‫ﻡ‪ .

‬ﺯﻴﻨﺎﺘﻲ‬ ‫ﻤﺠﻠﺔ ﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ ﻟﻠﻌﻠﻭﻡ ﺍﻟﺼﺤﻴﺔ– ﺍﻟﻤﺠﻠﺩ ‪ -26‬ﺍﻟﻌﺩﺩ ﺍﻟﺜﺎﻨﻲ‪2010-‬‬

‫ﺩﺭﺍﺴﺔ ﺘﺄﺜﻴﺭ ﺍﻟﺒﻼﺯﻤﺎ ﺍﻟﻐﻨﻴﺔ ﺒﺎﻟﺼﻔﻴﺤﺎﺕ ﻋﻠﻰ ﺩﺭﺠﺔ ﺍﻻﻟﺘﻬﺎﺏ ﻨﺴﻴﺠﻴﺎﹰ‬

‫*‬
‫ﻤﺎﺯﻥ ﻴﺤﻴﻰ ﺯﻴﻨﺎﺘﻲ‬

‫ﺍﻟﻤﻠﺨﺹ‬
‫ﻫﺩﻑ ﻫﺫﻩ ﺍﻟﺩﺭﺍﺴﺔ ﻫﻭ ﺘﻘﻴﻴﻡ ﺭﺩﻭﺩ ﺍﻟﻔﻌل ﺍﻻﻟﺘﻬﺎﺒﻴﺔ ﻨﺴﻴﺠﻴ‪‬ﺎﹰ ﻟﻠﺒﻼﺯﻤﺎ ﺍﻟﻐﻨﻴﺔ ﺒﺎﻟـﺼﻔﻴﺤﺎﺕ‬
‫‪ PRP‬ﻋﻨﺩ ﺤﻘﻨﻬﺎ ﻀﻤﻥ ﺍﻟﻨﺴﻴﺞ ﺍﻟﻀﺎﻡ ﺍﻟﺤﻲ‪.‬‬
‫ﺍﻟﻤﻭﺍﺩ ﻭﺍﻟﻁﺭﺍﺌﻕ‪ :‬ﺒﻌﺩ ﺇﺤﺩﺍﺙ ﺠﺭﺡ ﻓﻲ ﺸﻔﺔ ﺨﺭﻭﻑ )‪ 6‬ﺨﺭﺍﻑ( ﺃﻋﻤﺎﺭﻫﻡ ﺴـﻨﺔ ﺇﻟـﻰ‬
‫ﺴﻨﺔ ﻭﻨﺼﻑ ﺤ‪‬ﻘِﻨﹶﺕﹾ ‪ 11‬ﺸﻔﺔ ﺒﺎﻟﺴﻴﺭﻭﻡ ﺍﻟﻤﻠﺤﻲ‪ ،‬ﻭ‪ 11‬ﺸﻔﺔ ﺒﺎﻟﺠﻬـﺔ ﺍﻟﻤﻘﺎﺒﻠـﺔ ﺤﻘﻨـﺕ‬
‫ﺒﺎﻟﺒﻼﺯﻤﺎ ﺍﻟﻐﻨﻴﺔ ﺒﺎﻟﺼﻔﻴﺤﺎﺕ ﺒﻌﺩ ﺴﺤﺏ ‪ 10‬ﻤل ﻤﻥ ﺩﻡ ﺍﻟﺨﺭﻭﻑ‪ .‬ﺃﺨﺫﺕ ‪ 22‬ﺨﺯﻋﺔ ﻤﻥ‬
‫ﺍﻟﺨﺭﺍﻑ ﺒﻌﺩ ﺃﺴﺒﻭﻉ ﻭﺒﻌﺩ ﺃﺴﺒﻭﻋﻴﻥ ﻟﻠﺩﺭﺍﺴﺔ ﺍﻟﻨﺴﻴﺠﻴﺔ‪ .‬ﺍﺴﺘﺨﺩﻡ ﺍﺨﺘﺒﺎﺭ ‪Mann-Whitney‬‬
‫‪ U‬ﻟﻠﺩﺭﺍﺴﺔ ﺍﻹﺤﺼﺎﺌﻴﺔ )‪.(p=o.o5‬‬
‫ﺍﻟﻨﺘﺎﺌﺞ‪ :‬ﻨﺴﻴﺠﻴﺎﹰ ﻟﻡ ﺘﺤﺩﺙ ﺍﻟﺒﻼﺴﻤﺎ ﺍﻟﻐﻨﻴﺔ ﺒﺎﻟﺼﻔﻴﺤﺎﺕ ﺭﺩ ﻓﻌل ﺍﻟﺘﻬﺎﺒﻴﺎﹰ ﻋﻨﻴﻑ ﻨـﺴﻴﺠﻴﺎﹰ‪ ،‬ﻭﻗـﺩ‬
‫ﺒﻠﻐﺕ ﻗﻴﻤﺔ ‪ 8=U‬ﺒﻌﺩ ﺃﺴﺒﻭﻉ ﻭ‪ 3 =U‬ﺒﻌﺩ ﺃﺴﺒﻭﻋﻴﻥ‪ ،‬ﻭﻫﻜﺫﺍ ﻟﻡ ﺘﻭﺠﺩ ﻓﺭﻭﻕ ﺩﺍﻟـﺔ ﺇﺤـﺼﺎﺌﻴﺎﹰ‬
‫ﺒﻴﻥ ﺍﻟﻤﺠﻤﻭﻋﺘﻴﻥ ﺍﻟﻤﺩﺭﻭﺴﺘﻴﻥ ﻤﻬﻤﺎﹰ ﻜﺎﻨﺕ ﺍﻟﻤﺩﺓ ﺍﻟﻤﺩﺭﻭﺴﺔ‪ ،‬ﻤﻤ‪‬ﺎ ﻴﺠﻌﻠﻨﺎ ﻨﻌﺘﻘـﺩ ﺃﻥ‪ ‬ﺍﻟﺒﻼﺴـﻤﺎ‬
‫ﺍﻟﻐﻨﻴﺔ ﺒﺎﻟﺼﻔﻴﺤﺎﺕ ﻟﻴﺱ ﻟﻬﺎ ﺩﻭﺭ ﺃﻴﻀﺎﹰ ﻓﻲ ﺍﻟﺘﻘﻠﻴل ﻤﻥ ﺸـﺩ‪‬ﺓ ﺭﺩ ﺍﻟﻔﻌـل ﺍﻻﻟﺘﻬـﺎﺒﻲ ﺇﻥ ﻜـﺎﻥ‬
‫ﺴﻴﺤﺼل‪ ،‬ﻭﻤﻥ ﺜﻡ‪ ‬ﻓﺈﻥ‪ ‬ﺭﺩ ﺍﻟﻔﻌل ﺍﻟﻤﻨﺎﻋﻲ ﺍﻟﺫﺍﺘﻲ ﻟﻠﺠﺴﻡ ﻫﻭ ﺍﻟﻤﺭﺠ‪‬ﺢ ﻓﻲ ﻫﺫﺍ ﺍﻟﻤﻭﻀﻭﻉ ‪.‬‬
‫ﺍﻻﺴﺘﻨﺘﺎﺝ‪ :‬ﻴﺒﺩﻭ ﺃﻥ‪ ‬ﺍﻟﺒﻼﺯﻤﺎ ﺍﻟﻐﻨﻴﺔ ﺒﺎﻟﺼﻔﻴﺤﺎﺕ ﻻ ﺘﺅﺜﺭ ﻓﻲ ﺍﻟﻌﻤﻠﻴﺔ ﺍﻻﻟﺘﻬﺎﺒﻴﺔ ﻭﺇﺫﺍ ﻜـﺎﻥ‬
‫ﺍﻟﻬﺩﻑ ﻫﻭ ﺍﻟﺘﺄﺜﻴﺭ ﻓﻲ ﺭﺩﻭﺩ ﺍﻟﻔﻌل ﺍﻻﻟﺘﻬﺎﺒﻴﺔ ﻓﻼ ﺩﺍﻋـﻲ ﻻﺴـﺘﺨﺩﺍﻡ ﺍﻟﺒﻼﺯﻤـﺎ ﺍﻟﻐﻨﻴـﺔ‬
‫ﺒﺎﻟﺼﻔﻴﺤﺎﺕ‪.‬‬

‫* ﺃﺴﺘﺎﺫ ﻤﺴﺎﻋﺩ – ﻗﺴﻡ ﺠﺭﺍﺤﺔ ﺍﻟﻔﻡ ﻭﺍﻟﻔﻜﻴﻥ – ﻜﻠﻴﺔ ﻁﺏ ﺍﻷﺴﻨﺎﻥ – ﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ‬

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 ‫ﺩﺭﺍﺴﺔ ﺘﺄﺜﻴﺭ ﺍﻟﺒﻼﺯﻤﺎ ﺍﻟﻐﻨﻴﺔ ﺒﺎﻟﺼﻔﻴﺤﺎﺕ ﻋﻠﻰ ﺩﺭﺠﺔ ﺍﻻﻟﺘﻬﺎﺏ ﻨﺴﻴﺠﻴﺎﹰ‬

A Histological Study of the Influence of PRP on

the Inflammation Degree

*
Mazen Zenati

Abstract
The aim of this study was to evaluate the effect of PRP on the histological
inflammatory reactions after injecting it in the connective tissue .
Materials and methods: after making a surgical incision in the lips of 6 sheep
(1-1.5 years old), 11 right lips were injected with sodium chloride serum, and 11
left lips were injected with PRP after with drawaling 10ml of the blood and
preparing PRP.
22 biopsies of lips were studied (11 with prp , 11 without prp) after one week
and two weeks , Mann-Whitney U test was performed ( p=o.o5 ) .
Result was : PRP did not cause severe inflammatory reactions and also did not
reduce the severity of that reactions when had happened , Mann-Whitney U was
U = 8 after one week , U=3 after 2 weeks , no important differences related to
the effect of the PRP in the two samples were observed.
So the immune response of the body seems to be the decisive factor .
Conclusion: there is no need to use PRP if the aim is to influence on the
inflammatory reactions .
Key words : PRP , inflammation

*
Ass. Prof. Dept. of Oral and Maxillofacial Surgery. Faculty of Dentistry-Damascus
University

206
‫ﻡ‪ .‬ﺯﻴﻨﺎﺘﻲ‬ ‫ﻤﺠﻠﺔ ﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ ﻟﻠﻌﻠﻭﻡ ﺍﻟﺼﺤﻴﺔ– ﺍﻟﻤﺠﻠﺩ ‪ -26‬ﺍﻟﻌﺩﺩ ﺍﻟﺜﺎﻨﻲ‪2010-‬‬

‫ﺍﻟﻤﻘﺩﻤﺔ‪:‬‬
‫ﺘﻌ‪‬ﺩ ﺍﻟﻌﻠﻘﺔ ﺍﻟﺩﻤﻭﻴﺔ ﻨﻭﺍﺓ ﻟﺒﺩﺀ ﺤﺩﻭﺙ ﺠﻤﻴﻊ ﻓﻌﺎﻟﻴﺎﺕ ﺍﻟﺘﺌﺎﻡ ﺍﻷﻨـﺴﺠﺔ ﺍﻟﺭﺨـﻭﺓ ﻭﺍﻟﺘﺠـﺩﺩ‬
‫ﺍﻟﻌﻅﻤﻲ‪ ،‬ﻭﺘﻠﺘﺌﻡ ﺍﻟﺠﺭﻭﺡ ﺍﻟﻁﺒﻴﻌﻴﺔ ﻋﺎﺩﺓ ﺒﻔﻀل ﺘﻜـﻭ‪‬ﻥ ﺍﻟﻌﻠﻘـﺔ ﺍﻟﺘـﻲ ﺘﺤﺘـﻭﻱ ﻋﻠـﻰ‬
‫ﺍﻟﺼﻔﻴﺤﺎﺕ ﺍﻟﺩﻤﻭﻴﺔ ﺍﻟﺘﻲ ﺘﺸﻜل ‪ %5‬ﻤﻥ ﻤﺤﺘﻭﻯ ﺍﻟﻌﻠﻘـﺔ‪ .‬ﺘﺤﺘـﻭﻱ ﺍﻟﺒﻼﺯﻤـﺎ ﺍﻟﻐﻨﻴـﺔ‬
‫ﺒﺎﻟﺼﻔﻴﺤﺎﺕ ﻭﺍﻟﺘﻲ ﻫﻲ ﺨﺜﺭﺓ ﺩﻤﻭﻴﺔ ﻁﺒﻴﻌﻴﺔ ﺫﺍﺘﻴﺔ ﻋﻠﻰ ﺘﺭﺍﻜﻴﺯ ﻋﺎﻟﻴﺔ ﻤـﻥ ﺍﻟـﺼﻔﻴﺤﺎﺕ‬
‫ﺍﻟﺩﻤﻭﻴﺔ ‪ %94‬ﻭ‪ %5‬ﻜﺭﻴﺎﺕ ﺤﻤﺭﺍﺀ ﻭ‪ %1‬ﻜﺭﻴﺎﺕ ﺒﻴﻀﺎﺀ؛ ﻭﻫﺫﺍ ﺒﺩﻭﺭﻩ ﺴـﻴﺯﻴﺩ ﻤـﻥ‬
‫ﺘﺭﻜﻴﺯ ﻋﻭﺍﻤل ﺍﻟﻨﻤﻭ‪ ،‬ﻭﺒﺎﻟﻤﻘﺎﺭﻨﺔ ﺘﺤﺘﻭﻱ ﺍﻟﺨﺜﺭﺓ ﺍﻟﻌﺎﺩﻴﺔ ﻋﻠﻰ ‪%94‬ﻜﺭﻴﺎﺕ ﺤﻤﺭﺍﺀ ﻭ‪%6‬‬
‫)‪.( 1‬‬
‫ﺼﻔﻴﺤﺎﺕ ﺩﻤﻭﻴﺔ ﻭﻨﺴﺒﺔ ﺃﻗل ﻤﻥ ‪ %1‬ﻜﺭﻴﺎﺕ ﺒﻴﻀﺎﺀ‬

‫ﻜﺜﹸﺭ ﺍﻟﺤﺩﻴﺙ ﻓﻲ ﺍﻟﻤﺩﺓ ﺍﻷﺨﻴﺭﺓ ﻋﻥ ﺍﺴﺘﻌﻤﺎل ﺍﻟـ ‪ PRP‬ﻤﻀﺎﻓﺎﹰ ﻓـﻲ ﺒﻌـﺽ ﺍﻟﺘﻘﻨﻴـﺎﺕ‬
‫ﺍﻟﺠﺭﺍﺤﻴﺔ ﺃﻭ ﻤﺤﻘﻭﻨﺎﹰ ﻤﺒﺎﺸﺭﺓ ﻜﺎﺴﺘﻌﻤﺎل ﻋﻼﺠﻲ ﻤﺒﺎﺸﺭ‪ ،‬ﻭﻗﺩ ﻻﻗﻰ ﻨﺠﺎﺤﺎﹰ ﺴـﺭﻴﺭﻴﺎﹰ ﻓـﻲ‬
‫ﻋﺩﺓ ﻤﺠﺎﻻﺕ ﻁﺒﻴﺔ ﻤﺜل‪ :‬ﺠﺭﺍﺤﺔ ﺍﻟﻘﻠﺏ ﻭﺍﻷﻋﺼﺎﺏ ﻭﺍﻟﻌﻅﺎﻡ ﻭﺍﻟﻭﺠﻪ ﻭﺍﻟﻔﻜﻴﻥ ﻭﺍﻟﺠﺭﺍﺤﺔ‬
‫ﺍﻟﻠﺜﻭﻴﺔ ﻭﺤﻭل ﺍﻟﺴﻨﻴﺔ‪ .‬ﻭﻗﺩ ﺍﻓﺘﺭﻀﺕ ﺒﻌﺽ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺃﻥ‪ ‬ﻫﺫﺍ ﺍﻟﻤﺭﻜﹼـﺏ ﻴﻌﻤـل ﻋﻠـﻰ‬
‫ﺘﺤﺭﻴﺽ ﺭﺩ ﻓﻌل ﺍﻟﺘﻬﺎﺒﻲ ﺒﺸﺩ‪‬ﺓ ﻤﻌﻴ‪‬ﻨﺔ ﻴﻜﻭﻥ ﺒﺩﻭﺭﻩ ﻤﺤﻔﹼﺯﺍﹰ ﻟﺘﺘﺎﺒﻊ ﺴﺭﻴﻊ ﻵﻟﻴـﺎﺕ ﺍﻟـﺸﻔﺎﺀ‬
‫ﻭﺍﻟﺘﺭﻤ‪‬ﻡ )‪.(2,3‬‬

‫ﺘﺤﺘﻭﻱ ﺍﻟﺒﻼﺯﻤﺎ ﺍﻟﻐﻨﻴﺔ ﺒﺎﻟﺼﻔﻴﺤﺎﺕ ﻋﻠﻰ ﺍﻟﻌﺩﻴﺩ ﻤﻥ ﻋﻭﺍﻤـل ﺍﻟﻨﻤـﻭ ﺍﻟﻤﻭﺠـﻭﺩﺓ ﻓـﻲ‬
‫ﺍﻟﺼﻔﻴﺤﺎﺕ ﻤﻥ ﻋﻭﺍﻤل ﺍﻟﻨﻤﻭ ﺍﻟﻤﺸﺘﻘﺔ ﻤﻥ ﺍﻟﺼﻔﻴﺤﺎﺕ ‪Platelet-derived Growth Factors‬‬
‫‪ PDGFs, PDGEaa, PDGFbb, PDGFab‬ﻭﻋﻭﺍﻤل ﺍﻟﻨﻤﻭ ﻫﺫﻩ ﻫﻲ ﺍﻟﻤﻭﺠﻭﺩﺓ ﺃﻜﺜـﺭ ﻓـﻲ‬
‫ﺸﻔﺎﺀ ﺍﻟﺠﺭﻭﺡ ﻭﻋﻭﺍﻤل ﺍﻟﻨﻤـﻭ ﺍﻟﻤﺤﻭﻟـﺔ ‪TGFB1 ) Transforming Growth Factors‬‬
‫‪ ,(TGFB2‬ﻭﺍﻟﺘﻲ ﺘﺸﺎﺒﻪ ﻋﻭﺍﻤل ﺍﻟﻨﻤﻭ ﺍﻟﻤﺸﺘﻘﺔ ﻤﻥ ﺍﻟﺼﻔﻴﺤﺎﺕ ﻭﺘﻨﺒ‪‬ﻪ ﺍﻻﺴﺘﺠﺎﺒﺔ ﺍﻟﺨﻠﻭﻴـﺔ‬
‫ﻭﻴﻤﻜﻥ ﺃﻥ ﺘﺤﺭﺽ ﺘﺸﻜل ﺍﻟﻌﻅﻡ ﺃﻭ ﺍﻟﻐﻀﺭﻭﻑ) ‪ ،(5‬ﻭﻤﻨﻬﺎ ﻋﺎﻤل ﺍﻟﻨﻤﻭ ﺍﻟﻭﻋﺎﺌﻲ ﺍﻟﺒﻁﺎﻨﻲ‬
‫‪ Vascular Endothelial Growth Factor‬ﺍﻟﺫﻱ ﻟﻪ ﺘﺄﺜﻴﺭ ﻤﺤﺩﻭﺩ ﻓﻲ ﺍﻟﺨﻼﻴﺎ ﺍﻟﺒﻁﺎﻨﻴﺔ ﻭﻓﻲ‬
‫ﺍﻟﺘﺸﻜل ﺍﻟﻭﻋﺎﺌﻲ ﺍﻟﺠﺩﻴﺩ ﻭﻋﺎﻤل ﺍﻟﻨﻤﻭ ﺍﻟﺒﺸﺭﻱ‪ Epithelial Growth Factor :‬ﻭﺍﻟﺫﻱ ﻴﻤﺘﻠﻙ‬

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 ‫ﺩﺭﺍﺴﺔ ﺘﺄﺜﻴﺭ ﺍﻟﺒﻼﺯﻤﺎ ﺍﻟﻐﻨﻴﺔ ﺒﺎﻟﺼﻔﻴﺤﺎﺕ ﻋﻠﻰ ﺩﺭﺠﺔ ﺍﻻﻟﺘﻬﺎﺏ ﻨﺴﻴﺠﻴﺎﹰ‬

‫ﺘﺄﺜﻴﺭﺍﹰ ﻤﺤﺩﻭﺩﺍﹰ ﻓﻲ ﺍﻟﺨﻼﻴﺎ ﺍﻟﻘﺎﻋﺩﻴﺔ ﻟﻠﺠﻠﺩ ﻭﺍﻟﻐﺸﺎﺀ ﺍﻟﻤﺨﺎﻁﻲ‪ .‬ﺘﻌﺘﻤـﺩ ﺍﻟﺒﻼﺯﻤـﺎ ﺍﻟﻐﻨﻴـﺔ‬
‫ﺒﺎﻟﺼﻔﻴﺤﺎﺕ ﻋﻠﻰ ﺘﺤﻔﻴﺯ ﺍﻟﺨﻼﻴﺎ ﺍﻟﻤﻭﺠﻭﺩﺓ ﻓﻲ ﺍﻷﻨﺴﺠﺔ ﺍﻟﺭﺨﻭﺓ ﺒﻤﺎ ﻓـﻲ ﺫﻟـﻙ ﺍﻟﺨﻼﻴـﺎ‬
‫ﺍﻟﻤﻭﻟﺩﺓ ﻟﻠﻴﻑ ‪ fibroblast‬ﻋﻠﻰ ﺇﻁﻼﻕ ﺍﻟﻜﻭﻻﺠﻴﻥ؛ ﻭﻟﺫﻟﻙ ﻓﺈﻥ‪ ‬ﺤﻘـﻥ ﺍﻟﺒﻼﺴـﻤﺎ ﺍﻟﻐﻨﻴـﺔ‬
‫ﺒﺎﻟﺼﻔﻴﺤﺎﺕ ﺍﻟﻤﺴﺘﺨﺭﺠﺔ ﻤﻥ ﺍﻟﺸﺨﺹ ﻨﻔﺴﻪ ﺘﺤﺕ ﺍﻟﺠﻠﺩ ﺘﻌﻤل ﻜـﺴﻘﺎﻟﺔ ﻟﺘـﺸﻜﻴل ﺸـﺒﻜﺔ‬
‫ﺜﻼﺜﻴﺔ ﺍﻟﺒﻌﺩ‪ ،‬ﻭﺘﻌﻤل ﻋﻠﻰ ﺇﻁﻼﻕ ﻋﻭﺍﻤل ﺍﻟﻨﻤﻭ‪ ،‬ﻭﻋﻠﻰ ﺇﺤﺩﺍﺙ ﺠﺫﺏ‬

‫ﻜﻴﻤﺎﻭﻱ ﻟﻠﺨﻼﻴﺎ ﺒﺎﻟﻌﺔ ﺍﻟﻜﺒﻴﺭ ﻭﺍﻟﺨﻼﻴـﺎ ﺍﻟﺠﺫﻋﻴـﺔ ﺍﻟﻤﻭﺠـﻭﺩﺓ ) ‪Chemo attraction of‬‬
‫‪ macrophages and resident stem cells‬ﻭﺘﻌﻤل ﻋﻠﻰ ﺘﻜﺎﺜﺭ ﺍﻟﺨﻼﻴﺎ ﺍﻟﺠﺫﻋﻴﺔ‪ ،‬ﻜﻤﺎ ﺘﻌﻤل‬
‫) ‪(6,7,8‬‬
‫‪.‬‬ ‫ﻋﻠﻰ ﺍﻨﻘﺴﺎﻡ ﺍﻟﺨﻼﻴﺎ ﺍﻟﺠﺫﻋﻴﺔ‬

‫ﺍﻟﻬﺩﻑ ﻤﻥ ﺍﻟﺒﺤﺙ‪:‬‬
‫ﻫﺩﻓﺕ ﻫﺫﻩ ﺍﻟﺩﺭﺍﺴﺔ ﺇﻟﻰ ﺘﻘﻴﻴﻡ ﺘﺄﺜﻴﺭ ﺍﻟﺒﻼﺯﻤﺎ ﺍﻟﻐﻨﻴﺔ ﺒﺎﻟﺼﻔﻴﺤﺎﺕ ‪ PRP‬ﻓﻲ ﺭﺩﻭﺩ ﺍﻟﻔﻌـل‬
‫ﺍﻻﻟﺘﻬﺎﺒﻴﺔ ﻨﺴﻴﺠﻴ‪‬ﺎﹰ ﻋﻨﺩ ﺤﻘﻨﻬﺎ ﻀﻤﻥ ﺍﻟﻨﺴﻴﺞ ﺍﻟﻀﺎﻡ ﻋﻨﺩ ﺍﻷﺤﻴﺎﺀ‪.‬‬

‫ﺍﻟﻤﻭﺍﺩ ﻭﺍﻟﻁﺭﺍﺌﻕ‪:‬‬
‫ﻋﻴﻨﺔ ﺍﻟﺒﺤﺙ‪:‬‬

‫ﺘﺄﻟﻔﺕ ﻋﻴﻨﺔ ﺍﻟﺒﺤﺙ ﻤﻥ ‪ 6‬ﺨﺭﺍﻑ )ﺍﻟﻌﻭﺍﺱ( ﺃﻋﻤﺎﺭﻫﻡ ‪ 1.5-1‬ﺴﻨﺔ‪ ،‬ﻭﺍﻨﺘﹸﻘِﻴ‪‬ـﺕِ ﺍﻟﺨـﺭﺍﻑ‬

‫ﺍﻟﺨﺎﻟﻴﺔ ﻤﻥ ﺍﻷﻤﺭﺍﺽ‪ ،‬ﺍﻟﺘﻲ ﻴﺯﻴﺩ ﻭﺯﻨﻬﺎ ﻋﻠﻰ ‪ 35‬ﻜﻎ‪ ،‬ﻭﻟﻡ ﻴﺘﻡ ﻭﺼـﻑ ﺼـﺎﺩﺍﺕ ﺒﻌـﺩ‬
‫ﺍﻟﻌﻤل‪.‬‬

‫ﺘﻡ ﺍﻟﻌﻤل ﻓﻲ ﻋﻴﺎﺩﺓ ﺍﻟﻁﺏ ﺍﻟﺒﻴﻁﺭﻱ ﺒﺭﻴﻑ ﺩﻤﺸﻕ‪ ،‬ﻭﻗﺩ ﻗﻤﻨﺎ ﺒﺎﻟﻨﺴﺒﺔ ﺇﻟﻰ ﻜـلّ ﺨـﺭﻭﻑ‬
‫ﺒﺈﺤﺩﺍﺙ ﺠﺭﺡ ﻓﻲ ﺍﻟﺸﻔﺔ ﺍﻟﻌﻠﻭﻴﺔ ﻭﺍﻟﺴﻔﻠﻴﺔ ﻓﻲ ﺍﻟﺠﻬﺘﻴﻥ ﺍﻟﻴﻤﻨﻰ ﻭﺍﻟﻴﺴﺭﻯ ﺒﻁﻭل ‪ 1,5‬ﺴﻡ‪،‬‬
‫ﻭﻋﻤﻕ ‪ 1‬ﺴﻡ‪ ،‬ﺜﻡ ﻭﺯﻋﺕ ﺍﻟﻌﻴ‪‬ﻨﺔ ﺒﺎﻟﺸﻜل ﺍﻵﺘﻲ‪:‬‬

‫ﺤ‪‬ﻘِﻥ‪ 11‬ﺠﺭﺤﺎﹰ ﻤﺒﺎﺸﺭﺓ ﺒﻨﺼﻑ ﻤﻠل ﺴﻴﺭﻭﻡ ﻤﻠﺤﻲ ﻟﻜل ﺠـﺭﺡ‪ ،‬ﻭ‪ 11‬ﺠﺭﺤـﺎﹰ ﺒﺎﻟﺠﻬـﺔ‬
‫ﺍﻟﻤﻘﺎﺒﻠﺔ ﺒﺎﻟﻤﻘﺩﺍﺭ ﻨﻔﺴﻪ ﻤﻥ ﺍﻟﺒﻼﺯﻤﺎ ﺍﻟﻐﻨﻴﺔ ﺒﺎﻟﺼﻔﻴﺤﺎﺕ )ﺒﻌﺩ ﺘﻔﻌﻴﻠﻬﺎ ﺒﻜﻠﻭﺭ ﺍﻟﻜﺎﻟـﺴﻴﻭﻡ(‪،‬‬

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‫ﻡ‪ .‬ﺯﻴﻨﺎﺘﻲ‬ ‫ﻤﺠﻠﺔ ﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ ﻟﻠﻌﻠﻭﻡ ﺍﻟﺼﺤﻴﺔ– ﺍﻟﻤﺠﻠﺩ ‪ -26‬ﺍﻟﻌﺩﺩ ﺍﻟﺜﺎﻨﻲ‪2010-‬‬

‫ﻭﻗﺩ ﺘﻡ ﺍﻟﺤﻘﻥ ﻓﻲ ﺍﻟﺠﻬﺔ ﺍﻟﻴﻤﻨﻰ ﻭﺍﻟﻴﺴﺭﻯ ﻟﻠﺸﻔﺔ ﺍﻟﻌﻠﻭﻴﺔ ﻭﺍﻟﺴﻔﻠﻴﺔ‪ ،‬ﺃﻱ ﺃﺭﺒﻊ ﻤﻨﺎﻁﻕ ﻋﻨـﺩ‬
‫ﻜل ﺨﺭﻭﻑ‪ ،‬ﺒﺤﻴﺙ ﻴﺨﺼﺹ ﺍﻟﻘﺴﻡ ﺍﻷﻴﻤﻥ ﺍﻟﻌﻠﻭﻱ ﻭﺍﻟﺴﻔﻠﻲ ﻟﺤﻘﻥ ﺍﻟـﺴﻴﺭﻭﻡ‪ ،‬ﻭﺍﻟﻘـﺴﻡ‬
‫ﺍﻷﻴﺴﺭ ﺍﻟﻌﻠﻭﻱ ﻭﺍﻟﺴﻔﻠﻲ ﻟﺤﻘﻥ ﺍﻟﺒﻼﺯﻤﺎ ﺍﻟﻐﻨﻴﺔ ﺒﺎﻟﺼﻔﻴﺤﺎﺕ ﻭﺨﺭﻭﻑ ﻭﺍﺤﺩ ﺘﻡ ﺤﻘﻨﻪ ﻓـﻲ‬
‫ﺍﻟﺠﻬﺔ ﺍﻟﻴﻤﻨﻰ ﻭﺍﻟﻴﺴﺭﻯ ﻟﻠﺸﻔﺔ ﺍﻟﻌﻠﻭﻴﺔ ﺃﻱ‪ ،‬ﻤﻨﻁﻘﺘﻴﻥ ﻓﻘﻁ‪ ،‬ﻭﻟﻡ ﻨﺤﻘﻥ ﻓﻲ ﺍﻟـﺸﻔﺔ ﺍﻟـﺴﻔﻠﻴﺔ‬
‫ﻟﻬﺫﺍ ﺍﻟﺨﺭﻭﻑ ﻓﻘﻁ ﻭﺘﺭﻜﻨﺎﻫﺎ ﻟﻨﺭﻯ ﺍﻟﺸﻔﺔ ﺍﻟﻁﺒﻴﻌﻴﺔ ﻟﺩﻯ ﺍﻟﺨﺭﺍﻑ ﺘﺤﺕ ﺍﻟﻤﺠﻬﺭ‪.‬‬

‫ﺘﺤﻀﻴﺭ ﺍﻟﺒﻼﺯﻤﺎ ﺍﻟﻐﻨﻴﺔ ﺒﺎﻟﺼﻔﻴﺤﺎﺕ‪:‬‬

‫ﺒﻌﺩ ﺴﺤﺏ ‪ 10‬ﻤل ﻤﻥ ﺩﻡ ﺍﻟﺨﺭﻭﻑ ﻤﻥ ﺃﺠل ﻓﺼل ﺍﻟﺒﻼﺯﻤﺎ ﺍﻟﻐﻨﻴﺔ ﺒﺎﻟﺼﻔﻴﺤﺎﺕ ﺃُﺠـﺭﻱ‪‬‬
‫ﺍﻟﻔﺼل ﻋﻠﻰ ﻤﺭﺤﻠﺘﻴﻥ‪:‬‬

‫ﺍﻟﺘﻨﺒﻴﺫ ﺍﻷﻭﻟﻲ ‪first centrifuge:‬‬

‫ﻭ‪‬ﻀِﻊ‪ 10 ‬ﻤل‪ 2,5 +‬ﻤل ﺴﺘﺭﺍﺕ ﺍﻟﺼﻭﺩﻴﻭﻡ ﺍﻟﻤﺄﺨﻭﺫﺓ ﻤﻥ ﺩﻡ ﺍﻟﺨﺭﻭﻑ ﻀﻤﻥ ﺃﻨﺒـﻭﺒﻴﻥ‪،‬‬
‫ﻜل ﺃﻨﺒﻭﺏ ﻴﺘﺴﻊ ‪ 5‬ﻤل ﻭﻤﺩﺓ ‪ 10‬ﺩﻗﺎﺌﻕ ﻋل ﺴﺭﻋﺔ ‪ 2400‬ﺩﻭﺭﺓ ﻓﻲ ﺍﻟﺩﻗﻴﻘـﺔ‪ ،‬ﻭﻜﺎﻨـﺕ‬
‫ﻨﺘﻴﺠﺔ ﺍﻟﺘﻨﺒﻴﺫ ﺍﻷﻭل ﺍﻟﺤﺼﻭل ﻋﻠﻰ ‪ 3‬ﻁﺒﻘﺎﺕ‪.‬‬

‫• ﺍﻟﻁﺒﻘﺔ ﺍﻷﻭﻟﻰ‪ :‬ﺘﻜﻭﻨﺕ ﻓﻲ ﺍﻟﺴﻁﺢ ﻭﻫﻲ ﺫﺍﺕ ﺍﻟﻠﻭﻥ ﺍﻷﺼﻔﺭ ﻭﻫﻲ ﻁﺒﻘﺔ ﺍﻟﺒﻼﺯﻤﺎ‪.‬‬

‫• ﺍﻟﻁﺒﻘﺔ ﺍﻟﺜﺎﻨﻴﺔ‪ :‬ﻭﻫﻲ ﺍﻟﺘﻲ ﺘﺭﺴﺒﺕ ﻓﻲ ﻗﺎﻉ ﺍﻷﻨﺒﻭﺏ ﻭﻫﻲ ﻋﺒﺎﺭﺓ ﻋـﻥ ﻜﺭﻴـﺎﺕ ﺍﻟـﺩﻡ‬
‫ﺍﻟﺤﻤﺭﺍﺀ‪.‬‬

‫• ﺍﻟﻁﺒﻘﺔ ﺒﻴﻥ ﺍﻟﻁﺒﻘﺘﻴﻥ ﺍﻟﺴﺎﺒﻘﺘﻴﻥ‪ :‬ﻭﻫﻲ ﻗﻠﻴﻠﺔ ﺍﻟﻜﻤﻴﺔ ﻭﺘﺤﻭﻱ ﻋﻠﻰ ﺍﻟﺼﻔﻴﺤﺎﺕ ﻭﺍﻟﻜﺭﻴﺎﺕ‬
‫ﺍﻟﺒﻴﻀﺎﺀ‪ ،‬ﻭﻫﻲ ﻁﺒﻘﺔ ‪.Buffy coat‬‬

‫ﺴ‪‬ﺤِﺒ‪‬ﺕِ ﺍﻟﻁﺒﻘﺔ ﺍﻷﻭﻟﻰ ﺍﻟﺼﻔﺭﺍﺀ ﻤﻊ ﺍﻟﻁﺒﻘﺔ ﺍﻟﻭﺴﻁﻰ ﻤﻊ ‪ 0,5‬ﻤﻠﻡ ﻤـﻥ ﻜﺭﻴـﺎﺕ ﺍﻟـﺩﻡ‬
‫ﺍﻟﺤﻤﺭﺍﺀ ﺍﻟﺫﻱ ﻴﻭﺍﻓﻕ ﺃﻋﻠﻰ ﺍﻟﻁﺒﻘﺔ ﺍﻟﺜﺎﻨﻴﺔ ﻭﻭﻀﻌﺕ ﻓﻲ ﺃﻨﺒﻭﺏ ﻭﺍﺤﺩ‪.‬‬

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 ‫ﺩﺭﺍﺴﺔ ﺘﺄﺜﻴﺭ ﺍﻟﺒﻼﺯﻤﺎ ﺍﻟﻐﻨﻴﺔ ﺒﺎﻟﺼﻔﻴﺤﺎﺕ ﻋﻠﻰ ﺩﺭﺠﺔ ﺍﻻﻟﺘﻬﺎﺏ ﻨﺴﻴﺠﻴﺎﹰ‬

‫ﺍﻟﺘﻨﺒﻴﺫ ﺍﻟﺜﺎﻨﻲ‪Second Centrifuge :‬‬

‫ﺃﺠﺭﻴﻨﺎ ﺍﻟﺘﻨﺒﻴﺫ ﺒﺎﻟﺠﻬﺎﺯ ﻨﻔﺴﻪ ﺍﻟﺫﻱ ﺃﺠﺭﻴﻨﺎ ﺒﻪ ﺍﻟﺘﻨﺒﻴﺫ ﺍﻷﻭل‪ ،‬ﺇﺫﹾ ﻨﻀﻊ ﺍﻷﻨﺒﻭﺏ ﺍﻟﻤﺴﺘﺤﺼل‬
‫ﻤﻥ ﺍﻟﻤﺭﺤﻠﺔ ﺍﻷﻭﻟﻰ ﺒﻌﺩ ﺍﻟﺴﺤﺏ ﺍﻟﺴﺎﺒﻕ ﺍﻟﺫﻜﺭ‪ ،‬ﻭﻨﻀﻌﻪ ﻋﻠﻰ ﺴـﺭﻋﺔ ﺍﻟـﺩﻭﺭﺍﻥ ‪3000‬‬
‫ﺩﻭﺭﺓ ﻓﻲ ﺍﻟﺩﻗﻴﻘﺔ ﻤﺩﺓ ‪ 10‬ﺩﻗﺎﺌﻕ‪.‬‬

‫ﻭﺒﻌﺩ ﺍﻻﻨﺘﻬﺎﺀ ﻤﻥ ﺍﻟﺘﻨﺒﻴﺫ ﺘﹸﺴﺤ‪‬ﺏ‪ ‬ﺍﻟﻁﺒﻘﺔ ﺍﻟﻌﻠﻴﺎ ﻭﻫﻲ ﻁﺒﻘﺔ ﺍﻟﺒﻼﺯﻤﺎ ﺍﻟﻔﻘﻴﺭﺓ ﺒﺎﻟـﺼﻔﻴﺤﺎﺕ‬
‫ﻭﺍﻟﺘﺨﻠﺹ ﻤﻨﻬﺎ‪ ،‬ﻭﺃﺒﻘﻴﻨﺎ ﻋﻠﻰ ﺍﻟﻁﺒﻘﺔ ﺍﻟﻤﻭﺠﻭﺩﺓ ﻓﻲ ﻗﺎﻉ ﺍﻷﻨﺒﻭﺏ ﺍﻟﺘﻲ ﺘﻭﺍﻓـﻕ ﺍﻟﺒﻼﺯﻤـﺎ‬
‫ﺍﻟﻐﻨﻴﺔ ﺒﺎﻟﺼﻔﻴﺤﺎﺕ ﻤﻊ ﻜﻤﻴﺔ ﺒﺴﻴﻁﺔ ﻤﻥ ﺍﻟﺒﻼﺯﻤﺎ ﺍﻟﻔﻘﻴﺭﺓ ﺒﺎﻟﺼﻔﻴﺤﺎﺕ ‪ 0,5‬ﻤـل ﺘﻘﺭﻴﺒـﺎﹰ‪،‬‬
‫ﻭﺫﻟﻙ ﻟﺘﺴﻬﻴل ﺴﺤﺏ ﻁﺒﻘﺔ ﺍﻟﺒﻼﺯﻤﺎ ﺍﻟﻐﻨﻴﺔ ﺒﺎﻟﺼﻔﻴﺤﺎﺕ‪ .‬ﻭﻤﻥ ﺜﻡ‪ ‬ﺤ‪‬ﻘِﻨﹶﺕِ ﺍﻟﺒﻼﺯﻤﺎ ﺍﻟﻐﻨﻴ‪‬ـﺔ‬
‫ﺒﺎﻟﺼﻔﻴﺤﺎﺕ ﻀﻤﻥ ﺍﻟﺠﺭﻭﺡ ﺍﻟﻤﺤﺩﺜﺔ ‪.‬‬

‫ﺍﻟﺩﺭﺍﺴﺔ ﺍﻟﻨﺴﻴﺠﻴﺔ‪:‬‬
‫ﺃﺨﺫﺕ ‪ 22‬ﺨﺯﻋﺔ ﻤﻥ ﺍﻟﺨﺭﺍﻑ ﺒﻌﺩ ﺃﺴﺒﻭﻉ ﻭﺒﻌﺩ ﺃﺴﺒﻭﻋﻴﻥ ﻟﻠﺩﺭﺍﺴﺔ ﺍﻟﻨﺴﻴﺠﻴﺔ‪ .‬ﺘﻡ ﺘﺜﺒﻴﺘﻬـﺎ‬
‫ﺒﺎﻟﻔﻭﺭﻤﻭل ‪ %10‬ﻭﺘﻠﻭﻴﻨﻬﺎ ﺒﺎﻟﻬﻴﻤﺎﺘﻭﻜﺴﻴﻠﻴﻥ ﺃﻴﻭﺯﻴﻥ‪ .‬ﻜﻤﺎ ﺘﻤﺕ ﻤﺭﺍﻗﺒﺔ ﻫـﺫﻩ ﺍﻟﺨـﺭﺍﻑ‬
‫ﻋﻴﺎﻨﻴﺎﹰ ﺃﻴﻀﺎﹰ ﺨﻼل ﺍﻟﻤﺩﺓ ﺍﻟﺴﺎﺒﻘﺔ‪.‬‬

‫ﺘﻤﺕ ﻤﺭﺍﻗﺒﺔ ﺩﺭﺠﺔ ﺍﻻﻟﺘﻬﺎﺏ ﻟﻜل ﺨﺯﻋﺔ ﻤﻥ ﺍﻟﺨﺯﻋﺎﺕ ﺍﻟﻤﺩﺭﻭﺴﺔ ﻓﻲ ﻋﻴﻨـﺔ ﺍﻟﺩﺭﺍﺴـﺔ‬
‫ﺍﻟﻨﺴﻴﺠﻴﺔ‪ ،‬ﻭﺘﻡ ﺇﻋﻁﺎﺀ ﺍﻟﻤﺘﻐﻴﺭ ﺍﻟﻤﺩﺭﻭﺱ ﻗﻴﻤﺎﹰ ﻤﺘﺯﺍﻴﺩﺓ ﺘﺼﺎﻋﺩﻴﺎﹰ ﻭﻓﻘـﺎﹰ ﻟـﺸﺩﺓ ﺍﻟﻤﺘﻐﻴـﺭ‬
‫ﺍﻟﻤﺩﺭﻭﺱ‪ ،‬ﻜﻤﺎ ﻓﻲ ﺍﻟﺠﺩﻭل ﺍﻵﺘﻲ‪:‬‬

‫ﺠﺩﻭل ﺭﻗﻡ )‪(1‬‬

‫ﻴﺒﻴ‪‬ﻥ ﺍﻟﺩﺭﺠﺎﺕ ﺍﻟﻤﻌﺘﻤﺩﺓ ﻟﻠﻤﺘﻐﻴﺭ ﺍﻟﻤﺩﺭﻭﺱ ﻓﻲ ﻋﻴﻨﺔ ﺍﻟﺩﺭﺍﺴﺔ ﺍﻟﻨﺴﻴﺠﻴﺔ ﻭﺍﻟﻘﻴﻡ‬
‫ﺍﻟﻤﻭﺍﻓﻘﺔ ﺍﻟﻤﻌﻁﺎﺓ ﻟﻜل ﺩﺭﺠﺔ‪.‬‬
‫ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻌﻁﺎﺓ‬ ‫ﺩﺭﺠﺔ ﺍﻻﻟﺘﻬﺎﺏ‬
‫‪0‬‬ ‫ﻻ ﻴﻭﺠﺩ ﺍﻟﺘﻬﺎﺏ‬
‫‪1‬‬ ‫ﻴﻭﺠﺩ ﺍﻟﺘﻬﺎﺏ ﺨﻔﻴﻑ‬
‫‪2‬‬ ‫ﻴﻭﺠﺩ ﺍﻟﺘﻬﺎﺏ ﺸﺩﻴﺩ‬

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‫ﻡ‪ .‬ﺯﻴﻨﺎﺘﻲ‬ ‫ﻤﺠﻠﺔ ﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ ﻟﻠﻌﻠﻭﻡ ﺍﻟﺼﺤﻴﺔ– ﺍﻟﻤﺠﻠﺩ ‪ -26‬ﺍﻟﻌﺩﺩ ﺍﻟﺜﺎﻨﻲ‪2010-‬‬

‫ﻭﻗﺩ ﺘﻌﻤ‪‬ﺩﻨﺎ ﻫﺫﺍ ﺍﻟﺘﻘﺴﻴﻡ ﻷﻥ‪ ‬ﻭﻀﻊ ﺘﺼﻨﻴﻑ ﺩﺭﺠﺔ ﻤﺘﻭﺴﻁﺔ ﻗﺩ ﻻ ﻴﻜﻭﻥ ﺩﻗﻴﻘـﺎﹰ ﺩﺍﺌﻤـﺎﹰ‪،‬‬
‫ﻓﺒﻌﻀﻬﻡ ﻗﺩ ﻴﻌﺩ‪ ‬ﺒﻌﺽ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺘﻭﺴﻁﺔ ﺃﻤﻴل ﻟﺘﺼﻨﹼﻑ ﻋﻠﻰ ﺃﻨﹼﻬﺎ ﺨﻔﻴﻔﺔ‪ ،‬ﻭﺒﻌﻀﻬﻡ ﻗـﺩ‬
‫ﻴﻤﻴل ﺇﻟﻰ ﺘﺼﻨﻴﻑ ﺒﻌﺽ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻤﺘﻭﺴ‪‬ﻁﺔ ﻋﻠﻰ ﺃﻨﹼﻬﺎ ﺸﺩﻴﺩﺓ‪ ،‬ﻟﺫﻟﻙ ﺨﺭﺠﻨﺎ ﻤﻥ ﺍﺤﺘﻤـﺎل‬
‫ﺍﻟﺨﻼﻑ ﺇﺫﹾ ﺇﻥ‪ ‬ﺍﻟﺤﺎﻟﺔ ﺇﺫﺍ ﻟﻡ ﺘﻅﻬﺭ ﺼﻭﺭﺓ ﻨﺴﻴﺠﻴ‪‬ﺔ ﻭﺍﻀﺤﺔ ﻓﻲ ﺸﺩ‪‬ﺘﻬﺎ ﻓﻬﻲ ﺨﻔﻴﻔـﺔ‪ ،‬ﻭﺇﺫﺍ‬
‫ﻟﻡ ﺘﻅﻬﺭ ﺃﻱ‪ ‬ﻤﻅﻬﺭ ﺍﻟﺘﻬﺎﺒﻲ ﻤﻤﻴ‪‬ﺯ ﻓﺈﺫﺍ ﻻ ﻴﻭﺠﺩ ﺍﻟﺘﻬﺎﺏ‪ ،‬ﻭﻫﺫﺍ ﻁﺒﻌـﺎﹰ ﺒﺎﻻﻋﺘﻤـﺎﺩ ﻋﻠـﻰ‬
‫ﻨﻭﻋﻴ‪‬ﺔ ﺍﻟﺨﻼﻴﺎ ﻭﻜﺜﺎﻓﺘﻬﺎ ﻓﻲ ﺍﻟﺴﺎﺤﺎﺕ ﺍﻟﻤﺩﺭﻭﺴﺔ‪.‬‬

‫‪ -‬ﺍﻟﺩﺭﺍﺴﺔ ﺍﻹﺤﺼﺎﺌﻴﺔ‪:‬‬
‫ﺍﺴﺘﺨﺩﻡ ﺍﺨﺘﺒﺎﺭ ‪ Mann-Whitney U‬ﻟﻠﺩﺭﺍﺴﺔ ﺍﻹﺤﺼﺎﺌﻴﺔ )‪.(p=o.o5‬‬

‫ﺍﻟﻨﺘﺎﺌﺞ‪:‬‬
‫– ﺩﺭﺍﺴﺔ ﺩﺭﺠﺔ ﺍﻻﻟﺘﻬﺎﺏ‪:‬‬

‫× ﻨﺘﺎﺌﺞ ﻤﺭﺍﻗﺒﺔ ﺩﺭﺠﺔ ﺍﻻﻟﺘﻬﺎﺏ ﻓﻲ ﻋﻴﻨﺔ ﺍﻟﺩﺭﺍﺴﺔ ﺍﻟﻨﺴﻴﺠﻴﺔ ﻭﻓﻘﺎﹰ ﻟﻠﻤﺎﺩﺓ ﺍﻟﻤـﺴﺘﺨﺩﻤﺔ‬
‫ﻓﻲ ﺍﻟﺤﻘﻥ ﻭﺍﻟﻤﺩﺓ ﺍﻟﺯﻤﻨﻴﺔ ﺍﻟﻤﺩﺭﻭﺴﺔ‪:‬‬

‫ﺒﻠﻎ ﻋﺩﺩ ﺍﻟﺨﺯﻋﺎﺕ ﺒﻌﺩ ﺃﺴﺒﻭﻉ ﻤﻥ ﺍﻟﺤﻘﻥ‪ ،‬ﺍﻟﺘﻲ ﻟﻡ ﺘﺒﺩِ ﺍﻟﺘﻬﺎﺒﺎﹰ ﻓﻲ ﻜﻠﺘﺎ ﺍﻟﻌﻴﻨﺘﻴﻥ ﺴﻭﺍﺀ ﻓﻲ‬
‫ﻋﻴ‪‬ﻨﺔ ﺍﻟﺴﻴﺭﻭﻡ ﺍﻟﻤﻠﺤﻲ ﺃﻡ ﻓﻲ ﻋﻴ‪‬ﻨﺔ ﺍﻟﺒﻼﺯﻤﺎ ﺨﻤﺱ ﺨﺯﻋﺎﺕ ﻟﻜل ﻤﺠﻤﻭﻋﺔ‪ ،‬ﻭﻜﺎﻨﺕ ﻫﻨﺎﻙ‬
‫ﺨﺯﻋﺔ ﻭﺍﺤﺩﺓ ﺃﻅﻬﺭﺕ ﺤﺎﻟﺔ ﺍﻟﺘﻬﺎﺏ ﺨﻔﻴﻔﺔ ﻓﻲ ﻤﺠﻤﻭﻋﺔ ﺍﻟﺴﻴﺭﻭﻡ‪ ،‬ﻭﺤﺎﻟﺔ ﻭﺍﺤﺩﺓ ﺃﻴﻀﺎﹰ ﻓﻲ‬
‫ﻤﺠﻤﻭﻋﺔ ﺍﻟﺒﻼﺯﻤﺎ‪ ،‬ﻜﻤﺎ ﺃﺒﺩﺕ ﺨﻤﺱ ﺨﺯﻋﺎﺕ ﺩﺭﺠﺔ ﺸﺩﻴﺩﺓ ﻤﻥ ﺍﻻﻟﺘﻬﺎﺏ ﻓﻲ ﻤﺠﻤﻭﻋـﺔ‬
‫ﺍﻟﺴﻴﺭﻭﻡ‪ ،‬ﻭﻜﺫﻟﻙ ﺨﻤﺱ ﺨﺯﻋﺎﺕ ﻓﻲ ﻤﺠﻤﻭﻋﺔ ﺍﻟﺒﻼﺯﻤﺎ‪ ،‬ﻓﻲ ﺤﻴﻥ ﺒﻌﺩ ﺃﺴـﺒﻭﻋﻴﻥ ﻤـﻥ‬
‫ﺍﻟﺤﻘﻥ ﻭﺠﺩﻨﺎ ﺘﺴﻊ ﺨﺯﻋﺎﺕ ﻤﻥ ﻋﻴ‪‬ﻨﺔ ﺍﻟﺴﻴﺭﻭﻡ ﻭﺘﺴﻊ ﺨﺯﻋﺎﺕ ﻤﻥ ﻋﻴ‪‬ﻨـﺔ ﺍﻟﺒﻼﺯﻤـﺎ ﻟـﻡ‬
‫ﻴﻅﻬﺭ ﻓﻴﻬﻡ ﺍﻟﺘﻬﺎﺏ‪ ،‬ﻭﻜﺎﻥ ﻟﺩﻴﻨﺎ ﺤﺎﻟﺘﺎﻥ ﻓﻘﻁ ﻓﻲ ﻜل ﻤﺠﻤﻭﻋﺔ ﺃﻅﻬﺭﺕ ﺍﻟﺘﻬﺎﺒﺎﹰ ﺨﻔﻴﻔﺎﹰ ﻭﻟـﻡ‬
‫ﻴﻅﻬﺭ ﻟﺩﻴﻨﺎ ﺍﻟﺘﻬﺎﺏ ﺸﺩﻴﺩ ﻓﻲ ﺃﻱ‪ ‬ﻤﻥ ﺍﻟﻤﺠﻤﻭﻋﺘﻴﻥ ﻜﻤﺎ ﻫﻭ ﻤﻭﻀ‪‬ﺢ ﻓﻲ ﺍﻟﺠﺩﻭل ﺭﻗﻡ )‪:(2‬‬

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 ‫ﺩﺭﺍﺴﺔ ﺘﺄﺜﻴﺭ ﺍﻟﺒﻼﺯﻤﺎ ﺍﻟﻐﻨﻴﺔ ﺒﺎﻟﺼﻔﻴﺤﺎﺕ ﻋﻠﻰ ﺩﺭﺠﺔ ﺍﻻﻟﺘﻬﺎﺏ ﻨﺴﻴﺠﻴﺎﹰ‬

‫ﺠﺩﻭل ﺭﻗﻡ )‪(2‬‬

‫ﻴﺒﻴ‪‬ﻥ ﻨﺘﺎﺌﺞ ﻤﺭﺍﻗﺒﺔ ﺩﺭﺠﺔ ﺍﻻﻟﺘﻬﺎﺏ ﻓﻲ ﻋﻴﻨﺔ ﺍﻟﺩﺭﺍﺴﺔ ﺍﻟﻨﺴﻴﺠﻴﺔ ﻭﻓﻘﺎﹰ ﻟﻠﻤﺎﺩﺓ ﺍﻟﻤﺴﺘﺨﺩﻤﺔ‬
‫ﻓﻲ ﺍﻟﺤﻘﻥ ﻭﺍﻟﻤﺩﺓ ﺍﻟﺯﻤﻨﻴﺔ ﺍﻟﻤﺩﺭﻭﺴﺔ‬
‫ﻋﺩﺩ ﺍﻟﺨﺯﻋﺎﺕ‬
‫ﺩﺭﺠﺔ ﺍﻻﻟﺘﻬﺎﺏ‬ ‫ﻤﺩﺓ ﺍﻟﻤﺭﺍﻗﺒﺔ‬
‫ﺴﻴﺭﻭﻡ ﻤﻠﺤﻲ‬ ‫ﺍﻟﺒﻼﺯﻤﺎ ﺍﻟﻐﻨﻴﺔ ﺒﺎﻟﺼﻔﻴﺤﺎﺕ‬
‫‪5‬‬ ‫‪5‬‬ ‫ﻻ ﻴﻭﺠﺩ ﺍﻟﺘﻬﺎﺏ‬
‫‪1‬‬ ‫‪1‬‬ ‫ﻴﻭﺠﺩ ﺍﻟﺘﻬﺎﺏ ﺨﻔﻴﻑ‬
‫ﺒﻌﺩ ﺃﺴﺒﻭﻉ‬
‫‪5‬‬ ‫‪5‬‬ ‫ﻴﻭﺠﺩ ﺍﻟﺘﻬﺎﺏ ﺸﺩﻴﺩ‬
‫‪11‬‬ ‫‪11‬‬ ‫ﺍﻟﻤﺠﻤﻭﻉ‬
‫‪9‬‬ ‫‪9‬‬ ‫ﻻ ﻴﻭﺠﺩ ﺍﻟﺘﻬﺎﺏ‬
‫‪2‬‬ ‫‪2‬‬ ‫ﻴﻭﺠﺩ ﺍﻟﺘﻬﺎﺏ ﺨﻔﻴﻑ‬ ‫ﺒﻌﺩ ﺃﺴﺒﻭﻋﻴﻥ‬
‫‪0‬‬ ‫‪0‬‬ ‫ﻴﻭﺠﺩ ﺍﻟﺘﻬﺎﺏ ﺸﺩﻴﺩ‬
‫‪11‬‬ ‫‪11‬‬ ‫ﺍﻟﻤﺠﻤﻭﻉ‬
‫ﺇﺫﺍﹰ ﻓﻲ ﻜﻠﺘﺎ ﺍﻟﻤﺤﻤﻭﻋﺘﻴﻥ ﺒﻌﺩ ﺃﺴﺒﻭﻉ ﺃﻅﻬﺭﺕ ‪ 5‬ﺨﺯﻋﺎﺕ )‪ (%45‬ﻋﻼﻤـﺎﺕ ﺍﻻﻟﺘﻬـﺎﺏ‬
‫ﺍﻟﺤﺎﺩ‪ ،‬ﺨﺯﻋﺔ ﻭﺍﺤﺩﺓ )‪ (%10‬ﺃﻅﻬﺭﺕ ﻋﻼﻤﺎﺕ ﺍﻻﻟﺘﻬﺎﺏ ﺍﻟﺨﻔﻴﻑ ﻭ ‪5‬ﺨﺯﻋﺎﺕ )‪(%45‬‬
‫ﻟﻡ ﺘﺒﺩِ ﺃﻱ ﻋﻼﻤﺔ ﺍﻟﺘﻬﺎﺏ‪ ،‬ﻓﻲ ﺤﻴﻥ ﺒﻌﺩ ﺃﺴﺒﻭﻋﻴﻥ ﻭﻓﻲ ﻜﻠﺘﺎ ﺍﻟﻤﺠﻤـﻭﻋﺘﻴﻥ ‪ 9‬ﺨﺯﻋـﺎﺕ‬
‫)‪ (%82‬ﻟﻡ ﺘﺒﺩِ ﺃﻱ‪ ‬ﻋﻼﻤﺔ ﺍﻟﺘﻬﺎﺏ‪ ،‬ﻭﺃﻅﻬﺭﺕ ﺨﺯﻋﺘﺎﻥ ﻓﻘﻁ )‪ (%18‬ﻋﻼﻤﺎﺕ ﺍﻻﻟﺘﻬﺎﺏ‬
‫ﺍﻟﺨﻔﻴﻑ ‪.‬‬
‫ﻭﻟﺩﺭﺍﺴﺔ ﺍﻟﻔﺭﻭﻕ ﺍﻹﺤﺼﺎﺌﻴﺔ ﻟﺩﺭﺠﺔ ﺍﻻﻟﺘﻬﺎﺏ ﺒﻴﻥ ﺍﻟﻤﺠﻤﻭﻋﻴﻥ ﺍﻟﻤﺩﺭﻭﺴﺘﻴﻥ ﺍﺴﺘﻌﻤل‬
‫ﺍﺨﺘﺒﺎﺭ‪Mann-Whitney U‬‬
‫ﺠﺩﻭل ﺭﻗﻡ )‪(3‬‬
‫ﻴﺒﻴ‪‬ﻥ ﻨﺘﺎﺌﺞ ﺍﺨﺘﺒﺎﺭ ‪Mann-Whitney‬‬
‫ﺍﻟﻤﺘﻐﻴﺭ‬
‫ﺩﻻﻟﺔ ﺍﻟﻔﺭﻭﻕ‬ ‫ﻗﻴﻤﺔ ﻤﺴﺘﻭﻯ ﺍﻟﺩﻻﻟﺔ ﺍﻟﻤﻘﺩﺭﺓ‬ ‫‪U‬‬ ‫ﻗﻴﻤﺔ‬ ‫ﺍﻟﻤﺩﺓ ﺍﻟﺯﻤﻨﻴﺔ ﺍﻟﻤﺩﺭﻭﺴﺔ‬ ‫ﺍﻟﻤﺩﺭﻭﺱ‬
‫ﻻ ﺘﻭﺠﺩ ﻓﺭﻭﻕ ﺩﺍﻟﺔ‬ ‫‪1.000‬‬ ‫‪8.0‬‬ ‫ﺒﻌﺩ ﺃﺴﺒﻭﻉ‬ ‫ﺩﺭﺠﺔ ﺍﻻﻟﺘﻬﺎﺏ‬
‫ﻻ ﺘﻭﺠﺩ ﻓﺭﻭﻕ ﺩﺍﻟﺔ‬ ‫‪1.000‬‬ ‫‪3.0‬‬ ‫ﺒﻌﺩ ﺃﺴﺒﻭﻋﻴﻥ‬

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‫ﻡ‪ .‬ﺯﻴﻨﺎﺘﻲ‬ ‫ﻤﺠﻠﺔ ﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ ﻟﻠﻌﻠﻭﻡ ﺍﻟﺼﺤﻴﺔ– ﺍﻟﻤﺠﻠﺩ ‪ -26‬ﺍﻟﻌﺩﺩ ﺍﻟﺜﺎﻨﻲ‪2010-‬‬

‫ﻴﺒﻴ‪‬ﻥ ﺍﻟﺠﺩﻭل ﺭﻗﻡ )‪ (3‬ﺃﻥ ﻗﻴﻤﺔ ﻤﺴﺘﻭﻯ ﺍﻟﺩﻻﻟﺔ ﺍﻟﻤﻘﺩﺭﺓ ﺃﻜﺒﺭ ﻜﺜﻴﺭﺍﹰ ﻤـﻥ ﺍﻟﻘﻴﻤـﺔ ‪0.05‬‬
‫ﻤﻬﻤﺎ ﻜﺎﻨﺕ ﺍﻟﻤﺩﺓ ﺍﻟﺯﻤﻨﻴﺔ ﺍﻟﻤﺩﺭﻭﺴﺔ‪ ،‬ﺃﻱ ﺃﻨﻪ ﻋﻨﺩ ﻤﺴﺘﻭﻯ ﺍﻟﺜﻘﺔ ‪ %95‬ﻻ ﺘﻭﺠﺩ ﻓـﺭﻭﻕ‬
‫ﺩﺍﻟﺔ ﺇﺤﺼﺎﺌﻴﺎﹰ ﻓﻲ ﺩﺭﺠﺔ‬

‫ﺍﻻﻟﺘﻬﺎﺏ ﺒﻴﻥ ﻤﺠﻤﻭﻋﺔ ﺨﺯﻋﺎﺕ ﺍﻟﺒﻼﺯﻤﺎ ﺍﻟﻐﻨﻴـﺔ ﺒﺎﻟـﺼﻔﻴﺤﺎﺕ ﻭﻤﺠﻤﻭﻋـﺔ ﺨﺯﻋـﺎﺕ‬

‫ﺍﻟﺴﻴﺭﻭﻡ ﺍﻟﻤﻠﺤﻲ‪ ،‬ﻭﻻ ﺘﺄﺜﻴﺭ ﻟﻠﻤﺎﺩﺓ ﺍﻟﻤﺴﺘﺨﺩﻤﺔ ﻓﻲ ﺍﻟﺤﻘﻥ ﻋﻠﻰ ﺩﺭﺠﺔ ﺍﻻﻟﺘﻬﺎﺏ ﻓﻲ ﻋﻴﻨـﺔ‬
‫ﺍﻟﺩﺭﺍﺴﺔ ﺍﻟﻨﺴﻴﺠﻴﺔ ﻤﻬﻤﺎ ﻜﺎﻨﺕ ﺍﻟﻤﺩﺓ ﺍﻟﺯﻤﻨﻴﺔ ﺍﻟﻤﺩﺭﻭﺴﺔ )ﺒﻌﺩ ﺃﺴﺒﻭﻉ‪ ،‬ﺒﻌﺩ ﺃﺴﺒﻭﻋﻴﻥ(‪.‬‬

‫‪ -‬ﺩﺭﺍﺴﺔ ﻤﻅﺎﻫﺭ ﺭﺩ ﺍﻟﻔﻌل ﺍﻻﻟﺘﻬﺎﺒﻲ ﻋﻴﺎﻨﻴﺎﹰ‪:‬‬

‫ﺨﻼل ﺃﺴﺒﻭﻋﻴﻥ ﻤﻥ ﻤﺭﺍﻗﺒﺔ ﻤﻅﺎﻫﺭ ﺭﺩ ﺍﻟﻔﻌل ﺍﻻﻟﺘﻬﺎﺒﻲ ﻓﻲ ﺠﺭﻭﺡ ﺍﻟﺸﻔﺔ ﻋﻨﺩ ﺍﻟﺨـﺭﺍﻑ‬
‫ﻭﺠﺩﻨﺎ ﺃﻨﹼﻪ ﻋﻨﺩ ﺤﻘﻥ ﺍﻟﺴﻴﺭﻭﻡ ﺍﻟﻤﻠﺤﻲ ﻟﻡ ﻴﻜﻥ ﻫﻨﺎﻙ ﻤﻅﺎﻫﺭ ﺍﻟﺘﻬﺎﺒﻴﺔ ﻓﻲ ‪ 6‬ﺤﺎﻻﺕ‪ ،‬ﻓـﻲ‬
‫ﺤﻴﻥ ﺃﺒﺩﺕ ﺨﻤﺱ ﺤﺎﻻﺕ ﻤﻅﺎﻫﺭ‪ ‬ﺍﻟﺘﻬﺎﺒﻴﺔ ﻅﺎﻫﺭﺓ ﻟﻠﻌﻴﺎﻥ ﻭﻜﺎﻥ ﻟﺩﻴﻨﺎ ﺍﻷﻋﺩﺍﺩ ﻨﻔﺴﻬﺎ ﻋﻨـﺩ‬
‫ﺍﻟﻤﺭﺍﻗﺒﺔ ﺍﻟﻌﻴﺎﻨﻴ‪‬ﺔ ﺒﻌﺩ ﺤﻘﻥ ﺍﻟﺒﻼﺯﻤﺎ ﺍﻟﻐﻨﻴﺔ ﺒﺎﻟﺼﻔﻴﺤﺎﺕ‪ ،‬ﻜﻤﺎ ﻴﻭﻀ‪‬ﺢ ﺍﻟﺠﺩﻭل ﺭﻗﻡ )‪( 4‬‬

‫ﺠﺩﻭل ﺭﻗﻡ )‪(4‬‬

‫ﻴﺒﻴ‪‬ﻥ ﻨﺘﺎﺌﺞ ﻤﺭﺍﻗﺒﺔ ﺤﺩﻭﺙ ﺍﻟﺨﻤﺞ ﻓﻲ ﻋﻴﻨﺔ ﺍﻟﺩﺭﺍﺴﺔ ﻭﻓﻘﺎﹰ ﻟﻠﻤﺎﺩﺓ ﺍﻟﻤﺴﺘﺨﺩﻤﺔ ﻓﻲ ﺍﻟﺤﻘﻥ‬

‫ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ‬ ‫ﺍﻟﻤﻅﻬﺭ‬ ‫ﺍﻟﻤﺎﺩﺓ ﺍﻟﻤﺴﺘﺨﺩﻤﺔ ﻓﻲ ﺍﻟﺤﻘﻥ‬

‫‪6‬‬ ‫ﻻ ﻴﻭﺠﺩ ﻤﻅﺎﻫﺭ ﻭﺍﻀﺤﺔ‬

‫‪5‬‬ ‫ﻴﻭﺠﺩ ﻤﻅﺎﻫﺭ ﻭﺍﻀﺤﺔ‬ ‫ﺴﻴﺭﻭﻡ ﻤﻠﺤﻲ‬
‫‪11‬‬ ‫ﺍﻟﻤﺠﻤﻭﻉ‬

‫‪6‬‬ ‫ﻻ ﻴﻭﺠﺩ ﻤﻅﺎﻫﺭ ﻭﺍﻀﺤﺔ‬

‫‪5‬‬ ‫ﻴﻭﺠﺩ ﻤﻅﺎﻫﺭ ﻭﺍﻀﺤﺔ‬ ‫ﺒﻼﺯﻤﺎ ﻏﻨﻴﺔ ﺒﺎﻟﺼﻔﻴﺤﺎﺕ‬
‫‪11‬‬ ‫ﺍﻟﻤﺠﻤﻭﻉ‬

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 ‫ﺩﺭﺍﺴﺔ ﺘﺄﺜﻴﺭ ﺍﻟﺒﻼﺯﻤﺎ ﺍﻟﻐﻨﻴﺔ ﺒﺎﻟﺼﻔﻴﺤﺎﺕ ﻋﻠﻰ ﺩﺭﺠﺔ ﺍﻻﻟﺘﻬﺎﺏ ﻨﺴﻴﺠﻴﺎﹰ‬

‫ﺍﻟﻤﻨﺎﻗﺸﺔ‪:‬‬
‫ﻗﻤﻨﺎ ﻓﻲ ﻫﺫﻩ ﺍﻟﺩﺭﺍﺴﺔ ﺒﺘﺤﺭﻱ ﺍﻟﺘﻐﻴ‪‬ﺭﺍﺕ ﺍﻟﻨﺴﻴﺠﻴﺔ ﺍﻻﻟﺘﻬﺎﺒﻴﺔ ﺍﻟﺘﺎﻟﻴﺔ ﻟﺤﻘﻥ ﺍﻟﺒﻼﺯﻤﺎ ﺍﻟﻐﻨﻴـﺔ‬
‫ﺒﺎﻟﺼﻔﻴﺤﺎﺕ ﻤﻘﺎﺭﻨﺔ ﺒﺎﻟﺴﻴﺭﻭﻡ ﺍﻟﻤﻠﺤﻲ ﻭﺒﻴ‪‬ﻨﺕ ﺩﺭﺍﺴﺘﻨﺎ ﺍﻟﻨﺴﻴﺠﻴﺔ ﺃﻨﻪ ﻓﻲ ﻜﻠﺘﺎ ﺍﻟﻤﺠﻤﻭﻋﺘﻴﻥ‬
‫ﻭ ﺒﻌﺩ ﺃﺴﺒﻭﻉ ﻤﻥ ﺍﻟﺤﻘﻥ ﺃﻅﻬﺭﺕ )‪ (%45‬ﻤﻥ ﺍﻟﺨﺯﻋﺎﺕ ﻋﻼﻤـﺎﺕ ﺍﻻﻟﺘﻬـﺎﺏ ﺍﻟﺤـﺎﺩ‪،‬‬
‫ﻭ‪ %10‬ﺃﻅﻬﺭﺕ ﻋﻼﻤﺎﺕ ﺍﻻﻟﺘﻬﺎﺏ ﺍﻟﺨﻔﻴﻑ ﻭ‪ %45‬ﻤﻥ ﺍﻟﺨﺯﻋﺎﺕ ﻟﻡ ﺘﺒـﺩ ﺃﻱ ﻋﻼﻤـﺔ‬
‫ﺍﻟﺘﻬﺎﺏ‪ ،‬ﺒﻴﻨﻤﺎ ﺒﻌﺩ ﺃﺴﺒﻭﻋﻴﻥ ﻭﻓﻲ ﻜﻠﺘﺎ ﺍﻟﻤﺠﻤﻭﻋﺘﻴﻥ ‪ 9‬ﺨﺯﻋﺎﺕ )‪ (%82‬ﻟﻡ ﺘﺒﺩِ ﺃﻱ‪ ‬ﻋﻼﻤﺔ‬
‫ﺍﻟﺘﻬﺎﺏ ﻭﺃﻅﻬﺭﺕ ﺨﺯﻋﺘﺎﻥ ﻓﻘﻁ )‪ (%18‬ﻋﻼﻤﺎﺕ ﺍﻻﻟﺘﻬﺎﺏ ﺍﻟﺨﻔﻴﻑ‪ .‬ﻭﻴﻌـﻭﺩ ﺤـﺼﻭل‬
‫ﺍﻻﻟﺘﻬﺎﺏ ‪-‬ﺒﺤﺩ ﺫﺍﺘﻪ‪ -‬ﺇﻟﻰ ﺭﺩ ﻓﻌل ﺍﻟﺠﺴﻡ ﺍﻟﻁﺒﻴﻌﻲ ﺘﺠﺎﻩ ﺇﺤﺩﺍﺙ ﺍﻟﺸﻕ ﻭﺘﺠﺎﻩ ﻋﻤﻠﻴﺔ ﺤﻘﻥ‬
‫ﺍﻟﺴﻴﺭﻭﻡ ﻭﺍﻟـ ‪ ،PRP‬ﻭﻟﻜﻥ ﻟﻡ ﻨﺠﺩ ﻓﺭﻭﻗﺎﹰ ﺩﺍﻟﺔ ﺇﺤﺼﺎﺌﻴﺎﹰ ﻓـﻲ ﺩﺭﺠـﺔ ﺍﻻﻟﺘﻬـﺎﺏ ﺒـﻴﻥ‬
‫ﻤﺠﻤﻭﻋﺔ ﺨﺯﻋﺎﺕ ﺍﻟﺴﻴﺭﻭﻡ ﺍﻟﻤﻠﺤﻲ ﻭﻤﺠﻤﻭﻋﺔ ﺨﺯﻋﺎﺕ ﺍﻟﺒﻼﺯﻤﺎ ﺍﻟﻐﻨﻴﺔ ﺒﺎﻟﺼﻔﻴﺤﺎﺕ ﻭﻻ‬
‫ﺘﺄﺜﻴﺭ ﻟـ ‪ PRP‬ﻓﻲ ﺩﺭﺠﺔ ﺍﻻﻟﺘﻬﺎﺏ ﻓﻲ ﻋﻴﻨﺔ ﺍﻟﺩﺭﺍﺴﺔ ﺍﻟﻨﺴﻴﺠﻴﺔ ﻤﻬﻤﺎ ﻜﺎﻨﺕ ﺍﻟﻤﺩﺓ ﺍﻟﺯﻤﻨﻴﺔ‬
‫ﺍﻟﻤﺩﺭﻭﺴﺔ )ﺒﻌﺩ ﺃﺴﺒﻭﻉ‪ ،‬ﺒﻌﺩ ﺃﺴﺒﻭﻋﻴﻥ( ‪.‬‬

‫ﺃﻥ ﺍﻟــ ‪PRP‬‬

‫ﻭﻋﻨﺩ ﻤﻘﺎﺭﻨﺔ ﻨﺘﺎﺌﺠﻨﺎ ﺒﺩﺭﺍﺴﺎﺕ ﺴﺎﺒﻘﺔ ﻨﺠﺩ ﺃﻥ‪ ‬ﺒﻌﺽ ﺍﻟﺩﺭﺍﺴﺎﺕ ﻭﺠـﺩﺕ ّ‬
‫ﺘﺜﺒ‪‬ﻁ ﺍﻻﻟﺘﻬﺎﺏ ﻭﺍﻟﻤﻅﺎﻫﺭ ﺍﻻﻟﺘﻬﺎﺒﻴﺔ‪ ،‬ﻭﻤﻥ ﻫﻨﺎ ﺘﺄﺘﻲ ﻓﺎﺌﺩﺘﻬﺎ ﺍﻟـﺴﺭﻴﺭﻴ‪‬ﺔ‪ ،‬ﻭﻜﺄﻨﻨﹼـﺎ ﻨﻁﺒ‪‬ـﻕ‬
‫ﺍﻟﻜﻭﺭﺘﻴﺯﻭﻥ )‪ ،(12‬ﺒﻴﻨﻤﺎ ﻭﺠﺩﺕ ﺩﺭﺍﺴﺎﺕ ﺃﺨﺭﻯ ﺃﻥ‪ ‬ﺍﻟـ ‪ PRP‬ﺘﺤﺴ‪‬ﻥ ﺍﻟﺤﺎﻟﺔ ﺴـﺭﻴﺭﻴ‪‬ﺎﹰ‪.‬‬
‫ﻋﻥ ﻁﺭﻴﻕ ﺩﻋﻤﻬﺎ ﻭﺘﺴﺭﻴﻌﻬﺎ ﻵﻟﻴﺎﺕ ﺍﻟﺸﻔﺎﺀ ﺒﺘﺤﺭﻴﺽ ﺭﺩ ﻓﻌل ﺍﻟﺘﻬﺎﺒﻲ ﻤﻥ ﺸﺩ‪‬ﺓ ﻤﻌﻴ‪‬ﻨـﺔ‬
‫ﺒﺤﻴﺙ ﻴﻘﺩﺡ ﺯﻨﺎﺩ ﺘﺘﺎﺒﻊ ﺁﻟﻴﺎﺕ ﺍﻟﺸﻔﺎﺀ ﺒﺸﻜل ﺴﺭﻴﻊ ﻓﺘﺘﺤﺴ‪‬ﻥ ﺍﻟﺤﺎﻟﺔ ﺴﺭﻴﺭﻴً‪‬ﺎ‪ .‬ﻭﻫﻜﺫﺍ ﻨﺠﺩ ﺃﻥ‪‬‬
‫‪ Woodall J Jr‬ﻭ ‪ Tucci M‬ﻭ ‪ Mishra A,‬ﻋﺎﻡ ‪ 2007‬ﻭﺠﺩﻭﺍ ﺃﻨﹼﻪ ﺒﻌﺩ ﺤﻘﻥ ﺍﻟــ ‪PRP‬‬
‫ﺤﺼل ﺭﺩ ﻓﻌل ﺨﻠﻭﻱ ﺘﻅﺎﻫﺭ ﺒﺘﺜﺒﻴﻁ ﺒﺎﻟﻌﺎﺕ ﺍﻟﻜﺒﻴﺭ ‪ Macrophage cell‬ﻭﺍﻟﺘﺨﻔﻴﻑ ﻤـﻥ‬
‫ﺍﻟﻤﻅﺎﻫﺭ ﺍﻻﻟﺘﻬﺎﺒﻴﺔ )‪ (13‬ﻭﻫﺫﺍ ﻴﺩﻋﻡ ﺩﺭﺍﺴﺎﺕ ﻜﺎﻥ ﻗﺩ ﻗﺎﻡ ﺒﻬـﺎ ‪ Mishra A‬ﻭ‪Pavelko T‬‬
‫ﺘﺤﺩ‪‬ﺜﻭﺍ ﻓﻴﻬﺎ ﻋﻥ ﺘﺨﻔﻴﻑ ﻭﺍﻀﺢ ﻓﻲ ﺍﻷﻟﻡ ﻭﺍﻟﻤﻅﺎﻫﺭ ﺍﻻﻟﺘﻬﺎﺒﻴﺔ ﺒﻌﺩ ﺤﻘﻥ ﺍﻟـ ‪(14) PRP‬‬
‫ﻭﻜﺫﻟﻙ ﺃﻭﻀﺤﺕ ﺩﺭﺍﺴﺎﺕ ﻭ‪. Mishra A‬ﻭ ‪ Woodall J Jr,‬ﻭ ‪ Vieira‬ﺍﻟﻔﻭﺍﺌﺩ ﺍﻟـﺴﺭﻴﺭﻴ‪‬ﺔ‬
‫ﻟﻠﻤﻌﺎﻟﺠﺔ ﺒﺎﻟﺒﻼﺯﻤﺎ ﺍﻟﻐﻨﻴ‪‬ﺔ ﺒﺎﻟﺼﻔﻴﺤﺎﺕ )‪ (12‬ﺒﻴﻨﻤﺎ ﻭﺠﺩ ‪ Kajikawa Y,‬ﻭ ‪Morihara T,‬‬

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‫ﻡ‪ .‬ﺯﻴﻨﺎﺘﻲ‬ ‫ﻤﺠﻠﺔ ﺠﺎﻤﻌﺔ ﺩﻤﺸﻕ ﻟﻠﻌﻠﻭﻡ ﺍﻟﺼﺤﻴﺔ– ﺍﻟﻤﺠﻠﺩ ‪ -26‬ﺍﻟﻌﺩﺩ ﺍﻟﺜﺎﻨﻲ‪2010-‬‬

‫ﻭ ‪ 2008 Sakamoto H,‬ﺃﻥ‪ ‬ﺍﻟـ ‪ PRP‬ﺘﻌﻤل ﻋﻠﻰ ﺠﺫﺏ ﺍﻟﺨﻼﻴﺎ ﺇﻟﻰ ﻤﻨﻁﻘﺔ ﺍﻹﺼـﺎﺒﺔ‬
‫ﻭﺃﻨﹼﻬﺎ ﺒﺤﺩ ﺫﺍﺘﻬﺎ ﺘﺜﻴﺭ ﺭﺩ ﻓﻌل ﺍﻟﺘﻬﺎﺒﻴﺎﹰ ﻭﺒﻬﺫﻩ ﺍﻵﻟﻴﺔ‪ ،‬ﻭﻤﻥ ﺜﻡ‪ ‬ﺘﺴﻬﻡ ﻓـﻲ ﺘـﺴﺭﻴﻊ ﺁﻟﻴـﺎﺕ‬
‫ﺍﻟﺸﻔﺎﺀ )‪ ،(15‬ﻭﻫﺫﺍ ﻤﺎ ﻴﺘﻔﻕ ﻤﻊ ﺩﺭﺍﺴﺔ ‪ Sánchez‬ﻋﺎﻡ ‪ 2007‬ﺍﻟـﺫﻱ ﺃﺜﺒـﺕ ﺃﻴـﻀﺎﹰ ﺃﻥ‪‬‬
‫ﺍﻟﺒﻼﺯﻤﺎ ﺍﻟﻐﻨﻴﺔ ﺒﺎﻟﺼﻔﻴﺤﺎﺕ ﺘﺴﺭ‪‬ﻉ ﻤﻥ ﺁﻟﻴ‪‬ﺎﺕ ﺍﻟﺸﻔﺎﺀ ﺒﻌﺩ ﺍﻟﻌﻤﻠﻴ‪‬ﺎﺕ ﺍﻟﺠﺭﺍﺤﻴﺔ )‪ .(16‬ﻭﻗـﺩ‬
‫ﻴﻌﻭﺩ ﺍﻻﺨﺘﻼﻑ ﺒﻴﻥ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺒﺭﺃﻴﻨﺎ ﺇﻟﻰ ﺃﻥ‪ ‬ﺭﺩ ﺍﻟﻔﻌل ﺍﻟﻤﻨﺎﻋﻲ ﺍﻟﺫﺍﺘﻲ ﻟﻠﺠﺴﻡ ﻴﺭﺠ‪‬ﺢ ﺃﺤﺩ‬
‫ﺍﻻﺘﺠﺎﻫﻴﻥ ﻓﺈﺫﺍ ﻜﺎﻥ ﺭﺩ ﺍﻟﻔﻌل ﺍﻟﺫﺍﺘﻲ ﻗﻭﻴ‪‬ﺎ ﻤﻨﺫ ﺍﻟﺒﺩﺍﻴﺔ ﻜﺎﻥ ﺍﻻﺘﺠﺎﻩ ﻨﺤﻭ ﺇﺤﺩﺍﺙ ﺭﺩ ﺍﻟﻔﻌـل‬
‫ﺍﻹل ﺘﻬﺎﺒﻲ ﺍﻟﺩﻓﺎﻋﻲ‪ ،‬ﻭﻤﻥ ﺜﻡ‪ ‬ﺘﻌﻤل ﺍﻟـ ‪ PRP‬ﻋﻠﻰ ﺘﻌﺯﻴﺯ ﻫﺫﺍ ﺍﻷﻤﺭ ﻭﺍﻻﻨﻁـﻼﻕ ﻤﻨـﻪ‬
‫ﻨﺤﻭ ﺘﺴﺭﻴﻊ ﺁﻟﻴ‪‬ﺎﺕ ﺍﻟﺸﻔﺎﺀ‪ .‬ﺃﻤ‪‬ﺎ ﺇﺫﺍ ﻜﺎﻥ ﺭﺩ ﺍﻟﻔﻌل ﺍﻟﺩﻓﺎﻋﻲ ﺍﻷﻭ‪‬ﻟﻲ ﻟﻠﺠـﺴﻡ ﺒﻁﻴﺌـﺎﹰ ﻓـﺈﻥ‪‬‬
‫ﺍﻟـ ‪ PRP‬ﺤﻴﻨﺫﺍﻙ ﺴﺘﻌﻤل ﻋﻠﻰ ﺘﺜﺒﻴﻁ ﺍﻟﻤﻅـﺎﻫﺭ ﺍﻻﻟﺘﻬﺎﺒﻴـﺔ ﻭﺘﺨﻔﻴـﻑ ﻤﻅـﺎﻫﺭ ﺍﻷﻟـﻡ‬
‫ﻭﺍﻻﻟﺘﻬﺎﺏ ﺒﺼﻭﺭﺓ ﻋﺎﻤ‪‬ﺔ‪.‬‬

‫ﻭﺭﺒ‪‬ﻤﺎ ﺘﺅﻜﹼﺩ ﻤﺘﺎﺒﻌﺘﻨﺎ ﺍﻟﻌﻴﺎﻨﻴ‪‬ﺔ ﻟﻠﺸﻔﺎﻩ ﺍﻟﻤﺤﻘﻭﻨﺔ ﺒﺎﻟﺴﻴﺭﻭﻡ ﻭﺍﻟﻤﺤﻘﻭﻨﺔ ﺒﺎﻟﺒﻼﺯﻤﺎ ﻫﺫﺍ ﺍﻷﻤﺭ ﺇﺫ‬
‫ﻜﺎﻨﺕ ﻟﺩﻴﻨﺎ ﺃﻋﺩﺍﺩ ﻤﺘﺸﺎﺒﻬﺔ ﻤﻥ ﺍﻟﺸﻔﺎﻩ ﺍﻟﺘﻲ ﺃﻅﻬﺭﺕ ﻤﻅﺎﻫﺭ ﺍﻟﺘﻬﺎﺒﻴ‪‬ﺔ ﻭﺍﻀﺤﺔ‪ ،‬ﻭﺍﻟﺘﻲ ﻟـﻡ‬
‫ﺘﻅﻬﺭ ﻤﻅﺎﻫﺭ ﺍﻟﺘﻬﺎﺒﻴﺔ ﻭﺍﻀﺤﺔ ﺴﻭﺍﺀ ﻓﻲ ﻤﺠﻤﻭﻋﺔ ﺍﻟﺴﻴﺭﻭﻡ ﺃﻭ ﻓﻲ ﻤﺠﻤﻭﻋﺔ ﺍﻟــ‪PRP‬‬
‫ﻋﻴﺎﻨﻴﺎﹰ‪ ،‬ﻭﺃﻥ‪ ‬ﺭﺩ ﺍﻟﻔﻌل ﺍﻟﺩﻓﺎﻋﻲ ﺍﻟﺫﺍﺘﻲ ﻤﻥ ﺍﻟﺠﺴﻡ ﻫﻭ ﺍﻟﻤﻭﺠ‪‬ﻪ ﺍﻟﺤﻘﻴﻘﻲ ﻟﻬـﺫﺍ ﺍﻻﺘﺠـﺎﻩ ﺃﻭ‬
‫ﺫﺍﻙ‪.‬‬

‫ﻭﺒﺎﻟﺨﻼﺼﺔ ﺇﻥ‪ ‬ﺇﻀﺎﻓﺔ ﺍﻟﺒﻼﺯﻤﺎ ﺍﻟﻐﻨﻴﺔ ﺒﺎﻟﺼﻔﻴﺤﺎﺕ ﺒﺤﺩ ﺫﺍﺘﻬﺎ ﻻ ﺘـﺅﺜﹼﺭ ﻓـﻲ ﺩﺭﺠـﺔ ﺭﺩ‬
‫ﺍﻟﻔﻌل ﺍﻻﻟﺘﻬﺎﺒﻲ ﻨﺴﻴﺠﻴ‪‬ﺎ‪.‬‬

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 ‫ﺩﺭﺍﺴﺔ ﺘﺄﺜﻴﺭ ﺍﻟﺒﻼﺯﻤﺎ ﺍﻟﻐﻨﻴﺔ ﺒﺎﻟﺼﻔﻴﺤﺎﺕ ﻋﻠﻰ ﺩﺭﺠﺔ ﺍﻻﻟﺘﻬﺎﺏ ﻨﺴﻴﺠﻴﺎﹰ‬

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