýíý ¿åä ýä ñóäëàëûí øèíæèëãýýíä äåðìèñèéí äîîä äàâõàðãàä ýýð¿¿ë õýëáýðèéí ìåëàíîöèò ýñ¿¿ä èëýðäýã áà õ¿¿õýä òîìðîõ òóñàì ìåëàíîöèò ýñ¿¿ä ýïèäåðìèñèéí äàâõàðãà ðóó á¿ðýí øèëæèæ äóóñàõ, ýñâýë ìàêðîôàã ýñ¿¿äèéí òóñëàìæòàéãààð Ìîíãîë õºõ òîëáî àðèëäàã áàéíà.16,17

Ñóäëàà÷ Hanson M, Lupski J íàð ìåëàíîöèò ýñ¿¿ä ìýäðýëèéí äàëàíãààðäàìæèí àðüñíû äåðìèñ äàâõàðãààñ ýïèäåðìèñ äàâõàðãà ðóó í¿¿í øèëæèõ ¿éë ÿâö ñààòàñíààñ Ìîíãîë õºõ òîëáî ¿¿ñäýã ãýæýý.Çàðèì ñóäëàà÷äûí òààìàãëàñíààð ýíýõ¿¿ í¿¿í øèëæèëò íü ýêçîãåí ïåïòèäèéí ºñºëòèéí õ¿÷èí ç¿éëñ¿¿ä òèðîçèíêèíàçà ôåðìåíòèéí ðåöåïòîðóóäûã èäýâõæ¿¿ëñíýýð çîõèöóóëàãääàã. Ìýäðýëèéí äàëàíãààñ øèëæèõ ÿâö ñààòñàíààñ ìýäðýëèéí óðãàëòûí õ¿÷èí ç¿éëèéí èäýâõè íýìýãäýí, òèðîçèíêèíàçûí ðåöåïòîðòîé õîëáîãääîã GM1 áà ãåïàðèí ñóëüôàò çýðýã ìåòàáîëèòóóä õóðèìòëàãääàã.Ìåëàíîöèò ýñ¿¿ä ìýäðýëèéí ºñºëòèéí õ¿÷èí ç¿éëñ¿¿äòýé õîëáîãäîõ õåìîòðîï ðåöåïòîðûã àãóóëäàã. Èéìýýñ òèðîçèíêèíàçà áîäèñûí ñîëèëöîîíû äóíäûí á¿òýýãäýõ¿¿íòýé õîëáîãäñîíîîð äåðìèñûí äàâõàðãûí øèëæèëòýíä õîðèã ¿¿ñäýã. Ãýñýí õýäèé ÷ ¿¿íèéã íàðèéâ÷ëàí ñóäàëæ, çàðèì ºñºëòèéí õ¿÷èí ç¿éëñ¿¿äèéí ¿¿ðýã, íºëººã òîäîòãîæ, çîõèöóóëãûí ãåíèéí íºëººã ñóäëàõ íü ÷óõàë õýìýýí òýìäýãëýñýí áàéíà.18

Ýä ñóäëàëûíò¿âøèíä Ìîíãîë õºõ òîëáî íü áàãà ºñãºëòºíä äåðìèñèéí äîîä-äóíä õýñýãò ýýð¿¿ë õýëáýðòýé, ñóíàñàí, õî¸ð òóéëòàé, äîëãèîíòñîí ýñâýë çºâ áóñ õýëáýðòýé, 5-10μm çóçààíòàé, 30-100μm óðòòàé, àðüñíû õýâèéí á¿òýö çîõèîí áàéãóóëàëòã¿é, àðüñíû ãàäàðãóó äàãóó áàéðëàñàí ìîäíû õýëáýð á¿õèé ýñ õàðàãäàíà. Èõ ºñãºëòºíä

ýäãýýð ýñ íü äîòðîî ìåëàíèí ìºõëºã àãóóëñàí õàðàãäàõ áà Ìàññîí-Ôîíòàíà ìºíãºí áóäãàíä ýåðýã áóäàãäàíà. Ýñèéíòºâä ºðãºí õýñýã áàéõ áà çóóâàí, ñóë ºíãººð áóäàãäàõ áººìèéã àãóóëíà. Ýñ íü ààæèìäàà íàðèéí óðò ýñâýë ëèéð õýëáýðòýé áîëäîã.18 Ýëåêòðîí ìèêðîñêîïîîð õàðàõàä äåðìèéí ìåëàíîöèò¿¿ä íü ýñèéí ãàäíàõ ôèáðîçîí á¿ðõ¿¿ëòýé áà óã á¿ðõ¿¿ë íü ìåëàíîöèò ýñèéí ìåìáðàíààñ 20-50 íì-ûí çàéòàé, 1,5 μm õ¿ðòýë çóçààíòàé áàéäàã.18-20

1930 îíä ßïîíû ñóäëàà÷ Morooka K íàð 480 íÿðàéä Ìîíãîë õºõ òîëáîíû èëðýëèéã 7 æèë äàãàæ ñóäàëñàí áàéíà. Óã ñóäàëãààãààð Ìîíãîë õºõ òîëáî íü íÿðàé ¿åä 91.9%, 1 íàñòàéä 97.4%, 2 íàñòàéä 100% áîëîí èõýñ÷, 3 íàñòàéä 90%, 4 íàñòàéä 78,3%, 5 íàñòàéä 58.5%, 6 íàñòàéä 43.8%, 7 íàñòàéä 32.6% áîëîí áàãàññàíààñ ¿çâýë Ìîíãîë õºõ òîëáîíû èëðýë íàñíààñ õàìààðàëòàé áàéãààã õàðóóëæ áàéíà (Çóðàã 1).21

Figure 1. Incidence of Mongolian blue spot by age

Ìîíãîë õºõ òîëáîíû èëðýë íàñíààñ õàìààðàëòàé áàéãààã ñóäëàà÷ Inoue íàðÄÎÔÀ(3,4-Äèîêñèôåíèëàëàíèí) óðâàëòàé õîëáîí òàéëáàðëàñàí áàéíà. Ìåëàíèíèéã ýóìåëàíèí, ôåîìåëàíèí áîëîí íåéðîìåëàíèí á¿ðä¿¿ëíý. Ýóìåëàíèí íü õ¿íèé áèåèéí àðüñ, ¿ñíèé ºíãèéã òîäîðõîéëäîã áºãººä Ìîíãîë õºõ òîëáûã íºõöºëä¿¿ëýã÷ ãîë õ¿÷èí ç¿éë ãýæ ¿çäýã. Ýóìåëàíèíèé íèéëýãæèëò ýëãýíä ÿâàãäàõ áà ôåíèëàëàíèí ãèäðîêñèëàçà ôåðìåíòèéí òóñëàìæòàéãààð ôåíèëàëàíèí òèðîçèí áîëæ õóâèðíà. Òèðîçèíàçà ôåðìåíòèéí íºëººãººð çàäðàõ óðâàë èäýâõæèæ òèðîçèí íü äîôà-ã ¿¿ñãýõ áà äîôà íü èñýëäýæ äîôàõèíîí áîëíî. Öààøèä äîôàõèíîí íü ººðºº èñýëäýõ çàìààð ëåéêîäîôàõðîì, ¿¿íýýñ äîôàõðîì áîëæ õóâèðíà. ¯¿íèé äàðàà 2 çàìààð ýóìåëàíèí ¿¿ñíý. 1-ðò:Äîôàõðîìääîôàõðîì òàóòîìåðàçà ôåðìåíò ¿éë÷èëæ 5,6 äèãèäðîêñèèíäîë-2 êàðáîêñèë àöèä áîëæ õóâèðàí öààøèä õèíîí áîëñíîîð ýóìåëàíèíèéã ¿¿ñãýíý. 2-ðò:Äîôàõðîì

92%

97% 100%

90%

78%

59%

44%

33%

0%

20%

40%

60%

80%

100%

Infant 1 year 2 years 3 years 4 years 5 years 6 years 7 yearsMongolian blue spot


íü 5,6 äèãèäðîêñèèíäîë áîëæ ¿¿íä òèðîçèíàçà õàìààðàëò óóðàã-1 íºëººëñíººð õèíîí, öààøèä ýóìåëàíèíèéã ¿¿ñãýíý.Ýóìåëàíèíû ¿¿ñëèéã Çóðàã 2-ò õàðóóëëàà.19,22-24

Figure 2.Biosynthetic pathway of eumelanin

Ìîíãîë õºõ òîëáûã õ¿¿õäèéí áýðòýë ãýìòëýýñ ¿¿ññýí õºõðºëò, àðüñíû ìåëàíîöèò ýñèéí õýâèéí áóñ õºãæëººñ ¿¿ññýí Îòà áîëîí Èòî

òîëáîîñ ÿëãàõ øààðäëàãàòàé.1,25,20,26,27Îòà òîëáî íü õàð, õàð áîð, ñààðàë õºõ çýðýã ºíãºòýé áàéõ áà í¿¿ðíèé àëü íýã òàëä ýñâýë õî¸ð òàëä èëýð÷ áîëíî. Õàðèí Èòî òîëáî íü ìºð õàâüöàà áàéðëàëòàé áà çàðèìäàà Îòà òîëáîòîé õàìò òîõèîëääîã.26,28Îòà áîëîí Èòî òîëáîíóóä ãîë÷ëîí Àçè õ¿ì¿¿ñò òîõèîëääîã áà Îòà òîëáî ßïîí õ¿ì¿¿ñò 0.2%-0.6% òàðõàëòòàé áàéíà ãýæ òýìäýãëýãäæýý. Õàðèí Èòî òîëáî íü õàðüöàíãóé ýëáýã òîõèîëääîã ÷ îäîîãîîð áàòòàé òîî áàðèìò á¿ðòãýãäýýã¿é áàéíà.29Ñóäëàà÷ Leung A õ¿¿õýä òîìðîõ òóñàì Ìîíãîë õºõ òîëáî àðèëäàã áîë Îòà òîëáî àðèëäàãã¿é ãýæýý.30

Ìºí ñóäëàà÷ Alexandar K, Leung M íàð Ìîíãîë õºõ òîëáî íü ãýìòëýýñ ¿¿ññýí õºõðºëòòýé èæèë õàðàãääàã òóë ýìíýëýãèéí àæèë÷èä íàð õ¿¿õäèéí áýðòýë ãýìòëèéã íóóõ òîõèîëäîë ãàðäàã áàéíà. Ìîíãîë õºõ òîëáûã ÿëãàí òàíèõ ãîë øèíæ íü ºíãºº ººð÷èëæ, õ¿ðýýãýý òýëäýãã¿é, ààæèì ÿâöòàé àðèëäàãààðàà ÿëãàãääàã áàéíà.25

Ñóäëàà÷Gupta Díàð Ìîãîë õºõ òîëáûã áóñàä àäèë òºñòýé òîëáóóäààñ õýðõýí ÿëãàõ òàëààð Õ¿ñíýãò 1-ò òàéëáàðëàí õàðóóëæýý.20

Table 1. Key features of various dermal melanocytoses

FeaturesMongolian blue spot

Nevus of Îtà Nevus of Itî Hori nevus Blue nevus

Onset Congenital Congenital Congenital Acquired CongenitalFamilial incidence

Common Rare Rare Rare None

Racial incidence

Oriental and dark skinned

Oriental Oriental Oriental Dark skinned

Size 5 ñm 5 ñm 5 ñm 5 ñm 1.5 ñm

ColorBlue-state gray

Blue-state gray

Blue-state gray Blue-state gray Bluish-black

Site LumbosacralTrigeminal nerve 1st, 2nd division

AcromioclavicularMalar area, forehead, upper eyelid, temple

Dorsa of hands and feet, buttoks, face

Distribution Mid-line Unilateral Unilateral Bilateral UnilateralGender F=M F>M F>M F>M F>MFate Disappear Persist Persist Persist PersistTendency to malignancy

None Rare Rare Rare Rare

Ñóäëàà÷äûí òýìäýãëýñýíýýð õÿçãààðëàãäìàë õ¿ðýýòýé, ººðºº àÿíäàà àðèëäàã Ìîíãîë õºõ òîëáî íü ÿìàð íýãýí ýìãýãòýé õîëáîîã¿é ãýäãèéã îíöëîí òýìäýãëýæýý.7,31,32

Ìîíãîë õºõ òîëáîíû ñóäëàãäñàí ò¿¿õ, òàðõàëò

Àíõ 1745 îíä àðüñ ñóäëàà÷ ýì÷ Gumilia F íàð “Èíäèàí íÿðàé õ¿¿õäèéí óóö íóðóó õýñýãò

õàð áàðààí ºíãºòýé òîëáî áàéõ áà òîì æèæèã ÿíç á¿ðèéí õýìæýýòýé òîõèîëäîæ áàéíà” ãýæ òýìäýãëýæýý. ¯¿íèé äàðàà 1816 îíä ñóäëàà÷èäòºðºëõèéí õºõ òîëáîíû òàëààð ìýäýýëýë õèéæ, 1885 îíä Ãåðìàíû ýðäýìòýí Baelz Å Ìîíãîë õºõ òîëáî ãýæ íýðëýñýí áàéíà.33,34

XIX-XX çóóíû ¿åä õ¿í ñóäëàà÷èä Ìîíãîë õºõ òîëáûã èõýýõýí ñîíèðõîæ ýíý ñýäâýýð ñóäàëãàà øèíæèëãýý, õóðàë çîõèîí áàéãóóëäàã


áàéæýý.35Òóõàéëáàë Ìåêñèêèéí õ¿í ñóäëàë áîëîí ò¿¿õèéí¿íäýñíèé ìóçåéä“10 000 æèëèéí ºìíº Ìîíãîë õ¿íèé ãåí ìóòàöàä îðñíîîð õºõ òîëáî ¿¿ñ÷ Àçè òèâ óëìààð Àìåðèêèéí Èíäèàí÷óóäàä õºõ òîëáîíû ãåí òàðõñàí”ãýñýí òýìäýãëýë îäîîã õ¿ðòýë õàäãàëàãäàí ¿ëäñýí áàéíà.36Çàðèì ñóäëàà÷äûí òýìäýãëýëä“Åâðî Àçèéí èðãýíøëèéí ýõ ºëãèé íü Ìîíãîë þì. Ó÷èð íü Õ¿íí¿ áîëîí Ìîíãîë áààòðóóäûí áàéëäàí äàãóóëàëòûí ¿åä Àçèéí óëñóóä áîëîõ ßïîí, Õÿòàä, Òóðê, Ñîëîíãîñ áîëîí Óíãàð ¿íäýñòýíä Ìîíãîë õºõ òîëáî òàðõñàí”ãýæýý.Ò¿¿í÷ëýí2009 îíä Óëààíáààòàð õîòîä áîëñîí “Ìîíãîë áèëýãäëèéí ñóäàëãàà: Ýðýë õàéãóóë, èðýýä¿éí òºëºâ” ñýäýâò ýðäýì øèíæèëãýýíèé áàãà õóðàëäñóäëàà÷ BilleF Ìîíãîë õºõ òîëáîíû òàëààð èëòãýë õýëýëö¿¿ëæ áàéñàí áàéíà. Òýðýýð èëòãýëäýý “10 000 æèëèéí ºìíº Ìîíãîë õ¿ì¿¿ñèéí ãåíä îðñîí ººð÷ëºëòººñ Ìîíãîë õºõ òîëáî ¿¿ñ÷ Ãðèíëàíä, Õîéä áîëîí ªìíºä Àìåðèêò òàðõñàí” ãýñýí áîë ßïîíû ñóäëàà÷ Morooko K“Ìîíãîë õºõ òîëáî íü äýëõèé äàÿàð òàðõñàí ÷ öàãààí àðüñòàíä õàìãèéí áàãà òàðõàëòòàé áàéíà” ãýæ òýìäýãëýæýý.21,35

Õàðèí ñóäëàà÷ Cordova A, Baelz E íàð Åâðîï, Ñèíî¿ (Sioux), Èíóèò (Inuit), Ñàìàî (Samoans) çýðýã Àìåðèêèéí óóãóóë ¿íäýñòýí, ìºí Ïîëèíåç (Polynesians) óóãóóë èðãýä íü Ìîíãîëòîé õîëáîîã¿é áîëîâ÷ õºõ òîëáîòîé òºðäºã ãýæ äýýðõ ä¿ãíýëòèéã ¿ã¿éñãýæýý.13

Ñóäëàà÷èä Àçè, Àôðèê, öàãààí àðüñòàé õ¿¿õä¿¿äèéí äóíäÌîíãîë õºõ òîëáîíû òàðõàëòûã ñóäàëñàí áàéíà.Òýäíèé ñóäàëãààíû ä¿íä Àçè, Àôðèê õ¿¿õä¿¿äèéí äèéëýíõ õóâüä íüèëýðäýã áîë öàãààí àðüñòàé õ¿¿õä¿¿äýä õàðüöàíãóé áàãà òîõèîëääîãèéãòîãòîîí òýìäýãëýæýý.13¯¿íèéã öàãààí àðüñòàíäìåëàíèí ¿¿ñãýã÷ ìåëàíîöèò ýñ¿¿äèéí èäýâõ ñóë áàéäàãòàé õîëáîîòîé õýìýýí òàéëáàðëàñàí áàéíà.8

Ìîíãîë õºõ òîëáîíû òàðõàëòûã ãàçàð íóòãèéí õóâüä àâ÷ ¿çâýë Àçè, òýð äóíäàà Ìîíãîëä 91.6%, ßïîíä 81.5%, Òàéâàíä 62% òàðõàëòòàé áàéñàí áîë Õîéä Ýíýòõýãò ñóäëàà÷ Sachdeva Ì íàðûí ñóäàëãààãààð 60%, Nanda A íàðûí ñóäàëãààãààð 62%-èéí òàðõàëòòàé áàéëàà.37-41

1982 îíä Õîíã Êîíãèéí ñóäëàà÷ Lau,Chingíàðûí 1676 ýðýãòýé, 1554 ýìýãòýé íÿðàéä õèéñýí ñóäàëãààãààð Ìîíãîë õºõ òîëáî 792 ýðýãòýéä, 720 ýìýãòýéä èëýðñýí ä¿í ãàð÷ýý.42

Ìºí 1988 îíä Õÿòàäûí ñóäëàà÷ Leung À92 íÿðàé, 1633 áàãà íàñíû õ¿¿õäýä ñóäàëãàà õèéæ ¿çýõýä íÿðàé õ¿¿õä¿¿äýä Ìîíãîë õºõ òîëáî 100% èëýðñýí áîë íàñ íýìýõ òóñàì õºõ òîëáî á¿äãýðñýýð 6-ààñ äýýø íàñíû õ¿¿õäýä èëðýýã¿é áàéíà. Íàñíààñ õàìààðàõã¿éãýýð íèéò õºâã¿¿äèéí 58%, îõèäûí 53.3%-ä Ìîíãîë õºõ òîëáî èëýðñýí áà èõýâ÷ëýí óóö íóðóó, àõàð ñ¿¿ë, ºãçºã îð÷èì áàéðëàñàí áàéâ. Õàðèí í¿¿ð,

õ¿ç¿¿, ãàðûí àëãà áîëîí õºëèéí óëàíä èëðýýã¿é áàéíà.1

Ñóäëàà÷ Moosavi Z 2002-2003 îíä Èðàíä 1000 íÿðàéãñóäëàõàä 71.3%íü Ìîíãîë õºõ òîëáîòîé áàéñàí áîë Èðàíû ñóäëàà÷ ShajariH íàðûí2007 îíä õèéñýí ñóäàëãààãààð 81%-èéí òàðõàëòòàé áàéñàí áà íèéò õ¿¿õä¿¿äèéí 52% íü ýðýãòýé, 48% íü ýìýãòýé áàéñàí áàéíà.7,43

Íÿðàé õ¿¿õä¿¿äýäÌîíãîë õºõ òîëáîíû òàðõàëòûã Àìåðèêò 1924 îíä ñóäëàà÷ Ferreira Ñ, 1982 îíä ñóäëàà÷ Cordova À íàðòóñ òóñòîäîðõîéëñîí áàéíà.Ñóäëàà÷ Ferraira Ñ-èéí ñóäàëãààãààð Àìåðèêèéí Àôðèê ãàðàëòàé õ¿¿õä¿¿äèéí 70%-ä,õàðèí öàãààí àðüñòàé õ¿¿õä¿¿äèéí 4% íü õºõ òîëáîòîé áàéñàí áîë ñóäëàà÷ Cordova A íàðûí ñóäàëãààãààð Àìåðèêèéí Àôðèê ¿íäýñòýíä 96%, Èñïàí÷óóäàä 46%, öàãààí àðüñòàé õ¿¿õä¿¿äýä 9%-èéíòàðõàëòòàé áàéñàí áàéíà. Áàéðëàëûí õóâüä Ìîíãîë õºõ òîëáî íüóóö, ºãçºãºíä80.6%, ìºðºíä 23.4%, á¿ñýëõèéí õýñýãò14.1%, àõàð ñ¿¿ëýíä10.3%, ãàðûí àð õýñýãò5.9%, íóðóóíä5.6%, ãóÿàíä5.6%, øóóíä4.4%, ãàðàíä4.1%, õºëºíä 1.6%, òàøààíä0.6%, äóõ0.6%, õóðóóíä0.3% èëýðñýí áîëãàðûí àëãà, õºëèéí óëàíä èëýðñýíã¿é.13,44

Ñóäëàà÷ Rivers J íàðûí 1990 îíä Àâñòðàëèä õèéãäñýí ñóäàëãààãààð 25.5% òàðõàëòòàé áàéñàí áàéíà.45

Ò¿¿í÷ëýí ñóäëàà÷ Boccardi D íàðûí 2007 îíä Èòàëèä õèéñýí ñóäàëãààãààð Ìîíãîë õºõ òîëáî íü îðøèí ñóóãàà ãàçàðç¿éí áàéðëàëòàé èõýýõýí õàìààðàëòàé òºäèéã¿é Àçè õ¿¿õä¿¿äýä Åâðîï õ¿¿õä¿¿äýýñ èë¿¿ òîõèîëäîæ áàéñàí áàéíà.21

Èõýíõ ñóäëàà÷èä Ìîíãîë õºõ òîëáûã õ¿éñíýýñ õàìààðäàãã¿é ãýñýí áàéõàä çàðèì ñóäëàà÷èä ýðýãòýé õ¿¿õäýä, òýð äóíäàà õàð àðüñòàé õ¿¿õäýä öàãààí àðüñòàé õ¿¿õä¿¿äýýñ ºíäºð òàðõàëòòàé òàëàààð äóðüäæýý.1,46-49¯¿íèéã òàéëáàðëàõäàà õàð àðüñòàíä ìåëàíîöèò íü èõ õýìæýýíèé ìåëàíèí àãóóëñàí òîì ìåëàíîñîìòîé, õàðèí öàãààí àðüñòàíä ìåëàíîöèò íü öººí òîîíû æèæèã ìåëàíîñîìòîé ó÷ðààñ õàð àðüñòàíäºíäºð òàðõàëòòàé áàéäàã áàéíà.50

Ìàíàé îðîíä Ìîíãîë õºõ òîëáîíû òàëààð ñóäàëñàí õýä õýäýí ñóäàëãàà áàéäàã áàñ¿¿ëèéí ¿åèéí ñóäàëãààíààñ äóðüäàõàä 2011 îíä ñóäëàà÷ Á.Áóðìààæàâ íàð Ìîíãîë õºõ òîëáîíû òàðõàëò, áàéðëàë, õýëáýðèéã ñóäàëñàí áîë 2012 îíä Á.Áàéãàëüìàà íàð Ìîíãîë õºõ òîëáîíû áàéðëàë, õýëáýð áîëîí áè÷èë á¿òöèéã ñóäàëæýý.34,51

2011 îíä Ñóäëàà÷ Á.Áóðìààæàâ íàð Óëààíáààòàð õîòîä òºðñºí 502 íÿðàéã õàìðóóëàíõèéñýí ñóäàëãààãààðÌîíãîë õºõ òîëáîíû òàðõàëò 85.5% áàéñíààñ 96.6% íü ýõýýñ òºðºõäºº õºõ òîëáîòîé òºðñºí áàéõàä 0.4% íü 1-4 õîíîãèéí äîòîð õºõ òîëáî ¿¿ññýí áàéíà. Õºõ òîëáîòîé òºðñºí íèéò íÿðàéí 81.1% ºãçºãºíäºº òîëáîòîé


áàéñàí áà äèéëýíõ íü çóóâàí õýëáýðòýé, ã¿í õºõ ºíãºòýé áàéæýý.35

2012 îíä Ñóäëàà÷ Á.Áàéãàëüìàà íàðûí Óëààíáààòàð õîòîä îðøèí ñóóäàã 0-3 íàñíû Ìîíãîë õ¿¿õä¿¿äýä õèéñýí ñóäàëãààãààð óóö á¿ñýëõèé ºãçºã õýñãýýð Ìîíãîë õºõ òîëáî çîíõèëîí òîõèîëäîæ áàéñàí áà õ¿éñèéí ÿëãàà àæèãëàãäààã¿é áàéíà. Ìºí Ìîíãîë õºõ òîëáîòîé õýñãèéí àðüñíû ýïèäåðìèñ äàâõàðãàä êåðàòèíîöèò, ìåëàíîöèò ýñ¿¿ä 4:2 ãýñýí õàðüöààòàé, õºõ òîëáîòîé õýñãèéí àðüñíû á¿òöèéã õºõ òîëáîã¿é õýñãèéíõòýé õàðüöóóëàõàä àðüñíû æèíõýíý äàâõàðãàä ìåëàíîöèòûí õóðèìòëàë èõ áàéõûí ñàöóó õºõ òîëáîòîé õýñãèéí àðüñíû ºíãºí õºðñíèé ñóóðü, ºðãºñò, ìºõëºãò äàâõàðãàä ìåëàíèíèé õóðèìòëàë èëò èõ áàéãààã òîãòîîñîí áàéíà.51

¯íýõýýð Ìîíãîë õºõ òîëáî íü Ìîíãîë÷óóä áèäíèé óäàìç¿éí îíöëîãèéã èëýðõèéëýã÷ íýãýí ºâºðìºö õýâ øèíæ áàéõ ìàãàäòàé.Ìîíãîë õºõ òîëáî õýìýýí íýðëýãääýã àðüñíû íºñººæèëò íü ¿å óäàì äàìæèí ºâëºãääºã, óäàìç¿éí øàëòãààíò áèåèéí õýâ øèíæ ãýæ íèéòýýð õ¿ëýýí çºâøººðäºã ÷, ò¿¿íèéã íºõöºëä¿¿ëæ áóé ãåí, ãåíîìûí õýñãèéã õàðààõàí èëð¿¿ëýýã¿é áàéãàà áèëýý. Èéìä ìàíàé ìîíãîë õ¿¿õä¿¿äýä èëýð÷ áóé õºõ òîëáûã íºõöºëä¿¿ëýã÷ ãåí, ãåíîìûí õýñãèéã èëð¿¿ëýõ ìîëåêóë ãåíåòèêèéí ñóäàëãààã õèéæ ìîíãîë óãñààòíû óäàì ç¿éí îíöëîãèéã õºõ òîëáîòîé õîëáîí òàéëáàðëàõ çàéëøã¿é øààðäëàãà óðãàí ãàð÷ áàéíà. Èéíõ¿¿ Ìîíãîë õºõ òîëáûã òîéðñîí ñóäàëãàà øèíæèëãýýíèé àæèë, ò¿¿õèéí áàðèìò áè÷ã¿¿ä íü ºíººã õ¿ðòýë ìîëåêóë áèîëîãè÷, óäàìç¿é áîëîí õ¿í ñóäëàà÷, ýì÷ ýðäýìòýäèéí àíõààðëûã ç¿é ¸ñîîð òàòñààð áàéíà.13

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47. Jacobs AH, Walton RG. The incidence of birthmarks in the neonate. Pediatrics. Aug 1976;58(2):218-222.

48. Dash K, Grover S, Radhakrishnan S, Vani M. Clinico epidemiological study of cutaneous manifestations in the neonate. Indian J Dermatol Venereol Leprol. Jan-Feb 2000;66(1):26-28.

49. Saracli.T KJA, Jr.Scott R. B. Common skin disorders in the newborn Negro infant. Observations based on the examination of 1,000 babies. J Pediatr. Mar 1963;62:359-362.

50. Thong HY, Jee SH, Sun CC, Boissy RE. The patterns of melanosome distribution in keratinocytes of human skin as one determining factor of skin colour. Br J Dermatol. Sep 2003;149(3):498-505.

51. Á.Áàéãàëüìàà, À.Àâèðìýä, Ä.Àìãàëàíáààòàð Óëààíáààòàð õîòîä îðøèí ñóóãàà 0-3 íàñíû Ìîíãîë õ¿¿õäèéí õºõ òîëáîíû áàéðøèë, á¿òöèéí ñóäàëãàà Ýð¿¿ë Àíàòîìèéí òýíõèì, Ýð¿¿ë Ìýíäèéí Øèíæëýõ Óõààíû Èõ Ñóðãóóëü; 2012.


ïðîôåññîð Ä.Àìãàëàíáààòàð


Ø¯¯ÌÆ, ÁÎÄÎË, ÝÐÃÝÖ¯¯ËÝË

“Ìîíãîëûí ¿íäýñíèé íýâòýðõèé òîëü” ãýý÷èéí òóõàé

Àêàäåìè÷ Á.×àäðàà íàð “Ìîíãîëûí ¿íäýñíèé íýâòýðõèé òîëü” [1] õýìýýõ 3 áîòü íèéòäýý 2000 ãàðóé í¿¿ð òîì òîëèéã 2009 îíä õýâë¿¿ëñýí áèëýý. Á.×àäðàà ýíý òîëèéí í¿¿ðýí õóóäàñíû àðä óã òîëèéã èøëýõ çàãâàðûã ºã÷, “Îðøèë ¿ã”-ýíäýý «...Ìèíèé áèå ñóäëàà÷èä, ñýõýýòí¿¿äèéíõýý íîì çîõèîë áîëîí àñàð õóðäòàé ººð÷ëºãäºæ áóé áàéãàëü äýëõèéí øèíæëýõ óõààíû ¿ð ä¿í áàðèìò ñýëòèéã 20 ãàðóé æèë öóãëóóëæ áè÷ñýíýý ýìõòãýí öýãöëýæ, øàìäàí ñóäëàæ, áîäîò ¿íýí ìºíèéã ñîíãîæ àâàõûã ÷àðìàéæ, ñîð øèìèéã íü àìòëàí õóðèìòëóóëæ, ºäºð øºíèéã óìàðòàí ÷àðìàéñààð “Ìîíãîëûí ¿íäýñíèé íýâòýðõèé òîëü”-ûí àíõíû íýãýí õóâèëáàðûã áîñãîñîí íü ýíý áèëýý... » [1: õ.7] õýìýýñýí íü ýíý òîëü 2000 îíä ØÓÀ-ààñ Á.×àäðààãèéí åðºíõèé ðåäàêöèéí äîð õýâë¿¿ëñýí 2 áîòèîñ [2] îãò ººð íîì ãýäãèéã òóí ýâòýéõýí èëýðõèéëñýí áàéíà. Õîæèì îëæ ìýäýõíýý óã òîëèéã Øèíæëýõ óõààí, òåõíîëîãèéí ñàíãààñ 60 ñàÿ ãàðóé òºãðºã çàðæ á¿òýýëãýñýí íü òîäîðõîé áîëñîí òóë ýíý òîëèéí çîõèîã÷èéí ýðõèéí àñóóäëààð ýðãýëçýý áóéãàà ìèíèé áèå 2010 îíä òýð ¿åèéí ØÓÀ-èéí Òýðã¿¿ëýã÷äèéí ãàçàð àëáàí ¸ñîîð ºðãºí ìýä¿¿ëñýí áîëîâ÷ îëèãòîé àíõààðàë òàâèëã¿é, áóëçààðóóëñààð ºíãºðñºí áèëýý. Ãýâ÷ óã òîëèéí òóõàé ø¿¿ìæëýëòýé õàíäñàí ãàð áè÷ìýë ìààíü îäîî ÷ áàéñààð òóë 1971 îíîîñ ýõëýýä 30 øàõàì æèëèéí òóðøèä ìàíàé îëîí ýðäýìäèéí õ¿÷ýýð á¿òýýñýí 2000 îíû 2 áîòü íýâòýðõèé òîëèîñ Á.×àäðàà íàðûí 3 áîòü ÿìàð ãýý÷èéí ÿëãààòàéã ãàðãàõûã õè÷ýýí áè÷èæ áàéñíàà õàâ äàðàõ áèø íèéòèéí õ¿ðòýýë áîëãîâîë õîé÷èéí òîëü çîõèîã÷äîä õýðýã áîëóóæèí ãýæ áîäëîî.Óã õî¸ð òîëèéã çýðýãö¿¿ëýí ¿çâýýñ:

1. Õóó÷èí òîëüä “À” òîëãîéò 1969 ¿ã [2: õ.7-100] áàéñíààñ øèíý òîëüä 285 ¿ãèéã õàñ÷, øèíýýð 47 ¿ã íýìñíýýð 1731 ¿ãòýé áîëñîí áàéíà [1: õ.9-149]. ªºðººð õýëáýë øèíý òîëèéí “À” òîëãîéò ¿ãñýýð æèøèã àâáàë òîëèéí ¿ãñèéí ñàí íü 14.5%-èàð áàãàñ÷, ¿ëäñýí õýñýã íü 2.7%-èàð øèíý÷ëýãäýõýä õóóäàñíû òîî 33.6%-èàð ºññºí áàéãàà þì. ̄ ¿íèéã òóí óõààëàã áîäîæ õèéæýý. Íýãä¿ãýýðò, ¿ñãèéí õýìæýýã òîìðóóëñíààð õóó÷èí íýã í¿¿ðò áàãòàæ áàéñàí òåêñòèéã 1.5 îð÷èì í¿¿ðò áàãòàõ áîëãîñîí áàéíà, õî¸ðäóãààðò, îëîí çóðàã íýìæýý. Ò¿¿íýýñ áèø àãóóëãûã áàÿæóóëñàíã¿é. Õóó÷èí òîëèîñ õàññàí “À” òîëãîéò ¿ãñèéã õàñààä ¿ëäñýí 1680-ààä ¿ã áóþó øèíý òîëèéí “À” òîëãîéò ¿ãñèéí 97.3% íü “Àòèëëà” ãýæ áàéñíûã “Àòèëü” áîëãîõ ãýõ ìýòèéí ºíãºöõºí çàñâàðóóäûã ýñ òîîöâîë ÿã õóó÷íààðàà áàéíà.

2. Õóó÷èí òîëèéí õî¸ðäóãààð áîòèéí òºãñãºëä òîëèéã çîõèîñîí 540 ãàðóé ýðäýìòäèéí íýð [2: õ.1200-1205], õî¸ð áîòèéí õî¸óëàíãèéíõ íü õî¸ðäîõü í¿¿ð õóóäñàíä ýðäýì øèíæèëãýýíèé ðåäàêòîð 43 ýðäýìòíèé, ìºí ñàëáàðûí ðåäàêòîð, óðàí ñàéõíû ðåäàêòîð, çóðàà÷èä, ýõ áýëòãýã÷èä ãýýä áàñ 30-40-ººä õ¿íèé íýð áàéãàà. ªºðººð õýëáýë, øèíý òîëèéí “À” òîëãîéò ¿ãñýýð æèøèæ áîäâîë òîëèéí 97.3%-èéã ýíý 600 øàõàì õ¿ì¿¿ñ îëîí æèëèéí õºäºëìºðººðºº á¿òýýñýí áîëíî. Ãýòýë øèíý òîëüä ýíý õ¿ì¿¿ñèéí íýð àëãà áîëæ, ýðõëýí òóóðüâèã÷ (“òóóðâèõ” ãýäýã ìîíãîë ¿ã íü “çîõèîõ” ãýñýíòýé àäèë óòãàòàé ãýäãèéã ìîíãîë õýëíèé òàéëáàð òîëèóä áàòëàæ áàéíà [3: õ.2088; 4II: õ.334]) íü ãàíöõàí àêàäåìè÷ Á.×àäðàà áîë÷èõñîí áàéíà. Á.×àäðàà ýíý øèíý òîëèéíõîî ëàâ ë 90%-èàñ èë¿¿ õóâèéã çîõèîã÷èéí íýðèéã èø òàòàëã¿é õóóëáàðëà÷èõààä ººðèéãºº çîõèîã÷ ãýýä áàéãàà íü á¿òýýëèéí õóëãàéí (plagarism) ñîíãîäîã æèøýý áîëíî.

3. Õóó÷èí òîëèéí “À” òîëãîéò ¿ãýýñ õàññàí 280-ààä ¿ãèéí äîòîð ¿íýíõýýð õóó÷èðñàí þì óó, Ìîíãîëòîé ãýõýýñýý ãàäààä îðîíòîé èë¿¿ õîëáîîòîé ¿ãñ íèëýýä áàéãàà íü ¿íýí áîëîâ÷ ãàâúÿàò áàðèëãà÷èí Ë.Àâàðçýä, õ¿íèé ãàâúÿàò ýì÷ Ñ.Àâäûêàäûð, ãàâúÿàò ìåõàíèêæóóëàã÷ Æ.Àâèðìýä, ñïîðòûí ãàâúÿàò ìàñòåð Ò.Àðòàã, ØÓÀ-èéí ñóðâàëæëàã÷ ãèø¿¿í Ã.Àþóøæàâ íàðûí 20-èîä ìîíãîë÷óóä, îð÷èí öàãèéí øèíæëýõ óõààíû ýìíýëãèéí ¿íäýñ ñóóðèéã òàâèã÷èéí íýã ãýæ ç¿é ¸ñîîð ¿çäýã Ïåðñ ýì÷ Àâèöåííà (Èáí Ñèí), ººðèéíõ íü íýðýýð íýðëýãäñýí õèéí õóóëèóäûã íýýñíýýðýý àëäàðøñàí Èòàëèéí ýðäýìòýí À.Àâîãàäðî, Íîáåëèéí øàãíàëòàí ôèçèê÷ Ê.Ä.Àíäåðñîí, áèîõèìè÷ Ê.Á.Àíôèñåí, çîõèîë÷ ×.Àéòìàòîâ, Õ.Õ.Àíäåðñåí çýðýã îð÷èí öàãèéí ñî¸ëò õ¿í á¿ð ìýäýæ áàéãóóøòàé ñóóòíóóäûí íàìòàð õàñàãäñàí ó÷ðûã áè ¿íýíäýý óõàæ îéëãîæ ÷àäñàíã¿é. Èéì ãàéòñàí õ¿ì¿¿ñèéí òîîíä Ìîíãîë óëñûí Øèíæëýõ óõààíû àêàäåìèéí àíõíû 9 ãèø¿¿íèé íýã, ìàíàé àíàãààõûí àíõíû äîêòîð (òóõàéí ¿åèéíõýýðýý áîë äýä ýðäýìòýí), Ìîíãîë óëñàä ÷èõ, õàìàð õîîëîéí áîëîí öýýæíèé õºíäèéí ìýñ çàñëûã ¿íäýñëýã÷, òºðèéí øàãíàëò, õ¿íèé ãàâúÿàò ýì÷ Ò¿íäýâèéí Øàãäàðñ¿ðýí áàãø ìààíü îð÷èõñîí íü íýí õàðàìñàëòàé. Óã íü Ò.Øàãäàðñ¿ðýí áàãøèéí íàìòàð õýä¿éãýýð äóòóó äóëèì áîëîâ÷ íýâòýðõèé òîëèéí àíõíû õýâëýëä îðñîí áàéñàí þì [2: õ.1125].

4. Øèíý òîëü àãóóëãûí õóâüä ÷ òóí ÿäðóó áîëæýý. Çºâõºí íýãä¿ãýýð áîòèéã íü ë ºíãºö


ã¿éëãýí õàðààä 100 ãàðóé àëäàà îëæ áîëæ áàéíà. Òýð á¿õíèéã ýíä ÿàæ á¿ãäèéã òîî÷èõîâ, ãàíö õî¸ð àðàé ÷ äýý ãýìýýð æèøýýã ë äóðüäàÿ.

• “Á¿ñë¿¿ð ¿ëä” (herpes zoster) ãýäýã ºâ÷íèéã “êîêñàêè À á¿ëãèéí âèðóñò öî÷ìîã ºâ÷èí” õýìýýí [1: õ.306] òîäîðõîéëæýý. Óã íü “á¿ñë¿¿ð ¿ëä” ãýäýã íü ìàíàé àíàãààõûíõàí õîîðîíäîî ãîëäóó “çîñòåð” õýìýýí õýëýëöäýã, àðäûí õýëýíä áîë “ìîãîé ÿð” ÷ õýìýýäýã “õàâèðãà çàâñðûí ìýäð¿¿ë äàãàñàí õºíä¿¿ð ãèíæèí öýâð¿¿ ¿¿ñýõýýð èëýðäýã, íàñàíä õ¿ðýãñýäèéí õàëäâàðò ºâ÷èí” áºãººä ¿¿ñãýã÷ íü õ¿íèé àëüôà-õåðïåñâèð¿ñèéí 3 äóãààð õýâøèíæ [5: õ.39]. Óã âèð¿ñèéã ñàëõèí öýöýã/á¿ñë¿¿ð ¿ëäèéí âèð¿ñ (VZV: varicella-zoster virus) ãýõ íü ÷ áèé áºãººä õ¿¿õýä íàñàíä àíõ õàëäâàðëàõ ¿åäýý ñàëõèí öýöýã õýìýýõ á¿õ áèåèéí òóóðàëòàò õàëäâàð ¿¿ñãýõ áîëîâ÷, àíõ õàëäâàð ¿¿ñãýñíèé äàðàà îëîí æèë ìýäðýëèéí øèðõýãò á¿ãæ õîöðîîä íàñàíä õ¿ðñýí ¿åä áèåèéí ýñýðã¿¿öýë ñóëðàõ (äàðõëàà äàðàíãóéëàõ ýì÷èëãýý õèéëãýõ, ÄÎÕ, õîðò õàâäðààð ºâ÷ëºõ, õºãøèð÷ òóéëäàõ ã.ì.) ¿åä “ìîãîé ÿð” õýëáýðýýð ãàðäàã áîëîõîîð íü èéí íýðèéäñýí áîëîé. Âèð¿ñ ñóäëàëûí ¿¿äíýýñ áîë õåðïåñâèð¿ñèéã êîêñàêè-âèð¿ñòýé ýíä¿¿ðñýí íü òýìýýã ÿìààòàé ýíä¿¿ðñýíòýé àäèë õýðýã. Õåðïåñâèð¿ñ íü ëèïèä àãóóëñàí ãàäàð á¿ðõ¿¿ëòýé, ÄÍÕ öºìòýé, 100 íì õºíäëºí îãòëîëòîé, áºìáºëºã õýëáýðòýé âèð¿ñ áàéäàã áîë êîêñàêè áóþó ïèêîðíàâèð¿ñ íü ãàäóóðàà á¿ðõ¿¿ëã¿é, ÐÍÕ öºìòýé, 24-30 íì õºíäëºí îãòëîëòîé, îëîí òàëò òàëñò õýëáýðèéí âèð¿ñ áîëíî [6: õ.194-195; 7: õ.347-351].

• Øèíý òîëüä õóó÷íààñ õóóëàõäàà çàñàõ ãýýä “íóóõûã íü àâàõ áèø, í¿äèéã íü ñîõëî÷èõñîí” æèøýý áîë õóó÷èí òîëüä “àíèñûí äóñààëãà” [2: õ.64] ãýæ îðñíûã øèíý òîëüä “àíüñíû äóñààëãà” [1: õ.93] áîëãî÷èõñîí íü áîëîé. Öýð õîâõëîõ, õàíèàëãà íàìäààõ ¿éë÷èëãýýòýé, ñýíãýíýñýí ¿íýðòýé ýíý øèíãýí ýìèéã ìàíàé ýì÷ íàð ººð õîîðîíäîî “àíèéñûí äóñààëãà” õýìýýí õººðºëääºã íü ëàòèíààð Liquor ammînii anisatusõýìýýí íýðëýäýãýýñ óëáààòàé.Ìîíãîëîîð áîë óã íü “ãîíüäûí æàöàí óóñìàë” ãýõ ¸ñòîé þì. Ýíý ýìèéí íàéðëàãàíä 2,81 ã ãîíüäûí òîñ (Oleum Anisi), 15 ìë ø¿âòýðèéí óóñìàë áóþó æàö äýýð 100 ìë 90 ãðàäóñûí ýòèëèéí ñïèðò íýìæ áýëòãýäýã àæýý [8: õ.361]. Õàíèàäàíä óóäàã, öýð õîâõëîõ ¿éëäýëòýé“ãîíüäíû æàöàí äóñààëãà”-ûã “àíüñíû äóñààëãà” (àíüñ æèìñòýé õîëáîí áóðóó îéëãîæ áîëîõîîð)

ãýã÷ áîëãîñîí õºãæèëòýé ÷ ãýæ áîëîõ, ãóíèãòàé ÷ ãýæ áîëîõ ò¿¿õ èéì áîëîé.

• Òîëüä îðñîí àíàãààõûí áóñ íýðòîìú¸îíóóäûí òàéëáàð ÷ èõýýõýí õóó÷èðñàí áîëîëòîé. Àðãà ÷ ¿ã¿é, æèíõýíý çîõèîã÷èä íü 1970-1980 îíû ¿åä àíõ õèéñýí òàéëáàðûã îäîî ººð ýòãýýä ë õóóëààä õýâë¿¿ëýýä áàéãààãààñ áóñ áàÿæóóëàí ñàéæðóóëñàí þì àëãà. Æèøýý íü: “Àæ Áîãä-I” ÷óëóóí ñîëèð [1: õ.37] íü õàòóó ÷óëóóëãûí õýëòýðõèéí¿¿ä çººëºíäºº øèãñýí õîëèìîã ÷óëóóí á¿òýöòýé [9] áºãººä íàéðëàãàí äàõü ãàíòèãíû õýëòýðõèéí¿¿ä íü 4.48±0.1 òýðáóì æèëèéí íàñòàé áóþó íàðíû àéìãèéí ñèñòåì äýõü õàìãèéí ýðòíèé (îäîîãèéí Äýëõèé áîëîí Ñàðàí äýýðõè á¿õ ãàíòèãíóóäààñ àõ íàñòàé) ãàíòèã áîëîõ òóõàé ßïîíû áîëîí Ãåðìàíû ñóäëàà÷äûí õàìòàðñàí ñóäàëãààíû ä¿í 2009 îíû çóí øèíæëýõ óõààíû åðòºíöèéã á¿õýëä íü øóóãèóëñàí áèëýý [10; 11]. Õàðèí ýíý ñîëèðûã àíõ îëæ, Äýëõèéí ñîëèðûí êàòàëîãò îðóóñàí õ¿í íü Î.Íàìíàíäîðæ ãóàé áºãººòºë Á.×àäðààãèéí òîëüä ýíý õ¿íèé òóõàé ìýäýýëýë îãò àëãà.

5. Òîëèéí ëàâëàãàà àïïàðàò ¿íýíõýýð îãò øààðäëàãà õàíãàõààðã¿é áîëæýý. Èéì õýìæýýíèé òîëüä îðñîí ºã¿¿ëýë á¿ð íü çîõèîã÷òîé, çàðèì òîìîîõîí ºã¿¿ëýë íü èø òàòñàí íîì, õýâëýëèéí æàãñààëòòàé, òîëãîé ¿ãñ íü óòãûí õèéãýýä ¿ãèéí àéí çààëòòàé, òîëü àøèãëàõ òàëààð òàéëáàðëàñàí “ªìíºõ ¿ã”-òýé, àøèãëàñàí çóðàã, ÷èìýãëýë íü ìºí çîõèîã÷òîé, æèíõýíý ýõ íü õààíà õàäãàëàãäàæ áàéãàà òóõàé òàéëáàðòàé áàéõ ¸ñòîé áèëýý. Îéðìîãõîí ãàðñàí ìîíãîë õýëíèé òàéëáàð òîëèóä [3-4] ýíý òàëààð ¿ëãýð àâàõààð áîëñîí íü “¿íäýñíèé” õýìýýõ òîäîòãîëòîé, ¿íýòýé öààñíààñ ººð àâàõ þìã¿é ýíý òîëèéã á¿ð ÷ ¿íý õ¿íäã¿é áîëãîæ áàéíà.

Èéì íýãýí “õóëãàéí” çóçààí òîëü 21 ä¿ãýýð çóóíû ýõýí ¿åèéí Ìîíãîëûí øèíæëýõ óõààíû “õóóðàì÷” äóðñãàë áîëîí ¿ëäýõ áîëæ áóé íü ë íýí õàðàìñàëòàé.

Àêàäåìè÷ Ï.Íÿìäàâàà

Èøëýë:

1. ×àäðàà, Á. (2009): Ìîíãîëûí ¿íäýñíèé íýâòýðõèé òîëü, I áîòü, 1-696 õ., II áîòü, 697-1320 õ., III áîòü 1321-2028 õ.;

2. Ìîíãîë óëñûí ØÓÀ (2000): Ìîíãîëûí íýâòýðõèé òîëü, Åðºíõèé ðåäàêòîð àêàäåìè÷ Á.×àäðàà, I áîòü, 1-604 õ., II áîòü, 605-1205 õ.;

3. Ìîíãîë óëñûí ØÓÀ, Õýë Çîõèîëûí Õ¿ðýýëýí


(2008): Ìîíãîë õýëíèé äýëãýðýíã¿é òàéëáàð òîëü, Åðºíõèé ðåäàêòîð Ë.Áîëä, I áîòü (À-Ã), I-XXXX+1-594+i-ix, õ., II áîòü (Ä-Ë), I-XXXX+595-1176+i-ix, õ., III áîòü (Ì-Ñ), I-XXXX+1177-1858+i-ix, õ., IV áîòü (Ò-Õ), I-XXXX+1859-2650+i-ix, õ., V áîòü (Õ-ß), I-XXXX+2651-3278+i-ix, x.;

4. Äàìáàæàâ, È. (2010): Îþóí áèëãèéí ìýëìèéã íýýã÷ àÿëãóó ñàéõàí ìîíãîë ¿ãèéí äýýæ (Ìîíãîë õýëíèé äýëãýðýíã¿é òàéëáàð òîëü áè÷èã), Íýìæ çàñâàðëàñàí õî¸ðäàõü õýâëýë, “ªíãºò õýâëýë”, ÕÕÊ, Óëààíáààòàð, I áîòü (À-Îþóòàí), I-XIII+1-1218 õ., II áîòü (ª-ßøèí), I-VI+1-1240;

5. Íÿìäàâàà, Ï., Íàðàíáààòàð, Í., Íàðàíáàò, Í., Íàðàíáîëä, Í. (2006): Àíàãààõ óõààíû ìîíãîë íýðòîìú¸îíû àíãëè, ãåðìàí, ëàòèí, îðîñ, ôðàíö õýëýýð õàäìàë îð÷óóëãàòàé òîâ÷ òàéëáàð òîëü, 395 õ.;

6. Íÿìäàâàà, Ï. (1986): Âèð¿ñ ñóäëàëûí ¿íäýñ,Óëñûí õýâëýëèéí ãàçàð, Óëààíáààòàð, 224 õ.;

7. Àìåðèêèéí Íèéãìèéí ýð¿¿ë ìýíäèéí õîëáîî, Äýëõèéí ýð¿¿ë ìýíäèéí áàéãóóëëàãà, Ìîíãîëûí àíàãààõ óõààíû àêàäåìè (2010): Õàëäâàðò ºâ÷íèé õÿíàëòûí ëàâëàõ, 18 äàõü õýâëýëèéí ìîíãîë îð÷óóëãà, Îð÷óóëãûí ðåäàêòîð Ìàõáàë îâîãò Ï.Íÿìäàâàà, Óëààíáààòàð, 798 õ.;

8. Ìàøêîâñêèé, Ì.Ä. (2005): Ëåêàðñòâåííûå ñðåäñòâà, Ïîñîáèå äëÿ âðà÷åé, 15-å èçäàíèå, ïåðåðàáîòàííîå, èñïðàâëåííîå è äîïîëíåííîå, Ì., “Íîâàÿ Âîëíà”, 1206 ñ.;

9. Bischoff, A., Geiger, T., Palme, H. et al. (1993): Minerology, chemistry, and noble gas contents of Azhi-Bogdo – an LL3-6 chondriticbreccias with L-chondrites and granatoidalclasts, Meteoritics, 28: 570-578;

10. Terada, K. and Bischoff, A. (2009): Asteroidal granite-like magmatism 4.53 Gyr ago, Astrophys. J, 699: L68-L71;

11. Editor’s Choice (2009): Well aged granite, Science, 325:13;


2013 ÎÍÄ ÀÍÀÃÀÀÕ ÓÕÀÀÍÛ ÄÎÊÒÎÐÛÍ ÇÝÐÝÃ ÕÀÌÃÀÀËÑÀÍ ÝÐÄÝÌÒÝÄ

Áàÿíäîðæèéí Öîãçîëìàà(Èõ Áðèòàíè, Óìàðä Èðëàíäûí Íýãäñýí Âàíò Óëñ, Áîëîâñðîëûí äîêòîð)

”Ìîíãîë óëñûí íýã õ¿ðòýëõ íàñíû õ¿¿õäèéí õîîëëîëòûí àñóóäëûã õºõººð õîîëëîõ áîëîí ºëãèéäýõ äàäàëòàé õîëáîí ñóäàëñàí íü” ñýäâýýð 2013 îíû 1 äóãýýð ñàðûí 15-íä Àíãëèéí Áðèñòîë õîòíîî àíàãààõ óõààíû äîêòîðûí çýðýã õàìãààëñàí áàéíà.

Ìîíãîëûí õîò ñóóðèí ãàçðûí ýð¿¿ë òºðñºí íÿðàé õ¿¿õäèéã ñàíàìñàðã¿é ò¿¿âýðëýëò-õÿíàëòàò ñóäàëãàà (RCT)-íû àðãààð ºëãèéäýõ, õóâöàñëàõ ãýñýí 2 á¿ëýãò õóâààðèëàí íýã íàñ õ¿ðòýë íü àæèãëàõ áàéäëààð íÿðàé õ¿¿õäèéí õîîëëîëòûí òºðëèéã ñóäàëñàí áàéíà. Ñóäàëãààíû àæëûí çîðèëãî íü íÿðàé õ¿¿õäèéã òºðñíººñ õîéø àíõ óäàà êîãîðò ñóäàëãààíû àæèãëàëòûí àðãààð íýã íàñ õ¿ðòýë íü òàñðàëòã¿é 7 ñàð àæèãëàæ õ¿¿õäèéí õîîëëîëòûí òàëààðõè äýëãýðýíã¿é ìýäýýëëèéã öóãëóóëàí, õîîëëîëòûí àñóóäëûã ºëãèéäýõ áîëîí õ¿¿õäèéí ºâ÷ëºëòýé õîëáîí ñóäàëñàí áàéíà. Ñóäàëãààíû õ¿ðýýíä Äýëõèéí Ýð¿¿ë Ìýíäèéí Áàéãóóëëàãà áîëîí áóñàä îëîí óëñûí áàéãóóëëàãóóäûí çºâëºìæèéã ¿íäýñëýí õºãæèæ áóé áîëîí õºãæñºí îðíóóäàä õèéãäñýí ñóäàëãààíû á¿òýýë¿¿ä, Ìîíãîë óëñàä ýíý ÷èãëýëýýð ºìíº íü õèéãäñýí ñóäàëãààíû á¿òýýë¿¿äýä ä¿í øèíæèëãýý õèéæ, õàðüöóóëñàí áàéíà.

Óëààíáààòàð õîòûí 4 àìàðæèõ ãàçàð ýð¿¿ë òºðñºí 1225 íÿðàéã òºðñíèé äàðààõü 48 öàãèéí äîòîð ñóäàëãààíä õàìðóóëæ ýõíèé 1 ñàðûí òóðø 7 õîíîãò 1 óäàà, äàðààõü 2-6 ñàðûí òóðø 3 äîëîî õîíîãò íýã óäàà áîëîí 13 ñàðä íü 1 óäàà òóñ òóñ ãýðèéí ýðãýëò õèéæ õ¿¿õäèéí õîîëëîëò, ºñºëò, õóâöàñëàëò áîëîí ýð¿¿ë ìýíäèéí òàëààðõè äýëãýðýíã¿é ìýäýýëëèéã öóãëóóëñàí áàéíà. Ñóäàëãààíä õàìðàãäñàí õ¿¿õäèéí õîîëëîëòûí áàéäëûí òàëààðõè ìýäýýëýëä äàí õºõººð õîîëëîëòûí õóâü áîëîí ò¿¿íèé ¿ðãýëæèëñýí õóãàöàà, õºõººð õîîëëîëòûí áóñàä õàâñàðñàí õýâ ìàÿã òºðë¿¿ä, íýìýëò ñ¿¿í òýæýýë áîëîí íýìýëò õîîëîíä îðóóëñàí íàñûã ñàðààð á¿ðòãýõ, õîò ñóóðèí ãàçðûí íÿðàé õ¿¿õäèéí õîîëëîëòûí õýâ ìàÿã íü õ¿¿õäèéí ºñºëò, ºâ÷ëºë, ºëãèéäýõ áîëîí ýõèéí àæèë ýðõëýëòýé õèð çýðýã õîëáîîòîé áàéãààã ñóäàëæýý.

Ñóäàëãààíä õàìðàãäñàí ýõ÷¿¿äèéí äóíä õ¿¿õäèéã òºðñíèé äàðààõü 1 öàã (87%) áîëîí 24 öàãèéí äîòîð (11%) õºõººð àìëóóëàõ äàäàë ºíäºð áàéñàí. Õ¿¿õäèéí ñ¿¿í òýæýýë áîëîí íýìýëò õîîëòîé õàâñàðñàí õºõººð õîîëëîëòûí õóâü 10-13 ñàðòàéä ºíäºð áàéñàí ÷ ÄÝÌÁ-ààñ ìºðäºæ áóé òºðñíèé äàðààõü ýõíèé 6 ñàð äàí õºõººð õîîëëîõ çºâëºìæèéí äàãóó òîîöîõîä áàãà õàìòðàëòòàé (6%) áàéñàí áàéíà. Ãýõäýý òóõàéí ¿åä ìºðäºãäºæ áàéñàí òºðñíèé äàðààõü ýõíèé 4 ñàð äàí õºõººð õîîëëîõ íü 60 õóâü, äàí õºõººð õîîëëîõ äóíäàæ õóãàöàà 2 ñàð áàéñíûã òîãòîîñîí áàéíà.

Ýõèéí áîëîâñðîëûí ò¿âøèí, ºðõèéí îðëîãî áàãà ýõ÷¿¿äèéí äóíä õ¿¿õäýý õºõººð õîîëëîõ íü ºíäºð, õàðèí òóðøëàãàòàé, àõèìàã íàñíû ýõ÷¿¿ä õ¿¿õäèéí ñ¿¿í òýæýýëä íýìýëòýýð îðóóëàõ íü ýëáýã áàéæýý. Òºðñíèé äàðààõü ýõíèé 6 ñàðä àæèëäàà ýðãýí îðñîí ýõ÷¿¿äèéí 15% íü õ¿¿õäýý õºõíèé ñ¿¿íýýñ ãàðãàñàí. Õºõººð õîëëîõ õóâü õ¿¿õäèéã ºëãèéäýõ (89%), õóâöàñëàõ (88%) äàäëààñ ¿ë õàìààðàí ºíäºð áàéñàí áàéíà.

Ñóäàëãààíû ¿ð ä¿íã Ìîíãîë óëñûí ýð¿¿ë ìýíäèéí òóñëàìæ ¿éë÷èëãýý, õ¿¿õäèéí õîîëëîëò, ýð¿¿ë ìýíäèéí ÷èãëýëýýð áàðèìòàëæ áóé Çàñãèéí ãàçðûí áîäëîãîòîé óÿëäóóëàí ø¿¿í õýëöýæ, õ¿í àìä ñóóðèëñàí õºõººð õîîëëîëòûã äýìæèõ çàìààð Ìîíãîë óëñàä äàí õºõººð õîîëëîõ õóãàöàà, õóâèéã èõýñãýõýä øààðäëàãàòàé çºâëºìæ, ñàíàëûã áîëîâñðóóëñàí áàéíà.

ÌÝÄÝÝËÝË, ÑÓÐÒÀË×ÈËÃÀÀ


Áàëäîîãèéí Ëàãøìàà (ÝÌØÓÈÑ, Äîêòîðàíò)

“Ìºðíèé àðõàã ºâäºëòèéí õàìøèíæèéí ç¿¿ ýì÷èëãýýíèé ¿ð ä¿í áà ñèñòåì÷èëñýí òîéì ¿íýëãýý” ñýäâýýð 2013 îíû 6 äóãààð ñàðûí 20-íä Óëààíáààòàð õîòíîî àíàãààõ óõààíû äîêòîðûí çýðýã õàìãààëñàí áàéíà.

Ìºðíèé àðõàã ºâäºëòèéí õàìøèíæèéí ç¿¿ ýì÷èëãýýíèé ¿ð ä¿íã ñèñòåì÷èëñýí òîéì ¿íýëãýýíèé áîëîí ñàíàìñàðã¿é õÿíàëòàò ýìíýëç¿éí òóðøèëò ñóäàëãààíû (ÑÕÝÒÑ) àðãààð òîîöîõ çîðèëãî äýâø¿¿ëýí òóñ ñóäàëãààã õèéæýý.

Ñèñòåì÷èëñýí òîéì ¿íýëãýýã ã¿éöýòãýõýä MEDLINE, EMBASE, CINAHL, SCISEARCH, Cochrane Controlled Trials Register ìýäýýëëèéí ñàíãóóäààñ õàéëò õèéæ, ñîíãîñîí 12 ºã¿¿ëë¿¿äýä ä¿í øèíæèëãýý õèéñýí. ÑÕÝÒÑ-íä 94 ºâ÷òºíã õàìðóóëæ ýì÷èëãýýíèé áà õÿíàëòûí á¿ëýãò ñàíàìñàðã¿é ò¿¿âðèéí àðãààð õóâààðèëàí ýì÷èëãýýíèé ºìíº, ýì÷èëãýý äóóññàí äàðóéä, ýì÷èëãýý äóóññàíààñ õîéø 1 ñàðûí äàðàà ºâäºëòèéí çýðýãëýë (VAS), ãàð, ìºð, ñàðâóóíû ÷àäâàð àëäàëòûí çýðýãëýë (DASH), ñýòãýë ãóòðàëûí ò¿âøèí (CESD-10) çýðýã àñóóìæ ñóäàëãààãààð ¿íýëýí ¿ð ä¿íã òîäîðõîéëñîí áàéíà.

Ñèñòåì÷èëñýí òîéì ñóäàëãààíû ¿ð ä¿íãýýñ õàðàõàä ºíººãèéí áàéäëààð ìºðíèé àðõàã ºâäºëòèéí õàìøèíæèéí ç¿¿ ýì÷èëãýýíèé ¿ð ä¿íã õàðóóëñàí ñóäàëãààíóóäûí àðãà ç¿é, ¿íýëãýýíèé àðãóóä æèãä áóñ áàéíà. Èéìýýñ óã ñóäàëãààãààð äýýðõ ýì÷èëãýýíèé ¿ð ä¿íã òîîöîõ áîëîìæã¿é, öààøèä ÷àíàðûí øààðäëàãà õàíãàñàí òóðøèëò ñóäàëãàà õèéõ øààðäëàãàòàé áàéíà ãýæ ä¿ãíýæýý.

Ýìíýëç¿éí òóðøèëò ñóäàëãààíû ¿ð ä¿íãýýñ õàðàõàä ç¿¿ ýì÷èëãýý äóóññàí äàðóéä ñóäàëãààíä õàìðàãäàãñäûí ìºðíèé ºâäºëò, ãàð, ìºð, ñàðâóóíû ¿éë àæèëëàãààíû àëäàãäàë, ñýòãýë ãóòðàëûí øèíæ õÿíàëò áóþó õóóðàì÷ ç¿¿ ýì÷èëãýýíèé á¿ëýãòýé õàðüöóóëàõàä ñòàòèñòèêèéí ¿íýí ìàãàäëàëòàéãààð áóóðñàí áàéíà. Ýì÷èëãýý äóóññàíààñ 30 õîíîãèéí äàðàà ìºðíèé ºâäºëò, ãàð, ìºð, ñàðâóóíû ¿éë àæèëëàãààíû àëäàãäàë õÿíàëòòàé õàðüöóóëàõàä ñòàòèñòèêèéí ¿íýí ìàãàäòàé áóóðñàí õýâýýð, ñýòãýë ãóòðàëûí ¿ç¿¿ëýëòèéí ñòàòèñòèê ÿëãàà àðèëñàí áàéíà.

Ñóäàëãààíààñ ãàðñàí ïðàêòèê çºâëºìæèä ç¿¿ ýì÷èëãýýãýýð ìºðíèé ºâäºëòèéã íàìäààí, ìºðíèé ¿åíèé õºäºëãººíèé õÿçãààðëàëòûã áàãàñãàñíû äàðàà õºäºëãººí çàñàë, ãàð çàñàë õèéõ áîëîèæòîé áºãººä áóñàä íºõºí ñýðãýýõ ýì÷èëãýýí¿¿äèéã ç¿¿ ýì÷èëãýýòýé õàâñðóóëàí õèéõ íü ÷óõëûã òóñãàæýý.

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