‫اﻟﻤﺠﻠﺪ ‪ ،20‬اﻟﻌﺪد ‪2009 ،3‬‬
‫ﻣﺠﻠﺔ ﻋﻠﻮم اﻟﻤﺴﺘﻨﺼﺮﯾﺔ‬
‫ﻣﻘﺎرﻧﺔ اﻟﺒﻜﺘﯿﺮﯾﺎ اﻟﻤﻌﺰوﻟﮫ ﻣﻦ اﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻟﻤﺮﺿﻰ اﻟﺴﻜﺮي اﻟﻤﺼﺎﺑﯿﻦ‬
‫ﺑﺎﻋﺘﻼل ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ واﻟﻤﺼﺎﺑﯿﻦ ﺑﺎﻟﺘﮭﺎب اﻟﻘﺪم‬
‫ﻧﮭﺎد ﺧﻼوي ﺗﻜﺘﻮك اﻟﺰﺑﯿﺪي‬
‫ﻛﻠﯿﺔ اﻟﺘﻘﻨﯿﺎت اﻟﻄﺒﯿﮫ و اﻟﺼﺤﯿﮫ‬
‫ﺗﺎرﯾﺦ ﺗﻘﺪﯾﻢ اﻟﺒﺤﺚ ‪ - 2008/8/12‬ﺗﺎرﯾﺦ ﻗﺒﻮل اﻟﺒﺤﺚ ‪2009/4/15‬‬
‫‪ABSTRACT‬‬
‫‪Forty – mid stream urine samples were collected from patients (20 suffering‬‬
‫‪from diabetic retinopathy and 20 suffering from diabetic foot infections) who‬‬
‫‪attended Al-Kindy Hospital (Baghdad) for medication including males and females‬‬
‫‪of various ages.‬‬
‫‪API20 E and strep kits were used for bacteriological identification.‬‬
‫‪The results indicated that‬‬
‫)‪Escherichia coli was the most prominent bacteria in diabetic retinopathy (3 isolates‬‬
‫‪while pseudomonas aeroginosa was dominant in diabetic foot (6 isolates).Klebsiella‬‬
‫‪pneumoniae has constituted (6 isolates) in UTI control group.‬‬
‫‪UTI in type 1 of diabetic foot patients more than type 2 (66.6, 33.4)%‬‬
‫‪espectively,while in type 2 of retinopathy UTI more than type 1(63.6, 36.3)%‬‬
‫‪respectively, and appear in this study UTI in female (73.3,63.6)% respectively more‬‬
‫‪than male(26.6,63.3)% respectively in both study group (diabetic retinopathy and‬‬
‫‪diabetic foot infections).‬‬
‫اﻟﺨﻼﺻﺔ‬
‫ﺗﻢ ﺟﻤﻊ ‪40‬ﻋﯿﻨﺔ ﺑﻮل ﻟﻤﺮﺿﻰ اﻟﺴﻜﺮي اﻟﺬﯾﻦ ﯾﻌﺎﻧﻮن ﻣﻦ اﻟﺘﮭﺎب اﻟﻤﺠﺎري اﻟﺒﻮﻟﯿﺔ ) ‪ 20‬ﻣﻨﮭﻢ ﯾﻌﺎﻧﻮن ﻣﻦ‬
‫اﻋﺘﻼل ﻓﻲ ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ و ‪ 20‬ﻟﺪﯾﮭﻢ اﺻﺎﺑﺎت ﺑﺎﻟﻘﺪم‪ ،‬ﻣﻘﺎرﻧﺔ ﺑـ ‪ 20‬ﻋﯿﻨﺔ ﺳﯿﻄﺮة ﻟﻤﺮﺿﻰ ﯾﻌﺎﻧﻮن ﻣﻦ اﻟﺘﮭﺎب‬
‫اﻟﻤﺠﺎري اﻟﺒﻮﻟﯿﺔ ﻓﻘﻂ ( ﻣﻦ ﻣﺴﺘﺸﻔﻰ اﻟﻜﻨﺪي اﻟﺘﻌﻠﯿﻤﻲ ‪ ،‬و ﻗﺪ ﺗﻢ ﺗﺸﺨﯿﺺ اﻟﺒﻜﺘﯿﺮي ﺑﺎﺳﺘﺨﺪام طﺮﯾﻘﺔ ‪API 20 E‬‬
‫و ‪ Strep kits‬وﻗﺪ ﺗﺒﯿﻦ أن ‪ 3 ) Escherichia coli‬ﻋﺰﻻت ( ھﻲ اﻟﺴﺎﺋﺪه ﻓﻲ )ﻣﺮﺿﻰ اﻟﺴﻜﺮي اﻟﺬﯾﻦ‬
‫ﯾﻌﺎﻧﻮن ﻣﻦ اﻋﺘﻼل ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ(و ‪ 6 ) pseudomonas aeroginosa‬ﻋﺰﻻت ( )ﻣﺮﺿﻰ اﻟﺴﻜﺮي اﻟﺬﯾﻦ‬
‫ﯾﻌﺎﻧﻮن ﻣﻦ إﺻﺎﺑﺎت اﻟﻘﺪم وﻟﺪﯾﮭﻢ اﻟﺘﮭﺎب اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ( ﻣﻘﺎرﻧﺔ ﺑﻤﺠﻤﻮﻋﺔ اﻟﺴﯿﻄﺮة ﺣﯿﺚ اﺣﺘﻠﺖ ﺑﻜﺘﺮﯾﺎ‬
‫اﻟـ ‪ Klebsiella pneumoniae‬اﻟﻤﺮﺗﺒﺔ اﻻوﻟﻰ ﺑـ)‪ (6‬ﻋﺰﻻت‪ .‬وﻗﺪ وﺟﺪ أن اﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻟﺬوي‬
‫إﺻﺎﺑﺎت اﻟﻘﺪم ﺗﻮاﺟﺪت أﻛﺜﺮ ﻓﻲ ﻧﻮع اﻟﺴﻜﺮي)‪ (I‬ﻣﻨﺔ ﻓﻲ ﻧﻮع اﻟﺴﻜﺮي)‪ %( 33.4,66.6) (II‬ﻋﻠﻰ اﻟﺘﻮاﻟﻲ ﻓﻲ‬
‫ﺣﯿﻦ اﻟﻤﻌﺘﻠﯿﻦ ﺑﺸﺒﻜﯿﺔ اﻟﻌﯿﻦ وﺟﺪ ان اﻟﻨﻮع اﻟﺴﻜﺮي)‪ (II‬ﻛﺎن أﻛﺜﺮ ﻧﺼﯿﺒﺎ"ﻣﻦ اﻟﻨﻮع )‪ %( 36.3, 63.6) (I‬ﻋﻠﻰ‬
‫اﻟﺘﻮاﻟﻲ‪،‬واظﮭﺮت اﻟﺪراﺳﺔ ان اﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻓﻲ اﻹﻧﺎث )‪ % (73.3,63.6‬ﻋﻠﻰ اﻟﺘﻮاﻟﻲ أﻋﻠﻰ ﻣﻤﺎ‬
‫ﻛﺎﻧﺖ ﻓﻲ اﻟﺬﻛﻮر )‪ %(26.6,63.3‬ﻋﻠﻰ اﻟﺘﻮاﻟﻲ ﻓﻲ ﻣﺠﻤﻮﻋﺘﻲ اﻟﺪراﺳﮫ )ﻣﺮﺿﻰ ﯾﻌﺎﻧﻮن ﻣﻦ اﻋﺘﻼل ﻓﻲ ﺷﺒﻜﯿﺔ‬
‫اﻟﻌﯿﻦ وﻣﺮﺿﻰ ﯾﻌﺎﻧﻮن ﻣﻦ اﺻﺎﺑﺎت ﺑﺎﻟﻘﺪم(‪.‬‬
‫اﻟﻤﻘﺪﻣﺔ‬
‫ﻟﻘﺪ ﻛﺎن ﻣﺮض اﻟﺴﻜﺮي ﻣﻌﺮوﻓﺎ"ﻋﻨﺪ اﻷطﺒﺎء اﻟﻌﺮب ﻓﻲ اﻟﻌﺼﺮ اﻟﺬھﺒﻲ ﻟﺘﻄﻮر اﻟﻄﺐ‬
‫اﻟﻌﺮﺑﻲ اﻟﻘﺪﯾﻢ ﺑﯿﻦ اﻟﻘﺮﻧﯿﻦ اﻟﺘﺎﺳﻊ واﻟﺤﺎدي ﻋﺸﺮ]‪. [1‬وﻗﺪ وﺻﻒ اﺑﻦ ﺳﯿﻨﺎ )‪1073-960‬م (‬
‫اﻷﻋﺮاض اﻟﻜﻼﺳﯿﻜﯿﺔ ﻟﻠﻤﺮض ﻣﻦ ﺗﺒﻮل ﻛﺜﯿﺮ وﻋﻄﺶ وھﺰال ﻟﻜﻨﺔ ﺗﻔﺮد ﺑﻮﺻﻒ اﺛﻨﯿﻦ ﻣﻦ‬
‫ﻣﻀﺎﻋﻔﺎت اﻟﻤﺮض ‪ ،‬ھﻤﺎ ﻏﻨﻐﺮﯾﻦ اﻷطﺮاف‪ ،‬واﻟﻌﺠﺰ اﻟﺠﻨﺴﻲ]‪.[1‬‬
‫أن داء اﻟﺴﻜﺮي ﻣﺎ ھﻮ إﻻ ﺣﺎﻟﺔ ﻧﺎﺗﺠﺔ ﻋﻦ ﺧﻠﻞ ﻓﻲ اﻟﺘﻤﺜﯿﻞ اﻟﻐﺬاﺋﻲ ﻟﻠﻤﻮاد اﻟﻨﺸﻮﯾﺔ ﯾﺼﺤﺒﮭﺎ‬
‫ارﺗﻔﺎع ﻣﺰﻣﻦ ﻟﻤﺴﺘﻮى اﻟﺘﻤﺜﯿﻞ اﻟﻐﺬاﺋﻲ ﻟﻠﻤﻮاد اﻟﻨﺸﻮﯾﮫ واﻟﺴﻜﺮﯾﮫ ﻋﻦ طﺮﯾﻖ اﻻﻟﺘﺼﺎق ﺑﺄﻣﺎﻛﻦ‬
‫ﻣﺤﺪده )ﻣﺴﺘﻠﻤﺎت ﻋﻠﻰ ﺟﺪار اﻟﺨﻼﯾﺎ اﻟﺨﺎرﺟﯿﺔ( ﻹدﺧﺎل اﻟﻜﻠﻮﻛﻮز إﻟﯿﮭﺎ ﻟﺘﻘﻮم ﺑﺎﻟﻮظﺎﺋﻒ]‪. [3,2‬‬
‫وﻓﻲ ﺣﺎﻟﺔ ﺣﺪوث ﻧﻘﺺ ﻓﻲ اﻷﻧﺴﻮﻟﯿﻦ او وﺟﻮد ﺧﻠﻞ ﻣﺎ ﻓﻲ اﻻﻣﺎﻛﻦ اﻟﻤﺤﺪدة ﻟﻸﻧﺴﻮﻟﯿﻦ ﻋﻠﻰ‬
‫ﺟﺪران اﻟﺨﻼﯾﺎ ﺗﻈﮭﺮ زﯾﺎده ﻓﻲ ﻛﻤﯿﺔ اﻟﻜﻠﻮﻛﻮز ﺑﺎﻟﺪم ﻣﻊ ﻋﺪم ﻗﺪرة اﻟﺨﻼﯾﺎ ﻣﻦ اﻻﺳﺘﻔﺎدة ﻣﻨﺔ ﻣﻤﺎ‬
‫‪14‬‬
‫ﻣﻘﺎرﻧﺔ اﻟﺒﻜﺘﯿﺮﯾﺎ اﻟﻤﻌﺰوﻟﮫ ﻣﻦ اﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻟﻤﺮﺿﻰ اﻟﺴﻜﺮي اﻟﻤﺼﺎﺑﯿﻦ ﺑﺎﻋﺘﻼل ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ واﻟﻤﺼﺎﺑﯿﻦ ﺑﺎﻟﺘﮭﺎب اﻟﻘﺪم‬
‫ﻧﮭﺎد‬
‫ﯾﺆدي اﻟﻰ ظﮭﻮر أﻋﺮاض داء اﻟﺴﻜﺮي]‪.[4 ،3‬ان ھﺬا اﻟﻤﺮض ﯾﺸﻜﻞ اﺣﺪ اﻟﻤﺸﻜﻼت اﻟﺮﺋﯿﺴﯿﺔ‬
‫اﻟﺘﻲ ﺗﻮاﺟﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻣﺔ ﻟﻺﻧﺴﺎن]‪. [5‬‬
‫وﯾﻌﺪ ﻣﺮض اﻟﺴﻜﺮي ﻣﻦ اﻷﻣﺮاض اﻟﺸﺎﺋﻌﺔ اﻟﺘﻲ ﺗﺼﯿﺐ ﻣﺨﺘﻠﻒ اﻷﻋﻤﺎر واﻟﻄﺒﻘﺎت ‪ ،‬ﺣﯿﺚ‬
‫ﺧﻄﻮرة ھﺬا اﻟﻤﺮض ﺗﺘﺄﺗﻰ ﻣﻦ أﻣﻜﺎﻧﯿﺔ ﺣﺪوث ﻣﻀﺎﻋﻔﺎت ﻛﺜﯿﺮة وﺧﻄﯿﺮة ﻗﺪ ﺗﺆدي اﻟﻰ اﻟﻮﻓﺎة او‬
‫اﻹﺻﺎﺑﺔ ﺑﻌﺎھﺎت ﻣﺴﺘﺪﯾﻤﺔ ﯾﺼﻌﺐ ﻋﻼﺟﮭﺎ ﻣﺜﻞ ﻓﻘﺪان اﻟﺒﺼﺮ ﺑﺴﺒﺐ ﺗﺨﺮﯾﺐ ﻓﻲ ﺷﺒﻜﯿﺔ‬
‫اﻟﻌﯿﻦ]‪.[6,3‬‬
‫وﻣﻦ أھﻢ ﻣﻀﺎﻋﻔﺎﺗﮫ ھﻮﻏﻨﻐﺮﯾﻦ اﻟﺴﻜﺮي ‪ diabetic gangrene‬اﻟﺬي ﯾﻨﺸﺄ ﻋﻦ ﺿﻌﻒ اﻟﺪورة‬
‫اﻟﺪﻣﻮﯾﺔ ﻓﻲ اﻟﺴﺎﻗﯿﻦ وﻓﻘﺮ ﻓﻲ ﺗﻐﺬﯾﺔ اﻷﻧﺴﺠﺔ ﻣﻤﺎ ﯾﺠﻌﻠﮭﺎ ﻋﺮﺿﺔ ﻟﻺﺻﺎﺑﺔ ﺑﺎﻟﻐﺎﻧﻐﺮﯾﻦ]‪.[7‬‬
‫أﻣﺎ اﻋﺘﻼل ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ ﻓﮭﻲ ﺗﺤﺪث ﺑﺼﻮرة ارﺗﺸﺎﺣﺎت ﻓﻲ ﺟﺪران اﻟﺸﺒﻜﯿﺔ ﻣﻊ ﺗﻐﯿﺮات ﺑﺎﻷوﻋﯿﺔ‬
‫اﻟﺪﻣﻮﯾﺔ ‪ ،‬وھﻲ ﻓﻲ ﻣﺮاﺣﻠﮭﺎ اﻷوﻟﻰ ﺗﻜﻮن ﺑﺪون أي أﻋﺮاض وﻻ ﺗﺤﺘﺎج ﻟﻌﻼج ﻏﯿﺮ ﺗﻨﻈﯿﻢ ﻣﻌﺪل‬
‫اﻟﺴﻜﺮ ﺑﺎﻟﺪم ﻣﻊ اﻟﻜﺸﻒ اﻟﺪوري ﻋﻠﻰ اﻟﻌﯿﻨﯿﻦ ]‪ .[8‬وﻗﺪ ﺗﺘﺪھﻮر اﻟﺤﺎﻟﺔ ﺑﻤﺮور اﻟﻮﻗﺖ ﻻﺳﯿﻤﺎ ﻋﻨﺪ‬
‫اﻟﺘﻌﺮض ﻟﻌﺪم اﻧﻀﺒﺎط ﻣﻌﺪل اﻟﺴﻜﺮ ﺑﺎﻟﺪم وﯾﺘﻌﺮض اﻟﻤﺮﯾﺾ ﻟﺘﻐﯿﺮات اﺷﺪ ﺧﻄﻮرة ﻣﻊ اﺣﺘﻤﺎل‬
‫ﺣﺪوث ﻧﺰف داﺧﻞ اﻟﻌﯿﻦ وھﺬه اﻟﻤﻀﺎﻋﻔﺎت ﺗﺆﺛﺮ ﻓﻲ ﻗﻮة اﻹﺑﺼﺎر ﺑﺪرﺟﺎت ﻣﺘﻔﺎوﺗﺔ ﻗﺪ ﺗﺼﻞ‬
‫ﻟﻔﻘﺪان اﻟﺒﺼﺮ ﺧﺎﺻﺔ ﻋﻨﺪﻣﺎ ﺗﺆﺛﺮ ﻓﻲ اﻟﺒﺆرة ]‪.[9‬‬
‫ﻻ ﺗﻈﮭﺮ اﻻﻋﺮاض ﻋﻠﻰ اﻟﺸﺒﻜﯿﺔ اﻻ ﻓﻲ اﻟﻤﺮاﺣﻞ اﻟﻤﺘﺄﺧﺮة ﻣﻦ اﻟﻤﺮض ﻟﺪرﺟﺔ ﻻﯾﻤﻜﻦ‬
‫ﻓﯿﮭﺎ اﻟﻌﻼج ﺑﯿﻨﻤﺎ ﯾﻜﻮن اﻟﺘﺸﺨﯿﺺ اﻟﻤﺒﻜﺮ ﻧﺎﺟﺤﺎ ﻓﻲ اﻟﻤﺮﺣﻠﺔ اﻟﻤﺒﻜﺮة ﻣﻦ ﺗﻐﯿﺮات ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ‬
‫‪.‬أن اﻟﻤﺮﺣﻠﺔ اﻟﻤﺒﻜﺮة ﻣﻦ اﻟﺘﻐﯿﺮات ﺑﺎﻟﺸﺒﻜﯿﺔ ھﻲ اﻷﻛﺜﺮ ﺷﯿﻮﻋﺎ وﺗﻤﺜﻞ أﻛﺜﺮ ﻣﻦ ‪ % 75‬ﻣﻦ ﺟﻤﯿﻊ‬
‫إﺻﺎﺑﺎت اﻟﻌﯿﻦ اﻟﻤﺘﻌﻠﻘﺔ ﺑﺎﻟﺴﻜﺮي ﺣﯿﺚ ﻣﻦ اﻟﻨﺎدر أن ﺗﺆدي اﻹﺻﺎﺑﺔ ﻓﻲ ھﺬه اﻟﻤﺮﺣﻠﺔ إﻟﻰ ﻓﻘﺪان‬
‫اﻟﺒﺼﺮ إﻻ أن )‪ % (15-5‬ﻣﻦ اﻟﻤﺮﺿﻰ ﻣﻌﺮﺿﻮن ﻟﻔﻘﺪان اﻟﺒﺼﺮ ﺧﻼل ‪ 5‬ﺳﻨﻮات ﻋﻨﺪ ﻋﺪم‬
‫أﻧﺘﻈﺎم اﻟﺴﻜﺮ ﺑﺎﻟﺪم]‪.[10‬‬
‫وﻧﺘﯿﺠﺔ ﻟﻀﻌﻒ اﻟﺠﮭﺎز اﻟﻤﻨﺎﻋﻲ ﻟﻤﺮﺿﻰ اﻟﺴﻜﺮي ﺗﻈﮭﺮ ﺣﺎﻻت اﻟﺘﮭﺎﺑﯿﺔ ﻷﺟﮭﺰة اﻟﺠﺴﻢ‬
‫اﻷﺧﺮى ﻛﺎﻟﺘﮭﺎب اﻟﺠﮭﺎز اﻟﺒﻮﻟﻲ‪ ،‬ﺣﯿﺚ ﯾﻌﺪ اﻟﺘﮭﺎب اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻣﻦ اﻷﻣﺮاض اﻟﺮﺋﯿﺴﯿﺔ اﻟﺘﻲ‬
‫ﺗﺼﯿﺐ ﻣﺮﺿﻰ اﻟﺴﻜﺮي ﻧﺘﯿﺠﺔ ﻻرﺗﻔﺎع اﻟﺴﻜﺮ ﺑﺎﻟﺒﻮل ﻓﯿﻜﻮن ﺑﺬﻟﻚ وﺳﻄﺎ" ﻣﻼﺋﻤﺎ" ﻟﻨﻤﻮ اﻟﺒﻜﺘﺮﯾﺎ‬
‫اﻟﻤﺮﺿﯿﺔ ﺧﺎﺻﺔ أﻟـ ‪ Enteric bacteria‬ﻛـ‬
‫‪Escherichia coli, Klebsiella,, Pseudomonas aeruginosa‬‬
‫‪,‬‬
‫‪Streptococcus‬‬
‫ﻛﻤﺎ ﯾﻤﻜﻦ أن ﺗﺴﺒﺐ أﻟـ ‪ Chlamydia‬و ‪ Mycoplasma‬اﻟﺘﮭﺎب اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻟﻤﺮﺿﻰ‬
‫اﻟﺴﻜﺮي ]‪. [11‬‬
‫ﯾﮭﺪف اﻟﺒﺤﺚ اﻟﻰ دراﺳﺔ اﻟﺘﮭﺎب اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﮫ ﻟﻤﺮﺿﻰ اﻟﺴﻜﺮي ﻟﻤﺠﻤﻮﻋﺘﯿﻦ ‪:‬‬
‫اﻟﻤﺠﻤﻮﻋﮫ اﻻوﻟﻰ ﯾﻌﺎﻧﻮن ﻣﻦ اﻋﺘﻼل ﻓﻲ ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ واﻟﻤﺠﻤﻮﻋﮫ اﻻﺧﺮى ﯾﻌﺎﻧﻮن ﻣﻦ اﻟﺘﮭﺎﺑﺎت‬
‫ﻓﻲ اﻟﻘﺪم‪ ،‬واﻟﺘﻌﺮف ﻋﻠﻰ اﻟﻤﺴﺒﺐ اﻟﺒﻜﺘﯿﺮي ﻓﻲ ﻛﻼ اﻟﻤﺠﻤﻮﻋﺘﯿﻦ واﺳﺒﺎب اﻻﺻﺎﺑﮫ ﺑﮫ ﻣﻊ ﺗﺎﺛﯿﺮ‬
‫ﻋﻮاﻣﻞ اﺧﺮى ﻋﻠﻰ ﻣﻌﺪل اﻻﺻﺎﺑﮫ ﻛﻨﻮع ﻣﺮض اﻟﺴﻜﺮي وﻋﻤﺮ اﻟﻤﺮﯾﺾ وﺟﻨﺴﮫ وﻣﺪى اﻟﺘﺮاﺑﻂ‬
‫اﻟﻤﻮﺟﻮد ﺑﯿﻦ ھﺬه اﻟﻌﻮاﻣﻞ اﻟﺘﻲ ﺗﻌﻤﻞ ﻋﻠﻰ زﯾﺎده ﻧﺴﺒﺔ اﻟﺘﮭﺎب اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﮫ ﻟﻤﺠﻤﻮﻋﺘﻲ‬
‫اﻟﺪراﺳﮫ‪.‬‬
‫اﻟﻤﻮاد وطﺮاﺋﻖ اﻟﻌﻤﻞ‬
‫ﺗﻨﺎوﻟﺖ ھﺬه اﻟﺪراﺳﺔ ‪ 40‬ﻋﯿﻨﺔ ﺑﻮل ﻣﻦ ﻣﺮﺿﻰ اﻟﺴﻜﺮي اﻟﺬﯾﻦ ﯾﺰورون ﻣﺴﺘﺸﻔﻰ اﻟﻜﻨﺪي‬
‫اﻟﺘﻌﻠﯿﻤﻲ ﺧﻼل ﺷﮭﺮ ﺷﺒﺎط ‪ 2008‬وﻟﻐﺎﯾﺔ ﺷﮭﺮ ﺣﺰﯾﺮان ‪ 2008‬ﺟﻤﻌﺖ ھﺬ ة اﻟﻌﯿﻨﺎت ﻣﻦ‬
‫ﻣﺮﺿﻰ اﻟﺴﻜﺮي اﻟﺬﯾﻦ ﯾﻌﺎﻧﻮن ﻣﻦ اﻋﺘﻼل ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ )‪ 20‬ﻋﯿﻨﮫ ( و إﺻﺎﺑﺎت اﻟﻘﺪم وﻟﺪﯾﮭﻢ‬
‫اﻟﺘﮭﺎب اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ)‪ 20‬ﻋﯿﻨﮫ ( وﻋﯿﻨﺎت اﺧﺮى ﻣﻦ ﻣﺮﺿﻰ اﻟﺴﻜﺮي اﻟﻤﺼﺎﺑﯿﻦ ﺑﺎﻟﺘﮭﺎب‬
‫اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ وﻻ ﯾﺸﻜﻮن ﻣﻦ اﻋﺘﻼل ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ وﻻ إﺻﺎﺑﺎت اﻟﻘﺪم) ﻛﻤﺠﻤﻮﻋﺔ ﺳﯿﻄﺮة(‪.‬‬
‫ﺗﺮاوﺣﺖ أﻋﻤﺎر اﻟﻤﺮﺿﻰ اﻟﻤﺸﻤﻮﻟﯿﻦ ﺑﮭﺬه اﻟﺪراﺳﺔ ‪ 70-18‬ﻋﺎﻣﺎ" ﻣﻦ ﻛﻼ اﻟﺠﻨﺴﯿﻦ ذﻛﻮرا"‬
‫وإﻧﺎﺛﺎ"ﻣﻘﺴﻤﯿﻦ إﻟﻰ ﺛﻼث ﻓﺌﺎت ﻋﻤﺮﯾﺔ ‪ ،‬اﻷوﻟﻰ ﺗﻀﻤﻨﺖ اﻷﻋﻤﺎر اﻗﻞ او ﯾﺴﺎوي ‪ 20‬ﻋﺎﻣﺎ"‬
‫‪15‬‬
‫اﻟﻤﺠﻠﺪ ‪ ،20‬اﻟﻌﺪد ‪2009 ،3‬‬
‫ﻣﺠﻠﺔ ﻋﻠﻮم اﻟﻤﺴﺘﻨﺼﺮﯾﺔ‬
‫واﻟﻔﺌﺔ اﻟﺜﺎﻧﯿﺔ ﻣﻦ ‪ 40-21‬واﻷﺧﯿﺮة أﻛﺜﺮ ﻣﻦ ‪ 41‬ﻋﺎﻣﺎ"‪ .‬ﺣﯿﺚ ﺗﻢ ﺗﺸﺨﯿﺺ ھﺆﻻء اﻟﻤﺮﺿﻰ ﻣﻦ‬
‫ﻗﺒﻞ طﺒﯿﺐ اﺧﺘﺼﺎص‪ ،‬وﻗﺪ ﻓﺤﺺ اﻟﺒﻮل ﺑﻄﺮﯾﻘﺔ ‪ GUE‬ﺛﻢ زرﻋﮫ ﻋﻠﻰ وﺳﻄﻲ اﻟﻤﺎﻛﻮﻧﻜﻲ أﻛﺎر‬
‫ووﺳﻂ اﻛﺎر اﻟﺪم ﺛﻢ ﺣﻀﻨﺖ اﻷطﺒﺎق ﺑﺪرﺟﺔ ‪˚ 37‬م وﻟﻤﺪة ‪ 48 – 24‬ﺳﺎﻋﺔ ﺑﺠﮭﺎز اﻟﺤﺎﺿﻨﺔ‬
‫‪ [12]Incubator‬وأﺟﺮﯾﺖ ﻋﻠﻰ ﺗﻠﻚ اﻟﻌﯿﻨﺎت ﻓﺤﻮﺻﺎت ﻣﺨﺘﺒﺮﯾﺔ ﻟﻠﺘﺤﺮي ﻋﻦ وﺟﻮد اﻷﻧﻮاع‬
‫اﻟﺒﻜﺘﯿﺮﯾﺔ اﻟﻤﺨﺘﻠﻔﺔ‪ .‬وﺑﺎﺳﺘﺨﺪام ‪ [13] Strep kits , API 20 E‬ﺗﻢ اﻟﺘﻌﺮف ﻋﻠﻰ ﻧﺴﺒﺔ‬
‫اﻟﻌﺰﻻت اﻟﺒﻜﺘﯿﺮﯾﺔ ﺑﺎﻟﻨﺴﺒﺔ ﻟﻠﻤﺠﻤﻮﻋﺘﯿﻦ ‪.‬‬
‫وﻗﺪ ﻓﺤﺼﺖ ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ ﻟﻤﺮﺿﻰ اﻟﺴﻜﺮي اﻟﺬﯾﻦ ﯾﻌﺎﻧﻮن ﻣﻦ اﻋﺘﻼل ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ ﺑﺎﺳﺘﺨﺪام‬
‫ﺟﮭﺎز اﻟـ ‪ Ophthalmoscope‬أﻣﺎ إﺻﺎﺑﺎت اﻟﻘﺪم ﻓﻘﺪ زرﻋﺖ ﻣﺴﺒﻘﺎ ﻣﺴﺤﺎت ﻣﺎﺧﻮذه ﻣﻦ‬
‫ﻣﻮﺿﻊ اﺻﺎﺑﺔ اﻟﻘﺪم ﻣﻦ اﻟﻤﺮﺿﻰ ﺑﻌﺪ ﺗﺸﺨﯿﺺ اﻟﺤﺎﻟﺔ ﻣﻦ ﻗﺒﻞ طﺒﯿﺐ ﺟﺮاح ‪،‬وﻗﺪ اﻋﺘﻤﺪ اﻟﺘﺤﻠﯿﻞ‬
‫اﻻﺣﺼﺎﺋﻲ ﻋﻠﻰ اﻟﻨﺴﺐ اﻟﻤﺌﻮﯾﺔ واﻟﻮﺳﻂ اﻟﺤﺴﺎﺑﻲ ‪.‬‬
‫اﻟﻨﺘﺎﺋﺞ و اﻟﻤﻨﺎﻗﺸﺔ‬
‫ﯾﻮﺿﺢ اﻟﺠﺪول )‪ (1‬اﻟﻰ أن ﻧﺴﺒﺔ اﻟﺘﮭﺎب اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻟﻤﺮﺿﻰ اﻟﺴﻜﺮي اﻟﻤﺼﺎﺑﯿﻦ ﺑﺎﻋﺘﻼل‬
‫ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ ﻓﻲ اﻟﻔﺌﺔ اﻟﻌﻤﺮﯾﺔ اﻟﺜﺎﻧﯿﺔ)‪ (40-21‬ﻟﻢ ﯾﻜﻦ ﺳﻮى ‪، %27.3‬ﺑﯿﻨﻤﺎ ارﺗﻔﻌﺖ اﻹﺻﺎﺑﺔ ﻓﻲ‬
‫اﻟﻔﺌﺔ اﻟﻌﻤﺮﯾﺔ اﻟﺜﺎﻟﺜﺔ ) ‪ (≥41‬إﻟﻰ ‪ %72.7‬ﻣﻊ ﻣﻼﺣﻈﺔ ﻋﺪم ظﮭﻮر اي ﺣﺎﻟﺔ اﺻﺎﺑﺔ ﻟﺪى اﻟﻔﺌﺔ‬
‫اﻟﻌﻤﺮﯾﺔ اﻻوﻟﻰ)≥ ‪.(20‬‬
‫اﻣﺎ ﻣﺮﺿﻰ اﻟﺴﻜﺮي اﻟﺬﯾﻦ ﯾﻌﺎﻧﻮن ﻣﻦ إﺻﺎﺑﺎت ﻓﻲ اﻟﻘﺪم ﻓﻘﺪ ﺗﻘﺎرﺑﺖ اﻟﻨﺘﺎﺋﺞ ﻣﻊ اﻟﻤﺮﺿﻰ‬
‫اﻟﻤﺼﺎﺑﯿﻦ ﺑﺎﻋﺘﻼل ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ ﺣﯿﺚ ﻟﻢ ﺗﻈﮭﺮ اي اﺻﺎﺑﺔ ﻟﺪى اﻟﻔﺌﺔ اﻟﻌﻤﺮﯾﺔ اﻻوﻟﻰ أﻣﺎ اﻟﻔﺌﺘﯿﻦ‬
‫اﻟﺜﺎﻧﯿﺔ واﻟﺜﺎﻟﺜﺔ ﻓﻘﺪ ﻛﺎﻧﺖ )‪ % (80,20‬ﻋﻠﻰ اﻟﺘﻮاﻟﻲ‪ .‬ﻟﻜﻦ ﻟﺪى ﻣﺠﻤﻮﻋﺔ اﻟﺴﯿﻄﺮة )ﻣﺮﺿﻰ‬
‫اﻟﺴﻜﺮي ﻏﯿﺮاﻟﻤﺼﺎﺑﯿﻦ ﺑﺎﻋﺘﻼل ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ وﻻ إﺻﺎﺑﺎت ﻓﻲ اﻟﻘﺪم( ﻓﻤﺎ ﺑﯿﻨﮫ اﻟﺠﺪول ھﻮ زﯾﺎدة‬
‫ﺑﻨﺴﺒﺔ اﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻟﻠﻔﺌﺘﯿﻦ اﻟﻌﻤﺮﯾﺔاﻷوﻟﻰ واﻟﺜﺎﻧﯿﺔ )‪15‬و‪ %(30‬ﻋﻠﻰ اﻟﺘﻮاﻟﻲ وﺗﺰداد‬
‫ﻟﺘﺼﻞ)‪ (%55‬ﻟﺪى اﻷﻋﻤﺎر )‪.(≥ 41‬‬
‫ﺟﺪول‪ :1-‬ﻧﺴﺒﺔ اﻟﺘﮭﺎب اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻟﻤﺮﺿﻰ اﻟﺴﻜﺮي اﻟﻤﺼﺎﺑﯿﻦ ﺑﺎﻋﺘﻼل ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ و إﺻﺎﺑﺎت اﻟﻘﺪم ﻟﻔﺌﺎت‬
‫ﻋﻤﺮﯾﮫ ﻣﺨﺘﻠﻔﮫ‬
‫ﻣﺠﺎﻣﯿﻊ‬
‫اﻟﻤﺮﺿﻰ‬
‫اﻟﻌﻤﺮ‬
‫) اﻟﺴﻨﺔ(‬
‫≥ ‪20‬‬
‫‪40-21‬‬
‫‪≥41‬‬
‫اﻟﻤﺠﻤﻮع )‪(%‬‬
‫اﻋﺘﻼل ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ‬
‫ﺑﺪون‬
‫اﻟﺘﮭﺎﺑﺎت‬
‫اﻟﻤﺴﺎﻟﻚ‬
‫اﻟﻤﺴﺎﻟﻚ‬
‫اﻟﺒﻮﻟﯿﺔ)‪(%‬‬
‫اﻟﺒﻮﻟﯿﺔ‬
‫)‪(%‬‬
‫‪1‬‬
‫‪0‬‬
‫) ‪(11.1‬‬
‫) ‪(0‬‬
‫‪2‬‬
‫‪3‬‬
‫) ‪(22.2‬‬
‫)‪(27.3‬‬
‫‪6‬‬
‫‪8‬‬
‫)‪( 66.7‬‬
‫)‪( 72.7‬‬
‫اﻟﺘﮭﺎﺑﺎت‬
‫‪11‬‬
‫) ‪(100‬‬
‫‪9‬‬
‫) ‪(100‬‬
‫إﺻﺎﺑﺎت اﻟﻘﺪم‬
‫اﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ ﺑﺪون‬
‫اﻟﻤﺴﺎﻟﻚ‬
‫اﻟﺒﻮﻟﯿﺔ)‪(%‬‬
‫اﻟﺒﻮﻟﯿﺔ)‪(%‬‬
‫اﻟﺘﮭﺎﺑﺎت‬
‫‪0‬‬
‫)‪( 0‬‬
‫‪3‬‬
‫) ‪(20‬‬
‫‪12‬‬
‫)‪(80‬‬
‫‪0‬‬
‫)‪( 0‬‬
‫‪1‬‬
‫) ‪(20‬‬
‫‪4‬‬
‫)‪( 80‬‬
‫‪15‬‬
‫) ‪(100‬‬
‫‪5‬‬
‫) ‪(100‬‬
‫اﻟﻤﺠﻤﻮع‬
‫)‪(%‬‬
‫اﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ‬
‫دون‬
‫اﻟﺒﻮﻟﯿﺔ‬
‫إﺻﺎﺑﺎت اﻟﻘﺪم وﻻ‬
‫ﺷﺒﻜﯿﺔ‬
‫اﻋﺘﻼل‬
‫اﻟﻌﯿﻦ)‪(%‬‬
‫‪3‬‬
‫) ‪(15‬‬
‫‪6‬‬
‫) ‪(30‬‬
‫‪11‬‬
‫(‪)55‬‬
‫‪4‬‬
‫) ‪(6.8‬‬
‫‪15‬‬
‫)‪( 25‬‬
‫‪41‬‬
‫)‪(68‬‬
‫‪20‬‬
‫) ‪(100‬‬
‫‪60‬‬
‫) ‪(100‬‬
‫ﻣﻦ ﺧﻼل ﺟﺪول )‪ (2‬ظﮭﺮأن اﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻹﻧﺎث ﻣﺮﺿﻰ اﻟﺴﻜﺮي اﻟﻤﺼﺎﺑﺎت‬
‫ﺑﺎﻋﺘﻼل ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ )‪ ( %63.6‬ﺗﻔﻮق ﻧﺴﺒﺔ اﻟﺬﻛﻮر)‪ ( %36.3‬وﻗﺪ اﺗﻀﺤﺖ ﻧﻔﺲ اﻟﻨﺘﺎﺋﺞ ﻓﻲ‬
‫ﺣﺎﻟﺔ إﺻﺎﺑﺎت اﻟﻘﺪم ﺣﯿﺚ ﻛﺎﻧﺖ اﻟﻨﺴﺒﺔ ﻋﻨﺪ اﻹﻧﺎث ) ‪ ( %73.3‬أﻋﻠﻰ ﻣﻤﺎ ﻓﻲ اﻟﺬﻛﻮر) ‪26.6‬‬
‫‪ ( %‬إﻻ أن ﻧﺴﺒﺔ اﻹﻧﺎث إﻟﻰ اﻟﺬﻛﻮر ﺗﻜﻮن اﻛﺒﺮ ﻓﻲ ﺣﺎﻟﺔ اﺻﺎﺑﺎت اﻟﻘﺪم ﻋﻨﮫ ﻋﻨﺪ اﻟﻤﺼﺎﺑﯿﻦ‬
‫ﺑﺘﻐﯿﺮات ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ) ‪ (4:7,4:11‬ﻋﻠﻰ اﻟﺘﻮاﻟﻲ‪.‬‬
‫‪16‬‬
‫ﻣﻘﺎرﻧﺔ اﻟﺒﻜﺘﯿﺮﯾﺎ اﻟﻤﻌﺰوﻟﮫ ﻣﻦ اﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻟﻤﺮﺿﻰ اﻟﺴﻜﺮي اﻟﻤﺼﺎﺑﯿﻦ ﺑﺎﻋﺘﻼل ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ واﻟﻤﺼﺎﺑﯿﻦ ﺑﺎﻟﺘﮭﺎب اﻟﻘﺪم‬
‫ﻧﮭﺎد‬
‫وﺑﯿﻦ اﻟﺠﺪول أﯾﻀﺎ" أن اﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﺑﺎﻟﻨﺴﺒﺔ ﻟﻠﻤﻌﺘﻠﯿﻦ ﺑﺸﺒﻜﯿﺔ اﻟﻌﯿﻦ ﺗﺰداد ﻟﺪى‬
‫ﻧﻮع اﻟﺴﻜﺮي)‪ ( %63.6) (II‬أﻋﻠﻰ ﻣﻦ اﻟﻨﻮع )‪ ( %36.3) (I‬وﺧﻼﻓﺎ" ﻓﻲ ﻣﺮﺿﻰ إﺻﺎﺑﺎت‬
‫اﻟﻘﺪم ﻧﺠﺪھﺎ ﻓﻲ اﻟﺴﻜﺮي اﻟﻨﻮع)‪ (%66.6) (I‬أﻋﻠﻰ ﻣﻦ اﻟﻨﻮع )‪ (%33.4) (II‬ﻣﻘﺎرﻧﺔ‬
‫ﺑﻤﺠﻤﻮﻋﺘﻲ اﻟﺴﯿﻄﺮة‪.‬‬
‫أن ﻣﺪة اﻻﺻﺎﺑﮫ ﺑﺎﻻﻟﺘﮭﺎب ﻟﺪى اﻟﻔﺌﮫ اﻟﻌﻤﺮﯾﮫ )‪ (10-5‬ﺳﻨﮫ ﻛﺎﻧﺖ ) ‪ (6,3,3‬أﻣﺎ ﻓﻲ اﻟﻔﺌﮫ اﻷﻛﺜﺮ‬
‫ﻣﻦ ‪ 11‬ﺳﻨﺔ ﻓﻘﺪ ﻛﺎﻧﺖ )‪ (12,10,7‬ﺑﺎﻟﻨﺴﺒﺔ ﻟﻤﺮﺿﻰ اﻟﺴﻜﺮي اﻟﻤﺼﺎﺑﯿﻦ ﺑﺎﻋﺘﻼل ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ‬
‫واﺻﺎﺑﺎت اﻟﻘﺪم وﻣﺠﻤﻮﻋﺔ اﻟﺴﯿﻄﺮة ﻋﻠﻰ اﻟﺘﻮاﻟﻲ‪.‬‬
‫ﺟﺪول‪ :2-‬ﻧﺴﺒﺔ اﻟﺘﮭﺎب اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻟﻤﺮﺿﻰ اﻟﺴﻜﺮي اﻟﻤﺼﺎﺑﯿﻦ ﺑﺎﻋﺘﻼل ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ و إﺻﺎﺑﺎت اﻟﻘﺪم‬
‫ﺣﺴﺐ اﻟﺠﻨﺲ و ﻧﻮع و ﻣﺪة اﻹﺻﺎﺑﺔ ﺑﺎﻟﺴﻜﺮي‬
‫ﻣﺪة اﻹﺻﺎﺑﺔ ﺑﺎﻟﺴﻜﺮي)ﺳﻨﺔ(‬
‫اﻟﺤﺎﻟﺔ اﻟﻤﺮﺿﯿﺔ‬
‫اﻟﺠﻨﺲ )‪(%‬‬
‫ذﻛﺮ‬
‫أﻧﺜﻰ‬
‫ﻧﻮع اﻟﺴﻜﺮي )‪(%‬‬
‫اﻟﻨﻮع اﻷول‬
‫)‪(I‬‬
‫اﻟﻨﻮع اﻟﺜﺎﻧﻲ‬
‫)‪(II‬‬
‫اﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ‬
‫واﻋﺘﻼل ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ‬
‫اﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ‬
‫وإﺻﺎﺑﺎت اﻟﻘﺪم‬
‫‪4‬‬
‫)‪(36.3‬‬
‫‪4‬‬
‫)‪(26.6‬‬
‫‪7‬‬
‫)‪(63.6‬‬
‫‪11‬‬
‫)‪(73.3‬‬
‫‪4‬‬
‫)‪(36.3‬‬
‫‪10‬‬
‫)‪(66.6‬‬
‫‪7‬‬
‫)‪(63.6‬‬
‫‪5‬‬
‫)‪(33.3‬‬
‫اﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ دون‬
‫إﺻﺎﺑﺎت اﻟﻘﺪم وﻻ اﻋﺘﻼل‬
‫ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ‬
‫اﻟﻤﺠﻤﻮع )‪(%‬‬
‫<‪5‬‬
‫‪1‬‬
‫‪10-5‬‬
‫‪3‬‬
‫>‪11‬‬
‫‪7‬‬
‫‪2‬‬
‫‪3‬‬
‫‪10‬‬
‫‪5‬‬
‫)‪(25‬‬
‫‪15‬‬
‫)‪(75‬‬
‫‪6‬‬
‫)‪(30‬‬
‫‪14‬‬
‫)‪(70‬‬
‫‪2‬‬
‫‪6‬‬
‫‪12‬‬
‫‪13‬‬
‫)‪(28.2‬‬
‫‪33‬‬
‫)‪(71.8‬‬
‫‪20‬‬
‫)‪(43.5‬‬
‫‪26‬‬
‫)‪(56.5‬‬
‫‪5‬‬
‫)‪(10.5‬‬
‫‪12‬‬
‫)‪(26.5‬‬
‫‪29‬‬
‫)‪(63‬‬
‫ﯾﻈﮭﺮ ﻣﻦ اﻟﺠﺪول )‪ (3‬أن ﺑﻜﺘﺮﯾﺎ اﻟـ ‪ Escherichia coli‬ﻗﺪ اﺣﺘﻠﺖ اﻟﻤﺮﺗﺒﺔ اﻷوﻟﻰ)‪ 3‬ﻋﺰﻻت‬
‫( اﻟﻤﺴﺒﺒﺔ ﻻﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻟﻤﺮﺿﻰ اﻟﺴﻜﺮي اﻟﻤﺼﺎﺑﯿﻦ ﺑﺎﻋﺘﻼل ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ اﻣﺎ‬
‫‪2) Proteus mirabilis, Staphylococcus aureus Klebsiella pneumoniae‬‬
‫ﻋﺰﻟﺔ ( ﻟﻜﻞ ﻣﻨﮭﺎ وﻋﺰﻟﺔ واﺣﺪة ﻟﻜﻞ ﻣﻦ ‪Streptococcus ، Pseudomonas aeruginosa,‬‬
‫‪.agalactiae‬‬
‫ﻛﺬﻟﻚ ظﮭﺮ ﻣﻦ ﺧﻼل ھﺬه اﻟﺪراﺳﺔ أن أﻛﺜﺮ اﻷﻧﻮاع اﻟﺒﻜﺘﯿﺮﯾﺔ ﻗﺪ ﺗﻢ ﻋﺰﻟﮭﺎ ﻣﻦ ﻣﺮﺿﻰ‬
‫اﻟﺴﻜﺮي اﻟﻨﻮع )‪ 7 ) (II‬ﻋﺰﻻت ( ﻣﻘﺎرﻧﺔ ﺑﺎﻟﻨﻮع )‪ 4 ) (I‬ﻋﺰﻻت(وأﯾﻀﺎ" ﺑﯿﻨﺖ اﻟﺪراﺳﺔ‬
‫وﺟﻮد ﻓﺮق ﻣﻌﻨﻮي ﻛﺒﯿﺮ ﺑﯿﻦ ﻧﺴﺒﺔ اﻹﺻﺎﺑﺎت اﻟﺒﻜﺘﯿﺮﯾﺔ ﻓﻲ اﻹﻧﺎث )‪(%63.6‬ﻋﻤﺎ ھﻮ ﻓﻲ‬
‫اﻟﺬﻛﻮر)‪, (%36.4‬أﻣﺎ ﺑﺎﻟﻨﺴﺒﺔ ﻟﻸﻋﻤﺎر ﻓﺎن اﻟﻔﺌﺔ اﻟﻌﻤﺮﯾﺔ اﻟﺜﺎﻟﺜﺔ )‪ ،(≥41‬ﻛﺎﻧﺖ اﻷﻛﺜﺮ إﺻﺎﺑﺔ‬
‫ﺑﺎﻟﺒﻜﺘﺮﯾﺎ) ‪ 8‬ﻋﺰﻻت ( ﻣﻘﺎرﻧﺔ ﺑﺎﻟﻔﺌﺔ اﻟﻌﻤﺮﯾﺔ اﻷوﻟﻰ و اﻟﺜﺎﻧﯿﺔ )‪ (3,0‬ﻋﺰﻟﺔ ﻋﻠﻰ اﻟﺘﻮاﻟﻲ ‪.‬‬
‫‪17‬‬
‫اﻟﻤﺠﻠﺪ ‪ ،20‬اﻟﻌﺪد ‪2009 ،3‬‬
‫ﻣﺠﻠﺔ ﻋﻠﻮم اﻟﻤﺴﺘﻨﺼﺮﯾﺔ‬
‫ﺟﺪول ‪ : 3-‬اﻷﻧﻮاع اﻟﺒﻜﺘﯿﺮﯾﺔ اﻟﻤﺴﺒﺒﺔ ﻻﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻟﻤﺮﺿﻰ اﻟﺴﻜﺮي اﻟﻤﺼﺎﺑﯿﻦ ﺑﺎﻋﺘﻼل ﺷﺒﻜﯿﺔ‬
‫اﻟﻌﯿﻦ ﺣﺴﺐ اﻟﻌﻤﺮ واﻟﺠﻨﺲ و ﻧﻮع اﻟﺴﻜﺮي‬
‫اﺳﻢ اﻟﺒﻜﺘﺮﯾﺎ اﻟﻤﺴﺒﺒﺔ‬
‫ﻋﺪد‬
‫اﻟﻌﺰﻻت‬
‫ﻧﻮع اﻟﺴﻜﺮي )‪(%‬‬
‫اﻟﻨﻮع اﻷول اﻟﻨﻮع اﻟﺜﺎﻧﻲ‬
‫)‪(II‬‬
‫)‪(I‬‬
‫اﻟﻌﻤﺮ)ﺳﻨﺔ(‬
‫اﻟﺠﻨﺲ‬
‫ذﻛﺮ‬
‫أﻧﺜﻰ‬
‫≥ ‪20‬‬
‫‪40-21‬‬
‫‪≥ 41‬‬
‫‪0‬‬
‫‪3‬‬
‫‪0‬‬
‫‪1‬‬
‫‪2‬‬
‫‪0‬‬
‫‪2‬‬
‫‪0‬‬
‫‪0‬‬
‫‪2‬‬
‫‪0‬‬
‫‪0‬‬
‫‪1‬‬
‫‪1‬‬
‫‪0‬‬
‫‪0‬‬
‫‪2‬‬
‫‪0‬‬
‫‪1‬‬
‫‪0‬‬
‫‪8‬‬
‫) ‪72.8‬‬
‫(‬
‫‪Escherichia coli‬‬
‫‪3‬‬
‫‪Staphylococcus‬‬
‫‪aureus‬‬
‫‪2‬‬
‫‪1‬‬
‫)‪(33.4‬‬
‫‪1‬‬
‫)‪(50‬‬
‫‪2‬‬
‫)‪(66.6‬‬
‫‪1‬‬
‫)‪(50‬‬
‫‪Klebsiella‬‬
‫‪pneumoniae‬‬
‫‪2‬‬
‫‪0‬‬
‫)‪( 0‬‬
‫‪2‬‬
‫)‪(100‬‬
‫‪2‬‬
‫‪Proteus mirabilis‬‬
‫‪2‬‬
‫‪Pseudomonas‬‬
‫‪aeruginosa‬‬
‫‪Streptococcus‬‬
‫‪agalactiae‬‬
‫اﻟﻤﺠﻤﻮع )‪(%‬‬
‫‪1‬‬
‫‪0‬‬
‫)‪( 0‬‬
‫‪1‬‬
‫)‪(100‬‬
‫‪1‬‬
‫)‪(100‬‬
‫‪4‬‬
‫)‪(36.4‬‬
‫‪2‬‬
‫)‪(100‬‬
‫‪0‬‬
‫)‪( 0‬‬
‫‪0‬‬
‫)‪( 0‬‬
‫‪7‬‬
‫)‪(63.6‬‬
‫‪2‬‬
‫‪0‬‬
‫‪0‬‬
‫‪1‬‬
‫‪0‬‬
‫‪0‬‬
‫‪1‬‬
‫‪0‬‬
‫‪1‬‬
‫‪4‬‬
‫) ‪( 36.4‬‬
‫‪7‬‬
‫)‪(63.6‬‬
‫‪0‬‬
‫)‪( 0‬‬
‫‪3‬‬
‫) ‪( 27.2‬‬
‫‪1‬‬
‫‪11‬‬
‫)‪(100‬‬
‫ﻧﻼﺣﻆ ﻓﻲ اﻟﺠﺪول)‪ (4‬أن اﻏﻠﺐ اﻟﺒﻜﺘﺮﯾﺎ اﻟﻤﺴﺒﺒﺔ اﻻﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻟﻤﺼﺎﺑﻲ اﻟﻘﺪم ھﻲ‬
‫‪ 6) Pseudomonas aeruginosa‬ﻋﺰﻻت(‪ ،‬ﺗﻠﯿﮭﺎ ﺑﺎﻟﻤﺮﺗﺒﺔ اﻟﺜﺎﻧﯿﺔ اﻟـ ‪Klebsiella spp.‬‬
‫)‪ 4‬ﻋﺰﻻت( و )‪ 3‬ﻋﺰﻻت( ﻟﺒﻜﺘﺮﯾﺎ اﻟـ ‪ Staphylococcus epidermedis‬ﻓﻲ ﺣﯿﻦ ﻋﺰﻟﺔ‬
‫واﺣﺪة ﻟﻜﻞ ﻣﻦ‪ Streptococcus faecalis‬و‪ ، Escherichia coli‬أن اﻏﻠﺐ اﻟﻌﺰﻻت‬
‫اﻟﺒﻜﺘﯿﺮﯾﺔ ﻗﺪ ﺗﻢ ﻋﺰﻟﮭﺎ ﻣﻦ ﻣﺮﺿﻰ إﺻﺎﺑﺎت اﻟﻘﺪم اﻟﻨﻮع )‪ (I‬أﻋﻠﻰ ﻣﻦ اﻟﻨﻮع ) ‪ (II‬وﺑﻨﺴﺒﺔ )‬
‫‪ % ( 33.3 ،66.7‬ﻋﻠﻰ اﻟﺘﻮاﻟﻲ‪.‬‬
‫ﻛﺎﻧﺖ إﺻﺎﺑﺎت اﻹﻧﺎث أﻋﻠﻰ ﻣﻨﮭﺎ ﻓﻲ اﻟﺬﻛﻮر وذﻟﻚ ﻋﻨﺪﻣﺎ ﺑﻠﻐﺖ ﻋﺰﻻت اﻹﻧﺎث )‪( 11‬ﻋﺰﻟﺔ‬
‫وﺑﻨﺴﺒﺔ ‪ % 73.4‬ﻣﻘﺎرﻧﺔ ﺑﺎﻟﺬﻛﻮر ) ‪( 4‬ﻋﺰﻟﺔ وﺑﻨﺴﺒﺔ ‪. % 26.6‬أﻣﺎ ﺑﺎﻟﻨﺴﺒﺔ ﻟﻠﻌﻤﺮ ﻓﻘﺪ ظﮭﺮت‬
‫اﻹﺻﺎﺑﺎت اﻷﻛﺜﺮ ﺗﻮاﺟﺪا" ﻓﻲ اﻟﻔﺌﺔ اﻟﻌﻤﺮﯾﺔ اﻟﺜﺎﻟﺜﺔ )‪ (≥ 41‬وﺑﻨﺴﺒﺔ )‪ (% 80‬ﺑﯿﻨﻤﺎ ﺗﻘﻞ ﻓﻲ اﻟﻔﺌﺔ‬
‫اﻟﻌﻤﺮﯾﺔ اﻟﺜﺎﻧﯿﺔ )‪ (% 20 ) (40-21‬وﺗﺼﻞ إﻟﻰ )‪ (0‬ﻟﺪى اﻟﻔﺌﺔ اﻟﻌﻤﺮﯾﺔ اﻷوﻟﻰ‪.‬‬
‫‪18‬‬
‫ﻣﻘﺎرﻧﺔ اﻟﺒﻜﺘﯿﺮﯾﺎ اﻟﻤﻌﺰوﻟﮫ ﻣﻦ اﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻟﻤﺮﺿﻰ اﻟﺴﻜﺮي اﻟﻤﺼﺎﺑﯿﻦ ﺑﺎﻋﺘﻼل ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ واﻟﻤﺼﺎﺑﯿﻦ ﺑﺎﻟﺘﮭﺎب اﻟﻘﺪم‬
‫ﻧﮭﺎد‬
‫ﺟﺪول‪ :4 -‬اﻷﻧﻮاع اﻟﺒﻜﺘﯿﺮﯾﺔ اﻟﻤﺴﺒﺒﺔ ﻻﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻟﻤﺮﺿﻰ اﻟﺴﻜﺮي اﻟﻤﺼﺎﺑﯿﻦ ﺑﺎﻟﻘﺪم ﺣﺴﺐ اﻟﻌﻤﺮ‬
‫واﻟﺠﻨﺲ و ﻧﻮع اﻟﺴﻜﺮي‬
‫ﻧﻮع اﻟﺴﻜﺮي )‪(%‬‬
‫اﺳﻢ اﻟﺒﻜﺘﺮﯾﺎ اﻟﻤﺴﺒﺒﺔ‬
‫ﻋﺪد‬
‫اﻟﻌﺰﻻت‬
‫‪Pseudomonas‬‬
‫‪aeruginosa‬‬
‫‪6‬‬
‫) ‪(40‬‬
‫‪Klebsiella spp.‬‬
‫‪Staphylococcus‬‬
‫‪epidermedis‬‬
‫‪Streptococcus‬‬
‫‪faecalis‬‬
‫‪Escherichia coli‬‬
‫اﻟﻤﺠﻤﻮع )‪(%‬‬
‫اﻟﺠﻨﺲ‬
‫اﻟﻌﻤﺮ)ﺳﻨﺔ(‬
‫اﻟﻨﻮع‬
‫اﻷول‬
‫)‪(I‬‬
‫اﻟﻨﻮع‬
‫اﻟﺜﺎﻧﻲ‬
‫)‪(II‬‬
‫‪4‬‬
‫)‪( 66.6‬‬
‫‪2‬‬
‫)‪( 33.3‬‬
‫‪2‬‬
‫‪4‬‬
‫)‪( 26‬‬
‫‪3‬‬
‫)‪( 20‬‬
‫‪2‬‬
‫)‪( 50‬‬
‫‪3‬‬
‫)‪( 100‬‬
‫‪2‬‬
‫)‪( 50‬‬
‫‪0‬‬
‫)‪( 0‬‬
‫‪1‬‬
‫‪1‬‬
‫)‪( 7‬‬
‫‪1‬‬
‫)‪( 100‬‬
‫‪0‬‬
‫)‪( 0‬‬
‫‪1‬‬
‫)‪( 7‬‬
‫‪15‬‬
‫)‪( 100‬‬
‫‪0‬‬
‫)‪( 0‬‬
‫‪10‬‬
‫) ‪( 66.7‬‬
‫‪1‬‬
‫)‪( 100‬‬
‫‪5‬‬
‫) ‪( 33.3‬‬
‫ذﻛﺮ‬
‫أﻧﺜﻰ‬
‫‪4‬‬
‫≥ ‪20‬‬
‫‪40-21‬‬
‫‪≥41‬‬
‫‪0‬‬
‫‪1‬‬
‫‪5‬‬
‫‪3‬‬
‫‪0‬‬
‫‪1‬‬
‫‪3‬‬
‫‪0‬‬
‫‪3‬‬
‫‪0‬‬
‫‪1‬‬
‫‪2‬‬
‫‪1‬‬
‫‪0‬‬
‫‪0‬‬
‫‪0‬‬
‫‪1‬‬
‫‪0‬‬
‫‪1‬‬
‫‪0‬‬
‫‪0‬‬
‫‪1‬‬
‫‪4‬‬
‫)‪(26.6‬‬
‫‪11‬‬
‫)‪(73.4‬‬
‫‪0‬‬
‫) ‪(0‬‬
‫‪3‬‬
‫)‪( 20‬‬
‫‪12‬‬
‫)‪( 80‬‬
‫ﻧﻼﺣﻆ ﻓﻲ ﺟﺪول )‪ (5‬اﻟﺬي ﯾﻤﺜﻞ ﻣﺠﻤﻮﻋﺔ اﻟﺴﯿﻄﺮة أن ﺑﻜﺘﺮﯾﺎ اﻟـ ‪Klebsiella pneumoniae‬‬
‫ﻛﺎﻧﺖ اﻻوﻟﻰ ﻣﻦ ﺣﯿﺚ ﺗﺴﺒﺒﮭﺎ ﺑﺎﻻﺻﺎﺑﺔ ) ‪ (6‬ﻋﺰﻻت ﻓﻲ ﺣﯿﻦ ﺗﻠﯿﮭﺎ ‪) Escherichia coli‬‬
‫‪ (5‬ﻋﺰﻻت اﻣﺎ ﺑﻜﺘﺮﯾﺎ اﻟـ ‪، Staphylococcus aureus, Streptococcus agalactae‬‬
‫‪ Pseudomonas aeruginosa‬ﻓﻘﺪ ﻛﺎن ﻧﺼﯿﺐ ﻛﻞ ﻣﻨﮭﺎ )‪ ( 2,3,4‬ﻋﺰﻟﺔ ﻋﻠﻰ اﻟﺘﻮاﻟﻲ ‪.‬‬
‫وﯾﺘﺒﯿﻦ ﻣﻦ ﺟﺪول ﻣﺠﻤﻮﻋﺔ اﻟﺴﯿﻄﺮة ان اﻏﻠﺐ اﻻﺻﺎﺑﺎت ﻛﺎﻧﺖ ﻓﻲ ﻣﺮﺿﻰ اﻟﺴﻜﺮي ﻧﻮع )‪(II‬‬
‫) ‪ 14‬ﻋﺰﻟﺔ ( ﻣﻘﺎرﻧﺔ ﺑﺎﻟﻨﻮع )‪ 6 ) (I‬ﻋﺰﻟﺔ( اﻣﺎ ﺑﺎﻟﻨﺴﺒﺔ ﻟﻠﺠﻨﺲ ﻓﺎن اﻟﻌﺰﻻت ﻟﺒﻜﺘﯿﺮﯾﺔ ﺑﺎﻟﻨﺴﺒﺔ‬
‫ﻟﻺﻧﺎث ﻛﺎﻧﺖ )‪ (15‬ﻋﺰﻟﺔ اﻋﻠﻰ ﻣﻤﺎ ھﻲ ﻓﻲ اﻟﺬﻛﻮر)‪ (5‬ﻋﺰﻟﺔ وﺗﺰداد ﺣﺎﻟﺔ اﻻﺻﺎﺑﺔ ﺑﺎﻟﺘﮭﺎب‬
‫اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻛﻠﻤﺎ ﺗﻘﺪم اﻟﻤﺮﯾﺾ ﺑﺎﻟﻌﻤﺮ ﻓﻘﺪ ﻛﺎﻧﺖ )‪ 11‬ﻋﺰﻟﺔ( ﺑﺎﻟﻨﺴﺒﺔ ﻟﻠﻔﺌﺔ اﻟﻌﻤﺮﯾﺔ اﻟﺜﺎﻟﺜﺔ ) ≥‬
‫‪ 3,6) ،(41‬ﻋﺰﻻت ( ﺑﺎﻟﻨﺴﺒﺔ ﻟﻠﻔﺌﺘﯿﻦ اﻟﻌﻤﺮﯾﺔ اﻟﺜﺎﻧﯿﺔ واﻷوﻟﻰ ﻋﻠﻰ اﻟﺘﻮاﻟﻲ ‪.‬‬
‫ﺟﺪول‪ : 5-‬اﻷﻧﻮاع اﻟﺒﻜﺘﯿﺮﯾﺔ اﻟﻤﺴﺒﺒﺔ ﻻﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻟﻤﺮﺿﻰ اﻟﺴﻜﺮي ﻏﯿﺮ اﻟﻤﺼﺎﺑﯿﻦ ﺑﺎﻋﺘﻼل ﺷﺒﻜﯿﺔ‬
‫اﻟﻌﯿﻦ وﻻ اﺻﺎﺑﺎت اﻟﻘﺪم ) ﻣﺠﻤﻮﻋﺔ اﻟﺴﯿﻄﺮة(‬
‫اﺳﻢ اﻟﺒﻜﺘﺮﯾﺔ اﻟﻤﺴﺒﺒﺔ‬
‫ﻋﺪد‬
‫اﻟﻌﺰﻻت‬
‫ﻧﻮع اﻟﺴﻜﺮي )‪(%‬‬
‫اﻟﻨﻮع اﻷول اﻟﻨﻮع اﻟﺜﺎﻧﻲ‬
‫)‪(II‬‬
‫)‪(I‬‬
‫اﻟﻌﻤﺮ)ﺳﻨﺔ(‬
‫اﻟﺠﻨﺲ‬
‫ذﻛﺮ‬
‫أﻧﺜﻰ‬
‫‪Klebsiella‬‬
‫‪pneumoniae‬‬
‫‪6‬‬
‫) ‪(30‬‬
‫‪1‬‬
‫)‪( 17‬‬
‫‪5‬‬
‫)‪( 83‬‬
‫‪1‬‬
‫‪5‬‬
‫≥ ‪20‬‬
‫‪1‬‬
‫‪40-21‬‬
‫‪1‬‬
‫‪≥ 41‬‬
‫‪4‬‬
‫‪Escherichia‬‬
‫‪coli‬‬
‫‪Streptococcus‬‬
‫‪agalactiae‬‬
‫‪Staphylococcus‬‬
‫‪aureus‬‬
‫‪Pseudomonas‬‬
‫‪aeruginosea‬‬
‫اﻟﻤﺠﻤﻮع )‪(%‬‬
‫‪5‬‬
‫)‪(25‬‬
‫‪4‬‬
‫)‪( 20‬‬
‫‪3‬‬
‫)‪( 15‬‬
‫‪2‬‬
‫)‪( 10‬‬
‫‪20‬‬
‫)‪(100‬‬
‫‪3‬‬
‫)‪( 60‬‬
‫‪1‬‬
‫)‪( 25‬‬
‫‪1‬‬
‫)‪( 33‬‬
‫‪0‬‬
‫)‪( 0‬‬
‫‪6‬‬
‫)‪(30‬‬
‫‪2‬‬
‫)‪( 40‬‬
‫‪3‬‬
‫)‪( 75‬‬
‫‪2‬‬
‫)‪( 67‬‬
‫‪2‬‬
‫)‪( 100‬‬
‫‪14‬‬
‫)‪(70‬‬
‫‪2‬‬
‫‪3‬‬
‫‪2‬‬
‫‪2‬‬
‫‪1‬‬
‫‪1‬‬
‫‪3‬‬
‫‪0‬‬
‫‪3‬‬
‫‪1‬‬
‫‪1‬‬
‫‪2‬‬
‫‪0‬‬
‫‪0‬‬
‫‪3‬‬
‫‪0‬‬
‫‪2‬‬
‫‪0‬‬
‫‪0‬‬
‫‪2‬‬
‫‪5‬‬
‫‪15‬‬
‫‪3‬‬
‫‪6‬‬
‫‪11‬‬
‫‪19‬‬
‫اﻟﻤﺠﻠﺪ ‪ ،20‬اﻟﻌﺪد ‪2009 ،3‬‬
‫ﻣﺠﻠﺔ ﻋﻠﻮم اﻟﻤﺴﺘﻨﺼﺮﯾﺔ‬
‫اظﮭﺮت ﻧﺘﺎﺋﺞ اﻟﺒﺤﺚ وﻛﻤﺎ ﻓﻲ اﻟﺠﺪول )‪ (1‬أن اﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻟﻤﺮﺿﻰ اﻟﺴﻜﺮي‬
‫اﻟﻤﺼﺎﺑﯿﻦ ﺑﺎﻋﺘﻼل ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ واﺻﺎﺑﺎت اﻟﻘﺪم وﺣﺴﺐ اﻟﻔﺌﺎت اﻟﻌﻤﺮﯾﺔ اﻟﺜﻼث ﻛﺎﻧﺖ اﻻﻋﻠﻰ‬
‫ﻟﺪى اﻟﻔﺌﺔ اﻟﻌﻤﺮﯾﺔ اﻟﺜﺎﻟﺜﺔ)‪ ،(≥ 41‬وھﺬا ﯾﻔﺴﺮ ﻧﺘﯿﺠﺔ ﻟﻠﺘﻐﯿﺮات اﻟﮭﺮﻣﻮﻧﯿﺔ ﻻﺳﯿﻤﺎ ﺑﻌﺪ اﻟﺰواج‬
‫ﺑﺎﻟﻨﺴﺒﺔ ﻟﻠﻨﺴﺎء وأﯾﻀﺎ"ﻓﺎن اﻟﻌﻼﻗﺔ اﻟﺰوﺟﯿﺔ ﺗﺰﯾﺪ ﻣﻦ اﻻﺳﺘﻌﺪاد ﻟﻺﺻﺎﺑﺔ ﺑﺎﻻﻟﺘﮭﺎب واﻟﻌﺪوى أﻣﺎ‬
‫اﻟﺮﺟﺎل ﻓﻤﺸﺎﻛﻞ اﻟﺒﺮوﺳﺘﺎت ﻓﻲ ھﺬا اﻟﺴﻦ ﻣﻦ اﻟﻌﻮاﻣﻞ اﻟﻤﺸﺠﻌﺔ ﻟﻼﻟﺘﮭﺎب وﺗﺒﻘﻰ ﺿﻌﻒ اﻟﺤﺎﻟﺔ‬
‫اﻟﻤﻨﺎﻋﯿﺔ اﻷوﻟﻰ ﻓﻲ ﺣﺪوﺛﮫ‪ ،‬وھﺬا ﯾﺘﻔﻖ ﻣﻊ]‪.[14,8,5‬اﺿﺎﻓﺔ ﻟﺬﻟﻚ ﻋﺪم اﻟﺴﯿﻄﺮة ﻋﻠﻰ ﻣﺴﺘﻮى‬
‫اﻟﺴﻜﺮ ﺑﺎﻟﺪم وھﺬا ﯾﺘﻔﻖ ﻣﻊ ﻣﺎﺟﺎء ﺑﮫ اﻻﺧﺮون ]‪.[16‬‬
‫ان ارﺗﻔﺎع ﺣﺎﻻت اﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻟﻤﺮﺿﻰ اﻟﺴﻜﺮي ﻛﻠﻤﺎ ﺗﻘﺪم اﻟﻤﺮﯾﺾ ﺑﺎﻟﻌﻤﺮ ‪ ،‬ﯾﺆﻛﺪ‬
‫اﻟﺪور اﻟﺬي ﯾﻠﻌﺒﮫ ﻋﺎﻣﻞ اﻟﻌﻤﺮﻓﻲ ﺣﺪوث اﻻﻟﺘﮭﺎﺑﺎت ﻟﻠﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ]‪.[17‬‬
‫ھﺬا وان زﯾﺎدة ﻧﺴﺒﺔ اﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻟﻤﺮﺿﻰ اﻟﺴﻜﺮي اﻟﺬﯾﻦ ﯾﻌﺎﻧﻮن ﻣﻦ اﻋﺘﻼل‬
‫ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ وإﺻﺎﺑﺎت ﻓﻲ اﻟﻘﺪم ﻟﺪى اﻷﻋﻤﺎر )‪ (≥ 41‬ھﻮ ﻟﻮﺟﻮد ﺿﻌﻒ ﻓﻲ اﻟﺠﮭﺎز اﻟﻤﻨﺎﻋﻲ‬
‫ﻟﻠﻤﺮﯾﺾ ]‪.[16‬‬
‫وﻗﺪ ﺗﺒﯿﻦ ﻣﻦ ﺧﻼل ﺟﺪول )‪ (2‬أن اﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻹﻧﺎث ﻣﺮﺿﻰ اﻟﺴﻜﺮي اﻟﻤﺼﺎﺑﯿﻦ‬
‫ﺑﺎﻋﺘﻼل ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ و إﺻﺎﺑﺎت اﻟﻘﺪم ﻗﺪ ﻓﺎﻗﺖ ﻧﺴﺒﺔ اﻟﺬﻛﻮر ﻏﯿﺮ ان ﻧﺴﺒﺔ اﻹﻧﺎث إﻟﻰ اﻟﺬﻛﻮر‬
‫ﻛﺎﻧﺖ اﻋﻠﻰ ﻓﻲ ﺣﺎﻟﺔ اﻟﻤﺼﺎﺑﯿﻦ ﻓﻲ اﻟﻘﺪم ﻋﻨﮫ ﻋﻦ اﻟﻤﺮﺿﻰ اﻟﺬﯾﻦ ﻟﺪﯾﮭﻢ اﻋﺘﻼل ﻓﻲ ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ‪.‬‬
‫وھﺬا ﯾﻔﺴﺮ ﻟﻌﺪة أﺳﺒﺎب ﻣﻨﮭﺎ ﻗﺼﺮ اﻻﺣﻠﯿﻞ واﻟﺘﻐﯿﺮات اﻟﮭﺮﻣﻮﻧﯿﺔ ﻻﺳﯿﻤﺎ ﺑﻌﺪ ﺳﻦ اﻟﯿﺄس ﺑﺎﻟﻨﺴﺒﺔ‬
‫ﻟﻠﻨﺴﺎء وأﯾﻀﺎ"ﻟﻮﺟﻮد اﻻﺧﺘﻼﻓﺎت اﻟﺘﺸﺮﯾﺤﯿﺔ ﺑﯿﻦ اﻷﻧﺜﻰ واﻟﺬﻛﺮ]‪ ، [15‬ﻛﻠﮭﺎ ﻋﻮاﻣﻞ ﺗﺴﺎﻋﺪ ﻋﻠﻰ‬
‫ﺣﺪوث اﻻﻟﺘﮭﺎﺑﺎت ‪ ،‬وﻣﻊ ھﺬه اﻟﻨﺘﺎﺋﺞ ﯾﺘﻔﻖ ﻛﻞ ﻣﻦ]‪ , [19,18,14‬ﻛﺬﻟﻚ ﺑﯿﻨﺖ اﺣﺪ اﻟﺪراﺳﺎت أن‬
‫اﺣﺘﻤﺎﻟﯿﺔ إﺻﺎﺑﺔ ﻧﺴﺎء اﻟﺴﻜﺮي ﺑﺎﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ أﻛﺜﺮ ﻣﻦ اﻟﻨﺴﺎء ﻏﯿﺮ اﻟﻤﺼﺎﺑﺎت‬
‫ﺑﺎﻟﺴﻜﺮي ]‪. [20‬‬
‫واظﮭﺮت ﻧﺘﺎﺋﺞ اﻟﺠﺪول أﯾﻀﺎ" أن اﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﺑﺎﻟﻨﺴﺒﺔ ﻟﻠﻤﻌﺘﻠﯿﻦ ﺑﺸﺒﻜﯿﺔ اﻟﻌﯿﻦ‬
‫ﻛﺎﻧﺖ ﻓﻲ ﻧﻮع اﻟﺴﻜﺮي)‪ (II‬ﺗﻔﻮق اﻟﺴﻜﺮي ﻧﻮع )‪ (I‬وﻋﻜﺲ ھﺬة اﻟﺤﺎﻟﺔ ﻧﺠﺪھﺎ ﻓﻲ اﺻﺎﺑﺎت اﻟﻘﺪم‬
‫ﺣﯿﺚ ﻓﻲ اﻟﺴﻜﺮي اﻟﻨﻮع)‪ (I‬أﻋﻠﻰ ﻣﻦ اﻟﻨﻮع )‪ (II‬ﻣﻘﺎرﻧﺔ ﺑﻤﺠﻤﻮﻋﺔ اﻟﺴﯿﻄﺮة ﺣﯿﺚ اﻻﺻﺎﺑﺔ ﻓﻲ‬
‫ﻧﻮع اﻟﺴﻜﺮي اﻟﻨﻮع)‪ (II‬أﻋﻠﻰ ﻣﻨﮭﺎ ﻓﻲ اﻟﻨﻮع )‪،(I‬ان داء اﻟﺴﻜﺮي اﻟﻨﻮع)‪ (II‬ﯾﺼﯿﺐ اﻟﻤﺮاﺣﻞ‬
‫اﻟﻤﺘﻘﺪﻣﺔ ﻣﻦ اﻟﻌﻤﺮ ﻓﺎﻧﺔ ﯾﻤﺜﻞ ﺧﻠﻞ ﻓﻲ اﻓﺮاز اﻻﻧﺴﻮﻟﯿﻦ وان ﻛﻤﯿﺔ اﻟﺴﻜﺮ ﻓﻲ اﻟﺪم واﻻدرار‬
‫ﻻﺗﻜﻮن ﻋﺎﻟﯿﺔ ﻣﻘﺎرﻧﺔ ﺑﺎﻟﻨﻮع )‪ (I‬وﺑﺬﻟﻚ ﺗﻜﻮن اﻟﻔﺮﺻﺔ اﻛﺒﺮ ﻟﻠﺒﻜﺘﺮﯾﺎ ﻛﻲ ﺗﻨﻤﻮ ﻓﻲ ادرار‬
‫اﻟﻤﺠﻤﻮﻋﺔ اﻟﺴﻜﺮي اﻟﻨﻮع )‪ (I‬وﻗﺪ ﺗﺤﺪث ﻋﻜﺲ ھﺬة اﻟﻨﺘﺎﺋﺞ وﯾﺮﺟﻊ اﻟﺴﺒﺐ ﻓﻲ ھﺬا ھﻮ ﻋﺪم‬
‫اﻧﺘﻈﺎم ﻣﺴﺘﻮى اﻟﺴﻜﺮ ﺑﺎﻟﺪم ﺣﯿﺚ ارﺗﻔﺎﻋﮫ ﯾﺆدي اﻟﻰ زﯾﺎدة اﺣﺘﻤﺎﻟﯿﺔ اﻻﺻﺎﺑﺔ‪.‬‬
‫وﺑﺰﯾﺎدة ﻣﺪة اﻹﺻﺎﺑﺔ ﺑﺎﻟﺴﻜﺮي ﺗﺰداد ﺣﺎﻻت اﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻟﺪى اﻟﻤﺼﺎﺑﯿﻦ وﻏﯿﺮ‬
‫اﻟﻤﺼﺎﺑﯿﻦ ﺑﺎﻋﺘﻼل اﻟﺸﺒﻜﯿﺔ و إﺻﺎﺑﺎت اﻟﻘﺪم‪ ،‬وھﺬا ﯾﺘﻔﻖ ﻣﻊ ﻣﺎ ﺟﺎء ﺑﮫ ]‪، [21‬اﻣﺎ ]‪ [10‬ﻓﻘﺪ ﺑﯿﻦ‬
‫إﻟﻰ زﯾﺎدة اﺣﺘﻤﺎﻟﯿﺔ اﻹﺻﺎﺑﺔ ﺑﺎﻟﺘﮭﺎب اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﺑﺰﯾﺎدة ﻣﺪة اﻹﺻﺎﺑﺔ ﺑﻤﺮض اﻟﺴﻜﺮي‪ ،‬وﻗﺪ‬
‫أوﺿﺢ ﺑﻌﺾ اﻟﺒﺎﺣﺜﯿﻦ أن ﻟﺘﺸﺨﯿﺺ ﺗﻄﻮر اﻋﺘﻼل اﻟﺸﺒﻜﯿﺔ ﻟﻤﺮﺿﻰ اﻟﺴﻜﺮي ﯾﺤﺘﺎج ﻟﻔﺘﺮة ‪8‬‬
‫ﺳﻨﻮات ﻋﻠﻰ اﻷﻗﻞ‪ ،‬ﺣﯿﺚ ﺗﻮﺟﺪ ﻋﻼﻗﺔ ﺑﯿﻦ اﻋﺘﻼل ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ وﻓﺘﺮة اﻹﺻﺎﺑﺔ ﺑﺎﻟﺴﻜﺮي‬
‫]‪.[25,22‬‬
‫أن ﺑﻜﺘﺮﯾﺎ اﻟـ ‪ Escherichia coli‬ﻗﺪ ﺗﺼﺪرت اﻟﻤﺮﺗﺒﺔ اﻷوﻟﻰ ﻓﻲ ﺗﺴﺒﺒﮭﺎ ﻻﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ‬
‫اﻟﺒﻮﻟﯿﺔ ﻟﻤﺮﺿﻰ اﻟﺴﻜﺮي اﻟﻤﺼﺎﺑﯿﻦ ﺑﺎﻋﺘﻼل ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ ‪،‬اﻟﺠﺪول رﻗﻢ )‪.(3‬وﻗﺪ اﺷﺎر]‪ [23‬ﻓﻲ‬
‫دراﺳﺘﺔ اﻟﻰ ان اﻟـ ‪ Escherichia coli‬ﺗﺸﻜﻞ اﻟﺒﻜﺘﺮﯾﺎ اﻟﺮﺋﯿﺴﺔ واﻻﻛﺜﺮﻋﺰﻻت ﺑﯿﻦ اﻷﺟﻨﺎس‬
‫اﻷﺧﺮى ﻓﻘﺪ ﺑﻠﻐﺖ ﻧﺴﺒﺔ ﻋﺰﻟﮭﺎ ‪%68‬ﻓﯿﻤﺎ ﻛﺎﻧﺖ ﻧﺴﺒﺔ ﻋﺰل ‪(%4)Klebsiella pneumoniae‬‬
‫و‪.[23] (%6) Proteus mirabilis‬‬
‫إن اﻟـ ‪ Escherichia coli‬ﺗﻌﺪ ﻣﻦ اﻟﻤﻤﺮﺿﺎت اﻟﺮﺋﯿﺴﯿﺔ ﻓﻲ إﺻﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻛﻮﻧﮭﺎ‬
‫ﻧﺒﯿﺖ ﺟﺮﺛﻮﻣﻲ طﺒﯿﻌﻲ )‪ ( Normal flora‬ﻓﻲ اﻷﻣﻌﺎء أﻻ أن وﺟﻮدھﺎ ﻓﻲ اﻟﻤﺠﺮى اﻟﺒﻮﻟﻲ‬
‫ﯾﺆدي إﻟﻰ ﺣﺪوث ﺧﻤﺞ ‪،‬ذﻟﻚ ﺑﺴﺒﺐ اﻣﺘﻼﻛﮭﺎ ﻟﻌﻮاﻣﻞ اﻟﻀﺮاوة ﻛﺎﻷھﺪاب )‪ (pilli‬واﻟﺘﻲ ﺗﺴﮭﻞ‬
‫اﻟﺘﺼﺎﻗﮭﺎ ﺑﺎﻟﺨﻼﯾﺎ اﻟﻈﮭﺎرﯾﺔ اﻟﻤﺒﻄﻨﺔ ﻟﻠﺠﮭﺎز اﻟﺒﻮﻟﻲ]‪ [24‬واﻣﺘﻼﻛﮭﺎ ﺗﻮﻛﺴﯿﻨﺎت وﻋﻮاﻣﻞ أﺧﺮى‪.‬‬
‫‪20‬‬
‫ﻣﻘﺎرﻧﺔ اﻟﺒﻜﺘﯿﺮﯾﺎ اﻟﻤﻌﺰوﻟﮫ ﻣﻦ اﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻟﻤﺮﺿﻰ اﻟﺴﻜﺮي اﻟﻤﺼﺎﺑﯿﻦ ﺑﺎﻋﺘﻼل ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ واﻟﻤﺼﺎﺑﯿﻦ ﺑﺎﻟﺘﮭﺎب اﻟﻘﺪم‬
‫ﻧﮭﺎد‬
‫ﻛﺬﻟﻚ ﺗﺒﯿﻦ أن اﻷﻧﻮاع اﻟﺒﻜﺘﯿﺮﯾﺔ اﻟﺘﻲ ﻋﺰﻟﺖ ﻣﻦ ﻣﺮﺿﻰ اﻟﺴﻜﺮي اﻟﻨﻮع )‪ (II‬ﻛﺎﻧﺖ اﻛﺜﺮ‬
‫ﻣﻘﺎرﻧﺔ ﺑﺎﻟﻨﻮع )‪ (I‬وأﯾﻀﺎ" ﻓﻘﺪ ظﮭﺮ ﻣﻦ ﺧﻼل ھﺬة اﻟﺪراﺳﺔ وﺟﻮد ﻓﺮق ﻣﻌﻨﻮي ﻛﺒﯿﺮ ﻓﻲ ﻧﺴﺐ‬
‫اﻹﺻﺎﺑﺎت اﻟﺒﻜﺘﯿﺮﯾﺔ ﻓﻲ اﻹﻧﺎث اﻛﺜﺮ ﻣﻘﺎرﻧﺔ ﺑﺎﻟﺬﻛﻮروھﺬا ﯾﺘﻔﻖ ﻣﻊ ﻣﺎ ﺟﺎء ﺑﺔاﻟـ ]‪،[16‬أﻣﺎ ﺑﺎﻟﻨﺴﺒﺔ‬
‫ﻟﻸﻋﻤﺎر ﻓﺎن اﻻﺻﺎﺑﺔ اﻟﺒﻜﺘﯿﺮﯾﺔ ﻛﺎﻧﺖ اﻻﻛﺜﺮ ﻓﻲ اﻟﻔﺌﺔ اﻟﻌﻤﺮﯾﺔ اﻟﺜﺎﻟﺜﺔ وذﻟﻚ ﯾﺘﻔﻖ ﻣﻊ ﻣﺎ ﺟﺎء ﺑﺔ‬
‫اﻻﺧﺮون ]‪.[17‬‬
‫ان ﺑﻜﺘﺮﯾﺎ ‪ Pseudomonas aeruginosa‬ﻛﺎﻧﺖ اﻛﺜﺮ اﻧﻮاع اﻟﺒﻜﺘﺮﯾﺎ اﻟﻤﺴﺒﺒﺔ ﻻﻟﺘﮭﺎب‬
‫اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻟﻤﺼﺎﺑﻲ اﻟﻘﺪم ﺣﯿﺚ ﺗﺆﻛﺪ اﻟﻜﺜﯿﺮ ﻣﻦ اﻟﺪراﺳﺎت ﺑﺎن ھﺬه اﻟﺒﻜﺘﺮﯾﺎ ﺗﺴﺒﺐ اﻟﺘﮭﺎب‬
‫اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻣﻦ ﺧﻼل اﺳﺘﺨﺪام اﻟﻘﺴﻄﺮة ﻛﺬﻟﻚ ﺗﻌﺪ ﻣﻦ ﻣﺴﺒﺒﺎت ﻣﺎﯾﻌﺮف ﺑﻌﺪوى اﻟﻤﺴﺘﺸﻔﯿﺎت‬
‫وﻗﺪ ظﮭﺮ أن اﻟﻌﺰﻻت اﻟﺒﻜﺘﯿﺮﯾﺔ اﻟﺘﻲ ﺗﻢ ﻋﺰﻟﮭﺎ ﻣﻦ ﻣﺮﺿﻰ إﺻﺎﺑﺎت اﻟﻘﺪم اﻟﻨﻮع )‪ (I‬ﺗﻔﻮق ﺑﻜﺜﯿﺮ‬
‫ﻣﺎ ﺗﻢ ﻋﺰﻟﺔ ﻓﻲ ﻣﺮﺿﻰ اﻟﺴﻜﺮي اﻟﻨﻮع ) ‪. (II‬‬
‫وﻗﺪ ﺗﺒﯿﻦ ان ﻧﺴﺒﺔ إﺻﺎﺑﺎت اﻹﻧﺎث ﻓﺎﻗﺖ ﻧﺴﺒﺔ اﺻﺎﺑﺎت اﻟﺬﻛﻮر وھﺬا ﯾﻨﻄﺒﻖ ﻣﻊ ﻣﺎﺣﺼﻠﺖ‬
‫ﻋﻠﯿﮫ اﻟـ ]‪ [24‬اﻟﺘﻲ ﺑﯿﻨﺖ أن اﻹﻧﺎث أﻛﺜﺮ ﻋﺮﺿﺔ ﻟﻺﺻﺎﺑﺔ ﺑﺎﻟﺘﮭﺎب اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻣﻦ اﻟﺬﻛﻮر‬
‫ﺣﯿﺚ ﺑﻠﻐﺖ ﻧﺴﺒﺔ ﻋﺰﻟﮭﺎ ﻓﻲ اﻹﻧﺎث ‪ %61.7‬ﻓﯿﻤﺎ ﻛﺎﻧﺖ ﻧﺴﺒﺔ اﻟﻌﺰل ﻓﻲ اﻟﺬﻛﻮر‪. % 38.3‬‬
‫اﻣﺎ اﻟﻌﻤﺮ ﻓﺎن اﻟﻔﺌﺔ اﻟﻌﻤﺮﯾﺔ اﻟﺜﺎﻟﺜﺔ )‪ (≥ 41‬ﺗﻤﯿﺰت وﺑﺸﻜﻞ ﻛﺒﯿﺮ ﻋﻦ اﻟﻔﺌﺘﯿﻦ اﻟﺜﺎﻧﯿﺔ واﻻوﻟﻰ ‪.‬‬
‫وﻓﻲ ﺟﺪول اﻟﺴﯿﻄﺮة ﻓﻤﺎ ﻧﻼﺣﻈﮫ ان ﺑﻜﺘﺮﯾﺎ اﻟـ ‪ Klebsiella spp‬ﻛﺎﻧﺖ اﻻﻛﺜﺮ ﺗﻮاﺟﺪا ﻓﻲ‬
‫اﻟﻤﺮﺿﻰ اﻟﻤﺼﺎﺑﯿﻦ ﺑﺎﻟﺘﮭﺎب اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ وھﺬا ﯾﻨﻄﺒﻖ ﻣﻊ ﻣﺎ اﺷﺎر اﻟﯿﺔ اﻟﻜﺜﯿﺮ ﻣﻦ اﻟﺒﺎﺣﺜﯿﻦ‬
‫]‪ [17,16‬اﻟﻰ اھﻤﯿﺔ ھﺬه اﻟﺒﻜﺘﺮﯾﺎ ﻓﻲ اﺣﺪاﺛﮭﺎ ﻟﻼﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻟﻜﻮﻧﮭﺎ اﺣﺪ اﻧﻮاع‬
‫اﻟﻔﻠﻮرا اﻟﻄﺒﯿﻌﯿﺔ اﻟﻤﺘﻮاﺟﺪة ﻓﻲ اﻻﻣﻌﺎء ﻣﻤﺎ ﯾﺘﯿﺢ اﻟﻔﺮﺻﺔ ﻟﺘﻠﻮث اﻟﺠﮭﺎز اﻟﺒﻮﻟﻲ واﯾﻀﺎ ﻻﻣﺘﻼﻛﮭﺎ‬
‫ﻋﻮاﻣﻞ ﺿﺮاوة ﻛﺎﻟﻤﺤﻔﻈﺔ اﻟﺘﻲ ﺗﺴﺎﻋﺪھﺎ ﻓﻲ ﻣﻘﺎوﻣﺔ دﻓﺎﻋﺎت اﻟﺠﺴﻢ اﻟﻤﻨﺎﻋﯿﺔ ﻛﺎﻟﺒﻠﻌﻤﺔ ]‪. [16‬‬
‫اﻣﺎ ظﮭﻮر ﺣﺎﻻت اﻻﺻﺎﺑﺔ ﺑﺎﻟﺘﮭﺎب اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻣﺮﺿﻰ اﻟﺴﻜﺮي اﻟﻨﻮع ) ‪ (II‬اﻋﻠﻰ ﻣﻦ‬
‫ﻣﺮﺿﻰ اﻟﺴﻜﺮي اﻟﻨﻮع ) ‪ (I‬واﯾﻀﺎ ﻛﺎﻧﺖ ﻧﺴﺒﺔ اﻻﺻﺎﺑﺔ ﺑﺎﻻﻧﺎث اﻋﻠﻰ ﻣﻦ اﻟﺬﻛﻮر ﻓﻘﺪ ﺗﻢ ﻣﻨﺎﻗﺸﺘﺔ‬
‫ﻓﻲ ﺟﺪول )‪.(3‬‬
‫ﻣﻦ اﻟﻤﺤﺘﻤﻞ أن ﺗﺒﺎﯾﻦ ﺗﺴﻠﺴﻞ اﻷﻧﻮاع اﻟﺒﻜﺘﯿﺮﯾﺔ وﻧﺴﺐ إﺻﺎﺑﺘﮭﺎ اﻟﻤﻌﺰوﻟﺔ ﻣﻦ ﺑﻮل اﻟﻤﺼﺎﺑﯿﻦ‬
‫ﺑﺎﻋﺘﻼل اﻟﺸﺒﻜﯿﺔ و إﺻﺎﺑﺎت اﻟﻘﺪم ﯾﻤﻜﻦ ﺗﻔﺴﯿﺮھﺎ ﺑﺄن ﻗﺴﻢ ﻣﻦ اﻟﻤﺼﺎﺑﯿﻦ ﺗﻜﻮن اﻹﺻﺎﺑﺔ ﻟﺪﯾﮭﻢ‬
‫ﻗﺪﯾﻤﺔ وﻣﺘﻄﻮرة ﻣﻊ ﻣﻀﺎﻋﻔﺎت ﺗﺘﺠﻠﻰ ﻓﻲ ﻋﺪم ﻛﻔﺎءة اﻟﺠﮭﺎز اﻟﺒﻮﻟﻲ ﻟﻠﻘﯿﺎم ﺑﻮظﺎﺋﻔﮫ اﻻﻋﺘﯿﺎدﯾﺔ ﻣﻤﺎ‬
‫ﯾﻌﻄﻲ ﻓﺮﺻﺔ ﻟﻐﺰو ﺑﻜﺘﯿﺮي ﻣﻦ ﻣﻨﺎطﻖ أﺧﺮى ‪ ،‬ﻛﺬﻟﻚ ﻓﺎن ﺗﺒﺎﯾﻦ ﺗﺮﻛﯿﺰ اﻟﺴﻜﺮ ﻓﻲ ﺑﻮل‬
‫اﻟﻤﺼﺎﺑﯿﻦ ﻣﻦ ﺷﺄﻧﮫ إﻋﻄﺎء ﻓﺮﺻﺔ ﻟﻨﻤﻮ أﻧﻮاع ﻣﻌﯿﻨﺔ وﺳﯿﺎدﺗﮭﺎ ﻋﻠﻰ اﻷﻧﻮاع اﻷﺧﺮى ﺣﯿﺚ زﯾﺎدة‬
‫ﻣﺴﺘﻮى اﻟﺴﻜﺮ ﯾﺆدي اﻟﻰ ﺗﻐﯿﯿﺮ ﻗﯿﻢ درﺟﺎت اﻟﺤﺎﻣﻀﯿﺔ ﻟﻺدرار ﻣﻤﺎ ﻗﺪ ﺗﻜﻮن ﻣﻼﺋﻤﺔ ﻟﻨﻤﻮ أﻧﻮاع‬
‫ﻣﻌﯿﻨﺔ وﺳﯿﺎدﺗﮫ ﻋﻠﻰ أﻧﻮاع أﺧﺮى ]‪ ،[17‬ﻋﻼوة ﻋﻠﻰ ذﻟﻚ ﻓﺄن ﺑﻘﺎء ﺟﺰء ﻣﻦ اﻟﺒﻮل ) اﻟﺒﻮل‬
‫اﻟﻤﺮﺗﺪ ﻣﻦ اﻟﻤﺜﺎﻧﺔ ( ﯾﺰﯾﺪ ﻣﻦ ﻓﺮﺻﺔ ﺣﺪوث اﻻﻟﺘﮭﺎب]‪.[16‬‬
‫ﻧﺴﺘﻨﺘﺞ ﻣﻦ ﺧﻼل ھﺬه اﻟﺪراﺳﮫ اﻟﺒﺤﺜﯿﮫ ‪:‬‬
‫‪ -1‬أن ﻧﺴﺒﺔ اﻟﺘﮭﺎب اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻟﻤﺮﺿﻰ اﻟﺴﻜﺮي اﻟﻤﺼﺎﺑﯿﻦ ﺑﺎﻋﺘﻼل ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ ﻛﺎﻧﺖ‬
‫اﻻﻛﺜﺮ ﺗﻮاﺟﺪا ﻓﻲ اﻟﻔﺌﺔ اﻟﻌﻤﺮﯾﺔ اﻟﺜﺎﻟﺜﺔ ) ‪ (≥41‬ﺣﯿﺚ ﺳﺠﻠﺖ ﻧﺴﺒﺔ اﺻﺎﺑﮫ ) ‪ (%72.7‬اﻣﺎ ﻟﺪى‬
‫ﻣﺮﺿﻰ اﻟﺴﻜﺮي اﻟﺬﯾﻦ ﯾﻌﺎﻧﻮن ﻣﻦ إﺻﺎﺑﺎت ﻓﻲ اﻟﻘﺪم ﻓﻘﺪ ﻛﺎﻧﺖ )‪. % (80‬‬
‫‪ -2‬أن اﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻹﻧﺎث ﻣﺮﺿﻰ اﻟﺴﻜﺮي اﻟﻤﺼﺎﺑﺎت ﺑﺎﻋﺘﻼل ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ‬
‫)‪ ( %63.6‬ﺗﻔﻮق ﻧﺴﺒﺔ اﻟﺬﻛﻮر)‪ ( %36.3‬وﻗﺪ ﺳﺠﻠﺖ ﻧﺘﺎﺋﺞ ﻣﺘﻘﺎرﺑﮫ ﻓﻲ ﺣﺎﻟﺔ إﺻﺎﺑﺎت اﻟﻘﺪم‬
‫ﺣﯿﺚ ﻛﺎﻧﺖ اﻟﻨﺴﺒﺔ ﻋﻨﺪ اﻹﻧﺎث ) ‪ ( %73.3‬أﻋﻠﻰ ﻣﻤﺎ ﻓﻲ اﻟﺬﻛﻮر) ‪.( % 26.6‬‬
‫‪ -3‬ﺗﺒﯿﻦ أن اﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﺑﺎﻟﻨﺴﺒﺔ ﻟﻠﻤﻌﺘﻠﯿﻦ ﺑﺸﺒﻜﯿﺔ اﻟﻌﯿﻦ ﺗﺰداد ﻟﺪى ﻧﻮع اﻟﺴﻜﺮي)‪(II‬‬
‫)‪ ( %63.6‬أﻋﻠﻰ ﻣﻦ اﻟﻨﻮع )‪ ( %36.3) (I‬وﻋﻜﺲ ذﻟﻚ ﻓﻲ ﻣﺮﺿﻰ إﺻﺎﺑﺎت اﻟﻘﺪم ﻧﺠﺪھﺎ ﻓﻲ‬
‫اﻟﺴﻜﺮي اﻟﻨﻮع)‪ (%66.6) (I‬أﻋﻠﻰ ﻣﻦ اﻟﻨﻮع )‪. (%33.4) (II‬‬
‫‪ -4‬اﺣﺘﻠﺖ ﺑﻜﺘﺮﯾﺎ اﻟـ ‪ Escherichia coli‬اﻟﻤﺮﺗﺒﺔ اﻷوﻟﻰ)‪ 3‬ﻋﺰﻻت ( اﻟﻤﺴﺒﺒﺔ ﻻﻟﺘﮭﺎﺑﺎت‬
‫اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ ﻟﻤﺮﺿﻰ اﻟﺴﻜﺮي اﻟﻤﺼﺎﺑﯿﻦ ﺑﺎﻋﺘﻼل ﺷﺒﻜﯿﺔ اﻟﻌﯿﻦ‪ ،‬ﻓﻲ ﺣﯿﻦ ﻛﺎﻧﺖ ﺑﻜﺘﺮﯾﺎ اﻟـ‬
‫‪21‬‬
2009 ،3 ‫ اﻟﻌﺪد‬،20 ‫اﻟﻤﺠﻠﺪ‬
‫ﻣﺠﻠﺔ ﻋﻠﻮم اﻟﻤﺴﺘﻨﺼﺮﯾﺔ‬
‫ ﻋﺰﻻت(ھﻲ اﻟﻤﺴﺒﺐ اﻟﺮﺋﯿﺴﻲ ﻻﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ‬6) Pseudomonas aeruginosa
. ‫ﻟﻤﺼﺎﺑﻲ اﻟﻘﺪم‬
‫اﻟﻤﺼﺎدر‬
‫اﻟﻤﺠﻠﺔ اﻟﺼﺤﯿﺔ ﻟﻠﺸﺮق‬.(‫ )ﺗﺎرﯾﺦ ﻣﺮض اﻟﺴﻜﺮي ﻟﻤﺤﺔ ﻣﻮﺟﺰة‬.‫ﻣﺤﻤﺪ اﺣﻤﺪ‬، ‫ ﻋﻮض‬-1
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23