بررسي فراواني علائم باليني و يافت ههاي پاتولوژيك، در بيمار يهاي ريوي در دانشگاه علوم پزشكي شهيد صدوقي يزد طي سال هاي 1380- 1385

Evaluation of Frequency of Clinical and Pathological Findings in Lung Diseases in Shahid Sadoughi University of Medical Sciences of Yazd, during 2001-2006

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺑﻴﻤﺎﺭﻱ ﻫﺎﻱ ﺭﻳﻪ ﮐﻪ ﺍﺯ ﺷﺎﻳﻊ ﺗﺮﻳﻦ ﺑﻴﻤﺎﺭﻱ ﻫﺎ ﻣﻲ ﺑﺎﺷﻨﺪ، ﺑﻪ ﺩﻭ ﮔﺮﻭﻩ ﺧﻮﺵ ﺧﻴﻢ ﻭ ﺑﺪﺧﻴﻢ ﺗﻘﺴﻴﻢ ﻣﻲ ﺷﻮﻧﺪ. ﺑﻴﻤﺎﺭﻱ ﻫﺎﻱ ﺧﻮﺵ ﺧﻴﻢ ﺭﻳﻪ ﺷﺎﻣﻞ ﺳﻞ، ﻓﻴﺒﺮﻭﺯ ﺭﻳﻪ، ﺑﻴﻤﺎﺭﻱ ﻫﺎﻱ ﺍﻟﺘﻬﺎﺑﻲ ﺭﻳﻪ، ﻭﺍﺳﮑﻮﻟﻴﺖ ﻫﺎﻱ ﺩﺭﮔﻴﺮﮐﻨﻨﺪﻩ ﻭ ﭘﻨﻮﻣﻮﮐﻮﻧﻴﻮﺯﻳﺲ ﺍﺳﺖ. ﺑﻴﻤﺎﺭﻱ ﻫﺎﻱ ﺑﺪﺧﻴـﻢ ﺷﺎﻣﻞ ﺳﺮﻃﺎﻥ ﻫﺎﻱ ﺑﺮﻧﺶ ﻣﺎﻧﻨﺪ ﺍﺳﮑـﻮﺍﻣﻮﺱ ﺳﻞ ﮐﺎﺭﺳﻴﻨﻮﻣﺎ ﻭ ﺁﺩﻧﻮﮐﺎﺭﺳﻴﻨﻮﻣﺎ ﻭ ﺿﺎﻳﻌﺎﺕ ﻣﺘﺎﺳﺘﺎﺗﻴﮏ ﺑﻪ ﺭﻳﻪ ﻣﻲ ﺑﺎﺷﺪ. ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺷﻴـﻮﻉ ﺑﺎﻻ ﻭ ﺗﺸﺎﺑﻪ ﻋﻼﻳﻢ ﮐﻠﻴﻨﻴـﮑﻲ ﺁﻧﻬﺎ ﺑﺮﺭﺳﻲ ﻫﻴﺴﺘـﻮﭘﺎﺗﻮﻟﻮﮊﻱ ﺩﺭ ﺗﺸﺨﻴﺺ ﺑﻴﻤﺎﺭﻱ ﮐﻤﮏ ﮐﻨﻨﺪﻩ ﺍﺳﺖ. ﻫﺪﻑ ﺍﺯ ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﺮﺭﺳﻲ ﻓـﺮﺍﻭﺍﻧﻲ ﻋﻼﺋﻢ ﺑﺎﻟﻴﻨﻲ ﻭ ﻳﺎﻓﺘﻪ ﻫﺎﻱ ﭘﺎﺗﻮﻟـﻮﮊﻳﮏ، ﺩﺭ ﺑﻴﻤـﺎﺭﻱ ﻫﺎﻱ ﺭﻳﻮﻱ ﺩﺭ ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﮑﻲ ﺷﻬﻴﺪ ﺻﺪﻭﻗﻲ ﻳﺰﺩ ﻃﻲ ﺳﺎﻝ ﻫﺎﻱ 1385 -1380ﻣﻲ ﺑﺎﺷﺪ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺍﻳﻦ ﺗﺤﻘﻴﻖ ﺍﺯ ﻧﻮﻉ ﺗﻮﺻﻴﻔﻲ ﻭ ﮔﺬﺷﺘﻪ ﻧﮕﺮ ﺑﻮﺩﻩ ﮐﻪ ﺑﺮ ﺭﻭﻱ 400 ﻧﻤﻮﻧﻪ ﺍﺯ ﺑﺎﻓﺖ ﺭﻳﻪ200 ﻧﻤﻮﻧﻪ ﺿﺎﻳﻌﺎﺕ ﺧﻮﺵ ﺧﻴﻢ ﻭ 200 ﻧﻤﻮﻧﻪ ﺿﺎﻳﻌﺎﺕ ﺑﺪﺧﻴﻢ( ﺩﺭ ﺑﻴﻤﺎﺭﺍﻧﻲ ﮐﻪ ﻃﻲ ﺳﺎﻝ ﻫﺎﻱ 1385 -1380 ﺑﻪ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﻫﺎﻱ ﺷﻬﻴﺪ ﺻﺪﻭﻗﻲ، ﺷﻬﻴﺪ ﺭﻫﻨﻤﻮﻥ ﻭ ﺍﻓﺸﺎﺭ ﻳﺰﺩ ﻣﺮﺍﺟﻌﻪ ﮐﺮﺩﻩ ﺍﻧﺪ، ﺍﻧﺠﺎﻡ ﮔﺮﻓﺘﻪ ﺍﺳﺖ. ﺍﻃﻼﻋﺎﺕ ﻣﻮﺭﺩ ﻧﻴﺎﺯ ﺷﺎﻣﻞ ﺗﺸﺨﻴﺺ ﺑﺮ ﺍﺳﺎﺱ ﺑﻴﻮﭘﺴﻲ ﺳﻦ، ﺟﻨﺲ، ﻋﻼﻳﻢ ﺑﺎﻟﻴﻨﻲ ﻭ ﺗﺸﺨﻴﺺ ﻗﺒﻞ ﺍﺯ ﺑﻴﻮﭘﺴﻲ ﺍﺳﺘﺨﺮﺍﺝ ﺷﺪﻩ ﺍﻧﺪ. ﺩﺍﺩﻩ ﻫﺎ ﺑﻪ ﻭﺳﻴﻠﻪ ﻧﺮﻡ ﺍﻓﺰﺍﺭ ﺷﺎﺧﺺSPSS ﺍﺳﺘﺨﺮﺍﺝ ﻭ ﺁﺯﻣﻮﻥ ﻫﺎﻱ ﺁﻣﺎﺭﻱ ﮐﺎﻱ ﺍﺳﮑﻮﺍﺭ ﻣﻮﺭﺩ ﺗﺠﺰﻳﻪ ﻭ ﺗﺤﻠﻴﻞ ﻧﻬﺎﻳﻲ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺍﺯ 400 ﺑﻴﻤﺎﺭ ﻣﻮﺭﺩ ﻣﻄﺎﻟﻌﻪ 273 ﻣﻮﺭﺩ ﻣﺮﺩ68/3 ﻭ 127 ﻣﻮﺭﺩ ﺯﻥ )31/7 ﺑﻮﺩﻧﺪ. ﺍﺯ 200 ﻧﻤﻮﻧﻪ ﺿﺎﻳﻌﺎﺕ ﺧﻮﺵ ﺧﻴﻢ، 39 ﺳﻞ، 27% ﭘﻨﻮﻣﻮﮐﻮﻧﻴﻮﺯﻳﺲ، 23 ﺿﺎﻳﻌﺎﺕ ﻓﻴﺒﺮﺯﺍﻥ، 6 ﻭﺍﺳﮑﻮﻟﻴﺖ ﻫﺎ ﻭ 5 ﺑﻴﻤﺎﺭﻱ ﻫﺎﻱ ﺍﻟﺘﻬﺎﺑﻲ ﺭﻳﻪ ﺑﻮﺩﻧﺪ. ﺍﺯ 200 ﻧﻤﻮﻧﻪ ﺿﺎﻳﻌﺎﺕ ﺑﺪﺧﻴﻢ، 56/5 ﺁﻧﻬﺎ ﺑﺪﺧﻴﻢ ﺍﻭﻟﻴﻪ ﻭ 13/5% ﺿﺎﻳﻌﺎﺕ ﻣﺘﺎﺳﺘﺎﺗﻴﮏ ﺭﻳﻪ ﺑﻮﺩﻩ ﺍﺳﺖ. ﻫﻤﭽﻨﻴﻦ ﮐﻠﻴﻪ ﺿﺎﻳﻌﺎﺕ ﺭﻳﻪ ﺩﺭ ﻣﺮﺩﺍﻥ ﺷﺎﻳﻊ ﺗﺮ ﻭ ﺩﺭ ﮔﺮﻭﻩ ﺑﺎﻻﻱ 60 ﺳﺎﻟﻪ ﺑﻴﺸﺘﺮ ﺑﻮﺩﻩ )ﺑﻪ ﺍﺳﺘﺜﻨﺎﻱ ﻭﺍﺳﮑﻮﻟﻴﺖ ﻫﺎ(. ﺷﺎﻳﻊ ﺗﺮﻳﻦ ﻋﻼﻳﻢ ﺑﺎﻟﻴﻨﻲ ﺩﺭ ﮔﺮﻭﻩ ﻫﺎﻱ ﻣﻮﺭﺩ ﺑﺮﺭﺳﻲ ﺳﺮﻓﻪ، ﺗﻨﮕﻲ ﻧﻔﺲ ﺑﻪ ﻏﻴﺮ ﺍﺯ ﻭﺍﺳﮑﻮﻟﻴﺖ ﻫﺎ ﮐﻪ ﻫﻤﻮﭘﺘﻴﺰﻱ ﺑﻮﺩ، ﺑﻴﺸﺘﺮﻳﻦ ﺿﺎﻳﻌﺎﺕ ﺑﺪﺧﻴﻢ ﺷﺎﻣﻞ ﺍﺳﮑﻮﺍﻣﻮﺱ ﺳﻞ ﮐﺎﺭﺳﻴﻨﻮﻣﺎ22/5 %( ﻭ ﺁﺩﻧﻮﮐﺎﺭﺳﻴﻨﻮﻣﺎ )23/5 ﺑﻮﺩﻩ ﺍﺳﺖ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻧﺘﺎﻳﺞ ﺗﺤﻘﻴﻖ، ﻣﻮﺍﺭﺩ ﺗﺸﺨﻴﺺ ﺑﺎﻟﻴﻨﻲ ﺍﺯ ﺿﺎﻳﻌﺎﺕ ﺭﻳﻪ ﮐﻪ ﻗﺒﻞ ﺍﺯ ﺑﻴﻮﭘﺴﻲ ﻣﻮﺭﺩ ﺑﺮﺭﺳﻲ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﺑﻮﺩ ﺑﺎ ﺑﻴﻮﭘﺴﻲ ﻧﻴﺰ ﻣﻮﺭﺩ ﺗﺄﻳﻴﺪ ﻗﺮﺍﺭ گرفت

Introduction & Objective: The pulmonary diseases which are the most common diseases are categorized into two groups of Non Neoplastic and Neoplastic diseases. Non neoplastic diseases are tuberculosis, pulmonary fibrosis, inflammatory lung diseases, vasculitis and pneumoconiosis. Neoplastic diseases are Bronchogenic carcinoma such as squamous cell carcinoma (SCC), adenocarcinoma (AC) and lung metastatic lesions. With high prevalence and similarity of clinical signs, histopatology is helpful in diagnosis of diseases. The aim of this study is evaluation of frequency of clinical and pathological findings in lung diseases in Shahid Sadoughi University. Materials & Methods: This study was descriptive and retrospective and it involed 400 lung samples (200 samples Non Neoplastic lesions and 200 samles of Neoplastic lesions) who referred to Shahid Sadoughi, Shahid Rahnemoon and Afshar hospitals of Yazd, Iran, in the time interval 2001-2006. The information including diagnosis by biopsy, age, sex, clinical signs and diagnosis before biopsy, were filled out and data was analyzed by chi-square. Results: From 400 cases 273 were males (68.3%) and 127 females (31.7%), From 200 of Non Neoplastic lesions, TB was 39.9%, pneumoconiosis 27%, pulmonary fibrosis 23%, Vasculitis 6%, inflamatory lung diseases was 5% and of 200 Neoplastic lesions, primary lung Neoplastic lesions was 56.5% and lung metastatic lesions 12.5%. All lesions were more common in men than women and more common in ages over 60 years (except for vasculitis). The most clinical features were cough and dyspenica (except for vasculitis). The most common type of Neoplastic lesions were SCC (22.5%) and AC (23.5%). Conclusions: 1- All lesions were more common in men. 2- All lesions were more common in age more than 60 years except for vasculitis. 3- Cough and dyspenica were the most clinical findings. 4- The most common type of Neoplastic lesions were SCC (22.5%) and AC.