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8/17/2019 Lupus Eritematosus Sistemik / Systemic Lupus Erythematosus (SLE)
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Fupus Krltk`otdus ]lstk`lj
Fupus krltk`otdsus slstk`lj (systk`lm fupus krythk`otdsus) (]FK) `krupojoa pkayojlt
labfo`osl outdl`ua jrdals gkaeoa ktldfdel yoae nkfu` gljktohul skrto `oalbkstosl jflals,
pkrcofoaoa pkayojlt goa prdeadsls yoae soaeot nkroeo`. Ykayojlt lal tkruto`o `kaykroae woaltouslo rkprdgujsl gkaeoa oaejo jk`otloa yoae mujup tlaeel. Bojtdr ekaktlj, l`uadfdelj goa
hdr`daof skrto flaejuaeoa glgueo nkrpkroa gofo` potdblsldfdel ]FK.?
Yotdekaksls goa Ktldfdel
@kjoals`k potdekaksls ]FK `krupojoa latkrojsl gorl eka tkrsoaejo goa bojtdr
flaejuaeoa yoae `kayknonjoa rkspda l`ua onadr`of. ^kspda tkrsknut `kflputl (?) Ojtlvosl
l`ualtos laaotk (skf gkagrltlj) dfkh MpE GAO, GAO pogo jd`pfkjs l`ua, goa ^AO pogo prdtkla
skfb-oatleka: (>) pkauruaoa o`noae ojtlvosl gorl skf l`ua ogoptlb (fl`bdslt spkslblj oatleka W goa
N): rkeufosl goa lahlnlsl lakbkjtlb gorl MG7+ goa MG8+ skf W: pkaeuroaeoa nkrslhoa skf opdptdsls
goa jd`pfkjs l`ua. ]kfb-oatleka gopot gljkaofl dfkh slstk` l`ua pogo pkr`ujooa skf opdptdtlj:
skhlaeeo oatleka, outdoatlndgl goa jd`pfkj l`ua `kaktop pogo coaejo wojtu poacoae,
`kayknonjoa labfo`osl goa pkayojlt nkrjk`noae.>
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Ojtlvosl l`ua gorl skf yoae nkrslrjufosl `oupua `kfkjot pogo corlaeoa glskrtol gkaeoa
pkfkposoa tu`dr akmrdsls bomtdr (WAB) prdlabfo`otdr, latkrbkrda tlpk ? goa > (LBAs), goa sltdjla
N stl`ufotdr fl`bdslt (NFy]) goa latkrfkujla (LF)-?9. Fupus W goa skf aoturof jlffkr (AJ) eoeof
`k`prdgujsl LF-> goa troasbdr`lae erdwth bomtdr (WEB) yoae `kaelagujsl rkeufosl MG7+ goa
skf lahlnlsl MG8+. Ojlnot onadr`ofltos lal ogofoh prdgujsl gorl oatlndgl potdekalj goa jd`pfkjs
l`ua. Ojtlvosl jd`pfk`ka goa skf l`ua `kayknonjoa pkfkposoa mhk`dtoxla, sltdjla, mhk`djla,
pkptlgo vosdojtlb goa kazl` pkrusoj. Yogo labfo`osl jrdals, oju`ufosl gorl erdwth bomtdr goa
prdguj djslgosl jrdals `kayknonjoa jkrusojoa corlaeoa lrkvkrslnkf pogo efd`krufus, poru goa
corlaeoa folaayo.>
]FK `krupojoa pkayojlt `uftlekalj. Yogo laglvlgu yoae rkatoa, jd`nlaosl gorl nkrnoeol
eka adr`of yoae `oslae-`oslae nkrjdatrlnusl tkrhogop skgljlt rkspda l`ua yoae onadr`of. Cljo
vorlosl tkrsknut tkroju`ufosl `ojo ojoa tl`nuf pkayojlt. Gkblslkasl hd`dzledt tkrhogop
jd`pdaka jd`pfk`ka M?q,M>,M7 `krupojoa prkglspdslsl juot tkrcoglayo ]FK. Nknkropo eka
`k`pkaeoruhl `oalbkstosl jflals pkayojlt (mdatdhayo akbrltls glpkaeoruhl dfkh Bm^ >O/=O,
@NF, YGMG?: ortrltls goa vosjufltls glpkaeoruhl @MY-?)>
Uoalto fknlh `ugoh tkrjkao fupus jorkao `k`lfljl rkspda oatlndgl yoae fknlh tlaeel.
Uoalto yoae tkrkjspds jdatroskpsl yoae `kaeoaguae kstkrdeka rksljdayo `kalaejot ?,>-> jofl
flpot. Nknkropo stl`ufus flaejuaeoa gopot `k`pkaeoruhl ]FK. Yoporoa uftrovldfkt `kayknonjoa
bfork ]FK pogo ho`plr 59% poslka, vlrus Kpstkla Norr `uaejla `krupojoa oeka labkjslus yoae
gopot `k`lmu ]FK.>
Kplgk`ldfdel
Laslgka tohuaoa ]FK gl O`krljo skrljot sknksor ;,? pkr ?99.999 pkaguguj, sk`katoro
prkvofkasl ]FK gl O`krljo glfopdrjoa ;> josus pkr ?99.999 pkaguguj, gkaeoa rosld ekagkr
woalto goa fojl-fojl oatoro 99> gl ^][Y Mlptd @oaeuajusu`d (^][email protected]) Cojorto, glgopotjoa
?.7% josus ]FK gorl tdtof juacuaeoa poslka gl pdfljflalj ^ku`otdfdel Ykayojlt Gofo`7,
sk`katoro gl ^] Hosoa ]ogljla Noaguae tkrgopot >
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@oalbkstosl jflals ]FK soaeot fuos, `kflputl jktkrflnotoa juflt goa `ujdso, skagl, goroh,
coatuae, poru, elacof, susuaoa sorob pusot (]]Y) goa slstk` l`ua. Glfopdrjoa nohwo pogo ?999
poslka ]FK gl Krdpo yoae glljutl skfo`o ?9 tohua, `oalbkstosl jflals tkrnoayoj nkrturut-turut
ogofoh ortrltls sknksor 78,?%, ruo` `ofor =?,?%, akbrdpotl >5,>,
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otou
n.
]lflagkr skfufkr 3 - gopot nkrupo slflagkr krltrdslt, hk`defdnla,
eroaufor, tunufor otou mo`puroa.
Eoaeeuoa akurdfdel o. Jkcoae yoae nujoa glsknonjoa dfkh dnot-dnotoa otou eoaeeuoa
`ktondflm (`lsofayo urk`lo, jktdoslgdsls, otou jktlgoj-skl`noaeoakfkjtrdflt).
otou
n.
Ysljdsls yoae nujoa glsknonjoa dfkh dnot-dnotoa otou eoaeeuoa
`ktondflm (`lsofayo urk`lo, jktdoslgdsls, otou jktlgoj-skl`noaeoa
kfkjtrdflt).
Eoaeeuoa hk`otdfdelj o. Oak`lo hk`dfltlj gkaeoa rktljufdsls
otou
n.
Fkjdpkalo 67.999/``= pogo guo jofl pk`krljsooa/fknlh
otoum.
Fl`bdpkalo 6?.;99/``= pogo guo jofl pk`krljsooa/fknlh
otou
g. Wrd`ndsltdpkalo 6?99.999/``= toapo glsknonjoa dfkh dnot-dnotoa
Eoaeeuoa l`uadfdelj o.
Oatl-GAO3 oatlndgl tkrhogop aotlvk GAO gkaeoa tltkr yoae onadr`of
otou
n. Oatl-]`3 tkrgopotayo oatlndgl tkrhogop oatleka aujfkor ]`, otou
m.
Wk`uoa pdsltlb tkrhogop oatlndgl oatlbdsbdflplg yoae glgosorjoa otos3
?) Jogor skru` oatlndgl oatljorgldflpla onadr`of nolj LeE otou
>) Wks fupus oatljdoeufoa pdsltlb `kaeeuaojoa `ktdgo stoagorg,
otou
=) Hoslf tks skrdfdel pdsltlb pofsu tkrhogop slblfls skjuroae-
juroaeayo skfo`o 2 nufoa goa gljdabl r`osl gkaeoa tkst
l`dnlflsosl Wrkpdak`o pofflgu` otou tks bfudrkskasl onsdrpsl
oatlndgl trkpdak`o.
Oatlndgl oatlaujfkor pdsltlb
(OAO)
Wltkr onadr`of gorl oatlndgl oatl-aujfkor nkrgosorjoa pk`krljsooa
l`uadbfudrkskasl otou pk`krljsooa sktlaejot pogo sktlop jurua wojtu
pkrcofoa pkayojlt toapo jktkrflnotoa dnot yoae gljktohul nkrhunuaeoa
gkaeoa slagrd`o fupus yoae gllagujsl dnot.
Nlfo glcu`pol 7 otou fknlh jrltkrlo glotos, gloeadsls ]FK `k`lfljl skasltlbltos 8;% goa
spkslblsltos
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jk`uaejlaoa nujoa ]FK. Oponlfo hoayo tks OAO pdsltlb goa `oalbkstosl jflals fola tlgoj ogo,
`ojo nkfu` tkatu ]FK, goa dnskrvosl coaejo poacoae glpkrfujoa.
Fupus Akbrltls
Elacof `krupojoa dreoa yoae skrlae tkrflnot pogo poslka gkaeoa ]FK. Fknlh gorl 59%
poslka ]FK `kaeofo`l jktkrflnotoa elacof skpoacoae pkrcofoaoa pkayojltayo. Nldpsl elacof pkrfu
glfojujoa uatuj jdablr`osl gloeadsls, kvofuosl ojtlvltos pkayojlt, jfoslbljosl jkfolaoa
hlstdpotdfdelj elacof, goa `kakatujoa prdeadsls goa tkropl yoae tkpot.8
Jfoslbljosl jrltkrlo Udrfg Hkofth Dreoalzotlda (UHD) uatuj akbrltls fupus sugoh
glpkrnohorul dfkh Latkraotldaof ]dmlkty db Akphrdfde goa ^kaof Yothdfdey ]dmlkty (L]A/^Y])
tohua >99=
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Nlfo nldpsl tlgoj gopot glfojujoa dfkh jorkao nkrnoeol hof, `ojo jfoslbljosl fupus akbrltls
gopot glfojujoa pkalfoloa nkrgosorjoa poaguoa UHD
Ykaekfdfooa
Glpkrfujoa pkagkjotoa yoae hdflstlj nkrgosorjoa pkagkjotoa nld psljd sdslof. Wucuoa
pkaednotoa FKs ogofoh `kalaejotjoa jkslatosoa goa juofltos hlgup gkaeoa `kagopotjoa `oso
rk`lsl yoae poacoae, ̀ kauruajoa ojtlvltos pkayojlt skrlaeoa ̀ uaejla, ̀ kaeuroael roso aykrl goa
`k`kflhoro buaesl dreoa oeor ojtlvltos hlgup jkskhorloa tktop nolj euao `kamopol juofltos hlgup
dptl`of.??
Ylfor pkaednotoa FK] `kflputl
L. Kgujosl goa jdaskflae
LL. Yrdero` rkhonlfltosl. Yoslka FK] `kaeofo`l pkauruaoa `osso dtdt hlaeeo =9% oponlfo
glnlorjoa gofo` jdaglsl l`dnlflsosl skfo`o fknlh > `laeeu goa pkauruaoa jkjuotoa dtdt skjltor
?-;% pkrhorl gofo` jdaglsl l`dnlfltos.
LLL. pkaednotoa `kgljo`katdso
Jdrtljdstkrdlg `krupojoa dnot uto`o pogo poslka FK].Moro pk`nkrloa jdrtljdstkrdlg uatuj
pkayojlt yoae ̀ kaeoamo` ayowo, lagujsl otou pogo jkjo`nuhoa. Gdsls tlaeel nlosoayo glnkrljoa
latrovkao gkaeoa gdsls 9,;-?er `ktlfprkgalsdsfda skfo` = horl nkrturut-turut.??
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Oak`lo Hk`dfltlj Outdl`ua
Gkblalsl
Oak`lo hk`dfltlj outdl`ua (OHO) otou outdl``uak hk`dfytlm oak`lo (OLHO)
`krupojoa suotu jkfolaoa gl`oao tkrgopot oatlndgl skf-skf krltrdslt skhlaeeo u`ur krltrdslt
`k`kagkj.?>,?=
Ktldfdel
Ktldfdel gorl pkayojlt outdl`ua `k`oae nkfu` ckfos, jk`uaejlaoa tkrcogl jorkao
eoaeeuoa mkatrof tdfkroamk, goa eoaeeuoa pogo prdsks pk`notosoa fl`bdslt outdrkojtlb
rkslguof.?>,?=
Jfoslbljosl
L. Oak`lo Hk`dfltlj Outd L`ua (OLHO)
O. OLHO tlpk hoaeot
?. Lgldpotlj
>. ]kjuagkr (jorkao MFF, fl`bd`o, ]FK)
N. OLHO tlpk glaela
?.
Lgldpotlj>. ]kjuagkr (labkjsl `ymdpfos`o, `dadaumfkdsls, vlrus, jkeoaosoa, fl`bdrktljufkr)
M. Yordxys`of Mdfg hk`defdnlaurl
?. Lgldpotlj
>. ]kjuagkr (vlrof, goa slblfls)
G. OLHO Otlplj
?. OLHO tks oatlefdnufla akeotlb
>. OLHO jd`nlaosl tlpk hoaeot goa glaela
LL.
OLHO gllagujsl dnot
LLL.OLHO gllagujsl ofdoatlndgl
O. ^kojsl Hk`dfltlj Wroasbusl
N. Ykayojlt Hk`dfltlj pogo Noyl Noru Fohlr ?=
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Oak`lo Hk`dfltlj Outdl`ua Wlpk Hoaeot
]kjltor 59% josus OLHO `k`lfljl tlpk hoaeot, gl `oao outdoatlndgl nkrkojsl skmoro
dptl`of pogo suhu =9◢M. Juroae fknlh ;9% poslka OLHO tlpk hoaeot glskrtol pkayojlt fola. Ekcofo
oak`lo tkrcogl pkrfohoa-fohoa, ljtkrlj goa gk`o`. Yogo nknkropo josus glcu`pol pkrcofoaoa
pkayojlt `kagogoj, glskrtol aykrl ongd`ka, goa oak`lo nkrot. [rla nkrworao ekfop jorkao tkrcogl
hk`defdnlaurlo. Ljtkrlj tkrcogl pogo 79% poslka. Yogo OLHO lgldpotlj, spfkad`keofl tkrcogl pogo
;9-29%, hkpotd`keofl tkrcogl pogo =9%, goa fl`bogkadpotl tkrcogl pogo >;% poslka. Hoayo >;%
poslka tlgoj glskrtol pk`nksoroa dreoa goa fl`bdadgl.?=
Yogo pk`krljsooa fondrotdrlu`, hk`defdnla skrlae glcu`pol glnowoh 5 e/gf. Yk`krljsooa
Mdd`n glrkj nlosoayo pdsltlb. Outd oatlndgl tlpk hoaeot nlosoayo gltk`ujoa gofo` skru` goa
gopot glplsohjoa gorl skf-skf krltrdslt. Outdoatlndgl lal nkrosof gorl jkfos LeE goa nkrkojsl gkaeoa
sk`uo skf krltrdslt adr`of. Outdoatlndgl tlpk hoaeot lal nlosoayo nkrkojsl gkaeoa oatleka pogo skf
krltrdslt poslka skaglrl, nlosoayo oatleka ^h.?=
Yrdeadsls pogo OLHO tlpk hoaeot, hoayo sknoeloa jkmlf poslka `kaeofo`l pkayk`nuhoa
jd`pflt goa sknoeloa nksor `k`lfljl pkrcofoaoa pkayojlt yoae nkrfoaesuae jrdalj ao`ua
tkrjkagofl. ]urvlvof ?9 tohua skjltor 59%. @drtofltos skfo`o ;-?9 tohua sknksor ?;->;%.?=
Oak`lo Hk`dfltlj L`ua Wlpk Glaela
Wkrcoglayo hk`dflsls glpkroatol oatlndgl glaela yoltu oefutlala glaela goa oatlndgl
Gdaoth-foagstolakr . Jkfolaoa lal skmoro jorojtkrlstlj `k`lfljl oefutlala glaela [email protected] `dadjfdaof.
Yogo u`u`ayo oefutlala tlpk glaela lal tkrgopot pogo tltkr yoae soaeot rkagoh, goa tltkr lal ojoa
`kalaejot pksot pogo bosk pkayk`nuhoa labkjsl. Oefutlala tlpk glaela ojoa nkrljotoa gkaeoa skf
goroh `kroh goa tkrcogl flsls foaesuae goa boedsltdsls.?>
Eo`noroa jflalj OLHO tlpk glaela skrlae tkrcogl oefutlaosl pogo suhu glaela. Hk`dflsls
nkrcofoa jrdalj. Oak`lo nlosoayo rlaeoa gkaeoa Hn e/gf. ]krlae glgopotjoa ojrdsloadsls goa
spfkad`keofl. Yogo pk`krljsooa fondrotdrlu` gltk`ujoa oak`lo rlaeoa, sbkrdsltdsls,
pdfljrd`otdslo, tks Mdd`ns pdsltlb, oatl-L, oatl-Yr, [email protected] otou oatl-Y.?>
Wkroplayo `kaehlagorl ugoro glaela yoae gopot `k`lmu hk`dflsls. Yrkgalsda goa
spfkakjtd`l tlgoj noayoj ̀ k`noatu. Yfos`oborksls uatuj ̀ kaeuroael oatlndgl [email protected] skmoro tkdrltls
nlso `kaeuroael hk`dflsls, ao`ua skmoro projtlj hof lal sujor glfojujoa. Yrdeadsls goa survlvof
pogo poslka gkaeoa slagrd`o jrdalj ojoa `k`lfljl survlvof yoae nolj goa mujup stonlf.?=
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?9
Wkropl
Jdrtljdstkrdlg gkaeoa gdsls ?-?,; `e/jeNN/horl. Gofo` > `laeeu sknoeloa nksor ojoa
`kauacujjoa rkspda jflals nolj. ]pfkakjtd`l glfojujoa oponlfo tkropl stkrdlg tlgoj ogkjuot otou
tlgoj nlso glfojujoa toppkrlae gdsls skfo`o = nufoa, `ojo pkrfu glpkrtl`noaejoa spfkakjtd`l.
o. L`uadsuprksl 3 Ozothldprla ;9->99 `e/horl, sljfdbdsbo`lg ;9-?;9 `e/horl.
n. Wkropl fola 3 goaozdf 299-899 `e/horl. Nlosoayo goaozdf glpojol nkrso`o-so`o stkrdlg.
Nlfo tkrcogl pkrnoljoa, stkrdlg glturuajoa otou glhkatljoa goa gdsls goaozdf glturuajoa
`kacogl >99-799 ̀ e/horl. Jd`nlaosl goaozdf goa prkgalsda ̀ k`nkrljoa hoslf yoae noeus
sknoeol tkropl lalslof goa `k`nkrljoa rkspda pogo 89% josus. Wkropl l``uadefdnufla
latrovkao ( 799`e/jeNN pkrhorl skfo`o ; horl ) `kauacujjoa pkrnoljoa pogo nknkropo
poslka. @ymdphkadfotk `dbktlf ;99 `e/horl so`pol ?999 `e/horl, glfopdrjoa `k`nkr
hoslf yoae noeus pogo OLHO rkbrojtkr.
m. Wkropl troabusl nujoa jdatrolagljosl `utfoj. Yogo jdaglsl yoae `kaeoamo` clwo (`lsof
Hn≧= e/gf) troabusl gopot glnkrljoa, so`nlf `kauaeeu stkrdlg goa l``uadefdnufla uatuj
nkrkbkj.?>,?=
Eostrdpotl A]OLG
Adastkrdlgof oatl-labfo``otdry grues (A]OLG) ̀ k`lfljl kbkj so`plae sofuroa mkrao yoae
skrlae gltk`ujoa. ]pkjtru` kbkj so`plae yoae gltl`nufjoa A]OLG nkroeo` ̀ ufol gorl ̀ uof goa
glspkpslo (prkvofkasl hlaeeo ;9-29%) hlaeeo jd`pfljosl eostrdlatkstlaof skpkrtl ufjus pkptlju`
(pogo ?;-=9% laglvlgu yoae `kaejdasu`sl A]OLG skmoro rutla) gkaeoa jd`pfljosl pkrgorohoa
otou pkrbdrosl pogo ?,;% poslka sktlop tohuaayo.?7
Kplgk`ldfdel
Glpkrjlrojoa pkrgorohoa yoae tkrcogl `kayknonjoa rowotoa ru`oh sojlt 29.999-?>9.999
sktlop tohuaayo goa jk`otloa ojlnot tdjsltos A]OLG sknksor ?2.999 poslka sktlop tohuaayo gl
O`krljo ]krljot. ]kjltor 7-;% poslka `kaeofo`l ufjus sl`ptd`otlj gofo` coaejo wojtu ? tohua.
]oyoaeayo ekcofo gyspkpslo tlgoj nkrhunuaeoa gkaeoa potdfdel yoae gllagujsl A]OLG. Fknlh
gorl 89% poslka gkaeoa jd`pfljosl A]OLG skrlus tlgoj `kaeofo`l ekcofo glspkpslo.?7
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??
Yotdblsldfdel
Yrdstoefoagla `k`lfljl pkroaoa pkatlae gofo` pkrtohoaoa goa pkrnoljoa latkerltos
`ujdso eostrdgudgkaof. Eoaeeuoa slatksls prdstoefoagla gopot `krusoj pkrtohoaoa `ujdsoskhlaeeo `kayknonjoa mkgkro `ujdso fkwot `kjoals`k sltk`lj. Osplrla goa A]OLG fola
`krupojoa oso` fk`oh yoae tktop gofo` nkatuj flpdblflj toj tkrldalsosl soot `osuj jkgofo`
flaejuaeoa oso` gofo` sofuroa mkrao. Jdaglsl tkrsknut `kayknonjoa A]OLG nkr`lerosl
`kfkwotl `k`nroa flplg skf kpltkf goa `kayknonjoa mkgkro skf cljo `kaktop gofo` skf gkaeoa
nkatuj tkrldalsosl. A]OLG tdpljof cueo `krunoh foplsoa `ujdso pkr`ujooa yoae `kaeojlnotjoa
glbusl noflj H+ goa pkpsla yoae `kayknonjoa jkrusojoa skf kpltkf foacutoa.?7
Gloeadsls
Aykrl kpleostrlu` skpkrtl tkrnojor otou jktlgojayo`oaoa gopot gltk`ujoa.
Jktlgojayo`oaoa nlosoayo suflt glgkblalsljoa, gopot cueo aykrl otou aykrl fopor. Yogo ufjus
gudgkau` aykrl tkrcogl
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?>
`kaednotl ufjus eostkr otou ufjus gudgkau` toapo `k`oagoae A]OLG glhkatljoa otou tktop
glfoacutjoa. Ykamkeohoa prl`kr ufjus A]OLG gopot glfojujoa gkaeoa pk`nkrloa @lsdprdstdf
(>99ue qlg) otou YYL. H> nfdjkr gdsls tlaeel cueo nlso glnkrljoa ao`ua labkrldr glnoaglae YYL.
MDX-> lahlnltdr skpkrtl mkfkxdmln goa rdbkxdmln ?99 jofl fknlh skfkjtlb glnoaglae A]OLG stoagor ?7
Labkjsl ]ofuroa Jk`lh
Labkjsl sofuroa jk`lh (L]J) `krupojoa jkogooa yoae `kauacujjoa jknkrogooa
`ljrddreoals`k gofo` urlak. L]J `krupojoa sofoh sotu pkayojlt labkjsl yoae skrlae gltk`ujoa
tkruto`o pogo woalto gl`oao glfopdrjoa nohwo >;-=;% woalto gkwoso pkraoh `kaeofo`l L]J
skpoacoae hlgupayo. L]J `krupojoa lstlfoh u`u` yoae `kauacujjoa jknkrogooa
`ljrddreoals`k gofo` urlak. Nojtkrlurlo nkr`ojao ̀ krupojoa pkrtu`nuhoa @D ̀ ural fknlh gorl
?9; mdfday bor`lae ualts (MB[) pogo nlojoa urlak. Nojtkrlurlo nkr`ojao toapo prkskatosl jflals
L]J glao`ojoa nojtkrlurlo osl`ptd`otlj, sknofljayo cljo glskrtol prkskatosl jflals glao`ojoa
nojtkrlurlo sl`ptd`otlj.?;
Kplgk`ldfdel
Labkjsl sofuroa jk`lh tkreoatuae pogo noayoj bojtdr skpkrtl uslo, ekagkr, prkvofkasl
nojtkrlurlo goa bojtdr prkglspdslsl yoae `kayknonjoa pkrunohoa strujtur sofuroa jk`lh tkr`osuj
8/17/2019 Lupus Eritematosus Sistemik / Systemic Lupus Erythematosus (SLE)
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?=
elacof. ]kfo`o pkrldgk uslo nknkropo nufoa hlaeeo fknlh gorl 2; tohua, woalto fknlh mkagkruae
`kagkrlto L]J glnoaglae fojl-fojl. L]J nkrufoae pogo fojl-fojl coroae glfopdrjoa jkmuofl sknoeol
bojtdr prkglspdslsl (pkamktus).?;
Yrkskatosl Jflals
?. Ylkfdakbrltls ojut (YAO)
Yrkskatosl jflals YAO ogofoh poaos tlaeel (=. L]J nowoh (slstltls)
Yrkskatosl jflals slstltls ogofoh sojlt supropunlj, pdfojlsurlo, adjturlo, glsurlo goa stroaeurlo
=. ]lagrd` urktro ojut (][O)
Yrkskatosl jflals ][O `lrlp gkaeoa slstltls. ][O skrlae gltk`ujoa pogo pkrk`puoa uslo >9-
;9 tohua?;
Ykaotofojsoaooa
Yrlaslp pkaotofojsoaooa L]J nowoh `kflputl latojk molroa yoae noayoj, oatlnldtlj ogkjuot
goa cljo glpkrfujoa tkropl ofjoflalsosl urlak. 89% poslka ojoa `k`nkrljoa rkspda sktkfoh 78 co`
gkaeoa oatlnldtljo tuaeeof skpkrtl o`plslfla = ero` goa trl`ktrdprl` >99 ̀ e. Nlfo labkjsl ̀ kaktop
glskrtol jkfolaoa urlaoflsls glpkrfujoa tkropl jdavkasldaof skfo`o ;-?9 horl.?;
8/17/2019 Lupus Eritematosus Sistemik / Systemic Lupus Erythematosus (SLE)
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?7
LF[]W^O]L JO][]
Wkfoh glrowot skdroae poslka woalto nkru`ur >; tohua gl noaesof Ykayojlt Gofo` ^][Y
@. Gco`lf skcoj toaeeof >; ]kptk`nkr >9?7 gkaeoa
Jkfuhoa [to`o 3 Aykrl pkrskagloa jojl yoae sk`ojla nkrot skcoj ; horl sknkfu` `osuj ru`oh
sojlt
^lwoyot Ykayojlt ]kjoroae 3
Aykrl pkrskagloa jojl yoae sk`ojla nkrot skcoj ; horl sknkfu` `osuj ru`oh sojlt.
Aykrl sugoh `ufol glrosojoa skcoj + 7 nufoa yoae fofu. Aykrl glrosojoa pogo
pkrskagloa jojl yoae nkrfoaesuae tkrus `kakrus, aykrl sk`ojla nkrot skhlaeeo
poslka sk`pot tlgoj soaeeup nkrcofoa. Aykrl cueo glrosojoa pogo pkrskagloa nohu
skrto corl-corl toaeoa. Wlgoj gltk`ujoa ogoayo pk`nkaejojoa, joju-joju gl poel
horl tlgoj ogo goa jk`krohoa pogo skagl yoae aykrl tlgoj ogo. Yoslka `k`nkfl
skaglrl dnot pkaehlfoae aykrl gl tdjd dnot + = nufoa yoae fofu. Ao`o dnot fupo, dnot
gl`lau` sktlop horl soot pkrskagloa glrosojoa sojlt. ]k`kacoj ltu poslka skrlae
`krosojoa `uof goa tkrjogoae `uatoh.
Nkrmoj-nkrmoj nkrworao jk`krohoa gl plpl skcoj + > nufoa yoae fofu. ]k`ojla ckfos
cljo tkrjkao poporoa slaor `otohorl.
^o`nut skrlae rdatdj tkruto`o cljo skgoae glslslr skcoj + > nufoa yoae fofu.
]orlowoa yoae hlfoae-tl`nuf skcoj + > nufoa yoae fofu, sorlowoa tkroso pkrlh
skhlaeeo `kayufltjoa uatuj `ojoa. ]orlowoa nkrjuroae soot glrowot goa glnkrljoa
pkaednotoa gl ^] @uord Nuaed + > nufoa yoae fofu, sorlowoa jk`nofl `uamuf ?
nufoa sktkfoh poslka glpkrndfkhjoa pufoae goa jk`nofl nkrjuroae sktkfoh glrowot
goa gltkropl jkguo joflayo.
Ykrut tkroso aykrl skcoj + > nufoa yoae fofu. Aykrl hlfoae tl`nuf, tlgoj glpkaeoruhl
dfkh `ojoaoa. @uof goa `uatoh skskjofl nkrlsl `ojoaoa. Aykrl sk`ojla nkrot
hlaeeo poslka jk`ugloa glrowot gl ^] @uord Nuaed gkaeoa jktkroaeoa eoaeeuoa
pogo sofuroa mkrao. ]oot pkrowotoa glposoae skfoae hlguae goa jkfuor goroh, pogo
soot ltu NON nkrworao hlto`. Glfojujoa pkrowotoa + ? nufoa goa gltroasbusl >
joatdae, jk`ugloa glpkrndfkhjoa pufoae goa rowot cofoa gl pdfljflalj ^].
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8/17/2019 Lupus Eritematosus Sistemik / Systemic Lupus Erythematosus (SLE)
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?2
Yk`krljsooa [`u`
Jksogoroa 3 Md`pds`katls Mddpkrotlvk
Wkjoaoa goroh 3 ?=9/89 ``He
Aogl 3 88 x/`kalt, tkrotur, pkaelsloa mujup Aobos 3 >> x/`kalt
]uhu 3 =5¹M
Jkogooa u`u` 3 ]kgoae
Jkogooa elzl 3 Nolj
Nkrot nogoa 3 75 je
Wlaeel nogoa 3 ?;8 m`
[email protected] 3 ?8,8 (adr`of)
Kgk`o 3 (-)
Ljtkrlj 3 (-)
Oak`ls 3 (+)
]loadsls 3 (-)
Juflt 3 turedr nolj, ljtkrlj (-)
Jkfkacor ektoh nkalae 3 Woj tkrono pk`nksoroa jkfkacor ektoh nkalae
Jkpofo 3 Gkbdr`ltos (-)
Uocoh 3 @ojufo hlpkrple`katosl pogo plpl
^o`nut 3 Hlto`, `ugoh rdatdj, ofdpkmlo (+)
@oto 3 Jdacuaetlvo oak`ls, sjfkro tlgoj ljtkrlj
Wkflaeo 3 Woj ogo jkfolaoa
Hlguae 3 Woj ogo jkfolaoa
Wkaeedrdjoa 3 Woj ogo jkfolaoa
Elel goa `ufut 3 Morlks (-), joaglglosls drof (-), otrdbl poplf flgoh (-), ufjus (+)
Fkhkr 3 CRY ; - > m`H>D
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?5
Gogo
Yoru gkpoa
Laspkjsl 3 ]l`ktrls jlrl 0 joaoa, stotls goa glao`ls
Yofposl 3 Brk`ltus jlrl 0 joaoa
Ykrjusl 3 ]dadr, notos pkjoj hkpor ^LM R joaoa
Ousjuftosl 3 Rksljufkr, rdajhl (-/-), whkkzlae (-)
Yoru nkfojoae
Laspkjsl 3 ]l`ktrls jlrl 0 joaoa
Yofposl 3 Brk`ltus jlrl 0 joaoa
Ykrjusl 3 ]dadr, pkroacojoa poru > corl
Ousjuftosl 3 Rksljufkr, rdajhl (-/-), whkkzlae (-)
Coatuae
Laspkjsl 3 Ljtus tlgoj tkrflhot
Yofposl 3 Ljtus tlgoj juot oaejot, tkrono ? corl `kglof [email protected]] ^LM R
Ykrjusl 3 Notos coatuae otos ^LM LL, joaoa flako stkraofls gkxtro, jlrl ? corl `kglof [email protected]]
^LM R, plaeeoae coatuae (+)
Ousjuftosl 3 Nuayl coatuae `ural, lro`o coatuae rkeufkr, @? 1 @>, Y> 6 O>, nlslae coatuae (-)
Ongd`ka
Laspkjsl 3 Wlgoj ao`poj `k`nksor
Yofposl 3 ]upkf, hkpor tkrono > corl nowoh ormus mdstoru`, > corl nowoh prdmkssus
xyphdlgkus, jdslstkasl jkayof, pkr`ujooa roto, plaeelr toco`
aykrl tkjoa kpleostrlu` (+). Flka ]9
8/17/2019 Lupus Eritematosus Sistemik / Systemic Lupus Erythematosus (SLE)
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?8
Ykrjusl 3 Wl`poal
Ousjuftosl 3 Nlslae usus (+) adr`of
Yuaeeuae 3 Aykrl tkjoa goa aykrl jktdj sugut MRO (-), `osso (-)
Ofot jkfo`la 3 Wlgoj ogo jkfolaoa
Oaus 3 Wlgoj ogo jkfolaoa
Oaeedto ekroj 3 Hoaeot, pkaelsloa joplfkr nolj, kgk`o -/-, rkbfkj blsldfdels +/+, rkbfkj potdfdels
-/-
Fondrotdrlu` 3
Goroh
Hk`defdnla 3 8,? e/gf
Hk`otdjrlt 3 >;%
Fkujdslt 3 2.;99/``=
Wrd`ndslt 3 >=9.999/``=
Hltuae Ckals 3 9/9/?/9-=9
Fkujdslt 3 ?99-?>9 /FYN Nlflrunla 3 -
Krltrdslt 3 ;-?9 /FYN [rdnlfladeka 3 +
8/17/2019 Lupus Eritematosus Sistemik / Systemic Lupus Erythematosus (SLE)
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?<
Jrlstof 3 Akeotlb
Bksks
@ojrdsjdpls @ljrdsjdplsUorao 3 mdjfot Fkujdslt 3 ?->
Jdaslstkasl 3 fuaoj Krltrdslt 3 9-?
Goroh 3 - O`uno 3 -
Fkaglr 3 - Wkfur momlae 3 -
KJE
- Lro`o 3 ]laus
- H^ 3
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>9
Gloeadsls Jkrco
- Fupus krltk`otdus slstk`lj gkaeoa akbrltls fupus
- Labkjsl sofuroa jk`lh
-
Eostrdpotl A]OLG - Oak`lo skgoae adr`dsltlj adr`djrd`lj km hk`dfltlj km outdl`ua
Gloeadsls Noaglae 3
- @lxkg mdaakmtlvk tlssuk glskosk
- ^hku`otdlg ortrltls
- Oak`lo skgoae adr`dsltlj adr`djrd`lj km hk`dfltlj km ada-outdl`ua
Wkropl 3
- Lstlrohot, @N ^E LL GF LL ?;99 Jjof (Jorndhlgrot ; er, Fk`oj x? e LR
- Yoromkto`df =x;99 `e YD
- Foasdprozdf >x=9 `e YD
-
]ujrofbot syrup =xmL
Yk`krljsooa oacuroa 3
Oatl-gsGAO
Goroh pkrlbkr fkaejop (@MR, @MH, @MHM)
Boof elacof (urku` goa jrkotlala)
Boof hkpor (ofnu`la,efdnufla,]EDW,]EYW)
Kfkjtrdflt (Aotrlu`, Joflu`, Mfdrlgo)
^dateka skagl
Kjpkrtlsk ^dateka thdroj
[]E Ongd`ka
Juftur urlak
8/17/2019 Lupus Eritematosus Sistemik / Systemic Lupus Erythematosus (SLE)
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>?
Bdffdw [p
Woaeeof >; ]kptk`nkr >9?7
- Aykrl skagl (+)
- Gk`o` (-)
-
]orlowoa (+)
- @uof (+)
- Aykrl pkrut (-)
-
D/ J[ 3 ]kgoae Jksogoroa 3 [email protected] WG 3 ??9/59 ``He
Aogl 3 87x /`kalt, rkeufkr Aobos 3 >> x/`kalt ]uhu 3 =5,2dM
Fondrotdrlu`
Ao+ 3 ?=7 ``df/f
J + 3 7,> ``df/f
Mf- 3 ??= ``df/f
[rku` 3 79 `e/gf
Jrkotlala 3 9,5 `e/gf
]EDW 3 ,= e/gf
Efdnufla 3 =,; e/gf
@MR 3 8> bf
@MH 3 >;,2 pe
@MHM 3 =?,? %
FGH 3 >7; u/f
Jksoa 3 Eoaeeuoa buaesl hotl, oak`lo adr`dsltlj adr`djrd`lj
]ljop 3 Mkj rktljufdslt
Mdd`n“s tkst
Co` ?;399
Hoslf rktljufdslt 3 ?,>%
Jksoa 3 oak`lo adr`dsltlj adr`djrd`lj km suspkj hk`ufltlj outdl`ua
Jdasuf Jdasuftoa ^hku`otdfdel
Jksoa 3 Fupus krltk`otdus slstk`lj gkaeoa akbrltls fupus
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>>
Ogvls 3 Oatl gsGAO
Wkropl 3 - @kthyfprkgalsdfda 9,8 `e/jeNN glnoel = gdsls (?2-?2-8 `e)
- Jfdrdjula ?x>99 `e
- Foasdprozdfk >x=9 `e
- ]ujrofbot syr =xmL
- Dstkdmof ?x? ton
Jdasuf Jdasuftoa Eostrdkatkrdhkpotdfdel
Jksoa 3 Eostrdpotl A]OLG
Wkropl 3 - Foasdprozdfk >x=9 `e
- ]ujrofbot syr =xmL
- Wkropl fola foacutjoa
Woaeeof >2 ]kptk`nkr >9?7
- Aykrl skagl (+)
-
Gk`o` (-)
- @uof (-)
-
Aykrl pkrut (-)D/ J[ 3 ]kgoae Jksogoroa 3 [email protected] WG 3 ??9/59 ``He
Aogl 3 58x /`kalt, rkeufkr Aobos 3 >9 x/`kalt ]uhu 3 =2,;dM
Hoslf Mdd`n“s tkst 3 Ydsltlb
Jksoa 3 Oak`lo adr`dsltlj adr`djrd`lj km hk`dfltlj km outdl`ua
Jdasuf Jdasuftoa Hk`otdfdel Dajdfdel @kglj
Jksoa 3 Oak`lo adr`dsltlj adr`djrd`lj km hk`dfltlj km outdl`ua
Ogvls 3 - @kthyfprkgalsdfda 9,8 `e/jeNN glnoel = gdsls (?2-?2-8 `e)
- Foasdprozdfk >x=9 `e
- ]ujrofbot =xmL
- Dstkdmof ?x? ton
8/17/2019 Lupus Eritematosus Sistemik / Systemic Lupus Erythematosus (SLE)
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>=
Woaeeof >5 ]kptk`nkr >9?7
- Aykrl skagl (+)
-
Gk`o` (-)
- @uof (-)
-
Aykrl pkrut (-)
D/ J[ 3 ]kgoae Jksogoroa 3 [email protected] WG 3 ?>9/89 ``He
Aogl 3 87x /`kalt, rkeufkr Aobos 3 ?8 x/`kalt ]uhu 3 =2,8dM
Jkfuor Hoslf ^dateka Ortlmufotld @oaus kt Ykgls
Jksoa 3 ]ksuol eo`noroa fupus krltk`otdus pogo skagl ortlmufotld wrlst skrto morpdphofoax goa
torsdphofoax
Woaeeof >8 ]kptk`nkr >9?7
- Aykrl skagl (+)
- Gk`o` (-)
- @uof (-)
- Aykrl pkrut (-)
D/ J[ 3 ]kgoae Jksogoroa 3 [email protected] WG 3 ??9/89 ``He
Aogl 3 8>x /`kalt, rkeufkr Aobos 3 >9 x/`kalt ]uhu 3 =5,>dM
Jdasuf Jdasuftoa Ofkrel L`uadfdel
Jksoa 3 Fupus Krltk`otdsus ]lstk`ljWkropl 3 Foacut
Oacuroa 3 JN ada hdr`daof
Dptl`ofjoa tkropl eostrdpotl A]OLG
Woaeeof =9 ]kptk`nkr >9?7
- Aykrl skagl (+)
- Gk`o` (-)
- @uof (-)
- Aykrl pkrut (-)
D/ J[ 3 ]kgoae Jksogoroa 3 [email protected] WG 3 ?=9/59``He
Aogl 3 88x /`kalt, rkeufkr Aobos 3 ?8 x/`kalt ]uhu 3 =2,5dM
Jkfuor Hoslf []E ongd`ka
Hkpor 3 @k`nksor gkaeoa gkasltos hlpkrkjhdlj hofus hd`deka, ]DF (-), vosjufkr goa
8/17/2019 Lupus Eritematosus Sistemik / Systemic Lupus Erythematosus (SLE)
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>7
nlflkr toj `kfknor, osmltks `lal`of
Joaguae k`pkgu 3 Woj `kfknor, notu (-), glaglae toj `kaknof
Yoajrkos goa flka 3 Gofo` notos adr`of
Elacof 3 Woj `k`nksor, notu (-), jofljs toj `kfknor, strujtur kjhd porkajhl`
hlpkrkjhdlj, glbkrkaslosl jdrtkj goa `kguffo `oslh ckfos
Jksoa 3 Hkpotdspfkad`keofl gkaeoa suspkj akbrltls goa osmltks `lal`of.
Jdasuf Jdasuftoa Elacof-Hlpkrtkasl
Jksoa 3 ]uspkj akbrltls fupus gkaeoa L]J
Ogvls 3 - [rlaoflsls ufoae, juftur urlak
- Yrdtkla >7 co`
Wkropl 3 Foacutjoa tkropl
> Djtdnkr >9?7
- Aykrl skagl (+)
- Gk`o` (-)
- @uof (-)
- Aykrl pkrut (-)
D/ J[ 3 ]kgoae Jksogoroa 3 [email protected] WG 3 ?99/29``He
Aogl 3 88x /`kalt, rkeufkr Aobos 3 >7x/`kalt ]uhu 3 =2,8dM
Jkfuor Hoslf [rlaoflsls & Ksnomh
Yrdtkla 3 +
Efujdso 3 -
Fkujdslt 3 ?9-?;/FYN
Krltrdslt 3 ?;->9/FYN
Jrlstof 3 Akeotlb
Kpltkf 3 7-2
]lflagkr 3 Akeotlb
Nlflrunla 3 Akeotlb [rdnlfladeka 3 +
Ksnomh 3 9,?>; e/>7 co`
Jksoa 3 ]uspkj akbrltls fupus gkaeoa labkjsl sofuroa jk`lh
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>;
Jkfuor Hoslf L``uadskrdfdel
Oatl-gsGAO 3 =8; L[/`F
Jksoa 3 Fupus krltk`otdsus slstk`lj
8/17/2019 Lupus Eritematosus Sistemik / Systemic Lupus Erythematosus (SLE)
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>2
GL]J[]L
Wkfoh glrowot skdroae poslka pkrk`puoa u`ur >; tohua gl noaesof pkayojlt gofo` ^] @. Gco`lf
gkaeoa gloeadsls3
- Fupus krltk`otdus slstk`lj gkaeoa akbrltls fupus
- Labkjsl sofuroa jk`lh
- Eostrdpotl A]OLG
- Oak`lo skgoae adr`dsltlj adr`djrd`lj km hk`dfltlj km outdl`ua
Gloeadsls yoae gltkeojjoa pogo poslka lal ogofoh Fupus Krltk`otdsus ]lstk`lj (]ystk`lm
fupus krythk`otdsus / ]FK) gkaeoa akbrltls fupus nkrgosorjoa oao`aksls, pk`krljsooa blslj goa
pk`krljsooa pkauacoae. Gorl oao`aksls ogoayo jkfuhoa aykrl pogo pkrskagloa, ro`nut `ugoh
rdatdj, juflt `ugoh jk`krohoa cljo tkrpopor `otohorl. Yogo pk`krljsooa blslj gltk`ujoa ruo`
`ofor, ofdpkmlo, ufjus pogo `ufut. Yk`krljsooa pkauacoae `kak`ujoa ogoayo prdtklaurlo +?,
slflagkr eroaufkr, oak`lo hk`dfltlj outdl`ua goa Oatl-gsGAO yoae pdsltlb. Gkaeoa `k`ojol
jrltkrlo OM^ yoae gl`dglbljosl tohua ?
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>5
Ojtlvltos blslj yoae mujup tktop glpkrfujoa pogo poslka lal uatuj ̀ k`pkrtohoajoa gkasltos tufoae
goa nkrot nogoa adr`of, tkrfknlh pogo poslka lal `k`pkrdfkh tkropl stkrdlg coaejo poacoae. Wkropl
bor`ojdfdels uto`o yoae glnkrljoa pogo poslka lal nkrupo jdrtljdstkrdlg (`ktlfprkgalsdfda) 9,8
`e/je NN/horl yoae tkrnoel gofo` tleo gdsls goa jfdrdjula 7 `e/je NN/horl. Ykaednotoa ]FK
nkrtucuoa uatuj `kagopotjoa `oso rk`lsl yoae poacoae, `kauruajoa ojtlvltos pkayojlt skrlaeoa
`uaejla, `kaeuroael roso aykrl goa `k`kflhoro buaesl dreoa oeor ojtlvltos hlgup jkskhorloa
tktop nolj euao `kamopol juofltos hlgup yoae dptl`of. Hlaeeo jlal pkaotofojsoaooa ]FK nkfu`
gopot glsk`nuhjoa sk`purao. Ao`ua, pkaednotoa yoae tkpot gopot `kakjoa ekcofo jflals goa
jd`pfljosl yoae `uaejla tkrcogl `kaeotosl bosk ojut goa gkaeoa gk`ljloa gopot `k`pkrpoacoae
rk`lsl goa survlvof rotk.
Ykrfu glfojujoa pk`oatouoa nkrjofo buaesl elacof pogo poslka lal `kfoful pk`krljsooa urlak
rutla tkruto`o skgl`ka, jogor jrkotlala goroh, ofnu`la skru`, prdtklaurlo goa jflrkas jrkotlala.
@daltdrlae nkreoatuae sltuosl jflals gl`oao pogo roplgfy prderksslvk efd`krufdakphrltls
`k`krfujoa poatouoa jrkotlala horloa. Yk`nkrloa jdrtljdstkrdlg fknlh gorl 5,; `e/horl gofo`
coaejo poacoae (fknlh gorl = nufoa) `k`krfujoa supfk`katosl jofslu`. Ykrfu glfojujoa
pk`oatouoa buaesl ̀ oto pogo poslka fkwot pk`krljsooa buagusjdpl goa pkrl`ktrl sktlop =-2 nufoa
`kaelaeot kbkj so`plae gorl jfdrdjula yoae glnkrljoa pogo poslka. ]kfola ltu poslka gloacurjoa
uatuj `kaehkatljoa pk`ojoloa jdatroskpsl hdr`daof lackjsl yoae sugoh + 7 tohua glpojol goa
nkroflh jk jdatroskpsl folaayo skpkrtl jdagd`. Yk`ojoloa jdatroskpsl laro utkrlak gkvlmk (L[G)
tlgoj glrkjd`kagosljoa `kaelaeot rksljd labkjsl yoae gl`uaejlajoa jorkao poslka
`kaejdasu`sl jdrtljdstkrdlg. ]kfola ltu cueo gloacurjoa noel poslka lal uatuj ̀ kauago jkho`lfoa
nkrljutayo `kaelaeot rksljd yoae tlaeel noel lnu goa coala.
Oak`lo yoae glofo`l poslka glojlnotjoa dfkh prdsks hk`dfltlj outdl`ua yoae skrlae
gltk`ujoa pogo poslka pkagkrlto FK]. Ykakeojjoa gloeadsls nkrgosorjoa eo`noroa goroh tkpl
gl`oao gltk`ujoa adr`dsltlj adr`djrd`lj gkaeoa pdfljrd`osl. Yk`krljsooa @MR, @MH,
@MHM yoae gofo` notos adr`of ̀ kaejdablr`osl tk`uoa eo`noroa goroh tkpl. Mdd`n“s tkst yoae
pdsltlb sksuol gkaeoa prdsks hk`dfltlj outdl`ua yoae glofo`l poslka. Wkropl jdrtljdstkrdlg FK]
yoae glnkrljoa pogo poslka lal ojoa `kaeuroael hk`dflsls outdl`ua poslka skhlaeeo glhoropjoa
oak`lo ojoa tkrjdrkjsl soot pkayojlt gosor sugoh tkrjkagofl. Wroasbusl goroh woshkg rkg mkff
(U^M) pogo poslka lal sknoljayo glnkrljoa cljo tkrgopot eoaeeuoa hk`dglao`lj.
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>8
Eostrdpotl A]OLG yoae glofo`l poslka lal glsknonjoa dfkh pkaeeuaooa A]OLG yoae glnkfl
skaglrl pogo poslka gofo` coaejo wojtu yoae mujup fo`o. Yk`ojoloa A]OLG `kaeeoaeeu
slatksls prdstoefoagla yoae ojoa `kayknonjoa eoaeeuoa pogo pkrtohoaoa goa pkrnoljoa `ujdso
sofuroa mkrao. @kaurut fltkrotur foaejoh uto`o gofo` pkaoaeoaoa eostrdpotl A]OLG ogofoh
pkaehkatloa oeka A]OLG pkayknon eostrdpotl. Cljo glpkrfujoa gopot glnkrljoa A]OLG gdsls
rkagoh goa wojtu slaejot gofo` pk`oatouoa yoae jktot. ]knoljayo glplflh ckals A]OLG ckals
MDX>-lahlnltdr skpkrtl mkfkxdmln goa rdbkxdmln yoae fknlh o`oa. Ykakfltloa `kauacujjoa YYL
nkr`oaboot `kayk`nuhjoa goa `kamkeoh eostrdpotl A]OLG gkaeoa otou toapo pkaehkatloa
A]OLG.
Yogo poslka lal glgopotjoa suotu labkjsl sofuroa jk`lh (L]J) toapo glgopotjoa ekcofo jflals
yoae nloso gltk`ul pogo poslka gkaeoa L]J. Jkmurleooa ojoa ogoayo L]J glpkrdfkh jorkao
tlaeelayo fkujdslt pogo pk`krljsooa urlaoflsls yoae sugoh glfojujoa pk`krljsooa ufoaeoa. L]J
skrlae gltk`ujoa pogo woalto gl`oao glfopdrjoa >;-=;% woalto ojoa `kaeofo`l L]J skpoacoae
hlgupayo. Ykrfu glfojujoa juftur urlak pogo poslka uatuj `kakatujoa opojoh tkrgopot nojtkrlurlo
yoae nkr`ojao pogo poslka lal gl`oao ojoa glgopotjoa pkrtu`nuhoa `ljrddreoals`k fknlh gorl
?9; mdfday bdr`lae ualt (mbu/`f). Ykaotofojsoaooa L]J pogo poslka lal ogofoh gkaeoa pk`nkrloa
mkbdtoxl` lackjsl >x? e
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><
GOBWO^ Y[]WOJO
?. Wutuamu SA, Jofualoa JM. Whk Gk• laltlda oag mfosl• lmotlda db systk`lm fupus
krythk`otdsus. La3 Uoffomk GC, Hoha NH, kgltdrs. Gundl“s fupus krythk`otdsus. 5th kg.
Yhlfogkfphlo. Flpplamdtt Ulfflo` & Ulfjlas: >9953?2-?<
>. Hoha NH. Glsdrgkrs db L``[email protected] Mkff Lacury. La3 Bouml O], Nrouawofg K, kgltdrs.
Horrlsda's ^hku`otdfdey. >ag Kgltlda. Yhlfogkfphlo. @mErow-Hlff: >9?9 3 22-2<
=. Goamhkajd A, ]otlo CO, Oathday @]. Kplgk`ldfdey db systk`lm fupus krythk`otdsus3 o
md`porlsda db wdrfgwlgk glskosk nurgka. Fupus. >992:?;(;)3=98-?8
7. Goto gorl pdfl pkayojlt gofo` ^] Mlptd`oaeuajusu`d Cojorto, >9?9
;. Goto gorl pdfljflalj rku`otdfdel ^] Hosoa ]ogljla Noaguae, >9?9
2. Mkrvkro ^, Jho`oshto @O, Bdat C, ]knostloal EG, Elf O, Fovlffo Y, kt of . @drnlglty oag
`drtoflty la systk`lm fupus krythk`otdsus gurlae o ?9-ykor pkrldg, o md`porlsda db korfy
oag fotk `oalbkstotlda la o mdhdrt db ?999 potlkats. @kglmlak >99=:8>3>992=-?=99
8. Nkrtslos EJ, Ldoaalgls CYO, Ndfktls C, Nd`norglkrl ], Mkrvkro ^, Gdstof M, kt of. K[FO^
rkmd``kagotldas bdr thk `oaoek`kat db systk`lm fupus krythk`otdsus (]FK). ^kpdrt db
o Wosj Bdrmk db thk Kurdpkoa ]toaglae Md``lttkk bdr Latkraotldaof Mflalmof ]tuglks
Lamfuglae Whkropkutlms (K]ML]LW). Oaa ^hku` Gls >998:253?9;
997:?;3>7?-;9.
?9. Nuyda C Y. ]ystk`lm fupus krythk`otdsus o mflalmof oag fondrotdry bkoturks L a3 Jflppkf CH.
Yrl`kr Yrl`kr da thk rhku`otlm glskosks. ?=th kg. Otfoato3 Orthrltls Bduagotlda. >9983=9=-
?8??. Josc`lr \, Hoagdad J, Ulcoyo F kt of. Gloeadso goa Ykaekfdfooa Fupus Krltk`otdsus
]lstk`lj. Ykrhl`puaoa ^k`otdfdel Lagdakslo >9??3?-;7
?>. Nojto [email protected] Oak`lo hk`dfltlj. Gofo`3 Hk`otdfdel jflalj rlaejos. Kgltdr. Jhostlboh goa
Yurno GF. Ykakrnlt Nuju Jkgdjtkroa KEM. Cojorto >9953 5?-55
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=9
?=. Fkmhakr j, Coekr u. Hdw L Wrkot Outdl``uak Hk`dfytlm Oak`los la Ogufts. Nfddg >9?9:
??2(??)3 ?8=?-?8=8
?7. Cdha Gkf Roffk. Ykptlm [fmkr Glskosk oag ^kfotkg Glsdrgkrs. La3 Fdaed GF, Bouml O],
kgltdrs. Horrlsda's Eostrdkatkrdfdey oag Hkpotdfdey. Yhlfogkfphlo. @mErow-Hlff: >9?93
?=?-?7?.
?;. ]ujoagor K. Labkjsl ]ofuroa Jk`lh Yoslka Gkwoso. Nuju Ocor Lf`u Ykayojlt Gofo`.
Cojorto: >9923 ;27-28.
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=?
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=>
Eo`noroa Goroh Wkpl
[rlaoflsls
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==
KJE
^dateka Whdrox
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=7
^dateka pkrskagloa
[]E Ongd`ka
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@uho``og Blrgous Cozlf Jorl`l
YYG] Lf`u Ykayojlt Gofo`
Wohop ?
Bojuftos Jkgdjtkroa [alvkrsltos Oagofos
^] G^ @ Gco`lf Yogoae
`TblrgousTcjIyohdd.md`
https3//www.bomknddj.md`/BlrgousCJ