ﻣﺰﻣﻦ ﺑﻴﻤﺎﺭﻱ ﻭ ﻣﺰﻣﻦ ﺑﺮﻭﻧﺸﻴﺖ ﺑﻪ ﻣﺒﺘﻼ ﺑﻴﻤﺎﺭﺍﻥ ﺩﺭ ﻣﺘ

(1)

ﻪﻠﺠﻣ ﻡﻮﻠﻋ ﻱﺯﺍﺭ ﻲﻜﺷﺰﭘ

ﻩﺭﻭﺩ 20

، ﻩﺭﺎﻤﺷ 108 ﺩﺍﺩﺮﺧ ، 1392

http://rjms.tums.ac.ir

ﻲﺸﻫﻭﮋﭘ ﻪﻟﺎﻘﻣ

ﻪﻣﺪﻘﻣ ﻡﻭﺭﺪﻨــــــــﺳ ﻚــــــــﻴﻟﻮﺑﺎﺘﻣ

)

Metabolic

syndrome=MetS

( ﻲﻋﻮﻧ ﻪﻛ ﻝﻼﺘﺧﺍ

ﻚﻳژﻮﻟﻮﻳﺰﻴﻓ

ﻭ ﻲﻳﺎﻴﻤﻴﺷﻮﻴﺑ ﺖﺳﺍ

، ﺎﺑ ﺖﺑﺎﻳﺩ ﺎﻳ ﺶﻳﺍﺰﻓﺍ ﺪﻨﻗ ﻥﻮـﺧ

،ﺎﺘﺷﺎﻧ ﻲﻗﺎﭼ

،ﻱﺰﻛﺮﻣ ﺕﻻﻼﺘـﺧﺍ

ﺢﻄـﺳ ﻲﻳﺎﻤـﺳﻼﭘ

ﻱﺮﺗ ﺪﻳﺮﺴﻴﻠﮔ ﻭ

ﻝﻭﺮﺘﺴﻠﻛ ﻭ

ﺰﻴﻧ ﺶﻳﺍﺰﻓﺍ ﺭﺎﺸﻓ ﻥﻮـﺧ

ﺖﺳﺍ ﻩﺍﺮﻤﻫ )

1 ﻭ 2 .(

ﺯﺍ ﺮﻫ 4 ﺎﺗ 5 ﺩﺮﻓ ﻎﻟﺎﺑ ﻚﻳ

ﺮﻔﻧ ﻞﻴﻟﺩﻪﺑﺐﻠﻏﺍﻪﻛ،ﺖﺳﻼﺘﺒﻣ ﻡﻭﺭﺪﻨﺳﻦﻳﺍﻪﺑ ﻂﻳﺍﺮﺷ

ﻲﻄﻴﺤﻣ ﻭ ﻂﻳﺍﺮﺷ ﻲﮔﺪﻧﺯ ﻪﻧﺍﺯﻭﺭ ﻦﻳﺍ ﺩﺍﺮﻓﺍ ﻲﻣ ﺪـﺷﺎﺑ

.ﻩﮋﻳﻭﻪﺑ ﻭﺩﺍﺮﻓﺍﻦﺳﺶﻳﺍﺰﻓﺍ ﺎﺑﻡﻭﺭﺪﻨﺳﻦﻳﺍﺯﻭﺮﺑﺥﺮﻧ ﺎﺑ ﺶﻳﺍﺰﻓﺍ ﻦﺳ ﻪﺑ ﺮﺗﻻﺎـﺑ ﺯﺍ 50 ﻝﺎـﺳ ﺶﻳﺍﺰـﻓﺍ ﺍﺪـﻴﭘ

ﻲﻣ ﺪـﻨﻛ . ﻦـﻳﺍ ﻪـﺿﺭﺎﻋ ًﺎـﺒﻳﺮﻘﺗ

30 % ﻡﺩﺮـﻣ ﺎـﭘﻭﺭﺍ ﺍﺭ ﺭﺎــﺘﻓﺮﮔ

ﻩﺩﺮــﻛ ﺖــﺳﺍ ) 2 .(

ﺶﻴــﺑ ﺯﺍ 40 % ﺯﺍ ﻡﺩﺮــﻣ

ﺎﻜﻳﺮﻣﺁ ﺰﻴﻧ ﻪﺑ ﻦﻳﺍ ﻪﺿﺭﺎﻋ ﻼﺘﺒﻣ ﺪﻨﺘـﺴﻫ ) 3 .(

ﺐـﻠﻏﺍ

ﻥﺍﺮﮕﺸﻫﻭﮋﭘ ﺮﺑ

ﻦـﻳﺍ ﻩﺪـﻴﻘﻋ ﺪـﻧﺍ ﻪـﻛ ﻲﻋﻮـﻧMetS

ﻪﻧﺎﺸﻧ ﺶﻴﭘ ﻲﻬﮔﺁ ﻩﺪﻨﻫﺩ ﻱﺍﺮﺑ ﻼﺘﺑﺍ ﻪﺑ ﻱﺭﺎﻤﻴﺑ

ﻱﺎﻫ ) ﺖـﺳﺍ ﻡﻭﺩﻉﻮﻧﺖﺑﺎﻳﺩ ﻪﺑ ﻼﺘﺑﺍﺰﻴﻧ ﻭﻲﻗﻭﺮﻋﻲﺒﻠﻗ 4 ﺮـﺑﺍﺮﺑ ﻭﺩﻡﻭﺭﺪﻨﺳﻦﻳﺍﻪﺑﻼﺘﺒﻣﺩﺍﺮﻓﺍ .(5ﻭ ﺖـﻴﻌﻤﺟ

ﻱﺩﺎﻋ ﺭﺩ ﺮﻄﺧ ﻼﺘﺑﺍ ﻪﺑ ﻱﺭﺎﻤﻴﺑ ﻱﺎﻫ ﻲﺒﻠﻗ ﻲﻗﻭﺮﻋ

ﻭ ﺖﺑﺎﻳﺩ ﻪﺑﻼﺘﺑﺍﺮﻄﺧﺭﺩﻱﺩﺎﻋﺖﻴﻌﻤﺟ ﺮﺑﺍﺮﺑﺞﻨﭘ ﻉﻮﻧ .( 5ﻭ 1 ) ﺪﻧﺭﺍﺩ ﺭﺍﺮﻗﻡﻭﺩ

ﺡﻼﻄﺻﺍ ﻪﺑ MetS

ﺮﺧﺍﻭﺍ ﻪﻫﺩ 1950 ﻲﻣﺮﺑ ﺩﺩﺮﮔ

.ﺪﺷﻝﻭﺍﺪﺘﻣ1970ﻪﻫﺩ ﺮﺧﺍﻭﺍﺭﺩﻱﺭﺍﺬﮔ ﻡﺎﻧﻦﻳﺍﺎﻣﺍ ﻭ ﻱﺍﺮﺑ ﻡﺎﻧ ﻥﺩﺮـﺑ ﺯﺍ ﻲﻣﻭﺭﺪﻨـﺳ ﻪـﻛ

ﻪـﻋﻮﻤﺠﻣ ﻱﺍ

ﺯﺍ

ﺪﻴﺳﺮﺘﻛﺩ ﻲﻠﻋ ﺩﺍﻮﺟ ﻱﻮﺳﻮﻣ : ﻕﻮﻓ ﻭ ﺭﺎﻴﺸﻧﺍﺩ ﺺﺼﺨﺗ

،ﻪﻳﺭ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺕﺮﻀﺣ ﻝﻮﺳﺭ

،ﻡﺮﻛﺍ ﻩﺎﮕﺸﻧﺍﺩ ﻡﻮﻠﻋ ﻲﻜﺷﺰﭘ ﻥﺍﺮﻬﺗ

، ﻥﺍﺮﻬﺗ

، ﻥﺍﺮﻳﺍ . [email protected]

ﺪﻴﺳﺮﺘﻛﺩ ﺪﻤﺤﻣ ﻲﻧﺍﺪﻤﺻ ﺩﺮﻓ : ﻕﻮﻓﻭ ﺭﺎﻳﺩﺎﺘﺳﺍ ﺺﺼﺨﺗ

،ﺩﺪﻏ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺕﺮﻀﺣ ﻝﻮﺳﺭ

، ﻥﺍﺮﻬﺗ

، ﻥﺍﺮﻳﺍ .

[email protected]

* ﺮﺘﻛﺩ ﻞﻴﻋﺎﻤﺳﺍ ﻲﻤﺳﺎﻗ ﻲﻳﻼﻛﺎﺷﺎﭘ ﻱﻮﻠﻓ:

ﻕﻮﻓ ﺺﺼﺨﺗ

،ﻪﻳﺭ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺕﺮﻀﺣ ﻝﻮﺳﺭ

، ﻥﺍﺮﻬﺗ

، ﻥﺍﺮﻳﺍ . )

* ﻩﺪﻨﺴﻳﻮﻧ ﻝﻮﺌﺴﻣ (

ﻱﻮﺠﺸﻧﺍﺩ: ﻲﮕﻴﺑﺪﻴﺷﺭﺩﻼﻴﻣﺮﺘﻛﺩ

،ﻲﻜﺷﺰﭘ ﻪﺘﻴﻤﻛ ﺕﺎﻘﻴﻘﺤﺗ

،ﻲﻳﻮﺠﺸﻧﺍﺩ ﻩﺎﮕﺸﻧﺍﺩ ﻡﻮﻠﻋ ﻲﻜﺷﺰﭘ ﻡﻼﻳﺍ

، ﻡﻼﻳﺍ

، ﻥﺍﺮﻳﺍ . [email protected]

ﻉﻮﻴﺷ ﻡﺭﺪﻨﺳ

ﻚﻴﻟﻮﺑﺎﺘﻣ ﺭﺩ

ﻥﺍﺭﺎﻤﻴﺑ ﻼﺘﺒﻣ

ﻪﺑ ﺖﻴﺸﻧﻭﺮﺑ ﻦﻣﺰﻣ

ﻭ ﻱﺭﺎﻤﻴﺑ ﻦﻣﺰﻣ

ﻱﺩﺍﺪﺴﻧﺍ ﻪﻳﺭ

ﻪﻌﺟﺍﺮﻣ ﻩﺪﻨﻨﻛ

ﻪﺑ ﻩﺎﮕﻧﺎﻣﺭﺩ ﻪﻳﺭ

ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺕﺮﻀﺣ

ﻝﻮﺳﺭ ﻡﺮﻛﺍ

ﻥﺍﺮﻬﺗ

ﺯﺍ ﺮﻬﻣ 1389 ﺎﺗ

ﺪﻨﻔﺳﺍ 1389

ﻩﺪﻴﻜﭼ ﻪﻨﻴﻣﺯ ﻭ ﻑﺪﻫ : ﻡﻭﺭﺪﻨﺳ ﻚﻴﻟﻮﺑﺎﺘﻣ ) Metaboloc Syndrome=MetS (

ﻲﻋﻮﻧ ﻝﻼﺘﺧﺍ ﻚﻳژﻮﻟﻮﻳﺰﻴﻓ ﻭ ﻲﻳﺎﻴﻤﻴﺷﻮﻴﺑ ﺖﺳﺍ ﻪﻛ ﺎﺑ ﺖﺑﺎﻳﺩ ﺎﻳ ﺶﻳﺍﺰﻓﺍ ﺪﻨﻗ

ﻥﻮﺧﻩﺩﺍﺩﻥﺎﺸﻧﺪﻳﺪﺟﻱﺎﻫﻪﻳﺮﻈﻧﻲﺧﺮﺑ .ﺪﺷﺎﺑ ﻲﻣ ﻩﺍﺮﻤﻫﻥﻮﺧﺭﺎﺸﻓﺶﻳﺍﺰﻓﺍﺰﻴﻧ ﻭﻝﻭﺮﺘﺴﻠﻛ ﻭﺪﻳﺮﺴﻴﻠﮔﻱﺮﺗﻲﻳﺎﻤﺳﻼﭘﺢﻄﺳﺕﻻﻼﺘﺧﺍ،ﻱﺰﻛﺮﻣﻲﻗﺎﭼ،ﺎﺘﺷﺎﻧ ﺪﻧﺍ )ﻪﻳﺭ ﻱﺩﺍﺪﺴﻧﺍ ﻦﻣﺰﻣ ﻱﺭﺎﻤﻴﺑ ﻭﻦﻣﺰﻣ ﺖﻴﺸﻧﻭﺮﺑﺮﻴﻈﻧ ﻱﻮﻳﺭ ﻱﺎﻫ ﻱﺭﺎﻤﻴﺑﻪﺑ ﻥﺎﻳﻼﺘﺒﻣﺭﺩﻡﻭﺭﺪﻨﺳﻦﻳﺍ ﺯﻭﺮﺑ ﻪﻛ COPD= Chronic Obstructive

Pulmonary Disease (

ﺮﺘﺸﻴﺑ ﺯﺍ ﺖﻴﻌﻤﺟ ﻱﺩﺎﻋ ﺖﺳﺍ . ﺭﺩ ﻦﻳﺍ ﻪﻌﻟﺎﻄﻣ ﺪﺼﻗ ﻢﻳﺭﺍﺩ ﺎﺗ ﻪﺑ ﻲﺳﺭﺮﺑ ﻉﻮﻴﺷ ﻡﻭﺭﺪﻨﺳ ﻚﻴﻟﻮﺑﺎﺘﻣ ﺭﺩ ﻥﺎﻳﻼﺘﺒﻣ ﻪﺑ ﻭCOPD ﺖﻴﺸﻧﻭﺮﺑ

ﻦﻣﺰﻣ ﺭﺩ ﻚﻳ ﻪﻧﻮﻤﻧ ﻲﻧﺍﺮﻳﺍ ﻢﻳﺯﺍﺩﺮﭙﺑ .

ﺵﻭﺭ ﺭﺎﻛ : ﺭﺩ ﻦﻳﺍ ﻪﻌﻟﺎﻄﻣ ﻲﻌﻄﻘﻣ

، 204 ﺭﺎﻤﻴﺑ ﻼﺘﺒﻣ ﻪﺑ ﻭCOPD ﺖﻴﺸﻧﻭﺮﺑ ﻦﻣﺰﻣ ﻪﻌﺟﺍﺮﻣ ﻩﺪﻨﻨﻛ ﻩﺎﮕﻧﺎﻣﺭﺩ ﻪﺑ ﻪﻳﺭ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺕﺮﻀﺣ ﻝﻮﺳﺭ ﻡﺮﻛﺍ ﻥﺍﺮﻬﺗ ﺯﺍ

ﺮﻈﻧ ﻼﺘﺑﺍ ﻪﺑ ﻡﻭﺭﺪﻨﺳ ﻚﻴﻟﻮﺑﺎﺘﻣ ﻲﺳﺭﺮﺑ ﺪﻧﺪﺷ . ﺢﻄﺳ ﻲﻧﻮﺧ ﻲﺑﺮﭼ ﻱﺎﻫ ﻥﻮﺧ ) ﻭTG (، HDL ﺢﻄﺳ

، CRP ﻑﺮﺼﻣ ﺭﺎﮕﻴﺳ ﻭ ﺢﻄﺳ ﻲﺑﺎﻳﺯﺭﺍFBS

ﻭ ﻁﺎﺒﺗﺭﺍ ﻥﺁ

ﺎﺑ .ﺪﺷﻩﺪﻴﺠﻨﺳﻚﻴﻟﻮﺑﺎﺘﻣﻡﻭﺭﺪﻨﺳﻪﺑﻼﺘﺑﺍ

ﺎﻫ ﻪﺘﻓﺎﻳ : ﻉﻮﻴﺷ ﻡﻭﺭﺪﻨﺳ ﻚﻴﻟﻮﺑﺎﺘﻣ ﺭﺩ ﺖﻴﻌﻤﺟ ﻥﺎﻳﻼﺘﺒﻣ ﻪﺑ ﺽﺭﺍﻮﻋ ﻱﻮﻳﺭ 48 % ﺩﻮﺑ . ﻦﺳ ﻥﺍﺭﺎﻤﻴﺑ ) 0,003 = (، P ﻲﻗﺎﭼ ﻲﻤﻜﺷ ) 0,001

<

(، P ﻻﺎﺑFBS

) 0,04 = (، P ﻻﺎﺑTG ) 0,001

<

(P ﻭ ﺖﺒﺜﻣCRP ) 0,004 = (P ﻪﺑ ﻥﺍﻮﻨﻋ ﻱﺎﻫﺮﻴﻐﺘﻣ ﻂﺒﺗﺮﻣ ﺎﺑ (MetS ﻪﺘﺧﺎﻨﺷ ﺪﻧﺪﺷ .

ﻪﺠﻴﺘﻧ ﻱﺮﻴﮔ : ﻲﻧﺍﻭﺍﺮﻓ ﻡﻭﺭﺪﻨﺳ ﻚﻴﻟﻮﺑﺎﺘﻣ ﺭﺩ ﺖﻴﻌﻤﺟ ﻼﺘﺒﻣ ﻪﺑ ﻭCOPD ﺖﻴﺸﻧﻭﺮﺑ ﻦﻣﺰﻣ ﺶﻴﺑ ﺮﺗ ﺯﺍ ﻦﻳﺮﻳﺎﺳ ﺖﺳﺍ . ﻪﺑ ﺮﻈﻧ ﻲﻣ

،ﺪﺳﺭ ﻦﺳ ﻭ ﻱﺎﻫﺪﻨﻳﺁﺮﻓ ﻲﺑﺎﻬﺘﻟﺍ

، . ﺪﻨﺷﺎﺑﻡﻭﺭﺪﻨﺳﻦﻳﺍﺯﻭﺮﺑﺭﺩﻞﻴﺧﺩﻱﺎﻫﻢﺴﻴﻧﺎﻜﻣﻦﻳﺮﺗﻢﻬﻣ

ﻠﻛ ﻴ ﻩژﺍﻭﺪ ﺎﻫ : ﻡﻭﺭﺪﻨﺳ

،ﻚﻴﻟﻮﺑﺎﺘﻣ ﺖﻴﺸﻧﻭﺮﺑ

،ﻦﻣﺰﻣ ﻱﺭﺎﻤﻴﺑ ﻦﻣﺰﻣ ﻱﺩﺍﺪﺴﻧﺍ ﻪﻳﺭ (COPD) .

ﺖﻓﺎﻳﺭﺩ ﺦﻳﺭﺎﺗ :

25 /5 / 88 ﺵﺮﻳﺬﭘ ﺦﻳﺭﺎﺗ :

11 / 11 / 89

ﺖﻓﺎﻳﺭﺩ ﺦﻳﺭﺎﺗ :

ﺵﺮﻳﺬﭘ ﺦﻳﺭﺎﺗ :

(2)

ﺖﻴﺸﻧﻭﺮﺑ ﻪﺑ ﻼﺘﺒﻣ ﻥﺍﺭﺎﻤﻴﺑ ﺭﺩ ﻚﻴﻟﻮﺑﺎﺘﻣ ﻡﺭﺪﻨﺳ ﻉﻮﻴﺷ ...

ﻡﻮﻠﻋ ﻪﻠﺠﻣ ﻱﺯﺍﺭ ﻲﻜﺷﺰﭘ

ﻩﺭﻭﺩ 20 ﻩﺭﺎﻤﺷ ، 108 ﺩﺍﺩﺮﺧ ، 1392

79

ﺪﻨﭼ ﻞﻣﺎﻋ ﺮﻄﺧ ﺮﻴﻈﻧ ﺖﺑﺎﻳﺩ ﺩﻮﺑ

، ﻪﺑ ﺭﺎﻛ ﻲﻣ ﺖـﻓﺭ

. ﻦﻴـﻨﭼ ﺩﻮـﺟﻭ ﺯﺍ ﺰـﻴﻧ 1920 ﻪـﻫﺩﺭﺩﻊﺑﺎﻨﻣﻲﺧﺮﺑ ﻲﻣﻭﺭﺪﻨﺳ ﻉﻼﻃﺍ

ﻩﺩﺍﺩ ﺪﻧﺍ ) 6 ﻭ 7 .(

ﻦﻳﺮﻳﺎـﺳ ﺰـﻴﻧ

ﺎـﺗ ﺍﺭﻩژﺍﻭﻦــﻳﺍ ﻦــﻳﺍ ﺯﺍ80ﻪــﻫﺩﻲﻳﺍﺪــﺘﺑﺍﻱﺎــﻫ ﻝﺎـﺳ ﻞﻣﺎﻛ ﺮﺗ ﻩﺩﺮﻛ ﻭ ﻁﺎﺒﺗﺭﺍ ﻥﺁ ﺎﺑ ﺖﺑﺎﻳﺩ ﻭ ﻱﺭﺎﻤﻴﺑ

ﻲﺒﻠﻗ ^.(13-8 )ﺪﻧﺩﺍﺩﻥﺎﺸﻧﺍﺭ ﻚــﺴﻳﺭ ﻱﺎــﻫﺭﻮﺘﻛﺎﻓ

ﻞﻣﺎــﺷ MetS

ﺖــﻣﻭﺎﻘﻣ

ﻪــﺑ ) ﻲﻗﺎـﭼ (، Resistance IR=Insulin ) ﻦﻴﻟﻮـﺴﻧﺍ ﻪـﺑ ﺶﻳﺍﺰـﻓﺍ ،ﻥﻮـﺧ ﺭﺎـﺸﻓﺶﻳﺍﺰﻓﺍ (،ﻲﻤﻜﺷ ﻲﻗﺎﭼﻩﮋﻳﻭ ﺪﻨﻗ ﺎﺘﺷﺎﻧ ﺎﻳ ﻲﻤﺴﻴﻠﮔﺮﭙﻳﺎﻫ ﻭ

ﺕﻻﻼﺘﺧﺍ ﻱﺪﻴﭙﻴﻟ

ﻲﻣ ﻲﺗﺭﻮـﺻﺭﺩ، ﻩﺪـﺷ ﺡﺮـﻄﻣﻪﺿﺭﺎﻋ ﺞﻨﭘﺯﺍ .ﺪﺷﺎﺑ ﻪـﻛﻡﻭﺭﺪﻨﺳﺺﻴﺨﺸﺗ، ﺪﺷﺎﺑﻪﺿﺭﺎﻋ ﻪﺳﻪﺑ ﻼﺘﺒﻣﻱﺩﺮﻓ ﻚﻴﻟﻮﺑﺎﺘﻣ ﻱﺍﺮﺑ

ﻱﻭ ﻪﺘﺷﺍﺬﮔ ﻲﻣ

،ﺩﻮﺷ ﻦﻳﺍ ﺎـﻫﺭﺎﻴﻌﻣ

ﻪﺑ ﺭﺍﺮﻗ ﺮﻳﺯ ﺪﻨﺘﺴﻫ

: )^TGﺢﻄﺳ(1 ﻱﺮﺗ

ﺪﻳﺮﺴﻴﻠﮔ (

ﻥﻮـﺧ ﺭﺩ ﻲﺗﺭﻮـﺻ

ﻪـﻛ ﺶﻴـﺑ ﺮــﺗ ﺯﺍ

mg/dl

150 ﺪـﺷﺎﺑ . ﻲﻋﻮـﻧ ﻲــﺑﺮﭼ

ﻲﻳﺎﻤﺳﻼﭘ ﻪﻛ

ﻂﺳﻮﺗ ﻝﻮﻠﺳ ﻱﺎﻫ ﺖﻓﺎﺑ ﻲﺑﺮﭼ ﻩﺮـﻴﺧﺫ

ﻲﻣ ﺩﻮﺷ . (2 ﺢﻄـﺳ

High density lipoprotein (HDL)

) ﻢﻛ ﺮﺗ ﺯﺍ

mg/dl

50 ﻱﺍﺮﺑ ﻥﺎـﻧﺯ ﻭ ﻢـﻛ ﺮـﺗ ﺯﺍ

mg/dl

40 ﻱﺍﺮﺑ ﻥﺍﺩﺮﻣ ( ﺶﻳﺍﺰﻓﺍ(3 ﺭﺎﺸﻓ

ﻥﻮﺧ ) 85 / 130

HTN≥

( ﻥﻮـﺧ ﻱﺎﺘـﺷﺎﻧ ﺰﻛﻮـﻠﮔ ﺢﻄـﺳﺶﻳﺍﺰﻓﺍ(4 ﻪـﻛ

ﺭﺩ ﻪـﻴﻟﻭﺍ ﻪﻧﺎـﺸﻧ، ﺪـﺷﺎﺑ110 ﺎـﺗ100ﻦﻴﺑﻪﻛﻲﺗﺭﻮﺻ ﻝﺎﻤﺘﺣﺍ ﻼﺘﺑﺍ

ﻪﺑ ﺖﺑﺎﻳﺩ ﺖـﺳﺍ ﺭﺩ.

ﻲﺗﺭﻮـﺻ ﻪـﻛ

ﻦﻴـﺑ

100 125–

ﺪﺷﺎﺑ

، ﺶﻴـﭘ ﻲﻳﻮـﮔ ﻩﺪـﻨﻨﻛ ﻼﺘـﺑﺍ

ﻪـﺑ ﻪـﺑ ﻼﺘـﺑﺍ ﻱﺍﺮـﺑ ﻥﺍﺭﺎـﻤﻴﺑ ﻦـﻳﺍ ﺲﻧﺎـﺷ .ﺖﺳﺍﺖﺑﺎﻳﺩ ﻱﺭﺎﻤﻴﺑ ﻱﺎﻫ ﻲﺒﻠﻗ ﺖﺒﺴﻧ ﻪﺑ ﺩﺍﺮﻓﺍ ﻼﺘﺒﻣ ﻪـﺑ ﺖـﺑﺎﻳﺩ

ﻉﻮﻧ ﻡﻭﺩ ﻥﻭﺪﺑ ﻼﺘﺑﺍ ﻪﺑ

، MetS

15 % ﺶﻴﺑ ﺮﺗ ﺖﺳﺍ

. ﭻﻨـﻳﺍ35≤ ﻥﺎـﻧﺯﺭﺩ )ﻢﻜﺷﺭﻭﺩﻲﺑﺮﭼﺶﻳﺍﺰﻓﺍ ﻭ ﺮـﺘﻣﻲﺘﻧﺎﺳﻪﺑﺩﺪﻋﻦﻳﺍ .(ﭻﻨﻳﺍ40≤ﻥﺍﺩﺮﻣﺭﺩ ﻪـﺑ ﻲﺘﻧﺎـﺳ95≤ ﻲـﻧﺍﺮﻳﺍﺖﻴﻌﻤﺟ ﻱﺍﺮﺑﻲﻠﻛﺭﻮﻃ ﺮـﺘﻣ

ﻒﻳﺮﻌﺗ ﻩﺪﺷ ﺖﺳﺍ ) 14 ﻭ 15

.( ﻥﺎﻴﻣﻁﺎﺒﺗﺭﺍ ﻲﮔﺯﺎﺗﻪﺑ ﺽﺭﺍﻮﻋ

ﻱﻮﻳﺭ ﻭ ﺕﻻﻼﺘـﺧﺍ

ﻚﻴﻟﻮﺑﺎﺘﻣ ﺺﺨﺸﻣ

ﻩﺪﺷ ﺖﺳﺍ ﻭ ﺶﻴﺑ ﺮﺗ ﺩﺭﻮﻣ

ﻪﺟﻮﺗﺪﻧﺍ ﻩﺩﺍﺩﻥﺎﺸﻧﺕﺎﻌﻟﺎﻄﻣﻲﺧﺮﺑ .ﺖﺳﺍﻪﺘﻓﺮﮔ ﺭﺍﺮﻗ ﻪﻛ ﻪـﺑ ﻥﺎـﻳﻼﺘﺒﻣﺭﺩﻚﻴﻟﻮﺑﺎﺘﻣﻡﻭﺭﺪﻨﺳ ﻪﺑﻼﺘﺑﺍﺲﻧﺎﺷ

(obstructive sleep Apnea) OSA

9 ﺮـــﺑﺍﺮﺑ

ﻦﻳﺮﻳﺎﺳ ﺖﺳﺍ

) 16 .(

ﻭCOPD

ﺖﻴﺸﻧﻭﺮﺑ ﻦﻣﺰﻣ

ﺮـﻫ ﻪـﻳﺭ ﻩﺪـﻨﻨﻛ ﺮـﻴﮔﺭﺩ ﻱﺎﻫﻱﺭﺎﻤﻴﺑ ﻦﻳﺮﺗﻊﻳﺎﺷ ﺯﺍﻭﺩ ﺪﻨﺘﺴﻫ

. ﻪﺑ ﻲﮔﺯﺎـﺗ ﻥﺍﺮﮕـﺸﻫﻭﮋﭘ ﻪـﺟﻮﺘﻣ

ﻼﺘـﺑﺍ ﻦـﻳﺍ

ﻥﺍﺭﺎﻤﻴﺑ ﻪـﺑ ﻚـﻳ ﺎـﻳ ﺪـﻨﭼ ﻪـﺿﺭﺎﻋ ﻭ ﺭﺎـﻴﻌﻣ ﻲﻠـﺻﺍ

ﻡﻭﺭﺪﻨﺳ ﻚﻴﻟﻮﺑﺎﺘﻣ

ﻩﺪﺷ ﺪﻧﺍ ﻥﺎﻧﺁ .

ﻪـﺘﻓﺎﻳﺭﺩ ﺪـﻧﺍ

ﻪـﻛ ﻲــﺧﺮﺑﺎــﺑﻱﻮــﻳﺭﻱﺎــﻫﻱﺭﺎــﻤﻴﺑﻦــﻳﺍ ﺕﻻﻼﺘــﺧﺍ

ﻲﻜﻴﻟﻮﺑﺎﺘﻣ ﻭ

ﻲﻳﺎﻴﻤﻴﺷﻮﻴﺑ ﻩﺍﺮـﻤﻫ

ﺪﻨﺘـﺴﻫ . ﺯﺍ ﻥﺁ

ﺎـﺟ ﻡﻭﺭﺪﻨـﺳ ﻪـﺑ ﻼﺘـﺑﺍﻲﻠﺻﺍﻞﻣﺎﻋﺯﻮﻨﻫ ﻪﻛ ﻚـﻴﻟﻮﺑﺎﺘﻣ

ﺺﺨﺸﻣ ﻩﺪﺸﻧ

ﺖﺳﺍ

، ﻲﻤﻧ ﻥﺍﻮﺗ ﻪـﺑ ﻊـﻄﻗ ﺯﺍ ﻪـﻄﺑﺍﺭ

ﻲﻠﻋ ﻲﻟﻮﻠﻌﻣ-

ﺽﺭﺍﻮﻋ ﻱﻮﻳﺭ ﻭ ﺕﻻﻼﺘـﺧﺍ ﻚـﻴﻟﻮﺑﺎﺘﻣ

ﺖﺒﺤﺻ ﺩﺮﻛ ﺎﻣﺍ;

ﻥﺁ ﻪﭼ ﺶﻫﻭﮋﭘ ﻱﺎﻫ

ﻪﺘﺷﺬﮔ

ﻥﺎﺸﻧ ﺮـﻫﺭﺩﻱﺍ ﻪـﻨﻴﻣﺯﻲﺑﺎﻬﺘﻟﺍﻞﺣﺍﺮﻣ ﺩﻮﺟﻭ ﺪﻧﺍ ﻩﺩﺍﺩ ﻭﺩﻭﺩ ﺮـﻫ ﺖـﻳﻮﻘﺗ ﺚـﻋﺎﺑًﻻﺎﻤﺘﺣﺍ ﻪﻛﺖﺳﺍﻪﺿﺭﺎﻋ ﻉﻮﻧ ﻝﻼﺘﺧﺍ ﻲﻣ ﺩﻮﺷ . ﺭﺩ ﻦﻳﺍ ﻪـﻌﻟﺎﻄﻣ ﺮـﺑ

ﻥﺁ ﻢﻳﺪـﺷ

ﺎـﺗ ﻥﺎﻴﻣﺭﺩ ﺍﺭﻚﻴﻟﻮﺑﺎﺘﻣﻡﻭﺭﺪﻨﺳﻪﺑ ﻼﺘﺑﺍﻉﻮﻴﺷ ﻦﻴﻐﻟﺎﺑ

ﻼﺘﺒﻣ ﻪﺑ ﺖﻴﺸﻧﻭﺮﺑ ﻦﻣﺰﻣ

ﻭ ﻲﺑﺎﻳﺯﺭﺍCOPD

ﻢﻴﻨﻛ .

ﺵﻭﺭ ﺭﺎﻛ ﻦــﻳﺍ ﺭﺩ ﻪــﻌﻟﺎﻄﻣ

ﻲــﻌﻄﻘﻣ

، ﺯﺍ ﻦﻴــﺑ ﻦﻴﻌﺟﺍﺮــﻣ

ﻪــﺑ1389 ﺮـﻬﻣ ﺯﺍﻡﺮﻛﺍ ﻝﻮﺳﺭﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﻪﻳﺭﻩﺎﮕﻧﺎﻣﺭﺩ ﺎﺗ ﺪﻨﻔﺳﺍ 1389

، ﻡﺎﻤﺗ ﻲﻧﺍﺭﺎﻤﻴﺑ ﻪﻛ

ﺯﺍ ﺮﻈﻧ ﻲﻨﻴﻟﺎـﺑ

ﻭ ﻭ ﻦﻣﺰـﻣ ﺖﻴـﺸﻧﻭﺮﺑ ﻩﻭﺮـﮔﺭﺩﻱﺮﺘﻣﻭﺮﻴﭙﺳﺍ

COPD

ﺭﺍﺮﻗ ﻲﻣ ﺪـﻨﺘﻓﺮﮔ ﻭ

ﺭﺩ 2 ﻩﺎـﻣ ﺮـﻴﺧﺍ ﺭﺎـﭼﺩ ﺪﻳﺪـﺸﺗ

ﺎـﻳ ﻭ ﻱﺭﺎﻤﻴﺑ ﻪـﻠﻤﺣ

ﻩﺪـﺸﻧ ﺪـﻧﺩﻮﺑ

، ﺲـﭘ ﺯﺍ ﺐـﺴﻛ

ﺖﻳﺎﺿﺭ ﻲﺒﺘﻛ ﺩﺭﺍﻭ ﻪﻌﻟﺎﻄﻣ ﺪﻧﺪﺷ ﻪﻛ ﻪﺑ ﻦﻳﺍ ﺐـﻴﺗﺮﺗ

204 ﺭﺎــﻤﻴﺑ ﺩﺭﺍﻭ ﻪــﻌﻟﺎﻄﻣ ﺪﻧﺪــﺷ

. ﻚــﭼ ﺖــﺴﻴﻟ

ﺕﺎـﻋﻼﻃﺍ ﻱﺩﺮــﻓ

ﻞﻣﺎــﺷ ،ﻦـﺳ

،ﺲﻨــﺟ ﺪــﻗ

ﻭ

،ﻥﺯﻭ ﺩﺭﻮـﻣﻱﻮﻴﻠﻛﻱﺭﺎﻤﻴﺑ ﻪﻘﺑﺎﺳ ﻭﺭﺎﮕﻴﺳﻑﺮﺼﻣﻪﻘﺑﺎﺳ ﺶــﺳﺮﭘ ﺭﺍﺮــﻗ

ﺖــﻓﺮﮔ . ﻚــﺴﻳﺭ ﻱﺎــﻫﺭﻮﺘﻛﺎﻓ

MetS

ﻞﻣﺎﺷ ﺖﻣﻭﺎﻘﻣ ﻪﺑ

،ﻦﻴﻟﻮﺴﻧﺍ ﻲﻗﺎﭼ

) ﻪـﺑ ﻩﮋـﻳﻭ ﻲﻗﺎـﭼ

ﻲﻤﻜﺷ (،

ﺶﻳﺍﺰﻓﺍ ﺭﺎﺸﻓ

،ﻥﻮﺧ ﺶﻳﺍﺰﻓﺍ ﺪﻨﻗ ﺎﺘـﺷﺎﻧ

ﺎـﻳﺪــﺷﺎﺑﻲــﻣﻱﺪــﻴﭙﻴﻟﺕﻻﻼﺘــﺧﺍ ﻭﻲﻤــﺴﻴﻠﮔﺮﭙﻳﺎﻫ . ﺞﻨـﭘ ﺯﺍ ﻪـﺿﺭﺎﻋﻪﺳﻪﺑﻼﺘﺒﻣﻱﺩﺮﻓ ﻪﭽﻧﺎﻨﭼ ﻪـﺿﺭﺎﻋ

ﻕﻮﻓ ﺩﻮﺑ

، ﺺﻴﺨـﺸﺗ ﻡﻭﺭﺪﻨـﺳ

ﻚـﻴﻟﻮﺑﺎﺘﻣ ﻱﺍﺮـﺑ

ﻱﻭ ﻡﻭﺭﺪﻨـﺳ ﻪـﺑ ﻼﺘـﺑﺍ ﻱﺎـﻫ ﺭﺎـﻴﻌﻣ ^. ﺪـﺷ ﻲﻣﻪﺘﺷﺍﺬﮔ ﻚﻴﻟﻮﺑﺎﺘﻣ ﻥﺎﻤﻫ

ﺭﻮﻃ ﻪﻛ ﺭﺩ ﻪﻣﺪﻘﻣ ﺮـﻛﺫ ﻥﺁ ﺖـﻓﺭ

، . ﺪﺷﻲﺳﺭﺮﺑﻥﺍﺭﺎﻤﻴﺑ ﻦﻳﺍﺭﺩ

ﺎﺑ ﻩﺩﺎﻔﺘﺳﺍ ﺯﺍ ﻡﺮﻧ ﺭﺍﺰـﻓﺍ ﻱﺭﺎـﻣﺁ

Spss

ﻪﺨـﺴﻧ 19

ﻭ ،ﺭﺎـﻴﻌﻣﻑﺍﺮﺤﻧﺍ ،ﺪﺣ،ﻪﻧﺎﻴﻣ،ﻦﻴﮕﻧﺎﻴﻣﻲﻔﻴﺻﻮﺗﺰﻴﻟﺎﻧﺁ ﻲﻧﺍﻭﺍﺮﻓ ﻭ ﺪﺻﺭﺩ ﻲﻧﺍﻭﺍﺮﻓ ﺺﺨﺸﻣ ﺪﺷ

. ﻱﺍﺮﺑ ﻪﺴﻳﺎﻘﻣ

ﻦﻴﮕﻧﺎﻴﻣ ﻱﺎﻫ

ﻲﻤﻛ ﺲﭘ ﺯﺍ ﻥﺩﻮﻣﺯﺁ ﻱﻭﺮﻴﭘ

ﺯﺍ ﻝﺎﻣﺮﻧ

ﻥﺩﻮــﺑ ﻊــﻳﺯﻮﺗ ﻩﺩﺍﺩ ﺎــﻫ ﻂــﺳﻮﺗ

1-sample KS

ﺯﺍ

(3)

ﻥﺍﺭﺎﻜﻤﻫ ﻭ ﻱﻮﺳﻮﻣ ﺩﺍﻮﺟ ﻲﻠﻋ ﺪﻴﺳ ﺮﺘﻛﺩ

80 ﻝﻭﺪﺟ

1 - ﻲﻧﺍﻭﺍﺮﻓ ﻭ ﺪﺻﺭﺩ ﻲﻧﺍﻭﺍﺮﻓ ﻥﺍﺭﺎﻤﻴﺑ ﺩﺭﻮﻣ ﻲﺳﺭﺮﺑ ﺮﺑ ﺱﺎﺳﺍ Gold stage

ﻲﻧﺍﻭﺍﺮﻓ Gold stage

)4 /7 (%

15

0 45 (%22/ )1

1 64 (%31/ )4

2 41 (%20/ )1

3 39 (%19/ )1

4

ﻝﻭﺪﺟ 2 - ﻦﻴﮕﻧﺎﻴﻣ ﻲﺧﺮﺑ ﻱﺎﻫﺮﻴﻐﺘﻣ ﻲﻤﻛ ﻩﺯﺍﺪﻧﺍ ﻱﺮﻴﮔ ﻩﺪﺷ ﺭﺩ ﻥﺍﺭﺎﻤﻴﺑ

ﺮﻴﻐﺘﻣ Range

ﻦﻴﮕﻧﺎﻴﻣ

ﻦﺳ ) ﻝﺎﺳ 88 (

38– 2/

10 6± /

64/55±5 5/ 20–46 ( ﺮﺘﻣﺭﻭﺬﺠﻣﺮﺑﻡﺮﮔﻮﻠﻴﻛ )ﻲﻧﺪﺑﻩﺩﻮﺗﻪﻳﺎﻤﻧ

2493/ 6±93/ 73–180 cm(W/c )ﻦﺳﺎﺑﻪﺑﻢﻜﺷﺭﻭﺩ

Po2 mmHg

100 30– 2/

8 5± / 66

Pco2 mmHg

84 32– 2/

10 5± / 51

FEV ↑% predicted 95

20– 3/

21 6± / 56

) Index ( 92 FVC

27– 6/

14 63±

) ﺪﺻﺭﺩ : ﺖﺒﺴﻧ ( ﺪﺻﺭﺩ 94 FEV1

27– 11

11± / 59

) mg/dl ( ) ﺪﻨﻗ ﻥﻮﺧ ﺎﺘﺷﺎﻧ ( 281 FBS

60– 31

101±

) mg/dL ( 381 TG

59– 6/

55 144±

) mg/dL ( 89 HDL

21– 14

4± / 51

) (mmHg 165 BP

90– 74

128±

) mg/dL ( 46 BUN

6– 8/

6 4± /

17/107±0 6/ /0 5–4 3/ Cr(mg/dL)

ﻪﺟﻮﺗ : ﻦﻴﮕﻧﺎﻴﻣ ﺎﻫ ﻪﺑ ﻦﻴﮕﻧﺎﻴﻣ ﺕﺭﻮﺻ ﺭﺎﻴﻌﻣ ﻑﺍﺮﺤﻧﺍ±

ﺮﻛﺫ ﻩﺪﺷ

،ﺪﻧﺍ :BP ﺭﺎﺸﻓ ،ﻥﻮﺧ :FBS ﺪﻨﻗ ﻥﻮﺧ ﺎﺘﺷﺎﻧ

Independent T test

ﻩﺩﺎﻔﺘﺳﺍ ﺪﺷ

ﻭ ﻱﺍﺮﺑ ﻪـﺴﻳﺎﻘﻣ

ﺖﺒــﺴﻧ ﻱﺎــﻫ ﻲــﻔﻴﻛ ﺯﺍ ﺖــﺴﺗ ﻱﺭﺎــﻣﺁ -k.s

Ttest

-

Chisquare

ﻩﺩﺎﻔﺘــﺳﺍ ﺪــﺷ

. ﺖــﻬﺟ ﻦﻴــﻴﻌﺗ ﺮﻴﺛﺎــﺗ

ﺮــﻴﻐﺘﻣ ﻱﺎــﻫ ﻢــﻫ ﺪــﻨﻳﺁﺮﺑ ﺯﺍ ﻥﻮــﻣﺯﺁ

Binary

Regression

. ﺭﺩ ﻲﻣﺎﻤﺗ ﻦﻳﺍ ﻥﻮﻣﺯﺁ

ﺎﻫ ^p<0.05 ﻭﻪﻨﻣﺍﺩ ﻭﺩﺕﺭﻮﺻﻪﺑﻱﺭﺍﺩﻲﻨﻌﻣﺢﻄﺳ

ﺭﺩ . ﺪﺷﻪﺘﻓﺮﮔ ﺮﻈﻧ

ﻪﺘﻓﺎﻳ ﺎﻫ 204 ﺭﺎﻤﻴﺑ ﺭﺩ ﻦﻳﺍ ﻪﻌﻟﺎﻄﻣ ﻲﺳﺭﺮﺑ ﺪﻧﺪـﺷ ﻪـﻛ

160. ﺪـﻧﺩﻮﺑﻥﺯ (%216/ ) ﺮـﻔﻧ 44 ﻭﺩﺮﻣ (%784/ )ﺮﻔﻧ 35216/ )ﺮــﻔﻧ44، (%172/ )ﺪــﻧﺩﻮﺒﻧﻱﺭﺎﮕﻴــﺳﺭﺎــﻤﻴﺑ (%162/ )33،ﻝﺎــﺳ 2 ﺯﺍﺶﻴــﺑﺭﺎﮕﻴــﺳ ﻙﺮــﺗﻪﻘﺑﺎــﺳ (% ﻭ ﺪﻨﺘـﺷﺍﺩ ﻝﺎـﺳ 2 ﺯﺍ ﺮـﺘﻤﻛﺭﺎﮕﻴﺳﻙﺮﺗﻪﻘﺑﺎﺳﺭﺎﻤﻴﺑ 92 ﺭﺎﻤﻴﺑ ) 1/

45 (%

active smoker

ﺪﻧﺩﻮﺑ

. ﺯﺍﻪﻠﺣﺮﻣ 4ﺭﺩﻥﺍﺭﺎﻤﻴﺑ ﻱﺍﺮﺑ ﻲﻧﺎﻬﺟ ﺭﺎﻜﺘﺑﺍ ﺡﺮﻃﺮﻈﻧ

ﻦﻣﺰـﻣ ﻱﻮـﻳﺭ ﻱﺩﺍﺪﺴﻧﺍ ﻱﺭﺎﻤﻴﺑ

(global initiative for chronic obstructive lung disease

( ﻢﻴﺴﻘﺗ

ﺪﻧﺪﺷ . ﻲﻧﺍﻭﺍﺮﻓ ﺮﻫ ﻩﻭﺮﮔ ﺭﺩ ﻝﻭﺪﺟ 1 ﻩﺪﻣﺁ ﺖﺳﺍ

. ﺱﺎـﺳﺍ ﺮـﺑ) (%48 ) ﺭﺎـﻤﻴﺑ ﺶـﺷ ﻭ ﺪـﺻ ﻱﺎــﻫﺭﺎﻴﻌﻣ

ﻥﺍﻮﻨﻋ ﻩﺪﺷ ﺭﺩ ﻝﻮﺼﻓ ﻝﻭﺍ ﻭ ﻡﻭﺩ ( ﻼﺘﺒﻣ ﻪـﺑ ﻡﻭﺭﺪﻨـﺳ

ﻚﻴﻟﻮﺑﺎﺘﻣ ﺺﻴﺨﺸﺗ

ﻩﺩﺍﺩ ﺪﻧﺪﺷ .

ﺭﺩCRP

ﻭﺩ ﻩﻭﺮﮔ ﻢﻛ ﺮﺗ ﻭ ﺶﻴﺑ ﺮﺗ ﺯﺍ 6 ﻲﺳﺭﺮﺑ ﺪﺷ

ﻭ . ﺪﻨﺘﺷﺍﺩ 6 ﺯﺍﺮﺗﻢﻛ ^CRP (%667/ )ﺭﺎﻤﻴﺑ136 ﻦﻴﮕﻧﺎﻴﻣ ﻲﺧﺮﺑ

ﻱﺎـﻫﺮﻴﻐﺘﻣ ﻩﺯﺍﺪـﻧﺍ

ﻱﺮـﻴﮔ ﻩﺪـﺷ

ﺭﺩ ﺖـﺳﺍ ﻩﺪـﺷﻩﺩﺭﻭﺁ 2 ﻩﺭﺎﻤـﺷ ﻝﻭﺪـﺟﺭﺩﺰﻴﻧﻥﺍﺭﺎﻤﻴﺑ .ﻥﻭﺪﺑ ﻭ ﺎﺑﻩﻭﺮﮔ ﻭﺩﻦﻴﺑﻕﻮﻓ ﻲﻤﻛﻱﺎﻫﺮﻴﻐﺘﻣﻦﻴﮕﻧﺎﻴﻣ ﻼﺘﺑﺍ ﻪﺑ ﺎﺑMetS

ﺰﻴﻟﺎﻧﺁ ﻲﻠﻴﻠﺤﺗ ﻪﺴﻳﺎﻘﻣ

ﺪﻧﺪﺷ . ﻑﻼﺘﺧﺍ

ﻦﻴﮕﻧﺎﻴﻣ

،ﻦﺳ ﻭTG

ﻦﻴﺑFBS

ﻭﺩ ﻩﻭﺮﮔ ﺯﺍ ﺮﻈﻧ ﻱﺭﺎﻣﺁ

ﻲﻨﻌﻣ ﺭﺍﺩ ﺩﻮـﺑ ) ﻪـﺑ ﺐـﻴﺗﺮﺗ 003 /0

=

، p

003 /0 = ﻭp

001 /0

<

.(p

ﻦﻴﮕﻧﺎﻴﻣ ﻦﺳ

ﺭﺩ ﻩﻭﺮﮔ ﻥﺎﻳﻼﺘﺒﻣ 5

66/

ﻭ ﻱﺭﺎـﻣﺁ ﺮـﻈﻧ ﺯﺍ ﻪـﻛ ﺩﻮﺑﻝﺎﺳ62 ﻥﺎﻳﻼﺘﺒﻣﺮﻴﻏﺭﺩ ﻪـﺑ0/002 )ﺩﻮﺑﺮﺗﻻﺎﺑﻥﺎﻳﻼﺘﺒﻣﻩﻭﺮﮔﺭﺩﻱﺭﺍﺩﻲﻨﻌﻣﺭﻮﻃ

.(p=

(4)

81

ﻝﻭﺪﺟ 3 - ﻱﺎﻫ ﺕﺪﺷ ﻉﺍﻮﻧﺍ ﻲﻧﺍﻭﺍﺮﻓ ﻪﺑ ﻼﺘﺑﺍ ﺱﺎﺳﺍ ﺮﺑCOPD

Mets

COPD Stage Mets

+

- 9(60%) 0

6(40%)

1 25(55%)

20(45%)

2 32

32 19(46%) 3

22(54%)

4 21(46%)

18(54%)

ﻝﻭﺪﺟ 4 - ﻥﺎﻣﺯ ﻢﻫ ﺮﺛﺍ ﻲﺳﺭﺮﺑ ﺯﺍ ﺲﭘ ﻚﻴﻟﻮﺑﺎﺘﻣ ﻡﻭﺭﺪﻨﺳ ﻪﺑ ﻼﺘﺑﺍ ﺎﺑ ﻲﺳﺭﺮﺑ ﺩﺭﻮﻣ ﻱﺎﻫ ﺮﻴﻐﺘﻣ ﻁﺎﺒﺗﺭﺍ ﺎﻫ ﺮﻴﻐﺘﻣ

ﺮﻴﻐﺘﻣ p value

EXP(B) ﻱﺭﺍﺩ ﻲﻨﻌﻣ

ﻦﺳ 0.003

ﺩﺭﺍﺩ 1.07

ﺲﻨﺟ 0.3

ﺩﺭﺍﺪﻧ 0.53

ﻲﻧﺪﺑ ﻩﺩﻮﺗ ﻪﻳﺎﻤﻧ 0.5

ﺩﺭﺍﺪﻧ 1

ﺭﺎﮕﻴﺳ 0.98

ﺩﺭﺍﺪﻧ 0.8

PO2 0.21

PCO2 0.64

FEV1 0.17

FVC 0.78

FEV1/FVC 0.23

FBS 0.003

ﺩﺭﺍﺩ 1.01

TG

<0.001 ﺩﺭﺍﺩ 1.02

HDL 0.28

ﻚﻴﻟﻮﺘﺴﻴﺳ ﻥﻮﺧ ﺭﺎﺸﻓ

<0.001 ﺩﺭﺍﺩ 1

ﻚﻴﻟﻮﺘﺳﺎﻳﺩ ﻥﻮﺧ ﺭﺎﺸﻓ

<0.001 ﺩﺭﺍﺩ 1

CRP

<0.001 ﺩﺭﺍﺩ 0.25

BUN 0.38

Cr 0.43

ﺩﺭﺍﺪﻧ 1.3

CRF 0. 22

ﻲﻛﺍﺭﻮﺧ ﺪﻴﻳﻭﺮﺘﺳﺍﻮﻜﻴﺗﺭﻮﻛ 0.9

ﻲﻗﺎﺸﻨﺘﺳﺍ ﺪﻴﻳﻭﺮﺘﺳﺍﻮﻜﻴﺗﺭﻮﻛ 0.5

ﺖﻬﺟ ﻲﺳﺭﺮﺑ ﺮﺛﺍ ﻥﺎﻣﺯ ﻢﻫ ﻱﺎﻫﺮﻴﻐﺘﻣ

ﻕﻮﻓ ، ﺯﺍ ﺰﻴﻟﺎﻧﺁ

binary regression

. ﺭﺩ ﻦﻳﺍ

،ﻝﺪﻣ ﻼﺘـﺑﺍ

ﻪﺑ ﻪﺑMetS

ﻥﺍﻮﻨﻋ ﺮـﻴﻐﺘﻣ ﻪﺘـﺴﺑﺍﻭ ﺩﺭﺍﻭ

ﺪـﺷ ﻭ ﺮﻳﺎـﺳ

ﺎﻫﺮﻴﻐﺘﻣ ﺭﺩ

ﻁﺎـﺒﺗﺭﺍ ﺎـﺑ

ﻥﺁ ﻩﺪﻴﺠﻨـﺳ ﺪﻧﺪـﺷ

. ﺯﺍ ﻥﺎـﻴﻣ

ﻱﺎــﻫﺮﻴﻐﺘﻣ ﻲــﺳﺭﺮﺑ

ﻩﺪــﺷ ﻦــﺳ ) 003 /0

= (،p

ﻲﻗﺎــﭼ

ﻲﻤﻜــﺷ ) 001 /0

<

(،p

ﻻﺎــﺑFBS

) 04 0 /

= (p

ﻭ

TG

ﻻﺎﺑ ) 001 /0

<

(،p

ﺖﺒﺜﻣ CRP

) 004 /0 = (p

ﻭ

ﻼﺘﺑﺍ ﻂﺒﺗﺮـﻣ ﻱﺎﻫﺮﻴﻐﺘﻣﻥﺍﻮﻨﻋﻪﺑ (^{p =}0/02 )^CRFﻪﺑ ﺎـﺑ ﻩﺪـﻣﺁ ﺖـﺳﺩﻪﺑ ﺮﻳﺩﺎﻘﻣ .ﺪﻧﺪﺷﻪﺘﺧﺎﻨﺷ^MetS ﻪﺑﻼﺘﺑﺍ ﺯﺍ ﻦﻳﺍ ﺰﻴﻟﺎﻧﺁ ﺭﺩ ﻝﻭﺪﺟ 4 ﻪﺑ ﻞﻴﺼﻔﺗ ﻩﺪﻣﺁ ﺖﺳﺍ

. ﻡﺪـﻋ ﺯﺍ ﻲﻛﺎـﺣ ﻱﺎـﻛ ﺭﻭﺬـﺠﻣﻲﻔﻴﻛﺰﻴﻟﺎﻧﺁ ﺕﻭﺎـﻔﺗ

ﻱﺭﺎﻣﺁ ﻲﻨﻌﻣ ﺭﺍﺩ ﺕﺪﺷ ﺮﺑCOPD

ﺱﺎﺳﺍ ﺭﺎﻴﻌﻣ

Gold

stage

ﺭﺩ ﻭﺩ ﻩﻭﺮﮔ ﻥﺎﻳﻼﺘﺒﻣ ﻭ

ﺮﻴﻏ ﻥﺎﻳﻼﺘﺒﻣ ﻪﺑ

MetS

ﺩﻮﺑ ) 05 /0 ﻭp=

06 /0 .(r=

ﺭﺩ ﻥﺍﺭﺎﻤﻴﺑ ﺩﺭﻮـﻣ ﻲـﺳﺭﺮﺑ

43 ﺮﻔﻧ ) 1 21/

(%

ﻼﺘﺒﻣ ﻪﺑ ﻱﺭﺎﻤﻴﺑ ﻱﺎﻫ ﻦﻣﺰﻣ ﻱﻮـﻴﻠﻛ

) (CRF chronic renal failure

ﺪﻧﺩﻮﺑ

. ﺯﺍﻥﺎــﺸﻧﻲــﻠﻴﻠﺤﺗﻱﺭﺎــﻣﺁﺰﻴﻟﺎــﻧﺁ ﻁﺎــﺒﺗﺭﺍ

ﻱﺭﺎــﻣﺁ

ﻲﻨﻌﻣ ﺭﺍﺩ ﻥﺎﻴﻣ ﻭCRF

ﻼﺘـﺑﺍ ﻪـﺑ ﻡﻭﺭﺪﻨـﺳ ﻚـﻴﻟﻮﺑﺎﺘﻣ

ﺖﺷﺍﺩ ) 02 / 0 (p =

ﻭ ﻥﺎﺸﻧ ﺩﺍﺩ ﻪﻛ ﻲـﻧﺍﻭﺍﺮﻓ ﻼﺘـﺑﺍ

ﻪـﺑ

ﺭﺩCRF

ﻩﻭﺮﮔ ﻥﺎﻳﻼﺘﺒﻣ ﻪﺑ

ﺮﺘـﺸﻴﺑ

ﺖﺳﺍ . ﺚﺤﺑ ﻭ ﻪﺠﻴﺘﻧ

ﻱﺮﻴﮔﻱﺪﻳﺪﺟﻱﻪﻳﺮﻈﻧ ﺡﺮـﻄﻣ

ﻲـﻣ ﺪـﻨﻛ ﻪـﻛ ًﻻﺎـﻤﺘﺣﺍ

ﺭﺩMetS

ﻥﺎﻴﻣ ﻥﺎﻳﻼﺘﺒﻣ ﻪﺑ

ﺶﻴﺑCOPD

ﺮﺗ ﺖـﺳﺍ

.ﺯﻮﻨﻫ ﻭﻩﺪﺷﺡﺮﻄﻣﻲﮔﺯﺎﺗ ﻪﺑﻪﻳﺮﻈﻧﻦﻳﺍﻪﻛﺪﻨﭼﺮﻫ

(5)

82

ﺯﺍ ﻲﮕﻧﻮﮕﭼ ﻢـﺴﻴﻧﺎﻜﻣ

ﻥﺁ ﻲـﻋﻼﻃﺍ ﻢﻳﺭﺍﺪـﻧ

. ﺏﺎـﻬﺘﻟﺍ

ﻲﻣﻮﻤﻋ ﺭﺩ ﻥﺍﺭﺎﻤﻴﺑ ﻼﺘـﺒﻣ ﻪـﺑ ﻭCOPD

ﺖﻴـﺸﻧﻭﺮﺑ

ﻦﻣﺰﻣ ﻩﺪﻳﺩ ﻲـﻣ ،ﺩﻮـﺷ ﻪـﻛ ﺭﺩ ﻥﺍﺭﺎـﻤﻴﺑ ﻼﺘـﺒﻣ

ﻪـﺑ

ﺰﻴﻧMetS

ﻩﺪﻳﺩ ﻲﻣ ﺩﻮﺷ . ﺏﺎﻬﺘﻟﺍ ﺭﺩ ﻪﻳﺭ ﺎـﻫ ﻪـﻛ

ﺯﺍ ﻪـﺑ ﻪـﻳﺭ ﺯﺍ ﻲﺑﺎـﻬﺘﻟﺍ ﻱﺎﻫﺭﻮﺗﺎﻳﺪـﻣ ﻲﻳﺎﺟﻪﺑﺎﺟ ﻥﻮـﺧ

ﺕﺄﺸﻧ ﻲﻣ ﺪﻧﺮﻴﮔ

، ﺰﻴﻧ ﻪﺑ ﻥﺍﻮﻨﻋ ﻱﺎﻫﺪﻨﻳﺁﺮﻓ ﻞـﻤﺘﺤﻣ

ﺭﺩ ﻦﻳﺍ ﺶﻨﻛﺍﻭ ﺎﻫ ﺡﺮﻄﻣ ﻩﺪـﺷ ﺪـﻧﺍ . ﺯﺍ ﻱﻮـﺳ ﺮـﮕﻳﺩ

ﻲﺴﻛﻮﭙﻴﻫ )

Hypoxia

( ﻂﺒﺗﺮﻣ ﺎﺑ ﻲﻗﺎﭼ ﺰﻴﻧ ﺯﺍ

ﺕﺎﻜﻧ . ﺪﺷﺎﺑﻲﻣﻪﻨﻴﻣﺯﻦﻳﺍﺭﺩﺡﺮﻄﻣ ﺶﻳﺍﺰﻓﺍ ﻱﺎﻫﺭﻮﺗﺎﻳﺪﻣ ﻲﺑﺎﻬﺘﻟﺍ

ﻥﻮﺧ ﻪﻛ ﺯﺍ ﺖﻓﺎﺑ

ﻱﺎﻫ ﺯﺍ ﺰـﻴﻧ،ﺪﻧﻮﺷ ﻲﻣﺩﺍﺯﺁﻚﻴﻤﺘﺴﻴﺳ ﻥﺎﻳﺮﺟﻪﺑﻲﺑﺮﭼ ﺮﮕﻳﺩ ﺕﺎﻜﻧ ﺡﺮﻄﻣ ﻩﺪﺷ ﺭﺩ ﻦﻳﺍ ﻪـﻨﻴﻣﺯ ﻲـﻣ ﺪﻨـﺷﺎﺑ

. ﻲﺑﺎـﻬﺘﻟﺍ ﺪـﻨﻳﺁﺮﻓ ﻪـﻛﺖﺳﺍﺭﻭﺎﺑﻦﻳﺍﺮﺑ ﺪﻳﺪﺟﻪﻳﺮﻈﻧ ﺎﻬﻨﺗ ﺦﺳﺎﭘ ﺩﻮﺟﻮﻣ ﻪﺑ ﻦﻳﺍ ﻝﺍﺆﺳ ﻲـﻣ ﺪـﻧﺍﻮﺗ ﺪـﺷﺎﺑ

ﻭ ﺰﻴﻧﻲﺑﺎﻬﺘﻟﺍﻱﺎﻫﺭﻮﺗﺎﻳﺪﻣﻦﻳﺍﻥﺩﺮﻛ ﺩﺍﺯﺁﻊﺒﻨﻣ ﻩﻭﻼﻋ ﺮﺛﺆـﻣ ﻞـﻣﺎﻋ . ﺪﻨﺘـﺴﻫﻲﺑﺮﭼ ﻱﺎﻫﺖﻓﺎﺑ ، ﺎﻫﻪﻳﺭ ﺮﺑ ﺭﺩﺕﺪﺷ :ﺪﻧﺍﻩﺪﺷ ﻪﺻﻼﺧﺭﻮﺘﻛﺎﻓ ﻪﺳﺭﺩﻱﺯﺎﺳﺩﺍﺯﺁﻦﻳﺍ ﺐﻴﺳﺁ ﻱﻮﻳﺭ ) ﻪﻛ ﻦﻴﻴﻌﺗ ﻩﺪﻨﻨﻛ ﻥﺍﺰﻴﻣ ﻱﺎﻫﺭﻮﺗﺎﻳﺪـﻣ

ﻲﺑﺎﻬﺘﻟﺍ ﺩﺍﺯﺁ ﻩﺪﺷ ﺯﺍ ﻪﻳﺭ ﻪﺑ ﻥﻮـﺧ ﺪﻨﺘـﺴﻫ (،

ﺕﺪـﺷ

ﻲﺴﻛﻮﭙﻳﺎﻫ ﻪﺘﺴﺑﺍﻭ

ﻪﺑ ﻲﻗﺎﭼ ﻭ ﺰﻴﻧ ﺕﺪﺷ ﻲﺴﻛﻮﭙﻳﺎﻫ

ﻪﺑ ﻞﻴﻟﺩ ﻡﺪﻋ ﺩﺮﻛﺭﺎﻛ ﺐﺳﺎﻨﻣ ﻱﻮﻳﺭ

. ﺏﺎﻬﺘﻟﺍﺪﺿﻱﺎﻫﻭﺭﺍﺩ ﺯﺍﻩﺩﺎﻔﺘﺳﺍ ﻲﻤﻧ

ﺪـﻧﺍﻮﺗ ﺚـﻋﺎﺑ

ﺭﺎﻬﻣ ﻞﻣﺎﻛ ﻦﻳﺍ ﺏﺎﻬﺘﻟﺍ ﻚﻴﻤﺘﺴﻴﺳ ﺩﻮﺷ

، ﺎﻣﺍ

ًﻻﺎﻤﺘﺣﺍ

ﻲﻣ ﺪﻧﺍﻮﺗ ﺯﺍ ﺽﺭﺍﻮﻋ ﺝﺭﺎﺧ ﻱﻮـﻳﺭ ﻦـﻳﺍ ﻉﻮـﻧ ﺏﺎـﻬﺘﻟﺍ

ﻱﺮﻴﮔﻮﻠﺟ ﺪﻨﻛ

. ﻦﻳﺍﺭﺩ ﻪﻌﻟﺎﻄﻣ ﺎـﻣ ﻪـﺑ ﻦﻴـﻴﻌﺗ ﻲـﻧﺍﻭﺍﺮﻓ ﻡﻭﺭﺪﻨـﺳ

ﻚــﻴﻟﻮﺑﺎﺘﻣ ﺭﺩ

ﻥﺎــﻳﻼﺘﺒﻣ ﻪــﺑ

ﻭCOPD

ﺖﻴــﺸﻧﻭﺮﺑ

ﻦﻣﺰﻣ ﻢﻴﺘﺧﺍﺩﺮﭘ .

ﻲﻧﺍﻭﺍﺮﻓ ﻲـﻠﻛ ﻦـﻳﺍ ﻉﻮﻴـﺷ ﺭﺩ ﻦـﻳﺍ

ﻥﺍﺭﺎﻤﻴﺑ ﺭﺎﻴﺴﺑ ﺮﺗﻻﺎﺑ ﺯﺍ ﺖﻴﻌﻤﺟ ﻝﺎﻣﺮﻧ

ﺩﻮﺑ ) 48 (%

ﻭ ﺍﺭ ﻪـﻌﻟﺎﻄﻣ ﺖـﺤﺗ ﺖـﻴﻌﻤﺟ ﺯﺍ ﻲـﻤﻴﻧًﺎﺒﻳﺮﻘﺗ ﺮـﻴﮔﺭﺩ

ﻩﺩﺮﻛ ﺩﻮﺑ ﺭﺩ ﻲﻟﺎﺣ ﻪﻛ ﺎﻬﻨﺗ 33 % ﺯﺍ ﺖﻴﻌﻤﺟ ﻱﺩﺎـﻋ

ﻲﻧﺍﺮﻳﺍ ﻪﺑ ﻦﻳﺍ ﻡﻭﺭﺪﻨﺳ ﻼﺘﺒﻣ

ﺪﻨﺘﺴﻫ ) 16

.( ﺭﺩﻪﻛﺖﺳﺍﻱﺍﻪﺠﻴﺘﻧﻪﺑﺎﺸﻣﻪﺠﻴﺘﻧﻦﻳﺍ ﺕﺎـﻌﻟﺎﻄﻣ

ﻪﺘﺷﺬﮔ ﻪﺘﻓﺮﮔ ﻩﺪـﺷ ﺖـﺳﺍ ) 17 - 21 .(

ﻪـﺑ ﻥﺍﻮـﻨﻋ

ﻝﺎــﺜﻣ ﻲــﻘﻴﻘﺤﺗ ﻥﺎــﺸﻧ

ﺩﺍﺩ ﻪــﻛ 5 / 47 % ﺯﺍ ﻥﺍﺭﺎــﻤﻴﺑ

ﺖﺤﺗ ﻪﻌﻟﺎﻄﻣ ﻼﺘـﺒﻣ ﻪـﺑ ﻪـﺑCOPD

ﻦـﻳﺍ ﻡﻭﺭﺪﻨـﺳ

ﻼﺘﺒﻣ

،ﺪﻨﺘﺴﻫ ﻪﻛ

ﺭﺎﻴـﺴﺑ ﻪﺑﺎـﺸﻣ ﻪـﺠﻴﺘﻧ ﻪـﺑ ﺖـﺳﺩ

ﻩﺪﻣﺁ ﺯﺍ ﻦﻳﺍ ﻪﻌﻟﺎﻄﻣ ﺖﺳﺍ ) 17

.( ﻪﻛﺩﺍﺩﻥﺎﺸﻧﺎﻣﻪﻌﻟﺎﻄﻣ ﺕﺪﺷ

)COPD

ﺮﺑ

ﺱﺎﺳﺍ ﻪــﺴﻳﺎﻘﻣﺱﺎــﺳﺍ ﺮــﺑﺰــﻴﻧ ﻭ (^Goldﺭﺎــﻴﻌﻣ ﻦﻴﮕﻧﺎــﻴﻣ

ﻭFEV1

ﺎﺑFVC

ﻼﺘﺑﺍ ﻪﺑ ﻡﻭﺭﺪﻨﺳ ﻚﻴﻟﻮﺑﺎﺘﻣ

ﻁﺎﺒﺗﺭﺍ

ﻲﻨﻌﻣ ﻱﺭﺍﺩ ﺩﺭﺍﺪﻧ . ﺮﻫ ﺪـﻨﭼ ﻪـﻛ ﺭﺩ ﻦـﻳﺍ ﺩﺭﻮـﻣ

ﺭﺩ .ﺩﺭﺍﺩ ﺩﻮﺟﻭﺮﻈﻧﻑﻼﺘﺧﺍ ﻪﺘﺷﺬﮔﻱﺎﻫ ﺶﻫﻭﺆﭘ ﺐﻠﻏﺍﻡﻭﺭﺪﻨﺳ ﻦﻳﺍﻪﺑﻼﺘﺑﺍﻪﻛﺪﻧﺍﻩﺩﺍﺩﻥﺎﺸﻧﺕﺎﻌﻟﺎﻄﻣﻦﻳﺍ ﺎﺑ ﺕﺪﺷ ﺶﻴﺑCOPD

ﺮﺗ ﻂﺒﺗﺮـﻣ ﺖـﺳﺍ

) 17

، 19

، .( 22 ﻭ21

ﻲﻗﺎﭼ ﻲﻤﻜﺷ ﺮﺗﻻﺎـﺑ ﻭ ﻦـﺳ ﺮﺗﻻﺎـﺑ ﺰـﺒﻧ ﺯﺍ ﺮـﮕﻳﺩ

ﻞﻣﺍﻮﻋ ﻂﺒﺗﺮﻣ ﺎﺑ ﻼﺘﺑﺍ ﻪﺑ ﺭﺩMetS

ﻥﺍﺭﺎﻤﻴﺑ

COPD ﺖـﺑﺎﺛ ﺕﺎـﻌﻟﺎﻄﻣ ﻲﻣﺎـﻤﺗ ﺭﺩًﺎﺒﻳﺮﻘﺗﻦﺳﺭﻮﺘﻛﺎﻓ .ﺩﻮﺑ ﻩﺪﺷ ﺖﺳﺍ ) 17 ﻭ 19 - 23 .(

ﻲﻣﺎﻤﺗ ﺕﺎﻌﻟﺎﻄﻣ ﺭﺩ

ﻦﻳﺍ ﻥﺍﺭﺎﻤﻴﺑ ﻦﻳﺍﻦﺳﺶﻳﺍﺰﻓﺍ ﺎﺑﻪﻛﺪﻨﻛﺮﺘﺸﻣﺮﻈﻧ ﻥﺍﺰﻴﻣ

ﻼﺘﺑﺍ ﻪﺑ ﻡﻭﺭﺪﻨﺳ ﻚﻴﻟﻮﺑﺎﺘﻣ

ﺰﻴﻧ ﺭﺩ ﻥﺁ ﺎﻫ ﺶﻳﺍﺰﻓﺍ ﻲﻣ

ﻝﻭﺪﺟ 5 - ﻥﻭﺪﺑ ﻭ ﺎﺑ ﻩﻭﺮﮔ ﻭﺩ ﻚﻴﻜﻔﺗ ﻪﺑ ﻲﻤﻛ ﻱﺎﻫ ﺮﻴﻐﺘﻣ ﻦﻴﮕﻧﺎﻴﻣ Mets

ﺮﻴﻐﺘﻣ ﻦﻴﮕﻧﺎﻴﻣ

p value

ﻥﻭﺪﺑ ﺎﺑ Mets

Mets

ﻦﺳ 10

4/± 62 10

6/± 66 0.003

3/ Po2 8 3/± 67 1/

8 7/± 65 0.1

9/ PCo2 9 8/± 51 5/

10 2/± 51 0.6

3/ FEV1 21 9/± 54 2/

22 2/± 58 0.2

9/ FVC 13 9/± 62 4/

15 2/± 63 0.8

9/ FBS 30 5/± 94 30

4/± 107 0.003

7/ TG 44 8/± 124 9/

58 7/± 161 0.001

<

8/ HDL 11 3/± 50 8/

15 4/± 52 0.2

ﻚﻴﻟﻮﺘﺴﻴﺳ ﻥﻮﺧ ﺭﺎﺸﻓ 6/

10 128± 3/

17 128± 0.9

ﻥﻮﺧ ﺭﺎﺸﻓ ﻚﻴﻟﻮﺘﺳﺎﻳﺩ 2/

1 9/± 8 2/

1 5/± 8 0.9

7/ BUN 6 17± 9/

6 8/± 17 0.3

6/ Cr 0 03± /1 6/

0 1/± 1 0.4

(6)

83

ﺪﺑﺎﻳ . ﻲﻗﺎﭼ ﻲﻤﻜﺷ ﺰﻴﻧ ﺯﺍ ﺮﮕﻳﺩ ﻞﻣﺍﻮﻋ ﻂﺒﺗﺮﻣ ﺎﺑ

ﻦﻳﺍ ﻥﺁ ﻲـﺼﻴﺨﺸﺗ ﻱﺎـﻫﺭﺎﻴﻌﻣ ﺯﺍﻲﻜﻳ ﻭﻡﻭﺭﺪﻨﺳ ﺖـﺳﺍ

. ﺮـﮕﻳﺩ ﺯﺍ ﺰـﻴﻧ ﺎﺘـﺷﺎﻧ ﻥﻮـﺧ ﺪـﻨﻗ ﺰـﻴﻧ ﻭ^TGﺶﻳﺍﺰﻓﺍ ﻞﻣﺍﻮﻋ ﻂﺒﺗﺮﻣ ﺎﺑ ﻼﺘﺑﺍ ﻦﻳﺍ ﻥﺍﺭﺎﻤﻴﺑ ﻪﺘﺧﺎﻨﺷ ﺪﺷ

.

ﻦﻳﺍ . ﺖﺳﺍﻩﺪﺷﻩﺩﺍﺩ ﻥﺎﺸﻧﻪﺘﺷﺬﮔﺕﺎﻌﻟﺎﻄﻣﺭﺩﺕﺎﻜﻧ ﺭﺩ ﻪﻌﻟﺎﻄﻣ ﺎﻣ ﻥﺎﺸﻧ ﻩﺩﺍﺩ ﺪﺷ ﻪﻛ ﺢﻄـﺳ ﺭﺩCRP

ﻩﻭﺮﮔ ﻥﺎﻳﻼﺘﺒﻣ ﻪﺑ

ﻪﺑ MetS

ﻮﺤﻧ ﻲﻨﻌﻣ ﻱﺭﺍﺩ ﺮﺗﻻﺎـﺑ

ﺖﺳﺍ . ﺮﻫ ﺪﻨﭼ ﻪﻛ ﻦـﻳﺍ ﻪـﺠﻴﺘﻧ ﺭﺩ ﺮـﺜﻛﺍ ﺕﺎـﻘﻴﻘﺤﺗ

ﻲﻠﺒﻗ ﺪﻴﻳﺄﺗ ﻩﺪﺷ ﺖﺳﺍ ) 17 ﻭ 19 - 22 (،

ﺎـﻣﺍ ﻲـﺧﺮﺑ

ﺕﺎــﻌﻟﺎﻄﻣ ﻦــﻳﺍ

ﺮــﻈﻧ ﺍﺭ ﻝﻮــﺒﻗ ﻩﺩﺮــﻜﻧ ﺪــﻧﺍ . ﻪــﻌﻟﺎﻄﻣ

ﻱﺮﮕﻳﺩ ﻥﺎﺸﻧ ﺩﺍﺩ ﻪﻛ ﺢﻄﺳ ﻭﺩCRP

ﻩﻭﺮـﮔ ﺯﺍ ﺮـﻈﻧ

ﻱﺭﺎﻣﺁ ﻑﻼﺘﺧﺍ ﻲﻨﻌﻣ

ﻱﺭﺍﺩ ﺎﺑ ﻢﻫ ﺪﻧﺭﺍﺪﻧ ) 46 .(

ﺮـﻫ ﻪــﺸﻳﺭ ﻪــﻳﺮﻈﻧﺕﺎــﻌﻟﺎﻄﻣﺐــﻠﻏﺍﻪــﻛﺪــﻨﭼ ﻲﺑﺎــﻬﺘﻟﺍ

ﻙﺮﺘﺸﻣ ﻭMetS

ﺍﺭCOPD

ﺡﺮﻄﻣ ﻩﺩﺮﻛ ﺪـﻧﺍ ﻭ

ﻪـﺑ ﺪـﻧﺍﻩﺩﺍﺩ ﻥﺎـﺸﻧ ﻪﺘﺷﺬﮔﺕﺎﻌﻟﺎﻄﻣﺐﻠﻏﺍﺖﻠﻋﻦﻴﻤﻫ ﻪــﻛ ﻱﺎــﻫ ﻪــﺼﺨﺸﻣ ﻲﺑﺎــﻬﺘﻟﺍ

ﺮــﻴﻈﻧ

، CRP

، IL-6

ﺭﺩTNFα

ﻩﻭﺮــﮔ ﻥﺎــﻳﻼﺘﺒﻣ ﻪــﺑ

، MetS

ﻪــﺑ ﻮــﺤﻧ

ﻲﻨﻌﻣ ﻱﺭﺍﺩ ﺮﺗﻻﺎﺑ ﺖﺳﺍ

. ﺮﮕﻳﺩ ﺕﺎﻌﻟﺎﻄﻣ ﺮﻴﻈﻧ ﻱ

ﻦﺴﻣﺎﺗ ﻖﻴﻘﺤﺗ

، ﻪﺑ ﻲﺳﺭﺮﺑ

ﻁﺎــﺒﺗﺭﺍ ﻥﺎــﻴﻣ

ﻲﻗﺎــﭼ ﻭ ﺶﻳﺍﺰــﻓﺍ ﺎــﺑ BMI

ﻢــﺳﺁ

ﺪــﻨﺘﺧﺍﺩﺮﭘ .

ﻪــﺠﻴﺘﻧ ﻦــﻳﺍ ﻪــﻌﻟﺎﻄﻣ ﻲﻛﺎــﺣ

ﺯﺍ ﻁﺎــﺒﺗﺭﺍ

ﻲﻨﻌﻣ ﺭﺍﺩ ﻥﺎﻴﻣ ﻼﺘﺑﺍ ﻪﺑ ﻭMetS

ﻼﺘﺑﺍ ﻪـﺑ ﻢـﺳﺁ ﺩﻮـﺑ

) 18 .( ﻦﻳﺍ ﻪﻌﻟﺎﻄﻣ ﺰﻴﻧ ﺯﺍ ﻪﻠﻤﺟ ﺶﻫﻭﮋﭘ ﻲﻳﺎﻫ

ﺖـﺳﺍ

ﻪـﻛ ﻭﻲﺑﺎــﻬﺘﻟﺍ ﻪــﺸﻳﺭﻪــﻛﺪــﻫﺩﻲــﻣﻥﺎــﺸﻧ ﺏﺎــﻬﺘﻟﺍ

ﻚﻴﻤﺘﺴﻴﺳ ﻪﺑ

ﻞﻴﻟﺩ ﺩﺍﺯﺁ ﻥﺪﺷ ﻱﺎﻫﺭﻮﺗﺎﻳﺪﻣ ﻲﺑﺎﻬﺘﻟﺍ

ﻪﻨﻴﻣﺯ ﻼﺘﺑﺍ ﻪﺑ ﺮﻫ ﻭﺩ ﻉﻮﻧ ﻪﺿﺭﺎﻋ ﺍﺭ ﻢﻫﺍﺮﻓ ﻲﻣ ﺪـﻨﻛ

) ﺽﺭﺍﻮﻋ ﻱﻮﻳﺭ ﺮﻴﻈﻧ ﻢﺳﺁ

، ﻭCOPD

ﺰـﻴﻧ ﻼﺘـﺑﺍ ﻪـﺑ

.( MetS

ﻪﻴﺻﻮﺗ ﻲﻣ ﺩﻮﺷ ﺎﺗ ﺭﺩ ﺕﺎﻌﻟﺎﻄﻣ ﻱﺪﻌﺑ

ﻪﺑ ﻲـﺳﺭﺮﺑ

ﻲﺧﺮﺑ ﻱﺎﻫﺭﻮﺘﻛﺎﻓ ﺮﮕﻳﺩ

ﺮﻴﻈﻧ ﻥﺍﺰﻴﻣ ﺖﻴﻟﺎﻌﻓ ﻲﻜﻳﺰﻴﻓ

ﻥﺍﺭﺎــﻤﻴﺑ ﻭ

ﺰــﻴﻧ ﻦﻴــﻴﻌﺗ ﺢﻄــﺳ

ﻲــﺧﺮﺑ ﺮــﮕﻳﺩ

ﺯﺍ ^IL-6 ﻭ^TNFα ﺮــﻴﻈﻧﻲﺑﺎــﻬﺘﻟﺍﻱﺎﻫﺭﻮﺗﺎﻳﺪــﻣ ﺰــﻴﻧ

ﻪﺘﺧﺍﺩﺮﭘ ﺩﻮﺷ

. ﻲﻠﻛﺭﻮﻃﻪﺑ ﺶﻫﻭﮋﭘ

ﺎـﻣ ﻥﺎـﺸﻧ ﺩﺍﺩ ﻪـﻛ ﻲـﻧﺍﻭﺍﺮﻓ

ﺭﺩ ﻥﺎﻳﻼﺘﺒﻣ ﻪﺑ

ﺖﻴﺸﻧﻭﺮﺑ ﻦﻣﺰـﻣ

ﻭ ﺶﻴــﺑCOPD

ﺮــﺗ ﺯﺍ ﺖــﻴﻌﻤﺟ ﻱﺩﺎــﻋ

ﺖــﺳﺍ

ﻪــﻛ.ﺪﻧﺭﺍﺩﺶﻘﻧ ﺪﻨﻳﺁﺮﻓﻦﻳﺍﺭﺩﻲﺑﺎﻬﺘﻟﺍﻡﺰﻴﻧﺎﻜﻣ ًﻻﺎﻤﺘﺣﺍ ﺎﺑ ﻪﺟﻮﺗ ﻪﺑ ﻪﻜﻨﻳﺍ ﻡﻭﺭﺪﻨﺳ ﻚـﻴﻟﻮﺑﺎﺘﻣ

ﺭﺩ ﺶﻴـﺑ

ﺯﺍ ﺯﺍ ﻱﻮـﻳﺭﺕﻼﻜﺸﻣ ﻪﺑﻼﺘﺒﻣﻥﺍﺭﺎﻤﻴﺑ ﺯﺍﻲﻤﻴﻧ ﻪـﻠﻤﺟ

ﻩﺪﻳﺩCOPD

ﻲﻣ ﺩﻮـﺷ ﻭ ﻦـﻳﺍ ﻪـﺘﻓﺎﻳ ﺭﺩ ﺕﺎـﻌﻟﺎﻄﻣ

ﻲﻠﺒﻗ ﺎﺑ ﺩﺍﺪﻋﺍ ﻪﺑﺎﺸﻣ ﺰﻴﻧ ﺪﻴﻳﺎﺗ ﻩﺪﺷ ﻭ ﺯﺍ ﻥﺁ ﻪﺘـﺷﺬﮔ

ﻲﺧﺮﺑ ﺕﺎﻌﻟﺎﻄﻣ ﻲﺘﺣ

ﻱژﻮﻟﻮﻴﺗﺍ ﻱﺎﻫ

ﻲـﺻﺎﺧ ﺍﺭ ﺰـﻴﻧ

ﻱﺍﺮﺑ ﻥﺁ ﺩﺎﻬﻨﺸﻴﭘ ﻩﺩﺮﻛ

ﺪﻧﺍ

، ﺍﺬﻟ ﻪﺑ ﺮﻈﻧ ﻲﻣ ﺪـﺳﺭ

ﻪـﻛ ﻩﮋـﻳﻭ ﻪـﺑ ﻭ ﻲـﺴﻔﻨﺗ ﺕﻼﻜـﺸﻣ ﺎﺑﻥﺍﺭﺎﻤﻴﺑﻱﺮﮕﻟﺎﺑﺮﻏ ﺯﺍCOPD

ﺮﻈﻧ ﻼﺘـﺑﺍ ﻪـﺑ ﻦـﻳﺍ ﻡﻭﺭﺪﻨـﺳ ﺭﺩ

ﻦﻴﻨـﺳ

ﻦﻴﻳﺎﭘ ﺮﺗ ﻲﻣ ﺪﻧﺍﻮﺗ ﺭﺎﻴﺴﺑ ﺪﻴﻔﻣ ﺪـﺷﺎﺑ . ﺪﻳﺎـﺷ ﻥﺎـﻣﺭﺩ

ﻥﺍﺭﺎﻤﻴﺑ ﺯﺍ ﺮـﻈﻧ ﻢـﺋﻼﻋ ﻡﻭﺭﺪﻨـﺳ ﻚـﻴﻟﻮﺑﺎﺘﻣ

ﺪـﻧﺍﻮﺘﺑ

ﻚﻤﻛ ﻱﺮﺛﻮﻣ ﺭﺩ ﻪﻨﻴﻣﺯ ﺶﻫﺎـﻛ ﺕﻼﻜـﺸﻣ

ﻲـﺴﻔﻨﺗ

ﺪﺷﺎﺑ ﻦﻳﺍ . ﻦﻳﺍ ﻪﺑ ﻪﻌﻟﺎﻄﻣ ﻪﻛ ﺖﻠﻋ

ﻖـﻴﻘﺤﺗ ﻪـﺑ

ﺕﺭﻮـﺻ

ﻚﺗ ﻩﺰﻛﺮﻣ ﻭ ﻲﻌﻄﻘﻣ ﻡﺎﺠﻧﺍ

ﺪـﺷ

، ﺖﻳﺩﻭﺪـﺤﻣ ﻱﺍﺭﺍﺩ

ﻲﻣ ﺪﺷﺎﺑ ﻪﻛ ﻪﻴﺻﻮﺗ ﻲﻣ ﺩﻮﺷ ﺭﺩ ﺕﺎﻌﻟﺎﻄﻣ ﻩﺪﻨﻳﺁ

ﻪـﺑ . ﺩﻮـﺷ ﻡﺎـﺠﻧﺍﺮﮕﻧﻩﺪﻨﻳﺁ ﻭﻩﺰﻛﺮﻣ ﺪﻨﭼﺕﺭﻮﺻ ﺮـﺘﻬﺑ

ﺖﺳﺍ ﺭﺩ ﺕﺎﻌﻟﺎﻄﻣ ﻱﺪﻌﺑ

ﺶﻘﻧ ﻱﺮﮕﻟﺎـﺑﺮﻏ ﻡﻭﺭﺪﻨـﺳ

ﻚﻴﻟﻮﺑﺎﺘﻣ ﺭﺩ

ﻥﺍﺭﺎﻤﻴﺑ ﻼﺘﺒﻣ ﻪﺑ ﻱﺭﺎﻤﻴﺑ ﻱﺎﻫ ﻲﺴﻔﻨﺗ

ﻭ ﺯﺍ ﻪــﻠﻤﺟ ﺭﺩCOPD

ﻞــﺣﺍﺮﻣ ﻪــﻴﻟﻭﺍ

ﺰــﻴﻧ ﻲــﺳﺭﺮﺑ

ﺩﻮﺷ . ﺮﻜﺸﺗ ﻭ ﺮﻳﺪﻘﺗ ﻥﺎﮔﺪﻨﺴﻳﻮﻧ ﻦﻳﺍ

ﻪﻌﻟﺎﻄﻣ ﺯﺍ ﻲﻣﺎﻤﺗ ﻲﻧﺍﺭﺎﻤﻴﺑ ﻪﻛ

ﺭﺩ ﻦﻤﺿ .ﺪﻨﻨﻛ ﻲﻣﺮﻜﺸﺗﺪﻧﺍ ﻩﺩﺮﻛﺖﻛﺮﺷﻪﻌﻟﺎﻄﻣ ﻥﺁ ﻭ ﻲﻤﻇﺎـﻛﺍﺮﺘﻴﻣﺮﺘﻛﺩ ﻢﻧﺎﺧﻥﺍﺭﺎﻜﻤﻫﺕﺎﻤﺣﺯ ﺯﺍﻪﻛ ﻱﺎﻗﺁ ﺮﺘﻛﺩ ﻩﻭﺎﻛ ﻱﻮﺳﻮﻣ ﻲﻧﺎﻛ

ﻪﻛ ﻥﻭﺪـﺑ ﻚـﺷ

ﻪـﺑ ﻪـﻌﻟﺎﻄﻣ ﻦـﻳﺍ ﺮﺘـﺸﻴﺑﻪﭼﺮﻫﺖﻴﻔﻴﻛﻥﺩﻭﺰﻓﺍ ﻚـﻤﻛ

ﻥﺍﻭﺍﺮﻓ

،ﺪﻧﺩﻮﻤﻧ ﻝﺎﻤﻛ

ﺮﻜﺸﺗ ﻭ ﻲﻧﺍﺩﺭﺪﻗ ﻢﻳﺭﺍﺩ

.

ﻊﺑﺎﻨﻣ

1. Grundy SM. Metabolic syndrome pandemic.

Arterioscler Thromb Vasc Biol. 2008; 28:629-636.

2. Cameron AJ, Shaw JE, Zimmet PZ. The metabolicsyndrome: Prevalence in worldwide populations. Endocrinol Metab Clin North Am.

2004; 33:351-375.

3. Ford ES, Giles WH, Mokdad AH. Increasing prevalence of the metabolic syndrome among U.S.

adults. Diabetes Care. 2004; 27:2444-2449.

4. Alberti KG, Zimmet PZ. Should we dump the metabolic syndrome? No. BMJ. 2008; 336:641.

5. Nesto RW. The relation of insulin resistance syndromes to risk of cardiovascular disease. Rev Cardiovasc Med. 2003; 4 (Suppl 6):S11-S18.

6. Joslin EP. The prevention of diabetes mellitus.

JAMA. 1921; 76:79-84.

(7)

84 7. Kylin E. Studies of the hypertension- hyperglycemiahyperuricemia syndrome. Zentralbl Inn Med. 1923; 44:105-127. [ German]

8. Vague J. La differentiation sexually, factor determinant des formes de l'ob sit. Presse Med.

1947; 30:339-340[French].

9. Avogaro P, Crepaldi G, Enzi G, Tiengo A.

Associazione di iperlipidemia, diabete mellito e obesità di medio grado. Acta Diabetol Lat. 1967;

4:572-590. Haller H. Epidemiology and associated risk factors of hyperlipoproteinemia. Z Gesamte Inn Med. 1977; 32:124-128.

10. Singer P. Diagnosis of primary hyperlipoproteinemias. Z Gesamte Inn Med. 1977;

32:129-133.

11. Ph i l l i p s GB. Se x hormones, r i s k f a c t o r s and cardiovascular disease. Am J Med. 1978;

65:7-11.

12. Phillips GB. Relationship between serum sex hormones and glucose, insulin, and lipid abnormalities in men with myocardial infarction.

Proc Natl Acad Sci U S A. 1977; 74:1729-1733.

13. Grundy SM, Cleeman JI, Daniels SR, et al.

Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and BloodInstitute Scientific Statement. Circulation .2005; 112: 2735–2752.

14. Fereidoun Azizi. Appropriate Definition of Metabolic Syndrome among Iranian Adults: Report of the Iranian National Committee of Obesity.

Archives of Iranian Medicine.2010; 13(5); 426-8.

15. Marquis K, Maltais F, Duguay V. The metabolic syndrome in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2005; 25: 226–232.

16. Henrik Watz, Benjamin Waschki, Anne Kirsten, Kai-Christian Müller,Gunther Kretschmar, Thorsten Meyeret al. the metabolic syndrome in patients with chronic bronchitis and COPD frequency and associated Consequences for Systemic inflammation and physical inactivity:

Chest .2009;136:1039-1046.

17.

2 diabetes and increased body mass index.

2010, 17: 21-6.

18.

associated with increased risk of acute exacerbation of COPD: a preliminary study.

38(1):76-8.

19.

metabolic syndrome: the Guangzhou Biobank Cohort Study

20.

inflammatory profile in obese patients with chronic obstructive pulmonary disease.

2008; 5(1):35-41.

21.

syndrome in patients with chronic obstructive pulmonary disease.

25(4):226-32.

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Original Article http://rjms.tums.ac.ir

Razi Journal of Medical Sciences Vol. 20, No. 108, May-June 2013 85

Metabolic syndrome and underlying predisposing factors among Iranian Chronic Obstructive Pulmonary Disease and Chronic Bronchitis patients

Seyed Ali javadMousavi, MD, Associate Professor of Internal Diseases, pulmonary specialist, Rasool Akram Hospital, Tehran university of medical science, Tehran, Iran. [email protected]

Seyed Mohammad Samedanifard, MD, Assisstant Professor of Internal Diseases, Endocrinologist, Rasool Akram Hospital, Tehran university of medical science, Tehran, Iran. [email protected]

*Esmaiil Ghasemi Pashaee, MD, pulmonary specialist, Rasool Akram Hospital,Tehran university of medical science, Tehran, Iran.( *Corresponding Author)

Milad Rashid Beigi, MD, medical student, student committee research, Ilam University of Medical Sciences, Ilam, Iran. [email protected]

Abstract

Background: Metabolic Syndrome (MetS) is a physiological and biochemical disorder that are associated diabetes or elevated fasting blood sugar , obesity , triglyceride level and cholesterol disorders and hypertension.. The syndrome has been given several names such as Insulin resistance syndrome, Plurimetabolic syndrome, Reavens syndrome, Syndrome X and the deadly quartet. Some recent evidence have shown a significant correlation between MetS and lung disease especially Chronic Obstructive Pulmonary Disease (COPD). So we aimed to estimate frequency of MetS among a sample of Iranian patients of COPD (Chronic Obstructive Pulmonary Disease) and Chronic Bronchitis (CB).

Methods: In this cross-sectional study, 204 COPD and CB Known cases evaluated as MetS development and demographic criteria, lipid profile, C reactive Protein (CRP) blood level, and smoking history and correlation of these criteria were assessed in these patients.

Results: Frequency of MetS involvement among these subjects was approximately 48%. Age (p=0.003), abdominal obesity (p<0.001), high TG amount (p<0.001) and positive CRP (p=0.04) were correlated with MetS involvement.

Conclusions: MetS was more frequent among COPD and CB patient.Age and underlying systematic inflammation Appears to be related to MetS.

Keywords: Metabolic Syndrome, Chronic Bronchitis, Chronic Obstructive Pulmonary Disease.