{"id":10035,"date":"2020-04-23T04:54:35","date_gmt":"2020-04-23T01:54:35","guid":{"rendered":"https:\/\/www.synevo.ro\/product\/anti-hcv-confirmare\/"},"modified":"2025-02-05T15:07:35","modified_gmt":"2025-02-05T13:07:35","slug":"anti-hcv-confirmare","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/anti-hcv-confirmare\/","title":{"rendered":"\u0410\u043d\u0442\u0438-HCV (\u043f\u043e\u0434\u0442\u0432\u0435\u0440\u0436\u0434\u0435\u043d\u0438\u0435)"},"content":{"rendered":"

Utilitatea testului<\/em><\/strong><\/span><\/p>\n

Acest test este util pentru a confirma prezen\u0163a anticorpilor IgG specifici<\/span> fa\u0163a de virusul hepatitei C \u00een probele de ser care au dat rezultate reactive (pozitive) la testele screening anti-HCV (efectuate prin tehnici ELISA sau similare acestora). Este folosit mai ales\u00a0\u00een b\u0103ncile de s\u00e2nge. Spre deosebire de testele screening, testul de confirmare permite, prin separarea electroforetic\u0103 a antigenelor, o detectare a anticorpilor asocia\u0163i cu diferite etape ale infec\u0163iei1;2;3;4;5<\/sup>.<\/span><\/p>\n

Datorit\u0103 \u00eembun\u0103t\u0103\u0163irii performan\u0163ei testelor screening \u015fi dezvolt\u0103rii tehnicilor moleculare testul de confirmare este din ce\u00a0\u00een ce mai mult rezervat cazurilor\u00a0\u00een care s-au ob\u0163inut rezultate slab pozitive<\/span> la etapa de screening1;3<\/sup>.<\/span><\/p>\n

Preg\u0103tire pacient <\/em><\/strong>\u2013 preferabil \u00e0 jeun (pe nem\u00e2ncate)4<\/sup>.<\/span><\/p>\n

Specimen recoltat <\/em><\/strong>\u2013 s\u00e2nge venos4<\/sup>.<\/span><\/p>\n

Recipient de recoltare <\/em><\/strong>\u2013 vacutainer f\u0103r\u0103 anticoagulant cu\/f\u0103r\u0103 gel separator4<\/sup>.<\/span><\/p>\n

Prelucrare necesar\u0103 dup\u0103 recoltare <\/em><\/strong>\u2013 se separ\u0103 serul prin centrifugare \u00een ziua recolt\u0103rii4<\/sup>.<\/span><\/p>\n

Volum prob\u0103 <\/em><\/strong>\u2013 minim 2 mL ser4<\/sup>.<\/span><\/p>\n

Cauze de respingere a probei <\/em><\/strong>\u2013\u00a0 specimen intens hemolizat; specimen contaminat bacterian4<\/sup>.<\/span><\/p>\n

Stabilitate prob\u0103 <\/em><\/strong>\u2013 serul este stabil 6 zile<\/em> \u00een condi\u0163ii ambientale; 7 zile la 2-8\u00b0C; timp \u00eendelungat<\/em> la -20\u00b0C; evita\u0163i decongelarea\/recongelarea repetat\u01034<\/sup>.<\/span><\/p>\n

Metod\u0103 <\/i><\/b>- Imunoblot<\/span><\/span><\/p>\n

Testul utilizeaz\u0103 6 antigene HCV recombinate purificate, relevante serologic, care sunt separate pe baza greut\u0103\u0163ii moleculare prin electroforez\u0103 \u00een gel de poliacrilamid\u0103 \u00een prezen\u0163\u0103 de sodium dodecil sulfat (SDS-PAGE) \u015fi transferate ulterior electroforetic pe o membran\u0103 de nitroceluloz\u0103 (Western blotting). Situsurile de legare libere de pe membran\u0103 sunt saturate cu o solu\u0163ie de proteine, dup\u0103 care matricea este sp\u0103lat\u0103 \u015fi t\u0103iat\u0103 \u00een f\u00e2\u015fii (strip-uri). Antigenele sunt reprezentate, \u00een ordinea fix\u0103rii pe strip, de:<\/span><\/p>\n

- Core 1 \u015fi Core 2<\/b>: proteine structurale provenite din regiunea core care formeaz\u0103 cea mai mare parte a nucleocapsidei virale;<\/span><\/div>\n
-\u00a0Helicaz\u0103<\/b>: protein\u0103 nonstructural\u0103\/parte din NS3 cu activitate de helicaz\u0103 viral\u0103;<\/span><\/div>\n
-\u00a0NS-3<\/b>: protein\u0103 nonstructural\u0103 cu activitate de helicaz\u0103 viral\u0103 \u015fi proteaz\u0103;<\/span><\/div>\n
-\u00a0NS-4<\/b>: protein\u0103 nonstructural\u0103;<\/span><\/div>\n
-\u00a0NS-5<\/b>: protein\u0103 nonstructural\u0103.<\/span><\/div>\n

\u00centr-o prim\u0103 etap\u0103 strip-ul \u00eenc\u0103rcat cu antigenele HCV este incubat \u00eempreun\u0103 cu serul diluat al pacientului. Dac\u0103 \u00een ser sunt prezen\u0163i anticorpi specifici ace\u015ftia se vor lega de antigenele corespunz\u0103toare de pe strip. Dup\u0103 o etap\u0103 de sp\u0103lare, strip-ul este incubat cu un conjugat anti-IgG uman marcat cu peroxidaz\u0103. Conjugatul se va ata\u015fa la por\u0163iunea IgG a complexului antigen-anticorp. Dup\u0103 \u00eendep\u0103rtarea prin sp\u0103lare a conjugatului nelegat se adaug\u0103 solu\u0163ia de colorare \u2013 un sistem de detec\u0163ie enzimatic\u0103 colorimetric\u0103 care con\u0163ine peroxid de hidrogen \u015fi 4-cloro-1-naftol. Dac\u0103 este prezent conjugatul legat reac\u0163ia enzimatic\u0103 va genera un produs colorat albastru-\u00eenchis la nivelul benzilor ocupate de anticorpi specifici. Astfel, benzile vizualizate la nivelul stripului sunt rezultatul leg\u0103rii \u00a0anticorpilor specifici de antigenele individuale recombinate de la nivelul strip-ului.<\/span><\/p>\n

Prin acest test sunt detecta\u0163i anticorpii specifici fa\u0163\u0103 de cele 6 genotipuri HCV4<\/sup>.<\/span><\/p>\n

Valori de referin\u0163\u0103 <\/i><\/b>\u00a0\u0438<\/i><\/b> interpretarea rezultatelor<\/i><\/b><\/span><\/p>\n

Intensitatea benzilor probelor este comparat\u0103 cu cea a benzii controlului cut-off prezent pe fiecare strip. Sunt posibile urm\u0103toarele exprim\u0103ri semicantitative:<\/span><\/p>\n

Intensitate band\u0103<\/b><\/span><\/p>\n\n\n\n\n\n\n\n\n
\u00a0<\/span><\/td>\nExprimare rezultat<\/b><\/span><\/td>\n<\/tr>\n
Absent\u0103<\/span><\/td>\n-<\/span><\/td>\n<\/tr>\n
Intensitate mai mic\u0103 dec\u00e2t cea a benzii controlului cut-off<\/span><\/td>\n+\/-<\/span><\/td>\n<\/tr>\n
Intensitate comparabil\u0103 cu cea a benzii controlului cut-off<\/span><\/td>\n+<\/span><\/td>\n<\/tr>\n
Intensitate mai mare dec\u00e2t cea a benzii controlului cut-off<\/span><\/td>\n++<\/span><\/td>\n<\/tr>\n
Intensitate foarte mare<\/span><\/td>\n+++<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Interpretarea definitiv\u0103 a rezultatelor testului se face cu ajutorul unui software (dup\u0103 scanarea strip-urilor), criteriile utilizate fiind men\u0163ionate \u00een tabelul de mai jos4<\/sup>:<\/span><\/p>\n

\n\n\n\n\n\n\n
\u00a0Criterii<\/b><\/span><\/td>\n\n

Rezultat test Imunoblot<\/b><\/span><\/p>\n<\/td>\n<\/tr>\n

\u2022 Niciun antigen \u2265 control cut-off \u0438\u043b\u0438<\/span>\u2022 NS3, NS4 sau NS5 izolate \u2265 control cut-off<\/span><\/td>\n\n

Negativ<\/span><\/p>\n<\/td>\n<\/tr>\n

\u2022 Core 1 izolat \u2265 control cut-off \u0438\u043b\u0438<\/span>\u2022 Core 2 izolat \u2265 control cut-off \u0438\u043b\u0438<\/span><\/span><\/p>\n

\u2022 Helicaz\u0103 izolat\u0103\u2265 control cut-off \u0438\u043b\u0438<\/span><\/span><\/p>\n

\u2022 Helicaz\u0103 \u015fi o protein\u0103 NS (NS3, NS4 sau NS5) \u2265 control cut-off \u0438\u043b\u0438<\/span><\/span><\/p>\n

\u2022 Alte 2 antigene \u2265 control cut-off<\/span><\/td>\n

\n

Echivoc<\/span><\/p>\n<\/td>\n<\/tr>\n

\u2022 Core 1 \u015fi Core 2 \u2265 control cut-off \u0438\u043b\u0438<\/span>\u2022 Core 1 \u015fi un alt antigen \u2265 control cut-off \u0438\u043b\u0438<\/span><\/span><\/p>\n

\u2022 Core 2 \u015fi un alt antigen \u2265 control cut-off \u0438\u043b\u0438<\/span><\/span><\/p>\n

\u2022 3 antigene \u2265 control cut-off<\/span><\/td>\n

\n

Pozitiv<\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n

Un rezultat pozitiv confirm\u0103 prezen\u0163a anticorpilor specifici anti-HCV datora\u0163i unei infec\u0163ii \u00een antecedente sau cronice.<\/span><\/p>\n

Un rezultat echivoc indic\u0103 faptul c\u0103 prezen\u0163a anticorpilor anti-HCV este incert\u0103; testul trebuie repetat la un interval de 3-4 s\u0103pt\u0103m\u00e2ni pentru a determina statusul definitiv anti-HCV. Sunt posibile urm\u0103toarele situa\u0163ii \u00een cazul unui rezultat echivoc:<\/span><\/p>\n

\u2013 reactivitate specific\u0103 \u00een cursul fazei de seroconversie (la repetarea testului se va ob\u0163ine un rezultat pozitiv);<\/span><\/div>\n
\u2013\u00a0produc\u0163ia limitat\u0103 a unui anticorp specific la pacien\u0163i imunodeprima\u0163i;<\/span><\/div>\n
\u2013 reactivitate nespecific\u0103.<\/span><\/div>\n

Rezultatele echivoce trebuie interpretate \u00een contextul clinic \u015fi epidemiologic al\u00a0pacientului (existen\u0163a factorilor de risc pentru infec\u0163ia HCV). La pacien\u0163ii imunodeprima\u0163i cu risc crescut de a dezvolta infec\u0163ie, dar care prezint\u0103 un rezultat echivoc la testul de confirmare se indic\u0103 ARN viral hepatit\u0103 C.<\/span><\/p>\n

Un rezultat negativ indic\u0103 absen\u0163a anticorpilor specifici anti-HCV \u015fi un rezultat fals-pozitiv la testele screening1;2;3<\/sup>.<\/span><\/p>\n

Analiza r\u0103spunsului imun dup\u0103 o infec\u0163ie HCV recent\u0103 indic\u0103 faptul c\u0103 anticorpii fa\u0163\u0103 de NS3 \u015fi antigenul core apar \u00een mod obi\u015fnuit cu c\u00e2teva s\u0103pt\u0103m\u00e2ni \u00eenaintea anticorpilor anti- NS4 \u015fi NS5. \u00cen timp ce anticorpii anti-NS3 sunt aproape \u00eentotdeauna detectabili, anticorpii fa\u0163\u0103 de antigenul core pot fi ini\u0163ial absen\u0163i, \u00een special \u00een cazul infec\u0163iilor auto-limitante sau asimptomatice, \u015fi la aproximativ o treime din pacien\u0163i nu apar dec\u00e2t \u00een faza cronic\u0103.<\/span><\/p>\n

\u00cen infec\u0163ia HCV cronic\u0103 apare de obicei \u00eentreaga palet\u0103 de anticorpi. Cu toate acestea, intensitatea benzilor variaz\u0103 semnificativ \u00een\u00a0 decursul infec\u0163iei. \u00cen eventualitatea unui spectru incomplet de benzi, care este \u00eent\u00e2lnit\u00a0 \u00een special la pacien\u0163ii imunodeprima\u0163i, anticorpii anti-NS4 \u015fi anti-NS5 sunt \u00een mod obi\u015fnuit absen\u0163i.<\/span><\/p>\n

Dup\u0103 vindecarea infec\u0163iei HCV anticorpii specifici dispar de obicei \u00een decurs de c\u00e2\u0163iva ani; anticorpii fa\u0163\u0103 de antigenul core persist\u0103 cel mai mult2<\/sup>.<\/span><\/p>\n

Limite \u015fi interferen\u0163e<\/i><\/b><\/span><\/p>\n

O band\u0103 NS4 izolat\u0103 reprezint\u0103 cel mai adesea o reac\u0163ie nespecific\u0103. Benzi NS3 sau NS4 izolate pot fi depistate \u00een serul unor pacien\u0163i c\u0103rora li s-a administrat s\u00e2nge sau alte derivate2<\/sup>.<\/span><\/div>\n
De asemenea, o band\u0103 NS5 izolat\u0103 poate s\u0103 apar\u0103 la pacien\u0163ii av\u00e2nd infec\u0163ie acut\u0103 cu virusul Epstein-Barr4<\/sup>.<\/span><\/div>\n

\u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/span><\/strong><\/p>\n

1.\u00a0ARUP Laboratories. Test Directory. Hepatitis C Virus Antibody, RIBA. www.aruplab.com. Ref Type: Internet Communication, 2014.<\/span><\/span><\/div>\n
2.\u00a0Gert Fr\u00f6sner. Viral hepatitis. In Clinical Laboratory Diagnostics-Use and Assessment of Clinical Laboratory Results.<\/i> Lothar Thomas. TH-Books Verlagsgesellschaft mbH, Frankfurt \/Main, Germany,1 ed. 1998, 1275-1276.<\/span><\/div>\n
3.\u00a0Guidelines for Laboratory Testing and Result Reporting of Antibody to Hepatitis C Virus. CDC. Morbidity and Mortality Weekly Report; February 7, 2003 \/ Vol. 52 \/ No. RR-3.<\/span><\/div>\n
4.\u00a0Laborator Synevo. Referin\u0163ele specifice tehnologiei de lucru utilizate.\u00a0 2014. Ref Type: Catalog<\/span><\/div>\n
5.\u00a0Mayo Clinic\/Mayo Medical Laboratories. Test Catalog. Hepatitis C Virus Antibody Confirmation, Serum. \u00a0www.mayomedicallaboratories.com. Ref Type: Internet Communication, 2014.<\/span><\/div>\n

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\u0421\u043f\u0435\u0446\u0438\u0444\u0438\u0447\u0435\u0441\u043a\u0438\u0435 \u0438\u043c\u043c\u0443\u043d\u043e\u0433\u043b\u043e\u0431\u0443\u043b\u0438\u043d\u044b \u0432\u044b\u0440\u0430\u0431\u0430\u0442\u044b\u0432\u0430\u044e\u0442\u0441\u044f \u043a \u044f\u0434\u0440\u0443 \u0432\u0438\u0440\u0443\u0441\u0430 (\u043d\u0443\u043a\u043b\u0435\u043e\u043a\u0430\u043f\u0441\u0438\u0434\u043d\u043e\u043c\u0443 \u0431\u0435\u043b\u043a\u0443 core), \u043e\u0431\u043e\u043b\u043e\u0447\u043a\u0435 \u0432\u0438\u0440\u0443\u0441\u0430 (\u043d\u0443\u043a\u043b\u0435\u043e\u043f\u0440\u043e\u0442\u0435\u0438\u043d\u0430\u043c \u04151-\u04152) \u0438 \u0444\u0440\u0430\u0433\u043c\u0435\u043d\u0442\u0430\u043c \u0433\u0435\u043d\u043e\u043c\u0430 \u0432\u0438\u0440\u0443\u0441\u0430 \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u0430 \u0421 (\u043d\u0435\u0441\u0442\u0440\u0443\u043a\u0442\u0443\u0440\u043d\u044b\u043c \u0431\u0435\u043b\u043a\u0430\u043c NS). \u0423 \u0431\u043e\u043b\u044c\u0448\u0438\u043d\u0441\u0442\u0432\u0430 \u0431\u043e\u043b\u044c\u043d\u044b\u0445 \u0412\u0413\u0421 \u043f\u0435\u0440\u0432\u044b\u0435 \u0430\u043d\u0442\u0438\u0442\u0435\u043b\u0430 \u043f\u043e\u044f\u0432\u043b\u044f\u044e\u0442\u0441\u044f \u0447\u0435\u0440\u0435\u0437 1-3 \u043c\u0435\u0441\u044f\u0446\u0430 \u043f\u043e\u0441\u043b\u0435 \u0438\u043d\u0444\u0438\u0446\u0438\u0440\u043e\u0432\u0430\u043d\u0438\u044f, \u043d\u043e \u0438\u043d\u043e\u0433\u0434\u0430 \u043c\u043e\u0433\u0443\u0442 \u043e\u0442\u0441\u0443\u0442\u0441\u0442\u0432\u043e\u0432\u0430\u0442\u044c \u0432 \u043a\u0440\u043e\u0432\u0438 \u0431\u043e\u043b\u044c\u0448\u0435 \u0433\u043e\u0434\u0430. \u0412 5 % \u0441\u043b\u0443\u0447\u0430\u0435\u0432 \u0430\u043d\u0442\u0438\u0442\u0435\u043b\u0430 \u043a \u0432\u0438\u0440\u0443\u0441\u0443 \u0442\u0430\u043a \u043d\u0438\u043a\u043e\u0433\u0434\u0430 \u0438 \u043d\u0435 \u043e\u0431\u043d\u0430\u0440\u0443\u0436\u0438\u0432\u0430\u044e\u0442\u0441\u044f. \u041f\u0440\u0438 \u044d\u0442\u043e\u043c \u043e \u0412\u0413C \u0431\u0443\u0434\u0435\u0442 \u0441\u0432\u0438\u0434\u0435\u0442\u0435\u043b\u044c\u0441\u0442\u0432\u043e\u0432\u0430\u0442\u044c \u0432\u044b\u044f\u0432\u043b\u0435\u043d\u0438\u0435 \u0441\u0443\u043c\u043c\u0430\u0440\u043d\u044b\u0445 \u0430\u043d\u0442\u0438\u0442\u0435\u043b \u043a \u0430\u043d\u0442\u0438\u0433\u0435\u043d\u0430\u043c \u0432\u0438\u0440\u0443\u0441\u0430 \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u0430 \u0421.<\/p>\n

\u0412 \u043e\u0441\u0442\u0440\u044b\u0439 \u043f\u0435\u0440\u0438\u043e\u0434 \u0431\u043e\u043b\u0435\u0437\u043d\u0438 \u043e\u0431\u0440\u0430\u0437\u0443\u044e\u0442\u0441\u044f \u0430\u043d\u0442\u0438\u0442\u0435\u043b\u0430 \u043a\u043b\u0430\u0441\u0441\u043e\u0432 IgM \u0438 IgG \u043a \u043d\u0443\u043a\u043b\u0435\u043e\u043a\u0430\u043f\u0441\u0438\u0434\u043d\u043e\u043c\u0443 \u0431\u0435\u043b\u043a\u0443 core. \u0412 \u043f\u0435\u0440\u0438\u043e\u0434 \u043b\u0430\u0442\u0435\u043d\u0442\u043d\u043e\u0433\u043e \u0442\u0435\u0447\u0435\u043d\u0438\u044f \u0438\u043d\u0444\u0435\u043a\u0446\u0438\u0438 \u0438 \u043f\u0440\u0438 \u0435\u0435 \u0440\u0435\u0430\u043a\u0442\u0438\u0432\u0430\u0446\u0438\u0438 \u0432 \u043a\u0440\u043e\u0432\u0438 \u043f\u0440\u0438\u0441\u0443\u0442\u0441\u0442\u0432\u0443\u044e\u0442 \u0430\u043d\u0442\u0438\u0442\u0435\u043b\u0430 \u043a\u043b\u0430\u0441\u0441\u0430 IgG \u043a \u043d\u0435\u0441\u0442\u0440\u0443\u043a\u0442\u0443\u0440\u043d\u044b\u043c \u0431\u0435\u043b\u043a\u0430\u043c NS \u0438 \u043d\u0443\u043a\u043b\u0435\u043e\u043a\u0430\u043f\u0441\u0438\u0434\u043d\u043e\u043c\u0443 \u0431\u0435\u043b\u043a\u0443 core.<\/p>\n

\u041f\u043e\u0441\u043b\u0435 \u043f\u0435\u0440\u0435\u043d\u0435\u0441\u0435\u043d\u043d\u043e\u0439 \u0438\u043d\u0444\u0435\u043a\u0446\u0438\u0438 \u0441\u043f\u0435\u0446\u0438\u0444\u0438\u0447\u0435\u0441\u043a\u0438\u0435 \u0438\u043c\u043c\u0443\u043d\u043e\u0433\u043b\u043e\u0431\u0443\u043b\u0438\u043d\u044b \u0446\u0438\u0440\u043a\u0443\u043b\u0438\u0440\u0443\u044e\u0442 \u0432 \u043a\u0440\u043e\u0432\u0438 8-10 \u043b\u0435\u0442 \u0441 \u043f\u043e\u0441\u0442\u0435\u043f\u0435\u043d\u043d\u044b\u043c \u0441\u043d\u0438\u0436\u0435\u043d\u0438\u0435\u043c \u043a\u043e\u043d\u0446\u0435\u043d\u0442\u0440\u0430\u0446\u0438\u0438 \u0438\u043b\u0438 \u0441\u043e\u0445\u0440\u0430\u043d\u044f\u044e\u0442\u0441\u044f \u043f\u043e\u0436\u0438\u0437\u043d\u0435\u043d\u043d\u043e \u0432 \u043e\u0447\u0435\u043d\u044c \u043d\u0438\u0437\u043a\u0438\u0445 \u0442\u0438\u0442\u0440\u0430\u0445. \u041e\u043d\u0438 \u043d\u0435 \u0437\u0430\u0449\u0438\u0449\u0430\u044e\u0442 \u043e\u0442 \u0432\u0438\u0440\u0443\u0441\u043d\u043e\u0439 \u0438\u043d\u0444\u0435\u043a\u0446\u0438\u0438 \u0438 \u043d\u0435 \u0441\u043d\u0438\u0436\u0430\u044e\u0442 \u0440\u0438\u0441\u043a\u0430 \u043f\u043e\u0432\u0442\u043e\u0440\u043d\u043e\u0433\u043e \u0437\u0430\u0440\u0430\u0436\u0435\u043d\u0438\u044f \u0438 \u0440\u0430\u0437\u0432\u0438\u0442\u0438\u044f \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f.<\/p>\n

\u0414\u043b\u044f \u0447\u0435\u0433\u043e \u0438\u0441\u043f\u043e\u043b\u044c\u0437\u0443\u0435\u0442\u0441\u044f \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0435?<\/strong><\/p>\n

    \n
  1. \u0414\u043b\u044f \u0434\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u043a\u0438 \u0432\u0438\u0440\u0443\u0441\u043d\u043e\u0433\u043e \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u0430 \u0421.<\/li>\n
  2. \u0414\u043b\u044f \u0434\u0438\u0444\u0444\u0435\u0440\u0435\u043d\u0446\u0438\u0430\u043b\u044c\u043d\u043e\u0439 \u0434\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u043a\u0438 \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u043e\u0432.<\/li>\n
  3. \u0414\u043b\u044f \u0432\u044b\u044f\u0432\u043b\u0435\u043d\u0438\u044f \u0440\u0430\u043d\u0435\u0435 \u043f\u0435\u0440\u0435\u043d\u0435\u0441\u0435\u043d\u043d\u043e\u0433\u043e \u0432\u0438\u0440\u0443\u0441\u043d\u043e\u0433\u043e \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u0430 \u0421.<\/li>\n<\/ol>\n

    \u041a\u043e\u0433\u0434\u0430 \u043d\u0430\u0437\u043d\u0430\u0447\u0430\u0435\u0442\u0441\u044f \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0435?<\/strong><\/p>\n

      \n
    1. \u041f\u0440\u0438 \u0441\u0438\u043c\u043f\u0442\u043e\u043c\u0430\u0445 \u0432\u0438\u0440\u0443\u0441\u043d\u043e\u0433\u043e \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u0430 \u0438 \u043f\u043e\u0432\u044b\u0448\u0435\u043d\u0438\u0438 \u0443\u0440\u043e\u0432\u043d\u044f \u043f\u0435\u0447\u0435\u043d\u043e\u0447\u043d\u044b\u0445 \u0442\u0440\u0430\u043d\u0441\u0430\u043c\u0438\u043d\u0430\u0437.<\/li>\n
    2. \u0415\u0441\u043b\u0438 \u0438\u0437\u0432\u0435\u0441\u0442\u043d\u043e \u043e \u043f\u0435\u0440\u0435\u043d\u0435\u0441\u0435\u043d\u043d\u043e\u043c \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u0435 \u043d\u0435\u0443\u0442\u043e\u0447\u043d\u0435\u043d\u043d\u043e\u0439 \u044d\u0442\u0438\u043e\u043b\u043e\u0433\u0438\u0438.<\/li>\n
    3. \u041f\u0440\u0438 \u043e\u0431\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0438 \u043b\u044e\u0434\u0435\u0439 \u0438\u0437 \u0433\u0440\u0443\u043f\u043f\u044b \u0440\u0438\u0441\u043a\u0430 \u043f\u043e \u0437\u0430\u0440\u0430\u0436\u0435\u043d\u0438\u044e \u0432\u0438\u0440\u0443\u0441\u043d\u044b\u043c \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u043e\u043c \u0421.<\/li>\n
    4. \u041f\u0440\u0438 \u0441\u043a\u0440\u0438\u043d\u0438\u043d\u0433\u043e\u0432\u044b\u0445 \u043e\u0431\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u044f\u0445.<\/li>\n<\/ol>\n

      \u0427\u0442\u043e \u043e\u0437\u043d\u0430\u0447\u0430\u044e\u0442 \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442\u044b?<\/strong><\/p>\n

      \u0420\u0435\u0444\u0435\u0440\u0435\u043d\u0441\u043d\u044b\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u044f<\/strong>: \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442 \u043e\u0442\u0440\u0438\u0446\u0430\u0442\u0435\u043b\u044c\u043d\u044b\u0439.<\/p>\n

      \u041e\u0442\u0440\u0438\u0446\u0430\u0442\u0435\u043b\u044c\u043d\u044b\u0439 \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442<\/strong>:<\/p>\n

        \n
      • \u043e\u0442\u0441\u0443\u0442\u0441\u0442\u0432\u0438\u0435 \u0432\u0438\u0440\u0443\u0441\u0430 \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u0430 \u0421 \u0432 \u043e\u0440\u0433\u0430\u043d\u0438\u0437\u043c\u0435;<\/li>\n
      • \u0440\u0430\u043d\u043d\u0438\u0439 \u043f\u0435\u0440\u0438\u043e\u0434 \u043f\u043e\u0441\u043b\u0435 \u0438\u043d\u0444\u0438\u0446\u0438\u0440\u043e\u0432\u0430\u043d\u0438\u044f;<\/li>\n
      • \u043e\u0442\u0441\u0443\u0442\u0441\u0442\u0432\u0438\u0435 \u0430\u043d\u0442\u0438\u0442\u0435\u043b \u043f\u0440\u0438 \u0432\u0438\u0440\u0443\u0441\u043d\u043e\u043c \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u0435 \u0421 (\u0441\u0435\u0440\u043e\u043d\u0435\u0433\u0430\u0442\u0438\u0432\u043d\u044b\u0439 \u0432\u0430\u0440\u0438\u0430\u043d\u0442, \u043e\u043a\u043e\u043b\u043e 5 % \u0441\u043b\u0443\u0447\u0430\u0435\u0432).<\/li>\n<\/ul>\n

        \u041f\u043e\u043b\u043e\u0436\u0438\u0442\u0435\u043b\u044c\u043d\u044b\u0439 \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442<\/strong>:<\/p>\n

          \n
        • \u043e\u0441\u0442\u0440\u044b\u0439 \u0438\u043b\u0438 \u0445\u0440\u043e\u043d\u0438\u0447\u0435\u0441\u043a\u0438\u0439 \u0432\u0438\u0440\u0443\u0441\u043d\u044b\u0439 \u0433\u0435\u043f\u0430\u0442\u0438\u0442 \u0421;<\/li>\n
        • \u0440\u0430\u043d\u0435\u0435 \u043f\u0435\u0440\u0435\u043d\u0435\u0441\u0435\u043d\u043d\u044b\u0439 \u0432\u0438\u0440\u0443\u0441\u043d\u044b\u0439 \u0433\u0435\u043f\u0430\u0442\u0438\u0442 \u0421.<\/li>\n<\/ul>\n

          \u0427\u0442\u043e \u043c\u043e\u0436\u0435\u0442 \u0432\u043b\u0438\u044f\u0442\u044c \u043d\u0430 \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442?<\/strong><\/p>\n

          \u0420\u0435\u0432\u043c\u0430\u0442\u043e\u0438\u0434\u043d\u044b\u0439 \u0444\u0430\u043a\u0442\u043e\u0440 \u0432 \u043a\u0440\u043e\u0432\u0438 \u043c\u043e\u0436\u0435\u0442 \u043f\u0440\u0438\u0432\u043e\u0434\u0438\u0442\u044c \u043a \u043b\u043e\u0436\u043d\u043e\u043f\u043e\u043b\u043e\u0436\u0438\u0442\u0435\u043b\u044c\u043d\u043e\u043c\u0443 \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442\u0443.<\/p>\n

          \u0412\u0430\u0436\u043d\u044b\u0435 \u0437\u0430\u043c\u0435\u0447\u0430\u043d\u0438\u044f<\/strong><\/p>\n

          \u0418\u043d\u043a\u0443\u0431\u0430\u0446\u0438\u043e\u043d\u043d\u044b\u0439 \u043f\u0435\u0440\u0438\u043e\u0434 \u043c\u043e\u0436\u0435\u0442 \u0441\u043e\u0441\u0442\u0430\u0432\u043b\u044f\u0442\u044c \u0434\u043e \u043f\u043e\u043b\u0443\u0433\u043e\u0434\u0430, \u043e\u0434\u043d\u0430\u043a\u043e \u0432\u0441\u0451 \u0438\u043d\u0434\u0438\u0432\u0438\u0434\u0443\u0430\u043b\u044c\u043d\u043e \u0438 \u0437\u0430\u0432\u0438\u0441\u0438\u0442 \u043e\u0442 \u0432\u0438\u0440\u0443\u0441\u043d\u043e\u0439 \u0438 \u0431\u0430\u043a\u0442\u0435\u0440\u0438\u0430\u043b\u044c\u043d\u043e\u0439 \u043d\u0430\u0433\u0440\u0443\u0437\u043a\u0438 \u0438 \u0438\u043c\u043c\u0443\u043d\u043d\u043e\u0433\u043e \u043e\u0442\u0432\u0435\u0442\u0430 \u043e\u0440\u0433\u0430\u043d\u0438\u0437\u043c\u0430.<\/p>\n

          \u041f\u0440\u0438 \u043f\u043e\u043b\u043e\u0436\u0438\u0442\u0435\u043b\u044c\u043d\u043e\u043c \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442\u0435 anti-HCV \u0434\u043b\u044f \u043f\u043e\u0434\u0442\u0432\u0435\u0440\u0436\u0434\u0435\u043d\u0438\u044f \u0434\u0438\u0430\u0433\u043d\u043e\u0437\u0430 “\u0432\u0438\u0440\u0443\u0441\u043d\u044b\u0439 \u0433\u0435\u043f\u0430\u0442\u0438\u0442 \u0421” \u0432\u044b\u043f\u043e\u043b\u043d\u044f\u0435\u0442\u0441\u044f \u0442\u0435\u0441\u0442 \u0441 \u043e\u043f\u0440\u0435\u0434\u0435\u043b\u0435\u043d\u0438\u0435\u043c \u0441\u0442\u0440\u0443\u043a\u0442\u0443\u0440\u043d\u044b\u0445 \u0438 \u043d\u0435\u0441\u0442\u0440\u0443\u043a\u0442\u0443\u0440\u043d\u044b\u0445 \u0431\u0435\u043b\u043a\u043e\u0432 \u0432\u0438\u0440\u0443\u0441\u0430 (NS, Core).
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