Tehran University Medical Journal (TUMJ), Vol.70, No.2, May 2012 by TUMJ TUMJ

‫داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‬ ‫دوره ‪70‬‬

‫ﺷﻤﺎره ‪2‬‬

‫اردﻳﺒﻬﺸﺖ ‪1391‬‬

‫ﺻﺎﺣﺐ اﻣﺘﻴﺎز‪ :‬داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‬ ‫ﻣﺪﻳﺮ ﻣﺴﺆول‪ :‬دﻛﺘﺮ ﺳﻴﺪ ﺣﺴﻦ اﻣﺎﻣﻲرﺿﻮي‬ ‫ﺳﺮدﺑﻴﺮ‪ :‬دﻛﺘﺮ ﻧﺎدره ﺑﻬﺘﺎش‬ ‫ﻣﺪﻳﺮ اﺟﺮاﻳﻲ‪ :‬دﻛﺘﺮ ﻣﺤﻤﺪ ﻋﻠﻲ ﻧﻮﻳﺎن اﺷﺮف‬ ‫ﺷﻮراي دﺑﻴﺮان‬

‫دﻛﺘﺮ ﺷﺎﻫﻴﻦ آﺧﻮﻧﺪزاده‪ ،‬دﻛﺘﺮ ﺻﺪﻳﻘﻪ ﺑﺮﻧﺎ‪ ،‬دﻛﺘﺮ ﺟﻤﺸﻴﺪ ﺣﺎﺟﺘﻲ‪ ،‬دﻛﺘﺮ ﻋﻠﻴﺮﺿﺎ ﺧﻮﺷﻨﻮﻳﺴﺎن‪ ،‬دﻛﺘﺮ ﻧﻴﻤﺎ رﺿﺎﻳﻲ‪ ،‬دﻛﺘﺮ ﻧﮕﺎر ﺳﺠﺎدﻳﺎن‪،‬‬ ‫دﻛﺘﺮ ﻋﻠﻲ ﻋﺮبﺧﺮدﻣﻨﺪ‪ ،‬دﻛﺘﺮ ﻧﻌﻤﺖاﷲ ﻋﻄﺎﻳﻲ‪ ،‬دﻛﺘﺮ راﻣﺶ ﻋﻤﺮاﻧﻲﭘﻮر‪ ،‬دﻛﺘﺮ ﻣﺤﻤﻮد ﻗﺎﺿﻲ ﺧﻮاﻧﺴﺎري‪ ،‬دﻛﺘﺮ ﺳﻴﺪﺟﻮاد ﻗﺎﺿﻲ ﻣﻴﺮ ﺳﻌﻴﺪ‪،‬‬ ‫دﻛﺘﺮ ﻣﻬﺮي ﻛﺪﺧﺪاﻳﻲ‪ ،‬دﻛﺘﺮ ﺳﻴﻨﺎ ﻣﺮادﻣﻨﺪ‪ ،‬دﻛﺘﺮ زﻳﻨﺖ ﻧﺎدﻳﺎﺣﺘﻤﻲ‪ ،‬دﻛﺘﺮ ﻣﺤﻤﺪ ﻋﻠﻲ ﻧﻮﻳﺎن اﺷﺮف‬ ‫ﻫﻴﺄت ﺗﺤﺮﻳﺮﻳﻪ‬

‫دﻛﺘﺮ ﻧﺎﺻﺮ اﺑﺮاﻫﻴﻤﻲ درﻳﺎﻧﻲ‪ ،‬دﻛﺘﺮ ﻣﺤﻤﻮد اﻛﺒﺮﻳﺎن‪ ،‬دﻛﺘﺮ ﻓﺮﻧﺎز آﻣﻮزﮔﺎر ﻫﺎﺷﻤﻲ‪ ،‬دﻛﺘﺮ ﺑﺎﺑﻚ ﺑﻬﺎر‪ ،‬دﻛﺘﺮ ﭘﺮوﻳﻦ ﭘﺎﺳﺎﻻر‪ ،‬دﻛﺘﺮ ﭘﺮﻳﭽﻬﺮ ﭘﺎﺳﺒﺨﺶ‪،‬‬ ‫دﻛﺘﺮ زاﻫﺪ ﺣﺴﻴﻦ ﺧﺎن‪ ،‬دﻛﺘﺮ زﻫﺮا ﺣﻼﺟﻲ‪ ،‬دﻛﺘﺮ ﻓﺎﻃﻤﻪ داوري ﺗﻨﻬﺎ‪ ،‬دﻛﺘﺮ ﻣﻬﺮﻧﺎز رﺳﻮﻟﻲﻧﮋاد‪ ،‬دﻛﺘﺮ ﻣﺴﻌﻮد ﺳﺘﻮده‪ ،‬دﻛﺘﺮ ﻋﻠﻴﺮﺿﺎ ﺷﻌﺒﺎﻧﻲ‪،‬‬ ‫دﻛﺘﺮ اﺣﻤﺪرﺿﺎ ﻃﻼﺋﻲﭘﻮر‪ ،‬دﻛﺘﺮ ﻣﺤﻤﺪرﺿﺎ ﻇﻔﺮﻗﻨﺪي‪ ،‬دﻛﺘﺮ ﻣﺤﻤﺪ ﻛﺠﺒﺎفزاده‪ ،‬دﻛﺘﺮ ﺳﻴﺪ ﻣﺤﻤﺪﺟﻮاد ﻣﺮﺗﻀﻮي‪ ،‬دﻛﺘﺮ اﻋﻈﻢاﻟﺴﺎدات ﻣﻮﺳﻮي‪،‬‬ ‫دﻛﺘﺮ ﻣﺤﻤﺪﺟﻮاد ﻣﻴﻜﺎﺋﻴﻠﻲ‪ ،‬دﻛﺘﺮ ﺑﻬﺮوز ﻧﺒﺌﻲ‪ ،‬دﻛﺘﺮ ﻣﺮﺿﻴﻪ وﺣﻴﺪ دﺳﺘﺠﺮدي‪ ،‬دﻛﺘﺮ ﻣﺤﻤﺪرﺿﺎ ﻫﺎدﻳﺎن‬ ‫ﻫﻴﺄت ﺗﺤﺮﻳﺮﻳﻪ ﺑﻴﻦ اﻟﻤﻠﻠﻲ‬

‫دﻛﺘﺮ ﻓﺮﻫﻨﺎك اﺳﺪي )ﺷﻴﻜﺎﮔﻮ(‪ ،‬دﻛﺘﺮ ﺟﻮاد ﭘﺮوﻳﺰي )ﻓﻴﻼدﻟﻔﻴﺎ(‪ ،‬دﻛﺘﺮ ﻣﺤﻤﺪرﺿﺎ ﻛﺸﺘﮕﺮ )ﻟﻨﺪن(‪ ،‬دﻛﺘﺮ اﻓﺸﻴﻦ ﮔﻨﺠﻲ )اﺳﺘﺮاﺳﺒﻮرگ(‪،‬‬ ‫دﻛﺘﺮ ﺷﻬﻼ ﻣﺴﻌﻮد )ﻓﻠﻮرﻳﺪا(‪ ،‬دﻛﺘﺮ ﭘﺮوﻳﺰ ﻫﻨﺠﻨﻲ )ﭘﻨﺴﻴﻠﻮاﻧﻴﺎ(‬ ‫وﻳﺮاﺳﺘﺎران‬

‫دﻛﺘﺮ ﻧﺎدره ﺑﻬﺘﺎش‪ ،‬دﻛﺘﺮ ﻣﺤﻤﺪ ﻋﻠﻲ ﻧﻮﻳﺎن اﺷﺮف‪ ،‬دﻛﺘﺮ وﺣﻴﺪ ﻧﻴﻜﻮﻳﻲ‪ ،‬دﻛﺘﺮ ﺳﻴﺪ ﺑﻬﻨﺎم ﻫﺎﺷﻤﻲ‬ ‫ﻫﻤﻜﺎران دﻓﺘﺮ ﻣﺠﻠﻪ‬

‫ﺣﺴﻴﻦ ﭼﺎﻳﭽﻲ‪ ،‬راﺣﻠﻪ رﻣﻀﺎﻧﻲ‪ ،‬ﺳﺤﺮ ﺻﺪﻳﻖ‪ ،‬ﻣﻌﺼﻮﻣﻪ ﻋﺴﮕﺮي‪ ،‬آرزو ﻛﻤﻴﺰاﻧﻲ‬ ‫ﻧﺸﺎﻧﻲ‪ :‬ﺗﻬﺮان‪ ،‬ﺧﻴﺎﺑﺎن ﻗﺪس‪ ،‬ﺧﻴﺎﺑﺎن ﭘﻮرﺳﻴﻨﺎ‪ ،‬داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬ﺳﺎﺧﺘﻤﺎن آﻣﻮزش‪ ،‬ﻃﺒﻘﻪ اول‪ ،‬ﺷﻤﺎره ‪ ،202‬دﻓﺘﺮ ﻣﺠﻠﻪ‬ ‫آدرس اﻟﻜﺘﺮوﻧﻴﻚ‪ http://tumj.tums.ac.ir :‬ﭘﺴﺖ اﻟﻜﺘﺮوﻧﻴﻚ‪medjournal@tums.ac.ir :‬‬ ‫ﺻﻨﺪوق ﭘﺴﺘﻲ ‪ ،14155/6447‬ﺗﻠﻔﻜﺲ‪Online submission: http://journals.tums.ac.ir/login ، 88962510 :‬‬ ‫ﺑﺮاﺳﺎس ﻣﺼﻮﺑﻪ ﻛﻤﻴﺴﻴﻮن ﻧﺸﺮﻳﺎت ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﻛﺸﻮر‪ ،‬ﺑﻪ ﻧﻮﻳﺴﻨﺪﮔﺎن ﻣﻘﺎﻻت اﻳﻦ ﻣﺠﻠﻪ اﻣﺘﻴﺎز ارﺗﻘﺎي ﻋﻠﻤﻲ ﭘﮋوﻫﺸﻲ ﺗﻌﻠﻖ ﻣﻲﮔﻴﺮد‪.‬‬ ‫ﺗﻴﺮاژ‪ 1000 :‬ﻧﺴﺨﻪ‬

‫ﻟﻴﺘﻮﮔﺮاﻓﻲ‪ ،‬ﭼﺎپ و ﺻﺤﺎﻓﻲ‪ :‬ﺑﻬﺮﻧﮓ‬

‫)راﻳﮕﺎن(‬

‫ﻧﻤﺎﻳﻪ ﺷﺪه در‪:‬‬

‫‪SCOPUS, EMBASE, Cambridge Scientific Abstracts (CSA), CAB Abstracts (CABI), Chemical Abstract Service (CAS),‬‬ ‫‪DOAJ, Psych Info, ULRICH΄S, Index Copernicus, IMEMR, EMR Beta, SID, Magiran, Iran Medex‬‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‬ ‫دوره ‪70‬‬

‫ﺷﻤﺎره ‪2‬‬

‫اردﻳﺒﻬﺸﺖ ‪1391‬‬

‫ﻓﻬﺮﺳﺖ‬ ‫ﺑﺮرﺳﻲ آﺳﻴﺐ ﻛﻠﻴﻮي ﭘﺬﻳﺮﻧﺪه ﭘﺲ از اﻧﺘﻘﺎل ﻟﻜﻮﺳﻴﺖﻫﺎ از ﻣﻮش ﺳﻮري ‪ Inbred‬ﻣﺒﺘﻼ ﺑﻪ اﻳﺴﻜﻤﻲ‪ -‬ﺧﻮنرﺳﺎﻧﻲ ﻣﺠﺪد ﻛﻠﻴﻮي‪69.................................................‬‬ ‫ﻣﻬﺮي ﻛﺪﺧﺪاﻳﻲ‪ ،‬ﺣﺴﻴﻦ ﺧﻮاﺳﺘﺎر‪ ،‬ﺑﻬﺠﺖ ﺳﻴﻔﻲ‪ ،‬ﻋﺎﻃﻔﻪ ﻧﺠﻔﻲ‪ ،‬ﻓﺎﻃﻤﻪ دﻻوري‬

‫ارزﻳﺎﺑﻲ ﻫﻴﺴﺘﻮﭘﺎﺗﻮﻟﻮژي و ﻫﻴﺴﺘﻮﻣﻮرﻓﻮﻣﺘﺮي ﺗﺎﺛﻴﺮ آﺗﻮرواﺳﺘﺎﺗﻴﻦ ﺑﺮ ﺗﺮﻣﻴﻢ ﻧﻘﻴﺼﻪ ﺗﺠﺮﺑﻲ اﻳﺠﺎد ﺷﺪه در اﺳﺘﺨﻮان ﻣﺘﺮاﻛﻢ ران ﻣﻮش ﺻﺤﺮاﻳﻲ‪78...............................‬‬ ‫ﻏﻔﻮر ﻣﻮﺳﻮي‪ ،‬دارﻳﻮش ﻣﻬﺎﺟﺮي‪ ،‬ﻋﻠﻲ رﺿﺎﻳﻲ‪ ،‬ﻣﺤﻤﺪرﺿﺎ وﻟﻴﻠﻮ‪ ،‬آرﻣﺎن ﻋﻠﻴﻤﺤﻤﺪي‬

‫ﻣﻬﺎر ﻣﺴﻴﺮ ‪ TGF-b‬ﺑﻪوﺳﻴﻠﻪ ﺗﻜﻨﻴﻚ ‪ RNAi‬در ﺳﻠﻮلﻫﺎي ﺑﻨﻴﺎدي ﺧﻮنﺳﺎز ﻛﺸﺖ داده ﺷﺪه روي دارﺑﺴﺖ ﺳﻪ ﺑﻌﺪي ‪" DBM‬ﻣﺎﺗﺮﻳﻜﺲ‬

‫اﺳﺘﺨﻮاﻧﻲ ﻣﻌﺪﻧﻲ زداﺷﺪه"‪86.................................................................................................................................................................................‬‬ ‫زﻫﺮااﻟﺴﺎدات ﻫﺎﺷﻤﻲ‪ ،‬ﻣﻬﺪي ﻓﺮوزﻧﺪه ﻣﻘﺪم‪ ،‬ﻣﺴﻌﻮد ﺳﻠﻴﻤﺎﻧﻲ‪ ،‬ﻣﺮﻳﻢ ﺣﻔﻴﻈﻲ‪ ،‬ﻧﺎﺻﺮ اﻣﻴﺮي زاده‬

‫ﺣﺴﺎﺳﻴﺖ ﮔﻮﻧﻪﻫﺎي ﻛﺎﻧﺪﻳﺪاي دﻫﺎﻧﻲ اﻓﺮاد آﻟﻮده ﺑﻪ ‪ HIV‬ﻧﺴﺒﺖ ﺑﻪ داروﻫﺎي ﺿﺪ ﻗﺎرﭼﻲ ﺗﺤﺖ ﺷﺮاﻳﻂ ﺑﺮون ﺗﻨﻲ در اﻳﺮان‪96.....................................................‬‬ ‫ﻓﺮزاد ﻛﺘﻴﺮاﺋﻲ‪ ،‬ﻋﻠﻴﺮﺿﺎ ﺧﺴﺮوي‪ ،‬وﺣﻴﺪ ﺧﻠﺞ‪ ،‬ﻣﺤﺒﻮﺑﻪ ﺣﺎﺟﻲ ﻋﺒﺪاﻟﺒﺎﻗﻲ‪ ،‬ﻋﻠﻲاﺻﻐﺮ ﺧﺎﻛﺴﺎر‪ ،‬ﻣﻬﺮﻧﺎز رﺳﻮﻟﻲﻧﮋاد‬

‫ﺑﺮرﺳﻲ ﺗﻜﻨﻴﻚ ﺻﻔﺤﻪﮔﺬاري ﺑﻴﻮﻟﻮژﻳﻚ در ﺷﻜﺴﺘﮕﻲﻫﺎي ﭼﻨﺪ ﻗﻄﻌﻪاي ﺳﺎبﺗﺮوﻛﺎﻧﺘﺮﻳﻚ اﺳﺘﺨﻮان ران‪104..............................................................................‬‬ ‫ﺳﻌﻴﺪرﺿﺎ ﻣﻬﺮﭘﻮر‪ ،‬ﻣﺤﻤﺪرﺿﺎ ﻃﻮاﻓﻲ‪ ،‬رﺿﺎ ﺳﺮﺑﻲ‪ ،‬ﻣﺤﻤﺪرﺿﺎ آﻗﺎﻣﻴﺮﺳﻠﻴﻢ‬

‫ﺗﺄﺛﻴﺮ ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ و اﺳﺘﻘﺎﻣﺘﻲ ﺑﺮ ﭘﺎﺳﺦ ﺣﺎد آﻧﺪروژنﻫﺎ‪ ،‬ﻛﻮرﺗﻴﺰول و ﻻﻛﺘﺎت زﻧﺎن ﻣﺴﻦ ‪110..............................................................................................‬‬ ‫دﻧﻴﺎ ﺻﻮرﺗﻲ ﺟﺎﺑﻠﻮ‪ ،‬ﺳﻴﺪ رﺿﺎ ﻋﻄﺎرزاده ﺣﺴﻴﻨﻲ‪ ،‬دﻻرام ﺻﻴﺎدﭘﻮر زﻧﺠﺎﻧﻲ‪ ،‬اﻣﻴﻦ اﺣﻤﺪي‬

‫ﻣﻘﺎﻳﺴﻪ ﺗﺎﺛﻴﺮ ﻫﻴﺎﻟﻮروﻧﻴﻚ اﺳﻴﺪ و دﻛﺴﺘﺮوز ﭘﺮوﻟﻮﺗﺮاﭘﻲ داﺧﻞ ﻣﻔﺼﻠﻲ در درﻣﺎن درد اﺳﺘﺌﻮآرﺗﺮﻳﺖ زاﻧﻮ‪119.............................................................................‬‬ ‫ﺳﻴﺪ ﻣﺴﻌﻮد ﻫﺎﺷﻤﻲ‪ ،‬ﻓﻴﺮوز ﻣﺪدي‪ ،‬ﺳﻌﻴﺪ رﺿﻮي‪ ،‬ﻣﻬﺸﻴﺪ ﻧﻴﻜﻮﺳﺮﺷﺖ‪ ،‬ﻓﺮﺷﺎد ﺣﺴﻦ زاده ﻛﻴﺎﺑﻲ‪ ،‬ﺳﻤﻴﻪ ﻧﺼﻴﺮي ﭘﻮر‬

‫ﺑﺮرﺳﻲ ﻓﺮاواﻧﻲ ﭘﻮﻟﻴﭗﻫﺎ و ﺑﺪﺧﻴﻤﻲﻫﺎي ﻛﻮﻟﻮرﻛﺘﺎل در زﻧﺎن ﻣﺒﺘﻼ ﺑﻪ ﺳﺮﻃﺎن ﺗﺨﻤﺪان و اﻧﺪوﻣﺘﺮ در ﺳﺎل ‪1389-90‬‬

‫در ﺑﻴﻤﺎرﺳﺘﺎن ﻓﻴﺮوزﮔﺮ اﻛﺒﺮآﺑﺎدي و رﺳﻮل اﻛﺮم ‪ :‬ﮔﺰارش ﻛﻮﺗﺎه ‪126.................................................................................................................................‬‬ ‫ﺳﻴﻤﺎ ﺟﻌﻔﺮي‪ ،‬ﺳﻴﺎﻣﻚ ﺧﺎﻟﻘﻲ‪ ،‬ﻋﻠﻲ ﺑﺎﺳﻲ‪ ،‬ﻃﻴﺐ رﻣﻴﻢ‬

‫ﺧﺼﻮﺻﻴﺎت ﺑﺎﻟﻴﻨﻲ‪ ،‬آزﻣﺎﻳﺸﮕﺎﻫﻲ و اﭘﻴﺪﻣﻴﻮﻟﻮژﻳﻚ ﺑﻴﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﺑﺮوﺳﻠﻮز در اﺳﺘﺎن ﻫﻤﺪان‪:‬‬

‫ﻳﻚ ﻣﻄﺎﻟﻌﻪ ﮔﺬﺷﺘﻪﻧﮕﺮ روي ‪ 230‬ﺑﻴﻤﺎر ‪ :‬ﮔﺰارش ﻛﻮﺗﺎه ‪130.............................................................................................................................................‬‬ ‫ﭘﻴﻤﺎن ﻋﻴﻨﻲ‪ ،‬ﻓﺮزاﻧﻪ اﺛﻨﻲ ﻋﺸﺮي‪ ،‬اﺣﻤﺪ رﺿﺎ ﻣﺒﻴﻦ‪ ،‬ﻣﻬﺪي ﺣﺴﻦ زاده‬

‫درﻣﺎن ﺗﺮوﻣﺒﻮﺳﻴﺘﻮﭘﻨﻲ واﺑﺴﺘﻪ ﺑﻪ اﻳﺪز ‪ :‬ﮔﺰارش ﻣﻮردي ‪136.............................................................................................................................................‬‬ ‫زﻫﺮا ﻋﺒﺪي‪ ،‬ﻧﺪا ﻋﻠﻴﺠﺎﻧﻲ‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ،70‬ﺷﻤﺎره ‪ ،2‬اردﻳﺒﻬﺸﺖ ‪1391‬‬

‫راﻫﻨﻤﺎي ﻧﻮﻳﺴﻨﺪﮔﺎن‬ ‫‪ -1‬اﺻﻮل ﻛﻠﻲ‪ -1 :‬آﻳﻴﻦ ﻧﮕﺎرش زﺑﺎن ﻓﺎرﺳﻲ رﻋﺎﻳﺖ ﺷﺪه و از ﺑﻪﻛﺎر ﺑـﺮدن ﻛﻠﻤـﺎت‬

‫ﺑﺎﺷﺪ و ﻋﻨﻮان ﺟﺪول‪ ،‬ﺑﺎﻻي آن و در ﻧﻤﻮدار‪ ،‬زﻳﺮ آن ﻗﺮار ﮔﻴﺮد )ﺑﺎ ذﻛـﺮ ﺷـﻤﺎره(‪ .‬ﺑـﺎ‬

‫ﺧــﺎرﺟﻲ ﻛــﻪ ﻣﻌــﺎدل رﺳــﺎ در ﻓﺎرﺳــﻲ دارﻧــﺪ‪ ،‬ﺧــﻮدداري ﺷــﻮد‪ -2 .‬ﻣﻘــﺎﻻت ﺑــﻪ‬

‫ﺗﻮﺟﻪ ﺑﻪ ﻣﺤﺪودﻳﺖ ﺻﻔﺤﺎت ﻣﺠﻠﻪ‪ ،‬ﺑﺪﻳﻬﻲ اﺳﺖ از ﺗﻜﺮار اراﻳﻪ ﻣﻄـﺎﻟﺒﻲ ﻛـﻪ در ﻣـﺘﻦ‬

‫آدرس اﻟﻜﺘﺮوﻧﻴﻚ ﻣﺠﻠﻪ "‪ "http://journals.tums.ac.ir/login.aspx‬ارﺳـﺎل ﮔـﺮدد‬

‫آورده ﺷﺪهاﻧﺪ در ﺟﺪاول و ﺑﺎﻟﻌﻜﺲ ﺑﺎﻳﺪ اﺟﺘﻨﺎب ﻧﻤﻮد‪ ،‬ﺟـﺪاول و ﻧﻤﻮدارﻫـﺎ ﻓﺎرﺳـﻲ‬

‫)‪ Microsoft word 2003‬ﻳـﺎ ﺑﺎﻻﺗﺮ(‪ -3 .‬ﻣﻘﺎﻟﻪ ﺑﻪﻃﻮر ﻫﻢزﻣـﺎن ﺑـﺮاي ﺳـﺎﻳﺮ ﻣﺠـﻼت‬

‫ﺑﺎﺷﻨﺪ‪ .‬ﻋﻜﺲﻫﺎ‪ ،‬ﻧﻤﻮدارﻫﺎ و ﺟﺪاول ﻣﺮﺑﻮط ﺑﻪ ﻣﻘﺎﻟﻪ ﺑﻪﻫﻤﺮاه ﺗﻮﺿﻴﺤﺎت آنﻫﺎ ﺑﺎﻳﺴﺘﻲ‬

‫ارﺳﺎل ﻧﮕﺮدد و در ﺳﺎﻳﺮ ﻣﺠﻼت )ﺣﺘﻲ ﺑﻪ زﺑﺎن اﻧﮕﻠﻴﺴﻲ و ﻏﻴﺮه( ﺑﻪ ﭼﺎپ ﻧﺮﺳﻴﺪه‬

‫ﺟﺪاﮔﺎﻧﻪ و در دﻧﺒﺎﻟﻪ ﻣﺘﻦ اﺻﻠﻲ ﻣﻘﺎﻟﻪ آورده و ﺷﻤﺎرهﮔـﺬاري ﮔـﺮدد‪ .‬ﻛﻴﻔﻴـﺖ ﺗـﺼﺎوﻳﺮ‬

‫ﺑﺎﺷﺪ‪ -4 .‬ﻣﻘﺎﻻت ﭘﺬﻳﺮﻓﺘﻪ ﺷﺪه ﺷﺎﻣﻞ ﻣﻘـﺎﻻت ﺗﺤﻘﻴﻘـﻲ‪ ،‬ﻣـﺮوري‪ ،‬ﮔـﺰارش ﻛﻮﺗـﺎه و‬

‫ارﺳﺎﻟﻲ ﻣﻄﻠﻮب ﺑﺎﺷﺪ‪.‬‬

‫ﮔﺰارش ﻣﻮردي ﻣﻲﺑﺎﺷﺪ‪ -5 .‬در اﻧﺠﺎم ﭘـﮋوﻫﺶ‪ ،‬اﺻـﻮل ﺑﻴﺎﻧﻴـﻪ ﻫﻠـﺴﻴﻨﻜﻲ )‪ (2008‬و‬

‫ﺑﺤﺚ‪ -1 :‬آﺛﺎر و اﻫﻤﻴﺖ ﻳﺎﻓﺘﻪﻫﺎي ﺑﻪدﺳﺖ آﻣﺪه و ﻣﺤﺪودﻳﺖ آنﻫﺎ‪ -2 .‬ذﻛﺮ ﻧﺘـﺎﻳﺞ‬

‫ﺿﻮاﺑﻂ اﺧﻼق ﭘﺰﺷﻜﻲ رﻋﺎﻳﺖ ﮔﺮدد‪.‬‬

‫ﺗﺤﻘﻴﻖ ﻣﺸﺎﺑﻪ دﻳﮕﺮان و ذﻛﺮ ﻣﻐﺎﻳﺮات و ﻣﻮارد ﻧﻘﺾﻛﻨﻨﺪه‪ -3 .‬ﺗﻮﺿﻴﺢ ﻋﻠـﺖ ﺗﻔـﺎوت‬

‫‪ -2‬ﻧﺤﻮه ﺗﻨﻈﻴﻢ ﻣﻘﺎﻻت ﺗﺤﻘﻴﻘﻲ‪ -1 :‬ﺻﻔﺤﻪ اول )ﻋﻨﻮان( ﺷﺎﻣﻞ ﻋﻨﻮان ﻣﻘﺎﻟـﻪ‪ ،‬ﻧـﺎم و‬

‫ﺑﻴﻦ ﻧﺘﺎﻳﺞ اﻳﻦ ﺗﺤﻘﻴﻖ ﺑﺎ ﻣﻘﺎﻻت ﻗﺒﻠـﻲ‪ -4 .‬ﺗﻮﺿـﻴﺢ ﻣـﻮارد ﻛـﺎرﺑﺮد ﻋﻤﻠـﻲ و ﻗﺎﺑﻠﻴـﺖ‬

‫ﻧﺎمﺧﺎﻧﻮادﮔﻲ ﻧﻮﻳﺴﻨﺪﮔﺎن‪ ،‬درﺟﻪ ﻋﻠﻤـﻲ و آدرس دﻗﻴـﻖ ﻛﻠﻴـﻪ ﻧﻮﻳـﺴﻨﺪﮔﺎن )از ﺟﻤﻠـﻪ‬

‫ﺗﻌﻤﻴﻢﭘﺬﻳﺮي ﻧﺘﺎﻳﺞ‪ -5 .‬راﻫﻨﻤﺎﻳﻲ ﺑﺮاي اداﻣﻪ ﺗﺤﻘﻴﻖ ﺧﻮد ﻳﺎ دﻳﮕﺮان‪ ،‬در ﻣﺠﻤﻮع اراﻳـﻪ‬

‫ﻛﺪﭘﺴﺘﻲ‪ ،‬ﺗﻠﻔﻦ‪ ،‬دورﻧﮕﺎر و ﭘﺴﺖ اﻟﻜﺘﺮوﻧﻴﻚ( ﻣﺤﻞ اﻧﺠﺎم ﭘـﮋوﻫﺶ‪ ،‬ﻣـﺴﺌﻮل ﻣﻘﺎﻟـﻪ و‬ ‫ﺗﺎرﻳﺦ ارﺳﺎل ﻣﻘﺎﻟﻪ ﺑﺎﺷﺪ‪ -2 .‬ﺻﻔﺤﻪ دوم و ﺳﻮم ﺷﺎﻣﻞ ﺧﻼﺻﺔ ﻓﺎرﺳـﻲ و اﻧﮕﻠﻴـﺴﻲ و‬ ‫ﻛﻠﻤﺎت ﻛﻠﻴﺪي ﻓﺎرﺳﻲ و اﻧﮕﻠﻴﺴﻲ ﺑﺎﺷﺪ‪.‬‬ ‫ﭼﻜﻴﺪه ﻓﺎرﺳﻲ‪ 240-250 :‬ﻛﻠﻤﻪ و در ﭼﻬﺎر ﭘﺎراﮔﺮاف ﺑﺎ ﻋﻨﺎوﻳﻦ زﻣﻴﻨـﻪ و ﻫـﺪف‪،‬‬ ‫روشﺑﺮرﺳﻲ‪ ،‬ﻳﺎﻓﺘﻪﻫﺎ‪ ،‬ﻧﺘﻴﺠﻪﮔﻴﺮي و ﻛﻠﻤـﺎت ﻛﻠﻴـﺪي )ﺣـﺪاﻗﻞ ‪ 3‬و ﺣـﺪاﻛﺜﺮ ‪ 7‬واژه(‬ ‫ﺗﻨﻈﻴﻢ ﺷﻮد‪ .‬ﺗﻮﺻﻴﻪ ﻣﻲﺷﻮد ﻧﺴﺒﺖ ‪ 1-2-2-1‬در ﺗﻬﻴﻪ ﭼﻜﻴﺪه ﺑـﺎ ﭼﻬـﺎر ﻋﻨـﻮان ﻓـﻮق‬ ‫ﻟﺤﺎظ ﺷﻮد‪ .‬ﭼﻜﻴﺪه اﻧﮕﻠﻴﺴﻲ ﺑﺎﻳﺪ ﻣﻨﻄﺒﻖ ﺑﺎ ﭼﻜﻴـﺪه ﻓﺎرﺳـﻲ ﺑﺎﺷـﺪ و در ﺑﺨـﺶﻫـﺎي‬ ‫‪ Conclusion ،Results ،Methods ،Background‬و ‪ Keywords‬ﺗﻨﻈـــﻴﻢ و در ﺣـــﺪود‬ ‫‪ 240-250‬ﻛﻠﻤﻪ ﺑﺎﺷﺪ‪ -3 .‬اﺻﻞ ﻣﻘﺎﻟﻪ ﺷﺎﻣﻞ ﻣﻮارد زﻳﺮ اﺳﺖ‪:‬‬ ‫ﻣﻘﺪﻣﻪ‪ :‬ﻳﻚ ﺻﻔﺤﻪ ﺷﺎﻣﻞ‪ -1 :‬اﻃﻼﻋﺎت ﻗﺒﻠﻲ و زﻣﻴﻨﻪاي اﻧﺠﺎم ﺷﺪه و ﺳﺎﺑﻘﻪ ﺑﺎ ذﻛﺮ‬ ‫رﻓﺮاﻧﺲ‪ -2 .‬ﺿﺮورت اﻧﺠﺎم ﺗﺤﻘﻴﻖ‪ -3 .‬ﺳﺆاﻻت ﺑﺪون ﭘﺎﺳﺨﻲ ﻛﻪ اﻳﻦ ﺗﺤﻘﻴﻖ ﺑﻪ آنﻫﺎ‬ ‫ﭘﺎﺳﺦ ﻣﻲﮔﻮﻳﺪ و ﺑﻴﺎن اﻳﻦ ﻣﻮﺿﻮع ﻛﻪ ﭼﮕﻮﻧﻪ ﻧﺘﺎﻳﺞ اﻳـﻦ ﺗﺤﻘﻴـﻖ ﻣـﻲﺗﻮاﻧـﺪ ﺑـﻪ رﻓـﻊ‬ ‫اﺑﻬﺎﻣﺎت ﻛﻤﻚ ﻛﻨﺪ‪ -4 .‬ﺗﻌﺮﻳﻒ اﺻﻄﻼﺣﺎت ﺗﺨﺼﺼﻲ ﻳﺎ اﺧﺘﺼﺎرات ﻋﻠﻤﻲ‪ -5 .‬ﻫﺪف‬ ‫ﺗﺤﻘﻴﻖ ﺑﻪ ﻧﺤﻮ روﺷﻦ‪.‬‬

‫آنﭼﻪ ﻛﻪ از اﻳﻦ ﺗﺤﻘﻴﻖ ﺑﻪ ﻋﻠﻢ اﺿﺎﻓﻪ ﺷﺪه اﺳﺖ‪.‬‬ ‫ﻣﻨﺎﺑﻊ‪ :‬ﺷﻤﺎره ﻣﻨﺎﺑﻊ در ﻣﺘﻦ ﻗﻴﺪ ﺷﻮد و از ﻋﺪد ﻳﻚ ﺷﺮوع و ﺑﻪﺗﺮﺗﻴﺐ اﺿﺎﻓﻪ ﮔـﺮدد‪.‬‬ ‫ﺿﻤﻦ اﻧﻄﺒﺎق ﺗﻌﺪاد رﻓﺮاﻧﺲﻫﺎي ﻣﺤﺘﻮاي ﻣﻘﺎﻟﻪ و ﻟﻴﺴﺖ اﻧﺘﻬﺎﻳﻲ آن‪ ،‬ﻣﺘﻦ رﻓـﺮاﻧﺲﻫـﺎ‬ ‫ﺑﻪﺗﺮﺗﻴﺐ ﻇﻬﻮر‪ ،‬در ﻓﻬﺮﺳﺖ ﻣﻨﺎﺑﻊ آورده ﺷﻮﻧﺪ‪ .‬ﻣﻨﺎﺑﻊ ﻓﺎرﺳـﻲ ﺑـﻪ اﻧﮕﻠﻴـﺴﻲ ﺑﺮﮔـﺮدان‬ ‫ﺷﻮد‪ .‬ﻧﺤﻮه ﺗﻨﻈﻴﻢ ﻣﻨﺎﺑﻊ در ﻣﺜﺎلﻫﺎي زﻳﺮ آورده ﺷﺪه اﺳﺖ‪:‬‬ ‫‪1. Qazi F, McGuire WP. The treatment of epithelial ovarian cancer. CA Cancer‬‬ ‫‪J Clin 1995;45(2):88-101.‬‬ ‫‪2. Piazza AJ, Stoll BJ. Jaundice and hyperbilirobinemia in the newborn. In:‬‬ ‫‪Kliegman RM, Behrman RE, Jenson HB, Stanton BF, editors. Nelson‬‬ ‫‪Textbook of Pediatrics. 18th ed. Philadelphia, PA: Saunders Elsevier; 2007. p.‬‬ ‫‪756-65.‬‬ ‫‪3. O'Callaghan C, Stephenson T. Pocket Paediatrics. 2nd ed. Edinburgh:‬‬ ‫‪Churchill Livingstone; 2004.‬‬ ‫‪4. Williams FM, Cherkas LF, Spector TD, MacGregor AJ. A common genetic‬‬ ‫‪factor underlies hypertension and other cardiovascular disorders. BMC‬‬ ‫‪Cardiovasc Disord [Internet]. 2004 Apr 20 [cited 2009 Mar 23]; Available‬‬ ‫‪from: http://www.biomedcentral.com/1471-2261/4/20‬‬ ‫‪5. Ghofranipour F, Shojaee zade D. Use of health belief model in prevention of‬‬ ‫]‪brucelosis in Shahr-e-cord City in Iran. Daneshvar J 1997;15:23-8. [Persian‬‬

‫روش ﺑﺮرﺳﻲ‪ :‬ﺑﻪﻧﺤﻮي ﺑﺎﻳﺪ ﻧﻮﺷﺘﻪ ﺷﻮد ﻛﻪ ﻫﺮ ﺧﻮاﻧﻨـﺪهاي ﺑﺘﻮاﻧـﺪ ﺑـﺎ آن‪ ،‬ﺗﺠﺮﺑـﻪ‬

‫‪ -3‬ﻧﺤﻮه ﺗﻨﻈﻴﻢ ﻣﻘﺎﻻت ﮔﺰارش ﻣﻮارد‪ -1 :‬ﺻﻔﺤﻪ اول ﻣﺸﺎﺑﻪ ﻣﻘـﺎﻻت ﺗﺤﻘﻴﻘـﻲ‪-2 .‬‬

‫ﻧﻮﻳﺴﻨﺪه ﻣﻘﺎﻟﻪ را ﺗﻜﺮار ﻛﻨﺪ‪ ،‬ﺷﺎﻣﻞ ﻃﺮاﺣﻲ ﺗﺤﻘﻴـﻖ‪ :‬ﺟﺰﻳﻴـﺎت روش ﻣﻄﺎﻟﻌـﻪ و ﻋﻠـﺖ‬

‫ﺻﻔﺤﻪ دوم و ﺳﻮم ﺷﺎﻣﻞ ﺧﻼﺻﻪ ﻓﺎرﺳـﻲ و اﻧﮕﻠﻴـﺴﻲ و ﻛﻠﻤـﺎت ﻛﻠﻴـﺪي ﻓﺎرﺳـﻲ و‬

‫اﻧﺘﺨﺎب آن )ﻣﺜﻼ ﻛﻮﻫﻮرت(‪ -‬ﻣﺪت زﻣﺎن اﺟﺮاي ﻃﺮح و ﭘﻲﮔﻴﺮي‪ -1 .‬زﻣـﺎن و ﻣﻜـﺎن‬

‫اﻧﮕﻠﻴﺴﻲ ﻣﻲ ﺑﺎﺷﺪ‪ .‬ﺧﻼﺻﻪ ﮔﺰارش ﻣﻮردي ﺣﺪاﻛﺜﺮ ‪ 130-150‬ﻛﻠﻤﻪ ﺑﺎﺷـﺪ‪ -3 .‬اﺻـﻞ‬

‫اﺟﺮاي ﭘﮋوﻫﺶ‪ -2 .‬ﺳﻮژهﻫـﺎ و ﻧﻤﻮﻧـﻪﻫـﺎي ﻣـﻮرد آزﻣـﻮن و ﻣـﻼك اﻧﺘﺨـﺎب‪ .‬روش‬

‫ﻣﻘﺎﻟﻪ ﺷﺎﻣﻞ ﻣﻮارد زﻳﺮ اﺳﺖ‪ :‬ﻣﻘﺪﻣﻪ‪ :‬ﺷﺮح ﺣﺎل ﺑﻴﻤﺎر‪ ،‬ﺑﺤﺚ‪ :‬ﮔـﺰارش ﻣـﻮرد و ﺑﺤـﺚ‬

‫ﻧﻤﻮﻧﻪﮔﻴﺮي و ﻣﻨﻄﻖ ﺗﻌﺪاد ﻧﻤﻮﻧﻪ )اﻳﻦ ﻗﺴﻤﺖ ﺑﺴﻴﺎر ﻣﻬﻢ اﺳﺖ و در اﺑﺘﺪاي اﻣﺮ ﻣـﻮرد‬

‫ﻣﺠﻤﻮﻋﺎً از ‪ 1500‬ﻛﻠﻤﻪ ﺑﻴﺶﺗﺮ ﻧﺒﻮده و ﺣﺪاﻛﺜﺮ دو ﺟﺪول ﻳﺎ ﺗـﺼﻮﻳﺮ اراﻳـﻪ ﺷـﻮد‪-4 .‬‬

‫ﻛﺎرﺷﻨﺎﺳﻲ ﻗﺮار ﻣﻲﮔﻴﺮد(‪ -‬ﻣﻼكﻫﺎي ورود و ﺧﺮوج ﺑﻪ ﻣﻄﺎﻟﻌﻪ‪ -3 .‬ﻧﺤﻮه ﺟﻤـﻊآوري‬

‫ﻣﻨﺎﺑﻊ ﻣﺸﺎﺑﻪ ﻣﻘﺎﻻت ﺗﺤﻘﻴﻘﻲ اﺳﺖ‪.‬‬

‫اﻃﻼﻋــﺎت‪ -4 .‬رﻋﺎﻳــﺖ ﻣــﻮازﻳﻦ اﺧــﻼق در ﭘــﮋوﻫﺶ‪ -5 .‬اﺑﺰارﻫــﺎي اﻧــﺪازهﮔﻴــﺮي‪.‬‬

‫‪ -4‬ﻧﺤﻮه ﺗﻨﻈﻴﻢ ﻣﻘﺎﻻت ﻣﺮوري‪ -1 :‬اﻳﻦ ﻣﻘﺎﻻت ﺑﺮاي اراﻳﻪ آﺧﺮﻳﻦ ﻳﺎﻓﺘﻪﻫﺎي ﻋﻠﻤـﻲ‬

‫‪ -6‬آزﻣﻮنﻫﺎي آﻣﺎري‪ -7 .‬ﻧﺎم ﻛﺸﻮر و ﺷﺮﻛﺖ ﺳﺎزﻧﺪه ﻣﻮاد و دﺳﺘﮕﺎهﻫﺎ )ﺑﻪ اﻧﮕﻠﻴـﺴﻲ‬

‫درﺑﺎره ﻳﻚ ﻣﻮﺿﻮع ﺧﺎص ﺑﺎﺷﺪ‪ -2 .‬ﻧﻮﻳﺴﻨﺪه در زﻣﻴﻨﻪ ﻣﻮﺿﻮع ﻣﻘﺎﻟﻪ ﺻـﺎﺣﺐ ﻧﻈـﺮ و‬

‫ﻧﻮﺷﺘﻪ ﺷﻮﻧﺪ(‪.‬‬

‫داراي ﻣﻘﺎﻟﻪ ﺑﺎﺷﻨﺪ‪ -3 .‬از رﻓﺮﻧﺲﻫﺎي ﻧﻮﻳﺴﻨﺪه در ﻣﻘﺎﻟﻪ اﺳﺘﻔﺎده ﺷﺪه ﺑﺎﺷﺪ‪.‬‬

‫ﻳﺎﻓﺘﻪﻫﺎ‪ :‬اراﻳﻪ ﻧﺘﺎﻳﺞ دﻗﻴﻖ‪ -1 :‬رﻋﺎﻳـﺖ اﺻـﻮل ﻋﻠﻤـﻲ )ﮔـﺰارش ﻋـﺪد ﺑـﺎ درﺻـﺪ‪-‬‬

‫‪ -5‬ﻫﻴﺄت ﺗﺤﺮﻳﺮﻳﻪ ﻣﺠﻠﻪ در ﻗﺒﻮل ﻳﺎ رد‪ ،‬ﻳﺎ اﺻﻼح ﻣﻘﺎﻟﻪ )ﺑـﺎ ﺗﺄﻳﻴـﺪ ﻣﺆﻟـﻒ( آزاد‬

‫ﮔﺰارش ﻣﻴﺎﻧﮕﻴﻦ ﺑﺎ ﺣﺪود اﻃﻤﻴﻨﺎن‪ -‬ﻣﻴﺎﻧﻪ ﺑـﺎ ‪ -2 .(Range‬ﭘﺮﻫﻴـﺰ از ﻧـﺸﺎن دادن ﻫﻤـﻪ‬

‫اﺳﺖ و از ﭘﺲ دادن ﻣﻘﺎﻟﻪ و ﻣﻠﺤﻘﺎت آن ﻣﻌﺬور ﻣﻲﺑﺎﺷﺪ‪.‬‬

‫ﻳـﺎﻓﺘﻪﻫﺎي ﺑﻪدﺳﺖ آﻣﺪه ﺑﻪﺟﺰ ﻳـﺎﻓﺘﻪﻫﺎي ﻣﻬﻢ و ﺗﻌﻴـﻴﻦﻛﻨﻨـﺪه‪ -3 .‬اﺳﺘــﻔﺎده ﻣﻨــﺎﺳﺐ‬

‫‪ -6‬ﻧﻮﻳﺴﻨﺪﮔﺎن ﻣﻘﺎﻻت ﻣﺴﺌﻮل ﻧﻮﺷﺘﻪﻫﺎ و ﻣﺪاﻓﻊ ﻣﻄﺎﻟﺐ ﭼﺎپ ﺷﺪه از ﻣﻘﺎﻟﻪ ﺧـﻮد در‬

‫از ﺟﺪول و ﻧﻤﻮدار ﺑﺎ ﺣﺪاﻗﻞ ﺗﻌﺪاد ﻣﻤﻜﻦ ﺑﻪﻃﻮريﻛﻪ ﺑﻪ ازاي ﻫﺮ ﺳـﻪ ﺻـﻔﺤﻪ ﺗـﺎﻳﭙﻲ‬

‫ﻣﺠﻠﻪ ﺧﻮاﻫﻨﺪ ﺑﻮد‪.‬‬

‫ﻳﻚ ﺟﺪول ﻳﺎ ﻧﻤﻮدار اﺳﺘﻔﺎده ﺷﻮد‪ ،‬ﺿﻤﻦ اﻳﻦﻛﻪ ﻧﻤﻮدار ﺑﺎﻳﺪ ﺳﻴﺎه و ﺳﻔﻴﺪ و دو ﺑﻌﺪي‬

‫‪ -7‬اﺳﺘﻔﺎده از ﻣﻨﺪرﺟﺎت ﻣﺠﻠﻪ ﺑﺎ ذﻛﺮ ﻛﺎﻣﻞ ﻣﺄﺧﺬ آزاد اﺳﺖ‪.‬‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 70‬ﺷﻤﺎره ‪ ،2‬اردﻳﺒﻬﺸﺖ ‪1391‬‬

‫‪77‬ي‪69-‬‬ ‫‪،1391‬‬ ‫ﺷﻤﺎره ‪،2‬‬ ‫‪70‬ﻳ‪، ،‬‬ ‫داﻧﺸﮕﺎه ﻋﻠﻮم‬ ‫ﭘﺰﺷﻜﻲ‪،‬‬ ‫داﻧﺸﻜﺪه‬ ‫ﻣﺠﻠﻪ‬ ‫ﻛﻠﻴﻮ‬ ‫اردﻳﺒﻬﺸﺖﻣﺠﺪد‬ ‫ﺧﻮنرﺳﺎﻧﻲ‬ ‫ﺴﻜﻤﻲ‪-‬‬ ‫دوره ﺑﺎ ا‬ ‫ﺗﻬﺮان‪،‬ﻣﻮش‬ ‫ﭘﺰﺷﻜﻲﺖﻫﺎ از‬ ‫اﻧﺘﻘﺎل ﻟﻜﻮﺳﻴ‬ ‫ﺮﻧﺪه ﭘﺲ از‬ ‫ﻛﻠﻴﻮي ﭘﺬﻳ‬ ‫آﺳﻴﺐ‬

‫‪69‬‬

‫ﺑﺮرﺳﻲ آﺳﻴﺐ ﻛﻠﻴﻮي ﭘﺬﻳﺮﻧﺪه ﭘﺲ از اﻧﺘﻘﺎل ﻟﻜﻮﺳﻴﺖﻫﺎ از ﻣﻮش ﺳﻮري ‪ Inbred‬ﻣﺒﺘﻼ ﺑﻪ‬ ‫اﻳﺴﻜﻤﻲ‪ -‬ﺧﻮنرﺳﺎﻧﻲ ﻣﺠﺪد ﻛﻠﻴﻮي‬

‫ﺗﺎرﻳﺦ درﻳﺎﻓﺖ ﻣﻘﺎﻟﻪ‪ 1390/06/08 :‬ﺗﺎرﻳﺦ ﭘﺬﻳﺮش‪1390/11/03 :‬‬

‫ﭼﻜﻴﺪه‬

‫‪*1‬‬

‫ﻣﻬﺮي ﻛﺪﺧﺪاﻳﻲ‬

‫‪1‬‬

‫‪2‬‬

‫ﺣﺴﻴﻦ ﺧﻮاﺳﺘﺎر‪ ،‬ﺑﻬﺠﺖ ﺳﻴﻔﻲ‬ ‫‪1‬‬

‫ﻋﺎﻃﻔﻪ ﻧﺠﻔﻲ‪ 3،‬ﻓﺎﻃﻤﻪ دﻻوري‬

‫زﻣﻴﻨﻪ و ﻫﺪف‪ :‬در ﻣﻄﺎﻟﻌﻪ ﻗﺒﻠﻲ ﻣﺎ ﻧﻘﺶ اﻧﺘﻘﺎل ﻟﻜﻮﺳﻴﺖﻫﺎ را در اﻟﻘﺎي آﺳﻴﺐ ﻛﺒﺪي ﺑـﻪدﻧﺒـﺎل اﻳـﺴﻜﻤﻲ‪ -‬ﺧـﻮنرﺳـﺎﻧﻲ‬ ‫ﻣﺠﺪد )‪ (IR‬ﻛﻠﻴﻮي در ﻣﻮش ﺳﻮري ‪ Inbred‬ﻧﺸﺎن داده ﺷﺪ‪ .‬ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﻧﻘﺶ اﻧﺘﻘﺎل ﻟﻜﻮﺳﻴﺖﻫﺎ را از ﻣﻮش ﻣﺒـﺘﻼ ﺑـﻪ‬

‫‪ -1‬ﮔﺮوه ﻓﻴﺰﻳﻮﻟﻮژي‪ ،‬داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه‬ ‫ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬ﺗﻬﺮان‪ ،‬اﻳﺮان‪.‬‬ ‫‪ -2‬ﮔﺮوه ﻓﻴﺰﻳﻮﻟﻮژي‪ ،‬داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه‬ ‫ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺷﺎﻫﺮود‪ ،‬ﺷﺎﻫﺮود‪ ،‬اﻳﺮان‪.‬‬

‫آﺳﻴﺐ اﻳﺴﻜﻤﻲ‪ -‬ﺧﻮنرﺳﺎﻧﻲ ﻣﺠﺪد )‪ 60‬دﻗﻴﻘﻪ اﻧﺴﺪاد دو ﻃﺮﻓﻪ ﺷﺮﻳﺎن ﻛﻠﻴﻮي و ﺳﻪ ﺳﺎﻋﺖ ﭘﺮﻓﻴﻮژن ﻣﺠـﺪد( در اﻳﺠـﺎد‬ ‫آﺳﻴﺐ ﻛﻠﻴﻮي در ﻣﻮش ﭘﺬﻳﺮﻧﺪه ﺑﺮرﺳﻲ ﻣﻲﻧﻤﺎﻳﺪ‪ .‬روش ﺑﺮرﺳﻲ‪ :‬ﻣﻮشﻫﺎ در دو ﮔﺮوه ‪ Sham‬و ‪ IR‬ﻗﺮار ﮔﺮﻓﺘﻨﺪ‪ .‬ﭘﺲ از‬ ‫ﺑﻴﻬﻮﺷﻲ و ﺑﺮداﺷﺖ ﺧﻮن و ﺑﺎﻓﺖ ﻛﻠﻴﻮي‪ ،‬ﻟﻜﻮﺳﻴﺖﻫﺎ از ﺧﻮن ﺟﺪا ﺷﺪه و ﺑﻪ دو ﮔﺮوه ﭘﺬﻳﺮﻧﺪه ﻣﻨﺘﻘﻞ ﺷﺪﻧﺪ‪ :‬ﻣﻮشﻫـﺎي‬ ‫)‪recipient‬‬

‫‪ (Sham‬و ﻣﻮشﻫﺎي ﭘﺬﻳﺮﻧﺪه ﻛﻪ ﻟﻜﻮﺳﻴﺖﻫـﺎي ﮔـﺮوه‬

‫‪ -3‬ﮔﺮوه آﻧﺎﺗﻮﻣﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪،‬‬

‫ﭘﺬﻳﺮﻧﺪه ﻛﻪ ﻟﻜﻮﺳﻴﺖﻫﺎي ﮔﺮوه ﺷﻢ را درﻳﺎﻓﺖ ﻛﺮدﻧﺪ‬

‫ﺗﻬﺮان‪ ،‬اﻳﺮان‪.‬‬

‫‪ IR‬را درﻳﺎﻓﺖ ﻧﻤﻮدﻧﺪ )‪ .(IR recipient‬ﺑﻌﺪ از ‪ 24‬ﺳﺎﻋﺖ ﻧﻤﻮﻧﻪﻫﺎي ﺧﻮن و ﺑﺎﻓﺖ ﻛﻠﻴﻪ ﺟﻤﻊآوري ﺷﺪ‪ .‬ﻳﺎﻓﺘﻪﻫﺎ‪ :‬در ﮔﺮوه‬ ‫‪recipient‬‬

‫‪ IR‬ﻧﺴﺒﺖ ﺑﻪ ﮔﺮوه‬

‫‪recipient‬‬

‫‪ Sham‬ﻣﻴﺰان ﻣﺎﻟﻮن دي آﻟﺪﻫﺎﻳﺪ )‪ (MDA‬ﺑﺎﻓﺖ ﻛﻠﻴﻪ ﺑﻪﻃـﻮر ﻣﻌﻨـﻲدار اﻓـﺰاﻳﺶ و‬

‫ﮔﻠﻮﺗﺎﺗﻴﻮن و ﺳﻮﭘﺮاﻛﺴﻴﺪ دﻳﺴﻤﻮﺗﺎز ﻛﺎﻫﺶ ﻳﺎﻓﺘﻨﺪ‪ Blood Urea Nitrogen (BUN) .‬و ﻛﺮآﺗﻴﻨﻴﻦ ﭘﻼﺳﻤﺎ اﮔﺮﭼﻪ در ﮔﺮوه‬

‫‪IR‬‬

‫‪ donor‬ﺑﺎ ﺷﻢ ﺗﻔﺎوت ﻣﻌﻨﻲداري داﺷﺖ )‪ (P<0/05‬وﻟﻲ در دو ﮔﺮوه ﭘﺬﻳﺮﻧﺪه ﺗﻔﺎوت ﻣﻌﻨﻲدار وﺟﻮد ﻧﺪاﺷﺖ‪ .‬ﺑﺎﻓـﺖ ﻛﻠﻴـﻪ‬ ‫در ﮔﺮوه ‪ IR donor‬در ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﮔﺮوه ‪ Sham donor‬آﺳﻴﺐﻫﺎي ﺑﺴﻴﺎري را ﻧﺸﺎن داد‪ .‬اﻣﺎ ﮔـﺮوه ‪ IR recipient‬اﮔﺮﭼـﻪ ﺑـﺎ‬ ‫*‬

‫ﮔﺮوه ﺷﻢ ﻣﺮﺑﻮﻃﻪ ﺑﺴﻴﺎر ﻣﺘﻔﺎوت اﺳﺖ وﻟﻲ ﺑﺎ ﮔﺮوه ‪ IR donor‬ﻫﻢ ﺗﻔـﺎوت ﺑـﺴﻴﺎري دارد‪ .‬ﻧﺘﻴﺠـﻪﮔﻴـﺮي‪ :‬اﻳـﻦ ﻳﺎﻓﺘـﻪﻫـﺎ‬ ‫ﻧﻮﻳﺴﻨﺪه ﻣﺴﺌﻮل‪ :‬ﺗﻬﺮان‪ ،‬ﺧﻴﺎﺑﺎن ﭘﻮرﺳﻴﻨﺎ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم‬

‫ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬ﮔﺮوه ﻓﻴﺰﻳﻮﻟﻮژي‬

‫ﻟﻜﻮﺳﻴﺖﻫﺎ را ﺑﻪ ﻋﻨﻮان ﻳﻚ ﻋﺎﻣﻞ دﺧﻴﻞ در آﺳﻴﺐ ﺑﺎﻓﺘﻲ و اﻟﻘﺎي اﺳﺘﺮس اﻛﺴﻴﺪاﺗﻴﻮ در آﺳﻴﺐ ‪ IR‬ﻛﻠﻴﻪ ﻣﻄﺮح ﻣﻲﻧﻤﺎﻳﺪ‪.‬‬

‫ﺗﻠﻔﻦ‪021-64053288 :‬‬ ‫‪E-mail: kadkhodm@tums.ac.ir‬‬

‫ﻛﻠﻤﺎت ﻛﻠﻴﺪي‪ :‬ﻛﻠﻴﻪﻫﺎ‪ ،‬آﺳﻴﺐ اﻳﺴﻜﻤﻲ‪ ،‬ﭘﺮﻓﻴﻮژن ﻣﺠﺪد‪ ،‬ﻟﻜﻮﺳﻴﺖﻫﺎ‪ ،‬اﺳﺘﺮس اﻛﺴﻴﺪاﺗﻴﻮ‪.‬‬

‫ﺑﻪﺧﺼﻮص ‪ ،TNF-α‬ﺧﻮد ﺑﺎ ﻓﻌﺎل ﻛﺮدن ﻟﻜﻮﺳـﻴﺖﻫـﺎ ﻧﻘـﺶ ﻣﻬﻤـﻲ در‬

‫ﻣﻘﺪﻣﻪ‬

‫ﮔﺴﺘﺮش آﺳﻴﺐ ﻧﺎﺷﻲ از اﻳﺴﻜﻤﻲ دارﻧـﺪ‪5.‬و‪ 4‬آﺳـﻴﺐ ﻧﺎﺷـﻲ از ‪ IR‬ﻳـﻚ‬ ‫)‪Ischemia-Reperfusion (IR‬‬

‫اﻧﺪام ﻣﻮﺟﺐ ﭘﺎﺳﺦ اﻟﺘﻬﺎﺑﻲ ﺳﻴﺴﺘﻤﻴﻚ ﻣﻲﮔﺮدد ﻛﻪ در ﻧﺘﻴﺠﻪ آن آﺳـﻴﺐ‬

‫ﻛﻠﻴﻮي در ﺑﺴﻴﺎري از ﻣﻮارد ﻛﻠﻴﻨﻴﻜﻲ ﻣﺎﻧﻨﺪ ﺷﻮك‪ ،‬ﭘﻴﻮﻧﺪ اﻋﻀﺎ‪ ،‬ﻋﻔﻮﻧـﺖ‬

‫در اﻧﺪامﻫﺎي دور دﺳﺖ دﻳﮕـﺮ ﻣﺎﻧﻨـﺪ ﻗﻠـﺐ‪ ،‬رﻳـﻪ‪ ،‬روده و ﻛﺒـﺪ اﻳﺠـﺎد‬

‫آﺳﻴﺐ اﻳﺴﻜﻤﻲ‪ -‬ﺧﻮنرﺳﺎﻧﻲ ﻣﺠﺪد‬

‫و ﺟﺮاﺣﻲﻫﺎي ﻋﺮوق اﻳﺠﺎد ﻣﻲﺷﻮد ﻛﻪ در ﻧﻬﺎﻳﺖ ﻣـﻲﺗﻮاﻧـﺪ ﻣﻨﺠـﺮ ﺑـﻪ‬

‫ﻣﻲﺷﻮد‪ .‬ﻣﻄﺎﻟﻌﺎت اﭘﻴﺪﻣﻴﻮﻟﻮژﻳﻚ ﻧـﺸﺎن ﻣـﻲدﻫـﺪ ﻛـﻪ ‪ IR‬ﻛﻠﻴـﻮي ﻧﻴـﺰ‬

‫ﻧﺎرﺳﺎﻳﻲ ﺣﺎد ﻛﻠﻴﻮي )‪ (ARF‬و ﻣـﺮگ و ﻣﻴـﺮ ﻗﺎﺑـﻞ ﺗﻮﺟـﻪ ﻧﺎﺷـﻲ از آن‬

‫‪6-8‬‬

‫ﻣﻮﺟﺐ اﺧﺘﻼل در اﻧﺪامﻫﺎي دﻳﮕﺮ ﻣﺎﻧﻨﺪ ﻣﻐﺰ‪ ،‬رﻳﻪ و ﻛﺒـﺪ ﻣـﻲﮔـﺮدد‪.‬‬

‫ﮔﺮدد‪ ،‬ﭼﻨﺎنﻛﻪ ﻋﻠﻲرﻏﻢ ﭘﻴﺸﺮﻓﺖ ﺑﺴﻴﺎر در اﻣﺮ ﭘﻴﻮﻧﺪ ﻛﻠﻴﻪ‪ ،‬ﻣﺮگ و ﻣﻴـﺮ‬

‫در ﻣﻮرد ﻧﻘﺶ ‪ IR‬ﻛﻠﻴﻮي در آﺳﻴﺐ اﻧﺪامﻫﺎي دوردﺳﺖ ﻣﻄﺎﻟﻌﺎت ﺑﺴﻴﺎر‬

‫‪1‬‬

‫اﻧﺪﻛﻲ اﻧﺠﺎم ﺷﺪه ﻛﻪ ﺻﺮﻓﺎً وﺟﻮد آﺳﻴﺐ را در آن اﻧﺪام ﻧـﺸﺎن دادهاﻧـﺪ‬

‫ﭘﻴﺸﻨﻬﺎد ﺷﺪه ﻛﻪ ‪ IR‬ﻛﻠﻴﻮي ﻣﻮﺟـﺐ اﻟﻘـﺎ ﺗﻮﻟﻴـﺪ ﺳـﺎﻳﺘﻮﻛﻴﻦﻫـﺎي ﭘـﻴﺶ‬

‫وﻟﻲ ﻣﻜﺎﻧﻴﺴﻢ اﻳﺠﺎد ﺿﺎﻳﻌﻪ ﺑﺮرﺳﻲ ﻧﺸﺪه اﺳﺖ‪ .‬ﺑـﺎ ﺗﻮﺟـﻪ ﺑـﻪ ﺷـﻴﻮع و‬

‫اﻟﺘﻬﺎﺑﻲ ﻣﺎﻧﻨﺪ ‪ ،TNF-α‬ﺑﻴﺎن ﻣﻮﻟﻜﻮلﻫﺎي ﭼﺴﺒﻨﺪه ﮔﻮﻧﺎﮔﻮن‪ ،‬ﻓﻌـﺎل ﺷـﺪن‬

‫ﻣﺨﺎﻃﺮهﻫﺎي ‪ IR‬ﻛﻠﻴﻮي و ﺑـﻪدﻟﻴـﻞ اﻫﻤﻴـﺖ ﻛﻠﻴـﻪ در ﺣﻔـﻆ ﺳـﻼﻣﺖ و‬

‫ﻟﻜﻮﺳﻴﺖﻫﺎ و ورود آنﻫﺎ ﺑﻪ داﺧﻞ ﺑﺎﻓﺖ ﻛﻠﻴﻪ ﻣﻲﺷﻮد‪3‬و‪ 2‬و ﺳﺎﻳﺘﻮﻛﻴﻦﻫﺎ‬

‫ﻧﮕﻪداري ﺛﺒﻮت ﻣﺤﻴﻂ داﺧﻠـﻲ ﺑـﺪن‪ ،‬ﺑﺮرﺳـﻲ ﻣﻜﺎﻧﻴـﺴﻢ ‪ IR‬ﻛﻠﻴـﻮي در‬

‫)‪ (Mortality‬ﺑﻴﻤﺎران ﺑﻪ ﻋﻠﺖ آﺳﻴﺐ ﻛﻠﻴﻮي ﻫـﻢﭼﻨـﺎن ﺑـﺎﻻ ﻣـﻲﺑﺎﺷـﺪ‪.‬‬

‫ﻣﻬﺮي ﻛﺪﺧﺪاﻳﻲ و ﻫﻤﻜﺎران‬

‫‪70‬‬

‫اﻳﺠﺎد آﺳﻴﺐﻫﺎي ﻣﻮﺿﻌﻲ دوردﺳﺖ )‪ (Remote‬داراي اﻫﻤﻴـﺖ ﺧﺎﺻـﻲ‬

‫ﺣﻴﻮاﻧﺎت ﮔﺮﻓﺘﻪ ﺷﺪه و ﺑﺎﻓﺖ ﻛﻠﻴﻪ ﻧﻴﺰ ﺟﻤـﻊآوري ﺷـﺪ‪ .‬ﻣﻴـﺰان ‪ BUN‬و‬

‫‪IR‬‬

‫ﻛــﺮاﺗﻴﻨﻴﻦ ﭘﻼﺳــﻤﺎ ﺑــﻪﻋﻨــﻮان ﺷــﺎﺧﺺﻫــﺎي آﺳــﻴﺐ ﻋﻤﻠﻜــﺮد ﻛﻠﻴــﻮي‬

‫اﻧﺪامﻫﺎي ﻣﺨﺘﻠﻒ ﻣﺎﻧﻨﺪ رﻳﻪ‪ ،‬ﻗﻠﺐ‪ ،‬ﻣﻐﺰ‪ ،‬ﻛﻠﻴﻪ‪ ،‬ﻛﻮﻟﻮن و ﻛﺒـﺪ ﺑﺮرﺳـﻲ و‬

‫اﻧﺪازهﮔﻴﺮي ﺷﺪ‪ .‬ﺑﺎﻓﺖ ﻛﻠﻴﻪ ﺑﺮاي ﺑﺮرﺳﻲ ﺑﺎﻓﺖﺷﻨﺎﺳـﻲ و اﻧـﺪازهﮔﻴـﺮي‬

‫ﺗﺄﻳﻴﺪ ﻛﺮدهاﻧﺪ‪ 9-11.‬در ﻳﻚ ﻣﻄﺎﻟﻌﻪ اﺧﻴﺮ ﻣـﺎ ﻣﻮﻓـﻖ ﺷـﺪﻳﻢ ﻧﻘـﺶ اﻧﺘﻘـﺎل‬

‫ﺷﺎﺧﺺﻫﺎي اﻛﺴﻴﺪاﺗﻴﻮ ﺧﺎرج ﺷﺪه و ﭘﺲ از ﺷﺴﺘﺸﻮ در ﻣﺤﻠـﻮل ﺑـﺎﻓﺮ‬

‫ﻟﻜﻮﺳﻴﺖﻫﺎ را در اﻟﻘﺎي آﺳﻴﺐ ﻛﺒﺪي ﺑﻪدﻧﺒﺎل اﻳﺴﻜﻤﻲ‪ -‬ﭘﺮﻓﻴﻮژن ﻣﺠﺪد‬

‫ﻓﺴﻔﺎت ﺳﺎﻟﻴﻦ )‪ (PBS‬ﺑﻪ دو ﺑﺨﺶ ﺗﻘﺴﻴﻢ ﮔﺮدﻳﺪ ﻛﻪ ﻧﻴﻤﻲ از آن‪ ،‬ﺟﻬﺖ‬

‫ﻛﻠﻴﻮي در ﻣﻮش ﺳﻮري ‪ Inbred‬ﻧﺸﺎن دﻫـﻴﻢ‪ 12.‬ﻣﻄﺎﻟﻌـﻪ ﺣﺎﺿـﺮ ﻧﻘـﺶ‬

‫آزﻣﺎﻳﺸﺎت ﺑﺎﻓﺖﺷﻨﺎﺳﻲ در ﻣﺤﻠﻮل ﻓﺮﻣﺎﻟﻴﻦ ‪ %10‬ﻓﻴﻜﺲ ﮔﺮدﻳﺪه و ﻧـﻴﻢ‬

‫اﻧﺘﻘﺎل ﻟﻜﻮﺳﻴﺖﻫﺎ را از ﻣـﻮش ﻣﺒـﺘﻼ ﺑـﻪ آﺳـﻴﺐ ‪ IR‬ﻛﻠﻴـﻮي در اﻳﺠـﺎد‬

‫دﻳﮕﺮ ﺑﺮاي ﺗﻌﻴﻴﻦ ﻣﻴﺰان ﻣﺎﻟﻮن دي آﻟﺪﻫﺎﻳﺪ‬

‫)‪Malondialdehyde (MDA‬‬

‫آﺳﻴﺐ ﻛﻠﻴﻮي در ﻣﻮش ﭘﺬﻳﺮﻧﺪه ﺑﺮرﺳﻲ ﻣﻲﻧﻤﺎﻳﺪ‪ .‬در اﻳﻦ ﻣﻄﺎﻟﻌـﻪ ﭘـﺲ‬

‫و ﺳـﻮﭘﺮ اﻛـﺴﺎﻳﺪ دﻳـﺴﻤﻮﺗﺎز )‪ Superoxide Dismutase (SOD‬ﻛﺎﺗـﺎﻻز‪،‬‬

‫از ‪ 60‬دﻗﻴﻘﻪ اﻳﺴﻜﻤﻲ دوﻃﺮﻓﻪ ﺷﺮﻳﺎن ﻛﻠﻴﻮي و ﺧﻮنرﺳﺎﻧﻲ ﻣﺠـﺪد ﺳـﻪ‬

‫ﮔﻠﻮﺗﺎﺗﻴﻮن ﺗﻮﺗﺎل و )‪ Ferric Reducing Antioxidant Power (FRAP‬ﺗـﺎ‬

‫ﻣﻲﺑﺎﺷﺪ‪ .‬ﺳﺎﻟﻴﺎن زﻳﺎدي اﺳﺖ ﻛﻪ ﻧﻘﺶ ﻟﻜﻮﺳﻴﺖﻫـﺎ را در ﺿـﺎﻳﻌﺎت‬

‫ﺳﺎﻋﺘﻪ ﻧﻤﻮﻧﻪ ﺧﻮن ﻣﺤﻴﻄﻲ از ﻣﻮشﻫﺎ ﮔﺮﻓﺘﻪ و ﺳﭙﺲ ﻟﻜﻮﺳﻴﺖﻫـﺎي آن‬

‫روز آﻧﺎﻟﻴﺰ در‬

‫‪C‬‬

‫‪°‬‬

‫‪ -70‬ﻧﮕﻪداري ﺷﺪ‪.‬‬

‫اﻳﺰوﻟﻪ و ﺑﻪ ﻣﻮشﻫﺎي ﺳﺎﻟﻢ ﺗﺰرﻳﻖ ﺷـﺪ ﺗـﺎ اﺛـﺮ اﻳـﻦ ﻟﻜﻮﺳـﻴﺖﻫـﺎ ﺑـﺮ‬

‫آﻣــﺎدهﺳــﺎزي و اﻧﺘﻘــﺎل ﻟﻜﻮﺳــﻴﺖﻫــﺎ ﺑــﻪ ﻣــﻮشﻫــﺎي ﭘﺬﻳﺮﻧــﺪه‬

‫وﺿﻌﻴﺖ ﻋﻤﻠﻜﺮدي‪ ،‬ﺑﺎﻓﺘﻲ و اﺳﺘﺮس اﻛﺴﻴﺪاﺗﻴﻮ ﻛﻠﻴﻪ ﻣﻮشﻫـﺎي ﺳـﺎﻟﻢ‬

‫)‪ :(Recipient‬ﻧﻤﻮﻧﻪ ﺧﻮن ﺟﻤﻊآوري ﺷﺪه از ﻗﻠﺐ ﻣﻮشﻫﺎي ﮔﺮوهﻫﺎي‬ ‫‪C‬‬

‫‪°‬‬

‫‪4‬‬

‫ﻧﺸﺎن داده ﺷﻮد‪ .‬ﻧﺘﺎﻳﺞ اﻳﻦ ﭘﮋوﻫﺶ ﺑﻪﻃﻮر اﺧﺘﺼﺎﺻﻲ ﻧﻘﺶ ﻟﻜﻮﺳﻴﺖﻫﺎ‬

‫دﻫﻨــﺪه )ﻳــﻚ و دو( ﺑــﻪ ﻣــﺪت ‪ 10‬دﻗﻴﻘــﻪ در ‪ 4000‬دور در‬

‫را در اﻳﺠﺎد آﺳﻴﺐ ﻛﻠﻴﻪ ﺑﻪدﻧﺒﺎل ‪ IR‬ﻛﻠﻴﻮي ارزﻳﺎﺑﻲ ﻣﻲﻛﻨﺪ‪.‬‬

‫ﺳـﺎﻧﺘﺮﻳﻔﻮژ ﺷـﺪ‪ .‬ﺑﻌـﺪ از ﺑﺮداﺷـﺘﻦ ﭘﻼﺳـﻤﺎ‪ ،‬ﺑـﻪ ﺑﺎﻗﻴﻤﺎﻧـﺪه ﺟﻬـﺖ ﻟﻴــﺰ‬ ‫ارﻳﺘﺮوﺳﻴﺖﻫﺎ ﺑﻪ ﻧﺴﺒﺖ ﻳﻚ ﺑﻪ ‪ 10‬ﻣﺤﻠﻮل ﻛﻠﺮﻳﺪ آﻣﻮﻧﻴﻮم اﺿﺎﻓﻪ و ﭘـﻨﺞ‬ ‫دﻗﻴﻘﻪ در دﻣﺎي اﺗﺎق ﻧﮕﻪداري ﺷﺪ‪ .‬ﺳﭙﺲ ﺑﺮاي ﺧﺘﻢ واﻛﻨﺶ ‪ 20‬اﻟﻲ ‪30‬‬

‫روش ﺑﺮرﺳﻲ‬

‫ﻣﻴﻠﻲﻟﻴﺘﺮ ﺑـﺎﻓﺮ ﻓـﺴﻔﺎت ﺑـﻪ آن اﺿـﺎﻓﻪ و ﺑﻌـﺪ از ﺳـﺎﻧﺘﺮﻳﻔﻮژ ﻣﺠـﺪد در‬

‫اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﻨﻴﺎدي در ﺳﺎل ‪ 1389‬در ﮔـﺮوه ﻓﻴﺰﻳﻮﻟـﻮژي داﻧـﺸﻜﺪه‬

‫‪ ،1200rpm‬ﻟﻜﻮﺳﻴﺖﻫﺎي ﺗﻪﻧﺸﻴﻦ ﺷﺪه دو ﺑﺎر ﺑﺎ ﺑﺎﻓﺮ ﻓﺴﻔﺎت ﺷﺴﺘـﺸﻮ‬

‫ﭘﺰﺷﻜﻲ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان ﺑﻪ اﻧﺠﺎم رﺳﻴﺪه اﺳﺖ‪ .‬ﺗﻌـﺪاد ‪32‬‬

‫داده ﺷﺪ‪ .‬رﺳﻮب ﺑﺎ ‪ 500‬ﻣﻴﻜﺮوﻟﻴﺘﺮ ﻧﺮﻣﺎل ﺳﺎﻟﻴﻦ رﻗﻴﻖ ﺷﺪه و در واﺣﺪ‬

‫ﺳﺮ ﻣﻮش ﺳﻮري ‪ BALB/c‬ﻧﺮ در ﻣﺤﺪوده وزﻧﻲ ‪ 25-35‬ﮔـﺮم ﺑـﻪﻃـﻮر‬

‫‪(Trypan blue exclusion‬‬

‫ﺣﺠﻢ ﺑﺎ ﺗﻜﻨﻴـﻚ رﻧـﮓآﻣﻴـﺰي ﺗﺮﻳﭙـﺎن ﺑﻠـﻮ‬ ‫‪6‬‬

‫‪(IR‬‬

‫ﺗﺼﺎدﻓﻲ اﻧﺘﺨﺎب و ﺑﻪ ﭼﻬﺎر ﮔﺮوه ﻫﺸﺖ ﺗﺎﻳﻲ ﺗﻘﺴﻴﻢ ﺷـﺪﻧﺪ‪ -1 :‬ﮔـﺮوه‬

‫)‪ technique‬ﺷــﻤﺎرش ﮔﺮدﻳــﺪ‪ 5×10 .‬ﻟﻜﻮﺳــﻴﺖ از ﮔــﺮوه ﻳــﻚ‬

‫‪ ،IR‬دﻫﻨﺪه ﻟﻜﻮﺳـﻴﺖ )‪ -2 .(IR donor‬ﮔـﺮوه ‪ ،Sham‬دﻫﻨـﺪه ﻟﻜﻮﺳـﻴﺖ‬

‫)‪ donor‬ﺑﻪ ﮔﺮوه ﺳﻪ )‪ (IR recipient‬و ﻫﻤﻴﻦ ﺗﻌﺪاد ﻟﻜﻮﺳـﻴﺖ از ﮔـﺮوه‬

‫‪IR donor‬‬

‫دو )‪ (Sham donor‬ﺑﻪ ﮔﺮوه ﭼﻬﺎر )‪ (Sham recipient‬ﺗﻮﺳﻂ ﺗﺰرﻳـﻖ از‬

‫)‪ -3 .(Sham donor‬ﮔــﺮوه درﻳﺎﻓــﺖﻛﻨﻨــﺪه ﻟﻜﻮﺳــﻴﺖ از‬ ‫)‪ -4 .(IR recipient‬ﮔــﺮوه درﻳﺎﻓــﺖﻛﻨﻨــﺪه ﻟﻜﻮﺳــﻴﺖ از‬

‫‪Sham donor‬‬

‫راه ورﻳﺪ دﻣﻲ اﻧﺘﻘﺎل داده ﺷﺪ‪.‬‬

‫)‪ .(Sham recipient‬دو ﮔﺮوه اول ﻣﻮشﻫﺎ ﺗﻮﺳﻂ ﺗﺰرﻳﻖ داﺧﻞ ﺻـﻔﺎﻗﻲ‬

‫روش ﻧﻤﻮﻧﻪﮔﻴﺮي از ﺣﻴﻮاﻧﺎت ﭘﺬﻳﺮﻧﺪه ﻟﻜﻮﺳﻴﺖﻫﺎ‪ :‬ﺣﻴﻮاﻧﺎت ﭘـﺲ‬

‫‪ (60mg/kg ،Sigma, Co,‬ﺑﻴﻬـﻮش ﺷـﺪﻧﺪ‪ .‬در‬

‫از ﻣــﺪت ‪ 24‬ﺳــﺎﻋﺖ ﺑــﺎ ﺗﺰرﻳــﻖ داﺧــﻞ ﺻــﻔﺎﻗﻲ ﭘﻨﺘﻮﺑﺎرﺑﻴﺘــﺎل ﺳــﺪﻳﻢ‬

‫ﺗﻤﺎم اﻳﻦ ﻣﺪت درﺟﻪ ﺣﺮارت ﺑﺪن ﺣﻴﻮان ﻛﻨﺘﺮلﺷﺪه و ﻓـﺸﺎر ﺷـﺮﻳﺎﻧﻲ‬

‫)‪ (60mg/kg‬ﺑﻴﻬﻮش ﺷﺪﻧﺪ و ﻧﻤﻮﻧـﻪ ﺧـﻮن ورﻳـﺪي از ورﻳـﺪ اﺟـﻮف‬

‫ﺗﻮﺳﻂ ‪ Tail cuff‬اﻧﺪازهﮔﻴﺮي ﺷﺪ‪ .‬ﺳﭙﺲ ﺗﺤﺖ ﺷﺮاﻳﻂ اﺳـﺘﺮﻳﻞ ﺑﺮﺷـﻲ‬

‫ﺗﺤﺘﺎﻧﻲ ﺑﻪ ﻣﻨﻈﻮر اﻧﺪازهﮔﻴﺮي ﺷﺎﺧﺺﻫﺎي ﻋﻤﻠﻜﺮدي ﻛﻠﻴﻪ ﮔﺮﻓﺘﻪ ﺷـﺪ‪.‬‬

‫در ﺧﻂ وﺳﻂ روي ﺷﻜﻢ اﻳﺠﺎد ﮔﺮدﻳﺪ‪ .‬در ﮔﺮوه ‪ ،IR donor‬ﺑﺎ اﺳـﺘﻔﺎده‬

‫ﺳﭙﺲ ﻛﻠﻴﻪ ﭼـﭗ در آورده ﺷـﺪ و ﭘـﺲ از ﺷﺴﺘـﺸﻮ در ﻣﺤﻠـﻮل ﺑـﺎﻓﺮ‬

‫از ﻛﻠﻤﭗ ﺑﻮﻟﺪاگ ‪ 60‬دﻗﻴﻘﻪ اﻳﺴﻜﻤﻲ دوﻃﺮﻓﻪ ﺷﺮﻳﺎن ﻛﻠﻴﻮي داده ﺷﺪ و‬

‫ﻓﺴﻔﺎت ﺳﺎﻟﻴﻦ )‪ (PBS‬ﻗﺴﻤﺘﻲ از ﻛﻠﻴﻪ ﺑﺮاي ﺑﺮرﺳﻲﻫـﺎي ﻣﻮرﻓﻮﻟﻮژﻳـﻚ‬

‫ﭘﺲ از آن ﺳﻪ ﺳﺎﻋﺖ ﺧﻮنرﺳﺎﻧﻲ ﻣﺠﺪد ﺑﺮﻗـﺮار ﮔﺮدﻳـﺪ‪ .‬ﺗﻐﻴﻴـﺮ رﻧـﮓ‬

‫در ﻓﺮﻣﺎﻟﻴﻦ ‪ %10‬ﻓﻴﻜﺲ ﮔﺮدﻳﺪ‪ .‬ﺑﻘﻴﻪ آن ﺑﺮاي ﻳﺦ زدﮔﻲ ﺳﺮﻳﻊ ﺑﻼﻓﺎﺻﻠﻪ‬

‫ﻛﻠﻴﻪﻫﺎ ﻧﺸﺎنﮔﺮ ﺗﺎﻳﻴﺪ و رﻓﻊ اﻧﺴﺪاد ﺷﺮﻳﺎن ﻛﻠﻴﻮي ﻣـﻲﺑﺎﺷـﺪ‪ .‬در ﮔـﺮوه‬

‫ﺑﻪداﺧـﻞ ﻧﻴﺘـﺮوژن ﻣـﺎﻳﻊ ﮔﺬاﺷـﺘﻪ ﺷـﺪ و ﺳـﭙﺲ ﺟﻬـﺖ اﻧـﺪازهﮔﻴـﺮي‬

‫ﭘﻨﺘﻮﺑﺎرﺑﻴﺘﺎل ﺳﺪﻳﻢ‬

‫)‪USA‬‬

‫‪C‬‬

‫‪°‬‬

‫‪-70‬‬

‫‪ Sham donor‬ﻧﻴﺰ ﺗﻤﺎم اﻋﻤﺎل ﺟﺮاﺣﻲ ﻓﻮق اﻧﺠﺎم ﺷـﺪه اﻣـﺎ ﺷـﺮﻳﺎنﻫـﺎ‬

‫ﺷﺎﺧﺺﻫـﺎي ذﻛـﺮ ﺷـﺪه در ﺑـﺎﻻ ﺗـﺎ زﻣـﺎن آﻧـﺎﻟﻴﺰ در ﻓﺮﻳـﺰر‬

‫ﻛﻠﻤــﭗ ﻧﮕﺮدﻳـﺪ‪ .‬در اﻧﺘﻬــﺎي آزﻣــﺎﻳﺶ ﻧﻤﻮﻧــﻪ ﺧــﻮن ﻣﺤﻴﻄــﻲ از ﻗﻠــﺐ‬

‫ﻧﮕﻪداري ﺷﺪ‪ .‬ﺑﺮاي ﺗﻬﻴﻪ ﭘﻼﺳﻤـﺎ‪ ،‬ﻧﻤﻮﻧـﻪﻫـﺎي ﺧـﻮن ﺑـﺎ دور ‪ 4000‬ﺑﻪ‬

‫آﺳﻴﺐ ﻛﻠﻴﻮي ﭘﺬﻳﺮﻧﺪه ﭘﺲ از اﻧﺘﻘﺎل ﻟﻜﻮﺳﻴﺖﻫﺎ از ﻣﻮش ﺑﺎ اﻳﺴﻜﻤﻲ‪ -‬ﺧﻮنرﺳﺎﻧﻲ ﻣﺠﺪد ﻛﻠﻴﻮي‬

‫‪Reperfusion‬‬

‫‪Ischemia‬‬ ‫‪IR group‬‬ ‫‪60 min‬‬

‫‪3 hrs‬‬

‫‪71‬‬

‫ﻧﺎرﺳﺎﻳﻲ ﺣﺎد ﻛﻠﻴـﻪ اﻳـﺴﻜﻤﻴﻚ ﺳـﺒﺐ اﻟﻘـﺎي آﺳـﻴﺐ ﻋﻤﻠﻜـﺮدي ﻛﻠﻴـﻪ‬ ‫ﮔﺮدﻳــﺪ‪ .‬در ﮔــﺮوهﻫــﺎي ‪ IR recipient‬و ‪ Sham recipient‬ﺗﻔــﺎوت‬

‫‪Sham group‬‬ ‫‪4 hrs‬‬

‫ﻣﻌﻨﻲداري در ﻏﻠﻈﺖ ﭘﻼﺳﻤﺎﻳﻲ ‪ BUN‬ﻣﻼﺣﻈﻪ ﻧﺸﺪ )ﻧﻤﻮدار ‪.(1b‬‬ ‫ﻏﻠﻈﺖ ﻛﺮاﺗﻴﻨﻴﻦ ﭘﻼﺳﻤﺎ در ﮔﺮوه ‪ IR donor‬اﻓﺰاﻳﺶ ﻣﻌﻨـﻲداري در‬

‫‪WBC receptive‬‬ ‫‪groups‬‬ ‫‪WBC transfer‬‬

‫‪24 hrs‬‬

‫‪Time‬‬

‫ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﮔﺮوه ‪ Sham donor‬داﺷﺖ )ﻧﻤـﻮدار ‪ .(1a‬اﻓـﺰاﻳﺶ ﻛـﺮاﺗﻴﻨﻴﻦ‬ ‫ﻧﺸﺎندﻫﻨﺪه آﺳﻴﺐ ﻋﻤﻠﻜﺮدي ﻛﻠﻴـﻪ در ﮔـﺮوه ‪ IR donor‬ﻣـﻲﺑﺎﺷـﺪ‪ .‬در‬

‫ﺧﻼﺻﻪ ﻣﺮاﺣﻞ ﻣﻄﺎﻟﻌﻪ ﻛﻪ زﻣﺎن اﻧﺘﻘﺎل ﻟﻜﻮﺳﻴﺖﻫﺎ ﺑﻪ ﻣﻮشﻫﺎي ﺳﺎﻟﻢ و ﺧﺎﺗﻤﻪ‬

‫ﮔــﺮوهﻫــﺎي ‪ IR recipient‬و ‪ Sham recipient‬ﺗﻔــﺎوت ﻣﻌﻨــﻲداري در‬

‫ﭘﺮوﺗﻜﻞ و زﻣﺎن ﻧﻤﻮﻧﻪﮔﻴﺮي را ﻧﺸﺎن ﻣﻲدﻫﺪ‪.‬‬

‫ﻏﻠﻈﺖ ﭘﻼﺳﻤﺎﻳﻲ ﻛﺮاﺗﻴﻨﻴﻦ ﻣﻼﺣﻈﻪ ﻧﺸﺪ )ﻧﻤﻮدار ‪.(1b‬‬ ‫ﺑﺮرﺳﻲ ﺗﻐﻴﻴﺮات ﺷﺎﺧﺺﻫﺎي اﺳﺘﺮس اﻛﺴﻴﺪاﺗﻴﻮ ﻛﻠﻴﻪ در ﮔﺮوهﻫـﺎ‪:‬‬ ‫ﻣﻴﺰان ﻣﺎﻟﻮن ديآﻟﺪﻫﺎﻳﺪ )‪ (MDA‬در ﺑﺎﻓﺖ ﻛﻠﻴﻪ ﮔﺮوه ‪ IR donor‬اﻓﺰاﻳﺶ‬

‫ﻣﺪت ‪ 10‬دﻗﻴﻘﻪ در دﻣﺎي ‪ 0-4 °C‬ﺳﺎﻧﺘﺮﻳﻔﻮژ ﺷﺪ‪ .‬ﺗﻤﺎم ﻧﻤﻮﻧﻪﻫﺎ ﺗﺎ زﻣﺎن‬

‫ﻣﻌﻨﻲداري در ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﮔﺮوه ‪ Sham donor‬داﺷـﺖ )ﻧﻤـﻮدار ‪ .(2a‬ﺑـﻪ‬

‫آﻧﺎﻟﻴﺰ در ﻓﺮﻳﺰر ‪ -70 °C‬ﻧﮕﻪداري ﺷﺪﻧﺪ‪.‬‬

‫اﻳﻦ ﺗﺮﺗﻴﺐ در اﻳﻦ ﺗﺤﻘﻴﻖ ﻣﻴﺰان ‪ MDA‬ﺑﻪ ﻋﻨﻮان ﺷﺎﺧﺺ اﻳﺠﺎد اﺳﺘﺮس‬

‫ﺑﺮرﺳــﻲ ﺗﻐﻴﻴــﺮات ﻓــﺸﺎر ﺳﻴــﺴﺘﻮﻟﻴﻚ‪ :‬در ﻃــﻲ ﺟﺮاﺣــﻲ ﻓــﺸﺎر‬ ‫ﺳﻴﺴﺘﻮﻟﻴﻚ و ﺿﺮﺑﺎن ﻗﻠـﺐ در ﮔـﺮوه ‪ IR donor‬و‬

‫ﮔـﺮوه ‪Sham donor‬‬ ‫‪B‬‬

‫ﺗﻮﺳﻂ ‪ Tail cuff‬ﻣﺘﺼﻞ ﺑﻪ دﺳﺘﮕﺎه ‪ Power lab‬ﻣﺎﻧﻴﺘﻮر و ﺛﺒﺖ ﮔﺮدﻳﺪ‪.‬‬

‫‪A‬‬

‫ﺑﺮرﺳﻲ ﺑﺎﻓﺖﺷﻨﺎﺳﻲ ﻛﻠﻴﻪﻫﺎ‪ :‬ﻛﻠﻴﻪﻫﺎ در ﻓﺮﻣﺎﻟﻴﻦ ‪ %10‬ﻓﻴﻜﺲ و ﭘﺲ‬ ‫از آبﮔﻴﺮي در ﭘﺎراﻓﻴﻦ ﻗﺎﻟﺐﮔﻴﺮي ﮔﺮدﻳﺪﻧـﺪ‪ .‬از اﻳـﻦ ﻛﻠﻴـﻪﻫـﺎ ﻣﻘـﺎﻃﻊ‬ ‫ﺑﺎﻓﺘﻲ )ﭼﻬﺎر ﻣﻴﻜﺮوﻣﺘﺮ( ﺗﻬﻴﻪ و ﺑﺎ اﺋﻮزﻳﻦ و ﻫﻤﺎﺗﻮﻛﺴﻴﻠﻴﻦ رﻧـﮓآﻣﻴـﺰي‬ ‫ﺷﺪ‪ .‬ﺑﺮرﺳﻲ ﻣﻘﺎﻃﻊ ﺑﺎﻓﺘﻲ ﺑﺎ ﻣﻴﻜﺮوﺳﻜﻮپ ﻧـﻮري اﻧﺠـﺎم ﮔﺮدﻳـﺪ‪ .‬ﻫﻤـﻪ‬ ‫ﻣﻘﺎﻃﻊ ﻛﻠﻴﻪ ﺣﺪاﻗﻞ در ‪ 10‬ﺣﻮزه ﺗﺼﺎدﻓﻲ ﻛﻪ ﺑﺎ ﻫﻢ ﺗﺪاﺧﻞ ﻧﺪاﺷـﺘﻨﺪ ﺑـﺎ‬ ‫‪D‬‬

‫ﺑﺰرگﻧﻤﺎﻳﻲ ‪ 400‬ﻣﺸﺎﻫﺪه ﺷﺪﻧﺪ‪ .‬ﻣﻴﺰان آﺳـﻴﺐ ﺑـﻪ ﺻـﻮرت واﻛﻮﺋﻮﻟـﻪ‬

‫‪C‬‬

‫ﺷﺪن و اﻧﻬﺪام ﺳﻠﻮلﻫﺎ‪ ،‬اﻧﻬﺪام ﺗﻮﺑﻮلﻫﺎ‪ ،‬ﺣﻀﻮر ‪ Cast‬ﻫـﺎي ﻟﻮﻣﻴﻨـﺎل و‬ ‫ﻣﻮاد ﭘﺮوﺗﻴﻴﻨﻲ و از دﺳﺖ رﻓﺘﻦ ﻟﺒﻪ ﺑﺮوﺳﻲ ﺗﻮﺑﻮل ﭘﺮوﮔﺰﻳﻤﺎل ﻣﻲﺑﺎﺷﻨﺪ‪.‬‬ ‫در اﻳﻦ ﺗﺤﻘﻴﻖ ﻧﺘﺎﻳﺞ ﺑﺮاﺳﺎس ﺑﺮﻧﺎﻣﻪ آﻣﺎري ‪ SPSS‬وﻳﺮاﺳﺖ ‪ 10‬و ﺗﻮﺳﻂ‬ ‫‪ Unpaired t- test‬اﻧﺠﺎم ﺷﺪ‪ .‬دادهﻫﺎ ﺑﻪﺻـﻮرت ‪ Mean±S.E.M‬ﮔـﺰارش‬ ‫ﮔﺮدﻳﺪ و اﺧﺘﻼف ﻣﻌﻨﻲدار در ﺳﻄﺢ ‪ P<0/05‬در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ‪.‬‬

‫ﺷﻜﻞ‪ :1 -‬ﺗﻐﻴﻴﺮات ﻫﻴﺴﺘﻮﻟﻮژي ﻛﻠﻴﻪ در ﮔﺮوهﻫﺎي ﻣﺨﺘﻠﻒ‪ .‬ﺑﺰرگﻧﻤﺎﻳﻲ‪:A .400 × :‬‬ ‫ﮔﺮوه ‪ :B ،IR donor‬ﮔﺮوه ‪ :C ،Sham donor‬ﮔﺮوه ‪ IR recipient‬و ‪ :D‬ﮔﺮوه ‪.Sham recipient‬‬ ‫ﮔﺮوه ‪ IR donor‬در ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﮔﺮوه ‪ Sham donor‬آﺳﻴﺐﻫﺎي ﺑﺴﻴﺎري را ﻧﺸﺎن داد‪ .‬اﻳﻦ ﺗﻐﻴﻴﺮات‬

‫ﻳﺎﻓﺘﻪﻫﺎ‬

‫ﺷﺎﻣﻞ اﻧﻬﺪام ﮔﺴﺘﺮده ﺗﻮﺑﻮلﻫﺎ‪ ،‬ﻧﻜﺮوز ﻧﺴﺒﺘﺎ وﺳﻴﻊ ﺑﻪﺧﺼﻮص در ﺗﻮﺑﻮلﻫﺎي ﭘﺮوﮔﺰﻳﻤﺎل‪ ،‬وﺟﻮد‬ ‫اﻧﺴﺪاد ﺗﻮﺑﻮﻟﻲ ﻗﺎﺑﻞ ﻣﻼﺣﻈﻪ ﺑﻪوﻳﮋه در ﺗﻮﺑﻮلﻫﺎي اﻧﺘﻬﺎﻳﻲﺗﺮ‪ ،‬ﻛﻢ ﺷﺪن ﺿﺨﺎﻣﺖ ﺳﻠﻮلﻫﺎ و ﺗﺤﺖ‬

‫ﺑﺮرﺳﻲ ﺗﻐﻴﻴﺮات ﻓﺸﺎر ﺳﻴﺴﺘﻮﻟﻴﻚ در ﮔﺮوهﻫﺎ‪ :‬ﺗﻔـﺎوت ﻣﻌﻨـﻲداري‬ ‫ﺑﻴﻦ ﻣﻴﺎﻧﮕﻴﻦ ﻓﺸﺎر ﺳﻴﺴﺘﻮﻟﻴﻚ در ﮔﺮوهﻫﺎ ﻣﺸﺎﻫﺪه ﻧﮕﺮدﻳﺪ‪.‬‬ ‫ﺑﺮرﺳﻲ ﺗﻐﻴﻴﺮات ﺷﺎﺧﺺﻫﺎي ﻋﻤﻠﻜﺮدي ﻛﻠﻴﻪ در ﮔﺮوهﻫـﺎ‪ :‬ﻏﻠﻈـﺖ‬

‫ﻓﺸﺎر ﺑﻮدن ﺳﻠﻮلﻫﺎي اﭘﻴﺘﻠﻴﺎل ﺗﻮﺑﻮﻟﻲ ﻣﻲﺑﺎﺷﺪ‪ .‬در ﮔﺮوه ‪ ،Sham recipient‬اﮔﺮﭼﻪ ﻣﻘﺪاري از‬ ‫ﺿﺨﺎﻣﺖ ﺳﻠﻮلﻫﺎ ﻛﻢ ﺷﺪه و ﺗﺎ ﺣﺪي ﺣﺎﺷﻴﻪﻫﺎي ﻟﻮﻣﻴﻨﺎل ﺳﻠﻮلﻫﺎ ‪ Attenuation‬ﻧﺸﺎن ﻣﻲدﻫﻨﺪ‬ ‫وﻟﻲ اﻧﻬﺪام ﺳﻠﻮلﻫﺎ و آﺳﻴﺐ ﻏﻴﺮ ﻗﺎﺑﻞ ﺑﺮﮔﺸﺘﻲ وﺟﻮد ﻧﺪارد‪ .‬در ﮔﺮوه ‪ ،IR recipient‬ﻧﺴﺒﺖ ﺑﻪ‬ ‫ﮔﺮوه ﺷﻢ ﻣﺮﺑﻮﻃﻪ واﻛﻮﺋﻮﻟﻪ ﺷﺪن ﺳﻠﻮلﻫﺎ و ﺗﺸﻜﻴﻞ ﻣﻘﺎدﻳﺮي رﺳﻮب درون ﺗﻮﺑﻮلﻫﺎ ﺑﻪ ﭼﺸﻢ‬ ‫ﻣﻲرﺳﺪ اﻣﺎ ﺗﻮﺑﻮلﻫﺎ ﻫﻨﻮز دﺳﺖ ﻧﺨﻮرده ﻫﺴﺘﻨﺪ و ﺗﻐﻴﻴﺮ ﻏﻴﺮ ﻗﺎﺑﻞ ﺑﺮﮔﺸﺘﻲ از ﺟﻤﻠﻪ ﻧﻜﺮوز ﺗﻮﺑﻮﻟﻲ‬

‫‪ BUN‬در ﭘﻼﺳﻤﺎي ﮔﺮوه ‪ IR donor‬اﻓﺰاﻳﺶ ﻣﻌﻨـﻲداري در ﻣﻘﺎﻳـﺴﻪ ﺑـﺎ‬

‫دﻳﺪه ﻧﻤﻲﺷﻮد‪ .‬در ﻣﺠﻤﻮع اﻳﻦ ﮔﺮوه در آﻏﺎز ﮔﺴﺘﺮش آﺳﻴﺐ ﺑﺎﻓﺘﻲ اﺳﺖ و ﺗﻔﺎوت ﺑﺴﻴﺎري ﺑﺎ‬

‫ﮔﺮوه ‪ Sham donor‬داﺷﺖ )ﻧﻤﻮدار ‪ .(1a‬ﺑﻪ اﻳﻦ ﺗﺮﺗﻴﺐ در اﻳﻦ ﺗﺤﻘﻴـﻖ‬

‫ﮔﺮوه ‪ IR donor‬دارد‪.‬‬

‫‪72‬‬

‫ﻣﻬﺮي ﻛﺪﺧﺪاﻳﻲ و ﻫﻤﻜﺎران‬

‫اﻛﺴﻴﺪاﺗﻴﻮ در ﺑﺎﻓﺖ ﻛﻠﻴﻪ ﭘﺲ از اﻟﻘﺎي ﻧﺎرﺳـﺎﻳﻲ ﺣـﺎد ﻛﻠﻴـﻪ اﻳـﺴﻜﻤﻴﻚ‬

‫ﻣﻌﻨﻲداري در ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﮔﺮوه ‪ Sham donor‬داﺷـﺖ )ﻧﻤـﻮدار ‪ .(3a‬ﺑـﻪ‬

‫اﻓﺰاﻳﺶ ﻳﺎﻓﺖ‪ .‬ﻫﻢﭼﻨﻴﻦ ﺗﻔﺎوت ﻣﻌﻨﻲداري در ﻣﻴﺰان ‪ MDA‬ﺑﺎﻓـﺖ ﻛﻠﻴـﻪ‬

‫اﻳﻦ ﺗﺮﺗﻴﺐ در اﻳﻦ ﺗﺤﻘﻴﻖ ﻛﺎﻫﺶ ﻣﻴـﺰان ﮔﻠﻮﺗـﺎﺗﻴﻮن ﺑـﻪ ﻋﻨـﻮان اﻳﺠـﺎد‬

‫در ﮔﺮوهﻫﺎي ‪ IR recipient‬و ‪ Sham recipient‬دﻳﺪه ﺷﺪ )ﻧﻤـﻮدار ‪.(2b‬‬

‫اﺳﺘﺮس اﻛﺴﻴﺪاﺗﻴﻮ در ﺑﺎﻓﺖ ﻛﻠﻴـﻪ ﭘـﺲ از اﻟﻘـﺎي ﻧﺎرﺳـﺎﻳﻲ ﺣـﺎد ﻛﻠﻴـﻪ‬

‫‪IR‬‬

‫اﻳــﺴﻜﻤﻴﻚ ﺗﻠﻘــﻲ ﮔﺮدﻳــﺪ‪ .‬ﻫــﻢﭼﻨــﻴﻦ ﺗﻔــﺎوت ﻣﻌﻨــﻲداري در ﻣﻴــﺰان‬

‫‪ recipient‬ﺳﺒﺐ اﻓـﺰاﻳﺶ ﻣﻴـﺰان ‪ MDA‬در اﻳـﻦ ﮔـﺮوه ﮔﺮدﻳـﺪ‪ .‬ﻣﻴـﺰان‬

‫ﮔﻠﻮﺗﺎﺗﻴﻮن ﺑﺎﻓﺖ ﻛﻠﻴـﻪ در ﮔـﺮوهﻫـﺎي‬

‫‪ IR recipient‬و ‪Sham recipient‬‬

‫ﮔﻠﻮﺗﺎﺗﻴﻮن )‪ (Total glutathione‬در ﺑﺎﻓﺖ ﻛﻠﻴﻪ ﮔﺮوه ‪ IR donor‬ﻛـﺎﻫﺶ‬

‫دﻳـﺪه ﺷﺪ )ﻧﻤﻮدار ‪ .(3b‬ﺑﻪ اﻳـﻦ ﺗﺮﺗﻴـﺐ اﻧﺘـﻘﺎل ﻟـﻜﻮﺳﻴـﺖﻫﺎي ﮔـﺮوه‬

‫ﺑﻪ اﻳﻦ ﺗﺮﺗﻴـﺐ اﻧﺘﻘـﺎل ﻟﻜﻮﺳـﻴﺖﻫـﺎي ﮔـﺮوه ‪ IR donor‬ﺑـﻪ ﮔـﺮوه‬

‫ﻧﻤﻮدار‪ :1 -‬ﺗﻐﻴﻴﺮات ﻏﻠﻈﺖ ‪ BUN‬و ﻛﺮاﺗﻴﻨﻴﻦ ﭘﻼﺳﻤﺎ در ﮔﺮوهﻫﺎي ﻣﺨﺘﻠﻒ‪ (a .‬ﻣﻘﺎﻳﺴﻪ ‪ IR donor‬و ‪ (b .Sham donor‬ﻣﻘﺎﻳﺴﻪ ‪ IR recipient‬و ‪ .Sham recipient‬ﺳﺘﻮنﻫﺎ ﻧﻤﺎﻳﺎنﮔﺮ‬

‫ﻣﻴـﺎﻧﮕﻴﻦ‪±‬‬

‫ﺧﻄﺎي ﻣﻌﻴﺎر ﻣﻲﺑﺎﺷﺪ‪ * .‬اﺧﺘﻼف ﻣﻌﻨﻲدار را ﻧﺴﺒﺖ ﺑﻪ ﮔﺮوه ‪ Sham donor‬در ﺳﻄﺢ ‪ P<0/05‬ﻧﺸﺎن ﻣﻲدﻫﺪ‪.‬‬

‫ﻧﻤﻮدار‪ :2 -‬ﺗﻐﻴﻴﺮات ﻏﻠﻈﺖ ‪ MDA‬ﻛﻠﻴﻮي در ﮔﺮوهﻫﺎي ﻣﺨﺘﻠﻒ‪ (a .‬ﻣﻘﺎﻳﺴﻪ ‪ IR donor‬و ‪ (b .Sham donor‬ﻣﻘﺎﻳﺴﻪ ‪ IR recipient‬و ‪ .Sham recipient‬ﺳﺘﻮنﻫﺎ ﻧﻤﺎﻳﺎنﮔﺮ ﻣﻴﺎﻧﮕﻴﻦ‪ ±‬ﺧﻄﺎي ﻣﻌﻴـﺎر‬ ‫ﻣﻲﺑﺎﺷﺪ‪ * .‬اﺧﺘﻼف ﻣﻌﻨﻲدار را ﻧﺴﺒﺖ ﺑﻪ ﮔﺮوه ‪ Sham‬ﻣﺮﺑﻮﻃﻪ در ﺳﻄﺢ ‪ P<0/05‬ﻧﺸﺎن ﻣﻲدﻫﺪ‪.‬‬

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‫ﻧﻤﻮدار‪ :3 -‬ﺗﻐﻴﻴﺮات ﻏﻠﻈﺖ ﮔﻠﻮﺗﺎﺗﻴﻮن و ‪ FRAP‬ﻛﻠﻴﻮي در ﮔﺮوهﻫﺎي ﻣﺨﺘﻠـﻒ‪ (a .‬ﻣﻘﺎﻳـﺴﻪ ‪ IR donor‬و ‪ (b .Sham donor‬ﻣﻘﺎﻳـﺴﻪ ‪ IR recipient‬و ‪ .Sham recipient‬ﺳـﺘﻮنﻫـﺎ ﻧﻤﺎﻳـﺎنﮔـﺮ‬ ‫ﻣﻴﺎﻧﮕﻴﻦ‪ ±‬ﺧﻄﺎي ﻣﻌﻴﺎر ﻣﻲﺑﺎﺷﺪ‪ * .‬اﺧﺘﻼف ﻣﻌﻨﻲدار را ﻧﺴﺒﺖ ﺑﻪ ﮔﺮوه ‪ Sham‬ﻣﺮﺑﻮﻃﻪ در ﺳﻄﺢ ‪ P<0/05‬ﻧﺸﺎن ﻣﻲدﻫﺪ‪.‬‬

‫ﻧﻤﻮدار‪ :4 -‬ﺗﻐﻴﻴﺮات ﻣﻴﺰان آﻧﺰﻳﻢﻫﺎي ﺳﻮﭘﺮ اﻛﺴﻴﺪ دﻳﺴﻤﻮﺗﺎز و ﻛﺎﺗﺎﻻز ﻛﻠﻴـﻮي در ﮔـﺮوهﻫـﺎي ﻣﺨﺘﻠـﻒ‪ (a .‬ﻣﻘﺎﻳـﺴﻪ ‪ IR donor‬و ‪ (b .Sham donor‬ﻣﻘﺎﻳـﺴﻪ ‪ IR recipient‬و‬

‫‪Sham‬‬

‫‪ .recipient‬ﺳﺘﻮنﻫﺎ ﻧﻤﺎﻳﺎنﮔﺮ ﻣﻴﺎﻧﮕﻴﻦ‪ ±‬ﺧﻄﺎي ﻣﻌﻴﺎر ﻣﻲﺑﺎﺷﺪ‪ * .‬اﺧﺘﻼف ﻣﻌﻨﻲدار را ﻧﺴﺒﺖ ﺑﻪ ﮔﺮوه ‪ Sham‬ﻣﺮﺑﻮﻃﻪ در ﺳﻄﺢ ‪ P<0/05‬ﻧﺸﺎن ﻣﻲدﻫﺪ‪.‬‬

‫ﻣﻬﺮي ﻛﺪﺧﺪاﻳﻲ و ﻫﻤﻜﺎران‬

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‫‪ IR donor‬ﺑﻪ ﮔﺮوه ‪ IR recipient‬ﺳﺒﺐ ﻛﺎﻫﺶ ﻣﻴﺰان ﮔﻠﻮﺗﺎﺗﻴﻮن ﺗـﺎم در‬

‫ﻣﻼﺣﻈﻪ ﺑﻪوﻳﮋه در ﺗﻮﺑﻮلﻫﺎي اﻧﺘﻬﺎﻳﻲﺗﺮ‪ ،‬ﻛﻢ ﺷﺪن ﺿﺨﺎﻣﺖ ﺳﻠﻮلﻫﺎ و‬

‫اﻳﻦ ﮔﺮوه ﮔﺮدﻳﺪ‪ .‬ﻣﻴﺰان ﻗﺪرت ﺗﺎم آﻧﺘـﻲ اﻛـﺴﻴﺪاﻧﻲ )‪ (FRAP‬در ﺑﺎﻓـﺖ‬

‫‪Sham‬‬

‫ﻛﻠﻴﻪ ﮔﺮوه ‪ IR donor‬ﻛـﺎﻫﺶ ﻣﻌﻨـﻲداري در ﻣﻘﺎﻳـﺴﻪ ﺑـﺎ ﮔـﺮوه‬

‫ﺗﺤﺖ ﻓﺸﺎر ﺑﻮدن ﺳﻠﻮلﻫﺎي اﭘﻴﺘﻠﻴﺎل ﺗﻮﺑﻮﻟﻲ ﻣﻲﺑﺎﺷﺪ‪ .‬در ﮔـﺮوه‬

‫‪Sham‬‬

‫‪ ،recipient‬اﮔﺮﭼﻪ ﻣﻘﺪاري از ﺿﺨﺎﻣﺖ ﺳﻠﻮلﻫﺎ ﻛﻢ ﺷـﺪه و ﺗـﺎ ﺣـﺪي‬

‫‪ donor‬داﺷﺖ )ﻧﻤﻮدار ‪ .(3a‬ﺑﻪ اﻳﻦ ﺗﺮﺗﻴﺐ در اﻳﻦ ﺗﺤﻘﻴﻖ ﻛﺎﻫﺶ ﻣﻴـﺰان‬

‫ﺣﺎﺷﻴﻪﻫﺎي ﻟﻮﻣﻴﻨﺎل ﺳﻠﻮلﻫﺎ ﻛﺎﻫﺶ ﻧﺸﺎن ﻣﻲدﻫﻨﺪ وﻟﻲ اﻧﻬﺪام ﺳﻠﻮلﻫـﺎ‬

‫‪ FRAP‬ﺑﻪ ﻋﻨﻮان اﻳﺠﺎد اﺳﺘﺮس اﻛﺴﻴﺪاﺗﻴﻮ در ﺑﺎﻓﺖ ﻛﻠﻴـﻪ ﭘـﺲ از اﻟﻘـﺎي‬

‫و آﺳﻴﺐ ﻏﻴﺮ ﻗﺎﺑﻞ ﺑﺮﮔـﺸﺘﻲ وﺟـﻮد ﻧـﺪارد )ﺷـﻜﻞ ‪ .(1D‬در ﮔـﺮوه‬

‫‪IR‬‬

‫ﻧﺎرﺳﺎﻳﻲ ﺣﺎد ﻛﻠﻴﻪ اﻳﺴﻜﻤﻴﻚ ﺗﻠﻘﻲ ﮔﺮدﻳﺪ‪ .‬اﮔﺮﭼﻪ اﻧﺘﻘﺎل ﻟﻜﻮﺳﻴﺖﻫـﺎي‬

‫‪ ،recipient‬ﻧﺴﺒﺖ ﺑﻪ ﮔﺮوه ﺷـﻢ ﻣﺮﺑﻮﻃـﻪ واﻛﻮﺋﻮﻟـﻪ ﺷـﺪن ﺳـﻠﻮلﻫـﺎ و‬

‫ﮔﺮوه ‪ IR donor‬ﺑﻪ ﮔـﺮوه ‪ IR recipient‬ﺳـﺒﺐ ﻛـﺎﻫﺶ ﻣﻴـﺰان ﻓﻌﺎﻟﻴـﺖ‬

‫ﺗﺸﻜﻴﻞ ﻣﻘﺎدﻳﺮي رﺳﻮب درون ﺗﻮﺑﻮلﻫﺎ ﺑﻪ ﭼﺸﻢ ﻣﻲرﺳﺪ اﻣﺎ ﺗﻮﺑﻮلﻫـﺎ‬

‫‪ FRAP‬در اﻳﻦ ﮔﺮوه ﮔﺮدﻳﺪ‪ ،‬اﻣﺎ از ﻧﻈﺮ آﻣـﺎري اﻳـﻦ ﺗﻔـﺎوت در ﻣﻴـﺰان‬

‫ﻫﻨﻮز دﺳﺖ ﻧﺨﻮرده ﻫﺴﺘﻨﺪ و ﺗﻐﻴﻴﺮ وﺳﻴﻊ ﻏﻴﺮ ﻗﺎﺑﻞ ﺑﺮﮔـﺸﺘﻲ از ﺟﻤﻠـﻪ‬

‫‪Sham recipient‬‬

‫ﻧﻜﺮوز ﻛﺎﻣﻞ ﺗﻮﺑﻮﻟﻲ دﻳﺪه ﻧﻤﻲﺷﻮد )ﺷﻜﻞ ‪ .(1C‬در ﻣﺠﻤﻮع اﻳﻦ ﮔـﺮوه‬

‫)‪(SOD‬‬

‫در آﻏﺎز ﮔﺴﺘﺮش آﺳﻴﺐ ﺑﺎﻓﺘﻲ اﺳﺖ و اﮔﺮﭼـﻪ ﺑـﺎ ﮔـﺮوه ﺷـﻢ ﻣﺮﺑﻮﻃـﻪ‬

‫‪ FRAP‬ﺑﺎﻓــﺖ ﻛﻠﻴــﻪ در ﮔــﺮوهﻫــﺎي ‪ IR recipient‬و‬

‫ﻣﻌﻨﻲدار ﻧﺒﻮد )ﻧﻤﻮدار ‪ .(3b‬ﻣﻴﺰان آﻧﺰﻳﻢ ﺳﻮﭘﺮ اﻛﺴﻴﺪ دﻳـﺴﻤﻮﺗﺎز‬

‫در ﺑﺎﻓﺖ ﻛﻠﻴﻪ ﮔﺮوه ‪ IR donor‬ﻛﺎﻫﺶ ﻣﻌﻨﻲداري در ﻣﻘﺎﻳـﺴﻪ ﺑـﺎ ﮔـﺮوه‬

‫ﺑﺴﻴﺎر ﻣﺘﻔﺎوت اﺳﺖ وﻟﻲ ﺑﺎ ﮔﺮوه ‪ IR donor‬ﻫﻢ ﺗﻔﺎوت ﺑﺴﻴﺎري دارد‪.‬‬

‫‪ Sham donor‬داﺷﺖ )ﻧﻤﻮدار ‪ .(4a‬ﺑﻪ اﻳﻦ ﺗﺮﺗﻴﺐ در اﻳﻦ ﺗﺤﻘﻴﻖ ﻛﺎﻫﺶ‬ ‫ﻣﻴﺰان ‪ SOD‬ﺑﻪ ﻋﻨﻮان اﻳﺠﺎد اﺳﺘﺮس اﻛـﺴﻴﺪاﺗﻴﻮ در ﺑﺎﻓـﺖ ﻛﻠﻴـﻪ ﭘـﺲ از‬

‫ﺑﺤﺚ‬

‫اﻟﻘﺎي ﻧﺎرﺳﺎﻳﻲ ﺣﺎد ﻛﻠﻴﻪ اﻳﺴﻜﻤﻴﻚ ﺗﻠﻘـﻲ ﮔﺮدﻳـﺪ‪ .‬ﻫـﻢ ﭼﻨـﻴﻦ ﺗﻔـﺎوت‬ ‫ﻣﻌﻨﻲداري در ﻣﻴﺰان ‪ SOD‬ﺑﺎﻓـﺖ ﻛﻠﻴـﻪ در ﮔـﺮوهﻫـﺎي ‪ IR recipient‬و‬

‫ﺗﺎﻛﻨﻮن ﻣﻄﺎﻟﻌﺎت زﻳﺎدي درﺑـﺎره ﻋﻮاﻣـﻞ دﺧﻴـﻞ در اﻳﺠـﺎد آﺳـﻴﺐ‬

‫‪ Sham recipient‬دﻳــﺪه ﺷــﺪ )ﻧﻤــﻮدار ‪ .(4b‬ﺑــﻪ اﻳــﻦ ﺗﺮﺗﻴــﺐ اﻧﺘﻘــﺎل‬

‫اﻳﺴﻜﻤﻲ ﺧﻮنرﺳﺎﻧﻲ ﻣﺠﺪد در اﻧﺪامﻫﺎي ﻣﺨﺘﻠﻒ ﺻﻮرت ﮔﺮﻓﺘﻪ اﺳـﺖ‬

‫ﻟﻜﻮﺳﻴﺖﻫﺎي ﮔـﺮوه ‪ IR donor‬ﺑـﻪ ﮔـﺮوه ‪ IR recipient‬ﺳـﺒﺐ ﻛـﺎﻫﺶ‬

‫ﻛــﻪ ﺑﺮﺧــﻲ از آنﻫــﺎ ﻣﻜﺎﻧﻴــﺴﻢﻫــﺎي اﻟﺘﻬــﺎﺑﻲ از ﻗﺒﻴــﻞ اﻧﻔﻴﻠﺘﺮاﺳــﻴﻮن‬

‫‪(Catalase‬‬

‫ﻟﻜﻮﺳﻴﺖﻫﺎ‪ ،‬اﻟﻘﺎي ﺳﺎﻳﺘﻮﻛﻴﻦﻫﺎ و ﻛﻤﻮﻛﻴﻦﻫﺎ را ﺑـﻪ ﻋﻨـﻮان ﻓﺎﻛﺘﻮرﻫـﺎي‬

‫)‪ activity‬در ﺑﺎﻓﺖ ﻛﻠﻴﻪ ﮔﺮوه ‪ IR donor‬ﻛﺎﻫﺶ ﻣﻌﻨﻲداري در ﻣﻘﺎﻳـﺴﻪ‬

‫ﻣﻮﺛﺮ ﭘﻴﺸﻨﻬﺎد ﻧﻤﻮدهاﻧﺪ‪ .‬از اﻳﻦرو ﺑﺴﻴﺎري ﺗﺤﻘﻴﻘـﺎت ﺑـﻪ ﺑﺮرﺳـﻲ ﻧﻘـﺶ‬

‫ﻣﻴﺰان ‪ SOD‬در اﻳﻦ ﮔﺮوه ﮔﺮدﻳﺪ‪ .‬ﻣﻴﺰان ﻓﻌﺎﻟﻴﺖ آﻧﺰﻳﻢ ﻛﺎﺗﺎﻻز‬

‫‪10-12‬‬

‫ﺑﺎ ﮔﺮوه ‪ Sham donor‬داﺷـﺖ )ﻧﻤـﻮدار ‪ .(4a‬ﺑـﻪ اﻳـﻦ ﺗﺮﺗﻴـﺐ در اﻳـﻦ‬

‫ﻟﻜﻮﺳﻴﺖﻫـﺎ در اﻳﺠـﺎد اﻳـﻦ آﺳـﻴﺐ ﭘﺮداﺧﺘـﻪ اﺳـﺖ‪.‬‬

‫ﺗﺤﻘﻴﻖ ﻛﺎﻫﺶ ﻣﻴﺰان ﻛﺎﺗﺎﻻز ﺑﻪ ﻋﻨﻮان اﻳﺠﺎد اﺳﺘﺮس اﻛﺴﻴﺪاﺗﻴﻮ در ﺑﺎﻓﺖ‬

‫ﻣﻄﺎﻟﻌﺎت‪ ،‬روي ﺑﺮرﺳﻲ ﻧﻘﺶ ﻟﻜﻮﺳﻴﺖﻫـﺎ در ﻳـﻚ ﻋـﻀﻮ ﻣﺘﻌﺎﻗـﺐ‬

‫ﻛﻠﻴﻪ ﭘﺲ از اﻟﻘﺎي ﻧﺎرﺳﺎﻳﻲ ﺣﺎد ﻛﻠﻴﻪ اﻳﺴﻜﻤﻴﻚ ﺗﻠﻘـﻲ ﮔﺮدﻳـﺪ‪ .‬اﮔﺮﭼـﻪ‬

‫ﻫﻤﺎن ﻋﻀﻮ ﺻﻮرت ﮔﺮﻓﺘﻪ اﺳﺖ ﻛﻪ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺣﻀﻮر و دﺧﺎﻟﺖ ﺳﺎﻳﺮ‬

‫اﻧﺘﻘﺎل ﻟﻜﻮﺳـﻴﺖﻫـﺎي ﮔـﺮوه ‪ IR donor‬ﺑـﻪ ﮔـﺮوه ‪ IR recipient‬ﺳـﺒﺐ‬

‫ﻋﻮاﻣﻞ ﻧﺘﺎﻳﺞ ﻣﺘﻔﺎوﺗﻲ داﺷﺘﻪ اﺳﺖ‪ .‬ﺑﻪ ﻋﻨﻮان ﻣﺜﺎل ﻣﻄﺎﻟﻌﺎت اﺧﻴـﺮ ﻧـﺸﺎن‬

‫ﻛﺎﻫﺶ ﻣﻴﺰان ﻓﻌﺎﻟﻴﺖ ﻛﺎﺗﺎﻻز در اﻳﻦ ﮔﺮوه ﮔﺮدﻳﺪ‪ ،‬اﻣﺎ از ﻧﻈﺮ آﻣﺎري اﻳﻦ‬

‫دادهاﻧﺪ ﻛﻪ ‪ IR‬ﻛﻠﻴـﻮي ﻣﻮﺟـﺐ اﻓـﺰاﻳﺶ ﺑﻴـﺎن ‪ TNF-α‬و اﻓـﺰاﻳﺶ ورود‬

‫ﺗﻔﺎوت در ﻣﻴﺰان ﻛﺎﺗﺎﻻز ﺑﺎﻓﺖ ﻛﻠﻴﻪ در ﮔﺮوهﻫﺎي ‪ IR recipient‬و‬

‫‪Sham‬‬

‫‪ recipient‬ﻣﻌﻨﻲدار ﻧﺒﻮد )ﻧﻤﻮدار ‪.(4b‬‬

‫‪14‬و‪13‬‬

‫ﻧﻮﺗﺮوﻓﻴﻞﻫﺎ ﺑﻪداﺧﻞ ﺑﺎﻓﺖ ﻛﻠﻴﻪ ﻣﻲﺷﻮد‪.‬‬

‫اﻏﻠـﺐ اﻳـﻦ‬

‫در ﺳﺎل ‪،2000‬‬

‫‪IR‬‬

‫‪Mizutani‬‬

‫ﺑﺎ اﺳﺘﻔﺎده از ﭘﺮوﺗﻴﻴﻦ ‪ C‬ﻓﻌﺎل ﺷﺪه از ﻓﻌﺎل ﺷﺪن ﻟﻜﻮﺳﻴﺖﻫﺎ ﺟﻠﻮﮔﻴﺮي‬

‫ﺑﺮرﺳﻲ ﺗﻐﻴﻴﺮات ﺑﺎﻓﺖﺷﻨﺎﺳﻲ ﻛﻠﻴﻪ در ﮔﺮوهﻫﺎ‪ :‬ﺑﺎﻓﺖ ﻛﻠﻴﻪ در ﮔﺮوه‬

‫‪4‬‬

‫ﻛﺮده و در ﻧﺘﻴﺠﻪ از اﻳﺠﺎد آﺳﻴﺐ ﺑﺮ اﺛـﺮ ‪ IR‬ﻛﻠﻴـﻮي ﺟﻠـﻮﮔﻴﺮي ﻧﻤـﻮد‪.‬‬

‫‪ Sham donor‬ﺿﺎﻳﻌﻪ ﻗﺎﺑﻞ ﻣﻼﺣﻈﻪاي را ﺑﺎ ﻣﻴﻜﺮوﺳﻜﻮپ ﻧـﻮري ﻧـﺸﺎن‬

‫وي ﻫﻢﭼﻨﻴﻦ در ﺳـﺎل ‪ 2003‬در ﻣﻄﺎﻟﻌـﻪ دﻳﮕـﺮي ﮔـﺰارش ﻧﻤـﻮد ﻛـﻪ‬

‫ﻧﻤﻲدﻫﺪ )ﺷﻜﻞ ‪ .(1B‬ﺑﺎﻓﺖﻫﺎ در ﮔﺮوه ‪ IR donor‬در ﻣﻘﺎﻳﺴﻪ ﺑـﺎ ﮔـﺮوه‬

‫آﻧﺘﻲﺗﺮوﻣﺒﻴﻦ ﻧﻴﺰ ﺑﺎ ﻣﻬﺎر ﻓﻌﺎل ﺷﺪن ﻟﻜﻮﺳﻴﺖﻫـﺎ ‪ IR‬ﻛﻠﻴـﻮي را ﻛـﺎﻫﺶ‬ ‫‪15‬‬

‫‪ Sham donor‬آﺳﻴﺐﻫﺎي ﺑـﺴﻴﺎري را ﻧـﺸﺎن داد )ﺷـﻜﻞ ‪ .(1A‬در اﻳـﻦ‬

‫ﻣﻲدﻫﺪ‪.‬‬

‫ﮔﺮوه‪ ،‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻃﻮﻻﻧﻲ ﺑﻮدن زﻣـﺎن ﭘﺮﻓﻴـﻮژن ﻣﺠـﺪد )ﺳـﻪ ﺳـﺎﻋﺖ(‬

‫ﻟﻨﻔﻮﺳﻴﺖ ‪ CD4/CD8‬درﻳﺎﻓﺖ ﻛﻪ اﻳﻦ ﻣﻮشﻫـﺎ ﻧـﺴﺒﺖ ﺑـﻪ ﻣـﻮشﻫـﺎي‬

‫ﺑﺎﻓﺖ ﻛﻠﻴﻪ ﺗﻐﻴﻴﺮات ﻗﺎﺑﻞ ﻣﻼﺣﻈﻪاي را ﻧﺴﺒﺖ ﺑﻪ ﮔﺮوه ‪ Sham‬ﻧﺸﺎن داد‪.‬‬

‫ﻧﺮﻣﺎل‪ ،‬در ﺑﺮاﺑﺮ ‪ IR‬ﻛﻠﻴﻮي دﭼﺎر آﺳﻴﺐ ﻛﻢﺗﺮي ﻣـﻲﺷـﻮﻧﺪ‪ 16.‬از ﺳـﻮي‬

‫اﻳﻦ ﺗﻐﻴﻴﺮات ﺷﺎﻣﻞ اﻧﻬـﺪام ﮔـﺴﺘﺮده ﺗﻮﺑـﻮل ﻫـﺎ‪ ،‬ﻧﻜـﺮوز ﻧـﺴﺒﺘﺎ وﺳـﻴﻊ‬

‫دﻳﮕﺮ‪ Park ،‬ﻣﻄﺮح ﻧﻤﻮد ﻛﻪ ﺿﺎﻳﻌﺎت ﻛﻠﻴـﻮي ﻣﺘﻌﺎﻗـﺐ ‪ IR‬ارﺗﺒـﺎﻃﻲ ﺑـﺎ‬

‫ﺑﻪ ﺧﺼﻮص در ﺗﻮﺑﻮلﻫﺎي ﭘﺮوﮔﺰﻳﻤـﺎل‪ ،‬وﺟـﻮد اﻧـﺴﺪاد ﺗﻮﺑـﻮﻟﻲ ﻗﺎﺑـﻞ‬

‫اﻳﻤﻮﻧﻮﮔﻠﻮﺑﻮﻟﻴﻦﻫﺎ و ﻳﺎ ﻟﻨﻔﻮﺳـﻴﺖﻫـﺎي ‪ T‬ﻧـﺪارد‪ 17.‬ﻫـﻢﭼﻨـﻴﻦ ﻛـﺎﻫﺶ‬

‫‪ Rabb‬ﻧﻴﺰ در ﻣﻄﺎﻟﻌـﻪ ﺧـﻮد ﺑـﺮ روي ﻣـﻮشﻫـﺎي ﻓﺎﻗـﺪ ژن‬

‫‪75‬‬

‫ﻧﻮﺗﺮوﻓﻴﻞﻫﺎ در ﻣﻮشﻫﺎي ﻓﺎﻗﺪ ژن ﻓﻌﺎلﻛﻨﻨﺪه ‪ Recombinase‬ﻧﺘﻮاﻧـﺴﺖ‬

‫ﻣﺸﺎﺑﻪ ﻳﻌﻨﻲ ﻛﻠﻴﻪﻫﺎي ﭘﺬﻳﺮﻧـﺪه ﺑﺮرﺳـﻲ ﻧﻤـﺎﻳﻴﻢ‪ .‬وﻳﮋﮔـﻲ اﻳـﻦ ﺗﺤﻘﻴـﻖ‬

‫‪B‬‬

‫ﺑﺮرﺳﻲ ﺗﻐﻴﻴﺮات ﻛﻠﻴﻮي در ﻛﻠﻴﻪاي اﺳﺖ ﻛﻪ ﺧﻮد ﻣﺴﺘﻘﻴﻤﺎ ﺗﺤﺖ اﻟﻘـﺎي‬

‫ﻳﺎ ‪ T‬ﺑﻪ اﻳﻦ ﻣﻮشﻫﺎ ﺗﻮاﻧﺴﺖ ﻣﺤﺎﻓﻈﺖ ﭼﺸﻤﮕﻴﺮي ﻧﺸﺎن دﻫﺪ‪ .‬ﻫﻢﭼﻨﻴﻦ‬

‫‪ IR‬ﻗﺮار ﻧﮕﺮﻓﺘﻪ اﺳﺖ‪ .‬ﺑﻨﺎﺑﺮاﻳﻦ اﺛﺮات ﻧﺎﺷﻲ از ‪ IR‬ﻋﻀﻮ ﺣـﺬف ﺷـﺪه و‬

‫در ﻣﻘﺎﺑﻞ آﺳﻴﺐﻫﺎي ﻛﻠﻴﻮي ﻣﺤﺎﻓﻈﺖ ﻧﻤﺎﻳﺪ‪ 18،‬ﺑﻠﻜﻪ اﻧﺘﻘﺎل ﺳﻠﻮلﻫﺎي‬

‫اﻓﺰودن ﻟﻜﻮﺳﻴﺖﻫﺎ ﺑﻪ ﻣﺤﻴﻂ ﺣﺎوي ﺳﻠﻮلﻫﺎي ﻣﻐﺰي اﻧﺴﺎﻧﻲ ﺿـﺎﻳﻌﺎت‬

‫ﺗﻨﻬﺎ اﺛﺮ ﻟﻜﻮﺳﻴﺖﻫﺎي ﻓﻌﺎل ﺷـﺪه را ﺑﺮرﺳـﻲ ﻣـﻲﻧﻤﺎﻳـﺪ‪ .‬ﻟـﺬا ﺗﻐﻴﻴـﺮات‬

‫‪19‬‬

‫ﺣﺎﺻﻞ ﻣﻲﺗﻮاﻧﺪ ﻣﻄﺮح ﻛﻨﻨﺪه ﺗﻐﻴﻴﺮات اﻳﺠﺎد ﺷﺪه در ﻛﻠﻴﻪ ﺳﺎﻟﻢ ﻣﻮﺟﻮد‬

‫‪IL-10‬‬

‫در ﺑﺪن ﻣﺘﻌﺎﻗﺐ ‪ IR‬ﻛﻠﻴﻪ دﻳﮕﺮ ﻫﻢ ﺑﺎﺷﺪ‪ .‬ﻣﻮشﻫﺎ در دو ﮔـﺮوه ‪ Sham‬و‬

‫آﺳﻴﺐﻫﺎي ‪ IR‬ﻛﻠﻴﻮي را ﻛﻢ ﻛﻨﺪ‪ 20.‬ﻟﺬا اﻳـﻦ ﻣﺠﻤﻮﻋـﻪ ﻣﻄﺎﻟﻌـﺎت ﻧـﺸﺎن‬

‫‪ IR‬ﻛﻠﻴــﻮي دوﻃﺮﻓــﻪ ﻛــﻪ ‪ 60‬دﻗﻴﻘــﻪ اﻧــﺴﺪاد دو ﻃﺮﻓــﻪ ﺷــﺮﻳﺎن ﻛﻠﻴــﻮي‬

‫‪IR‬‬

‫)اﻳﺴﻜﻤﻲ( و ﺑﻪدﻧﺒﺎل آن ﺳﻪ ﺳﺎﻋﺖ ﭘﺮﻓﻴﻮژن ﻣﺠـﺪد را ﺗﺤﻤـﻞ ﻛﺮدﻧـﺪ‪،‬‬

‫ﺑﺴﻴﺎر ﭘﻴﭽﻴﺪه ﻣﻲﺑﺎﺷﻨﺪ‪ .‬ﻳﻜﻲ از ﻋﻮاﻣﻞ آﺳﻴﺐ رﺳﺎن ﻣﺘﻌﺎﻗﺐ ‪ IR‬ﻛﻠﻴﻮي‬

‫ﻗﺮار ﮔﺮﻓﺘﻨﺪ‪ .‬ﭘﺲ از آن ﺣﻴﻮاﻧﺎت ﺑﻴﻬﻮش ﺷﺪه و ﻧﻤﻮﻧﻪ ﺧـﻮن و ﺑﺎﻓـﺖ‬

‫اﻓﺰاﻳﺶ ﺗﻮﻟﻴﺪ ﻣﺘﺎﺑﻮﻟﻴﺖﻫﺎي ﻓﻌﺎل اﻛﺴﻴﮋن )‪ (ROS‬ﺗﻮﺳـﻂ ﻓﺎﮔﻮﺳـﻴﺖﻫـﺎ‬

‫ﻛﻠﻴﻮي ﺟﻤﻊآوري ﮔﺮدﻳﺪ‪ .‬ﻟﻜﻮﺳﻴﺖﻫﺎ از ﺧﻮن ﺟﺪا ﺷﺪه و ﺑﻪ دو ﮔﺮوه‬

‫ﻣﻲﺑﺎﺷﺪ‪ Demirbilek .‬از ﻳﻚ آﻧﺘﻲاﻛـﺴﻴﺪان ﺑـﻪ ﻧـﺎم ﭘﻠـﻲانﻓـﺴﻔﺎﺗﻴﺪﻳﻞ‬

‫ﭘﺬﻳﺮﻧﺪه ﻣﻨﺘﻘﻞ ﺷﺪﻧﺪ‪ :‬ﻣﻮشﻫﺎي ﭘﺬﻳﺮﻧﺪه ﻛﻪ ﻟﻜﻮﺳﻴﺖﻫﺎي ﮔﺮوه ﺷﻢ را‬

‫ﻛﻮﻟﻴﻦ )‪ (Polyenylphosphatidylcholine‬ﺟﻬﺖ ﻛﺎﻫﺶ ﺿﺎﻳﻌﺎت ﻧﺎﺷﻲ‬

‫درﻳﺎﻓــﺖ ﻛﺮدﻧــﺪ )‪ (Sham recipient‬و ﻣــﻮشﻫــﺎي ﭘﺬﻳﺮﻧــﺪه ﻛــﻪ‬

‫از ‪ IR‬ﻛﻠﻴﻮي اﺳﺘﻔﺎده ﻛﺮده و درﻳﺎﻓﺖ ﻛﻪ اﻳﻦ آﻧﺘﻲاﻛﺴﻴﺪان اﺛﺮ ﻣﺤﺎﻓﻈﺘﻲ‬

‫ﻟﻜﻮﺳﻴﺖﻫﺎي ﮔﺮوه ‪ IR‬را درﻳﺎﻓﺖ ﻧﻤﻮدﻧـﺪ )‪ .(IR recipient‬ﺑﻌـﺪ از ‪24‬‬

‫در ‪ IR‬ﻛﻠﻴﻮي دارد‪ 21.‬ﻫﻢﭼﻨﻴﻦ در ﺳﺎلﻫﺎي اﺧﻴﺮ ﻣﻄﺮح ﺷﺪه اﺳﺖ ﻛـﻪ‬

‫ﺳﺎﻋﺖ ﻣﻮشﻫﺎي ﭘﺬﻳﺮﻧﺪه ﺑﻴﻬﻮش ﺷﺪﻧﺪ و ﻧﻤﻮﻧﻪﻫـﺎي ﺧـﻮن و ﺑﺎﻓـﺖ‬

‫آﺳﻴﺐ ﻳﻚ ﻋﻀﻮ ﻣﻲﺗﻮاﻧﺪ ﺗﻮﺳﻂ ﻋﻮاﻣﻞ ﻣﺨﺘﻠﻒ در اﺧﺘﻼل اﻧـﺪامﻫـﺎي‬

‫‪Sham‬‬

‫ﺳﻠﻮﻟﻲ را در ﻳﻚ ﻣﺪل ﻣﺤﺮوﻣﻴﺖ از ﮔﻠـﻮﻛﺰ و اﻛـﺴﻴﮋن ﻛـﺎﻫﺶ داد‪.‬‬ ‫ﺳﻠﻮلﻫﺎي ‪ B‬ﺧﺎرج ﭘﺮﻳﺘﻮان ﺗﻮاﻧﺴﺖ اﺣﺘﻤﺎﻻ از ﻃﺮﻳـﻖ اﻓـﺰاﻳﺶ‬

‫ﻣﻲدﻫﺪ ﻛﻪ ﻣﻜﺎﻧﻴﺴﻢﻫﺎي در ﺑﺮﮔﻴﺮﻧﺪه ﻧﻘﺶ ﻟﻜﻮﺳﻴﺖﻫـﺎ در آﺳـﻴﺐ‬

‫دﻳﮕﺮ ﻧﻴﺰ ﻧﻘﺶ داﺷﺘﻪ ﺑﺎﺷﺪ‪ Hassoun .‬در ﺑﺮرﺳﻲ ﺧﻮد ﻧﺸﺎن داد ﻛـﻪ‬

‫ﻛﻠﻴﻪ ﺟﻤﻊآوري ﺷﺪ‪ .‬در ﮔـﺮوه ‪ IR recipient‬ﻧـﺴﺒﺖ ﺑـﻪ ﮔـﺮوه‬

‫‪IR‬‬

‫‪ recipient‬ﻣﻴــﺰان ‪ MDA‬ﺑﺎﻓــﺖ ﻛﻠﻴــﻪ ﺑ ـﻪﻃــﻮر ﻣﻌﻨــﻲداري اﻓــﺰاﻳﺶ و‬

‫ﻛﻠﻴﻮي ﻣﻮﺟﺐ آﺳـﻴﺐ ﺑﺎﻓـﺖ رﻳـﻪ ﺑـﻪ ﻋﻨـﻮان ﻳـﻚ ﻋـﻀﻮ دوردﺳـﺖ‬

‫ﮔﻠﻮﺗﺎﺗﻴﻮن ﺗﺎم و ﻣﻴﺰان ﻓﻌﺎﻟﻴﺖ آﻧﺰﻳﻢ ‪ SOD‬ﻛﻠﻴﻮي ﺑـﻪﻃـﻮر ﻣﻌﻨـﻲداري‬

‫)‪ (Remote‬ﻣﻲﺷـﻮد‪ IR .‬ﻛﻠﻴـﻮي ﻣﻮﺟـﺐ اﻓـﺰاﻳﺶ ﻧﻔﻮذﭘـﺬﻳﺮي رﻳـﻮي‬

‫ﻛﺎﻫﺶ ﻳﺎﻓﺘﻨﺪ‪ .‬ﺷﺎﺧﺺﻫﺎي ﻋﻤﻠﻜﺮدي ﻛﻠﻴﻮي ﺷـﺎﻣﻞ ‪ BUN‬و ﻛـﺮاﺗﻴﻨﻴﻦ‬

‫ﮔﺮدﻳﺪ و در آزﻣﺎﻳﺸﺎت ﺑﺎﻓﺖﺷﻨﺎﺳـﻲ ﻧﻴـﺰ اﻟﺘﻬـﺎب ﺳـﻠﻮلﻫـﺎي رﻳـﻮي‬

‫ﭘﻼﺳﻤﺎ اﮔﺮﭼﻪ در ﮔﺮوه ‪ IR‬دﻫﻨﺪه ﺑﺎ ﺷﻢ ﺗﻔﺎوت ﻣﻌﻨﻲداري داﺷﺖ وﻟﻲ‬

‫ﻣﺸﺎﻫﺪه ﺷﺪ‪ Liu 1.‬اﻟﺘﻬـﺎب و ﺗﻐﻴﻴـﺮات ﻋﻤﻠﻜـﺮدي ﺑﺎﻓـﺖ ﻣﻐـﺰ را ﻧﻴـﺰ‬

‫اﻳﻦ ﭘﺎراﻣﺘﺮﻫﺎ در دو ﮔﺮوه ﭘﺬﻳﺮﻧﺪه ﺑـﺎ ﻳﻜـﺪﻳﮕﺮ ﺗﻔـﺎوت ﻣﻌﻨـﻲداري را‬

‫ﺑﻪدﻧﺒﺎل ‪ IR‬ﻛﻠﻴﻮي ﮔﺰارش ﻛﺮد‪ 6.‬در ﺳﺎل ‪ 2009‬ﻧﻴﺰ ﮔـﺰارش ﺷـﺪه ﻛـﻪ‬

‫ﻧﺸﺎن ﻧﺪادﻧﺪ‪ .‬در ﺑﺮرﺳﻲﻫﺎي ﻫﻴـﺴﺘﻮﻟﻮژﻳﻚ ﺑﺎﻓـﺖ ﻛﻠﻴـﻪ در ﮔـﺮوه‬

‫‪IR‬‬

‫ﺑﻪدﻧﺒﺎل ‪ IR‬ﻛﻠﻴﻮي ﻏﻠﻈﺖ ﻛﺒﺪي ‪ ،TNF-α‬اﻳﻨﺘﺮﻟﻮﻛﻴﻦ ‪ MDA ،10‬اﻓﺰاﻳﺶ‬

‫‪ donor‬در ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﮔﺮوه ‪ Sham donor‬آﺳﻴﺐﻫﺎي ﺑـﺴﻴﺎري را ﺷـﺎﻣﻞ‬

‫و ﻏﻠﻈﺖ ﮔﻠﻮﺗﺎﺗﻴﻮن اﺣﻴﺎ ﺷﺪه ﻛﺎﻫﺶ ﻳﺎﻓﺘﻪ و ﻣﻄﺎﻟﻌﺎت ﺑﺎﻓﺖﺷﻨﺎﺳﻲ ﻧﻴﺰ‬

‫اﻧﻬﺪام ﮔﺴﺘﺮده ﺗﻮﺑـﻮلﻫـﺎ‪ ،‬ﻧﻜـﺮوز ﺑـﻪ ﻧـﺴﺒﺖ وﺳـﻴﻊ ﺑـﻪﺧـﺼﻮص در‬

‫آﺳﻴﺐ ﺑﺎﻓﺖ ﻛﺒﺪي را ﺗﺎﻳﻴﺪ ﻛﺮدهاﻧﺪ‪ 8.‬ﺟﻬﺖ ﺑﺮرﺳﻲ ﻧﻘـﺶ اﺧﺘـﺼﺎﺻﻲ‬

‫ﺗﻮﺑﻮلﻫﺎي ﭘﺮوﮔﺰﻳﻤﺎل‪ ،‬وﺟﻮد اﻧﺴﺪاد ﺗﻮﺑﻮﻟﻲ ﻗﺎﺑﻞ ﻣﻼﺣﻈﻪ ﺑـﻪوﻳـﮋه در‬

‫ﻟﻜﻮﺳﻴﺖﻫﺎ‪ ،‬در ﻳﻚ ﻣﻄﺎﻟﻌﻪ اﺧﻴﺮ ﻣـﺎ ﻧﻘـﺶ اﻧﺘﻘـﺎل ﻟﻜﻮﺳـﻴﺖﻫـﺎ را در‬

‫ﺗﻮﺑﻮلﻫﺎي اﻧﺘﻬﺎﻳﻲﺗﺮ‪ ،‬ﻛﻢ ﺷﺪن ﺿﺨﺎﻣﺖ ﺳﻠﻮلﻫﺎ و ﺗﺤﺖ ﻓـﺸﺎر ﺑـﻮدن‬

‫اﻟﻘﺎي آﺳﻴﺐ ﻛﺒﺪي ﺑﻪدﻧﺒﺎل اﻳﺴﻜﻤﻲ‪ -‬ﭘﺮﻓﻴﻮژن ﻣﺠﺪد ﻛﻠﻴﻮي در ﻣـﻮش‬

‫ﺳﻠﻮلﻫﺎي اﭘﻴﺘﻠﻴﺎل ﺗﻮﺑﻮﻟﻲ ﻧﺸﺎن داد‪ .‬در ﮔﺮوه ‪ ،IR recipient‬ﻧﺴﺒﺖ ﺑـﻪ‬

‫ﺳﻮري ‪ Inbred‬ﺑﺮرﺳﻲ ﻧﻤﻮده و ﻧﺸﺎن دادﻳﻢ ﻛـﻪ ﻟﻜﻮﺳـﻴﺖﻫـﺎي ﻓﻌـﺎل‬

‫ﮔﺮوه ﺷﻢ ﻣﺮﺑﻮﻃﻪ واﻛﻮﺋﻮﻟﻪ ﺷﺪن ﺳﻠﻮلﻫﺎ و ﺗﺸﻜﻴﻞ ﻣﻘـﺎدﻳﺮي رﺳـﻮب‬

‫ﺷﺪه در اﺛﺮ ‪ IR‬ﻛﻠﻴﻮي ﻣﻲﺗﻮاﻧﻨﺪ در ﻛﺒﺪ ﻣﻮش ﭘﺬﻳﺮﻧﺪه اﻳﺠﺎد ﺿـﺎﻳﻌﺎت‬

‫درون ﺗﻮﺑﻮلﻫﺎ ﺑﻪ ﭼـﺸﻢ ﻣـﻲرﺳـﺪ‪ .‬در ﻣﺠﻤـﻮع اﻳـﻦ ﮔـﺮوه در آﻏـﺎز‬

‫ﺑﺎﻓﺘﻲ و اﺳﺘﺮس اﻛﺴﻴﺪاﺗﻴﻮ ﻧﻤﻮده و آﻧﺰﻳﻢﻫﺎي ﻛﺒـﺪي را ﻧﻴـﺰ در ﺧـﻮن‬

‫ﮔﺴﺘﺮش آﺳﻴﺐ ﺑﺎﻓﺘﻲ اﺳـﺖ و اﮔﺮﭼـﻪ ﺑـﺎ ﮔـﺮوه ﺷـﻢ ﻣﺮﺑﻮﻃـﻪ ﺑـﺴﻴﺎر‬

‫اﻓﺰاﻳﺶ دﻫﻨﺪ‪ 15.‬اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﻪ ﺧـﻮﺑﻲ ﻧـﺸﺎن داد ﻛـﻪ ﻟﻜﻮﺳـﻴﺖﻫـﺎ ﺑـﻪ‬

‫ﻣﺘﻔﺎوت اﺳﺖ وﻟﻲ ﺑﺎ ﮔـﺮوه ‪ IR donor‬ﻫـﻢ ﺗﻔـﺎوت ﺑـﺴﻴﺎري دارد‪ .‬در‬

‫ﺗﻨﻬﺎﻳﻲ و ﺑﺪون ﺣﻀﻮر ﺳﺎﻳﺮ ﻋﻮاﻣﻞ ﭘﻼﺳﻤﺎﻳﻲ و ﻳﺎ ﻣﻴﺎﻧﺠﻲﻫﺎي ﻋـﺼﺒﻲ‬

‫ﻣﻘﺎﻟﻪ ﻣﺸﺎﺑﻬﻲ ‪ Burne-Taney‬ﻧﺸﺎن داد ﻛﻪ اﻧﺘﻘﺎل ﻟﻨﻔﻮﺳﻴﺖﻫـﺎ از ﻣـﻮش‬

‫اﻧﺘﻘﺎل ﻳﺎﻓﺘﻪ از دﻫﻨﺪه ﻣﻲﺗﻮاﻧﻨﺪ در اﻳﺠﺎد ﺿﺎﻳﻌﺎت در ﻛﺒﺪ ﮔﻴﺮﻧﺪه ﻧﻘـﺶ‬

‫دﭼﺎر ‪ IR‬ﻛﻠﻴﻮي ﻣﻲﺗﻮاﻧﺪ در ﮔﻴﺮﻧﺪه ﺳﺎﻟﻢ اﻳﺠـﺎد ﺿـﺎﻳﻌﻪ ﻛﻠﻴـﻮي و در‬ ‫‪22‬‬

‫داﺷــﺘﻪ ﺑﺎﺷــﻨﺪ‪ .‬در اداﻣــﻪ و در ﻃــﺮح ﺣﺎﺿــﺮ ﺑــﺮ آن ﺷــﺪﻳﻢ ﺗــﺎ ﻧﻘــﺶ‬

‫ﻧﺘﻴﺠﻪ آﻟﺒﻮﻣﻴﻨﻮري ﻧﻤﺎﻳﺪ‪ .‬ﻫﻢﭼﻨﻴﻦ ﻣﻘﺎﻳﺴﻪ آﺳﻴﺐﭘﺬﻳﺮي ﻛﻠﻴﻪ ﺑـﺎ ﻛﺒـﺪ‬

‫ﻟﻜﻮﺳﻴﺖﻫﺎي ﻓﻌﺎل ﺷﺪه در اﺛﺮ ‪ IR‬ﻛﻠﻴﻪ را در اﻳﺠـﺎد آﺳـﻴﺐ در ﻋـﻀﻮ‬

‫ﮔﻴﺮﻧـﺪه ﭘـﺲ از اﻧﺘﻘــﺎل ﻟﻜﻮﺳـﻴﺖﻫـﺎ در ﻧﺘــﺎﻳﺞ اﺧﻴـﺮ ﺣﺎﺻـﻞ از اﻳــﻦ‬

‫ﻫﻤﻜﺎران‬ ‫ﻛﺪﺧﺪاﻳﻲ و‬ ‫ﻣﻬﺮي‬ Kadkhodaee M. et al.

‫ اﻳﻦ ﻳﺎﻓﺘﻪﻫﺎ ﻟﻜﻮﺳﻴﺖﻫﺎ را ﺑﻪ ﻋﻨﻮان ﻳﻚ ﻋﺎﻣﻞ دﺧﻴﻞ در آﺳـﻴﺐ‬.‫ﻧﺪادﻧﺪ‬

‫آزﻣﺎﻳﺸﮕﺎه ﻧﺸﺎن ﻣﻲدﻫﺪ ﻛﻪ ﻛﻠﻴﻪﻫﺎ ﻧﺴﺒﺘﺎ اﻋـﻀﺎي ﻣﻘـﺎومﺗـﺮي ﺑـﻮده و‬

.‫ ﻛﻠﻴﻪ ﻣﻄﺮح ﻣﻲﻧﻤﺎﻳﺪ‬IR ‫ﺑﺎﻓﺘﻲ و اﻟﻘﺎي اﺳﺘﺮس اﻛﺴﻴﺪاﺗﻴﻮ در آﺳﻴﺐ‬

‫ﺗﺰرﻳﻖ ﺗﻌﺪاد ﻳﻜﺴﺎن ﻟﻜﻮﺳﻴﺖﻫـﺎي ﻓﻌـﺎل ﺷـﺪه ﻣﻮﺟـﺐ آﺳـﻴﺐﻫـﺎي‬

‫ اﻳﻦ ﻣﻘﺎﻟﻪ ﺣﺎﺻﻞ ﺑﺨـﺸﻲ از ﻃـﺮح ﺗﺤﻘﻴﻘـﺎﺗﻲ ﺗﺤـﺖ‬:‫ﺳﭙﺎﺳﮕﺰاري‬

‫ ﭼﺮا ﻛـﻪ ﻛﺒـﺪ ﭘﺬﻳﺮﻧـﺪه از‬.‫ﻓﺮاوانﺗﺮي در ﻛﺒﺪ ﻧﺴﺒﺖ ﺑﻪ ﻛﻠﻴﻪﻫﺎ ﻣﻲﺷﻮد‬

‫ﻋﻨﻮان "ﺑﺮرﺳﻲ آﺳﻴﺐ ﻛﻠﻴﻮي ﭘﺬﻳﺮﻧﺪه ﭘـﺲ از اﻧﺘﻘـﺎل ﻟﻜﻮﺳـﻴﺖﻫـﺎ از‬

‫ﻧﻈﺮ ﻋﻤﻠﻜﺮدي و ﺑﺎﻓﺘﻲ و اﺳﺘﺮس اﻛﺴﻴﺪاﺗﻴﻮ ﺗﻐﻴﻴﺮات ﺑﺴﻴﺎري را ﻧﺴﺒﺖ‬

"‫ ﺧﻮنرﺳـﺎﻧﻲ ﻣﺠـﺪد ﻛﻠﻴـﻮي‬-‫ ﻣﺒﺘﻼ ﺑﻪ اﻳﺴﻜﻤﻲ‬Inbred ‫ﻣﻮش ﺳﻮري‬

‫ ﻛﻠﻴـﻪﻫـﺎي‬،‫ ﺣﺎل آنﻛﻪ در ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿـﺮ‬8.‫ﺑﻪ ﮔﺮوه ﺷﻢ ﮔﻴﺮﻧﺪه داﺷﺖ‬

‫ ﺑﻪ ﻛﺪ‬1389 ‫ﻣﺼﻮﺑﻪ و ﺑﺎ ﺣﻤﺎﻳﺖ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان در ﺳﺎل‬

‫ﭘﺬﻳﺮﻧﺪه ﻋﻠﻲرﻏﻢ اﻳﺠﺎد اﺳﺘﺮس اﻛﺴﻴﺪاﺗﻴﻮ و آﻏﺎز ﺗﻐﻴﻴﺮات ﭘﺎﺗﻮﻟﻮژﻳـﻚ‬

.‫ ﻣﻲﺑﺎﺷﺪ‬10991

‫)ﺑﺎﻓﺖﺷﻨﺎﺳﻲ( از ﻧﻈﺮ ﻋﻤﻠﻜﺮدي ﺗﻔﺎوت ﭼﻨﺪاﻧﻲ ﺑـﺎ ﮔـﺮوه ﺷـﻢ ﻧـﺸﺎن‬

References 1.

Hassoun HT, Grigoryev DN, Lie ML, Liu M, Cheadle C, Tuder RM, et al. Ischemic acute kidney injury induces a distant organ functional and genomic response distinguishable from bilateral nephrectomy. Am J Physiol Renal Physiol 2007;293(1):F30-40. 2. Lee HT, Kim M, Kim M, Kim N, Billings FT 4th, D'Agati VD, et al. Isoflurane protects against renal ischemia and reperfusion injury and modulates leukocyte infiltration in mice. Am J Physiol Renal Physiol 2007;293(3):F713-22. 3. Zhang ZX, Wang S, Huang X, Min WP, Sun H, Liu W, et al. NK cells induce apoptosis in tubular epithelial cells and contribute to renal ischemia-reperfusion injury. J Immunol 2008;181(11):7489-98. 4. Mizutani A, Okajima K, Uchiba M, Noguchi T. Activated protein C reduces ischemia/reperfusion-induced renal injury in rats by inhibiting leukocyte activation. Blood 2000;95(12):37817. 5. Kanoria S, Jalan R, Seifalian AM, Williams R, Davidson BR. Protocols and mechanisms for remote ischemic preconditioning: a novel method for reducing ischemia reperfusion injury. Transplantation 2007;84(4):445-58. 6. Liu M, Liang Y, Chigurupati S, Lathia JD, Pletnikov M, Sun Z, et al. Acute kidney injury leads to inflammation and functional changes in the brain. J Am Soc Nephrol 2008;19(7):1360-70. 7. Serteser M, Koken T, Kahraman A, Yilmaz K, Akbulut G, Dilek ON. Changes in hepatic TNF-alpha levels, antioxidant status, and oxidation products after renal ischemia/reperfusion injury in mice. J Surg Res 2002;107(2):234-40. 8. Golab F, Kadkhodaee M, Zahmatkesh M, Hedayati M, Arab H, Schuster R, et al. Ischemic and non-ischemic acute kidney injury cause hepatic damage. Kidney Int 2009;75(8):783-92. 9. Chen WT, Huang WH, Wang D, Yu FC, Chi YC, Wu JC, et al. The protective effect of adenosine triphosphate-MgCl2 on ischemia-reperfusion lung injury is leukocyte dependent. J Biomed Sci 2003;10(6 Pt 2):725-30. 10. Marcheselli VL, Hong S, Lukiw WJ, Tian XH, Gronert K, Musto A, et al. Novel docosanoids inhibit brain ischemiareperfusion-mediated leukocyte infiltration and proinflammatory gene expression. J Biol Chem 2003;278(44):43807-17. 11. Harada N, Okajima K, Murakami K, Usune S, Sato C, Ohshima K, et al. Adenosine and selective A(2A) receptor agonists reduce ischemia/reperfusion injury of rat liver mainly by inhibiting

leukocyte activation. J Pharmacol Exp Ther 2000;294(3):1034-42. 12. Khastar H, Kadkhodaee M, Sadeghipour HR, Seifi B, Hadjati J, Delavari F, et al. Leukocyte involvement in renal reperfusioninduced liver damage. Ren Fail 2011;33(1):79-83. 13. Donnahoo KK, Meng X, Ayala A, Cain MP, Harken AH, Meldrum DR. Early kidney TNF-alpha expression mediates neutrophil infiltration and injury after renal ischemia-reperfusion. Am J Physiol 1999;277(3 Pt 2):R922-9. 14. Meldrum KK, Meldrum DR, Meng X, Ao L, Harken AH. TNFalpha-dependent bilateral renal injury is induced by unilateral renal ischemia-reperfusion. Am J Physiol Heart Circ Physiol 2002;282(2):H540-6. 15. Mizutani A, Okajima K, Uchiba M, Isobe H, Harada N, Mizutani S, et al. Antithrombin reduces ischemia/reperfusion-induced renal injury in rats by inhibiting leukocyte activation through promotion of prostacyclin production. Blood 2003;101(8):3029-36. 16. Rabb H, Daniels F, O'Donnell M, Haq M, Saba SR, Keane W, et al. Pathophysiological role of T lymphocytes in renal ischemiareperfusion injury in mice. Am J Physiol Renal Physiol 2000;279(3):F525-31. 17. Park P, Haas M, Cunningham PN, Bao L, Alexander JJ, Quigg RJ. Injury in renal ischemia-reperfusion is independent from immunoglobulins and T lymphocytes. Am J Physiol Renal Physiol 2002;282(2):F352-7. 18. Burne-Taney MJ, Yokota-Ikeda N, Rabb H. Effects of combined Tand B-cell deficiency on murine ischemia reperfusion injury. Am J Transplant 2005;5(6):1186-93. 19. Cowan KM, Easton AS. Neutrophils block permeability increases induced by oxygen glucose deprivation in a culture model of the human blood-brain barrier. Brain Res 2010;1332:20-31. 20. Renner B, Strassheim D, Amura CR, Kulik L, Ljubanovic D, Glogowska MJ, et al. B cell subsets contribute to renal injury and renal protection after ischemia/reperfusion. J Immunol 2010;185(7):4393-400. 21. Demirbilek S, Karaman A, Baykarabulut A, Akin M, Gürünlüoglu K, Türkmen E, et al. Polyenylphosphatidylcholine pretreatment ameliorates ischemic acute renal injury in rats. Int J Urol 2006;13(6):747-53. 22. Burne-Taney MJ, Liu M, Ascon D, Molls RR, Racusen L, Rabb H. Transfer of lymphocytes from mice with renal ischemia can induce albuminuria in naive mice: a possible mechanism linking early injury and progressive renal disease? Am J Physiol Renal Physiol 2006;291(5):F981-6.

1391 ‫ اردﻳﺒﻬﺸﺖ‬،2 ‫ ﺷﻤﺎره‬،70 ‫ دوره‬،‫ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‬،‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‬

‫ﻋﻤﻮﻣﻲ‬ ‫ﺑﺨﺸﻬﺎي ﺟﺮاﺣﻲ‬ ‫ﺟﺮاﺣﻲ در‬ ‫ﻋﻔﻮﻧﺖ ﻣﺤﻞ‬ ‫ﺑﺮاي‬2,‫ﭘﺎﻳﺶ‬ ‫روش‬ ‫ﻛﺎراﻳﻲ دو‬ Tehran University Medical Journal; Vol.‫ﺗﺸﺨﻴﺺ‬ 70, No. May 2012: 69-77

Recipient kidney damage after leukocyte transfer from inbred mice with renal ischemia-reperfusion injury

Abstract Mehri Kadkhodaee Ph.D.1* Hossein Khastar Ph.D.2 Behjat Seifi Ph.D.1 Atefeh Najafi M.Sc.3 Fatemeh Delavari M.Sc.1

Received: September 07, 2011 Accepted: January 23, 2012

Background: In a recent study, we were able to demonstrate a role for leukocyte transfer in the induction of liver damage in recipient mice after induction of IR (60 min of bilateral renal artery occlusion and 3 hrs reperfusion) injury in donors. The present

1- Department of Physiology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2- Department of Physiology, Faculty of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran. 3- Department of Anatomy, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

study investigates the role of leukocyte transfer in the induction of kidney damage in recipient mice after induction of renal IR injury in donors. Methods: Mice were divided into two sham and renal IR groups. After anesthesia, leukocytes were isolated from blood and were transferred to the two recipient groups: the intact recipient mice received leukocytes from the sham donor group (Sham recipient) and the intact recipient mice that received leukocytes from IR donor group (IR recipient). After 24 hrs, the recipient mice were anesthetized and blood samples and renal tissues were collected. Results: Renal malondialdehyde (MDA) increased and glutathione and superoxide dismutase (SOD) decreased significantly in IR recipient group in comparison to sham recipient group. Although renal function tests, including BUN and plasma creatinine were significantly different between IR donor and sham donor groups, but they were not significantly different in two recipient groups. Renal tissues in IR donor group showed extensive damage compared to sham group, but in IR recipients’ kidneys, they were different from IR donor tissues despite being different from their respective sham group. Conclusion: These findings are suggestive of implication of leukocytes in renal tissue damage and oxidative stress after renal IR injury. Keywords: Ischemia-reperfusion injury, kidneys, leukocytes, oxidative stress.

Corresponding author: Department of Physiology, Faculty of Medicine, Tehran Medical Sciences University, Poursina St., Tehran, Iran. Tel: +98- 21- 64053288 E-mail: kadkhodm@tums.ac.ir

‫‪78-85 ،1391‬‬ ‫اردﻳﺒﻬﺸﺖ‬ ‫ﺷﻤﺎره ‪2‬‬ ‫ﺼﻪدوره‬ ‫ﺗﻬﺮان‪،‬‬ ‫ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه‬ ‫ﻣﻮش‬ ‫ﺷﺪه‪ ،‬در ران‬ ‫‪70‬اﻳ‪،‬ﺠﺎد‬ ‫ﺗﺠﺮﺑﻲ‬ ‫ﭘﺰﺷﻜﻲﻢ ﻧﻘﻴ‬ ‫ﻋﻠﻮم ﺑﺮ ﺗﺮﻣﻴ‬ ‫آﺗﻮرواﺳﺘﺎﺗﻴﻦ‬ ‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﺗﺎﺛﻴﺮ‬

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‫ارزﻳﺎﺑﻲ ﻫﻴﺴﺘﻮﭘﺎﺗﻮﻟﻮژي و ﻫﻴﺴﺘﻮﻣﻮرﻓﻮﻣﺘﺮي ﺗﺎﺛﻴﺮ آﺗﻮرواﺳﺘﺎﺗﻴﻦ ﺑﺮ ﺗﺮﻣﻴﻢ ﻧﻘﻴﺼﻪ ﺗﺠﺮﺑﻲ اﻳﺠﺎد ﺷﺪه‬ ‫در اﺳﺘﺨﻮان ﻣﺘﺮاﻛﻢ ران ﻣﻮش ﺻﺤﺮاﻳﻲ‬

‫ﺗﺎرﻳﺦ درﻳﺎﻓﺖ ﻣﻘﺎﻟﻪ‪ 1390/06/05 :‬ﺗﺎرﻳﺦ ﭘﺬﻳﺮش‪1390/11/15 :‬‬

‫ﻏﻔﻮر ﻣﻮﺳﻮي‪ *1،‬دارﻳﻮش ﻣﻬﺎﺟﺮي‪،‬‬

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‫ﭼﻜﻴﺪه‬

‫‪3‬‬

‫ﻋﻠﻲ رﺿﺎﻳﻲ‪ 1،‬ﻣﺤﻤﺪرﺿﺎ وﻟﻴﻠﻮ‪،‬‬

‫زﻣﻴﻨﻪ و ﻫﺪف‪ :‬ﺗﺮﻣﻴﻢ اﺳﺘﺨﻮان‪ ،‬ﻳﻜﻲ از ﻣﺴﺎﻳﻞ ﭼﺎﻟﺶﺑﺮاﻧﮕﻴﺰ ﺟﺮاﺣﺎن از زﻣﺎنﻫﺎي دور ﺑﻮده اﺳﺖ‪ .‬داروﻫـﺎي اﺳـﺘﺎﺗﻴﻨﻲ‬

‫‪4‬‬

‫آرﻣﺎن ﻋﻠﻴﻤﺤﻤﺪي‬

‫ﺑﻪ ﻋﻨﻮان ﭘﺎﻳﻴﻦ آورﻧﺪه ﻛﻠﺴﺘﺮول ﺧﻮن داراي اﺛﺮات ﻣﻔﻴﺪ در ﺗﺮﻣﻴﻢ اﺳﺘﺨﻮان ﻣﻲﺑﺎﺷﻨﺪ‪ .‬ﻫﺪف اﻳﻦ ﻣﻄﺎﻟﻌﻪ ارزﻳـﺎﺑﻲ ﺗـﺎﺛﻴﺮ‬ ‫‪ -1‬ﮔﺮوه ﺟﺮاﺣﻲ داﻣﭙﺰﺷﻜﻲ‪ ،‬ﮔﺮوه ﻋﻠﻮم‬

‫آﺗﻮرواﺳﺘﺎﺗﻴﻦ ﺑﺮ روﻧﺪ اﺳﺘﺨﻮانﺳﺎزي در ﻧﻘﻴﺼﻪ ﺗﺠﺮﺑﻲ اﻳﺠﺎد ﺷﺪه در اﺳﺘﺨﻮان ﻣﺘﺮاﻛﻢ ﻓﻤﻮر ﻣﻮش ﺻﺤﺮاﻳﻲ ﻣﻲﺑﺎﺷـﺪ‪.‬‬

‫درﻣﺎﻧﮕﺎﻫﻲ‪ ،‬داﻧﺸﻜﺪه داﻣﭙﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه آزاد‬

‫روش ﺑﺮرﺳﻲ‪ :‬اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺗﺠﺮﺑﻲ آزﻣﺎﻳﺸﮕﺎﻫﻲ ﺑﺮ روي ‪ 30‬ﺳﺮ ﻣﻮش ﺻﺤﺮاﻳﻲ ﻧﺮ ﻧـﮋاد ‪ SD‬اﻧﺠـﺎم ﺷـﺪ‪ .‬ﻣـﻮشﻫـﺎ ﺑـﻪ‬

‫اﺳﻼﻣﻲ‪ ،‬واﺣﺪ ﺗﺒﺮﻳﺰ‪ ،‬ﺗﺒﺮﻳﺰ‪ ،‬اﻳﺮان‪.‬‬ ‫‪ -2‬ﮔﺮوه ﭘﺎﺗﻮﺑﻴﻮﻟﻮژي‪ ،‬داﻧﺸﻜﺪه داﻣﭙﺰﺷﻜﻲ‪،‬‬

‫ﺻﻮرت ﺗﺼﺎدﻓﻲ ﺑﻪ ﺳﻪ ﮔﺮوه )آزﻣﺎﻳﺶ و ﺷﺎﻫﺪ( ﺗﻘﺴﻴﻢ ﺷﺪﻧﺪ‪ .‬ﭘﺲ از اﻟﻘﺎي ﺑﻴﻬﻮﺷﻲ‪ ،‬ﺳﻮراﺧﻲ ﺑﻪ ﻗﻄﺮ دو ﻣﻴﻠﻲﻣﺘـﺮ در‬

‫داﻧﺸﮕﺎه آزاد اﺳﻼﻣﻲ‪ ،‬واﺣﺪ ﺗﺒﺮﻳﺰ‪ ،‬ﺗﺒﺮﻳﺰ‪ ،‬اﻳﺮان‬

‫ﻋﺮض اﺳﺘﺨﻮان ران اﻳﺠﺎد ﺷﺪ‪ .‬ﮔﺮوه ﺷﺎﻫﺪ ﻳﻚ ﻣﻴﻠﻲﻟﻴﺘﺮ ﺳﺮم ﻓﻴﺰﻳﻮﻟﻮژي و ﮔﺮوهﻫﺎي آزﻣﺎﻳﺶ ﻳﻚ و دو ﺑﻪ ﺗﺮﺗﻴﺐ ‪10‬‬

‫‪ -3‬ﮔﺮوه داﻣﭙﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه آزاد اﺳﻼﻣﻲ‪ ،‬واﺣﺪ‬

‫و ‪ 20‬ﻣﻴﻠﻲﮔﺮم ﺑﻪ ازاي ﻛﻴﻠﻮﮔﺮم آﺗﻮرواﺳﺘﺎﺗﻴﻦ ﺑﻪ ﺻﻮرت ﺧﻮراﻛﻲ درﻳﺎﻓﺖ ﻧﻤﻮدﻧﺪ‪ 45 .‬روز ﺑﻌﺪ‪ ،‬ﻣﻮشﻫﺎ آﺳـﺎن ﻛـﺸﻲ‬

‫ﺷﺒﺴﺘﺮ‪ ،‬ﺷﺒﺴﺘﺮ‪ ،‬اﻳﺮان‬ ‫‪ -4‬ﮔﺮوه داﻣﭙﺰﺷﻜﻲ‪ ،‬داﻧﺸﻜﺪه داﻣﭙﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه‬ ‫آزاد اﺳﻼﻣﻲ‪ ،‬واﺣﺪ ﺗﺒﺮﻳﺰ‪ ،‬ﺗﺒﺮﻳﺰ‪ ،‬اﻳﺮان‬

‫ﺷﺪه و ﻣﻘﺎﻃﻊ ﻫﻴﺴﺘﻮﭘﺎﺗﻮﻟﻮژﻳﻚ از ﻣﺤﻞ ﻧﻘﻴﺼﻪ ﺗﻬﻴﻪ و ﻣﻮرد ارزﻳﺎﺑﻲ ﻫﻴﺴﺘﻮﭘﺎﺗﻮﻟﻮژي و ﻫﻴﺴﺘﻮﻣﻮرﻓﻮﻣﺘﺮي ﻗﺮار ﮔﺮﻓـﺖ‪.‬‬ ‫ﻳﺎﻓﺘﻪﻫﺎ‪ :‬در ﮔﺮوه ﺷﺎﻫﺪ ﻣﺤﻞ ﻧﻘﻴﺼﻪ ﺗﻮﺳﻂ اﺳـﺘﺨﻮان ﻧﺎﺑـﺎﻟﻎ ﺑـﻪ ﻫﻤـﺮاه ﻓـﻀﺎﻫﺎﻳﻲ از ﻣﻐـﺰ اﺳـﺘﺨﻮان ﭘـﺮ ﺷـﺪه ﺑـﻮد و‬ ‫اﺳﺘﺨﻮانﺳﺎزي ﺿﻌﻴﻔﻲ در ﻣﺤﻞ ﻧﻘﻴﺼﻪ ﻗﺎﺑﻞ ﻣﺸﺎﻫﺪه ﺑﻮد‪ .‬در ﮔﺮوهﻫﺎي آزﻣﺎﻳﺶ‪ ،‬ﻣﻘﺎدﻳﺮ ﻓﺮاوان اﺳﺘﺌﻮﺑﻼﺳﺖ ﺑـﻪ ﻫﻤـﺮاه‬ ‫ﺗﻌﺪاد زﻳﺎدي ﺗﺮاﺑﻜﻮلﻫﺎي اﺳﺘﺨﻮاﻧﻲ ﺟﻮان ﻗﺎﺑﻞ ﻣﺸﺎﻫﺪه ﺑﻮد ﻛﻪ ﺳـﺎزﻣﺎن ﻳﺎﻓﺘـﻪ ﺑـﻪ ﻧﻈـﺮ ﻣـﻲرﺳـﻴﺪﻧﺪ‪ .‬ﻧﺘـﺎﻳﺞ ارزﻳـﺎﺑﻲ‬ ‫ﻫﻴﺴﺘﻮﻣﻮرﻓﻮﻣﺘﺮي ﻧﺸﺎن داد ﻛﻪ آﺗﻮرواﺳﺘﺎﺗﻴﻦ داراي ﺗﺎﺛﻴﺮ ﻣﻌﻨﻲداري در اﻟﺘﻴﺎم اﺳﺘﺨﻮان در ﮔﺮوهﻫﺎي ﻣﻮرد آزﻣـﺎﻳﺶ دوم‬ ‫و ﺳﻮم ﻧﺴﺒﺖ ﺑﻪ ﮔﺮوه ﺷﺎﻫﺪ ﻣﻲﺑﺎﺷﺪ )‪ ،(P<0/0001‬ارزﻳﺎﺑﻲ ﻧﺘﺎﻳﺞ ﺑﻪ دﺳﺖ آﻣﺪه ﻧﺸﺎن ﻣﻲدﻫﺪ ﻛﻪ آﺗﻮرواﺳﺘﺎﺗﻴﻦ ﺑـﺎ دوز‬

‫*‬

‫ﻧﻮﻳﺴﻨﺪه ﻣﺴﺌﻮل‪ :‬ﺗﺒﺮﻳﺰ‪ ،‬ﺿﻠﻊ ﺷﺮﻗﻲ اﺗﻮﺑﺎن ﭘﺎﺳﺪاران‪،‬‬

‫داﻧﺸﮕﺎه آزاد اﺳﻼﻣﻲ واﺣﺪ ﺗﺒﺮﻳﺰ‪ ،‬داﻧﺸﻜﺪه داﻣﭙﺰﺷﻜﻲ‪،‬‬ ‫ﮔﺮوه ﻋﻠﻮم درﻣﺎﻧﮕﺎﻫﻲ‪ ،‬ﺑﺨﺶ ﺟﺮاﺣﻲ و رادﻳﻮﻟﻮژي‬

‫ﺑﺎﻻ در ﮔﺮوه ﺳﻮم داراي ﺗﺎﺛﻴﺮ ﻣﻌﻨﻲداري ﻧﺴﺒﺖ ﺑﻪ ﮔﺮوه دوم ﻣﻲﺑﺎﺷﺪ )‪ .(P<0/0001‬ﻧﺘﻴﺠﻪﮔﻴﺮي‪ :‬ﻧﺘﺎﻳﺞ ﻧﺸﺎن ﻣﻲدﻫﺪ ﻛﻪ‬ ‫آﺗﻮرواﺳﺘﺎﺗﻴﻦ ﻗﺎدر ﺑﻪ ﺗﺤﺮﻳﻚ اﺳﺘﺨﻮانﺳﺎزي در ﻣﻮش ﺻﺤﺮاﻳﻲ ﻣﻲﺑﺎﺷﺪ‪.‬‬

‫ﺗﻠﻔﻦ‪0411-6372274 :‬‬ ‫‪E-mail: gh_mousavi@iaut.ac.ir‬‬

‫ﻛﻠﻤﺎت ﻛﻠﻴﺪي‪ :‬آﺗﻮرواﺳﺘﺎﺗﻴﻦ‪ ،‬اﻟﺘﻴﺎم اﺳﺘﺨﻮان‪ ،‬ﻣﻮش ﺻﺤﺮاﻳﻲ‪ ،‬ﻫﻴﺴﺘﻮﭘﺎﺗﻮﻟﻮژي‪ ،‬ﻫﻴﺴﺘﻮﻣﻮرﻓﻮﻣﺘﺮي‪.‬‬

‫ﻣﻘﺪﻣﻪ‬

‫آزﻣﺎﻳﺶ‪ ،‬ﺗﺎﺛﻴﺮ ﻋﺎﻣﻞ زﻣﺎن را در ﺗﺮﻣﻴﻢ ﺷﻜﺴﺘﮕﻲ اﺳﺘﺨﻮان ﺗﺎﻳﻴﺪ ﻛﺮدﻧﺪ‪،‬‬ ‫ﺑﻪ اﻳﻦ ﺻﻮرت ﻛﻪ ﻫﺮ ﭼﻪ اﻟﺘﻴﺎم ﺳﺮﻳﻊﺗﺮ ﺷﻜﻞ ﺑﮕﻴﺮد‪ ،‬ﻧﻘﻴﺼﻪ اﺳﺘﺨﻮاﻧﻲ‬

‫ﺑﺎ وﺟﻮد ﭘﻴﺸﺮﻓﺖﻫﺎي ﻓﺮاواﻧﻲ ﻛﻪ در ﺟﺮاﺣﻲ اﺳﺘﺨﻮان اﻳﺠﺎد ﺷﺪه‬

‫از ﻗﻮام و اﺳﺘﺤﻜﺎم ﺑﻴﺶﺗﺮي ﺑﺮﺧﻮردار ﺧﻮاﻫـﺪ ﺑـﻮد و اﺣﺘﻤـﺎل ﺑـﺮوز‬

‫اﺳﺖ‪ ،‬وﻟﻲ اﻟﺘﻴﺎم اﺳﺘﺨﻮان )‪ (Bone healing‬ﻧﺎﺷﻲ از ﺗﺮوﻣـﺎ ﻳـﺎ ﻋﻮاﻣـﻞ‬

‫ﻋﺪم ﺟﻮشﺧﻮردﮔﻲ ﻳﺎ ﺟﻮشﺧﻮردﮔﻲ ﺑﺎ ﺗﺎﺧﻴﺮ ﻛﻢﺗﺮ ﺷﺪه و ﻧﻴﺰ ﺑﺮوز‬ ‫‪1-3‬‬

‫دﻳﮕﺮي ﻧﻈﻴـﺮ ﺗﻮﻣﻮرﻫـﺎي اﺳـﺘﺨﻮاﻧﻲ ﻳـﻚ ﻣـﺴﺌﻠﻪ ﭼـﺎﻟﺶ ﺑﺮاﻧﮕﻴـﺰ در‬

‫ﻋﻔﻮﻧﺖ و ﻋﺪم ﻣﻮﻓﻘﻴﺖ در ﺟﺮاﺣﻲ ارﺗﻮﭘﺪي ﻛﻢﺗﺮ ﺧﻮاﻫﺪ ﺷﺪ‪.‬‬

‫ﺟﺮاﺣﻲﻫﺎي ارﺗﻮﭘﺪي ﻣﻲﺑﺎﺷـﺪ‪ .‬ﺗﺤﻘﻴﻘـﺎت اﻧﺠـﺎم ﮔﺮﻓﺘـﻪ روي ﺗـﺮﻣﻴﻢ‬

‫اﻳﻦ ﺳﻮال ﭘﻴﺶ ﻣﻲآﻳﺪ ﻛﻪ آﻳﺎ ﻣﻲﺗﻮان از دارو ﻳﺎ داروﻫﺎﻳﻲ اﺳﺘﻔﺎده ﻛـﺮد‬

‫ﺷﻜﺴﺘﮕﻲﻫﺎي اﺳﺘﺨﻮاﻧﻲ‪ ،‬ﺑﻴﺎنﮔﺮ اﻳﻦ ﻣﻮﺿﻮع اﺳﺖ ﻛﻪ ﻋﺎﻣﻞ زﻣـﺎن در‬

‫ﻛﻪ زﻣـﺎن اﻟﺘﻴـﺎم را ﻛـﺎﻫﺶ دﻫـﺪ؟ آﺗﻮرواﺳـﺘﺎﺗﻴﻦ )‪ (Atorvastatin‬ﻳـﻚ‬

‫روﻧﺪ ﺑﻬﺒﻮدي ﻣﻮﺛﺮ ﻣـﻲﺑﺎﺷـﺪ‪ .‬اﻳـﻦ ﻧﺘﻴﺠـﻪ‪ ،‬ﺣﺎﺻـﻞ اﻧﺠـﺎم آزﻣﺎﻳـﺸﺎت‬

‫داروي اﺳﺘﺎﺗﻴﻨﻲ و ﺗﻨﻈﻴﻢﻛﻨﻨﺪه ﭼﺮﺑﻲ ﺧﻮن ﺑﺎ ﻋﻤﻠﻜﺮد روي ﭼﺮﺑﻲﻫـﺎي‬

‫ﺧﻮاص ﻣﻜﺎﻧﻴﻜﻲ و رادﻳﻮﮔﺮاﻓﻲ ﻧﺎﺣﻴﻪ ﺷﻜﺴﺘﮕﻲ ﺑﻮده ﻛﻪ ﻫـﺮ دو ﻧـﻮع‬

‫ﭘﻼﺳﻤﺎﺳــﺖ‪ .‬داروﻫــﺎي اﺳــﺘﺎﺗﻴﻨﻲ ﻣﻬﺎرﻛﻨﻨــﺪهﻫــﺎي رﻗــﺎﺑﺘﻲ آﻧــﺰﻳﻢ‬

‫ﺣﺎل‬

‫ﻏﻔﻮر ﻣﻮﺳﻮي و ﻫﻤﻜﺎران‬

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‫)‪Hydroxymethyl Glutaryl CoA Reductase (HMG-CoA reductase‬‬

‫ﺑﺎﻟﻎ ﻧﮋاد )‪ Sprague-Dawley (SD‬ﺑﺎ وزن ﺗﻘﺮﻳﺒﻲ ‪ 250-300‬ﮔﺮم و ﺳﻦ‬

‫ﻫﺴﺘﻨﺪ‪ .‬اﻣﺮوزه اﻳﻦ داروﻫﺎ ﻛﺎرﺑﺮد وﺳﻴﻌﻲ در درﻣﺎن ﺑﻴﻤﺎريﻫـﺎي ﻗﻠﺒـﻲ‬

‫‪ 10‬ﻫﻔﺘــﻪ در ﺳــﺎل ‪ 1389‬در ﻣﺮﻛــﺰ ﺗﺤﻘﻴﻘــﺎت داﻧــﺸﻜﺪه داﻣﭙﺰﺷــﻜﻲ‬

‫ﻋﺮوﻗﻲ دارﻧﺪ‪ 4.‬ﻣﻄﺎﻟﻌﺎت اﻧﺠﺎم ﺷﺪه روي ﺗﺮﻛﻴﺒﺎت اﺳﺘﺎﺗﻴﻨﻲ ﻧﺸﺎندﻫﻨﺪه‬

‫داﻧﺸﮕﺎه آزاد اﺳﻼﻣﻲ ﺗﺒﺮﻳﺰ اﻧﺠﺎم ﮔﺮﻓﺖ‪ .‬ﻣـﻮشﻫـﺎ از ﻣﺮﻛـﺰ ﭘـﺮورش‬

‫ﺗﺎﺛﻴﺮ اﻳﻦ ﺗﺮﻛﻴﺒﺎت ﺑﺮ اﺳﺘﺨﻮان ﻣـﻲﺑﺎﺷـﺪ‪ .‬اﻓـﺰاﻳﺶ اﺳـﺘﺨﻮانﺳـﺎزي و‬

‫ﺣﻴﻮاﻧﺎت آزﻣﺎﻳﺸﮕﺎﻫﻲ داﻧﺸﻜﺪه داﻣﭙﺰﺷﻜﻲ داﻧﺸﮕﺎه آزاد اﺳﻼﻣﻲ ﺗﺒﺮﻳـﺰ‬

‫ﺟﻠﻮﮔﻴﺮي از ﺑﺎزﺟﺬب اﺳﺘﺨﻮاﻧﻲ ﺗﻮﺳﻂ ﺗﺮﻛﻴﺒـﺎت اﺳـﺘﺎﺗﻴﻦ ﻧـﺸﺎن داده‬

‫ﺗﻬﻴﻪ ﮔﺮدﻳﺪﻧﺪ و ﭘﺲ از اﻧﺘﻘﺎل ﺑﻪ ﺑﺨﺶ ﺟﺮاﺣـﻲ ﺑـﻪ ﻣﻨﻈـﻮر ﭘﺮﻫﻴـﺰ از‬

‫ﺷﺪه اﺳﺖ‪6.‬و‪ 5‬ﺗﺮﻛﻴﺒﺎت اﺳﺘﺎﺗﻴﻨﻲ داراي اﺛﺮات ﺿﺪاﻟﺘﻬﺎﺑﻲ ﺑﻮده و اﻳﻦ اﺛﺮ‬

‫اﺳﺘﺮس و ﺳﺎزﮔﺎر ﺷﺪن ﺑﺎ ﻣﺤﻴﻂ ﻫﻴﭻﮔﻮﻧـﻪ آزﻣﺎﻳـﺸﻲ ﺑـﻪ ﻣـﺪت ﻳـﻚ‬

‫را ﺑﺎ ﻛﺎﻫﺶ اﻳﻨﺘﺮﻟﻮﻛﻴﻦ‪ 6 -‬و اﻳﻨﺘﺮﻟﻮﻛﻴﻦ‪ 8 -‬اﻋﻤﺎل ﻣـﻲﻧﻤﺎﻳﻨـﺪ‪ 7.‬اوﻟـﻴﻦ‬

‫ﻫﻔﺘﻪ روي آنﻫﺎ ﺻﻮرت ﻧﮕﺮﻓﺖ‪ .‬ﻣﻮشﻫﺎ در درﺟﻪ ﺣـﺮارت ‪23±2 ºC‬‬

‫ﺑﺎر ‪ Mundy‬در ﻳﻚ ﻣﻄﺎﻟﻌﻪ ﺗﺠﺮﺑﻲ ﮔﺰارش ﻛﺮد ﻛـﻪ اﺳـﺘﺎﺗﻴﻦﻫـﺎ ﺗـﺎﺛﻴﺮ‬

‫و رﻃﻮﺑﺖ ﻧﺴﺒﻲ ﻫﻔﺘﺎد درﺻﺪ و ﭼﺮﺧﻪ روﺷﻨﺎﻳﻲ‪ -‬ﺗﺎرﻳﻜﻲ ‪ 12‬ﺳـﺎﻋﺖ‬

‫ﻣﺜﺒﺘــﻲ در ﺣﺠــﻢ اﺳــﺘﺨﻮان دارﻧــﺪ‪ .‬در اﻳــﻦ ﻣﻄﺎﻟﻌــﻪ ﺣﺠــﻢ اﺳــﺘﺨﻮان‬

‫و در ﻗﻔﺲﻫﺎي ﺟﺪاﮔﺎﻧﻪ ﻧﮕﻪداري ﺷﺪﻧﺪ‪ .‬ﺗﻐﺬﻳﻪ ﺑﺎ اﺳﺘﻔﺎده از ﭘﻠﺖ آﻣﺎده‬

‫ﺗﺮاﺑﻜﻮﻻر در ﻧﻤﻮﻧﻪﻫﺎي رتﻫﺎﻳﻲ ﻛﻪ ﺗﺨﻤـﺪان آنﻫـﺎ ﺑﺮداﺷـﺘﻪ ﺷـﺪه و‬

‫ﻣﺨﺼﻮص ﺣﻴﻮاﻧﺎت آزﻣﺎﻳﺸﮕﺎﻫﻲ ﺻﻮرت ﮔﺮﻓﺘﻪ و آب ﻧﻴﺰ ﺑﻪ ﻃﻮر آزاد‬

‫روزاﻧﻪ ﺑﻪ ﻣﺪت ‪ 35‬روز ﺳﻴﻤﻮاﺳـﺘﺎﺗﻴﻦ ﺑـﺎ دوز ﭘـﻨﺞ ﺗـﺎ ‪ 10‬ﻣﻴﻠـﻲﮔـﺮم‬

‫در اﺧﺘﻴﺎر ﺣﻴﻮاﻧﺎت ﻗﺮار ﮔﺮﻓﺖ‪ .‬ﻣﻮشﻫﺎ ﺑﻪ ﺻـﻮرت ﺗـﺼﺎدﻓﻲ ﺑـﻪ ﺳـﻪ‬

‫درﻳﺎﻓﺖ ﻛﺮدﻧﺪ‪ ،‬اﻓﺰاﻳﺶ ﻳﺎﻓﺘﻪ ﺑﻮد‪ 5.‬ﻣﻄﺎﻟﻌﺎت زﻳﺎدي ﺑـﺮاي اﺛﺒـﺎت ﺗـﺎﺛﻴﺮ‬

‫ﮔﺮوه ﺑﺮاﺑﺮ ﺑﺎ ‪ 10‬ﺳﺮ ﻣﻮش در ﻫﺮ ﮔﺮوه ﺗﻘـﺴﻴﻢ ﺷـﺪﻧﺪ‪ .‬ﭘﺮوﺗﻜـﻞ اﻳـﻦ‬

‫ﺗﻘﻮﻳﺘﻲ اﺳﺘﺨﻮان در ﻛﺎرﺑﺮد ﻣﻮﺿﻌﻲ اﺳﺘﺎﺗﻴﻦﻫﺎ در ﻧﻤﻮﻧﻪﻫـﺎي ﺣﻴـﻮاﻧﻲ‬

‫ﻣﻄﺎﻟﻌﻪ ﻣﻄﺎﺑﻖ اﺻﻮل اﺧﻼﻗﻲ ﻣﻮرد ﺗﺎﻳﻴﺪ ﻛﻤﻴﺘﻪﻫﺎي ﺑﻴﻦاﻟﻤﻠﻠﻲ ﺣﻤﺎﻳـﺖ‬

‫اﻧﺠﺎم ﺷﺪه اﺳﺖ‪ .‬در اﻳـﻦ زﻣﻴﻨـﻪ ﺗـﺎﺛﻴﺮ ﺳﻴﻤﻮاﺳـﺘﺎﺗﻴﻦ‪ ،‬ﻳﻜـﻲ دﻳﮕـﺮ از‬

‫از ﺣﻘﻮق ﺣﻴﻮاﻧﺎت آزﻣﺎﻳﺸﮕﺎﻫﻲ ﻃﺮاﺣﻲ ﺷﺪه اﺳﺖ‪.‬‬

‫داروﻫــﺎي اﺳــﺘﺎﺗﻴﻨﻲ‪ ،‬در اﻓــﺰاﻳﺶ ﺣﺠــﻢ ﺑﺎﻓــﺖ اﺳــﺘﺨﻮان‪ ،‬ﺳــﺮﻋﺖ‬ ‫ﺷﻜﻞﮔﻴﺮي اﺳﺘﺨﻮان و اﺳﺘﺤﻜﺎم ﺑﺎﻓﺖ اﺳﻔﻨﺠﻲ اﺳﺘﺨﻮان ﺛﺎﺑﺖ ﮔﺮدﻳﺪه‬

‫ﺑﻪ ﻣﻨﻈـﻮر اﻳﺠـﺎد ﺑﻴﻬﻮﺷـﻲ از ﻛﺘـﺎﻣﻴﻦ‬

‫‪(Ketamine 10%, Alfasan,‬‬

‫)‪ Woerden-Holland‬ﺑـﻪ ﻣﻴـﺰان ‪ 50mg/kg‬و زاﻳﻼزﻳـﻦ‬

‫‪(Xylazin 2%,‬‬

‫اﺳﺖ‪ 8.‬در زﻣﻴﻨﻪ ﺗﺮﻛﻴﺒﺎت اﺳﺘﺎﺗﻴﻦ و ﻣﺘﺎﺑﻮﻟﻴﺴﻢ اﺳﺘﺨﻮان‪ ،‬ﭼﻨﺪ ﻣﻜﺎﻧﻴﺴﻢ‬

‫)‪Woerden-Holland‬‬

‫ﻣﻮرد ﺗﻮﺟﻪ ﻣﻲﺑﺎﺷﺪ‪ .‬اﻳﻦ ﺗﺮﻛﻴﺒﺎت ﺑﺎ اﻓﺰاﻳﺶ ﻓﻌﺎﻟﻴﺖ اﺳﺘﺌﻮﺑﻼﺳـﺖ ﻛـﻪ‬

‫ﺻﻔﺎﻗﻲ اﺳﺘﻔﺎده ﺷﺪ‪ .‬ﭘﺲ از اﻳﺠﺎد ﺑﻴﻬﻮﺷﻲ‪ ،‬ﻧﺎﺣﻴﻪ ﺳﺘﻴﻎ ﻟﮕﻨﻲ ﺗﺎ ﻣﻔﺼﻞ‬

‫ﺗﻮﺳﻂ ‪ BMP-2‬اﻋﻤﺎل ﻣﻲﺷﻮد ﺳﺒﺐ ﺗﺤﺮﻳﻚ اﺳﺘﺨﻮانﺳﺎزي ﻣﻲﺷـﻮﻧﺪ‪.‬‬

‫زاﻧﻮي اﻧﺪام ﺣﺮﻛﺘﻲ ﺧﻠﻔﻲ ﭼﭗ ﺑـﻪ ﺻـﻮرت ﻣﻌﻤـﻮل آﻣـﺎده ﺟﺮاﺣـﻲ‬

‫اﺛﺮ دﻳﮕﺮ اﺳﺘﺎﺗﻴﻦ ﻫﺎ ﻣﻬﺎر آﻧﺰﻳﻢ ﻫﻴﺪروﻛـﺴﻲﻣﺘﻴـﻞﮔﻠﻮﺗﺎرﻳـﻞﻛـﻮآﻧﺰﻳﻢ‪-‬آ‬

‫ﮔﺮدﻳﺪ‪ .‬ﺑﺮﺷﻲ ﺑﻪ ﻃﻮل ﺳﻪ ﺳﺎﻧﺘﻲﻣﺘﺮ روي ﭘﻮﺳﺖ ﺑﺨـﺶ ﺟـﺎﻧﺒﻲ اﻧـﺪام‬

‫ردوﻛﺘﺎز و ﺟﻠﻮﮔﻴﺮي از ﺳﻨﺘﺰ ﻣﻮاﻟﻮﻧﺎت اﺳﺖ ﻛﻪ ﺳﺒﺐ اﺧﺘﻼل ﻓﻌﺎﻟﻴـﺖ‬

‫ﺧﻠﻔﻲ ﭼﭗ ﺑﻪ ﻣﻮازات اﺳﺘﺨﻮان ﻓﻤﻮر اﻳﺠﺎد ﺷﺪ‪ .‬ﻓﺎﺷـﻴﺎ و ﺑﺎﻓـﺖﻫـﺎي‬

‫اﺳﺘﺌﻮﻛﻼﺳﺖﻫﺎ و اﻓﺰاﻳﺶ آﭘﻮﭘﺘﻮزﻳﺲ آنﻫـﺎ ﻣـﻲﮔـﺮدد و ﺳـﺮاﻧﺠﺎم از‬

‫ﻫﻤﺒﻨﺪي زﻳﺮ ﺟﻠﺪي ﺑﻪ ﺻﻮرت ﻛُﻨـﺪﻛﺎري ﺟـﺪا و ﺳـﭙﺲ ﻋـﻀﻼت از‬

‫اﻓﺰاﻳﺶ ﺑﺎزﺟﺬب اﺳﺘﺨﻮاﻧﻲ ﺟﻠﻮﮔﻴﺮي ﻣﻲﻛﻨﺪ‪ 9.‬ﺳﻮﻣﻴﻦ ﺗﺎﺛﻴﺮ ﺗﺮﻛﻴﺒـﺎت‬

‫ﻣﺤﻞ اﺗﺼﺎل آنﻫﺎ ﺑﻪ ﻫﻤﺪﻳﮕﺮ ﺑﺎز ﮔﺮدﻳﺪ و اﺳﺘﺨﻮان ﻓﻤـﻮر در ﻣﻌـﺮض‬

‫اﺳﺘﺎﺗﻴﻦ اﺛﺮ ﺿﺪ اﻟﺘﻬﺎﺑﻲ آنﻫﺎ ﻣﻲﺑﺎﺷﺪ ﻛﻪ در ﻫﻨﮕﺎم ﺷﻜﻞﮔﻴـﺮي ﻧﻘﻴـﺼﻪ‬

‫دﻳﺪ ﻗﺮار ﮔﺮﻓﺖ‪ .‬ﺑﺎ اﺳﺘﻔﺎده از ﻣﺘـﻪ دﻧـﺪانﭘﺰﺷـﻜﻲ و ﺣـﺪاﻛﺜﺮ ﺳـﺮﻋﺖ‬

‫اﺳﺘﺨﻮاﻧﻲ در اﺳﺘﺨﻮان درﮔﻴﺮ و ﺑﺎﻓـﺖﻫـﺎي ﻣﺠـﺎور اﻟﺘﻬـﺎب ﺷـﺪﻳﺪي‬

‫ﭼﺮﺧﺶ ‪ 6000‬دور در دﻗﻴﻘﻪ ﺳﻮراﺧﻲ ﺑﻪ ﻗﻄﺮ دو ﻣﻴﻠﻲﻣﺘـﺮ در ﻋـﺮض‬

‫اﻳﺠﺎد ﻣﻲﺷﻮد ﻛﻪ اﻳﻦ اﺛﺮ اﺳﺘﺎﺗﻴﻦﻫﺎ ﻧﻴﺰ ﻣﻲﺗﻮاﻧـﺪ ﺑـﻪ ﺗـﺮﻣﻴﻢ اﺳـﺘﺨﻮان‬

‫اﺳﺘﺨﻮان ﻓﻤﻮر ﺗﺎ رﺳﻴﺪن ﺑﻪ ﻛﺎﻧﺎل ﻣﺪوﻻري اﻳﺠﺎد ﺷـﺪ‪ .‬ﺑـﺎ اﻃﻤﻴﻨـﺎن از‬

‫ﻛﻤﻚ ﻧﻤﺎﻳﺪ‪ 10.‬ﻫﺪف اﻳﻦ ﻣﻄﺎﻟﻌﻪ ارزﻳﺎﺑﻲ ﺗﺎﺛﻴﺮ آﺗﻮرواﺳـﺘﺎﺗﻴﻦ در اﻟﺘﻴـﺎم‬

‫ﻧﺤﻮه اﻧﺠﺎم ﺟﺮاﺣﻲ‪ ،‬ﻣﻮﺿﻊ ﺑﺎ ﻧﺮﻣﺎل ﺳﺎﻟﻴﻦ ﺷﺴﺘﺸﻮ داده ﺷـﺪ‪ .‬ﻧﻘﻴـﺼﻪ‬

‫ﻧﻘﻴﺼﻪ اﻳﺠﺎد ﺷﺪه در اﺳﺘﺨﻮان ﻣﺘﺮاﻛﻢ ﻓﻤـﻮر در ﻣـﺪل ﺣﻴـﻮاﻧﻲ ﻣـﻮش‬

‫اﻳﺠﺎد ﺷﺪه ﺑﻪ ﺻﻮرت ﺧﺎﻟﻲ رﻫﺎ ﺷﺪه و ﻋﻀﻼت ﻧﺎﺣﻴـﻪ ﺑـﺎ اﺳـﺘﻔﺎده از‬

‫ﺻــﺤﺮاﻳﻲ ﻣــﻲﺑﺎﺷــﺪ ﻛــﻪ ﺑــﻪ ﺻــﻮرت ارزﻳــﺎﺑﻲ ﻫﻴــﺴﺘﻮﭘﺎﺗﻮﻟﻮژي و‬

‫ﻧﺦ ﺑﺨﻴﻪ ﻗﺎﺑﻞ ﺟﺬب ﺳﻨﺘﺘﻴﻚ ﭘﻠﻲﮔﻠـﻲﻛـﻮﻻت‬

‫‪(Supa, Co, Iran) 0-4‬‬

‫ﻫﻴﺴﺘﻮﻣﻮرﻓﻮﻣﺘﺮي اﻧﺠﺎم ﺷﺪه اﺳﺖ‪.‬‬

‫اﻳﺮان ﺑﻪ ﺻﻮرت ﺳﺎده ﺳﺮﺗﺎﺳﺮي ﺑﺨﻴﻪ زده ﺷﺪ‪ .‬ﭘﻮﺳﺖ ﻣﺤﻞ ﺑﺮش ﻧﻴـﺰ‬

‫‪ Alfasan,‬ﺑﻪ ﻣﻴـﺰان ‪ 5mg/kg‬ﺑـﻪ ﺻـﻮرت داﺧـﻞ‬

‫ﺗﻮﺳﻂ ﻧﺦ ﺑﺨﻴﻪ ﺳﻴﻠﻚ ﺳﻪ ﺻﻔﺮ ﺳﺎﺧﺖ ﻛﺎرﺧﺎﻧﻪ ﺳﻮﭘﺎ ﺑﻪ ﺻﻮرت ﺗﻜﻲ‬

‫روش ﺑﺮرﺳﻲ‬

‫ﺳﺎده ﺑﺨﻴﻪ ﮔﺮدﻳﺪ‪ .‬ﺑﻌﺪ از ﺑﻪ ﻫﻮش آﻣﺪن ﻛﺎﻣﻞ‪ ،‬ﺣﻴﻮاﻧﺎت ﺑﻪ ﻗﻔﺲﻫـﺎي‬ ‫ﻣﺨﺼﻮص ﺧﻮد اﻧﺘﻘـﺎل داده ﺷـﺪﻧﺪ و در اﺧﺘﻴﺎرﺷـﺎن آب و ﻏـﺬا ﻗـﺮار‬

‫اﻳﻦ ﻣﻄﺎﻟﻌـﻪ ﺗﺠﺮﺑـﻲ آزﻣﺎﻳﺸﮕﺎﻫﻲ روي ‪ 30‬ﺳﺮ ﻣﻮش ﺻﺤﺮاﻳﻲ ﻧﺮ‬

‫ﮔﺮﻓﺖ‪ .‬ﺟﻬﺖ ﺟﻠﻮﮔﻴﺮي از ﻋﻔﻮﻧﺖﻫﺎي اﺣﺘﻤﺎﻟﻲ روزاﻧﻪ ‪ 40000‬واﺣـﺪ‬

‫ﺗﺎﺛﻴﺮ آﺗﻮرواﺳﺘﺎﺗﻴﻦ ﺑﺮ ﺗﺮﻣﻴﻢ ﻧﻘﻴﺼﻪ ﺗﺠﺮﺑﻲ اﻳﺠﺎد ﺷﺪه در ران ﻣﻮش‬

‫‪80‬‬

‫‪ (Jaber-ebn-Hayan‬و ‪ 5mg‬ﺟﻨﺘﺎﻣﺎﻳــﺴﻴﻦ‬

‫ﮔﺮدﻳﺪ‪ .‬ﺑﻪ ﻣﻨﻈﻮر ﺗﻌﻴﻴﻦ ﻣﻘﺎدﻳﺮ ﻧﺮﻣﺎل اﺳﺘﺨﻮان ﻻﻣﻼر‪ ،‬اﺳﺘﺨﻮان ﺗﻴﻐﻪاي‬

‫)‪ (Alborz daru, Co , Iran‬ﺑﻪ ازاي ﻫﺮ ﻛﻴﻠﻮﮔﺮم وزن ﺑـﺪن ﺑـﻪ ﺻـﻮرت‬

‫و ﻣﻐﺰ اﺳﺘﺨﻮان‪ ،‬ﻗﻄﻌﻪ اﺳﺘﺨﻮاﻧﻲ ﺳﺎﻟﻢ اﻧﺪام ﺣﺮﻛﺘﻲ ﻣﻘﺎﺑﻞ ﻧﻴـﺰ ﺟـﺪا و‬

‫ﻋﻀﻼﻧﻲ ﺑﻪ ﻣﺪت ﭘﻨﺞ روز ﺗﺰرﻳﻖ ﺷﺪ‪ .‬ﭘﺲ از اﻳﺠﺎد ﻧﻘﻴﺼﻪ اﺳـﺘﺨﻮاﻧﻲ‬

‫ﻣﻮرد ارزﻳﺎﺑﻲ ﻫﻴﺴﺘﻮﻣﻮرﻓﻮﻣﺘﺮي ﻗﺮار ﮔﺮﻓﺖ‪.‬‬

‫ﭘﻨــﻲﺳــﻴﻠﻴﻦ‬

‫‪Co, Iran) G‬‬

‫ﺑﻪ ﮔﺮوه اول ﻛﻪ ﺑﻪ ﻋﻨﻮان ﮔﺮوه ﺷﺎﻫﺪ در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ‪ ،‬ﻳﻚ ﻣﻴﻠﻲﻟﻴﺘـﺮ‬

‫ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻧﺘﺎﻳﺞ آزﻣﻮن ﻫﻤﮕـﻮﻧﻲ وارﻳـﺎﻧﺲﻫـﺎ و آزﻣـﻮن ﺗﻮزﻳـﻊ‬

‫ﺳﺮم ﻓﻴﺰﻳﻮﻟﻮژي ﺑﻪ ﻃﻮر روزاﻧﻪ و ﺑﻪ ﻣﺪت ‪ 45‬روز ﺑﻪ ﺻﻮرت ﺧﻮراﻛﻲ‬

‫ﻧﺮﻣﺎل دادهﻫﺎ )‪ (Kolmogorov-Smirnoff‬دادهﻫﺎي ﺑﻪدﺳﺖ آﻣـﺪه ﻛﻤ‪‬ـﻲ‪،‬‬

‫ﺗﻮﺳﻂ ﺳﻮﻧﺪ ﻣﺮي ﺧﻮراﻧﺪه ﺷﺪ‪ .‬ﻫﻢﭼﻨﻴﻦ ﺑﻪ ﻣﻮشﻫﺎي ﮔﺮوهﻫـﺎي دوم‬

‫ﺑﻪ ﺻﻮرت ﻣﻴﺎﻧﮕﻴﻦ و اﻧﺤﺮاف اﺳﺘﺎﻧﺪارد اراﻳﻪ و اﺧﺘﻼف ﻣﻌﻨـﻲدار ﺑـﻴﻦ‬

‫و ﺳــﻮم ﻧﻴــﺰ ﭘــﺲ از اﻳﺠــﺎد ﻧﻘﻴــﺼﻪ اﺳــﺘﺨﻮاﻧﻲ‪ ،‬ﺑــﻪ ﺗﺮﺗﻴــﺐ ‪ 10‬و ‪20‬‬

‫ﮔﺮوهﻫﺎ ﺗﻮﺳﻂ آزﻣﻮن آﻣﺎري آﻧﺎﻟﻴﺰ وارﻳـﺎﻧﺲ ﻳـﻚ ﻃﺮﻓـﻪ )‪ (ANOVA‬و‬

‫ﻣﻴﻠﻲﮔﺮم ﺑﻪ ازاي ﻫﺮ ﻛﻴﻠﻮﮔﺮم وزن ﺑﺪن داروي آﺗﻮرواﺳـﺘﺎﺗﻴﻦ )ﻗـﺮص‬

‫آزﻣﻮن ﺗﻌﻘﻴﺒﻲ ﺗﻮﻛﻲ )‪ (Tukey‬و ‪ ،α=0/05‬در ﺳﻄﺢ ﻣﻌﻨﻲداري‬

‫آﺗﻮرواﺳﺘﺎﺗﻴﻦ ‪ 20‬ﻣﻴﻠـﻲﮔﺮﻣـﻲ‪ ،‬ﺳـﺎﺧﺖ ﺷـﺮﻛﺖ‬

‫داروﺳـﺎزي ‪Sobhan‬‬

‫‪P<0/05‬‬

‫ﺗﻮﺳﻂ ﺑﺴﺘﻪ ﻧﺮماﻓﺰاري ‪ SPSS‬وﻳﺮاﺳﺖ ‪ 18‬ﺑﺮآورد ﮔﺮدﻳﺪ‪.‬‬

‫دارو( ﻛﻪ در ﻳﻚ ﻣﻴﻠﻲﻟﻴﺘﺮ ﺳﺮم ﻓﻴﺰﻳﻮﻟﻮژي ﺗﻬﻴـﻪ ﺷـﺪه ﺑـﻮد‪ ،‬ﺑـﻪ ﻃـﻮر‬ ‫روزاﻧﻪ و در ﻳﻚ ﺳﺎﻋﺖ ﻣﻌﻴﻦ‪ ،‬ﺑﻪ ﻣـﺪت ‪ 45‬روز ﺗﻮﺳـﻂ ﺳـﻮﻧﺪ ﻣـﺮي‬ ‫ﺧﻮراﻧﺪه ﺷﺪ‪ 11.‬ﻛﻠﻴﻪ ﻣﺮاﺣﻞ آزﻣﺎﻳﺶ )ﺷـﺎﻣﻞ ﺗﻴﻤـﺎر‪ ،‬ﻧﻤﻮﻧـﻪﺑـﺮداري و‬ ‫ارزﻳﺎﺑﻲ ﻫﻴﺴﺘﻮﭘﺎﺗﻮﻟﻮژي( ﺑﻪ ﺻﻮرت دوﺳﻮ ﺑﻲﺧﺒﺮ ﺷﺪ‪.‬‬

‫ﻳﺎﻓﺘﻪﻫﺎ‬ ‫ﻳﺎﻓﺘﻪﻫﺎي ﻫﻴﺴﺘﻮﭘﺎﺗﻮﻟﻮژي‪ :‬ارزﻳﺎﺑﻲ ﺟﺎﻳﮕـﺎه ﺗـﺮﻣﻴﻢ در ﻣـﻮشﻫـﺎي‬

‫ارزﻳﺎﺑﻲ ﻫﻴﺴﺘﻮﭘﺎﺗﻮﻟﻮژي‪ :‬ﺑﻪ ﻣﻨﻈﻮر ارزﻳﺎﺑﻲ ﻫﻴﺴﺘﻮﭘﺎﺗﻮﻟﻮژي در روز‬

‫ﮔﺮوه ﺷﺎﻫﺪ ‪ 45‬روز ﭘﺲ از ﺟﺮاﺣﻲ ﻧﺸﺎن داد ﻛﻪ ﻧﻘﻴﺼﻪ اﻳﺠﺎد ﺷﺪه در‬

‫‪ 46‬ﭘﺲ از ﺟﺮاﺣﻲ‪ ،‬ﻣﻮشﻫﺎ اﺑﺘﺪا ﺗﻮﺳﻂ اﺗﺮ ﺑﻴﻬـﻮش ﺷـﺪه‪ ،‬ﺳـﭙﺲ ﺑـﺎ‬

‫ﻗﺴﻤﺖ ﻣﻴﺎﻧﻲ دﻳﺎﻓﻴﺰ اﺳﺘﺨﻮان ﻓﻤـﻮر ﺗﻮﺳـﻂ اﺳـﭙﻴﻜﻮلﻫـﺎي اﺳـﺘﺨﻮان‬

‫‪(Thiopental Sodium,‬‬

‫ﻧﺎﺑﺎﻟﻎ ﭘﺮ ﺷﺪه اﺳﺖ و ﻣﺎﺑﻴﻦ اﺳﺘﺨﻮانﻫﺎي ﺗﺎزه ﺗﺸﻜﻴﻞ ﻓﻀﺎﻫﺎي وﺳﻴﻌﻲ‬

‫)‪ Trittau, Germany‬ﺑﻪ ﺻﻮرت داﺧﻞ ﺻﻔﺎﻗﻲ آﺳﺎنﻛﺸﻲ ﺷﺪﻧﺪ‪ .‬ﺳـﭙﺲ‬

‫از ﻣﻐﺰ اﺳﺘﺨﻮان وﺟﻮد دارد‪ .‬اﺳـﺘﺨﻮان ﺗـﺎزه ﺗـﺸﻜﻴﻞ ﻧﺎﺑـﺎﻟﻎ در ﻣﺤـﻞ‬

‫ﺑــﺮش در ﭘﻮﺳــﺖ اﻳﺠــﺎد ﺷــﺪه‪ ،‬ﻓﺎﺳــﻴﺎ و ﻋــﻀﻼت از روي ﻛــﺎﻟﻮس‬

‫اﺗﺼﺎل آن ﺑﺎ اﺳﺘﺨﻮان ﻗﺪﻳﻤﻲ‪ ،‬ﺗﻮﺳﻂ اﺳﺘﺨﻮان ﺗﻴﻐـﻪاي اوﻟﻴـﻪ در ﺣـﺎل‬

‫اﺳﺘﺨﻮاﻧﻲ ﻛﻨﺎر زده ﺷﺪ‪ .‬اﺳﺘﺨﻮان ﻓﻤﻮر ﺟﺪا و در ﻣﺤﻠﻮل ﻓﺮﻣﺎﻟﻴﻦ ﺑـﺎﻓﺮ‬

‫ﺟﺎﻳﮕﺰﻳﻨﻲ ﻣﻲﺑﺎﺷﺪ )ﺷـﻜﻞ ‪ .(1‬در ﻣـﻮشﻫـﺎي ﮔـﺮوه دوم )ﺗﻴﻤـﺎر ﺑـﺎ‬

‫‪ 10‬درﺻﺪ ﻗﺮار داده ﺷﺪ‪ .‬ﭘﺲ از ﭘﺎﻳﺪار ﺷﺪن ﻧﻤﻮﻧﻪﻫﺎ‪ ،‬ﻛﻠـﺴﻴﻢﮔﻴـﺮي از‬

‫آﺗﻮرواﺳﺘﺎﺗﻴﻦ ‪ (10mg/kg‬ﻻﻳﻪ ﺑﺎرﻳﻜﻲ از اﺳﺘﺨﻮان ﻧﺎﺑﺎﻟﻎ ﻧﻘﻴـﺼﻪ اﻳﺠـﺎد‬

‫ﺑﺎﻓﺖ اﺳﺘﺨﻮان ﺗﻮﺳﻂ ﻣﺤﻠﻮل اﺳﻴﺪﻧﻴﺘﺮﻳﻚ ‪ 10‬درﺻﺪ اﻧﺠﺎم ﮔﺮدﻳـﺪ‪ .‬از‬

‫ﺷــﺪه را ﻣــﺴﺪود ﻛــﺮده اﺳــﺖ و اﺳــﺘﺨﻮان ﻣﺘــﺮاﻛﻢ اوﻟﻴــﻪ در ﺣــﺎل‬

‫ﻫﺮ ﻧﻤﻮﻧﻪ ﺑﺮشﻫﺎي ﭘﻲدرﭘﻲ ﺑﻪ ﻗﻄـﺮ ﭘـﻨﺞ ﻣﻴﻜﺮوﻣﺘـﺮ از ﻣﺤـﻞ ﻧﻘﻴـﺼﻪ‬

‫ﺷﻜﻞﮔﻴﺮي ﻣـﻲﺑﺎﺷـﺪ و ﻓـﻀﺎﻫﺎي اﺳـﺘﺨﻮاﻧﻲ ﻣـﺎﺑﻴﻦ اﺳـﺘﺨﻮان ﻧﺎﺑـﺎﻟﻎ‬

‫اﺳﺘﺨﻮاﻧﻲ ﺗﻬﻴﻪ ﺷﺪ‪ .‬ﻻمﻫﺎي ﺗﻬﻴﻪ ﺷﺪه ﺑﻪ روش ﻫﻤﺎﺗﻮﻛـﺴﻴﻠﻴﻦ اﺋـﻮزﻳﻦ‬

‫ﻣﺘﺮاﻛﻢﺗﺮ ﺷﺪهاﻧﺪ‪ .‬ﻓﻀﺎﻫﺎي ﻣﻐﺰ اﺳـﺘﺨﻮاﻧﻲ ﻣـﺎﺑﻴﻦ ﺗﻴﻐـﻪ ﻫـﺎي ﻧﺎﺑـﺎﻟﻎ و‬

‫رﻧﮓآﻣﻴﺰي ﮔﺮدﻳﺪ و ﺑﺎ اﺳﺘﻔﺎده از ﻣﻴﻜﺮوﺳﻜﻮپ ﻧﻮري ﺳﺎﺧﺖ ﺷـﺮﻛﺖ‬

‫ﻣﺘﺮاﻛﻢ اوﻟﻴﻪ ﺗﺎزه ﺗﺸﻜﻴﻞ ﻫﻢﭼﻨـﺎن ﺑـﺎﻗﻲ ﺑـﻮده‪ ،‬ﺑﺎﻓـﺖ اﺳـﺘﺨﻮان ﺗـﺎزه‬

‫ﻧﻴﻜﻮن ﻣـﺪل )‪ (ECLIPSE E200, Japan‬ﻣـﻮرد ﻣﻄﺎﻟﻌـﻪ ﻫﻴـﺴﺘﻮﭘﺎﺗﻮﻟﻮژي‬

‫ﺗﺸﻜﻴﻞ از ﺗـﺮاﻛﻢ ﺑـﻪ ﻧـﺴﺒﺖ ﺑـﻴﺶﺗـﺮي در ﻣﻘﺎﻳـﺴﻪ ﺑـﺎ ﮔـﺮوه ﺷـﺎﻫﺪ‬

‫ﻗﺮار ﮔﺮﻓﺖ‪.‬‬

‫ﺑﺮﺧﻮردار ﻣﻲ ﺑﺎﺷﺪ )ﺷﻜﻞ ‪ .(2‬در ﻣـﻮشﻫـﺎي ﮔـﺮوه ﺳـﻮم )ﺗﻴﻤـﺎر ﺑـﺎ‬

‫ﺗﺰرﻳﻖ دوز ﺑﺎﻻي )‪ (20mg/kg‬ﺗﻴﻮﭘﻨﺘﺎل ﺳـﺪﻳﻢ‬

‫ارزﻳﺎﺑﻲ ﻫﻴﺴﺘﻮﻣﻮرﻓﻮﻣﺘﺮي‪ :‬ﺑﺮاي ارزﻳﺎﺑﻲ ﻫﻴﺴﺘﻮﻣﻮرﻓﻮﻣﺘﺮي ﺗﻮﺳـﻂ‬

‫آﺗﻮرواﺳﺘﺎﺗﻴﻦ ‪ (20mg/kg‬ﻧﻘﻴﺼﻪ اﺳﺘﺨﻮاﻧﻲ ﺗﻘﺮﻳﺒﺎ ﺑﻪ ﺻﻮرت ﻛﺎﻣـﻞ ﺑـﺎ‬

‫اﻧﺪازهﮔﻴﺮي ﺧﻄـﻲ از ﻃﺮﻳـﻖ ﺧﻄـﻮط ﻣـﺸﺒﻚ ﻣﺘﻘـﺎﻃﻊ و ﺗﻮﺳـﻂ ﻳـﻚ‬

‫اﺳﺘﺨﻮان ﺗﺎزه ﺗﺸﻜﻴﻞ ﭘﺮ ﺷﺪه اﺳﺖ و ﻧﺴﺒﺖ ﺑـﻪ ﮔـﺮوه ‪ 10‬ﻣﻴﻠـﻲﮔـﺮم‬

‫ﻋﺪﺳﻲ ﭼﺸﻤﻲ ﻣﺸﺒﻚ‪ ،‬ﺣﺎوي ‪ 100‬ﺧﺎﻧﻪ ﻣﺮﺑﻌﻲ‪ ،‬ﺑﺎ ﺗﻌﻴﻴﻦ درﺻـﺪي از‬

‫اﺳﺘﺨﻮان ﺷﻜﻞ ﮔﺮﻓﺘﻪ ﻣﺘﺮاﻛﻢﺗﺮ و ﺳﺎزﻣﺎن ﻳﺎﻓﺘﻪﺗﺮ ﻣﻲﺑﺎﺷـﺪ و ﻓـﻀﺎﻫﺎي‬

‫ﻧﻘﻴﺼﻪ اﺳﺘﺨﻮاﻧﻲ ﻛﻪ ﺗﻮﺳﻂ ‪ (1‬ﻣﻐـﺰ اﺳـﺘﺨﻮان‪ (2 ،‬اﺳـﺘﺨﻮان ﻧﺎﺑـﺎﻟﻎ و‬

‫ﻣﺎﺑﻴﻦ اﺳﺘﺨﻮان ﺗﺎزه ﺗﺸﻜﻴﻞ ﺑﻪ ﻫﻢ ﻓﺸﺮده ﺷـﺪه و ﺗﻘﺮﻳﺒـﺎ از ﺑـﻴﻦ رﻓﺘـﻪ‬

‫‪ (3‬اﺳﺘﺨﻮان ﻻﻣﻼر اﺷﻐﺎل ﺷﺪه ﺑﻮد‪ ،‬ﺻﻮرت ﭘﺬﻳﺮﻓﺖ‪ 12.‬اﺟـﺰاي ﺑـﺎﻓﺘﻲ‬

‫اﺳﺖ‪ .‬در ﻧﻤﺎي ﻧﺰدﻳﻚﺗﺮ از ﻣﻴﺰان اﺳﺘﺨﻮانﻫﺎي ﻧﺎﺑـﺎﻟﻎ )ﺗﺮاﺑﻜـﻮلﻫـﺎي‬

‫ﻣﺬﻛﻮر ﺑﺎ ﺑﺰرگﻧﻤﺎﻳﻲ ‪ ×40‬و ﻧﺸﺎنﮔﺮ ﻣﺎوس‪ ،‬ﺗﻌﻴـﻴﻦ و ﻣـﻮرد ﺳـﻨﺠﺶ‬

‫ﻧﺎﻣﻨﻈﻢ( ﻛﺎﺳﺘﻪ ﺷﺪه اﺳﺖ و ﻗـﺴﻤﺖ اﻋﻈـﻢ ﻧﻘﻴـﺼﻪ اﺳـﺘﺨﻮاﻧﻲ ﺗﻮﺳـﻂ‬

‫ﻗﺮار ﮔﺮﻓﺘﻨﺪ‪ .‬ﻣﻐﺰ اﺳﺘﺨﻮان ﺑﺎ ﺳﻠﻮلﻫﺎي ﭼﺮﺑﻲ ﻓﺮاوان و ﺑﺎﻓﺖ ﻫﻤﺒﻨﺪ ﺑﺎ‬

‫اﺳﺘﺨﻮان ﻻﻣﻼر ﺑﺎ اﻳﺠﺎد و ﺗﻮﺳﻌﻪ ﺳﻴﺴﺘﻢ ﻫﺎورس ﺑﻪ ﺷـﻜﻞ اﺳـﺘﺨﻮان‬

‫ﺣﻀﻮر ﺗﻌﺪاد ﻓﺮاواﻧﻲ از ﻓﻴﺒﺮوﺑﻼﺳﺖﻫﺎ و رﺷﺘﻪﻫﺎي ﻛـﻼژن ﻣـﺸﺨﺺ‬

‫ﻣﺘﺮاﻛﻢ ﻛﻮرﺗﻴﻜﺎل ﭘﺮ ﺷﺪه اﺳـﺖ و اﻓﺰاﻳـﺶ ﻗﺎﺑـﻞ ﺗﻮﺟﻬـﻲ در ﺗﺸﻜﻴـﻞ‬

‫ﻏﻔﻮر ﻣﻮﺳﻮي و ﻫﻤﻜﺎران‬

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‫ﺷﻜﻞ‪ :1 -‬ﻧﻤﺎي رﻳﺰﺑﻴﻨﻲ از ﺟﺎﻳﮕﺎه ﺗﺮﻣﻴﻢ ﻧﻘﻴﺼﻪ اﻳﺠﺎد ﺷﺪه در اﺳﺘﺨﻮان ﻣﺘﺮاﻛﻢ‬

‫ﺷﻜﻞ‪ :3 -‬ﻧﻤﺎي رﻳﺰﺑﻴﻨﻲ از ﺟﺎﻳﮕﺎه ﺗﺮﻣﻴﻢ ﻧﻘﻴﺼﻪ اﻳﺠﺎد ﺷﺪه در اﺳﺘﺨﻮان ﻣﺘﺮاﻛﻢ‬

‫ﻓﻤﻮر ﻳﻚ ﻣﻮش ﺻﺤﺮاﻳﻲ ﮔﺮوه ﺷﺎﻫﺪ‪ -A .‬ﺑﻪ اﺳﭙﻴﻜﻮلﻫﺎي اﺳﺘﺨﻮان ﻧﺎﺑﺎﻟﻎ ﺗﺎزه ﺗﺸﻜﻴﻞ و‬

‫ﻓﻤﻮر ﻳﻚ ﻣﻮش ﺻﺤﺮاﻳﻲ از ﮔﺮوه ﺗﻴﻤﺎر ﺑﺎ دوز ‪ -A .20mg/kg‬ﻧﻘﻴﺼﻪ اﺳﺘﺨﻮاﻧﻲ‬

‫ﻓﻀﺎﻫﺎي وﺳﻴﻊ ﻣﻐﺰ اﺳﺘﺨﻮاﻧﻲ ﻣﺎﺑﻴﻦ آنﻫﺎ ﻛﻪ ﻗﺴﻤﺖ اﻋﻈﻢ ﻧﻘﻴﺼﻪ )ﻓﻀﺎي ﺑﻴﻦ دو ﭘﻴﻜﺎن( را ﭘﺮ‬

‫ﺗﻘﺮﻳﺒﺎَ ﺑﻪﻃﻮر ﻛﺎﻣﻞ ﺗﻮﺳﻂ اﺳﺘﺨﻮان ﺗﺎزه ﺗﺸﻜﻴﻞ ﭘﺮ ﺷﺪه اﺳﺖ )ﻓﻀﺎي ﺑﻴﻦ دو ﭘﻴﻜﺎن(‪ .‬ﻓﻀﺎﻫﺎي‬

‫ﻛﺮده ﺗﻮﺟﻪ ﻓﺮﻣﺎﻳﻴﺪ‪) .‬ﻫﻤﺎﺗﻮﻛﺴﻴﻠﻴﻦ‪ -‬اﺋﻮزﻳﻦ‪ ،‬ﺑﺰرگﻧﻤﺎﻳﻲ ‪ -B ،(×100‬اﺳﺘﺨﻮان ﻧﺎﺑﺎﻟﻎ ﻗﺴﻤﺖ‬

‫ﻣﻐﺰ اﺳﺘﺨﻮاﻧﻲ ﻣﺎﺑﻴﻦ ﺗﻴﻐﻪﻫﺎي اﺳﺘﺨﻮاﻧﻲ ﻣﺘﺮاﻛﻢ اوﻟﻴﻪ ﺑﻪ ﺷﺪت ﻛﺎﻫﺶ ﻳﺎﻓﺘﻪ و ﻣﻘﺪار اﺳﺘﺨﻮان ﺗﺎزه‬

‫اﻋﻈﻢ ﻧﺴﺞ ﺗﺮﻣﻴﻤﻲ را در ﻣﺤﻞ ﻧﻘﻴﺼﻪ ﺑﻪ ﺧﻮد اﺧﺘﺼﺎص داده اﺳﺖ‪ .‬اﺳﺘﺨﻮان ﻧﺎﺑﺎﻟﻎ ﺗﺎزه ﺗﺸﻜﻴﻞ‬

‫ﺗﺸﻜﻴﻞ ﻧﺴﺒﺖ ﺑﻪ ﮔﺮوه ﺗﻴﻤﺎر ﺑﺎ دوز ‪ 10‬ﻣﻴﻠﻲﮔﺮم ﺑﻴﺶﺗﺮ ﻣﻲﺑﺎﺷﺪ‪ .‬اﻓﺰاﻳﺶ ﻗﺎﺑﻞ ﺗﻮﺟﻬﻲ در‬

‫در ﻣﺤﻞ ارﺗﻔﺎق ﺑﺎ اﺳﺘﺨﻮان ﻗﺪﻳﻤﻲ ﻣﺠﺎور ﻧﻘﻴﺼﻪ‪ ،‬در ﺣﺎل ﺟﺎﻳﮕﺰﻳﻨﻲ ﺑﺎ اﺳﺘﺨﻮان ﺗﻴﻐﻪاي اوﻟﻴﻪ‬

‫ﺗﺸﻜﻴﻞ اﺳﺘﺨﻮان ﻧﻮﺑﻨﻴﺎد ﻣﺸﺎﻫﺪه ﻣﻲﺷﻮد‪ .‬ﭘﻴﻮﺳﺘﮕﻲ ﺑﻴﻦ اﺳﺘﺨﻮان ﺗﺎزه ﺗﺸﻜﻴﻞ و اﺳﺘﺨﻮان ﻗﺪﻳﻤﻲ‬

‫ﻣﻲﺑﺎﺷﺪ )ﻫﻤﺎﺗﻮﻛﺴﻴﻠﻴﻦ‪ -‬اﺋﻮزﻳﻦ‪ ،‬ﺑﺰرگﻧﻤﺎﻳﻲ ‪.(×400‬‬

‫ﻫﻢﭼﻨﺎن ﺑﺮﻗﺮار ﻣﻲﺑﺎﺷﺪ )ﻣﺤﻞ ﭘﻴﻜﺎن( )ﻫﻤﺎﺗﻮﻛﺴﻴﻠﻴﻦ‪ -‬اﺋﻮزﻳﻦ‪ ،‬ﺑﺰرگﻧﻤﺎﻳﻲ ‪ -B .(×250‬اﺳﺘﺨﻮان‬ ‫ﺗﺎزه ﺗﺸﻜﻴﻞ ﺑﺎ اﺳﺘﺨﻮان ﻗﺪﻳﻤﻲ )ﺳﺘﺎره( ﭘﻴﻮﺳﺘﻪ و ﻣﺪاوم ﺑﻮده و اﻓﺰاﻳﺶ ﻗﺎﺑﻞ ﺗﻮﺟﻬﻲ در‬ ‫رﻳﻤﻮدﻟﻴﻨﮓ ﺑﺎﻓﺖ اﺳﺘﺨﻮاﻧﻲ ﺗﺎزه ﺗﺸﻜﻴﻞ و ﺗﻮﺳﻌﻪ ﺳﻴﺴﺘﻢﻫﺎي ﻫﺎورﺳﻲ )ﭘﻴﻜﺎنﻫﺎي ﻧﺎزك( در اﻳﻦ‬ ‫ﻧﻤﻮﻧﻪ ﻣﺸﺨﺺ ﻣﻲﺑﺎﺷﺪ‪ .‬ﺳﻄﺢ ﻣﺸﺘﺮك ﻣﺸﺨﺼﻲ )ﭘﻴﻜﺎن ﺿﺨﻴﻢ( ﺑﻴﻦ اﺳﺘﺨﻮان ﺗﺎزه ﺗﺸﻜﻴﻞ‬ ‫ﻣﺘﺮاﻛﻢ و اﺳﺘﺨﻮان ﻗﺪﻳﻤﻲ ﻗﺎﺑﻞ ﻣﺸﺎﻫﺪه ﻣﻲﺑﺎﺷﺪ )ﻫﻤﺎﺗﻮﻛﺴﻴﻠﻴﻦ‪ -‬اﺋﻮزﻳﻦ‪ ،‬ﺑﺰرگﻧﻤﺎﻳﻲ ‪.(×400‬‬

‫اﺳﺘﺨﻮان ﻧﻮﺑﻨﻴﺎد ﻣـﺸﺎﻫﺪه ﻣـﻲﺷـﻮد‪ .‬ﭘﻴﻮﺳـﺘﮕﻲ ﻣـﺎﺑﻴﻦ اﺳـﺘﺨﻮان ﺗـﺎزه‬ ‫ﺗﺸﻜﻴﻞ و اﺳﺘﺨﻮان ﻗﺪﻳﻤﻲ ﺑﻪوﺟﻮد آﻣﺪه اﺳﺖ )ﺷﻜﻞ ‪.(3‬‬ ‫ﻳﺎﻓﺘﻪﻫﺎي ﻫﻴﺴﺘﻮﻣﻮرﻓﻮﻣﺘﺮي‪ :‬ارزﻳﺎﺑﻲ ﻧﺘـﺎﻳﺞ ﻫﻴـﺴﺘﻮﻣﻮرﻓﻮﻣﺘﺮي ﺑـﻪ‬ ‫دﺳﺖ آﻣﺪه‪ ،‬ﻧﺸﺎندﻫﻨﺪه آن اﺳﺖ ﻛـﻪ ﻣﻘـﺎدﻳﺮ اﺳـﺘﺨﻮان ﻻﻣـﻼر ﺷـﻜﻞ‬ ‫ﮔﺮﻓﺘﻪ در ﮔﺮوهﻫﺎي آزﻣﺎﻳﺶ دوم و ﺳﻮم ﺑﻪ ﻃﻮر ﻣﻌﻨﻲداري ﺑﻴﺶﺗـﺮ از‬ ‫ﮔﺮوه ﺷﺎﻫﺪ و ﻛﻢﺗﺮ از اﺳﺘﺨﻮان ﺳﺎﻟﻢ ﻣﻲﺑﺎﺷﺪ )‪ .(P<0/0001‬ﺑﻴﺶﺗﺮﻳﻦ‬ ‫ﻣﻘﺪار اﺳﺘﺨﻮان ﻻﻣﻼر ﺷﻜﻞ ﮔﺮﻓﺘﻪ ﺑﻴﻦ ﮔـﺮوهﻫـﺎي ﻣـﻮرد ﻣﻄﺎﻟﻌـﻪ‪ ،‬در‬ ‫ﮔﺮوه آزﻣﺎﻳﺶ ﺳﻮم )آﺗﻮرواﺳﺘﺎﺗﻴﻦ ﺑﺎ دوز ﺑﺎﻻ( ﻣﻲﺑﺎﺷﺪ‪ .‬ﻣﻘﺪار اﺳﺘﺨﻮان‬ ‫ﺷﻜﻞ‪ :2 -‬ﻧﻤﺎي رﻳﺰﺑﻴﻨﻲ از ﺟﺎﻳﮕﺎه ﺗﺮﻣﻴﻢ ﻧﻘﻴﺼﻪ اﻳﺠﺎد ﺷﺪه در اﺳﺘﺨﻮان ﻣﺘﺮاﻛﻢ‬ ‫ﻓﻤﻮر ﻳﻚ ﻣﻮش ﺻﺤﺮاﻳﻲ از ﮔﺮوه ﺗﻴﻤﺎر ﺑﺎ دوز ‪.10mg/kg‬‬

‫ﻧﺎﺑﺎﻟﻎ و ﻣﻐﺰ اﺳﺘﺨﻮان در ﮔﺮوه ﺷﺎﻫﺪ ﺑـﻪﻃـﻮر ﻣﻌﻨـﻲداري ﺑـﻴﺶﺗـﺮ از‬ ‫ﮔﺮوهﻫﺎي آزﻣﺎﻳﺶ دوم و ﺳﻮم ﻣﻲﺑﺎﺷﺪ )‪ .(P<0/0001‬در ﻣﻘﺎﻳﺴﻪ دو ﺑﻪ‬

‫‪ -A‬ﺗﻮده ﺑﺎرﻳﻜﻲ ﻣﺘﺸﻜﻞ از اﺳﺘﺨﻮان ﻧﺎﺑﺎﻟﻎ و اﺳﺘﺨﻮان ﻣﺘﺮاﻛﻢ اوﻟﻴﻪ ﺗﺎزه ﺗﺸﻜﻴﻞ‪ ،‬ﻓﻀﺎي ﻧﻘﻴﺼﻪ‬

‫دو ﻣﺎﺑﻴﻦ ﮔﺮوهﻫﺎي ﻣـﻮرد ﻣﻄﺎﻟﻌـﻪ از ﻟﺤـﺎظ ﻣﻴـﺰان ﺗـﺸﻜﻴﻞ اﺳـﺘﺨﻮان‬

‫)ﻓﻀﺎي ﺑﻴﻦ دوﭘﻴﻜﺎن( را ﺗﺎ ﺣﺪودي اﺷﻐﺎل ﻧﻤﻮده و ﻧﻘﻴﺼﻪ را ﻣﺴﺪود ﻧﻤﻮده اﺳﺖ‬

‫ﻻﻣﻼر ﺗﻔﺎوت ﻣﻌﻨﻲداري ﺑﻴﻦ ﮔﺮوه آﺗﻮرواﺳﺘﺎﺗﻴﻦ ﺑﺎ دوز ﭘﺎﻳﻴﻦ و ﮔـﺮوه‬

‫)ﻫﻤﺎﺗﻮﻛﺴﻴﻠﻴﻦ‪ -‬اﺋﻮزﻳﻦ‪ ،‬ﺑﺰرگﻧﻤﺎﻳﻲ ‪ -B .(×250‬ﻓﻀﺎﻫﺎي ﻣﻐﺰ اﺳﺘﺨﻮاﻧﻲ ﻣﺎﺑﻴﻦ ﺗﻴﻐﻪﻫﺎي ﻧﺎﺑﺎﻟﻎ و‬ ‫ﻣﺘﺮاﻛﻢ اوﻟﻴﻪ ﺗﺎزه ﺗﺸﻜﻴﻞ ﻫﻢﭼﻨﺎن ﺑﺎﻗﻲ ﺑﻮده‪ ،‬ﻟﻜﻦ ﺑﺎﻓﺖ اﺳﺘﺨﻮان ﺗﺎزه ﺗﺸﻜﻴﻞ از ﺗﺮاﻛﻢ ﻧﺴﺒﺘﺎَ‬

‫ﺷﺎﻫﺪ وﺟﻮد دارد ﻫﻢﭼﻨﻴﻦ ﻣـﺎﺑﻴﻦ ﮔـﺮوه آﺗﻮرواﺳـﺘﺎﺗﻴﻦ ﺑـﺎ دوز ﺑـﺎﻻ و‬

‫ﺑﻴﺶﺗﺮي ﻧﺴﺒﺖ ﺑﻪ ﮔﺮوه ﺷﺎﻫﺪ ﺑﺮﺧﻮردار ﻣﻲﺑﺎﺷﺪ )ﻫﻤﺎﺗﻮﻛﺴﻴﻠﻴﻦ‪ -‬اﺋﻮزﻳﻦ‪ ،‬ﺑﺰرگﻧﻤﺎﻳﻲ ‪.(×400‬‬

‫ﮔﺮوه ﺷﺎﻫﺪ ﻧﻴﺰ ﺗﻔﺎوت ﻣﻌﻨﻲدار ﻣﻲﺑﺎﺷـﺪ )‪ (P<0/0001‬و ﻧﻴـﺰ ﺗﻔـﺎوت‬

‫ﺗﺎﺛﻴﺮ آﺗﻮرواﺳﺘﺎﺗﻴﻦ ﺑﺮ ﺗﺮﻣﻴﻢ ﻧﻘﻴﺼﻪ ﺗﺠﺮﺑﻲ اﻳﺠﺎد ﺷﺪه در ران ﻣﻮش‬

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‫ﺟﺪول‪ :1 -‬ﻣﻘﺎﻳﺴﻪ ﻣﻴﺎﻧﮕﻴﻦ و اﻧﺤﺮاف اﺳﺘﺎﻧﺪارد اﺟﺰاي ﺑﺎﻓﺖ اﺳﺘﺨﻮان ﺟﺎﻳﮕﺎه ﺗﺮﻣﻴﻢ ﺑﻴﻦ ﮔﺮوهﻫﺎي ﻣﻮرد ﻣﻄﺎﻟﻌﻪ )ﺗﻌﺪاد ﻣﻮشﻫﺎي ﻣﻮرد ﻣﻄﺎﻟﻌﻪ ﻫﻴﺴﺘﻮﻣﻮرﻓﻮﻣﺘﺮي در ﻫﺮ ﮔﺮوه ‪ 10‬ﺳﺮ‬ ‫ﻣﻲﺑﺎﺷﺪ‪(.‬‬

‫اﺟﺰاي ﺑﺎﻓﺖ اﺳﺘﺨﻮان‬

‫اﺳﺘﺨﻮان ﺳﺎﻟﻢ‬

‫اﺳﺘﺨﻮان ﻻﻣﻼر‬

‫‪95/10±1/59a‬‬

‫ﮔﺮوه اول‬ ‫)ﺷﺎﻫﺪ(‬

‫اﺳﺘﺨﻮان ﻧﺎﺑﺎﻟﻎ‬ ‫ﻣﻐﺰ اﺳﺘﺨﻮان‬

‫‪a‬‬ ‫‪a‬‬

‫‪4/20±1/31‬‬ ‫‪0/80±0/63‬‬

‫ﮔﺮوه دوم‬ ‫)آﺗﻮرواﺳﺘﺎﺗﻴﻦ ‪(10mg/kg‬‬

‫‪13/10±2/02b‬‬

‫‪c‬‬

‫‪b‬‬

‫‪c‬‬

‫‪b‬‬

‫‪37/20±2/25‬‬ ‫‪49/70±2/86‬‬

‫‪c‬‬

‫‪42/30±1/41‬‬ ‫‪29/20±1/22‬‬ ‫‪28/60±1/17‬‬

‫ﮔﺮوه ﺳﻮم‬ ‫)آﺗﻮرواﺳﺘﺎﺗﻴﻦ ‪(20mg/kg‬‬ ‫‪d‬‬ ‫‪d‬‬ ‫‪d‬‬

‫‪55/90±2/55‬‬ ‫‪21/30±1/41‬‬ ‫‪22/80±1/31‬‬

‫‪ :a b c‬ﺣﺮوف ﻏﻴﺮ ﻣﺸﺎﺑﻪ ﻧﺸﺎندﻫﻨﺪه ﻣﻌﻨﻲدار ﺑﻮدن اﺧﺘﻼف در ﻫﺮ ردﻳﻒ ﻣﻲﺑﺎﺷﺪ‪ .‬ﻣﻘﺎدﻳﺮ اﺳﺘﺨﻮان ﻻﻣﻼر ﺷﻜﻞ ﮔﺮﻓﺘﻪ در ﮔﺮوهﻫﺎي آزﻣﺎﻳﺶ دوم و ﺳـﻮم ﺑـﻴﺶﺗـﺮ از ﮔـﺮوه ﺷـﺎﻫﺪ )‪ .(P<0/0001‬ﺗﻔـﺎوت‬ ‫ﻣﻌﻨﻲداري ﺑﻴﻦ دو ﮔﺮوه آﺗﻮرواﺳﺘﺎﺗﻴﻦ ﺑﺎ دوز ﺑﺎﻻ و ﭘﺎﻳﻴﻦ از ﻟﺤﺎظ ﻣﻴﺰان ﺗﺸﻜﻴﻞ اﺳﺘﺨﻮان ﻻﻣﻼر ﻣﺸﺎﻫﺪه ﻣﻲﺷﻮد )‪.(P<0/0001‬‬

‫ﻣﻌﻨﻲداري ﺑﻴﻦ دو ﮔﺮوه آﺗﻮرواﺳـﺘﺎﺗﻴﻦ ﺑـﺎ دوز ﺑـﺎﻻ و ﭘـﺎﻳﻴﻦ از ﻟﺤـﺎظ‬

‫ﺗﺸﻜﻴﻞ ﺷﺪه ﺑﻮدﻧﺪ‪ .‬در ﮔﺮوه ﺗﻴﻤﺎر ﺑﺎ آﺗﻮرواﺳـﺘﺎﺗﻴﻦ ﺑـﺎ دوز ‪10mg/kg‬‬

‫ﻣﻴﺰان ﺗﺸﻜﻴﻞ اﺳﺘﺨﻮان ﻻﻣﻼر ﻣـﺸﺎﻫﺪه ﻣـﻲﺷـﻮد )‪ .(P<0/0001‬ﻧﺘـﺎﻳﺞ‬

‫ﺗﻨﻬﺎ ﻻﻳﻪ ﻧﺎزﻛﻲ از اﺳﺘﺨﻮان ﻧﺎﺑﺎﻟﻎ و ﻣﺘﺮاﻛﻢ اوﻟﻴﻪ ﻧﻘﻴﺼﻪ اﺳﺘﺨﻮاﻧﻲ را ﭘﺮ‬

‫ارزﻳﺎﺑﻲ ﻫﻴﺴﺘﻮﻣﻮرﻓﻮﻣﺘﺮي ﺗﺮﻣﻴﻢ و ﻣﻘﺎﻳﺴﻪ آن ﻣﺎﺑﻴﻦ ﮔـﺮوهﻫـﺎي ﻣـﻮرد‬

‫ﻛﺮده ﺑﻮد‪ ،‬اﻳﻦ در ﺣﺎﻟﻲ اﺳﺖ ﻛﻪ ﺑﺎ اﻓﺰاﻳﺶ دوز دارو ﺑﻪ ‪ 20mg‬ﻧﻘﻴـﺼﻪ‬

‫آزﻣﺎﻳﺶ‪ ،‬در ﺟﺪول ‪ 1‬اراﻳﻪ ﮔﺮدﻳﺪه اﺳﺖ‪.‬‬

‫اﺳﺘﺨﻮاﻧﻲ ﺑﻪ ﺻﻮرت ﺗﻘﺮﻳﺒﺎ ﻛﺎﻣﻞ ﺑﺎ اﺳـﺘﺨﻮان ﺟﺪﻳـﺪ ﻣﺘـﺮاﻛﻢ ﺷـﺪه و‬ ‫ﺳﺎزﻣﺎن ﻳﺎﻓﺘﻪ ﻣﺴﺪود ﮔﺮدﻳﺪه ﺑﻮد ﻻﻳﻪﻫﺎي اﺳﺘﺨﻮاﻧﻲ ﺑﻪ ﻫﻢ ﻓـﺸﺮدهﺗـﺮ‬

‫ﺑﺤﺚ‬

‫ﮔﺸﺘﻪ و ﺳﻴﺴﺘﻢ ﻫﺎورس در ﺣﺎل ﺷﻜﻞﮔﻴﺮي ﺑﻮد و ﻣﻘـﺎدﻳﺮ ﻣﺨﺘﻠﻔـﻲ از‬ ‫اﺳﺘﺨﻮان دﻳﺪه ﻣﻲﺷﺪ ﻛﻪ ﻧﺎﺣﻴﻪ ﺗﺮﻣﻴﻢ را ﭘﺮ ﻛﺮده ﺑﻮد‪ .‬ﺑﻪ ﻃﻮري ﻛﻪ ﭘﺲ‬

‫در ﺑﺮرﺳــﻲ ﺣﺎﺿــﺮ‪ ،‬ﻧﺘــﺎﻳﺞ رﻳﺰﺑﻴﻨــﻲ ﺳــﺎﺧﺘﺎر ﺗــﺮﻣﻴﻢ ﺣﻜﺎﻳــﺖ از‬

‫از ﮔﺬﺷﺖ ‪ 45‬روز ﻣﻘﺎدﻳﺮي از ﺗﺮاﺑﻜﻮلﻫـﺎي اﺳـﺘﺨﻮاﻧﻲ ﻧـﺴﺒﺘﺎً ﺑـﺎﻟﻎ و‬

‫اﺳﺘﺨﻮانﺳﺎزي داﺧﻞ ﻏﺸﺎﻳﻲ در ﻧﻘﻴﺼﻪ اﻳﺠﺎد ﺷﺪه در اﺳﺘﺨﻮان ﻣﺘﺮاﻛﻢ‬

‫ﻣﻨﻈﻢ و در ﺣﺎل ﺗﺒﺪﻳﻞ ﺷﺪن ﺑﻪ اﺳﺘﺨﻮان از ﻧﻮع ﻻﻣﻼر ﻧﺎﺣﻴﻪ ﺗـﺮﻣﻴﻢ را‬

‫ران ﻣﻮشﻫﺎي ﺻﺤﺮاﻳﻲ دارد‪ .‬در اﻳﻦ ﻣﻄﺎﻟﻌـﻪ ﺗﺠﺮﺑـﻲ ﺑـﻪ دﻟﻴـﻞ آنﻛـﻪ‬

‫ﭘﺮ ﻛﺮده ﺑﻮد ﻛﻪ ﻧﺘﺎﻳﺞ ﺑﻪدﺳﺖ آﻣﺪه از ﻣﻄﺎﻟﻌﺎت ﻗﺒﻠﻲ را ﻣﻮرد ﺗﺎﻳﻴﺪ ﻗﺮار‬

‫ﻛﺎﻧﺎل اﻳﺠﺎد ﺷﺪه داراي ﻗﻄﺮ ﻣﺤﺪودي ﺑﻮد‪ ،‬اﻟﺘﻴﺎم ﺗﻨﻬـﺎ ﺑـﺎ ﻓﻌـﺎل ﺷـﺪن‬

‫ﻣﻲدﻫﺪ و ﺑﻪ ﺗﺎﺛﻴﺮ ﻣﺜﺒﺖ آﺗﻮرواﺳﺘﺎﺗﻴﻦ در روﻧﺪ اﺳﺘﺨﻮانﺳـﺎزي دﻻﻟـﺖ‬

‫ﺳﻠﻮلﻫـﺎي اﺳـﺘﺌﻮﭘﺮوژﻧﻴﺘﻮر آﻧﺪوﺳـﺘﻲ ﻛـﻪ ﻗﺎﺑﻠﻴـﺖ ﺗﺒـﺪﻳﻞ ﺷـﺪن ﺑـﻪ‬

‫ﻣﻲﻧﻤﺎﻳﺪ‪ .‬ﻣﻘﺎﻳﺴﻪ ﻛﻴﻔﻲ ﻧﺘﺎﻳﺞ ﺑﻴﻦ دو ﮔـﺮوه ﻧـﺸﺎندﻫﻨـﺪه ﺗـﺎﺛﻴﺮ ﻣﺜﺒـﺖ‬

‫اﺳﺘﺌﻮﺑﻼﺳﺖﻫﺎ را دارﻧﺪ‪ ،‬ﺻﻮرت ﮔﺮﻓﺘﻪ اﺳﺖ‪ .‬ﺑﺎ ﺷﻜﻞﮔﻴﺮي اﺳـﺘﺨﻮان‬

‫آﺗﻮرواﺳﺘﺎﺗﻴﻦ ﺑﺎ دوز ﺑﺎﻻ ﻧﺴﺒﺖ ﺑﻪ آﺗﻮرواﺳﺘﺎﺗﻴﻦ ﺑﺎ دوز ﭘﺎﻳﻴﻦ ﻣﻲﺑﺎﺷـﺪ‬

‫ﻧﺎﻣﻨﻈﻢ و ﻧﺎﺑﺎﻟﻎ و ﺑﺎ ﮔﺬﺷﺖ زﻣﺎن ﺗﻐﻴﻴﺮاﺗﻲ در اﺳﭙﻴﻜﻮلﻫـﺎي اﺳـﺘﺨﻮان‬

‫و ﺑﻪ ﻧﻈﺮ ﻣﻲرﺳﺪ ﻛﻪ ﺗﺎﺛﻴﺮ اﻳﻦ دارو واﺑﺴﺘﻪ ﺑﻪ دوز ﻣـﻲﺑﺎﺷـﺪ‪ .‬ارزﻳـﺎﺑﻲ‬

‫ﻧﺎﺑﺎﻟﻎ ﭘﺪﻳﺪ آﻣـﺪه و ﺑـﺎ ﻣـﻨﻈﻢ ﺷـﺪن رﺷـﺘﻪﻫـﺎي ﻛـﻼژن در آنﻫـﺎ ﺑـﻪ‬

‫ﻧﺘﺎﻳﺞ ﻫﻴﺴﺘﻮﻣﻮرﻓﻮﻣﺘﺮي ﻧﻴﺰ ﻧﺸﺎن ﻣﻲدﻫﺪ ﻛﻪ ﻗﺴﻤﺖ اﻋﻈـﻢ ﻧﻘﻴـﺼﻪ در‬

‫اﺳﺘﺨﻮانﻫﺎي ﻣﻨﻈﻢ ﺑﺎﻟﻎ ﺗﺒﺪﻳﻞ ﺷﺪه ﺑﻮدﻧﺪ ﻣﺴﻠﻢ اﺳﺖ ﻛﻪ ﺑﻪ اﻳـﻦ ﻧـﻮع‬

‫ﮔﺮوه ﺷﺎﻫﺪ ﺗﻮﺳﻂ اﺳﺘﺨﻮان ﻧﺎﺑـﺎﻟﻎ و ﻓـﻀﺎﻫﺎي وﺳـﻴﻊ ﻣﻐـﺰ اﺳـﺘﺨﻮان‬

‫اﺳﺘﺨﻮانﺳﺎزي‪ ،‬درون ﻏﺸﺎﻳﻲ اﻃﻼق ﻣﻲﮔﺮدد‪14.‬و‪ 13‬در ﮔﺮوه ﺷﺎﻫﺪ ﻛـﻪ‬

‫ﻣﺎﺑﻴﻦ آن ﭘﺮ ﺷﺪه اﺳﺖ‪ .‬اﺳﺘﺨﻮان ﻧﺎﺑﺎﻟﻎ و ﻓﻀﺎي ﻣﻐﺰ اﺳﺘﺨﻮان ﺑـﻪﻃـﻮر‬

‫ﭘﺲ از اﻳﺠﺎد ﻧﻘﻴﺼﻪ اﺳﺘﺨﻮاﻧﻲ درﻣﺎن داروﻳﻲ اﻧﺠﺎم ﻧﺸﺪه ﺑـﻮد‪ ،‬ﺗﺒـﺪﻳﻞ‬

‫ﻣﻌﻨﻲداري ﺑﻴﺶﺗﺮ از ﮔﺮوهﻫﺎي آزﻣﺎﻳﺶ دوم و ﺳﻮم ﻣﻲﺑﺎﺷـﺪ و ﻣﻘـﺪار‬

‫ﺑﺎﻓﺖ ﻫﻤﺒﻨﺪي ﺑﻪ اﺳﺘﺨﻮان و ﺷﻜﻞﮔﻴـﺮي اﻟﺘﻴـﺎم از وﺳـﻌﺖ و ﻛﻴﻔﻴـﺖ‬

‫اﺳﺘﺨﻮان ﻻﻣﻼر ﺗﺸﻜﻴﻞ ﺷﺪه در ﮔﺮوه ﺷﺎﻫﺪ ﺑﺴﻴﺎر ﻛﻢ ﻣﻲﺑﺎﺷﺪ‪ ،‬اﻳﻦ در‬

‫ﺑﺎﻻﻳﻲ ﺑﺮﺧﻮردار ﻧﺒﻮد و ﭘﺲ از ﮔﺬﺷـﺖ ‪ 45‬روز ﺗﻨﻬـﺎ ﻻﻳـﻪ ﻧـﺎزﻛﻲ از‬

‫ﺣﺎﻟﻲ اﺳﺖ ﻛﻪ در ﮔـﺮوهﻫـﺎي آزﻣـﺎﻳﺶ دوم و ﺳـﻮم ﻣﻘـﺪار اﺳـﺘﺨﻮان‬

‫اﺳﺘﺨﻮان ﻧﺎﺑﺎﻟﻎ ﻛﻪ ﻓﻀﺎﻫﺎي وﺳﻴﻌﻲ از ﻣﻐﺰ اﺳـﺘﺨﻮان در ﺑـﻴﻦ آن دﻳـﺪه‬

‫ﻻﻣﻼر ﺑﻪ ﻃﻮر ﻣﻌﻨﻲداري ﺑﻴﺶﺗﺮ از ﮔﺮوه ﺷﺎﻫﺪ اﺳﺖ‪ .‬ﻣﻘﺎﻳﺴﻪ ﺑـﻴﻦ دو‬

‫ﻣﻲﺷﺪ ﺗﺸﻜﻴﻞ ﺷﺪه ﺑﻮد‪ .‬ﭼﻨﺎنﭼﻪ از ﻧﺘﺎﻳﺞ ﻫﻴﺴﺘﻮﭘﺎﺗﻮﻟﻮژي ﺑﺮ ﻣـﻲآﻳـﺪ‬

‫ﮔﺮوه درﻳﺎﻓﺖ ﻛﻨﻨﺪه آﺗﻮرواﺳﺘﺎﺗﻴﻦ ﺑﺎ دوز ﺑﺎﻻ و ﭘﺎﻳﻴﻦ ﻧﺸﺎن ﻣﻲدﻫﺪ ﻛـﻪ‬

‫در ﮔﺮوهﻫﺎي ﺗﻴﻤﺎر ﺑﺎ آﺗﻮرواﺳﺘﺎﺗﻴﻦ ﺑﻌﺪ از ﮔﺬﺷﺖ ‪ 45‬روز از ﺟﺮاﺣـﻲ‬

‫ﺑﺎ اﻓﺰاﻳﺶ دوز دارو‪ ،‬ﺑﺮ ﻣﻘﺪار اﺳﺘﺨﻮان ﻻﻣﻼر ﻧﻴﺰ ﺑﻪ ﻃـﻮر ﻣﻌﻨـﻲداري‬

‫ﺗﻴﻐﻪﻫﺎي اﺳﺘﺨﻮاﻧﻲ ﺳﺎزﻣﺎن ﻳﺎﻓﺘﻪ و ﻣـﻨﻈﻢﺗـﺮ ﻧـﺴﺒﺖ ﺑـﻪ ﮔـﺮوه ﺷـﺎﻫﺪ‬

‫اﻓﺰوده ﺷﺪه اﺳﺖ ﻛﻪ ﻧـﺸﺎندﻫﻨـﺪه اﺳـﺘﺨﻮانﺳـﺎزي ﻓﻌـﺎل ﻧـﺴﺒﺖ ﺑـﻪ‬

‫ﻫﻤﻜﺎران‬ ‫ﻣﻮﺳﻮي و‬ ‫‪Mousavi‬‬ ‫ﻏﻔﻮر‪Gh. et‬‬ ‫‪al.‬‬

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‫ﮔﺮوهﻫﺎي دﻳﮕﺮ ﻣﻲﺑﺎﺷﺪ‪ ،‬وﻟﻲ ﺑﺎ اﻳﻦ ﺣـﺎل ﻣﻘـﺪار اﺳـﺘﺨﻮان ﻻﻣـﻼر از‬

‫اﺳﺘﻔﺎده ﺷﻮد )‪ (1mg/kg/day‬ﺗﺸﻜﻴﻞ اﺳﺘﺨﻮان ﻛـﺎﻫﺶ ﻣـﻲﻳﺎﺑـﺪ‪ 20.‬در‬

‫ﻣﻘﺪار ﻃﺒﻴﻌﻲ آن در اﺳﺘﺨﻮان ﺳـﺎﻟﻢ ﻛـﻢﺗـﺮ ﻣـﻲﺑﺎﺷـﺪ‪ .‬ارزﻳـﺎﺑﻲ ﻧﺘـﺎﻳﺞ‬

‫ﻣﻄﺎﻟﻌــﻪ ‪ Kawane‬ﻣــﺸﺨﺺ ﺷــﺪه اﺳــﺖ ﻛــﻪ داﻧــﺴﻴﺘﻪ اﺳــﺘﺨﻮان در‬

‫ﻫﻴﺴﺘﻮﭘﺎﺗﻮﻟﻮژي و ﻫﻴﺴﺘﻮﻣﻮرﻓﻮﻣﺘﺮي ﺑـﻪ دﺳـﺖ آﻣـﺪه در اﻳـﻦ ﺗﺤﻘﻴـﻖ‬

‫ﻣﻮشﻫﺎي ﺻﺤﺮاﻳﻲ ﻛﻪ رﺣﻢ و ﺗﺨﻤﺪانﻫﺎي آنﻫﺎ ﺑﺮداﺷـﺘﻪ ﺷـﺪه ﺑـﻮد‪،‬‬

‫ﻧﺸﺎندﻫﻨﺪة آن اﺳـﺖ ﻛـﻪ داروي آﺗﻮرواﺳـﺘﺎﺗﻴﻦ ﺑﺎﻋـﺚ ﺗـﺴﺮﻳﻊ روﻧـﺪ‬

‫‪22‬‬

‫ﻣﺘﻌﺎﻗﺐ ﺗﻴﻤﺎر ﺑﺎ آﺗﻮرواﺳﺘﺎﺗﻴﻦ ﺑﻪ ﻃﻮر ﻣﻌﻨﻲداري اﻓﺰاﻳﺶ ﭘﻴﺪا ﻣﻲﻛﻨﺪ‪.‬‬

‫اﺳﺘﺨﻮان ﺳﺎزي ﻣﻲ ﺷﻮد‪ Mundy .‬ﻧﺸﺎن داد ﻛﻪ اﺳـﺘﺎﺗﻴﻦﻫـﺎ ﺑـﺎ اﻓـﺰاﻳﺶ‬

‫در راﺑﻄــﻪ ﺑــﺎ ﻓﺎرﻣﺎﻛﻮﻛﻴﻨﺘﻴــﻚ‪ ،‬ﻣﺤﻘﻘــﺎن ﻣﻼﺣﻈــﻪ ﻛــﺮدهاﻧــﺪ ﻛــﻪ دوز‬

‫‪ BMP-2‬ﺑﺎﻋﺚ اﻓﺰاﻳﺶ ﻓﻌﺎﻟﻴﺖ اﺳﺘﺌﻮﺑﻼﺳـﺖﻫـﺎ ﺷـﺪه و از اﻳـﻦ ﻃﺮﻳـﻖ‬

‫‪ 10mg/kg/day‬ﺑﺮاي ﻣﻮش ﺻﺤﺮاﻳﻲ ﻣﻌﺎدل ‪ 70mg/kg/day‬ﺑﺮاي اﻧﺴﺎن‬

‫‪Wong‬‬

‫اﺳﺖ‪ .‬ﻣﺤﺎﺳﺒﻪﻫﺎ اﻳﻦ ﻃﻮر ﻧﺸﺎن دادهاﻧـﺪ ﻛـﻪ ﻓﺮآﻳﻨـﺪﻫﺎي ﻣﺘﺎﺑﻮﻟﻴـﻚ در‬

‫ﺣﺠﻢ اﺳﺘﺨﻮاﻧﻲ را اﻓﺰاﻳﺶ ﻣﻲدﻫﻨﺪ‪ 5.‬در ﻣﻄﺎﻟﻌﻪاي ﻛـﻪ ﺗﻮﺳـﻂ‬

‫‪21‬‬

‫اﻧﺠﺎم ﺷﺪه اﺳﺖ‪ ،‬ﻧﺸﺎن ﻣﻲدﻫﺪ ﻛﻪ ﺗﺮﻛﻴﺐ ﻛﻼژن و اﺳﺘﺎﺗﻴﻦ ﻳـﻚ ﻣـﺎده‬

‫ﺟﻮﻧﺪﮔﺎن ‪ 10‬ﻣﺮﺗﺒﻪ ﻧﺴﺒﺖ ﺑﻪ اﻧﺴﺎن ﺳﺮﻳﻊﺗﺮ اﻧﺠﺎم ﻣﻲﮔﻴﺮد‪.‬‬

‫اﺳﺘﺌﻮاﻳﻨﺪاﻛﺘﻴﻮ اﺳﺖ و زﻣـﺎﻧﻲ ﻛـﻪ در ﺷﻜـﺴﺘﮕﻲﻫـﺎي ﺟﻤﺠﻤـﻪ ﻣـﻮرد‬

‫ﭘﺲ از ﺟﺬب ﮔﻮارﺷﻲ‪ %95 ،‬اﺳﺘﺎﺗﻴﻦ در ﻛﺒﺪ ﻣﺘـﺎﺑﻮﻟﻴﺰه ﻣـﻲﺷـﻮد‪،‬‬

‫اﺳﺘﻔﺎده ﻗﺮار ﻣﻲﮔﻴﺮد ﺑﺎ اﺳﺘﺨﻮان ﺑـﻪ راﺣﺘـﻲ ﭘﻴﻮﻧـﺪ ﻣـﻲﻳﺎﺑـﺪ و ﺑﺎﻋـﺚ‬

‫ﺗﻨﻬﺎ ﺑﺨﺶ ﻛﻮﭼﻜﻲ از آن از ﻃﺮﻳﻖ ﻛﺒﺪ ﻋﺒﻮر ﻣﻲﻛﻨﺪ و ﺑـﻪ ﺳـﻠﻮلﻫـﺎي‬

‫‪Wong‬‬

‫اﺳﺘﺨﻮان ﻣﻲرﺳﺪ‪ .‬ﺑﻨﺎﺑﺮاﻳﻦ داروﻫﺎي اﺳﺘﺎﺗﻴﻨﻲ ﻛـﻪ ﻫـﻢ اﻛﻨـﻮن ﺑـﻪﻃـﻮر‬

‫‪BMP‬‬

‫ﺗﺠﺎري در دﺳﺘﺮس ﻗﺮار ﻣﻲﮔﻴﺮﻧﺪ‪ ،‬ﻛﺒﺪ را ﻫﺪف ﻗﺮار ﻣﻲدﻫﻨﺪ و ﺑـﺮاي‬

‫ﺗﺴﺮﻳﻊ در زﻣﺎن اﻟﺘﻴﺎم ﻣﻲﮔﺮدد‪ 15.‬در ﻣﻄﺎﻟﻌﻪ دﻳﮕﺮي ﻛـﻪ ﺗﻮﺳـﻂ‬

‫اﻧﺠﺎم ﺷﺪه اﺳﺖ‪ ،‬اﺳـﺘﺎﺗﻴﻦ ﻣﺤﻠـﻮل در آب ﻧﻴـﺰ ﺑﺎﻋـﺚ اﻓـﺰاﻳﺶ‬

‫درﻣﺎن اﻓﺰاﻳﺶ ﻛﻠﺴﺘﺮول اﺧﺘﺼﺎص ﻳﺎﻓﺘﻨﺪ ﻧﻪ ﺳﻠﻮلﻫﺎي اﺳﺘﺨﻮاﻧﻲ‪.‬‬

‫ﻣﻲﮔﺮدد‪ ،‬ﺑﻪ دﻧﺒﺎل آن اﺳﺘﺌﻮﺑﻼﺳﺖﻫﺎ و ﺗﺤﺮﻳﻚ اﺳﺘﺨﻮانﺳﺎزي اﻓﺰاﻳﺶ‬ ‫ﻣﻲ ﻳﺎﺑﺪ‪ 16.‬در ﻣﻄﺎﻟﻌﻪ ‪ Majima‬ﺗـﺎﺛﻴﺮ ﻣﺜﺒـﺖ آﺗﻮرواﺳـﺘﺎﺗﻴﻦ در اﻓـﺰاﻳﺶ‬

‫ﻣﻮارد ﻓﻮق ﻃﺮاﺣﻲ اﺳﺘﺎﺗﻴﻦﻫﺎي ﺟﺪﻳﺪ را ﺑﺎ ﻫﺪفﮔﻴﺮي ﺳﻠﻮلﻫﺎي‬

‫ﺣﺠــﻢ اﺳــﺘﺨﻮاﻧﻲ در اﻓــﺮاد ﻫﻴﭙﺮﻛﻠــﺴﺘﺮوﻟﻤﻲ و ﺗــﺎﺛﻴﺮ ﻣﺜﺒــﺖ داروي‬

‫اﺳﺘﺨﻮاﻧﻲ ﭘﻴﺸﻨﻬﺎد ﻣﻲﻛﻨﺪ و ﺑﺮاي ﺗﺎﻳﻴﺪ دوز ﻣﻄﻠﻮب ﺑﺮاي ﺗﺎﺛﻴﺮ درﻣﺎﻧﻲ‪،‬‬

‫آﺗﻮرواﺳﺘﺎﺗﻴﻦ ﺑﺮ ﺗﺮﻣﻴﻢ اﺳﺘﺨﻮان در ﻣﺪت ﻛﻮﺗﺎﻫﻲ ﻧﺸﺎن داده ﺷﺪ‪ 17.‬در‬

‫اﻳﺪهآل ﻧﻴﺎز ﺑﻪ ﻣﻄﺎﻟﻌﺎت زﻳﺎدي ﻣﻲﺑﺎﺷﺪ‪ .‬ﻳﺎﻓﺘﻪﻫـﺎي اﻳـﻦ ﻣﻄﺎﻟﻌـﻪ ﻧـﺸﺎن‬

‫ارزﻳﺎﺑﻲ ﺑﻴﻤﺎراﻧﻲ ﻛﻪ داروي ﺧﻮراﻛﻲ آﺗﻮرواﺳﺘﺎﺗﻴﻦ را ﺑﻪ ﻣﻨﻈﻮر درﻣـﺎن‬

‫ﻣﻲدﻫﺪ آﺗﻮرواﺳﺘﺎﺗﻴﻦ ﺳﺒﺐ اﻓﺰاﻳﺶ اﺳﺘﺨﻮانﺳﺎزي ﺷـﺪه و ﻣـﻲﺗﻮاﻧـﺪ‬

‫اﻓﺰاﻳﺶ ﻛﻠﺴﺘﺮول ﺧﻮن درﻳﺎﻓﺖ ﻛﺮده ﺑﻮدﻧﺪ‪ ،‬اﻓـﺰاﻳﺶ ﻛﻤـﻲ در ﺗـﺮاﻛﻢ‬

‫اﻟﺘﻴﺎم ﻧﻘﻴﺼﻪ اﺳﺘﺨﻮاﻧﻲ را ﺗﺴﺮﻳﻊ ﻧﻤﺎﻳﺪ‪.‬‬

‫ﻣﻮاد ﻣﻌﺪﻧﻲ اﺳﺘﺨﻮان ﻧﺸﺎن داده ﺷﺪ و ﺧﻄﺮ ﺷﻜﺴﺘﮕﻲ ﻟﮕﻦ را ﻛـﺎﻫﺶ‬

‫ﺳﭙﺎﺳﮕﺰاري‪ :‬اﻳﻦ ﻣﻘﺎﻟﻪ ﺣﺎﺻﻞ ﭘﺎﻳﺎنﻧﺎﻣﻪ ﺑﺎ ﻋﻨـﻮان "ارزﻳـﺎﺑﻲ ﺗـﺎﺛﻴﺮ‬

‫داد‪19.‬و‪ 18‬ﺗﺴﺖﻫﺎي ﺣﻴﻮاﻧﻲ ﻧﺸﺎن دادهاﻧﺪ ﻛﻪ دوز ﺑـﺎﻻي ﺳﻴﻤﻮاﺳـﺘﺎﺗﻴﻦ‬

‫آﺗﻮرواﺳﺘﺎﺗﻴﻦ در ﺗﺮﻣﻴﻢ ﻧﻘﻴﺼﻪ ﺗﺠﺮﺑﻲ اﻳﺠﺎد ﺷﺪه در اﺳـﺘﺨﻮان ﻣﺘـﺮاﻛﻢ‬

‫)‪ (20mg/kg/day‬ﻳﻜﻲ دﻳﮕﺮ از داروﻫﺎي اﺳﺘﺎﺗﻴﻨﻲ‪ ،‬ﺗﺸﻜﻴﻞ اﺳﺘﺨﻮان را‬

‫ﻓﻤﻮر ﻣﻮش ﺻﺤﺮاﻳﻲ" در ﻣﻘﻄـﻊ دﻛﺘـﺮاي داﻣﭙﺰﺷـﻜﻲ در ﺳـﺎل ‪1388‬‬

‫اﻓﺰاﻳﺶ و ﺑﺎزﺟﺬب آن را ﻛﺎﻫﺶ ﻣـﻲدﻫـﺪ و ﻫﻨﮕـﺎﻣﻲﻛـﻪ ﺑـﺎ دوز ﻛـﻢ‬

‫ﻣﻲﺑﺎﺷﺪ و ﺑﺎ ﺣﻤﺎﻳﺖ داﻧﺸﮕﺎه آزاد اﺳﻼﻣﻲ ﺗﺒﺮﻳﺰ اﺟﺮا ﺷﺪه اﺳﺖ‪.‬‬

‫‪References‬‬ ‫‪6.‬‬

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‫‪Blokhuis TJ, den Boer FC, Bramer JA, van Lingen A, Roos JC,‬‬ ‫‪Bakker FC, et al. Evaluation of strength of healing fractures with‬‬ ‫‪dual energy Xray absorptiometry. Clin Orthop Relat Res‬‬ ‫‪2000;(380):260-8.‬‬ ‫‪Hara Y, Nakamura T, Fukuda H, Harada Y, Nezu Y, Tagawa M.‬‬ ‫‪Changes of biomechanical characteristics of the bone in‬‬ ‫‪experimental tibial osteotomy model in the dog. J Vet Med Sci‬‬ ‫‪2003;65(1):103-7.‬‬ ‫‪Kim JC, Crawford Downs J, Azuola ME, Devon Graham H 3rd.‬‬ ‫‪Time scale for periosteal readhesion after brow lift.‬‬ ‫‪Laryngoscope 2004;114(1):50-5.‬‬ ‫‪Law MR, Wald NJ, Rudnicka AR. Quantifying effect of statins‬‬ ‫‪on low density lipoprotein cholesterol, ischaemic heart disease,‬‬ ‫‪and stroke: systematic review and meta-analysis. BMJ‬‬ ‫‪2003;326(7404):1423.‬‬ ‫‪Mundy G, Garrett R, Harris S, Chan J, Chen D, Rossini G, et al.‬‬ ‫‪Stimulation of bone formation in vitro and in rodents by statins.‬‬ ‫‪Science 1999;286(5446):1946-9.‬‬

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‫‪3.‬‬ ‫‪4.‬‬

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Histopathologic effects of atorvastatin on experimental cortical bone defect healing in rats

12. Carmagnola D, Berglundh T, Lindhe J. The effect of a fibrin glue on the integration of Bio-Oss with bone tissue. A experimental study in labrador dogs. J Clin Periodontol 2002;29(5):377-83. 13. Liacouras PC, Owen JR, Jiranek WA, Wayne JS. Effect of pigmentation on the mechanical and polymerization characteristics of bone cement. J Arthroplasty 2006;21(4):60611. 14. Link DP, van den Dolder J, Jurgens WJ, Wolke JG, Jansen JA. Mechanical evaluation of implanted calcium phosphate cement incorporated with PLGA microparticles. Biomaterials 2006;27(28):4941-7. 15. Wong RW, Rabie AB. Statin collagen grafts used to repair defects in the parietal bone of rabbits. Br J Oral Maxillofac Surg 2003;41(4):244-8. 16. Wong RW, Rabie AB. Histologic and ultrastructural study on statin graft in rabbit skulls. J Oral Maxillofac Surg 2005;63(10):1515-21. 17. Majima T, Komatsu Y, Fukao A, Ninomiya K, Matsumura T, Nakao K. Short-term effects of atorvastatin on bone turnover in

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male patients with hypercholesterolemia. Endocr J 2007;54(1):14551. Cauley JA, Jackson R, Pettinger M, LaCroix AZ, Bauer DC, Chen Z, et al. Statin use and bone mineral density (BMD) in older women: the women’s health initiative observational study (WHI-OS). J Bone Miner Res 2000;15(S1):S155. Watanabe S, Fukumoto S, Takeuchi Y, Nakano T, Fujita T. Effect of one year treatment with statins on bone mass and metabolism. J Bone Miner Res 2000;15(S1):S194. Maritz FJ, Conradie MM, Hulley PA, Gopal R, Hough S. Effect of statins on bone mineral density and bone histomorphometry in rodents. Arterioscler Thromb Vasc Biol 2001;21(10):1636-41. Wang JW, Xu SW, Yang DS, Lv RK. Locally applied simvastatin promotes fracture healing in ovariectomized rat. Osteoporos Int 2007;18(12):1641-50. Kawane T, Terashima S, Kurahashi I, Yanagawa T, Yoshida H, Horiuchi N. Atorvastatin enhances bone density in ovariectomized rats given 17beta-estradiol or human parathyroid hormone(1-34). Endocrine 2004;24(2):121-9.

‫ﻋﻤﻮﻣﻲ‬ ‫ﺑﺨﺸﻬﺎي ﺟﺮاﺣﻲ‬ ‫ﺟﺮاﺣﻲ در‬ ‫ﻋﻔﻮﻧﺖ ﻣﺤﻞ‬ ‫ﺑﺮاي‬2,‫ﭘﺎﻳﺶ‬ ‫روش‬ ‫ﻛﺎراﻳﻲ دو‬ Tehran University Medical Journal; Vol.‫ﺗﺸﺨﻴﺺ‬ 70, No. May 2012: 78-85

Histopathological and histomorphometrical effects of atorvastatin on experimental femoral cortical bone defect healing in rats

Abstract Ghafour Mousavi Ph.D.1* Daryoush Mohajeri Ph.D.2 Ali Rezaie Ph.D.1 Muhammadreza Valilu Ph.D.3 Arman Alimohamadi D.V.M.4 1- Veterinary Surgery Section, Department of Clinical Science, Faculty of Veterinary Medicine, Tabriz Branch, Islamic Azad University, Tabriz, Iran. 2- Pathology Section, Department of Pathobiology, Faculty of Veterinary Medicine, Tabriz Branch, Islamic Azad University, Tabriz, Iran. 3- Department of Veterinary Medicine, Shabestar Branch, Islamic Azad University, Shabestar, Iran. 4- Graduate of Veterinary Medicine, Faculty of Veterinary Medicine, Tabriz Branch, Islamic Azad University, Tabriz, Iran.

Received: September 09, 2011 Accepted: February 04, 2012

Background: Bone remodeling has always been the goal of surgeons for a long time. Recently, it was shown that statins that are commonly prescribed for lowering cholesterol also have beneficial effects on bone healing. Therefore, the present study was undertaken to evaluate the probable effects of atorvastatin on osteogenesis in the rat femur. Methods: This experimental study was conducted on 30 male Sprague-Dawley (SD) rats. The animals were divided randomly into one control and two experiment groups. After induction of anesthesia, a hole of 2 mm in diameter was made in femur width. The control group received physiological serum but the experiment groups one and two, respectively, received 10 and 20 mg/kg/PO of atorvastatin on daily basis. After euthanizing the rats, histopathological and histomorphometrical evaluations of the bones were performed 45 days after the intervention. Results: In the control group, the defects seemed to be filled with woven bone and bone marrow, depictive of a poor osteogenic activity. In the experiment groups, many osteoblast groupings and young bone trabeculae had been formed and bone trabeculae were more organized. Histomorphometric results, showed that atorvastatin had significantly promoted bone healing in the experiment groups compared with the controls (P<0.001). Moreover, the analysis showed that atorvastatin had more significant effects in group three receiving high doses of the medication in comparison with group two (P<0.001). Conclusion: The findings of this study showed that atorvastatin is capable of stimulating osteogenesis in rats.

Corresponding author: Department of Clinical Science, Faculty of Veterinary Medicine, Tabriz Branch, Islamic Azad University, East side of Pasdaran highway, Tabriz, Iran. Tel: +98- 411- 6372274 E-mail: gh_mousavi@iaut.ac.ir

Keywords: Atorvastatin, bone healing, histomorphometry, histopathology, rat.

‫ﺳﺎز‪86-95 ،1391‬‬ ‫اردﻳﺒﻬﺸﺖ‬ ‫ﺷﻤﺎرهﺑﻨﻴ‪،2‬‬ ‫دوره ‪، ،70‬‬ ‫ﺗﻬﺮان‪،‬‬ ‫داﻧﺸﮕﺎه ﻋﻠﻮم‬ ‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪،‬‬ ‫ﺎدي ﺧﻮن‬ ‫ﺳﻠﻮلﻫﺎي‬ ‫‪ RNAi‬در‬ ‫ﭘﺰﺷﻜﻲﻴﻚ‬ ‫‪ TGF-b‬ﺑﺎ ﺗﻜﻨ‬ ‫ﻣﻬﺎر ﻣﺴﻴﺮ‬

‫‪86‬‬

‫ﻣﻬﺎر ﻣﺴﻴﺮ ‪ TGF-b‬ﺑﻪوﺳﻴﻠﻪ ﺗﻜﻨﻴﻚ ‪ RNAi‬در ﺳﻠﻮلﻫﺎي ﺑﻨﻴﺎدي ﺧﻮنﺳﺎز ﻛﺸﺖ داده ﺷﺪه روي دارﺑﺴﺖ‬ ‫ﺳﻪ ﺑﻌﺪي ‪" DBM‬ﻣﺎﺗﺮﻳﻜﺲ اﺳﺘﺨﻮاﻧﻲ ﻣﻌﺪﻧﻲ زداﺷﺪه"‬

‫ﺗﺎرﻳﺦ درﻳﺎﻓﺖ ﻣﻘﺎﻟﻪ‪ 1390/09/01 :‬ﺗﺎرﻳﺦ ﭘﺬﻳﺮش‪1390/11/16 :‬‬

‫ﭼﻜﻴﺪه‬

‫زﻫﺮااﻟﺴﺎدات ﻫﺎﺷﻤﻲ‪ 1،‬ﻣﻬﺪي ﻓﺮوزﻧﺪه‬ ‫ﻣﻘﺪم‪ *1،‬ﻣﺴﻌﻮد ﺳﻠﻴﻤﺎﻧﻲ‪ 2،‬ﻣﺮﻳﻢ‬ ‫‪4‬‬

‫ﺣﻔﻴﻈﻲ‪ 3،‬ﻧﺎﺻﺮ اﻣﻴﺮي زاده‬

‫زﻣﻴﻨﻪ و ﻫﺪف‪ :‬ﺧﻮن ﺑﻨﺪﻧﺎف در ﭘﻴﻮﻧﺪ ﻣﻐﺰ اﺳﺘﺨﻮان‪ ،‬ﺑﻪﻋﻠﺖ دوز ﭘﺎﻳﻴﻦ ﺳﻠﻮلﻫﺎي ‪ CD34+‬داراي ﻣﺤﺪودﻳﺖﻫﺎﻳﻲ اﺳﺖ‬ ‫ﻛﻪ ﻣﻲﺑﺎﻳﺴﺖ اﻳﻦ ﺳﻠﻮلﻫﺎ ﻣﻮرد ﺗﺰاﻳﺪ ﻗﺮار ﮔﻴﺮﻧﺪ‪ .‬ﺗﻜﺜﻴﺮ ﺳﻠﻮلﻫﺎي ﺑﻨﻴﺎدي ﺑﺎ اﺳﺘﻔﺎده از اﻓﺰاﻳﺶ ﻓﻌﺎﻟﻴﺖ ﺧـﻮد ﺗﻜﺜﻴـﺮي‬

‫‪ -1‬ﮔﺮوه ﺑﻴﻮﺗﻜﻨﻮﻟﻮژي ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪،‬‬ ‫داﻧﺸﮕﺎه ﺗﺮﺑﻴﺖ ﻣﺪرس‪ ،‬ﺗﻬﺮان‪ ،‬اﻳﺮان‬ ‫‪ -2‬ﮔﺮوه ﻫﻤﺎﺗﻮﻟﻮژي و ﺑﺎﻧﻚ ﺧﻮن‪ ،‬داﻧﺸﻜﺪه‬ ‫ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﺗﺮﺑﻴﺖ ﻣﺪرس‪ ،‬ﺗﻬﺮان‪ ،‬اﻳﺮان‬

‫آنﻫﺎ در ﺷﺮاﻳﻂ آزﻣﺎﻳﺸﮕﺎﻫﻲ روي دارﺑﺴﺖ ‪) DBM‬ﻣﺎﺗﺮﻳﻜﺲ اﺳﺘﺨﻮاﻧﻲ ﻣﻌﺪﻧﻲزدا ﺷﺪه( ﭘﻮﺷﻴﺪه ﺷـﺪه ﺑـﺎ ﺳـﻠﻮلﻫـﺎي‬ ‫ﭘﺮوژﻧﻴﺘﻮر ﻣﺰاﻧﺸﻴﻤﻲ ﻳﻌﻨﻲ ﺳﻠﻮلﻫﺎي ﺑﻨﻴﺎدي ﺳﻮﻣﺎﺗﻴﻚ ﻏﻴﺮ ﻣﺤﺪود ﺷـﺪه )‪ (USSC‬ﭘﻴـﺸﻨﻬﺎد ﻣـﻲﺷـﻮد‪ .‬ﻣـﺴﻴﺮ ‪ TGF-b‬از‬ ‫ﻋﻮاﻣﻞ ﻣﻬﻢ ﻣﻬﺎري ﺑﺮاي ﻓﻌﺎﻟﻴﺖ ﺧﻮد ﺗﺠﺪﻳﺪ ﺷﻮﻧﺪﮔﻲ ﺳﻠﻮلﻫﺎي ﺑﻨﻴﺎدي اﺳﺖ ﻛﻪ در اﻳﻦ ﺗﺤﻘﻴﻖ از ﻫـﻢزﻣـﺎﻧﻲ ﻛـﺸﺖ‬ ‫)‪vivo‬‬

‫‪ (Ex‬و ﻣﻬﺎر ﻣﺴﻴﺮ ‪ TGF-b‬ﺑﺎ ﻛﻤﻚ ﺗﻜﻨﻴﻚ ‪ RNAi‬اﺳﺘﻔﺎده ﺷﺪ‪ .‬روش ﺑﺮرﺳﻲ‪ :‬ﺳﻠﻮلﻫﺎي ‪ ،USSC‬از ﺧﻮن‬

‫‪ -3‬ﮔﺮوه ﺑﻴﻮﻟﻮژي ﺳﻠﻮلﻫﺎي ﺑﻨﻴﺎدي‪ ،‬ﻣﺮﻛﺰ‬

‫ﺑﺮون ﺗﻦ‬

‫ﺗﺤﻘﻴﻘﺎت ﻓﻨﺎوري ﺑﻦﻳﺎﺧﺘﻪ‪ ،‬ﺗﻬﺮان‪ ،‬اﻳﺮان‬

‫ﺑﻨﺪﻧﺎف ﺟﺪا ﺷﺪه و ﺳﭙﺲ روي دارﺑﺴﺖ ‪ DBM‬و ﻫﻢ ﻛﻒ ﭘﻠﻴﺖ‪ ،‬ﺑﻪ ﻋﻨﻮان ﻻﻳﻪ ﻣﻐﺬي‪ ،‬ﭘﻮﺷﺶ داده ﺷﺪﻧﺪ‪ .‬ﺳـﻠﻮلﻫـﺎي‬

‫‪ -4‬ﻣﺮﻛﺰ ﺗﺤﻘﻴﻘﺎت ﺳﺎزﻣﺎن اﻧﺘﻘﺎل ﺧﻮن‪ ،‬ﺗﻬﺮان‪،‬‬

‫‪ CD34+‬ﺑﺎ روش )‪ Magnetic-Activated Cell Sorting (MACS‬از ﺟﻔﺖ اﻧﺴﺎﻧﻲ ﺗﺨﻠـﻴﺺ و در ﺷـﺮاﻳﻂ دو ﺑﻌـﺪي و ﺳـﻪ‬

‫اﻳﺮان‬

‫ﺑﻌﺪي ﻫﻢ ﻛﺸﺘﻲ‪ ،‬ﺑﺎ ‪ siRNA‬ﻋﻠﻴﻪ ‪ TGFbR2‬ﺗﻴﻤﺎر ﺷﺪﻧﺪ‪ .‬ﻣﻴﺰان ﺳﺮﻛﻮب ﺑﻴﺎن ژن ﻣﺮﺑﻮﻃﻪ ﺑﺎ ‪ Real-Time PCR‬ﻛﻤﻲ ﺑﺮرﺳﻲ‬

‫ﺷﺪﻧﺪ‪ .‬در ﻧﻬﺎﻳﺖ ﺷﻤﺎرش ﺳﻠﻮﻟﻲ‪ ،‬ﻓﻠﻮﺳﺎﻳﺘﻮﻣﺘﺮي و ﻓﻌﺎﻟﻴﺖ ﻛﻠﻨﻲزاﻳﻲ ﺳﻠﻮلﻫﺎ ﻣﻮرد ارزﻳـﺎﺑﻲ ﻗـﺮار ﮔﺮﻓـﺖ‪ .‬ﻳﺎﻓﺘـﻪﻫـﺎ‪:‬‬ ‫ﻛﺸﺖ ﺳﻪ ﺑﻌﺪي ﺑﻪﻫﻤﺮاه ﻣﻬﺎر ژن ‪ TGFbR2‬ﻣﻮﺟﺐ اﻓﺰاﻳﺶ ﻗﺎﺑﻞ ﺗﻮﺟﻪ ‪ 41±0/7‬ﺑﺮاﺑـﺮ ﺳـﻠﻮلﻫـﺎي ‪ CD34+‬ﺷـﺪ‪ .‬وﻟـﻲ‬ ‫اﻓﺰاﻳﺶ ﻧﺴﺒﺖ ﺗﺰاﻳﺪ در دو ﺑﻌﺪي ﺳﺎده ﺑﻴﺶ از ﺳﻪ ﺑﻌﺪي ﺑﻮد و ﻧﻴﺰ ﺑﻴﺶﺗﺮﻳﻦ ﻣﻬﺎر ﺑﻴﺎن ژن‪ ،‬ﺑﻴﺶﺗﺮﻳﻦ اﻓﺰاﻳﺶ در ﻣﺎرﻛﺮ‬ ‫ﺳﻄﺤﻲ ﺑﺎ آﻧﺎﻟﻴﺰ ﻓﻠﻮﺳﺎﻳﺘﻮﻣﺘﺮي در ﺣﺎﻟﺖ ﻛﺸﺖ دو ﺑﻌﺪي ﺳﺎده ﻧﺸﺎن داده ﺷﺪ )‪ .(P<0/05‬ﻧﺘﻴﺠﻪﮔﻴﺮي‪ :‬ﺑﻨـﺎﺑﺮاﻳﻦ از ﻧﻈـﺮ‬ ‫*‬

‫ﻧﻮﻳﺴﻨﺪه ﻣﺴﺌﻮل‪ :‬ﺗﻬﺮان‪ ،‬ﺗﻘﺎﻃﻊ ﺑﺰرگراه ﭼﻤﺮان و ﺟﻼل‬

‫آل اﺣﻤﺪ‪ ،‬داﻧﺸﮕﺎه ﺗﺮﺑﻴﺖ ﻣﺪرس‪ ،‬داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬ﮔﺮوه‬ ‫ﺑﻴﻮﺗﻜﻨﻮﻟﻮژي ﭘﺰﺷﻜﻲ‪ .‬ﺻﻨﺪوق ﭘﺴﺘﻲ‪14115 -111 :‬‬

‫ﻣﻮﺛﺮ ﺑﻮدن ﺳﻴﺴﺘﻢ اﻧﺘﻘﺎل ‪ ،RNAi‬ﻛﺸﺖ دو ﺑﻌﺪي ﺳﺎده ﻧﺴﺒﺖ ﺑﻪ ﺳﻪ ﺑﻌﺪي ﻛﺎرآﻣﺪﺗﺮ ﺑﻮد ﺑﻪﻃﻮري ﻛـﻪ ﺳـﻠﻮلﻫـﺎ آزادي‬ ‫ﻛﻢﺗﺮ داﺷﺘﻪ و ﺑﻴﺶﺗﺮ ﺑﺎ ﺳﻠﻮلﻫﺎي ﻻﻳﻪ ﻣﻐﺬي درﮔﻴﺮ ﺑﻮدﻧﺪ‪.‬‬

‫ﺗﻠﻔﻦ‪021-82883861 :‬‬ ‫‪E-mail: foroz@modares.ac.ir‬‬

‫ﻛﻠﻤﺎت ﻛﻠﻴﺪي‪ :‬ﺳﻠﻮلﻫﺎي ﺑﻨﻴﺎدي ﺧﻮن ﺑﻨﺪﻧﺎف‪ ،‬ﺳﻠﻮلﻫﺎي ‪ ،USSC‬دارﺑﺴﺖ ‪ ،DBM‬ﻣﺴﻴﺮ ‪.siRNA ،TGF-b‬‬

‫ﺧﻮﻧﻲ ﻧﻴﺎز ﺑﻪ دوز ﺑﺎﻻﻳﻲ از ﺳﻠﻮلﻫﺎي ﺑﻨﻴﺎدي ﺧﻮنﺳﺎز اﺳـﺖ‪ .‬در اﺛـﺮ‬

‫ﻣﻘﺪﻣﻪ‬

‫ﺷﻴﻤﻲدرﻣﺎﻧﻲ ﻳﺎ اﺷﻌﻪ درﻣﺎﻧﻲ‪ ،‬ﺳﻠﻮلﻫﺎ دﭼﺎر آﺳﻴﺐ ﻣﻲﺷﻮﻧﺪ و ﻧﻴﺎز ﺑـﻪ‬ ‫‪Hematopoietic Stem Cells‬‬

‫ﺗﺠﺪﻳﺪ آنﻫـﺎ ﻣـﻲﺑﺎﺷـﺪ‪ .‬در اﻳـﻦ ﺷـﺮاﻳﻂ ﻛـﺸﺖ ﺳـﻠﻮﻟﻲ ﻳـﻚ روش‬

‫)‪ (HSCs‬ﺑﺎ دﺳﺖورزيﻫﺎي ژﻧﺘﻴﻜﻲ ﺑﻪ ﻣﻨﻈﻮر ﺗﻤـﺎﻳﺰ و ﻳـﺎ ﺗﺰاﻳـﺪ ﺑـﺮاي‬

‫ﻛﻤﻚﻛﻨﻨﺪه اﺳﺖ‪ .‬در ﭘﻴﻮﻧﺪﻫﺎي ﭼﻨﺪﮔﺎﻧﻪ ﻛﻪ ﺑﻪ دﻟﻴـﻞ رد ﭘﻴﻮﻧـﺪ اﻧﺠـﺎم‬

‫اﻫﺪاف ﺑﺎﻟﻴﻨﻲ ﺑﻪﻛﺎر ﺑﺮده ﻣﻲﺷﻮﻧﺪ‪ 1.‬ﺑـﺎ اﻓـﺰاﻳﺶ ﻣﺤﺘـﻮاي ﺳـﻠﻮلﻫـﺎي‬

‫ﻣﻲﺷﻮﻧﺪ‪ ،‬ﻧﻴﺎز ﺑـﻪ ﺗﺰاﻳـﺪ ﺳـﻠﻮلﻫـﺎي ﺑﻨﻴـﺎدي اﺳـﺖ‪ .‬ﻛـﺸﺖ و ﺗﺰاﻳـﺪ‬

‫ﺑﻨﻴﺎدي در ﺧﻮن‪ ،‬درﻣﺎن ﻣـﻮﺛﺮﺗﺮ اﻧﺠـﺎم ﻣـﻲﺷـﻮد و ﺣﺘـﻲ ﻣـﻲﺗـﻮان از‬

‫ﺳﻠﻮلﻫﺎي ‪ CD34+‬ﺑﺎﻋﺚ ورود اﻳﻦ ﺳـﻠﻮلﻫـﺎ ﺑـﻪ ﻓـﺎز ﺗﻘـﺴﻴﻢ ﺳـﻠﻮﻟﻲ‬

‫ﺣﺠﻢﻫﺎي ﻛﻢ ﺧﻮن ﺑﻨﺪﻧﺎف ﻛﻪ در ﺣﺎﻟﺖ ﻋﺎدي ﻛﻨﺎر ﮔﺬاﺷﺘﻪ ﻣﻲﺷـﻮﻧﺪ‬

‫ﻣﻲﺷﻮد ﺑﻪﻃﻮري ﻛﻪ ﺑﺮاي ژن درﻣﺎﻧﻲ و اﻧﺘﻘـﺎل ژن وﻳﺮوﺳـﻲ ﻧﻴـﺎز ﺑـﻪ‬

‫‪Ex‬‬

‫‪Bone Marrow‬‬

‫اﻣﺮوزه ﺳﻠﻮلﻫﺎي ﺑﻨﻴﺎدي ﺧـﻮنﺳـﺎز‬

‫ﻧﻴﺰ اﺳﺘﻔﺎده ﻛﺮد‪ .‬اﻣﻴﺪ اﺳﺖ ﻛﻪ ﺑﺎ ازدﻳﺎد اﻳـﻦ ﺳـﻠﻮلﻫـﺎ از ﻃﺮﻳــﻖ‬

‫‪ vivo‬ﺑـﻪ اﻳـﻦ ﻫـﺪف رﺳﻴـﺪ‪3.‬و‪ 2‬ﺑـﺮاي درﻣـﺎن ﺑﺴﻴﺎري از ﺑﻴﻤـﺎريﻫﺎي‬

‫ﺳﻠﻮﻟﻲ در ﻓﺎز ﺗﻘﺴﻴﻢ اﺳﺖ‪ .‬در ﭘﻴﻮﻧـﺪ ﻣﻐـﺰ اﺳـﺘﺨﻮان‬ ‫)‪(BMT‬‬

‫‪ Transplant‬ﻛﻪ اﻓﺮاد ﺑﺴﻴﺎري ﺑﺎ آن ﺑﺮاي ﺑﻴﻤﺎريﻫﺎي ﻣﺎدرزادي‬

‫زﻫﺮااﻟﺴﺎدات ﻫﺎﺷﻤﻲ و ﻫﻤﻜﺎران‬

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‫و اﻛﺘﺴﺎﺑﻲ ﺧﻮﻧﻲ درﻣﺎن ﻣﻲﺷﻮﻧﺪ‪ 4،‬ﻧﻴﺎز ﺑـﻪ دوز ﺑـﺎﻻﻳﻲ از ﺳـﻠﻮلﻫـﺎي‬

‫ﻃﻲ ﭘﻴﻮﻧﺪﻫﺎي ﻣﺘﻮاﻟﻲ ﺷﺎﻫﺪ ﻧﻮﻋﻲ از دﺳﺖ رﻓﺘﻦ ذاﺗـﻲ ﺗﻮاﻧـﺎﻳﻲ ﺧـﻮد‬

‫ﺑﻨﻴﺎدي ﻳﺎ ﺳﻠﻮلﻫﺎي ﭘﻴﺶﺳﺎز ﺧﻮﻧﻲ ﻣﻲﺑﺎﺷﺪ‪ 5.‬ﺳـﻠﻮلﻫـﺎي ‪ CD34+‬در‬

‫ﺗﻜﺜﻴﺮي در ﺳﻠﻮلﻫﺎي ﺑﻨﻴﺎدي ﺧﻮنﺳﺎز ﻫﺴﺘﻴﻢ ﻛﻪ ﺑﻪ دﻟﻴﻞ ﺧـﺮوج اﻳـﻦ‬

‫‪ BMT‬ﺑﻴﺶﺗﺮ از ﻣﻨﺒﻊ ﺧﻮن ﺑﻨﺪﻧﺎف ﺑﻪ دﻟﻴﻞ ﭘﺎﻳﻴﻦ ﺑـﻮدن آﻟـﻮآﻧﺘﻲژنﻫـﺎ‬

‫ﺳﻠﻮلﻫﺎ از ﻓﺎز اوﻟﻴﻪ و ﺗﺎ ﺣﺪودي ﺑﻪ ﺳـﻤﺖ ﺗﻤـﺎﻳﺰ رﻓـﺘﻦ اﺳـﺖ‪ 14.‬از‬

‫)‪Human Leukocyte Antigen (HLA‬‬

‫اﻳﻦرو ﺟﺴﺘﺠﻮي راﻫﻲ ﺑﺮاي ﺗﺰاﻳﺪ آنﻫﺎ در ﺟﻬﺖ ﻋﺪم ﺗﻤـﺎﻳﺰ ﻣﻮﻗـﺖ‬

‫ﺳﻄﺤﻲ و در ﻧﺘﻴﺠﻪ ﻋﺪم ﻧﻴﺎز ﺑﻪ ﺳﺎزﮔﺎري ﺑﺎﻻﻳﻲ ﺑﻴﻦ دﻫﻨﺪه و ﮔﻴﺮﻧـﺪه‪،‬‬

‫آنﻫﺎ و اﻟﺒﺘﻪ ﺑﺎ ﺣﻔﻆ ﭘﺘﺎﻧﺴﻴﻞ ﺗﻤﺎﻳﺰ ﺑﻪ ردهﻫﺎي ﻣﺨﺘﻠﻒ ﺧﻮﻧﻲ‪ ،‬ﺿﺮوري‬

‫ﺗﻬﻴﻪ ﻣﻲﮔﺮدﻧﺪ‪ 6.‬ﺗﻌﺪاد ﻛﻞ ﺳﻠﻮلﻫﺎي ﺑـﻪدﺳـﺖ آﻣـﺪه از اﻳـﻦ ﻣﻨﺒـﻊ در‬

‫ﻣﻲﺑﺎﺷﺪ‪ .‬در اﻳﻦ راﺳﺘﺎ ﺑﺎ ﺑﻬﺮهﮔﻴﺮي از روشﻫﺎﻳﻲ ﻫﻤﺎﻧﻨﺪ اﻓﺰاﻳﺶ ﺑﻴـﺎن‬

‫ﺳﻄﺢ ﻛﻢﺗﺮي ﻣﻲﺑﺎﺷﺪ‪ 7‬ﻛﻪ ﺑﺮاي ﻏﻠﺒﻪ ﺑﺮ اﻳﻦ ﻣﺸﻜﻞ ﭼﻨﺪ راه ﺣﻞ اراﻳـﻪ‬

‫ﻓﺎﻛﺘﻮرﻫﺎي روﻧﻮﻳﺴﻲ ﻛﻪ در اﻓﺰاﻳﺶ ﻓﻌﺎﻟﻴﺖ ﺧﻮد ﺗﻜﺜﻴﺮي ﻧﻘﺶ دارﻧـﺪ‪،‬‬

‫ﮔﺮدﻳﺪه اﺳﺖ‪ :‬ﭘﻴﻮﻧﺪ ﻫﻢزﻣـﺎن ﭼﻨـﺪﻳﻦ واﺣـﺪ ‪ ،UCB‬ﺗﺰرﻳـﻖ ﻫـﻢزﻣـﺎن‬

‫و ﻳﺎ ﻣﻬﺎر ﻓﺎﻛﺘﻮرﻫﺎي روﻧﻮﻳﺴﻲ ﻛﻪ ﺑﺎﻋﺚ ﻣﻬﺎر ﻓﻌﺎﻟﻴـﺖ ﺧـﻮد ﺗﻜﺜﻴـﺮي‬

‫‪BM‬‬

‫ﻣﻲﺷﻮﻧﺪ‪ ،‬ﻣﻲﺗﻮان راﻫـﻲ ﻣﻨﺎﺳـﺐ ﺟﻬـﺖ رﺳـﻴﺪن ﺑـﻪ اﻓـﺰاﻳﺶ ﺗﺰاﻳـﺪ‬

‫‪UCB CD34+‬‬

‫ﺳﻠﻮلﻫﺎي ﺑﻨﻴﺎدي ﭘﻴﺪا ﻛﺮد‪ .‬در اﻳﻦ ﺑﻴﻦ ﻋﻮاﻣﻞ ﺧﺎرج ﺳﻠﻮﻟﻲ ﻳﺎ اﮔﺰوژن‬

‫)‪ (Alloantigen‬و آﻧﺘـﻲژنﻫـﺎي‬

‫ﺳﻠﻮلﻫﺎي ‪ UCB CD34+‬ﺑﺎ دوز ﻛﻢ ﻫﻤﺮاه ﺑﺎ ﺳﻠﻮلﻫـﺎي اﺳـﺘﺮوﻣﺎل‬ ‫ﺧﻮد ﺑﻴﻤﺎر ﻳﺎ ﻓﺮد اﻫﺪا ﻛﻨﻨﺪه‪ ،‬ﺗﻜﺜﻴﺮ ‪ Ex vivo‬ﺳـﻠﻮلﻫـﺎي‬

‫ﻣﺎﻧﻨﺪ ﻛـﺸﺖ ﺳـﻪ ﺑﻌـﺪي و ﺳـﭙﺲ ﺗﺰرﻳـﻖ ﺳـﻠﻮلﻫـﺎي ﺗﻜﺜﻴـﺮ ﺷـﺪه‪،‬‬

‫ﻧﻴﺰ در اﻟﻘﺎ ﻳﺎ ﻣﻬﺎر ﻓﻌﺎﻟﻴﺖ ﺧﻮد ﺗﻜﺜﻴﺮي ﺣﺎﻳﺰ اﻫﻤﻴﺖ ﻫﺴﺘﻨﺪ‪.‬‬

‫دﺳﺖﻛﺎري ژﻧﺘﻴﻜﻲ ﺳﻠﻮلﻫﺎي ﺑﻨﻴـﺎدي ﺟﻬـﺖ اﻓـﺰاﻳﺶ ﺗﻮاﻧـﺎﻳﻲ ﺧـﻮد‬

‫از ﺟﻤﻠﻪ ﻣﻬﻢﺗﺮﻳﻦ اﻳﻦ ﻋﻮاﻣﻞ ﻣﻲﺗﻮان ﺑﻪ ﻋﻮاﻣﻞ اﻟﻘﺎ ﻛﻨﻨﺪه ﺗﻜﺜﻴﺮ از‬

‫ﺗﺠﺪﻳﺪﺷﻮﻧﺪﮔﻲ و ﺗﺰاﻳﺪ اﻳﻦ ﺳﻠﻮلﻫﺎ‪9.‬و‪ 8‬راه ﺣـﻞ اراﻳـﻪ ﺷـﺪه در اﻳـﻦ‬

‫ﻗﺒﻴــﻞ ‪ Notch ،Wnt ،BMP-4 ،Sonic hedgehog‬و دﻳﮕــﺮ ﻓﺎﻛﺘﻮرﻫــﺎي‬

‫ﺗﺤﻘﻴﻖ‪ ،‬ادﻏﺎم دو راه ﺣﻞ آﺧﺮ اﺳﺖ‪ .‬ﺑﺎﻳﺪ ﮔﻔﺖ ﭘﻮدرﻫﺎي اﺳﺘﺨﻮاﻧﻲ را‬

‫رﺷﺪ و ﻳﺎ ﻋﻮاﻣـﻞ ﻣﻬﺎرﻛﻨﻨـﺪه ﻣﺎﻧﻨـﺪ ‪ TGF-β‬و ‪ TNF-α‬و ﻧﻴـﺰ ﺑـﻪ ﺳـﺎﻳﺮ‬ ‫‪15‬‬

‫‪Transforming Growth Factor-β‬‬

‫ﻣﻲﺗﻮان ﺑﻪﻋﻨﻮان دارﺑﺴﺖ ﺑﺮاي ﭘﻴﻮﻧﺪ اﺳـﺘﺨﻮان ﺑـﻪﻛـﺎر ﺑـﺮد زﻳـﺮا ﻛـﻪ‬

‫ﺳﺎﻳﺘﻮﻛﻴﻦﻫﺎي ﻣﻬﺎري اﺷﺎره ﻛـﺮد‪.‬‬

‫ﻛﺎراﻳﻲ ﺑﻴﺶﺗﺮ ﻧﺴﺒﺖ ﺑﻪ روشﻫﺎي ﮔﺬﺷﺘﻪ و ﺳﺎﻳﺮ ﻣﻮاد دارﻧﺪ‪ .‬اﻳﻦ ﻣﻮاد‬

‫)‪ (TGF-β‬ﻳﻚ ﺳﺎﻳﺘﻮﻛﻴﻦ ﭼﻨﺪ ﻛـﺎره )‪ (Multifunctional‬ﻣـﻲﺑﺎﺷـﺪ‪ .‬اﻳـﻦ‬

‫ﺧﻮد داراي ﻗﺪرت ﺗﺤﺮﻳﻚﻛﻨﻨﺪﮔﻲ ﺑﺮاي ﺑﺎﻓﺖ اﺳﺘﺨﻮان ﻫﺴﺘﻨﺪ زﻳﺮا ﻛﻪ‬

‫ﺳﺎﻳﺘﻮﻛﻴﻦ در ﻓﺮآﻳﻨﺪ ﺟﻨﻴﻦزاﻳﻲ‪ ،‬ﺗﻤﺎﻳﺰ ﺳﻠﻮﻟﻲ‪ ،‬ﻣﺮگ ﺑﺮﻧﺎﻣﻪرﻳـﺰي ﺷـﺪه‬

‫داراي ﭘــﺮوﺗﻴﻴﻦﻫــﺎي زﻣﻴﻨــﻪاي ﻛــﻼژن و ﻧﻴــﺰ ﻓﺎﻛﺘﻮرﻫــﺎي رﺷــﺪ ﻣﺜــﻞ‬

‫ﺳــﻠﻮﻟﻲ )آﭘﻮﭘﺘــﻮزﻳﺲ( و ﻧﻴــﺰ ﭼﺮﺧــﻪ ﺳــﻠﻮﻟﻲ دﺧﺎﻟــﺖ دارد و ﺗﻮﺳــﻂ‬

‫ﺧﺎﻧﻮادهي ‪ TGF‬ﻣﻲﺑﺎﺷﻨﺪ ﻛﻪ ﺑﺎﻋﺚ وﺟﻮد ﺧﺎﺻﻴﺖ ﺗﺤﺮﻳﻚﻛﻨﻨـﺪﮔﻲ در‬

‫ﺳــﻠﻮلﻫــﺎي ﺧــﻮنﺳــﺎز ﺑــﻪ دو ﺻــﻮرت اﺗــﻮﻛﺮاﻳﻦ و ﭘــﺎراﻛﺮاﻳﻦ‬

‫اﻳـــﻦ دارﺑـــﺴﺖﻫـــﺎ ﺷـــﺪه اﺳـــﺖ‪11.‬و‪ 10‬ﺗﺤﻘﻴﻘـــﺎت روي دارﺑـــﺴﺖ‬

‫‪18‬و‪17‬‬

‫ﺗﺮﺷﺢ ﻣﻲﺷﻮد‬

‫ﻛﻪ ﻣـﻲﺗﻮاﻧـﺪ ﺳـﻠﻮلﻫـﺎ را در ﻣﺮﺣﻠـﻪ ‪ G1‬ﭼﺮﺧـﻪ‬

‫‪ Demineralized Bone‬ﻧــﺸﺎن داده اﺳــﺖ ﻛــﻪ اﻳــﻦ‬

‫ﺳﻠﻮﻟﻲ ﻧﮕﻪ داﺷﺘﻪ و ﻣﻨﺠﺮ ﺑﻪ ﺗﻤﺎﻳﺰ ﺳﻠﻮلﻫﺎ ﺷﻮد‪ 19-21.‬اﻳـﻦ ﺳـﺎﻳﺘﻮﻛﻴﻦ‬

‫دارﺑﺴﺖ ﺑﺮاي ﺗﺰاﻳﺪ ﺳﻠﻮلﻫـﺎي ﺧـﻮنﺳـﺎز ﻣﻨﺎﺳـﺐ ﻣـﻲﺑﺎﺷـﺪ‪ 11.‬اﻳـﻦ‬

‫ﻣﻮﺟﺐ ﻣﻬﺎر ورود ﺑﻪ ﻣﻴﺘـﻮز و در ﻧﺘﻴﺠـﻪ ﺑﺎﻋـﺚ ﻣﻬـﺎر ﻓﻌﺎﻟﻴـﺖ ﺧـﻮد‬

‫)‪Matrix (DBM‬‬

‫دارﺑﺴﺖ ﻣﺎﺗﺮﻳﻜﺲ اﺳﺘﺨﻮاﻧﻲ اﺳﺖ ﻛﻪ از ﺑﺎﻓﺖ ﻃﺒﻴﻌﻲ اﺳﺘﺨﻮان ﺗﻬﻴﻪ و‬ ‫ﻣﻮاد ﻣﻌﺪﻧﻲ آن ﺑﺎ ﻛﻤﻚ اﺳﺘﺨﺮاج اﺳﻴﺪي ﺣﺬف ﺷـﺪه اﺳـﺖ ﺗـﺎ ﻣـﻮاد‬ ‫ﭘﺮوﺗﻴﻴﻨﻲ ﺑﺴﺘﺮ آﺷﻜﺎر ﺷﺪه و در اﺧﺘﻴﺎر ﺳﻠﻮلﻫﺎي ﻓﻴـﺪر ﻗـﺮار ﮔﻴﺮﻧـﺪ‪.‬‬

‫‪22-25‬‬

‫ﺗﻜﺜﻴﺮي اﺳﺖ‪.‬‬

‫ﺗﺤﻘﻴﻘﺎت ﺟﺪﻳﺪ ﻧﺸﺎندﻫﻨﺪه ﻧﻘﺶ اﻳﻦ ﺳﺎﻳﺘﻮﻛﻴﻦ در اﻟﻘـﺎي ﺣﺎﻟـﺖ‬ ‫‪26‬‬

‫ﺧﻔﺘﮕﻲ در ﺑﺪن اﺳﺖ ﺣﺎل آنﻛﻪ در ﻣﻄﺎﻟﻌﺎت ﻗﺒﻠﻲ اﻳـﻦ ﻧﻘـﺶ ﺑـﺮاي‬ ‫‪27‬‬

‫اﻳﻦ دارﺑﺴﺖ ﺑﻪ ﻫﻤـﺮاه ﻻﻳـﻪ ﺗﻐﺬﻳـﻪﻛﻨﻨـﺪهاي از ﺳـﻠﻮلﻫـﺎي ﭼـﺴﺒﻨﺪه‬

‫ﺳﺎﻳﺘﻮﻛﻴﻦ ‪ TGF-b‬رد ﺷﺪه ﺑﻮد‪ .‬ﺑـﻪ دﻟﻴـﻞ اﻳـﻦﻛـﻪ در ﻣﺤـﻴﻂ ﻛـﺸﺖ‬

‫ﭘﺮوژﻧﻴﺘﻮر ﻣﺰاﻧﺸﻴﻤﻲ ﻳﺎ ﺳﻠﻮلﻫﺎي ﺑﻨﻴﺎدي ﺳﻮﻣﺎﺗﻴﻚ ﻏﻴﺮ ﻣﺤـﺪود ﺷـﺪه‬

‫آزﻣﺎﻳﺸﮕﺎﻫﻲ و در ﻛﺸﺖ ﻃﻮﻻﻧﻲﻣﺪت ﺳﻠﻮلﻫﺎي ﻣﻐﺰ اﺳـﺘﺨﻮان و ﻧﻴـﺰ‬

‫)‪13،Unrestricted Somatic Stem Cells (USSC‬و‪ 12‬ﻣﻲﺗﻮاﻧﺪ ﺗﺎ ﺣـﺪودي‬

‫در ﺧﻮد ﺑﺎﻓﺖ دارﺑﺴﺖﻫﺎي ﻣﻬﻨﺪﺳﻲ ﺑﺎﻓﺖ ﺑﺎ ﻣﻨﺸﺎ ﻣﻐﺰ اﺳـﺘﺨﻮان‪ ،‬ﻫـﻢ‬

‫رﻳﺰﻣﺤﻴﻂ )‪ (Microenvironment‬ﺳﻪ ﺑﻌﺪي ﻣﻐﺰ اﺳﺘﺨﻮان را ﺗﻘﻠﻴﺪ ﻛﻨﺪ‪.‬‬

‫ﭘﺮوﺗﻴﻴﻦ و ﻫﻢ ‪ RNA‬ﭘﻴﺎﻣﺒﺮ آن ﻣﻮﺟﻮد اﺳﺖ‪ ،‬ﺑﻨﺎﺑﺮاﻳﻦ ﺑـﺮاي ﻣﻬـﺎر اﻳـﻦ‬

‫ﻫﻤﻮاره دﺳﺖورزي ژﻧﺘﻴﻜﻲ روي ﻣﺴﻴﺮﻫﺎي ﻣﺨﺘﻠﻒ ﺑﻪ ﻣﻨﻈﻮر اﻓـﺰاﻳﺶ‬

‫ﻣﺴﻴﺮ ﺳﻴﮕﻨﺎلدﻫﻲ ﺑﻪ ﺳﺮاغ ﮔﻴﺮﻧﺪه ﻧﻮع دو ﻛﻪ ﮔﻴﺮﻧـﺪه اﺻـﻠﻲ در اﻳـﻦ‬

‫ﻗﺪرت ﺗﻜﺜﻴﺮ ﺳﻠﻮلﻫﺎ اﻧﺠـﺎم ﺷـﺪه اﺳـﺖ‪ .‬اﻟﻘـﺎي ﻓﺎﻛﺘﻮرﻫـﺎي رﺷـﺪ و‬

‫ﻣﺴﻴﺮ اﺳﺖ ﻣﻲروﻳﻢ‪ .‬اﻳـﻦ ﮔﻴﺮﻧـﺪه ﺳـﺮﻳﻦ‪-‬ﺗﺮﻳـﻮﻧﻴﻦ ﻛﻴﻨـﺎزي ﻋﺮﺿـﻲ‬

‫روﻧﻮﻳﺴﻲ و ﻳﺎ ﻣﻬﺎر ﭘﺎرهاي دﻳﮕﺮ از ﻓﺎﻛﺘﻮرﻫـﺎ و ﺳـﺎﻳﺘﻮﻛﻴﻦﻫـﺎ در اﻳـﻦ‬

‫ﻏﺸﺎﻳﻲ )‪ (Transmembrane‬و ﺑﺎ ﺣﺬف آن‪ TGF-β ،‬ﺷﻨﺎﺳـﺎﻳﻲ ﻧـﺸﺪه و‬

‫زﻣﻴﻨﻪ ﺑﺮرﺳﻲ ﺷﺪهاﻧﺪ‪ .‬در ﻃﻲ ﻓﺮاﻳﻨﺪ ﺗﺰاﻳﺪ‪ ،‬ﺳﻠﻮلﻫﺎي ﺑﻨﻴـﺎدي ﺗﻮاﻧـﺎﻳﻲ‬

‫ﻣﺴﻴﺮ ﺳﻴﮕﻨﺎلدﻫﻲ ﻣﺘﻮﻗﻒ ﻣﻲﺷﻮد‪ .‬ﺑﻨﺎﺑﺮاﻳﻦ در اﻳﻦ ﺗﺤﻘﻴﻖ ﺳـﻌﻲ ﺷـﺪه‬

‫ﺑﻨﻴﺎدي ﺧﻮد را از دﺳﺖ داده و ﺑﻪ ﺳﻤﺖ ﺗﻤﺎﻳﺰ ﻣﻲروﻧﺪ‪ .‬ﻫـﻢﭼﻨـﻴﻦ در‬

‫اﺳﺖ ﺗﺎ ﺑﺎ اﻧﺠﺎم ﻫﻢزﻣﺎن اﺳﺘﻔﺎده از ﻛـﺸﺖ ﺳـﻪ ﺑﻌـﺪي و ﻣﻬـﺎر ﻣـﺴﻴﺮ‬

‫‪88‬‬

‫ﻣﻬﺎر ﻣﺴﻴﺮ ‪ TGF-b‬ﺑﺎ ﺗﻜﻨﻴﻚ ‪ RNAi‬در ﺳﻠﻮلﻫﺎي ﺑﻨﻴﺎدي ﺧﻮنﺳﺎز‬

‫‪ TGF-β‬ﺑﻪ ﺗﺰاﻳﺪ ﻗﺎﺑﻞ ﺗﻮﺟﻬﻲ از ﺳﻠﻮلﻫﺎي ﺑﻨﻴـﺎدي ﺧـﻮنﺳـﺎز رﺳـﻴﺪ‪.‬‬

‫ﻣﻴﻠﻲﻣﺘﺮ ﺑﺮش داده ﺷﺪﻧﺪ‪ .‬اﻳﻦ ﻣﻜﻌـﺐﻫـﺎ در ﭘﻠﻴـﺖ ﺷـﺶ ﺧﺎﻧـﻪ و ﺑـﻪ‬

‫ﻫﻢﭼﻨﻴﻦ ﺳﺎﺧﺘﺎر ﺷﺒﻴﻪﺳﺎزي ﺷﺪه آﺷﻴﺎﻧﻪ ﺳـﻠﻮﻟﻲ )‪ (Niche‬ﺳـﻠﻮلﻫـﺎي‬

‫ﺻﻮرت ﻳﻚ ردﻳﻒ و ﺗﺎ ﺣﺪ اﻣﻜﺎن ﻓﺸﺮده‪ ،‬ﭼﻴﺪه ﺷﺪﻧﺪ‪ .‬ﺳﭙﺲ ﺑﻪ روي‬

‫ﺑﻨﻴﺎدي ﻣﻲﺗﻮاﻧﺪ ﺑﻪ ﻋﻨﻮان ﻣﺪﻟﻲ ﺑﺮاي ﺣﺎﻟﺖ ‪ In vivo‬ﺑﺎﺷﺪ ﺑﻪﻃﻮري ﻛـﻪ‬

‫اﻳﻦ ﻗﻄﻌﺎت ﺳﻮﺳﭙﺎﻧﺴﻴﻮن ﻏﻠﻴﻆ ﺳـﻠﻮﻟﻲ در ﻣﺤـﻴﻂ ‪ DMEM‬ﺑـﻪ ﻫﻤـﺮاه‬

‫ﺳﺮﻛﻮب ﻳﻚ ﻣﺴﻴﺮ ﺳﻴﮕﻨﺎلدﻫـﻲ ﺑـﺎ ﻛﻤـﻚ ﺗﻜﻨﻴـﻚ ‪ RNAi‬در ﻣﺤـﻴﻂ‬

‫‪) FBS‬ﺑﻪ ﻣﻴﺰان ‪ %30‬در ﺣﺠﻢ ﻣﺤﻴﻂ ﻛﺸﺖ( اﺿﺎﻓﻪ ﮔﺸﺖ و ﺑـﻪ ﻣـﺪت‬

‫‪siRNA‬‬

‫‪ 12‬ﺳﺎﻋﺖ اﻧﻜﻮﺑﻪ ﺷﺪ‪ .‬ﺳﭙﺲ ﻫﺮ ﻗﻄﻌـﻪ دارﺑـﺴﺖ ﺑـﻪ آراﻣـﻲ ﺑـﻪ ﻳـﻚ‬

‫آزﻣﺎﻳﺸﮕﺎه ﻣﻮرد ارزﻳﺎﺑﻲ ﻗﺮار ﮔﻴﺮد ﺗﺎ ﺷﺪت اﺛﺮ ﺳﻴـﺴﺘﻢ اﻧﺘﻘـﺎل‬ ‫در ﺣﺎﻟﺖ دو ﺑﻌﺪي و ﺳﻪ ﺑﻌﺪي ﺑﺮرﺳﻲ ﺷﻮد‪.‬‬

‫ﭼﺎﻫﻚ ﭘﻠﻴﺖ ‪48‬ﺗﺎﻳﻲ ﻣﻨﺘﻘﻞ ﺷﺪه و ﺑﻪ ﻣﺪت ﺳﻪ روز اﻧﻜﻮﺑﻪ ﺷـﺪﻧﺪ ﺗـﺎ‬ ‫ﺗﺮاﻛﻢ ‪ %80‬ﺑﻪدﺳﺖ آﻳﺪ‪ .‬در اﻳﻦ ﻣﺪت ﺳﻠﻮلﻫﺎي ﭼﺴﺒﻨﺪه دوﻛﻲ ﺷـﻜﻞ‬ ‫‪ USSC‬اﺗﺼﺎﻻت ﺧﻮد را ﺑﺎ ﻳﻚدﻳﮕﺮ و ﺑﺎ دارﺑﺴﺖ ﻣﺤﻜﻢ ﻛـﺮده و روي‬

‫روش ﺑﺮرﺳﻲ‬

‫ﻣﺤﻠﻲ ﻛﻪ ﺟﺎيﮔﻴﺮي ﻛﺮدهاﻧﺪ ﭘﻬﻦ و ﺑﺎز ﻣﻲﺷﻮﻧﺪ‪ .‬ﺑﻌـﺪ از رﺳـﻴﺪن ﺑـﻪ‬ ‫ﻧﻮع ﻣﻄﺎﻟﻌﻪ ﻋﻠﻤـﻲ ﭘﮋوﻫـﺸﻲ ﻣـﻲﺑﺎﺷـﺪ ﻛـﻪ در ﺳـﺎل ‪ 1389‬و در‬

‫اﻳﻦ ﻣﺮﺣﻠﻪ ﭼﻨﺪ دارﺑﺴﺖ ﺑـﺮاي اﻧﺠـﺎم ﻋﻜـﺲﺑـﺮداري ﻣﻴﻜﺮوﺳـﻜﻮپ‬ ‫اﻟﻜﺘﺮوﻧــﻲ روﺑــﺸﻲ )‪ (Scanning electron microscope‬ﺑﺮداﺷــﺘﻪ )در‬

‫داﻧﺸﮕﺎه ﺗﺮﺑﻴﺖ ﻣﺪرس اﻧﺠﺎم ﺷﺪ‪.‬‬ ‫ﺟﻤﻊآوري ﻧﻤﻮﻧﻪ و ﺟﺪاﺳﺎزي ﺳﻠﻮلﻫﺎي ‪ :USSC‬واﺣﺪﻫﺎي ﺧـﻮن‬

‫داﻧﺸﻜﺪه اﻟﻜﺘﺮوﻧﻴﻚ داﻧﺸﮕﺎه ﺗﻬﺮان آزﻣﺎﻳﺸﮕﺎه ﻻﻳـﻪ ﻧـﺎزك( و ﺑﻘﻴـﻪ ﺑـﺎ‬

‫ﺑﻨـﺪﻧﺎف ﺑـﺮ اﺳـﺎس راﻫﻜﺎرﻫـﺎي ﻣـﺼﻮب ﻛﻤﻴﺘـﻪ اﺧـﻼق ﭘﺰﺷــﻜﻲ در‬

‫ﻣﻴﺘﻮﻣﺎﻳﺴﻴﻦ ‪ C‬ﻏﻴﺮﻓﻌﺎل ﺷﺪﻧﺪ‪ .‬ﻏﻴﺮﻓﻌﺎلﺳﺎزي ﺑﺎ ﻛﻤﻚ اﺷـﻌﻪ ﮔﺎﻣـﺎ ﻧﻴـﺰ‬

‫داﻧﺸﮕﺎه ﺗﺮﺑﻴﺖ ﻣﺪرس و ﺑﻴﻤﺎرﺳﺘﺎن ﺷﺮﻳﻌﺘﻲ ﺟﻤﻊآوري ﺷﺪﻧﺪ‪ .‬از اﻳـﻦ‬

‫اﻧﺠﺎم ﻣـﻲﺷـﻮد وﻟـﻲ در اﻳﻨﺠـﺎ اﺳـﻼﻳﺲﻫـﺎي دارﺑـﺴﺖ ‪ DBM‬داراي‬

‫اﻓﺮاد ﺑﺮاي ﮔﺮﻓﺘﻦ ﻧﻤﻮﻧﻪ ﺑﻪﻣﻨﻈﻮر ﺗﻬﻴﻪ ﺟﺎﻣﻌﻪ آﻣﺎري رﺿﺎﻳﺖﻧﺎﻣﻪ ﮔﺮﻓﺘـﻪ‬

‫ﺗﺨﻠﺨﻞ ﻫﺴﺘﻨﺪ و ﻧﻤﻲﺗﻮان ﺑﻪﻃﻮر ﻛﺎﻣﻞ ﺗﻤـﺎم ﻧﻘـﺎط را ﺗﺤـﺖ ﭘﻮﺷـﺶ‬

‫ﺷﺪ‪ .‬در اﺑﺘﺪا ﺑﺎ روش ﻣﻌﻤﻮل ﻓﺎﻳﻜﻮل‪ ،‬ﺳﻠﻮلﻫﺎي ﺗـﻚﻫـﺴﺘﻪاي ﺧـﻮن‬

‫اﺷﻌﻪ ﻗﺮار داد‪.‬‬

‫ﺑﻨﺪﻧﺎف ﺟﺪا ﺷﺪه و ﺳﭙﺲ ﺳﻠﻮلﻫﺎي ‪ USSC‬ﺑﺮ اﺳﺎس ﭘﺮوﺗﻜﻞ‬

‫‪Kogler‬‬

‫‪28-30‬‬

‫ﻫﻢﻛﺸﺘﻲ ﺳـﻠﻮلﻫـﺎي‬

‫‪CD34+‬‬

‫ﺑـﺎ ‪ :USSC‬در ﻧﻬﺎﻳـﺖ ﺳـﻠﻮلﻫـﺎي‬

‫‪ CD34+‬ﺑﺎ روش ﻣﻌﻤـﻮل ﻓـﺎﻳﻜﻮل و ﺳـﭙﺲ ﺑـﺎ اﺳـﺘﻔﺎده از آﻧﺘـﻲﺑـﺎدي‬

‫‪ G.‬از ﺧﻮن ﺑﻨﺪﻧﺎف ﺟﺪاﺳﺎزي‪ ،‬ﻧﮕﻪداري و ﭘﺎﺳﺎژ داده ﺷﺪﻧﺪ‪.‬‬

‫ﻛـــﺸﺖ ﺳـــﻠﻮلﻫـــﺎي ‪ USSC‬روي ﭼﺎﻫـــﻚ و دارﺑـــﺴﺖ ‪:DBM‬‬

‫ﻧـﺸﺎندار ﺷـﺪه ﺑـﺎ ﻣﮕﻨـﺖ‬

‫‪(Miltenyi Biotech, BergischGladbach,‬‬

‫ﺳﻠﻮلﻫﺎي ‪ USSC‬ﺟﺪاﺳﺎزي ﺷﺪه‪ ،‬روي ﭼﺎﻫﻚﻫﺎي ‪48‬ﺗﺎﻳﻲ ﺑﻪ ﻋﻨـﻮان‬

‫)‪ Germany‬و ﺳــﺘﻮنﻫــﺎي روش‬

‫ﻻﻳﻪ ﻣﻐﺬي و ﭘﻮﺷـﺎﻧﻨﺪه ﺳـﻄﺢ دو ﺑﻌـﺪي ﻛـﺸﺖ داده ﺷـﺪﻧﺪ‪ .‬ﭘـﺲ از‬

‫)‪ Miltenyi Biotech‬ﻣﺘﻌﻠﻖ ﺑـﻪ ﻛـﺸﻮر آﻟﻤـﺎن( ﻃﺒـﻖ ﭘﺮوﺗﻜـﻞ ﺷـﺮﻛﺖ‬

‫‪C‬‬

‫ﺳﺎزﻧﺪه‪ ،‬از ﺧﻮن ﺑﻨﺪﻧﺎف ﺟﺪاﺳﺎزي ﺷﺪﻧﺪ‪ .‬ﭘﺲ از ﺗﻌﻴـﻴﻦ ﻣﻴـﺰان زﻧـﺪه‬

‫)‪ (Mitomycin‬ﺑﻪ ﻣﻴـﺰان ‪ 10µg/ml‬ﺟﻬـﺖ ﻫـﻢﻛـﺸﺘﻲ ﺑـﺎ ﺳـﻠﻮلﻫـﺎي‬

‫ﺑﻮدن ﺳﻠﻮلﻫﺎ و ﺗﺎﻳﻴﺪ ﺑﺎ روش ﻓﻠﻮﺳﺎﻳﺘﻮﻣﺘﺮي‪ ،‬ﺑﻪ ﺳﻪ ﺣﺎﻟﺖ ﻛﺸﺖ داده‬

‫ﺧﻮنﺳﺎز ‪ CD34+‬ﻏﻴﺮﻓﻌﺎل ﺷﺪﻧﺪ‪ .‬ﺑﻪﻃﻮري ﻛـﻪ ﻓﻌﺎﻟﻴـﺖ ﻣﻴﺘـﻮزي ﻻﻳـﻪ‬

‫ﺷﺪﻧﺪ‪:‬‬

‫رﺳﻴﺪن ﺑﻪ ﺗﺮاﻛﻢ ‪ ،%80‬اﻳﻦ ﻻﻳـﻪ ﺳـﻠﻮلﻫـﺎي ‪ USSC‬ﺑـﺎ ﻣﻴﺘﻮﻣﺎﻳـﺴﻴﻦ‬

‫ﭘﺸﺘﻴﺒﺎن ﻣﺘﻮﻗﻒ ﺷﺪ‪ .‬ﻣﻴﺘﻮﻣﺎﻳﺴﻴﻦ ﻓﻌﺎﻟﻴﺖ آﻧﺘﻲﺑﻴﻮﺗﻴﻚ و ﺿـﺪ ﺗﻮﻣـﻮري‬ ‫‪31‬‬

‫دارد و ﺑﺎ اﺗﺼﺎل ﻣﺘﻘﺎﻃﻊ ﺑﻪ ‪ DNA‬از ﺗﻜﺜﻴﺮ ﺳﻠﻮﻟﻲ ﺟﻠﻮﮔﻴﺮي ﻣﻲﻛﻨـﺪ‪.‬‬

‫‪LS separation columns- MACS‬‬

‫ﺣﺎﻟﺖ اول‪ :‬ﻛـﺸﺖ ﺳـﺎده ﺳـﻠﻮلﻫـﺎي ‪ CD34+‬در ﭼﺎﻫـﻚ ﭘﻠﻴـﺖ‬ ‫‪48‬ﺗﺎﻳﻲ ﺑﺪون ﻓﻴﺪر و ﺑﺪون دارﺑﺴﺖ‪.‬‬

‫ﺑﺮاي ﭘﻮﺷﺶ دادن ﺳـﻠﻮلﻫـﺎي اﺳـﺘﺮوﻣﺎل ‪ USSC‬روي اﺳـﻼﻳﺲﻫـﺎي‬

‫ﺣﺎﻟﺖ دوم‪ :‬ﻫﻢ ﻛﺸﺘﻲ ﺳﻠﻮلﻫﺎي ﺧﻮنﺳﺎز ﺑﺎ ﻓﻴﺪري از ﺳﻠﻮلﻫﺎي‬

‫دارﺑﺴﺖ ‪) DBM‬ﺗﻬﻴﻪ ﺷﺪه از ﻣﺮﻛﺰ ﺑﺎﻧﻚ ﭘﻴﻮﻧﺪ ﻣﻐﺰ اﺳﺘﺨﻮان اﻳﺮان( ﺑـﻪ‬

‫‪ .USSC‬ﺣﺎﻟﺖ ﺳﻮم‪ :‬ﻫﻢﻛﺸﺘﻲ ﺳﻠﻮلﻫﺎي ﺧﻮنﺳﺎز ﺑﺎ ﻓﻴﺪر و ﺑﻪ ﻫﻤـﺮاه‬

‫‪T75‬‬

‫دارﺑﺴﺖ ‪ .DBM‬در ﻛﻠﻴﻪ اﻳﻦ ﺳﻪ ﺣﺎﻟـﺖ از ﻣﺤـﻴﻂ ﻛـﺸﺖ اﺧﺘـﺼﺎﺻﻲ‬

‫ﺑﺎ ﺗﺮاﻛﻢ ‪ %80‬اﺳﺖ )در ﻣﺠﻤﻮع ‪ 3×106‬ﺳﻠﻮل(‪ .‬ﻗﺒـﻞ از ﻋﻤـﻞ ﻛﺎﺷـﺖ‬

‫ﺳﻠﻮلﻫﺎي ﺑﻨﻴﺎدي ﺧﻮنﺳﺎز ﻳﻌﻨﻲ ﻣﺤﻴﻂ ‪) Stemspan‬ﻓﺮم ﺗﺠـﺎري آن از‬

‫ﺳﻠﻮﻟﻲ‪ ،‬دارﺑﺴﺖﻫﺎ ﺑﺎﻳﺪ ﺑﺮاي اﺗﺼﺎل ﺳﻠﻮلﻫﺎ ﻣﺴﺘﻌﺪ ﺷـﺪه و ﻣﻨﺎﻓـﺬ آن‬

‫‪StemSpan‬‬

‫ﻋﻨﻮان ﻻﻳﻪ ﻣﻐﺬي و ﭘﻮﺷﺎﻧﻨﺪه ﺳﻄﺢ ﺳﻪ ﺑﻌﺪي ﻧﻴﺎز ﺑﻪ ﺳﻪ ﻓﻼﺳـﻚ‬

‫ﺷﺮﻛﺖ ‪ Stem cell technologies‬در ﻛﺸﻮر ﻛﺎﻧـﺎدا ﺑـﻪ ﻧـﺎم‬

‫ﺑﻨﻴﺎدي ‪Stem Cell Factor‬‬

‫ﺑﺎز ﺷﻮﻧﺪ‪ .‬ﺑﺪﻳﻦ ﻣﻨﻈﻮر ﺑﻪ ﻣﺪت ‪ 24‬ﺳﺎﻋﺖ اﺳﻼﻳﺲﻫـﺎي دارﺑـﺴﺖ در‬

‫‪ SFEM‬ﺗﻬﻴﻪ ﺷﺪ( ﺑﻪ ﻫﻤﺮاه ﻓﺎﻛﺘﻮر رﺷﺪ ﺳﻠﻮل‬

‫ژﻻﺗﻴﻦ ‪ %0/1‬در ﺑﺎﻓﺮ ‪ PBS‬ﻏﻮﻃﻪور ﮔﺸﺘﻪ و اﻧﻜﻮﺑﻪ ﺷﺪﻧﺪ‪ .‬ﭘـﺲ از اﻳـﻦ‬

‫)‪ ،(SCF‬ﺗﺮوﻣﺒﻮﭘـﻮﻳﺘﻴﻦ )‪ flt-3 ،(Thrombopoietin –TPO‬ﻟﻴﮕﺎﻧـﺪ‬

‫ﻣﺪت اﺳﻼﻳﺲﻫﺎي دارﺑﺴﺖ ﺑﻪ ﻣﻜﻌﺐﻫﺎﻳﻲ ﺑـﺎ ﻗﻄـﺮ ﺷـﺶ ﺗـﺎ ﻫـﺸﺖ‬

‫)‪ ،like tyrosine kinase 3-ligand‬ﻫﺮ ﻳﻚ ﺑﻪ ﻣﻴـﺰان ‪ 50ng/ml‬اﺳـﺘﻔﺎده‬

‫‪(FMS-‬‬

‫زﻫﺮااﻟﺴﺎدات ﻫﺎﺷﻤﻲ و ﻫﻤﻜﺎران‬

‫‪89‬‬

‫ﮔﺸﺖ‪ TGFbR 2 .‬ﻋﻠﻴﻪ ‪ 2-4SiRNA‬ﺗﺮاﻧﺴﻔﻜﺸﻦ‪ :‬ﺑﺮاي اﻧﺠﺎم ﺗﺮاﻧﺴﻔﻜﺸﻦ‬

‫ﺑﺮاي ﻃﺮاﺣﻲ آﻏﺎزﮔﺮ دو ژن ﺑﻪﻛﺎر رﻓﺘﻪ در اﻳـﻦ ﺗﺤﻘﻴـﻖ )ﺑﺘـﺎ‪-‬اﻛﺘـﻴﻦ و‬

‫ﻛﻠﻴﻪ ﻣـﻮاد از ﺷـﺮﻛﺖ ‪ Invitrogen‬ﺗﻬﻴـﻪ ﮔـﺸﺖ‪ .‬در اﻳـﻦﺟـﺎ از روش‬

‫‪ (TGFbR2‬از ﻧﺮماﻓﺰار ‪ Oligo 6‬اﺳﺘﻔﺎده ﺷﺪ‪ .‬ﺑﻪ ﺗﺮﺗﻴـﺐ ﭘـﻨﺞ دﻗﻴﻘـﻪ در‬ ‫‪º‬‬

‫‪º‬‬

‫ﺗﺮاﻧﺴﻔﻜﺸﻦ ﺟﻠﻮﻳﻲ )‪ (Forward transfection‬اﺳﺘﻔﺎده ﺷﺪ ﺑﻪﻃﻮري ﻛـﻪ‬

‫‪C‬‬

‫روز ﻗﺒــﻞ از ﺗﺮاﻧﺴﻔﻜــﺸﻦ ﺣــﺪود ‪ 25‬ﺗــﺎ ‪ 35‬ﻫــﺰار ﺳــﻠﻮل در ‪200‬‬

‫دﻗﻴﻘﻪ در ‪ 72 ºC‬ﺑﺮاي ﻣﺮاﺣﻞ واﺳﺮﺷﺘﮕﻲ اوﻟﻴﻪ )‪،(Initial denaturation‬‬

‫ﻣﻴﻜﺮوﻟﻴﺘﺮ ﻣﺤﻴﻂ ﻓﺎﻗﺪ آﻧﺘﻲﺑﻴﻮﺗﻴﻚ و ﺳﺮم ﺑﻪ ﻫﺮ ﺧﺎﻧﻪ ﭘﻠﻴـﺖ ‪ 48‬ﺧﺎﻧـﻪ‬

‫واﺳﺮﺷﺘﮕﻲ ﺛﺎﻧﻮﻳﻪ‪ ،‬اﺗـﺼﺎل )‪ ،(Annealing‬ﺑـﺴﻂ )‪ (Extension‬و ﺑـﺴﻂ‬

‫در ﺳﻪ ﺣﺎﻟﺖ ﻛﺸﺖ‪ :‬ﻛﺸﺖ ﺳﺎده‪ ،‬ﻛﺸﺖ روي ﻓﻴﺪر و ﻛﺸﺖ ﺳﻪ ﺑﻌﺪي‬

‫ﻧﻬﺎﻳﻲ ﺑﻪﻛﺎر ﺑﺮده ﺷﺪ‪.‬‬

‫‪ 15 ،95‬ﺛﺎﻧﻴﻪ در‬

‫‪C‬‬

‫‪ 15 ،95‬ﺛﺎﻧﻴﻪ در‬

‫‪C‬‬

‫‪ 25 ،56‬ﺛﺎﻧﻴـﻪ در‬

‫‪C‬‬

‫‪10 ،72‬‬

‫در ‪ DBM‬ﻣﻨﺘﻘﻞ ﺷﺪ‪ .‬ﺑﺮاي ﻫﺮ ﺣﺎﻟﺖ ﻛﺸﺖ‪ ،‬دو ﮔـﺮوه در ﻧﻈـﺮ ﮔﺮﻓﺘـﻪ‬

‫اﻳﻦ ﻣﺮاﺣـﻞ ﺑـﺮاي ‪ 45‬ﭼﺮﺧـﻪ ﺗﻜـﺮار ﮔـﺸﺖ و در ﻧﻬﺎﻳـﺖ ذوب‬

‫ﺷﺪ‪ :‬ﮔﺮوه اول ﺑﺎ ‪ Stealth Select RNAi TM siRNA‬ﺑﺮ ﻋﻠﻴﻪ ‪ TGFbR2‬و‬

‫)‪ (Melting‬در ‪ Rotor-Gene Real-Time PCR‬اﻧﺠﺎم ﺷﺪ‪ .‬واﻛﻨﺶﻫـﺎ ﺑـﻪ‬

‫‪ StealthTM‬ﺗﻴﻤـﺎر‬

‫ﺻﻮرت دوﺗﺎﻳﻲ ﺑﻮد و ﻣﻴﺎﻧﮕﻴﻦ آنﻫﺎ اراﻳﻪ ﺷﺪ‪ .‬ﺑﺮاي اﻧﺪازهﮔﻴﺮي ﻣﻘـﺪار‬

‫ﺷﺪﻧﺪ‪ .‬ﺑﺮاي ﺑﺮرﺳﻲ ﻣﻴﺰان ﺗﺮاﻧﺴﻔﻜﺸﻦ در ﮔـﺮوه ﻛـﺸﺖ ﺳـﺎده ﻧﻴـﺰ از‬

‫و ﺑﻴﺎن ﻧﺴﺒﻲ ژن )‪ (Relative quantitation‬از روش ‪ Pfaffl‬اﺳﺘﻔﺎده ﺷـﺪ‬

‫‪ Block-iT TM alexa fluor red fluorescent oligo‬اﺳﺘﻔﺎده ﺷـﺪ‪ .‬ﻛﻠﻴـﻪ‬

‫ﻛﻪ در آن ﻣﻘﺪار )‪ Threshold Cycle (TC‬ﺑﺮاي ژن ﻫﺪف ﻫﻢ در ﺣﺎﻟـﺖ‬

‫اﻟﻴﮕﻮﻧﻮﻛﻠﻴﻮﺗﻴﺪﻫﺎي ﻣﺬﻛﻮر ﺑـﻪ ﻣﻴـﺰان ‪ 2/4‬ﭘﻴﻜﻮﻣـﻮل در ‪ 20‬ﻣﻴﻜﺮوﻟﻴﺘـﺮ‬

‫ﻛﻨﺘﺮل و ﻫﻢ در ﺣﺎﻟﺖ ﺗﻴﻤﺎر ﺷﺪه ﺑﺎ ‪ siRNA‬وﻧﻴـﺰ ژن ﻛﻨﺘـﺮل درون زاد‬

‫‪ Opti-MEM‬در ﻳـــــﻚ ﺗﻴـــــﻮب و ﺣـــــﺪود ‪ 0/4‬ﻣﻴﻜﺮوﻟﻴﺘـــــﺮ از‬

‫)در اﻳﻦﺟﺎ از ژن ﺑﺘﺎ‪-‬اﻛﺘﻴﻦ ﻣﻮرد ارزﻳﺎﺑﻲ ﻗﺮار ﮔﺮﻓـﺖ( ﻫـﻢ در ﺣﺎﻟـﺖ‬

‫‪ Lipofectamine™ RNAiMAX‬در ‪ 20‬ﻣﻴﻜﺮوﻟﻴﺘﺮ ‪ Opti-MEM‬در ﺗﻴﻮب‬

‫ﻛﻨﺘﺮل و ﻫﻢ در ﺣﺎﻟﺖ ﺗﻴﻤﺎر ﺷـﺪه ﺑـﺎ ‪ ،siRNA‬در ﻓﺮﻣـﻮل ‪ Pfaffl‬ﻗـﺮار‬

‫دﻳﮕﺮي اﺿﺎﻓﻪ ﺷﺪﻧﺪ‪ .‬ﭘﺲ از ﮔﺬﺷﺖ زﻣﺎن ﭘـﻨﺞ دﻗﻴﻘـﻪ اﻧﻜﻮﺑﺎﺳـﻴﻮن در‬

‫داده ﺷﺪ ﺗﺎ ﺑﻴﺎن ژن ﺑﺎ ژن ﻛﻨﺘﺮل درون زاد ﻧﺮﻣـﺎﻟﻴﺰه ﺷـﻮد و در ﻧﻬﺎﻳـﺖ‬

‫دﻣﺎي اﺗﺎق‪ ،‬ﻣﺤﺘﻮﻳﺎت دو ﺗﻴﻮب ﺑﻪ ﻳﻚدﻳﮕـﺮ اﺿـﺎﻓﻪ ﺷـﺪﻧﺪ و ﭘـﺲ از‬

‫ﻛﺎﻫﺶ ﺑﻴﺎن ژن ﺑﻪدﺳﺖ آﻣﺪ‪.‬‬

‫ﮔـﺮوه دوم ﺑـﺎ‬

‫‪RNAi negative control duplexes‬‬

‫ﮔﺬﺷﺖ ‪ 20‬دﻗﻴﻘﻪ ﻛﻤﭙﻠﻜﺲ ﻧﻬﺎﻳﻲ ﺗﺸﻜﻴﻞ ﺷﺪه و آن را ﺑـﻪ ﺧﺎﻧـﻪﻫـﺎي‬

‫ﻓﻠﻮﺳﺎﻳﺘﻮﻣﺘﺮي‪ :‬ﻗﺒﻞ و ﺑﻌـﺪ از ﺗﻴﻤـﺎر ﺑـﺎ ‪ RNAi‬و ازدﻳـﺎد ﺳـﻠﻮﻟﻲ‪،‬‬

‫ﭘﻠﻴﺖ اﺿﺎﻓﻪ ﻣﻲﻛﻨﻴﻢ‪ .‬ﺑﺎ اﺿﺎﻓﻪ ﻛﺮدن اﻳﻦ ﻛﻤﭙﻠﻜﺲ ﺣﺠﻢ ﻧﻬﺎﻳﻲ ﺑﻪ ‪240‬‬

‫ﺳــﻠﻮلﻫــﺎي ‪ CD34+‬از ﻧﻈــﺮ ﻣــﺎرﻛﺮ ﺳــﻄﺢ ﺳــﻠﻮﻟﻲ ﺑــﺎ اﺳــﺘﻔﺎده از‬

‫ﻣﻴﻜﺮوﻟﻴﺘﺮ ﻣﻲرﺳﺪ ﻛﻪ ﻏﻠﻈـﺖ ﻧﻬـﺎﻳﻲ اﻟﻴﮕﻮﻧﻮﻛﻠﻴﻮﺗﻴـﺪ ﺑـﻪ ‪ 10‬ﻧـﺎﻧﻮﻣﻮل‬

‫ﻓﻠﻮﺳﺎﻳﺘﻮﻣﺘﺮي ‪ PARTEC Germany‬ارزﻳﺎﺑﻲ ﺷﺪﻧﺪ‪ .‬ﺗﻌـﺪاد ‪ 105‬ﺳـﻠﻮل‬

‫ﻣﻲرﺳﺪ‪ .‬ﺑﻪ آراﻣﻲ ﭘﻠﻴﺖ را ﺑﻪ ﺳـﻤﺖ ﺟﻠـﻮ و ﻋﻘـﺐ ﺗﻜـﺎن داده ﺗـﺎ ﺑـﻪ‬

‫ﺷﻤﺎرش ﺷﺪه و ﺑﺎ ﺑﺎﻓﺮ ‪ PBS‬ﺣﺎوي ‪ FBS %5‬ﺷﺴﺘﺸﻮ ﺷﺪه و ﺑﺎ اﺳـﺘﻔﺎده‬

‫ﺧﻮﺑﻲ ﻛﻤﭙﻠﻜﺲ ﺑﺎ ﻣﺤﻴﻂ ﻛـﺸﺖ ﻣﺨﻠـﻮط ﺷـﻮد‪ .‬ﺳـﭙﺲ ﭘﻠﻴـﺖﻫـﺎ در‬

‫از آﻧﺘـﻲﺑـﺎديﻫـﺎي ﻛﻮﻧﮋوﮔـﻪ ﺷـﺪه ﺑـﺎ ﻓﻠـﻮروﻛﺮوم‬

‫‪(Fluorescein‬‬

‫اﻧﻜﻮﺑﺎﺗﻮر ‪ 37 ºC‬و ‪ %5 CO2‬ﮔﺬاﺷﺘﻪ و ﻣﻲﺗـﻮان ﺑﻌـﺪ از ﺷـﺶ ﺳـﺎﻋﺖ‬

‫)‪ Isothiocyanate (FITC)- conjugated Antibodies‬رﻧـﮓآﻣﻴـﺰي ﺿـﺪ‬

‫ﻣﺤﻴﻂ ﺳﻠﻮﻟﻲ را ﺗﻌﻮﻳﺾ ﻛﺮد‪.‬‬

‫‪ CD34‬اﻧﺠﺎم ﺷﺪ‪ .‬از آﻧﺘﻲﺑﺎدي ‪ FITC-mouse IgG1‬ﺑﻪ ﻋﻨـﻮان اﻳﺰوﺗﻴـﭗ‬

‫اﻧﺪازهﮔﻴﺮي ﻛﻤﻲ ﻣﻴﺰان ﺳﺮﻛﻮب ﺑﻴـﺎن ژن ‪ TGFbR2‬ﺑـﺎ اﺳـﺘﻔﺎده از‬

‫ﻛﻨﺘﺮل ﺑﺮاي ﺗﻀﻤﻴﻦ اﺧﺘﺼﺎﺻﻲ ﺑﻮدن واﻛﻨﺶ اﺳﺘﻔﺎده ﺷﺪ‪ .‬ﺳﻠﻮلﻫـﺎ در‬

‫‪ Real-Time PCR‬ﻛﻤﻲ )‪ :Quantitative Real-Time PCR (QRT-PCR‬ﺑﺮ‬

‫ﻧﺎﺣﻴﻪاي ﻛﻪ داراي ﭘﺮاﻛﻨﺶ ﻧﻮري ﭘـﺎﻳﻴﻦ ﺑﻮدﻧـﺪ ﺑـﻪ ﻋﻨـﻮان‬

‫‪Low side‬‬

‫اﺳﺎس ﭘﺮوﺗﻜﻞ ﺷـﺮﻛﺖ ﺳـﻴﻨﺎژن و ﻣﺤﻠـﻮل ‪ RNA ،RNXTM-plus‬ﻛـﻞ‬

‫‪ scatter-gate‬ﺗﻌﻴــﻴﻦ ﺷــﺪﻧﺪ و ﺑــﺮاي ارزﻳــﺎﺑﻲ از ﻧــﺮماﻓــﺰار‬

‫ﺳﻠﻮﻟﻲ ﺗﺨﻠﻴﺺ ﮔﺸﺖ‪ .‬اﻳﻦ ﻋﻤﻞ در ﻓﻮاﺻﻞ ‪ 48‬و ‪ 72‬ﺳـﺎﻋﺖ ﭘـﺲ از‬

‫اﺳﺘﻔﺎده ﺷﺪ‪.‬‬

‫)‪(Fermentase‬‬

‫آزﻣﻮن ﻛﻠﻮﻧﻲزاﻳﻲ‪ :‬ﺳﻠﻮلﻫﺎي ازدﻳﺎد ﺷﺪه از ﮔﺮوه ﻛﻨﺘﺮل و آزﻣـﻮن‬

‫‪Revert AidTM M-‬‬

‫ﺑﺮاي ﺑﺮرﺳﻲ ﻛﻠﻨﻲزاﻳﻲ ﺑﺎ اﺳﺘﻔﺎده از ﻣﺤـﻴﻂ ‪) Methocult‬ﻓـﺮم ﺗﺠـﺎري‬

‫‪ MuLV‬و ﭘﺮاﻳﻤــﺮ ‪ Random hexamer‬ﺑــﺮ‬

‫‪Stem‬‬

‫ﺗﺮاﻧﺴﻔﻜﺸﻦ اﻧﺠﺎم ﺷﺪ‪ .‬ﺳﭙﺲ ﻣﺤﻠﻮل ﺣﺎﺻﻞ ﺷـﺪه ﺑـﺎ‬ ‫‪ DNaseI‬ﺗﻴﻤﺎر ﮔﺸﺘﻪ و ﺑﺮاي ﺳﻨﺘﺰ ‪ cDNA‬از آﻧـﺰﻳﻢ‬ ‫‪Reverse Transcriptase‬‬

‫‪FloMax‬‬

‫اﺳﺎس ﺷﺮﻛﺖ ﺳﺎزﻧﺪه )‪ (Fermentase‬اﺳﺘﻔﺎده ﺷﺪ‪ .‬ﺑﺮاي اﻧﺠﺎم واﻛـﻨﺶ‬

‫آن ‪ (Methocult H4435 Enriched‬و ﭘﺮوﺗﻜﻞ ﺷـﺮﻛﺖ ﺳـﺎزﻧﺪه )‬ ‫‪ cell technologies‬ﻛﺸﻮر ﻛﺎﻧﺎدا( ﻣﻮرد ارزﻳﺎﺑﻲ ﻗﺮار ﮔﺮﻓﺘﻨﺪ‪.‬‬

‫ﺑﻪ ﺗﺮﺗﻴﺐ از ﻣﺨﻠﻮط اﺻﻠﻲ )‪ ،(Master Mix-Takara‬آﻏﺎزﮔﺮ )‪5-Primer‬‬

‫ﻧﺘﺎﻳﺞ ﺑﻪدﺳﺖ آﻣﺪه در ﻧﺮماﻓﺰار ‪ SPSS‬وﻳﺮاﺳﺖ ‪ 16‬ﺑﺮرﺳﻲ ﺷﺪﻧﺪ و‬

‫ﭘﻴﻜﻮﻣﻮل( و ‪ 50) cDNA‬ﻧﺎﻧﻮﮔﺮم( ﺑﻪ ﻣﻴﺰان ﺷﺶ‪ ،‬ﻳﻚ و ﻳﻚ ﻣﻴﻜﺮوﻟﻴﺘﺮ‬

‫ﺑﺎ ﻛﻤﻚ ‪ P ،Student’s t-test‬ﻣﺤﺎﺳﺒﻪ ﮔﺸﺖ و دادهﻫﺎ از ﻟﺤﺎظ ﻣﻌﻨﻲدار‬

‫را ﻣﺨﻠﻮط ﻛﺮده و ﺑﺎ آب ﻣﻘﻄﺮ ﺣﺠﻢ ﺑﻪ ‪ 12/5‬ﻣﻴﻜﺮوﻟﻴﺘﺮ رﺳـﺎﻧﺪه ﺷـﺪ‪.‬‬

‫ﺑﻮدن و ﻧﺒﻮدن ﺑﺮرﺳﻲ ﺷﺪﻧﺪ و ﻣﻘﺎدﻳﺮ ‪ P<0/05‬ﻣﻌﻨﻲدار ﻣﻲﺑﺎﺷﺪ‪.‬‬

‫ﻣﻬﺎر ﻣﺴﻴﺮ ‪ TGF-b‬ﺑﺎ ﺗﻜﻨﻴﻚ ‪ RNAi‬در ﺳﻠﻮلﻫﺎي ﺑﻨﻴﺎدي ﺧﻮنﺳﺎز‬

‫‪90‬‬

‫ﺳﻪ ﺣﺎﻟﺖ ﻛﺸﺖ و در دو ﮔﺮوه ﺗﻴﻤﺎر ﺷﺪه ﺑـﺎ ‪ siRNA‬و ﻛﻨﺘـﺮل ﻣﻨﻔـﻲ‬

‫ﻳﺎﻓﺘﻪﻫﺎ‬

‫ﺷﻤﺎرش ﺷﺪﻧﺪ‪ .‬اﻳﻦ ﺷـﻤﺎرش ‪ 48‬و ‪ 72‬ﺳـﺎﻋﺖ ﭘـﺲ از ﺗﺮاﻧﺴﻔﻜـﺸﻦ‬ ‫ﻛﺸﺖ ﺳﻠﻮلﻫﺎي ‪ :USSC‬ﺳﻠﻮلﻫـﺎي ‪ USSC‬ﭘـﺲ از ﺟﺪاﺳـﺎزي از‬

‫اﻧﺠﺎم ﮔﺸﺖ‪ .‬ﻫﻤﺎنﻃﻮر ﻛﻪ اﺷﺎره ﺷﺪ ﺗﺮاﻧﺴﻔﻜﺸﻦ در روز ﺳﻮم ﭘﺲ از‬

‫ﺧﻮن ﺑﻨﺪﻧﺎف ﺑﻪ ﻣﺪت دو ﻫﻔﺘﻪ در ﻣﺤﻴﻂ ﻛﺸﺖ اﺧﺘـﺼﺎﺻﻲ ﻧﮕـﻪداري‬

‫ﺟﺪاﺳﺎزي اﻧﺠﺎم ﮔـﺸﺖ و ﺑﻌـﺪ از ‪ 48‬و ‪ 72‬ﺳـﺎﻋﺖ از زﻣـﺎن ﺗـﺮاﻧﺲ‬

‫ﺷﺪن ﺗﺎ ﻛﻠﻨﻲﻫﺎي اوﻟﻴﻪ ﺗﺸﻜﻴﻞ ﺷﻮﻧﺪ‪ .‬اﻳﻦ ﺳﻠﻮلﻫـﺎ در اﺑﺘـﺪا ﺑـﻪ ﻓـﺮم‬

‫ﻓﻜﺸﻦ از ﻧﻈﺮ ﻣﻴـﺰان ﺑﻴـﺎن ﻧـﺴﺨﻪ ‪ (Transcript) RNA‬ژن ‪ TGFbR2‬ﺑـﺎ‬

‫ﺳﺘﺎرهاي ﺷﻜﻞ ﻫﺴﺘﻨﺪ وﻟـﻲ ﭘـﺲ از رﺳـﻴﺪن ﺑـﻪ ﺗـﺮاﻛﻢ ‪ %80‬ﻛـﺸﻴﺪه‪،‬‬

‫اﺳﺘﻔﺎده از ‪ QRT-PCR‬ارزﻳـﺎﺑﻲ ﺷـﺪﻧﺪ‪ .‬در ﻧﻬﺎﻳـﺖ ‪ 96‬ﺳـﺎﻋﺖ ﭘـﺲ از‬

‫ﻣﻮازي و ﺗﺎ ﺣﺪودي دوﻛﻲ ﺷﻜﻞ ﺷﺪﻧﺪ )ﺷﻜﻞ ‪ -1‬ب(‪ .‬اﻳﻦ ﺳـﻠﻮلﻫـﺎ‬

‫ﺗﺮاﻧﺴﻔﻜﺸﻦ ﺳﻠﻮلﻫﺎ از ﻧﻈﺮ اﻳﻤﻮﻧﻮﻓﻨﻮﺗﻴﭙﻲ ﺑﺎ ﻓﻠﻮﺳـﺎﻳﺘﻮﻣﺘﺮي و از ﻧﻈـﺮ‬

‫ﺑﺮاي ﭘﻮﺷﺎﻧﺪن ﺳﻄﺢ دارﺑﺴﺖ ‪ DBM‬و ﻫﻢﭼﻨﻴﻦ ﻛـﻒ ﭘﻠﻴـﺖ ‪ 48‬ﺧﺎﻧـﻪ‬

‫ﻋﻤﻠﻜﺮدي ﺑﺎ آزﻣﻮن ﻛﻠﻮﻧﻲزاﻳﻲ ﻣﻮرد ارزﻳﺎﺑﻲ ﻗﺮار ﮔﺮﻓﺘﻨﺪ‪ .‬ﺑﻨﺎﺑﺮاﻳﻦ ﻛﻞ‬

‫ﺑﻪﻛﺎر ﺑﺮده ﺷﺪﻧﺪ‪ .‬ﭘﺲ از رﺳﻴﺪن ﺑﻪ ﺗﺮاﻛﻢ ﻣﻨﺎﺳﺐ اﻳﻦ ﻻﻳﻪ ﺗﻐﺬﻳﻪ ﻛﻨﻨﺪه‬

‫روﻧﺪ ﺗﺰاﻳﺪ در ﻃﻲ ﻫﺸﺖ روز اﻧﺠﺎم ﮔﺸﺖ‪ .‬ﺟﺪول ‪ 1‬ﻧﺸﺎن ﻣﻲدﻫﺪ ﻛﻪ‬

‫)ﺳﻠﻮلﻫﺎي ﻓﻴﺪر ‪ (USSC‬ﺑﺎ ﻣﻴﺘﻮﻣﺎﻳﺴﻴﻦ ‪ C‬ﻏﻴﺮ ﻓﻌﺎل ﮔﺸﺘﻨﺪ‪ .‬ﭼﻨﺪ ﻗﻄﻌـﻪ‬

‫ﺑﻴﺶﺗﺮﻳﻦ ﺗﻌﺪاد ﺳﻠﻮل در ﮔﺮوه ﺗﻴﻤـﺎر ﺷـﺪه و در ‪ 72‬ﺳـﺎﻋﺖ ﭘـﺲ از‬

‫از دارﺑــﺴﺖ ‪ DBM‬ﺣــﺎوي ﺳــﻠﻮلﻫــﺎي ﻓﻴــﺪر ﺑــﺮاي ﻋﻜــﺲﺑــﺮداري‬

‫ﺗﺮاﻧﺴﻔﻜﺸﻦ ﻣﺸﺎﻫﺪه ﺷﺪ‪ .‬اﻳﻦ ﺗﺰاﻳﺪ در ﺣﺎﻟـﺖ ﻛـﺸﺖ روي ﻓﻴـﺪر ﺑـﻪ‬

‫ﻣﻴﻜﺮوﺳﻜﻮپ اﻟﻜﺘﺮوﻧﻲ روﺑﺸﻲ )‪ (SEM‬ﺑﻪﻛﺎر رﻓﺘﻨـﺪ‪ .‬ﺗـﺼﺎوﻳﺮ ‪ SEM‬از‬

‫وﺿﻮح ﻗﺎﺑﻞ ﻣﺸﺎﻫﺪه ﺑﻮد‪.‬‬

‫‪DBM‬‬

‫آزﻣﻮن ‪ :QRT-PCR‬ﺑﺮاي ﺳﻨﺠﺶ ﺗﻐﻴﻴﺮات اﻳﺠﺎد ﺷﺪه در ﻣﻴﺰان ﺑﻴﺎن‬

‫ﭘﻮﺷﻴﺪه ﺷﺪه از ﺳﻠﻮلﻫﺎي ﻓﻴﺪر ﺳـﻄﺤﻲ روﺷـﻦﺗـﺮ دارد و ﺳـﻠﻮلﻫـﺎ‬

‫ژن ﻣﻮرد ﻧﻈﺮ از آزﻣﻮن ‪ QRT-PCR‬اﺳﺘﻔﺎده ﺷﺪ‪ .‬ﺑﻴﺎن ﻧﺴﺨﻪ ‪ RNA‬ﺑـﺮاي‬

‫ﺑﻪﻃﻮر ﻣﺠﺰا ﺑﻪﺻﻮرت ﻧﻮارﻫﺎي ﻛﺸﻴﺪه و روﺷﻦ ﻗﺎﺑﻞ ﻣـﺸﺎﻫﺪه ﻫـﺴﺘﻨﺪ‬

‫ژن ﺑﺘــﺎ‪-‬اﻛﺘــﻴﻦ و ژن ‪ TGFbR2‬در دو ﮔــﺮوه ﻛﻨﺘــﺮل و ﺗﻴﻤــﺎر ﺷــﺪه ﺑــﺎ‬

‫)ﺷﻜﻞ ‪.(1‬‬

‫‪ SiRNA‬ﺑﻌﺪ از ‪ 48‬و ‪ 72‬ﺳﺎﻋﺖ ارزﻳـﺎﺑﻲ ﺷـﺪ‪ .‬ﻣﻴـﺰان ﻧـﺴﺒﺖ اﻳـﻦ دو‬

‫ﺳﻄﺢ دارﺑﺴﺖ ‪ DBM‬ﺗﺨﻠﺨﻞ ‪ %40‬را ﻧﺸﺎن ﻣـﻲدﻫـﺪ‪ .‬دارﺑـﺴﺖ‬

‫ﺗﺮاﻧﺴﻔﻜــﺸﻦ ﺳــﻠﻮلﻫــﺎي ‪ :CD34+‬ﺳــﻠﻮلﻫــﺎي ‪ CD34+‬ﺑــﺎ روش‬

‫روﻧﻮﺷﺖ ﺑﺎ روش ‪ Pfaffl‬ﻗﺎﻧﻮﻧﻤﻨﺪ ﺷﺪ‪ .‬در ﻧﻬﺎﻳـﺖ ﻧﺘـﺎﻳﺞ ﺣـﺎﻛﻲ از آن‬

‫‪ MACS‬از ﺧﻮن ﺑﻨﺪﻧﺎف ﺟﺪاﺳﺎزي ﺷﺪﻧﺪ و ﺳﭙﺲ ﺑـﻪ ﺗﻌـﺪاد ‪ 30‬ﻫـﺰار‬

‫ﺑﻮد ﻛﻪ ﺑﺮاي ﻫﺮ ﺳﻪ ﺣﺎﻟﺖ ﻛﺸﺖ‪ ،‬ﺑﻴﺶﺗﺮﻳﻦ ﻛﺎﻫﺶ ﺑﻴﺎن ژن ﺣﺪود ‪72‬‬

‫ﺳﻠﻮل در ﺳﻪ ﺣﺎﻟﺖ‪ :‬ﻛﺸﺖ ﺳﺎده‪ ،‬ﻛﺸﺖ روي ﻓﻴﺪر و ﻛﺸﺖ ﺳﻪ ﺑﻌﺪي‬

‫ﺳﺎﻋﺖ ﭘﺲ از ﺗﺮاﻧﺴﻔﻜﺸﻦ ﺣﺎﺻﻞ ﺑﻮده اﺳـﺖ‪ .‬اﻣـﺎ در ﺑـﻴﻦ اﻳـﻦ ﺳـﻪ‬

‫ﺑﻪ ﭘﻠﻴـﺖ ‪ 48‬ﺧﺎﻧـﻪ اﺿـﺎﻓﻪ ﺷـﺪ‪ .‬ﻣﺤـﻴﻂ ﺑـﻪﻛـﺎر رﻓﺘـﻪ ﻣﺤـﻴﻂ ﻛـﺸﺖ‬

‫ﺣﺎﻟﺖ‪ ،‬ﺑﻴﺶﺗﺮﻳﻦ ﻛﺎﻫﺶ ﺑﻴﺎن ژن ‪ TGFbR2‬در ﻛﺸﺖ ﺳﺎده ﻣﺸﺎﻫﺪه ﺷﺪ‬

‫اﺧﺘﺼﺎﺻﻲ ﺳﻠﻮلﻫﺎي ﺑﻨﻴـﺎدي ‪ StemSpan‬ﻫﻤـﺮاه ﺑـﺎ ﻓﺎﻛﺘﻮرﻫـﺎي ‪،SCF‬‬

‫ﻛﻪ در ﺣﺪود ‪ %51‬ﺑﻮد )ﻧﻤﻮدار ‪.(1‬‬

‫™‪ Stealth‬ﻋﻠﻴـﻪ ‪ TGFbR2‬و‬

‫ﺑﺮرﺳﻲ ﻓﻠﻮﺳﺎﻳﺘﻮﻣﺘﺮﻳﻚ ﺳﻠﻮلﻫﺎي ﺗﺰاﻳـﺪ ﻳﺎﻓﺘـﻪ از ﻧﻈـﺮ ﻧـﺸﺎنﮔـﺮ‬

‫‪ TPO‬و ‪ flt-3‬ﻣﻲﺑﺎﺷﺪ‪ .‬ﻫﺮ ﺣﺎﻟﺖ ﺑﺎ‬

‫™‪ Stealth‬ﺗﺮاﻧــﺴﻔﻜﺖ ﺷــﺪﻧﺪ‪ .‬ﺑــﺮاي‬

‫‪ :CD34‬در روز اول )روز ﺟﺪاﺳــﺎزي( و در روز ﻫــﺸﺘﻢ ﺳــﻠﻮلﻫــﺎي‬

‫‪BLOCK-iT TM alexa fluor‬‬

‫‪ HSCs‬در ﺳﻪ ﺣﺎﻟﺖ ﻛﺸﺖ و ﺑﺮاي ﻫﺮ ﺣﺎﻟﺖ در دو ﮔﺮوه ﺗﻴﻤـﺎر ﺷـﺪه‬

‫‪ red‬اﺳﺘﻔﺎده ﺷﺪ‪ .‬ﭘﺲ از ﺷﺶ ﺗﺎ ﻫﺸﺖ ﺳـﺎﻋﺖ از زﻣـﺎن ﺗﺮاﻧﺴﻔﻜـﺸﻦ‪،‬‬

‫ﺑﺎ ‪ siRNA‬ﻋﻠﻴﻪ ‪ TGFbR2‬و ﻧﻴﺰ ﻛﻨﺘﺮل‪ ،‬از ﻧﻈﺮ ﻣﻴﺰان ﻧـﺸﺎنﮔـﺮ ﺳـﻄﺤﻲ‬

‫ﻣﻴﺰان ﺗﺮاﻧﺴﻔﻜﺸﻦ در ﺳﻠﻮلﻫﺎي اﻳﻦ ﮔﺮوه ﺑﺎ اﺳﺘﻔﺎده از ﻣﻴﻜﺮوﺳﻜﻮپ‬

‫‪ CD34‬ارزﻳﺎﺑﻲ ﺷﺪﻧﺪ‪ .‬ﺗﻌﺪاد ‪100‬ﻫﺰار ﺳﻠﻮل ﺑﺮاي ﻫـﺮ ﮔـﺮوه ﺑﺮداﺷـﺖ‬

‫ﻓﻠﻮرﺳﺎﻧﺲ ﺑﺮرﺳﻲ ﺷﺪ‪ .‬ﺑﻪ ﻃﻮر ﻣﻴﺎﻧﮕﻴﻦ ﻣﻴﺰان ﺗﺮاﻧﺴﻔﻜﺸﻦ ﺣﺪود ‪%60‬‬

‫ﺷﺪ و ﭘﺲ از اﻧﻜﻮﺑﻪ ﺷﺪن ﺑﺎ آﻧﺘﻲﺑﺎدي ﻋﻠﻴﻪ ﻧـﺸﺎنﮔـﺮ ‪ CD34‬ﻧـﺸﺎندار‬

‫ﺗﺨﻤﻴﻦ زده ﺷﺪ )ﺷﻜﻞ ‪ .(2‬ﺗﺮاﻧﺴﻔﻜﺸﻦ روز ﺳـﻮم ﭘـﺲ از ﺟﺪاﺳـﺎزي‬

‫ﺷﺪه ﺑﺎ ‪ FITC‬و ﻫﻢﭼﻨﻴﻦ اﻳﺰوﺗﻴﭗ ﻛﻨﺘﺮل‪ ،‬ﻧﺘﺎﻳﺞ ﻓﻠﻮﺳـﺎﻳﺘﻮﻣﺘﺮي ﻣﻄﺎﻟﻌـﻪ‬

‫ﺳﻠﻮلﻫﺎي ‪ CD34+‬اﻧﺠﺎم ﺷﺪ ﻛﻪ ﻋﻠﺖ اﻳﻦ ﻣﻮﺿﻮع ﻣﻘﺎوﻣﺖ ﺳﻠﻮلﻫﺎي‬

‫ﺷﺪﻧﺪ‪ .‬ﺑﻪ ﻃﻮر ﻣﻴﺎﻧﮕﻴﻦ ﻣﻴﺰان ﺑﻴﺎن ‪ CD34‬در روز اول ﭘﺲ از ﺟﺪاﺳﺎزي‬

‫ﺧﻔﺘﻪ در ﺑﺮاﺑﺮ ﺗﺮاﻧﺴﻔﻜﺸﻦ اﺳﺖ‪ .‬ﺑﻨﺎﺑﺮاﻳﻦ ﺑﺎ اﻟﻘﺎي رﺷﺪ در ﺳﻠﻮلﻫـﺎي‬

‫ﺣﺪود ‪ %89‬ﺑﻮد و در روز ﻫﺸﺘﻢ ﻣﻴﺰان ﺳﻠﻮلﻫﺎي ‪ CD34+‬در ﺟﻤﻌﻴـﺖ‬

‫ﺑﻨﻴﺎدي ﺧﻮنﺳﺎز ﺑﺎ اﺳﺘﻔﺎده از ﻣﺤﻴﻂ ﻛﺸﺖ ازدﻳﺎد ﺳﻠﻮلﻫﺎي ﺑﻨﻴـﺎدي و‬

‫ﺳﻠﻮﻟﻲ اﻓﺖ ﻛﺮده و ﺑﻪ ﻣﻴﺰان ‪ 20/3 ،27/2‬و ‪ 14/1‬درﺻﺪ ﺑـﺮاي ﮔـﺮوه‬

‫در ﺣﻀﻮر ﺳﺎﻳﺘﻮﻛﻴﻦﻫﺎي اوﻟﻴﻪ‪ ،‬ﺳﻠﻮلﻫـﺎي ﺧـﻮنﺳـﺎز اوﻟﻴـﻪ ﺑـﻴﺶﺗـﺮ‬

‫ﻛﻨﺘﺮل ﺑﻪ ﺗﺮﺗﻴﺐ در ﺳﻪ ﺣﺎﻟﺖ ﻛﺸﺖ ﺳﺎده‪ ،‬ﻛﺸﺖ روي ﻓﻴﺪر و ﻛـﺸﺖ‬

‫ﻣﺴﺘﻌﺪ ﺗﺮاﻧﺴﻔﻜﺸﻦ ﺷﺪﻧﺪ‪.‬‬

‫روي ‪ DBM‬رﺳﻴﺪ‪ .‬وﻟﻲ در ﮔﺮوه ﺗﻴﻤﺎر ﺷﺪه ﺑﺎ ‪ siRNA‬ﻋﻠﻴـﻪ ‪،TGFbR2‬‬

‫ﻧﻴــﺰ‬

‫‪RNAi negative control‬‬

‫‪RNAi‬‬

‫ﺑﺮرﺳﻲ ﺑﺎزده و ﻛـﺎراﻳﻲ ﺗﺮاﻧﺴﻔﻜـﺸﻦ از‬

‫ﻧﺘﺎﻳﺞ ﺣﺎﺻﻞ از ﺷﻤﺎرش ﺳﻠﻮلﻫﺎي ‪ :CD34+‬ﺳﻠﻮلﻫﺎي ‪ CD34+‬در‬

‫ﺣﺪود ‪ 30‬ﻫﺰار ﺳﻠﻮل ﺑﺎ آﻧﺎﻟﻴﺰ ﻓﻠﻮﺳﺎﻳﺘﻮﻣﺘﺮي ‪ %89‬اﺳﺘﻔﺎده ﺷـﺪ‪ ،‬ﺗﻌﺪاد‬

‫زﻫﺮااﻟﺴﺎدات ﻫﺎﺷﻤﻲ و ﻫﻤﻜﺎران‬

‫‪91‬‬

‫ﺟﺪول‪ :1 -‬ﺷﻤﺎرش ﺳﻠﻮلﻫﺎي ‪ CD34+‬در ﺣﺎﻻت و زﻣﺎنﻫﺎي ﻣﺨﺘﻠﻒ‬ ‫روز ﻗﺒﻞ از اﻧﺠﺎم‬

‫زﻣﺎن‬ ‫ﺣﺎﻟﺖ‬ ‫ﮔﺮوه‬

‫ﺗﻌﺪاد ﺳﻠﻮلﻫﺎ‬

‫ﻛﻨﺘﺮل‬

‫‪30×10‬‬

‫ﺗﺴﺖ‬

‫‪3‬‬

‫‪30×10‬‬

‫ﻛﻨﺘﺮل‬

‫‪3‬‬

‫‪30×10‬‬

‫ﺗﺴﺖ‬

‫‪3‬‬

‫‪30×10‬‬

‫ﻛﺸﺖ در ﺷﺮاﻳﻂ ﺳﻪ ﺑﻌـﺪي‬

‫ﻛﻨﺘﺮل‬

‫‪3‬‬

‫‪30×10‬‬

‫‪DBM‬‬

‫ﺗﺴﺖ‬

‫‪30×103‬‬

‫ﻛﺸﺖ روي ﻓﻴﺪر‬

‫‪ 48‬ﺳﺎﻋﺖ ﭘﺲ از ﺗﺮاﻧﺴﻔﻜﺸﻦ‬

‫ﺗﺮاﻧﺴﻔﻜﺸﻦ‬ ‫‪3‬‬

‫ﻛﺸﺖ دو ﺑﻌﺪي ﺳﺎده‬

‫‪ 72‬ﺳﺎﻋﺖ ﭘﺲ از ﺗﺮاﻧﺴﻔﻜﺸﻦ‬

‫ﺗﻌﺪاد ﺳﻠﻮلﻫﺎ‬ ‫‪3‬‬

‫‪(939)×10‬‬

‫ﺗﺰاﻳﺪ ﺳﻠﻮﻟﻲ‬ ‫‪3/10/3‬‬

‫‪3‬‬

‫‪(16512)×10‬‬

‫‪3‬‬

‫‪(18915)×10‬‬

‫‪3‬‬

‫‪(29122)×10‬‬

‫‪3‬‬

‫‪(45017)×10‬‬

‫‪150/56‬‬

‫‪(71428)×103‬‬

‫‪23/80/9‬‬

‫‪5/50/42‬‬ ‫‪6/30/51‬‬ ‫‪9/70/74‬‬

‫ﺗﻌﺪاد ﺳﻠﻮلﻫﺎ‬

‫ﺗﺰاﻳﺪ ﺳﻠﻮﻟﻲ‬

‫‪3‬‬

‫‪7/050/25‬‬

‫‪(2117)×10‬‬

‫‪3‬‬

‫‪(43330)×10‬‬

‫‪3‬‬

‫‪(39012)×10‬‬

‫‪3‬‬

‫‪(66110)×10‬‬

‫‪3‬‬

‫‪(89219)×10‬‬

‫‪29/730/63‬‬

‫‪(123222)×103‬‬

‫‪41/060/73‬‬

‫‪14/451‬‬ ‫‪12/990/4‬‬ ‫‪22/040/86‬‬

‫ﺷﻜﻞ‪ :1 -‬ﻋﻜﺲﺑﺮداري ‪ SEM‬از ﺳﻄﺢ دارﺑﺴﺖ ‪ .DBM‬اﻟﻒ( ﺗﺼﻮﻳﺮ ﺳﻄﺢ دارﺑﺴﺖ ‪ DBM‬ﺑﺎ ﻛﻤﻚ ﻣﻴﻜﺮوﺳﻜﻮپ ‪ SEM‬ﺑﺪون ﺳﻠﻮلﻫﺎي ﻓﻴﺪر ﺑﻪ ﻋﻨﻮان ﻛﻨﺘﺮل‪ .‬ب و ج( ﺗـﺼﻮﻳﺮ ﺳـﻄﺢ دارﺑـﺴﺖ‬ ‫‪ DBM‬زﻣﺎﻧﻲ ﻛﻪ ﺑﺎ ﺳﻠﻮلﻫﺎي ‪ USSC‬ﭘﻮﺷﺶ داده ﺷﺪه اﺳﺖ ﺑﺎ اﻧﺪازه اﺷﺎره ﺷﺪه در زﻳﺮ ﺷﻜﻞ ﻣﻲﺗﻮان ﺳﻠﻮلﻫﺎي ‪ USSC‬را ﺑﻪﻃﻮر ﻣﺠﺰا ﻣﺸﺎﻫﺪه ﻛﺮد ﺣﺎل آنﻛﻪ در ﺗﺼﻮﻳﺮ اﻟﻒ ﺳﻠﻮﻟﻲ ﻣﺸﺎﻫﺪه ﻧﻤﻲﺷﻮد‪.‬‬

‫ﺳﻠﻮل ‪ CD34+‬در اﻳﻦ ﺟﻤﻌﻴﺖ ﺳﻠﻮﻟﻲ ﺑﻪدﺳـﺖ ﻣـﻲآﻳـﺪ ﻛـﻪ ﺑﺮاﺑـﺮ ﺑـﺎ‬ ‫ﺣﺪود ‪ 26700‬ﺳﻠﻮل اﺳﺖ‪ .‬ﺑﻨﺎﺑﺮاﻳﻦ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺟـﺪول ﺗﺰاﻳـﺪ ﺳـﻠﻮﻟﻲ‬ ‫)ﺟﺪول ‪ (2‬و ﻣﻴﺰان درﺻـﺪ ﻓﻠﻮﺳـﺎﻳﺘﻮﻣﺘﺮي ﺳـﻠﻮلﻫـﺎ در روز ﻫـﺸﺘﻢ‪،‬‬ ‫ﺗﺰاﻳﺪ ﺳﻠﻮﻟﻲ از ﻧﻈﺮ ﻓﻨﻮﺗﻴﭙﻲ ﺑﻪدﺳﺖ ﻣﻲآﻳﺪ )ﻧﻤﻮدار ‪.(2‬‬ ‫ﻧﺘﺎﻳﺞ ﺣﺎﺻﻞ از آزﻣﻮن ﻛﻠﻨﻲزاﻳﻲ‪ :‬ﺑﺮاي ﺑﺮرﺳﻲ ﻋﻤﻠﻜﺮد ﺳﻠﻮلﻫﺎي‬ ‫ﺷﻜﻞ‪ :2 -‬ﺳﻠﻮلﻫﺎي ‪ HSCs‬ﺗﺮاﻧﺴﻔﻜﺖ ﺷـﺪه ﺑـﺎ‬

‫‪BLOCK-iT TM Alexa Fluor‬‬

‫‪ HSCs‬از آزﻣﻮن ﻛﻠﻨﻲزاﻳﻲ اﺳﺘﻔﺎده ﺷﺪ‪ .‬ﺑﺪﻳﻦ ﺻﻮرت ﻛـﻪ ﺳـﻠﻮلﻫـﺎي‬

‫‪ .Red‬اﻟﻒ( ﺗﺼﻮﻳﺮ ﺑﺎ اﺳﺘﻔﺎده از ﻧﻮر ﻣﺎوراي ﺑﻨﻔﺶ ﻣﻴﻜﺮوﺳﻜﻮپ ﻓﻠﻮرﺳﺎﻧﺲ‪ .‬ب( ﺗﺼﻮﻳﺮ ﻫﻤـﻴﻦ‬

‫ﮔﺮوه ﻛﻨﺘﺮل و ﺗﻴﻤﺎر ﺷﺪه ﭘﺲ از ﻫﺸﺖ روز ﺗﺰاﻳﺪ ﺑﻪ ﻣﺪت دو ﻫﻔﺘﻪ در‬

‫ﺳﻠﻮلﻫﺎ ﺑﺎ ﻧﻮر ﻣﺮﺋﻲ ﻣﻴﻜﺮوﺳﻜﻮپ ﻓﻠﻮرﺳﺎﻧﺲ در ﻫﻤﺎن زﻣﻴﻨﻪ ﻗﺒﻠﻲ ﻛﻪ ﻧﺸﺎندﻫﻨﺪه ﻣﻮﻓﻘﻴـﺖآﻣﻴـﺰ‬

‫ﻣﺤﻴﻂ ﻧﻴﻤﻪ ﺟﺎﻣـﺪ ﻣﺘﻮﻛﺎﻟـﺖ )‪ (Methocult‬ﻧﮕـﻪ داري ﺷـﺪﻧﺪ‪ .‬ﺑﺮرﺳـﻲ‬

‫ﺑﻮدن ﺗﺮاﻧﺴﻔﻜﺸﻦ اﺳﺖ‪.‬‬

‫ﻛﻠﻨـﻲﻫﺎ ﻧﺸـﺎن داد ﻛـﻪ ﻛﻠﻨـﻲﻫﺎي ﻣﺘﻌﻠﻖ ﺑﻪ ﮔﺮوه آزﻣﻮن در ﻣﻘﺎﻳﺴﻪ ﺑـﺎ‬

‫ﻣﻬﺎر ﻣﺴﻴﺮ ‪ TGF-b‬ﺑﺎ ﺗﻜﻨﻴﻚ ‪ RNAi‬در ﺳﻠﻮلﻫﺎي ﺑﻨﻴﺎدي ﺧﻮنﺳﺎز‬

‫‪92‬‬

‫ﺗﺸﻜﻴﻞدﻫﻨﺪه ﻛﻠﻨﻲ دارد‪ .‬در ﮔﺮوه آزﻣﻮن ﺑﻪﻃﻮر ﻣﻴـﺎﻧﮕﻴﻦ ﺑـﻪ ازاي ﻫـﺮ‬ ‫‪ 1000‬ﺳﻠﻮل ‪ 90±15‬و در ﮔﺮوه ﻛﻨﺘﺮل ‪ 50±10‬ﻛﻠﻨﻲ ﺑﻪدﺳﺖ آﻣﺪ‪ .‬ﺑﻴﻦ‬ ‫ﺳﻪ ﺣﺎﻟﺖ ﻛﺸﺖ ﺳﺎده‪ ،‬روي ﻓﻴﺪر و ‪ DBM‬ﺗﻔﺎوت ﻣﺤﺴﻮﺳﻲ ﻣـﺸﺎﻫﺪه‬ ‫ﻧﺸﺪ و ﺑﻪﻃﻮر ﻣﺘﻮﺳﻂ اﻳﻦ ﺗﻌﺪاد ﻛﻠﻨﻲ در ﮔﺮوه آزﻣﻮن و ﻛﻨﺘﺮل ﻫﺮ ﺳـﻪ‬ ‫ﺣﺎﻟﺖ ﺑﻪدﺳﺖ آﻣﺪ‪.‬‬

‫ﺑﺤﺚ‬ ‫ﺳﻠﻮلﻫﺎي ‪ USSC‬ﺗﺤﺮﻳﻚ ﻧﺸﺪه‪ ،‬در ﺣﺎﻟﺖ ﻃﺒﻴﻌﻲ ﻗﺎدر ﺑـﻪ ﺗﻮﻟﻴـﺪ‬ ‫ﻣـــﺸﺨﺺ ﺳـ ـﺎﻳﺘﻮﻛﻴﻦﻫـــﺎي ‪،CSF ،LIF ،TGF-1β ،M-CSF ،GM-CSF‬‬ ‫‪،IL-15 ،IL-12 ،IL-11 ،IL-8 ،IL-6 ،IL-1β ،VEGF‬‬ ‫ﻧﻤﻮدار‪ :1 -‬درﺻﺪ ﻛﺎﻫﺶ ﺑﻴـﺎن ژن ‪ TGFbR2‬در ﺳـﻠﻮلﻫـﺎي ‪ HSCs‬ﺗﺮاﻧـﺴﻔﻜﺖ‬ ‫ﺷﺪه‪.‬‬

‫*‪.P<0/05‬‬

‫‪HGF ،SDF-1α‬‬

‫ﻣﻲﺑﺎﺷﻨﺪ‪ .‬ﺳﻠﻮلﻫﺎي ‪ USSC‬ﭼـﻪ در ﺣﺎﻟـﺖ ﺗﺤﺮﻳـﻚ ﻧـﺸﺪه و ﭼـﻪ در‬ ‫ﺣﺎﻟﺖ ﺗﺤﺮﻳﻚ ﺷﺪه ﺑﺎ ‪ IL-1β‬ﻗﺎدر ﺑﻪ ﺗﻮﻟﻴﺪ ‪ FLt-3L‬و ‪ TPO‬ﻧﻴﺴﺘﻨﺪ وﻟﻲ‬ ‫‪ G-SCF‬را در ﻣﻘﺎدﻳﺮ ﻛﻢ ﻳﻌﻨﻲ ‪ 0/2pg/ml‬ﺗﻮﻟﻴﺪ ﻣـﻲﻛﻨﻨـﺪ‪ .‬ﺳـﻠﻮلﻫـﺎي‬ ‫‪ USSC‬در ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﺳﻠﻮلﻫـﺎي ‪ BM-MSC‬ﺳـﻄﺢ ﺑـﺎﻻﺗﺮي از ‪،M-CSF‬‬ ‫‪ IL-11 ،SDF-1α ،SCF ،LIF ،TGF-1β‬و ﺳــﻄﺢ ﭘــﺎﻳﻴﻦﺗــﺮي از ‪،VEGF‬‬ ‫‪ IL-6 ،GM-CSF‬را ﺗﻮﻟﻴﺪ ﻣـﻲﻛﻨﻨـﺪ‪ .‬ﺳـﻠﻮلﻫـﺎي ‪ USSC‬در ﻣﻘﺎﻳـﺴﻪ ﺑـﺎ‬ ‫ﺳﻠﻮلﻫﺎي ﻣﺰاﻧﺸﻴﻤﻲ‪ ،‬ﺗﻠﻮﻣﺮاز ﺑﻠﻨﺪﺗﺮي دارﻧﺪ و ﺑﻨﺎﺑﺮاﻳﻦ ﻇﺮﻓﻴﺖ ﺑـﺎﻻﻳﻲ‬ ‫ﺑﺮاي ﺗﺰاﻳﺪ دارﻧﺪ‪ .‬ﺳﻠﻮلﻫﺎي ‪ MSC‬در ﭘﺎﺳﺎژﻫﺎي ﭘﺎﻳﻴﻦ ﺑﻪ ﺳﻤﺖ ﭘﻴـﺮي‬ ‫رﻓﺘﻪ و ﻗﺪرت ﺗﻜﺜﻴﺮ ﺧﻮد را از دﺳﺖ ﻣﻲدﻫﻨﺪ ﺣﺎل آنﻛـﻪ ﺳـﻠﻮلﻫـﺎي‬ ‫‪ USSC‬در ﭘﺎﺳﺎژﻫﺎي ﺑﺎﻻ ﻧﻴﺰ ﻫﻢﭼﻨﺎن ﺟﻮان ﻫﺴﺘﻨﺪ و ﺑـﻪ ﺳـﻤﺖ ﭘﻴـﺮي‬ ‫ﻧﻤﻲروﻧﺪ‪32.‬و‪ 28-30‬زﻣﺎﻧﻲ ﻛﻪ ﺳﻠﻮلﻫﺎي ﻓﻴﺪر ﻣﺎﻧﻨﺪ ﻛـﺸﺖ دو ﺑﻌـﺪي از‬ ‫ﻳﻚ ﻃﺮف ﺑﻪ ﻛﻒ ﭘﻠﻴﺖ و از ﻃﺮف دﻳﮕﺮ ﺑﺎ ﺳﻠﻮلﻫﺎي ﻫﺪف در ﺗﻤﺎس‬ ‫ﺑﺎﺷﻨﺪ‪ ،‬ﺗﻨﻬﺎ ﻗﺎدر ﺑﻪ ﺗﺮﺷﺢ ﻓﺎﻛﺘﻮرﻫﺎ در ﻳﻚ ﺳﻄﺢ ﻫﺴﺘﻨﺪ‪ .‬اﻣﺎ زﻣﺎﻧﻲ ﻛـﻪ‬

‫ﻧﻤﻮدار‪ :2 -‬ﻣﻴﺰان ازدﻳﺎد ﺳﻠﻮلﻫﺎي ‪ CD34‬ﺑﺮ اﺳﺎس ارزﻳﺎﺑﻲﻫﺎي اﻳﻤﻮﻧﻮﻓﻨﻮﺗﻴﭙﻲ در‬ ‫ﮔﺮوه آزﻣﻮن و ﻛﻨﺘﺮل‪.P<0/05* .‬‬

‫ﺳﻠﻮلﻫﺎي ﻓﻴﺪر در ﺳﻪ ﺑﻌﺪ ﺑﺎ ﻣﺤﻴﻂ در ﺗﻤﺎس ﺑﺎﺷﻨﺪ‪ ،‬اﻓـﺰاﻳﺶ ﺗﺮﺷـﺢ‬ ‫ﻓﺎﻛﺘﻮرﻫﺎ را داﺷﺘﻪ و ﻣﻨﺠﺮ ﺑﻪ اﻓﺰاﻳﺶ ﻛﺎراﻳﻲ ﻓﻴﺪر ﻣﻲﺷﻮد ﺑﻪﻃﻮري ﻛـﻪ‬ ‫ﻏﻠﻈﺖ ﻓﺎﻛﺘﻮرﻫﺎ در اﻳﻦ ﻧﺎﺣﻴﻪ اﻓﺰاﻳﺶ ﻣﻲﻳﺎﺑﺪ‪ .‬ﺳﻠﻮلﻫﺎي ﻓﻴﺪر واﺑـﺴﺘﻪ‬ ‫ﺑﻪ ﺳﻄﺢ ﻫﺴﺘﻨﺪ ﺑﻨﺎﺑﺮاﻳﻦ ﺑﺎ اﻓﺰاﻳﺶ ﻧﺴﺒﺖ ﺳﻄﺢ ﺑﻪ ﺣﺠﻢ اﺛﺮ ﺳﻠﻮلﻫﺎي‬

‫ﻣﻴﺰان ‪ CD34‬در ﺟﻤﻌﻴﺖ ﺑﻴﺶﺗﺮ ﺑﻮده و ﺑـﺮاي ﺳـﻪ ﺣﺎﻟـﺖ ﻣـﺬﻛﻮر ﺑـﻪ‬

‫ﻓﻴﺪر اﻓﺰاﻳﺶ ﻣﻲﻳﺎﺑﺪ‪ .‬ﺗﺮﺷﺢ ﺑﻴﺶ از ﺣﺪ اﻳﻦ ﻓﺎﻛﺘﻮرﻫﺎ و ﻧﻴﺰ ﺗﻤـﺎس ﺑـﺎ‬

‫‪CD34‬‬

‫ﺳﻠﻮلﻫﺎي ﻓﻴﺪر ﻣﻨﺠﺮ ﺑﻪ ﺗﻤﺎﻳﺰ ﺳﻠﻮلﻫﺎي ﺑﻨﻴﺎدي ﺧﻮنﺳﺎز ﻣﻲﺷﻮد ﻛـﻪ‬

‫در ﮔﺮوه آزﻣﻮن ﻫﺮ ﺣﺎﻟﺖ ﻛﺸﺖ ﻧﺴﺒﺖ ﺑﻪ ﮔﺮوه ﻛﻨﺘﺮل ﻣﺮﺑﻮط ﺑﻪ ﻫﻤﺎن‬

‫اﻳﻦ ﺳﻠﻮلﻫـﺎي ‪ CD34+‬در اﻳـﻦ ﺣﺎﻟـﺖ دﻳﮕـﺮ ﺟﻤﻌﻴﺘـﻲ ﻧـﺎﻫﻤﮕﻮن از‬

‫ﺣﺎﻟﺖ‪ ،‬ﻧﺸﺎندﻫﻨﺪه ﺗﺄﺛﻴﺮ ﻣﻬﺎر ﻋﻼﻣﺖدﻫﻲ ‪ TGF-b‬ﺑﺮ ﻣﻴـﺰان ﺑـﺮوز اﻳـﻦ‬

‫ﺳﻠﻮلﻫﺎي ﺧﻮﻧﻲ ﻣﻲﺑﺎﺷـﻨﺪ ﻛـﻪ ﻣﺎرﻛﺮﻫـﺎي ﺳـﻄﺤﻲ ﻣﺨﺘﻠﻔـﻲ را ﺑﻴـﺎن‬

‫ﻧﺸﺎنﮔﺮ ﺳﻄﺤﻲ اﺳﺖ‪ .‬ﺑﺎ ﺗﻮﺟـﻪ ﺑـﻪ اﻳـﻦ ﻛـﻪ در روز اول آزﻣـﺎﻳﺶ در‬

‫ﻣﻲﻛﻨﻨﺪ‪ .‬ﻫﺮ ﻳﻚ از اﻳﻦ ﺳﻠﻮلﻫﺎ در ﻳﻚ ﻣﺮﺣﻠﻪ ﺗﻤﺎﻳﺰي ﻫﺴﺘﻨﺪ ﻛﻪ اﻳـﻦ‬

‫ﮔﺮوه ﻛﻨﺘﺮل اﻧﺪازه ﺑﺰرگﺗﺮي داﺷﺘﻨﺪ ﻛﻪ ﻧﺸﺎن از اوﻟﻴﻪ ﺑﻮدن ﺳﻠﻮلﻫﺎي‬

‫ﺳﻠﻮلﻫﺎ ﻣﻲﺗﻮاﻧﻨﺪ ﺳﻠﻮل ﺑﻨﻴﺎدي ﺧﻮنﺳﺎز اوﻟﻴﻪ ﺗﺎ ﺳﻠﻮل ﻣﺮﺑﻮط ﺑـﻪ رده‬

‫ﺗﺮﺗﻴﺐ ‪ 24/7 ،32/6‬و ‪ 17/5‬درﺻﺪ ﻣﺸﺎﻫﺪه ﺷﺪ‪ .‬اﻓﺰاﻳﺶ ﻣﻴـﺰان‬

‫ﻫﻤﻜﺎران‬ ‫ﻫﺎﺷﻤﻲ و‬ ‫زﻫﺮااﻟﺴﺎدات‬ ‫‪Hashemi‬‬ ‫‪Z.S. et‬‬ ‫‪al.‬‬

‫‪93‬‬

‫ﺧﺎص ﺑﺎﺷﻨﺪ‪ .‬ﺑﻨﺎﺑﺮاﻳﻦ در اﻃﺮاف ﺳﻠﻮلﻫـﺎي ﻓﻴـﺪر ﻏﻠﻈـﺖ ﻛـﺎﻧﻮﻧﻲ از‬

‫ﮔﺮوه آزﻣﻮن ﺑﻪ ﮔﺮوه ﻛﻨﺘـﺮل در ﺣﺎﻟـﺖ ﻛـﺸﺖ دو ﺑﻌـﺪي ﺳـﺎده ‪2/46‬‬

‫ﻓﺎﻛﺘﻮرﻫﺎ و ﭘﺮوﺗﻴﻴﻦﻫﺎي ﻣﺨﺘﻠﻒ اﺳـﺖ ﻛـﻪ ﺑﺎﻋـﺚ درﮔﻴـﺮي و اﻳﺠـﺎد‬

‫ﺧﻮاﻫﺪ ﺑﻮد ﺣﺎل آنﻛﻪ در ﻛﺸﺖ روي ﻓﻴﺪر اﻳﻦ ﻋﺪد ‪ 2/06‬و در ﻛﺸﺖ‬

‫ﺳﻄﺢ ﭼﺴﺒﻨﺪه ﺑﺮاي ﺳﻠﻮلﻫﺎي ‪ HSC‬ﻣﻲﻛﻨﺪ‪ .‬در ﺣﺎﻟﺖ ﺳﻪ ﺑﻌـﺪي اﻳـﻦ‬

‫ﺳﻪ ﺑﻌﺪي ‪ DBM‬ﺑﻪ ‪ 1/71‬رﺳﻴﺪه اﺳﺖ‪ .‬ﺑﺮرﺳﻲ ﻣﺎرﻛﺮ ﺳﻄﺤﻲ ﻧﻴﺰ ﻧﺸﺎن‬

‫ﺗﺮاﻛﻢ ﺑﻴﺶ از دو ﺑﻌﺪي ﻫﻤﺮاه ﺑﺎ ﻓﻴﺪر اﺳﺖ‪ .‬ﺳﻠﻮلﻫﺎي ‪ CD34+‬ﻛـﻪ در‬

‫داد ﻛﻪ اﻓﺰاﻳﺶ ﺑﻴﺎن ﻣﺎرﻛﺮ ‪ CD34‬در ﮔﺮوه ﺗﻴﻤﺎر ﻧﺴﺒﺖ ﺑﻪ ﮔﺮوه ﻛﻨﺘـﺮل‬

‫ﻧﺰدﻳﻚ ﺳﻠﻮلﻫﺎي ‪ USSC‬ﻗـﺮار دارﻧـﺪ ﺗﺤـﺖ ﺗـﺎﺛﻴﺮ ﻣـﺎﺗﺮﻳﻜﺲ ﺧـﺎرج‬

‫در ﺣﺎﻟﺖ دو ﺑﻌﺪي ﺳﺎده ‪ %5/4‬و در ﺣﺎﻟﺖ ﺳـﻪ ﺑﻌـﺪي ‪ %3/4‬ﺑـﻮد‪ .‬در‬

‫ﺳﻠﻮﻟﻲ اﻳﻦ ﺳﻠﻮلﻫﺎ ﻫﺴﺘﻨﺪ و آزادي ﻛﺎﻓﻲ در ﺳﻪ ﺑﻌﺪ را ﻧﺪارﻧﺪ‪ .‬زﻣﺎﻧﻲ‬

‫ﻧﻬﺎﻳﺖ ﺑﺎ اﻧﺠﺎم ‪ Real time PCR‬ﻣﻴﺰان ﻛﺎﻫﺶ ﺑﻴﺎن ژن ﺑـﻪﻃـﻮر ﺧـﺎﻟﺺ‬

‫ﻛﻪ اﻟﻴﮕﻮﻧﻮﻛﻠﺌﻮﺗﻴـﺪ ﺗـﺪاﺧﻠﻲ )‪ (siRNA‬وارد اﻳـﻦ ﻣﺤـﻴﻂ ﻣـﻲﺷـﻮد در‬

‫ﺑﻪدﺳﺖ آﻣﺪ ﻛﻪ در اﻳﻦﺟﺎ ﻧﻴﺰ ﻧﺸﺎن از ﺑﻴﺶﺗﺮﻳﻦ ﻛﺎﻫﺶ ﺑﻴﺎن در ﻛـﺸﺖ‬

‫اﻃﺮاف ﺳﻠﻮلﻫﺎي ‪ CD34+‬ﺷـﻨﺎور ﻣـﻲﺑﺎﺷـﻨﺪ ﺗـﺎ ﺑـﺎ ﻛﻤـﻚ ﻛﻤـﭙﻠﻜﺲ‬

‫دو ﺑﻌﺪي ﺳﺎده داﺷﺖ‪ .‬اﻳﻦ ﻧﺘﺎﻳﺞ ﻧـﺸﺎندﻫﻨـﺪه ﻣـﻮﺛﺮﺗﺮ ﺑـﻮدن ﺳﻴـﺴﺘﻢ‬

‫ﻟﻴﭙﻮﻓﻜﺘــﺎﻣﻴﻦ وارد ﺳــﻠﻮلﻫــﺎ ﺷــﻮﻧﺪ‪ .‬در اﻳــﻦ ﺣﺎﻟــﺖ ﺑــﺮاي ورود ﺑــﻪ‬

‫اﻧﺘﻘﺎل و ﺗﺤﻮﻳﻞ ‪ siRNA‬در ﻣﺤﻴﻂ دو ﺑﻌﺪي ﺳـﺎده دارد ﺑـﻪﻃـﻮري ﻛـﻪ‬

‫ﺳﻠﻮلﻫﺎي ﺧﻮنﺳﺎز ﺑﺎﻳﺪ از ﺳﻪ ﺑﻌﺪ ﻛﻤﻚ ﺑﮕﻴﺮد ﺗـﺎ اﻧﺘﻘـﺎل ﺳـﻠﻮﻟﻲ ﺑـﺎ‬

‫ﺳﻠﻮلﻫﺎ در ﺳﻪ ﺑﻌﺪ آزاد ﺑﺎﺷﻨﺪ و ﻣﻨﺎﻓﺬ آنﻫﺎ ﺑﺮاي ورود ‪ siRNA‬ﺑﻴﺶﺗﺮ‬

‫ﻛﺎراﻳﻲ ﺑﻬﺘﺮ اﻧﺠﺎم ﺷﻮد‪ .‬ﺑﺮاي ﺳﻠﻮلﻫـﺎي ﺧـﻮنﺳـﺎز ﻛـﻪ ﺗﺤـﺖ ﺗـﺎﺛﻴﺮ‬

‫در دﺳﺘﺮس ﺑﺎﺷﻨﺪ‪ .‬اﻳﻦ ﺳﻠﻮلﻫﺎي دﺳﺖورزي ﺷﺪه ﺑﺎ ‪ siRNA‬ﻋﻠﻴﻪ ژن‬

‫ﺳﻠﻮلﻫﺎي ﻓﻴﺪر ﻫـﺴﺘﻨﺪ اﻳـﻦ اﻟﻴﮕﻮﻧﻮﻛﻠﺌﻮﺗﻴـﺪ ﺑﺎﻳـﺪ از ﺳـﺪ ﻣـﺎﺗﺮﻳﻜﺲ‬

‫‪ TGFbR2‬ﻗﺎﺑﻞ اﺳﺘﻔﺎده در ﻓﺎز ﺑﺎﻟﻴﻨﻲ ﻣﻲﺑﺎﺷـﻨﺪ زﻳـﺮا اﻳـﻦ دﺳـﺖورزي‬

‫ﺳﻠﻮﻟﻲ ﻋﺒﻮر ﻛﻨﺪ ﻛﻪ اﺣﺘﻤـﺎل ﺗﻤـﺎس و دﺳﺘﺮﺳـﻲ آن ﺑـﻪ ﺳـﻠﻮلﻫـﺎي‬

‫ﺑﻪﺻﻮرت ﻣﻮﻗﺖ ﻣـﻲﺑﺎﺷـﺪ و ‪ siRNA‬در ﺣـﺪاﻛﺜﺮ ‪ 72‬ﺳـﺎﻋﺖ ﭘـﺲ از‬

‫ﺧﻮنﺳﺎز ﻛﺎﻫﺶ ﻣﻲﻳﺎﺑﺪ و ﺑﺴﻴﺎري از ‪siRNA‬ﻫﺎ ﺑﻪ ﺳـﻠﻮلﻫـﺎي ﻫـﺪف‬

‫ﺗﺮاﻧﺴﻔﻜﺸﻦ از ﻣﺤﻴﻂ ﺣﺬف ﻣﻲﺷﻮد و اﻳﻦ ﺗﻴﻤـﺎر ﺑـﻪﺻـﻮرت داﻳﻤـﻲ‬

‫وارد ﻧﻤﻲﺷﻮﻧﺪ و در ﻧﻬﺎﻳﺖ ﻧـﺸﺎن از ﻛـﺎﻫﺶ ﻛـﺎراﻳﻲ ﺳﻴـﺴﺘﻢ اﻧﺘﻘـﺎل‬

‫ﻧﻤﻲﺑﺎﺷﺪ‪ .‬زﻳﺮا ﻣﺴﻴﺮ ‪ TGFb‬در ﺑﺴﻴﺎري از ﻣـﺴﻴﺮﻫﺎي ﺳـﻠﻮﻟﻲ دﺧﺎﻟـﺖ‬

‫)‪ (siRNA delivery‬در ﺣﺎﻟﺖ ﺳﻪ ﺑﻌﺪي ﻣﻲﺑﺎﺷﺪ‪ .‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺟـﺪول ‪1‬‬

‫داﺷﺘﻪ و ﭘﻴﺎمﻫﺎي ﺣﺴﺎس ﺳﻠﻮﻟﻲ ﺑﺎ اﻳﻦ ﻓﺎﻛﺘﻮر ﻣﻨﺘﻘﻞ ﻣـﻲﺷـﻮد‪ .‬ﻫـﺪف‬

‫ﻣﺸﺎﻫﺪه ﻣﻲﺷﻮد ﻛﻪ ﻧﺴﺒﺖ ﺗﺰاﻳﺪ ﺳﻠﻮﻟﻲ در ﺣﺎﻟـﺖ ﺳـﺎده در دو ﮔـﺮوه‬

‫ﻧﻬﺎﻳﻲ ﺗﺰاﻳﺪ ﺳﻠﻮلﻫﺎي ﺑﻨﻴﺎدي ﺧﻮنﺳﺎز اﺳـﺘﻔﺎده آنﻫـﺎ در ﭘﻴﻮﻧـﺪ ﻣﻐـﺰ‬

‫ﻛﻨﺘﺮل و آزﻣﻮن ﺑﺮاﺑﺮ ﺑﺎ ‪ 2/04‬ﻣﻲﺑﺎﺷـﺪ }‪ {14/45÷7/05 =2/04‬ﻳﻌﻨـﻲ‬

‫اﺳﺘﺨﻮان اﺳﺖ‪.‬‬

‫در ﺣﺎﻟﺖ ﺳﺎده ﮔﺮوه ﺗﻴﻤﺎر ﺷﺪه ﻧﺴﺒﺖ ﺑﻪ ﻛﻨﺘـﺮل ﺧـﻮد در ﺣـﺪود دو‬

‫ﺳﭙﺎﺳﮕﺰاري‪ :‬اﻳﻦ ﻣﻘﺎﻟﻪ ﺣﺎﺻﻞ ﺑﺨﺸﻲ از ﭘﺎﻳـﺎنﻧﺎﻣـﻪ ﺗﺤـﺖ ﻋﻨـﻮان‬

‫ﺑﺮاﺑﺮ اﻓﺰاﻳﺶ ﺗﻌﺪاد داﺷﺘﻪ اﺳﺖ ﺣﺎل آنﻛﻪ اﻳﻦ ﻧـﺴﺒﺖ در ﻛـﺸﺖ روي‬

‫"ﺑﺮرﺳﻲ ﻣﻬﺎر ﺑﻴﺎن ژن ‪ TGF-β‬در ﺳﻠﻮلﻫﺎي ﺑﻨﻴﺎدي ﺧـﻮن ﺑﻨـﺪﻧﺎف ﺑـﺮ‬

‫ﻓﻴﺪر ‪ 1/69‬و ﻛﺸﺖ روي ‪ DBM‬ﺑﻪ ‪ 1/38‬ﻛﺎﻫﺶ ﻳﺎﻓﺘﻪ اﺳﺖ‪ .‬ﺑـﺎ ﺗﻮﺟـﻪ‬

‫روي دارﺑــﺴﺖ ﺳــﻪ ﺑﻌــﺪي ‪ MBA‬ﺟﻬــﺖ اﻓــﺰاﻳﺶ ﺧــﻮدﺗﻜﺜﻴﺮي اﻳــﻦ‬

‫ﺑﻪ ﻧﺘﺎﻳﺞ‪ ،‬اﻓﺰاﻳﺶ ﻓﻨﻮﺗﻴﭙﻲ در ﮔﺮوه ﺗﻴﻤﺎر ﺷﺪه ﻛﺸﺖ دو ﺑﻌـﺪي ﺳـﺎده‪،‬‬

‫ﺳﻠﻮلﻫﺎ" در ﻣﻘﻄﻊ ﻛﺎرﺷﻨﺎﺳﻲ ارﺷﺪ در ﺳـﺎل ‪ 1389‬و ﻛـﺪ ‪1017637‬‬

‫‪ 5/28‬و ﮔﺮوه ﻛﻨﺘﺮل ‪ 2/14‬ﻣﻲﺑﺎﺷﺪ ﺑﻨـﺎﺑﺮاﻳﻦ ﻧـﺴﺒﺖ اﻓـﺰاﻳﺶ ﻓﻨـﻮﺗﻴﭙﻲ‬

‫ﻣﻲﺑﺎﺷﺪ ﻛﻪ ﺑﺎ ﺣﻤﺎﻳﺖ داﻧﺸﮕﺎه ﺗﺮﺑﻴﺖ ﻣﺪرس اﺟﺮا ﺷﺪه اﺳﺖ‪.‬‬

‫‪References‬‬ ‫‪6.‬‬

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‫‪Alimoghaddam K, Mohyedin M, Vatandoust S, Goliaei Z,‬‬ ‫‪Alijanipour P, Forouzia F. Ex vivo-Expansion of Cord Blood‬‬ ‫‪Cells and Its Clinical Application. Yakhteh Med J 2006;8(3):211.‬‬ ‫‪Hofmeister CC, Zhang J, Knight KL, Le P, Stiff PJ. Ex vivo‬‬ ‫‪expansion of umbilical cord blood stem cells for transplantation:‬‬ ‫‪growing knowledge from the hematopoietic niche. Bone Marrow‬‬ ‫‪Transplant 2007;39(1):11-23.‬‬ ‫‪Broxmeyer HE, Douglas GW, Hangoc G, Cooper S, Bard J,‬‬ ‫‪English D, et al. Human umbilical cord blood as a potential‬‬ ‫‪source of transplantable hematopoietic stem/progenitor cells.‬‬ ‫‪Proc Natl Acad Sci U S A 1989;86(10):3828-32.‬‬ ‫‪Bordignon C. Stem-cell therapies for blood diseases. Nature‬‬ ‫‪2006;441(7097):1100-2.‬‬ ‫‪Siena S, Schiavo R, Pedrazzoli P, Carlo-Stella C. Therapeutic‬‬ ‫‪relevance of CD34 cell dose in blood cell transplantation for‬‬ ‫‪cancer therapy. J Clin Oncol 2000;18(6):1360-77.‬‬

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TGF-b downregulation by RNAi technique in ex vivo-expanded HSCs on 3D DBM scaffold

11. Kasten P, Luginbühl R, van Griensven M, Barkhausen T, Krettek C, Bohner M, et al. Comparison of human bone marrow stromal cells seeded on calcium-deficient hydroxyapatite, betatricalcium phosphate and demineralized bone matrix. Biomaterials 2003;24(15):2593-603. 12. Thibault RA, Scott Baggett L, Mikos AG, Kasper FK. Osteogenic differentiation of mesenchymal stem cells on pregenerated extracellular matrix scaffolds in the absence of osteogenic cell culture supplements. Tissue Eng Part A 2010;16(2):431-40. 13. Langenbach F, Naujoks C, Kersten-Thiele PV, Berr K, Depprich RA, Kübler NR, Kögler G, et al. Osteogenic differentiation influences stem cell migration out of scaffold-free microspheres. Tissue Eng Part A 2010;16(2):759-66. 14. Harrison DE. Proliferative capacity of erythropoietic stem cell lines and aging: an overview. Mech Ageing Dev 1979;9(56):409-26. 15. Ruscetti FW, Akel S, Bartelmez SH. Autocrine transforming growth factor-beta regulation of hematopoiesis: many outcomes that depend on the context. Oncogene 2005;24(37):5751-63. 16. Blobe GC, Schiemann WP, Lodish HF. Role of transforming growth factor beta in human disease. N Engl J Med 2000;342(18):1350-8. 17. Cashman JD, Eaves CJ, Sarris AH, Eaves AC. MCP-1, not MIP1alpha, is the endogenous chemokine that cooperates with TGFbeta to inhibit the cycling of primitive normal but not leukemic (CML) progenitors in long-term human marrow cultures. Blood 1998;92(7):2338-44. 18. Liesveld JL, Harbol AW, Belanger T, Rosell KE, Abboud CN. MIP-1alpha and TGF-beta production in CD34+ progenitorstromal cell coculture systems: effects of progenitor isolation method and cell-cell contact. Blood Cells Mol Dis 2000;26(4):261-75. 19. Ohishi K, Katayama N, Itoh R, Mahmud N, Miwa H, Kita K, et al. Accelerated cell-cycling of hematopoietic progenitors by the flt3 ligand that is modulated by transforming growth factor-beta. Blood 1996;87(5):1718-27. 20. Tanaka R, Katayama N, Ohishi K, Mahmud N, Itoh R, Tanaka Y, et al. Accelerated cell-cycling of hematopoietic progenitor cells by growth factors. Blood 1995;86(1):73-9. 21. Ruscetti FW, Bartelmez SH. Transforming growth factor beta, pleiotropic regulator of hematopoietic stem cells: potential physiological and clinical relevance. Int J Hematol 2001;74(1):18-25.

22. Sitnicka E, Ruscetti FW, Priestley GV, Wolf NS, Bartelmez SH. Transforming growth factor beta 1 directly and reversibly inhibits the initial cell divisions of long-term repopulating hematopoietic stem cells. Blood 1996;88(1):82-8. 23. Ramsfjell V, Borge OJ, Cui L, Jacobsen SE. Thrombopoietin directly and potently stimulates multilineage growth and progenitor cell expansion from primitive (CD34+ CD38-) human bone marrow progenitor cells: distinct and key interactions with the ligands for ckit and flt3, and inhibitory effects of TGF-beta and TNF-alpha. J Immunol 1997;158(11):5169-77. 24. Keller JR, Mcniece IK, Sill KT, Ellingsworth LR, Quesenberry PJ, Sing GK, et al. Transforming growth factor beta directly regulates primitive murine hematopoietic cell proliferation. Blood 1990;75(3):596-602. 25. Pierelli L, Marone M, Bonanno G, Mozzetti S, Rutella S, Morosetti R, et al. Modulation of bcl-2 and p27 in human primitive proliferating hematopoietic progenitors by autocrine TGF-beta1 is a cell cycle-independent effect and influences their hematopoietic potential. Blood 2000;95(10):3001-9. 26. Yamazaki S, Iwama A, Takayanagi S, Eto K, Ema H, Nakauchi H. TGF-beta as a candidate bone marrow niche signal to induce hematopoietic stem cell hibernation. Blood 2009;113(6):1250-6. 27. Larsson J, Blank U, Klintman J, Magnusson M, Karlsson S. Quiescence of hematopoietic stem cells and maintenance of the stem cell pool is not dependent on TGF-beta signaling in vivo. Exp Hematol 2005;33(5):592-6. 28. Kögler G, Sensken S, Wernet P. Comparative generation and characterization of pluripotent unrestricted somatic stem cells with mesenchymal stem cells from human cord blood. Exp Hematol 2006;34(11):1589-95. 29. Kögler G, Somville T, Göbel U, Hakenberg P, Knipper A, Fischer J, et al. Haematopoietic transplant potential of unrelated and related cord blood: the first six years of the EUROCORD/NETCORD Bank Germany. Klin Padiatr 1999;211(4):224-32. 30. Kogler G, Callejas J, Hakenberg P, Enczmann J, Adams O, Daubener W, et al. Hematopoietic transplant potential of unrelated cord blood: critical issues. J Hematother 1996;5(2):105-16. 31. Tomasz M. Mitomycin C: small, fast and deadly (but very selective). Chem Biol 1995;2(9):575-9. 32. Kögler G, Radke TF, Lefort A, Sensken S, Fischer J, Sorg RV, et al. Cytokine production and hematopoiesis supporting activity of cord blood-derived unrestricted somatic stem cells. Exp Hematol 2005;33(5):573-83.

‫ﻋﻤﻮﻣﻲ‬ ‫ﺑﺨﺸﻬﺎي ﺟﺮاﺣﻲ‬ ‫ﺟﺮاﺣﻲ در‬ ‫ﻋﻔﻮﻧﺖ ﻣﺤﻞ‬ ‫ﺑﺮاي‬2,‫ﭘﺎﻳﺶ‬ ‫روش‬ ‫ﻛﺎراﻳﻲ دو‬ Tehran University Medical Journal; Vol.‫ﺗﺸﺨﻴﺺ‬ 70, No. May 2012: 86-95

TGF-b downregulation by RNAi technique in ex vivo-

expanded HSCs on 3D DBM scaffold

Abstract Zahra Sadat Hashemi M.Sc.1 Mahdi Forouzandeh Moghadam Ph.D.1* Masoud Soleimani Ph.D.2 Maryam Hafizi M.Sc.3 Naser Amirizadeh Ph.D.4 1- Department of Biotechnology, Faculty of Medicine, Tarbiat Modares University, Tehran, Iran. 2- Department of Hematology and Blood Banking, Faculty of Medical Science, Tarbiat Modares University, Tehran, Iran. 3- Department of Stem Cell Biology, Stem Cell Technology Research Center, Tehran, Iran. 4- Research Center of Iranian Blood Transfusion Organization, Tehran, Iran.

Received: November 22, 2011 Accepted: February 05, 2012

Background: Bone Marrow Transplantations (BMT) are limited by low CD34+ cell counts in umbilical cord blood (UCB) and these cells need to be expanded for success in such procedures. To achieve this goal, ex vivo expansion of hematopoietic stem cells (HSCs) by enhancing their self-renewal activity on demineralized bone matrix (DBM) scaffold coated with mesenchymal progenitor cells (MPCs) and unrestricted somatic stem cells (USSCs) was recommended. TGF-b pathway is a key inhibitory factor for HSCs self-renewal. In this study ex vivo expansion and downregulation of TGF-b

pathway were simultaneously performed. Methods: USSC cells were isolated from UCB and then coated on DBM scaffold as a feeder layer. UCB CD34+ cells were isolated from UCB by magnetic activated cell sorting (MACS) method and were transfected by siRNA against TGFbR2 in twodimensional (2D) and three-dimensional (3D) cultures by co-cultivation with USSC. TGFbR2 expression levels were evaluated by quantitative real-time PCR. Cell count and

flow cytometry were performed and clonogenic activity was evaluated. Results: Ex vivo expansion of CD34+ cells was significantly enhanced (41±0.7 folds) by TGFbR2 downregulation, especially in 2D than 3D cultures. Finally, 2D culture showed

less TGFbR2 expression levels and higher increase in the percentage of CD34 markers by flow cytometry assay. Conclusion: The 3D siRNA delivery system would be of lower efficiency in contrast to 2D settings where the cells have less freedom and are in more contact with the feeder

layer. Keywords: Demineralized bone matrix, scaffold, hematopoietic stem cells, siRNA, TGF*

Corresponding author: Department of Biotechnology, Tarbiat Modares University, Medical Faculty, Intersection of Chamran and AL-E-Ahmad Highways P.O. Box: 14115-111, Tehran, Iran. Tel: +98- 21- 82883861 E-mail: foroz@modares.ac.ir

beta pathway.

‫دﻫﺎﻧ‪-‬ﻲ‪96‬‬ ‫ﺲ‪103‬‬ ‫‪،1391‬‬ ‫ﺷﻤﺎره ‪،2‬‬ ‫اﻓﺮاد ‪، 70‬‬ ‫ﺗﻬﺮان‪،‬ازدوره‬ ‫ﭘﺰﺷﻜﻲ‬ ‫داﻧﺸﮕﺎهيﻋﻠﻮم‬ ‫اردﻳﺒﻬﺸﺖﺪﻳﺎزﻳ‬ ‫ﻣﺒﺘﻼ ﺑﻪ ﻛﺎﻧﺪﻳ‬ ‫‪ HIV‬ﻣﺜﺒﺖ‬ ‫ﺟﺪاﺷﺪه‬ ‫ﻛﺎﻧﺪﻳﺪاي‬ ‫ﭘﺰﺷﻜﻲ‪ ،‬ﮔﻮﻧﻪﻫﺎ‬ ‫داﻧﺸﻜﺪهﺣﺴﺎﺳﻴﺖ‬ ‫ﻣﺠﻠﻪﺑﺮرﺳﻲ‬

‫‪96‬‬

‫ﺣﺴﺎﺳﻴﺖ ﮔﻮﻧﻪﻫﺎي ﻛﺎﻧﺪﻳﺪاي دﻫﺎﻧﻲ اﻓﺮاد آﻟﻮده ﺑﻪ ‪ HIV‬ﻧﺴﺒﺖ ﺑﻪ داروﻫﺎي‬ ‫ﺿﺪ ﻗﺎرﭼﻲ ﺗﺤﺖ ﺷﺮاﻳﻂ ﺑﺮون ﺗﻨﻲ در اﻳﺮان‬

‫ﺗﺎرﻳﺦ درﻳﺎﻓﺖ ﻣﻘﺎﻟﻪ‪ 1390/09/17 :‬ﺗﺎرﻳﺦ ﭘﺬﻳﺮش‪1390/11/01 :‬‬

‫ﭼﻜﻴﺪه‬

‫ﻓﺮزاد ﻛﺘﻴﺮاﺋﻲ‪ *1،‬ﻋﻠﻴﺮﺿﺎ ﺧﺴﺮوي‪،‬‬

‫‪2‬‬ ‫‪4‬‬

‫وﺣﻴﺪ ﺧﻠﺞ‪ 3،‬ﻣﺤﺒﻮﺑﻪ ﺣﺎﺟﻲ ﻋﺒﺪاﻟﺒﺎﻗﻲ‪،‬‬

‫‪4‬‬

‫ﻋﻠﻲاﺻﻐﺮ ﺧﺎﻛﺴﺎر‪ 3،‬ﻣﻬﺮﻧﺎز رﺳﻮﻟﻲ ﻧﮋاد‬

‫زﻣﻴﻨﻪ و ﻫﺪف‪ :‬ﻣﻘﺎوﻣﺖ ﻋﻮاﻣﻞ اﻳﺠﺎد ﻛﺎﻧﺪﻳﺪﻳﺎزﻳﺲ دﻫﺎﻧﻲ ﺑﻪ داروﻫﺎي ﺿﺪ ﻗﺎرﭼﻲ از ﻣﺸﻜﻼت ﺑﻴﻤﺎران آﻟـﻮده ﺑـﻪ‬

‫‪HIV‬‬

‫اﺳﺖ‪ .‬اﻓﺰاﻳﺶ ﻣﻘﺎوﻣﺖ و اﺳﺘﻔﺎده ﺑﻴﺶ از ﭘﻴﺶ از داروﻫﺎ‪ ،‬اﻫﻤﻴﺖ ﺑﺮرﺳﻲ ﺣﺴﺎﺳﻴﺖ آﻧﺘـﻲﺑﻴـﻮﺗﻴﻜﻲ را ﻧـﺸﺎن ﻣـﻲدﻫـﺪ‪.‬‬ ‫‪ -1‬ﻣﺮﻛﺰ ﺗﺤﻘﻴﻘﺎت ﻗﺎرچﺷﻨﺎﺳﻲ‪ ،‬داﻧﺸﻜﺪه ﻋﻠﻮم‬

‫ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﻣﻴﺰان ﺣﺴﺎﺳﻴﺖ ﮔﻮﻧﻪﻫﺎي ﻛﺎﻧﺪﻳﺪاي ﺟﺪا ﺷﺪه از ﺑﻴﻤﺎران آﻟـﻮده ﺑـﻪ ‪ HIV‬را ﺑـﻪ داروﻫـﺎي ﺿـﺪ ﻗـﺎرﭼﻲ‬

‫داﻣﭙﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه آزاد اﺳﻼﻣﻲ واﺣﺪ ﻋﻠﻮم و‬

‫ﺑﺮرﺳﻲ ﻣﻲﻛﻨﺪ‪ .‬روش ﺑﺮرﺳﻲ‪ 150 :‬ﻧﻤﻮﻧﻪ دﻫﺎﻧﻲ از ﺑﻴﻤﺎران آﻟﻮده ﺑﻪ ‪ HIV‬ﺑﺮ روي ﻣﺤﻴﻂﻫﺎي ﻛﺮوم آﮔﺎر و ﺳﺎﺑﻮرو آﮔﺎر‬

‫ﺗﺤﻘﻴﻘﺎت ﺗﻬﺮان‪ ،‬ﺗﻬﺮان‪ ،‬اﻳﺮان‪.‬‬ ‫‪ -2‬ﮔﺮوه ﻣﻴﻜﺮوﺑﻴﻮﻟﻮژي‪ ،‬داﻧﺸﻜﺪه داﻣﭙﺰﺷﻜﻲ‪،‬‬

‫ﻛﺸﺖ داده ﺷﺪ‪ .‬ﺟﺪاﻳﻪﻫﺎي رﺷﺪ ﻳﺎﻓﺘﻪ ﺑﺮ اﺳﺎس روشﻫﺎي ﻣﺘﺪاول ﺗﺸﺨﻴﺺ ﻣﺨﻤﺮﻫﺎ ﺗﻌﻴﻴﻦ ﻫﻮﻳﺖ ﺷﺪﻧﺪ‪ .‬ﺑﺎ روشﻫﺎي‬

‫داﻧﺸﮕﺎه ﺗﻬﺮان‪ ،‬ﺗﻬﺮان‪ ،‬اﻳﺮان‪.‬‬

‫اﻧﺘﺸﺎر دﻳﺴﻚ و ﻣﻴﻜﺮوداﻳﻠﻮﺷﻦ ﺑﺮاث اﻟﮕﻮي ﺣﺴﺎﺳﻴﺖ ﺑﻪ ﺷﺶ داروي ﺿﺪ ﻗﺎرﭼﻲ ﺗﻌﻴﻴﻦ ﮔﺮدﻳـﺪ‪ .‬ﻳﺎﻓﺘـﻪﻫـﺎ‪ :‬ﻛﺎﻧﺪﻳـﺪا‬

‫‪ -3‬ﻣﺮﻛﺰ ﺗﺤﻘﻴﻘﺎت ﺑﻴﻮﺗﻜﻨﻮﻟﻮژي‪ ،‬اﻧﺴﺘﻴﺘﻮ ﭘﺎﺳﺘﻮر‬

‫آﻟﺒﻴﻜﻨﺲ )‪ (%50/2‬و ﻛﺎﻧﺪﻳﺪا ﮔﻼﺑﺮاﺗﺎ )‪ (%22‬ﺷﺎﻳﻊﺗﺮﻳﻦ ﮔﻮﻧﻪﻫـﺎي ﺟـﺪا ﺷـﺪه ﺑﻮدﻧـﺪ‪ %25/7 .‬از ﺟﺪاﻳـﻪﻫـﺎي ﻛﺎﻧﺪﻳـﺪا‬

‫اﻳﺮان‪.‬‬ ‫‪ -4‬ﻣﺮﻛﺰ ﺗﺤﻘﻴﻘﺎت اﻳﺪز اﻳﺮان‪ ،‬ﺑﻴﻤﺎرﺳﺘﺎن اﻣﺎم‬

‫آﻟﺒﻴﻜﻨﺲ ﻧﺴﺒﺖ ﺑﻪ داروي ﻓﻠﻮﻛﻮﻧﺎزول ﻣﻘﺎوم ﺑﻮدﻧﺪ و اﻳﻦ ﻣﻴﺰان ﺑﺮاي ﻛﺘﻮﻛﻮﻧﺎزول و ﻛﻠﻮﺗﺮﻳﻤﺎزول ﺑـﻪ ﺗﺮﺗﻴـﺐ ‪ %21/9‬و‬

‫ﺧﻤﻴﻨﻲ )ره(‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬ﺗﻬﺮان‪،‬‬

‫‪ %16/4‬ﺑﻮده اﺳﺖ‪ .‬ﻣﻘﺎوﻣﺖ ﻧﺴﺒﺖ ﺑﻪ داروﻫﺎي آﻣﻔﻮﺗﺮﻳـﺴﻴﻦ‪ ،‬ﻧﻴـﺴﺘﺎﺗﻴﻦ و داروي ﻛﺎﺳـﭙﻮﻓﺎﻧﮋﻳﻦ دﻳـﺪه ﻧـﺸﺪ‪ .‬از ﻃﺮﻓـﻲ‬

‫اﻳﺮان‪.‬‬

‫‪ %57/7‬از ﺟﺪاﻳﻪﻫﺎي ﻛﺎﻧﺪﻳﺪا ﮔﻼﺑﺮاﺗﺎ ﻧﺴﺒﺖ ﺑﻪ ﻓﻠﻮﻛﻮﻧﺎزول ﻣﻘﺎوم ﺑﻮدﻧﺪ و اﻳﻦ ﻣﻴﺰان ﺑﺮاي ﻛﺘﻮﻛﻮﻧﺎزول و ﻛﻠﻮﺗﺮﻳﻤﺎزول‬ ‫ﺑﻪ ﺗﺮﺗﻴﺐ ‪ %31‬و ‪ %35‬ﺑـﻮد‪ .‬ﻧﺘﻴﺠﻪﮔﻴﺮي‪ :‬ﻣﻘﺎوﻣـﺖ ﮔﻮﻧـﻪﻫـﺎي ﻛﺎﻧﺪﻳـﺪا ﺑـﻪ داروي آزوﻟـﻲ‪ ،‬ﺑـﻪﺧـﺼﻮص ﻓﻠﻮﻛﻮﻧـﺎزول‬ ‫رو ﺑﻪ اﻓﺰاﻳﺶ اﺳﺖ‪ .‬ﺑﺮرﺳﻲ ﻣﻘﺎوﻣـﺖ ﺟﺪاﻳـﻪﻫـﺎي ﻛﺎﻧﺪﻳـﺪا ﺑـﻪروش اﻧﺘـﺸﺎر دﻳـﺴﻚ و ﻳـﺎ ﻣﻴﻜﺮوداﻳﻠﻮﺷـﻦ ﺑـﺮاث در‬ ‫آزﻣﺎﻳﺸﮕﺎهﻫﺎ ﺟﻬﺖ ﻛﻨﺘﺮل ﻋﻔﻮﻧﺖ ﻛﺎﻧﺪﻳﺪﻳﺎزﻳﺲ دﻫﺎﻧﻲ ﻣﻄﻠﻮب اﺳﺖ‪ .‬ﻫﺮﭼﻨﺪ داروي ﻧﻴﺴﺘﺎﺗﻴﻦ ﺑﻪوﻓـﻮر ﺑـﺮاي ﺑﻴﻤـﺎران‬

‫*‬

‫ﻧﻮﻳﺴﻨﺪه ﻣﺴﺌﻮل‪ :‬ﻣﺮﻛﺰ ﺗﺤﻘﻴﻘﺎت ﻗﺎرچﺷﻨﺎﺳﻲ داﻧﺸﮕﺎه‬

‫آزاد اﺳﻼﻣﻲ واﺣﺪ ﻋﻠﻮم و ﺗﺤﻘﻴﻘﺎت ﺗﻬﺮان‪ ،‬ﺑﺎﻻﺗﺮ از‬ ‫ﻣﻴﺪان ﺳﺮو‪ ،‬ﻧﺮﺳﻴﺪه ﺑﻪ ﻓﺮوﺷﮕﺎه ﺷﻬﺮوﻧﺪ‪ ،‬ﻧﺒﺶ ﻓﺮاز ﻳﻜﻢ‬

‫ﻣﻮرد اﺳﺘﻔﺎده ﻗﺮار ﻣﻲﮔﻴﺮد اﻣﺎ ﻣﻘﺎوﻣﺖ ﺑﻪ اﻳﻦ دارو ﻧﺎﭼﻴﺰ اﺳﺖ‪ .‬اﺳﺘﻔﺎده از داروي ﻛﺎﺳﭙﻮﻓﺎﻧﮋﻳﻦ ﻧﻴﺰ ﺑـﺎ ﺗﻮﺟـﻪ ﺑـﻪ ﻋـﺪم‬ ‫ﻣﻘﺎوﻣﺖ ﺗﻮﺻﻴﻪ ﻣﻲﮔﺮدد‪.‬‬

‫ﺗﻠﻔﻦ‪0912-6047311 :‬‬ ‫‪E-mail: katiraee_f@yahoo.com‬‬

‫ﻛﻠﻤﺎت ﻛﻠﻴﺪي‪ :‬ﻛﺎﻧﺪﻳﺪﻳﺎزﻳﺲ دﻫﺎﻧﻲ‪ ،‬ﮔﻮﻧﻪﻫﺎي ﻛﺎﻧﺪﻳﺪا‪ ،‬ﻣﻘﺎوﻣﺖ داروﻳﻲ‪ ،‬ﺑﻴﻤﺎران آﻟﻮده ﺑﻪ ‪.HIV‬‬

‫ﻣﻘﺪﻣﻪ‬

‫ﺣﺎوي ﻣﻘﺎدﻳﺮ اﻧﺪﻛﻲ از ﮔﻮﻧﻪﻫﺎي ﻣﺨﻤﺮي ﺑﻪ ﺻﻮرت ﻫﻢزﻳﺴﺖ اﺳـﺖ‬ ‫و اﻟﺒﺘﻪ ﮔﻮﻧﻪﻫﺎي ﻛﺎﻧﺪﻳﺪاﻳﻲ ﺑﻪ ﻃﻮر ﻣﻌﻤﻮل ﺣﻔﺮه دﻫـﺎﻧﻲ ﺑﻴﻤـﺎران‬

‫‪HIV‬‬

‫اﻫﻤﻴﺖ ﺑﻴﻤﺎريﻫﺎي ﻗﺎرﭼﻲ ﻓﺮﺻـﺖ ﻃﻠـﺐ در ﺑﻴﻤـﺎران ﻣﺒـﺘﻼ ﺑـﻪ‬

‫را ﺑﻴﺶ از ﺣﺪ ﻃﺒﻴﻌﻲ ﻛﻮﻟﻮﻧﻴﺰه ﻣﻲﻛﻨﻨﺪ ﻛﻪ ﺧﻮد از ﻋﻮاﻣﻞ ﻣﺴﺘﻌﺪ ﻛﻨﻨﺪه‬

‫ﻧﻘﺎﻳﺺ ﺳﻴﺴﺘﻢ اﻳﻤﻨﻲ و ﺧـﺼﻮﺻﺎ اﻳﻤﻨـﻲ ﺳـﻠﻮﻟﻲ ﺑـﺮ ﻛـﺴﻲ ﭘﻮﺷـﻴﺪه‬

‫ﺑﺮاي اﻳﺠﺎد ﺑﻴﻤﺎري ﻛﺎﻧﺪﻳﺪاﻳﻲ اﺳﺖ‪ .‬اﻣﺮوزه از ﻣﺸﻜﻼت اﺻـﻠﻲ در راه‬

‫ﻧﻴﺴﺖ‪ .‬ﻛﺎﻧﺪﻳﺪﻳﺎزﻳﺲ دﻫﺎﻧﻲ )‪ (Oral candidiasis‬راﻳـﺞﺗـﺮﻳﻦ ﻋﻔﻮﻧـﺖ‬

‫درﻣﺎن ﺑﻴﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﻋﻔﻮﻧﺖﻫﺎي ﻗـﺎرﭼﻲ و ﺧـﺼﻮﺻﺎ ﺑﻴﻤـﺎريﻫـﺎي‬

‫ﻗﺎرﭼﻲ ﻓﺮﺻﺖ ﻃﻠﺐ در ﺑﻴﻤﺎران آﻟﻮده ﺑﻪ وﻳﺮوس ﻧﻘﺺ ﺳﻴﺴﺘﻢ اﻳﻤﻨـﻲ‬

‫ﻛﺎﻧﺪﻳﺪاﻳﻲ ﺑﺮوز ﻣﻘﺎوﻣﺖﻫﺎي داروﻳﻲ اﺳﺖ و ﻫﻤﺎنﻃﻮر ﻛـﻪ ﻣـﻲداﻧﻴـﺪ‬

‫اﺳﺖ و از ﻃﺮﻓﻲ ﺑﻴﻤﺎريﻫﺎي ﻛﺎﻧﺪﻳﺪاﻳﻲ ﺷﺎﻳﻊﺗﺮﻳﻦ ﻋﻔﻮﻧﺖ ﻗـﺎرﭼﻲ در‬

‫درﻣﺎن ﻋﻔﻮﻧﺖﻫﺎي ﻗﺎرﭼﻲ ﺑﻪ دﻟﻴﻞ ﻃﻮل ﻣﺪت درﻣﺎن‪ ،‬ﻋﻮد ﻣﻜﺮر‪ ،‬ﻋـﺪم‬

‫اﻧﺴﺎن و ﺣﻴﻮان ﻧﻴـﺰ ﻣـﻲﺑﺎﺷـﻨﺪ و اﻳـﻦ اﻫﻤﻴـﺖ ﺑﺮرﺳـﻲ ﺑـﺮ روي اﻳـﻦ‬

‫‪4‬و‪3‬‬

‫وﺟﻮد ﺗﻨﻮع در اﻧﺘﺨﺎب داروﻫﺎي ﻣﺨﺘﻠﻒ ﺑﻪﻃﻮر اوﻟﻴﻪ ﻣﺸﻜﻞ اﺳـﺖ‪.‬‬

‫ﮔﻮﻧﻪﻫﺎي ﻗﺎرﭼـﻲ را ﻧﺸـﺎن ﻣـﻲدﻫـﺪ‪2.‬و‪ 1‬ﺣﻔـﺮه دﻫﺎﻧﻲ اﻧﺴﺎن و ﺣﻴﻮان‬

‫ازدﻳﺎد ﮔﺰارشﻫﺎي ﻣﺨﺘﻠﻒ و ﻣﺘﻔﺎوت از ﺳﺮاﺳﺮ دﻧﻴﺎ در راﺑﻄﻪ ﺑﺎ ﺑـﺮوز‬

‫ﻓﺮزاد ﻛﺘﻴﺮاﺋﻲ و ﻫﻤﻜﺎران‬

‫‪97‬‬

‫و اﻓﺰاﻳﺶ ﻣﻘﺎوﻣﺖﻫﺎي داروﻳﻲ در ﺑﻴﻦ ﮔﻮﻧﻪﻫﺎي ﻗـﺎرﭼﻲ و ﻛﺎﻧﺪﻳـﺪاﻳﻲ‬

‫ﺑﻴﻤﺎريﻫﺎي رﻓﺘﺎري واﻗﻊ در ﺑﻴﻤﺎرﺳـﺘﺎن اﻣـﺎم ﺧﻤﻴﻨـﻲ ﺗﻬـﺮان در ﺳـﺎل‬

‫و ﻫﻢﭼﻨﻴﻦ ﻛﻤﻚ و ﺗﻬﻴﻴﺞ ﭘﺰﺷﻜﺎن ﺑـﻪ ﺗﺠـﻮﻳﺰ داروي ﻣﻨﺎﺳـﺐ و ﻛـﺎرا‬

‫‪ 1387‬ﺑﻪدﺳﺖ آﻣﺪهاﻧﺪ‪ .‬ﻋﻔﻮﻧﺖ ﺑﻴﻤﺎران ﺑﻪ وﻳﺮوس ‪ HIV‬ﺑﺎ روش اﻻﻳﺰا‬

‫ﺑﺮاي ﺑﻴﻤﺎران‪ ،‬و در ﻛﻨﺎر آن ﺗﻮﻟﻴﺪ داروﻫﺎي ﺿﺪ ﻗﺎرﭼﻲ ﺟﺪﻳﺪ ﻧﻴـﺎز ﺑـﻪ‬

‫و وﺳﺘﺮن ﺑﻼت ﺑﻪ ﺗﺎﻳﻴﺪ رﺳﻴﺪه ﺑﻮد و ﺑﻴﻤﺎران داراي ﭘﺮوﻧﺪه ﭘﺰﺷﻜﻲ در‬

‫اﻧﺠﺎم آزﻣﺎﻳﺶﻫـﺎي ﺗﻌﻴـﻴﻦ ﺣـﺴﺎﺳﻴﺖ را ﺑـﻪ داروﻫـﺎي ﻣـﺬﻛﻮر ﻧـﺸﺎن‬

‫راﺑﻄﻪ ﺑﺎ ﻋﻔﻮﻧﺖ ‪ HIV‬ﺑﻮدهاﻧﺪ‪ .‬ﺿﺎﻳﻌﺎت دﻫﺎﻧﻲ در ﻛﻠﻴﻪ ﺑﻴﻤـﺎران از ﻧﻈـﺮ‬

‫ﻣﻲدﻫﺪ و ﻣﺤﻘﻘﺎن را ﻣﺸﺘﺎق ﺑﻪ ﺗﻌﻴﻴﻦ اﻟﮕﻮي ﺣـﺴﺎﺳﻴﺖ ﺑـﻪ داروﻫـﺎي‬

‫ﺑﺎﻟﻴﻨﻲ ﺑﺮرﺳﻲ ﺷﺪ و از ﻫﺮ ﺑﻴﻤﺎر ﻧﻤﻮﻧﻪ ﺳﻮاب دﻫﺎﻧﻲ از ﻧـﻮاﺣﻲ ﻣﺨـﺎط‬

‫‪5‬‬

‫ﻣﺨﺘﻠﻒ ﺿﺪ ﻗﺎرﭼﻲ ﻣﻲﻛﻨﺪ‪.‬‬

‫دﻫﺎن‪ ،‬زﺑﺎن و ﻟﺜﻪ در ﻣﺤﻴﻂ ﺳﺎﺑﻮرو دﻛﺴﺘﺮوز آﮔـﺎر )‪ (Merck‬و ﻣﺤـﻴﻂ‬

‫ﺑﺎ وﺟﻮد درﻣﺎن وﺳﻴﻊ ﺿﺪ ﻗﺎرﭼﻲ و درﻣﺎن ﺿﺪ وﻳﺮوﺳﻲ ﻣﻮﺛﺮ ﻛـﻪ‬

‫ﻛﺮوم آﮔﺎر ﻛﺎﻧﺪﻳﺪا )‪ (Paris France company‬ﺑﻪﻃـﻮر ﻣـﺴﺘﻘﻴﻢ ﻛـﺸﺖ‬

‫ﻣﻨﺠﺮ ﺑـﻪ ﺑﻬﺒـﻮد ﺳﻴـﺴﺘﻢ اﻳﻤﻨـﻲ در ﺑﻴﻤـﺎران ‪ HIV‬ﻣـﻲﮔـﺮدد‪ ،‬ﺑﻴﻤـﺎري‬

‫داده ﺷﺪ‪ .‬ﻫﻢﭼﻨﻴﻦ ﻧﻤﻮﻧـﻪ دﻫـﺎﻧﻲ ﺑـﺎ اﺳـﺘﻔﺎده از ﭘﺘـﺎس ‪ %10‬ﺑـﻪروش‬

‫ﻛﺎﻧﺪﻳﺪﻳﺎزﻳﺲ دﻫﺎﻧﻲ در اﻳﻦ ﺑﻴﻤﺎران راﻳـﺞ اﺳـﺖ و اﻟﺒﺘـﻪ ﻣﻴـﺰان ﺑـﺮوز‬

‫ﻣﻴﻜﺮوﺳﻜﻮﭘﻲ از ﻧﻈﺮ وﺟﻮد ﻫﺎﻳﻒ ﻛﺎذب و ﺳﻠﻮلﻫﺎي ﻣﺨﻤﺮي ﺑﺮرﺳﻲ‬

‫ﺑﻴﻤﺎري واﺑﺴﺘﻪ ﺑﻪ ﮔﻮﻧﻪ ﻋﺎﻣﻞ اﻳﺠﺎد ﺑﻴﻤﺎري‪ ،‬ﺷـﻴﻮع ﻣﻘﺎوﻣـﺖ داروﻳـﻲ‪،‬‬

‫ﺷﺪﻧﺪ‪ .‬ﭘﻠﻴﺖﻫﺎي ﻛﺸﺘﻪ داده ﺷﺪه ﻛﺮوم آﮔﺎر ﺑـﺮاي ﺗـﺸﺨﻴﺺ اﺣﺘﻤـﺎﻟﻲ‬

‫درﻣﺎن ﻗﺒﻠﻲ ﺑﺎ داروي ﺿﺪ ﻗﺎرﭼﻲ و ﺷﺮاﻳﻂ ﺳﻴﺴﺘﻢ اﻳﻤﻨﻲ ﻣﻴﺰﺑـﺎن دارد‪.‬‬

‫ﮔﻮﻧﻪﻫﺎي ﻣﺨﻤﺮي و ﺷﻜﻞ و رﻧﮓ ﻛﻠﻨﻲ ﺑﻪﻣﺪت ‪ 72‬ﺳـﺎﻋﺖ در دﻣـﺎي‬ ‫‪º‬‬

‫ﻣﻄﺎﻟﻌﺎت ﻣﺨﺘﻠﻔﻲ ﺑﺮ روي ﻣﻴﺰان ﺣﺴﺎﺳﻴﺖ ﮔﻮﻧﻪﻫـﺎي ﻛﺎﻧﺪﻳـﺪاي ﺟـﺪا‬

‫‪C‬‬

‫ﺷﺪه از ﺑﻴﻤﺎران ‪ HIV‬در ﺳﺮاﺳﺮ دﻧﻴﺎ اﻧﺠﺎم ﺷﺪه اﺳﺖ اﻣﺎ ﻣﻴـﺰان ﺷـﻴﻮع‬

‫در ﺷﺮاﻳﻂ ﻫﻮازي ﺑﻪﻣﺪت ﻫﻔﺖ روز در دﻣﺎي‬

‫ﮔﻮﻧﻪﻫﺎي ﻛﺎﻧﺪﻳﺪاي ﻣﻘﺎوم ﺑﻪ داروﻫﺎي ﺿﺪ ﻗﺎرﭼﻲ در ﺑﻴﻤﺎران آﻟﻮده ﺑﻪ‬

‫ﺗﺎ ﺗﻤﺎم ﻋﻮاﻣﻞ اﺣﺘﻤﺎﻟﻲ در اﻳﻦ ﻣﺤﻴﻂ رﺷﺪ ﻳﺎﺑﻨـﺪ‪ .‬ﭘـﺲ از ﻃـﻲ زﻣـﺎن‬

‫‪ HIV‬در اﻳﺮان ﻣﻮرد ﺑﺮرﺳﻲ ﻗﺮار ﻧﮕﺮﻓﺘﻪ اﺳﺖ‪ .‬ﭘﺮ واﺿﺢ اﺳـﺖ ﺗﻌﻴـﻴﻦ‬

‫اﻧﻜﻮﺑﺎﺳﻴﻮن ﮔﻮﻧﻪﻫﺎي ﻣﺨﻤﺮي ﺑﺎ روشﻫﺎي ﻣﺨﺘﻠﻒ از ﺟﻤﻠـﻪ ﺗـﺸﻜﻴﻞ‬

‫اﻟﮕﻮي ﺣﺴﺎﺳﻴﺖ ﺑﻪ داروﻫﺎي ﺿﺪ ﻗﺎرﭼﻲ ﮔﻮﻧـﻪﻫـﺎي ﻛﺎﻧﺪﻳـﺪاي ﺟـﺪا‬

‫ﻛﻼﻣﻴﺪوﺳﭙﻮر در ﻣﺤﻴﻂ ﻛﻮرن ﻣﻴﻞ آﮔـﺎر ﺣـﺎوي ﺗـﻮﻳﻴﻦ ‪ 80‬و ﺟـﺬب‬

‫ﺷﺪه از ﺑﻴﻤﺎران ﻧﻘـﺺ اﻳﻤﻨـﻲ و از ﺟﻤﻠـﻪ ﺑﻴﻤـﺎران آﻟـﻮده ﺑـﻪ ‪ HIV‬در‬

‫)‪(Rap IDTM yeast identification system remel‬‬

‫ﭘﻴﺸﮕﻴﺮي و درﻣﺎن ﺻﺤﻴﺢ اﻳﻦ ﺑﻴﻤﺎران ﻣـﻮﺛﺮ و اﺳﺎﺳـﻲ اﺳـﺖ‪ .‬ﺗﻌﻴـﻴﻦ‬

‫‪ 35‬و در ﺗﺎرﻳﻜﻲ اﻧﻜﻮﺑﻪ ﺷﺪﻧﺪ و ﭘﻠﻴﺖﻫﺎي ﺳﺎﺑﻮرو دﻛـﺴﺘﺮوز آﮔـﺎر‬

‫ﻛﺮﺑﻮﻫﻴـﺪراتﻫـﺎ‬

‫‪C‬‬

‫‪º‬‬

‫‪ 30‬اﻧﻜﻮﺑﻪ ﮔﺮدﻳﺪﻧـﺪ‬

‫‪10-13‬‬

‫ﺷﻨﺎﺳﺎﻳﻲ ﺷﺪﻧﺪ‪.‬‬

‫ﺣﺴﺎﺳﻴﺖ ﺑﻪ روش اﻧﺘﺸﺎر دﻳﺴﻚ ﻛﻪ ﻳﻚ روش ﺳﺎده و ﭘﺬﻳﺮﻓﺘﻪ ﺷـﺪه‬

‫‪ -‬آزﻣﺎﻳﺶ ﺗﻌﻴﻴﻦ ﺣﺴﺎﺳﻴﺖ ﺑﻪ داروﻫﺎي ﺿﺪ ﻗﺎرﭼﻲ‬

‫در آزﻣﺎﻳﺸﮕﺎهﻫﺎ اﺳﺖ ﺟﻬﺖ ﺗﻌﻴﻴﻦ ﺣﺴﺎﺳﻴﺖ ﮔﻮﻧـﻪﻫـﺎي ﻛﺎﻧﺪﻳـﺪا ﺑـﻪ‬

‫روش اﻧﺘﺸﺎر دﻳﺴﻚ‪ :‬اﻳﻦ روش ﺑﺮاي ﭘﻨﺞ داروي ﺿﺪ ﻗـﺎرﭼﻲ ﺑـﺮ‬

‫داروﻫﺎي ﺿﺪ ﻗﺎرﭼﻲ ﺑﻪ ﺧﻮﺑﻲ اراﻳﻪ ﺷﺪه و ﮔﺴﺘﺮش ﻳﺎﻓﺘﻪ اﺳـﺖ و ﺑـﺎ‬

‫‪Clinical and Laboratory Standards‬‬

‫اﺳــﺎس روش ﭘﻴــﺸﻨﻬﺎدي‬

‫‪ Institute‬ﺗﺤﺖ ﻋﻨﻮان ‪ M44-A‬اﻧﺠﺎم ﮔﺮﻓﺖ‪15.‬و‪ 14‬ﺑﺪﻳﻦ ﻣﻨﻈـﻮر‬

‫وﺟﻮد آنﻛﻪ در ﺗﻌﻴﻴﻦ دﻗﻴﻖ ﻣﻘﺎوﻣﺖ ﺑﻪ دارو ﺑﺎ ﻣﺸﻜﻼﺗﻲ ﻣﻮاﺟﻪ ﻫﺴﺘﻴﻢ‬

‫)‪(CLSI‬‬

‫اﻣﺎ ﺑﻪ ﻧﻈﺮ ﻣﻲرﺳﺪ روش اﻧﺘﺸﺎر دﻳﺴﻚ ﻳﻚ روش ﺳـﺎده و ﺑـﻪ ﻧـﺴﺒﺖ‬

‫دﻳﺴﻚﻫﺎي آﻧﺘﻲﺑﻴﻮﺗﻴﻜﻲ ﻓﻠﻮﻛﻮﻧـﺎزول )‪ ،(25µg‬ﻛﺘﻮﻛﻮﻧـﺎزول )‪،(15µg‬‬

‫ارزان ﺑﺮاي آزﻣﺎﻳﺶ ﺗﻌﻴﻴﻦ ﺣﺴﺎﺳﻴﺖ در آزﻣﺎﻳﺸﮕﺎهﻫﺎي ﺑﺎﻟﻴﻨﻲ ﻣﺨﺘﻠـﻒ‬

‫ﻛﻠﻮﺗﺮﻳﻤــﺎزول )‪ ،(10µg‬ﻧﻴــﺴﺘﺎﺗﻴﻦ )‪ (50µg‬و آﻣﻔﻮﺗﺮﻳــﺴﻴﻦ ‪(10µg) B‬‬

‫اﺳﺖ‪ 6-9.‬ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﻣﻴﺰان ﺣﺴﺎﺳﻴﺖ ﮔﻮﻧﻪﻫﺎي ﻛﺎﻧﺪﻳﺪاي ﺟﺪا ﺷـﺪه‬

‫ﺗﻬﻴﻪ و ﻣﻮرد اﺳﺘﻔﺎده ﻗﺮار ﮔﺮﻓﺖ )‪ .(Mast group Ltd, UK‬از دو ﺳـﻮﻳﻪ‬

‫از ﺑﻴﻤﺎران آﻟﻮده ﺑـﻪ ‪ HIV‬را ﺑـﻪ ﺑﺮﺧـﻲ داروﻫـﺎي ﺿـﺪ ﻗـﺎرﭼﻲ ﻧـﺸﺎن‬

‫اﺳﺘﺎﻧﺪارد ﻛﺎﻧﺪﻳﺪا آﻟﺒﻴﻜﻨﺲ )‪ (ATCC1023‬و ﻛﺎﻧﺪﻳﺪا داﺑﻠﻲ ﻧﻴﻨﺴﻴﺲ‬

‫‪(CD‬‬

‫ﻣﻲدﻫﺪ و در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺟﻬﺖ ﺗﻌﻴﻴﻦ ﻫﺮ ﭼﻪ ﺑﻬﺘﺮ ﻣﻴﺰان ﻣﻘﺎوﻣﺖ از دو‬

‫)‪ 36‬در ﻛﻨﺎر ﺳﺎﻳﺮ ﺟﺪاﻳﻪﻫﺎي ﻛﺎﻧﺪﻳﺪاﻳﻲ ﺑﻪﻛﺎر ﺑﺮده ﺷﺪه در اﻳﻦ ﻣﻄﺎﻟﻌـﻪ‬

‫روش اﻧﺘﺸﺎر دﻳﺴﻚ و ﻣﻴﻜﺮوداﻳﻠﻮﺷﻦ ﺑﺮاث اﺳﺘﻔﺎده ﺷﺪه اﺳﺖ‪.‬‬

‫ﺑﻪﻋﻨﻮان ﻛﻨﺘﺮل اﺳﺘﻔﺎده ﺷﺪ‪ .‬ﭘﻠﻴﺖﻫﺎي ﻣﻮﻟﺮ ﻫﻴﻨﺘﻮن آﮔﺎر )‪ (MHA‬ﺣﺎوي‬ ‫‪ %2‬ﮔﻠــﻮﻛﺰ و ﻣﺘـﻴﻠﻦ ﺑﻠـﻮ )‪ (GMB‬ﺑــﺎ ﻗﻄــﺮ ﭼﻬــﺎر ﻣﻴﻠـﻲﻣﺘــﺮ ﺑــﺮ ﻃﺒــﻖ‬

‫روش ﺑﺮرﺳﻲ‬

‫دﺳــﺘﻮراﻟﻌﻤﻞ ﺷــﺮﻛﺖ ﺳــﺎزﻧﺪه ﺗﻬﻴ ـﻪ و ﻣــﻮرد اﺳــﺘﻔﺎده ﻗــﺮار ﮔﺮﻓــﺖ‪.‬‬ ‫ﺳﻮﺳﭙﺎﻧﺴﻴﻮن ﺳﻠﻮلﻫﺎي ﻣﺨﻤﺮي در ﺳﺮم ﻓﻴﺰﻳﻮﻟﻮژي اﺳﺘﺮﻳﻞ ﻣﻄﺎﺑﻖ ﺑـﺎ‬

‫اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻳﻚ ﻣﻄﺎﻟﻌﻪ ﺗﻮﺻﻴﻔﻲ‪ -‬ﺗﺤﻠﻴﻠﻲ اﺳـﺖ‪ .‬در اﻳـﻦ ﻣﻄﺎﻟﻌـﻪ‬

‫ﻛﺪورت ﻧﻴﻢ ﻣﻚ ﻓﺎرﻟﻨـﺪ )ﻛـﻪ ﺣـﺎوي ‪ 1-5×106‬ﺳـﻠﻮل اﺳـﺖ( ﺗﻬﻴـﻪ‬

‫ﺣﺴﺎﺳﻴﺖ ﮔﻮﻧﻪﻫﺎي ﻛﺎﻧﺪﻳﺪاي ﺑﻪﻛﺎر رﻓﺘﻪ در اﻳﻦ ﻣﻄﺎﻟﻌﻪ از ‪ 150‬ﺑﻴﻤـﺎر‬

‫ﮔﺮدﻳﺪ‪ .‬ﺳﭙﺲ ﺳﻄﺢ ﻣﺤﻴﻂ ﻛﺸﺖ آﻣﺎده ﺷﺪه ﺑﻪوﺳﻴﻠﻪ ﺳـﻮآب اﺳـﺘﺮﻳﻞ‬

‫آﻟﻮده ﺑﻪ وﻳﺮوس ﻧﻘﺺ ﺳﻴﺴﺘﻢ اﻳﻤﻨﻲ ﻣﺮاﺟﻌﻪ ﻛﻨﻨﺪه ﺑـﻪ ﻣﺮﻛـﺰ ﻣـﺸﺎوره‬

‫آﻏﺸﺘﻪ ﺷﺪه ﺑﻪ ﺳﻮﺳﭙﺎﻧﺴﻴﻮن ﺳﻠﻮلﻫﺎي ﻣﺨﻤﺮي ﺗﺎزه ﻛـﺸﺖ داده ﺷـﺪه‬

‫ﺑﺮرﺳﻲ ﺣﺴﺎﺳﻴﺖ ﮔﻮﻧﻪﻫﺎي ﻛﺎﻧﺪﻳﺪاي ﺟﺪاﺷﺪه از اﻓﺮاد ‪ HIV‬ﻣﺜﺒﺖ ﻣﺒﺘﻼ ﺑﻪ ﻛﺎﻧﺪﻳﺪﻳﺎزﻳﺲ دﻫﺎﻧﻲ‬

‫‪98‬‬

‫ﺗﻠﻘﻴﺢ ﮔﺮدﻳﺪ‪ .‬ﭘﻠﻴﺖﻫﺎي ﺗﻠﻘﻴﺢ ﺷﺪه ﺑﻪﻣﺪت ‪ 24‬و ‪ 48‬ﺳﺎﻋﺖ در دﻣـﺎي‬ ‫‪ 35 ºC‬اﻧﻜﻮﺑﻪ ﮔﺮدﻳﺪﻧﺪ‪ .‬ﻗﻄﺮ ﻫﺎﻟﻪ ﻋﺪم رﺷﺪ از ﻧﻘﻄﻪاي ﻛﻪ رﺷﺪ ﻣﺨﻤـﺮ‬

‫ﻳﺎﻓﺘﻪﻫﺎ‬

‫‪ MIC‬ﮔﻮﻧﻪﻫﺎي‬

‫ﺑــﺮ اﺳــﺎس ﺟــﺪول ‪ 1‬ﻛﺎﻧﺪﻳـﺪا آﻟﺒﻴﻜــﻨﺲ )‪ (%50/2‬و ﺑـﻪدﻧﺒــﺎل آن‬

‫ﻣﺨﻤﺮي ﻣﺘﻨﺎﺳﺐ ﺑﺎ ﻗﻄﺮ ﻫﺎﻟﻪ ﻋﺪم رﺷﺪ و ﺑﺮ اﺳﺎس ﻣﻌﻴﺎر ﺗﻮﺻﻴﻒ ﺷﺪه‬

‫ﻛﺎﻧﺪﻳﺪا ﮔﻼﺑﺮاﺗﺎ )‪ (%22‬ﺷﺎﻳﻊﺗﺮﻳﻦ ﮔﻮﻧﻪﻫﺎي ﺟﺪا ﺷﺪه از ﺣﻔﺮه دﻫـﺎﻧﻲ‬

‫از ﻃﺮف ‪ CLSI‬و ﺷﺮﻛﺖ ﺳﺎزﻧﺪه دﻳﺴﻚﻫـﺎي آﻧﺘـﻲﺑﻴـﻮﺗﻴﻜﻲ ﻣﺤﺎﺳـﺒﻪ‬

‫ﺑﻴﻤــﺎران آﻟــﻮده ﺑــﻪ وﻳـﺮوس ‪ HIV‬ﺑﻮدﻧــﺪ‪ .‬در راﺑﻄــﻪ ﺑــﺎ ﻣﻴـﺰان ﺷـﻴﻮع‬

‫ﮔﺮدﻳﺪ‪.‬‬

‫ﻛﺎﻧﺪﻳﺪﻳﺎزﻳﺲ دﻫﺎﻧﻲ و اﺷﻜﺎل ﺑـﺎﻟﻴﻨﻲ ﻣﺨﺘﻠـﻒ آن در اﻳـﻦ ﺑﻴﻤـﺎران در‬

‫ﺑﻪ ﻣﻴﺰان ‪ %80‬ﻛﺎﺳﺘﻪ ﺷﺪه ﺑﻮد ﻣﺤﺎﺳﺒﻪ ﮔﺮدﻳﺪ‪ .‬ﺳﭙﺲ‬

‫‪90‬‬

‫‪19‬‬

‫روش ﻣﻴﻜﺮوداﻳﻠﻮﺷﻦ ﺑﺮاث‪ :‬در ﻛﻨـﺎر روش اﻧﺘـﺸﺎر دﻳـﺴﻚ و ﺑـﺎ‬

‫ﻣﻘﺎﻟﻪ دﻳﮕﺮي ﺑﻪ ﺗﻔﺼﻴﻞ ﭘﺮداﺧﺘﻪاﻳﻢ‪ .‬دوﻳﺴﺖ ﺟﺪاﻳﻪ ﻛﺎﻧﺪﻳـﺪا از ﻧﻈـﺮ‬

‫ﻫﺪف ﻣﻘﺎﻳﺴﻪ و ﺗﺎﻳﻴﺪ از روش رﻗﺖﺳﺎزي ﺳﺮﻳﺎﻟﻲ در ﻣﺤـﻴﻂ ﻣـﺎﻳﻊ در‬

‫ﺣﺴﺎﺳﻴﺖ ﺑﻪ ﭘﻨﺞ داروي ﺿﺪ ﻗﺎرﭼﻲ ﻣﻮرد ﺑﺮرﺳﻲ ﻗﺮار ﮔﺮﻓﺘﻨﺪ‪ .‬ﺟﺪول‬

‫ﻣﻴﻜﺮوﭘﻠﻴﺖﻫﺎي ‪ 96‬ﺧﺎﻧـﻪاي ﺑـﺮ ﻃﺒـﻖ روش ﭘﻴـﺸﻨﻬﺎدي ‪ CLSI‬ﺗﺤـﺖ‬

‫‪ 2‬ﻣﻴﺰان ﺣﺴﺎﺳﻴﺖ ﮔﻮﻧﻪﻫﺎي ﻛﺎﻧﺪﻳﺪاي ﻣﻮرد ﺑﺮرﺳـﻲ را ﺑـﻪ داروﻫـﺎي‬

‫ﻋﻨﻮان ‪ M27-A2‬اﺳﺘﻔﺎده ﮔﺮدﻳﺪ‪ 16.‬در اﻳـﻦ روش ﺑـﺎ اﺳـﺘﻔﺎده از ﻣﺤـﻴﻂ‬

‫ﻛﻠﻮﺗﺮﻳﻤﺎزول‪ ،‬ﻛﺘﻮﻛﻮﻧـﺎزول‪ ،‬ﻛﻠﻮﺗﺮﻳﻤـﺎزول‪ ،‬آﻣﻔﻮﺗﺮﻳـﺴﻴﻦ‪ ،‬ﻧﻴـﺴﺘﺎﺗﻴﻦ و‬

‫‪pH:7‬‬

‫ﻛﺎﺳﭙﻮﻓﺎﻧﮋﻳﻦ را ﻧﺸﺎن ﻣﻲدﻫﺪ‪ .‬ﺑﺮ اﺳﺎس روش اﻧﺘـﺸﺎر دﻳـﺴﻚ از ‪105‬‬

‫ﺣﺪاﻗﻞ ﻏﻠﻈﺖ ﻣﻬﺎري ﺗﻌﻴﻴﻦ ﮔﺮدﻳﺪ‪ .‬در اﺑﺘﺪا ﻏﻠﻈﺖﻫﺎي اﺳـﺘﻮك ﭘـﻨﺞ‬

‫ﺟﺪاﻳﻪ ﻛﺎﻧﺪﻳﺪا آﻟﺒﻴﻜﻨﺲ ﻣﻮرد ﺑﺮرﺳﻲ ‪ %25/7‬ﺑﻪ ﻓﻠﻮﻛﻮﻧـﺎزول ﻣﻘﺎوﻣـﺖ‬

‫داروي ﻣﻮرد ﻧﻈﺮ ﺑـﺮ ﻃﺒـﻖ دﺳـﺘﻮراﻟﻌﻤﻞ ‪ CLSI‬در ﻣﺤـﻴﻂ ‪ RPMI‬ﺗﻬﻴـﻪ‬

‫ﻧﺸﺎن دادﻧﺪ )‪ ،(MIC≥64µg/ml‬ﻫـﻢﭼﻨـﻴﻦ ‪ %21/9‬و ‪ %16/4‬از ﻛﺎﻧﺪﻳـﺪا‬

‫ﮔﺮدﻳﺪ و در ﻫﻨﮕﺎم آزﻣﺎﻳﺶ در ﭼﺎﻫﻚﻫﺎي ﭘﻠﻴﺖ ‪ 96‬ﺧﺎﻧﻪاي ﺑﺎ اﺳﺘﻔﺎده‬

‫آﻟﺒﻴﻜﻨﺲﻫﺎي ﻣﻮرد ﺑﺮرﺳﻲ ﺑﻪ ﺗﺮﺗﻴﺐ ﺑـﻪ ﻛﺘﻮﻛﻮﻧـﺎزول و ﻛﻠﻮﺗﺮﻳﻤـﺎزول‬

‫از ﻣﺤﻴﻂ ‪ RPMI‬ﺑﻪ رﻗﺖ ﻣﻮرد ﻧﻈﺮ رﺳـﺎﻧﺪه ﺷـﺪ‪ .‬در ﻛﻨـﺎر رﻗـﺖﻫـﺎي‬

‫ﻣﻘﺎوﻣــﺖ ﻧــﺸﺎن دادﻧــﺪ )‪ .(MIC>0/125µg/ml‬ﻣﻘــﺎدﻳﺮ ‪ MIC-%90‬و‬

‫ﺳﺮﻳﺎﻟﻲ ﺗﻬﻴﻪ ﺷﺪه از دو ﭼﺎﻫـﻚ ﺑـﺮاي ﻛﻨﺘـﺮل ﻣﺜﺒـﺖ و ﻛﻨﺘـﺮل ﻣﻨﻔـﻲ‬

‫ﻣﺤﺪوده ‪ MIC‬ﺑﻪدﺳﺖ آﻣﺪه ﺑﻪروش ﻣﻴﻜﺮوداﻳﻠﻮﺷﻦ ﺑﺮاث ﺑـﺮاي ﺳـﺎﻳﺮ‬

‫اﺳﺘﻔﺎده ﺷﺪ‪ .‬ﺳﻮﺳﭙﺎﻧﺴﻴﻮن ﺳـﻠﻮلﻫـﺎي ﻣﺨﻤـﺮي در ﺳـﺮم ﻓﻴﺰﻳﻮﻟـﻮژي‬

‫ﺟﺪاﻳﻪﻫﺎي ﻛﺎﻧﺪﻳﺪا ﻣﻮرد ﺑﺮرﺳﻲ در ﺟﺪول ‪ 2‬ﻧﺸـﺎن داده ﺷـﺪه اﺳـﺖ‪.‬‬

‫‪RPMI1640‬‬

‫ﺣﺎوي ﮔﻠﻮﺗﺎﻣﻴﻦ و ﮔﻠﻮﻛﺰ ﺑـﻪ ﻫﻤـﺮاه ﺑـﺎﻓﺮ ‪ MOPS‬ﺑـﺎ‬

‫اﺳﺘﺮﻳﻞ ﺑﺎ اﺳﺘﻔﺎده از ﺳﻠﻮلﻫﺎي ﻣﺨﻤﺮي ﺗﺎزه ﻛﺸﺖ داده ﺷﺪه در ﻣﺤﻴﻂ‬ ‫‪ SDA‬آﻣﺎده ﺷﺪ و ﺑﻪ ﻣﻴﺰاﻧﻲ از آن ﺑﺮداﺷﺖ ﮔﺮدﻳﺪ ﻛﻪ ﭘﺲ از اﻓﺰودن آن‬ ‫ﺑﻪ ﭼﺎﻫﻚﻫﺎي ﻣﻴﻜﺮوﭘﻠﻴﺖ ‪ 96‬ﺧﺎﻧـﻪاي ﺣـﺎوي ﻣﺤـﻴﻂ ﻛـﺸﺖ و دارو‬ ‫ﺷﻤﺎرش ﻧﻬﺎﻳﻲ آن در ﻣﺤﺪوده ‪ 0/5-2/5×103/ml‬ﻗﺮار ﮔﻴﺮد‪ .‬ﭘﻠﻴﺖﻫﺎي‬

‫ﺟﺪول‪ :1 -‬ﻓﺮاواﻧﻲ ﮔﻮﻧﻪﻫﺎي ﻛﺎﻧﺪﻳﺪاي ﺟﺪا ﺷﺪه از ﺑﻴﻤﺎران آﻟﻮده ﺑﻪ‬ ‫ﮔﻮﻧﻪﻫﺎ‬

‫‪HIV‬‬

‫ﻓﺮاواﻧﻲ‬

‫درﺻﺪ‬

‫ك‪ .‬آﻟﺒﻴﻜﻨﺲ‬

‫‪103‬‬

‫‪50/2‬‬

‫ﻣﺠﺪدا ﻛﺸﺖ داده ﺷﺪﻧﺪ و ﺑﻪﻣﺪت ‪ 24‬ﺳﺎﻋﺖ در دﻣﺎي ‪ 35 ºC‬اﻧﻜﻮﺑـﻪ‬

‫ك‪ .‬ﮔﻼﺑﺮاﺗﺎ‬

‫‪45‬‬

‫‪22‬‬

‫ك‪.‬داﺑﻠﻲ ﻧﻴﻨﺴﻴﺲ‬

‫‪9‬‬

‫‪4/4‬‬

‫ﮔﺮدﻳﺪﻧﺪ‪ .‬ﺣﺪاﻗﻞ ﻏﻠﻈﺖ داروي ﺿﺪ ﻗﺎرﭼﻲ ﻛﻪ ﺑﻪ ﻣﻴﺰان ‪ %90‬ﻣـﺎﻧﻊ از‬

‫ك‪ .‬ﺗﺮوﭘﻴﻜﺎﻟﻴﺲ‬

‫‪7‬‬

‫‪3/4‬‬

‫رﺷﺪ ﻗﺎرچ در ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﭼﺎﻫﻚ ﻛﻨﺘـﺮل ﻣﺜﺒـﺖ ﺷـﺪه ﺑﺎﺷـﺪ ﺑـﻪ ﻋﻨـﻮان‬

‫ك‪ .‬ﻛﻔﻴﺮ‬

‫‪7‬‬

‫‪3/4‬‬

‫‪ MIC90‬ﺗﻠﻘﻲ ﻣﻲﮔﺮدد‪ .‬ﻣﻼك ﺣـﺴﺎﺳﻴﺖ ﻳـﺎ ﻣﻘﺎوﻣـﺖ ﺑـﺮاي ﺑﺮﺧـﻲ از‬

‫ك‪ .‬ﭘﺎراﭘﺴﻠﻴﻮزﻳﺲ‬

‫‪6‬‬

‫‪2/9‬‬

‫ك‪ .‬ﻓﺎﻣﺎﺗﺎ‬

‫‪2‬‬

‫‪1/0‬‬

‫ك‪ .‬ﮔﻠﻴﺮﻣﻮﻧﺪي‬

‫‪1‬‬

‫‪0/5‬‬

‫ك‪ .‬ﻛﺮوزهاي‬

‫‪1‬‬

‫‪0/5‬‬

‫واﺑﺴﺘﻪ ﺑﻪ دوز و ‪ 64µg/ml≥MIC‬ﺑﻪ ﻋﻨﻮان ﻣﻘﺎوم ﺷﻨﺎﺧﺘﻪ ﻣـﻲﺷـﻮد‪ .‬در‬

‫ﺳﺎﻛﺎروﻣﺎﻳﺴﺲ‬

‫‪2‬‬

‫‪1/0‬‬

‫راﺑﻄﻪ ﺑﻪ ﻛﺘﻮﻛﻮﻧـﺎزول و ﻛﻠﻮﺗﺮﻳﻤـﺎزول ‪ 0/125µg/ml>MIC‬ﺑـﻪ ﻋﻨـﻮان‬

‫ﺗﺮﻳﻜﻮﺳﭙﻮرون‬

‫‪2‬‬

‫‪1/0‬‬

‫ﺣﺴﺎس ﺷﻨﺎﺧﺘﻪ ﻣﻲﺷﻮد‪ .‬اﻳﻦ ﻣﻴﺰان ﺑـﺮاي داروﻫـﺎي آﻣﻔﻮﺗﺮﻳـﺴﻴﻦ ‪ B‬و‬

‫ﺳﺎﻳﺮ ﻣﺨﻤﺮﻫﺎ‬

‫‪1‬‬

‫‪0/5‬‬

‫ﻧﻴﺴﺘﺎﺗﻴﻦ و ﻛﺎﺳﭙﻮﻓﺎﻧﮋﻳﻦ ‪ 1/0µg/ml≤MIC‬اﺳﺖ و ‪ MIC>1/0µg/ml‬ﺑـﻪ‬

‫ﮔﻮﻧﻪﻫﺎي ﻛﺎﻧﺪﻳﺪا‬

‫‪19‬‬

‫‪9/0‬‬

‫ﻣﺠﻤﻮع‬

‫‪205‬‬

‫‪100‬‬

‫ﺗﻠﻘﻴﺢ ﺷﺪه ﺑﻪﻣـﺪت ‪ 24‬ﺳـﺎﻋﺖ در دﻣـﺎي ‪ 35 ºC‬اﻧﻜﻮﺑـﻪ ﮔﺮدﻳﺪﻧـﺪ و‬ ‫ﺳﭙﺲ در ﻳﻚ ﻣﺤﻴﻂ ‪ SDA‬ﺟﻬـﺖ ﺷـﻤﺎرش ﺗﻌـﺪاد ﻛﻠﻨـﻲ رﺷـﺪ ﻳﺎﻓﺘـﻪ‬

‫داروﻫــﺎ ﺗﻮﺳــﻂ ‪ CLSI‬ﭘﻴــﺸﻨﻬﺎد ﺷــﺪه اﺳــﺖ‪ .‬ﺑــﺮاي ﻓﻠﻮﻛﻮﻧــﺎزول‬ ‫‪ 8µg/ml≤MIC‬ﺑﻪ ﻋﻨﻮان ﺣﺴﺎس‪ MIC:16-32µg/ml ،‬ﺑﻪ ﻋﻨﻮان ﺣﺴﺎس‬

‫‪18‬و‪17‬‬

‫ﻋﻨﻮان ﻣﻘﺎوم ﺷﻨﺎﺧﺘﻪ ﺷﺪه اﺳﺖ‪.‬‬

‫ﻓﺮزاد ﻛﺘﻴﺮاﺋﻲ و ﻫﻤﻜﺎران‬

‫‪99‬‬

‫ﺟﺪول‪ :2 -‬ﺣﺴﺎﺳﻴﺖ ﺟﺪاﻳﻪﻫﺎي ﻛﺎﻧﺪﻳﺪاي ﺟﺪا ﺷﺪه از ﺑﻴﻤﺎران آﻟﻮده ﺑﻪ ‪ HIV‬ﺑﺮ اﺳﺎس ﻣﻴﻜﺮوداﻳﻠﻮﺷﻦ ﺑﺮاث و اﻧﺘﺸﺎر دﻳﺴﻚ‬ ‫داروﻫﺎي ﺿﺪ ﻗﺎرﭼﻲ‬ ‫آﻣﻔﻮﺗﺮﻳﺴﻴﻦ‬

‫‪B‬‬

‫ﻧﻴﺴﺘﺎﺗﻴﻦ‬

‫ﻓﻠﻮﻛﻮﻧﺎزول‬

‫ﻛﺘﻮﻛﻮﻧﺎزول‬

‫ﻛﻠﻮﺗﺮﻳﻤﺎزول‬

‫ﻛﺎﺳﭙﻮﻓﺎﻧﮋﻳﻦ‬

‫ﮔﻮﻧﻪﻫﺎي ﻣﺨﻤﺮي‬

‫اﻧﺘﺸﺎر دﻳﺴﻚ‬

‫ﻣﻴﻜﺮوداﻳﻠﻮﺷﻦ ﺑﺮاث‬ ‫‪MIC Rang‬‬

‫‪MIC90 µg/ml‬‬

‫ﺣﺴﺎس ‪%‬‬

‫‪0/03-4‬‬

‫‪0/125‬‬

‫‪96/2‬‬

‫واﺑﺴﺘﻪ ﺑﻪ دوز ‪%‬‬ ‫‪1‬‬

‫‪2/9‬‬

‫‪0/03-0/5‬‬

‫‪0/125‬‬

‫‪95/6‬‬

‫‪4/4‬‬

‫‪0‬‬

‫‪0/06-0/5‬‬

‫‪0/125‬‬

‫‪100‬‬

‫‪0‬‬

‫‪0/03-1‬‬

‫‪0/125‬‬

‫‪92/3‬‬

‫‪7/7‬‬

‫‪0‬‬

‫ﻣﻘﺎوم ‪%‬‬

‫ﻛﺎﻧﺪﻳﺪا آﻟﺒﻴﻜﻨﺲ‬ ‫ﻛﺎﻧﺪﻳﺪا ﮔﻼﺑﺮاﺗﺎ‬ ‫ﻛﺎﻧﺪﻳﺪا داﺑﻠﻲ ﻧﻴﻨﺴﻴﺲ‬ ‫ﻛﺎﻧﺪﻳﺪا ﺗﺮوﭘﻴﻜﺎﻟﻴﺲ‬ ‫ﻛﺎﻧﺪﻳﺪا ﭘﺎراﭘﺴﻴﻠﻮزﻳﺲ‬ ‫ﻛﺎﻧﺪﻳﺪا ﻛﻔﻴﺮ‬

‫‪0/125-0/25‬‬

‫‪0/125‬‬

‫‪100‬‬

‫‪0‬‬

‫‪0/06-0/125‬‬

‫‪0/125‬‬

‫‪100‬‬

‫‪0‬‬

‫ﺳﺎﻳﺮ ﮔﻮﻧﻪﻫﺎي ﻛﺎﻧﺪﻳﺪا‬

‫‪0/06-1‬‬

‫‪0/125‬‬

‫‪85‬‬

‫‪11/7‬‬

‫‪3/3‬‬

‫‪0/06-1‬‬

‫‪0/125‬‬

‫‪98/1‬‬

‫‪1/9‬‬

‫‪0‬‬

‫‪0/06-0/25‬‬

‫‪0/125‬‬

‫‪100‬‬

‫‪0‬‬

‫‪0/06-0/25‬‬

‫‪0/125‬‬

‫‪100‬‬

‫‪0‬‬

‫‪0/06-0/25‬‬

‫‪0/125‬‬

‫‪100‬‬

‫‪0‬‬

‫‪0/06-0/125‬‬

‫‪0/125‬‬

‫‪100‬‬

‫‪0‬‬

‫‪0/03-0/25‬‬

‫‪0/125‬‬

‫‪100‬‬

‫‪0‬‬

‫ﺳﺎﻳﺮ ﮔﻮﻧﻪﻫﺎي ﻛﺎﻧﺪﻳﺪا‬

‫‪0/03-0/25‬‬

‫‪0/125‬‬

‫‪100‬‬

‫‪0‬‬

‫‪1-128‬‬

‫‪8‬‬

‫‪55/2‬‬

‫‪19/1‬‬

‫‪25/7‬‬

‫‪2-128‬‬

‫‪128‬‬

‫‪37/9‬‬

‫‪4/4‬‬

‫‪57/7‬‬

‫‪1-128‬‬

‫‪4‬‬

‫‪77/8‬‬

‫‪11/1‬‬

‫‪2-128‬‬

‫‪8‬‬

‫‪56/2‬‬

‫‪17/7‬‬

‫‪26/2‬‬

‫‪1-128‬‬

‫‪16‬‬

‫‪60‬‬

‫‪16/7‬‬

‫‪23/3‬‬

‫‪2-128‬‬

‫‪4‬‬

‫‪67/1‬‬

‫‪0‬‬

‫‪32/9‬‬

‫ﺳﺎﻳﺮ ﮔﻮﻧﻪﻫﺎي ﻛﺎﻧﺪﻳﺪا‬

‫‪1-128‬‬

‫‪16‬‬

‫‪64‬‬

‫‪25/2‬‬

‫‪10/8‬‬

‫‪0/06-8‬‬

‫‪0/125‬‬

‫‪63/3‬‬

‫‪14/8‬‬

‫‪21/9‬‬

‫‪0/06-8‬‬

‫‪0/125‬‬

‫‪55/6‬‬

‫‪13/3‬‬

‫‪31/1‬‬

‫‪0/06-0/125‬‬

‫‪0/06‬‬

‫‪100‬‬

‫‪0‬‬

‫‪0/06-8‬‬

‫‪0/125‬‬

‫‪56/2‬‬

‫‪23/1‬‬

‫‪20/8‬‬

‫‪0/06-0/5‬‬

‫‪0/06‬‬

‫‪76/7‬‬

‫‪23/3‬‬

‫‪0‬‬

‫‪0/06-4‬‬

‫‪0/125‬‬

‫‪67/1‬‬

‫‪0‬‬

‫‪32/9‬‬

‫ﺳﺎﻳﺮ ﮔﻮﻧﻪﻫﺎي ﻛﺎﻧﺪﻳﺪا‬

‫‪0/06-4‬‬

‫‪0/06‬‬

‫‪79/6‬‬

‫‪10/2‬‬

‫‪0/06-8‬‬

‫‪0/125‬‬

‫‪75/7‬‬

‫‪11/9‬‬

‫‪16/4‬‬

‫‪0/03-8‬‬

‫‪0/25‬‬

‫‪60‬‬

‫‪4/4‬‬

‫‪35/6‬‬

‫‪0/125-0/25‬‬

‫‪0/06‬‬

‫‪100‬‬

‫‪0‬‬

‫‪0/06-4‬‬

‫‪0/06‬‬

‫‪79/2‬‬

‫‪15/4‬‬

‫‪5/4‬‬

‫‪0/125-1‬‬

‫‪0/125‬‬

‫‪60‬‬

‫‪28/3‬‬

‫‪11/7‬‬

‫‪0/06-8‬‬

‫‪0/125‬‬

‫‪67/1‬‬

‫‪0‬‬

‫‪32/9‬‬

‫ﺳﺎﻳﺮ ﮔﻮﻧﻪﻫﺎي ﻛﺎﻧﺪﻳﺪا‬

‫‪0/125-0/25‬‬

‫‪0/125‬‬

‫‪100‬‬

‫‪0‬‬

‫‪0/06-1‬‬

‫‪0/125‬‬

‫‪100‬‬

‫‪0‬‬

‫‪0/06-0/25‬‬

‫‪0/125‬‬

‫‪100‬‬

‫‪0‬‬

‫‪0/06-0/25‬‬

‫‪0/125‬‬

‫‪100‬‬

‫‪0‬‬

‫‪0/06-0/25‬‬

‫‪0/125‬‬

‫‪100‬‬

‫‪0‬‬

‫‪0/06-0/125‬‬

‫‪0/125‬‬

‫‪100‬‬

‫‪0‬‬

‫‪0/03-0/25‬‬

‫‪0/125‬‬

‫‪100‬‬

‫‪0‬‬

‫ﺳﺎﻳﺮ ﮔﻮﻧﻪﻫﺎي ﻛﺎﻧﺪﻳﺪا‬

‫‪0/03-0/25‬‬

‫‪0/125‬‬

‫‪100‬‬

‫‪0‬‬

‫‪100‬‬

‫ﻣﻘﺪار ‪ MIC-%90‬داروي ﻓﻠﻮﻛﻮﻧﺎزول ﺑﺮاي ﻛﺎﻧﺪﻳـﺪا آﻟﺒﻴﻜـﻨﺲ ‪8µg/ml‬‬

‫اﻓﺰاﻳﺶ ﺑﻴﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﻧﻘﺎﻳﺺ ﺳﻴﺴﺘﻢ اﻳﻤﻨﻲ از ﻣﻬﻢﺗـﺮﻳﻦ ﻋﻮاﻣـﻞ ﻳـﺎ‬

‫ﺑــﻪدﺳــﺖ آﻣــﺪه اﺳــﺖ‪ .‬اﻳــﻦ ﻣﻘــﺪار ﺑــﺮاي داروي ﻛﺘﻮﻛﻮﻧــﺎزول و‬

‫ﻓﺎﻛﺘﻮرﻫﺎي دﺧﻴﻞ در اﭘﻴﺪﻣﻴﻮﻟﻮژي ﺑﻴﻤـﺎري ﻛﺎﻧﺪﻳـﺪﻳﺎزﻳﺲ و ﺧـﺼﻮﺻﺎ‬

‫ﻛﻠﻮﺗﺮﻳﻤﺎزول ﺑﺮاﺑـﺮ ﺑـﺎ ‪ 0/125µg/ml‬ﻣـﻲﺑﺎﺷـﺪ‪ .‬در راﺑﻄـﻪ ﺑـﺎ ﺟﺪاﻳـﻪ‬

‫ﻛﺎﻧﺪﻳﺪﻳﺎزﻳﺲ دﻫﺎﻧﻲ اﺳﺖ‪ .‬ﺗﻌﻴﻴﻦ اﻟﮕﻮي ﺣﺴﺎﺳﻴﺖ ﺑﻪ داروﻫـﺎي ﺿـﺪ‬

‫‪ (ATCC‬ﻛﺎﻧﺪﻳﺪا آﻟﺒﻴﻜﻨﺲ ﺑﻪﻋﻨﻮان ﻳﻚ ﻧﻤﻮﻧـﻪ ﻣﻘـﺎوم‬

‫ﻗﺎرﭼﻲ و ﺷﻨﺎﺳﺎﻳﻲ ﻳـﺎ ﺗـﺸﺨﻴﺺ ﻇﻬـﻮر ﻣﻘﺎوﻣـﺖ از اﻫﻤﻴـﺖ وﻳـﮋهاي‬

‫واﺑﺴﺘﻪ ﺑﻪ دوز داروي آزول ﻧﺘﺎﻳﺞ ﺑﻪدﺳﺖ آﻣﺪه ﺑﺎ واﺑﺴﺘﻪ ﺑﻪ دوز ﺑـﻮدن‬

‫ﺑﺮﺧﻮردار اﺳﺖ زﻳﺮا ﻣﻘﺎوﻣﺖ ﺑﻪ داروﻫﺎ ﻣﻬﻢﺗـﺮﻳﻦ ﻣﻌـﻀﻞ ﺑـﺮ ﺳـﺮ راه‬

‫‪Candida dubliniensis‬‬

‫درﻣﺎن اﻳﻦ ﺑﻴﻤﺎريﻫﺎ اﺳﺖ‪ .‬در ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ دو روش اﻧﺘـﺸﺎر دﻳـﺴﻚ‬

‫)‪ (CD36‬ﺑﻪ ﻋﻨﻮان ﺟﺪاﻳﻪ ﺣﺴﺎس ﺑﻪ داروي آزول ﻧﺘﺎﻳﺞ ﺑﻪدﺳﺖ آﻣﺪه ﺑﺎ‬

‫و ﻣﻴﻜﺮوﺑﺮاث داﻳﻠﻮﺷﻦ ﺑﺮاي ‪ 200‬ﮔﻮﻧﻪ ﻛﺎﻧﺪﻳﺪاي ﺟﺪا ﺷﺪه از ﺑﻴﻤـﺎران‬

‫ﺣﺴﺎس ﺑﻮدن آن ﻣﻄـﺎﺑﻖ ﺑـﻮد‪ .‬ﻣﻴـﺰان ﻣﻘﺎوﻣـﺖ ﻛﺎﻧﺪﻳـﺪا آﻟﺒﻴﻜـﻨﺲ ﺑـﻪ‬

‫آﻟﻮده ﺑﻪ ‪ HIV‬ﺑﻪﻛﺎر ﺑﺮده ﺷﺪ ﻛﻪ ‪ 98‬ﮔﻮﻧﻪ آن ﮔﻮﻧﻪﻫـﺎي ﻏﻴـﺮ آﻟﺒﻴﻜـﻨﺲ‬

‫داروﻫﺎي ﮔﺮوه ﭘﻠﻲ ان ﺷﺎﻣﻞ آﻣﻔﻮﺗﺮﻳﺴﻴﻦ و ﻧﻴـﺴﺘﺎﺗﻴﻦ در ﺣـﺪ ﭘـﺎﻳﻴﻨﻲ‬

‫ﺑﻮدهاﻧﺪ و اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺟﺪﻳﺪﺗﺮﻳﻦ ﺑﺮرﺳﻲ اﻧﺠﺎم ﺷﺪه در راﺳﺘﺎي ﺗﻌﻴـﻴﻦ‬

‫ﺑﻪدﺳﺖ آﻣﺪ )ﺑﻪ ﺗﺮﺗﻴﺐ ‪ 2/9‬و ﺻﻔﺮ درﺻﺪ(‪ .‬ﻛﺎﻧﺪﻳﺪا ﮔﻼﺑﺮاﺗﺎ‪ -‬دوﻣـﻴﻦ‬

‫ﺣﺴﺎﺳﻴﺖ داروﻳﻲ ﺑﺮ روي اﻳﻦ ﺑﻴﻤﺎران در اﻳﺮان اﺳﺖ‪ .‬ﻧﺘﺎﻳﺞ ﺑـﻪدﺳـﺖ‬

‫ﮔﻮﻧﻪ ﺟﺪا ﺷﺪه از ﻧﻈﺮ ﺷﻴﻮع در اﻳﻦ ﻣﻄﺎﻟﻌﻪ‪ -‬ﻣﻘﺎوﻣﺖ ﻗﺎﺑﻞ ﺗﻮﺟﻬﻲ ﺑـﻪ‬

‫آﻣﺪه در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻧﺸﺎن ﻣﻲدﻫـﺪ اﻧـﻮاع ﻣﺨﺘﻠﻔـﻲ از ﮔﻮﻧـﻪﻫـﺎي ﻏﻴـﺮ‬

‫داروي ﻓﻠﻮﻛﻮﻧﺎزول ﻧﺸﺎن داد ﺑﻪﻃﻮري ﻛﻪ ‪ %57/7‬از ﺟﺪاﻳﻪﻫﺎي ﻛﺎﻧﺪﻳﺪا‬

‫آﻟﺒﻴﻜﻨﺲ ﺷﺎﻣﻞ ﻛﺎﻧﺪﻳﺪا ﺗﺮوﭘﻴﻜﺎﻟﻴﺲ‪ ،‬ﻛﺎﻧﺪﻳﺪا ﭘﺎراﭘـﺴﻴﻠﻮزﻳﺲ‪ ،‬ﻛﺎﻧﺪﻳـﺪا‬

‫ﮔﻼﺑﺮاﺗﺎ داراي ‪ MIC>125µg/ml‬ﺑﺮاي اﻳﻦ دارو ﺑﻮدهاﻧﺪ‪ .‬ﻫﻢﭼﻨﻴﻦ ﻣﻴﺰان‬

‫ﮔﻴﻠﺮﻣﻮﻧﺪي و ﻛﺎﻧﺪﻳﺪا ﮔﻼﺑﺮاﺗﺎ از اﻳﻦ ﺑﻴﻤﺎران ﺟﺪا ﻣﻲﺷﻮد‪ .‬در ﺑﻴﻦ اﻳـﻦ‬

‫ﻣﻘﺎوﻣﺖ ﺑﻪ داروﻫﺎي ﻛﺘﻮﻛﻮﻧﺎزول و ﻛﻠﻮﺗﺮﻳﻤﺎزول ﺑـﻪ ﺗﺮﺗﻴـﺐ ‪ 31‬و ‪35‬‬

‫ﮔﻮﻧﻪﻫﺎي ﻏﻴـﺮ آﻟﺒﻴﻜـﻨﺲ ﻛﺎﻧﺪﻳـﺪا داﺑﻠـﻲ ﻧﻴﻨـﺴﻴﺲ ﺑـﺎ اﻳﺠـﺎد ﺑﻴﻤـﺎري‬

‫‪ .(MIC‬در راﺑﻄﻪ ﺑﺎ ﻛﺎﻧﺪﻳـﺪا‬

‫‪20‬‬

‫داﺑﻠﻲ ﻧﻴﻨﺴﻴﺲ ﻣﻴﺰان ﺣﺴﺎﺳﻴﺖ ﺑﺎﻻﻳﻲ ﻧﺴﺒﺖ ﺑﻪ داروﻫـﺎي ﮔـﺮوه آزول‬

‫ﻣﻄﺎﺑﻖ ﺑﺎ ﺑﺴﻴﺎري از ﻣﻄﺎﻟﻌﺎت ﺻﻮرت ﮔﺮﻓﺘـﻪ در ﺳﺮاﺳـﺮ دﻧﻴـﺎ ﻛﺎﻧﺪﻳـﺪا‬

‫ﺑﻪدﺳﺖ آﻣﺪ ﺑـﻪﻃـﻮريﻛـﻪ ‪ %77/8‬ﺟﺪاﻳـﻪﻫـﺎ ﻧـﺴﺒﺖ ﺑـﻪ ﻓﻠﻮﻛﻮﻧـﺎزول‬

‫آﻟﺒﻴﻜﻨﺲ ﺷﺎﻳﻊﺗﺮﻳﻦ ﮔﻮﻧﻪ ﻛﺎﻧﺪﻳﺪا در اﻳﺠﺎد ﺑﻴﻤﺎري و ﺷﺎﻳﻊﺗـﺮﻳﻦ ﮔﻮﻧـﻪ‬

‫ﺣﺴﺎﺳﻴﺖ ﻧﺸﺎن دادﻧﺪ و ‪ %11/1‬ﻧﻴﺰ ﺣﺴﺎﺳﻴﺖ واﺑﺴﺘﻪ ﺑـﻪ دوز داﺷـﺘﻨﺪ‪.‬‬

‫ﺟﺪا ﺷﺪه از ﺑﻴﻤـﺎران ‪ HIV‬اﺳـﺖ‪ ،‬ﻫﺮﭼﻨـﺪ ﻣﻴـﺰان ﺟﺪاﺳـﺎزي ﻛﺎﻧﺪﻳـﺪا‬

‫ﻫﻢﭼﻨﻴﻦ ‪ %100‬از ﺟﺪاﻳﻪﻫﺎي ﻛﺎﻧﺪﻳﺪا داﺑﻠﻲ ﻧﻴﻨﺴﻴﺲ ﺑﻪ ﻛﺘﻮﻛﻮﻧـﺎزول و‬

‫ﮔﻼﺑﺮاﺗﺎ ﻗﺎﺑﻞ ﺗﻮﺟﻪ و دور از اﻧﺘﻈﺎر ﺑـﻮده اﺳـﺖ‪ .‬ﺑـﺮ اﺳـﺎس ﻣﻄﺎﻟﻌـﺎت‬

‫ﻛﻠﻮﺗﺮﻳﻤﺎزول ﺣﺴﺎﺳﻴﺖ ﻧﺸﺎن دادﻧﺪ‪ .‬ﻛﺎﻧﺪﻳﺪا ﻛﻔﻴﺮ ﺑﻪﻋﻨﻮان ﻳـﻚ ﮔﻮﻧـﻪ‬

‫ﺻﻮرت ﮔﺮﻓﺘﻪ در ﺳﺎﻳﺮ ﻛﺸﻮرﻫﺎ ﻛﺎﻧﺪﻳﺪا ﮔﻼﺑﺮاﺗﺎ ﺑـﻪ ﻋﻨـﻮان اوﻟـﻴﻦ ﻳـﺎ‬

‫ﺣﺴﺎس ﺑﻪ داروﻫﺎي آزول ﺷﻨﺎﺧﺘﻪ ﺷﺪه اﺳﺖ‪ ،‬در ﺻﻮرﺗﻲﻛﻪ ‪ %32/9‬از‬

‫دوﻣﻴﻦ ﮔﻮﻧﻪ ﺷﺎﻳﻊ ﻏﻴﺮ آﻟﺒﻴﻜﻨﺲ در ﺑﻴﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ‪ HIV‬ﮔﺰارش ﺷـﺪه‬

‫ﺟﺪاﻳﻪﻫﺎي ﺑﻪدﺳﺖ آﻣﺪه در اﻳﻦ ﻣﻄﺎﻟﻌـﻪ ﺑـﻪ داروﻫـﺎي آزول ﻣﻘﺎوﻣـﺖ‬

‫اﺳﺖ‪ 21-23.‬ذﻛﺮ اﻳﻦ ﻧﻜﺘﻪ ﺿﺮوري ﺑﻪﻧﻈﺮ ﻣﻲرﺳﺪ ﻛـﻪ ﻛﻠﻮﻧﻴﺰاﺳـﻴﻮن ﺑـﺎ‬

‫اﺳﺘﺎﻧﺪارد‬

‫)‪10231‬‬

‫آن ﻣﻄﺎﺑﻘﺖ داﺷﺖ‪ ،‬ﻫﻢﭼﻨﻴﻦ ﺟﺪاﻳﻪ اﺳـﺘﺎﻧﺪارد‬

‫درﺻﺪ ﺑﻪدﺳﺖ آﻣﺪ‬

‫)‪range:0/06-8µg/ml‬‬

‫ﻛﺎﻧﺪﻳﺪﻳﺎزﻳﺲ دﻫﺎﻧﻲ‪ -‬ﺣﻠﻘﻲ در ﺑﻴﻤﺎران ‪ HIV‬ﻣﺜﺒﺖ در ارﺗﺒﺎط اﺳـﺖ‪.‬‬

‫‪24‬‬

‫ﻧﺸﺎن دادﻧﺪ و ﺗﻤﺎم اﻳﻦ ﺟﺪاﻳﻪﻫﺎي ﻣﻘﺎوم از ﺑﻴﻤﺎران ﻣﺒـﺘﻼ ﺑـﻪ ﺑﻴﻤـﺎري‬

‫ﻛﺎﻧﺪﻳﺪا ﮔﻼﺑﺮاﺗﺎ ﭘﺲ از درﻣﺎن ﺑﺎ ﻓﻠﻮﻛﻮﻧـﺎزول اﻓـﺰاﻳﺶ ﻣـﻲﻳﺎﺑـﺪ‪ .‬در‬

‫ﻋﻮد ﻛﻨﻨﺪه ﻛﺎﻧﺪﻳﺪاﻳﻲ ﺑﻪدﺳﺖ آﻣﺪه اﺳﺖ‪ .‬در ﻣﺠﻤﻮع ﻣﻴﺰان ﻣﻘﺎوﻣﺖ ﺑﻪ‬

‫راﺑﻄﻪ ﺑﺎ آزﻣﺎﻳﺸﺎت ﺗﻌﻴﻴﻦ ﺣﺴﺎﺳﻴﺖ ﺑـﻪ داروﻫـﺎي ﺿـﺪ ﻗـﺎرﭼﻲ از دو‬

‫داروﻫﺎي آزول ﻓﺮاﮔﻴﺮ اﺳﺖ‪ .‬ﺗﻔﺎوت ﻗﺎﺑـﻞ ﺗـﻮﺟﻬﻲ ﺑـﻴﻦ ﺑﻴﻤـﺎراﻧﻲ ﻛـﻪ‬

‫روش ﻣﻮرد ﺗﺎﻳﻴﺪ ‪ CLSI‬اﺳﺘﻔﺎده ﺷﺪه اﺳﺖ ﻛﻪ اﻟﺒﺘﻪ در راﺑﻄﻪ ﺑﺎ ﻣﺰاﻳـﺎ و‬

‫داروﻫﺎي آزول درﻳﺎﻓﺖ ﻛﺮدﻧﺪ و آندﺳﺘﻪ ﻛﻪ اﻳﻦ داروﻫـﺎي را درﻳﺎﻓـﺖ‬

‫ﻣﻌﺎﻳﺐ و ﻧﻜﺎت ﺗﻜﻨﻴﻜﻲ اﻳﻦ روشﻫﺎ ﺑﺤﺚ ﺑـﺴﻴﺎر اﺳـﺖ و ﻣﺠـﺎل آن‬

‫ﻧﻤﻲﻛﺮدﻧﺪ در ﺟﺪاﺳﺎزي ﮔﻮﻧﻪﻫﺎي ﻛﺎﻧﺪﻳﺪاي ﻣﻘﺎوم ﺑـﻪ آزول ﻣـﺸﺎﻫﺪه‬

‫ﻧﻴﺴﺖ‪ .‬ﺑـﻪﻃـﻮر ﻣﻌﻤـﻮل ﻣﻘﺎوﻣـﺖ ﺑـﻪ داروي آﻣﻔﻮﺗﺮﻳـﺴﻴﻦ ‪ B‬در ﺑـﻴﻦ‬ ‫‪25‬‬

‫ﮔﺮدﻳﺪ )‪ .(P:0/02‬ﻛﻠﻴﻪ ﺟﺪاﻳﻪﻫﺎي ﺑﻪدﺳﺖ آﻣﺪه ﮔﻮﻧـﻪﻫـﺎي ﻛﺎﻧﺪﻳـﺪاﻳﻲ‬

‫ﮔﻮﻧﻪﻫﺎي ﻛﺎﻧﺪﻳﺪا درﺻﺪ ﻛﻤﻲ را ﺷﺎﻣﻞ ﻣﻲﺷﻮد و در ﻣﻄﺎﻟﻌـﻪ ﺣﺎﺿـﺮ‬

‫در اﻳﻦ ﻣﻄﺎﻟﻌـﻪ ﺑـﻪ داروي ﻧﻴـﺴﺘﺎﺗﻴﻦ‪ ،‬آﻣﻔﻮﺗﺮﻳـﺴﻴﻦ ‪ B‬و ﻛﺎﺳـﭙﻮﻓﺎﻧﮋﻳﻦ‬

‫ﺣﺴﺎﺳﻴﺖ ﺑﻪ داروي آﻣﻔﻮﺗﺮﻳﺴﻴﻦ ‪ B‬و ﻧﻴﺴﺘﺎﺗﻴﻦ ﻛﻪ از داروﻫﺎي ﺧﺎﻧﻮاده‬

‫ﺣﺴﺎﺳﻴﺖ ﻧﺸﺎن دادﻧﺪ‪.‬‬

‫ﭘﻠﻲ انﻫﺎ داروي ﻛﺎﺳﭙﻮﻓﺎﻧﮋﻳﻦ از ﺧﺎﻧﻮاده اﻛﻴﻨﻮﻛﺎﻧـﺪﻳﻦﻫـﺎ ﻗﺎﺑـﻞ ﺗﻮﺟـﻪ‬ ‫ﺑﻮد‪ ،‬ﻫﺮ ﭼﻨﺪ در ﻣﻮارد اﻧﺪﻛﻲ ﻧﻴﺰ ﻧﺴﺒﺖ ﺑﻪ داروي آﻣﻔﻮﺗﺮﻳﺴﻴﻦ در ﺑﻴﻦ‬

‫ﺑﺤﺚ‬

‫ﮔﻮﻧﻪﻫﺎي ﻛﺎﻧﺪﻳﺪا ﻣﻘﺎوﻣﺖ ﻣﺸﺎﻫﺪه ﮔﺮدﻳﺪ )ﻛـﻢﺗـﺮ از ‪ .(%3‬اﻳـﻦ ﻳﺎﻓﺘـﻪ‬ ‫ﻣﻄﺎﺑﻖ ﺑﺎ ﺳﺎﻳﺮ ﻣﻄﺎﻟﻌﺎت اﻧﺠﺎم ﮔﺮﻓﺘﻪ اﺳﺖ ﻧﺸﺎن ﻣﻲدﻫﺪ ﻣﻴﺰان ﻣﻘﺎوﻣﺖ‬

‫ﻇﻬـﻮر ﮔﻮﻧـﻪﻫـﺎي ﻛﺎﻧـﺪﻳـﺪاي ﻣﻘـﺎوم ﺑـﻪ داروﻫﺎي ﺿﺪ ﻗﺎرﭼﻲ و‬

‫ﺑﻪ اﻳﻦ دارو ﭘﺎﻳﻴﻦ اﺳﺖ‪ ،‬ﻫﺮ ﭼﻨﺪ ‪ Badiee‬در ﺑﻴﻤﺎران ﻧﻘﺺ اﻳﻤﻨﻲ ﻣﻴﺰان‬

‫‪ F.‬و ﻫﻤﻜﺎران‬ ‫ﻓﺮزاد‪al.‬ﻛﺘﻴ‪et‬ﺮاﺋﻲ‬ ‫‪Katiraee‬‬

‫ﻣﻘﺎوﻣﺖ ﺑﻪ دارو را در ﻛﺎﻧﺪﻳﺪا آﻟﺒﻴﻜﻨﺲ در ﺣﺪود ‪ %7‬ﮔﺰارش ﻧﻤﻮده و‬

‫‪101‬‬

‫ﺑﻪﻧﺤﻮي ﺑﺎﻳﺪ ﺷﺮاﻳﻂ واردات ﻳﺎ ﺗﻮﻟﻴﺪ داروﻫﺎي ﺟﺪﻳﺪ را ﻣﻬﻴﺎ ﻛﻨﻨـﺪ‪ .‬در‬

‫‪26-28‬و‪22‬‬

‫ﻣﻘﺎﻳﺴﻪ ﺑﺎ روش ﻣﻴﻜﺮوداﻳﻠﻮﺷﻦ‪ ،‬در روش اﻧﺘﺸﺎر دﻳﺴﻚ ﻧﻴﺰ ﻧﺘﺎﻳﺞ ﻗﺎﺑﻞ‬

‫در ﺑﺮﺧﻲ ﻣﻄﺎﻟﻌﺎت دﻳﮕﺮ اﻳﻦ ﻣﻴﺰان ﺗﺎ ﺣـﺪود ‪ %8‬ﺑـﻮده اﺳـﺖ‪.‬‬

‫ﻋﻠﻲرﻏﻢ ﺳﺎﻳﺮ ﻣﻄﺎﻟﻌﺎت اﻧﺠﺎم ﺷﺪه‪ ،‬ﺑﺎ وﺟﻮد آنﻛـﻪ در ﺑﻴﻤـﺎران ﻣـﻮرد‬

‫ﻗﺒﻮﻟﻲ ﺑﻪدﺳﺖ آﻣﺪ و اﺧﺘﻼف ﻣﻌﻨﻲداري ﺑﻴﻦ اﻳﻦ دو روش دﻳﺪه ﻧـﺸﺪ‪.‬‬

‫ﺑﺮرﺳﻲ در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺗﺠـﻮﻳﺰ ﻧﻴـﺴﺘﺎﺗﻴﻦ راﻳـﺞ ﺑـﻮده اﺳـﺖ اﻣـﺎ ﻫـﻴﭻ‬

‫ﺑﻪﻧﻈﺮ ﻣﻲرﺳﺪ اﺳﺘﻔﺎده از روشﻫﺎي ﺗﻌﻴﻴﻦ ﺣﺴﺎﺳﻴﺖ ﺑﻪ داروﻫﺎي ﺿـﺪ‬

‫ﻣﻘﺎوﻣﺘﻲ ﺑﻪ اﻳﻦ دارو دﻳﺪه ﻧﺸﺪ و ﻧﺸﺎن ﻣﻲدﻫﺪ اﻳﻦ دارو ﻫـﻢﭼﻨـﺎن ﺑـﻪ‬

‫ﻗــﺎرﭼﻲ ﻧﻴــﺰ ﺑــﻪراﺣﺘــﻲ ﺑــﺎ اﺳــﺘﻔﺎده از روش اﻧﺘــﺸﺎر دﻳــﺴﻚ در‬

‫ﻋﻨﻮان ﻳﻚ داروي ﻣﻮﺛﺮ ﺑﺮاي ﭘﻴﺸﮕﻴﺮي از ﻛﺎﻧﺪﻳﺪﻳﺎزﻳﺲ دﻫﺎﻧﻲ ﻣﻨﺎﺳﺐ‬

‫آزﻣﺎﻳﺸﮕﺎهﻫﺎي روﺗﻴﻦ ﻗﺎﺑﻞ اﻧﺠﺎم ﺑﺎﺷﺪ و ﺑﻪﻧﺤﻮي ﺑﺎﻳﺪ در دﺳـﺘﻮر ﻛـﺎر‬

‫اﺳﺖ‪ .‬ﻫﺮﭼﻨﺪ ﻛﻪ ﻣﺼﺮف ﻣﻮﺿﻌﻲ و ﻓﻘﺪان ﺟﺬب ﺳﻴﺴﺘﻤﻴﻚ در ﻣـﻮرد‬

‫ﻗﺮار ﮔﻴﺮد‪ .‬ﺑـﻪﻃـﻮر ﺧﻼﺻـﻪ‪ ،‬در اﻳـﻦ ﺗﺤﻘﻴـﻖ اﻟﮕـﻮي ﺣـﺴﺎﺳﻴﺖ ﺑـﻪ‬

‫اﻳــﻦ دارو از دﻻﻳــﻞ ﻋــﺪم ﻛــﺎرﺑﺮد آن ﺑــﺮاي ﺑﻴﻤــﺎري ﺳﻴــﺴﺘﻤﻴﻚ و‬

‫داروﻫﺎي ﺿﺪ ﻗﺎرﭼﻲ ﮔﻮﻧﻪﻫﺎي ﻛﺎﻧﺪﻳﺪا ﺑﻪدﺳﺖ آﻣﺪه از ﺑﻴﻤﺎران آﻟـﻮده‬

‫ﻛﺎﻧﺪﻳـﺪﻳﺎزﻳﺲ ﻣــﺮي اﺳــﺖ‪ .‬ﻣﻘﺎوﻣــﺖ ﺑــﻪ داروي ﻓﻠﻮﻛﻮﻧــﺎزول در اﺛــﺮ‬

‫ﺑﻪ ‪ HIV‬ﻣﺮاﺟﻌﻪ ﻛﻨﻨﺪه ﺑﻪ ﻣﺮﻛﺰ ﺗﺤﻘﻴﻘﺎت اﻳﺪز اﻳﺮان واﻗﻊ در ﺑﻴﻤﺎرﺳـﺘﺎن‬

‫اﺳﺘﻔﺎده ﻃﻮﻻﻧﻲ ﻣﺪت از اﻳﻦ دارو ﺗﻮﺳﻂ ﺳﺎﻳﺮ ﻣﺤﻘﻘﻴﻦ ﺑﻪ اﺛﺒﺎت رﺳﻴﺪه‬

‫اﻣﺎمﺧﻤﻴﻨﻲ ﺗﻬﺮان ﺑﺮرﺳـﻲ ﺷـﺪ‪ .‬درﺻـﺪ ﺑـﺎﻻي ﺟﺪاﺳـﺎزي ﮔﻮﻧـﻪﻫـﺎي‬

‫اﺳﺖ‪ 29.‬ﺑﻨﺎﺑﺮاﻳﻦ اﻳـﻦﻛـﻪ ﻓﻠﻮﻛﻮﻧـﺎزول داروي ﻛـﺎﻣﻼ ﻣـﻮﺛﺮي در ﺑﺮاﺑـﺮ‬

‫ﻛﺎﻧﺪﻳﺪاي ﻏﻴﺮ آﻟﺒﻴﻜﻨﺲ زﻧﮓ ﺧﻄﺮ ﺗﻐﻴﻴﺮ در اﭘﻴﺪﻣﻴﻮﻟﻮژي ﻛﺎﻧﺪﻳﺪﻳﺎزﻳﺲ‬

‫ﮔﻮﻧﻪﻫﺎي ﻛﺎﻧﺪﻳﺪا و ﺑﻪﻃﻮر ﺧﺎص ﻛﺎﻧﺪﻳﺪا آﻟﺒﻴﻜﻨﺲ )ﺑﻪﻋﻨﻮان ﺷﺎﻳﻊﺗﺮﻳﻦ‬

‫دﻫﺎﻧﻲ را در ﺑﻴﻤﺎران اﻳﺮاﻧﻲ در آورده اﺳﺖ‪ .‬ﺑﺮ اﺳﺎس ﻧﺘـﺎﻳﺞ ﺑـﻪدﺳـﺖ‬

‫ﮔﻮﻧﻪ در اﻳﺠﺎد ﺑﻴﻤﺎريﻫـﺎي ﻛﺎﻧﺪﻳـﺪاﻳﻲ( ﻧﺒﺎﺷـﺪ دور از ذﻫـﻦ ﻧﻴـﺴﺖ‪،‬‬

‫آﻣﺪه‪ ،‬ﻧﻮﻳﺴﻨﺪﮔﺎن اﻳﻦ ﻣﻘﺎﻟﻪ ﺑﺮرﺳـﻲ و ردﻳـﺎﺑﻲ ﺟﺪاﻳـﻪﻫـﺎي ﻛﺎﻧﺪﻳـﺪاي‬

‫ﺑﻪﻃﻮريﻛﻪ در ﺣﺪود ‪ %25‬از ﺟﺪاﻳﻪﻫﺎي ﻛﺎﻧﺪﻳﺪا آﻟﺒﻴﻜﻨﺲ ﻣﻘﺎوﻣﺖ ﺑـﻪ‬

‫ﻣﻘــﺎوم ﺑــﻪ دارو را ﺑــﺎ روش اﻧﺘــﺸﺎر دﻳــﺴﻚ و رﻗــﺖﺳــﺎزي ﻣــﺎﻳﻊ در‬

‫ﻓﻠﻮﻛﻮﻧﺎزول را ﻧﺸﺎن دادﻧﺪ‪ .‬ﻳﺎﻓﺘﻪ اﺧﻴﺮ ﺗﺎ ﺣﺪودي از ﻧﻈﺮ درﺟﻪ و ﻣﻴﺰان‬

‫آزﻣﺎﻳﺸﮕﺎهﻫﺎي ﺑﺎﻟﻴﻨﻲ ﺑﺮاي اراﻳﻪ ﺧﺪﻣﺎت ﺑﻬﺘﺮ ﺑﻪ ﺑﻴﻤﺎران ﻣﺒـﺘﻼ ﺗﻮﺻـﻴﻪ‬

‫ﻣﻘﺎوﻣﺖ ﺑﻪ اﻳﻦ دارو ﺑﺎ ﺳـﺎﻳﺮ ﮔﺰارﺷـﺎت اراﻳـﻪ ﺷـﺪه ﻣﺘﻔـﺎوت اﺳـﺖ‪.‬‬

‫ﻣﻲﻛﻨﻨﺪ‪ .‬ﺑﺎ وﺟﻮد آنﻛﻪ ﻧﻴﺴﺘﺎﺗﻴﻦ ﺑﻪﻃﻮر ﮔﺴﺘﺮده در اﻳﻦ ﺑﻴﻤـﺎران ﻣـﻮرد‬

‫ﻫﺮﭼﻨﺪ در ﺑﺴﻴﺎري از ﻣﻄﺎﻟﻌﺎت ﻣﻘﺎوﻣـﺖ ﺑـﻪ اﻳـﻦ دارو ﮔـﺰارش ﺷـﺪه‬

‫ﻣﺼﺮف ﺑﻮده اﺳﺖ و ﻣﻘﺎوﻣﺘﻲ در ﺑﺮاﺑﺮ اﻳﻦ دارو دﻳﺪه ﻧﺸﺪ ﺗﺠﻮﻳﺰ اﻳـﻦ‬

‫‪29-32‬‬

‫دارو ﺑﺮاي ﭘﻴﺸﮕﻴﺮي از ﺑﻴﻤﺎري ﻛﺎﻧﺪﻳﺪﻳﺎزﻳﺲ دﻫﺎﻧﻲ ﺗﻮﺻﻴﻪ ﻣﻲﺷﻮد‪ .‬از‬

‫اﺣﺘﻤﺎل ﻣﻲرود ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﻳﻦﻛﻪ ﺟﻤﻌﻴﺖ ﻣﻮرد ﺑﺮرﺳﻲ ﺑﻴﻤـﺎران ﻣﺒـﺘﻼ‬

‫ﻃﺮﻓﻲ ﻣﻴﺰان ﺑﺎﻻي ﻣﻘﺎوﻣﺖ ﺑﻪ داروﻫﺎي آزول‪ ،‬ﺧﺼﻮﺻﺎ ﻓﻠﻮﻛﻮﻧﺎزول ﻣﺎ‬

‫ﺑﻪ وﻳﺮوس ﻧﻘﺺ ﺳﻴﺴﺘﻢ اﻳﻤﻨﻲ ﺑﻮده اﺳﺖ و اﻳﻦ ﺑﻴﻤـﺎران در ﺑـﻴﺶﺗـﺮ‬

‫را در اﺳﺘﻔﺎده از اﻳﻦ دارو ﺑﻪ ﻋﻨﻮان داروي ﭘﻴﺸﮕﻴﺮي ﻛﻨﻨـﺪه از ﺑﻴﻤـﺎري‬

‫ﻣﻮارد ﺳﺎﺑﻘﻪ درﻣﺎنﻫﺎي ﻗﺒﻠﻲ و ﻣﺪاوم را داﺷﺘﻪاﻧـﺪ‪ ،‬ﻣﻴـﺰان ﻣﻘﺎوﻣـﺖ در‬

‫دﻫﺎﻧﻲ ﻛﺎﻧﺪﻳﺪا ﺑﺎ ﺗﺮدﻳﺪ ﻣﻮاﺟﻪ ﻣﻲﻛﻨﺪ‪.‬‬

‫اﺳﺖ اﻣﺎ درﺻﺪ ﻣﻘﺎوﻣﺖ ﻧﺴﺒﺖ ﺑﻪ اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻛﻢﺗـﺮ ﺑـﻮده اﺳـﺖ‪.‬‬

‫ﺳﭙﺎﺳﮕﺰاري‪ :‬اﻳﻦ ﻣﻘﺎﻟﻪ ﺣﺎﺻﻞ ﺑﺨﺸﻲ از ﭘﺎﻳـﺎنﻧﺎﻣـﻪ ﺗﺤـﺖ ﻋﻨـﻮان‬

‫آنﻫﺎ ﺑﻴﺶﺗﺮ ﺑﻮده اﺳﺖ‪ .‬ﺑﺎ ﺗﻮﺟـﻪ ﺑـﻪ آزﻣﺎﻳـﺸﺎت اﻧﺠـﺎم ﺷـﺪه در اﻳـﻦ‬

‫"ﺗﻌﻴﻴﻦ ژﻧﻮﺗﺎﻳﭗ و اﻟﮕﻮي ﺣﺴﺎﺳﻴﺖ ﮔﻮﻧﻪﻫﺎي ﻛﺎﻧﺪﻳﺪاي ﺟﺪا ﺷـﺪه از‬

‫ﻣﻄﺎﻟﻌﻪ ﻣﻴﺰان ﺣﺴﺎﺳﻴﺖ در ﺑﻴﻦ ﮔﻮﻧﻪﻫﺎي ﻛﺎﻧﺪﻳﺪا ﺑﻪﺗﺮﺗﻴﺐ زﻳﺮ اﺳﺖ‪:‬‬

‫ﺑﻴﻤﺎران آﻟﻮده ﺑﻪ وﻳﺮوس ‪ HIV‬ﻣﺒﺘﻼ ﺑﻪ ﻛﺎﻧﺪﻳﺪﻳﺎزﻳﺲ دﻫﺎﻧﻲ در اﻳﺮان"‪،‬‬

‫> ‪C. dubliniensis> C. kefyr > C. parapsilosis > C. tropicalis‬‬ ‫‪C. albicans > C. Krusei > C.glabrata.‬‬

‫در ﻣﻘﻄﻊ دﻛﺘﺮاي ﺗﺨﺼﺼﻲ در ﺳﺎل ‪ 1388‬ﺑﻪ ﻛﺪ ‪ 380‬ﻣﻲﺑﺎﺷﺪ ﻛـﻪ ﺑـﺎ‬

‫ﻣﺘﺎﺳﻔﺎﻧﻪ ﺑﻪدﻟﻴﻞ در دﺳﺘﺮس ﻧﺒﻮدن داروي ﺟﺪﻳﺪ ﺿﺪ ﻗـﺎرﭼﻲ و ﻳـﺎ در‬

‫ﺣﻤﺎﻳﺖ داﻧﺸﮕﺎه ﺗﻬﺮان اﻧﺠﺎم ﺷـﺪه اﺳـﺖ‪ .‬ﻧﻮﻳـﺴﻨﺪﮔﺎن ﻣﻘﺎﻟـﻪ از ﻛﻠﻴـﻪ‬

‫ﭘﺎرهاي ﻣﻮارد ﮔﺮاﻧﻲ ﺑﺮﺧﻲ داروﻫﺎ ﺑﻴﻤﺎران راﻫـﻲ ﺟـﺰ ﻣـﺼﺮف داروي‬

‫ﻫﻤﻜﺎراﻧﻲ ﻛﻪ در اﻳـﻦ ﺗﺤﻘﻴـﻖ ﻣـﺎ را ﻳـﺎري ﻧﻤﻮدﻧـﺪ‪ ،‬ﺗﻘـﺪﻳﺮ و ﺗـﺸﻜﺮ‬

‫ﻓﻠﻮﻛﻮﻧﺎزول را ﻧﺪارﻧﺪ‪ .‬ﺑﻪﻧﻈﺮ ﻣﻲرﺳـﺪ ﭘﺰﺷـﻜﺎن ﻣـﻲﺑﺎﻳـﺴﺖ ﺗﻮﺟـﻪ و‬

‫ﻣﻲﻧﻤﺎﻳﻨﺪ و ﺑﺮ ﺳـﻔﻴﺪ ﺟﺎﻣﮕـﺎن ﻋﻠـﻮم آزﻣﺎﻳـﺸﮕﺎﻫﻲ و ﭘﺮﺳـﺘﺎري درود‬

‫ﺗﻤﺎﻳﻞ ﺑﻪ ﺗﺠﻮﻳﺰ داروﻫﺎي ﺟﺪﻳـﺪ داﺷـﺘﻪ ﺑﺎﺷـﻨﺪ و ارﮔـﺎنﻫـﺎي ذﻳـﺮﺑﻂ‬

‫ﻣﻲﻓﺮﺳﺘﻨﺪ‪.‬‬

‫‪References‬‬ ‫‪M. Bharathi and A. Usha Rani. Pathogenic fungal isolates in sputum‬‬ ‫‪of HIV positive patients. Journal of AIDS and HIV Research, June‬‬ ‫‪2011, Vol. 3(6), pp. 107-113.‬‬

‫‪2.‬‬

‫‪Pelletier R, Peter J, Antin C, Gonzalez C, Wood L, Walsh TJ.‬‬ ‫‪Emergence of resistance of Candida albicans to clotrimazole in‬‬ ‫‪human immunodeficiency virus-infected children: in vitro and‬‬ ‫‪clinical correlations. J Clin Microbiol 2000;38(4):1563-8.‬‬

‫‪1.‬‬

In vitro antifungal susceptibility of oral candida species from Iranian HIV infected patients

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18. Matar MJ, Ostrosky-Zeichner L, Paetznick VL, Rodriguez JR, Chen E, Rex JH. Correlation between E-test, disk diffusion, and microdilution methods for antifungal susceptibility testing of fluconazole and voriconazole. Antimicrob Agents Chemother 2003;47(5):1647-51. 19. Katiraee F, Khosravi AR, Khalaj V, Hajiabdolbaghi M, Khaksar AA, Rasoulinjad M. Oral candidiasis in Human Immunodeficiency Virus (HIV) infected individuals in Iran. Tehran Univ Med J (TUMJ);68(1):37-44. 20. Repentigny LD, Lewandowski D, Jolicoeur P. Immunopathogenesis of oropharyngeal candidiasis in human immunodeficiency virus infection. Clin Microbiol Rev 2004;17(4):729-59. 21. Blignaut E, Messer S, Hollis RJ, Pfaller MA. Antifungal susceptibility of South African oral yeast isolates from HIV/AIDS patients and healthy individuals. Diagn Microbiol Infect Dis 2002;44(2):169-74. 22. Enwuru CA, Ogunledun A, Idika N, Enwuru NV, Ogbonna F, Aniedobe M, et al. Fluconazole resistant opportunistic oropharyngeal Candida and non-Candida yeast-like isolates from HIV infected patients attending ARV clinics in Lagos, Nigeria. Afr Health Sci 2008;8(3):142-8. 23. Lyon JP, Moreira LM, Cardoso MAG, Saade J, Resende MA. Antifungal susceptibility profile of Candida spp. oral isolates obtained from denture wearers. Brazil J Microbiol 2008;39:668-72. 24. Sobel JD, Ohmit SE, Schuman P, Klein RS, Mayer K, Duerr A, et al. The evolution of Candida species and fluconazole susceptibility among oral and vaginal isolates recovered from human immunodeficiency virus (HIV)-seropositive and at-risk HIVseronegative women. J Infect Dis 2001;183(2):286-93. 25. Ruhnke M, Eigler A, Tennagen I, Geiseler B, Engelmann E, Trautmann M. Emergence of fluconazole-resistant strains of Candida albicans in patients with recurrent oropharyngeal candidosis and human immunodeficiency virus infection. J Clin Microbiol 1994;32(9):2092-8. 26. Mokaddas EM, Al-Sweih NA, Khan ZU. Species distribution and antifungal susceptibility of Candida bloodstream isolates in Kuwait: a 10-year study. J Med Microbiol 2007;56(Pt 2):255-9. 27. Powderly WG, Kobayashi GS, Herzig GP, Medoff G. Amphotericin B-resistant yeast infection in severely immunocompromised patients. Am J Med 1988;84(5):826-32. 28. Badiee P, Alborzi A, Shakiba E, Ziyaeyan M, Rasuli M. Molecular identification and in-vitro susceptibility of Candida albicans and C. dubliniensis isolated from immunocompromised patients. Iran Red Crescent Med J 2009;11(4):391-7. 29. Lewis RE, Klepser ME, Pfaller MA. Update on clinical antifungal susceptibility testing for Candida species. Pharmacotherapy 1998;18(3):509-15. 30. Haberland-Carrodeguas C, Allen CM, Beck FM, Buesching WJ, Koletar SL, Sundstrom P. Prevalence of fluconazole-resistant strains of Candida albicans in otherwise healthy outpatients. J Oral Pathol Med 2002;31(2):99-105. 31. Rubio Calvo MC, Gil J, Ramírez de Ocáriz I, Benito R, Rezusta A. In vitro activity of fluconazole, voriconazole and posaconazole against Candida spp. Rev Esp Quimioter 2003;16(2):227-32. 32. Bailey DA, Feldmann PJ, Bovey M, Gow NA, Brown AJ. The Candida albicans HYR1 gene, which is activated in response to hyphal development, belongs to a gene family encoding yeast cell wall proteins. J Bacteriol 1996;178(18):5353-60.

103

‫ﺟﺮاﺣﻲ ﻋﻤﻮﻣﻲ‬Medical ‫در ﺑﺨﺸﻬﺎي‬ ‫ﻣﺤﻞ ﺟﺮاﺣﻲ‬ ‫ﻋﻔﻮﻧﺖ‬ ‫روش‬96-103 ‫ﻛﺎراﻳﻲ دو‬ Tehran University Journal; Vol. 70,‫ﺗﺸﺨﻴﺺ‬ No. 2, ‫ﺑﺮاي‬ May‫ﭘﺎﻳﺶ‬ 2012:

In vitro antifungal susceptibility of oral candida species from Iranian HIV infected patients

Abstract Farzad Katiraee Ph.D.1* Ali Reza Khosravi Ph.D.2 Vahid Khalaj Ph.D.3 Mahbobeh Hajiabdolbaghi M.D.4 Ali Asghar Khaksar D.V.M.3 Mehrnaz Rasoulinejad M.D.4 1- Mycology Research Center, Faculty of Veterinary Medicine, Azad University, Science and Research Branch, Tehran, Iran. 2- Department of Microbiology, Faculty of Veterinary Medicine, University of Tehran, Iran. 3- Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran. 4- IRCHA, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Received: December 08, 2011 Accepted: January 21, 2012

Background: Oropharyngeal candidiasis and antifungal drug resistance are major problems in HIV positive patients. The increased reports of antifungal resistance and expanding therapeutic options prompted the determination of antifungal susceptibility profile of Candida species isolates in Iranian patients living with HIV/AIDS (PLWHA) in the present study. Methods: One hundred fifty oral samples from Iranian HIV positive patients were obtained and cultured on CHROMagar and Sabouraud’s dextrose agar. All isolates were identified according to assimilation profile, germ tube, colony color and other conventional methods. Disk diffusion testing and Broth Microdilution of six antifungal agents were performed according to the methods described in CLSI. Results: Candida albicans (50.2%) was the most frequent isolated yeast, followed by C. glabrata (22%). Non-Candida albicans species were isolated from 71 (61%) positive cultures. 25.7% of Candida albicans isolates were resistant to fluconazole (MIC≥64 µg/ml) as were 21.9% and 16.4% to ketoconazole and clotrimazole (MIC>0.125 µg/ml), respectively. Resistance to polyene antifungals including amphotericin B and nystatin, and caspofungin were scarce. 57.7% of candida glabrata isolates were resistant to fluconazole, 31% to ketoconazole and 35% to clotrimazole. Conclusion: Screening for antifungal resistant candida isolates by disk diffusion or broth dilution methods in clinical laboratories is an ideal surveillance measure in the management of oral thrush in patients with HIV/AIDS. Although nystatin is widely used in clinical practice for HIV positive patients, there was no evidence of enhanced resistance to it. Regarding no resistance to caspofungin, its administration is suggested.

Corresponding author: Mycology Research Center, Islamic Azad University, Science and Research Branch, Sarv Sq., Before Shahrvand Shop, Tehran, Iran. Tel: +98- 912- 6047311 E-mail: katiraee_f@yahoo.com

Keywords: Antifungal drug resistance, azoles, candida species, HIV infections, oral candidiasis, patients.

‫‪104‬‬ ‫ردﻳﺒﻬﺸﺖﻚ‪،1391‬‬ ‫ﺷﻤﺎره ‪،2‬‬ ‫ﭼﻨﺪ‪، ،70‬‬ ‫دوره‬ ‫ﭘﺰﺷﻜﻲ‬ ‫داﻧﺸﮕﺎه ﻋﻠﻮم‬ ‫ﭘﺰﺷﻜﻲ‪،‬‬ ‫‪-109‬ران‬ ‫اﺳﺘﺨﻮان‬ ‫ﺳﺎب اﺗﺮوﻛﺎﻧﺘﺮﻳ‬ ‫ﻗﻄﻌﻪاي‬ ‫ﺗﻬﺮان‪،‬ﻫﺎي‬ ‫ﺷﻜﺴﺘﮕﻲ‬ ‫‪ biologic‬در‬ ‫‪plate‬‬ ‫داﻧﺸﻜﺪهﺗﻜﻨﻴﻚ‬ ‫ﻣﺠﻠﻪ ﺑﺮرﺳﻲ‬

‫‪104‬‬

‫ﺑﺮرﺳﻲ ﺗﻜﻨﻴﻚ ﺻﻔﺤﻪﮔﺬاري ﺑﻴﻮﻟﻮژﻳﻚ در ﺷﻜﺴﺘﮕﻲﻫﺎي ﭼﻨﺪ ﻗﻄﻌﻪاي ﺳﺎبﺗﺮوﻛﺎﻧﺘﺮﻳﻚ اﺳﺘﺨﻮان ران‬

‫ﺗﺎرﻳﺦ درﻳﺎﻓﺖ ﻣﻘﺎﻟﻪ‪ 1390/10/11 :‬ﺗﺎرﻳﺦ ﭘﺬﻳﺮش‪1390/11/09 :‬‬

‫ﭼﻜﻴﺪه‬

‫‪1‬‬

‫ﺳﻌﻴﺪرﺿﺎ ﻣﻬﺮﭘﻮر‬

‫‪2‬‬

‫‪1‬‬

‫ﻣﺤﻤﺪرﺿﺎ ﻃﻮاﻓﻲ‪ ،‬رﺿﺎ ﺳﺮﺑﻲ‬ ‫‪*2‬‬

‫ﻣﺤﻤﺪرﺿﺎ آﻗﺎﻣﻴﺮﺳﻠﻴﻢ‬

‫زﻣﻴﻨﻪ و ﻫﺪف‪ :‬ﺷﻜﺴﺘﮕﻲﻫﺎي ﭼﻨﺪ ﻗﻄﻌﻪاي ﺳﺎبﺗﺮوﻛﺎﻧﺘﺮﻳﻚ اﺳﺘﺨﻮان ﻓﻤﻮر ﺣﺪود ‪ 10-34‬درﺻﺪ ﻛﻞ ﺷﻜﺴﺘﮕﻲﻫـﺎي‬ ‫ﻣﻔﺼﻞ ﻟﮕﻦ را ﺗﺸﻜﻴﻞ ﻣﻲدﻫﻨﺪ‪ .‬درﻣﺎن ﺷﻜﺴﺘﮕﻲﻫﺎي ﭼﻨﺪ ﻗﻄﻌﻪاي ﺳﺎبﺗﺮوﻛﺎﻧﺘﺮﻳﻚ ﺑﺮاي ﺟﺮاﺣﺎن ارﺗﻮﭘﺪ ﻫﻤﻮاره ﻳﻜﻲ‬

‫‪ -1‬ﮔﺮوه ارﺗﻮﭘﺪي‪ ،‬ﺑﻴﻤﺎرﺳﺘﺎن دﻛﺘﺮ ﺷﺮﻳﻌﺘﻲ‬

‫از ﭼﺎﻟﺶﺑﺮاﻧﮕﻴﺰﺗﺮﻳﻦ ﻣﻮﺿﻮﻋﺎت ﺑﻮده اﺳﺖ‪ .‬ﺗﺎﻛﻨﻮن ﺗﻜﻨﻴـﻚﻫـﺎي ﻣﺘﻔـﺎوﺗﻲ در ﺷﻜـﺴﺘﮕﻲﻫـﺎي ﭼﻨـﺪ ﻗﻄﻌـﻪاي ﺳـﺎب‬

‫داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬ﺗﻬﺮان‪ ،‬اﻳﺮان‪.‬‬

‫ﺗﺮوﻛﺎﻧﺘﺮﻳﻚ اﺳﺘﻔﺎده ﺷﺪه اﺳﺖ‪ .‬ﺑﻌﻀﻲ از اﻳﻦ ﺗﻜﻨﻴﻚﻫﺎي ﻣﻮرد اﺳﺘﻔﺎده در ﺟﺮاﺣﻲ ﺑـﺎ ﻋـﻮارض و ﻣـﺸﻜﻼت ﻓﺮاواﻧـﻲ‬

‫‪ -2‬داﻧﺸﺠﻮي ﭘﺰﺷﻜﻲ‪ ،‬ﻣﺮﻛﺰ رﺷﺪ اﺳﺘﻌﺪادﻫﺎي‬

‫ﻫﻤﺮاه ﻫﺴﺘﻨﺪ‪ .‬ﻟﺬا ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻣﻄﺎﻟﻌﺎت ﻗﺒﻠﻲ و ﻧﺘﺎﻳﺞ آنﻫﺎ ﺑﺮ آن ﺷﺪﻳﻢ ﺗﺎ ﻣﻄﺎﻟﻌﻪاي را ﻃﺮاﺣﻲ ﻛﻨـﻴﻢ ﻛـﻪ در آن ﺑﺘـﻮاﻧﻴﻢ‬

‫درﺧﺸﺎن و ﻣﺮﻛﺰ ﭘﮋوﻫﺶﻫﺎي ﻋﻠﻤﻲ داﻧﺸﺠﻮﻳﺎن‪،‬‬ ‫داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬ﺗﻬﺮان‪ ،‬اﻳﺮان‬

‫ﻛﺎراﻳﻲ ﻓﻴﻜﺴﺎﺳﻴﻮن ﺑﻴﻮﻟﻮژﻳﻚ در ﺷﻜﺴﺘﮕﻲﻫﺎي ﭼﻨﺪ ﻗﻄﻌـﻪاي ﺳـﺎبﺗﺮوﻛﺎﻧﺘﺮﻳـﻚ اﺳـﺘﺨﻮان ﻓﻤـﻮر را ﺑﺮرﺳـﻲ ﻛﻨـﻴﻢ‪.‬‬ ‫روش ﺑﺮرﺳﻲ‪ :‬در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ‪ 20‬ﺑﻴﻤﺎر ﺑﺎ ﺷﻜﺴﺘﮕﻲﻫﺎي ﭼﻨﺪ ﻗﻄﻌﻪاي ﺳﺎبﺗﺮوﻛﺎﻧﺘﺮﻳﻚ اﺳﺘﺨﻮان ﻓﻤﻮر ﺑﺮرﺳﻲ ﺷـﺪﻧﺪ‪.‬‬ ‫ﺑﻴﻤﺎران ﺑﻪ ﺻﻮرت ﺑﺎﻟﻴﻨﻲ ﺑﺮاي درد‪ ،‬ﻣﻴﺰان ﺣﺮﻛﺖ ﻣﻔﺎﺻﻞ ﻫﻴﭗ و زاﻧﻮ‪ ،‬اﻧﺤﺮاﻓـﺎت ﭼﺮﺧـﺸﻲ و اﺧـﺘﻼف ﻃـﻮل دو ﭘـﺎ‬ ‫ﺑﺮرﺳﻲ ﺷﺪﻧﺪ‪ ،‬در ﺿﻤﻦ‪ ،‬ﭼﮕﻮﻧﮕﻲ ﺟﻮشﺧﻮردﮔﻲ ﺑﺮ اﺳﺎس ﻳﺎﻓﺘﻪﻫﺎي رادﻳﻮﮔﺮاﻓﻲ ﺑﺮرﺳﻲ ﺷﺪ‪ .‬ﻳﺎﻓﺘﻪﻫـﺎ‪ :‬از ﺑﻴـﺴﺖ و‬ ‫ﺳﻪ ﺑﻴﻤﺎر ﭘﺬﻳﺮﻓﺘﻪ ﺷﺪه ﺑﺎ ﺷﻜﺴﺘﮕﻲﻫﺎي ﭼﻨﺪ ﻗﻄﻌـﻪاي ﺳـﺎبﺗﺮوﻛﺎﻧﺘﺮﻳـﻚ‪ 20 ،‬ﺑﻴﻤـﺎر وارد ﻣﻄﺎﻟﻌـﻪ ﺷـﺪﻧﺪ‪ .‬ﺑـﺮ اﺳـﺎس‬ ‫ﻃﺒﻘﻪﺑﻨﺪي ‪ ،Seinheimer‬ﭼﻬﺎر ﺑﻴﻤﺎر دﭼﺎر ﺷﻜﺴﺘﮕﻲ از ﺗﻴﭗ ﺳﻪ‪ 9 ،‬ﺷﻜﺴﺘﮕﻲ از ﺗﻴـﭗ ﭼﻬـﺎر و ﻫﻔـﺖ ﻧﻔـﺮ از ﺑﻴﻤـﺎران‬ ‫دﭼﺎر ﺷﻜﺴﺘﮕﻲ از ﻧﻮع ﭘﻨﺞ ﺑﻮدﻧﺪ‪ .‬در ﻫﺸﺖ ﺑﻴﻤﺎر ﻓﻴﻜﺴﺎﺳﻴﻮن ﺑﺎ ﭘـﻴﭻ دﻳﻨﺎﻣﻴـﻚ ﻛﻨـﺪﻳﻼر‬

‫‪Dynamic Condylar Screw‬‬

‫)‪ (DCS‬و در ‪ 12‬ﻧﻔﺮ دﻳﮕﺮ ﺑﺎ ﭘﻴﭻ دﻳﻨﺎﻣﻴﻚ ﻫﻴﭗ )‪ Dynamic Hip Screw (DHS‬اﻧﺠﺎم ﺷﺪ‪ .‬ﺟﻮشﺧﻮردﮔﻲ در ﺗﻤﺎم ﺑﻴﻤﺎران‬ ‫*‬

‫دﻳﺪه ﺷﺪ‪ .‬ﻫﻴﭻﻛﺪام از ﺑﻴﻤﺎران درد ﻳﺎ اﺧﺘﻼل ﺣﺮﻛﺖ ﻧﺪاﺷﺘﻨﺪ‪ .‬ﻧﺘﻴﺠﻪﮔﻴﺮي‪ :‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻧﺘﺎﻳﺞ ﺑﻪدﺳﺖ آﻣﺪه‪ ،‬ﻧﻮﻳـﺴﻨﺪﮔﺎن‬ ‫ﻧﻮﻳﺴﻨﺪه ﻣﺴﺌﻮل‪ :‬ﺗﻬﺮان‪ ،‬ﺑﻠﻮار ﻛﺸﺎورز‪ ،‬ﺑﻴﻦ ‪ 16‬آذر و‬

‫ﻗﺪس‪ ،‬ﺧﻴﺎﺑﺎن ﭘﻮرﺳﻴﻨﺎ‪ ،‬داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم‬ ‫ﭘﺰﺷﻜﻲ ﺗﻬﺮان‬

‫ﺻﻔﺤﻪﮔﺬاري ﺳﺎب ﻣﺎﺳﻜﻮﻻر در ﺷﻜﺴﺘﮕﻲﻫﺎي ﭼﻨﺪ ﻗﻄﻌﻪاي ﺳﺎبﺗﺮوﻛﺎﻧﺘﺮﻳﻚ را ﭘﻴﺸﻨﻬﺎد ﻣﻲﻛﻨﻨﺪ‪.‬‬

‫ﺗﻠﻔﻦ‪021-88717358 :‬‬

‫‪E-mail: aghamirsalim@gmail.com‬‬

‫ﻛﻠﻤﺎت ﻛﻠﻴﺪي‪ :‬ﺷﻜـﺴﺘﮕﻲ ﺳـﺎبﺗﺮوﻛﺎﻧﺘﺮﻳـﻚ‪ ،‬ﻓﻴﻜـﺴﺎﺳﻴﻮن‬

‫ﺑﻴﻮﻟﻮژﻳـﻚ‪Dynamic Hip ،Dynamic Condylar Screw ،‬‬

‫‪.Screw‬‬

‫ﺳﻤﺖ اﺳﺘﺨﻮان ﻛﻮرﺗﻴﻜﺎل ﺗﻨﻪ اﺳﺘﺨﻮان ران اداﻣﻪ دارد‪ .‬ﺷﻜﺴﺘﮕﻲﻫـﺎي‬

‫ﻣﻘﺪﻣﻪ‬

‫ﭼﻨﺪ ﻗﻄﻌﻪاي ﺳﺎبﺗﺮوﻛﺎﻧﺘﺮﻳﻚ اﺳﺘﺨﻮان ﻓﻤﻮر اﻏﻠﺐ ﻧﺘﻴﺠﻪ ﻳﻚ ﺗﺮوﻣـﺎ‬ ‫درﻣــﺎن ﺷﻜــﺴﺘﮕﻲﻫــﺎي ﺳــﺎبﺗﺮوﻛﺎﻧﺘﺮﻳــﻚ‬

‫‪(Subtrochantric‬‬ ‫‪1‬‬

‫ﺑﺎ اﻧﺮژي ﺑﺎﻻ ﻣﻲﺑﺎﺷﻨﺪ‪ 2.‬اﻳﻦ ﺷﻜﺴﺘﮕﻲﻫﺎ ﻣﻤﻜﻦ اﺳﺖ ﺑﻪ ﺳﻤﺖ ﻧـﻮاﺣﻲ‬ ‫‪3‬‬

‫)‪ fractures‬ﺑﺮاي ﺟﺮاﺣﺎن ارﺗﻮﭘﺪ ﺑﺴﻴﺎر ﭼﺎﻟﺶﺑﺮاﻧﮕﻴﺰ اﺳﺖ‪ .‬اﻳﻦ ﻣﻨﻄﻘﻪ‬

‫ﺗﺮوﻛﺎﻧﺘﺮ ﺑﺰرگ ﻳﺎ اﻳﻨﺘﺮﺗﺮوﻛﺎﻧﺘﺮ ﮔﺴﺘﺮش ﻳﺎﺑﻨﺪ‪ .‬ﺟﺎاﻧﺪازي ﺑﻪ روش ﺑـﺎز‬

‫ﺑﻴﻦ دو ﻧﺎﺣﻴﻪ ﻛﻪ ﻧﻴﺮوﻫﺎي ﺑـﺎ ﻓـﺸﺎر ﺑـﺎﻻ از ﻃـﺮف داﺧـﻞ و ﻧﻴﺮوﻫـﺎي‬

‫)‪ (Open reduction‬ﺑﻪ ﺗﻐﺬﻳـﻪ ﻋﺮوﻗـﻲ آﺳـﻴﺐ ﻣـﻲرﺳـﺎﻧﺪ‪ ،‬ﻗﻄﻌـﺎت را‬

‫ﻛﺸﺸﻲ از ﻃﺮف ﺧﺎرج وارد ﻣﻲﺷﻮﻧﺪ ﻗﺮار دارد ﻛﻪ ﻣﻲﺗﻮاﻧﺪ ﻣﻨﺠـﺮ ﺑـﻪ‬

‫ﺗﻀﻌﻴﻒ ﻛﺮده و ﺑﺎﻓﺖﻫﺎي ﻧﺮم را آﺳﻴﺐ ﻣﻲزﻧﺪ‪ ،‬ﻫـﻢﭼﻨـﻴﻦ ﻣـﻲﺗﻮاﻧـﺪ‬

‫ﻧﺎرﺳﺎﻳﻲ اﻳﻤﭙﻠﻨﺖﻫﺎ ﺷﻮد‪ .‬اﻳﻦ ﻗﺴﻤﺖ از اﺳﺘﺨﻮان ﻳـﻚ ﻧﺎﺣﻴـﻪ اﻧﺘﻘـﺎﻟﻲ‬

‫‪4‬‬

‫ﺧﻄﺮ ﻋﺪم ﺟﻮشﺧﻮردن و ﻧﺎرﺳـﺎﻳﻲ اﻳﻤﭙﻠﻨـﺖ را ﻧﻴـﺰ اﻓـﺰاﻳﺶ دﻫـﺪ‪.‬‬

‫اﺳﺖ ﻛـﻪ از اﺳﺘﺨـﻮان اﺳﻔﻨﺠـﻲ )‪ (Cancellous‬ﻧﺎﺣﻴـﻪ ﺗﺮوﻛﺎﻧﺘﺮﻳﻚ ﺑﻪ‬

‫ﺗﻜﻨﻴﻚﻫﺎي ﺟﺮاﺣﻲ ﺑﺎ اﺳﺘﻔﺎده از اﺑﺰارﻫـﺎي اﻳﻨﺘﺮاﻣـﺪوﻻري ﻛـﻢﺗـﺮ ﺑـﻪ‬

‫ﺳﻌﻴﺪرﺿﺎ ﻣﻬﺮﭘﻮر و ﻫﻤﻜﺎران‬

‫‪105‬‬

‫ﺑﺎﻓﺖﻫﺎي ﻧﺮم آﺳﻴﺐ ﻣﻲرﺳﺎﻧﻨﺪ‪ 5.‬ﻃﺒـﻖ ﻣﻄﺎﻟﻌـﺎت ﻗﺒﻠـﻲ‪ ،‬ﺗﻜﻨﻴـﻚﻫـﺎي‬

‫ﻣﻨﺎﺳﺐ اﻧﺠﺎم ﺷﺪ‪ .‬اﻋﻤﺎل ﺟﺮاﺣﻲ ﻃﻲ دو ﺗـﺎ ‪ 13‬روز ﺑﻌـﺪ از ﭘـﺬﻳﺮش‬

‫ﻣﺬﻛﻮر ﺑﺮاي درﻣﺎن ﺷﻜﺴﺘﮕﻲﻫﺎي وﺳﻴﻊ ﺳﺎبﺗﺮوﻛﺎﻧﺘﺮﻳـﻚ ﻛـﻪ ﻧﺎﺣﻴـﻪ‬

‫ﺻﻮرت ﮔﺮﻓﺖ‪ .‬ﺑﻴﻤﺎران ﺑﺮاي ﺗﻌﻴﻴﻦ ﻣﻴﺰان درد‪ ،‬ﻣﻴﺰان ﺣﺮﻛﺖ در ﻫﻴـﭗ‬

‫اﻳﻨﺘﺮﺗﺮوك را ﻧﻴﺰ درﮔﻴﺮ ﻧﻤﻮده اﺳﺖ‪ ،‬ﻣﻨﺎﺳﺐ ﻧﻤﻲﺑﺎﺷﺪ‪ .‬ﻫﻢﭼﻨـﻴﻦ اﻳـﻦ‬

‫و زاﻧﻮ‪ ،‬دﻓﻮرﻣﻴﺘﻲﻫﺎي زاوﻳﻪاي و ﭼﺮﺧﺸﻲ و اﺧﺘﻼف ﻃﻮل ﭘﺎﻫﺎ و ﻧﻴـﺰ‬

‫ﺗﻜﻨﻴﻚﻫﺎ در ﺑﻌـﻀﻲ از ﺑﻴﻤـﺎران ﺑﺎﻋـﺚ ﺑـﻪ وﺟـﻮد آﻣـﺪن ﻋـﻮارض و‬

‫ﺟﻮشﺧﻮردﮔﻲ ﺑﺮاﺳﺎس ﻳﺎﻓﺘﻪﻫﺎي رادﻳﻮﮔﺮاﻓﻲ ﺑﺮرﺳﻲ ﺷﺪﻧﺪ‪.‬‬

‫ﻣﺸﻜﻼت ﻓﺮاوان ﺷﺪهاﻧﺪ‪7.‬و‪ 6‬ﻳﻜﻲ دﻳﮕﺮ از ﺗﻜﻨﻴﻚﻫﺎي ﻣـﻮرد اﺳـﺘﻔﺎده‪،‬‬

‫ﺗﻜﻨﻴﻚ ﺟﺮاﺣﻲ‪ :‬ﺑﻴﻤـﺎر ﺑـﻪ ﺻـﻮرت ﺧﻮاﺑﻴـﺪه ﺑـﻪ ﭘـﺸﺖ ﺑـﺮ روي‬

‫ﺟﺎاﻧــﺪازي ﺑــﻪ روش ﺑــﺴﺘﻪ )‪ (Closed reduction‬و ﺻــﻔﺤﻪﮔــﺬاري‬

‫‪ Fracture table‬ﻗﺮار ﮔﺮﻓﺘﻪ و ﻋﻤﻞ ‪ Reduction‬اﻧﺠﺎم ﻣـﻲﺷـﻮد‪ .‬ﺑـﺮش‬

‫ﺑﻴﻮﻟﻮژﻳﻚ )‪ (Biologic plating‬ﻣﻲﺑﺎﺷﺪ ﻛﻪ از ﺑﺮش ﮔﺴﺘﺮده ﺑﺎﻓﺖ ﻧـﺮم‬

‫‪ 5cm‬ﻟﺘﺮال ﺗﺮوﻛﺎﻧﺘﺮ ﺑﺰرگ اﻳﺠﺎد و ﻓﺎﺷﻴﺎي ﻋﻤﻘﻲ ﻛﻨﺎر زده ﻣﻲﺷﻮد‪ .‬ﺑـﺎ‬

‫در درﻣﺎن ﺷﻜﺴﺘﮕﻲﻫﺎي ﭼﻨﺪ ﻗﻄﻌـﻪاي ﺳـﺎبﺗﺮوﻛﺎﻧﺘﺮﻳـﻚ ﺟﻠـﻮﮔﻴﺮي‬

‫‪OEC® fluoroscopic unit Plus, Salt Lake‬‬

‫ﻣﻲﻛﻨﺪ‪ .‬ﺑﺮﺧﻼف ‪ Condylar blade plate‬ﻛﻪ ﻧﻴـﺎز ﺑـﻪ ﻫـﻢ ﺗـﺮازي ﺳـﻪ‬

‫ﻛﻨﺘـﺮل ﻓﻠﻮﺋﻮروﺳـﻜﻮﭘﻲ‬ ‫‪Utah) C-Arm‬‬

‫‪ (9800City,‬ﭘــﻴﻦ راﻫﻨﻤــﺎ در ﻗــﺴﻤﺖ ﭘﺮوﮔﺰﻳﻤــﺎل و‬

‫‪Dynamic‬‬

‫‪ Condylar lag screw‬ﺑﻪ وﺳﻴﻠﻪ ﻳﻚ ﮔﻴﺮه ﺳﻪ ﺷﺎﺧﻪ در ﻣﻜـﺎن ﻣـﺬﻛﻮر‬

‫‪Dynamic Hip Screw‬‬

‫ﻗﺮار داده ﺷﺪ‪ .‬ﭘﻠﻴﺖ ‪ Barrel‬ﺑﻪ اﻧـﺪازه ﭼﻬـﺎر ﺗـﺎ ﭘـﻨﺞ ﺳـﻮراخ ﭘـﻴﭻ در‬

‫)‪ (DHS‬ﺗﻨﻬﺎ ﻧﻴﺎز ﺑﻪ ﻫﻢ ﺗﺮازي دو ﺻﻔﺤﻪاي دارﻧﺪ و ﻛﺎرﮔﺰاري آن آﺳﺎن‬

‫ﻗﺴﻤﺖ دﻳﺴﺘﺎل ﺷﻜﺴﺘﮕﻲ ﻗﺮار ﮔﺮﻓﺖ‪ .‬ﺳﭙﺲ در ﻗﺴﻤﺖ دﻳـﺴﺘﺎل ﻳـﻚ‬

‫ﻣﻲﺑﺎﺷﺪ‪ 8.‬اﻳﻦ ﻣﻄﺎﻟﻌﻪ آﻳﻨﺪهﻧﮕﺮ در ﺑﺨﺶ ارﺗﻮﭘﺪي ﺑﻴﻤﺎرﺳﺘﺎن ﺷـﺮﻳﻌﺘﻲ‬

‫ﺑﺮش ﺻﻮرت ﮔﺮﻓﺖ )ﺷﻜﻞ ‪ .(1‬ﭘﻠﻴﺖ از ﻃﺮﻳﻖ ﺑـﺮش ﭘﺮوﮔﺰﻳﻤـﺎل ﺑـﻪ‬

‫اﻧﺠﺎم ﺷﺪ و ﻫﺪف آن ﺑﺮرﺳﻲ ﻓﻴﻜﺴﺎﺳﻴﻮن ﺑﻴﻮﻟﻮژﻳﻚ در ﺷﻜﺴﺘﮕﻲﻫﺎي‬

‫ﺻﻮرﺗﻲ ﻛﻪ ‪ Barrel‬ﻫﺎ ﺑﻪ ﺳﻤﺖ ﺟﺮاح ﻗﺮار ﮔﻴﺮد وارد ﺳﺎﻳﺖ ﺷﻜﺴﺘﮕﻲ‬

‫ﭼﻨﺪ ﻗﻄﻌﻪاي ﺳﺎب ﺗﺮوﻛﺎﻧﺘﺮﻳﻚ ﻣﻲﺑﺎﺷﺪ‪.‬‬

‫ﺷﺪ‪ .‬ﺳﭙﺲ ﭘﻼك ‪ 180‬درﺟﻪ ﭼﺮﺧﺎﻧﺪه ﺷﺪ ﺗﺎ در ﻣﻘﺎﺑﻞ اﺳـﺘﺨﻮان ﻗـﺮار‬

‫ﺻﻔﺤﻪاي ﺑﺮاي ﻓﻴﻜﺴﺎﺳﻴﻮن دارد‪ ،‬ﺑﺎ ﭘﻴﭻ دﻳﻨﺎﻣﻴـﻚ ﻛﻨـﺪﻳﻼر‬ ‫)‪ Condylar Screw (DCS‬ﻳﺎ ﭘﻴﭻ دﻳﻨﺎﻣﻴﻚ ﻫﻴﭗ‬

‫ﮔﻴﺮد‪ .‬ﭘﺲ از اﻃﻤﻴﻨﺎن از ﻗﺮارﮔﻴﺮي ﭘﻼك در ﻣﻜﺎن ﻣﻨﺎﺳﺐ‪ ،‬ﻫﻢ ﺗـﺮازي‬ ‫و ﻃﻮل ﭘﺎﻫﺎ ﭼﻚ ﺷﺪ‪ .‬ﻫﻢﺗﺮازي ﭼﺮﺧﺸﻲ )‪ (Rotational alignment‬ﺑﻪ‬

‫روش ﺑﺮرﺳﻲ‬

‫وﺳﻴﻠﻪ ‪ Cortical step sign‬ﻳﺎ ﻣﻘﺎﻳﺴﻪ ﺷﻜﻞ ﺗﺮوﻛﺎﻧﺘﺮﻫﺎي ﻛﻮﭼﻚ ﻣـﻮرد‬

‫اﻳﻦ ﻣﻄﺎﻟﻌﻪ آﻳﻨﺪهﻧﮕﺮ در ﺑﺨﺶ ارﺗﻮﭘﺪي ﺑﻴﻤﺎرﺳﺘﺎن ﺷﺮﻳﻌﺘﻲ اﻧﺠـﺎم‬

‫ارزﻳﺎﺑﻲ ﻗﺮار ﮔﺮﻓﺘﻪ ﺷﺪ‪ 11.‬ﻫﻢﭼﻨﻴﻦ ﺑـﺮاي ﺑـﻪدﺳـﺖ آوردن ﻫـﻢﺗـﺮازي‬

‫ﺷﺪ‪ .‬در اﻳﻦ ﻣﻄﺎﻟﻌﻪ از ﻛﻤﻴﺘﻪ اﺧﻼق داﻧﺸﮕﺎه اﺟﺎزه ﮔﺮﻓﺘـﻪ و اﻃﻼﻋـﺎت‬

‫ﻃﻮل اﻧﺪامﻫﺎ‪ ،‬اﻧﺪام آﺳﻴﺐ دﻳﺪه ﺑﺎ ﻃﻮل اﻧﺪام ﺳﺎﻟﻢ ﻣﻘﺎﻳﺴﻪ ﺷﺪ‪ .‬ﭘﻼك ﺑﻪ‬

‫ﺑﻴﻤــﺎران ﺑــﻪ ﺻــﻮرت ﻣﺤﺮﻣﺎﻧــﻪ ﺑﺮرﺳــﻲ ﺷــﺪ‪ .‬از ﺳــﺎل ‪،1385-1390‬‬

‫وﺳﻴﻠﻪ ﭼﻬﺎر ﺗﺎ ﭘﻨﺞ ﭘﻴﭻ در دﻳﺴﺘﺎل ﺷﻜﺴﺘﮕﻲ ﺛﺎﺑـﺖ ﮔـﺸﺖ‪ .‬در ﻃـﻮل‬

‫‪ 20‬ﺑﻴﻤﺎر ﺑﺎ ﻣﻴﺎﻧﮕﻴﻦ ﺳﻨﻲ ‪ 25) 42/5‬ﺗﺎ ‪ 72‬ﺳﺎل( ﺑﺎ ﺷﻜﺴﺘﮕﻲﻫﺎي ﭼﻨﺪ‬

‫ﺟﺮاﺣﻲ ﻣﻜﺎن ﺷﻜﺴﺘﮕﻲ ﺗﺤﺖ ﻋﻤﻞ ﻣﺴﺘﻘﻴﻢ ﻗﺮار ﻧﮕﺮﻓـﺖ و درنﻫـﺎي‬

‫ﻗﻄﻌﻪاي ﺳﺎبﺗﺮوﻛﺎﻧﺘﺮﻳﻚ اﺳﺘﺨﻮان ﻓﻤﻮر ﺑﻪ ﺻﻮرت آﻳﻨﺪهﻧﮕﺮ ﺑﺮرﺳـﻲ‬

‫ﺟﺪاﮔﺎﻧﻪاي ﺑﺮاي زﺧﻢ ﭘﺮوﮔﺰﻳﻤﺎل و دﻳﺴﺘﺎل ﻗـﺮار داده ﺷـﺪ‪ .‬در اوﻟـﻴﻦ‬

‫ﺷﺪﻧﺪ‪ .‬ﺑﻴﻤﺎران در ﻃـﻮل ﻳـﻚ ﻫﻔﺘـﻪ ﺑﻌـﺪ از ﺗﺮوﻣـﺎ ﺗﺤـﺖ ﺟﺎاﻧـﺪازي‬

‫روز ﭘﺲ از ﻋﻤﻞ‪ ،‬ورزش ﻋﻀﻼت ﭼﻬﺎر ﺳـﺮ و در روز دوم ﺣﺮﻛـﺎت‬

‫)‪ (Reduction‬ﻏﻴﺮ ﻣﺴﺘﻘﻴﻢ ﺑﺎ ﻓﻴﻜـﺴﺎﺳﻴﻮن ‪ DHS‬ﻳـﺎ ‪ DCS‬ﻗـﺮار ﮔﺮﻓﺘﻨـﺪ‪.‬‬

‫ﻣﻔﺎﺻﻞ ران و زاﻧﻮ و وزنﮔﺬاري ﺑﺮ روي ﭘﺎﻫﺎ در روز ﺳﻮم ﺗﻮﺻﻴﻪ ﺷﺪ‪.‬‬

‫ﺑﻴﻤﺎراﻧﻲ ﻛﻪ در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺷﺮﻛﺖ داده ﺷﺪﻧﺪ دﭼﺎر ﻳﻚ ﺷﻜﺴﺘﮕﻲ ﺑﻴﻦ‬

‫ﻣﻌﺎﻳﻨﺎت دورهاي در ﻫﻔﺘﻪﻫﺎي ﭼﻬﺎرم‪ ،‬ﻫﺸﺘﻢ‪ 12 ،‬و ‪ 24‬ﺻﻮرت ﮔﺮﻓﺖ‪.‬‬

‫ﻗﺴﻤﺖ ﺗﺤﺘﺎﻧﻲ ﺗﺮوﻛﺎﻧﺘﺮ ﻛﻮﭼﻚ ﺗﺎ ‪ 5cm‬زﻳﺮ آن ﺷﺪه ﺑﻮدﻧﺪ‪ .‬ﺷﻜﺴﺘﮕﻲ‬

‫ﭘﺲ از ﻇﻬﻮر ﻛﺎﻟﻮس در رادﻳﻮﮔﺮاﻓﻲ ﺑﻪ ﺑﻴﻤﺎر اﺟﺎزه وزنﮔـﺬاري ﻛﺎﻣـﻞ‬

‫ﺣﺪاﻗﻞ ﺷﺎﻣﻞ ﺳﻪ ﺗﻜﻪ ﺑﻮد‪ .‬ﺑﻴﻤﺎران ﺑﺎ ﺷﻜﺴﺘﮕﻲﻫﺎي ﺑـﺎز و ﭘﺎﺗﻮﻟﻮژﻳـﻚ‬

‫داده ﺷﺪ‪ .‬ارزﻳﺎﺑﻲ ﻧﻬﺎﻳﻲ ﻳﻚ ﺳﺎل ﭘﺲ از ﻋﻤﻞ ﺻﻮرت ﮔﺮﻓﺖ‪.‬‬

‫از ﻣﻄﺎﻟﻌﻪ ﻛﻨﺎر ﮔﺬاﺷﺘﻪ ﺷﺪﻧﺪ‪ .‬رادﻳﻮﮔﺮاﻓﻲﻫﺎي ﻗﺪاﻣﻲ ﺧﻠﻔﻲ و ﻟﺘـﺮال از‬ ‫ﻫﻴﭗ ﺗﺎ زاﻧﻮ ﮔﺮﻓﺘﻪ و ﺷﻜﺴﺘﮕﻲﻫـﺎ ﺑﺮاﺳـﺎس ﻃﺒﻘـﻪﺑﻨـﺪيﻫـﺎي ‪ 9AO‬و‬ ‫‪ 10Seinsheimer‬ﻛﻼسﺑﻨﺪي ﺷﺪﻧﺪ‪ .‬ﻗﺒﻞ از ﻋﻤﻞ ﺑﻴﻤﺎران ﺗﺤـﺖ ﻛـﺸﺶ‬

‫ﻳﺎﻓﺘﻪﻫﺎ‬

‫‪DVT‬‬

‫‪ 23‬ﺑﻴﻤﺎر ﺑﺎ ﺷﻜﺴﺘﮕﻲﻫـﺎي ﭼﻨـﺪ ﻗﻄﻌـﻪاي ﺳـﺎبﺗﺮوﻛﺎﻧﺘﺮﻳـﻚ در‬

‫)‪ 40 LMWH‬ﻣﻴﻠﻲﮔﺮم روزاﻧﻪ( ﺗﺠﻮﻳﺰ ﺷﺪ‪ .‬ﻗﺒﻞ از ﻋﻤـﻞ رادﻳـﻮﮔﺮاﻓﻲ‪-‬‬

‫ﺑﻴﻤﺎرﺳﺘﺎن ﺷﺮﻳﻌﺘﻲ ﭘﺬﻳﺮﻓﺘﻪ ﺷﺪﻧﺪ‪ .‬ﻳﻜـﻲ از ﺑﻴﻤـﺎران ﺑـﻪ ﻋﻠـﺖ ﺷـﺪت‬

‫ﻫﺎي ﻓﻤﻮر ﻣﻘﺎﺑﻞ ﺑﻪ ﻣﻨﻈﻮر ﺗﻌﻴﻴﻦ ﻣﺤـﻞ ورود و ﻃـﻮل ﭘـﻼك )ﭘﻠﻴـﺖ(‬

‫ﺿﺮﺑـﻪ ﺑـﻪ ﺳـﺮ ﻓـﻮت ﻛـﺮد و دو ﻧﻔـﺮ دﻳﮕﺮ در ﻃﻮل ﻣﻌﺎﻳﻨﺎت دورهاي‬

‫اﺳــﻜﻠﺘﻲ ﻗــﺮار ﮔﺮﻓﺘ ـﻪ و ﭘﺮوﻓﻴﻼﻛــﺴﻲ ﺗﺮوﻣﺒــﻮز ﻋــﺮوق ﻋﻤﻘــﻲ‬

‫ﺑﺮرﺳﻲ ﺗﻜﻨﻴﻚ ‪ biologic plate‬در ﺷﻜﺴﺘﮕﻲﻫﺎي ﭼﻨﺪ ﻗﻄﻌﻪاي ﺳﺎب ﺗﺮوﻛﺎﻧﺘﺮﻳﻚ اﺳﺘﺨﻮان ران‬

‫‪106‬‬

‫ﺟﺪول‪ :1 -‬ارزﻳﺎﺑﻲ ﻧﻬﺎﻳﻲ‬ ‫ﻣﻮرد‬

‫ﺳﻦ‬

‫ﻧﻮع ﺷﻜﺴﺘﮕﻲ‬ ‫‪AO‬‬

‫‪Seinsheimer‬‬

‫ﻋﻠﺖ‬

‫ﻧﻮع‬

‫ﻣﻴﺰان ﺧﻮن ﻣﺪت زﻣﺎن اﺧﺘﻼف ﻃﻮل‬

‫ﻓﻴﻜﺴﺎﺳﻴﻮن از دﺳﺖ‬

‫ﻋﻤﻞ )دﻗﻴﻘﻪ(‬

‫اﻧﺪام‬

‫ﻣﻴﺰان‬

‫ﻫﻢﺗﺮازي‬

‫ﺣﺮﻛﺖ‬

‫دﻓﻮرﻣﻴﺘﻲ‬

‫ﻋﻤﻠﻜﺮد‬

‫ﭼﺮﺧﺸﻲ‬

‫زﻣﺎن‬ ‫ﭘﻲﮔﻴﺮي‬ ‫)ﻣﺎه(‬

‫رﻓﺘﻪ‬ ‫‪1‬‬

‫‪64‬‬

‫‪32C‬‬

‫‪3B‬‬

‫اﻓﺘﺎدن‬

‫‪DHS‬‬

‫‪410‬‬

‫‪81‬‬

‫‪-‬‬

‫ﻧﺮﻣﺎل‬

‫‪2‬‬

‫‪72‬‬

‫‪32C‬‬

‫‪4‬‬

‫اﻓﺘﺎدن‬

‫‪DCS‬‬

‫‪924‬‬

‫‪110‬‬

‫‪-‬‬

‫‪ 15‬درﺟﻪ‬

‫ﻧﺮﻣﺎل‬

‫ﻛﻢﺗﺮ از ‪10‬‬

‫ﺧﻮب‬

‫‪22‬‬

‫درﺟﻪ ﻛﺎﻫﺶ‬ ‫اﻛﺴﺘﻨﺸﻦ‬ ‫‪-‬‬

‫ﺧﻮب‬

‫‪12‬‬

‫ﻛﺎﻫﺶ‬ ‫ﻓﻠﻜﺸﻦ‬ ‫‪3‬‬

‫‪29‬‬

‫‪32B‬‬

‫‪5‬‬

‫ﺗﺼﺎدف‬

‫‪DHS‬‬

‫‪742‬‬

‫‪91‬‬

‫‪-‬‬

‫ﻧﺮﻣﺎل‬

‫‪4‬‬

‫‪47‬‬

‫‪32C‬‬

‫‪4‬‬

‫ﺗﺼﺎدف‬

‫‪DHS‬‬

‫‪650‬‬

‫‪63‬‬

‫‪1‬‬

‫ﻧﺮﻣﺎل‬

‫‪5‬‬

‫‪45‬‬

‫‪32C‬‬

‫‪3B‬‬

‫ﺗﺼﺎدف‬

‫‪DHS‬‬

‫‪473‬‬

‫‪66‬‬

‫‪-‬‬

‫ﻧﺮﻣﺎل‬

‫ﭘﻨﺞ درﺟﻪ‬

‫‪6‬‬

‫‪32‬‬

‫‪32B‬‬

‫‪4‬‬

‫ﺗﺼﺎدف‬

‫‪DCS‬‬

‫‪410‬‬

‫‪70‬‬

‫‪-‬‬

‫ﻧﺮﻣﺎل‬

‫‪7‬‬

‫‪38‬‬

‫‪32B‬‬

‫‪4‬‬

‫ﺗﺼﺎدف‬

‫‪DCS‬‬

‫‪388‬‬

‫‪8‬‬

‫‪40‬‬

‫‪32C‬‬

‫‪4‬‬

‫ﺗﺼﺎدف‬

‫‪-‬‬

‫ﻋﺎﻟﻲ‬

‫‪18‬‬

‫ﻋﺎﻟﻲ‬

‫‪20‬‬

‫ﺧﻮب‬

‫‪28‬‬

‫واروس‬ ‫‪67‬‬

‫‪2‬‬

‫ﻧﺮﻣﺎل‬

‫‪DHS‬‬

‫‪639‬‬

‫‪90‬‬

‫‪-‬‬

‫ﻧﺮﻣﺎل‬

‫ﻧﺮﻣﺎل‬ ‫ﻧﺮﻣﺎل‬

‫‬‫‪-‬‬

‫ﭘﻨﺞ درﺟﻪ‬

‫ﻛﻢﺗﺮ از ‪10‬‬

‫واروس‬

‫درﺟﻪ ﻛﺎﻫﺶ‬

‫ﻋﺎﻟﻲ‬ ‫ﻋﺎﻟﻲ‬ ‫ﺧﻮب‬

‫‪15‬‬ ‫‪16‬‬ ‫‪21‬‬

‫اﻛﺴﺘﻨﺸﻦ‬ ‫‪9‬‬

‫‪33‬‬

‫‪32C‬‬

‫‪5‬‬

‫ﺗﺼﺎدف‬

‫‪DHS‬‬

‫‪684‬‬

‫‪83‬‬

‫‪-‬‬

‫ﻧﺮﻣﺎل‬

‫‪-‬‬

‫ﻋﺎﻟﻲ‬

‫‪20‬‬

‫‪10‬‬

‫‪47‬‬

‫‪32C‬‬

‫‪3a‬‬

‫ﺗﺼﺎدف‬

‫‪DCS‬‬

‫‪491‬‬

‫‪72‬‬

‫‪-‬‬

‫ﻧﺮﻣﺎل‬

‫‪-‬‬

‫ﻋﺎﻟﻲ‬

‫‪14‬‬

‫‪11‬‬

‫‪25‬‬

‫‪32C‬‬

‫‪3B‬‬

‫ﺗﺼﺎدف‬

‫‪DHS‬‬

‫‪645‬‬

‫‪75‬‬

‫‪-‬‬

‫‪ 15‬درﺟﻪ‬

‫‪ 22‬درﺟﻪ‬

‫‪-‬‬

‫ﻣﺘﻮﺳﻂ‬

‫‪35‬‬

‫ﻛﺎﻫﺶ‬

‫واروس و‬

‫ﻓﻠﻜﺸﻦ‬

‫‪ 19‬درﺟﻪ‬ ‫ﻓﻠﻜﺸﻦ‬

‫‪12‬‬

‫‪30‬‬

‫‪32C‬‬

‫‪4‬‬

‫ﺗﺼﺎدف‬

‫‪DCS‬‬

‫‪1020‬‬

‫‪66‬‬

‫‪1/8‬‬

‫ﻧﺮﻣﺎل‬

‫‪-‬‬

‫ﺧﻮب‬

‫‪30‬‬

‫‪13‬‬

‫‪41‬‬

‫‪32C‬‬

‫‪5‬‬

‫ﺗﺼﺎدف‬

‫‪DHS‬‬

‫‪396‬‬

‫‪74‬‬

‫‪-‬‬

‫ﻧﺮﻣﺎل‬

‫‪-‬‬

‫ﻋﺎﻟﻲ‬

‫‪21‬‬

‫‪14‬‬

‫‪42‬‬

‫‪32C‬‬

‫‪5‬‬

‫ﺗﺼﺎدف‬

‫‪DHS‬‬

‫‪340‬‬

‫‪73‬‬

‫‪1/3‬‬

‫ﻧﺮﻣﺎل‬

‫‪-‬‬

‫ﺧﻮب‬

‫‪19‬‬

‫‪15‬‬

‫‪40‬‬

‫‪32B‬‬

‫‪4‬‬

‫ﺗﺼﺎدف‬

‫‪DHS‬‬

‫‪895‬‬

‫‪125‬‬

‫‪-‬‬

‫ﻧﺮﻣﺎل‬

‫ﻛﻢﺗﺮ از ‪10‬‬

‫ﺧﻮب‬

‫‪31‬‬

‫‪16‬‬

‫‪62‬‬

‫‪32C‬‬

‫‪5‬‬

‫اﻓﺘﺎدن‬

‫‪DHS‬‬

‫‪455‬‬

‫‪71‬‬

‫‪-‬‬

‫‪ 20‬درﺟﻪ‬

‫ﻧﺮﻣﺎل‬

‫‪17‬‬

‫‪31‬‬

‫‪32B‬‬

‫‪4‬‬

‫ﺗﺼﺎدف‬

‫‪DCS‬‬

‫‪743‬‬

‫‪73‬‬

‫‪-‬‬

‫‪18‬‬

‫‪32‬‬

‫‪32B‬‬

‫‪4‬‬

‫ﺗﺼﺎدف‬

‫‪DCS‬‬

‫‪390‬‬

‫‪19‬‬

‫‪49‬‬

‫‪32C‬‬

‫‪5‬‬

‫اﻓﺘﺎدن‬

‫‪DHS‬‬

‫‪860‬‬

‫‪20‬‬

‫‪51‬‬

‫‪32B‬‬

‫‪5‬‬

‫‪DCS‬‬

‫‪1125‬‬

‫درﺟﻪ ﻛﺎﻫﺶ‬ ‫اﻛﺴﺘﻨﺸﻦ‬ ‫‪-‬‬

‫ﺧﻮب‬

‫‪25‬‬

‫ﻛﺎﻫﺶ‬ ‫ﻓﻠﻜﺸﻦ‬ ‫‪70‬‬ ‫‪65‬‬ ‫‪104‬‬

‫‪1/5‬‬ ‫‬‫‪-‬‬

‫ﻧﺮﻣﺎل‬ ‫ﻧﺮﻣﺎل‬ ‫ﻧﺮﻣﺎل‬ ‫ﻧﺮﻣﺎل‬

‫‬‫‬‫‬‫ﻛﻢﺗﺮ از ‪10‬‬

‫ﻋﺎﻟﻲ‬ ‫ﺧﻮب‬ ‫ﻋﺎﻟﻲ‬ ‫ﺧﻮب‬

‫‪14‬‬ ‫‪16‬‬ ‫‪29‬‬ ‫‪23‬‬

‫درﺟﻪ ﻛﺎﻫﺶ‬ ‫اﻛﺴﺘﻨﺸﻦ‬ ‫‪DHS: Dynamic Hip Screw, DCS: Dynamic Condylar Screw, AO: Arbeitsgemeinschaft für Osteosynthese‬‬

‫ﺳﻌﻴﺪرﺿﺎ ﻣﻬﺮﭘﻮر و ﻫﻤﻜﺎران‬

‫‪107‬‬

‫ﺷــﻜﻞ‪ -A :1 -‬رادﻳــﻮﮔﺮاﻓﻲ ﻗﺒــﻞ از ﻋﻤــﻞ‪ :‬ﺷﻜــﺴﺘﮕﻲﻫــﺎي ﭼﻨــﺪ ﻗﻄﻌــﻪاي‬ ‫ﺳــﺎبﺗﺮوﻛﺎﻧﺘﺮﻳــﻚ‪ -B .‬در دو ﺑــﺮش ﻛﻮﭼــﻚ ‪ Submuscular plate‬در ﻣﺤــﻞ‬ ‫ﺷﻜﺴﺘﮕﻲ ﻗﺮار داده ﻣﻲﺷﻮد‪ -C .‬رادﻳﻮﮔﺮاﻓﻲ ﺑﻌﺪ از ﻋﻤﻞ‪ -D .‬ﺟﻮشﺧﻮردن ﻛﺎﻣﻞ‬ ‫ﺷﻜﺴﺘﮕﻲ در رادﻳﻮﮔﺮاﻓﻲ ﺑﻌﺪ از ﺷﺶ ﻣﺎه‪.‬‬

‫ﺣﺎﺿﺮ ﺑﻪ اداﻣﻪ ﻫﻤﻜﺎري ﻧـﺸﺪﻧﺪ‪ .‬ﺑﻨـﺎﺑﺮاﻳﻦ در ﻧﻬﺎﻳـﺖ ‪ 20‬ﺑﻴﻤـﺎر ﺑـﺮاي‬ ‫اﻧﺠﺎم اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺎﻗﻲ ﻣﺎﻧﺪﻧﺪ‪ 16 .‬ﺑﻴﻤﺎر ﺑـﺮ اﺛـﺮ ﺗـﺼﺎدﻓﺎت ﺟـﺎدهاي و‬ ‫ﭼﻬﺎر ﺑﻴﻤﺎر ﺑﺮ اﺛﺮ اﻓﺘﺎدن از ارﺗﻔﺎع دﭼـﺎر ﺷﻜـﺴﺘﮕﻲ ﺷـﺪه ﺑﻮدﻧـﺪ‪ .‬ﺑـﺮ‬ ‫اﺳﺎس ﻃﺒﻘﻪﺑﻨﺪي ‪ Seinheimer‬ﭼﻬﺎر ﺑﻴﻤﺎر در ﺗﻴـﭗ ﺳـﻪ ﻗـﺮار داﺷـﺘﻨﺪ‬

‫ﺷﻜﻞ‪ -A :2 -‬رادﻳﻮﮔﺮاﻓﻲ ﺑﻴﻤﺎر ﺷﻤﺎره ‪ -B ،11‬رادﻳﻮﮔﺮاﻓﻲ ﺑﻌـﺪ از ﻋﻤـﻞ ﺑﻴﻤـﺎر‬ ‫ﺷﻤﺎره ‪ -C ،11‬رادﻳﻮﮔﺮاﻓﻲ درﻣﺎن ﺑﻌﺪ از ﮔﺬﺷﺖ ﻳﻚ ﺳﺎل از ﻋﻤﻞ‬

‫)ﻳﻚ ﺑﻴﻤﺎر ﺗﻴﭗ ‪ 3A‬و ﺳﻪ ﺑﻴﻤﺎر در ﺗﻴﭗ ‪ 9 ،(3B‬ﺑﻴﻤﺎر در ﺗﻴﭗ ﭼﻬﺎر و‬ ‫ﻫﻔﺖ ﺑﻴﻤﺎر در ﺗﻴﭗ ﭘﻨﺞ ﺷﻜﺴﺘﮕﻲ ﺑﻮدﻧـﺪ‪ .‬ﺑـﻪ ﻃـﻮر ﻣﺘﻮﺳـﻂ ﺑﻴﻤـﺎران‬ ‫‪ 22/5‬ﻣﺎه )‪ 12‬ﺗﺎ ‪ 35‬ﻣﺎه( ﺗﺤﺖ ﭘﻲﮔﻴﺮي درﻣﺎﻧﻲ ﻗـﺮار ﮔﺮﻓﺘﻨـﺪ‪ .‬ﻫـﺸﺖ‬ ‫ﻣﻮرد از ﺑﻴﻤﺎران ﺗﺤﺖ درﻣﺎن ‪ DCS‬و ‪ 12‬ﻣﻮرد ﺗﺤـﺖ درﻣـﺎن ﺑـﺎ‬

‫‪DHS‬‬

‫ﭘﺎﻳﺎن ﺳﺎل اول ﺻﻮرت ﮔﺮﻓﺖ‪ .‬ﺟﻮشﺧﻮردن ﺗﻤﺎم ﺑﻴﻤـﺎران در ﻧﻬﺎﻳـﺖ‬ ‫ﻣﺸﺎﻫﺪه ﺷﺪ )ﺷﻜﻞ ‪) (2‬ﺟﺪول ‪.(1‬‬

‫ﻗﺮار ﮔﺮﻓﺘﻨﺪ‪ .‬ﻃﻮل ﻣﺘﻮﺳﻂ ﺟﺮاﺣﻲ ‪ 79/4‬دﻗﻴﻘﻪ )‪ 60‬ﺗـﺎ ‪ 125‬دﻗﻴﻘـﻪ( و‬ ‫ﻣﻴﺰان ﻣﺘﻮﺳﻂ ﺧﻮنرﻳﺰي در ﺣﻴﻦ ﻋﻤﻞ ‪ 634‬ﻣﻴﻠﻲﻟﻴﺘﺮ )‪ 340‬ﺗـﺎ ‪(1160‬‬ ‫ﺑﻮد‪ .‬ﻣﺘﻮﺳﻂ زﻣﺎن ﺟﻮشﺧﻮردن ﺷﻜﺴﺘﮕﻲﻫﺎ ‪ 19‬ﻫﻔﺘﻪ ﺑﻮد‪ .‬ﭘﻨﺞ ﻧﻔـﺮ از‬

‫ﺑﺤﺚ‬

‫ﺑﻴﻤﺎران دﭼﺎر ﻋﺪم ﺗﻨﺎﺳﺐ ﻃﻮل اﻧﺪامﻫﺎ ﺷﺪﻧﺪ ﻛﻪ ﺑﻪ ﻃﻮر ﻣﻌﻤﻮل اﻧـﺪام‬

‫ﻣﻌﻤﻮﻻً ﺷﻜﺴﺘﮕﻲﻫﺎي ﺳﺎبﺗﺮوﻛﺎﻧﺘﺮﻳﻚ ﺑﺮ اﺛﺮ ﺗﺮوﻣﺎﻫﺎي ﺑﺎ اﻧـﺮژي‬

‫ﺗﺤﺖ ﺟﺮاﺣﻲ ‪ 1/52cm‬ﻛﻮﭼﻚﺗﺮ از اﻧﺪام ﺳﺎﻟﻢ ﺑﻮد ﻛﻪ اﻟﺒﺘﻪ ﻫﻴﭻﻛـﺪام‬

‫ﺑﺎﻻ در اﻓﺮاد ﺟﻮان رخ ﻣﻲدﻫﺪ‪ .‬از ﻃﺮﻓﻲ اﻳﻦ ﻗﺴﻤﺖ از ﺑـﺪن در ﺑﺮاﺑـﺮ‬

‫از اﻳﻦ ﺑﻴﻤﺎران ﭘﺲ از ﺟﺮاﺣﻲ ﺑﻪ ﻋﻠـﺖ ﻋـﺪم ﺗﻨﺎﺳـﺐ اﻧـﺪامﻫـﺎ دﭼـﺎر‬

‫ﻧﻴﺮوﻫــﺎي ﻓــﺸﺎرﻧﺪه زﻳــﺎدي از ﻃــﺮف ﻗــﺴﻤﺖ داﺧــﻞ ﻗــﺮار دارد‪.‬‬

‫ﻟﻨﮕﻴﺪن ﻧﺸﺪﻧﺪ‪ .‬دو ﻧﻔﺮ از ﺑﻴﻤـﺎران در ﺣـﺪود ‪ 20‬درﺟـﻪ واروس ﭘﻴـﺪا‬

‫ﺷﻜﺴﺘﮕﻲﻫﺎي اﻳﻦ ﻧﺎﺣﻴﻪ از ﺑﺪن ﻳﻜـﻲ از ﻣﻌـﻀﻼت درﻣـﺎن ﺑـﻪ ﻋﻠـﺖ‬

‫ﻛﺮده و ﻳﻜﻲ از ﺑﻴﻤﺎران ﻧﻴﺰ در ﻗـﺴﻤﺖ ﭘﺮوﮔﺰﻳﻤـﺎل ﺷﻜـﺴﺘﮕﻲ دﭼـﺎر‬

‫ﻣﻴﺰان ﺑﺎﻻي ﻋﻮارض ﻧﺎﺷﻲ از ﻋﻤﻞ ﻣﺎﻧﻨـﺪ ﻋـﺪم ﺟـﻮشﺧـﻮردﮔﻲ‪ ،‬ﺑـﺪ‬ ‫‪13‬‬

‫ﻓﻠﻜﺸﻦ دﻓـﻮرﻣﻴﺘﻲ )‪ (Anterior angulation‬ﻗﻄﻌـﻪ ﭘﺮوﮔﺰﻳﻤـﺎل ﺷـﺪﻧﺪ‪،‬‬

‫ﺟــﻮشﺧــﻮردﮔﻲ ﺑــﻪ وﺳــﻴﻠﻪ ﺟﺮاﺣــﺎن ارﺗﻮﭘــﺪ ﻣــﻲﺑﺎﺷــﺪ‪ .‬وﺳــﺎﻳﻞ‬

‫ﺷﺎﻳﺎن ذﻛﺮ اﺳﺖ ﻛﻪ ﻫﻴﭻﻛﺪام از اﻳﻦ دﻓﻮرﻣﻴﺘﻲﻫﺎ ﻣﻨﺠﺮ ﺑﻪ درد ﻳـﺎ ﻋـﺪم‬

‫اﻳﻨﺘﺮاﻣﺪوﻻري در درﻣﺎن اﻳـﻦ ﻧـﻮع از ﺷﻜـﺴﺘﮕﻲﻫـﺎ ﻧـﺴﺒﺖ ﺑـﻪ ﺳـﺎﻳﺮ‬

‫ﻛﺎراﻳﻲ اﻧﺪام ﻧﺸﺪه اﺳﺖ‪ .‬ﻃﺒﻖ ﻣﻌﻴﺎرﻫﺎي ‪ 12Radford‬آﺧﺮﻳﻦ ارزﻳﺎﺑﻲ در‬

‫ﺗﻜﻨﻴﻚﻫﺎ ﻣﺎﻧﻨﺪ ‪ DHS‬و ‪ DCS‬ﻳﺎ ‪ Angle blades‬ﺑﻴﺶﺗﺮ ﻣﻮرد ﺗﻮﺟﻪ ﻗﺮار‬

Mehrpour et al. ‫ در‬biologic plate ‫ﺑﺮرﺳﻲ ﺗﻜﻨﻴﻚ‬ ‫ﻗﻄﻌﻪاي ﺳﺎب ﺗﺮوﻛﺎﻧﺘﺮﻳﻚ اﺳﺘﺨﻮان ران‬ ‫ﻫﺎي ﭼﻨﺪ‬S. ‫ﺷﻜﺴﺘﮕﻲ‬

108

‫ﺗﻨﻬﺎ روش ﺑﺴﻴﺎر آﺳﺎﻧﻲ ﻣـﻲﺑﺎﺷـﺪ ﺑﻠﻜـﻪ ﻧـﺴﺒﺖ ﺑـﻪ ﺳـﺎﻳﺮ روشﻫـﺎ از‬

‫ ﺑﺮ اﺳﺎس ﻣﻄﺎﻟﻌﺎت ﻗﺒﻠﻲ ﻋﻮارض ﻧﺎﺷﻲ از ﻋﻤﻞ ﺑـﻪ وﺳـﻴﻠﻪ‬14.‫ﮔﺮﻓﺘﻪاﻧﺪ‬

‫ ﻫـﻢﭼﻨـﻴﻦ‬،‫ﻛﻢﺗﺮﻳﻦ ﻣﻴﺰان ﺑﻬﺮهﮔﻴﺮي از ﻓﻠﻮروﺳﻜﻮﭘﻲ ﺑﺮﺧﻮردار اﺳـﺖ‬

‫ ﻫـﻢﭼﻨـﻴﻦ‬15‫و‬16.‫ از ﺑﻴﻤـﺎران رخ ﻣـﻲدﻫـﺪ‬%20 ‫اﻳﻦ ﺗﻜﻨﻴﻚ در ﺑﻴﺶ از‬

،Pon-Cheng Lee .‫زﻣﺎن ﺟﺮاﺣﻲ ﺑﻪ ﻃﻮر ﻗﺎﺑﻞ ﺗﻮﺟﻬﻲ ﻛﺎﻫﺶ ﻣـﻲﻳﺎﺑـﺪ‬

‫ﻋﻮارض ﭘﺲ از ﻋﻤﻞ ﻣﺎﻧﻨﺪ ﺑﻴﺮونزدﮔﻲ ﭘﻴﭻﻫـﺎ از ﻧﺎﺣﻴـﻪ ﻟﺘـﺮال و ﻧﻴـﺰ‬

‫ﻛﺎراﻳﻲ ﺻﻔﺤﻪﮔـﺬاري ﺑﻴﻮﻟﻮژﻳـﻚ و ﻣـﻴﺦﮔـﺬاري درون اﺳـﺘﺨﻮاﻧﻲ را‬

‫ﻣﻬﺎﺟﺮت آنﻫﺎ ﺑﻪ داﺧﻞ ﻣﻔﺼﻞ و اﻳﺠـﺎد درد ﻓـﺮاوان و ﻛـﺎﻫﺶ ﻣﻴـﺰان‬

‫ در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺎ ﺗﻮﺟـﻪ‬.‫ﻣﻘﺎﻳﺴﻪ و ﺗﻔﺎوت ﻣﻌﻨﻲداري را ﮔﺰارش ﻧﻜﺮد‬

‫ ﺑﻴﻤـﺎران ﺗﺤـﺖ‬%20 15.‫ﺣﺮﻛﺎت از ﺳﺎﻳﺮ ﻋﻮارض اﻳﻦ ﺗﻜﻨﻴﻚ ﻣﻲﺑﺎﺷـﺪ‬

‫ﺑﻪ ﺑﻬﺒﻮدي ﻛﺎﻣﻞ ﺑﻴﻤﺎران و اﺳﺘﻔﺎده از وﺳﺎﻳﻞ ارزان ﻗﻴﻤﺖ و ﻫـﻢﭼﻨـﻴﻦ‬

‫ ﻗﻮﻳﺎً ﺻﻔﺤﻪﮔﺬاري ﺳـﺎبﻣﺎﺳـﻜﻮﻻر را‬،‫ ﻧﻮﻳﺴﻨﺪﮔﺎن‬،‫ﻛﺎﻫﺶ زﻣﺎن ﻋﻤﻞ‬

‫ﻣﻌﻤﻮﻻً اﻋﻤﺎل ﺟﺮاﺣﻲ ﻛﻪ ﺑﻪ ﺻﻮرت ﻣﺴﺘﻘﻴﻢ ﻣﻜﺎن ﺷﻜﺴﺘﮕﻲ را ﻫﺪف‬

‫ﺑﺮاي درﻣﺎن ﺷﻜﺴﺘﮕﻲﻫﺎي ﭼﻨـﺪ ﻗﻄﻌـﻪاي ﺳـﺎبﺗﺮوﻛﺎﻧﺘﺮﻳـﻚ ﺗﻮﺻـﻴﻪ‬

‫ ﻋﻮارﺿـﻲ ﻣﺎﻧﻨـﺪ‬،‫ﻗﺮار ﻣﻲدﻫﻨﺪ ﺑﻪ ﻋﻠﺖ در ﻣﻌﺮض ﻗﺮار دادن اﺳﺘﺨﻮان‬

‫ اﻳﻦ ﻣﻘﺎﻟﻪ ﺣﺎﺻﻞ ﭘﺎﻳﺎنﻧﺎﻣـﻪ ﺑـﺎ ﻋﻨـﻮان "ﺑﺮرﺳـﻲ‬:‫ ﺳﭙﺎﺳﮕﺰاري‬.‫ﻣﻲﻛﻨﻨﺪ‬

‫ ﺷﻜــﺴﺘﮕﻲ دوﺑــﺎره و ﺗـﺄﺧﻴﺮ در ﺟــﻮشﺧــﻮردن را اﻓــﺰاﻳﺶ‬،‫ﻋﻔﻮﻧــﺖ‬

‫ﻧﺘﺎﻳﺞ درﻣﺎﻧﻲ ﺷﻜﺴﺘﮕﻲﻫﺎي ﭼﻨﺪ ﻗﻄﻌﻪاي ﺳﺎبﺗﺮوﻛﺎﻧﺘﺮﻳـﻚ اﺳـﺘﺨﻮان‬

‫ ﻣـﻲﺗﻮاﻧـﺪ‬DHS ‫ ﻳـﺎ‬DCS ‫ ﺻﻔﺤﻪ ﮔﺬاري زﻳﺮ ﻋﻀﻼﻧﻲ ﻣﺎﻧﻨـﺪ‬17.‫ﻣﻲدﻫﺪ‬

‫ران ﺑﺎ روش ﻓﻴﻜﺴﺎﺳﻴﻮن ﺑﻴﻮﻟﻮژﻳﻚ در ﺑﻴﻤﺎران ﺗﺤﺖ ﻋﻤﻞ ﺟﺮاﺣﻲ در‬

‫ ﻗـﺴﻤﺖ‬.‫ﮔﺰﻳﻨﻪ ﻣﻨﺎﺳﺒﻲ در درﻣﺎن اﻳـﻦ ﺷﻜـﺴﺘﮕﻲﻫـﺎي دﺷـﻮار ﺑﺎﺷـﺪ‬

‫" در ﻣﻘﻄــﻊ دﻛﺘــﺮاي‬1385-90 ‫ﺑﻴﻤﺎرﺳــﺘﺎن ﺷــﺮﻳﻌﺘﻲ در ﺳــﺎلﻫــﺎي‬

‫ﺷﻜﺴﺘﮕﻲ ﭼﻨﺪ ﻗﻄﻌﻪاي ﺑﻪ ﺻﻮرت ﻣﺴﺘﻘﻴﻢ ﺑـﻪ وﺳـﻴﻠﻪ ﺻـﻔﺤﻪﮔـﺬاري‬

239 ‫ و ﻛــﺪ‬1390 ‫ﺗﺨﺼــﺼﻲ ﺟــﺮاح اﺳــﺘﺨﻮان و ﻣﻔﺎﺻــﻞ در ﺳــﺎل‬

‫ اﻣﺎ ﺗﻤﺎم ﺷﻜـﺴﺘﮕﻲﻫـﺎي ﺑﻴﻤـﺎران در اﻳـﻦ‬،‫ﺳﺎبﻣﺎﺳﻜﻮﻻر ﺛﺎﺑﺖ ﻧﺸﺪه‬

‫ ﻣﻲﺑﺎﺷﺪ ﻛﻪ ﺑﺎ ﺣﻤﺎﻳﺖ داﻧﺸﮕﺎه ﻋﻠـﻮم ﭘﺰﺷـﻜﻲ ﺗﻬـﺮان اﺟـﺮا‬90/7/10

.‫ ﺗـﺮﻣﻴﻢ ﻛﺎﻣـﻞ ﻳﺎﻓﺘـﻪاﻧـﺪ‬،‫ﻣﻄﺎﻟﻌﻪ ﺑﺪون ﻧﻴﺎز ﺑﻪ ﮔﺮﻓﺖ ﻳﺎ ﺳﺎﻳﺮ درﻣﺎنﻫـﺎ‬

‫ در اﻳﻦ ﻣﻘﺎﻟﻪ از ﻣﺮﻛﺰ رﺷﺪ اﺳﺘﻌﺪادﻫﺎي درﺧـﺸﺎن و ﻣﺮﻛـﺰ‬.‫ﺷﺪه اﺳﺖ‬

‫ﻋﻠــﺖ آن ﺣــﺪاﻗﻞ دﺳــﺖﻛــﺎري در ﺑﺎﻓــﺖﻫــﺎي اﻃــﺮاف ﺷﻜــﺴﺘﮕﻲ و‬

‫ﭘﮋوﻫﺶﻫـﺎي داﻧـﺸﺠﻮﻳﻲ داﻧـﺸﮕﺎه ﻋﻠـﻮم ﭘﺰﺷـﻜﻲ ﺗﻬـﺮان ﺑـﻪ ﻣﻨﻈـﻮر‬

‫ اﺳــﺘﺨﻮان در ﺷﻜــﺴﺘﮕﻲﻫــﺎي ﻧﺎﺣﻴــﻪ‬.‫ﭘﺮﻳﻮﺳــﺖ اﺳــﺘﺨﻮان ﻣــﻲﺑﺎﺷــﺪ‬

.‫ﺣﻤﺎﻳﺖﻫﺎي اﻧﺠﺎم ﺷﺪه در اﻧﺠﺎم اﻳﻦ ﻃﺮح ﺗﻘﺪﻳﺮ و ﻗﺪرداﻧﻲ ﻣﻲﺷﻮد‬

‫ اﻳﻦ روش ﻧﻪ‬.‫ﺳﺎبﺗﺮوﻛﺎﻧﺘﺮﻳﻚ ﻛﺎﻟﻮس ﺗﺸﻜﻴﻞ داده و ﺟﻮش ﻣﻲﺧﻮرد‬

.‫ﻋﻤﻞ ﻓﻴﻜﺴﺎﺳﻴﻮن اﻳﻨﺘﺮاﻣﺪوﻻري ﻧﻴﺎز ﺑﻪ ﻋﻤﻞ ﻣﺠـﺪد ﭘﻴـﺪا ﻣـﻲﻛﻨﻨـﺪ‬

References 1. 2.

3. 4. 5.

Seinsheimer F. Subtrochanteric fractures of the femur. J Bone Joint Surg Am 1978;60(3):300-6. Celebi L, Can M, Muratli HH, Yagmurlu MF, Yuksel HY, Bicimoğlu A. Indirect reduction and biological internal fixation of comminuted subtrochanteric fractures of the femur. Injury 2006;37(8):740-50. Siebenrock KA, Müller U, Ganz R. Indirect reduction with a condylar blade plate for osteosynthesis of subtrochanteric femoral fractures. Injury 1998;29 Suppl 3:C7-15. Kinast C, Bolhofner BR, Mast JW, Ganz R. Subtrochanteric fractures of the femur. Results of treatment with the 95 degrees condylar blade-plate. Clin Orthop Relat Res 1989;(238):122-30. Starr AJ, Hay MT, Reinert CM, Borer DS, Christensen KC. Cephalomedullary nails in the treatment of high-energy proximal femur fractures in young patients: a prospective, randomized comparison of trochanteric versus piriformis fossa entry portal. J Orthop Trauma 2006;20(4):240-6. Boldin C, Seibert FJ, Fankhauser F, Peicha G, Grechenig W, Szyszkowitz R. The proximal femoral nail (PFN): a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a follow-up of 15 months. Acta Orthop Scand 2003;74(1):53-8. Ertürer E, Tekkeşin M, Dirik Y, Aksoy B, Oztürk I. Radiographic and functional results of osteosynthesis with locked intramedulary nailing of subtrochanteric fractures of the femur. Acta Orthop Traumatol Turc 2004;38(4):265-9.

9. 10. 11.

12. 13. 14. 15. 16. 17.

Lee PC, Hsieh PH, Yu SW, Shiao CW, Kao HK, Wu CC. Biologic plating versus intramedullary nailing for comminuted subtrochanteric fractures in young adults: a prospective, randomized study of 66 cases. J Trauma 2007;63(6):1283-91. Müller ME, Nazarian S, Koch P, Schatzker J. The Comprehensive Classification of Fractures of Long Bones. New York: Springer; 1990. Seinsheimer F. Subtrochanteric fractures of the femur. J Bone Joint Surg Am 1978;60(3):300–306. Krettek C, Rudolf J, Schandelmaier P, Guy P, Könemann B, Tscherne H. Unreamed intramedullary nailing of femoral shaft fractures: operative technique and early clinical experience with the standard locking option. Injury 1996;27(4):233-54. Radford PJ, Howell CJ. The AO dynamic condylar screw for fractures of the femur. Injury 1992;23(2):89-93.. Bedi A, Toan Le T. Subtrochanteric femur fractures. Orthop Clin North Am 2004;35(4):473-83. Tencer AF, Johnson KD, Johnston DW, Gill K. A biomechanical comparison of various methods of stabilization of subtrochanteric fractures of the femur. J Orthop Res 1984;2(3):297-305. Pervez H, Parker MJ. Results of the long Gamma nail for complex proximal femoral fractures. Injury 2001;32(9):704-7. Kakkar R, Kumar S, Singh AK. Cephalomedullary nailing for proximal femoral fractures. Int Orthop 2005;29(1):21-4. Kinast C, Bolhofner BR, Mast JW, Ganz R. Subtrochanteric fractures of the femur. Results of treatment with the 95 degrees condylar blade-plate. Clin Orthop Relat Res 1989;(238):122-30.

109

‫ﻋﻤﻮﻣﻲ‬ ‫ﺑﺨﺸﻬﺎي ﺟﺮاﺣﻲ‬ ‫ﺟﺮاﺣﻲ در‬ ‫ﻋﻔﻮﻧﺖ ﻣﺤﻞ‬ ‫ﺗﺸﺨﻴﺺ‬ ‫ ﭘﺎﻳﺶ‬2012: ‫دو روش‬104-109 ‫ﻛﺎراﻳﻲ‬ Tehran University Medical Journal; Vol. 70, No.‫ﺑﺮاي‬ 2, May

Biological plating in comminuted subtrochanteric fractures

Abstract Saeedreza Mehrpour M.D.1 Mohamadreza Tavvafi M.D.1 Reza Sorbi2 Mohamad Reza Aghamirsalim2*

Received: January 01, 2012 Accepted: January 29, 2012

Background: Comminuted subtrochanteric fractures have been a challenge for orthopedic surgeons in terms of appropriate reduction and stable fixation. Numerous methods have been used for the fixation of comminuted subtrochanteric fractures

1- Department of Orthopaedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2- Medical Student, Students’ Scientific Research Center (SSRC), Exceptional Talent Development Center (ETDC), Tehran University of Medical Sciences, Tehran, Iran.

among which some are accompanied with technical difficulties and complications of their own. Regarding the results of previous studies, we decided to evaluate the biological fixation method in comminuted subtrochanteric fractures. Methods: In this prospective study, we evaluated 20 men with comminuted subtrochanteric femoral fractures. The patients underwent indirect reduction with dynamic hip screw (DHS) or dynamic condylar screw (DCS) fixation within one week of injury. The patients were evaluated clinically for pain, hip and knee range of motion, leg-length discrepancy and angular and rotational deformities, in addition the radiographic assessment of the union. Results: According to Seinsheimer's classification of subtrochanteric fractures, four patients had type III, nine had type IV and seven had type V fractures. Fracture fixation was performed by DCS in eight and by DHS in 12 cases. The average time of the operations was 79.4 (ranging from 60-125) minutes. Mean blood loss was 634 (ranging from 340-1160) milliliters. Uneventfully, union occurred in all patients with no clinical pain or dysfunction. Conclusion: Submuscular plating with either DCS or DHS is a viable option to treat comminuted subtrochanteric fractures. The results of this study highly suggest use of submuscular plating in the treatment of comminuted subtrochanteric fractures, especially in the third world countries.

Corresponding author: School of Medicine, Tehran University of Medical Sciences, Poursina St., Keshavarz Blvd., Tehran, Iran. Tel: +98- 21- 88717358 E-mail: aghamirsalim@gmail.com

Keywords: Biological fixation, dynamic condylar screw, dynamic hip screw, subtrochanteric fracture.

‫زﻧﺎن‪110-118‬‬ ‫‪،1391‬‬ ‫اردﻳﺒﻬﺸﺖ‬ ‫ﺷﻤﺎره ‪2‬‬ ‫دوره ‪، ،70‬‬ ‫ﭘﺰﺷﻜﻲ‬ ‫داﻧﺸﮕﺎه ﻋﻠﻮم‬ ‫ﻻﻛﺘﺎت‬ ‫ﻛﻮرﺗ‪،‬ﻴﺰول و‬ ‫آﻧﺪروژنﻫﺎ‪،‬‬ ‫ﺗﻬﺮان‪ ،‬ﺑﺮ‬ ‫اﺳﺘﻘﺎﻣﺘﻲ‬ ‫ﻣﻘﺎوﻣﺘﻲ و‬ ‫ﭘﺰﺷﻜﻲ‪،‬ﺗﻤﺮﻳﻨﺎت‬ ‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﺗﺄﺛﻴﺮ‬

‫‪110‬‬

‫ﺗﺄﺛﻴﺮ ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ و اﺳﺘﻘﺎﻣﺘﻲ ﺑﺮ ﭘﺎﺳﺦ ﺣﺎد آﻧﺪروژنﻫﺎ‪ ،‬ﻛﻮرﺗﻴﺰول و ﻻﻛﺘﺎت زﻧﺎن ﻣﺴﻦ‬

‫ﺗﺎرﻳﺦ درﻳﺎﻓﺖ ﻣﻘﺎﻟﻪ‪ 1390/06/26 :‬ﺗﺎرﻳﺦ ﭘﺬﻳﺮش‪1390/11/09 :‬‬

‫دﻧﻴﺎ ﺻﻮرﺗﻲ ﺟﺎﺑﻠﻮ‪ 1،‬ﺳﻴﺪ رﺿﺎ ﻋﻄﺎرزاده‬

‫ﭼﻜﻴﺪه‬

‫ﺣﺴﻴﻨﻲ‪ *1،‬دﻻرام ﺻﻴﺎدﭘﻮر زﻧﺠﺎﻧﻲ‪،‬‬

‫‪2‬‬

‫زﻣﻴﻨﻪ و ﻫﺪف‪ :‬ﺑﺎ اﻓﺰاﻳﺶ ﺳﻦ زﻧﺎن ﺑﻪ ﺗﺪرﻳﺞ ﺳﻄﺢ ﭘﺎﻳﻪ آﻧﺪروژنﻫﺎ ﻛﺎﻫﺶ ﻣﻲﻳﺎﺑﺪ‪ ،‬ﻛﻪ ﻣﻤﻜﻦ اﺳﺖ ﺳـﺒﺐ ﺧـﺴﺘـﮕﻲ‪،‬‬

‫‪1‬‬

‫اﻣﻴﻦ اﺣﻤﺪي‬

‫ﻛﺎﻫﺶ ﻗﺪرت ﻋﻀﻼﻧﻲ و ﺗﺮاﻛﻢ اﺳﺘﺨﻮان ﺷﻮد‪ .‬ﺑﻪ ﻫﻤﻴﻦ ﻣﻨﻈﻮر اﻳﻦ ﺗﺤﻘﻴﻖ ﺑﺎ ﻫﺪف ﺗﺄﺛﻴﺮ ﺗﻤﺮﻳﻨﺎت ﻣﻘﺎوﻣﺘﻲ و اﺳﺘﻘﺎﻣﺘﻲ‬ ‫‪ -1‬ﮔﺮوه ﻓﻴﺰﻳﻮﻟﻮژي ورزﺷﻲ داﻧﺸﻜﺪه ﺗﺮﺑﻴﺖ‬

‫ﺑﺮ ﭘﺎﺳﺦﻫﺎي ﺣﺎد آﻧﺪروژنﻫﺎ‪ ،‬ﻛﻮرﺗﻴﺰول و ﻻﻛﺘﺎت زﻧﺎن ﻣﺴﻦ اﻧﺠﺎم ﺷﺪ‪ .‬روش ﺑﺮرﺳﻲ‪ 10 :‬زن ﻣﺴﻦ ﺑﺎ ﻣﻴـﺎﻧﮕﻴﻦ ﺳـﻦ‬

‫ﺑﺪﻧﻲ و ﻋﻠﻮم ورزﺷﻲ داﻧﺸﮕﺎه ﻓﺮدوﺳﻲ ﻣﺸﻬﺪ‪،‬‬

‫‪ 54/30±3/74‬ﺳﺎل و ﻧﻤﺎﻳﻪ ﺗﻮده ﺑﺪن ‪ 24/88±2/07‬ﻛﻴﻠﻮﮔﺮم ﻣﺘﺮﻣﺮﺑﻊ ﺑﻪ ﻃﻮر ﺗﺼﺎدﻓﻲ در ﻳﻚ ﺟﻠﺴﻪ ﺗﻤـﺮﻳﻦ ﻣﻘـﺎوﻣﺘﻲ‪،‬‬

‫ﻣﺸﻬﺪ‪ ،‬اﻳﺮان‪.‬‬ ‫‪ -2‬ﮔﺮوه ﭘﺎﺗﻮﻟﻮژي‪ ،‬ﻣﺮﻛﺰ ﻓﺮﻫﻨﮕﻲ ﺗﺤﻘﻴﻘﺎﺗﻲ‬ ‫ﻋﻠﻤﻲ ﺟﻬﺎد داﻧﺸﮕﺎﻫﻲ اﻳﺮان‪ ،‬ﻣﺸﻬﺪ‪ ،‬اﻳﺮان‪.‬‬

‫اﺳﺘﻘﺎﻣﺘﻲ و ﻳﻚ ﺟﻠﺴﻪ اﺳﺘﺮاﺣﺖ ﺷﺮﻛﺖ ﻛﺮدﻧﺪ‪ .‬ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ ‪ 45‬دﻗﻴﻘﻪ‪ ،‬ﺷﺎﻣﻞ‪ :‬ﺳﻪ ﺳﺖ ‪ 10‬ﺗﻜﺮاري ﻫﺸﺖ ﺣﺮﻛـﺖ‬ ‫وزﻧﻪ ﺗﻤﺮﻳﻨﻲ ﺑﺎ ‪ %80‬ﻳﻚ ﺗﻜﺮار ﺑﻴﺸﻴﻨﻪ ﺑﻮد‪ .‬ﺗﻤـﺮﻳﻦ اﺳـﺘﻘﺎﻣﺘﻲ ‪ 45‬دﻗﻴﻘـﻪ ﻓﻌﺎﻟﻴـﺖ روي دوﭼﺮﺧـﻪ ﻛﺎرﺳـﻨﺞ ﺑـﺎ ﺷـﺪت‬ ‫‪ %60-%70‬ﺣﺪاﻛﺜﺮ اﻛﺴﻴﮋن ﻣﺼﺮﻓﻲ ﺑﻮد‪ .‬در ﺟﻠﺴﻪ اﺳﺘﺮاﺣﺖ )ﻛﻨﺘﺮل( ‪ 45‬دﻗﻴﻘﻪاي ﻫﻴﭻ ﻓﻌﺎﻟﻴﺘﻲ اﻧﺠـﺎم ﻧﻤـﻲﮔﺮﻓـﺖ‪ .‬از‬ ‫اﻓﺮاد ﻗﺒﻞ‪ ،‬ﺑﻼﻓﺎﺻﻠﻪ و ‪ 15‬دﻗﻴﻘﻪ ﺑﻌﺪ از ﺗﻤﺮﻳﻦ و اﺳﺘﺮاﺣﺖ‪ ،‬ﻧﻤﻮﻧـﻪﮔﻴـﺮي ﺧـﻮﻧﻲ ﮔﺮﻓﺘـﻪ ﺷـﺪ و ﻣﻘـﺎدﻳﺮ آﻧـﺪروژنﻫـﺎ‪،‬‬ ‫ﻛﻮرﺗﻴﺰول و ﻻﻛﺘﺎت ﺳﺮم اﻧﺪازهﮔﻴﺮي ﺷﺪﻧﺪ‪ .‬ﻧﺘﺎﻳﺞ ﺑﺎ اﺳﺘﻔﺎده از روش اﻧﺪازهﮔﻴﺮيﻫـﺎي ﺗﻜـﺮاري در ﺳـﻄﺢ ﻣﻌﻨـﻲداري‬ ‫‪ P<0/05‬ﺗﺠﺰﻳﻪ و ﺗﺤﻠﻴﻞ ﺷﺪﻧﺪ‪ .‬ﻳﺎﻓﺘﻪﻫﺎ‪ :‬ﺗﻐﻴﻴﺮات درون ﮔﺮوﻫﻲ ﺳﻄﻮح اﻓﺰاﻳﺶ ﻳﺎﻓﺘﻪ ﺗﺴﺘﻮﺳﺘﺮون ﭘﺲ از ﻣﺪاﺧﻠـﻪ ﻳـﻚ‬ ‫ﺟﻠﺴﻪ ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ و اﺳﺘﻘﺎﻣﺘﻲ ﻣﻌﻨﻲدار ﺑﻮد )‪ .(P<0/05‬ﻧﺘﺎﻳﺞ ﻧﺸﺎن داد ﭘﺲ از ﻣﺪاﺧﻠﻪ ﻳﻚ ﺟﻠﺴﻪ ﺗﻤـﺮﻳﻦ ﻣﻘـﺎوﻣﺘﻲ‬ ‫ﺳﻄﺢ دﻫﻴﺪرواﭘﻲاﻧﺪرﺳﺘﺮون ﺳﻮﻟﻔﺎت اﻓﺰاﻳﺶ ﻣﻌﻨﻲدار ﻳﺎﻓﺖ )‪ .(P<0/05‬در ﺣﺎﻟﻲ ﻛـﻪ ﺗﻐﻴﻴـﺮات درون ﮔﺮوﻫـﻲ ﻣﻘـﺎدﻳﺮ‬ ‫ﻛﻮرﺗﻴﺰول ﮔﺮوهﻫﺎ ﻣﻌﻨﻲدار ﻧﺒﻮد )‪ ،(P>0/05‬ﺗﻐﻴﻴﺮات ﺑﻴﻦ ﮔﺮوﻫﻲ ﻣﻘﺎدﻳﺮ ﻛﻮرﺗﻴﺰول ﮔـﺮوهﻫـﺎ ﻣﻌﻨـﻲدار ﺑـﻮد )‪.(P<0/05‬‬

‫*‬

‫ﻧﺘﻴﺠﻪﮔﻴﺮي‪ :‬ﻳﻚ ﺟﻠﺴﻪ ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ ﻣﻲﺗﻮاﻧﺪ ﺳﻄﻮح آﻧﺪروژنﻫـﺎ را در زﻧـﺎن ﻣـﺴﻦ اﻓـﺰاﻳﺶ دﻫـﺪ و از اﻳـﻦ ﻧﻈـﺮ‬ ‫ﻧﻮﻳﺴﻨﺪه ﻣﺴﺌﻮل‪ :‬ﻣﺸﻬﺪ‪ ،‬ﻣﻴﺪان آزادي‪ ،‬ﭘﺮدﻳﺲ داﻧﺸﮕﺎه‬

‫ﻓﺮدوﺳﻲ‪ ،‬داﻧﺸﻜﺪه ﺗﺮﺑﻴﺖ ﺑﺪﻧﻲ و ﻋﻠﻮم ورزﺷﻲ‬

‫ﻣﻲﺗﻮاﻧﺪ ﺑﺮاي ﺳﻼﻣﺖ و ﺗﻨﺪرﺳﺘﻲ آنﻫﺎ ﺿﺮوري ﺑﺎﺷﺪ‪.‬‬

‫ﺗﻠﻔﻦ‪0511-8934474 :‬‬ ‫‪E-mail: attarzadeh@um.ac.ir‬‬

‫ﻛﻠﻤﺎت ﻛﻠﻴﺪي‪ :‬آﻧﺪروژنﻫﺎ‪ ،‬ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ‪ ،‬ﺳﻼﻣﺖ‪ ،‬زﻧﺎن ﻣﺴﻦ‪.‬‬

‫ﻣﻘﺪﻣﻪ‬

‫ﻛﺎﻫـﺶ ﻗـﺪرت ﻋﻀﻼﻧـﻲ‪ ،‬ﺗﺮاﻛﻢ اﺳﺘﺨﻮاﻧﻲ‪ ،‬ﺗﻤﺮﻛــﺰ و ﻣﻴـﻞ ﺟﻨـﺴﻲ‬ ‫‪6‬و‪2‬‬

‫ﺷﺪه و ﻣﻮﺟﺒﺎت اﺣﺴﺎس ﺧﺴﺘـﮕﻲ و اﻓﺴـﺮدﮔﻲ را ﻓﺮاﻫﻢ ﻣﻲﺳﺎزد‪.‬‬ ‫زﻧﺎن ﺑﺎ اﻓﺰاﻳﺶ ﺳﻦ ﺗﻐﻴﻴــﺮات ﻗﺎﺑـﻞ ﺗـﻮﺟﻬﻲ در ﻋﻤﻠﻜــﺮد ﻏـﺪد‬

‫اﻋﺘﻘﺎد ﺑﺮ اﻳﻦ اﺳﺖ ﻛﻪ آﻧﺪروژنﻫﺎ ﺑﻪ ﻃﻮر ﻋﻤﺪه ﻣﺘﺎﺑﻮﻟﻴـﺴﻢ اﺳﺘﺨــﻮان‬

‫درونرﻳﺰ )‪ (Endocrine‬ﺗﺠـﺮﺑﻪ ﻣﻲﻛﻨﻨﺪ ﻛﻪ ﻣﻮﺟﺐ ﻣﻲﺷﻮد در ﻣﻌـﺮض‬

‫را ﺗﻨﻈﻴـﻢ ﻣﻲﻛﻨﻨﺪ‪ ،‬ﺑـﻪ ﻋـﻼوه ﻧﻘـﺶ آنﻫـﺎ ﺑـﻪ وﻳـﮋه ﺗـﺴﺘﻮﺳﺘﺮون در‬ ‫‪8‬و‪7‬‬

‫ﻋﻼﻳﻢ و ﻣﺸﻜﻼت ﺟﺴﻤﻲ و رواﻧﻲ ﻣﺘﻌﺪدي ﭼﻮن‪ :‬ﮔُﺮﮔﺮﻓﺘﮕﻲ‪ ،‬ﭘـﻮﻛﻲ‬

‫ﭘﻴﺸﮕﻴﺮي از ﻛﺎﻫﺶ ﺗﻮده اﺳﺘﺨﻮاﻧﻲ‪،‬‬

‫اﺳﺘﺨﻮان‪ ،‬ﺑﻴﻤﺎريﻫـﺎي ﻗﻠﺒـﻲ‪ -‬ﻋﺮوﻗـﻲ‪ ،‬ﻓـﺸﺎرﻫﺎي رواﻧـﻲ‪ ،‬ﺧـﺴﺘﮕﻲ‪،‬‬

‫‪10‬و‪9‬‬

‫ﺧـﻮن‪ 7،‬ارﺗﻘﺎي ﺳﻼﻣﺘـﻲ‪ ،‬ﺷﺎدﻛـﺎﻣﻲ و ﻣﻴﻞ ﺟﻨﺴﻲ ﻧﻴﺰ ﻣﻬـﻢ اﺳـﺖ‪.‬‬

‫ﺗﺤﺮﻳﻚ ﭘﺬﻳﺮي‪ ،‬ﻋﺼﺒﺎﻧﻴﺖ‪ ،‬اﺿﻄﺮاب و اﻓﺴﺮدﮔﻲ ﻗﺮار ﻣﻲﮔﻴﺮﻧﺪ‪ 1-3.‬ﺑـﺎ‬

‫ﺗﺤﻘﻴﻘﺎت ﻧﺸﺎن دادهاﻧﺪ ﻛﻪ ﺳﻄـﻮح ﭘﺎﻳﻴﻦ ﺗﺴﺘﻮﺳﺘﺮون ﻋﺎﻣـﻞ ﻣﺤــﺪود‬

‫اﻓــــﺰاﻳﺶ ﺳــــﻦ‪ ،‬ﺳــــﻄﻮح آﻧــــﺪروژنﻫــــﺎ )ﺗــــﺴﺘﻮﺳﺘﺮون و‬

‫ﻛﻨﻨﺪه ﻗﺪرت و رﺷﺪ ﻋﻀﻼﻧﻲ در زﻧـﺎن ﻣـﺴﻦ اﺳـﺖ‪ 5.‬اﮔﺮﭼـﻪ ﻣﻘـﺪار‬

‫دﻫﻴـﺪرواﭘـﻲآﻧـﺪروﺳﺘﺮون ﺳﻮﻟﻔﺎت( زﻧﺎن ﻛﺎﻫﺶ ﻣﻲﻳﺎﺑﺪ‪5‬و‪ 4‬ﻛﻪ ﺑﺎﻋـﺚ‬

‫ﺗﺴﺘﻮﺳﺘﺮون در زﻧﺎن ﻳﻚ دﻫـﻢ ﻣﻘـﺪار آن در ﻣـﺮدان اﺳـﺖ‪12،‬و‪11‬و‪ 7‬اﻣـﺎ‬

‫اﻓﺰاﻳــﺶ ﮔﻠﺒــﻮلﻫـﺎي ﻗﺮﻣــﺰ‬

‫دﻧﻴﺎ ﺻﻮرﺗﻲ ﺟﺎﺑﻠﻮ و ﻫﻤﻜﺎران‬

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‫ﻫﻤﻴﻦ ﻣﻘﺪار ﻛﻢ‪ ،‬در ﻓﺮاﻳﻨﺪﻫﺎي ﻣﺘﺎﺑﻮﻟﻴﻜﻲ و ﻣﻴﻞ ﺟﻨﺴﻲ ﻧﻘﺶ ﻣﺤـﻮري‬

‫ﺳـــﻨﻲ اﻓـــﺰاﻳﺶ ﻳﺎﻓـــﺖ‪ ،‬اﻣـــﺎ اﻓـــﺰاﻳﺶ در ﺳـــﻄﻮح ﻫﻮرﻣـــﻮن‬

‫دﻫﻴﺪرواﭘﻲآﻧﺪرﺳﺘﺮون ﺳﻮﻟﻔﺎت ﻧﻴﺰ ﻓﺮاوانﺗـﺮﻳﻦ آﻧـﺪروژن در‬

‫دﻫﻴﺪرواﭘﻲآﻧﺪرﺳﺘﺮون ﺗﻨﻬﺎ ﺑﻌﺪ از ﻳﻚ ﺟﻠﺴﻪ ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ ﻣـﺸﺎﻫﺪه‬

‫‪9‬و‪6‬‬

‫دارد‪.‬‬

‫‪13‬‬

‫ﮔﺮدش ﺧﻮن ﻣﺮدان و زﻧﺎن اﺳـﺖ ﻛـﻪ از ﻏـﺪه ﻓـﻮق ﻛﻠﻴـﻮي ﺗﺮﺷـﺢ‬

‫ﺷﺪ‪ .‬آنﻫﺎ ﮔﺰارش دادﻧﺪ ﻛـﻪ ﺳـﻄﺢ ﻛـﻮرﺗﻴﺰول ﻃـﻲ ﺟﻠـﺴﺎت ﺗﻤـﺮﻳﻦ‬

‫ﻣﻲﺷﻮد‪ 14.‬دﻫﻴﺪرواﭘﻲآﻧﺪرﺳﺘﺮون و ﺳﻮﻟﻔﺎت آن ذﺧﺎﻳﺮ ﺑﺎﻟﻘﻮهاي ﻫﺴﺘﻨﺪ‬

‫ﻣﻘﺎوﻣﺘﻲ و اﺳﺘﻘﺎﻣﺘﻲ ﻛـﺎﻫﺶ ﻣﻌﻨـﻲداري ﻳﺎﻓـﺖ‪ ،‬اﻟﺒﺘـﻪ اﻳـﻦ ﻛـﺎﻫﺶ در‬

‫ﻛﻪ ﻣﻲﺗﻮاﻧﻨﺪ در ﺑﺎﻓـﺖﻫـﺎي ﻣﺤﻴﻄـﻲ ﻣﺎﻧﻨـﺪ ﻣﻐـﺰ‪ ،‬اﺳـﺘﺨﻮان‪ ،‬ﺳـﻴﻨﻪ و‬

‫ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ ﻛﻢﺗﺮ ﺑﻮد‪ .‬ﻫﻢﭼﻨﻴﻦ ﺳﻄﻮح ﻻﻛﺘﺎت ﺧﻮن ﻧﻴﺰ ﺗﻨﻬـﺎ ﺑﻌـﺪ‬

‫ﺗﺨﻤﺪانﻫﺎ ﺑﻪ ﺗﺴﺘﻮﺳﺘﺮون ﺗﺒـﺪﻳﻞ ﺷـﻮﻧﺪ‪15.‬و‪ 13‬دﻫﻴـﺪرواﭘﻲآﻧﺪرﺳـﺘﺮون‬

‫از ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ در ﻫﻤﻪ ﮔﺮوهﻫﺎ اﻓﺰاﻳﺶ ﻣﻌﻨﻲداري داﺷﺖ اﻣﺎ ﻣﻘﺎدﻳﺮ‬

‫ﺳــﻮﻟﻔﺎت )‪ ،(DHEAS‬ﺑــﺎ اﻓــﺰاﻳﺶ ﺗـــﻮده ﺑــﺪون ﭼـــﺮﺑﻲ و داﻧــﺴﻴﺘـﻪ‬

‫اﻳــﻦ اﻓــﺰاﻳﺶ در زﻧــﺎن ﻣﻴــﺎنﺳــﺎل ﺑــﻴﺶﺗــﺮ از زﻧــﺎن ﻣــﺴﻦ ﺑــﻮد‪ 5.‬در‬

‫اﺳﺘﺨـﻮان‪ ،‬ﻛﻴﻔﻴـﺖ زﻧﺪﮔـﻲ زﻧﺎن را اﻓﺰاﻳـﺶ داده‪ 5‬و ﺑﺮ ﻣﻴـﻞ ﺟﻨـﺴﻲ‪،‬‬

‫ﺗﺤﻘﻴﻘﻲ ‪ Hakkinen‬ﭘﺎﺳﺦ ﺣﺎد ﻫﻮرﻣﻮنﻫﺎي ﺗـﺴﺘﻮﺳﺘﺮون و ﻛـﻮرﺗﻴﺰول‬

‫ﺳﻄﺢ اﻧﺮژي و ﺣﺴﺎﺳﻴﺖ اﻧـﺴﻮﻟﻴﻨﻲ ﺗـﺄﺛﻴﺮ ﻣﻄﻠـﻮب دارد‪ 16.‬از ﻃﺮﻓـﻲ‪،‬‬

‫ﺑﻪ ﻳﻚ ﺟﻠﺴﻪ ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ ﺷـﺪﻳﺪ را روي ﻫﻔـﺖ زن ﻣﻴـﺎنﺳـﺎل ﺑـﺎ‬

‫ﻣﺤﻘﻘﻴﻦ ﻧـﺸﺎن دادهاﻧـﺪ ﻛـﻪ ﺑـﻴﻦ ﺳـﻄﻮح ‪ DHEAS‬و ﺑﻴﻤـﺎري ﺷـﺮﻳﺎن‬

‫ﻣﻴﺎﻧﮕﻴﻦ ﺳﻨﻲ ‪ 50‬ﺳﺎل و ﻫﺸﺖ زن ﻣـﺴﻦ ﺑـﺎ ﻣﻴـﺎﻧﮕﻴﻦ ﺳـﻨﻲ ‪ 70‬ﺳـﺎل‬

‫ﻛﺮوﻧﺮي ارﺗﺒﺎط ﻣﻌﻜﻮس وﺟﻮد دارد‪ 17.‬ﺟﺪاي از اﻳﻦ ﺗﻐﻴﻴﺮات‪ ،‬ﺗﻮأم ﺑـﺎ‬

‫ﺑﺮرﺳﻲ ﻛﺮد‪ .‬ﻧﺘﺎﻳﺞ ﺗﺤﻘﻴﻖ ﺗﻐﻴﻴﺮ ﻣﻌﻨﻲداري در ﺳـﻄﻮح ﺗـﺴﺘﻮﺳﺘﺮون و‬

‫اﻓﺰاﻳﺶ ﺳﻦ‪ ،‬ﺳﻄﺢ ﭘﺎﻳﻪ ﻫﻮرﻣﻮن ﻛﺎﺗﺎﺑﻮﻟﻴﻚ ﻛـﻮرﺗﻴﺰول زﻧـﺎن اﻓـﺰاﻳﺶ‬

‫ﻛﻮرﺗﻴﺰول ﻧﺸﺎن ﻧﺪاد‪ 25.‬در ﺗﺤﻘﻴﻘـﻲ ﻛـﻪ ‪ Johnson‬روي ‪ 16‬زن ﻳﺎﺋـﺴﻪ‬

‫ﻣﻲﻳﺎﺑﺪ‪ 5.‬ﻛﺎﻫﺶ ﻧﺴﺒﺖ ﻫﻮرﻣﻮنﻫﺎي آﻧﺎﺑﻮﻟﻴﻚ ﺑـﻪ ﻛﺎﺗﺎﺑﻮﻟﻴـﻚ در اﻓـﺮاد‬

‫اﻧﺠــــﺎم داد‪ ،‬اﻓــــﺰاﻳﺶ ﻣﻘــــﺎدﻳﺮ دﻫﻴــــﺪرواﭘﻲآﻧﺪرﺳــــﺘﺮون و‬

‫ﻣﺴﻦ ﻣﻤﻜﻦ اﺳﺖ ﺑﺎ ﻛﺎﻫﺶ ﻗﺪرت و اﻓﺖ ﺑﺎر ارﺗﺒﺎط داﺷـﺘﻪ ﺑﺎﺷـﺪ‪ .‬در‬

‫دﻫﻴﺪرواﭘﻲ آﻧﺪرﺳﺘﺮون ﺳﻮﻟﻔﺎت را ﺑﻪ دﻧﺒﺎل ﻣﺪاﺧﻠﻪ ‪ 30‬دﻗﻴﻘـﻪ ﻓﻌﺎﻟﻴـﺖ‬

‫واﻗﻊ ﻧﺴﺒﺖ آﻧﺪروژنﻫـﺎ ﺑـﻪ ﻛـﻮرﺗﻴﺰول ﺑﻴـﺎنﻛﻨﻨـﺪه ﺗﻌـﺎدل ﻣﺘﺎﺑﻮﻟﻴـﺴﻢ‬

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‫روي ﺗﺮدﻣﻴﻞ ﺑﺎ ‪ %80‬ﺣﺪاﻛﺜﺮ اﻛﺴﻴﮋن ﻣﺼﺮﻓﻲ ﻣﺸﺎﻫﺪه ﻛﺮد‪.‬‬

‫آﻧﺎﺑﻮﻟﻴﻚ و ﻛﺎﺗﺎﺑﻮﻟﻴﻚ ﻋﻀﻠﻪ اﺳـﺖ‪ 18.‬آﻧـﺪروژنﻫـﺎ و ﻛﻮرﺗﻴــﺰول ﺑـﻪ‬

‫ﺑﻪ ﻃﻮر ﺧﻼﺻﻪ‪ ،‬ﮔﺮﭼﻪ زﻧﺎن ﻣﺴﻦ اﺧﺘﻼﻻت اﻧـﺪوﻛﺮﻳﻦ زﻳـﺎدي را‬

‫ﻋﻨـﻮان ﻣﻬﻢﺗﺮﻳﻦ ﺗﻨﻈﻴﻢﻛﻨﻨـﺪهﻫـﺎ در ﺳـﺎزﮔﺎري ﺑـﻪ ﺗﻤﺮﻳﻨــﺎت ﻗـﺪرﺗﻲ‬

‫ﺗﺠﺮﺑﻪ ﻣﻲﻛﻨﻨﺪ اﻣﺎ در راﺑﻄﻪ ﺑﺎ ﭘﺎﺳﺦ آﻧﺪروژنﻫﺎ‪ ،‬ﻛـﻮرﺗﻴﺰول و ﻻﻛﺘـﺎت‬

‫ﻣﻄﺮح ﻣﻲﺑﺎﺷﻨﺪ‪ 19.‬ﻳﻜﻲ از روشﻫﺎي اﻓﺰاﻳﺶ ﺗﻮده ﻋـﻀﻼﻧﻲ در اﻓـﺮاد‬

‫آنﻫﺎ ﺑﻪ ﺗﻤﺮﻳﻦ اﻃﻼﻋـﺎت ﻣﺤـﺪودي در دﺳـﺖ اﺳـﺖ‪ .‬ﺑـﺎ اﻳـﻦ ﺣـﺎل‬

‫ﻣﺴﻦ‪ ،‬ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ اﺳﺖ‪ 20.‬ﺗﺤﻘﻴﻘﺎت ﻧﺸﺎن دادهاﻧﺪ ﺣﺘﻲ ﻳﻚ ﺟﻠﺴﻪ‬

‫ﺗﺤﻘﻴﻘﺎت اﻧﺪﻛﻲ ﻛﻪ ﭘﺎﺳﺦ آﻧﺪروژنﻫﺎ را در زﻧﺎن ﻣﺴﻦ ﺑﺮرﺳﻲ ﻛﺮدهاﻧـﺪ‬

‫ﺗﻤﺮﻳﻦ ﻣﻘـﺎوﻣﺘﻲ ﻣـﻲﺗﻮاﻧـﺪ آﻏـﺎزﮔﺮ ﻓﺮاﻳﻨـﺪﻫﺎي ﺳـﺎزﮔﺎري در ﻋـﻀﻠﻪ‬

‫ﻧﺘﺎﻳﺞ ﻣﺘﻨﺎﻗﺼﻲ داﺷﺘﻪ اﺳﺖ‪ ،‬ﺑﻪ ﻃﻮري ﻛﻪ ﺑﻌﻀﻲ از آنﻫﺎ ﺑﻼﻓﺎﺻﻠﻪ ﭘﺲ‬

‫اﺳﻜﻠﺘﻲ ﺑﺎﺷﺪ‪ 21.‬زﻳﺮا اﻓﺰاﻳﺶ ﺣﺎد ﻫﻮرﻣﻮنﻫﺎي آﻧﺎﺑﻮﻟﻴﻚ ﻃـﻲ ﺗﻤـﺮﻳﻦ‪،‬‬

‫از ﻣﺪاﺧﻠﻪ ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ و اﺳﺘﻘﺎﻣﺘﻲ اﻓﺰاﻳﺶ ﺗﺴﺘﻮﺳﺘﺮون را ﮔـﺰارش‬

‫ﻣــﻲﺗﻮاﻧــﺪ ﻣﺤــﺮك ﻓﺮاﻳﻨــﺪﻫﺎي ﺳــﺎزﮔﺎري ﻣــﺮﺗﺒﻂ ﺑــﺎ اﻓــﺰاﻳﺶ ﺳــﻨﺘﺰ‬

‫‪25‬و‪24‬‬

‫ﻛﺮدﻧﺪ‪ 5‬و ﺑﺮﺧﻲ دﻳﮕﺮ از ﺗﺤﻘﻴﻘﺎت ﺗﻐﻴﻴﺮي را ﻧﺸﺎن ﻧﺪاﻧﺪ‪.‬‬

‫ﭘﺮوﺗﻴﻴﻦﻫﺎي ﻋـﻀﻠﻪ ﺑﺎﺷـﺪ‪ 22.‬ﺑـﺎ اﻳـﻦ ﻛـﻪ ﺑـﻪ ﻧﻈـﺮ ﻣـﻲرﺳـﺪ ﺳـﻄﻮح‬

‫از آنﺟﺎ ﻛﻪ ﺣﻔﻆ ﺑﻬﻴﻨﻪ ﺳﻄﻮح آﻧﺪروژنﻫـﺎ و ﻛـﻮرﺗﻴﺰول در زﻧـﺎن‬

‫آﻧﺪروژنﻫﺎ‪ ،‬ﻛﻮرﺗﻴﺰول و ﻻﻛﺘﺎت اﻓﺮاد ﺟﻮان ﺗﺤﺖ ﺗـﺎﺛﻴﺮ ﺗﻤـﺮﻳﻦ ﻗـﺮار‬

‫ﻣﺴﻦ ﺑﻴﺎنﻛﻨﻨﺪه ﺗﻌﺎدل ﻣﺘﺎﺑﻮﻟﻴﺴﻢ آﻧﺎﺑﻮﻟﻴﻚ و ﻛﺎﺗﺎﺑﻮﻟﻴﻚ ﻋـﻀﻠﻪ اﺳـﺖ و‬

‫ﻣﻲﮔﻴﺮد‪ ،‬اﻣﺎ ﺗﻮاﻓﻖ ﻧﻈﺮ درﺑﺎره ﻫﻤﻴﻦ ﺗﻐﻴﻴﺮات در اﻓـﺮاد ﻣـﺴـﻦ وﺟـﻮد‬

‫وﺟﻮد ارﺗﺒﺎط ﻣﺴﺘﻘﻴﻢ ﻣﻴﺎن آن دو ﺑﺎ ﺳﻄﺢ ﻣﻘﻄـﻊ و ﻗـﺪرت ﻋـﻀﻠﻪ ﺑـﻪ‬

‫ﻧﺪارد‪23.‬و‪ 19‬ﺷﺎﻳﺪ ﭘﺎﺳﺦ آﻧﺪروژنﻫﺎ و ﻛﻮرﺗﻴﺰول ﺑﻪ ﺗﻤـﺮﻳﻦ ﻣﻘـﺎوﻣﺘﻲ و‬

‫اﺛﺒﺎت رﺳﻴﺪه اﺳﺖ و از ﻃﺮﻓﻲ ﺑﻨﺎﺑﺮ ﺗﺤﻘﻴﻘـﺎت ﻣﺘﻌـﺪد ﻣﻤﻜـﻦ اﺳـﺖ‬

‫اﺳﺘﻘﺎﻣﺘﻲ در زﻧﺎن ﻣﺴﻦ ﭘﺎﻳﻴﻦﺗﺮ از زﻧﺎن ﺟﻮان ﺑﺎﺷـﺪ‪ 5.‬در ﺗﺤﻘﻴﻘـﻲ ﻛـﻪ‬

‫ﻛﺎﻫﺶ ﺳﻄﻮح آﻧﺪروژنﻫﺎ در زﻧﺎن ﻣﺴﻦ ﺑﺎ ﻣﺸﻜﻼت ﺟﺴﻤﻲ و رواﻧـﻲ‬

‫‪ Hakkinen‬روي ‪ 10‬زن ﻣﺴﻦ ‪ 67‬ﺳﺎﻟﻪ اﻧﺠـﺎم داد‪ ،‬ﻧﺘﻴﺠـﻪ ﮔﺮﻓـﺖ ﻛـﻪ‬

‫ﻣﺨﺘﻠﻔﻲ ﺗﻮام ﺑﺎﺷﺪ‪ 1.‬ﺑﺮرﺳﻲ راﻫﺒﺮدﻫﺎي ﺗﻤﺮﻳﻨﻲ ﮔﻮﻧﺎﮔﻮن در اﻳﻦ راﺑﻄﻪ‬

‫ﺳﻄﻮح ﺗﺴﺘﻮﺳﺘﺮون ﻣﺘﻌﺎﻗﺐ ﻳﻚ ﺟﻠﺴﻪ ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ ﺷﺪﻳﺪ اﻓـﺰاﻳﺶ‬

‫ﺑﻪ ﻋﻨﻮان ﻳـﻚ روش ﻏﻴـﺮ داروﻳـﻲ ﺑـﺪون ﻋـﻮارض ﺟـﺎﻧﺒﻲ ﻣﻬـﻢ ﺑـﻪ‬

‫ﻣﻌﻨﻲداري ﻧﺪاﺷﺖ‪ ،‬اﻣﺎ ﻣﻘﺎدﻳﺮ ﻻﻛﺘﺎت ﺧﻮن ﺑﻌﺪ از ﻳﻚ ﺟﻠـﺴﻪ ﺗﻤـﺮﻳﻦ‬

‫ﻧﻈﺮ ﻣﻲرﺳﺪ‪ .‬ﻟﺬا ﺿﺮورت و اﻫﻤﻴﺖ اﻧﺠﺎم اﻳﻦ ﭘﮋوﻫﺶ را ﻣﻲﺗـﻮان ﺑـﺎ‬

‫‪Copeland‬‬

‫ﺑﻴﺎن اﻳﻦ ﺳﻮال ﺗﺤﻘﻴﻘﻲ ﻣﻄﺮح ﻛﺮد ﻛﻪ آﻳﺎ ﻣﺪاﺧﻠﻪ ﻳـﻚ ﺟﻠـﺴﻪ ﺗﻤـﺮﻳﻦ‬

‫روي ‪ 30‬زن ﺳﺎﻟﻢ در ﭘﻨﺞ ﮔﺮوه ﺳﻨﻲ ﻣﺘﻔﺎوت ‪ 16‬ﺗﺎ ‪ 69‬ﺳﺎل اﻧﺠﺎم داد‪،‬‬

‫ﻣﻘــﺎوﻣﺘﻲ و ﻳــﻚ ﺟﻠــﺴﻪ ﺗﻤــﺮﻳﻦ اﺳــﺘﻘﺎﻣﺘﻲ ﻣﻨﺠــﺮ ﺑــﻪ ﺗﻐﻴﻴــﺮات‬

‫ﺑﻪ اﻳﻦ ﻧﺘﻴﺠﻪ رﺳـﻴﺪ ﻛـﻪ ﭘـﺲ از ﻣﺪاﺧﻠـﻪ ﻫـﺮ دو ﺗﻤـﺮﻳﻦ اﺳـﺘﻘﺎﻣﺘﻲ و‬

‫ﺣﺎد آﻧﺪروژنﻫـﺎ‪ ،‬ﻛـﻮرﺗﻴﺰول و ﻻﻛﺘـﺎت زﻧـﺎن ﺳـﻨﻴﻦ ‪ 50‬ﺗـﺎ ‪ 60‬ﺳـﺎﻟﻪ‬

‫ﻣﻘﺎوﻣﺘﻲ ﻳﻚ ﺟﻠﺴﻪاي ﺳﻄﻮح ﻫﻮرﻣﻮن ﺗﺴﺘﻮﺳﺘﺮون در ﺗﻤﺎم ﮔﺮوهﻫـﺎي‬

‫ﻣﻲﺷﻮد ﻳﺎ ﺧﻴﺮ؟‬

‫ﻣﻘﺎوﻣﺘﻲ ﺷﺪﻳﺪ اﻓﺰاﻳﺶ ﻣﻌﻨـﻲدار ﻳﺎﻓـﺖ‪ 24.‬در ﺗﺤﻘﻴﻘـﻲ ﻛـﻪ‬

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‫ﺗﺄﺛﻴﺮ ﺗﻤﺮﻳﻨﺎت ﻣﻘﺎوﻣﺘﻲ و اﺳﺘﻘﺎﻣﺘﻲ ﺑﺮ آﻧﺪروژنﻫﺎ‪ ،‬ﻛﻮرﺗﻴﺰول و ﻻﻛﺘﺎت زﻧﺎن‬

‫ﺗﺮﺗﻴﺐ در ﺟﻠﺴﺎت ﺗﻤﺮﻳﻦ اﺳﺘﻘﺎﻣﺘﻲ‪ ،‬ﻣﻘﺎوﻣﺘﻲ و اﺳـﺘﺮاﺣﺖ و ﺑـﻪ ﻃـﻮر‬

‫روش ﺑﺮرﺳﻲ‬

‫ﻫﻢزﻣﺎن و ﻣﻮازي ﮔﺮوه دوم ﺑﻪ ﺗﺮﺗﻴﺐ در ﺟﻠـﺴﺎت ﺗﻤـﺮﻳﻦ ﻣﻘـﺎوﻣﺘﻲ‪،‬‬ ‫اﻳــﻦ ﺗﺤﻘﻴـــﻖ از ﻧــﻮع ﻧﻴﻤــﻪ ﺗﺠـــﺮﺑﻲ ﺑــﺎ ﻃــﺮح ﭘــﻴﺶآزﻣـــﻮن و‬

‫اﺳﺘﻘﺎﻣﺘﻲ و اﺳﺘﺮاﺣﺖ ﺷﺮﻛﺖ ﻛﺮدﻧﺪ‪ .‬ﺑﻨﺎﺑﺮاﻳﻦ ﺗﻤﺎﻣﻲ آزﻣـﻮدﻧﻲﻫـﺎ ﻃـﻲ‬

‫ﭘﺲآزﻣﻮن‪ ،‬ﺑﺎ ﻳﻚ ﮔﺮوه آزﻣﻮدﻧﻲ )ﺟﺎﺑﻪﺟﺎﻳﻲ‪ -‬ﻣﺘﻘﺎﻃﻊ( ﺑﻮد ﻛﻪ در ﺳﺎل‬

‫‪ 12‬روز در ﺳﻪ ﺟﻠﺴﻪ ﻣﺨﺘﻠـﻒ )ﻳـﻚ ﺟﻠـﺴﻪ ﺗﻤـﺮﻳﻦ اﺳـﺘﻘﺎﻣﺘﻲ‪ ،‬ﻳـﻚ‬

‫‪ 1389 -90‬در ﮔﺮوه ﻓﻴﺰﻳﻮﻟﻮژي ورزﺷﻲ داﻧﺸﮕﺎه ﻓﺮدوﺳﻲ ﻣﺸﻬﺪ اﻧﺠﺎم‬

‫ﺟﻠﺴﻪ ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ و ﻳﻚ ﺟﻠﺴﻪ اﺳـﺘﺮاﺣﺖ ﻳـﺎ ﻛﻨﺘـﺮل( ﺑـﺎ ﻓﺎﺻـﻠﻪ‬

‫ﺷــﺪ‪ .‬ﻧﻤﻮﻧــﻪ آﻣــﺎري ﺗﺤﻘﻴــﻖ ﺷــﺎﻣﻞ ‪ 10‬زن ﻣــﺴﻦ )ﻣﻴــﺎﻧﮕﻴﻦ ﺳــﻦ‪:‬‬

‫ﭼﻬﺎر روز اﺳﺘﺮاﺣﺖ ﺑﻴﻦ ﺟﻠﺴﺎت ﻗـﺮار ﻣـﻲﮔﺮﻓﺘﻨـﺪ‪ .‬ﺗﻤـﺎﻣﻲ ﺟﻠـﺴﺎت‬

‫‪ 54/30±3/74‬ﺳﺎل‪ ،‬ﻧﻤﺎﻳﻪ ﺗﻮده ﺑﺪن‪ 24/88±2/07 :‬ﻛﻴﻠﻮﮔﺮم ﺑﺮ ﻣﺘﺮﻣﺮﺑﻊ‬

‫)ﻣﻘﺎوﻣﺘﻲ‪ ،‬اﺳﺘﻘﺎﻣﺘﻲ و اﺳﺘﺮاﺣﺖ( ﺑﻴﻦ ﺳﺎﻋﺖ ‪ 8‬ﺗﺎ ‪ 10:30‬ﺻـﺒﺢ اﻧﺠـﺎم‬

‫و درﺻﺪ ﭼﺮﺑﻲ ﺑﺪن ﻛﻢﺗﺮ از ‪ (%36‬ﻏﻴﺮ ﻓﻌﺎل ﺳﺎﻛﻦ ﺷﻬﺮ ﻣﺸﻬﺪ ﺑﻮدﻧـﺪ‬

‫ﺷﺪ‪ .‬ﺑﻪ آزﻣﻮدﻧﻲﻫﺎ ﮔﻔﺘﻪ ﺷﺪ ‪ 24‬ﺳﺎﻋﺖ ﻗﺒـﻞ از ﻫـﺮ ﻛـﺪام از ﺟﻠـﺴﺎت‬

‫ﻛﻪ ﺑﻪ ﺷﻴﻮه ﻫﺪفدار و در دﺳﺘﺮس از ﻣﻴـﺎن ‪ 46‬زن داوﻃﻠـﺐ اﻧﺘﺨـﺎب‬

‫ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ‪ ،‬اﺳﺘﻘﺎﻣﺘﻲ و اﺳﺘﺮاﺣﺖ از ﻓﻌﺎﻟﻴﺖ ﺑﺪﻧﻲ ﺷﺪﻳﺪ اﺟﺘﻨـﺎب‬

‫ﺷﺪﻧﺪ‪ .‬ﭘﻴﺶ از اﻧﺘﺨﺎب ﻧﻤﻮﻧﻪ آﻣﺎري‪ ،‬اﻃﻼﻋﺎت ﻓﺮدي‪ ،‬ﺳﺎﺑﻘﻪ ورزﺷﻲ و‬

‫ﻛﻨﻨﺪ‪ ،‬رژﻳﻢ ﻏﺬاﻳﻲ ﺛﺎﺑﺘﻲ داﺷﺘﻪ ﺑﺎﺷﻨﺪ و دو ﺳﺎﻋﺖ ﻗﺒـﻞ از ﻫـﺮ ﺟﻠـﺴﻪ‬

‫ﭘﺰﺷﻜﻲ ‪ 46‬زن داوﻃﻠﺐ ﻣـﺸﺎرﻛﺖ در ﺗﺤﻘﻴـﻖ از ﻃﺮﻳـﻖ ﭘﺮﺳـﺶﻧﺎﻣـﻪ‬

‫ﻛﺎﻓﻴﻴﻦ ﻣﺼﺮف ﻧﻜﻨﻨﺪ‪ .‬ﺻﺒﺢ روز ﻫﺮ ﺟﻠﺴﻪ )‪ 2/5‬ﺳﺎﻋﺖ ﻗﺒﻞ از ﺷـﺮوع‬

‫ﺟﻤﻊآوري ﺷﺪ‪ .‬در اﻳﻦ ﺗﺤﻘﻴﻖ ﻣﻼك ورود ﺑﻪ ﻣﻄﺎﻟﻌﻪ‪ ،‬ﺳﻦ ﺣـﺪاﻗﻞ ‪50‬‬

‫ﺟﻠﺴﻪ( ﺑﻪ ﺗﻤﺎم آزﻣﻮدﻧﻲﻫﺎ ﻳﻚ وﻋـﺪه ﻏـﺬاي اﺳـﺘﺎﻧﺪارد ﻣﻌــﺎدل ‪4/3‬‬

‫و ﺣﺪاﻛﺜﺮ ‪ 60‬ﺳﺎل و ﮔﺬﺷﺖ ﺣﺪاﻗﻞ ﻳﻚ ﺳﺎل از ﺳﻦ ﻳﺎﺋﺴﮕﻲ در ﻧﻈـﺮ‬

‫ﻛﻴﻠـﻮﻛﺎﻟﺮي اﻧــﺮژي ﺑـﻪ ازاي ﻫـﺮ ﻛــﻴﻠﻮﮔﺮم وزن ﺑـﺪن‪ ،‬ﺷــﺎﻣﻞ ‪%65‬‬

‫ﮔﺮﻓﺘﻪ ﺷﺪه ﺑﻮد‪ .‬ﺑﺮاي ﻛﻨﺘﺮل ﺑﻬﺘﺮ ﻋﻮاﻣﻞ ﻣﺪاﺧﻠـﻪﻛﻨﻨـﺪه‪ ،‬اﻓـﺮاد ﭼـﺎق و‬

‫ﻛﺮﺑﻮﻫﻴﺪرات‪ %20 ،‬ﭼﺮﺑﻲ و ‪ %15‬ﭘﺮوﺗﻴﻴﻦ داده ﺷﺪ‪ 27.‬در اﻳﻦ ﭘـﮋوﻫﺶ‬

‫ﻛﺴﺎﻧﻲ ﻛﻪ ﺳﺎﺑﻘﻪ ﺑﻴﻤﺎري‪ ،‬ﻳﺎﺋﺴﮕﻲ ﻏﻴﺮﻃﺒﻴﻌـﻲ‪ ،‬ﻣـﺼﺮف دارو و ﻣﻜﻤـﻞ‬

‫از ﻧﺎن ﺗﺴﺖ ﻣﺎرك ﺳﻪ ﻧﺎن و ﭘﻨﻴﺮ ﺧﺎﻣﻪاي ﻣﺎرك ﭘﮕﺎه اﺳﺘﻔﺎده ﺷـﺪ ﻛـﻪ‬

‫اﺳﺘﺮوﻳﻴﺪي‪ ،‬ﺳﺎﺑﻘﻪ ورزﺷﻲ و ﻣﺼﺮف دﺧﺎﻧﻴﺎت داﺷﺘﻨﺪ از ﺗﺤﻘﻴـﻖ ﻛﻨـﺎر‬

‫ﻫﺮ دو ﻣﺤﺼﻮل داراي ﻧﺸﺎن اﺳﺘﺎﻧﺪارد ﺑﻮدﻧﺪ‪ .‬در اﻳﻦ ﺗﺤﻘﻴﻖ ﻳﻚ ﺟﻠﺴﻪ‬

‫ﮔﺬاﺷﺘﻪ ﺷﺪﻧﺪ‪ .‬ﭘﺲ از ﮔﺰﻳﻨﺶ ﻧﻤﻮﻧﻪ آﻣﺎري ﻫﻤﻪ آزﻣﻮدﻧﻲﻫـﺎ در ﻣـﻮرد‬

‫ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ ﺑﻪ ﻣﺪت ‪ 45‬دﻗﻴﻘﻪ و ﺷﺎﻣﻞ ﺳـﻪ ﺳـﺖ ‪ 10‬ﺗﻜـﺮاري ﺑـﺎ‬

‫ﻣﺮاﺣﻞ ﺗﺤﻘﻴﻖ ﺗﻮﺟﻴﻪ ﺷـﺪﻧﺪ و ﺳـﭙﺲ ﻓـﺮم رﺿـﺎﻳﺖﻧﺎﻣـﻪ ﺷـﺮﻛﺖ در‬

‫‪ %80‬ﻳﻚ ﺗﻜﺮار ﺑﻴﺸﻴﻨﻪ و ﺑﺎ اﺳﺘﺮاﺣﺖﻫﺎي ﻳﻚ دﻗﻴﻘـﻪاي ﺑـﻴﻦ ﺳـﺖﻫـﺎ‬

‫ﭘﮋوﻫﺶ و ﭘﺮﺳﺶﻧﺎﻣﻪﻫﺎى آﻣﺎدﮔﻲ اﻧﺠـﺎم ﻓﻌﺎﻟﻴـﺖ ورزﺷـﻲ )‪،(PAR-Q‬‬

‫روي دﺳﺘﮕﺎهﻫﺎي ﺑﺪنﺳﺎزي اﻳﺰوﺗﻮﻧﻴﻚ اﻧﺠـﺎم ﺷـﺪ‪ .‬ﺣﺮﻛـﺎت ﺷـﺎﻣﻞ‪:‬‬

‫ﺳﻼﻣﺖ ﻋﻤﻮﻣﻲ )‪ ،(GHQ28‬وﺿـﻌﻴﺖ ﺗﻐﺬﻳـﻪ و ﻣﻄﺎﻟﻌـﻪ ﺳـﻼﻣﺖ زﻧـﺎن‬

‫‪ (1‬ﭘﺮس ﺳﻴﻨﻪ ﺧﻮاﺑﻴﺪه‪ (2 ،‬ﻛﺸﺶ دوﻃﺮﻓـﻪ ﺑـﻪ ﭘـﺎﻳﻴﻦ‪ (3 ،‬ﭘـﺮس ﭘـﺎي‬

‫ﻣﺎﺳﺎﭼﻮﺳﺖ )‪ (MWHS‬را ﺗﻜﻤﻴﻞ ﻛﺮدﻧﺪ‪ .‬ﻗﺒﻞ از ﺷـﺮوع ﺗﺤﻘﻴـﻖ ﻣﺠـﻮز‬

‫ﻧﺸﺴﺘﻪ‪ (4 ،‬ﺧﻢ ﻛﺮدن آرﻧﺞ‪ (5 ،‬ﺑﺎز ﻛﺮدن آرﻧـﺞ‪ (6 ،‬ﺧـﻢ ﻛـﺮدن زاﻧـﻮ‪،‬‬

‫ﻛﻤﻴﺘﻪ اﺧﻼق درﻳﺎﻓﺖ ﺷﺪ و ﻋﺪم ﻣﺤـﺪودﻳﺖ اﻧﺠـﺎم ﻓﻌﺎﻟﻴـﺖ ورزﺷـﻲ‬

‫‪ (7‬ﺑﺎز ﻛﺮدن زاﻧﻮ و ‪ (8‬ﭘﺮس ﺳﺮﺷﺎﻧﻪ ﺑﻮد‪ .‬ﻳﻚ ﺟﻠﺴﻪ ﺗﻤﺮﻳﻦ اﺳـﺘﻘﺎﻣﺘﻲ‬

‫آزﻣﻮدﻧﻲﻫﺎ ﺑﻪ وﺳﻴﻠﻪ ﭘﺰﺷﻚ ﺗﺄﻳﻴﺪ ﺷﺪ‪ .‬ﻗﺪ و وزن اﻓﺮاد ﺑـﺪون ﻛﻔـﺶ و‬

‫ﺷﺎﻣﻞ ‪ 45‬دﻗﻴﻘﻪ ﻓﻌﺎﻟﻴﺖ روي دوﭼﺮﺧﻪ ﻛﺎرﺳﻨﺞ ‪ Technogym‬ﺳـﺎﺧﺖ‬

‫ﺑﺎ ﻟﺒﺎسﻫﺎي ﺳﺒﻚ ﺗﻮﺳﻂ ﺑﺎﺳﻜﻮل ﺑﺎ دﻗﺖ ‪ 0/1‬ﻛﻴﻠﻮﮔﺮم و ﻧﻤﺎﻳـﻪ ﺗـﻮده‬

‫ﻛﺸﻮر اﻳﺘﺎﻟﻴﺎ ﺑﺎ ﺷﺪت ‪ 60‬ﺗﺎ ‪ 70‬درﺻﺪ ﺣﺪاﻛﺜﺮ اﻛـﺴﻴﮋن ﻣـﺼﺮﻓﻲ ﺑـﻮد‪.‬‬

‫ﺑﺪن و درﺻﺪ ﭼﺮﺑﻲ ﺑﺪن آزﻣﻮدﻧﻲﻫﺎ ﺑﻪ روش ﺑﻴﻮاﻟﻜﺘﺮﻳﻜﺎل اﻳﻤﭙـﺪاﻧﺲ‬

‫ﺷﺪت ﺗﻤﺮﻳﻦ ﺑﻪ ﻃﻮر ﻣﺪاوم ﺑﺎ اﺳﺘﻔﺎده از ﺿﺮﺑﺎن ﺳﻨﺞ ﭘﻼر ﻛﻨﺘﺮل ﺷـﺪ‬

‫‪(Inbody-720 Body‬‬

‫و آزﻣﻮدﻧﻲﻫﺎ ﻫﺮ ﭘﻨﺞ دﻗﻴﻘﻪ ﺑﺎ اﺳﺘﻔﺎده از ﺷـﺎﺧﺺ درك ﺗـﻼش ﺑـﻮرگ‬

‫)‪ Composition Analyzer‬ﺳﺎﺧﺖ ﻛﺸﻮر ﻛﺮه ﺟﻨﻮﺑﻲ اﻧﺪازهﮔﻴﺮي ﺷـﺪ‪.‬‬

‫)‪ (Borg‬ﺷﺪت ﺗﻤﺮﻳﻦ را اﻋﻼم ﻣﻲﻛﺮدﻧـﺪ‪ .‬آزﻣـﻮدﻧﻲﻫـﺎ ﻗﺒـﻞ از ﺷـﺮوع‬

‫ﻫﺸﺖ و ‪ 12‬روز ﭘﻴﺶ از اوﻟﻴﻦ ﺟﻠﺴﻪ )ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ ﻳﺎ اﺳـﺘﻘﺎﻣﺘﻲ و‬

‫ﺗﻤﺮﻳﻨﺎت ﺑﻪ ﻣﺪت ‪ 10‬دﻗﻴﻘﻪ ﺑﺪن ﺧﻮد را ﮔﺮم ﻣﻲﻛﺮدﻧﺪ‪ .‬در اﻳﻦ ﺗﺤﻘﻴﻖ‬

‫ﻳﺎ اﺳﺘﺮاﺣﺖ(‪ ،‬ﺑﻪ ﺗﺮﺗﻴﺐ ﺣﺪاﻛﺜﺮ اﻛﺴﻴﮋن ﻣﺼﺮﻓﻲ آزﻣﻮدﻧﻲﻫﺎ ﺑﺎ اﺳﺘﻔﺎده‬

‫ﻃــﻲ اﺳــﺘﺮاﺣﺖ )ﻛﻨﺘــﺮل( ﺑــﻪ ﻣــﺪت ‪ 45‬دﻗﻴﻘــﻪ ﻫــﻴﭻ ﻓﻌــﺎﻟﻴﺘﻲ اﻧﺠــﺎم‬

‫ﺗﻮﺳـــﻂ دﺳـــﺘﮕﺎه ﺳـــﻨﺠﺶ ﺗﺮﻛﻴـــﺐ ﺑـــﺪﻧﻲ‬

‫‪5‬‬

‫از آزﻣﻮن آﻣﺎدﮔﻲ ﻫﻮازي دوﭼﺮﺧﻪ آﺳﺘﺮاﻧﺪ و ﻫﻢﭼﻨـﻴﻦ آزﻣـﺎﻳﺶ ﻳـﻚ‬

‫ﻧﻤﻲﮔﺮﻓﺖ و اﻓﺮاد ﻣﻲﻧﺸﺴﺘﻨﺪ‪ .‬ﻧﻤﻮﻧﻪﮔﻴﺮي ﺧﻮﻧﻲ در ﺳﻪ ﻣﺮﺣﻠﻪ ﭘﻴﺶ‪،‬‬

‫ﺗﻜﺮار ﺑﻴﺸﻴﻨﻪ ﺣﺮﻛﺎت وزﻧﻪ ﺗﻤﺮﻳﻨﻲ ﺗﻌﻴﻴﻦ ﺷﺪ‪ .‬دادهﻫﺎي ﻣﺮﺑﻮط ﺑﻪ ﺳﻦ‪،‬‬

‫ﺑﻼﻓﺎﺻﻠﻪ و ‪ 15‬دﻗﻴﻘﻪ ﺑﻌﺪ از اﺗﻤﺎم ﻫﺮ ﺟﻠﺴﻪ )ﻣﻘﺎوﻣﺘﻲ ﻳﺎ اﺳﺘﻘﺎﻣﺘﻲ و ﻳﺎ‬

‫ﺷﺎﺧﺺﻫﺎي اﺑﻌﺎد ﺑﺪﻧﻲ و اوج اﻛﺴﻴﮋن ﻣﺼﺮﻓﻲ آزﻣﻮدﻧﻲﻫﺎ در ﺟـﺪول‬

‫اﺳﺘﺮاﺣﺖ( اﻧﺠﺎم ﺷـﺪ‪ .‬در ﻫـﺮ ﻧﻮﺑـﺖ ﭘـﻨﺞ ﻣﻴﻠـﻲﻟﻴﺘـﺮ ﺧـﻮن از ورﻳـﺪ‬

‫‪ 1‬آﻣﺪه اﺳﺖ‪ .‬در ﻃﺮح ﺗﺤﻘﻴﻖ ﻣﺘﻘﺎﻃﻊ ﻧﺨﺴﺖ ﻧﻤﻮﻧﻪﻫﺎي آﻣﺎري ﺑﻪ ﻃﻮر‬

‫آﻧﺘﻪﻛﻮﺑﻴﺘﺎل ﮔﺮﻓﺘﻪ ﺷﺪ‪ .‬ﻧﻤﻮﻧﻪﻫﺎي ﺧـﻮﻧﻲ ﺑﻌـﺪ از ﺟﺪاﺳـﺎزي ﺳـﺮم‪ ،‬در‬

‫ﺗﺼﺎدﻓﻲ ﺑﻪ دو ﮔﺮوه ﭘﻨﺞ ﻧﻔﺮي ﺗﻘـﺴﻴﻢ ﺷـﺪﻧﺪ و ﺳـﭙﺲ ﮔـﺮوه اول ﺑـﻪ‬

‫دﻣﺎي‬

‫‪C‬‬

‫‪º‬‬

‫‪ -18‬ﻓﺮﻳﺰ ﺷﺪه و ﭘﺲ از ﺟﻤﻊآوري‪ ،‬ﺗﻤﺎﻣﻲ ﻧﻤﻮﻧﻪﻫﺎ در ﻳـﻚ‬

‫دﻧﻴﺎ ﺻﻮرﺗﻲ ﺟﺎﺑﻠﻮ و ﻫﻤﻜﺎران‬

‫‪113‬‬

‫روز ﻣــﻮرد ﺑﺮرﺳــﻲ ﻗــﺮار ﮔﺮﻓﺘﻨــﺪ‪ .‬ﻣﻘــﺎدﻳﺮ ﺗــﺴﺘﻮﺳﺘﺮون‪ ،‬دﻫﻴــﺪرواﭘﻲ‬

‫ﻣﺮاﺣﻞ ﻣﺨﺘﻠﻒ در ﺟﺪول ‪ 2‬ﻧـﺸﺎن داده ﺷـﺪه اﺳـﺖ‪ .‬ﻫﻤـﺎنﻃـﻮر ﻛـﻪ‬

‫آﻧﺪرﺳﺘﺮون ﺳﻮﻟﻔﺎت و ﻛﻮﺗﻴﺰول ﺑـﺎ روش ‪ Chemiluminescence‬و ﺑـﺎ‬

‫ﻣﺸﺎﻫﺪه ﻣﻲﺷﻮد ﻋﻠـﻲرﻏـﻢ اﻳـﻦ ﻛـﻪ ﺗﻐﻴﻴـﺮات درون ﮔﺮوﻫـﻲ ﻣﻘـﺎدﻳﺮ‬

‫دﺳﺘﮕﺎه و ﻛﻴﺖ ‪ Liaison‬ﺳﺎﺧﺖ ﻛﺸﻮر اﻧﮕﻠﺴﺘﺎن اﻧـﺪازهﮔﻴـﺮي ﺷـﺪﻧﺪ‪.‬‬

‫ﺗﺴﺘﻮﺳﺘﺮون ﻫﺮ دو ﮔـﺮوه ﺗﻤـﺮﻳﻦ ﻣﻘـﺎوﻣﺘﻲ و اﺳـﺘﻘﺎﻣﺘﻲ ﻃـﻲ ﻣﺮاﺣـﻞ‬

‫ﻣﻘﺎدﻳﺮ ﻻﻛﺘﺎت ﻧﻴﺰ ﺑﺎ دﺳﺘﮕﺎه ﺑﻴﻮﺷﻴﻤﻲ ‪ Selectra‬و ﻛﻴﺖ ﺷﺮﻛﺖ ﭘـﺎرس‬

‫ﻣﺨﺘﻠﻒ ﻣﻌﻨﻲدار اﺳﺖ )‪ (P<0/05‬و اﻳـﻦ ﻣﻘـﺎدﻳﺮ ﺑﻼﻓﺎﺻـﻠﻪ و ﭘـﺲ از‬

‫آزﻣﻮن ﺳﺎﺧﺖ ﻛﺸﻮر اﻳﺮان ﻣﻮرد ارزﻳﺎﺑﻲ ﻗﺮار ﮔﺮﻓﺖ‪ .‬دادهﻫﺎ ﺑﺎ اﺳﺘﻔﺎده‬

‫ﮔﺬﺷﺖ ‪ 15‬دﻗﻴﻘﻪ از ﻣﺪاﺧﻠﻪ ﻳﻚ ﺟﻠﺴﻪ ﺗﻤـﺮﻳﻦ ﻣﻘـﺎوﻣﺘﻲ و اﺳـﺘﻘﺎﻣﺘﻲ‬

‫از ﻧﺮماﻓﺰاري آﻣﺎري ‪ SPSS‬وﻳﺮاﺳﺖ ‪ 11/5‬ﺗﺠﺰﻳﻪ و ﺗﺤﻠﻴـﻞ ﺷـﺪﻧﺪ ﺑـﻪ‬

‫اﻓﺰاﻳﺶ داﺷﺘﻪ اﺳﺖ وﻟﻲ اﻳﻦ ﺗﻐﻴﻴﺮات ﺑﻪ اﻧـﺪازهاي ﻧﻴـﺴﺖ ﻛـﻪ ﺑﺘﻮاﻧـﺪ‬

‫‪Levene‬‬

‫روي ﺗﻐﻴﻴﺮات ﺑﻴﻦ ﮔﺮوﻫﻲ ﺗﺎﺛﻴﺮﮔﺬار ﺑﺎﺷﺪ‪ .‬ﺑﻪ ﻋﺒﺎرت دﻳﮕـﺮ‪ ،‬ﺗﻐﻴﻴـﺮات‬

‫ﻃﻮري ﻛﻪ از روش ﺗﺤﻠﻴﻞ اﻛﺘﺸﺎﻓﻲ ‪ Kolmogorov-smirnov‬و‬

‫ﺑﻪ ﺗﺮﺗﻴﺐ ﺑﺮاي ﺗﻌﻴﻴﻦ ﻧﺮﻣﺎل ﺑﻮدن ﺗﻮزﻳـﻊ دادهﻫـﺎ و ﺗﺠـﺎﻧﺲ وارﻳـﺎﻧﺲ‬ ‫ﮔﺮوهﻫﺎ و از آزﻣﻮن اﻧﺪازهﻫـﺎي ﺗﻜـﺮاري و ﺗﻌﻘﻴﺒـﻲ ‪ Bonferroni‬ﺑـﺮاي‬ ‫ﺗﻌﻴﻴﻦ ﺗﻐﻴﻴﺮات درون و ﺑﻴﻦ ﮔﺮوﻫﻲ اﺳﺘﻔﺎده ﺷﺪ‪ .‬ﺑﺮاي ﺗـﺼﻤﻴﻢ آﻣـﺎري‬

‫ﺟﺪول‪ :1 -‬ﺷﺎﺧﺺﻫﺎي اﺑﻌﺎد ﺑﺪﻧﻲ و اوج اﻛﺴﻴﮋن ﻣﺼﺮﻓﻲ آزﻣﻮدﻧﻲﻫﺎ‬ ‫ﺷﺎﺧﺺﻫﺎ‬

‫ﻣﻴﺎﻧﮕﻴﻦ‬

‫اﻧﺤﺮافﻣﻌﻴﺎر‬

‫ﺳﻦ )ﺳﺎل(‬

‫‪54/30‬‬

‫‪3/74‬‬

‫ﻗﺪ )ﺳﺎﻧﺘﻲﻣﺘﺮ(‬

‫‪161/92‬‬

‫‪5/93‬‬

‫وزن )ﻛﻴﻠﻮﮔﺮم(‬

‫‪65/42‬‬

‫‪8/28‬‬

‫ﻧﻤﺎﻳﻪ ﺗﻮده ﺑﺪن )ﻛﻴﻠﻮﮔﺮم ﺑﺮ ﻣﺘﺮﻣﺮﺑﻊ(‬

‫‪24/88‬‬

‫‪2/07‬‬

‫درﺻﺪ ﭼﺮﺑﻲ ﺑﺪن )درﺻﺪي از وزن ﺑﺪن(‬

‫‪33/50‬‬

‫‪2/63‬‬

‫ﻣﻘﺎدﻳﺮ ﺗﺴﺘﻮﺳﺘﺮون‪ ،‬دﻫﻴـﺪرواﭘـﻲآﻧﺪرﺳﺘـﺮون ﺳﻮﻟﻔـﺎت‪ ،‬ﻛﻮرﺗﻴـﺰول و‬

‫ﺣﺪاﻛﺜﺮ اﻛﺴﻴﮋن ﻣﺼﺮﻓﻲ )ﻣﻴﻠﻲﻟﻴﺘﺮ‪ /‬ﻛﻴﻠﻮﮔﺮم‪/‬‬

‫‪27/32‬‬

‫‪2/49‬‬

‫ﻻﻛﺘﺎت ﮔـﺮوه ﺗﻤﺮﻳـﻦ ﻣﻘﺎوﻣﺘـﻲ‪ ،‬اﺳﺘﻘﺎﻣﺘـﻲ و اﺳﺘﺮاﺣـﺖ )ﻛﻨﺘﺮل( ﻃﻲ‬

‫دﻗﻴﻘﻪ(‬

‫ﺳﻄﺢ ﻣﻌﻨﻲداري ‪ P<0/05‬در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ‪.‬‬

‫ﻳﺎﻓﺘﻪﻫﺎ‬ ‫ﻧﺘﺎﻳﺞ آزﻣﻮن ﺗﺤﻠﻴﻞ وارﻳـﺎﻧﺲ )اﻧـﺪازهﻫـﺎي ﺗﻜـﺮاري( ﻣﺮﺑـﻮط ﺑـﻪ‬

‫ﺟﺪول‪ :2 -‬ﺗﻐﻴﻴﺮات درون و ﺑﻴﻦ ﮔﺮوﻫﻲ ﺗﺴﺘﻮﺳﺘﺮون‪ ،‬دﻫﻴﺪرواﭘﻲآﻧﺪرﺳﺘﺮون ﺳﻮﻟﻔﺎت‪ ،‬ﻛﻮرﺗﻴﺰول و ﻻﻛﺘﺎت ﺳﺮم ﮔﺮوهﻫﺎ‬ ‫ﻣﺘﻐﻴﺮﻫﺎ‬

‫ﺟﻠﺴﻪﻫﺎ‬

‫ﮔﺮوه‬ ‫ﭘﻴﺶ از ﺗﻤﺮﻳﻦ‬

‫*‬

‫ﺗﻐﻴﻴﺮات درون ﮔﺮوﻫﻲ‬

‫ﺑﻼﻓﺎﺻﻠﻪ‬

‫‪ 15‬دﻗﻴﻘﻪ‬

‫ﭘﺲ از ﺗﻤﺮﻳﻦ‬

‫‪P‬‬

‫ﭘﺲ از ﺗﻤﺮﻳﻦ‬

‫ﻣﻘﺪار‬

‫ﺗﺴﺘﻮﺳﺘﺮون‬

‫ﻣﻘﺎوﻣﺘﻲ‬

‫‪0/19±0/13‬‬

‫‪0/28±0/07‬‬

‫‪0/32±0/12‬‬

‫‪6/386‬‬

‫†‪0/008‬‬

‫)ﻧﺎﻧﻮﮔﺮم ﺑﺮ ﻣﻴﻠﻲﻟﻴﺘﺮ(‬

‫اﺳﺘﻘﺎﻣﺘﻲ‬

‫‪0/18±0/10‬‬

‫‪0/30±0/08‬‬

‫‪0/32±0/16‬‬

‫‪8/311‬‬

‫†‪0/003‬‬

‫ﻛﻨﺘﺮل‬

‫‪0/22±0/14‬‬

‫‪0/24±0/13‬‬

‫‪0/27±0/14‬‬

‫‪1/077‬‬

‫‪0/362‬‬

‫دﻫﻴﺪرواﭘﻲآﻧﺪرﺳﺘﺮون ﺳﻮﻟﻔﺎت‬

‫ﻣﻘﺎوﻣﺘﻲ‬

‫‪49/29±41/21‬‬

‫‪55/99±39/35‬‬

‫‪58/94±43/27‬‬

‫‪3/816‬‬

‫†‬

‫)ﻣﻴﻜﺮوﮔﺮم ﺑﺮ دﺳﻲﻟﻴﺘﺮ(‬

‫اﺳﺘﻘﺎﻣﺘﻲ‬

‫‪45/41±34/48‬‬

‫‪48/37±31/05‬‬

‫‪54/20±46/74‬‬

‫‪1/476‬‬

‫‪0/255‬‬

‫ﻛﻨﺘﺮل‬

‫‪45/51±33/97‬‬

‫‪45/50±36/99‬‬

‫‪47/42±41/67‬‬

‫‪0/186‬‬

‫‪0/832‬‬

‫ﻛﻮرﺗﻴﺰول‬

‫ﻣﻘﺎوﻣﺘﻲ‬

‫‪6/40±1/64‬‬

‫‪5/10±1/06‬‬

‫‪5/32±1/21‬‬

‫‪3/407‬‬

‫‪0/083‬‬

‫)ﻣﻴﻜﺮوﮔﺮم ﺑﺮ دﺳﻲﻟﻴﺘﺮ(‬

‫اﺳﺘﻘﺎﻣﺘﻲ‬

‫‪6/26±1/64‬‬

‫‪8/78±3/31‬‬

‫‪7/87±2/86‬‬

‫‪3/059‬‬

‫‪0/101‬‬

‫‪F‬‬

‫‪0/042‬‬

‫ﻛﻨﺘﺮل‬

‫‪5/83±1/88‬‬

‫‪5/25±1/79‬‬

‫‪5/52±0/90‬‬

‫‪0/444‬‬

‫‪0/648‬‬

‫ﻻﻛﺘﺎت‬

‫ﻣﻘﺎوﻣﺘﻲ‬

‫‪26/60±4/79‬‬

‫‪40/00±7/40‬‬

‫‪27/40±4/67‬‬

‫‪17/671‬‬

‫†‪0/000‬‬

‫)ﻣﻴﻜﺮوﮔﺮم ﺑﺮ دﺳﻲﻟﻴﺘﺮ(‬

‫اﺳﺘﻘﺎﻣﺘﻲ‬

‫‪24/30±4/35‬‬

‫‪34/40±8/34‬‬

‫‪26/70±3/89‬‬

‫‪13/504‬‬

‫†‬

‫ﻛﻨﺘﺮل‬

‫‪25/70±4/83‬‬

‫‪30/10±5/88‬‬

‫‪29/40±5/78‬‬

‫‪8/279‬‬

‫ﺗﻐﻴﻴﺮات ﺑﻴﻦ ﮔﺮوﻫﻲ‬ ‫ﻣﻘﺪار‬

‫‪P‬‬

‫‪F‬‬

‫‪0/111‬‬

‫‪0/129‬‬

‫‪7/677‬‬

‫‪1/435‬‬

‫‪0/895‬‬

‫‪0/880‬‬

‫†‬

‫‪0/002‬‬

‫‪0/256‬‬

‫‪0/000‬‬

‫†‪0/003‬‬

‫* اﻋﺪاد ﺑﻪ ﺻﻮرت ﻣﻴﺎﻧﮕﻴﻦ‪ ±‬اﻧﺤﺮافﻣﻌﻴﺎر ﺑﻴﺎن ﺷﺪهاﻧﺪ‪ P<0/05 † .‬ﻣﻌﻨﻲدار در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪه اﺳﺖ‪.‬‬

‫ﺗﺄﺛﻴﺮ ﺗﻤﺮﻳﻨﺎت ﻣﻘﺎوﻣﺘﻲ و اﺳﺘﻘﺎﻣﺘﻲ ﺑﺮ آﻧﺪروژنﻫﺎ‪ ،‬ﻛﻮرﺗﻴﺰول و ﻻﻛﺘﺎت زﻧﺎن‬

‫‪114‬‬

‫ﺑﻴﻦ ﮔﺮوﻫﻲ ﻣﻘﺎدﻳﺮ ﺗﺴﺘﻮﺳﺘﺮون ﻫﺮ ﺳﻪ ﮔﺮوه ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ‪،‬‬

‫ﺗﺴﺘﻮﺳﺘﺮون ﻣﺘﻌﺎﻗﺐ ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ و اﺳـﺘﻘﺎﻣﺘﻲ‪ 5‬را ﮔـﺰارش ﻛـﺮده و‬ ‫‪25‬و‪24‬‬

‫ﻫﻢ اﻳﻦ ﻃﻮر در ﺧـﺼﻮص‬

‫اﺳﺘﻘﺎﻣﺘﻲ و ﻛﻨﺘﺮل ﻣﻌﻨﻲدار ﻧﻴﺴﺖ‪ .‬ﻗﺎﺑﻞ ذﻛﺮ اﻳﻦ ﻛﻪ ﺗﻐﻴﻴﺮات ﻣﻘﺎدﻳﺮ‬

‫ﺑﻌﻀﻲ ﻫﻴﭻﮔﻮﻧﻪ ﺗﻐﻴﻴﺮي را ﻧﺸﺎن ﻧﺪاﻧﺪ‪.‬‬

‫ﺗﺴﺘﻮﺳﺘﺮون ﻣﺮﺑﻮط ﺑﻪ ﻫﺮ ﺳﻪ ﮔﺮوه ﻃﻲ ﻣﺮاﺣﻞ ﻣﺨﺘﻠﻒ از ﻳﻚ اﻟﮕﻮي‬

‫ﭘﺎﺳﺦ ‪ DHEAS‬ﺑﻪ ﺗﻤﺮﻳﻦ ورزﺷـﻲ و ﻓﻌﺎﻟﻴـﺖ ﺑـﺪﻧﻲ‪ ،‬ﺑﺮﺧـﻲ ﻣﻄﺎﻟﻌـﺎت‬

‫ﻃﻲ‬

‫اﻓﺰاﻳﺶ ﻣﻌﻨﻲدار ‪ DHEAS‬ﺑﻪ ﺗﻤﺮﻳﻦ اﺳﺘﻘﺎﻣﺘﻲ را ﮔﺰارش ﻛﺮدهاﻧـﺪ‪ 26.‬در‬

‫ﻣﺮاﺣﻞ ﻣﺨﺘﻠﻒ ﻧﺸﺎن ﻣﻲدﻫﺪ ﻛﻪ از ﻣﻴﺎن اﺛﺮ ﻳﻚ ﺟﻠﺴﻪ ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ‬

‫ﺗﺤﻘﻴﻖ ﻣﺎ ﻣﻘﺎدﻳﺮ درون ﮔﺮوﻫﻲ ﺗﺴﺘﻮﺳﺘﺮون ﺑﻌﺪ از ﺗﻤـﺮﻳﻦ ﻣﻘـﺎوﻣﺘﻲ و‬

‫و اﺳﺘﻘﺎﻣﺘﻲ ﺗﻨﻬﺎ ﻣﺪاﺧﻠﻪ ﻳﻚ ﺟﻠﺴﻪ ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ اﺳﺖ ﻛﻪ ﺑﺮ ﭘﺎﺳﺦ‬

‫اﺳﺘﻘﺎﻣﺘﻲ ﺗﻐﻴﻴﺮ ﻣﻌﻨﻲداري ﻳﺎﻓﺖ ﻛﻪ ﺑﺎ ﻧﺘﺎﻳﺞ و ﻫﻤﻜﺎران ﻫﻢﺧﻮاﻧﻲ دارد‬

‫ﻣﺸﺎﺑﻪ ﭘﻴﺮوي ﻣﻲﻛﻨﺪ‪ .‬ﺗﻐﻴﻴﺮات درون ﮔﺮوﻫﻲ ﻣﻘﺎدﻳﺮ‬

‫ﺣﺎد‬

‫‪DHEAS‬‬

‫ﺗﺎﺛﻴﺮ ﻣﻌﻨﻲدار داﺷﺘﻪ اﺳﺖ )‪ .(P<0/05‬ﺿﻤﻦ اﻳﻦ ﻛﻪ‬

‫‪25‬و‪24‬و‪5‬‬

‫و ﺑﺎ ﻧﺘﺎﻳﺞ ‪ Hakkinen‬ﻣﻐﺎﻳﺮ اﺳﺖ‪.‬‬

‫ﻫﻢﭼﻨﻴﻦ ﻣﻘﺎدﻳﺮ درون ﮔﺮوﻫﻲ‬

‫ﻣﺮﺑﻮط ﺑﻪ ﻫﺮ ﺳﻪ ﮔﺮوه ﻃﻲ ﻣﺮاﺣﻞ‬

‫‪ DHEAS‬ﺳﺮم ﺗﻨﻬﺎ ﺑﻌﺪ از ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ ﺗﻐﻴﻴﺮ ﻣﻌﻨـﻲداري ﻳﺎﻓـﺖ ﻛـﻪ‬

‫ﻣﺨﺘﻠﻒ از ﻳﻚ اﻟﮕﻮي ﻣﺸﺎﺑﻪ ﭘﻴﺮوي ﻣﻲﻛﻨﺪ‪ ،‬ﺗﻐﻴﻴﺮات ﺑﻴﻦ ﮔﺮوﻫﻲ‬

‫ﻣﻮاﻓـﻖ ﺑــﺎ ﻧﺘـﺎﻳﺞ ﺗﺤﻘﻴــﻖ ‪ Johnson‬ﻣـﻲﺑﺎﺷــﺪ‪ 26.‬در واﻗـﻊ ﭘﺎﺳــﺦﻫــﺎي‬

‫ﻣﻴﺎﻧﮕﻴﻦ ﺗﻐﻴﻴﺮات ﻣﻘﺎدﻳﺮ‬ ‫ﻣﻘﺎدﻳﺮ‬

‫‪DHEAS‬‬

‫ﻫﺮ ﺳﻪ ﮔﺮوه ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ‪ ،‬اﺳﺘﻘﺎﻣﺘﻲ و ﻛﻨﺘﺮل‬

‫ﻣﻌﻨﻲدار ﻧﻴﺴﺖ‪ .‬در ﺣﺎﻟﻲ ﻛﻪ ﺗﻐﻴﻴﺮات درون ﮔﺮوﻫﻲ ﻣﻘﺎدﻳﺮ ﻛﻮرﺗﻴﺰول‬ ‫ﻣﺮﺑﻮط ﺑﻪ ﻫﺮ ﺳﻪ ﮔﺮوه ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ‪ ،‬اﺳﺘﻘﺎﻣﺘﻲ و ﻛﻨﺘﺮل ﻃﻲ ﻣﺮاﺣﻞ‬

‫‪28‬‬

‫ﻫﻮرﻣﻮﻧﻲ ﺑﻪ ﺗﻤﺮﻳﻦ ﺑﻪ ﻋﻮاﻣﻠﻲ ﭼـﻮن ﻣـﺪت و ﻧـﻮع ﺗﻤـﺮﻳﻦ‪ ،‬ﺷـﺪت‬ ‫‪29‬‬

‫ﻓﻌﺎﻟﻴﺖ ﻋـﻀﻼﻧﻲ‪ ،‬زﻣﻴﻨـﻪ ژﻧﺘﻴﻜـﻲ‪ ،‬ﺟﻨـﺴﻴﺖ‪ ،‬ﺗﻐﺬﻳـﻪ‪ ،‬ﺳـﻦ‪ ،‬ﭼﺮﺧـﻪ‬ ‫‪28‬‬

‫‪30‬‬

‫ﺷﺒﺎﻧﻪروزي و ﻣﻴـﺰان ورزﻳﺪﮔﻲ اﻓـﺮاد ﺑـﺴﺘﮕﻲ دارد‪ .‬ﻣﻴــﺰان ﺗـﻮده‬ ‫‪31-33‬‬

‫‪34-38‬‬

‫ﺷـﺪت و ﺣﺠـﻢ ﺗﻤـﺮﻳﻦ‪،‬‬

‫ﻣﻴـﺰان‬

‫ﻣﺨﺘﻠﻒ ﻣﻌﻨﻲدار ﻧﻴﺴﺖ‪ .‬ﻣﻴﺎﻧﮕﻴﻦ ﺗﻐﻴﻴﺮات ﻣﻘﺎدﻳﺮ ﻛﻮرﺗﻴﺰول ﻣﺮﺑﻮط ﺑﻪ‬

‫ﻋﻀﻼﻧﻲ درﮔﻴﺮ در ﻓﻌﺎﻟﻴﺖ‪،‬‬

‫ﻫﺮ ﺳﻪ ﮔﺮوه ﻃﻲ ﻣﺮاﺣﻞ ﻣﺨﺘﻠﻒ از ﻳﻚ اﻟﮕﻮي ﻣﺸﺎﺑﻪ ﭘﻴﺮوي ﻧﻤﻲﻛﻨﺪ‪،‬‬

‫اﺳﺘﺮاﺣﺖ ﺑﻴﻦ ﺳﺖﻫﺎ‪ 34،‬ﻏﺬاي ﻣﺼﺮﻓﻲ‪ 39،‬ﺳﻦ‪ 40‬و ﺗﺠﺮﺑﻪ ﺗﻤﺮﻳﻨـﻲ‬

‫ﺑﻪ ﻃﻮري ﻛﻪ ﺗﻨﻬﺎ در ﻧﺘﻴﺠﻪ ﻣﺪاﺧﻠﻪ ﺗﻤﺮﻳﻦ اﺳﺘﻘﺎﻣﺘﻲ اﺳﺖ ﻛﻪ ﻣﻘﺎدﻳﺮ‬

‫ﻣﺴﺘﻘﻞ از ﻣﻴﺰان ﻗـﺪرت ﻋـﻀﻼﻧﻲ از ﻋﻮاﻣـﻞ ﻣـﺆﺛﺮ ﺑـﺮ ﻣﻴــﺰان ﭘﺎﺳـﺦ‬

‫‪42‬و‪41‬‬

‫‪42‬‬

‫ﻛﻮرﺗﻴﺰول اﻓﺰاﻳﺶ ﻣﻲﻳﺎﺑﺪ‪ .‬ﺗﻐﻴﻴﺮات ﺑﻴﻦ ﮔﺮوﻫﻲ ﻣﻘﺎدﻳﺮ ﻛﻮرﺗﻴﺰول ﻫﺮ‬

‫ﻫﻮرﻣـﻮن ﺗﺴﺘﻮﺳﺘﺮون ﻫـﺴﺘﻨﺪ‪ .‬ﻧـﺸﺎن داده ﺷـﺪه ﻛـﻪ ﭘﺮوﺗﻜـﻞﻫـﺎي‬

‫ﺳﻪ ﮔﺮوه ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ‪ ،‬اﺳﺘﻘﺎﻣﺘﻲ و ﻛﻨﺘﺮل ﻃﻲ ﻣﺮاﺣﻞ ﻣﺨﺘﻠﻒ‬

‫ﺗﻤﺮﻳﻨــﻲ ﺷــﺪﻳﺪ ﻛــﻪ ﻋــﻀﻼت ﺑــﺰرگ و ﻧﻴــﺰ ﭼﻨــﺪ ﻣﻔــﺼﻞ را درﮔﻴــﺮ‬

‫ﻣﻌﻨﻲدار اﺳﺖ )‪ .(P<0/05‬ﺑﺮاﺳﺎس ﻧﺘﺎﻳﺞ آزﻣﻮن ﺗﻌﻘﻴﺒﻲ ﺑﻨﻔﺮوﻧﻲ ﺑﻴﻦ‬

‫‪43‬‬

‫ﻣﻲﺳﺎزﻧﺪ‪ ،‬ﻣﻮﺟﺐ اﻓﺰاﻳﺶ ﺣﺎد ﻏﻠﻈﺖﻫـﺎي ﺗـﺴﺘﻮﺳﺘﺮون ﻣـﻲﺷـﻮﻧﺪ‪.‬‬

‫ﻣﻘﺎدﻳﺮ ﻛﻮرﺗﻴﺰول ﮔﺮوه ﺗﻤﺮﻳﻦ اﺳﺘﻘﺎﻣﺘﻲ ﺑﺎ ﻛﻨﺘﺮل و اﺳﺘﻘﺎﻣﺘﻲ ﺑﺎ‬

‫ﺣﺮﻛﺎﺗﻲ ﻣﺎﻧﻨﺪ ﻟﻴﻔﺖ اﻟﻤﭙﻴﻚ‪ 44،‬ﻟﻴﻔﺖ ﻣﺮده‪ 45‬و اﺳﻜﺎت ﭘﺮﺷﻲ‪ 32‬ﻛﻪ ﺗﻮده‬

‫ﻣﻘﺎوﻣﺘﻲ ﺗﻔﺎوت ﻣﻌﻨﻲدار اﺳﺖ )‪ .(P<0/05‬ﻫﻢﭼﻨﻴﻦ ﻧﺘﺎﻳﺞ آزﻣﻮن‬

‫ﻋﻀﻼﻧﻲ ﺑﺰرﮔﻲ را درﮔﻴﺮ ﻓﻌﺎﻟﻴﺖ ﻣﻲﻛﻨﻨﺪ ﻧﺴﺒﺖ ﺑﻪ ﺣﺮﻛﺎﺗﻲ ﻛـﻪ ﺗـﻮده‬

‫ﺗﺤﻠﻴﻞ وارﻳﺎﻧﺲ )اﻧﺪازهﻫﺎي ﺗﻜﺮاري( ﻣﺮﺑﻮط ﺑﻪ ﻣﻘﺎدﻳﺮ ﻻﻛﺘﺎت ﮔﺮوه‬

‫ﻋﻀﻼﻧﻲ ﻛﻮﭼﻚ را درﮔﻴﺮ ﻣﻲﺳﺎزﻧﺪ ﺑﻪ ﺳـﺒﺐ ﻧـﺮخ ﻣﺘـﺎﺑﻮﻟﻴﻜﻲ ﺑـﺎﻻﺗﺮ‬

‫ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ‪ ،‬اﺳﺘﻘﺎﻣﺘﻲ و ﻛﻨﺘﺮل ﻃﻲ ﻣﺮاﺣﻞ ﻣﺨﺘﻠﻒ ﻧﺸﺎن ﻣﻲدﻫﺪ‬

‫ﺑﺎﻋﺚ اﻓﺰاﻳﺶ ﺗﺤﺮﻳﻚ ﺗﺮﺷﺢ ﺗـﺴﺘﻮﺳﺘﺮون ﻣـﻲﺷـﻮﻧﺪ‪47.‬و‪ 46‬ﻧـﺸﺎن داده‬

‫ﻛﻪ ﺗﻐﻴﻴﺮات درون ﮔﺮوﻫﻲ ﻻﻛﺘﺎت ﻫﺮ ﺳﻪ ﮔﺮوه ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ‪،‬‬

‫ﺷﺪه زﻣﺎﻧﻲ ﻛﻪ ﻣﻴﺰان ﺑﺎر در ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ از ‪ 10‬ﺗﻜﺮار ﺑﻴﺸﻴﻨﻪ ﺑـﻪ ‪10‬‬

‫اﺳﺘﻘﺎﻣﺘﻲ و ﻛﻨﺘﺮل ﻣﻌﻨﻲدار اﺳﺖ )‪ .(P<0/05‬در ﺻﻮرﺗﻲ ﻛﻪ ﺗﻐﻴﻴﺮات‬

‫ﺗﻜﺮار ﺑﺎ ‪ %70‬ﻳﻚ ﺗﻜﺮار ﺑﻴﺸﻴﻨﻪ ﻛﺎﻫﺶ ﻳﺎﺑﺪ‪ ،‬ﭘﺎﺳﺦﻫﺎي ﻫﻮرﻣـﻮﻧﻲ ﻫـﻢ‬

‫ﺑﻴﻦ ﮔﺮوﻫﻲ ﻻﻛﺘﺎت ﻫﺮ ﺳﻪ ﮔﺮوه ﻣﻌﻨﻲدار ﻧﻴﺴﺖ )‪.(P>0/05‬‬

‫‪35‬‬

‫در زﻧﺎن و ﻫﻢ در ﻣﺮدان ﻛﺎﻫﺶ ﻣﻲﻳﺎﺑﺪ‪ .‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﻳﻦ ﻣﺒﺎﺣﺚ ﺷﺎﻳﺪ‬ ‫ﺣﺠﻢ و ﺷﺪت ﺗﻤﺮﻳﻦ در ﺗﺤﻘﻴﻖ ﺣﺎﺿﺮ ﺑﻪ اﻧﺪازه ﻛـﺎﻓﻲ ﺑـﺎﻻ ﻧﺒـﻮده ﻳـﺎ‬

‫ﺑﺤﺚ‬

‫ﺣﺮﻛﺎت اﻧﺠﺎم ﺷﺪه ﺗﻮده ﻋﻀﻼﻧﻲ ﺑـﺰرگ را ﺑـﻪ اﻧـﺪازه ﻛـﺎﻓﻲ ﺑـﻪ ﻛـﺎر‬ ‫ﻧﮕﺮﻓﺘﻨــﺪ ﺗــﺎ ﺳــﺒﺐ ﺗﻐﻴﻴــﺮ ﻣﻌﻨــﻲداري در ﺳــﻄﻮح ﺗــﺴﺘﻮﺳﺘﺮون و‬

‫ﻧﺘﺎﻳﺞ ﺗﺤﻘﻴﻖ ﺣﺎﺿﺮ ﻧﺸﺎن داد ﻣﺘﻌﺎﻗﺐ ﻳﻚ ﺟﻠﺴﻪ ﺗﻤﺮﻳﻦ ﻣﻘـﺎوﻣﺘﻲ‬

‫دﻫﻴﺪرواﭘﻲآﻧﺪرﺳﺘﺮون ﺳﻮﻟﻔﺎت ﺑﻴﻦ ﮔﺮوﻫﻲ ﺷﻮد‪ .‬اﻓﺰاﻳﺶ ﺗﺴﺘﻮﺳﺘﺮون‬

‫و ﻳﻚ ﺟﻠﺴﻪ ﺗﻤﺮﻳﻦ اﺳـﺘﻘﺎﻣﺘﻲ‪ ،‬ﺳـﻄﻮح آﻧـﺪروژنﻫـﺎ )ﺗـﺴﺘﻮﺳﺘﺮون و‬

‫در ﺑﺮﺧﻲ ﺗﺤﻘﻴﻘﺎت ﻣﻤﻜﻦ اﺳﺖ ﺑﻪ دﻟﻴﻞ ﻛﺎﻫﺶ ﺣﺠﻢ ﭘﻼﺳﻤﺎ‪ ،‬ﺗﺤﺮﻳﻚ‬ ‫‪48‬‬

‫‪49‬‬

‫دﻫﻴﺪرواﭘﻲآﻧﺪرﺳﺘﺮون ﺳﻮﻟﻔﺎت( ﺑﻼﻓﺎﺻﻠﻪ و ﭘﺲ از ﮔﺬﺷﺖ ‪ 15‬دﻗﻴﻘـﻪ‬

‫آدرﻧﺎﻟﻴﻨﻲ‪ ،‬اﺛـﺮ ﺗﺤﺮﻳﻜـﻲ ﻻﻛﺘـﺎت و ﻳـﺎ ﺗﻮاﻧـﺎﻳﻲ ﺳـﺎزﮔﺎري ﺗﺮﺷـﺢ‬

‫از ﻣﺪاﺧﻠﻪ ﺗﻤﺮﻳﻨﻲ اﻓﺰاﻳﺶ داﺷﺘﻪ اﺳﺖ وﻟﻲ اﻳﻦ اﻓـﺰاﻳﺶ ﺑـﻪ اﻧـﺪازهاي‬

‫ﺗﺴﺘﻮﺳﺘﺮون ﺑﺎﺷﺪ‪ 50.‬ﭘﮋوﻫﺸﮕﺮان ﻧﺸﺎن دادهاﻧﺪ ﻛـﻪ ﭘﺎﺳـﺦ ﺗـﺴﺘﻮﺳﺘﺮون‬

‫ﻧﺒﻮده ﻛﻪ ﺑﺘﻮاﻧﺪ ﺑﺮ ﺗﻐﻴﻴﺮات ﺑﻴﻦ ﮔﺮوﻫﻲ ﺗﺎﺛﻴﺮﮔـﺬار ﺑﺎﺷـﺪ‪ .‬ﺑـﺎ اﻳـﻦ ﻛـﻪ‬

‫‪29‬‬

‫ﺑﻪ ﺗﻤﺮﻳﻦ در اﻓﺮاد ﺗﻤﺮﻳﻦ ﻛﺮده ﻧﺴﺒﺖ ﺑﻪ ﺗﻤﺮﻳﻦ ﻧﻜﺮده ﺑـﺎﻻﺗﺮ اﺳـﺖ‪.‬‬

‫ﺗﺤﻘﻴﻘــﺎت در اﻳــﻦ زﻣﻴﻨــﻪ ﻣﺤــﺪود اﺳــﺖ‪ ،‬ﺑﻌــﻀﻲ از آنﻫــﺎ اﻓــﺰاﻳﺶ‬

‫از آنﺟﺎ ﻛﻪ آزﻣﻮدﻧﻲﻫﺎي ﺗﺤﻘﻴﻖ ﺣﺎﺿﺮ ﻏﻴﺮ ورزﺷﻜﺎر ﺑﻮدﻧﺪ‪ ،‬ﺷﺎﻳﺪ اﻳﻦ‬

‫دﻧﻴﺎ ﺻﻮرﺗﻲ ﺟﺎﺑﻠﻮ و ﻫﻤﻜﺎران‬

‫‪115‬‬

‫ﻋﺎﻣﻞ دﻟﻴﻞ دﻳﮕﺮ ﺑﺮاي ﻣﻌﻨﻲدار ﻧﺒـﻮدن ﺗﻐﻴﻴـﺮات ﺑـﻴﻦ ﮔﺮوﻫـﻲ ﻣﻘـﺎدﻳﺮ‬

‫‪58‬‬

‫ﻃﻮﻻﻧﻲ ﺑﺎﺷﺪ‪ ،‬اﻳﻦ ﻋﺎﻣﻞ ﺳﺒﺐ اﻓﺰاﻳﺶ ﻣﻌﻨﻲدار ﻛﻮرﺗﻴﺰول ﻣـﻲﺷـﻮد‪.‬‬

‫آﻧﺪروژنﻫﺎ ﺑﺎﺷﺪ‪ .‬ﻫﻢﭼﻨﻴﻦ ﭘﺎﺳﺦ ﻫﻮرﻣـﻮﻧﻲ ﭘـﺎﻳﻴﻦ در زﻧـﺎن ﺑـﻪ دﻟﻴـﻞ‬

‫ﻋﻮاﻣﻞ زﻳﺎدي ﻣﺎﻧﻨﺪ ﻓﺸﺎرﻫﺎي ﻓﻴﺰﻳﻮﻟﻮژﻳﻜﻲ‪ ،‬رﻳﺘﻢ ﺷـﺒﺎﻧﻪروزي‪ ،‬ﻏـﺬاي‬

‫ﺣﺠﻢ ﻛﻢ ﺗﻮده ﻋﻀﻼﻧﻲ درﮔﻴـﺮ در ﻓﻌﺎﻟﻴـﺖ ﻣـﻲﺗﻮاﻧـﺪ ﻋﻠـﺖ دﻳﮕـﺮي‬

‫ﺧﻮرده ﺷﺪه ﻳـﺎ ﻧﺎﺷـﺘﺎ ﺑـﻮدن و درﺟـﻪ ﺣـﺮارت ﺑـﺪن ﺑـﺮ ﭘﺎﺳـﺦ ﺣـﺎد‬

‫ﺑﺎﺷﺪ‪ 51-53.‬ﺗﺤﻘﻴﻘﺎت ﻧﺸﺎن دادهاﻧﺪ ﻛﻪ آدرﻧﻮﻛﻮرﺗﻴﻜﻮﺗﺮوﭘﻴﻦ در ﭘﺎﺳﺦ ﺑﻪ‬

‫ﻛﻮرﺗﻴﺰول ﺑﻪ ﻳﻚ ﺟﻠﺴﻪ ﺗﻤﺮﻳﻦ ﺗـﺄﺛﻴﺮ ﻣـﻲﮔﺬارﻧـﺪ‪ 59.‬ﻧـﺸﺎن داده ﺷـﺪه‬

‫ﺗﻤﺮﻳﻦ ﺷﺪﻳﺪ اﻓﺰاﻳﺶ ﻣﻲﻳﺎﺑﺪ ﻛﻪ ﻣﻲﺗﻮاﻧﺪ ﺑﻪﻧﻮﺑﻪ ﺧـﻮد ﻣﻮﺟـﺐ ﺗﺮﺷـﺢ‬

‫اﺳﺖ ﻛﻪ ﻛﻮرﺗﻴﺰول در ﻓﻌﺎﻟﻴﺖﻫﺎﻳﻲ ﻛﻪ ﻣﻮﺟـﺐ ﻫﻴﭙﻮﻛـﺴﻲ ﻣـﻲﺷـﻮﻧﺪ‬

‫ﺑﻴﺶﺗﺮ ﺗﺴﺘﻮﺳﺘﺮون ﺗﻮﺳﻂ ﻏـﺪد ﻓـﻮق ﻛﻠﻴـﻪ ﺷـﻮد‪ 54.‬از ﺳـﻮي دﻳﮕـﺮ‬

‫ﻧﺴﺒﺖ ﺑﻪ ﻓﻌﺎﻟﻴـﺖﻫـﺎﻳﻲ ﻛـﻪ ﻣﻮﺟـﺐ ﻫﻴﭙﻮﻛـﺴﻲ ﻧﻤـﻲﺷـﻮﻧﺪ اﻓـﺰاﻳﺶ‬

‫ﻣﺸﺨﺺ ﺷﺪه ﻛﻪ ﺗﺎرﻫﺎي ﻋﻀﻠﻪ اﺳﻜﻠﺘﻲ داراي ﮔﻴﺮﻧﺪهﻫﺎي اﺧﺘـﺼﺎﺻﻲ‬

‫ﺑﻴﺶﺗﺮي ﻣﻲﻳﺎﺑﺪ‪ 60.‬ﺑﻨـﺎﺑﺮاﻳﻦ اﺣﺘﻤـﺎل دارد اﻓـﺰاﻳﺶ ﻛـﻮرﺗﻴﺰول در اﺛـﺮ‬

‫آﻧﺪروژن ﻫﺴﺘﻨﺪ ﻛﻪ ﻣﻲﺗﻮاﻧﻨﺪ ﺑﺎ ﻣﺘﺎﺑﻮﻟﻴﺰه ﻛﺮدن اﻳﻦ ﻫﻮرﻣﻮنﻫﺎ ﻣﻮﺟـﺐ‬

‫ﺗﻤﺮﻳﻦ اﺳﺘﻘﺎﻣﺘﻲ در ﺗﺤﻘﻴﻖ ﺣﺎﺿﺮ ﺑﻪ دﻟﻴﻞ ﻣﺪت زﻣﺎن ﻧﺴﺒﺘﺎً ﻃﻮﻻﻧﻲ آن‬

‫اﻓﺰاﻳﺶ ﺑﺮداﺷﺖ و ﭘﺎكﻛﻨﻨﺪﮔﻲ آنﻫـﺎ از ﮔـﺮدش ﺧـﻮن ﺷـﻮﻧﺪ‪ 55‬و از‬

‫ﺑﻮده ﻛﻪ ﻣﻮﺟﺐ ﻫﻴﭙﻮﻛﺴﻲ ﺷﺪه اﺳﺖ‪ .‬اﮔﺮﭼﻪ ﺳـﻄﻮح زﻳـﺎد و ﻃـﻮﻻﻧﻲ‬

‫‪56‬‬

‫ﻣﺪت ﻛﻮرﺗﻴﺰول ﻣﻤﻜﻦ اﺳﺖ اﺛﺮات زﻳﺎنآور داﺷﺘﻪ ﺑﺎﺷﺪ‪ ،‬اﻣـﺎ اﻓـﺰاﻳﺶ‬

‫ﺗﺨﺮﻳﺐ ﭘﺮوﺗﻴﻴﻦ ﻋﻀﻼت اﺳﻜﻠﺘﻲ ﺑﻪ ﻫﻨﮕﺎم ﺗﻤﺮﻳﻦ ﺟﻠـﻮﮔﻴﺮي ﻛﻨﻨـﺪ‪.‬‬

‫‪61‬‬

‫ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻧﻜﺎت ذﻛﺮ ﺷﺪه‪ ،‬در ﺗﺤﻘﻴﻖ ﺣﺎﺿﺮ ﺷﺎﻳﺪ اﻓـﺰاﻳﺶ ﺑﺮداﺷـﺖ‬

‫ﺣﺎد آن‪ ،‬ﺑﺨﺸﻲ از روﻧﺪ ﺷﻜﻞﮔﻴﺮي ﭘﺮوﺳﻪ رﺷﺪ ﻋﻀﻠﻪ ﻣﻲﺑﺎﺷـﺪ‪ .‬در‬

‫ﺗﺴﺘﻮﺳﺘﺮون ﺗﻮﺳﻂ ﻋﻀﻼت ﻣﻮﺟﺐ اﻓﺰاﻳﺶ ﻧﺎﻣﺤـﺴﻮس ﺗـﺴﺘﻮﺳﺘﺮون‬

‫ﺗﺤﻘﻴﻖ ‪ Hakkinen‬در زﻧﺎن ﻣﺴﻦ‪ ،‬ﻣﻘـﺎدﻳﺮ ﻛـﻮرﺗﻴﺰول ﻣﺘﻌﺎﻗـﺐ ﺗﻤـﺮﻳﻦ‬

‫ﺑﺎﺷﺪ‪ .‬ﻫﻢﭼﻨـﻴﻦ ﺑـﺎ ﺗﻮﺟـﻪ ﺑـﻪ اﻳـﻦ ﻛـﻪ در ﺗﺤﻘﻴـﻖ ‪ Copeland‬ﻣﻘـﺎدﻳﺮ‬

‫ﻣﻘﺎوﻣﺘﻲ ﺗﻐﻴﻴﺮي ﻧﻴﺎﻓﺖ ﻛﻪ ﺑﺎ ﻧﺘﺎﻳﺞ ﺗﺤﻘﻴﻖ ﺣﺎﺿﺮ ﻫﻢﺧﻮاﻧﻲ دارد‪ .‬اﻳﺠﺎد‬

‫ﺗﺴﺘﻮﺳﺘﺮون ﺑﻌﺪ از ﻫﺮ دو ﻧﻮع ﺗﻤـﺮﻳﻦ ﻣﻘـﺎوﻣﺘﻲ و اﺳـﺘﻘﺎﻣﺘﻲ اﻓـﺰاﻳﺶ‬

‫ﭘﺎﺳﺦ ﻛﻮرﺗﻴﺰول ﺑﻪ ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ ﺑـﻪ ﻋـﻮاﻣﻠﻲ ﻣﺎﻧﻨـﺪ درﮔﻴـﺮي ﺗـﻮده‬

‫ﻳﺎﻓﺖ اﻣﺎ ﻣﻘﺎدﻳﺮ ﻛﻮرﺗﻴﺰول ﻛﺎﻫﺶ ﻳﺎﻓﺖ‪ ،‬ﺑﻨﺎﺑﺮاﻳﻦ ﺷﺎﻳﺪ اﻓـﺰاﻳﺶ‬

‫‪ACTH‬‬

‫‪44‬و‪34‬‬

‫ﻋﻀﻼﻧﻲ ﺑﺰرگ‪ ،‬ﺷﺪت و ﺣﺠـﻢ ﺑـﺎﻻي ﺗﻤـﺮﻳﻦ ﺑـﺴﺘﮕﻲ دارد‪.‬‬

‫در‬

‫در زﻧﺎن ﻣﺴﻦ ﻣﺤﺮك ﻗﻮي ﺑﺮاي اﻓـﺰاﻳﺶ ﺗﺮﺷـﺢ ﺗـﺴﺘﻮﺳﺘﺮون ﻧﺒﺎﺷـﺪ‪.‬‬

‫ﺻﻮرﺗﻲ ﻛﻪ ﻣﺪت زﻣﺎن اﺳﺘﺮاﺣﺖ ﺑـﻴﻦ ﺳـﺖﻫـﺎ ﻛـﺎﻫﺶ ﻳﺎﺑـﺪ‪ ،‬ﭘﺎﺳـﺦ‬

‫ﻣﻄﺎﻟﻌﺎت ﻧﺸﺎن دادهاﻧﺪ ﻛﻪ اﻓﺰاﻳﺶ ﻻﻛﺘﺎت ﻣﺘﻌﺎﻗـﺐ ﺗﻤﺮﻳﻨـﺎت ورزﺷـﻲ‬

‫ﻛﻮرﺗﻴﺰول ﺑﻪ ﺗﻤﺮﻳﻦ ﻗﺎﺑﻞ ﺗﻮﺟﻪ اﺳﺖ‪ 34‬زﻳﺮا ﻛـﺎﻫﺶ زﻣـﺎن اﺳـﺘﺮاﺣﺖ‬ ‫‪35‬‬

‫ﺷﺪﻳﺪ ﺑﺎ اﺛﺮ ﺗﺤﺮﻳﻜﻲ ﺑﺮ ﺗﺮﺷﺢ ﮔﻨﺎدﻫﺎ و ﺑﻪ دﻧﺒـﺎل آن اﻓـﺰاﻳﺶ رﻫـﺎﻳﺶ‬

‫ﺑﻴﻦ ﺳﺖﻫﺎ ﻣﻮﺟﺐ اﻓﺰاﻳﺶ ﻓﺸﺎر ﺗﻤﺮﻳﻦ ﻣﻲﺷﻮد‪ .‬ﺑﺮاي اﻳﺠﺎد اﻓﺰاﻳﺶ‬

‫ﻫﻮرﻣﻮن ﻟﻮﺗﻴﻴﻨﻲ از ﻫﻴﭙﻮﻓﻴﺰ ﻗﺪاﻣﻲ ﻣﻮﺟﺐ اﻓﺰاﻳﺶ ﺗﺮﺷﺢ ﺗـﺴﺘﻮﺳﺘﺮون‬

‫در ﻛــﻮرﺗﻴﺰول‪ ،‬ﺷــﺪت ﺗﻤــﺮﻳﻦ ﻣﻘــﺎوﻣﺘﻲ ﺑﺎﻳــﺪ ﺑــﻪ اﻧــﺪازه ﻛــﺎﻓﻲ زﻳــﺎد‬ ‫‪42‬و‪39‬و‪32‬‬

‫ﻣﻲﺷﻮد‪ 56.‬ﺑﻨﺎﺑﺮاﻳﻦ ﺷﺎﻳﺪ ﻣﻌﻨﻲدار ﻧﺒﻮدن ﺗﻐﻴﻴﺮات ﺑﻴﻦ ﮔﺮوﻫـﻲ ﻣﻘـﺎدﻳﺮ‬

‫ﺑﺎﺷﺪ‪.‬‬

‫آﻧﺪروژنﻫﺎ در ﺗﺤﻘﻴﻖ ﺣﺎﺿﺮ ﺑﻪ دﻟﻴﻞ اﻓﺰاﻳﺶ ﻛﻢ ﻣﻘﺎدﻳﺮ ﻻﻛﺘﺎت ﺧـﻮن‬

‫ﻣﻘﺎوﻣﺘﻲ ﺑﻪ اﻧﺪازه ﻛﺎﻓﻲ زﻳﺎد ﻧﺒﻮده ﺗﺎ ﻣﻮﺟﺐ اﻓﺰاﻳﺶ ﺑﻴﺶﺗﺮ ﻛﻮرﺗﻴﺰول‬

‫در ﭘﻲ ﺗﻤﺮﻳﻨﺎت آﺳﺘﺎﻧﻪ و زﻳﺮ آﺳﺘﺎﻧﻪ ﺑﺎﺷﺪ‪.‬‬

‫ﺷﻮد‪ .‬ﻫﻢﭼﻨﻴﻦ ﻣﻤﻜﻦ اﺳﺖ ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ ﻣﻮﺟﺐ ﻫﻴﭙﻮﻛﺴﻲ ﻧﺸﺪه ﺗـﺎ‬

‫ﺑﻨﺎﺑﺮاﻳﻦ ﺑﻪ ﻧﻈﺮ ﻣﻲرﺳﺪ در ﺗﺤﻘﻴﻖ ﺣﺎﺿﺮ‪ ،‬ﺷﺪت ﺗﻤـﺮﻳﻦ‬

‫ﻧﺘﺎﻳﺞ اﻳﻦ ﺗﺤﻘﻴﻖ ﻧﺸﺎن داد ﺗﻐﻴﻴﺮات ﺑﻴﻦ ﮔﺮوﻫﻲ ﻣﻘﺎدﻳﺮ ﻛـﻮرﺗﻴﺰول‬

‫ﻣﻮﺟﺐ اﻓﺰاﻳﺶ ﺑـﻴﺶﺗـﺮ ﻛـﻮرﺗﻴﺰول ﻣﻬﻴـﺎ ﺷـﻮد‪ .‬در ﭘـﮋوﻫﺶ ﺣﺎﺿـﺮ‬

‫ﻣﻌﻨﻲدار اﺳﺖ‪ .‬ﺑﻪ ﻋﺒﺎرت دﻳﮕﺮ ﺗﻨﻬﺎ در ﻧﺘﻴﺠﻪ ﻣﺪاﺧﻠﻪ ﺗﻤﺮﻳﻦ اﺳـﺘﻘﺎﻣﺘﻲ‬

‫ﺗﻐﻴﻴــﺮات درون ﮔﺮوﻫــﻲ ﻻﻛﺘــﺎت ﺧــﻮن ﻣﺘﻌﺎﻗــﺐ ﺗﻤــﺮﻳﻦ ﻣﻘــﺎوﻣﺘﻲ و‬

‫ﻣﻘﺎدﻳﺮ ﻛﻮرﺗﻴﺰول اﻓﺰاﻳﺶ ﻳﺎﻓـﺖ‪ .‬ﺗﻐﻴﻴـﺮات ﻛـﻮرﺗﻴﺰول ﺳـﺮم ﺑـﻪ ﻧـﻮع‪،‬‬

‫اﺳﺘﻘﺎﻣﺘﻲ ﻣﻌﻨﻲدار اﺳﺖ در ﺻﻮرﺗﻲ ﻛﻪ اﻓﺰاﻳﺶ آﻧـﻲ و ﻛـﺎﻫﺶ ﺳـﺮﻳﻊ‬

‫ﺷﺪت و ﻣﺪت ﻓﻌﺎﻟﻴﺖ ﺑﺴﺘﮕﻲ دارد‪ ،‬ﺑﻪ ﻃﻮري ﻛﻪ ﻓﻌﺎﻟﻴﺖ ﺑﺪﻧﻲ ﺑﻴﺶ از‬

‫ﻻﻛﺘﺎت ﺑﻼﻓﺎﺻﻠﻪ و ﭘﺲ از ﮔﺬﺷﺖ ‪ 15‬دﻗﻴﻘـﻪ از ﺗﻤـﺮﻳﻦ ﺑـﻪ اﻧـﺪازهاي‬

‫‪ %60‬ﺣﺪاﻛﺜﺮ اﻛﺴﻴﮋن ﻣﺼﺮﻓﻲ از ﻣﻬـﻢﺗـﺮﻳﻦ ﻣﺤـﺮكﻫـﺎي ﺗﺮﺷـﺢ اﻳـﻦ‬

‫ﻧﻴﺴﺖ ﻛﻪ ﺗﻐﻴﻴﺮات ﺑﻴﻦ ﮔﺮوﻫﻲ ﻻﻛﺘﺎت ﻫﺮ ﺳﻪ ﮔـﺮوه ﻣﻌﻨـﻲدار ﺷـﻮد‪،‬‬

‫ﻫﻮرﻣﻮن اﺳﺖ‪ .‬ﺑﻪ ﻧﻈﺮ ﻣﻲرﺳﺪ ﻓﻌﺎﻟﻴﺖ ﺟﺴﻤﺎﻧﻲ ﺷﺪﻳﺪ ﻣﻮﺟﺐ اﻓﺰاﻳﺶ‬

‫اﻳﻦ ﻳﺎﻓﺘﻪ ﺑﺎ ﻧﺘﺎﻳﺞ ﺗﺤﻘﻴﻘـﺎت ‪ Copeland‬و ‪ Hakkinen‬ﻫـﻢﺧـﻮاﻧﻲ دارد‪.‬‬

‫ﺗﺮﺷﺢ ‪ ACTH‬و در ﻧﺘﻴﺠـﻪ اﻓـﺰاﻳﺶ ﺗﺮﺷـﺢ ﻛـﻮرﺗﻴﺰول ﺷـﻮد‪ .‬اﻓـﺰاﻳﺶ‬

‫ﻣﻘﺎدﻳﺮ ﻻﻛﺘﺎت ﺧﻮن ﺑﻪ ﻃﻮر ﻣﻌﻨﻲداري ﺗﺤﺖ ﺗﺄﺛﻴﺮ ﺷﺪت ﺗﻤﺮﻳﻦ ﻗـﺮار‬

‫ﻛﻮرﺗﻴﺰول ﺗﻨﻬﺎ ﺑﻪ ﺷﺪت ﻓﻌﺎﻟﻴﺖ ﺟﺴﻤﺎﻧﻲ ﺑـﺴﺘﮕﻲ ﻧـﺪارد ﺑﻠﻜـﻪ ﻣـﺪت‬

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‫ﻣﻲﮔﻴﺮد‪ .‬ﻋﻼوه ﺑﺮ اﻳﻦ ﻧﺸﺎن دادهاﻧﺪ ﻛﻪ ﭘﺎﺳﺦ ﻻﻛﺘـﺎت ﺑـﻪ ﺗﻤـﺮﻳﻦ در‬ ‫‪18‬‬

‫ﻓﻌﺎﻟﻴﺖ ﺟﺴﻤﺎﻧﻲ ﻳﺎ ﺗﻌﺎﻣﻞ ﻫﺮ دو ﺑﺎ ﻫﻢ ﻧﻴـﺰ ﻣـﺆﺛﺮ ﻣـﻲﺑﺎﺷـﻨﺪ‪ .‬درﺳـﺖ‬

‫اﻓﺮاد ﻣﺴﻦ‪ ،‬ﻧﺴﺒﺖ ﺑﻪ ﺟﻮاﻧﺎن ﻛﻢﺗﺮ اﺳﺖ‪ .‬دﻟﻴـﻞ اﻳـﻦ اﻣـﺮ را ﻇﺮﻓﻴـﺖ‬

‫اﺳﺖ ﻛﻪ ﻣﻴﺰان ﻛﻮرﺗﻴﺰول ﻣﺘﻨﺎﺳﺐ ﺑﺎ ﺷﺪت ﻓﻌﺎﻟﻴﺖ ﺟـﺴﻤﺎﻧﻲ اﻓـﺰاﻳﺶ‬

‫ﻛﻢﺗﺮ اﻓﺮاد ﻣﺴﻦ در ﺗﻮاﻧﺎﻳﻲ ﺗﺤﻤﻞ ﻓﺸﺎر ﺗﻤﺮﻳﻦ داﻧﺴﺘﻪاﻧﺪ‪ ،‬اﻓـﺮاد ﻣـﺴﻦ‬

‫ﻣﻲﻳﺎﺑﺪ اﻣﺎ ﺣﺪاﻛﺜﺮ اﻓﺰاﻳﺶ ﻛﻮرﺗﻴﺰول ﺑﻪ ﻣﺪت زﻣـﺎن ﻓﻌﺎﻟﻴـﺖ ﺑـﺴﺘﮕﻲ‬

‫ﻗﺎدر ﺑﻪ اﻧﺠﺎم ﺗﻤﺮﻳﻦ ﺑﺎ ﺷﺪت ﭘﺎﻳﻴﻦﺗﺮ ﻣﻲﺑﺎﺷﻨﺪ‪ ،‬ﻫﻢﭼﻨـﻴﻦ ﻛﺎﻫـﺸﻲ در‬

‫دارد‪ 57،‬ﺣﺘﻲ اﮔﺮ ﺷﺪت ﻓﻌﺎﻟﻴﺖ زﻳﺎد ﻧﺒﺎﺷﺪ وﻟﻲ ﻓﻌﺎﻟﻴﺖ ﺑﻪ اﻧﺪازه ﻛـﺎﻓﻲ‬

‫اوج ﻻﻛﺘﺎت ﺧﻮن ﻃﻲ ﺗﻤﺮﻳﻦ‪ ،‬ﻫﻤﺮاه ﺑﺎ اﻓﺰاﻳﺶ ﺳﻦ اﻳﺠﺎد ﻣﻲﺷﻮد ﻛـﻪ‬

Sourati D. et ‫و‬al.‫ﺗﺄﺛﻴﺮ ﺗﻤﺮﻳﻨﺎت ﻣﻘﺎوﻣﺘﻲ‬ ‫ ﻛﻮرﺗﻴﺰول و ﻻﻛﺘﺎت زﻧﺎن‬،‫ﻫﺎ‬ ‫آﻧﺪروژن‬Jabloo ‫اﺳﺘﻘﺎﻣﺘﻲ ﺑﺮ‬

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‫ ﺗﺎﺛﻴﺮي ﻣﻄﻠﻮب ﺑﺮ ﺳﻼﻣﺖ ﺑﺎﻓﺖ‬،‫در ﺳﻄﻮح ﭘﺎﻳﻪ ﻫﻮرﻣﻮنﻫﺎي آﻧﺎﺑﻮﻟﻴﻚ‬

‫ اﻳﻦ اﻣﺮ ﻧﺎﺷﻲ‬.‫ﺑﺎ ﻛﻢ ﺷﺪن ﻇﺮﻓﻴﺖ ﮔﻠﻴﻜﻮﻟﻴﺘﻴﻜﻲ ﻋﻀﻠﻪ در ارﺗﺒﺎط اﺳﺖ‬

‫ ﺑﺎ اﻳﻦ ﻛﻪ اﻧﺠﺎم ﺗﻤﺮﻳﻨﺎت ﻣﻘﺎوﻣﺘﻲ ﺑﻪ ﻋﻨﻮان روش ﻏﻴﺮ داروﻳﻲ‬.‫ﺑﮕﺬارﻧﺪ‬

‫ ﮔﻠﻴﻜـﻮﻟﻴﺘﻴﻜﻲ و ﻛﺎﻫــﺶ‬IIB ‫از آﺗﺮوﻓﻲ ﻋﻀﻼﻧﻲ اﻧﺘﺨﺎﺑﻲ ﺗﺎرﻫﺎي ﻧﻮع‬

،‫ﺑﺮاي ﺣﻔﻆ ﺳﻄﻮح ﺑﻬﻴﻨﻪ آﻧﺪروژنﻫـﺎ و ﻛـﻮرﺗﻴﺰول ﭘﻴـﺸﻨﻬﺎد ﻣـﻲﺷـﻮد‬

‫ﻓﻌﺎﻟﻴﺖ ﻻﻛﺘﺎت دﻫﻴـﺪروژﻧﺎز ﻋـﻀـﻼﻧﻲ و ﻛﺎﻫــﺶ در ﺣـﺴﺎﺳﻴﺖ ﺑـﻪ‬

‫ﺗﺤﻘﻴﻘﺎت ﺑﻴﺶﺗﺮي ﻻزم اﺳﺖ ﺗﺎ ﺗﺄﺛﻴﺮ ﺗﻤﺮﻳﻦ ﺑﺮ ﺳﻄﻮح ﻫﻮرﻣـﻮنﻫـﺎي‬

‫ ﺑﻨـﺎﺑﺮاﻳﻦ‬62.‫آدرﻧﺎﻟﻴـﻦ ﻣﻲﺑﺎﺷﺪ ﻛـﻪ ﻫﻤـﺮاه ﺑﺎ اﻓﺰاﻳـﺶ ﺳـﻦ رخ ﻣﻲدﻫﺪ‬

‫آﻧﺎﺑﻮﻟﻴﻚ دﻳﮕـﺮ ﻧﻈﻴـﺮ ﻫﻮرﻣـﻮن رﺷـﺪ و ﻓـﺎﻛﺘﻮر رﺷـﺪ ﺷـﺒﻪ اﻧـﺴﻮﻟﻴﻦ‬

‫ﻣﻌﻨﻲدار ﻧﺒﻮدن ﺗﻐﻴﻴﺮات ﺑﻴﻦ ﮔﺮوﻫﻲ ﻣﻘﺎدﻳﺮ ﻻﻛﺘﺎت در ﺗﺤﻘﻴـﻖ ﺣﺎﺿـﺮ‬

.‫ﺑﺮرﺳﻲ ﮔﺮدد‬

‫ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺿﺮورت ﺣﻔﻆ ﺑﻬﻴﻨﻪ ﺳﻄﻮح‬.‫ﺷﺎﻳﺪ ﺑﻪ دﻻﻳﻞ ذﻛﺮ ﺷﺪه ﺑﺎﺷﺪ‬

‫ اﻧﺠـﺎم اﻳـﻦ‬،‫ ﺑﺎ ﺗﻘﺪﻳﺮ از ﻣﺎدراﻧﻲ ﻛﻪ ﻣﺎ را ﻳﺎري دادﻧﺪ‬:‫ﺳﭙﺎﺳﮕﺰاري‬

‫آﻧﺪروژنﻫﺎ و ﻛﻮرﺗﻴﺰول در زﻧﺎن ﻣﺴﻦ و اﻫﻤﻴﺖ ﺣﻔﻆ ذﺧﺎﻳﺮ ﭘﺮوﺗﻴﻴﻨﻲ‬

‫ﺗﺤﻘﻴﻖ ﺑﺎ ﺣﻤﺎﻳﺖ ﻣﻌﺎوﻧـﺖ ﭘﮋوﻫـﺸﻲ داﻧـﺸﮕﺎه ﻓﺮدوﺳـﻲ و ﻫﻤﻜـﺎري‬

‫ ﺑﻪ ﻧﻈﺮ ﻣﻲرﺳﺪ ﺗﻤﺮﻳﻨـﺎت ﻣﻘـﺎوﻣﺘﻲ ﻳـﻚ‬،‫ﻋﻀﻼت ﻃﻲ ﻓﺮاﻳﻨﺪ ﭘﻴﺮﺷﺪن‬

‫ﻣﻌﺎوﻧﺖ ﭘﮋوﻫﺸﻲ واﺣﺪ ﺟﻬﺎد داﻧﺸﮕﺎﻫﻲ ﻣﺸﻬﺪ ﻣﻴﺴﺮ ﮔﺮدﻳﺪ ﻛﻪ ﺑـﺪﻳﻦ‬

‫روش ﻣﻔﻴﺪ ﺑﺮاي ﺣﻔﻆ و ﺣﺘﻲ اﻓﺰاﻳﺶ ﺗﻮده ﻋـﻀﻼﻧﻲ در زﻧـﺎن ﻣـﺴﻦ‬

.‫وﺳﻴﻠﻪ از آنﻫﺎ ﻗﺪرداﻧﻲ ﻣﻲﮔﺮدد‬

‫ ﺷﻮاﻫﺪ ﻧﺸﺎن ﻣﻲدﻫﻨﺪ ﺗﻤﺮﻳﻨﺎت ورزﺷﻲ ﻣﻲﺗﻮاﻧﻨﺪ ﺑﺪون اﻓـﺰاﻳﺶ‬.‫ﺑﺎﺷﺪ‬

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‫ﻋﻤﻮﻣﻲ‬ ‫ﺑﺨﺸﻬﺎي ﺟﺮاﺣﻲ‬ ‫ﻣﺤﻞ ﺟﺮاﺣﻲ در‬cortisol ‫ﺗﺸﺨﻴﺺ ﻋﻔﻮﻧﺖ‬ ‫ﭘﺎﻳﺶ ﺑﺮاي‬ ‫ﻛﺎراﻳﻲ دو‬ Effects of exercise on androgens, and lactate in‫روش‬ elderly women

elderly men and women. J Gerontol A Biol Sci Med Sci 2000;55(2):B95-105. Häkkinen K, Pakarinen A. Acute hormonal responses to heavy resistance exercise in men and women at different ages. Int J Sports Med 1995;16(8):507-13. Johnson LG, Kraemer RR, Haltom R, Kraemer GR, Gaines HE, Castracane VD. Effects of estrogen replacement therapy on dehydroepiandrosterone, dehydroepiandrosterone sulfate, and cortisol responses to exercise in postmenopausal women. Fertil Steril 1997;68(5):836-43. Grosvenor MB, Smolin LA, editors. Nutrition from science to life. Fort Worth, TX: Harcourt College Publishers; 2002. Karkoulias K, Habeos I, Charokopos N, Tsiamita M, Mazarakis A, Pouli A, et al. Hormonal responses to marathon running in non-elite athletes. Eur J Intern Med 2008;19(8):598-601. Majumdar P, Srividhya S, Mandal M, Kalinski M. Response of selected hormonal markers during training cycles on Indian females swimmers. Biol Sport 2010;27(1):53-7. Kraemer WJ, Ratamess NA. Hormonal responses and adaptations to resistance exercise and training. Sports Med 2005;35(4):339-61. Weiss LW, Cureton KJ, Thompson FN. Comparison of serum testosterone and androstenedione responses to weight lifting in men and women. Eur J Appl Physiol Occup Physiol 1983;50(3):413-9. Volek JS, Kraemer WJ, Bush JA, Incledon T, Boetes M. Testosterone and cortisol in relationship to dietary nutrients and resistance exercise. J Appl Physiol 1997;82(1):49-54. Hansen S, Kvorning T, Kjaer M, Sjøgaard G. The effect of short-term strength training on human skeletal muscle: the importance of physiologically elevated hormone levels. Scand J Med Sci Sports 2001;11(6):347-54. Kraemer WJ, Marchitelli L, Gordon SE, Harman E, Dziados JE, Mello R, et al. Hormonal and growth factor responses to heavy resistance exercise protocols. J Appl Physiol 1990;69(4):144250. Linnamo V, Pakarinen A, Komi PV, Kraemer WJ, Häkkinen K. Acute hormonal responses to submaximal and maximal heavy resistance and explosive exercises in men and women. J Strength Cond Res 2005;19(3):566-71. Kraemer WJ, Gordon SE, Fleck SJ, Marchitelli LJ, Mello R, Dziados JE, et al. Endogenous anabolic hormonal and growth factor responses to heavy resistance exercise in males and females. Int J Sports Med 1991;12(2):228-35. Vingren JL, Kraemer WJ, Hatfield DL, Volek JS, Ratamess NA, Anderson JM, et al. Effect of resistance exercise on muscle steroid receptor protein content in strength-trained men and women. Steroids 2009;74(13-14):1033-9. Fry AC, Kraemer WJ, Ramsey LT. Pituitary-adrenal-gonadal responses to high-intensity resistance exercise overtraining. J Appl Physiol 1998;85(6):2352-9. Kraemer WJ, Volek JS, Bush JA, Putukian M, Sebastianelli WJ. Hormonal responses to consecutive days of heavy-resistance exercise with or without nutritional supplementation. J Appl Physiol 1998;85(4):1544-55. Häkkinen K, Pakarinen A, Newton RU, Kraemer WJ. Acute hormone responses to heavy resistance lower and upper extremity exercise in young versus old men. Eur J Appl Physiol Occup Physiol 1998;77(4):312-9. Tremblay MS, Copeland JL, Van Helder W. Effect of training status and exercise mode on endogenous steroid hormones in men. J Appl Physiol 2004;96(2):531-9. Kraemer WJ, Staron RS, Hagerman FC, Hikida RS, Fry AC, Gordon SE, et al. The effects of short-term resistance training on endocrine function in men and women. Eur J Appl Physiol Occup Physiol 1998;78(1):69-76.

43. Fry AC, Lohnes CA. Acute testosterone and cortisol responses to high power resistance exercise. Fiziol Cheloveka 2010;36(4):102-6. 44. Kraemer WJ, Fry AC, Warren BJ, Stone MH, Fleck SJ, Kearney JT, et al. Acute hormonal responses in elite junior weightlifters. Int J Sports Med 1992;13(2):103-9. 45. Fahey TD, Rolph R, Moungmee P, Nagel J, Mortara S. Serum testosterone, body composition, and strength of young adults. Med Sci Sports 1976;8(1):31-4. 46. Ratamess NA, Kraemer WJ, Volek JS, Maresh CM, Vanheest JL, Sharman MJ, et al. Androgen receptor content following heavy resistance exercise in men. J Steroid Biochem Mol Biol 2005;93(1):35-42. 47. Ballor DL, Becque MD, Katch VL. Metabolic responses during hydraulic resistance exercise. Med Sci Sports Exerc 1987;19(4):3637. 48. Jezová D, Vigas M. Testosterone response to exercise during blockade and stimulation of adrenergic receptors in man. Horm Res 1981;15(3):141-7. 49. Lu SS, Lau CP, Tung YF, Huang SW, Chen YH, Shih HC, et al. Lactate and the effects of exercise on testosterone secretion: evidence for the involvement of a cAMP-mediated mechanism. Med Sci Sports Exerc 1997;29(8):1048-54. 50. Fry AC, Kraemer WJ. Resistance exercise overtraining and overreaching. Neuroendocrine responses. Sports Med 1997;23(2):106-29. 51. Kraemer WJ, Fleck SJ, Dziados JE, Harman EA, Marchitelli LJ, Gordon SE, et al. Changes in hormonal concentrations after different heavy-resistance exercise protocols in women. J Appl Physiol 1993;75(2):594-604. 52. Bunt JC, Bahr JM, Bemben DA. Comparison of estradiol and testosterone levels during and immediately following prolonged exercise in moderately active and trained males and females. Endocr Res 1987;13(2):157-72. 53. Nindl BC, Kraemer WJ, Gotshalk LA, Marx JO, Volek JS, Bush FA, et al. Testosterone responses after resistance exercise in women: influence of regional fat distribution. Int J Sport Nutr Exerc Metab 2001;11(4):451-65. 54. Nakamura Y, Hornsby PJ, Casson P, Morimoto R, Satoh F, Xing Y, et al. Type 5 17beta-hydroxysteroid dehydrogenase (AKR1C3) contributes to testosterone production in the adrenal reticularis. J Clin Endocrinol Metab 2009;94(6):2192-8. 55. Snochowski M, Saartok T, Dahlberg E, Eriksson E, Gustafsson JA. Androgen and glucocorticoid receptors in human skeletal muscle cytosol. J Steroid Biochem 1981;14(8):765-71. 56. Azarbaijani MA, Nikbakht H, Rasae MJ, Sabeti Kh. Effect of exhaustive incremental exercise session on salivary testosterone and cortisol in wrestlers. Res Sport Sci 2002;4:101-14. [Persian] 57. Hill EE, Zack E, Battaglini C, Viru M, Viru A, Hackney AC. Exercise and circulating cortisol levels: the intensity threshold effect. J Endocrinol Invest 2008;31(7):587-91. 58. Brownlee KK, Moore AW, Hackney AC. Rlationship between circulating cortisol and testosterone: influence of physical exercise. J Sports Sci Med 2005;4:76-83. 59. Howlett TA. Hormonal responses to exercise and training: a short review. Clin Endocrinol (Oxf) 1987;26(6):723-42. 60. Terblanche SE. Recent advances in hormonal response to exercise. Comp Biochem Physiol B 1989;93(4):727-39. 61. Sedghi B, Kahrizi S, Zakeri HR, Omidfar K, Rahmani M. Evaluation of acute hormonal responses to concentric, eccentric and concentriceccentric muscle actions in healthy young men. Physiol Pharmacol 2009;13(2):216-28. 62. Crewther B, Cronin J, Keogh J. Possible stimuli for strength and power adaptation: acute metabolic responses. Sports Med 2006;36(1):65-78.

Tehran University Medical Journal; Vol. 70, No. 2, May 2012: 110-118

118

Effects of resistance and endurance exercises on androgens, cortisol and lactate in elderly women

Abstract Donya Sourati Jabloo M.Sc.1 Seyyed Reza Attarzadeh Hosseini Ph.D.1* Delaram Sayadpour Zanjani Ph.D.2 Amin Ahmadi M.Sc.1 1- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, Ferdowsi University of Mashhad, Mashhad, Iran. 2- Department of Pathology, Iranian Academic Center for Education, Culture and Research (ACECR), Mashhad, Iran.

Received: September 17, 2011 Accepted: January 29, 2012

Background: The basal levels of androgens in women decline gradually with age. These changes may reduce muscle strength and bone density leading to fatigue and psychological problems. Thus, the aim of this study was to compare the effects of resistance and endurance exercises on androgens, cortisol and lactate concentrations in elderly women. Methods: In this study, 10 elderly women with a mean age of 54.3±3.74 years and a BMI of 24.88±2.07 kg/m2 completed an endurance exercise session (ES), a resistance exercise session (RS), and a control session (CS) in a randomized, cross-balanced design. The RS consisted of three sets of 10 repetitions of eight exercises with 80% 1RM (one repetition maximum) over of 45 minutes and the ES consisted of cycling at 60%-70% of maximum oxygen consumption for 45 minutes. During the CS, subjects performed no exercise. Before and immediately after exercises, and after 15 minutes of recovery, and also during CS blood samples were obtained an analyzed for serum testosterone, dehydroepiandrosterone sulfate, cortisol and lactate. Results: There was a significant increase in testosterone levels following resistance and endurance exercise sessions (P<0.05). Dehydroepiandrosterone sulfate demonstrated a significant increase after resistance exercise (P<0.05). While differences in cortisol levels were not significant within groups, but they were significant (P<0.05) between groups. Conclusion: A session of resistance exercise in elderly women can increase concentrations of androgens that are essential for their health and well-being. Keywords: Androgen, elderly women, health benefits, resistance exercise.

Corresponding author: Faculty of Physical Education and Sport Sciences, Ferdowsi University of Mashhad, Paradise Daneshgah, Azadi Sq., Mashhad, Iran. Tel: +98- 511- 8833910 E-mail: attarzadeh@um.ac.ir

‫‪-125 ،1391‬‬ ‫ﻣﻔﺼﻠ ‪2‬‬ ‫داﺧﻞﺷﻤﺎره‬ ‫دورهﻲ ‪، ،70‬‬ ‫دﻛﺴﺘﺮوزﺗﻬﺮان‪،‬‬ ‫ﻋﻠﻮم ﭘﺰﺷﻜﻲ‬ ‫داﻧﺸﮕﺎه‬ ‫ﭘﺰﺷﻜﻲ‪،‬‬ ‫داﻧﺸﻜﺪه‬ ‫‪ 119‬زاﻧﻮ‬ ‫اﺳﺘﺌﻮآرﺗﺮﻳﺖ‬ ‫اردﻳﺒﻬﺸﺖدرد‬ ‫ﻲ‪ ،‬در درﻣﺎن‬ ‫ﭘﺮوﻟﻮﺗﺮاﭘ‬ ‫اﺳﻴﺪ و‬ ‫ﺎﻟﻮروﻧﻴﻚ‬ ‫ﺗﺎﺛﻴﺮ ﻫﻴ‬ ‫ﻣﺠﻠﻪﻣﻘﺎﻳﺴﻪ‬

‫‪119‬‬

‫ﻣﻘﺎﻳﺴﻪ ﺗﺎﺛﻴﺮ ﻫﻴﺎﻟﻮروﻧﻴﻚ اﺳﻴﺪ و دﻛﺴﺘﺮوز ﭘﺮوﻟﻮﺗﺮاﭘﻲ داﺧﻞ ﻣﻔﺼﻠﻲ در درﻣﺎن درد اﺳﺘﺌﻮآرﺗﺮﻳﺖ زاﻧﻮ‬

‫ﺗﺎرﻳﺦ درﻳﺎﻓﺖ ﻣﻘﺎﻟﻪ‪ 1390/08/14 :‬ﺗﺎرﻳﺦ ﭘﺬﻳﺮش‪1390/10/21 :‬‬

‫ﺳﻴﺪ ﻣﺴﻌﻮد ﻫﺎﺷﻤﻲ‬

‫ﭼﻜﻴﺪه‬

‫‪*1‬‬ ‫‪1‬‬

‫ﻓﻴﺮوز ﻣﺪدي‪ 2،‬ﺳﻌﻴﺪ رﺿﻮي‬

‫زﻣﻴﻨﻪ و ﻫﺪف‪ :‬در درﻣﺎن اﺳﺘﺌﻮآرﺗﺮﻳﺖ زاﻧﻮ ﻗﺒﻞ از ﺟﺮاﺣﻲ از درﻣﺎنﻫﺎي ﻧﮕﻪدارﻧﺪه اﺳﺘﻔﺎده ﻣـﻲﺷـﻮد‪ .‬در اﻳـﻦ ﻣﻄﺎﻟﻌـﻪ‬

‫‪3‬‬

‫ﻣﻬﺸﻴﺪ ﻧﻴﻜﻮﺳﺮﺷﺖ‬

‫اﺛﺮات ﻛﻮﺗﺎهﻣﺪت ﻫﻴﺎﻟﻮروﻧﻴﻚ اﺳﻴﺪ و دﻛﺴﺘﺮوز ﭘﺮوﻟﻮﺗﺮاﭘﻲ داﺧـﻞ ﻣﻔـﺼﻠﻲ در ﺑﻬﺒـﻮد درد و ﻋﻤﻠﻜـﺮد زاﻧـﻮ و ﻛﻴﻔﻴـﺖ‬

‫‪1‬‬

‫ﻓﺮﺷﺎد ﺣﺴﻦ زاده ﻛﻴﺎﺑﻲ‬

‫زﻧﺪﮔﻲ در ﺑﻴﻤﺎران ﻣﺒﺘﻼ ﺑﻪ اﺳﺘﺌﻮآرﺗﺮﻳﺖ زاﻧﻮ ارزﻳﺎﺑﻲ و ﻣﻘﺎﻳﺴﻪ ﺷﺪ‪ .‬روش ﺑﺮرﺳﻲ‪ :‬اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑـﻪﺻـﻮرت ﻛﺎرآزﻣـﺎﻳﻲ‬

‫‪4‬‬

‫ﺳﻤﻴﻪ ﻧﺼﻴﺮي ﭘﻮر‬

‫ﺑﺎﻟﻴﻨﻲ دوﺳﻮﻛﻮر اﻧﺠﺎم ﺷﺪ‪ .‬از ‪ 100‬ﺑﻴﻤﺎر ﺑﺎ ﺳﻦ ‪ 40-70‬ﺳﺎل‪ ،‬ﻛـﻪ ﺑـﺮ اﺳـﺎس ﻛﺮاﻳﺘﺮﻳـﺎي ‪ ACR‬ﺑـﺮاي آنﻫـﺎ ﺗـﺸﺨﻴﺺ‬ ‫‪ -1‬ﮔﺮوه ﺑﻴﻬﻮﺷﻲ و درد‪ ،‬ﺑﻴﻤﺎرﺳﺘﺎن اﺧﺘﺮ‪ ،‬داﻧﺸﮕﺎه‬

‫اﺳﺘﺌﻮآرﺗﺮﻳﺖ زاﻧﻮ داده ﺷﺪه ﺑﻮد و ﺑﻴﺶ از ﺳﻪ ﻣﺎه درد داﺷﺘﻨﺪ‪ 50 ،‬ﺑﻴﻤﺎر در ﮔﺮوه ﻫﻴﺎﻟﻮروﻧﻴﻚ اﺳﻴﺪ‪ 2ml ،‬ﺗﺰرﻳﻖ داﺧـﻞ‬

‫ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺷﻬﻴﺪﺑﻬﺸﺘﻲ‪ ،‬ﺗﻬﺮان‪ ،‬اﻳﺮان‪.‬‬

‫ﻣﻔﺼﻠﻲ ﻫﻴﺎﻟﻮروﻧﻴﻚ اﺳﻴﺪ )ﺳﻴﻨﻮﻛﺮوم ﻓﻮرت ‪ (%1‬ﭘﻨﺞ ﺟﻠﺴﻪ ﻫﻔﺘﻪاي ﻳﻚﺑﺎر و ‪ 50‬ﺑﻴﻤﺎر در ﮔﺮوه دﻛﺴﺘﺮوز ﭘﺮوﻟﻮﺗﺮاﭘﻲ‪،‬‬

‫‪ -2‬ﮔﺮوه ارﺗﻮﭘﺪي‪ ،‬ﺑﻴﻤﺎرﺳﺘﺎن اﺧﺘﺮ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم‬

‫در ﺳﻪ ﺟﻠﺴﻪ ﻣﺎﻫﻴﺎﻧﻪ ‪ 2ml‬ﭘﺮوﻟﻮﺗﺮاﭘﻲ ﺑﺎ دﻛﺴﺘﺮوز ‪ %25‬درﻳﺎﻓﺖ ﻛﺮدﻧﺪ‪ .‬ﺑﻴﻤـﺎران ﻗﺒـﻞ و ﭘـﺲ از درﻣـﺎن از ﻧﻈـﺮ درد و‬

‫ﭘﺰﺷﻜﻲ ﺷﻬﻴﺪﺑﻬﺸﺘﻲ‪ ،‬ﺗﻬﺮان‪ ،‬اﻳﺮان‪.‬‬

‫ﻋﻤﻠﻜﺮد زاﻧﻮ ﺑﺎ اﺳﺘﻔﺎده از ﭘﺮﺳﺶﻧﺎﻣﻪ ‪ KOOS‬ﺑﺮرﺳﻲ ﺷﺪﻧﺪ‪ .‬ﺑﻴﻤﺎران ﺗﻮﺳﻂ ﻓﺮد ﻏﻴﺮ ﻣﻄﻠﻊ از ﻧﻮع درﻣﺎن ‪ 12‬ﻫﻔﺘﻪ ﭘﺲ از‬

‫‪ -3‬ﮔﺮوه ﺑﻴﻬﻮﺷﻲ و درد‪ ،‬ﺑﻴﻤﺎرﺳﺘﺎن ﺑﻌﺜﺖ‪،‬‬ ‫داﻧﺸﮕﺎه ﻋﻠﻮمﭘﺰﺷﻜﻲ ﻫﻤﺪان‪ ،‬ﻫﻤﺪان‪ ،‬اﻳﺮان‪.‬‬

‫ﺗﺰرﻳﻖ ارزﻳﺎﺑﻲ ﺷﺪﻧﺪ‪ .‬ﺳﭙﺲ اﻃﻼﻋﺎت ﺣﺎﺻﻠﻪ از ﺑﻴﻤﺎران ﺛﺒـﺖ ﺷـﺪﻧﺪ‪ .‬ﻳﺎﻓﺘـﻪﻫـﺎ‪ :‬ﻣﻴـﺎﻧﮕﻴﻦ ﺳـﻦ اﻓـﺮاد ﻣـﻮرد ﺑﺮرﺳـﻲ‬

‫‪ -4‬ﮔﺮوه داروﺳﺎزي ﺑﺎﻟﻴﻨﻲ‪ ،‬داﻧﺸﻜﺪه داروﺳﺎزي‪،‬‬

‫‪ 60/6±8/2‬ﺳﺎل ﺑﻮد‪ .‬ﺗﻔﺎوت ﻣﻌﻨﻲداري ﺑﻴﻦ دو ﮔﺮوه در اﺳـﻜﻮرﻫﺎي درد زاﻧـﻮ و ﻋﻤﻠﻜـﺮد آن دﻳـﺪه ﻧـﺸﺪ )‪.(P<0/05‬‬

‫داﻧﺸﮕﺎه ﻋﻠﻮمﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬ﺗﻬﺮان‪ ،‬اﻳﺮان‪.‬‬

‫اﺳﻜﻮرﻫﺎي ﺗﻤﺎم ﻣﻮارد ﭘﺮﺳﺶﻧﺎﻣﻪ ‪ KOOS‬ﭘﺲ از درﻣﺎن ﺑﻬﺒﻮد ﻣﻌﻨﻲداري را ﻧﺸﺎن داد )‪ .(P<0/001‬ﺗﻐﻴﻴـﺮات اﺳـﻜﻮرﻫﺎ‬ ‫ﻧﺴﺒﺖ ﺑﻪ ﻣﻴﺰان ﭘﺎﻳﻪ ﭘﺲ از درﻣﺎن ﺑﻴﻦ دو ﮔﺮوه ﺗﻔﺎوت ﻣﻌﻨﻲداري را ﻧﺸﺎن ﻧﺪاد )‪ .(P<0/05‬ﻧﺘﻴﺠﻪﮔﻴﺮي‪ :‬ﺑﻪﻧﻈﺮ ﻣﻲرﺳﺪ‪،‬‬ ‫ﺗﺰرﻳﻖ داﺧﻞ ﻣﻔﺼﻠﻲ دﻛﺴﺘﺮوز ﭘﺮوﻟﻮﺗﺮاﭘﻲ ‪ %25‬ﺑﻪ اﻧﺪازه ﻫﻴﺎﻟﻮروﻧﻴـﻚ اﺳـﻴﺪ )ﺳـﻴﻨﻮﻛﺮوم ﻓـﻮرت ‪ (%1‬در درﻣـﺎن درد‬

‫*‬

‫ﻧﻮﻳﺴﻨﺪه ﻣﺴﺌﻮل‪ :‬ﺗﻬﺮان‪ ،‬اﻟﻬﻴﻪ‪ ،‬ﺑﻴﻤﺎرﺳﺘﺎن اﺧﺘﺮ‪ ،‬ﺑﺨﺶ‬

‫درد‬

‫اﺳﺘﺌﻮآرﺗﺮﻳﺖ زاﻧﻮ‪ ،‬ﻣﻮﺛﺮ و اﻳﻤﻦ اﺳﺖ‪.‬‬

‫ﺗﻠﻔﻦ‪021-22612252 :‬‬ ‫‪E-mail: dr.hashemi@sbmu.ac.ir‬‬

‫ﻛﻠﻤﺎت ﻛﻠﻴﺪي‪ :‬اﺳﺘﺌﻮآرﺗﺮﻳﺖ زاﻧﻮ‪ ،‬ﻫﻴﺎﻟﻮروﻧﻴﻚ اﺳﻴﺪ‪ ،‬دﻛﺴﺘﺮوز ﭘﺮوﻟﻮﺗﺮاﭘﻲ‪.‬‬

‫ﺑﺎﻻﻳﻲ ﺑﺮﺧﻮردار اﺳـﺖ‪ 3.‬ﺑـﺎ اﻧﺠـﺎم روزاﻓـﺰون ﺟﺮاﺣـﻲ ﺑـﺮاي درﻣـﺎن‬

‫ﻣﻘﺪﻣﻪ‬

‫اﺳﺘﺌﻮآرﺗﺮﻳﺖ زاﻧﻮ‪ ،‬ﻫﻨﻮز ﺟﻬﺖ اﺟﺘﻨﺎب از اﺛﺮات ﺳﻴﺴﺘﻤﻴﻚ ﻧﺎﺧﻮاﺳـﺘﻪ‬ ‫)‪Degenerative Joint Disease (DJD‬‬

‫ﻧﻴﺎز ﺑﻪ اﻧﺠﺎم ﻣﺪاﺧﻼت درﻣـﺎﻧﻲ ﻧﮕـﻪدارﻧـﺪه ﺷـﺎﻣﻞ آﻣـﻮزش ﺑﻴﻤـﺎران‪،‬‬

‫از ﺷﺎﻳﻊﺗﺮﻳﻦ ﺑﻴﻤﺎريﻫﺎي روﻣﺎﺗﻴﺴﻤﻲ در ﺳﺮاﺳﺮ ﺟﻬﺎن ﻣـﻲﺑﺎﺷـﻨﺪ ﻛـﻪ‬

‫ﺗﻌﺪﻳﻞ ﻓﻌﺎﻟﻴﺖ‪ ،‬اﺳﺘﻔﺎده از ﺑﺮﻳﺲ‪ ،‬داروﻫـﺎي ﺿـﺪ اﻟﺘﻬـﺎﺑﻲ و ﺿـﺪ درد‪،‬‬

‫ﺷﺎﻳﻊﺗﺮﻳﻦ آنﻫﺎ اﺳﺘﺌﻮآرﺗﺮﻳﺖ ﻣـﻲﺑﺎﺷـﺪ‪ .‬اﻳـﻦ ﺑﻴﻤـﺎري ﺑـﻪﻃـﻮر ﺷـﺎﻳﻊ‬

‫درﻣـﺎنﻫــﺎي ﻓﻴﺰﻳـﻮﺗﺮاﭘﻲ‪ ،‬ﺗﺰرﻳــﻖ داﺧـﻞ ﻣﻔــﺼﻠﻲ اﺳــﻴﺪﻫﻴﺎﻟﻮروﻧﻴﻚ و‬

‫ﺑﻴﻤﺎريﻫﺎي دژﻧﺮاﺗﻴﻮ ﻣﻔﺼﻠﻲ‬

‫‪5‬و‪4‬‬

‫ﻣﻔﺎﺻــﻞ ران‪ ،‬زاﻧــﻮ‪ ،‬ﺳــﺘﻮن ﻓﻘــﺮات و اﻧﮕــﺸﺘﺎن را درﮔﻴــﺮ ﻣــﻲﻛﻨــﺪ‪.‬‬

‫ﭘﺮوﻟﻮﺗﺮاﭘﻲ ﺑﺎ دﻛﺴﺘﺮوز ﻣﻲﺑﺎﺷﺪ‪.‬‬

‫اﺳﺘﺌﻮآرﺗﺮﻳﺖ ﭼﻬـﺎرﻣﻴﻦ ﻋﻠـﺖ ﻧـﺎﺗﻮانﻛﻨﻨـﺪه زﻧـﺪﮔﻲ و ‪ %3‬ﻛـﻞ ﻋﻠـﻞ‬

‫اﺳــﻴﺪ و ﻛﻮرﺗﻴﻜﻮاﺳــﺘﺮوﻳﻴﺪﻫﺎ از راﻳــﺞﺗــﺮﻳﻦ روشﻫــﺎي درﻣــﺎﻧﻲ‬

‫ﻧﺎﺗﻮانﻛﻨﻨﺪه زﻧﺪﮔﻲ را ﺷﺎﻣﻞ ﻣﻲﺷـﻮد‪ 1.‬ﺷـﻴﻮع اﺳـﺘﺌﻮآرﺗﺮﻳﺖ زاﻧـﻮ در‬

‫اﺳﺘﺌﻮآرﺗﺮﻳﺖ ﺑﻪﺧﺼﻮص در ﺑﻴﻤﺎراﻧﻲ اﺳﺖ ﻛﻪ ﺳﺎﻳﺮ روشﻫﺎي درﻣﺎﻧﻲ‬

‫ﺳﻨﻴﻦ ﺑﻴﺶ از ‪ 15‬ﺳﺎل ‪ %7/9‬ﻣﻲﺑﺎﺷﺪ‪ 2.‬در اﻳـﺮان ﺷـﻴﻮع اﺳـﺘﺌﻮآرﺗﺮﻳﺖ‬

‫ﺑﻪدﻟﻴﻞ ﺳﻤﻴﺖ ﻳﺎ ﻋﺪم ﺗﺎﺛﻴﺮ ﺑﺎ ﺷﻜﺴﺖ ﻣﻮاﺟﻪ ﺷـﺪهاﻧـﺪ‪ .‬در ﺑـﺴﻴﺎري از‬

‫زاﻧﻮ در ﺳﻨﻴﻦ ﺑﻴﺶ از ‪ 15‬ﺳﺎل ﺣﺪود ‪ %15/34‬ﻣﻲﺑﺎﺷـﺪ ﻛـﻪ از ﺷﻴـﻮع‬

‫ﻣﻄﺎﻟﻌﺎت اﺛﺮات ﻣﻔﻴﺪ ﺗﺰرﻳﻖ داﺧﻞ ﻣﻔﺼﻠﻲ ﻫﻴﺎﻟﻮروﻧﻴﻚ اﺳﻴﺪ در ﻛﻨﺘﺮل‬

‫ﺗﺰرﻳﻖ داﺧﻞ ﻣﻔﺼﻠﻲ ﻫﻴﺎﻟﻮروﻧﻴـﻚ‬

‫‪120‬‬

‫ﺳﻴﺪ ﻣﺴﻌﻮد ﻫﺎﺷﻤﻲ و ﻫﻤﻜﺎران‬

‫درد و ﻓﻌﺎﻟﻴﺖ ﺑﻴﻤﺎران ﻧﺸﺎن داده ﺷﺪه اﺳﺖ‪ 6-10.‬ﭘﺮوﻟﻮﺗﺮاﭘﻲ ﻳﻜﻲ دﻳﮕﺮ‬

‫ﻣﺮاﺟﻌﻪ ﻛﻨﻨﺪه ﺑﻪ ﻛﻠﻴﻨﻴﻚ درد ﺑﻴﻤﺎرﺳﺘﺎن اﺧﺘﺮ ﻃﻲ ﺳﺎلﻫﺎي ‪،1389-90‬‬

‫از روشﻫﺎي درﻣﺎﻧﻲ اﺳﺖ ﻛﻪ ﻣﻨﺠﺮ ﺑﻪ اﻓﺰاﻳﺶ ﻣﻴـﺰان ﻓـﺎﻛﺘﻮر رﺷـﺪ و‬

‫‪ 100‬ﻧﻔﺮ ﺑﻪ روش ﻏﻴﺮﺗﺼﺎدﻓﻲ ﺳﺎده اﻧﺘﺨﺎب ﺷﺪﻧﺪ‪ .‬ﻣﻌﻴﺎر ورود ﺷـﺎﻣﻞ‬

‫ﺗــﺎﺛﻴﺮ آن در ﺗــﺮﻣﻴﻢ ﺑﺎﻓــﺖ ﻳــﺎ رﺷــﺪ آن ﻣــﻲﺷــﻮد‪ .‬ﭘﺮوﻟــﻮﺗﺮاﭘﻲ‬

‫ﺳﻦ ﺑﻴﻦ ‪ 40‬ﺗـﺎ ‪ 70‬ﺳـﺎل‪ ،‬درد اﺳـﺘﺌﻮآرﺗﺮﻳﺖ زاﻧـﻮ ﺑـﻴﺶ از ﺳـﻪ ﻣـﺎه‪،‬‬

‫)‪ (Prolotherapy‬اوﻟﻴﻦ ﺑﺎر ﺗﻮﺳﻂ ‪ Hackett‬در ﺳﺎل ‪ 1950‬ﺗﻮﺻﻴﻒ ﺷﺪ‬

‫ﻳﺎﻓﺘــﻪﻫــﺎي رادﻳﻮﻟﻮژﻳــﻚ ﺗﺄﻳﻴــﺪ ﻛﻨﻨــﺪه اﺳــﺘﺌﻮآرﺗﺮﻳﺖ زاﻧــﻮ ﺑﺮاﺳــﺎس‬ ‫‪25‬‬

‫)‪American College of Rheumatology (ACR‬‬

‫و داﺷـﺘﻦ‬

‫و ﺑﻪ دﻧﺒﺎل آن ﻣﻄﺎﻟﻌﺎت ﻣﺨﺘﻠﻒ ﺑﺎﻟﻴﻨﻲ ﺑﺮ روي اﻧـﺴﺎن و ﺣﻴـﻮان اﻧﺠـﺎم‬

‫ﻛﺮاﻳﺘﺮﻳﺎي‬

‫ﺷﺪ‪ 11-16.‬در دﻛـﺴﺘﺮوز ﭘﺮوﻟـﻮﺗﺮاﭘﻲ‪ ،‬اﻓـﺰاﻳﺶ ﮔﻠـﻮﻛﺰ ﺧـﺎرج ﺳـﻠﻮﻟﻲ‬

‫رﺿﺎﻳﺖ ﻣﺒﻨﻲ ﺑﺮ ﺷﺮﻛﺖ در ﻃﺮح ﺑﻮد‪ .‬ﺑﻴﻤﺎراﻧﻲ ﻛﻪ رﺿﺎﻳﺖ ﺑﻪ ﺷـﺮﻛﺖ‬

‫ﻣﻮﺟﺐ اﻓﺰاﻳﺶ ﻓﺎﻛﺘﻮرﻫﺎي رﺷـﺪ ﭼﻨﺪﮔﺎﻧـﻪ ﭘﻠـﻲﭘﭙﺘﻴـﺪ در ﺳـﻠﻮلﻫـﺎي‬

‫در ﻃﺮح ﻧﺪاﺷﺘﻨﺪ‪ ،‬ﺑﻴﻤﺎران ﺑﺎ ﺳﺎﺑﻘﻪ ﺟﺮاﺣﻲ زاﻧﻮ‪ ،‬دﻓﻮرﻣﻴﺘﻲ و ﻛﻨﺘﺮاﻛﭽﺮ‬

‫ﻣﺨﺘﻠﻒ اﻧﺴﺎﻧﻲ ﻣﻲﺷـﻮد‪ 17-21.‬ﺗﻤـﺎس ﺳـﻠﻮلﻫـﺎي اﻧـﺴﺎﻧﻲ ﺑـﺎ ﻣﺤـﻴﻂ‬

‫اﻧﺪام ﺗﺤﺘﺎﻧﻲ‪ ،‬ﺑﻴﻤﺎري ﻧﻮروﻣﺎﺳﻜﻮﻻر اﻧﺪام ﺗﺤﺘـﺎﻧﻲ‪ ،‬ﭘـﺎﺗﻮﻟﻮژي ﻛﻤـﺮي‬

‫‪DNA‬‬

‫ﺣﺎد‪ ،‬ﺗﺰرﻳﻖ داروﻫﺎي اﺳﺘﺮوﻳﻴﺪي ﻃـﻲ دو ﻣـﺎه اﺧﻴـﺮ‪ ،‬ﺳـﺎﺑﻘﻪ آرﺗﺮﻳـﺖ‬

‫ﻓﺎﻛﺘﻮرﻫﺎي رﺷﺪ ﻣﻲﺷـﻮد‪23.‬و‪ 22‬ﻣﺤﻠـﻮل دﻛـﺴﺘﺮوز ﻫﻴﭙﺮﺗﻮﻧﻴـﻚ ﺑـﺎ دو‬

‫روﻣﺎﺗﻮﻳﻴﺪ اﻟﺘﻬﺎﺑﻲ‪ ،‬دﻳﺎﺑﺖ‪ ،‬ﺣﺎﻣﻠﮕﻲ‪ ،BMI>35 ،‬ﺑﻴﻤﺎران ﻛﺎﻧﺪﻳﺪ ﺟﺮاﺣـﻲ‬

‫ﻣﻜﺎﻧﻴﺴﻢ ﻓﻮق ﻣﻨﺠﺮ ﺑﻪ اﻓﺰاﻳﺶ ﻣﻴﺰان ﻓﺎﻛﺘﻮرﻫﺎي رﺷﺪ ﻣﻲﺷﻮد و داراي‬

‫زاﻧﻮ‪ ،‬وﺟﻮد اﻧﺤﺮاف زاﻧﻮ )واروس ﻳﺎ واﻟﮕﻮس ﺑﻴﺶﺗﺮ از ﭘـﻨﺞ درﺟـﻪ(‬

‫ﻗﺎﺑﻠﻴﺖ ﺑﻬﺒﻮد وﺿﻌﻴﺖ ﺑﺤﺮاﻧﻲ ﺳﻠﻮلﻫﺎي ﻣﻔﺎﺻﻞ ﻣﺎﻧﻨﺪ ﻛﻨﺪروﺳـﻴﺖﻫـﺎ‬

‫ﻛﻪ ﺑﺎ ﮔﺮاﻓﻲ ‪ Three joint view‬ﺗﺄﻳﻴﺪ ﺷﺪه ﺑﻮد‪ ،‬وﺟﻮد درد رادﻳﻮﻛـﻮﻻر‬

‫)ﺗﻮﻟﻴﺪ ﺳـﻠﻮلﻫـﺎي ﻏـﻀﺮوﻓﻲ(‪ ،‬اوﺳﺘﺌﻮﺳـﻴﺖﻫـﺎ )ﺗﻮﻟﻴـﺪ ﺳـﻠﻮلﻫـﺎي‬

‫زاﻧﻮ‪ ،‬ﻣﺼﺮف داروﻫﺎي ﺿﺪ اﻧﻌﻘـﺎدي‪ ،‬آرﺗـﺮوز ﭘـﺲ از ﺗﺮوﻣـﺎ‪ ،‬ﺗﺰرﻳـﻖ‬

‫اﺳﺘﺨﻮاﻧﻲ( و ﻓﻴﺒﺮوﺑﻼﺳﺖﻫﺎ )ﺗﻮﻟﻴﺪ ﺳﻠﻮلﻫﺎي ﺗﺎﻧﺪون‪ ،‬ﻟﻴﮕﺎﻣﺎن و دﻳﮕﺮ‬

‫اﻳﻨﺘﺮاآرﺗﻴﻜﻮﻻر ﻫﻴﺎﻟﻮروﻧﻴﻚ اﺳﻴﺪ ﻃﻲ ‪ 12‬ﻣﺎه ﮔﺬﺷﺘﻪ از ﻣﻄﺎﻟﻌـﻪ ﺧـﺎرج‬

‫ﺑﺎﻓــﺖﻫــﺎي ﻧــﺮم( ﻣــﻲﺑﺎﺷــﺪ‪ .‬در ﻣﻄﺎﻟﻌــﻪ ‪ Reeves‬ﮔــﺰارش ﻛــﺮد ﻛــﻪ‬

‫ﺷﺪﻧﺪ‪ .‬ﻻزم ﺑﻪ ذﻛﺮ اﺳﺖ ﻛﻪ در اﻳﻦ ﺑﻴﻤـﺎران ﺗـﺸﺨﻴﺺ اﺳـﺘﺌﻮآرﺗﺮﻳﺖ‬

‫ﭘﺮوﻟﻮﺗﺮاﭘﻲ ﺑﺎ دﻛـﺴﺘﺮوز ‪ %10‬ﺑـﻪﻃـﻮر ﻣﻌﻨـﻲداري ﻧـﺴﺒﺖ ﺑـﻪ ﭘﻼﺳـﺒﻮ‬

‫زاﻧﻮ ﺑﺮاﺳﺎس ﻳﺎﻓﺘﻪﻫـﺎي رادﻳـﻮﮔﺮاﻓﻲ ﻣﻄـﺎﺑﻖ ﺑـﺎ ﻛﺮاﻳﺘﺮﻳـﺎي‬

‫‪Kellgren-‬‬

‫ﻣﻮﺟﺐ ﺑﻬﺒﻮد درد و ﻋﻼﻳﻢ ﺑﺎﻟﻴﻨﻲ ﺑﻴﻤﺎر ﻣـﻲﺷـﻮد‪ 24.‬ﺗـﺎﻛﻨﻮن ﻣﻄﺎﻟﻌـﺎت‬

‫‪ lawrence‬داده ﺷﺪ‪ 26.‬ﺳﭙﺲ ﺑﻴﻤﺎران ﺑﺮ اﺳﺎس ﺟﺪول اﻋﺪاد ﺗﺼﺎدﻓﻲ ﺑﻪ‬

‫ﻣﺨﺘﻠﻔﻲ در ﻣﻮرد اﺛﺮات درﻣﺎﻧﻲ دﻛﺴﺘﺮوز ﭘﺮوﻟـﻮﺗﺮاﭘﻲ ﺑـﺎ ﻏﻠﻈـﺖﻫـﺎي‬

‫دو ﮔﺮوه ‪ 50‬ﻧﻔﺮي ﺗﺰرﻳﻖ ﻫﻴﺎﻟﻮروﻧﻴﻚ اﺳﻴﺪ )ﮔﺮوه اول( و ﭘﺮوﻟـﻮﺗﺮاﭘﻲ‬

‫ﻣﺨﺘﻠﻒ در درﻣﺎن اﺳﺘﺌﻮآرﺗﺮﻳﺖ ﺻﻮرت ﮔﺮﻓﺘﻪ اﺳﺖ وﻟﻲ ﻫﻨﻮز اﺛـﺮات‬

‫ﺑﺎ دﻛﺴﺘﺮوز ‪) %25‬ﮔﺮوه دوم( ﺗﻘﺴﻴﻢ ﺷﺪﻧﺪ‪ .‬ﺳﭙﺲ ﺑﻴﻤـﺎر در وﺿـﻌﻴﺖ‬

‫درﻣﺎﻧﻲ آن ﻧﺎﻣﺸﺨﺺ ﻣﺎﻧﺪه و ﺑﻪ آن ﭘﺎﺳﺦ داده ﻧﺸﺪه اﺳﺖ‪ .‬ﺑﺎ ﺗﻮﺟﻪ ﺑـﻪ‬

‫ﺳﻮﭘﺎﻳﻦ ﻗﺮار داده ﺷﺪ‪ ،‬ﺑﺎ ﻓﻠﻜﺴﻴﻮن زاﻧـﻮ ﺑـﻪ اﻧـﺪازه ‪ 10-15‬درﺟـﻪ در‬

‫ﻧﻈﺮات ﻣﺘﻨﺎﻗﺾ و ﻣﻄﺎﻟﻌﺎت ﺑﺴﻴﺎر ﻣﺤﺪودي ﻛﻪ در ﻣﻮرد ﺗـﺎﺛﻴﺮ درﻣـﺎﻧﻲ‬

‫ﺳﻤﺖ ﻣﺪﻳﺎل زاﻧﻮ ﻟﻨﺪﻣﺎرك ﻧﺎﺣﻴﻪ ﺗﺰرﻳﻖ ﻣـﺸﺨﺺ ﺷـﺪ‪ .‬ﺳـﭙﺲ ﻣﺤـﻞ‬

‫دﻛﺴﺘﺮوز ﭘﺮوﻟﻮﺗﺮاﭘﻲ ﺑﺮاي درﻣﺎن درد اﺳﺘﺌﻮآرﺗﺮﻳﺖ زاﻧﻮ اﻧﺠﺎم ﺷـﺪه و‬

‫ﺗﺰرﻳﻖ ﺑﺎ ﻣﺤﻠﻮل ﭘﻮوﻳﺪون آﻳﻮدﻳﻦ ﺿﺪﻋﻔﻮﻧﻲ و ﺑﺎ ﺗﺰرﻳﻖ ﻳﻚ ﻣﻴﻠﻲﻟﻴﺘـﺮ‬

‫اﻳﻦﻛﻪ ﺗﺎﻛﻨﻮن ﻣﻄﺎﻟﻌﻪاي در ﻣﻮرد دﻛﺴﺘﺮوز ﭘﺮوﻟﻮﺗﺮاﭘﻲ ﺑـﺎ ﻏﻠﻈـﺖ ‪%25‬‬

‫ﻣﺤﻠﻮل ﻟﻴﺪوﻛﺎﻳﻴﻦ ‪ %2‬ﻧﺎﺣﻴﻪ ﺗﺰرﻳﻖ ﺑﻲﺣﺲ ﺷﺪ و ﺑﺎ اﺳﺘﻔﺎده از ﺳـﻮزن‬

‫و ﻣﻘﺎﻳﺴﻪ آن ﺑﺎ ﻫﻴﺎﻟﻮروﻧﻴﻚ اﺳﻴﺪ ﺑﺮاي درﻣﺎن درد اﺳـﺘﺌﻮآرﺗﺮﻳﺖ زاﻧـﻮ‬

‫ﺷﻤﺎره ‪ 27‬ﭘﺲ از آﺳﭙﻴﺮاﺳﻴﻮن و اﻃﻤﻴﻨﺎن از ﻗﺮارﮔﻴﺮي ﺻﺤﻴﺢ ﺳـﻮزن‪،‬‬

‫اﻧﺠﺎم ﻧﺸﺪه اﺳﺖ‪ ،‬ﻟﺬا ﭘﻴﺸﻨﻬﺎد ﮔﺮدﻳﺪ ﺑﺎ ﻃﺮاﺣـﻲ اﻳـﻦ ﻣﻄﺎﻟﻌـﻪ‪ ،‬اﺛـﺮات‬

‫داﺧــﻞ ﻣﻔــﺼﻞ ﺗﺰرﻳــﻖ اﻧﺠــﺎم ﺷــﺪ‪ .‬ﮔــﺮوه اول دو ﻣﻴﻠــﻲﻟﻴﺘــﺮ ﻣﺤﻠــﻮل‬

‫ﻛﻮﺗﺎهﻣﺪت ﻫﻴﺎﻟﻮروﻧﻴﻚ اﺳﻴﺪ و دﻛﺴﺘﺮوز ﭘﺮوﻟﻮﺗﺮاﭘﻲ داﺧﻞ ﻣﻔﺼﻠﻲ در‬

‫ﻫﻴﺎﻟﻮروﻧﻴﻚ اﺳﻴﺪ )ﺳـﻴﻨﻮﻛﺮوم ‪ ،%1‬ﺷـﺮﻛﺖ ﺳـﺎزﻧﺪه ‪ ،CROMA‬ﻛـﺸﻮر‬

‫ﺑﻬﺒــﻮد درد و ﻋﻤﻠﻜــﺮد زاﻧــﻮ و ﻛﻴﻔﻴــﺖ زﻧــﺪﮔﻲ در ﺑﻴﻤــﺎران ﻣﺒــﺘﻼ ﺑــﻪ‬

‫اﺗﺮﻳﺶ(‪ ،‬ﭘﻨﺞ ﺗﺰرﻳﻖ ﺑﻪ ﻓﻮاﺻﻞ ﻳـﻚ ﻫﻔﺘـﻪ و ﮔـﺮوه دوم دو ﻣﻴﻠـﻲﻟﻴﺘـﺮ‬

‫اﺳﺘﺌﻮآرﺗﺮﻳﺖ زاﻧﻮ ارزﻳﺎﺑﻲ و ﻣﻘﺎﻳﺴﻪ ﺷﻮد‪.‬‬

‫دﻛﺴﺘﺮوز ‪ ،%25‬ﺳﻪ ﺗﺰرﻳﻖ ﺑﻪ ﻓﻮاﺻﻞ ﻳﻚﻣﺎه درﻳﺎﻓﺖ ﻛﺮدﻧﺪ‪ .‬ﭘـﻨﺞ آﻳـﺘﻢ‬

‫ﻫﻴﭙﺮﺗﻮﻧﻴﻚ ﻃﻲ ﭼﻨﺪ ﺛﺎﻧﻴﻪ ﺗﺎ ﭼﻨﺪ دﻗﻴﻘﻪ ﻣﻨﺠﺮ ﺑﻪ اﻓـﺰاﻳﺶ ﺳـﻄﺢ‬

‫ﺷﺎﻣﻞ درد‪ ،‬ﻋﻼﻳﻢ ﺧﺸﻜﻲ زاﻧﻮ‪ ،‬ﻓﻌﺎﻟﻴﺖﻫﺎي روزاﻧﻪ‪ ،‬ﻋﻤﻠﻜﺮد ورزﺷﻲ و‬

‫روش ﺑﺮرﺳﻲ‬

‫ﺗﻔﺮﻳﺤﻲ و ﻛﻴﻔﻴﺖ زﻧﺪﮔﻲ ﻣﺮﺗﺒﻂ ﺑﺎ زاﻧﻮ ﺑﺮ اﺳـﺎس ﭘﺮﺳـﺶﻧﺎﻣـﻪ‬

‫‪Knee‬‬

‫)‪ 27injury and Osteoarthritis Outcome Score (KOOS‬در دو ﻧﻮﺑـﺖ‪،‬‬

‫ﭘﺲ از اﺧﺬ ﺗﺎﻳﻴﺪﻳﻪ ﻛﻤﻴﺘﻪ اﺧﻼق و ﭘﮋوﻫﺶ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ‬

‫ﻗﺒﻞ از ﺷﺮوع درﻣﺎن و ﺳﻪ ﻣـﺎه ﭘـﺲ از آﺧـﺮﻳﻦ ﺗﺰرﻳـﻖ ﺗﻮﺳـﻂ ﺑﻴﻤـﺎر‬

‫ﺷﻬﻴﺪﺑﻬﺸﺘﻲ‪ ،‬در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻛﻪ ﺑﻪ ﺻﻮرت ﻛﺎرآزﻣﺎﻳﻲ ﺑﺎﻟﻴﻨﻲ دوﺳـﻮﻛﻮر‬

‫ﺗﻜﻤﻴﻞ ﺷﺪ‪ .‬ﺳﭙﺲ اﻃﻼﻋﺎت دﻣﻮﮔﺮاﻓﻴﻚ و ﻧﺘﺎﻳﺞ ﺣﺎﺻﻠﻪ از ﭘﺮﺳﺶﻧﺎﻣﻪ‬

‫ﺗﺼﺎدﻓﻲ ﺷﺪه اﻧﺠﺎم ﺷﺪ‪ ،‬از ﺑﻴﻦ ﺑﻴﻤـﺎران ﻣﺒـﺘﻼ ﺑـﻪ اﺳـﺘﺌﻮآرﺗﺮﻳﺖ زاﻧـﻮ‬

‫‪ KOOS‬در ﺑﺮﮔﻪﻫﺎي اﻃﻼﻋﺎﺗﻲ از ﭘﻴﺶ آﻣـﺎده ﺷـﺪه ﺛﺒـﺖ ﺷـﺪﻧﺪ‪ .‬ﻛﻠﻴـﻪ‬

‫‪121‬‬

‫اﻃﻼﻋﺎت ﻛﺪﮔﺬاري ﺷﺪه‪ ،‬ﺗﻮﺳﻂ ﺑﺮﻧﺎﻣﻪ آﻣﺎري ‪ SPSS‬وﻳﺮاﺳﺖ ‪ 16‬وارد‬

‫‪ 40-70‬ﺳﺎل ﺑﻮد‪ .‬ﻣﻴـﺰان ﻛـﺎﻫﺶ درد دوازده ﻫﻔﺘـﻪ ﭘـﺲ از ﺗﺰرﻳـﻖ در‬

‫‪Kolmogorov-‬‬

‫ﮔــﺮوه دﻛــﺴﺘﺮوز ﭘﺮوﻟــﻮﺗﺮاﭘﻲ ‪ (P=0/0001) 24/2±11/05‬و در ﮔــﺮوه‬

‫‪ Smirnov‬ﻧﺮﻣــﺎل ﺑــﻮدن ﭘﺮاﻛﻨــﺪﮔﻲ ﻧﻤﻮﻧــﻪﻫــﺎ ﺑﺮرﺳــﻲ ﺷــﺪ و ﻣﻘﺎﻳــﺴﻪ‬

‫ﻫﻴﺎﻟﻮروﻧﻴﻚ اﺳﻴﺪ ‪ (P=0/0001) 24/7±12/4‬ﺑـﻮد‪ .‬ﻣﻘﺎﻳـﺴﻪ ﺷـﺪت درد‬

‫‪Paired t- ،Student’s t-test‬‬

‫ﻗﺒﻞ از ﺗﺰرﻳﻖ و دوازده ﻫﻔﺘﻪ ﭘﺲ از ﺗﺰرﻳـﻖ ﺑـﻴﻦ ﮔـﺮوهﻫـﺎي ﻣﺨﺘﻠـﻒ‬

‫ﺣﺎﻓﻈﻪ راﻳﺎﻧﻪ ﮔﺮدﻳﺪﻧـﺪ‪ .‬ﺳـﭙﺲ ﺑـﺎ اﺳـﺘﻔﺎده از آزﻣـﻮن‬ ‫ﻣﺘﻐﻴﺮﻫﺎي ﻛﻤﻲ ﺑﻴﻦ ﮔﺮوهﻫﺎ ﺗﻮﺳﻂ آزﻣـﻮن‬

‫‪2‬‬

‫‪ Mann-Whitney ،test‬و ﻣﺘﻐﻴﺮﻫﺎي ﻛﻴﻔـﻲ ﺗﻮﺳـﻂ آزﻣـﻮن ‪ ‬ﻣﺤﺎﺳـﺒﻪ‬

‫ﺑﻴﻤﺎران از ﻧﻈـﺮ آﻣـﺎري ﺗﻔـﺎوت ﻣﻌﻨـﻲداري را ﻧـﺸﺎن ﻧـﺪاد )‪.(P>0/05‬‬

‫ﮔﺮدﻳﺪ‪ .‬ﻫﻢﭼﻨﻴﻦ از ﻧﻈﺮ آﻣﺎري ‪ P<0/05‬ﻣﻌﻨﻲدار در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ‪.‬‬

‫ﺗﻐﻴﻴﺮات ﻛﺎﻫﺶ درد ﭘﺲ از درﻣﺎن ﺑﻴﻦ دو ﮔﺮوه ﺗﻔـﺎوت ﻣﻌﻨـﻲداري را‬ ‫ﻧﺸﺎن ﻧﺪاد )‪.(P=0/880‬‬ ‫ﻣﻘﺎﻳﺴﻪ اﻃﻼﻋﺎت دﻣﻮﮔﺮاﻓﻴﻚ ﺑﻴﻤﺎران ﺑﻴﻦ دو ﮔـﺮوه ﻣـﻮرد ﺑﺮرﺳـﻲ در‬

‫ﻳﺎﻓﺘﻪﻫﺎ‬

‫ﺟﺪول ‪ 1‬آﻣﺪه اﺳﺖ‪ .‬ﻣﻘﺎﻳﺴﻪ اﺳﻜﻮرﻫﺎي ﻗﺒـﻞ و ﭘـﺲ از درﻣـﺎن در دو‬ ‫ﻣﻴﺎﻧﮕﻴﻦ ﺳﻦ اﻓﺮاد ﻣﻮرد ﺑﺮرﺳﻲ ‪ 60/6±8/2‬ﺳﺎل در ﻣﺤـﺪوده ﺳﻨﻲ‬

‫ﮔﺮوه ﺑﻴﻤﺎران در ﺟﺪول ‪ 2‬آﻣﺪه اﺳﺖ‪.‬‬

‫ﺟﺪول‪ :1 -‬ﻣﻘﺎﻳﺴﻪ اﻃﻼﻋﺎت دﻣﻮﮔﺮاﻓﻴﻚ ﺑﻴﻤﺎران ﺑﻴﻦ دو ﮔﺮوه ﻣﻮرد ﺑﺮرﺳﻲ‬ ‫*‪P‬‬

‫ﻣﺠﻤﻮع‬

‫ﻫﻴﺎﻟﻮروﻧﻴﻚ اﺳﻴﺪ )‪ 50‬زاﻧﻮ(‬

‫دﻛﺴﺘﺮوز ﭘﺮوﻟﻮﺗﺮاﭘﻲ ‪ 50) %25‬زاﻧﻮ(‬

‫ﺳﻦ )ﺳﺎل(‬

‫‪60/6±8/2‬‬

‫‪60/1±8/3‬‬

‫‪60/1±8/2‬‬

‫‪0/650‬‬

‫‪(kg/m2) BMI‬‬

‫‪25/5±2/2‬‬

‫‪25/8±2/2‬‬

‫‪25/2±2/2‬‬

‫‪0/320‬‬

‫ﺟﻨﺲ‪ :‬ﻣﺮد‬

‫)‪38(%37/3‬‬

‫)‪18(%36‬‬

‫)‪20(%38/5‬‬

‫زن‬

‫)‪63(%62/7‬‬

‫)‪32(%64‬‬

‫)‪30(%61/5‬‬

‫ﺷﻐﻞ‪ :‬آزاد‬

‫)‪30(%29/4‬‬

‫)‪16(%32‬‬

‫)‪14(%26/9‬‬

‫ﺧﺎﻧﻪدار‬

‫)‪26(%52/9‬‬

‫)‪28(%56‬‬

‫)‪24(%50‬‬

‫ﺑﺎزﻧﺸﺴﺘﻪ‬

‫)‪9(%17/6‬‬

‫)‪6(%12‬‬

‫)‪12(%23/1‬‬

‫‪0/856‬‬

‫‪0/581‬‬

‫* آزﻣﻮن آﻣﺎري‪ ،t- test :‬ﻣﻘﺎدﻳﺮ ﻣﻌﻨﻲدار ‪.P<0/05‬‬

‫ﺟﺪول‪ :2 -‬ﻣﻘﺎﻳﺴﻪ اﺳﻜﻮرﻫﺎي ﻗﺒﻞ و ﭘﺲ از درﻣﺎن ﺑﻴﻦ دو ﮔﺮوه ﻣﻮرد ﺑﺮرﺳﻲ‬ ‫ﻫﻴﺎﻟﻮروﻧﻴﻚ اﺳﻴﺪ )‪ 50‬زاﻧﻮ(‬

‫‪1‬‬

‫دﻛﺴﺘﺮوز ﭘﺮوﻟﻮﺗﺮاﭘﻲ ‪ 50) %25‬زاﻧﻮ(‬ ‫‪1‬‬

‫‪2‬‬

‫‪3‬‬

‫‪4‬‬

‫ﻗﺒﻞ‬

‫ﺑﻌﺪ‬

‫ﻗﺒﻞ‬

‫ﺑﻌﺪ‬

‫‪P‬‬

‫ﻧﻤﺮه درد‬

‫‪45/1±19/8‬‬

‫‪69/8±10/2‬‬

‫‪44/6±16/8‬‬

‫‪68/8±11/4‬‬

‫‪0/880‬‬

‫‪0/644‬‬

‫‪<0/001‬‬

‫‪0/816‬‬

‫ﻧﻤﺮه ﻋﻼﻳﻢ ﺧﺸﻜﻲ زاﻧﻮ‬

‫‪46/4±10/4‬‬

‫‪56/1±8/3‬‬

‫‪44/8±9/4‬‬

‫‪54/9±8/9‬‬

‫‪0/462‬‬

‫‪0/459‬‬

‫‪<0/001‬‬

‫‪0/595‬‬

‫ﻧﻤﺮه ﻓﻌﺎﻟﻴﺖﻫﺎي روزاﻧﻪ‬

‫‪44/2±17/9‬‬

‫‪70±11‬‬

‫‪43/2±16/2‬‬

‫‪71/5±12/7‬‬

‫‪0/757‬‬

‫‪0/538‬‬

‫‪<0/001‬‬

‫‪0/573‬‬

‫ﻧﻤﺮه ﻋﻤﻠﻜﺮد ورزﺷﻲ و ﺗﻔﺮﻳﺤﻲ‬

‫‪24/4±21/8‬‬

‫‪48/4±15/2‬‬

‫‪13/7±15/5‬‬

‫‪42/5±13/4‬‬

‫‪0/038‬‬

‫‪0/042‬‬

‫‪<0/001‬‬

‫‪0/063‬‬

‫ﻧﻤﺮه ﻛﻴﻔﻴﺖ زﻧﺪﮔﻲ ﻣﺮﺗﺒﻂ ﺑﻪ زاﻧﻮ‬

‫‪26/3±17/8‬‬

‫‪41/3±11/2‬‬

‫‪25±17/6‬‬

‫‪38/8±14/6‬‬

‫‪0/802‬‬

‫‪0/338‬‬

‫‪<0/001‬‬

‫‪0/184‬‬

‫‪2‬‬

‫‪ :P‬ﻣﻘﺎﻳﺴﻪ ﻗﺒﻞ از درﻣﺎن ﺑﻴﻦ دو ﮔﺮوه‪ :P ،‬ﻣﻘﺎﻳﺴﻪ ﺑﻌﺪ از درﻣﺎن ﺑﻴﻦ دو ﮔﺮوه‪،‬‬

‫‪3‬‬ ‫‪:P‬‬

‫ﻣﻘﺎﻳﺴﻪ ﻗﺒﻞ و ﭘﺲ از درﻣﺎن در ﻫﺮ ﮔﺮوه‪،‬‬

‫‪4‬‬ ‫‪:P‬‬

‫ﺗﻐﻴﻴﺮات ﭘﺲ از درﻣﺎن ﻧﺴﺒﺖ ﺑﻪ ﻣﻴﺰان ﭘﺎﻳﻪ ﺑﻴﻦ دو ﮔﺮوه‬

‫* آزﻣﻮن آﻣﺎري‪ Mann-Whitney :‬ﻣﻘﺎدﻳﺮ ﻣﻌﻨﻲدار ‪.P<0/05‬‬

‫‪122‬‬

‫ﺳﻴﺪ ﻣﺴﻌﻮد ﻫﺎﺷﻤﻲ و ﻫﻤﻜﺎران‬

‫ﻗﺎﺑﻞ ﺗﻮﺟﻪ ﺷﻠﻲ ﻟﻴﮕﺎﻣﺎنﻫﺎي زاﻧﻮ ﻣﻲﺷﻮد‪ 35.‬در ﻣﻄﺎﻟﻌﻪ دﻳﮕـﺮي ﺑـﺮاي‬

‫ﺑﺤﺚ‬

‫درﻣﺎن اﺳﺘﺌﻮآرﺗﺮﻳﺖ ﻣﻔﺎﺻﻞ اﻧﮕﺸﺖ از دﻛـﺴﺘﺮوز ‪ %10‬ﺑـﻪ ﻓﻮاﺻـﻞ دو‬ ‫اﺳﺘﺌﻮآرﺗﺮﻳﺖ زاﻧﻮ ﻳﻜﻲ از ﻋﻠﻞ اﺻﻠﻲ ﺑﻴﻤـﺎريﻫـﺎي ﻧـﺎﺗﻮانﻛﻨﻨـﺪه‬

‫ﻣﺎه اﺳﺘﻔﺎده ﻛﺮدﻧﺪ ﻛﻪ ﺑﺎ اﺛﺮات ﺳﻮدﻣﻨﺪ درﻣﺎﻧﻲ ﻫﻤﺮاه ﺑﻮد‪ 24.‬در ﻣﻄﺎﻟﻌـﻪ‬

‫ﻣﻲﺑﺎﺷﺪ ﻛﻪ درﻣﺎن ﺟﺮاﺣﻲ آن ﺑﺎ ﻧﺘﺎﻳﺞ ﻣﻄﻠـﻮﺑﻲ ﻫﻤـﺮاه اﺳـﺖ وﻟـﻲ ﺑـﺎ‬

‫دﻳﮕﺮي ﮔﺰارش ﻛﺮدﻧﺪ در ﻛـﺸﻮرﻫﺎي ﺟﻬـﺎن ﺳـﻮم ﻛـﻪ اﻧﺠـﺎم اﻋﻤـﺎل‬

‫ﺗﻮﺟﻪ ﺑﻪ ﺧﻄﺮات ﺟﺮاﺣﻲ ﻧﻤﻲﺗﻮان در ﺗﻤﺎم ﻣﻮارد اﺳﺘﺌﻮآرﺗﺮﻳﺖ اﻗـﺪام‬

‫ﺟﺮاﺣﻲ ﻛﺎرﮔﺬاري زاﻧﻮ ﻗﺎﺑﻞ دﺳﺘﺮﺳﻲ ﻧﻴﺴﺖ‪ ،‬ﺑـﺮ ﺧـﻼف ﻋﻼﻣـﺖدار‬

‫ﺑﻪ ﺟﺮاﺣﻲ ﻧﻤﻮد‪ .‬ﻋﻼوه ﺑﺮ آن ﻫﻴﭻﻳﻚ از ﺑﻴﻤﺎران ﻣﺒﺘﻼ ﺑﻪ اﺳﺘﺌﻮآرﺗﺮﻳﺖ‬

‫ﺑﻮدن ﺑﻴﻤﺎران‪ ،‬ورزش‪ ،‬ﻓﻴﺰﻳﻮﺗﺮاﭘﻲ ﻳـﺎ ‪ NSAIDs‬ﺗﺠـﻮﻳﺰ ﻣـﻲﺷـﻮد‪ .‬اﻳـﻦ‬

‫ﺗﻤﺎﻳﻞ ﺑﻪ اﻧﺠﺎم ﺟﺮاﺣﻲ ﻧﺪارﻧﺪ‪ 28.‬ﺑﻨﺎﺑﺮاﻳﻦ ﺗﺸﺨﻴﺺ زودرس ﺑﻴﻤﺎري و‬

‫ﭘﮋوﻫﺶﮔﺮان ﻧﺸﺎن دادﻧﺪ دﻛﺴﺘﺮوز ‪ %10‬ﻣﻲﺗﻮاﻧﺪ ﺷﻠﻲ ﻟﻴﮕﺎﻣﺎن ‪ ACL‬را‬

‫‪5‬و‪4‬‬

‫ﻛﻪ ﺑﺎ ﭘﺎرﮔﻲ ﻫﻤﺮاه ﻧﺒﺎﺷﺪ‪ ،‬اﺻﻼح ﻛﻨﺪ و ﻫﻢﭼﻨﻴﻦ ﺳـﺒﺐ ﭘﻴـﺸﮕﻴﺮي از‬

‫اﻣﺮوزه از ﺗﺰرﻳﻖ داﺧﻞ ﻣﻔﺼﻠﻲ ﻫﻴﺎﻟﻮروﻧﻴﻚ اﺳﻴﺪ ﺑـﻪﻃـﻮر وﺳـﻴﻌﻲ در‬

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‫ﺷﻠﻲ ﺗﺪرﻳﺠﻲ ﭘﺲ از ﺟﺮاﺣﻲ در ﻣﻔﺎﺻﻞ ﺑﺎ ﭘﺘﺎﻧﺴﻴﻞ ﺟﺎﺑﻪﺟﺎﻳﻲ ﺷﻮد‪.‬‬

‫درﻣﺎن اﺳﺘﺌﻮآرﺗﺮﻳﺖ زاﻧﻮ اﺳﺘﻔﺎده ﻣﻲﺷﻮد‪ 6-10.‬ﻣﻜﺎﻧﻴﺴﻢ اﺛﺮ ﻫﻴﺎﻟﻮروﻧﻴﻚ‬

‫اﺣﺘﻤﺎﻻ ﺗﺰرﻳﻖ ﻳﻚ ﻣﺤﻠﻮل ﻣﺤﺮك ﻣﺎﻧﻨﺪ دﻛـﺴﺘﺮوز ﺑـﻪ داﺧـﻞ ﻣﻔـﺼﻞ‬

‫اﺳﻴﺪ از ﻃﺮﻳﻖ اﻓﺰاﻳﺶ ﺗﻌﺪاد ﻛﻨﺪروﺳﻴﺖﻫﺎي زﻧﺪه‪ ،‬اﻳﺠـﺎد ﺿـﺨﺎﻣﺖ و‬

‫آﺳــﻴﺐ دﻳــﺪه‪ ،‬ﺑــﺎ واﻛــﻨﺶﻫــﺎي اﻟﺘﻬــﺎﺑﻲ ﻣﻮﺿــﻌﻲ ﻣﻮﺟــﺐ اﻓــﺰاﻳﺶ‬

‫ﺗﺮﻣﻴﻢ در ﺳﻄﺢ ﻏﻀﺮوف‪ ،‬ﭘﻴﺸﮕﻴﺮي از ﺗﻮﻟﻴﺪ ﻧﻴﺘﺮﻳﻚ اﻛـﺴﺎﻳﺪ در ﻣـﺎﻳﻊ‬

‫ﺧﻮنرﺳﺎﻧﻲ در اﻃﺮاف ﻣﻔﺼﻞ و ﺑﺎﻓﺖ آﺳﻴﺐ دﻳﺪه ﻣـﻲﺷـﻮد و از اﻳـﻦ‬

‫‪ Synovia‬و ﻣﻴﻨﻴــﺴﻚ‪ ،‬ﻣﻬــﺎر آﭘﭙﺘــﻮز ﻛﻨﺪروﺳــﻴﺖ‪ ،‬ﻛــﺎﻫﺶ ﻣ ـﺎﺗﺮﻳﻜﺲ‬

‫ﻃﺮﻳﻖ ﺧﻮدﺑﻪﺧﻮد ﻣﻮﺟﺐ ﺗﺮﻣﻴﻢ در آن ﻧﺎﺣﻴﻪ ﻣﻲﺷﻮد‪ .‬در ﻣﻄﺎﻟﻌﺎﺗﻲ ﻧﻴـﺰ‬

‫‪29-32‬‬

‫ﻧﺸﺎن دادﻧﺪ ﻛﻪ ﭘﺮوﻟﻮﺗﺮاﭘﻲ در ﻛﻨﺘﺮل درد و ﺑﺮﮔﺸﺖ آﺳﻴﺐ ﻣﻔﺼﻞ ﻣﻮﺛﺮ‬

‫ﻣﺪاﺧﻼت درﻣﺎﻧﻲ ﻧﮕﻪدارﻧﺪه در اﻳﻦ ﺑﻴﻤﺎران در اوﻟﻮﻳـﺖ ﻣـﻲﺑﺎﺷـﺪ‪.‬‬

‫ﻣﺘﺎﻟﻮﭘﺮوﺗﺌﻴﻨﺎز‪ 3 -‬و اﻳﻨﺘﺮﻟﻮﻛﻴﻦ‪ 1 -‬ﺑﺘﺎ در ﻣﺎﻳﻊ ‪ Synovia‬ﻣﻲﺑﺎﺷـﺪ‪.‬‬

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‫ﻫﻴﺎﻟﻮروﻧﻴﻚ اﺳﻴﺪ ﺟﺰﻳﻲ از ﺗﺮﻛﻴـﺐ ﻃﺒﻴﻌـﻲ ﻏـﻀﺮوف اﺳـﺖ و ﻧﻘـﺶ‬

‫اﺳﺖ‪ .‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻳﺎﻓﺘـﻪﻫـﺎي ﻣﻄﺎﻟﻌـﻪ ﺣﺎﺿـﺮ‪ ،‬اﺳـﺘﻔﺎده از دﻛـﺴﺘﺮوز‬

‫ﻣﻬﻤﻲ در ﺧﺎﺻﻴﺖ وﻳﺴﻜﻮاﻻﺳﺘﻴﺴﻴﺘﻪ ﻣﺎﻳﻊ ﺳﻴﻨﻮوﻳﺎل دارد‪ .‬ﻫﻴﺎﻟﻮروﻧﻴﻚ‬

‫ﭘﺮوﻟﻮﺗﺮاﭘﻲ روﺷﻲ ﺳﺎده‪ ،‬اﻳﻤـﻦ‪ ،‬ارزان‪ ،‬در دﺳـﺘﺮس و ﺑـﺪون ﻋﺎرﺿـﻪ‬

‫اﺳﻴﺪ ﻟﻮﺑﺮﻳﻜﺎﻧﺖ ﻣﻔﺼﻞ و ﻓﺎﻛﺘﻮر ﻓﻴﺰﻳﻮﻟﻮژﻳﻚ رﺷﺪ ﻏﻀﺮوف ﻣﻲﺑﺎﺷﺪ‪.‬‬

‫ﻧﺴﺒﺖ ﺑﻪ درﻣﺎنﻫﺎي دﻳﮕﺮ در اﻳﻦ ﺑﻴﻤﺎران ﻣﻲﺑﺎﺷـﺪ ﻛـﻪ ﺗﻮﺳـﻂ دﻳﮕـﺮ‬

‫در ﻣﻄﺎﻟﻌـﻪ ﺣﺎﺿـﺮ‪ ،‬در ﻫــﺮ ﻳـﻚ از ﮔـﺮوهﻫــﺎي ﻫﻴﺎﻟﻮروﻧﻴـﻚ اﺳــﻴﺪ و‬

‫‪38-41‬‬

‫ﻣﻄﺎﻟﻌﺎت ﻧﻴﺰ ﺗﺎﻳﻴﺪ ﺷﺪه اﺳﺖ‪.‬‬

‫دﻛﺴﺘﺮوز ﭘﺮوﻟﻮﺗﺮاﭘﻲ درد زاﻧـﻮ ﻛـﺎﻫﺶ ﻣﻌﻨـﻲداري را ﻧـﺸﺎن داد وﻟـﻲ‬

‫در ﻳﻚ ﻣﻄﺎﻟﻌﻪ ﻣﺮوري ﺗﻮﺳﻂ ‪ Uthman‬ﻧﻴﺰ ﻛﻪ درﻣﺎنﻫﺎي ﻣﺨﺘﻠـﻒ‬

‫ﻣﻘﺎﻳــﺴﻪ ﻧﺘــﺎﻳﺞ درﻣــﺎﻧﻲ در دو ﮔــﺮوه درﻣــﺎﻧﻲ ﻫﻴﺎﻟﻮروﻧﻴــﻚ اﺳــﻴﺪ و‬

‫اﻳﻨﺘﺮاآرﺗﻴﻜﻮﻻر ﺑﺮاي اﺳﺘﺌﻮآرﺗﺮﻳﺖ را در ﺳﺎلﻫﺎي ‪ 1968-2002‬ﺑﺮرﺳﻲ‬

‫دﻛﺴﺘﺮوز ﭘﺮوﻟﻮﺗﺮاﭘﻲ از ﻧﻈﺮ آﻣﺎري ﺗﻔﺎوت ﻣﻌﻨـﻲداري را ﻧـﺸﺎن ﻧـﺪاد‪.‬‬

‫ﻛﺮده ﺑﻮد‪ ،‬ﮔﺰارش ﻛـﺮد دﻛـﺴﺘﺮوز ﭘﺮوﻟـﻮﺗﺮاﭘﻲ داراي ﻗﺎﺑﻠﻴـﺖ درﻣـﺎن‬

‫ﺑﺮاﺳﺎس ﻧﺘﺎﻳﺞ دﻳﮕﺮ ﻣﻄﺎﻟﻌﺎت اﻧﺠﺎم ﺷﺪه‪ ،‬اﻓﺰاﻳﺶ ﮔﻠﻮﻛﺰ ﺧﺎرج ﺳﻠﻮﻟﻲ‬

‫آرﺗﺮﻳﺖ ﻣﻔﺎﺻﻞ ﻣـﻲﺑﺎﺷـﺪ‪ 42.‬در ﻣﻄﺎﻟﻌـﻪ ﺣﺎﺿـﺮ ﻧـﺸﺎن داده ﺷـﺪ ﻛـﻪ‬

‫ﺣﺘﻲ ﺑﻪ ﻣﻴﺰان ‪ %5‬ﻣﻮﺟﺐ اﻓـﺰاﻳﺶ ﻣﻴـﺰان ‪ ،IGF-2 ،IGF-1‬در ﻣﺰاﻧـﺸﻴﺎل‬

‫دﻛﺴﺘﺮوز ﭘﺮوﻟﻮﺗﺮاﭘﻲ ﺑﻪ اﻧﺪازه ﺗﺰرﻳﻖ داﺧﻞ ﻣﻔﺼﻠﻲ ﻫﻴﺎﻟﻮروﻧﻴﻚ اﺳـﻴﺪ‬

‫ﺳﻠﻮلﻫﺎي اﻧﺴﺎﻧﻲ‪ TGF-β1 20،‬در ﺳﻠﻮلﻫﺎي ﺗـﻚﻫـﺴﺘﻪاي اﻧـﺴﺎﻧﻲ‪ 21‬و‬

‫در درﻣﺎن درد اﺳﺘﺌﻮآرﺗﺮﻳﺖ زاﻧﻮ ﻣﻮﺛﺮ اﺳﺖ‪ .‬ﻟﺬا در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﻪ دﻟﻴﻞ‬

‫ﻣﺰاﻧﺸﻴﺎل اﻧﺴﺎﻧﻲ‪20،‬و‪) PDGF-β 17‬ﭘﻼﻛﺖ ﻣﺸﺘﻖ ﺷﺪه از ﻓﺎﻛﺘﻮر رﺷﺪ ‪،(β‬‬

‫اﻳﻤﻨﻲ‪ ،‬ﻧﺘﺎﻳﺞ درﻣﺎن‪ ،‬ارزان ﺑﻮدن دﻛﺴﺘﺮوز‪ ،‬ﻛـﻢﺗـﺮ ﺗﻬـﺎﺟﻤﻲ ﺑـﻮدن ﻳـﺎ‬

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‫ﺗﻌــﺪاد ﻛــﻢﺗــﺮ دﻓﻌــﺎت ﺗﺰرﻳــﻖ و ﭘــﺬﻳﺮش راﺣــﺖ آن ﺗﻮﺳــﻂ ﺑﻴﻤــﺎر‪،‬‬

‫‪ bFGF‬در ﻓﻴﺒﺮوﺑﻼﺳﺖﻫﺎي ﻟﺜﻪاي اﻧﺴﺎﻧﻲ‪ CTGF 19،‬ﻓﺎﻛﺘﻮر رﺷـﺪ ﺑﺎﻓـﺖ‬

‫ﭘﺮوﻟـﻮﺗﺮاﭘﻲ ﺑـﺎ دﻛـﺴﺘﺮوز ‪ %25‬در درﻣـﺎن درد اﺳـﺘﺌﻮآرﺗﺮﻳﺖ زاﻧـﻮ در‬

‫ﻧﺮم در ﺳـﻠﻮلﻫـﺎي ﻣﺰاﻧـﺸﻴﺎل اﻧـﺴﺎن‪ 18،‬ﻣـﻲﺷـﻮد‪ .‬ﻫـﻢﭼﻨـﻴﻦ ﮔﻠـﻮﻛﺰ‬

‫ﻛﻮﺗﺎهﻣﺪت درﻣـﺎﻧﻲ ﻣـﻮﺛﺮ و اﻳﻤـﻦ ﺷـﻨﺎﺧﺘﻪ ﺷـﺪه اﺳـﺖ‪ .‬ﺑﻨـﺎﺑﺮاﻳﻦ ﺑـﻪ‬

‫ﺳﻠﻮلﻫﺎي ﻣﻨﻮﻧﻮﻛﻠﺌﺎر ﺧﻮﻧﻲ ﭘﺘﺎﻧﺴﻴﻞ ﻓﺎﻛﺘﻮرﻫﺎي ﻣﺨﺮب )اﻳﻨﺘﺮﻟﻮﻛﻴﻦﻫـﺎ‬

‫ﻣﺘﺨﺼﺼﻴﻦ درد ﭘﻴﺸﻨﻬﺎد ﻣﻲﮔﺮدد ﻛﻪ در درﻣﺎن درد ﺑﻴﻤـﺎران ﻣﺒـﺘﻼ ﺑـﻪ‬

‫ﻣﺎﻧﻨﺪ ‪ (IL-10 ،IL-6 ،IL-2‬را ﺳﺎﭘﺮس ﻣﻲﻛﻨﺪ‪ 21.‬از ﻃﺮﻓﻲ ﭘﺎﺳـﺦ ﺳـﻠﻮﻟﻲ‬

‫اﺳﺘﺌﻮآرﺗﺮﻳﺖ زاﻧﻮ ﭘﺮوﻟﻮﺗﺮاﭘﻲ ﺑﺎ دﻛـﺴﺘﺮوز ‪ %25‬را در ﺳـﻪ ﺗﺰرﻳـﻖ ﺑـﻪ‬

‫ﺑﻪ اﻓﺰاﻳﺶ ﮔﻠﻮﻛﺰ ﺧﺎرج ﺳﻠﻮﻟﻲ ﺳﺮﻳﻊ ﻣﻲﺑﺎﺷﺪ و ﻣﻴﺰان ‪ DNA‬ﻣﺮﺑﻮط ﺑﻪ‬

‫ﻓﻮاﺻﻞ ﻳﻚﻣﺎه در ﻧﻈﺮ داﺷﺘﻪ ﺑﺎﺷﻨﺪ‪ .‬ﭘﻴﺸﻨﻬﺎد ﻣﻲﮔـﺮدد اﻳـﻦ ﻣﻄﺎﻟﻌـﻪ ﺑـﺎ‬

‫ﺗﻮﻟﻴﺪ ﻓﺎﻛﺘﻮر رﺷﺪ در اﺛﺮ ﺗﻤﺎس ﺳﻠﻮﻟﻲ ﺑﺎ اﻓﺰاﻳﺶ ﮔﻠـﻮﻛﺰ ﻧﻴـﺰ اﻓـﺰاﻳﺶ‬

‫ﺣﺠﻢ ﻧﻤﻮﻧﻪ ﺑﻴﺶﺗﺮ ﺑﺎ ﭘﻲﮔﻴﺮي ﻛﻮﺗﺎهﻣﺪت و ﺑﻠﻨﺪﻣﺪت و ﻏﻠﻈـﺖﻫـﺎي‬

‫ﻣﻲﻳﺎﺑﺪ‪ 34.‬در ﻣﻄﺎﻟﻌﻪاي ﻧﻴﺰ ﮔﺰارش ﻛﺮدﻧﺪ اﺳـﺘﻔﺎده از ﻣﺤﻠـﻮل ﺗﺮﻛﻴﺒـﻲ‬

‫ﻣﺨﺘﻠﻒ دﻛﺴﺘﺮوز و دﻓﻌﻪﻫـﺎي ﻣﺨﺘﻠـﻒ ﭘﺮوﻟـﻮﺗﺮاﭘﻲ و ﻣﻘﺎﻳـﺴﻪ آن ﺑـﺎ‬

‫)ﻓﻨﻞ ‪ ،%1/25‬دﻛـﺴﺘﺮوز ‪ %12/5‬و ﮔﻠﻴـﺴﻴﺮﻳﻦ ‪ (%12/5‬ﻣﻮﺟـﺐ ﺑﻬﺒـﻮد‬

‫ﺳﻴﻨﻮﻛﺮوم ﻓﻮرت ‪ %2‬اﻧﺠﺎم ﺷﻮد‪.‬‬

‫در ﺳﻠﻮلﻫﺎي ﻣﺰاﻧﺸﻴﺎل اﻧﺴﺎﻧﻲ‪ 17‬و ﺳﻠﻮلﻫـﺎي اﻧـﺪوﺗﻠﻴﺎل ﻛـﺎﭘﻴﻼري‪،‬‬

S.M. et ‫دﻛﺴﺘﺮوز‬ al. ‫ﻣﻔﺼﻠﻲ در درﻣﺎن درد اﺳﺘﺌﻮآرﺗﺮﻳﺖ زاﻧﻮ‬Hashemi ‫ﭘﺮوﻟﻮﺗﺮاﭘﻲ داﺧﻞ‬ ‫ﻣﻘﺎﻳﺴﻪ ﺗﺎﺛﻴﺮ ﻫﻴﺎﻟﻮروﻧﻴﻚ اﺳﻴﺪ و‬

123

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Intra-articular hyaluronic acid vs. dextrose prolotherapy in osteoarthritic knee pain

36. Reeves KD, Harris AL. Recurrent dislocation of total knee prostheses in a large patient: Case report of dextrose proliferant use. Arch Phys Med Rehabil 1997;78:1039. 37. Arthritis MD. Zakhary BA, Omaha NE, Visco A. Joint Trauma and Osteoarthritis. [Internet] 2005 [cited 2012 Jan 15]; Available from: http://www.arthritismd.com/jointtrauma_and_osteoarthritis.html 38. Kobayashi D, Kurosaka M, Yoshiya S, Mizuno K. Effect of basic fibroblast growth factor on the healing of defects in the canine anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 1997;5(3):189-94.

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39. Dye SF. The future of anterior cruciate ligament restoration. Clin Orthop Relat Res 1996;(325):130-9. 40. Gerich TG, Kang R, Fu FH, Robbins PD, Evans CH. Gene transfer to the rabbit patellar tendon: potential for genetic enhancement of tendon and ligament healing. Gene Ther 1996;3(12):1089-93. 41. Pelletier JP, Caron JP, Evans C, Robbins PD, Georgescu HI, Jovanovic D, et al. In vivo suppression of early experimental osteoarthritis by interleukin-1 receptor antagonist using gene therapy. Arthritis Rheum 1997;40(6):1012-9. 42. Uthman I, Raynauld JP, Haraoui B. Intra-articular therapy in osteoarthritis. Postgrad Med J 2003;79(934):449-53.

125

‫ﻋﻤﻮﻣﻲ‬ ‫ﺑﺨﺸﻬﺎي ﺟﺮاﺣﻲ‬ ‫ﺟﺮاﺣﻲ در‬ ‫ﻋﻔﻮﻧﺖ ﻣﺤﻞ‬ ‫ﺗﺸﺨﻴﺺ‬ ‫روش ﭘﺎﻳﺶ‬ ‫ﻛﺎراﻳﻲ‬ Tehran University Medical Journal; Vol. 70, No.‫ﺑﺮاي‬ 2, May 2012:‫دو‬119-125

Intra-articular hyaluronic acid injections Vs. dextrose prolotherapy in the treatment of osteoarthritic knee pain ]

Abstract Seyed Masoud Hashemi M.D.1* Firooz Madadi M.D.2 Saied Razavi M.D.1 Mahshid Nikooseresht M.D.3 Farshad Hassanzadeh Kiyabi M.D.1 Somayyeh Nasiripour Ph.D.4 1- Department of Anesthesiology Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2- Department of Orthopedic, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 3- Department of Anesthesiology, Beasat Hospital, Hamedan University of Medical Sciences, Hamedan, Iran. 4- Pharm D., Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

Received: September 13, 2011 Accepted: January 11, 2010

Background: Conservative treatment needs to be tried prior to surgical treatment of knee osteoarthritis. This study was designed to evaluate the short-term effects of dextrose prolotherapy on pain relief and functional improvement in knee osteoarthritis in comparison with intra-articular hyaluronic acid injections. Methods: In this double blind clinical trial, 100 patients, aged 40-70 years, with complaints of knee pain lasting >3 months were recruited in Akhtar hospital during the years 2010 to 2011. The patients met the criteria proposed by the American College of Rheumatology (ACR) for knee osteoarthritis. 50 patients in hyaluronic acid group received five 2 ml injections of hyaluronic acid (Synocrom Forte® 1%) weekly and 50 patients in dextrose prolotherapy group received three 2 ml bimonthly injections of 25% dextrose. The patients were evaluated before and after treatment in terms of pain and functionality using the Knee injury and Osteoarthritis Outcome Score (KOOS) selfquestionnaire. The patients were followed up for 12 weeks and were examined 12 weeks after the injections by an observer unaware of group assignments. The data were recorded for statistical analysis. Results: The mean age of the patients was 60.68.2 years. No significant differences were found between the two groups with respect to pre- and post-treatment KOOS scores. The scores showed significant improvements in all items following treatment in both groups (P<0.001). Conclusion: It seems that intra-articular injections of 25% dextrose prolotherapy could be as effective as hyaluronic acid injections for the treatment of knee pain due to OA. Keywords: Dextrose prolotherapy, hyaluronic acid, knee osteoarthritis.

Corresponding author: Akhtar Hospital, Elahiyeh St., Tehran, 1964714953, Islamic Republic of Iran. Tel: +98- 21- 22612252 E-mail: dr.hashemi@sbmu.ac.ir

‫ﻛﻠﻴﻪ‪ ،‬اردﻳﺒﻬﺸﺖ ‪126-129 ،1391‬‬ ‫ﺷﻤﺎره ‪2‬‬ ‫ﻧﺎرﺳﺎ‪70‬‬ ‫در دوره‬ ‫ﺗﻬﺮان‪،‬‬ ‫ﻋﻠﻮمﭘﻠﻲﭘﺰﺷﻜﻲ‬ ‫داﻧﺸﮕﺎه‬ ‫ﭘﺰﺷﻜﻲ‪،‬‬ ‫آﻧﺘﻲﺑﺎديﻣﺠﻠﻪ‬ ‫ﻳﻲ‪، ،‬ﻣﺰﻣﻦ‬ ‫ﺳﺎﻛﺎرﻳﺪي‬ ‫واﻛﺴﻦ‬ ‫ﺗﺰرﻳﻖ‬ ‫داﻧﺸﻜﺪه ﺑﻌﺪ از‬ ‫اﺧﺘﺼﺎﺻﻲ‬

‫‪126‬‬

‫ﺑﺮرﺳﻲ ﻓﺮاواﻧﻲ ﭘﻮﻟﻴﭗﻫﺎ و ﺑﺪﺧﻴﻤﻲﻫﺎي ﻛﻮﻟﻮرﻛﺘﺎل در زﻧﺎن ﻣﺒﺘﻼ ﺑﻪ ﺳﺮﻃﺎن ﺗﺨﻤﺪان و اﻧﺪوﻣﺘﺮ در ﺳﺎل‬ ‫‪ 1389-90‬در ﺑﻴﻤﺎرﺳﺘﺎن ﻓﻴﺮوزﮔﺮ‪ ،‬اﻛﺒﺮآﺑﺎدي و رﺳﻮل اﻛﺮم‪ :‬ﮔﺰارش ﻛﻮﺗﺎه‬

‫ﺗﺎرﻳﺦ درﻳﺎﻓﺖ ﻣﻘﺎﻟﻪ‪ 1390/10/19 :‬ﺗﺎرﻳﺦ ﭘﺬﻳﺮش‪1390/11/09 :‬‬

‫ﺳﻴﻤﺎ ﺟﻌﻔﺮي‪ *1،‬ﺳﻴﺎﻣﻚ ﺧﺎﻟﻘﻲ‪،‬‬

‫‪2‬‬

‫ﭼﻜﻴﺪه‬

‫‪4‬‬

‫ﻋﻠﻲ ﺑﺎﺳﻲ‪ 3،‬ﻃﻴﺐ رﻣﻴﻢ‬

‫زﻣﻴﻨﻪ و ﻫﺪف‪ :‬آدﻧﻮﻛﺎرﺳﻴﻨﻮم ﻛﻮﻟﻮن ﺑﻪ وﻳﮋه اﻧﻮاع ﺛﺎﻧﻮﻳﻪ ﺑﻪ ﺳﺮﻃﺎنﻫﺎي ﺗﺨﻤﺪان اﻏﻠﺐ در ﺗـﺸﺨﻴﺺﻫـﺎ ﻧﺎدﻳـﺪه ﮔﺮﻓﺘـﻪ‬

‫ﻣﻲﺷﻮﻧﺪ‪ .‬ﻫﺪف از اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺮرﺳﻲ ﻫﻤﺮاﻫﻲ ﭘﻮﻟﻴﭗﻫﺎي ﻛﻮﻟﻮن ﺑﺎ ﺳﺮﻃﺎنﻫـﺎي ﺗﺨﻤـﺪان ﻣـﻲﺑﺎﺷـﺪ‪ .‬روش ﺑﺮرﺳـﻲ‪:‬‬

‫‪ -1‬ﮔﺮوه داﺧﻠﻲ‬ ‫‪ -2‬ﮔﺮوه ﮔﻮارش‬

‫ﺑﻴﻤﺎران ﺑﻴﻤﺎرﺳﺘﺎنﻫﺎي ﻓﻴﺮوزﮔﺮ‪ ،‬اﻛﺒﺮآﺑﺎدي و رﺳﻮل اﻛﺮم از ﺳﺎل ‪ 1389‬ﺗﺎ ‪ 1390‬ﺑﺎ ﺗﺸﺨﻴﺺ ﺳﺮﻃﺎن ﺗﺨﻤﺪان و اﻧﺪوﻣﺘﺮ‬

‫‪ -3‬ﮔﺮوه ﺧﻮن و اﻧﻜﻮﻟﻮژي‬ ‫‪ -4‬ﭘﮋوﻫﺸﮕﺮ‪ ،‬ﻋﻀﻮ ﻣﺮﻛﺰ ﺗﺤﻘﻴﻘﺎت ﺗﺮوﻣﺎ و‬

‫ﻣﻮرد ﺑﺮرﺳﻲ ﻗﺮار ﮔﺮﻓﺘﻨﺪ‪ .‬ﭘﻮﻟﻴﭗﻫﺎ و ﺗﻮﻣﻮرﻫﺎي ﻳﺎﻓﺖ ﺷﺪه در ﻛﻮﻟﻮﻧﻮﺳﻜﻮﭘﻲ ﺑﺎ روش اﻳﻤﻮﻧﻮﻫﻴﺴﺘﻮﺷﻴﻤﻲ از ﻧﻈﺮ اوﻟﻴﻪ‬ ‫ﻳﺎ ﻣﺘﺎﺳﺘﺎﺗﻴﻚ ﺑﻮدن ﺑﺮرﺳﻲ ﮔﺮدﻳﺪﻧﺪ‪ .‬ﻳﺎﻓﺘﻪ ﻫﺎ‪ 100 :‬ﺑﻴﻤﺎر ﺑﺎ ﻣﻴﺎﻧﮕﻴﻦ ﺳﻨﻲ ‪ 50/21‬ﺳﺎل‪ ،‬ﻣﻴﺎﻧﮕﻴﻦ وزﻧﻲ ‪ 65/9‬ﻛﻴﻠـﻮﮔﺮم و‬

‫ﺟﺮاﺣﻲ ﺑﻴﻤﺎرﺳﺘﺎن ﺳﻴﻨﺎ‬

‫ﻣﻴﺎﻧﮕﻴﻦ ‪ 26/07kg/m2 ،BMI‬در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺷﺮﻛﺖ ﻛﺮدﻧﺪ‪ .‬ﻓﺮاواﻧﻲ ﻛﻠﻲ ﭘﻮﻟﻴﭗﻫﺎي ﻛﻮﻟﻮرﻛﺘﺎل ﭘـﻨﺞ ﻣـﻮرد در‪ 100‬ﻧﻔـﺮ‬ ‫داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬ﺗﻬﺮان‪ ،‬اﻳﺮان‪.‬‬ ‫*‬

‫ﻧﻮﻳﺴﻨﺪه ﻣﺴﺌﻮل‪ :‬ﺗﻬﺮان‪ ،‬ﻣﻴﺪان ﺗﻮﺣﻴﺪ‪ ،‬ﺧﻴﺎﺑﺎن ﺳﺘﺎرﺧﺎن‪،‬‬

‫ﺧﻴﺎﺑﺎن ﻧﻴﺎﻳﺶ‪ ،‬ﺑﻴﻤﺎرﺳﺘﺎن ﺣﻀﺮت رﺳﻮل اﻛﺮم‬

‫ﺑﻮد‪ .‬اﻓﺮاد داراي ﺗﺸﺨﻴﺺ ﭘﻮﻟﻴﭗ‪ ،‬ﺳﺎﺑﻘﻪ ﻓﺎﻣﻴﻠﻲ ﻣﺜﺒﺖ از ﻧﻈﺮ اﺑﺘﻼ ﺑﻪ ﺳﺮﻃﺎن ﺗﺨﻤﺪان داﺷﺘﻨﺪ‪ .‬ﻧﺘﻴﺠﻪﮔﻴﺮي‪ :‬ﺑﺎ ﺗﻮﺟـﻪ ﺑـﻪ‬ ‫ﭘﺎﻳﻴﻦ ﺑﻮدن آﻣﺎر ﻣﺒﺘﻼﻳﺎن ﺑﻪ ﭘﻮﻟﻴﭗﻫﺎي ﻛﻮﻟﻮرﻛﺘﺎل‪ ،‬ﭘﻲﮔﻴﺮي ﺑﻴﻤﺎران ﺟﻬﺖ اﻧﺠﺎم ﻏﺮﺑﺎﻟﮕﺮي ﺗﻮﺻﻴﻪ ﻧﻤﻲﺷﻮد‪.‬‬

‫ﺗﻠﻔﻦ‪021-66348529 :‬‬ ‫‪E-mail: slr_1975@yahoo.com‬‬

‫ﻛﻠﻤﺎت ﻛﻠﻴﺪي‪ :‬ﭘﻮﻟﻴﭗ ﻛﻮﻟﻮرﻛﺘﺎل‪ ،‬ﺳﺮﻃﺎن ﻛﻮﻟﻮرﻛﺘﺎل‪ ،‬ﺳﺮﻃﺎن ﺗﺨﻤﺪان‪ ،‬ﺳﺮﻃﺎن اﻧﺪوﻣﺘﺮ‪ ،‬ﻏﺮﺑﺎﻟﮕﺮي‪.‬‬

‫از راهﻫﺎي ﺳﺎده و ﻛﻢ ﻫﺰﻳﻨﻪ ﺑﺮاي اﻃﻼع از زﻣﻴﻨـﻪﻫـﺎي ارﺛـﻲ اﺑـﺘﻼ ﺑـﻪ‬

‫ﻣﻘﺪﻣﻪ‬

‫ﺳﻨﺪرمﻫﺎي ﻛﻮﻟﻮرﻛﺘﺎل اﺳـﺖ‪ .‬ﻣﻤﻜـﻦ اﺳـﺖ ﺳـﺎﺑﻘﻪ ﻓـﺎﻣﻴﻠﻲ دﻗﻴﻘـﻲ از‬

‫ﺳﺮﻃﺎن ﻛﻮﻟﻮرﻛﺘﺎل دوﻣﻴﻦ ﻋﻠﺖ ﺷﺎﻳﻊ ﻣﺮگ و ﻣﻴﺮ ﻧﺎﺷﻲ از ﺳﺮﻃﺎن‬

‫ﻣﺒﺘﻼﻳﺎن ﺳﻨﺪرم ﻟﻴﻨﭻ ﺑﻪ دﻟﻴﻞ ﻛﻢ ﺑﻮدن ﺗﻌـﺪاد اﻋـﻀﺎي ﺧـﺎﻧﻮاده‪ ،‬ﻋـﺪم‬

‫ﻣﻲﺑﺎﺷﺪ‪ .‬اﻳﻦ ﺳـﺮﻃﺎن ﻣـﺴﻮول ﻣـﺮگ ﺳـﺎﻻﻧﻪ ﺣـﺪود ‪ 52000‬ﻧﻔـﺮ در‬

‫آﺷﻨﺎﻳﻲ ﭘﺰﺷﻜﺎن ﺑﺎ زﻣﻴﻨﻪﻫﺎي ارﺛﻲ اﻳﻦ ﺑﻴﻤﺎري و ﺗﻼش ﺟﻬﺖ ﺛﺒـﺖ آن‬

‫آﻣﺮﻳﻜﺎ و ‪ 146000‬ﻧﻔﺮ در اروﭘـﺎ ﺑـﻮده اﺳـﺖ‪ 1-3.‬ﺣـﺪود ‪ 2-5‬درﺻـﺪ‬

‫‪7-9‬‬

‫و ﻣﺎﻧﻨﺪ آن وﺟـﻮد ﻧﺪاﺷـﺘﻪ ﺑﺎﺷـﺪ‪.‬‬

‫در ﺑﺮﺧـﻲ ﻣﺮاﻛـﺰ درﻣـﺎﻧﻲ ﺑـﺮاي‬

‫)‪(Lynch syndrome‬‬

‫ﺟﻠــﻮﮔﻴﺮي از ﻋــﻮارض ﻣﺘﺎﺳــﺘﺎﺗﻴﻚ اﻳـﻦ ﻧــﻮع ﺳــﺮﻃﺎنﻫــﺎ ﭘـﻲﮔﻴـﺮي‬

‫ﻫﺴﺘﻨﺪ ﻛﻪ ﻗﺒﻼً ﺗﺤـﺖ ﻋﻨـﻮان ﺳـﺮﻃﺎن ﻛﻮﻟﻮرﻛﺘـﺎل ﻏﻴـﺮ ﭘـﻮﻟﻴﭙﻲ ارﺛـﻲ‬

‫ﻛﻮﻟﻮﻧﻮﺳﻜﻮﭘﻲ و اﻧﺠﺎم ﺑﺮﺧﻲ آزﻣﺎﻳﺸﺎت آﻧﺘﻲﺑـﺎدي اﻧﺠـﺎم ﻣـﻲﮔـﺮدد‪.‬‬

‫ﻣﻮارد ﺟﺪﻳـﺪ ﺗـﺸﺨﻴﺺ داده ﺷـﺪه ﺳـﻨﺪرم ﻟﻴـﻨﭻ‬ ‫)‪(HNPCC‬‬

‫‪ Hereditary Nonpolyposis Colorectal Cancer‬ﺷــﻨﺎﺧﺘﻪ‬

‫‪10-12‬‬

‫آدﻧﻮﻛﺎرﺳﻴﻨﻮﻣﺎي ﻛﻮﻟﻮن ﺷﺒﻴﻪ ﺑﻪ ﻛﺎرﺳﻴﻨﻮﻣﺎي اوﻟﻴﻪ ﺗﺨﻤﺪان اﺳـﺖ‪.‬‬

‫ﻣﻲﺷﺪ‪ .‬ﺳﻨﺪرم ﻟﻴﻨﭻ ﻳﻚ اﺧﺘﻼل اﺗﻮزوﻣﺎل ﻏﺎﻟﺐ اﺳﺖ ﻛﻪ ﺗﻈﺎﻫﺮات آن‬

‫آدﻧﻮﻛﺎرﺳﻴﻨﻮﻣﺎي ﻛﻮﻟﻮن ﺑﻪ وﻳـﮋه اﻧـﻮاﻋﻲ ﻛـﻪ ﺛﺎﻧﻮﻳـﻪ ﺑـﻪ ﺳـﺮﻃﺎنﻫـﺎي‬

‫ﺑﻪ ﺻﻮرت ﺳﺮﻃﺎن اوﻟﻴﻪ ﻛﻮﻟﻮرﻛﺘﺎل و اﻧﺪوﻣﺘﺮ ﻣﻲﺑﺎﺷﺪ‪ .‬اﻳﻦ اﺧـﺘﻼل ﺑـﺎ‬

‫ﺗﺨﻤﺪان ﺑﺎﺷﻨﺪ اﻏﻠﺐ در ﺗﺸﺨﻴﺺﻫﺎ ﻧﺎدﻳﺪه ﮔﺮﻓﺘﻪ ﻣﻲﺷﻮﻧﺪ‪ .‬ﺗـﺸﺨﻴﺺ‬

‫اﻓﺰاﻳﺶ ﺧﻄﺮ ﺳﺮﻃﺎن در دﺳﺘﮕﺎه ﮔـﻮارش‪ ،‬دﺳـﺘﮕﺎه ادراري و دﺳـﺘﮕﺎه‬

‫اﻳﻦ دو ﻋﺎرﺿﻪ از ﻫﻢ ﺑﺴﻴﺎر اﻫﻤﻴﺖ دارد ﭼﺮا ﻛﻪ درﻣـﺎنﻫـﺎي ﻣﺘﻔـﺎوﺗﻲ‬

‫ﺗﻮﻟﻴﺪ ﻣﺜﻞ زﻧﺎن ﻫﻤﺮاه اﺳﺖ‪ .‬دوﻣﻴﻦ ﺳﺮﻃﺎن ﺷﺎﻳﻊ در ﻣﺒﺘﻼﻳﺎن ﺑﻪ ﺳﻨﺪرم‬

‫ﺑﺮاي آنﻫﺎ ﭘﻴﺸﻨﻬﺎد ﺷﺪه اﺳﺖ‪ .‬در ﺑﺮﺧﻲ ﺳﻨﺪرمﻫﺎ ﻧﻈﻴﺮ آنﭼﻪ در ﻟﻴـﻨﭻ‬

‫ﻟﻴﻨﭻ‪ ،‬ﺳﺮﻃﺎن اﻧـﺪوﻣﺘﺮﻳﺎل اﺳـﺖ‪ .‬ﻣﻴـﺰان ﺧﻄـﺮ اﺑـﺘﻼ ﺑـﻪ ﺳـﺮﻃﺎنﻫـﺎي‬

‫ﻣﻲﺑﻴﻨﻴﻢ اﻳﻦ ﻫﻢزﻣﺎﻧﻲ ﺑﻪ اﺛﺒﺎت رﺳﻴﺪه اﺳﺖ‪ .‬در اﻳﻦ ﺳﻨﺪرمﻫﺎ ﻫﻢزﻣﺎﻧﻲ‬ ‫‪12-14‬‬

‫ﺗـﺎﻛﻨﻮن‬

‫اﻧﺪوﻣﺘﺮﻳﺎل و ﺗﺨﻤﺪان در زﻧﺎن ﻣﺒﺘﻼ ﺑـﻪ ﺳـﻨﺪرم ﻟﻴـﻨﭻ ‪ 15-70‬درﺻـﺪ‬

‫ﻋﻮارض ﺗﺨﻤﺪاﻧﻲ ﺑﺎ ﭘﻮﻟﻴـﭗﻫـﺎي ﻛﻮﻟـﻮن ﻣﻄـﺮح اﺳـﺖ‪.‬‬

‫اﺳﺖ‪ 4-6.‬ﺑﺮرﺳﻲ ﺳﺎﺑﻘﻪ ﻓﺎﻣﻴﻠﻲ اﻓﺮاد ﻣﺒﺘﻼ از ﻧﻈﺮ اﺑﺘﻼ ﺑﻪ ﺳﺮﻃـﺎن ﻳﻜـﻲ‬

‫ﺑﺮرﺳﻲ ﺟﺎﻣﻌﻲ ﻛﻪ ﺑﺘﻮاﻧﺪ ﻋﻜﺲ اﻳﻦ ﻗﻀﻴﻪ ﻳﻌﻨﻲ ﻫﻤﺮاﻫﻲ ﭘﻮﻟﻴـﭗﻫـﺎي‬

‫ﺳﻴﻤﺎ ﺟﻌﻔﺮي و ﻫﻤﻜﺎران‬

‫‪127‬‬

‫ﻛﻮﻟﻮن ﺑﺎ ﺳﺮﻃﺎنﻫـﺎي ﺗﺨﻤـﺪاﻧﻲ را ﻧـﺸﺎن دﻫـﺪ اﻧﺠـﺎم ﻧـﺸﺪه اﺳـﺖ‪.‬‬

‫‪ SPSS‬وﻳﺮاﺳﺖ ‪ 17‬ﺷﺪه و ﺑﺮاي ﻣﺤﺎﺳﺒﻪ ﻣﻴـﺎﻧﮕﻴﻦﻫـﺎ و ﻓﺮاواﻧـﻲﻫـﺎ از‬

‫ﺗﻔﺎوتﻫﺎي ﻧـﮋادي و ﭘـﺮاﻛﻨﺶ ﺟﻐﺮاﻓﻴـﺎﻳﻲ در ﺷـﻴﻮع و ﺑـﺮوز ﻫـﺮ دو‬

‫آﻧﺎﻟﻴﺰ ﺗﻮﺻﻴﻔﻲ اﺳﺘﻔﺎده ﮔﺮدﻳﺪ‪ .‬در ﺻﻮرت ﻧﻴﺎز ﺑـﻪ ﻣﻘﺎﻳـﺴﻪ ﮔـﺮوهﻫـﺎي‬

‫ﺑﻴﻤﺎري ﺗﺎﺛﻴﺮ دارﻧﺪ ﻟﺬا اﻧﺠـﺎم ﻣﻄﺎﻟﻌـﻪاي ﺟـﺎﻣﻊ ﻛـﻪ ﺑﺘﻮاﻧـﺪ ﻫـﻢزﻣـﺎﻧﻲ‬

‫‪2‬‬

‫ﻛﻴﻔﻲ‪ ،‬از ﺗﺴﺖ ‪ ‬اﺳﺘﻔﺎده ﺷﺪ‪.‬‬

‫ﭘﻮﻟﻴﭗﻫﺎي ﻛﻮﻟﻮن را در ﺳﺮﻃﺎنﻫﺎي ﺗﺨﻤﺪاﻧﻲ ﻧـﺸﺎن دﻫـﺪ ﻋـﻼوه ﺑـﺮ‬ ‫اﻳﻦﻛﻪ ﺑﺮاي ﻧﺨﺴﺘﻴﻦ ﺑﺎر ﻧﺴﺒﺘﻲ واﻗﻌـﻲ از رﺧـﺪاد اﻳـﻦ دو ﺑﻴﻤـﺎري را‬ ‫ﻧﺸﺎن ﻣﻲدﻫﺪ ﻣﻲﺗﻮاﻧﺪ اﻫﻤﻴﺖ اﻧﺠﺎم ﻛﻮﻟﻮﻧﻮﺳﻜﻮﭘﻲ ﭘﻲﮔﻴـﺮي و ﻣﻴـﺰان‬ ‫وﻗﻮع ﭘﻮﻟﻴﭗﻫﺎ را ﭘﺲ از اﺑﺘﻼ ﺑﻪ ﺳﺮﻃﺎن ﺗﺨﻤﺪان ﻧﺸﺎن دﻫﺪ‪ .‬ﺑـﺎ ﺗﻮﺟـﻪ‬

‫ﻳﺎﻓﺘﻪﻫﺎ‬ ‫در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ‪ 100‬ﻧﻔـﺮ ﺑـﺮ اﺳـﺎس ﻣﻌﻴﺎرﻫـﺎي ورود ﺑـﻪ ﻣﻄﺎﻟﻌـﻪ‬

‫ﺑﻪ ﺷﻴﻮع ﺑﺎﻻي ﻫﻤﺮاﻫﻲ ﺳﺮﻃﺎنﻫﺎي ﺗﺨﻤﺪان و اﻧﺪوﻣﺘﺮ ﺑﺎ ﺳﺮﻃﺎنﻫـﺎي‬

‫اﻧﺘﺨﺎب ﺷﺪﻧﺪ‪ .‬ﻣﻴﺎﻧﮕﻴﻦ ﺳﻦ اﻓﺮاد ‪ 50/219/582‬ﺳﺎل و ﻣﻴـﺎﻧﮕﻴﻦ‬

‫ﻛﻮﻟﻮن ﻛﻪ در ﺳﻨﺪرم ﻟﻴﻨﭻ دﻳﺪه ﻣﻲﺷﻮد در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻫﺪف اﻳﻦ اﺳﺖ‬

‫در آنﻫﺎ ‪ 26/072/84kg/m2‬ﺑﻮد‪ .‬ﺑﻴﻤﺎري اوﻟﻴﻪ در ‪ %80‬ﻣﻮارد ﺳـﺮﻃﺎن‬

‫ﻛﻪ ﻣﺸﺨﺺ ﻛﻨﻴﻢ آﻳﺎ در اﻓﺮادي ﻛﻪ ﺳﺮﻃﺎنﻫﺎي ﺗﺨﻤﺪان و اﻧـﺪوﻣﺘﺮﻳﺎل‬

‫ﺗﺨﻤﺪان و در ‪ %20‬ﻣﻮارد ﺳﺮﻃﺎن اﻧﺪوﻣﺘﺮ ﺑـﻮد‪ .‬ﻣﻴـﺎﻧﮕﻴﻦ زﻣـﺎن ﺳـﭙﺮي‬

‫دارﻧﺪ ﻫﻤﺮاﻫﻲ ﺑﺎ ﺳﺮﻃﺎنﻫﺎ و ﭘﻮﻟﻴﭗﻫﺎي ﻛﻮﻟﻮن ﻧﻴﺰ دﻳﺪه ﻣـﻲﺷـﻮد ﻳـﺎ‬

‫ﺷﺪه از ﺗﺸﺨﻴﺺ ﺑﻴﻤﺎري ‪ 11/125/426‬ﻣﺎه ﺑﻮد‪ .‬ﺑﻴﺶﺗﺮﻳﻦ ﻧﻮع درﻣﺎن‬

‫ﺧﻴﺮ‪ .‬ﺷﻨﺎﺧﺖ زودرس ﺳﺮﻃﺎنﻫﺎي ﻛﻮﻟﻮرﻛﺘﺎل در ﻣﺮاﺣـﻞ اوﻟﻴـﻪ ﻗﺎﺑـﻞ‬

‫اﻧﺠﺎم ﺷﺪه ﻣﺮﺑﻮط ﺑﻪ ﮔﺮوه درﻣﺎﻧﻲ ﺟﺮاﺣﻲ و ﺷﻴﻤﻲ درﻣﺎﻧﻲ ﺗﻮام ﺑﺎ ‪65‬‬

‫درﻣﺎن ﺑﻮده وﻟﻲ ﺑـﺎ ﭘﻴـﺸﺮﻓﺖ ﺑﻴﻤـﺎري‪ ،‬ﭘـﻴﺶآﮔﻬـﻲ ﺑﻴﻤـﺎران ﺿـﻌﻴﻒ‬

‫درﺻﺪ ﺑﻮد‪ %36 .‬اﻓﺮاد ﺳﺎﺑﻘﻪ ﻓﺎﻣﻴﻠﻲ اﺑﺘﻼ ﺑـﻪ ﺳـﺮﻃﺎنﻫـﺎي ﺗﺨﻤـﺪان و‬

‫ﻣﻲﺷﻮد‪ .‬ﺑﻨﺎﺑﺮاﻳﻦ در ﺻﻮرﺗﻲﻛﻪ اﻳـﻦ ﺳـﺮﻃﺎنﻫـﺎ در ﺑﻴﻤـﺎران ﻣﺒـﺘﻼ ﺑـﻪ‬

‫اﻧــﺪوﻣﺘﺮ داﺷــﺘﻪ و ﺗﻨﻬــﺎ ‪ %12‬از اﻓــﺮاد داراي ﺳــﺎﺑﻘﻪ ﻓــﺎﻣﻴﻠﻲ اﺑــﺘﻼ ﺑــﻪ‬

‫ﺳﺮﻃﺎن اﻧﺪوﻣﺘﺮ و ﺗﺨﻤﺪان ﺑﻪ ﺻﻮرت ﻫـﻢزﻣـﺎن وﺟـﻮد داﺷـﺘﻪ ﺑﺎﺷـﻨﺪ‬

‫ﺳﺮﻃﺎنﻫﺎي ﻛﻮﻟﻮرﻛﺘﺎل ﺑﻮدﻧﺪ‪ .‬از ﻣﺠﻤـﻮع ﻧﻤﻮﻧـﻪﻫـﺎي ﭘـﺎﺗﻮﻟﻮژي ‪100‬‬

‫ﺷﻨﺎﺳﺎﻳﻲ زودرس آنﻫﺎ در درﻣﺎن و ﭘﻴﺶآﮔﻬﻲ ﺑﻴﻤﺎري ﻣﻮﺛﺮ ﻣﻲﺑﺎﺷﺪ‪.‬‬

‫ﺑﻴﻤﺎر ﺗﻨﻬﺎ در ﭘﻨﺞ ﻣﻮرد ﭘﻮﻟﻴﭗ ﻳﺎﻓﺖ ﮔﺮدﻳﺪ )‪ %60‬ﻣﻮارد ﺗﻮﺑـﻮﻻر و در‬

‫‪BMI‬‬

‫‪ %40‬ﻣﻮارد آدﻧﻮﻣﺎﺗﻮز(‪ .‬ﺳﺎﻳﺰ ﭘﻮﻟﻴﭗ در ‪ %35‬ﻣﻮارد زﻳﺮ ﻳﻚ ﺳـﺎﻧﺘﻲﻣﺘـﺮ‬

‫روش ﺑﺮرﺳﻲ‬

‫و در ‪ %65‬ﻣﻮارد زﻳﺮ ‪ 3cm‬ﺑﻮد‪ .‬ﻣﺤﻞ ﺗﻮﻣﻮر در اﻏﻠﺐ ﻣﻮارد )‪ (%65‬در‬ ‫ﻛﻮﻟﻮن ﺻﻌﻮدي ﺑﻮد‪ .‬ﻫﺮ ﭘﻨﺞ ﺑﻴﻤﺎر ﻣﺒﺘﻼ ﺑﻪ ﭘﻮﻟﻴﭗ‪ ،‬ﺳﺎﺑﻘﻪ ﻓﺎﻣﻴﻠﻲ اﺑﺘﻼ ﺑﻪ‬

‫اﻳﻦ ﻣﻄﺎﻟﻌﻪ‪ ،‬ﻳﻚ ﭘﮋوﻫﺶ ﺗﻮﺻﻴﻔﻲ و ﻣﻘﻄﻌﻲ ﻣﻲﺑﺎﺷﺪ ﻛـﻪ در ﺳـﺎل‬

‫ﺳﺮﻃﺎن ﺗﺨﻤﺪان داﺷﺘﻪ و ﺳﺎﺑﻘﻪ ﻓﺎﻣﻴﻠﻲ ﺳﺮﻃﺎن ﻛﻮﻟﻮرﻛﺘﺎل ﻧﺪاﺷﺘﻨﺪ‪.‬‬

‫‪ 1389-90‬اﻧﺠﺎم ﮔﺮدﻳﺪ‪ .‬ﺑﻴﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﺳﺮﻃﺎن ﺗﺨﻤﺪان و اﻧﺪوﻣﺘﺮ ﻛﻪ‬ ‫در ﺑﻴﻤﺎرﺳﺘﺎنﻫﺎي ﻓﻴﺮوزﮔﺮ‪ ،‬اﻛﺒﺮ آﺑﺎدي و رﺳـﻮل اﻛـﺮم ﺗﻬـﺮان ﭘﺮوﻧـﺪه‬

‫ﺑﺤﺚ‬

‫ﺑﺴﺘﺮي داﺷﺘﻨﺪ‪ ،‬اﻧﺘﺨﺎب ﺷﺪﻧﺪ‪ .‬ﺑﺎ ﺑﻴﻤﺎران ﺗﻤﺎس ﺗﻠﻔﻨﻲ ﺑﺮﻗﺮار ﮔﺮدﻳﺪه و‬ ‫ﺗﻮﺿﻴﺢ ﻛﺎﻣﻞ در ﻣﻮرد ﻛﻮﻟﻮﻧﻮﺳﻜﻮﭘﻲ و آﻣﺎدﮔﻲﻫﺎي ﻣﺮﺑﻮط ﺑﻪ آن داده‬

‫اﺑﺘﻼي ﺑﻴﻤﺎران ﻣﺒﺘﻼ ﺑﻪ اﻧﻮاع ﺳﺮﻃﺎنﻫـﺎي ﺗﺨﻤـﺪان ﺑـﻪ اﺧـﺘﻼﻻت‬

‫ﺷﺪ‪ .‬ﺑﻴﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﺳـﺮﻃﺎن ﺗﺨﻤـﺪان و اﻧـﺪوﻣﺘﺮ ﻛـﻪ ﺳـﻨﺪرم ‪ FAP‬و‬

‫دﺳﺘﮕﺎه ﮔﻮارش و از ﺟﻤﻠﻪ اﻧﻮاع ﺣﺎﻻت ﺳﺮﻃﺎﻧﻲ و ﻳﺎ ﭘـﻴﺶ ﺳـﺮﻃﺎﻧﻲ‬

‫ﺳﻨﺪرم ﻟﻴﻨﭻ )‪ (HNPCC‬در آنﻫﺎ ﻣﺜﺒﺖ ﺑﻮد از ﻣﻄﺎﻟﻌﻪ ﺧﺎرج ﺷﺪﻧﺪ‪ .‬ﭼﻚ‬

‫ﻣﺮﺑﻮط ﺑﻪ ﻛﻮﻟﻮن از ﻣﻮاردي اﺳﺖ ﻛﻪ ﺗﺎﻛﻨﻮن ﻛﻢﺗـﺮ ﻣـﻮرد ﺗﻮﺟـﻪ ﻗـﺮار‬

‫ﻟﻴﺴﺖ ﺗﻬﻴﻪ ﺷﺪه ﺷﺎﻣﻞ ﺷﺶ ﺑﺨﺶ و ‪ 24‬ﺳﻮال ﺑـﻪ ﺗﺮﺗﻴـﺐ زﻳـﺮ ﺑـﻮد‪:‬‬

‫ﮔﺮﻓﺘﻪ اﺳﺖ اﻣﺎ در ﺑﺮﺧﻲ از ﺟﺪﻳﺪﺗﺮﻳﻦ ﭘـﮋوﻫﺶﻫـﺎ ﺑـﻪ ﻣﺤـﻞ ﭼـﺎﻟﺶ‬

‫اﻃﻼﻋﺎت ﻓﺮدي )ﭘﻨﺞ ﺳﻮال(‪ ،‬ﻣﺸﺨﺼﺎت ﺑﻴﻤﺎري )ﻫﻔﺖ ﺳﻮال(‪ ،‬ﺳـﺎﺑﻘﻪ‬

‫ﺗﺒﺪﻳﻞ ﺷﺪه اﺳﺖ‪ .‬در ﻣﻄﺎﻟﻌﻪاي ﻛﻪ ﺗﻮﺳﻂ ‪ Singh‬ﺑـﺎ ﻫـﺪف ﻏﺮﺑـﺎﻟﮕﺮي‬

‫ﻓﺎﻣﻴﻠﻲ )دو ﺳﻮال(‪ ،‬وﺟﻮد ﻋﻼﻳﻢ ﻫﻤﺮاه )ﭼﻬـﺎر ﺳـﻮال(‪ ،‬ﺳـﺎﺑﻘﻪ اﻧﺠـﺎم‬

‫ﺳﺮﻃﺎن ﻛﻮﻟﻮرﻛﺘﺎل در زﻧﺎن ﻣﺒﺘﻼ ﺑـﻪ ﺳـﺮﻃﺎن اﻧـﺪوﻣﺘﺮ اﻧﺠـﺎم ﮔﺮدﻳـﺪ‪،‬‬

‫ﻛﻮﻟﻮﻧﻮﺳﻜﻮﭘﻲ ﻗﺒﻠﻲ و زﻣﺎن آن )دو ﺳﻮال(‪ ،‬ﻧﺘﻴﺠﻪ اﻧﺠﺎم ﻛﻮﻟﻮﻧﻮﺳﻜﻮﭘﻲ‬

‫ﭘﺮوﻧﺪهﻫﺎي ﭘﺰﺷﻜﻲ ﺗﻤﺎم ﺑﻴﻤﺎران زن ﻛﻪ ﺑﺎ ﺗﺸﺨﻴﺺ ﺳﺮﻃﺎن اﻧﺪوﻣﺘﺮ در‬

‫ﻓﻌﻠﻲ )ﻳﻚ ﺳﻮال(‪ ،‬ﻧﻮع‪ ،‬ﺳﺎﻳﺰ و ﻣﺤﻞ ﭘﻮﻟﻴﭗ )ﺳﻪ ﺳﻮال(‪ .‬در ﺻـﻮرت‬

‫ﺳﺎلﻫﺎي ‪ 1997‬ﺗﺎ ‪ 2007‬ﺑﺴﺘﺮي ﺷﺪه ﺑﻮدﻧﺪ‪ ،‬ﻣﻮرد ﺑﺮرﺳﻲ ﻗﺮار ﮔﺮﻓﺖ‪.‬‬

‫ﻳﺎﻓﺖ ﺷﺪن ﺗﻮﻣﻮر ﻳﺎ ﭘﻮﻟﻴﭗ در ﻛﻮﻟﻮن ﺗﻮﺳﻂ ﻛﻮﻟﻮﻧﻮﺳﻜﻮﭘﻲ‪ ،‬ﭘﻮﻟﻴﭗﻫـﺎ‬

‫ﺳﻦ زﻣﺎن ﺗﺸﺨﻴﺺ‪ ،‬ﻧﻮع ﺗﻮﻣﻮر‪ ،‬ﺳـﺎﺑﻘﻪ ﻓـﺎﻣﻴﻠﻲ ﺑـﺪﺧﻴﻤﻲ‪ ،‬ﻏﺮﺑـﺎﻟﮕﺮي‬

‫و ﺗﻮﻣﻮرﻫﺎ ﺑﺎ روش اﻳﻤﻮﻧﻮﻫﻴﺴﺘﻮﺷﻴﻤﻲ از ﻧﻈﺮ اوﻟﻴﻪ ﻳﺎ ﻣﺘﺎﺳﺘﺎﺗﻴﻚ ﺑﻮدن‬

‫ﺳﺮﻃﺎن ﻛﻮﻟﻮرﻛﺘﺎل و ﻳﺎﻓﺘﻪﻫﺎي اﻳﻦ ﻏﺮﺑـﺎﻟﮕﺮي ﻣـﺸﺨﺺ ﮔﺮدﻳـﺪ‪267 .‬‬

‫آنﻫﺎ ﺑﺮرﺳﻲ ﮔﺮدﻳﺪﻧﺪ‪ .‬اﻃﻼﻋﺎت ﺑﻪ دﺳﺖ آﻣﺪه از ﻣﻄﺎﻟﻌﻪ وارد ﻧﺮماﻓﺰار‬

‫زن ﻣﺒﺘﻼ ﺑﻪ ﺳﺮﻃﺎن اﻧﺪوﻣﺘﺮ ﺑﺎ ﻣﻴﺎﻧﮕﻴﻦ ﺳﻨﻲ ‪ 66‬ﺳـﺎل در اﻳـﻦ ﻣﻄﺎﻟﻌـﻪ‬

‫ﻣﺰﻣﻦ ﻛﻠﻴﻪ‬Jafari ‫ﻧﺎرﺳﺎﻳﻲ‬ ‫در‬al. ‫آﻧﺘﻲﺑﺎدي اﺧﺘﺼﺎﺻﻲ ﺑﻌﺪ از ﺗﺰرﻳﻖ واﻛﺴﻦ ﭘﻠﻲﺳﺎﻛﺎرﻳﺪي‬ S. et

128

‫ ﺳﺎﻟﮕﻲ ﺑﺎ اﻓـﺰاﻳﺶ ﺧﻄـﺮ ﺳـﺮﻃﺎن‬50 ‫ﺗﺸﺨﻴﺺ ﺳﺮﻃﺎن اﻧﺪوﻣﺘﺮ ﻗﺒﻞ از‬

‫ ﺳﺎل در زﻣـﺎن ﺗـﺸﺨﻴﺺ‬60 ‫ آنﻫﺎ ﺳﻦ ﻛﻢﺗﺮ از‬%39 ‫ﺷﺮﻛﺖ ﻛﺮدﻧﺪ ﻛﻪ‬

‫ ارﺗﺒـﺎط ﻣﺸﺨـﺼﻲ در اﻓـﺰاﻳﺶ ﺧﻄـﺮ اﺑـﺘﻼ ﺑـﻪ‬.‫ﻛﻮﻟﻮرﻛﺘﺎل ﻫﻤﺮاه ﺑـﻮد‬

‫ ذﻛـﺮ‬%2/4 ‫ در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻣﻴﺰان اﺑـﺘﻼ ﺑـﻪ ﺳـﺮﻃﺎن ﻛﻮﻟﻮرﻛﺘـﺎل‬.‫داﺷﺘﻨﺪ‬

‫ﺳﺮﻃﺎن ﻛﻮﻟﻮرﻛﺘﺎل در زﻧﺎن ﺑﺎ ﺳﺎﺑﻘﻪ اﺑﺘﻼ ﺑﻪ ﺳـﺮﻃﺎن ﺳـﺮوﻳﻜﺲ دﻳـﺪه‬

‫ ﺑﻴﺶﺗﺮﻳﻦ ﻣﻴﺰان ﺧﻄﺮ در اﺑﺘﻼي‬،Weinberg ‫ در ﻣﻄﺎﻟﻌﻪ‬15.‫ﮔﺮدﻳﺪه اﺳﺖ‬

‫ ﻳﺎﻓﺘﻪﻫﺎي ﻣﻄﺎﻟﻌﻪ‬16.‫ﻧﺸﺪ‬

‫ در ﺑﺮرﺳـﻲ‬16.‫ ﺳﺎل ذﻛـﺮ ﺷـﺪه اﺳـﺖ‬50 ‫ﺳﺮﻃﺎن ﻛﻮﻟﻮرﻛﺘﺎل ﺳﻨﻴﻦ زﻳﺮ‬

‫ در ﻣﻌـﺮض ﺧﻄـﺮ ﺑـﺎﻻي اﺑـﺘﻼ ﺑـﻪ‬،‫اﺑﺘﻼ ﺑﻪ ﺳﺮﻃﺎن اﻧﺪوﻣﺘﺮ و ﺗﺨﻤﺪان‬

‫ ﺳﺎل‬65 ‫ ﻧﻴﺰ ﺧﻄﺮ اﺑﺘﻼ در ﺳﻨﻴﻦ ﺑﺎﻻي‬Newschaffer ‫اﻧﺠﺎم ﺷﺪه ﺗﻮﺳﻂ‬

‫ ﻧﻴﺰ ارﺗﺒﺎط ﻣﺸﺨـﺼﻲ‬Jung ‫ در ﻣﻄﺎﻟﻌﻪ‬18.‫ﺳﺮﻃﺎن ﻛﻮﻟﻮرﻛﺘﺎل ﻗﺮار دارﻧﺪ‬

‫ اﻳﻦ ﻣﻄﺎﻟﻌـﺎت اﻫﻤﻴـﺖ ﺳـﻦ اﻓـﺮاد‬17.‫ﻛﺎﻫﺶ ﻣﺸﺨﺼﻲ را ﻧﺸﺎن ﻣﻲداد‬

‫ﻣﻴﺎن ﺳـﺎﺑﻘﻪ ﻓـﺎﻣﻴﻠﻲ اﺑـﺘﻼ ﺑـﻪ ﺳـﺮﻃﺎن ﭘـﺴﺘﺎن و ﺧﻄـﺮ ﺑـﺮوز ﺳـﺮﻃﺎن‬

‫ در ﺑﺮرﺳﻲ اﻧﺠﺎم‬.‫ﻣﻮرد ﺑﺮرﺳﻲ را ﺟﻬﺖ اﻧﺠﺎم ﻏﺮﺑﺎﻟﮕﺮي ﻧﺸﺎن ﻣﻲدﻫﺪ‬

‫ در ﺻﻮرت در ﻧﻈﺮ ﮔﺮﻓﺘﻦ ﺧﻮﻳﺸﺎوﻧﺪان درﺟﻪ‬.‫ﻛﻮﻟﻮرﻛﺘﺎل ﺑﻪدﺳﺖ آﻣﺪ‬

50 ،‫ ﻫﺰار ﻣـﻮرد ﺳـﺮﻃﺎن ﺳـﺮوﻳﻜﺲ‬21 ‫ ﺗﻌﺪاد‬Weinberg ‫ﺷﺪه ﺗﻮﺳﻂ‬

‫دوم و ﺳﻮم اﻳﻦ ارﺗﺒﺎط ﺗﻘﻮﻳﺖ ﻣﻲﻳﺎﺑﺪ و ﺳﺎﺑﻘﻪ اﺑﺘﻼ ﻓﺎﻣﻴﻠﻲ ﺑﻪ ﺳـﺮﻃﺎن‬

‫ ﻫﺰار ﻣـﻮرد ﺳـﺮﻃﺎن ﺗﺨﻤـﺪان ﻣـﻮرد‬28 ‫ﻫﺰار ﻣﻮرد ﺳﺮﻃﺎن اﻧﺪوﻣﺘﺮ و‬

‫ ﻧﺸﺎن داد ﻛـﻪ زﻧـﺎن داراي ﺳـﺎﺑﻘﻪ‬Schoen

‫ ﺑـﺎ‬.‫ﺗﺨﻤﺪان ﺑﺎﻋﺚ ﻛﺎﻫﺶ ﺧﻄﺮ اﺑﺘﻼ ﺑﻪ ﺳﺮﻃﺎن ﻛﻮﻟﻮرﻛﺘﺎل ﻣـﻲﮔـﺮدد‬

‫ ﻧﺴﺒﺖ ﺑﺮوز اﺳﺘﺎﻧﺪارد ﺷـﺪه در ﻫـﺮ زﻳـﺮ ﮔـﺮوه از‬.‫ﺑﺮرﺳﻲ ﻗﺮار ﮔﺮﻓﺖ‬

‫ اﻧﺠـﺎم‬،‫در ﻧﻈﺮ ﮔﺮﻓﺘﻦ آﻣﺎر ﭘﺎﻳﻴﻦ ﻣﺒﺘﻼﻳﺎن ﺑـﻪ ﭘﻮﻟﻴـﭗﻫـﺎي ﻛﻮﻟﻮرﻛﺘـﺎل‬

‫ﻧﻈﺮ ﺧﻄﺮ ﻧـﺴﺒﻲ اﺑـﺘﻼ ﺑـﻪ ﺳـﺮﻃﺎن ﻛﻮﻟﻮرﻛﺘـﺎل در زﻧـﺎن داراي ﺳـﺎﺑﻘﻪ‬

‫ﻏﺮﺑﺎﻟﮕﺮي ﺗﻮﺻﻴﻪ ﻧﻤﻲﺷﻮد وﻟﻲ ﻣﻲﺗﻮاﻧﺪ در ﻏﺎﻟـﺐ ﻣﻌﻴـﺎر روﺗـﻴﻦ ﻛـﻪ‬

‫ ﻳﺎﻓﺘﻪﻫﺎي ﺑﻪدﺳﺖ آﻣﺪه‬.‫ﺳﺮﻃﺎن ژﻧﻴﻜﻮﻟﻮژي ﺑﺎ ﺳﺎﻳﺮ زﻧﺎن ﻣﻘﺎﻳﺴﻪ ﮔﺮدﻳﺪ‬

‫ اﻳـﻦ‬:‫ ﺳﭙﺎﺳﮕﺰاري‬.‫ در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﻮد‬،‫ﺑﺮاي ﺳﺎﻳﺮ اﻓﺮاد اﻧﺠﺎم ﻣﻲﮔﺮدد‬

‫ﻧﺸﺎن دﻫﻨﺪه اﻓﺰاﻳﺶ ﻣﻴـﺰان ﺑـﺮوز ﺳـﺮﻃﺎن ﻛﻮﻟﻮرﻛﺘـﺎل در زﻧـﺎن داراي‬

1389 ‫ﻣﻘﺎﻟﻪ ﺑﺨﺸﻲ از ﭘﺎﻳﺎنﻧﺎﻣﻪ دﻛﺘﺮاي ﺗﺨﺼﺼﻲ رﺷـﺘﻪ داﺧﻠـﻲ ﺳـﺎل‬

‫ ﺳـﺎل‬50 ‫ ﻣﻴﺰان ﺧﻄﺮ در زﻧﺎن زﻳـﺮ‬.‫ﺳﺎﺑﻘﻪ اﺑﺘﻼ ﺑﻪ ﺳﺮﻃﺎن ﺗﺨﻤﺪان ﺑﻮد‬

.‫ﻣﻲﺑﺎﺷﺪ ﻛﻪ ﺑﺎ ﺣﻤﺎﻳﺖ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان اﻧﺠﺎم ﺷﺪه اﺳﺖ‬

.‫ ﺳـﺎل دوﺑـﺎره رو ﺑـﻪ اﻓـﺰاﻳﺶ ﺑـﻮد‬64 ‫ ﺗـﺎ‬50 ‫ﺑﻴﺶﺗﺮ ﺑﻮد اﻣﺎ در ﺳﻨﻴﻦ‬

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‫ﻋﻤﻮﻣﻲ‬ ‫ﺑﺨﺸﻬﺎي ﺟﺮاﺣﻲ‬ ‫ﺟﺮاﺣﻲ در‬ ‫ﻋﻔﻮﻧﺖ ﻣﺤﻞ‬ ‫ﺗﺸﺨﻴﺺ‬ ‫ ﭘﺎﻳﺶ‬2012: ‫دو روش‬126-129 ‫ﻛﺎراﻳﻲ‬ Tehran University Medical Journal; Vol. 70, No.‫ﺑﺮاي‬ 2, May

Prevalence of colorectal polyps among women with ovarian and endometrial cancers admitted in Firoozgar, Akbarabadi and Rasol Akram Hospitals during 2010- 2011: a brief report Abstract Sima Jafari M.D.1* Siamak Khaleghi M.D.2 Ali Basi M.D.3 Tayeb Ramim M.D.4 1- Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2- Department of Gastrointestinal Medicine, Tehran University of Medical Sciences, Tehran, Iran. 3- Department of Hematology Oncology Medicine, Tehran University of Medical Sciences, Tehran, Iran. 4- Researcher, Trauma & Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Received: January 09, 2012 Accepted: January 29, 2012

Background: Patients with endometrial or ovarian cancer have an increased risk for breast or colon cancer. The aim of this study was to assess the individual and agerelated characteristics of patients with a combination of these malignancies. Methods: In this retrospective descriptive study, we reviewed the medical records of 100 patients admitted for endometrial or ovarian cancer in Rasol Akram, Akbarabadi and Firozgar educational Hospitals in Tehran, Iran, during 2010- 2011. Colon polyps were evaluated by immunohistochemistry assay. Results: The mean age, weight and BMI of the patients were 50.21, 65.9 and 26.07, respectively. Among 100 cases participating in this study, five (5%) patients had colon polyps. All the five cases with colon polyp had positive familial histories of ovarian cancer. Conclusion: With considering the low prevalence of colorectal polyps among women with ovarian and endometrial cancers, patient's follow-up for screening test is not recommended Keywords: Colorectal cancer, colorectal polyps, endometrial cancer, ovarian cancer, screening.

Corresponding author: Tohid Sq., Satarkhan Ave., Niyayesh St., Rasool Akram Hospital, Tehran, Iran. Tel: +98- 21- 66348529 E-mail: slr_1975@yahoo.com

‫‪130-135 ،1391‬‬ ‫ﻣﺒﺘﻼ‪،2‬ﻳﺎناردﻳﺒﻬﺸﺖ‬ ‫ﺷﻤﺎره‬ ‫دورهﻴ ‪،70‬‬ ‫ﭘﺰﺷﻜﻲ‬ ‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪،‬‬ ‫ﺑﺮوﺳﻠﻮزﻳﺲ‬ ‫ﻮﻟﻮژ‪،‬ﻳﻚ‬ ‫ﺗﻬﺮان‪ ،‬اﭘﻴﺪﻣ‬ ‫ﺸﮕﺎﻫﻲ و‬ ‫ﻋﻠﻮم آزﻣﺎﻳ‬ ‫داﻧﺸﮕﺎهﺑﺎﻟﻴﻨﻲ‪،‬‬ ‫ﺧﺼﻮﺻﻴﺎت‬

‫‪130‬‬

‫ﺧﺼﻮﺻﻴﺎت ﺑﺎﻟﻴﻨﻲ‪ ،‬آزﻣﺎﻳﺸﮕﺎﻫﻲ و اﭘﻴﺪﻣﻴﻮﻟﻮژﻳﻚ ﺑﻴﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﺑﺮوﺳﻠﻮز در اﺳﺘﺎن ﻫﻤﺪان‪:‬‬ ‫ﻳﻚ ﻣﻄﺎﻟﻌﻪ ﮔﺬﺷﺘﻪﻧﮕﺮ روي ‪ 230‬ﺑﻴﻤﺎر‪ :‬ﮔﺰارش ﻛﻮﺗﺎه‬

‫ﺗﺎرﻳﺦ درﻳﺎﻓﺖ ﻣﻘﺎﻟﻪ‪ 1390/09/30 :‬ﺗﺎرﻳﺦ ﭘﺬﻳﺮش‪1390/11/03 :‬‬

‫ﭼﻜﻴﺪه‬

‫‪1‬‬

‫ﭘﻴﻤﺎن ﻋﻴﻨﻲ‬

‫‪*3‬‬

‫‪2‬‬

‫ﻓﺮزاﻧﻪ اﺛﻨﻲ ﻋﺸﺮي‪ ،‬اﺣﻤﺪ رﺿﺎ ﻣﺒﻴﻦ‬

‫زﻣﻴﻨﻪ و ﻫﺪف‪ :‬ﺑﺮوﺳﻠﻮز ﺑﻴﻤﺎري ﺷﺎﻳﻊ ﻋﻔﻮﻧﻲ در اﻳﺮان ﺑﺎ ﺗﻈﺎﻫﺮات ﺑﺎﻟﻴﻨﻲ ﻣﺘﻨﻮع اﺳﺖ ﻛﻪ در ﺗﺸﺨﻴﺺ اﻓﺘﺮاﻗﻲ ﺑـﺴﻴﺎري‬

‫‪4‬‬

‫ﻣﻬﺪي ﺣﺴﻦ زاده‬

‫‪ -1‬ﮔﺮوه ﺑﻴﻤﺎريﻫﺎي ﻋﻔﻮﻧﻲ و ﮔﺮﻣﺴﻴﺮي‪،‬‬

‫از ﺑﻴﻤﺎريﻫﺎ ﻗﺮار ﻣﻲﮔﻴﺮد‪ .‬روش ﺑﺮرﺳﻲ‪ :‬ﻛﻠﻴﻪ ﺑﻴﻤﺎران ﺑﺴﺘﺮيِ ﻣﺒﺘﻼ ﺑﻪ ﺑﺮوﺳﻠﻮز ﻃﻲ ﺳﺎلﻫﺎي ‪ 1384-88‬در ﺑﻴﻤﺎرﺳﺘﺎن‬

‫داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﻫﻤﺪان‪ ،‬ﻫﻤﺪان‪ ،‬اﻳﺮان‪.‬‬

‫ﻓﺮﺷﭽﻴﺎن ﻫﻤﺪان ﺑﺮرﺳﻲ ﺷﺪﻧﺪ‪ .‬اﻃﻼﻋﺎت از ﭘﺮوﻧﺪهﻫﺎ اﺳﺘﺨﺮاج و در ﻓﺮمﻫﺎي ﺟﻤﻊآوري ﺛﺒﺖ و ﺑﺮرﺳـﻲ آﻣـﺎري ﺷـﺪ‪.‬‬

‫‪ -2‬ﮔﺮوه ﭘﺰﺷﻜﻲ اﺟﺘﻤﺎﻋﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ‬

‫ﻳﺎﻓﺘﻪ ﻫﺎ‪ :‬ﺗﻌﺪاد ‪ 230‬ﺑﻴﻤﺎر ])‪ 130(%56/5‬ﻣﺮد و )‪ 100(%43/5‬زن[ ﺑﺎ ﻣﻴﺎﻧﮕﻴﻦ ﺳﻨﻲ ‪ 40/84±29/29‬ﻛـﻪ اﻛﺜـﺮاً روﺳـﺘﺎﻳﻲ‬

‫ﻫﻤﺪان‪ ،‬ﻫﻤﺪان‪ ،‬اﻳﺮان‪.‬‬

‫])‪ [167(%72/6‬ﺑﻮدﻧﺪ وارد ﻣﻄﺎﻟﻌﻪ ﺷﺪﻧﺪ‪ .‬ﺑﻴﺶﺗﺮﻳﻦ اﺑﺘﻼ در ﻓﺼﻞ ﺑﻬﺎر ﺑﻮد‪ .‬ﺷﺎﻳﻊﺗﺮﻳﻦ راه اﻧﺘﻘﺎل )‪ (%60/3‬ﻣﺼﺮف ﻣﻮاد‬

‫‪ -3‬ﮔﺮوه ﺑﻴﻤﺎريﻫﺎي ﻋﻔﻮﻧﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم‬ ‫ﭘﺰﺷﻜﻲ زﻧﺠﺎن‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ زﻧﺠﺎن‪،‬‬

‫ﻟﺒﻨﻲ ﻏﻴﺮ ﭘﺎﺳﺘﻮرﻳﺰه ﺑﻮد‪ .‬ﻧﺸﺎﻧﻪﻫﺎي ﺑﺎﻟﻴﻨﻲ ﺑﻪ ﺗﺮﺗﻴﺐ ﺷﺎﻣﻞ‪ :‬ﺗﺐ‪ ،‬درد ﻣﻔﺎﺻﻞ‪ ،‬ﺗﻌﺮﻳﻖ و ﺿﻌﻒ و ﺑﻲﺣﺎﻟﻲ ﺑﻮد‪ .‬آرﺗﺮﻳﺖ و‬

‫زﻧﺠﺎن‪ ،‬اﻳﺮان‪.‬‬

‫اﭘﻴﺪﻳﺪﻳﻤﻮارﻛﻴﺖ ﺑﺮوﺳﻼﻳﻲ در )‪ 61(%26/5‬و )‪ 21(%9/1‬ﺑﻴﻤﺎران ﺑﻮد‪ .‬اﻓـﺰاﻳﺶ ‪ ESR‬در )‪ 137(%59/5‬ﺑﻴﻤـﺎر و اﻓـﺰاﻳﺶ‬

‫‪ -4‬ﻣﺮﻛﺰ ﺗﻮﺳﻌﻪ ﺗﺤﻘﻴﻘﺎت ﺑﺎﻟﻴﻨﻲ ﻓﺮﺷﭽﻴﺎن‪،‬‬

‫‪ CRP‬و ﻟﻜﻮﺳﻴﺘﻮز ﺑﻪ ﺗﺮﺗﻴﺐ در )‪ 121(%52/9‬و )‪ 48(%20/8‬ﺑﻴﻤﺎران وﺟﻮد داﺷﺖ‪ .‬ﻧﺘﻴﺠﻪﮔﻴﺮي‪ :‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺗﻨﻮع ﻋﻼﻳـﻢ‬

‫داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﻫﻤﺪان‪ ،‬ﻫﻤﺪان‪ ،‬اﻳﺮان‪.‬‬

‫ﺑﺎﻟﻴﻨﻲ ﺑﺮوﺳﻠﻮز ﺑﻪ ﻧﻈﺮ ﻣﻲرﺳﺪ در ﺑﻴﻤﺎران ﺗـﺐدار ﺑـﺎ ﺳـﻴﺮ ﻃـﻮﻻﻧﻲ ﻳـﺎ ﻫﻤـﺮاه درﮔﻴـﺮي ارﮔـﺎنﻫـﺎ‪ ،‬ﺑﺮوﺳـﻠﻮزﻳﺲ در‬

‫*‬

‫ﻧﻮﻳﺴﻨﺪه ﻣﺴﺌﻮل‪ :‬زﻧﺠﺎن‪ ،‬ﺧﻴﺎﺑﺎن ﻓﻀﻞاﷲ‪ ،‬ﺑﻴﻤﺎرﺳﺘﺎن‬

‫وﻟﻴﻌﺼﺮ‪ ،‬ﮔﺮوه ﺑﻴﻤﺎريﻫﺎي ﻋﻔﻮﻧﻲ‬

‫ﺗﺸﺨﻴﺺﻫﺎي اﻓﺘﺮاﻗﻲ ﻗﺮار ﮔﻴﺮد‪.‬‬

‫ﺗﻠﻔﻦ‪0241-7123303 :‬‬ ‫‪E-mail: amobaien@yahoo.com‬‬

‫ﻛﻠﻤﺎت ﻛﻠﻴﺪي‪ :‬ﺑﺮوﺳﻠﻮزﻳﺲ‪ ،‬ﻋﻼﻳﻢ ﺑﺎﻟﻴﻨﻲ‪ ،‬ﻧﺘﺎﻳﺞ آزﻣﺎﻳﺸﮕﺎﻫﻲ‪ ،‬اﭘﻴﺪﻣﻴﻮﻟﻮژي‪.‬‬

‫درﻣﺎن ﻣﻨﺎﺳﺐ و ﺳﺮﻳﻊ ﺑﻴﻤﺎر را از ﻧـﺎﺗﻮاﻧﻲ و ﻣﻌﻠﻮﻟﻴـﺖ ﺑﻌـﺪي ﻧﺠـﺎت‬

‫ﻣﻘﺪﻣﻪ‬

‫ﺧﻮاﻫﺪ داد‪10.‬و‪ 9‬ﻫﻢﭼﻨﻴﻦ ﺑﺮوﺳﻠﻮز ﺑﺎ ﻋﻮارض ﻣﺘﻌﺪدي ﻣﺎﻧﻨـﺪ ﻋـﻮارض‬

‫ﺑﺮوﺳﻠﻮز )‪ (Brucellosis‬ﻳﺎ ﺗﺐ ﻣﺎﻟﺖ ﻳﻚ ﺑﻴﻤﺎري ﻣﻬﻢ ﻣﺸﺘﺮك ﺑﻴﻦ‬

‫ﮔﻮارﺷﻲ‪ ،‬اﺧﺘﻼل ﺳﻴﺴﺘﻢ ﻛﺒﺪي‪ -‬ﺻﻔﺮاوي‪ ،‬ﻋﻮارض ﻋﺼﺒﻲ‪ ،‬ﻋـﻮارض‬

‫اﻧﺴﺎن و دام اﺳﺖ ﻛﻪ از ﺣﻴﻮان آﻟﻮده ﺑﻪ اﻧﺴﺎن اﻧﺘﻘﺎل ﻣـﻲﻳﺎﺑـﺪ‪ .‬ﺗﻌﺮﻳـﻖ‪،‬‬

‫ﻗﻠﺒﻲ ﻋﺮوﻗـﻲ‪ ،‬ﺗﻨﻔـﺴﻲ‪ ،‬ادراري ﺗﻨﺎﺳـﻠﻲ‪ ،‬ﺧـﻮﻧﻲ‪ ،‬ﭘﻮﺳـﺘﻲ‪ ،‬ﭼـﺸﻤﻲ و‬

‫ﺗﺐ و آرﺗﺮاﻟﮋي‪ ،‬ﻋﻼﻳﻢ اﺻﻠﻲ آن ﻫﺴﺘﻨﺪ‪ ،‬اﻳﻦ ﺑﻴﻤﺎري ﺑﻪ ﺗﺐ ﻣﻮاج ﻧﻴـﺰ‬

‫ﻋﻮارض اﺳﺘﺨﻮاﻧﻲ ﻣﻔﺼﻠﻲ ﻫﻤﺮاه اﺳـﺖ‪2.‬و‪ 1‬ﺷـﻴﻮع ﺟﻬـﺎﻧﻲ ﺑﺮوﺳـﻠﻮز‬

‫ﻣﻌﺮوف اﺳﺖ‪ 1-3.‬ﺑﻴﻤﺎري ﺑﺮوﺳـﻠﻮز ﻋﻠـﻲرﻏـﻢ ﻛﻨﺘـﺮل در ﺑـﺴﻴﺎري از‬

‫اﻧﺴﺎﻧﻲ ﺑﻪ ﻋﻠﺖ دﻗﻴـﻖ ﻧﺒـﻮدن روشﻫـﺎي ﺗﺸﺨﻴـﺼﻲ و ﻧﺎﻛـﺎﻓﻲ ﺑـﻮدن‬

‫ﻛﺸﻮرﻫﺎ ﻫﻢﭼﻨﺎن ﺑﻪ ﻋﻨﻮان ﻳﻚ ﻣﻌﻀﻞ در ﻣـﺴﻴﺮ ﺳـﻼﻣﺖ ﻋﻤـﻮﻣﻲ در‬

‫ﺳﻴﺴﺘﻢ ﮔﺰارشدﻫﻲ و ﭘـﻲﮔﻴـﺮي در ﺑـﺴﻴﺎري از ﻛـﺸﻮرﻫﺎ ﻧﺎﻣـﺸﺨﺺ‬

‫ﺳﺮاﺳﺮ ﺟﻬﺎن ﻣﻄﺮح ﺑﻮده و ﻳﻜﻲ از ﻣﺴﺎﻳﻞ ﻣﻬﻢ ﺑﻬﺪاﺷﺘﻲ‪ -‬اﻗﺘﺼﺎدي در‬

‫اﺳﺖ‪ .‬ﺳﺎﻻﻧﻪ ﺣﺪود ﻧﻴﻢ ﻣﻴﻠﻴﻮن ﻣﻮرد ﺑﺮوﺳﻠﻮز اﻧﺴﺎﻧﻲ در ﺳﻄﺢ ﺟﻬـﺎن‬

‫ﺑــﺴﻴﺎري از ﻛــﺸﻮرﻫﺎ ﻣــﻲﺑﺎﺷــﺪ‪5.‬و‪ 4‬ﺑﻴﻤــﺎري ﺑﺮوﺳــﻠﻮز ﻳــﻚ ﺑﻴﻤــﺎري‬

‫ﺑﻪ ‪ WHO‬ﮔﺰارش ﻣﻲﺷﻮد ﻛﻪ ﻗﺴﻤﺖ اﻋﻈﻢ آن ﺧﺎص ﻛﺸﻮرﻫﺎي ﺟﻬﺎن‬

‫ﺳﻴﺴﺘﻤﻴﻚ ﺑﺎ ﺗﻈﺎﻫﺮات ﮔﻮﻧﺎﮔﻮن و ا‪‬زﻣﺎن ﻣﺘﻐﻴﺮ اﺳﺖ ﺑﻪﻃﻮريﻛﻪ ﻣﻤﻜﻦ‬

‫ﺳﻮم ﻣﻲﺑﺎﺷﺪ‪ 11.‬ﻃﺒﻖ آﻣﺎر اﻋﻼم ﺷﺪه از ﺳﻮي وزارت ﺑﻬﺪاﺷﺖ درﻣـﺎن‬

‫اﺳﺖ ﺑﺴﻴﺎري از ارﮔﺎنﻫﺎي ﺑـﺪن را درﮔﻴـﺮ ﻛﻨـﺪ‪ 6.‬ﺑـﻴﺶﺗـﺮﻳﻦ درﺻـﺪ‬

‫و آﻣﻮزش ﭘﺰﺷﻜﻲ اﻳﺮان‪ ،‬ﺗﺐ ﻣﺎﻟﺖ اﻧﺴﺎﻧﻲ در ﺳـﺎل ‪ 39 ،1384‬ﻣـﻮرد‪،‬‬

‫‪8‬و‪7‬و‪1‬‬

‫در ﺳﺎل ‪ 34 ،1385‬ﻣﻮرد و در ﺳﺎل ‪ 30 ،1386‬ﻣﻮرد ﺑﻪ ازاي ﻫـﺮ ‪100‬‬

‫و از آنﺟﺎ ﻛﻪ اﻳﻦ ﻋﺎرﺿﻪ ﺑﺴﻴﺎر ﻣﺨـﺮب اﺳﺖ‪ ،‬ﺗﺸﺨﻴـﺺ ﺑـﻪ ﻣﻮﻗـﻊ و‬

‫ﻫﺰار ﻧﻔﺮ ﺟﻤﻌﻴﺖ ﺑﻮده‪ 12،‬اﻣﺎ در ﻃﻲ ﺳﺎلﻫﺎي اﺧﻴﺮ اﻓﺰاﻳﺶ ﻳﺎﻓﺘﻪ و ﺑـﻪ‬

‫درﮔﻴﺮيﻫﺎي ﻣﻮﺿﻌﻲ در ﺳﻴﺴﺘﻢ ﻋﻀﻼﻧﻲ‪ -‬اﺳﻜﻠﺘﻲ دﻳﺪه ﻣﻲﺷـﻮد‬

‫ﭘﻴﻤﺎن ﻋﻴﻨﻲ و ﻫﻤﻜﺎران‬

‫‪131‬‬

‫‪ 130‬در ﻫﺮ ‪ 100‬ﻫﺰار ﻧﻔﺮ رﺳـﻴﺪه اﺳـﺖ‪ 3.‬ﻳﻜـﻲ از ﻋﻠـﻞ اﺻـﻠﻲ اﻳـﻦ‬

‫‪ 1384 -88‬در ﺑﻴﻤﺎرﺳﺘﺎن ﻓﺮﺷﭽﻴﺎن ﻫﻤﺪان ﺑﺴﺘﺮي ﺷﺪه ﺑﻮدﻧﺪ و ﻣـﻮرد‬

‫اﻓــﺰاﻳﺶ روﻧــﺪ را ﻧــﺎﺗﻮاﻧﻲ در رﻳ ـﺸﻪ ﻛــﻦ ﻛــﺮدن ﻛﺎﻣــﻞ آن در ﻣﻴ ـﺎن‬

‫ﺑﺮرﺳﻲ ﻗﺮار ﮔﺮﻓﺘﻨﺪ‪ .‬اﻃﻼﻋﺎت دﻣﻮﮔﺮاﻓﻴﻚ و ﻣﺘﻐﻴﺮﻫـﺎي ﺳـﻦ‪ ،‬ﺟـﻨﺲ‪،‬‬

‫ﮔﻮﺳﻔﻨﺪان ذﻛﺮ ﻛﺮدهاﻧـﺪ‪ 13.‬در ﺿـﻤﻦ‪ ،‬ﻃﻴـﻒ ﮔـﺴﺘﺮده ﻋﻼﻳـﻢ ﺑـﺎﻟﻴﻨﻲ‬

‫ﻣﻴﺰان ﺗﺤﺼﻴﻼت‪ ،‬ﻓﺼﻞ اﺑﺘﻼ‪ ،‬راه اﻧﺘﻘـﺎل و ﻣﺤـﻞ ﺳـﻜﻮﻧﺖ ﻋـﻼوه ﺑـﺮ‬

‫ﺑﺮوﺳﻠﻮز در اﻧﺴﺎن ﺑﺎﻋﺚ ﺷﺪه ﻛﻪ ﺗﻌﺪاد ﺑﻴﻤـﺎران ﺗـﺸﺨﻴﺺ داده ﺷـﺪه‪،‬‬

‫ﻳﺎﻓﺘﻪﻫﺎي ﺑﺎﻟﻴﻨﻲ‪ ،‬ﻋـﻮارض ﺑﻴﻤـﺎري و ﻧﺘـﺎﻳﺞ آزﻣﺎﻳـﺸﮕﺎﻫﻲ ﺑﻴﻤـﺎران از‬

‫ﺑﺴﻴﺎر ﻛﻢﺗﺮ از آنﭼﻪ واﻗﻌﺎً ﻣـﻲﺑﺎﺷـﻨﺪ ﺗﺨﻤـﻴﻦ زده ﺷـﻮد‪15.‬و‪ 14‬در ﻫـﺮ‬

‫ﭘﺮوﻧﺪهﻫﺎ اﺳﺘﺨﺮاج و در ﭘﺮﺳﺶﻧﺎﻣﻪﻫﺎﻳﻲ ﻛﻪ ﺑﻪ ﻫﻤﻴﻦ ﻣﻨﻈـﻮر ﻃﺮاﺣـﻲ‬

‫ﺻﻮرت‪ ،‬ﻫﻨﻮز اﻳﺮان در ﺷﻤﺎر ﻣﻨﺎﻃﻖ اﻧﺪﻣﻴﻚ ﺑﻪ ﺣـﺴﺎب ﻣـﻲآﻳـﺪ‪ 12.‬از‬

‫ﺷﺪه ﺑﻮد‪ ،‬ﺛﺒﺖ و ﻧﺘﺎﻳﺞ ﺑﻪ ﺻﻮرت آﻣﺎر ﺗﻮﺻﻴﻔﻲ اراﻳﻪ ﮔﺮدﻳﺪ و ﭘـﺲ از‬

‫ﻋﻠﻞ اﻧﺘﺸﺎر ﺗﺐ ﻣﺎﻟﺖ در اﻳﺮان زﻧﺪﮔﻲ روﺳﺘﺎﻳﻲ و ﻋـﺸﺎﻳﺮي اﺳـﺖ در‬

‫ﺟﻤﻊآوري اﻃﻼﻋﺎت ﺑﺮاي ﺗﻮﺻﻴﻒ ﻣﺘﻐﻴﺮ ﻛﻤﻲ از ﻣﻴﺎﻧﮕﻴﻦ و ﺣـﺪاﻗﻞ و‬

‫اﻳﻦ ﻣﻘﺎﻃﻊ‪ ،‬ﺑﻴﻦ ﻣﺤﻞ زﻧﺪﮔﻲ ﺧﺎﻧﻮادهﻫﺎ و ﻣﺤـﻞ ﻧﮕـﻪداري ﮔﻮﺳـﻔﻨﺪان‬

‫ﺣﺪاﻛﺜﺮ و ﺑﺮاي ﻣﺘﻐﻴﺮ ﻛﻴﻔﻲ از ﻓﺮاواﻧـﻲ اﺳـﺘﻔﺎده ﺷـﺪ‪ .‬ﻣﻌﻴـﺎر ورود ﺑـﻪ‬

‫ﻓﺎﺻﻠﻪ ﭼﻨﺪاﻧﻲ وﺟﻮد ﻧﺪارد و ﻧﻮازش ﻧﻮزاد ﺗﺎزه ﺑﻪ دﻧﻴﺎ آﻣﺪه دام ﺗﻮﺳﻂ‬

‫ﻣﻄﺎﻟﻌﻪ ﺗﺸﺨﻴﺺ ﻗﻄﻌﻲ ﺑﻴﻤﺎري ﺑﺎ ﺳﺮوﻟﻮژي ﻣﻨﻄﺒﻖ ﺑـﺮ ﻋﻼﻳـﻢ ﺑـﺎﻟﻴﻨﻲ‬

‫ﻛﻮدﻛﺎن و ﻣﺼﺮف ﻣﺤﺼﻮﻻت ﻟﺒﻨﻲ و ﺗﺎزه ﺗﻬﻴﻪ ﺷﺪه داﻣﻲ و ﻫـﻢﭼﻨـﻴﻦ‬

‫ﺑﻮد‪ .‬در ﺻﻮرﺗﻲ ﻛﻪ ﺗﺸﺨﻴﺺ ﺑﺮ اﺳﺎس ﻇﻦ ﺑﺎﻟﻴﻨﻲ و ﭘﺎﺳـﺦ ﺑـﻪ درﻣـﺎن‬

‫ذﺑﺢ ﻏﻴﺮ اﺳﺘﺎﻧﺪارد دامﻫﺎ از اﻫﻤﻴﺖ ﺑﺎﻻﻳﻲ در ﺑﻴﻤـﺎريزاﻳـﻲ ﺑﺮﺧـﻮردار‬

‫ﺑﻮده و ﺳﺮوﻟﻮژي ﺗﺎﻳﻴﺪﻛﻨﻨﺪه ﻧﺒﻮد‪ ،‬از ﻣﻄﺎﻟﻌﻪ ﺣﺬف ﻣﻲﺷﺪ‪.‬‬

‫اﺳﺖ‪ 3.‬ﺗﺴﺖﻫﺎي آزﻣﺎﻳﺸﮕﺎﻫﻲ ﻣﺨﺘﻠﻔﻲ از ﺟﻤﻠﻪ آﻧﺘﻲﺑﺎدي اﺧﺘـﺼﺎﺻﻲ‬ ‫ﺿﺪ ﺑﺮوﺳﻼ‪ ،‬روشﻫﺎي ﺗﺸﺨﻴﺼﻲ ﻣﻮﻟﻜﻮﻟﻲ ﻣﺎﻧﻨﺪ ‪ PCR‬و ﺟﺪاﺳﺎزي و‬ ‫‪16‬‬

‫ﻳﺎﻓﺘﻪﻫﺎ‬

‫ﻛﺸﺖ ﺑﺮوﺳﻼ از ﻧﻤﻮﻧﻪ ﮔﺮﻓﺘﻪ ﺷﺪه‪ ،‬ﺑـﺮاي ﺗـﺸﺨﻴﺺ وﺟـﻮد دارﻧـﺪ‪.‬‬

‫ﺑﻌﻀﻲ از اﻳﻦ آزﻣﺎﻳﺸﺎت را ﻧﻤﻲﺗﻮان ﺑﻪ ﻋﻨﻮان اﺑﺰار آزﻣﺎﻳﺸﮕﺎﻫﻲ روﺗﻴﻦ‬

‫در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ‪ 230‬ﺑﻴﻤﺎر ])‪ 130(%56/5‬ﻣـﺮد و )‪ 100(%43/5‬زن[‬

‫ﺑﻪ وﻳﮋه در ﻛﺸﻮرﻫﺎي در ﺣﺎل ﺗﻮﺳﻌﻪ ﻛﻪ اﻧﺪﻣﻴﻚ ﺑﺮوﺳﻠﻮز ﻫـﺴﺘﻨﺪ ﺑـﻪ‬

‫ﺑﺎ ﻣﻴﺎﻧﮕﻴﻦ ﺳﻨﻲ ‪ 40/84±20/29‬و ﻣﺤﺪوده ﺳـﻨﻲ ‪ 9‬ﺗـﺎ ‪ 88‬ﺳـﺎل ﺳـﻦ‪،‬‬

‫ﻛﺎر ﮔﺮﻓﺖ‪ .‬ﻫﺮ ﭼﻨﺪ اﺳﺘﻔﺎده از ﻛـﺸﺖ ﺧـﻮن ﻣﺮﺳـﻮم ﻛﺎﺳـﺘﺎﻧﺪا ﺑـﺮاي‬

‫وارد ﻣﻄﺎﻟﻌﻪ ﺷﺪﻧﺪ‪ .‬در اﻳﻦ ﺟﻤﻌﻴﺖ‪ 75 ،‬ﺑﻴﻤﺎر )‪ (%39/7‬ﺳـﺎﺑﻘﻪ ﺗﻤـﺎس‬

‫ﺑﺮوﺳﻼ ﻣﺸﻜﻼت ﻣﺘﻌﺪدي دارد‪ ،‬ﺑﻪ ﻫﺮ ﺣﺎل راه ﺗﺎﻳﻴﺪ ﺗﺸﺨﻴﺺ ﻋﻔﻮﻧﺖ‬

‫ﺑﺎ دام و ‪ 114‬ﺑﻴﻤﺎر )‪ (%60/3‬ﺳﺎﺑﻘﻪ ﻣﺼﺮف ﻣﻮاد ﻟﺒﻨﻲ را داﺷـﺘﻨﺪ‪ .‬اﻛﺜـﺮ‬

‫ﺣﺎد ﺑﺮوﺳﻠﻮز ﻛﺸﺖ ﻣﻲﺑﺎﺷﺪ‪ 16.‬از آنﺟـﺎﻳﻲﻛـﻪ ﺑﻴﻤـﺎري ﺑﺮوﺳـﻠﻮز در‬

‫ﺑﻴﻤﺎران ]‪ 166‬ﻧﻔﺮ )‪ [(%72/2‬ﺳﺎﻛﻦ روﺳﺘﺎ ﺑﻮدﻧﺪ‪ .‬ﻓﺮاواﻧﻲ اﺑـﺘﻼ ﻓـﺼﻠﻲ‬

‫ﻛﺸﻮرﻫﺎي ﺧﺎورﻣﻴﺎﻧﻪ‪ ،‬ﻣﺪﻳﺘﺮاﻧﻪ و ﺣﺎﺷﻴﻪ ﺧﻠﻴﺞ ﻓﺎرس از ﺟﻤﻠﻪ اﻳﺮان ﺑﻪ‬

‫ﺑﻪ ﺑﺮوﺳﻠﻮز در ﺑﻴﻤﺎران ﺗﺤـﺖ ﻣﻄﺎﻟﻌـﻪ ﺑـﻪ ﺗﺮﺗﻴـﺐ در ﺑﻬـﺎر )‪،(%33/6‬‬

‫وﻓﻮر ﻳﺎﻓﺖ ﻣﻲﺷﻮد‪ 3‬و در ﻣﻴﺎن ﺷـﻬﺮﻫﺎي اﻳـﺮان ﻧﻴـﺰ‪ ،‬اﻳـﻦ ﺑﻴﻤـﺎري در‬

‫ﺗﺎﺑﺴﺘﺎن )‪ ،(%29/6‬ﭘﺎﻳﻴﺰ )‪ (%18/8‬و زﻣﺴﺘﺎن )‪ (%17/9‬ﺑﻮد )ﺟـﺪول ‪.(1‬‬

‫اﺳﺘﺎن ﻫﻤﺪان ﺷﻴﻮع ﺑﺎﻻﻳﻲ دارد و ﻋﺪم آﮔﺎﻫﻲ از وﺿـﻌﻴﺖ ﺑﻴﻤـﺎري در‬

‫ﺑﻴﺶﺗﺮﻳﻦ ﻋﻼﻣـﺖ ﺑـﺎﻟﻴﻨﻲ ﻛـﻪ در اﻳـﻦ ﺑﻴﻤـﺎران وﺟـﻮد داﺷـﺖ‪ ،‬ﺗـﺐ‬

‫ﻣﻨﻄﻘﻪ و ﺑﻪ ﻣﻨﻈﻮر ﺑﻪ روز ﻛﺮدن اﻃﻼﻋﺎت و ﺗﻌﻴﻴﻦ ﻓﺮاواﻧﻲ ﻧـﺸﺎﻧﻪﻫـﺎي‬

‫)‪ (%77/4‬و ﺳﭙﺲ‪ ،‬درد ﻣﻔﺼﻠﻲ)‪ (%70‬ﺑﻮد )ﻧﻤﻮدار ‪ 55(%24) .(1‬ﻧﻔﺮ از‬

‫ﺑﺎﻟﻴﻨﻲ و ﻳﺎﻓﺘﻪﻫﺎي ﺳﺮوﻟﻮژي ﻣﺮﺑﻮط ﺑﻪ اﻳﻦ ﺑﻴﻤﺎري‪ ،‬ﻣﻄﺎﻟﻌـﻪاي در اﻳـﻦ‬

‫ﺑﻴﻤﺎران‪ ،‬دﭼﺎر ﺑﺮوﺳﻠﻮز ﺣﺎد ﺑﻮدﻧﺪ و ﻃﻮل ﻣﺪت ﺑﻴﻤﺎرﻳـﺸﺎن ﻛـﻢﺗـﺮ از‬

‫زﻣﻴﻨﻪ ﻃﺮاﺣﻲ ﺷﺪ ﺗﺎ از ﻧﺘﺎﻳﺞ آن در ﺳﻴﺴﺘﻢ ﺑﻬﺪاﺷﺘﻲ‪ -‬درﻣﺎﻧﻲ اﺳـﺘﻔﺎده‬

‫ﺳﻪ ﻣﺎه ﺑﻮد‪ .‬اﻛﺜﺮ ﺑﻴﻤـﺎران ])‪ 163(70/8‬ﺑﻴﻤـﺎر[ ﺑـﻪ ﺷـﻜﻞ ﺗﺤـﺖ ﺣـﺎد‬

‫ﺷﻮد و ﻛﻤﻚ ﺑﻪ ﺗﺸﺨﻴﺺ و درﻣﺎن ﺑﻪ ﻣﻮﻗﻊ ﺑﺮاي ﺟﻠـﻮﮔﻴﺮي از ﻣـﺰﻣﻦ‬

‫ﺑﺮوﺳﻠﻮز ﻣﺒﺘﻼ ﺑﻮدﻧﺪ و ﻃﻮل ﻣﺪت ﺑﻴﻤﺎرﻳﺸﺎن ﺗﺎ ﻗﺒﻞ از ﻣﺮاﺟﻌﻪ ﺑﻴﻦ ﺳﻪ‬

‫ﺷﺪن و ﻋﻮارض ﺑﻌﺪي ﺑﻴﻤﺎري ﺑﺮوﺳﻠﻮز ﺷﻮد‪.‬‬

‫ﻣﺎه ﺗﺎ ﻳﻚﺳﺎل ﺑﻮد‪ .‬ﺗﻨﻬﺎ ‪ 12‬ﺑﻴﻤﺎر )‪ (%5/2‬ﺳﺎﺑﻘﻪ ﺑﻴﻤـﺎري ﺑـﻴﺶ از ﻳـﻚ‬ ‫ﺳﺎل داﺷﺘﻨﺪ و ﺑﻪ ﻧﻮع ﻣﺰﻣﻦ ﺑﺮوﺳﻠﻮز ﻣﺒﺘﻼ ﺑﻮدﻧﺪ‪ .‬از ﻧﻈـﺮ ﺗﺤـﺼﻴﻼت‪،‬‬

‫روش ﺑﺮرﺳﻲ‬

‫‪ 106‬ﻧﻔﺮ )‪ (%50/7‬زﻳﺮ دﻳﭙﻠﻢ ﺑﻮدﻧﺪ و ﻓﻘﻂ ﺷﺶ ﻧﻔﺮ )‪ (%2/9‬از ﺑﻴﻤﺎران‬ ‫ﺗﺤﺼﻴﻼت ﻓﻮق دﻳﭙﻠﻢ داﺷﺘﻨﺪ )ﺟﺪول ‪ 146 .(1‬ﺑﻴﻤـﺎر )‪ (%63/4‬دﭼـﺎر‬

‫ﺑﺎ ﻃﺮاﺣﻲ ﻳﻚ ﻣﻄﺎﻟﻌﻪ ﺗﻮﺻﻴﻔﻲ ﮔﺬﺷﺘﻪﻧﮕﺮ‪ ،‬ﭘﺮوﻧﺪه ﻛﻠﻴﻪ ﺑﻴﻤﺎراﻧﻲﻛﻪ‬

‫ﻋﺎرﺿﻪ ﺷﺪﻧﺪ ﺑﻪ ﻃﻮريﻛﻪ اﺳﭙﻮﻧﺪﻳﻠﻴﺖ ﺑﺎ ‪ 61‬ﺑﻴﻤﺎر)‪ (%26/5‬ﺑﻴﺶﺗـﺮﻳﻦ‬

‫ﺷﻜﺎﻳﺎت ﺑﺎﻟﻴﻨﻲ ﻣﻨﻄﺒﻖ ﺑﺎ ﺑﺮوﺳﻠﻮز ﻫﻤﺮاه ﺑﺎ آزﻣﺎﻳﺶ راﻳﺖ ﺑـﻴﺶﺗـﺮ ﻳـﺎ‬

‫و ﻣﻨﻨﮋﻳﺖ ﺑﺎ ﻫﻔﺖ ﺑﻴﻤﺎر )‪ (%3‬ﻛـﻢﺗـﺮﻳﻦ آﻣـﺎر را ﺑـﻪ ﺧـﻮد اﺧﺘـﺼﺎص‬

‫ﻣﺴﺎوي ‪ 1/80‬ﻳﺎ ﻛﻮﻣﺒﺲ راﻳﺖ ﺑﺎﻻي ‪) 1/40‬ﻫﻨﮕـﺎﻣﻲﻛـﻪ راﻳـﺖ ﻣﻨﻔـﻲ‬

‫ﻣﻲدادﻧﺪ )ﺟﺪول ‪ .(1‬از ﻧﻈـﺮ ﺑﺮرﺳـﻲ آزﻣﺎﻳـﺸﮕﺎﻫﻲ‪ ،‬ﺗﻌـﺪاد ﻟﻜﻮﺳـﻴﺖ‬

‫ﺑﻮد( ﻫﻤﺮاه ﺑﺎ ‪ 2ME≥1/40‬داﺷﺘﻨﺪ و ﺑﺎ ﺗﺸﺨﻴﺺ ﺑﺮوﺳﻠﻮز ﻃﻲ ﺳﺎلﻫﺎي‬

‫ﺑﻴﻤﺎران در اﻛﺜﺮ ﻣﻮارد ])‪ 170(%76/9‬ﺑﻴﻤﺎر[ در ﻣﺤﺪوده ﻃﺒﻴﻌﻲ ﺑﻮد‪.‬‬

‫ﺧﺼﻮﺻﻴﺎت ﺑﺎﻟﻴﻨﻲ‪ ،‬آزﻣﺎﻳﺸﮕﺎﻫﻲ و اﭘﻴﺪﻣﻴﻮﻟﻮژﻳﻚ ﻣﺒﺘﻼﻳﺎن ﺑﺮوﺳﻠﻮزﻳﺲ‬

‫‪132‬‬

‫ﻧﻤﻮدار‪ :1 -‬درﺻﺪ ﻓﺮاواﻧﻲ ﻋﻼﻳﻢ ﺑﺎﻟﻴﻨﻲ در ﺑﻴﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﺗﺐ ﻣﺎﻟﺖ ﺑﺴﺘﺮي‬

‫ﻧﻤﻮدار‪ :2 -‬درﺻﺪ ﻓﺮاواﻧﻲ ﻳﺎﻓﺘﻪﻫﺎي آزﻣﺎﻳﺸﮕﺎﻫﻲ در ﺑﻴﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﺗﺐ ﻣﺎﻟﺖ‬

‫ﺟﺪول‪ :1 -‬ﻓﺮاواﻧﻲ ﻣﺒﺘﻼﻳﺎن ﺗﺐﻣﺎﻟﺖ ﺑﺮ ﺣـﺴﺐ ﻣﺘﻐﻴﺮﻫـﺎي ﺟـﻨﺲ‪ ،‬ﺳـﻦ‪ ،‬ﻣﺤـﻞ‬

‫‪ 46‬ﻧﻔﺮ )‪ (%20/8‬ﻟﻜﻮﺳﻴﺘﻮز داﺷﺘﻨﺪ و ﺗﻨﻬﺎ ﭘـﻨﺞ ﻧﻔـﺮ )‪ (%2/3‬ﻟﻜﻮﭘﻨﻴـﻚ‬

‫زﻧﺪﮔﻲ‪ ،‬ﺗﻤﺎس ﺑﺎ دام‪ ،‬ﻣﺼﺮف ﻟﺒﻨﻴﺎت )ﻏﻴﺮﭘﺎﺳﺘﻮرﻳﺰه(‪ ،‬ﺗﺤﺼﻴﻼت و ﻋﺎرﺿﻪ ﺑﻴﻤﺎري‬ ‫ﺗﻌﺪاد )درﺻﺪ(‬

‫ﻣﺘﻐﻴﺮ‬

‫ﺷﺪه ﺑﻮدﻧﺪ‪ .‬ﺷﺎﻳﻊﺗﺮﻳﻦ ﻳﺎﻓﺘﻪ آزﻣﺎﻳﺸﮕﺎﻫﻲ ﺑﻪدﺳـﺖ آﻣـﺪه اﻓـﺰاﻳﺶ‬

‫‪ESR‬‬

‫در ‪ %59/5‬ﺑﻴﻤﺎران و ﺳـﭙﺲ اﻓـﺰاﻳﺶ ‪ CRP‬در ‪ %52/9‬از ﺑﻴﻤـﺎران ﺑـﻮد‪.‬‬

‫ﻣﺮد‬

‫)‪130(56/5‬‬

‫زن‬

‫)‪100(43/5‬‬

‫‪0-20‬‬

‫)‪50(21/7‬‬

‫‪21-40‬‬

‫)‪69(30‬‬

‫‪41-60‬‬

‫)‪62(27‬‬

‫‪61-80‬‬

‫)‪45(19/6‬‬

‫<‪80‬‬

‫)‪4(1/7‬‬

‫ﺷﻬﺮ‬

‫)‪64(23/8‬‬

‫ﺑﺮﺧﻼف ﻣﻄﺎﻟﻌﻪﻫﺎﻳﻲ ﻣﻲﺑﺎﺷﺪ ﻛﻪ ﻗﺒﻼ در ﻋﺮﺑﺴﺘﺎن و ﻫﻢﭼﻨﻴﻦ در اﻳﺮان‬

‫روﺳﺘﺎ‬

‫)‪166(72/2‬‬

‫اﻧﺠﺎم ﺷﺪه ﺑﻮد‬

‫‪19‬‬

‫دارد‬

‫)‪75(39/7‬‬

‫ﻟﻴﺒﻲ‪ 20‬و اﺧﻴﺮاً در اﻳـﺮان ﻛـﻪ ﺗﻮﺳـﻂ ‪ 21Haj Abdolbaghi‬اﻧﺠـﺎم ﺷـﺪه‪،‬‬

‫ﻧﺪارد‬

‫)‪155(60/3‬‬

‫ﺳﺎﺑﻘﻪ ﻣﺼﺮف ﻣﻮاد ﻟﺒﻨﻲ‬

‫دارد‬

‫)‪114(60/3‬‬

‫ﻏﻴﺮ ﭘﺎﺳﺘﻮرﻳﺰه‬

‫ﻧﺪارد‬

‫)‪116(39/7‬‬

‫ﺑﻲﺳﻮاد‬

‫)‪82(35/9‬‬

‫ﺟﻨﺲ‬

‫ﺳﻦ‬

‫ﻣﺤﻞ زﻧﺪﮔﻲ‬

‫ﺳﺎﺑﻘﻪ ﺗﻤﺎس ﺑﺎ دام‬

‫ﻣﻴﺰان ﺗﺤﺼﻴﻼت‬

‫ﻋﺎرﺿﻪ‬

‫ﻟﻜﻮﺳـــﻴﺘﻮز در ‪ %20/8‬و آﻧﻤـــﻲ در ‪ %14/7‬و ﻟﻨﻔﻮﺳـــﻴﺘﻮز در ‪%13/6‬‬ ‫ﺑﻴﻤﺎران وﺟﻮد داﺷﺖ )ﻧﻤﻮدار ‪.(2‬‬

‫ﺑﺤﺚ‬ ‫در اﻳﻦ ﺗﺤﻘﻴﻖ اﻛﺜﺮ ﺑﻴﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﺑﺮوﺳـﻠﻮز ﻣـﺮد ﺑﻮدﻧـﺪ و اﻳـﻦ‬ ‫‪18‬و‪17‬‬

‫اﻣﺎ در اﻏﻠﺐ ﻣﻄﺎﻟﻌﺎت دﻳﮕـﺮ از ﺟﻤﻠـﻪ در ﻟﺒﻨـﺎن‪،‬‬

‫ﺑﻴﻤﺎري ﺑﺮوﺳﻠﻮز در ﻣﺮدان ﺑﻴﺶﺗﺮ از زﻧﺎن ﮔﺰارش ﺷﺪه‪ .‬ﻣﻤﻜـﻦ اﺳـﺖ‬ ‫ﻳﻜﻲ از دﻻﻳﻞ ﺑﻪ دﺳﺖ آﻣﺪن اﻳﻦ ارﺟﺤﻴﺖ‪ ،‬اﻧﺘﻘﺎل ﺷﻐﻠﻲ اﻳـﻦ ﺑﻴﻤـﺎري‬ ‫ﺑﺎﺷﺪ‪ ،‬ﮔﺮﭼﻪ در ﻣﻨﺎﻃﻖ اﻧﺪﻣﻴﻚ اﻳﻦ ﺑﻴﻤﺎري اﻏﻠﺐ زﻧﺎن ﻧﻴﺰ ﻣﺎﻧﻨﺪ ﻣﺮدان‬ ‫ﺑﻪ ﻛﺸﺎورزي و دام داري ﻣﺸﻐﻮﻟﻨﺪ اﻣﺎ ﻣﺸﺎرﻛﺖ آنﻫﺎ در اﻳﻦ ﻣﺸﺎﻏﻞ و‬

‫زﻳﺮ دﻳﭙﻠﻢ‬

‫)‪117(50/7‬‬

‫دﻳﭙﻠﻢ‬

‫)‪24(10/5‬‬

‫ﻣﺘﻌﺎﻗﺒﺎً ﺗﻤﺎس آنﻫﺎ ﻧﻴﺰ ﻛﻢﺗﺮ از ﻣﺮدان ﺑﻪ ﻧﻈﺮ ﻣﻲرﺳﺪ‪ .‬از ﻧﻈﺮ ﻣﺤـﺪوده‬

‫داﻧﺸﮕﺎﻫﻲ‬

‫)‪7(2/9‬‬

‫ﺳﻨﻲ‪ ،‬ﺑﻴﺸﺘﺮ ﻣﺒﺘﻼﻳﺎن در دﻫﻪ ﺳﻮم و ﭼﻬﺎرم زﻧﺪﮔﻲ ﺑﻮدﻧﺪ‪ ،‬ﻛﻪ ﺑـﺎ ﺳـﺎﻳﺮ‬

‫آرﺗﺮﻳﺖ‬

‫)‪57(24/8‬‬

‫ﻣﻄﺎﻟﻌﺎت اﻧﺠﺎم ﺷﺪه در ﻛـﺸﻮرﻫﺎي ﻣﺠـﺎور ﻣﺎﻧﻨـﺪ ﺗﺮﻛﻴـﻪ و ﻋﺮﺑـﺴﺘﺎن‬

‫اﺳﭙﻮﻧﺪﻳﻠﻴﺖ‬

‫)‪61(26/5‬‬

‫ﻣﻄﺎﺑﻘﺖ دارد‪.‬‬

‫اﭘﻴﺪﻳﺪﻳﻤﻴﻮارﻛﻴﺖ‬

‫)‪21(9/2‬‬

‫ﻣﻮاد ﻟﺒﻨﻲ ﻏﻴﺮﭘﺎﺳﺘﻮرﻳﺰه ﺑﻮد ﻛﻪ اﮔﺮﭼﻪ ﺑﻪ ﺑﻌـﻀﻲ ﻣﻄﺎﻟﻌـﺎت ﺑـﺎ ‪ 67/9‬و‬

‫ﻣﻨﻨﮋﻳﺖ‬

‫)‪7(3‬‬

‫‪ 66/7‬درﺻﺪ‪ ،‬ﻧﺰدﻳﻚ ﺑﻮد‪22.‬و‪ 21‬اﻣﺎ در ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﺑﻌﻀﻲ ﻣﻄﺎﻟﻌﺎت ﻗﺒﻠﻲ ﺑﺎ‬

‫ﻧﺪارد‬

‫)‪84(36/5‬‬

‫‪ 76/4‬و ‪ 88/3‬درﺻﺪ‪ ،‬ﻛﻢﺗﺮ ﺑﻮد‪23.‬و‪ 20‬درﺻـﺪي از اﻳـﻦ ﻛـﺎﻫﺶ ﻣﻴـﺰان‬

‫‪22‬و‪20‬و‪17‬‬

‫در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ‪ %60/3‬ﻣﻮارد ﻋﻠﺖ اﺑﺘﻼ‪ ،‬ﻣـﺼﺮف‬

‫ﻫﻤﻜﺎران‬ ‫ﻋﻴﻨﻲ و‬ ‫‪Eini P.‬‬ ‫ﭘﻴﻤﺎن‪et al.‬‬

‫اﺑﺘﻼ از اﻳﻦ راه‪ ،‬ﻣﻲﺗﻮاﻧﺪ ﻧﺎﺷﻲ از آﮔﺎﻫﻲ ﻣﺮدم در راﺑﻄﻪ ﺑـﺎ ﺟﻮﺷـﺎﻧﺪن‬

‫‪133‬‬

‫ﻣﺨﺘﺼﺮ ﻳﺎ ﺑﺪون دﻳﺰاوري ﻣﻲﮔﺮدد‪ .‬ﺑﺮرﺳﻲ ادرار اﻳﻦ ﺑﻴﻤـﺎران ﻣﻌﻤـﻮﻻ‬ ‫‪1‬‬

‫ﺷﻴﺮ ﺑﺎﺷﺪ و ﺑﻪ ﻧﻈﺮ ﻣﻲرﺳﺪ ﻛﻪ ﺑﺎ ﮔﺬر زﻣﺎن از درﺻﺪ ﻓﺮاواﻧﻲ اﻳـﻦ راه‬

‫ﻃﺒﻴﻌــﻲ اﺳــﺖ و ﻛــﺸﺖ ﻣﻌﻤــﻮل ادرار‪ ،‬ﻣﻨﻔــﻲ ﻣــﻲﺑﺎﺷــﺪ‪ .‬ﻓﺮاواﻧــﻲ‬

‫اﻧﺘﻘﺎل ﻛﺎﺳﺘﻪ ﺷﻮد‪ .‬در ﺗﺤﻘﻴﻖ ﺣﺎﺿﺮ‪ ،‬ﻣﻴﺰان ﺗﻤﺎس ﺑﺎ دام ﺣﺪود ‪%39/7‬‬

‫اﭘﻴﺪﻳﺪﻳﻤﻮاورﻛﻴﺖ در اﻳﻦ ﺑﺮرﺳﻲ ‪ %9/2‬ﺑﻮد‪ .‬در دﻳﮕﺮ ﻣﻄﺎﻟﻌـﺎت اﻧﺠـﺎم‬

‫ﺑﺮآورد ﺷﺪ‪ .‬در ﺳﻪ ﻣﻄﺎﻟﻌﻪ دﻳﮕﺮ ﻛﻪ در اﻳﺮان اﻧﺠﺎم ﺷﺪه ﺑـﻮد ‪27 ،17/1‬‬

‫ﺷﺪه در اﻳﺮان ‪ 10/9‬و ‪ 7/4‬درﺻﺪ ﮔﺰارش ﺷﺪه اﺳـﺖ‪23.‬و‪ 22‬در ﻣﻄﺎﻟﻌـﻪ‬

‫و ‪ 34/25‬درﺻﺪ را ﺑﻪدﺳﺖ آورده ﺑﻮدﻧﺪ‪23‬و‪ 21‬و در ﺳـﺎﻳﺮ ﻣﻄﺎﻟﻌـﺎت در‬

‫ﺣﺎﺿﺮ‪ ،‬ﺗﻐﻴﻴﺮات ﻫﻤﺎﺗﻮﻟﻮژﻳﻚ ﺑـﻪ ﺻـﻮرت ‪ %20/8‬ﻟﻜﻮﺳـﻴﺘﻮز‪%13/6 ،‬‬

‫ﻛــﺸﻮرﻫﺎي ﻣﺠــﺎور آﻣــﺎري ﺑــﻴﻦ ‪ 32‬ﺗــﺎ ‪ 71‬درﺻــﺪ ﮔــﺰارش ﺷــﺪه‬

‫ﻟﻨﻔﻮﺳﻴﺘﻮز و ‪ %14/7‬آﻧﻤﻲ ﺑـﻮد و اﻓـﺰاﻳﺶ ‪ ESR‬و ‪ CRP‬ﺑـﻪ ﺗﺮﺗﻴـﺐ در‬

‫اﺳﺖ‪22.‬و‪20‬و‪ 19‬ﺑﻨﺎﺑﺮاﻳﻦ ﮔﺮﭼﻪ ﺷﻐﻞ ﻳﻚ ﻋﺎﻣﻞ ﺧﻄﺮ ﻣﺤﺴﻮب ﻣـﻲﺷـﻮد‪،‬‬

‫‪ %59/5‬و ‪ %52/9‬از ﺑﻴﻤﺎران وﺟﻮد داﺷﺖ‪ .‬اﻳﻦ در ﺣـﺎﻟﻲ اﺳـﺖ ﻛـﻪ در‬

‫اﻣﺎ ﺑﻪ ﻧﻈﺮ ﻧﻤﻲرﺳﺪ ﻛﻪ در ﻛﺸﻮرﻫﺎي ﺟﻬﺎن ﺳﻮم ﺑﻴﻤﺎري اﻟﺰاﻣـﺎً ﺷـﻐﻠﻲ‬

‫ﻣﻄﺎﻟﻌﻪ ‪ Haddadi‬در ﺗﻬﺮان‪ ،‬اﻛﺜﺮ ﺑﻴﻤﺎران ﺗﻐﻴﻴـﺮات ﻫﻤﺎﺗﻮﻟﻮژﻳـﻚ ﺑـﺎرز‬

‫ﺑﺎﺷﺪ و ﻋﻮاﻣﻞ دﺧﻴﻞ دﻳﮕﺮي ﻧﻴﺰ وﺟﻮد دارد‪ .‬ﻓﺼﻞ ﺑﻬﺎر و ﺗﺎﺑﺴﺘﺎن ﻛـﻪ‬

‫ﻧﺪاﺷــﺘﻨﺪ و در اﻛﺜــﺮ ﻣــﻮارد ‪ CBC‬ﺑﻴﻤــﺎران ﻧﺮﻣــﺎل ﺑــﻮد‪ 22.‬از ﻧﻈــﺮ‬

‫ﻓﺼﻞ زاﻳﺶ دامﻫﺎﺳﺖ‪ ،‬ﺷﺎﻳﻊﺗـﺮﻳﻦ ﻓـﺼﻮل اﺑـﺘﻼ ﺑﻮدﻧـﺪ ﻛـﻪ ﺑـﺎ ﺳـﺎﻳﺮ‬

‫آزﻣﺎﻳﺸﮕﺎﻫﻲ‪ Namiduru ،‬در ﺗﺮﻛﻴﻪ ﺷﺎﻳﻊﺗـﺮﻳﻦ ﺗﻐﻴﻴـﺮ ﻫﻤﺎﺗﻮﻟﻮژﻳـﻚ را‬

‫ﻣﻄﺎﻟﻌﺎت ﻣﻄﺎﺑﻘﺖ داﺷﺖ‪ 23-25.‬ﺳﻜﻮﻧﺖ در روﺳﺘﺎ ﺑﺎ ﻓﺮاواﻧﻲ ‪ %72/2‬در‬

‫ﻟﻨﻔﻮﻣﻮﻧﻮﺳﻴﺘﻮز و ﺳﭙﺲ آﻧﻤﻲ ﮔـﺰارش ﻛـﺮد‪ .‬در ﻣﻄﺎﻟﻌـﻪ‬

‫‪18‬‬

‫ﻣﺒﺘﻼﻳﺎن ﺑﺎ ﻣﻄﺎﻟﻌﻪ ‪ 23Haddadi 21،Haj Abdolbaghi‬ﻛﻪ ﻗﺒﻼً اﻧﺠﺎم ﺷـﺪه‬

‫‪ %84/5‬ﺑﻴﻤﺎران ﺗﻌﺪاد ﮔﻠﺒﻮل ﺳﻔﻴﺪ ﻧﺮﻣﺎل داﺷـﺘﻨﺪ و ‪ CRP %60/4‬ﻣﺜﺒـﺖ‬

‫ﺑﻮد ﻣﻄﺎﺑﻘﺖ ﻧﺪاﺷﺖ و ﺧﻴﻠﻲ ﺑﻴﺶﺗﺮ از آنﻫـﺎ ﺑـﻮد )‪ %15/67‬و ‪%40/5‬‬

‫ﺑﻮدﻧﺪ ﻛﻪ ﺗﻘﺮﻳﺒﺎً ﺑﺎ ﻣﻄﺎﻟﻌـﻪ ﺣﺎﺿـﺮ ﻫـﻢﺧـﻮاﻧﻲ داﺷـﺖ اﻣـﺎ ‪ ESR‬را در‬

‫در ﺟﻤﻌﻴﺖ روﺳﺘﺎﻳﻲ(‪ .‬اﻳﻦ ﺗﻔـﺎوت ﺷـﺎﻳﺪ ﻧﺎﺷـﻲ از اﻳـﻦ ﺑـﻮد ﻛـﻪ دو‬

‫‪ %80/7‬ﻣﻮارد ﻧﺮﻣﺎل ﮔﺰارش ﻛﺮده ﺑـﻮد ﻛـﻪ ﺑـﺎ ﻣﻄﺎﻟﻌـﻪ ﻣـﺎ ﺗﻘﺮﻳﺒـﺎً ‪%19‬‬

‫ﻣﻄﺎﻟﻌﻪ ذﻛﺮ ﺷﺪه در ﻣﺮاﻛـﺰ درﻣـﺎﻧﻲ ﺗﻬـﺮان اﻧﺠـﺎم ﺷـﺪه ﺑـﻮد‪ .‬در اﻳـﻦ‬

‫ﺗﻔﺎوت داﺷﺖ‪.‬‬

‫‪26‬‬

‫‪Roushan‬‬

‫ﻣﻄﺎﻟﻌﻪ‪ ،‬ﻣﻴﺰان ﺗﺤﺼﻴﻼت ﻓـﺎﻛﺘﻮر ﻣﻔﻴـﺪي در ﺟﻠـﻮﮔﻴﺮي از اﺑـﺘﻼ ﺑـﻮد‬

‫ﺑﺮوﺳﻼ از ﺟﻤﻠﻪ ارﮔﺎﻧﻴﺴﻢﻫﺎي درون ﺳﻠﻮﻟﻲ اﺳـﺖ ﻛـﻪ ﻣـﻲﺗﻮاﻧـﺪ‬

‫ﺑﻪﻃﻮريﻛﻪ داﺷﺘﻦ ﻣﺪرك دﻳﭙﻠﻢ ﻳﺎ ﺑﺎﻻﺗﺮ ﺑﻪ ﺷﻜﻞ ﻣﻌﻨـﻲداري از ﻣﻴـﺰان‬

‫ﻫﻢﭼﻮن ﻣﻴﻜﺮوب ﺳﻞ ﺑﺎ درﮔﻴﺮي اﻧﺪامﻫﺎي ﻣﺨﺘﻠـﻒ و اﺷـﻜﺎل ﻣﺘﻨـﻮع‬

‫اﺑﺘﻼ ﻣﻲﻛﺎﺳﺖ‪ .‬ﺑﻪﻋﺒﺎرﺗﻲ اﻓﺰاﻳﺶ ﺳﻄﺢ داﻧﺶ ﻣﺮدم ﺑﻪ وﻳﮋه روﺳـﺘﺎﻳﻴﺎن‬

‫ﺑﺎﻟﻴﻨﻲ ﺗﻈـﺎﻫﺮ ﻛﻨﻨـﺪ و دﻗـﺖ ﭘﺰﺷـﻚ ﻣﻮﺟـﺐ ﺗـﺸﺨﻴﺺ ﺑـﻪ ﻣﻮﻗـﻊ و‬

‫ﻣﻲﺗﻮاﻧﺪ ﻳﻜﻲ از روشﻫﺎي ﻣﺤﺎﻓﻈﺘﻲ ﻣﻔﻴﺪ در ﺑﺮاﺑﺮ اﻳﻦ ﺑﻴﻤﺎري ﺑﺎﺷـﺪ‪.‬‬

‫ﭘﻴﺸﮕﻴﺮي از ﻋﻮد و ﻋﻮارض ﺧﻮاﻫﺪ ﺷﺪ‪ .‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺗﻨﻮع ﻋﻼﻳﻢ ﺑﺎﻟﻴﻨﻲ‬

‫از ﻧﻈﺮ ﻋﻼﻳﻢ ﺑﺎﻟﻴﻨﻲ‪ ،‬ﺷﺎﻳﻊﺗﺮﻳﻦ ﻧﺸﺎﻧﻪ ﺑﺎﻟﻴﻨﻲ ﺗﺐ‪ ،‬درد ﻣﻔﺎﺻﻞ‪ ،‬ﺗﻌﺮﻳـﻖ‪،‬‬

‫ﻻزم اﺳﺖ در ﻫﺮ ﺑﻴﻤﺎر ﺗﺐ دار ﻃﻮل ﻛﺸﻴﺪه و ﻳﺎ ﺗﺐ ﺑﻪ ﻫﻤـﺮاه ﻋﻼﻳـﻢ‬

‫ﺿﻌﻒ و ﺑﻲﺣﺎﻟﻲ ﺑﻮده اﺳﺖ ﻛﻪ اﻳﻦ ﻳﺎﻓﺘـﻪﻫـﺎ ﺑـﺎ ﻧﺘـﺎﻳﺞ ‪ 23Haddadi‬در‬

‫درﮔﻴﺮي اﻧﺪامﻫﺎي ﻣﺨﺘﻠﻒ ﺑﻪ وﻳﮋه ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﻧﺪﻣﻴﻚ ﺑﻮدن ﺑﺮوﺳـﻠﻮز‬

‫اﻳﺮان ﻫﻢﺧﻮاﻧﻲ داﺷﺖ اﻣﺎ ﺑﺎ ﻣﻄﺎﻟﻌﺎت دﻳﮕﺮ ﻛﻤﻲ ﺗﻔﺎوت داﺷـﺖ ﺑـﺮاي‬

‫در اﻳﺮان‪ ،‬اﻳﻦ ﺑﻴﻤﺎري در ﺗﺸﺨﻴﺺﻫﺎي اﻓﺘﺮاﻗﻲ ﻗﺮار ﮔﻴﺮد‪.‬‬

‫ﻣﺜﺎل در ﺑﺮرﺳﻲ ‪ 18Roushan‬ﺷﺎﻳﻊﺗﺮﻳﻦ ﻧﺸﺎﻧﻪﻫﺎ ﺗﻌﺮﻳﻖ‪ ،‬ﺗﺐ و آرﺗﺮاﻟﮋي‬

‫ﺳﭙﺎﺳﮕﺰاري‪ :‬اﻳﻦ ﻣﻘﺎﻟﻪ ﺣﺎﺻﻞ ﭘﺎﻳﺎنﻧﺎﻣـﻪ ﺗﺤـﺖ ﻋﻨـﻮان "ﺑﺮرﺳـﻲ‬

‫ﺑﻮد اﻣﺎ ‪ 17Malik‬در ﻋﺮﺑﺴﺘﺎن‪ ،‬ﺗﺐ‪ ،‬ﺗﻌﺮﻳـﻖ‪ ،‬درد اﺳـﺘﺨﻮان‪ ،‬ﻛﻤـﺮدرد و‬

‫ﺗﻈﺎﻫﺮات ﺑﺎﻟﻴﻨﻲ‪ ،‬آزﻣﺎﻳﺸﮕﺎﻫﻲ و اﭘﻴﺪﻣﻴﻮﻟﻮژﻳﻚ ﺑﻴﻤﺎران ﻣﺒـﺘﻼ ﺑـﻪ ﺗـﺐ‬

‫ﺳﺮدرد را ﺷﺎﻳﻊﺗﺮﻳﻦ ﻧﺸﺎﻧﻪﻫﺎ ﻳﺎﻓﺘﻨـﺪ و ‪ 25Mousa‬ﺗـﺐ‪ ،‬ﻟـﺮز‪ ،‬ﺗﻌﺮﻳـﻖ و‬

‫ﻣﺎﻟﺖ ﺑﺴﺘﺮي در ﺑﻴﻤﺎرﺳـﺘﺎن ﻓﺮﺷـﭽﻴﺎن ﺷـﻬﺮ ﻫﻤـﺪان ﻃـﻲ ﺳـﺎلﻫـﺎي‬

‫ﺳﺮدرد را ﺷﺎﻳﻊﺗﺮﻳﻦ ﻧﺸﺎﻧﻪﻫﺎ ﮔﺰارش ﻛﺮدﻧـﺪ‪ .‬اﭘﻴﺪﻳـﺪﻳﻤﻮاورﻛﻴﺖ ﻳـﻚ‬

‫‪ "1384-88‬در ﻣﻘﻄـــﻊ دﻛﺘـــﺮاي ﭘﺰﺷـــﻜﻲ در ﺳـــﺎل ‪ 1389‬و ﻛـــﺪ‬

‫ﻃﺮﻓﻪ‪ ،‬ﻳﻜﻲ از ﺷﺎﻳﻊﺗﺮﻳﻦ ﻋﻮارض ادراري ﺗﻨﺎﺳﻠﻲ ﺑﺮوﺳـﻠﻮز اﺳـﺖ ﻛـﻪ‬

‫‪ 16/70/35552‬ﻣﻲﺑﺎﺷـﺪ ﻛـﻪ ﺑـﺎ ﺣﻤﺎﻳـﺖ داﻧـﺸﮕﺎه ﻋﻠـﻮم ﭘﺰﺷـﻜﻲ و‬

‫در اﻏﻠﺐ ﻣﻮارد ﺑﺎﻋﺚ اﻳﺠﺎد درد و ﺗﻮرم ﻣﻮﺿـﻌﻲ ﻫﻤـﺮاه ﺑـﺎ دﻳـﺰوري‬

‫ﺧﺪﻣﺎت ﺑﻬﺪاﺷﺘﻲ درﻣﺎﻧﻲ ﻫﻤﺪان اﺟﺮا ﺷﺪه اﺳﺖ‪.‬‬

‫‪References‬‬ ‫‪Harrison’s Principles of Internal Medicine. 17th ed. New York, NY:‬‬ ‫‪McGraw-Hill; 2008. p. 973-6.‬‬ ‫‪Joafshani M, Zoghi E, Soleimani S. Important Zoonoses in Iran.‬‬ ‫‪Tehran: Ettelaat Publication, 2005. 11-48 [Persian].‬‬ ‫‪Sofian M, Aghakhani A, Velayati AA, Banifazl M, Eslamifar A,‬‬ ‫‪Ramezani A. Risk factors for human brucellosis in Iran: a case‬‬‫‪control study. Int J Infect Dis 2008;12(2):157-61.‬‬

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‫‪Edward J. Young brucellosis. In: Mandell GL, Bennett JE, Dolin‬‬ ‫‪R, editors. In: Mandell, Douglas, and Bennett's Principles and‬‬ ‫‪Practice of Infectious Diseases. 7th ed. Philadelphia: Elsevier‬‬ ‫‪Churchill Livingstone Inc.; 2010. p. 2921-5.‬‬ ‫‪Corbel MJ, Beeching NJ. Brucellosis. In: Fauci AS, Braunwald‬‬ ‫‪E, Kasper DL, Hauser SL, Longo DL, Jameson L, et al, editors.‬‬

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Epidemiological And clinical study of brucellosis in 230 patients

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Hall WH. Modern chemotherapy for brucellosis in humans. Rev Infect Dis 1990;12(6):1060-99. Hajia M, Keramat F. Study on the rate of Brucellosis relapse and efficiency different treatment protocols in among hospitalized patients in educational hospital of Hamadan. Military Med 2004;3:195-9. Colmenero JD, Reguera JM, Martos F, Sánchez-De-Mora D, Delgado M, Causse M, et al. Complications associated with Brucella melitensis infection: a study of 530 cases. Medicine (Baltimore) 1996;75(4):195-211. Colmenero JD, Reguera JM, Fernández-Nebro A, CabreraFranquelo F. Osteoarticular complications of brucellosis. Ann Rheum Dis 1991;50(1):23-6. Alp E, Doganay M. Current therapeutic strategy in spinal brucellosis. Int J Infect Dis 2008;12(6):573-7. Schutze GE, Richard F. Brucellosis. In: Behrman RE, Kliegman RM, Jenson HB, editors. Nelson Textbook of Pediatrics. 17th ed. Philadelpha, PA: WB Saunders Co.; 2004. p. 939-41. Salata RA. Brucellosis. In: Goldman L, Schafer AI, editors. Goldman's Cecil Medicine. Philadelphia, PA: Saunders Elsevier; 2012. p. 1891-3. Annual Report of Center for Disease Control of Ministry of Health and Medical Education. 2004. [Persian] Maleknejad P, Peeri-DoGaheh H, AmirZargar A, Jafari S, Fatollahzadeh B. Diagnosis of brucellosis by use of BACTEC blood culture and confirmation by PCR. J Vet Res 2007;62(4):83-6. Dames S, Tonnerre C, Saint S, Jones SR. Clinical problemsolving. Don't know much about history. N Engl J Med 2005;352(22):2338-42. Mantur BG, Biradar MS, Bidri RC, Mulimani MS, Veerappa, Kariholu P, et al. Protean clinical manifestations and diagnostic challenges of human brucellosis in adults: 16 years' experience in an endemic area. J Med Microbiol 2006;55(Pt 7):897-903.

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16. Mantur BG, Mulimani MS, Bidari LH, Akki AS, Tikare NV. Bacteremia is as unpredictable as clinical manifestations in human brucellosis. Int J Infect Dis 2008;12(3):303-7. 17. Malik GM. A clinical study of brucellosis in adults in the Asir region of southern Saudi Arabia. Am J Trop Med Hyg 1997;56(4):375-7. 18. Hasanjani Roushan MR, Mohrez M, Smailnejad Gangi SM, Soleimani Amiri MJ, Hajiahmadi M. Epidemiological features and clinical manifestations in 469 adult patients with brucellosis in Babol, Northern Iran. Epidemiol Infect 2004;132(6):1109-14. 19. Serra Alvarez J, Godoy García P. Incidence, etiology and epidemiology of brucellosis in a rural area of the province of Lleida. Rev Esp Salud Publica 2000;74(1):45-53. 20. Elbeltagy KE. An epidemiological profile of brucellosis in Tabuk Province, Saudi Arabia. East Mediterr Health J 2001;7(4-5):791-8. 21. Haj Abdolbaghi M, Rasooli Nejad M, Yaghoob Zadeh M, Looti Shahrokhi B. Epidemiological, clinical, diagnostic and therapeutic survey in 505 cases with Brucellosis. Tehran Univ Med J (TUMJ) 2001;59(4):34-46. 22. Tasbakan MI, Yamazhan T, Gokengin D, Arda B, Sertpolat M, Ulusoy S, et al. Brucellosis: a retrospective evaluation. Trop Doct 2003;33(3):151-3. 23. Haddadi A, Rasoulinejad M, Afhami SH, Mohraz M. Epidemiological, clinical, para clinical aspects of brucellosis in Imam Khomeini and Sina Hospital of Tehran (1998-2005). Behbood J 2006;10(3):242-51. 24. Tohmé A, Hammoud A, el Rassi B, Germanos-Haddad M, Ghayad E. Human brucellosis. Retrospective studies of 63 cases in Lebanon. Presse Med 2001;30(27):1339-43. 25. Mousa AR, Elhag KM, Khogali M, Marafie AA. The nature of human brucellosis in Kuwait: study of 379 cases. Rev Infect Dis 1988;10(1):211-7. 26. Namiduru M, Gungor K, Dikensoy O, Baydar I, Ekinci E, Karaoglan I, et al. Epidemiological, clinical and laboratory features of brucellosis: a prospective evaluation of 120 adult patients. Int J Clin Pract 2003;57(1):20-4.

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‫ﻋﻤﻮﻣﻲ‬ ‫ﺑﺨﺸﻬﺎي ﺟﺮاﺣﻲ‬ ‫ﺟﺮاﺣﻲ در‬ ‫ﻋﻔﻮﻧﺖ ﻣﺤﻞ‬ ‫ﺗﺸﺨﻴﺺ‬ ‫روش ﭘﺎﻳﺶ‬ ‫ﻛﺎراﻳﻲ‬ Tehran University Medical Journal; Vol. 70, No.‫ﺑﺮاي‬ 2, May 2012:‫دو‬130-135

A retrospective evaluation of epidemiological, clinical and laboratory features of brucellosis in 230 patients in Hamadan, Iran: a brief report

Abstract Peyman Eini M.D.1 Farzaneh Esna-Ashari M.D.2 Ahmad Reza Mobaien M.D.3* Mehdi Hasanzadeh M.D.4 1- Department of Infectious Diseases, Hamadan University of Medical Sciences, Hamadan, Iran. 2- Department of Community Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. 3- Department of Infectious Diseases, Zanjan University of Medical Sciences, Zanjan, Iran. 4- Clinical Research Center of Farshchian, Hamadan University of Medical Sciences, Hamadan, Iran.

Received: December 21, 2011 Accepted: January 23, 2012

Background: Brucellosis is one of the most common infectious diseases in Iran with very different clinical manifestations. Methods: In this retrospective descriptive study, all patients with brucellosis, who were admitted in Farshchian Hospital in Hamadan, Iran in 2005 to 2010, were enrolled in the study. The data were collected from the patients’ medical records and were entered in forms for analysis. Results: A total of 230 patients with brucellosis, including 130 (56.5%) male and 100 (43.5%) female patients with a mean age of 40.84±20.29 years, who mostly (72.2%) lived

in rural areas were enrolled in the study. Outbreaks were most common in spring and summer and the main route of transmission was consumption of contaminated dairy products (60.3%). The most common symptoms were fever (77.4%), arthralgia (70%), sweating (47%), malaise and fatigue (46.5%). Arthritis and epididymo- orchitis were seen in 121 (52.9%) and 48 (8.20%) patients, respectively. CBC analysis showed leukocytosis in 20.8% of the participants. ESR rise was noted in 59.5% of the patients and 52.9% had positive CRP. Conclusion: Given to various clinical presentations, brucellosis should be considered in the differential diagnosis of individuals with chronic fever with or without other organ abnormalities. Keywords: Brucellosis, clinical, epidemiology, laboratory, manifestation, serologic test.

Corresponding author: Department Of Infectious Diseases, Valiasr Hospital, Fazlolah Ave., Zanjan, Iran. Tel: +98- 241- 7123303 E-mail: amobaien@yahoo.com

‫ﻛﻠﻴﻪ اردﻳﺒﻬﺸﺖ ‪136-139 ،1391‬‬ ‫ﺷﻤﺎره ‪،2‬‬ ‫در دوره‬ ‫ﺗﻬﺮان‪،‬‬ ‫ﭘﻠﻲﭘﺰﺷﻜﻲ‬ ‫ﻋﻠﻮم‬ ‫داﻧﺸﮕﺎه‬ ‫ﭘﺰﺷﻜﻲ‪،‬‬ ‫آﻧﺘﻲﺑﺎديﻣﺠﻠﻪ‬ ‫‪، 70‬ﻣﺰﻣﻦ‬ ‫ﻧﺎرﺳﺎﻳﻲ‬ ‫ﺳﺎﻛﺎرﻳﺪي‬ ‫واﻛﺴﻦ‬ ‫ﺗﺰرﻳﻖ‬ ‫داﻧﺸﻜﺪهﺑﻌﺪ از‬ ‫اﺧﺘﺼﺎﺻﻲ‬

‫‪136‬‬

‫درﻣﺎن ﺗﺮوﻣﺒﻮﺳﻴﺘﻮﭘﻨﻲ واﺑﺴﺘﻪ ﺑﻪ اﻳﺪز‪ :‬ﮔﺰارش ﻣﻮردي‬

‫ﺗﺎرﻳﺦ درﻳﺎﻓﺖ ﻣﻘﺎﻟﻪ‪ 1390/05/15 :‬ﺗﺎرﻳﺦ ﭘﺬﻳﺮش‪1390/11/01 :‬‬

‫ﭼﻜﻴﺪه‬

‫زﻫﺮا ﻋﺒﺪي‬ ‫*‬

‫ﻧﺪا ﻋﻠﻴﺠﺎﻧﻲ‬

‫زﻣﻴﻨﻪ و ﻫﺪف‪ :‬ﺗﺮوﻣﺒﻮﺳﻴﺘﻮﭘﻨﻲ در ﺑﻴﻤﺎران اﻳﺪز دﻳﺪه ﻣﻲﺷﻮد‪ .‬ﻣﻴﺰان ﺑﺮوز ﺗﺮوﻣﺒﻮﺳﻴﺘﻮﭘﻨﻲ ﺑﺎ اﻓﺰاﻳﺶ ﻧﻘﺺ اﻳﻤﻨﻲ اﻓﺰاﻳﺶ‬ ‫ﮔﺮوه ﻋﻔﻮﻧﻲ‪ ،‬ﺑﻴﻤﺎرﺳﺘﺎن اﻣﺎمﺧﻤﻴﻨﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم‬

‫ﻣﻲﻳﺎﺑﺪ‪ .‬ﻋﻠﺖ ﺗﺮوﻣﺒﻮﺳﻴﺘﻮﭘﻨﻲ در اﻳﺪز ﺑﻪ دو دﺳﺘﻪ اوﻟﻴﻪ و ﺛﺎﻧﻮﻳﻪ ﺗﻘﺴﻴﻢ ﻣﻲﺷﻮد‪ .‬ﺗﺮوﻣﺒﻮﺳﻴﺘﻮﭘﻨﻲ اوﻟﻴﻪ ﺷﺎﻳﻊﺗـﺮﻳﻦ ﻋﻠـﺖ‬

‫ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬ﺗﻬﺮان‪ ،‬اﻳﺮان‪.‬‬

‫ﻛﺎﻫﺶ ﭘﻼﻛﺖ در اﻳﺪز ﻣﻲﺑﺎﺷﺪ‪ .‬ﻣﻌﺮﻓﻲ ﺑﻴﻤﺎر‪ :‬ﺑﻴﻤﺎر آﻗﺎي ‪ 35‬ﺳﺎﻟﻪ ﻣﻮرد اﻳـﺪز از ﺳـﺎل ‪ 1375‬ﻛـﻪ ﺑـﺎ ﭘﺘـﺸﻲ‪ ،‬ﭘﻮرﭘـﻮرا‪،‬‬ ‫اﻛﻴﻤﻮز در اﻃﺮاف ﭼﺸﻢ و اﻧﺪامﻫﺎ و ﺧﻮنرﻳﺰي ﻣﻠﺘﺤﻤﻪ ﭼﺸﻢ در ﺷﻬﺮﻳﻮر ﻣﺎه ‪ 1389‬در ﺑﺨﺶ ﻋﻔﻮﻧﻲ ﺑﻴﻤﺎرﺳـﺘﺎن اﻣـﺎم‬ ‫ﺧﻤﻴﻨﻲ )ره( ﺑﺴﺘﺮي ﺷﺪه اﺳﺖ‪ .‬در ﺑﺮرﺳﻲ ﭘﻼﻛﺖ ﺑﻴﻤﺎر ‪ 5000cu/mm‬ﺑﻮد و ﺑﻌـﺪ از رد ﻋﻠـﻞ ﺛﺎﻧﻮﻳـﻪ ﺗﺮوﻣﺒﻮﺳـﻴﺘﻮﭘﻨﻲ‪،‬‬ ‫ﺗﺮوﻣﺒﻮﺳﻴﺘﻮﭘﻨﻲ اوﻟﻴﻪ ﻣﻄﺮح ﺷﺪ و ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺗﺮوﻣﺒﻮﺳﻴﺘﻮﭘﻨﻲ ﺷﺪﻳﺪ و ﻋﻼﻳﻢ ﺧـﻮنرﻳـﺰي و ﺗﻮﺟـﻪ ﺑـﻪ اﻳـﻦ ﻧﻜﺘـﻪ ﻛـﻪ‬ ‫زﻳﺪوودﻳﻦ و ﺳﺎﻳﺮ داروﻫﺎي ﺿﺪ رﺗﺮووﻳﺮوﺳﻲ ﺟﻬﺖ ﺗﺄﺛﻴﺮ ‪ 4-6‬ﻫﻔﺘﻪ زﻣﺎن ﻧﻴﺎز دارﻧﺪ‪ ،‬ﺟﻬﺖ ﺑﻴﻤﺎر ﭘﺮدﻧﻴﺰون ﺑﻪ ﻫﻤـﺮاه‬ ‫آﻧﺘﻲرﺗﺮوواﻳﺮال ﺷﺮوع ﺷﺪ‪ .‬ﺑﻌﺪ از ﺣﺪود دو ﻫﻔﺘﻪ از ﺷﺮوع ﻛﻮرﺗﻮن ﭘﻼﻛﺖ ﺑﻪ ﺣـﺪود ‪ 50000cu/mm‬رﺳـﻴﺪ و ﺑﻌـﺪ از‬ ‫ﻫﺸﺖ ﻫﻔﺘﻪ از ﻣﺼﺮف آﻧﺘﻲ رﺗﺮوواﻳﺮال )زﻳﺪوودﻳﻦ( ﭘﻼﻛﺖ ﺑﻪ ﺣﺪود ‪ 140000cu/mm‬رﺳﻴﺪ‪ .‬ﻧﺘﻴﺠـﻪ ﮔﻴـﺮي‪ :‬ﺑـﻪ ﻧﻈـﺮ‬ ‫ﻣﻲرﺳﺪ در درﻣﺎن ﺗﺮوﻣﺒﻮﺳﻴﺘﻮﭘﻨﻲ اوﻟﻴﻪ در ﺑﻴﻤﺎران ‪ HIV‬در ﺻﻮرت ﺗﺮوﻣﺒﻮﺳﻴﺘﻮﭘﻨﻲ ﺷﺪﻳﺪ و ﻋﻼﻳﻢ ﺧﻮنرﻳﺰي ﻣﻲﺗـﻮان‬

‫*‬

‫ﻧﻮﻳﺴﻨﺪه ﻣﺴﺌﻮل‪ :‬ﺗﻬﺮان‪ ،‬ﺑﻠﻮار ﻛﺸﺎورز‪ ،‬ﺑﻴﻤﺎرﺳﺘﺎن اﻣﺎم‬

‫ﺧﻤﻴﻨﻲ‬

‫از ﭘﺮدﻧﻴﺰون ﺑﻪ ﻫﻤﺮاه آﻧﺘﻲرﺗﺮوواﻳﺮال اﺳﺘﻔﺎده ﻛﺮد‪.‬‬

‫ﺗﻠﻔﻦ‪021-61192811 :‬‬ ‫‪E-mail: dna1461@yahoo.com‬‬

‫ﻛﻠﻤﺎت ﻛﻠﻴﺪي‪ :‬اﻳﺪز‪ ،‬ﺗﺮوﻣﺒﻮﺳﻴﺘﻮﭘﻨﻲ‪ ،‬درﻣﺎن آﻧﺘﻲرﺗﺮوواﻳﺮال‪.‬‬

‫ﻣﻘﺪﻣﻪ‬

‫‪ HIV‬ﻛﻨﺘﺮل ﻧﺸﺪه و ﻋﻔﻮﻧﺖ ﻫﻢزﻣﺎن ﻫﭙﺎﺗﻴﺖ ‪ c‬دﻳﺪه ﻣـﻲﺷـﻮد‪ 4.‬ﻋﻠـﺖ‬ ‫ﺗﺮوﻣﺒﻮﺳﻴﺘﻮﭘﻨﻲ در اﻳﺪز ﺑﻪ دو دﺳﺘﻪ اوﻟﻴـﻪ و ﺛﺎﻧﻮﻳـﻪ ﺗﻘـﺴﻴﻢ ﻣـﻲﺷـﻮد‪.‬‬

‫ﺗﺮوﻣﺒﻮﺳــﻴﺘﻮﭘﻨﻲ )‪ (Thrombocytopenia‬در ﺑﻴﻤــﺎران اﻳــﺪز دﻳــﺪه‬

‫ﺗﺮوﻣﺒﻮﺳﻴﺘﻮﭘﻨﻲ اوﻟﻴﻪ‬

‫‪Primary HIV Associated Thrombocytopenia‬‬

‫ﻣﻲﺷﻮد‪ .‬در ﻳﻚ ﻣﻄﺎﻟﻌﻪ در ﺑﻴﻤﺎران اﻳـﺪز‪ ،‬آﻧﻤـﻲ در ‪ ،%70‬ﻟﻨﻔـﻮﭘﻨﻲ در‬

‫)‪ (PHAT‬ﺷﺎﻳﻊﺗﺮﻳﻦ ﻋﻠﺖ ﻛـﺎﻫﺶ ﭘﻼﻛـﺖ در اﻳـﺪز ﻣـﻲﺑﺎﺷـﺪ‪ .‬از ﻧﻈـﺮ‬

‫‪ ،%70‬ﻧﻮﺗﺮوﭘﻨﻲ در ‪ %50‬و ﺗﺮوﻣﺒﻮﺳﻴﺘﻮﭘﻨﻲ در ‪ %40‬ﻣﻮارد ﮔﺰارش ﺷـﺪه‬

‫ﻛﻠﻴﻨﻴﻜــﻲ ﺗﺮوﻣﺒﻮﺳــﻴﺘﻮﭘﻨﻲ اوﻟﻴــﻪ ﺷــﺒﻴﻪ ﭘﻮرﭘــﻮراي ﺗﺮوﻣﺒﻮﺳــﻴﺘﻮﭘﻨﻲ‬

‫اﺳﺖ‪ 1.‬ﺗﺮوﻣﺒﻮﺳﻴﺘﻮﭘﻨﻲ واﺑﺴﺘﻪ ﺑﻪ اﻳﺪز در ﺑﻴﻤﺎران ﺑﺎ رﻳﺴﻚ ﺑـﺎﻻ ﺷـﺎﻣﻞ‬

‫اﻳﺪﻳﻮﭘﺎﺗﻴﻚ‬

‫اﻓﺮادي ﻛﻪ از ﻃﺮﻳﻖ ﻫﻤﻮﺳﻜﺴﻮال‪ ،‬ﻫﺘﺮوﺳﻜﺴﻮال‪ ،‬ﻣﺼﺮف ﻣﻮاد ﻣﺨـﺪر‬

‫وﻟﻲ اﺳﭙﻠﻨﻮﻣﮕﺎﻟﻲ ﺑﻴﺶﺗﺮ از ‪ ITP‬دﻳﺪه ﻣﻲﺷﻮد و ﻣﻴﺰان ﭘﻼﻛﺖ ﺑـﻴﺶﺗـﺮ‬

‫ﺗﺰرﻳﻘﻲ‪ ،‬ﺗﺰرﻳﻖ ﺧﻮن ﻣﺒﺘﻼ ﺷﺪهاﻧﺪ‪ ،‬اﺗﻔﺎق ﻣﻲاﻓﺘﺪ‪ .‬ﻣﻴﺰان ﺑﺮوز ﺗﺮوﻣﺒـﻮ‪-‬‬

‫از ‪ ITP‬ﻣﻲﺑﺎﺷﺪ‪ 5-7.‬ﺗﺮوﻣﺒﻮﺳﻴﺘﻮﭘﻨﻲ ﺛﺎﻧﻮﻳﻪ ﺑﻪ ﻋﻠﺖ ﻋﻔﻮﻧﺖﻫﺎي ﻓﺮﺻـﺖ‬

‫ﺳﻴﺘﻮﭘﻨﻲ ﺑﺎ اﻓﺰاﻳﺶ ﻧﻘﺺ اﻳﻤﻨﻲ اﻓﺰاﻳﺶ ﻣﻲﻳﺎﺑﺪ‪ .‬در ﻳﻚ ﻣﻄﺎﻟﻌـﻪ ﺑـﺮوز‬

‫)‪(ITP‬‬

‫‪ Idiopathic Thrombocytopenic Purpura‬ﻣﻲﺑﺎﺷـﺪ‬

‫‪8‬‬

‫ﻃﻠﺐ‪ ،‬ﻫﺎﻳﭙﺮاﺳﭙﻠﻨﻴﺴﻢ و ﻋﻮارض داروﻳﻲ ﻣﻲﺑﺎﺷﺪ‪.‬‬

‫ﭘﻼﻛﺖ زﻳﺮ ‪ %8 ،150000cu/mm‬در ﺑﻴﻤﺎران ﺑـﺎ ‪%30 ،200-500 CD4‬‬ ‫در ﺑﻴﻤﺎران ﺑﺎ ‪ CD4‬ﻛﻢﺗﺮ از ‪ 200‬ﮔﺰارش ﺷﺪه اﺳـﺖ‪ 2.‬ﺗﺮوﻣﺒﻮﺳـﻴﺘﻮﭘﻨﻲ‬ ‫ﻣﻤﻜﻦ اﺳﺖ اوﻟﻴﻦ ﻋﻼﻣﺖ اﻳﺪز در ‪ %10‬ﺑﻴﻤﺎران ﺑﺎﺷﺪ‪ 3.‬از زﻣﺎن اﺳﺘﻔﺎده‬ ‫داروﻫـﺎي ﺿـﺪ رﺗﺮووﻳﺮوﺳـﻲ ﺗﺮوﻣﺒﻮﺳﻴﺘﻮﭘﻨـﻲ ﺑﻴـﺶﺗﺮ در ﺑﻴﻤـﺎران ﺑﺎ‬

‫ﻣﻌﺮﻓﻲ ﺑﻴﻤﺎر‬ ‫ﺑﻴﻤـﺎر آﻗـﺎي ‪ 35‬ﺳﺎﻟﻪ ﻣﻮرد اﻳﺪز از ﺳﺎل ‪ 75‬ﻛﻪ ﺑﺎ ﭘﺘﺸﻲ‪ ،‬ﭘﻮرﭘﻮرا‪،‬‬

‫زﻫﺮا ﻋﺒﺪي و ﻫﻤﻜﺎران‬

‫‪137‬‬

‫ﺟﺪول‪ :1 -‬روﻧﺪ ﭘﻼﻛﺖ ﺑﻴﻤﺎر‬ ‫‪CBC / date‬‬

‫‪89/5/31‬‬

‫‪89/6/3‬‬

‫‪89/6/13‬‬

‫‪89/7/6‬‬

‫‪89/8/19‬‬

‫‪WBC‬‬

‫‪5/4‬‬

‫‪6/9‬‬

‫‪8‬‬

‫‪11/2‬‬

‫‪6/3‬‬

‫‪Hb‬‬

‫‪8/8‬‬

‫‪11/2‬‬

‫‪10/2‬‬

‫‪10/5‬‬

‫‪11/3‬‬

‫‪Mcv‬‬

‫‪84/6‬‬

‫‪84/1‬‬

‫‪88/8‬‬

‫‪92/5‬‬

‫‪93/3‬‬

‫‪5‬‬

‫‪6‬‬

‫‪22‬‬

‫‪54‬‬

‫‪140‬‬

‫‪Plt‬‬

‫اﻛﻴﻤﻮز در اﻃﺮاف ﭼﺸﻢ و اﻧﺪامﻫﺎ و ﺧﻮنرﻳﺰي ﻣﻠﺘﺤﻤﻪ ﭼﺸﻢ ﺷﻬﺮﻳﻮر‬

‫ﺳﻴﺘﻮﭘﻨﻲ اوﻟﻴﻪ ﻣﻲﺑﺎﺷﺪ ﻛﻪ ﻣﻴﺰان ﭘﻼﻛﺖ را ﺑـﻴﺶﺗـﺮ از ‪50000cu/mm‬‬

‫ﻣﺎه ‪ 1389‬در ﺑﺨﺶ ﻋﻔﻮﻧﻲ ﺑﻴﻤﺎرﺳﺘﺎن اﻣـﺎمﺧﻤﻴﻨـﻲ )ره( ﺑـﺴﺘﺮي ﺷـﺪه‬

‫ﺑﻌﺪ از ﻫﺸﺖ ﻫﻔﺘﻪ درﻣـﺎن اﻓـﺰاﻳﺶ ﻣـﻲدﻫـﺪ‪ 9.‬در اﺑﺘـﺪا زﻳـﺪودﻳﻦ ﺑـﺎ‬

‫اﺳﺖ‪ .‬ﺑﻴﻤﺎر ﺳﺎﺑﻘﻪ ﻧﺎرﺳﺎﻳﻲ ﺣﺎد ﻛﻠﻴﻪ در ﺳﺎل ‪ 74‬را ﻣﻲدﻫﺪ ﻛﻪ ﭼﻨﺪﻳﻦ‬

‫دوز ‪ 600mg/day‬آﻏﺎز ﻣﻲﺷﻮد و در ﺻـﻮرﺗﻲ ﻛـﻪ ﺑﻌـﺪ از ‪ 4-8‬ﻫﻔﺘـﻪ‬

‫ﻧﻮﺑﺖ ﻫﻤﻮدﻳﺎﻟﻴﺰ ﺷﺪه اﺳﺖ ﻫﻢﭼﻨﻴﻦ ﺑﻪ ﻣﺪت ﭼﻬﺎر ﺳﺎل ﻗﺒـﻞ از ﺳـﺎل‬

‫ﺗﻐﻴﻴﺮي در ﺗﻌﺪاد ﭘﻼﻛﺖ اﻳﺠﺎد ﻧﺸﻮد دوز آن ﺑـﻪ ‪1000-1500mg/day‬‬ ‫‪10‬‬

‫‪ ،75‬ﻣــﺼﺮف ﻣــﻮاد ﻣﺨــﺪر ﺗﺰرﻳﻘ ـﻲ داﺷــﺘﻪ اﺳــﺖ‪ .‬در ﻣﻌﺎﻳﻨــﻪ اوﻟﻴــﻪ‪،‬‬

‫اﻓﺰاﻳﺶ ﻣـﻲﻳﺎﺑـﺪ‪ .‬اﺳـﺘﻔﺎده از درﻣـﺎنﻫـﺎي اﺿـﺎﻓﻲ ﺑـﺴﺘﻪ ﺑـﻪ ﺷـﺪت‬

‫‪ ،RR:18/min ،OT:37 ºC ،PR:80/min ،BP:120/80mmHg‬ﻣﻠﺘﺤﻤـــــﻪ‬

‫ﺗﺮوﻣﺒﻮﺳــﻴﺘﻮﭘﻨﻲ‪ ،‬ﻋﻼﻳــﻢ ﺧــﻮنرﻳــﺰي ﻣﺎﻧﻨــﺪ ﭘﺘــﺸﻲ‪ ،‬اﭘﻴﺴﺘﺎﻛــﺴﻲ و‬

‫رﻧﮓ ﭘﺮﻳﺪه‪ ،‬ﺧﻮنرﻳﺰي در ﻣﻠﺘﺤﻤﻪ‪ ،‬ﭘﺘﺸﻲ در اﻃﺮاف ﭼﺸﻢﻫـﺎ‪ ،‬ﭘﺘـﺸﻲ‪،‬‬

‫ﻫﻤﺎﭼﻮري و ﺷﺮاﻳﻂ ﻫﻤﺮاه ﻣﺎﻧﻨﺪ ﻛﻤﺒﻮد ﻓﺎﻛﺘﻮرﻫﺎي اﻧﻌﻘﺎدي ﻣـﻲﺑﺎﺷـﺪ‪.‬‬

‫ﭘﻮرﭘﻮرا‪ ،‬اﻛﻴﻤﻮز در اﻧﺪامﻫﺎ داﺷـﺘﻪ اﺳـﺖ و در ﻣﻌﺎﻳﻨـﻪ اﻓﺘﺎﻟﻤﻮﺳـﻜﻮﭘﻲ‬

‫از درﻣﺎنﻫﺎي ﻣﺘﺪاول اﺳﺘﻔﺎده از اﻳﻤﻮﻧﻮﮔﻠﻮﺑﻮﻟﻴﻦ داﺧﻞ ورﻳـﺪي‬

‫ﺧﻮنرﻳﺰي در اﻳﻨﻔﺮاﺗﻤﭙﻮرال ﺷﺒﻜﻴﻪ داﺷﺘﻪ اﺳﺖ‪ ،‬وﻟﻲ ﺷﻮاﻫﺪي ﺑﻪ ﻧﻔـﻊ‬

‫ﻣﻲﺑﺎﺷﺪ ﻛﻪ اﻓﺰاﻳﺶ دراﻣﺎﺗﻴﻚ در ﺗﻌﺪاد ﭘﻼﻛـﺖﻫـﺎ اﻳﺠـﺎد ﻣـﻲﻛﻨـﺪ در‬

‫ﻋﻔﻮﻧﺖﻫﺎي ﻓﺮﺻﺖ ﻃﻠﺐ ﻧﺪاﺷﺖ‪ .‬در آزﻣﺎﻳﺸﺎت اﻧﺠـﺎم ﺷـﺪه ﻗﺒـﻞ از‬

‫ﻣﻄﺎﻟﻌﻪاي اﻳﻤﻮﻧﻮﮔﻠﻮﺑﻮﻟﻴﻦ داﺧـﻞ ورﻳـﺪي اﻓـﺰاﻳﺶ ‪ 50000cu/mm‬در‬

‫)‪(IVIG‬‬

‫‪11‬‬

‫ﺑﺴﺘﺮي‪ HBS Ag, HBC Ab ، Ab، HCV Ab :‬ﻣﺜﺒﺖ و آﺧﺮﻳﻦ ‪ CD4‬ﺑﻴﻤﺎر‬

‫‪ %90‬ﺑﻴﻤﺎران ﺑﻌﺪ از ﺗﺠﻮﻳﺰ دوز واﺣﺪ داﺷﺘﻪ اﺳﺖ‪ .‬اﺛﺮ آن ﮔﺬار ﺑـﻮده‬

‫در ﺗــﺎرﻳﺦ ‪ ،VDRL ،95 ،89/5/27‬آﻧﺘــﻲﺗﻮﻛــﺴﻮﭘﻼﺳﻤﺎ آﻧﺘــﻲﺑــﺎدي‪،‬‬

‫و ﺑﻪ ﺗﻜﺮار ﺗﺠﻮﻳﺰ ﻣﺘﻌﺪد ﻧﻴﺎزﻣﻨﺪ اﺳﺖ‪ 12.‬ﻋﻼوه ﺑﺮ آن ﻗﻴﻤﺖ ﺑﺎﻻ‪ ،‬ﻣﺪت‬

‫آﻧﺘﻲﺳﺎﻳﺘﻮﻣﮕﺎﻟﻮوﻳﺮوس آﻧﺘﻲﺑﺎدي ﻣﻨﻔﻲ ﺑﻮده اﺳﺖ آزﻣﺎﻳﺶ ‪ CBD‬ﺑﻴﻤﺎر‬

‫ﻃﻮﻻﻧﻲ اﻧﻔﻮزﻳﻮن )‪ 4-5‬ﺳﺎﻋﺖ( و ﻛﻤﺒﻮد اﻳﻤﻮﻧﻮﮔﻠﻮﺑﻮﻟﻴﻦﻫـﺎي اﻧـﺴﺎﻧﻲ‬

‫در ﺗﺎرﻳﺦ ‪،Mcv=84/6fl ،Hb=8/8mg/dl ،WBC=5/4cu/mm :89/5/31‬‬

‫ﻣﻮﺟﺐ ﻣﺤﺪودﻳﺖ اﺳﺘﻔﺎده از آن ﻣﻲﺷﻮد‪ .‬اﻳﻤﻮﻧﻮﮔﻠﻮﺑﻴﻦ داﺧﻞ ورﻳﺪي‬

‫‪ Plt=5×103cu/mm‬ﺑــﻮده اﺳــﺖ‪ .‬ﺑــﺎ ﺗﻮﺟــﻪ ﺑــﻪ ﺑــﺎي ﺳــﻴﺘﻮﭘﻨﻲ ﺑﻴﻤــﺎر‬

‫درﻣــﺎن اﻧﺘﺨــﺎﺑﻲ در ﻣــﻮاردي اﺳــﺖ ﻛــﻪ ﻧﻴــﺎز ﺑــﻪ اﺻــﻼح ﺳــﺮﻳﻊ‬

‫آﺳﭙﻴﺮاﺳﻴﻮن و ﺑﻴﻮﭘﺴﻲ ﻣﻐـﺰ اﺳـﺘﺨﻮان اﻧﺠـﺎم ﺷـﺪ ﻛـﻪ ﻫـﺎﻳﭙﺮﭘﻼزي و‬

‫ﺗﺮوﻣﺒﻮﺳﻴﺘﻮﭘﻨﻲ وﺟﻮد دارد‪ 13.‬درﻣﺎن دﻳﮕﺮ روﮔﺎم )‪ Anti Rh (D‬ﻣﻲﺑﺎﺷﺪ‬

‫دﻳﺴﭙﻼﺳﺘﻴﻚ ﮔﺮاﻧﻮﻟﻮﺳﻴﺖ و ﻣﮕﺎﻛﺎرﻳﻮﺳﻴﺖ ﮔﺰارش ﺷﺪ‪ .‬ﺑﺎ ﺗﻮﺟـﻪ ﺑـﻪ‬

‫و در ﺑﻴﻤﺎراﻧﻲ ﻛﻪ اﺳﭙﻠﻨﻜﺘﻮﻣﻲ ﻧﺸﺪهاﻧـﺪ و ‪ Rh‬ﻣﺜﺒـﺖ ﻣـﻲﺑﺎﺷـﻨﺪ ﻣـﺆﺛﺮ‬

‫رد ﻋﻠﻞ ﺛﺎﻧﻮﻳﻪ ﺗﺮوﻣﺒﻮﺳﻴﺘﻮﭘﻨﻲ ﺗﺸﺨﻴﺺ ﺗﺮوﻣﺒﻮﺳـﻴﺘﻮﭘﻨﻲ اوﻟﻴـﻪ ﻣﻄـﺮح‬

‫‪14‬‬

‫اﺳﺖ‪.‬‬

‫روﮔﺎم )‪ Anti Rh (D‬ارزانﺗﺮ از اﻳﻤﻮﻧﻮﮔﻠﻮﺑﻴﻦ داﺧﻞ ورﻳﺪي اﺳـﺖ‬

‫ﺷﺪ و ﺑﺎ ﺗﻮﺟـﻪ ﺑـﻪ ‪ CD4‬ﺑﻴﻤـﺎر و ﺗﺮوﻣﺒﻮﺳـﻴﺘﻮﭘﻨﻲ از ﺗـﺎرﻳﺦ ‪89/6/16‬‬ ‫ﺗﺤﺖ درﻣﺎن آﻧﺘﻲرﺗﺮوواﻳﺮال ﻗﺮار ﮔﺮﻓﺖ و ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺗﺮوﻣﺒﻮﺳـﻴﺘﻮﭘﻨﻲ‬

‫و ﻣﺪت اﻧﻔﻮزﻳﻮن آن ﻛﻢﺗﺮ ﻣﻲﺑﺎﺷﺪ )ﻛﻢﺗﺮ از ﭘﻨﺞ دﻗﻴﻘﻪ(‪ 15.‬روﮔﺎم‬

‫‪Anti‬‬

‫‪ Rh‬ﻣﻮﺟﺐ ﻛﺎﻫﺶ ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﺣﺪود ‪ 0/5-2gr/dl‬ﻣﻲﺷﻮد و ﺑﺎﻳـﺪ‬

‫ﺷﺪﻳﺪ و ﻋﻼﻳﻢ ﺧﻮنرﻳﺰي ﺗﺤـﺖ درﻣـﺎن ﺑـﺎ ﭘﺮدﻧﻴـﺰون ‪ 1mg/kg‬ﻗـﺮار‬

‫)‪(D‬‬

‫ﮔﺮﻓﺖ‪ .‬در ﺟﺪول ‪ 1‬ﻧﺘﺎﻳﺞ ‪ CBC‬ﺑﻴﻤﺎر ﺧﻼﺻﻪ ﺷﺪه اﺳﺖ‪.‬‬

‫در ﺑﻴﻤﺎران دﭼﺎر ﻛﻢ ﺧﻮﻧﻲ ﺑﺎ اﺣﺘﻴﺎط ﺑﻪ ﻛـﺎر ﮔﺮﻓﺘـﻪ ﺷـﻮد‪ .‬ﺗﻜـﺮار دوز‬ ‫‪17‬و‪16‬‬

‫ﻣﻌﻤﻮﻻ ‪ 3-4‬ﻫﻔﺘﻪ ﺑﻌﺪ از دوز اوﻟﻴﻪ ﻻزم ﻣـﻲﺷـﻮد‪.‬‬

‫ﺑﺤﺚ‬

‫از درﻣـﺎنﻫـﺎي‬

‫دﻳﮕﺮ ﻛﻮرﺗﻴﻜﻮاﺳﺘﺮوﻳﻴﺪ )ﭘﺮدﻧﻴﺰون ‪ (1mg/kg/d‬ﻣﻲﺑﺎﺷﺪ ﻛـﻪ ﺑـﻪ ﻋﻠـﺖ‬ ‫اﻓﺰاﻳﺶ ﻋﻔﻮﻧﺖﻫﺎي ﻓﺮﺻﺖ ﻃﻠﺐ در ﻣﺪت ﻛﻮﺗﺎه اﺳﺘﻔﺎده ﻣـﻲﺷـﻮد در‬

‫زﻳﺪوودﻳﻦ )‪ (Zidovudine‬ﻳﻜـﻲ از درﻣـﺎنﻫﺎي اﺻﻠـﻲ ﺗـﺮوﻣﺒـﻮ‪-‬‬

‫ﻳﻚ ﻣﻄﺎﻟﻌﻪ ‪ %80‬ﺑﻴﻤﺎران ﭘﺎﺳﺦ ﻣﻨﺎﺳﺐ ﺑﻪ ﻛﻮرﺗـﻮن دادهاﻧـﺪ و رﻳـﺴﻚ‬

‫ﻳﻲ ﻣﺰﻣﻦ ﻛﻠﻴﻪ‬Abdi ‫ﻧﺎرﺳﺎ‬Z.‫در‬et‫ي‬al. ‫آﻧﺘﻲﺑﺎدي اﺧﺘﺼﺎﺻﻲ ﺑﻌﺪ از ﺗﺰرﻳﻖ واﻛﺴﻦ ﭘﻠﻲﺳﺎﻛﺎرﻳﺪ‬

‫ﻧﻴﺎز ﺟﻬﺖ اﺛﺮ آﻧﺘﻲرﺗﺮوواﻳﺮال ﻧﻴﺎز ﺑﻪ درﻣﺎن ﻛﻤﻜﻲ وﺟـﻮد داﺷـﺖ ﻛـﻪ‬

138

‫ از درﻣـﺎنﻫـﺎي‬18.‫ﺧﻮنرﻳﺰي ﺑﻌﺪ از ﺳﻪ ﻫﻔﺘﻪ درﻣﺎن ﻛﺎﻫﺶ ﻳﺎﻓﺘﻪ اﺳﺖ‬

‫ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻋﺪم اﻣﻜﺎن اﺳﺘﻔﺎده از اﻳﻤﻮﻧﻮﮔﻠﻮﺑﻴﻦ داﺧﻞ ورﻳﺪي ﺑﻪ ﻋﻠـﺖ‬

‫دﻳﮕﺮ در ﺑﻴﻤﺎراﻧﻲ ﻛﻪ ﺑﺎ درﻣﺎن آﻧﺘﻲرﺗﺮوواﻳﺮال ﺑﻪ ﺗﻨﻬـﺎﻳﻲ ﭘﺎﺳـﺦ ﻣـﺆﺛﺮ‬

‫ ﭘـﺎﻳﻴﻦ در اﻳـﻦ ﺑﻴﻤـﺎر از ﭘﺮدﻧﻴـﺰون‬Hb ‫ﻗﻴﻤﺖ ﺑﺎﻻ و روﮔـﺎم ﺑـﻪ ﻋﻠـﺖ‬

.‫ اﻳﻨﺘﺮﻓﺮون آﻟﻔﺎ و وﻳﻦﻛﺮﻳﺴﺘﻴﻦ ﻣﻲﺑﺎﺷـﺪ‬،‫ داﭘﺴﻮن‬،‫ داﻧﺎزول‬:‫ﻧﻤﻲدﻫﻨﺪ‬

‫ ﺑﻌـﺪ از ﺣـﺪود دو ﻫﻔﺘـﻪ از‬.‫ ﺑﻪ ﻣﺪت ﺳﻪ ﻫﻔﺘﻪ اﺳﺘﻔﺎده ﺷﺪ‬1mg/kg/d

‫در ﺻــﻮرﺗﻲ ﻛــﻪ ﺗﺮوﻣﺒﻮﺳــﻴﺘﻮﭘﻨﻲ ﻣﻘــﺎوم و واﺑــﺴﺘﻪ ﺑــﻪ ﺗﺠــﻮﻳﺰ ﻣﻜــﺮر‬

.(1 ‫ رﺳـﻴﺪ )ﺟـﺪول‬54000cu/mm ‫ﺷﺮوع ﭘﺮدﻧﻴﺰون ﭘﻼﻛﺖ ﺑﻴﻤـﺎر ﺑـﻪ‬

‫ ﺷﻮد ﻣﻤﻜـﻦ اﺳـﺖ‬Anti Rh (D) ‫اﻳﻤﻮﻧﻮﮔﻠﻮﺑﻴﻦ داﺧﻞ ورﻳﺪي ﻳﺎ روﮔﺎم‬

‫ﺧﻮنرﻳﺰي ﻣﻠﺘﺤﻤﻪ و ﺿـﺎﻳﻌﺎت ﭘﻮﺳـﺘﻲ رﻓـﻊ ﺷـﺪ و ﺑـﺎ درﻣـﺎن ﺿـﺪ‬

‫ در ﺑﻴﻤﺎر ﻣﻌﺮﻓﻲ ﺷﺪه ﺑﺎ ﺗﻮﺟـﻪ ﺑـﻪ‬16.‫ﺑﻴﻤﺎران از اﺳﭙﻠﻨﻜﺘﻮﻣﻲ ﺳﻮد ﺑﺒﺮﻧﺪ‬

.‫ رﺳﻴﺪ‬140000cu/mm ‫رﺗﺮووﻳﺮوﺳﻲ ﺑﻌﺪ از ﻫﺸﺖ ﻫﻔﺘﻪ ﭘﻼﻛﺖ ﺑﻪ‬

‫ﭘﻼﻛﺖ ﺑﺴﻴﺎر ﭘﺎﻳﻴﻦ ﺑﻴﻤﺎر و ﻋﻼﻳﻢ ﺧﻮنرﻳﺰي و ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ زﻣﺎن ﻣـﻮرد‬

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Morris L, Distenfeld A, Amorosi E, Karpatkin S. Autoimmune thrombocytopenic purpura in homosexual men. Ann Intern Med 1982;96(6 Pt 1):714-7. 2. Sloand EM, Klein HG, Banks SM, Vareldzis B, Merritt S, Pierce P. Epidemiology of thrombocytopenia in HIV infection. Eur J Haematol 1992;48(3):168-72. 3. Galli M, Musicco M, Gervasoni C, Ridolfo AL, Niero F, Rusconi S, et al. No evidence of a higher risk of progression to AIDS in patients with HIV-1-related severe thrombocytopenia. J Acquir Immune Defic Syndr Hum Retrovirol 1996;12(3):268-75. 4. Marks KM, Clarke RM, Bussel JB, Talal AH, Glesby MJ. Risk factors for thrombocytopenia in HIV-infected persons in the era of potent antiretroviral therapy. J Acquir Immune Defic Syndr 2009;52(5):595-9. 5. Ehmann WC, Rabkin CS, Eyster ME, Goedert JJ. Thrombocytopenia in HIV-infected and uninfected hemophiliacs. Multicenter Hemophilia Cohort study. Am J Hematol 1997;54(4):296-300. 6. Peltier JY, Lambin P, Doinel C, Couroucé AM, Rouger P, Lefrére JJ. Frequency and prognostic importance of thrombocytopenia in symptom-free HIV-infected individuals: a 5-year prospective study. AIDS 1991;5(4):381-4. 7. Glatt AE, Anand A. Thrombocytopenia in patients infected with human immunodeficiency virus: treatment update. Clin Infect Dis 1995;21(2):415-23. 8. Thompson GR 3rd, Lawrence VA, Crawford GE. HIV infection increases the risk of heparin-induced thrombocytopenia. Clin Infect Dis 2007;45(10):1393-6. 9. Zidovudine for the treatment of thrombocytopenia associated with human immunodeficiency virus (HIV). A prospective study. The Swiss Group for Clinical Studies on the Acquired Immunodeficiency Syndrome (AIDS). Ann Intern Med 1988;109(9):718-21. 10. Landonio G, Cinque P, Nosari A, Gafa S, Rizzo F, Coen M, et al. Comparison of two dose regimens of zidovudine in an open,

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randomized, multicentre study for severe HIV-related thrombocytopenia. AIDS 1993;7(2):209-12. Pollak AN, Janinis J, Green D. Successful intravenous immune globulin therapy for human immunodeficiency virus-associated thrombocytopenia. Arch Intern Med 1988;148(3):695-7. Godeau B, Lesage S, Divine M, Wirquin V, Farcet JP, Bierling P. Treatment of adult chronic autoimmune thrombocytopenic purpura with repeated high-dose intravenous immunoglobulin. Blood 1993;82(5):1415-21. Holzman RS, Walsh CM, Karpatkin S. Risk for the acquired immunodeficiency syndrome among thrombocytopenic and nonthrombocytopenic homosexual men seropositive for the human immunodeficiency virus. Ann Intern Med 1987;106(3):383-6. Ware RE, Zimmerman SA. Anti-D: mechanisms of action. Semin Hematol 1998;35(1 Suppl 1):14-22. Gringeri A, Cattaneo M, Santagostino E, Mannucci PM. Intramuscular anti-D immunoglobulins for home treatment of chronic immune thrombocytopenic purpura. Br J Haematol 1992;80(3):337-40. Oksenhendler E, Bierling P, Brossard Y, Schenmetzler C, Girard PM, Seligmann M, et al. Anti-RH immunoglobulin therapy for human immunodeficiency virus-related immune thrombocytopenic purpura. Blood 1988;71(5):1499-502. Scaradavou A, Woo B, Woloski BM, Cunningham-Rundles S, Ettinger LJ, Aledort LM, et al. Intravenous anti-D treatment of immune thrombocytopenic purpura: experience in 272 patients. Blood 1997;89(8):2689-700. Abrams DI, Kiprov DD, Goedert JJ, Sarngadharan MG, Gallo RC, Volberding PA. Antibodies to human T-lymphotropic virus type III and development of the acquired immunodeficiency syndrome in homosexual men presenting with immune thrombocytopenia. Ann Intern Med 1986;104(1):47-50. Walsh C, Krigel R, Lennette E, Karpatkin S. Thrombocytopenia in homosexual patients. Prognosis, response to therapy, and prevalence of antibody to the retrovirus associated with the acquired immunodeficiency syndrome. Ann Intern Med 1985;103(4):542-5.

139

‫ﻋﻤﻮﻣﻲ‬ ‫ﺑﺨﺸﻬﺎي ﺟﺮاﺣﻲ‬ ‫ﺟﺮاﺣﻲ در‬ ‫ﻋﻔﻮﻧﺖ ﻣﺤﻞ‬ ‫ﺗﺸﺨﻴﺺ‬ ‫ ﭘﺎﻳﺶ‬2012: ‫دو روش‬136-139 ‫ﻛﺎراﻳﻲ‬ Tehran University Medical Journal; Vol. 70, No.‫ﺑﺮاي‬ 2, May

Treatment of AIDS-related thrombocytopenia: a case report

Abstract

Received: August 06, 2011 Accepted: January 21, 2012

Zahra Abdi M.D. Neda Alijani M.D.*

Background: Thrombocytopenia is a common finding in individuals infected with HIV Department of Infectious Disease Specialist, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.

and its incidence increases with progressive immunosuppression. Thrombocytopenia due to AIDS is divided into primary and secondary forms and primary HIV associated thrombocytopenia (PHAT) is the most common cause of thrombocytopenia in these patients. Case presentation: The patient was a 35-year old man with HIV since 1996, who was admitted to Imam Khomeini hospital in August of 2010 with petechiae, purpura, ecchymosis around the eyes and on the limbs and subconjunctival hemorrhage. In laboratory investigation, platelet count was 5000/µL. After ruling out the secondary causes of thrombocytopenia, Primary HIV Associated Thrombocytopenia (PHAT) was diagnosed. Due to the presence of severe thrombocytopenia and bleeding symptoms and considering the fact that antiretroviral agents require 4- 6 weeks to reach therapeutic effects, prednisone and antiretrovirals (AZT) were prescribed. After about two weeks of steroids administration, platelet count reached 50,000/µL and about eight weeks after antiretroviral (AZT) therapy platelets reached nearly 140,000/µL. Conclusion: Prednisone can be used safely in conjunction with antiretrovirals for primary thrombocytopenia in HIV infected patients with severe thrombocytopenia and bleeding symptoms. Keywords: Antiretroviral, HIV, thrombocytopenia.

Corresponding author: Imam Khomeini Hospital, Blvd., Keshavarz Blvd., Tehran, Iran. Tel: +98- 21- 61192811 E-mail:dna1461@yahoo.com

14. Proof Reading: A computer printout is sent to the corresponding author for proof reading before publication in order to avoid any mistakes. Corrections should be marked clearly and sent immediately to the Journal office. 15. Abbreviations and symbols: use only standard abbreviations. Avoid using them in the title and abstract. The full term for which an abbreviation stands should precede its first use in the text unless it is a standard unit of measurement. Short communication when possible; follow the same structure as original papers. 16. The corresponding author will be supplied with 3 free issues. 17. Ethics: Ethical considerations must be addressed in the Materials and Methods section. 1) Please state that informed consent was obtained from all human adult participants and from the parents or legal guardians of minors. Include the name of the appropriate institutional review board that approved the project. 2) Indicate in the text that the maintenance and care of experimental animals complies with National Institutes of Health guidelines for the humane use of laboratory animals, or those of your Institute or agency. 18. Conflicts of interest: Authors must acknowledge and declare any sources of funding and potential conflicting interest, such as receiving funds or fees by, or holding stocks and shares in, an organization that may profit or lose through publication of your paper. Declaring a competing interest will not lead to automatic rejection of the paper, but we like to be made aware of it. 19. Page charges: There are no charges for publication in this Journal. 20. Copyright: Accepted manuscripts become the permanent property of the TUMJ and may not be reproduced, in whole or in part, without the written permission of the Editor. 21. Peer review process: All manuscripts are considered to be confidential. They are peer-reviewed by at least 2 anonymous reviewers selected by the Editorial Board. The corresponding author is notified as soon as possible of the editor decision to accept, reject, or require modifications. If the manuscript is completely acceptable according to the criteria set forth in these instructions, it is scheduled for the next available issue. 22. Disposal of material: Once published, all copies of the manuscript, correspondence and artwork will be held for 6 months before disposal. The Final Checklist The authors must ensure that before submitting the manuscript for publication, they have taken care of the following: 1. Title page should contain title, name of the author/co-authors, their qualifications, designation & institutions they are affiliated with and mailing address for future correspondence, E-mail address, Phone & Fax number. 2. Abstract in Structured format up to 250 words. 3. References mentioned as stated in the Instruction to Authors section. 4. Tables should be typed on separate pages. 6. Make sure for Headings of Tables, their numbers and Captions of illustrations. Don’t repeat the information in tables if it is covered in the text. 7. Photographs / illustrations along with their captions. 8. Manuscript in Triplicate 9. Letter of Undertaking signed by all the authors. 10. Disclosure regarding source of funding and conflict of interest if any besides approval of the study from respective Ethics Committee/Institution Review Board. 11. Covering Letter 12. Floppy disk (latest version of windows) for on-line edition Nadereh Behtash M.D. Editor-in-Chief, Tehran University Medical Journal P.O. Box: 14155-6447, Tehran, Iran. Tel/Fax: + 98-21-88962510 Email: medjournal@tums.ac.ir URL: http://tumj.tums.ac.ir and http://www.tumj.ir The Editorial Board of the journal, reserves the right to accept or reject the article in any stage and any time or delete a part of the text, tables or figures, if necessary.

INSTRUCTION FOR AUTHORS: 1. Aims and Scope: The “Tehran University Medical Journal” (TUMJ) is the official scientific and clinical monthly publication of the Tehran University of Medical Sciences. It accepts Original Papers, Review Articles, Short Communications and Letters to the Editor in the fields of basic science and medicine. All correspondences should be addressed to: The Editor-in-Chief, Tehran University Medical Journal. P.O. Box: 14155-6447. Tehran, Iran Tel/Fax: + 98-21-88962510 2. Submission: Papers submitted for publication should describe original work, not previously published elsewhere, totally or partly. Manuscripts must be submitted only in Persian with English abstracts and should be written according to sound grammar and proper terminology. Submission is acceptable via Journal URL: http://journals.tums.ac.ir/login. The Manuscript must be accompanied by a covering letter to the Editor-in-Chief, including title and author(s) name and undertaking that it has not been published or submitted elsewhere, and should include: Title; No author(s) name; the Abstract; Introduction; Materials & Methods; Results; Discussion; Acknowledgement and References. 3. The title page: The complete title of the manuscript, the name of all the authors with their highest qualifications, the department or institution to which they are attached, address for correspondence with telephone numbers, e-mail, and Fax number. 4. The abstract (no more than 250 words) in structured format as Background, Methods, Results and Conclusion followed by 3 to 6 Keywords must be presented. Use terms from the Medical Subject Headings (MeSH) list of index medicus: (http://www.nlm.nih.gov/mesh/MBrowser.html). 5. Introduction: This should summarize the purpose and the rationale for the study. It should neither review the subject extensively nor should it have data or conclusions of the study [in Persian]. 6. Materials & Methods: This should include exact method or observation or experiment. If an apparatus is used, its manufacturer’s name and address should be given in parenthesis. If the method is established, give reference but if the method is new, give enough information so that another author is able to perform it. If a drug is used, its generic name, dose and route of administration must be given. For patients, age, sex with mean age ± standard deviation must be given. Statistical method must be mentioned and specify any general computer program used. The Info system used should be clearly mentioned [in Persian]. 7. Results: It must be presented in the form of text, tables and illustrations. The contents of the tables should not be all repeated in the text. Instead, a reference to the table number may be given. Long articles may need sub-headings within some sections (especially the Results and Discussion parts) to clarify their contents [in Persian]. 8. Discussion: This should emphasize the present findings and the variations or similarities with other work done in the field by other workers. The detailed data should not be repeated in the discussion again. Emphasize the new and important aspects of the study and the conclusions that follow from them. It must be mentioned whether the hypothesis mentioned in the article is true, false or no conclusions can be derived [in Persian]. 9. Acknowledgement: All contributors who do not meet the criteria for authorship should be covered in the acknowledgement section. It should include persons who provided technical help, writing assistance and departmental head who only provided general support. Financial and material support should also be acknowledged [in Persian]. 10. Tables in limited numbers should be submitted with the captions placed above. Do not submit tables as photograph. Place explanatory matters in footnotes, not in the heading [in Persian]. 11. Figures should be in limited numbers, with high quality art work and mounted on separate pages. The captions should be placed below. 12. The same data should not be presented in tables, figures and text, simultaneously. 13. References: Personal communications, manuscripts in preparation and other unpublished data are not cited in the reference list but may be mentioned in the text in parentheses. Identify references in the text by Farsi numerals in parentheses on the line. References should be typed, double-spaced, and separate from the text and numbered consecutively in the order in which they are mentioned in the text. (References cited in figures and tables, but not in the text, should be numbered consecutively following the text references.) Journal references should contain inclusive page numbers; book references specific page numbers. Indicate abstracts by the abbreviation ‘Abst’ and letters by ‘Lett’ in parentheses. Abbreviations of journals should conform to those used in Index Medicus, National Library of Medicine. The references should observe the following style: Periodicals: List all authors if six or fewer; otherwise, list first six and add ‘et al’. Do not use periods after the authors initials 1. Vimala N, Mittal S, Kumar S. Sublingual misoprostol versus oxytocin infusion to reduce blood loss at cesarean section. Int J Gynaecol Obstet 2006;92(2):106-10. 2. Patted SS, Goudar SS, Naik VA, Bellad MB, Edlavitch SA, Kodkany BS, et al. Side effects of oral misoprostol for the prevention of postpartum hemorrhage: results of a community-based randomised controlled trial in rural India. J Matern Fetal Neonatal Med 2009;22(1):24-8. Books: Basmajian JV. Grant's Method of Anatomy. 11th ed. Baltimore: Williams Wilkins; 1989. Chapter in book: Monks R. Psychotropic drugs. In: Wall PD, Melzack RA, editors. Textbook of Pain. 3rd ed. Edinburgh: Churchill Livingstone; 1994. p. 963-89.

Tehran University Medical Journal Tehran University Medical Journal Volume64, 70Number Number 2 May2006 2012 Volume 8, November

Contents

Recipient kidney damage after leukocyte transfer from inbred mice with renal ischemia-reperfusion injury………………………..………………………………………….…............69 Kadkhodaee M, Khastar H, Seifi B, Najafi A, Delavari F.

Histopathological and histomorphometrical effects of atorvastatin on experimental femoral cortical bone defect healing in rats……………………………………...…...........78 Mousavi Gh, Mohajeri D, Rezaie A, Valilu M.R, Alimohamadi A.

TGF-b downregulation by RNAi technique in ex vivo-expanded HSCs on 3D DBM scaffold………............86 Hashemi Z. S, Forouzandeh Moghadam M, Soleimani M, Hafizi M, Amirizadeh N.

In vitro antifungal susceptibility of oral candida species from Iranian HIV infected patients…….............96 Katiraee F, Khosravi A.R, Khalaj V, Hajiabdolbaghi M, Khaksar A.A, Rasoulinejad M.

Biological plating in comminuted subtrochanteric fractures…................................................................104 Mehrpour S.R, Tavvafi M.R, Sorbi R, Aghamirsalim M.R.

Effects of resistance and endurance exercises on androgens, cortisol and lactate in elderly women…......................................................................................................................................110 Sourati Jabloo D, Attarzadeh Hosseini S. R, Sayadpour Zanjani D, Ahmadi A.

Intra- articular hyaluronic acid injections Vs. dextrose prolotherapy in the treatment of osteoarthritic knee pain…........................................................................................................................119 Hashemi S. M, Madadi F, Razavi S, Nikooseresht M, Hassanzadeh Kiyabi F, Nasiripour S.

A retrospective evaluation of epidemiological, clinical and laboratory features of brucellosis in 230 patients in Hamadan, Iran: a brief report….................................................................130 Eini P, Esna-Ashari F, Mobaien A.R, Hasanzadeh M.

Treatment of AIDS-related thrombocytopenia: a case report ….................................................................136 Abdi Z, Alijani N.

TUMJ

TEHRAN UNIVERSITY MEDICAL JOURNAL The Official Publication of Medical School, Tehran University of Medical Sciences Volume 70

Number 2

May 2012

Chairman: S.H. Emami Razavi Editor in Chief: N. Behtash Executive Editor: M.A. Noyan Ashraf Associate Editors: SH. Akhondzadeh, A. Arab Kheradmand, N. Ataei, S. Borna, M. Ghazi Khansari, S.J. Ghazi Mirsaeed, J. Hajati, M. Kadkhodaei, A. Khoshnevisan, S. Moradmand, Z. Nadiya Hatmi, M.A. Noyan Ashraf, R. Omranipoor, N. Rezaei, N. Sajjadian Editorial Board: M. Akbarian, F. AmoozegarHashemi, B. Bahar, F. Davari Tanha, N. Ebrahimi Daryani, M.R. Hadiyan, Z. Hallaji, Z. Hussain Khan, M. Kajbaf Zadeh, M.J Mikaeli, A. Mousavi, S.M.J. Mortazavi, B. Nabaei, P. Pasalar , P. Pasbakhsh, M. Rasooli Negad, A. Shaabani, M. Sotoodeh, A.R. Talaeipoor, M. Vahid Dasjerdi, M.R. Zafarghandi International Board: F. Assadi (Chicago), J. Parvizi (Philadelphia), A. Gangi (Strasbourg), M.R. Keshtgar (London), Sh. Masood (Florida), P. Hanjani (Pennsylvania) Editors: N. Behtash, S.B. Hashemi, V. Nikoui, M.A. Noyan Ashraf Office staff: M. Asgari, H. Chaychi, A. Kamizani, R. Ramezani, S. Sadigh Publisher: Tehran University of Medical Sciences Office: Tehran University Medical Journal, Medical School, 202 Amouzesh building, Poursina Ave., Ghods St., Keshavarz Blvd., Tehran, Iran, P.o. Box: 14155-6447, Tel: +98(21)88962510, Fax: +98(21)88962510, Online submission: http://journals.tums.ac.ir/login, and http://tumj.tums.ac.ir, Email: medjournal@tums.ac.ir

TUMJ is indexed/ abstracted in: SCOPUS, EMBASE, Cambridge Scientific Abstracts (CSA), CAB Abstracts (CABI), Chemical Abstract Service (CAS), DOAJ, Psych Info, ULRICHÎ&#x201E;S, Index Copernicus, IMEMR, EMR Beta, SID, Magiran and Iran Medex