ﻲﻣﺮﺳ حﻮﻄﺳ ﻦﻴﺑ طﺎﺒﺗرا ﻲﺳرﺮﺑ
ﻦﻴﻛﻮﺘﻴﺳ
لﻮﻠﺳ زا هﺪﺷ ﺢﺷﺮﺗ يﺎﻫ
يﺎﻫ
Th1
،
Th2
،
ﻦﻴﻛﻮﻟﺮﺘﻨﻳا
8
و
ICAM-1
سﺎﺳاﺮﺑ ﺲﻳزﺎﻳرﻮﺴﭘ يرﺎﻤﻴﺑ تﺪﺷ ﺎﺑ
PASI
ﻦﻳرﺎﺼﻧاﺐﻴﺒﺣﺮﺘﻛد I ﻲﺑآﺮﻜﺷيﺪﻬﻣﺮﺘﻛد II * ﻲﮕﻧﺮﻬﺑمﺎﻬﻟاﺮﺘﻛد III
هﺪﻴﻜﭼ
فﺪﻫوﻪﻨﻴﻣز : ﻳﺎﺷوﻦﻣﺰﻣﻲﺑﺎﻬﺘﻟاﻲﺘﺳﻮﭘيرﺎﻤﻴﺑﻚﻳﺲﻳزﺎﻳرﻮﺴﭘ دوﺪﺣردﻪﻛﺖﺳاﻊ 3 ـ 1 % نآﻪـﺑﺎﻴﻧدﺖﻴﻌﻤﺟ ﻲﻣﻪﻛﺪﻧرﺎﺘﻓﺮﮔ دﻮـﺷرﺎـﻤﻴﺑﻲﮔﺪﻧزﺖﻴﻔﻴﻛﺶﻫﺎﻛﺖﻳﺎﻬﻧردورﺎﻤﻴﺑردﻪﺟﻮﺗﻞﺑﺎﻗسﺮﺘﺴﻳدﻪﺑﺮﺠﻨﻣﺪﻧاﻮﺗ . يﺎـﻤﻧرد كﻼﭘدﺎﺠﻳا،ﻲﻨﻴﻟﺎﺑ ﻪﺘﺳﻮﭘ،هﺮﻴﺗﺰﻣﺮﻗﮓﻧرﻪﺑﻪﺘﺴﺟﺮﺑيﺎﻫ ﻪﺘﺳﻮﭘﺎﺑراد ﻲﻣﻢﻴﺨﺿيﺎﻫ ﺪﻨﻛ . رﻮﺴــﭘﻪــﻛﺖــﺳاﻦــﻳاﺮــﺑهﺪــﻴﻘﻋهزوﺮــﻣا ﻪﻄــﺳاوﺎــﺑيرﺎــﻤﻴﺑﺲﻳزﺎﻳ T ﺖﻴــﺳﻮﻔﻨﻟ ﻲــﻣﺎــﻫ ﺮــﻴﺜﻜﺗﺶﻳاﺰــﻓاوﺪــﺷﺎﺑ ﺖﻴﺳﻮﻨﻴﺗاﺮﻛ ﻦﻴﻛﻮﺘﻴﺳنﺪﺷ دازآوﻲﻨﻤﻳاﻢﺘﺴﻴﺳنﺪﺷلﺎﻌﻓﻪﺑﻪﻳﻮﻧﺎﺛﺎﻫ ﺖـﺳاﺎـﻫ . ياﺮـﺑﻲـﻌﻄﻗنﺎـﻣردﭻﻴـﻫزﻮـﻨﻫ نﺎــﻣردوﺖــﺳاهﺪﺸــﻧﺖــﻓﺎﻳﺲﻳزﺎﻳرﻮﺴــﭘ ﺪــﻧرادﻲﻳﻻﺎــﺑدﻮــﻋناﺰــﻴﻣﻲــﻠﻌﻓيﺎــﻫ . وﺰﻧژﻮﺗﺎــﭘﻮﻨﻤﻳاﺮﺘﺸــﻴﺑﺖﺧﺎﻨــﺷ ﻦﻴﻛﻮﺘﻴﺳ ﻲﻣ،ﺲﻳزﺎﻳرﻮﺴﭘيرﺎﻤﻴﺑتﺪﺷردﻞﻴﺧديﺎﻫ نﺎﻣردﻒﺸﻛﻪﺑﺪﻧاﻮﺗ ﻲﺻﺎﺼﺘﺧايﺎﻫ ﻦـﻳاياﺮـﺑﺮﺗﺮﺛﺆـﻣوﺮﺗ ﺪﻨﻛﻚﻤﻛيرﺎﻤﻴﺑ . ﻲﺳرﺮﺑشور : يورﻲﻌﻄﻘﻣﻪﻌﻟﺎﻄﻣﻦﻳا 40 نﺎﺘـﺳرﺎﻤﻴﺑﻪـﺑهﺪـﻨﻨﻛﻪـﻌﺟاﺮﻣﺲﻳرﺎـﮕﻟوﺲﻳزﺎﻳرﻮﺴﭘﻪﺑﻼﺘﺒﻣرﺎﻤﻴﺑ لﺎﺳردمﺮﻛالﻮﺳر 87 ـ 1386 ﺪﺷمﺎﺠﻧا . ﺎﺑﻪﻨﻳﺎﻌﻣرﺎﻤﻴﺑﺮﻫزا رﺎﻴﻌﻣسﺎﺳاﺮﺑيرﺎﻤﻴﺑتﺪﺷﻦﻴﻴﻌﺗياﺮﺑﻲﻨﻴﻟ PASI ﺪﻣآﻞﻤﻋﻪﺑ . ﺲﭙﺳ 3 ﻲﺳ يﺎـﻣدردوﺪـﻳدﺮﮔاﺪﺟﻲﻣﺮﺳﻪﻧﻮﻤﻧ،ژﻮﻔﻳﺮﺘﻧﺎﺳﺎﺑوﻪﻴﻬﺗيﺪﻳرونﻮﺧﻪﻧﻮﻤﻧﻲﺳ oC 70 ﺪﺷهﺮﻴﺧذﻲﻳﺎﻬﻧﻲﺳرﺮﺑنﺎﻣزﺎﺗ . شورزاهدﺎﻔﺘـﺳاﺎـﺑﺲﭙـﺳ ELIZA ﻦﻴﻛﻮﺘﻴـﺳﻲﻣﺮـﺳﺢﻄـﺳ، ﺮـﻈﻧدرﻮـﻣيﺎـﻫ هزاﺪﻧا ﻔﺘﺳاﺎﺑوﺪﺷيﺮﻴﮔ يرﺎﻣآراﺰﻓامﺮﻧزاهدﺎ SPSS ، ﻲﻣﺮـﺳﺢﻄـﺳﻦﻴـﺑطﺎـﺒﺗراﻦﻣﺮﻴﭙـﺳاﻲﮕﺘﺴـﺒﻤﻫﺐﻳﺮﺿﺎﺑ ﻦﻴﻛﻮﺘﻴﺳ ﺪﻳدﺮﮔﻲﺑﺎﻳزرايرﺎﻤﻴﺑتﺪﺷﺎﺑقﻮﻓيﺎﻫ . ﻪــﺘﻓﺎﻳ ﺎــﻫ : ﺎــﻣﺎﮔنوﺮــﻓﺮﺘﻨﻳاﻲﻣﺮــﺳﺢﻄــﺳﻦﻴــﺑ،ﻲــﺳرﺮﺑﻦــﻳاﻖــﺒﻃ ) 001 / 0 = P ، 50 / 0 = r ( ﻦﻴﻛﻮــﻟﺮﺘﻨﻳا، 8 ) 018 / 0 = P ، 37 / 0 = P ( ، ICAM-1 ) 047 / 0 = P ، 31 / 0 = r ( تﺪﺷﺎﺑ سﺎﺳاﺮﺑﺲﻳزﺎﻳرﻮﺴﭘيرﺎﻤﻴﺑ PASI ﻲﻨﻌﻣطﺎﺒﺗرا، يرﺎﻣآراد دراددﻮﺟو . ﻦﻴﻛﻮﻟﺮﺘﻨﻳاﻲﻣﺮﺳﺢﻄﺳﻦﻴﺑﻲﻃﺎﺒﺗراﻦﻴﻨﭼﻲﻟو 4 يرﺎﻤﻴﺑتﺪﺷﺎﺑ ﺪﺸﻧهﺪﻫﺎﺸﻣ ) 24 / 0 = P ، 18 / 0 = r (. ﻪﺠﻴﺘﻧ يﺮﻴﮔ : ﻦﻴﻛﻮﻟﺮﺘﻨﻳا،ﺎﻣﺎﮔنوﺮﻓﺮﺘﻨﻳاﺎﻣﻪﻌﻟﺎﻄﻣسﺎﺳاﺮﺑ 8 و ICAM-1 طﺎـﺒﺗراﺲﻳزﺎﻳرﻮﺴـﭘيرﺎﻤﻴﺑتﺪﺷﺎﺑ ﺪﻧراد . ﺎﻨﺑ نﺎﻣردﻦﻳاﺮﺑ ﻦﻴﻛﻮﺘﻴﺳﻲﺑﺎﺨﺘﻧارﻮﻄﺑﻪﻛﻲﻳﺎﻫ ﻦﺌﻤﻄﻣﺪﻧﺮﻴﮕﺑفﺪﻫارقﻮﻓيﺎﻫ ﻲﻣﺮﺗﺮﺛﺆﻣوﺮﺗ ﺪﻨﺷﺎﺑ . ﻪﻴـﺻﻮﺗ ﻲﻣ نﺎﻣردﺮﺛاﻲﺳرﺮﺑياﺮﺑيﺮﺘﺸﻴﺑتﺎﻌﻟﺎﻄﻣدﻮﺷ دﻮﺷمﺎﺠﻧاﺲﻳزﺎﻳرﻮﺴﭘيرﺎﻤﻴﺑيورقﻮﻓﻚﻳژﻮﻟﻮﻴﺑيﺎﻫ . هژاوﺪﻴﻠﻛ ﺎﻫ : 1 ﻦﻴﻳﺎﻛﻮﺘﻴﺳ 2 -ﺲﻳزﺎﻳرﻮﺴﭘيرﺎﻤﻴﺑتﺪﺷ 3 -ﻮﻨﻤﻳا ﺰﻧژﻮﺗﺎﭘ ﺖﻓﺎﻳردﺦﻳرﺎﺗ : 9 / 10 / 87 ، شﺮﻳﺬﭘﺦﻳرﺎﺗ : 16 / 2 / 88
ﻪﻣﺪﻘﻣ
ﻪـﻛﺖـﺳاﻊﻳﺎـﺷوﻦﻣﺰﻣﻲﺑﺎﻬﺘﻟايرﺎﻤﻴﺑﺲﻳزﺎﻳرﻮﺴﭘ دوﺪﺣرد 1 ﺎﺗ 3 وﺪـﻧرﺎﺘﻓﺮﮔنآﻪـﺑﺎـﻴﻧدﺖـﻴﻌﻤﺟﺪﺻرد ﻲﻣ ردورﺎـﻤﻴﺑردﻪـﺟﻮﺗﻞـﺑﺎﻗسﺮﺘﺴـﻳدﻪـﺑﺮﺠﻨﻣﺪﻧاﻮﺗ دﻮﺷرﺎﻤﻴﺑﻲﮔﺪﻧزﺖﻴﻔﻴﻛﺶﻫﺎﻛﺖﻳﺎﻬﻧ . ) 1 ، 2 و 3 ( ﺲﻳزﺎﻳرﻮﺴﭘ ﺮـﻈﻧزاﻪـﻛدراداﺰﺠﻣعﻮﻧودﺲﻳرﺎﮕﻟو ﻲﮔﮋﻳو،زوﺮﺑﻦﺳ توﺎـﻔﺗﻢﻫﺎﺑﻲﻨﻴﻟﺎﺑهرودوﻚﻴﺘﻧژيﺎﻫ ﺪﻧراد ) 4 ( يرﺎـﻤﻴﺑعوﺮـﺷﻦـﺳسردوزعوﺮـﺷﺎـﺑعﻮﻧرد 22 ـ 16 ﻲﻣﻲﮕﻟﺎﺳ دراديﻮﻗﻲﻜﻴﺘﻧژﻪﻨﻴﻣزوﺪﺷﺎﺑ . عﻮﻧرد يرﺎﻤﻴﺑعوﺮﺷﻦﺳسرﺮﻳدعوﺮﺷﺎﺑ 60 ـ 57 ﺖﺳاﻲﮕﻟﺎﺳ راﺪـﻧﻚـﻴﺘﻧژﺎﺑيدﺎﻳزطﺎﺒﺗرا و ﻒـﻴﻔﺧود ﺎـﺑعﻮـﻧزاﺮـﺗ ﻲﻣسردوزعوﺮﺷ ﺪﺷﺎﺑ . ) 5 و 6 ( دﺎـــﺠﻳا،ﻲﻨﻴﻟﺎـــﺑيﺎـــﻤﻧردﺲﻳرﺎـــﮕﻟوﺲﻳزﺎﻳرﻮﺴـــﭘ كﻼﭘ ﻪﺘـﺳﻮﭘوهﺮـﻴﺗﺰـﻣﺮﻗﮓـﻧرﻪـﺑﻪﺘﺴﺟﺮﺑيﺎﻫ ﺎـﺑراد ﻪﺘﺳﻮﭘ ﻲـﻣ ﻢﻴﺨﺿيﺎﻫ ﺪـﻨﻛ . ) 7 و 8 ( رد ﺲﻳزﺎﻳرﻮﺴـﭘعﻮﻴـﺷ ﻪﺻﻼﺧﻪﻟﺎﻘﻣﻦﻳا يا زاﺖﺳا نﺎﻳﺎﭘ ﻪﻣﺎﻧ ﺟردﺖﻓﺎﻳردﺖﻬﺟﻲﮕﻧﺮﻬﺑمﺎﻬﻟاﺮﺘﻛد ،ﻲﺑآﺮﻜﺷيﺪﻬﻣﺮﺘﻛدهروﺎﺸﻣوﻦﻳرﺎﺼﻧاﺐﻴﺒﺣﺮﺘﻛدﻲﻳﺎﻤﻨﻫارﻪﺑﻲﺼﺼﺨﺗياﺮﺘﻛدﻪ لﺎﺳ 1388 . (I يرﺎﻤﻴﺑدﺎﺘﺳا ناﺮﻳا،ناﺮﻬﺗ،ناﺮﻳاﻲﻧﺎﻣردﻲﺘﺷاﺪﻬﺑتﺎﻣﺪﺧوﻲﻜﺷﺰﭘمﻮﻠﻋهﺎﮕﺸﻧاد،مﺮﻛالﻮﺳرنﺎﺘﺳرﺎﻤﻴﺑ،ﺖﺳﻮﭘﺶﺨﺑ،ﺖﺳﻮﭘيﺎﻫ (II ﻮﻠﻋهﺎﮕﺸﻧاد،ﻲﻜﺷﺰﭘهﺪﻜﺸﻧاد،يژﻮﻟﻮﻧﻮﻤﻳاهوﺮﮔرﺎﻴﺸﻧاد ناﺮﻳا،ناﺮﻬﺗ،ناﺮﻳاﻲﻧﺎﻣردﻲﺘﺷاﺪﻬﺑتﺎﻣﺪﺧوﻲﻜﺷﺰﭘم (III يرﺎﻤﻴﺑرﺎﻴﺘﺳد ناﺮﻳا،ناﺮﻬﺗ،ناﺮﻳاﻲﻧﺎﻣردﻲﺘﺷاﺪﻬﺑتﺎﻣﺪﺧوﻲﻜﺷﺰﭘمﻮﻠﻋهﺎﮕﺸﻧاد،مﺮﻛالﻮﺳرنﺎﺘﺳرﺎﻤﻴﺑ،ﺖﺳﻮﭘﺶﺨﺑ،ﺖﺳﻮﭘيﺎﻫ *) لوﺆﺴﻣﻒﻟﺆﻣ (
ﺖﺳايوﺎﺴﻣدﺮﻣونز . ) 5 ( لﺎـﺳزاﻞـﺒﻗﺎﺗ 1980 رﻮﺼـﺗ ﻲﻣ ﺪﻤﻋﺲﻳزﺎﻳرﻮﺴﭘﺪﺷ ناﺪـﻘﻓوﺮﻴﺜﻜﺗﺶﻳاﺰﻓايرﺎﻤﻴﺑًﺎﺗ ﺖﻴﺳﻮﻨﻴﺗاﺮﻛﺰﻳﺎﻤﺗ ﻚـﻳﺖـﺳﻮﭘبﺎﻬﺘﻟاوﺖﺳامرﺪﻴﭘا يﺎﻫ ﻲﻣﻪﻳﻮﻧﺎﺛﻲﮔﮋﻳو ﺪﺷﺎﺑ . ﻪـﻛﺖﺳاﻦﻳاﺮﺑهﺪﻴﻘﻋهزوﺮﻣاﻲﻟو ﻪﻄﺳاو ﺎﺑيرﺎﻤﻴﺑﺲﻳزﺎﻳرﻮﺴﭘ T ﺖﻴﺳﻮﻔﻨﻟ ﻲﻣﺎﻫ وﺪـﺷﺎﺑ ﺖﻴﺳﻮﻨﻴﺗاﺮﻛﺮﻴﺜﻜﺗﺶﻳاﺰﻓا ﻢﺘﺴﻴﺳنﺪﺷلﺎﻌﻓﻪﺑﻪﻳﻮﻧﺎﺛ،ﺎﻫ ﻮﺘﻴﺳنﺪﺷدازآوﻲﻨﻤﻳا ﻦﻴﻛ ﺖﺳاﺎﻫ . ) 1 ، 4 و 5 ( ﻲـﺘﻧآﻚﻳﻲﻨﻤﻳاﻢﺘﺴﻴﺳنﺪﺷلﺎﻌﻓﺖﻠﻋ ﻪﺘﺧﺎﻨـﺷﺎﻧنژ ﻲﻧﻮــﻔﻋﺮﻴﻏﺎــﻳﻲﻧﻮــﻔﻋﺖــﺳاﻦــﻜﻤﻣﻪــﻛﺖــﺳاﻲﺘــﺳﻮﭘ ﺪﺷﺎﺑ . ) 1 و 5 ( لﻮﻠﺳ ﻲـﺘﻧآهﺪـﻨﻨﻛﻪﺿﺮﻋيﺎﻫ ومرﺪـﻴﭘاردنژ ﻲــﺘﻧآﻦــﻳامرد ردوهﺪــﺷلﺎــﻌﻓ،هدﺮــﻛﻲﻳﺎــﺳﺎﻨﺷارنژ ﻒﻨﻟ ﻪﺑارنآﺖﺳﻮﭘهﺪﻨﻨﻛژﺎﻧرديﺎﻫدﻮﻧ T ﺖﻴﻴﺳﻮﻔﻨﻟ يﺎـﻫ CD4+ و CD8+ ﻲــﻣﻪــﺋارا ﺪــﻨﻫد . ) 9 ( نﺪــﺷلﺎــﻌﻓﺎــﺑ T ﺖﻴــﺳﻮﻔﻨﻟ ﻲــﻣدﺎــﺠﻳاﻪــﻧﺎﮔاﺪﺟﺰﻳﺎــﻤﺗهارودﺎــﻫ دﻮــﺷ . T ﺖﻴﺳﻮﻔﻨﻟ يﺎﻫ CD4+ ﭗﻴﺗﻮﻨﻓﻪﺑ T ﺖﻴﺳﻮﻔﻨﻟ عﻮﻧﻲﻜﻤﻛيﺎﻫ 1 (Th1) ﭗﻴﺗﻮﻨﻓﻪﺑﺎﻳ T ﺖﻴﺳﻮﻔﻨﻟ عﻮﻧﻲﻜﻤﻛيﺎﻫ 2 (Th2) ﻲﻣﺰﻳﺎﻤﺗ ﺪﻨﺑﺎﻳ . ﻲـﻣﻪﺘﻓﺮﮔﺮﻈﻧرد ﻚﻳﭗﻴﺗيرﺎﻤﻴﺑﺲﻳزﺎﻳرﻮﺴﭘ دﻮـﺷ ﺑﻪﻛ ﻦﻴﻛﻮﺘﻴﺳﻪﺒﻠﻏﺎ ﺎـﻣﺎﮔنوﺮـﻓﺮﺘﻨﻳاﻞـﺜﻣﻚـﻳﭗـﻴﺗيﺎـﻫ ﻲﻣﺺﺨﺸﻣ دﻮﺷ . رد ﻦﻴﻛﻮﺘﻴﺳﻪﻛﻲﻟﺎﺣ ﭗـﻴﺗيﺎﻫ 2 ﻞـﺜﻣ ﻦﻴﻛﻮﻟﺮﺘﻨﻳا 4 تﺎﻌﻳﺎـﺿدﻮـﺒﻬﺑﺚـﻋﺎﺑﻲـﻠﻌﻓتﺎﻌﻟﺎﻄﻣﻖﺒﻃ ﻲﻣﺲﻳزﺎﻳرﻮﺴﭘ دﻮﺷ . ) 10 ( T ﺖﻴﺳﻮﻔﻨﻟ ﺖـﺳﻮﭘدراو ﺪـﻨﻧاﻮﺘﺑﺪـﻳﺎﺑ هﺪﺷلﺎﻌﻓ يﺎﻫ ﺪـﻨﭼﻪـﺳوﺮﭘﻚـﻳﻪـﻛﺪـﻨﻨﻛلﺎـﻤﻋاارنﺎﺸـﺗاﺮﺛاﺎﺗﺪﻧﻮﺷ ﺮﻣ ﻪﻠﺣ ﻦﻴﺑ يا T ﺖﻴﺳﻮﻔﻨﻟ ﻲﻣمﻮﻴﻠﺗوﺪﻧاولﺎﻌﻓيﺎﻫ ﺪـﺷﺎﺑ . لﻮﻜﻟﻮﻣزاﻲﻜﻳ لﻮﻠـﺳﺢﻄـﺳردﻪـﻛﻲﻳﺎﻫ لﺎﻴﻠﺗوﺪـﻧايﺎـﻫ ﻲﻣنﺎﻴﺑ تﺮﺟﺎـﻬﻣردودﻮـﺷ T ﺖﻴـﺳﻮﻔﻨﻟ ﺖـﺳﻮﭘﻪـﺑﺎـﻫ ﺖﺳاﻞﻴﺧد ICAM-1 ﺖﺳا . ) 11 و 12 ( هﻮﻘﻟﺎـﺑﺶـﻘﻧزاﻲﻫﺎـﮔآ لﻮﻜﻟﻮﻣﻦﻳا ﻒﺸـﻛﻪـﺑﺮـﺠﻨﻣﺲﻳزﺎﻳرﻮﺴـﭘﺰﻧژﻮﺗﺎﭘردﺎﻫ نﺎﻣرد ـﻳﺎﭘﺮـﺑﻲﻳﺎﻫ تﺮﺟﺎـﻬﻣكﻮـﻠﺑﻪ T ﺖﻴـﺳﻮﻔﻨﻟ ﻪـﺑﺎـﻫ ﺪــﺷﺖــﺳﻮﭘ . ) 13 ( T ﺖﻴــﺳﻮﻔﻨﻟ كﺮــﺤﻣمرﺪــﻴﭘاﻞــﺧاديﺎــﻫ ﺖﻴــﺳﻮﻨﻴﺗاﺮﻛنﻮﻴــﺳاﺮﻔﻴﻟوﺮﭘﺮﭙﻴﻫ ﻲــﻣﺎــﻫ ًﻻﺎــﻤﺘﺣاﺪﻨــﺷﺎﺑ ﻦﻴﻛﻮﺘﻴﺳرﺎﺸﺑآ ﺢﺷﺮﺗيﺎﻫ لﻮﻠﺳزاهﺪﺷ ﻪـﻛﻒﻠﺘﺨﻣيﺎﻫ ﭗﻴﺗﻮﻨﻓردﻲﻠﺻاﺶﻘﻧﺖﺳاهﺪﺷﺖﻓﺎﻳنارﺎﻤﻴﺑﺖﺳﻮﭘرد دراديرﺎﻤﻴﺑ . ) 14 ( ﻦﻴﻛﻮﻟﺮﺘﻨﻳا 8 ﻚﻳﺰﻴﻧ ﻪﻛﺖﺳايﻮﻗﻚﻴﺘﻛﺎﺗﻮﻤﻛ رﻮﺘﻛﺎﻓ ﻞﻴﻓوﺮﺗﻮﻧ ﻲـﻣبﺬﺟبﺎﻬﺘﻟاﻞﺤﻣﻪﺑارﺎﻫ ﺪـﻨﻛ . ﻪـﻛﻲﻠﻣاﻮـﻋ ﻦﻴﻛﻮﻟﺮﺘﻨﻳانﺪﺷﺪﻧﺎﺑ 8 ﻲﻣكﻮﻠﺑارشرﻮﺘﭙﺳر ﻪﺑ ردﺪﻨﻨﻛ لﺪﻣ هدﻮـﺑﺮﺛﺆـﻣبﺎﻬﺘﻟاﺶﻫﺎﻛردﻲﻧاﻮﻴﺣيﺎﻫ ﺪـﻧا . ) 15 ( رد ﺦﺳﺎﭘ ﻦﻴﻛﻮﻟﺮﺘﻨﻳاﻲﺑﺎﻬﺘﻟايﺎﻫ 8 لﻮﻠـﺳعاﻮـﻧاﻂﺳﻮﺗ زاﺎـﻫ ﺮﺗﻮﻧ،ﺎﻫژﺎﻓوﺮﻛﺎﻣﻪﻠﻤﺟ ﻞﻴﻓو ﺖﻴـﺳﻮﻔﻨﻟ،ﺎﻫ لﻮﻠـﺳ،ﺎـﻫ يﺎـﻫ ﺖﻴﺳﻮﻨﻴﺗاﺮﻛولﺎﻴﻠﺗوﺪﻧا ﻲـﻣ ﺪﻴﻟﻮﺗﺎﻫ دﻮـﺷ . ) 16 و 17 ( ًﻻﺎـﻤﺘﺣا ﻦﻴﻛﻮﻟﺮﺘﻨﻳاﻲﻠﺻاﺮﺛا 8 يﺎـﻘﻟاﺎـﺑﻲﺘﻓﺎـﺑﺐﻴـﺳآدﺎـﺠﻳارد ﻞﻴﻓوﺮﺗﻮﻧنﻮﻴﺳاﺮﺘﻠﻴﻔﻧا ﻢﻳﺰﻧآنﺪﺷدازآﻚﻳﺮﺤﺗوﺎﻫ يﺎـﻫ ﻞـــﻴﻓوﺮﺗﻮﻧزازاﺪﻴﺴـــﻛاﺮﭘﻮﺳنﻮـــﻴﻧآوﻲـــﻣوزوﺰﻴﻟ ﺎـــﻫ ﻲﻣ ﺪﺷﺎﺑ . ) 18 ( ﺑﻦﻳﺪﻨﭼرد ﻦﻴﻛﻮـﻟﺮﺘﻨﻳاﻲﻣﺮـﺳﺢﻄـﺳرﺎﻤﻴ 8 ﻲﺑﺎﻳزرا ﺶﻴﭘهﺪﻨﻨﻛ ﺖﺳاهدﻮﺑيرﺎﻤﻴﺑﻲﻬﮔآ . ﻪﻌﻟﺎﻄﻣﻚﻳرد رد 2008 ﻦﻴﻛﻮــﻟﺮﺘﻨﻳانﺎــﻴﺑ 8 مرﺪــﻴﭘاردنآرﻮﺘﭙــﺳرو ﺪــﺷﻪﺴــﻳﺎﻘﻣﺲﻳزﺎﻳرﻮﺴــﭘﻪــﺑﻼﺘــﺒﻣمرﺪــﻴﭘاولﺎــﻣﺮﻧ . mRNA ﻦﻴﻛﻮﻟﺮﺘﻨﻳا 8 ﺲﻳزﺎﻳرﻮﺴـﭘيارادمرﺪﻴﭘارد ﻂﻘﻓ وﺪـﺷﻲﻳﺎﺳﺎﻨﺷ mRNA ﻦﻴﻛﻮـﻟﺮﺘﻨﻳارﻮﺘﭙـﺳر 8 ﺰـﻴﻧ 10 دﻮـﺑهﺪـﺷنﺎـﻴﺑﺮﺘﺸﻴﺑﻪﻌﻳﺎﺿيارادمرﺪﻴﭘاردﺮﺑاﺮﺑ . رد ﻢــﺋﻼﻋﺖــﻠﻋًﻻﺎــﻤﺘﺣاﻪــﻛﺪــﺷدﺎﻬﻨﺸــﻴﭘﻪــﻌﻟﺎﻄﻣﻦــﻳا ﻦﻴﻛﻮـﻟﺮﺘﻨﻳاﺢﻄـﺳﺶﻳاﺰﻓا ﺲﻳزﺎﻳرﻮﺴﭘ 8 نآرﻮﺘﭙـﺳرو ﻲﻣ ﺪﺷﺎﺑ . ﻦﻴﻛﻮـﻟﺮﺘﻨﻳارﻮﺘﭙـﺳرﻦﻳاﺮﺑﺎـﻨﺑ 8 ﻲـﻣ ﻚـﻳﺪـﻧاﻮﺗ ﺪــﺿﺪــﻳﺪﺟﻚــﻳژﻮﻟﻮﻴﺑيﺎــﻫورادﻒﺸــﻛياﺮــﺑفﺪــﻫ ﺪﺷﺎﺑﺲﻳزﺎﻳرﻮﺴﭘ . ) 19 ( وﻲﻨﻫذ سﺮﺘﺴﻳدﺲﻳزﺎﻳرﻮﺴﭘ نارﺎﻤﻴﺑ ﻲـﻜﻳﺰﻴﻓ ﻞـﺑﺎﻗ يرﺎــﻤﻴﺑﺮﻳﺎــﺳﺎــﺑﻪﺴــﻳﺎﻘﻣ ﺪــﻧرادارﻦﻣﺰــﻣيﺎــﻫ . ) 20 ( ياﺮﺑ ﻦﻴـﻴﻌﺗ ،هارﻚـﻳ،ﺐـﺳﺎﻨﻣنﺎـﻣردعﻮـﻧبﺎﺨﺘﻧا تﺪـﺷ يرﺎﻤﻴﺑ هدﺎﻔﺘـﺳاﺎﺑيرﺎﻤﻴﺑتﺪﺷ ﻲﺑﺎﻳزراًﻻﻮﻤﻌﻣﻪﻛﺖﺳا زا
PASI (Psoriasis area and Severity index)
ﻲﻣ ﺪﺷﺎﺑ . ) 21 ( ﻣ سﺎﺳاﺮﺑ يدﺎﻳزﻲﻨﻴﻟﺎﺑﻲﻧﺎﺷﻮﭙﻤﻫقﻮﻓرﺎﻴﻌ دراددﻮـﺟويرﺎـﻤﻴﺑﺪﻳﺪﺷوﻂﺳﻮﺘﻣعاﻮﻧاﻦﻴﺑ . ﻦﻳاﺮﺑﺎـﻨﺑ PASI نﺎـﻣردعﻮـﻧبﺎﺨﺘﻧاياﺮﺑوﺖﺳا ﻲﻨﻴﻟﺎﺑرﺎﻴﻌﻣﻚﻳ ﻲـﻤﻧﺪﻨﻤـﺷزرادﺎﻳزيرﺎﻤﻴﺑعوﺮﺷرد ﺪـﺷﺎﺑ . ) 22 ( ﻦﻳاﺮﺑﺎـﻨﺑ
ﻲﻣﺮــﺳﺢﻄــﺳﻦﻴــﺑطﺎــﺒﺗراﻦﺘﻓﺎــﻳﺎــﻣفاﺪــﻫازاﻲــﻜﻳ ﻦﻴﻛﻮﺘﻴﺳ تﺪﺷردﻞﻴﺧدهﺪﺷضﺮﻓيﺎﻫ تﺪﺷﺎﺑيرﺎﻤﻴﺑ ﻲﻣﺲﻳزﺎﻳرﻮﺴﭘيرﺎﻤﻴﺑ هزاﺪـﻧاﺎـﺑﺎـﺗﺪﺷﺎﺑ ﺖـﻈﻠﻏيﺮـﻴﮔ ﻦﻴﻛﻮﺘﻴﺳﻲﻣﺮﺳ نارﺎﻤﻴﺑ ردرﻮﻛﺬﻣيﺎﻫ ردﺲﻳزﺎﻳرﻮﺴـﭘ ﺶﻴـﭘﻪـﺑﻲﭘزﻮﻨﮔوﺮﭘرﻮﺘﻛﺎﻓناﻮﻨﻋﻪﺑﻪﻌﺟاﺮﻣوﺪﺑ ﻲـﻬﮔآ ﺐﺳﺎﻨﻣنﺎﻣردوهدﺮﺑيرﺎﻤﻴﺑ نﺎـﻤﻫزااررﺎـﻤﻴﺑياﺮـﺑﺮﺗ ﻪﻨﻳﺰﻫوﺖﻗوفﻼﺗازاوهدﺮﻛبﺎﺨﺘﻧااﺪﺘﺑا ايﺎﻫ وﻲﻓﺎـﺿ ﻢﻴﻫﺎـﻜﺑنارﺎـﻤﻴﺑﻦـﻳاﻲﮔﺪـﻧزﺖـﻴﻔﻴﻛﺶﻫﺎﻛ . ﻦﻴـﻨﭽﻤﻫ ﺎـﺑ تﺪـﺷﻦﻴـﺑطﺎـﺒﺗراﻦﺘﻓﺎـﻳوﺰﻧژﻮﺗﺎﭘﻮﻨﻤﻳا ﺮﺘﺸﻴﺑﺖﺧﺎﻨﺷ ﻦﻴﻛﻮﺘﻴـﺳﻲﺧﺮﺑﺎﺑيرﺎﻤﻴﺑ ﻪـﻣﺪﻘﻣ ،ﺎـﻫ ﺶﻫوﮋـﭘياﺮـﺑيا فﺪـﻫﺎـﺑﺪﻳﺪﺟﻚﻳژﻮﻟﻮﻴﺑيﺎﻫورادﻦﺘﻓﺎﻳﻪﻨﻴﻣزردﺮﺘﺸﻴﺑ ﻦﻳاﻲﺻﺎﺼﺘﺧاﻦﺘﻓﺮﮔ ﻦﻴﻛﻮﺘﻴﺳ دﻮﺷﻢﻫاﺮﻓﺎﻫ .
ﻲﺳرﺮﺑ
شور
ﻦﻳارد ،ﻲﻌﻄﻘﻣﻪﻌﻟﺎﻄﻣ 40 ﻞﻣﺎﺷرﺎﻤﻴﺑ 18 ونزرﺎﻤﻴﺑ 22 ﻲﻨـﺳهدوﺪـﺤﻣﺎـﺑدﺮﻣرﺎﻤﻴﺑ 70 ــ 7 ﻲﻨـﺳﻦﻴﮕﻧﺎـﻴﻣو 7 / 38 ﺪﻨﺘﻓﺮﮔراﺮﻗﻲﺳرﺮﺑدرﻮﻣلﺎﺳ . ﻲـﻣﺮـﭘﻪﻣﺎﻨﺸـﺳﺮﭘﻪـﮔﺮﺑﻚﻳرﺎﻤﻴﺑﺮﻫ ياﺮﺑ ﻪـﻛﺪـﺷ دﻮﺑرﺎﻤﻴﺑﻦﺳومﺎﻧﻞﻣﺎﺷ . تﺪـﺷﻲﺑﺎـﻳزراياﺮﺑﻦﻴﻨﭽﻤﻫ سﺎــﺳاﺮﺑيرﺎــﻤﻴﺑ PASI ﺪــﺻردوﺪــﺷﻪــﻨﻳﺎﻌﻣرﺎــﻤﻴﺑ ﻪﺘﺳﻮﭘ،يﺰﻣﺮﻗناﺰﻴﻣونﺪﺑﺢﻄﺳيﺮﻴﮔرد ﻲﺘﻔﺳويﺰﻳر ﺖــﺒﺛﻪﻣﺎﻨﺸــﺳﺮﭘردودروآﺮــﺑﻪــﻴﺣﺎﻧﺮــﻫردتﺎﻌﻳﺎــﺿ ﻲﻣ ﺪﺷ . رﺎﻤﻴﺑﺮﻫزاﺲﭙﺳ cc 3 وهﺪﺷﻪﺘﻓﺮﮔيﺪﻳرونﻮﺧ يﺎـﻣدردوهﺪﺷاﺪﺟﻲﻣﺮﺳﻪﻧﻮﻤﻧژﻮﻔﻳﺮﺘﻧﺎﺳﺎﺑ oC 70 -ﺪــﺷهﺮــﻴﺧذﻲﻳﺎــﻬﻧﻲــﺳرﺮﺑنﺎــﻣزﺎــﺗ . سﺎــﺳاﺮﺑﺲﭙــﺳ ﻪﻣﺎﻨﺸﺳﺮﭘتﺎﻋﻼﻃا ﻊﻤﺟيﺎﻫ آ يرﺎـﻤﻴﺑتﺪـﺷ،هﺪـﺷيرو رﺎﻴﻌﻣﺎﺑدﺮﻓﺮﻫ PASI هزاﺪﻧا ﺪﺷيﺮﻴﮔ . اﺪﺘﺑاشورﻦﻳارد نﻮﻧﺎــﻗﻖــﺒﻃﺖــﺳﻮﭘﺢﻄــﺳيﺮــﻴﮔردﺪــﺻرد 9 ﻪﺒــﺳﺎﺤﻣ ﻲﻣ دﻮﺷ (A%) ) ﺖﺳدوﺮﺳ ماﺪﻛﺮﻫﺎﻫ 9 % ﺖﻤﺴـﻗ،ﺎـﻫﺎﭘ، ماﺪﻛﺮﻫﻪﻨﺗﻲﻔﻠﺧﺖﻤﺴﻗوﻲﻣاﺪﻗ 18 % لﺎﺘﻴﻧژﻪﻴﺣﺎﻧو 1 % ﻲﻣﻪﺘﻓﺮﮔﺮﻈﻧرد دﻮﺷ .( ﻣﺎﺨـﺿ،يﺰـﻣﺮﻗناﺰﻴﻣﺲﭙﺳ وﺖ ﻪﺘﺳﻮﭘ هﺪـﺷهدادلﻮﻣﺮﻓسﺎﺳاﺮﺑﺮﻴﮔردﻲﺣاﻮﻧرديﺰﻳر ﻲﻣﻪﺒﺳﺎﺤﻣ ودﻮﺷ PASI ﻪﺒـﺳﺎﺤﻣﺮـﻳزلﻮـﻣﺮﻓﺎﺑﻲﻳﺎﻬﻧ ﻲﻣ ددﺮﮔ : A% × PASI=(E+I+D) =E ﻢﺘﻳرا =I ﺖﻣﺎﺨﺿﺎﻳنﻮﻴﺳاﺮﺘﻠﻴﻔﻧا =D ﻪﺘﺳﻮﭘﺎﻳنﻮﻴﺳﺎﻣاﻮﻜﺳد يﺰﻳر ﻊﻤﺟزاﺲﭘ يروآ 40 مﺮﺳ،ﻲﻣﺮﺳﻪﻧﻮﻤﻧ ﺰﻳﺮﻓزاﺎﻫ جرﺎﺧ ﻦﻴﻛﻮـﻟﺮﺘﻨﻳاﻲﻣﺮـﺳﺢﻄﺳوﺪﺷ 4 ﻦﻴﻛﻮـﻟﺮﺘﻨﻳا، 8 نوﺮـﻓﺮﺘﻨﻳا، وﺎﻣﺎﮔ ICAM-1 ﺖﻴﻛﺎﺑ يرﺎﺠﺗيﺎﻫ ELIZA هزاﺪﻧا ﺪﺷيﺮﻴﮔ هدادﺲﭙﺳ مﺮﻧدراوﺰﻴﻟﺎﻧآﺖﻬﺟﺎﻫ يرﺎﻣآراﺰﻓا SPSS ﺪـﺷ . و ﺎـﺑيرﺎـﻤﻴﺑتﺪـﺷﺎـﺑﺎﻫﺮﻴﻐﺘﻣزاﻚﻳﺮﻫﻲﻣﺮﺳﺢﻄﺳطﺎﺒﺗرا ﺪـﺷﻲـﺳرﺮﺑﻦﻣﺮﻴﭙـﺳاﻲﮕﺘﺴـﺒﻤﻫﺐﻳﺮﺿزاهدﺎﻔﺘﺳا . ياﺮـﺑ يرﺎﻤﻴﺑتﺪﺷﺎﺑﺎﻫﺮﻴﻐﺘﻣزاﻚﻳﺮﻫﻞﻘﺘﺴﻣطﺎﺒﺗراندادنﺎﺸﻧ زا Linear Regression ﺪﺷهدﺎﻔﺘﺳا .
ﻪﺘﻓﺎﻳ
ﺎﻫ
عﻮﻤﺠﻣردﻪﻌﻟﺎﻄﻣﻦﻳارد 40 ماﺪـﻛﺮـﻫﻲﻣﺮـﺳﻪﻧﻮﻤﻧ ﺖـــﻓﺮﮔراﺮـــﻗﻲـــﺳرﺮﺑدرﻮـــﻣرﺎـــﻤﻴﺑﻚـــﻳزا . ﺢﻄـــﺳ ﻦﻴﻛﻮــﻟﺮﺘﻨﻳا،ﺎــﻣﺎﮔنوﺮــﻓﺮﺘﻨﻳاﻲﻣﺮــﺳ 4 ﻦﻴﻛﻮــﻟﺮﺘﻨﻳا، 8 ــﺳﻦﻴــﺑﻲﮔﺪﻨﺒﺴــﭼلﻮــﻜﻟﻮﻣو ﻚــﻳﻲﻟﻮﻠ (ICAM-1) رد، 40 ﺪﻳﺪـﺷوﻂـﺳﻮﺘﻣ،ﻒـﻴﻔﺧﺲﻳزﺎﻳرﻮﺴﭘﻪﺑﻼﺘﺒﻣرﺎﻤﻴﺑ سﺎﺳاﺮﺑ PASI هزاﺪﻧا ﺪﺷيﺮﻴﮔ . ﻦﻴـﺑطﺎـﺒﺗراﻦﺘﻓﺎـﻳياﺮﺑ لﻮﻜﻟﻮﻣزاﻚﻳﺮﻫﻲﻣﺮﺳﺢﻄﺳ يرﺎﻤﻴﺑتﺪﺷﺎﺑقﻮﻓيﺎﻫ ﺪﺷهدﺎﻔﺘﺳاﻦﻣﺮﻴﭙﺳاﻲﮕﺘﺴﺒﻤﻫﺐﻳﺮﺿزا . ﻪﺘﻓﺎﻳ ﻦـﻳايﺎﻫ ﻲﻣﺮـﺳﺢﻄـﺳويرﺎـﻤﻴﺑتﺪـﺷﻦﻴـﺑدادنﺎﺸـﻧﺶﻫوﮋﭘ ﻲــﻨﻌﻣطﺎــﺒﺗراﺎــﻣﺎﮔنوﺮــﻓﺮﺘﻨﻳا دراددﻮــﺟويرﺎــﻣآراد ) 001 / 0 = P ، 50 / 0 = r ( ، ) هرﺎﻤﺷرادﻮﻤﻧ 1 .( ﻦﻴﻛﻮﻟﺮﺘﻨﻳاﻲﻣﺮﺳﺢﻄﺳﺎﺑيرﺎﻤﻴﺑتﺪﺷﻦﻴﺑ 4 طﺎـﺒﺗرا دراﺪﻧدﻮﺟو ) . 24 / 0 = P ، 15 / 0 = r ( ) هرﺎﻤﺷرادﻮﻤﻧ 2 .( ﻦﻴﻛﻮﻟﺮﺘﻨﻳاﻲﻣﺮﺳﺢﻄﺳويرﺎﻤﻴﺑتﺪﺷﻦﻴﺑ 8 طﺎﺒﺗرا ﻲﻨﻌﻣ دراددﻮﺟويرﺎﻣآراد (r=0.37, p=0.018) ، ) رادﻮﻤﻧ هرﺎﻤﺷ 3 .( ﻲﻣﺮـﺳﺢﻄـﺳويرﺎﻤﻴﺑتﺪﺷﻦﻴﺑ ICAM-1 طﺎـﺒﺗرا، ﻲﻨﻌﻣ دراددﻮﺟويرﺎﻣآراد (r=0.31, p=0.047) ، ) رادﻮﻤﻧ هرﺎﻤﺷ 4 .(
هرﺎﻤﺷرادﻮﻤﻧ 1 تﺪﺷﺎﺑﺎﻣﺎﮔنوﺮﻓﺮﺘﻨﻳاﻲﻣﺮﺳﺢﻄﺳﻦﻴﺑطﺎﺒﺗرا ﺲﻳزﺎﻳرﻮﺴﭘيرﺎﻤﻴﺑ هرﺎﻤﺷرادﻮﻤﻧ 2 ﻮﻟﺮﺘﻨﻳاﻲﻣﺮﺳﺢﻄﺳﻦﻴﺑطﺎﺒﺗرا ﻦﻴﻛ 4 تﺪـﺷﺎـﺑ ﺲﻳزﺎﻳرﻮﺴﭘيرﺎﻤﻴﺑ ﺎـﺑﺎﻫﺮﻴﻐﺘﻣزاﻚﻳﺮﻫﻞﻘﺘﺴﻣ طﺎﺒﺗراندادنﺎﺸﻧ ياﺮﺑ زايرﺎــﻤﻴﺑتﺪــﺷ Linear Regression وﺪــﺷهدﺎﻔﺘــﺳا نوﺮـﻓﺮﺘﻧاﻲﻣﺮـﺳﺢﻄﺳﻦﻴﺑطﺎﺒﺗرا ﻂﻘﻓﻪﻛﺪﺷﺺﺨﺸﻣ ﻲـﻣﺎﻫﺮﻴﻐﺘﻣ ﺮﻳﺎﺳزاﻞﻘﺘﺴﻣ،يرﺎﻤﻴﺑتﺪﺷﺎﺑﺎﻣﺎﮔ ﺪـﺷﺎﺑ . ﻨﻳاﻲﻣﺮـﺳ ﺢﻄـﺳندﻮﺑ ﻻﺎﺑﻦﻴﺑطﺎﺒﺗرا ﻲﻟو ﻦﻴﻛﻮـﻟﺮﺘ 8 و ICAM-1 ﺢﻄـﺳندﻮـﺑﻻﺎـﺑﻪـﺑﻪﺘﺴﺑاو،يرﺎﻤﻴﺑتﺪﺷﺎﺑ ﻲﻣﺎﻣﺎﮔنوﺮﻓﺮﺘﻨﻳاﻲﻣﺮﺳ ﺪﺷﺎﺑ . هرﺎﻤﺷرادﻮﻤﻧ 3 ﻦﻴﻛﻮﻟﺮﺘﻨﻳاﻲﻣﺮﺳﺢﻄﺳﻦﻴﺑطﺎﺒﺗرا 8 تﺪـﺷﺎـﺑ ﺲﻳزﺎﻳرﻮﺴﭘيرﺎﻤﻴﺑ هرﺎﻤﺷرادﻮﻤﻧ 4 ﻲﻣﺮـﺳﺢﻄـﺳﻦﻴـﺑطﺎـﺒﺗرا ICAM-1 تﺪـﺷﺎـﺑ ﺲﻳزﺎﻳرﻮﺴﭘيرﺎﻤﻴﺑ
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ــﻓتﺎــﻌﻟﺎﻄﻣيﺎﺘــﺳاررد ﻪــﻌﻟﺎﻄﻣﻦــﻳاردﺰــﻴﻧﺎــﻣقﻮ ﻦﻴﻛﻮﺘﻴﺳ ﺲﻧﻻﺎﺑ يﺎﻫ Th1/Th2 ﻢﻴﻨﻴﺒﺑﺎﺗهدﺮﻛﻲﺳرﺮﺑار ﻦﻴﻛﻮﺘﻴﺳ ﺖـﺳاﻂﺒﺗﺮـﻣيرﺎـﻤﻴﺑتﺪﺷﺎﺑهوﺮﮔماﺪﻛيﺎﻫ . ﻲﻣﺮــﺳﺢﻄــﺳويرﺎــﻤﻴﺑتﺪــﺷﻦﻴــﺑﻪــﻌﻟﺎﻄﻣﻦــﻳاﻖــﺒﻃ ﭗـﻴﺗﻦﻴﻛﻮﺘﻴﺳﻪﻛﺎﻣﺎﮔنوﺮﻓﺮﺘﻨﻳا 1 دﻮـﺟوطﺎـﺒﺗراﺖـﺳا ﺖﺷاد . ،ﺰـﻴﻧﺮـﮕﻳدهﺪـﺷمﺎـﺠﻧاتﺎـﻌﻟﺎﻄﻣ ﺮـﺜﻛاسﺎـﺳاﺮﺑ ﺖﻴﺳﻮﻔﻨﻟﻪﺒﻠﻏﺎﺑيرﺎﻤﻴﺑﺲﻳزﺎﻳرﻮﺴﭘ يﺎﻫ T عﻮﻧﻲﻜﻤﻛ 1 ﻲﻣﻪﺘﻓﺮﮔﺮﻈﻧرد ﻦﻴﻛﻮﺘﻴﺳﺎﺑﻪﻛدﻮﺷ ﭗﻴﺗيﺎﻫ 1 ﻪﻠﻤﺟزا
ﻲﻣﺺﺨﺸﻣﺎﻣﺎﮔنوﺮﻓﺮﺘﻨﻳا دﻮﺷ . ) 10 ( ﺲﻳزﺎﻳرﻮﺴـﭘيرﺎـﻤﻴﺑتﺪﺷﻦﻴﺑ،ﺎﻣﻪﻌﻟﺎﻄﻣسﺎﺳاﺮﺑ ﻲﻣﺮﺳﺢﻄﺳﺎﺑ IL4 ﭗـﻴﺗﻦﻴﻛﻮﺘﻴـﺳﻪـﻛ 2 ﻲﻃﺎـﺒﺗراﺖـﺳا دراﺪﻧدﻮﺟو . ﻴﻧﺮﮕﻳدﻪﻌﻟﺎﻄﻣودرد ﺪـﺷهدادنﺎﺸـﻧﺰ ﻪـﻛ ﺖﻴﺳﻮﻔﻨﻟ ﭗﻴﺗﻲﻜﻤﻛيﺎﻫ 2 ﻦﻴﻛﻮﺘﻴﺳﻪﺠﻴﺘﻧردو ﭗـﻴﺗيﺎﻫ 2 ﻦﻴﻛﻮـــﻟﺮﺘﻨﻳاﻞـــﺜﻣ 4 يرﺎـــﻤﻴﺑﺰﻧژﻮﺗﺎـــﭘردﻲﺸـــﻘﻧ ﺪﻧراﺪﻧ . ) 11 و 23 ( ﻪﻛهﺪﺷﺮﻛذﻲﺘﺣ IL4 ﻲﻣ دﻮـﺒﻬﺑﺚﻋﺎﺑﺪﻧاﻮﺗ دﻮــﺷﺲﻳزﺎﻳرﻮﺴــﭘتﺎﻌﻳﺎــﺿ . ) 24 ( ﺮﺘﺸــﻴﺑتﺎــﻌﻟﺎﻄﻣﻪــﺘﺒﻟا ﻲﻠﺻاﺶﻘﻧﺎﺗﺖﺳازﺎﻴﻧدرﻮﻣ IL4 ـﺷﺎـﺑنآطﺎﺒﺗراو تﺪ ﺪﻨﻛ ﺺﺨﺸﻣارﺲﻳزﺎﻳرﻮﺴﭘ ) 25 ( ﺰـﻴﻧﺎـﻣﻪﻌﻟﺎﻄﻣ ﻦﻳاﺮﺑﺎﻨﺑ ﻪــﺒﻠﻏﻲــﻠﺒﻗتﺎــﻌﻟﺎﻄﻣﺪــﻨﻧﺎﻣ Th1 ﻪــﺑ Th2 ﺰﻧژﻮﺗﺎــﭘردار دﺮﻛﺪﻴﻳﺎﺗﺲﻳزﺎﻳرﻮﺴﭘ . ) 10 ، 11 ، 23 و 24 ( ﺢﻄـﺳوﺲﻳزﺎﻳرﻮﺴﭘيرﺎﻤﻴﺑتﺪﺷﻦﻴﺑﺎﻣﻪﻌﻟﺎﻄﻣرد ﻦﻴﻛﻮﻟﺮﺘﻨﻳاﻲﻣﺮﺳ 8 ﺖﺷاددﻮﺟوطﺎﺒﺗرا .. ﻪـﻌﻟﺎﻄﻣﻚﻳرد لﺎﺳرد 2008 ﺎﻬﻨﺸﻴﭘﺰﻴﻧ ﻢـﺋﻼﻋﺖـﻠﻋًﻻﺎـﻤﺘﺣاﻪـﻛﺪـﺷد ﻦﻴﻛﻮـﻟﺮﺘﻨﻳا ﺢﻄـﺳﺶﻳاﺰﻓاﺲﻳزﺎﻳرﻮﺴﭘ 8 نآرﻮﺘﭙـﺳرو ﻲﻣ ﻦﻴﻛﻮـﻟﺮﺘﻨﻳاﻲﻣﺮـﺳﺢﻄـﺳرﺎـﻤﻴﺑﻦﻳﺪﻨﭼردوﺪﺷﺎﺑ 8 ﺶﻴﭘهﺪﻨﻨﻛﻲﺑﺎﻳزرا هدﻮﺑيرﺎﻤﻴﺑﻲﻬﮔآ ﺖﺳا . ) 19 ( ﺢﻄـﺳﻂﻘﻓﻪﻧنارﺎﻤﻴﺑﻪﻛﺪﺷﺮﻛذﺰﻴﻧيﺮﮕﻳدﻪﻌﻟﺎﻄﻣرد ﻦﻴﻛﻮﺘﻴﺳﻦﻳايﻻﺎﺑ ﻪﻜﻠﺑﺪﻧرادﺖﺳﻮﭘردارﺎﻫ ﺎﺑنارﺎﻤﻴﺑرد ﻲﻣﺮـﺳﺢﻄـﺳﺶﻳاﺰـﻓالﺎﻌﻓﺲﻳزﺎﻳرﻮﺴﭘ IL8 و ICAM-1 دراددﻮﺟو . ) 26 ( ﺢﻄـﺳﻦﻴـﺑﺰـﻴﻧقﻮـﻓتﺎـﻌﻟﺎﻄﻣردﻦﻳاﺮﺑﺎﻨﺑ ﻦﻴﻛﻮﻟﺮﺘﻨﻳاﻲﻣﺮﺳ 8 ﺖﺷاددﻮﺟوطﺎﺒﺗرايرﺎﻤﻴﺑتﺪﺷو . ﻲﻣﺮــﺳﺢﻄــﺳﻦﻴــﺑﺎــﻣﻪــﻌﻟﺎﻄﻣرد ICAM-1 تﺪــﺷﺎــﺑ ﺖــﺷاددﻮــﺟوطﺎــﺒﺗراﺲﻳزﺎﻳرﻮﺴــﭘيرﺎــﻤﻴﺑ . تﺎــﻌﻟﺎﻄﻣرد ـﺷشراﺰـﮔﻪﺑﺎﺸﻣ ﻪـﻛﺖـﺳاهﺪ ICAM-1 ردﻲﺗﺎـﻴﺣﺶـﻘﻧ ﺖﻴﺳﻮﻛﻮﻟﻲﻧاﻮﺧاﺮﻓ ﺖﻓﺎﺑﻪﺑشدﺮﮔلﺎﺣرديﺎﻫ فﺪـﻫيﺎـﻫ دراد . ) 27 ( لﻮﻜﻟﻮﻣﻦﻳا لﻮﻠﺳﺢﻄﺳردنﺪﺷنﺎﻴﺑزاﺪﻌﺑﺎﻫ يﺎﻫ لﻮﻠــﺳﻂــﺳﻮﺗﺎــﻳشﺰــﻳرﻢﺴــﻴﻧﺎﻜﻣﺎــﺑلﺎﻴﻠﺗوﺪــﻧا يﺎــﻫ ﻲــﻣدازآنﻮــﺧشدﺮــﮔنوردﻪــﺑﻚــﻴﺘﻴﻟﻮﺌﺗوﺮﭘ ﺪﻧﻮــﺷ ) 27 ( لﻮـﻜﻟﻮﻣﻦــﻳالﻮـﻠﺤﻣلﺎﻜـﺷاﻦﻳاﺮﺑﺎـﻨﺑ رد،ﻲﮔﺪﻨﺒﺴــﭼيﺎـﻫ ﻲﻣﻲﻳﺎﺳﺎﻨﺷﻞﺑﺎﻗنﻮﺧشدﺮﮔ يﺪﻴﻔﻣﻪﻧﺎﺸﻧﺮﻈﻧﻪﺑوﺪﻨﺷﺎﺑ ﻲﻣﺲﻳزﺎﻳرﻮﺴﭘﻲﺑﺎﻬﺘﻟاﺖﻴﻟﺎﻌﻓلﺮﺘﻨﻛرد ﺪﻨﺷﺎﺑ . ) 28 ( يرﺎــﻣآشورﺎــﺑﺎــﻣﻪــﻌﻟﺎﻄﻣرد Linear Regression ﺎـﻣﺎﮔنوﺮﻓﺮﺘﻨﻳاﻲﻣﺮﺳﺢﻄﺳﻦﻴﺑطﺎﺒﺗراﻂﻘﻓﻪﻛﺪﺷﺺﺨﺸﻣ ﻲـﻣﺎـﻫﺮﻴﻐﺘﻣﺮﻳﺎﺳزاﻞﻘﺘﺴﻣيرﺎﻤﻴﺑتﺪﺷﺎﺑ ﺪـﺷﺎﺑ . ﻫ ﻦﻴـﻨﭽﻤ ﻲﻣﺮﺳﺢﻄﺳﻦﻴﺑطﺎﺒﺗرا ICAM-1 ﺎـﺑﺰـﻴﻧيرﺎـﻤﻴﺑتﺪـﺷﺎـﺑ ﻲﻣﻞﻘﺘﺴﻣﺮﺘﻤﻛﻲﻠﻴﺧلﺎﻤﺘﺣا ﻦﻴﻛﻮـﻟﺮﺘﻨﻳاطﺎـﺒﺗراﻲـﻟوﺪﺷﺎﺑ 8 ﺖﺳاﺎﻣﺎﮔنوﺮﻓﺮﺘﻨﻳاﻲﻣﺮﺳﺢﻄﺳندﻮﺑﻻﺎﺑﻪﺑﻪﺘﺴﺑاو .
ﻪﺠﻴﺘﻧ
يﺮﻴﮔ
ﺖﻴﺳﻮﻔﻨﻟﻪﺑطﻮﺑﺮﻣ ﻦﻴﻛﻮﺘﻴﺳﺎﻣﻪﻌﻟﺎﻄﻣ سﺎﺳاﺮﺑ يﺎﻫ T عﻮــﻧﻲــﻜﻤﻛ 1 ) ﺎــﻣﺎﮔنوﺮــﻓﺮﺘﻨﻳا ( ــﻤﻴﺑتﺪــﺷﺎــﺑ يرﺎ ﺖﺷادطﺎﺒﺗراﺲﻳزﺎﻳرﻮﺴﭘ . ﻂﺒﺗﺮـﻣﻦﻴﻛﻮﺘﻴﺳﻪﻛﻲﻟﺎﺣرد ﺎﺑ T ﺖﻴﺳﻮﻔﻨﻟ يﺎﻫ عﻮﻧﻲﻜﻤﻛ 2 ) IL-4 ( تﺪـﺷﺎـﺑﻲﻃﺎﺒﺗرا ﺖﺷاﺪﻧيرﺎﻤﻴﺑ . ﻪـﺒﻠﻏﺎـﺑ يرﺎـﻤﻴﺑﺲﻳزﺎﻳرﻮﺴـﭘﻦﻳاﺮﺑﺎـﻨﺑ ﺖﻴﺳﻮﻔﻨﻟ يﺎﻫ T عﻮﻧﻲﻜﻤﻛ 1 ﻲﻣ ﺪﺷﺎﺑ . ﻪﺘﻓﺎﻳﻪﺑﻪﺟﻮﺗﺎﺑ ﻪـﻛﺖـﺳاﻦـﻳاﻲﻠﻌﻓﻪﻴﺿﺮﻓقﻮﻓيﺎﻫ ﻦﻣﺰـﻣيرﺎـﻤﻴﺑﻚـﻳﺲﻳزﺎﻳرﻮﺴﭘ ﻪﻄـﺳاوﺎـﺑًﺎﺗﺪـﻤﻋ Th1 ﻲــﻣ ﺪــﺷﺎﺑ . ﻞــﺜﻣﻚــﻴﺘﻛﺎﺗﻮﻤﻛيﺎــﻫرﻮﺘﻛﺎﻓﻦﻴــﻨﭽﻤﻫ IL8 و لﻮﻜﻟﻮﻣ ﻪﻠﻤﺟزاﻲﮔﺪﻨﺒﺴﭼيﺎﻫ ICAM-1 ردًًﻻﺎـﻤﺘﺣاﺰﻴﻧ ﻲﻣﻞﻴﺧديرﺎﻤﻴﺑﺰﻧژﻮﺗﺎﭘ ﺪﻨﺷﺎﺑ . تﺪـﻣﺎـﺗ نﺎـﻣردﺎـﻫ يﺎـﻫ ﻞــﺜﻣﻦﻴــﺗورﻮﻴــﺳﺮﭘﺎﺳﻮﻨﻤﻳا PUVA ، وﻦﻳرﻮﭙــﺳﻮﻠﻜﻴﺳ ﻲــﻣهدﺎﻔﺘــﺳانارﺎــﻤﻴﺑنﺎــﻣردردتﺎﺴــﻛوﺮﺗﻮﺘﻣ وﺪــﺷ ﻲﻣ دﻮﺷ . ﺮﺛﺆـﻣيرﺎـﻤﻴﺑلﺮـﺘﻨﻛرد يﺪـﺣﺎـﺗﺎـﻫورادﻦﻳا نﺎــﻣردﻲــﻟوﺪــﻧدﻮﺑ ﺻﺎﺼــﺘﺧاﺪــﻴﻛﺎﺗﺎــﺑﻲﻳﺎــﻫ ﻲ يورﺮــﺗ فﺪﻫ ردﻞﻴﺧدﻲﻨﻤﻳاﺮﻴﺴﻣيﺎﻫ ﺲﻳزﺎﻳرﻮﺴﭘ ) نوﺮـﻓﺮﺘﻨﻳا ،ﺎﻣﺎﮔ IL8 ، ICAM-1 ( ﺢﺟرا ﺪﻨﺘﺴـﻫﺮﺗ . دﺎﻬﻨﺸـﻴﭘﻦﻳاﺮﺑﺎـﻨﺑ ﻲﻣ يرﺎـﻤﻴﺑﺰﻧژﻮﺗﺎﭘﻮﻨﻤﻳاﻪﻨﻴﻣزرديﺮﺘﺸﻴﺑتﺎﻘﻴﻘﺤﺗدﻮﺷ ﺎــﺑﺎــﺗدﻮــﺷمﺎــﺠﻧا مﺰﻴﻧﺎــﻜﻣﺮﺘﺸــﻴﺑﻢــﻬﻓ ﻲﻟﻮــﻜﻟﻮﻣيﺎــﻫ ﻪﻨﻴﻣز نﺎﻣرد،يا ﻢﻛوﺮﺗﺮﺛﺆﻣيﺎﻫ ﻪﺿرﺎﻋ يرﺎﻤﻴﺑياﺮﺑﺮﺗ دﻮﺷﻢﻫاﺮﻓﻚﻳدﺰﻧهﺪﻨﻳآرد . ﻲﻣدﺎﻬﻨﺸﻴﭘﻦﻴﻨﭽﻤﻫ زادﻮـﺷ هزاﺪﻧا ﻦﻴﻛﻮﺘﻴـﺳﻲﻣﺮـﺳﺢﻄـﺳيﺮـﻴﮔ وﺪـﺑردقﻮـﻓيﺎـﻫ ﻦﻴـﻴﻌﺗياﺮـﺑزﻮﻨﮔوﺮﭘرﻮﺘﻛﺎﻓﻚﻳناﻮﻨﻋﻪﺑ رﺎﻤﻴﺑﻪﻌﺟاﺮﻣ ﺶﻴﭘ دﻮﺷهدﺎﻔﺘﺳايرﺎﻤﻴﺑﻲﻬﮔآ نﺎـﻣرداﺪـﺘﺑانﺎـﻤﻫزاﺎﺗ ﺐﺳﺎﻨﻣ ﺶﻴـﭘﻪﺑﻪﺟﻮﺗﺎﺑارﺮﺗ فﺮـﺻزاوبﺎـﺨﺘﻧاﻲـﻬﮔآ
ﻪﻨﻳﺰﻫ ﻢﻴﻨﻛيﺮﻴﮔﻮﻠﺟرﺎﻤﻴﺑﺖﻗوفﻼﺗاوﻲﻓﺎﺿايﺎﻫ . هزاﺪﻧاولﻮﻠﺳﺖﺸﻛﻪﻌﻟﺎﻄﻣﻦﻳاردﺮﮔا يﺮﻴﮔ ﻢﻴﻘﺘﺴـﻣ ﻦﻴﻛﻮﺘﻴﺳ ﺖﻴﺳﻮﻔﻨﻟدﻮﺧزاهﺪﺷﺢﺷﺮﺗيﺎﻫ يﺎﻫ T ﻲـﻜﻤﻛ عﻮﻧ 1 و 2 مﺎﺠﻧاﺖﺸﻛﻂﻴﺤﻣرد ﻲﻣ ﺞﻳﺎﺘﻧ،ﺪﺷ ﻖـﻴﻗد يﺮـﺗ ﻲﻣﺖﺳدﻪﺑ ﺪﻣآ . لﺎـﻘﺘﻧاﻪـﺑزﺎـﻴﻧوﻻﺎﺑﻪﻨﻳﺰﻫﻞﻴﻟدﻪﺑﻲﻟو ﻪﻧﻮﻤﻧيرﻮﻓ ﺪﺸﻧﻢﻫاﺮﻓنﺎﻜﻣاﻦﻳا،ﺎﻫ .
ﺮﻜﺸﺗ
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ﻪـﻧﻮﻤﻧﻪـﻴﻬﺗردﻪﻛﻲﻟﻼﺟيﺎﻗآبﺎﻨﺟزاﺮﻜﺸﺗﺎﺑ يﺎـﻫ ﻖـﻴﻘﺤﺗﻦـﻳامﺎـﺠﻧاﺖـﻬﺟنارﺎـﻤﻴﺑﻲﻣﺮـﺳﻪﻧﻮﻤﻧونﻮﺧ ﺪﻧدﺮﻛيرﺎﻜﻤﻫﻪﻧﺎﻤﻴﻤﺻ . يﺪﺳايﺎﻗآزاﺮﻜﺸﺗﺎﺑ ﻪﻛﺮﻓ نﻮـﻣزآ ELIZA يورار ﻪﻧﻮﻤﻧ ﺪﻧدادمﺎﺠﻧاﻲﻣﺮﺳيﺎﻫ .
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Investigation of the Relationship between Serum Levels of
Cytokines Secreted from Th1 and Th2 Cells, IL8 and ICAM-1 and
Psoriasis Severity Based on PASI
H.Ansarin,MDI M.Shekarabi,PhDII *E.Behrangi,MDIII
Abstract
Background & Aim: Psoriasis is a common chronic inflammatory skin disease that affects 1-3% of the world's population. It can cause significant distress to the patient and ultimately the reduction of the patient's life quality. From the clinical perspective, it can create bright, red, elevated, and scaly plaques. Psoriasis is now recognized as a T-cell mediated disease with epidermal hyperplasia being a consequence of the activation of the immune system and cytokines release. No definite cure has been found for this lesion and existing treatments have high rates of relapse. Further recognition of immunopathogenesis and cytokines contributing to the severity of the disease can help to discover more specific and efficient treatments for this disease.The aim of the present study is to determine the relationship between serum levels of cytokines secreted from Th1 and Th2 cells, IL8 and ICAM-1 and psoriasis severity based on PASI in order to distinguish the possible role of cytokines in the immunopathogenesis of psoriasis.
Patients and Method: This study was performed on 40 patients with psoriasis vulgaris referred to Rasool-e-Akram Hospital between 2007 and 2008. In order to determine the severity of the disease based on PASI, each patient was examined clinically. Then 3 cc of vein blood sample was taken and serum sample was separated through centrifuge and stored at -70°C until the final examination. Next, through ELIZA method, serum levels of the above-mentioned cytokines were measured and by using Spearman correlation coefficient, the relationship between serum levels of the above-mentioned cytokines and the severity of the disease was evaluated.
Results: According to this study, there is a meaningful statistical relationship between the serum level of interferon ɣ (p=0.001, r=0.50), interleukine 8(p=0.018, r=0.37), and ICAM-1 (P=0.047, R=0.31) and the severity of psoriasis based on PASI. However, such a relationship was not observed between the serum level of interleukine 4 and the severity of the disease (p=0.24, r=0.18).
Conclusion: Based on our study, interferone ɣ , interleukine 8, and ICAM-1 are related to the severity of psoriasis. Therefore, the treatments which selectively target the above-mentioned cytokines, are more reliable and efficient. It is strongly recommended that further studies and researches be conducted to investigate the effects of the above-mentioned biological treatments on psoriasis.
Key Words: 1) Cytokine 2) Psoriasis Severity 3) Immunopathogenesis
This article is an abstract of Ms.Behrangi's thesis advised by Dr.Ansarin and read by Dr.Shekarabi in partial fulfillment of a medical doctor's degree in dermatology.
I) Professor of Dermatology. Dermatology Department. Rasool-e-Akram Hospital.Iran University of Medical Sciences and Health Services.Tehran,Iran.
II) Associate Professor of Immunology. Faculty of Medicine. Iran University of Medical Sciences and Health Services.Tehran,Iran.
III) Resident of Dermatology. Dermatology Department. Rasool-e-Akram Hospital.Iran University of Medical Sciences and Health Services.Tehran,Iran.(*Corresponding Author)
