{"id":402,"date":"2022-12-27T23:40:20","date_gmt":"2022-12-27T22:40:20","guid":{"rendered":"https:\/\/antikoncepcia.org\/?p=402"},"modified":"2022-12-28T19:27:18","modified_gmt":"2022-12-28T18:27:18","slug":"nudzova-antikoncepcia-zdravotne-a-moralne-aspekty","status":"publish","type":"post","link":"https:\/\/antikoncepcia.org\/?p=402","title":{"rendered":"N\u00fadzov\u00e1 antikoncepcia, zdravotn\u00e9 a mor\u00e1lne aspekty"},"content":{"rendered":"

N\u00fadzov\u00e1 antikoncepcia alebo hovorovo \u201etabletka po\u201c sa zvykne prezentova\u0165 ako druh antikoncepcie ktor\u00fd zabra\u0148uje tehotenstvu blokovan\u00edm, alebo oddialen\u00edm ovul\u00e1cie.[i]<\/a> Existuj\u00fa v\u0161ak d\u00f4kazy, \u017ee n\u00fadzov\u00e1 antikoncepcia m\u00e1 aj potratov\u00fd \u00fa\u010dinok \u2212 br\u00e1ni uhniezdeniu embrya v\u00a0maternici (anti-implanta\u010dn\u00fd \u00fa\u010dinok), \u010do vedie n\u00e1sledne k\u00a0jeho uhynutiu.[ii]<\/a> [iii]<\/a> [iv]<\/a> [v]<\/a> Ulipristal acet\u00e1t a\u00a0levonorgestrel (syntetick\u00e9 horm\u00f3ny pou\u017e\u00edvan\u00e9 v\u00a0n\u00fadzovej antikoncepcii)<\/strong> zni\u017euj\u00fa frekvenciu cili\u00e1rneho rytmu vo vajcovodoch, \u010do spoma\u013euje putovanie embrya do maternice.[vi]<\/a> [vii]<\/a> [viii]<\/a> V\u00fdsledkom m\u00f4\u017ee by\u0165, \u017ee embryo doputuje do maternice mimo obdobia tzv. implanta\u010dn\u00e9ho okna (\u010dasov\u00fd \u00fasek v lute\u00e1lnej f\u00e1ze men\u0161trua\u010dn\u00e9ho cyklu, po\u010das ktor\u00e9ho je mo\u017en\u00e9 uhniezdenie embrya), nedok\u00e1\u017ee sa uhniezdi\u0165 a\u00a0odumiera. V\u00a0\u0161t\u00fadii, ktor\u00fa vykonali Lira-Albarr\u00e1n a\u00a0kol.<\/em> (2017), \u017eeny, ktor\u00fdm bola podan\u00e1 n\u00fadzov\u00e1 antikoncepcia obsahuj\u00faca ulipristal acet\u00e1t v\u00a0najplodnej\u0161\u00edch, pred-ovula\u010dn\u00fdch d\u0148och, mali norm\u00e1lnu ovul\u00e1ciu, ale ich endometrium (sliznica maternice) bolo nevn\u00edmav\u00e9 vo\u010di embryu. D\u00f4le\u017eit\u00fdm zisten\u00edm v tejto \u0161t\u00fadii, ktor\u00e9 potvrdilo schopnos\u0165 ulipristal acet\u00e1tu zabr\u00e1ni\u0165 tehotenstvu zmenami vo funkci\u00e1ch sliznice maternice, bola skuto\u010dnos\u0165, \u017ee expresia PAEP<\/em> g\u00e9nu (Progestogen Associated Endometrial Protein), ktor\u00fd je k\u013e\u00fa\u010dov\u00fd v procese uchytenia trofoblastu k endometriu, bola zn\u00ed\u017een\u00e1 najviac zo v\u0161etk\u00fdch g\u00e9nov. Uliprist\u00e1l acet\u00e1t taktie\u017e v\u00fdznamne zn\u00ed\u017ei expresiu g\u00e9nov zodpovedn\u00fdch za metabolizmus mastn\u00fdch kysel\u00edn, ktor\u00e9 s\u00fa nevyhnutn\u00e9 pre uhniezdenie embrya, preto\u017ee poskytuj\u00fa zdroj energie pre morfologick\u00e9 a\u00a0funk\u010dn\u00e9 zmeny\/decidualiz\u00e1ciu sliznice maternice. Negat\u00edvne ovplyvnen\u00e1 bola aj expresia g\u00e9nov riadiacich imunitn\u00e9 a z\u00e1palov\u00e9 reakcie a\u00a0taktie\u017e cytok\u00ednov. V\u0161etky tieto faktory s\u00fa nevyhnutn\u00e9 pre vn\u00edmavos\u0165 endometria a\u00a0uhniezdenie embrya. Zistenia tejto \u0161t\u00fadie uk\u00e1zali, \u017ee zmeny v\u00a0expresii g\u00e9nov v\u00a0sliznici maternice, ktor\u00e9 boli vystaven\u00e9 \u00fa\u010dinkom ulipristal acet\u00e1tu, sp\u00f4sobuj\u00fa nevn\u00edmavos\u0165 sliznice maternice vo\u010di embryu<\/strong>.[ix]<\/a><\/p>\n

Ak n\u00fadzov\u00e1 antikoncepcia nezabr\u00e1ni uhniezdeniu embrya a\u00a0nastane nechcen\u00e9 tehotenstvo, \u017eeny sa ho \u010dasto rozhodn\u00fa definit\u00edvne ukon\u010di\u0165 umel\u00fdm potratom<\/strong> (Levy a\u00a0kol., 2014<\/em>[x]<\/a>, Glasier <\/em><\/a>a kol., 2010<\/em>[xi]<\/a>). Napr\u00edklad vo \u0160v\u00e9dsku, zv\u00fd\u0161en\u00e1 dostupnos\u0165 n\u00fadzovej antikoncepcie (predaj bez receptu) viedla k zv\u00fd\u0161eniu po\u010dtu interrupci\u00ed.[xii]<\/a> Podobne vo Ve\u013ekej Brit\u00e1nii bola n\u00fadzov\u00e1 antikoncepcia obsahuj\u00faca levonorgestrel vo\u013ene dostupn\u00e1 od roku 2001, av\u0161ak miera umel\u00fdch potratov sa na\u010falej zvy\u0161ovala a\u017e do roku 2008.[xiii]<\/a><\/p>\n

V\u00a0s\u00favislosti s\u00a0umel\u00fdm potratom je d\u00f4le\u017eit\u00e9 zd\u00f4razni\u0165, \u017ee sp\u00f4sobuje nielen usmrtenie \u013eudsk\u00e9ho plodu, ale po\u0161kodzuje zdravie matiek a\u00a0ich det\u00ed v\u00a0nasleduj\u00facom tehotenstve.<\/strong> Ned\u00e1vna meta-anal\u00fdza 25 \u0161t\u00fadi\u00ed (Deng a\u00a0kol., 2018<\/em>) preuk\u00e1zala, \u017ee umel\u00fd potrat v\u00fdznamne zv\u00fd\u0161il riziko rakoviny prsn\u00edka<\/strong> (P<\/em>=0.01).[xiv]<\/a> V\u00a0\u0161t\u00fadii, ktor\u00fa vykonali Carl\u00e9 a\u00a0kol.<\/em> (2019), dva a\u00a0viac umel\u00fdch potratov s\u00faviselo s\u00a0v\u00fdznamne zv\u00fd\u0161en\u00fdm rizikom Gravesovej hypertyre\u00f3zy<\/strong> (P<\/em><0.05).[xv]<\/a> Na ned\u00e1vnej konferencii Alzheimer’s Association International Conference<\/em> (AAIC) 2018 v Chicagu, v\u00fdskumn\u00edci predlo\u017eili zistenie, \u017ee ka\u017ed\u00fd umel\u00fd potrat zv\u00fd\u0161il riziko demencie<\/strong> o 8 % (HR 1.08, 95%Cl: 1.05\u22121.12) a \u017eeny s 3 a viac potratmi mali riziko demencie zv\u00fd\u0161en\u00e9 a\u017e o 47% v porovnan\u00ed so \u017eenami, ktor\u00e9 potrat nemali (HR=1.47, 95%Cl: 1.27-1.71).[xvi]<\/a> Ou a\u00a0kol.<\/em> (2002) pozorovali o\u00a020% (OR 1.2, 95%CI: 1.0-1.4) zv\u00fd\u0161en\u00e9 riziko ak\u00fatnej lymfoblastickej leuk\u00e9mie,<\/strong> ke\u010f umel\u00fd potrat bol vykonan\u00fd \u017een\u00e1m, ktor\u00e9 e\u0161te nerodili.[xvii]<\/a> Zn\u00e1me s\u00fa psychick\u00e9 probl\u00e9my<\/strong> u\u00a0\u017eien, ktor\u00e9 podst\u00fapili umel\u00fd potrat, a\u00a0to najm\u00e4 v\u00a0mlad\u0161om veku.[xviii]<\/a> [xix]<\/a> [xx]<\/a> V\u00fdsledky\u00a0meta-anal\u00fdzy, ktor\u00e1 zah\u0155\u0148ala 22 \u0161t\u00fadi\u00ed (Coleman a\u00a0kol., 2011<\/em>), uk\u00e1zali, \u017ee \u017eeny, ktor\u00e9 podst\u00fapili umel\u00fd potrat, mali o 81% vy\u0161\u0161ie riziko r\u00f4znych foriem psychick\u00fdch zdravotn\u00fdch probl\u00e9mov v porovnan\u00ed so \u017eenami, ktor\u00e9 ho nepodst\u00fapili (OR 1.81, 95%CI: 1.57\u20132.09, P<\/em><0.0001). Umel\u00fd potrat v\u00fdznamne s\u00favisel s u\u017e\u00edvan\u00edm marihuany (OR 3.30, 95%CI: 1.64\u20137.44, P<\/em>=0.001), samovra\u017eedn\u00fdm spr\u00e1van\u00edm (OR 2.55, 95%CI: 1.31\u20134.96, P<\/em>=0.006) a\u00a0konzum\u00e1ciou alkoholu (OR 2.10, 95%CI: 1.77\u20132.49, P<\/em><0.0001) v\u00a0\u010fal\u0161om obdob\u00ed \u017eivota \u017eien.[xxi]<\/a><\/p>\n

Umel\u00e9 potraty m\u00f4\u017eu negat\u00edvne ovplyvni\u0165 aj zdravie n\u00e1sledne po\u010dat\u00fdch potomkov<\/strong>. V\u00fdsledky ESTELLE \u0161t\u00fadie<\/em> (2014) preuk\u00e1zali v\u00fdznamne zv\u00fd\u0161en\u00e9 riziko ak\u00fatnej<\/strong> lymfoblastickej leuk\u00e9mie<\/strong> (OR 1.4, 95%Cl: 1.1\u22121.8) u\u00a0det\u00ed, ktor\u00fdch matky v\u00a0minulosti podst\u00fapili umel\u00fd potrat.[xxii]<\/a> V\u00a0meta-anal\u00fdze, ktor\u00fa vykonali Zou a\u00a0kol.<\/em> (2014), deti matiek, ktor\u00e9 v\u00a0minulosti podst\u00fapili umel\u00fd potrat, mali v\u00fdznamne zv\u00fd\u0161en\u00e9 riziko v\u00fdvinu detskej ak\u00fatnej leuk\u00e9mie (OR 1.23, 95%CI: 1.07\u22121.43).[xxiii]<\/a> A\u00a0nakoniec v\u00a0ned\u00e1vnej meta-anal\u00fdze (Karalexi a\u00a0kol., 2017<\/em>), strata plodu (spont\u00e1nny potrat, narodenie m\u0155tveho die\u0165a\u0165a, umel\u00fd potrat a\u00a0mol\u00e1rne tehotenstvo) s\u00favisela so zv\u00fd\u0161en\u00edm rizikom detsk\u00fdch ak\u00fatnych leuk\u00e9mi\u00ed (OR 1.10, 95%CI: 1.04\u20131.18) u\u00a0n\u00e1sledn\u00fdch potomkov. Pozit\u00edvna s\u00favislos\u0165 bola zisten\u00e1 jednak pre ak\u00fatnu lymfoblastick\u00fa (OR 1.12, 95%CI: 1.05\u20131.19) ako aj pre ak\u00fatnu myeloidn\u00fa leuk\u00e9miu (OR 1.54, 95%CI: 1.23\u22121.92).[xxiv]<\/a> Viacer\u00e9 \u0161t\u00fadie pozorovali zv\u00fd\u0161en\u00e9 riziko vroden\u00fdch v\u00fdvinov\u00fdch ch\u00fdb <\/strong>u potomkov\u00a0\u017eien, ktor\u00e9 v\u00a0minulosti podst\u00fapili umel\u00fd potrat.[xxv]<\/a> [xxvi]<\/a> [xxvii]<\/a> Desta a kol.<\/em> (2019) zistili, \u017ee predch\u00e1dzaj\u00faci umel\u00fd potrat v\u00fdznamne s\u00favisel s n\u00edzkou p\u00f4rodnou hmotnos\u0165ou<\/strong> novorodencov v\u00a0nasleduj\u00facom tehotenstve (P<\/em><0.05), ktor\u00e1 s\u00favisela s n\u00edzkym Apgar sk\u00f3re (RR 2.29, 95%Cl: 1.88\u22125.96, P<\/em><0.05) a\u00a0tie\u017e so skorou novorodeneckou \u00famrtnos\u0165ou<\/strong> (RR 3.02, 95%Cl: 1.63\u22126.26, P<\/em><0.05).[xxviii]<\/a> V EUROPOP \u0161t\u00fadii<\/em> vykonanej v 10 krajin\u00e1ch Eur\u00f3py predch\u00e1dzaj\u00face umel\u00e9 potraty v\u00fdznamne s\u00faviseli s pred\u010dasn\u00fdm p\u00f4rodom<\/strong>, a\u00a0toto riziko r\u00e1stlo s po\u010dtom interrupci\u00ed.[xxix]<\/a><\/p>\n

V\u00a0 celon\u00e1rodnej d\u00e1nskej \u0161t\u00fadii (Hemmingsen a\u00a0kol., 2020<\/em>), mali deti, ktor\u00fdch matky pou\u017eili n\u00fadzov\u00fa hormon\u00e1lnu antikoncepciu viac ako 3 mesiace pred za\u010diatkom tehotenstva, o\u00a044% zv\u00fd\u0161en\u00e9 riziko detskej poruchy pozornosti a\u00a0hyperaktivity<\/strong> (HR 1.44, 95%Cl: 1.35\u20131.53) a\u00a0deti, ktor\u00fdch matky naposledy u\u017eili n\u00fadzov\u00fa antikoncepciu menej ako 3 mesiace pred za\u010diatkom tehotenstva, mali toto riziko zv\u00fd\u0161en\u00e9 a\u017e o\u00a060% (HR 1.60, 95%Cl: 1.23\u20132.09).[xxx]<\/a><\/p>\n

Pou\u017e\u00edvanie n\u00fadzovej antikoncepcie sp\u00f4sobuje \u017een\u00e1m viacer\u00e9 ne\u017eiaduce \u00fa\u010dinky<\/strong>. V anal\u00fdze zah\u0155\u0148aj\u00facej 47 \u0161t\u00fadi\u00ed a\u00a0\u00fadaje z US FDA Syst\u00e9mu hl\u00e1senia ne\u017eiaducich udalost\u00ed (FAERS), pou\u017eitie n\u00fadzovej antikoncepcie obsahuj\u00facej levonorgestrel sp\u00f4sobilo najm\u00e4 zmeny men\u0161trua\u010dn\u00e9ho toku (46.8%), krv\u00e1canie (31.0%), slab\u00e9 cyklick\u00e9 krv\u00e1canie (26.2%), medzimen\u0161trua\u010dn\u00e9 \u0161pinenie (23,5%) a skor\u00fa men\u0161tru\u00e1ciu (18.5%)<\/strong>. Naj\u010dastej\u0161ie uv\u00e1dzan\u00fdm gynekologick\u00fdm probl\u00e9mami boli bolesti prsn\u00edkov<\/strong> (8.3%). Neurologick\u00e9 ne\u017eiaduce \u00fa\u010dinky zah\u0155\u0148ali najm\u00e4 bolesti hlavy (12.4%) a z\u00e1vraty (10,8%).<\/strong> Tr\u00e1viace probl\u00e9my zah\u0155\u0148ali nevo\u013enos\u0165 (15.0%), vracanie (8.5%), boles\u0165 v dolnej \u010dasti brucha (11.4%) a hna\u010dku (4.4%). <\/strong>Z\u00e1va\u017ene ne\u017eiaduce \u00fa\u010dinky hl\u00e1sen\u00e9 v datab\u00e1ze FAERS zah\u0155\u0148ali: jednostrann\u00fa <\/strong>slepotu<\/strong> (tromb\u00f3za sietnicov\u00fdch \u017e\u00edl), p\u013e\u00facnu emb\u00f3liu, tromb\u00f3zu,<\/strong> n\u00e1dor p\u013e\u00fac, rakovinu kr\u010dka maternice,<\/strong> \u00fazkos\u0165, halucin\u00e1cie, samovra\u017eedn\u00e9 my\u0161lienky,<\/strong> r<\/strong>upt\u00faru ovari\u00e1lnej cysty, poruchy vaje\u010dn\u00edkov,<\/strong> bru\u0161n\u00fa herniu, z\u00e1pal slep\u00e9ho \u010dreva,<\/strong> anafylaktick\u00fa reakciu, \u017eih\u013eavku, syst\u00e9mov\u00fd lupus erythematodes,<\/strong> infekciu mo\u010dov\u00fdch ciest, bakteri\u00e1lnu vulvovaginit\u00eddu, pneum\u00f3niu, perikardit\u00eddu, muskuloskelet\u00e1lnu stuhnutos\u0165, boles\u0165<\/strong> (Leelakanok a\u00a0kol., 2020<\/em>[xxxi]<\/a>).<\/p>\n

V anal\u00fdze vykonanej In\u0161tit\u00fatom pre bezpe\u010dn\u00e9 lie\u010debn\u00e9 praktiky<\/em> (Institute for Safe Medication Practices, QuarterWatch, 2018<\/em>), ktor\u00e1 pou\u017eila \u00fadaje z FDA Adverse Event Reporting System, bolo v\u00a0priebehu 2 rokov (2015-2017) zaznamenan\u00fdch 7\u00a0568 ne\u017eiaducich \u00fa\u010dinkov s\u00favisiacich s\u00a0pou\u017eit\u00edm n\u00fadzovej antikoncepcie, z\u00a0ktor\u00fdch 595 bolo z\u00e1va\u017en\u00fdch<\/strong> (smr\u0165, \u017eivot ohrozuj\u00face ne\u017eiaduce \u00fa\u010dinky lieku, hospitaliz\u00e1cia v nemocnici alebo pred\u013a\u017eenie existuj\u00facej hospitaliz\u00e1cie, pretrv\u00e1vaj\u00face alebo z\u00e1va\u017en\u00e9 postihnutie\/neschopnos\u0165). Naj\u010dastej\u0161\u00edm ne\u017eiaducim \u00fa\u010dinkom bolo vagin\u00e1lne krv\u00e1canie (2623 \u017eien, 34,7%), psychick\u00e9 probl\u00e9my sa vyskytli u\u00a0206 \u017eien (2.7%<\/strong>), 5.4% \u017eien otehotnelo aj po pou\u017eit\u00ed n\u00fadzovej antikoncepcie.[xxxii]<\/a><\/p>\n

 <\/p>\n

 <\/p>\n

Odborn\u00e9 pramene<\/strong><\/em><\/p>\n

[i]<\/a> International Consortium for Emergency Contraception (ICEC), International Federation of Gynecology & Obstetrics (FIGO). Statement on Mechanism of Action (October 2008). <\/em>How do Levonorgestrel-only emergency contraceptive pills (LNG ECPs) work to prevent pregnancy? http:\/\/www.thaidrugwatch.org\/blog\/wp-content\/uploads\/2013\/12\/ICEC2008Oct-HowDoECPspreventpregnancy.pdf. Accessed 31 March 2021.<\/p>\n

[ii]<\/a> Peck R, Rella W, Tudela J, et al. Does levonorgestrel emergency contraceptive have a post-fertilization effect? A review of its mechanism of action. Linacre Q. 2016;83(1):35\u201351.<\/p>\n

[iii]<\/a> Stratton P, Levens ED, Hartog B, et al. Endometrial effects of a single early luteal dose of the selective progesterone receptor modulator CDB-2914. Fertility and Sterility. 2010;93(6):2035\u20132041.<\/p>\n

[iv]<\/a> Williams AR<\/a>, Bergeron C<\/a>, Barlow DH<\/a>, et al. Endometrial morphology after treatment of uterine fibroids with the selective progesterone receptor modulator, ulipristal acetate. International Journal of Gynecological Pathology : Official Journal of the International Society of Gynecological Pathologists. 2012 Nov;31(6):556-69<\/p>\n

[v]<\/a> Kahlenborn C<\/a>, Peck R<\/a>, Severs WB<\/a>. Mechanism of action of levonorgestrel emergency contraception. Linacre Q.<\/a> 2015 Feb;82(1):18-33.<\/p>\n

[vi]<\/a> Li HW<\/a>, Liao SB<\/a>, Yeung WS<\/a>, et al. Ulipristal acetate resembles mifepristone in modulating human fallopian tube function. Human Reproduction. 2014 Oct 10;29(10):2156-62.<\/p>\n

[vii]<\/a> Yuan J<\/a>, Zhao W<\/a>, Yan M<\/a>, et al.\u00a0 Ulipristal Acetate Antagonizes the Inhibitory Effect of Progesterone on Ciliary Beat Frequency and Upregulates Steroid Receptor Expression Levels in Human Fallopian Tubes. Reproductive Sciences. 2015 Dec;22(12):1516-23.<\/p>\n

[viii]<\/a> Li C, Wu YT, Zhu Q, et al. TRPV4 is involved in levonorgestrel-induced reduction in oviduct ciliary beating. The Journal of Pathology. 2019;248(1):77\u201387.<\/p>\n

[ix]<\/a> Lira-Albarr\u00e1n S<\/a>, Durand M<\/a>, Larrea-Schiavon MF<\/a>, et al. Ulipristal acetate administration at mid-cycle changes gene expression profiling of endometrial biopsies taken during the receptive period of the human menstrual cycle. Molecular and Cellular Endocrinology. 2017 May 15;447:1-11.<\/p>\n

[x]<\/a> Levy DP<\/a>, Jager M<\/a>, Kapp N<\/a>,\u00a0 et al. Ulipristal acetate for emergency contraception: postmarketing experience after use by more than 1 million women. Contraception.<\/a> 2014 May;89(5):431-3.<\/p>\n

[xi]<\/a> Glasier AF<\/a>, Cameron ST<\/a>, Fine PM<\/a>, et al. Ulipristal acetate versus levonorgestrel for emergency contraception: a randomised non-inferiority trial and meta-analysis. Lancet.<\/a> 2010 Feb 13;375(9714):555-62.<\/p>\n

[xii]<\/a>Tyd\u00e9n T, Aneblom G, von Essen L, et al. Trots l\u00e4ttillg\u00e4ngliga akut-p-piller sjunker inte antalet aborter. Studier av kvinnors kunskaper, attityder och erfarenheter av metoden [No reduced number of abortions despite easily available emergency contraceptive pills. Studies of women’s knowledge, attitudes and experience of the method]. Lakartidningen. 2002 Nov 21;99(47):4730-2, 4735. Swedish.<\/p>\n

[xiii]<\/a> Department of Health. Abortion statistics, England and Wales. 2017. https:\/\/www.gov.uk\/government\/ uploads\/system\/uploads\/attachment_data\/file\/319460\/Abortion_Statistics__England_and_Wales_2017.pdf. Accessed 30 April 2020.<\/p>\n

[xiv]<\/a> Deng Y, Xu H, Zeng X. Induced abortion and breast cancer: An updated meta-analysis. Medicine (Baltimore). 2018;97(3):e9613.<\/p>\n

[xv]<\/a> Carl\u00e9 A, Knudsen N, J\u00f8rgensen T, et al. Previous Live Births and Induced Abortions May Precede Later Development of Graves‘ Hyperthyroidism. European Thyroid Journal. 2019;8(2):70\u201378.<\/p>\n

[xvi]<\/a> Alzheimer’s Association. Pregnancy and reproductive history may impact dementia risk, study suggests: Plus, the move to re-think the impact of hormone therapy on cognition. https:\/\/www.alz.org\/aaic\/downloads2018\/Mon-am-briefing-women-dementia-risk.pdf. Accessed 31 Jan 2021.<\/p>\n

[xvii]<\/a> Ou SX<\/a>, Han D<\/a>, Severson RK<\/a>,\u00a0 et al. Birth characteristics, maternal reproductive history, hormone use during pregnancy, and risk of childhood acute lymphocytic leukemia by immunophenotype (United States). Cancer Causes Control.<\/a> 2002 Feb;13(1):15-25.<\/p>\n

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