ÐÎÑÑÈÉÑÊÀß ÀÊÀÄÅÌÈß ÌÅÄÈÖÈÍÑÊÈÕ ÍÀÓÊ
Íàó÷íî-èññëåäîâàòåëüñêèé èíñòèòóò âàêöèí è ñûâîðîòîê
èì. È.È. Ìå÷íèêîâà.
Íà ïðàâàõ ðóêîïèñè
ÓÄÊ.
ÊÀÐÏÎ×ÅÂÀ ÑÂÅÒËÀÍÀ ÂÈÊÒÎÐÎÂÍÀ
Âàêöèíàöèÿ ïðîòèâ äèôòåðèè è ñòîëáíÿêà äåòåé, èìåþùèõ â àíàìíåçå ñîëèäíûå îïóõîëè.
14.00.36. - àëëåðãîëîãèÿ è èììóíîëîãèÿ
ÄÈÑÑÅÐÒÀÖÈß
íà ñîèñêàíèå ó÷åíîé ñòåïåíè
êàíäèäàòà ìåäèöèíñêèõ íàóê.
Ìîñêâà - 1998.
ÎÃËÀÂËÅÍÈÅ
ÂÂÅÄÅÍÈÅ.......................................................................................................................................................................................... 4
×ÀÑÒÜ ÏÅÐÂÀß. ÎÁÇÎÐ ËÈÒÅÐÀÒÓÐÛ............................................................................................................................... 9
ÈÇÌÅÍÅÍÈß Â ÑÈÑÒÅÌÅ ÈÌÌÓÍÎÊÎÌÏÅÒÅÍÒÍÛÕ ÊËÅÒÎÊ ÏÐÈ ÂÀÊÖÈÍÀÖÈÈ. ÑÎÑÒÎßÍÈÅ ÈÌÌÓÍÍÎÉ ÑÈÑÒÅÌÛ Ó ÄÅÒÅÉ Ñ ÑÎËÈÄÍÛÌÈ ÎÏÓÕÎËßÌÈ. ÂÀÊÖÈÍÎÏÐÎÔÈËÀÊÒÈÊÀ ÈÍÔÅÊÖÈÎÍÍÛÕ ÇÀÁÎËÅÂÀÍÈÉ Ó ÄÅÒÅÉ Ñ ÎÍÊÎËÎÃÈ×ÅÑÊÈÌÈ ÇÀÁÎËÅÂÀÍÈßÌÈ....................................................................................................... 9
ÈÇÌÅÍÅÍÈß Â ÑÈÑÒÅÌÅ ÈÌÌÓÍÎÊÎÌÏÅÒÅÍÒÍÛÕ ÊËÅÒÎÊ ÏÐÈ ÂÀÊÖÈÍÀÖÈÈ................................... 9
ÑÎÑÒÎßÍÈÅ ÈÌÌÓÍÍÎÉ ÑÈÑÒÅÌÛ Ó ÄÅÒÅÉ Ñ ÑÎËÈÄÍÛÌÈ ÎÏÓÕÎËßÌÈ........................................... 16
ÂÀÊÖÈÍÎÏÐÎÔÈËÀÊÒÈÊÀ ÈÍÔÅÊÖÈÎÍÍÛÕ ÇÀÁÎËÅÂÀÍÈÉ Ó ÄÅÒÅÉ Ñ ÎÍÊÎËÎÃÈ×ÅÑÊÈÌÈ ÇÀÁÎËÅÂÀÍÈßÌÈ................................................................................................................................................................................................................. 19
×ÀÑÒÜ ÏÅÐÂÀß. ÎÁÇÎÐ ËÈÒÅÐÀÒÓÐÛ............................................................................................................................. 24
ÈÇÌÅÍÅÍÈß Â ÑÈÑÒÅÌÅ ÈÌÌÓÍÎÊÎÌÏÅÒÅÍÒÍÛÕ ÊËÅÒÎÊ ÏÐÈ ÂÀÊÖÈÍÀÖÈÈ. ÑÎÑÒÎßÍÈÅ ÈÌÌÓÍÍÎÉ ÑÈÑÒÅÌÛ Ó ÄÅÒÅÉ Ñ ÑÎËÈÄÍÛÌÈ ÎÏÓÕÎËßÌÈ. ÂÀÊÖÈÍÎÏÐÎÔÈËÀÊÒÈÊÀ ÈÍÔÅÊÖÈÎÍÍÛÕ ÇÀÁÎËÅÂÀÍÈÉ Ó ÄÅÒÅÉ Ñ ÎÍÊÎËÎÃÈ×ÅÑÊÈÌÈ ÇÀÁÎËÅÂÀÍÈßÌÈ..................................................................................................... 24
ÈÇÌÅÍÅÍÈß Â ÑÈÑÒÅÌÅ ÈÌÌÓÍÎÊÎÌÏÅÒÅÍÒÍÛÕ ÊËÅÒÎÊ ÏÐÈ ÂÀÊÖÈÍÀÖÈÈ................................. 24
ÑÎÑÒÎßÍÈÅ ÈÌÌÓÍÍÎÉ ÑÈÑÒÅÌÛ Ó ÄÅÒÅÉ Ñ ÑÎËÈÄÍÛÌÈ ÎÏÓÕÎËßÌÈ........................................... 31
ÂÀÊÖÈÍÎÏÐÎÔÈËÀÊÒÈÊÀ ÈÍÔÅÊÖÈÎÍÍÛÕ ÇÀÁÎËÅÂÀÍÈÉ Ó ÄÅÒÅÉ Ñ ÎÍÊÎËÎÃÈ×ÅÑÊÈÌÈ ÇÀÁÎËÅÂÀÍÈßÌÈ................................................................................................................................................................................................................. 34
ÃËÀÂÀ II. ÑÎÑÒÎßÍÈÅ ÈÌÌÓÍÍÎÃÎ ÑÒÀÒÓÑÀ Ó ÄÅÒÅÉ Ñ ÑÎËÈÄÍÛÌÈ ÇËÎÊÀ×ÅÑÒÂÅÍÍÛÌÈ ÍÎÂÎÎÁÐÀÇÎÂÀÍÈßÌÈ Â ÏÐÎÖÅÑÑÅ ÄËÈÒÅËÜÍÎÉ ÐÅÌÈÑÑÈÈ......................................................................... 39
1. ÏÎÊÀÇÀÒÅËÈ ÊËÅÒÎ×ÍÎÃÎ ÈÌÌÓÍÈÒÅÒÀ Ó ÄÅÒÅÉ Ñ ÎÏÓÕÎËßÌÈ Â ÀÍÀÌÍÅÇÅ Â ÑÐÀÂÍÅÍÈÈ Ñ ÂÎÇÐÀÑÒÍÛÌÈ ÍÎÐÌÀÌÈ................................................................................................................................................ 39
2. ÏÎÊÀÇÀÒÅËÈ ÊËÅÒÎ×ÍÎÃÎ ÈÌÌÓÍÈÒÅÒÀ Ó ÄÅÒÅÉ Ñ ÑÎËÈÄÍÛÌÈ ÎÏÓÕÎËßÌÈ Â ÇÀÂÈÑÈÌÎÑÒÈ ÎÒ ÄËÈÒÅËÜÍÎÑÒÈ ÐÅÌÈÑÑÈÈ............................................................................................................................................ 43
3. ÏÎÊÀÇÀÒÅËÈ ÊËÅÒÎ×ÍÎÃÎ ÈÌÌÓÍÈÒÅÒÀ Ó ÄÅÒÅÉ Â ÇÀÂÈÑÈÌÎÑÒÈ ÎÒ ÄÈÀÃÍÎÇÀ ÎÍÊÎËÎÃÈ×ÅÑÊÎÃÎ ÇÀÁÎËÅÂÀÍÈß........................................................................................................................................................................ 44
4. ÏÎÊÀÇÀÒÅËÈ ÊËÅÒÎ×ÍÎÃÎ ÈÌÌÓÍÈÒÅÒÀ  ÇÀÂÈÑÈÌÎÑÒÈ ÎÒ ÏÎËÓ×ÅÍÍÎÃÎ ÑÏÅÖÈÔÈ×ÅÑÊÎÃÎ ÏÐÎÒÈÂÎÎÏÓÕÎËÅÂÎÃÎ ËÅ×ÅÍÈß.............................................................................................................................. 46
ÃËÀÂÀ III. ÐÅÂÀÊÖÈÍÀÖÈß ÏÐÎÒÈ ÄÈÔÒÅÐÈÈ È ÑÒÎËÁÍßÊÀ ÀÄÑ-Ì ÀÍÀÒÎÊÑÈÍÎÌ ÄÅÒÅÉ, ÈÌÅÞÙÈÕ Â ÀÍÀÌÍÅÇÅ ÑÎËÈÄÍÛÅ ÎÏÓÕÎËÈ................................................................................................................................... 52
1. ÊËÈÍÈ×ÅÑÊÎÅ ÒÅ×ÅÍÈÅ ÏÎÑÒÂÀÊÖÈÍÀËÜÍÎÃÎ ÏÅÐÈÎÄÀ .......................................................................... 53
1.1. Ðåòðîñïåêòèâíûé àíàëèç êëèíè÷åñêîãî òå÷åíèÿ ïîñòâàêöèíàëüíîãî ïåðèîäà ó äåòåé, ïðèâèòûõ äî âûÿâëåíèÿ ó íèõ îíêîëîãè÷åñêîãî çàáîëåâàíèÿ............................................................................................................................................... 53
1.2 Êëèíè÷åñêîå òå÷åíèå ïîñòâàêöèíàëüíîãî ïåðèîäà ó ðåâàêöèíèðîâàííûõ äåòåé.......................... 55
2. ÈÇÓ×ÅÍÈÅ È ÎÖÅÍÊÀ ÏÎÊÀÇÀÒÅËÅÉ ÊËÅÒÎ×ÍÎÃÎ ÈÌÌÓÍÈÒÅÒÀ ÏÎÑËÅ ÏÐÎÂÅÄÅÍÈß ÐÅÂÀÊÖÈÍÀÖÈÈ. 59
2.1. ÊÎËÈ×ÅÑÒÂÅÍÍÛÅ ÈÇÌÅÍÅÍÈß ÑÓÁÏÎÏÓËßÖÈÉ ÈÌÌÓÍÎÊÎÌÏÅÒÅÍÒÍÛÕ ÊËÅÒÎÊ Â ÏÐÎÖÅÑÑÅ ÍÀÁËÞÄÅÍÈß......................................................................................................................................................................... 60
2.2. ÈÍÄÈÂÈÄÓÀËÜÍÛÅ ÎÑÎÁÅÍÍÎÑÒÈ ÈÇÌÅÍÅÍÈÉ ÏÎÊÀÇÀÒÅËÅÉ ÊËÅÒÎ×ÍÎÃÎ ÈÌÌÓÍÈÒÅÒÀ Ó ÐÅÂÀÊÖÈÍÈÐÎÂÀÍÍÛÕ...................................................................................................................................................... 63
3. ÄÈÍÀÌÈÊÀ ÏÎÊÀÇÀÒÅËÅÉ ÃÓÌÎÐÀËÜÍÎÃÎ ÈÌÌÓÍÈÒÅÒÀ............................................................................. 65
4. ÏÎÊÀÇÀÒÅËÈ ÑÏÅÖÈÔÈ×ÅÑÊÎÃÎ ÀÍÒÈÒÎÊÑÈ×ÅÑÊÎÃÎ ÈÌÌÓÍÈÒÅÒÀ..................................................... 66
4.1. ÑÏÅÖÈÔÈ×ÅÑÊÈÉ ÈÌÌÓÍÈÒÅÒ Ó ÄÅÒÅÉ, ÏÐÈÂÈÂÀÂØÈÕÑß ÄÎ ÂÛßÂËÅÍÈß ÎÍÊÎËÎÃÈ×ÅÑÊÎÃÎ ÇÀÁÎËÅÂÀÍÈß........................................................................................................................................................................ 66
... , â êîòîðûõ îïðåäåëåíû ñðîêè è ïîäõîäû ê ïðîâåäåíèþ âàêöèíàöèè äàííîãî êîíòèíãåíòà äåòåé. Ðàçðàáîòàííûå ìåòîäè÷åñêèå ðåêîìåíäàöèè ïîçâîëÿò â ìàñøòàáàõ âñåé ñòðàíû ïðîâîäèòü ïðîôèëàêòè÷åñêóþ âàêöèíàöèþ ïðîòèâ äèôòåðèè è ñòîëáíÿêà äåòÿì, èìåþùèì â àíàìíåçå ñîëèäíûå îïóõîëè. Ìàòåðèàëû è ìåòîäû èññëåäîâàíèÿ. Ìû îáñëåäîâàëè 120 äåòåé ñ ðàçëè÷íûìè íîçîëîãèÿìè â âîçðàñòå îò 4 äî 15 ëåò, íàõîäÿùèõñÿ â ...
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