35$&$25<*,1$/1$
Zawartość cholesterolu we fragmentach tętnic
– studium 34 przypadków
7KHFRQWHQWRIFKROHVWHUROLQDUWHULDOIUDJPHQWV
±VWXG\RIFDVHV
Aleksandra Kuzan1,2, Agnieszka Chwiłkowska2, MagdalenaKobielarz1,3
ST R E SZ C Z E N I E
W S T Ę P
0LDĪGĪ\FDMHVWFKRUREąZLHORF]\QQLNRZą3RZV]HFKQLHXZDĪDVLĊĪHJáyZQ\P F]\QQLNLHPRGSRZLHG]LDOQ\P]DSRZVWDZDQLHEODV]HNPLDĪGĪ\FRZ\FKZWĊWQL FDFK MHVW Z\VRNL SR]LRP FKROHVWHUROX Z RVRF]X NUZL &]ąVWHF]NL WHJR OLSLGX ZFKRG]ąZVNáDGQLHW\ONRWĊWQLFREMĊW\FKSDWRORJLF]Q\PVWáXV]F]HQLHPDOHWHĪ NDĪGHJR QDF]\QLD NUZLRQRĞQHJR MDNR HOHPHQW EXGXOFRZ\ EáRQ NRPyUNRZ\FK &HOHP SUDF\ MHVW RGSRZLHGĨ QD S\WDQLH F]\ LORĞü FKROHVWHUROX FDáNRZLWHJR ZWĊWQLFDFKMHVWVNRUHORZDQD]SR]LRPHP]DDZDQVRZDQLDPLDĪGĪ\F\
M A T E R IA Ł I M E T O D Y
0DWHULDáHPEDGDZF]\PE\á\Z\FLQNLWĊWQLFSRFKRG]ąFH]H]ZáRNOXG]L]PDU á\FKĞPLHUFLą QDJáą3UyENLE\á\SRG]LHORQH QDJUXS\]H Z]JOĊGX QD VWRSLHĔ ]DDZDQVRZDQLD PLDĪGĪ\F\ &KROHVWHURO R]QDF]DQR NRORU\PHWU\F]Qą PHWRGą ]XĪ\FLHPFKORUNXĪHOD]DZVWĊĪRQ\PNZDVLHVLDUNRZ\PLIRVIRURZ\P W Y N IK I =DREVHUZRZDQRĪHĞUHGQLD]DZDUWRĞüFKROHVWHUROXZSUyENDFKWĊWQLFZ]UDVWDáD ZUD] ]H VWRSQLHP ]DDZDQVRZDQLD PLDĪGĪ\F\ 7ĊWQLFH SRFKRG]ąFH RG RVyE ]H ]QDF]Q\PLEDUG]RGXĪ\P QDVLOHQLHPFKRURE\FKDUDNWHU\]XMą VLĊ Z\VRNLPSR ]LRPHPFKROHVWHUROX W N IO S K I ,VWQLHMH]ZLą]HNPLĊG]\]DZDUWRĞFLąFKROHVWHUROXZĞFLDQLHQDF]\QLDNUZLR QRĞQHJRD]DDZDQVRZDQLHP PLDĪGĪ\F\QLHMHVWWRMHGQDN]DOHĪQRĞü ZSURVW SURSRUFMRQDOQDJG\ĪEODV]NLPLDĪGĪ\FRZHZUD]]SRVWĊSHPFKRURE\Z]ER JDFDQHVą QLH W\ONR Z OLSLG\DOH WDNĪH Z NRPyUNRZHLELDáNRZHVNáDGQLNL WDNLH MDN PRQRF\W\ PDNURIDJL WURPERF\W\ NRPyUNL QHNURW\F]QH ELDáND PDFLHU]\]HZQąWU]NRPyUNRZHMLLQQH
.RQLHF]QHVąGDOV]HEDGDQLDZFHOXSRJáĊELHQLDZLHG]\QDWHPDWSDWRPHFKD QL]PX PLDĪGĪ\F\ L ZHU\ILNDFML WH]\ R QDGU]ĊGQHM UROL FKROHVWHUROX Z SR ZVWDZDQLX]PLDQPLDĪGĪ\FRZ\FK
1Wojewódzki Szpital Specjalistyczny
we Wrocławiu, Ośrodek Badawczo-Rozwojowy
2Katedra i Zakład Biochemii Lekarskiej
Uniwersytetu Medycznego we Wrocławiu
3Politechnika Wrocławska, Zakład Inżynierii
Biomedycznej i Mechaniki Eksperymentalnej
A D R E S D O K O R E S PO N D E NC J I:
Mgr Aleksandra Kuzan
Katedra i Zakład Biochemii Lekarskiej Uniwersytetu Medycznego we Wrocławiu ul. Chałubińskiego 10
50-368 Wrocław tel. +71 784 13 75
e-mail: aleksandra.kuzan@gmail.com
Ann. Acad. Med. Siles. 2014, 68, 1, 23–27
Copyright © Śląski Uniwersytet Medyczny w Katowicach
eISSN 1734-025X www.annales.sum.edu.pl
S Ł OW A K L U C Z OW E
FKROHVWHUROWĊWQLFHPLDĪGĪ\FD
ABSTRACT
B A C K G R O UN D
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ĘP
: NUDMDFK Z\VRNRUR]ZLQLĊW\FK FKRURE\ VHUFRZR QDF]\QLRZHVąMHGQą]JáyZQ\FKSU]\F]\Q]JRQyZ± Z 6WDQDFK =MHGQRF]RQ\FK FR WU]HFL F]áRZLHN XPLHUD QD ]DZDá XGDU ] SRZRGX SĊNQLĊWHJR WĊWQLDND OXE LQQ\FKSU]\F]\Q]ZLą]DQ\FK]XNáDGHPNUZLRQRĞQ\P >@ : 3ROVFH XPLHUDOQRĞü ZVNXWHN FKRUyE VHUFRZR QDF]\QLRZ\FKZ\QRVL>@
*áyZQąSU]\F]\QąW\FKFKRUyEMHVWSU]HZOHNá\SURFHV ]ZDQ\ PLDĪGĪ\Fą SRGF]DV NWyUHJR Z WĊWQLFDFK ± QD VNXWHN SURFHVyZ ELRPHFKDQLF]Q\FK L ELRFKHPLF] Q\FK ± SRZVWDMą W]Z EODV]NL PLDĪGĪ\FRZH PRJąFH SR SHZQ\P F]DVLH SĊNDü OXE WZRU]\ü EORNDGĊ GOD VZRERGQHJR SU]HSá\ZX NUZL VWHQR]Ċ 3RZV]HFKQLH ]DUR]ZyMFKRURE\REZLQLDVLĊFKROHVWHURO5]HF]\ZL ĞFLH VWZLHUG]RQR NRUHODFMĊ PLĊG]\ ]DZDUWRĞFLą WHJR
OLSLGX ZH NUZL D VWRSQLHP ]DDZDQVRZDQLD FKRURE\ U\]\NLHP Z\VWąSLHQLD ]DZDáX VHUFD F]\ U\]\NLHP ]JRQX ]SRZRGX FKRUyE VHUFRZRQDF]\QLRZ\FK >@ 1DWHMSRGVWDZLHVWZRU]RQR]áRW\VWDQGDUGGLDJQRVW\NL PLDĪGĪ\F\SROHJDMąF\QDR]QDF]DQLXFKROHVWHUROXZH NUZLFKROHVWHUROFDáNRZLW\/'/+'/2SUDFRZDQR WDNĪHVWUDWHJLHWHUDSHXW\F]QH ±SRGDZDQLHOHNyZPD MąF\FKREQLĪDüSR]LRPFKROHVWHUROXZHNUZLJáyZQLH VWDW\Q WDNLFK MDN SUDZDVWDW\QD ORZDVWDW\QD IOXZD VWDW\QD VLPZDVWDW\QD DWRUZDVWDW\QD URVXZDVWDW\QD SLWDZDVWDW\QD FHULZDVWDW\QD >@ :HGáXJ EDGDĔ HSL GHPLRORJLF]Q\FKSU]HSURZDG]RQ\FK]XG]LDáHPGXĪHM F]ĊĞFLSRSXODFML1$732/:2%$6=XFRQDMPQLHM SRáRZ\3RODNyZQDOHĪ\UR]ZDĪDüLQWHUZHQFMHPDMąFH QDFHOXREQLĪHQLHVWĊĪHQLD/'/>@ 0LPRXZUDĪOLZLDQLDSDFMHQWyZQDV]NRGOLZRĞüFKROH VWHUROX ZDUWR ]DXZDĪ\ü ĪH F]ąVWHF]ND WD VSHáQLD ZLHOH LVWRWQ\FK IXQNFML Z RUJDQL]PLH -HVW RQD PLQ
[]DZDUWRĞüFKROHVWHUROXZUR]WZRU]HVWDQGDUGRZ\P>PJ@ SUHNXUVRUHP ZLHOX KRUPRQyZ WHVWRVWHURQX HVWURJH
QyZ DOGRVWHURQX NRUW\NRVWHURQX NRUW\]ROX RUD] ZLWDPLQ\'DZLĊFPDGXĪH]QDF]HQLHZJRVSRGDUFH ZDSQLRZRIRVIRUDQRZHM SU]H] FR RGSRZLDGD ]D SUD ZLGáRZą EXGRZĊ NRĞüFD = OLSLGX WHJR WZRU]RQH Vą SRQDGWR NZDV\ ĪyáFLRZH QLH]EĊGQH GR WUDZLHQLD &KROHVWHURO MHVW WHĪ VNáDGQLNLHP EáRQ NRPyUNRZ\FK UHJXOXMąF\PLFKSá\QQRĞü>@
:DUWRSDPLĊWDüĪHSR]LRPFKROHVWHUROXMHVW]ZLą]DQ\ ] Z\VWĊSRZDQLHP PLDĪGĪ\F\QLH MHVWMHGQDNF]\QQL NLHPGHF\GXMąF\PRMHMSU]HELHJXJG\ĪPDRQDFKD UDNWHUZ\MąWNRZR]áRĪRQ\=DSU]\F]\QĊSRZVWDZDQLD EODV]HN PLDĪGĪ\FRZ\FK XZDĪD VLĊ UyZQLHĪ XZDUXQ NRZDQLD JHQHW\F]QH >@ QDGFLĞQLHQLH >@ F]\QQLNL LQIHNF\MQHJáyZQLHChlamydia pneumoniaeLHelico-bacter pylori RUD] F\WRPHJDORZLUXV L ZLUXV\ Herpes >@ QDGHNVSUHVMĊ ELDáHN VWDQX ]DSDOQHJR >@ QDG HNVSUHVMĊ PHWDORSURWHLQD] PDFLHU]\ ]HZQąWU]NRPyU NRZHM 003 ± matrix metalloproteinases >@ LQ WHQV\ZQąJOLNDFMĊELDáHN]ZLą]DQą]FXNU]\FąSURZD G]ąFą GR SRZVWDZDQLD ]E\W GXĪHM LORĞFL SURGXNWyZ $*( advanced glycation end-products ± NRĔFRZH SURGXNW\]DDZDQVRZDQHMJOLNDFML>@F]\ZNRĔ FX VWUHV RNV\GDF\MQ\ Z\ZRá\ZDQ\ JáyZQLH SU]H] UHDNW\ZQH IRUP\ WOHQX NWyU\ PRĪH RGSRZLDGDü ]D XV]NRG]HQLD NRPyUHN ĞUyGEáRQND L ]DSRF]ąWNRZ\ZD QLHSRZVWDZDQLDEODV]NLPLDĪGĪ\FRZHM>@
&HOHP SUDF\ E\áR RNUHĞOHQLH ]ZLą]NX PLĊG]\ LORĞFLą FKROHVWHUROX Z WĊWQLFDFK D VWRSQLHP ]DDZDQVRZDQLD PLDĪGĪ\F\ =D]QDF]D VLĊĪH MHVWWREDGDQLH ZVWĊSQH NWyUH ]DPLHU]D VLĊ UR]V]HU]\ü Z FHOX SRJáĊELHQLD ZLHG]\QDWHPDWSDWRPHFKDQL]PXPLDĪGĪ\F\
MATERIAŁY I METODY
0DWHULDáHP EDGDZF]\P E\á\ Z\FLQNL WĊWQLF SR FKRG]ąFH ]H ]ZáRN OXG]L ]PDUá\FK ĞPLHUFLą QDJáą 3UyENL ]JRGQLH ] PDNURVNRSRZą REVHUZDFMą E\á\ SRG]LHORQHQDJUXS\]HZ]JOĊGXQDVWRSLHĔ]LGHQW\ ILNRZDQ\FK]PLDQPLDĪGĪ\FRZ\FK
JUXSD ± SUyEHN QLH]PLHQLRQ\FK SDWRORJLF] QLH
JUXSD±SUyEHN]QLH]QDF]Q\PLQDFLHF]HQLDPL WáXV]F]RZ\PL
JUXSD ± SUyEHN ] EODV]NDPL PLDĪGĪ\FRZ\PL W\SXpreatheromaOXEatheroma
JUXSD ± SUyEHN Z\ND]XMąF\FK FHFK\ ]DDZDQ VRZDQHM PLDĪGĪ\F\ GXĪH WáXV]F]RZH UG]HQLHGH SR]\W\ZDSQLDRJQLVNDPDUWZLF\LWS
3URFHGXUĊR]QDF]DQLD]DZDUWRĞFLFKROHVWHUROXZWNDQ FH SU]HSURZDG]DQR ZHGáXJ ]PRG\ILNRZDQHJR SURWR NRáX .DWHV >@ 'R PJ ĞZLHĪHM WNDQNL GRGDQR
O ZRG\LOPLHV]DQLQ\ PHWDQRO±FKORIRURUP YY KRPRJHQL]RZDQR Z KRPRJHQL]DWRU]H )DVW3UHS±03%LRPHGLFDOVPLQZWHPSHUD WXU]H SRNRMRZHM D QDVWĊSQLH SU]HSURZDG]RQR ZLUR ZDQLHPLQSU]\[JSRF]\P]GHNDQWRZDQR VXSHUQDWDQW D GR SR]RVWDáRĞFL WNDQNL GRGDQR O PLHV]DQLQ\PHWDQRO±FKORIRURUP±1+&O YYKRPRJHQL]RZDQRLZLURZDQRMDNZ\ĪHM 'R]áąF]RQ\FKVXSHUQDWDQWyZGRGDQRSROFKOR URIRUPX L ZRG\ SU]HSURZDG]DQR NROHMQH ZLURZDQLH SRF]\PGROQąFKORURIRUPRZąID]Ċ]ELHUDQRQHXWUDOL
]RZDQRGRGDMąFNURSOĊ1PHWDQRORZHJR1+2+
LSU]HSURZDG]DQRHZDSRUDFMĊQDGVWUXPLHQLHPD]RWX 'RRWU]\PDQHJRRVDGXGRGDQROORGRZHJRNZDVX RFWRZHJR L O EDUZQHJR UHDJHQWX )H&O + Z NZDVLH RUWRIRVIRURZ\P L NZDVLHVLDUNRZ\PZ\PLHV]DQRLQNXERZDQRPLQ LPLHU]RQRDEVRUEDQFMĊSU]\QPZ]JOĊGHPSUyE\ ĞOHSHM ] RGF]\QQLNDPL $QDORJLF]QH SRVWĊSRZDQLH SU]HSURZDG]RQR ]H VWDQGDUGRZ\P UR]WZRUHP FKROH VWHUROX =DZDUWRĞü FKROHVWHUROX FDáNRZLWHJR >PJ@ REOLF]DQRZHGáXJZ]RUX
$ESUyENL
$EVWDQGDUGX
:\NRQDQR VWDW\VW\F]Qą DQDOL]Ċ WHVWHP $129$ UDQJ .UXVNDOD:DOOLVD ZHGáXJ NWyUHM UyĪQLFD SR]LRPX FKROHVWHUROXZSRV]F]HJyOQ\FKID]DFKPLDĪGĪ\F\MHVW LVWRWQDVWDW\VW\F]QLHGODS 2EOLF]RQRUyZQLHĪZVSyáF]\QQLNNRUHODFML6SHDUPDQD S D WDNĪH SU]HSURZDG]RQR WHVW 0DQQD :KLWQH\D]SRSUDZNą+ROPD WYNIKI ĝUHGQLH]DZDUWRĞFLFKROHVWHUROXZĞFLDQDFKWĊWQLFE\á\ QDVWĊSXMąFHZJUXSLH±ȝJPJWNDQNLZJUXSLH ±ȝJPJWNDQNLZJUXSLH±ȝJPJWNDQ NLZJUXSLH±ȝJPJWNDQNLWDE,U\F1D SRGVWDZLH DQDOL]\ VWDW\VW\F]QHM PRĪQD VWZLHUG]Lü ĪH ]DZDUWRĞü FKROHVWHUROX Z SUyENDFK WĊWQLF Z]UDVWD ZUD]]H VWRSQLHP]DDZDQVRZDQLD PLDĪGĪ\F\ ZVSyá F]\QQLN NRUHODFML 6SHDUPDQD SU]\ S JG]LH SU]HG]LDá XIQRĞFL ]DZLHUDá VLĊ PLĊG]\ D : RVWDWQLHM JUXSLH ]DREVHUZRZDQR QLH ]QDF]Q\ VSDGHN ĞUHGQLHM ]DZDUWRĞFL FKROHVWHUROX ZVWRVXQNX GR JUXS\ $QDOL]D post hoc Z\NRQDQD PHWRGą ZLHORNURWQ\FK SRZWyU]HĔ WHVWHP 0DQQD :KLWQH\DZ\ND]DáDĪHZ\áąF]QLHUyĪQLFDZ]DZDUWR ĞFLFKROHVWHUROXGODWĊWQLFZLID]LH]DDZDQVRZDQLD PLDĪGĪ\F\MHVWLVWRWQDVWDW\VW\F]QLH
Tabela I. Zawartość cholesterolu w badanych tętnicach Table I. Content of cholesterol in examined arteries
Stopień miażdżycy n Mediana 25–75% Poziom cholesterolu
0 12 0,250 0,130–0,925
1 9 1,450 0,233–1,505
2 5 3,000 1,695–4,725
3 8 2,525 0,815–4,095
Q±ZLHONRĞüSUyE\VDPSOHVL]H
Ryc. 1. Wykres zależności między zawartością cholesterolu w wycinkach tętnic a stopniem zaawansowania miażdżycy w poszczególnych grupach:
0 – bez widocznych zmian miażdżycowych (12 próbek), 1 – niewielkie blaszki z nacieczeniami tłuszczowymi (9 próbek), 2 – większe, złożone blaszki miażdżycowe (5 próbek), 3 – blaszki miażdżycowe z ogniskami nekrozy, dużym tłuszczowym rdzeniem i/lub depozytami wapnia. Zaznaczono wartości mediany i minimalne–maksymalne.
Fig. 1. Dependency graph of cholesterol content in arterial specimens on severity of atherosclerosis. Numbers in individual groups: 0 – no visible
atherosclerosis (12 samples), 1 – small plates with fatty infiltration (9 samples), 2 – larger, complex atherosclerotic plaques (5 samples), 3 – plaques with necrotic core, fatty core and/or calcium deposits (8 samples). Median and minimum–maximum are marked.
DYSKUSJA
=DSUH]HQWRZDQH Z\QLNL Z\ND]Dá\ ]ZLą]HN PLĊG]\ VWRSQLHP ]DDZDQVRZDQLD PLDĪGĪ\F\ D ]DZDUWRĞFLą FKROHVWHUROX Z SUyENDFK WĊWQLF ,P ZLĊFHM E\áR JR ZWNDQFH W\P VWRSLHĔ ]DDZDQVRZDQLD ]PLDQ FKRUR ERZ\FK E\á Z\ĪV]\ $QDORJLF]QLH MHVW Z SU]\SDGNX ]DZDUWRĞFLFKROHVWHUROXZHNUZL >@0RĪQDSRVWDZLü KLSRWH]Ċ ĪH LP MHVW RQD ZLĊNV]D Z W\P ZLĊNV]\P VWRSQLX MHVW RQ SRFKáDQLDQ\ SU]H] NRPyUNL PLĊĞQL JáDGNLFK L PDNURIDJL Z WĊWQLFDFK :DUWR MHGQDN ]DX ZDĪ\ü ĪH DĪ · FKROHVWHUROX PD SRFKRG]HQLH HQGRJHQQH F]\OLMHVW Z\WZDU]DQH SU]H] XVWUyMJáyZ QLHSU]H]ZąWUREĊMHOLWDLVNyUĊ>@DOHWHĪSU]H]LQQH NRPyUNL Z W\P PLĊĞQLH JáDGNLH WĊWQLF V]F]HJyOQLH ZPLHMVFDFKJG]LHWZRU]ąVLĊRJQLVND]DSDOQH>@ 1D SRGVWDZLH SU]HSURZDG]RQ\FK EDGDĔ RGQRWRZDQR ĪH QD QLVNLP L ĞUHGQLP SR]LRPLH ]DDZDQVRZDQLD PLDĪGĪ\F\ ]DZDUWRĞü FKROHVWHUROX Z ĞFLDQDFK WĊWQLF URĞQLH Z PLDUĊ UR]ZRMX FKRURE\ W\ONR Z RVWDWQLHM
JUXSLH ]DREVHUZRZDQR QLH]QDF]Q\ VSDGHN ĞUHGQLHM ]DZDUWRĞFLFKROHVWHUROXZVWRVXQNXGRJUXS\0RĪH WRZVND]\ZDüLĪSR]LRPWHJROLSLGXZWĊWQLF\Z]UDVWD W\ONR GR SHZQHJR VWRSQLD D GDOV]\ UR]ZyM SDWRORJLL SURZDG]L GR ]PLDQ ]DZDUWRĞFL LQQ\FK ]ZLą]NyZ EX GXMąF\FK ĞFLDQĊ QDF]\QLD NUZLRQRĞQHJR WM ELDáHN WNDQNLáąF]QHMPDFLHU]\]HZQąWU]NRPyUNRZHM]ZLą] NyZ QLHRUJDQLF]Q\FK QS K\GURNV\DSDW\WX WOHQNX ZDSQLDLLQQ\FK2ND]XMHVLĊĪHQDMEDUG]LHM]áRĪRQH EODV]NL PLDĪGĪ\FRZH VNáDGDMą VLĊ Z GXĪ\P VWRSQLX UyZQLHĪ ] LQQ\FK VNáDGQLNyZ NRPyUNRZ\FK L UyĪQR URGQ\FK ]ZLą]NyZ RUJDQLF]Q\FK ± WURPERF\WyZ PDNURIDJyZLQQ\FKNRPyUHNXNáDGXRGSRUQRĞFLRZH JR UHV]WHN QHNURW\F]Q\FK NRPyUHN D Z NRĔFX ]ELDáHN PDFLHU]\ ]HZQąWU]NRPyUNRZ\FK JáyZQLH NRODJHQX>@
=EDGDĔLQQ\FKDXWRUyZZ\QLNDĪHZUD]]UR]ZRMHP PLDĪGĪ\F\SU]\E\ZDNRODJHQX>@3RWZLHUG]DWR UyZQLHĪ REVHUZRZDQH SRVWĊSXMąFH V]W\ZQLHQLH WĊWQLF X SDFMHQWyZ ] FKRUREDPL VHUFRZRQDF]\QLRZ\PL 0QLHMV]D VSUĊĪ\VWRĞü ĞFLDQ WĊWQLF MHVW ] SHZQRĞFLą ]ZLą]DQD]ZLĊNV]ąLORĞFLąNRODJHQXNWyU\MDNRELDá -1 0 1 2 3 4 5 6 7
Stopień zaawansowania miażdzycy
Zaw ar to ść c hol es te ro lu [ g/ m g tk ank i] 0 1 2 3 = DZD UWR Ğü FK RO HV WH UR OX > J P JW ND QNL @
NRGáXJLHZáyNLHQNRZH]ELWHZILEU\OHQDGDMHWNDQFH V]W\ZQRĞü 1D MHM Z]URVW PD ZLĊF ZSá\Z SU]\URVW LORĞFL NRODJHQX Z WĊWQLFDFK ± QDGHNVSUHVMD WHJR ELDá ND D SU]\QDMPQLHM SU]HZDJD HNVSUHVML NRODJHQX QDG MHJRGHJUDGDFMą ]DFRRGSRZLDGDMą PHWDORSURWHLQD]\ PDFLHU]\ ]HZQąWU]NRPyUNRZHM D WDNĪH ]ZLĊNV]HQLH XVLHFLRZDQLDNRODJHQXSU]H]WZRU]HQLHVLĊ]DDZDQVR ZDQ\FKSURGXNWyZJOLNDFML$*(*OLNRZDQ\NRODJHQ QLH W\ONR MHVW EDUG]LHM V]W\ZQ\ DOH ZSá\ZD WDNĪH QD ]ZLĊNV]HQLHV]\ENRĞFLXWOHQLDQLD /'/DW\PVDP\P VW\PXOXMHSURFHV\PLDĪGĪ\FRZH>@
: OLWHUDWXU]H SU]HGPLRWX IXQNFMRQXMH WHRULD ZLąĪąFD NRODJHQ FKROHVWHURO RUD] PLDĪGĪ\FĊ 5DWK L 3DXOLQJ ]DSURSRQRZDOLMXĪZODWDFKXELHJáHJRZLHNXKLSR WH]Ċ ZHGáXJ NWyUHM SLHUZRWQą SU]\F]\Qą IRUPRZDQLD EODV]HN PLDĪGĪ\FRZ\FK MHVW VXENOLQLF]Q\ QLHGREyU ZLWDPLQ\ & SRZRGXMąF\ DJUHJDFMĊ OLSRSURWHLQ\D LILEU\QRJHQXILEU\Q\ ]DĞ NRODJHQ GR SURGXNFML NWyUHJR ZLWDPLQD & MHVW QLH]EĊGQD QLH MHVW V\QWHW\ ]RZDQ\OXEMHJRV\QWH]DMHVWQLHZ\VWDUF]DMąFDSU]H]FR PLHMVFRZR ]ZáDV]F]D Z UHJLRQDFK XNáDGX NUZLRQR ĞQHJRJG]LHFLĞQLHQLHNUZLMHVWQDMZLĊNV]HGRFKRG]L GR ]QLV]F]HQLD ZHZQĊWU]QHM ZDUVWZ\ WĊWQLF\ L]DSRF]ąWNRZDQLD WZRU]HQLD EODV]NL >@ $XWRU]\ VXJHUXMą ĪH FKROHVWHURO QLH MHVW SU]\F]\Qą SRZVWDZDQLD FKRURE\ FKRü RF]\ZLĞFLH RGJU\ZD ZQLHMGXĪąUROĊD ZLĊF PHWRG\SUHZHQF\MQHLOHF] QLF]H GRW\F]ąFH PLDĪGĪ\F\ QLH SRZLQQ\ NRQFHQWUR ZDü VLĊ QD OHNDFK REQLĪDMąF\FK MHJR SR]LRP DOH QD
VXEVWUDWDFK L NRIDNWRUDFK SRWU]HEQ\FK GR V\QWH]\ NRODJHQXZLWDPLQD &SUROLQDOL]\QDLSU]HFLZXWOH QLDF]DFK>@
-DN]D]QDF]DQRZHZVWĊSLHQLQLHMV]DSUDFDMHVWEDGD QLHP ZVWĊSQ\P $QDOL]D Z\QLNyZ GRSURZDG]LáD GR ZQLRVNX ĪH QDOHĪ\ MH UR]V]HU]\ü R WDNLH SDUDPHWU\ MDN]DZDUWRĞüNRODJHQyZUyĪQ\FKW\SyZPHWDORSURWH LQD] PDFLHU]\ ]HZQąWU]NRPyUNRZHM LQQ\FK ELDáHN PDFLHU]\ MDN RVWHRSURWHJHU\QD RVWHRSRQW\QD ]DD ZDQVRZDQ\FK SURGXNWyZ JOLNDFML D WDNĪH R EDGDQLD VWUXNWXUDOQH±LPPXQRKLVWRFKHPLF]QHLLQQH'RSLHUR ZQLNOLZD DQDOL]D ZV]\VWNLFK X]\VNDQ\FK GDQ\FK SR]ZROL Z\VQXü ZLDU\JRGQH ZQLRVNL L SU]\EOLĪ\ SR ]QDQLHSDWRPHFKDQL]PXPLDĪGĪ\F\
2SLV\ZDQHWXEDGDQLDQLHVąUR]VWU]\JDMąFHDOHZVND ]XMą QD SHZQą SUREOHPDW\NĊ GRW\F]ąFą SUHZHQFML L]DELHJyZ WHUDSHXW\F]Q\FK Z PLDĪGĪ\F\ XNLHUXQ NRZD\FKQDREQLĪHQLHSR]LRPXFKROHVWHUROXZHNUZL $QDOL]D GDQ\FK ZáDVQ\FK L OLWHUDWXURZ\FK SR]ZDOD ZVND]Dü SRWHQFMDOQH OHNL SU]\QRV]ąFH ]DPLHU]RQ\ HIHNWWM]ZLą]NLSU]HáDPXMąFH$*(>@F]\WHĪVXE VWUDW\GRV\QWH]\NRODJHQX>@
3XEOLNDFMDMHVWF]ĊĞFLąSURMHNWXÄ:URYDVF±=LQWHJURZD QH &HQWUXP 0HG\F\Q\ 6HUFRZR1DF]\QLRZHM´ ZVSyá ILQDQVRZDQHJR SU]H] (XURSHMVNL )XQGXV] 5R]ZRMX 5HJLRQDOQHJRZUDPDFK3URJUDPX2SHUDF\MQHJR,QQR ZDF\MQD*RVSRGDUNDQDODWD±UHDOL]RZDQHJR Z :RMHZyG]NLP 6]SLWDOX 6SHFMDOLVW\F]Q\P ZH :UR FáDZLX2ĞURGNX%DGDZF]R5R]ZRMRZ\P
PIŚM IEN NI CT WO
1. *R$60R]DIIDULDQ'5RJHU9/LZVS$PHULFDQ+HDUW$VVRFLDWLRQ 6WDWLVWLFV &RPPLWWHH DQG 6WURNH 6WDWLVWLFV 6XEFRPPLWWHH +HDUW GLVHDVH DQG VWURNHVWDWLVWLFV±XSGDWHDUHSRUWIURPWKH$PHULFDQ+HDUW$VVRFLDWLRQ &LUFXODWLRQH±H
2. *HUVK %- 6OLZD . 0D\RVL %0 <XVXI 6 1RYHO WKHUDSHXWLF FRQ FHSWVWKHHSLGHPLFRIFDUGLRYDVFXODUGLVHDVHLQWKHGHYHORSLQJZRUOGJOREDO LPSOLFDWLRQV(XU+HDUW-±
3. (OLV $ 6KRXOG +'/ FKROHVWHURO OHYHOV EH WKH SULPDU\ WDUJHW RIFDUGLR YDVFXODUGLVHDVHULVNDVVHVVPHQWDQGWKHUDS\"([SHUW5HY&DUGLRYDVF7KHU ±
4. 6WDU]\N.:RĪDNRZVND.DSáRQ%6WDW\Q\ZWHUDSLLFKRUHJR]QDGFL ĞQLHQLHPWĊWQLF]\P1DGFLĞQ7ĊWQ±
5. %DĔNRZVNL ( %LRFKHPLD 3RGUĊF]QLN GOD VWXGHQWyZ XF]HOQL PHG\F] Q\FK :\GDZQLFWZR 0HG\F]QH 8UEDQ 3DUWQHU :URFáDZ VWU ± ±± 6. 3DVLHUVNL 7 3DWRJHQH]D PLDĪGĪ\F\ L Z\VWĊSRZDQLH ]GDU]HĔ ZLHĔFR Z\FK3RVW1DXN0HG± 7. 6]QDMGHUPDQ00LDĪGĪ\FDDQDGFLĞQLHQLHWĊWQLFH±DNWXDOQHSUREOHP\ &]\Q5\]± 8. %DQDFK00DUNXV]HZVNL/=DVáRQND-*U]HJRUF]\N-2NRĔVNL3 -HJLHU%7KHUROHRILQIODPPDWLRQLQWKHSDWKRJHQHVLVRIDWKHURVFOHURVLV3U] (SLGHPLRO± 9. .RĞPLFNL 0 &]\QQLNL ]DNDĨQH Z SDWRJHQH]LH FKRURE\ ZLHĔFRZHM 3U]HZ/HN±
10. &KáRSLFNL 6 =DSDOHQLH ĞUyGEáRQND Z DWKHURWKURPERVLV .DUGLRO '\SO
±
11. %lFN 0 .HWHOKXWK ') $JHZDOO 6 0DWUL[ PHWDOORSURWHLQDVHV LQ
DWKHURWKURPERVLV3URJ&DUGLRYDVF'LV±
12. .LXFKL . 1HMLPD - 7DNDQR 7 2KWD 0 +DVKLPRWR + ,QFUHDVHG
VHUXP FRQFHQWUDWLRQV RI DGYDQFHG JO\FDWLRQ HQG SURGXFWV D PDUNHU RI FRURQDU\ DUWHU\ GLVHDVH DFWLYLW\ LQ W\SH GLDEHWLF SDWLHQWV +HDUW ±
13. .X]DQ $ &KZLáNRZVND $ .RELHODU] 0 3H]RZLF] & *DPLDQ $
*OLNDFMDELDáHN PDFLHU]\]HZQąWU]NRPyUNRZHMLMHM]QDF]HQLHZ PLDĪGĪ\F\ 3RVWĊS\+LJ0HG'RĞZ±
14. )HQ\R ,0 *DIHQFX $9 7KH LQYROYHPHQW RI WKH PRQRF\WHVPDF
URSKDJHV LQ FKURQLF LQIODPPDWLRQ DVVRFLDWHG ZLWK DWKHURVFOHURVLV ,PPXQR ELRORJ\±
15. .DWHV07HFKQLTXHVRIOLSLGRORJ\LVRODWLRQDQDO\VLVDQGLGHQWLILFDWLRQ
RIOLSLGV,Q/DERUDWRU\7HFKQLTXHVLQ%LRFKHPLVWU\DQG0ROHFXODU%LRORJ\ (GV 5+ %XUGRQ 3+ YDQ .QLSSHQEHUJ (OVHYLHU $PVWHUGDP S ±
16. 5XVVHOO ' : &KROHVWHURO %LRV\QWKHVLV DQG 0HWDEROLVP &DUGLRYDVF
'UXJV7KHU±
17. 5XDQ ;= 0RRUKHDG -) 7DR -/ 0D ./ :KHHOHU '& 3RZLV
6+ 9DUJKHVH = 0HFKDQLVPV RI G\VUHJXODWLRQ RI ORZGHQVLW\ OLSRSURWHLQ UHFHSWRU H[SUHVVLRQ LQ YDVFXODU VPRRWK PXVFOH FHOOV E\ LQIODPPDWRU\ F\WR NLQHV$UWHULRVFOHU7KURPE9DVF%LRO±
18. .RW 0 .RELHODU] 0 0DNV\PRZLF] . $VVHVVPHQW RI PHFKDQLFDO
SURSHUWLHV RI DUWHULDO FDOFLXP GHSRVLWLRQ 7UDQVDFWLRQV RI )DPHQD ±
19. /HH+<2K%+$JLQJDQGDUWHULDOVWLIIQHVV&LUF-±
±
20. $GLJX]HO ( $KPDG 3- )UDQFR & %HQGHFN 03 &ROODJHQV LQ WKH
SURJUHVVLRQDQGFRPSOLFDWLRQVRIDWKHURVFOHURVLV9DVF0HG±
21. +LFNV0'HOEULGJH/<XH'.5HHYH76&DWDO\VLVRIOLSLGSHUR[L
GDWLRQ E\ JOXFRVH DQG JO\FRV\ODWHG FROODJHQ %LRFKHP %LRSK\V5HV &RP PXQ±
22. 5DWK 0 3DXOLQJ / ,PPXQRORJLFDO HYLGHQFH IRU WKH DFFXPXODWLRQ RI
OLSRSURWHLQDLQWKHDWKHURVFOHURWLFOHVLRQRIWKHK\SRDVFRUEHPLFJXLQHDSLJ 3URF1DWO$FDG6FL86$±
23. 5DWK 0 3DXOLQJ / +\SRWKHVLV OLSRSURWHLQD LV D VXUURJDWH IRU DVFRU
EDWH3URF1DWO$FDG6FL86$±(UUDWXPLQ3URF1DWO $FDG6FL86$
24. ,YDQRY95RRPL0:.DOLQRYVN\71LHG]ZLHFNL$5DWK0$QWL
DWKHURJHQLF HIIHFWV RI D PL[WXUH RI DVFRUELF DFLG O\VLQH SUROLQH DUJLQLQH F\VWHLQH DQG JUHHQ WHD SKHQROLFV LQ KXPDQ DRUWLF VPRRWK PXVFOH FHOOV - &DUGLRYDVF3KDUPDFRO±
25. %DLOH\ $- 3DXO 5* .QRWW / 0HFKDQLVPV RI PDWXUDWLRQ DQG DJHLQJ