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0ЗЕКТ1 МАКАЛАЛАР ПРОБЛЕМНЫЕ СТАТЬИ TOPICAL ARTICLES
UDC 616.33-002.2.379-008.64
YE.ZH.BEKMUKHAMBETOV, KH.I. KUDABAYEVA, YE.SH. BAZARGALIYEV, R.T.AGZAMOVA
PECULIARITIES OF CHRONIC GASTRITIS IN DIABETES MELLITUS TYPE II
Marat Ospanov West Kazakhstan State Medical University, Aktobe
Abstract. A research objective was assessment of histological and functional features of chronic gastritis in patients with diabetes mellitus type II. 95 patients with diabetes type II underwent endoscopic study of the stomach with target biopsy, intragastric рН - metry.
At morphological research in patients with diabetes mellitus type II atrophic gastritis was observed more often than superficial gastritis. The specific gravity of atrophic gastritis increases with elevated duration of diabetes, moreover, high prevalence of atrophy is observed in group of patients suffering from diabetes more than 10 years. 71,6 % of patients revealed chronic gastritis associated with Helicobacter pylori. HP-colonization in patients with diabetes type II has its features.
Diabetes type II was mostly associated with high HP- colonization. Decrease in HP - colonization and frequent intestinal metaplasia are noticed with increased duration of diabetes. At increasing duration of Diabetes, reduction in the main indicators of acid production of the stomach becomes notable.
Key words: Diabetes Mellitus Type II, atrophic gastritis, Helicobacter pylori, acid formation, duration of Diabetes, age.
Actuality. Diabetes Mellitus refers to the immediate problems with which medical science and health care practically of all countries of the world are facing today. Diabetes Mellitus gets global scales due to prevalence of obesity. Since the first atlas of IDF was published in 2000 spread of diabetes mellitus significantly increased from 151 to 285 million, 95 % of them are patients with diabetes type II. It is expected that number of patients with diabetes on the globe will reach to 552 million by 2030 (IDF, 2012). Annually in the world the number of patients with diabetes increases to 7 million [1, 2].
In Diabetes Mellitus the pathogenesis of disturbances of gastro- intestinal tract is difficult and is not studied enough. In literature there is no common view on this matter. In pathogenesis of gastroenterological disturbances the majority of authors point out microangiopathy and lesion of visceral innervations. In Diabetes secretory and acid-forming functions of the stomach decreases due to existence of miroangiopathy of mucosa and histaminemia, decrease of its blood supply, autoimmune processes, change of structure of mucosa [3, 4].
At present Helicobacter pylori (HP) is known to be one of the most widespread chronic infections in man. This microorganism causes gastritis approximately in 20-30 % of adult population of the globe, is also being as etiological factor of more than 95 % of all duodenal ulcers, nearly 90 % of benign stomach ulcers and is the reason of 60-70 % of gastric carcinoma and other illnesses. The general infectivity of the population of the globe reaches nearly 60 %, and its level in different countries is not identical [5, 6]. Patients with diabetes are not an exception. Literary data on НР infectivity prevalence among patients with diabetes are contradictory. According to findings of some authors HP infectivity reaches 80-90 %, and it depends on compensation, type of diabetes and other factors. According to other authors, difference in HP infectivity between diabetics and non diabetics is not revealed [7, 8, 9].
Wide prevalence of diabetes type II and diseases of digestive organs as well, change of quality of life under the influence of these diseases, new possibilities of diagnostics and approaches to treatment define that this question is open to study in detail.
The purpose of the research.To estimate histological and functional features of chronic gastritis in patients with diabetes type II.
Materials and methods of the research. 41 men (43,2 %) and 54 (56,8 %) women in total 95 patients with diabetes type II are selected to carry out this study. Median age 49,7±3,27. The main group was composed of persons aged between 40
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and 59 (52,6 %). The duration of diabetes was from 2 months to 32 years. The median duration of Diabetes was 11, 45±5,78 years. In accordance with duration of Diabetes patients are divided into 3 groups according to age, sex and compensation of diabetes. In group 1 duration of Diabetes was from 2 months to 5 years, in the 2nd group - from 5 to 10 years, in the 3rd group - more than 15 years.
To certify diagnosis «chronic gastritis» for all patients, esophagogastroduodenoscopy with target biopsy of mucous membrane of the antral part of the stomach and stomach body (not less than three tissue sampling) has been carried out. Biopsy materials were processed by the standard technique. According to modern international classification (Houston, the USA) the following forms of chronic gastritis: gastritis without an atrophy (superficial), gastritis with an atrophy (atrophic) are defined.
To define HP-infection (and its eradication) biopsy material was studied. Biopsy materials were exposed to inspection by carrying out fast ureas test, cytologic, histological studies. HP- infection degrees were estimated as: high (more than 50 bacteria in field of vision); average (20-50 in fields of vision); mild (less than 20 in field of vision).
Definition of intragastric pH - metry has been carried out by using acidogastrometr AGM - 03 (Istok system). Study has been carried out by a traditional technique in two stages: basal and stimulated. PH value in the stomach body in basal conditions estimated as: hyperacidity (pH less than 1,2), a normacidity (pH from 1,2 to 2,0) and hypoacidity (pH more than 2,0).
The control group comparable to age and sex consisted of 32 patients with morphologically confirmed diagnosis of chronic gastritis who do not suffer from diabetes type II.
Statistical processing was carried out by using applied Exell and Statistica programs. Correlation analysis was carried out in order to reveal intercommunication.
Results of the research and discussion. At morphological research in patients with diabetes mellitus type II atrophic gastritis was observed more (the R <0,001) than superficial gastritis. In control group superficial gastritis prevailed over atrophic (R <0,001).
In the analysis of histological changes of mucous membrane of the stomach depending on duration of Diabetes it was revealed that frequency of atrophic gastritis in patients with Diabetes in all 3 groups was higher than in control group. Moreover, the longer is the duration of diabetes, the more is the frequency of atrophy of mucous membrane of the stomach. The highest degree of reliability of differences (R <0,001) in comparison with control group and group I, indicators reach in group of patients suffering from Diabetes more than 10 years (table 1).
Table 1 - Intensity of histological changes of mucous membrane of the stomach in patients with various duration of Diabetes
Histological changes of mucous membrane of the stomach Diabetes group I Diabetes group II Diabetes group III Control group
M±m % Pi M±m % Pi P2 M±m % Pi P2 M±m %
superficial gastritis 60,0±8,26 <0,05 t=0,7 33,3±8,20 <0,005 t=3,06 <0,05 t=2,34 7,4±5,03 <0,001 t=6,39 <0,001 t=5,49 68,8±8,19
atrophic gastritis 40,0±8,29 <0,05 t=0,76 66,7±8,22 <0,005 t=3,06 <0,05 t=2,29 92,6±5,04 <0,001 t=6,39 <0,001 t=5,42 31,2±8,17
Activity 22,8±7,09 <0,05 t=2.12 18,1±6,70 <0,05 t=2,59 >0,05 t=0,48 14,8±6,83 <0,005 t=2,87 >0,05 t=0,81 46,8±8,82
HPcolonization 85,7±5,91 > 0,05 t=0,15 84,8±6,25 >0,05 t=0,04 >0,05 t=0,10 40,7±9,45 <0,001 t=3,82 <0,001 t=4,03 84,4±6,41
Interstinal metaplasia 17,1±6,36 >0,05 t=0,16 36,4±8,37 >0,05 t=1,64 >0,05 t=1,83 62,9±9,29 <0,001 t=3,83 <0,001 t=4,06 18,6±6,88
Note: p, ... . . p-comparison with group I Diabetes Type II ~1 -comparison with control group; ~2 ~ a r jr
Prevalence of atrophic gastritis in patients with Diabetes in comparison with control group is explained by the influence of the whole complex of damaging factors (Helicobacter pylori infection, an angiopathy, polyneuropathy, duodenogastric reflux, age, hypoacidity).
It is known that HP-colonization of the mucous membrane of the stomach in persons occurs at young age. Chronic Helicobacterial gastritis develops in more than 70 % HP infected children and teenagers. After becoming infected with HP, at first superficial gastritis develops which is an intermediate form upon transition to atrophic gastritis, but process regression
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is possible. According to different literary data, the onset of atrophic processes in Helicobacterial gastritis range from 10 to 20 years from the moment of becoming infected [10].
As a rule, after 35 years diabetes type II joins. With increasing duration of HP-colonization transformation of mucous membrane of the stomach occurs and atrophic processes augment. Moreover, HP moves from antral part of the stomach to fundal one where cause similar changes, leading to reduction of acid formation.
Duration of Diabetes influences on the development rate of atrophy of mucous membrane of the stomach. With increasing duration of Diabetes, other damaging factors join. According to numerous studies, disturbances in microcirculation of organs and tissues are noticed at the beginning of diabetes type II. Majority of patients with the long course of the disease develop sclerotic changes of vessels of mucous membrane of the stomach that leads to depression of reparative processes of mucous membrane and development of atrophic gastritis [11].
On modern representations, more than 70 % of diabetic patients reveal vegetative neuropathy already at the beginning of a disease. In our opinion, decordination of motor - evacuate function of the upper parts of digestive tract that leads to the development of duodenogastric and duodenogastrooesophageal refluxes develops on the basis of visceral neuropathy. Dystrophic and necrobiotic changes of gastric epithelium and development of atrophy of mucous membrane of the stomach results from persistent damage of mucous membrane of the stomach by intestinal content. According to some researchers, development of atrophic gastritis goes promptly when two factors, HP and chemical gastritis are combined.
According to literary data, hypoacidity itself plays great part in the development of atrophic processes of mucous membrane of the stomach. In decreased acid formation, all harmful substances entering the stomach are not destroyed and exert damaging effects on mucous membrane of the stomach. Due to this, reparative processes leading to acceleration of chronic gastritis formation decrease.
It is necessary to note close connection between development of chronic gastritis and age. Calculations showed that the annual growth in frequency of chronic gastritis in general, and of atrophic, in particular, composes 1,40 ± 0,1 % and 1,25 ± 0,19 % respectively. Such indicators assume larger prevalence of atrophic gastritis at senile age. This question is especially up-to-date for sick persons with diabetes type II, since median age of the patients surveyed by us was 49,7±3,24 years.
Morphological changes of mucous membrane of the stomach depending on severity of Diabetes as follows: in mild form of Diabetes the atrophy was observed in 44,7±8,06 by %, at moderate severity - in 72,2±7,46 %, at serious course of diabetes - in 85,7±7,63 %. Thus the highest significance value of differences was observed in group with severe Diabetes (with control group - R <0,001, t = 4,86; with the mild course of diabetes (R <0,001, t = 3,69) (table 1).
Activity of chronic gastritis was observed (R <0,05; t= 2,75) more in control group than in patients with diabetes type II. In the analysis of activity of gastritis depending on duration of Diabetes it was noticed that the more is duration the less is activity and minimum activity was in group of patients experiencing Diabetes more than 10 years (R <0,05) (table 1). Some researchers, explain it by poor activity of inflammation of mucous membrane in diabetes in response to HP colonization, chemotaxis depression and phagocytosis of leucocytes.
During researches Helicobacter pylori infection was often found equally in control group, and in patients with diabetes type II as well (84,4 % and 71,6 % respectively). Unlike control group, diabetes type II was associated more often with high degree HP- colonization (R <0,001, t = 4,76) In group of patients with Diabetes weak HP- colonization was observed in 8,8±2,90, moderate -in 12 patients 17,6±3,90 in %, and high -in 50 patients 73,6±5,43 %. In control group moderate (37±8,53 than %) and weak (37±8,53 %), HP colonization was observed more often, high is rare (26,0±8,44 than %).
HP- colonization dynamics depending on duration of Diabetes had also its own features. With increased duration of Diabetes reduction of obsemenennost of HP infection of mucous of the stomach became noted, and the lowest obsemenennost was observed in group of the patients suffering from diabetes more than 10 years. Thus, level of differences in the 3rd group was the highest in comparison with control group (R <0,001), and with patients of 1 group (R <0,001) as well.
Analysis of frequency in HP - colonization depending on gravity of Diabetes revealed that NR an infection was more often found in patients with the mild course of diabetes (89,5±4,91 in %),average - in 72,2±8,78 % of patients and is more rarely in serious Diabetes - in 38,1±10,2 % ((R <0,001; t= 3,74) in comparison with control group (R <0,001; t= 3,91), in comparison with the mild course of diabetes. Literary data on prevalence of HP infection in sick people with diabetes are the contradictory. According to some authors spread of HP infection reaches 80-90 %, and depends on compensation, type of
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Diabetes and other factors [12]. High prevalence of HP - infection cannot be explained by differences in social and economic status or use of antibiotics. According to other authors, difference in HP infectivity between diabetics and non diabetics was not revealed or is even below than in population [13].
During observations frequency of intestinal metaplasia was authentically higher in tissue materials of patients with diabetes type II (R <0,05; t= 2,15). Biopsy materials of sick persons with diabetes type II revealed intestinal metaplasia in 36,8±4,95 % of patients , whereas in control group it was 18,6±6,87. While analyzing frequency in intestinal metaplasia depending on duration of Diabetes, it was noticed that with the increase in duration of Diabetes, frequency in intestinal metaplasia also increases. In the 3rd group the highest frequency in intestinal metaplasia is noted both in control group and 1st group (table 1).
Studies on correlation interrelations showed that there is a direct positive link between frequency of atrophic gastritis and duration of Diabetes, severity of Diabetes, age, and negative communication with HP - colonization. The researchers did not reveal interrelation between level of glycogen hemoglobin and development of atrophic processes (table 1).
Studies made on functional conditions of the stomach in basal conditions showed that among patients with diabetes mellitus type II hypoacidity prevailed. At the same time in control group such indicators as normacidity was seen more often. In the analysis of acid production depending on duration of Diabetes, it was noticed that in the 2nd and 3rd groups of patients with diabetes type II exact decrease in acid production became notable in comparison with indicators in control group (table 2).
Table 2 - Indicators of acid-forming function of the stomach (in %) in patients with diabetes mellitus type II depending on duration of Diabetes
Acidity indicators Diabetes Group I Diabetes Group II Diabetes Group III Control Group
M±m % Pi M±m % Pi P2 M±m % Pi P2
(рН < 1,2) Hyperacidity 48,6±8,44 > 0,05 t = 1,46 9,1±5,00 < 0,05 t = 2,31 < 0,001 t = 4,02 7,4±5,07 < 0,05 t = 2,48 < 0,001 t = 4,19 31,3±8,19
(рН 1,2 - 2,0) Normacidity 31,4±7,84 > 0,05 t = 0,78 30,3±7,9 > 0,05 t = 0,86 > 0,05 t = 0,09 14,8±6,83 < 0,05 t = 2,34 > 0,05 t = 1,59 40,6±8,68
(рН > 2,0) hypoacidity 20,0±6,76 > 0,05 t = 0,77 60,6±8,51 < 0,05 t = 2,79 < 0,001 t = 3,75 77,8±7,99 < 0,001 t = 4,41 < 0,001 t = 5,51 28,1±7,95
Notes : p., - comparison with control group, ; p2 - comparison with Diabetes Type II Group I
The analysis in group of patients with Diabetes showed exact difference in acid formation in the 2nd group (R <0,001; t= 3,75) and in the 3rd group (R <0,001; t= 5,51) in comparison with group 1.
Studies on acid formation of the stomach depending on severity of Diabetes showed equal distribution of acid formation values: at mild severity of Diabetes hyperacidity - 36,8 %±7,82; normacidity - 39 ,5±7,93 %; hypoacidity - 23,7±6,89 %. Hypoacidity prevails in groups of patients with moderate and serious severities of Diabetes (69,4±7,68 % and 66,7±10,28 % respectively). In comparison with indicators of mild degree of Diabetes, differences in these groups of patients are statistically significant (R <0,05; t= 4,43; t= 3,47 respectively).
Level of acid forming function of the stomach changed as follows depending on the compensation extent of Diabetes. At compensation of Diabetes the hypoacidity was observed in 36,4 % of patients, at subcompensation - in 35,7 % of patients, at decompensation - in 23,7 % of patients. There is not any marked regularity between glycogen hemoglobin level and acid forming conditions of the stomach in patients with Diabetes.
Direct positive link between development of hypoacidity and atrophic changes of mucous membrane of the stomach, duration, severity of Diabetes, age, HP - colonization feedback was noticed while studying correlation interrelations. But the study failed to reveal correlation between development of hypoacidity and compensation extent of Diabetes.
In literature there is no commonly accepted opinion about conditions of secretory functions of the stomach at a combination of diabetes, probably, it is due to the use of various methods of gastric secretion and their different explanations. So according to some authors, development of peptic ulcers of the stomach as a result of hypoacidity is characteristic to patients suffering from diabetes type II for a long time [14, 15].
Conclusion. Thus, with increased duration of Diabetes specific gravity of atrophic gastritis increases, moreover high prevalence of atrophy is observed in group of patients suffering from diabetes more than 10 years. HP-infection plays great role for the development of chronic gastritis in sick people with diabetes type II. 71,6 % of patients develop chronic gastritis
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associated with Helicobacter pylori. HP-colonization in patients with diabetes type II has its own features. Diabetes type II is mostly associated with high HP - colonization, and the longer is duration of diabetes, the less HP colonization and more frequent is intestinal metaplasia. When studying indicators of acid forming function of the stomach , decrease in рН indicators of the stomach with longer duration of Diabetes are defined. List of the literatures:
1. Thomson G.A. /FRCP, FRCP (Edin), FRCP (Glasg), MCCP (Hon) Honorary Professor of Diabetes Do current IDF predictions underestimate the true and future burden of diabetes? //Practical Diabetes International -2011 -28: p: 5-6.
2. David R. Whiting, Leonor Guariguata, Clara Weil, Jonathan Shaw. /IDF Diabetes Atlas: Global estimates of the prevalence of diabetes for 2011 and 2030 //Diabetes Reserch and Clinical Practice -2011 -94 (3), p: 311 - 321.
3. Nicholas Verne G., Charles A. /Sninsky Diabetes and the gastrointestinal tract //Gastroenterology Clinics of North America -2011 -27, p: 861 - 874.
4. Koch K.L. /Diabetic Gastropathy (Gastric Neuromuscular Dysfunction in Diabetes Mellitus A Review of Symptoms, Pathophysiology, and Treatment) //Digestive diseases and sciences -1999 -6, p: 1061 - 1075.
5. Аруин Л.И., Григорьев П.Я., Исаков В.А., Яковенко Э.П. /Хронический гастрит //Амстердам -1993; 362 с.
6. Исаков В.А., Доморадский И.В. /Хеликобактериоз //М: Медицина -2003; 411 с.
7. Gasbarrini A., Ojetti V., Pitocco D., Armuzzi A., et al. /Efficacy of Different Helicobacter pylori Eradication Regimens in Pati ents Affected by Insulin-Dependent Diabetes Mellitus //Scandinavian Journal of Gastroenterology -2000 -3, p: 260-263.
8. Oldenburg B., Diepersloot A.R.J., Hoekstra J.B.L. /High seroprevalence of Helicobacter pylori in diabetes mellitus patients //Digestive Diseases and Sciences -1996 -41(3), p: 458 - 461.
9. Кудабаева Х.И., Кушимова Д.Е., Базаргалиев Е.Ш. /Особенности течения хронического гастрита при сахарном диабете 2 типа // Гастроэнтерологический журнал Вестник клуба панкреатологов. Украина-2012г. -№1, 14 c.
10. Ивашкин В.Т., Лапина Т.В. /Хронический гастрит: современные представления, принципы диагностики и лечения. //Рус. мед. журнал -2011 -2, 54 - 60 c.
11. Кирилюк Д.В., Шишкин А.Н. /Диабетическая гастропатия (обзор литературы) //Вестник Санкт-Петербург унив. -2006 -1, 5 - 15 c.
12. Perdichizzi G., Bottari M., Pallio S., Fera M.T., Carbone M., Barresi G. /Gastric infection by Helicobacter pylori and antral gastritis in hyperglycemic obese and in diabetic subjects //The new Microbiologica -1996 -19(2), p: 149 - 154.
13. Anastasios R., Goritsas C., Paramihail C. et al. //Helicobacter pylory infection in diabetic patients: prevalence and endoscopic findings //Eur. J. Int. Med. -2002 -3 (6), p: 376 - 379.
14. Смолянинов А.Б., Новицкий В.А., Лебедев Н.Н. /Состояние кислотообразующей функции желудка у больных язвенной болезнью двенадцатиперстной кишки, сочетанной с сахарным диабетом //Клин. мед. -2001 -8, 44 - 47 c.
15. Агзамова РТ., Кудабаева Х.И., Базаргалиев Е.Ш., Турдалина А.К., Мергалиева К.Ж . /Изучение качества жизни у больных сахарным диабетом 2 типа //Батыс Казахстан Медицина журналы -2010 -3 (27) .
Е.Ж. БЕКМ¥ХАМБЕТОВ, Х.И. КУДАБАЕВА, Е.Ш. БАЗАРГАЛИЕВ, РТ. АГЗАМОВА
2-ТИПТ1 КАНТ ДИАБЕТ1МЕН АУЫРАТЫН НАУКАСТАРДАГЫ СОЗЫЛМАЛЫ ГАСТРИТТЩ ЕРЕКШЕЛ1Г1
Марат Оспанов атындагы Батыс Казахстан мемлекеттк медицина университету А^тебе
Бул ма^алада 2-типт ^ант диабет бар нау^астардагы созылмалы гастриттщ функциональдьщ жэне гистологияльщ ерекшелИн багалау ма^сатымен зерттеу жYргiзiлгендiгi жазылады. 2-типт ^ант диабет бар 95 нау^ас^а ас^азан кезделген биопсиясымен эндоскопиялыщ зерттеумен ^атар ас^азашштк рН - метрия жYргiзiлдi. 2-типт ^ант диабет бар нау^астарды морфологиялыщ зерттеу нэтижесшде беткей гастритке Караганда, атрофиялыщ гастрит жи ушырайтыны аны^талды. Диабетпен ауыру уза^тыгы арт^ан сайын атрофиялыщ гастрит жш кездеседк 71,6% жагдайда созылмалы гастрит Helicobacter pylori-мен бiрiккен. 2-типт 1^ант диабет бар нау^астарда НР- таралуыныц езЫдк ерекшелп бай^алды. 2-типтi ^ант диабетiмен ауыратын нау^астарга НР- таралуыныц жогары дэрежес тэн. Диабет уза^тыгы арт^ан сайын НР- таралуы темендейдi, бiра^ шектк метаплазияныц жшлИнщ артатындыгы аны^талды. Диабет уза^тыгы арт^ан
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сайын ас^азанныц непзп ^ыш^ыл белу керсеткштерЫщ твмендейтiндiгi аны^талды.
Нег/'зг/ свздер: 2-munmi цант dua6emi, атрофиялыц гастрит, Helicobacter pylori, цышцыл бел/'ну, диабет узацтыгы, жас мелшерi.
РЕЗЮМЕ
Е.Ж. БЕКМУХАМБЕТОВ, Х.И. КУДАБАЕВА, Е.Ш. БАЗАРГАЛИЕВ, РТ. АГЗАМОВА
ОСОБЕННОСТИ ХРОНИЧЕСКОГО ГАСТРИТА ПРИ САХАРНОМ ДИАБЕТЕ 2 ТИПА
Западно-Казахстанский государственный медицинский университет имени Марата Оспанова, Актобе
Целью исследования явилась оценка гистологических и функциональных особенностей хронического гастрита у больных сахарным диабетом 2 типа. Проведено эндоскопическое исследование желудка с прицельной биопсией, внутрижелудочная рН - метрия 95 больных СД 2 типа. При морфологическом исследовании у больных СД 2 типа чаще наблюдался атрофический гастрит, чем поверхностный гастрит. С увеличением длительности диабета удельный вес атрофического гастрита возрастает, при этом высокая распространенность атрофии наблюдается в группе больных со стажем диабета более 10 лет. В 71,6% выявляется хронический гастрит, ассоциированный с Helicobacter pylori. НР-колонизация у больных СД 2 типа имеет свои особенности. СД 2 типа чаще всего ассоциировался с НР-колонизацией высокой степени, с увеличением длительности диабета отмечается снижение НР-колонизации и нарастание частоты кишечной метаплазии. Отмечается снижение основных показателей кислотообразования желудка с увеличением длительности диабета.
Ключевые слова: сахарный диабет 2 типа, атрофический гастрит, Helicobacter pylori, кислотообразование, длительность диабета, возраст.
E-mail: [email protected]
УДК 614.2.
И.Б. КЕНЖЕБАЕВА, Ж.А. ИТЕГУЛОВ
ПЕРВИЧНАЯ МЕДИКО-САНИТАРНАЯ ПОМОЩЬ И РОЛЬ АЛМА-АТИНСКОЙ
ДЕКЛАРАЦИИ 1978 ГОДА
Западно-Казахстанский государственный медицинский университет имени Марата Оспанова1, Актобе
Аннотация: В статье представлены принципы ПМСП и роль Алма-Атинской Декларации 1978 года. Декларация ориентирована на неотложные национальные и международные действия для достижения здоровья в мире. В ней нашло отражение единство мнений мирового сообщества относительно сотрудничества между странами в системах здравоохранения для обеспечения удовлетворительного уровня здоровья всех людей.
Ключевые слова: первичная медико-санитарная помощь, Алма-Атинская декларация.
С середины 70-х годов концепция первичной медико-санитарной помощи (ПМСП) стала объектом пристального внимания со стороны международного сообщества и медико-санитарных служб, но признание и реализацию концепция ПМСП получила с сентября 1978 года с Международной конференции, организованной в Алма-Ате ВОЗ и ЮНИСЕФ. Активное участие в ней приняли 134 страны-члены В03 и представители 67 основных неправительственных и межправительственных организаций.
И сегодня спустя 35 лет после Алма-Атинской конференции (1978г.) первичная медико-санитарная помощь и ее неотъемлемая составляющая - поликлиническое звено по-прежнему рассматривается ВОЗ в качестве одного из ведущих инструментов достижения стратегии здоровья для всех в начале 21 века. Историческая значимость ПМСП определяется в первую очередь тем, что она оказала существенное воздействие на преобладающие представления в здоровье и его составляющих, а во многих странах она была принята в качестве стержневого элемента политики здравоохранения. 10
Батыс Цазацстан медицина журналы №3 (39) 2013 ж.
