نﻮﻣرﻮﻫ ﺖﻴﻌﺿو و ناﻮﺨﺘﺳا ﻢﻛاﺮﺗ ﻦﻴﺑﺎﻣ طﺎﺒﺗرا ﻪﺑ ﻼﺘﺒﻣ نادﺮﻣ رد ﻲﺴﻨﺟ يﺎﻫ
ﻪﻴﻠﻛ ﻦﻣﺰﻣ ﻲﻳﺎﺳرﺎﻧ
يرﺎﺒﺟ قﺪﺼﻣ ﺮﺘﻛد
I
ﺮﻫﺎﻃ ﻲﺒﻟﺎﻃ ﺪﻴﺸﻬﻣ ﺮﺘﻛد*
II
يﺮﻔﻌﺟ ﻪﻧازﺮﻓ ﺮﺘﻛد
III
ﻲﺑﺎﻨﺟ ﺎﻳرآ ﺮﺘﻛد
IV
هﺪﻴﻜﭼ
فﺪﻫ و ﻪﻨﻴﻣز :
ﻲـﻣ يﻮـﻴﻠﻛ ﻲﻓوﺮﺘﺴﻳدﻮﺌﺘﺳا ﺮﻄﺧ رد ﻪﻴﻠﻛ ﻦﻣﺰﻣ ﻲﻳﺎﺳرﺎﻧ ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﻴﺑ
ﺪﻨـﺷﺎﺑ . رد ﻂﻳاﺮـﺷ ﻦـﻳا
ﻲﻣ هﺪﻳد يﻮﻴﻠﻛ ﻲﻳﺎﺳرﺎﻧ ﻪﻴﻟوا ﻞﺣاﺮﻣ
ﻞﻣﺎـﺷ ار زورﻮﭘﻮﺌﺘـﺳا ﺪـﻨﻧﺎﻣ ناﻮﺨﺘـﺳا تاﺮـﻴﻴﻐﺗ زا ﻲـﻔﻴﻃ و دﻮـﺷ ﻲـﻣ
دﻮـﺷ .
ﻳﺎﺳرﺎﻧ ﻪﺑ ﻼﺘﺒﻣ نادﺮﻣ رد ﻢﺴﻳدﺎﻨﮔﻮﭙﻴﻫ
ﺖﺳا ﻊﻳﺎﺷ ﻪﻴﻠﻛ ﻦﻣﺰﻣ ﻲ .
يرﺎـﻤﻴﺑ ﺪـﻨﻧﺎﻣ ﻢﺴـﻳدﺎﻨﮔﻮﭙﻴﻫ تاﺮﻫﺎـﻈﺗ زا يرﺎﻴﺴـﺑ
هﺪﻫﺎﺸـﻣ ﺰﻴﻟﺎـﻳد ﺖـﺤﺗ نارﺎـﻤﻴﺑ ﻦﻴﺑﺎـﻣ رد ﻊﻳﺎـﺷ رﻮﻃ ﻪﺑ ،ناﻮﺨﺘﺳا ﻲـﻣ
ددﺮـﮔ . ﺢﻄـﺳ ﻪﺴـﻳﺎﻘﻣ ﻪـﻌﻟﺎﻄﻣ ﻦـﻳازا فﺪـﻫ
،نوﺮﺘﺳﻮﺘﺴﺗ
،PTH
،LH
ود رد ﻪـﻴﻠﻛ ﻦﻣﺰـﻣ ﻲﻳﺎـﺳرﺎﻧ ﻪـﺑ ﻼﺘـﺒﻣ نادﺮﻣ رد نﻮﺧ ﻲﻳﺎﻴﻠﻗ زﺎﺗﺎﻔﺴﻓ و ،ﻦﻴﻨﻴﺗاﺮﻛ ،BUN
ﻲﻣ ﻲﻌﻴﺒﻃﺮﻴﻏ و ﻲﻌﻴﺒﻃ ناﻮﺨﺘﺳا ﻢﻛاﺮﺗ ﺶﺠﻨﺳ ﺎﺑ هوﺮﮔ ﺪﺷﺎﺑ
.
ﻲﺳرﺮﺑ شور :
ﻲﻌﻄﻘﻣ ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد 63
ﺪﻧﺪـﺷ ﻲﺑﺎـﻳزرا ﻪـﻴﻠﻛ ﻦﻣﺰـﻣ ﻲﻳﺎـﺳرﺎﻧ ﻪـﺑ ﻼﺘـﺒﻣ رﺎـﻤﻴﺑ .
ﻢﻛاﺮـﺗ ﺶﺠﻨـﺳ
شور ﺎﺑ ناﻮﺨﺘﺳا
DEXA
ﺪﺷ ﺖﺳاﻮﺧرد نارﺎﻤﻴﺑ ﻪﻤﻫ ياﺮﺑ .
،نوﺮﺘﺳﻮﺘﺴـﺗ ﻲﻧﻮـﺧ ﺢﻄـﺳ
،PTH
،ﻦﻴﻨﻴﺗاﺮـﻛ ،BUN
و ﻲﻳﺎﻴﻠﻗ زﺎﺗﺎﻔﺴﻓ رد LH
ﺪﺷ ﻪﺴﻳﺎﻘﻣ ﻲﻌﻴﺒﻃﺮﻴﻏ و ﻲﻌﻴﺒﻃ ﻢﻛاﺮﺗ ﺶﺠﻨﺳ ﺎﺑ هوﺮﮔ ود .
ﺖﺴـﺗ ﺎﺑ ﺞﻳﺎﺘﻧ t-test
Pearson ،
Chi-squareو ﺪﺷ ﻞﻴﻠﺤﺗ و ﻪﻳﺰﺠﺗ
p value. زاﺮﺘﻤﻛ 05 / 0 ﺪﻳدﺮﮔ ﻲﻘﻠﺗ شزرا ﺎﺑ .
ﺎﻫ ﻪﺘﻓﺎﻳ : ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد 63
ﺪﻧﺪﺷ ﻲﺑﺎﻳزرا رﺎﻤﻴﺑ .
نارﺎـﻤﻴﺑ ﻦﺳ ﻂﺳﻮﺘﻣ 32
/
±13 58 / 50
ﺖـﺳا هدﻮـﺑ لﺎـﺳ .
طﺎـﺒﺗرا
ﻲﻨﻌﻣ يراد و نوﺮﺘﺳﻮﺘﺴـﺗ ناﺰـﻴﻣ ،ﻦـﺳ ﻦﻴﺑﺎـﻣ
و ﻲـﻌﻴﺒﻃ ناﻮﺨﺘـﺳا ﻢﻛاﺮـﺗ ﺶﺠﻨـﺳ ﺎـﺑ نارﺎـﻤﻴﺑ هوﺮـﮔ ود رد PTH
ﺪﻣآ ﺖﺳد ﻪﺑ ﻲﻌﻴﺒﻃﺮﻴﻏ )
05 / p<0 .(
ﻪﺠﻴﺘﻧ يﺮﻴﮔ : ياﺮـﺑ يﺮـﮕﻳد ﻪـﻌﻟﺎﻄﻣ و ﺖـﺳا ﻪـﻴﻠﻛ ﻦﻣﺰـﻣ ﻲﻳﺎﺳرﺎﻧ ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﻴﺑ رد ﻢﻬﻣ ﻪﺘﻓﺎﻳ ﻚﻳ زورﻮﭘﻮﺌﺘﺳا
ﻲﻣ ﻪﻴﺻﻮﺗ ﻞﻤﻜﻣ نوﺮﺘﺳﻮﺘﺴﺗ ﺎﺑ نﺎﻣرد ﺞﻳﺎﺘﻧ ﻦﻴﻴﻌﺗ دﻮﺷ
.
هژاوﺪﻴﻠﻛ ﺎﻫ : 1 - ﻪﻴﻠﻛ ﻦﻣﺰﻣ ﻲﻳﺎﺳرﺎﻧ
2 - ناﻮﺨﺘﺳا ﻢﻛاﺮﺗ
3 - نﻮﻣرﻮﻫ ﻪﻧادﺮﻣ ﻲﺴﻨﺟ يﺎﻫ
ﺖﻓﺎﻳرد ﺦﻳرﺎﺗ :
16 / 5 /
،87 شﺮﻳﺬﭘ ﺦﻳرﺎﺗ :
21 / 8 / 87
ﻪﻣﺪﻘﻣ
ﻢـﻬﻣ زا ﻲﻜﻳ
،يﻮـﻴﻠﻛ ﻦﻣﺰـﻣ ﻲﻳﺎـﺳرﺎﻧ ضراﻮـﻋ ﻦﻳﺮـﺗ
ﻲﻧﺪﻌﻣ داﻮﻣ ﻢﺴﻴﻟﻮﺑﺎﺘﻣ رد لﻼﺘﺧا )
ﺮﻔﺴـﻓ و ﻢﻴﺴﻠﻛ ًﺎﺗﺪﻤﻋ (
نآ لﺎﺒﻧد ﻪﺑ و ًﺎﺣﻼﻄﺻا ﻪﻛ ﺖﺳا ﻲﻧاﻮﺨﺘﺳا يرﺎﻤﻴﺑ زوﺮﺑ
ﻲﻣ هﺪﻴﻣﺎﻧ يﻮﻴﻠﻛ ﻲﻓوﺮﺘﺴﻳدﻮﺌﺘﺳا
دﻮﺷ . ﻞـﺣاﺮﻣ رد ﻪﺿرﺎﻋ ﻦﻳا
ﻪﻴﻠﻛ ﻦﻣﺰﻣ ﻲﻳﺎﺳرﺎﻧ زوﺮﺑ ﻪﻴﻟوا (Chronic Renal Failure-CRF)
ﻲﻣ زﺎﻏآ ﻪﺑ نﺪﻴﺳر زا ﻞﺒﻗ نارﺎﻤﻴﺑ ﻦﻳا ﻪﻛ يرﻮﻃ ﻪﺑ ،ددﺮﮔ ظﺎـﺤﻟ زا و ﺪـﺻرد هد رد ﻲﻨﻴﻟﺎـﺑ ظﺎـﺤﻟ زا ﺰﻴﻟﺎـﻳد ﻪﻠﺣﺮﻣ
ﺷ ﺖــﻓﺎﺑ رد ناﻮﺨﺘــﺳا ﻲــﺳﺎﻨ
40 - 35 % ﻪــﺑ ﻼﺘــﺒﻣ ﻊــﻗاﻮﻣ
ﻲﻣ ﻲﻓوﺮﺘﺴﻳدﻮﺌﺘﺳا
ﺪﻨﺷﺎﺑ
).
1 و 2
ﻲﻣ ﻢﺴﻳدﺎﻨﮔﻮﭙﻴﻫ(
رد ﺪـﻧاﻮﺗ يرﺎﻤﻴﺑ ﻪﻨﻴﻣز
ﻪﻠﻤﺟ زا ﻦﻣﺰﻣ و دﺎﺣ يﺎﻫ و ﺪـﻫد خر CRF
ﺮﻛذ ﻲﻣ دﻮﺷ
رد نوﺮﺘﺳﻮﺘﺴـﺗ ﻲﻧﻮـﺧ ﺢﻄـﺳ
3 / 2 نادﺮـﻣ
ﻢﺴﻳدﺎﻨﮔﻮﭙﻴﻫ ﺪﺣ رد ﺰﻴﻟﺎﻳد ﺖﺤﺗ ﻲﻣ
ﺪﺷﺎﺑ .
لﻮﻠﺳ رد ﺶﻫﺎﻛ و نژورﺪﻧآ دﻮﺒﻤﻛ Leydig يﺎﻫ
سﺎﺴﺣ
LH ﻪﺑ رد
نﻮﻴـﺳاﺮﺘﻠﻴﻓ رد ﻂـﺳﻮﺘﻣ ﺶﻫﺎـﻛ ﺎـﺑ ﻲـﺘﺣ CRF
ﻲﻟوﺮﻣﻮـــﻠﮔ (Glomerular Filteration Rate -GFR)
خر
ﻲﻣ ﺪﻫد
).
3
(
ﻲﻣ ﻢﺴﻳدﺎﻨﮔﻮﭙﻴﻫ
زﺎﻴﻧ زا ﻞﺒﻗ ﺪﻧاﻮﺗ زﺎـﻏآ ﺰﻴﻟﺎـﻳد ﻪﺑ
ﻲـﻤﻧ دﻮـﺒﻬﺑ ﺰـﻴﻧ ﺰﻴﻟﺎـﻳد عوﺮـﺷ ﺎﺑ و دﻮﺷ
ﺪـﺑﺎﻳ .
زا يرﺎﻴﺴـﺑ
و ناﻮﺨﺘـﺳا يرﺎـﻤﻴﺑ ﺪﻨﻧﺎﻣ ﻢﺴﻳدﺎﻨﮔﻮﭙﻴﻫ تاﺮﻫﺎﻈﺗ ﺖﻴﻌـﺿو
ﻪﺻﻼﺧ ﻪﻟﺎﻘﻣ ﻦﻳا نﺎﻳﺎﭘ زا ﺖﺳا يا
ياﺮﺘﻛد ﻪﺟرد ﺖﻓﺎﻳرد ﺖﻬﺟ يﺮﻔﻌﺟ ﻪﻧازﺮﻓ ﺮﺘﻛد ﻪﻣﺎﻧ ﻲﻣﻮﻤﻋ
يرﺎﺒﺟ قﺪﺼﻣ ﺮﺘﻛد ﻲﻳﺎﻤﻨﻫار ﻪﺑ ،
لﺎﺳ 86 - 1385 .
ﻲﻟﺎﻣ ﺖﻳﺎﻤﺣ ﺖﺤﺗ ﻪﻌﻟﺎﻄﻣ ﻦﻳا ﺖﺳا هﺪﺷ مﺎﺠﻧا ناﺮﻳا ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد
.
يژﻮﻟوﺮﻔﻧ ﺺﺼﺨﺘﻣ و رﺎﻳدﺎﺘﺳا (I ،
نﺎﺘﺳرﺎﻤﻴﺑ تﺮﻀﺣ مﺮﻛا لﻮﺳر )
ص ( ، ﻲﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ و ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد -
ناﺮﻳا ﻲﻧﺎﻣرد ،
ناﺮﻬﺗ ، ناﺮﻳا
و رﺎﻳدﺎﺘﺳا(II يرﺎﻤﻴﺑ ﺺﺼﺨﺘﻣ
يﺎﻫ ﻲﻧﻮﻔﻋ ، نﺎﺘﺳرﺎﻤﻴﺑ تﺮﻀﺣ
مﺮﻛا لﻮﺳر )
ص ( ، نﺎﺧرﺎﺘﺳ نﺎﺑﺎﻴﺧ ،
ﺶﻳﺎﻴﻧ نﺎﺑﺎﻴﺧ ،
ﻲﺘـﺷاﺪﻬﺑ تﺎﻣﺪﺧ و ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد -
ناﺮﻳا ﻲﻧﺎﻣرد ،
ناﺮﻬﺗ ، ناﺮﻳا *) لوﻮﺌﺴﻣ ﻒﻟﻮﻣ (
اد ﺺﺼﺨﺘﻣ(III ﻲﻠﺧ
، ﻲﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ و ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد -
ناﺮﻳا ﻲﻧﺎﻣرد ،
ناﺮﻬﺗ ، ناﺮﻳا
يژﻮﻟوﺮﻔﻧ ﺺﺼﺨﺘﻣ و رﺎﻳدﺎﺘﺳا (IV ،
نﺎﺘﺳرﺎﻤﻴﺑ تﺮﻀﺣ مﺮﻛا لﻮﺳر )
ص ( ، ﻲﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ و ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد -
ناﺮﻳا ﻲﻧﺎﻣرد ،
ناﺮﻬﺗ ، ناﺮﻳا
رد ﻊﻳﺎﺷ رﻮﻃ ﻪﺑ ﻲﻧﻼﻀﻋ هﺪﻫﺎﺸﻣ ﺰﻴﻧ ﺰﻴﻟﺎﻳد ﺖﺤﺗ نارﺎﻤﻴﺑ
ﻲﻣ دﻮﺷ
).
4 و 5
(
نوﺮﺘﺳﻮﺘﺴﺗ ناﺰﻴﻣ ﻪﺴﻳﺎﻘﻣ ﻪﻌﻟﺎﻄﻣ ﻦﻳا زا فﺪﻫ
،PTH
،BUN
ﻪـﺑ ﻼﺘﺒﻣ نادﺮﻣ رد ﻲﻳﺎﻴﻠﻗ زﺎﺗﺎﻔﺴﻓ و ﻦﻴﻨﻴﺗاﺮﻛ ،LH
ناﻮﺨﺘـﺳا ﻢﻛاﺮـﺗ ﺎـﺑ ﺰﻴﻟﺎـﻳد زا ﻞـﺒﻗ ﻪـﻴﻠﻛ ﻦﻣﺰﻣ ﻲﻳﺎﺳرﺎﻧ ﻲﻣ ﻲﻌﻴﺒﻃ ﺪﺣ زا ﺮﺘﻤﻛ و ﻲﻌﻴﺒﻃ ﺪﺷﺎﺑ
.
ﻲﺳرﺮﺑ شور
،سﺮﺘـﺳد رد نﺎـﺳآ شور ﺎـﺑ ﻲـﻌﻄﻘﻣ ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد
63 ﻼﺘﺒﻣ دﺮﻣ رﺎﻤﻴﺑ CRF ] ﻪﺑ
ﺮﺗﻻﺎـﺑ ﻦﻴﻨﻴﺗاﺮﻛ ﻒﻳﺮﻌﺗ ﻖﺒﻃ
زا 5 / 1 ﻲﻠﻴﻣ ﺮﺘﻴﻟ ﻲﺳد رد مﺮﮔ dl)
(mg/ ﺶـﺷ ﻞﻗاﺪﺣ ياﺮﺑ
[هﺎﻣ ﺪﻨﺘﻓﺮﮔ راﺮﻗ ﻲﺳرﺮﺑ ﺖﺤﺗ ﻲﻳﺎﭘﺮﺳ ﺎﻳ و يﺮﺘﺴﺑ ، .
ﻦﻣﺰـﻣ ﻲﻳﺎـﺳرﺎﻧ ﺖـﻠﻋ و ﻦـﺳ درﻮﻣ رد مزﻻ تﺎﻋﻼﻃا
ﺪـﻳدﺮﮔ دراو ﻪﻣﺎﻧ ﺶﺳﺮﭘ رد ﻪﻴﻠﻛ .
،ﻦﻴﻨﻴﺗاﺮـﻛ ،هروا ناﺰـﻴﻣ
،ﻲﻳﺎــﻴﻠﻗ زﺎﺗﺎﻔﺴــﻓ ،ﺮﻔﺴــﻓ ،ﻢﻴﺴــﻠﻛ
و نوﺮﺘﺳوﺮﺘﺴــﺗ ،LH
ﻪﺑ ﻼﺘﺒﻣ نادﺮﻣ هوﺮﮔ ود رد PTH
ﺎـﺑ ﺰﻴﻟﺎـﻳد زا ﻞـﺒﻗ CRF
ﺮﮕﻳﺪـﻜﻳ ﺎـﺑ ﻲـﻌﻴﺒﻃ ﺪـﺣ زا ﺮﺘﻤﻛ و ﻲﻌﻴﺒﻃ ناﻮﺨﺘﺳا ﻢﻛاﺮﺗ ﺪﻧﺪﺷ ﻪﺴﻳﺎﻘﻣ .
لﻮـــﺳر تﺮﻀـــﺣ نﺎﺘـــﺳرﺎﻤﻴﺑ رد نارﺎـــﻤﻴﺑ ﻲﻣﺎـــﻤﺗ مﺮــﻛا ) ص (
شور ﻪــﺑ ناﻮﺨﺘــﺳا ﻢﻛاﺮــﺗ ناﺰــﻴﻣ ظﺎــﺤﻟ زا
DEXA (Dual energy X Ray absorptiometry) درﻮـﻣ
ﺑ ﺪــﻨﺘﻓﺮﮔ راﺮــﻗ ﻲــﺳرﺮ T-score .
زا ﺮﺗﻻﺎــﺑ ﻢﻛاﺮــﺗ ناﻮــﻨﻋ ﻪــﺑ-1
،لﺎـــــﻣﺮﻧ ناﻮﺨﺘـــــﺳا -2.5<Tscore<-1
و ﻲﻨﭘﻮﺌﺘـــــﺳا
Tscore<-2.5 ﺪﻳدﺮﮔ ﻲﻘﻠﺗ زورﻮﭘﻮﺌﺘﺳا
.
هداد يرﺎﻣآ ﻞﻴﻠﺤﺗ و ﻪﻳﺰﺠﺗ
مﺮـﻧ زا هدﺎﻔﺘﺳا ﺎﺑ ﺎﻫ
راﺰـﻓا
يرﺎﻣآ SPSS V. 13 ﺖﺴﺗ و
يرﺎﻣآ يﺎﻫ ،t
Chi2 ﺐﻳﺮﺿ و
واﺮﻓ ﺺﺧﺎﺷ و نﻮﺳﺮﻴﭘ ﻲﮕﺘﺴﺒﻤﻫ فاﺮـﺤﻧا ،ﻦﻴﮕﻧﺎـﻴﻣ ﻲﻧا
ﺪﺷ مﺎﺠﻧا رﺎﻴﻌﻣ يﺎﻄﺧ و رﺎﻴﻌﻣ .
ﻲـﻨﻌﻣ ﺢﻄﺳ
زا ﺮـﺘﻤﻛ راد
05 / 0 ﺪﺷ ﻪﺘﻓﺮﮔ ﺮﻈﻧ رد .
ﻪﺘﻓﺎﻳ ﺎﻫ ﻦﺳ ﻂﺳﻮﺘﻣ 63
ﻪﻌﻟﺎﻄﻣ درﻮﻣ دﺮﻣ رﺎﻤﻴﺑ 32
/
±13 58 / 50
ﺖﺳا هدﻮﺑ لﺎﺳ .
ﻲﻨﭘﻮﺌﺘـﺳا ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﻴﺑ رد ﻦﺳ ﻂﺳﻮﺘﻣ
زورﻮﭘﻮﺌﺘــﺳا و 35
/
±12 20 / 53 رد ﻦــﺳ ﻂــﺳﻮﺘﻣ و لﺎــﺳ
اﺮﺗ ﺎﺑ نرﺎﻤﻴﺑ لﺎﻣﺮﻧ ناﻮﺨﺘﺳا ﻢﻛ
21 /
±11 94 / 40 هدﻮـﺑ لﺎـﺳ
ﺖﺳا . زورﻮﭘﻮﺌﺘـﺳا و ﻲﻨﭘﻮﺌﺘﺳا و نارﺎﻤﻴﺑ ﻦﺳ ﻦﻴﺑﺎﻣ طﺎﺒﺗرا
ﻲﻨﻌﻣ راد ﺖﺳا هدﻮﺑ )
006 / p<0 .(
ﻲﻣ ﺮﻳز حﺮﺷ ﻪﺑ ﻪﻴﻠﻛ ﻦﻣﺰﻣ ﻲﻳﺎﺳرﺎﻧ ﻞﻠﻋ :ﺪﺷﺎﺑ
15 ﺮﻔﻧ
) 80 / 23 (%
،نﻮﺧرﺎﺸـﻓ ﺶﻳاﺰﻓا 19
ﺮـﻔﻧ ) 15 / 30 (%
،ﺖـﺑﺎﻳد
ﺮــﻔﻧ ﻚــﻳ )
58 / 1 (%
يداﺪﺴــﻧا ﻲﺗﺎــﭘوﺮﻔﻧ ،
7 ﺮــﻔﻧ ) 11 / 11 (%
،ﺖـــﻳﺮﻔﻧﻮﻟوﺮﻣﻮﻠﮔ 3
ﺮـــﻔﻧ ) 76 / 4 (%
،ﺲـــﻛﻼﻓر 11
ﺮـــﻔﻧ
) 46 / 17 (%
ﺮــﻔﻧ ﻚــﻳ ،ﻚﻴﺗﺎﭘﻮﻳﺪــﻳا )
58 / 1 (%
و ﺮــﻨﮔو 6
ﺮــﻔﻧ
) 52 / 9 (%
نﻮﺧرﺎﺸﻓ ﺶﻳاﺰﻓا و ﺖﺑﺎﻳد .
زا 63 ﻪﺑ ﻼﺘﺒﻣ رﺎﻤﻴﺑ
22CRF
ﺮﻔﻧ ) 93 / 34 (%
لﺎﻣﺮﻧ ناﻮﺨﺘﺳا ﻢﻛاﺮﺗ ﺎﺑ هوﺮﮔ رد
و 41 ًﺎـــﻋﻮﻤﺠﻣ ﺮـــﻔﻧ )
08 / 65 (%
و ﻲﻨﭘﻮﺌﺘـــﺳا ﻪـــﺑ ﻼﺘـــﺒﻣ
ﺌﺘﺳا هدﻮﺑ زورﻮﭘﻮ ﺪﻧا
.
،ﻢﻴﺴـﻠﻛ ،ﻦﻴﻨﻴﺗاﺮـﻛ ،هروا ﺮﻳدﺎـﻘﻣ ﻚﻳ هرﺎﻤﺷ لوﺪﺟ رد ،ﻲﻳﺎـﻴﻠﻗ زﺎﺗﺎﻔﺴـﻓ ،ﺮﻔﺴﻓ
و نوﺮﺘﺳﻮﺘﺴـﺗ ،LH
رد ار PTH
نﺎﺸـﻧ ﻲﻨﭘﻮﺌﺘﺳا و زورﻮﭘﻮﺌﺘﺳا ﻪﺑ ﻼﺘﺒﻣﺮﻴﻏ و ﻼﺘﺒﻣ هوﺮﮔ
ﺖﺳا هﺪﺷ هداد .
ﻲﻨﻌﻣ طﺎﺒﺗرا ﻂﻘﻓ
ﻲﻧﻮﺧ ﺢﻄﺳ ﻦﻴﺑﺎﻣ يراد
و نوﺮﺘﺳﻮﺘﺴﺗ
ﻪﺑ ﻪﻌﻟﺎﻄﻣ درﻮﻣ هوﺮﮔ ود رد PTH
ﺖـﺳد
ﺪﻣآ ) 05 / p<0 ( . و ﻦـﺳ ﻦﻴﺑﺎـﻣ ﺰـﻴﻧ يﻮـﻗ ﻲـﻔﻨﻣ طﺎﺒﺗرا ﻚﻳ
نوﺮﺘﺳﻮﺘﺴﺗ ناﺰﻴﻣ )
228 / R = -0 ( ﺪﻣآ ﺖﺳد ﻪﺑ .
هرﺎﻤﺷ لوﺪﺟ 1
- ﺶﻳﺎﻣزآ ﻪﺴﻳﺎﻘﻣ
ﻼﺘﺒﻣﺮـﻴﻏ و ﻼﺘﺒﻣ هوﺮﮔ ود رد ﺎﻫ
ﻲﻧاﻮﺨﺘﺳا تاﺮﻴﻴﻐﺗ ﻪﺑ
و ﻼﺘﺒﻣ هوﺮﮔ ﻼﺘﺒﻣﺮﻴﻏ
ﺶﻳﺎﻣزآ ﻪﺑ ﻼﺘﺒﻣ هوﺮﮔ
و ﻲﻨﭘﻮﺌﺘﺳا زورﻮﭘﻮﺌﺘﺳا
) 41 n= ( ﻴﻏ هوﺮﮔ ﺮ
ﻼﺘﺒﻣ
) 22 n= ( p value
BUN(mg/dl)
63 /
±25 62 / 71 94 /
±20 71 /
NS 61
Cr(mg/dl)
35 /
±2 16 / 6 89 /
±1 32 /
NS 5
Ca(mg/dl)
10 /
±1 93 / 8 04 /
±1 97 /
NS 9
P(mg/dl)
37 /
±1 60 / 5 30 /
±1 35 /
NS 5
Alk.P(mg/dl)
30 /
±117 86 / 157 96 /
±51
NS 146
LH(ng/ml)
66 /
±8 38 / 16 04 /
±12 65 /
NS 12
Testosterone (ng/ml)
51 /
±1 73 / 2 34 /
±1 15 / 7
001
/
<0
PTH(ng/ml)
73 /
±66 20 / 131 88 /
±39 40 /
003 97
/
<0
NS=Non- Significant
ﺚﺤﺑ
يرﺎـﻤﻴﺑ زا يرﺎﻴﺴﺑ
ﻲﻤﻴﺧﺪـﺑ ﺪـﻨﻧﺎﻣ ﻚﻴﻤﺘﺴـﻴﺳ يﺎـﻫ
،ﺎـﻫ
ﺎﺑ ﺖﻧﻮﻔﻋ ،ﻪﻴﻠﻛ ﻦﻣﺰﻣ ﻲﻳﺎﺳرﺎﻧ ،ﺪﺒﻛ ﻲﻳﺎﺳرﺎﻧ و ﺖـﺑﺎﻳد ،HIV
ﻲﻣ هﺮﻴﻏ ﻢﺴﻳدﺎﻨﮔﻮﭙﻴﻫ و ﺪﻧﻮﺷ ﻢﺴﻳدﺎﻨﮔﻮﭙﻴﻫ ﺚﻋﺎﺑ ﺪﻨﻧاﻮﺗ ﺰﻴﻧ
ﻲﻣ ﻞﻴﻬﺴـﺗ ناﻮﺨﺘـﺳا ﻢﻛاﺮﺗ ﺶﻫﺎﻛ دﺎﺠﻳا ياﺮﺑ ار ﻪﻨﻴﻣز ﺪﻧاﻮﺗ
ﺪﻳﺎﻤﻧ .
يرﺎﻤﻴﺑ رد نوﺮﺘﺳﻮﺘﺴﺗ ﻲﻧﻮﺧ ﺢﻄﺳ ﺶﻫﺎﻛ
دﺎـﺣ يﺎﻫ
ﻲـﻣ نآ ﻞﻠﻋ و ﺖﺳا ﻊﻳﺎﺷ ًﺎﺘﺒﺴﻧ ﻦﻣﺰﻣ و
،نزو ﺶﻫﺎـﻛ ﺪـﻧاﻮﺗ
ﺪﺷﺎﺑ ﺖﻧﻮﻔﻋ و ﺎﻫوراد ،سﺮﺘﺳا
).
3
(
ﻪـﻴﻠﻛ ﻦﻣﺰـﻣ يرﺎﻤﻴﺑ ﺎﺑ هاﺮﻤﻫ دﺪﻌﺘﻣ ضراﻮﻋ ﻦﻴﺑﺎﻣ زا ﻲﻣ
ورﻮﭘﻮﺌﺘﺳا زا ناﻮﺗ ﻲﻧﻮـﻣرﻮﻫ تﻻﻼﺘﺧا و ﻲﻨﭘﻮﺌﺘﺳا ،ز
دﺮــﺑ مﺎــﻧ نﺎــﻧز و نادﺮــﻣ رد .
،نژوﺮﺘــﺳا ﻦﻴﺑﺎــﻣ طﺎــﺒﺗرا
ﻪﺘﺧﺎﻨـﺷ ًﻼﻣﺎـﻛ ﺰـﻴﻧ زورﻮﭘﻮﺌﺘـﺳا و ناﻮﺨﺘﺳا ﻢﺴﻴﻟﻮﺑﺎﺘﻣ
ﻲﻣ هﺪﺷ ﺪﺷﺎﺑ
).
6 و 7
(
يور ﺮﺑ ﻪﻛ ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد 63
ﻪﺑ ﻼﺘﺒﻣ رﺎﻤﻴﺑ ﻪـﻛ CRF
هدﻮـﺒﻧ ﺰﻴﻟﺎﻳدﻮﻤﻫ ﺖﺤﺗ
يﻮـﻗ طﺎـﺒﺗرا ،ﻪـﺘﻓﺮﮔ ترﻮـﺻ ﺪـﻧا
ﺢﻄﺳ ﺶﻫﺎﻛ ﻦﻴﺑﺎﻣ
ﻢﻛاﺮـﺗ ﺶﻫﺎـﻛ و نﻮـﺧ نوﺮﺘﺳﻮﺘﺴـﺗ
ﺮـﮕﻳد تﺎـﻌﻟﺎﻄﻣ ﺎـﺑ ﻪـﻛ ﺖـﺳا هﺪـﺷ هداد نﺎﺸـﻧ ناﻮﺨﺘﺳا دراد ﻲﻧاﻮﺨﻤﻫ
).
3 و 10 - 8
(
ﺮـــﺛا تﺪـــﻣ ﻲﻧﻻﻮـــﻃ ﻲﻨﻴﻟﺎـــﺑ ﺞﻳﺎـــﺘﻧ يور ﺮـــﺑ CRF
نآ ﺖـﻠﻋ ﻪـﻛ ﺖـﺳا ﺺﺨﺸـﻣﺎﻧ ﻦﺳ ﻪﺑ ﻪﺘﺴﺑاو زورﻮﭘﻮﺌﺘﺳا
ﻲــﻣ نارﺎــﻤﻴﺑ ﺮــﻤﻋ لﻮــﻃ ندﻮــﺑ هﺎــﺗﻮﻛ ﺪــﺷﺎﺑ
. ﺮــﻄﺧ ﺎــﻣا
ﺮﺘﺸﻴﺑ ،ﻦﺳ ﺶﻳاﺰﻓا ﺎﺑ ﻲﻓوﺮﺘﺴﻳدﻮﺌﺘﺳا ﻲﻣ
ﻦﻴـﻨﭽﻤﻫ و دﻮﺷ
ﻪـﺑ ﻼﺘـﺒﻣ داﺮﻓا و ﻦﺴﻣ داﺮﻓا رد
ﻢﺴـﻳﺪﻴﺋوﺮﻴﺗارﺎﭘﺮﭙﻴﻫ CRF
ﻲــﻣ ﻊﻳﺎــﺷ ﺰــﻴﻧ ﻪــﻳﻮﻧﺎﺛ ﺖــﻴﻟﺎﻌﻓ ﺶﻳاﺰــﻓا ﺚــﻋﺎﺑ ﻪــﻛ ﺪــﺷﺎﺑ
(Resorptive activity) Resorptive ﻲﻣ
دﻮﺷ
).
11
(
دﺎـﺠﻳا و نارﺎـﻤﻴﺑ ﻦـﺳ ﻦﻴﺑﺎـﻣ طﺎـﺒﺗرا ﻪـﻌﻟﺎﻄﻣ ﻦﻳا رد
ﺖﺳا هﺪﺷ ﺖﺑﺎﺛ زورﻮﭘﻮﺌﺘﺳا .
ﺖﻣﻼﺳ ياﺮﺑ نژورﺪﻧآ ﺶﻘﻧ
ا ناﻮﺨﺘﺳ (Bone health)
ﺎـﻣا ،ﺖـﺳا ﺺﺨﺸﻣﺎﻧ نادﺮﻣ رد
ﻪﻌﻟﺎﻄﻣ رد
هداد نﺎﺸـﻧ ﺪﺋﻮـﺳ رد هﺪـﺷ مﺎـﺠﻧا ي ﻪـﻛ ﺪـﺷ
ﻪﻧ
ﻪﻜﻠﺑ نژوﺮﺘﺳا ﺎﻬﻨﺗ
ﺖﻣﻼـﺳ رد ﻢـﻬﻣ ﺶـﻘﻧ ﺰﻴﻧ نژورﺪﻧآ
دراد ﻦﺴﻣ داﺮﻓا ناﻮﺨﺘﺳا
).
7
(
ﻪﻌﻟﺎﻄﻣ رد
ﻦـﺳ ﺮـﺛا ﺮﮕﻳد يا
ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﻴﺑ رد ﻲﻓوﺮﺘﺴﻳدﻮﺌﺘﺳا يور ﺮﺑ زا ﻞﺒﻗ CRF
ﺎﺸـﻧ ﺰﻴﻟﺎﻳد
ﺖـﺳا هﺪـﺷ هداد ن .
و عﻮﻴـﺷ ﻪـﻌﻟﺎﻄﻣ ﻦـﻳا رد ﻦﺳ زا ﺮﺗﻻﺎﺑ نادﺮﻣ رد ﻲﻧاﻮﺨﺘﺳا تاﺮﻴﻴﻐﺗ تﺪﺷ
40 لﺎﺳ
ﺖﺳا هدﻮﺑ ﻪﺟﻮﺗ ﻞﺑﺎﻗ
).
12
يﻮـﻗ ﻲـﻔﻨﻣ طﺎﺒﺗرا ﻚﻳ ﻦﻴﻨﭽﻤﻫ (
نوﺮﺘﺳﻮﺘﺴﺗ ناﺰﻴﻣ و ﻦﺳ ﻦﻴﺑﺎﻣ (R=-0.228)
ﺪﺷ هﺪﻳد .
ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﻴﺑ رد
سردوز زﻮﭘورﺪـﻧآ و زﻮﭘﻮﻨﻣ CRF
ﻲﻣ ترﻮﺻ
دﺮﻴﮔ
).
13
(
اﺮﺑﺎـﻨﺑ و ﻦـﺳ ﻦﻳ ﺮـﺛا ﺮﮕﻳﺪـﻜﻳ ﺎـﺑ CRF
ﺪﻧراد زورﻮﭘﻮﺌﺘﺳا دﺎﺠﻳا ياﺮﺑ ﻲﺘﻳﻮﻘﺗ .
نﻮـﻣرﻮﻫ ﺖﻈﻠﻏ يﺎـﻫ
ﻲﻣ ﺶﻫﺎﻛ ﻪﻴﻠﻛ ﻲﻳﺎﺳرﺎﻧ رد ﻲﺴﻨﺟ
ياﺮﺑ ﻲﻤﻬﻣ ﻞﻣﺎﻋ ﻪﻛ ﺪﺑﺎﻳ
ﻲﻣ نارﺎﻤﻴﺑ ﻦﻳا رد يﻮﻴﻠﻛ ﻲﻓوﺮﺘﺴﻳدﻮﺌﺘﺳا
ﺪﺷﺎﺑ . ﻪﻌﻟﺎﻄﻣ رد
نوﺮﺘﺳﻮﺘﺴـﺗ ﺖـﻈﻠﻏ ،ﺰﻴﻟﺎﻳدﻮﻤﻫ ﺖﺤﺗ نادﺮﻣ رد هﺪﺷ مﺎﺠﻧا
ﺑﺎﻗ رﻮﻃ ﻪﺑ ﻦﺳ ﺶﻳاﺰﻓا ﺎﺑ
دﻮﺑ ﻪﺘﻓﺎﻳ ﺶﻫﺎﻛ ﻪﺟﻮﺗ ﻞ .
ﻦﻴـﻨﭽﻤﻫ
ﺢﻄﺳ
يﺮﺘﻣﻮﺘﻴﺴـﻧد شراﺰـﮔ ﺎـﺑ ﻲﻔﻨﻣ طﺎﺒﺗرا نادﺮﻣ رد LH
ﺖﺳا ﻪﺘﺷاد رﻮﻤﻓ ﻲﻧﺎﻗﻮﻓ ﺖﻤﺴﻗ
).
14
(
ﺮﻳدﺎﻘﻣ
زورﻮﭘﻮﺌﺘﺳا ﻪﺑ ﻼﺘﺒﻣ هوﺮﮔ رد LH
) ﺢﻄـﺳ ﻪـﻛ
ﺪـﻧراد يﺮـﺘﻤﻛ نوﺮﺘﺳﺮﺘﺴﺗ (
ﻼﺘـﺒﻣ ﺮـﻴﻏ هوﺮـﮔ زا ﺮﺗﻻﺎـﺑ
ﻲﻣ
ﻲـﻨﻌﻣ يرﺎـﻣآ ﺮـﻈﻧ زا ﻪـﻌﻟﺎﻄﻣ ﻦـﻳا ﻪﺘﻓﺎﻳ ﺎﻣا ،ﺪﺷﺎﺑ
راد
رد ﻪـﻳﻮﻧﺎﺛ ﻢﺴـﻳدﺎﻨﮔﻮﭙﻴﻫ نآ ﺖـﻠﻋ ﺪﻳﺎـﺷ ﻪـﻛ ،ﺖﺳا هدﻮﺒﻧ ﻲــﻣروا ﻪــﺑ ﻼﺘــﺒﻣ نادﺮــﻣ ﻲــﻠﻋ ﻪــﻛ ﺪــﺷﺎﺑ
راﺪــﻘﻣ ﻢــﻏر
هﺪــﺷ دازآ ﺮﻳدﺎــﻘﻣ ،ﻪــﺘﻓﺎﻳ ﺶﻫﺎــﻛ نوﺮﺘﺳﻮﺘﺴــﺗ ﺰــﻴﻧ LH
ﻲﻣ ﺶﻫﺎﻛ ﺪﺑﺎﻳ
).
15
(
ﻲــﻨﻌﻣ طﺎــﺒﺗرا ﻪــﻌﻟﺎﻄﻣ ﻦــﻳا رد ﻦﻴﺑﺎــﻣ راد
ود رد PTH
ﺎـﺑ ﻲﻧاﻮـﺨﻤﻫ ﻪـﻛ ،ﺪـﻣآ ﺖـﺳد ﻪـﺑ ﻼﺘﺒﻣﺮـﻴﻏ و ﻼﺘﺒﻣ هوﺮﮔ ﻣ دراد ﺮــﮕﻳد تﺎــﻌﻟﺎﻄ .
ﺖــﻓﺎﺑ كرﺪــﻣ يرﺎــﻤﻴﺑ زا ﻲــﺳﺎﻨﺷ
ﺰﺘﻨـﺳ رد دﻮﺒﻤﻛ و ﺖﺳا ﻊﻳﺎﺷ ﻪﻴﻠﻛ ﻲﻳﺎﺳرﺎﻧ رد ناﻮﺨﺘﺳا ﻦﻴﻣﺎﺘﻳو لﺎﻌﻓ D
(Calcitriol) رد ﻢـﻬﻣ رﺎﻴﺴـﺑ ﻞـﻣﺎﻋ ﻚـﻳ
ﻲــﻣ ﻪــﻳﻮﻧﺎﺛ ﻢﺴــﻳﺪﻴﺋوﺮﻴﺗارﺎﭘﺮﭙﻴﻫ ﺰﻧژﻮﺗﺎــﭘ ﺪــﺷﺎﺑ
).
10
، 16 و 17 (
يﻮـﻴﻠﻛ ﻞﻣاﻮﻋ زا ﺰﻴﻧ ﻢﻴﺴﻠﻛ دﻮﺒﻤﻛ و ﺮﻔﺴﻓ راﺪﻘﻣ ﺶﻳاﺰﻓا دﺎﺠﻳا رد ﻲﻣ ﻪﻳﻮﻧﺎﺛ يﺪﻴﺋوﺮﻴﺗارﺎﭘﺮﭙﻴﻫ
ﺪﻨﺷﺎﺑ .
ﻪﻌﻟﺎﻄﻣ رد
ﻪـﭽﺑ يور ﺮـﺑ هﺪﺷ مﺎﺠﻧا ي
ﻪـﺑ ﻼﺘـﺒﻣ يﺎـﻫ
ﻪﭽﺑ ﻪﻛ ﺖﺳا هﺪﺷ هداد نﺎﺸﻧ CRF ﺎﺑ يﺎﻫ
زا ﺮﺗﻻﺎﺑ PTH
200
ﻲﺳ ﺮﻫ رد مﺮﮔﻮﻜﻴﭘ
(pg/ml)ﻲﺳ
ﻊﻳﺎﺷ رﻮﻃ ﻪﺑ
زا ﺮﺗ
ﺎﺑ داﺮﻓا ﻲﻨﭘﻮﺌﺘﺳا ﻪﺑ ﻼﺘﺒﻣ ﺮﺘﻤﻛ PTH
هدﻮﺑ ﺪﻧا
).
18
(
ﺎﻔﺴﻓ ﺮﻳدﺎﻘﻣ ﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ رد ﺮﻔﺴـﻓ و ﻢﻴﺴـﻠﻛ ،ﻲﻳﺎﻴﻠﻗ زﺎﺗ
ﻲﻨﻌﻣ توﺎﻔﺗ
ﺮـﺑ ﻪـﻛ ﺖـﺳا هداﺪـﻧ نﺎﺸـﻧ هوﺮـﮔ ود رد ار يراد
ﺮﺼـﻣ رد هﺪـﺷ مﺎـﺠﻧا ﻪـﻌﻟﺎﻄﻣ رد هﺪﻣآ ﺖﺳد ﻪﺑ ﺞﻳﺎﺘﻧ فﻼﺧ ﻲﻣ زﺎﺗﺎﻔﺴـﻓ ﺮﻳدﺎـﻘﻣ زورﻮﭘﻮﺌﺘـﺳا ﻪـﺑ ﻼﺘﺒﻣ هوﺮﮔ رد ﻪﻛ ،ﺪﺷﺎﺑ
ﺖﺳا هدﻮﺑ ﺮﺘﻤﻛ ﻢﻴﺴﻠﻛ راﺪﻘﻣ و ﺮﺘﺸﻴﺑ ﺮﻔﺴﻓ و ﻲﻳﺎﻴﻠﻗ
).
18
(
شراﺰــﮔ ﺮــﺿﺎﺣ لﺎــﺣ رد ﻲﻳﺎــﻫ
درﻮــﻣ رد ﺎــﻴﻧد رد
ﻪــﺑ ﻼﺘــﺒﻣ نادﺮــﻣ رد نوﺮﺘﺳﻮﺘﺴــﺗ ﺰﻳﻮــﺠﺗ ياﺮــﺑ CRF
ﺎـﻣا ،دراد دﻮـﺟو زورﻮﭘﻮﺌﺘﺳا زا يﺮﻴﮕﺸﻴﭘ
ﻲـﺑ
و ﺮـﻄﺧ
دﻮـﺷ ﺪـﻴﻳﺄﺗ ﺪـﻳﺎﺑ ﻲﻧﺎـﻣرد شور ﻦﻳا ندﻮﺑ ﺮﺛﺆﻣ
).
19
رد (
ﻪﻌﻟﺎﻄﻣ
ﻪـﺑ ﺎﻜﻳﺮﻣآ رد هﺪﺷ مﺎﺠﻧا ي هﺪﻴـﺳر ﻪـﺠﻴﺘﻧ ﻦـﻳا
ﺎـﺑ نادﺮـﻣ رد ﻪـﻛ ﺪﺷ
ﻞـﺧاد ﺰﻳﻮـﺠﺗ ،نژورﺪـﻧآ دﻮـﺒﻤﻛ
ﺘﺴــﺗ ﻲﻧﻼﻀــﻋ ﻢﻛاﺮــﺗ رد ﻲﺒﺴــﻧ ﺶﻳاﺰــﻓا ﺚــﻋﺎﺑ نوﺮﺘﺳﻮ
ﻲﻣ رﺎﺒﻣﻮﻟ ﻪﻴﺣﺎﻧ رد ناﻮﺨﺘﺳا زا ﻲﺘﺒﺜﻣ ﻲﻨﻴﻟﺎﺑ ﺮﺛا ﺎﻣا ،دﻮﺷ
رد زورﻮﭘﻮﺌﺘﺳا نﺎﻣرد و يﺮﻴﮕﺸﻴﭘ يور ﺮﺑ نوﺮﺘﺳﻮﺘﺴﺗ
ﺖـﺳا هداﺪـﻧ نﺎﺸﻧ نادﺮﻣ
).
5
(
يﺮـﮕﻳد ﻪـﻌﻟﺎﻄﻣ رد ﻦﻴـﻨﭽﻤﻫ
هدﺮﻛ ﺮﻛذ
تﺎﻌﻟﺎﻄﻣ و دراد ﻲﺒﻧﺎﺟ ضراﻮﻋ نژورﺪﻧآ ﻪﻛ ﺪﻧا
اﺮـﺛا درﻮـﻣ رد يﺮﺘﺸﻴﺑ رد نژورﺪـﻧآ ﺎـﺑ نﺎـﻣرد ﺖـﺒﺜﻣ ت
ﺖﺳا زﺎﻴﻧ درﻮﻣ ﻢﺴﻳدﺎﻨﮔﻮﭙﻴﻫ ﻪﺑ ﻼﺘﺒﻣ نادﺮﻣ
).
6
(
ﻪﺠﻴﺘﻧ يﺮﻴﮔ
ﻪﺑﻼﺘﺒﻣ نارﺎﻤﻴﺑ رد ﺪﻳﺎﺑ زورﻮﭘﻮﺌﺘﺳا ناﻮـﻨﻋ ﻪـﺑ CRF
زا ﻲﺋﺰﺟ Renal osteodystrophy
و دﻮـﺷ ﻪـﺘﻓﺮﮔ ﺮﻈﻧ رد
ﻦـﻳا رد نوﺮﺘﺳﻮﺘﺴﺗ ﺰﻳﻮﺠﺗ ﺮﺛﺆﻣ تاﺮﺛا درﻮﻣ رد ﻪﻌﻟﺎﻄﻣ ﻲﻣ زﺎﻴﻧ درﻮﻣ داﺮﻓا ﺪﺷﺎﺑ
.
ﺗ ﺮﻜﺸﺗ و ﺮﻳﺪﻘ
و ﻲﻜـﺷﺰﭘ مﻮـﻠﻋ هﺎﮕﺸـﻧاد ﻲﻟﺎﻣ ﺖﻳﺎﻤﺣ ﺎﺑ ﻲﺳرﺮﺑ ﻦﻳا تﺎﻣﺪﺧ ﻲﺘﺷاﺪﻬﺑ -
ﻪﻠﻴـﺳو ﻦﻳﺪﺑ و ﺪﺷ مﺎﺠﻧا ناﺮﻳا ﻲﻧﺎﻣرد
يراﺰﮕـﺳﺎﭙﺳ لﺎﻤﻛ مﺮﺘﺤﻣ ﻦﻴﻟوﺆﺴﻣ زا ﻪﻟﺎﻘﻣ نﺎﮔﺪﻨﺴﻳﻮﻧ
ﺪﻧراد ار .
ﻊﺑﺎﻨﻣ ﺖﺳﺮﻬﻓ
1. Dolgos S, Hartmann A, , Bonsnes S, Ueland T, Isaksen GA, Godang K, et al. Determinants of bone mass in end-stage renal failure patients at the time of kidney transplantation. Clin Transplant 2008; 22(4): 462-8.
2.Ferreira A. Development of renal bone disease. Eur J Clin Invest 2006; 36(Suppl 2): 2-12.
3. Kalyani RR, Gavini S, Dobs AS. Male hypogonadism in systemic disease. Endocrinol Metab Clin North Am 2007; 36(2): 333-48.Review.
4. Johansen KL. Treatment of hypogonadism in men with chronic kidney disease. Adv Chronic Kidney Dis 2004; 11(4): 348-56.
5.Johansen KL. Testosterone metabolism and replacement therapy in patients with end-stage renal disease. Semin Dial 2004; 17(3): 202-8.
6. Diaz Lopez JB, Rodriguez Rodriguez A, Ramos B, Caramelo C, Rodrlguez Garcia M, Cannata Andia JB.
Osteoporosis, estrogens, and bone metabolism.
Implications for chronic renal insufficiency. Nefrologia 2003; 23(Suppl 2): 78-83.
7. Me llstrom D, Johnell O, Ljunggren O, Eriksson
AL, Lorentzon M, Mallmin H, et al. Free testosterone is an independent predictor of BMD and prevalent fractures in elderly men: Mr OS Sweden. J Bone Miner Res 2006; 21(4): 529-35.
8. Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Synder PJ, Swerdloff RS, et al. Testosterone therapy in adult with androgen deficiency syndrome: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2006; 91(6): 1995-2010.
9. Kurnatowska I, , Zygmunt A, Fijalkowska- Morawska J, Bialkowska J, Jablkowski M, Nowicki M, et al. Hormonal activity of the hypophysial- gonadal axis versus the mineral bone density and specific markers of bone turnover in hemodialysis population. Pol Merkur Lekarski 2006; 20(118): 408-12.
10. Peters BS, Moyses RM, Jorgetti V, Martini LA.
Effects of parathyroidectomy on bone remodeling markers and vitamin D status in patients with chronic kidney disease- mineral and bone disorder. Int Urol Nephrol 2007; 39(4): 1251-6.
11. Hruska KA. New insights related to aging and renal osteodystrophy. Geriatr Nephrol Urol 1999; 9(1): 49-56.
12. Kumchev EP, Tzvetkova SB, Enchev ED,
Yaneva MP, Dimitrova RH, Botushanova AD, et al.
Influence of age, sex and body weight on renal osteodystrophy in predialysis patients with chronic renal failure. Folia Med (plovdiv) 2000; 42(2): 28-33.
13. Valdes Socin H, Magis D, Betea D, Dechenne C, Legros JJ, Beckers A. Pituitary diseases in elderly patients with chronic renal insufficiency. Rev Med Liege 2002; 57(6): 375-81.
14. Doumouchtsis KK, Kostakis AI, Doumouchtsis SK, Graspa EI, Passalidou IA, Tziamalis MP, et al. The effect of sexual hormone abnormalities on proximal femur bone mineral density in hemodialysis patients and the possible role of RANKL. Hemodial Int 2008; 12(1): 100-7.
15. Palmer BF. Sexual dysfunction in uremia. J Am Soc Nephrol 1999; 10(6):1381-8. Review.
16. Ismail N. Use of erythropoietin, active vitamin D3 metabolites, and alkali agents in predialysis patients.
Semin Nephrol 1997; 17(4): 270-84.
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18. Bakr Am. Bone mineral density and bone turnover markers in children with chronic renal failure.
Pediatr Nephrol 2004; 19(12): 1390-3.
19. Chatterjee R, Wood S, Mc Garrigle HH. A novel therapy with testosterone and Sildenafil for erectile dysfunction in patients on renal dialysis or after renal transplantation. J Fam Plann Reprod Health Care 2004;
30(2): 88-90.
The Relation Between Bone Density and Sexual Hormone in Men with Chronic Renal Failure
M. Jabbari, MDI *M Talebi Taher, MDII F. Jaffari, MDIII A. Jenabi, MDIV
Abstract
Background and Aim: Patients with Chronic Renal Failure (CRF) are at high risk of renal osteodystrophy, and this condition develops at the early stages of chronic renal failure and covers a spectrum of bone changes such as osteoporosis. Hypogonadism is common among men with CRF. Many of the manifestations of hypogonadism such as bone disease, are also frequently seen among dialysis patients. The goal of this study was to determine the levels of testosterone, PTH, LH, BUN, Cr, and Alkaline phosphatase (Alk.p) in men with CRF in two groups with normal and abnormal bone densitometry.
Patients and Methods: In this cross-sectional study, 63 patients with CRF were evaluated. Bone mineral densitometries (BMD) by DEXA method were requested for all patients. The level of testosterone, PTH, BUN, Cr, Alk.p and LH were compared in two groups with normal and abnormal densitometry. The results were analyzed by Pearson, T and Chi-square tests. A p value of <0.05 was regarded as a significant level.
Results: Sixty three patients were studied in this research. The average age of the patients was 50.58±13.32 years. We found significant relation between age, level of testosterone and PTH between patients with normal and abnormal BMD(p value<0.05).
Conclusion: Osteoporosis is an important finding in CRF patients and another study to determine the beneficial results of testosterone replacement therapy is recommended.
Key Words: 1) Chronic Renal Failure (CRF) 2) Bone density 3) Male sexual hormone
This article is a summary of the thesis by F. Jaffari, MD under the supervision of M.Jabbari, MD (2006-07).
This study has been conducted under the financial support of of Iran University of Medical Sciences and Health Services.
I) Assistant Professor of Nephrology, Hazrat-e-Rasool Akram Hospital, Iran University of Medical Sciences and Health Services, Tehran, Iran
II) Assistant Professor of Infectious Diseases, Niayesh Str, Sattarkhan Ave, Hazrat-e-Rasool Akram Hospital, Iran University of Medical Sciences and Health Services, Tehran, Iran(* Corresponding Author)
III) Internist, Iran University of Medical Sciences and Health Services, Tehran, Iran
IV) Assistant Professor of Nephrology, Hazrat-e-Rasool Akram Hospital, Iran University of Medical Sciences and Health Services, Tehran, Iran
