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Investigating the effects of fluoxetine on cortisol and thyroid hormone levels in rats

Authors:

Abstract

Introduction: Fluoxetine or Prozac is a serotonin reuptake inhibitor (SSRI). Considering the importance of this drug for the treatment of neurological disorder, such as anorexia and depression; its side effects on the endocrine axis of body are of significance. Hence, the present study was conducted to evaluate the effects of fluoxetine on cortisol and thyroid hormone levels and body weight in male rates. Methods: In this experimental study, 30 adult male rats (230±20 gr BW) were randomly divided into 3 equal groups: sham, control and treatment. Rats in the control group were kept in normal conditions in animal house, whereas treatment and sham groups were, respectively, injected 32 mg/kg BW of fluoxetine and 0.9 ml of normal saline (i.p) for 35 days. During this time, body weight of all animal was measured and after 35 days, blood was collected by heart puncture and separation of serums to evaluate T3, T4, fT3, fT4, and cortisol hormones through RIA method. The results were statisticaly evaluated by one-way ANOVA test. Results: Taking fluoxetine for 35 days significantly decreased the level (p≤0.05) in serum concentrations of Ft3, fT4, T4 and cortisol hormones compared to the control and sham groups. However, no significant differences were observed in the serum concentration of T3 hormone in treatment group compared to the the control group. The drug also caused a significant decrease in the average weight ofrats in the treatment group compared to the control group (p≤ 0.05). Conclusion: By affecting the activity of different levels of hypothalamus-pituitary-adrenal hormones axis, fluoxetin decreases the level of cortisol hormones. It also reduces the activity of the thyroid gland; this is probably due to the increased prolactin secretion through inhibiting TRH secretion and reducing the production of TSH and thyroid hormones. Keywords: Cortisol, Fluoxetine, Male rats, Thyroid hormone
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Original Article ) AMUJ(Arak Medical University Journal 2014; 17(83): 82-89
Investigating the effects of fluoxetine on cortisol and thyroid hormone levels
in rats
Hashemi SS1*, Jelodar GA2, Rafati AR3
1. Shiraz Burn Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
2. Department of Basic Sciences, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
3. Department of Pharmacology, Islamic Azad University of Sarvestan, Sarvestan, Iran
Received: 21 Oct 2013, Accepted: 5 March 2014
Abstract
Introduction: Fluoxetine or Prozac is a serotonin reuptake inhibitor (SSRI). Considering the
importance of this drug for the treatment of neurological disorder, such as anorexia and depression; its
side effects on the endocrine axis of body are of significance. Hence, the present study was conducted
to evaluate the effects of fluoxetine on cortisol and thyroid hormone levels and body weight in male
rates. Methods: In this experimental study, 30 adult male rats (230±20 gr BW) were randomly
divided into 3 equal groups: sham, control and treatment. Rats in the control group were kept in
normal conditions in animal house, whereas treatment and sham groups were, respectively, injected 32
mg/kg BW of fluoxetine and 0.9 ml of normal saline (i.p) for 35 days. During this time, body weight
of all animal was measured and after 35 days, blood was collected by heart puncture and separation of
serums to evaluate T3, T4, fT3, fT4, and cortisol hormones through RIA method. The results were
statisticaly evaluated by one-way ANOVA test.
Results: Taking fluoxetine for 35 days significantly decreased the level (p≤0.05) in serum
concentrations of Ft3, fT4, T4 and cortisol hormones compared to the control and sham groups.
However, no significant differences were observed in the serum concentration of T3 hormone in
treatment group compared to the the control group. The drug also caused a significant decrease in the
average weight of rats in the treatment group compared to the control group (p≤ 0.05).
Conclusion: By affecting the activity of different levels of hypothalamus-pituitary-adrenal
hormones axis, fluoxetin decreases the level of cortisol hormones. It also reduces the activity of the
thyroid gland; this is probably due to the increased prolactin secretion through inhibiting TRH
secretion and reducing the production of TSH and thyroid hormones.
Keywords: Cortisol, Fluoxetine, Male rats, Thyroid hormone
*Corresponding author:
Address: Shiraz Burn Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
E-mail: sara_hashemi@sums.ac.ir
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كارا ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ﯽﺸﻫوﮋﭘ ﯽﻤﻠﻋ ﻪﻠﺠﻣ ﯽﺸﻫوﮋﭘ ﻪﻟﺎﻘﻣ
لﺎﺳ
17
هرﺎﻤﺷ ،
2)
ﯽﭘﺎﯿﭘ هرﺎﻤﺷ
83(
،ﺖﺸﻬﺒﯾدرا
1393
،
89-82
نﻮﻣرﻮﻫ ناﺰﯿﻣ ﺮﺑ ﻦﯿﺘﺴﮐﻮﻠﻓ ﺮﯿﺛﺎﺗ ﯽﺳرﺮﺑ رد لﺰﯿﺗرﻮﮐ و يﺪﯿﺋوﺮﯿﺗ يﺎﻫ
شﻮﻣ ﯽﯾاﺮﺤﺻ يﺎﻫ
ﯽﻤﺷﺎﻫ ارﺎﺳ هﺪﯿﺳ
*1
،رادﻮﻠﺟ ﯽﻠﻌﻣﻼﻏ
2
ﻋ ،ﯽﺘﻌﻓر ﺎﺿر ﯽﻠ
3
1 .ناﺮﯾا ،زاﺮﯿﺷ ،زاﺮﯿﺷ ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،زاﺮﯿﺷ ﯽﮕﺘﺧﻮﺳ تﺎﻘﯿﻘﺤﺗ ﺰﮐﺮﻣ ،رﺎﯾدﺎﺘﺳا 2 .ناﺮﯾا ،زاﺮﯿﺷ ،زاﺮﯿﺷ هﺎﮕﺸﻧاد ،ﻪﯾﺎﭘ مﻮﻠﻋ هوﺮﮔ ،دﺎﺘﺳا
3 .ناﺮﯾا ،نﺎﺘﺳوﺮﺳ ،نﺎﺘﺳوﺮﺳ ﺪﺣاو ﯽﻣﻼﺳا دازآ هﺎﮕﺸﻧاد ،يژﻮﻟﻮﮐﺎﻣرﺎﻓ هوﺮﮔ ،ﯽﺑﺮﻣ
ﺖﻓﺎﯾرد ﺦﯾرﺎﺗ: 29/7/92ﺮﯾﺬﭘ ﺦﯾرﺎﺗ ش :14/12/92
هﺪﯿﮑﭼ
فﺪﻫ و ﻪﻨﯿﻣز :ﯽﻣ ﻦﯿﻧﻮﺗوﺮﺳ دﺪﺠﻣ بﺬﺟ هﺪﻨﻨﮐرﺎﻬﻣ ﻦﯿﺘﺴﮐﻮﻠﻓ ﺎﯾ كازوﺮﭘ يوراد ﺪﺷﺎﺑ . رد وراد ﻦﯾا ﺖﯿﻤﻫا ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ
يرﺎﻤﯿﺑ نﺎﻣرد يﺎﻫرﻮﺤﻣ ﺮﺑ نآ ﯽﺒﻧﺎﺟ تاﺮﺛا ﯽﮔدﺮﺴﻓا و ﯽﺒﺼﻋ ﯽﯾﺎﻬﺘﺷا ﺮﭘ ،ﻪﺘﺳاﻮﺧﺎﻧ ساﻮﺳو تﻻﻼﺘﺧا ﻞﺜﻣ ﯽﺒﺼﻋ يﺎﻫ
ﺖﺳا ﻢﻬﻣ رﺎﯿﺴﺑ نﺪﺑ ﯽﻨﯾﺮﮐوﺪﻧا .نﻮﻣرﻮﻫ ناﺰﯿﻣ ﺮﺑ ﻦﯿﺘﺴﮐﻮﻠﻓ يوراد ﺮﯿﺛﺎﺗ رﻮﻈﻨﻣ ﻪﺑ ﻪﻌﻟﺎﻄﻣ ﻦﯾا و لﺰﯿﺗرﻮﮐ ،يﺪﯿﺋوﺮﯿﺗ يﺎ
ﺖﺳا هﺪﺷ مﺎﺠﻧا ﺮﻧ ﯽﯾاﺮﺤﺻ شﻮﻣ رد نزو تاﺮﯿﯿﻐﺗ.
شور و داﻮﻣ ﺎﻫ: ،ﯽﺑﺮﺠﺗ ﻪﻌﻟﺎﻄﻣ ﻦﯾا رد 30 ﯽﺒﯾﺮﻘﺗ نزو ﺎﺑ ﻎﻟﺎﺑ ﺮﻧ ﯽﯾاﺮﺤﺻ شﻮﻣ ﺮﺳ 20±230 ﻪﺑ و بﺎﺨﺘﻧا مﺮﮔ 3 هوﺮﮔ 10ﯽﯾﺎﺗ )ﺎﻣرد و ﺪﻫﺎﺷ ،لﺮﺘﻨﮐن (ﺪﻧﺪﺷ ﻢﯿﺴﻘﺗ .ﺪﻧﺪﺷ يراﺪﻬﮕﻧ تﺎﻧاﻮﯿﺣ ﻪﻧﺎﺧ رد ﯽﻌﯿﺒﻃ ﻂﯾاﺮﺷ رد ،لﺮﺘﻨﮐ هوﺮﮔ . ﺪﻫﺎﺷ هوﺮﮔ
تﺪﻣ ﻪﺑ ﻪﻧازور ،نﺎﻣرد و35 ،ﺐﯿﺗﺮﺗ ﻪﺑ زور 9/0ﯽﻠﯿﻣ و يژﻮﻟﻮﯾﺰﯿﻓ مﺮﺳ ﺮﺘﯿﻟ32ﯽﻠﯿﻣ مﺮﮔﻮﻠﯿﮐ ﺮﻫ يازا ﻪﺑ ﻦﯿﺘﺴﮐﻮﻠﻓ مﺮﮔ
ﺪﻧدﺮﮐ ﺖﻓﺎﯾرد ﯽﻗﺎﻔﺻ نورد ﻖﯾرﺰﺗ ترﻮﺻ ﻪﺑ ،نﺪﺑ نزو .و تﺪﻣ ﻦﯾا لﻮﻃ ردشﻮﻣ نز و هﺪﺷ يﺮﯿﮔ هزاﺪﻧا ﺐﺗﺮﻣ رﻮﻃ ﻪﺑ ﺎﻫ
نﺎﯾﺎﭘ زا ﺪﻌﺑ35نﻮﺧ زور نﻮﻣرﻮﻫ ناﺰﯿﻣ ،مﺮﺳ يزﺎﺳاﺪﺟ زا ﺲﭘ و هﺪﻣآ ﻞﻤﻋ ﻪﺑ ﺐﻠﻗ زا يﺮﯿﮔ ،دازآ ﻦﯿﻧوﺮﯿﺗوﺪﯾ يﺮﺗ يﺎﻫ
ﺖﻓﺮﮔ راﺮﻗ ﺶﺠﻨﺳ درﻮﻣ ﯽﺳا ﻮﻨﻤﯾا ﻮﯾدار شور ﻪﺑ لﺰﯿﺗرﻮﮐ و دازآ ﻦﯿﺴﮐوﺮﯿﺗ ،ﻦﯿﺴﮐوﺮﯿ . يرﺎﻣآ ﺮﻈﻧ زا تﺎﺸﯾﺎﻣزآ ﺞﯾﺎﺘﻧ
ﺳﻮﺗﺖﻓﺮﮔ راﺮﻗ ﯽﺑﺎﯾزرا درﻮﻣ اوﻮﻧآ ﻪﻓﺮﻃ ﮏﯾ ﺲﻧﺎﯾراو ﺰﯿﻟﺎﻧآ نﻮﻣزآ ﻂ .
ﻪﺘﻓﺎﯾ ﺎﻫ: تﺪﻣ رد ﻦﯿﺘﺴﮐﻮﻠﻓ فﺮﺼﻣ 35ﻄﺳ رد يراد ﯽﻨﻌﻣ ﺶﻫﺎﮐ ﺚﻋﺎﺑ زور )05/0p (نﻮﻣرﻮﻫ ﯽﻣﺮﺳ ﺖﻈﻠﻏ رد يﺎﻫ
ﻣ فﻼﺘﺧا ﺎﻣا ،ﺪﺷ ﺪﻫﺎﺷ و لﺮﺘﻨﮐ هوﺮﮔ ﻪﺑ ﺖﺒﺴﻧ لﺰﯿﺗرﻮﮐ و دازآ ﻦﯿﺴﮐوﺮﯿﺗ ،ﻦﯿﺴﮐوﺮﯿﺗ ،دازآ ﻦﯿﻧوﺮﯿﺗوﺪﯾ يﺮﺗ رد يراد ﯽﻨﻌ
ﺪﯾدﺮﮕﻧ هﺪﻫﺎﺸﻣ لﺮﺘﻨﮐ هوﺮﮔ ﻪﺑ ﺖﺒﺴﻧ نﺎﻣرد هوﺮﮔرد دازآ ﻦﯿﺋوﺮﯿﺗوﺪﯾ يﺮﺗ نﻮﻣرﻮﻫ ﯽﻣﺮﺳ ﺖﻈﻠﻏ .ﻢﻫ وراد فﺮﺼﻣ ﻦﯿﻨﭼ
شﻮﻣ نزو ﻦﯿﮕﻧﺎﯿﻣ رد يراد ﯽﻨﻌﻣ ﺶﻫﺎﮐ ﺐﺒﺳ ﺪﯾدﺮﮔ لﺮﺘﻨﮐ هوﺮﮔ ﻪﺑ ﺖﺒﺴﻧ نﺎﻣرد هوﺮﮔ يﺎﻫ)05/0p .(
ﻪﺠﯿﺘﻧ يﺮﯿﮔ:ﻮﺤﻣ ﻒﻠﺘﺨﻣ حﻮﻄﺳ ﺖﯿﻟﺎﻌﻓ ﺮﺑ ﺮﯿﺛﺎﺗ ﺎﺑ ﻦﯿﺘﺴﮐﻮﻠﻓ سﻮﻣﻻﺎﺗﻮﭙﯿﻫ ر-ﺰﯿﻓﻮﭙﯿﻫ - نﻮﻣرﻮﻫ ﺢﺷﺮﺗ ناﺰﯿﻣ ،لﺎﻧردآ
ﯽﻣ ﺶﻫﺎﮐ ار لوﺰﯿﺗرﻮﮐ ﺪﻫد .ﻢﻫ ﻦﯿﺘﮐﻻوﺮﭘ ﺢﺷﺮﺗ ﺶﯾاﺰﻓا زا ﯽﺷﺎﻧ ﻻﺎﻤﺘﺣا ﻪﮐ هﺪﺷ ﺪﯿﺋوﺮﯿﺗ هﺪﻏ ﺖﯿﻟﺎﻌﻓ ﺶﻫﺎﮐ ﺚﻋﺎﺑ ﻦﯿﻨﭼ
ﺶﻫﺎﮐ و ﻦﯿﭘوﺮﺗوﺮﯿﺗ هﺪﻨﻨﮐ دازآ نﻮﻣرﻮﻫ ﺢﺷﺮﺗ رﺎﻬﻣ ﻖﯾﺮﻃ ﻦﯾا زا و وراد ﻦﯾا ﻂﺳﻮﺗ نﻮﻣرﻮﻫ و ﻦﯿﭘوﺮﺗوﺮﯿﺗ ﺪﯿﻟﻮﺗ يﺎﻫ
ﺖﺳا هﺪﺷ يﺪﯿﺋوﺮﯿﺗ.
نﺎﮔژاو يﺪﯿﻠﮐ:نﻮﻣرﻮﻫ ،ﺮﻧ ﯽﯾاﺮﺤﺻ شﻮﻣ ،ﻦﯿﺘﺴﮐﻮﻠﻓ ،لﺰﯿﺗرﻮﮐ يﺪﯿﺋوﺮﯿﺗ يﺎﻫ
*لﻮﺌﺴﻣ هﺪﻨﺴﯾﻮﻧ:زاﺮﯿﺷ ﯽﮕﺘﺧﻮﺳ تﺎﻘﯿﻘﺤﺗ ﺰﮐﺮﻣ ،زاﺮﯿﺷ ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،زاﺮﯿﺷ
Email: sara_hashemi@sums.ac.ir
و يﺪﯿﺋﺮﯿﺗ يﺎﻫ نﻮﻣرﻮﻫ ناﺰﯿﻣ ﺮﺑ ﻦﯿﺘﺴﮐﻮﻠﻓ ﺮﯿﺛﺎﺗ ﯽﺳرﺮﺑ ...نارﺎﮑﻤﻫ و ﯽﻤﺷﺎﻫ ارﺎﺳ هﺪﯿﺳ
لﺎﺳ ،كارا ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ﯽﺸﻫوﮋﭘ ﯽﻤﻠﻋ ﻪﻠﺠﻣﻢﻫﺪﻔﻫ هرﺎﻤﺷ ،2 ، ﺖﺸﻬﺒﯾدرا1393 84
ﻪﻣﺪﻘﻣ
تﻻﻼﺘﺧا ﯽﮔدﺮﺴﻓا ﯽﮑﯾ زا ﯾﺎﺷ ﻦﯾﺮﺗ تﻻﻼﺘﺧا
اورن ﺖﺳا ﯽﮑﺷﺰﭘ ﻪﮐ10-25 و نﺎﻧز زا ﺪﺻرد 5-12
زا ﺪﺻرد نادﺮﻣ رد لﻮﻃ ﺮﻤﻋ ﻪﺑ نآ ﯽﻣ رﺎﭼد ﺪﻧﻮﺷ .مﺪﻋ
نﺎﻣرد ﻦﯾا ،لﻼﺘﺧا ﺐﯿﺳآ يﺎﻫ ﯽﻧاور و ﯽﻋﺎﻤﺘﺟا ضراﻮﻋ و
يدﺎﺼﺘﻗا يرﺎﯿﺴﺑ ياﺮﺑ نارﺎﻤﯿﺑ دﺎﺠﯾا ﯽﻣ ﺪﻨﮐ . نﺎﻣرد ياﺮﺑ
ﯽﻣ فﺮﺼﻣ ﯽﻔﻠﺘﺨﻣ يﺎﻫوراد تﻻﻼﺘﺧا ﻦﯾا رﻮﻃ ﻪﺑ ﻪﮐ دﻮﺷ
سﺎﺳا ﺮﺑ هﺪﻤﻋﻞﻗﺎﻧ دﺮﮑﻠﻤﻋ ﻞﯾﺪﻌﺗ هﮋﯾو ﻪﺑ ﺰﻐﻣ ﯽﺒﺼﻋ يﺎﻫ
ﯽﻣ ﻪﺘﺧﺎﺳ ﻦﯿﻣﺎﭘود و ﻦﯾﺮﻔﻧ ﯽﭘارﻮﻧ ،ﻦﯿﻧﻮﺗوﺮﺳ دﻮﺷ)1 ،2( .
ﻦﯿﻧﻮﺗﺮﺳ)5- Hydroxytryptamine- 5HT ( زا ﯽﮑﯾ
ﻢﻬﻣ هﺰﯿﮕﻧا لﺎﻘﺘﻧا ﺐﺟﻮﻣ ﻪﮐ ﺖﺳا يداﻮﻣ ﻦﯾﺮﺗ مﺎﯿﭘ و ﺎﻫ يﺎﻫ
ﯽﻣ ﯽﺒﺼﻋ هدﺎﻣ ﻊﻗاو رد و دﻮﺷ ار نآ ﺰﻐﻣ ﻪﮐ ﺖﺳا ﯽﻌﯿﺒﻃ يا
ﯽﻣ ﺪﯿﻟﻮﺗ ﺪﻨﮐدراد ﺶﺨﺑ مارآ و ﯽﮔدﺮﺴﻓا ﺪﺿ ﺖﯿﺻﺎﺧ و .
،ﯽﮔدﺮﺴﻓا زوﺮﺑ ﺐﺟﻮﻣ ﻦﯿﻧﻮﺗﺮﺳ ناﺰﯿﻣ ﺶﻫﺎﮐ ﻦﯾا ﺮﺑﺎﻨﺑ
ﯽﻣ ﯽﺑاﻮﺧ ﯽﺑ و باﺮﻄﺿا ددﺮﮔ .زا ﻦﯿﺘﺴﮐﻮﻠﻓ ﺮﺑ ﺮﯿﺛﺄﺗ ﻖﯾﺮﻃ
ار دﻮﺧ ﺮﺛا ،ﻦﯿﻧﻮﺗوﺮﺳ يور ﯽﻣ لﺎﻤﻋا ﺮﻈﻧ زا و ﺪﻨﮐ
بﺬﺟ زﺎﺑ رﺎﻬﻣ ﺐﺒ ﯽﺑﺎﺨﺘﻧا رﻮﻃ ﻪﺑ ﮏﯾژﻮﻟﻮﯾﺰﯿﻓ
ﻦﯿﺋﻮﺗوﺮﺳ)Selective serotonin reuptake inhibitor -
SSRI ( جرﺎﺧ رد ﻦﯿﻧﻮﺗﺮﺳ ناﺰﯿﻣ ﺶﯾاﺰﻓا و ﺐﺼﻋ يﺎﻬﺘﻧا رد
ﯽﻣ لﻮﻠﺳ هداﻮﻧﺎﺧ ﺰﺟ و ددﺮﮔ SSRIﯽﻣ ﺪﺷﺎﺑ . ءﺰﺟ وراد ﻦﯾا
فﺮﺼﻣﺮﭘ ﮏﯾ ناﻮﻨﻪﺑ ﯽﻌﯿﺳو رﻮﻃ ﻪﺑ و هدﻮﺑ ﺎﻫوراد ﻦﯾﺮﺗ
دﻮﺷ ﯽﺰﯾﻮﺠﺗ ﯽﮔدﺮﺴﻓا ﺪﺿ يوراد)1 ،2( . ﺖﺳا مزﻻ ﻪﺘﺒﻟا
هداﻮﻧﺎﺧ ﻦﯾا يﺎﻫوراد ﻪﮐ ﻢﯿﻧاﺪﺑﻞﻗﺎﻧ يور ﺮﮕﯾد ﯽﺒﺼﻋ يﺎﻫ
ﺪﻧراد ﺮﺛا ﻢﻫ .ﯽﻧﻻﻮﻃ ﻦﯿﺘﺴﮐﻮﻠﻓ ﺮﻤﻋ ﻪﻤﯿﻧ ﻦﯾﺮ)26-220
ﺖﻋﺎﺳ (دراد هداﻮﻧﺎﺧ ﻦﯾا رد ار . ﻞﯿﻟد ﻪﺑ ﯽﻧﻻﻮﻃ ﺮﻤﻋ ﻪﻤﯿﻧ ﻦﯾا
ﯽﻣ ﻦﯿﺘﺴﮐﻮﻠﻓرﻮﻧ مﺎﻧ ﻪﺑ لﺎﻌﻓ ﺖﯿﻟﻮﺑﺎﺘﻣ ﮏﯾ دﻮﺟو ﺪﺷﺎﺑ . مﺎﻤﺗ
ةداﻮﻧﺎﺧ يﺎﻫورادSSRI ﯽﺑﻮﺧ ﻪﺑ ﯽﮐارﻮﺧ فﺮﺼﻣ زا ﺲﭘ
ﯾز ناﺰﯿﻣ ﻪﺑ و هﺪﺷ بﺬﺟﯽﻣ هﺰﯿﻟﻮﺑﺎﺘﻣ ﺪﺒﮐ رد يدﺎ ﺪﻧﻮﺷ)3 ،4( .
رد ﯽﺗوﺎﻔﺘﻣ تاﺮﺛا ياراد ﻦﯿﺘﺴﮐﻮﻠﻓ ﻪﻠﻤﺟ زا ﺎﻫوراد ﻦﯾا
ﯽﺘﺣارﺎﻧ ،ﯽﮔدﺮﺴﻓا يرﺎﻤﯿﺑ نﺎﻣرد ،ﯽﮔﺪﻋﺎﻗ زا ﻞﺒﻗ يﺎﻫ
ﻪﯾﺬﻐﺗ تﻻﻼﺘﺧا و ﯽﺴﭘاﻮﻟد ﯽﺑ ﻪﻠﻤﺟ زا يا ﺦﻔﻧ و ﯽﯾﺎﻬﺘﺷا
ﺪﻨﺘﺴﻫ)5 ،6(ﻢﻧﺎﺧ رد ﻪﮐ لواﺪﺘﻣ نﺎﯾﺎﻗآ ﻪﺑ ﺖﺒﺴﻧ ﺎﻫ ﺖﺳا ﺮﺗ)7(.
رد ﺪﯾﺎﺑلﺎﺳ ﯽﻃ ﻪﮐ ﺖﺷاد ﺮﻈﻧ يدﺎﻤﺘﻣ يﺎﻫ
هدﻮﺑ حﺮﻄﻣ اﺬﻏ فﺮﺼﻣ هﺪﻨﻨﮐ ﻢﯿﻈﻨﺗ ﻞﻣﺎﻋ ناﻮﻨﻋ ﻪﺑ ﻦﯿﻧﻮﺗﺮﺳ
ﺖﺳا)8( . ﯽﺑ ﺐﺒﺳ ﯽﻌﯿﺳو رﻮﻃ ﻪﺑ ﻦﯿﺘﺴﮐﻮﻠﻓ ﻪﮐ هﺪﺷ ﺺﺨﺸﻣ
ﯽﻔﻨﻣ يژﺮﻧا ﺲﻧﻻﺎﺑ ﮏﯾ ﺪﯿﻟﻮﺗ ﺎﺑ ﯽﯾﺎﻬﺘﺷا) زا ﺖﻋﺎﻤﻣ ﺎﺑ
اﺬﻏ فﺮﺻ (ﯽﻣ ددﺮﮔ)9- 11( . ﺪﺿ يﺎﻫوراد ﻦﯿﺑ طﺎﺒﺗرا
ﻫ ﺰﮐﻮﻠﮔ ﻢﺴﯿﻟﻮﺑﺎﺘﻣ و ﯽﮔدﺮﺴﻓا ﻪﭼ ﺮﮔا ،ﺖﺴﯿﻧ ﺺﺨﺸﻣ زﻮﻨ
و ﺰﮐﻮﻠﮔ ﻢﺴﯿﻟﻮﺑﺎﺘﻣ ﺮﺑ ﯿﻘﺘﺴﻣ ﺮﯿﺛﺎﺗ ﯽﮔدﺮﺴﻓا ﺪﺿ يوراد
ﯽﺒﻧﺎﺟ تاﺮﺛا و نزو ﺶﯾاﺰﻓا ﻞﯿﺒﻗ زا نآ ﻪﺑ ﻪﺘﺴﺑاو يﺎﻫرﻮﺘﮐﺎﻓ
دراد نآ ﻪﺑ ﻪﺘﺴﺑاو ﻪﯾﻮﻧﺎﺛ)12( . ﺳا هﺪﺷ شراﺰﮔ
ﻦﯿﻠﺘﭘﺮﺗرﻮﻧ ﮏﯾﮋﻧردارﻮﻧ)Noradrenergic
Nortriptyline (ﯽﻣ ﯽﺘﺑﺎﯾد رد ار نﻮﺧ ﺪﻨﻗ ﺪﻧاﻮﺗ لﺮﺘﻨﮐ ﺎﻫ
ﺪﻨﮐ)13( . رد نزو لﺮﺘﻨﮐ ياﺮﺑ وراد ﻦﯾا ﺮﯿﺧا تﺎﻌﻟﺎﻄﻣ رد
تﺎﺷراﺰﮔ ﺪﻨﭼ ﺮﻫ ،ﻪﺘﻓﺮﮔ راﺮﻗ هدﺎﻔﺘﺳا درﻮﻣ قﺎﭼ داﺮﻓا
ﻦﯾا ﺮﺜﮐا ،ﺖﺳا هﺪﺷ ﻪﺋارا ﻪﻨﯿﻣز ﻦﯾا رد ﺖﯿﻘﻓﻮﻣ زا ﯽﺗوﺎﻔﺘﻣ
ﺪﻧراد ﺪﯿﮐﺎﺗ نزو ﺶﻫﺎﮐ ﺮﺑ نآ ندﻮﺑ ﺮﺛﻮﻣ ﺮﺑ تﺎﺷراﺰﮔ .
ﻪﯿﺿﺮﻓ وراد ﻦﯾا ﺮﯿﺛﺎﺗ ﺮﺑ لاد ﯽﻔﻠﺘﺨﻣ يﺎﻫ فﺮﺼﻣ ناﺰﯿﻣ ﺮ
دراد دﻮﺟو ﺎﻬﺘﺷا ناﺰﯿﻣ ﺶﻫﺎﮐ و اﺬﻏ)12(.
ﺖﯿﻌﻗﻮﻣ عاﻮﻧا لﻮﻃ رد سﺮﺘﺳا يﺎﻫ كﺮﺤﻣ ،از يﺎﻫ
نﻮﻣرﻮﻫ ﺢﺷﺮﺗ دﺎﺣ سﺮﺘﺳا و ﯽﻧﺎﺠﯿﻫ سﺮﺘﺳا يﺎﻫ
ﯽﻣ ﺶﯾاﺰﻓا لوﺰﯿﺗرﻮﮐ صﻮﺼﺧ ﺪﺑﺎﯾ .ﻬﻣ زا ،لوﺰﯿﺗرﻮﮐ ﻦﯾﺮﺗ
ﯽﻣ ﺎﻫﺪﯿﺋﻮﮑﯿﺗرﻮﮐﻮﮐﻮﻠﮔ زا ﯽﻌﯿﺒﻃ رﻮﻃ ﻪﺑ ﻪﮐ ﺪﺷﺎﺑ
ﻪﯿﻠﮐ قﻮﻓ هﺪﻏ ﺲﮑﺗرﻮﮐﯽﻣ ﺢﺷﺮ دﻮﺷ . ياﺮﺑ نﻮﻣرﻮﻫ ﻦﯾا
لﻮﻠﺳ عاﻮﻧا مﺎﻤﺗ ﯽﻌﯿﺒﻃ ﺖﯿﻟﺎﻌﻓ تروﺮﺿ تﺎﻧاﻮﯿﺣ رد ﺎﻫ دراد .
ﯽﻣاﺪﻗ بﻮﻟ زا ﻦﯿﭘﻮﺗﻮﮑﯿﺗرﻮﮐﻮﻧردآ ﺢﺷﺮﺗ ﻪﺑ ﺦﺳﺎ رد
هﺪﻧﺮﯿﮔ ﺎﺑ و هﺪﺷ دازآ لﺎﻧردآ ﺮﺸﻗ زا لوﺰﯿﺗرﻮﮐ ،ﺰﯿﻓﻮﭙﯿﻫ يﺎﻫ
ﯽﻣ ﺶﻨﮑﻤﻫ ﺮﺑ ﯽﺘﻓﺎﺑ ﺪﻫد)14( . نﺎﺸﻧ تﺎﻌﻟﺎﻄﻣ زا يداﺪﻌﺗ
ﯽﻣ ا ﯽﮔدﺮﺴﻓا ﻪﮐ ﺪﻫد دﺮﮑﻠﻤﻋ ﺮﺑ لﻼﺘﺧا ﺎﺑ هاﺮﻤﻫ ﺐﻠﻏ
سﻮﻣﻻﺎﺗﻮﭙﯿﻫ رﻮﺤﻣ-ﺰﯿﻓﻮﭙﯿﻫ- لﺎﻧردآ(Hypothalamus-
Pituitary-Adrenal -HPA) ﺢﺷﺮﺗ ﺶﯾاﺰﻓا و
لوﺰﯿﺗرﻮﮐ(CORT)ﺖﺳا . ﯽﮔدﺮﺴﻓا ﺪﺿ يﺎﻫوراد ﺮﺘﺸﯿﺑ
ﺶﯾاﺰﻓا ار ﻦﯿﻠﯿﺘﭘﺮﺗرﻮﻧ و ﻦﯿﻧﻮﺗﺮﺳ ﮏﯾژﺮﻨﯿﻣآﻮﻧﻮﻣ ناﺰﯿﻣ
ﯽﻣ سﻮﻣﻻﺎﺗﻮﭙﯿﻫ رﻮﺤﻣ دﺮﮑﻠﻤﻋ و ﺪﻨﻫد-ﺰﯿﻓﻮﭙﯿﻫ -آ ار لﺎﻧرد
ﯽﻣ ﻢﯿﻈﻨﺗ ﻦﯾا ﻦﯿﺑ ﯽﻠﺻا طﺎﺒﺗرا هﺪﻨﻫد نﺎﺸﻧ ﻦﯾا ﻪﮐ ﺪﻨﮐ
ﺖﺳا ﻦﯿﻟﻮﺴﻧا ﻪﺑ ﺖﺒﺴﻧ ﺖﻣوﺎﻘﻣ يرﺎﻤﯿﺑ و ﺎﻫوراد)14( .
و يﺪﯿﺋﺮﯿﺗ يﺎﻫ نﻮﻣرﻮﻫ ناﺰﯿﻣ ﺮﺑ ﻦﯿﺘﺴﮐﻮﻠﻓ ﺮﯿﺛﺎﺗ ﯽﺳرﺮﺑ ...نارﺎﮑﻤﻫ و ﯽﻤﺷﺎﻫ ارﺎﺳ هﺪﯿﺳ
لﺎﺳ ،كارا ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ﯽﺸﻫوﮋﭘ ﯽﻤﻠﻋ ﻪﻠﺠﻣﻢﻫﺪﻔﻫ هرﺎﻤﺷ ،2 ، ﺖﺸﻬﺒﯾدرا1393 85
ﯽﺧﺮﺑ دﺮﮑﻠﻤﻋ ياﺮﺑ دﻮﺧ هﺪﻨﻫد هزﺎﺟا ﻞﻤﻋ ﺎﺑ لوﺰﯿﺗرﻮﮐ
نﻮﻣرﻮﻫ ﺎﻫ)ﻦﯿﻣآ لﻮﮑﺗﺎﮐ ﺎﻫ ( ﺮﯾﺎﺳ ﺰﺘﻨﺳ ياﺮﺑ و
نﻮﻣرﻮﻫ ﺎﻫ)ﺪﺷر نﻮﻣرﻮﻫ (ﯽﻣ دﻮﺧ ﮏﯿﻧژﻮﺘﺑﺎﯾد ﺖﯿﻟﺎﻌﻓ ﺪﻨﻧاﻮﺗ
رﺪﻨﻫد مﺎﺠﻧا ا)15(.
نﺪﺑ نﻮﺧﺮﭘ و گرﺰﺑ دﺪﻏ زا ﯽﮑﯾ ﺪﯿﺋوﺮﯿﺗ هﺪﻏ
ﻦﯿﺴﮐوﺮﯿﺗ نﻮﻣرﻮﻫ ود ﻪﮐ ﺖﺳا)T4
( يﺮﺗ و
ﻦﯿﻧوﺮﯿﺗوﺪﯾ)T3
(ﯽﻣ ﺢﺷﺮﺗ و ﺪﯿﻟﻮﺗ ار يور ﺮﺑ ﻪﮐ ﺪﻨﮐ
ﺪﻧراد ﯽﯾاﺰﻪﺑ ﺮﯿﺛﺎﺗ نﺪﺑ ﻢﺴﯿﻟﻮﺑﺎﺘﻣ . ﺪﯿﺋوﺮﯿﺗ نﻮﻣرﻮﻫ ﺢﺷﺮﺗ
ﻦﯿﭘوﺮﺗوﺮﯿﺗ ﻂﺳﻮﺗ)Thyrotropin or Thyroid
stimulating hormone-TSH ( هﺪﺷ ﻢﯿﻈﻨﺗ ﺰﯿﻓﻮﭙﯿﻫ هﺪﻏ
ﻦﯿﭘوﺮﺗوﺮﯿﺗ هﺪﻨﻨﮐ دازآ نﻮﻣرﻮﻫ ﻂﺳﻮﺗ دﻮﺧ ﻪﮐ
سﻮﻣﻻﺎﺗﻮﭙﯿﻫ)Thyrotropin-Releasing Hormone -
TRH ( ﯽﻣﺮﺳ ﺖﻈﻠﻏ ﻂﺳﻮﺗ ﺮﺘﻤﮐ ناﺰﯿﻣ ﻪﺑ و هﺪﺷ ﮏﯾﺮﺤﺗ
نﻮﻣرﻮﻫ ﯽﻣ ﻢﯿﻈﻨﺗ ﺪﯿﺋوﺮﯿﺗ يﺎﻫ دﻮﺷ .ﺶﯿﺑ دازآ نﻮﻣﻮﻫ ﻦﯾﺮﺗ
ﺪﯿﺋوﺮﯿﺗ زا هﺪﺷT4
ﻢﻈﻋا ﺖﻤﺴﻗ و هدﻮﺑ T3
رد ﻪﮐ شدﺮ
ﯽﻣ ﺖﻓﺎﯾ نﻮﺧ ﺪﺒﮐ رد ﻦﯿﺴﮐوﺮﯿﺗ ﯽﻄﯿﺤﻣ ﻢﺴﯿﻟﻮﺑﺎﺘﻣ زا دﻮﺷ
ﯽﻣ ﻞﺻﺎﺣ دﻮﺷ)14 ،16( .ﻪﻨﯿﻣز رد ﻖﯿﻘﺤﺗ ﺞﯾﺎﺘﻧ ،ﯽﻤﯿﺷﻮﯿﺑ يﺎﻫ
دﺮﮑﻠﻤﻋ ﻦﯿﺑ طﺎﺒﺗرا هﺪﻨﻫد نﺎﺸﻧ يرادﺮﺑﺮﯾﻮﺼﺗ و ﮏﯿﺘﻧژ
ﺖﺳا ﯽﮔدﺮﺴﻓا يرﺎﻤﯿﺑ و ﺪﯿﺋوﺮﯿﺗ)17( . ﻖﯿﻘﺤﺗ ﻦﯾا فﺪﻫ اﺬﻟ
نﻮﻣرﻮﻫ ﯽﺧﺮﺑ تاﺮﯿﯿﻐﺗ ﯽﺳرﺮﺑ ﯿﻟﻮﺑﺎﺘﻣ ﺮﺑ ﺮﺛﻮﻣ يﺎﻫ ﺪﻨﻧﺎﻣ ﻢﺴ
نﻮﻣرﻮﻫ ﻦﯿﺘﺴﮐﻮﻠﻓ ﺰﯾﻮﺠﺗ ﺐﻗﺎﻌﺘﻣ لوﺰﯿﺗرﻮﮐ ،يﺪﯿﺋوﺮﯿﺗ يﺎﻫ
ﯽﻣ ﯽﻧاﻮﯿﺣ يﻮﮕﻟا ﮏﯾ رد ﺪﺷﺎﺑ.
شور و داﻮﻣ ﺎﻫ
داﺪﻌﺗ ،ﯽﺑﺮﺠﺗ ﻪﻌﻟﺎﻄﻣ ﻦﯾا مﺎﺠﻧا ﺖﻬﺟ30 ﺮﺳ
داﮋﻧ زا ﻎﻟﺎﺑ ﺮﻧ ﯽﯾاﺮﺤﺻ شﻮﻣSprague-Dawley نزو ﺎﺑ
ﯽﺒﯾﺮﻘﺗ20±230 تﺎﻧاﻮﯿﺣ شروﺮﭘ ﺰﮐﺮﻣ زا مﺮﮔ
ﮑﺷﺰﭘ هﺪﮑﺸﻧاد ﯽﻫﺎﮕﺸﯾﺎﻣزآﺪﯾدﺮﮔ ﻪﯿﻬﺗ . تﺎﻧاﻮﯿﺣ ﻪﯿﻠﮐ
يﺎﻣد رد22 دراﺪﻧﺎﺘﺳا يرﻮﻧ ﻂﯾاﺮﺷ رد و ﻪﺟرد 12 ﺖﻋﺎﺳ
و ﯽﯾﺎﻨﺷور12 اﺬﻏ و بآ ﻪﺑ و ﺪﻨﺘﻓﺮﮔ راﺮﻗ ﯽﮑﯾرﺎﺗ ﺖﻋﺎﺳ
ﺪﻨﺘﺷاد ﯽﺳﺮﺘﺳد ﯽﺘﯾدوﺪﺤﻣ ﭻﯿﻫ نوﺪﺑ و ﯽﻓﺎﮐ راﺪﻘﻣ ﻪﺑ .
رﺎﮐ درﻮﻣ رد ﯽﻠﻠﻤﻟا ﻦﯿﺑ ﻦﯿﻧاﻮﻗ سﺎﺳا ﺮﺑ ﻖﯿﻘﺤﺗ ﻦﯾا ﻞﮑﺗوﺮﭘ
و ﯽﻫﺎﮕﺸﯾﺎﻣزآ تﺎﻧاﻮﯿﺣ ﺎﺑ ﯽﻗﻼﺧا ﻦﯾزاﻮﻣ ﻞﻣﺎﮐ ﺖﯾﺎﻋر ﺎﺑ
ﺖﻓﺮﮔ مﺎﺠﻧا.
ﺖﻗد ﺎﺑ لﺎﺘﯿﺠﯾد يوزاﺮﺗ ﺎﺑ تﺎﻧاﻮﯿﺣ01/0 مﺮﮔ
و ﺪﻫﺎﺷ ،لﺮﺘﻨﮐ هوﺮﮔ ﻪﺳ ﻪﺑ ﯽﻓدﺎﺼﺗ ترﻮﺻ ﻪﺑ و هﺪﺷ نزو
ﺪﻧﺪﺷ ﻢﯿﺴﻘﺗ نﺎﻣرد . ﯽﯾوراد رﺎﻤﯿﺗ ﭻﯿﻫ لﺮﺘﻨﮐ هوﺮﮔ تﺎﻧاﻮﯿﺣ
ﺖﻓﺮﮕﻧ ترﻮﺻ ﺎﻬﻧآ يور ﺮﺑ ﯽﯾوراد ﺮﯿﻏ ﺎﯾ . هوﺮﮔ تﺎﻧاﻮﯿﺣ
ﻪﻧازور ﺪﻫﺎﺷ9/0ﻠﯿﻣ يژﻮﻟﻮﯾﺰﯿﻓ مﺮﺳ ﺮﺘﯿﻟ)وراد لﻼﺣ ( و
تﺪﻣ ﻪﺑ نﺎﻣرد هوﺮﮔ35 ناﺰﯿﻣ ﻪﺑ ﻪﻧازور ،زور 32ﯽﻠﯿﻣ مﺮ
ﺖﻋﺎﺳ رد و نﺪﺑ نزو مﺮﮔﻮﻠﯿﮐ ﺮﻫ يازا ﻪﺑ ﻦﯿﺘﺴﮐﻮﻠﻓ
ﻦﯿﻌﻣ)10ﺢﺒﺻ (ﺪﻧدﻮﻤﻧ ﺖﻓﺎﯾرد ﯽﻗﺎﻔﺻ ﻞﺧاد ترﻮﺻ ﻪﺑ . رد
شﻮﻣ نﺪﺑ نزو تﺪﻣ ﻦﯾا لﻮﻃ هزاﺪﻧا ﺐﺗﺮﻣ رﻮﻃ ﻪﺑ ﺎﻫ يﺮﯿﮔ
نﺎﯾﺎﭘ زا ﺪﻌﺑ و ﺪﺷ35 و زور8 ﻦﯾﺮﺧآ ﺖﻓﺎﯾرد زا ﺪﻌﺑ ﺖﻋﺎﺳ
ﯽﺑ زا ﺲﭘ و هدﺮﮐ نزو ار تﺎﻧاﻮﯿﺣ ،ﯽﯾوراد هﺪﻋو شﻮﻫ
ﺪﺷ مﺎﺠﻧا ﺐﻠﻗ زا يﺮﯿﮔ نﻮﺧ ،ندﺮﮐ . دوﺪﺣ شﻮﻣ ﺮﻫ زا3-
4ﯽﻠﯿﻣ ﻪﻟﻮﻟ رد نﻮﺧ ﺮﺘﯿﻟ ﻗﺎﻓ ﻪﮐ هﺪﺷ ﻞﯾﺮﺘﺳا ﺶﯾﺎﻣزآ يﺎﻫ
ﺪﺷ يروآ ﻊﻤﺟ دﻮﺑ دﺎﻘﻌﻧا ﺪﺿ هدﺎﻣ .نﻮﺧ ﻪﺑ هﺪﺷ ﻪﺘﻓﺮﮔ يﺎﻫ
تﺪﻣ15ﮑﻧا رد ﻪﻘﯿﻗد يﺎﻣد رد رﻮﺗﺎﺑﻮ37ﯽﺘﻧﺎﺳ ﻪﺟرد داﺮﮔ
ﺪﻧﺪﺷ هداد راﺮﻗ .ﻪﻧﻮﻤﻧ ،دﺎﻘﻌﻧا عﻮﻗو زا ﺪﻌﺑ ﻊﻤﺟ ﯽﻧﻮﺧ يﺎﻫ
تﺪﻣ ﻪﺑ هﺪﺷ يروآ15 ﺖﻋﺮﺳ ﺎﺑ ﻪﻘﯿﻗد 3000 ﻪﻘﯿﻗد رد رود
زا هدﺎﻔﺘﺳا ﺎﺑ ﺲﭙﺳ دﻮﺷ اﺪﺟ ﻪﺘﺨﻟ زا مﺮﺳ ﺎﺗ ﺪﺷ ژﻮﻔﯾﺮﺘﻧﺎﺳ
ﯽﻧﻮﻣرﻮﻫ ﺶﺠﻨﺳ نﺎﻣز ﺎﺗ و اﺪﺟ ﻪﺘﺨﻟ زا ﻪﻧﻮﻤﻧ ﺮﻫ مﺮﺳ ﺮﻠﭙﻤﺳ
يﺎﻣد رد20-ﯽﺘﻧﺎﺳ ﻪﺟرد ﺖﻈﻠﻏ يﺮﯿﮔ هزاﺪﻧا ياﺮﺑ داﺮﮔ
نﻮﻣرﻮﻫ ﯽﻣﺮﺳ يﺎﻫ دازآ ﻦﯿﻧوﺮﯿﺗ وﺪﯾ يﺮﺗ)freet3-Ft3
( ،
ﻦﯿﻧوﺮﯿﺗوﺪﯾ يﺮﺗ)T3
(دازآ ﻦﯿﺴﮐوﺮﯿﺗ ،)freeT4- Ft4
( ،
ﻦﯿﺴﮐوﺮﯿﺗ)T4
(ﺪﻧﺪﺷ يراﺪﻬﮕﻧ لوﺰﯿﺗرﻮﮐ نﻮﻣرﻮﻫ و .
هزاﺪﻧا و ﯽﺳاﻮﻧﻮﻤﯾاﻮﯾدار شور زا هدﺎﻔﺘﺳا ﺎﺑ ﯽﻧﻮﻣرﻮﻫ يﺮﯿﮔ
ﺖﯿﮐIMMUNOTEkﺎﺳ سﺎﺳاﺮﺑ و ﻪﺴﻧاﺮﻓ رﻮﺸﮐ ﺖﺧ
ﺖﻓﺮﮔ ترﻮﺻ ﺖﯿﮐ ﻞﻤﻌﻟارﻮﺘﺳد.
ﺰﯿﻟﺎﻧآ يرﺎﻣآ ﺖﺴﺗ زا هدﺎﻔﺘﺳا ﺎﺑ ﻞﺻﺎﺣ تﺎﻋﻼﻃا
راﺰﻓا مﺮﻧ ﮏﻤﮐ ﺎﺑ و اوﻮﻧآ فﺮﻃ ﮏﯾ ﺲﻧﺎﯾراوSPSS درﻮﻣ
ﺖﻓﺮﮔ راﺮﻗ ﯽﺑﺎﯾزرا .هداد ﻦﯿﮕﻧﺎﯿﻣ ترﻮﺻ ﻪﺑ ﺎﻫ± فاﺮﺤﻧا
زا ﺮﺘﻤﮐ ﺰﯿﻧ يراد ﯽﻨﻌﻣ ﺢﻄﺳ و هﺪﺷ نﺎﯿﺑ رﺎﯿﻌﻣ05/0 ﺮﻈﻧ رد
ﺷ ﻪﺘﻓﺮﮔ .
ﻪﺘﻓﺎﯾ ﺎﻫ
نﻮﻣرﻮﻫ ﯽﯾﺎﻤﺳﻼﭘ ﺖﻈﻠﻏ رﺎﯿﻌﻣ فاﺮﺤﻧا و ﻦﯿﮕﻧﺎﯿﻣ
ﯽﻠﯿﻣ رد مﺮﮔﻮﻧﺎﻧ ﺐﺴﺣ ﺮﺑ لوﺰﯿﺗرﻮﮐ ،لﺮﺘﻨﮐ هوﺮﮔ ياﺮﺑ ﺮﺘﯿﻟ
و يﺪﯿﺋﺮﯿﺗ يﺎﻫ نﻮﻣرﻮﻫ ناﺰﯿﻣ ﺮﺑ ﻦﯿﺘﺴﮐﻮﻠﻓ ﺮﯿﺛﺎﺗ ﯽﺳرﺮﺑ ...نارﺎﮑﻤﻫ و ﯽﻤﺷﺎﻫ ارﺎﺳ هﺪﯿﺳ
لﺎﺳ ،كارا ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ﯽﺸﻫوﮋﭘ ﯽﻤﻠﻋ ﻪﻠﺠﻣﻢﻫﺪﻔﻫ هرﺎﻤﺷ ،2 ، ﺖﺸﻬﺒﯾدرا1393 86
ﺐﯿﺗﺮﺗ ﻪﺑ نﺎﻣرد و ﺪﻫﺎﺷ308/3±555/14 ،668/3±62/15 و 879/1±371/3دﻮﺑ . رد لوﺰﯿﺗرﻮﮐ نﻮﻣرﻮﻫ ﺖﻈﻠﻏ ﻦﯿﮕﻧﺎﯿﻣ
ﻨﻌﻣ ﺮﯿﯿﻐﺗ ﺪﻫﺎﺷ و لﺮﺘﻨﮐ هوﺮﮔ ﻪﺑ ﺖﺒﺴﻧ نﺎﻣرد هوﺮﮔ
يراد)05/0p (داد نﺎﺸﻧ ار) لوﺪﺟ1 .(
نﻮﻣرﻮﻫ ناﺰﯿﻣ ﯽﺳرﺮﺑ رد ﺮﺛﻮﻣ يﺎﻫ T3
،fT3,
fT4,T4
ﺪﻣآ ﺖﺳد ﻪﺑ ﺮﯾز ﺞﯾﺎﺘﻧ . رﺎﯿﻌﻣ فاﺮﺤﻧا و ﻦﯿﮕﻧﺎﯿﻣ
نﻮﻣرﻮﻫ ﯽﯾﺎﻤﺳﻼﭘ ﺖﻈﻠﻏT3
ياﺮﺑ ﺮﺘﯿﻟ رد لﻮﻣﻮﻧﺎﻧ ﺐﺴﺣ ﺮﺑ
ﺐﯿﺗﺮﺗ ﻪﺑ نﺎﻣرد و ﺪﻫﺎﺷ ،لﺮﺘﻨﮐ هوﺮﮔ310/0±9005/0 ، 190/0±8844/0 و 239/0±9986/0 دﻮﺑ . ﺖﻈﻠﻏ ﻦﯿﮕﻧﺎﯿﻣ
نﻮﻣرﻮﻫT3 ار يراد ﯽﻨﻌﻣ ﺮﯿﯿﻐﺗ هوﺮﮔ رد ﺖﺒﺴﻧ نﺎﻣرد يﺎﻫ
ﯽﻤﻧ نﺎﺸﻧ ﺪﻫﺎﺷ و لﺮﺘﻨﮐ هوﺮﮔ ﻪﺑ ﺪﻫد) لوﺪﺟ1 .(
نﻮﻣرﻮﻫ ﯽﯾﺎﻤﺳﻼﭘ ﺖﻈﻠﻏ رﺎﯿﻌﻣ فاﺮﺤﻧا و ﻦﯿﮕﻧﺎﯿ
ﺪﻫﺎﺷ ،لﺮﺘﻨﮐ هوﺮﮔ ياﺮﺑ ﺮﺘﯿﻟ رد لﻮﻣﻮﻧﺎﻧ ﺐﺴﺣ ﺮﺑ ﻦﯿﺴﮐوﺮﯿﺗ
ﺐﯿﺗﺮﺗ ﻪﺑ نﺎﻣرد و079/7±125/65 ،141/11±125/59 و 935/8±571/38دﻮﺑ . ﺖﻈﻠﻏ رﺎﯿﻌﻣ فاﺮﺤﻧا و ﻦﯿﮕﻧﺎﯿﻣ
ياﺮﺑ ﺮﺘﯿﻟ رد مﺮﮔﻮﻧﺎﻧ ﺐﺴﺣ ﺮﺑ دازآ ﻦﯿﺴﮐوﺮﯿﺗ ﯽﯾﺎﻤﺳﻼﭘ
ﺐﯿﺗﺮﺗ ﻪﺑ نﺎﻣرد و ﺪﻫﺎﺷ ،لﺮﺘﻨﮐ هوﺮﮔ677/2±2375/17 ، 739/2±4625/15 و 888/3±3286/10دﻮﺑ . و ﻦﯿﮕﻧﺎﯿﻣ
وﺪﯾ يﺮﺗ نﻮﻣرﻮﻫ دازآ عﻮﻧ ﯽﯾﺎﻤﺳﻼﭘ ﺖﻈﻠﻏ رﺎﯿﻌﻣ فاﺮﺤﻧا
ﻦﯿﻧوﺮﯿﺗ)fT3
( ،لﺮﺘﻨﮐ هوﺮﮔ ياﺮﺑ ﺮﺘﯿﻟ رد مﺮﮔﻮﻧﺎﻧ ﺐﺴﺣ ﺮ
ﺐﯿﺗﺮﺗ ﻪﺑ نﺎﻣرد و ﺪﻫﺎﺷ451/0±799/2 ،769/0±086/2 و 249/0±817/0دﻮﺑ . يوراد فﺮﺼﻣ ﻪﮐ داد نﺎﺸﻧ ﺞﯾﺎﺘﻧ ﻦﯾا
زا ﺲﭘ هﺪﺷﺮﮐذ ﺮﯾدﺎﻘﻣ ﺎﺑ ﻦﯿﺘﺴﮐﻮﻠﻓ35 ﺶﻫﺎﮐ ﺚﻋﺎﺑ زور
يراد ﯽﻨﻌﻣ)05/0p (نﻮﻣرﻮﻫ ﯽﻣﺮﺳ ﺖﻈﻠﻏ رد يﺎﻫfT3,
fT4,T4
لﺰﯿﺗرﻮﮐ و ﺪﻫﺎﺷ و لﺮﺘﻨﮐ هوﺮﮔ ﻪﺑ ﺖﺒﺴ
ﯽﻣ دﻮﺷ) لوﺪﺟ1.(
هوﺮﮔ رد نزو تاﺮﯿﯿﻐﺗ ﯽﺳرﺮﺑ زا ﻞﺻﺎﺣ ﺞﯾﺎﺘﻧ يﺎﻫ
ﺎﺑ نﺎﻣرد ﺖﺤﺗ هوﺮﮔرد نزو ﺶﻫﺎﮐ هﺪﻨﻫد نﺎﺸﻧ ﻒﻠﺘﺨﻣ
هوﺮﮔ ﻪﺑ ﺖﺒﺴﻧ ﻦﯿﺘﺴﮐﻮﻠﻓ نزو تاﺮﯿﯿﻐﺗ ﻦﯾا و ﺖﺳا ﺮﮕﯾد يﺎﻫ
فﻼﺘﺧا ﯽﻨﻌﻣ يراد)05/0p ( لﺮﺘﻨﮐ هوﺮﮔ ﻪﺑ ﺖﺒﺴﻧ ار
ﯽﻣ نﺎﺸﻧ ﺪﻫد) لوﺪﺟ1.(
لوﺪ1 .نﻮﻣرﻮﻫ ﯽﻣﺮﺳ ﺖﻈﻠﻏ رﺎﯿﻌﻣ فاﺮﺤﻧا و ﻦﯿﮕﻧﺎﯿﻣ ﻪﺴﯾﺎﻘﻣ هوﺮﮔ رد نزو تاﺮﯿﯿﻐﺗ و لﺰﯿﺗرﻮﮐ و يﺪﯿﺋوﺮﯿﺗ يﺎﻫ ﻒﻠﺘﺨﻣ يﺎﻫ
ﻦﯿﮕﻧﺎﯿﻣ
تاﺮﯿﯿﻐﺗ
نﻮﻣرﻮﻫ
ﻦﯿﺴﮐوﺮﯿﺗ دازآ عﻮﻧ )ﺮﺘﯿﻟ رد مﺮﮔﻮﻧﺎﻧ(
ﻦﯿﺴﮐوﺮﯿﺗ )ﺮﺘﯿﻟ رد لﻮﻣﻮﻧﺎﻧ(
وﺪﯾ يﺮﺗ دازآ عﻮﻧ
ﻦﯿﻧوﺮﯿﺗ )ﺮﺘﯿﻟ رد مﺮﮔﻮﻧﺎﻧ(
ﻦﯿﻧوﺮﯿﺗ وﺪﯾ يﺮﺗ )ﺮﺘﯿﻟ رد لﻮﻣﻮﻧﺎﻧ(
لوﺰﯿﺗرﻮﮐ )ﯽﻠﯿﻣ رد مﺮﮔﻮﻧﺎﻧ ﺮﺘﯿﻟ(
نزو )مﺮﮔ(
لﺮﺘﻨﮐ 2375/17 ±677/2 125/65 ± 079/7 799/2 ± 451/0 9005/0 ±310/0 555/14 ±308/3 87/263 ±61/20
ﺪﻫﺎﺷ 4625/15 ±739/2 125/59 ±141/11 086/2 ± 769/0 8844/0 ±190/0 062/15 ± 668/3 5/258 ±32/26
نﺎﻣرد 3286/10 ±888/3
*
571/38 ±
935/8 *
817/0 ± 249/0 * 9986/0 ±239/0 371/3 ± 879/1 * 01/227 ±64/22 *
*هوﺮﮔ ﺎﺑ نﺎﻣرد هوﺮﮔ ﻦﯿﺑ اوﻮﻧآ يرﺎﻣآ نﻮﻣزآ سﺎﺳا ﺮﺑ راد ﯽﻨﻌﻣ فﻼﺘﺧا هﺪﻨﻫد نﺎﺸﻧ ﺖﺳا لﺮﺘﻨﮐ و ﺪﻫﺎﺷ يﺎﻫ)05/0p.(
ﺚﺤﺑ
و نزو ﺮﺑ ﻦﯿﺘﺴﮐﻮﻠﻓ يوراد ﺮﯿﺛﺎﺗ ﺶﻫوﮋﭘ ﻦﯾا رد
نﻮﻣرﻮﻫ ﯽﯾﺎﻤﺳﻼﭘ حﻮﻄﺳ يﺎﻫﺑ لوﺰﯿﺗرﻮﮐ و يﺪﯿﺋوﺮﯿﺗ
يور30ﺖﻓﺮﮔ راﺮﻗ ﯽﺳرﺮﺑ درﻮﻣ ﻎﻟﺎﺑ ﺮﻧ ﯽﯾاﺮﺤﺻ شﻮﻣ ﺮﺳ .
نﻮﻣرﻮﻫ تاﺮﯿﯿﻐﺗ ﯽﺳرﺮﺑ رد داد نﺎﺸﻧ ﻢﺴﯿﻟﻮﺑﺎﺘﻣ ﺮﺑ ﺮﺛﻮﻣ يﺎﻫ
نﺎﯾﺎﭘ رد هﺪﺷ هداد ﺮﯾدﺎﻘﻣ ﺎﺑ وراد فﺮﺼﻣ ﻪﮐ35 ﺚﻋﺎﺑ زور
،لوﺰﯿﺗرﻮﮐ ﯽﻣﺮﺳ ﺖﻈﻠﻏ رد يراد ﯽﻨﻌﻣ ﺶﻫﺎﮐfT4
و fT3
ﻢﻫ ﯿﺗ نﻮﻣرﻮﻫ ﺶﻫﺎﮐ ﺐﺒﺳ ﻦﯿﻨﭼﺪﯾدﺮﮔ ﻦﯿﺴﮐوﺮ .ﯿﺘﺴﮐﻮﻠﻓ
هﺪﻨﻨﮐرﺎﻬﻣ هوﺮﮔ زا ﯽﮔدﺮﺴﻓا ﺪﺿ يوراد ﮏﯾ بﺬﺟ زﺎﺑ يﺎﻫ
،ﯽﮔدﺮﺴﻓا نﺎﻣرد ياﺮﺑ نآ زا هدﺎﻔﺘﺳا ﻪﮐ ﺖﺳا ﻦﯿﻧﻮﺗوﺮﺳ
ﯽﺑ و ساﺮﻫ لﻼﺘﺧا ،يرﺎﺒﺟا ﯽﺳاﻮﺳو لﻼﺘﺧا ﯽﺒﺼﻋ ﯽﯾﺎﻬﺘﺷا
هﺪﺷ ﻪﺘﻓﺮﯾﺬ ﺖﺳا .ﯽﻣ نﺎﺸﻧ ﺪﻫاﻮﺷ ﻦﯿﻧﻮﺗوﺮﺳ ﻪﮐ ﺪﻫد ﻪﺑ
ﺮﻗ ﯽﮔدﺮﺴﻓا ﻂﯾاﺮ ﺮﯿﺛﺎﺗ ﺖﺤﺗ تﺪﺷﯽﻣ را دﺮﯿﮔ)18( .
ﻢﻫ رد نآ ﮏﯾژﻮﻟﻮﯾﺰﯿﻓﻮﺗﺎﭘ ﺶﻘﻧ ﻪﻌﻟﺎﻄﻣ ﻦﯾﺪﻨﭼ رد ﻦﯿﻨﭼ
يرﺎﻤﯿﺑ هداد نﺎﺸﻧ و ﻪﺘﻓﺮﮔ راﺮﻗ ﯽﺳرﺮﺑ درﻮﻣ ﺪﯿﺋوﺮﯿﺗ يﺎﻫ
شﻮﻣ ﺰﻐﻣ رد ﻦﯿﻧﻮﺗوﺮﺳ ﺰﺘﻨﺳ ﻪﮐ هﺪﺷ ﻢﮐ رد ﯽﯾاﺮﺤﺻ يﺎﻫ
ﯽﻣ ﺶﯾاﺰﻓا ﺪﯿﺋوﺮﯿﺗ يرﺎﮐﺮﭘ رد و ﺶﻫﺎﮐ ﺪﯿﺋوﺮﯿﺗ يرﺎﮐ ﺪﺑﺎﯾ .
ﮔدﺮﺴﻓا نﺎﻣرد ﻦﯿﺑ طﺎﺒﺗرا ﯽﻤﮐ تﺎﻌﻟﺎﻄﻣ ﺎﺑ ﯽSSRI و
و يﺪﯿﺋﺮﯿﺗ يﺎﻫ نﻮﻣرﻮﻫ ناﺰﯿﻣ ﺮﺑ ﻦﯿﺘﺴﮐﻮﻠﻓ ﺮﯿﺛﺎﺗ ﯽﺳرﺮﺑ ...نارﺎﮑﻤﻫ و ﯽﻤﺷﺎﻫ ارﺎﺳ هﺪﯿﺳ
لﺎﺳ ،كارا ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ﯽﺸﻫوﮋﭘ ﯽﻤﻠﻋ ﻪﻠﺠﻣﻢﻫﺪﻔﻫ هرﺎﻤﺷ ،2 ، ﺖﺸﻬﺒﯾدرا1393 87
نﻮﻣرﻮﻫ ناﺰﯿﻣ رد تاﺮﯿﯿﻐﺗ ﯽﺑﺎﯾزرا درﻮﻣ ار يﺪﯿﺋوﺮﯿﺗ يﺎﻫ
ﯽﻣ راﺮﻗ ﺪﻫد)19،20( . حﻮﻄﺳ ياراد هدﺮﺴﻓا داﺮﻓا ﺮﺘﺸﯿﺑ ﻪﭼ ﺮﮔا
ﯽﻣﺮﺳT3
،T4
و TSH دراﻮﻣ ﯽﺧﺮﺑ رد ﺎﻣا ،ﺪﻨﺘﺴﻫ ﯽﻌﯿﺒﻃ
سﻮﻣﻻﺎﺗﻮﭙﯿﻫ رﻮﺤﻣ ﺖﯿﻟﺎﻌﻓ ﺮﯿﯿﻐﺗ زا ﯽﺷﺎﻧ ﺪﻫاﻮﺷ ﯽﮔدﺮﺴﻓا-
ﺰﯿﻓﻮﭙﯿﻫ-ﺪﯿﺋوﺮﯿﺗ)HPT(ﻞﻣﺎﺷ :1 (اﺰﻓا رد ﺶﯾT4
،دازآ ﺎﯾ مﺎﺗ
ﯽﯾﺎﻤﺳﻼﭘ حﻮﻄﺳ ﺮﺘﺸﯿﺑ ﯽﮔﮋﯾو ﻦﯾا ،لﺎﻣﺮﻧ حﻮﻄﺳ ﺎﺑ ﺮﺘﺸﯿﺑ
يﻻﺎﺑT4
ﺎﯾ T4
تاﺮﯿﯿﻐﺗ نوﺪﺑ و دازآ T3
ﯽﻣ ﺖﻓﺎﯾ دﻮﺷ .2 (
ﺪﺣ زا ﺶﯿﺑ ﺦﺳﺎﭘTSH ﺖﺴﺗ ﻪﺑ TRH رد 10ﺻرد
رد ﺦﺳﺎﭘ ﺶﻫﺎﮐ و نارﺎﻤﯿﺑ25 نارﺎﻤﯿﺑ زا ﺪﺻرد 3 ( حﻮﻄﺳ
يدﺎﺑ ﯽﺘﻧآ زا ﯽﯾﻻﺎﺑ رد ﺪﯿﺋوﺮﯿﺗ ﺪﺿ يﺎﻫ15 و دراﻮﻣ ﺪﺻرد 4 ( زا ﯽﯾﻻﺎﺑ ﺖﻈﻠﻏTRH هدﺮﺴﻓا داﺮﻓا ﯽﻋﺎﺨﻧ يﺰﻐﻣ ﻊﯾﺎﻣ رد
ﺖﺳا)18( .ﯽﻣ نﺎﺸﻧ ﺪﻫاﻮﺷ ﯽﺘﺣ ،ﮏﭼﻮﮐ تاﺮﯿﯿﻐﺗ ﻪﮐ ﺪﻫد
نﻮﻣرﻮﻫ حﻮﻄﺳ زا ،ﯽﻌﯿﺒﻃ هدوﺪﺤﻣ نورد رد رد ﺪﯿﺋوﺮﯿﺗ يﺎﻫ
رد ﯽﻬﺟﻮﺗ ﻞﺑﺎﻗ تاﺮﺛا ياراد ﯽﮔدﺮﺴﻓا ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﯿﺑ نﺎﯿﻣ
ﯽﻣ و هدﻮﺑ ﺰﻐﻣ دﺮﮑﻠﻤﻋ رد ﺪﻧاﻮﺗﺘﺧﺎﻨﺷ ﺖﺴﯾز لﻮﺻا كرد
ﺪﺷﺎﺑ ﻢﻬﻣ ﯽﮔدﺮﺴﻓا . دﺮﮑﻠﻤﻋ رد ﺶﻫﺎﮐ ﻪﮐ ﻪﯿﺿﺮﻓ ﻦﯾا
ﺶﻨﮐاو ﺎﺑ ﺪﯿﺋوﺮﯿﺗ نﺎﺸﻧ ،ﺖﺳا هاﺮﻤﻫ ﯽﮔدﺮﺴﻓا ﺪﺿ يﺎﻫ
ﯽﻣ ﺖﯿﻌﺿو ﺎﺑ هاﺮﻤﻫ ﺪﯿﺋوﺮﯿﺗ دﺮﮑﻠﻤﻋ رد ﺶﯾاﺰﻓا ﻪﮐ ﺪﻫد
ﺖﺳا ﻂﺒﺗﺮﻣ ﯽﻌﯿﺒﻃ ﺮﯿﻏ ﯽﻧاور)18( .ﺺﺧﺎﺷ ﺶﻫﺎﮐ يﺎﻫ
ﺮﺑ ﺎﺑ ﺰﯿﻧ ﯽﮔدﺮﺴﻓا ﺪﺿ نﺎﻣرد زا ﺲﭘ ﯽﻄﯿﺤﻣ ﺪﯿﺋوﺮﯿﺗ ﯽﺧ
ﺖﺳا رﺎﮔزﺎﺳ ﯽﻠﺒﻗ تﺎﻌﻟﺎﻄﻣ)19-21( . ﭻﯿﻫ نارﺎﮑﻤﻫ و نﻮﺘﻠﺷ
ﯽﻨﻌﻣ ﺮﯿﯿﻐﺗ ناﺰﯿﻣ رد يرادTSHT4
ﻦﯿﺘﺴﮐﻮﻠﻓ ﺎﺑ نﺎﻣرد رد
ﻨﻌﻣ طﺎﺒﺗرا ﺎﻣا ،ﺪﻨﺘﻓﺎﯿﻧ ﺢﻄﺳ رد ﺶﻫﺎﮐ ﻦﯿﺑ يرادT3
و
ﺪﻨﺘﻓﺎﯾ ﻦﯿﺘﺴﮐﻮﻠﻓ ﺎﺑ نﺎﻣرد)21( . يﻻﺎﺑ ناﺰﯿﻣ ﻪﮐ ﻪﯿﺿﺮﻓ ﻦﯾا
ﺎﻤﺳﻼﭘ ﺢﻄﺳT4
ﺦﺳﺎﭘ و TSH ﻪﺑTRHد نﺎﺸﻧ ، ﻪﺟرد هﺪﻨﻫ
ﺖﺳا ﺪﯿﺋوﺮﯿﺗ يرﺎﮐﺮﭘ ﻒﯿﻔﺧ . ﺢﺷﺮﺗ رد ﺶﯾاﺰﻓا لﺎﻤﺘﺣا
TRHسﻮﻣﻻﺎﺗﻮﭙﯿﻫ رﻮﺤﻣ رد لﻼﺘﺧا ﺐﺟﻮﻣ سﻮﻣﻻﺎﺗﻮﭙﯿﻫ -
ﺰﯿﻓﻮﭙﯿﻫ-لﺎﻧردآ )HPA (ﺖﺳا ﯽﮔدﺮﺴﻓا رد)18( . ﯽﺳرﺮﺑ رد
ﺶﻫﺎﮐ ﮏﯾژﺮﻧﻮﺗﺮﺳ ﻢﺘﺴﯿﺳ و ﺪﯿﺋوﺮﯿﺗ دﺮﮑﻠﻤﻋ ﻦﯿﺑ ﻞﻣﺎﻌﺗ
ﻪﺑ ﻦﯿﺘﮐﻻوﺮﭘ و لوﺰﯿﺗرﻮﮐ ﺦﺳﺎﭘ ناﺰﯿﻣ ﻦﯿﺑ ﯽﻬﺟﻮﺗ ﻞﺑﺎﻗ
ﮔآد ﻦﯿﻧﻮﺗوﺮﺳ ﺖﺴﯿﻧﻮ-ﻦﯿﻣارﻮﻠﻓ ﻦﻓ)5-HT d-
fenfluramine (ﺪﺷ اﺪﯿﭘ . ﻢﮐ ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﯿﺑ نﺎﯿﻣ رد
دﺮﮑﻠﻤﻋ ﺶﻫﺎﮐ دراﻮﻣ ﻦﯾا رد ،هﺪﺸﻧ نﺎﻣرد ﺪﯿﺋوﺮﯿﺗ يرﺎﮐ
ﯽﻣ دﺎﻬﻨﺸﯿﭘ ﻦﯿﻧﻮﺗوﺮﺳ يﺰﮐﺮﻣ ﺪﻨ)18( . ﯽﻧﻮﻣرﻮﻫ لوﺰﯿﺗرﻮﮐ
يﺮﺸﻗ ﺶﺨﺑ زا سﺮﺘﺳا ﻂﯾاﺮﺷ رد ﻪﮐ ﺖﺳا يﺪﯿﺋوﺮﺘﺳا
هﺪﻏ ﯽﻣ ﺢﺷﺮﺗ يﻮﯿﻠﮐ قﻮﻓ ي نﺎﯿﺑ و دﻮﺷ تﻻﺎﺣ ﺶﯾاﺰﻓا ﺮﮔ
ﯽﻣ ﯽﺳﺮﺘﺳا و ﯽﮑﯿﻟﻮﺑﺎﺗﺎﮐ ﺷﺎﺑ . هزﺎﺟا ﻞﻤﻋ ﺎﺑ لوﺰﯿﺗرﻮﮐ
نﻮﻣرﻮﻫ ﯽﺧﺮﺑ دﺮﮑﻠﻤﻋ ياﺮﺑ دﻮﺧ هﺪﻨﻫد ﺎﻫ) لﻮﮑﺗﺎﮐ
ﻦﯿﻣآ ﺎﻫ (نﻮﻣرﻮﻫ ﺮﯾﺎﺳ ﺰﺘﻨﺳ ياﺮﺑ و ﺎﻫ)ﺪﺷر نﻮﻣرﻮﻫ (
ﯽﻣ ﺪﻫد مﺎﺠﻧا ار دﻮﺧ ﮏﯿﻧژﻮﺘﺑﺎﯾد ﺖﯿﻟﺎﻌﻓ ﺪﻧاﻮﺗ)14( . رد
ز سﺮﺘﺳا ﻣاﻮﻋ ﻪﮐ هﺪﺷ ناﻮﻨﻋ ﺸﻫوﮋﭘ ﯽﻧاور يا-
ﯽﻣ ﯽﻋﺎﻤﺘﺟا ﻪﺘﺷاد نﻮﺧ ﺪﻨﻗ ناﺰﯿﻣ ﺮﺑ ﯽﺸﯾاﺰﻓا ﺮﺛا ﮏﯾ ﺪﻧاﻮﺗ
ﻢﻫ و ﺪﺷﺎﺑ ﺢﻄﺳ ﺶﯾاﺰﻓا و ﺖﺑﺎﯾد لﺮﺘﻨﮐ ﺶﻫﺎﮐ ﺚﻋﺎﺑ ﻦﯿﻨﭼ
ﯽﻣ ﺰﮐﻮﻠﮔ ﺪﻧﻮﺷ)22( . ﺪﺿ يوراد ناﻮﻨﻋ ﻪﺑ ﻦﯿﺘﺴﮐﻮﻠﻓ نﻮﭼ
ﯽﻣ فﺮﺼﻣ ﺰﯿﻧ ﯽﮔدﺮﺴﻓا ﺪﺿ و باﺮﻄﺿا ﻪﺑ ًﻻﺎﻤﺘﺣا ،دﻮﺷ
نﻮﻣرﻮﻫ ناﺰﯿﻣ ﺶﻫﺎﮐ ﺐﺒﺳ باﺮﻄﺿا ﺶﻫﺎﮐ ﻞﯿﻟد
ﻮﮐﺖﺳا هﺪﺷ لوﺰﯿﺗر . ﺖﻈﻠﻏ ﺮﺑ وراد ﻦﯾا ﺮﺛا درﻮﻣ رد
هﺪﺷ ﺮﺸﺘﻨﻣ شراﺰﮔ ﺰﯿﻧ لوﺰﯿﺗرﻮﮐ ﻟو دراﺪﻧ دﻮﺟو يا
ﺶﯾاﺰﻓا ﺐﺒﺳ وراد ﻦﯾا فﺮﺼﻣ ﺖﺳا هﺪﺷ شراﺰﮔ
ﻦﯿﭘوﺮﺗﻮﮑﯿﺗرﻮﮐ)CRH ( ددﺮﮔ)24( ﺶﯾاﺰﻓا CRH
ﯽﻣ ﺪﺷﺎﺑ مﺮﺳ لوﺰﯿﺗﻮﮐ ناﺰﯿﻣ ﺶﻫﺎﮐ ﻞﯿﻟد ﻪﺑ ﺪﻧاﻮﺗ)23 .(
يﺎﻫوراد ﺮﯾﺎﺳ و ﻦﯿﺘﺴﮐﻮﻠﻓSSRI ﺐﺒﺳ زا ﺢﺷﺮﺗ ﺶﯾاﺰﻓا
سﻮﻣﻻﺎﺗﻮﭙﯿﻫ رﻮﺤﻣ نﺪﺷ لﺎﻌﻓ و سﻮﻣﻻﺎﺗﻮﭙﯿﻫ-ﺰﯿﻓﻮﭙﯿﻫ -
ﯽﻣ لﺎﻧردآ ددﺮﮔ)23(ﻦﯿﻣآ لﻮﮐﺎﺗﺎﮐ ﺢﺷﺮﺗ نآ لﺎﺒﻧد ﻪﺑ ﻪﮐ ﺎﻫ
ﯽﻣ ﺐﺟﻮﻣ ار ددﺮﮔ . ﯽﻧﻮﻣرﻮﻫ ﻢﺘﺴﯿﺳ رد تاﺮﯿﯿﻐﺗ ﻪﮐ ﺪﻨﭼ ﺮﻫ
ﺪﺷﺎﺑ ﻪﺘﺷاد ﯽﭘ رد ﺖﺳا ﻦﮑﻤﻣ ﺰﯿﻧ ار ﺮﮕﯾد)23-25( .ﻢﻫ ﻦﯿﻨﭼ
ﯽﻣ ﺶﻫﺎﮐ ﻪﮐ دﺮﮐ ﻪﯿﺟﻮﺗ ﻦﯿﻨﭼ ناﻮﺗنﻮﻣرﻮﻫ يﺪﯿﺋوﺮﯿﺗ يﺎﻫ
ﯽﻣ ﻦﯿﺘﭙﯿﻟ نﻮﻣرﻮﻫ ﺖﻈﻠﻏ ﺶﯾاﺰﻓا ﺐﺒﺳ ﺶﯾاﺰﻓا ﻪﮐ ددﺮﮔ
ﯽﻣ اﺬﻏ فﺮﺼﻣ و ﺎﻬﺘﺷا ﺶﻫﺎﺐﺟﻮﻣ ﻦﯿﺘﭙﯿﻟ ددﺮﮔ)14( . ﻪﺑ
ﯽﻣ ﺮﻈﻧ ﻢﺴﯿﻧﺎﮑﻣ ﺮﺑ هوﻼﻋ ﺪﺳرSSRI زا وراد ﻦﯾا فﺮﺼﻣ
ﯽﻣ ﺰﯿﻧ قﻮﻓ ﻢﺴﯿﻧﺎﮑﻣ ﻖﯾﺮﻃ ﺶﻫﺎﮐ و اﺬﻏ فﺮﺼﻣ ﺮﺑ ﺪﻧاﻮﺗ
ﺪﺷﺎﺑ ﺮﺛﻮﻣ نﺪﺑ نزو.
زا هﺪﻣآ ﺖﺳد ﻪﺑ ﯾﺎﺘﻧ ﯽﻣ نﺎﺸﻧ ﺮﺿﺎﺣ ﺶﻫوﮋﭘ
رد هﺪﺷ هداد ﺮﯾدﺎﻘﻣ ﺎﺑ ﻦﯿﺘﺴﮐﻮﻠﻓ يوراد فﺮﺼﻣ ﻪﮐ ﺪﻫد
نﺎﯾﺎ35شﻮﻣ نزو رد يراد ﯽﻨﻌﻣ ﺶﻫﺎﮐ ﺐﺒﺳ زور يﺎﻫ
هوﺮﮔ ﻪﺑ ﺖﺒﺴﻧ هﺪﺷ نﺎﻣرد ﺪﯾدﺮلﺮﺘﻨﮐ و ﺪﻫﺎﺷ يﺎﻫ . ﻦﯾا
وراد فﺮﺼﻣ دراﻮﻣ صﻮﺼﺧ رد دﻮﺟﻮﻣ تﺎﺷراﺰﮔ ﺎﺑ ﺮﺛا
و يﺪﯿﺋﺮﯿﺗ يﺎﻫ نﻮﻣرﻮﻫ ناﺰﯿﻣ ﺮﺑ ﻦﯿﺘﺴﮐﻮﻠﻓ ﺮﯿﺛﺎﺗ ﯽﺳرﺮﺑ ...نارﺎﮑﻤﻫ و ﯽﻤﺷﺎﻫ ارﺎﺳ هﺪﯿﺳ
لﺎﺳ ،كارا ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ﯽﺸﻫوﮋﭘ ﯽﻤﻠﻋ ﻪﻠﺠﻣﻢﻫﺪﻔﻫ هرﺎﻤﺷ ،2 ، ﺖﺸﻬﺒﯾدرا1393 88
دراد ﯽﻧاﻮﺨﻤﻫ)26-29( .ﻮﺠﺗ دراﻮﻣ زا ﯽﮑﯾ ًﻻﻮﺻا وراد ﻦﯾا ﺰ
ﯽﻣ حﺮﻄﻣ ﯽﺒﻧﺎﺟ ترﻮﺻ ﻪﺑ ﻪﮐ لﺎﺒﻧد ﻪﺑ نزو ﺶﻫﺎﮐ ﺪﺷﺎﺑ
ﯽﻣ ﺎﻬﺘﺷا ﺶﻫﺎﮐ ﺪﺷﺎﺑ . ﺶﻫﺎﮐ ﺖﺒﺜﻣ تاﺮﺛا ﺮﺑ هوﻼﻋ وراد
ﯽﮕﻨﻫﺎﻤﻫ و لدﺎﻌﺗ رد نارﺎﻤﯿﺑ ﻪﺑ ﯽﻗﺎﭼ ضﺮﻣ دﻮﺒﻬﺑ و نزو
ﯽﻣ ﮏﻤﮐ ﯽﯾاﺬﻏ ﻢﯾژر ﺪﻨﮐ)26( . ﺮﺑ هار ﻦﯾﺪﻨﭼ زا ﻦﯿﺘﺴﮐﻮﻠﻓ
ﯽﻣ ﺮﯿﺛﺎﺗ نزو ﺶﻫﺎﮐ دراﺬﮔ:1-ﺮﻃ زا ﺎﻬﺘﺷا ﺶﻫﺎﮐ رﺎﻬﻣ ﻖﯾ
ﻦﯿﺋﻮﺗوﺮﺳ بﺬﺟ(SSRI)سﻮﻣﻻﺎﺗﻮﭙﯿﻫ رﻮﺤﻣ رد )1( 2-
نﺪﺑ يﺎﻣد ندﺮﺑ ﻻﺎﺑ و يژﺮﻧا فﺮﺼﻣ ﺶﯾاﺰﻓا)27( 3- ﺶﯾاﺰﻓا
تارﺪﯿﻫﻮﺑﺮﮐ ﺖﺧﻮﺳ ﻢﺴﯿﻧﺎﮑﻣ ﻦﯾا ﻪﻤﻫ ،ﺎﻫ ﺖﺳا ﻦﮑﻤﻣ ﺎﻫ
ﺪﯿﯾوﺮﺘﺳا ﮏﯾﺮﺤﺗ ﺎﺑ مﺎﮕﻤﻫ ﮏﻤﮐ نﺪﺑ نزو ﺶﻫﺎﮐ ﻪﺑ ﺎﻫ
ﺪﻨﻨﮐ . يور ﺮﺑ نارﺎﮑﻤﻫ و ﯽﻟﻮﻧﺎﮐ ﻪﻌﻟﺎﻄﻣ30 يﻻﺎﺑ رﺎﻤﯿﺑ 60
عﻮﻧ ﺖﺑﺎﯾد ﻪﺑ ﻼﺘﺒﻣ قﺎﭼ و لﺎﺳ2 فﺮﺼﻣ ﻪﮐ داد نﺎﺸﻧ
تﺪﻣ ﻪﺑ ﻦﯿﺘﺴﮐﻮﻠﻓ3 و 6 نزو ﺶﻫﺎﮐ ﺚﻋﺎﺑ ﺐﯿﺗﺮﺗ ﻪﺑ هﺎﻣ
ناﺰﯿﻣ ﻪﺑ نارﺎﻤﯿﺑ6/2 و 9/3 ﻪﺑ نﻮﺧ ﺪﻨﻗ ﺶﻫﺎﮐ و مﺮﮔﻮﻠﯿﮐ
ناﺰﯿﻣ35ﯽﻠﯿﻣ ﯽﻣ مﺮ ﺮﯿﯿﻐﺗ ﻪﻧﻮﮔ ﭻﯿﻫ ﺪﻫﺎهوﺮﮔ ﺎﻣا دﻮﺷ
ﯽﻤﻧ نﺎﺸﻧ نﻮﺧ ﺪﻨﻗ و نزو ﺪﻫد)28( . ﺪﺿ يﺎﻫوراد ﯽﺳرﺮﺑ
ﺴﻓا ﻪﮐ هداد نﺎﺸﻧ ،نﻮﺧ ﺪﻨﻢﯿﻈﻨﺗ ﺮﺑ ﮏﯿﻠﮑﯿﺳ يﺮﯽﮔدﺮ
ﺎﺘﺷﺎﻧ نﻮﺧ ﺪﻨﻗ ناﺰﯿﻣ ﮏﯾژﺮﻧﻮﺗوﺮﺳ ﯽﮔدﺮﺴﻓا ﺪﺿ يﺎﻫوراد
ار ﻦﯿﺑﻮﻠﮔﻮﻤﻫ تﻼﯿﺳﻮﮐﻮﻠﮔ ﺖﻈﻠﻏ و هداد ﺶﯾاﺰﻓا ار
ﯽﻣ ﺶﻫﺎﮐ ﺪﻫد)12( . ﯽﺳرﺮﺑ زا19 عﻮﻧ ﺖﺑﺎﯾد ﻪﺑ ﻼﺘﺒﻣ رﺎﻤﯿﺑ 2
تﺪﻣ ﻪﺑ ﻪﮐ12ﻦﯿﺘﺴﮐﻮﻠﻓ هﺎﻣ )60ﯽﻠﯿﻣ ﻪﻧازور مﺮﮔ ( ﺎﻤﻧوراد ﺎﯾ
رد ﺎﺘﺷﺎﻧ نﻮﺧ ﺪﻨﻗ ﺖﻈﻠﻏ ﻪﮐ هﺪﺷ هداد نﺎﺸﻧ ،ﺪﻧدﻮﺑ ﻪﺘﻓﺮﮔ
هﺪﻨﻨﮐ ﺖﻓﺎﯾرد نارﺎﻤﯿﺑ هﺎﻣ رد ﻦﯿﺘﺴﮐﻮﻠﻓ ي يﺎﻫ3 و 6) ﻪﺑ
ﺐﯿﺗﺮﺗ9/1ﯽﻠﯿﻣ و ﺮﺘﯿﻟ ﺮﺑ لﻮﻣ8/1ﯽﻠﯿﻣ ﺮﺘﯿﻟ ﺮﺑ لﻮﻣ ( ﺶﻫﺎﮐ
ﻢﺸﭼ هﺎﻣ رد يﺮﯿﯿﻐﺗ ﻦﯿﻨﭼ و ﺖﺷاد يﺮﯿﮔ ﻢﻫدزاود و ﻢﻬﻧ يﺎﻫ
ﺪﺸﻧ هﺪﯾد نﺎﻣرد)13( .ﻢﻫ ﺸﻧ ﻪﻌﻟﺎﻄﻣ ﮏﯾ رد ﻦﯿﻨﭼ هﺪﺷ هداد نﺎ
ﻦﯿﻠﯿﺘﭙﯾﺮﺗرﻮﻧ ﻪﮐ ﺖﺳا)ﻪﻘﻠﺣ ﻪﺳ ﯽﮔدﺮﺴﻓا ﺪﺿ ﮏﯾ يا ( ﻪﺑ
رد نﻮﺧ ﺪﻨﻗ لﺮﺘﻨﮐ ﺮﺑ ،ﯽﻤﺴﯿﻠﮔﺮﭙﯿﻫ ﻪﺿرﺎﻋ دﺎﺠﯾا ﺖﻠﻋ
يﺎﻫوراد ﻪﮐ ﯽﻟﺎﺣ رد دراد ﯽﻔﻨﻣ ﺮﺛا هدﺮﺴﻓا ﯽﺘﺑﺎﯾد نارﺎﻤﯿﺑ
هداﻮﻧﺎﺧ SSRIﺪﻨﺘﺴﻫ يﺮﺛا ﻦﯿﻨﭼ ﺪﻗﺎﻓ)29( .
يﺮﯿﮔ ﻪﺠﯿﺘﻧ
ﯽﻣ نﺎﺸﻧ ﯽﺳرﺮﺑ ﻦﯾا زا ﻞﺻﺎﺣ ﺞﯾﺎﺘﻧ ﻪﮐ ﺪﻫد
دنﻮﻣرﻮﻫ ﺶﻫﺎﮐ ﺚﻋﺎﺑ ﻦﯿﺘﺴﮐﻮﻠﻓ يوراد ﺎﺑ نﺎﻣر يﺎﻫ
ﯽﻣ لوﺰﯿﺗرﻮﮐ و يﺪﯿﺋوﺮﯿﺗ ﯽﮔدﺮﺴﻓا ﻂﯾاﺮﺷ رد ﻪﮐ دﻮ
ﯽﻣ ﺶﯾاﺰﻓا ﺪﻨﺑﺎﯾ ﻦﯾا ﺶﯾاﺰﻓا ﻮﺳ تاﺮﺛا زا ﻪﺠﯿﺘﻧ رد و
نﻮﻣرﻮﻫ ﯽﻣ يﺮﯿﮔﻮﻠﺟ يﺰﮐﺮﻣ ﯽﺒﺼﻋ ﻢﺘﺴﯿﺳ ﺎﻫ ﺪﻨﮐ .
ﻢﻫ ياﺮﺑ ﻪﺿرﺎﻋ نوﺪﺑ يوراد ﮏﯾ ناﻮﻨﻋ ﻪﺑ ﻦﯿﺘﺴﮐﻮﻠﻓ ﻦﯿﻨﭼ
لﺮﺘﻨﮐ و نزو ﺶﻫﺎﮐﯽﻣ دﺎﻬﻨﺸﯿﭘ ﯽﺘﺑﺎﯾد نﻮﺧ ﺪﻨﻗ دﻮﺷ .
ﯽﻧادرﺪﻗ و ﺮﮑﺸﺗ
ار ﺎﻣ ﻪﮐ زاﺮﯿﺷ هﺎﮕﺸﻧاد ﯽﺸﻫوﮋﭘ مﺮﺘﺤﻣ ﺖﻧوﺎﻌﻣ زا
هدﺮﮐ يرﺎﯾ هژوﺮﭘ ﻦﯾا مﺎﺠﻧا رد ﻢﻫ و ﺪﻧا هوﺮﮔ زا ﻦﯿﻨﭼ
ﻮﻟﻮﯾﺰﯿﻓ ماد هﺪﮑﺸﻧاد يﮋ ﻪﮐ ﯽﻣﺮﺘﺤﻣ نارﺎﮑﻤﻫ ﻪﯿﻠﮐ و ﯽﮑﺷﺰﭘ
هدﻮﻤﻧ يرﺎﮑﻤﻫ ﺶﻫوﮋﭘ ﻦﯾا مﺎﺠﻧا رد رﺎﮐﺮﺳ هﮋﯾو ﻪﺑ ،ﺪﻧا
ﻢﻧﺎﺧ هﺎﮕﺸﯾﺎﻣزآ مﺮﺘﺤﻣ سﺎﻨﺷرﺎﮐ ﯽﻧﺎﮐزﻮﺟ يﺪﻤﺣا هﺪﯿﻌﺳ
سﺎﭙﺳ و ﺮﮑﺸﺗ لﺎﻤﮐ ،يژﻮﻟﻮﯾﺰﯿﻓ ﻢﯾراد ار يراﺬﮔ . ﻪﻟﺎﻘﻣ ﻦﯾا
ﺖﺳا هدﻮﺒﻧ ﻪﻣﺎﻧ نﺎﯾﺎﭘ ﺎﯾ حﺮﻃ ﻞﺻﺎﺣ.
ﻊﺑﺎﻨﻣ
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و يﺪﯿﺋﺮﯿﺗ يﺎﻫ نﻮﻣرﻮﻫ ناﺰﯿﻣ ﺮﺑ ﻦﯿﺘﺴﮐﻮﻠﻓ ﺮﯿﺛﺎﺗ ﯽﺳرﺮﺑ ...نارﺎﮑﻤﻫ و ﯽﻤﺷﺎﻫ ارﺎﺳ هﺪﯿﺳ
لﺎﺳ ،كارا ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ﯽﺸﻫوﮋﭘ ﯽﻤﻠﻋ ﻪﻠﺠﻣﻢﻫﺪﻔﻫ هرﺎﻤﺷ ،2 ، ﺖﺸﻬﺒﯾدرا1393 89
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... Since Flx administration increased corticosterone levels compared to the patient group in the current study, but IMP administration has little effect on serum corticosterone levels compared to the patient group. Since studies have shown that Flx and other Flx drugs, as well as other SSRIs, increase hypothalamic secretion and stimulate the HPA axis, Flx tends to increase corticosterone levels by increasing HPA axis activity [35], which in turn causes the secretion of catecholamine. Frost et al. (2003) found that chronic IMP treatment of depressed individuals could modulate HPA axis activity, meaning that the HPA axis could be an effective target for antidepressant efficacy [36]. ...
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