Низькоінтенсивна лазерна терапія в реабілітації хворих на ішемічну хворобу серця: огляд доказових досліджень

  • Л. Я. Васильева-Линецкая Харківська медична академія післядипломної освіти http://orcid.org/0000-0001-7227-7656
Ключові слова: низькоінтенсивна лазеротерапія, фотобіомодуляція, кардіореабілітація, ішемічна хвороба серця, доказові дослідження

Анотація

Вступ. Кардіореабілітація є одним з головних досягнень кардіології та фізичної реабілітаційної
медицини другої половини 20-го століття. Заснована на методології доказової медицини, кардіореа-
білітація за короткий час еволюціонувала від «вигаданого» «альтернативного» бездоказово лікуваль-
ного напряму до абсолютно безальтернативних багатопрофільних програм, що довели свою безумовну
ефективність. У статті представлені сучасні дані про реабілітацію хворих на ішемічну хворобу серця та
аналіз доказових експериментальних і клінічних досліджень про ефективність застосування низькоін-
тенсивної лазеротерапії.
Мета — пошук доказових досліджень щодо застосування низькоінтенсивної лазеротерапії
у реабілітації хворих на ішемічну хворобу серця та аналіз їх основних положень і рекомендацій.
Матеріал і методи. Стратегія пошуку доказових досліджень включала пошук рандомізованих клініч-
них досліджень, систематичних оглядів, мета-аналізів і клінічних протоколів за ключовими словами в
електронних базах публікацій з доказової фізіотерапії PEDro, EMBASE, PubMed і «Cochrane library» за
2000–2019 рр.
Результати та обговорення. Детально розглянуті експериментальні і клінічні дослідження,
проаналізовані дані про механізми дії низькоінтенсивної лазеротерапії, її позитивний вплив на процеси
ремоделювання міокарда, зменшення зони інфаркту, профілактики рестенозу і надання кардіозахисного
ефекту. Велику увагу приділено клінічним доказовим дослідженням щодо застосування фотобіомодуляціі
для підвищення ефективності хірургічної реваскуляризації міокарда, а також в неінвазивній кардіології
та фізичній реабілітаційній медицині.
Висновок. Необхідний регулярний аналіз проведених та проведення нових доказових досліджень з
вивчення ефективності застосування низькоінтенсивної лазеротерапії в реабілітації хворих на ішемічну
хворобу серця.

Завантаження

Дані завантаження ще не доступні.

Посилання

Аbreu A. Hot topics in cardiac rehabilitation. Dialogues

cardiovasc med. 2017;22(3):21-3.

Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H,

Rees K. Exercise-based rehabilitation for patients with

coronary heart disease: systematic review and meta-

analysis of randomized controlled trials. Am J Med.

;116(10):682-92.

Smith SC Jr, Benjamin EJ, Bonow RO, Braun LT, Creager

MA, Franklin BA, et al. AHA/ACCF secondary prevention

and risk reduction therapy for patients with coronary

and other atherosclerotic vascular disease: 2011 update:

a guideline from the American Heart Association and

American College of Cardiology Foundation. Circulation2011;

(22):2458–73.

Niebauer J, Velich T, Hambrecht DR. 6 years of intensive

physical exercise and low-fat diet: effects on progression

of coronary artery disease. Circulation 1995;92(1):398.

Giudice R, Izzo R, Manzi MV, Pagnano G, Santoro M,

Rao MA, et al. Lifestyle-related risk factors, smoking

status and cardiovascular disease. High Blood Press

Cardiovasc Prev. 2012;19(22):85-92.

Mozaffarian D, Fahimi S, Singh GM, Micha R, Khatibzadeh

S, Engell RE, et al. Global Burden of Diseases Nutrition

and Chronic Diseases Expert Group. Global sodium

consumption and death from cardiovascular causes. N

Engl J Med. 2014;371(7):624−34.

Schuler G, Hambrecht R, Schliert G. Regular physical exercise

and low-fat diet. Effects on progression of coronary

artery disease. Circulation 1992;86(1):1-11.

Pasquali SK, Alexander KP, Coombs LP, Lytle BL, Peterson

ED. Effect of cardiac rehabilitation on functional

outcomes after coronary revascularization. Am Heart J.

;145(3):445-51.

Aronov DM, Bubnova MG, Ivanova GE. [Organizational

basis of cardiological rehabilitation in Russia: the modern

stage]. Cardio Somatica. 2012;4:5-11. (in Russian)

Aronov DM, Krasnickij VB, Bubnova MG, Pozdnyakov

YuM, Ioseliani DG, Shchegol’kov AN et al. [The effect

of physical training on physical performance, hemodynamics,

blood lipids, clinical course and prognosis in

patients with coronary heart disease after acute coronary

events with complex rehabilitation and secondary prevention

at the outpatient stage (Russian cooperative study)].

Kardiologiya [Cardiology]. 2009;3:49-56. (in Russian)

Belardinelli R, Paolini I, Cianci G. Exercise training intervention

after coronary angioplasty: the ETICA trial.

J Am Coll Cardiol. 2001;37(7):1891-900.

Hambrecht R, Walther C, Möbius-Winkler S, Gielen

S, Linke A, Conradi K, et al. Percutaneous coronary

angioplasty compared with exercise training in patients

with stable coronary artery disease: a randomized trial.

Circulation 2004;109(11):1371-8.

Smith SC Jr, Allen J, Blair SN, Bonow RO, Brass LM,

Fonarow GC, et al. АНА/АСС Guidelines for Secondary

Prevention for Patients With Coronary and Other Atherosclerotic

Vascular Diseases: 2006 Update. J Am Coll

Cardiol 2006;47(10):2130-9.

Wijns W, Kolh P, Danchin N, Di Mario C, Falk V, Folliguet

T, et al. Guidelines on myocardial revascularization:

The Task Force on Myocardial Revascularization of the

European Society of Cardiology (ESC) and the European

Association for Cardio-Thoracic Surgery (EACTS). Eur

Heart J. 2010;31(20):2501–55.

Amirov NB. [Low-intensity laser radiation in the treatment

of coronary heart disease]. Fundamental’nye issledovaniya

[Basic research]. 2008;5:14-6. (in Russian)

Amirov NB, Abdrahmanova AI. [The use of low-intensity

laser radiation in the complex treatment of coronary heart

disease]. Rossijskij kardiologicheskij zhurnal [Russian

Journal of Cardiology]. 2002;5:24-7. (in Russian)

Volotovskaya AG, Ulashchik VS, Filipovich VT. [Antioxidant

effect and therapeutic efficacy of laser blood

irradiation in patients with coronary heart disease]. Vopr.

kurort. fizioter. LFK [Q. resort. fizioter. exercise therapy].

;3:22-5. (in Russian)

Vasil’ev AV, Sekisova MN, Strel’cova NF, Senatorov II.

[Laser correction of microcirculation disorders in patients

with coronary artery disease with hypercholesterolemia].

Klin Med [Clin. Med.]. 2005;2:33-7. (in Russian)

Doncov AV. [Low-intensity laser radiation in the treatment

of patients with coronary artery disease with

metabolic syndrome (literature review)]. Vestnik novyh

medicinskih tekhnologij [Bulletin of new medical technologies].

;19(4):144-6. (in Russian)

Kemalov RN. [The effect of low-intensity laser radiation

on lipid metabolism and hemostasis in patients with myocardial

infarction]. Vopr. kurort, fizioter, LFK [Questions

of resort, physiotherapist, exercise therapy]. 2006;2:6-8.

(in Russian)

Moskvin SV. Effektivnost’ lazernoj terapii. Seriya “Effektivnaya

lazernaya terapiya” [The effectiveness of

laser therapy. Series “Effective Laser Therapy”]. V. 2.

Moscow-Tver: Triada Publ.; 2014. 251 p. (in Russian)

Nikitin AV, El’zhurkaev AA.[ Ultravascular low-intensity

laser radiation in the complex treatment of coronary heart

disease]. Vestnik novyh medicinskih tekhnologij [Bulletin

of new medical technologies]. 2013;1:15-21. (in Russian)

Popov VD, editor. Sovremennye aspekty lazernoj terapii

[Modern aspects of laser therapy]. Cherkasy: Vertikal’,

Kandych S.G. Publ.; 2011. 231 p. (in Russian)

Loboda MV, Babov KD, Zolotar’ova TA, Grіnyaєva LYa,

editors. Standarti (klіnіchnі protokoli) sanatorno-kurortnogo

lіkuvannya [Standards (clinical reports) of the

sanatorium resort]. 2008. 416 p. (in Russian)

Duarte FO, Sene-Fiorese M, de Aquino Junior AE, da

Silveira Campos RM, Masquio DC, Tock L, et al. Can

low-level laser therapy (LLLT) associated with an aerobic

plus resistance training change the cardiometabolic

risk in obese women? A placebo-controlled clinical trial.

J Photochem Photobiol B. 2015;153:103-10.

Mandel A, Hamblin MR. A renaissance in low-level

laser (light) therapy–LLLT. Photonics Lasers Med.

;1(4):231–4.

Liebert A, Krause A, Goonetilleke N, Bicknell B, Kiat H.

A Role for Photobiomodulation in the Prevention of

Myocardial Ischemic Reperfusion Injury: A Systematic

Review and Potential Molecular Mechanisms. Sci Rep.

;7:42386.

Lyubimov AV, Shabanov PD. [Ischemia, reperfusion and

new approaches in the treatment of myocardial infarction].

Obzory po klinicheskoj farmakologii i lekarstvennoj

terapii [Clinical pharmacology and drug therapy reviews].

;3:3-9. (in Russian)

Yang J, Huang Z, Zhou Y, Sai S, Zhu F, Lv R, et al. Effect

of low-level laser irradiation on oxygen free radicals and

ventricular remodeling in the infarcted rat heart. Photomed

Laser Surg. 2013;31:447–52.

Quirk BJ, Sonowal P, Jazayeri MA, Baker JE, Whelan HT.

Cardioprotection from ischemia-reperfusion injury

by nearinfrared light in rats. Photomed. Laser Surg.

;32:505–11.

Oron U, Yaakobi T, Oron A, Mordechovitz D, Shofti R,

Hayam G, et al. Low-energy laser irradiation reduces

formation of scar tissue after myocardial infarction in

rats and dogs. Circulation 2001;103:296–301.

Keszler A, Baumgardt S, Hwe C, Bienengraeber M. Far

red/near infrared light-induced cardioprotection under

normal and diabetic conditions. Proc. SPIE 9309, Mechanisms

for Low-Light Therapy X, 93090P.

Keszler A, Brandal G, Baumgardt S, Ge ZD, Pratt PF,

Riess ML, et al. Far red/near infrared light-induced protection

against cardiac ischemia and reperfusion injury

remains intact under diabetic conditions and is independent

of nitric oxide synthase. Front Physiol. 2014;5:305.

Gatsura S, Gladkikh S, Titov M. Effect of low-energy

laser irradiation on the area of experimental myocardial

infarction, lipidperoxidation, and hemoglobin affinity for

oxygen. B Exp Biol Med. 2004;137:355–7.

Yang Z, Wu Y, Zhang H, Jin P, Wang W, Hou J, et al.

Low-level laser irradiation alters cardiac cytokine expression

following acute myocardial infarction: a potential

mechanism for laser therapy. Photomed Laser Surg.

;29:391–8.

Yaakobi T, Shoshany Y, Levkovitz S, Rubin O, Ben

Haim SA, Oron U. Long-term effect of low energy laser

irradiation on infarction and reperfusion injury in the rat

heart. J Appl Physiol. 2001;90:2411–9.

Tuby H, Maltz L, Oron U. Modulations of VEGF and iNOS

in the rat heart by low level laser therapy are associated

with cardioprotection and enhanced angiogenesis. Laser

Surg Med. 2006;38:682–8.

Tuby H, Maltz L, Oron U. Induction of autologous mesenchymal

stem cells in the bone marrow by low-level laser

therapy has profound beneficial effects on the infarcted

rat heart. Laser Surg Med. 2011;43:401–9.

Ad N, Oron U. Impact of low level laser irradiation on

infarct size in the rat following myocardial infarction. Int

J Cardiol. 2001;80:109–16.

Lohr NL, Keszler A, Pratt P, Bienengraber M, Warltier

DC, Hogg N. Enhancement of nitric oxide release from

nitrosyl hemoglobin and nitrosyl myoglobin by red/near

infrared radiation: potential role in cardioprotection.

J Mol Cell Cardiol. 2009;47:256–63.

Manchini MT, Serra AJ, Feliciano Rdos S, Santana ET,

Antônio EL, de Tarso Camillo de Carvalho P, et al.

Amelioration of cardiac function and activation of anti-

inflammatory vasoactive peptides expression in the

rat myocardium by low level laser therapy. PloS One

;9:e101270.

Carlos FP, Gradinetti V, Manchini M, de Tarso Camillo

de Carvalho P, Silva JA Jr, Girardi ACC, et al. Role of

low-level laser therapy on the cardiac remodeling after

myocardial infarction: A systematic review of experimental

studies. Life Sci. 2016;151:109-14.

Mirsky N, Krispel Y, Shoshany Y, Maltz L, Oron U. Promotion

of angiogenesis by low energy laser irradiation.

Antioxid Redox Signal. 2002;4(5):785-90.

Oron U. Photoengineering of tissue repair in skeletal and

cardiac muscles. Photomed Laser Surg. 2006;24(2):111-20.

Blatt A, Elbaz-Greener GA, Tuby H, Maltz L, Siman-Tov Y,

Ben-Aharon G, et al. Low-Level Laser Therapy to the Bone Marrow Reduces Scarring and Improves Heart Function

Post-Acute Myocardial Infarction in the Pig. Photomed

Laser Surg. 2016;34(11):516-24.

Derkacz A, Protasiewicz M, Poreba R, Szuba A, Andrzejak

R. Usefulness of intravascular low power laser

illumination in preventing restenosis after percutaneous

coronary intervention. Am J Cardiol. 2010;106:1113–7.

De Scheerder IK, Wang K, Nikolaychik V, Kaul U, Singh B,

Sahota H, et al. Long-term follow-up after coronary stenting

and intravascular red laser therapy. Am. J. Cardiol.

;86:927–30.

De Scheerder IK, Wang K, Kaul U, Singh B, Sahota H,

Keelan MH, et al. Intravascular low-power laser irradiation

after coronary stenting: Long-term follow-up. Laser

Surg Med. 2001;28:212–5.

Salem M, Rotevatn S, Nordrehaug JE. Long-term results

following percutaneous myocardial laser therapy. Coron

Artery Dis. 2006;17:385–90.

Lima AC, Fernandes GA, de Barros Araújo R, Gonzaga IC,

de Oliveira RA, Nicolau RA. Photobiomodulation (laser

and LED) on sternotomy healing in hyperglycemic and

normoglycemic patients who underwent coronary bypass

surgery with internal mammary artery grafts: A randomized,

double-blind study with follow-up. Photomed Laser

Surg. 2017;35(1):24-31.

Karu T. Mitochondrial signaling in mammalian cells

activated by red and near-IR radiation. Photochem Photobiol.

;28:1091–9.

Hüttemann M, Helling S, Sanderson TH, Sinkler C,

Samavati L, Mahapatra G, et al. Regulation of mitochondrial

respiration and apoptosis through cell signaling:

cytochrome c oxidase and cytochrome c in ischemia/

reperfusion injury and inflammation. Biochim Biophys

Acta. 2012;1817(14):598–609.

Heusch G. Molecular basis of cardioprotection signal

transduction in ischemic pre-, post-, and remote conditioning.

Circ Res. 2015;116:674–99.

Hu Y, Zhang H, Lu Y, Bai H, Xu Y, Zhu X, et al. Class A

scavenger receptor attenuates myocardial infarction-induced

cardiomyocyte necrosis through suppressing

M1macrophage subset polarization. Basic Res Cardiol.

;106:1311–28.

Gao X, Xing D. Molecular mechanisms of cell proliferation

induced by low power laser irradiation. J Biomed

Sci. 2009;16:4.

Zhang H, Xing D, Wu S, Sun X. Protein kinase C δ promotes

cell apoptosis induced by high fluence low-power

laserirradiation. Proc. SPIE 7519, Eighth International

Conference on Photonics and Imaging in Biology and

Medicine (PIBM 2009), 751919.

Hsieh YL, Chou LW, Chang PL, Yang CC, Kao MJ,

Hong CZ. Low-level laser therapy alleviates neuropathic

pain and promotes function recovery in rats with

chronic constriction injury: Possible involvements in

hypoxia-inducible factor 1α (HIF-1α ). J Comp Neurol.

;520:2903–16.

Zyciński P, Krzemińska-Pakuła M, Peszyński-Drews C,

Kierus A, Trzos E, Rechciński T, Figiel L, Kurpesa M,

Plewka M, Chrzanowski L, Drozdz J. Laser biostimulation

in end-stage multivessel coronary artery disease-a preliminary

observational study. Kardiol Pol. 2007;65(1):13-

; discussion 22-3.

Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron

DJ, Kostuk WJ, et al. Optimal medical therapy with

or without PCI for stable coronary disease. N Engl J Med.

;356(15):1503–16.

Katritsis DG, Ioannidis JP. Percutaneous coronary

intervention versus conservative therapy in non-acute

coronary artery disease: a meta-analysis. Circulation

;111(22):2906–12.

Kaul U, Singh B, Sudan D, Ghose T, Kipshidze N. Intravascular

red light therapy after coronary stenting—angiographic

and clinical follow-up study in humans. J Invas

Cardiol. 1998;10:534–8.

Derkacz A, Protasiewicz M, Poręba R, Doroszko A, Andrzejak

R. Effect of the intravascular low energy laser

illumination during percutaneous coronary intervention

on the inflammatory process in vascular wall. Lasers Med

Sci. 2013;28(3):763-8.

Derkacz A, Protasiewicz M, Rola P, Podgorska K,

Szymczyszyn A, Gutherc R, et. al. Effects of intravascular

low-level laser therapy during coronary intervention

on selected growth factors levels. Photomed Laser Surg.

;32(10):582-7.

Derkacz A, Szymczyszyn A, Szahidewicz-Krupska E,

Protasiewicz M, Poręba R, Doroszko A. Effect of endovascular

coronary low-level laser therapy during angioplasty

on the release of endothelin-1 and nitric oxide. Adv Clin

Exp Med. 2017;26(4):595-9.

Fernandes GA, Araújo Júnior RB, Lima AC, Gonzaga

IC, de Oliveira RA, Nicolau RA. Low-intensity Laser

(660 nm) has Analgesic Effects on Sternotomy of Patients

Who Underwent Coronary Artery Bypass Grafts. Ann

Card Anaesth. 2017; 20(1): 52–6.

Lima AC, Fernandes GA, Gonzaga IC, de Barros Araújo

R, de Oliveira RA, Nicolau RA. Low-level laser and

light-emitting diode therapy for pain control in hyperglycemic

and normoglycemic patients who underwent

coronary bypass surgery with internal mammary artery

grafts: A randomized, double-blind study with follow-up.

Photomed Laser Surg. 2016;34:244–51.

Huang AP, Sakata RK. Pain after sternotomy – Review.

Rev Bras Anestesiol. 2016;66:395–401.

Aras MH, Omezli MM, Güngörmüs M. Does low-level

laser therapy have an antianesthetic effect? A review.

Photomed Laser Surg. 2010;28:719–22.

de Oliveira RA, Fernandes GA, Lima AC, Tajra Filho AD,

de Barros Araújo R Jr, Nicolau RA. The effects of LED

emissions on sternotomy incision repair after myocardial

revascularization: A randomized double-blind study with

follow-up. Lasers Med Sci. 2014;29:1195–202.

Pinto NC, Pereira MH, Stolf NA, Chavantes MC. Low

level laser therapy in acute dehiscence saphenectomy:

therapeutic proposal. Rev Bras Cir Cardiovasc.

;24(1):88-91.

Pinto NC, Pereira MH, Tomimura S, de Magalhães AC,

Pomerantzeff PM, Chavantes MC. Low-level laser therapy

prevents prodromal signal complications on saphenectomy

post myocardial revascularization. Photomed Laser

Surg. 2014;32(6):330-5.

de Barros Araújo Júnior R, Gonzaga ICA, Fernandes GA,

Lima ACG, Cortelazzi PST, de Oliveira RA, et al. Low-intensity

LED therapy (λ 640 ± 20 nm) on saphenectomy

healing in patients who underwent coronary artery bypass

graft: a randomized, double-blind study. Lasers Med Sci.

;33(1):103-9.

Kovlen DV, Ponomarenko GN. [Physical therapy and

rehabilitation of patients with coronary heart disease: scientometric analysis of evidence-based studies]. Fizioterapiya,

bal’neologiya i reabilitaciya [Physiotherapy, balneology

and rehabilitation]. 2015;14(2):11-16. (in Russian)

Kovlen DV, Ponomarenko GN. [Physical therapy of hypertension:

scientometric analysis of evidence-based studies].

Fizioterapiya, bal’neologiya i reabilitaciya [Physiotherapy,

balneology and rehabilitation]. 2017;16(3):121-7.

doi: http://dx.doi.org/10.18821/1681-3456-2017-16-

-121-127

Agov BS, Devyatkov ND, Zhuk LE. [The use of laser radiation

in coronary heart disease]. Klinicheskaya medicina

[Clinical medicine]. 1982;5:65-7. (in Russian)

Kulikov VYu, Kim LB, Azbel’ DI, Dzyuba MT. [The antioxidant

effect of laser therapy in patients with coronary

heart disease and post-infarction cardiosclerosis]. Byull.

SO AMN SSSR [Bull. SB AMS USSR]. 1987;6:121-3.

(in Russian)

Belyaev AA, Ragimov SE, Afanas’eva LS. [The use of

lasers in cardiovascular diseases: the beginning of a long

journey]. Terapevticheskij arhiv [Therapeutic Archive].

;5:139-46. (in Russian)

Vasil’ev AP, Strel’cova NN, Kiyanyuk NS. [Stress-limiting

effect of low-intensity laser radiation in patients with

coronary heart disease]. Voprosy kurortologii, fizioterapii

i lechebnoj fizicheskoj kul’tury [Questions of balneology,

physiotherapy]. 1997;6:3-5. (in Russian)

Vladimirov, YuA. Tri gipotezy o mekhanizme dejstviya

krasnogo (lazernogo) sveta. Efferentnaya medicina

[Three hypotheses about the mechanism of action of red

(laser) light. Efferent medicine]. Moscow: NII fiz.-him.

mediciny Publ.; 1994:23-35. (in Russian)

Gamaleya NF. Aktual’nye voprosy mekhanizma biologicheskogo

dejstviya izlucheniya lazerov. Primenenie

metodov i sredstv lazernoj tekhniki v biologi i medicine

[Actual questions of the mechanism of the biological effect

of laser radiation. Application of methods and means

of laser technology in biology and medicine]. Kiev; 1981.

P. 128-34. (in Russian)

Illarionov VE. Osnovy lazernoj terapii [The basics of laser

therapy]. Moscow: Respekt Publ.; 1992. p. 123. (in Russian)

Kipshidze NN. Chapidze GE, Korochkin IM. Lechenie

ishemicheskoj bolezni serdca gelij-neonovym lazerom

[Treatment of coronary heart disease with a helium-neon

laser]. Tbilisi: Amirani Publ.; 1993. 192 p. (in Russian)

Meshalkin EN, Sergievskij VS. Rezul’taty i perspektivy

primeneniya gelij-neonovyh lazerov v kardiohirurgii.

Primenenie pryamogo lazernogo oblucheniya v eksperimental’noj

i klinicheskoj kardiohirurgii [Results and

prospects for the use of helium-neon lasers in cardiac surgery.

The use of direct laser irradiation in experimental

and clinical cardiac surgery]. Novosibirsk; 1981. P. 6-28.

(in Russian)

Mihno LE, Krivoruchenko AI. [Laser therapy for coronary

heart disease]. Med. reabilitaciya, kurortologiya, fizioterapiya

[Med. rehabilitation, balneology, physiotherapy].

;2:55-61. (in Russian)

Sorokina EI, Kenevich NA. [On the comparative effect

of laser radiation of various ranges on patients with

coronary heart disease]. Vopr. kurort., fizioter. i LFK

[Q. resort., fizioter. and exercise therapy]. 1997;4:11-3.

(in Russian)

Shuvalova IN. [The effect of repeated laser therapy courses

on blood pressure and exercise tolerance in patients

with essential hypertension in combination with coronary

heart disease]. Ukr. kardіol. zhurn. [Ukr. cardіol. journal].

;12:69-71. (in Russian)

Опубліковано
2020-01-14
Як цитувати
Васильева-Линецкая, Л. (2020). Низькоінтенсивна лазерна терапія в реабілітації хворих на ішемічну хворобу серця: огляд доказових досліджень. Фотобіологія та фотомедицина, (28), 39-53. https://doi.org/10.26565/2076-0612-2019-28-05
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