,,,,,,,,,,,,,,?,,,,,, (PTCA),,, 1
,, 2001 3 2
( 1 ) ( 2 ) ( 3 ) ( 3 ) ( 5 ) ( 8 ) (11) (15) (15) (16) (17) (17) (18) (19) (20) (21) (22) (24) (24) 1
(25) (25) (26) (27) (30) (33) (36) (36) (39) (40) (42) (43) (44) (53) 2
(62) (64) (65) (65) (66) (67) (71) (73) (73) (74) (75) (76) (78) (78) (79) (80) (81) (82) (86) (88) 3
( 90 ) ( 95 ) ( 98 ) (100) (103) (104) (106) (108) (109) (113) (118) (118) 4
(132) (143) (144) (144) (146) (149) (151) (153) (153) (154) (155) (156) (159) (159) (165) (168) (172) 5
(173) ( % ) (174) (175) (Bruce) (177) 6
,, 16,, 700010000,,,,,, 1
,, ;,,,,,,?,,,,, 350 ( 1),,,,,,, 2
, ;, 0.2,,, ( ) ( ) ( ),,,,,,, 3
,,,, ;,, 4
100, 26,,,,,, ( ),,,,, 5
( ),,, 6080,, 150180,,, ( ),,,,,,,,,,, AO = RV = LV = LA = IVS = PW =, 6
( ),,,,,,,,,, 3.76,,,,,, 7
,,,,, (, ),,,,,,, ( ) 8,,
,,, ( ),,,,,,,,,,,,, ( ) : ( Eating ) ( Excitement ) ( Exertion) ( Exposure to cold), 4 E 9
E, :,,,,,,,,?,,,, 10
:,,,, 11
,,?, ;,,,, ( 70 % ),,,,,,,,,? 12,
, ( ),,, ;,,,,, ( ),,,,,, 13
, (,,, ) 14
,,,,,, 660,, 60 70 1972, 22 52298, 6.4%,,,,,,,,, 508, 9 15
3.22 %, 6069 87.09%,,, 40, 50, 10,,,,, 40,, 2,, 5 :, 60,, ( ) ( ) 16,
1500 ), 40 30,,, 11, 181, 59 ( 32.5 % ), 150 2 ( 1.3 % ),, ;,,, : ( TG) ( LDL-C) (HDL-C),,, 2.6, 3.6 ( ) 0.53 17
,, ;,,,, 3 % 6% (2030 ), ( 250 ),,,,, 100, 160, 18
:,,,,,, :,,,,,,,,, : 19
23,,,,,,,,,,,, : = ( ) / ( ) 24, 30, 35 %, 26,, 20
,,,,,,,,,,, 21
2.54, 23,,,,,,, 2.54, 22
, ;, ;,, 23
,,,, ( PAI-I ), ( LDL-C),,,, PAI-I, ( ) 24
, C,,,, 1218 /, : 6 ; 4 ;, 2,, 25
,,,,,,, ;, ;, ( 100200 ), ( HDL-C), 26
, /,,,,,,, ( HDL-C ) ( LDL-C),,,,,,,,, ( TG ) ( TC) ( HDL-C) ( LDL-C) 4 27
,, ( ),,,,,, ( % % % % ( -) ( -) ( ) 4555 18 30 2 2025 43 20 10 213 923 923 4674 0.52.5 212 318 7494 28
:,,, 29
: 5, 14, ( ),, 4 24,, AB, a - ( ) ; b -, ( + ),,,, 30,
, 4 24,,,,,, 4 24,,,,,,,,,, 31
4 a b, 32
,, ;, ; ;,, 33
),,,,,,,,,,,, 34
,,,,,,,,,,, 1 %, 2%, 510,,,, 35
,,,,, ;,, 1 4, ; 30,,,,,, :, 36
,, 1,,, 1,, 1,,,,,,,,, 8 % 10 %,,,, :,, 37
,, ST,,,,,,,,, 13,,,,,,,,,, 50 %,, 38
( ) 110 140, 70 / 90 /, ( 11070 ) ( 140 90),,, :, ;, ( ) ; ;,, 39
,,,, :,,, 40
, 35, 15, 23,,, 1,,,,,,, 41
, 1, 23, 2 23 3 3,,,,, 42
,,,,,, :,,,,,,, 43
,,,,,,,,,,,,,,,,,,,, 50,,, 35,,, : 44
,, A ST B.ST C. T 45
, ST / T ST, 46,,,,,
, ( < Bruce > ),,,,,,, : (2 ) Holter, 80 Holter 24 24,, 47
,,,,,,,,,,,, 48
, : 99m 201, 99m 201, ( 3 4),, 99m -,, 99m 201,,,,,,,,,,,,,, 49
,,,,,,,,,,,, X, X,,,, 50
,,,,,,,,,,,,,,, 51
,,, :, 360,,, 52
:,,,, (PTCA), PTCA,,,,,, 53
,,,,, :, ;,, ; ;,,,, ( ),,,,?,,, 1,, 23 1, 2 3,, 54
: ( ) 5-( ),,,,,,,, :,, 2030,,,,, 1 23, 2 3, 3 20,, 1, 1, 55
),,, 6, 12,,,,,, 3, 6 1, ( ),,,,,,?, 56
,,,, 100150 /, 1 250, 2 /, ( PTCA),, ( ),,,,, PTCA,,,, PTCA, PTCA,, PTCA 57
40 %, PTCA 1,,,,, PTCA,,,,, 25 %, : PTCA ; PTCA :,, Wallstent,,,,,,, Cook Palmaz-Schatz 58 PTCA
,, PTCA,,,,,,,,,,,,, 59
,,,,,, ( ) 60
,,,,,,,, : ( ) ( 1.5 ) PTCA, ( ) PTCA,, 61
5 6,,,,, 1, 2 1 15, 4 15, 4 2, 2030, 3 3, 2030, 3 4 50 200, 2, 50 200, 4 62
,,,, 24 /, 120 / ( 20 / ), 20,,,,,, 1, 7,,,, PTCA 1 100200 2 2 200400 2 3 1/ 4 810 4 1/ 2 15 5 1 30 6 1.75 30 7 2 40 63
,,,, : 1015 1, ( ) 64
,, : 6 23 1,, ;, ;,,, 75 %, 65
,,,, 4, 10,,,,,,,,,,,,,,,, 66
, ABC A.,,,,,,,,,, ; 2 3,,,,, 67
B,,,,, 14 16, 11.5,,, 800,,, C., 23,,, 1/ 3,,,, :,,,, 68
, 80,,,, 30 2, 15 2 ; 5, 1,, ( ), 1/ 3, 69
,,,,,, 40 %,, 3.55, 15 80100 /, 60 80 / 70
80,,,, 71
< 40 %,,,,,, 72
,,,,,,,, 120 80,,,,, 73
,,,,, ( 6.26 12.5 / ) ( ) ( > 25 / ),,,,,,,,,,, 74
,,, HDL-C, LDL,,,,,,,,,,,,, B,,,, 75
150 /,,,, (100 / ), 50,,, 30 %,,,,,,,,,,,,,,, ; 76
,,, 80 /, 100 /,,,,,,,,, :, 70 % 77
,,,, :,,,,,,,,,,,,, 78,
,,,, 1/ 3, 2/ 3,, 1, 12,, :,,,,,, 79
,,,,,,,, ( 2),,,,,,,,,,, 80
,,,,,,,,,, ( ),,,,,, ( ) ( ),,,,,, 81
, ;,,,,,,,, ( ),,,,,, 82
,,,,,, ( Q Q ) :, ST, T ; T,, T, Q, R ST, ST Q, T T, ST ST, Q ST T 83
,,, (GOT) ( LDH) 84
CK) (CK-MB), CK CK-MB, CK-MB, LDH1, LDH1 > LDH2 CK, MM MBBB, MB, CK-MB, : ( ) ( ) ( ) GOT 68 2448 35 CK 46 1836 37 CK-MB 46 1824 37 LDH 818 3272 814, 48,,,,, 85
, 12,,,,,,,,,,,, 86
,,, (160300 ),, 30,,,, 1,,,,,,,,,,, : 10 ( ) 100 5 % 10, 3,, 1015 1, ( ) 50 110/ 70, 80,, ;,, 4 10 / 100 / 60 87
,,, 0.51, 50, 24 /, 100, 1,,,,,, :,,,,, 88,
,,,,,,,,,,, 89
;,,, 1, 1, 1,, 10 :,, ( 100 ) ( 60 ),,,,,,,,, 90
,,,, 24 91
,, ( ),, X,,,,,,,,, 92
,,,,,,, 80 % 90%, ( PTCA), 50% : 80,,, ( < 30 / ),, > 40 %, 93
7,,,,,,,,,,,,, 94
, ST,,, (CCV),,,,, ( ),, 95
, 96
,,,, 1,,,,,, 1,,,,,,, : ; ;, (6 ),,,,,, 70,,,, 97
X,,,,, 98 3,
24,,,,, 35 :, : :,, :, 6, 12,, 60% PTAC ( PTAC), 99
, 4,, ;, ;,,,,,,, 2,, ( 70 ),,,,, CK-MB 34,, < 40 %,,,,,,, 100
2,, 34,, 56, 78 910,,,,,,, 101
,,,,,,,,,, 1,,,,,,, 814 /, 1, 1, 1,,,,,,,,,,, 102
1 ), ( ),,,,,,, 68,,,,,,,, 103
, 2,,, 1,, 1,,,, 72,,,,, 3,,?, 104
,,,, 3, 4, 2, 34,, 1, 2 8, 23,,,, 105
6, 3,, 2, :??????,,, ( AAMHR) 60 %,,,,,,,,, 34, 24, 106
:,,,,, ( ),,,,,,,,, :, ( EF), 30%, 30 % 40 %, 40 % 55%,, 107
??, 1 10% 15%, 1, 8% 10 % 2 5 %,,,,, 108
1 20 %, 24, 45,,,,,, ( ),, 90 %,, : ( rt-pa) 6, 50 % 60 %, rt-pa 60% 70% 109
, 6,,,,,,,, 15% 25%, 3, 12, : ; ST > 0.2, AVF ST 0.1 12 ; 12 24,,, 75, 1000 10,,, :, 110
; > 180/ 120, 1,, : ST 2, ST > 50% 2 2, CK-MB, 14 4 2, (PTCA) : PTCA PTCA 111
PTCA PTCA, PTCA, PTCA,, PTCA PTCA,,,,, ( IABP ) X, 24,,,,,,,,, 112
,,,,,,,,,,,, 3,,, 113
,,,,,, 2,, 1 ( ), ( ) 114
),,, 15 ( ), 1,,, 115
,,,,,,,,,,,,,,,,,,,, 116
,,,, 117
,,,, 2 ;, 3 ;, 10,,,,?, :, ( ),, 2,,, 118
:,,,,,,,,,,,, 119
:,,,,, :,,, 16.7, 1 37.7 :,,, :?,, 120?
,,?, :, (BMI) = ( ) / ( ) 24, 30,,,, ( WHR),, 1 0.85 (WHO) BMI BMI ( / 2 ) WHO < 18.5 18.524.9 25.029.9 1 30.039.9 2 > 40.0 3 121
() 94 2 ( ) 102 80 88 1 WHO (BMI > 25 / 2 ) ( WHR0.95, WHR0.80 ) ; (BMI > 30 / 2 ) 0.85) 2 WHO ( WHR 1.0, WHR,,,,, 1/ 2 (FC), (MAC), ( HC), (WD) :, ; (LBW), 122
1625 25%, 3068 29 % 34 % ; 1625 13% 15%, 2759 22 % 27%,,, 30%, 20 %, MAC) ] : Wilmore Behnke LBW ( ) = 98.42 + [ ( 1.082BW) - ( 4.15 LBW = ( ) BW = ( ) MAC = ( ) 123
LBW( ) = 8.987 + [ (0.732BW)+(3.786 WD) - ( 0.157AC) - ( 0.249HC) + (0.434FC) ] WD = ( ) AC = ( ) HC = ( ) FC = ( ) BW = ( ) LBW = ( ) 1 = 0.45 1 = 2.54 ( % ) = [ (BW - LBW)/ BW] 100 LBW = ( ) BW = ( ), (, ), ( ), ( ), ( ), ( ) ( ),,,,,,, 124
, 20 %,,, ( ), ( ),, 140 ( ) 90, 1999 10, : (/ ) < 120/ 80 < 130/ 85 130139/ 8589 1 ( ) 140159/ 9099 : 140149/ 9094 2 ( ) 160179/ 100109 3 ( ) 180/ 110 125
140 90 140149, 90 60, 3 160,, 5, 3, 3, 3 20,, Korokov, Korokov ( ),,,,, ( ),, ( HOT) 139, 83 126
( 90 8580 ),, 130/ 85 ;, 140/ 90,,, 127
20 %,, 5 ( 15 ),, :,,,,, LDL-C, LDL-C, 128
LDL C,, 1 2 3, (/ ) TC < 5.17 5.176.18 6.21 < 6.21 ( < 200) (200239) (240) ( < 240) LDL-C < 3.36 3.364.11 4.14 < 4.14 ( < 130) (130159) (160) ( < 160) HDL-C 1.16 0.931.16 0.91 > 0.91 (45) (3645) (35) ( > 35) TG < 1.47 1.471.8 1.81 < 1.81 ( < 130) (130159) (160) ( < 160) TC, LDL-C, HDL-C, TG / ( ), 129
,,, ( 12 ),,,, HMG-CoA,,,,,,, HDL-C, 68,,,, :,, 14, 130
,, 20 / 80 / 510 / 40 / 10 / 40 / 20 / 40 /, : ( ) ( ) ( ),, HDL-C, LDL-C,,,, LDL-C, 131
HDL-C,,,,,, HDL-C,,,,,,,,,,, 50%,,, 132
,,,,,,,,,,,,, ( ),,,, 25 %, 1/ 3, 200 ( 1 ) ( ), : 12%, 40 % 50%, 133
,,,,,,,,,,,, 134
,,,,,,,,,,?,, 58 /,,,,, 135
,,,,,,,,,,,,,,,,,?,,,,, N-3, 136
N N-3,,,,,,,,,,,,,,,,, 20, 25 200, 50 % ;, 250, 250, 200,, 137
, 200, 150 200 250 1,,,,,,,, 138
,,,,,,,,,,,,,,,,,,, ;,,,,,,,,,,,, 139
, :,,,, 1,,, 20 :,, 20, 12, 140
,,,,,,,, (Sedentary Syndrome),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 141
, 142
,,,,,,, ( ),,,, ST-T,,, (, ),,,,,,,, 143
,,,,,,,,,,,,, 144
,, 5 1, 4, 23 ),,,,,, Valsalva ( ),,,,,,,, :, ( 100 ) 100 /,,,, 45 1, 12, 8002000, (50 200 ) (1000 ), 120 / 23, 145
,,,, ( MET), 1 MET ( ), 3.5 / ( ), MET, 146
MET,, 50 % 85%, 65% 75 %,,, (AAMHR) AAMHR = 220 -, 80 % AAMHR 65 : AAMHR = 220-65 = 155 / 80% AAMHR = 1550.8 = 124 /, (Bruce),,,,, ( VO 2 ), 147
Bruce VO2ma x) VO2 [ / () ] = (2.94 ) + 8.33 VO2 [ / ( ) ] = (2.36 ) + 10.16 VO2 [ / ( ) ] = (4.326 ) - 4.66 VO2 [ / () ] = (2.74 ) + 8.05 () 65% 75% 2130 190 125 145 3140 185 120 140 4150 175 115 130 5160 170 110 125 6170 160 105 120, 48, 6, 172 / ( AAMHR = 172 / ) : VO2[ / ( ) ] = ( 2.366 ) + 10.16 = 24.32 MET max ( ) = 24.32/ 3.5 = 7 148
6MET S :THR = 172( 65 % 75% ) = TZ = 7( 50% 85 % ) = 3.5 112129 /,,, ( ), ( ) ( ) 10, 6,,, 10,,, 510,,, 149
23, 2030,,, ( ),,,,,,,,,, 5 10, 5, 1015,, 150
, 3, 12,,,,,, :,, ;,,,, ;,, ( 170 - ),,, 151
, 23, 12,,, 152
,,,,,,?,, 36,, 23 45,, : 153
,,,,,,,,,,, ;,,, :,, 154
,,,,,,,,, ;,,,,,,, 155
,,,,,,,,,,, ( ),,,,,,,,,,,, 156
,, 1, 1,,,, 24,,, 56,, ;,,,,,, 6 157
,,,, 158
,,,,,, 159
, 200, 300, 360 : :,, :, 510 /, 1. < 90,, > 60 / 35 / ( ),, 160 2., 3. < 60 /,,
, /, 0.5, 3 4. 0, < 2 /,,, : 1 1 1 4% 60,, 10% 5 1, 0.5,, : 0.5 (5 ),, 5 4% 60,, 10 10% 5,, 10 ( ) 161
2 0.5,, 5 1, 5., > 6 /, T,, ), 50100,, ( 1 / 2000 500 ( 23 / ), 5 50,, 225 ) 4 / ( 60 /, 6. < 60 /,, < 90 0.5,, 5 1, 2 162
/,, 1 5 % 250,, 220 /, 60100 / ) 7., 12 50100,, ( 1 / 2000 500 ( 23 / ), 5 50,, 225 ) 4 / ( 60 /, 8.,,, 50100, ( 1 / 163
200300, 2000 500, 23 /, ), : 4% 60, 50, 4 / ( 60 / 200300 9., ( ),, 150, 300 164 10. 12,,, 200300 1, 2 360,, :
( 5 ), 4% 60, 2 360, : 50100, 23 / 2 360 3 11.,, < 90 Valsalva ( ) ( ) Isordil, Sorbitrate, 165
60, 1,, ;,,,,,,,,,,,,,,,,,, 166
,,,,,,,,,,, : :,,,,, 167
, ( ),,,,,,,,,,,,,,, 168
,,,,,,,,,,,,,, ( ),, 169
), X ( ), : ; ; ;, X,,,,,,,,,,,, 170
,,,,,, MET, 1MET,,,,,,, 171
( % ) ) 10.0 2.8 7.8 15.0 7.3 13.3 20.0 10.5 17.2 25.0 13.0 20.3 30.0 15.1 22.8 35.0 16.9 25.0 40.0 18.5 26.9 50.0 21.1 30.2 55.0 22.2 31.6 60.0 23.2 32.8 65.0 24.2 34.0 70.0 25.1 35.1 80.0 26.7 37.1 85.0 27.4 38.0 90.0 28.1 38.9 95.0 28.7 39.7 100.0 29.4 40.5 105.0 30.0 41.2 110.0 30.5 41.9 115.0 31.1 42.6 120.0 31.6 43.3 125.0 32.1 43.9 130.0 32.6 44.5 172
( % ) ) 135.0 33.0 45.1 140.0 33.5 45.7 145.0 33.9 46.2 150.0 34.4 46.7 98 150 2300 95 150 2000 91 150 690 90 145 610 89 145 230470 87 100140 230470 60 126 420 88 125 420 70 110 400 70 106 340 70 300 65 280 5069 173
136261 60 240 50 230 26 240 26 190 24 185 24 185 10 185 0 (%) 25 75 50 30 70 26 6 94 22 13 87 53 6 14 86 42 92 8 6 2 0.2 60 40 3.2 0.9 42 58 8.0 53 47 2.0 57 43 4.0 Hardinge M, 174
70 ) 1. 5 2 MET, 4 7 / ( ( 1. 6 / ),, ),, 8. 4 10. 5 / ( 2 2. 5 / ),,, 2 3 MET ( 3. 2 7 11 / (, / ), ), ( 8. 0 / 10. 5 16. 7 ), ), / ( 2. 5 4,, / ), 3 4 MET, ( 4. 8 11 14 /, / ), ( ),,, ( 9.6 / 16. 7 20. 9 ), ( / ( 4 5, ), / ) ( ),, ( ),, 4 5 MET,, ( 5. 6 14 18 /, / ), ( ),,, ( 12.8 / 20. 9 25. 1, ),, / ( 5 6 2, / ) ( ),,,, 5 6 MET 18 21 / ( ) 25. 1 29. 3 / ( 6 7 / ), ( 6.4 / ), ( 16.0 / ), ( 6.4 / ), ( ), ( 1.44 / ) 175
70 ) 6 7 MET 21 25 / ( ) 29. 3 33. 5 / ( 7 8 / ) 7 8 MET 25 28 / ( ) 33. 5 41. 8 / ( 8 10 / ) 10 / ( 4. 5 ),,, ( 8. 0 / ), ( 17.6 / ),,,, ( 18 / ), 36 ( 8. 0, / ), ( 19.2 / ),,,,,, ( 8.0 / ), 8 9 MET 28 32 / ( ) 41. 8 46. 0 / ( 10 11 / ) 10 + MET 32 + / ( ) 46. 0 + / ( 11 + / ) 10 / ( 5. 5 ) 10 / ( 7. 5 ) ( 8. 8 / ), ( 20. 8 / ),, ( ), ( 27 / ), ( 9. 6 / = 10 MET 11. 2 / = 11. 5MET 12. 8 / = 13. 5MET 14. 4 / = 15MET 16. 0 / = 17MET ), ( 8. 0 / ), ( ), ( 37 / ) Fox, Naughton Gorman, Mod. Concepts Cardiov. Dis, 1972, 41 : 2530 ; MET = 176
Bruce) (/ ) ( % ) ( ) MET 1 1.7 0 3 2 2 1.7 5 3 3 3 1.7 10 3 5 4 2.5 12 3 7 5 3.4 14 3 10 6 4.2 16 3 13 7 5.0 18 3 16 8 5.5 20 3 19 9 6.0 22 3 22 MET = 177