{"id":9183,"date":"2020-04-23T04:30:35","date_gmt":"2020-04-23T01:30:35","guid":{"rendered":"https:\/\/www.synevo.ro\/product\/calciu-seric\/"},"modified":"2026-02-18T23:48:45","modified_gmt":"2026-02-18T21:48:45","slug":"calciu-seric","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/calciu-seric\/","title":{"rendered":"\u041a\u0430\u043b\u044c\u0446\u0438\u0439 \u0432 \u043a\u0440\u043e\u0432\u0438"},"content":{"rendered":"<p style=\"text-align: justify;\"><strong><em>\u041e\u0431\u0449\u0430\u044f \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f <\/em><\/strong><\/p>\n<p style=\"text-align: justify;\">Calciul este componentul mineral major al oaselor. 99% din cantitatea de\u00a0 calciu din organism se afla in oase si dinti, care constituie un rezervor imens pentru mentinerea nivelului calciului seric, iar restul este distribuit in lichidele biologice si tesuturi moi. Ionii de calciu joaca un rol important in transmiterea impulsurilor nervoase, contractia musculara, functia cardiaca si in procesele de coagulare<sup>1<\/sup>.<\/p>\n<p style=\"text-align: justify;\">Reglarea hormonala a metabolismului calciului ca si cea a fosforului este complexa. Relatiile reciproce intre intestinul subtire, schelet, rinichi si sistemul endocrin, in particular paratiroidele, mentin homeostazia calciului si fosforului<sup>6<\/sup>. De asemenea, calcitonina, vitamina D, estrogenii, androgenii sunt factori care influenteaza nivelul calciului<sup>1<\/sup>.<\/p>\n<p style=\"text-align: justify;\">Cantitatea de proteine din sange afecteaza nivelul calciului, deoarece 45% din calciul seric este legat de proteine<sup>6<\/sup>. Astfel scaderea albuminei serice determina scaderea calciului seric total<sup>1;6<\/sup>.<\/p>\n<p style=\"text-align: justify;\">Concentratii anormale de calciu seric pot indica disfunctii paratiroidiene, boli ale oaselor, carcinoame, sindrom de malnutritie si malabsorbtie, carenta de vitamina D si boli renale. 90% din cazurile de hipercalcemie apar in context de hiperparatiroidism, ca manifestare paraneoplazica sau in afectiuni granulomatoase. Hipercalcemia din cadrul sarcoidozei, insuficientei suprarenaliene si hipertiroidismului este detectata de regula intr-un cadru clinic sugestiv pentru diagnostic<sup>5<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Recomandari pentru determinarea calciului seric<\/em><\/strong><\/p>\n<ul>\n<li style=\"text-align: justify;\">din doi in doi ani, la pacienti cu varsta peste de 50 ani, pentru screening-ul osteoporozei (impreuna cu masurarea inaltimii si greutatii); \u2022 in tetanie (investigarea tipului hipocalcemic); \u2022 fracturi spontane, dureri osoase, modificari osoase radiologice, tulburari de crestere, alterari dentare; \u2022 nefro- sau urolitiaza, nefrocalcinoza, poliurie, polidipsie, boli renale cronice; \u2022 pancreatita acuta, calculi biliari, diaree recurenta, malabsorbtie; \u2022 post-operator in caz de tiroidectomie si paratiroidectomie, in hiperparatiroidism, boli tiroidiene, testiculare, ovariene, adrenale; \u2022 boli granulomatoase; \u2022 tumori;<\/li>\n<li style=\"text-align: justify;\">reactii adverse la anumite medicamente: vitamina D, A, anticonvulsivante, corticosteroizi, tiazide, digitala<sup>1;3;6<\/sup><span style=\"font-size: 16px;\">.<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><strong><em>Pregatire pacient <\/em><\/strong><em>- <\/em>\u00a0\u00e0 jeun (pe nemancate)<sup>4<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><em><span style=\"text-decoration: underline;\">Nota<\/span><\/em><em>:<\/em> nu se administreaza suplimente de calciu cu 8-12 ore inainte; nu se poate face determinarea calcemiei la pacienti tratati cu EDTA sau care au primit substante de contrast radiologice<sup>4<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Specimen recoltat <\/em><\/strong><em>- <strong>\u00a0<\/strong><\/em>sange venos<sup>4<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><em><span style=\"text-decoration: underline;\">Mentiuni<\/span><\/em><em>:<\/em> recoltarea se face dimineata (exista variatii diurne), in clinostatism (exista variatii de postura, deoarece jumatate din calciu este legat de proteine; in clinostatism calcemia ca si proteinemia sunt mai mici decat in ortostatism). La recoltare se va evita staza venoasa cu garoul (produce valori fals crescute). Daca folosirea garoului este indispensabila, proba se va preleva la mai mult de 1 minut de la restabilirea circulatiei. La recoltare si ulterior, in timpul manipularii probelor<strong>, <\/strong>nu se utilizeaza manusi pudrate cu carbonat de calciu (spalati manusile in apa curgatoare, fara sapun sau detergenti, chiar daca sunt etichetate \u201cpowder free\u201d).<\/p>\n<p style=\"text-align: justify;\"><strong><em>Recipient de recoltare <\/em><\/strong><em>-<\/em> vacutainer fara anticoagulant cu\/fara gel separator<sup>4<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Prelucrare necesara dupa recoltare <\/em><\/strong><em>-<\/em> se separa serul prin centrifugare<sup>4<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Volum proba<\/em><\/strong> \u2013 minim 0.5 mL ser<sup>4<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Cauze de respingere a probei <\/em><\/strong><em>- <\/em>\u00a0specimen hemolizat<sup>4<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Stabilitate proba<\/em><\/strong><em> - <\/em>\u00a0serul separat este stabil <em>7 zile<\/em> la temperatura camerei; <em>3 saptamani<\/em> la\u00a0 2-8 \u00b0C; <em>8 luni<\/em> la -20\u00b0C <sup>4<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Metoda\u00a0 <\/em><\/strong><em>- <\/em>\u00a0<span style=\"text-decoration: underline;\">spectrofotometrica (colorimetrica)<\/span><sup>4<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Valori de referinta<\/em><\/strong><\/p>\n<table class=\"wp-block-table w-100\" border=\"1\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td width=\"132\">\n<p style=\"text-align: center;\"><strong><em>Varsta<\/em><\/strong><\/p>\n<\/td>\n<td width=\"204\">\n<p style=\"text-align: center;\"><strong><em>Valori mmol\/L<br \/>\n<\/em><\/strong><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"132\">\n<p style=\"text-align: left;\">\u00a0\u00a0 Copii (0-10 zile)<\/p>\n<\/td>\n<td valign=\"top\" width=\"204\">\n<p style=\"text-align: center;\">1.90 &#8211; 2.60<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"132\">\u00a0\u00a0\u00a0\u00a0Copii (10 zile-2 ani)<\/td>\n<td valign=\"top\" width=\"204\">\n<p style=\"text-align: center;\">2.25 &#8211; 2.75<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"132\">\u00a0\u00a0\u00a0\u00a0 Copii (2-12 ani)<\/td>\n<td valign=\"top\" width=\"204\">\n<p style=\"text-align: center;\">2.20 &#8211; 2.70<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"132\">\u00a0\u00a0\u00a0\u00a0 Copii (12-18 ani)<\/td>\n<td valign=\"top\" width=\"204\">\n<p style=\"text-align: center;\">2.10 &#8211; 2.55<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"132\">\u00a0\u00a0\u00a0\u00a0 Adulti (18-60 ani)<\/td>\n<td valign=\"top\" width=\"204\">\n<p style=\"text-align: center;\">2.15 &#8211; 2.50<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"132\">\u00a0\u00a0\u00a0\u00a0 Adulti (60-90 ani)<\/td>\n<td valign=\"top\" width=\"204\">\n<p style=\"text-align: center;\">\u00a02.20 &#8211; 2.55<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"132\">\u00a0\u00a0\u00a0\u00a0 Adulti (&gt;90 ani)<\/td>\n<td valign=\"top\" width=\"204\">\n<p style=\"text-align: center;\">2.05 &#8211; 2.40<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: justify;\"><strong><em>Limita de detectie <\/em><\/strong>\u2013 0.2 mmol\/L (0.8 mg\/dL)<sup>4<\/sup><\/p>\n<p style=\"text-align: justify;\"><em>Factor de conversie: nmol\/L x 4 = mg\/dL ;\u00a0 mg\/dL x 0.25 = mmol\/L. <\/em><\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #ff0000;\"><strong><em>Valori critice <\/em><\/strong><em>-<\/em><strong>\u00a0 <\/strong>nivel scazut<strong> &lt;6 mg\/dL; <\/strong>nivel crescut<strong>\u00a0 &gt;13 mg\/dL<\/strong><sup>1;4<\/sup>.\u00a0\u00a0<\/span><\/p>\n<p style=\"text-align: justify;\"><strong><em>Interpretarea rezultatelor<\/em><\/strong><\/p>\n<table class=\"wp-block-table w-100\" border=\"1\" width=\"576\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td valign=\"top\" width=\"288\">\n<p style=\"text-align: center;\"><strong><em>Cresteri<\/em><\/strong><\/p>\n<\/td>\n<td valign=\"top\" width=\"288\">\n<p style=\"text-align: center;\"><strong><em>Scaderi<\/em><\/strong><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"288\">\n<p style=\"text-align: left;\">\u2022 hiperparatiroidism primar (adenom sau hiperplazia glandelor suprarenaliene) si secundar (insuficienta renala acuta si cronica, posttransplant renal, osteomalacie si malabsorbtie);<\/p>\n<p style=\"text-align: left;\">\u2022 tumori maligne: cancer osos metastatic, cancer de plaman, san, tiroida, rinichi, ficat, pancreas, prostata, mielom multiplu, carcinom scuamocelular pulmonar sau de cap si gat; 2% dintre pacientii cu limfom Hodgkin sau non-Hodgkin; in aceste situatii hipercalcemia se explica prin: metastaze osoase, factori de activare ai osteoclastelor\u00a0 (mielom multiplu, limfom Burkitt, limfomul cu celule T al adultului), sindrom paraneoplazic (secretie a unei proteine similare hormonului paratiroidian, secretie ectopica de 1,25-dihidroxivitamina D<sub>3<\/sub>);<\/p>\n<p style=\"text-align: left;\">\u2022 boli granulomatoase (tuberculoza, sarcoidoza), prin exces de 1,25-dihidroxivitamina D<sub>3<\/sub>;<\/p>\n<p style=\"text-align: left;\">\u2022 reactii adverse la medicamente [intoxicatie cu vitamina D, sindrom lapte-alcaline (Burnett), diuretice, alti agenti terapeutici];<\/p>\n<p style=\"text-align: left;\">\u2022 insuficienta renala cronica;<\/p>\n<p style=\"text-align: left;\">\u2022 alte afectiuni endocrine: hipertiroidism (la 20\u201340% dintre pacienti, de obicei &lt;14mg\/dL), hipotiroidism,\u00a0 insuficienta suprarenaliana, acromegalie, feocromocitom, sindromul de neoplazie endocrina multipla (MEN);<\/p>\n<p style=\"text-align: left;\">\u2022 osteoporoza acuta (imobilizare la pat a unor pacienti tineri sau in boala Paget);<\/p>\n<p style=\"text-align: left;\">\u2022 cauze diverse: hipercalcemia familiala hipocalciurica, porfiria, deshidratarea cu hiperproteinemie, hipofosfatazia, hipercalcemia idiopatica a sugarului<sup>1;3;5<\/sup>.<\/p>\n<\/td>\n<td valign=\"top\" width=\"288\">\u2022 pseudohipocalcemia care reflecta reducerea nivelului albuminei;<\/p>\n<p style=\"text-align: left;\">\u2022 hipoparatiroidism chirurgical, postiradiere, idiopatic, infiltrarea paratiroidelor de diverse cauze (sarcoidoza, amiloidoza, hemocromatoza, tumori), congenital (sindromul DiGeorge);<\/p>\n<p style=\"text-align: left;\">\u2022 pseudohipoparatiroidism (rezistenta la actiunea PTH);<\/p>\n<p style=\"text-align: left;\">\u2022 malabsorbtie de calciu si vitamina D din sprue, boala celiaca, disfunctii pancreatice;<\/p>\n<p style=\"text-align: left;\">\u2022 icter obstructiv;<\/p>\n<p style=\"text-align: left;\">\u2022 insuficienta renala cronica cu uremie si hiperfosfatemie; sindrom Fanconi; acidoza tubulara renala;<\/p>\n<p style=\"text-align: left;\">\u2022 pancreatita acuta cu plaje intinse de necroza grasoasa;<\/p>\n<p style=\"text-align: left;\">\u2022 aport redus de calciu, fosfor si vitamina D (inanitie, malnutritie, afectiuni osoase, ultimul trimestru de sarcina);<\/p>\n<p style=\"text-align: left;\">\u2022 administrarea unor medicamente (chimioterapice anticanceroase, intoxicatie cu fluor, antibiotice, diuretice de ansa, anticonvulsivante, corticosteroizi, calcitonina, transfuzii multiple cu sange citratat, administrarea in exces de fluide i.v. care scad nivelul albuminei);<\/p>\n<p style=\"text-align: left;\">\u2022 hipomagneziemie;<\/p>\n<p style=\"text-align: left;\">\u2022 tumori cu metastaze osteoblastice (san, prostata, plaman, tiroida);<\/p>\n<p style=\"text-align: left;\">\u2022 sindromul de soc toxic;<\/p>\n<p style=\"text-align: left;\">\u2022 sindromul de liza tumorala<sup>1;3;5<\/sup>.<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: justify;\"><strong><em>Limite si interferente<\/em><\/strong><\/p>\n<p style=\"text-align: justify;\">Hipercalcemia se insoteste adesea de hipopotasemie si conduce intotdeauna la deshidratare, deoarece calciul in exces determina diabet insipid nefrogen.<\/p>\n<p style=\"text-align: justify;\">Pentru ca valorile calciului seric sa fie interpretate corect, intotdeauna trebuie determinate simultan proteinele serice totale si albumina, deoarece in ser 0.8 mg de calciu se leaga de 1.0 g de albumina; pentru corectie, la valoarea obtinuta pentru calciu se adauga 0.8 mg\/dL pentru fiecare 1.0 g\/dL cu care albumina serica scade sub 4.0 g\/dL; legarea de globuline afecteaza valoarea calciului total doar daca globulinele sunt in concentratie de peste 6 g\/dL.<\/p>\n<p style=\"text-align: justify;\"><span style=\"text-decoration: underline;\"><strong>Valori crescute<\/strong><\/span>: proteine serice totale crescute, sindrom de deshidratare, staza venoasa secundara aplicarii garoului timp indelungat, dozarea folosind tuburi inchise cu dop, hiponatremia (&lt;120mEq\/L), care creste fractiunea de calciu legat de proteine si deci creste usor valoarea calciului total<sup>3<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><span style=\"text-decoration: underline;\">Valori scazute<\/span>:<\/strong> hipomagneziemie (de exemplu, cea secundara chimioterapiei cu cisplatin), hiperfosfatemie (secundara administrarii de laxative, clismelor cu fosfati, chimioterapiei in leucemii sau limfoame, rabdomiolizei), hipernatremie, hipoalbuminemie, hemodilutie<sup>3<\/sup>.<\/p>\n<p style=\"text-align: justify;\">\u2022 Medicamente<\/p>\n<p style=\"text-align: justify; padding-left: 30px;\"><strong><span style=\"text-decoration: underline;\">Cresteri<\/span>:<\/strong> medicamente antiacide (alcaline), androgeni, saruri de calciu, danazol, dietilstilbestrol (crestere rapida in 24 ore la pacienti cu cancer de san), dihidrotahisterol, administrare cronica de diuretice (clortalidon, acid etacrinic, furosemid, tiazide), ergocalciferol, isotretinoin, litiu, progesteron, PTH, tamoxifen, vitamina D, vitamina A<sup>2<\/sup>.<\/p>\n<p style=\"text-align: justify; padding-left: 30px;\"><span style=\"text-decoration: underline;\"><strong>Scaderi<\/strong><\/span>: albuterol, alprostadil, aminoglicozide (ex.: gentamicina), asparaginaza, barbiturice (la batrani), calcitonina, carbamazepin, carbenoxolona, carboplatin, corticosteroizi; diuretice (efect initial): acetazolamida, acid etacrinic, furosemid; ergocalciferol, estrogeni (in post-menopauza), fluoruri, gastrina, glucagon, glucoza, indapamid, insulina, izoniazida, laxative (exces), saruri de magneziu, meticilina, fenitoin, fosfati, plicamicin, solutii saline (efectul apare in caz de hipercalcemie), tetraciclina (la gravide), tacrolimus, tobramicina<sup>2<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: small;\">\u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: small;\">1. Frances Fischbach. Pulmonary Function, ANGs and Electrolyte Studies. In A Manual of Laboratory and Diagnostic Tests. Lippincott Williams &amp; Wilkins, USA, 8 Ed., 2009, 994-997.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: small;\">2. Frances Fischbach. Effects of the Drugs on Laboratory Tests. In A Manual of Laboratory and Diagnostic Tests. Lippincott Williams &amp; Wilkins, USA, 7 Ed., 2004, 1231.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: small;\">3. Jacques Wallach. Analizele de sange. In Interpretarea testelor de diagnostic. Editura Stiintelor Medicale, Romania, 7 Ed., 2001, 61-64.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: small;\">4. Laborator Synevo. Referinte specifice tehnologiei de lucru utilizate 2015. Ref Type: Catalog.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: small;\">5. Laboratory Corporation of America. Directory of Services and Interpretive Guide. Calcium, Serum. www.labcorp.com 2015. Ref Type: Internet Communication.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: small;\">6. Lothar Thomas. Bone and Mineral Metabolism. In Clinical Laboratory Diagnostics-Use and Assessment of Clinical Laboratory Results. TH-Books Verlagsgesellschaft mbH, Frankfurt \/Main, Germany, 1 Ed., 1998, 231-237.<\/span><\/p>","protected":false},"excerpt":{"rendered":"<p>\u041a\u0430\u043b\u044c\u0446\u0438\u0439 &#8211; \u043e\u0441\u043d\u043e\u0432\u043d\u043e\u0439 \u043c\u0438\u043d\u0435\u0440\u0430\u043b\u044c\u043d\u044b\u0439 \u043a\u043e\u043c\u043f\u043e\u043d\u0435\u043d\u0442 \u043a\u043e\u0441\u0442\u0435\u0439. 99% \u043a\u0430\u043b\u044c\u0446\u0438\u044f \u0432 \u043e\u0440\u0433\u0430\u043d\u0438\u0437\u043c\u0435 \u043d\u0430\u0445\u043e\u0434\u0438\u0442\u0441\u044f \u0432 \u0441\u0442\u0440\u0443\u043a\u0442\u0443\u0440\u0435 \u043a\u043e\u0441\u0442\u0435\u0439 \u0438 \u0437\u0443\u0431\u043e\u0432, \u043e\u0441\u0442\u0430\u043b\u044c\u043d\u0430\u044f \u0447\u0430\u0441\u0442\u044c \u043d\u0430\u0445\u043e\u0434\u0438\u0442\u0441\u044f \u0432 \u0431\u0438\u043e\u043b\u043e\u0433\u0438\u0447\u0435\u0441\u043a\u0438\u0445 \u0436\u0438\u0434\u043a\u043e\u0441\u0442\u044f\u0445 \u0438 \u043c\u044f\u0433\u043a\u0438\u0445 \u0442\u043a\u0430\u043d\u044f\u0445.<\/p>\n<p>\u041a\u0430\u043b\u044c\u0446\u0438\u0439 \u0441\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0438 \u043f\u0440\u0435\u0434\u0441\u0442\u0430\u0432\u043b\u0435\u043d \u0442\u0440\u0435\u043c\u044f \u0444\u0440\u0430\u043a\u0446\u0438\u044f\u043c\u0438:<\/p>\n<ul>\n<li>\u0441\u0432\u043e\u0431\u043e\u0434\u043d\u044b\u0439 (\u0438\u043e\u043d\u0438\u0437\u0438\u0440\u043e\u0432\u0430\u043d\u043d\u044b\u0439) \u043a\u0430\u043b\u044c\u0446\u0438\u0439 &#8212; \u043e\u043a\u043e\u043b\u043e 50%, \u043a\u0430\u043b\u044c\u0446\u0438\u0439, \u0441\u0432\u044f\u0437\u0430\u043d\u043d\u044b\u0439 \u0441 \u0431\u0435\u043b\u043a\u0430\u043c\u0438 (\u043f\u0440\u0435\u0438\u043c\u0443\u0449\u0435\u0441\u0442\u0432\u0435\u043d\u043d\u043e \u0441 \u0430\u043b\u044c\u0431\u0443\u043c\u0438\u043d\u043e\u043c) &#8212; \u043e\u043a\u043e\u043b\u043e 40% \u0438<\/li>\n<li>\u043a\u0430\u043b\u044c\u0446\u0438\u0439, 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\u0433\u0438\u043f\u043e\u0430\u043b\u044c\u0431\u0443\u043c\u0438\u043d\u0435\u043c\u0438\u0438, \u043f\u0430\u0440\u0430\u043f\u0440\u043e\u0442\u0435\u0438\u043d\u0435\u043c\u0438\u0438, \u043d\u0430\u0440\u0443\u0448\u0435\u043d\u0438\u0438 \u043a\u0438\u0441\u043b\u043e\u0442\u043d\u043e-\u0449\u0435\u043b\u043e\u0447\u043d\u043e\u0433\u043e \u0431\u0430\u043b\u0430\u043d\u0441\u0430, \u0431\u0435\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442\u0438) \u043e\u043f\u0440\u0435\u0434\u0435\u043b\u044f\u0435\u0442\u0441\u044f \u043a\u043e\u043d\u0446\u0435\u043d\u0442\u0440\u0430\u0446\u0438\u044f \u0438\u043e\u043d\u0438\u0437\u0438\u0440\u043e\u0432\u0430\u043d\u043d\u043e\u0433\u043e \u043a\u0430\u043b\u044c\u0446\u0438\u044f.<\/p>\n<table>\n<tbody>\n<tr>\n<td width=\"262\"><b>\u041f\u043e\u043a\u0430\u0437\u0430\u0442\u0435\u043b\u044c<\/b><\/td>\n<td width=\"366\"><b>\u0425\u0430\u0440\u0430\u043a\u0442\u0435\u0440\u0438\u0441\u0442\u0438\u043a\u0430<\/b><\/td>\n<\/tr>\n<tr>\n<td width=\"262\"><b>\u041c\u0430\u0442\u0435\u0440\u0438\u0430\u043b<\/b><\/td>\n<td width=\"366\">\u0412\u0435\u043d\u043e\u0437\u043d\u0430\u044f\u00a0\u043a\u0440\u043e\u0432\u044c<\/td>\n<\/tr>\n<tr>\n<td width=\"262\"><b>\u041f\u0440\u0430\u0432\u0438\u043b\u0430\u00a0\u043f\u043e\u0434\u0433\u043e\u0442\u043e\u0432\u043a\u0438\u00a0\u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430<\/b><\/td>\n<td width=\"366\">\u0421\u0442\u0430\u043d\u0434\u0430\u0440\u0442\u043d\u044b\u0435<\/td>\n<\/tr>\n<tr>\n<td width=\"262\"><b>\u0422\u0440\u0430\u043d\u0441\u043f\u043e\u0440\u0442\u043d\u0430\u044f\u00a0\u0441\u0440\u0435\u0434\u0430,\u00a0\u043f\u0440\u043e\u0431\u0438\u0440\u043a\u0430<\/b><\/td>\n<td width=\"366\">\u0412\u0430\u043a\u0443\u0442\u0430\u0439\u043d\u0435\u0440\u00a0\u0441\/\u0431\u0435\u0437\u00a0\u0430\u043d\u0442\u0438\u043a\u043e\u0430\u0433\u0443\u043b\u044f\u043d\u0442\u0430\u00a0\u0441\/\u0431\u0435\u0437\u00a0\u0433\u0435\u043b\u0435\u0432\u043e\u0439\u00a0\u0444\u0430\u0437\u044b<\/td>\n<\/tr>\n<tr>\n<td width=\"262\"><b>\u041f\u0440\u0430\u0432\u0438\u043b\u0430\u00a0\u0438\u00a0\u0443\u0441\u043b\u043e\u0432\u0438\u044f\u00a0\u0442\u0440\u0430\u043d\u0441\u043f\u043e\u0440\u0442\u0438\u0440\u043e\u0432\u043a\u0438,\u00a0\u0441\u0442\u0430\u0431\u0438\u043b\u044c\u043d\u043e\u0441\u0442\u044c\u00a0\u043f\u0440\u043e\u0431\u044b<\/b><\/td>\n<td width=\"366\">\u0421\u0442\u0430\u043d\u0434\u0430\u0440\u0442\u043d\u044b\u0435<\/td>\n<\/tr>\n<tr>\n<td width=\"262\"><\/td>\n<td width=\"366\"><\/td>\n<\/tr>\n<tr>\n<td width=\"262\"><\/td>\n<td width=\"366\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" width=\"629\"><\/td>\n<\/tr>\n<tr>\n<td width=\"262\"><\/td>\n<td width=\"366\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" width=\"629\"><b>\u0418\u043d\u0442\u0435\u0440\u0444\u0435\u0440\u0438\u0440\u0443\u044e\u0449\u0438\u0435\u00a0\u0444\u0430\u043a\u0442\u043e\u0440\u044b.\u00a0\u041c\u0435\u0434\u0438\u043a\u0430\u043c\u0435\u043d\u0442\u044b<\/b><\/td>\n<\/tr>\n<tr>\n<td width=\"262\"><b>\u041f\u043e\u0432\u044b\u0448\u0430\u044e\u0442<\/b><\/td>\n<td width=\"366\"><b>\u0421\u043d\u0438\u0436\u0430\u044e\u0442<\/b><\/td>\n<\/tr>\n<tr>\n<td width=\"262\">\u0422\u0430\u043c\u043e\u043a\u0441\u0438\u0444\u0435\u043d,\u00a0\u0430\u043d\u0442\u0430\u0446\u0438\u0434\u044b,\u00a0\u0430\u043d\u0434\u0440\u043e\u0433\u0435\u043d\u044b,\u00a0\u0441\u043e\u043b\u0438\u00a0\u043a\u0430\u043b\u044c\u0446\u0438\u044f,\u00a0\u0434\u043b\u0438\u0442\u0435\u043b\u044c\u043d\u044b\u0439\u00a0\u043f\u0440\u0438\u0435\u043c\u00a0\u0434\u0438\u0443\u0440\u0435\u0442\u0438\u043a\u043e\u0432,<\/p>\n<p>\u043f\u0440\u043e\u0433\u0435\u0441\u0442\u0435\u0440\u043e\u043d,\u00a0\u0432\u0438\u0442\u0430\u043c\u0438\u043d\u00a0D\u00a0\u0438\u00a0\u0410<\/td>\n<td width=\"366\">\u0410\u043c\u0438\u043d\u043e\u0433\u043b\u0438\u043a\u043e\u0437\u0438\u0434\u044b,\u00a0\u0431\u0430\u0440\u0431\u0438\u0442\u0443\u0440\u0430\u0442\u044b,\u00a0\u043a\u0430\u043b\u044c\u0446\u0438\u0442\u043e\u043d\u0438\u043d,\u00a0\u043a\u0430\u0440\u0431\u0430\u043c\u0430\u0437\u0435\u043f\u0438\u043d,\u00a0\u0441\u0442\u0435\u0440\u043e\u0438\u0434\u044b,<\/p>\n<p>\u0434\u0438\u0443\u0440\u0435\u0442\u0438\u043a\u0438,\u00a0\u044d\u0441\u0442\u0440\u043e\u0433\u0435\u043d\u00a0(\u0432\u00a0\u043f\u043e\u0441\u0442\u043c\u0435\u043d\u043e\u043f\u0430\u0443\u0437\u0435),\u00a0\u0433\u043b\u044e\u043a\u0430\u0433\u043e\u043d,\u00a0\u0433\u043b\u044e\u043a\u043e\u0437\u0430,\u00a0\u0438\u043d\u0441\u0443\u043b\u0438\u043d,<\/p>\n<p>\u043c\u0430\u0433\u043d\u0438\u0435\u0432\u044b\u0435\u00a0\u0441\u043e\u043b\u0438,\u00a0\u043c\u0435\u0442\u0438\u0446\u0438\u043b\u043b\u0438\u043d,\u00a0\u0441\u043e\u043b\u0435\u0432\u044b\u0435\u00a0\u0440\u0430\u0441\u0442\u0432\u043e\u0440\u044b<\/p>\n<p>(\u044d\u0444\u0444\u0435\u043a\u0442\u00a0\u043d\u0430\u0431\u043b\u044e\u0434\u0430\u0435\u0442\u0441\u044f\u00a0\u0432\u00a0\u0441\u043b\u0443\u0447\u0430\u0435\u00a0\u0433\u0438\u043f\u0435\u0440\u043a\u0430\u043b\u044c\u0446\u0438\u0435\u043c\u0438\u0438)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<table>\n<tbody>\n<tr>\n<td colspan=\"2\" width=\"627\"><b>\u041f\u043e\u043a\u0430\u0437\u0430\u043d\u0438\u044f\u00a0\u043a\u00a0\u043d\u0430\u0437\u043d\u0430\u0447\u0435\u043d\u0438\u044e<\/b><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" width=\"627\">\u00b7\u00a0\u0414\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u043a\u0430\u00a0\u0438\u00a0\u043a\u043e\u043d\u0442\u0440\u043e\u043b\u044c\u00a0\u0437\u0430\u00a0\u044d\u0444\u0444\u0435\u043a\u0442\u0438\u0432\u043d\u043e\u0441\u0442\u044c\u044e\u00a0\u043b\u0435\u0447\u0435\u043d\u0438\u044f\u00a0\u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u0439\u00a0\u043f\u0430\u0440\u0430\u0449\u0438\u0442\u043e\u0432\u0438\u0434\u043d\u044b\u0445\u00a0\u0436\u0435\u043b\u0451\u0437;<\/p>\n<p>\u00b7\u00a0\u0437\u043b\u043e\u043a\u0430\u0447\u0435\u0441\u0442\u0432\u0435\u043d\u043d\u044b\u0435\u00a0\u043d\u043e\u0432\u043e\u043e\u0431\u0440\u0430\u0437\u043e\u0432\u0430\u043d\u0438\u044f\u00a0(\u0440\u0430\u043a\u00a0\u043b\u0435\u0433\u043a\u0438\u0445,\u00a0\u043c\u043e\u043b\u043e\u0447\u043d\u043e\u0439\u00a0\u0436\u0435\u043b\u0435\u0437\u044b,\u00a0\u043b\u0438\u043c\u0444\u043e\u043c\u0430);<\/p>\n<p>\u00b7\u00a0\u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f\u00a0\u043a\u043e\u0441\u0442\u043d\u043e\u0439\u00a0\u0442\u043a\u0430\u043d\u0438;<\/p>\n<p>\u00b7\u00a0\u0445\u0440\u043e\u043d\u0438\u0447\u0435\u0441\u043a\u0438\u0435\u00a0\u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f\u00a0\u043f\u043e\u0447\u0435\u043a;<\/p>\n<p>\u00b7\u00a0\u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f\u00a0\u0416\u041a\u0422\u00a0(\u044f\u0437\u0432\u0435\u043d\u043d\u0430\u044f\u00a0\u0431\u043e\u043b\u0435\u0437\u043d\u044c\u00a0\u0436\u0435\u043b\u0443\u0434\u043a\u0430\u00a0\u0438\u00a012-\u043f\u0435\u0440\u0441\u0442\u043d\u043e\u0439\u00a0\u043a\u0438\u0448\u043a\u0438,\u00a0\u043e\u0441\u0442\u0440\u044b\u0439\u00a0\u043f\u0430\u043d\u043a\u0440\u0435\u0430\u0442\u0438\u0442);<\/p>\n<p>\u00b7\u00a0\u043f\u0430\u0442\u043e\u043b\u043e\u0433\u0438\u044f\u00a0\u0441\u0435\u0440\u0434\u0435\u0447\u043d\u043e-\u0441\u043e\u0441\u0443\u0434\u0438\u0441\u0442\u043e\u0439\u00a0\u0441\u0438\u0441\u0442\u0435\u043c\u044b<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" width=\"627\"><b>\u0418\u043d\u0442\u0435\u0440\u043f\u0440\u0435\u0442\u0430\u0446\u0438\u044f\u00a0\u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442\u043e\u0432<\/b><\/td>\n<\/tr>\n<tr>\n<td width=\"310\"><b>\u041f\u043e\u0432\u044b\u0448\u0435\u043d\u0438\u0435\u00a0\u0443\u0440\u043e\u0432\u043d\u044f<\/b><\/td>\n<td width=\"317\"><b>\u0421\u043d\u0438\u0436\u0435\u043d\u0438\u0435\u00a0\u0443\u0440\u043e\u0432\u043d\u044f<\/b><\/td>\n<\/tr>\n<tr>\n<td width=\"310\">\u00b7\u00a0\u041f\u0435\u0440\u0432\u0438\u0447\u043d\u044b\u0439\u00a0\u0438\u00a0\u0432\u0442\u043e\u0440\u0438\u0447\u043d\u044b\u0439\u00a0\u0433\u0438\u043f\u0435\u0440\u043f\u0430\u0440\u0430\u0442\u0438\u0440\u0435\u043e\u0437;<\/p>\n<p>\u00b7\u00a0\u0437\u043b\u043e\u043a\u0430\u0447\u0435\u0441\u0442\u0432\u0435\u043d\u043d\u044b\u0435\u00a0\u043e\u043f\u0443\u0445\u043e\u043b\u0438;<\/p>\n<p>\u00b7\u00a0\u0433\u0435\u043c\u043e\u0431\u043b\u0430\u0441\u0442\u043e\u0437\u044b;<\/p>\n<p>\u00b7\u00a0\u0433\u0440\u0430\u043d\u0443\u043b\u0435\u043c\u0430\u0442\u043e\u0437\u043d\u044b\u0435\u00a0\u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f\u00a0(\u0442\u0443\u0431\u0435\u0440\u043a\u0443\u043b\u0435\u0437,\u00a0\u0441\u0430\u0440\u043a\u043e\u0438\u0434\u043e\u0437);<\/p>\n<p>\u00b7\u00a0\u0434\u0438\u0430\u043b\u0438\u0437\u043d\u0430\u044f\u00a0\u043e\u0441\u0442\u0435\u043e\u043c\u0430\u043b\u044f\u0446\u0438\u044f;<\/p>\n<p>\u00b7\u00a0\u041e\u041f\u041d;<\/p>\n<p>\u00b7\u00a0\u0433\u0438\u043f\u0435\u0440\u0442\u0438\u0440\u0435\u043e\u0437,\u00a0\u0433\u0438\u043f\u043e\u0442\u0438\u0440\u0435\u043e\u0437;<\/p>\n<p>\u00b7\u00a0\u043d\u0435\u0434\u043e\u0441\u0442\u0430\u0442\u043e\u0447\u043d\u043e\u0441\u0442\u044c\u00a0\u043d\u0430\u0434\u043f\u043e\u0447\u0435\u0447\u043d\u0438\u043a\u043e\u0432,\u00a0\u0430\u043a\u0440\u043e\u043c\u0435\u0433\u0430\u043b\u0438\u044f,\u00a0\u0444\u0435\u043e\u0445\u0440\u043e\u043c\u043e\u0446\u0438\u0442\u043e\u043c\u0430;<\/p>\n<p>\u00b7\u00a0\u043e\u0441\u0442\u0435\u043e\u043f\u043e\u0440\u043e\u0437;<\/p>\n<p>\u00b7\u00a0\u0431\u043e\u043b\u0435\u0437\u043d\u044c\u00a0\u041f\u0435\u0434\u0436\u0435\u0442\u0430;<\/p>\n<p>\u00b7\u00a0\u0433\u0438\u043f\u0435\u0440\u0432\u0438\u0442\u0430\u043c\u0438\u043d\u043e\u0437\u00a0\u0410;<\/p>\n<p>\u00b7\u00a0\u044f\u0442\u0440\u043e\u0433\u0435\u043d\u043d\u0430\u044f\u00a0\u0433\u0438\u043f\u0435\u0440\u043a\u0430\u043b\u044c\u0446\u0438\u0435\u043c\u0438\u044f;<\/p>\n<p>\u00b7\u00a0\u0434\u043b\u0438\u0442\u0435\u043b\u044c\u043d\u0430\u044f\u00a0\u0438\u043c\u043c\u043e\u0431\u0438\u043b\u0438\u0437\u0430\u0446\u0438\u044f;<\/p>\n<p>\u00b7\u00a0\u0441\u0438\u043d\u0434\u0440\u043e\u043c\u00a0\u0412\u0438\u043b\u044c\u044f\u043c\u0441\u0430;<\/p>\n<p>\u00b7\u00a0\u0433\u0438\u043f\u043e\u043a\u0430\u043b\u0438\u0435\u043c\u0438\u044f\u00a0(\u043f\u0440\u0438\u00a0\u044d\u0442\u043e\u043c\u00a0\u0438\u0437\u0431\u044b\u0442\u043e\u043a\u00a0\u043a\u0430\u043b\u044c\u0446\u0438\u044f\u00a0\u043c\u043e\u0436\u0435\u0442\u00a0\u0432\u044b\u0437\u044b\u0432\u0430\u0442\u044c\u00a0\u0432\u044f\u043b\u043e\u0442\u0435\u043a\u0443\u0449\u0438\u0439<\/p>\n<p>\u043d\u0435\u0444\u0440\u043e\u0433\u0435\u043d\u043d\u044b\u0439\u00a0\u043d\u0435\u0441\u0430\u0445\u0430\u0440\u043d\u044b\u0439\u00a0\u0434\u0438\u0430\u0431\u0435\u0442)<\/td>\n<td 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