بررسي ارتباط بين نوع سيگار مصرفي و بروز بيماري برگر در بيماران مبتلا به برگر در بيمارستان هاي دانشگاه علوم پزشكي شهيد بهشتي در سال 1387 - 1388

Study of the Correlation between the Kind of Tobacco Product Usage and the Incidence of Buerger’s Disease in Buerger’s Patients in Shahid Beheshty Medicine University Hospitals in 2008-2009

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺑﻴﻤﺎﺭﻱ ﺑﺮﮔﺮ ﻳﮏ ﺑﻴﻤﺎﺭﻱ ﺍﻟﺘﻬﺎﺑﻲ ﻭ ﺗﺮﻭﻣﺒﻮﺯ ﻋﺮﻭﻕ ﺩﺳﺖ ﻫﺎ ﻭ ﭘﺎﻫﺎ ﻣﻲ ﺑﺎﺷﺪ. ﺍﻳﻦ ﺑﻴﻤﺎﺭﻱ ﺍﺭﺗﺒﺎﻁ ﺑﺴﻴﺎﺭ ﻧﺰﺩﻳﮏ ﺑﺎ ﻣﺼﺮﻑ ﻣﺤﺼﻮﻻﺕ ﺩﺧﺎﻧﻲ ﺩﺍﺭﺩ. ﺑﻴﻤﺎﺭﺍﻥ ﺑﺮﮔﺮﻱ ﻏﺎﻟﺒﺎﹰ ﻣﺮﺩﺍﻥ ﺟﻮﺍﻥ )ﺯﻳﺮ 45-40 ﺳﺎﻟﻪ( ﻫﺴﺘﻨﺪ ﮐﻪ ﺳﺎﺑﻘﻪ ﻣﺼﺮﻑ ﺯﻳﺎﺩ ﺳﻴﮕﺎﺭ ﺭﺍ ﺩﺍﺭﻧﺪ. ﺍﮔﺮ ﭼﻪ ﺍﺧﻴﺮﺍﹰ ﺩﺭﺻﺪ ﺧﺎﻧﻢ ﻫﺎ ﻭ ﺍﻓﺮﺍﺩ ﺑﺎﻻﻱ 50 ﺳﺎﻝ ﻣﺒﺘﻼ ﺑﻪ ﺑﻴﻤﺎﺭﻱ ﺑﺮﮔﺮ ﻧﻴﺰ ﺍﻓﺰﺍﻳﺶ ﻳﺎﻓﺘﻪ ﺍﺳﺖ. ﺑﻴﻤﺎﺭﻱ ﺑﺮﮔﺮ ﺩﺭ ﻣﻴﺎﻥ ﻣﺮﺩﻣﺎﻥ ﮐﺸﻮﺭﻫﺎﻱ ﺷﺮﻗﻲ، ﺟﻨﻮﺏ ﺷﺮﻗﻲ ﺁﺳﻴﺎ، ﻫﻨﺪ ﻭ ﺧﺎﻭﺭﻣﻴﺎﻧﻪ ﺷﻴﻮﻉ ﺑﻴﺸﺘﺮﻱ ﺩﺍﺭﺩ ﻭ ﺩﺭ ﻣﻴﺎﻥ ﺁﻣﺮﻳﮑﺎﻳﻲ ﻫﺎﻱ ﺁﻓﺮﻳﻘﺎﻳﻲ ﺗﺒﺎﺭ ﺷﻴﻮﻉ ﺑﺴﻴﺎﺭ ﮐﻤﺘﺮﻱ ﺩﺍﺭﺩ. ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺍﻓﺰﺍﻳﺶ ﺗﻤﺎﻳﻞ ﺑﻪ ﻣﺼﺮﻑ ﺳﻴﮕﺎﺭ ﻻﻳﺖ ﻭ ﺍﻭﻟﺘﺮﺍﻻﻳﺖ ﺑﺎ ﮔﻤﺎﻥ ﮐﻢ ﺧﻄﺮ ﺑﻮﺩﻥ ﺁﻥ، ﺑﺮﺭﺳﻲ ﺍﺭﺗﺒﺎﻁ ﺍﺑﺘﻼ ﺑﻪ ﺑﺮﮔﺮ ﺑﺎ ﻧﻮﻉ ﻣﺤﺼﻮﻻﺕ ﺩﺧﺎﻧﻲ ﻣﺼﺮﻓﻲ ﻻﺯﻡ ﺑﻨﻈﺮ ﻣﻲ ﺭﺳﺪ ﮐﻪ ﺩﺭ ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﻪ ﺁﻥ ﭘﺮﺩﺍﺧﺘﻪ ﺍﻳﻢ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺩﺭ ﺍﻳﻦ ﺗﺤﻘﻴﻖ ﮔﺬﺷﺘﻪ ﻧﮕﺮ ﻣﺎ ﺑﻪ ﺑﺮﺭﺳﻲ 100 ﺑﻴﻤﺎﺭ ﮐﻪ ﺩﺭ ﻣﺪﺕ ﺯﻣﺎﻥ ﻳﮏ ﺳﺎﻝ ﺑﺎ ﺷﮑﺎﻳﺖ ﺑﻴﻤﺎﺭﻱ ﺑﺮﮔﺮ ﺩﺭ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﻫﺎﻱ ﺷﻬﺪﺍﻱ ﺗﺠﺮﻳﺶ ﻭ ﻃﺎﻟﻘﺎﻧﻲ ﺑﺴﺘﺮﻱ ﺑﻮﺩﻧﺪ، ﭘﺮﺩﺍﺧﺘﻴﻢ. 5 ﺑﻴﻤﺎﺭ ﺑﻪ ﺧﺎﻃﺮ ﺑﻴﻤﺎﺭﻱ ﻫﺎﻱ ﺯﻣﻴﻨﻪ ﺍﻱ ﻫﻤﺮﺍﻩ ﺍﺯ ﻃﺮﺡ ﺧﺎﺭﺝ ﺷﺪﻧﺪ. ﺍﻃﻼﻋﺎﺕ ﺍﻳﻦ ﺑﻴﻤﺎﺭﺍﻥ ﺗﻮﺳﻂ ﭘﺮﺳﺸﻨﺎﻣﻪ ﺑﻪ ﻭﺳﻴﻠﻪ ﺳﻮﺍﻝ ﻣﺴﺘﻘﻴﻢ ﭘﺮﺳﺸﮕﺮ ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ ﮔﺮﺩﺁﻭﺭﻱ ﺷﺪﻩ ﺍﺳﺖ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺩﺭ ﺍﻳﻦ ﺗﺤﻘﻴﻖ ﻣﺎ 95 ﺑﻴﻤﺎﺭ ﮐﻪ ﻭﺍﺭﺩ ﺍﻳﻦ ﺗﺤﻘﻴﻖ ﺷﺪﻧﺪ ﺭﺍ ﺑﺮﺭﺳﻲ ﮐﺮﺩﻳﻢ. ﻣﺘﻮﺳﻂ ﺳﻨﻲ ﺑﻴﻤﺎﺭﺍﻥ 42 ﺳﺎﻝ )75 -26 ﺳﺎﻝ( ﺑﻮﺩ. ﻣﺘﻮﺳﻂ ﺯﻣﺎﻥ ﻣﺼﺮﻑ ﺳﻴﮕﺎﺭ 0/2 ± 21 ﺳﺎﻝ )6 ﺗﺎ 57 ﺳﺎﻝ( ﺑﻮﺩ. ﺁﺧﺮﻳﻦ ﺳﻴﮕﺎﺭ ﻣﺼﺮﻓﻲ ﺩﺭ 29 ﺑﻴﻤﺎﺭ ﺳﻴﮕﺎﺭﻫﺎﻱ ﻻﻳﺖ ﻭ ﺍﻭﻟﺘﺮﺍ ﻻﻳﺖ ﺑﻮﺩ ﻭ 31 ﻧﻔﺮ ﺳﻴﮕﺎﺭﻫﺎﻱ ﺍﻳﺮﺍﻧﻲ ﻓﻴﻠﺘﺮﺩﺍﺭ ﻭ 21 ﻧﻔﺮ ﺳﻴﮕﺎﺭﻫﺎﻱ ﺧﺎﺭﺟﻲ ﻓﻴﻠﺘﺮﺩﺍﺭ ﻭ 13 ﻧﻔﺮ ﺳﻴﮕﺎﺭﻫﺎﻱ ﺍﻳﺮﺍﻧﻲ ﻏﻴﺮ ﻓﻴﻠﺘﺮﺩﺍﺭ ﻣﺼﺮﻑ ﻣﻲ ﮐﺮﺩﻧﺪ. ﻣﺘﻮﺳﻂ ﺯﻣﺎﻥ ﻣﺼﺮﻑ ﺁﺧﺮﻳﻦ ﻧﻮﻉ ﺳﻴﮕﺎﺭ ﻣﺼﺮﻓﻲ ﻗﺒﻞ ﺍﺯ ﺑﺮﻭﺯ ﺑﻴﻤﺎﺭﻱ ﺑﺮﮔﺮ 2±0/2 ﺳﺎﻝ ﺑﻮﺩ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﻧﺘﺎﻳﺞ ﺣﺎﺻﻞ ﺍﺯ ﺑﺮﺭﺳﻲ ﻣﺎ ﻧﺸﺎﻥ ﻣﻲ ﺩﻫـﺪ ﺑﺮ ﺧﻼﻑ ﺗﺼﻮﺭ ﺟﺎﻣﻌﻪ ﺍﻳﻦ ﻧﻮﻉ ﺳﻴـﮕﺎﺭﻫﺎﻱ ﻻﻳﺖ ﻭ ﺍﻭﻟﺘـﺮﺍ ﻻﻳﺖ ﻧﻴﺰ ﺍﺛـﺮﺍﺕ ﻣﺨـﺮﺑﻲ ﻣﺸﺎﺑﻪ ﺑﺎ ﺳﻴـﮕﺎﺭﻫﺎﻱ ﻣﻌﻤـﻮﻟﻲ ﺩﺭ ﺳﻼﻣﺖ ﺍﻧﺴﺎﻥ ﺍﺯ ﺟﻤﻠﻪ ﺍﺑﺘﻼ ﺑﻪ ﺑﻴﻤـﺎﺭﻱ ﺑﺮﮔـﺮ ﺩﺍﺭﻧﺪ ﻭ ﺗﺤﻘﻴﻘـﺎﺕ ﺑﻴﺸﺘﺮ ﺩﺭ ﺯﻣﻴﻨﻪ ﻣﻘﺎﻳﺴﻪ ﺩﻗﻴﻖ ﺗﺮ ﻣﻴﺰﺍﻥ ﺗﺄﺛﻴـﺮ ﺳﻴﮕﺎﺭﻫﺎﻱ ﻻﻳﺖ ﻭ ﺍﻭﻟﺘـﺮﺍ ﻻﻳﺖ ﻣﻮﺟـﻮﺩ ﺩﺭ ﮐﺸﻮﺭ ﻭ ﺳﻴﮕﺎﺭﻫﺎﻱ ﻣﻌﻤﻮﻟﻲ ﺑﺮﺍﻱ ﺍﻳﺠﺎﺩ ﺍﺳﺘﻌﺪﺍﺩ ﺑﻪ ﺍﺑﺘﻼ ﺑﻪ ﺑﻴﻤـﺎﺭﻱ ﺑﺮﮔﺮ ﺿﺮﻭﺭﻱ ﺍﺳﺖ.

Introduction & Objective: Buerger’s diseases are an acute inflammation and thrombosis of arteries and veins of the hands and the feet. It is strongly associated with use of tobacco products. Buerger’s patients are mostly young males (below40-45 years old) who are a heavy cigarette smokers. More recently, however, a higher percentage of woman and people over the age of 50 have been recognized to have this disease. Buerger’s disease is most common in the Orient, Southeast Asia, India and the Middle East, but appears to be rare among African-Americans. People prefer to use light or ultra light cigarettes rather than full flavor cigarette because they think those products are less harmful. In this study, we have attempted in this study to assess the relation of buerger’s disease with the kind of tobacco product usage. Materials & Methods: In this retrospective study we evaluated 100 patients with buerger’s disease, in a period of one year at Shohada Tajrish hospital and Talaghani hospital. Because of underlying associated diseases five patients were excluded from our study. Data of these patients were gathered by through a direct questioning of the patients. Results: We evaluated 95 patients in this project. The mean age of the patients was 42 years (26-75 /years). Mean duration of smoking was 21± 0.2 years (6- 57 / years). Last smoked cigarette in 29 persons was light or ultra light, 31 persons smoked full flavor and filtered Iranian cigarette, 21 persons smoked full flavor and filtered foreign cigarette, and 13 persons used non-filtered Iranian cigarette. The mean duration of usage of last cigarette brand before the onset of buerger’s disease was 2±0.2 years. Conclusions: The results of our study show that contrary to what is thought in our society light and ultra light cigarettes have the same detrimental effects on human health, including buerger’s disease, as full flavor cigarettes. Further research is needed for a more precise comparison of the effect of light and ultra-light cigarettes with and ordinary ones, available in the country, as far as leading to buerger’s disease is concerned