Нестероидные противовоспалительные препараты в практике терапевта


DOI: https://dx.doi.org/10.18565/therapy.2024.1.138-148

А.Е. Каратеев

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой», г. Москва
Аннотация. Нестероидные противовоспалительные препараты (НПВП) занимают центральную позицию в современной системе мультимодальной анальгетической терапии, основанной на комплексном применении немедикаментозных методов и фармакологических средств с различным механизмом действия. Многоплановое действие НПВП определяет их высокий терапевтический потенциал при таких распространенных болезнях скелетно-мышечной системы, как остеоартрит, неспецифическая боль в спине и патология околосуставных мягких тканей. По своей эффективности НПВП превосходят максимальные дозы парацетамола и не уступают опиоидам. При использовании противовоспалительных доз НПВП в течение 7–14 дней уменьшение боли ≥ 50% отмечается у 40–50% пациентов. Однако НПВП могут вызывать серьезные осложнения со стороны желудочно-кишечного тракта (ЖКТ), почек и, главное, сердечно-сосудистой системы. Поэтому при их назначении следует учитывать наличие коморбидных заболеваний и факторов риска, использовать препараты с наилучшим профилем безопасности (для конкретной ситуации) и при необходимости назначать препараты для предупреждения ЖКТ-осложнений (ингибиторы протонной помпы, ребамипид).

Литература


1. Насонов Е.Л., Яхно Н.Н., Каратеев А.Е. с соавт. Общие принципы лечения скелетно-мышечной боли: междисциплинарный консенсус. Научно-практическая ревматология. 2016; 54(3): 247–265. (Nasonov E.L., Yakhno N.N., Karateev A.E. et al. General principles of treatment for musculoskeletal pain: Interdisciplinary consensus. Nauchno-Prakticheskaya revmatologiya = Rheumatology Science and Practice. 2016; 54(3): 247–265 (In Russ.)). https://doi.org/10.14412/1995-4484-2016-247-265. EDN: WXHGNX.


2. Adogwa O., Reid M.C., Chilakapati S., Makris U.E. Clin-STAR corner: 2021 update in musculoskeletal pain in older adults with a focus on osteoarthritis-related pain. J Am Geriatr Soc. 2023; 71(8): 2373–80. https://doi.org/10.1111/jgs.18369. PMID: 37186060. PMCID: PMC10524733.


3. Лила А.М., Алексеева Л.И., Таскина Е.А., Кашеварова Н.Г. Остеоартрит как междисциплинарная проблема: алгоритм лечения для терапевтов и врачей общей практики. Современная ревматология. 2021; 15(5): 68–75. (Lila A.M., Alekseeva L.I., Taskina E.A., Kashevarova N.G. Osteoarthritis as an interdisciplinary problem: Treatment algorithm for physicians and general practitioners. Sovremennaya revmatologiya = Modern Rheumatology Journal. 2021; 15(5): 68–75 (In Russ.)). https://doi.org/10.14412/1996-7012-2021-5-68-75. EDN: PVZTIZ.


4. Каратеев А.Е. Болезни костно-мышечной системы в практике 2102 врачей различных специальностей: структура патологии и мнение специалистов об эффективности НПВП: предварительные данные эпидемиологического исследования КОРОНА-2. Consilium Medicum. 2013; 15(9): 95–100. (Karateev A.E. Diseases of the musculoskeletal system in the practice of 2102 doctors of various specialties: the structure of pathology and the opinion of specialists on the effectiveness of NSAIDs: Preliminary data of the CORONA-2 epidemiological study). Consilium Medicum, 2013; 15(9): 95–100 (In Russ.)). EDN: RLSWTH.


5. Sorondo D., Delpierre C., Cote P. et al. Determinants of clinical practice guidelines’ utilization for the management of musculoskeletal disorders: A scoping review. BMC Musculoskelet Disord. 2021; 22(1): 507. https://doi.org/10.1186/s12891-021-04204-w. PMID: 34074285. PMCID: PMC8170973.


6. Scheuing W.J., Reginato A.M., Deeb M., Acer Kasman S. The burden of osteoarthritis: Is it a rising problem? Best Pract Res Clin Rheumatol. 2023; 37(2): 101836. https://doi.org/10.1016/j.berh.2023.101836. PMID: 37633827.


7. Chen S.., Chen M., Wu X. et al. Global, regional and national burden of low back pain 1990–2019: A systematic analysis of the Global Burden of Disease study 2019. J Orthop Translat. 2021; 32: 49–58. https://doi.org/10.1016/j.jot.2021.07.005. PMID: 34934626. PMCID: PMC8639804.


8. Crookes T., Wall C., Byrnes J. et al. Chronic shoulder pain. Aust J Gen Pract. 2023; 52(11): 753–58. https://doi.org/10.31128/AJGP-04-23-6790. PMID: 37935145.


9. Верткин А.Л., Каратеев А.Е., Кукушкин М.Л. с соавт. Ведение пациентов с болью в спине для терапевтов и врачей общей практики (Клинические рекомендации). Терапия. 2018; 4(2): 8–17. (Vertkin A.L., Karateyev A.Ye., Kukushkin M.L. et al. Management of patients with back pain for therapists and general practitioners (Clinical recommendations). Terapiya = Therapy. 2018; 4(2): 8–17 (In Russ.)). EDN: YUDWUE.


10. Лила А.М., Мазуров В.И., Мартынов А.И. с соавт. Резолюция консенсуса экспертов Российской Федерации по диагностике и лечению остеоартрита 2022. Современная ревматология. 2022; 16(6): 106–116. (Lila A.M., Mazurov V.I., Martynov A.I. et al. Resolution of the consensus of the Russian Federation experts on the diagnosis and treatment of osteoarthritis, 2022. Sovremennaya revmatologiya = Modern Rheumatology Journal. 2022; 16(6): 106–116 (In Russ.)). https://doi.org/10.14412/1996-7012-2022-6-106-116. EDN: SHTRCF.


11. Каратеев А.Е., Лила А.М., Загородний Н.В. с соавт. Совет экспертов: хроническая боль в области плечевого сустава как мультидисциплинарная проблема. Современная ревматология. 2023; 17(3): 111–120. (Karateev A.E., Lila A.M., Zagorodniy N.V. et al. Council of Experts: chronic shoulder pain as a multidisciplinary problem. Sovremennaya revmatologiya = Modern Rheumatology Journal. 2023; 17(3): 111–120 (In Russ.)). https://doi.org/10.14412/1996-7012-2023-3-111-120. EDN: IBZGYY.


12. Cohen S.P., Mora J. Chronic pain, disease and mortality: Will we follow the path of Noah or Pharaoh? Reg Anesth Pain Med. 2021; 46(9): 743–44. https://doi.org/10.1136/rapm-2021-102949. PMID: 34168061.


13. Fayaz A., Ayis S., Panesar S.S. et al. Assessing the relationship between chronic pain and cardiovascular disease: A systematic review and meta-analysis. Scand J Pain. 2016; 13: 76–90. https://doi.org/10.1016/j.sjpain.2016.06.005. PMID: 28850537.


14. Veronese N., Cereda E., Maggi S. et al. Osteoarthritis and mortality: A prospective cohort study and systematic review with meta-analysis. Semin Arthritis Rheum. 2016; 46(2): 160–67. https://doi.org/10.1016/j.semarthrit.2016.04.002. PMID: 27179749.


15. de Luca K., Tavares P., Yang H. et al. Spinal pain, chronic health conditions and health behaviors: Data from the 2016–2018 national health interview survey. Int J Environ Res Public Health. 2023; 20(7): 5369. https://doi.org/10.3390/ijerph20075369. PMID: 37047983. PMCID: PMC10094294.


16. Tinnirello A., Mazzoleni S., Santi C. Chronic pain in the elderly: Mechanisms and distinctive features. Biomolecules. 2021; 11(8): 1256. https://doi.org/10.3390/biom11081256. PMID: 34439922. PMCID: PMC8391112.


17. Chen C., Smith M.T. The NLRP3 inflammasome: Role in the pathobiology of chronic pain. Inflammopharmacology. 2023; 31(4): 1589–603. https://doi.org/10.1007/s10787-023-01235-8. PMID: 37106238. PMCID: PMC10352419.


18. Dahmani D., Taik F.Z., Berrichi I. et al. Impact of central sensitization on pain, disability and psychological distress in patients with knee osteoarthritis and chronic low back pain. BMC Musculoskelet Disord. 2023; 24(1): 877. https://doi.org/10.1186/s12891-023-07019-z. PMID: 37950225. PMCID: PMC10636971.


19. Otero-Ketterer E., Penacoba-Puente C., Ferreira Pinheiro-Araujo C. et al. Biopsychosocial factors for chronicity in individuals with non-specific low back pain: An umbrella review. Int J Environ Res Public Health. 2022; 19(16): 10145. https://doi.org/10.3390/ijerph191610145. PMID: 36011780. PMCID: PMC9408093.


20. Stevans J.M., Delitto A., Khoja S.S. et al. Risk factors associated with transition from acute to chronic low back pain in US patients seeking primary care. JAMA Netw Open. 2021; 4(2): e2037371. https://doi.org/10.1001/jamanetworkopen.2020.37371. PMID: 33591367. PMCID: PMC7887659.


21. Gerard B., Bailly F., Trouvin A.P. How to treat chronic pain in rheumatic and musculoskeletal diseases (RMDs) – A pharmacological review. Joint Bone Spine. 2024; 91(1): 105624. https://doi.org/10.1016/j.jbspin.2023.105624. PMID: 37495074.


22. Nadeau S.E., Lawhern R.A. Management of chronic non-cancer pain: A framework. Pain Manag. 2022; 12(6): 751–77. https://doi.org/10.2217/pmt-2022-0017. PMID: 35642546.


23. Leopoldino A.O., Machado G.C., Ferreira P.H. et al. Paracetamol versus placebo for knee and hip osteoarthritis. Cochrane Database Syst Rev. 2019; 2(2): CD013273. https://doi.org/10.1002/14651858.CD013273. PMID: 30801133. PMCID: PMC6388567.


24. Saragiotto B.T., Machado G.C., Ferreira M.L. et al. Paracetamol for low back pain. Cochrane Database Syst Rev. 2016; 2016(6): CD012230. https://doi.org/10.1002/14651858.CD012230. PMID: 27271789. PMCID: PMC6353046.


25. Fisher E.S., Curry S.C. Evaluation and treatment of acetaminophen toxicity. Adv Pharmacol. 2019; 85: 263–72. https://doi.org/10.1016/bs.apha.2018.12.004. PMID: 31307590.


26. Hallberg S., Rolfson O., Karppinen J. et al. Burden of disease and management of osteoarthritis and chronic low back pain: healthcare utilization and sick leave in Sweden, Norway, Finland and Denmark (BISCUITS): Study design and patient characteristics of a real world data study. Scand J Pain. 2022; 23(1): 126–38. https://doi.org/10.1515/sjpain-2021-0212. PMID: 35858277.


27. Abdel Shaheed C., Awal W., Zhang G. et al. Efficacy, safety, and dose-dependence of the analgesic effects of opioid therapy for people with osteoarthritis: Systematic review and meta-analysis. Med J Aust. 2022; 216(6): 305–11. https://doi.org/10.5694/mja2.51392. PMID: 35137418.


28. Petzke F., Klose P., Welsch P. et al. Opioids for chronic low back pain: An updated systematic review and meta-analysis of efficacy, tolerability and safety in randomized placebo-controlled studies of at least 4 weeks of double-blind duration. Eur J Pain. 2020; 24(3): 497–517. https://doi.org/10.1002/ejp.1519. PMID: 31876347.


29. Wongrakpanich S., Wongrakpanich A., Melhado K., Rangaswami J. A comprehensive review of non-steroidal anti-inflammatory drug use in the elderly. Aging Dis. 2018; 9(1): 143–50. https://doi.org/10.14336/AD.2017.0306. PMID: 29392089. PMCID: PMC5772852.


30. Rasu R.S., Vouthy K., Crowl A.N. et al. Cost of pain medication to treat adult patients with nonmalignant chronic pain in the United States. J Manag Care Spec Pharm. 2014; 20(9): 921–28. https://doi.org/10.18553/jmcp.2014.20.9.921. PMID: 25166291. PMCID: PMC10438355.


31. Ribeiro H., Rodrigues I., Napoleão L. et al. Non-steroidal anti-inflammatory drugs (NSAIDs), pain and aging: Adjusting prescription to patient features. Biomed Pharmacother. 2022; 150: 112958. https://doi.org/10.1016/j.biopha.2022.112958. PMID: 35453005.


32. da Costa B.R., Pereira T.V., Saadat P. et al. Effectiveness and safety of non-steroidal anti-inflammatory drugs and opioid treatment for knee and hip osteoarthritis: Network meta-analysis. BMJ. 2021; 375: n2321. https://doi.org/10.1136/bmj.n2321. PMID: 34642179. PMCID: PMC8506236.


33. Cashin A.G., Wand B.M., O’Connell N.E. et al. Pharmacological treatments for low back pain in adults: An overview of Cochrane reviews. Cochrane Database Syst Rev. 2023; 4(4): CD013815. https://doi.org/10.1002/14651858.CD013815.pub2. PMID: 37014979. PMCID: PMC10072849.


34. Boudreault J., Desmeules F., Roy J.S. et al. The efficacy of oral non-steroidal anti-inflammatory drugs for rotator cuff tendinopathy: A systematic review and meta-analysis. J Rehabil Med. 2014; 46(4): 294–306. https://doi.org/10.2340/16501977-1800. PMID: 24626286.


35. Smith S.R., Deshpande B.R., Collins J.E. et al. Comparative pain reduction of oral non-steroidal anti-inflammatory drugs and opioids for knee osteoarthritis: Systematic analytic review. Osteoarthritis Cartilage. 2016; 24(6): 962–72. https://doi.org/10.1016/j.joca.2016.01.135. PMID: 26844640. PMCID: PMC4996269.


36. Osani M.C., Vaysbrot E.E., Zhou M. et al. Duration of symptom relief and early trajectory of adverse events for oral nonsteroidal antiinflammatory drugs in knee osteoarthritis: A systematic review and meta-analysis. Arthritis Care Res (Hoboken). 2020; 72(5): 641–51. https://doi.org/10.1002/acr.23884. PMID: 30908885. PMCID: PMC6761047.


37. Gregori D., Giacovelli G., Minto C. et al. Association of pharmacological treatments with long-term pain control in patients with knee osteoarthritis: A systematic review and meta-analysis. JAMA. 2018; 320(24): 2564–79. https://doi.org/10.1001/jama.2018.19319. PMID: 30575881. PMCID: PMC6583519.


38. Cooper C., Chapurlat R., Al-Daghri N. et al. Safety of oral non-selective non-steroidal anti-inflammatory drugs in osteoarthritis: What does the literature say? Drugs Aging. 2019; 36(Suppl 1): 15–24. https://doi.org/10.1007/s40266-019-00660-1. PMID: 31073921. PMCID: PMC6509083.


39. Zeng C., Doherty M., Persson M.S.M. et al. Comparative efficacy and safety of acetaminophen, topical and oral non-steroidal anti-inflammatory drugs for knee osteoarthritis: Evidence from a network meta-analysis of randomized controlled trials and real-world data. Osteoarthritis Cartilage. 2021; 29(9): 1242–51. https://doi.org/10.1016/j.joca.2021.06.004. PMID: 34174454.


40. Aw T.J., Haas S.J., Liew D., Krum H. Meta-analysis of cyclooxygenase-2 inhibitors and their effects on blood pressure. Arch Intern Med. 2005; 165(5): 490–96. https://doi.org/10.1001/archinte.165.5.IOI50013. PMID: 15710786.


41. Villa J., Cano A., Franco D. et al. (Clinical relevance of drug interactions between nonsteroidal antiinflammatory drugs (NSAIDs) and antihypertensives). Aten Primaria. 2014; 46(9): 464–74 (In Spanish)). https://doi.org/10.1016/j.aprim.2013.11.010. PMID: 24667116. PMCID: PMC6983655.


42. Ungprasert P., Srivali N., Kittanamongkolchai W. Non-steroidal anti-inflammatory drugs and risk of heart failure exacerbation: A systematic review and meta-analysis. Eur J Intern Med. 2015; 26(9): 685–90. https://doi.org/10.1016/j.ejim.2015.09.012. PMID: 26427540.


43. Chokesuwattanaskul R., Chiengthong K., Thongprayoon C. et al. Nonsteroidal anti-inflammatory drugs and incidence of atrial fibrillation: a meta-analysis. QJM. 2020; 113(2): 79–85. https://doi.org/10.1093/qjmed/hcz307. PMID: 32031227.


44. Bhala N., Emberson J., Merhi A. et al. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: Meta-analyses of individual participant data from randomised trials. Lancet. 2013; 382(9894): 769–79. https://doi.org/10.1016/S0140-6736(13)60900-9. PMID: 23726390. PMCID: PMC3778977.


45. Каратеев А.Е., Насонов Е.Л., Ивашкин В.Т. с соавт. Рациональное использование нестероидных противовоспалительных препаратов. Клинические рекомендации. Научно-практическая ревматология. 2018; 56(S1): 1–29. (Karateev A.E., Nasonov E.L., Ivashkin V.T. et al. Rational use of nonsteroidal anti-inflammatory drugs. Clinical guidelines. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2018; 56(S1): 1–29 (In Russ.)). https://doi.org/10.14412/1995-4484-2018-1-29. EDN: PCPKRP.


46. Scally B., Emberson J.R., Spata E. et al. Effects of gastroprotectant drugs for the prevention and treatment of peptic ulcer disease and its complications: A meta-analysis of randomised trials. Lancet Gastroenterol Hepatol. 2018; 3(4): 231–41. https://doi.org/10.1016/S2468-1253(18)30037-2. PMID: 29475806. PMCID: PMC5842491.


47. Мороз Е.В., Каратеев А.Е. Ребамипид: эффективная медикаментозная профилактика НПВП-энтеропатии возможна. Современная ревматология. 2016; 10(4): 97–105. (Moroz E.V., Karateev A.E. Rebamipide: Effective drug prevention of NSAID enteropathy is possible. Sovremennaya revmatologiya = Modern Rheumatology Journal. 2016; 10(4): 97–105 (In Russ.)). http://dx.doi.org/10.14412/1996-7012-2016-4-97-105. EDN: XEKFED.


48. Hasegawa M., Horiki N., Tanaka K. et al. The efficacy of rebamipide add-on therapy in arthritic patients with COX-2 selective inhibitor-related gastrointestinal events: A prospective, randomized, open-label blinded-endpoint pilot study by the GLORIA study group. Mod Rheumatol. 2013; 23(6): 1172–78. https://doi.org/10.1007/s10165-012-0819-2. PMID: 23306427.


49. Сивохина Т.А., Кожина М.В. Опыт применения цитопротектора ребамипид в лечении эрозивной гастропатии вследствие приема нестероидных противовоспалительных средств. Фарматека. 2017; (18): 32–35. (Sivokhina T.A., Kozhina M.V. Experience of the use of cytoprotector rebamipide in the treatment of NSAID-induced erosive gastropathy. Farmateka. 2017; (18): 32–35 (In Russ.)). EDN: ZSLPJB.


50. Каратеев А.Е., Мороз Е.В., Крюков Е.В. Поражение тонкой кишки, ассоциированное с приемом нестероидных противовоспалительных препаратов. Альманах клинической медицины. 2019; 47(6): 559–567. (Karateev A.E., Moroz E.V., Kryukov E.V. Small intestinal damage associated with the use of nonsteroidal anti-inflammatory drugs. Al’manakh klinicheskoy meditsiny = Almanac of Clinical Medicine. 2019; 47(6): 559–567 (In Russ.)). https://doi.org/10.18786/2072-0505-2019-47-048. EDN: KPKVAI.


51. Watanabe T., Fujiwara Y., Chan F.K.L. Current knowledge on non-steroidal anti-inflammatory drug-induced small-bowel damage: a comprehensive review. J Gastroenterol. 2020; 55(5): 481–95. https://doi.org/10.1007/s00535-019-01657-8. PMID: 31865463. PMCID: PMC7188723.


52. Oh D.J., Yoon H., Kim H.S. et al. The effect of rebamipide on non-steroidal anti-inflammatory drug-induced gastro-enteropathy: A multi-center, randomized pilot study. Korean J Intern Med. 2022; 37(6): 1153–66. https://doi.org/10.3904/kjim.2021.216. PMID: 36375487. PMCID: PMC9666262.


53. Zhang S., Qing Q., Bai Y. et al. Rebamipide helps defend against nonsteroidal anti-inflammatory drugs induced gastroenteropathy: A systematic review and meta-analysis. Dig Dis Sci. 2013; 58(7): 1991–2000. https://doi.org/10.1007/s10620-013-2606-0. PMID: 23456504.


54. Teutsch B., Boros E., Váncsa S. et al. Mucoprotective drugs can prevent and treat nonsteroidal anti-inflammatory drug-induced small bowel enteropathy: A systematic review and meta-analysis of randomized controlled trials. Therap Adv Gastroenterol. 2021; 14: 17562848211038772. https://doi.org/10.1177/17562848211038772. PMID: 34616487. PMCID: PMC8488515.


55. Imai T., Hazama K., Kosuge Y. et al. Preventive effect of rebamipide on NSAID-induced lower gastrointestinal tract injury using FAERS and JADER. Sci Rep. 2022; 12(1): 2631. https://doi.org/10.1038/s41598-022-06611-y. PMID: 35173236. PMCID: PMC8850592.


56. Reed G.W., Abdallah M.S., Shao M. et al. Effect of aspirin coadministration on the safety of celecoxib, naproxen, or ibuprofen. J Am Coll Cardiol. 2018; 71(16): 1741–51. https://doi.org/10.1016/j.jacc.2018.02.036. PMID: 29673465.


57. Hunt R.H., Lanas A., Stichtenoth D.O., Scarpignato C. Myths and facts in the use of anti-inflammatory drugs. Ann Med. 2009; 41(6): 423–37. https://doi.org/10.1080/07853890902887295. PMID: 19430988.


58. Moore R.A., Moore O.A., Derry S. et al. Responder analysis for pain relief and numbers needed to treat in a meta-analysis of etoricoxib osteoarthritis trials: bridging a gap between clinical trials and clinical practice. Ann Rheum Dis. 2010; 69(2): 374–79. https://doi.org/10.1136/ard.2009.107805. PMID: 19364730. PMCID: PMC2800200.


59. Moore A.R., Smugar S.S., Wang H. et al. Numbers-needed-to-treat analyses--do timing, dropouts, and outcome matter? Pooled analysis of two randomized, placebo-controlled chronic low back pain trials. Pain. 2010; 151(3): 592–97. https://doi.org/10.1016/j.pain.2010.07.013. PMID: 20810214.


60. Gottesdiener K., Schnitzer T., Fisher C. et al. Protocol 007 Study Group. Results of a randomized, dose-ranging trial of etoricoxib in patients with osteoarthritis. Rheumatology (Oxford). 2002; 41(9): 1052–61. https://doi.org/10.1093/rheumatology/41.9.1052. PMID: 12209041.


61. Dougados M., Le Henanff A., Logeart I., Ravaud P. Short-term efficacy of rofecoxib and diclofenac in acute shoulder pain: a placebo-controlled randomized trial. PLoS Clin Trials. 2007; 2(3): e9. https://doi.org/10.1371/journal.pctr.0020009. PMID: 17347681. PMCID: PMC1817652.


62. Lin H.Y., Cheng T.T., Wang J.H. et al. Etoricoxib improves pain, function and quality of life: Results of a real-world effectiveness trial. Int J Rheum Dis. 2010; 13(2): 144–50. https://doi.org/10.1111/j.1756-185X.2010.01468.x. PMID: 20536599.


63. Kim W.Y., Lee S., Jun K. et al. Underutilization of gastrointestinal prophylaxis in high-risk chronic nonsteroidal anti-inflammatory drug users in Korea. Int J Clin Pharm. 2021; 43(3): 645–53. https://doi.org/10.1007/s11096-020-01176-0. PMID: 33147346.


64. Whitner J.B., Fabiili N.A., Siewart J. et al. Pharmacist-led provider education on inappropriate NSAID prescribing rates. Fam Med. 2020; 52(8): 592–96. https://doi.org/10.22454/FamMed.2020.147410. PMID: 32931009.


Об авторах / Для корреспонденции


Андрей Евгеньевич Каратеев, д. м. н., начальник отдела воспалительных заболеваний суставов ФГБНУ «Научно-исследовательский институт ревматологии имени В.А. Насоновой». Адрес: 115522, г. Москва, Каширское шоссе, д. 34а.
E-mail: aekarat@yandex.ru
ORCID: https://orcid.org/0000-0002-1391-0711


Похожие статьи


Бионика Медиа