ﻴﻣﻮﻤﺴﻣ ﺲﻴﺳ زا ﻲﺷﺎﻧ يﻮﻴﻠﻛ ﺖ
ﻦﻴﺗﻼﭘ يروﺮﻣ ﻪﻌﻟﺎﻄﻣ :
ﺳ
ﻴ ﺪ ﺳ ﻴ ﻒ ﻪﻟا دﻼﺑ ي ﻮﺳﻮﻣ
1
ي
، سﺎﺒﻋ ﻲﺘﻋارز ﻲﻠﻋ
2
هﺪﻴﻜﭼ
ﺲﻴﺳ ﻦﻴﺗﻼﭘ
، يﻮﻗ يوراد ﻚﻳ ﻲﻤﻴﺷ
ﻲﻧﺎﻣرد ﺖﺳا زا ﻲﻌﻴﺳو ﻒﻴﻃ نﺎﻣرد رد ﻪﻛ نﺎﻃﺮﺳ
ﺪﻣﺎﺟ يﺎﻫ
(Solid)
ﻲﻣ هدﺎﻔﺘﺳا نآ زا دﻮﺷ
. ﺎﺑ
دﻮﺟو ﻦﻳا
، آ زا ﻲﻜﻴﻨﻴﻠﻛ هدﺎﻔﺘﺳا ن
، ﺑ ﻪ ناﺰﻴﻣ ﺶﻫﺎﻛ و يﻮﻴﻠﻛ ﺐﻴﺳآ زوﺮﺑ ﻞﻴﻟد ﻪﻴﻔﺼﺗ
ﻲﻟوﺮﻣﻮﻠﮔ رد ﻪﻛ 15 ﺎﺗ 30 % خر نارﺎﻤﻴﺑ زا
ﻲﻣ ﻲﻣ دوﺪﺤﻣ ،ﺪﻫد ددﺮﮔ
. ﻢﺴﻴﻧﺎﻜﻣ دﺮﻜﻠﻤﻋ لﻼﺘﺧا رد ﻪﻛ يدﺪﻌﺘﻣ يﺎﻫ ﻪﻴّﻠﻛ
ﻪﺑ ﺲﻴﺳ ﺖﻓﺎﻳرد لﺎﺒﻧد ﺪﻧراد ﺶﻘﻧ ﻦﻴﺗﻼﭘ
، ﻪﻛ زا ﺪﻨﺗرﺎﺒﻋ :
لﻮﻠﺳ ﺐﻴﺳآ ﻲﭘا يﺎﻫ
،لﻮﺑﻮﺗ لﺎﻴﻠﺗ ضﺎﺒﻘﻧا
ﻚﭼﻮﻛ قوﺮﻋ رد ﻪﻴّﻠﻛ
ﻦﻴﻛﻮﺘﻴﺳ زوﺮﺑ ﺶﻳاﺰﻓا و ﺶﻴﭘ يﺎﻫ
ﻲﺑﺎﻬﺘﻟا .
ﻴﻣﻮﻤﺴﻣ تاﺮﻫﺎﻈﺗ ﻦﻳﺮﺘﻤﻬﻣ ﺲﻴﺳ يﻮﻴﻠﻛ ﺖ
ﻦﻴﺗﻼﭘ ﻞﻣﺎﺷ : ﺎﺳرﺎﻧ ﻳ
دﺎﺣ ﻲ ﻪﻴّﻠﻛ ) (ARF
ﻲﻣ ﻪﻛ ﻚﻳرﻮﮕﻴﻟا ﺮﻴﻏ ،ﺪﺷﺎﺑ هﺪﻧوﺮﺸﻴﭘ ﺪﻧاﻮﺗ
ﺖﺳا ﻲﻤﻧآ و ﻲﻧﻮﻜﻧﺎﻓ ﻪﻴﺒﺷ مرﺪﻨﺳ ،ﻲﻤﻳﺰﻴﻨﻣﻮﭙﻴﻫ .
ﺶﻳاﺰﻓا ﺮﻄﺧ
،ARF
ﺲﻴﺳ ﺮﺗﻻﺎﺑ يﺎﻫزود ﺖﻓﺎﻳرد ﺎﺑ ﺷ ،ﻦﻴﺗﻼﭘ
ﻲﻤﻴ ﻲﻧﺎﻣرد ﺎﺑ ﻲﻠﺒﻗ
ﺲﻴﺳ ﻪﻨﻴﻣز يﻮﻴﻠﻛ دﺮﻜﻠﻤﻋ لﻼﺘﺧا ،ﻦﻴﺗﻼﭘ دراد طﺎﺒﺗرا ﻚﻴﺴﻛﻮﺗوﺮﻔﻧ ﻞﻣاﻮﻋ ﺮﻳﺎﺳ نﺎﻣﺰﻤﻫ ﺰﻳﻮﺠﺗ و يا
.
دراﺪﻧﺎﺘﺳا دﺮﻜﻳور ياﺮﺑ
ﻴﻣﻮﻤﺴﻣ زا يﺮﻴﮕﺸﻴﭘ ﺲﻴﺳ زا ﻲﺷﺎﻧ يﻮﻴﻠﻛ ﺖ
ﺲﻴﺳ ﺮﺘﻤﻛ يﺎﻫزود ﺰﻳﻮﺠﺗ ،ﻦﻴﺗﻼﭘ ﺰﻳﻮﺠﺗ هاﺮﻤﻫ ﻪﺑ ﻦﻴﺗﻼﭘ
لﻮﻓ نﻮﺗوﺰﻳا ﻦﻴﻟﺎﺳ
، ﺠﺗ زا ﺪﻌﺑ و ﻞﺒﻗ ﺲﻴﺳ ﺰﻳﻮ
ﻲﻣ ﻦﻴﺗﻼﭘ ﺪﺷﺎﺑ .
ﺮﮔا وراد ﻞﻣاﻮﻋ زا يداﺪﻌﺗ ﻪﭼ ﻳ
ﻞﻣﺎﺷ ﻲ : نا ،ﻢﻳﺪﺳ تﺎﻔﻟﻮﺳﻮﻴﺗ -
ﻴﻣﻮﻤﺴﻣ ﺶﻫﺎﻛ ياﺮﺑ ﻦﻴﺴﻴﻠﮔ و ﻦﻴﻠﻴﻓﻮﺌﺗ ،ﻦﻴﺌﺘﺴﻴﺳ ﻞﻴﺘﺳا يﻮﻴﻠﻛ ﺖ
،
ﻪﺘﻓﺮﮔ راﺮﻗ ﻲﺑﺎﻳزرا درﻮﻣ ﺪﻧا
، ﺎﻣا ﭻﻴﻫ ﺶﻘﻧ ماﺪﻛ تﺎﺒﺛا
هﺪﺷ ﻪﺘﺷاﺪﻧ يا ﺪﻧا تاﺮﺛا تﺎﺒﺛا ياﺮﺑ يﺮﺘﺸﻴﺑ ﻲﻜﻴﻨﻴﻠﻛ تﺎﻌﻟﺎﻄﻣ و ﻟﺎﻤﺘﺣا
ﻲ زﺎﻴﻧ ﺎﻬﻧآ
دﻮﺑ ﺪﻫاﻮﺧ .
هژاو يﺪﻴﻠﻛ يﺎﻫ ﺳ:
ﻴ ﺲ ﺗﻼﭘ ﻴ ﻦ
؛ ﺳآ ﻴ ﺐ ﻠﻛ ﻴ ﻮ ي ﺳ ﻴ ﺲ ﺗﻼﭘ ﻴ ﻦ
؛ ﺷ ﻴ ﻤ ﻲ ﻧﺎﻣرد ﻲ
ﺪﻨﺟﺮﻴﺑ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ﻲﻤﻠﻋ ﻪﻠﺠﻣ .
1392
؛ 20 ) 2 :(
327 - 337 .
ﺖﻓﺎﻳرد : 11 / 12 / 1391 شﺮﻳﺬﭘ : 18 / 10 / 1392
رﺎﻴﺸﻧاد1
، ژﻮﻟوﺮﻔﻧ ﺺﺼﺨﺗ قﻮﻓ ي
، ﻠﺧاد هوﺮﮔ ﻲ
، ﻜﺷﺰﭘ هﺪﻜﺸﻧاد ﻲ
، ﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ﻲ
ﺪﻨﺟ ي زاﻮﻫا رﻮﭘﺎﺷ ناﺮﻳا ،زاﻮﻫا ، .
،لوﺆﺴﻣ هﺪﻨﺴﻳﻮﻧ2
رﺎﻴﺸﻧاد
،يژﻮﻟوﺮﻔﻧ هوﺮﮔ ﻲﻠﺧاد ﻘﺤﺗ ﺰﻛﺮﻣ ، ﻴ تﺎﻘ ﭘ ضراﻮﻋ ﻴ ﺪﻧﻮ ﻠﻛ ﻴ
،ﻪ ﺑﻴ نﺎﺘﺳرﺎﻤ ا ﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﺎﺿر مﺎﻣ ﻲ
ﺪﻬﺸﻣ ناﺮﻳا ،ﺪﻬﺸﻣ ، .
سردآ : ﺪﻬﺸﻣ ﺿر مﺎﻣا نﺎﺘﺳرﺎﻤﻴﺑ- ﺎ
- يژﻮﻟوﺮﻔﻧ ﺶﺨﺑ
ﻦﻔﻠﺗ : 09155037124
ﺮﺑﺎﻤﻧ : 05118598818
ﻲﻜﻴﻧوﺮﺘﻜﻟاا ﺖﺴﭘ :
ﻪﻣﺪﻘﻣ ﺲﻴﺳ ﻦﻴﺗﻼﭘ
، ﻲﻤﻴﺷ يوراد ﻚﻳ و يﻮﻗ ﻲﻧﺎﻣرد
را ﺪﻨﻤﺷز
ﻲﻤﻴﺧﺪﺑ زا ﻲﻌﻴﺳو ﻒﻴﻃ نﺎﻣرد ياﺮﺑ ﻪﻛ ﺖﺳا ﻪﻠﻤﺟ زا ﺎﻫ
:
نﺎﻃﺮﺳ ﺮﺳ يﺎﻫ و
ندﺮﮔ ، ﻪﻧﺎﺜﻣ ، ﻪﻳر ﻚﭼﻮﻛ ﺮﻴﻏ لﻮﻠﺳ ،
يﺮﻣ ،
نﺎﻃﺮﺳ و ﻢﺣر ندﺮﮔ نﺎﺘﺴﭘ ﻚﻴﺗﺎﺘﺳﺎﺘﻣ يﺎﻫ
، و ﻪﻀﻴﺑ ناﺪﻤﺨﺗ
ﻪﺑ ﻲﻣ رﺎﻛ دور ) 1 - 8 (.
لﻮﺑﻮﺗ دﺮﻜﻠﻤﻋ لﻼﺘﺧا يﺎﻫ
ﻪﻴّﻠﻛ ناﺰﻴﻣ ﺶﻫﺎﻛ ﺚﻋﺎﺑ ﻪﻛ
ﻪﻴﻔﺼﺗ و ﻲﻟوﺮﻣﻮﻠﮔ ﺣ ﻲﻳﺎﺳرﺎﻧ
و دﺎ ﻦﻣﺰﻣ ﻪﻴّﻠﻛ ﻲﻣ ﻲﻜﻳ ،ددﺮﮔ
ﻲﻣ وراد ﻦﻳا زا هدﺎﻔﺘﺳا ضراﻮﻋ زا ﺪﺷﺎﺑ
ﻪﻛ هزوﺮﻣا رد 15 ﺎﺗ
30 % ﺑ زا ﻴ نارﺎﻤ ﻣ خر ﻲ ﺪﻫد . ﻪﺿرﺎﻋ ﻦﻳا عﻮﻴﺷ
، لﺎﺳ رد ﺎﻫ ي
ﻟوا ﻴ ﻪ ا زا هدﺎﻔﺘﺳا ﻳ
ﻦ ﻪﻛ وراد دﻮﺟو نآ ﺎﺑ يﺮﺘﻤﻛ ﻲﻳﺎﻨﺷآ
ﺖﺷاد
، و دﻮﺑ ﺮﺘﺸﻴﺑ ﺰﻴﻧ راﺪﻘﻣ ﻦﻳا زا ﻲﺘﺣ دوﺪﺣ
50
% زا
رد ﻳ ﺖﻓﺎ نﺎﮔﺪﻨﻨﻛ
، ا رﺎﭼد ﻳ ﻦ ﻪﺿرﺎﻋ ﻣ ﻲ ﺪﻧﺪﺷ ) 9 ، 10 .(
ﻢﺴﻴﻧﺎﻜﻣ زا ﻲﺷﺎﻧ يﻮﻴﻠﻛ ﺐﻴﺳآ دﺎﺠﻳا رد يدﺪﻌﺘﻣ يﺎﻫ
ﺲﻴﺳ ﻣ ﻦﻴﺗﻼﭘ ﺆ
ّﺛ هدﻮﺑ ﺮ ﺪﻧا ﻞﻣﺎﺷ رﺎﺼﺘﺧا رﻮﻃ ﻪﺑ ﻪﻛ ﻦﻳا
دراﻮﻣ
ﻲﻣ ﺪﺷﺎﺑ : لﻮﻠﺳ ﻪﺑ ﻲﺑﺎﺨﺘﻧا و ﻢﻴﻘﺘﺴﻣ ﺐﻴﺳآ ﻲﭘا يﺎﻫ
لﺎﻴﻠﺗ
ﻲﻣ نآ زﻮﺘﭘﻮﭘآ و زوﺮﻜﻧ ﺚﻋﺎﺑ ﻪﻛ لﺎﻤﻳﺰﮔوﺮﭘ لﻮﺑﻮﺗ ددﺮﮔ
؛
ﻋ رد ضﺎﺒﻘﻧا ﻚﭼﻮﻛ قوﺮ
ﻪﻴّﻠﻛ نﻮﺧ نﺎﻳﺮﺟ ﺶﻫﺎﻛ ﺚﻋﺎﺑ ﻪﻛ
ﻪﻴّﻠﻛ ﻲﻣ و دﻮﺷ دازآ و زوﺮﺑ ﺶﻳاﺰﻓا
ﻮﺘﻴﺳ يزﺎﺳ ﻦﻴﻛ
يﺎﻫ
ﺶﻴﭘ ﻞﻴﺒﻗ زا ﻲﺑﺎﻬﺘﻟا ﻦﻴﻛﻮﻟﺮﺘﻨﻳا ،ﺎﻔﻟآ TNF
6 ، ﺮﺘﻨﻳا ﺎﻣﺎﮔ نوﺮﻓ
ﺖﻴﺳﻮﻜﻟ نﻮﻴﺳاﺮﺘﻠﻴﻔﻧا ﺚﻋﺎﺑ ﺖﻳﺎﻬﻧ رد ﻪﻛ زﺎﭙﺳﺎﻛ و ﺖﻓﺎﺑ رد ﺎﻫ
ﻪﻴّﻠﻛ ﻲﻣ دﺮﮔ ﺪﻧ ) 11 - 14 ( .
ﻲﻠﻋ
ًﺎﺘﺒﺴﻧ عﻮﻴﺷ ﻢﻏر يﻻﺎﺑ
دﺎﺣ ﻲﻳﺎﺳرﺎﻧ ﻪﻴّﻠﻛ
يﻮﻗ تاﺮﺛا ،
يرﻮﻣﻮﺗ ﺪﺿ وراد ﻦﻳا زا هدﺎﻔﺘﺳا ﻪﻛ ﺖﺳا هﺪﺷ ﺚﻋﺎﺑ وراد
،
و هﺪﻳدﺮﮕﻧ دوﺪﺤﻣ ﻲﻠﺻا يﺎﻫوراد زا ﻲﻜﻳ وراد ﻦﻳا نﺎﻨﭽﻤﻫ
ﻞﻜﺗوﺮﭘ ﻲﻤﻴﺷ يﺎﻫ ﺪﺷﺎﺑ ﻲﻧﺎﻣرد
) 2 ، 4 ، 15 (.
ﻳ ﻜ ﻲ ﺻﻮﺼﺧ زا ﻴ
تﺎ ﺎﺳرﺎﻧ ﻲﻳ
دﺎﺣ ﻪﻴّﻠﻛ ) ( ARF رد ﻪﻛ
90 % د دراﻮﻣ ﻳ هﺪ ﻣ ﻲ دﻮﺷ
، ﺖﺸﮔﺮﺑ ﺬﭘ ﻳ ﺮ ﺑ دﺮﻜﻠﻤﻋ ندﻮ ﻪﻴّﻠﻛ
ﺖﺳا
؛ ا ﺎﺑ ﻳ ﻦ دﻮﺟو
، ﺘﻣ ﺄ ﻪﻧﺎﻔﺳ ﺎﻫ ARF
ﻲﻳ ﺑ ﻪﻛ ﻪ ﻮﺠﺗ لﺎﺒﻧد ﻳ
ﺰ
ﺳ ﻴ ﺲ ﺗﻼﭘ ﻴ ﻦ اﻳ دﺎﺠ ﻣ ﻲ ددﺮﮔ
، ﺖﺸﮔﺮﺑ ًﻻﻮﻤﻌﻣ ﺬﭘﺎﻧ
ﻳ ﺮ و هدﻮﺑ اﺬﻟ
ﺮﺗﺪﺑ ﺚﻋﺎﺑ ﺶﻴﭘ نﺪﺷ
نارﺎﻤﻴﺑ ﻦﻳا ﻲﻬﮔآ ﻲﻣ
ﺷ
؛دﻮ زا ﻤﻫ ﻴ ﻦ ور
،
ﻤﻫا ﻴ ﺖ ﺗﺎﻣاﺪﻗا ﺶﻘﻧ ﻲ
ﻪﻛ ﭘ ﺚﻋﺎﺑ ﻴ ﮕﺸ ﻴ ﺮ ي ا زا ﻳ دﺎﺠ ﺖﻴﻣﻮﻤﺴﻣ يﻮﻴﻠﻛ
زا ﻲﺷﺎﻧ اﻳ
ﻦ راد ﻣ و ﻲ ﺪﻧﻮﺷ
، ﻣ ﻒﻋﺎﻀﻣ ﻲ
ددﺮﮔ ) 16 -
18 .(
ﻞﻜﺗوﺮﭘ زا يرﺎﻴﺴﺑ رد هزوﺮﻣا ﻪﻜﻨﻳا ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ يﺎﻫ
ﻲﻤﻴﺷ ﻲﻧﺎﻣرد
، ﺲﻴﺳ يوراد زا ﻲﻣ هدﺎﻔﺘﺳا ﻦﻴﺗﻼﭘ
دﻮﺷ ﺎﺑ و
ﺎﺳرﺎﻧ يﻻﺎﺑ عﻮﻴﺷ ﻪﺑ ﺖﻳﺎﻨﻋ ﻳ
ﻲ ﻪﻴّﻠﻛ و ﻤﻫا ﻴ ﺖ تﺎﻣاﺪﻗا
ﭘﻴ ﮕﺸ ﻴ ﺮ ي هﺪﻨﻨﻛ نآ زا ، ﺖﺳا هﺪﺷ ﻲﻌﺳ ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد ﻪﻛ
ﻪﺑ
ﻗا ﻦﻳا يروﺮﻣ ﻲﺳرﺮﺑ ﺗ و تﺎﻣاﺪ
ﺄ رد و هﺪﺷ ﻪﺘﺧادﺮﭘ ﺎﻬﻧآ ﺮﻴﺛ
اﺪﺘﺑا
، زا ﻲﺷﺎﻧ يﻮﻴﻠﻛ ﺐﻴﺳآ ﻲﻜﻴﻨﻴﻠﻛ تاﺮﻫﺎﻈﺗ ﺎﺑ ﻪﻄﺑار رد
ﺲﻴﺳ دﻮﺷ ﺚﺤﺑ ﻦﻴﺗﻼﭘ .
ﻠﻛ تاﺮﻫﺎﻈﺗ ﻴ
ﻨ ﻴ ﻜ ﻲ ﺳآ ﻴ ﺐ ﻠﻛ ﻴ ﻮ ي ﺷﺎﻧ ﻲ ﺳ زا ﻴ ﺲ ﺗﻼﭘ ﻴ ﻦ
زا ﻲﺷﺎﻧ يﻮﻴﻠﻛ ﺐﻴﺳآ ﻲﻜﻴﻨﻴﻠﻛ ﺮﻫﺎﻈﺗ ﻦﻳﺮﺘﻤﻬﻣ ﺲﻴﺳ ﻦﻴﺗﻼﭘ
، دﺮﻜﻠﻤﻋ لﻼﺘﺧا ﻪﻴّﻠﻛ
ﻪﺑ ﻪﻛ هدﻮﺑ رﻮﻃ
لﻮﻤﻌﻣ
،
ﺪﻨﭼ زور ﻦﻳ ) دوﺪﺣ 10 زور ( ﺲﻴﺳ ﺰﻳﻮﺠﺗ زا ﺪﻌﺑ عوﺮﺷ ﻦﻴﺗﻼﭘ
ﻲﻣ دﻮﺷ و ﻣ ﻲ ﭘ ﺪﻧاﻮﺗ ﻴ هﺪﻧوﺮﺸ ﻏ و ﻴ ﺮ ﺪﺷﺎﺑ ﺖﺸﮔﺮﺑ ﻞﺑﺎﻗ
؛ رد اﺬﻟ
ﻲﻧارﺎﻤﻴﺑ هﺪﻧوﺮﺸﻴﭘ ﺐﻴﺳآ رﺎﭼد ﻪﻛ
ﻪﻴّﻠﻛ ﻲﻣ ﺪﻧﻮﺷ
، ﻪﻴﺻﻮﺗ
ﻲﻣ ددﺮﮔ ﻊﻄﻗ نﺎﻣرد ﻪﻣادا ﻪﻛ دﻮﺷ )
19 - 22 .(
ﺲﻴﺳ ﻪﻜﻨﻳا ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ ﻦﻴﺗﻼﭘ
، ﻪﻠﻨﻫ سﻮﻗ ﻪﺑ ﺐﻴﺳآ ﺚﻋﺎﺑ
ﺰﻴﻧ ﻲﻣ ﺎﺳرﺎﻧ ،ددﺮﮔ ﻳ
ﻲ ﻪﻴّﻠﻛ نآ زا ﻲﺷﺎﻧ
ًﻻﻮﻤﻌﻣ ﻪﺑ ترﻮﺻ
ﻏ ﻴ ﺮ ﻟوا ﻴ رﻮﮕ ﻳ ﻚ ﻪﺑ و هدﻮﺑ رﻮﻃ
لﻮﻤﻌﻣ نوﺮﺑ ناﺰﻴﻣ يراردا هد
، زا
ﻲﺳ راﺰﻫ ﺖﺳا ﺮﺘﺸﻴﺑ زور رد ﻲﺳ
، ﺎﺳرﺎﻧ ﻪﻜﻨﻳا ﺮﮕﻣ ﻳ
ﺪﻳﺪﺷ ﻲ
ﻪﻴّﻠﻛ ﺪﺷﺎﺑ هدﺎﺘﻓا قﺎﻔﺗا )
23 .(
ﺮﺿﺎﺣ لﺎﺣ رد
، ياﺮﺑ رﺎﻴﻌﻣ ود
دﺎﺣ ﺐﻴﺳآ ﺺﻴﺨﺸﺗ ﺮﻗ هدﺎﻔﺘﺳا درﻮﻣ يﻮﻴﻠﻛ
ﻲﻣ را ﻪﻛ دﺮﻴﮔ
ﻞﻣﺎﺷ : يﺎﻫرﺎﻴﻌﻣ RIFLE
ﺎﻳ و AKI Network staging
ﻲﻣ نوﺮﺑ و مﺮﺳ ﻦﻴﻨﻴﺗاﺮﻛ يﺎﻫرﺎﻴﻌﻣ ﺮﺑ ﻪﻛ ﺪﺷﺎﺑ يراردا هد
ﻲﻣ راﻮﺘﺳا ﺪﻨﺷﺎﺑ
) 24 .(
زا Neutrophil gelatinase associated lipoclain
) ( NGAL ﻲﻣ يرﺎﻴﻌﻣ ناﻮﻨﻋ ﻪﺑ ناﻮﺗ ياﺮﺑ
دﺎﺣ ﺐﻴﺳآ ﻦﻴﻴﻌﺗ
ﻪﻴّﻠﻛ زا ﻲﺷﺎﻧ ﺲﻴﺳ
ﻴﺗﻼﭘ ﻻﺎﺑ زا ﻞﺒﻗ ،ﻦ ﻦﻴﻨﻴﺗاﺮﻛ ﺢﻄﺳ ﻦﺘﻓر
دﺮﻛ هدﺎﻔﺘﺳا مﺮﺳ .
ﻦﻴﺌﺗوﺮﭘ ﻦﻳا
، ﻞﻴﻓوﺮﺗﻮﻧ ﻂﺳﻮﺗ رد و ﺢﺷﺮﺗ ﺎﻫ
لﻮﻠﺳ زا يداﺪﻌﺗ ﺢﻄﺳ ،ﺖﻧﻮﻔﻋ مﺎﮕﻨﻫ رد و هﺪﻳدﺮﮔ نﺎﻳﺎﻤﻧ ﺎﻫ
و نﺎﻃﺮﺳ ﺚﻋﺎﺑ ﺐﻴﺳآ ﺎﻳ
ﻪﻴﻠﻛ ﻲﻟﻮﺑﻮﺗ يﺎﻫ upregulate
ﻲﻣ
ددﺮﮔ
)
26
-
25
.(
ﻲﻜﻳ د ﻳ ﺮﮕ زا ﻪﺘﺧﺎﻨﺷ ضراﻮﻋ هﺪﺷ
يﻮﻴﻠﻛ ﺖﻴﻣﻮﻤﺴﻣ
ﺳ ﻴ ﺲ ﺗﻼﭘ ﻴ ﻦ ﺑ رد ﻪﻛ ﻴ ﺶ ﻧ زا ﻴ ﻤ ﻲ ﺑ زا ﻴ نارﺎﻤ رد ﻳ ﺖﻓﺎ نآ هﺪﻨﻨﻛ
د ﻳ هﺪ ﻣ ﻲ دﻮﺷ
، ﻫ ﻴ ﻨﻣﻮﭙ ﻴ ﺰ ﻳ ﻤ ﻲ ﺷﺎﻧ ﻲ زا زا ﺖﺳد ﻨﻣ نداد ﻴ ﺰ ﻳ ﻢ زا
ﺮﻃ ﻳ ﻖ راردا ﻪﻛ ﺖﺳا ﻪﺑ
ﻟد ﻴ ﻞ ﺳآ ﻴ ﺐ ﻘﺘﺴﻣ ﻴ ﻢ ﺳ ﻴ ﺲ ﺗﻼﭘ ﻴ ﻦ ﻪﺑ
ﺨﺿ ﺖﻤﺴﻗ ﻴ
ﻢ ﻻﺎﺑ و ﻪﻠﻨﻫ سﻮﻗ ور لﻮﺑﻮﺗ
د ﻳ لﺎﺘﺴ ﻣ ﻲ ﺪﺷﺎﺑ .
اﻳ ﻦ ﻪﺑ ﺖﺳا ﻦﻜﻤﻣ ﻪﻛ ﻪﺿرﺎﻋ ﺪﺷ ترﻮﺻ
ﻳ ﺪ ﻧﻴ ﺰ ﺎﻤﻧ زوﺮﺑ ﻳ ﺪ
،
ﻣ ﻲ ا ﺮﺑ هوﻼﻋ ﺪﻧاﻮﺗ ﻳ
دﺎﺠ ﻮﭙﻴﻫ ﺮﻳﺎﺳ و ﻲﻤﻟﺎﻛ ﻠﻛ تاﺮﻫﺎﻈﺗ
ﻴﻨ ﻴ ﻜ ﻲ
ﺪﺸﺗ ﺚﻋﺎﺑ ،دﻮﺧ لﻮﻤﻌﻣ ﻳ
ﺪ ﺳآ ﻴ ﺐ ﻠﻛ ﻴ ﻮ ي و اﺰﻓا ﻳ ﺶ و گﺮﻣ ﻣ ﻴ ﺮ
ﺷﺎﻧ ﻲ ﺳ زا ﻴ ﺲ ﺗﻼﭘ ﻴ ﻦ ددﺮﮔ ) 27 - 29 (
؛ ﻲﺗاﺮﻫﺎﻈﺗ ﻦﻴﻨﭽﻤﻫ
و ﺰﻛﻮﻠﮔ يراردا ﻊﻓد ﺶﻳاﺰﻓا ﺎﺑ ﻲﻧﻮﻜﻧﺎﻓ مرﺪﻨﺳ ﻪﺑ ﻪﻴﺒﺷ لﻮﻠﺳ ﻪﺑ ﺐﻴﺳآ ﻪﻧﺎﺸﻧ ﻪﻛ ﻪﻨﻴﻣآ يﺎﻫﺪﻴﺳا ﻮﺗ يﺎﻫ
لﻮﺑ
ﻲﻣ لﺎﻤﻳﺰﮔوﺮﭘ هﺪﺷ هداد نﺎﺸﻧ نارﺎﻤﻴﺑ ﻦﻳا رد ﺰﻴﻧ ﺪﺷﺎﺑ
، ﻲﻟو
ﺖﺳا هﺪﺸﻧ شراﺰﮔ ﻚﻴﺳﻼﻛ ﻲﻧﻮﻜﻧﺎﻓ مرﺪﻨﺳ )
30 - 33 (.
ﻪﺑ ﺰﻴﻧ ﻲﻤﻧآ ﺖﻓﺎﻳرد نارﺎﻤﻴﺑ رد ﻊﻳﺎﺷ رﻮﻃ
هﺪﻨﻨﻛ
ﺲﻴﺳ هﺪﺷ هﺪﻳد ﻦﻴﺗﻼﭘ ﺖﺳا
ﺪﺷ و
ﺪﺣ نآ زا ﺶﻴﺑ نآ ت ي
بﻮﻛﺮﺳ ﺮﺛا زا ﻪﻛ ﺖﺳا ﺮﺑ نآ ﻲﮔﺪﻨﻨﻛ
ناﻮﺨﺘﺳا ﺰﻐﻣ يور
رﺎﻈﺘﻧا ﻲﻣ دور . مﺎﺠﻧا ﻲﻧﺎﺴﻧا و ﻲﻧاﻮﻴﺣ تﺎﻌﻟﺎﻄﻣ رد هﺪﺷ
، هرﺎﺷا
ﺲﻴﺳ ﺖﺳا ﻦﻜﻤﻣ ﻪﻛ ﺖﺳا هﺪﺷ ﻦﻴﺗﻼﭘ
، ﻪﺑ ﺐﻴﺳآ ﺎﺑ
لﻮﺑﻮﺗ يﺎﻫ ﻪﻴّﻠﻛ
، ﻦﻳا ﺎﺑ و هﺪﺷ ﻦﻴﺘﻳﻮﭘوﺮﺘﻳرا دﻮﺒﻤﻛ ﺚﻋﺎﺑ
ددﺮﮔ ﻲﻤﻧآ ﺚﻋﺎﺑ ﺰﻴﻧ ﻢﺴﻴﻧﺎﻜﻣ
ّﺮﺤﻣ يﺎﻫوراد ﺰﻳﻮﺠﺗ اﺬﻟ و ك
ﻲﻣ ﺪﻴﻔﻣ نآ نﺎﻣرد رد ﺲﻛﺮﭘا ﻞﻴﺒﻗ زا ﺰﺋﻮﭘوﺮﺘﻳرا ﺪﺷﺎﺑ
) 34 .(
ﺮﻄﺧ ﻞﻣاﻮﻋ ﻣﻮﻤﺴﻣ
ﻴ ﺖ ﻠﻛ ﻴ ﻮ ي ﺳ ﻴ ﺲ ﺗﻼﭘ ﻴ ﻦ
ﺮﻄﺧ ﻞﻣاﻮﻋ دﺎﺠﻳا ياﺮﺑ يدﺪﻌﺘﻣ
ﻣﻮﻤﺴﻣ ﻴ ﺖ ﻠﻛ ﻴ ﻮ ي
ﺳ ﻴ ﺲ ﺗﻼﭘ ﻴ ﻦ ﺖﺳا هﺪﺷ ﺺﺨﺸﻣ .
ًﻻﻮﻤﻌﻣ ﻣ يﻮﻴﻠﻛ ﺖﻴﻣﻮﻤﺴ
، ﺎﺑ
ﺰﻳﻮﺠﺗ زود ناﺰﻴﻣ وراد ﻲﻌﻤﺠﺗ زود و ﺰﻳﻮﺠﺗ تﺎﻌﻓد داﺪﻌﺗ ،هﺪﺷ
دراد ﻢﻴﻘﺘﺴﻣ طﺎﺒﺗرا .
ﻪﻌﻟﺎﻄﻣ رد ﻪﻛ ﺖﺳا هﺪﺷ هداد نﺎﺸﻧ يا
ﻮﻴﺳاﺮﺘﻠﻴﻓ ناﺰﻴﻣ ﺎﻤﺳﻼﭘ ﺖﻈﻠﻏ و ﻲﻟوﺮﻣﻮﻠﮔ ن
ﻳ ﻳﺰﻴﻨﻣ ﻲ
،ﻢ زا ﺪﻌﺑ
ﺲﻴﺳ ﺰﻳﻮﺠﺗ زا ﺮﺘﺸﻴﺑ يﺎﻫزود ﺎﺑ ﻦﻴﺗﻼﭘ
50 ﻲﻠﻴﻣ ﺮﺘﻣ ﺮﺑ مﺮﮔ
ﻊﺑﺮﻣ
، زا ﺮﺘﻤﻛ يﺎﻫزود رد و ﻪﺘﻓﺎﻳ ﺶﻫﺎﻛ 20
ﻲﻠﻴﻣ ﺮﻴﻴﻐﺗ مﺮﮔ
ﻲﻤﻧ ﺪﺑﺎﻳ
؛ ﻨﭽﻤﻫ ﻴ ﻦ ﻻﺎﺑ ﺎﻤﺳﻼﭘ ﺖﻈﻠﻏ ندﻮﺑ ﻳ
ﻲ ﺗﻼﭘ ﻴﻨ ﻴ مﻮ دازآ
ﻧﻴ ﺰ
، ﻣﻮﻤﺴﻣ ﺎﺑ
ﻴ ﺖ ﻠﻛ ﻴ ﻮ ي ﻘﺘﺴﻣ طﺎﺒﺗرا ﻴ
ﻢ دراد ) 35 ، 36 .(
ﺮﻳﺎﺳ
ﺎﻫﺮﻴﻐﺘﻣ ﻳ
ﻴﻣﻮﻤﺴﻣ ﺶﻳاﺰﻓا ﺚﻋﺎﺑ ﺖﺳا ﻦﻜﻤﻣ ﻪﻛ ﻲ يﻮﻴﻠﻛ ﺖ
ﺳ ﻴ ﺲ ﺗﻼﭘ ﻴ ﻦ ﻞﻣﺎﺷ دﻮﺷ :
ﻣ ﺲﻨﺟ ﺆ
ّﻧ ،ﺮﺗﻻﺎﺑ ﻦﺳ ،ﺚ
رﺎﮕﻴﺳ ﻲﻣ ﻲﻤﻨﻴﻣﻮﺒﻟآﻮﭙﻴﻫ و نﺪﻴﺸﻛ ﺪﺷﺎﺑ
؛ يرﺎﻤﻴﺑ ﻦﻴﻨﭽﻤﻫ
ﺶﻳاﺰﻓا ﺚﻋﺎﺑ ﺰﻴﻧ يﻮﻴﻠﻛ ﻲﻠﺒﻗ ﺮﻄﺧ
ﻴﻣﻮﻤﺴﻣ ﺎﺳرﺎﻧ و ﺖ ﻳ
دﺎﺣ ﻲ
ﻪﻴّﻠﻛ ﻲﻣ ددﺮﮔ ) 37 ، 38 (.
ﺮﮕﻳد فﺮﻃ زا
، دﻮﺟو ﻲﺗﺎﺷراﺰﮔ راد
ﻧ ﻲﻣ نﺎﺸﻧ ﻪﻛ ﺪ ﻫد
ﻨ ،ﺪ
ﺖﺑﺎﻳد
، ﺮﻄﺧ
ﻴﻣﻮﻤﺴﻣ ﺲﻴﺳ يﻮﻴﻠﻛ ﺖ لﺪﻣ رد ار ﻦﻴﺗﻼﭘ
يﺎﻫ
ﻲﻣ ﺶﻫﺎﻛ ﻲﻧاﻮﻴﺣ ﺪﻫد
) 39 (
؛ رد دﻮﺟو ﻦﻳا ﺎﺑ تﺎﻌﻟﺎﻄﻣ
مﺎﺠﻧا ﻲﻜﻴﻨﻴﻠﻛ هﺪﺷ
، ﺗ ﻦﻴﻨﭼ نﺎﺴﻧا رد ﺄ
ﺖﺳا هﺪﺸﻧ هﺪﻳد يﺮﻴﺛ
) 40
، 41 (
؛ زا ﻲﻀﻌﺑ ﻪﻛ ﺖﺳا هﺪﺷ شراﺰﮔ ﻦﻴﻨﭽﻤﻫ
ﻲﻠﭘ ﻢﺴﻴﻓرﻮﻣ ﻲﻠﭘ ﻞﺜﻣ ﻲﻜﻴﺘﻧژ يﺎﻫ ﻢﺴﻴﻓرﻮﻣ
نژ ﻪﻛ OCT2
لﻮﻠﺳ ﻞﺧاد ﻪﺑ مﻮﻴﻨﻴﺗﻼﭘ دورو يﺎﻫ
ﻪﻴّﻠﻛ ﻲﻣ ﻢﻴﻈﻨﺗ ار ﺰﻴﻧ ﺪﻳﺎﻤﻧ
ﺎﺑ ﺮﻄﺧ
ﻴﻣﻮﻤﺴﻣ ﺮﺘﻤﻛ دراد طﺎﺒﺗرا يﻮﻴﻠﻛ ﺖ
) 42 ، 43 (.
ﭘ ﻴ ﮕﺸ ﻴ ﺮ ي ﻣﻮﻤﺴﻣ زا
ﻴ ﺖ ﻠﻛ ﻴ ﻮ ي ﺳ ﻴ ﺲ ﺗﻼﭘ ﻴ ﻦ
ﻪﻴﺻﻮﺗ و دراﺪﻧﺎﺘﺳا شور ﻪﻤﻫ رد هﺪﺷ
بﺎﺘﻛ ﺎﻤﻨﻫار يﺎﻫ
ياﺮﺑ زا يﺮﻴﮕﺸﻴﭘ يﻮﻴﻠﻛ ﺖﻴﻣﻮﻤﺴﻣ
زا ﻲﺷﺎﻧ ﺲﻴﺳ
ﻴﺗﻼﭘ ﻦ ،
ﺲﻴﺳ ﺮﺘﻤﻛ يﺎﻫزود زا هدﺎﻔﺘﺳا ﻦﻴﻟﺎﺳ ﺰﻳﻮﺠﺗ و ﻦﻴﺗﻼﭘ
نﻮﺗوﺰﻳا
ﻲﻣ ﻦﻳا رد يدﺪﻌﺘﻣ يﺎﻫوراد ﻪﭼ ﺮﮔا و ﺪﺷﺎﺑ درﻮﻣ و حﺮﻄﻣ هرﺎﺑ
ﻪﺘﻓﺮﮔ راﺮﻗ ﻲﺳرﺮﺑ و ﻪﻌﻟﺎﻄﻣ ﺪﻧا
، ﻲﻟو ﭻﻴﻫ ماﺪﻛ ياراد ﺎﻬﻧآ زا
تﺎﺒﺛا ﺶﻘﻧ هﺪﺷ
ﻲﻤﻧ يا ﺪﻨﺷﺎﺑ ) 44 .(
ﻪﺗارﺪﻴﻫ ﺲﻴﺳ ﺖﻓﺎﻳرد زا ﻞﺒﻗ رﺎﻤﻴﺑ نﺪﺷ ﻦﻴﺗﻼﭘ
ﺎﺳا ﺮﺑ ﻒﻠﺘﺨﻣ تﺎﻌﻟﺎﻄﻣ س
، زوﺮﺑ ناﺰﻴﻣ زا ﻲﺷﺎﻧ ARF
وراد ﻦﻳا
، ﻲﻧارﺎﻤﻴﺑ رد و ﻞﺒﻗ ﻪﻛ
نآ ﺖﻓﺎﻳرد زا ﺪﻌﺑ
، مﺮﺳ ﺎﺑ يﺎﻫ
يﺪﻳرو ﻪﺑ هﮋﻳو لﺎﻣﺮﻧ مﺮﺳ ﻲﺑﻮﺧ ﻪﺑ ﻦﻴﻟﺎﺳ
ﻪﺗارﺪﻴﻫ و هﺪﺷ
نوﺮﺑ راردا هد ي ﺒﺳﺎﻨﻣ ﻲ و ﻞﺒﻗ رد زا ﺪﻌﺑ ﻳ
ﺖﻓﺎ وراد ﻪﺘﺷاد ﺪﻧا
،
ﺶﻫﺎﻛ ﭼ ﻲﻣ يﺮﻴﮕﻤﺸ ﺪﺑﺎﻳ
؛ ﻪﺑ يرﻮﻃ ﺑ رد ﻪﻛ ﻳا زا ﻲﻀﻌ
ﻦ
ﺮﻴﻏ ﻪﺘﺒﻟا ﻪﻛ تﺎﻌﻟﺎﻄﻣ لﺮﺘﻨﻛ
هدﻮﺑ هﺪﺷ ﺪﻧا
، زوﺮﺑ ناﺰﻴﻣ
، ARF ﻪﺑ
ﻚﻳدﺰﻧ ﺎﻳ و ﺮﻔﺻ ناﺰﻴﻣ ﻪﺑ
ﺮﻔﺻ ﺖﺳا هﺪﻴﺳر ﺪﺻرد ؛
ور ﻦﻳا زا
،
ﺖﻓﺎﻳرد نارﺎﻤﻴﺑ ﻪﻤﻫ ﺪﻳﺎﺑ ﺲﻴﺳ هﺪﻨﻨﻛ
ﻦﻴﺗﻼﭘ
، زا ﺪﻌﺑ و ﻞﺒﻗ
ﺪﻨﺷﺎﺑ ﻪﺗارﺪﻴﻫ ﻲﺑﻮﺧ ﻪﺑ نآ ﺖﻓﺎﻳرد .
ﺮﮔا ﻪﻌﻟﺎﻄﻣ ﻪﭼ دﻮﺟو يا
ﻧ ﻮﺠﺗ مﺮﺳ عﻮﻧ ﻪﺴﻳﺎﻘﻣ ﻪﺑ ﻪﻛ دراﺪ ﺰﻳ
هﺪﺷ ﻪﺘﺧادﺮﭘ نآ ناﺰﻴﻣ و
ﻲﻣ ﺮﻈﻧ ﻪﺑ دﻮﺟو ﻦﻳا ﺎﺑ ،ﺪﺷﺎﺑ ﻦﻴﻟﺎﺳ مﺮﺳ ﻪﻛ ﺪﺳر
نﻮﺗوﺰﻳا
،
ﺐﺳﺎﻨﻣ مﺮﺳ ﺪﺷﺎﺑ يﺮﺗ
؛ نوﺮﺑ ﻪﻛ ﺖﺳا هﺪﺷ ﻪﻴﺻﻮﺗ ﻦﻴﻨﭽﻤﻫ هد
ﺲﻴﺳ ﺰﻳﻮﺠﺗ زا ﻞﺒﻗ ،نارﺎﻤﻴﺑ يراردا ﻦﻴﺗﻼﭘ
، ناﺰﻴﻣ ﻪﺑ 100
ﻲﺳ ﺪﺷﺎﺑ هﺪﺷ هﺪﻧﺎﺳر ﺖﻋﺎﺳ رد ﻲﺳ )
44 - 46 (
؛ ﻪﺑ ناﻮﻨﻋ
لﺎﺜﻣ
، ﻪﻌﻟﺎﻄﻣ ﺞﻳﺎﺘﻧ آﻳ
ﻨ هﺪ رﻮﻛﻮﺳود و ﺮﮕﻧ ي
ًﺮﻴﺧا ﻪﻛ يور ﺮﺑ ا
76 ﺖﺤﺗ رﺎﻤﻴﺑ ﻲﻤﻴﺷ
ﻲﻧﺎﻣرد ﺎﺑ وراد ي ﺳ ﻴ ﺲ ﺗﻼﭘ ﻴ ﻦ زود ﺎﺑ
ﻞﻗاﺪﺣ mg/m
250 ﺖﺳا هﺪﺷ مﺎﺠﻧا
، ﺗﺄ عﻮﺿﻮﻣ ﻦﻳا هﺪﻨﻨﻛﺪﻴﻳ
ﻲﻣ ﺪﺷﺎﺑ . ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد
، ﻳ ﻞﻗاﺪﺣ نارﺎﻤﻴﺑ ﻚ
ﻟﻴ ﺮﺘ لﻮﻠﺤﻣ زا
ﻟﺎﺳ ﻴ ﻦ اﻳ نﻮﺗوﺰ ار ﻟ ﺮﻫ ﻪﺑ ﻪﻛ ﻴ
ﺮﺘ نآ
، 20 ﻣ ﻴﻠ ﻲ ﻛا ﻲ ﺮﻠﻛ نﻻاو ﻳ
ﺪ
ﺳﺎﺘﭘ ﻴ ﻢ و 2 ﻨﻣ تﺎﻔﻟﻮﺳ مﺮﮔ ﻴ
ﺰ ﻳ ﻢ دﻮﺑ هﺪﺷ ﻪﻓﺎﺿا
، 2 ﻞﺒﻗ ﺖﻋﺎﺳ
و ﻧﻴ ﻢ ﻟﻴ ﺮﺘ ار نآ زا 2
زا ﺪﻌﺑ ﺖﻋﺎﺳ ﻖﻳرﺰﺗ
ﺳ ﻴ ﺲ ﺗﻼﭘ ﻴ ﻦ ،
ﺖﻓﺎﻳرد ﻲﻣ
؛ﺪﻧدﻮﻤﻧ ﻪﺑ يرﻮﻃ ﻪﻛ ﺚﻋﺎﺑ ﻲﻣ ﺪﺷ نوﺮﺑ رادا هد ي
، ﻪﺑ
ﻣ ﻴ ناﺰ ﻞﻗاﺪﺣ ﻳ ﺪﺼﻜ ﺳ ﻲ ﺳ ﻲ اﺮﺑ ﺖﻋﺎﺳ رد ي
2 و ﻞﺒﻗ ﺖﻋﺎﺳ
زا ﺪﻌﺑ ﻲﻤﻴﺷ ﻲﻧﺎﻣرد دﻮﺷ . ﺷ ﻴ عﻮ ﺳآ ﻴ ﺐ ﻠﻛ ﻴ ﻮ ي ﺷﺎﻧ ﻲ زا
ﺳ ﻴ ﺲ ﺗﻼﭘ ﻴ ﻦ ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد
، ﺶﻫﺎﻛ يﺮﻴﮕﻤﺸﭼ ﻪﺘﺷاد
ﺖﺳا و
ﻂﻘﻓ 5 ﺑﻴ رﺎﻤ ) 6 / 6 ﺪﺻرد ) ( 4 و دﺮﻣ ﻳ ﻚ نز ( اﺰﻓا رﺎﭼد ﻳ ﺶ
ﺗاﺮﻛ ﻴﻨ ﻴ ﻦ ﺪﺷ ﺪﻧدﻮﺑ ه ﺮﻈﻧ زا و ﺳآ زوﺮﺑ
ﻴ ﺐ ﻠﻛ ﻴ ﻮ ي
، رﺎﻣآ توﺎﻔﺗ ي
ﺑﻴ ﻦ و دﺮﻣ نز ﺘﺷاﺪﻧ دﻮﺟو ﺖﺳا ﻪ
) 46 .(
اﻳ ﻦ ﺎﭘ عﻮﻴﺷ ﻴﻳ ﻦ رد
ﻟﺎﺣ ﻲ لﺎﺳ رد ﻪﻛ ﺖﺳا ﺎﻫ
ي ﻟوا ﻴ ﻪ ا زا هدﺎﻔﺘﺳا ﻳ
ﻦ ﻪﻛ وراد
ﺑﻴ نارﺎﻤ ﻪﺑ ﻓﺎﻛ رﻮﻃ ﻲ ﻫ ﻴ ﻪﺗارﺪ ﻤﻧ ﻲ ﻣ ،ﺪﻧﺪﺷ ﻴ ناﺰ زوﺮﺑ ARF
ﺴﺑ ﻴ رﺎ و هدﻮﺑ ﻻﺎﺑ دوﺪﺣ
50 % رد زا ﻳ ﺖﻓﺎ نﺎﮔﺪﻨﻨﻛ
، ا رﺎﭼد ﻳ ﻦ
ﻣ ﻪﺿرﺎﻋ ﻲ ﺪﻧﺪﺷ ) 47 ، 48 .(
لﺎﺜﻣ ناﻮﻨﻋ ﻪﺑ
، ﻪﻌﻟﺎﻄﻣ رد Wittes
و زا ﻪﻛ نارﺎﻜﻤﻫ اﻳ
ﻦ ﺎﻣﻮﺌﻠﺑ هاﺮﻤﻫ ﻪﺑ وراد ﻳ
ﺴ ﻴ ﻦ
، نﺎﻣرد رد 28
ﺑﻴ رﺎﻤ ﺎﻫرﻮﻣﻮﺗ ﻪﺑ ﻼﺘﺒﻣ ي
ﺳ ﺮ و هدﺎﻔﺘﺳا ندﺮﮔ ﺪﻧدﻮﺑ هدﺮﻛ
، 13
ﺮﻔﻧ ) 42 / 46 (%
ﺳآ ﺪﻫاﻮﺷ رﺎﭼد ﻴ
ﺐ ﻠﻛ ﻴ ﻮ ي ﺷﺎﻧ ﻲ و هﺪﺷ وراد زا
2 ﻧ ﺮﻔﻧ ﻴ ﺰ تﻮﻓ دﺮﻛ ه ﺪﻧا ) 48 .(
،ﺪﺷ ﻪﺘﻔﮔ ﻪﻛ نﺎﻨﭽﻤﻫ ﻫ
ﻴ ﻨﻣﻮﭙ ﻴ ﺰ ﻳ ﻤ ﻲ
، زا ﻲﻜﻳ ضراﻮﻋ
ﻪﺘﺧﺎﻨﺷ ﺲﻴﺳ هﺪﺷ ﻦﻴﺗﻼﭘ
ﻲﻣ ﺪﺷﺎﺑ زا ﻲﻤﻴﻧ زا ﺶﻴﺑ رد ﻪﻛ
ﺖﻓﺎﻳرد نارﺎﻤﻴﺑ ﻲﻣ هﺪﻳد نآ هﺪﻨﻨﻛ
دﻮﺷ . ﻫ ﻴ ﻤﻟﺎﻛﻮﭙ ﻲ ﻧﻴ ﺰ ﻳ ﻜ ﻲ
د ﻳ ﺮﮕ ﺳ ضراﻮﻋ زا ﻴ
ﺲ ﺗﻼﭘ ﻴ ﻦ ﺖﺳا ﻪﺑ ﺖﺳا ﻦﻜﻤﻣ ﻪﻛ ترﻮﺻ
ﻏ ﻴ ﺮ ﻘﺘﺴﻣ ﻴ ﻢ و ﻮﻧﺎﺛ ﻳ ﻪ ﻫ ﻪﺑ ﻴ ﻨﻣﻮﭙ ﻴ ﺰ ﻳ ﻤ ﻲ ﺷﺎﻧ ﻲ ﺳ زا ﻴ ﺲ ﺗﻼﭘ ﻴ ﻦ
اﻳ دﺎﺠ دﻮﺷ
؛ ﻤﻫ زا ﻴ ﻦ ور
، ﻫ ﻞﻜﺗوﺮﭘ رد ﻴ
ﺳﺎﺗارﺪ ﻴ ﻧﻮ ﻲ رد ﻪﻛ
ﻪﻌﻟﺎﻄﻣ Wittes نآ زا ﺮﮕﻳد تﺎﻌﻟﺎﻄﻣ زا ﻲﻀﻌﺑ رد و
هدﺎﻔﺘﺳا ﺖﺳا هﺪﺷ
، ﻨﻣ تﺎﻔﻟﻮﺳ مﺮﮔ ود ﻴ
ﺰ ﻳ مﻮ و 20 ﻣ ﻴﻠ ﻲ ﻛا ﻲ نﻻاو
ﺮﻠﻛ ﻳ ﺪ ﺘﭘ ﺳﺎ ﻴ ﻢ
، ﻟ ﺮﻫ ﻪﺑ ﻴ ﺮﺘ ﻟﺎﺳ مﺮﺳ ﻴ ﻦ اﻳ نﻮﺗوﺰ ﺪﺷ ﻪﻓﺎﺿا زا ﺎﺗ
اﻳ دﺎﺠ ﻫ ﻴ ﻤﻟﺎﻛﻮﭙ ﻲ و ﻫ ﻴ ﻨﻣﻮﭙ ﻴ ﺰ ﻳ ﻤ ﻲ و ﺷﺎﻧ ضراﻮﻋ ﻲ
ﺎﻬﻧآ زا
ددﺮﮔ بﺎﻨﺘﺟا )
44 - 46 .(
لﻮﺘﻴﻧﺎﻣ و ﺪﻳﺎﻣزورﻮﻓ زا هدﺎﻔﺘﺳا
لﻮﺘﻴﻧﺎﻣ و ﺪﻳﺎﻣزورﻮﻓ ﻪﻜﻨﻳا ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ
، ﺶﻫﺎﻛ ﺚﻋﺎﺑ
ﻲﻣ راردا رد مﻮﻴﻨﻴﺗﻼﭘ ﺖﻈﻠﻏ ﻮﺷ
ﻧ
،ﺪ ﻪﻛ ﺖﺳا هﺪﺷ هرﺎﺷا
ﻦﻳا زا هدﺎﻔﺘﺳا ﺎﻫوراد
، ﻦﻜﻤﻣ
ﻴﻣﻮﻤﺴﻣ ﺶﻫﺎﻛ ﺚﻋﺎﺑ ﺖﺳا ﺖ
ﺲﻴﺳ يﻮﻴﻠﻛ دﻮﺷ ﻦﻴﺗﻼﭘ
. دﻮﺟو ﻦﻳا ﺎﺑ
، شراﺰﮔ ﻪﭼﺮﮔا ﺎﻫ
ﻳ ﻲ
نﺎﺸﻧ ﻪﻛ دراد دﻮﺟو ﻦﻳا ﻲﺘﻇﺎﻔﺣ تاﺮﺛا هﺪﻨﻫد
وراد ود
ﻲﻣ ﺷﺎﺑ ﻨ ﺪ ﻲﻣ نﺎﺸﻧ ﻪﻛ دراد دﻮﺟو ﺰﻴﻧ ﻲﺗﺎﻌﻟﺎﻄﻣ ، ﻦﻳا ﻪﻛ ﺪﻫد
ود
، ﺖﺳا ﻦﻜﻤﻣ
،
ﻴﻣﻮﻤﺴﻣ ﺪﻳﺪﺸﺗ ﺚﻋﺎﺑ ﺪﻧﻮﺷ يﻮﻴﻠﻛ ﺖ
؛
نﺎﺸﻧ ﻪﻛ دراﺪﻧ دﻮﺟو يﺪﻫاﻮﺷ عﻮﻤﺠﻣ رد ﻦﻴﻨﭽﻤﻫ
ﺪﻫد
،
ﻚﻴﺗرﻮﻳد ﺎﻫ
ﻴﻣﻮﻤﺴﻣ ﺶﻫﺎﻛ ﺚﻋﺎﺑ ﺲﻴﺳ يﻮﻴﻠﻛ ﺖ
رد ﻦﻴﺗﻼﭘ
نﺎﺴﻧا ﻲﻣ ﻮﺷ ﻧ ﺪ
؛ ،دﻮﺟﻮﻣ تﺎﻌﻟﺎﻄﻣ عﻮﻤﺠﻣ سﺎﺳا ﺮﺑ ﻦﻳاﺮﺑﺎﻨﺑ
ﻚﻴﺗرﻮﻳد ﺰﻳﻮﺠﺗ ياﺮﺑ ﻲﻠﻴﻟد يﺮﻴﮕﺸﻴﭘ ناﻮﻨﻋ ﻪﺑ ﺎﻫ
زا هﺪﻨﻨﻛ
ﻴﻣﻮﻤﺴﻣ ﺲﻴﺳ يﻮﻴﻠﻛ ﺖ دراﺪﻧ دﻮﺟو ﻦﻴﺗﻼﭘ
. ﻦﻤﺿ رد
ﻦﻴﻟﺎﺳ مﺮﺳ ﺰﻳﻮﺠﺗ ﺎﺑ ﻲﻓﺎﻛ نﻮﻴﺳﺎﺗارﺪﻴﻫ نﻮﺗوﺰﻳا
، ﻲﻣ ﺪﻧاﻮﺗ
ﻚﻴﺗرﻮﻳد زا ﻲﺷﺎﻧ ﻲﺘﻴﻟوﺮﺘﻜﻟا تﻻﻼﺘﺧا دﺎﺠﻳا نوﺪﺑ زرﻮﻳد ،ﺎﻫ
ﺪﻳﺎﻤﻧ دﺎﺠﻳا ار مزﻻ )
44 .(
ﻪﺑﺎﺸﻣ ﺲﻴﺳ يﺎﻫ ﻦﻴﺗﻼﭘ
زا ﻲﺷﺎﻧ يﻮﻴﻠﻛ ﺐﻴﺳآ يﻻﺎﺑ عﻮﻴﺷ ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ ﺲﻴﺳ ﻢﻳژر زا ﻲﻀﻌﺑ رد هزوﺮﻣا ،ﻦﻴﺗﻼﭘ ﻲﻤﻴﺷ يﺎﻫ
ﺎﻣرد ﻲﻧ
)
ًﻼﺜﻣ نﺎﻃﺮﺳ ﺎﻳ و ناﺪﻤﺨﺗ نﺎﻃﺮﺳ
ﻚﭼﻮﻛ لﻮﻠﺳ ﺮﻴﻏ ﻪﻳر (
1،
ﺲﻴﺳ گﻮﻟﺎﻧآ ﻪﻛ ﻦﻴﺗﻼﭘﻮﺑرﺎﻛ زا ﺎﺑ ﻦﻴﺗﻼﭘ
يﻮﻴﻠﻛ ﺖﻴﻣﻮﻤﺴﻣ
ﻲﻣ ﺮﺘﻤﻛ ﻲﻣ هدﺎﻔﺘﺳا ،ﺪﺷﺎﺑ
دﻮﺷ . ﻦﻳا زا ناﻮﺘﺑ ﻪﻜﻨﻳا زا ﻞﺒﻗ ﻪﺘﺒﻟا
،دﺮﻛ دﺎﻳ ﺐﺳﺎﻨﻣ رﺎﻜﻫار ﻚﻳ ناﻮﻨﻋ ﻪﺑ ماﺪﻗا ﺖﺳا مزﻻ
تاﺮﺛا
ﺮﺳ بﻮﻛﺮﺳ رد وراد ود ﻦﻳا ﻲﻧﺎﻣرد نﺎﻃ
ﻒﻠﺘﺨﻣ يﺎﻫ
، درﻮﻣ
دﺮﻴﮔ راﺮﻗ ﻲﺑﺎﻳزرا )
44 .(
1non small cell
ﻦﻴﺘﺳﻮﻔﻴﻣآ )
Amifostine
(
ﻀﻌﺑ رد ﻲ ﺪﻣ زا ﺎﻫ ي ﺣ ﻴ ﻧاﻮ ﻲ ﻠﻛ تﺎﻌﻟﺎﻄﻣ و ﻴﻨ
ﻴ ﻜ ﻲ ﺑﺮﺠﺗ ﻲ
ﺖﺳا هﺪﺷ هداد نﺎﺸﻧ
؛ ﺗرﻮﺻ رد ﻲ
ﻪﻛ ﻮﺠﺗ زا ﻞﺒﻗ ﻳ
ﺰ
ﺳ ﻴ ﺲ ﺗﻼﭘ ﻴ ﻦ
، زا ﻚﻴﻧﺎﮔروا تﺎﻔﺴﻓﻮﻴﺗ ﻚﻳ ﻪﻛ ﻦﻴﺘﺳﻮﻔﻴﻣآ
ﻲﻣ دﻮﺷ هدﺎﻔﺘﺳا ﺪﺷﺎﺑ
، ﻲﻣ ﻴﻣﻮﻤﺴﻣ ﺶﻫﺎﻛ ﺚﻋﺎﺑ ﺪﻧاﻮﺗ ﺖ
ددﺮﮔ يﻮﻴﻠﻛ
؛ سﺎﺳا ﺮﺑ دﻮﺟو ﻦﻳا ﺎﺑ بﺎﺘﻛ
يﺎﻤﻨﻫار يﺎﻫ
ﻲﻤﻧ ﻪﻴﺻﻮﺗ ،دﻮﺟﻮﻣ ا زا ﻪﻛ دﻮﺷ
ﻳ وراد ﻦ ياﺮﺑ زا يﺮﻴﮕﺸﻴﭘ
ﻴﻣﻮﻤﺴﻣ ﺲﻴﺳ يﻮﻴﻠﻛ ﺖ ﻻد ﻪﻛ دﻮﺷ هدﺎﻔﺘﺳا ﻦﻴﺗﻼﭘ
ﻳ نآ ﻞ
،
يﺮﻴﮕﺸﻴﭘ ﺮﮕﻳد تﺎﻣاﺪﻗا دﻮﺟو
ﻴﻣﻮﻤﺴﻣ ،هﺪﻨﻨﻛ ﻪﺟﻮﺗ ﻞﺑﺎﻗ ﺖ
ﻦﻴﺘﺳﻮﻔﻴﻣآ )
ﻞﻴﺒﻗ زا :
،عﻮﻬﺗ و غاﺮﻔﺘﺳا ﻦﻴﻳﺎﭘ نﻮﺧ رﺎﺸﻓ
( و
ﺰﻫ ﻳ ﻪﻨ ﻻﺎﺑ ي ﻣ نآ ﻲ ﺪﺷﺎﺑ . ﺰﻴﻧ ﻲﻧاﺮﮕﻧ ﻦﻳا ﻦﻜﻤﻣ ﻪﻛ دراد دﻮﺟو
ﻦﻴﺘﺳﻮﻔﻴﻣآ زا هدﺎﻔﺘﺳا ﺖﺳا
،
ﺪﺿ تاﺮﺛا ﺎﺑ ﺲﻴﺳ يرﻮﻣﻮﺗ
ﻦﻴﺗﻼﭘ
ﻪﺘﺷاد ﻞﺧاﺪﺗ دﻮﺷ نآ ﺮﺛا ﺶﻫﺎﻛ ﺚﻋﺎﺑ و
؛ ﻨﭽﻤﻫ ﻴ ﻦ ﻪﻴﺻﻮﺗ
ﺖﻴﻌﺿو رد ﺖﺳا هﺪﺷ ﺎﻫ
ﻳ ﻪﻛ ﻲ ﻲﻤﻴﺷ ﻲﻧﺎﻣرد ﺲﻴﺳ ﺎﺑ ﻦﻴﺗﻼﭘ
،
ﺎﻗ ﺶﻳاﺰﻓا ﺎﻳ و رﻮﻣﻮﺗ ﻞﻣﺎﻛ يدﻮﺒﻬﺑ ﺚﻋﺎﺑ رﺎﻤﻴﺑ ﺮﻤﻋ ﻪﺟﻮﺗ ﻞﺑ
ﻲﻣ زا ،ددﺮﮔ دﻮﺸﻧ هدﺎﻔﺘﺳا ﻦﻴﺘﺳﻮﻔﻴﻣآ )
49 ، 52 .(
تﺎﻔﻟﻮﺳﻮﻴﺗ ﻢﻳﺪﺳ )
Sodium Thiosulfate
(
شور زا ﻲﻜﻳ ﻲﻧارﺎﻤﻴﺑ رد ﻲﻧﺎﻣرد يﺎﻫ
ﻪﺑ ﻼﺘﺒﻣ ﻪﻛ
ﺪﻨﺘﺴﻫ لﺎﺌﻧﻮﺘﻳﺮﭘ ﻞﺧاد يﺎﻫرﻮﻣﻮﺗ
، ﺲﻴﺳ زا هدﺎﻔﺘﺳا ﺎﻳ و ﻦﻴﺗﻼﭘ
ﻲﻣ لﺎﺌﻧﻮﺘﻳﺮﭘ ﻞﺧاد ﻦﻴﺗﻼﭘﻮﺑرﺎﻛ ﺪﺷﺎﺑ
. ﺎﺑ زا هدﺎﻔﺘﺳا ﻦﻳا
شور
،
ﺮﮕﻳد فﺮﻃ زا و هﺪﻴﺳر ﺮﺜﻛاﺪﺣ ﻪﺑ رﻮﻣﻮﺗ ﻊﺿﻮﻣ رد وراد ﺖﻈﻠﻏ ﺎﻤﺳﻼﭘ ﺢﻄﺳ ﻳ
ﻴﻣﻮﻤﺴﻣ ﺚﻋﺎﺑ ﻪﻛ وراد ﻲ ﻲﻣ يﻮﻴﻠﻛ ﺖ
ددﺮﮔ
، ﻪﺑ
ﻲﻣ ﻞﻗاﺪﺣ ﺪﺳر
. تﺎﻔﻟﻮﺳﻮﻴﺗ ﻢﻳﺪﺳ لﻮﭙﻣآ ،دراﻮﻣ ﻦﻳا رد
ﻪﺑ ﻪﺑ و يﺪﻳرو ترﻮﺻ لﺎﺌﻧﻮﺘﻳﺮﭘ ﻞﺧاد ﺰﻳﻮﺠﺗ ﺎﺑ نﺎﻣﺰﻤﻫ رﻮﻃ
ﺲﻴﺳ ﻲﻣ هداد ﻦﻴﺗﻼﭘ ﺲﻴﺳ ﻪﺑ ﺎﺗ دﻮﺷ
ﻦﻴﺗﻼﭘ ﺎﻫ ﻳ دراو ﻪﻛ ﻲ
ﻲﻣ ﻚﻴﻤﺘﺴﻴﺳ نﻮﺧ شدﺮﮔ ﺪﻧﻮﺷ
، ﺪﻨﻨﻛ اﺪﻴﭘ لﺎﺼﺗا .
ﻦﻴﻨﭼ
ﻲﻣ ﺚﻋﺎﺑ ﻲﻟﺎﺼﺗا ﻪﻛ دﻮﺷ
فﺮﻃ ﻚﻳ زا
، ﺲﻴﺳ ﺚﻋﺎﺑ ﻦﻴﺗﻼﭘ
ﻴﻣﻮﻤﺴﻣ تاﺮﺛا ﺮﮕﻳد فﺮﻃ زا و دﻮﺸﻧ ﻚﻴﻤﺘﺴﻴﺳ و يﻮﻴﻠﻛ ﺖ
ﺪﺿ ﺪﻳﺎﻤﻨﻧ اﺪﻴﭘ ﺶﻫﺎﻛ وراد يرﻮﻣﻮﺗ )
53 ، 54 .(
نا ﻞﻴﺘﺳا ﻦﻴﺌﺘﺴﻴﺳ )
N-acetylecysteine
(
رد ﻟﺎﻄﻣ زا ﻲﻀﻌﺑ مﺎﺠﻧا تﺎﻌ
زا يﺮﻴﮕﺸﻴﭘ ياﺮﺑ ،هﺪﺷ
ﻴﻣﻮﻤﺴﻣ ﺲﻴﺳ يﻮﻴﻠﻛ ﺖ ﻦﻴﺗﻼﭘ
، نا يوراد زا ﻞﻴﺘﺳا
ﻦﻴﺌﺘﺴﻴﺳ ﺖﺳا ﻪﺘﺷاد ﻲﻀﻗﺎﻨﺘﻣ ﺞﻳﺎﺘﻧ و هﺪﺷ هدﺎﻔﺘﺳا
؛ ﻦﻜﻤﻣ دﻮﺟو ﻦﻳا ﺎﺑ
وراد ﻦﻳا ﺖﺳا
، ﻲﻧارﺎﻤﻴﺑ رد
ﻴﻣﻮﻤﺴﻣ ﻪﺑ ﻼﺘﺑا ياﺮﺑ ﻪﻛ ﺖ
يﻮﻴﻠﻛ
، ﻲﻣ بﻮﺴﺤﻣ ﺮﻄﺧ ﺮﭘ ﺪﻧدﺮﮔ
، ﺪﺷﺎﺑ ﺪﻴﻔﻣ .
و Wu
نارﺎﻜﻤﻫ دﻮﻤﻧ هرﺎﺷا
ه نا ﻪﻛ ﺪﻧا ﻞﻴﺘﺳا
ﻦﻴﺌﺘﺴﻴﺳ
، رد ﻞﺧاﺪﺗ ﺎﺑ
يرﺪﻨﻛﻮﺘﻴﻣ زﻮﺘﭘﻮﭘآ ﺑ ﻪﻛ ﺎﻫ
ﻪ ﺲﻴﺳ ﻪﻠﻴﺳو ﻲﻣ دﺎﺠﻳا ﻦﻴﺗﻼﭘ
،دﻮﺷ
ﻲﻣ زا يﺮﻴﮕﺸﻴﭘ ﺚﻋﺎﺑ ﺪﻧاﻮﺗ يﻮﻴﻠﻛ ﺖﻴﻣﻮﻤﺴﻣ
ﺲﻴﺳ ﻦﻴﺗﻼﭘ
ددﺮﮔ .
،ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد نا ﻲﺘﻇﺎﻔﺣ ﺮﺛا
ﻞﻴﺘﺳا ﻦﻴﺌﺘﺴﻴﺳ
،
ﻲﺗرﻮﺻ رد ﻪﺑ ﻪﻛ
ضﺮﻋ رد ﺮﺜﻛاﺪﺣ ﺎﻳ و نﺎﻣﺰﻤﻫ ترﻮﺻ 2
ا ﺪﻌﺑ ﺖﻋﺎﺳ ﺲﻴﺳ ﺰﻳﻮﺠﺗ ز
هﺪﺷ هﺪﻳد ،دﻮﺷ هداد ﻦﻴﺗﻼﭘ و
رد
ﻲﺗرﻮﺻ زا ﺪﻌﺑ نآ ﺰﻳﻮﺠﺗ ﻪﻛ 2
زا ﺪﻌﺑ ﺎﺗ ﺎﻳ و 8
ﺖﻓﺎﻳرد زا ﺖﻋﺎﺳ
ﺲﻴﺳ ﺗ ﻪﺑ ﻦﻴﺗﻼﭘ ﺄ
نا ﻲﺘﻇﺎﻔﺣ ﺮﺛا ،ﺪﺘﻓا ﺮﻴﺧ ﻞﻴﺘﺳا
ﻦﻴﺌﺘﺴﻴﺳ
ﻲﻣ ﻞﻗاﺪﺣ ﻪﺑ ﺎﻳ و ﺶﻫﺎﻛ ﺪﺳر
) 55 .(
ﻦﻴﻠﻴﻓﻮﺌﺗ
ﻪﻴﺿﺮﻓ ﻲﻣ هرﺎﺷا ﻪﻛ دراد دﻮﺟو يا ﻪﻛ ﺪﻳﺎﻤﻧ
ضﺎﺒﻘﻧا
دﺎﺠﻳا رد هﺪﺷ قوﺮﻋ
ﻚﭼﻮﻛ
، ﺲﻴﺳ زا ﻲﺷﺎﻧ ﻦﻴﺗﻼﭘ
، ﺑ ﻪ ﻪﻠﻴﺳو
ﺮﺑﺎﻨﺑ و هﺪﺷ لﺎﻤﻋا ﻦﻳزﻮﻧدآ هﺪﻧﺮﻴﮔ رﺎﻬﻣ ﻦﻳا
ﺑ نآ ندﻮﻤﻧ ﻪ
ﻪﻠﻴﺳو
ﻦﻴﻠﻴﻓﻮﺌﺗ
، ﻲﻣ ﺪﻳﺎﻤﻧ يﺮﻴﮕﺸﻴﭘ نآ زا ﺪﻧاﻮﺗ )
56 ، 57 .(
ﻪﻴﺿﺮﻓ ﻦﻳا
ﻦﻴﻟوا ياﺮﺑ ﻪﻌﻟﺎﻄﻣ رد رﺎﺑ
Heidemann ﻤﻫ و
ﺮﺑ ﻪﻛ نارﺎﻜ
،هﺪﺷ مﺎﺠﻧا شﻮﮔﺮﺧ يور راﺮﻗ ﻲﺳرﺮﺑ درﻮﻣ
ﻪﺘﻓﺮﮔ ﺖﺳا و
ﻦﻴﻠﻴﻓﻮﺌﺗ ﺖﺳا ﻦﻜﻤﻣ ﻪﻛ هﺪﺷ هرﺎﺷا
، زا يﺮﻴﮕﺸﻴﭘ رد
ﻴﻣﻮﻤﺴﻣ يﻮﻴﻠﻛ ﺖ زا ﻲﺷﺎﻧ
ﺲﻴﺳ ﺪﺷﺎﺑ ﺪﻴﻔﻣ ﻦﻴﺗﻼﭘ )
56 .(
ﻲﻨﻴﻟﺎﺑ ﻲﻳﺎﻣزآرﺎﻛ ﻪﻌﻟﺎﻄﻣ ﺮﺑ ﻪﻛ دراد دﻮﺟو ﺰﻴﻧ ﻲﻧﺎﺴﻧا
ﻦﻳا رد ﻦﻴﻠﻴﻓﻮﺌﺗ ندﻮﺑﺪﻴﻔﻣ ﺖﺳا ﻪﺘﺷاد هرﺎﺷا هرﺎﺑ
. ناﻮﻨﻋ ﻪﺑ
لﺎﺜﻣ
، ﻪﻌﻟﺎﻄﻣ Benoehr يور ﺮﺑ ﻪﻛ نارﺎﻜﻤﻫ و
41 يرﺎﻤﻴﺑ
ﻛ ﻪ ﺖﺤﺗ ﻲﻤﻴﺷ ﻲﻧﺎﻣرد وراد ﺎﺑ ي ﺳ ﻴ ﺲ ﺗﻼﭘ ﻴ ﻦ ﻞﻗاﺪﺣ زود ﺎﺑ
mg/m
250 هدﻮﺑ ﺪﻧا ﻪﺑ و ترﻮﺻ ﻲﻓدﺎﺼﺗ ﺎﻤﻧوراد ﺎﻳ و ﻦﻴﻠﻴﻓﻮﺌﺗ
ﻲﻣ ﺖﻓﺎﻳرد ﻣ ﺰﻴﻧ ،ﺪﻧدﺮﻛ
ﺆ
ﻳ ﺪﻴﻔﻣ ﺪ ﻲﻣ ﻦﻴﻠﻴﻓﻮﺌﺗ ندﻮﺑ ﺪﺷﺎﺑ
. رد
ﻪﻌﻟﺎﻄﻣ ﻦﻳا
، ﻲﻧارﺎﻤﻴﺑ ﺪﻧدﻮﺑ هدﻮﻤﻧ ﺖﻓﺎﻳرد ﻦﻴﻠﻴﻓﻮﺌﺗ ﻪﻛ
، ﺶﻫﺎﻛ
ﺑ ﻪﻛ GFR ﻪ ﻪﻠﻴﺳو ﻠﻛ ﻴ ﺲﻧاﺮ ﻠﻛ ﻴ ﻮ ي اﻳ ﻨ ﻟﻮ ﻴ ﻦ ﻲﻣ ﻲﺳرﺮﺑ
،ﺪﺷ
ﺪﻨﺘﺷاﺪﻧ
، ﻲﻟﺎﺣرد ﺖﻓﺎﻳرد هوﺮﮔ رد ﻲﻬﺟﻮﺗ ﻞﺑﺎﻗ ﺶﻫﺎﻛ ﻪﻛ هﺪﻨﻨﻛ
ﺪﺷ هﺪﻳد ﺎﻤﻧوراد )
57 .(
قﻮﻓ تﺎﻌﻟﺎﻄﻣ فﻼﺧ ﺮﺑ
ﻪﻛ دراد دﻮﺟو ﺰﻴﻧ ﻲﺗﺎﻌﻟﺎﻄﻣ ،
نﺎﺸﻧ هﺪﻨﻫد مﺪﻋ ﺗﺄ ﻦﻴﻠﻴﻓﻮﺌﺗ ﺮﻴﺛ ﺮﺑ
زا ﻲﺷﺎﻧ يﻮﻴﻠﻛ ﺖﻴﻣﻮﻤﺴﻣ
ﺲﻴﺳ ﻦﻴﺗﻼﭘ ﻲﻣ ﺪﺷﺎﺑ . ﻪﺑ لﺎﺜﻣ ناﻮﻨﻋ
، ﻮﺳود ﻪﻌﻟﺎﻄﻣ رد يرﻮﻛ
ا ﻪﻛ
ًاﺮﻴﺧ هﺪﺷ مﺎﺠﻧا ﺖﺳا
و نآ رد نارﺎﻤﻴﺑ ﺎﺑ نﺎﻣرد ﺖﺤﺗ
ﺲﻴﺳ ﻪﺑ ﻦﻴﺗﻼﭘ ترﻮﺻ
ﻲﻓدﺎﺼﺗ رد
ﺖﻓﺎﻳرد هوﺮﮔ ود هﺪﻨﻨﻛ
ﺎﻳ و ﻦﻴﻠﻴﻓﻮﺌﺗ ﺎﻤﻧوراد
ﺪﻨﺘﻓﺮﮔ راﺮﻗ ناﺰﻴﻣ ،
يﻮﻴﻠﻛ ﺖﻴﻣﻮﻤﺴﻣ رد
ﺖﺳا هدﻮﺑ نﺎﺴﻜﻳ هوﺮﮔ ود ﺮﻫ .
،ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد ﻪﺘﺒﻟا ﺳآ
ﻴ ﺐ
ﻠﻛ ﻴ ﻮ ي ﺷﺎﻧ ﻲ وراد زا
، اﺰﻓا ﻪﺑ ﻳ ﺶ ﺑﻴ ﺮﺘﺸ ﻳﺎ وﺎﺴﻣ ي mg/dl 5 / 0
رد ﺗاﺮﻛ ﻴﻨ ﻴ ﻦ ﺎﻫزور رد مﺮﺳ ي
ﺷ زا ﺪﻌﺑ ﻴ ﻤ ﻲ ﻧﺎﻣرد ﻲ ﻪﺑ ﺖﺒﺴﻧ
ﺗاﺮﻛ ﻴﻨ ﻴ ﻦ رد زا ﻞﺒﻗ ﻳ
ﺖﻓﺎ ﺷ ﻴ ﻤ ﻲ ﻧﺎﻣرد ﻲ ﻣ قﻼﻃا ﻲ دﺮﮔ ﻳ ﺪ ﻪﻛ
ﻪﻌﻟﺎﻄﻣ ﻪﺑ ﺖﺒﺴﻧ Benoehr
ﻦﻴﻟﻮﻨﻳا يﻮﻴﻠﻛ ﺲﻧاﺮﻴﻠﻛ زا ﻪﻛ
،
ﻪﺴﻳﺎﻘﻣ و ﻪﺒﺳﺎﺤﻣ ياﺮﺑ ﺖﺳا هﺪﺷ هدﺎﻔﺘﺳا هوﺮﮔ ود رد GFR
،
ﻴﺳﺎﺴﺣ
ﻴﺻﺎﺼﺘﺧا و ﺖ دراد يﺮﺘﻤﻛ ﺖ
) 58 .(
ﻪﭼ ﺮﮔا عﻮﻤﺠﻣ رد نﺎﺸﻧ ﻪﻛ دراد دﻮﺟو يﺪﻫاﻮﺷ
هﺪﻨﻫد
ﺪﻴﻔﻣ زا يﺮﻴﮕﺸﻴﭘ رد ﻦﻴﻠﻴﻓﻮﺌﺗ ندﻮﺑ
ﻴﻣﻮﻤﺴﻣ ﺖ يﻮﻴﻠﻛ زا ﻲﺷﺎﻧ
ﺲﻴﺳ ﻦﻴﺗﻼﭘ ﻲﻣ ﺪﺷﺎﺑ
، نآ تاﺮﺛا تﺎﺒﺛا ياﺮﺑ دﻮﺟو ﻦﻳا ﺎﺑ
، زﺎﻴﻧ
ﻪﺑ ﻧا ﺠ ﺎ م ﻲﻨﻴﻟﺎﺑ ﻲﻳﺎﻣزآرﺎﻛ تﺎﻌﻟﺎﻄﻣ ﻲﻣ يﺮﺘﺸﻴﺑ
ﺪﺷﺎﺑ ) 44 .(
ﻦﻴﺴﻴﻠﮔ دوﺪﺤﻣ ﻲﺑﺮﺠﺗ تﺎﻌﻟﺎﻄﻣ رد مﺎﺠﻧا
هﺪﺷ
، ا ﻪﻛ هﺪﺷ هرﺎﺷ
ﺪﻴﺳا ﺰﻳﻮﺠﺗ ﺖﺳا ﻦﻜﻤﻣ ﻦﻴﺴﻴﻠﮔ ﻪﻨﻴﻣآ
ﺮﺘﻤﻛ ﺚﻋﺎﺑ ﺪﻧاﻮﺘﺑ ، نﺪﺷ
ﺲﻴﺳ زا ﻲﺷﺎﻧ يﻮﻴﻠﻛ ﺐﻴﺳآ دﻮﺷ ﻦﻴﺗﻼﭘ
. لﺎﺜﻣ ناﻮﻨﻋ ﻪﺑ
، رد
ﻪﻌﻟﺎﻄﻣ Heyman
،نارﺎﻜﻤﻫ و ﻖﻳرﺰﺗ
ﺖﺳا ﻪﺘﺴﻧاﻮﺗ ﻦﻴﺴﻴﻠﮔ
ﻂﺳﻮﺗ مﻮﻴﻨﻴﺗﻼﭘ ﺖﺷادﺮﺑ ﺶﻫﺎﻛ ﺚﻋﺎﺑ ﻪﻴّﻠﻛ
ددﺮﮔ
؛ دﻮﺟو ﻦﻳا ﺎﺑ
ﻦﻳا رد نآ زا هدﺎﻔﺘﺳا ياﺮﺑ رﺎﺑ
رد ﺖﺳا مزﻻ ،ه تﺎﻌﻟﺎﻄﻣ ﺐﻟﺎﻗ
،ﻲﻨﻴﻟﺎﺑ ﻲﻳﺎﻣزآرﺎﻛ دﻮﺷ ﻲﺳرﺮﺑ عﻮﺿﻮﻣ ﻦﻳا
) 59 .(
ﻪﺠﻴﺘﻧ و ﻪﺻﻼﺧ يﺮﻴﮔ
ﺳ ﻴ ﺲ ﺗﻼﭘ ﻴ ﻦ
، ﻳ ﻚ وراد ي ﻮﻗ ي و ﻣ ﺆ
ّﺛ ﺮﺑ ﺮ
ﺪﺿ ﻢﺳﻼﭘﻮﺌﻧ ﺎﻫ
ﻲﻣ ﺪﺷﺎﺑ نﺎﻣرد رد ﻪﻛ زا ﻲﻌﻴﺳو ﻒﻴﻃ
نﺎﻃﺮﺳ ﺎﻫ ي ﺪﻣﺎﺟ
) Solid ( نآ زا ﻣ هدﺎﻔﺘﺳا ﻲ
دﻮﺷ .
ﻴﻣﻮﻤﺴﻣ زا ﻲﺷﺎﻧ يﻮﻴﻠﻛ ﺖ
ﺲﻴﺳ ﻦﻴﺗﻼﭘ رد ﻪﻛ 15 ﺎﺗ 30 % ﺑ زا ﻴ نارﺎﻤ ﻣ خر ﻲ ﺪﻫد
، رﻮﻃ ﻪﺑ
ﺎﺳرﺎﻧ ﺚﻋﺎﺑ ﻊﻳﺎﺷ ﻳ
ﻦﻣﺰﻣ و دﺎﺣ ﻲ ﻪﻴّﻠﻛ
ﻲﻣ ددﺮﮔ .
ﺮﻄﺧ ﻞﻣاﻮﻋ ﺳآ هﺪﻤﻋ
ﻴ ﺐ ﻪﻴّﻠﻛ ﺷﺎﻧ ﻲ ﺳ زا ﻴ ﺲ ﺗﻼﭘ ﻴ ﻦ ﻞﻣﺎﺷ : رد ﻳ ﺖﻓﺎ ﻣﺮﺳ ﺖﻈﻠﻏ و ﺮﺗﻻﺎﺑ زود ﻲ
ﺑﻴ
،ﺮﺘﺸ رد ﻳ ﺖﻓﺎ
ﺳ ﻴ ﺲ ﺗﻼﭘ ﻴ ﻦ و ﺎﻫزور رد ﻳﺎ
هﺎﻣ ﺎﻫ ي ﺳآ دﻮﺟو ،ﻞﺒﻗ ﻴ
ﺐ ﻣز ﻴ ﻪﻨ ا ي
ﻲﻠﺒﻗ رد ﻪﻴّﻠﻛ و ﻮﺠﺗ ﻳ ﺰ ﺎﻫوراد نﺎﻣﺰﻤﻫ ي
ﺴﻛﻮﺗوﺮﻔﻧ ﻴ
ﻚ د ﻳ ﺮﮕ زا
ﺒﻗ ﻴ ﻞ ﻣآ ﻴ ﻠﮔﻮﻨ ﻴ زﻮﻜ ﻳ ﺎﻫﺪ ﺮﺗﻮﻔﻣآ و ﻳ ﺴ ﻴ ﻦ ﻣ ﻲ ﺪﺷﺎﺑ .
يدﺪﻌﺘﻣ تﺎﻣاﺪﻗا ﻪﭼ ﺮﮔا ياﺮﺑ
ﻴﻣﻮﻤﺴﻣ زا يﺮﻴﮕﺸﻴﭘ ﺖ
يﻮﻴﻠﻛ زا ﻲﺷﺎﻧ ﺲﻴﺳ
ﻦﻴﺗﻼﭘ هﺪﺷ مﺎﺠﻧا ﺪﻧا
ﻪﻛ ﻲﺗوﺎﻔﺘﻣ ﺞﻳﺎﺘﻧ
ﺰﻴﻧ ﻪﺘﺷاد زا يﺮﻴﮕﺸﻴﭘ يﺎﻨﺑ ﮓﻨﺳ زﻮﻨﻫ دﻮﺟو ﻦﻳا ﺎﺑ ،ﺪﻧا
ﻴﻣﻮﻤﺴﻣ يﻮﻴﻠﻛ ﺖ ﺎﻧ
زا ﻲﺷ ﺲﻴﺳ
زا هدﺎﻔﺘﺳا ،ﻦﻴﺗﻼﭘ
نﻮﻴﺳﺎﺗارﺪﻴﻫ مﺮﺳ ﺎﺑ ﻲﻓﺎﻛ
ﻦﻴﻟﺎﺳ نﻮﺗوﺰﻳا ﻲﻣ
؛ﺪﺷﺎﺑ
ﻪﺑ يرﻮﻃ نوﺮﺑ ناﺰﻴﻣ ﻪﻛ يراردا هد
، ﻞﻗاﺪﺣ زا 2
و ﻞﺒﻗ ﺖﻋﺎﺳ
ﺲﻴﺳ ﺰﻳﻮﺠﺗ زا ﺪﻌﺑ ﻦﻴﺗﻼﭘ
، ناﺰﻴﻣ ﻪﺑ 100
ﻲﺳ ﺖﻋﺎﺳ رد ﻲﺳ
ﺪﺷﺎﺑ . ﻟد ،دﻮﺟﻮﻣ تﺎﻌﻟﺎﻄﻣ عﻮﻤﺠﻣ سﺎﺳا ﺮﺑ ﻴﻠ
ﻲ اﺮﺑ ي ﻮﺠﺗ ﻳ ﺰ
د ﻳ ﺗرﻮ ﻴ ﻚ ﺎﻫ ﻞﻴﺒﻗ زا :
لﻮﺘﻴﻧﺎﻣ و ﺪﻳﺎﻣزورﻮﻓ ﻪﺑ
ناﻮﻨﻋ
ﭘﻴ ﮕﺸ ﻴ ﺮ ي ﻣﻮﻤﺴﻣ زا هﺪﻨﻨﻛ
ﻴ ﺖ ﻠﻛ ﻴ ﻮ ي زا ﻲﺷﺎﻧ ﺳ
ﻴ ﺲ ﺗﻼﭘ ﻴ ﻦ
دراﺪﻧ دﻮﺟو .
ﺑ سﺎﺳا ﺮﺑ ﻪﭼ ﺮﮔا ﻀﻌ
ﻲ زا ﻠﻛ تﺎﻌﻟﺎﻄﻣ ﻴﻨ
ﻴ ﻜ ﻲ
ﺑﺮﺠﺗ ﻲ
، ﺎﺑ نﺎﻣرد ﻣآ
ﻴ ﺘﺳﻮﻔ ﻴ ﻦ ﺶﻫﺎﻛ ﺚﻋﺎﺑ ﺖﺳا ﻪﺘﺴﻧاﻮﺗ
ﻣﻮﻤﺴﻣ
ﻴ ﺖ ﻠﻛ ﻴ ﻮ ي دﻮﺷ ، ا ﺎﺑ ﻳ ﻦ دﻮﺟو
، ضراﻮﻋ ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ ﻞﺑﺎﻗ
ﻣآ ﻪﺟﻮﺗ ﻴ ﺘﺳﻮﻔ ﻴ ﻦ
، ﺰﻫ ﻳ ﻪﻨ ﻻﺎﺑ تاﺮﺛا ﺎﺑ ﻞﺧاﺪﺗ لﺎﻤﺘﺣا و ﺪﺿ
ﺲﻴﺳ يرﻮﻣﻮﺗ ،ﻦﻴﺗﻼﭘ
هدﺎﻔﺘﺳا ا زا ﻳ وراد ﻦ ياﺮﺑ ﭘﻴ ﮕﺸ ﻴ ﺮ ي زا
ﻣﻮﻤﺴﻣ
ﻴ ﺖ ﻠﻛ ﻴ ﻮ ي ﺳ ﻴ ﺲ ﺗﻼﭘ ﻴ ﻦ ﺻﻮﺗ ﻴ ﻪ ﻤﻧ ﻲ دﻮﺷ .
دوﺪﺤﻣ تﺎﻌﻟﺎﻄﻣ رد مﺎﺠﻧا
هﺪﺷ
، ﺖﺳا ﻦﻜﻤﻣ ﻪﻛ هﺪﺷ هرﺎﺷا
ﻮﺠﺗ ﻳ ﺰ ﻞﻴﺒﻗ زا ﺎﻫوراد زا ﻲﻀﻌﺑ :
نا ﺘﺳا ﻴ ﻞ ﺳ ﻴ ﺌﺘﺴ ﻴ ﻦ و ﻦﻴﻠﻴﻓﻮﺌﺗ ،
ﺳا ﻴ ﺪ ﻣآ ﻴ ﻪﻨ ﻠﮔ ﻴ ﺴ ﻴ ﻦ
، ﺳآ نﺪﺷﺮﺘﻤﻛ ﺚﻋﺎﺑ ﺪﻧاﻮﺘﺑ ﻴ
ﺐ ﻠﻛ ﻴ ﻮ ي ﺷﺎﻧ ﻲ
ﺳ زا ﻴ ﺲ ﺗﻼﭘ ﻴ ﻦ دﻮﺷ ؛ ا ﺎﺑ ﻳ ﻦ اﺮﺑ دﻮﺟو ي ﻧآ تاﺮﺛا تﺎﺒﺛا ﺎﻬ
، ﻧﻴ زﺎ
ﻪﺑ ﻲﻨﻴﻟﺎﺑ ﻲﻳﺎﻣزآرﺎﻛ تﺎﻌﻟﺎﻄﻣ مﺎﺠﻧا ﺑﻴ
ﺮﺘﺸ ي ﻣ ﻲ ﺪﺷﺎﺑ .
ﻲﻣ ﻪﻴﺻﻮﺗ
،دﻮﺷ ﻲﻧارﺎﻤﻴﺑ رد ﺲﻴﺳ ﺰﻳﻮﺠﺗ ﻪﻛ
ﻦﻴﺗﻼﭘ
عﻮﻨﻤﻣ ﺶﻳاﺰﻓا ﺎﻳ و هدﻮﺑ ﺮﻄﺧ
،دراد دﻮﺟو يﻮﻴﻠﻛ ﺖﻴﻣﻮﻤﺴﻣ
ﻴﺗﻼﭘﻮﺑرﺎﻛ ﻦ
ﺎﺑ ﺲﻴﺳ ﻦﻴﺗﻼﭘ ددﺮﮔ ﻦﻳﺰﮕﻳﺎﺟ .
ﻲﻠﻛ رﻮﻃ ﻪﺑ
ﻲﻣ ﻪﻴﺻﻮﺗ دﻮﺷ
، نﺎﻜﻣا ترﻮﺻ رد
، ﺲﻴﺳ ﺰﻳﻮﺠﺗ زا رد ﻦﻴﺗﻼﭘ
ﺎﺳرﺎﻧ ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﻴﺑ ﻳ
ﻲ ﻪﻴّﻠﻛ ددﺮﮔ بﺎﻨﺘﺟا .
ًﻻﺎﻤﺘﺣا
ﺖﻴﻌﺿو ﺎﻫ ﻳ ﻞﻴﺒﻗ زا ﻲ نﺎﻃﺮﺳ
يﺎﻫ
ﺰﻳﻮﺠﺗ ﻪﻛ ﻪﻀﻴﺑ يﺎﻫ
ﺲﻴﺳ ﺎﻬﻧآ رد ﻦﻴﺗﻼﭘ ﻲﻣ ﻲﻌﻄﻗ نﺎﻣرد ﺚﻋﺎﺑ
دﻮﺷ
، هﺪﻋﺎﻗ ﻦﻳا زا
ﺘﺴﻣ ﺜ ﻲﻨ ﻲﻣ ﺪﻨﺷﺎﺑ
؛ ﻲﻣ ﻪﻴﺻﻮﺗ ﻦﻴﻨﭽﻤﻫ ﺰﻳﻮﺠﺗ زا ﻪﻛ دﻮﺷ
ﻞﻴﺒﻗ زا ﻚﻴﺴﻛﻮﺗوﺮﻔﻧ يﺎﻫوراد نﺎﻣﺰﻤﻫ :
،ﺪﻳزﻮﻜﻴﻠﮔﻮﻨﻴﻣآ يﺎﻫوراد
ﺮﻴﻏ ﻲﺑﺎﻬﺘﻟا ﺪﺿ نارﺎﻤﻴﺑ رد ﺐﺟﺎﺣ داﻮﻣ و يﺪﻴﺋوﺮﺘﺳا
ﺖﻓﺎﻳرد دﻮﺷ ﺰﻴﻫﺮﭘ ﻦﻴﺗﻼﭘ ﺲﻴﺳ هﺪﻨﻨﻛ .
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Abstract Review Article
Cisplatin Induced Nephrotoxicity
Seyed Seifollah Beladi Mousavi
1, Abbas Ali Zeraati
2,Cisplatin is a potent chemotherapy agent which is used to treat a broad spectrum of solid cancers. However, its clinical use is limited due to its nephrotoxicity with a decline in the glomerular filtration rate that occur in 15-30% of patients. Multiple mechanisms contribute to renal dysfunction following exposure to cisplatin include tubular epithelial cell toxicity, vasoconstriction in the renal microvasculature, and increase the expression of proinflammatory cytokines.
The most important manifestations of cisplatin nephrotoxicity are non oliguric acute renal failure (ARF) which can be progressive, hypomagnesemia, fanconi-like syndrome, and anemia. An increasing risk of ARF is associated with higher doses of cisplatin, previous cisplatin chemotherapy, underlying kidney dysfunction, and the concomitant use of other nephrotoxic agents.
The standard approach to prevent cisplatin-induced nephrotoxicity is the administration of lower doses of cisplatin in combination with the administration of full intravenous isotonic saline before and after cisplatin administration. Although a number of pharmacologic agents including sodium thiosulfate, N-acetylcysteine, theophylline and glycine have been evaluated for prevention of nephrotoxicity, none have proved to have an established role, thus, additional clinical studies will be required to confirm their probable effects.
Key Words: Cisplatin; Cisplatin nephrotoxicity; chemotherapy
Journal of Birjand University of Medical Sciences. 2014; 20 (4): 327-337.
Received: March 1, 2013 Accepted: January 8, 2014
1Associate professor ,Chronic Renal Failure Research Center, Ahwaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
2Corresponding author, Associate professor , Kidney Transplantation Complications Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran [email protected]
