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1 ﻣ Research & Scientific Journal of Ardabil University of Medical Sciences & Health Services ١٣٨٢ Vol 2, No 7,Mar- Jun 2003 ﻫﻔﺘﻢ ﺳ Downloaded from jarumsarumsacir at 7:13 IRST on Friday October 12th ۴ ۳ ۲ ۱ : ﻬ ﻣﺸﻜﻞ ﺗﻌﻴﻴﻦ ﻣﺸﻬﺪ ﺿﺪ ﺳﻞ ۷۵ ﺣﺴﺎﺳﻴﺖ : ۱۳۸۱ ﺷﺪ ﻟﻐﺎﻳﺖ ۱۳۸۰ Indirect Proportion Method ﻛﻤﺘﺮ ﮔﺮﻓﺖ ﻧﻬﺎﻳﻲ ﻛﻪ ﺳﺎﺑﻘﻪ ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪﻧﺪ (%۶/۶) ۷۵ ۵ (%۹۳/۳) ۲۳ ۷۵ (%۹/۳) ۷۰ ۷ ( ﺑﻪ ﺳﻞ %۹۰/۶) ﺳﻪ DOTS ۶۸ ﺷﺪ : ﻳﺎﻓﺘﻪ ﻫﺎ ۷۵ %۱/۴۳ ﻳﻲ % ۴۰ : ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﻧﺴﺒﺖ ﺑﻪ ﺿﻤﻦ ﻧﺘﻴﺠﻪ ﺑﺎﺷﺪ ﺳﻞ ﺳﻞ : ﺗﻮﺑﺮﻛ : - -۱-٢ - -٣ - -٤
2 ١٣٨٢ ۴۸ ﻣﺠﻠﻪ ﻋﻠﻤﻲ ﻣﻘﺪﻣﻪ ﻳﻚ ﻋﺎﻣﻞ ﻣ ] [۱ ﻃﺒﻖ ﺑﺎﺷﺪ] [۹-۱۱ ـﺖ ﺟﻬﺎﻧﻲ ﻣﻲ ﻣﻲ ﺑﺎﺷﺪ ﻋﺎﻣﻞ ﻣﻬﻤﻲ ] [۱۳ ۱۲ ۵۲۰۰۰ ۷۰۰۰ ] [ ۳ ۲ ﻛﻮﭼﻜﻲ ﻣﺸﺨﺺ ﻣﻲ ﺗﺎ %۴۸ ﻧﻴﺰ ﻣﻲ %۸۰ ( ) ۱۵-۵۴ ﻫﺴﺘﻨﺪ] [۴ ] [۱۵ ۱۴ ﺑﺎ ﻣﺎﻳﻜﻮﺑﺎﻛﺘﺮ ﻪ ] [٥ ﻣﺤﻘﻘﻴﻦ ﻳﺎﻓﺘﻪ ﺟﻬﺎﻧﻲ ﺑﺪ ﺷﻴﻤﻲ ﺳﻞ ﻣﻲ ﻳﺎﺑﺪ ] [۴ ﻫﺎ ] [۶ ﻣﻤﺘﺪ ﺖ ۷ ۱۳۸۰ ۱۳۸۱ ﺷﻨﺎﺳﻲ )ﻋﺞ( ﺷﻬﺮ ﻣﺸﻬﺪ ﺷﺪ] [۷ ﻋﺎﻣﻞ ﺑﺮﮔﺸﺖ ﻣﺴﻴﺮ ﻛﺎﻫﺶ ۱۷۰۰ ﻧﻤﻮﻧﻪ ﻛﻪ ﺗﻤﺎﻣﻲ ۴ ﺳﻞ ) (MDR-TB ﺑﺎ ﺑﺎﻻ ) ۵۰-۸۰ ﺗﺸﺨﻴﺺ ﺗﺎ ﻣ ( ( ] [١۶ ) ۴ ﺗﺎ ۶ ﻫﻔﺘﻪ ﺗﻤﺎ ] [۸ ﻧﻤﻮﻧﻪ ﻫﺎ ﺑﻪ Downloaded from jarumsarumsacir at 7:13 IRST on Friday October 12th 2018 ﺳﺎﻻﻧﻪ ۸/۸
3 ۴۹ ﻳﺎﻓﺘﻪ ﻫﺎ ﻳﻞ ﻧﻠﺴﻮ ﮔﺮﻓﺘﻨﺪ ۷۵ ۳ ۳۶ ۳۹ ) Jensen ۳۷ c ﻣﻲ ﺑﺎﺷﻨﺪ ۷ ﻧﻔﺮ o ۸ ۶۸ ﻧﻔﺮ ﻣﺒﺘﻼ ﺑﻪ ) ۱ ﻧﻔﺮ ﺳﻞ ﻣﻔﺼﻠﻲ ۲ ۴ ﻧﻔﺮ( ﺗﻬﻴﻪ ٧٥ ﻳﻞ ﻧﻠﺴﻮ ٢٧ ﻫﺎ ۹۸ ۱۷۰۰ ) ﺷﺪ (١ 3067% ﺗﻤﺎﻣﻲ ﻧﻤﻮﻧﻪ ۴ 3600% 133% 400% 6400% ﻳﻲ ﺣﺴﺎس ﺑﮫ ﭼﮭﺎر دارو ﻣﻘﺎوم ﺑﮫ اﺳﺘﺮﭘﺘﻮﻣﺎﯾﺴﯿﻦ ﺑﮫ ﺗﻨﮭﺎﯾﻲ ﻣﻘﺎوم ﺑﮫ اﯾﺰوﻧﯿﺎزﯾﺪ و اﺗﺎﻣﺒﻮﺗﻮل و اﺳﺘﺮﭘﺘﻮﻣﺎﯾﺴﯿﻦ ﻣﻘﺎوم ﺑﮫ ﭼﮭﺎر دارو ﻣﺤﻴﻂ Indirect Proportion Method,,,۰/۲ g / ml,۴۰ g / ml ۴ g / ml ۲ g / ml ﻣﻲ ﺑﺎﺷﺪ] [١٦ ۹۸ ١ ۸ ۱۵ ﺑﻴﺸﺘﺮﻳﻦ ) (%۳۶ ﻣﻲﺑﺎﺷﺪ ۳ ۷۵ ) (%۱/۳۳ ﺷﺪ ۶۸ ﺿﺪ ﺳﻞ ﺗﻘﺴﻴﻢ ﺷﺪﻧﺪ ﺮﻓﺘﻦ ۳۰ ) (%۴ ﻣﺒﺘﻼ ﺑﻪ ﺳﻞ ﺣﺎﻟﻲ ﻛﻪ ﻣﺎﺑﻘﻲ ) ۴۲ ﻧﻔﺮ ﻋﻔﻮﻧﺖ ﻣﺒﺘﻼ ﺑﻪ ﻋﻔﻮﻧﺖ (٢ ۷ ﻣﺒﺘﻼ ﺑﻪ ﺳﻞ ﺑﻪ ﺗﺮﺗﻴﺐ ۱ ۶ ﻣﻲ ﺑﺎﺷﺪ ﺑﺎ Downloaded from jarumsarumsacir at 7:13 IRST on Friday October 12th 2018 ۲ (Lowenstein- ۷۲
4 ١٣٨٢ ۵۰ ﻣﺠﻠﻪ ﻋﻠﻤﻲ ۵ ﺗﻮﺟﻪ ﺑﻪ ﺳﺎﺑﻘﻪ ۳۰ ﻧﻔﺮ ۲۲ ﻫﺮ ) ﺷﺪ ﻣﺎ ﻧﺴﺒﺖ ﺑﻪ (٣ 6176% 3235% ﺑﺨﺎﻃﺮ 3824% ﭘﻨﺠﻤﻴﻦ 147% 441% ﺣﺴﺎس ﺑﮫ ﭼﮭﺎر دارو ﻣﻘﺎوم ﺑﮫ اﺳﺘﺮﭘﺘﻮﻣﺎﯾﺴﯿﻦ ﺑﮫ ﺗﻨﮭﺎﯾﻲ ﻣﻘﺎوم ﺑﮫ اﯾﺰوﻧﯿﺎزﯾﺪ و اﺗﺎﻣﺒﻮﺗﻮل و اﺳﺘﺮﭘﺘﻮﻣﺎﯾﺴﯿﻦ ﻣﻘﺎوم ﺑﮫ ﭼﮭﺎر دارو ) (١ ﻣﻘﺎﻳﺴﻪ ٢ % % ﻳﻲ ﺑﺮ %۱/۴۳ ) (Primary MDR-TB % 143 % ﺷﺖ 143 % ﺣﺴﺎس ﺑﮫ ﭼﮭﺎر دارو ﻣﻘﺎوم ﺑﮫ اﺳﺘﺮﭘﺘﻮﻣﺎﯾﺴﯿﻦ ﺑﮫ ﺗﻨﮭﺎﯾﻲ ﻣﻘﺎوم ﺑﮫ اﯾﺰوﻧﯿﺎزﯾﺪ و اﺗﺎﻣﺒﻮﺗﻮل و اﺳﺘﺮﭘﺘﻮﻣﺎﯾﺴﯿﻦ ﻣﻘﺎوم ﺑﮫ ﭼﮭﺎر دارو %۴۰ ﺷﺪ ۱ ﻣﻘﺎﻳﺴﻪ ﺑﻪ ﺗﻨﻬﺎﻳﻲ ٣ ) ۴۸(%۶۴ ) ۲۳ (%۳۰/۶۷ ) ۱ (%۱/۳۳ ) ۳ ( %۴ ) ۴۲(%۶۱۷۶ ) ۲۲(%۳۲۳۵ ) ۱(%۱۴۷ ) ۳(%۴۴۱ ) ۴۶(%۶۵۷۱ ) ۲۲(%۳۱۴۳ ) ۱(%۱۴۳ ) ۱(%۱۴۳ ) ۲(%۴۰ ) ۱(%۲۰ ۰ ) ۲(%۴۰ Downloaded from jarumsarumsacir at 7:13 IRST on Friday October 12th 2018
5 ۵۱ ﺑﺤﺚ - ﺑﺨﺎﻃﺮ, ﭼﻨﻴﻦ ﺳﻮﻳﻪ ﻨ ﺪ ] [١٥ ﺳﻞ ﺗﺒﺮﻳﺰ ) (MDR-TB ﺑﻪ ﮔﻔﺘﻪ ﺑﺎﺷﺪ] [١٥ ﮔﺮﻓﺘﻪ ۱۹۹۴ SRL ﻣﻨﺘﺸﺮ ﺣﺎﺿﺮ ﻫﻴﭻ ﮔﺰ ﺑﺎﺷﺪ ) (۲ ﻜﺲ ﻧﻤﻲ ] [١٧ %۱ ﻣﻨﺒﻊ ﻣﺨﺘﻠﻒ ﻣﻲ ﺑﺎﺷﺪ ﺑﺤﺚ ﻣﻲ ﺑﺎﺷﻨﺪ ﻣﻨﻄﻘﻪ ﻣﻲ ﺑﺎﺷﺪ ـﻞ ﻣـ ﻧﺘﺎﻳﺞ ﻬﺎ ﻗﺎﺑﻞ ۵۰ ﻫﺎ ﺑﺎﺷﺪ ﻫﺎ Downloaded from jarumsarumsacir at 7:13 IRST on Friday October 12th 2018
6 ١٣٨٢ ۵۲ ﻣﺠﻠﻪ ﻋﻠﻤﻲ ﺑﺎ ) (٢ ﻏﻠﻂ ﻣﻲ ﺑﺎﺷﺪ ﻣﻲ ﺑﺎﺷﺪ DOTS ] [١٧ ) (DOTS ﻛﻠﻴـ ] [١٧ ﻧﺘﺎﻳﺞ ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﻳﻲ ﻛﻪ ﻳﻲ ﻫﺎ ﺑﺎ ﺑﺎﺷﺪ ـﻲ ﺿـﺪ ۶ ۱۳۷۹ ۱۳۷۹ ۷۴۵ ﻧﻪ ۱۷ ﻧﻔﺮ %۲/۳ ﻳﻲ ﺿﺪ ] [١٧ ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﻋﺎﻣﻞ ﺧﻄﺮ ـﺖ] [٢٩ ﻣﻄﺎﻟﻌﻪ ﺑﺎ ﺑﻴﺎﻧﮕﺮ Downloaded from jarumsarumsacir at 7:13 IRST on Friday October 12th 2018
7 Downloaded from jarumsarumsacir at 7:13 IRST on Friday October 12th 2018 ۵۳ 10- Frieden TR, Sterling T, Pablos-Mendez A, Kilburn JO, Cauthen JM, Dooley SW The emergence of drug-resistant tuberculosis in New York City N Engl J Med 1993 Feb; 328(8): Nosocomial transmission of multi-drug resistant tuberculosis among human immunodeficiency virus infected patients Florida and New York, MMWR Morb Mortal Wkly Rep 1991; 40: Edlin BR, Tokars JI, Grieco MH, Crawford JT, Williams J, Sordillo EM, et al An outbreak of multidrug-resistant tuberculosis among hospitalized patients with the acquired immuno deficiency syndrome N Engl J Med 1992 Jun; 326: Pearson ML, Jereb JA, Frieden TR, Crawford JT, Davis BJ, Dooley SW, et al Nosocomial transmission of multidrugresistant tuberculosis A risk to patients and health care workers Ann Intern Med 1992 Aug; 117(3): Iseman MD, Sbarbaro JA The increasing prevalence of resistance to antituberculosis chemotherapeutic agents: implications for global tuberculosis control Curr Clin Top Infect Dis 1992; 12: Cohn DL, Flavia B, Raviglione MC Drugresistant tuberculosis: review of the worldwide situation and the WHO/IUATLD Global Surveillance Project Clin Infect Dis 1997 Jan; 24 (Suppl1): S121-S Hans L Rieder, T Martin Chonde, Helge Myking, Richard Urbanczik, Adalbert Laszlo, Sang Jae Kim, Armand Van Deun, Arnaud Trebucq The Public Health Service National Tuberculosis Reference Laboratory and the National Laboratory Network; Minimum Requirements, Role and Operation in a LowIncome Country; International Union Against Tuberculosis and Lung Disease (IUATLD), 68, boulevard Saint-Michel, Paris, France 17- World Health Organization, Antituberculosis drug resistance in the world, Report No 2 Prevalence and Trends The WHO/IUATLD global project on antituberculosis surveillance, Geneva, Switzerland, 2000, WHO/CDS/TB/ (Primary MDRTB) ﺑﻪ ﻧﻈﺮ ﻛﺎﻣﻞ ﻧﺴﺒﺖ ﺑﻪ ﻣﻨﺎﺑﻊ 1- Bloom BR, Murray CJ Tuberculosis Commentary on a reemergent killer Science 1992 Aug; 257(5073): World Health Organization Bridging the gaps: the world health report Geneva: The Organization; World Health Organization report on TB epidemic Global TB programme Geneva: The Organization; Ashok R, Awdhesh K, Nishat A MultidrugResistant Mycobacterium Tuberculosis: Molecular Perspectives Emerging Infectiousi Diseases 1998 Vol 4, No 2 5- Barnes P, Blotch AB, Davidson PT, Snider DE Tuberculosis in patients with immunodeficiency virus infection N Engl J Med 1991 Jun; 324(23): Kochi A, Vareldzis B, Styblo K Multidrugresistant tuberculosis and control Res Microbiol 1993 Feb; 144(2): Bell RT Tuberculosis of the 1990s: the quiet public health threat Pa Med 1992 Mar; 95(3): Dooley SW, Jarvis WR, Martone WJ, Snider DE Multidrug-resistant tuberculosis Ann Intern Med 1992 Aug; 117(3): Snider DE Jr, Roper WL The new tuberculosis N Engl J Med 1992 Mar; 326(10): 703-5
8 ١٣٨٢ ﻣﺠﻠﻪ ﻋﻠﻤﻲ ۵۴-٢٥ Downloaded from jarumsarumsacir at 7:13 IRST on Friday October 12th 2018 ﺧﻼﺻﻪ ١٣٨٠ ﻣﻬﺮ ٢٣-٢٥ ٥١ ﺗﺎ ٥٠ ١٣٨١ 18- Gonzalez E, Armas L, Alonso A Tuberculosis in the Republic of Cuba: its possible elimination Tuberc Lung Dis 1994 Jun; 75(3): Farga V, 1999, The origins of DOTS, Int J Tuberc Lung Dis 1999 Feb; 3(2): ٢٠-٢٦ ﺻﻔﺤﻪ ١٣٧٥ ﻣﻬﺮ ٢١-٢٣ ﺧﻼﺻﻪ Economic Proportion ٤٢ ﻣﻬﺮ ٢٣-٢٥ ٤١ ﺗﺎ ٤٠ ﺣﻴ -٢١ ١٣٨١ 27- Bahrmand AR, Siadati A, Samar G, Sanami A Report of drug resistance in strains of Mycobacterium tuberculosis isolated from patients in Iran Rev Cubana Med Trop 1996; 48(2): Mohammad A, Nasrollahie M, Vahedi M Determination of Mycobacterium tuberculosis drug sensitivity in mazandaran province health center in 2002 available at: ansorp org -٢٩,, ﻣﺎﻳﻜﻮﺑﺎﻛﺘﺮﻳﻮ ﻧﺘﺎﻳﺞ ١٣٧٥-٧٤ ٤٩ ﺻﻔﺤﻪ ١٣٧٥ ﻣﻬﺮ ٢١-٢٣ -٢٢ ٦٣ ٢١-٢٣ ٤٩ ﺻﻔﺤﻪ ١٣٧٥ ﻣﻬﺮ ۱۳۸٠, ﻫﺎ -٢٣ ١-٤ ١٣٧٦-٢٤, ٥ ﺻﻔﺤﻪ ١٣٨٠ ﻣﻬﺮ ٢١-٢٣ ٨٠ ﺗﺎ ٧٧
9 Downloaded from jarumsarumsacir at 7:13 IRST on Friday October 12th 2018 ۵۵
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