‫ﻤﺠﻠﺔ ﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ ﻟﻠﻌﻠﻭﻡ ﺍﻷﺴﺎﺴﻴﺔ ـ ﺍﻟﻤﺠﻠﺩ )‪ (20‬ـ ﺍﻟﻌﺩﺩ ﺍﻷﻭل ـ ‪2004‬‬

‫ﺩﺭﺍﺴﺔ ﺘﺸﺨﻴﺼﻴﺔ ﻤﺼﻠﻴﺔ ﺃﻭﻟﻴﺔ ﻟﺩﻋﻡ ﺍﻟﻁﺭﺍﺌﻕ ﺍﻟﺘﻘﻠﻴﺩﻴﺔ‬

‫ﻟﻠﻜﺸﻑ ﻋﻥ ﺩﺍﺀ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠﺩﻱ ﻓﻲ ﺴﻭﺭﻴﺔ‬

‫ﻤﻬﺎ ﺸﻌﺒﺎﻥ ﻭ ﻻﻨﺎ ﺤﻤﻭﺩ ﻭ ﺴﻤﺭ ﺍﻟﻨﺤﺎﺱ‬

‫ﻗﺴﻡ ﻋﻠﻡ ﺍﻟﺤﻴﺎﺓ ﺍﻟﺤﻴﻭﺍﻨﻴﺔ – ﻜﻠﻴﺔ ﺍﻟﻌﻠﻭﻡ – ﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ‬

‫ﺘﺎﺭﻴـﺦ ﺍﻹﻴﺩﺍﻉ ‪2003/07/14‬‬

‫ﻗﺒل ﻟﻠﻨﺸـﺭ ﻓﻲ ‪2003/09/27‬‬

‫ﺍﻟﻤﻠﺨﺹ‬

‫ﺤﺎﻭﻟﻨﺎ ﻤﻥ ﺨﻼل ﻫﺫﻩ ﺍﻟﺩﺭﺍﺴﺔ ﺍﻷﻭﻟﻴﺔ ﻓﻲ ﺴﻭﺭﻴﺔ‪ ،‬ﺘﺴﻠﻴﻁ ﺍﻟﻀﻭﺀ ﻋﻠـﻰ ﺇﻤﻜﺎﻨﻴـﺔ ﺍﺴـﺘﺨﺩﺍﻡ ﺍﺨﺘﺒـﺎﺭ‬
‫ﺍﻟﻤﻘﺎﻴﺴﺔ ﺍﻟﻤﻨﺎﻋﻴﺔ ﺍﻷﻨﺯﻴﻤﻴﺔ )‪ (ELISA‬ﻓﻲ ﺍﻟﻜﺸﻑ ﻋﻥ ﺃﻀﺩﺍﺩ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠﺩﻴﺔ ﻓﻲ ﻤﺼﻭل ﺍﻟﻤﺼﺎﺒﻴﻥ ﺃﻭ‬
‫ﺍﻟﻤﺸﻜﻭﻙ ﺒﺈﺼﺎﺒﺘﻬﻡ ﻟﺩﻋﻡ ﺍﻟﻁﺭﺍﺌﻕ ﺍﻟﺘﻘﻠﻴﺩﻴﺔ )ﻓﺤﺹ ﻤﺠﻬﺭﻱ ﻤﺒﺎﺸﺭ ﻭﺍﺴﺘﻨﺒﺎﺕ( ﺍﻟﻤﺴﺘﺨﺩﻤﺔ ﻓـﻲ ﺘـﺸﺨﻴﺹ‬
‫ﺍﻹﺼﺎﺒﺔ ﺒﺩﺍﺀ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠﺩﻱ ﻨﻅﺭﹰﺍ ﻷﻥ ﺤﺴﺎﺴﻴﺔ ﻫﺫﺍ ﺍﻻﺨﺘﺒﺎﺭ ﻭﻨﻭﻋﻴﺘﻪ ﻤﺭﺘﻔﻌﺘﺎﻥ‪ .‬ﻓﻠﺩﻯ ﺇﺠﺭﺍﺀ ﺍﺨﺘﺒـﺎﺭ‬
‫ﺍﻹﻟﻴﺯﺍ ﻋﻠﻰ ‪ 270‬ﺤﺎﻟﺔ ﻤﺄﺨﻭﺫﺓ ﻤﻥ ﻤﺸﻔﻰ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺠﻠﺩﻴﺔ ﻭﺍﻟﺯﻫﺭﻴﺔ – ﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ‪ ،‬ﺤﺼﻠﻨﺎ ﻋﻠﻰ ‪250‬‬
‫ﻋﻴﻨﺔ ﺇﻴﺠﺎﺒﻴﺔ ﺃﻱ ﺒﻨﺴﺒﺔ ‪ %92.5‬ﺒﺎﻟﻤﻘﺎﺭﻨﺔ ﻤﻊ ﻋﺩﺩ ﺍﻟﻌﻴﻨﺎﺕ ﺍﻹﻴﺠﺎﺒﻴﺔ ﺍﻟﺘﻲ ﺘﻡ ﺘﺸﺨﻴﺼﻬﺎ ﺒﺎﻟﻁﺭﺍﺌﻕ ﺍﻟﺘﻘﻠﻴﺩﻴﺔ‬
‫ﻭﺍﻟﺘﻲ ﺒﻠﻎ ﻋﺩﺩﻫﺎ ‪ 225‬ﺤﺎﻟﺔ ﺃﻱ ﺒﻨﺴﺒﺔ ‪ .%83.3‬ﻓﻲ ﺤﻴﻥ ﻜﺎﻨﺕ ﻨﺘﻴﺠﺔ ﺍﺨﺘﺒﺎﺭ ﺍﻹﻟﻴﺯﺍ ﺍﻟﻤﻁﺒﻕ ﻋﻠﻰ ﺍﻟﻤﺼﻭل‬
‫ﻼ( ﺴﺎﻟﺒﺔ‪.‬‬
‫ﺍﻟﺸﺎﻫﺩﺓ )‪ 20‬ﻤﺼ ﹰ‬

‫ﺍﻟﻜﻠﻤﺎﺕ ﺍﻟﻤﻔﺘﺎﺤﻴﺔ‪ :‬ﺍﻻﻟﻴﺯﺍ‪ ،‬ﺍﻟﻠﻴـﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠﺩﻴـﺔ‪ ،‬ﺍﻷﻀـﺩﺍﺩ‪ ،‬ﺍﻟﻔﺤـﺹ ﺍﻟﻤﺠﻬـﺭﻱ‪،‬‬

‫ﺍﻻﺴﺘﻨﺒﺎﺕ‪.‬‬

‫‪49‬‬
 … ‫ﺩﺭﺍﺴﺔ ﺘﺸﺨﻴﺼﻴﺔ ﻤﺼﻠﻴﺔ ﺃﻭﻟﻴﺔ ﻟﺩﻋﻡ ﺍﻟﻁﺭﺍﺌﻕ ﺍﻟﺘﻘﻠﻴﺩﻴﺔ ﻟﻠﻜﺸﻑ ﻋﻥ ﺩﺍﺀ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ‬ ‫ﺸﻌﺒﺎﻥ ﻭﺤﻤﻭﺩ ﻭﻨﺤﺎﺱ ـ‬

Preliminary Serodiagnosis study to certify the

diagnosis of cutaneous leishmaniasis in Syria

Shaaban M., Hammoud L., Al-Nahhas S.

Department of Animal Biology-Faculty of Sciences-Damascus University

Received 14/07/2003
Accepted 27/09/2003

ABSTRACT
According to the high specificity and sensitivity of ELISA test, we tried in
this preliminary study, to certify the usefulness of ELISA test in the detection of
specific antibodies (IgG) to cutaneous leishmaniasis(CL) in SYRIA, in order to
certify the diagnosis of this disease by using the classic methods (observation
microscopic – culture).

Key Words: ELISA test, Cutaneous Leishmaniasis, Antibodies,

Microscopic test, Culture.

50
 ‫ﻤﺠﻠﺔ ﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ ﻟﻠﻌﻠﻭﻡ ﺍﻷﺴﺎﺴﻴﺔ ـ ﺍﻟﻤﺠﻠﺩ )‪ (20‬ـ ﺍﻟﻌﺩﺩ ﺍﻷﻭل ـ ‪2004‬‬

‫ﺍﻟﻤﻘـﺩﻤـﺔ‬
‫ﻴﻨﺘﺸﺭ ﺩﺍﺀ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺎﺕ ‪ Leishmaniasis‬ﻓﻲ ﻜـل ﻤﻨـﺎﻁﻕ ﺍﻟﻌـﺎﻟﻡ ﺍﻻﺴـﺘﻭﺍﺌﻴﺔ ﻭﺸـﺒﻪ‬
‫ﺍﻻﺴﺘﻭﺍﺌﻴﺔ‪ ،‬ﻭﺘﺘﻔﺎﻭﺕ ﺍﻹﺼﺎﺒﺔ ﻤﻥ ﺁﻓﺔ ﺠﻠﺩﻴﺔ )ﻴﻤﻜﻥ ﺃﻥ ﺘﺸﻔﻰ ﺘﻠﻘﺎﺌﻴﹰﺎ ﺒﻌﺩ ﻋﺩﺓ ﺃﺴﺎﺒﻴﻊ( ﺇﻟﻰ ﺁﻓﺎﺕ‬
‫ﺠﻠﺩﻴﺔ ﻤﺨﺎﻁﻴﺔ )ﺘﺅﺩﻱ ﺇﻟﻰ ﺘﺂﻜل ﺍﻷﻨﻑ ﻭﺍﻟﺒﻠﻌﻭﻡ ﺍﻷﻨﻔﻲ( ﺃﻭ ﺇﺼﺎﺒﺔ ﺤﺸﻭﻴﺔ ﻤﻤﻴﺘﺔ ﺇﺫﺍ ﻟـﻡ ﻴـﺘﻡ‬
‫ﺘﺸﺨﻴﺼﻬﺎ ﻓﻲ ﻭﻗﺕ ﻤﺒﻜﺭ‪.‬‬
‫ﻭﺤﺴﺏ ﺇﺤﺼﺎﺌﻴﺎﺕ ﻤﻨﻅﻤﺔ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻟﻤﻴﺔ‪ ،‬ﻴﺘﻡ ﺘﺴﺠﻴل ﻗﺭﺍﺒﺔ ‪ 12‬ﻤﻠﻴﻭﻥ ﺇﺼـﺎﺒﺔ ﺴـﻨﻭﻴﹰﺎ‪،‬‬
‫ﻭﻫﻨﺎﻙ ‪ 350‬ﻤﻠﻴﻭﻥ ﻨﺴﻤﺔ ﻤﻬﺩﺩﻭﻥ ﺒﺎﻹﺼﺎﺒﺔ ﻓﻲ ‪ 88‬ﺒﻠﺩﹰﺍ ﻤﻥ ﺒﻴﻨﻬﺎ ﺴﻭﺭﻴﺔ ﺍﻟﺘﻲ ﻴﻨﺘﺸﺭ ﻓﻴﻬﺎ ﺩﺍﺀ‬
‫ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠﺩﻱ‪ ،‬ﻟﻴﺸﻤل ﻤﻌﻅﻡ ﺍﻟﻤﻨﺎﻁﻕ ﻭﺍﻟﻤﺤﺎﻓﻅﺎﺕ‪ .‬ﺤﻴﺙ ﻴﻌﺩ ﺍﻟﻌﺎﻤل ﺍﻟﻁﻔﻴﻠﻲ ﺍﻟﻤﺴﺒﺏ ﻟﻬﺫﺍ‬
‫ﺍﻟﺩﺍﺀ ﻓﻲ ﺴﻭﺭﻴﺔ )ﻤﻥ ﺍﻟﻌﺎﻟﻡ ﺍﻟﻘﺩﻴﻡ( ﻫﻭ ﻁﻔﻴﻠﻲ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﻜﺒﺭﻯ ‪ L.major‬ﺃﻭ ﻁﻔﻴﻠﻲ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ‬
‫ﺍﻟﻤﺩﺍﺭﻴﺔ ‪.(1) L. tropica‬‬
‫ﻴﺘﻡ ﺘﺸﺨﻴﺹ ﺍﻹﺼﺎﺒﺔ ﺒﺩﺍﺀ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺇﻤﺎ ﺒﺎﻟﻔﺤﺹ ﺍﻟﻤﺠﻬﺭﻱ ﺍﻟﻤﺒﺎﺸـﺭ ﻟﻠﻁﺎﺨـﺎﺕ ﻤﻠﻭﻨـﺔ‬
‫ﺒﻐﻴﻤﺯﺍ ﻟﺭﺅﻴﺔ ﺍﻟﻌﻨﺎﺼﺭ ﺍﻟﻁﻔﻴﻠﻴﺔ ﻋﺩﻴﻤﺔ ﺍﻟﺴﻭﻁ ‪ ،amastigotes‬ﺃﻭ ﺒﺎﻻﺴـﺘﻨﺒﺎﺕ ﻓـﻲ ﺍﻟﻭﺴـﻁ‬
‫ﺍﻟﺼﻨﻌﻲ ﻟﻤﺸﺎﻫﺩﺓ ﺍﻟﻌﻨﺎﺼﺭ ﺃﻤﺎﻤﻴﺔ ﺍﻟﺴﻭﻁ ‪ promastigotes‬ﺒﻌﺩ ‪ 24‬ﺇﻟﻰ ‪ 48‬ﺴﺎﻋﺔ )‪.(4 ،3 ،2‬‬
‫ﻭﺘﻌﺩ ﻁﺭﻴﻘﺔ ﺍﻻﺴﺘﻨﺒﺎﺕ ﺃﻜﺜﺭ ﺤﺴﺎﺴﻴﺔ ﻤﻥ ﺍﻟﻔﺤﺹ ﺍﻟﻤﺠﻬﺭﻱ ﺍﻟﻤﺒﺎﺸﺭ‪ ،‬ﻷﻨﻬـﺎ ﺘـﺴﻤﺢ ﺒـﺈﺠﺭﺍﺀ‬
‫ﺩﺭﺍﺴﺎﺕ ﻨﻭﻋﻴﺔ ﻟﻁﻔﻴﻠﻲ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ )‪ (3‬ﺇﻻ ﺃﻨﻬﺎ ﻤﻜﻠﻔﺔ ﻭﺼﻌﺒﺔ‪ ،‬ﻭﺘﺤﺘﺎﺝ ﺇﻟﻰ ﻭﻗﺕ ﻁﻭﻴل )‪،4 ،3‬‬
‫‪.(6 ،5‬‬
‫ﻟﺫﻟﻙ ﻜﺎﻥ ﻻ ﺒﺩ ﻤﻥ ﺍﻋﺘﻤﺎﺩ ﻁﺭﺍﺌﻕ ﺘﺸﺨﻴﺼﻴﺔ ﺃﺨﺭﻯ ﺃﻜﺜﺭ ﻓﺎﻋﻠﻴﺔ ﺘﻔﻴﺩ ﻓـﻲ ﺍﻟﻜـﺸﻑ ﻋـﻥ‬
‫ﺍﻹﺼﺎﺒﺔ ﺒﺩﺍﺀ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺨﺎﺼﺔ ﺒﺎﻟﻨﺴﺒﺔ ﻟﻠﺤﺎﻻﺕ ﺍﻟﻤﺸﻜﻭﻙ ﺒﻬﺎ ﻭﺍﻟﺘـﻲ ﺘﻌﻁـﻲ ﻨﺘﻴﺠـﺔ ﺴـﻠﺒﻴﺔ‬
‫ﺒﺎﻟﻁﺭﺍﺌﻕ ﺍﻟﺘﻘﻠﻴﺩﻴﺔ ﺁﻨﻔﺔ ﺍﻟﺫﻜﺭ )‪ .(8 ،4‬ﺤﻴﺙ ﻁﺒﻘﺕ ﻓﻲ ﺍﻟﻔﺘﺭﺓ ﺍﻷﺨﻴﺭﺓ ﻋﺩﺓ ﺍﺨﺘﺒﺎﺭﺍﺕ ﻤﻨﺎﻋﻴـﺔ‬
‫ﻤﺼﻠﻴﺔ ﺒﺎﺴﺘﺨﺩﺍﻡ ﺨﻼﺼﺎﺕ ﻁﻔﻴﻠﻴﺔ ﺨﺎﻡ‪ ،‬ﺴﺎﻋﺩﺕ ﻓﻲ ﺍﻟﻜﺸﻑ ﻋﻥ ﺃﻀﺩﺍﺩ ﺍﻟﻠﻴـﺸﻤﺎﻨﻴﺔ ﺍﻟﻨﻭﻋﻴـﺔ‬
‫ﺍﻟﻤﺘﺸﻜﻠﺔ ﻓﻲ ﻤﺼل ﺍﻟﻤﺼﺎﺒﻴﻥ ﺒﻬﺫﺍ ﺍﻟﺩﺍﺀ )ﺍﻟﻌﺭﻀﻴﻴﻥ ﻭﺍﻟﻼﻋﺭﻀﻴﻴﻥ( ﻭﻓﻲ ﺘﺤﺩﻴـﺩ ﻗـﻴﻡ ﺸـﺩﺓ‬
‫ﺍﻻﻤﺘﺼﺎﺼﻴﺔ ﺍﻟﻀﻭﺌﻴﺔ ﺃﻭ ﺘﺤﺩﻴﺩ ﺘﺭﻜﻴﺯﻫﺎ‪.‬‬
‫ﻓﻘﺩ ﺍﺴﺘﺨﺩﻤﺕ ﺍﺨﺘﺒﺎﺭﺍﺕ ﺍﻟﺘﺄﻟﻕ ﺍﻟﻤﻨﺎﻋﻲ ‪ IFA‬ﻭﺍﻟﺘﺭﺍﺹ ﺍﻟﻤﺒﺎﺸﺭ ‪ DAT‬ﻭﺍﻟﻤﻘﺎﻴﺴﺔ ﺍﻟﻤﻨﺎﻋﻴﺔ‬
‫ﺍﻷﻨﺯﻴﻤﻴﺔ ‪ ELISA‬ﻭﺍﻟﺘﺒﺼﻴﻡ ﺍﻟﻤﻨﺎﻋﻲ ‪ IB‬ﺍﺴﺘﺨﺩﺍﻤﹰﺎ ﻜﺒﻴﺭﹰﺍ ﻓﻲ ﺘﺸﺨﻴﺹ ﺍﻹﺼﺎﺒﺔ ﺒﺩﺍﺀ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ‬
‫ﺍﻟﺤﺸﻭﻱ ﺒﺴﺒﺏ ﺍﻟﻤﻌﺩﻻﺕ ﺍﻟﻤﺭﺘﻔﻌﺔ ﻤﻥ ﺍﻷﻀﺩﺍﺩ ﺍﻟﻨﻭﻋﻴﺔ ﺍﻟﻤﺘﺸﻜﻠﺔ ﻓﻲ ﻤﺼﻭل ﺍﻟﻤﺼﺎﺒﻴﻥ )ﻤﻥ ‪9‬‬
‫ﺇﻟﻰ ‪ (17‬ﻭﺒﺸﻜل ﺃﻗل ﻓﻲ ﺘﺸﺨﻴﺹ ﺍﻹﺼﺎﺒﺔ ﺒﺩﺍﺀ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠﺩﻱ ﺒﺴﺒﺏ ﺍﻟﻨـﺴﺒﺔ ﺍﻟﻤﻨﺨﻔـﻀﺔ‬
‫ﻟﻸﻀﺩﺍﺩ )ﻤﻥ ‪ 18‬ﺇﻟﻰ ‪. (24‬‬
‫ﻟﻘﺩ ﻫﺩﻓﺕ ﻫﺫﻩ ﺍﻟﺩﺭﺍﺴﺔ ﺍﻷﻭﻟﻴﺔ ﺍﻟﺘﻲ ﺘﺠﺭﻱ ﺃﻭل ﻤﺭﺓ ﻓﻲ ﺴﻭﺭﻴﺔ‪ ،‬ﻟﻠﻜﺸﻑ ﻋـﻥ ﺍﻷﻀـﺩﺍﺩ‬
‫ﺍﻟﻨﻭﻋﻴﺔ )‪ (IgG‬ﻟﺩﺍﺀ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠﺩﻱ ﻓﻲ ﻤﺼﻭل ﺍﻟﻤـﺼﺎﺒﻴﻥ ﻭﺍﻟﻤـﺸﻜﻭﻙ ﺒﺈﺼـﺎﺒﺘﻬﻡ ﻋـﻥ‬
‫ﻁﺭﻴﻕ ﻗﻴﺎﺱ ﺸﺩﺓ ﺍﻻﻤﺘﺼﺎﺼﻴﺔ ﺍﻟﻀﻭﺌﻴﺔ )‪ (Optic Density‬ﺒﺘﻁﺒﻴﻕ ﺍﺨﺘﺒﺎﺭ ﺍﻟﻤﻘﺎﻴﺴﺔ ﺍﻟﻤﻨﺎﻋﻴﺔ‬

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 ‫ﺩﺭﺍﺴﺔ ﺘﺸﺨﻴﺼﻴﺔ ﻤﺼﻠﻴﺔ ﺃﻭﻟﻴﺔ ﻟﺩﻋﻡ ﺍﻟﻁﺭﺍﺌﻕ ﺍﻟﺘﻘﻠﻴﺩﻴﺔ ﻟﻠﻜﺸﻑ ﻋﻥ ﺩﺍﺀ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ …‬ ‫ﺸﻌﺒﺎﻥ ﻭﺤﻤﻭﺩ ﻭﻨﺤﺎﺱ ـ‬

‫ﺍﻷﻨﺯﻴﻤﻴﺔ ﺘﻤﻬﻴﺩﹰﺍ ﻻﻋﺘﻤﺎﺩﻫﺎ ﻜﻁﺭﻴﻘﺔ ﺘﺸﺨﻴﺼﻴﺔ ﻤﻨﺎﻋﻴﺔ ﻤﺴﺎﻋﺩﺓ ﺘﻔﻴﺩ ﻓﻲ ﺍﻟﻜﺸﻑ ﻋﻥ ﺍﻹﺼـﺎﺒﺔ‬
‫ﺒﻬﺫﺍ ﺍﻟﺩﺍﺀ‪.‬‬
‫ﻤـﻭﺍﺩ ﺍﻟﺒﺤـﺙ ﻭﻁﺭﺍﺌﻘﻪ‬
‫ﺍﻟﻔﺤﺹ ﺍﻟﻤﺠﻬﺭﻱ ﺍﻟﻤﺒﺎﺸﺭ‪:‬‬
‫ﻗﻤﻨﺎ ﺒﺈﺠﺭﺍﺀ ﻫﺫﺍ ﺍﻟﻔﺤﺹ ﻋﻠﻰ ‪ 270‬ﺤﺎﻟﺔ ﻤﻥ ﺍﻟﺤﺎﻻﺕ ﺍﻟﺘﻲ ﺭﺍﺠﻌﺕ ﻤﺸﻔﻰ ﺍﻷﻤـﺭﺍﺽ‬
‫ﺍﻟﺠﻠﺩﻴﺔ ﻭﺍﻟﺯﻫﺭﻴﺔ ﺒﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ‪ ،‬ﺨﻼل ﻋﺎﻡ ‪ 2002‬ﻭﻓﻘﹰﺎ ﻟﻠﻁﺭﻴﻘﺔ ﺍﻟﻤﺫﻜﻭﺭﺓ ﻓـﻲ ﺩﺭﺍﺴـﺔ‬
‫‪ Shaaban‬ﻭﺯﻤﻼﺌﻪ ﻋﺎﻡ ‪. (4) 2003‬‬
‫ﺍﻻﺴـﺘﻨﺒﺎﺕ‪:‬‬
‫ﺘﻡ ﻋﺯل ﻁﻔﻴﻠﻴﺎﺕ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﻭﺍﺴﺘﻨﺒﺎﺘﻬﺎ )ﻤﻥ ﺠﻤﻴﻊ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺩﺭﻭﺴﺔ ﺇﻴﺠﺎﺒﻴﺔ ﺍﻟﻔﺤـﺹ‬
‫ﺍﻟﻤﺒﺎﺸﺭ ﻭﺴﻠﺒﻴﺘﻪ( ﻋﻠﻰ ﺍﻟﻭﺴﻁ ‪ NNN‬ﺘﻤﻬﻴﺩﹰﺍ ﻟﻠﺘﻔﺘﻴﺵ ﻋﻥ ﺍﻟﻌﻨﺎﺼﺭ ﺍﻟﻤﻐﺯﻟﻴﺔ ﺃﻤﺎﻤﻴﺔ ﺍﻟـﺴﻭﻁ‬
‫ﺒﻌﺩ ‪ 24‬ﺇﻟﻰ ‪ 48‬ﺴﺎﻋﺔ ﻜﻤﺎ ﻭﺭﺩ ﻓﻲ ﺩﺭﺍﺴﺔ ‪ Shaaban‬ﻭﺯﻤﻼﺌﻪ ﻋﺎﻡ ‪. (4) 2003‬‬
‫ﺍﻷﻤﺼـﺎل‪:‬‬
‫ﺘﻡ ﺍﻟﺤﺼﻭل ﻋﻠﻰ ﻋﻴﻨﺔ ﻤﺼﻠﻴﺔ ﻤﻥ ﻜل ﺤﺎﻟﺔ ﻤﻥ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺩﺭﻭﺴﺔ )ﺴـﻠﺒﻴﺔ ﺍﻟﻔﺤـﺹ‬
‫ﺍﻟﻤﺠﻬﺭﻱ ﻭﺇﻴﺠﺎﺒﻴﺘﻪ ﻭ‪ /‬ﺃﻭ ﺍﻻﺴﺘﻨﺒﺎﺕ(‪ .‬ﻜﻤﺎ ﺘﻡ ﺍﻟﺤﺼﻭل ﻋﻠﻰ ﺃﻤﺼﺎل ﻤﻥ ﺃﺸﺨﺎﺹ ﺃﺼﺤﺎﺀ‬
‫)ﻋﺩﺩ ‪ (20‬ﻟﻡ ﻴﺘﻌﺭﻀﻭﺍ ﻟﻺﺼﺎﺒﺔ ﺴﺎﺒﻘﹰﺎ ﻭ ﻴﻘﻁﻨﻭﻥ ﻓﻲ ﻤﻨﺎﻁﻕ ﻏﻴـﺭ ﻤﻭﺒـﻭﺀﺓ ﺒﺎﻟﻠﻴـﺸﻤﺎﻨﻴﺔ‬
‫ﺍﻟﺠﻠﺩﻴﺔ ﻜﺸﺎﻫﺩ ﺴﻠﺒﻲ‪ .‬ﺤﻔﻅﺕ ﺠﻤﻴﻊ ﺍﻷﻤﺼﺎل ﻓﻲ ﺍﻟﺩﺭﺠﺔ –‪ 20‬ﻤﺌﻭﻴﺔ ﺇﻟﻰ ﺤﻴﻥ ﺍﻻﺴﺘﻌﻤﺎل‪.‬‬
‫ﺍﻟﻤﻘﺎﻴﺴﺔ ﺍﻟﻤﻨﺎﻋﻴﺔ ﺍﻷﻨﺯﻴﻤﻴﺔ ‪:ELISA‬‬
‫ﺃﺠﺭﻱ ﻫﺫﺍ ﺍﻻﺨﺘﺒﺎﺭ ﺃﻭل ﻤﺭﺓ ﻓﻲ ﺴﻭﺭﻴﺔ‪ ،‬ﻭﺍﺴﺘﺨﺩﻡ ﻓﻴﻪ ﺍﻟﻜﺎﺸـﻑ ‪(Leismmaniasis-‬‬
‫)‪ IgG-CELISA, CELLABS‬ﺍﻟﺨﺎﺹ ﺒﺎﻟﻜﺸﻑ ﻋﻥ ﺍﻷﻀﺩﺍﺩ ﺍﻟﻨﻭﻋﻴﺔ ﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠﺩﻴـﺔ‬
‫ﻓﻲ ﻤﺼﻭل ﺍﻟﻤﺭﻀﻰ ﺍﻟﻤﺼﺎﺒﻴﻥ ﺒﺄﺤﺩ ﺃﺸﻜﺎل ﺩﺍﺀ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠﺩﻱ ﺃﻭ ﺍﻟﺠﻠـﺩﻱ ﺍﻟﻤﺨـﺎﻁﻲ‬
‫)‪ .(23, 21‬ﻓﻘﺩ ﺘﻡ ﺤﻀﻥ ﺼﻔﺎﺌﺢ ﺍﻹﻟﻴﺯﺍ ﺍﻟﻤﻌﻠﻤﺔ ﺒﻤﺴﺘﻀﺩﺍﺕ ﺍﻷﺸﻜﺎل ﺍﻟﻤﺴﻭﻁﺔ ﻟﻁﻔﻴﻠﻴـﺎﺕ‬
‫ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠﺩﻴﺔ ﻤﻊ ﻋﻴﻨﺎﺕ ﺍﻟﻤﺼل ﺍﻟﺒﺸﺭﻴﺔ )ﺃﺼﺤﺎﺀ ﻭﻤﺼﺎﺒﻴﻥ( ﺍﻟﻤﻤﺩﺩﺓ ﺒﺩﺍﺭﺌـﺔ ﺍﻟﻌﻴﻨـﺔ‬
‫‪ 1:100‬ﻤﺩﺓ ﺴﺎﻋﺘﻴﻥ ﺒﺩﺭﺠﺔ ﺤﺭﺍﺭﺓ ﺍﻟﻐﺭﻓﺔ ﻭﻓﻲ ﻤﻜﺎﻥ ﺭﻁﺏ ﺜﻡ ﻏﺴﻠﺕ ﺍﻟﺼﻔﺎﺌﺢ ‪ 4‬ﻤـﺭﺍﺕ‬
‫ﺒﺩﺍﺭﺌﺔ ﺍﻟﻐﺴﻴل ﺘﻤﻬﻴﺩﹰﺍ ﻟﺤﻀﻨﻬﺎ ﻤﻊ ﻀﺩ – ‪ IgG‬ﺍﻟﺒﺸﺭﻱ ﺍﻟﻤﻌﻠﹼﻡ ﺒﺎﻟﺒﻴﺭﻭﻜﺴﻴﺩﺍﺯ ﻤﺩﺓ ﻨـﺼﻑ‬
‫ﺴﺎﻋﺔ ﻭ ﺒﺎﻟﺸﺭﻭﻁ ﺍﻟﺴﺎﺒﻘﺔ ﻨﻔﺴﻬﺎ ﻟﻠﺤﻀﻥ‪ .‬ﻭﺒﻌﺩ ﺘﻜﺭﺍﺭ ﻋﻤﻠﻴﺔ ﺍﻟﻐﺴل ‪ 4‬ﻤﺭﺍﺕ ﺃﻀﻴﻑ ﺇﻟﻴﻬﺎ‬
‫ﺍﻟﺭﻜﻴﺯﺓ ﺍﻷﻨﺯﻴﻤﻴﺔ ﻭﺘﺭﻜﺕ ﻤﺩﺓ ﻨﺼﻑ ﺴﺎﻋﺔ ﻓﻲ ﺍﻟﻅﻼﻡ ﺒﺩﺭﺠﺔ ﺤﺭﺍﺭﺓ ﺍﻟﻐﺭﻓﺔ‪ .‬ﺘﻡ ﻗﺭﺍﺀﺓ ﻫﺫﻩ‬
‫ﺍﻟﺼﻔﺎﺌﺢ ﺒﻌﺩ ﺇﻴﻘﺎﻑ ﺍﻟﺘﻔﺎﻋل ﺒﺈﻀﺎﻓﺔ ﺤﻤﺽ ﺍﻟﻔﻭﺴﻔﺎﺕ )‪ ،(1M‬ﺒﺎﺴـﺘﺨﺩﺍﻡ ﻗـﺎﺭﺉ ﺍﻹﻟﻴـﺯﺍ‬
‫)‪ (Digiscan‬ﻭﻋﻠﻰ ﻁﻭل ﻤﻭﺠﺔ ﻗﺩﺭﻩ ‪ 450‬ﻨﺎﻨﻭﻤﺘﺭﹰﺍ‪ .‬ﻭﻗﺩ ﺍﻋﺘﻤﺩﺕ ﻗﻴﻤﺔ ﺸﺩﺓ ﺍﻻﻤﺘﺼﺎﺼﻴﺔ‬
‫ﺍﻟﻀﻭﺌﻴﺔ ‪ OD = 0.2 nm‬ﻫﻲ ﺍﻟﺤﺩ ﺍﻟﻔﺎﺼل ‪ Cutoff‬ﺒﻴﻥ ﺩﺭﺠﺔ ﺍﻹﻴﺠﺎﺒﻴﺔ ﻭﺍﻟﺴﻠﺒﻴﺔ ﻟﻠﻌﻴﻨﺎﺕ‬
‫ﺍﻟﻤﻔﺤﻭﺼﺔ‪.‬‬

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 ‫ﻤﺠﻠﺔ ﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ ﻟﻠﻌﻠﻭﻡ ﺍﻷﺴﺎﺴﻴﺔ ـ ﺍﻟﻤﺠﻠﺩ )‪ (20‬ـ ﺍﻟﻌﺩﺩ ﺍﻷﻭل ـ ‪2004‬‬

‫ﺍﻟﺘﺤﻠﻴـل ﺍﻹﺤﺼﺎﺌـﻲ‪:‬‬
‫ﺘﻡ ﺘﻁﺒﻴﻕ ﺩﺭﺍﺴﺔ ﺇﺤﺼﺎﺌﻴﺔ ﺒﺎﻻﻋﺘﻤـﺎﺩ ﻋﻠـﻰ ﺍﺨﺘﺒـﺎﺭ ‪ Z‬ﺒـﻴﻥ ﻨـﺴﺒﺘﻴﻥ ‪(Z test for‬‬
‫)‪ differences in two proportions‬ﻤﻥ ﺃﺠل ﺒﻴﺎﻥ ﻫل ﻜﺎﻨﺕ ﺍﻟﻔـﺭﻭﻕ ﺍﻟﻤﻼﺤﻅـﺔ ﺒـﻴﻥ‬
‫ﺍﻻﺨﺘﺒﺎﺭﺍﺕ ﺍﻟﺜﻼﺙ ﺍﻟﻤﺴﺘﺨﺩﻤﺔ ﻤﻌﻨﻭﻴﺔ ﺃﻡ ﻻ؟‪ .‬ﻜﻤﺎ ﺘﻡ ﺤﺴﺎﺏ ﺤﺩﻭﺩ ﺍﻟﺜﻘﺔ ﻟﻠﻨـﺴﺒﺔ ﺍﻟﻤﺌﻭﻴـﺔ‬
‫ﻭﺍﻟﺨﻁﺄ ﺍﻟﻤﻌﻴﺎﺭﻱ ﻟﻬﺎ‪ .‬ﻭﺩﺭﺱ ﻤ‪‬ﻌﺎﻤل ﺍﻻﺭﺘﺒﺎﻁ ﺒﻴﻥ ﻨﺘﺎﺌﺞ ﺍﺨﺘﺒـﺎﺭ ‪ ELISA‬ﻭﻋﻤـﺭ ﺍﻵﻓـﺔ‬
‫ﺍﻟﺠﻠﺩﻴﺔ ﻭﻋﺩﺩﻫﺎ‪.‬‬
‫ﺍﻟﻨﺘﺎﺌـﺞ ﻭﺍﻟﻤﻨـﺎﻗﺸـﺔ‬
‫ﺇﻥ ﺍﻟﻁﺭﺍﺌﻕ ﺍﻟﺘﻘﻠﻴﺩﻴﺔ ﺍﻟﻤﻌﺘﻤﺩﺓ ﻓﻲ ﺘﺸﺨﻴﺹ ﺍﻹﺼﺎﺒﺔ ﺒﺩﺍﺀ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠﺩﻱ ﻓﻲ ﺴﻭﺭﻴﺔ‬
‫ﻜﻤﺎ ﻫﻭ ﺍﻟﺤﺎل ﻓﻲ ﺃﻏﻠﺏ ﺍﻟﺒﻠﺩﺍﻥ‪ ،‬ﻫﻲ ﺘﺤﺭﻱ ﺍﻟﻁﻔﻴﻠﻴﺎﺕ ﻋﺩﻴﻤﺔ ﺍﻟﺴﻭﻁ ﻓﻲ ﻟﻁﺎﺨﺔ ﻤﻥ ﺍﻵﻓـﺔ‬
‫ﺍﻟﻤﺸﻜﻭﻙ ﺒﻬﺎ ﺃﻭ ﺍﺴﺘﻨﺒﺎﺕ ﺭﺸﺎﻓﺔ ﻤﻥ ﺤﺎﻓﺔ ﺍﻹﺼﺎﺒﺔ ﻟﺭﺅﻴﺔ ﺍﻟﻌﻨﺎﺼﺭ ﺍﻟﻤﻐﺯﻟﻴﺔ ﺃﻤﺎﻤﻴﺔ ﺍﻟﺴﻭﻁ‬
‫ﺒﻌﺩ ‪ 48-24‬ﺴﺎﻋﺔ‪ ،‬ﻋﻠﻰ ﺍﻟﺭﻏﻡ ﻤﻥ ﻗﻠﺔ ﺤﺴﺎﺴﻴﺘﻬﺎ ﺃﺤﻴﺎﻨﹰﺎ )ﺨﺎﺼـﺔ ﻋﻨـﺩﻤﺎ ﻴﻜـﻭﻥ ﻋـﺩﺩ‬
‫ﺍﻟﻁﻔﻴﻠﻴﺎﺕ ﻤﺤﺩﻭﺩﹰﺍ ﺠﺩﹰﺍ( ﻭ ﺤﺎﺠﺘﻬﺎ ﻟﻭﻗﺕ ﻁﻭﻴل )‪.(8 ،7 ،6‬‬
‫ﻓﻘﺩ ﺃﺠﺭﻴﻨﺎ ﻫﺫﻩ ﺍﻟﺩﺭﺍﺴﺔ ﻓﻲ ﻤﺸﻔﻰ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺠﻠﺩﻴﺔ ﻭﺍﻟﺯﻫﺭﻴﺔ ﺒﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ‪ ،‬ﻋﻠـﻰ‬
‫‪ 270‬ﻤﺼﺎﺒﹰﺎ ﻤﻨﻬﻡ ‪ 168‬ﺫﻜﺭﹰﺍ ‪ % 62.2‬ﻭ‪ 102‬ﺃﻨﺜﻰ ‪ .% 37.8‬ﺘﺭﺍﻭﺤﺕ ﺃﻋﻤـﺎﺭ ﻫـﺅﻻﺀ‬
‫ﺍﻟﻤﺼﺎﺒﻴﻥ‪ ،‬ﺍﻟﺫﻴﻥ ﻴﻘﻁﻨﻭﻥ ﻓﻲ ﺃﻤﺎﻜﻥ ﻋﺩﻴﺩﺓ )ﺩﻤﺸﻕ ﻭﺭﻴﻔﻬـﺎ‪ ،‬ﺤﻠـﺏ‪ ،‬ﺇﺩﻟـﺏ‪ ،‬ﺍﻟﻼﺫﻗﻴـﺔ‪،‬‬
‫ﻁﺭﻁﻭﺱ‪ ،‬ﺤﻤﺎﺓ( ﻤﺎ ﺒﻴﻥ ‪ 60 -10‬ﺴﻨﺔ‪.‬‬
‫ﻓﺒﻌﺩ ﺘﺤﺭﻱ ﺍﻟﻌﻨﺎﺼﺭ ﺍﻟﻁﻔﻴﻠﻴﺔ ﺍﻟﺩﺍﺨل ﺨﻠﻭﻴﺔ ﻓﻲ ﻟﻁﺎﺨﺔ ﻤﺄﺨﻭﺫﺓ ﻤـﻥ ﺍﻵﻓـﺎﺕ ﻟﺠﻤﻴـﻊ‬
‫ﺍﻟﻤﺼﺎﺒﻴﻥ‪ ،‬ﻭﺍﺴﺘﻨﺒﺎﺕ ﺭﺸﺎﻓﺔ ﻤﻥ ﺤﺎﻓﺔ ﺍﻵﻓﺔ ﻋﻠـﻰ ﺍﻟﻭﺴـﻁ ﺍﻟـﺼﻨﻌﻲ‪ ،NNN‬ﺘﺒـﻴﻥ ﺃﻥ‬
‫‪ 270/225‬ﺤﺎﻟﺔ )‪ (%83.3‬ﻜﺎﻨﺕ ﺇﻴﺠﺎﺒﻴﺔ ﻓﻲ ﺍﻟﻔﺤـﺹ ﺍﻟﻤﺠﻬـﺭﻱ ﺍﻟﻤﺒﺎﺸـﺭ ﻭ‪ /‬ﺃﻭ ﻓـﻲ‬
‫ﺍﻻﺴﺘﻨﺒﺎﺕ ﻋﻠﻰ ﺍﻟﻭﺴﻁ ﺍﻟﺼﻨﻌﻲ‪ .‬ﻭﻗﺩ ﺘﻭﺍﻓﻘﺕ ﻫﺫﻩ ﺍﻟﻨﺘﻴﺠﺔ ﻤﻊ ﺍﻟﻌﺩﻴﺩ ﻤﻥ ﻨﺘـﺎﺌﺞ ﺍﻟﺩﺭﺍﺴـﺎﺕ‬
‫ﺍﻟﺘﻲ ﺍﻋﺘﻤﺩﺕ ﻓﻲ ﺘﺸﺨﻴﺼﻬﺎ ﻋﻠﻰ ﻫﺫﻩ ﺍﻟﻁﺭﺍﺌﻕ‪ ،‬ﻭﺃﻜﺩﺕ ﻀﺭﻭﺭﺓ ﺇﺠﺭﺍﺀ ﻫﺎﺘﻴﻥ ﺍﻟﻁـﺭﻴﻘﺘﻴﻥ‬
‫)ﺍﻟﻔﺤﺹ ﺍﻟﻤﺠﻬﺭﻱ ﺍﻟﻤﺒﺎﺸﺭ ﻭﺍﻻﺴﺘﻨﺒﺎﺕ( ﺒﺂﻥ ﻭﺍﺤﺩ ﻟﺘﺄﻜﻴﺩ ﺍﻹﺼﺎﺒﺔ ﺒﺩﺍﺀ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠـﺩﻱ‬
‫)‪ .(8 ،7 ،6 ،4‬ﺃﻤﺎ ﺒﺎﻗﻲ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺩﺭﻭﺴﺔ ﻭﺍﻟﺘﻲ ﻴﺒﻠﻎ ﻋﺩﺩﻫﺎ ‪ 270/45‬ﺤﺎﻟـﺔ ‪% 16.7‬‬
‫ﻓﺒﻘﻴﺕ ﺴﻠﺒﻴﺔ‪ ،‬ﻋﻠﻰ ﺍﻟﺭﻏﻡ ﻤﻥ ﻤﻌﺎﻨﺎﺓ ﻫﺅﻻﺀ ﺍﻟﻤﺼﺎﺒﻴﻥ ﻤﻥ ﺁﻓـﺎﺕ ﺠﻠﺩﻴـﺔ ﻟﻬـﺎ ﺍﻟﻌﻼﻤـﺎﺕ‬
‫ﺍﻟﺴﺭﻴﺭﻴﺔ ﻨﻔﺴﻬﺎ ﻟﺩﺍﺀ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠﺩﻱ ﻭﻴﻘﻁﻨﻭﻥ ﻓﻲ ﻤﻨﺎﻁﻕ ﻤﻭﺒﻭﺀﺓ ﺒﻬﺫﺍ ﺍﻟﺩﺍﺀ )‪.(25 ،4‬‬
‫ﻟﺫﻟﻙ ﻭﻟﺘﻔﺭﻴﻕ ﺍﻹﺼﺎﺒﺔ ﺒﺩﺍﺀ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠﺩﻱ ﻋﻥ ﺃﻤـﺭﺍﺽ ﺠﻠﺩﻴـﺔ ﺃﺨـﺭﻯ )ﺍﻟـﺫﺃﺏ‬
‫ﺍﻟﺤﻤﺎﻤﻲ‪ ،‬ﺍﻟﺴﺎﺭﻜﻭﺌﻴﺩ‪ ،‬ﺍﻹﻓﺭﻨﺠﻲ‪ ،‬ﺍﻟﻔﻁﺎﺭ ﺍﻟﺒﺭﻋﻤﻲ( ﺘﺸﺒﻪ ﺴﺭﻴﺭﻴﹰﺎ ﻫـﺫﺍ ﺍﻟـﺩﺍﺀ ﻟﺘﻤﻴ‪‬ﺯﻫـﺎ‬
‫ﺒﻅﻬﻭﺭ ﻗﺭﺤﺎﺕ ﺠﻠﺩﻴﺔ ﻤﺯﻤﻨﺔ ﻏﻴﺭ ﻤﺅﻟﻤﺔ )‪ ،(26‬ﻜﺎﻥ ﻻ ﺒﺩ ﻤﻥ ﺘﻁﺒﻴﻕ ﻁﺭﺍﺌﻕ ﺘﺸﺨﻴـﺼﻴﺔ‬
‫ﺃﺨﺭﻯ ﺘﻌﺘﻤﺩ ﻋﻠﻰ ﻜﺸﻑ ﺍﻷﻀﺩﺍﺩ ﺍﻟﻨﻭﻋﻴﺔ ﺍﻟﺨﺎﺼﺔ ﺒﺎﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠﺩﻴﺔ‪ .‬ﺤﻴﺙ ﺘ ‪‬ﻡ ﺍﻟﺘﺄﻜﻴﺩ ﻋﻠﻰ‬
‫ﻭﺠﻭﺩ ﺩﺭﺠﺔ ﻤﻥ ﺍﻻﺴﺘﺠﺎﺒﺔ ﺍﻟﻤﻨﺎﻋﻴﺔ ﻟﺩﻯ ﺍﻟﻤﺼﺎﺒﻴﻥ ﺒﺩﺍﺀ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠﺩﻱ ﺘﺘﺠﻠﻰ ﺒﻅﻬﻭﺭ‬
‫ﺍﻷﺠﺴﺎﻡ ﺍﻟﻀﺩﻴﺔ ﺍﻟﻤﻔﺭﺯﺓ )‪/Th2‬ﺨﻠﻁﻴﺔ( ﻓﻲ ﻤﺼﻭﻟﻬﻡ ﻭﺫﻟﻙ ﺒﺘﻁﺒﻴـﻕ ﺍﺨﺘﺒـﺎﺭﺍﺕ ﻤﻨﺎﻋﻴـﺔ‬

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 ‫ﺩﺭﺍﺴﺔ ﺘﺸﺨﻴﺼﻴﺔ ﻤﺼﻠﻴﺔ ﺃﻭﻟﻴﺔ ﻟﺩﻋﻡ ﺍﻟﻁﺭﺍﺌﻕ ﺍﻟﺘﻘﻠﻴﺩﻴﺔ ﻟﻠﻜﺸﻑ ﻋﻥ ﺩﺍﺀ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ …‬ ‫ﺸﻌﺒﺎﻥ ﻭﺤﻤﻭﺩ ﻭﻨﺤﺎﺱ ـ‬

‫ﻤﺨﺘﻠﻔﺔ ﻤﺜل ﺍﻟﺘﺄﻟﻕ ﺍﻟﻤﻨﺎﻋﻲ ﻭﺍﻹﻟﻴـﺯﺍ ﻭﺍﻟﺘﺒـﺼﻴﻡ ﺍﻟﻤﻨـﺎﻋﻲ )‪،23 ،22 ،21 ،19،20 ،18‬‬
‫‪.(24‬‬
‫ﻭﺍﻋﺘﻤﺎﺩﹰﺍ ﻋﻠﻰ ﺫﻟﻙ ﻗﻤﻨﺎ ﺒﺘﻁﺒﻴﻕ ﺍﺨﺘﺒﺎﺭ ﺍﻟﻤﻘﺎﻴﺴﺔ ﺍﻟﻤﻨﺎﻋﻴﺔ ﺍﻷﻨﺯﻴﻤﻴﺔ ‪ ELISA‬ﻋﻠﻰ ﺠﻤﻴﻊ‬
‫ﻼ ﺒﺎﺴﺘﺨﺩﺍﻡ ﻜﺎﺸـﻑ ﺃﻀـﺩﺍﺩ‬ ‫ﺍﻟﻌﻴﻨﺎﺕ ﺍﻟﻤﺼﻠﻴﺔ ﺍﻟﻤﺄﺨﻭﺫﺓ ﻤﻥ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺩﺭﻭﺴﺔ ‪ 270‬ﻤﺼ ﹰ‬
‫ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠﺩﻴﺔ ﻭﻋﻠﻰ ‪ 20‬ﻋﻴﻨﺔ ﺸﺎﻫﺩﺓ‪ .‬ﻭﻗﺩ ﺍﻋﺘﻤﺩﺕ ﻗﻴﻤﺔ ﺸﺩﺓ ﺍﻻﻤﺘﺼﺎﺼﻴﺔ ‪OD = 0.2‬‬
‫‪ nm‬ﻜﻨﻘﻁﺔ ﻓﺼل ﺒﻴﻥ ﺇﻴﺠﺎﺒﻴﺔ ﺍﻟﻌﻴﻨﺔ ﻭﺴﻠﺒﻴﺘﻬﺎ ﺒﻨﺎﺀ ﻋﻠﻰ ﺍﻟﻜﺎﺸﻑ ﺍﻟﻤﺴﺘﺨﺩﻡ‪ ،‬ﻓﺠﻤﻴـﻊ ﺍﻟﻘـﻴﻡ‬
‫ﺍﻷﻗل ﻤﻥ ‪ 0.2‬ﻫﻲ ﻋﻴﻨﺎﺕ ﺴﻠﺒﻴﺔ ﻓﻲ ﺤﻴﻥ ﺍﻟﻘﻴﻡ ﺍﻷﻋﻠﻰ ﻤﻥ ‪ 0.2‬ﻫﻲ ﻋﻴﻨﺎﺕ ﺇﻴﺠﺎﺒﻴﺔ )ﺸـﻜل‬
‫‪.(1‬‬

‫‪1.6‬‬
‫)‪Optical Density ( 450 nm‬‬

‫‪1.4‬‬

‫‪1.2‬‬

‫‪1‬‬

‫‪0.8‬‬

‫‪0.6‬‬

‫‪0.4‬‬

‫‪0.2‬‬

‫‪0‬‬
‫‪Cont‬‬ ‫‪CL‬‬
‫)‪(20‬‬ ‫)‪(270‬‬

‫ﺍﻟﺸﻜل )‪ (1‬ﻴﺒﻴﻥ ﺘﻔﺎﻋل ﻤﺴﺘﻀﺩﺍﺕ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠﺩﻴﺔ ﻤﻊ ‪ 270‬ﻋﻴﻨﺔ ﻤﺩﺭﻭﺴﺔ )‪ (CL‬ﻭ‪ 20‬ﻋﻴﻨﺔ‬
‫ﺸﺎﻫﺩﺓ )‪ (Cont‬ﺍﻟﺨﻁ ﺍﻷﻓﻘﻲ ﻴﺸﻴﺭ ﺇﻟﻰ ﻨﻘﻁﺔ ﺍﻟﻔﺼل ﺒﻴﻥ ﺍﻹﻴﺠﺎﺒﻴﺔ ﻭﺍﻟـﺴﻠﺒﻴﺔ ‪Cut‬‬
‫‪Off = 0.2 nm‬‬

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 ‫ﻤﺠﻠﺔ ﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ ﻟﻠﻌﻠﻭﻡ ﺍﻷﺴﺎﺴﻴﺔ ـ ﺍﻟﻤﺠﻠﺩ )‪ (20‬ـ ﺍﻟﻌﺩﺩ ﺍﻷﻭل ـ ‪2004‬‬

‫ﻭﺒﻨﺎﺀ ﻋﻠﻰ ﺫﻟﻙ ﺤﺼﻠﻨﺎ ﻋﻠﻰ ‪ 270/250‬ﻋﻴﻨﺔ ﻤﺼل ﺇﻴﺠﺎﺒﻴﺔ ﺘﺤﻭﻱ ﺃﺠﺴﺎﻤﹰﺎ ﻀﺩﻴﺔ ﻨﻭﻋﻴـﺔ‬
‫ﻀﺩ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠﺩﻴﺔ‪ ،‬ﺃﻱ ﺒﺯﻴﺎﺩﺓ ‪ 25‬ﺤﺎﻟﺔ ﻋﻥ ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ ﺍﻹﻴﺠﺎﺒﻴﺔ ﺍﻟﺘﻲ ﺤـﺼﻠﻨﺎ ﻋﻠﻴﻬـﺎ‬
‫ﺒــﺎﻟﻁﺭﺍﺌﻕ ﺍﻟﺘﻘﻠﻴﺩﻴــﺔ‪ ،‬ﺃﻤــﺎ ﺒــﺎﻗﻲ ﺍﻟﻌﻴﻨــﺎﺕ ﺍﻟﻤــﺼﻠﻴﺔ ﻭﺍﻟﺘــﻲ ﺒﻠــﻎ ﻋــﺩﺩﻫﺎ‬
‫‪ 20‬ﻓﺒﻘﻴﺕ ﺴﻠﺒﻴﺔ‪ .‬ﻭﻴﻭﻀﺢ ﺍﻟﺠﺩﻭل )‪ (1‬ﺃﻥ ﻓﺭﻭﻕ ﺍﻟﻨﺴﺒﺔ ﻜﺎﻨﺕ ﻜﺒﻴﺭﺓ ﺒـﻴﻥ ﺍﺨﺘﺒـﺎﺭ ﺍﻹﻟﻴـﺯﺍ‬
‫ﻭﺍﻻﺴﺘﻨﺒﺎﺕ ﻭﺍﻟﻔﺤﺹ ﺍﻟﻤﺠﻬﺭﻱ ﺤﻴﺙ ﻫﺫﻩ ﺍﻟﻔﺭﻭﻕ ﻤﻌﻨﻭﻴﺔ ﻋﻨﺩ ﻤﺴﺘﻭﻯ ﺜﻘﺔ ‪. 0.01‬‬

‫ﺍﻟﺠﺩﻭل )‪ (1‬ﻴﺒﻴﻥ ﻓﺭﻭﻕ ﺍﻟﻨﺴﺒﺔ ﺍﻟﻤﺌﻭﻴﺔ ﺒﻴﻥ ﺍﻻﺨﺘﺒﺎﺭﺍﺕ ﺍﻟﺜﻼﺜﺔ ﺍﻟﻤﻁﺒﻘﺔ )ﻤﻊ ﺒﻴﺎﻥ ﻤﺩﻯ ﻤﻌﻨﻭﻴﺘﻬﺎ‬
‫ﺒﺎﻻﻋﺘﻤﺎﺩ ﻋﻠﻰ ﺍﺨﺘﺒﺎﺭ ‪ Z‬ﺒﻴﻥ ﻨﺴﺒﺘﻴﻥ(‪.‬‬
‫ﺨﻁﺄ ﻤﻌﻴﺎﺭﻱ ﻟﻠﻨﺴﺒﺔ‬ ‫‪ %‬ﻟﻺﻴﺠﺎﺒﻴﺔ‬ ‫ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ ‪±‬‬ ‫ﻨﻭﻉ ﺍﻻﺨﺘﺒﺎﺭ‬
‫‪0.02‬‬ ‫‪% 62‬‬ ‫‪7 ± 168‬‬ ‫ﺍﻟﻔﺤﺹ ﺍﻟﻤﺠﻬﺭﻱ‬
‫‪0.02‬‬ ‫‪% 83‬‬ ‫‪6 ± 225‬‬ ‫ﺍﻻﺴﺘﻨﺒﺎﺕ‬
‫‪0.01‬‬ ‫‪% 92.5‬‬ ‫‪4 ± 250‬‬ ‫ﺍﻻﺨﺘﺒﺎﺭ ﺍﻟﻤﺼﻠﻲ‬
‫ﻓﺭﻭﻕ ﺍﻟﻨﺴﺏ ﺍﻟﻤﺌﻭﻴﺔ‬
‫)ﺍﻟﻔﺤﺹ ﺍﻟﻤﺠﻬﺭﻱ‪+‬ﺍﻻﺴﺘﻨﺒﺎﺕ( )ﺍﻟﻔﺤﺹ ﺍﻟﻤﺠﻬﺭﻱ‪ +‬ﺍﻻﺨﺘﺒﺎﺭ ﺍﻟﻤﺼﻠﻲ( )ﺍﻻﺴﺘﻨﺒﺎﺕ ‪+‬ﺍﻻﺨﺘﺒﺎﺭ ﺍﻟﻤﺼﻠﻲ(‬
‫‪%‬‬ ‫‪%‬‬ ‫‪%‬‬
‫**‪9‬‬ ‫**‪30.5‬‬ ‫**‪21‬‬
‫‪P.value = 0.0005‬‬ ‫‪P.value = 0.000‬‬ ‫‪P.value = 0.000‬‬
‫** ﺘﺸﻴﺭ ﺇﻟﻰ ﺍﻟﻔﺭﻭﻕ ﺍﻟﻤﻌﻨﻭﻴﺔ ﻋﻨﺩ ﻤﺴﺘﻭﻯ ﺜﻘﺔ ‪0.01‬‬

‫ﺒﻴﻨﻤﺎ ﻜﺎﻨﺕ ﻨﺘﻴﺠﺔ ﻫﺫﺍ ﺍﻻﺨﺘﺒﺎﺭ ﺍﻟﻤﻁﺒﻕ ﻋﻠﻰ ﺠﻤﻴﻊ ﺍﻟﻤﺼﻭل ﺍﻟﺸﺎﻫﺩﺓ ﺴﻠﺒﻴﺔ ‪ %100‬ﻤﻤـﺎ‬
‫ﻴﺸﻴﺭ ﺇﻟﻰ ﺃﻥ ﺩﺭﺠﺔ ﺤﺴﺎﺴﻴﺔ ﻭﻨﻭﻋﻴﺔ ﻫﺫﺍ ﺍﻻﺨﺘﺒﺎﺭ ﺒﺎﺴﺘﺨﺩﺍﻡ ﻜﺎﺸﻑ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠﺩﻴـﺔ ﻜﺎﻨـﺕ‬
‫ﻤﺭﺘﻔﻌﺔ ﻭﻭﺼﻠﺕ ﺇﻟﻰ ‪ %92.5‬ﻭ‪ %100‬ﻋﻠﻰ ﺍﻟﺘﺭﺘﻴﺏ‪.‬‬
‫ﺇﻥ ﻤﻼﺤﻅﺔ ﺍﻷﻀﺩﺍﺩ ﺨﺎﺼﺔ ﻓﻲ ﻤﺼﻭل ﺍﻟﻤﺭﻀﻰ ﺍﻟﺫﻴﻥ ﻜﺎﻨـﺕ ﻟـﺩﻴﻬﻡ ﻨﺘﻴﺠـﺔ ﺍﻟﻔﺤـﺹ‬
‫ﺍﻟﻤﺠﻬﺭﻱ ﺍﻟﻤﺒﺎﺸﺭ ﻭﺍﻻﺴﺘﻨﺒﺎﺕ ﺴﻠﺒﻴﺔ‪ ،‬ﻋﻠﻰ ﺍﻟﺭﻏﻡ ﻤﻥ ﻭﺠﻭﺩ ﻋﻼﻤﺎﺕ ﺴﺭﻴﺭﻴﺔ ﻭﺍﻀﺤﺔ ﻟﻺﺼﺎﺒﺔ‬
‫ﺒﻬﺫﺍ ﺍﻟﺩﺍﺀ ﻴﺸﻴﺭ ﺇﻟﻰ ﻓﺸل ﺇﻤﻜﺎﻨﻴﺔ ﻋﺯل ﺍﻟﻁﻔﻴﻠﻴﺎﺕ ﻭﺘﻤﻴﻴﺯﻫﺎ ﻓﻲ ﺍﻟﻠﻁﺎﺨﺔ ﺃﻭ ﻓﻲ ﻭﺴﻁ ﺍﻻﺴﺘﻨﺒﺎﺕ‪.‬‬
‫ﻭﻫﺫﺍ ﻴﻌﻭﺩ ﺇﻤﺎ ﺇﻟﻰ ﻗﻠﺔ ﻋﺩﺩ ﺍﻟﻁﻔﻴﻠﻴﺎﺕ ﻓﻲ ﺍﻵﻓﺔ )‪ (7‬ﺃﻭ ﺇﻟﻰ ﺤﺩﻭﺙ ﺘﻠﻭﺙ ﻓﻁﺭﻱ ﺃﻭ ﺒﻜﺘﻴﺭﻱ ﻓﻲ‬
‫ﺃﺜﻨﺎﺀ ﺍﻻﺴﺘﻨﺒﺎﺕ )‪.(27‬‬
‫ﻭﻗﺩ ﺘﻭﺍﻓﻘﺕ ﻨﺘﺎﺌﺠﻨﺎ ﻤﻊ ﻨﺘﺎﺌﺞ ﺍﻟﻌﺩﻴﺩ ﻤﻥ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻟﺘﻲ ﺘﻤﺕ ﻓـﻲ ﻤﺠـﺎل ﺘـﺸﺨﻴﺹ ﺩﺍﺀ‬
‫ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠﺩﻱ ﻭﺩﺭﺍﺴﺔ ﺍﻻﺴﺘﺠﺎﺒﺔ ﺍﻟﻤﻨﺎﻋﻴﺔ ﺍﻟﻀﺩﻴﺔ ﻟﺘﺤﺩﻴﺩ ﺍﻟﻤﺼﺎﺒﻴﻥ ﺃﻭ ﺍﻟـﺫﻴﻥ ﺘﻌﺭﻀـﻭﺍ‬
‫ﻹﺼﺎﺒﺔ ﺴﺎﺒﻘﺔ ﺩﻭﻥ ﺃﻥ ﺘﻅﻬﺭ ﻋﻠﻴﻬﻡ ﺍﻟﻌﻼﻤﺎﺕ ﺍﻟﺴﺭﻴﺭﻴﺔ ﻟﻬﺫﺍ ﺍﻟﺩﺍﺀ‪ ،‬ﺤﻴﺙ ﺘـﻡ ﺍﻟﻜـﺸﻑ ﻋـﻥ‬
‫ﺍﻷﻀﺩﺍﺩ ﺍﻟﻨﻭﻋﻴﺔ ﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠﺩﻴﺔ ﻓﻲ ﻤﺼﻭﻟﻬﻡ ﺒﺘﻁﺒﻴﻕ ﺘﻘﺎﻨﺔ ﺍﻹﻟﻴـﺯﺍ ﻭﺒﺎﺴـﺘﺨﺩﺍﻡ ﺨﻼﺼـﺎﺕ‬

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 ‫ﺩﺭﺍﺴﺔ ﺘﺸﺨﻴﺼﻴﺔ ﻤﺼﻠﻴﺔ ﺃﻭﻟﻴﺔ ﻟﺩﻋﻡ ﺍﻟﻁﺭﺍﺌﻕ ﺍﻟﺘﻘﻠﻴﺩﻴﺔ ﻟﻠﻜﺸﻑ ﻋﻥ ﺩﺍﺀ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ …‬ ‫ﺸﻌﺒﺎﻥ ﻭﺤﻤﻭﺩ ﻭﻨﺤﺎﺱ ـ‬

‫ﻤﻨﺤﻠﺔ ﻟﻸﺸﻜﺎل ﺍﻟﻁﻔﻴﻠﻴﺔ ﺃﻤﺎﻤﻴﺔ ﺍﻟﺴﻭﻁ ﺍﻟﻤﺄﺨﻭﺫﺓ ﻓﻲ ﺍﻟﻴﻭﻡ ﺍﻟﺴﺎﺒﻊ ﻤﻥ ﺍﻻﺴﺘﻨﺒﺎﺕ )‪،22 ،21 ،20‬‬
‫‪.(23‬‬
‫ﻭﻋﻨﺩﻤﺎ ﻗﻤﻨﺎ ﺒﺩﺭﺍﺴﺔ ﺍﻟﻌﻼﻗﺔ ﺒﻴﻥ ﻋﻤﺭ ﺍﻵﻓﺔ ﻭﻗﻴﻡ ﺍﻟﺸﺩﺓ ﺍﻻﻤﺘﺼﺎﺼﻴﺔ ‪ OD‬ﻷﻀﺩﺍﺩ ﺩﺍﺀ‬
‫ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠﺩﻱ ﺘﻡ ﺘﻭﺯﻴﻊ ﺍﻟﺤﺎﻻﺕ ﺍﻹﻴﺠﺎﺒﻴﺔ ﻋﻠﻰ ﻤﺠﻤـﻭﻋﺘﻴﻥ )ﺸـﻜل ‪ :(2‬ﺍﻟﻤﺠﻤﻭﻋـﺔ‬
‫ﺍﻷﻭﻟﻰ )‪ 219‬ﺤﺎﻟﺔ( ﺘﺭﺍﻭﺡ ﻋﻤﺭ ﺍﻵﻓﺔ ﻤﻥ ‪ 1‬ﺇﻟﻰ ‪ 6‬ﺃﺸﻬﺭ‪ ،‬ﺃﻤﺎ ﺍﻟﻤﺠﻤﻭﻋﺔ ﺍﻟﺜﺎﻨﻴﺔ ﻓﻜﺎﻥ ﻋﻤﺭ‬
‫ﺍﻵﻓﺔ ﻓﻴﻬﺎ ﺃﻜﺜﺭ ﻤﻥ ﺴﺘﺔ ﺃﺸﻬﺭ )‪ 31‬ﺤﺎﻟﺔ ﻤﻥ ﺒﻴﻨﻬﺎ ‪ 10‬ﺤﺎﻻﺕ ﻨﺎﻜﺴﺔ ﻋﻤﺭﻫﺎ ﻤﻥ ﻋﺎﻡ ﺇﻟـﻰ‬
‫ﻋﺎﻡ ﻭ ﻨﺼﻑ( ﺤﻴﺙ ﺴﺠﻠﻨﺎ )ﺠﺩﻭل ‪:(2‬‬
‫• ﻗﻴﻡ ﺸﺩﺓ ﺍﻤﺘﺼﺎﺼﻴﺔ ﻀﻭﺌﻴﺔ‪ OD = >0.2 - 0.5 nm :‬ﺒﻨﺴﺒﺔ ‪ %60.7‬ﻓﻲ ﺍﻟﻤﺠﻤﻭﻋﺔ‬
‫ﺍﻷﻭﻟﻰ ﻭﺒﻨﺴﺒﺔ ‪ %64.5‬ﻓﻲ ﺍﻟﻤﺠﻤﻭﻋﺔ ﺍﻟﺜﺎﻨﻴﺔ‪.‬‬
‫• ﻗﻴﻡ ﺸﺩﺓ ﺍﻤﺘﺼﺎﺼﻴﺔ ﻀﻭﺌﻴﺔ‪ OD = >0.5 - 1≤ nm :‬ﺒﻨﺴﺒﺔ ‪ %39.3‬ﻓﻲ ﺍﻟﻤﺠﻤﻭﻋـﺔ‬
‫ﺍﻷﻭﻟﻰ ﻭﺒﻨﺴﺒﺔ ‪ %35.5‬ﻓﻲ ﺍﻟﻤﺠﻤﻭﻋﺔ ﺍﻟﺜﺎﻨﻴﺔ‪.‬‬

‫‪ -B‬ﺁﻓﺔ ﺠﻠﺩﻴﺔ ﻋﻤﺭﻫﺎ ﺘﻘﺭﻴﺒ ﹰﺎ ‪ 8‬ﺃﺸﻬﺭ‬ ‫‪ -A‬ﺁﻓﺎﺕ ﺠﻠﺩﻴﺔ ﻋﻤﺭﻫﺎ ﺘﻘﺭﻴﺒ ﹰﺎ ‪ 75‬ﻴﻭﻤ ﹰﺎ‬
‫ﺍﻟﺸﻜل )‪(2‬‬

‫ﺍﻟﺠﺩﻭل )‪ (2‬ﻴﺒﻴﻥ ﺍﻟﻌﻼﻗﺔ ﺒﻴﻥ ﻨﺴﺒﺔ ﺍﻷﻀﺩﺍﺩ ﺍﻟﻨﻭﻋﻴﺔ ﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠﺩﻴﺔ ﺍﻟﻤﻘﺎﺴﺔ ﺒـﺎﻹﻟﻴﺯﺍ ﻭﻋﻤـﺭ‬
‫ﺍﻵﻓﺔ ﺍﻟﺠﻠﺩﻴﺔ‪.‬‬
‫ﺍﺨﺘﺒﺎﺭﺍﻹﻟﻴﺯﺍ‬ ‫ﻋﺩﺩ‬
‫ﻋﻤﺭ ﺍﻵﻓﺔ‬
‫‪ OD=>0.2-0.5nm‬ﺍﻟﻨﺴﺒﺔ ﺍﻟﻤﺌﻭﻴﺔ ‪ OD=>0.5-1≤nm‬ﺍﻟﻨﺴﺒﺔ ﺍﻟﻤﺌﻭﻴﺔ‬ ‫ﺍﻟﺤﺎﻻﺕ‬
‫‪% 39.3‬‬ ‫‪86‬‬ ‫‪% 60.7‬‬ ‫‪133‬‬ ‫‪219‬‬ ‫ﻤﻥ ‪ 6-1‬ﺃﺸﻬﺭ‬
‫‪% 35.5‬‬ ‫‪11‬‬ ‫‪% 64.5‬‬ ‫‪20‬‬ ‫‪31‬‬ ‫ﺃﻜﺜﺭ ﻤﻥ‪ 6‬ﺃﺸﻬﺭ‬

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 ‫ﻤﺠﻠﺔ ﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ ﻟﻠﻌﻠﻭﻡ ﺍﻷﺴﺎﺴﻴﺔ ـ ﺍﻟﻤﺠﻠﺩ )‪ (20‬ـ ﺍﻟﻌﺩﺩ ﺍﻷﻭل ـ ‪2004‬‬

‫ﻭﻜﺫﻟﻙ ﺩﺭﺍﺴﺔ ﺍﻟﻌﻼﻗﺔ ﺒﻴﻥ ﻋﺩﺩ ﺍﻵﻓﺎﺕ ﻭ ﻗﻴﻡ ﺍﻟﺸﺩﺓ ﺍﻻﻤﺘﺼﺎﺼﻴﺔ ﻟﻸﻀﺩﺍﺩ ﻨﻔـﺴﻬﺎ ﺘـﻡ‬
‫ﺘﻭﺯﻴﻊ ﺍﻟﺤﺎﻻﺕ ﺍﻹﻴﺠﺎﺒﻴﺔ ﻋﻠﻰ ﻤﺠﻤﻭﻋﺘﻴﻥ‪ :‬ﺍﻟﻤﺠﻤﻭﻋﺔ ﺍﻷﻭﻟﻰ )‪ 180‬ﺤﺎﻟﺔ( ﺘـﺭﺍﻭﺡ ﻋـﺩﺩ‬
‫ﺍﻵﻓﺎﺕ ﻓﻴﻬﺎ ﻤﻥ ‪ 1‬ﺇﻟﻰ ‪ 5‬ﺁﻓﺎﺕ‪ ،‬ﺃﻤﺎ ﺍﻟﻤﺠﻤﻭﻋﺔ ﺍﻟﺜﺎﻨﻴﺔ )‪ 70‬ﺤﺎﻟﺔ( ﻓﻜﺎﻥ ﻋﺩﺩ ﺍﻵﻓﺎﺕ ﻓﻴﻬـﺎ‬
‫ﺃﻜﺜﺭ ﻤﻥ ﺨﻤﺱ ﺁﻓﺎﺕ ﺤﻴﺙ ﺴﺠﻠﻨﺎ )ﺠﺩﻭل ‪: (3‬‬
‫• ﻗﻴﻡ ﺸﺩﺓ ﺍﻤﺘﺼﺎﺼﻴﺔ ﻀﻭﺌﻴﺔ‪ OD = >0.2 - 0.5 nm :‬ﺒﻨﺴﺒﺔ ‪ %76.1‬ﻓﻲ ﺍﻟﻤﺠﻤﻭﻋﺔ‬
‫ﺍﻷﻭﻟﻰ ﻭﺒﻨﺴﺒﺔ ‪ %22.8‬ﻓﻲ ﺍﻟﻤﺠﻤﻭﻋﺔ ﺍﻟﺜﺎﻨﻴﺔ‪.‬‬
‫• ﻗﻴﻡ ﺸﺩﺓ ﺍﻤﺘﺼﺎﺼﻴﺔ ﻀﻭﺌﻴﺔ‪ OD = >0.5 - 1≤ nm :‬ﺒﻨﺴﺒﺔ ‪ %23.9‬ﻓﻲ ﺍﻟﻤﺠﻤﻭﻋـﺔ‬
‫ﺍﻷﻭﻟﻰ ﻭﺒﻨﺴﺒﺔ ‪ %77.1‬ﻓﻲ ﺍﻟﻤﺠﻤﻭﻋﺔ ﺍﻟﺜﺎﻨﻴﺔ‪.‬‬

‫ﺍﻟﺠﺩﻭل )‪ (3‬ﻴﺒﻴﻥ ﺍﻟﻌﻼﻗﺔ ﺒﻴﻥ ﻨﺴﺒﺔ ﺍﻷﻀﺩﺍﺩ ﺍﻟﻨﻭﻋﻴﺔ ﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠﺩﻴﺔ ﺍﻟﻤﻘﺎﺴﺔ ﺒـﺎﻹﻟﻴﺯﺍ ﻭﻋـﺩﺩ‬
‫ﺍﻵﻓﺎﺕ ﺍﻟﺠﻠﺩﻴﺔ‪.‬‬
‫ﺍﺨﺘﺒﺎﺭﺍﻹﻟﻴﺯﺍ‬ ‫ﻋﺩﺩ‬
‫‪ OD=>0.2-0.5nm‬ﺍﻟﻨﺴﺒﺔ ﺍﻟﻤﺌﻭﻴﺔ ‪ OD=>0.5-1≤nm‬ﺍﻟﻨﺴﺒﺔ ﺍﻟﻤﺌﻭﻴﺔ‬ ‫ﺍﻟﺤﺎﻻﺕ‬ ‫ﻋﺩﺩ ﺍﻵﻓﺎﺕ‬
‫‪% 23.9‬‬ ‫‪43‬‬ ‫‪% 76.1‬‬ ‫‪137‬‬ ‫‪180‬‬ ‫ﻤﻥ ‪ 5-1‬ﺁﻓﺎﺕ‬
‫‪% 77.1‬‬ ‫‪54‬‬ ‫‪% 22.8‬‬ ‫‪16‬‬ ‫‪70‬‬ ‫ﺃﻜﺜﺭ ﻤﻥ ‪ 5‬ﺁﻓﺎﺕ‬

‫ﻭﻤﻥ ﺨﻼل ﺍﻟﺩﺭﺍﺴﺔ ﺍﻹﺤﺼﺎﺌﻴﺔ ﻟﺩﺭﺠﺔ ﺍﻻﺭﺘﺒﺎﻁ‪ ،‬ﺘﺒﻴﻥ ﻋﺩﻡ ﻭﺠﻭﺩ ﺃﻱ ﺍﺭﺘﺒﺎﻁ ﻤﻌﻨـﻭﻱ‬
‫ﺒﻴﻥ ﻋﻤﺭ ﺍﻵﻓﺔ ﻭﺍﺨﺘﺒﺎﺭ ﺍﻹﻟﻴﺯﺍ ﻓﻲ ﺤﻴﻥ ﺴﺠل ﺍﺭﺘﺒﺎﻁ ﺇﻴﺠﺎﺒﻲ ﻗﻭﻱ ﻭﻤﻌﻨﻭﻱ ﻋﻨﺩ ﻤـﺴﺘﻭﻯ‬
‫ﺜﻘﺔ ‪ 0.01‬ﺒﻴﻥ ﻋﺩﺩ ﺍﻵﻓﺎﺕ ﺍﻟﺠﻠﺩﻴﺔ ﻭﺍﺨﺘﺒﺎﺭ ﺍﻹﻟﻴﺯﺍ )ﺠﺩﻭل ‪.(4‬‬

‫ﺍﻟﺠﺩﻭل )‪ (4‬ﻴﺒﻴﻥ ﺩﺭﺠﺔ ﺍﻻﺭﺘﺒﺎﻁ ﺒﻴﻥ ﺍﻻﺨﺘﺒﺎﺭ ﺍﻟﻤﺼﻠﻲ ﻭﻋﻤﺭ ﺍﻵﻓﺔ ﻭﻋﺩﺩﻫﺎ‬
‫‪OD‬‬ ‫ﻋﺩﺩ ﺍﻵﻓﺎﺕ‬
‫‪0.104‬‬ ‫‪0.065‬‬ ‫ﻋﻤﺭ ﺍﻵﻓﺔ‬
‫‪0.089‬‬ ‫‪0.286‬‬ ‫ﻤﻌﺎﻤل ﺍﻻﺭﺘﺒﺎﻁ ‪P.value‬‬
‫‪**0.825‬‬ ‫‪-‬‬ ‫ﻋﺩﺩ ﺍﻵﻓﺎﺕ‬
‫‪0.000‬‬ ‫ﻤﻌﺎﻤل ﺍﻻﺭﺘﺒﺎﻁ ‪P.value‬‬
‫** ﻴﺸﻴﺭ ﺇﻟﻰ ﺍﺭﺘﺒﺎﻁ ﻤﻌﻨﻭﻱ ﻋﻨﺩ ﻤﺴﺘﻭﻯ ﺜﻘﺔ ‪0.01‬‬

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 ‫ﺩﺭﺍﺴﺔ ﺘﺸﺨﻴﺼﻴﺔ ﻤﺼﻠﻴﺔ ﺃﻭﻟﻴﺔ ﻟﺩﻋﻡ ﺍﻟﻁﺭﺍﺌﻕ ﺍﻟﺘﻘﻠﻴﺩﻴﺔ ﻟﻠﻜﺸﻑ ﻋﻥ ﺩﺍﺀ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ …‬ ‫ﺸﻌﺒﺎﻥ ﻭﺤﻤﻭﺩ ﻭﻨﺤﺎﺱ ـ‬

‫ﻭﻗﺩ ﺘﻭﺍﻓﻘﺕ ﻨﺘﺎﺌﺠﻨﺎ ﻤﻊ ﻤﺎ ﺘﻤﺕ ﺍﻹﺸﺎﺭﺓ ﺇﻟﻴﻪ ﻤﺴﺒﻘﹰﺎ ﻓﻲ ﺩﺭﺍﺴﺔ ‪ Mosleh‬ﻭﺯﻤﻼﺌـﻪ )‪(8‬‬
‫ﻟﺩﻯ ﺘﻁﺒﻴﻕ ﺘﻘﺎﻨﺔ ﺍﻹﻟﻴﺯﺍ ﻋﻠﻰ ‪ 100‬ﺤﺎﻟﺔ ﻤﺼﺎﺒﺔ ﺒﺩﺍﺀ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠﺩﻱ ﻓﻲ ﺍﻷﺭﺩﻥ ﻭﺩﺭﺍﺴﺔ‬
‫‪ Ozbilge‬ﻭﺯﻤﻼﺌﻪ )‪ (28‬ﻋﻠﻰ ‪ 118‬ﻤﺼﺎﺒﹰﺎ ﺒﻬﺫﺍ ﺍﻟﺩﺍﺀ ﻓﻲ ﺘﺭﻜﻴـﺎ‪ .‬ﺤﻴـﺙ ﺃﻜـﺩﺕ ﻫـﺫﻩ‬
‫ﺍﻟﺩﺭﺍﺴﺎﺕ ﺃﻥ ﻋﺩﺩ ﺍﻵﻓﺎﺕ ﺍﻟﺠﻠﺩﻴﺔ ﻟﺩﻯ ﺍﻟﻤﺼﺎﺏ ﻴﺅﺩﻱ ﺩﻭﺭﹰﺍ ﻓﻲ ﺯﻴـﺎﺩﺓ ﻜﻤﻴـﺔ ﺍﻷﻀـﺩﺍﺩ‬
‫ﺍﻟﻨﻭﻋﺒﺔ ﺍﻟﻤﺘﺸﻜﻠﺔ ﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠﺩﻴﺔ ﻓﻲ ﺤﻴﻥ ﻟﻡ ﻴﻼﺤﻅ ﻟﻌﻤﺭ ﺍﻵﻓﺔ ﺍﺭﺘﺒﺎﻁ ﺒﻜﻤﻴﺔ ﺍﻷﻀﺩﺍﺩ‪.‬‬
‫ﻭﻓﻘﹰﺎ ﻟﻤﺎ ﺘﻘﺩ‪‬ﻡ ﻋﺭﻀﻪ ﻓﻲ ﺩﺭﺍﺴﺘﻨﺎ ﺍﻷﻭﻟﻴﺔ‪ ،‬ﻴﻤﻜﻨﻨﺎ ﺍﻗﺘﺭﺍﺡ ﺘﻁﺒﻴﻕ ﺘﻘﺎﻨﺔ ﺍﻹﻟﻴﺯﺍ ﻟﻠﻜـﺸﻑ‬
‫ﻋﻥ ﺍﻷﻀﺩﺍﺩ ﺍﻟﻨﻭﻋﻴﺔ ﺍﻟﻤﻭﺠﻬﺔ ﻀﺩ ﻁﻔﻴﻠﻴﺎﺕ ﺍﻟﻠﻴﺸﻤﺎﻨﻴﺔ ﺍﻟﺠﻠﺩﻴﺔ ﻓﻲ ﻤـﺼﻭل ﺍﻟﻤـﺼﺎﺒﻴﻥ ﺃﻭ‬
‫ﺍﻟﻤﺸﻜﻭﻙ ﺒﺈﺼﺎﺒﺘﻬﻡ ﺒﻬﺫﺍ ﺍﻟﺩﺍﺀ‪ ،‬ﺇﻟﻰ ﺠﺎﻨﺏ ﺍﻟﻁﺭﺍﺌﻕ ﺍﻟﺘﻘﻠﻴﺩﻴﺔ ﺍﻟﻤﺘﺒﻌﺔ)ﺨﺎﺼﺔ ﻋﻨﺩ ﺴﻠﺒﻴﺔ ﻨﺘﺎﺌﺞ‬
‫ﻫﺫﻩ ﺍﻟﻁﺭﺍﺌﻕ( ﻨﻅﺭﹰﺍ ﻟﻤﺎ ﺘﺘﻤﺘﻊ ﺒﻪ ﻤﻥ ﺩﺭﺠﺔ ﺤﺴﺎﺴﻴﺔ ﻭ ﻨﻭﻋﻴﺔ ﻤﺭﺘﻔﻌﺘﻴﻥ ﻨﺴﺒﻴﹰﺎ‪.‬‬

‫ﻜﻠﻤﺔ ﺸﻜﺭ‬
‫ﻨﺘﻭﺠﻪ ﺒﺎﻟﺸﻜﺭ ﻭﺍﻻﻤﺘﻨﺎﻥ ﺇﻟﻰ ﺍﻷﺴﺘﺎﺫ ﺍﻟﺩﻜﺘﻭﺭ ﺼﺎﻟﺢ ﺩﺍﻭﻭﺩ ﺭﺌﻴﺱ ﻗﺴﻡ ﺍﻷﻤﺭﺍﺽ‬
‫ﺍﻟﺠﻠﺩﻴﺔ ﻭﺍﻟﺯﻫﺭﻴﺔ ﺒﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ ﻟﻤﺴﺎﻫﻤﺘﻪ ﺍﻟﻔﻌﺎﻟﺔ ﻓﻲ ﺇﻨﺠﺎﺡ ﻫﺫﻩ ﺍﻟﺩﺭﺍﺴﺔ‪ ،‬ﻭﺇﻟﻰ ﺍﻟﺩﻜﺘﻭﺭ‬
‫ﻋﻤﺎﺩ ﺍﻟﻘﺎﻀﻲ ﻟﺘﻘﺩﻴﻤﻪ ﺍﻟﻤﺴﺎﻋﺩﺓ ﻓﻲ ﺍﻟﺩﺭﺍﺴﺔ ﺍﻹﺤﺼﺎﺌﻴﺔ ﻭﻜﺫﻟﻙ ﺇﻟﻰ ﺍﻟﺴﻴﺩﺓ ﺴﻨﺎﺀ ﺤﻤﺎﺩﺓ‬
‫ﻟﺘﻘﺩﻴﻤﻬﺎ ﺍﻟﻤﺴﺎﻋﺩﺓ ﻓﻲ ﺍﻟﺤﺼﻭل ﻋﻠﻰ ﺍﻟﻌﻴﻨﺎﺕ‪.‬‬

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