* لﻮﺌﺴﻣهﺪﻨﺴﻳﻮﻧ : ،دﺮﻛﺮﻬﺷ ،ﻲﻧﻮﻔﻋ يﺎﻫ يرﺎﻤﻴﺑ هوﺮﮔ ،دﺮﻛﺮﻬﺷ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد . ﻦﻔﻠﺗ : 09133815531 ، rastabi669@gmail.com E- mail:
ﺪﻳﺪﺷ
يﻮﻳر
ﻦﻣﺰﻣ
داﺪﺴﻧا
ﻪﺑ
نﺎﻳﻼﺘﺒﻣ
رد
ﻪﻴﻧﻮﻣﻮﻨﭘ
ﺎﻳﺪﻴﻣﻼﻛ
دﺎﺣ
ﺖﻧﻮﻔﻋ
عﻮﻴﺷ
ﻲﻈﻴﻔﺣ
دﻮﻌﺴﻣ
ﺮﺘﻛد
1،
ﻲﺑﺎﺘﺳار
ﻲﻧﺎﻤﻳا
ﺎﺿر
ﺮﺘﻛد
1 *،
يﻮﺳﻮﻣ
ﺪﻤﺤﻣ
ﺮﺘﻛد
2ﻲﻤﻳﺮﻛ
ﻲﻠﻋ
ﺮﺘﻛد
،
3 1 ؛ناﺮﻳا ،دﺮﻛﺮﻬﺷ ،دﺮﻛﺮﻬﺷ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﻲﻧﻮﻔﻋ يﺎﻫ يرﺎﻤﻴﺑ هوﺮﮔ 2 ﺮﻛﺮﻬﺷ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﻲﻠﺧاد هوﺮﮔ ؛ناﺮﻳا ،دﺮﻛﺮﻬﺷ ،د 3 ناﺮﻳا ،دﺮﻛﺮﻬﺷ ،دﺮﻛﺮﻬﺷ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،يژﻮﻟﻮﻨﻤﻳا و يژﻮﻟﻮﻴﺑوﺮﻜﻴﻣ هوﺮﮔ . ﺖﻓﺎﻳرد ﺦﻳرﺎﺗ : 21 / 3 / 92 ﻲﻳﺎﻬﻧ حﻼﺻا : 17 / 4 / 92 شﺮﻳﺬﭘ ﺦﻳرﺎﺗ : 29 / 4 / 92ﻪﻣﺪﻘﻣ
:
يﻮﻳر
ﻦﻣﺰﻣ
يداﺪﺴﻧا
يرﺎﻤﻴﺑ
ﻚﺷ
نوﺪﺑ
)
Chronic Obstructive Pulmonary Disease= COPD
(
و
ﺖﺳا
نﺎﻬﺟ
ﺮﺳﺎﺗﺮﺳ
رد
ﺮﻴﻣ
و
گﺮﻣ
ﻲﻠﺻا
ﻞﻳﻻد
زا
ﻲﻜﻳ
ًﻻﺎﻤﺘﺣا
نآ
عﻮﻴﺷ
ﺪﻫاﻮﺧ
ﺶﻳاﺰﻓا
ﻪﺑ
ور
هﺪﻨﻳآ
لﺎﺳ
ﺖﺴﻴﺑ
رد
دﻮﺑ
)
3
-1
.(
ﻪﻛ
ﺎﺠﻧآ
زا
COPDهﺪﻨﻨﻛ
ﺪﻳﺪﺸﺗ
ﻞﻣاﻮﻋ
ﺮﺛا
ﺮﺑ
مﺎﻈﻧ
ﺮﺑ
ار
ﻲﻨﻴﮕﻨﺳ
يﺎﻫ
ﻪﻨﻳﺰﻫ
،دﻮﺑ
ﺪﻫاﻮﺧ
ﺮﻳﺬﭘ
ﺖﺸﮔﺮﺑ
يرﺎﻤﻴﺑ
عﻮﻗو
دراﻮﻣ
و
ﺪﻨﻛ
ﻲﻣ
ﻞﻴﻤﺤﺗ
ﺖﻣﻼﺳ
ﻻﺎﺑ
ار
دﺮﺑ
ﻲﻣ
)
6
-4
.(
يﻮﻳر
ﻦﻣﺰﻣ
يداﺪﺴﻧا
يرﺎﻤﻴﺑ
ﺪﻳﺪﺸﺗ
AECOPD)=
(Acute Exacerbations of Chronic Obstructive Pulmonary Disease
ﺎﻳ
ﺲﻔﻧ
ﻲﮕﻨﺗ
رد
دﺎﺣ
يﺮﻴﻴﻐﺗ
ﺎﺑ
،ﻪﻴﻟوا
ﻲﺴﻔﻨﺗ
ﻞﻜﺸﻣ
ﻴﻣ
ﺎﻳ
ﻪﻓﺮﺳ
ـــ
ناﺰ
ﻤﻫ
يروآ
ﻂﻠﺧ
ــــ
ﻪــــﺟﻮﺗ
ﻪﻛ
ﺖﺳا
هاﺮ
دﻮﺒﻬﺑ
ﺖﻳﺮﻳﺪﻣ
رد
ار
يا
هﮋﻳو
ﺪﺒﻠﻃ
ﻲﻣ
يرﺎﻤﻴﺑ
ﻦﻳا
)
7
.(
ًﺎﺒﻳﺮﻘﺗ
ﺎﻫدروآﺮﺑ
سﺎﺳا
ﺮﺑ
رد
نﻻﺎﺴﮔرﺰﺑ
ﺪﺻرد
ﺶﺷ
ﻪﺑ
ﺎﻜﻳﺮﻣآ
COPDﺪﻨﺘﺴﻫ
ﻼﺘﺒﻣ
)
8
(
يرﺎﻤﻴﺑ
ﺪﻳﺪﺸﺗ
و
ﻪﻌﺟاﺮﻣ
ﻪﺑ
ﺮﺠﻨﻣ
ﻪﻧﻻﺎﺳ
يﻮﻳر
ﻦﻣﺰﻣ
يداﺪﺴﻧا
13
نﻮﻴﻠﻴﻣ
دﻮﺷ
ﻲﻣ
ﻚﺷﺰﭘ
ﻪﺑ
رﺎﻤﻴﺑ
)
9
.(
و
نارﺎﻤﻴﺑ
رﺮﻜﻣ
يﺮﺘﺴﺑ
رد
ﺮﺛﻮﻣ
ﺮﻄﺧ
ﻞﻣاﻮﻋ
ﺮﺛا
ﺮﺑ
گﺮﻣ
AECOPDا
ﻞﻣﺎﺷ
ﺮﻛﺬﻣ
،ﻦﺳ
ﺶﻳاﺰﻓ
و
يﺮﺘﺴﺑ
ﻪﻘﺑﺎﺳ
،ندﻮﺑ
زا
نﺎﻣﺰﻤﻫ
يﺎﻫ
يرﺎﻤﻴﺑ
دﻮﺟو
ﺪﺷﺎﺑ
ﻲﻣ
ﻲﺴﻔﻨﺗ
نﻮﺧ
رﺎﺸﻓ
و
ﻢﺳآ
ﻪﻠﻤﺟ
.
ﻦﻴﻨﭽﻤﻫ
ﺎﺗ
ﻪﺘﻓﺮﮔ
ﻲﺳوﺮﻳو
عاﻮﻧا
زا
ﻲﻧﻮﻔﻋ
يﺎﻫ
نژﻮﺗﺎﭘ
دﻮﺟو
ﻤﻌﻣ
يﺎﻫ
يﺮﺘﻛﺎﺑ
عاﻮﻧا
ـــ
ﻴﻏ
و
لﻮ
ــ
ﺮــﺘﺸﻴﺑ
رد
لﻮﻤﻌﻣ
ﺮ
هﺪﻴﻜﭼ
:
و ﻪﻨﻴﻣز
فﺪﻫ
:
يرﺎﻤﻴﺑ يﻮﻳرﻦﻣﺰﻣيداﺪﺴﻧا ) COPD ( ﻦﻴﻣرﺎﻬﭼ،ﺖﺳاﻦﻣﺰﻣﺖﻴﺸﻧوﺮﺑومﺰﻴﻔﻣآزاﻲﺒﻴﻛﺮﺗﻪﻛ ﺪﺷﺎﺑ ﻲﻣ نﺎﻬﺟرد ﺮﻴﻣ و گﺮﻣﺖﻠﻋ . ﺪﻳﺪﺷيﻮﻳر ﻦﻣﺰﻣيداﺪﺴﻧا يرﺎﻤﻴﺑ ) AECOPD ( ﻪﺑرﻮﺒﺠﻣ ار نارﺎﻤﻴﺑ ﺖﺒﻗاﺮﻣ يﺮﻴﮕﻴﭘ ﺪﻳﺎﻤﻧ ﻲﻣ ﻲﻜﺷﺰﭘ يﺎﻫ . ،دراد ﺶﻘﻧ يرﺎﻤﻴﺑ ﻦﻳا زوﺮﺑ رد ﻪﻛ ﻲﻤﻬﻣ ﻞﻣاﻮﻋ زا ﻲﻜﻳ يﺮﺘﻛﺎﺑ ﻛ ﺖﺳا ﻪﻴﻧﻮﻣﻮﻨﭘﺎﻳﺪﻴﻣﻼ . ﻪﻴﻧﻮﻣﻮﻨﭘﺎﻳﺪﻴﻣﻼﻛﺎﺑدﺎﺣﺖﻧﻮﻔﻋعﻮﻴﺷﻲﺳرﺮﺑفﺪﻫﺎﺑﻖﻴﻘﺤﺗﻦﻳا ) Chlamydia pneumoniae ( ﺖﻠﻋﻪﺑهﺪﺷشﺮﻳﺬﭘنارﺎﻤﻴﺑرد AECOPD ﺖﻓﺮﻳﺬﭘترﻮﺻدﺮﻛﺮﻬﺷﺮﺟﺎﻫنﺎﺘﺳرﺎﻤﻴﺑرد .ﻲﺳرﺮﺑ شور
:
ﻲﻔﻴﺻﻮﺗﻪﻌﻟﺎﻄﻣﻦﻳارد -داﺪﻌﺗﻲﻌﻄﻘﻣ 100 ﻪﺑﻼﺘﺒﻣرﺎﻤﻴﺑ AECOPD ﺘﺷادﺖﻛﺮﺷ ﺪﻨ . ﺮﺑهوﻼﻋ ﻲﺘﻧآ يﺎﻫﺮﺘﻴﺗ و ﺪﺷ ﻪﺘﻓﺮﮔ نارﺎﻤﻴﺑ زا ﻪﺘﻔﻫ ﻪﺳ ﻪﻠﺻﺎﻓ ﻪﺑ ﻲﻧﻮﺧ ﻪﻧﻮﻤﻧ ود يژﻮﻟﻮﻳدار و ﻲﻨﻴﻟﺎﺑ تﺎﻨﻳﺎﻌﻣيدﺎﺑ
اﺰﻳﻻاشورﻪﺑﻪﻴﻧﻮﻣﻮﻨﭘﺎﻳﺪﻴﻣﻼﻛ ) ELISA ( راﺰﻓامﺮﻧزاهدﺎﻔﺘﺳاﺎﺑﺎﻫهداديرﺎﻣآﺰﻴﻟﺎﻧآوﺪﻳدﺮﮔﻦﻴﻴﻌﺗ SPSS و ﺷمﺎﺠﻧاﻲﻨﺘﻳوﻦﻣوﺮﺸﻴﻓيرﺎﻣآيﺎﻫنﻮﻣزآ ﺪ .ﺎﻫ ﻪﺘﻓﺎﻳ
:
ﻪﺑﻼﺘﺒﻣنارﺎﻤﻴﺑردﻪﻴﻧﻮﻣﻮﻨﭘﺎﻳﺪﻴﻣﻼﻛﺖﻧﻮﻔﻋعﻮﻴﺷ AECOPD7
%
ياﻪﻄﺑارﻪﻛدﻮﺑ ﻦﻳاعﻮﻴﺷﻦﻴﺑ ﺪﺸﻧهﺪﻫﺎﺸﻣﻲﻨﻴﻟﺎﺑﻢﻳﻼﻋويرﺎﻤﻴﺑتﺪﻣلﻮﻃ،ﺖﻴﺴﻨﺟ،ﻦﺳﺎﺑيرﺎﻤﻴﺑ)
05
/
0
> P.(
يﺎﻫيرﺎﻤﻴﺑﻦﻴﺑلﺎﺣﻦﻳاﺎﺑ ﺎﺑهداﻮﻧﺎﺧردﻪﺑﺎﺸﻣيرﺎﻤﻴﺑويرﺎﺸﻓﺮﭘوﺖﺑﺎﻳدياﻪﻨﻴﻣز AECOPD ﻪﻄﺑار يرادﺎﻨﻌﻣ ﺪﺷهﺪﻫﺎﺸﻣ)
05 / 0 < P(
.يﺮﻴﮔ ﻪﺠﻴﺘﻧ
:
ﻲﺒﺒﺳنژﻮﺗﺎﭘﻚﻳناﻮﻨﻋﻪﺑيﻮﻳرﻦﻣﺰﻣيداﺪﺴﻧايرﺎﻤﻴﺑدﺎﺣﺪﻳﺪﺸﺗردﻪﻴﻧﻮﻣﻮﻨﭘﺎﻳﺪﻴﻣﻼﻛﺶﻘﻧ ﺪﺷﺎﺑﻲﻣرادرﻮﺧﺮﺑيﺮﺘﻤﻛﺖﻴﻤﻫازاهﺪﻨﻨﻛدﺎﺠﻳاﻞﻣاﻮﻋﺮﻳﺎﺳﻪﺑﺖﺒﺴﻧ .هژاو
يﺪﻴﻠﻛ
يﺎﻫ
:
ﻪﻴﻧﻮﻣﻮﻨﭘﺎﻳﺪﻴﻣﻼﻛ ، AECOPD ، ﺖﻧﻮﻔﻋ،اﺰﻳﻻا دﺎﺣ .ﺖﻟﺎﺧد
يرﺎﻤﻴﺑ
ﻞﺣاﺮﻣ
ﺪﻧراد
)
10
.(
ﻠﻠﻤﻟا
ﻦﻴﺑ
يﺎﻫ
ﻞﻤﻌﻟارﻮﺘﺳد
،ﺪﻨﻛ
ﻲﻣ
ﺺﺨﺸﻣ
ﺪﻳﺪﺟ
ﻲ
رﺎﻤﻴﺑ
ماﺪﻛ
AECOPDًﻻﺎﻤﺘﺣا
ﺰﻴﻧ
ﻲﻳﺎﻳﺮﺘﻛﺎﺑ
ﺖﻧﻮﻔﻋ
رﺎﭼد
ﺖﺳا
هﺪﺷ
)
9
،
7
،
6
.(
ﻪﺑ
ﻼﺘﺑا
ﺪﺳر
ﻲﻣ
ﺮﻈﻧ
ﻪﺑ
AECOPDﺮﺛا
ﺮﺑ
ﻋﻮﻨﺘﻣ
ﻲﻧﻮﻔﻋ
ﺮﻴﻏ
و
ﻲﻧﻮﻔﻋ
يﺎﻫ
كﺮﺤﻣ
ﺪﻫد
ﻲﻣ
يور
ﻲ
.
ﺰﻧآﻮﻠﻔﻧآ
سﻮﻠﻴﻓﻮﻤﻫ
ا
)
Haemophilus Influenzae(
،
ﻪﻴﻧﻮﻣﻮﻨﭘ
ﺲﻛﻮﻛﻮﺘﭘﺮﺘﺳا
)
Streptococcus Pneumoniae(
و
ﺲﻴﻟارﺎﺗﺎﻛ
ﻼﺴﻛارﻮﻣ
)
Moraxella Caterrhalis(
ﻪﺑ
زﺎﺑﺮﻳد
زا
يرﺎﻤﻴﺑ
ﻦﻳا
هﺪﻤﻋ
يﺎﻫ
نژﻮﺗﺎﭘ
ناﻮﻨﻋ
ﺪﻧا
هﺪﺷ
ﻲﻳﺎﺳﺎﻨﺷ
)
11
.(
دﺎﺣ
ﺖﻧﻮﻔﻋ
ﻲﻟﺎﻤﺘﺣا
ﺶﻘﻧ
رد
ﻪﻴﻧﻮﻣﻮﻨﭘ
ﺎﻳﺪﻴﻣﻼﻛ
ﻦﻣﺰﻣ
و
نارﺎﻤﻴﺑ
COPDﻪﺘﻓﺮﮔ
راﺮﻗ
ﻲﺳرﺮﺑ
درﻮﻣ
ﻲﺗﺎﻌﻟﺎﻄﻣ
رد
ﺖﺳا
)
15
-12
.(
ﺑ
ﻚﻳ
ﻪﻴﻧﻮﻣﻮﻨﭘ
ﺎﻳﺪﻴﻣﻼﻛ
ﺎﺑ
ﻲﻟﻮﻠﺳ
نورد
يﺮﺘﻛﺎ
ﻪﺑ
ﻪﺘﺴﺑاو
ًﻼﻣﺎﻛ
و
دﺮﻓ
ﻪﺑ
ﺮﺼﺤﻨﻣ
يزﺎﻓ
ود
ﻲﺗﺎﻴﺣ
ﻪﺧﺮﭼ
ﺖﺳا
نﺎﺑﺰﻴﻣ
ﻂﺳﻮﺗ
هﺪﺷ
ﺪﻴﻟﻮﺗ
يژﺮﻧا
.
ياراد
ﻞﻣﺎﻋ
ﻦﻳا
ﻞﺑﺎﻗ
يﺎﻫ
نﺎﻜﻴﻠﮔوﺪﻴﺘﭙﭘ
ﺪﻗﺎﻓ
ﻲﻔﻨﻣ
مﺮﮔ
ﺶﺷﻮﭘ
ﻚﻳ
ﻲﻠﭘﻮﭙﻴﻟ
نژ
ﻲﺘﻧآ
ﻚﻳ
دﻮﺧ
مﻮﻧژ
ﻂﺳﻮﺗ
و
ﺖﺳا
ﻲﻳﺎﺳﺎﻨﺷ
ﺪﻨﻛ
ﻲﻣ
ﺪﻴﻟﻮﺗ
ار
صﺎﺧ
ﺪﻳرﺎﻛﺎﺳ
)
17
،
16
.(
ﺎﻳﺪﻴﻣﻼﻛ
ﻪﻴﻧﻮﻣﻮﻨﭘ
و
ﻲﻧﺎﻗﻮﻓ
ﻲﺴﻔﻨﺗ
هﺎﮕﺘﺳد
يﺎﻫ
ﺖﻧﻮﻔﻋ
زا
ﻲﻌﻴﺳو
ﻒﻴﻃ
دﺎﺠﻳا
رد
رد
ﻪﭼ
و
ﻢﻟﺎﺳ
ﻲﻨﻤﻳا
ﻢﺘﺴﻴﺳ
ياراد
نﺎﻧﺎﺑﺰﻴﻣ
رد
ﻪﭼ
ﻲﻨﻴﻳﺎﭘ
دراد
ﺖﻛﺮﺷ
،ﻲﻨﻤﻳا
ﺺﻘﻧ
رﺎﭼد
نﺎﻧﺎﺑﺰﻴﻣ
)
18
.(
داﺮﻓا
ﻪﻤﻫ
ًﺎﺒﻳﺮﻘﺗ
ﺎﻳﺪﻴﻣﻼﻛ
ﻪﺑ
ﻲﮔﺪﻧز
لﻮﻃ
رد
رﺎﺑ
ﻚﻳ
ﻞﻗاﺪﺣ
ﺖﺳا
ﻦﻜﻤﻣ
ﺪﻧﻮﺷ
هدﻮﻟآ
ﻪﻴﻧﻮﻣﻮﻨﭘ
.
ﺮﺑ
دﺪﺠﻣ
ﺖﻧﻮﻔﻋ
بوﺎﻨﺘﻣ
يﺮﺘﻛﺎﺑ
ﻦﻳا
ﺮﺛا
دﻮﺷ
ﻞﻳﺪﺒﺗ
ﺰﻴﻧ
ﻦﻣﺰﻣ
ﺖﻧﻮﻔﻋ
ﻪﺑ
ﺖﺳا
ﻦﻜﻤﻣ
و
هدﻮﺑ
)
19
.(
ﺲﭘ
ﻲﻗﺎﺑ
نﺪﺑ
رد
ﺖﺳا
ﻦﻜﻤﻣ
ﻪﻴﻧﻮﻣﻮﻨﭘ
ﺎﻳﺪﻴﻣﻼﻛ
،ﻪﻴﻟوا
ﺖﻧﻮﻔﻋ
زا
ﺪﻧﺎﻤﺑ
)
20
(
يﺎﻫ
يرﺎﻤﻴﺑ
ياﺮﺑ
ﻲﻟﺎﻤﺘﺣا
ﺮﻄﺧ
ﻞﻣﺎﻋ
ﻚﻳ
ﻦﻳا
ﻪﻛ
ﺖﺳا
ﻦﻴﻳاﺮﺷ
ﺐﻠﺼﺗ
ﺎﻳ
ﻦﻣﺰﻣ
ﻲﺑﺎﻬﺘﻟا
يﻮﻳر
)
22
،
21
.(
ﻴﻣﻼﻛ
ﺖﻧﻮﻔﻋ
ﺺﻴﺨﺸﺗ
يﺎﻫ
شور
ﻪﻴﻧﻮﻣﻮﻨﭘ
ﺎﻳﺪ
ﺖﺳا
ﺮﻳز
دراﻮﻣ
ﻞﻣﺎﺷ
:
يﺮﺘﻛﺎﺑ
ﺖﺸﻛ
ﺖﺸﻛ
ﻂﻴﺤﻣ
رد
شور
ﻦﻳا
ﺖﻴﺳﺎﺴﺣ
ﻪﻛ
ﻲﻟﻮﻠﺳ
80
-70
ﺪﺻرد
ﺪﺷﺎﺑ
ﻲﻣ
،
ﻪﻛ
مﺮﺳ
رد
ﺎﻳﺪﻴﻣﻼﻛ
ﻪﻴﻠﻋ
ﺮﺑ
يدﺎﺑ
ﻲﺘﻧآ
رﻮﻀﺣ
ﻲﺳرﺮﺑ
نﺎﻤﻠﭙﻤﻛ
نﻮﻴﺳﺎﺴﻜﻴﻓ
ﺖﺴﺗ
مﺎﺠﻧا
نآ
ﻞﻜﺷ
ﻦﻳﺮﺗ
ﺞﻳار
)
Complement Fixationtest(
ﺪﺷﺎﺑ
ﻲﻣ
ﻪﻛ
57
ﺪﺻرد
ﻲﻣ
شور
ﻦﻳا
ﺖﻴﺳﺎﺴﺣ
ﺪﺷﺎﺑ
،
ﻲﺳاﻮﻧﻮﻤﻳا
وﺮﻜﻴﻣ
ﺖﺴﺗ
رد
ﻲﺘﻴﺳﺎﺴﺣ
ﻪﻛ
)
Micro Immunoassay= MIF
(
دوﺪﺣ
9
/
87
ﺪﺻرد
نداد
نﺎﺸﻧ
ياﺮﺑ
و
دراد
ﻦﻴﻟﻮﺑﻮﻠﮔﻮﻨﻤﻳا
G)
IgG(
ﻦﻴﻟﻮﺑﻮﻠﮔﻮﻨﻤﻳا
و
M)
IgM(
رد
ﺎﻬﻨﺗ
ﻲﻟو
دﻮﺷ
ﻲﻣ
هدﺎﻔﺘﺳا
ﻪﻴﻧﻮﻣﻮﻨﭘ
ﺎﻳﺪﻴﻣﻼﻛ
ﺪﺿ
ﺪﺷﺎﺑ
ﻲﻣ
مﺎﺠﻧا
ﻞﺑﺎﻗ
ﺲﻧاﺮﻓر
يﺎﻫ
هﺎﮕﺸﻳﺎﻣزآ
،
شور
يﺎﻫ
ﺎﻣ
ﻲﻟﻮﻜﻟﻮﻣ
ﺪﻨﻧ
)
Polymerase Chain Reaction=PCR
(
ﻛ
ياراد
ﻪ
ﺖﻴﺳﺎﺴﺣ
87
ﺪﺻرد
ﻞﻴﻟد
ﻪﺑ
ﻲﻟو
،ﺖﺳا
ﺎﺟ
ﻪﻤﻫ
رد
ﻲﺳﺮﺘﺳد
مﺪﻋ
و
مزﻻ
يﺎﻫدراﺪﻧﺎﺘﺳا
دﻮﺒﻧ
ﺪﻨﺷﺎﺑ
ﻲﻤﻧ
ﺞﻳار
،
ﻢﻴﻘﺘﺴﻣ
يدﺎﺑ
ﻲﺘﻧآ
ﺖﻨﺳرﻮﻠﻓ
شور
)
Direct Fluorescent Antibody= DFA
(
ﻪﻛ
ﻦﻳا
شور
ﺖﻴﺳﺎﺴﺣ
ياراد
نادﺮﻣ
ياﺮﺑ
100
-70
ﺪﺻرد
اﺮﺑ
و
نﺎﻧز
ي
100
-68
ﺪﺻرد
ﺪﺷﺎﺑ
ﻲﻣ
،
ﻲﺳاﻮﻧﻮﻤﻳا
ﻢﻳﺰﻧآ
)
Enzyme Immuno Assay= EIA
(
نادﺮﻣ
ياﺮﺑ
ﻪﻛ
97
-62
ﺪﺻرد
نﺎﻧز
ياﺮﺑ
و
100
-64
ﺪﺻرد
شور
و
دراد
ﺖﻴﺳﺎﺴﺣ
اﺰﻳﻻا
)
Enzyme-Linked Immunosorbent Assay= ELISA
(
ﻪﻛ
ﺖﻴﺳﺎﺴﺣ
ياراد
ﻲﺼﻴﺨﺸﺗ
شور
ﻦﻳا
100
و
ﺪﺻرد
ﺖﻴﺻﺎﺼﺘﺧا
85
ﺪﺻرد
ﺪﺷﺎﺑ
ﻲﻣ
و
ﻪﺟﻮﺗ
ﺎﺑ
ﺮﺿﺎﺣ
لﺎﺣ
رد
ﺮﺜﻛا
رد
نآ
ﻪﺑ
نﺎﺳآ
ﻲﺳﺮﺘﺳد
و
ﻻﺎﺑ
رﺎﻴﺴﺑ
ﺖﻗد
ﻪﺑ
ﺮﻫ
دﻮﺟو
ﺎﺑ
و
دﺮﻴﮔ
ﻲﻣ
راﺮﻗ
هدﺎﻔﺘﺳا
درﻮﻣ
ﺎﻫ
هﺎﮕﺸﻳﺎﻣزآ
دﻮﻤﻧ
ﻲﺑﺎﻳزرا
ناﻮﺗ
ﻲﻣ
ار
ﻪﻧﻮﻤﻧ
يدﺎﻳز
ناﺰﻴﻣ
نآ
ﺖﻴﻛ
)
26
-23
.(
يﻻﺎﺑ
عﻮﻴﺷ
ﻪﺑ
ﻪﺟﻮﺗ
ﺎﺑ
COPDنﺎﺘﺳا
رد
ﻤﻴﺑ
نﺪﺷ
يﺮﺘﺴﺑ
ﻪﺑ
ﺮﺠﻨﻣ
ﻪﻛ
يرﺎﻴﺘﺨﺑ
و
لﺎﺤﻣرﺎﻬﭼ
ﻪﺑ
نارﺎ
ﻪﻠﻤﺟ
زا
دﺪﻌﺘﻣ
ﻞﻳﻻد
AECOPDبآ
ﻦﻴﻨﭽﻤﻫ
،دﻮﺷ
ﻲﻣ
رد
توﺎﻔﺗ
ﺰﻴﻧ
و
نﺎﺘﺳا
ﻦﻳا
صﺎﺧ
ﻲﻧﺎﺘﺴﻫﻮﻛ
ياﻮﻫ
و
ﻔﻋ
ياﺮﺑ
هﺪﻣآ
ﺖﺳد
ﻪﺑ
ﺮﻳدﺎﻘﻣ
ﻞﻣﺎﻋ
ﻦﻳا
ﺎﺑ
ﺖﻧﻮ
)
زا
4
ﺎﺗ
30
%
(
دﺎﺣ
ﺖﻧﻮﻔﻋ
عﻮﻴﺷ
ﻲﺳرﺮﺑ
فﺪﻫ
ﺎﺑ
ﻪﻌﻟﺎﻄﻣ
ﻦﻳا
،
رﺎﭼد
نارﺎﻤﻴﺑ
رد
ﻪﻴﻧﻮﻣﻮﻨﭘ
ﺎﻳﺪﻴﻣﻼﻛ
AECOPDرد
ﺮﻬﺷ
ﺮﺟﺎﻫ
نﺎﺘﺳرﺎﻤﻴﺑ
ﺪﻳدﺮﮔ
اﺮﺟا
و
ﻲﺣاﺮﻃ
دﺮﻛ
.
ﻲﺳرﺮﺑ
شور
:
ﻬﺷ
ﺮﺟﺎﻫ
نﺎﺘﺳرﺎﻤﻴﺑ
ـــ
ﺟا
ﺖﻬﺟ
دﺮﻛﺮ
ﻦﻳا
ياﺮــــ
ﺪﻳدﺮﮔ
بﺎﺨﺘﻧا
ﻲﻔﻴﺻﻮﺗ
ﻲﻌﻄﻘﻣ
ﻪﻌﻟﺎﻄﻣ
.
100
رﺎﻤﻴﺑ
لﺎﺴﮔرﺰﺑ
)
53
و
دﺮﻣ
47
نز
(
ﻞﻴﻟد
ﻪﺑ
هﺪﺷ
شﺮﻳﺬﭘ
AECOPDنﺎﺑآ
ﻪﻠﺻﺎﻓ
رد
1386
ﺖﺸﻬﺒﻳدرا
ﺎﺗ
1387
ﺪﻨﺘﻓﺮﮔ
راﺮﻗ
ﻲﺑﺎﻳزرا
درﻮﻣ
ﻪﻌﻟﺎﻄﻣ
ﻦﻳا
ياﺮﺑ
.
رﺎﻤﻴﺑ
رد
نا
ﻞﻗاﺪﺣ
ﻪﻛ
ﺪﻧﺪﺷ
ﻲﻣ
ﻪﻌﻟﺎﻄﻣ
دراو
ﻲﺗرﻮﺻ
24
ﺖﻋﺎﺳ
ﻢﺠﺣ
ﺶﻳاﺰﻓا
ﻞﻣﺎﺷ
يرﺎﻤﻴﺑ
ﺪﻳﺪﺸﺗ
زا
يراﺪﻳﺎﭘ
ﻪﻧﺎﺸﻧ
،ﺖﻣﻼﻋ
ود
ﺮﻫ
دﻮﺟو
ﺎﻳ
نآ
رد
كﺮﭼ
دﻮﺟو
،ﻂﻠﺧ
دﻮﺟو
و
ﻪﻨﻴﺳ
ﻲﮕﺘﻓﺮﮔ
،ﺲﺧ
ﺲﺧ
ﺎﻳ
ﺲﻔﻧ
ﻲﮕﻨﺗ
IgGﺪﻨﺷﺎﺑ
ﻪﺘﺷاد
ار
هﺪﺷ
ﺬﺧا
ﻲﻣﺮﺳ
ﻪﻧﻮﻤﻧ
رد
ﺎﻳﺪﻴﻣﻼﻛ
.
ﻪﻨﻴﺳ
زا
ﻲﻓاﺮﮔﻮﻳدار
)
ﻲﻣاﺪﻗ
يﺎﻤﻧ
-ﻲﻧوﺮﻴﺑ
يﺎﻤﻧ
و
ﻲﻔﻠﺧ
(
ﺎﻬﻧآ
ﻲﺳرﺮﺑ
زا
ﺲﭘ
و
ﺖﻓﺮﮔ
مﺎﺠﻧا
يﺮﺘﻣوﺮﻴﭙﺳا
و
يرﺎﻤﻴﺑ
ﺰﺠﺑ
ﻪﻛ
ﺪﺷ
ﺺﺨﺸﻣ
AECOPDيﺎﻫ
يرﺎﻤﻴﺑ
،
ﺪﻧراﺪﻧ
دﻮﺟو
يﺮﮕﻳد
ﻲﺴﻔﻨﺗ
و
ﻲﺒﻠﻗ
)
رد
نارﺎﻤﻴﺑ
ﻦﻳا
رد
ﻲﻳاﻮﻫ
نﺎﻳﺮﺟ
ﺖﻳدوﺪﺤﻣ
ﻚﻳﺮﺘﻣوﺮﻴﭙﺳا
يﺎﻫﺮﺘﻣارﺎﭘ
رد
ﻲﺗرﺎﺒﻋ
ﻪﺑ
،دﻮﺒﻧ
ﺮﻳﺬﭘ
ﺖﺸﮔﺮﺑ
ًﻼﻣﺎﻛ
ﻪﻛ
ﺖﺷاد
دﻮﺟو
ﺮﺘﻣوﺮﻴﭙﺳا
ي
FEV1زا
ﺮﺘﻤﻛ
رﻮﺗﻼﻳدﻮﻜﻧوﺮﺑ
ﺐﻗﺎﻌﺘﻣ
80
ﺪﺻرد
و
FEV1/FVCزا
ﺮﺘﻤﻛ
70
ﺪﺻرد
رد
و
دﻮﺑ
درﻮﻣ
ﺐﻠﻗ
يﺮﻴﮔراﺮﻗ
زﺮﻃ
و
هزاﺪﻧا
ﻪﻨﻴﺳ
زا
ﻲﻓاﺮﮔﻮﻳدار
ﺖﻓﺮﮔ
راﺮﻗ
ﻲﺑﺎﻳزرا
.(
و
ﻚﻴﻓاﺮﮔﻮﻣد
تﺎﻋﻼﻃا
ﻪﻣﺎﻨﺸﺳﺮﭘ
يرﺎﻤﻴﺑ
،رﺎﻤﻴﺑ
ﻲﻠﺻا
ﺖﻳﺎﻜﺷ
،ﺲﻨﺟ
،ﻦﺳ
ﻞﻣﺎﺷ
ﻲﻜﺷﺰﭘ
رد
ﻪﺑﺎﺸﻣ
يرﺎﻤﻴﺑ
ﻪﻘﺑﺎﺳ
،يا
ﻪﻨﻴﻣز
تﺪﻣ
لﻮﻃ
،هداﻮﻧﺎﺧ
ﻪﺑ
ﻼﺘﺑا
يﺎﻫرﺎﻴﻌﻣ
و
يرﺎﻤﻴﺑ
COPDرﺎﻤﻴﺑ
ﺮﻫ
ياﺮﺑ
ﺪﺷ
يروآدﺮﮔ
.
مﺮﺳ
يزﺎﺳاﺪﺟ
رﻮﻈﻨﻣ
ﻪﺑ
نﻮﺧ
يﺎﻫ
ﻪﻧﻮﻤﻧ
يﺮﻴﮕﻴﭘ
ﺖﻬﺟ
ﺪﻌﺑ
ﻪﺘﻔﻫ
ﻪﺳ
و
نارﺎﻤﻴﺑ
يﺮﺘﺴﺑ
ياﺪﺘﺑا
رد
ﺪﺷ
ﻪﺘﻓﺮﮔ
نارﺎﻤﻴﺑ
.
يﺎﻣد
رد
ﻲﻣﺮﺳ
يﺎﻫ
ﻪﻧﻮﻤﻧ
ﻦﻳا
20
-يﺎﻣد
رد
ﻲﺳرﺮﺑ
نﺎﻣز
ﺎﺗ
و
ﺪﻤﺠﻨﻣ
داﺮﮔ
ﻲﺘﻧﺎﺳ
ﻪﺟرد
70
-ﺪﻧﺪﺷ
يراﺪﻬﮕﻧ
داﺮﮔ
ﻲﺘﻧﺎﺳ
ﻪﺟرد
.
قﻼﺧا
ﻪﺘﻴﻤﻛ
ار
ﺶﻫوﮋﭘ
ﻦﻳا
مﺎﺠﻧا
دﺮﻛﺮﻬﺷ
ﻲﻜﺷﺰﭘ
مﻮﻠﻋ
هﺎﮕﺸﻧاد
زا
ﻪﻧﺎﻫﺎﮔآ
ﻪﻣﺎﻨﺘﻳﺎﺿر
ﻪﻌﻟﺎﻄﻣ
ياﺮﺟا
زا
ﻞﺒﻗ
و
ﺪﻴﻳﺄﺗ
ﺪﻳدﺮﮔ
ﺬﺧا
نارﺎﻤﻴﺑ
.
دﻮﺟو
Ig Gﺖﺴﺗ
ﺎﺑ
ﻪﻴﻧﻮﻣﻮﻨﭘ
ﺎﻳﺪﻴﻣﻼﻛ
ELISAو
ﺎﺑ
ﺎﻳﺪﻴﻣﻼﻛ
ﺺﻴﺨﺸﺗ
يﺎﻫ
ﺖﻴﻛ
زا
هدﺎﻔﺘﺳا
)
ﺖﻛﺮﺷ
ﺖﺧﺎﺳ
DRGﺎﻤﻟآ
ن
(
زا
هﺪﺷ
ﺖﻓﺎﻳرد
ﻲﻣﺮﺳ
يﺎﻫ
ﻪﻧﻮﻤﻧ
رد
ﺪﺷ
هداد
ﺺﻴﺨﺸﺗ
نارﺎﻤﻴﺑ
.
ﺖﻧﻮﻔﻋ
ﻚﻳژﻮﻟوﺮﺳ
تﺎﺒﺛا
ﺮﺘﻴﺗ
ﺎﺑ
دﺎﺣ
Ig Gزا
ﺮﺘﺸﻴﺑ
ﺎﻳ
ﺮﺑاﺮﺑ
512
ﺶﻳاﺰﻓا
ﺎﻳ
و
4
ﺪﻳدﺮﮔ
ﺺﺨﺸﻣ
ﺮﺘﻴﺗ
ﻦﻳا
رد
يﺮﺑاﺮﺑ
)
27
(
ﻪﻛ
ﺎﺠﻧآ
زا
و
ﺎﻳ
ﻲﻠﺒﻗ
ﺖﻧﻮﻔﻋ
ﻚﻳژﻮﻟوﺮﺳ
تﺎﺒﺛا
ياﺮﺑ
ﻲﻌﻄﻗ
رﺎﻴﻌﻣ
ﭻﻴﻫ
ﺘﻴﺗ
،ﺖﺷاﺪﻧ
دﻮﺟو
موﺎﻘﻣ
ﺖﻧﻮﻔﻋ
ﺮ
IgGﺎﺑ
ﺮﺑاﺮﺑ
64
و
زا
ﺮﺘﻤﻛ
512
و
ﻖﺑﺎﺳ
ﺖﻧﻮﻔﻋ
ﺖﻣﻼﻋ
ناﻮﻨﻋ
ﻪﺑ
ﺐﻴﺗﺮﺗ
ﻪﺑ
ﺪﺷ
ﻪﺘﻓﺮﮔ
ﺮﻈﻧ
رد
موﺎﻘﻣ
.
زا
ﺎﻫ
هداد
ﻞﻴﻠﺤﺗ
ياﺮﺑ
يرﺎﻣآ
يﺎﻫ
نﻮﻣزآ
ﺮﺸﻴﻓ
راﺰﻓا
مﺮﻧ
رد
ﻲﻨﺘﻳو
ﻦﻣ
و
SPSSﺪﺷ
هدﺎﻔﺘﺳا
.
ﺎﻫ
ﻪﺘﻓﺎﻳ
:
100
رﺎﻤﻴﺑ
)
53
و
دﺮﻣ
47
نز
(
ﻪﺑ
ﻼﺘﺒﻣ
AECOPDﻲﻨﺳ
ﻦﻴﮕﻧﺎﻴﻣ
ﺎﺑ
5
/
12
±5
/
65
ياﺮﺑ
لﺎﺳ
يدﺎﺑ
ﻲﺘﻧآ
Ig Gراﺮﻗ
ﻲﺑﺎﻳزرا
درﻮﻣ
ﻪﻴﻧﻮﻣﻮﻨﭘ
ﺎﻳﺪﻴﻣﻼﻛ
ﺪﻨﺘﻓﺮﮔ
.
7
نارﺎﻤﻴﺑ
ﺪﺻرد
)
4
و
دﺮﻣ
3
نز
(
ﺶﻳاﺰﻓا
ياراد
ﺮﺘﻴﺗ
رد
يﺮﺑاﺮﺑ
رﺎﻬﭼ
Ig Gﺪﻧدﻮﺑ
ﻲﻧﻮﺧ
يﺎﻫ
ﻪﻧﻮﻤﻧ
.
ﻪﺑ
ﻪﻴﻧﻮﻣﻮﻨﭘ
ﺎﻳﺪﻴﻣﻼﻛ
ﺮﻈﻧ
زا
نﺎﻧآ
ﻲﻧﻮﺧ
ﻪﻧﻮﻤﻧ
ﺮﮕﻳد
ترﺎﺒﻋ
دﻮﺑ
ﺖﺒﺜﻣ
.
ﺖﻧﻮﻔﻋ
ناﺰﻴﻣ
ﻮﻣﻮﻨﭘ
ﺎﻳﺪﻴﻣﻼﻛ
دﺎﺣ
ﻪﻄﺑار
ﻪﻴﻧ
ﻲﻨﻌﻣ
ﺖﺷاﺪﻧ
ﺲﻨﺟ
و
ﻦﺳ
ﺎﺑ
يراد
)
05
/
0
> P.(
ﻦﻴﻨﭽﻤﻫ
ﺪﻳﺪﺸﺗ
ﺲﻔﻧ
ﻲﮕﻨﺗ
نارﺎﻤﻴﺑ
ﻲﻠﺻا
يﺎﻫ
ﻪﻳﻼﮔ
ﻪﻓﺮﺳ
و
هﺪﺷ
ﻲﻨﻌﻣ
ﻪﻄﺑار
و
دﻮﺑ
دﺎﺣ
يرﺎﻤﻴﺑ
ﻢﺋﻼﻋ
و
ﺎﻫ
ﻪﻧﺎﺸﻧ
نﺎﻴﻣ
يراد
ﻪﻴﻧﻮﻣﻮﻨﭘ
ﺎﻳﺪﻴﻣﻼﻛ
دﺎﺣ
ﺖﻧﻮﻔﻋ
ﺮﺛا
ﺮﺑ
يرﺎﻤﻴﺑ
ﺪﻳﺪﺸﺗ
و
ﺪﺸﻧ
هﺪﻫﺎﺸﻣ
)
05
/
0
> P.(
تﺪﻣ
لﻮﻃ
ﻦﻴﮕﻧﺎﻴﻣ
COPDﺮﺑاﺮﺑ
5
/
2
و
لﺎﺳ
ﻦﻴﺑ
1
ﺎﺗ
10
ﻲﻨﻌﻣ
ﻪﻄﺑار
و
دﻮﺑ
لﺎﺳ
يراد
ﺪﺸﻧ
هﺪﻳد
ﻪﻴﻧﻮﻣﻮﻨﭘ
ﺎﻳﺪﻴﻣﻼﻛ
دﺎﺣ
ﺖﻧﻮﻔﻋ
ناﺰﻴﻣ
ﺎﺑ
)
05
/
0
> P.(
ﻪﻛ
ﺪﺷ
ﺺﺨﺸﻣ
نارﺎﻤﻴﺑ
ﻪﻨﻳﺎﻌﻣ
زا
ﺲﭘ
36
ﻣز
يﺎﻫ
يرﺎﻤﻴﺑ
زا
نﺎﻧآ
ﺪﺻرد
و
ﺪﻧدﺮﺑ
ﻲﻣ
ﺞﻧر
يا
ﻪﻨﻴ
ﻲﻨﻌﻣ
ﻪﻄﺑار
ﺎﻳﺪﻴﻣﻼﻛ
دﺎﺣ
ﺖﻧﻮﻔﻋ
ناﺰﻴﻣ
نﺎﻴﻣ
يراد
ﻛا
ﻪﺑ
ﻼﺘﺑا
و
ﻪﻴﻧﻮﻣﻮﻨﭘ
ﻪﻨﻴﻣز
يﺎﻫ
يرﺎﻤﻴﺑ
ﺮﺜ
دﻮﺟو
يا
ﺖﺷاﺪﻧ
)
05
/
0
> P(
ﻦﻴﺑ
ﺎﻬﻨﺗ
و
AECOPDدﻮﺟو
و
و
ﺖﺑﺎﻳد
يا
ﻪﻨﻴﻣز
يرﺎﻤﻴﺑ
فﻼﺘﺧا
نﻮﺧ
يرﺎﺸﻓﺮﭘ
ﻲﻨﻌﻣ
ﺪﺷ
هﺪﻳد
يراد
)
05
/
0
< P.(
4
و
ﺪﺻرد
73
ﺪﺻرد
ﻪﻛ
ﺪﻧدﻮﺑ
زﻮﻧﺎﻴﺳ
و
ﻲﺴﻔﻨﺗ
ﺮﺟز
رﺎﭼد
ﺐﻴﺗﺮﺗ
ﻪﺑ
نارﺎﻤﻴﺑ
زا
ﺑ
ﻦﻳا
زا
ماﺪﻜﭽﻴﻫ
ﻪﻄﺑار
يرﺎﻣآ
ﺮﻈﻧ
زا
ﺎﻫ
يرﺎﻤﻴ
ﻣ
ﻲﻨﻌ
ﺷاﺪﻧ
ﻪﻴﻧﻮﻣﻮﻨﭘ
ﺎﻳﺪﻴﻣﻼﻛ
دﺎﺣ
ﺖﻧﻮﻔﻋ
ﺎﺑ
يراد
ﺪﻨﺘ
.
ﻲﻨﻌﻣ
يرﺎﻣآ
ﻪﻄﺑار
ﭻﻴﻫ
ﻦﻴﻨﭽﻤﻫ
ﺖﻧﻮﻔﻋ
ناﺰﻴﻣ
نﺎﻴﻣ
يراد
نارﺎﻤﻴﺑ
رد
ﻪﻛ
ﻪﻴﻧﻮﻣﻮﻨﭘ
ﺎﻳﺪﻴﻣﻼﻛ
دﺎﺣ
AECOPDيور
ﺪﺸﻧ
هﺪﻫﺎﺸﻣ
هداﻮﻧﺎﺧ
رد
ﻪﺑﺎﺸﻣ
يﺎﻫ
يرﺎﻤﻴﺑ
ﻪﻘﺑﺎﺳ
و
داد
)
05
/
0
> P.(
نﺎﻴﻣ
ﻪﻄﺑار
ﺮﻈﻧ
زا
AECOPDﻪﻘﺑﺎﺳ
ﺎﺑ
ﺑﺎﺸﻣ
يﺎﻫ
يرﺎﻤﻴﺑ
ﻪ
ﻲﻨﻌﻣ
توﺎﻔﺗ
هداﻮﻧﺎﺧ
رد
دﻮﺑ
راد
)
05
/
0
< P) (
لوﺪﺟ
هرﺎﻤﺷ
1
.(
هرﺎﻤﺷلوﺪﺟ 1 :
نﺎﮔﺪﻨﻨﻛ
ﺖﻛﺮﺷ
ﻲﻜﺷﺰﭘ
و
ﻚﻴﻓاﺮﮔﻮﻣد
يﺎﻫ
ﻲﮔﮋﻳو
ﺮﺘﻴﺗﺶﻳاﺰﻓايارادداﺮﻓاداﺪﻌﺗ داﺪﻌﺗ ﺎﻫﻲﮔﮋﻳو 4 53 دﺮﻣ 3 47 نز ﺲﻨﺟ 2 49 يﺮﻬﺷ 5 51 ﻲﻳﺎﺘﺳور ﺖﻣﺎﻗاﻞﺤﻣ 6 79 ﺲﻔﻧﻲﮕﻨﺗﺪﻳﺪﺸﺗ 1 18 ﻪﻓﺮﺳﺪﻳﺪﺸﺗ - 2 ﻪﻨﻴﺳﻂﻠﺧﺪﻳﺪﺸﺗ - 1 ﺐﺗ ﻼﻋوﺎﻫﻪﻧﺎﺸﻧعﻮﻧ ﺎﻫﺖﻣ - 4 دﻮﺟو 7 96 دﻮﺟومﺪﻋ درد 5 73 دﻮﺟو 2 27 دﻮﺟومﺪﻋ زﻮﻧﺎﻴﺳ 2 33 دﻮﺟو 5 67 دﻮﺟومﺪﻋ ﻪﺑﺎﺸﻣيﺎﻫيرﺎﻤﻴﺑﻲﻠﻴﻣﺎﻓﻪﻘﺑﺎﺳ 1 36 دﻮﺟو 6 64 دﻮﺟومﺪﻋ ياﻪﻨﻴﻣزيﺎﻫيرﺎﻤﻴﺑ * * ﻞﻣﺎﺷ : ﻤﻴﺑ،ﻻﺎﺑنﻮﺧرﺎﺸﻓ،ﺖﺑﺎﻳد ﺎﺳرﺎﻧ،ﻲﺒﻠﻗﻚﻴﻤﻜﺴﻳايرﺎ ﻳ يﻮﻴﻠﻛﻦﻣﺰﻣﻲﻳﺎﺳرﺎﻧوﻲﺒﻠﻗﻦﻣﺰﻣﻲﺚﺤﺑ
:
ﺎﻳﺪﻴﻣﻼﻛ
دﺎﺣ
ﺖﻧﻮﻔﻋ
ﺺﻴﺨﺸﺗ
ﺮﺿﺎﺣ
ﻖﻴﻘﺤﺗ
رد
ﺶﻳاﺰﻓا
ﻲﻨﻌﻳ
ﻚﻳژﻮﻟوﺮﺳ
يﺎﻫرﺎﻴﻌﻣ
يﺎﻨﺒﻣ
ﺮﺑ
ﻪﻴﻧﻮﻣﻮﻨﭘ
ﺮﺘﻴﺗ
رد
ﺮﺑاﺮﺑ
رﺎﻬﭼ
Ig Gﻪﻛ
داد
نﺎﺸﻧ
ﺞﻳﺎﺘﻧ
و
ﺖﺳا
هدﻮﺑ
AECOPDرد
ﻂﻘﻓ
7
ﺪﺻرد
دﺎﺣ
ﺖﻧﻮﻔﻋ
ﺎﺑ
نارﺎﻤﻴﺑ
زا
ﺪﻴﻣﻼﻛ
ﺖﺷاد
ﻪﻄﺑار
ﻪﻴﻧﻮﻣﻮﻨﭘ
ﺎﻳ
.
ﺎﻳﺪﻴﻣﻼﻛ
ﺺﻴﺨﺸﺗ
ناﺰﻴﻣ
ﻞﻣﺎﻋ
ناﻮﻨﻋ
ﻪﺑ
دﺎﺣ
ﻪﻴﻧﻮﻣﻮﻨﭘ
AECOPDتﺎﻌﻟﺎﻄﻣ
رد
زا
ﺮﺘﻤﻛ
زا
و
توﺎﻔﺘﻣ
نﻮﮔﺎﻧﻮﮔ
3
زا
ﺶﻴﺑ
ﺎﺗ
30
ﺪﺻرد
ﺖﺳا
هدﻮﺑ
.
يدوﺪﺣ
ﺎﺗ
ﺎﻣ
ﻪﻌﻟﺎﻄﻣ
رد
هﺪﻣآ
ﺖﺳد
ﻪﺑ
خﺮﻧ
تﺎﻘﻴﻘﺤﺗ
ﻲﺧﺮﺑ
زا
ﺮﺗﻻﺎﺑ
)
6
،
15
،
30
-28
(
رد
و
ﺪﺷﺎﺑ
ﻲﻣ
د
ﻪﺑ
ﺮﻳدﺎﻘﻣ
ﺎﺑ
ﻪﺴﻳﺎﻘﻣ
زا
ﺮﮕﻳد
ﻲﺧﺮﺑ
رد
هﺪﻣآ
ﺖﺳ
تﺎﻌﻟﺎﻄﻣ
)
29
-27
(
ﺖﺳا
ﺮﺗ
ﻦﻴﻳﺎﭘ
.
خﺮﻧ
ﻪﻌﻟﺎﻄﻣ
ﻦﻳا
رد
،نارﺎﻤﻴﺑ
رد
ﻪﻴﻧﻮﻣﻮﻨﭘ
ﺎﻳﺪﻴﻣﻼﻛ
دﺎﺣ
ﺖﻧﻮﻔﻋ
ﻪﺑ
ﻼﺘﺑا
ﻦﻴﻳﺎﭘ
ياﺮﺑ
يرﺎﺼﺤﻧا
شور
ﻚﻳ
زا
هدﺎﻔﺘﺳا
ﺖﻠﻋ
ﻪﺑ
ًﻻﺎﻤﺘﺣا
ﺖﺳا
ﻢﺴﻴﻧﺎﮔراوﺮﻜﻴﻣ
ﻦﻳا
ﻲﻳﺎﺳﺎﻨﺷ
.
ﻦﻳا
،ﺮـﮕﻳد
فﺮﻃ
زا
ﻣ
ﻞﻴﻟد
ﻪﺑ
ﺖﺳا
ﻦﻜﻤﻣ
توﺎﻔﺘﻣ
ﺮﻳدﺎﻘﻣ
عﻮﻧ
ندﻮﺑ
دوﺪﺤ
ﺎﻫ
ﻪﻧﻮﻤﻧ
ﺖﻓﺎﻳرد
)
،مﺮﺳ
ﻪﻧﻮﻤﻧ
ﺎﻬﻨﺗ
لﺎﺜﻣ
ناﻮﻨﻋ
ﻪﺑ
ﻲﻨﻴﺑ
يﺎﻫ
بآﻮﺳ
–
و
رﻻﻮﺋﻮﻟآﻮﻜﻧوﺮﺑ
ژﺎﻧرد
،يا
هﺮﺠﻨﺣ
ﻪﻨﻴﺳ
ﻂﻠﺧ
(
رﺎﻛ
ﻪﺑ
يﺎﻫ
ﺖﻴﻛ
ﺖﻴﺻﺎﺼﺘﺧا
و
ﺖﻴﺳﺎﺴﺣ
ﺰﻴﻧ
و
ﺪﺷﺎﺑ
ﻪﺘﻓر
.
ﻪﺑ
ﻼﺘﺒﻣ
نارﺎﻤﻴﺑ
يور
ﺮﺑ
ﻪﻛ
يا
ﻪﻌﻟﺎﻄﻣ
رد
ﻪﺘﺒﻟا
COPDﻪﻴﻧﻮﻣﻮﻨﭘ
ﺎﻳﺪﻴﻣﻼﻛ
ندﺮﻛ
اﺪﺟ
ﺪﺷ
مﺎﺠﻧا
ژﺎﻧرد
زا
رﻻﻮﺋﻮﻟآﻮﻜﻧوﺮﺑ
)
Bronchoalveolar Drainage(
رﺎﻴﺴﺑ
ﺪﺷ
ﻲﺑﺎﻳزرا
ﻞﻜﺸﻣ
)
31
.(
ﻦﻴﺑ
يا
ﻪﻄﺑار
ﭻﻴﻫ
ﺎﻣ
ﻪﻴﻟوا
يﺎﻫ
هداد
AECOPDﺲﻨﺟ
و
ﻦﺳ
ﺎﺑ
ﻪﻴﻧﻮﻣﻮﻨﭘ
ﺎﻳﺪﻴﻣﻼﻛ
دﺎﺣ
ﺖﻧﻮﻔﻋ
ﻞﻴﻟد
ﻪﺑ
ﺮﮕﻳد
نﺎﻘﻘﺤﻣ
يﺎﻫ
ﻪﺘﻓﺎﻳ
ﺎﺑ
ﻪﻛ
ﺪﻧداﺪﻧ
نﺎﺸﻧ
)
33
،
32
(
ﻖﺑﺎﻄﺗ
ﺖﺷاد
.
ﺮﮕﺸﻫوﮋﭘ
زا
ﺮﮕﻳد
ﻲﺧﺮﺑ
ﻦﻴﻨﭽﻤﻫ
يا
ﻪﻄﺑار
ﭻﻴﻫ
نا
ﻦﻴﺑ
AECOPDﻦﺳ
و
ﻪﻴﻧﻮﻣﻮﻨﭘ
ﺎﻳﺪﻴﻣﻼﻛ
دﺎﺣ
ﺖﻧﻮﻔﻋ
ﺎﺑ
هﺪﻫﺎﺸﻣ
ﺪﻧدﺮﻜﻧ
)
12
،
37
-34
.(
و
ﻢﺋﻼﻋ
ﻦﻴﺑ
يا
ﻪﻄﺑار
ﭻﻴﻫ
ﺎﻣ
يﺎﻫ
هداد
رد
ﺎﺑ
نارﺎﻤﻴﺑ
يﺎﻫ
ﻪﻧﺎﺸﻧ
AECOPDﺎﻳﺪﻴﻣﻼﻛ
دﺎﺣ
ﺖﻧﻮﻔﻋ
و
ﺪﺸﻧ
هﺪﻫﺎﺸﻣ
ﻪﻴﻧﻮﻣﻮﻨﭘ
.
ﻪﻌﻟﺎﻄﻣ
رد
،ﻖﻴﻘﺤﺗ
ﻦﻳا
ﺎﺑ
ﻖﺑﺎﻄﺗ
رد
ﻳﺪﺷ
ﺲﻔﻧ
ﻲﮕﻨﺗ
ﺰﻴﻧ
يﺮﮕﻳد
ﻪﻧﺎﺸﻧ
ﻦﻳﺮﺗ
ﺞﻳار
ناﻮﻨﻋ
ﻪﺑ
ﺪ
AECOPDﻢﺋﻼﻋ
ﻦﻴﺑ
يرادﺎﻨﻌﻣ
ﻪﻄﺑار
ﭻﻴﻫ
ﻲﻟو
ﺪﺷ
ﻪﺋارا
ﺖﺷاﺪﻧ
دﻮﺟو
ﻪﻴﻧﻮﻣﻮﻨﭘ
ﺎﻳﺪﻴﻣﻼﻛ
دﺎﺣ
ﺖﻧﻮﻔﻋ
و
ﻲﻨﻴﻟﺎﺑ
)
38
.(
ﻦﻳاﺮﺑﺎﻨﺑ
AECOPDﺎﻳﺪﻴﻣﻼﻛ
دﺎﺣ
ﺖﻧﻮﻔﻋ
ﺖﻠﻋ
ﻪﺑ
هداد
ﺺﻴﺨﺸﺗ
ﻲﻨﻴﻟﺎﺑ
ﻢﺋﻼﻋ
يﺎﻨﺒﻣ
ﺮﺑ
ﺎﻬﻨﺗ
ﺪﻳﺎﺷ
ﻪﻴﻧﻮﻣﻮﻨﭘ
دﻮﺸﻧ
.
ﺑ
ﻼﺘﺑا
تﺪﻣ
لﻮﻃ
ﻦﻴﺑ
ﻦﻴﻨﭽﻤﻫ
ﻪ
COPDﺖﻧﻮﻔﻋ
و
ﻨﻌﻣ
ﻪﻄﺑار
ﭻﻴﻫ
ﻪﻴﻧﻮﻣﻮﻨﭘ
ﺎﻳﺪﻴﻣﻼﻛ
دﺎﺣ
ﻲ
دﻮﺟو
يراد
تﺎﻌﻟﺎﻄﻣ
ﻲﺧﺮﺑ
ﺎﺑ
ﻖﺑﺎﻄﻣ
ﻪﻛ
ﺖﺷاﺪﻧ
)
41
-39
(
ﺖﺳا
.
ﻦﻳا
ﺎﻳﺪﻴﻣﻼﻛ
دﺎﺣ
ﺖﻧﻮﻔﻋ
عﻮﻴﺷ
ﺖﻠﻋ
ﻪﺑ
ﺖﺳا
ﻦﻜﻤﻣ
ﻪﺘﻓﺎﻳ
ﺪﺷﺎﺑ
ﻞﻣﺎﻋ
ﻦﻳا
ﺎﺑ
سﺎﻤﺗ
بوﺎﻨﺗ
و
ﻪﻴﻧﻮﻣﻮﻨﭘ
.
ﺖﻧﻮﻔﻋ
ناﺰﻴﻣ
ﻦﻴﺑ
يراد
ﻲﻨﻌﻣ
ﻪﻄﺑار
ﻪﻌﻟﺎﻄﻣ
ﻦﻳا
رد
ﭘ
ﺎﻳﺪﻴﻣﻼﻛ
دﺎﺣ
ﺪﺸﻧ
هﺪﻫﺎﺸﻣ
يا
ﻪﻨﻴﻣز
يرﺎﻤﻴﺑ
ﺮﺜﻛا
و
ﻪﻴﻧﻮﻣﻮﻨ
.
دراﻮﻣ
لﺎﺣ
ﻦﻳا
ﺎﺑ
AECOPDﻲﺧﺮﺑ
ﺎﺑ
يﺮﻴﮔ
ﻢﺸﭼ
رﻮﻃ
ﻪﺑ
ﻪﺑ
يا
ﻪﻨﻴﻣز
يﺎﻫ
يرﺎﻤﻴﺑ
و
ﺪﻧدﻮﺑ
ﻂﺒﺗﺮﻣ
يا
ﻪﻨﻴﻣز
يرﺎﻤﻴﺑ
زا
ﻞﻣاﻮﻋ
ناﻮﻨﻋ
ﺎﻳﺪﻴﻣﻼﻛ
دﺎﺣ
ﺖﻧﻮﻔﻋ
ﻪﺑ
ﻼﺘﺑا
ﺮﻄﺧ
ﺶﻳاﺰﻓا
رد
ﻪﻴﻧﻮﻣﻮﻨﭘ
AECOPDنارﺎﻤﻴﺑ
اﺮﻳز
،ﺪﻧﻮﺷ
بﻮﺴﺤﻣ
ﺖﺑﺎﻳد
ﻪﺑ
ﻼﺘﺒﻣ
ﻪﺑ
ﻼﺘﺑا
ﺮﻄﺧ
ضﺮﻌﻣ
رد
ﺮﺘﺸﻴﺑ
يرﺎﺸﻓﺮﭘ
و
ﺪﻳﺪﺸﺗ
AECOPDﺪﻨﺘﺷاد
راﺮﻗ
.
ﻦﻳا
ﻪﺑ
ناﻮﺗ
ﻲﻣ
ﻖﻴﻘﺤﺗ
ﻦﻳا
يﺎﻫ
ﺖﻳدوﺪﺤﻣ
زا
ﻪﻧﻮﻤﻧ
ﻢﺠﺣ
ﻪﻛ
دﺮﻛ
هرﺎﺷا
ﻪﺘﻜﻧ
ﺎﺑ
ﻖﻴﻘﺤﺗ
ياﺪﺘﺑا
رد
عﻮﻴﺷ
ضﺮﻓ
30
نﺎﻨﻴﻤﻃا
ﺎﺑ
و
ﺪﺻرد
90
يﺎﻄﺧ
و
ﺪﺻرد
ﻲﺒﺴﻧ
25
ﺪﺻرد
ﻦﻳا
يﺎﻫ
ﻪﺘﻓﺎﻳ
سﺎﺳا
ﺮﺑ
اﺬﻟ
و
ﺪﺷ
ﻦﻴﻴﻌﺗ
،ﻪﻌﻟﺎﻄﻣ
ﻮﻴﺷ
ﻪﻴﻧﻮﻣﻮﻨﭘ
ﺎﻳﺪﻴﻣﻼﻛ
دﺎﺣ
ﺖﻧﻮﻔﻋ
ع
7
ﺪﺻرد
رد
ﺪﺷ
ﻪﺘﻓﺮﮔ
ﺮﻈﻧ
.
ﻪﺠﻴﺘﻧ
يﺮﻴﮔ
:
دﺎﺣ
ﺖﻧﻮﻔﻋ
ﻪﻛ
داد
نﺎﺸﻧ
ﻪﻌﻟﺎﻄﻣ
ﻦﻳا
يﺎﻫ
ﻪﺘﻓﺎﻳ
ﻪﺑ
ﻼﺘﺒﻣ
نارﺎﻤﻴﺑ
رد
ﻪﻴﻧﻮﻣﻮﻨﭘ
ﺎﻳﺪﻴﻣﻼﻛ
AECOPDزا
دﻮﺷ
ﻲﻤﻧ
ﻲﻘﻠﺗ
ﻢﻬﻣ
ﻲﺳﺎﻨﺷ
ﺐﺒﺳ
ظﺎﺤﻟ
.
رد
ﺎﺑ
،ﻦﻳاﺮﺑﺎﻨﺑ
رد
ﺮﮕﻳد
ﻞﻣاﻮﻋ
ﺶﻘﻧ
ﻦﺘﻓﺮﮔ
ﺮﻈﻧ
COPDفﺪﻫ
ﺎﺑ
و
فﺎﻔﺷ
رد
ﺎﻫ
سوﺮﻳو
ﺖﻟﺎﺧد
ندﺮﻛ
AECOPDﻪﺑ
ﺖﺳا
زﺎﻴﻧ
يﺮﺘﺸﻴﺑ
تﺎﻌﻟﺎﻄﻣ
)
42
(
يﺎﻫدﺮﻜﻳور
ﻪﺑ
ﺎﺗ
ﻲﺘﻧآ
ﺰﻳﻮﺠﺗ
ﺶﻫﺎﻛ
ﻦﻤﺿ
و
ﻪﺘﻓﺎﻳ
ﺖﺳد
صﺎﺧ
ﻲﻧﺎﻣرد
يﺮﺘﺴﺑ
و
يروﺮﺿ
ﺮﻴﻏ
يﺎﻫ
ﻪﻨﻳﺰﻫ
ﺖﺧادﺮﭘ
زا
ﺎﻫ
ﻚﻴﺗﻮﻴﺑ
دﻮﺷ
بﺎﻨﺘﺟا
تﺪﻣ
ﻲﻧﻻﻮﻃ
يﺎﻫ
نﺪﺷ
.
ﻲﻧادرﺪﻗ
و
ﺮﻜﺸﺗ
:
ﻮﻠﻋهﺎﮕﺸﻧاديروﺎﻨﻓوتﺎﻘﻴﻘﺤﺗﺖﻧوﺎﻌﻣزا ﻲﻜﺷﺰﭘم حﺮﻃﺪﻛﺺﻴﺼﺨﺗﺖﻬﺟدﺮﻛﺮﻬﺷ 489 ﻲﻟﺎﻣيﺎﻫﺖﻳﺎﻤﺣو ﻖﻴﻘﺤﺗﻦﻳامﺎﺠﻧا ردياﻪﻧﻮﮔ ﻪﺑﻪﻛيداﺮﻓاﻪﻤﻫو حﺮﻃزا ددﺮﮔﻲﻣﺮﻜﺸﺗوﺮﻳﺪﻘﺗ،ﺪﻨﺘﺷاديرﺎﻜﻤﻫ .
ﻊﺑﺎﻨﻣ
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Cite this article as: Hafizi M, Imani-Rastabi R, Mousavi M, Karimi A. The prevalence of acute Chlamydia pneumoniae infection in patients with acute exacerbation of the chronic obstructive
pulmonary. J Shahrekord Univ Med Sci. 2013 Oct, Nov; 15(4): 93-100.
*
Corresponding author:
Infectious Diseases and Tropical Medicine Dept., Shahrekord University of Medical Sciences, Shahrekord, I.R. Iran. Tel:00989133815531, E-mail: rastabi669@gmail.com
The prevalence of acute Chlamydia pneumoniae infection in patients with
acute exacerbation of the chronic obstructive pulmonary
Hafizi M
(MD) 1, Imani-Rastabi R
(MD)1*,Mousavi M
(MD)2,Karimi A
(PhD)3 1Infectious and Tropical Diseases Dept., Shahrekord University of Medical Sciences, Shahrekord, Iran; 2Internal MedicineDept., Shahrekord University of Medical Sciences, Shahrekord, I.R. Iran; 3Microbiology and Immunology Dept., Shahrekord University of Medical
Sciences, Shahrekord, I.R. Iran.
Received: 11/June/2013 Revised: 8/July/2013 Accepted: 20/July/2013
Background and aims: The chronic obstructive pulmonary disease (COPD) is the 4th cause of morbidity in world. Acute exacerbation of COPD (AECOPD) represents a common complaint that leads patients to seek medical attention. One of the major agents that cause AECOPD is Chlamydia pneumoniae. This study was aimed to investigate the prevalence of acute C. pneumoniae infection in patients admitted with AECOPD at Hajar hospital in Shahrekord.
Methods: In this descriptive cross-sectional study, 100 patients with AECOPD were studied. In addition to clinical and radiological examinations, two blood samples were taken three weeks apart. Antibody titers against C. pneumoniae determined by enzyme- linked immunosorbent assay (ELISA).
Results: The prevalence of C. pneumoniae infection in AECOPD was 7% and no relation with age, sex, duration of disease, and clinical signs were observed (P>0.05). However, a significant relationship between diabetic diseases: having family history and high pressure and similar diseases in family with AECOPD was observed (P<0.05).
Conclusion: Our results showed Acute C. pneumoniae infection is a low significant causative pathogen in AECOPD.