fa ‫ﺗﻌﯿﯿﻦ ﻣﻘﺪار ﮐﭙﯽ ‪ HBV-DNA‬در ﺳﺮوﻣﻦ و ﺳﺮم ﺑﯿﻤﺎران ﻣﺰﻣﻦ ﻫﭙﺎﺗﯿﺖ‬ ‫‪ B‬ﺑﻪ روش ‪ RealTtime PCR‬و ارﺗﺒﺎط آن ﺑﺎ ﺑﺮﺧﯽ ﻣﺘﻐﯿﺮﻫﺎی‬ ‫اﭘﯿﺪﻣﯿﻮﻟﻮژﯾﮏ‬ ویروس شناسی پزشکی Medical Virology مقاله پژوهشی Original Research Article <div align="justify" style="direction: rtl"> <b>ﻣﻘﺪﻣﻪ و هدف:</b> ﻫﭙﺎﺗﯿﺖ ﻣﺰﻣﻦ ‪ B‬ ﺷﺎﯾﻊ ﺗﺮﯾﻦ ﻋﻔﻮﻧﺖ وﯾﺮوﺳﯽ ﻣﺰﻣﻦ ﺷﻨﺎﺧﺘﻪ ﺷﺪه ی ﺑﺸﺮی ﻣﯽ ﺑﺎﺷﺪ. ﻗﺮﯾﺐ ﯾـﮏ ﺳـﻮم ﻣـﺮدم دﻧﯿـﺎ‬ ‫ﺗﺎﮐﻨﻮن ﺑﻪ ﻋﻔﻮﻧﺖ ﻫﭙﺎﺗﯿﺖ ‪  B‬ﻣﺒﺘﻼ ﺷﺪﻧﺪ، ﺑﯿﺶ از ﭼﻬﺎرﺻﺪ ﻣﯿﻠﯿﻮن ﻧﻔﺮ ﺣﺎﻣﻞ ‪ HBV‬ در ﺟﻬﺎن ﻫﺴﺘﻨﺪ، و از اﯾﻦ ﺗﻌﺪاد ﺣﺪود‬ ‫ﭼﻬﻞ ﻣﯿﻠﯿﻮن ﻧﻔﺮ ﺑﻪ ﺳﯿﺮوز ﮐﺒﺪی و ﺷﺼﺖ ﻣﯿﻠﯿﻮن ﻧﻔﺮ ﻧﯿﺰ ﺑﻪ ﻋﻠﺖ ﮐﺎرﺳﯿﻨﻮﻣﺎ ﻫﭙﺎﺗﻮﺳﻠﻮﻻر ﻓﻮت ﻧﻤﻮده اﻧﺪ. ﺷﯿﻮع ﺑﯿﻤﺎری‬ ‫در ﺟﻨﻮب ﺷﺮﻗﯽ آﺳﯿﺎ از ﺳﺎﯾﺮ ﻣﻨﺎﻃﻖ ﺟﻬﺎن ﺑﯿﺸﺘﺮ اﺳﺖ. ﺑﺮآورد ﻣﯽ ﺷﻮد ﮐﻪ ﺗﺎﮐﻨﻮن ﺑﯿﺴﺖ و ﭘﻨﺞ ﻣﯿﻠﯿﻮن ﻧﻔﺮ در اﯾﺮان ﺑﻪ‬ ‫ﻋﻔﻮﻧﺖ ‪  HBV‬ﻣﺒﺘﻼ ﺷﺪه ﺑﺎﺷﻨﺪ و ﺣﺪود 3 درﺻﺪ ﺣﺎﻣﻞ ‪  HBV‬در ﺟﺎﻣﻌﻪ اﯾﺮان وﺟﻮد داﺷﺘﻪ ﺑﺎﺷﺪ.‬ ‫ﻣﻘﺎدﯾﺮ ‪ HBV-DNA‬ در ﺗﺮﺷﺤﺎت ﻣﺨﺘﻠﻒ ﺑﺪن از ﺟﻤﻠﻪ ﺳﺮم، ﺳﺮوﻣﻦ، ﺑﺰاق و ﻏﯿﺮه ﺑﻪ ﻋﻮاﻣﻞ اﯾﻤﻨﻮﻟﻮژﯾﮏ ﻓﺮدی و ﺑﺮﺧﯽ‬ ‫ﻣﺘﻐﯿﺮﻫﺎی اﭘﯿﺪﻣﯿﻮﻟﻮژﯾﮏ ﺑﺴﺘﮕﯽ دارد. اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺮای اوﻟـﯿﻦ ﺑـﺎر ﺑـﻪ ﻣﻨﻈـﻮر ﺗﻌﯿـﯿﻦ ﻣﻘـﺪار ﮐﭙـﯽ ‪  HBV-DNA‬در ﺳـﺮم‬ ‫و ﺳﺮوﻣﻦ و ارﺗﺒﺎط آن ﺑﺎ ﺑﺮﺧﯽ ﻋﻮاﻣﻞ اﭘﯿﺪﻣﯿﻮﻟﻮژﯾﮏ در اﯾﺮان اﻧﺠﺎم ﺷﺪه اﺳﺖ.‬ ‫<br><b>ﻣﻮاد و روش ﻫﺎ:</b> در اﯾﻦ ﻣﻄﺎﻟﻌﻪ 70 ﻧﻔﺮ ﺑﯿﻤﺎر ﻣﺒﺘﻼ ﺑﻪ ﻫﭙﺎﺗﯿﺖ ‪  B‬ﻣـﺰﻣﻦ در ﮔـﺮوه ﺳـﻨﯽ 40-20 ﺳـﺎﻟﻪ ﮐـﻪ ﻫﻤﮕـﯽ از ﻧﻈـﺮ‬ ‫‪ HBsAg‬ ﻣﺜﺒﺖ ﺑﻮدﻧﺪ ﺑﻪ ﻋﻨﻮان ﻧﻤﻮﻧﻪ اﻧﺘﺨﺎب ﺷﺪﻧﺪ. در اﯾـﻦ ﺑﺮرﺳـﯽ ﺑـﺮای ﺗﻌﯿـﯿﻦ ﻣﻘـﺪار ‪  HBV-DNA‬ﺳـﺮوﻣﻦ و ﺳـﺮم  ‫ﺑﯿﻤﺎران از روش ﻣﻠﮑﻮﻟﯽ ﮐﻤﯽ ‪ ، Real time PCR‬دﺳﺘﮕﺎه 69 ‪ (detectionsystem Biorad PCR/USA) CFX‬ و ﮐﯿﺖ‬ ‫‪ ‫ﺗﺸﺨﯿﺼﯽ (‪ (aj Roboscreen – Germany‬اﺳﺘﻔﺎده ﮔﺮدﯾﺪ.‬ ‫<br><b>ﯾﺎﻓﺘﻪ ﻫﺎ:</b> در اﯾﻦ ﺑﺮرﺳﯽ 54.3 درﺻﺪ ﮔﺮوه ﻣﻮرد ﻣﻄﺎﻟﻌﻪ ﻣﺮد و 54.7 درﺻﺪ زن ﺑﻮدﻧﺪ . 100درﺻﺪ ﺑﯿﻤﺎران ﻣﻮرد ﻣﻄﺎﻟﻌﻪ‬ ‫ﺣﺪاﻗﻞ ﯾﮑﺴﺎل از ﺗﺸﺨﯿﺺ اﺑﺘﻼءﺷﺎن ﺑـﻪ ﺑﯿﻤـﺎری ﻫﭙﺎﺗﯿـﺖ ‪ B‬ ﮔﺬﺷـﺘﻪ ﺑـﻮد . 61 ﻧﻔـﺮ (78.2درﺻـﺪ) از ﺑﯿﻤـﺎران در ﺳـﺮوﻣﻦ‬ ‫ﺧﻮد‪ HBV-DNA ‬داﺷﺘﻨﺪ. 19ﻧﻔﺮ (27درﺻﺪ) ﺗﺤﺖ درﻣﺎن و 51 ﻧﻔﺮ (73 درﺻﺪ) ﻫﯿﭽﮕﻮﻧﻪ داروﯾﯽ درﯾﺎﻓﺖ ﻧﮑﺮده ﺑﻮدﻧﺪ . 58‬ ‫ﻧﻔﺮ (83درﺻﺪ) از ﺑﯿﻤﺎران ﻣﺘﺄﻫﻞ ﺑﻮدﻧﺪ . ﻣﯿﺎﻧﮕﯿﻦ ﮐﭙﯽ در ﻣﯿﻠﯽ ﻟﯿﺘﺮ ‪ HBV-DNA‬ ﺳﺮوﻣﻦ ﻣﺮدان 10⁶ × 8.73 و زﻧﺎن 10⁶‬ ‫× 7.44 ﺑﻮده اﺳﺖ. آزﻣﻮن ﻫﻤﻮژﻧﺘﯽ وارﯾﺎﻧﺲ ﻣﯿﺎﻧﮕﯿﻦ ﻫﺎ در ﮔﺮوه ﻫﺎی ﺳﻨﯽ ﻧﺸﺎن داد ﮐﻪ اﺧﺘﻼف ﻣﻌﻨﯽ داری ﺑﯿﻦ ﻣﯿﺎﻧﮕﯿﻦ‬ ‫ﮐﭙﯽ ﻫﺎی ﺳﺮوﻣﻦ در ﮔﺮوه ﻫﺎی ﺳﻨﯽ ﻣﻮرد ﺑﺮرﺳﯽ وﺟﻮد دارد (0.003=‪.(P‬‬ ‫<br><b>ﺑﺤﺚ:</b> اﺳﺘﻔﺎده از روش ﻫﺎی ﻣﻠﮑﻮﻟﯽ ﮐﻤﯽ ﻣﯽ ﺗﻮاﻧﺪ وﺿﻌﯿﺖ ﺑﯿﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ‪ CHB‬را در ﻣﺮاﺣﻞ ﻣﺨﺘﻠـﻒ‬ ‫ﺑﯿﻤﺎری ﺑﻪ دﻗﺖ ﻣﺸﺨﺺ ﻧﻤﺎﯾﺪ . ﻧﻮع ﺗﺮﺷﺤﺎت ﺑﯿﻤﺎر از ﺟﻤﻠﻪ ﺳﺮم، ﺳﺮوﻣﻦ، ﺑﺰاق و ﻏﯿـﺮه و ﻫﻤﭽﻨـﯿﻦ ﺑﺮﺧـﯽ ﻣﺘﻐﯿﺮﻫـﺎی‬ ‫اﭘﯿﺪﻣﯿﻮﻟﻮژﯾﮏ ﻣﺎﻧﻨﺪ ﺟﻨﺴﯿﺖ ، ﻣﺼﺮف دارو، ﺳﯿﺴﺘﻢ اﯾﻤﻨﯽ ﻓﺮد ﺑﺮ ﻣﻘﺪار ﮐﭙﯽ ‪ HBV-DNA‬ ﺗﺄﺛﯿﺮ ﮔﺬار ﻫﺴﺘﻨﺪ، ﻫﺮ ﭼﻨﺪ‬ ‫ﺑﻌﻀﺎً ﻣﻤﮑﻦ اﺳﺖ از ﻧﻈﺮ ﺗﺴﺖ ﻫﺎی آﻣﺎری اﯾﻦ اﺧﺘﻼف ﻫﺎ ﻣﻌﻨﯽ دار ﻧﺒﺎﺷﻨﺪ. ﺑﻨﺎﺑﺮاﯾﻦ ﺷﻨﺎﺧﺖ اﯾﻦ ﻋﻮاﻣـﻞ و ﺑـﻪ ﮐـﺎرﮔﯿﺮی‬ ‫روش ﻫﺎی ﻧﻮﯾﻦ ﺗﺸﺨﯿﺼﯽ، در ﮐﻨﺘﺮل و ﻫﻤﻪ ﮔﯿﺮ ﺷﻨﺎﺧﺘﯽ ﺑﯿﻤﺎری ﻫﭙﺎﺗﯿﺖ ‪  B‬اﻫﻤﯿﺖ ﺑﺴﯿﺎر زﯾﺎدی دارﻧﺪ.‬ </div> <div align="justify"> <b>Background:</b> Chronic hepatitis B is most common chronic viral infection in the human. Nearly a third of the world already infected with hepatitis B were more than four hundred million people worldwide are HBV carriers, and of these approximately forty million people and cirrhosis of the liver due to the sixty million people have died hepatocellular carcinoma. Outbreaks in Southeast Asia than other regions further. Is estimated that so far twenty -five million people in Iran are infected HBV infection and about three percent of HBV carriers exist in Iranian society. HBV-DNA levels in different body fluids including serum, cerumen, saliva and other immunological factors, individual and depends on some epidemiological variables. The first study to determine the amount of HBV-DNA copies in serum and cerumen its relationship with epidemiologic factors in Iran population. <br><b>Methods:</b> In this study, 70 patients with chronic hepatitis B in the age group 20 - 40years, all were positive for HBsAg were selected as samples. In the study were used to determine the amount of HBV-DNA serum and cerumen by molecular methods Real time PCR (detection system Biorad) and diagnostic kits (aj Roboscreen - Germany). Results: In this study, 54.3 percent of male study group and 45.7 percent were women. 100 percent of patients at least one year of diagnosis Abtla’shan to hepatitis B was passed. 61 ( 87.2%) of patients had HBV-DNA to cerumen. 19 (27%) and 51 treated patients (73 percent) had not received any medication. 58 (83%) of patients were married. Average copies ml HBV-DNA has been in men cerumen 8.73×10⁶ and women's 7.44× 10⁶ . Hmogenety test average variance in age groups showed a significant difference between the mean copies cerumen the age groups studied there<br><b>Conclusion:</b> The use of quantitative molecular methods can conditions CHB patients in different stages of disease to determine accurately. Type of discharge the patient, including serum, Srvmn, saliva, etc. as well as some epidemiological variables such as sex, drugs, and immune system. The amount of HBV-DNA copies are affected, though some might consider testing the statistical differences are not significant </div> ‬ﺳﺮم، ﺳﺮوﻣﻦ، ‪ ، CHB‬اﭘﯿﺪﻣﯿﻮﻟﻮژﯾﮏ ، ‪ ، Real Time PCR‬اﯾﻼم‬ HBV-DNA, Serum, Cerumen, CHBV, Epidemiologic, Real-Time PCR, Ilam. 42 51 http://ijmm.ir/browse.php?a_code=A-10-1-168&slc_lang=fa&sid=1 Eskandar Gholami Parizad اﺳﮑﻨﺪر ﻏﻼﻣﯽ ﭘﺮﯾﺰاد eskandar_parizad@yahoo.com 10031947532846001031 10031947532846001031 No Ilam University Of Medical Science,Department Of Health داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﮑﯽ اﯾﻼم داﻧﺸﮑﺪه ﺑﻬﺪاﺷﺖ Elahe Gholami Parizad اﻟﻬﻪ ﻏﻼﻣﯽ ﭘﺮﯾﺰاد elahehparizad@gmail.com‬‬ 10031947532846001032 10031947532846001032 Yes Ilam University Of Medical Science,Department Of Health داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﮑﯽ اﯾﻼم داﻧﺸﮑﺪه ﺑﻬﺪاﺷﺖ Ali Delpisheh ﻋﻠﯽ دﻟﭙﯿﺸﻪ alidelpisheh@yahoo.com‬‬ 10031947532846001033 10031947532846001033 No Ilam University Of Medical Science,Department Of Health داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﮑﯽ اﯾﻼم داﻧﺸﮑﺪه ﺑﻬﺪاﺷﺖ Mostafa Nikfar ﻣﺼﻄﻔﯽ ﻧﯿﮏ ﻓﺮ 10031947532846001034 10031947532846001034 No -داﻧﺸﮕﺎه آزاد اﺳﻼﻣﯽ واﺣﺪ ﻻﻫﯿﺠﺎن