* ﺝ
هﺎﮕﺸﻧاد ،ﻲﻣﻮﻤﻋ ﻲﺣاﺮﺟ هوﺮﮔ رﺎﻴﺸﻧاد مﻮﻠﻋ
ﻲﻜﺷﺰﭘ نﺎﺘﺳرﺎﻤﻴﺑ ،ﻲﺘﺸﻬﺑ ﺪﻴﻬﺷ ﺖﻳآ
ا ...
ﻲﻧﺎﻘﻟﺎﻃ ﻮـﮕﺨﺳﺎﭘ ةﺪﻨﺴﻳﻮﻧ
: ﺮﺘﻛد يﺪﻤﺤﻣ دﺎﺠﺳﺪﻴﺳ
ﮕﺸﻧاد ،ﻲﻣﻮﻤﻋ ﻲﺣاﺮﺟ هوﺮﮔ رﺎﻴﺘﺳد**
هﺎ مﻮﻠﻋ ﻲﻜﺷﺰﭘ نﺎﺘﺳرﺎﻤﻴﺑ ،ﻲﺘﺸﻬﺑ ﺪﻴﻬﺷ ﺖﻳآ
ا ...
ﻲﻧﺎﻘﻟﺎﻃ ﻦﻔﻠﺗ
: 23031449
هﺎﮕﺸﻧاد ،ﻲﻨﻴﺑ و ﻖﻠﺣ و شﻮﮔ هوﺮﮔ رﺎﻴﺘﺳد***
مﻮﻠﻋ ﻲﻜﺷﺰﭘ نﺎﺘﺳرﺎﻤﻴﺑ ،ﺰﻳﺮﺒﺗ ﺎﺿر مﺎﻣا
) ع ( E-mail: [email protected]
هﺎﮕﺸﻧاد ،ﻲﻣﻮﻤﻋ ﻲﺣاﺮﺟ هوﺮﮔ دﺎﺘﺳا****
مﻮﻠﻋ ﻲﻜﺷﺰﭘ نﺎﺘﺳرﺎﻤﻴﺑ ،ﻲﺘﺸﻬﺑ ﺪﻴﻬﺷ ﺖﻳآ
ا ...
ﻲﻧﺎﻘﻟﺎﻃ
لﻮﺻو ﺦﻳرﺎﺗ : 16 / 05 / 1389
شﺮﻳﺬﭘ ﺦﻳرﺎﺗ : 25 / 08 / 1390
ﻪﺘﻓﺎﻳ ﻲﺳرﺮﺑ ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﻴﺑ ﻲﻨﻴﻟﺎﺑ يﺎﻫ
ﻪﻴﻟوا ﻢﺴﻳﺪﻴﺋوﺮﻴﺗارﺎﭘﺮﭙﻴﻫ ﻪﻛ
ﻲﻃ رد 20
لﺎﺳ
ﺮﻴﺧا ناﺮﻬﺗ ﻲﻧﺎﻘﻟﺎﻃ نﺎﺘﺳرﺎﻤﻴﺑ رد ﻪﺘﻓﺮﮔ راﺮﻗ ﻲﺣاﺮﺟ ﻞﻤﻋ ﺖﺤﺗ
ﺪﻧا
ﺮﺘﻛد ﻲﻧﺎﻤﻛ ﻪﺘﺷﺮﻓ ،
*ﺮﺘﻛد يﺪﻤﺤﻣ دﺎﺠﺳﺪﻴﺳ ،
**ﻲﻠﺳﻮﺗ ﺎﺒﺻ ﺮﺘﻛد
،
***ﺮﺘﻛد ﺎﺿر ﻲﻣﺎﺴﺣ
**د يوﺮﻴﭘ ﷲا ﺐﻴﺒﺣ ﺮﺘﻛ
****
ﻭ ﻩﮊﺍ ﻱﺪﻴﻠﻛ ﻱﺎﻫ :
ﻢﺴﻳﺪﻴﺋﻭﺮﻴﺗﺍﺭﺎﭘﺮﭙﻴﻫ
،ﻪﻴﻟﻭﺍ ﺪﻴﺋﻭﺮﻴﺗﺍﺭﺎﭘ
ﻨﻴﻣز ﻪ فﺪﻫ و
هﺪﻏ جرﺎـﺧ ﻢﻴﺴﻠﻛ ﺖﻈﻠﻏ ﻢﻴﻈﻨﺗ ﻲﻠﻛ رﻮﻄﺑ ﺪﻴﺋوﺮﻴﺗارﺎﭘ يﺎﻫ
ﺪﻧراد هﺪﻬﻋ ﻪﺑ ار ﻲﻟﻮﻠﺳ .
ﺐـﻠﻏا 4 ﻒـﻠﺧ رد ﺪـﻴﺋوﺮﻴﺗارﺎﭘ هﺪـﻏ ﺪﻧراد دﻮﺟو ﺪﻴﺋوﺮﻴﺗ
. ﻪـﻴﻟوا ﻢﺴﻳﺪﻴﺋوﺮﻴﺗارﺎﭘﺮﭙﻴﻫ ﺪـﻴﻟﻮﺗ ﺚـﻋﺎﺑ
رﻮﺗارﺎﭘ نﻮﻣرﻮﻫ ﺪﺣ زا ﺶﻴﺑ نﻮﻣ
دﻮﺷ ﻲﻣ زﺎﺘـﺳﻮﻣﻮﻫ ﺐﺟﻮﻣ ﻪﻛ
ﻩﺪﻴﻜﭼ :
ﺯ ﻣ ﻨﻴ ﻪ ﻑﺪﻫ ﻭ : ﭙﻴﻫ ـ ﺴﻳﺪﻴﺋﻭﺮﻴﺗﺍﺭﺎﭘﺮ ـ
ﻢ ﺘﺒﺴﻧ ﻱﺭﺎﻤﻴﺑ ﻪﻴﻟﻭﺍ ـ
ﻢﻧﺎﺧ ﺭﺩ ﻪﮐ ﺖﺳﺍ ﻲﻌﻳﺎﺷ ﹰﺎ ﺘﺸﻴﺑ ﺎﻫ
ـ ﻲﻣ ﻩﺪﻳﺩ ﺮ ﺩﻮﺷ . ﻦﻳﺍ ﻱﺭﺎﻤﻴﺑ ﺭﺩ ﻱﺎﻫﺭﻮﺸﮐ ﺭﺩ ﻝﺎﺣ ﺳﻮﺗ ـ ﻪﻌ ﺑ ﻪ
ﺕﺭﻮﺻ ﺖﻣﻼﻋ ﺭﺍﺩ ﻭ ﺭﺩ ﺘﺴﻴﺳ ﻪﮐ ﻲﻳﺎﻫﺭﻮﺸﮐ ـ
ﮕﻟﺎﺑﺮﻏ ﻢ ـ
،ﺪﻧﺭﺍﺩ ﻲﻟﺎﻌﻓ ﻱﺮ ﻠﻏﺍ
ـ ﺑ ﺐ ﻪ ﻲﻣ ﻥﺎﻣﺭﺩ ﻭ ﻪﺘﺧﺎﻨﺷ ﺖﻣﻼﻋ ﻥﻭﺪﺑ ﺕﺭﻮﺻ ﺩﻮﺷ
. ،ﺖﺳﺍ ﻩﺪﺷ ﯽﻌﺳ ﻪﻌﻟﺎﻄﻣ ﻦﻳﺍ ﺭﺩ
ﺭﻮﺸﮐ ﺮﮕﻳﺩ ﺭﺩ ﻩﺪﺷ ﻡﺎﺠﻧﺍ ﺕﺎﻌﻟﺎﻄﻣ ﺎﺑ ﺩﻮﺟﻮﻣ ﯼﺎﻫ ﺕﻭﺎﻔﺗ ﻭ ﻩﺪﺷ ﯽﺳﺭﺮﺑ ،ﻪﻌﻟﺎﻄﻣ ﺩﺭﻮﻣ ﻥﺍﺭﺎﻤﻴﺑ ﺭﺩ ﯼﺭﺎﻤﻴﺑ ﻦﻳﺍ ﯽﻨﻴﻟﺎﺑ ﺕﺍﺮﻫﺎﻈﺗ ﻉﺍﻮﻧﺍ ﯽﻧﺍﻭﺍﺮﻓ ﺩﻮﺷ ﻥﺎﻴﺑ ﺎﻫ
.
ﺵﻭﺭ ﻭ ﺩﺍﻮﻣ ﺎﻫ
: ﻦﻳﺍ ﺭﺩ ﻌﻟﺎﻄﻣ ﻲﻔﻴﺻﻮﺗ ﻪ ﻪﺘﺷﺬﮔ ﺮﮕﻧ ﻩﺪﻧﻭﺮﭘ ، ﻱﺎﻫ ﻧﺍﺭﺎﻤﻴﺑ ﻲ ﻪﮐ ﺭﺩ ۲۰ ﺮﻴﺧﺍ ﻝﺎﺳ ) ۱۳۸۹ - ۱۳۶۹ ( ﻞﻤﻋ ﺖﺤﺗ ﻲﺣﺍﺮﺟ ﺗﺍﺭﺎﭘ ﻴ ﺋﻭﺮ ﻴ ﺪ ﻲﻣﻮﺘﮐ ﺭﺍﺮﻗ
ﺪﻧﺩﻮﺑ ﻪﺘﻓﺮﮔ ﻊﻤﺟ ، ﺪﺷ ﻱﺭﻭﺁ ﻭ
،ﺲﭙﺳ
،ﺲﻨﺟ ﻼﻋ ﻳ ﻢ ﻟﺎﺑ ﻴﻨ ﻲ
، ﺵﻭﺭ ﻮﺼﺗ ﻳ ﺭﺍﺩﺮﺑﺮ ﻱ ﺖﻬﺟ ﺨﺸﺗ ﻴ ﺺ ﻞﺤﻣ ﻡﻮﻧﺩﺁ ﻭ ﺵﻭﺭ ﺣﺍﺮﺟ ﻲ ﻭ ﺽﺭﺍﻮﻋ ﺪﻌﺑ ﺯﺍ ﻞﻤﻋ ﺣﺍﺮﺟ ﻲ ﺭﺩ
ﺩﺭﻮﻣ ﺮﻫ ﻳ ﮏ ﺯﺍ ﺑﻴ ﻥﺍﺭﺎﻤ ﺍ ﺝﺍﺮﺨﺘﺳ ﺪﺷ . ﺕﺎﻋﻼﻃﺍ ﻡﺎﺧ ﺯﺍ ﻩﺪﻧﻭﺮﭘ ﺑﻴ ﻥﺍﺭﺎﻤ ﺝﺍﺮﺨﺘﺳﺍ ﻩﺪﺷ ﻭ ﻩﺩﺍﺩ ﺎﻫ ﻪﺑ ﻡﺮﻧ ﺭﺍﺰﻓﺍ ﺍSPSS ﻝﺎﻘﺘﻧ ﻳ ﻪﺘﻓﺎ ﻭ ﺭﺩ ﺐﻟﺎﻗ ﻝﻭﺍﺪﺟ ﻭ ﺎﻫﺭﺍﺩﻮﻤﻧ ﻪﺻﻼﺧ
ﺩﺮﮔ ﻳ ﺪ .
ﻪﺘﻓﺎﻳ ﺎﻫ : ﻥﺎﻴﻣ ﺯﺍ ۷۴ ،ﻩﺪﺷ ﻲﺳﺭﺮﺑ ﺭﺎﻤﻴﺑ ۸۲
) % ۶۱ ﺮﻔﻧ ( ﻩﺩﻮﺑ ﻥﺯ ﻥﺍﺭﺎﻤﻴﺑ ﻲﻨﺳ ﻦﻴﮕﻧﺎﻴﻣ ﻭ ﺪﻧﺍ ۱۱
/
±۱۲ ۴ / ۴۷ ﺖﺳﺍ ﻩﺩﻮﺑ ﻝﺎﺳ .
ﭻﻴﻫ ﺯﺍ ﻡﺍﺪﮐ ﻢﻳﻼﻋ ﻥﻭﺪﺑ ﻥﺍﺭﺎﻤﻴﺑ
ﻩﺩﻮﺒﻧ ﻲﻨﻴﻟﺎﺑ ﺭﺩ ﻲﻧﺍﻮﺨﺘﺳﺍ ﻢﻳﻼﻋ ﻭ ﺪﻧﺍ ۶۲
) % ۴۶ ﺮﻔﻧ ( ﺭﺩ ﻱﻮﻴﻠﮐ ﻢﻳﻼﻋ ﻭ ۴۵
% ﻥﺍﺭﺎﻤﻴﺑ ) ۳۴ ﺮﻔﻧ ( ﺖﺳﺍ ﻩﺪﺷ ﻩﺪﻫﺎﺸﻣ .
۷۷
% ﺑ ﻥﺍﺭﺎﻤﻴ ) ۵۷ ﺮﻔﻧ ( ﻪﺘﺷﺍﺩ ﻡﻮﻧﺩﺁ
،ﺪﻧﺍ ﻪﮑﻴﻟﺎﺣ ﺭﺩ
ﺪﻴﺋﻭﺮﻴﺗﺍﺭﺎﭘ ﻱﺯﻼﭘﺮﭙﻴﻫ ۱۲
) % ۹ ﺮﻔﻧ ( ﺮﺳ ﻭ ﻥﺎﻃ ﺭﺩ ﺪﻴﺋﻭﺮﻴﺗﺍﺭﺎﭘ ۷
/ ۶ ) % ۵ ﺮﻔﻧ ( ﺩ ﺩﻮﺟﻭ ﻥﺍﺭﺎﻤﻴﺑ ﺖﺷﺍ
. ۴ % ﻥﺍﺭﺎﻤﻴﺑ ) ۳ ﺮﻔﻧ ( ﻪﺘﺷﺍﺩ ﻞﺑﻭﺩ ﻡﻮﻧﺩﺁ ﺰﻴﻧ ﺪﻧﺍ
.
ﻪﺠﻴﺘﻧ ﻴﮔ ـ ﻱﺮ : ﻱﺭﺎﻤﻴﺑ ﻫ ﻴ ﺗﺍﺭﺎﭘﺮﭙ ﻴ ﺋﻭﺮ ﻴ ﺪ ﻳ ﻢﺴ ﻟﻭﺍ ﻴ ﻪ ﻲﻣ ﺍﺪﻴﭘ ﺮﻫﺎﻈﺗ ﻝﺎﺘﻠﮑﺳﺍﻮﻟﻮﮑﺳﻮﻣ ﻭ ﻱﻮﻴﻠﮐ ﺕﻻﻼﺘﺧﺍ ﺎﺑ ﻪﮐ ﺖﺳﺍ ﮏﻴﺗﺎﻣﻮﺘﭙﻤﺳ ﻝﻼﺘﺧﺍ ﮏﻳ ﻥﺍﺮﻳﺍ ﺭﺩ ﺪﻨﮐ
. ﻦﻳﺍ
ﻪﻫﺩ ﺭﺩ ﻪﮑﻨﻳﺍ ﺩﻮﺟﻭ ﺎﺑ ﻱﺭﺎﻤﻴﺑ ﺭﺩ ﻪﺘﺷﺬﮔ ﻱﺎﻫ
ﻱﻼﺘﺑﺍ ﻦﺳ ﺞﻳﺭﺪﺗ ﻪﺑ ﻥﺍﺮﻬﺗ ﻱﺭﺎﻤﻴﺑ ﻦﻳﺍ
ﺖﺳﺍ ﻪﺘﻓﺎﻳ ﺶﻳﺍﺰﻓﺍ
، ﻦﻴﻳﺎﭘ ﻦﻴﻨﺳ ﺭﺩ ﻲﺑﺮﻏ ﻱﺎﻫﺭﻮﺸﮐ ﺯﺍ ﻥﺎﮐﺎﻤﮐ ﻥﺎﻳﺎﻤﻧ ﻱﺮﺗ
ﻲﻣ ﺩﻮﺷ .
ﻲﻣ ﻢﻴﺴﻠﻛ ﻲﻌﻴﺒﻃﺮﻴﻏ دﺮﮔ
د . ﻪﻴﻟوا ﻢﺴﻳﺪﻴﺋوﺮﻴﺗارﺎﭘﺮﭙﻴﻫ يژﻮﻟﻮﻴﺗا
،ﺖﺳا ﻲﻳﺎﺳﺎﻨﺷ ﻞﺑﺎﻗ نارﺎﻤﻴﺑ زا ﻲﻤﻛ داﺪﻌﺗ رد ﺎﻬﻨﺗ ﻪﻘﺑﺎـﺳ ﺪﻨﻧﺎﻣ
مرﺪﻨـﺳ ﺪـﻨﻧﺎﻣ ﻲـﻜﻴﺘﻧژ ردﺎـﻧ تﻻﻼﺘـﺧا ﻪﻘﺑﺎـﺳ و نﻮﻴﺳﺎﻳدار (Multiple Endocrine Neoplasia) MEN .
شراﺰــﮔ يﺎــﻫ
هرﺎـــﺑرد يدﺪـــﻌﺘﻣ زوﺮـــﺑ و ﻮـــﻴﺘﻛاﻮﻳدار ﺪـــﻳ طﺎـــﺒﺗرا
ﺪﻧراد دﻮﺟو ﻪﻴﻟوا ﻢﺴﻳﺪﻴﺋوﺮﻴﺗارﺎﭘﺮﭙﻴﻫ
1.
دﺮﻔﻨﻣ مﻮﻧدآ 89
%
ـﭙﻴﻫ دراﻮـﻣ ـ
ار ﻪـﻴﻟوا ﻢﺴﻳﺪﻴﺋوﺮﻴﺗارﺎﭘﺮ
ﻲﻣ ﻞﻣﺎﺷ رد ﻪـﻓﺮﻃ ود مﻮـﻧدآ و دﻮﺷ 5
% ﺖـﻓﺎﻳ قﻮـﻓ نارﺎـﻤﻴﺑ
ﻲﻣ دﻮﺷ
2.
و
ﻠﻏا رد3
ـ ﻣ ﺐ ـ ـﻠﺳ يوﺎﺣ مﻮﻧدآ دراﻮ ـ
لﻮ ﻲﻠـﺻا يﺎـﻫ
ﻲﻣ ﺪﺷﺎﺑ . ﻣﻮﺗ ﻦﻳا ـ
،ﺎﻫرﻮ ﭙﻛ يوﺎﺣ ﺐﻠﻏا
ﻲـﻣ لﻮـﺴ ـﻨﺷﺎﺑ
ـ رد و ﺪ
50 % ﻴﺗارﺎﭘ لﺎﻣﺮﻧ ﺖﻓﺎﺑ ﺎﺑ دراﻮﻣ ـ
هﺪﺷ ﻪﻃﺎﺣا ﺪﻴﺋوﺮ ﺪﻧا
. زا ﻲـﺧﺮﺑ
مﻮﻧدآ ﻠﺳ ﻊﻤﺠﺗ زا ﺎﻫ ـ
لﻮ ﻲﺴﻛا يﺎﻫ ﻴﻠﻴﻓ
ـ ﻲـﻣ دﻮﺟﻮﺑ ﻚ آ
و ﺪـﻨﻳ
ﻧدآ ﻦﻳا ـ مﻮ ﻧدآ زا ﺐﻠﻏا ﺎﻫ ـ
مﻮ ﻠﺳ يﺎﻫ ـ لﻮ ا يﺎـﻫ ﻠـﺻ ﺮـﺘﮔرﺰﺑ ﻲ
ﻲﻣ ﺪﻨﺷﺎﺑ . دوﺪــﺣ رد ﺪــﻴﺋوﺮﻴﺗارﺎﭘ دﺪــﻏ يزﻼﭘﺮــﭙﻴﻫ 6
% دراﻮــﻣ زا
ﺮﻴﺗارﺎﭘﺮﭙﻴﻫ ﻲﻣ ﻞﻣﺎﺷ ار ﻪﻴﻟوا ﻢﺴﻳﺪﻴﺋو
دﻮﺷ
3. مﺎﻤﺗ دراﻮﻣ ﻦﻳا رد
4 ﻲﻣ گرﺰﺑ هﺪﻏ دﺪـﻏ ﻪﺑ ﺖﺒﺴﻧ ﻲﻧﺎﺘﺤﺗ دﺪﻏ ﺢﺿاو رﻮﻄﺑ و دﻮﺷ
ﻲﻣ ﺮﺘﮔرﺰﺑ ﻲﻧﺎﻗﻮﻓ ﺪﻧﻮﺷ
.
ﺮﺳ نﺎﻃ ﺪﻴﺋوﺮﻴﺗارﺎﭘ 1
ﺎﺗ 2 % ار ﻢﺴﻳﺪﻴﺋوﺮﻴﺗارﺎﭘﺮﭙﻴﻫ دراﻮﻣ زا
ﻲﻣ ﻞﻣﺎﺷ دﻮﺷ . ﺺﻴﺨﺸﺗ ﺮﺳ نﺎﻃ
دراﻮـﻣ زا ﻲﻜﻳ ﻞﻗاﺪﺣ دﻮﺟو ﺎﺑ
ﻞﻳذ هداد ﻲﻣ ﻮﺷ د : ﻢﺟﺎﻬﺗ ﺖﻓﺎﺑ ﻪﺑ لﺎﻛﻮﻟ
،فاﺮﻃا يﺎﻫ ﻪـﺑ زﺎﺘﺳﺎﺘﻣ
هﺮﮔ ﺖﺳدرود زﺎﺘﺳﺎﺘﻣ ﺎﻳ و يوﺎﻔﻨﻟ يﺎﻫ .
ﺪﻫاﻮـﺷ ﻪـﻛ ﻲﺗرﻮﺻ رد
،ﺪﻨﺷﺎﺑ ﻪﺘﺷاﺪﻧ دﻮﺟو قﻮﻓ زوﺮﺒﻴﻓ ﻲﻳﺎﺳﺎﻨﺷ ﺎﺑ ﻚﻳژﻮﻟﻮﺗﺎﭘ ﻪﻌﻟﺎﻄﻣ
،ﻻﻮﻜﺑاﺮﺗ
،زﻮﺘﻴﻣ ناﺰﻴﻣ لﻮـﺴﭙﻛ ﻪـﺑ ﻢﺟﺎـﻬﺗ ﺎﻳ و ﻲﻗوﺮﻋ ﻢﺟﺎﻬﺗ
دﻮﺑ ﺪﻫاﻮﺧ روﺪﻘﻣ .
ا ﻢﺴﻳﺪﻴﺋوﺮﻴﺗارﺎﭘﺮﭙﻴﻫ ﺮﻫﺎﻈﺗ ﻦﻳﺮﺘﻌﻳﺎﺷ ﻲﻤـﺴﻠﻛﺮﭙﻴﻫ ﻪـﻴﻟو
ﺖـﻬﺟ ﻲﻤﻴـﺷﻮﻴﺑ ﻦﻴـﺗور تﺎـﻌﻟﺎﻄﻣ رد ﻪـﻛ ﺖﺳا ﺖﻣﻼﻋ نوﺪﺑ ﻲﻣ ﺖﻓﺎﻳ يﺮﮕﻟﺎﺑﺮﻏ دﻮﺷ
. توﺎﻔﺗ تاﺮﻫﺎـﻈﺗ رد ﻚـﻴﻓاﺮﮔﻮﺋژ يﺎـﻫ
ﻞﻗاﺪـﺣ ﻪﻛ ﺖﺳا ﻒﻴﺻﻮﺗ ﻞﺑﺎﻗ ﻪﻴﻟوا ﻢﺴﻳﺪﻴﺋوﺮﻴﺗارﺎﭘﺮﭙﻴﻫ ﻲﻨﻴﻟﺎﺑ ﻦﻴﻣﺎﺘﻳو يﺎﻫدﻮﺒﻤﻛ ﻪﺑ طﻮﺑﺮﻣ يدوﺪﺣ ﺎﺗ ﻲﻣD
ﺪﺷﺎﺑ ﺪﻧاﻮﺗ
5.
-
رد7
ﻦﻴﻣﺎــﺘﻳو دﻮــﺒﻤﻛ ﻪــﻛ ﻲﻌﻣاﻮــﺟ ــﺷD
،دراد يﺮﺘــﺸﻴﺑ عﻮﻴ
يرﺎﻤﻴﺑ ترﻮﺼﺑ ﻪﻴﻟوا ﻢﺴﻳﺪﻴﺋوﺮﻴﺗارﺎﭘﺮﭙﻴﻫ ﺎـﺑ ﺎﻳ و ﻲﻧاﻮﺨﺘﺳا يﺎﻫ
ﮓﻨﺳ تاﺮﻫﺎﻈﺗ داد ﺪـﻫاﻮﺧ نﺎﺸﻧ ﺮﺘﺸﻴﺑ ار دﻮﺧ يراردا يﺎﻫ
6.
و 7
ﻪﻧﺎﺸﻧ و ﻢﻳﻼﻋ
ﻚﻴﺳﻼﻛ يﺎﻫ
ﻫ ﻴ ﺗارﺎﭘﺮﭙ ﻴ ﺋوﺮ ﻴ ﺪ ﻳ ﻢﺴ ﻟوا ـﻴ ﻪ نﺎـﺸﻧ
ﺢﺷﺮﺗ ﺶﻳاﺰﻓا ﻞﺑﺎﻘﺘﻣ تاﺮﺛا هﺪﻨﻫد نﻮﻣرﻮﺗارﺎـﭘ
ﻲﻤـﺴﻠﻛﺮﭙﻴﻫ و
ﻲﻣ ترﻮﺼﺑ ﻪﻛ ﺪﺷﺎﺑ
"
ﻲﻧاﻮﺨﺘـﺳا ﻢـﺋﻼﻋ
، ﮓﻨـﺳ يراردا يﺎـﻫ
،
ﻚﻳژﻮﻟﻮﻜﻳﺎﺳ و ﻲﻤﻜﺷ تاﺮﻫﺎﻈﺗ
"
ﻲﻣ هدﺮﺒﻣﺎﻧ دﻮﺷ
.
رد ﻢـﺴﻳﺪﻴﺋوﺮﻴﺗارﺎﭘﺮﭙﻴﻫ ﺎـﺑ ﻢﻴﻘﺘـﺴﻣ رﻮـﻄﺑ ﻪﻛ ﻲﺗﻻﻼﺘﺧا يرﺎﻤﻴﺑ زا ﺪﻨﺗرﺎﺒﻋ ﺖﺳا طﺎﺒﺗرا
ﮓﻨـﺳ و ﻲﻧاﻮﺨﺘـﺳا يﺎـﻫ يﺎـﻫ
تﺪـﻣ ﻲﻧﻻﻮـﻃ ﺶﻳاﺰﻓا ﺖﻠﻋ ﻪﺑ ﻪﻛ يراردا نﻮﻣرﻮﺗارﺎـﭘ
دﺎـﺠﻳا
ﻲﻣ ﺪﻧﻮﺷ
8.
و
ﻪﺑ ﻪﻛ ﻲﻤﻳﻼﻋ9
ﻲـﻣ دﺎـﺠﻳا ﻲﻤﺴﻠﻛﺮﭙﻴﻫ ﺖﻠﻋ ﺪﻧﻮـﺷ
،عﻮﻬﺗ زا ﺪﻨﺗرﺎﺒﻋ
،غاﺮﻔﺘﺳا
،ﺖﺳﻮﺒﻳ ﻲﺷﻮﻧﺮﭘ و يرﻮﺧﺮﭘ
10.
ﻪﻴﻟوا يﺪﻴﺋوﺮﻴﺗارﺎﭘﺮﭙﻴﻫ ﻲﻧاﻮﺨﺘﺳا ﻚﻴﺳﻼﻛ ﺮﻫﺎﻈﺗ ﺖﻴﺌﺘﺳا
ﻚﻴﺘﺴﻴﻛوﺮﺒﻴﻓ
ناﻮﺨﺘـﺳا بﺬـﺟزﺎﺑ و ﻲﻧاﻮﺨﺘﺳا درد ﻪﻛ
بﺎـﺳ
،ﻲﻧﺎﻴﻣ ﺲﻜﻨﻟﺎﻓ لﺎﻳدار ﺢﻄﺳ رد ﺖﺳﻮﻳﺮﭘ رد ﻲـﻜﻤﻧ ﻞـﻔﻠﻓ يﺎﻤﻧ
،ﻪﻤﺠﻤﺟ ﺖﺴﻴﻛ ﺨﺘﺳا يﺎﻫ رﻮﻣﻮﺗ و ﻲﻧاﻮ
ﻮﻬﻗ ه ناﻮﺨﺘﺳا رد يا يﺎﻫ
ﻲﻣ هداد ﺺﻴﺨﺸﺗ هدﺎﺳ ﻲﻓاﺮﮔ رد زارد دﻮـﺷ
.
،لﻼﺘـﺧا ﻦـﻳا رد
ﺮـﺳ رد صﻮـﺼﺨﺑ ﺪﻳﺪـﺷ يرﺎـﻤﻴﺑ ﺎﺑ نارﺎﻤﻴﺑ نﺎﻃ
ﺪـﻴﺋوﺮﻴﺗارﺎﭘ
ﻲﻣ هﺪﻫﺎﺸﻣ دﻮﺷ
) ﺼﺗ ﺎ ﺮﻳو 1 و 2 (
8.
ﺮﻳﻮﺼﺗ ۱ ـ ﺪﻴﺋﻭﺮﻴﺗﺍﺭﺎﭘ ﻡﻮﻧﺩﺁ )
ﻞﻤﻋ ﻕﺎﺗﺍ (
ﺮﻳﻮﺼﺗ ۲ ـ ﻲﻓﺍﺮﮔﻮﻳﺩﺍﺭ ﻩﺪﻨﻫﺩ ﻥﺎﺸﻧ ﻪﮐ ﺭﺎﻤﻴﺑ ﺖﺳﺩ
ﻩﻮﻬﻗ ﺭﻮﻣﻮﺗ ﻲﻣ ﻱﺍ ﺪﺷﺎﺑ
يﻮـﻴﻠﻛ تاﺮﻫﺎـﻈﺗ ﻦﻳﺮﺘﻌﻳﺎﺷ ﻫ
ﻴ ﺗارﺎﭘﺮﭙ ﻴ ﺋوﺮ ﻴ ﺪ ﻳ ﻢـﺴ ﻟوا ـﻴ ﻪ
ﮓﻨﺳ ﻞﻣﺎﺷ
،يﻮﻴﻠﻛ يﺎﻫ
،يرﻮﻴﺴﻠﻛﺮﭙﻴﻫ
،زﻮﻨﻴﺴﻠﻛوﺮﻔﻧ ﻲﻳﺎﺳرﺎﻧ
ﻲﻣ يﻮﻴﻠﻛ ﻦﻣﺰﻣ ﺪﺷﺎﺑ
11.
ﻲﺑ و ﻒﻌﺿ زا ﺖﻳﺎﻜﺷ نارﺎﻤﻴﺑ رد ﻲﻟﺎﺣ
ﻫ ﻴ ﺗارﺎﭘﺮﭙ ﻴ ﺋوﺮ ﻴ ﺪ ﻳ ﻢﺴ
ﻟوا ﻴ ﻪ ﺖـﺳا ﻊﻳﺎﺷ .
رد ﻫ ﻴ ـﭙ ـ ﺗارﺎﭘﺮ ﻴ ﺋوﺮ ﻴ ﺪ ﻳ ﻢﺴ ﻟوا ـﻴ ﻪ
،ﻚﻴـﺳﻼﻛ
ﻨﺳ ـ ـﻜﺳﻮﻣورﻮﻧ مرﺪ ـ
ﺎـﺑ رﻻﻮ آ ـﺗ ـ ـﻴﺗ ﻲﻓوﺮ ـ ـﺒﻴﻓ ود ﭗ ـ
يﺎﻫﺮ
ﻤﻫ ﻲﻧﻼﻀﻋ ـ
ﺖﺳا هاﺮ
12. ﺟو ﻦﻳا ﺎﺑ ـ ﻳا دﻮ ـ ﻨﺳ ﻦ ـ ـﻴﺳﻼﻛ مرﺪ ـ
ﻚ
ﻣا ـ ﺼﺑ هزوﺮ ـ ﻧ ترﻮ ـ ﻤﻴﺑ رد ردﺎ ـ
نارﺎ ﻫ ﻴ ﭙ ـ ﺗارﺎﭘﺮ ﻴ ﺋوﺮ ﻴ ﺪ ﻳ ﻢﺴ ﻟوا ﻴ ﻪ
ﻲﻣ هﺪﻳد دﻮﺷ . نارﺎﻤﻴﺑ رد نﻮﻴﺴﻧﺎﺗﺮﭙﻴﻫ ﻫ
ﻴ ﺗارﺎﭘﺮﭙ ﻴ ﺋوﺮ ﻴ ﺪ ﻳ ﻢﺴ ﻟوا ﻴ ﻪ ﻲـﺘﺣ
ا ﻊﻳﺎﺷ ﻒﻴﻔﺧ يرﺎﻤﻴﺑ ﺎﺑ نارﺎﻤﻴﺑ رد ﺖﺳ
13.
-
زوﺮـﺑ ﻲﻠـﺻا ﺖﻠﻋ15
نارﺎــﻤﻴﺑ رد نﻮﻴـﺴﻧﺎﺗﺮﭙﻴﻫ ﻫ
ﻴ ﺗارﺎﭘﺮﭙ ﻴ ﺋوﺮ ﻴ ﺪ ﻳ ﻢـﺴ ﻟوا ــﻴ ﻪ نوﺪــﺑ
لﻼﺘــﺧا
نﺎــﻣرد ﺎــﺑ نﻮﻴــﺴﻧﺎﺗﺮﭙﻴﻫ و ﺖــﺳا ﺺﺨــﺸﻣﺎﻧMEN
ﻫ ﻴ ﺗارﺎﭘﺮﭙ ﻴ ﺋوﺮ ﻴ ﺪ ﻳ ﻢﺴ ﻟوا ﻴ ﻪ ﻲﻤﻧ دﻮﺒﻬﺑ ﺪﺑﺎﻳ
.
ﻲﻌـﺳ ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد
نارﺎﻤﻴﺑ رد يرﺎﻤﻴﺑ ﻦﻳا ﻲﻨﻴﻟﺎﺑ تاﺮﻫﺎﻈﺗ عاﻮﻧا ﻲﻧاواﺮﻓ ،ﺖﺳا هﺪﺷ رﺮﺑ ،ﻪﻌﻟﺎﻄﻣ درﻮﻣ مﺎﺠﻧا تﺎﻌﻟﺎﻄﻣ ﺎﺑ دﻮﺟﻮﻣ يﺎﻫ توﺎﻔﺗ و هﺪﺷ ﻲﺳ
دﻮﺷ نﺎﻴﺑ ﺎﻫرﻮﺸﻛ ﺮﮕﻳد رد هﺪﺷ .
ﻣ ـ شور و داﻮ ﺎﻫ
ﻲﻔﻴﺻﻮﺗ ترﻮﺼﺑ ﻪﻌﻟﺎﻄﻣ ﻦﻳا
ـ ﻪﺘﺷﺬﮔ ﺖـﺳا هﺪﺷ مﺎﺠﻧا ﺮﮕﻧ
هﺪﻧوﺮﭘ و نﺎﺘﺳرﺎﻤﻴﺑ ﻲﻧﺎﮕﻳﺎﺑ رد دﻮﺟﻮﻣ يﺎﻫ آ
ا ﺖـﻳ ...
زا ﻲﻧﺎـﻘﻟﺎﻃ
لﺎﺳ 1369 ﺎﺗ 1389
ﻪـﺘﻓﺮﮔ راﺮـﻗ ﻲـﺳرﺮﺑ ﺖـﺤﺗ ﺪـﻧا
. هﺪـﻧوﺮﭘ
ــﻛ ﻲﻧارﺎــﻤﻴﺑ رد ﻪ
20 ﻲــﺣاﺮﺟ ﻞــﻤﻋ ﺖــﺤﺗ ﺮــﻴﺧا لﺎــﺳ
ﻴﺋوﺮﻴﺗارﺎﭘ ـ ﮔ راﺮﻗ ﻲﻣﻮﺘﻛﺪ ـ
ﺪﻧدﻮﺑ ﻪﺘﻓﺮ
، ﻊﻤﺟ آ ﺲﭙـﺳ و ﺪﺷ يرو
،ﻦﺳ ﻨﺟ ـ
،ﺲ ﺑﺮﻳﻮﺼﺗ شور ،ﻲﻨﻴﻟﺎﺑ ﻢﻳﻼﻋ ـ
ﺺﻴﺨﺸﺗ ﺖﻬﺟ يرادﺮ
مﻮﻧدآ ﻞﺤﻣ )
ﻲﺒﻴﻣﺎﺘﺴﻴﺳ ﻦﻜﺳا (
ﻋ و ﻲﺣاﺮﺟ شور ، ـ
ﺪـﻌﺑ ضراﻮ
ﺪﺷ جاﺮﺨﺘﺳا نارﺎﻤﻴﺑ زا ﻚﻳ ﺮﻫ درﻮﻣ رد ﻲﺣاﺮﺟ ﻞﻤﻋ زا .
ﺲﭙﺳ
هداد ﺎﻫ آ ﺖﺳﺪﺑ هﺪﻣ مﺮﻧ ﻪﺑ راﺰﻓا ﺐـﻟﺎﻗ رد و ﻪـﺘﻓﺎﻳ لﺎﻘﺘﻧاSPSS
ﻤﻧ و لواﺪﺟ ـ
ﻪﺻﻼﺧ ﺎﻫرادﻮ دﺮﮔ
ﻳ ﺪ .
ﻪﺘﻓﺎﻳ ﺎﻫ
لﺎﺳ ﻲﻃ رد يﺎﻫ
1369 - 1389 ، 74 ﻲﺣاﺮﺟ ﻞﻤﻋ ﺖﺤﺗ رﺎﻤﻴﺑ
ﻴﺗارﺎﭘ ـ ﻗ ﻲﻣﻮﺘﻛﺪﻴﺋوﺮ ـ
ﮔ راﺮ ـ ﻪﺘﻓﺮ ﻪﻛ ﺪﻧا 13 دﺮـﻣ درﻮـﻣ )
18 (%
و
61 ﻣ ـ درﻮ نز ) 82 (%
ﺑ ـ هدﻮ ﺪﻧا . ﻣ ﻪﺑ نز ﺖﺒﺴﻧ ـ
ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد دﺮ
6 / 4 ﺑ ﻪ 1 ﺖﺳا هدﻮﺑ )
ﻤﻧ ـ رادﻮ 1 .(
ـﺳﻮﺘﻣ ﻦﺳ ـ
ـﻤﻴﺑ ﻂ ـ ﻪـﻛ ﻲﻧارﺎ ﺤﺗ
ـ
ـﺟ ﻞـﻤﻋ ﺖ ـ
ﻴﺋوﺮﻴﺗارﺎﭘ ﻲﺣاﺮ ـ
ـﺘﻛﺪ ـ ـﻗ ﻲﻣﻮ ـ ـﮔ راﺮ ـ ﻪﺘﻓﺮ
ﺑ ـ
،ﺪﻧدﻮ 11 /
±12 4 / 47 ﺑ لﺎﺳ ـ ﺖﺳا هدﻮ . زا نﺎﻴﻣ 74 ﻤﻴﺑ ـ ،قﻮﻓ رﺎ
رد 68 رﺎﻤﻴﺑ ) 91 (%
ﻲﺒﻴﻣﺎﺘـﺴﻴﺳ ﻦﻜـﺳا ﻲـﺣاﺮﺟ ﻞـﻤﻋ زا ﻞﺒﻗ
دﻮﺑ هﺪﺷ مﺎﺠﻧا .
ﺭﺍﺩﻮﻤﻧ ۱ ـ ﺭﺍﺩﻮﻤﻧ ﻩﺮﻳﺍﺩ ﻼﺘﺒﻣ ﻥﺍﺭﺎﻤﻴﺑ ﺖﻴﺴﻨﺟ ﻊﻳﺯﻮﺗ ﻱﺍ
ﻴﺗا ﺮﻈﻧ زا ـ ﺘﻌﻳﺎﺷ ،يژﻮﻟﻮ ـ
ﻠﻋ ﻦﻳﺮ ـ ﻴﺗارﺎﭘ ﺖ ـ ـﺘﻛﺪﻴﺋوﺮ ـ ﻲﻣﻮ
ﻣ نارﺎﻤﻴﺑ رد ـ
نﺎﺘﺳرﺎﻤﻴﺑ ﻪﺑ هﺪﻨﻨﻛ ﻪﻌﺟاﺮ آ
ا ﺖﻳ ...
،ﻲﻧﺎﻘﻟﺎﻃ مﻮﻧدآ
ﻴﺗارﺎﭘ ـ ﺖـﺳا هدﻮﺑ ﺪﻴﺋوﺮ )
77 (%
و ﻞـﺑﺎﻘﻣ رد 4
%
ﻞـﺑود مﻮـﻧدآ
ﺪﻨﺘﺷاد . ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد 5
ﺮـﻔﻧ ) 7 / 6 (%
ـﻴﺋوﺮﻴﺗارﺎﭘ مﻮﻨﻴـﺳرﺎﻛ ﺪ
رد ﺪﻴﺋوﺮﻴﺗارﺎﭘ يزﻼﭘﺮﭙﻴﻫ و ﺪﻨﺘﺷاد 9
ﺮﻔﻧ ) 12 (%
ﻪﺘـﺷاد دﻮـﺟو
ﺖﺳا ) لوﺪﺟ 1 و ﻮﻤﻧ راد 2 ( .
ﻝﻭﺪــﺟ ۱ ـــ ﺭﺩ ﻥﺍﺭﺎــﻤﻴﺑ ﺭﺩ ﻲﻣﻮﺘﮐﺪــﻴﺋﻭﺮﻴﺗﺍﺭﺎﭘ ﮏــﻳﮊﻮﻟﻮﺗﺎﭘ ﺞﻳﺎــﺘﻧ ﻊــﻳﺯﻮﺗ
ﻝﺎﺳ ﻱﺎﻫ ۱۳۶۹ ﺎﺗ ۱۳۸۹
ﻱﮊﻮﻟﻮﺗﺎﭘ ﺩﺍﺪﻌﺗ
ﺪﺻﺭﺩ
ﻡﻮﻧﺩﺁ ﻞﺑﻭﺩ ﻡﻮﻧﺩﺁ
ﻱﺯﻼﭘ ﺮﭙﻴﻫ
ﺮﺳ ﻥﺎﻃ ۵۷
۳
۹
۵ ۷۷
%
۴
%
۱۲
%
۷ / ۶
%
ﺭﺍﺩﻮﻤﻧ ۲ ـ ﺭﺍﺩﻮﻤﻧ ﻧﻮﺘﺳ ﯽ ﺯﻮﺗ ﻳ ﻊ ﺗﺍ ﻴ ﮊﻮﻟﻮ ﯼ ﺑﻴ ﻥﺍﺭﺎﻤ ﻼﺘﺒﻣ
ﺖــﺤﺗ ﻪــﻛ ﻲﻧارﺎــﻤﻴﺑ يور ﺮــﺑ هﺪــﺷ مﺎــﺠﻧا ﻪــﻌﻟﺎﻄﻣ رد ﻴﺗارﺎﭘ ـ ﮔ راﺮﻗ ﻲﻣﻮﺘﻛﺪﻴﺋوﺮ ـ
ﻪﺘﻓﺮ
،ﺪﻧا ﻤﺗ ـ ـﺑ نارﺎﻤﻴﺑ ﻲﻣﺎ ﻪ
لﺎـﺒﻧد
ﻳﻼﻋ زوﺮﺑ ـ
،ﻲﻨﻴﻟﺎﺑ ﻢ
ـﻛ ﻪـﻌﺟاﺮﻣ ﺰـﻛﺮﻣ ﻦﻳا ﻪﺑ ـ
هدﺮ ﺖـﺤﺗ و ﺪـﻧا
راﺮﻗ ﻲﻣﻮﺘﻛﺪﻴﺋوﺮﻴﺗارﺎﭘ و ﻲﺳرﺮﺑ ﮔ
ﻪﺘﻓﺮ ﺖـﻣﻼﻋ نوﺪﺑ دراﻮﻣ و ﺪﻧا
ـﺤﺗ ﻪـﻛ ﻲﻨﻴﻟﺎﺑ ـ
ـﺘﻛﺪﻴﺋوﺮﻴﺗارﺎﭘ ﻲـﺣاﺮﺟ ﻞـﻤﻋ ﺖ ـ
راﺮـﻗ ﻲﻣﻮ
ﮔ ـ ﻪﺘﻓﺮ ﺪﻧا
، ـﺟو ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد ـ
ﺖـﺷاﺪﻧ دﻮ .
ﻢـﻳﻼﻋ ﻦﻳﺮﺘﻌﻳﺎـﺷ
ﻨﻴﻟﺎﺑ ـ
،قﻮﻓ نارﺎﻤﻴﺑ رد ﻲ ﻲﺑ و ﻒﻌﺿ
رد ﻪـﻛ ﺖـﺳا هدﻮﺑ ﻲﻟﺎﺣ 50
ﺮﻔﻧ ) 67 (%
ـﻤﻴﺑ زا ـ
ﺖـﺳا ﻪﺘـﺷاد دﻮـﺟو نارﺎ .
و ﻒﻌـﺿ زا ﺪـﻌﺑ
ﻲﺑ ﺘﻌﻳﺎﺷ ﻲﻟﺎﺣ ـ
ﻣ ﻦﻳﺮ ﻜﺸ ـ ﻤﻴﺑ تﻼ ـ ﺨﺘﺳا ﻢﻳﻼﻋ ،قﻮﻓ نارﺎ ـ
ﻲﻧاﻮ
ﺎﺑ 62 % ﭙﺳ و ـ ﻳﻼﻋ ﺲ ـ ﺎﺑ يﻮﻴﻠﻛ ﻢ 45
% ﺖﺳا هدﻮﺑ . نﻮﻴﺴﻧﺎﺗﺮﭙﻴﻫ
رد 24 % ﺖﺳا ﻪﺘﺷاد دﻮﺟو قﻮﻓ نارﺎﻤﻴﺑ زا )
لوﺪﺟ 2
، رادﻮﻤﻧ 3 .(
ﻈﻧ زا ـ ﺑ ﺮ ـ نارﺎـﻤﻴﺑ رد ،ﻲـﺣاﺮﺟ ﻞـﻤﻋ لﺎـﺒﻧد ﻪـﺑ ضراﻮـﻋ زوﺮ
ﺘﻛﺪﻴﺋوﺮﻴﺗارﺎﭘ ـ
ـﺘﺳرﺎﻤﻴﺑ رد هﺪﺷ ﻲﻣﻮ ـ
،ﻲﻧﺎـﻘﻟﺎﻃ نﺎ رد
2 ـﻣ درﻮ
) 2 (%
ﺠﻨﺣ ﺐﺼﻋ ﺐﻴﺳآ ـ
هﺮ
ـﺟو ﻪـﻌﺟار يا ـ
ﺖـﺳا ﻪﺘـﺷاد دﻮ .
ﮕﻳد ضراﻮﻋ ـ
زا ﻚـﻳ ﭻﻴـﻫ رد ﻢـﺧز ﺖﻧﻮﻔﻋ ﺎﻳ و مﻮﺗﺎﻤﻫ ﺪﻨﻧﺎﻣ ﺮ
ﺪﺸﻧ هﺪﻳد نارﺎﻤﻴﺑ .
ﻝﻭﺪﺟ ۲ ـ ﻪﻧﺎﺸﻧ ﻊﻳﺯﻮﺗ ﻲﻨﻴﻟﺎﺑ ﻱﺎﻫ
ﻪﻴﻟﻭﺍ ﻢﺴﻳﺪﻴﺋﻭﺮﻴﺗﺍﺭﺎﭘﺮﭙﻴﻫ ﻞـﻤﻋ ﺖـﺤﺗ ﻪﮐ
ﺪﻧﺩﻮﺑ ﻪﺘﻓﺮﮔ ﺭﺍﺮﻗ ﻲﺣﺍﺮﺟ
ﻥﺍﺭﺎﻤﻴﺑ ﻲﻠﺻﺍ ﺕﺎﻳﺎﮑﺷ
ﺩﺍﺪﻌﺗ ﻲﺒﺴﻧ ﺪﺻﺭﺩ
ﻮﻴﻠﮐ ﺕﻼﮑﺸﻣ ﻱ
ﻲﻧﻼﻀﻋ ﺕﻼﮑﺸﻣ ـ
ﻲﺘﻠﮑﺳﺍ
ﻲﮕﺘﺴﺧ ﻭ ﻒﻌﺿ
ﻥﻮﻴﺴﻧﺎﺗﺮﭙﻴﻫ ﺖﻣﻼﻋ ﻥﻭﺪﺑ
۳۴
۴۶
۵۰
۱۸
۰ ۴۵
%
۶۲
%
۶۷
%
۲۴
%
۰
%
ﺭﺍﺩﻮـــﻤﻧ ۳ ــــ ﺭﺍﺩﻮـــﻤﻧ ﻧﻮﺘـــﺳ ﯽ ﻢـــﺋﻼﻋ ﻭ ﻪﻧﺎـــﺸﻧ ﺎـــﻫ ﯼ ﻟﺎـــﺑ ﻴﻨ ﯽ ﺑﻴ ﻥﺍﺭﺎـــﻤ
ﻪﻴﻟﻭﺍ ﻢﺴﻳﺪﻴﺋﻭﺮﻴﺗﺍﺭﺎﭘﺮﭙﻴﻫ ﻪﮐ
ﺖﺤﺗ ﻞﻤﻋ ﺣﺍﺮﺟ ﯽ ﺭﺍﺮﻗ ﻪﺘﻓﺮﮔ ﺪﻧﺩﻮﺑ
ﺚﺤﺑ ﻪﺠﻴﺘﻧ و يﺮـﻴﮔ
ﺗارﺎﭘﺮﭙﻴﻫ ﻢﺴﻳﺪﻴﺋوﺮﻴ ًﺎـﺒﻳﺮﻘﺗ ﺰـﻳر نورد دﺪﻏ يرﺎﻤﻴﺑ ﻪﻴﻟوا
زا ﺶﻴﺑ ﺲﻧاﺪﻴﺴﻧا ﺎﺑ ﻪﻛ ﺖﺳا ﻲﻌﻳﺎﺷ /1000
د1
ﻲـﻣ هﺪﻳ دﻮـﺷ . ﻦـﻳا
ﺢﻄـﺳ ﺶﻳاﺰـﻓا و ﻲﻤﺴﻠﻛﺮﭙﻴﻫ ﺎﺑ يرﺎﻤﻴﺑ نﻮﻣرﻮﺗارﺎـﭘ
ﻪﺘﺧﺎﻨـﺷ
ﻲﻣ دﻮﺷ .
ﻞـﻠﻋ ﻦﻳﺮﺘﻌﻳﺎـﺷ ﻢـﺴﻳﺪﻴﺋوﺮﻴﺗارﺎﭘﺮﭙﻴﻫ
مﻮـﻧدآ ﻪـﻴﻟوا
ﺮـﺳ و ﻞـﺑود مﻮـﻧدآ ،ﺪـﻴﺋوﺮﻴﺗارﺎﭘ يزﻼﭘﺮﭙﻴﻫ ،ﺪﻴﺋوﺮﻴﺗارﺎﭘ ﺎﻃ
ن
ﻲﻣ ﺪﻴﺋوﺮﻴﺗارﺎﭘ ﺪﻨﺷﺎﺑ
.
زا ﺎﻣ ﻪﻌﻟﺎﻄﻣ رد 74
،ﻲـﺳرﺮﺑ ﺖﺤﺗ رﺎﻤﻴﺑ 82
) % 61 ﺮـﻔﻧ ( نز
هدﻮﺑ دﺮﻣ ﻪﺑ نز ﺖﺒﺴﻧ و ﺪﻧا 6
/ 4 ﻪﺑ 1
ﺖـﺳا هدﻮـﺑ .
تﺎـﻌﻟﺎﻄﻣ رد
لﺎـﺳ زا ﺖـﺳا هﺪـﺷ مﺎﺠﻧا ناﺮﻬﺗ رد ﻪﻛ ﺮﮕﻳد ﻪﺑﺎﺸﻣ 1356
ﺎـﺗ
1376 ﻦﻴﺑ ﺖﺒﺴﻧ ﻦﻳا 5
ﻪـﺑ 1 ﺎـﺗ 14 ﻪـﺑ 1
ﺖـﺳا هدﻮـﺑ
16.
-
رد18
ﺮﮕﻳد ﻲﻧﺎﻬﺟ تﺎﻌﻟﺎﻄﻣ ﺖﺳا هدﻮﺑ يﺮﺘﻤﻛ ناﺰﻴﻣ ﻪﺑ ﺖﺒﺴﻧ ﻦﻳا ﺰﻴﻧ
) 3 ﻪﺑ 1 ﺎﺗ 5 ﻪﺑ 1 (
، ﻪﻌﻟﺎﻄﻣ ﺪﻨﻧﺎﻣ هﺪـﺷ مﺎﺠﻧا ﺪﻨﻫ لﺎﻤﺷ رد ﻪﻛ يا
ﺖﺒﺴﻧ ﻦﻳا ﻪﻛ ﺖﺳا 3
/ 3 ﻪﺑ 1 ﺖﺳا هﺪﺷ شراﺰﮔ
19.
و
ﻦﺳ ﻂﺳﻮﺘﻣ20
ﺎﻣ ﻪﻌﻟﺎﻄﻣ رد نارﺎﻤﻴﺑ 4
/ 47 ﻦﻴﻳﺎﭘ ﻪﻛ ﺖﺳا هدﻮﺑ لﺎﺳ ﻦـﺳ زا ﺮـﺗ
يﺎﻫرﻮـﺸﻛ رد ﻲﻠﺒﻗ ﻪﺑﺎﺸﻣ تﺎﻌﻟﺎﻄﻣ رد نارﺎﻤﻴﺑ ﻂﺳﻮﺘﻣ ﻪﻌـﺳﻮﺗ
ﺖﺳا هدﻮﺑ ﻪﺘﻓﺎﻳ )
55 ﺎﺗ 62 لﺎـﺳ (
21.
و
ـﻌﻟﺎﻄﻣ رد22
ـ رد ﻲـﻠﺒﻗ تﺎ
ﻪﻫد 60 و 70 دوﺪﺣ نارﺎﻤﻴﺑ ﻦﺳ ﻂﺳﻮﺘﻣ ناﺮﻳا رد 38
هدﻮـﺑ لﺎﺳ
ﺖﺳا . ﺪﻨﻧﺎﻣ ﻪﻌﺳﻮﺗ لﺎﺣ رد يﺎﻫرﻮﺸﻛ رد يرﺎﻤﻴﺑ ﻦﻳا ﻪﻜﻨﻳا ﺖﻠﻋ
ﻦﻴﻳﺎﭘ ﻦﻴﻨﺳ رد ناﺮﻳا ﻪـﺘﻓﺎﻳ ﻪﻌـﺳﻮﺗ يﺎﻫرﻮـﺸﻛ ﻪـﺑ ﺖﺒﺴﻧ يﺮﺗ
ﻲﻣ دﺎﺠﻳا ﻨﻫ دﻮﺷ ـ هداد ﺢﻴﺿﻮﺗ زﻮ ﺖـﺳا هﺪﺸﻧ
. زا ﻲـﻜﻳ ﺪﻳﺎـﺷ
ﻬﻇ ﻞﻳﻻد ـ ﻦﻴﻳﺎﭘ ﻦﻴﻨﺳ رد يرﺎﻤﻴﺑ رﻮ
،ﺮـﺗ ـﻣ ـ طﺎـﺒﺗرا ﻪـﺑ طﻮﺑﺮ
ﺘﻳو دﻮﺒﻤﻛ ـ
ﻦﻴﻣﺎ دﻮـﺒﻤﻛ ندﻮـﺑ ﻊﻳﺎـﺷ ﺰـﻴﻧ و يرﺎـﻤﻴﺑ ﻦﻳا ﺎﺑD
ﻦﻴﻣﺎﺘﻳو ردD
ﺘﻤﻛ يﺎﻫرﻮﺸﻛ ـ
ﺪـﻨﻫ و ناﺮﻳا ﺪﻨﻧﺎﻣ ﻪﺘﻓﺎﻳ ﻪﻌﺳﻮﺗ ﺮ
ﻲﻣ ﺪﺷﺎﺑ
5.
- 7 و 24 و
ﺐـﻠﻏا ﻪـﻛ ﻪـﺘﻓﺎﻳ ﻪﻌـﺳﻮﺗ يﺎﻫرﻮﺸﻛ فﻼﺧﺮﺑ25
ﺖﻬﺟ ﻪﻌﺟاﺮﻣ دراﻮﻣ
ﻲﺣاﺮﺟ ﻞﻤﻋ
ﻫ ﻴ ﺗارﺎﭘﺮﭙ ﻴ ﺋوﺮ ﻴ ﺪ ﻳ ﻢـﺴ ﻟوا ـﻴ ﻪ ،
ﻲﺳرﺮﺑ رد ﻲﻤﺴﻠﻛﺮﭙﻴﻫ
،ﺖﺳا هدﻮﺑ يﺮﮕﻟﺎﺑﺮﻏ يﺎﻫ ﺎـﻣ ﻪﻌﻟﺎﻄﻣ رد
ﭻﻴﻫ زا ماﺪﻛ 74 هدﻮﺒﻧ ﻲﻨﻴﻟﺎﺑ ﻢﻳﻼﻋ نوﺪﺑ درﻮﻣ ﺪﻧا
.
نارﺎــﻤﻴﺑ ﻪــﻌﻟﺎﻄﻣ ﺎــﺑ ﻪــﻌﻟﺎﻄﻣ ﻦــﻳا زا ﻞــﺻﺎﺣ ﺞﻳﺎــﺘﻧ لﺎﺳ ﻲﻃ ﻲﻨﻴﻤﺧ مﺎﻣا نﺎﺘﺳرﺎﻤﻴﺑ رد ﻲﻣﻮﺘﻛﺪﻴﺋوﺮﻴﺗارﺎﭘ يﺎـﻫ
68
ﺎــﺗ 78 ﻪــﻛ 12 % نوﺪــﺑ ﻲــﺣاﺮﺟ ﻞــﻤﻋ ﺖــﺤﺗ ﻲﻨﻴﻟﺎــﺑ ﻢــﻳﻼﻋ
هدﻮﺑ ﻪﺘﻓﺮﮔ راﺮﻗ ﻲﻣﻮﺘﻛﺪﻴﺋوﺮﻴﺗارﺎﭘ
،ﺪـﻧا
دراﺪـﻧ ﻲﻧاﻮـﺨﻤﻫ
16. رد
ﻲﻳﺎـﺳﺎﻨﺷ دراﻮـﻣ داﺪـﻌﺗ زﻮـﻨﻫ ﻪـﺘﻓﺎﻳ ﻪﻌﺳﻮﺗ ﺮﺘﻤﻛ يﺎﻫرﻮﺸﻛ ﻫ ﻴ ﺗارﺎﭘﺮﭙ ﻴ ﺋوﺮ ﻴ ﺪ ﻳ ﻢــﺴ ﻟوا ــﻴ ﻪ كﺪــﻧا يﺮﮕﻟﺎــﺑﺮﻏ لﺎــﺒﻧد ﻪــﺑ
ﻲﻣ ﺪﺷﺎﺑ
19،
و
،ﻲـﺑﺮﻏ يﺎﻫرﻮﺸﻛ رد ﻪﻛ ﻲﻟﺎﺣ رد26
داﺪـﻌﺗ ﻪﻧﺎﻴﻟﺎـﺳ
نارﺎــﻤﻴﺑ زا يﺮﺘــﺸﻴﺑ ﻫ
ﻴ ﺗارﺎﭘﺮﭙ ﻴ ﺋوﺮ ﻴ ﺪ ﻳ ﻢــﺴ ﻟوا ــﻴ ﻪ لﺎــﺒﻧد ﻪــﺑ
ﺖﺴﺗ ﻲﻣ ﻲﻳﺎﺳﺎﻨﺷ يﺮﮕﻟﺎﺑﺮﻏ يﺎﻫ ﺪﻧﻮﺷ
27.
ﺘﻌﻳﺎﺷ ـ ﻫﺎﻈﺗ ﻦﻳﺮ ـ ﻤﻴﺑ ﻲﻨﻴﻟﺎﺑ تاﺮ ـ
،نارﺎ ﻲـﺑ و ﻒﻌﺿ ﻲﻟﺎـﺣ
ﺑ ـ ﺖﺳا هدﻮ . ﺸﻣ ﻦﻳا ـ ﻌﻟﺎﻄﻣ رد نارﺎﻤﻴﺑ ﻲﻣﺎﻤﺗ رد ﻞﻜ ـ
،ﻲـﻠﺒﻗ تﺎ
ﻤﻋ ﺖﻤﺴﻗ ـ
هﺪ ﻤﻴﺑ تﻼﻜﺸﻣ زا يا ـ
ﻓ نارﺎ ـ ﻲﻣ ﻞﻣﺎﺷ ار قﻮ هﺪـﺷ
ﺖﺳا . ﮓﻨﺳ ﻴﻠﻛ يﺎﻫ ـ ﻼﻜﺸﻣ و يﻮ ﻴﻠﻛ ت
ـ ـﻓ نارﺎﻤﻴﺑ رد يﻮ ـ
قﻮ
رد 45 % ﻣ ـ ﺖﺳا هﺪﺷ هﺪﻳد دراﻮ .
ﻟﺎﻄﻣ ود رد ـ
ناﺮـﻳا رد ﻲﻠﺒﻗ ﻪﻌ
ﺿاو رﻮﻃ ﻪﺑ ـ
ـﻫﺎﻛ لﺎـﺣ رد ﺪـﺻرد ﻦﻳا ﺢ ـ
زا و ﺖـﺳا هدﻮـﺑ ﺶ
3 / 84 % لﺎﺳ رد يﺎﻫ 57 ﺎﺗ 67 ﻪﺑ 6 / 61 % لﺎﺳ رد يﺎﻫ 68 ﺎـﺗ 78
ﻓﺎﻳ ﺶﻫﺎﻛ ـ ﻜﻴﻟو ﺖﺳا ﻪﺘ ـ
ـﺘﺧا زﻮـﻨﻫ ﻦ ـ
ـﻓ فﻼ ـ ـﻴﺑ ﻲﻧاواﺮ ـ
ﻦ
ﺻرد ـ ﺟو ﺪ ـ ﻨﺳ دﻮ ـ ﮓ يﺎﻫ ﻴﻠﻛ ـ ﻳا ﻦﻴﺑ يﻮ ـ
ـﺸﻛ ﺎـﺑ ناﺮ ـ
يﺎﻫرﻮ
دراد دﻮﺟو ﻲﺑﺮﻏ .
نارﺎـﻤﻴﺑ زا ﻲﻬﺟﻮـﺗ ﻞﺑﺎﻗ ﺪﺻرد رد ﺰﻴﻧ ﻲﻧاﻮﺨﺘﺳا تﻼﻜﺸﻣ
ﺖﺳا هﺪﺷ هﺪﻫﺎﺸﻣ .
ﻲﻧاواﺮﻓ ﻫ ﻴ ﺴﻧﺎﺗﺮﭙ ﻴ نﻮ ﻚـﻳ ناﻮـﻨﻋ ﻪـﺑ ﺰﻴﻧ
ﺎـﺑ ﻂﺒﺗﺮﻣ ﻲﻗوﺮﻋ ﻲﺒﻠﻗ لﻼﺘﺧا ﻫ
ﻴ ﺗارﺎﭘﺮﭙ ﻴ ﺋوﺮ ﻴ ﺪ ﻳ ﻢـﺴ ﻟوا ـﻴ ﻪ رد
دﻮﺑ هﺪﺸﻧ ﻲﺳرﺮﺑ ناﺮﻳا رد ﻲﻠﺒﻗ تﻻﺎﻄﻣ
،
ـﻣ ﻪـﻌﻟﺎﻄﻣ رد ﻲﻟو رد ﺎ
24 % ﺪﺷ هﺪﻫﺎﺸﻣ نارﺎﻤﻴﺑ .
ﻟﻮﺗﺎﭘ ﻲﺳرﺮﺑ ﺞﻳﺎﺘﻧ ﺮﻈﻧ زا ـ
ﻲﻣﻮﺘﻛﺪـﻴﺋوﺮﻴﺗارﺎﭘ نارﺎﻤﻴﺑ يژﻮ
ﻴﺗارﺎﭘ مﻮﻧدآ هﺪﺷ ـ
رد ﺪﻴﺋوﺮ 77 ) % 57 ﻔﻧ ـ ﺮ ( رد ﻞـﺑود مﻮـﻧدآ و
4 ) % 3 ﺮﻔﻧ ( ﺪﺷ ﺖﻓﺎﻳ نارﺎﻤﻴﺑ زا .
ﻲﺳرﺮﺑ ﺞﻳﺎﺘﻧ ﻪﺑﺎﺸﻣ قﻮﻓ ﺞﻳﺎﺘﻧ
ﻲﻣ ﻲﺑﺮﻏ تﺎﻌﻟﺎﻄﻣ ﺮﮕﻳد رد ﺪﺷﺎﺑ
29.
و
رد ﺪـﻴﺋوﺮﻴﺗارﺎﭘ مﻮﻨﻴﺳرﺎﻛ30
ﻪــﻜﻴﻟﺎﺣ 1 ﺎــﺗ 2 % دراﻮــﻣ زا ﻫ
ﻴ ﺗارﺎﭘﺮﭙ ﻴ ﺋوﺮ ﻴ ﺪ ﻳ ﻢــﺴ ﻟوا ــﻴ ﻪ رد ار
ﻲﻣ ﻞﻣﺎﺷ ﺮﮕﻳد يﺎﻫرﻮﺸﻛ ﻪﺑ ار يﺮﺗﻻﺎﺑ ﺪﺻرد ﺎﻣ ﻪﻌﻟﺎﻄﻣ رد ،دﻮﺷ
ﺖﺳا هداد صﺎﺼﺘﺧا دﻮﺧ )
7 / 6
% - 5 ﺮﻔﻧ (
30.
و
31
ﻫ ﻴ ﺗارﺎﭘﺮﭙ ﻴ ﺋوﺮ ﻴ ﺪ ﻳ ﻢــﺴ ﻟوا ــﻴ ﻪ ﻊﻳﺎــﺷ ًﺎــﺒﻳﺮﻘﺗ يرﺎــﻤﻴﺑ ﻚــﻳ
ﻦﻳﺮﻛوﺪﻧا ا
ﺖﺳ نز زا يﺮﺘﺸﻴﺑ ﺪﺻرد ﺎﻣ رﻮﺸﻛ رد ﻪﻛ ﻣﺎـﺷ ار ﺎﻫ
ﻞ
ﻲﻣ ﻦﻴﻳﺎﭘ ﻦﻴﻨﺳ رد و دﻮﺷ ﻲﻣ ﺮﻫﺎﻈﺗ ﺮﺗ
ﺪﺑﺎﻳ .
ﻦﻳا هﺪﻨﻨﻛ ناﻮﺗﺎﻧ ضراﻮﻋ ﺎﺑ نارﺎﻤﻴﺑ ﺮﺜﻛا ﻪﻌﺟاﺮﻣ ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ و يﻮـﻴﻠﻛ ضراﻮﻋ ،ﻲﻗوﺮﻋ و ﻲﺒﻠﻗ ،ﻲﻧاور تﻻﻼﺘﺧا ﺪﻨﻧﺎﻣ يرﺎﻤﻴﺑ
ﺖﺴﺗ مﺎﺠﻧا ﻪﺑ زﺎﻴﻧ لﺎﺘﻠﻜﺳاﻮﻟﻮﻜﺳﻮﻣ
ﺖـﻬﺟ ﮓﻨﻴﻨﻳﺮﻜـﺳا يﺎﻫ
ﻪـﺑ ﻪﺟﻮﺗ ﺎﺑ ،نآ ﻲﺣاﺮﺟ نﺎﻣرد و يرﺎﻤﻴﺑ ﻦﻳا يﺮﮕﻟﺎﺑﺮﻏ ضراﻮـﻋ
ﻲﻣ ﺮﻈﻧ ﻪﺑ ﻲﻘﻄﻨﻣ قﻮﻓ ﻲﺣاﺮﺟ ﻞﻤﻋ ﻢﻛ ﺪﺳر
.
زا ﻞـﺒﻗ مﻮـﻧدآ نﻮﻴﺳاﺰﻴﻟﺎﻛﻮﻟ يرادﺮﺑﺮﻳﻮﺼﺗ تﺎﻌﻟﺎﻄﻣ مﺎﺠﻧا
ﺪـﻌﺑ ضراﻮﻋ ﺶﻫﺎﻛ ﻪﺑ ﻲﺒﻴﻣﺎﺘﺴﻴﺳ ﻦﻜﺳا ﺪﻨﻧﺎﻣ ﻲﺣاﺮﺟ ﻞﻤﻋ زا
ﻲﻣ ﻚﻤﻛ ﻞﻤﻋ ﺪﻨﻛ
.
Abstract:
Clinical Survey of Patients with Primary Hyperparathyroidism who Underwent Surgery at Taleghani Hospital
during 20 Years Ago
Kamani F. MD*, Mohammadi S. S. MD**, Tavassoli S. MD***
Hessami R. MD**, Peirovi H. MD****
(Received: 7 Aug 2011 Accepted: 15 Nov 2011)
Introduction & Objective:Primary hyperparathyroidism (PHPI) is a common disease mostly seen in women. Symptomatic PHPT is the predominant form of the disease in many parts of the developing world. In the countries with a screening system, it is usually seen and treated without presenting any symptom. In this study it is tried to define the frequency of different clinical symptoms in these group of patients in compare with other countries.
Materials & Methods: A retrospective descriptive study of records of the patients, who had surgical operation from 1990 to 2010 at Taleghani Hospital, was done. All relevant information (age, sex, clinical presentation and diagnostic imaging procedures) were collected in this survey. Then the data were analyzed by SPSS.
Results: 82% of patients were female with the mean age of 47.4 years. None of the patients were without clinical symptoms. Bone disease (62%) and renal disease (45%) were most common manifestation of PHPT.
Pathological review of cases revealed adenoma (77%), hyperplasia (12%), double adenoma (4%) and carcinoma (6.7%).
Conclusions: PHPT in Iran is a symptomatic disease with predominant features of renal and bone disorders at a much younger age in compare with other countries. In recent decades, the age of becoming afflicted by this disease has increased in Tehran, but it is still lower than that of the west.
Key Words: Primary Hyperparathyroidism, Parathyroid
*Associate Professor of General Surgery, Shahid Beheshti University of Medical Sciences and Health Services, Taleghani Hospital, Tehran, Iran
**Resident of General Surgery, Shahid Beheshti University of Medical Sciences and Health Services, Taleghani Hospital, Tehran, Iran
***Resident of ENT, Tabriz University of Medical Sciences and Health Services, Emam Reza Hospital, Tabriz, Iran
****Professor of General Surgery, Shahid Beheshti University of Medical Sciences and Health Services, Taleghani Hospital, Tehran, Iran
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