ﺪﻧﻮﺷﯽﻣ ﺰﯿﻟﺎﯾدﻮﻤﻫ ﻪﮐ ﯽﻧارﺎﻤﯿﺑ رد ب ﺖﯿﺗﺎﭙﻫ ﻦﺴﮐاو ﯽﺸﺨﺑﺮﺛا ﺮﺑ ﺮﺛﺆﻣ ﻞﻣاﻮﻋ ﻦﯿﯿﻌﺗ
I ﯽﻤﺳﺎﻗ ﻦﯿﻫﺎﺷ ﺮﺘﮐد
II یرﺎﻨﻠﮔ مارﺪﭘ*
III داﮋﻧﻢﺷﺎﻫ ﻢﯾﺮﻣ
IIIﯽﻠﻘﻫﺎﺷ ﻦﯿﺷﻮﻧ
III ﯽﻤﯾﺮﮐ ﺎﺴﯾﺮﭘ
ﻪﻣﺪﻘﻣ ﻪــﮐ ﺖﺳا ﯽﺳوﺮﯾو یﺎﻬﯾرﺎﻤﯿﺑ ﻦﯾﺮﺘﻤﻬﻣ زا ﯽﮑﯾ ب ﺖﯿﺗﺎﭙﻫ .ﺪﺷﺎﺑﯽﻣ رادرﻮﺧﺮﺑ ﯽﯾﻻﺎﺑ عﻮﯿﺷ زا ﺎﯿﻧد طﺎﻘﻧ مﺎﻤﺗ رد ﺪﺼﻧﺎـﭘ ﺎـﺗ ﺪﺻرﺎﻬـﭼ ،ب ﺖﯿﺗﺎــﭙﻫ ﻦﻣﺰﻣ ﻞﻣﺎﺣ داﺮﻓا داﺪﻌﺗ
ﺮﮕﯾد ﻪﯿﺣﺎﻧ ﻪﺑ ﻪﯿﺣﺎﻧ ﮏﯾ زا ﻪﮐ ﺖﺳا هﺪﺷ هدز ﻦﯿﻤﺨﺗ نﻮﯿﻠﯿﻣ
هﺪﯿﮑﭼ
مﺎــﺠﻧا ﺎﻣا ﺖﺳا رادرﻮﺧﺮﺑ یدﺎﯾز رﺎﯿﺴﺑ ﺖﯿﻤﻫا زا ﺪﻧﻮﺷﯽﻣ ﺰﯿﻟﺎﯾدﻮﻤﻫ ﻪﮐ ﯽﻧارﺎﻤﯿﺑ رد ب ﺖﯿﺗﺎﭙﻫ ﺖﻧﻮﻔﻋ زا یﺮﯿﮕﺸﯿﭘ رد ب ﺖﯿﺗﺎﭙﻫ ﻦﺴﮐاو ﯽﺸﺨﺑﺮﺛا ﺶﻫﺎﮐ ﻪﺑ ناﻮﺗﯽﻣ نآ ﻪﻠﻤﺟ زا ﻪﮐ دراد هاﺮﻤﻫ ﻪﺑ ار یدﺎﯾز ﯽﯾاﺮﺟا تﻼﮑﺸﻣ ،ﻢﻬﻣ رﺎﮐ ﻦﯾا هرﺎـﺷا ،مﻮﻠﻌﻣﺎـﻧ نﺎـﻣز تﺪــﻣ ﺖﺷﺬﮔ زا ﺲﭘ هﺪﻨﻨﮐ ﺖﻈﻓﺎﺤﻣ ﺮﯿﻏ ﺢﻄﺳ ﻪﺑ (HbsAb)یدﺎﺑﯽﺘﻧآ ﺮﺘﯿﺗ ﺶﻫﺎﮐ و نارﺎﻤﯿﺑ ﻦﯾا ﺰـﯾﻮﺠﺗ و (هﺎـﻣ 6 لﺎـﺜﻣ ناﻮــﻨﻋ ﻪﺑ) ﺺﺨﺸﻣ ﯽﻧﺎﻣز یﺎﻫﻪﻠﺻﺎﻓ رد یدﺎﺑﯽﺘﻧآ ﺮﺘﯿﺗ رﺮﮑﻣ ﯽﺳرﺮﺑ موﺰﻟ ﻞﻣاﻮﻋ ﻦﯾا ﻪﮐ دﺮﮐ ﻦـﺴﮐاو ﯽـﺸﺨﺑﺮﺛا ﺮـﺑ ﺮـﺛﻮﻣ ﻞـﻣاﻮﻋ ﯽـﺳرﺮﺑ فﺪــﻫ ﺎﺑ ﻪﻌﻟﺎﻄﻣ ﻦﯾا .ﺪﻫدﯽﻣ نﺎﺸﻧ ار زﺎﯿﻧ درﻮﻣ ﻊﻗاﻮﻣ رد ﻦﺴﮐاو دﺪﺠﻣ هﺪــﻨﻨﮐ ﻪﻌﺟاﺮﻣ رﺎﻤﯿﺑ 121 یور یﺪﻫﺎﺷ ـ درﻮﻣ ﻖﯿﻘﺤﺗ ﻦﯾا .ﺖﻓﺮﮔ ترﻮﺻ ﺪﻧﻮﺷﯽﻣ ﺰﯿﻟﺎﯾدﻮﻤﻫ ﻪﮐ ﯽﻧارﺎﻤﯿﺑ رد ب ﺖﯿﺗﺎﭙﻫ زا ﺮﺘـﻤﮐ یدﺎـﺑﯽﺘﻧآ ﺮﺘـﯿﺗ)درﻮـﻣ هوﺮـﮔ رد ﺮـﻔﻧ 64 .ﺪـﺷ مﺎــﺠﻧا ناﺮﻬﺗ داﮋﻧﯽﻤﺷﺎﻫ ﺪﯿﻬﺷ نﺎﺘﺳرﺎﻤﯿﺑ ﺰﯿﻟﺎﯾدﻮﻤﻫ ﺶﺨﺑ ﻪﺑ ﻪـﮐ ﻪﻣﺎﻧﺶــﺳﺮﭘ ﮏﯾ .ﺪﻨﺘﻓﺮﮔ راﺮﻗ ،(10mIU/ml یوﺎﺴﻣ ﺎﯾ ﺮﺘﺸﯿﺑ یدﺎﺑﯽﺘﻧآ ﺮﺘﯿﺗ)ﺪﻫﺎﺷ هوﺮﮔ رد ﺮﻔﻧ 57 و (10mIU/ml هدﺎﻔﺘــﺳا ﺎﺑ دﻮﺑ رﺎﮕﯿﺳ فﺮﺼﻣ و ﺖﺑﺎﯾد یرﺎﻤﯿﺑ ﻪﻘﺑﺎﺳ ،ﺰﯿﻟﺎﯾدﻮﻤﻫ نﺎﻣز تﺪﻣ ،ﯽﻫﺎﮕﺸﯾﺎﻣزآ ،ﮏﯿﻓاﺮﮔﻮﻣد تﺎﻋﻼﻃا ﻞﻣﺎﺷ زا هدﺎﻔﺘﺳا ﺎﺑ هﺪﻣآ ﺖﺳد ﻪﺑ تﺎﻋﻼﻃا ﺲﭙﺳ .ﺪﯾدﺮﮔ ﻞﯿﻤﮑﺗ نارﺎﻤﯿﺑ زا ﺶﺳﺮﭘ ﻦﯿﻨﭽﻤﻫ و ﺎﻫهﺪﻧوﺮﭘ رد دﻮﺟﻮﻣ تﺎﻋﻼﻃا زا ﯽـﻧاواﺮﻓ یﺎﻬﺼﺧﺎـﺷ زا ﺞﯾﺎــﺘﻧ ﺰﯿﻟﺎﻧآ یاﺮﺑ .ﺖﻓﺮﮔ راﺮﻗ ﻞﯿﻠﺤﺗ و ﻪﯾﺰﺠﺗ درﻮﻣ EPI Info 6 و SPSS10 یرﺎﻣآ راﺰﻓامﺮﻧ و t و Kolmogorov-Smirnov ،Levene ،chi2 یﺎﻬﺘـﺴﺗ زا ﻦــﯿﻨﭽﻤﻫ و رﺎﯿﻌﻣ یﺎﻄﺧ و رﺎﯿﻌﻣ فاﺮﺤﻧا ،ﻦﯿﮕﻧﺎﯿﻣ ،ﯽﺒﺴﻧ Multiple Linear لﺪـﻣ زا هﺪـﻨﻨﮐ ﯽـﯾﻮﮔﺶـﯿﭘ ﻞـﻣاﻮﻋ ﯽـﺳرﺮﺑ یاﺮـﺑ و ﻦﻣﺮﯿﭙـﺳا و نﻮـﺳﺮﯿﭘ ﯽﮕﺘـﺴﺒﻤﻫ یﺎﻬـﺒﯾﺮﺿ ﺖﺒﺜﻣ Rh ﯽﻧﻮﺧ هوﺮﮔ ﯽﻧاواﺮﻓ .ﺪﻧدﻮﺑ دﺮﻣ ﺮﻔﻧ 65 و نز ﺮﻔﻧ 56 ،ﯽﺳرﺮﺑ درﻮﻣ رﺎﻤﯿﺑ 121 زا .ﺪﺷ هدﺎﻔﺘﺳا Regression هوﺮﮔ رد یرﺎﮕﯿﺳ داﺮﻓا ﯽﻧاواﺮﻓ و (odds ratio=2/63 و P=0/010)ﺪﻫﺎﺷ هوﺮﮔ زا ﺶﯿﺑ یرادﯽﻨﻌﻣ رﻮﻄﺑ درﻮﻣ هوﺮﮔ رد هﺪـﻣآ ﺖـﺳد ﻪـﺑ ﺞﯾﺎـﺘﻧ ﻪـﺑ ﻪـﺟﻮﺗ ﺎـﺑ .(odds ratio=0/27 و P=0/031)دﻮـﺑ ﺪﻫﺎﺷ هوﺮﮔ زا ﺮﺘﻤﮐ یرادﯽﻨﻌﻣ رﻮﻄﺑ درﻮﻣ رد ار یدﺎـﺑﯽﺘﻧآ ﯽـﻧﻮﺧ ﺢﻄــﺳ یرادﯽﻨﻌﻣ رﻮﻄﺑ (r=-0/253 و P=0/006) ﻦﺳ و (r=-0/225 و P=0/015) نزو ﺶﯾاﺰﻓا .ﺪـﻧاهدﻮﺑ ﯽﻧﻮﯿـﺳﺮﮔر لﺪــﻣ رد یدﺎﺑﯽﺘﻧآ ﺮﺘﯿﺗ هﺪﻨﻨﮐ ﯽﯾﻮﮔﺶﯿﭘ ﻞﻣاﻮﻋ ﻪﻠﻤﺟ زا Rh و رﺎﻤﯿﺑ ﻦﺳ و دادﯽﻣ ﺶﻫﺎﮐ نارﺎﻤﯿﺑ ﻪـﮐ ﯽﻧارﺎـﻤﯿﺑ رد ب ﺖﯿﺗﺎـﭙﻫ ﻦـﺴﮐاو ﯽـﺸﺨﺑﺮﺛا ﺶﻫﺎـﮐ ﺮـﻄﺧ ﻞـﻣاﻮﻋ زا ﺖــﺒﺜﻣ Rh ﯽﻧﻮﺧ هوﺮﮔ و ﻪﯾﺬﻐﺗ ءﻮﺳ ،ﻻﺎﺑ ﻦﺳ یﺮﺘــﻘﯿﻗد یﺮﯿﮕﯿﭘ و ﺮﺘﺸﯿﺑ یﺎﻬﺘﺒﻗاﺮﻣ ﺪﻧراد دﻮﺟو ﺮﻄﺧ ﻞﻣاﻮﻋ ﻦﯾا ﻪﮐ ﯽﻧارﺎﻤﯿﺑ رد ﻦﯾاﺮﺑﺎﻨﺑ .ﺪﻨﺘﺴﻫ ،ﺪﻧﻮﺷﯽﻣ ﺰﯿﻟﺎﯾدﻮﻤﻫ .ﺪﺷﺎﺑﯽﻣ زﺎﯿﻧ درﻮﻣ نﺎﻣز لﻮﻃ رد یدﺎﺑﯽﺘﻧآ ﺮﺘﯿﺗ – 3 ب ﺖﯿﺗﺎﭙﻫ ﻦﺴﮐاو – 2 ﺰﯿﻟﺎﯾدﻮﻤﻫ – 1 :ﺎﻫهژاوﺪﯿﻠﮐ ﯽﻬﮔآﺶﯿﭘ هﺪﻨﻨﮐ ﯽﯾﻮﮔﺶﯿﭘ ﻞﻣاﻮﻋ – 4
.ﺖﺳا هﺪﺷ ﻪﺋارا 1381 لﺎﺳ ناﺮﻬﺗ رد ﯽﮑﺷﺰﭘ مﻮﻠﻋ نﺎﯾﻮﺠﺸﻧاد ﯽﺸﻫوﮋﭘ رﺎﻨﯿﻤﺳ ﻦﯿﻣﻮﺳ رد ﻪﻟﺎﻘﻣ ﻦﯾا .ناﺮﻬﺗ ،ناﺮﯾا ﯽﻧﺎﻣرد ـ ﯽﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ و ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﯽﻧﻮﻔﻋ یﺎﻬﯾرﺎﻤﯿﺑ رﺎﯾدﺎﺘﺳا (I .(لﻮﺌﺴﻣ ﻒﻟﻮﻣ*)ناﺮﻬﺗ ،ناﺮﯾا ﯽﻧﺎﻣرد ـ ﯽﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ و ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﯽﮑﺷﺰﭘ هﺪﮑﺸﻧاد ﯽﯾﻮﺠﺸﻧاد ﯽﺸﻫوﮋﭘ ﻪﺘﯿﻤﮐ ﻮﻀﻋ ،ﯽﮑﺷﺰﭘ یﻮﺠﺸﻧاد (II .ناﺮﻬﺗ ،ناﺮﯾا ﯽﻧﺎﻣرد ـ ﯽﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ و ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﯽﮑﺷﺰﭘ هﺪﮑﺸﻧاد ﯽﯾﻮﺠﺸﻧاد ﯽﺸﻫوﮋﭘ ﻪﺘﯿﻤﮐ ﻮﻀﻋ ،ﯽﮑﺷﺰﭘ یﻮﺠﺸﻧاد (III
ب ﺖـــﯿﺗﺎﭙﻫ سوﺮـــﯾو ،یرﺎــﻤﯿﺑ ﻞــﻣﺎﻋ .ﺪــﺷﺎﺑﯽﻣ توﺎﻔﺘﻣ داﺮـــﻓا ﯽـــﻌﻓد داﻮـــﻣ و نﺪـــﺑ تﺎـﻌﯾﺎﻣ مﺎــﻤﺗ رد ﻪﮐ هدﻮﺑ ﻞﻘﺘﻨﻣ ﯽــﮐارﻮﺧﺮﯿﻏ یﺎــﻬﺷور ﻪــﺑ و دراد دﻮــﺟو ﻞــــﻗﺎﻧ .دﻮﺷﯽﻣ و نﻮـــﺧ ﻖــﯾﺮﻃ زا ﺮـــﺘﺸﯿﺑ یرﺎــﻤﯿﺑ لﺎــﻘﺘﻧا ﻦﯾاﺮﺑﺎــﻨﺑ ﯽـــﺴﻨﺟ یﺎﻬـﺳﺎﻤﺗ و هدﻮـﻟآ یﺎﻬﻧزﻮـﺳ ،ﯽـﻧﻮﺧ تﻻﻮـﺼﺤﻣ .دﺮﯿﮔﯽﻣ ترﻮﺻ ضﺮـﻌﻣ رد یدﺎـﯾز ناﺰﯿـﻣ ﻪـــﺑ ﻪــــﮐ نارﺎﻤﯿﺑ زا ﯽﻫوﺮﮔ یﺰﯿﻟﺎــﯾدﻮﻤﻫ نارﺎــﻤﯿﺑ ،ﺪﻨﺘـــﺴﻫ ب ﺖﯿﺗﺎـﭙﻫ ﻪـﺑ ﻼـﺘﺑا ﺮـﻄﺧ .ﺪﻨﺷﺎﺑﯽﻣ ﺶــﯾاﺰﻓا و هدﻮــﺑ ﺖـــﻣﻼﻋ نوﺪـﺑ ًﻻﻮـﻤﻌﻣ داﺮـــﻓا ﻦـــﯾا مﺮــــﺳ یﺎﻫزاﺮﻔــﺴﻧاﺮﺗﻮﻨﯿﻣآ یﺎـــﻬﺘﯿﻟﺎﻌﻓ رد یﺮــــﺼﺘﺨﻣ .(1-4)ﺪﻧراد نارﺎـﻤﯿﺑ رد ب ﺖﯿﺗﺎـﭙﻫ ﻪـﺑ ﻼـﺘﺑا یﻻﺎـﺑ ﺮــﻄﺧ ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ لﻮـــﻤﻌﻣ ﻖـﯾرﺰﺗ ،ﺖـﻧﻮﻔﻋ زا یﺮﯿﮕـﺸﯿﭘ یاﺮـﺑ ،یﺰﯿﻟﺎـﯾدﻮﻤﻫ .دﻮﺷﯽﻣ ﻪﯿﺻﻮﺗ ﻦﺴﮐاو ب ﺖــﯿﺗﺎﭙﻫ زا یﺮـــﯿﮕﺸﯿﭘ رد تﻼﮑــﺸﻣ ﻦﯾﺮﺘﻤﻬﻣ زا ﯽﮑﯾ ﺶـــﻫﺎﮐ و ﻦـﺴﮐاو ﯽـــﺸﺨﺑﺮـﺛا ﺶـــﻫﺎﮐ نارﺎــﻤﯿﺑ ﻦﯾا رد ﻪـﺑ (10mIU/ml یوﺎــﺴﻣ ﺎﯾ ﺮﺘﺸﯿﺑ)یدﺎﺑﯽﺘﻧآ بﻮﻠﻄﻣ ﺢﻄﺳ یﺎﻬﻫﺎﻣ رد زود 3 ترﻮﺻ ﻪﺑ) نﻮﯿﺳﺎﻨﯿﺴﮐاو هرود ﮏﯾ لﺎﺒﻧد (ﺪـﯿﯾﻮﺘﻟد ﻪـﻠﻀﻋ رد مﺮـﮔوﺮــﮑﯿﻣ 40 راﺪﻘﻣ ﻪﺑ و 6 و 1 ،ﺮﻔﺻ .(5-7)ﺪﺷﺎﺑﯽﻣ داﺮــﻓا رد ب ﺖـــﯿﺗﺎﭙﻫ نﻮـــﯿﺳﺎﻨﯿﺴﮐاو هرود ﮏـﯾ مﺎـﺠﻧا ﺮﺧآ ﺎﺗ یرﺎﻤﯿﺑ ﺮﺑاﺮﺑ رد ﺖﻈﻓﺎﺤﻣ %95 ناﺰﯿﻣ ﻪﺑ ﻪﻌﻣﺎﺟ ﻢﻟﺎﺳ دﻮـﺟو ﺰﯿـﻧ روآدﺎـﯾ زود ﺰــﯾﻮﺠﺗ ﻪﺑ زﺎﯿﻧ و ﺪﻨﮐﯽﻣ دﺎﺠﯾا ﺮﻤﻋ .دراﺪﻧ ﻪــــﮐ ﯽــــﻧارﺎﻤﯿﺑ زا %50-60 ﺎــــﻬﻨﺗ ﻪــــﮐ ﯽــــﻟﺎﺣ رد ،ﻦـــــﺴﮐاو ﺰـــﯾﻮﺠﺗ لﺎـــﺒﻧد ﻪــﺑ ﺪـــﻧﻮﺷﯽﻣ ﺰـــﯿﻟﺎﯾدﻮﻤﻫ ﺖــــﺳد ﻪـــــﺑ نﻮـﺧ رد ار یدﺎـﺑﯽﺘﻧآ زا ﯽـﺑﻮﻠﻄﻣ ﺢـــﻄﺳ ﯽﺘﻈﻓﺎــﺤﻣ ﺢﻄــﺳ ﯽــــﺗﺪﻣ ﺖـــــﺷﺬﮔ زا ﺲـﭘ و ﺪـﻧروآﯽﻣ ﺪــﻨﻫاﻮﺧ ﺖـﺳد زا یرﺎـﻤﯿﺑ ﻪـﺑ ﻼـﺘﺑا ﺮـﺑاﺮﺑ رد ار یدﺎـﺑﯽﺘﻧآ .(8 و7)داد ﺪﯾﺎـﺑ ﺐـﺳﺎﻨﻣ ﯽـﻨﻤﯾا ﺦـﺳﺎﭘ ﮏـﯾ یاﺮـﺑ ﻪـﮑﻨﯾا ﻪــﺑ ﻪﺟﻮﺗ ﺎﺑ و CD+4 ﺖﺒـﺴﻧ ﺶـﯾاﺰﻓا و T و B ﺖﯿـﺳﻮﻔﻨﻟ ﻦــﯿﺑ ﯽﮕﻨﻫﺎﻤﻫ ﺪﻧﻮـﺷﯽﻣ ﺰﯿﻟﺎــﯾدﻮﻤﻫ ﻪﮐ ﯽﻧارﺎﻤﯿﺑ ،ﺪﺷﺎﺑ ﻪﺘﺷاد دﻮﺟو CD+8
ب ﺖﯿﺗﺎـﭙﻫ ﻦـﺴﮐاو ﻪـﺑ ،ﻪـﻌﻣﺎﺟ ﻢﻟﺎــﺳ ﺖﯿﻌﻤﺟ ﺎﺑ ﻪﺴﯾﺎﻘﻣ رد .(9-14 ،1)ﺪﻨﻫدﯽﻣ ﺦﺳﺎﭘ ﺮﺘﻤﮐ ﯽـﺸﺨﺑﺮﺛا ﺮـﺑ ﺮـﺛﻮﻣ ﻞــﻣاﻮﻋ ﯽﺳرﺮﺑ فﺪﻫ ﺎﺑ ﻪﻌﻟﺎﻄﻣ ﻦﯾا ﺪﻧﻮــﺷﯽﻣ ﺰﯿﻟﺎـــﯾدﻮﻤﻫ ﻪـﮐ ﯽﻧرﺎـﻤﯿﺑ رد ب ﺖﯿﺗﺎـﭙﻫ ﻦـﺴﮐاو .ﺖﻓﺮﮔ ترﻮﺻ
ﯽﺳرﺮﺑ شور هﺪﻨﻨﮐ ﻪﻌﺟاﺮﻣ رﺎﻤﯿﺑ 121 یور یﺪﻫﺎﺷ ـ درﻮﻣ ﻖﯿﻘﺤﺗ ﻦﯾا ﺮﻬــﺷ داﮋﻧﯽﻤـﺷﺎﻫ ﺪﯿﻬـﺷ نﺎﺘـﺳرﺎﻤﯿﺑ ﺰﯿﻟﺎـﯾدﻮﻤﻫ ﺶـﺨﺑ ﻪـﺑ .ﺪﺷ مﺎﺠﻧا ناﺮﻬﺗ زا ﺮﺘﻤﮐ یدﺎﺑﯽﺘﻧآ ﺮﺘﯿﺗ) درﻮﻣ هوﺮﮔ رد نارﺎﻤﯿﺑ زا ﺮﻔﻧ 64 یدﺎــﺑﯽﺘﻧآ ﺮﺘـــﯿﺗ)ﺪﻫﺎـﺷ هوﺮـﮔ رد ﺮـﻔﻧ 57 و (10MIU/ml رد داﺮـﻓا ﻦـﯾا ،ﺪـﻨﺘﻓﺮﮔ راﺮــﻗ (10MIU/ml یوﺎﺴﻣ ﺎﯾ ﺮﺘﺸﯿﺑ .ﺪﻧﺪﺷﯽﻣ ﺰﯿﻟﺎﯾدﻮﻤﻫ ﺰﮐﺮﻣ ﻦﯾا رد حﺮﻃ مﺎﺠﻧا نﺎﻣز ﺎـﺑ و ﺖﺒـﺴﻧ 2 ﻪــﺴﯾﺎﻘﻣ ﻪﻄﺑار زا هدﺎﻔﺘﺳا ﺎﺑ ﻪــﻧﻮﻤﻧ ﻢﺠﺣ رد ﻪـﻬﺟاﻮﻣ ﻞﻣﺎـﻋ ﺪـﺻرد ،β=%20 و α=%5 ﻦــﺘﻓﺮﮔ ﺮﻈﻧ رد ﻪﺒـﺳﺎﺤﻣ odds ratio(OR)=3/2 و 0/25 ﺮﺑاﺮﺑ لﺮﺘﻨﮐ هوﺮﮔ .ﺪﺷ ﻪﻘﺑﺎــﺳ :زا ﺪــﻧدﻮﺑ ترﺎــﺒﻋ ﻪــﻌﻟﺎﻄﻣ ﻪـــﺑ دورو ﻂـﯾاﺮﺷ ﺖـــﺑﻮﻧ 3 مﺎـــﺠﻧا ،لﺎــــﺳ 2 ﻞــﻗاﺪﺣ یاﺮــﺑ ﺰــــﯿﻟﺎﯾدﻮﻤﻫ و 6 و 1 ،ﺮــﻔﺻ یﺎﻬـــﻫﺎﻣ رد ب ﺖــﯿﺗﺎﭙﻫ نﻮــــﯿﺳﺎﻨﯿﺴﮐاو زود ﻦـــــﯾﺮﺧآ زا ﺪـــﻌﺑ لﺎـﺳ ﮏـﯾ ،HbsAb ﺮـــﺘﯿﺗ ﻦـﯿﯿﻌﺗ .نﻮـﯿﺳﺎﻨﯿﺴﮐاو تﺎــــﻋﻼﻃا ﻞﻣﺎــﺷ ﻪﻣﺎﻧﺶــﺳﺮﭘ ﮏــﯾ رﺎــﻤﯿﺑ ﺮــﻫ یاﺮﺑ یدﺎـﺑﯽﺘﻧآ و نژﯽـﺘﻧآ ﺮﺘـﯿﺗ ،ﯽــــﻫﺎﮕﺸﯾﺎﻣزآ و ﮏــﯿﻓاﺮﮔﻮﻣد ﺮﺘــﯿﺗ و (HCVAb و HCVAg)C ﺖﯿﺗﺎـــﭙﻫ سوﺮـﯾو ﺪـﺿ فﺮـﺼﻣ و ﺖﺑﺎﯾد یرﺎﻤﯿﺑ ﻪﻘﺑﺎﺳ ،ﺰﯿﻟﺎﯾدﻮﻤﻫ ﻪﻣﺎﻧﺮﺑ ،HbsAb و ﺎــﻫهﺪﻧوﺮﭘ رد دﻮــﺟﻮﻣ تﺎـــﻋﻼﻃا زا هدﺎﻔﺘـﺳا ﺎـﺑ رﺎﮕﯿـﺳ ﺖـﺳد ﻪــﺑ تﺎﻋﻼﻃا .ﺪﯾدﺮﮔ ﻞﯿﻤﮑﺗ نارﺎﻤﯿﺑ زا ﺶﺳﺮﭘ ﻦﯿﻨﭽﻤﻫ EPI 6 و SPSS 10 یرﺎـﻣآ راﺰـﻓامﺮﻧ زا هدﺎﻔﺘـﺳا ﺎــﺑ هﺪﻣآ .ﺖﻓﺮﮔ راﺮﻗ ﻞﯿﻠﺤﺗ و ﻪــﯾﺰﺠﺗ درﻮﻣ Info ،ﯽﺒــﺴﻧ ﯽـــﻧاواﺮﻓ یﺎﻬﺼﺧﺎــﺷ زا ﺞـــــﯾﺎﺘﻧ ﺰـــﯿﻟﺎﻧآ رد زا ﻦـــــﯿﻨﭽﻤﻫ و رﺎـﯿﻌﻣ یﺎـﻄﺧ و رﺎـﯿﻌﻣ فاﺮـﺤﻧا ،ﻦﯿﮕﻧﺎـﯿﻣ
و t و Kolmogorov-Smirnov ،Levene ،chi2 یﺎﻬﺘـــﺴﺗ یاﺮــــﺑ و ﻦــــﻣﺮﯿﭙﺳا و نﻮــﺳﺮﯿﭘ ﯽﮕﺘــﺴﺒﻤﻫ یﺎﻬــﺒﯾﺮﺿ ﯽﻧﻮﯿـﺳﺮﮔر لﺪـﻣ زا هﺪـﻨﻨﮐ ﯽــﯾﻮﮔﺶـﯿﭘ ﻞــــﻣاﻮﻋ ﯽــﺳرﺮﺑ هدﺎﻔﺘـﺳا (Multiple Linear Regression) ﻪﻧﺎﮔﺪﻨﭼ ﯽﻄﺧ رد 0/05 ،ندﻮــﺑ رادﯽﻨﻌﻣ ﺢﻄﺳ ﻪﮐ ﺖﺳا ﺮﮐذ ﻪﺑ مزﻻ .ﺪﯾدﺮﮔ %95 لﺎـﻤﺘﺣا ﺎـﺑ نﺎـﻨﯿﻤﻃا یﺎـﻫهزﻮﺣ مﺎــﻤﺗ و ﺪﺷ ﻪﺘﻓﺮﮔ ﺮﻈﻧ .ﺪﯾدﺮﮔ ﻪﺒﺳﺎﺤﻣ ﻪــﻣﺎﻧﺪﻬﻋ لﻮـــﺻا ﻪـﺑ ﻖـﯿﻘﺤﺗ ﻞـﺣاﺮﻣ مﺎـﻤﺗ رد نﺎـﻘﻘﺤﻣ ﻪــﻧﺎﻣﺮﺤﻣ نارﺎﻤﯿﺑ تﺎﺼﺨﺸﻣ و مﺎﻧ و ﺪﻧدﻮﺑ ﺪﻬﻌﺘﻣ ﯽﮑﻨﯿﺴﻠﻫ هﺪـﺷ یروآﻊـﻤﺟ تﺎــﻋﻼﻃا رد ﺮﯿﯿﻐﺗ زا و ﺪﺷ ﻪﺘﻓﺮﮔ ﺮﻈﻧ رد .ﺪﯾدﺮﮔ بﺎﻨﺘﺟا
ﺞﯾﺎﺘﻧ ﺮﻔﻧ 65 و (%46/4)نز ﺮﻔﻧ 56 ،ﯽﺳرﺮﺑ درﻮﻣ رﺎﻤﯿﺑ 121 زا رد HbsAg دﻮــــﺟو ﺮــﻈﻧ زا ﺎﻬــﻧآ مﺎــﻤﺗ و (%53/7)دﺮــﻣ .ﺪﻧدﻮﺑ ﯽﻔﻨﻣ ،نﺎﺸﻧﻮﺧ (55/63-61/35)58/49 داﺮـــﻓا ﻦــــﯾا ﯽــــﻨﺳ ﻦـــﯿﮕﻧﺎﯿﻣ ﺎﻬـــﻧآ ﺰــــــﯿﻟﺎﯾد نﺎـــــﻣز تﺪــــﻣ ﻦــــﯿﮕﻧﺎﯿﻣ و لﺎـــــﺳ هوﺮــــــــﮔ رد نزو ﻦــــﯿﮕﻧﺎﯿﻣ و لﺎــﺳ (4/88-6/80)5/84 ﺪﻫﺎــــــﺷ هوﺮــــﮔ رد و (59/30-65/52)62/41 درﻮــــــﻣ و HCVAg .دﻮـــــﺑ مﺮــــﮔﻮــــﻠﯿﮐ (55/74-62/33)59/04 .دﻮﺑ ﺖﺒﺜﻣ نارﺎﻤﯿﺑ زا %54 و %16 رد ﺐﯿﺗﺮﺗ ﻪﺑ HCVAb ﺮﺘﯿﻟﯽـﺳد رد مﺮﮔ 10 زا ﺮﺘﻤﮐ ﻦﯿﺑﻮﻠﮔﻮﻤﻫ نارﺎﻤﯿﺑ زا %58 .ﺪﻨﺘﺷاد ﯽـﻧﻮﺧ یﺎﻬـﻫوﺮﮔ و (%49)دﻮــﺑ A ﯽﻧﻮﺧ هوﺮﮔ ﻦﯾﺮﺘﻌﯾﺎﺷ یﺎــﻫهدر رد %10 و %16 ،%25 ﺎﺑ ﺐﯿﺗﺮﺗ ﻪﺑ ﺰﯿﻧ AB و B ،O و ﺖـﺒﺜﻣ Rh ﺮــﻈﻧ زا نارﺎﻤﯿﺑ زا %47/5 .ﺪﻨﺘﺷاد راﺮﻗ یﺪــﻌﺑ ﺖــــﺑﺎﯾد ﻪـﺑ ﻼـﺘﺒﻣ %37 و یرﺎﮕﯿـﺳ %12 ،رﺎــﻤﯿﺑ 83 ﻦﯿﺑ زا .ﺪﻧدﻮﺑ رد ﻪﺘــﺴﺑ 34 ﯽـﻓﺮﺼﻣ رﺎﮕﯿـﺳ ﻦﯿﮕﻧﺎـﯿﻣ نارﺎـﻤﯿﺑ ﻦـﯾا رد ﺖﺑﺎـﯾد ﻪـﺑ ﻼـﺘﺑا نﺎــﻣز تﺪﻣ ﻦﯿﮕﻧﺎﯿﻣ و (-5/37-73/43)لﺎﺳ یﺎﻫﻪـــﺘﻓﺎﯾ ﻦﯿﮕﻧﺎــــﯿﻣ .دﻮــﺑ لﺎــﺳ (11/11-19/94)15/52 رد ﺎﻬـﻧآ راﺪـﻘﻣ ﻦﯾﺮﺘـﻤﮐ و ﻦﯾﺮﺘــﺸﯿﺑ و نارﺎﻤﯿﺑ ﯽﻫﺎﮕﺸﯾﺎﻣزآ .ﺖﺳا هﺪﻣآ 1 هرﺎﻤﺷ لوﺪﺟ
ﻦﯾﺮﺘﺸﯿﺑ و نارﺎﻤﯿﺑ ﯽﻫﺎﮕﺸﯾﺎﻣزآ یﺎﻫﻪﺘﻓﺎﯾ ﻦﯿﮕﻧﺎﯿﻣ -1 هرﺎﻤﺷ لوﺪﺟ
.ﺖﺳا هﺪﺷ هداد نﺎﺸﻧ ﺎﻬﻧآ راﺪﻘﻣ ﻦﯾﺮﺘﻤﮐ و
ﯽﻫﺎﮕﺸﯾﺎﻣزآ ﻪﺘﻓﺎﯾ ﻦﯾﺮﺘﻤﮐ
ﻦﯾﺮﺘﺸﯿﺑ ﻦﯿﮕﻧﺎﯿﻣ
رﺎﯿﻌﻣ یﺎﻄﺧ ﻦﯿﮕﻧﺎﯿﻣ
ﻢﯿﺳﺎﺘﭘ 3/3
7/1 5/3
7/6
ﻢﯾﺪﺳ 56
145 138
0/8
ﺮﻔﺴﻓ 2/9
139 7
1/2
ﻢﯿﺴﻠﮐ 4/7
11/8 8
0/1
زاﺮﻔﺴﻧاﺮﺗﻮﻨﯿﻣآ تﺎﺘﺳا 8
107 21
2/6
زاﺮﻔﺴﻧاﺮﺗﻮﻨﯿﻣآ ﻦﯿﻧﻻآ 3
201 159
5
زﺎﺗﺎﻔﺴﻓ ﻦﯿﻟﺎﮑﻟآ 4/8
1099 244
28/1
ﻢﯿﻘﺘﺴﻣ ﻦﯿﺑورﯽﻠﯿﺑ 0/1
103 4/9
3/1
ﻞﮐ ﻦﯿﺑورﯽﻠﯿﺑ 0/2
100 4
2/7
ﻦﯿﻨﯿﺗاﺮﮐ 4/9
17/1 10/5
0/2
نﻮﺧ هروا نژوﺮﺘﯿﻧ 7/1
87 57/2
1/4
ﻦﯿﻣﻮﺒﻟآ 2/8
5/1 4/3
6/1
Rh ﯽــﻧﻮﺧ هوﺮﮔ ﯽــﻧاواﺮﻓ ،هﺪﻣآ ﺖﺳد ﻪﺑ ﺞﯾﺎﺘﻧ سﺎﺳاﺮﺑ هوﺮــﮔ زا ﺶــﯿﺑ یرادﯽـــﻨﻌﻣ رﻮـﻄﺑ درﻮـﻣ هوﺮـﮔ رد ﺖـﺒﺜﻣ
هرﺎﻤــﺷ رادﻮـﻤﻧ)[(-1/26-5/52)OR=2/63 و P=0/010]ﺪﻫﺎـﺷ یرادﯽـﻨﻌﻣ رﻮﻄﺑ درﻮﻣ هوﺮﮔ رد یرﺎﮕﯿﺳ داﺮﻓا ﯽﻧاواﺮﻓ و (1
-0/08)OR=0/27 و P=0/031]دﻮـــﺑ ﺪﻫﺎـﺷ هوﺮـﮔ زا ﺮﺘـﻤﮐ [(0/94
و درﻮﻣ هوﺮﮔ 2 رد Rh ﯽﻧﻮﺧ هوﺮﮔ ﯽﻧاواﺮﻓ -1 هرﺎﻤﺷ رادﻮﻤﻧ
.ﺖﺳا هﺪﺷ هداد نﺎﺸﻧ ﺪﻫﺎﺷ
P=0/006) ﻦــﺳ و (r=-0/225 و P=0/015) نزو ﺶﯾاﺰﻓا ار یدﺎﺑﯽﺘﻧآ ﯽﻧﻮﺧ ﺢﻄﺳ یرادﯽﻨﻌﻣ رﻮﻄﺑ ﺰﯿﻧ (r=-0/253 و .(2 هرﺎﻤﺷ رادﻮﻤﻧ)دادﯽﻣ ﺶﻫﺎﮐ نارﺎﻤﯿﺑ رد یرﺎـﻣآ ﺮـﻈﻧ زا ﺰﯿﻟﺎـﯾد مﺎــﺠﻧا تﺪﻣ لﻮﻃ ﺎﺑ HbsAb ﺮﺘﯿﺗ نآ ﻪﻄﺑار ﺎﻣا (r=0/399 و P=0/000)ﺖﺷاد یرادﯽﻨﻌﻣ ﻪﻄﺑار رادﯽـﻨﻌﻣ یﺪـﺒﮐ یﺎﻬﺘـﺴﺗ و BUN ،ﻦــﯿﻨﯿﺗاﺮﮐ ،ﻦﯿﺑﻮﻠﮔﻮﻤﻫ ﺎﺑ ،ﺲـﻨﺟ ﺮـﻈﻧ زا ﺪﻫﺎـﺷ و درﻮـﻣ هوﺮـﮔ 2 ﻦــﯿﺑ ﻦﯿﻨﭽﻤﻫ .دﻮﺒﻧ فﻼﺘﺧا ﯽﻧﻮﺧ هوﺮﮔ و HCVAb ،HCVAg ،ﺖﺑﺎﯾد یرﺎﻤﯿﺑ .ﺖﺷاﺪﻧ دﻮﺟو یرادﯽﻨﻌﻣ یرﺎﻣآ و ﻻﺎــﺑ ﻦﺳ ﻪﮐ ﺪﺷ هﺪﻫﺎﺸﻣ ﯽﻧﻮﯿﺳﺮﮔر لﺪﻣ رد ﺖﯾﺎﻬﻧ رد ﺮﺘـﯿﺗ یاﺮـﺑ ﯽــﻔﻨﻣ هﺪﻨﻨﮐ ﯽﯾﻮﮔﺶﯿﭘ ﻞﻣاﻮﻋ ﻪﻠﻤﺟ زا ﺖﺒﺜﻣ Rh .(2 هرﺎﻤﺷ لوﺪﺟ)ﺪﻨﺘﺴﻫ یدﺎﺑﯽﺘﻧآ
ﺮﺘﯿﺗ و نزو ﻦﯿﺑ طﺎﺒﺗرا هﺪﻨﻫدنﺎﺸﻧرادﻮﻤﻧ ﻦﯾا -2 هرﺎﻤﺷ رادﻮﻤﻧ
.ﺪﺷﺎﺑﯽﻣ یدﺎﺑﯽﺘﻧآ
هﺪﻨﻨﮐ ﯽﯾﻮﮕﺸﯿﭘ ﻪﮐ ﻪﻧﺎﮔﺪﻨﭼ ﯽﻄﺧ ﯽﻧﻮﯿﺳﺮﮔر لﺪﻣ -2 هرﺎﻤﺷ لوﺪﺟ
.ﺪﺷﺎﺑﯽﻣ HbsAb ﺮﺘﯿﺗ راﺪﻘﻣ
ﺮﯿﻐﺘﻣ B ﺐﯾﺮﺿ
یﺎﻄﺧ B رﺎﯿﻌﻣ ﺐﯾﺮﺿ
دراﺪﻧﺎﺘﺳا B هﺪﺷ t
P value
(ﺖﺑﺎﺛ دﺪﻋ) 145/503
27/121 5/365
0/000
-51/504 Rh+
13/963 -0/320
-3/688 0/000
ﻦﺳ -1/088
0/448 -0/210
-2/427 0/017
%95 = (CC)نﺎﻨﯿﻤﻃا ﺐﯾﺮﺿ ،0/163 = (r2)r ﻊﺑﺮﻣ، 0/000= P value
ﺚﺤﺑ ﻪـــﮐ ﯽﻧارﺎــﻤﯿﺑ رد ب ﺖﯿﺗﺎــﭙﻫ ﻦــــﺴﮐاو ﯽـــــﺸﺨﺑﺮﺛا ﺖـﺳا ﻢــــﻟﺎﺳ داﺮـــــﻓا زا ﺮـــﺘﻤﮐ ﺪـــﻧﻮﺷﯽﻣ ﺰـــﯿﻟﺎﯾدﻮﻤﻫ ﯽــــﻨﻤﯾا ﺢــــﻄﺳ ﺶــــﻫﺎﮐ نآ ﺖــــﻠﻋ ﻦـــــﯾﺮﺘﻤﻬﻣ ﻪـــﮐ HbsAb ﯽـــــــــﺠﯾرﺪﺗ ﺶــــــﻫﺎﮐ و نارﺎـــــﻤﯿﺑ ﻦـــــﯾا .ﺪــــﺷﺎﺑﯽﻣ ﺎــﺗ 50 ﻦــــﯿﺑ ﯽــــﻌﯿﺳو ﻪــــﻨﻣاد رد ،ﯽــﺸﺨﺑﺮﺛا ﻦــﯾا مﺎـﺠﻧا تﺎـــﻌﻟﺎﻄﻣ و هدﻮــــﺑ ﺮـــــﯿﻐﺘﻣ ﯽــﻌﯿﺒﻃ ناﺰﯿﻣ %80 ﺮﯿــﻐﺘﻣ ناﺰــــﯿﻣ ﻦــــــﯾا ﻪـــﮐ ﺪــــﻧاهداد نﺎــــﺸﻧ هﺪـــﺷ ﻞــــﻣاﻮﻋ ﻪـــــﺑ ﻪــــﺘﺴﺑاو ،ﻦــــﺴﮐاو ﻪــــﺑ ﯽﻫدﺦــــﺳﺎﭘ نﺎـــﺑﺰﯿﻣ ﻪــﺑ طﻮـــﺑﺮﻣ ﻞـــﻣاﻮﻋ و یزﺎـﺳﻦﻤﯾا ﻪـﺑ طﻮـﺑﺮﻣ .ﺪﺷﺎﺑﯽﻣ ،ﻦــــﺴﮐاو زود ،یزﺎﺳﻦــــﻤﯾا ﻞــــــﻣﺎﻋ ﺎﺑ ﻪـــﻄﺑار رد ﺎـــــﯾ ﯽـــــﻧﻼﻀﻋ ﻞــــــــﺧاد)ﻦــــــﺴﮐاو ﺰـــــﯾﻮﺠﺗ هار و یراﺪﻬـــﮕﻧ شور و نﻮـــﯿﺳﺎﻨﯿﺴﮐاو ﻪـﻣﺎﻧﺮﺑ ،(یﺪﻠﺟﺮــﯾز ﺖــــﺑﺎﺛ یﺮــــﺛا ،ﻦــــﺴﮐاو دﺮــــﺳ هﺮـــــﯿﺠﻧز ﺖـــﯾﺎﻋر
،8 ،5 ،1)ﺪـﻧراد ب ﺖــــﯿﺗﺎﭙﻫ ﻦــــﺴﮐاو ﯽــــﺸﺨﺑﺮﺛا رد هﺪﺷ .(15-19
ﻒـﻠﺘﺨﻣ تﺎـﻌﻟﺎﻄﻣ رد نﺎـﺑﺰﯿﻣ ﻞـﻣاﻮﻋ ﺎــﺑ ﻪـــﻄﺑار رد ﺎﻣا رد .ﺖـــﺳا هﺪــــﻣآ ﺖــــــﺳد ﻪـــﺑ ﯽــــــﺗوﺎﻔﺘﻣ ﺞــــﯾﺎﺘﻧ ،نزو ،ﺲـﻨﺟ ،ﻻﺎـﺑ ﻦـﺳ ،HLA عﻮــــﻧ ،تﺎﻌﻟﺎﻄﻣ زا ﯽـــﺧﺮﺑ یﺎــــــﻬﺼﺧﺎﺷ ندﻮــــــﺑ ﺖــــــﺒﺜﻣ ،ﻪــــــﯾﺬﻐﺗ ءﻮـــــﺳ یﺎـﻬﯾرﺎﻤﯿﺑ ،C ﺖــــﯿﺗﺎﭙﻫ سوﺮـﯾو ﺎــﺑ ﺖﻧﻮﻔﻋ ﮏــﯾژﻮﻟوﺮﺳ مﺎـﺠﻧا تﺪــــﻣ لﻮـﻃ ،یﺪـﺒﮐ ﻦـﻣﺰﻣ یرﺎـﻤﯿﺑ ،زﺪــﯾا و ﺖﺑﺎﯾد ،رﺎـــــﮕﯿﺳ نﺪـــــﯿﺸﮐ ،هروا ﯽــــﻧﻮﺧ ﺢـــــﻄﺳ ،ﺰــــﯿﻟﺎﯾد ﺮـﺛﻮﻣ ﻞــﻣاﻮﻋ ناﻮﻨﻋ ﻪــﺑ ﻦــﯿﺑﻮﻠﮔﻮﻤﻫ و ﻦــﯿﻣﻮﺒﻟآ ناﺰـــﯿﻣ
،15 ،8 ،5 ،1)ﺪﻧاهﺪـﺷ ﯽـﻓﺮﻌﻣ ب ﺖﯿﺗﺎـﭙﻫ ﻦــﺴﮐاو ﯽﺸﺨﺑﺮﺛا ﺮﺑ .(18-25
زا ﯽـﺧﺮﺑ ﺮـــﺛا ،ﺮــــﮕﯾد تﺎـــﻌﻟﺎﻄﻣ رد ﻪـــﮐ ﯽـــﻟﺎﺣ رد
،24 ،21 ،15 ،5)ﺖــــﺳا هﺪـــــﯿﺳﺮﻧ تﺎﺒﺛا ﻪــﺑ ﺎﻫرﻮﺘﮐﺎﻓ ﻦـــﯾا و Sapio ﻂـــﺳﻮﺗ هﺪــﺷ مﺎــﺠﻧا ﻪــﻌﻟﺎﻄﻣ ﻪــﻠﻤﺟ زا .(26-28 ﺰﯿﻟﺎــﯾد تﺪــﻣ لﻮــﻃ و ﺲــﻨﺟ نآ رد ﻪـــﮐ (5)ﺶـــﻧارﺎﮑﻤﻫ ب ﺖﯿﺗﺎــﭙﻫ ﻦــﺴﮐاو ﯽـــﺸﺨﺑﺮﺛا ﺮـﺑ یﺮـــﺛﺆﻣ یﺎـﻫرﻮﺘﮐﺎﻓ .ﺪﻧاهدﻮﺒﻧ
ﺮﺘــﯿﺗ ﻦــﯿﺑ ﻪــــــﻄﺑار ﺰـــﯿﻧ (15)ﺶــــﻧارﺎﮑﻤﻫ و Sezer ،ﺰــــــﯿﻟﺎﯾد مﺎـــﺠﻧا تﺪـــــﻣ لﻮــﻃ یﺎــﻫﺮﯿﻐﺘﻣ و HbsAb ﺎـﻣا ﺪــــﻧدﺮﮐ شراﺰـﮔ رادﯽــــﻨﻌﻣ ار ﻦﯿﻣﻮﺒﻟآ و ﻦﯿﺑﻮﻠﮔﻮﻤﻫ ﻪــﺑ هدﻮﻟآﺮﯿﻏ و هدﻮﻟآ هوﺮﮔ 2 رد HbsAb ﻦـــﯿﮕﻧﺎﯿﻣ ﻦـــﯿﺑ ﺖـﺳد ﻪـﺑ ار یرادﯽـﻨﻌﻣ یرﺎـﻣآ فﻼـﺘﺧا HCV ﺎــﺑ ﺖﻧﻮﻔﻋ .ﺪﻧدروﺎﯿﻧ ﺮـﺑ ﺮـﺛﻮﻣ ﻞـﻣاﻮﻋ زا ﯽﻗﺎـﭼ و ﻻﺎــﺑ ﻦﺳ ﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ رد ﻦـﺴﮐاو ﯽـﺸﺨﺑﺮﺛا ﺶﻫﺎــﮐ ﻪﺠﯿﺘﻧ رد و HbsAb ﺮﺘﯿﺗ ﺶﻫﺎﮐ ﯽﮕﻨﻫﺎـﻤﻫ ﻪﺘـﺷﺬﮔ تﺎـﻌﻟﺎﻄﻣ ﺞﯾﺎـﺘﻧ ﺎــﺑ ﻪﮐ ﺪﻧاهدﻮﺑ ب ﺖﯿﺗﺎﭙﻫ .دراد هوﺮـﮔ ﻪـﮐ ﺪـــﺷ هﺪﻫﺎـﺸﻣ ﻪــﻌﻟﺎﻄﻣ ﻦﯾا رد ﺮﮕﯾد یﻮﺳ زا ﻦـــﺴﮐاو ﯽـﺸﺨﺑﺮﺛا ﺮـﺑ ﺮـﺛﻮﻣ ﻞﻣﺎـﻋ ﮏـﯾ ﺖـﺒﺜﻣ Rh ﯽـﻧﻮﺧ ﯽـﺳرﺮﺑ ﻪــﮐ ﯽﻟﺎﺣ رد ﺪﺷﺎﺑﯽﻣ نآ هﺪﻨﻫد ﺶﻫﺎﮐ و ب ﺖﯿﺗﺎﭙﻫ ﺖـﺳا هﺪـﺸﻧ مﺎـﺠﻧا ﻪﺑﺎـﺸﻣ تﺎـﻌﻟﺎﻄﻣ رد نﻮﻨﮐﺎـﺗ ﻞﻣﺎــﻋ ﻦﯾا زﺎــﯿﻧ درﻮــﻣ ﻪـــﻨﯿﻣز ﻦـﯾا رد ﯽـﻠﯿﻤﮑﺗ یﺎﻬﯿـﺳرﺮﺑ ﻦﯾاﺮﺑﺎـﻨﺑ .ﺪـﺷﺎﺑﯽﻣ ﺰﯿﻟﺎـﯾد نﺎﻣز تﺪﻣ ،هﺪﻣآ ﺖﺳد ﻪﺑ ﺞــﯾﺎﺘﻧ ﻖــﺒﻃ ﻦــﯿﻨﭽﻤﻫ ﻢﯿﻘﺘـﺴﻣ یاﻪـﻄﺑار و ﺖـــﺒﺜﻣ ﯽــــﮕﺘﺴﺒﻤﻫ ،یدﺎﺑﯽﺘﻧآ ﺮﺘﯿﺗ ﺎﺑ .دراد ،HCV ﺎـﺑ ﺖـﻧﻮﻔﻋ ﻪـﻌﻟﺎﻄﻣ ﻦــﯾا زا ﻞﺻﺎﺣ ﺞﯾﺎﺘﻧ سﺎﺳاﺮﺑ ﺐــﺟﻮﻣ رﺎﮕﯿـﺳ فﺮـﺼﻣ و ﺖﺑﺎـﯾد یرﺎـﻤﯿﺑ و دﺮـﻣ ﺲـــﻨﺟ ﺖﺒــﺴﻧ ﯽﺘﺣ و ﺪﻧﻮﺷﯽﻤﻧ ب ﺖﯿﺗﺎﭙﻫ ﻦﺴﮐاو ﯽﺸﺨﺑﺮﺛا ﺶﻫﺎﮐ هدﻮـﺑ ﺪﻫﺎــﺷ هوﺮﮔ زا ﺮﺘﻤﮐ درﻮﻣ هوﺮﮔ رد یرﺎﮕﯿﺳ نارﺎﻤﯿﺑ .ﺖﺳا ﻞﻣﺎــــﻋ ﮏــﯾ ناﻮــﻨﻋ ﻪـــــﺑ ار رﺎﮕﯿــﺳ ﺮـــــﻣا ﻦـــــﯾا ﯽــﻓﺮﻌﻣ HbsAb ﺮﺘـــﯿﺗ ﺶــﻫﺎﮐ ﺮـــﺑاﺮﺑ رد هﺪﻨﻨﮐﺖﻈﻓﺎـﺤﻣ ﺎــﺑ ﯽـــﺗﺎﻌﻟﺎﻄﻣ مﺎـﺠﻧا ،نآ در ﺎـﯾ تﺎــﺒﺛا یاﺮﺑ ﻪــﮐ ﺪــﻨﮐﯽﻣ دﺎﻬﻨــﺸﯿﭘ ﺮــــﺘﺸﯿﺑ (Power) ترﺪـــﻗ و ﻮـﻠﺟ ﻪـﺑ ور ﺖﻬـﺟ .دﻮﺷﯽﻣ
ﺮﮑﺸﺗ و ﺮﯾﺪﻘﺗ ﻎـﯾردﯽﺑ یﺎﻬــﮑﻤﮐ زا ﺎﺗ ﺪﻨﻧادﯽﻣ مزﻻ دﻮﺧ ﺮﺑ نﺎﮔﺪﻨﺴﯾﻮﻧ ﻪـﺑ ار ﯽـﻧادرﺪﻗ و ﺮﮑــﺸﺗ لﺎﻤﮐ ﯽﺋﺮﻬﭼ ﯽﻠﻋ ﺮﺘﮐد یﺎﻗآ بﺎﻨﺟ .ﺪﻧروآ ﻞﻤﻋ ﻊﺑﺎﻨﻣ
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FACTORS INFLUENCING THE EFFICACY OF HEPATITIS B VACCINATION IN PATIENTS UNDERGOING HEMODIALYSIS
I II III III III
Sh. Ghasemi, MD *P. Golnari M. Hashemnejad N. Shahgholi P. Karimi
ABSTRACT
Prevention of infection by hepatitis B virus in patients undergoing hemodialysis is very important but has its own problems such as reduction of hepatitis B vaccination efficacy and the falling of HbsAb to unprotective levels after unknown time. These factors bring up a need for assessing the antibody levels at specified times (e.g. every 6 months) and revaccinating the patients when it seems necessary. The present study was conducted to determine the factors that influence the efficacy of hepatitis B vaccination in patients undergoing hemodialysis. This case-control study was carried out on 121 patients undergoing hemodialysis in the hemodialysis ward of Shahid Hasheminejad Hospital in Tehran. 64 patients(with antibody levels under 10mlU/ml) were in case and 52 ones (with antibody levels equal or more than 10mlU/ml) were in the control group. The checklist consisted of demographic and laboratory information, duration of hemodialysis, history of having diabetes and history of smoking which were all extracted from the patients’ hospital records and/or asked from them. Analysis of the data was done via SPSS 10 and EPI Info 6 software using indices of frequency, mean, standard deviation and standard error. Different statistical tests such as Chi2, Levene, Kolmogorov-Smirnov, t, and Pearson and Spearman coefficients were also employed. Multiple linear regression was used for assessing the predicting factors. Of 121 patients, 56 were female and 65 were male. Rh-positive blood group had more frequency in cases than in controls (P=0.010, odds ratio=2.63) and the number of the smokers was significantly more in the control group than in the case (P=0.031, odds ratio=0.27). Moreover, increases in weight (P=0.015, r=-0.225) and age (P=0.006, r=-0.253) decreased the HbsAb levels significantly. The patients’ age and Rh blood group were the identifiers of antibody levels in the regression model. This study has found out that increasing age, malnutrition and Rh-positive blood group are factors in decreasing the efficacy of hepatitis B vaccination in patients undergoing hemodialysis and it has also marked the need for paying further attention to the patients having these risk factors.
Key Words: 1) Hemodialysis 2) Hepatitis B Vaccination 3) Antibody level 4) Prognosis predicting factors
This article is presented in the 3rd Medial Student’s Research Seminar in Tehran(2002).
I) Assistant Professor of Infectious Disease. Iran University of Medical Sciences and Health Services, Tehran, Iran.
II) Medical Student, Member of Student Research Committee, Faculty of Medicine, Iran University of Medical Sciences and Health Services, Tehran, Iran(*Corresponding author).
III) Medical Student, Member of Student Research Committee, Faculty of Medicine, Iran University of Medical Sciences and Health Services, Tehran, Iran.
