Vol 2, No. 3, 2008 Pages:237-244
1387 ﺰﻴﻳﺎﭘ،3 ﻩﺭﺎﻤﺷ،2 ﻩﺭﻭﺩ
237-244:ﺕﺎﺤﻔﺻ
Abstract
Introduction: Sulfur mustard -a chemical agent- has proven chronic effects on skin which make many problems such as sleep psychological and also sexual disorders and can reduce their quality of life. The aim of this study is to assess the association of quality of life and skin lesions in sulfur mustard exposed veterans.
Method: At current study 125 consecutive male chemical veterans suffering from skin lesion were being visited by dermatologists in the clinic of the Baqiyatallah hospital during 2007 summer. Pruritus severity in these patients was assessed with pruritus score questionnaire and their quality of life was assessed with Dermatology Life Quality Index.
Results: All subjects were men with mean age 44.3±8.0 years. More than pruritus, skin dryness (64%), burn sensation (63%), scaling (59%) and hyper pigmentation (51%) were more common skin lesions in chemical veterans. Mean of DLQI score in these patients were 19.42 ± 5.96. Pruritus severity was correlated with quality of life (r = 0.325, p < 0.001) and also correlated with other quality of life subscales expected work and school subscale. Allover pruritus, Burn sensation also related with Quality of life.
Discussion: Sulfur mustard exposed chemical veterans suffering from chronic skin complication such as pruritus and burn sensation witch affected their quality of life. Relieving this skin lesion could improve chemical veterans’ quality of life.
Key words: Quality of life, pruritus, Sulfur mustard.
:ﻩﺪﻴﻜﭼ
ﻲﺗﺪﻣ ﺯﺍﺭﺩ ﺕﺍﺮﻴﺛﺎﺗ ،ﻲﻳﺎﻴﻤﻴــﺷ ﻞﻣﺎﻋ ﻚﻳ ،ﻝﺩﺮﺧ ﺯﺎﮔ :ﻪﻣﺪﻘﻣ
ﺩﺎﺠﻳﺍ ﺎﺑ ﻲﺘــﺳﻮﭘ ﺕﺎﻌﻳﺎﺿ ﻦﻳﺍ ﻪــﻛ ﺩﺭﺍﺬﮔ ﻲﻣ ﻲﻗﺎﺑ ﺖــﺳﻮﭘ ﺮﺑ ﻱﺎﻫ ﻱﺭﺎﺠﻨﻫﺎﻧ ،ﺏﺍﻮــﺧ ﺕﻻﻼﺘﺧﺍ ﻪﻠﻤﺟ ﺯﺍ ﻱﺩﺎﻳﺯ ﺕﻼﻜــﺸﻣ ﺩﺍﺮﻓﺍ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﺎﻤﻴﻘﺘﺴﻣ ﻲــﺴﻨﺟ ﺕﻼﻜﺸﻣ ﻲﺘﺣ ﻭ ﻲﻧﺍﻭﺭ ﻪﻄﺑﺍﺭ ﻲــﺳﺭﺮﺑ ﺶﻫﻭﮋﭘ ﻦﻳﺍ ﻑﺪﻫ .ﺪﻫﺩ ﻲﻣ ﺭﺍﺮﻗ ﺮﻴﺛﺎﺗ ﺖﺤﺗ ﺍﺭ ﻪﻬﺟﺍﻮﻣ ﻲﻳﺎﻴﻤﻴﺷ ﻥﺍﺯﺎﺒﻧﺎﺟ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﻭ ﻲﺘﺳﻮﭘ ﺕﻼﻜــﺸﻣ .ﺪﺷﺎﺑ ﻲﻣ ﻝﺩﺮﺧ ﺯﺎﮔ ﺎﺑ ﻪﺘﻓﺎﻳ ﺖﻳﺎﻜﺷ ﺎﺑ ﻪﻛ ﺩﺮﻣ ﻲﻳﺎﻴﻤﻴﺷ ﺯﺎﺒﻧﺎﺟ 125 ﻪﻌﻟﺎﻄﻣ ﻦﻳﺍ ﺭﺩ :ﺵﻭﺭ
ﻥﺎﺘﺴﺑﺎﺗ ﺭﺩ ﷲﺍۂﻪﻴﻘﺑ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﻩﺎﮕﻧﺎﻣﺭﺩ ﻪﺑ ﻲﺘﺳﻮﭘ ﺕﻼﻜــﺸﻣ ﻪﻨﻳﺎﻌﻣ ﺖــﺳﻮﭘ ﻦﻴﺼﺼﺨﺘﻣ ﻂــﺳﻮﺗ ﺪﻧﺩﻮﺑ ﻩﺩﺮﻛ ﻪﻌﺟﺍﺮﻣ 1385 ﻭ ﺵﺭﺎﺧ ﺕﺪﺷ ﻪﻣﺎﻨﺸﺳﺮﭘ ﺎﺑ ﺩﺍﺮﻓﺍ ﻦﻳﺍ ﺭﺩ ﺵﺭﺎﺧ ﺕﺪﺷ .ﺪﻧﺪــﺷ Dermatology Life Quality ﻪﻣﺎﻨــﺸﺳﺮﭘ ﺎﺑ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ .ﺖﻓﺮﮔ ﺭﺍﺮﻗ ﻲﺑﺎﻳﺯﺭﺍ ﺩﺭﻮﻣ Index ±0/8 ﻲﺳﺭﺮﺑ ﺩﺭﻮﻣ ﻲﻳﺎﻴﻤﻴﺷ ﻥﺍﺯﺎﺒﻧﺎﺟ ﻦﺳ ﻦﻴﮕﻧﺎﻴﻣ :ﺎﻫﻪﺘﻓﺎﺑ
ﺵﺯﻮﺳ ،(%64) ﺖﺳﻮﭘ ﻲﻜﺸﺧ ،ﺵﺭﺎﺧ ﺮﺑ ﻩﻭﻼﻋ .ﺩﻮﺑ ﻝﺎﺳ 44/3 (%51) ﻥﻮﻴــﺳﺎﺘﻧﺎﻤﮕﻴﭘﺮﭙﻳﺎﻫ ﻭ (%59) ﻱﺰﻳﺭ ﻪﺘــﺳﻮﭘ ،(%63) ﻦﻴﮕﻧﺎﻴﻣ .ﺩﻮﺑ ﻲﻳﺎﻴﻤﻴــﺷ ﻥﺍﺯﺎﺒﻧﺎﺟ ﻲﺘﺳﻮﭘ ﺕﻼﻜــﺸﻣ ﻦﻳﺮﺗ ﻢﻬﻣ ﺭﺩ .ﺩﻮﺑ 19/42 ± 5/96 ﻕﻮــﻓ ﺩﺍﺮﻓﺍ ﺭﺩ ﻲﮔﺪﻧﺯ ﺖــﻴﻔﻴﻛ ﻩﺮــﻤﻧ ﺖﻴﻔﻴﻛ ﻞﻛ ﻩﺮﻤﻧ ﺎﺑ ﻱﺭﺍﺩ ﻲﻨﻌﻣ ﻪﻄﺑﺍﺭ ﺵﺭﺎﺧ ﺕﺪﺷ ﻥﺍﺭﺎﻤﻴﺑ ﻦﻳﺍ ﻥﺁ ﻱﺎﻫ ﺱﺎﻴﻘﻣﺮﻳﺯ ﻡﺎﻤﺗ ﻭ (r = 0/325 ،p< 0/001) ﻲــﮔﺪﻧﺯ ﺰﻴﻧ ﺵﺯﻮﺳ ﺱﺎﺴﺣﺍ ﺵﺭﺎﺧ ﺰﺟ ﻪﺑ .ﺖﺷﺍﺩ ﻞﻴﺼﺤﺗ ﻭ ﺭﺎﻛ ﺰﺟ ﻪﺑ .ﺩﻮﺑ ﺭﺍﺬﮔ ﺮﻴﺛﺎﺗ ﻥﺍﺯﺎﺒﻧﺎﺟ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﺭﺩ ﺎﺑ ﻪﻬﺟﺍﻮﻣ ﺯﺍ ﻩﺪﻧﺎﻣ ﻱﺎﺟ ﻪﺑ ﻲﺘﺳﻮﭘ ﺕﻼﻜــﺸﻣ :ﻯﺮﻴﮔﻪﺠﻴﺘﻧ
ﺍﺭ ﻥﺍﺯﺎﺒﻧﺎﺟ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﺵﺯﻮــﺳ ﻭ ﺵﺭﺎﺧ ﺪﻨﻧﺎﻣ ﻝﺩﺮــﺧ ﺯﺎﮔ ﺖﻴﻔﻴﻛ ﺕﻼﻜﺸﻣ ﻦﻳﺍ ﻝﺮﺘﻨﻛ ﺎﺑ ﻪﻛ ﺖــﺳﺍ ﻩﺩﺍﺩ ﺭﺍﺮﻗ ﺮﻴﺛﺎﺗ ﺖﺤﺗ .ﺖﻓﺎﻳ ﺪﻫﺍﻮﺧ ﺎﻘﺗﺭﺍ ﺩﺍﺮﻓﺍ ﻦﻳﺍ ﻲﮔﺪﻧﺯ ﺕﻼﻜــﺸﻣ ،ﻝﺩﺮﺧ ﺯﺎﮔ ،ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ :ﻱﺪﻴﻠﻛﻯﺎـﻫﻩژﺍﻭ
ﺵﺭﺎﺧ ،ﻲﺘﺳﻮﭘ
ﻲﻳﺎﻴﻤﻴﺷ
ﻥﺍﺯﺎﺒﻧﺎﺟ
ﻲﺘﺳﻮﭘ
ﺕﻼﻜﺸﻣ
ﺎﺑ
ﻂﺒﺗﺮﻣ
ﻲﮔﺪﻧﺯ
ﺖﻴﻔﻴﻛ
ﻝﺩﺮﺧ
ﺯﺎﮔ
ﺎﺑ
ﻩﺪﺷ
ﻪﻬﺟﺍﻮﻣ
Dermatology related Quality of Life
in Sulfur Mustard exposed Veterans
Panahi, Y. Ph.D, Davoodi, S.M. M.D,
Naghizadeh, M. M.Sc ،
*ﻱﺩﻭﻭﺍﺩﺩﻮﻌﺴﻣﺪﻴﺳﺮﺘﻛﺩ،"ﻲﻫﺎﻨﭘﺲﻧﻮﻳﺮﺘﻛﺩ
**ﻩﺩﺍﺯﻲﻘﻧﻱﺪﻬﻣﺪﻤﺤﻣ
#Corresponding author: Research Center of Chemical Injuries, Baqiyatallah University of Medical sciences, Tehran, Iran.
ﺰﻛﺮﻣ،(ﺞﻋ)ﷲﺍﻪﻴﻘﺑﻲﻜــﺷﺰﭘﻡﻮﻠﻋﻩﺎﮕــﺸﻧﺍﺩﺭﺎﻴــﺸﻧﺍﺩ :ﻝﻮﺌـﺴﻣﻩﺪﻨـﺴﻳﻮﻧ "
ﻲﻳﺎﻴﻤﻴﺷﻱﺎﻫﺐﻴﺳﺁﺕﺎﻘﻴﻘﺤﺗ ﺖﺳﻮﭘﻩﻭﺮﮔ،(ﺞﻋ)ﷲﺍﻪﻴﻘﺑﻲﻜﺷﺰﭘﻡﻮﻠﻋﻩﺎﮕﺸﻧﺍﺩﺭﺎﻴﺸﻧﺍﺩ *
ﺪﺣﺍﻭ،(ﺞﻋ)ﷲﺍ ﻪﻴﻘﺑﻲﻜــﺷﺰﭘﻡﻮﻠﻋﻩﺎﮕــﺸﻧﺍﺩ،ﻲﺘــﺴﻳﺯﺭﺎﻣﺁﺪــﺷﺭﺍﺱﺎﻨــﺷﺭﺎﻛ **
87/5/9 :ﺖﻓﺎﻳﺭﺩﺦﻳﺭﺎﺗ
ﻪﻣﺪﻘﻣ
(di-2 chloroethyl sulfide) ﻩﺮﺛﻮﻣ ﻩﺩﺎﻣ ﺎﺑ ﺩﺭﺎﺘﺳﻮﻣ ﺭﻮﻔﻟﻮﺳ
ﻱﺍﻮﻫ ﻭ ﺏﺁ ﺭﺩ ﻲﮕﺘــﺴﻫﺁ ﻪﺑ ﻪﻛ ﻞﻜــﺷ ﻲﻨﻏﻭﺭ ﺖــﺳﺍ ﻲﻌﻳﺎﻣ
ﻱﺪﻳﺪﺷ ﻱﺎﻫ ﺐﻴﺳﺁ ﻩﺩﺎﻣ ﻦﻳﺍ ﺎﺑ ﻪﻬﺟﺍﻮﻣ .ﺩﻮﺷ ﻰﻣ ﺮﻴﺨﺒﺗ ﻝﺪﺘﻌﻣ
ﻪﺑ ﺯﺎﮔ ﻦﻳﺍ .[1ﻭ2] ﺩﺭﺍﺬــﮔ ﻲﻣ ﻱﺎﺟﺮﺑ ﻢــﺸﭼ ﻭ ﻪﻳﺭ ،ﺖــﺳﻮﭘ ﺮﺑ
ﺩﺭﻮﻣ ﻲﻳﺎﻴﻤﻴﺷ ﻱﺎﻫ ﺡﻼــﺳ ﺭﺩ ﻩﺪﻨﻨﻛ ﻥﺍﻮﺗﺎﻧ ﻞﻣﺎﻋ ﻚﻳ ﻥﺍﻮﻨﻋ
ﮓﻨﺟ ﺭﺩ ﻕﺍﺮــﻋ ﻂــﺳﻮﺗ ﺕﺎﻌﻓﺩ ﻪﺑ ﻭ ﺩﺮﻴﮔ ﻲﻣ ﺭﺍﺮــﻗ ﻩﺩﺎﻔﺘــﺳﺍ
ﺭﺍﺮﻗ ﻩﺩﺎﻔﺘﺳﺍ ﺩﺭﻮﻣ ﻲﻧﺍﺮﻳﺍ ﻥﺍﺪﻧﻭﺮﻬﺷ ﻭ ﻥﺍﺯﺎﺑﺮــﺳ ﻪﻴﻠﻋ ﻲﻠﻴﻤﺤﺗ
.[3ﻭ 4] ﺖﺳﺍ ﻪﺘﻓﺮﮔ
ﻭ ﺱﺭ ﺩﻭﺯ ﺽﺭﺍﻮﻋ ﻪﺑ ﻥﺍﻮﺗ ﻲﻣ ﺍﺭ ﻝﺩﺮﺧ ﺯﺎﮔ ﻲﺘــﺳﻮﭘ ﺽﺭﺍﻮﻋ
ﻝﺩﺮﺧ ﺯﺎﮔ ﺎﺑ ﺱﺎﻤﺗ ﺯﺍ ﺲﭘ .ﺩﻮﻤﻧ ﻱﺪﻨﺑ ﻢﻴﺴﻘﺗ ﻱﺮﻴﺧﺎﺗ ﺽﺭﺍﻮﻋ ﻭ ﺵﺯﻮﺳ ،ﺵﺭﺎﺧ ﺎﺑ ًﺎﺒﻟﺎﻏ ﻢﺘﻳﺭﺍ ،ﻱﺮﻴﺧﺄﺗ ﻩﺎﺗﻮﻛ ﺓﺭﻭﺩ ﻚﻳ ﺯﺍ ﺪﻌﺑ ،ﺪﺷﺎﺑ ﺩﺎﻳﺯ ﻚﻴﺴﻛﻮﺗ ﻞﻣﺎﻋ ﺭﺍﺪﻘﻣ ﺮﮔﺍ ﻪﻛ ﺩﻮــﺷ ﻰﻣ ﺩﺎﺠﻳﺍ ﺩﺭﺩ ﺎﻳ
ﺩﻮﺷ ﻰﻣ ﺩﺎﺠﻳﺍ ﻮﺗﺎﻤﺘﻳﺭﺍ ﻲﺣﺍﻮﻧ ﻑﺍﺮﻃﺍ ﺭﺩ ﻲﻜﭼﻮﻛ ﻱﺎﻫ ﻝﻮﻜﻳﺯﻭ
ﺱﺭﺮﻳﺩ ﺽﺭﺍﻮﻋ ﺎﻣﺍ .[5 ﻭ 6] ﺪﻧﺩﺮﮔ ﻲﻣ ﻝﻭﺎﺗ ﻪﺑ ﻞﻳﺪﺒﺗ ًﺍﺪﻌﺑ ﻪﻛ
،ﻲﻜﺸﺧ ،ﻢﺘﻳﺭﺍ ،ﻥﻮﻴــﺳﺎﺘﻧﺎﻤﮕﻴﭘ ﺯﺍ ﺪﻨﺗﺭﺎﺒﻋ ﻝﺩﺮﺧ ﺯﺎﮔ ﻲﺘــﺳﻮﭘ
.[7 ﻭ 8] ﺵﺭﺎﺧ ﻭ ﺵﺯﻮﺳ ﻱﺰﻳﺭ ﻪﺘﺳﻮﭘ
ﺖﻴﻔﻴﻛ ﻥﺩﺍﺩ ﺭﺍﺮﻗ ﺮﻴﺛﺎﺗ ﺖﺤﺗ ﻥﺎﻜﻣﺍ ﻕﻮــﻓ ﺽﺭﺍﻮﻋ ﺯﺍ ﻚﻳ ﺮﻫ
ﻦﻳﺮﺗ ﻲﻠﺻﺍ ﻥﺍﻮﻨﻋ ﻪﺑ ﺵﺭﺎﺧ ﻝﺎﺜﻣ ﻥﺍﻮﻨﻋ ﻪﺑ ﺩﺭﺍﺩ ﺍﺭ ﺩﺍﺮﻓﺍ ﻲﮔﺪﻧﺯ
ﺯﺍ ﻱﺩﺎﻳﺯ ﺕﻼﻜﺸﻣ ﺩﺎﺠﻳﺍ ﺎﺑ ﻝﺩﺮﺧ ﺯﺎﮔ ﺯﺍ ﻲــﺷﺎﻧ ﻦﻣﺰﻣ ﻪﺿﺭﺎﻋ
ﺕﻼﻜﺸﻣ ﻲﺘﺣ ﻭ ﻲﻧﺍﻭﺭ ﻱﺎﻫ ﻱﺭﺎﺠﻨﻫﺎﻧ ،ﺏﺍﻮﺧ ﺕﻻﻼﺘﺧﺍ ﻪﻠﻤﺟ
ﺪﻫﺩ ﻰﻣ ﺭﺍﺮﻗ ﺮﻴﺛﺎﺗ ﺖﺤﺗ ﺍﺭ ﺩﺍﺮﻓﺍ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﺎﻤﻴﻘﺘﺴﻣ ﻲﺴﻨﺟ
ﻱﺪﻨﭼ ﻲﺘــﺳﻮﭘ ﺕﻼﻜــﺸﻣ ﺎﺑ ﻂﺒﺗﺮﻣ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ .[9 ﻭ 10]
.[11ﻭ12] ﺖﺳﺍ ﻩﺩﻮﻤﻧ ﺐﻠﺟ ﺩﻮﺧ ﻪﺑ ﺍﺭ ﻦﻴﻘﻘﺤﻣ ﻪﺟﻮﺗ ﻪﻛ ﺖﺳﺍ
ﺯﺍ ﺖﺳﺍ ﻩﺪــﺷ ﻪﻳﺍﺭﺍ ﻥﺁ ﺶﺠﻨــﺳ ﻱﺍﺮﺑ ﺰﻴﻧ ﻲﻔﻠﺘﺨﻣ ﻱﺎﻬــﺷﻭﺭ Dermatology Life Quality) DLQI ﻪﻣﺎﻨــﺸﺳﺮﭘ ﻪﻠﻤﺟ
ﻲﺑﺎﻳﺯﺭﺍ ﻱﺍﺮــﺑ ﺪﻴﻔﻣ ﻭ ﻪﺻﻼﺧ ﻪﻣﺎﻨــﺸﺳﺮﭘ ﻚﻳ ﻪــﻛ (Index
.[13ﻭ14] ﺪﺷﺎﺑ ﻲﻣ ﻲﺘﺳﻮﭘ ﺕﻼﻜﺸﻣ ﺎﺑ ﻂﺒﺗﺮﻣ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ
ﺖﻴﻔﻴﻛ ﻭ ﻲﺘﺳﻮﭘ ﺕﻼﻜﺸﻣ ﻪﻄﺑﺍﺭ ﻲــﺳﺭﺮﺑ ﺶﻫﻭﮋﭘ ﻦﻳﺍ ﻑﺪﻫ
.ﺪﺷﺎﺑ ﻲﻣ ﻝﺩﺮﺧ ﺯﺎﮔ ﺎﺑ ﻪﺘﻓﺎﻳ ﻪﻬﺟﺍﻮﻣ ﻲﻳﺎﻴﻤﻴﺷ ﻥﺍﺯﺎﺒﻧﺎﺟ ﻲﮔﺪﻧﺯ
ﺵﻭﺭ
.ﺖﺳﺍ ﻩﺪﺷ ﻡﺎﺠﻧﺍ 1385 ﻝﺎﺳ ﺭﺩ ﻲﻌﻄﻘﻣ ﺕﺭﻮﺻ ﻪﺑ ﻪﻌﻟﺎﻄﻣ ﻦﻳﺍ
ﻪﻛ ﻩﺪﺷ ﻞﻴﻜــﺸﺗ ﻲﻳﺎﻴﻤﻴــﺷ ﻦﻴﻣﻭﺪﺼﻣ ﺯﺍ ﻪﻌﻟﺎﻄﻣ ﺩﺭﻮﻣ ﻪﻌﻣﺎﺟ ﻕﻮﻓ ﻥﺍﺭﺎﻤﻴﺑ .ﺖﺳﺍ ﻩﺪﺷ ﺕﺎﺒﺛﺍ ﺩﺭﺎﺘﺳﻮﻣﺭﻮﻔﻟﻮﺳ ﺎﺑ ﺎﻬﻧﺁ ﺕﺭﻭﺎﺠﻣ
ﺖﻳﺎﻜﺷ ﺎﺑ ﻭ ﻩﺩﻮﺑ ﻩﺩﺎﻣ ﻦﻳﺍ ﺯﺍ ﻲﺷﺎﻧ ﻦﻣﺰﻣ ﻲﺘﺳﻮﭘ ﺕﺎﻌﻳﺎﺿ ﺭﺎﭼﺩ
ﻪﻌﺟﺍﺮﻣ ﷲﺍ ﻪﻴﻘﺑ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺖﺳﻮﭘ ﻚﻴﻨﻴﻠﻛ ﻪﺑ ﻪﻌﺟﺍﺮﻣ ﻲﺘــﺳﻮﭘ
65 ﺎﺗ 30 ﻲﻨــﺳ ﻪﻨﻣﺍﺩ ﺭﺩ ﻭ ﺩﺮﻣ ﻕﻮﻓ ﻥﺍﺭﺎﻤﻴﺑ ﻪﻴﻠﻛ .ﺪــﻧﺍ ﻩﺩﻮﻤﻧ
ﺰﺟ ﻪﺑ ﻲﻠﻴﻟﺩ ﻪــﺑ ﻕﻮﻓ ﺩﺍﺮﻓﺍ ﻪﻛ ﻲﺗﺭﻮﺻﺭﺩ .ﺪﻨﺘــﺷﺍﺩ ﺭﺍﺮﻗ ﻝﺎــﺳ
ﺎﻳ ﻭ ﺪﻧﺩﻮﺑ ﻩﺪﺷ ﻲﺘــﺳﻮﭘ ﺕﻼﻜــﺸﻣ ﺭﺎﭼﺩ ﻝﺩﺮﺧ ﺯﺎﮔ ﺎﺑ ﻪﻬﺟﺍﻮﻣ
ﻑﺮﺼﻣ ﺎﻳ ﻦﻣﺰﻣ ﻱﺎﻫ ﻱﺭﺎﻤﻴﺑ ﻪﺠﻴﺘﻧ ﺭﺩ ﺎﻬﻧﺁ ﻲﺘﺳﻮﭘ ﺕﻼﻜــﺸﻣ
.ﺪﻧﺪﺷ ﻪﺘﺷﺍﺬﮔ ﺭﺎﻨﻛ ﻪﻌﻟﺎﻄﻣ ﺯﺍ ﺩﻮﺑ ﻭﺭﺍﺩ
ﻩﺩﻮﻤﻧ ﺪﻴﻳﺎﺗ ﺍﺭ ﻕﻮﻓ ﺶﻫﻭﮋﭘ ﷲﺍ ۂﻪﻴﻘﺑ ﻩﺎﮕــﺸﻧﺍﺩ ﻲﻗﻼﺧﺍ ﻪﺘﻴﻤﻛ
ﻪﻌﻟﺎﻄﻣ ﺭﺩ ﺖﻛﺮﺷ ﺯﺍ ﺍﺭ ﺩﻮﺧ ﺖﻳﺎﺿﺭ ﻲﺒﺘﻛ ﺕﺭﻮﺻ ﻪﺑ ﻥﺭﺎﻤﻴﺑ ﻭ
.ﺪﻧﺩﻮﺑ ﻩﺩﻮﻤﻧ ﻡﻼﻋﺍ
ﻦﻴﺼﺼﺨﺘﻣ ﻂﺳﻮﺗ ﺪﻧﺩﻮﺑ ﻪﻌﻟﺎﻄﻣ ﺭﺩ ﺖﻛﺮــﺷ ﺪﺟﺍﻭ ﻪﻛ ﻲﻧﺍﺭﺎﻤﻴﺑ
ﺭﺩ ﺎﻬﻧﺁ ﻲﺘﺳﻮﭘ ﺕﺎﻌﻳﺎﺿ ﻭ ﺪﻧﺪــﺷ ﻰﻣ ﻲﻜﻳﺰﻴﻓ ﻪﻨﻳﺎﻌﻣ ﺖــﺳﻮﭘ
ﺵﺭﺎﺧ ﻪﻛ ﺎﺠﻧﺁ ﺯﺍ .ﺪﻳﺩﺮﮔ ﻲﻣ ﺖﺒﺛ ﺖﺳﻮﭘ ﺕﻼﻜﺸﻣ ﺖﺴﻴﻟ ﻚﭼ
ﺯﺎﮔ ﺎﺑ ﻥﺎﮕﺘﻓﺎﻳ ﻪﻬﺟﺍﻮﻣ ﺭﺩ ﻲﺘﺳﻮﭘ ﺖﻳﺎﻜــﺷ ﻦﻳﺮﺗ ﻢﻬﻣ ﻥﺍﻮﻨﻋ ﻪﺑ
ﺩﺭﻮﻣ ﻪﻧﺎﮔﺍﺪﺟ ﺕﺭﻮﺻ ﻪﺑ ﻞﻜــﺸﻣ ﻦﻳﺍ ﺕﺪــﺷ ﺪــﺷﺎﺑ ﻲﻣ ﻝﺩﺮﺧ
.ﺖﻓﺮﮔ ﺭﺍﺮﻗ ﻲﺳﺭﺮﺑ
ﺵﺭﺎﺧ ﺕﺪﺷ ﻪﻣﺎﻨﺸﺳﺮﭘ ﺯﺍ ﻥﺍﺭﺎﻤﻴﺑ ﺵﺭﺎﺧ ﺕﺪﺷ ﻲﺳﺭﺮﺑ ﺭﻮﻈﻨﻣ ﻪﺑ
(Visual Analog Scale) VAS ﺭﺎﻴﻌﻣ ﻭ (Pruritic Score)
ﺮﻴﻏ ﻲﻘﻓﺍ ﻂﺧ ﻪﻌﻟﺎﻄﻣ ﻦﻳﺍ ﺭﺩ ﺵﺭﺎﺧ ﺕﺪﺷ VAS .ﺪﺷ ﻩﺩﺎﻔﺘــﺳﺍ
ﻥﻭﺪﺑ ﺕﺍﺭﺎﺒﻋ ﺎﺑ ﻥﺁ ﻱﺎﻬﺘﻧﺍ ﻭ ﺯﺎﻏﺁ ﻪﻄﻘﻧ ﻪﻛ ﺩﻮﺑ 100 mm ﺝﺭﺪﻣ
ﻥﺍﺭﺎﻤﻴﺑ ﺯﺍ .ﺩﻮﺑ ﻩﺪــﺷ ﺺﺨﺸﻣ ﺪﻳﺪــﺷ ﺭﺎﻴــﺴﺑ ﺵﺭﺎﺧ ﻭ ﺵﺭﺎﺧ
ﺭﻮﺤﻣ ﻦﻳﺍ ﺮﺑ ﺩﻮﻤﻋ ﻲﻄﺧ ﺍﺭ ﺩﻮﺧ ﺵﺭﺎﺧ ﺕﺪﺷ ﻪﻛ ﺪﺷ ﻪﺘــﺳﺍﻮﺧ
ﻦﻳﺍ ﺭﺩ ﻩﺩﺎﻔﺘﺳﺍ ﺩﺭﻮﻣ ﺵﺭﺎﺧ ﺕﺪﺷ ﻪﻣﺎﻨﺸﺳﺮﭘ .ﺪﻨﻳﺎﻤﻧ ﺺﺨــﺸﻣ
ﻪﻣﺎﻨﺸﺳﺮﭘ ﺯﺍ ﻱﺭﺍﺩﺮﺑ ﻮﮕﻟﺍ ﺎﺑ ﻭ [15ﻭ16] Duo ﻂــﺳﻮﺗ ﺶﻫﻭﮋﭘ
ﻪﻤﺟﺮﺗ ﺯﺍ ﺲﭘ ﻪﻛ ﺖــﺳﺍ ﻩﺪــﺷ ﻲﺣﺍﺮﻃ [17] Yosipovitch ﻭ
ﺕﺪﺷ ،ﻲﻧﺍﻭﺍﺮﻓ ﻪﻣﺎﻨﺸﺳﺮﭘ ﻦﻳﺍ .ﺖﺳﺍ ﻪﺘﻓﺮﮔ ﺭﺍﺮﻗ ﻩﺩﺎﻔﺘــﺳﺍ ﺩﺭﻮﻣ
ﺕﻼﻜــﺸﻣ ﻦﻴﻨﭽﻤﻫ ﺮﻬﻇ ﺯﺍ ﺪﻌﺑ ﻭ ﻞﺒﻗ ﺍﺭ ﺵﺭﺎﺧ ﻲــﮔﺪﻨﻛﺍﺮﭘ ﻭ
ﺐﺷ ﺭﺩ ﺍﺭ ﺵﺭﺎﺧ ﺮﺛﺍ ﺭﺩ ﺏﺍﻮﺧ ﺯﺍ ﻥﺪﺷ ﺭﺍﺪﻴﺑ ﻭ ﺏﺍﻮﺧ ﻪﺑ ﻁﻮﺑﺮﻣ
ﺮﻔﺻ ﻦﻴﺑ ﺯﺎﻴﺘﻣﺍ ﺖﻳﺎﻬﻧ ﺭﺩ .(1 ﻝﻭﺪﺟ) ﺪﻫﺩ ﻲﻣ ﺭﺍﺮﻗ ﻲﺳﺭﺮﺑ ﺩﺭﻮﻣ
ﻩﺮﻤﻧ ﻪﻛ .ﺩﻮﺑ ﺪــﻫﺍﻮﺧ ﺭﺎﻤﻴﺑ ﺵﺭﺎﺧ ﺕﺪــﺷ ﻩﺪﻨﻨﻛ ﻦﻴﻴﻌﺗ 48 ﺎــﺗ
ﻪﻣﺎﻨﺸﺳﺮﭘ ﻦﻳﺍ .ﺪﺷﺎﺑ ﻲﻣ ﺮﺘﺸﻴﺑ ﺕﻼﻜﺸﻣ ﺕﺪﺷ ﻲﻨﻌﻣ ﻪﺑ ﺮﺗﻻﺎﺑ
ﻲﻳﺎﻴﻤﻴــﺷﺮﻴﻏ ﻥﺍﺭﺎﻤﻴﺑ ﻭ ﻲﻳﺎﻴﻤﻴــﺷ ﻥﺍﺯﺎﺒﻧﺎﺟ ﺭﺩ ﺰﻴﻧ ﻦﻳﺍ ﺯﺍ ﺶﻴﭘ
ﺯﺍ ﻩﺩﺎﻔﺘــﺳﺍ ﺎﺑ ﺰﻴﻧ ﻲﺘــﺳﻮﭘ ﺕﻼﻜــﺸﻣ ﻪﺑ ﻁﻮﺑﺮﻣ ﻲﮕﻧﺯ ﺖﻴﻔﻴﻛ
ﻪﻣﺎﻨﺸﺳﺮﭘ ﻦﻳﺍ ﻲﺣﺍﺮﻃ .[21] ﺪــﺷ ﻲﺑﺎﻳﺯﺭﺍ DLQI ﻪﻣﺎﻨﺸﺳﺮﭘ
ﺮﺑ ﻲﺘﺳﻮﭘ ﺕﻼﻜﺸﻣ ﺮﻴﺛﺎﺗ ﻪﻛ ﺖــﺳﺍ ﻪﺘﻓﺮﮔ ﺕﺭﻮﺻ ﻱﺍ ﻪﻧﻮﮔ ﻪﺑ
ﺭﺩ ﻩﺩﺎﻔﺘﺳﺍ ﺖﻴﻠﺑﺎﻗ ﻭ ﺪﻫﺩ ﺭﺍﺮﻗ ﻲــﺳﺭﺮﺑ ﺩﺭﻮﻣ ﺍﺭ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ
ﺯﺍ DLQI ﻪﻣﺎﻨــﺸﺳﺮﭘ .ﺩﺭﺍﺩ ﺍﺭ ﻲﺘﺳﻮﭘ ﺕﻼﻜــﺸﻣ ﺯﺍ ﻱﺭﺎﻴــﺴﺑ
ﺱﺎﺴﺣﺍ ﻪﻋﻮﻤﺠﻣ ﺮﻳﺯ ﺶﺷ ﻪﻛ ﺖﺳﺍ ﻩﺪــﺷ ﻞﻴﻜﺸﺗ ﻝﺍﻮﺳ 10
ﻂﺑﺍﻭﺭ ،ﻞﻴﺼﺤﺗ ﻭ ﺭﺎﻛ ،ﺖــﺻﺮﻓ ،ﻪــﻧﺍﺯﻭﺭ ﺖــﻴﻟﺎﻌﻓ ،ﺎﻫ ﻪﻧﺎــﺸﻧ ﻭ
ﺯﺍ ﻚﻳ ﺮﻫ .ﺪــﻫﺩ ﻲﻣ ﺭﺍﺮﻗ ﻲــﺳﺭﺮﺑ ﺩﺭﻮﻣ ﺍﺭ ﻥﺎﻣﺭﺩ ﻭ ﻲﺼﺨــﺷ
0 ﺯﺍ ﻱﺯﺎﻴﺘﻣﺍ ﻭ ﻩﺩﻮﺑ ﻱﺍ ﻪﻨﻳﺰﮔ ﺭﺎﻬﭼ ﻪﻣﺎﻨــﺸﺳﺮﭘ ﻦﻳﺍ ﺕﻻﺍﻮــﺳ
ﺮﻴﺛﺎﺗ ﻝﺍﻮــﺳ ﺮﻫ ﺯﺎﻴﺘﻣﺍ ﻊﻤﺟ ﺎﺑ ﺖﻳﺎﻬﻧ ﺭﺩ ﻭ ﺖــﺳﺍ ﻪﺘــﺷﺍﺩ 3 ﺎﺗ
30 ﺎﺗ ﺮﻔﺻ ﺯﺍ ﻱﺯﺎﻴﺘﻣﺍ ﺎﺑ ﺍﺭ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﺭﺩ ﻲﺘﺳﻮﭘ ﺕﻼﻜﺸﻣ
ﻱﺮﻳﺬﭘ ﺮﻴﺛﺎﺗ ﻲﻨﻌﻣ ﻪﺑ ﺮﺗﻻﺎﺑ ﻩﺮﻤﻧ ﻪﻛ .ﺖــﺳﺍ ﻩﺪﻳﺩﺮﮔ ﺺﺨﺸﻣ
.ﺪﺷﺎﺑ ﻲﻣ ﻲﺘﺳﻮﭘ ﺕﻼﻜﺸﻣ ﺯﺍ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﺮﺘﺸﻴﺑ
ﺐﻳﺮﺿ ﻚﻤﻛ ﺎــﺑ ﺵﺭﺎﺧ ﺕﺪــﺷ ﻭ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﻦﻴﺑ ﻪــﻄﺑﺍﺭ
ﻱﺎﻫ ﻩﻭﺮﮔ ﺭﺩ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﻪــﺴﻳﺎﻘﻣ ﻭ ﻥﻮــﺳﺮﻴﭘ ﻲﮕﺘــﺴﺒﻤﻫ ﻱﺮﺘﻣﺍﺭﺎﭘﺎﻧ ﻥﻮﻣﺯﺁ ﺯﺍ ﻩﺩﺎﻔﺘــﺳﺍ ﺎﺑ ﻲﺘﺳﻮﭘ ﺕﻼﻜــﺸﻣ ﻥﻭﺪﺑ ﻭ ﺍﺭﺍﺩ
ﺪﻨﭼ ﻲﻄﺧ ﻥﻮــﺳﺮﮔﺭ ﺎﺑ ﺎﻬﺘﻧﺍ ﺭﺩ .ﺪــﺷ ﻡﺎﺠﻧﺍ Mann Whitney
ﺎﺑ ﻲﺘﺳﻮﭘ ﺕﻼﻜﺸﻣ ﻡﺎﻤﺗ ﻭ (PS) ﺵﺭﺎﺧ ﺕﺪﺷ ﻦﻴﺑ ﻪﻄﺑﺍﺭ ﻪﻠﻤﺟ
ﻦﻳﺍ ﺞﻳﺎﺘﻧ .ﺖﻓﺮﮔﺭﺍﺮﻗ ﻲﺳﺭﺮﺑ ﺩﺭﻮﻣ DLQI ﻪﻣﺎﻨﺸﺳﺮﭘ ﻞﻛ ﻩﺮﻤﻧ
ﻥﺁ ﻱﺪﺻﺭﺩ 95 ﻥﺎﻨﻴﻤﻃﺍ ﻪﻠﺻﺎﻓ ﻭ ﻥﻮﻴــﺳﺮﮔﺭ ﺐﻳﺮﺿ ﺎﺑ ﻥﻮــﻣﺯﺁ
.ﺪﺷ ﻡﺎﺠﻧﺍ SPSS ﺭﺍﺰﻓﺍ ﻡﺮﻧ ﻂﻴﺤﻣ ﺭﺩ ﻕﻮﻓ ﻱﺎﻬﻧﻮﻣﺯﺁ .ﺪﺷ ﻥﺎﻴﺑ
ﺎﻫ
ﻪﺘﻓﺎﻳ
ﺮﻔﻧ 11 ﺩﺍﺮﻓﺍ ﻦﻳﺍ ﺯﺍ ﻪﻛ ﺩﻮﺑ ﺮﻔﻧ 140 ﻞﻣﺎــﺷ ﻪﻴﻟﻭﺍ ﻪﻧﻮﻤﻧ ﻢﺠﺣ
ﻞﻴﻤﻜﺗ ﺺﻗﺎﻧ ﺭﻮﻃ ﻪﺑ ﺍﺭ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﻪﺑ ﻁﻮﺑﺮﻣ ﻪﻣﺎﻨــﺸﺳﺮﭘ
ﺺﻗﺎﻧ ﻞﻴﻟﺩ ﻪﺑ ﺰﻴﻧ ﺮﻔﻧ 4 .ﺪﻧﺪﺷ ﻪﺘﺷﺍﺬﮔ ﺭﺎﻨﻛ ﻪﻌﻟﺎﻄﻣ ﺯﺍ ﻭ ﻩﺩﻮﻤﻧ
ﺖﻳﺎﻬﻧ ﺭﺩ .ﺪﻧﺪﺷ ﻪﺘﺷﺍﺬﮔ ﺭﺎﻨﻛ ﻪﻌﻟﺎﻄﻣ ﺯﺍ ﺕﺎﻋﻼﻃﺍ ﺮﻳﺎــﺳ ﻥﺩﻮﺑ ﺭﺩ 44/3 ± 8/0 ﻦﺳ ﻦﻴﮕﻧﺎﻴﻣ ﺎﺑ ﺩﺮﻣ ﻲﻳﺎﻴﻤﻴــﺷ ﻥﺍﺯﺎﺒﻧﺎﺟ 125 ﻂﺳﻮﺘﻣ ﺭﻮﻄﺑ ﺩﺍﺮﻓﺍ ﻦﻳﺍ .ﺪﻨﺘﻓﺮﮔ ﺭﺍﺮﻗ ﻲــﺳﺭﺮﺑ ﺩﺭﻮﻣ ﻪﻌﻟﺎﻄﻣ ﻦﻳﺍ ﻝﺩﺮﺧ ﺯﺎﮔ ﺎﺑ ﻲﮔﺩﻮﻟﺁ ﺭﺎﭼﺩ 23/1 ± 3/0 ﻦﺳ ﺭﺩ ﻭ ﻞﺒﻗ ﻝﺎﺳ 19 .ﺪﻧﺩﻮﺑ ﻩﺪﺷ ﺱﺎــﺳﺍ ﺮﺑ 44/3 ± 16/8 ﻥﺍﺯﺎﺒﻧﺎﺟ ﺭﺩ ﺵﺭﺎﺧ ﺯﺎﻴﺘﻣﺍ ﻦــﻴﮕﻧﺎﻴﻣ .ﺪــﺷ ﻪﺒــﺳﺎﺤﻣ PS ﺱﺎــﺳﺍ ﺮﺑ 31/7 ± 9/8 ﻭ VAS ﺭﺎــﻴﻌﻣ
ﻪﻣﺎﻨﺸﺳﺮﭘ ﻖﻳﺮﻃ ﺯﺍ ﻩﺪﺷ ﻪﺒﺳﺎﺤﻣ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﻩﺮﻤﻧ ﻦﻴﮕﻧﺎﻴﻣ 19/42 ± 5/96 ﺎﺑ ﺖﺳﺍ ﺮﺑﺍﺮﺑ ﻲﺳﺭﺮﺑ ﺩﺭﻮﻣ ﻥﺍﺯﺎﺒﻧﺎﺟ ﺭﺩ DLQI ﻱﺪﻨﺑ ﻪﻘﺒﻃ ﺱﺎــﺳﺍ ﺮﺑ .30 ﻭ 1 ﺭﺍﺪﻘﻣ ﻦﻳﺮﺘــﺸﻴﺑ ﻭ ﻦﻳﺮﺘﻤﻛ ﺎﺑ
ﺭﺍﺮﻗ ﻲﻫﻭﺮﮔ ﺭﺩ 1 ﺯﺎﻴﺘﻣﺍ ﺎﺑ ﺮﻔﻧ ﻚﻳ ﺎﻬﻨﺗ ﻪﻣﺎﻨــﺸﺳﺮﭘ ﺩﺭﺍﺪﻧﺎﺘــﺳﺍ
ﻥﺎﺷ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﺭﺩ ﻱﺮﻴﺛﺎﺗ ﻲﺘــﺳﻮﭘ ﺕﻼﻜــﺸﻣ ﻪﻛ ﺖﺷﺍﺩ
ﺪﻨﺘﺷﺍﺩ ﺭﺍﺮﻗ ﻲﻫﻭﺮﮔ ﺭﺩ (ﺪﺻﺭﺩ 48,8) ﺮﻔﻧ 61 ﻪﻛ ﻲﻟﺎﺣﺭﺩ ﺩﺭﺍﺪﻧ
ﺎﻬﻧﺁ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﺭﺩ ﻱﺩﺎﻳﺯ ﺭﺎﻴﺴﺑ ﺮﻴﺛﺎﺗ ﻲﺘﺳﻮﭘ ﺕﻼﻜﺸﻣ ﻪﻛ
.(2 ﻝﻭﺪﺟ) ﺖﺷﺍﺩ
ﺵﺭﺎﺧ ﺕﺪــﺷ ﺯﺎﻴﺘﻣﺍ ﻦﻴﺑ ﻱﺭﺍﺩ ﻲــﻨﻌﻣ ﻭ ﺖﺒﺜﻣ ﻱﺭﺎــﻣﺁ ﻪــﻄﺑﺍﺭ
(ﻱﺯﺎﻴﺘﻣﺍ 48 ﻪﻣﺎﻨﺸﺳﺮﭘ) ﺵﺭﺎﺧﺕﺪﺷﻪﺒﺳﺎﺤﻣﺵﻭﺭ -1ﻝﻭﺪﺟ
ﺢﺒﺻ ﺮﻬﻇﺯﺍﺪﻌﺑ ﺐﺷ
ﻞﻛ
ﻥﺎﻣﺯ 1
1 1
3
ﺕﺪﺷ 5
5 *
10
ﻲﮔﺪﻨﻛﺍﺮﭘ 5
5 *
10
ﻲﻧﺍﻭﺍﺮﻓ 5
5 *
10
ﺏﺍﻮﺧ *
* 10
10
ﻥﺪﺷ ﺭﺍﺪﻴﺑ *
* 5
5
ﻞﻛ 16
16 16
48
ﺯﺍﻲﺧﺮﺑ .ﺪﻫﺩﻲﻣﺶﻳﺎﻤﻧﺍﺭﻝﻮﻠــﺳﺮﻫﺯﺎﻴﺘﻣﺍﺮﺜﻛﺍﺪﺣﻝﻭﺪﺟﻞﺧﺍﺩﻱﺩﺍﺪﻋﺍ
.ﺖﺷﺍﺩﺪﻨﻫﺍﻮﺨﻧﻱﺯﺎﻴﺘﻣﺍﻝﻭﺪﺟﻱﺎﻬﻟﻮﻠﺳ
.(ﺪﺷﺎﺑﻲﻣﺯﺎﻴﺘﻣﺍﻩﺪﻨﻫﺪﻧﺎﺸﻧﺰﺘﻧﺍﺮﭘﻞﺧﺍﺩﺩﺍﺪﻋﺍ) ﻝﻭﺪﺟﻞﻴﻤﻜﺗﺵﻭﺭ
.(2) ﺩﺭﺍﺩ ﻥﺪﻧﺍﺭﺎﺧ ﻪﺑﺯﺎﻴﻧﺮﺘﻤﻛ .(1) ﻥﺪﻧﺍﺭﺎﺧ ﻪﺑ ﺯﺎﻴﻧ ﻥﻭﺪﺑ ﺵﺭﺎﺧ :ﺕﺪـﺷ
ﺎﺑ ﻩﺍﺮﻤﻫ ﺵﺭﺎﺧ .(4) ﻥﺪــﻧﺍﺭﺎﺧﺎﺑ ﺵﺭﺎﺧ ﻦﻴﻜــﺴﺗ ﻡﺪﻋ (3) ﺭﺮﻜﻣ ﻥﺪﻧﺍﺭﺎﺧ
.(5) ﺕﺎﻗﻭﺍ ﻡﺎﻤﺗﻱﺍﺮﺑﻲﺘﺣﺍﺭﺎﻧ ﻲﻣﺎﻤﺗﺵﺭﺎﺧ .(1) (ﺎﻫﺎﭘﺎﻳﻪﻨﺗ،ﺎﻫﻭﺯﺎﺑ) ﺎﻀﻋﺍ ﺯﺍﻚــﻳﺮﻫﻱﺍﺮﺑ :ﻲﮔﺪﻨﻛﺍﺮﭘ
(5) ﻥﺪﺑﻲﺣﺍﻮﻧ ﻪﻘﻴﻗﺩﻩﺩﺯﺍﺶﻴﺑﺵﺭﺎﺧ ﻩﺭﻭﺩﻚﻳ ﺎﻳﻪﻘﻴﻗﺩﻩﺩﺯﺍﺮﺘﻤﻛﻩﺭﻭﺩﻭﺩ :ﻲـﻧﺍﻭﺍﺮﻓ
.(5) ﻪﻘﻴﻗﺩﻩﺩﺯﺍﺶﻴﺑ ﻩﺭﻭﺩﺞﻨﭘ ﺎﻳﻪﻘﻴﻗﺩﻩﺩﺯﺍﺮﺘﻤﻛﻩﺭﻭﺩ ﻩﺩ (1)
ﺮﺘﺸﻴﺑ ﺎﻳﺖﻋﺎﺳﺖﻔﻫ .(10) ﺯﻭﺭﻪﻧﺎﺒﺷﺕﺪﻣﻡﺎﻤﺗ ﺭﺩﺏﺍﻮﺧﻝﻼﺘﺧﺍ :ﺏﺍﻮﺧ
(5) ﻪﻧﺎﺒﺷﺏﺍﻮﺧ
(5) ﺮﺜﻛﺍﺪﺣ (1) ﺏﺍﻮﺧﺯﺍﻥﺪﺷﺭﺍﺪﻴﺑﺭﺎﺑﺮﻫﻱﺍﺯﺍﻪﺑ :ﻥﺪﺷﺭﺍﺪﻴﺑ
DLQI ﻪﻣﺎﻨﺸﺳﺮﭘﺯﺎﻴﺘﻣﺍﻱﺪﻨﺑﻪﻘﺒﻃ -2 ﻝﻭﺪﺟ
ﻲﮔﺪﻧﺯﺖﻴﻔﻴﻛﺭﺩﺵﺭﺎﺧﺮﻴﺛﺎﺗ ﺯﺎﻴﺘﻣﺍ
ﻲﻧﺍﻭﺍﺮﻓ
ﺮﻴﺛﺎﺗ ﻥﻭﺪﺑ 1-0
1 (% 0/8)
ﻢﻛ ﺮﺛﺍ 5-2
2 (% 1/6)
ﻂﺳﻮﺘﻣ ﺮﺛﺍ 10-6
5 (% 4/0)
ﺩﺎﻳﺯ ﺮﺛﺍ 20-11
56(% 44/8)
ﺩﺎﻳﺯ ﺭﺎﻴﺴﺑ ﺮﺛﺍ 30-21
ﺖــﺷﺍﺩ ﺩﻮـﺟﻭ DLQI ﻪﻣﺎــﻨــﺸﺳﺮــﭘ ﻞـﻛ ﻩﺮـﻤــﻧ ﻭ (PS)
ﺕﺪــﺷ ﺯﺎﻴﺘﻣﺍ ﻦﻴﺑ ﻱﺍ ﻪﻄﺑﺍﺭ ﻦﻴﻨﭼ .(P> 0/001 ،r = 0/325)
ﺪﺷ ﻩﺪﻫﺎﺸﻣ ﺰﻴﻧ DLQI ﻪﻣﺎﻨﺸﺳﺮﭘ ﻞﻛ ﻩﺮﻤﻧ ﻭ (VAS) ﺵﺭﺎﺧ ﺮﻳﺯ ﺎﺑ ﺵﺭﺎﺧ ﺕﺪﺷ ﻪﻄﺑﺍﺭ ﻲﺳﺭﺮﺑ .(P = 0/008 ، r = 0/237) ﺱﺎﻴﻘﻣ ﺮﻳﺯ ﺰﺟ ﻪﺑ ﻪﻛ ﺩﺍﺩ ﻥﺎﺸﻧ DLQI ﻪﻣﺎﻨﺸﺳﺮﭘ ﻱﺎﻬــﺳﺎﻴﻘﻣ
ﺎﺑ ﻱﺭﺍﺩ ﻲﻨﻌﻣ ﻭ ﺖﺒﺜﻣ ﻪﻄﺑﺍﺭ ﺎﻬﺳﺎﻴﻘﻣ ﺮﻳﺯ ﺮﻳﺎــﺳ ﻞﻴﺼﺤﺗ ﻭ ﺭﺎﻛ
.(3 ﻝﻭﺪﺟ) ﺪﻨﺘﺷﺍﺩ ﺵﺭﺎﺧ ﺕﺪﺷ ﺱﺎﻴﻘﻣ ﻭﺩ ﺮﻫ
ﻲﻛﺪﻧﺯ ﺖﻴﻔﻴﻛ ﻪﻣﺎﻨﺸﺳﺮﭘ ﻞﻛ ﻩﺮﻤﻧ (ﻡﻮــﺳ ﻭ ﻝﻭﺍ ﻙﺭﺎﭼ) ﻪﻧﺎﻴﻣ
21 ﺎﺑ ﺩﻮﺑ ﺮﺑﺍﺮﺑ ﺪﻨﺘﺷﺍﺩ ﺖﺳﻮﭘ ﺵﺯﻮﺳ ﻞﻜــﺸﻣ ﻪﻛ ﻲﻧﺍﺯﺎﺒﻧﺎﺟ ﺭﺩ ﻲﺘﺳﻮﭘ ﻞﻜﺸﻣ ﻦﻳﺍ ﻪﻛ ﺩﻮﺑ ﻲﻧﺍﺯﺎﺒﻧﺎﺟ ﺯﺍ ﺮﺘــﺸﻴﺑ ﻪﻛ (17 – 25) ﻪﻣﺎﻨﺸﺳﺮﭘ ﻞﻛ ﻩﺮﻤﻧ ﻪﻧﺎﻴﻣ ﻦﻴﻨﭽﻤﻫ (p = 0/012) ﺪﻨﺘــﺷﺍﺪﻧ ﺍﺭ (20 – 26) 23 ﺪﻨﺘــﺷﺍﺩ ﻲﺘــﺳﻮﭘ ﻝﻭﺎﺗ ﻪﻛ ﻲﻧﺍﺭﺎﻤﻴﺑ ﺭﺩDLQI – 23) 19 ﺪﻨﺘﺷﺍﺪﻧ ﻲﺘﺳﻮﭘ ﻝﻭﺎﺗ ﻪﻛ ﻥﺍﺭﺎﻤﻴﺑ ﺯﺍ ﻲﻫﻭﺮﮔ ﺭﺩ ﻭ ﺩﻮﺑ ﺰﻴﻧ lichenification ﻭ Excoriation (p = 0/002) ﺩﻮﺑ (15
ﻲﻳﺎﻴﻤﻴﺷ ﻥﺍﺯﺎﺒﻧﺎﺟ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﺭﺩ ﺭﺍﺬﮔ ﺮﻴﺛﺎﺗ ﻞﻣﺍﻮﻋ ﺮﮕﻳﺩ ﺯﺍ (4 ﻝﻭﺪﺟ) ﺩﻮﺑ ﻝﺩﺮﺧ ﺯﺎﮔ ﺎﺑ ﻪﺘﻓﺎﻳ ﻪﻬﺟﺍﻮﻣ
ﺯﺎﻴﺘﻣﺍ ﺰﺟ ﻪﺑ ﺩﺍﺩ ﻥﺎﺸﻧ ﻱﺍ ﻪﻠﻤﺟﺪﻨﭼ ﻲﻄﺧ ﻥﻮﻴــﺳﺮﮔﺭ ﺯﺍ ﻩﺩﺎﻔﺘﺳﺍ
(B = 0.178, 95%CI:0.071 to 0.285)ﺍ(PS) ﺵﺭﺎﺧ ﺕﺪﺷ
ﺯﺍ ﺰــﻴﻧ (B = 3.355, 95%CI: 1.295 to 5.416) ﺵﺯﻮــﺳ
ﻥﺍﺯﺎﺒﻧﺎﺟ ﻲﺘــﺳﻮﭘ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﺭﺩ ﺭﺍﺬﮔ ﺮــﻴﺛﺎﺗ ﻞﻣﺍﻮﻋ ﻪــﻠﻤﺟ
.ﺪﺷﺎﺑ ﻲﻣ ﻝﺩﺮﺧ ﺯﺎﮔ ﺎﺑ ﻪﺘﻓﺎﻳ ﻪﻬﺟﺍﻮﻣ
ﻱﺮﻴﮔ
ﻪﺠﻴﺘﻧ
ﻪﻬﺟﺍﻮﻣ ﻭ ﻲﻠﻴﻤﺤﺗ ﮓﻨﺟ ﺯﺍ ﻝﺎﺳ 20 ﻪﺑ ﺐﻳﺮﻗ ﻪﻜﻨﻳﺍ ﻢﻏﺭ ﻲﻠﻋ
ﺎﺘﺒﺴﻧ ﻩﺪﻋ ﻥﺎﻨﭽﻤﻫ ﺎﻣﺍ ﺖﺳﺍ ﻪﺘﺷﺬﮔ ﻲﻳﺎﻴﻤﻴﺷ ﻱﺎﻫﺯﺎﮔ ﺎﺑ ﺩﺍﺮﻓﺍ ﻲﺷﺎﻧ ﻲﺘﺳﻮﭘ ﺕﻼﻜﺸﻣ ﻞﻴﻟﺩ ﻪﺑ ﻲﻳﺎﻴﻤﻴــﺷ ﻥﺍﺯﺎﺒﻧﺎﺟ ﺯﺍ ﻱﺩﺎﻳﺯ ﺍﺬﻟ .ﺪﻨﻨﻛ ﻰﻣ ﻪﻌﺟﺍﺮﻣ ﺎﻫ ﻩﺎﮕﻧﺎﻣﺭﺩ ﻪــﺑ ﺵﺭﺎﺧ ﺮﻴﻈﻧ ﻝﺩﺮﺧ ﺯﺎﮔ ﺯﺍ ﺖﻴﻔﻴﻛ ﺭﺩ ﻲﺘﺳﻮﭘ ﺕﻼﻜﺸﻣ ﺮﻴﺛﺎﺗ ﻲــﺳﺭﺮﺑ ﻑﺪﻫ ﺎﺑ ﻪﻌﻟﺎﻄﻣ ﻦﻳﺍ ﻱﺰﻳﺭ ﺡﺮﻃ ﻝﺩﺮﺧ ﺯﺎﮔ ﺎﺑ ﻪﺘﻓﺎﻳ ﻪﺟﺍﻮﻣ ﻲﻳﺎﻴﻤﻴﺷ ﻥﺍﺯﺎﺒﻧﺎﺟ ﻲﮔﺪﻧﺯ .ﺪﺷ
ﻥﺁﻱﺎﻬﺳﺎﻴﻘﻣﺮﻳﺯﻭﻲﺘﺳﻮﭘﻲﮔﺪﻧﺯﺖﻴﻔﻴﻛﻭﺵﺭﺎﺧﺕﺪﺷﻦﻴﺑﻪﻄﺑﺍﺭ -3 ﻝﻭﺪﺟ
ﺕﺪﺷ ﺵﺭﺎﺧ (PS) ﺕﺪﺷ ﺵﺭﺎﺧ (VAS) ﻞﻛﻩﺮﻤﻧ ﺖﻴﻔﻴﻛ ﻲﮔﺪﻧﺯ ﻭﺱﺎﺴﺣﺍ ﺎﻫﻪﻧﺎﺸﻧ ﺖﻴﻟﺎﻌﻓ ﻪﻧﺍﺯﻭﺭ ﺖﺻﺮﻓ ﻭﺭﺎﻛ ﻞﻴﺼﺤﺗ ﻂﺑﺍﻭﺭ ﻲﺼﺨﺷ ﻥﺎﻣﺭﺩ
(PS) ﺵﺭﺎﺧ ﺕﺪﺷ r --0/218 0/325 0/342 0/291 0/225 0/097 0/201 0/237 p 0/015 <0/001 <0/001 0/001 0/012 0/281 0/025 0/008
(VAS) ﺵﺭﺎﺧ ﺕﺪﺷ r --0/237 0/191 0/179 0/189 0/088 0/225 0/186 p 0/008 0/032 0/045 0/044 0/327 0/004 0/038 ﺖﻴﻔﻴﻛ ﻞﻛ ﻩﺮﻤﻧ ﻲﮔﺪﻧﺯ r --0/672 0/775 0/820 0/451 0/790 0/588 p <0/001 <0/001 <0/001 <0/001 <0/001 <0/001 ﺎﻫ ﻪﻧﺎﺸﻧ ﻭ ﺱﺎﺴﺣﺍ r --0/408 0/411 0/231 0/362 0/433 p <0/001 <0/001 <0/001 <0/001 <0/001 ﻪﻧﺍﺯﻭﺭ ﺖﻴﻟﺎﻌﻓ r --0/610 0/211 0/506 0/342 p <0/001 <0/001 <0/001 <0/001 ﺖﺻﺮﻓ r --0/359 0/550 0/390 p <0/001 <0/001 <0/001 ﻞﻴﺼﺤﺗ ﻭ ﺭﺎﻛ r --0/237 0/243 p 0/006 0/005 ﻲﺼﺨﺷ ﻂﺑﺍﻭﺭ r --0/397 p <0/001
ﺖﻴﻔﻴﻛ ﻲﻠﻛ ﻩﺮــﻤﻧ ﻦﻴﮕﻧﺎﻴﻣ ﻪﻌﻟﺎﻄﻣ ﻦــﻳﺍ ﻱﺎﻫ ﻪﺘﻓﺎﻳ ﺱﺎــﺳﺍ ﺮﺑ
ﺎﺑ ﺩﻮﺑ ﺮﺑﺍﺮﺑ ﺖــﺳﺍ ﻩﺪــﺷ ﻪﺒــﺳﺎﺤﻣ ﺶﻫﻭﮋﭘ ﻦﻳﺍ ﺭﺩ ﻪﻛ ﻲــﮔﺪﻧﺯ
ﺱﺭﺮﻳﺩ ﺽﺭﺍﻮﻋ ﻪﻛ ﺩﻮﻤﻧ ﺎﻋﺩﺍ ﻥﺍﻮﺗ ﻲﻣ ﺐﻴﺗﺮﺗ ﻦــﻳﺍ ﻪﺑ .19/42
ﺖﻴﻔﻴﻛ ﻪﻛ ﺖﺳﺍ ﻲﻠﻣﺍﻮﻋ ﺯﺍ ﻲﻜﻳ ﻝﺩﺮﺧ ﺯﺎﮔ ﺎﺑ ﻪﻬﺟﺍﻮﻣ ﺯﺍ ﻲــﺷﺎﻧ
ﻱﺍ ﻪﻌﻟﺎﻄﻣ ﺭﺩ .ﺖــﺳﺍ ﻩﺩﺍﺩ ﺭﺍﺮﻗ ﺮﻴﺛﺎﺗ ﺖﺤﺗ ﺎﻘﻴﻤﻋ ﺍﺭ ﺩﺍﺮﻓﺍ ﻲﮔﺪﻧﺯ
ﻩﺪﺷ ﻩﺩﺎﻔﺘﺳﺍ ﻮﮕﻴﻠﻴﺘﻳﻭ ﻪﺑ ﻼﺘﺒﻣ ﻥﺍﺭﺎﻤﻴﺑ ﺭﺩ ﻪﻣﺎﻨﺸﺳﺮﭘ ﻦﻳﺍ ﺯﺍ ﻪﻛ ﺖﺳﺩ ﻪﺑ 6/9 ± 5/6 ﺎﺑ ﺮﺑﺍﺮﺑ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﻩﺮﻤﻧ ﻦﻴﮕﻧﺎﻴﻣ ﺖﺳﺍ ﺮﺑ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﻦﻴﮕﻧﺎﻴﻣ ﺮﮕﻳﺩ ﻱﺍ ﻪﻌﻟﺎﻄﻣ ﺭﺩ .[22] ﺖﺳﺍ ﻩﺪﻣﺁ
ﻲﻨﻣﺰﻣ ﻲﺘﺳﻮﭘ ﺕﻼﻜﺸﻣ ﺎﺑ ﻥﺍﺭﺎﻤﻴﺑ ﺭﺩ DLQI ﻪﻣﺎﻨﺸﺳﺮﭘ ﺱﺎﺳﺍ ﻭ 13/7 ± 6/8 ﺐﻴﺗﺮﺗ ﻪــﺑ ﺎﻣﺰﮔﺍ ﻚﻴﭘﻮﺗﺁ ﻭ ﺲﻳﺯﺎﻳﺭﻮــﺴﭘ ﺪﻨﻧﺎﻣ ﺕﺎﻌﻟﺎﻄﻣ ﺮﻳﺎﺳ ﻲﺳﺭﺮﺑ ﺎﺑ .[23] ﺖﺳﺍ ﻩﺪﺷ ﻪﺒﺳﺎﺤﻣ 18/5 ± 5/3
ﺪﻧﺍ ﻩﺩﻮﻤﻧ ﻩﺩﺎﻔﺘﺳﺍ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﻲﺳﺭﺮﺑ ﺭﺩ ﻲﻬﺑﺎﺸﻣ ﺵﻭﺭ ﺯﺍ ﻪﻛ
ﻥﺍﺯﺎﺒﻧﺎﺟ ﺭﺩ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﺯﺎﻴﺘﻣﺍ ﻦﻴﮕﻧﺎﻴﻣ ﻪﻛ ﺩﻮﺷ ﻲﻣ ﺺﺨﺸﻣ
ﻪﺑ ﻭ .ﺩﺭﺍﺩ ﻱﺎﺟ ﺎﻫﺯﺎﻴﺘﻣﺍ ﻦــﻴﮕﻧﺎﻴﻣ ﻱﻻﺎﺑ ﻪﻨﻣﺍﺩ ﺭﺩ ﻪﻌﻟﺎﻄﻣ ﻦــﻳﺍ
ﺯﺎﮔ ﺎﺑ ﻩﺪﺷ ﻡﻭﺪﺼﻣ ﻥﺍﺯﺎﺒﻧﺎﺟ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﻪﻛ ﺖــﺳﺍ ﻲﻨﻌﻣ ﻦﻳﺍ
ﻭ .ﺪﺷﺎﺑ ﻲﻣ ﻲﺘﺳﻮﭘ ﻦﻣﺰﻣ ﻲﺗﻼﻜﺸﻣ ﺮﻴﺛﺎﺗ ﺖﺤﺗ ﺕﺪﺷ ﻪﺑ ﻝﺩﺮﺧ
ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﻪﻛ ﺖﺳﺍ ﻲﻠﻣﺍﻮﻋ ﻦﻳﺮﺗ ﻢﻬﻣ ﺯﺍ ﺵﺭﺎﺧ ﻦﻴﺑ ﻦﻳﺍ ﺭﺩ
ﻭ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﻦﻴﺑ ﻪﻄﺑ ﺍﺭ ﺩﻮﺟﻭ .ﺪﻫﺩ ﻲﻣ ﺭﺍﺮــﻗ ﺮﻴﺛﺎﺗ ﺖﺤﺗ ﺍﺭ
.[24] ﺩﻮﺑ ﻩﺪﺷ ﺺﺨﺸﻣ ﺰﻴﻧ ﻦﻳﺍ ﺯﺍ ﺶﻴﭘ ﺵﺭﺎﺧ ﺕﺪﺷ
ﻱﺎﻫﺭﺎﻴﻌﻣ ﻦﻴﺑ ﺭﺩ (ﻲــﺴﻨﺟ ﻞﻳﺎــﺴﻣ ﻭ ﻂﺑﺍﻭﺭ) ﻲﺼﺨــﺷ ﻂﺑﺍﻭﺭ
ﻲﻳﺎﻴﻤﻴﺷﻥﺍﺯﺎﺒﻧﺎﺟﻲﺘﺳﻮﭘﺕﻼﻜﺸﻣﻚﻴﻜﻔﺗﻪﺑﻲﺘﺳﻮﭘﻲﮔﺪﻧﺯﺖﻴﻔﻴﻛﻞﻛﻩﺮﻤﻧﻱﺎﻬﻛﺭﺎﭼﻭﻪﻧﺎﻴﻣ -4 ﻝﻭﺪﺟ
ﻝﺩﺮﺧﺯﺎﮔﻦﻣﺰﻣﺽﺭﺍﻮﻋ
(ﺪﺻﺭﺩ) ﺩﺍﺪﻌﺗ
DLQIﻪﻣﺎﻨﺸﺳﺮﭘﻞﻛﻩﺮﻤﻧ
ﻱﺭﺍﺩﻲﻨﻌﻣ (Q1 – Q3) ﻪﻧﺎﻴﻣ
ﺖﺳﻮﭘ ﻲﻜﺸﺧ ﺩﺭﺍﺩ
(64/0) 80 (25 - 16) 21
0/211 (22 - 16) 19 (36/0) 45 ﺩﺭﺍﺪﻧ
ﺵﺯﻮﺳ ﺩﺭﺍﺩ
(63/2) 79 (25 - 17) 21
0/021 (22 - 14) 18 (36/8) 46 ﺩﺭﺍﺪﻧ
ﻱﺰﻳﺭ ﻪﺘﺳﻮﭘ ﺩﺭﺍﺩ
(59/2) 74 (24 - 16) 21
0/383 (23 - 16) 20 (40/8) 51 ﺩﺭﺍﺪﻧ
ﻥﻮﻴﺳﺎﺘﻧﺎﻤﮕﻴﭘ ﺮﭙﻳﺎﻫ ﺩﺭﺍﺩ
(51/2) 64 (25 - 16) 21
0/876 (23 - 17) 20 (48/8) 61 ﺩﺭﺍﺪﻧ
ﻝﻭﺎﺗ ﺩﺭﺍﺩ
(21/6) 27 (26 - 20) 23
0/002 (23 - 14) 19 (78/4) 98 ﺩﺭﺍﺪﻧ
ﻥﻮﻴﺳﺎﺘﻧﺎﻤﮕﻴﭘ ﻮﭙﻳﺎﻫ ﺩﺭﺍﺩ
(14/4) 18 (27 - 16) 21
0/738 (24 - 16) 20 (58/6) 107 ﺩﺭﺍﺪﻧ
ﺵﺭﺎﺧﺯﺍﻲﺷﺎﻧﻲﺘﺳﻮﭘﺕﻼﻜﺸﻣ
(ﺪﺻﺭﺩ) ﺩﺍﺪﻌﺗ
DLQI ﻪﻣﺎﻨﺸﺳﺮﭘﻞﻛﻩﺮﻤﻧ ﻱﺭﺍﺩﻲﻨﻌﻣ
(Q1 – Q3) ﻪﻧﺎﻴﻣ
Excoriation ﺩﺭﺍﺩ
(58/4) 73 (25 - 17) 21
0/041 (23 - 15) 19 (41/6) 52 ﺩﺭﺍﺪﻧ
Erythema ﺩﺭﺍﺩ
(60/0) 75 (26 - 16) 21
0/115 (22 - 16) 20 (40/0) 50 ﺩﺭﺍﺪﻧ
Lichenification ﺩﺭﺍﺩ
(68/0) 85 (25 - 16) 21
0/028 (22 - 15) 18 (32/0) 40 ﺩﺭﺍﺪﻧ
Fissure ﺩﺭﺍﺩ
(12/0) 15 (25 - 18) 21
0/340 (23 - 16) 20 (88/0) 110 ﺩﺭﺍﺪﻧ
ﺮﻴﺛﺎﺗ ﺖﺤﺗ ﻞﻣﺍﻮﻋ ﺮﻳﺎــﺳ ﺯﺍ ﺶﻴﺑ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﻲــﺳﺭﺮﺑ ﺩﺭﻮﻣ
ﻱﺎﻫ ﺵﺭﺎﺧ ﺭﺩ ﻦﻳﺍ ﺯﺍ ﺶﻴﭘ ﻉﻮﺿﻮﻣ ﻦﻳﺍ .ﺩﺮﻴﮔ ﻲﻣ ﺭﺍﺮﻗ ﺵﺭﺎــﺧ
ﺩﻮﺟﻭ .[25] ﺩﻮﺑ ﻩﺪﺷ ﺺﺨﺸﻣ ﺰﻴﻧ ﻚﻴﭘﻮﺗﺁ ﺖﻴﺗﺎﻣﺭﺩ ﺯﺍ ﻲــﺷﺎﻧ
ﺩﻮﺷ ﻲﻣ ﺐﺟﻮﻣ ﻥﺎﻳﺎﻨــﺷﺁ ﻭ ﻥﺎﺘــﺳﻭﺩ ﺎﺑ ﻪﻬﺟﺍﻮﻣ ﻡﺎﮕﻨﻫ ﺵﺭﺎﺧ
ﺍﺪﻴﭘ ﺩﺍﺮﻓﺍ ﻦﻳﺍ ﻪﺑ ﺖﺒﺴﻧ ﻱﺍ ﻩﺪﻨﻨﻛ ﺰﺌﻤﺸﻣ ﺱﺎــﺴﺣﺍ ﻥﺍﺮﮕﻳﺩ ﻪﻛ
ﺮﺑ ﻲﻨﺒﻣ ﻱﺭﻮﺼﺗ ﺩﺍﺮﻓﺍ ﻦﻳﺍ ﻦــﻳﺍ ﺩﻮﺧ ﺖــﺳﺍ ﻦﻜﻤﻣ ﻲﺘﺣ .ﺪﻨﻨﻛ
.ﺪﻧﺭﺍﺩ ﺎﻬﻧﺁ ﻪﺑ ﺖﺒﺴﻧ ﻱﺪﺑ ﺱﺎﺴﺣﺍ ﻥﺍﺮﮕﻳﺩ ﻪﻛ ﺪﻨﺷﺎﺑ ﻪﺘﺷﺍﺩ ﻦﻳﺍ
ﺍﺭ ﻲﺼﺨــﺷ ﻂﺑﻭﺭ ﺖﻴﻔﻴﻛ ﻪﻛ ﺖــﺳﺍ ﻲﻠﻳﻻﺩ ﺯﺍ ﻲﻜﻳ ﺎﻬﻨﺗ ﻦــﻳﺍ
.ﺪﻫﺩ ﻲﻣ ﺭﺍﺮﻗ ﺵﺭﺎﺧ ﺮﻴﺛﺎﺗ ﺖﺤﺗ
ﺮﻴﺛﺎﺗ ﺖﺤﺗ ﻪﻛ ﻲــﻠﻣﺎﻋ ﻦﻴﻣﻭﺩ ﻥﺍﻮﻨﻋ ﻪﺑ ﺎﻫ ﻪﻧﺎــﺸﻧ ﻭ ﺱﺎــﺴﺣﺍ
67/75 ﻲﻫﺎﻨﭘ ﻪــﻌﻟﺎﻄﻣ ﺱﺎــﺳﺍ ﺮﺑ .ﺖــﺳﺍ ﻪﺘﻓﺮﮔ ﺭﺍﺮﻗ ﺵﺭﺎﺧ
ﺭﺩ ﻞﻜﺸﻣ ﻦﻳﺍ ﺯﺍ ﺵﺭﺎﺧ ﺎﺑ ﺮﻴﮔﺭﺩ ﻲﻳﺎﻴﻤﻴــﺷ ﻥﺍﺯﺎﺒﻧﺎﺟ ﺯﺍ ﺪﺻﺭﺩ
ﻭ ﻲﻧﺎﻬﮔﺎﻧ ﺵﺭﺎﺧ ﺩﻮﺟﻭ .[19] ﺪــﻧﺮﺑ ﻲﻣ ﺞﻧﺭ ﻥﺍﺭ ﻪﻟﺎــﺸﻛ ﻪﻴﺣﺎﻧ
ﻥﺎﻜﻣﺍ ﻪﻛ ﻱﺩﺭﺍﻮﻣ ﺭﺩ ﻩﮋﻳﻭ ﻪﺑ ﻥﺍﺭ ﻪﻟﺎﺸﻛ ﺪﻨﻧﺎﻣ ﻲﺣﺍﻮﻧ ﺭﺩ ﺪﻳﺪﺷ
ﻪﺑ ﺍﺭ ﺵﺭﺎﺧ ﺩﻮﺟﻭ ﻪﻛ ﺖــﺳﺍ ﻲﻠﻳﻻﺩ ﺯﺍ ﺩﺭﺍﺪﻧ ﺩﻮﺟﻭ ﻥﺁ ﻥﺪﻧﺍﺭﺎﺧ
ﺭﺩ ﺪﻳﺎﻤﻧ ﻲﻣ ﺡﺮﻄﻣ ﺩﺍﺮﻓﺍ ﺭﺩ گﺭﺰﺑ ﺭﺎــﺴﺑ ﻞﻜــﺸﻣ ﻚﻳ ﺕﺭﻮﺻ
ﻪﺘﻓﺮﮔ ﺭﺍﺮﻗ ﺪﻴﻳﺎﺗ ﺩﺭﻮﻣ ﻪﻠﺌــﺴﻣ ﻦﻳﺍ ﺰﻴﻧ ﻱﺮﮕﻳﺩ ﻪﺑﺎــﺸﻣ ﻪﻌﻟﺎﻄﻣ
ﻭ ﺱﺎﺴﺣﺍ ﻝﻭﺍ ﻪﻠﺣﺮﻣ ﺭﺩ ﺎﻣﺰﮔﺍ ﻚﻴﭘﻮﺗﺁ ﺯﺍ ﻲﺷﺎﻧ ﺵﺭﺎﺧ .ﺖــﺳﺍ
.[26] ﺪﻫﺩ ﻲﻣ ﺭﺍﺮﻗ ﺮﻴﺛﺎﺗ ﺖﺤﺗ ﺍﺭ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﻱﺎﻫ ﻪﻧﺎﺸﻧ
ﺐﺟﻮﻣ ﺵﺭﺎﺧ ﺕﺪﺷ ﺶﻳﺍﺰﻓﺍ ﻪﻌﻟﺎﻄﻣ ﻦﻳﺍ ﻱﺎﻫ ﻪﺘﻓﺎﻳ ﺱﺎــﺳﺍﺮﺑ
ﻡﺎﺠﻧﺍ ﺭﺩ ﻲﻌﻧﺎﻣ ﺎﻣﺍ ؛ﺩﻮﺷ ﻲﻣ ﺰﻴﻧ ﻪﻧﺍﺯﻭﺭ ﻱﺎﻫ ﺖﻴﻟﺎﻌﻓ ﻥﺪﺷ ﻞﺘﺨﻣ
ﺍﺮﭼ .ﺖﺴﻴﻧ ﻲﻳﺎﻴﻤﻴﺷ ﻥﺍﺯﺎﺒﻧﺎﺟ ﺭﺩ ﻞﻴﺼﺤﺗ ﻭ ﺭﺎﻛ ﻪﺑ ﻁﻮﺑﺮﻣ ﺭﻮﻣﺍ
ﻱﺎﻫ ﺖﻴﻌﻗﻮﻣ ﻭ ﻂﻳﺍﺮــﺷ ﺯﺍ ﻪﻛ ﻲﺘﺧﺎﻨــﺷ ﻭ ﻙﺭﺩ ﺎﺑ ﻪﻌﻣﺎﺟ ﻪــﻛ
ﻲﺗﺍﺭﺎﻈﺘﻧﺍ ﻲﻳﺎﻴﻤﻴــﺷ ﻥﺍﺯﺎﺒﻧﺎﺟ ﺯﺍ ﺩﺭﺍﺩ ﻲﻠﻴﻤﺤﺗ ﮓﻨﺟ ﻪﺑ ﻁﻮﺑﺮﻣ
ﺭﺩ ﺍﺭ ﻲﺗﻼﻴﻬﺴﺗ ﺍﺬﻟ ﺩﺭﺍﺪﻧ ﻞﻴﺼﺤﺗ ﻭ ﺭﺎﻛ ﺭﺩ ﻱﺩﺎﻋ ﺩﺮﻓ ﻩﺯﺍﺪﻧﺍ ﻪﺑ
.ﺖﺳﺍ ﻩﺩﻮﻤﻧ ﻢﻫﺍﺮﻓ ﺩﺍﺮﻓﺍ ﻦﻳﺍ ﻱﺍﺮﺑ ﻪﻨﻴﻣﺯ ﻦﻳﺍ
ﻪﻛ ﺩﻮﻤﻧ ﻱﺮﻴﮔ ﻪﺠﻴﺘﻧ ﻥﺍﻮﺗ ﻲﻣ ﻦﻴﻨﭼ ﺶﻫﻭﮋﭘ ﻦﻳﺍ ﻱﺎﻫ ﻪﺘﻓﺎﻳ ﺯﺍ
ﺮﻴﺛﺎﺗ ﺖﺤﺗ ﺍﺭ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﻪﻛ ﺖــﺳﺍ ﻲﻠﻣﺍﻮﻋ ﺯﺍ ﻲﻜﻳ ﺵﺭﺎﺧ
ﺭﺩ ﻲﻳﺍﺰــﺳ ﻪﺑ ﺮﻴﺛﺎﺗ ﻥﺁ ﻝﺮﺘﻨﻛ ﺎﻳ ﻥﺎﻣﺭﺩ ﻦﻳﺍﺮﺑﺎﻨﺑ .ﺪﻫﺩ ﻲﻣ ﺭﺍﺮﻗ
ﺖــﺷﺍﺩ ﺮﻈﻧ ﺭﺩ ﺪﻳﺎﺑ ﺎﻣﺍ .ﺖــﺷﺍﺩ ﺪﻫﺍﻮﺧ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﻱﺎﻘﺗﺭﺍ
ﻭ ﺩﺪﻌﺘﻣ ﻱﺍ ﻩﺮﻴﺠﻧﺯ ﻝﺩﺮﺧ ﺯﺎﮔ ﺯﺍ ﻲــﺷﺎﻧ ﻲﺘﺳﻮﭘ ﺕﻼﻜــﺸﻣ ﻪﻛ
ﺵﺭﺎﺧ ﻪﻛ ﺪﻫﺩ ﻲﻣ ﻞﻴﻜــﺸﺗ ﺍﺭ ﻱﺭﺎﺠﻨﻫﺎﻧ ﻦــﻳﺪﻨﭼ ﺯﺍ ﻩﺪــﻴﭽﻴﭘ
ﺖﻴﻔﻴﻛ ﻪﻛ ﺖﺳﺍ ﺩﺪﻌﺘﻣ ﻩﺮﻴﺠﻧﺯ ﻦﻳﺍ ﻭ .ﺖﺳﺍ ﻞﻣﺍﻮﻋ ﻦﻳﺍ ﺯﺍ ﻲﻜﻳ
ﻪﻌﻟﺎﻄﻣ ﻦﻳﺍ ﺭﺩ ﻪﭽﻧﺎﻨﭼ .ﺪﻫﺩ ﻲﻣ ﺭﺍﺮﻗ ﺩﻮﺧ ﺮﻴﺛﺎﺗ ﺖﺤﺗ ﺍﺭ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﺭﺩ ﺭﺍﺬﮔ ﺮﻴﺛﺎﺗ ﻞﻣﺍﻮﻋ ﻪﻠﻤﺟ ﺯﺍ ﺵﺭﺎﺧ ﺭﺎﻨﻛ ﺭﺩ ﺰﻴﻧ ﺵﺯﻮﺳ
.ﺪﺷ ﻪﺘﺧﺎﻨﺷ ﻲﮔﺪﻧﺯ
ﺩﻮﺑ ﻩﺪﺷ ﻲﻫﺪﻧﺎﻣﺎــﺳ ﻲﻌﻄﻘﻣ ﺕﺭﻮﺻ ﻪﺑ ﻪﻌﻟﺎﻄﻣ ﻦﻳﺍ ﻪﻛ ﺎﺠﻧﺁ ﺯﺍ
ﺮﻴﺛﺎﺗ ﻢــﺴﻴﻧﺎﻜﻣ ﻭ ﻲﻟﻮﻠﻌﻣ ﻲﻠﻋ ﻪﻄﺑﺍﺭ ﺩﻮــﺟﻭ ﻪﺑ ﻲﭘ ﻥﺍﻮــﺗ ﻲﻤﻧ
ﻱﺭﺎﻴــﺷﻮﻫ ﻦﻳﺍ ﺎﻣﺍ .ﺩﺮﺑ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﺭﺩ ﻲﺘــﺳﻮﭘ ﺕﻼﻜــﺸﻣ
ﻥﺍﺯﺎﺒﻧﺎﺟ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ ﻪﻛ ﺪﻫﺩ ﻲﻣ ﺖــﺳﻮﭘ ﻦﻴﺼﺼﺨﺘﻣ ﻪﺑ ﺍﺭ
ﻲﺗﺎﻣﺍﺪﻗﺍ ﺍﺬﻟ .ﺖﺳﺍ ﻁﺎﺒﺗﺭﺍ ﺭﺩ ﺎﻬﻧﺁ ﻲﺘﺳﻮﭘ ﺕﻼﻜﺸﻣ ﺎﺑ ﻲﻳﺎﻴﻤﻴﺷ
ﻱﺎﻘﺗﺭﺍ ﺐﺟﻮﻣ ﺪﻧﺍﻮﺗ ﻲﻣ ،ﺩﺩﺮﮔ ﺕﺎﻌﻳﺎﺿ ﻦﻳﺍ ﻦﻴﻜﺴﺗ ﺐﺟﻮﻣ ﻪﻛ
.ﺩﻮﺷ ﻲﻳﺎﻴﻤﻴﺷ ﻥﺍﺯﺎﺒﻧﺎﺟ ﻲﮔﺪﻧﺯ ﺖﻴﻔﻴﻛ
:
ﻊﺑﺎﻨﻣ
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