و ﻼﺘﺒﻣ لﺎﺳ 14 ﺮﯾز نﺎﮐدﻮﮐ رد ( IgM&IgG )ﯽﯾﺎﯾﺪﯿﻣﻼﮐ ﺖﻧﻮﻔﻋ ﯽﻧاواﺮﻓ ﺪﺻرد ﻪﺴﯾﺎﻘﻣ نﺎﮐدﻮﮐ ﺶﺨﺑ رد هﺪﺷ یﺮﺘﺴﺑ ﯽﻧﻮﻣﻮﻨﭘ ﻪﺑ ﻼﺘﺒﻣﺮﯿﻏ
I ﺶﺨﺑرﻮﻧ ﻪﻠﯿﻤﺛ ﺮﺘﮐد*
II شاﺮﺗﺮﻫاﻮﺟ ﺮﺻﺎﻧ ﺮﺘﮐد
III زﺎﻤﯾر زﺎﻨﻬﺷ ﺮﺘﮐد
IV ﯽﯾﺎﺿر یﺪﻬﻣ ﺮﺘﮐد
V ﯽﯾﺎﺒﻃﺎﺒﻃ ﺖﺧدرذآ
هﺪﯿﮑﭼ
داﺮﻓا رد ﯽﻧﻮﻣﻮﻨﭘو ﺖﯿﺸﻧوﺮﺑ ﻞﻣﺎﻋ و نﺎﮐدﻮﮐ رد ﯽﻧﺎﺘﺤﺗ ﯽﺴﻔﻨﺗ ﺖﻧﻮﻔﻋ ﻞﻠﻋ زا ﯽﮑﯾ ﻪﯿﻧﻮﻣﻮﻨﭘ ﺎﯾﺪﯿﻣﻼﮐ هﺪـﯾد ﻦﯿﻨـﺳ مﺎـﻤﺗ رد نآ ﻪـﺑ ﻼـﺘﺑا ﻪــﮐ ﺖﺳا عﺎﻤﺘﺟا رد ﮏﯿﭙﯿﺗآ یﺎﻫﯽﻧﻮﻣﻮﻨﭘ زا %10-20 ﻞﻣﺎﻋ ﺰﯿﻧ و ﻎﻟﺎﺑ ﻦـﯾا ﺖـﺸﮐ .دراد ﯽﺻﺎـﺼﺘﺧا نﺎـﻣرد ﻪـﺑ زﺎــﯿﻧ و هﺪﺷ ﻢﺳآ تﻼﻤﺣ نﺪﺷ لﺎﻌﻓ ﺐﺒﺳ ﺖﻧﻮﻔﻋ ﻦﯾا .دﻮﺷﯽﻣ ﻦـﯾا زا فﺪـﻫ .ﺪﻨﺘـﺴﻫ هﺪـﻨﻨﮐ ﮏـﻤﮐ ﺺﯿﺨــﺸﺗ یاﺮﺑ یژﻮﻟوﺮﺳ یﺎﻫشور ﻦﯾاﺮﺑﺎﻨﺑ ﺖﺳا ﻞﮑﺸﻣ ﻢﺴﯿﻧﺎﮔرا ﻪـﺑ ﻼـﺘﺒﻣ لﺎـﺳ 14 ﺮـﯾز نﺎــﮐدﻮﮐ رد ﺎﯾﺪﯿﻣﻼﮐ ﺖﻧﻮﻔﻋ ﻪﺑ ﯽﻠﺒﻗ یﻼﺘﺑا و دﺎﺣ ﺖﻧﻮﻔﻋ ﯽﻧاواﺮﻓ ﻦﯿﯿﻌﺗ ﻪﻌﻟﺎﻄﻣ ﺎـﺑ ﯽﯾﺎـﯾﺪﯿﻣﻼﮐ ﯽــﻧﻮﻣﻮﻨﭘ ﺰﯿﻣآﺖﯿﻘﻓﻮﻣ نﺎﻣرد ﺎﺑ .ﺖﺳا هدﻮﺑ ﺖﻧﻮﻔﻋ ﻪﺑ ﻼﺘﺑا ﻦﺳ ﻂﺳﻮﺘﻣ ﻦﯿﯿﻌﺗ و ﯽﻧﻮﻣﻮﻨﭘ تﻼـﻤﺣ ﻪـﮑﻠﺑ دﻮـﺷﯽﻣ ﻪﺘـﺳﺎﮐ ﯽــﻧﻮﻣﻮﻨﭘ دراﻮﻣ زوﺮﺑ ناﺰﯿﻣ زا ﺎﻬﻨﺗ ﻪﻧ ﺎﻫﺪﯿﻟوﺮﮐﺎﻣ ﺮﯾﺎﺳ و ﻦﯿﺴﯾﺎﻣوﺮﺘﯾرا 14 ﺮـﯾز کدﻮـﮐ 73 نﻮـﺧ ﻪـﻧﻮﻤﻧ یور یﺪﻫﺎــﺷ ـ درﻮﻣ ﻪﻌﻟﺎﻄﻣ ﻦﯾا .ﺪﺑﺎﯾﯽﻣ ﺶﻫﺎﮐ یﺮﺘﺴﺑ دراﻮﻣ و ﻢﺳآ IgM و IgG ﯽﺻﺎـﺼﺘﺧا یدﺎـﺑﯽﺘﻧآ ﯽـﺳرﺮﺑ .ﺪـﺷ مﺎـﺠﻧا (ﺪﻫﺎــﺷ 38 و ﯽﻧﻮﻣﻮﻨﭘ ﻪﺑ ﻼﺘﺒﻣ رﺎﻤﯿﺑ 35)لﺎﺳ 3/7±3/87 نﺎــﮐدﻮﮐ ﻦﺳ ﻦﯿﮕﻧﺎﯿﻣ هﺪﻣآ ﺖﺳد ﻪﺑ ﺞﯾﺎﺘﻧ سﺎﺳاﺮﺑ .ﺖﻓﺮﮔ ترﻮﺻ ELISA شور ﺎﺑ ﺎﯾﺪﯿﻣﻼﮐ
%48 رد (ﺖــﺒﺜﻣ Chlamydia IgM)ﯽﯾﺎﯾﺪﯿﻣﻼﮐ دﺎﺣ ﺖﻧﻮﻔﻋ .ﺪﻧدﻮﺑ ﺮﺘﺧد %51/4 و ﺮﺴﭘ %48/6 و دﻮﺑ لﺎﺳ 2-3 ﯽﻨـﺳ هوﺮـﮔ رد ﯽــﻧاواﺮﻓ ﻦﯾﺮﺗﺶﯿﺑ .دﻮﺑ ﺖﺒﺜﻣ ﯽﻧﻮﻣﻮﻨﭘ ﻪﺑ ﻼﺘﺒﻣ نﺎﮐدﻮﮐ زا %57 رد و نﺎﮐدﻮﮐ ﻞﮐ زا نﺎـﮐدﻮﮐ ﻞـﮐ %27/4 رد ﺎــﯾﺪﯿﻣﻼﮐ ﻪﺑ ﺖﺒﺴﻧ ﯽﻠﺒﻗ ﯽﻨﻤﯾا .ﺪﺷ هﺪﻫﺎﺸﻣ لﺎﺳ 3/7 ﯽﻨﺳ ﻦﯿﮕﻧﺎﯿﻣ و (%40)لﺎﺳ دﺎـﺣ ﺖـﻧﻮﻔﻋ ﻪـﺑ ﻼـﺘﺑا .دﻮـﺑ (%50)لﺎـﺳ 5 زا ﺮﺗﻻﺎـﺑ ﻦـﺳ ﻪــﺑ طﻮﺑﺮﻣ ﯽﻧاواﺮﻓ ﻦﯾﺮﺗﺶﯿﺑ ﻪﮐ ﺖﺷاد دﻮﺟو ﯽـﻨﻤﯾا ﺎــﻣا دﻮﺑ ﺪﻫﺎﺷ هوﺮﮔ زا ﺶﯿﺑ (P<0/001)یرادﯽﻨﻌﻣ رﻮﻃ ﻪﺑ ﯽﻧﻮﻣﻮﻨﭘ ﻪﺑ ﻼﺘﺒﻣ هوﺮﮔ رد ﯽﯾﺎﯾﺪﯿﻣﻼﮐ دﺎــﺣ ﺖــﻧﻮﻔﻋ ﻪــﮐ ﺖــﻔﮔ ناﻮــﺗﯽﻣ ﯽــﻠﮐ یﺮﯿــﮔﻪــﺠﯿﺘﻧ ناﻮــﻨﻋ ﻪــﺑ .ﺖـــﺷاﺪﻧ ﯽـﺤﺿاو توﺎـﻔﺗ ﯽـﻠﺒﻗ ﯽﮕﻟﺎﺳ 3 ﻦﺳ رد نﺎﮐدﻮﮐ زا %50 رد ﯽﻧﻮﻣﻮﻨﭘ نوﺪﺑ ﺎﯾ ﯽﻧﻮﻣﻮﻨﭘ ﺎﺑ (ﺖﺒﺜﻣ Chlamydia-IgM)ﯽﯾﺎﯾﺪﯿﻣﻼﮐ ﻪـﺑ ﺖــﻧﻮﻔﻋ بﻮﺧ ﺦﺳﺎﭘ ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ .ﺪﺷ ﺪﻫاﻮﺧ ﺖﺒﺜﻣ IgG ﻦﯾا لﺎﺳ 5 ﻦﺳ ﻪﺑ نﺪﯿﺳر ﺎﺗ ﻪﮐ دﻮﺷﯽﻣ هﺪﯾد تﻼـﻤﺣ زا ﻪﮑﻠﺑ ﺪﺑﺎﯾﯽﻣ ﺶﻫﺎﮐ ﯽﻧﻮﻣﻮﻨﭘ دراﻮﻣ ﺎﻬﻨﺗ ﻪﻧ ﺖﻧﻮﻔﻋ ﻦﯾا لﺮﺘﻨﮐ ﺎﺑ ،ﻦﯿﺴﯾﺎﻣوﺮﺘﯾرا ﯽﮐارﻮﺧ نﺎﻣرد .ﺪﺷ ﺪﻫاﻮﺧ ﻢﮐ یرﺎﻤﯿﺑ یﺮﺘﺴﺑ دراﻮﻣ و ﻪﺘﻓﺎﯾ ﻒﯿﻔﺨﺗ ﻞﻗاﺪﺣ ﺎﯾ هﺪﺷ ﻪﺘﺳﺎﮐ ﺪﻌﺘﺴﻣ داﺮﻓا رد ﻢﺳآ ﮏﯿﭙﯿﺗآ ﯽﻧﻮﻣﻮﻨﭘ – 3 ﯽﻧﻮﻣﻮﻨﭘ – 2 ﺎﯾﺪﯿﻣﻼﮐ یدﺎﺑﯽﺘﻧآ – 1 :ﺎﻫهژاوﺪﯿﻠﮐ ﯽﯾﺎﯾﺪﯿﻣﻼﮐ ﯽﻧﻮﻣﻮﻨﭘ – 4
ﺮﺘـﮐد هروﺎـﺸﻣ و شاﺮــﺗﺮﻫاﻮﺟ ﺮﺻﺎﻧ ﺮﺘﮐد ﯽﯾﺎﻤﻨﻫار ﻪﺑ نﺎﮐدﻮﮐ یﺎﻫیرﺎﻤﯿﺑ ﯽﺼﺼﺨﺗ یاﺮﺘﮐد ﻪﺟرد ﺖﻓﺎﯾرد ﺖﻬﺟ ﯽﯾﺎﺿر یﺪﻬﻣ ﺮﺘﮐد ﻪﻣﺎﻧ نﺎﯾﺎﭘ زا ﺖﺳا یاﻪﺻﻼﺧ ﻪﻟﺎﻘﻣ ﻦﯾا
.1381-82 لﺎﺳ ،ﯽﯾﺎﺑﺎﺒﻃ ﺖﺧدرذآ و ﺶﺨﺑرﻮﻧ ﻪﻠﯿﻤﺛ
ﯽﻧﺎـﻣرد ﯽﺘـﺷاﺪﻬﺑ تﺎـﻣﺪﺧ و ﯽﮑـﺷﺰﭘ مﻮــﻠﻋ هﺎﮕﺸﻧاد ،ﺶﯾﺎﯿﻧ ،نﺎﺧرﺎﺘﺳ نﺎﺑﺎﯿﺧ ،(ص)مﺮﮐا لﻮﺳر تﺮﻀﺣ نﺎﺘﺳرﺎﻤﯿﺑ ،نﺎﮐدﻮﮐ ﯽﻧﻮﻔﻋ یﺎﻫیرﺎﻤﯿﺑ ﺺﺼﺨﺗقﻮﻓ و رﺎﯾدﺎﺘﺳا (I (لﻮﺌﺴﻣ ﻒﻟﻮﻣ*)ناﺮﯾا .ناﺮﯾا ﯽﻧﺎﻣرد ﯽﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ و ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﺶﯾﺎﯿﻧ ،نﺎﺧرﺎﺘﺳ نﺎﺑﺎﯿﺧ ،(ص)مﺮﮐا لﻮﺳر تﺮﻀﺣ نﺎﺘﺳرﺎﻤﯿﺑ ،نﺎﮐدﻮﮐ رد ﯽﺳﺎﻨﺷﯽﻨﻤﯾا ﺺﺼﺨﺗقﻮﻓ و رﺎﯿﺸﻧاد (II .ناﺮﯾا ﯽﻧﺎﻣرد ﯽﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ و ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،یژﻮﻟﻮﯿﻣﺪﯿﭘا رﺎﯾدﺎﺘﺳا (III
.ناﺮﯾا ﯽﻧﺎﻣرد ﯽﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ و ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،نﺎﮐدﻮﮐ یﺎﻫیرﺎﻤﯿﺑ رﺎﯿﺘﺳد (IV
.ناﺮﯾا ﯽﻧﺎﻣرد ﯽﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ و ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ﯽﺑﺮﻣ ،ﯽﻫﺎﮕﺸﯾﺎﻣزآ مﻮﻠﻋ ﺪﺷرا سﺎﻨﺷرﺎﮐ (V
ﻪﻣﺪﻘﻣ زا ﯽﻧﺎـﺘﺤﺗ ﯽـﺴﻔﻨﺗ ﺖـﻧﻮﻔﻋ ﻞــﻠﻋ زا ﯽﮑﯾ ﻪﯿﻧﻮﻣﻮﻨﭘ ﺎﯾﺪﯿﻣﻼﮐ داﺮـﻓا رد ﯽـﻧﻮﻣﻮﻨﭘ و ﺖﯿــﺸﻧوﺮﺑ و نﺎﮐدﻮﮐ رد ﯽﻧﻮﻣﻮﻨﭘ ﻪﻠﻤﺟ (3 و2 ،1).دراﺪﻧ دﻮﺟو ﯽﻧﺎﺴﻧا ﺮﯿﻏ ﻊﺒﻨﻣ نآ یاﺮﺑ و ﺪﺷﺎﺑﯽﻣ ﻎﻟﺎﺑ ،ﺖــﺳا هﺪﺷ مﺎﺠﻧا ًاﺮﯿﺧا ﻪﮐ یﺰﮐﺮﻣ ﺪﻨﭼ تﺎﻌﻟﺎﻄﻣ سﺎﺳاﺮﺑ زا ﯽـﺷﺎﻧ ﯽـﻧﻮﻣﻮﻨﭘ ﻪـﺑ ﻼـﺘﺒﻣ ﻪــﮐ ﻪﻟﺎﺳ 3-12 نﺎﮐدﻮﮐ زا %14 ﺖـﺸﮐ ناﺰﯿــﻣ و ﺪﻨﺘﺷاد ﺖﺒﺜﻣ ﯽﯾﺎﯾﺪﯿﻣﻼﮐ ﺖﺸﮐ ،ﺪﻧدﻮﺑ عﺎﻤﺘﺟا رد نآ عﻮﯿـﺷ (5 و4 ،3) .ﺖـﺳا هدﻮـﺑ %22 ﺎﻤــﺳﻼﭘﻮﮑﯾﺎﻣ ﺎﺑ ﺖﺒﺜﻣ هﺪـﺷ شراﺰـﮔ %18 لﺎـﺳ 6 زا ﺮﺗﻻﺎــﺑ و %15 لﺎﺳ 6 ﺮﯾز ﻦﺳ ﺎـــﺑ هاﺮــــﻤﻫ ،ﺖــﻧﻮﻔﻋ ،نارﺎــﻤﯿﺑ زا %20 رد و (3 و2 ،1)ﺖــﺳا یور ﺪـﻨﻫ رد هﺪـﺷ مﺎــﺠﻧا تﺎﻌﻟﺎﻄﻣ رد .ﺪﺷﺎﺑﯽﻣ ﺎﻤﺳﻼﭘﻮﮑﯾﺎﻣ زا %27/4 ،عﺎــﻤﺘﺟا زا ﯽـــﺷﺎﻧ ﯽـﻧﻮﻣﻮﻨﭘ ﻪـﺑ ﻼـﺘﺒﻣ کدﻮـﮐ 67 یاﺮـﺑ %6/4 و ﺎﻤـﺳﻼﭘﻮﮑﯾﺎـﻣ یاﺮــﺑ ﺖﺒﺜﻣ یژﻮﻟوﺮﺳ نﺎﮐدﻮﮐ
(5).ﺪﻨﺘﺷاد ﺎﯾﺪﯿﻣﻼﮐ
3 ،ﺐــﺗ نوﺪــﺑ ﯽـــﻧﻮﻣﻮﻨﭘ ﻪـﺑ ﻼـﺘﺒﻣ یاهﺮـﮐ نازﺎﺑﺮـﺳ رد ازیرﺎﻤﯿﺑ ﻞﻣﺎﻋ ﻪﻓﺮﺳهﺎﯿﺳ و ﺎﻤﺳﻼﭘﻮﮑﯾﺎﻣ ،ﺎﯾﺪﯿﻣﻼﮐ ﻢﺴﯿﻧﺎﮔرا ﻊﯾﺎـﺷ ﺎـﯾﺪﯿﻣﻼﮐ ،ﺪـﻨﻟزﻮﯿﻧ رد هﺪـﺷ مﺎــﺠﻧا ﻪﻌﻟﺎﻄﻣ رد (6).ﺪﻧدﻮﺑ ﻞﻣﺎـﻋ ﺎـﯾﺪﯿﻣﻼﮐ ،ﻪﻟﺎـﺳ 10 ﯽـﺳرﺮﺑ ﮏﯾ ﯽﻃ ﺪﻧﻼﻨﻓ رد ﺎﻣا دﻮﺒﻧ %9 لﺎـﺳ 5-9 ﻦﺳ رد نآ عﻮﯿﺷ و ﺪﺷ ﯽﻓﺮﻌﻣ ﺎﻫﯽﻧﻮﻣﻮﻨﭘ ﻢﻫد تﺎــﻌﻟﺎﻄﻣ رد .ﺪﯾدﺮﮔ شراﺰﮔ %31 لﺎﺳ 10 زا ﺮﺗﻻﺎﺑ ﻦﺳ رد و ﯽـﻧﻮﻣﻮﻨﭘ ﻪﻧﻻﺎـﺳ زوﺮـﺑ ﻪـﮐ ﺪـﺷ هداد نﺎـﺸﻧ ﻒــﻠﺘﺨﻣ ﻊﻣاﻮﺟ ﺎﻤـﺳﻼﭘﻮﮑﯾﺎــﻣ درﻮﻣ 1000 رد 5 ﻞﺑﺎﻘﻣ رد درﻮﻣ 2/3 ﺎﯾﺪﯿﻣﻼﮐ و ﺎــــﯾﺪﯿﻣﻼﮐ ﺖــﻧﻮﻔﻋ ﯽــﻫاﺮﻤﻫ نارﺎــﻤﯿﺑ زا %41 رد .ﺖــﺳا ﻦﯾاﺮﺑﺎــﻨﺑ ﺪﯿﺳر تﺎﺒﺛا ﻪﺑ یژﻮﻟوﺮﺳ یﺎﻫشور ﺎﺑ ﺎﻤﺳﻼﭘﻮﮑﯾﺎﻣ ﯽـﻧﻮﻣﻮﻨﭘ هﺪــﻨﻨﮐ دﺎﺠﯾا ﻢﻬﻣ ﺖﻧﻮﻔﻋ ﺎﯾﺪﯿﻣﻼﮐ ،ﻪﺳرﺪﻣ ﻦﯿﻨﺳ رد زا ﯽــﺷﺎﻧ ﺖـــﺒﺜﻣ یژﻮﻟوﺮـﺳ (7-10 و1-4)
.ﺪـﺷﺎﺑﯽﻣ نﺎـﮐدﻮﮐ رد ﺮﯿــﻏ یﺎﻫﺖﻧﻮﻔﻋ هﺪﻨﻫدنﺎﺸﻧ ﻎﻟﺎﺑ داﺮﻓا زا %30-45 رد ﺖﻧﻮﻔﻋ زا %10-20 ﻞﻣﺎــﻋ ﺎــﯾﺪﯿﻣﻼﮐ .ﺖــﺳا نآ ﺎــﺑ ﯽﻨﯿﻟﺎـــﺑ ﺢـﺿاو و ﺎﻫﺖﯿـﺸﻧوﺮﺑ %10 ،عﺎـﻤﺘﺟا زا ﯽــﺷﺎﻧ لﺎﮑﯿﭙﯿﺗآ یﺎﻫﯽﻧﻮﻣﻮﻨﭘ ﺮﯿـﮔرد ار ﯽﻨـﺳ یﺎــﻫهوﺮﮔ مﺎﻤﺗ و هدﻮﺑ ﺎﻫﺖﯾﮋﻧرﺎﻓ زا %5-10 ﻞــﻣاﻮﻋ ﺮﯾﺎــﺳ ﺎــﺑ ﺎـــﯾﺪﯿﻣﻼﮐ زا ﯽـﺷﺎﻧ ﺖـﻧﻮﻔﻋ (4-8).ﺪـﻨﮐﯽﻣ ﯽﻗاﺮﺘـﻓا ﺺﯿﺨـﺸﺗ ﺎﻤـﺳﻼﭘﻮﮑﯾﺎــﻣ هﮋﯾو ﻪﺑ ﯽﺴﻔﻨﺗ یازیرﺎﻤﯿﺑ (ﯽﯾﺎﯾﺮﺘﮐﺎﺑﺮﯿﻏ)لﺎﮑﯿﭙﯿﺗآ هوﺮﮔ رد نآ زا ﯽﺷﺎﻧ ﯽﻧﻮﻣﻮﻨﭘ و دراد لﺎـﻌﻓ و ﻢــﺳآ هﺪﻨﻨﮐ لﺎﻌﻓ ﻢﻬﻣ ﻞﻣﺎﻋ ﺖﻧﻮﻔﻋ ﻦﯾا .دﺮﯿﮔﯽﻣ راﺮﻗ ﮏﯿﺘﺴﯿﮐوﺮﺒﯿﻓ یرﺎﻤﯿﺑ ﻪﺑ ﻼﺘﺒﻣ نﺎﮐدﻮﮐ رد ﯽﺴﻔﻨﺗ ﻢﺋﻼﻋ هﺪﻨﻨﮐ
لﺎـﺳ رد ﺎـﮑﯾﺮﻣآ رد هﺪـﺷ مﺎـﺠﻧا ﻪــﻌﻟﺎﻄﻣ رد (9 و8 ،7 ،3 ،2)
.ﺖﺳا و ﺎﯾﺪﯿﻣﻼﮐ زا ﯽﺷﺎﻧ ،ﮏﯿﭙﯿﺗآ یﺎﻫﯽﻧﻮﻣﻮﻨﭘ دراﻮﻣ %1 ﺰﯿﻧ 1999
(6).ﺪﺷ ﺮﮐذ ﺎﻤﺳﻼﭘﻮﮑﯾﺎﻣ %15
شﻮـﮔ ﻊﯾﺎـﻣ زا ﺎـﯾﺪﻣ ﺖـﯿﺗوا ﻪــﺑ ﻼﺘﺒﻣ نﺎﮐدﻮﮐ رد ﺎﯾﺪﯿﻣﻼﮐ لﺎــﯾﺮﺘﮐﺎﺑ ﺖﻧﻮﻔﻋ ﺎﺑ هاﺮﻤﻫ ﺐﻠﻏا ﻪﮐ ﺖﺳا نﺪﺷ اﺪﺟ ﻞﺑﺎﻗ ﯽﻧﺎﯿﻣ رد لﺎﺳ 1 ﺎﺗ ﺪﻧاﻮﺗﯽﻣ نآ ﺎﺑ ﺖﻣﻼﻋ نوﺪﺑ ﯽﺴﻔﻨﺗ ﺖﻧﻮﻔﻋ .ﺖﺳا
(1-4)
.ﺪﺑﺎﯾ ﻪﻣادا نﺎﮐدﻮﮐ و ﻎﻟﺎﺑ داﺮﻓا %2-5 ﺮﯾﺎــﺳ زا ﯽﻨﯿﻟﺎﺑ ﻢﺋﻼﻋ سﺎﺳاﺮﺑ ﺎﯾﺪﯿﻣﻼﮐ ﯽﻧﻮﻣﻮﻨﭘ ﺺﯿﺨﺸﺗ ﺺﯿﺨــﺸﺗ یاﺮﺑ هار ﻦﯾﺮﺗﻖﯿﻗد و (1-4)هدﻮﺑ ﻞﮑﺸﻣ ﯽﻧﻮﻣﻮﻨﭘ ﻞﻠﻋ رﺎﯿـﺴﺑ و ﻪﺘـﺷاد ﯽﺻﺎـﺼﺘﺧا ﻂـﯿﺤﻣ ﻪـﺑ زﺎــﯿﻧ ﻪﮐ ﺖﺳا ﺖﺸﮐ ﺖـﺳا ﺲﮑﻧرﺎــﻓوزﺎﻧ ﺖﺸﮐ یاﺮﺑ ﻞﺤﻣ ﻦﯾﺮﺘﻬﺑ .ﺪﺷﺎﺑﯽﻣ ﻞﮑﺸﻣ ناﻮــﺗﯽﻣ ﺰﯿﻧ رﻮﻠﭘ ﻊﯾﺎﻣ و ژاوﻻ رﻻﻮﺋﻮﻟآ ،ﻂﻠﺧ تﺎﺤﺷﺮﺗ زا ﺎﻣا
(1-4)
.دﻮﻤﻧ اﺪﺟ ار ﻢﺴﯿﻧﺎﮔرا سﺎﺴﺣﺮﯿﻏ اﺰﯿﻟا ﺎﯾ ﺲﻧﺎﺳرﻮﻠﻓﻮﻧﻮﻤﯾا ﻂﺳﻮﺗ نژﯽﺘﻧآ ﻦﯿﯿﻌﺗ زا هدﺎﻔﺘـﺳا ﺎــﺑ یژﻮﻟوﺮﺳ یﺎﻫشور ﻂﺳﻮﺗ ﺺﯿﺨﺸﺗ و هدﻮﺑ مﺎــﺠﻧا ﺲﻧﺎــﺳرﻮﻠﻓﻮﻧﻮﻤﯾاوﺮﮑﯿﻣ ﺎـــﯾ نﺎـﻤﻠﭙﻣﺎﮐ ندﺮـﮐ ﺖﺑﺎـﺛ رآﯽــﺳﯽﭘ شور زا هدﺎﻔﺘــﺳا ﺎـــﺑ ﺰﯿـﻧ ًاﺮﯿـﺧا و (2-6).دﻮـﺷﯽﻣ ﺎــﯾ ﻦﯿﺴﯾﺎﻣوﺮﺘﯾرا ﺰﯾﻮﺠﺗ ﺎﺑ نﺎﻣرد (11 و10 ،6 ،5)
.دﺮﯿﮔﯽﻣ ترﻮﺻ ﻞﻣﺎـﮐ ﯽﻨﮐﻪـﺸﯾر یاﺮـﺑ ﻪـﺘﻔﻫ 2 زا ﺶـﯿﺑ تﺪــﻣ ﻪﺑ ﻦﯿﻠﮑﯿﺳاﺮﺘﺗ ،ﻦﯿــﺴﯾﺎﻣوﺮﺘﯾزآ زا هدﺎﻔﺘـﺳا ﺎـﻣا دﻮـﺷﯽﻣ دﺎﻬﻨـﺸﯿﭘ بوﺮـﮑﯿﻣ 5-10)ﺮﺗهﺎﺗﻮﮐ تﺪﻣ ﻪﺑ (ﺪﯾﺪﺟ یﺎﻫﺪﯿﻟوﺮﮐﺎﻣ) ﻦﯿﺴﯾﺎﻣوﺮﺘﯾرﻼﮐ ﻪــﺑ ﻞﻣﺎﮐ رﻮﻃ ﻪﺑ ﻢﺴﯿﻧﺎﮔراوﺮﮑﯿﻣ ﻦﯾا .ﺪﺷﺎﺑﯽﻣ ﺮﺛﻮﻣ ﺰﯿﻧ (زور ﻦـــﯿﯿﻌﺗ ﻪـﻌﻟﺎﻄﻣ ﻦـﯾا زا فﺪـﻫ (1-4).ﺖـﺳا موﺎـﻘﻣ ﺎﻫﺪﯿﻣﺎﻔﻟﻮـﺳ رد ﺎـﯾﺪﯿﻣﻼﮐ ﺖـﻧﻮﻔﻋ ﻪـﺑ ﯽـﻠﺒﻗ یﻼـﺘﺑا و دﺎــﺣ ﺖﻧﻮﻔﻋ ﯽﻧاواﺮﻓ ﻦـﺳ ﻂـﺳﻮﺘﻣ ﻦــﯿﯿﻌﺗ ﺎﺑ .ﺖﺳا هدﻮﺑ ﯽﻧﻮﻣﻮﻨﭘ ﻪﺑ ﻼﺘﺒﻣ نﺎﮐدﻮﮐ ار ﺎـﯾﺪﯿﻣﻼﮐ ﯽـﻧﻮﻣﻮﻨﭘ ﯽﻧﺎـﻣرد ﻂـﺧ ناﻮـﺗﯽﻣ ﺖــﻧﻮﻔﻋ ﻪﺑ ﻼﺘﺑا ﻪـﺑ ﺖـﻧﻮﻔﻋ ﻦـﯾا ﻪـﮐ ﺎـﺟ نآ زا .دﻮـﻤﻧ ﺺﺨــﺸﻣ ﻦﺳ ﺐﺴﺣﺮﺑ ﻪـﺑ اﺪـﺘﺑا رد و هدﻮـﺑ موﺎـﻘﻣ ﯽــﺑﺮﺠﺗ ﯽﮑﯿﺗﻮﯿﺑﯽﺘﻧآ یﺎﻫنﺎﻣرد لﺮﺘـﻨﮐ ،ﺪﻫدﯽﻣ ﺦﺳﺎﭘ ﯽﺑﻮﺧ ﻪﺑ ﻦﯿﺴﯾﺎﻣوﺮﺘﯾرا ﯽﮐارﻮﺧ نﺎﻣرد دراﻮــﻣ داﺪـﻌﺗ ﺎﻬـﻨﺗ ﻪـﻧ ﺐـﺳﺎﻨﻣ ﮏـﯿﺗﻮﯿﺑﯽﺘﻧآ ﺎـﺑ ﺖـﻧﻮﻔﻋ ﻦـﯾا ﺐﺒﺳ ﻪﮑﻠﺑ ﺪﻫدﯽﻣ ﺶﻫﺎﮐ ار نآ یﻮﯾرﺮﯿﻏ ضراﻮﻋ و ﯽﻧﻮﻣﻮﻨﭘ دراﻮــﻣ ﺶﻫﺎﮐ و ﻢﺋﻼﻋ نﺪﺷ ﻒﯿﻔﺧ ،ﻢﺳآ تﻼﻤﺣ زوﺮﺑ ﺶﻫﺎﮐ .ﺪﺷ ﺪﻫاﻮﺧ ﺪﻌﺘﺴﻣ داﺮﻓا رد یﺮﺘﺴﺑ
ﯽﺳرﺮﺑ شور یور 1382 لﺎــﺳ ﯽـــﻃ رد یﺪﻫﺎـﺷ ـ درﻮـﻣ ﻪـﻌﻟﺎﻄﻣ ﻦـﯾا ﮏــﺷﺰﭘ ﻂﺳﻮﺗ ﯽﻧﻮﻣﻮﻨﭘ ﺺﯿﺨﺸﺗ ﺎﺑ ﻪﮐ لﺎﺳ 14 ﺮﯾز نﺎﮐدﻮﮐ یﺮﺘـﺴﺑ (ص)مﺮﮐا لﻮﺳر نﺎﺘﺳرﺎﻤﯿﺑ نﺎﮐدﻮﮐ ﺶﺨﺑ رد ﺞﻟﺎﻌﻣ .ﺪﯾدﺮﮔ مﺎﺠﻧا ،ﺪﻧدﻮﺑ هﺪﺷ ﺺــﺼﺨﺘﻣ ﮏﺷﺰﭘ ﻂﺳﻮﺗ ﯽﻧﻮﻣﻮﻨﭘ ﻪﮐ ﯽﻧﺎﮐدﻮﮐ مﺎﻤﺗ یاﺮﺑ و دﻮـﺑ هﺪـﺷ هداد ﺺﯿﺨـﺸﺗ ﻪـﯾر ﻊﻤـﺳ و ﯽﻨﯿﻟﺎــﺑ ﻪﻨﯾﺎﻌﻣ ﺎﺑ و نﺪـﺷ مﺎــﺠﻧا زا ﺲﭘ ﻪﮐ ﯽﻧارﺎﻤﯿﺑ .ﺪﯾدﺮﮔ ﻞﯿﻤﮑﺗ یاﻪﻣﺎﻧﺶﺳﺮﭘ ﯽـﻧﻮﻣﻮﻨﭘ ﺺﯿﺨـﺸﺗ ﺎﻫﯽـﺳرﺮﺑ ﺮﯾﺎـﺳ و لﺎــﯾﺮﺘﮐﺎﺑ یﺎﻫﺖﺸﮐ بﺎـﺨﺘﻧا رﺎـﻤﯿﺑ هوﺮـﮔ ناﻮـﻨﻋ ﻪــﺑ دﻮﺑ هﺪﺷ ﻪﺘﺷاﺬﮔ ﺎﻫنآ یاﺮﺑ .ﺪﻧﺪﺷ یﺎـﻫﺶﺨﺑ رد یﺮﺘـﺴﺑ نارﺎــﻤﯿﺑ زا ﺰﯿﻧ ﻢﻟﺎﺳ و ﺪﻫﺎﺷ هوﺮﮔ بﺎـﺨﺘﻧا ،ﺪـﻧدﻮﺑ نﺎـﺴﮑﯾ نارﺎـﻤﯿﺑ ﺎـﺑ ﯽﻨــﺳ ﺮﻈﻧ زا ﻪﮐ ﯽﺣاﺮﺟ لﻮـﻤﻌﻣ رﻮـﻃ ﻪﺑ ﻪﮐ ﯽﻧﻮﺧ هﺪﻧﺎﻣﯽﻗﺎﺑ زا نارﺎﻤﯿﺑ ﻦﯾا رد .ﺪﻧﺪﺷ نﻮـﺧ یﺎـﻫزﺎﮔ ﺎــﯾ ﯽﻤﯿﺷﻮﯿﺑ یﺎﻫﺶﯾﺎﻣزآ و نﻮﺧ ﺖﺸﮐ ﺖﻬﺟ ژﻮﻔﯾﺮﺘﻧﺎــﺳ زا ﺲﭘ نﻮــﺧ .ﺪــﯾدﺮﮔﯽﻣ هدﺎﻔﺘﺳا ،ﺪﺷﯽﻣ ﻪﺘﻓﺮﮔ ﻞـﻘﺘﻨﻣ مﺮـﮐا لﻮـــﺳر نﺎﺘـﺳرﺎﻤﯿﺑ ﯽــــﺗﺎﻘﯿﻘﺤﺗ هﺎﮕﺸﯾﺎﻣزآ ﻪﺑ یرادﻪــﮕﻧ داﺮـــﮔﯽﺘﻧﺎــﺳ ﻪــــﺟرد -20 رﺰـــﯾﺮﻓ رد و هﺪـﺷ نآ یور یژﻮﻟوﺮـﺳ یﺎـﻫﺶﯾﺎﻣزآ ﻪـﮐ ﯽﻧﺎـﻣز ﺎـﺗ ﺪـــﯾدﺮﮔﯽﻣ .دﺮﯿﮔ ترﻮﺻ یاﺮـــﺑ ﻪــﮐ نﻮــﺧ هﺪﻧﺎــﻣﯽﻗﺎﺑ زا ﺰﯿــﻧ ﺪﻫﺎــﺷ هوﺮــﮔ رد رد .ﺪـﯾدﺮﮔ هدﺎﻔﺘــﺳا ،دﻮﺑ هﺪﺷ ﻪﺘﻓﺮﮔ ﻞﻤﻋ زا ﻞﺒﻗ یﺎﻫﺶﯾﺎﻣزآ یدﺎــﺑﯽﺘﻧآ ،اﺰﯿﻟا شور ﻪﺑ ﺪﻫﺎﺷ و رﺎﻤﯿﺑ هوﺮﮔ نﻮﺧ یﺎﻫﻪﻧﻮﻤﻧ زا ﺪـﻌﺑ .ﺪـﺷ یﺮﯿـﮔهزاﺪــﻧا (IgM&IgG)ﺎﯾﺪﯿﻣﻼﮐ ﯽﺻﺎﺼﺘﺧا ﺖـﻧﻮﻔﻋ ﻪـﺑ ﻼـﺘﺑا دراﻮــﻣ ،یژﻮﻟوﺮﺳ یﺎﻫﺶﯾﺎﻣزآ نﺪﺷ مﺎﺠﻧا راﺰــﻓامﺮﻧ زا هدﺎﻔﺘﺳا ﺎﺑ و ﺪﯾدﺮﮔ ﺺﺨﺸﻣ ﺎﯾﺪﯿﻣﻼﮐ ﯽﻠﺒﻗ و دﺎﺣ ﺖﻬﺟ .ﺖﻓﺮﮔ ترﻮﺻ تﺎﻋﻼﻃا یرﺎﻣآ ﻞﯿﻠﺤﺗ و ﻪﯾﺰﺠﺗ SPSS9 هدﺎﻔﺘــﺳا رﺎﯿﻌﻣ فاﺮﺤﻧا و ﻦﯿﮕﻧﺎﯿﻣ ﺺﺧﺎﺷ زا ﯽﻤﮐ یﺎﻫﺮﯿﻐﺘﻣ .ﺪﯾدﺮﮔ ﻪﺴﯾﺎﻘﻣ P<0/05 ﺎﺑ و ﺪﺷ
ﺞﯾﺎﺘﻧ ﻪـﺘﻓﺮﯾﺬﭘ ﯽـﻧﻮﻣﻮﻨﭘ ﺺﯿﺨــﺸﺗ ﺎﺑ رﺎﻤﯿﺑ 135 ﻪﻌﻟﺎﻄﻣ ﻦﯾا ﯽﻃ 101 رد ،ﯽﺼﯿﺨــﺸﺗ یﺎﻫﺶﯾﺎﻣزآ نﺪﺷ مﺎﺠﻧا زا ﺪﻌﺑ ﻪﮐ ﺪﻧﺪﺷ ﺪﻧدﻮﺑ یرﺎﻤﯿﺑ ﻞﻣﺎﻋ (ﯽﯾﺎﯾﺪﯿﻣﻼﮐﺮﯿﻏ)ﯽﻧﻮﻔﻋ ﻞﻣاﻮﻋ ﺮﯾﺎﺳ رﺎﻤﯿﺑ دراو ﻪـﮐ هﺪﻧﺎـﻣﯽﻗﺎﺑ رﺎــﻤﯿﺑ 35 زا .ﺪﻧﺪﯾدﺮﮔ فﺬﺣ ﻪﻌﻟﺎﻄﻣ زا و
نﻮـﺧ نﺪــﺷﺰﯿﻟ ﺎﯾ ندﻮﺑ ﯽﻓﺎﮐﺎﻧ ﺖﻠﻋ ﻪﺑ درﻮﻣ 2 ،ﺪﻧﺪﺷ ﻪﻌﻟﺎﻄﻣ ﺖﯾﺎـﺿر مﺪـﻋ ﺖـﻠﻋ ﻪـﺑ ﻪـﮐ ﺪﻨﺘــﺷاد دﺪﺠﻣ یﺮﯿﮔنﻮﺧ ﻪﺑ زﺎﯿﻧ ﺖﻧﻮﻔﻋ ﺺﯿﺨﺸﺗ ﺖﻬﺟ ﺮﮕﯾد رﺎﻤﯿﺑ 33 یاﺮﺑ .ﺪﺸﻧ مﺎﺠﻧا ﻦﯾﺪﻟاو کدﻮــﮐ 40 و ﺖﻓﺮﮔ ترﻮﺻ ﮏﯾژﻮﻟوﺮﺳ یﺎﻫﺖﺴﺗ ﯽﯾﺎﯾﺪﯿﻣﻼﮐ رد و ﺪﻧﺪـﺷ ﻪـﺘﻓﺮﮔ ﺮـﻈﻧ رد ﺪﻫﺎـﺷ هوﺮــﮔ ناﻮﻨﻋ ﻪﺑ ﺰﯿﻧ ﻢﻟﺎﺳ 1 هرﺎﻤﺷ لوﺪﺟ .ﺪﻨﺘﻓﺮﮔ راﺮﻗ ﯽﺳرﺮﺑ درﻮﻣ کدﻮﮐ 73 عﻮﻤﺠﻣ نﺎـﮐدﻮﮐ رد ار ﻦـﺳ ﺐـﺴﺣﺮﺑ ﯽﺒـﺴﻧ و ﻖــﻠﻄﻣ ﯽﻧاواﺮﻓ ﻊﯾزﻮﺗ .ﺪﻫدﯽﻣ نﺎﺸﻧ ﯽﺳرﺮﺑ درﻮﻣ و 14/50 ﻪـــﻨﻣاد ﺎـﺑ لﺎـﺳ 14 ﺎـﺗ هﺎـﻣ 5 ﻦـﯿﺑ نارﺎـﻤﯿﺑ ﻦﺳ درﻮـﻣ هوﺮـﮔ رد ﻦــﺳ ﻂﺳﻮﺘﻣ و دﻮﺑ لﺎﺳ 3/7±3/87 ﻦﯿﮕﻧﺎﯿﻣ زا %48/6 و ﺪـﻣآ ﺖـﺳد ﻪـﺑ لﺎــﺳ 4/6 ﺪﻫﺎﺷ هوﺮﮔ رد و 2/69 .ﺪﻧدﻮﺑ ﺮﺘﺧد %51/4 و ﺮﺴﭘ نارﺎﻤﯿﺑ
رد ﻦﺳ ﺐﺴﺣ ﺮﺑ ﯽﺒﺴﻧ و ﻖﻠﻄﻣ ﯽﻧاواﺮﻓ ﻊﯾزﻮﺗ -1 هرﺎﻤﺷ لوﺪﺟ
رد (ص)مﺮﮐا لﻮﺳر نﺎﺘﺳرﺎﻤﯿﺑ نﺎﮐدﻮﮐ ﺶﺨﺑ رد هﺪﺷ یﺮﺘﺴﺑ نﺎﮐدﻮﮐ 1382 لﺎﺳ
کدﻮﮐ ﻦﺳ ﯽﻧاواﺮﻓ
ﺪﺻرد
لﺎﺳ 1 ﺮﯾز 22
35/5
لﺎﺳ 3 ﺎﺗ 2 19
30/6
لﺎﺳ 5 ﺎﺗ 4 4
6/5
لﺎﺳ 5 زا ﺮﺗﻻﺎﺑ 17
27/4
ﻊﻤﺟ 73
100 Missing=11case
%48 رد Chlamydia-IgM ﯽﺻﺎــﺼﺘﺧا یژﻮﻟوﺮﺳ ﺖﺴﺗ
Chlamydia-IgM ﺖـﺴﺗ .دﻮـﺑ ﯽــﻔﻨﻣ %52 رد و ﺖﺒﺜﻣ دراﻮﻣ ﺪﻣآ ﺖﺳد ﻪﺑ %20 ﺪﻫﺎﺷ هوﺮﮔ رد و %57 رﺎﻤﯿﺑ هوﺮﮔ رد ﺖﺒﺜﻣ و ﯽـﻧﻮﻣﻮﻨﭘ ﻪـﺑ ﻼـﺘﺒﻣ هوﺮــﮔ ﻦﯿﺑ توﺎﻔﺗ ﻦﯾا یرﺎﻣآ ﺮﻈﻧ زا ﻪﮐ نﺪــﺷ ﺖـﺒﺜﻣ .(P=0/001)ﺖـﺳا هدﻮـﺑ رادﯽـﻨﻌﻣ ﺪﻫﺎـﺷ هوﺮـﮔ هوﺮــﮔ رد ،ﯽﯾﺎـــﯾﺪﯿﻣﻼﮐ دﺎـﺣ ﺖـﻧﻮﻔﻋ رد Chlamydia-IgM ﻦــﺳ رد ،%21 لﺎﺳ 1 ﺮﯾز ﯽﻨﺳ هدوﺪﺤﻣ رد ﯽﻧﻮﻣﻮﻨﭘ ﻪﺑ ﻼﺘﺒﻣ زا ﺮﺗﻻﺎـﺑ ﻦــﺳ رد و %8 لﺎﺳ 5 ﺎﺗ 4 ﻦﺳ رد ،%40 لﺎﺳ 3 ﺎﺗ 2 توﺎﻔﺗ ﻒﻠﺘﺨﻣ ﯽﻨﺳ یﺎﻫهوﺮﮔ رد ﺎﻣا ﺪﺷ هﺪﻫﺎﺸﻣ %26 لﺎﺳ 5 دﺎـﺣ ﺖــﻧﻮﻔﻋ ﻪﺑ ﻼﺘﺒﻣ نﺎﮐدﻮﮐ رد ﻦﺳ ﻦﯿﮕﻧﺎﯿﻣ .دﻮﺒﻧ رادﯽﻨﻌﻣ هوﺮــﮔ رد و لﺎﺳ 3/76 (ﺖﺒﺜﻣ Chlamydia-IgM)ﯽﯾﺎﯾﺪﯿﻣﻼﮐ
توﺎــﻔﺗ ﻪـــﻄﺑار ﻦـــﯾا رد ﻪـــﮐ دﻮـــــﺑ لﺎـﺳ 3/62 ﺪـــﻫﺎﺷ ﺎـﯾﺪﯿﻣﻼﮐ ﺖـﻧﻮﻔﻋ ﻪـﺑ ﯽـﻠﺒﻗ یﻼـﺘﺑا .ﺖــﺷاﺪﻧ دﻮﺟو یرادﯽﻨﻌﻣ ﺮﯾﺎـــﺳ رد و ﺖــﺒﺜﻣ دراﻮــﻣ %27/4 رد (Chlamydia-IgM) 2 ﻦﺳ رد ،%40 لﺎﺳ 1 ﺮﯾز ﯽﻨﺳ هدوﺪﺤﻣ رد .دﻮﺑ ﯽﻔﻨﻣ دراﻮﻣ لﺎــﺳ 5 زا ﺮﺗﻻﺎﺑ ﻦﺳ و %5 لﺎﺳ 5 ﺎﺗ 4 ﻦﺳ رد ،%5 لﺎﺳ 3 ﺎﺗ ﯽـﻨﻤﯾا)Chlamydia-IgG نﺪـﺷ ﺖــﺒﺜﻣ ﻦﯿﺑ .ﺪﻧدﻮﺑ ﺖﺒﺜﻣ %50 یرادﯽـﻨﻌﻣ ﻪـﻄﺑار ﻒــﻠﺘﺨﻣ ﯽﻨﺳ یﺎﻫهوﺮﮔ و (ﺖﻧﻮﻔﻋ ﻪﺑ ﯽﻠﺒﻗ .(P=0/07)ﺪﺸﻧ هﺪﻫﺎﺸﻣ هوﺮـﮔ 2 ﻦـﯿﺑ (ﺖـﺒﺜﻣ IgG)ﺎــﯾﺪﯿﻣﻼﮐ ﺖﻧﻮﻔﻋ ﻪﺑ ﯽﻠﺒﻗ یﻼﺘﺑا .ﺖـــﺷاﺪﻧ یرادﯽـﻨﻌﻣ توﺎـﻔﺗ یرﺎـﻣآ ﺮـﻈﻧ زا ﺪﻫﺎـﺷ و رﺎـﻤﯿﺑ ﺖـــﺒﺜﻣ Chlamydia-IgG هوﺮــﮔ 2 ﻦﯿﺑ ﯽﻨﺳ ﻦﯿﮕﻧﺎﯿﻣ توﺎﻔﺗ نﺪـــﺷ ﺖـﺒﺜﻣ ﻦـﯿﺑ و دﻮـﺒﻧ رادﯽـﻨﻌﻣ یرﺎـﻣآ ﺮـﻈﻧ زا ﯽـﻔﻨﻣ و دﻮــﺟو یرادﯽﻨﻌﻣ ﻪﻄﺑار نارﺎﻤﯿﺑ ﺲﻨﺟ ﺎﺑ Chlamydia-IgM .ﺖﺷاﺪﻧ
ﺚﺤﺑ ﺖــﻧﻮﻔﻋ زا ﯽﺷﺎﻧ یژﻮﻟوﺮﺳ نﺪﺷ ﺖﺒﺜﻣ تﺎﻌﻟﺎﻄﻣ ﺮﯾﺎﺳ رد
(1-4)
.ﺖـﺳا هﺪـﺷ ﺮـﮐذ ﻎﻟﺎـﺑ داﺮـﻓا رد %30-45 ،ﺎــﯾﺪﯿﻣﻼﮐ ﯽﻠﺒﻗ ﻞــﮐ زا %27/4 رد (Chlymidia-IgG)ﯽﯾﺎﯾﺪﯿﻣﻼﮐ ﯽﻠﺒﻗ ﺖﻧﻮﻔﻋ ﺮﯾز ﻦﺳ رد .دﻮﺑ ﺖﺒﺜﻣ (ﺪﻫﺎﺷ و درﻮﻣ)ﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ نﺎﮐدﻮﮐ ﺪـﻧاﻮﺗﯽﻣ ﻪــﮐ ﺪﻧدﻮﺑ یدﺎﺑﯽﺘﻧآ یاراد ناراﻮﺧﺮﯿﺷ %40 لﺎﺳ 1 ﺮﺗﻻﺎـﺑ ﻦــﺳ رد ﺎﻣا ﺪﺷﺎﺑ ردﺎﻣ زا ﺖﻔﺟ ﻖﯾﺮﻃ زا لﺎﻘﺘﻧا ﺖﻠﻋ ﻪﺑ ﻪﮐ ﺪﻧدﻮﺑ هﺪﺷ ﻼﺘﺒﻣ ﺖﻧﻮﻔﻋ ﻦﯾا ﻪﺑ ًﻼﺒﻗ نﺎﮐدﻮﮐ %50 لﺎﺳ 5 زا
(1-3)
.ﺖﺳﺎﻫرﻮﺸﮐ ﺮﯾﺎﺳ رﺎﻣآ زا ﺶﯿﺑ نﺪــﺷ ﺖــﺒﺜﻣ)ﯽﯾﺎـــﯾﺪﯿﻣﻼﮐ دﺎـﺣ ﺖـﻧﻮﻔﻋ ﻪـﻌﻟﺎﻄﻣ ﻦـﯾا رد هوﺮــﮔ ود ﺮـــﻫ)نﺎـﮐدﻮﮐ ﻞـﮐ زا %48 رد (Chlymidia-IgM زا %57 رد .ﺖــﺷاد دﻮـــﺟو ﯽـﺳرﺮﺑ درﻮـﻣ (ﺪﻫﺎـﺷ و رﺎـﻤﯿﺑ ﻪﺑ ﻪﮐ ﺪﺷ هﺪﯾد ﺎﯾﺪﯿﻣﻼﮐ دﺎﺣ یﻼﺘﺑا ،ﯽﻧﻮﻣﻮﻨﭘ ﻪﺑ ﻼﺘﺒﻣ نﺎﮐدﻮﮐ ﻦﯿﮕﻧﺎــﯿﻣ .(P<0/001)دﻮﺑ ﺪﻫﺎﺷ هوﺮﮔ زا ﺶﯿﺑ یرادﯽﻨﻌﻣ رﻮﻃ دﺎــــﺣ ﺖـــﻧﻮﻔﻋ ﻪـــﺑ ﻼـــﺘﺒﻣ هوﺮـــﮔ رد نارﺎـــﻤﯿﺑ ﯽﻨـــﺳ ﺖـﺳد ﻪـﺑ لﺎـﺳ 3/76 (ﺖــﺒﺜﻣ Chlymidia-IgM)ﯽﯾﺎﯾﺪﯿﻣﻼﮐ ﺮــﯾز ﯽﻨﺳ هوﺮﮔ رد ﯽﻧﻮﻣﻮﻨﭘ ﻪﺑ ﻼﺘﺒﻣ نﺎﮐدﻮﮐ عﻮﻤﺠﻣ رد .ﺪﻣآ ار ﯽﯾﺎـﯾﺪﯿﻣﻼﮐ دﺎـﺣ ﺖـﻧﻮﻔﻋ ﻪـﺑ ﻼــﺘﺑا ناﺰﯿﻣ ﻦﯾﺮﺗﺶﯿﺑ لﺎﺳ 3 توﺎــﻔﺗ ﻒﻠﺘﺨﻣ ﯽﻨﺳ یﺎﻫهوﺮﮔ رد ﻼﺘﺑا ناﺰﯿﻣ ﻪﭼ ﺮﮔا .ﺪﻨﺘﺷاد ﯽﮕﻟﺎـﺳ 3 دوﺪـﺣ رد ًﻻﺎــﻤﺘﺣا ﻪﮐ ﺖﻔﮔ ناﻮﺗﯽﻣ ،ﺖﺷاﺪﻧ ﯽﻧاﺪﻨﭼ
ﯽﯾﺎــﯾﺪﯿﻣﻼﮐ دﺎﺣ ﺖﻧﻮﻔﻋ ﻪﺑ ﻼﺘﺒﻣ (%48 دوﺪﺣ)نﺎﮐدﻮﮐ زا ﯽﻤﯿﻧ .ﺪﺷﺎﺑ ﯽﻧﻮﻣﻮﻨﭘ ﻢﺋﻼﻋ زوﺮﺑ نوﺪﺑ ﺎﯾ ﺎﺑ ﺪﻧاﻮﺗﯽﻣ ﻪﮐ ﺪﻧدﻮﺑ هﺪﺷ هﺪـﺷ ﻼــﺘﺒﻣ ﺖﻧﻮﻔﻋ ﻪﺑ نﺎﮐدﻮﮐ %50 ،لﺎﺳ 5 ﻦﺳ ﻪﺑ نﺪﯿﺳر ﺎﺗ نﺪـﺷ ﺖــﺒﺜﻣ .ﺪﻧﻮﺷﯽﻣ Chlymidia-IgM یدﺎﺑﯽﺘﻧآ یاراد و
.ﺪﺷﺎﺑﯽﻣ نﺎﺴﮑﯾ ﺲﻨﺟ ود ﺮﻫ رد Chlymidia-IgM
Chlymidia-IgG)ﯽﯾﺎــﯾﺪﯿﻣﻼﮐ ﺖـــﻧﻮﻔﻋ ﻪـﺑ ﯽـﻠﺒﻗ یﻼـﺘﺑا ﺖـﺷاد دﻮــﺟو ﯽﺳرﺮﺑ درﻮﻣ نﺎﮐدﻮﮐ ﻞﮐ زا %27/4 رد (ﺖﺒﺜﻣ .ﺖــﺷاﺪﻧ دﻮﺟو ﯽﺤﺿاو توﺎﻔﺗ ﺪﻫﺎﺷ و رﺎﻤﯿﺑ هوﺮﮔ 2 ﻦﯿﺑ ﺎﻣا لﺎـﺳ 14 ﺮـﯾز نﺎـﮐدﻮﮐ %20 ﻪـﮐ داد نﺎــﺸﻧ ﻪﻌﻟﺎﻄﻣ ﻦﯾا ﺞﯾﺎﺘﻧ دﺎـﺣ ﺖـﻧﻮﻔﻋ ﻪـﺑ ﻼـﺘﺒﻣ ،عﺎـﻤﺘﺟا زا ﯽـﺷﺎﻧ ﯽـﻧﻮﻣﻮﻨﭘ ﻪــﺑ ﻼﺘﺒﻣ رد هﺪـﺷ ﺮـﮐذ ناﺰﯿـﻣ ﺎـﺑ ﻪــﺴﯾﺎﻘﻣ رد ﻪﮐ ﺪﻨﺷﺎﺑﯽﻣ ﯽﯾﺎﯾﺪﯿﻣﻼﮐ ناﺰﯿـﻣ .ﺖـﺳا ﺮــﺗﺶﯿﺑ ،(لﺎﺳ 3-14)%14 ﯽﻨﻌﯾ تﺎﻌﻟﺎﻄﻣ ﺮﯾﺎﺳ و %15 لﺎـﺳ 6 ﺮـﯾز ﻦـﺳ رد ﯽــﻠﺒﻗ تﺎﻌﻟﺎﻄﻣ رد ﺖﻧﻮﻔﻋ عﻮﯿﺷ
(6-11 و1-4)
.ﺖﺳا هﺪﺷ ﺮﮐذ %18 لﺎﺳ 6 زا ﺮﺗﻻﺎﺑ ﻦﺳ ﻪﻟﺎـﺳ 3-5 نﺎـﮐدﻮﮐ رد ﯽـﺘﺣ هﺪــﺷ ﺮﮐذ ﺐﻟﺎﻄﻣ ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ ﯽﺴﻔﻨﺗ ﺖﻧﻮﻔﻋ اﺮﯾز دﻮﺑ ﺎﯾﺪﯿﻣﻼﮐ ﺮﮑﻓ ﻪﺑ ﺪﯾﺎﺑ ﯽﻧﻮﻣﻮﻨﭘ ﻪﺑ ﻼﺘﺒﻣ و ﻎﻟﺎـﺑ داﺮـﻓا %2-5 رد لﺎــﺳ 1 ﺎﺗ ﺪﻧاﻮﺗﯽﻣ نآ ﺎﺑ ﺖﻣﻼﻋ نوﺪﺑ ﺎﻫیﺮﺘﮐﺎﺑ ﺎﺑ هاﺮﻤﻫ ﺖﻧﻮﻔﻋ ﻪﮐ ﺎﺟ نآ زا (2-4).ﺪﺑﺎﯾ ﻪﻣادا نﺎﮐدﻮﮐ ﯽـﻧﻮﻣﻮﻨﭘ ﺦـﺳﺎﭘ مﺪـﻋ ترﻮــﺻ رد (1-4).ﺖﺳا هﺪﺷ شراﺰﮔ ﺰﯿﻧ ﺮـﺑ ﺮـﺛﻮﻣ یﺎـﻫﮏﯿﺗﻮﯿﺑﯽﺘﻧآ زا ،لﻮـﻤﻌﻣ یﺎـﻫوراد ﻪــﺑ نﺎﮐدﻮﮐ ﺎـﯾ ﻦﯿــﺴﯾﺎﻣوﺮﺘﯾرا ﺪﻨﻧﺎﻣ رﺎﻤﯿﺑ ﻦﺳ ﺎﺑ ﺐﺳﺎﻨﻣ ﺎﯾﺪﯿﻣﻼﮐ ﺖﻧﻮﻔﻋ ﺎـﯾ ﻦﯿـﺴﯾﺎﻣوﺮﺘﯾزآ ﺪﻨﻧﺎـﻣ ﺪـﯾﺪﺟ یﺎــﻫﺪﯿﻟوﺮﮐﺎﻣ ﺎﯾ ﻦﯿﻠﮑﯿﺳاﺮﺘﺗ .دﻮﻤﻧ هدﺎﻔﺘﺳا ناﻮﺗﯽﻣ ﻦﯿﺴﯾﺎﻣوﺮﺘﯾرﻼﮐ
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Comparative Study of Chlamydia Pneumonia(IgM&IgG) Frequency in under 14-Year Old Children with Pneumonia and in Unaffected
Children Hospitalized in Pediatric Ward
I II III
*S. Noorbakhsh, MD N. Javaher Tarash, MD Sh. Rimaz, Ph.D.
IV V
M. Rezaei, MD A. Tabatabaei, MSc
Abstract
Chlamydia pneumonia is a common cause of lower respiratory tract infection and causes about 10-20%
of community acquired pneumonia. It is seen in any age group and reactivates the asthma, so it needs specific treatment. Chlamydia pneumonia hardly grows in culture; therefore, serologic diagnosis is used.
The goal of the present study was to determine the frequency of acute and previous infection of chlamydia pneumonia and the mean age of infection in under 14-year-old children with pneumonia. Successful treatment of these patients with erythromycin and other macrolides not only decreases the rate of pneumonia in children but also dramatically decreases the asthmatic attacks in predisposed children and hospital admission. This case-control study was conducted on 73 children aged under 14 years(35 case and 28 control). For detection of specific IgM & IgG in serum enzyme, linked immunoassay was used.
Mean age of children was 3.87±3.7 years (48.6% male; 51.4% female). Acute infection (IgM) was positive in 48% of all children and 57% of children with pneumonia. The highest rate was seen in 2-3 age group (40%) with mean age of 3.7. Previous infection (IgG) detected in 27.4% of all children with highest rate (50%) was in over 5-year-old age group. Acute chlamydia infection (IgM) was significantly higher in case group (P>0.001), but no significant difference in previous infection was seen between case and control groups. In conclusion, acute C. pneumonia infection (IgM) is seen in 50% of the 3-year-old children population either with or without pneumonia. Additionally, treatment with oral erythromycin is a successful way to decrease the rate of pneumonia, asthmatic attacks in predisposed children and hospital admission. All of the children would be seropositive (IgG positive) up to the age of 5.
Key Words: 1) Chlamydia Antibody 2) Pneumonia
3) Atypical Pneumonia 4) Chlamydial Pneumonia
This article is a summary of the thesis by M. Rezaei, MD for the degree of specialty in Pediatrics under supervision of N. Javaher Tarash, MD and consultation with S. Nourbakhsh, MD and A.
Tabatabaei, MSc (2002-2003).
I) Assistant Professor of Pediatric Infectious Diseases. Hazrat Rasoul-e-Akram Hospital, Sattarkhan St., Niayesh Ave., Iran University of Medical Sciences and Health Services. Tehran, Iran.
(*Corresponding Author)
II) Associate Professor of Pediatric Immunology. Hazrat Rasoul-e-Akram Hospital. Iran University of Medical Sciences and Health Services. Tehran, Iran.
III) Assistant Professor of Epidemiology. Iran University of Medical Sciences and Health Services.
Tehran, Iran.
IV) Resident of Pediatrics. Iran University of Medical Sciences and Health Services. Tehran, Iran.
V) MSc in Laboratory Sciences. Instructor. Iran University of Medical Sciences and Health Services.
Tehran, Iran.