دراسة بعض الحغ رات الفسلج ة والك موح و ة المرافقة لمرضى الفشل الكلوي المزمن جحث الذ لزة الذمو ة ف محافظة النجف األشرف.
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- Barrie Nichols
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1 دراسة بعض الحغ رات الفسلج ة والك موح و ة المرافقة لمرضى الفشل الكلوي المزمن جحث الذ لزة الذمو ة ف محافظة النجف األشرف. ع عجذ ا ض شح ذ ا ذخ ١ و ١ خ ا ع \خب عخ ا ى فخ أ..د أسشذ س و ١ خ ا ز ش ٠ غ\خب عخ ا ى فخ الخالصة أخش ٠ ذ ز ا ذساسخ ف سزشف ا سى ١ ا عاب فا سبف اخ ا داش ا شاشد اذح ا 1\7\0212 غب ٠ اخ 1\1\0211 لذ ذفذ زم ١١ ثعغ ا زغ ١ شاد ا فس د ١ خ ا ى ١ ز ٠ ١ خ شػ ا فش ا ى ا خبػاع ١ اذ ٠ ضح ا ذ ٠ خ ش ذ ا ذساسخ زبثعخ )122( زب خ ىال ا د س ١ ػ ب )75( ش ٠ ؼب ثب فش ا ى ا اض ثبإلػبفخ إ د عخ ا سا ١ رشح ا زى اخ ا )05( زب اخ ا ا سا ٠ ب ث ١ اذ ا زابحح اإلزظابح ١ خ از ا ذساساخ خ د ا خفابع ع ا )0.05>P( فا رشو ١ اض اؼابة ا اذ ىاذاط ا اذ رعاذاد ا ظاف ١ سبد ا ذ ٠ اخ ا زعاذاد ا ى خال ٠ ب ا ذ ا ج ١ غ ذ شػ ا فش ا ى ا ض ثب مبس اخ ام د عاخ ا سا ١ رشح. أ اشد زابحح ا زعذاد ا زفش ٠ م خال ٠ ب ا ذ ا ج ١ غ خ د اسرفبع ع )0.05>P( ف سجخ ا خال ٠ ب ا عذ خ ا ز ١ ذح ا س ؼاخ فاا زاا ١ ا خفؼااذ سااجخ ا خال ٠ ااب ا فب ٠ ااخ ا خفبػااب ع ٠ ااب )0.05>P( فاا د عااخ ا شػاا ثب مبس ااخ اام ا س ١ رشح. أ ػسذ زبحح ا فس طبد ا ى ١ ز ٠ ١ خ خ د اسرفبع ع )0.05>P( ف رشو ١ ض ا ى ١ سا ١ ش ٠ ذاد ا ثالث ١ خ فعب ١ خ إ ض ٠ ا ف سفبر ١ ض ا مبعاذ ALP ا خفابع ع ا )0.05>P( فا رشو ١ اض ا جش ر ١ ابد ا ذ ١ اخ ا شرفعخ ا ىثبفخ HDL فعب ١ خ إ ض ٠ ALT AST ذ شػا ا فشا ا ى ا ا اض مبس اخ ام د عاخ ا س ١ رشح. لذ ا ظذ ا ذساسخ ا سب ١ خ إ خ د رؤث ١ ش س ج شع ا فش ا ى ا ض ف أغ ات ا زغ ١ اشاد ا فس د ١ خ ا ى ١ ز ٠ ١ خ ا ذس سخ. المقذمة ا فش ا ى ا ض رذ س غ ١ ش عىس ف ع ا ى ١ خ رفمذ ع ا ى ١ خ خض ا ب لاذسر ب ا زششا ١ س ١ خ فعب ١ بر ب ا فس د ١ خ ٠ زر ت ا فش ا ى ا ض ا عالج إ ب ثاضسع ا ى ١ اخ أ ثب اذ ٠ ضح ا ذ ٠ اخ ( al. Boon et 2006,(. ٠ عذ ا فش ا ى ا ض ا شاع راد اال زشبس ا عب لذ زازسد اخ ا ظاسخ ا عب ١ اخ شاوض ا ذساسبد ا زفش ا س ا ض ٠ بدح ا فزخ شع ا فش ا ى ا ض االي ا س اد ا ا ١ شح رزشا ذ سجخ اإلطبثخ ثب فش ا ى ا ض ف ا عشاق ب ث ١ ) ( زب خ خذ ٠ ذح ى ١ ا شاخض ا ا ساىب سا ٠ ب )ا سجاابي 0220(. رعاذ ا اذ ٠ ضح ا ذ ٠ اخ ا أفؼا ا راشق ا زجعاخ فا ا لاذ ا سبػاش عاالج ا فشا ا ى ا ا اض ف ا ػاش س ٠ خ الساز شاس ز ١ ابح ا اش ٠ غ رسسا ١ أداحا ا ا ١ ف إال أ اب رزاشن ثابسا س ج ١ خ عذ ٠ ذح ع ا ش ٠ غ ب خع ب أزاذ أ ا ا ١ ابد ٠ ا خظاجخ ذساسابد ا سذ ٠ ثاخ )2005, Himmelfarb ; 2010, al. )Checherita et. ٠ ؤثش ا فش ا ى ا فا د عاخ اساعخ ا ا سادخ ا عؼاب ا فعب ١ ابد ا س ٠ ١ اخ إر ٠ زساجت فا ؼابعفبد وث ١ اشح اب فماش ا اذ أ اشاع ا ع اب ا اشاع ا م ج ١ اخ ا عبح ١ اخ رظا ت ا شاشا ١٠ )2010, Kalaitzidis )Siamopoulos and رشا ١ ش ا ذساسابد ا سذ ٠ ثاخ أ ا اشاع ا م ج ١ اخ لاذ رسججذ ف فبح %52 شػ ا فش ا ى اظ طب م اإلطبثخ ثب ذا ا سىش أ ثبسرفبع ػغؾ ا ذ ( et 2010, al..)gupta, إ ا ذساسبد ا ز فشح ز ي ا زغ ١ شاد ا فس د ١ خ ا ى ١ ز ٠ ١ اخ شػا ا فشا ا ى ا ف ا عشاق ل ١ خ ال رز بست ار سح ا شع سشعخ ا زشبس ا س خ ف ا س اد ا ا ١ شح لذ خاب د از ا ذساسخ سذ خب ت ا فشاغ ا خ د ف زا ا دبي. المواد وطرائق العمل خ م ع ١ بد ا ذ : - ر سست ع ١ بد ا ذ ا س ٠ ذ د عز ١ و ز ١ ب ثبسزع بي سابل ؽج ١ اخ عم اخ ج ١ زح سعخ 12 م لس ا ذ ى ع ١ خ إ أ بث ١ ت زب ٠ خ ع بدح ب عخ زخثش م ١ ابط ا عاب ١٠ ش ا فسا د ١ خ ف ١ اب ػام ا مسا ا ٢ ااش ا ا اذ فا أ بث ١ ات ابطاخ اب ١ اخ ا أ ٠ اخ ابدح ب عاخ زخثاش رشواذ ثذسخاخ زاشاسح ا خزجش ذح )12-32( دل ١ ماخ ثا جازد ث سابؽخ خ ابص ا راشد ا شواض Centrifuge ثساشعخ 3222 د سح /دل ١ مخ ذح عشش دلبحك فظ ظ ا ذ ل ١ بط ا عب ١٠ ش ا ى ١ ز ٠ ١ خ. لذ رؼ ذ ا ذساسخ ل ١ بط ا عب ١٠ ش ا زب ١ خ : 1. ا عب ١٠ ش ا ذ ٠ خ : ش ذ ل ١ بط ا عب ١٠ ش ا زب ١ خ :
2 أ- ا زعذاد ا ى خال ٠ ب ا ذ ا ج ١ غ Total Leucocytes Count اسزع ذ ؽش ٠ مخ عذاد اال ٠ ب ا ذ س ي ا زخف ١ ش Fluid( )Turks سسبة عذد اال ٠ ب ا ذ ا ج ١ غ ا ى. )Brown, 1976 ( ة- ا زعذاد ا زفش ٠ م خال ٠ ب ا ذ ا ج ١ غ Differential Leucocytes Count ر رسؼ ١ ش سسخ ا ذ طجغ ب ثظجغخ ش ب ث فسظذ ثب عذسخ ا ض ٠ ز ١ خ إلخشا ا زعذاد ا زفش ٠ م خال ٠ ب ا ذ ا ج ١ غ ( 1976 )Brown,. Hemoglobin ج- رمذ ٠ ش رشو ١ ض اؼبة ا ذ (Hb) ر اسزع بي خ بص م ١ بط اؼبة ا ذ Meter( )Hemoglobin س ي دساثى ث طف س ي رخف ١ ش زمذ ٠ ش رشو ١ ض اؼبة ا ذ ف ع ١ خ ا ذ ( 1996 )Sood,. د- ل ١ بط ىذاط ا ذ (PCV( Packed Cell Volume اسزع ذ ا بث ١ ت ا شعش ٠ خ خ بص ا رشد ا شوض ا ذل ١ ك )Microcenterfuge( م ١ بط ا سجخ ا ئ ٠ خ ىذاط ا ذ ( 1976 )Brown,. - ا زعذاد ا ى ظف ١ سبد ا ذ ٠ خ Total Platelets Count اسازع ذ ؽش ٠ ماخ عاذاد اال ٠ اب ا اذ س ا ي اوسابالد اال ١ ا ث طاف س ا ي ا زخف ١ اش ا ظف ١ سبد ا ذ ٠ خ ا ى ( 1996 )Sood,. سسابة عاذد 0. ا عب ١٠ ش ا ى ١ ز ٠ ١ خ : ش ذ ا عب ١٠ ش ا زب ١ خ : أ- رمذ ٠ ش ا ى ١ سزش ي ا ى ظ Estimation of Total Cholesterol اسزع ذ ا رش ٠ مخ اإل ض ١ ٠ خ ا ز طف ب Siedel خ بعز (1981( زمذ ٠ ش ا ى سزش ي ا ى ف ا ظ. ة- رمذ ٠ ش ا ى ١ س ١ ش ٠ ذاد ا ثالث ١ خ Estimation of Triglycerides. )1982) ر اسزع بي ا رش ٠ مخ اإل ض ١ ٠ خ ا ز طف ب Prenci Fossati ج- رمذ ٠ ش رشو ١ ض ا جش ر ١ بد ا ذ ١ خ عب ١ خ ا ىثبفخ ف ا ظ Estimation of HDL اسزع ذ ؽش ٠ مخ رشس ١ ت ا جش ر ١ بد ا ذ ١ خ ا خ دح ف ا ظ ( 1978 al., )Finley et. د- زسبة رشو ١ ض ا جش ر ١ بد ا ذ ١ خ ا اؽئخ ا ىثبفخ ف ا ظ Calculation of LDL اسزع ذ ا عبد خ ا ز طف ب )1998 )Wilson, سسبة ا جش ر ١ بد ا ذ ١ خ اؽئخ ا ىثبفخ. - رمذ ٠ ش فعب ١ ز اإل ض ١ ٠ ا بل ١ د عخ ا ١ ف ا ظ Estimation of ALT & AST اسزع ذ ا رش ٠ مخ ا ز رعز ذ رمذ ٠ ش و ١ خ ا جبثش ف ١ ذ اال وضا اس ١ ز ١ ذ ا زسشس ٠ ث اسرخ رفبع ب م ث بح ب ٠ زش ف ١ ب ٠ ذساص ٠,1957( Frankal )Reitman and. - رمذ ٠ ش فعب ١ خ إ ض ٠ ا ف سفبر ١ ض ا مبعذ ف ا ظ Estimation of ALP رعز ذ ز ا رش ٠ مخ ع رمذ ٠ ش و ١ خ ا ف ١ ي ا زسشس ث سبؽخ رفبع م - 4 ا ١ أ ز ثب ٠ ش ٠ & (Belfield.Goldberg, 1971) ا زس ١ اإلزظبح Statistical Analysis
3 ر اسزع بي اازجبس ا رب ت t-student Test زس ١ ا زبحح ا ز رؼ زسبة ا ز سؾ ا سسبث إ خب ت اال سشاد ا م ١ بس SD( )Mean ± ر اازجبس ا فشػ ١ خ اإلزظبح ١ خ رسذ سز ازز ب ١ خ. )Chernick and Friis,2003( P<0.05 النحائج 1- رؤث ١ ش شع ا فش ا ى ا ض ف ثعغ ا عب ١٠ ش ا فس د ١ خ ذ ث ١ ذ ا زبحح ف ا دذ ي )1( خ د ا خفبع ع )0.05>P( ف رشو ١ ض اؼبة ا ذ ىذاط ا اذ رعاذاد ا ظف ١ سبد ا ذ ٠ خ ذ شػ ا فش ا ى ا ض ثب مبس خ م د عخ ا س ١ رشح. أشابسد زابحح ا ذساساخ ا سب ١ خ إ ا ا خفابع ا زعاذاد ا ى ا خال ٠ اب ا اذ ا جا ١ غ ا خفبػاب ع ٠ اب )0.05>P( اذ شػا ا فشا ا ى ا ا ض ثب مبس خ م د عخ ا س ١ رشح ا شى )1( أ شد زبحح ا زعذاد ا زفش ٠ م خال ٠ اب ا اذ ا جا ١ غ خا د اسرفبع ع )0.05>P( ف سجخ ا خال ٠ ب ا عذ خ ا ز ١ ذح ا س ؼخ ف ز ١ ا خفؼذ سجخ ا خال ٠ اب ا فب ٠ اخ ا خفبػب ع ٠ ب )0.05>P( ف د عخ ا شػ ثب مبس خ م ا س ١ رشح ا دذ ي )0(. خذ ي )1( ا زغ ١ شاد ف رشو ١ ض اؼبة ا ذ ىذاط ا ذ ا زعذاد ا ى ظف ١ سبد ا ذ ٠ خ شػ ا فش ا ى ا ض ا عب ١٠ ش د عخ ا شػ د عخ ا س ١ رشح ± ± 1.68 Hb (g/dl) 36.4 ± ± 5.25 PCV (%) ± ± Platelets )cell\mm 3 ( فشق ع ع ذ سز ازز ب ١ خ )0.05>P( خذ ي )0( ا زغ ١ شاد ف ا زعذاد ا زفش ٠ م خال ٠ ب ا ذ ا ج ١ غ شػ ا فش ا ى ا ض د عخ ا س ١ رشح د عخ ا شػ ا عب ١٠ ش 55.2 ± ± 8.27 Neutrophils (%) 0.36 ± ± 0.24 Basophils (%) 3.6 ± ± 0.85 Eosinophils (%) 4.9 ± ± 2.05 Monocytes (%) ± ± 9.01 Lymphocytes (%) فشق ع ع ذ سز ازز ب ١ خ )0.05>P(
4 WBC Count (cell\mm3) ` مجموعة المرضى مجموعة السيطرة المجاميع فشق ع ع ذ سز ازز ب ١ خ )0.05>P( شى )1( ا زغ ١ شاد ف ا زعذاد ا ى خال ٠ ب ا ذ ا ج ١ غ شػ ا فش ا ى ا ض 0- رؤث ١ ش شع ا فش ا ى ا ض ف ثعغ ا عب ١٠ ش ا ى ١ ز ٠ ١ خ ر ااش ا زاابحح فاا ا دااذ ي )3( خاا د اسرفاابع ع اا )0.05>P( فاا رشو ١ ااض ا ى ١ ساا ١ ش ٠ ذاد ا ثالث ١ ااخ ا خفاابع ع ا )0.05>P( فا رشو ١ اض ا جش ر ١ ابد ا ذ ١ اخ ا شرفعاخ ا ىثبفاخ HDL فا زا ١ ٠ جا ١ ا داذ ي )4( خا د اسرفبع ع )0.05>P( ف فعب ١ خ إ ض ٠ ا ف سفبر ١ ض ا مبعذ ALP ا خفابع ع ا )0.05>P( فا فعب ١ اخ إ ض ٠. ALT AST خذ ي )3( ا زغ ١ شاد ف سز ا ذ ف ظ شػ ا فش ا ى ا ض ا عب ١٠ ش د عخ ا شػ ± ± د عخ ا س ١ رشح ± ± Total Cholesterol (mg/dl) Triglycerides (mg/dl) ± ± 7.65 HDL (mg/dl) ± ± LDL (mg/dl) فشق ع ع ذ سز ازز ب ١ خ )0.05>P( خذ ي )4( ا زغ ١ شاد ف فعب ١ خ إ ض ٠ بد ا ىجذ ف ظ شػ ا فش ا ى ا ض
5 د عخ ا شػ د عخ ا س ١ رشح ا عب ١٠ ش ± ± ALP (U/l) 8.66 ± ± 2.18 AST (U/l) 7.5 ± ± 1.19 ALT (U/l) فشق ع ع ذ سز ازز ب ١ خ )0.05>P( المناقشة أشبسد زبحح ا ذساسخ ا سب ١ خ إ خ د ا خفبع ع )0.05>P( ف رشو ١ ض اؼبة ا ذ ا سجخ ا ئ ٠ اخ ىذاط ا ذ ؤششاد فمش ا ذ ف شػ ا فش ا ى ا ض لذ أشبسد ا عذ ٠ ذ ا ذساسبد أ فماش ا ذ ٠ ث أزذ أ ا ؼبعفبد ا ز رشافك ا فش ا ى ا ض )2001, al. )Costa et al. 2008, ; Hsu et. ٠ ىااا أ ٠ عاااض فماااش ا اااذ فااا زب اااخ ا فشااا ا ى ااا إ ااا ماااض فااا إفاااشاص ش ااا االسثش ثااا ٠ ز ١ Erslev and ( ا ساؤ ي عا رسف ١ اض ع ١ اخ رىا ٠ وش ٠ ابد ا اذ ا س اشا فا خابع ا ع ا )Erythropoietin( 1997, Besarab (Brunelli and Berns, 2009 ;. ا ا ساجبة ا زا راؤد إ ا فماش ا اذ فا شػا ا فش ا ى ا ض رد م ا فؼالد ا زش خ ١ ١ خ ف ا ذ )Uremia( ا ز رثاجؾ إ زابج ا خال ٠ اب ا اذح ىش ٠ ابد ا ذ ا س شا فا خابع ا ع ا )1989, al. )Besarab et لاذ ٠ عاض فماش ا اذ إ ا فاشؽ إفاشاص ش ا خ ١ ت ا ذسل ١ خ ا ز ٠ سجت ر ١ فب س ١ د ١ ب ف خبع ا ع )2007, al. )Al-Hilali et. ا سجبة ا اخ ا ا مض ا سبط ف ع ظش ا سذ ٠ ذ سز زب غ ا ف ١ اه ف ١ زاب ١ B6 B12 ا ا ا ساجبة ا عش فاخ فمااش ا ااذ ٠ اازح اازا ا اا مض ٠ سااجت ساا ا زغز ٠ ااخ ا زاا ٠ عااب ااب شػاا ا فشاا ا ى اا ا ااض )2002, )Bickford. أشاابسد زاابحح ا ذساسااخ ا سب ١ ااخ إ اا ا خفاابع أعااذاد ا ظااف ١ سبد ا ذ ٠ ااخ ا خفبػااب ع ٠ ااب )0.05>P( فاا د عااخ ا شػاا ثب مبس ااخ اام د عااخ ا ساا ١ رشح اازا ااب خااب د ثاا دساساابد واا اا ( al.,1999 )Galbusera et al.,2009 ; Altun et. ٠ ى أ ٠ عض زا اال خفبع إ ص ٠ بدح ز ػخ ا ذ )Acidosis( ذ شػ ا فش ا ى ا ا اض إر خاذ أ اب عاللاخ ؽشد ٠ اخ ثب خفابع رعاذاد ا ظاف ١ سبد ا ذ ٠ اخ )2005, )Kopple ا ا ع ا ا ا اخ ا ا ا مض ا سبطا فا ساز ش ا ا ثش ج ثا ٠ ز ١ Altun et ( ا سؤ ي ع ر ١ ع ١ خ رى ٠ ا ظف ١ سبد ا ذ ٠ خ ا فشص لج ا ى ١ خ )Thrombopoietin( )al., ر عت ع ١ خ ا ذ ٠ ضح ا ذ ٠ خ د سا وج ١ شا ف مض ا ظف ١ سبد ا ذ ٠ خ إر ٠ اؤد رفبعا ا اذ م أغش ١ خ ا ذ ٠ ضح اسزع بي بدح ا ١ جبس ٠ م ا زخثش فا أ بث ١ ات ا اذ ٠ ضح إ ا افاغ رعاذاد ا ظاف ١ سبد ا ذ ٠ اخ ثآ ١ ابد بع ١ اخ,1985( al. )Hall et al., 1992 ; Knudsen et. أ ػاسذ زابحح ا ذساساخ ا سب ١ اخ أ ا زعاذاد ا ى ا خال ٠ اب ا اذ ا جا ١ غ ا ساجخ ا ئ ٠ اخ خال ٠ اب ا فب ٠ اخ لاذ ا خفؼاب ا خفبػاب ع ٠ اب )0.05>P( فا د عخ ا شػ ثب مبس خ م د عخ ا س ١ رشح لذ ارفمذ زابحح از ا ذساساخ ام اب رواش ( al. Yoon et 2006, ; ف فا 0212(. ٠ ىا أ ٠ عاض ازا اال خفابع إ ا ص ٠ ابدح عاذي ا ا د ا خ ا )Apoptosis( خال ٠ ب ا فب ٠ خ ثسجت رد م ا فؼالد ا زش خ ١ ١ خ )0223 al..)moser et ٠ عذ اسرفبع سز ا سب ٠ ز و ١ بد اب لجا اال ز بث ١ اخ ثا (β IL-12, (TNF (α (IL-1 ا ا ع ا ا ا اخ فا افاغ ا زعاذاد ا ى ا خال ٠ اب ا ج ١ غ سجخ ا خال ٠ ب ا فب ٠ خ ذ شػ ا فش ا ى ا ض االي ا زذاا ام ع ١ اخ رىا ٠ اال ٠ اب ا اذ ا ج ١ غ فا خابع ا ع ا,1996( al. )Ishizuka et al.,2002 ; Kruz et. رعاذ ص ٠ ابدح اال زش ا و ١ 10 )IL-12( ف شػ ا فش ا ى ؤششا ع ص ٠ بدح أعذاد اسرفبع فعب ١ خ ا خال ٠ ب ا ز ١ ذح ا ساؤ خ عا إفاشاص ز ا بدح )2003, Kumar )Kaysen and لذ زظ أ زب خ ا ١ س ١ ٠ اب ض ٠ اذ أعاذاد ا خال ٠ اب ا عذ اخ فا ا اذ (2004 al., (Ottonello et زا ٠ زفك م ب خاب د ثا ا ذساساخ ا سب ١ اخ. أ ػاسذ ا زابحح فا ا ذساساخ ا سب ١ خ خ د اسرفبع ع )0.05>P( ف رشو ١ ض ا ى ١ س ١ ش ٠ ذاد ا ثالث ١ اخ )Triglycerides( فا ظا شػا ا فشا ا ى ا ا اض ثب مبس اخ ام د عاخ ا سا ١ رشح و اب أ اشد ا زابحح ا خفبػاب ع ٠ اب )0.05>P( فا رشو ١ ض ا جش ر ١ بد ا ذ ١ خ ا عب ١ خ ا ىثبفخ HDL ف د عخ ا شػ مبس اخ ام د عاخ ا سا ١ رشح ٠ عاذ ازا االػارشاة فا سزا ا اذ ا أ ا ا ساجبة ا شػا ١ خ اشاع ا م ج ١ اخ ا عبح ١ اخ لاذ ارفماذ زابحح از ا ذساسخ م ب روش )2009, al. )Cengiz et. رشا ١ ش ا ذساسابد إ ا أ شػا ا فشا ا ى ا ٠ عاب ا ص ٠ بدح ف سز ٠ بد ا جش ر ١ بد ا ذاا خ ف رشو ١ ت ا جش ر ١ بد ا ذ ١ خ ا غ ١ خ ثب ى ١ س ١ ش ٠ ذاد ا ثالث ١ خ ثا apo B
6 apo C-III apo E ا ١ ٢ خ ا مزشزخ ز ا ض ٠ بدح رز ث إ ب ثض ٠ بدح إ زبخ ب أ ث مض اإل ض ٠ بد ا ساؤ خ عا رس ١ اب (2001, Quaschning )Wanner and. ٠ ىا أ ٠ عاض االسرفابع فا رشو ١ اض ا ى ١ سا ١ ش ٠ ذاد ا ثالث ١ ااخ إ اا ا خفاابع سااز ٠ بد اإل ض ٠ اابد ا جش ر ١ اابد ا زاا رشاازشن فاا ١ ااخ ا ز م ١ ااخ ا ذ ٠ ااخ ى ١ ساا ١ ش ٠ ذاد ا ثالث ١ ااخ : ا ال ٠ ج ١ ااض ا ىجااذ Lipase( )Hepatic ساازمج )VLDL-Receptor( VLDL ساازمج LDL ا ىجاذ Protein( )Wu-Wong,2008( )Hepatic LDL Receptor. ٠ اؤد ا خفابع فعب ١ اخ إ اض ٠ )Lecithin-Cholesterol Acyltransferase( LCAT إ اا رعر ١ ا أاااز ا ى ١ ساازش ي ا سااش اا ا ساادخ ا س ١ ر ١ خ إ خض ٠ ئبد HDL ثب زب فئ مض إ ض ٠ ٠ ؤد LCAT إ مظب رشو ١ اض Saland ( HDL-C Ginsberg, 2007 )and. ٠ ش ثعغ ا ذساسبد ا سذ ٠ ثخ أ أوثش % 34 شػا ا فشا ا ى ا رسذ ا ذ ٠ ضح ا ذ ٠ خ ٠ عب ا اسرفابع ساز ثاش ر ١ )Cholesterol Ester Transfer Protein( CETP ا از ٠ اؤد إ ا ا خفابع رشو ١ اض )Ceska and Tesar )2008, HDL-C. ٠ ىا أ ٠ عاض اال خفابع فا رشو ١ اض خض ٠ ئابد HDL-C إ ا ص ٠ ابدح اإل اض ٠ ا ىجاذ Acyl- Cholesterol Acyltransferase( ACAT )CoA ا از ا ١ فاخ عبواسخ إل اض ٠ )Tsimihodimos et al.,2008( LCAT. أشابسد ا زبحح ف ا ذساسخ ا سب ١ خ إ خ د ا خفبع ع )0.05>P( ف فعب ١ خ إ ض ٠ ALT AST فا د عاخ ا شػ ا ظبث ١ ثب فشا ا ى ا ا اض ا عاب د ١ ثب اذ ٠ ضح ا ذ ٠ اخ ثب مبس اخ ام د عاخ ا سا ١ رشح لاذ ارفماذ از ا زابحح ام دساسابد وا ا,1984( al. )Ono et al.,1995 ; Tvedegaard et. ٠ ىا أ ٠ عض ا سجت ف ا خفبع فعب ١ خ إ ض ٠ ا ALT AST إ ا رد ام ا اد سا ١ خ ثجراخ فا ظا شػا ا فشا ا ى ا ا اض )1976 al. )Cohen et ا ا سز ا رساشة از اإل ض ٠ ابد ام اإلدساس ثساجت ا ؼاشس ا سا ١ د ا سبطا فا ا فش ابد ا ى ٠ اخ أ رساشث ب عجاش أغشا ١ خ ا اذ ٠ ضح أث اب خ سابد ا اذ ٠ ضح ا ذ ٠ اخ. لاذ روشد ثعغ ا ذساسبد أ مض ف ١ زب ١ )Pyridoxine( B6 ف شػ ا فش ا ى ٠ عذ أ ا سجبة فا ا خفاابع فعب ١ ااخ إ ض ٠ اا ا ىجااذ ALT AST إر ٠ ع اا ف ١ زااب ١ B6 و شافااك إ ض ٠ اا )Coenzyme( ااز ٠ اإل اض ١ ٠ ٠ اؤد مظا إ ا ا خفابع وج ١ اش فا فعب ١ ز اب )2009, Derzsiova )Mydlik and. أ اشد ا زبحح ف ز ا ذساسخ خ د اسرفبع ع )0.05>P( ف سز فعب ١ اخ إ اض ٠ ا ف سافبر ١ ض ا مبعاذ ALP فا د عااخ ا شػاا ثب مبس ااخ اام د عااخ ا ساا ١ رشح ارفمااذ ااز ا ز ١ داخ ام ااب أ سدرا )ا ١ ااخ 0224(. ٠ ر ك ظار ر ماض ا زىا ٠ ا ع ا ا ى ا Osteodystrophy( )Renal ع ا د ا االػارشاثبد ا زا رسذس ف ا ع ب ثسجت شع ا فش ا ى ا ز ٠ ى أ رؤد إ رسف ١ ض إ زبج إ ض ٠ ا ف سفبر ١ ض ا مبعاذ ا أ اابو رظاا ١ ع وب ىجااذ ا ع ااب ث ااذد رعاا ٠ غ ا اا مض ا سبطاا فاا ع ١ ااخ رشااى ١ ا ع ااب ( et Hruska. )al.,2007 المصادر ا سجبي س ذ خ ١ عجذ ا سزبس )0220(. ا عدض ا ى ا ض ) زالص خ ا ١ س ١ ٠ ب(. د خ أفبق ؽج ١ خ ا عذد ا عبشش ص ف ف عبدي عجبد. )0212(. ثعغ ا ؤششاد ا دشث ١ خ ا بع ١ خ ذ شػ ا فش ا ى ا ض. سسب خ بخسز ١ ش و ١ خ ا ع خب عخ ثبث ثبث ا عشاق. ا ١ خ ال س ذ ؽ ١ ت زس ١. )0224(. سز س خ ١ ت ا ذسل ١ خ ثعغ ا زغ ١ شاد ا ى ١ ز ٠ ١ خ ف ظ شػ ا عدض ا ى ا ض ا عب د ١ ثب ذ ٠ ضح ا ذ ٠ خ. سسب خ بخسز ١ ش و ١ خ ا ع خب عخ ا ط ا ط ا عشاق. Al-Hilali, N. ; Al-Humoud, H. ; Ninan, V. T. ; Nampoory, M. R. ; Puliyclil, M. A. and Johny, K. V. (2007). Does Parathyroid Hormone Affect Erythropoietin Therapy in Dialysis Patients?. Med Princ Pract, 16(1) : Altun, B. ; Arici, M. ; Haznedaroglu, C. ; Usalan, C. ; Erdem, Y. ; Yasavul, U. ; Turgan, C. ; Caglar, S. and Kirazli, S. (1999). Serum Thrombopoietin Levels in Haemodialysis Patients : Involvement of Arteriovenous Fistula. Nephrol Dial Transplant, 14 : Belfield, A. and Goldberg, D.M. (1971). Revised Assay for Serum Phenyl Phosphatase Activity Using 4-amino-antipyrine-Enzyme. Enzyme, 12: Besarab, A. ; Girone, J. F. Erslev, A. and Caro, J. (1989). Recent Developments in The Anemia of Chronic Renal Failure. Sem Dial, 2 :
7 Bickford, A. K. (2002). Evaluation and Treatment of Iron Deficiency in Patients with Kidney Disease. Nutr Clin Care, 5 : Boon, N. A. ; Colledge, N. R. and Walker, B. R. (2006). Davidson's Principles and Practice. 20thed., Churchill Livingstone, Philadelphia, USA. Brown, B. A. (1976). Hematology : Principles and Procedures. 2 nd ed., Lea and Febiger, Philadelphia, USA. Brunelli, S. M. and Berns, J. S. (2009). Anemia in Chronic Kidney Disease and End-Stage Renal Disease. Nephrology Rounds, 7(8) : 1-6. Cengiz, N. ; Baskin, E. ; Sezgin, N. ; Agras, P. and Haberal, M. (2009). Oxidative Stress in Children on Hemodialysis : Value of Autoantibodies Against Oxidized Low-Density Lipoprotein. Pediatr Nephrol, 24 : Ceska, R. and Tesar, V. (2008). Diabetes, Dyslipidaemia and Kidney Diseases. Vnitr Lek, 54(5) : Checherita, I. A. ; Turcu, F. ; Dragomirescu, R. F. and Ciocalteu, A. (2010). Chronic Complications in Hemodialysis : Correlations with Primary Renal Disease. Romanian Journal of Morphology and Embryology, 51(1) : Chernick, M. R. and Friis, R. H. (2003). Introductory Biostatistics for the Health Sciences. John Wiley & Sons, Inc., Hoboken, New Jersey, Canada. Cohen, G. A. ; Goffinet, J. A. ; Donabedian, R. K. and Conn, H. O. (1976). Observations on Decreased Glutamic Oxalacetic Transaminase (SGOT) Activity in Azotemic patients. Ann intern Med, 84 : 275. Costa, E. ; Rocha, S. ; Rocha-Pereira, P. ; Castro, E. ; Miranda, V. ; Faria, M. d.s. ; Loureiro, A. ; Quintanilha, A. ; Belo, L. and Santos-Silva, A. (2008). Band 3 Profile as a Marker of Erythrocyte Changes in Chronic Kidney Disease Patients. The Open Clinical Chemistry Journal, 1 : Erslev, A. J. and Besarab, A. (1997). Erythropoietin in The Pathogenesis and Treatment of The Anemia of Chronic Renal Failure. Kidney Int, 51 : Finley, P. R. ; Schifman, R. B. ; Williams, R. J. and Lichti, D. A. (1978). Cholesterol in High Density Lipoprotein : Use of mg2+ / Dextron Sulfate in its Enzymatic Measurement. Clin Chem, 24 : Fossati, P. and Prencipe, L. (1982). Serum Triglycerides Determined Colorimetrically with an Enzyme that Produces Hydrogen Peroxide. Clin Chem, 28: Galbusera, M. ; Remuzzi, G. and Boccardo, P. (2009). Treatment of Bleeding in Dialysis Patients. Semin Dial, 22(3) : Gupta, R. D. ; Rahman, M. ; Ahasan, H. N. ; Alam, B. ; Miah, T. ; Kabir, A. ; Das, A. ; Mahbub, S. and Khan, M. A. I.. (2010). Non-Traditional Cardiovascular Risk Factors in Chronic Kidney Disease (CKD) and Haemodialysis Dependent patients - A Case Control Study. J Medicine, 11 : Hall, A. V. ; Clark, W. F. and Parbtani, A. (1992). Heparin-Induced Thrombocytopenia in Renal Failure. Clin Nephrol, 38 : Himmelfarb, J. (2005). Hemodialysis Complications. Am J Kidney Dis, 45(6) :
8 Hruska, K. A. ; Saab, G. ; Mathew, S. and Lund, R. (2007). Renal Osteodystrophy, Phosphate Homeostasis, and Vascular Calcification. Semin Dial, 20 : Hsu, C-Y. ; Bates, D. W ; Kuperman, G. J. and Curhan, G. C. (2001). Relationship Between Hematocrit and Renal Function in Men and Women. Kidney International, 59 : Ishizuka, T. ; Nitta, K. ; Yokoyama, T. ; Hayashi, T. ; Futatsuyama, K. ; Kimata, N. ; Miwa, N. ; Nishida, E. ; Kawashima, A. ; Akiba, T. and Nihei, H. (2002). Increased Serum Levels of Interleukin-12 May be Associated with Th1 Differentiation in Hemodialysis Patients. Nephron, 90 : Kaysen, G. A, and Kumar, V. (2003). Inflammation in ESRD: Causes and Potential Consequences. J Ren Nutr, 13: Knudsen, F. ; Nielsen, A. H. and Kristensen, S. D. (1985). The Effect of Dialyser Membrane Material on Intradialytic Changes in Platelet Count, Platelet Aggregation, Circulating Platelet Aggregates and Antithrombin III. Scand J Urol Nephrol, 19: Kopple, J. D. ; Kalantar-Zadeh, K. and Mehrotra, R. (2005). Risks of Chronic Metabolic Acidosis in Patients with Chronic Kidney Disease. Kidney International, 67:21. Kruz, Z. ; Kohler, S. ; Meuer, T. and Meyerzum, K. H. (1996). Impaired Cellular Immune Responses in Chronic Renal Failure. Kidney Int, 29(6) : Moser, B. ; Roth, G. ; Brunner, M. ; Lilaj, T. ; Deicher, R. ; Wolner, E. ; Kovarik, J. ; Boltz-Nitulescu, G. ; Vychytil, A. and Ankersmit, H. J. (2003). Aberrant T cell Activation and Heightened Apoptotic Turnover in End-Stage Renal Failure Patients : a Comparative Evaluation Between Non-Dialysis, Haemodialysis, and Peritoneal Dialysis. Biochem Biophys Res Commun, 308: Mydlik, M. and Derzsiova, K. (2009). Metabolic Disorders of Vitamin B6 in Chronic Kidney Disease Patients. BANTAO Journal, 7 (2) : Ono, K. ; Ono, T. and Matsumata, T. (1995). The Pathogenesis of Decreased Aspartate Amino-transferase and Alanine Aminotransferase Activity in the Plasma of Hemodialysis Patients : the Role of Vitamin B6 Deficiency. Clin Nephrol, 43: Ottonello, L. ; Gnerre, P. ; Bertolotto, M. ; Mancini, M. ; Dapino, P. ; Russo, R. ; Garibotto, G. ; Barreca, T. and Dallegri, F. (2004). Leptin as a Uremic Toxin Interferes with Neutrophil Chemotaxis. J Am Soc Nephrol, 15 ; Reitman, S. and Frankal, S.. (1957). A Colorimetric Method for the Determination of Serum Glutamic Oxalaloacetic and Glutamic Pyruvic Transaminases. Am J clin Patho, 28 :
9 Saland, J. M. and Ginsberg, H. N. (2007). Lipoprotein Metabolism in Chronic Renal Insufficiency. Pediatr Nephrol, 22 : Siamopoulos, K. C. and Kalaitzidis, R. G. (2010). Metabolic Syndrome and Chronic Kidney Disease. European Nephrology, 4 : Siedel, J. ; Schlumberger, H. ; Klose, S. ; Ziehenhorn, J. and Wahleteld, A. W. (1981). Improved Reagent for the Enzymatic Determination of Serum Cholesterol. J Clin Chem Clin Biochem, 19 (8) : Sood, R. (1996). Haematology for Students and Practitioners. 4 th ed., Jaypee Brothers, New Delhi, India. Tsimihodimos, V. ; Dounousi, E. and Siamopoulos, K. C. (2008). Dyslipidemia in Chronic Kidney Disease : An Approach to Pathogenesis and Treatment. Am J Nephrology, 28 : Tvedegaard, E. ; Poulsen, H. E. ; Vilstrup, H. and Thomsen, H. K. (1984). Liver Function During Chronic Renal Failure in Rabbits. Experientia, 40 ; Wanner, C. and Quaschning, T. (2001). Dyslipidemia and Renal Disease : Pathogenesis and Clinical Consequences. Curr Opin Nephrol Hypertens, 10 : Wilson, P. W. (1998). Why Treated Dyslipidemia. Saudi med J, 19 (4) : Wu-Wong, J. R. (2008). Endothelial Dysfunction and Chronic Kidney Disease : Treatment Options. Curr Opin Investig Drugs, 9(9) : Yoon, J. W. ; Gollapudi, S. ; Pahl, M. V. and Vaziri, N. D. (2006). Naive and Central Memory T-cell Lymphopenia in End-Stage Renal Disease. Kidney International, 70 ; Study of Some Physiological and Biochemical Changes in Patients with Chronic Renal Failure (CRF) Undergoing Hemodialysis in Al-Najaf Governorate A. A. Al-Fahham A. N. Al-Dujaily College of Nursing / Kufa Un. College of Sciences/ Kufa Un. Abstract The current study aimed at assessing some physiological and biochemical changes in patients with chronic renal failure (CRF) undergoing hemodialysis. It was achieved at Al-Hakim general hospital in the Holy city of Najaf during the period from 1\7\2010 to 1\1\2011, (100) cases of both sexes were monitored including (75) patients with chronic renal failure and a control group of (25) healthy persons. The statistical analyses revealed a significant decrease (p<0.05) in the concentration of hemoglobin (Hb), packed cell volume (PCV), platelet count, and the total leucocytes count in the patients with CRF compared with the control group. The differential leucocytes count exhibited a significant increase in the percentage of neutrophils, monocytes and eosinophils ; while the percentage of lymphocytes decreased
10 significantly (p<0.05) in the patients group The biochemical investigations revealed a significant increase (p<0.05) in the concentration of serum triglycerides and the activity of alkaline phosphatase (ALP), and a significant decrease (P<0.05) in the concentration of serum high density lipoproteins (HDL) and the activity of aspartate & alanine transaminases (AST & ALT) in the CRF patients by comparing with control group. In summary, the current study came to that chronic renal failure had affected physiological and biochemical parameters under study.
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