{"id":10138,"date":"2020-04-23T03:57:42","date_gmt":"2020-04-23T00:57:42","guid":{"rendered":"https:\/\/www.synevo.ro\/product\/metanefrine-libere-plasmatice\/"},"modified":"2025-07-01T07:57:30","modified_gmt":"2025-07-01T04:57:30","slug":"metanefrine-libere-plasmatice","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/metanefrine-libere-plasmatice\/","title":{"rendered":"\u0421\u0432\u043e\u0431\u043e\u0434\u043d\u044b\u0435 \u043c\u0435\u0442\u0430\u043d\u0435\u0444\u0440\u0438\u043d\u044b \u043f\u043b\u0430\u0437\u043c\u044b"},"content":{"rendered":"

Informa\u0163ii generale. Recomand\u0103ri pentru determinarea metanefrinelor plasmatice.<\/em><\/strong><\/span><\/p>\n

Feocromocitomul este o tumor\u0103 cu celule cromafine care \u00ee\u015fi are, \u00een mod tipic, originea \u00een medulosuprarenal\u0103. De\u015fi constituie o cauz\u0103 rar\u0103 de hipertensiune arterial\u0103<\/a>, feocromocitomul trebuie exclus la un procent semnificativ de pacien\u0163i care dezvolt\u0103 HTA sus\u0163inut\u0103 sau episodic\u0103 sau care prezint\u0103 istoric familial pozitiv.<\/p>\n

Diagnosticul acestei tumori depinde \u00een mare m\u0103sur\u0103 de punerea \u00een eviden\u0163\u0103 prin teste de biochimie a produc\u0163iei excesive de catecolamine. Av\u00e2nd \u00een vedere diferen\u0163ele mari de sensibilitate \u015fi specificitate \u00eentre testele biochimice disponibile (determin\u0103rile de catecolamine \u015fi metaboli\u0163i ai acestora), este adesea dificil s\u0103 se exclud\u0103 sau s\u0103 se confirme feocromocitomul la pacien\u0163ii cu suspiciune clinic\u0103. Spre exemplu, catecolaminele (adrenalina \u015fi noradrenalina) sunt produse at\u00e2t de de nervii simpatici c\u00e2t \u015fi de medulosuprarenal\u0103, astfel \u00eenc\u00e2t cre\u015fterile concentra\u0163iei acestora nu sunt specifice pentru feocromocitom.<\/p>\n

Conform datelor actuale, se pare c\u0103 determinarea metanefrinelor libere plasmatice constituie cel mai bun test pentru excluderea feomocromocitomului (vezi anexa 10.1). Avantajul rezult\u0103 dintr-o corelare mai bun\u0103 a concentra\u0163iei metanefrinelor plasmatice cu produc\u0163ia de catecolamine \u015fi metanefrine a celulelor medulosuprarenalei \u015fi a celulelor tumorale \u00een feocromocitom. Sensibilitatea testului se apropie de 100% astfel \u00eenc\u00e2t, la persoanele care prezint\u0103 valori normale, existen\u0163a unui feocromocitom sau paragangliom este exclus\u0103 cu foarte mare probabilitate1;4;5;6<\/sup>.<\/p>\n

Termenul de \u201emetanefrine\u201d include 2 metaboli\u0163i ai catecolaminelor: normetanefrina \u015fi metanefrina, ce deriv\u0103 din norepinefrina \u015fi respectiv epinefrina sub ac\u0163iunea enzimei COMT (catecol-O-metiltransferaza). Ace\u015fti metaboli\u0163i denumi\u0163i \u201emetanefrine libere\u201d sunt stabili, fiind co-secreta\u0163i \u00eempreun\u0103 cu catecolaminele de c\u0103tre feocromocitoame \u015fi alte tumori de creast\u0103 neural\u0103, astfel \u00eenc\u00e2t \u00een afec\u0163iunile men\u0163ionate sunt \u00eent\u00e2lnite \u00een plasm\u0103 cre\u015fteri sus\u0163inute ale nivelului de metanefrine.<\/p>\n

Metanefrinele libere sunt \u00eendep\u0103rtate din circula\u0163ie de c\u0103tre aceea\u015fi transportori extraneuronali care sunt responsabili de \u00eendep\u0103rtarea catecolaminelor. Astfel, ace\u015fti compu\u015fi sunt metaboliza\u0163i ulterior sub ac\u0163iunea monoaminoxdazei (MAO)\u00a0\u00een 3-metoxi-4-hidroxifenilgliol (din care va rezulta\u00a0\u00een final acidul vanilmadelic \u2013 AVM) \u015fi a enzimei SULT1A3 (sulfotransferaza specific\u0103 ce \u201eprefer\u0103\u201d monoaminele)\u00a0\u00een forme sulfat-conjugate.<\/p>\n

Prezen\u0163a acestei izoenzime a sulfotransferazei \u015fi \u00een consecin\u0163\u0103 formarea metanefrinelor sulfoconjugate \u00een celulele cromafine ale medulosuprarenalei sau\u00a0\u00een celulele tumorale din feocromocitom nu a fost demonstrat\u0103. In schimb aceast\u0103 enzim\u0103 se g\u0103se\u015fte\u00a0\u00een cantit\u0103\u0163i mari\u00a0\u00een tractul gastrointestinal, care constituie sursa cea mai important\u0103 de catecolamine sulfoconjugate din organism. Metanefrinele sulfoconjugate sunt eliminate de c\u0103tre rinichi, de aceea\u00a0\u00een prezen\u0163a unei insuficien\u0163e renale \u00eendep\u0103rtarea acestora din circula\u0163ie este mult \u00eencetinit\u01031<\/sup>.<\/p>\n

Testele pentru metanefrinele urinare detecteaz\u0103 astfel \u00een principal formele conjugate \u015fi \u00eentr-un procent foarte redus (<3%) formele libere de metanefrine.<\/p>\n

Deoarece metanefrinele conjugate deriv\u0103 \u00een \u00eentregime din formele libere s-ar putea crede c\u0103 dozarea metanefrinelor libere plasmatice ar trebuie s\u0103 furnizeze rezultate similare cu cele ale determin\u0103rii metanefrinelor urinare. Cu toate acestea, contribu\u0163ia mai mare \u015fi mai variabil\u0103 a norepinefrinei produs\u0103\u00a0\u00een tractul intestinal sub forma sulfoconjugat\u0103\u00a0\u00een compara\u0163ie cu normetanefrina liber\u0103 \u201ecompromite\u201d sensibilitatea \u015fi specificitatea determin\u0103rilor metanefrinelor conjugate fa\u0163\u0103 de cea a formelor libere.<\/p>\n

Datorit\u0103 faptului c\u0103 rinichii sunt foarte pu\u0163in implica\u0163i\u00a0\u00een eliminarea metanefrinelor libere, existen\u0163a unei insuficien\u0163e renale nu influen\u0163eaz\u0103 rezultatul doz\u0103rii metanefrinelor libere. Nu\u00a0\u00een ultimul r\u00e2nd, trebuie men\u0163ionat c\u0103 metanefrinele libere sunt produse continuu de c\u0103tre celulele tumorale, \u00eentr-un mod independent de eliberarea catecolaminelor1;2<\/sup>.<\/p>\n

Testul are de asemenea utilitate \u00een stabilirea progresiei acestui tip de tumor\u01034<\/sup>.<\/p>\n

Preg\u0103tire pacient\u00ad<\/strong><\/h2>\n

\u00e0 jeun (pe nem\u00e2ncate); va evita consumul de alcool \u015fi b\u0103uturi ce con\u0163in cofein\u0103 cu 24 ore \u00eenaintea recolt\u0103rii; de asemenea se va evita administrarea de acetaminofen, antidepresive triciclice, fenoxibenzamina, alfa-agonisti (aldomet) \u015fi inhibitori de monoaminoxidaz\u0103 cu cel pu\u0163in 5 zile \u00eenaintea recolt\u0103rii; dac\u0103 este necesar\u0103 medica\u0163ia antihipertensiv\u0103 se recomand\u0103 folosirea de inhibitori ai enzimei de conversie, blocan\u0163i ai receptorilor pentru angiotensina II \u015fi alfa1-blocan\u0163i adrenergici selectivi (prazosin), care nu influen\u0163eaz\u0103 rezultatele ob\u0163inute5<\/sup>.<\/p>\n

Specimen recoltat\u00ad <\/strong>\u2013 s\u00e2nge venos; vacutainerul se agit\u0103 foarte u\u015for, prin r\u0103sturnare \u015fi se pune imediat pe ghea\u0163\u0103; se transport\u0103 la laborator \u00een maximum 2 ore3<\/sup>.\u00a0<\/strong><\/p>\n

Recipient de recoltare <\/strong>\u2013 vacutainer cu EDTA K3, r\u0103cit \u00eenainte de utilizare (\u0163inut \u00een frigider)3<\/sup>.<\/p>\n

Cantitate recoltat\u0103 <\/strong>\u2013 c\u00e2t permite vacuumul3<\/sup>.<\/p>\n

Cauze de respingere a probei <\/strong>\u2013 specimen hemolizat, icteric, lipemic, heparinat3<\/sup>.<\/p>\n

Prelucrare necesar\u0103 dup\u0103 recoltare <\/strong>\u2013 \u00een maxim 2 ore de la recoltare se separ\u0103 plasma prin centrifugare 15 minute la 1500 x g [g = (1118 + 10-8<\/sup>) x (raza \u00een cm) x (rpm)2<\/sup>]; pentru separarea plasmei se folose\u015fte o pipet\u0103 de plastic; dac\u0103 proba nu poate fi analizat\u0103 imediat va fi congelat\u0103 la -20\u00b0C; probele recoltate \u00een afara sediilor laboratorului vor fi transportate\u00a0\u00een recipientul destinat probelor congelate3<\/sup>.<\/p>\n

Stabilitate prob\u0103 <\/strong>\u2013 plasma separat\u0103 este stabil\u0103 6 ore la 2-8\u00b0C; 6 luni la -20\u00b0C3<\/sup>.<\/p>\n

Metod\u0103 <\/strong>\u2013 ELISA de tip competitiv. Metanefrinele \u015fi normetanefrinele libere plasmatice sunt determinate cantitativ dup\u0103 o etap\u0103 de precipitare. Anticorpii con\u0163inuti \u00een kit recunosc doar formele L relevante biologic ale metanefrinelor3<\/sup>.<\/p>\n

Valori de referin\u0163\u0103 Metanefrine libere plasmatice<\/strong><\/h2>\n
Metanefrina: < 65 pg\/mL<\/div>\n
Normetanefrina: < 196 pg\/mL3<\/sup>.<\/div>\n

Limita de detec\u0163ie:<\/strong><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Metanefrina: 5 pg\/mL<\/div>\n
\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Normetanefrina: 10 pg\/mL3<\/sup>.<\/div>\n
<\/div>\n

Interpretarea rezultatelor<\/strong><\/h2>\n

Diagnosticul de feocromocitom are probabilitate foarte mare \u00een cazurile\u00a0\u00een care se ob\u0163in concentra\u0163ii plasmatice de metanefrine \u015fi\/sau normetanefrine de aproximativ 4 ori mai mari fa\u0163\u0103 de limita superioar\u0103 a valorilor de referin\u0163\u0103. Pentru localizarea tumorii se folosesc tomografia axial\u0103 computerizat\u0103 \u015fi rezonan\u0163a magnetic\u0103 nuclear\u0103. Uneori tumora nu poate fi diagnosticat\u0103 dec\u00e2t prin scintigrafie cu 131<\/sup>I sau meta-iodobenzil-guanidina marcat\u0103 cu 123<\/sup>I (MIBG).<\/p>\n

In cazul unor valori mai pu\u0163in crescute sunt necesare investiga\u0163ii de laborator suplimentare: dozarea metanefrinelor urinare sau a catecolaminelor urinare; testul de supresie cu clonidina5<\/sup>.<\/p>\n

Limite \u015fi interferen\u0163e<\/strong><\/p>\n

Valori crescute ale excre\u0163iei de metanefrine pot fi \u00eent\u00e2lnite \u00een caz de hipoglicemie, de aceea\u00a0se va evita efectuarea testului la pacien\u0163ii care nu se alimenteaz\u0103 per os.<\/p>\n

Valori sc\u0103zute ale excre\u0163iei de metanefrine pot ap\u0103rea dup\u0103 administrarea de substan\u0163e radiologice de contrast4<\/sup>.<\/p>\n

Concentra\u0163iile de normetanefrina plasmatic\u0103 cresc cu v\u00e2rsta astfel c\u0103 pacien\u0163ii v\u00e2rstnici prezint\u0103 o probabilitate mai mare de a ob\u0163ine rezultate fals pozitive; la ace\u015ftia se recomand\u0103 testarea metanefrinelor \u015fi catecolaminelor urinare5<\/sup>.<\/p>\n

\u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/strong><\/h2>\n
1. Graeme Eisenhofer et al. Plasma Metanephrines: A Novel and Cost-Effective Test for Pheocromocytoma. In Brazilian Journal Of Medical and Biological Research (2000) 33:1157-1169.<\/div>\n
2. Graeme Eisenhofer. Free or Total Metanephrines for Diagnosis of Pheocromocytoma: What is the Difference? In Clinical Chemistry 47: 988\/989, 2001.<\/div>\n
3. Laborator Synevo. Referin\u0163ele specifice tehnologiei de lucru utilizate. 2010. Ref Type: Catalog.<\/div>\n
4. Laboratory Corporation of America. Directory of Services and Interpretive Guide. Metanephrines, Fractionated, Plasma Free. www.labcorp.com 2010. Ref Type: Internet Communication.<\/div>\n
5. Richard A. McPetersen, Matthew R. Pincus. Evaluation of Endocrine Function. In Henry\u2019s Clinical Diagnosis and Management by Laboratory Methods- Sauders Elsevier 21-Ed 2007- pg 342-344.<\/div>\n
6. Mayo Clinic\/Mayo Medical Laboratories. Test Catalog. Metanephrines, Fractionated, Free, Plasma. www.mayomedicallaboratories.com<\/a>. Ref Type: Internet Communication.<\/div>","protected":false},"excerpt":{"rendered":"

\u041c\u0435\u0442\u0430\u043d\u0435\u0444\u0440\u0438\u043d\u044b \u2013 \u043a\u043e\u043d\u0435\u0447\u043d\u044b\u0435 \u043f\u0440\u043e\u0434\u0443\u043a\u0442\u044b \u0440\u0430\u0441\u043f\u0430\u0434\u0430 \u043a\u0430\u0442\u0435\u0445\u043e\u043b\u0430\u043c\u0438\u043d\u043e\u0432: \u0430\u0434\u0440\u0435\u043d\u0430\u043b\u0438\u043d\u0430 \u0438 \u043d\u043e\u0440\u0430\u0434\u0440\u0435\u043d\u0430\u043b\u0438\u043d\u0430.<\/p>\n

\u041a\u0430\u0442\u0435\u0445\u043e\u043b\u0430\u043c\u0438\u043d\u044b \u2013 \u044d\u0442\u043e \u0433\u043e\u0440\u043c\u043e\u043d\u044b, \u043a\u043e\u0442\u043e\u0440\u044b\u0435 \u043e\u0431\u0440\u0430\u0437\u0443\u044e\u0442\u0441\u044f \u0432 \u043d\u0430\u0434\u043f\u043e\u0447\u0435\u0447\u043d\u0438\u043a\u0430\u0445, \u043d\u0435\u0431\u043e\u043b\u044c\u0448\u0438\u0445 \u043e\u0440\u0433\u0430\u043d\u0430\u0445 \u0442\u0440\u0435\u0443\u0433\u043e\u043b\u044c\u043d\u043e\u0439 \u0444\u043e\u0440\u043c\u044b, \u0440\u0430\u0441\u043f\u043e\u043b\u043e\u0436\u0435\u043d\u043d\u044b\u0445 \u043d\u0430 \u0432\u0435\u0440\u0445\u043d\u0438\u0445 \u043f\u043e\u043b\u044e\u0441\u0430\u0445 \u043e\u0431\u0435\u0438\u0445 \u043f\u043e\u0447\u0435\u043a. \u0415\u0441\u0442\u044c \u0442\u0440\u0438 \u0432\u0438\u0434\u0430 \u043a\u0430\u0442\u0435\u0445\u043e\u043b\u0430\u043c\u0438\u043d\u043e\u0432: \u0434\u043e\u0444\u0430\u043c\u0438\u043d, \u0430\u0434\u0440\u0435\u043d\u0430\u043b\u0438\u043d (\u044d\u043f\u0438\u043d\u0435\u0444\u0440\u0438\u043d) \u0438 \u043d\u043e\u0440\u0430\u0434\u0440\u0435\u043d\u0430\u043b\u0438\u043d. \u042d\u0442\u0438 \u0433\u043e\u0440\u043c\u043e\u043d\u044b \u0432\u044b\u0431\u0440\u0430\u0441\u044b\u0432\u0430\u044e\u0442\u0441\u044f \u0432 \u043a\u0440\u043e\u0432\u044c \u0432 \u043e\u0442\u0432\u0435\u0442 \u043d\u0430 \u0444\u0438\u0437\u0438\u0447\u0435\u0441\u043a\u043e\u0435 \u043f\u0435\u0440\u0435\u043d\u0430\u043f\u0440\u044f\u0436\u0435\u043d\u0438\u0435 \u0438\u043b\u0438 \u044d\u043c\u043e\u0446\u0438\u043e\u043d\u0430\u043b\u044c\u043d\u044b\u0439 \u0441\u0442\u0440\u0435\u0441\u0441. \u041e\u043d\u0438 \u0443\u0447\u0430\u0441\u0442\u0432\u0443\u044e\u0442 \u0432 \u043f\u0435\u0440\u0435\u0434\u0430\u0447\u0435 \u043d\u0435\u0440\u0432\u043d\u044b\u0445 \u0438\u043c\u043f\u0443\u043b\u044c\u0441\u043e\u0432 \u0432 \u0433\u043e\u043b\u043e\u0432\u043d\u043e\u043c \u043c\u043e\u0437\u0433\u0435, \u043f\u043e\u043c\u043e\u0433\u0430\u044e\u0442 \u0432\u044b\u0441\u0432\u043e\u0431\u043e\u0436\u0434\u0435\u043d\u0438\u044e \u0433\u043b\u044e\u043a\u043e\u0437\u044b \u0438 \u0436\u0438\u0440\u043d\u044b\u0445 \u043a\u0438\u0441\u043b\u043e\u0442 (\u043a\u043e\u0442\u043e\u0440\u044b\u0435 \u0438\u0441\u043f\u043e\u043b\u044c\u0437\u0443\u044e\u0442\u0441\u044f \u0432 \u043a\u0430\u0447\u0435\u0441\u0442\u0432\u0435 \u0438\u0441\u0442\u043e\u0447\u043d\u0438\u043a\u0430 \u044d\u043d\u0435\u0440\u0433\u0438\u0438), \u0443\u0432\u0435\u043b\u0438\u0447\u0438\u0432\u0430\u044e\u0442 \u043d\u0435\u0431\u043e\u043b\u044c\u0448\u0438\u0435 \u0431\u0440\u043e\u043d\u0445\u0438 \u0432 \u043b\u0435\u0433\u043a\u0438\u0445, \u0430 \u0442\u0430\u043a\u0436\u0435 \u0441\u043f\u043e\u0441\u043e\u0431\u0441\u0442\u0432\u0443\u044e\u0442 \u0440\u0430\u0441\u0448\u0438\u0440\u0435\u043d\u0438\u044e \u0437\u0440\u0430\u0447\u043a\u043e\u0432. \u041d\u043e\u0440\u0430\u0434\u0440\u0435\u043d\u0430\u043b\u0438\u043d \u0442\u0430\u043a\u0436\u0435 \u0441\u0443\u0436\u0430\u0435\u0442 \u043a\u0440\u043e\u0432\u0435\u043d\u043e\u0441\u043d\u044b\u0435 \u0441\u043e\u0441\u0443\u0434\u044b, \u0447\u0442\u043e \u043f\u0440\u0438\u0432\u043e\u0434\u0438\u0442 \u043a \u043f\u043e\u0434\u044a\u0435\u043c\u0443 \u0430\u0440\u0442\u0435\u0440\u0438\u0430\u043b\u044c\u043d\u043e\u0433\u043e \u0434\u0430\u0432\u043b\u0435\u043d\u0438\u044f, \u0430 \u0430\u0434\u0440\u0435\u043d\u0430\u043b\u0438\u043d \u043f\u043e\u0432\u044b\u0448\u0430\u0435\u0442 \u0447\u0430\u0441\u0442\u043e\u0442\u0443 \u0441\u0435\u0440\u0434\u0435\u0447\u043d\u044b\u0445 \u0441\u043e\u043a\u0440\u0430\u0449\u0435\u043d\u0438\u0439 \u0438 \u0443\u0441\u043a\u043e\u0440\u044f\u0435\u0442 \u043e\u0431\u043c\u0435\u043d \u0432\u0435\u0449\u0435\u0441\u0442\u0432.<\/p>\n

\u041f\u043e\u0441\u043b\u0435 \u0432\u044b\u043f\u043e\u043b\u043d\u0435\u043d\u0438\u044f \u0441\u0432\u043e\u0435\u0439 \u0444\u0443\u043d\u043a\u0446\u0438\u0438 \u0432 \u043e\u0440\u0433\u0430\u043d\u0438\u0437\u043c\u0435 \u043a\u0430\u0442\u0435\u0445\u043e\u043b\u0430\u043c\u0438\u043d\u044b \u043f\u0440\u0435\u0432\u0440\u0430\u0449\u0430\u044e\u0442\u0441\u044f \u0432 \u043d\u0435\u0430\u043a\u0442\u0438\u0432\u043d\u044b\u0435 \u0444\u043e\u0440\u043c\u044b: \u0434\u043e\u0444\u0430\u043c\u0438\u043d \u2013 \u0432 \u0433\u043e\u043c\u043e\u0432\u0430\u043d\u0438\u043b\u0438\u043d\u043e\u0432\u0443\u044e \u043a\u0438\u0441\u043b\u043e\u0442\u0443, \u043d\u043e\u0440\u0430\u0434\u0440\u0435\u043d\u0430\u043b\u0438\u043d \u2013 \u0432 \u043d\u043e\u0440\u043c\u0435\u0442\u0430\u043d\u0435\u0444\u0440\u0438\u043d \u0438 \u0432\u0430\u043d\u0438\u043b\u0438\u043b\u043c\u0438\u043d\u0434\u0430\u043b\u044c\u043d\u0443\u044e \u043a\u0438\u0441\u043b\u043e\u0442\u0443, \u0430 \u0430\u0434\u0440\u0435\u043d\u0430\u043b\u0438\u043d \u2013 \u0432 \u043c\u0435\u0442\u0430\u043d\u0435\u0444\u0440\u0438\u043d \u0438 \u0432\u0430\u043d\u0438\u043b\u0438\u043b\u043c\u0438\u043d\u0434\u0430\u043b\u044c\u043d\u0443\u044e \u043a\u0438\u0441\u043b\u043e\u0442\u0443. \u041f\u0440\u0438 \u044d\u0442\u043e\u043c \u0441\u043e\u0432\u0440\u0435\u043c\u0435\u043d\u043d\u044b\u0435 \u0430\u043d\u0430\u043b\u0438\u0437\u0430\u0442\u043e\u0440\u044b \u043f\u043e\u0437\u0432\u043e\u043b\u044f\u044e\u0442 \u0440\u0430\u0437\u043b\u0438\u0447\u0438\u0442\u044c \u0441\u0432\u043e\u0431\u043e\u0434\u043d\u0443\u044e \u0438 \u0441\u0432\u044f\u0437\u0430\u043d\u043d\u0443\u044e \u0444\u043e\u0440\u043c\u0443 \u043c\u0435\u0442\u0430\u043d\u0435\u0444\u0440\u0438\u043d\u043e\u0432 \u0432 \u0431\u0438\u043e\u043c\u0430\u0442\u0435\u0440\u0438\u0430\u043b\u0435.<\/p>\n

\u0414\u0430\u043d\u043d\u044b\u0439 \u0430\u043d\u0430\u043b\u0438\u0437 \u044f\u0432\u043b\u044f\u0435\u0442\u0441\u044f \u0433\u043e\u0440\u0430\u0437\u0434\u043e \u0431\u043e\u043b\u0435\u0435 \u0447\u0443\u0432\u0441\u0442\u0432\u0438\u0442\u0435\u043b\u044c\u043d\u044b\u043c \u0438 \u0441\u043f\u0435\u0446\u0438\u0444\u0438\u0447\u043d\u044b\u043c, \u0447\u0435\u043c \u043e\u043f\u0440\u0435\u0434\u0435\u043b\u0435\u043d\u0438\u0435 \u0430\u0434\u0440\u0435\u043d\u0430\u043b\u0438\u043d\u0430, \u0442\u0430\u043a \u043a\u0430\u043a \u0430\u0434\u0440\u0435\u043d\u0430\u043b\u0438\u043d \u0440\u0430\u0437\u0440\u0443\u0448\u0430\u0435\u0442\u0441\u044f \u0443\u0436\u0435 \u0447\u0435\u0440\u0435\u0437 \u043d\u0435\u0441\u043a\u043e\u043b\u044c\u043a\u043e \u043c\u0438\u043d\u0443\u0442 \u043f\u043e\u0441\u043b\u0435 \u0432\u044b\u0441\u0432\u043e\u0431\u043e\u0436\u0434\u0435\u043d\u0438\u044f \u0438\u0437 \u043a\u043b\u0435\u0442\u043e\u043a. \u041f\u0440\u0438\u0447\u0435\u043c \u0442\u0435\u0441\u0442 \u043d\u0430 \u0441\u0432\u043e\u0431\u043e\u0434\u043d\u044b\u0439 \u043c\u0435\u0442\u0430\u043d\u0435\u0444\u0440\u0438\u043d \u0431\u043e\u043b\u0435\u0435 \u0446\u0435\u043d\u0435\u043d \u0432 \u0434\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u043a\u0435 \u0444\u0435\u043e\u0445\u0440\u043e\u043c\u043e\u0446\u0438\u0442\u043e\u043c\u044b, \u0447\u0435\u043c \u043e\u043f\u0440\u0435\u0434\u0435\u043b\u0435\u043d\u0438\u0435 \u043e\u0431\u0449\u0435\u0433\u043e \u0441\u043e\u0434\u0435\u0440\u0436\u0430\u043d\u0438\u044f \u043c\u0435\u0442\u0430\u043d\u0435\u0444\u0440\u0438\u043d\u043e\u0432.<\/p>\n

\u0412 \u043d\u043e\u0440\u043c\u0435 \u0432 \u043a\u0440\u043e\u0432\u0438 \u0441\u043e\u0434\u0435\u0440\u0436\u0438\u0442\u0441\u044f \u043d\u0435\u0431\u043e\u043b\u044c\u0448\u043e\u0435 \u043a\u043e\u043b\u0438\u0447\u0435\u0441\u0442\u0432\u043e \u0441\u0432\u043e\u0431\u043e\u0434\u043d\u043e\u0433\u043e \u043c\u0435\u0442\u0430\u043d\u0435\u0444\u0440\u0438\u043d\u0430, \u043a\u043e\u0442\u043e\u0440\u043e\u0435 \u0437\u043d\u0430\u0447\u0438\u0442\u0435\u043b\u044c\u043d\u043e \u0443\u0432\u0435\u043b\u0438\u0447\u0438\u0432\u0430\u0435\u0442\u0441\u044f \u0432\u043e \u0432\u0440\u0435\u043c\u044f \u0438 \u043f\u043e\u0441\u043b\u0435 \u0441\u0442\u0440\u0435\u0441\u0441\u0430. \u0424\u0435\u043e\u0445\u0440\u043e\u043c\u043e\u0446\u0438\u0442\u043e\u043c\u0430 \u0438 \u0434\u0440\u0443\u0433\u0438\u0435 \u043d\u0435\u0439\u0440\u043e\u044d\u043d\u0434\u043e\u043a\u0440\u0438\u043d\u043d\u044b\u0435 \u043e\u043f\u0443\u0445\u043e\u043b\u0438 \u043c\u043e\u0433\u0443\u0442 \u0432\u044b\u0440\u0430\u0431\u0430\u0442\u044b\u0432\u0430\u0442\u044c \u043e\u0433\u0440\u043e\u043c\u043d\u044b\u0435 \u043a\u043e\u043b\u0438\u0447\u0435\u0441\u0442\u0432\u0430 \u043a\u0430\u0442\u0435\u0445\u043e\u043b\u0430\u043c\u0438\u043d\u043e\u0432, \u0447\u0442\u043e \u043f\u0440\u0438\u0432\u043e\u0434\u0438\u0442 \u043a \u043f\u043e\u0432\u044b\u0448\u0435\u043d\u0438\u044e \u043a\u043e\u043d\u0446\u0435\u043d\u0442\u0440\u0430\u0446\u0438\u0438 \u044d\u0442\u0438\u0445 \u0433\u043e\u0440\u043c\u043e\u043d\u043e\u0432 \u0432 \u043a\u0440\u043e\u0432\u0438 \u0438 \u043c\u043e\u0447\u0435. \u0427\u0440\u0435\u0437\u043c\u0435\u0440\u043d\u043e\u0435 \u043f\u0440\u043e\u0438\u0437\u0432\u043e\u0434\u0441\u0442\u0432\u043e \u043a\u0430\u0442\u0435\u0445\u043e\u043b\u0430\u043c\u0438\u043d\u043e\u0432, \u0432 \u0441\u0432\u043e\u044e \u043e\u0447\u0435\u0440\u0435\u0434\u044c, \u0432\u044b\u0437\u044b\u0432\u0430\u0435\u0442 \u0441\u0442\u043e\u0439\u043a\u043e\u0435 \u043f\u043e\u0432\u044b\u0448\u0435\u043d\u0438\u0435 \u0430\u0440\u0442\u0435\u0440\u0438\u0430\u043b\u044c\u043d\u043e\u0433\u043e \u0434\u0430\u0432\u043b\u0435\u043d\u0438\u044f (\u0438\/\u0438\u043b\u0438 \u044d\u043f\u0438\u0437\u043e\u0434\u044b \u0435\u0433\u043e \u0440\u0435\u0437\u043a\u043e\u0433\u043e \u043f\u043e\u0432\u044b\u0448\u0435\u043d\u0438\u044f). \u0414\u0440\u0443\u0433\u0438\u0435 \u0441\u0438\u043c\u043f\u0442\u043e\u043c\u044b \u0432\u043e\u0437\u0434\u0435\u0439\u0441\u0442\u0432\u0438\u044f \u043a\u0430\u0442\u0435\u0445\u043e\u043b\u0430\u043c\u0438\u043d\u043e\u0432 \u043d\u0430 \u043e\u0440\u0433\u0430\u043d\u0438\u0437\u043c: \u0433\u043e\u043b\u043e\u0432\u043d\u0430\u044f \u0431\u043e\u043b\u044c, \u043f\u043e\u0442\u043b\u0438\u0432\u043e\u0441\u0442\u044c, \u0442\u043e\u0448\u043d\u043e\u0442\u0430, \u0442\u0440\u0435\u0432\u043e\u0436\u043d\u043e\u0441\u0442\u044c \u0438 \u043f\u043e\u043a\u0430\u043b\u044b\u0432\u0430\u043d\u0438\u0435 \u0432 \u043a\u043e\u043d\u0435\u0447\u043d\u043e\u0441\u0442\u044f\u0445.<\/p>\n

\u0411\u043e\u043b\u044c\u0448\u0438\u043d\u0441\u0442\u0432\u043e \u0444\u0435\u043e\u0445\u0440\u043e\u043c\u043e\u0446\u0438\u0442\u043e\u043c \u043b\u043e\u043a\u0430\u043b\u0438\u0437\u0443\u0435\u0442\u0441\u044f \u0432 \u043d\u0430\u0434\u043f\u043e\u0447\u0435\u0447\u043d\u0438\u043a\u0430\u0445. \u041a\u0430\u043a \u043f\u0440\u0430\u0432\u0438\u043b\u043e, \u043e\u043d\u0438 \u0434\u043e\u0431\u0440\u043e\u043a\u0430\u0447\u0435\u0441\u0442\u0432\u0435\u043d\u043d\u044b\u0435 \u2013 \u043d\u0435 \u0440\u0430\u0441\u043f\u0440\u043e\u0441\u0442\u0440\u0430\u043d\u044f\u044e\u0442\u0441\u044f \u0437\u0430 \u043f\u0440\u0435\u0434\u0435\u043b\u044b \u0442\u043e\u0433\u043e \u043c\u0435\u0441\u0442\u0430, \u0433\u0434\u0435 \u043e\u0431\u0440\u0430\u0437\u043e\u0432\u0430\u043b\u0438\u0441\u044c, \u0445\u043e\u0442\u044f \u0438 \u043f\u0440\u043e\u0434\u043e\u043b\u0436\u0430\u044e\u0442 \u043c\u0435\u0434\u043b\u0435\u043d\u043d\u043e \u0440\u0430\u0441\u0442\u0438. \u0415\u0441\u043b\u0438 \u0444\u0435\u043e\u0445\u0440\u043e\u043c\u043e\u0446\u0438\u0442\u043e\u043c\u0443 \u043d\u0435 \u043b\u0435\u0447\u0438\u0442\u044c, \u0441\u0438\u043c\u043f\u0442\u043e\u043c\u044b \u043f\u043e \u043c\u0435\u0440\u0435 \u0435\u0435 \u0440\u043e\u0441\u0442\u0430 \u043f\u043e\u0441\u0442\u0435\u043f\u0435\u043d\u043d\u043e \u0441\u0442\u0430\u043d\u043e\u0432\u044f\u0442\u0441\u044f \u0431\u043e\u043b\u0435\u0435 \u0432\u044b\u0440\u0430\u0436\u0435\u043d\u043d\u044b\u043c\u0438: \u043f\u043e\u0432\u044b\u0448\u0435\u043d\u0438\u0435 \u0430\u0440\u0442\u0435\u0440\u0438\u0430\u043b\u044c\u043d\u043e\u0433\u043e \u0434\u0430\u0432\u043b\u0435\u043d\u0438\u044f \u2013 \u0433\u0438\u043f\u0435\u0440\u0442\u0435\u043d\u0437\u0438\u044f \u2013 \u0441\u043f\u043e\u0441\u043e\u0431\u0441\u0442\u0432\u0443\u0435\u0442 \u043f\u043e\u0432\u0440\u0435\u0436\u0434\u0435\u043d\u0438\u044e \u0440\u0430\u0437\u043b\u0438\u0447\u043d\u044b\u0445 \u043e\u0440\u0433\u0430\u043d\u043e\u0432, \u0432 \u0442\u043e\u043c \u0447\u0438\u0441\u043b\u0435 \u043f\u043e\u0447\u0435\u043a \u0438 \u0441\u0435\u0440\u0434\u0446\u0430, \u0430 \u0442\u0430\u043a\u0436\u0435 \u0443\u0432\u0435\u043b\u0438\u0447\u0438\u0432\u0430\u0435\u0442 \u0440\u0438\u0441\u043a \u0438\u043d\u0444\u0430\u0440\u043a\u0442\u0430 \u0438 \u0438\u043d\u0441\u0443\u043b\u044c\u0442\u0430.<\/p>\n

\u041d\u0435\u0441\u043c\u043e\u0442\u0440\u044f \u043d\u0430 \u0442\u043e \u0447\u0442\u043e \u0444\u0435\u043e\u0445\u0440\u043e\u043c\u043e\u0446\u0438\u0442\u043e\u043c\u0430 \u2013 \u0434\u043e\u0432\u043e\u043b\u044c\u043d\u043e \u0440\u0435\u0434\u043a\u043e\u0435 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u0435, \u043a\u0440\u0430\u0439\u043d\u0435 \u0432\u0430\u0436\u043d\u043e \u0441\u0432\u043e\u0435\u0432\u0440\u0435\u043c\u0435\u043d\u043d\u043e \u0434\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u0440\u043e\u0432\u0430\u0442\u044c \u0438 \u043b\u0435\u0447\u0438\u0442\u044c \u0435\u0433\u043e, \u043f\u043e\u0442\u043e\u043c\u0443 \u0447\u0442\u043e \u044d\u0442\u0430 \u043e\u043f\u0443\u0445\u043e\u043b\u044c \u0432\u044b\u0437\u044b\u0432\u0430\u0435\u0442 \u0444\u043e\u0440\u043c\u0443 \u0430\u0440\u0442\u0435\u0440\u0438\u0430\u043b\u044c\u043d\u043e\u0439 \u0433\u0438\u043f\u0435\u0440\u0442\u0435\u043d\u0437\u0438\u0438, \u043a\u043e\u0442\u043e\u0440\u0430\u044f \u043f\u043e\u0434\u0434\u0430\u0435\u0442\u0441\u044f \u043b\u0435\u0447\u0435\u043d\u0438\u044e. \u0412 \u0431\u043e\u043b\u044c\u0448\u0438\u043d\u0441\u0442\u0432\u0435 \u0441\u043b\u0443\u0447\u0430\u0435\u0432 \u043e\u043f\u0443\u0445\u043e\u043b\u044c \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043e\u043f\u0435\u0440\u0430\u0442\u0438\u0432\u043d\u043e \u0443\u0434\u0430\u043b\u0435\u043d\u0430 \u0438\/\u0438\u043b\u0438 \u0432\u044b\u043b\u0435\u0447\u0435\u043d\u0430 \u043c\u0435\u0434\u0438\u043a\u0430\u043c\u0435\u043d\u0442\u043e\u0437\u043d\u043e, \u0447\u0442\u043e \u043f\u043e\u0437\u0432\u043e\u043b\u044f\u0435\u0442 \u0443\u043c\u0435\u043d\u044c\u0448\u0438\u0442\u044c \u043a\u043e\u043b\u0438\u0447\u0435\u0441\u0442\u0432\u043e \u043a\u0430\u0442\u0435\u0445\u043e\u043b\u0430\u043c\u0438\u043d\u043e\u0432 \u0432 \u043a\u0440\u043e\u0432\u0438, \u043e\u0431\u043b\u0435\u0433\u0447\u0438\u0442\u044c \u0441\u0438\u043c\u043f\u0442\u043e\u043c\u044b \u0431\u043e\u043b\u0435\u0437\u043d\u0438 \u0438 \u043f\u0440\u0435\u0434\u043e\u0442\u0432\u0440\u0430\u0442\u0438\u0442\u044c \u043e\u0441\u043b\u043e\u0436\u043d\u0435\u043d\u0438\u044f.<\/p>\n

\u041e\u0431\u044b\u0447\u043d\u043e \u044d\u0442\u043e\u0442 \u0430\u043d\u0430\u043b\u0438\u0437 \u043d\u0430\u0437\u043d\u0430\u0447\u0430\u0435\u0442\u0441\u044f \u0432\u043c\u0435\u0441\u0442\u0435 \u0441 \u043e\u043f\u0440\u0435\u0434\u0435\u043b\u0435\u043d\u0438\u0435\u043c \u043d\u043e\u0440\u043c\u0435\u0442\u0430\u043d\u0435\u0444\u0440\u0438\u043d\u043e\u0432.<\/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?<\/p>\n

    \n
  1. \u0427\u0442\u043e\u0431\u044b \u043f\u043e\u0441\u0442\u0430\u0432\u0438\u0442\u044c \u0434\u0438\u0430\u0433\u043d\u043e\u0437 “\u0444\u0435\u043e\u0445\u0440\u043e\u043c\u043e\u0446\u0438\u0442\u043e\u043c\u0430” \u0442\u0435\u043c, \u0443 \u043a\u043e\u0433\u043e \u043d\u0430\u0431\u043b\u044e\u0434\u0430\u044e\u0442\u0441\u044f \u0445\u0430\u0440\u0430\u043a\u0442\u0435\u0440\u043d\u044b\u0435 \u0434\u043b\u044f \u044d\u0442\u043e\u0439 \u043e\u043f\u0443\u0445\u043e\u043b\u0438 \u0441\u0438\u043c\u043f\u0442\u043e\u043c\u044b.<\/li>\n
  2. \u0414\u043b\u044f \u043e\u0446\u0435\u043d\u043a\u0438 \u044d\u0444\u0444\u0435\u043a\u0442\u0438\u0432\u043d\u043e\u0441\u0442\u0438 \u043b\u0435\u0447\u0435\u043d\u0438\u044f \u0444\u0435\u043e\u0445\u0440\u043e\u043c\u043e\u0446\u0438\u0442\u043e\u043c\u044b.<\/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?<\/p>\n

    \u041f\u0440\u0438 \u043f\u043e\u0434\u043e\u0437\u0440\u0435\u043d\u0438\u0438 \u043d\u0430 \u0444\u0435\u043e\u0445\u0440\u043e\u043c\u043e\u0446\u0438\u0442\u043e\u043c\u0443. \u0415\u0435 \u043c\u043e\u0436\u043d\u043e \u043f\u0440\u0435\u0434\u043f\u043e\u043b\u043e\u0436\u0438\u0442\u044c \u043f\u043e \u0441\u043b\u0435\u0434\u0443\u044e\u0449\u0438\u043c \u0441\u0438\u043c\u043f\u0442\u043e\u043c\u0430\u043c: \u0441\u0442\u043e\u0439\u043a\u043e\u0435 \u043f\u043e\u0432\u044b\u0448\u0435\u043d\u0438\u0435 \u0430\u0440\u0442\u0435\u0440\u0438\u0430\u043b\u044c\u043d\u043e\u0433\u043e \u0434\u0430\u0432\u043b\u0435\u043d\u0438\u044f (\u0438\/\u0438\u043b\u0438 \u044d\u043f\u0438\u0437\u043e\u0434\u044b \u0435\u0433\u043e \u0440\u0435\u0437\u043a\u043e\u0433\u043e \u043f\u043e\u0432\u044b\u0448\u0435\u043d\u0438\u044f), \u0443\u0447\u0430\u0449\u0435\u043d\u0438\u0435 \u043f\u0443\u043b\u044c\u0441\u0430, \u043f\u0440\u0438\u043b\u0438\u0432\u044b, \u043f\u043e\u0442\u043b\u0438\u0432\u043e\u0441\u0442\u044c.<\/p>\n

    \u041f\u0440\u0438 \u0430\u0440\u0442\u0435\u0440\u0438\u0430\u043b\u044c\u043d\u043e\u0439 \u0433\u0438\u043f\u0435\u0440\u0442\u0435\u043d\u0437\u0438\u0438, \u043f\u043b\u043e\u0445\u043e \u043f\u043e\u0434\u0434\u0430\u044e\u0449\u0435\u0439\u0441\u044f \u043b\u0435\u0447\u0435\u043d\u0438\u044e.<\/p>\n

    \u0415\u0441\u043b\u0438 \u043e\u043f\u0443\u0445\u043e\u043b\u044c \u043d\u0430\u0434\u043f\u043e\u0447\u0435\u0447\u043d\u0438\u043a\u043e\u0432 \u0438\u043b\u0438 \u0434\u0440\u0443\u0433\u0430\u044f \u043d\u0435\u0439\u0440\u043e\u044d\u043d\u0434\u043e\u043a\u0440\u0438\u043d\u043d\u0430\u044f \u043e\u043f\u0443\u0445\u043e\u043b\u044c \u0431\u044b\u043b\u0438 \u0441\u043b\u0443\u0447\u0430\u0439\u043d\u043e \u0432\u044b\u044f\u0432\u043b\u0435\u043d\u0430 \u043f\u0440\u0438 \u0443\u043b\u044c\u0442\u0440\u0430\u0437\u0432\u0443\u043a\u043e\u0432\u043e\u043c \u0438\u043b\u0438 \u041c\u0420\u0422-\u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0438 \u0438\u043b\u0438 \u0442\u0430\u043a\u0430\u044f \u043e\u043f\u0443\u0445\u043e\u043b\u044c \u0431\u044b\u043b\u0430 \u0443 \u0431\u043b\u0438\u0436\u0430\u0439\u0448\u0438\u0445 \u0440\u043e\u0434\u0441\u0442\u0432\u0435\u043d\u043d\u0438\u043a\u043e\u0432 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430.<\/p>","protected":false},"featured_media":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"product_brand":[],"product_cat":[923],"product_tag":[],"class_list":{"0":"post-10138","1":"product","2":"type-product","3":"status-publish","5":"product_cat-markeri-tumorali","7":"first","8":"instock","9":"sold-individually","10":"shipping-taxable","11":"purchasable","12":"product-type-simple"},"_links":{"self":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product\/10138","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/types\/product"}],"replies":[{"embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/comments?post=10138"}],"wp:attachment":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/media?parent=10138"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_brand?post=10138"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_cat?post=10138"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_tag?post=10138"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}