1
Survival Time and Relative Risk of Death in Patients with
Colorectal Cancer in an Iranian Population: a Cohort Study
Ali Ahmadi1, Mahmoud Mobasheri2, Seyed Saeed Hashemi Nazari3 1
PhD Candidate in Epidemiology, Faculty of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2
Associate Professor of Epidemiology, Department of Epidemiology and Biostatistics, Shahrekord University of Medical Sciences, Shahrekord, Iran
3
Assistant Professor of Epidemiology, Department of Epidemiology, Faculty of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
(Received October 29, 2013 ; Accepted April 9, 2014)
Abstract
Background and purpose: Colorectal cancer (CRC) is one of the most prevalent health
problems in the world and Iran. This study aimed at determining the survival rate of patients with CRC and the factors influencing it in Iranian patients.
Material and Methods: A prospective cohort study was carried out in patients attending 10
state and private hospitals in Tehran during 2006-2011. In this study 1127 patients (totally 2570 individuals-year) were followed up every six months and the follow-up duration was from the definite time of CRC diagnosis until death (or censoring). Only 2% of the patients were censored. Data was analyzed using stata software, bivariate and multivariate analyses, and also Cox regression.
Results: The mean age of the patients was 53.5 ± 14 years old at the time of diagnosis. Most of
the patients were older than 45 years of age (69.7%). The age at diagnosis was significantly different between men and women (P<0.03). The patients were 61.2% male and the rest were female. The rates of mortality in male and female were 96.9 and 83 in 100,000. After the diagnosis has been made 75%, 50%, and 25% had a survival rate of less than 2.72 years, 5.84 years, and longer than 13 years, respectively. In Cox model some variables including ethnicity, marital status, cancer grade, family history of caner, and smoking were the main determinants of survival.
Conclusion: The mean survival time was 5.8 years after diagnosis has been made which shows
more improvements compared to previous studies. This study provides some information on CRC survival rate so that action plans could be designed to prevent and control this disease.
Keywords: Colorectal cancer, survival time, mortalities, relative risk
هرود مرﺎﻬﭼ و ﺖﺴﻴﺑ هرﺎﻤﺷ 111 ﻦﻳدروﺮﻓ لﺎﺳ 1393 ) 8 -2 (
ﻪﺑ
نﺎﻳﻼﺘﺒﻣ
رد
نآ
يﺎﻫ
هﺪﻨﻨﻛ
ﻦﻴﻴﻌﺗ
و
گﺮﻣ
ﻲﺒﺴﻧ
ﺮﻄﺧ
،
ﺎﻘﺑ
نﺎﻣز
لﺎﺘﻛرﻮﻟﻮﻛ
نﺎﻃﺮﺳ
:
ﺮﮕﻧ
هﺪﻨﻳآ
ﻲﻫوﺮﮕﻤﻫ
ﻪﻌﻟﺎﻄﻣ
ﻚﻳ
يﺪﻤﺣاﻲﻠﻋ 1 يﺮﺷﺎﺒﻣدﻮﻤﺤﻣ 2 يﺮﻈﻧﻲﻤﺷﺎﻫﺪﻴﻌﺳﺪﻴﺳ 3
هﺪﻴﻜﭼ
فﺪﻫوﻪﻨﻴﻣز : نﺎﻃﺮﺳ مﻮﺘﻛرونﻮﻟﻮﻛيﺎﻫ ) لﺎﺘﻛرﻮﻟﻮﻛ ( ﻢﻬﻣزاﻲﻜﻳ ﻊﻳﺎﺷوﻦﻳﺮﺗ ﻼـﺳتﻼـﻀﻌﻣﻦﻳﺮﺗ ناﺮـﻳاوﺎـﻴﻧدردﺖﻣ ﺖﺳا . ﻣﻞﻣاﻮﻋوگﺮﻣﻲﺒﺴﻧﺮﻄﺧ،ﺎﻘﺑنﺎﻣزﻦﻴﻴﻌﺗفﺪﻫﺎﺑﻪﻌﻟﺎﻄﻣﻦﻳا ﺆ ﺮﺛ ﺪﻳدﺮﮔمﺎﺠﻧالﺎﺘﻛرﻮﻟﻮﻛنﺎﻃﺮﺳﻪﺑﻼﺘﺒﻣنارﺎﻤﻴﺑردنآﺮﺑ . شوروداﻮﻣ ﺎﻫ : ﻪﻌﻟﺎﻄﻣ ﺮﺿﺎﺣ هﺪﻨﻳآترﻮﻫﻮﻛعﻮﻧزا ﺖﺳاﺮﮕﻧ . نﺎﻃﺮـﺳﻲـﻌﻄﻗﺺﻴﺨـﺸﺗنﺎـﻣززاداﺮـﻓايﺮﻴﮕﻴﭘتﺪﻣ ﻣنﺎﻣزﺎﺗلﺎﺘﻛرﻮﻟﻮﻛ نآنﺪﺷرﻮﺴﻧﺎﺳﺎﻳگﺮ دﻮﺑﺎﻫ . عﻮﻤﺠﻣرد 2570 ﺮﻔﻧ ياﺮـﺑيﺮـﻴﮕﻴﭘلﺎـﺳ 1127 نﺎﻃﺮـﺳﻪـﺑﻼﺘـﺒﻣﺮـﻔﻧ مﺎﺠﻧارﺎﺒﻜﻳهﺎﻣﺶﺷﺮﻫترﻮﺻﻪﺑلﺎﺘﻛرﻮﻟﻮﻛ ﺪﺷ . ﺎﻬﻨﺗ ود ﺪﺻرد ﺪﻧدﻮﺑهﺪﺷرﻮﺴﻧﺎﺳنارﺎﻤﻴﺑزا . هداد ودﻞﻴﻠﺤﺗﺎﺑﺎﻫ وهﺮـﻴﻐﺘﻣ وﺲﻛﺎﻛنﻮﻴﺳﺮﮔروهﺮﻴﻐﺘﻣﺪﻨﭼ زاهدﺎﻔﺘﺳاﺎﺑ راﺰﻓامﺮﻧ stata ﺪﻧﺪﺷﻞﻴﻠﺤﺗ . ﻢﻛﺮﻳدﺎﻘﻣ زاﺮﺗ 05 / 0 ﻲﻨﻌﻣ ﺪﻳدﺮﮔﻲﻘﻠﺗراد . ﻪﺘﻓﺎﻳ ﺎﻫ : نﺎﻃﺮـﺳﺺﻴﺨـﺸﺗنﺎﻣزردنارﺎﻤﻴﺑﻦﺳرﺎﻴﻌﻣفاﺮﺤﻧاوﻦﻴﮕﻧﺎﻴﻣ 14 ± 5 / 53 دﻮـﺑلﺎـﺳ . ﺶﻴـﺑ نارﺎـﻤﻴﺑﺮـﺗ ) 7 / 69 ﺪﺻرد ( زاﺮﺗﻻﺎﺑﻦﺳ 45 ﺪﻨﺘﺷادلﺎﺳ . 2 / 61 نآﺪﺻرد ﺪﻧدﻮﺑنزﻪﻴﻘﺑودﺮﻣﺎﻫ . نادﺮـﻣونﺎﻧزردﺺﻴﺨﺸﺗﻦﺳ ﻲـﻨﻌﻣوتوﺎـﻔﺘﻣ اد ر دﻮﺑ ) 03 / 0 p< ( . نادﺮﻣردگﺮﻣزوﺮﺑناﺰﻴﻣ 9 / 96 نﺎﻧزردو 83 ﻚﻳرد ﺪﺻ راﺰﻫ دﻮـﺑﺮﻔﻧ . 75 ﺪـﺻرد ﻢـﻛنارﺎـﻤﻴﺑ زاﺮـﺗ 72 / 2 ،لﺎﺳ 50 ﺪﺻرد نآ ﺎﻫ 83 / 5 ولﺎﺳ 25 ﺪﺻرد نآزا ﺶﻴﺑﺎﻫ زاﺮﺗ 13 ﺪﻨﺘﺷادﺎﻘﺑ،ﺺﻴﺨﺸﺗنﺎﻣززاﺪﻌﺑلﺎﺳ . ،ﺖـﻴﻣﻮﻗيﺎـﻫﺮﻴﻐﺘﻣ ﺖﻴﻌﺿو ﺗﺄ ﻪﻠﺣﺮﻣ،ﻞﻫ ﺪﻧدﻮﺑنارﺎﻤﻴﺑﺎﻘﺑهﺪﻨﻨﻛﻦﻴﻴﻌﺗﺲﻛﺎﻛلﺪﻣردرﺎﮕﻴﺳفﺮﺼﻣونﺎﻃﺮﺳﻲﮔداﻮﻧﺎﺧﻪﻘﺑﺎﺳ،نﺎﻃﺮﺳ . جﺎﺘﻨﺘﺳا : ﺎﻘﺑنﺎﻣزﻪﻧﺎﻴﻣ 83 / 5 لﺎﺳ ﻪﻛدﻮﺑ ﻲﻣنﺎﺸﻧﻲﻠﺒﻗتﺎﻌﻟﺎﻄﻣﻪﺑﺖﺒﺴﻧاريﺮﺘﻬﺑﺪﻧور ﺪﻫد . وﺎﻘﺑشراﺰﮔﺎﺑﻪﻌﻟﺎﻄﻣﻦﻳا ﻣﻞﻣاﻮﻋولﺎﺘﻛرﻮﻟﻮﻛنﺎﻃﺮﺳگﺮﻣﻲﺒﺴﻧﺮﻄﺧ ﺆ ارﻲﺘـﺻﺮﻓ،نآﺮـﺑﺮﺛ ﻲـﻣﻢﻫاﺮـﻓ ﻪـﻣﺎﻧﺮﺑياﺮـﺟاردﺎـﺗﺪـﻨﻛ ﻪـﻠﺧاﺪﻣيﺎـﻫ ،يا ﺖﻳﻮﻟوا،نﺎﻃﺮﺳلﺮﺘﻨﻛويﺮﻴﮕﺸﻴﭘ دﺮﻴﮔراﺮﻗﺮﻈﻧﺪﻣﺎﻫ . يﺪﻴﻠﻛيﺎﻫهژاو : ﻲﺒﺴﻧﺮﻄﺧ،گﺮﻣناﺰﻴﻣ،ﺎﻘﺑنﺎﻣز،لﺎﺘﻛرﻮﻟﻮﻛنﺎﻃﺮﺳ
ﻪﻣﺪﻘﻣ
نﺎﻃﺮﺳ مﻮـﺘﻛرونﻮـﻟﻮﻛيﺎﻫ ) لﺎـﺘﻛرﻮﻟﻮﻛ ( زاﻲـﻜﻳ ﻢﻬﻣ ﻲـﻣنﺎﻬﺟردگﺮﻣﻞﻠﻋﻦﻳﺮﺗ ﺪﻨـﺷﺎﺑ . نﺎﻃﺮـﺳﻦـﻳا ،ﺎـﻫ يﺎﻫرﻮـﺸﻛردﺮـﻴﻣوگﺮـﻣﻪـﺑﺮﺠﻨﻣﻊﻳﺎﺷنﺎﻃﺮﺳﻦﻴﻣﻮﺳ ﺪﻨﺘﺴﻫﻲﺑﺮﻏ ) 1 ( . ﺘﻴﻣﻮﻗيﺮﺑاﺮﺑﺎﻧ ـ ـﻧوﻲ ـ ـﻫﺪﻣﺎﻴﭘرديداﮋ ـ يﺎ ﺖﺳادﻮﻬﺸﻣنﺎﻃﺮﺳﻦﻳا . ﺶﻳاﺰﻓاﺮﮕﻧﺎﻴﺑﺎﻫرﺎﻣآ ﻬﺟرﺎﺑ ـ ﺳﻲﻧﺎ ـ نﺎﻃﺮ ﺎﻫ ا ﺖـﺳ . زا ﻲــﻓﺮﻃ ــﻘﺑ ـ يﺎ نﺎــﻳﻼﺘﺒﻣ نﺎﻃﺮــﺳﻪــﺑ لﺎــﺣرديﺎﻫرﻮــﺸﻛرد ﻫرﻮﺸﻛﻪﺑﺖﺒﺴﻧﻪﻌﺳﻮﺗ ـ ﻌﺳﻮﺗيﺎ ـ ﺎﻳﻪ ﺘﻓ ـ ﻢﻛﻪ ﺗـ ﺖﺳاﺮ . رد لﻮﺌﺴﻣﻒﻟﻮﻣ : يﺮﻈﻧﻲﻤﺷﺎﻫﺪﻴﻌﺳ -ناﺮﻬﺗ : ﻲﺘﺸﻬﺑﺪﻴﻬﺷﻲﻜﺷﺰﭘمﻮﻠﻋهﺎﮕﺸﻧاد E-mail: saeedh_1999@yahoo.com 1 . ياﺮﺘﻛديﻮﺠﺸﻧاد يژﻮﻟﻮﻴﻣﺪﻴﭘا ، ﺖﺷاﺪﻬﺑهﺪﻜﺸﻧاد ، ﻲﺘﺸﻬﺑﺪﻴﻬﺷﻲﻜﺷﺰﭘمﻮﻠﻋهﺎﮕﺸﻧاد ناﺮﻳا،ناﺮﻬﺗ، . 2 . رﺎﻴﺸﻧاد ، رﺎﻣآويژﻮﻟﻮﻴﻣﺪﻴﭘاهوﺮﮔ ، ﺖﺷاﺪﻬﺑهﺪﻜﺸﻧاد ، دﺮﻛﺮﻬﺷﻲﻜﺷﺰﭘمﻮﻠﻋهﺎﮕﺸﻧاد ناﺮﻳا،دﺮﻛﺮﻬﺷ، 3 . ،رﺎﻳدﺎﺘﺳا يژﻮﻟﻮﻴﻣﺪﻴﭘاهوﺮﮔ ، ﺖﺷاﺪﻬﺑهﺪﻜﺸﻧاد ، ﻲﺘﺸﻬﺑﺪﻴﻬﺷﻲﻜﺷﺰﭘمﻮﻠﻋهﺎﮕﺸﻧاد ناﺮﻳا،ناﺮﻬﺗ، ﺖﻓﺎﻳردﺦﻳرﺎﺗ : 7 / 8 / 1392 تﺎﺣﻼﺻاﺖﻬﺟعﺎﺟراﺦﻳرﺎﺗ : 12 / 12 / 1392 ﺐﻳﻮﺼﺗﺦﻳرﺎﺗ : 20 / 1 / 1393
نارﺎﻜﻤﻫويﺪﻤﺣاﻲﻠﻋ نارﺪﻧزﺎﻣﻲﻜﺷﺰﭘمﻮﻠﻋهﺎﮕﺸﻧادﻪﻠﺠﻣ هرود مرﺎﻬﭼوﺖﺴﻴﺑ ، هرﺎﻤﺷ 111 ﻦﻳدروﺮﻓ، 1393 3 ﻲﺸﻫوﮋﭘ ﻳا ــ ﻫرﻮﺸﻛﻦ ـﺎ يرﺎـﻤﻴﺑﻲﻧﺎـﻳﺎﭘﻞـﺣاﺮﻣردنﺎﻃﺮﺳﺺﻴﺨﺸﺗ دﻮﺷﻲﻣمﺎﺠﻧا ﻲـﺼﻴﺨﺸﺗتﺎﻣﺪﺧﻪﺑﻲﺳﺮﺘﺳدﺖﻳدوﺪﺤﻣو دراددﻮﺟودراﺪﻧﺎﺘﺳاﻲﻧﺎﻣردو ) 2 ( . ونادﺮـﻣردﻊﻳﺎـﺷنﺎﻃﺮﺳﻦﻴﻣﻮﺳلﺎﺘﻛرﻮﻟﻮﻛنﺎﻃﺮﺳ ﺖﺳانﺎﻧزردﻊﻳﺎﺷنﺎﻃﺮﺳﻦﻴﻣود . لﺎـﺳرد 2008 زاﺶﻴـﺑ 2 / 1 وﺪﻳﺪﺟدرﻮﻣنﻮﻴﻠﻴﻣ 608700 گﺮـﻣدرﻮـﻣ زاﻲـﺷﺎﻧ نآ ﺪـﺷشراﺰﮔ ) 3 -1 ( . ﺖـﻠﻋﻦﻴـﻣودلﺎـﺘﻛرﻮﻟﻮﻛنﺎﻃﺮـﺳ ﺎــﻜﻳﺮﻣآردنﺎﻃﺮــﺳﻪــﺑﺐــﺴﺘﻨﻣگﺮــﻣ ا ﺖــﺳ . ﻪــﭼﺮــﮔا گﺮﻣ ﺎـﻣاﺖـﺳاﺶﻫﺎـﻛﻪـﺑورﺎﻜﻳﺮﻣآردنآزاﻲﺷﺎﻧيﺎﻫ دراددﻮــﺟونآيﺎﻫﺪــﻣﺎﻴﭘرديداﮋــﻧوﻲﺘﻴﻣﻮــﻗيﺮﺑاﺮﺑﺎــﻧ . ﺖﻴﻠﻗا ﻢـﻛﻞـﻳﺎﻤﺗﻲﻣﻮـﻗيﺎﻫ نﺎﻃﺮـﺳيﺮﮕﻟﺎـﺑﺮﻏﻪـﺑيﺮـﺗ ﺪـﻧرادلﺎﺘﻛرﻮﻟﻮﻛ ) 4 ( . ﺮـﮕﻳديﻮـﺳزا ﻲﻋﺎـﻤﺘﺟاﺖﻴﻌـﺿو لﺎــﺘﻛرﻮﻟﻮﻛنﺎﻃﺮــﺳﺶﻳاﺰــﻓاﺮــﻄﺧﺎــﺑﻦﻴﻳﺎــﭘيدﺎــﺼﺘﻗا درادسﻮــﻜﻌﻣﻲﮕﺘــﺴﺒﻤﻫ . لﺎــﺘﻛرﻮﻟﻮﻛنﺎﻃﺮــﺳﺮــﻄﺧ 30 ﺪﺻرد ﺶﻴـﺑﻦﻴﻳﺎـﭘيدﺎﺼﺘﻗاﻲﻋﺎﻤﺘﺟاﻪﻘﺒﻃرد ﻪـﻘﺒﻃزاﺮـﺗ ﻻﺎﺑﻲﻋﺎﻤﺘﺟا ا ﺖﺳ ) 5 ( . لﺎـﺘﻛرﻮﻟﻮﻛنﺎﻃﺮـﺳعﻮﻴـﺷﺶﻳاﺰﻓا اﺰـﻓالﺎﺣردﺖﻋﺮﺳﻪﺑﻲﺑﺮﻏﮓﻨﻫﺮﻓﺎﺑيﺎﻫرﻮﺸﻛرد ﺶﻳ ﺖﺳا ) 6 ( . يﻻﺎـﺑداﺮﻓاردلﺎﺘﻛرﻮﻟﻮﻛنﺎﻃﺮﺳزوﺮﺑ 55 لﺎـﺳ ﺶﻴﺑ ﻲﻣهﺪﻳدﺮﺗ دﻮﺷ . ﺰـﻴﻧﻒﻠﺘﺨﻣﻊﻣاﻮﺟنﺎﻴﻣردزوﺮﺑﻦﻳا ﺖــﺳاﺶﻫﺎــﻛلﺎــﺣردﺎــﻜﻳﺮﻣآردوهدﻮــﺑتوﺎــﻔﺘﻣ ) 7 ، 8 ( . ﺎـﭘوراردلﺎـﺘﻛرﻮﻟﻮﻛنﺎﻃﺮـﺳﺖﺑﺎﺛﺎﻳنﺎﻬﻨﭘﺶﻳاﺰﻓا هﺪـﻳد ﻲﻣ ودﻮﺷ ﻲﻳﺎﻴـﺳآيﺎﻫرﻮﺸﻛردنﺎﻃﺮﺳﻦﻳا ﺰـﻴﻧ لﺎـﺣرد ﺰﻓا ﺶﻳا ﺖـﺳا ) 9 ( . ردنﺎﻃﺮـﺳردداﮋـﻧﺎـﻳﻲﺘﻴﻣﻮـﻗيﺮﺑاﺮﺑﺎـﻧ ،ﺪـﻨﻠﻳزﻮﻴﻧ،ﺎـﻜﻳﺮﻣآﻪـﻠﻤﺟزاﻊـﻣاﻮﺟوﺎﻫرﻮﺸﻛزايرﺎﻴﺴﺑ ﻲﻣﻮﺑنﺎﻴﻣردﻲﻟﺎﻤﺷيﺎﻜﻳﺮﻣآوﺎﻴﻟاﺮﺘﺳا وﺎﻫ ﻏ ﻲﻣﻮـﺑﺮﻴ ﺎـﻫ ﻲﻣهﺪﻫﺎﺸﻣنﺎﺘﺳﻮﭘﺪﻴﻔﺳونﺎﺘﺳﻮﭘهﺎﻴﺳو دﻮـﺷ ) 8 ، 13 -10 ( . ﻢﻬﻣﻲﻧﺎﻣردوﻲﺼﻴﺨﺸﺗتﺎﻣﺪﺧ ﺮﺑاﺮﺑﺎﻧردارﺶﻘﻧﻦﻳﺮﺗ ي ﻲﻣيزﺎﺑﻲﻣﻮﻗ ﺪﻨﻨﻛ ) 10 ، 14 ( . ،ﻲـﺼﻴﺨﺸﺗتﺎﻣﺪـﺧناﺮﻳارد يﺎﻫﺮﻬﺷوناﺮﻬﺗردلﺎﺘﻛرﻮﻟﻮﻛنﺎﻃﺮﺳﻲﻧﺎﻣردوﻲﺘﺒﻗاﺮﻣ ﺰــﻛﺮﻤﺘﻣگرﺰــﺑ ﺖــﺳا و تﺎﻣﺪــﺧﻦــﻳا ﺮﻳﺎــﺳزاتوﺎــﻔﺘﻣ ﺖﻴﻠﻗاﺖﺴﻳزﻞﺤﻣوﺎﻫﺮﻬﺷ ﺖﺳاﻲﻣﻮﻗيﺎﻫ . نﺎﻃﺮـﺳﻦـﻳا ﺖـﺳاﺶﻳاﺰـﻓالﺎـﺣردوﻊﻳﺎـﺷنﺎﻃﺮـﺳﻦﻴﻤﺸﺷناﺮﻳارد . ﻪﻧﺎﻴﻟﺎﺳ 4000 رﻮـﻣ وﺪـﻳﺪﺟد 1150 زاﻲـﺷﺎﻧگﺮـﻣدرﻮـﻣ ناﺮـﻳاردلﺎﺘﻛرﻮﻟﻮﻛنﺎﻃﺮﺳ ﻲـﻣشراﺰـﮔ دﻮـﺷ ) 15 ( . ﻖـﺒﻃ هﺪﺷمﺎﺠﻧايﺎﻫﻲﺳرﺮﺑ ﻪﻌﻟﺎﻄﻣ وناﺰـﻴﻣﻦﻴـﻴﻌﺗرﻮـﻈﻨﻣﻪﺑيا ﺎـﻳﺮـﺸﺘﻨﻣناﺮـﻳاردلﺎـﺘﻛرﻮﻟﻮﻛنﺎﻃﺮـﺳگﺮﻣﻲﺒﺴﻧﺮﻄﺧ ﺖﺳاهﺪﺸﻧمﺎﺠﻧا اﺬﻟ ﺮـﻄﺧ،ﺎـﻘﺑﻦﻴـﻴﻌﺗفﺪـﻫﺎﺑﻪﻌﻟﺎﻄﻣﻦﻳا ــﻣﻞــﻣاﻮﻋوگﺮــﻣﻲﺒــﺴﻧ ﺆ آﺮــﺑﺮﺛ ﻪــﺑﻼﺘــﺒﻣنارﺎــﻤﻴﺑردن ﺪﻳدﺮﮔمﺎﺠﻧالﺎﺘﻛرﻮﻟﻮﻛنﺎﻃﺮﺳ .
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شور
ﺎﻫ
ﻦﻳا هﺪﻨﻳآترﻮﻫﻮﻛعﻮﻧزاﻪﻌﻟﺎﻄﻣ ﺖﺳاﺮﮕﻧ . هداد يﺎﻫ هدﺎﻔﺘــﺳادرﻮــﻣ ﻪــﻌﻟﺎﻄﻣﻦــﻳارد ﺖــﺒﺛﻲﺗﺎــﻋﻼﻃاهﺎــﮕﻳﺎﭘزا يرﺎــﻤﻴﺑتﺎــﻘﻴﻘﺤﺗﺰــﻛﺮﻣردلﺎــﺘﻛرﻮﻟﻮﻛنﺎﻃﺮــﺳ يﺎــﻫ ﺪﻴﻬـﺷﻲﻜـﺷﺰﭘمﻮـﻠﻋهﺎﮕـﺸﻧادﻪـﺑﻪﺘـﺴﺑاوﺪـﺒﻛوشراﻮﮔ ﻬﺑ ﻪﻴﻬﺗﻲﺘﺸ ﺪـﺷ . هدادﻦـﻳا ﻪـﻌﺟاﺮﻣنارﺎـﻤﻴﺑﻪـﺑطﻮـﺑﺮﻣﺎـﻫ ﻪﺑهﺪﻨﻨﻛ 10 ﺪﻨﺘﺴﻫناﺮﻬﺗردﻲﺻﻮﺼﺧوﻲﺘﻟودنﺎﺘﺳرﺎﻤﻴﺑ ﻪـﺑﻼﺘﺒﻣنارﺎﻤﻴﺑﻪﻛ ﺖـﺒﺛﺰـﻛﺮﻣﻪـﺑارلﺎـﺘﻛرﻮﻟﻮﻛنﺎﻃﺮـﺳ عﺎﺟرارﻮﻛﺬﻣنﺎﻃﺮﺳ ﻲﻣ ﺪﻨﻫد . نارﺎـﻤﻴﺑترﻮﻫﻮﻛﺖﻴﻌﻤﺟ شراﺰﮔسﺎﺳاﺮﺑ ﺐﻴﺳآ نﺎﻃﺮـﺳﻲـﻌﻄﻗﺺﻴﺨـﺸﺗوﻲﺳﺎﻨﺷ ﻴﻌﺗلﺎﺘﻛرﻮﻟﻮﻛ ﻦﻴ ﺪﺷ . هﺎﻣﺮﻬﻣلوازاﻪﻌﻟﺎﻄﻣ 85 ﺪـﺷزﺎـﻏآ هﺎﻣنﺎﺑآلواﺎﺗنارﺎﻤﻴﺑو 1390 ﺪﻨﺘﻓﺮﮔراﺮﻗيﺮﻴﮕﻴﭘﺖﺤﺗ . مﺮـﻓﻪـﻌﻟﺎﻄﻣردهﺪﻨﻨﻛﺖﻛﺮﺷداﺮﻓا ﺖﻳﺎـﺿر وﻲـﺒﺘﻛﻪـﻣﺎﻧ ﻪــﻧﺎﻫﺎﮔآ ار ﻞــﻴﻤﻜﺗ ﺪــﻧدﺮﻛ و ﻪــﻌﻟﺎﻄﻣﻦــﻳا زﻮــﺠﻣياراد هرﺎﻤــﺷﻪــﺑقﻼــﺧاﻪــﺘﻴﻤﻛ 676 ﺖــﺳارﻮــﺑﺰﻣهﺎﮕــﺸﻧادزا . ﻣززاداﺮﻓايﺮﻴﮕﻴﭘ لﺎـﺘﻛرﻮﻟﻮﻛنﺎﻃﺮـﺳﻲﻌﻄﻗﺺﻴﺨﺸﺗنﺎ نآنﺪـﺷرﻮـﺴﻧﺎﺳﺎـﻳﻪـﻌﻟﺎﻄﻣنﺎـﻳﺎﭘوگﺮﻣنﺎﻣزﺎﺗ ﻪـﺑﺎـﻫ ﻚﻳهﺎﻣﺶﺷﺮﻫترﻮﺻ مﺎـﺠﻧارﺎﺑ ﺪـﺷ . نﺎﻃﺮـﺳﺺﻴﺨـﺸﺗ ﻪــﻘﺒﻃﻢﺘــﺴﻴﺳيﺎــﻫرﺎﻴﻌﻣﺎــﺑلﺎــﺘﻛرﻮﻟﻮﻛ يﺪــﻨﺑ ﻦﻴــﺑ ﻲــﻠﻠﻤﻟا يرﺎﻤﻴﺑ ﺐﻴـﺳآوﺎـﻫ ويژﻮﻟﻮﺗﺎـﭘشراﺰـﮔسﺎـﺳاﺮـﺑوﺎـﻫ نﺎﻃﺮـﺳياﺮـﺑﻲﻳﺎـﻜﻳﺮﻣآنﻮﻴﺴﻴﻤﻛيﺎﻫرﺎﻴﻌﻣ ﺪـﺷمﺎـﺠﻧا . نارﺎﻤﻴﺑردﻲﻳﺎﻬﻧﺪﻣﺎﻴﭘ ﻖﻳﺮﻃزا ﺶـﺳﺮﭘدرﻮﻣﻲﻨﻔﻠﺗسﺎﻤﺗ ﺖــﻓﺮﮔراﺮــﻗ . ود ﺪــﺻرد زاوهﺪــﺷرﻮــﺴﻧﺎﺳنارﺎــﻤﻴﺑ 98 ﺪﺻرد ﺮﻈﻧدرﻮﻣتﺎﻋﻼﻃانارﺎﻤﻴﺑ ﻊﻤﺟ ﺪـﺷيروآ . دراﻮـﻣ ﺎـﻳلﺎﺘﻛرﻮﻟﻮﻛنﺎﻃﺮﺳزاﻲﺷﺎﻧگﺮﻣﺖﻠﻋﻪﺑهﺪﺷرﻮﺴﻧﺎﺳ ﺐﻴﻗريﺎﻫﺮﻄﺧ ) ـﺑﻲـﺘﻠﻋﺮـﻫزاﻲﺷﺎﻧگﺮﻣ ﻪ نﺎﻃﺮـﺳﺰـﺟ ﻮﻟﻮﻛ لﺎﺘﻛر ( ﻪـﺑﻲـﺳﺮﺘﺳدمﺪـﻋﺎـﻳوﻪـﻌﻟﺎﻄﻣمﺎـﻤﺗازاﻞﺒﻗ دﻮﺑنارﺎﻤﻴﺑ . عﻮﻤﺠﻣرد زا 2570 ﺮﻔﻧ -ردلﺎﺳ 1127 رﺎـﻤﻴﺑ
ﺪـــﺷمﺎـــﺠﻧايﺮـــﻴﮕﻴﭘلﺎـــﺘﻛرﻮﻟﻮﻛنﺎﻃﺮـــﺳﻪـــﺑﻼﺘـــﺒﻣ . ﺺﺧﺎﺷ ردگﺮـﻣﻲﺒـﺴﻧﺮﻄﺧوزوﺮﺑناﺰﻴﻣ،ﻲﻔﻴﺻﻮﺗيﺎﻫ ﻞﻴﻠﺤﺗوﻪﺒﺳﺎﺤﻣنارﺎﻤﻴﺑ ﺪـﻳدﺮﮔمﺎـﺠﻧاهﺮـﻴﻐﺘﻣﻚـﺗيﺎـﻫ . ﻞﻣاﻮﻋﻲﺑﺎﻳزراياﺮﺑ فﺬـﺣونارﺎـﻤﻴﺑيﺎـﻘﺑهﺪـﻨﻨﻛﻦﻴﻴﻌﺗ يﺎﻫﺮﻴﻐﺘﻣ،هﺪﻨﻨﻛشوﺪﺨﻣيﺎﻫﺮﻴﻐﺘﻣ ﻊﻤﺟ ﻚـﺗهﺪﺷيروآ ﻚﻳدﺰﻧيﺎﻫﺮﻴﻐﺘﻣولﺪﻣدراوﻚﺗﻪﺑ ﻲﻨﻌﻣﻪﺑ يراد ) 2 / 0 p< ( نﻮﻴـﺳﺮﮔروهﺮﻴﻐﺘﻣﺪﻨﭼلﺪﻣدراو ﺪـﻳدﺮﮔﺲﻛﺎـﻛ . ضﺮـﻓ ﺮــﻄﺧﺐــﺳﺎﻨﺗ (Ph-Test) نﻮــﻣزآﺎــﺑ schoenfeld ياﺮــﺑ ﻲﺑﺎـﻳزرالﺪـﻣﻪـﺑهﺪﺷدراويﺎﻫﺮﻴﻐﺘﻣ ، راﺮـﻗﺮﺑ دﻮـﺑ . ﺮﻳدﺎـﻘﻣ 05 / 0 p< ﻨﻌﻣ ﻲ راد ﻲﻘﻠﺗ ﺪﻳدﺮﮔ . زا مﺮـﻧ راﺰـﻓا stata version 12 هدادﻞﻴﻠﺤﺗوﻪﻳﺰﺠﺗياﺮﺑ ﺪﺷهدﺎﻔﺘﺳاﺎﻫ .
ﺎﻫ
ﻪﺘﻓﺎﻳ
زا 1127 ،لﺎـﺘﻛرﻮﻟﻮﻛنﺎﻃﺮﺳﻪﺑﻼﺘﺒﻣدرﻮﻣ 690 ﺮـﻔﻧ ) 2 / 61 ﺪﺻرد ( ودﺮـﻣ 437 ﺮـﻔﻧ ) 8 / 38 ﺪـﺻرد ( ﺪـﻧدﻮﺑنز . ﻲﻨﺳﻪﻨﻣاد داﺮﻓا ﻦﻴﺑ 14 ﺎﺗ 94 ﻮﺑلﺎﺳ د . فاﺮـﺤﻧاوﻦﻴﮕﻧﺎﻴﻣ نﺎﻃﺮـﺳﺺﻴﺨﺸﺗنﺎﻣزردﻦﺳرﺎﻴﻌﻣ 14 ± 5 / 53 دﻮـﺑلﺎـﺳ . ﻪﻘﺒﻃرد ﻦﺳيﺪﻨﺑ ، ﻢﻛﻪﺑنارﺎﻤﻴﺑ زاﺮـﺗ 45 ،لﺎـﺳ 45 ﺎـﺗ 65 ﺶﻴﺑولﺎﺳ زاﺮﺗ 65 لﺎﺳ وﺪﻧﺪﺷيﺪﻨﺑﻪﻘﺒﻃ هوﺮﮔﺮﻫرد ﻪﺑ ﺐــﻴﺗﺮﺗ 2 / 30 ، 5 / 45 و 3 / 24 نارﺎــﻤﻴﺑﺪــﺻرد ﺪﻨﺘــﺷادراﺮــﻗ . ﺶﻴﺑ ﻲﻨـﺳهوﺮﮔردنارﺎﻤﻴﺑﺮﺗ 45 ـﺗ ﺎ 65 لﺎـﺳ ﺪـﻧدﻮﺑ . ﻦـﺳ نادﺮﻣردنﺎﻃﺮﺳﺺﻴﺨﺸﺗ 3 / 54 نﺎﻧزردو 4 / 52 لﺎﺳ دﻮـﺑ ﻪﻛ ﻲﻨﻌﻣتوﺎﻔﺗيرﺎﻣآﺮﻈﻧزا يراد ) 029 / 0 = p ( نﺎـﻧزﻦﻴـﺑ دﻮﺟونادﺮﻣو ﺖﺷاد . ﺶﻴـﺑ ﺮـﺗ نارﺎـﻤﻴﺑ ) 5 / 55 ﺪـﺻرد ( رد لﺎـﺘﻛرﻮﻟﻮﻛنﺎﻃﺮﺳلواﻪﻠﺣﺮﻣ دﻮﺑهﺪـﺷهدادﺺﻴﺨـﺸﺗ ﺪـﻧ . ﺎﺑﻦﺳﺎﺑنارﺎﻤﻴﺑرديرﺎﻤﻴﺑﻪﺘﻓﺮﺸﻴﭘﻞﺣاﺮﻣ ﻊﻳﺎﺷﺮﺗﻻ ﺮﺗ دﻮﺑ ) 012 / 0 = p .( ﻲــﮔﮋﻳو يﺎــﻫﺮﻴﻐﺘﻣﺐــﺴﺣﺮــﺑنارﺎــﻤﻴﺑيﺎــﻫ نﺎﻃﺮـــﺳزاﻲـــﺷﺎﻧگﺮـــﻣزوﺮـــﺑناﺰـــﻴﻣ،ﻚـــﻴﻓاﺮﮔﻮﻣد هرﺎﻤﺷلوﺪﺟردلﺎﺘﻛرﻮﻟﻮﻛ 1 ﺖـﺳاهﺪـﻣآ . ﺮـﻄﺧﺖﺒـﺴﻧ گﺮﻣ ) ﻲﺒﺴﻧﺮﻄﺧ ( لﺪـﻣوهﺮـﻴﻐﺘﻣﻚـﺗﻞـﻴﻠﺤﺗزاﻞـﺻﺎﺣ هرﺎﻤـﺷلوﺪـﺟردﺲﻛﺎـﻛنﻮﻴـﺳﺮﮔرهﺮﻴﻐﺘﻣﺪﻨﭼ 2 هﺪـﻣآ ﺖﺳا . 75 ﺪﺻرد ارﺎﻤﻴﺑ ﻢـﻛن زاﺮـﺗ 1 / 13 ،لﺎـﺳ 50 ﺪـﺻرد نآ ﺎﻫ 84 / 5 ولﺎﺳ 25 ﺪﺻرد نآزا ﺶﻴـﺑﺎـﻫ زاﺮـﺗ 13 لﺎـﺳ ﺪﻨﺘـﺷادﺎـﻘﺑ،ﺺﻴﺨـﺸﺗنﺎﻣززاﺪﻌﺑ . لﺪـﻣردﺮـﻄﺧﺖﺒـﺴﻧ يﺎﻫﺮﻴﻐﺘﻣلﺮﺘﻨﻛوﺎﻫﺮﻴﻐﺘﻣﺮﻳﺎﺳدﻮﺟوﺎﺑﺲﻛﺎﻛنﻮﻴﺳﺮﮔر شوﺪﺨﻣ دﺮـﻛمﻮـﻗياﺮﺑ،لﺪﻣردهﺪﻨﻨﻛ 95 / 1 ﻲـﻨﻌﻣو راد ) 046 / 0 = p (. ﺑ ﻪ ﺪﻣآﺖﺳد . ﺴﻧﻦﻳا ﺮـﻟمﻮـﻗياﺮـﺑﺖﺒ 44 / 0 ﻪﻛدﻮﺑ ﻢﻛ دﻮﺑلﺪﻣردﺮﻄﺧﺖﺒﺴﻧﻦﻳﺮﺗ . دﺮـﻛمﻮـﻗرد 75 ﺪﺻرد ﺎﺗنارﺎﻤﻴﺑ 4 / 2 تﻮـﻓنﺎﻃﺮـﺳﺺﻴﺨـﺸﺗزاﺪـﻌﺑلﺎﺳ ﺪﻧدﻮﻤﻧ . ﺖﻴﻣﻮﻗردلﺎﺳﺐﺴﺣﺮﺑﺎﻘﺑنﺎﻣزﻪﻧﺎﻴﻣ ،سرﺎﻓيﺎﻫ ﺐﻴﺗﺮﺗﻪﺑنارﺎﻤﻴﺑﻞﻛوماﻮﻗاﺮﻳﺎﺳ،كﺮﺗ،ﺮﻟ،دﺮﻛ 8 / 5 ، 0 ، 4 / 0 ، 5 / 8 ، 7 / 7 و 8 / 5 دﻮــﺑلﺎـﺳ . ﻨﻣ ﺮــﺑنارﺎـﻤﻴﺑيﺎــﻘﺑﻲـﻨﺤ نﺎـﻨﻴﻤﻃادوﺪـﺣﺎﺑﺖﻴﺴﻨﺟﺐﺴﺣ 95 ﺪـﺻرد ردوﻢﻴـﺳﺮﺗ رادﻮﻤﻧ هرﺎﻤﺷ 1 ﺖﺳاهﺪﻣآ . رادﻮﻤﻧ هرﺎﻤﺷ 1 : نﺎﻃﺮـﺳﻪﺑﻼﺘﺒﻣنارﺎﻤﻴﺑﻲﻗﺎﺑياﺮﺑﺮﻳﺎﻣنﻼﭘﺎﻛﻲﻨﺤﻨﻣ ﺖﻴﺴﻨﺟﺐﺴﺣﺮﺑلﺎﺘﻛرﻮﻟﻮﻛ هرﺎﻤﺷلوﺪﺟ 1 : ﺐـﺴﺣﺮـﺑﺮـﻔﻧراﺰـﻫﺪـﺼﻜﻳردگﺮـﻣزوﺮـﺑناﺰـﻴﻣ ﻚــﻴﻓاﺮﮔﻮﻣديﺎــﻫﺮﻴﻐﺘﻣ ﻪــﺑﻼﺘــﺒﻣنارﺎــﻤﻴﺑردهﺪــﺷﻲــﺳرﺮﺑﻞــﻣاﻮﻋو لﺎﺘﻛرﻮﻟﻮﻛنﺎﻃﺮﺳ نﺎﻨﻴﻤﻃاﻪﻠﺻﺎﻓ 95 ﺪﺻرد گﺮﻣزوﺮﺑناﺰﻴﻣ گﺮﻣﻲﻧاواﺮﻓ ﺪﺻرد ﺮﻴﻐﺘﻣ 1 / 113 -79 9 / 171 – 4 / 62 8 / 144 – 3 / 54 3 / 97 – 5 / 51 2 / 204 – 6 / 114 5 / 94 7 / 103 7 / 88 8 / 70 153 120 15 16 38 46 52 2 / 8 5 / 7 5 / 21 8 / 10 ﺎﻓ ﺖﻴﻣﻮﻗ سر دﺮﻛ ﺮﻟ كﺮﺗ ﺮﻳﺎﺳ * 8 / 113 – 9 / 82 7 / 102 – 1 / 67 9 / 96 83 150 85 3 / 61 7 / 38 دﺮﻣ ﺖﻴﺴﻨﺟ نز 1 / 98 – 2 / 74 3 / 240 – 9 / 107 3 / 85 161 197 24 93 7 ﻞﻫﺎﺘﻣ ﻞﻫﺎﺗﻊﺿو دﺮﺠﻣ 8 / 146 – 9 / 86 5 / 105 – 3 / 60 1 / 106 – 7 / 54 9 / 113 – 3 / 56 113 8 / 79 2 / 76 80 56 49 35 31 5 / 26 2 / 32 5 / 24 8 / 16 داﻮﺴﻴﺑ داﻮﺳﺢﻄﺳ ﻲﻳاﺪﺘﺑا نﺎﺘﺳﺮﻴﺑد هﺎﮕﺸﻧاد 84 – 8 / 51 126 – 77 191 – 79 1 / 66 6 / 98 7 / 123 66 63 20 5 / 55 7 / 35 8 / 8 ﻚﻳ رﻮﻣﻮﺗﻪﺟرد ود رﺎﻬﭼوﻪﺳ 4 / 88 – 4 / 56 131 – 92 6 / 70 8 / 109 76 124 2 / 45 8 / 54 ﻪﻴﻟوا نﺎﻃﺮﺳﻪﻠﺣﺮﻣ ﻪﺘﻓﺮﺸﻴﭘ 112 -8 / 70 101 -6 / 68 142 -87 89 83 111 73 99 63 2 / 30 5 / 45 3 / 24 ﻲﻨﺳهوﺮﮔ 45 < 65 -45 65 > 116 -84 97 -62 99 78 145 79 2 / 63 8 / 36 دراﺪﻧ ﻲﮔداﻮﻧﺎﺧﻪﻘﺑﺎﺳ دراد نﺎﻃﺮﺳ 9 / 101 – 64 5 / 121 – 6 / 79 8 / 86 5 / 101 150 65 5 / 73 5 / 26 دراﺪﻧ رﺎﮕﻴﺳلﺎﻤﻌﺘﺳا دراد * ﻧﻼﻴﮔ،چﻮﻠﺑﺮﺑﻞﻤﺘﺸﻣ ﻲﻧﺎﻐﻓاوبﺮﻋ،ﻲ
نارﺎﻜﻤﻫويﺪﻤﺣاﻲﻠﻋ نارﺪﻧزﺎﻣﻲﻜﺷﺰﭘمﻮﻠﻋهﺎﮕﺸﻧادﻪﻠﺠﻣ هرود مرﺎﻬﭼوﺖﺴﻴﺑ ، هرﺎﻤﺷ 111 ﻦﻳدروﺮﻓ، 1393 5 ﻲﺸﻫوﮋﭘ هرﺎﻤﺷلوﺪﺟ 2 : ﺮـﻄﺧﺖﺒﺴﻧﻦﻴﻴﻌﺗوهﺮﻴﻐﺘﻣﺪﻨﭼوهﺮﻴﻐﺘﻣﻚﺗﻞﻴﻠﺤﺗ گﺮﻣ ) ﻲﺒﺴﻧﺮﻄﺧ ( ﻣﻞﻣاﻮﻋو ﺆ نﺎﻃﺮـﺳﻪـﺑﻼﺘـﺒﻣنارﺎـﻤﻴﺑيﺎـﻘﺑﺮـﺑﺮﺛ لﺎﺘﻛرﻮﻟﻮﻛ هﺮﻴﻐﺘﻣﺪﻨﭼﻞﻴﻠﺤﺗ ) ﺲﻛﺎﻛنﻮﻴﺳﺮﮔرﻲﻳﺎﻬﻧلﺪﻣ ( هﺮﻴﻐﺘﻣﻚﺗﻞﻴﻠﺤﺗ ﺮﻴﻐﺘﻣ راﺪﻘﻣ P نﺎﻨﻴﻤﻃاﻪﻠﺻﺎﻓ 95 ﺪﺻرد رﺎﻴﻌﻣفاﺮﺤﻧا ﺮﻄﺧﺖﺒﺴﻧ ﻪﻠﺻﺎﻓوﺮﻄﺧﺖﺒﺴﻧ نﺎﻨﻴﻤﻃا 95 ﺪﺻرد - 046 / 0 76 / 3 – 01 / 1 071 / 0 07 / 1 -18 / 0 071 / 0 04 / 1 -33 / 0 45 / 0 67 / 2 -78 / 0 ﺲﻧاﺮﻓر - 95 / 1 65 / 0 44 / 0 19 / 0 59 / 0 17 / 0 44 / 1 45 / 0 ﺲﻧاﺮﻓر 8 / 1 -6 / 0 : 1 / 1 6 / 1 -5 / 0 : 9 / 0 1 / 1 -5 / 0 : 7 / 0 3 / 2 -1 / 1 : 6 / 1 ﺖﻴﻣﻮﻗ سرﺎﻓ دﺮﻛ ﺮﻟ كﺮﺗ ﺮﻳﺎﺳ * - 010 / 0 84 / 3 -19 / 1 ﺲﻧاﺮﻓر - 14 / 2 63 / 0 ﺲﻧاﺮﻓر 8 / 2 -2 / 1 : 8 / 1 ﻞﻫﺎﺗﻊﺿو ﻞﻫﺎﺘﻣ دﺮﺠﻣ 12 / 0 68 / 2 – 89 / 0 806 / 0 63 / 1 – 53 / 0 849 / 0 72 / 1 – 51 / 0 - 54 / 1 43 / 0 93 / 0 26 / 0 94 / 0 99 / 0 ر ﺲﻧاﺮﻓ - 1 / 2 – 9 / 0 : 4 / 1 5 / 1 -6 / 0 : 9 / 0 5 / 1 -5 / 0 : 9 / 0 ﺲﻧاﺮﻓر داﻮﺳﺢﻄﺳ داﻮﺴﻴﺑ ﻲﻳاﺪﺘﺑا نﺎﺘﺳﺮﻴﺑد هﺎﮕﺸﻧاد - 372 / 0 86 / 1 – 79 / 0 010 / 0 75 / 3 – 19 / 1 ﺲﻧاﺮﻓر - 21 / 1 26 / 0 11 / 2 61 / 0 ﺲﻧاﺮﻓر 1 / 2 – 1 / 1 : 4 / 1 1 / 3 -1 / 1 : 8 / 1 ﻚﻳ رﻮﻣﻮﺗﻪﺟرد ود رﺎﻬﭼوﻪﺳ 611 / 0 01 / 1 -98 / 0 0/07 1/01 1/2 :0/9 -1/7 نﺎﻃﺮﺳﺺﻴﺨﺸﺗﻦﺳ - 014 / 0 89 / 0 – 38 / 0 - 58 / 0 12 / 0 ﺲﻧاﺮﻓر 1 / 1 -6 / 0 : 7 / 0 دراﺪﻧ ﻲﮔداﻮﻧﺎﺧﻪﻘﺑﺎﺳ نﺎﻃﺮﺳ دراد - 036 / 0 34 / 2 – 03 / 1 - 55 / 1 32 / 0 ﺲﻧاﺮﻓر 5 / 1 -8 / 0 : 1 / 1 رﺎﮕﻴﺳلﺎﻤﻌﺘﺳا دراﺪﻧ دراد * ﻲﻧﺎﻐﻓاوبﺮﻋ،ﻲﻧﻼﻴﮔ،چﻮﻠﺑﺮﺑﻞﻤﺘﺸﻣ
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وﻊﻳﺎـﺷنﺎﻃﺮـﺳﻦﻴﻤﺸﺷناﺮﻳاردلﺎﺘﻛرﻮﻟﻮﻛنﺎﻃﺮﺳ ﺖﺳاﺶﻳاﺰﻓالﺎﺣرد . ﻪﻧﺎﻴﻟﺎﺳ 4000 وﺪـﻳﺪﺟدرﻮـﻣ 1150 ناﺮﻳاردلﺎﺘﻛرﻮﻟﻮﻛنﺎﻃﺮﺳزاﻲﺷﺎﻧگﺮﻣدرﻮﻣ شراﺰـﮔ ﻲﻣ دﻮﺷ . لﺎـﺳﻪﻌﻟﺎﻄﻣسﺎﺳاﺮﺑ 2008 نﺎـﻣزﻪـﻧﺎﻴﻣناﺮـﻳارد لﺎﺘﻛرﻮﻟﻮﻛنﺎﻃﺮﺳﺺﻴﺨﺸﺗزاﺲﭘنارﺎﻤﻴﺑيﺎﻘﺑ 5 / 3 لﺎﺳ شراﺰﮔ ﺪﺷ . ردلﺎـﺘﻛرﻮﻟﻮﻛنﺎﻃﺮـﺳﻼﺘـﺒﻣنارﺎـﻤﻴﺑيﺎـﻘﺑ دوﺪﺣ،ناﺮﻳا 41 ﺪﺻرد ﻦـﻳاﻪـﺑﻼﺘـﺒﻣنارﺎـﻤﻴﺑيﺎـﻘﺑناﺰﻴﻣ ﺖـﺳاﻪﺘﻓﺎﻳﻪﻌﺳﻮﺗيﺎﻫرﻮﺸﻛردنﺎﻃﺮﺳعﻮﻧ ) 15 ( . ﻞـﻴﻟدﻪـﺑ ﻪـﺑﻼﺘـﺒﻣنارﺎـﻤﻴﺑيﺎـﻘﺑنﺎـﻣزشراﺰـﮔمﺪـﻋﺎﻳمﺎﺠﻧامﺪﻋ نﺎﻃﺮﺳ مﺎـﺠﻧاﻪﻌﻟﺎﻄﻣﻦﻳا،قﻮﻓشراﺰﮔزاﺲﭘلﺎﺘﻛرﻮﻟﻮﻛ ﺪﺷ . ﺺﻴﺨـﺸﺗزاﺲﭘنارﺎﻤﻴﺑيﺎﻘﺑنﺎﻣزﻪﻧﺎﻴﻣﺎﻣﻪﻌﻟﺎﻄﻣرد لﺎﺘﻛرﻮﻟﻮﻛنﺎﻃﺮﺳ 84 / 5 ﺑلﺎﺳ ﻪ ﻪـﺑﺖﺒـﺴﻧﻪـﻛﺪﻣآﺖﺳد ﻲﻣنﺎﺸﻧاريﺮﺘﻬﺑﺪﻧورﻲﻠﺒﻗﻪﻌﻟﺎﻄﻣشراﺰﮔ ﺪـﻫد . ﻦـﻳارد ردلﺎﺘﻛرﻮﻟﻮﻛنﺎﻃﺮﺳزاﻲﺷﺎﻧﺮﻄﺧﺖﺒﺴﻧيﺮﺑاﺮﺑﺎﻧﻪﻌﻟﺎﻄﻣ ـﻴﻣﻮﻗﻦﻴﺑ ﺖ هﺪﻫﺎـﺸﻣﻲـﻧاﺮﻳايﺎـﻫ ﺪـﺷ . ﻦﻴـﻟواﻪـﻌﻟﺎﻄﻣﻦـﻳا ﻪﻠﻤﺟزاوﺎﻫنﺎﻃﺮﺳيﺎﻘﺑﺮﻄﺧيﺮﺑاﺮﺑﺎﻧﻪﻛﺖﺳاﻲﺸﻫوﮋﭘ ﻲــﻣشراﺰــﮔارناﺮــﻳاردلﺎــﺘﻛرﻮﻟﻮﻛنﺎﻃﺮــﺳ ﺪــﻨﻛ . رد ﻢﻛدﺮﻛمﻮﻗ،ﻲﻧاﺮﻳاماﻮﻗاﻦﻴﺑﻪﺴﻳﺎﻘﻣ وﺎـﻘﺑنﺎﻣزﻪﻧﺎﻴﻣﻦﻳﺮﺗ ﺶﻴﺑﺮﻟمﻮﻗ درادلﺎـﺘﻛرﻮﻟﻮﻛنﺎﻃﺮـﺳردارﺎﻘﺑنﺎﻣزﻦﻳﺮﺗ . و،ﺖــﻴﻣﻮﻗ ﺗﺖﻴﻌــﺿ ﺄ ﻪﻘﺑﺎــﺳ،نﺎﻃﺮــﺳمﻮــﺳﻪــﻠﺣﺮﻣ،ﻞــﻫ ﻮﻧﺎﺧ ا يﺎـﻫﺮﻴﻐﺘﻣﺰـﻴﻧنﺪﻴـﺸﻛرﺎﮕﻴﺳونﺎﻃﺮﺳﻪﺑﻼﺘﺑاﻲﮔد هﺪﻨﻨﻛﻦﻴﻴﻌﺗ ﺪـﻧدﻮﺑﺲﻛﺎـﻛلﺪـﻣردنارﺎـﻤﻴﺑيﺎﻘﺑ . ﺞﻳﺎـﺘﻧ ﻪـﻌﻟﺎﻄﻣﺞﻳﺎـﺘﻧﺎـﺑﺎﻣﻪﻌﻟﺎﻄﻣ رديﺮﺑاﺮﺑﺎـﻧﻪـﻛﺎـﻜﻳﺮﻣآرديا ﺮــﻴﻏوﺪﻴﻔــﺳيﺎــﻫﻲﻳﺎﻴﻧﺎﭙــﺳاردنﺎﻃﺮــﺳزوﺮــﺑناﺰــﻴﻣ ﻲﻳﺎﻴﻧﺎﭙﺳا شراﺰـﮔارﺎﻫ ﺖـﺳاﻪﺑﺎـﺸﻣ،دﻮـﻤﻧ ) 1 ، 8 ( . ﻦـﻳارد ﺢﻄـﺳﺎـﺑنآزاﻲـﺷﺎﻧگﺮـﻣولﺎﺘﻛرﻮﻟﻮﻛنﺎﻃﺮﺳﻪﻌﻟﺎﻄﻣ ﺖﺷادﻲﺳﻮﻜﻌﻣويﻮﻗﻪﻄﺑارداﺮﻓاداﻮﺳوشزﻮﻣآ . يﺎـﻘﺑ ﻲـﺑداﺮـﻓاردلﺎﺘﻛرﻮﻟﻮﻛنﺎﻃﺮﺳ ﻢـﻛداﻮـﺳ نﺎـﻳﻼﺘﺒﻣزاﺮـﺗ دﻮﺑداﻮﺳﺎﺑ . ﺎﻫرﻮﺸﻛﺮﻳﺎﺳردﻪﺑﺎﺸﻣتﺎﻌﻟﺎﻄﻣﺎﺑﺰﻴﻧﻪﺘﻓﺎﻳﻦﻳا ﻢﻫ درادﻲﻧاﻮﺧ ) 5 ، 11 ( . ﻪـﻠﺧاﺪﻣمﺎﺠﻧاياﺮﺑﻦﻳاﺮﺑﺎﻨﺑ ، لﺮـﺘﻨﻛ ﻲــﺑداﺮــﻓالﺎــﺘﻛرﻮﻟﻮﻛنﺎﻃﺮــﺳزايﺮﻴﮕــﺸﻴﭘو زاداﻮــﺳ ﺪــﻧرادرﻮﺧﺮﺑﺖــﻳﻮﻟوا . نﺎــﻣزردنﺎﻃﺮــﺳﺪــﻳﺮﮔﺎــﻳﻪــﻠﺣﺮﻣ ﻲﻨﻌﻣوﻢﻬﻣﺮﻴﻐﺘﻣ،ﺺﻴﺨﺸﺗ ﺮﻳﺎـﺳﺎـﺑﻪﻛدﻮﺑلﺪﻣرديراد هﺪﺷمﺎﺠﻧاتﺎﻌﻟﺎﻄﻣ ﻪﻨﻴﻣزﻦﻳارد درادﺖﻘﺑﺎﻄﻣ ) 12 ( . گﺮـﻣ لﺎــﺘﻛرﻮﻟﻮﻛنﺎﻃﺮــﺳزاﻲــﺷﺎﻧ زاﺮﺗﻻﺎــﺑداﺮــﻓارد 65 لﺎــﺳ ﺶﻴﺑ هوﺮﮔﺮﻳﺎﺳزاﺮﺗ دﻮـﺑﻲﻨﺳيﺎﻫ . نارﺎـﻤﻴﺑﺖﻴـﺴﻨﺟﻦﻴـﺑ ﻲﻨﻌﻣفﻼﺘﺧا ﺪﺸﻧهﺪﻫﺎﺸﻣﺎﻘﺑرديراد . ﺺﻴﺨـﺸﺗﻦـﺳﺎـﻣا ﻨﻌﻣفﻼﺘﺧانادﺮﻣونﺎﻧزرد ﻲ ﺖﺷاديراد . ﺺﻴﺨـﺸﺗﻦﺳ دﻮـﺑنادﺮـﻣزاﺮـﺗدوزلﺎﺳودنﺎﻧزرد . ﺮﻳﺎـﺳﺎـﺑﻪـﺘﻓﺎﻳﻦـﻳا هدﻮﻤﻧشراﺰﮔﻪﻛتﺎﻌﻟﺎﻄﻣ ـﻧزﺪﻧا ﺶﻴـﺑنﺎ ﻪـﺑنادﺮـﻣزاﺮـﺗ ﺖــﺒﻗاﺮﻣلﺎــﺒﻧد يﺎــﻫ ﺪﻨﺘــﺴﻫﻲﻜــﺷﺰﭘ ردو يﺎــﻫﻪــﻣﺎﻧﺮﺑ لﺎﺑﺮﻏ يﺮﮔ ﺶﻴﺑﺖﻛﺮﺷ راديﺮـﺗ ـﻧ ،ﺪ ﻢـﻫ درادﻲﻧاﻮـﺧ ) 20 -16 ( . ﺞﻳﺎﺘﻧ ﻪﻌﻟﺎﻄﻣﻦﻳا ﻪـﻛدادنﺎـﺸﻧ ﺮـﻄﺧنﺪﻴـﺸﻛرﺎﮕﻴـﺳ ﺶﻳاﺰﻓاارنارﺎﻤﻴﺑگﺮﻣ ﻲﻣ ﺪﻫد . ﻪـﻌﻟﺎﻄﻣﺎﺑﺰﻴﻧﻪﺘﻓﺎﻳﻦﻳا يا ﺪﻴﺸﻛرﺎﮕﻴﺳدﻮﻤﻧشراﺰﮔﻪﻛﺎﻜﻳﺮﻣآرد وگﺮـﻣﺮﻄﺧن ﻲﻣﺶﻳاﺰﻓالﺎﺘﻛرﻮﻟﻮﻛنﺎﻃﺮﺳﺺﻴﺨﺸﺗزاﺪﻌﺑارﺮﻴﻣ ﺪـﻫد ﻢــﻫ درادﻲﻧاﻮــﺧ ) 21 ( . ﺎــﻣﻪــﻌﻟﺎﻄﻣرد 8 / 36 ﺪــﺻرد نارﺎــﻤﻴﺑ ﺪـﻧدﻮﺑلﺎـﺘﻛرﻮﻟﻮﻛنﺎﻃﺮـﺳﻲﮔداﻮﻧﺎﺧﺖﺒﺜﻣﻪﻘﺑﺎﺳياراد . ﻪﻌﻟﺎﻄﻣزاﻢﻗرﻦﻳا يا ﻪﻛ يرﺎﺳرد مﺎﺠﻧا وﺪﺷ ﺖـﺒﺜﻣﻪﻘﺑﺎﺳ ارلﺎﺘﻛرﻮﻟﻮﻛنﺎﻃﺮﺳﻲﮔداﻮﻧﺎﺧ 24 ﺪﺻرد شراﺰﮔ دﻮﻤﻧ ،
ﺶﻴﺑ ﻲﻣﺮﺗ ﺪﺷﺎﺑ . ﻪـﻌﻟﺎﻄﻣﻪﻠﻤﺟزاوﻒﻠﺘﺨﻣتﺎﻌﻟﺎﻄﻣرد يا ﻪﻛ يرﺎﺳرد ﺪﺷمﺎﺠﻧا ﻪﺑﻪﺟﻮﺗ، ﻪـﺑﺖﺒﺜﻣﻲﮔداﻮﻧﺎﺧﻪﻘﺑﺎﺳ رﻮﺘﻛﺎﻓﻚﻳناﻮﻨﻋ ﺖﻬﺟ لﺎـﺘﻛرﻮﻟﻮﻛنﺎﻃﺮـﺳيﺮﮕﻟﺎـﺑﺮﻏ ﺖﺳاهﺪﺷﻪﻴﺻﻮﺗ ) 25 -22 ( . گﺮـﻣﺮـﻄﺧﻪـﻌﻟﺎﻄﻣﻦـﻳارد رد ﺪﻨﺘـﺷادلﺎـﺘﻛرﻮﻟﻮﻛنﺎﻃﺮﺳﻲﮔداﻮﻧﺎﺧﻪﻘﺑﺎﺳﻪﻛﻲﻧارﺎﻤﻴﺑ ، ا نارﺎﻤﻴﺑز نوﺪﺑ ﻲﮔداﻮﻧﺎﺧﻪﻘﺑﺎﺳ ﻛ ﻢ دﻮﺑﺮﺗ . ﺖـﺳاﻦـﻜﻤﻣ لﺎﺑﺮﻏﻪﺑلﺎﺒﻗا ﺶﻴـﺑمﺎﺠﻧاﺎﻳوسردوزﺺﻴﺨﺸﺗويﺮﮔ ﺮـﺗ نﺎﻃﺮـﺳﻲﮔداﻮﻧﺎﺧﻪﻘﺑﺎﺳﻪﻛﻲﻧﺎﺴﻛردﻪﻧاﺮﻴﮕﺸﻴﭘتﺎﻣاﺪﻗا ﺪـﺷﺎﺑگﺮـﻣﺮـﻄﺧﺶﻫﺎـﻛﻲﻟﺎـﻤﺘﺣاﻞـﻳﻻدزا،ﺪﻧراد . رد ﻪﻌﻟﺎﻄﻣ يا نﺎﻤﻟآردﻪﻛ مﺎﺠﻧا هﺪﺷ شراﺰﮔ هﺪﺷ رﺎﮕﻴـﺳﻪﻛ ونﺪﻴــﺸﻛ ﺶﻴــﺑدﺮــﻣﺖﻴــﺴﻨﺟ ردﻲﮔداﻮﻧﺎــﺧﻪﻘﺑﺎــﺳزاﺮــﺗ ﻣلﺎﺘﻛرﻮﻟﻮﻛنﺎﻃﺮﺳ ﺆ ﺖﺳاﺮﺛ ) 26 ( . زاﺪـﻌﺑﺎـﻘﺑنﺎـﻣزﻪـﻧﺎﻴﻣ لﺎﺘﻛرﻮﻟﻮﻛنﺎﻃﺮﺳنﺎﻣرد 4 ﺎـﺗ 13 ﻪـﻌﻟﺎﻄﻣردوهﺎـﻣ رديا ﺎﻜﻳﺮﻣآ 4 / 15 شراﺰﮔهﺎﻣ ﺪـﺷ ) 27 ( . ردﺎـﻘﺑﻪـﻌﻟﺎﻄﻣﻦـﻳارد ﺶﻴﺑﻞﻫﺎﺘﻣداﺮﻓا ﺮﻴﻏزاﺮﺗ دﻮﺑﻦﻴﻠﻫﺎﺘﻣ . تﺎﻌﻟﺎﻄﻣﺎﺑﻪﺘﻓﺎﻳﻦﻳا ـﺸﻣ ﻢـﻫﻪﺑﺎ درادﻲﻧاﻮــﺧ ) 28 ، 29 ( . يﺎــﻫﺮﻴﻐﺘﻣﻪـﻌﻟﺎﻄﻣﻦـﻳارد تﺎـﻌﻟﺎﻄﻣﺎـﺑﺰـﻴﻧنارﺎـﻤﻴﺑيﺎـﻘﺑهﺪـﻨﻨﻛﻦﻴﻴﻌﺗﻚﻴﻓاﺮﮔﻮﻣد درادﺖـﻘﺑﺎﻄﻣوﻪﺑﺎـﺸﻣناﺮﮕﻳد . گﺮـﻣﺮـﻄﺧﺖﺒـﺴﻧ ﻲـﺷﺎﻧ لﺎﺘﻛرﻮﻟﻮﻛنﺎﻃﺮﺳ ﻦﻳارد ﻪﻌﻟﺎﻄﻣ ﻦﺘﻓﺮـﮔﺮـﻈﻧردﺎـﺑ ﺖـﻴﻣﻮﻗ ﺖــﺳاهﺪــﺷشراﺰــﮔ . يﺎــﻫﺮﻴﻐﺘﻣﻦﻴــﻴﻌﺗﺎــﺑﻦﻳاﺮﺑﺎــﻨﺑ رﻮﻛﺬــﻣ ﻫاﺮﻓﻲﺘﺻﺮﻓ ﺖﺳﺎﻴﺳﺎﺗهﺪﺷﻢ مﺎـﻈﻧناﺰـﻳرﻪﻣﺎﻧﺮﺑوناراﺬﮔ ﻲﻧﺎﻣردوﻲﺼﻴﺨﺸﺗتﺎﻣﺪﺧﺖﻴﻔﻴﻛوﻲﺳﺮﺘﺳدﻪﺑﺖﻣﻼﺳ ﺖﻴﻣﻮﻗرد ﺶﻴـﺑيﺪـﻨﻣهﺮـﻬﺑوﻲـﻧاﺮﻳايﺎﻫ تﺎﻣﺪـﺧزاﺮـﺗ ﻢـﻛيﺎـﻘﺑﻪـﻛﻲﻣاﻮـﻗاردﻲﻧﺎﻣردوﻲﺼﻴﺨﺸﺗ ﺪـﻧراديﺮـﺗ ﺶﻴــﺑﻪــﺟﻮﺗ ردنارﺎــﻤﻴﺑيﺎــﻘﺑرديﺮﺑاﺮﺑﺎــﻧوهدﻮــﻤﻧيﺮــﺗ ﺖﻴﻣﻮﻗ ﺶﻫﺎﻛارﻒﻠﺘﺨﻣيﺎﻫ ﺪـﻨﻫد . دﺎﻬﻨـﺸﻴﭘﻪـﻌﻟﺎﻄﻣﻦـﻳا ﻲــﻣ نﺎﻃﺮــﺳيﺎــﻘﺑتوﺎــﻔﺗﻞــﻠﻋﻦﻴــﻴﻌﺗرﻮــﻈﻨﻣﻪــﺑﺪــﻨﻛ ﺖﻴﻣﻮﻗردلﺎﺘﻛرﻮﻟﻮﻛ ياﺮـﺑﻂﺒﺗﺮﻣتﺎﻌﻟﺎﻄﻣ،ﻒﻠﺘﺨﻣيﺎﻫ وﻲﻳاﺬـﻏﻢـﻳژرﻪـﻠﻤﺟزاوﻲـﻄﻴﺤﻣﺎـﻳﻲﻜﻴﺘﻧژﻞﻠﻋﻦﻴﻴﻌﺗ ﺖـﻴﻣﻮﻗرديرﺎـﺘﻓروﻲـﮕﻨﻫﺮﻓتادﺎﻋ ردوﻒـﻠﺘﺨﻣيﺎـﻫ مﺎﺠﻧاﻲﻠﻣﺢﻄﺳ دﻮﺷ . ﺎﺣﻪـﻌﻟﺎﻄﻣﺖﻳدوﺪـﺤﻣﻪﻠﻤﺟزا ﺮـﺿ مﺎﺠﻧا ﺖـﻴﻣﻮﻗﻪـﺑﺞﻳﺎـﺘﻧﻢﻴﻤﻌﺗوناﺮﻬﺗردﻪﻌﻟﺎﻄﻣ ﻲـﻧاﺮﻳايﺎـﻫ ﺖــﺳا ﻲــﻣﻪــﻛ زاﻲﻧارﺎــﻤﻴﺑﻦﺘﻓﺮــﮔﺮــﻈﻧردﺎــﺑﺖــﺴﻳﺎﺑ ﺖﻴﻣﻮﻗ نﺎﺘـﺳرﺎﻤﻴﺑﻪـﺑﻪـﻛﻲـﻧاﺮﻳايﺎﻫ ﻪـﻌﺟاﺮﻣناﺮـﻬﺗيﺎـﻫ ﻲﻣ ،ﺪﻨﻨﻛ دﻮﺷمﺎﺠﻧاطﺎﻴﺘﺣاﺎﺑﺮﻴﺴﻔﺗ . ﻢﻫ ﻪﻌﻟﺎﻄﻣمﺎﺠﻧاﻦﻴﻨﭼ زاﻲﻓﺎﻛﻪﻧﻮﻤﻧﻢﺠﺣندﻮﻤﻧظﺎﺤﻟوﺖﻴﻌﻤﺟﺮﺑﻲﻨﺘﺒﻣ ﻪـﻤﻫ ﺖﻴﻣﻮﻗ ﻲﻣدﺎﻬﻨﺸﻴﭘيﺪﻌﺑتﺎﻌﻟﺎﻄﻣردﻲﻧاﺮﻳايﺎﻫ دﻮﺷ .
يراﺰﮕﺳﺎﭙﺳ
يرﺎـﻤﻴﺑتﺎـﻘﻴﻘﺤﺗﺰﻛﺮﻣيرﺎﻜﻤﻫزا وشراﻮـﮔيﺎـﻫ ًﺎﺻﻮﺼﺨﻣوﻲﺘﺸﻬﺑﺪﻴﻬﺷﻲﻜﺷﺰﭘمﻮﻠﻋهﺎﮕﺸﻧادﺪﺒﻛ يﺎﻗآ ـﺑيزورﻮـﻧيﺪﻬﻣيﺎﻗآوﻲﻠﻘﻨﻴﺴﺣرﻮﭘﻦﻴﻣاﺪﻤﺤﻣﺮﺘﻛد ﻪ ﻢــﻫوتﺎــﻋﻼﻃاﻦﺘــﺷاﺬﮔرﺎــﻴﺘﺧاردﺮﻃﺎــﺧ ﻪــﻤﻫزاﻦﻴــﻨﭼ رﺎﻤﻴﺑ ﻲﻣﺮﻜﺸﺗﻪﻧﺎﻤﻴﻤﺻنﺎﺸﻳاهداﻮﻧﺎﺧونا دﻮﺷ . ﻪـﻟﺎﻘﻣﻦﻳا ﻲـــﺼﺼﺨﺗياﺮـــﺘﻛدﻊـــﻄﻘﻣترﻮـــﻫﻮﻛسردﻞـــﺼﺣﺎﻣ ﻲﻜـﺷﺰﭘمﻮـﻠﻋهﺎﮕﺸﻧادردﻪﻟﺎﻘﻣلواهﺪﻨﺴﻳﻮﻧيژﻮﻟﻮﻴﻣﺪﻴﭘا ﻲﻣﻲﺘﺸﻬﺑﺪﻴﻬﺷ ﺪﺷﺎﺑ .
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