مقايسه نتايج شناسايي DNA هليكوباكترپيلوري، كلاميديا پنومونيه و مايكوپلاسما پنومونيه در بيماران تحت عمل جراحي اورژانس و الكتيوآنوريسم آئورت شكمي

Comparison of Results of DNA Detection of Helicobacter Pylori, Chlamydia Pneumoniae and Mycoplasma Pneumoniae in Patients Undergoing Emergency and Elective Abdominal Aortic Aneurysm Surgery

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺳﻴﺰﺩﻫﻤﻴﻦ ﻋﻠﺖ ﺷﺎﻳﻊ ﻣﻨﺠﺮ ﺑﻪ ﻣﺮﮒ ﺩﺭ ﺟﻬﺎﻥ ﻏﺮﺏ ﭘﺎﺭﻩ ﺷﺪﻥ ﺁﻧﻮﺭﻳﺴﻢ ﺁﺋﻮﺭﺕ ﺷﮑﻤﻲ ﺍﺳﺖ. ﺍﮔﺮﭼﻪ ﺗﺤﻘﻴﻘﺎﺕ ﻗﺎﺑﻞ ﺗﻮﺟﻬﻲ ﺟﻬﺖ ﺷﻨﺎﺳﺎ ﻳﻲ ﻋﻠﺖ ﻭ ﻣﮑﺎﻧﻴﺴﻢ ﮔﺴﺘﺮﺵ ﺁﻧﻮﺭﻳﺴﻢ ﺍﻧﺠﺎﻡ ﺷﺪﻩ ﺍﺳﺖ، ﺍﻣﺎ ﺷﻨﺎﺧﺖ ﻧﺎﭼﻴﺰﻱ ﺩﺭ ﻣﻮﺭﺩ ﻣﮑﺎﻧﻴﺴﻢ ﭘﺎﺭﻩ ﺷﺪﻥ ﺁﻧﻮﺭﻳﺴﻢ ﻭﺟﻮﺩ ﺩﺍﺭﺩ. ﻫﺪﻑ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺍﺭﺯﻳﺎﺑﻲ ﻧﻘﺶ ﺍﺣﺘﻤﺎﻟﻲ ﻋﻔﻮﻧﺖﻫﺎﻱ ﻫﻠﻴﮑﻮﺑﺎﮐﺘﺮﭘﻴﻠﻮﺭﻱ، ﮐﻼﻣﻴﺪﻳﺎ ﭘﻨﻮﻣﻮﻧﻴﻪ ﻭ ﻣﺎﻳﮑﻮﭘﻼﺳﻤﺎ ﭘﻨﻮﻣﻮﻧﻴﻪ ﺩﺭ ﮔﺴﺘﺮﺵ ﻭ ﭘﺎﺭﻩ ﺷﺪﻥ ﺁﻧﻮﺭﻳﺴﻢ ﺁﺋﻮﺭﺕ ﺷﮑﻤﻲ ﺍﺳﺖ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺩﺭ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻣﻘﻄﻌﻲ ﻣﺎ ﺑﻪ ﺑﺮﺭﺳﻲ 50 ﺑﻴﻤﺎﺭ ﻣﺒﺘﻼ ﺑﻪ ﺁﻧﻮﺭﻳﺴﻢ ﺁﺋﻮﺭﺕ ﺷﮑﻤﻲ ﻣﺮﺍﺟﻌﻪ ﮐﻨﻨﺪﻩ ﺑﻪ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺷﻬﺪﺍﻱ ﺗﺠﺮﻳﺶ ﺩﺭ ﻣﺪﺕ ﺯﻣﺎﻥ 2 ﺳﺎﻝ ﭘﺮﺩﺍﺧﺘﻴﻢ. ﭼﻬﺎﺭ ﺑﻴﻤﺎﺭ ﺑﺎ ﺳﺎﺑﻘﻪ ﺳﻮﺀ ﻫﺎﺿﻤﻪ ﻭ ﺗﺤﺖ ﺩﺭﻣﺎﻥ ﺿﺪ ﻫﻠﻴﮑﻮﺑﺎﮐﺘﺮﭘﻴﻠﻮﺭﻱ ﻳﺎ ﺳﺎﺑﻘﻪ ﺍﺧﻴﺮ ﺍﺑﺘﻼﺀ ﺑﻪ ﻋﻔﻮﻧﺖ ﺗﻨﻔﺴﻲ ﺍﺯ ﻣﻄﺎﻟﻌﻪ ﺧﺎﺭﺝ ﺷﺪﻧﺪ. ﺑﻴﻤﺎﺭﺍﻥ ﺭﺍ ﺑﺮﺍﺳﺎﺱ ﺍﻧﺪﻳﮑﺎﺳﻴﻮﻥ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﺁﻧﻮﺭﻳﺴﻢ ﺑﻪ ﺩﻭ ﮔﺮﻭﻩ ﺗﻘﺴﻴﻢ ﺷﺪﻧﺪ. ﮔﺮﻭﻩ ﺍﻭﻝ ﺗﺤﺖ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﺍﻟﮑﺘﻴﻮ ﺁﻧﻮﺭﻳﺴﻢ ﺁﺋﻮﺭﺕ ﺷﮑﻤﻲ ﻭ ﮔﺮﻭﻩ ﺩﻭﻡ ﺗﺤﺖ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﺍﻭﺭﮊﺍﻧﺲ ﺁﻧﻮﺭﻳﺴﻢ ﺁﺋﻮﺭﺕ ﭘﺎﺭﻩ ﺷﺪﻩ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ. ﺩﺭ ﺣﻴﻦ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﻧﻤﻮﻧﻪﮔﻴﺮﻱ ﺍﺯ ﺟﺪﺍﺭ ﺁﻧﻮﺭﻳﺴﻢ ﺍﻧﺠﺎﻡ ﻣﻲﺷﺪ. ﻧﻤﻮﻧﻪﻫﺎ ﺟﻬﺖ ﺍﺳﺘﺨﺮﺍﺝ DNA ﻣﻴﮑـﺮﻭﺏﻫﺎﻱ ﻣﻮﺭﺩ ﻣﻄﺎﻟﻌﻪ ﺑﻪ ﺭﻭﺵ PCR ﺳﺮﻳﻌـﺎﹰ ﺑﻪ ﺁﺯﻣﺎﻳﺸﮕﺎﻩ ﻣﻨﺘﻘﻞ ﻣﻲﺷﺪ. ﺩﺭ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺟﻬﺖ ﻣﻘﺎﻳﺴﻪ ﺩﺍﺩﻩﻫﺎﻱ ﮐﻴﻔﻲ ﺍﺯ ﺁﺯﻣﻮﻥﻫﺎﻱ ﮐﺎﻱ ﺍﺳﮑﻮﺍﺭ ﻭ ﻓﻴﺸﺮ ﻭ ﺟﻬﺖ ﺩﺍﺩﻩﻫﺎﻱ ﮐﻤﻲ ﺍﺯ ﺁﺯﻣﻮﻥﻫﺎﻱ ﻣﺎﻥ ﻭﻳﺘﻨﻲ ﻭ ﺗﻲ ﺗﺴﺖ ﺍﺳﺘﻔﺎﺩﻩ ﮔﺮﺩﻳﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺩﺭ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ 46 ﺑﻴﻤﺎﺭ ﺑﺮﺭﺳﻲ ﺷﺪﻧﺪ. ﺩﺭ ﻫﺮ ﺩﻭ ﮔﺮﻭﻩ ﻫﻴﭻ ﻣﻮﺭﺩ DNA ﻫﻠﻴﮑﻮﺑﺎﮐﺘﺮﭘﻴﻠﻮﺭﻱ ﻭ ﻣﺎﻳﮑﻮﭘﻼﺳﻤﺎ ﭘﻨﻮﻣﻮﻧﻴﻪ ﺷﻨﺎﺳﺎﻳﻲ ﻧﺸﺪ، ﺍﻣﺎ ﺑﺎﻻﺗﺮﻳﻦ ﻣﻴﺰﺍﻥ DNA ﮐﻼﻣﻴﺪﻳﺎ ﭘﻨﻮﻣﻮﻧﻴﻪ ﺩﺭ ﺑﻴﻤﺎﺭﺍﻥ ﻣﺒﺘﻼ ﺑﻪ ﺁﻧﻮﺭﻳﺴﻢ ﺁﺋﻮﺭﺕ ﺷﮑﻤﻲ ﭘﺎﺭﻩ ﺷﺪﻩ ﺷﻨﺎﺳﺎﻳﻲ ﺷﺪ P<0.05(. ﺷﻨﺎﺳﺎﻳﻲ DNA ﮐﻼﻣﻴﺪﻳﺎ ﭘﻨﻮﻣﻮﻧﻴﻪ ﺩﺭ ﺟﺪﺍﺭ ﺁﻧﻮﺭﻳﺴﻢ ﭘﺎﺭﻩ ﺷﺪﻩ ﺍﺭﺗﺒﺎﻁ ﻣﻌﻨﻲﺩﺍﺭﻱ ﺑﺎ ﺳﻦ، ﺟﻨﺲ ﻭ ﺣﺪﺍﮐﺜﺮ ﻗﻄﺮ ﺁﻧﻮﺭﻳﺴﻢ ﻧﺪﺍﺭﺩ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻧﺸﺎﻥ ﻣﻲﺩﻫﺪ ﮐﻪ ﮐﻼﻣﻴﺪﻳﺎ ﭘﻨﻮﻣﻮﻧﻴﻪ ﺑﺎ ﻓﺮﺍﻭﺍﻧﻲ ﻗﺎﺑﻞ ﺗﻮﺟﻬﻲ ﺩﺭ ﺟﺪﺍﺭ ﺁﻧﻮﺭﻳﺴﻢ ﺁﺋﻮﺭﺕ ﭘﺎﺭﻩ ﺷﺪﻩ ﻳﺎﻓﺖ ﻣﻲﺷﻮﺩ. ﺍﺣﺘﻤﺎﻻﹰ ﮐﻼﻣﻴﺪﻳﺎ ﺩﺭ ﮔﺴﺘﺮﺵ ﻭ ﭘﺎﺭﻩ ﺷﺪﻥ ﺁﻧﻮﺭﻳﺴﻢ ﺁﺋﻮﺭﺕ ﻧﻘﺶ ﻣﻬﻤﻲ ﺩﺍﺭﺩ.

Introduction & Objective: The thirteenth most common cause of death in the Western world is ruptured abdominal aortic aneurysm. Although considerable researches have been done about to the etiology and mechanism of aneurysm expansion, little is known about the mechanism of rupture. The aim of this study was to evaluate the possible role of helicobacterpylori and chlamydia pneumoniae and mycoplasma pneumoniae in the expansion and rupture of abdominal aorta aneurysm. Materials & Methods: In this cross sectional study, we evaluated 50 patients with abdominal aorta aneurysm, in a period of 2 years at our hospital. Four patients with a history of dyspepsia and anti- Helicobacter pylori therapy or a recent history of upper respiratory infection were excluded from our study. Patients were divided into two groups, based on the indication for aneurysm surgery. The first group had undergone elective abdominal aortic aneurysm surgery and the second group had undergone emergency surgery of ruptured aortic aneurysm. During surgery, was performed sampling of the aneurysm wall was done. Samples were immediately transported to the laboratory to have the extraction of DNA of microbes by PCR. Results: In this study, 46 patients were evaluated. In both groups, helicobacterpylori DNA and mycoplasma pneumoniae DNA weren’t detected. But the highest rates of Chlamydia pneumoniae DNA was detected in patients with ruptured abdominal aortic aneurysm (P <0.05). The detection of Chlamydia pneumoniae DNA in ruptured aneurysm wall wasn’t correlated with age, sex and maximum diameter of the aneurysm. Conclusions: This study shows that the Chlamydia pneumoniae in ruptured aortic aneurysm wall was found with significant prevalence. Chlamydia may have an important role in the expansion and rupture of aortic aneurysms.