{"id":10262,"date":"2020-04-23T05:01:16","date_gmt":"2020-04-23T02:01:16","guid":{"rendered":"https:\/\/www.synevo.ro\/product\/anticorpi-antinucleari-imunofluorescenta\/"},"modified":"2025-02-06T11:28:06","modified_gmt":"2025-02-06T09:28:06","slug":"anticorpi-antinucleari-imunofluorescenta","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/anticorpi-antinucleari-imunofluorescenta\/","title":{"rendered":"\u0410\u043d\u0442\u0438\u043d\u0443\u043a\u043b\u0435\u0430\u0440\u043d\u044b\u0435 \u0430\u043d\u0442\u0438\u0442\u0435\u043b\u0430 (\u0438\u043c\u043c\u0443\u043d\u043e\u0444\u043b\u044e\u043e\u0440\u0435\u0441\u0446\u0435\u043d\u0446\u0438\u044f)"},"content":{"rendered":"<p style=\"text-align: justify;\"><strong><em>Informa\u0163ii generale \u015fi recomand\u0103ri pentru efectuarea testului<\/em><\/strong><\/p>\n<p style=\"text-align: justify;\">Identificarea anticorpilor antinucleari (ANA) reprezint\u0103 o parte important\u0103 a imunologiei clinice.<\/p>\n<p style=\"text-align: justify;\">Anticorpii antinucleari sunt anticorpi \u00eendrepta\u0163i impotriva antigenelor nucleare \u015fi au fost descri\u015fi \u00eentr-o multitudine de afec\u0163iuni autoimune sistemice \u015fi organ-specifice.<\/p>\n<p style=\"text-align: justify;\">Testul ANA \u00ee\u015fi are originea \u00een fenomenul L.E care a fost eviden\u0163iat pentru prima oar\u0103 \u00een 1948 de c\u0103tre Haargraves, Richmond \u015fi Morton. Totu\u015fi, determinarea celulelor lupice s-a dovedit a fi un test pu\u0163in sensibil \u015fi dificil de standardizat.<\/p>\n<p style=\"text-align: justify;\">\u00cen 1950, Coons \u015fi Kaplan au utilizat anticorpi specifici marca\u0163i cu fluorescein\u0103 pentru identificarea antigenelor tisulare. \u00cen 1957, Holborow, Weir \u015fi Johnson au folosit pentru prima dat\u0103 tehnica imunofluorescen\u0163ei pentru a demonstra c\u0103 serul pacien\u0163ilor LE pozitivi con\u0163ine anticorpi care produc o fluorescen\u0163\u0103 nuclear\u0103 omogen\u0103 pe \u0163esuturile umane. \u00cen 1961, Beck a descris\u00a0 \u015fi alte tipuri de fluorescen\u0163\u0103 nuclear\u0103 \u00een serul pacien\u0163ilor cu diferite afec\u0163iuni reumatice utiliz\u00e2nd sec\u0163iuni de ficat de \u015fobolan.<\/p>\n<p style=\"text-align: justify;\">Substratul ANA tradi\u0163ional a fost reprezentat mult timp de sec\u0163iuni de ficat, rinichi sau stomac de \u015fobolan. \u00cenlocuirea acestui substrat a fost realizat\u0103 cu mult succes de linia celular\u0103 Hep-2 (human epithelial type 2 cells) izolat\u0103 ini\u0163ial de la un carcinom laringian uman, aceasta permi\u0163\u00e2nd recunoa\u015fterea a peste 30 pattern-uri nucleare \u015fi citoplasmatice determinate de peste 100 autoanticorpi diferi\u0163i. Avantajele utiliz\u0103rii celulelor Hep-2 fa\u0163\u0103 de substratul animal sunt:<\/p>\n<ul style=\"text-align: justify;\">\n<li>sensibilitate mai mare care permite identificarea mai multor pattern-uri;<\/li>\n<li>originea uman\u0103 asigur\u0103 o mai bun\u0103 specificitate dec\u00e2t cea animal\u0103;<\/li>\n<li>nucleii celulelor sunt mai mari, iar detaliile nucleare pot fi eviden\u0163iate mai bine;<\/li>\n<li>dispunerea celulelor \u00een monostrat faciliteaz\u0103 o vizualizare bun\u0103 a nucleilor;<\/li>\n<li>distribu\u0163ia antigenului este uniform\u0103;<\/li>\n<li>rata diviziunii celulare este crescut\u0103 astfel \u00eenc\u00e2t antigenele exprimate predominant \u00een timpul mitozei \u00a0sunt u\u015for de localizat (de exemplu, pattern-ul de tip centromer).<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Astfel, substratul Hep-2 permite recunoa\u015fterea autoanticorpilor \u00eendrepta\u0163i \u00eempotriva antigenelor din toate etapele\u00a0mitozei (profaza, metafaza, anafaza, telofaza), ceea ce nu este posibil utiliz\u00e2nd substratul animal<sup>1<\/sup>.<\/p>\n<p style=\"text-align: justify;\">Cele mai importante aspecte nucleare descrise la examenul prin\u00a0 imunofluorescen\u0163\u0103 indirect\u0103 sunt:<\/p>\n<ul style=\"text-align: justify;\">\n<li><span style=\"text-decoration: underline;\">ASPECT NUCLEAR OMOGEN<\/span>: fluorescen\u0163a omogen\u0103 difuz\u0103 a \u00eentregului nucleu \u00een interfaza celular\u0103; intensitatea fluorescen\u0163ei este mai pronun\u0163at\u0103 \u00een regiunea cromozomial\u0103 la celulele \u00een mitoz\u0103; citoplasma este negativ\u0103. Apare asociat \u00een principal cu lupusul eritematos sistemic (LES) comun \u015fi lupusul indus medicamentos, dar mai poate s\u0103 apar\u0103 \u00een artrita reumatoid\u0103, artrita cronic\u0103 juvenil\u0103 \u015fi scleroza sistemic\u0103 (al\u0103turi de aspectul fin p\u0103tat). Antigenele implicate sunt: ADN dublu catenar (dsDNA), histone, Ku.<\/li>\n<li><span style=\"text-decoration: underline;\">ASPECTUL NUCLEAR OMOGEN INELAR<\/span>: similar cu cel nuclear omogen, dar cu cre\u015fterea intensit\u0103\u0163ii fluorescen\u0163ei marginale nucleare \u00een interfaza celular\u0103; citoplasma este negativ\u0103. Este un aspect \u00eent\u00e2lnit comun \u00een LES, mai ales \u00een forma activ\u0103. Antigenul este reprezentat de dsDNA.<\/li>\n<li><span style=\"text-decoration: underline;\">ASPECT MATRICE NUCLEARA<\/span>: fluorescen\u0163a p\u0103tat\u0103 ce d\u0103 na\u015ftere unei re\u0163ele nucleare spongioase \u00een interfaza celular\u0103. Acest aspect se poate \u00eent\u00e2lni \u00een LES, boala mixt\u0103 de \u0163esut conjuctiv sau \u00een boli cronice reumatice. Antigenele implicate sunt proteine ribonucleare heterogene (hnRNP).<\/li>\n<li><span style=\"text-decoration: underline;\">ASPECT PATAT FIN<\/span>: fluorescen\u0163a nuclear\u0103 p\u0103tat\u0103 cu aspect fin \u015fi distribu\u0163ie uniform\u0103 \u00een interfaza celular\u0103. Apare \u00een LES, sindromul Sj\u00f6gren, sclerodermie, miozit\u0103 \u015fi boala mixt\u0103 de \u0163esut conjunctiv. Antigenele sunt reprezentate de\u00a0 SS-A, SS-B, Ku, Ki \u015fi Mi-2.<\/li>\n<li><span style=\"text-decoration: underline;\">ASPECT PATAT GROSIER<\/span>: fluorescen\u0163a nuclear\u0103 p\u0103tat\u0103 cu aspect grosier \u00een interfaza celular\u0103. Apare\u00a0\u00een LES, boala mixt\u0103 de \u0163esut conjunctiv, sindroame overlap, sindrom Raynaud \u015fi psoriazis. Sunt implicate urm\u0103toarele antigene: U1-snRNP sau Sm (proteine ribonucleare mici).<\/li>\n<li><span style=\"text-decoration: underline;\">ASPECT DE TIP CENTROMER<\/span>: fluorescen\u0163a nuclear\u0103 p\u0103tat\u0103 cu aspect fin \u00een interfaza celular\u0103; \u00een cursul mitozei fluorescen\u0163a este prezent\u0103 la nivelul cromozomilor. Apare \u00een principal \u00een sindromul CREST.<\/li>\n<li><span style=\"text-decoration: underline;\">ASPECT NUCLEOLAR OMOGEN<\/span>: fluorescen\u0163a omogen\u0103 a nucleolilor. Apare \u00een sclerodermie, miozit\u0103, \u00a0sindrom overlap miozita-sclerodermie. Antigenul este constituit din complexul PM-Scl cu rol \u00een biosinteza ribozomilor.<\/li>\n<li><span style=\"text-decoration: underline;\">ASPECT NUCLEOLAR PATAT<\/span>: fluorescen\u0163a p\u0103tat\u0103 a nuclelolilor; \u00een cursul mitozei fluorescen\u0163a este prezent\u0103 la nivelul cromozomilor, cu dou\u0103 aspecte posibile: omogen (antigenul este reprezentat de Scl-70 \u2013 ADN topoizomeraza I) \u015fi punctat (antigenele implicate sunt ARN polimeraza I \u015fi NOR-90); este asociat cu sclerodermia.<\/li>\n<li><span style=\"text-decoration: underline;\">ASPECT NUCLEOLAR \u201d\u00ceN GRAMEZI\u201d (\u201dCLUMPY\u201d)<\/span>: \u00a0fluorescen\u0163a nucleolar\u0103 \u00een blocuri. Este \u00eent\u00e2lnit \u00een sclerodermie; antigenul implicat este fibrilarina \u2013 o protein\u0103 alcalin\u0103 asociat\u0103 cu ribonucleoproteina nucleolar\u0103 U3-snRNPs.<\/li>\n<li><span style=\"text-decoration: underline;\">ASPECT DE PUNCTE NUCLEARE:<\/span> fluorescen\u0163a punctiform\u0103 (aproximativ 10 puncte\/nucleu) care apare \u00een nucleoplasm\u0103 separat de nucleoli. Se asociaz\u0103 clinic cu: ciroza biliar\u0103 primitiv\u0103, sindromul Sj\u00f6gren, ocazional LES. Antigenele implicate includ complexe de multiproteine (Sp-100), cu rol insuficient cunoscut.<\/li>\n<li><span style=\"text-decoration: underline;\">ASPECT CENTRIOL\/CENTROZOM<\/span>: fluorescen\u0163a sub form\u0103 de spoturi fine la cei 2 poli ce corespund fusului mitotic. Apare \u00een sindromul Raynaud, mai rar \u00een sclerodermie, sindromul Sj\u00f6gren sau sindromul CREST. Antigenul este reprezentat de centrozom = sistem de microtubuli ce are rol \u00een formarea fusului mitotic.<\/li>\n<li><span style=\"text-decoration: underline;\">ASPECT MEMBRANA NUCLEARA<\/span>: fluorescen\u0163a fin\u0103 inelar\u0103 a membranei nucleare cu sc\u0103derea intensit\u0103\u0163ii fluorescen\u0163ei \u00een nucleoplasm\u0103. Apare \u00een hepatita cronic\u0103 asociat\u0103 sau nu cu vasculita, trombocitopenie \u015fi LES. Antigenele implicate sunt polipeptide care furnizeaz\u0103 situsuri de ancorare pentru cromozomi \u00een interfaza celular\u0103: laminine\u00a0 A, B1, B2, C.<\/li>\n<li><span style=\"text-decoration: underline;\">ASPECT PCNA (PROLIFERATING CELL NUCLEAR ANTIGEN)<\/span>: fluorescen\u0163a p\u0103tat\u0103 variabil\u0103 (prezent\u0103 doar \u00een unele celule) \u00een interfaza celular\u0103. Apare la 3-6% dintre pacien\u0163ii cu LES. Ca antigen este implicat\u0103 ciclina, cu rol \u00een replicarea \u015fi repararea ADN-ului.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">In figurile de mai jos sunt ilustrate c\u00e2teva din pattern-urile nucleare descrise:<\/p>\n<p style=\"text-align: justify;\">\u00a0<a title=\"\" href=\"\/wp-content\/uploads\/2010\/05\/AN4.jpg\" rel=\"wpdevart_lightbox lightbox-gallery-9S8oiB9u\" data-=\"\" data-rl_title=\"\" data-rl_caption=\"\"><img decoding=\"async\" class=\"alignnone size-full wp-image-8742\" src=\"\/wp-content\/uploads\/2010\/05\/AN4.jpg\" alt=\"-\" width=\"713\" height=\"399\"><\/a><a class=\"shutterset_7690 cboxElement\" title=\"Anticorpi antinucleari (imunofluorescen\u0163\u0103)\" href=\"https:\/\/www.synevo.md\/wp-content\/uploads\/2010\/05\/AN4.jpg\" rel=\"wpdevart_lightbox lightbox[7690] nofollow noopener\" data-rel=\"lightbox-gallery-JU4qHnQy\" data-rl_title=\"\" data-rl_caption=\"\" target=\"_blank\"><img decoding=\"async\" class=\"alignnone size-full wp-image-8742\" src=\"\/wp-content\/uploads\/2010\/05\/AN4.jpg\" alt=\"-\" width=\"713\" height=\"399\"><\/a><\/p>\n<p style=\"text-align: justify;\">\u00cen concluzie, pattern-ul fluorescen\u0163ei nucleare reflect\u0103 specificitatea pentru diferite afec\u0163iuni. Astfel, imunofluorescen\u0163a indirect\u0103 permite diagnosticul primar \u00een cazuri clinice incerte, monitorizarea tratamentului (prin titrul ANA) \u015fi poate furniza informa\u0163ii decisive pentru investiga\u0163iile ulterioare<sup>1;2;5<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Preg\u0103tire pacient <\/em><\/strong><em>- <\/em>\u00e0 jeun (pe nem\u00e2ncate) sau postprandial (dup\u0103 mese)<sup>3<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Specimen recoltat <\/em><\/strong><em>- <\/em>\u0432\u0435\u043d\u043e\u0437\u043d\u0430\u044f \u043a\u0440\u043e\u0432\u044c<sup>3<\/sup>.<strong><em>\u00a0<\/em><\/strong><\/p>\n<p style=\"text-align: justify;\"><strong><em>Recipient de recoltare <\/em><\/strong><em>- <\/em>vacutainer f\u0103r\u0103 anticoagulant cu\/f\u0103r\u0103 gel separator<sup>3<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Prelucrare necesar\u0103 dup\u0103 recoltare <\/em><\/strong><em>- <\/em>se separ\u0103 serul prin centrifugare<sup>3<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Volum prob\u0103<\/em><\/strong> \u2013 minim 0.5 mL ser<sup>3<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Cauze de respingere<\/em><\/strong> <strong><em>a probei <\/em><\/strong><em>- <\/em>ser intens hemolizat, lipemic sau puternic contaminat bacterian<sup>3<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Stabilitate prob\u0103 <\/em><\/strong><em>- <\/em>serul separat este stabil\u00a0<em>timp mai \u00eendelungat<\/em> la -20 \u00b0C<sup>3<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Metod\u0103 <\/em><\/strong>- <span style=\"text-decoration: underline;\">imunofluorescen\u0163\u0103 indirect\u0103<\/span><sup>3<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Valori de referin\u0163\u0103 \u015fi interpretarea rezultatelor<\/em><\/strong><\/p>\n<p style=\"text-align: justify; padding-left: 30px;\">&lt;1\/80: Negativ<sup>3<\/sup>.<\/p>\n<div style=\"text-align: justify;\">Rezultatele se exprim\u0103 sub forma unui titru (dilu\u0163ia p\u00e2n\u0103 la care poate fi detectat\u0103 fluorescen\u0163a).<\/div>\n<div style=\"text-align: justify;\">\u00cen cazul unui rezultat pozitiv al\u0103turi de titru este men\u0163ionat \u015fi aspectul ob\u0163inut \u00een imunofluorescen\u0163\u0103.<\/div>\n<div style=\"text-align: justify;\">Aproximativ 98% dintre pacien\u0163ii cu LES activ vor prezenta un rezultat pozitiv la screening-ul ANA prin imunofluorescen\u0163\u0103. Cu toate acestea a fost identificat un grup de pacien\u0163i cu boal\u0103 lupic\u0103 \u201cANA negativi\u201d. Aspectele nuclear omogen \u015fi\/sau nuclear omogen inelar se coreleaz\u0103 cu LES, activitatea bolii \u015fi cu nefrita lupic\u0103.<\/div>\n<div style=\"text-align: justify;\">Aspectul de tip centromer se coreleaz\u0103 \u00een mod tipic cu sindromul CREST (confirmare prin determinare cantitativ\u0103 imunoenzimatic\u0103).<\/div>\n<div style=\"text-align: justify;\">Aspectele de tip nuclear p\u0103tat se asociaz\u0103 cu prezen\u0163a anticorpilor fa\u0163\u0103 de antigenele nucleare extractibile (ENA): U1-RNP, Sm, SS-A, SS-B, Scl-70 \u015fi Jo-14.<\/div>\n<p style=\"text-align: justify;\">\u00cen unele cazuri, pe substratul Hep-2 se pot ob\u0163ine diverse pattern-uri de fluorescen\u0163\u0103 citoplasmatic\u0103:<\/p>\n<p style=\"text-align: justify; padding-left: 30px;\">-<em>p\u0103tat fin<\/em>, cu pete fluorescente dispersate, de dimensiuni mici, \u00een majoritatea cazurilor pe un fond omogen sau p\u0103tat fin dens; antigenele sunt reprezentate de aminoacil-t-ARN-sintetaze, \u00een special Jo-1; se asociaz\u0103 cu polimiozita\/dermatomiozita;<\/p>\n<p style=\"text-align: justify; padding-left: 30px;\">-<em>p\u0103tat fin dens<\/em>, cu fluorescen\u0163\u0103 granular\u0103 difuz\u0103, aproape omogen\u0103, \u00een \u00eentreaga citoplasm\u0103; antigenele includ rRNP \u2013 fosfoproteine ribozomale; este \u00eent\u00e2lnit la pacien\u0163ii cu LES care prezint\u0103 manifest\u0103ri SNC;<\/p>\n<p style=\"text-align: justify; padding-left: 30px;\">-<em>polar, <\/em>cu fluorescen\u0163\u0103 perinuclear\u0103 grosier\u0103, cu granule dispuse \u00een gr\u0103mezi la un pol al celulei ce corespund lamelelor aparatului Golgi; se \u00eent\u00e2lne\u015fte rareori \u00een LES, \u00een sindromul Sj\u00f6gren, boala mixt\u0103 de \u0163esut conjunctiv, granulomatoza Wegener, infec\u0163ii virale (EBV, HIV);<\/p>\n<p style=\"text-align: justify; padding-left: 30px;\">-<em>reticular grosier<\/em>, cu fluorescen\u0163\u0103 difuz\u0103 reticular\u0103 \u015fi granular\u0103 grosier\u0103 ce cuprinde aproape \u00eentreaga citoplasm\u0103; antigenele sunt proteine din membrana intern\u0103 a mitocondriilor (\u00een special M2); se asociaz\u0103 cu ciroza biliar\u0103 primitiv\u0103;<\/p>\n<p style=\"text-align: justify; padding-left: 30px;\">-<em>reticular fin<\/em>, cu fluorescen\u0163\u0103 difuz\u0103 reticular\u0103 \u015fi granular\u0103 fin\u0103 corespunz\u0103toare reticulului endoplasmatic; se asociaz\u0103 cu afec\u0163iuni hepatice cronice;<\/p>\n<p style=\"text-align: justify; padding-left: 30px;\">-<em>fibrilar<\/em>, cu o fluorescen\u0163\u0103 linear\u0103 a fibrelor de stres din citoschelet; antigenele implicate sunt reprezentate de actin\u0103 \u015fi miozin\u0103; se \u00eent\u00e2lne\u015fte \u00een hepatita autoimun\u0103, ciroza biliar\u0103 primitiv\u0103, boala mixt\u0103 de \u0163esut conjunctiv;<\/p>\n<p style=\"text-align: justify; padding-left: 30px;\">-<em>segmentar<\/em>, cu fluorescen\u0163a unor segmente mici de fibre; antigenele sunt \u03b1-actinina, vinculina, tropomiozina; se asociaz\u0103 cu miastenia gravis, boala Crohn, colita ulceroas\u0103.<\/p>\n<p style=\"text-align: justify;\">\u00cen figurile de mai jos sunt ilustrate c\u00e2teva din pattern-urile citoplasmatice descrise:<\/p>\n<p style=\"text-align: justify;\">\u00a0<a class=\"shutterset_7690 cboxElement\" title=\"Anticorpi antinucleari (imunofluorescen\u0163\u0103)\" href=\"https:\/\/www.synevo.md\/wp-content\/uploads\/2010\/05\/AN21.jpg\" rel=\"wpdevart_lightbox lightbox[7690] nofollow noopener\" data-rel=\"lightbox-gallery-JU4qHnQy\" data-rl_title=\"\" data-rl_caption=\"\" target=\"_blank\"><img decoding=\"async\" class=\"alignnone size-full wp-image-8744\" src=\"\/wp-content\/uploads\/2010\/05\/AN21.jpg\" alt=\"-\" width=\"704\" height=\"223\"><\/a><\/p>\n<p style=\"text-align: justify;\">\u00cen toate aceste cazuri este necesar\u0103 confirmarea rezultatului pe substraturi specifice sau determinarea prin metode imunoenzimatice<sup>2<\/sup>.<\/p>\n<div style=\"text-align: justify;\"><strong><em>Limite \u015f<\/em><\/strong><strong><em>i interferen\u0163e\u00a0<\/em><\/strong><\/div>\n<div style=\"text-align: justify;\">Persoanele peste 80 ani prezint\u0103 o inciden\u0163\u0103 crescut\u0103 (50%) de ANA \u00een titruri joase<sup>4<\/sup>.<\/div>\n<p style=\"text-align: justify;\"><span style=\"font-size: small;\">\u00a0<\/span><\/p>\n<p style=\"text-align: justify;\"><strong><span style=\"font-size: 10pt;\">\u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/span><\/strong><\/p>\n<div style=\"text-align: justify;\"><span style=\"font-size: small;\">1. <span style=\"font-size: 10pt;\">A.R. Bradwell, R.G. Hushes ,E.L. Harden. Atlas of Hep-2 patterns, Second Edition, 2003.<\/span><\/span><\/div>\n<div style=\"text-align: justify;\"><span style=\"font-size: 10pt;\">2. Carlos Alberto von M\u00fchlen, Robert M. Nakamura. Clinical and laboratory Evaluation of Systemic Rheumatic Diseases. In Henry\u00b4s.Clinical Diagnosis and Management By Laboratory Methods, Ed.Saunders, 2007, 924-928.<\/span><\/div>\n<div style=\"text-align: justify;\"><span style=\"font-size: 10pt;\">3. Laborator Synevo. Referin\u0163ele specifice tehnologiei de lucru utilizate 2010. Ref Type: Catalog<\/span><\/div>\n<div style=\"text-align: justify;\"><span style=\"font-size: 10pt;\">4. Laboratory Corporation of America. Directory of Services and Interpretive Guide. Antinuclear Antibodies. www.labcorp.com 2010. Ref Type: Internet Communication<\/span><\/div>\n<div style=\"text-align: justify;\"><span style=\"font-size: 10pt;\">5. Rudolf Mierau, Ekkehard Genth. Autoantibodies in Systemic Rheumatic Diseases. In Clinical Laboratory Diagnostics-Use and Assessment of Clinical Laboratory Results. Lothar Thomas. TH-Books Verlagsgesellschaft mbH, Frankfurt \/Main, Germany,1 ed. 1998, 807-833.<\/span><\/div>","protected":false},"excerpt":{"rendered":"<div>\u0422\u0435\u0440\u043c\u0438\u043d \u00ab\u0430\u043d\u0442\u0438\u043d\u0443\u043a\u043b\u0435\u0430\u0440\u043d\u044b\u0439 \u0444\u0430\u043a\u0442\u043e\u0440\u00bb &#8211; \u0442\u0440\u0430\u0434\u0438\u0446\u0438\u043e\u043d\u043d\u043e\u0435 \u043e\u0431\u043e\u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435 \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442\u043e\u0432 \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u044f \u0430\u043d\u0442\u0438\u043d\u0443\u043a\u043b\u0435\u0430\u0440\u043d\u044b\u0445 \u0430\u043d\u0442\u0438\u0442\u0435\u043b (\u0410\u041d\u0410), \u043f\u043e\u043b\u0443\u0447\u0435\u043d\u043d\u044b\u0445 \u043f\u0440\u0438 \u0438\u0441\u043f\u043e\u043b\u044c\u0437\u043e\u0432\u0430\u043d\u0438\u0438 \u043c\u0435\u0442\u043e\u0434\u0430 \u043d\u0435\u043f\u0440\u044f\u043c\u043e\u0439 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\u0438\u043c\u043c\u0443\u043d\u043e\u0444\u043b\u0443\u043e\u0440\u0435\u0441\u0446\u0435\u043d\u0446\u0438\u0438. \u041f\u043e\u044d\u0442\u043e\u043c\u0443 \u0438\u0441\u043f\u043e\u043b\u044c\u0437\u043e\u0432\u0430\u043d\u0438\u0435 \u0418\u0424\u0410-\u043c\u0435\u0442\u043e\u0434\u043e\u0432 (\u0441\u043c. \u0442\u0435\u0441\u0442\u044b \u2116\u00a0<a tabindex=\"0\" href=\"https:\/\/www.invitro.ru\/analizes\/for-doctors\/1520\/19539\/\" target=\"_blank\" rel=\"noopener\" data-invitro-test-id=\"19539\">825<\/a>, \u2116\u00a0<a tabindex=\"0\" href=\"https:\/\/www.invitro.ru\/analizes\/for-doctors\/1520\/2357\/\" target=\"_blank\" rel=\"noopener\" data-invitro-test-id=\"2357\">125<\/a>) \u0432 \u043a\u043e\u043c\u043f\u043b\u0435\u043a\u0441\u0435 \u0441 \u0432\u044b\u044f\u0432\u043b\u0435\u043d\u0438\u0435\u043c \u0430\u043d\u0442\u0438\u043d\u0443\u043a\u043b\u0435\u0430\u0440\u043d\u043e\u0433\u043e \u0444\u0430\u043a\u0442\u043e\u0440\u0430 \u043d\u0430 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\u043d\u0435\u043f\u0440\u044f\u043c\u043e\u0439 \u0438\u043c\u043c\u0443\u043d\u043e\u0444\u043b\u0443\u043e\u0440\u0435\u0441\u0446\u0435\u043d\u0446\u0438\u0438 \u043d\u0430 \u043a\u043b\u0435\u0442\u043e\u0447\u043d\u043e\u0439 \u043b\u0438\u043d\u0438\u0438 \u041d\u0415\u0440-2 \u0440\u0435\u043a\u043e\u043c\u0435\u043d\u0434\u043e\u0432\u0430\u043d \u0432 \u043a\u0430\u0447\u0435\u0441\u0442\u0432\u0435 \u00ab\u0437\u043e\u043b\u043e\u0442\u043e\u0433\u043e \u0441\u0442\u0430\u043d\u0434\u0430\u0440\u0442\u0430\u00bb \u0432\u044b\u044f\u0432\u043b\u0435\u043d\u0438\u044f \u0430\u043d\u0442\u0438\u043d\u0443\u043a\u043b\u0435\u0430\u0440\u043d\u044b\u0445 \u0430\u043d\u0442\u0438\u0442\u0435\u043b \u0432\u0435\u0434\u0443\u0449\u0438\u043c\u0438 \u044d\u043a\u0441\u043f\u0435\u0440\u0442\u0430\u043c\u0438, \u0432\u043a\u043b\u044e\u0447\u0430\u044f \u0435\u0432\u0440\u043e\u043f\u0435\u0439\u0441\u043a\u0438\u0435 (EASI Group, 2010) \u0438 \u0430\u043c\u0435\u0440\u0438\u043a\u0430\u043d\u0441\u043a\u0438\u0435 \u0433\u0440\u0443\u043f\u043f\u044b \u044d\u043a\u0441\u043f\u0435\u0440\u0442\u043e\u0432 (ACR ANA Task Force, 2008).<\/div>\n<div><\/div>\n<div>\u041f\u043e\u0437\u0438\u0442\u0438\u0432\u043d\u043e\u0441\u0442\u044c \u043f\u043e \u0430\u043d\u0442\u0438\u043d\u0443\u043a\u043b\u0435\u0430\u0440\u043d\u043e\u043c\u0443 \u0444\u0430\u043a\u0442\u043e\u0440\u0443 \u043d\u0430 \u043a\u043b\u0435\u0442\u043e\u0447\u043d\u043e\u0439 \u043b\u0438\u043d\u0438\u0438 \u041d\u0415\u0440-2 \u043e\u0442\u043c\u0435\u0447\u0430\u0435\u0442\u0441\u044f \u043f\u0440\u0438 \u0441\u0438\u0441\u0442\u0435\u043c\u043d\u043e\u0439 \u043a\u0440\u0430\u0441\u043d\u043e\u0439 \u0432\u043e\u043b\u0447\u0430\u043d\u043a\u0435, \u0441\u0438\u0441\u0442\u0435\u043c\u043d\u044b\u0445 \u0440\u0435\u0432\u043c\u0430\u0442\u0438\u0447\u0435\u0441\u043a\u0438\u0445 \u0438 \u043c\u043d\u043e\u0433\u0438\u0445 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\u0441\u043e\u0435\u0434\u0438\u043d\u0438\u0442\u0435\u043b\u044c\u043d\u043e\u0439 \u0442\u043a\u0430\u043d\u0438, \u0441\u0438\u043d\u0434\u0440\u043e\u043c \u0428\u0451\u0433\u0440\u0435\u043d\u0430. \u0412\u044b\u044f\u0432\u043b\u0435\u043d\u0438\u0435 \u0430\u043d\u0442\u0438\u043d\u0443\u043a\u043b\u0435\u0430\u0440\u043d\u043e\u0433\u043e \u0444\u0430\u043a\u0442\u043e\u0440\u0430 \u0438\u043c\u0435\u0435\u0442 \u0431\u043e\u043b\u044c\u0448\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435 \u0432 \u0434\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u043a\u0435 \u044e\u0432\u0435\u043d\u0438\u043b\u044c\u043d\u043e\u0433\u043e \u0440\u0435\u0432\u043c\u0430\u0442\u043e\u0438\u0434\u043d\u043e\u0433\u043e \u0430\u0440\u0442\u0440\u0438\u0442\u0430.<\/div>\n<div><\/div>\n<div>\u0414\u0430\u043d\u043d\u044b\u0435 \u0430\u0443\u0442\u043e\u0430\u043d\u0442\u0438\u0442\u0435\u043b\u0430 \u043c\u043e\u0433\u0443\u0442 \u0431\u044b\u0442\u044c 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\u0430\u043d\u0442\u0438\u043d\u0443\u043a\u043b\u0435\u0430\u0440\u043d\u043e\u0433\u043e \u0444\u0430\u043a\u0442\u043e\u0440\u0430 \u0434\u043e\u0441\u0442\u0438\u0433\u0430\u0435\u0442 1-3% \u0443 \u043a\u043b\u0438\u043d\u0438\u0447\u0435\u0441\u043a\u0438 \u0437\u0434\u043e\u0440\u043e\u0432\u044b\u0445 \u043b\u044e\u0434\u0435\u0439 \u0438 \u043d\u0435\u0441\u043a\u043e\u043b\u044c\u043a\u043e \u0432\u043e\u0437\u0440\u0430\u0441\u0442\u0430\u0435\u0442 \u0443 \u043b\u0438\u0446 \u0441\u0442\u0430\u0440\u0448\u0435 65 \u043b\u0435\u0442.<\/div>\n<div><\/div>","protected":false},"featured_media":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"product_brand":[],"product_cat":[929],"product_tag":[],"class_list":{"0":"post-10262","1":"product","2":"type-product","3":"status-publish","5":"product_cat-markeri-pentru-afectiuni-reumatismale-si-vasculite","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\/10262","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=10262"}],"wp:attachment":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/media?parent=10262"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_brand?post=10262"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_cat?post=10262"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_tag?post=10262"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}