‫ﻉ‪ .

‬ﺃﻨﺠﻕ‬ ‫ﻤﺠﻠﺔ ﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ ﻟﻠﻌﻠﻭﻡ ﺍﻟﺼﺤﻴﺔ‪ -‬ﺍﻟﻤﺠﻠﺩ ﺍﻟﻌﺸﺭﻭﻥ‪ -‬ﺍﻟﻌﺩﺩ ﺍﻟﺜﺎﻨﻲ‪2004 -‬‬

‫ﻤﺘﻼﺯﻤﺔ ﻓﺭﻁ ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻥ ﺍﻟﻤﻨﺎﻋﻲ ‪ E‬ﻓﻲ ﺍﻟﺩﻡ ﻤﻊ ﺍﻷﺨﻤﺎﺝ‬

‫ﺍﻟﻤﻌﺎﻭﺩﺓ ﺃﻭ ﻤﺘﻼﺯﻤﺔ ﺠﻭﺏ ‪Job‬‬

‫*‬
‫ﻋﺼﺎﻡ ﺃﻨﺠﻕ‬

‫ﺍﻟﻤﻠﺨﺹ‬
‫ﻤﺘﻼﺯﻤﺔ ﻓﺭﻁ ﺍﻟﻐﺎﻤﺎﻏﻠﻭﺒﻭﻟﻴﻥ ‪ IgE‬ﻤﻊ ﺍﻷﺨﻤﺎﺝ ﺍﻟﻤﻌﺎﻭﺩﺓ ﺃﻭ ﻤﺘﻼﺯﻤﺔ ﺠﻭﺏ ‪Job syndrome‬‬
‫ﻫﻲ ﻋﻭﺯ ﻤﻨﺎﻋﻲ ﻨﺎﺩﺭ ﻴﺘﻤﻴﺯ ﺒﺨﺭﺍﺠﺎﺕ ﺠﻠﺩﻴﺔ ﻭﺭﺌﻭﻴـﺔ ﻤﺘﻜـﺭﺭﺓ ﻤـﻊ ﺍﺭﺘﻔـﺎﻉ ﺸـﺩﻴﺩ ﻓـﻲ‬
‫ﻤﺴﺘﻭﻯ‪IgE‬ﻓﻲ ﺍﻟﻤﺼل ﻭﺍﻟﺘﻬﺎﺏ ﺠﻠﺩ ﺃﻜﺯﻴﻤﺎﺌﻲ ﺍﻟﺸﻜل‪ .‬ﺍﻻﻀـﻁﺭﺍﺒﺎﺕ ﺍﻟﻭﺠﻬﻴـﺔ ﻭ ﺍﻟﻌﻅﻤﻴـﺔ‬
‫ﻤﺩﺭﻭﺴﺔ ﻭﻟﻜﻥ ﻨﺴﺒﺔ ﺤﺩﻭﺜﻬﺎ ﻏﻴﺭ ﻤﻌﺭﻭﻓﺔ‪ .‬ﺍﻷﺴﺎﺱ ﺍﻟﻭﺭﺍﺜﻲ ﻟﻠﻤﺘﻼﺯﻤﺔ ﻏﻴﺭ ﻤﻔﻬـﻭﻡ ﺒـﺸﻜل‬
‫ﻭﺍﻀﺢ‪.‬‬
‫ﺃﺠﺭﻴﺕ ﺍﻟﺩﺭﺍﺴﺔ ﺍﻟﻌﻤﻠﻴﺔ ﻓﻲ ﻤﺴﺘﺸﻔﻰ ﺍﻷﻁﻔﺎل ﺍﻟﺠﺎﻤﻌﻲ ﻓﻲ ﺍﻟﻔﺘﺭﺓ ﻤﺎ ﺒﻴﻥ ‪ 1999/1/1‬ﻭﺤﺘـﻰ‬
‫‪ 2003/12/31‬ﻭﺸﻤﻠﺕ ﺍﻟﺩﺭﺍﺴﺔ ‪ 18‬ﺤﺎﻟﺔ ﻟﻤﺘﻼﺯﻤﺔ ﺠﻭﺏ ﻗﺒﻠﺕ ﻓﻲ ﺍﻟﻤﺴﺘﺸﻔﻰ ‪ 6‬ﺤﺎﻻﺕ ﻤﻨﻬـﺎ‬
‫ﺸﺨﺼﺕ ﺨﻼل ﻋﺎﻡ ‪ .2002‬ﻜﺎﻨﺕ ﻨﺴﺒﺔ ﺍﻟﺫﻜﻭﺭ ﺇﻟﻰ ﺍﻹﻨﺎﺙ ‪ .1/2‬ﺍﺤﺘﺎﺠﺕ ﺒﻌﺽ ﺍﻟﺤﺎﻻﺕ ﻟﻠﻘﺒﻭل‬
‫ﺃﻜﺜﺭ ﻤﻥ ﻤﺭﺓ ﺒﺴﺒﺏ ﺍﻷﺨﻤﺎﺝ ﺍﻟﻤﻌﺎﻭﺩﺓ‪.‬‬
‫ﺒﺎﻟﻨﺴﺒﺔ ﻟﻔﺌﺎﺕ ﺍﻷﻋﻤﺎﺭ ﻓﻘﺩ ﺒﺩﺃﺕ ﺍﻷﻋﺭﺍﺽ ﻓﻲ ﻋﻤﺭ ﻤﺎ ﻗﺒل ﺍﻟﺴﻨﺔ ﻓﻲ ‪ %83.3‬ﻤﻥ ﺍﻟﺤﺎﻻﺕ‪.‬‬
‫ﻜﺎﻨﺕ ﺍﻟﻘﺼﺔ ﺍﻟﻌﺎﺌﻠﻴﺔ ﺇﻴﺠﺎﺒﻴﺔ ﻓﻲ ‪ %39‬ﻤﻥ ﺍﻟﺤﺎﻻﺕ‪ .‬ﻜﺎﻥ ﺍﻟﺘﺸﺨﻴﺹ ﻋﻨﺩ ﺍﻟﻘﺒﻭل ﺸـﻙ ﻋـﻭﺯ‬
‫ﻤﻨﺎﻋﻲ ﻓﻲ ‪ % 55.6‬ﻤﻥ ﺍﻟﺤﺎﻻﺕ‪.‬‬
‫ﻜﺎﻨﺕ ﺍﻟﺤﺭﺍﺭﺓ ﺃﻜﺜﺭ ﺍﻷﻋﺭﺍﺽ ﻤﺸﺎﻫﺩﺓ ﻓﻲ ‪ %72.2‬ﻤﻥ ﺍﻟﺤﺎﻻﺕ ‪.‬ﺸﻭﻫﺩﺕ ﺍﻹﺼﺎﺒﺔ ﺍﻟﺠﻠﺩﻴﺔ ﻓﻲ‬
‫‪ %72.2‬ﻤﻥ ﺍﻟﺤﺎﻻﺕ‪ ،‬ﻭﺸﻭﻫﺩ ﺍﻟﺴﻌﺎل ﺒﺎﻟﻨﺴﺒﺔ ﻨﻔﺴﻬﺎ‪.‬‬
‫ﻤﺨﺒﺭﻴ ﹰﺎ ﻭﺠﺩ ﺍﺭﺘﻔﺎﻉ ﻓﻲ ﺘﻌﺩﺍﺩ ﺍﻟﻜﺭﻴﺎﺕ ﺍﻟﺒﻴﺽ ﻓﻲ ‪ %38.9‬ﻤﻥ ﺍﻟﺤﺎﻻﺕ ﻭﺯﻴـﺎﺩﺓ ﻓـﻲ ﻨـﺴﺒﺔ‬
‫ﺍﻟﻌﺩﻻﺕ ﻓﻲ ‪ ،%33.3‬ﺃﻤﺎ ﺯﻴﺎﺩﺓ ﻨﺴﺒﺔ ﺍﻟﺤﻤﻀﺎﺕ ﻓﻘﺩ ﻭﺠﺩﺕ ﻓﻲ ‪ 14/10‬ﺤﺎﻟﺔ ﺒﻨﺴﺒﺔ ‪.%71.4‬‬
‫ﻭﺠﺩ ﺍﺭﺘﻔﺎﻉ ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻥ ﺍﻟﻤﻨﺎﻋﻲ ‪ E‬ﻓﻲ ﺠﻤﻴﻊ ﺍﻟﺤﺎﻻﺕ‪.‬‬
‫ﻋﻭﻟﺠﺕ ﻤﻌﻅﻡ ﺍﻟﺤﺎﻻﺕ ﺒﺎﻟﻤﻀﺎﺩﺍﺕ ﺍﻟﺤﻴﻭﻴﺔ ﺤﺴﺏ ﻤﻜﺎﻥ ﺍﻟﺨﻤـﺞ ﻭﺯﺭﻉ ﺍﻟﺠﺭﺜـﻭﻡ ﺍﻟﻤﺘﻭﻗـﻊ‬
‫ﻭﻋﺩﻟﺕ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺤﺴﺏ ﺍﻟﺯﺭﻉ ﻭﺍﻟﺘﺤﺴﺱ ﺃﻭ ﺍﻻﺴﺘﺠﺎﺒﺔ‪ .‬ﺘﻭﻓﻲ ﻤﺭﻴﺽ ﻭﺍﺤﺩ ﻤـﻥ ﻤﺠﻤـﻭﻉ‬
‫ﺍﻟﻤﺭﻀﻰ‪.‬‬

‫*‬
‫ﺃﺴﺘﺎﺫ‪ -‬ﻗﺴﻡ ﺍﻷﻁﻔﺎل– ﻜﻠﻴﺔ ﺍﻟﻁﺏ ﺍﻟﺒﺸﺭﻱ‪ -‬ﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ‪.‬‬

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 Job ‫ ﻓﻲ ﺍﻟﺩﻡ ﻤﻊ ﺍﻷﺨﻤﺎﺝ ﺍﻟﻤﻌﺎﻭﺩﺓ ﺃﻭ ﻤﺘﻼﺯﻤﺔ ﺠﻭﺏ‬E ‫ﻤﺘﻼﺯﻤﺔ ﻓﺭﻁ ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻥ ﺍﻟﻤﻨﺎﻋﻲ‬

Hyperimmunoglobulinemia E (Hyper IgE )

Syndrome with Recurrent Infections or Job
Syndrome
Isam Anjak*
Summary
The hyper immuno-globuline E (IgE) syndrome with recurrent infections or
Job syndrome is a rare immunodeficiency characterized by recurrent skin
and pulmonary abscesses and extremely elevated levels of IgE in serum with
eczematous dermatitis. Associated facial and skeletal features have been
recognized but their frequency is unknown. The genetic basis of this
syndrome is poorly understood.
A retrospective clinical study was conducted in the Children’s Hospital of
Damascus University between 1/1/1999 and 31/12/2003 and 18 patients were
hospitalized during period with the diagnosis of Job syndrome, six of them
were in the year 2002. The sex ratio was 2/1. Some cases were hospitalized
more than once because of recurrent infections.
The symptoms appeared in the first year of life in 83.3 % of the cases. The
family history was positive in 39% of the cases.
The most common symptom was fever which was seen in 72.2% of cases.
The skin was affected in 72.2% and cough was present at the same
percentage.
Laboratory studies revealed increase in white blood cells count in 38.9%
and in neutrophils in 33.3% . The percentage of eosinophils was elevated in
10/14 patients ( 71.4%). IgE was high in all cases.
Most cases were treated by antibiotics according to the site of infection and
the expected organisms. Treatment was changed according to the cultures
and the sensitivity to antibiotics or to the clinical responses. One patient
died during the study.

*
Department of Pediatrics – Faculty of Medicine – Damascus University.

96
 ‫ﻉ‪ .‬ﺃﻨﺠﻕ‬ ‫ﻤﺠﻠﺔ ﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ ﻟﻠﻌﻠﻭﻡ ﺍﻟﺼﺤﻴﺔ‪ -‬ﺍﻟﻤﺠﻠﺩ ﺍﻟﻌﺸﺭﻭﻥ‪ -‬ﺍﻟﻌﺩﺩ ﺍﻟﺜﺎﻨﻲ‪2004 -‬‬
‫ﺍﻀﻁﺭﺍﺏ ﺍﻟﺠﺫﺏ ﺍﻟﻜﻴﻤﺎﻭﻱ ﻟﻬﺫﻩ ﺍﻟﺨﻼﻴـﺎ‬
‫ﺒﺎﻹﻀﺎﻓﺔ ﺇﻟﻰ ﺯﻴﺎﺩﺓ ﻤﺴﺘﻭﻴﺎﺕ ‪ IgE‬ﻜﻤـﺎ‬
‫ﺃﻥ ﺍﻷﻨﺘﺭﻟﻭﻜﻴﻥ ‪ 12‬ﻫﻭ ﻤﺤﺭﺽ ﺃﺴﺎﺴـﻲ‬
‫ﻻﺼﻁﻨﺎﻉ ﺍﻷﻨﺘﺭﻓﻴـﺭﻭﻥ ﻏﺎﻤـﺎ ﻭﻴﺜـﺒﻁ‬
‫ﺍﺼﻁﻨﺎﻉ ﺍل ‪.(3) IgE‬‬
‫ﺘﺘﻨﺎﻗﺹ ﻤﺴﺘﻭﻴﺎﺕ ‪ IgE‬ﻤﻊ ﺘﻘـﺩﻡ ﺍﻟﻌﻤـﺭ‬
‫ﻭﻗﺩ ﺘﺼل ﺇﻟﻰ ﻤـﺴﺘﻭﻴﺎﺕ ﻁﺒﻴﻌﻴـﺔ ﺩﻭﻥ‬
‫ﺤﺩﻭﺙ ﺘﺤﺴﻥ ﺴﺭﻴﺭﻱ ﻜﻤﺎ ﺃﻥ ﻤﺴﺘﻭﻴﺎﺘﻬﺎ‬
‫ﻻ ﺘﺘﻨﺎﺴﺏ ﻤﻊ ﺸﺩﺓ ﺍﻟﻤﺭﺽ )‪.(4,1‬‬
‫ﺍﻟﻭﺭﺍﺜﺔ ﻓﻲ ﺍﻟﻤﺭﺽ ﻏﻴﺭ ﻭﺍﻀﺤﺔ ﻭﻤﻌﻅﻡ‬
‫ﺍﻟﺤﺎﻻﺕ ﺘﺤﺩﺙ ﺒﺸﻜل ﻤﺘﻘﻁﻊ ﻭﻟﻜﻥ ﺒﻌﺽ‬
‫ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻗﺘﺭﺤﺕ ﻭﺠﻭﺩ ﻭﺭﺍﺜﺔ ﻗـﺎﻫﺭﺓ‬
‫ﻭﺤﺩﺩﻭﺍ ﺍﻟﻤﻭﻗـﻊ ﺍﻟـﻭﺭﺍﺜﻲ ﻋﻠـﻰ ﺫﺭﺍﻉ‬
‫ﺍﻟﺼﺒﻐﻲ ‪ 4q‬ﻓﻲ ﺍﻟﻤﻨﻁﻘﺔ ﺍﻟﻘﺭﻴﺒﺔ‪ ،‬ﻓﻲ ﺤﻴﻥ‬
‫ﻋﺩ‪‬ﻫﺎ ﺒﻌﻀﻬﻡ ﺍﻷﺨﺭ ﻤﻘﻬﻭﺭﺓ)‪.(5,4,3,2‬‬
‫ﺍﻟﻤﺭﺍﻀﺔ ﻭﺍﻟﻭﻓﻴﺎﺕ‪:‬‬
‫ﺇﻥ ﺃﻜﺒﺭ ﺴﻥ ﻟﻠﻤﺭﻀﻰ ﻜﺎﻥ ‪60‬ﺴﻨﺔ ﻭﻟﻜﻥ‬
‫ﺍﻟﻭﻓﺎﺓ ﺘﺤﺩﺙ ﻓﻲ ﺍﻟﻌﻘﺩ ﺍﻟﺜﺎﻨﻲ ﻏﺎﻟﺒﹰﺎ ﺒﺴﺒﺏ‬
‫ﺍﻷﺨﻤﺎﺝ ﺍﻟﺨﻁﺭﺓ ﻭﺍﻟﻤﻌﻨﺩﺓ ﺨﺎﺼﺔ ﺒﺎﻟﻔﻁﻭﺭ‬
‫ﻜﺎﻟﺭﺸﺎﺸﻴﺎﺕ ﻓﻲ ﺍﻟﻘﻴﻼﺕ ﺍﻟﻬﻭﺍﺌﻴﺔ ﺍﻟﺭﺌﻭﻴﺔ؛‬
‫ﺘﻘﺭﻴﺒﹰﺎ ﺯﻫﺎﺀ ‪ %80‬ﻤﻥ ﺍﻟﻤﺭﻀﻰ ﻴﺘﻁـﻭﺭ‬
‫ﻟﺩﻴﻬﻡ ﻗﻴﻼﺕ ﻫﻭﺍﺌﻴـﺔ ﺒـﺴﺒﺏ ﺍﻷﺨﻤـﺎﺝ‬
‫ﺍﻟﺭﺌﻭﻴﺔ ﺒﺎﻟﻌﻨﻘﻭﺩﻴﺎﺕ‪ .‬ﻟﻴﺱ ﻫﻨـﺎﻙ ﻋـﺭﻕ‬
‫ـﺅﺩﻱ ﺇﻟـ‬
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‫ﺍﻟﺘﻌﺭﻴﻑ‪:‬‬
‫ﻫﻭ ﻤﺘﻼﺯﻤﺔ ﺴﺭﻴﺭﻴﺔ ﺘﺘﻤﻴﺯ ﺒﺎﺭﺘﻔﺎﻉ ﺸﺩﻴﺩ‬
‫ﻓﻲ ﺍﻟﻐﺎﻤﺎﻏﻠﻭﺒﻴﻥ ‪ (IgE)E‬ﺍﻟﻤﺼﻠﻲ ﻭﺘﻜﺭﺭ‬
‫ﺃﺨﻤﺎﺝ ﺨﻁﺭﺓ ﺒﺎﻟﻌﻨﻘﻭﺩﻴـﺎﺕ ﻓـﻲ ﺍﻟﺠﻠـﺩ‬
‫ﻭﺍﻟﺴﺒﻴل ﺍﻟﺘﻨﻔﺴﻲ ﻭﺃﻜﺯﻤﺎ ﻤﺯﻤﻨﺔ ﺘﺒﺩﺃ ﻓـﻲ‬
‫ﺍﻷﺴﺎﺒﻴﻊ ﺍﻟﺜﻤﺎﻨﻴﺔ ﺍﻷﻭﻟﻰ ﻤﻥ ﺍﻟﻌﻤﺭ)‪.(1‬‬
‫ﻟﻤﺤﺔ ﺘﺎﺭﻴﺨﻴﺔ‪:‬‬
‫ﻭﺼﻑ ﺃﻭل ﻤﺭﺓ ﻤﻥ ﻗﺒل ﺍﻟﻌـﺎﻟﻡ ﺠـﻭﺏ‬
‫‪ Job‬ﻋﺎﻡ ‪ 1966‬ﻋﻨﺩ ﻤﺭﻴـﻀﻴﻥ ﻟـﺩﻴﻬﻤﺎ‬
‫ﺍﻟﺘﻬﺎﺏ ﺠﻠﺩ ﺘﺄﺘﺒﻲ ﻤـﻊ ﺃﺨﻤـﺎﺝ ﻤﻌـﺎﻭﺩﺓ‬
‫ﺒﺎﻟﻤﻜﻭﺭﺍﺕ ﺍﻟﻌﻨﻘﻭﺩﻴﺔ ﺍﻟﻤﺫﻫﺒﺔ ‪ ،‬ﻤﻔﺎﺼـل‬
‫ﻤﻔﺭﻁﺔ ﺍﻟﻤﺭﻭﻨﺔ ﻭﻭﺠﻪ ﺨﺸﻥ ﻤﻤﻴﺯ‪ .‬ﻓـﻲ‬
‫ﻋــﺎﻡ ‪ 1972‬ﺃﻀــﺎﻑ ﺍﻟﻌــﺎﻟﻡ ﺒــﻭﻜﻠﻲ‬
‫‪ Buckley‬ﻭﺠﻭﺩ ﺍﺭﺘﻔﺎﻉ ﺍﻟﻐﺎﻤﺎ ﻏﻠـﻭﺒﻴﻥ‬
‫‪.(2)IgE‬‬
‫ﺍﻟﻔﻴﺯﻴﻭﻟﻭﺠﻴﺎ ﺍﻹﻤﺭﺍﻀﻴﺔ‪:‬‬
‫ﻨﻅﺭﹰﺍ ﻟﻭﺠﻭﺩ ﺍﻷﺨﻤﺎﺝ ﺍﻟﻤﺘﻜﺭﺭﺓ ﻟﺫﻟﻙ ﺘـﻡ‬
‫ﺍﻟﺘﺭﻜﻴﺯ ﻋﻠﻰ ﺍﻟﻌﻴﺏ ﺍﻟﻤﻨﺎﻋﻲ ﻟﻠﻤـﺭﺽ‪،‬‬
‫ﻭﻗﺩ ﻭﺠﺩﺕ ﺍﻟﺩﺭﺍﺴﺎﺕ ﻨﻘﺼﹰﺎ ﻨـﺴﺒﻴﹰﺎ ﻓـﻲ‬
‫ﺍﻻﻨﺘﺭﻓﻴﺭﻭﻥ ﻏﺎﻤﺎ ﻤﻊ ﺯﻴﺎﺩﺓ ﺍﻻﻨﺘﺭﻟﻭﻜﻴﻥ–‬
‫‪ .(2) 4‬ﺇﻥ ﺍﻷﻨﺘﺭﻓﻴــﺭﻭﻥ ﻏﺎﻤــﺎ ﻫــﻭ‬
‫ﺍﻟﻤﺤﺭﺽ ﺍﻷﺴﺎﺴـﻲ ﻟﻠﻜﺭﻴـﺎﺕ ﺍﻟﺒـﻴﺽ‬
‫ـﻰ‬
‫ـﺼﻪ ﻴـ‬
‫ـﻭﺍﺓ‪ ،‬ﻭﻨﻘـ‬
‫ـﺩﺓ ﺍﻟﻨـ‬
‫ﻋﺩﻴـ‬
 ‫ﻤﺘﻼﺯﻤﺔ ﻓﺭﻁ ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻥ ﺍﻟﻤﻨﺎﻋﻲ ‪ E‬ﻓﻲ ﺍﻟﺩﻡ ﻤﻊ ﺍﻷﺨﻤﺎﺝ ﺍﻟﻤﻌﺎﻭﺩﺓ ﺃﻭ ﻤﺘﻼﺯﻤﺔ ﺠﻭﺏ ‪Job‬‬
‫ﺃﻤﺎ ﺍﻻﻀﻁﺭﺍﺒﺎﺕ ﺍﻟﺴﻨﻴﺔ ﻓﺘﺸﺎﻫﺩ ﻋﺎﺩﺓ ﺒﻌﺩ‬
‫ﺴﻥ‪ 8‬ﺴﻨﻭﺍﺕ ﻓﻘﺩ ﻴﺤﺩﺙ ﺒﻘـﺎﺀ ﺍﻷﺴـﻨﺎﻥ‬
‫ﺍﻟﻠﺒﻨﻴﺔ ﺃﻭ ﻋﺩﻡ ﺒﺯﻭﻍ ﺍﻷﺴـﻨﺎﻥ ﺍﻟﺩﺍﺌﻤـﺔ‬
‫ﻴﻼﺤﻅ ﻗﻭﺴﺎﻥ ﻤﻥ ﺍﻷﺴﻨﺎﻥ ﺤﻴـﺙ ﺘﺒﻘـﻰ‬
‫ﺍﻷﺴﻨﺎﻥ ﺍﻟﻠﺒﻨﻴﺔ ﻤﻊ ﻅﻬﻭﺭ ﺍﻟﺩﺍﺌﻤﺔ)‪.(6‬‬
‫ﺍﻷﺸﺨﺎﺹ ﺍﻵﺨﺭﻭﻥ ﻓﻲ ﺍﻟﻌﺎﺌﻠﺔ ﻤﻥ ﺩﻭﻥ‬
‫ﺇﺼﺎﺒﺔ ﻟﻴﺱ ﻟﺩﻴﻬﻡ ﺃﻱ ﻋـﺭﺽ ﻜﻤـﺎ ﺃﻥ‬
‫ﻤﺴﺘﻭﻯ ‪ IgE‬ﻓﻲ ﺍﻟﻤـﺼل ﻟـﺩﻴﻬﻡ ﻴﺒﻘـﻰ‬
‫ﻁﺒﻴﻌﻴﺎﹰ‪ ،‬ﻭﻟﻜﻥ ﻋﻨﺩﻤﺎ ﻴﻜﻭﻥ ﻫﻨـﺎﻙ ﺘﺄﺘـﺏ‬
‫‪ Atopy‬ﻓﻲ ﺍﻟﻌﺎﺌﻠﺔ ﻓﺈﻥ ﺍﻷﻋﺭﺍﺽ ﺍﻟﺠﻠﺩﻴﺔ‬
‫ﺘﻜﻭﻥ ﺃﻜﺜﺭ ﺸـﺩﺓ )‪ .(2‬ﺃﺸـﺎﺭﺕ ﺒﻌـﺽ‬
‫ﺍﻟﺩﺭﺍﺴﺎﺕ ﺇﻟﻰ ﻭﺠﻭﺩ ﺍﻀﻁﺭﺍﺒﺎﺕ ﻤﻨﺎﻋﻴﺔ‬
‫ﻤﻊ ﺍﻀﻁﺭﺍﺏ ﻓـﻲ ﺍﻷﺴـﻨﺎﻥ ﻭﺍﻟﻬﻴﻜـل‬
‫ﺍﻟﻌﻅﻤﻲ ﻋﻨﺩ ﺃﻗﺎﺭﺏ ﺍﻟﻤﺭﻀﻰ ﻓﻲ ﺍﻟﺸﻜل‬
‫ﺍﻟﻘﺎﻫﺭ ﻟﻠﻤﺭﺽ)‪.(6‬‬
‫ﺍﻟﻔﺤﻭﺹ ﺍﻟﻤﺨﺒﺭﻴﺔ‪:‬‬
‫ﻴﺯﺩﺍﺩ ﻋﻴﺎﺭ ‪ IgE‬ﻓﻲ ﺍﻟﻤﺼل ﻭﻴﺼل ﺇﻟﻰ‬
‫ﻤﻘﺎﺩﻴﺭ ﻋﺎﻟﻴﺔ ﻗﺩ ﺘـﺼل ﺤﺘـﻰ ﻋـﺸﺭﺓ‬
‫ﺃﻀﻌﺎﻑ ﺍﻟﻁﺒﻴﻌﻲ ﻭﻋﺎﺩﺓ ﺘﻜﻭﻥ ﺃﻜﺜـﺭﻤﻥ‬
‫‪ 2000‬ﻭﺤﺩﺓ ﺩﻭﻟﻴﺔ ‪ /‬ل ﻭﻫﻭ ﻴﻜﻭﻥ ﻋﻨـﺩ‬
‫ﺍﻟﺭﻀﻊ ﺃﻗل ﻭﻜﺫﻟﻙ ﻴﺘﻨﺎﻗﺹ ﻤﻊ ﺘﻘﺩﻡ ﺍﻟﺴﻥ‬
‫ﻋﻨﺩ ﺍﻟﻜﻬﻭل)‪،(2,1‬ﺃﻤﺎ ﺒﻘﻴﺔ ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻨـﺎﺕ‬
‫ﺍﻟﻤﻨﺎﻋﻴﺔ ﻓﺘﺒﻘﻰ ﻁﺒﻴﻌﻴﺔ ﻋﺩﺍ ﺯﻴـﺎﺩﺓ ﻓـﻲ‬
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‫ﻤﻌﻴﻥ ﻟﻺﺼﺎﺒﺔ‪ ،‬ﻜﻤﺎ ﺃﻥ ﺇﺼﺎﺒﺔ ﺍﻟﺠﻨـﺴﻴﻥ‬
‫ﻤﺘﺴﺎﻭﻴﺔ)‪.(2‬‬
‫ﻋﻤﺭ ﺍﻟﻤﺭﻀﻰ ﻴﺘﺭﺍﻭﺡ ﻤﺎ ﺒﻴﻥ ﺍﻟـﻭﻻﺩﺓ ﻭ‬
‫‪ 60‬ﺴﻨﺔ ﻭﻟﻜﻥ ﺍﻟﺼﻭﺭﺓ ﺍﻟﺴﺭﻴﺭﻴﺔ ﻗـﺩ ﻻ‬
‫ﺘﺘﻜﺎﻤل ﻋﻨﺩ ﺒﻌﺽ ﺍﻟﻤﺭﻀﻰ ﺇﻻ ﻓﻴﻤﺎ ﺒﻌـﺩ‬
‫ﻥ ﺍﻟﻤﺭﻀﻰ ﻻ ﻴﺘﻅﺎﻫﺭﻭﻥ ﺒﺎﻟﻤﻌﺩل‬
‫ﺤﻴﺙ ﺇ ‪‬‬
‫ﻨﻔﺴﻪ ﻤﻥ ﺍﻷﺨﻤﺎﺝ ﺃﻭ ﺍﻟﺴﺤﻨﺔ ﺍﻟﺨﺎﺼﺔ ﺃﻭ‬
‫ﺍﻟﺘﺸﻭﻫﺎﺕ ﺍﻟﺼﻘﻠﻴﺔ)‪.(2‬‬
‫ﺍﻷﻋﺭﺍﺽ ﺍﻟﺴﺭﻴﺭﻴﺔ‪:‬‬
‫ﺘﺒﺩﺃ ﻋﺎﺩﺓ ﺨﻼل ﺍﻷﺴـﺎﺒﻴﻊ ﺍﻷﻭﻟـﻰ ﻤـﻥ‬
‫ﺍﻟﺤﻴﺎﺓ ﺒﺤﺩﻭﺙ ﺃﻜﺯﻤﺎ ﺤﺎﺩﺓ ﺘﺨﺘﻠﻁ ﺒﺈﺼﺎﺒﺔ‬
‫ﺠﻠﺩﻴﺔ ﻤﺨﺎﻁﻴﺔ ﺒﺎﻟﻤﺒﻴﻀﺎﺕ ﺍﻟﺒـﻴﺽ‪ ،‬ﺜـﻡ‬
‫ﻴﺤﺩﺙ ﺍﻟﺘﻬـﺎﺏ ﺃﺫﻥ ﻭﺴـﻁﻰ ﻤﺘﻜـﺭﺭ‪،‬‬
‫ﺍﻟﺴﻌﺎل ﺍﻟﻤﺴﺘﻤﺭ ﻴﺒﺩﺃ ﻓﻲ ﺍﻟﻁﻔﻭﻟﺔ ﺍﻷﻭﻟـﻰ‬
‫)‪ .(2‬ﺍﻷﻋﺭﺍﺽ ﺍﻟﺘﺤﺴﺴﻴﺔ ﺍﻟﺘﻨﻔﺴﻴﺔ ﺘﻜﻭﻥ‬
‫ﻏﺎﺌﺒﺔ ﻋﺎﺩﺓ)‪ .(1‬ﺘﺘﻁﻭﺭ ﺍﻟﻘﻴﻼﺕ ﺍﻟﻬﻭﺍﺌﻴـﺔ‬
‫ﻓﻲ ﺍﻟﺭﺌﺘﻴﻥ ﺒﻌﺩ ﺍﻹﺼﺎﺒﺔ ﺒﺫﺍﺕ ﺍﻟﺭﺌﺔ ﻭﻤﻥ‬
‫ﺜﻡ ﻴﺘﺭﺍﻓﻕ ﺫﻟﻙ ﻤﻊ ﺴﻌﺎل ﻤـﺯﻤﻥ ﻭﻗـﺸﻊ‬
‫ﻗﻴﺤﻲ‪ .‬ﺍﻟﺘﻬﺎﺏ ﺍﻷﺫﻥ ﺍﻟﻭﺴﻁﻰ ﺃﻭ ﺍﻟﺠﻴﻭﺏ‬
‫ﺍﻟﻤﺘﻜﺭﺭﻴﻥ ﺃﻭ ﺍﻟﻤﻌﺎﻭﺩﻴﻥ ﻴﺴﺘﻤﺭﺍﻥ ﺤﺘـﻰ‬
‫ﺍﻟﻜﻬﻭﻟﺔ‪.‬‬
‫ﺍﻟﺴﺤﻨﺔ ﺍﻟﺨﺎﺼﺔ ﺒﺎﻟﻤﺭﺽ ﻭﺍﻟﻤﺸﺎﻫﺩﺓ ﻋﻨﺩ‬
‫ﺍﻟﻜﻬﻭل ﻻ ﺘﺸﺎﻫﺩ ﻋﺎﺩﺓ ﻋﻨﺩ ﺍﻷﻁﻔـﺎل)‪،(2‬‬
 ‫ﻉ‪ .‬ﺃﻨﺠﻕ‬ ‫ﻤﺠﻠﺔ ﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ ﻟﻠﻌﻠﻭﻡ ﺍﻟﺼﺤﻴﺔ‪ -‬ﺍﻟﻤﺠﻠﺩ ﺍﻟﻌﺸﺭﻭﻥ‪ -‬ﺍﻟﻌﺩﺩ ﺍﻟﺜﺎﻨﻲ‪2004 -‬‬

‫ﻭﻓﻲ ﺍﻹﺼﺎﺒﺔ ﺒﺎﻟﻌﺼﻴﺎﺕ ﺍﻟﺯﺭﻕ ﻴﻌﻁـﻰ‬ ‫ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻥ ‪ D‬ﻓﻲ ﺒﻌـﺽ ﺍﻟﺤـﺎﻻﺕ )‪.(1‬‬
‫ﺍﻟﺴﻴﻔﺘﺎﺯﻴﺩﻴﻡ‪ .‬ﺃﻤﺎ ﻓﻲ ﺍﻹﺼﺎﺒﺔ ﺒﺎﻟﺭﺸﺎﺸﻴﺎﺕ‬ ‫ﺘﺯﺩﺍﺩ ﺃﻴﻀﹰﺎ ﻨﺴﺒﺔ ﺍﻟﺤﻤﻀﺎﺕ ﻓـﻲ ﺍﻟـﺩﻡ‬
‫ﻓﻴﻌﻁﻰ ﺍﻷﻤﻔﻭﺘﺭﻴﺴﻴﻥ ‪.B‬‬ ‫ﺍﻟﻤﺤﻴﻁﻲ)‪ .(2,1‬ﺍﻟﺨﻼﻴﺎ ﺍﻟﻠﻤﻔﺎﻭﻴﺔ ﺍﻟﺘﺎﺌﻴـﺔ‬
‫ﺍﻟﻤﻀﺎﻋﻔﺎﺕ‪:‬‬ ‫ﻤــﻥ ﻨــﻭﻉ ‪CD8- ,CD4- ,CD3-‬‬
‫ﺘﺸﺎﻫﺩ ﻤﻀﺎﻋﻔﺎﺕ ﺭﺌﻭﻴـﺔ ﻨﺎﺠﻤـﺔ ﻋـﻥ‬ ‫‪,CD2-‬ﺘﻜﻭﻥ ﻁﺒﻴﻌﻴﺔ)‪.(1‬‬
‫ﺍﻷﺨﻤﺎﺝ ﻜﺎﻟﻨﻭﺍﺴـﻴﺭ ﺍﻟﺭﺌﻭﻴـﺔ ﺍﻟﻘـﺼﺒﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‪:‬‬
‫ﻭﺍﻟﻘﻴﻼﺕ ﺍﻟﻬﻭﺍﺌﻴﺔ ﻭﺍﻟﻨﺯﻭﻑ ﻜﻤﺎ ﻗﺩ ﻴﺸﺎﻫﺩ‬ ‫ﺇﻋﻁﺎﺀ ﺍﻟﻤﻀﺎﺩﺍﺕ ﺍﻟﺤﻴﻭﻴﺔ ﺍﻟﺘﻲ ﺘﺅﺜﺭ ﻓﻲ‬
‫ﺍﻟﺘﺤــــﺎﻡ ﺍﻟﺘــــﺩﺍﺭﻴﺯ ﺍﻟﺒــــﺎﻜﺭ‬ ‫ـﻰ‬
‫ـﺎﻓﺔ ﺇﻟـ‬
‫ـﺔ ﺒﺎﻹﻀـ‬
‫ـﺎﺕ ﺍﻟﻤﺫﻫﺒـ‬
‫ﺍﻟﻌﻨﻘﻭﺩﻴـ‬
‫‪ .Craniosynostosis‬ﻗﺩ ﺘﺸﺎﻫﺩ ﺃﺨﻤـﺎﺝ‬ ‫ﻤﻀﺎﺩﺍﺕ ﺍﻟﻔﻁﻭﺭ ﻫﻲ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻷﺴﺎﺴﻴﺔ‬
‫ﺜﺎﻨﻭﻴﺔ ﻓﻲ ﺍﻟﺭﺌﺘﻴﻥ ﺒﺎﻟﺠﺭﺍﺜﻴﻡ ﺴﺎﻟﺒﺔ ﺍﻟﻐﺭﺍﻡ‬ ‫ﺤﻴــﺙ ﻴﻌﻁــﻰ ﺍﻟﻜﻠﻭﻜــﺴﺎﺴﻴﻠﻠﻴﻥ ﺃﻭ‬
‫ﻭﻤﻨﻬﺎ ﺍﻟﻌـﺼﻴﺎﺕ ﺍﻟـﺯﺭﻕ ﺃﻭ ﺍﻟﻔﻁـﻭﺭ‬ ‫ﺍﻟﺘﺭﻴﻤﻴﺘـــﻭﺒﺭﻴﻡ –ﺴﻠﻔﺎﻤﻴﺘﻭﻜـــﺴﺎﺯﻭل‬
‫ﻜﺎﻟﺭﺸﺎﺸﻴﺎﺕ ‪.(2) Aspergillus‬‬ ‫ﻭﺍﻟﻔﻠﻭﻜﻭﻨﺎﺯﻭل‪ .‬ﺒﺎﻟﻨـﺴﺒﺔ ﺇﻟـﻰ ﻤﻌﺎﻟﺠـﺔ‬
‫ﺍﻟﻭﻗﺎﻴﺔ‪:‬‬ ‫ﺍﻷﻜﺯﻤﺎ ﺘﻜﻭﻥ ﺒﺈﻋﻁـﺎﺀ ﺍﻟـﺴﺘﻴﺭﻭﺌﻴﺩﺍﺕ‬
‫ﺘﻌﻁﻰ ﺍﻟﻤﻀﺎﺩﺍﺕ ﺍﻟﺤﻴﻭﻴﺔ ﻟﻠﻭﻗﺎﻴـﺔ ﻤـﻥ‬ ‫ﺍﻟﻘﺸﺭﻴﺔ ﻤﻭﻀﻌﻴﹰﺎ ﻤﻊ ﺍﻟﻤﺭﻁﺒﺎﺕ ﻟـﻀﺒﻁ‬
‫ﺍﻷﺨﻤﺎﺝ ﻜﻤﺎ ﻴﻔﻴﺩ ﺇﻋﻁـﺎﺀ ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻨـﺎﺕ‬ ‫ﺍﻟﺤﻜﺔ‪.‬‬
‫ﺍﻟﻤﻨﺎﻋﻴﺔ ﺃﻴﻀﹰﺎ‪ .‬ﺃﻤﺎ ﺯﺭﻉ ﺍﻟﻨﻘﻲ ﻓﻬﻭ ﻏﻴﺭ‬ ‫ﻋﻨﺩﻤﺎ ﺘﺘﻁﻭﺭ ﺫﺍﺕ ﺍﻟﺭﺌﺔ ﻴﺴﺘﻁﺏ ﺇﻋﻁـﺎﺀ‬
‫ﻤﻔﻴﺩ)‪ ،(9,8,7‬ﺍﻗﺘﺭﺤﺕ ﺇﺤﺩﻯ ﺍﻟﺩﺭﺍﺴـﺎﺕ‬ ‫ﻤﻀﺎﺩﺍﺕ ﺤﻴﻭﻴﺔ ﺃﻜﺜﺭ ﻓﻌﺎﻟﻴﺔ ﻭﺒـﺎﻟﻁﺭﻴﻕ‬
‫ﺇﻋﻁﺎﺀ ﺍﻷﻨﺘﺭﻓﻴﺭﻭﻥ ﺃﻟﻔﺎ ﻭ ﻏﺎﻤـﺎ ‪alpha‬‬ ‫ﺍﻟﻌﺎﻡ‪ ،‬ﻓﻲ ﺤـﺎل ﺍﻹﺼـﺎﺒﺔ ﺒﺎﻟﻌﻨﻘﻭﺩﻴـﺎﺕ‬
‫‪.(10) and gamma interferon‬‬ ‫ﺍﻟﻤﺫﻫﺒﺔ ﺍﻟﺤـﺴﺎﺴﺔ ﻟﻠﻤﻴﺘـﺴﻴﻠﻠﻴﻥ ﻴﻌﻁـﻰ‬
‫ﺍﻟﻨﺎﻓﺴﻴﻠﻠﻴﻥ ﻭﺭﻴﺩﻴﹰﺎ ﺃﻤﺎ ﻓﻲ ﺤﺎل ﺍﻟﻤﻘﺎﻭﻤـﺔ‬
‫ﺍﻟﺩﺭﺍﺴﺔ ﺍﻟﻌﻤﻠﻴﺔ‬
‫ﻓﻴﻌﻁﻰ ﺍﻟﻔﺎﻨﻜﻭﻤﺎﻴﺴﻴﻥ ﻭﻓﻲ ﺤﺎل ﺍﻹﺼﺎﺒﺔ‬
‫ﻫﺩﻑ ﺍﻟﺩﺭﺍﺴﺔ‪:‬‬
‫ﺒﻤﺤﺒﺎﺕ ﺍﻟﺩﻡ ﺍﻟﻨﺯﻟﻴـﺔ ﺘﻌﻁـﻰ ﻤﺭﻜﺒـﺎﺕ‬
‫ﺇﻟﻘﺎﺀ ﺍﻟﻀﻭﺀ ﻋﻠﻰ ﺤﺎﻻﺕ ﻤﺘﻼﺯﻤﺔ ﺠﻭﺏ‬
‫ﺍﻟﺴﻴﻔﺎﻟﻭﺴﺒﻭﺭﻴﻥ ﻤﻥ ﺍﻟﺠﻴل ﺍﻟﺜﺎﻟﺙ ﻭﺭﻴﺩﻴﹰﺎ‬
‫ﺍﻟﻤﻘﺒﻭﻟﺔ ﻓﻲ ﻤﺴﺘﺸﻔﻰ ﺍﻷﻁﻔﺎل ﺍﻟﺠـﺎﻤﻌﻲ‬

‫‪99‬‬
 ‫ﻤﺘﻼﺯﻤﺔ ﻓﺭﻁ ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻥ ﺍﻟﻤﻨﺎﻋﻲ ‪ E‬ﻓﻲ ﺍﻟﺩﻡ ﻤﻊ ﺍﻷﺨﻤﺎﺝ ﺍﻟﻤﻌﺎﻭﺩﺓ ﺃﻭ ﻤﺘﻼﺯﻤﺔ ﺠﻭﺏ ‪Job‬‬

‫ﻭﻋﺩﺩ ﻤﺭﺍﺕ ﺍﻟﻘﺒﻭل ﻭﻓﺌـﺎﺕ ﺍﻷﻋﻤـﺎﺭ‪،‬‬ ‫ﺒﺩﻤﺸﻕ ﺨﻼل ‪ 5‬ﺴﻨﻭﺍﺕ ﻭﺫﻟﻙ ﻓﻲ ﺍﻟﻔﺘـﺭﺓ‬
‫ﻭﻭﺠﻭﺩ ﻗﺼﺔ ﺇﺼﺎﺒﺔ ﻋﺎﺌﻠﻴﺔ ﻭﺍﻷﻋـﺭﺍﺽ‬ ‫ﻤﺎ ﺒﻴﻥ ‪ 1999/1/1‬ﺤﻴﺙ ﺒ‪‬ـﺩِﺉ ﺒﻤﻌـﺎﻴﺭﺓ‬
‫ﻭﺍﻟﺘﻅﺎﻫﺭﺍﺕ ﺍﻟﺴﺭﻴﺭﻴﺔ‪ ،‬ﻭﺒﻌﺽ ﺍﻟﻔﺤﻭﺹ‬ ‫ﺍﻟﻐﺎﻤﺎ ﻏﻠﻭﺒﻴﻥ ُ‪ E‬ﻓﻲ ﺍﻟﻤﺴﺘـﺸﻔﻰ ﻭﺤﺘـﻰ‬
‫ﺍﻟﻤﺨﺒﺭﻴﺔ ﻭﺘﻁﻭﺭ ﺍﻟﺤﺎﻻﺕ‪ ،‬ﻭﻤﺩﺓ ﺍﻹﻗﺎﻤـﺔ‬ ‫‪2003/12/31‬‬
‫ﻁﺭﻴﻘﺔ ﺍﻟﺩﺭﺍﺴﺔ ﻭﻤﻭﺍﺩﻫﺎ‪:‬‬
‫ﻓﻲ ﺍﻟﻤﺴﺘﺸﻔﻰ‪.‬‬
‫ـﻰ‬
‫ـﺎﺒﻴﺭ ﺍﻟﻤﺭﻀـ‬
‫ـﺔ ﻷﻀـ‬
‫ـﺔ ﺭﺍﺠﻌـ‬
‫ﺩﺭﺍﺴـ‬
‫ﺍﻟﻨﺘﺎﺌﺞ‪:‬‬
‫ﺍﻟﻤﻘﺒﻭﻟﻴﻥ ﻭﺍﻟﺫﻴﻥ ﺨﺭﺠﻭﺍ ﻤـﻥ ﺍﻟﻤـﺸﻔﻰ‬
‫ﺒﻠﻎ ﻤﺠﻤﻭﻉ ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﻘﺒﻭﻟـﺔ ﻓـﻲ‬
‫ﺒﺘﺸﺨﻴﺹ ﻤﺘﻼﺯﻤﺔ ﺠـﻭﺏ ﻓـﻲ ﺍﻟﻔﺘـﺭﺓ‬
‫ﺍﻟﻤﺴﺘﺸﻔﻰ )‪ (18‬ﺤﺎﻟـﺔ ﻭﺘﻭﺯﻋـﺕ ﻫـﺫﻩ‬
‫ﺍﻟﺴﺎﺒﻘﺔ ﻓﻲ ﺸﻌﺏ ﺍﻟﻤﺸﻔﻰ ﺍﻟﻤﺨﺘﻠﻔﺔ‪،‬‬
‫ﺍﻟﺤﺎﻻﺕ ﻋﻠﻰ ﺴﻨﻭﺍﺕ ﺍﻟﺩﺭﺍﺴـﺔ ﺤـﺴﺏ‬
‫ﻤﻥ ﺤﻴﺙ ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ ﻭﺘﻭﺯﻋﻬـﺎ ﻋﻠـﻰ‬
‫ﺍﻟﺠﺩﻭل ﺭﻗﻡ )‪(1‬‬
‫ﺴﻨﻭﺍﺕ ﺍﻟﺩﺭﺍﺴﺔ‪ ،‬ﻭﺍﻟﺘﻭﺯﻉ ﺤﺴﺏ ﺍﻟﺠﻨﺱ‬

‫ﺍﻟﻌﺎﻡ‬ ‫ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ‬ ‫ﺍﻟﻨﺴﺒﺔ ﺍﻟﻤﺌﻭﻴﺔ‬

‫‪1999‬‬ ‫‪3‬‬ ‫‪16.7‬‬
‫‪2000‬‬ ‫‪4‬‬ ‫‪22.2‬‬
‫‪2001‬‬ ‫‪3‬‬ ‫‪16.7‬‬
‫‪2002‬‬ ‫‪6‬‬ ‫‪33.3‬‬
‫‪2003‬‬ ‫‪2‬‬ ‫‪11.1‬‬
‫ﺍﻟﻤﺠﻤﻭﻉ‬ ‫‪18‬‬

‫ﺍﻟﺠﺩﻭل )‪ (1‬ﺘﻭﺯﻉ ﺍﻟﺤﺎﻻﺕ ﺤﺴﺏ ﺃﻋﻭﺍﻡ ﺍﻟﺩﺭﺍﺴﺔ‬

‫ﺃﻤﺎ ﺒﺎﻟﻨﺴﺒﺔ ﻟﺘﻜﺭﺍﺭ ﻗﺒﻭل ﺍﻷﻁﻔﺎل ﻓﻲ ﺍﻟﻤﺴﺘﺸﻔﻰ ﻓﺎﻟﺠﺩﻭل ﺭﻗﻡ )‪ (2‬ﻴﻭﻀﺢ ﺫﻟﻙ‬

‫ﻋﺩﺩ ﻤﺭﺍﺕ ﺍﻟﻘﺒﻭل‬ ‫ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ‬ ‫ﺍﻟﻨﺴﺒﺔ ﺍﻟﻤﺌﻭﻴﺔ‬

‫ﻤﺭﺓ ﻭﺍﺤﺩﺓ‬ ‫‪11‬‬ ‫‪61.1‬‬

‫ﻤﺭﺘﺎﻥ‬ ‫‪4‬‬ ‫‪22.2‬‬

‫ﺃﻜﺜﺭ ﻤﻥ ﻤﺭﺘﻴﻥ‬ ‫‪3‬‬ ‫‪16.7‬‬

‫ﺍﻟﻤﺠﻤﻭﻉ‬ ‫‪18‬‬

‫‪100‬‬
 ‫ﻉ‪ .‬ﺃﻨﺠﻕ‬ ‫ﻤﺠﻠﺔ ﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ ﻟﻠﻌﻠﻭﻡ ﺍﻟﺼﺤﻴﺔ‪ -‬ﺍﻟﻤﺠﻠﺩ ﺍﻟﻌﺸﺭﻭﻥ‪ -‬ﺍﻟﻌﺩﺩ ﺍﻟﺜﺎﻨﻲ‪2004 -‬‬

‫ﺍﻟﺠﺩﻭل ﺭﻗﻡ )‪ (2‬ﻋﺩﺩ ﻤﺭﺍﺕ ﺍﻟﻘﺒﻭل ﻓﻲ ﺍﻟﻤﺴﺘﺸﻔﻰ ﻟﻜل ﺤﺎﻟﺔ‬

‫ﻜﻤﺎ ﺘﻭﺯﻋﺕ ﺍﻟﺤﺎﻻﺕ ﺤﺴﺏ ﺍﻟﺠﻨﺱ ﻜﻤﺎ ﻓﻲ ﺍﻟﺠﺩﻭل ﺭﻗﻡ )‪(3‬‬

‫ﺍﻟﺠﻨﺱ‬ ‫ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ‬ ‫ﺍﻟﻨﺴﺒﺔ ﺍﻟﻤﺌﻭﻴﺔ‬
‫ﺫﻜﻭﺭ‬ ‫‪12‬‬ ‫‪66.7‬‬

‫ﺇﻨﺎﺙ‬ ‫‪6‬‬ ‫‪33.3‬‬

‫ﺍﻟﻤﺠﻤﻭﻉ‬ ‫‪18‬‬

‫ﺍﻟﺠﺩﻭل ﺭﻗﻡ )‪ (3‬ﺘﻭﺯﻉ ﺍﻟﺤﺎﻻﺕ ﺤﺴﺏ ﺍﻟﺠﻨﺱ‬

‫ﺍﻟﻤﺨﻁﻁ ﺭﻗﻡ )‪ (2‬ﺘﻭﺯﻉ ﺍﻟﺤﺎﻻﺕ ﺤﺴﺏ ﺍﻟﺠﻨﺱ‬
‫ﻭﻭﺯﻋﺕ ﺍﻟﺤﺎﻻﺕ ﺤﺴﺏ ﻓﺌﺎﺕ ﺍﻷﻋﻤﺎﺭ ﻋﻨﺩ ﺒﺩﺀ ﺍﻷﻋﺭﺍﺽ ﺤﺴﺏ ﺍﻟﺠﺩﻭل ﺭﻗﻡ)‪(4‬‬
‫ﻓﺌﺎﺕ ﺍﻷﻋﻤﺎﺭ‬ ‫ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ‬ ‫ﺍﻟﻨﺴﺒﺔ ﺍﻟﻤﺌﻭﻴﺔ‬
‫ﺃﻗل ﺃﻭ ﻴﺴﺎﻭﻱ ﺴﻨﺔ‬ ‫‪15‬‬ ‫‪83.3‬‬

‫ﺃﻜﺜﺭ ﻤﻥ ﺴﻨﺔ‪3-‬ﺴﻨﻭﺍﺕ‬ ‫‪1‬‬ ‫‪5.6‬‬

‫‪ 6-4‬ﺴﻨﻭﺍﺕ‬ ‫‪1‬‬ ‫‪5.6‬‬

‫‪10-7‬ﺴﻨﻭﺍﺕ‬ ‫‪1‬‬ ‫‪5.6‬‬

‫ﺍﻟﻤﺠﻤﻭﻉ‬ ‫‪18‬‬

‫ﺍﻟﺠﺩﻭل ﺭﻗﻡ )‪ (4‬ﺘﻭﺯﻉ ﺍﻟﺤﺎﻻﺕ ﺤﺴﺏ ﻓﺌﺎﺕ ﺍﻷﻋﻤﺎﺭ ﻋﻨﺩ ﺒﺩﺀ ﺍﻷﻋﺭﺍﺽ‬

‫ﻭﺒﺎﻟﻨﺴﺒﺔ ﻟﺘﻭﺯﻉ ﺍﻟﺤﺎﻻﺕ ﺤﺴﺏ ﻓﺌﺎﺕ ﺍﻷﻋﻤﺎﺭ ﻋﻨﺩ ﺍﻟﺘﺸﺨﻴﺹ ﻓﻜﺎﻨﺕ ﻜﻤﺎ ﻓﻲ ﺍﻟﺠﺩﻭل‬
‫ﺭﻗﻡ )‪(5‬‬
‫ﻓﺌﺎﺕ ﺍﻷﻋﻤﺎﺭ‬ ‫ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ‬ ‫ﺍﻟﻨﺴﺒﺔ ﺍﻟﻤﺌﻭﻴﺔ‬
‫ﺃﻗل ﺃﻭ ﻴﺴﺎﻭﻱ ﺴﻨﺔ‬ ‫‪3‬‬ ‫‪16.7‬‬
‫ﺃﻜﺜﺭ ﻤﻥ ﺴﻨﺔ‪3-‬ﺴﻨﻭﺍﺕ‬ ‫‪9‬‬ ‫‪50‬‬
‫‪ 6-4‬ﺴﻨﻭﺍﺕ‬ ‫‪3‬‬ ‫‪16.7‬‬
‫‪10-7‬ﺴﻨﻭﺍﺕ‬ ‫‪3‬‬ ‫‪16.7‬‬
‫ﺍﻟﻤﺠﻤﻭﻉ‬ ‫‪18‬‬
‫ﺍﻟﺠﺩﻭل ﺭﻗﻡ )‪ (5‬ﺘﻭﺯﻉ ﺍﻟﺤﺎﻻﺕ ﺤﺴﺏ ﻓﺌﺎﺕ ﺍﻷﻋﻤﺎﺭ ﻋﻨﺩ ﺍﻟﺘﺸﺨﻴﺹ‬

‫‪101‬‬
 ‫ﻤﺘﻼﺯﻤﺔ ﻓﺭﻁ ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻥ ﺍﻟﻤﻨﺎﻋﻲ ‪ E‬ﻓﻲ ﺍﻟﺩﻡ ﻤﻊ ﺍﻷﺨﻤﺎﺝ ﺍﻟﻤﻌﺎﻭﺩﺓ ﺃﻭ ﻤﺘﻼﺯﻤﺔ ﺠﻭﺏ ‪Job‬‬

‫ﺩﺭﺱ ﻭﺠﻭﺩ ﺇﺼﺎﺒﺔ ﻋﺎﺌﻠﻴﺔ ﺒﺎﻟﻤﺭﺽ ﻨﻔﺴﻪ ﺃﻭ ﻭﺠﻭﺩ ﺃﻋﺭﺍﺽ ﻤﺸﺎﺒﻬﺔ ﻭﻓﻕ ﺍﻟﺠﺩﻭل ﺭﻗﻡ‬
‫) ‪(6‬‬

‫ﺍﻟﻘﺼﺔ ﺍﻟﻌﺎﺌﻠﻴﺔ‬ ‫ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ‬ ‫ﺍﻟﻨﺴﺒﺔ ﺍﻟﻤﺌﻭﻴﺔ‬

‫ﻗﺼﺔ ﺃﺨﻤﺎﺝ ﻤﺘﻜﺭﺭﺓ‬ ‫‪3‬‬ ‫‪16.7‬‬
‫ﻤﺘﻼﺯﻤﺔ ﺠﻭﺏ ﻋﻨﺩ ﺍﻷﺨﻭﺓ‬ ‫‪1‬‬ ‫‪5.6‬‬
‫ﻤﺘﻼﺯﻤﺔ ﺠﻭﺏ ﻓﻲ ﺍﻟﻌﺎﺌﻠﺔ‬ ‫‪1‬‬ ‫‪5.6‬‬
‫ﺇﺼﺎﺒﺔ ﺘﺤﺴﺴﻴﺔ‬ ‫‪2‬‬ ‫‪11.1‬‬
‫ﺍﻟﻤﺠﻤﻭﻉ‬ ‫‪7‬‬ ‫‪39‬‬
‫ﺍﻟﺠﺩﻭل ﺭﻗﻡ )‪ (6‬ﺍﻟﻘﺼﺔ ﺍﻟﻌﺎﺌﻠﻴﺔ ﻋﻨﺩ ﻤﺭﻀﻰ ﺍﻟﺩﺭﺍﺴﺔ‬

‫ﻜﻤﺎ ﺩﺭﺱ ﺍﻟﺘﺸﺨﻴﺹ ﻋﻨﺩ ﺍﻟﻘﺒﻭل ﺍﻷﻭل ﻟﻠﻤﺭﻀﻰ ﻭﻓﻕ ﺍﻟﺠﺩﻭل ﺭﻗﻡ )‪(7‬‬
‫ﺍﻟﺘﺸﺨﻴﺹ‬ ‫ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ‬ ‫ﺍﻟﻨﺴﺒﺔ ﺍﻟﻤﺌﻭﻴﺔ‬
‫ﺸﻙ ﻋﻭﺯ ﻤﻨﺎﻋﻲ‬ ‫‪10‬‬ ‫‪55.6‬‬
‫ﺫﺍﺕ ﺭﺌﺔ‬ ‫‪2‬‬ ‫‪11.1‬‬
‫ﺍﻟﺘﻬﺎﺏ ﻨﺴﻴﺞ ﺨﻠﻭﻱ‬ ‫‪2‬‬ ‫‪11.1‬‬
‫ﺨﺭﺍﺠﺔ ﺭﺌﻭﻴﺔ‬ ‫‪1‬‬ ‫‪5.6‬‬
‫ﺨﺭﺍﺠﺎﺕ ﻤﺘﻌﺩﺩﺓ‬ ‫‪1‬‬ ‫‪5.6‬‬
‫ﺫﺍﺕ ﺭﺌﺔ ﻤﻊ ﻓﺭﻁ ‪IgE‬‬ ‫‪1‬‬ ‫‪5.6‬‬
‫ﺃﻜﺯﻤﺎ ﻤﻊ ﻓﺭﻁ ‪IgE‬‬ ‫‪1‬‬ ‫‪5.6‬‬
‫ﺍﻟﺠﺩﻭل ﺭﻗﻡ )‪ (7‬ﺍﻟﺘﺸﺨﻴﺹ ﻋﻨﺩ ﺍﻟﻘﺒﻭل ﺒﺎﻟﻨﺴﺒﺔ ﻟﻤﺭﻀﻰ ﺍﻟﺩﺭﺍﺴﺔ‬

‫ﺩﺭﺴﺕ ﺍﻟﺴﻭﺍﺒﻕ ﺍﻟﻤﺭﻀﻴﺔ ﻟﺩﻯ ﻤﺭﻀﻰ ﺍﻟﺩﺭﺍﺴﺔ ﻭﻓﻕ ﺍﻟﺠﺩﻭل ﺭﻗﻡ )‪(8‬‬

‫ﺍﻟﺴﻭﺍﺒﻕ ﺍﻟﻤﺭﻀﻴﺔ‬ ‫ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ‬ ‫ﺍﻟﻨﺴﺒﺔ ﺍﻟﻤﺌﻭﻴﺔ‬

‫ﺃﺨﻤﺎﺝ ﺭﺌﻭﻴﺔ ﻤﺘﻜﺭﺭﺓ‬ ‫‪9‬‬ ‫‪50‬‬

‫ﺃﺨﻤﺎﺝ ﺠﻠﺩﻴﺔ ﻤﺘﻜﺭﺭﺓ‬ ‫‪6‬‬ ‫‪33.3‬‬

‫‪102‬‬
‫ﻉ‪ .‬ﺃﻨﺠﻕ‬ ‫ﻤﺠﻠﺔ ﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ ﻟﻠﻌﻠﻭﻡ ﺍﻟﺼﺤﻴﺔ‪ -‬ﺍﻟﻤﺠﻠﺩ ﺍﻟﻌﺸﺭﻭﻥ‪ -‬ﺍﻟﻌﺩﺩ ﺍﻟﺜﺎﻨﻲ‪2004 -‬‬

‫ﺃﻜﺯﻤﺎ‬ ‫‪7‬‬ ‫‪38.9‬‬

‫ﺍﻟﺠﺩﻭل ﺭﻗﻡ )‪ (8‬ﺍﻟﺴﻭﺍﺒﻕ ﺍﻟﻤﺭﻀﻴﺔ ﻟﺩﻯ ﻤﺭﺽ ﺍﻟﺩﺭﺍﺴﺔ‬

‫ﺃﻤﺎ ﺍﻷﻋﺭﺍﺽ ﺍﻟﺴﺭﻴﺭﻴﺔ ﻓﻜﺎﻨﺕ ﻜﻤﺎ ﻓﻲ ﺍﻟﺠﺩﻭل ﺭﻗﻡ )‪(9‬‬

‫ﺍﻷﻋﺭﺍﺽ‬ ‫ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ‬ ‫ﺍﻟﻨﺴﺒﺔ ﺍﻟﻤﺌﻭﻴﺔ‬
‫ﺘﺭﻓﻊ ﺤﺭﻭﺭﻱ‬ ‫‪13‬‬ ‫‪72.2‬‬
‫ﺃﻋﺭﺍﺽ ﺠﻠﺩﻴﺔ‬
‫ﺃﺨﻤﺎﺝ ﺠﻠﺩﻴﺔ‬ ‫‪-‬‬ ‫‪13‬‬ ‫‪72.2‬‬
‫ﺃﻜﺯﻤﺎ‬ ‫‪-‬‬ ‫‪12‬‬ ‫‪66.7‬‬
‫ﺃﻋﺭﺍﺽ ﺼﺩﺭﻴﺔ‬
‫ﺴﻌﺎل‬ ‫‪-‬‬ ‫‪13‬‬ ‫‪72.2‬‬
‫ﺯﻟﺔ ﺘﻨﻔﺴﻴﺔ‬ ‫‪-‬‬ ‫‪9‬‬ ‫‪50‬‬

‫ﺍﻟﺘﻬﺎﺏ ﺃﻨﻑ ﺘﺤﺴﺴﻲ‬ ‫‪2‬‬ ‫‪11.1‬‬

‫ﺍﻟﺘﻬﺎﺏ ﻤﻠﺘﺤﻤﺔ ﻭﻗﺭﻨﻴﺔ‬ ‫‪1‬‬ ‫‪5.6‬‬
‫ﺍﻟﺠﺩﻭل ﺭﻗﻡ )‪ (9‬ﺍﻷﻋﺭﺍﺽ ﺍﻟﺴﺭﻴﺭﻴﺔ ﻋﻨﺩ ﻤﺭﻀﻰ ﺍﻟﺩﺭﺍﺴﺔ‬

‫ﻭﺃﻤﺎ ﺍﻟﺘﻅﺎﻫﺭﺍﺕ ﺍﻟﺴﺭﻴﺭﻴﺔ ﻓﻜﺎﻨﺕ ﻜﻤﺎ ﻓﻲ ﺍﻟﺠﺩﻭل ﺭﻗﻡ )‪(10‬‬

‫ﺍﻟﺘﻅﺎﻫﺭﺍﺕ ﺍﻟﺴﺭﻴﺭﻴﺔ‬ ‫ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ‬ ‫ﺍﻟﻨﺴﺒﺔ ﺍﻟﻤﺌﻭﻴﺔ‬

‫ﺠﻠﺩﻴﺔ‬
‫‪ -‬ﺨﻤﺞ ﺠﻠﺩﻱ‬ ‫‪10‬‬ ‫‪55.6‬‬
‫‪ -‬ﺃﻜﺯﻤﺎ‬ ‫‪13‬‬ ‫‪72.2‬‬
‫ﺼﺩﺭﻴﺔ‬
‫‪ -‬ﺨﺭﺍﺨﺭ ﻗﺼﺒﻴﺔ‬ ‫‪5‬‬ ‫‪27.8‬‬
‫‪ -‬ﺭﻴﺢ ﺼﺩﺭﻴﺔ‬ ‫‪1‬‬ ‫‪5.6‬‬

‫‪103‬‬
 ‫ﻤﺘﻼﺯﻤﺔ ﻓﺭﻁ ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻥ ﺍﻟﻤﻨﺎﻋﻲ ‪ E‬ﻓﻲ ﺍﻟﺩﻡ ﻤﻊ ﺍﻷﺨﻤﺎﺝ ﺍﻟﻤﻌﺎﻭﺩﺓ ﺃﻭ ﻤﺘﻼﺯﻤﺔ ﺠﻭﺏ ‪Job‬‬

‫ﺃﺨﻤﺎﺝ ﺃﺨﺭﻯ‬
‫‪ -‬ﺍﻟﺘﻬﺎﺏ ﺴﺤﺎﻴﺎ ﻗﻴﺤﻲ‬ ‫‪2‬‬ ‫‪11.1‬‬
‫‪ -‬ﺍﻟﺘﻬﺎﺏ ﺃﺫﻥ ﻭﺴﻁﻰ‬ ‫‪1‬‬ ‫‪5.6‬‬

‫ﺍﻟﺠﺩﻭل ﺭﻗﻡ)‪ (10‬ﺍﻟﺘﻅﺎﻫﺭﺍﺕ ﺍﻟﺴﺭﻴﺭﻴﺔ ﻟﺩﻯ ﻤﺭﻀﻰ ﺍﻟﺩﺭﺍﺴﺔ‬

‫ﺍﻟﺩﺭﺍﺴﺔ ﺍﻟﻤﺨﺒﺭﻴﺔ‬
‫ﺃﺠﺭﻴﺕ ﺒﻌﺽ ﺍﻟﻔﺤﻭﺹ ﺍﻟﻤﺨﺒﺭﻴﺔ ﺍﻟﻼﻨﻭﻋﻴﺔ ﻜﻤﺎ ﻫﻭ ﻤﺒﻴﻥ ﻓﻲ ﺍﻟﺠﺩﻭل ﺭﻗﻡ )‪(11‬‬
‫ﺍﻟﻔﺤﻭﺹ ﺍﻟﻤﺨﺒﺭﻴﺔ‬ ‫ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ‬ ‫ﺍﻟﻨﺴﺒﺔ ﺍﻟﻤﺌﻭﻴﺔ‬
‫ﺯﻴﺎﺩﺓ ﺘﻌﺩﺍﺩ ﺍﻟﻜﺭﻴﺎﺕ ﺍﻟﺒﻴﺽ‬ ‫‪7‬‬ ‫‪38.9‬‬
‫ﺯﻴﺎﺩﺓ ﻨﺴﺒﺔ ﺍﻟﻌﺩﻻﺕ‬ ‫‪6‬‬ ‫‪33.3‬‬
‫ﺯﻴﺎﺩﺓ ﻨﺴﺒﺔ ﺍﻟﺤﻤﻀﺎﺕ‬ ‫‪14/10‬‬ ‫‪71.4‬‬
‫ﺯﻴﺎﺩﺓ ﺍﻟﺒﺭﻭﺘﻴﻥ ﺍﻻﺭﺘﻜﺎﺴﻲ ‪C‬‬ ‫‪17/16‬‬ ‫‪94.1‬‬
‫ﺯﻴﺎﺩﺓ ﺴﺭﻋﺔ ﺍﻟﺘﺜﻔل‬ ‫‪14/11‬‬ ‫‪78.6‬‬
‫ﺍﻟﺠﺩﻭل ﺭﻗﻡ )‪ (11‬ﺍﻟﺩﺭﺍﺴﺔ ﺍﻟﻤﺨﺒﺭﻴﺔ ﻟﺩﻯ ﺍﻟﻤﺭﻀﻰ‬
‫ﺃﻤﺎ ﺒﺎﻟﻨﺴﺒﺔ ﻟﻌﻴﺎﺭ ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻨﺎﺕ ﺍﻟﻤﻨﺎﻋﻴﺔ ﻓﻜﺎﻨﺕ ﻜﻤﺎ ﻓﻲ ﺍﻟﺠﺩﻭل ﺭﻗﻡ )‪(12‬‬
‫ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻥ ﺍﻟﻤﻨﺎﻋﻲ‬ ‫ﻁﺒﻴﻌﻲ‬ ‫ﻤﻨﺨﻔﺽ‬ ‫ﻤﺭﺘﻔﻊ‬
‫‪IgG‬‬ ‫‪10‬‬ ‫‪-‬‬ ‫‪8‬‬
‫‪IgM‬‬ ‫‪12‬‬ ‫‪5‬‬ ‫‪1‬‬
‫‪IgA‬‬ ‫‪14‬‬ ‫‪-‬‬ ‫‪4‬‬
‫‪IgE‬‬ ‫‪-‬‬ ‫‪-‬‬ ‫‪18‬‬
‫ﺍﻟﺠﺩﻭل ﺭﻗﻡ )‪ (12‬ﻋﻴﺎﺭ ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻨﺎﺕ ﺍﻟﻤﻨﺎﻋﻴﺔ ﻋﻨﺩ ﻤﺭﻀﻰ ﺍﻟﺩﺭﺍﺴﺔ‬
‫ﺃﺠﺭﻴﺕ ﺩﺭﺍﺴﺔ ﻟﺘﻘﻴﻴﻡ ﻭﻅﻴﻔـﺔ ﺍﻟﺒﻠﻌﻤـﺔ ﺒﺎﺨﺘﺒـﺎﺭ ‪Nitro-blue tetrazolium dye test‬‬
‫ﻱ ﻟﺩﻯ ‪ 7‬ﻤﺭﻀﻰ ﻭﻜﺎﻥ ﻁﺒﻴﻌﻴﹰﺎ ﻓﻲ ﻫﺫﻩ ﺍﻟﺤﺎﻻﺕ‪.‬‬‫ﺠ ِﺭ ‪‬‬
‫)‪ (NBT‬ﺍﻟﺫﻱ ُﺃ ‪‬‬

‫ﺼﻭﺭﺓ ﺍﻟﺼﺩﺭ ﺍﻟﺸﻌﺎﻋﻴﺔ‪:‬‬

‫ﺃﺠﺭﻴﺕ ﺼﻭﺭﺓ ﺍﻟﺼﺩﺭ ﺍﻟﺸﻌﺎﻋﻴﺔ ﻓﻲ ﺠﻤﻴﻊ ﺍﻟﺤﺎﻻﺕ ﻭﻗﺩ ﺃﻅﻬﺭﺕ ﻤﻭﺠﻭﺩﺍﺕ ﻤﺭﻀﻴﺔ ﻓﻲ‬
‫‪ 9‬ﺤﺎﻻﺕ ﻨﺒﻴﻨﻬﺎ ﻓﻲ ﺍﻟﺠﺩﻭل ﺭﻗﻡ )‪(13‬‬

‫ﺍﻟﻤﻭﺠﻭﺩﺍﺕ ﺍﻟﻤﺭﻀﻴﺔ‬ ‫ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ‬ ‫ﺍﻟﻨﺴﺒﺔ ﺍﻟﻤﺌﻭﻴﺔ‬

‫ﺍﺭﺘﺸﺎﺤﺎﺕ ﺍﻟﺘﻬﺎﺒﻴﺔ‬ ‫‪5‬‬ ‫‪27.8‬‬
‫ﻜﺜﺎﻓﺔ ﻤﺩﻭﺭﺓ‬ ‫‪1‬‬ ‫‪5.6‬‬
‫ﺍﺭﺘﺸﺎﺡ ‪ +‬ﺍﻨﺼﺒﺎﺏ ﺠﻨﺏ‬ ‫‪1‬‬ ‫‪5.6‬‬

‫‪104‬‬
 ‫ﻉ‪ .‬ﺃﻨﺠﻕ‬ ‫ﻤﺠﻠﺔ ﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ ﻟﻠﻌﻠﻭﻡ ﺍﻟﺼﺤﻴﺔ‪ -‬ﺍﻟﻤﺠﻠﺩ ﺍﻟﻌﺸﺭﻭﻥ‪ -‬ﺍﻟﻌﺩﺩ ﺍﻟﺜﺎﻨﻲ‪2004 -‬‬

‫ﺍﺭﺘﺸﺎﺡ ‪ +‬ﺍﻨﺼﺒﺎﺏ ‪+‬ﺭﻴﺢ‬

‫ﺼﺩﺭﻴﺔ‪+‬ﻗﻴﻼﺕ ﻫﻭﺍﺌﻴﺔ‬ ‫‪1‬‬ ‫‪5.6‬‬
‫ﺠﻭﻑ ﻫﻭﺍﺌﻲ‬ ‫‪1‬‬ ‫‪5.6‬‬
‫ﺍﻟﻤﺠﻤﻭﻉ‬ ‫‪9‬‬ ‫‪50‬‬

‫ﺍﻟﺠﺩﻭل ﺭﻗﻡ )‪ (13‬ﻤﻭﺠﻭﺩﺍﺕ ﺼﻭﺭﺓ ﺍﻟﺼﺩﺭ ﺍﻟﺸﻌﺎﻋﻴﺔ ﻋﻨﺩ ﻤﺭﻀﻰ ﺍﻟﺩﺭﺍﺴﺔ‬

‫ﺍﻟﻤﻌﺎﻟﺠﺔ‪:‬‬ ‫ﺍﻟﺯﺭﻭﻋﺎﺕ ﺍﻟﺠﺭﺜﻭﻤﻴﺔ‪:‬‬

‫ﺃﻋﻁﻴﺕ ﺍﻟﻤﻀﺎﺩﺍﺕ ﺍﻟﺤﻴﻭﻴﺔ ﻓـﻲ ﺠﻤﻴـﻊ‬
‫ﺍﻟﺤﺎﻻﺕ ﻭﺍﺨﺘﻠﻔﺕ ﻨﻭﻋﻴﺔ ﺍﻟﻤﻀﺎﺩ ﺍﻟﺤﻴﻭﻱ‬
‫ﺍﻟﻤﺴﺘﺨﺩﻡ ﺤﺴﺏ ﻤﻭﻗﻊ ﺍﻟﺨﻤـﺞ ﻭﻋـﺩﻟﺕ‬
‫ﺍﻟﻤﻌﺎﻟﺠﺔ ﺤﺴﺏ ﺍﻻﺴﺘﺠﺎﺒﺔ ﺍﻟـﺴﺭﻴﺭﻴﺔ ﺃﻭ‬
‫ﺤﺴﺏ ﺍﻟﺯﺭﻉ ﺍﻟﺠﺭﺜﻭﻤﻲ ﻭﺍﻟﺘﺤﺴﺱ‪.‬‬
‫ﻁ ﺍﻟﻐﺎﻤﺎﻏﻠﻭﺒﻭﻟﻴﻥ ﺍﻟﻤﻨﺎﻋﻲ ﻓﻲ ﺃﻴـﺔ‬
‫ﻟﻡ ‪‬ﻴ ‪‬ﻌ ﹶ‬
‫ﺤﺎﻟﺔ‪.‬‬
‫‪ -‬ﻜﺎﻥ ﻫﻨﺎﻙ ‪ 4‬ﺯﺭﻭﻋﺎﺕ ﺇﻴﺠﺎﺒﻴـﺔ ﻤـﻥ‬
‫ﻤﺼﺩﺭ ﺠﻠﺩﻱ )ﺨﺭﺍﺠـﺎﺕ – ﺘﻘـﺭﺡ (‬
‫ﻭﻋﺯﻟﺕ ﺍﻟﻌﻨﻘﻭﺩﻴـﺎﺕ ﺍﻟﻤﺫﻫﺒـﺔ ﻓـﻲ‬
‫ﺤﺎﻟﺘﻴﻥ‪ ،‬ﻭﺍﻟﻌﺼﻴﺎﺕ ﺍﻟﺯﺭﻕ ﻓﻲ ﺍﻟﺤﺎﻟـﺔ‬
‫ﺍﻟﺜﺎﻟﺜﺔ‪ ،‬ﻭﺍﻟﻌﺼﻴﺎﺕ ﺍﻟﻜﻭﻟﻭﻨﻴﺔ ﻓﻲ ﺍﻟﺤﺎﻟﺔ‬
‫ﺍﻟﺭﺍﺒﻌﺔ‪.‬‬
‫‪ -‬ﻭﺠﺩ ﺃﻴﻀﹰﺎ ﺯﺭﻉ ﺇﻴﺠﺎﺒﻲ ﻤـﻥ ﺴـﻴﻼﻥ‬
‫ﺃﺫﻨﻲ ﻭﻜﺎﻨﺕ ﺍﻟﻨﺘﻴﺠﺔ ﻜﻠﻴﺒﺴﻴﻼ‪.‬‬

‫ﺘﻁﻭﺭ ﺍﻟﺤﺎﻻﺕ‪:‬‬
‫ﻜﺎﻥ ﺘﻁﻭﺭ ﺍﻟﺤﺎﻻﺕ‬ ‫ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ‬ ‫ﺍﻟﻨﺴﺒﺔ ﺍﻟﻤﺌﻭﻴﺔ‬
‫ﻜﻤﺎ ﻓﻲ ﺍﻟﺠﺩﻭل ﺭﻗﻡ‬
‫)‪(14‬ﺍﻟﺘﻁﻭﺭ‬
‫ﺘﺤﺴﻥ‬ ‫‪13‬‬ ‫‪72.2‬‬
‫ﻋﺩﻡ ﺘﺤﺴﻥ‬ ‫‪1‬‬ ‫‪5.6‬‬
‫ﻭﻓﺎﺓ‬ ‫‪1‬‬ ‫‪5.6‬‬
‫ﺨﺭﻭﺝ ﻋﻠﻰ‬ ‫‪3‬‬ ‫‪16.7‬‬
‫ﻤﺴﺅﻭﻟﻴﺔ ﺍﻷﻫل‬
‫ﺍﻟﻤﺠﻤﻭﻉ‬ ‫‪18‬‬

‫‪105‬‬
 ‫ﻤﺘﻼﺯﻤﺔ ﻓﺭﻁ ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻥ ﺍﻟﻤﻨﺎﻋﻲ ‪ E‬ﻓﻲ ﺍﻟﺩﻡ ﻤﻊ ﺍﻷﺨﻤﺎﺝ ﺍﻟﻤﻌﺎﻭﺩﺓ ﺃﻭ ﻤﺘﻼﺯﻤﺔ ﺠﻭﺏ ‪Job‬‬

‫ﺍﻟﺠﺩﻭل ﺭﻗﻡ )‪ ( 14‬ﺘﻁﻭﺭ ﺍﻟﺤﺎﻻﺕ‬

‫ﻤﺩﺓ ﺍﻻﺴﺘﺸﻔﺎﺀ‬
‫ﻜﺎﻨﺕ ﻤﺩﺓ ﺍﻻﺴﺘﺸﻔﺎﺀ ﻜﻤﺎ ﻫﻲ ﻓﻲ ﺍﻟﺠﺩﻭل ﺭﻗﻡ )‪(15‬‬
‫ﻤﺩﺓ ﺍﻻﺴﺘﺸﻔﺎﺀ‬ ‫ﺍﻟﻨﺴﺒﺔ ﺍﻟﻤﺌﻭﻴﺔ ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ‬
‫ﺃﻗل ﻤﻥ ﺃﺴﺒﻭﻉ‬ ‫‪3‬‬ ‫‪16.7‬‬
‫‪ 2-1‬ﺃﺴﺒﻭﻉ‬ ‫‪5‬‬ ‫‪27.8‬‬
‫‪ 4-3‬ﺃﺴﺎﺒﻴﻊ‬ ‫‪6‬‬ ‫‪33.3‬‬
‫ﺃﻜﺜﺭ ﻤﻥ ‪ 4‬ﺃﺴﺎﺒﻴﻊ‬ ‫‪4‬‬ ‫‪22.2‬‬
‫ﺍﻟﻤﺠﻤﻭﻉ‬ ‫‪18‬‬
‫ﺍﻟﺠﺩﻭل ﺭﻗﻡ) ‪ (15‬ﻤﺩﺓ ﺍﻻﺴﺘﺸﻔﺎﺀ ﻋﻨﺩ ﻤﺭﻀﻰ ﺍﻟﺩﺭﺍﺴﺔ‬

‫ﺍﻹﺼﺎﺒﺔ ﺍﻟﺠﻠﺩﻴﺔ ﻤﻊ ﺍﻷﺨﻤﺎﺝ ﺍﻟﻤﺘﻜـﺭﺭﺓ‬ ‫ﺍﻟﻤﻨﺎﻗﺸﺔ‪:‬‬

‫ﻭﻭﺠﻭﺩ ﺍﻹﺼـﺎﺒﺔ ﺍﻟـﺼﺩﺭﻴﺔ ﻭﺍﺭﺘﻔـﺎﻉ‬
‫ﺍﻟﻐﺎﻤﺎﻏﻠﻭﺒﻴﻥ ‪ E‬ﻓﻲ ﺍﻟﻤﺼل ﻭﺍﺭﺘﻔﺎﻉ ﻨﺴﺒﺔ‬
‫ﺍﻟﺤﻤﻀﺎﺕ ﻭﻨﻔﻲ ﺍﻷﻤﺭﺍﺽ ﺍﻷﺨﺭﻯ ﺍﻟﺘﻲ‬
‫ﺘﺩﺨل ﻓﻲ ﺍﻟﺘﺸﺨﻴﺹ ﺍﻟﺘﻔﺭﻴﻘﻲ‪.‬‬
‫ﺩﺭﺱ ﻋﺩﺩ ﻤﺭﺍﺕ ﺍﻟﻘﺒﻭل ﻓﻲ ﻫﺫﻩ ﺍﻟﺤﺎﻻﺕ‬
‫ﺇ ﹾﺫ ﻟﻭﺤﻅ ﺘﻜﺭﺭ ﻗﺒﻭل ﺒﻌﺽ ﺍﻟﻤﺭﺽ ﻓﻘـﺩ‬
‫ﻗﺒل ﺃﺭﺒﻌﺔ ﻤﺭﻀﻰ ﻤﺭﺘﻴﻥ ﺨـﻼل ﻓﺘـﺭﺓ‬
‫ﺍﻟﺩﺭﺍﺴﺔ ﻓﻲ ﺤﻴﻥ ﻗﺒل ﺜﻼﺜﺔ ﻤﺭﻀﻰ ﺃﻜﺜﺭ‬
‫ﻤﻥ ﻤﺭﺘﻴﻥ ﻭﺸﻜل ﺘﻜﺭﺭ ﺍﻟﻘﺒـﻭل ﻨـﺴﺒﺔ‬
‫‪ %38.9‬ﻤﻥ ﻤﺭﻀﻰ ﺍﻟﺩﺭﺍﺴﺔ‪.‬‬
‫ﺩﺭﺱ ﺘﻭﺯﻉ ﺤﺎﻻﺕ ﻤﺘﻼﺯﻤﺔ ﺠﻭﺏ ﺤﺴﺏ‬
‫ﺍﻟﺠﻨﺱ ﻭﻗﺩ ﻭﺠﺩﻨﺎ ﻓﻲ ﺍﻟﺩﺭﺍﺴﺔ ﺃﻥ ﺍﻟﺘﻭﺯﻉ‬
‫ﺤﺴﺏ ﺍﻟﺠﻨﺱ ﻜـﺎﻥ ﺒﻨـﺴﺒﺔ ‪ ،1/2‬ﻭﻫـﺫﺍ‬
‫ﻴﺨﺘﻠﻑ ﻋﻥ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻟﻌﺎﻟﻤﻴﺔ ﺍﻟﺘﻲ ﺘﺫﻜﺭ‬
‫ﺍﻷﺴﺎﺴﻴﺔ ﻟﻬﺫﻩ ﺍﻟﻤﺘﻼﺯﻤﺔ ﻭﻫـﻲ ﻭﺠـﻭﺩ‬
‫ﺇﻥ ﻤﺘﻼﺯﻤﺔ ﺠﻭﺏ ﻗﻠﻴﻠﺔ ﺍﻟﻤﺸﺎﻫﺩﺓ ﻋﺎﻟﻤﻴـﺎ‬
‫ﻭﻻ ﺘﻭﺠﺩ ﺩﺭﺍﺴﺎﺕ ﻟﻬﺫﻩ ﺍﻟﻤﺘﻼﺯﻤﺔ ﻋﻨـﺩ‬
‫ﺍﻷﻁﻔﺎل ﻭﺤﺩﻫﻡ ﺴﻭﻯ ﺍﻟﺩﺭﺍﺴﺔ ﺍﻟﻤﻭﺠﻭﺩﺓ‬
‫ﻓﻲ ﻤﺠﻠﺔ ﺍﻷﻁﻔﺎل )‪ (11‬ﻭﺍﻟﺘﻲ ﻜﺎﻨﺕ ﺤﻭل‬
‫ﺍﻟﺘﻅﺎﻫﺭﺍﺕ ﺍﻟﺠﻠﺩﻴﺔ ﻭﺸﻤﻠﺕ ﺍﻟﺩﺭﺍﺴـﺔ ‪8‬‬
‫ﺃﻁﻔﺎل‪ ،‬ﺃﻤﺎ ﺍﻟﺩﺭﺍﺴﺔ ﺍﻟﻤﻨﺸﻭﺭﺓ ﻓﻲ ﺍﻟﻤﺠﻠﺔ‬
‫ﺍﻟﻁﺒﻴﺔ ﺍﻹﻨﻜﻠﻴﺯﻴـﺔ ﺍﻟﺤﺩﻴﺜـﺔ )‪ (5‬ﻭﺍﻟﺘـﻲ‬
‫ﺸﻤﻠﺕ ‪30‬ﻤﺭﻴﻀﹰﺎ ﺒﻬﺫﻩ ﺍﻟﻤﺘﻼﺯﻤﺔ ﻜﺎﻨـﺕ‬
‫ﻋﻠﻰ ﺍﻷﻁﻔﺎل ﻭﺍﻟﻜﻬﻭل ﻭ ﻜـﺎﻥ ﻤـﻨﻬﻡ ‪5‬‬
‫ﺃﻁﻔﺎل ﺒﺴﻥ ﺃﻗل ﻤﻥ ‪14‬ﺴـﻨﺔ‪ .‬ﺃﻤـﺎ ﻓـﻲ‬
‫ﺩﺭﺍﺴﺘﻨﺎ ﻓﻘﺩ ﻭﺠﺩﻨﺎ ‪ 18‬ﺤﺎﻟﺔ ﻭﻜﺎﻥ ﺃﻋﻠـﻰ‬
‫ﻨﺴﺒﺔ ﻟﻬﺫﻩ ﺍﻟﺤﺎﻻﺕ ﻓﻲ ﻋﺎﻡ ‪ 2002‬ﺤﻴـﺙ‬
‫ﺸﻜﻠﺕ ﺜﻠﺙ ﺤﺎﻻﺕ ﺍﻟﺩﺭﺍﺴﺔ‪ ،‬ﻭﻗﺩ ﺍﻋﺘﻤﺩﻨﺎ‬
‫ﻓﻲ ﻭﻀﻊ ﺍﻟﺘـﺸﺨﻴﺹ ﻋﻠـﻰ ﺍﻟﻤﻌـﺎﻴﻴﺭ‬

‫‪106‬‬
 ‫ﻉ‪ .‬ﺃﻨﺠﻕ‬ ‫ﻤﺠﻠﺔ ﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ ﻟﻠﻌﻠﻭﻡ ﺍﻟﺼﺤﻴﺔ‪ -‬ﺍﻟﻤﺠﻠﺩ ﺍﻟﻌﺸﺭﻭﻥ‪ -‬ﺍﻟﻌﺩﺩ ﺍﻟﺜﺎﻨﻲ‪2004 -‬‬
‫ﺘﺸﺨﻴﺹ ﺸﻙ ﻋﻭﺯ ﻤﻨﺎﻋﻲ ﻓﻲ ‪ 10‬ﺤﺎﻻﺕ‬
‫ﺒﻨﺴﺒﺔ ‪ %55.6‬ﻭﻫﺫﺍ ﻴﻌﻭﺩ ﺇﻟﻰ ﺍﻷﺨﻤـﺎﺝ‬
‫ﺍﻟﻤﺘﻜﺭﺭﺓ ﻟﺩﻯ ﻫـﺅﻻﺀ ﺍﻟﻤﺭﻀـﻰ ﺃﻤـﺎ‬
‫ﺍﻟﺘﺸﺎﺨﻴﺹ ﺍﻷﺨﺭﻯ ﻓﻜﺎﻨﺕ ﻤﺨﺘﻠﻔﺔ ﺤﺴﺏ‬
‫ﻤﻭﻀﻊ ﺍﻹﺼﺎﺒﺔ ﺍﻟﺨﻤﺠﻴﺔ ﺴﻭﺍﺀ ﺍﻟﺠﻠﺩﻴﺔ ﺃﻭ‬
‫ﺍﻟﺭﺌﻭﻴﺔ ﻭﻗﺩ ﻭﺠﺩ ﺍﺭﺘﻔﺎﻉ ‪ IgE‬ﻋﻨﺩ ﺍﻟﻘﺒﻭل‬
‫ﺒﻨﺎﺀ ﻋﻠﻰ ﺘﺤﺎﻟﻴل ﺨﺎﺭﺠﻴﺔ ﻓﻲ ﺤﺎﻟﺘﻴﻥ‪.‬‬
‫ﺇﻥ ﺍﻷﻋﺭﺍﺽ ﺍﻟﺼﺩﺭﻴﺔ ﻭﺍﻟﺠﻠﺩﻴﺔ ﻭﺠـﺩﺕ‬
‫ﻋﻨﺩ ﺍﻟﻤﺭﻀﻰ ﻓـﻲ ﺃﺜﻨـﺎﺀ ﺍﻟﻘﺒـﻭل ﻓـﻲ‬
‫ﺍﻟﻤﺴﺘﺸﻔﻰ ﻓﻲ ‪ 13‬ﺤﺎﻟـﺔ ﺒﻨـﺴﺒﺔ ‪%72.2‬‬
‫ﻭﻟﻜﻥ ﻫﺫﻩ ﺍﻷﻋﺭﺍﺽ ﺫﻜﺭﺕ ﻓﻲ ﺍﻟﺴﻭﺍﺒﻕ‬
‫ﺍﻟﻤﺭﻀﻴﺔ ﻟﻠﻤﺭﻀﻰ ﺍﻵﺨﺭﻴﻥ ﺍﻟﺫﻴﻥ ﻟﻡ ﻴﻜﻥ‬
‫ﻟﺩﻴﻬﻡ ﺇﺼﺎﺒﺔ ﺨﻼل ﻓﺘﺭﺓ ﺍﻻﺴﺘﺸﻔﺎﺀ ﻭﻤـﻥ‬
‫ﺫﻟﻙ ﻭﺠﺩﻨﺎ ﺃﻥ ﺍﻹﺼﺎﺒﺔ ﺍﻟﺠﻠﺩﻴـﺔ ﻜﺎﻨـﺕ‬
‫ﻤﻭﺠﻭﺩﺓ ﻓﻲ ﺠﻤﻴﻊ ﺍﻟﺤﺎﻻﺕ ﺃﻤﺎ ﺍﻹﺼـﺎﺒﺔ‬
‫ﺍﻟﺼﺩﺭﻴﺔ ﻓﻘﺩ ﺫﻜﺭﺕ ﻓﻲ ‪ 15‬ﺤﺎﻟﺔ ﻭﻜﺎﻨﺕ‬
‫ﻋﻠﻰ ﺸﻜل ﺃﺨﻤﺎﺝ ﺘﻨﻔﺴﻴﺔ ﻓﻲ ﺍﻟﻐﺎﻟـﺏ ﺃﻭ‬
‫ﺴﻌﺎل ﻓﻘﻁ ﻓﻲ ﻋﺩﺩ ﻗﻠﻴل ﻤـﻥ ﺍﻟﺤـﺎﻻﺕ‪،‬‬
‫ﻭﻭﺠﺩﺕ ﺍﻹﺼﺎﺒﺘﺎﻥ ﺍﻟﺠﻠﺩﻴـﺔ ﻭﺍﻟـﺼﺩﺭﻴﺔ‬
‫ﻤﻌﹰﺎ ﻓﻲ ‪ 14‬ﺤﺎﻟﺔ‪ ،‬ﺃﻤﺎ ﺍﻟﺤـﺎﻻﺕ ﺍﻷﺭﺒـﻊ‬
‫ﺍﻷﺨﺭﻯ ﻓﻘﺩ ﺍﻋﺘﻤﺩ ﺍﻟﺘﺸﺨﻴﺹ ﻓﻴﻬﺎ ﻋﻠـﻰ‬
‫ـﺔ‬
‫ـﺎﺕ ﺍﻟﺠﻠﺩﻴـ‬
‫ـﺎ ﻭﺍﻟﺘﻘﻴﺤـ‬
‫ـﻭﺩ ﺍﻷﻜﺯﻤـ‬
‫ﻭﺠـ‬
‫ﺒﺎﻹﻀﺎﻓﺔ ﺇﻟﻰ ﺍﺭﺘﻔﺎﻉ ‪ IgE‬ﻷﻜﺜـﺭ ﻤـﻥ‬
‫‪ 2000‬ﻭﺤﺩﺓ ﺩﻭﻟﻴﺔ ﻋﻨﺩ ﻫﺅﻻﺀ ﺍﻟﻤﺭﻀﻰ‪.‬‬
‫‪107‬‬
‫ﺇﺼﺎﺒﺔ ﺍﻟﺠﻨﺴﻴﻥ ﺒﺎﻟﻨـﺴﺒﺔ ﻨﻔـﺴﻬﺎ )‪(5,2‬‬
‫ﻭﻟﻴﺱ ﻫﻨﺎﻙ ﺘﻔﺴﻴﺭ ﻟﺫﻟﻙ‪.‬‬
‫ﺇﻥ ﺍﻹﺼﺎﺒﺔ ﺒﻤﺘﻼﺯﻤﺔ ﺠﻭﺏ ﺘﺒﺩﺃ ﺒـﺎﻜﺭﹰﺍ‬
‫ﺤﺴﺏ ﻤﺨﺘﻠﻑ ﺍﻟﺩﺭﺍﺴﺎﺕ )‪ (5,4,2,1‬ﻭﻗـﺩ‬
‫ﺩﺭﺴﻨﺎ ﺘﻭﺯﻉ ﺤﺎﻻﺕ ﺍﻟﺩﺭﺍﺴﺔ ﺤﺴﺏ ﺍﻟﻌﻤﺭ‬
‫ﻋﻨــﺩ ﺒــﺩﺀ ﺍﻷﻋــﺭﺍﺽ‪ ،‬ﻭﻭﺠــﺩﻨﺎ ﺃﻥ‬
‫ﺍﻷﻋﺭﺍﺽ ﺒﺩﺃﺕ ﻓﻲ ﻋﻤﺭ ﻤﺎ ﻗﺒل ﺍﻟـﺴﻨﺔ‬
‫ﻓﻲ ﻏﺎﻟﺒﻴﺔ ﺍﻟﺤﺎﻻﺕ )‪ (%83.3‬ﺃﻤﺎ ﺒﺎﻟﻨﺴﺒﺔ‬
‫ﻟﻠﺘﺸﺨﻴﺹ ﻓﻘﺩ ﺘﻡ ﻭﻀﻊ ﺍﻟﺘﺸﺨﻴﺹ ﻓـﻲ‬
‫ﻫﺫﻩ ﺍﻟﻔﺌـﺔ ﺍﻟﻌﻤﺭﻴـﺔ ﻓـﻲ ‪ %16.7‬ﻤـﻥ‬
‫ﺍﻟﺤﺎﻻﺕ ﻓﻘﻁ‪.‬‬
‫ﺩﺭﺱ ﺘﻜﺭﺭ ﺍﻹﺼﺎﺒﺔ ﻓﻲ ﺍﻟﻌﺎﺌﻠـﺔ ﻨﻔـﺴﻬﺎ‬
‫ﻭﻗﺩ ﺠﺩﻨﺎ ﻗﺼﺔ ﺃﺨﻤـﺎﺝ ﻤﺘﻜـﺭﺭﺓ ﻓـﻲ‬
‫ﺍﻟﺠﻬﺎﺯ ﺍﻟﺘﻨﻔﺴﻲ ﺒﺸﻜل ﺨﺎﺹ ﻭ‪/‬ﺃﻭ ﺇﺼﺎﺒﺔ‬
‫ﺠﻠﺩﻴﺔ ﻋﻨﺩ ﺜﻼﺜﺔ ﻤﺭﻀﻰ ﻭﻟﻡ ﻴﺠﺭ ﻟﻬﺅﻻﺀ‬
‫ﺍﻟﻤﺭﻀﻰ ﺩﺭﺍﺴـﺔ ﺘﺸﺨﻴـﺼﻴﺔ ﺃﻭ ﻋﻴـﺎﺭ‬
‫ل‪ IgE‬ﺃﻤﺎ ﻭﺠﻭﺩ ﺇﺼـﺎﺒﺔ ﻤـﺸﺎﺒﻬﺔ ﻤـﻊ‬
‫ﺍﺭﺘﻔﺎﻉ ﺍل ‪ IgE‬ﻋﻨﺩ ﺃﺤﺩ ﺍﻷﺨﻭﺓ ﻓﻘﺩ ﻭﺠﺩ‬
‫ﻟﺩﻯ ﻤﺭﻴﺽ ﻭﺍﺤﺩ ﻭﻜﺫﻟﻙ ﺇﺼﺎﺒﺔ ﻤﺸﺎﺒﻬﺔ‬
‫ﺒﻤﺘﻼﺯﻤﺔ ﺠﻭﺏ ﻓﻲ ﺍﻟﻌﺎﺌﻠﺔ ﻟﺩﻯ ﻤـﺭﻴﺽ‬
‫ﺁﺨﺭ ﻭﺒﺫﻟﻙ ﻓﺈﻥ ﺍﻟﻘﺼﺔ ﺍﻟﻌﺎﺌﻠﻴـﺔ ﻜﺎﻨـﺕ‬
‫ﺇﻴﺠﺎﺒﻴﺔ ﻓﻲ ‪ %39‬ﻤﻥ ﺍﻟﺤﺎﻻﺕ‪.‬‬
‫ﺃﻤﺎ ﺒﺎﻟﻨﺴﺒﺔ ﻟﻠﺘﺸﺨﻴﺹ ﻋﻨﺩ ﺍﻟﻘﺒﻭل ﻟﻠﻤـﺭﺓ‬
‫ﺍﻷﻭﻟﻰ ﻟﻬﺅﻻﺀ ﺍﻟﻤﺭﻀـﻰ ﻓﻘـﺩ ﻭﻀـﻊ‬
 ‫ﻤﺘﻼﺯﻤﺔ ﻓﺭﻁ ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻥ ﺍﻟﻤﻨﺎﻋﻲ ‪ E‬ﻓﻲ ﺍﻟﺩﻡ ﻤﻊ ﺍﻷﺨﻤﺎﺝ ﺍﻟﻤﻌﺎﻭﺩﺓ ﺃﻭ ﻤﺘﻼﺯﻤﺔ ﺠﻭﺏ ‪Job‬‬
‫ِﺇ ﹾﺫ ﻭﺠﺩﺕ ﺯﻴﺎﺩﺓ ﺍﻟﺤﻤـﻀﺎﺕ ﻋﻨـﺩ ‪8/7‬‬
‫ـﺎﺩﺓ‬
‫ـﺎ ﺯﻴـ‬
‫ـﺴﺒﺔ ‪ ،%87.5‬ﺃﻤـ‬
‫ـﻰ ﺒﻨـ‬
‫ﻤﺭﻀـ‬
‫ﺍﻟﺒﺭﻭﺘﻴﻥ ﺍﻻﺭﺘﻜﺎﺴﻲ ‪ C‬ﻭﺴﺭﻋﺔ ﺍﻟﺘﺜﻔل ﻓﻘﺩ‬
‫ـﻥ‬
‫ـﺴﺒﺔ ‪ %94.1‬و‪ %78.6‬ﻤـ‬
‫ـﺩﺕ ﺒﻨـ‬
‫ﻭﺠـ‬
‫ﺍﻟﺤﺎﻻﺕ ﻋﻠﻰ ﺍﻟﺘﺭﺘﻴﺏ ﻭﻫﺫﺍ ﻴﻌـﻭﺩ ﺇﻟـﻰ‬
‫ﺍﻷﺨﻤﺎﺝ ﺍﻟﻤﻭﺠﻭﺩﺓ ﻟﺩﻯ ﺍﻟﻤﺭﻴﺽ ﺨـﻼل‬
‫ﻓﺘﺭﺓ ﺍﻻﺴﺘﺸﻔﺎﺀ‪.‬‬
‫ﺩﺭﺴﺕ ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻨﺎﺕ ﺍﻟﻤﻨﺎﻋﻴﺔ ‪IgG, IgM,‬‬
‫‪ IgA, IgE‬ﻟﺩﻯ ﺍﻟﻤﺭﻀﻰ ﺠﻤﻴﻌـﹰﺎ ﻭﺫﻟـﻙ‬
‫ﻟﺘﺤﺭﻱ ﺴﺒﺏ ﺍﻟﻌـﻭﺯ ﺍﻟﻤﻨـﺎﻋﻲ ﻭﺘﻜـﺭﺭ‬
‫ﺍﻷﺨﻤﺎﺝ‪ ،‬ﻭﻗـﺩ ﻭﺠـﺩﻨﺎ ﺃﻥ ‪ IgG‬ﻜـﺎﻥ‬
‫ﻤﺭﺘﻔﻌﹰﺎ ﻓﻲ ‪ 8‬ﺤﺎﻻﺕ ﻭﺍﻟﺴﺒﺏ ﻓـﻲ ﺫﻟـﻙ‬
‫ﻏﺎﻟﺒ ﹰﺎ ﺍﻟﺤﺎﻟﺔ ﺍﻟﺨﻤﺠﻴﺔ ﻟﻠﻤﺭﺽ‪ .‬ﺃﻤﺎ ‪IgM‬‬
‫ﻓﻜﺎﻥ ﻤﻨﺨﻔﻀﹰﺎ ﻓﻲ ‪ 5‬ﺤﺎﻻﺕ ﻭﻤﺭﺘﻔﻌﹰﺎ ﻓﻲ‬
‫ﺤﺎﻟﺔ ﻭﺍﺤﺩﺓ ﻭﻟﻡ ﻨﺠﺩ ﺘﻔﺴﻴﺭﹰﺍ ﻟﺫﻟﻙ ﻭﻜﺫﻟﻙ‬
‫ﺍﻷﻤﺭ ﺒﺎﻟﻨﺴﺒﺔ ل ‪ IgA‬ﺍﻟﺫﻱ ﺍﺭﺘﻔـﻊ ﻓـﻲ‬
‫‪4‬ﺤﺎﻻﺕ‪ .‬ﺃﻅﻬـﺭﺕ ﺩﺭﺍﺴـﺔ ‪ IgE‬ﻋﻨـﺩ‬
‫ﺍﻟﻤﺭﺽ ﺍﺭﺘﻔﺎﻋﻪ ﻓـﻲ ﺠﻤﻴـﻊ ﺍﻟﺤـﺎﻻﺕ‬
‫ﻭﺘﺭﺍﻭﺤﺕ ﻗﻴﻤﺘﻪ ﻤﺎ ﺒـﻴﻥ ‪ 345‬ﻭ ‪14120‬‬
‫ﻭﺤﺩﺓ ﺩﻭﻟﻴﺔ ﻭﻜﺎﻨﺕ ﺍﻟﻘﻴﻤﺔ ﺃﻜﺜﺭ ﻤﻥ ‪2000‬‬
‫ﻭﺤﺩﺓ ﻓﻲ ‪10‬ﺤﺎﻻﺕ‪ ،‬ﺃﻤﺎ ﺍﻟﺤﺎﻻﺕ ﺍﻷﺨﺭﻯ‬
‫ِﺇ ﹾﺫ ﻜﺎﻨﺕ ﺍﻟﻘﻴﻤﺔ ﺃﻗل ﻤﻥ ‪ 2000‬ﻭﺤﺩﺓ ﻓﻘـﺩ‬
‫ﺍﻋﺘﻤﺩ ﺍﻟﺘﺸﺨﻴﺹ ﻋﻠـﻰ ﻭﺠـﻭﺩ ﺘﻜـﺭﺭ‬
‫ﺍﻷﺨﻤﺎﺝ ﺍﻟﺠﻠﺩﻴﺔ ﻭﺍﻟﺼﺩﺭﻴﺔ ﻤﻊ ﺍﻷﻜﺯﻤـﺎ‬
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‫ﺒﺎﻟﻨﺴﺒﺔ ﺇﻟﻰ ﺍﻷﻋﺭﺍﺽ ﺍﻟﻌﻅﻤﻴﺔ ﻭﺍﻟﺼﻘﻠﻴﺔ‬
‫ﻭﺘﺄﺨﺭ ﺒﺯﻭﻍ ﺍﻷﺴﻨﺎﻥ ﺃﻭ ﺍﻀﻁﺭﺍﺒﺎﺘﻬﺎ ﻓﻠﻡ‬
‫ﺘﺸﺎﻫﺩ ﻋﻨﺩ ﻤﺭﻀﻰ ﺍﻟﺩﺭﺍﺴﺔ ﻭﻫﺫﺍ ﻋﺎﺌـﺩ‬
‫ﺇﻟﻰ ﺼﻐﺭ ﺴﻥ ﻤﺭﻀﻰ ﺍﻟﺩﺭﺍﺴﺔ ﻭﻫﻨـﺎﻙ‬
‫ﺘﻔﺴﻴﺭ ﺁﺨﺭ ﻟﺫﻟﻙ ﻤﻭﺠـﻭﺩ ﻓـﻲ ﺩﺭﺍﺴـﺔ‬
‫‪ (5)Renner et al‬ﻭﻫــﻭ ﻨــﺩﺭﺓ ﻫــﺫﻩ‬
‫ﺍﻟﻤﺸﺎﻫﺩﺍﺕ ﻓﻲ ﺍﻟﺤـﺎﻻﺕ ﺫﺍﺕ ﺍﻟﻭﺭﺍﺜـﺔ‬
‫ﺍﻟﻤﻘﻬﻭﺭﺓ ﻟﻠﻤﺭﺽ‪ .‬ﻭﺠﺩﺕ ﺃﺨﻤﺎﺝ ﺃﺨﺭﻯ‬
‫ﻋﻨﺩ ﺍﻟﻤﺭﻀﻰ ﻤﺜل ﺍﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﻴﺎ ﺍﻟﻘﻴﺤﻲ‬
‫ﺍﻟﺫﻱ ﺸﻭﻫﺩ ﻋﻨﺩ ﻤﺭﻴﻀﻴﻥ‪ ،‬ﻭﺃﻤﺎ ﺍﻟﺘﻬـﺎﺏ‬
‫ﺍﻷﺫﻥ ﺍﻟﻭﺴﻁﻰ ﻓﻘﺩ ﺸﻭﻫﺩ ﻋﻨـﺩ ﻤـﺭﻴﺽ‬
‫ﻭﺍﺤﺩ ﻓﻘﻁ ﻋﻠﻤﹰﺎ ﺃﻥ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺘﺫﻜﺭ ﻜﺜﺭﺓ‬
‫ﺤﺩﻭﺜﻪ ﻤﻊ ﺘﻜﺭﺍﺭ ﺫﻟﻙ‪.‬‬
‫ﺃﻅﻬﺭﺕ ﺍﻟﺩﺭﺍﺴﺔ ﺍﻟﻤﺨﺒﺭﻴﺔ ﻭﺠﻭﺩ ﺯﻴـﺎﺩﺓ‬
‫ﻓﻲ ﺘﻌﺩﺍﺩ ﺍﻟﻜﺭﻴﺎﺕ ﺍﻟﺒﻴﺽ ﻓﻲ ‪ 7‬ﺤـﺎﻻﺕ‬
‫ﺒﻨﺴﺒﺔ ‪ %38.9‬ﻭﻫﺫﺍ ﻴﻌﻭﺩ ﺇﻟﻰ ﺍﻷﺨﻤـﺎﺝ‬
‫ﺍﻟﺘﻲ ﻜﺎﻨﺕ ﻤﻭﺠﻭﺩﺓ ﻋﻨﺩ ﺍﻟﻤﺭﻀﻰ ﻜـﺫﻟﻙ‬
‫ﺕ ﺯﻴﺎﺩﺓ ﻓﻲ ﻨﺴﺒﺔ ﺍﻟﻌـﺩﻻﺕ ﻓـﻲ ‪6‬‬
‫ﻭﺠ ‪‬ﺩ ﹾ‬
‫ﺤﺎﻻﺕ ﺒﻨﺴﺒﺔ ‪ %33.3‬ﻭﻟﻡ ﺘﻅﻬﺭ ﺩﺭﺍﺴـﺔ‬
‫ﺍﻟﺼﻴﻐﺔ ﺍﻟﺩﻤﻭﻴﺔ ﻭﺠﻭﺩ ﺃﻴﺔ ﺍﻀﻁﺭﺍﺒﺎﺕ‪.‬‬
‫ﻭﺠﺩﺕ ﺯﻴﺎﺩﺓ ﻓﻲ ﻨﺴﺒﺔ ﺍﻟﺤﻤﻀﺎﺕ ﻓﻲ ﺍﻟﺩﻡ‬
‫ﺒﻨﺴﺒﺔ ‪ %71.4‬ﻤﻥ ﺍﻟﺤﺎﻻﺕ ﺍﻟﺘﻲ ﺃﺠﺭﻴـﺕ‬
‫ﻓﻴﻬﺎ ﻓﻲ ﺤﻴﻥ ﻜﺎﻨﺕ ﻫﺫﻩ ﺍﻟﻨﺴﺒﺔ ﺃﻋﻠﻰ ﻓـﻲ‬
‫ﺍﻟﺩﺭﺍﺴﺔ ﺍﻟﻤﻨﺸﻭﺭﺓ ﻓﻲ ﻤﺠﻠﺔ ﺍﻷﻁﻔﺎل )‪(11‬‬
 ‫ﻉ‪ .‬ﺃﻨﺠﻕ‬ ‫ﻤﺠﻠﺔ ﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ ﻟﻠﻌﻠﻭﻡ ﺍﻟﺼﺤﻴﺔ‪ -‬ﺍﻟﻤﺠﻠﺩ ﺍﻟﻌﺸﺭﻭﻥ‪ -‬ﺍﻟﻌﺩﺩ ﺍﻟﺜﺎﻨﻲ‪2004 -‬‬
‫ﺍﻟﺯﺭﻕ ﻓﻲ ﺤﺎﻟﺔ ﻭﺍﻟﻌﺼﻴﺎﺕ ﺍﻟﻜﻭﻟﻭﻨﻴﺔ ﻓﻲ‬
‫ﺤﺎﻟﺔ ﺃﻴﻀﺎﹰ‪ ،‬ﻜﻤﺎ ﻜﺎﻥ ﻫﻨﺎﻙ ﺯﺭﻉ ﺇﻴﺠـﺎﺒﻲ‬
‫ﻤﻥ ﺴﻴﻼﻥ ﺃﺫﻨﻲ ﻭﻜﺎﻨﺕ ﺍﻟﻨﺘﻴﺠﺔ ﻜﻠﻴﺒـﺴﻴﻼ‬
‫ﻭﻫﺫﺍ ﻴﺘﻤﺎﺸﻰ ﻤﻊ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻟﻌﺎﻟﻤﻴﺔ ﺤﻴﺙ‬
‫ﺘﻜﺜﺭ ﺍﻷﺨﻤﺎﺝ ﺒﺎﻟﺠﺭﺍﺜﻴﻡ ﺍﻟﻤﻌﺯﻭﻟﺔ ﺴـﺎﺒﻘﹰﺎ‬
‫ﺴﻭﺍﺀ ﻤﻥ ﺍﻟﺠﻠﺩ ﺃﻭ ﺍﻷﺫﻥ‪.‬‬
‫ﺃﻋﻁﻴﺕ ﺍﻟﻤﻀﺎﺩﺍﺕ ﺍﻟﺤﻴﻭﻴـﺔ ﻜﻤﻌﺎﻟﺠـﺔ‬
‫ﻤﺨﺒﺭﻴﺔ ﻓﻲ ﺠﻤﻴﻊ ﺤﺎﻻﺕ ﺍﻟﺩﺭﺍﺴﺔ ﻭﻗـﺩ‬
‫ﻜﺎﻥ ﺘﻁﺒﻴﻕ ﺍﻟﻤﻌﺎﻟﺠﺔ ﻴﻌﺘﻤﺩ ﻤﻜﺎﻥ ﺍﻟﺨﻤـﺞ‬
‫ﻭﺍﻟﺠﺭﺜــﻭﻡ ﺍﻟﻤﺘﻭﻗــﻊ‪ ،‬ﺤﻴــﺙ ﺃﻋﻁــﻲ‬
‫ﺍﻟﻜﻠﻭﻜــﺴﺎﺴﻴﻠﻠﻴﻥ ﻟﻤﻌﺎﻟﺠــﺔ ﺍﻹﺼــﺎﺒﺔ‬
‫ﺍﻟﻤﺘﻭﻗﻌﺔ ﺒﺎﻟﻌﻨﻘﻭﺩﻴـﺎﺕ‪ ،‬ﻜﻤـﺎ ﺃﻋﻁﻴـﺕ‬
‫ﻤﺭﻜﺒﺎﺕ ﺍﻟﺴﻔﺎﻟﻭﺴﺒﻭﺭﻴﻨﺎﺕ ﻤـﻥ ﺍﻟﺠﻴـل‬
‫ﺍﻟﺜﺎﻟﺙ ﺒﺎﻹﻀﺎﻓﺔ ﺇﻟﻰ ﺍﻷﻤﻴﻨﻭﻏﻠﻴﻜﻭﺯﻴـﺩﺍﺕ‬
‫ـﹰﺎ ﺃﻥ ﺩﺭﺍﺴـ‬
‫ﻓﻲ ﺍﻹﺼﺎﺒﺔ ﺒﺴﻠﺒﻴﺎﺕ ﺍﻟﻐﺭﺍﻡ ﻭﺘﻡ ﺘﻌـﺩﻴل‬
‫ﺍﻟﻤﻌﺎﻟﺠﺔ ﺇﻤﺎ ﺒﻨﺎﺀ ﻋﻠﻰ ﺍﻟﺯﺭﻉ ﻭﺍﻟﺘﺤـﺴﺱ‬
‫ﺃﻭ ﻋﻠﻰ ﻋﺩﻡ ﺍﻻﺴﺘﺠﺎﺒﺔ ﻟﻠﻌﻼﺝ‪ .‬ﻟﻡ ﻴﺫﻜﺭ‬
‫ﻓﻲ ﺴﺠﻼﺕ ﻫـﺅﻻﺀ ﺍﻟﻤﺭﻀـﻰ ﺇﻋﻁـﺎﺀ‬
‫ﺍﻟﻐﺎﻤﺎ ﻏﻠﻭﺒﻴﻥ ﻜﻌﻼﺝ ﺴﻭﺍﺀ ﻜﺎﻥ ﻭﻗﺎﺌﻴﹰﺎ ﺃﻡ‬
‫ﻋﻼﺠﻴﹰﺎ‪.‬‬
‫ﺒﺎﻟﻨﺴﺒﺔ ﺇﻟﻰ ﺘﻁﻭﺭ ﺍﻟﺤﺎﻻﺕ ﻓﻘـﺩ ﺤـﺩﺙ‬
‫ﺍﻟﺘﺤﺴﻥ ﺍﻟﺴﺭﻴﺭﻱ ﻟﻠﻤﺭﻀﻰ ﺒﺎﻟﻨﺴﺒﺔ ﺇﻟـﻰ‬
‫ﺍﻷﺨﻤﺎﺝ ﺍﻟﺘﻲ ﻋﻭﻟﺠﺕ ﻓﻲ ‪ 13‬ﺤﺎﻟﺔ ﻤـﻊ‬
‫ﺍﻟﻌﻠﻡ ﺃﻥ ﺒﻌﺽ ﺍﻟﺤﺎﻻﺕ ﺘﻜﺭﺭ ﻗﺒﻭﻟﻬﺎ ﻓﻲ‬
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‫ﻋﻠﻤﹰﺎ ﺃﻥ ﺒﻌﺽ ﺍﻟﺤﺎﻻﺕ ﻜﺎﻨﺕ ﻋﻨﺩ ﺭﻀﻊ‬
‫ﺩﻭﻥ ﺍﻟﺴﺘﺔ ﺃﺸﻬﺭ ﺤﻴـﺙ ﻻ ﻴﻜـﻭﻥ ‪IgE‬‬
‫ﻤﺭﺘﻔﻌﹰﺎ ﺒﺸﻜل ﻭﺍﻀﺢ ﻭﻴﺯﺩﺍﺩ ﻤﻊ ﺍﻟﻌﻤـﺭ‬
‫)‪ .(2‬ﺃﺠﺭﻱ ﺍﺨﺘﺒﺎﺭ ‪ NBT‬ﻋﻨﺩ ‪ 7‬ﻤﺭﻀﻰ‬
‫ﻟﺘﻘﻴﻴﻡ ﻭﻅﻴﻔﺔ ﺍﻟﺒﻠﻌﻤﺔ ﻭﻜﺎﻥ ﻁﺒﻴﻌﻴﹰﺎ ﻓﻲ ﻫﺫﻩ‬
‫ﺍﻟﺤﺎﻻﺕ‪.‬‬
‫ﺃﺠﺭﻴﺕ ﺍﻟﺩﺭﺍﺴﺔ ﺍﻟﺸﻌﺎﻋﻴﺔ ﻟﻠـﺼﺩﺭ ﻓـﻲ‬
‫ﺠﻤﻴﻊ ﺍﻟﺤﺎﻻﺕ ﻭﻗﺩ ﺃﻅﻬﺭﺕ ﻤﻭﺠـﻭﺩﺍﺕ‬
‫ﻤﺭﻀﻴﺔ ﻓـﻲ ‪ 9‬ﺤـﺎﻻﺕ ﻭﻜﺎﻨـﺕ ﻫـﺫﻩ‬
‫ﺍﻟﻤﻭﺠــﻭﺩﺍﺕ ﺘﺘﻤﺎﺸــﻰ ﻤــﻊ ﺇﺼــﺎﺒﺔ‬
‫ﺒﺎﻟﻌﻨﻘﻭﺩﻴﺎﺕ ﻓﻲ ‪4‬ﺤﺎﻻﺕ‪ ،‬ﺃﻤﺎ ﺒﺎﻟﻨﺴﺒﺔ ﺇﻟﻰ‬
‫ﺍﻟﻘﻴﻼﺕ ﺍﻟﻬﻭﺍﺌﻴﺔ ﺍﻟﺘـﻲ ﺘﺘﻠـﻭ ﺍﻷﺨﻤـﺎﺝ‬
‫ﺍﻟﺭﺌﻭﻴﺔ ﻓﻘﺩ ﺸﻭﻫﺩﺕ ﻓـﻲ ﺤـﺎﻟﺘﻴﻥ ﻋﻨـﺩ‬
‫ـﺔ‬
‫ـﺔ ﻋﻠﻤـ‬
‫ـﻰ ﺍﻟﺩﺭﺍﺴـ‬
‫ﻤﺭﻀـ‬
‫‪ (11) Chamlin et al‬ﺫﻜــﺭﺕ ﺘﻜــﺭﺭ‬
‫ﺍﻹﺼﺎﺒﺔ ﺍﻟﺼﺩﺭﻴﺔ ﻋﻨﺩ ‪ 6‬ﻤﺭﻀﻰ ﻤـﻥ ‪8‬‬
‫ﻤﺭﻀﻰ ﻭﺤﺩﻭﺙ ﺍﻟﻘﻴﻼﺕ ﺍﻟﻬﻭﺍﺌﻴﺔ ﻋﻨﺩ ‪5‬‬
‫ﻤﻨﻬﻡ‪ ،‬ﻭﻫﺫﺍ ﻗﺩ ﻴﻌﻭﺩ ﺇﻟﻰ ﻗﻠﺔ ﻤﺸﺎﻫﺩﺓ ﻫﺫﻩ‬
‫ﺍﻟﺘﻅﺎﻫﺭﺍﺕ ﻓﻲ ﺍﻟﺤـﺎﻻﺕ ﺫﺍﺕ ﺍﻟﻭﺭﺍﺜـﺔ‬
‫ﺍﻟﻤﻘﻬﻭﺭﺓ ﻟﻠﻤﺭﺽ )‪.(5‬‬
‫ﺒﺎﻟﻨﺴﺒﺔ ﺇﻟﻰ ﺍﻟﺩﺭﺍﺴﺔ ﺍﻟﺠﺭﺜﻭﻤﻴﺔ ﻭﺠـﺩ ‪4‬‬
‫ﺯﺭﻭﻋﺎﺕ ﺠﺭﺜﻭﻤﻴﺔ ﺇﻴﺠﺎﺒﻴﺔ ﻤﻥ ﺍﻵﻓـﺎﺕ‬
‫ﺍﻟﺠﻠﺩﻴﺔ ﺍﻟﻘﻴﺤﻴﺔ ﻭﺘـﻡ ﻋـﺯل ﺍﻟﻤﻜـﻭﺭﺍﺕ‬
‫ﺍﻟﻌﻨﻘﻭﺩﻴﺔ ﺍﻟﻤﺫﻫﺒﺔ ﻓﻲ ﺤﺎﻟﺘﻴﻥ ﻭﺍﻟﻌـﺼﻴﺎﺕ‬
 Job ‫ ﻓﻲ ﺍﻟﺩﻡ ﻤﻊ ﺍﻷﺨﻤﺎﺝ ﺍﻟﻤﻌﺎﻭﺩﺓ ﺃﻭ ﻤﺘﻼﺯﻤﺔ ﺠﻭﺏ‬E ‫ﻤﺘﻼﺯﻤﺔ ﻓﺭﻁ ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻥ ﺍﻟﻤﻨﺎﻋﻲ‬

‫ ﺃﺴﺎﺒﻴﻊ‬4-2 ‫ﻤﺭﻀﻰ ﻟﻔﺘﺭﺓ ﺍﺴﺘﺸﻔﺎﺀ ﻤﺎ ﺒﻴﻥ‬ ‫ ﻭﺤﺩﺜﺕ ﺍﻟﻭﻓﺎﺓ‬،‫ﺍﻟﻤﺴﺘﺸﻔﻰ ﻜﻤﺎ ﺫﻜﺭ ﺴﺎﺒﻘﺎﹰ‬
‫ ﻤﺭﻀﻰ ﻟﻔﺘـﺭﺓ ﺍﺴﺘـﺸﻔﺎﺀ‬4 ‫ﻜﻤﺎ ﺍﺤﺘﺎﺝ‬ ‫ﻓﻲ ﺤﺎﻟﺔ ﻭﺍﺤﺩﺓ ﺒـﺴﺒﺏ ﺸـﺩﺓ ﺍﻹﺼـﺎﺒﺔ‬
.‫ ﺃﺴﺎﺒﻴﻊ‬4 ‫ﺘﺯﻴﺩ ﻋﻠﻰ‬ ‫ﺍﻟﺼﺩﺭﻴﺔ ﺍﻟﺘﻲ ﺘﺭﺍﻓﻘﺕ ﻤﻊ ﺍﻨﺼﺒﺎﺏ ﺠﻨﺏ‬
‫ ﻜﻤﺎ ﺘﺨـﺭﺝ ﺜﻼﺜـﺔ‬،‫ﻭﻟﻡ ﺘﺴﺘﺠﺏ ﻟﻠﻌﻼﺝ‬
‫ﻤﺭﻀﻰ ﻗﺒل ﺍﻟﺸﻔﺎﺀ ﻋﻠﻰ ﻤﺴﺅﻭﻟﻴﺔ ﺍﻷﻫل‬
‫ﻭﺫﻟﻙ ﺒﺴﺒﺏ ﺇﺯﻤﺎﻥ ﺍﻹﺼﺎﺒﺔ ﻭﻁﻭل ﻓﺘﺭﺓ‬
‫ﺍﻻﺴﺘﺸﻔﺎﺀ ﺍﻟﺘـﻲ ﻜﺎﻨـﺕ ﻤﺨﺘﻠﻔـﺔ ﻋﻨـﺩ‬
‫ ﻤﺭﻀﻰ ﻓﻲ ﺍﻟﻤﺴﺘﺸﻔﻰ‬8 ‫ﺍﻟﻤﺭﻀﻰ ِﺇ ﹾﺫ ﺒﻘﻲ‬
6‫ﻟﻔﺘﺭﺓ ﺃﻗل ﻤﻥ ﺃﺴﺒﻭﻋﻴﻥ ﻓﻲ ﺤﻴﻥ ﺍﺤﺘﺎﺝ‬

References

1. Buckley, R. H., Hyperimmunoglobulinemia E( Hyper IgE)

Syndrome in Nelson Textbook Of Pediatrics Edited by Saunders;
2000 : 576-577.
2. Shigeoka, A. O., Hyperimmunoglobulinemia E (Job) Syndrome ,
E-medicine, last updated Sep. 23,2002.‫ﻣﻘﺎﻟﺔ ﻣﻦ اﻻﻧﺘﺮﻧﻴﺖ‬
3. Borges, W.G., Augustine, N. H. and Hill, H. R., Defective
Interleukin-12/Interferon-Gamma Pathway in Patients with
Hyperimmunoglobulinemia E Syndrome, J Pediatrics, 2000
Feb;136(2): 141-143.
4. Segal, B.H. and Holland S.M., Primary Phagocytic Disorders of
Childhood, The Pediatric Clinics of North America,2000 Dec.
47(6): 1330-1332.
5. Renner,E.D. et al Autosomal Recessive Hyperimmunoglobulin E
Syndrome: a Distinct Disease Entity, J Pediatrics, 2004
Jan;144(1); 93-99.
6. Grimbacher B. et al, Hyper-IgE Syndrome with Recurrent
Infections – An Autosomal Dominant multisystem Disorder, N
Engl. J. Med. 1999; 9: 692-702.

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 ‫ ﺃﻨﺠﻕ‬.‫ﻉ‬ 2004 -‫ ﺍﻟﻌﺩﺩ ﺍﻟﺜﺎﻨﻲ‬-‫ ﺍﻟﻤﺠﻠﺩ ﺍﻟﻌﺸﺭﻭﻥ‬-‫ﻤﺠﻠﺔ ﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ ﻟﻠﻌﻠﻭﻡ ﺍﻟﺼﺤﻴﺔ‬

7. Genny A R et al, Bone Marrow Transplantation Does Not

Correct the Job Syndrome , Bone Marrow Transplantat 2000
jun;25(12): 1303-1305.

8. Tanaka H, Ito R, Onodera N: Efficacy of long-term

sulfamethoxazole-trimethoprim therapy in a boy with
hyperimmunoglobulin E syndrome. Tohoku J Exp Med 1998
Sep; 186(1): 61-6
9. Wakim M, Alazard M, Yajima A, et al: High dose intravenous
immunoglobulin in atopic dermatitis and hyper-IgE syndrome.
Ann Allergy Asthma Immunol 1998 Aug; 81(2): 153-8.
10. Moneret- Vautan D A, Kann G, Thinus G, Hyperglobulinemia E
Syndrome with Reurrent Infections (Job’s Syndrome) Rev. Med.
Interne. 1999 Feb; 20(2) : 133-140.
11. Chamlin SL, et al Cutaneous Manifestations of Hyper-IgE
Syndrome in Infants and Children. J Pediatrics , 2002 Oct;
141(4): 572-575.

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‫ﻤﺘﻼﺯﻤﺔ ﻓﺭﻁ ﺍﻟﻐﻠﻭﺒﻭﻟﻴﻥ ﺍﻟﻤﻨﺎﻋﻲ ‪ E‬ﻓﻲ ﺍﻟﺩﻡ ﻤﻊ ﺍﻷﺨﻤﺎﺝ ﺍﻟﻤﻌﺎﻭﺩﺓ ﺃﻭ ﻤﺘﻼﺯﻤﺔ ﺠﻭﺏ ‪Job‬‬

‫ﺘﺎﺭﻴﺦ ﻭﺭﻭﺩ ﺍﻟﺒﺤﺙ ﺇﻟﻰ ﻤﺠﻠﺔ ﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ‪.2004/3/15:‬‬

‫ﺘﺎﺭﻴﺦ ﻗﺒﻭﻟﻪ ﻟﻠﻨﺸﺭ‪.2004/7/13:‬‬

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