postvaqcinaluri gartulebebis da reaqciebis prognozireba ... › dlibrary › collect › 0002 ›...

1

qptuwbrdjovsj

sfwnbujvmj

hbsUvmfcfcj eb

sfbrdjfcj

cbwTwfcTj

Tamar meliqia

samecnierosamecniero

xelmZRvanelixelmZRvaneli medicinismedicinis

mecnierebaTamecnierebaTa

doqtoridoqtori, , profesoriprofesori

m. m. JvaniaJvania

2

Sromis mizania

postvaqcinuripostvaqcinuri revmatiulirevmatiuli dada

sxvasxva garTulebebisgarTulebebis dada

reaqciebisreaqciebis maCveneblebismaCveneblebis

SefasebaSefaseba dada maTimaTi gamovlenisgamovlenis

riskisriskis prognozirebaprognozireba

inicialuriinicialuri maxasiaTeblebismaxasiaTeblebis

safuZvelzesafuZvelze

3

amocanebi:

postvaqcinur periodSi bavSvebSi revmatiuli postvaqcinur periodSi bavSvebSi revmatiuli da sxva garTulebebis da reaqciebis da sxva garTulebebis da reaqciebis ganviTarebis riskganviTarebis risk--faqtorTa dadgena da faqtorTa dadgena da fardobiTi Sansis Sefaseba TiToeuli fardobiTi Sansis Sefaseba TiToeuli faqtorisaTvisfaqtorisaTvis

anamnezuri monacemebis da fonuri anamnezuri monacemebis da fonuri mdgomareobis detalizaciis safuZvelze mdgomareobis detalizaciis safuZvelze postvaqcinuri revmatiuli da sxva postvaqcinuri revmatiuli da sxva garTulebebis ganviTarebis prognozirebis garTulebebis ganviTarebis prognozirebis sistemis Seqmna; sistemis Seqmna;

imunologiuri maCveneblebis Seswavla imunologiuri maCveneblebis Seswavla vaqcinaciis Semdgomi revmatiuli da sxva vaqcinaciis Semdgomi revmatiuli da sxva

garTulebis dros bavSvebSigarTulebis dros bavSvebSi

hematologiuri da imunologiuri parametrebis hematologiuri da imunologiuri parametrebis

informatiulobis gansazRvra acris Semdgomi informatiulobis gansazRvra acris Semdgomi revmatiuli da sxva garTulebebis dros revmatiuli da sxva garTulebebis dros bavSvebSibavSvebSi

4

klinikuriklinikuri jgufebijgufebi

revmatiulirevmatiuli

daavadebisdaavadebis

gamovleniTgamovleniT

garTulebisgarTulebis

gareSegareSerespiraciulirespiraciuli

garTulebiTgarTulebiT

adgilobriviadgilobrivi

dada zogadizogadi

reaqciebireaqciebi 4646

4141 108108

6363

150150

5

kvleviskvlevis

blokblok--sqemasqema

masalismasalis SerCevaSerCeva

AacrisAacris SemdgomiSemdgomi reaqciebireaqciebi

dada garTulebebigarTulebebiTandayoliliTandayolili

ganviTarebisganviTarebis mankebimankebi

150 150 pacientispacientis retropeqtuliretropeqtuli

kvlevakvleva SemTxvevSemTxvev--kontrolikontroli123 123 faqtorifaqtori

,,garTulebiTgarTulebiT

garTulebisgarTulebis gareSegareSe

imunologiuriimunologiuri

maCveneblebimaCveneblebi HhematologiuriHhematologiuri indeqsebiindeqsebi

sakontrolosakontrolo jgufSijgufSi

OROR95%CI95%CI

CarTvisCarTvis

kriteriumebikriteriumebi

gamoricxvisgamoricxvis

kriteriumebikriteriumebi

tt kriteriumikriteriumi

ppχχ22

raodenobriviraodenobrivi postvaqcinuripostvaqcinuri


dada

reaqciebisreaqciebis

riskisriskis

SefasebaSefaseba

xarisxobrivixarisxobrivi

6

revmatiuli garTulebebis damTxveva Semdeg

profilaqtikur acrebze

11%

11%

26%32%

20%

B hepatiti wiTela+ ybayura dty+opv bcJ+dt+opv+wiTela td

7

respiraciuli garTulebebi ganviTarda Semdegi

acrebis dros

39%

12%

39%

10%

dty+opv+Bhepatiti wiTela+ ybayura dty+opv bcJ+dt+opv+wiTela

8

adgilobrivi da zogadi reaqciebi

33%

8%14%32%

8% 5%

dty+opv+Bhepatiti B hepatiti wiTela+ ybayura dty+opv bcJ+dt+opv+wiTela td

9

0

10

20

socialur biologiuri faqtorebis ganawileba

pacientTa Soris

mZime socialuri mdgomareoba 13,04 3,7

ganaTlebis dabali done 19,57 7,41

mamis asaki >45w. 8,7 0,93

revmatiuli daavadebebi I-II xar 13,04 3,7

sixSire

revmatiuli

sixSire

kontrolSi

10

0

10

20

30

40

50

mkvdradSobadoba 17.39 0.93

menstrualuri ciklis darRveva 23.91 4.63

genitaluri daavadebebi 41.3 12.96

alergia sakvebze 23.91 5.56

alergia medikamentebis mimarT 17.39 2.78

alergiuli daavadebebi 17.39 4.63

sixSire revmatiuli

daavadebebis dros sixSire kontrolSi

dedis

anamnezi

11

orsulobis da mSobiarobis garTulebebi

0

10

20

30

40

50

60

hipe

rt

enz

ia

anem

ia

qr.

inf

eqc

iebi

to

qsik

oz

i o

rs.

I n

ax.

or

s.ES

ewyv

etis

niS

nebi

I n

ax

or

s. S

ewyv

etis

niS

nebi

II

nax

nayo

fis

hip

oqs

iapl

acen

tis

paT

ol

ogi

a

sake

isr

o k

veT

a

WuWy

iani

san

ayo

fe

wyl

ebi

sixSire revmatiuli daavadebebis dros sixSire kontrolSi

12

medikamentebis miReba orsulobis dros

010203040506070

vir

us

sawinaaR

md

ego

hemo

stazis

sistemaze

mo

qmd

i

nayo

fis

Semanar

Cunebel

io

rsul

obis I

nax

nayo

fis

Semanar

Cunebel

io

rsul

obis II

nax

vitaminebi

antihi

staminur

i

antibaqter

iul

i


13

0

5

10

15

20

25

30

35

40

45

50

aspiracia axalSobilTa

siyviTle

xelovnuri

kveba

ZuZuze gvian

miyvana

wonaSi

CamorCena

wonis

siWarbe

pacientis anamnezi ( I )


14

pacientis anamnezi ( I I )

0

10

20

30

40

50

60

70

80

mo

rec

id

ive

br

onqit

i

qr

oniku

li

deko

mpensir

ebu

li

to

nz

il

it

i

inf

eqc

iebis

gaxangr

Zl

ivebu

li

mimd

inar

eo

ba

ent

er

it

i d

aent

er

oko

lit

i

hel

minT

oz

i

hipo

vit

amino

zi

raqit

i

kanis d

al

or

wo

vani

gar

sebis

daavad

ebebi


15

0

5

10

15

20

25

30

35

40

45

tonzeleqtomiaantibaqteriuli

preparatebis

xSiri miReba

zeda sasunTqi

gzebis

virusuli

infeqciebi

daavadebebi

vaqcinaciamde 4

kviris ganmavl.

acris

kalendris

darRvevebi

pacientis anamnezi ( I I I )


16

bavSvis da mSoblebis anamnezi OR 95%CI

mZime

socialuri

mdgomareoba 5.25 1.25 18.25

ganaTlebis

dabali

done 3.51 1.22 18.93

mamis

asaki

>45w. 10.19 1.11 21.39

revmatiuli daavadebebi I_II xar. nTesavebSi 9.18 2.77 33.69

Ddedis

sameano-

ginekolo

giuri

anamnezi

mkvdradSobadoba 22.53 2.73 48.63

menstrualuri

ciklis

darRveva 6.47 2.10 26.93

genitaluri

daavadebebi 4.72 2.10 30.29alergia

sakvebze 5.34 1.84 24.60

alergia

medikamentebis

mimarT 7.37 1.86 24.73

alergiuli

daavadebebi 4.34 1.34 19.36

hipertenzia 4.34 1.34 19.36

anemia 3.10 1.45 25.61

qronikuli

infeqciebi 6.05 2.34 30.20

toqsikozi

orsulobis

I nax. 3.09 1.51 30.01

orsulobis

Sewyvetis

niSnebi

orsulobis

I

nax. 5.63 2.43 32.81

nayofis

hipoqsia 2.69 1.29 25.00

placentis

paTologia 4.34 1.34 19.36

sakeisro

kveTa 6.67 2.60 32.69

WuWyiani

sanayofe

wylebi 6.47 2.10 26.93

17

dedis

mier

orsulobis

dros

miRebuli

medikamentebi OR 95%CI

antibaqteriuli 13.87 4.31 49.18

virus

sawinaaRmdego 4.34 1.34 19.36

hemostazis

sistemaze

moqmdi 3.38 1.65 31.81

nayofis

SemanarCunebeli

orsulobis

I nax. 4.05 1.83 28.36

vitaminebi 4.40 2.07 32.49

antihistaminuri 57.07 7.27 124.9

18

pacientis

anamnezi

revmatiuli

garTulebebis

dros OR 95%CIaspiracia 18.71 3.99 51.55

axalSobilis

siyviTle 5.32 2.12 28.44

xelovnuri

kveba 8.82 3.77 45.77

probandis

anamnezi

–

wonaSi

CamorCena 11.16 2.27 31.13

wonis

siWarbe 9.18 2.77 33.69

xSirad

moavade 5.23 2.15 29.10

morecidive

bronqiti 3.46 1.32 20.66

qronikuli

dekompensirebuli

tonziliti 32.98 12.25 128.98

enteriti

da

enterokoliti 25.65 5.56 70.27

helminTozi 3.58 1.17 18.03

hipovitaminozi 37.76 4.74 82.30

raqiti 7.38 3.33 43.68

kanis da lorwovani garsis daavadeba 19.21 2.29 41.28

tonzeleqtomia 10.19 1.11 21.39

antibaqteriuli

preparatebis

xSiri

miReba 15.85 5.43 59.84

zeda

sasunTqi

gzebis

virusuli

infeqcia 9.51 1.89 26.67

avadoba

vaqcinaciamde

4 kv. ganmavlobaSi 51.77 6.58 113.23acris

kalendris

darRveva 4.74 1.94 27.02

19

0

10

20

30

40

50

60

mZime socialuri

mdgomareoba

ganaTlebis

dabali done

dedis Warbi

wona

sacxovrebeli

adgilis mavne

ekologiuri

faqtorebi

socialur biologiuri faqtorebis ganawileba pacientTa Soris

sixSire respiraciuli garTulebebis dros sixSire kontrolSi

20

dedis sameano-ginekologiuri anamnezi

0

10

20

30

40

50

60

70

neonataluri

sikvdilianoba

genitaluri

infeqciebi

hipertenzia anemia mwvave infeqciebi qronikuli

infeqciebi

toqsikozi ors. I

nax.

nayofis hipoqsia gaxangrZ.

orsuloba


21

0

10

20

30

40

50

antibaqteriuli virussawinaaRmdego vitaminebi

medikamentebis miReba orsulobis dros


22

pacientis anamnezi

0

5

10

15

20

25

30

35

40

45

aspiracia postvaqcinaciuri

garTuleba da-

ZmebSi

dRenakluloba Tandayolili

infeqciebi

c.n.s. dazianeba axalSobilis

siyviTle

xelovnuri kveba fermentopaTiebi


23

riskisriskis

faqtorebifaqtorebi

respresp. . garTulebisgarTulebis

drosdros OR 95%CI

mZime

socialuri

mdgomareoba 12.83 3.36 41.65ganaTlebis

dabali

done 16.71 6.26 70.35dedis

Warbi

wona 7.55 2.43 31.28sacxovrebeli

adgilis

mavne

ekologiuri

faqtorebi 5.79 1.81 25.05dedis

sameano-

ginekologiur

i anamnezi

neonataluri

sikvdilianoba 14.91 3.06 41.34

genitaluri

infeqciebi 3.23 1.27 22.34

hipertenzia 4.99 1.53 22.21

anemia 3.44 1.57 29.05

mwvave

infeqciebi 2.95 1.40 33.86

toqsikozi

orsulobis

I nax. 3.35 1.59 33.89

nayofis

hipoqsia 3.68 1.72 32.37

gaxangrZlivebuli

orsuloba 14.86 1.68 31.51medikamentebis

miReba

orsulobis

periodSi

mikrob-sawinaaRmdego

medikamentebi 5.35 1.48 21.39

virus

sawinaaRmdego

medikamentebi 9.56 3.14 38.38

vitaminebi 3.12 1.42 27.32

24

riskis

faqtorebi

respresp. . garTulebisgarTulebis

drosdros OR 95%CI

pacientis

anamnezi

aspiracia 12.85 2.60 35.78

postvaqcinuri

garTuleba

da-ZmebSi 9.09 1.75 25.60

dRenakli 5.35 1.48 21.39

Tandayolili

infeqciebi 17.10 3.56 47.25

c.n.s. mxriv

dazianebis

msubuqi

forma 20.19 5.44 63.95

xelovnuri

kveba 5.64 2.33 33.00

probandis

anamnezi

–

wonaSi

CamorCena 17.10 3.56 47.25

xSirad

moavade 6.27 2.54 34.59

bronqiti 6.35 2.50 33.63

pnevmonia 19.43 4.08 53.55

infeqciebis

gaxangrZlivebuli

mimdinareoba 14.86 1.68 31.51

hipovitaminozi 5.49 0.48 10.97

raqiti 4.85 2.13 32.99

Timomegalia 10.91 2.16 30.54

kanis da lorwovani garsis daavadeba 18.34 2.13 39.18

antibaqteriuli 4.99 1.53 22.21acris

kalendris

darRveva 4.06 1.59 25.04

25

adgilobriviadgilobrivi

dada

zogadizogadi

reaqciebisreaqciebis

fardobiTifardobiTi

SansiSansi OROR 95%CI95%CI

mZimemZime

socialurisocialuri

mdgomareobamdgomareoba 7.40 1.98 24.26mSoblebismSoblebis

ganaTlebisganaTlebis

dabalidabali

donedone 7.74 3.07 33.74sacxovrebelisacxovrebeli

adgilisadgilis

mavnemavne

ekologiuriekologiuri

faqtorebifaqtorebi 3.43 1.10 15.02postvaqcinuripostvaqcinuri

reaqciebireaqciebi

dada--ZmebSiZmebSi 5.58 1.09 15.80dedisdedis

anamnezianamnezi

neonatalurineonataluri

sikvdilianobasikvdilianoba 8.83 1.84 24.65alergiaalergia

medikamentebismedikamentebis

mimarTmimarT 7.40 1.98 24.26virusvirus

sawinaaRmdegosawinaaRmdego

medikamentebimedikamentebis s miRebamiReba 5.36 1.81 21.83pacientispacientis

anamnezianamnezi

dRenakldRenaklulobauloba 4.33 1.28 16.71masamasa<2500gr., <2500gr., sigrZesigrZe

<47sm.<47sm. 2.50 1.09 16.34TandayoliliTandayolili

infeqciebiinfeqciebi 10.00 2.11 27.82c.n.sc.n.s. . dazianebdazianeba a 10.94 3.02 35.07xelovnurixelovnuri

kvebakveba 3.00 1.29 18.05wonaSiwonaSi

CamorCenaCamorCena 10.00 2.11 27.82xSiradxSirad

moavademoavade 3.34 1.41 18.90bronqitibronqiti 3.44 1.40 18.66pnevmoniapnevmonia 11.21 2.40 31.11infeqciebisinfeqciebis

gaxangrZlivebuligaxangrZlivebuli

mimdinareobamimdinareoba 9.22 1.05 19.60fizikurfizikur

ganviTarebaSiganviTarebaSi

CamorCenaCamorCena 9.22 1.05 19.60kanis da lorwovani garsis daavadebebikanis da lorwovani garsis daavadebebi 9.22 1.05 19.60

probandis paTologia vaqcinaciamde 4 kviris ganmavl.probandis paTologia vaqcinaciamde 4 kviris ganmavl. 36.43 4.69 79.97

26


prediqtorebiprediqtorebi kdfkkdfk

mZimemZime

socialurisocialuri

mdgomareobamdgomareoba 1.161.16


dabalidabali

donedone 0.220.22

II--II xarII xar. . naTesavebis naTesavebis revmatiulirevmatiuli

daavadebebidaavadebebi 0.750.75

dedisdedis

anamnezianamnezi

genitalurigenitaluri


alergiaalergia

sakvebzesakvebze 1.341.34

alergiulialergiuli


hipertenziahipertenzia 1.281.28

anemiaanemia 0.410.41

qronikuliqronikuli

infeqciebiinfeqciebi 1.041.04

toqsikozitoqsikozi

orsulobisorsulobis

I I naxnax.. 0.720.72

mikrobmikrob--sawinaaRmdegosawinaaRmdego

medikamentebimedikamentebis s miRebamiReba 1.201.20

hemostazishemostazis

sistemazesistemaze

moqmdimoqmdi

mmedikamentebiedikamentebis s miRebamiReba 0.390.39

nayofisnayofis

SemanarCunebeliSemanarCunebeli

medikamentebimedikamentebis s miRebamiReba

orsors..

II II naxnax 0.790.79

kanonikuri

diskriminantuli

funqciis

koeficientebi

revmatiuli

garTulebis

Camoyalibebisas

27

kanonikuri

diskriminantuli

funqciis

koeficientebi

revmatiuli

garTulebis

Camoyalibebisas


prediqtorebiprediqtorebi kdfk

pacienpacien--

tistis

anamnezianamnezi

aspiraciaaspiracia 2.512.51

axalSobilisaxalSobilis

siyviTlesiyviTle 1.331.33

xelovnurixelovnuri

kvebakveba 0.400.40

woniswonis

siWarbesiWarbe 0.470.47

tonzilititonziliti 0.800.80

infeqciebisinfeqciebis


mimdinareobamimdinareoba 1.061.06

enteritienteriti

dada

enterokolitienterokoliti 0.950.95

helminTozihelminTozi 0.580.58

raqitiraqiti 0.820.82

kanis da lorwovani garsis infeqciuri daavadebakanis da lorwovani garsis infeqciuri daavadeba 1.131.13

paTologiapaTologia

vaqcinaciamdevaqcinaciamde

4 4 kviriskviris

ganmavlobaSiganmavlobaSi 1.151.15

acrisacris

kalendriskalendris

darRvevadarRveva 0.710.71

XX00 --2.712.71

28

garTulebis

prediqtorebi kdfk

mZime

socialuri

mdgomareoba 3.67

dedis

Warbi

wona 1.41

sacxovrebeli

adgilis

mavne

ekologiuri

faqtorebi 0.46orsulo

bis

da

mSobiar

obis

faqtore

bi

hipertenzia 0.35mwvave

infeqciebi 0.36

parazit-sawinaaRmdego

medikamentebis miReba 1.55

nayofis

SemanarCunebeli

medikamentebis

miReba

orsulobis

II nax 2.57

toqsikozi

orsulobis

I nax. 0.57

nayofis

hipoqsia 0.59

gaxangrZlivebuli

orsuloba 1.28

kanonikurikanonikuri

diskriminantulidiskriminantuli

funqciisfunqciis

koeficientebikoeficientebi

respiraciulirespiraciuli

garTulebebisasgarTulebebisas

drosdros

29

kanonikuri

diskriminantuli

funqciis

koeficientebi

respiraciuli

garTulebebisas


prediqtorebiprediqtorebi kdfkkdfk

pacientispacientis

anamnezianamnezi

aspiraciaaspiracia 1.171.17dabadebisdabadebis

rigirigi

II 1.591.59

TandayoliliTandayolili

infeqciebiinfeqciebi 0.700.70

c.n.sc.n.s. . mxrivmxriv

dazianebisdazianebis

msubuqimsubuqi

formaforma 1.001.00

xelovnurixelovnuri

kvebakveba 0.230.23

svelisveli

WipiTWipiT

gaweragawera 2.982.98

xSiradxSirad

moavademoavade 0.280.28

pnevmoniapnevmonia 0.210.21raqitiraqiti 0.770.77TimomegaliaTimomegalia 2.662.66zedazeda

sasunTqisasunTqi

gzebisgzebis

virusulivirusuli

infeqciainfeqcia 1.151.15

paTologiapaTologia


4 4 kviriskviris

ganmavlobaSiganmavlobaSi 1.211.21acrisacris

kalendriskalendris

darRvevadarRveva 0.270.27

XX00 --3.043.04

30

wrfiviwrfivi


funqciisfunqciis

maCveneblebimaCveneblebi

saSualebassaSualebas

iZlevaiZleva

ganisazRvrosganisazRvros


funqciafunqcia

nebismiernebismier

konkretulkonkretul

SemTxvevaSiSemTxvevaSi

kdfkdf

koeficientiskoeficientis

mniSvnelobasmniSvnelobas

CavsvamTCavsvamT

kdfkdf--ss

gantolebaSigantolebaSi,,

D=Xo+X1+X2+…Xn,romlisromlis

CasmiTacCasmiTac

formulaSiformulaSi

miviRebTmiviRebT


albaTobasalbaTobas

konkretulikonkretuli

avadmyofisaTvisavadmyofisaTvis

1P=---------------

1+e-D

e=2,7Tu

P>0.5 garTulebis

albaToba

maRalia

31



sakontrolosakontrolo

jgufSijgufSi



jgufSijgufSi

MM SDSD MM SDSD tt ppCD3CD3 65.9065.90 6.7356.735 51.2451.24 11.25911.259 9.999.99 0.00000.0000

CD4CD4 41.1341.13 5.8635.863 44.3544.35 19.63719.637 --1.551.55 0.1220.12233

CD8CD8 22.4822.48 5.0025.002 22.9122.91 5.7965.796 --0.440.44 0.6610.66122

CD4/CD8CD4/CD8 1.931.93 0.5460.546 2.632.63 0.5750.575 --7.057.05 0.00000.0000

B B limfocitilimfociti 18.1118.11 5.2615.261 24.3924.39 6.0796.079 --6.476.47 0.00000.0000

NkNk 15.4915.49 3.0033.003 17.6117.61 3.9973.997 --3.613.61 0.00040.0004

fagociturifagocituri

ricxviricxvi 6.266.26 2.1152.115 7.207.20 2.4482.448 --2.272.27 0.0260.02600


%% 72.7772.77 8.6878.687 69.3569.35 10.98510.985 2.062.06 0.040.041100

IgGIgG 7.727.72 2.7572.757 20.8920.89 8.5908.590 --14.3414.34 0.00000.0000

IgAIgA 1.371.37 0.5600.560 2.582.58 1.0971.097 --9.089.08 0.00000.0000

IgMIgM 1.521.52 0.3020.302 4.344.34 8.6568.656 --3.403.40 0.0000.00099

imunuriimunuri

kompleqsebikompleqsebi 38.7538.75 10.05110.051 31.7431.74 6.4386.438 4.364.36 0.00000.0000

32



sakontrolosakontrolo

jgufSijgufSi

respiraciuli respiraciuli

garTulebis garTulebis

jgufSijgufSi

M M SDSD M M SDSD tt ppCD3CD3 65.9065.90 6.7356.735 42.9042.90 8.9338.933 16.9416.94 0.00000.0000

CD4CD4 41.1341.13 5.8635.863 27.4927.49 3.7293.729 13.8613.86 0.00000.0000

CD8CD8 22.4822.48 5.0025.002 21.4421.44 5.3015.301 1.091.09 0.28020.2802

CD4/CD8CD4/CD8 1.931.93 0.5460.546 0.860.86 0.4970.497 11.3511.35 0.00000.0000

B B limfocitilimfociti 18.1118.11 5.2615.261 15.0415.04 10.09010.090 2.422.42 0.01680.0168

NkNk 15.4915.49 3.0033.003 13.1013.10 4.3174.317 3.263.26 0.00190.0019


ricxviricxvi 6.266.26 2.1152.115 7.227.22 3.2983.298 --2.102.10 0.03750.0375


procentiprocenti 72.7772.77 8.6878.687 67.3267.32 5.8585.858 3.713.71 0.00030.0003

IgGIgG 7.727.72 2.7572.757 12.8212.82 7.8427.842 --5.895.89 0.00000.0000

IgAIgA 1.371.37 0.5600.560 2.312.31 1.7281.728 --5.055.05 0.00000.0000

IgMIgM 1.521.52 0.3020.302 1.221.22 0.6120.612 3.953.95 0.00010.0001

imunuriimunuri

kkompleqsebiompleqsebi 38.7538.75 10.05110.051 15.0715.07 16.66316.663 10.5710.57 0.00000.0000

33

laboratoriulilaboratoriuli

dada


indeqsebiindeqsebi

sakontrolo sakontrolo

jgufi jgufi



jgufijgufi

MM SDSD MM SDSD tt pp

leikointqaciurileikointqaciuri

indeqsiindeqsi 0,6490,649 0,2720,272 0,2550,255 0,1790,179 9,0399,039 0,0000,000limfociturilimfocituri

indeqsiindeqsi 0,4170,417 0,1890,189 1,0691,069 0,6590,659 9,4569,456 0,0000,000iimunoreaqtimunoreaqti..

indeqsiindeqsi 3,5783,578 1,5721,572 5,5105,510 1,9371,937 5,9805,980 0,0000,000birTvisbirTvis

wanacvlwanacvl..

iindeqsindeqsi 0,1060,106 0,0520,052 0,1180,118 0,0400,040 1,5511,551 0,1240,124rrezistentobisezistentobis

koefickoefic.. 0,4640,464 0,2220,222 1,1851,185 0,6890,689 9,7819,781 0,0000,000

limfociturlimfocitur

eozinofilurieozinofiluri

fardobafardoba 8,2408,240 5,4505,450 16,19416,194 11,12311,123 5,9565,956 0,0000,000

limfocitarullimfocitarul--monociturimonocituri

koeficientikoeficienti 3,1683,168 1,6261,626 5,0425,042 1,7391,739 6,2366,236 0,0000,000

neitrofilurneitrofilur--monocitmonocit..koefkoef.. 7,8907,890 3,3503,350 5,6915,691 2,4652,465 4,0104,010 0,0000,000

lleikocitebisaeikocitebisa

dada

edsisedsis

fardobafardoba 1,8601,860 1,2831,283 0,6840,684 0,4960,496 6,0196,019 0,0000,000leikocitleikocit,.,.

wanacvwanacv. . indeqsiindeqsi 0,1160,116 0,0360,036 0,1730,173 0,0570,057 7,5587,558 0,0000,000

B/TB/T 0,1340,134 0,0350,035 0,2420,242 0,1210,121 8,4928,492 0,0000,000

IgMIgM/B/B 0,00,02200 0,0080,008 0,0900,090 0,1820,182 3,4303,430 0,0010,001

IgGIgG/B/B 0,1540,154 0,0600,060 0,4470,447 0,2630,263 10,97510,975 0,0000,000

IgAIgA/B/B 0,0270,027 0,0120,012 0,0530,053 0,0250,025 8,3858,385 0,0000,000

IgG+IgA+IgMIgG+IgA+IgM 0,2120,212 0,0730,073 0,5900,590 0,2900,290 12,71112,711 0,0000,000

34

laboratoriulilaboratoriuli

dada


indeqsebiindeqsebi

sakontrolo sakontrolo

jgufi jgufi

respirac. respirac.

garT. jgufigarT. jgufi

MM SDSD MM SDSD tt ppleikointleikointooqqsikasikaciuriciuri

indeqsiindeqsi 0,6490,649 0,2720,272 0,2520,252 0,1680,168 8,6348,634 0,0000,000

limfociturilimfocituri

indeqsiindeqsi 0,4170,417 0,1890,189 1,5111,511 0,4920,492 19,61619,616 0,0000,000

iimunoreaqtimunoreaqti..

indeqsiindeqsi 3,5783,578 1,5721,572 12,85912,859 11,53811,538 8,2028,202 0,0000,000

birTvisbirTvis

wanacvlwanacvl..

iindeqsindeqsi 0,1060,106 0,0520,052 0,1680,168 0,0850,085 5,3135,313 0,0000,000

rrezistentobisezistentobis

koefickoefic.. 0,4640,464 0,2220,222 1,7911,791 0,7040,704 17,47317,473 0,0000,000

limfociturlimfocitur

eozinofilurieozinofiluri

fardobafardoba 8,2408,240 5,4505,450 30,17430,174 19,13019,130 10,81710,817 0,0000,000

limfocitarullimfocitarul--monociturimonocituri

koeficientikoeficienti 3,1683,168 1,6261,626 12,18312,183 10,70510,705 8,5378,537 0,0000,000

neitrofilurneitrofilur--monocitmonocit..koefkoef.. 7,8907,890 3,3503,350 7,9707,970 5,8885,888 0,1040,104 0,9180,918

lleikocitebisaeikocitebisa

dada

edsisedsis

fardobafardoba 1,8601,860 1,2831,283 1,1251,125 1,2051,205 3,2363,236 0,0020,002

leikocitleikocit,.,.

wanacvwanacv. . indeqsiindeqsi 0,1160,116 0,0360,036 0,1360,136 0,0840,084 2,0532,053 0,0420,042

B/TB/T 0,1340,134 0,0350,035 0,4040,404 0,1410,141 18,53818,538 0,0000,000

IgMIgM/B/B 0,00,02200 0,0080,008 0,0220,022 0,0120,012 5,1195,119 0,0000,000

IgGIgG/B/B 0,1540,154 0,0600,060 0,2270,227 0,1280,128 4,6914,691 0,0000,000

IgAIgA/B/B 0,0270,027 0,0120,012 0,0430,043 0,0420,042 3,5963,596 0,0000,000

IgG+IgA+IgMIgG+IgA+IgM 0,2120,212 0,0730,073 0,2920,292 0,1580,158 4,2074,207 0,0000,000

35

1.1.

postvaqcinuripostvaqcinuri


garTulebebisgarTulebebis

fardobiTfardobiT

SanssSanss

zrdiszrdis

sicialurisicialuri

faqtorebifaqtorebi, ,

dedisdedis

samenosameno--ginekologiuriginekologiuri

anamnezianamnezi, , agreTveagreTve

pacientispacientis

anamnezianamnezi

--

axalSobilisaxalSobilis

siyviTlesiyviTle, ,

xelovnurixelovnuri

kvebakveba, , ZuZuzeZuZuze

gviangvian

miyvanamiyvana, , wonaSiwonaSi

CamorCenaCamorCena, , woniswonis

siWarbesiWarbe, , xSirixSiri

avadobaavadoba, ,

infeqciebisinfeqciebis


mimdinareobamimdinareoba, ,

bronqitibronqiti, , dekompensirebulidekompensirebuli

tonzilititonziliti, ,

enteritienteriti

dada

enterokolitienterokoliti, , helminTozihelminTozi, ,

hipovitaminozihipovitaminozi, , raqitiraqiti, , kaniskanis

dada

lorwovanilorwovani

garsisgarsis

daavadebebidaavadebebi, , tonzeleqtomiatonzeleqtomia. .

antibaqteriuliantibaqteriuli

preparatebispreparatebis

miRebamiReba, , zedazeda

sasunTqisasunTqi

gzebisgzebis

virusulivirusuli

infeqciainfeqcia, , fardobiTifardobiTi

SansiSansi

gansakuTrebiTgansakuTrebiT

maRaliamaRalia

imim

SemTxvevaSiSemTxvevaSi, ,

rodesacrodesac

adgiliadgili

aqvsaqvs


daavadebebisdaavadebebis

mimarTmimarT

genetikurgenetikur

ganwyobasganwyobas

dada

avadobasavadobas


4 4 kviriskviris

ganmavlobaSiganmavlobaSi. .


fardobiTfardobiT

SanssSanss

zrdiszrdis

vaqcinaciisvaqcinaciis

vadebisvadebis

darRvevadarRveva

daskvnebi:

36

daskvnebidaskvnebi

2.2.

postvaqcinuripostvaqcinuri

respiraciulirespiraciuli


fardobiTifardobiTi

SansiSansi maRaliamaRalia

dabalidabali

socialursocialur--

ekonomikuriekonomikuri

dada


donisdonis, , dedisdedis

damZimebulidamZimebuli

sameanosameano--

ginekologiuriginekologiuri

anamnezisanamnezis SemTxvevaSiSemTxvevaSi, , bavSvisbavSvis

xSirixSiri

avadobisavadobis, , antibaqteriuliantibaqteriuli preparatebispreparatebis

ganmeorebiTiganmeorebiTi

miRebismiRebis

SemTxvevaSiSemTxvevaSi. . fardobiTfardobiT

SanssSanss

zrdiszrdis vaqcinirebulisvaqcinirebulis

kontaqtikontaqti

infeqciasTaninfeqciasTan

dada

vaqcinaciisvaqcinaciis vadebisvadebis

daRrvevadaRrveva

37

daskvnebi

3.

postvaqcinuri

adgilobrivi

da

zigadi

reaqciebis

fardobiTi

Sansi

maRalia

im bavSvebSi, romelTa

ojaxebi

gamoirCevian

mZime

socialuri

mdgomareobiT

da ganaTlebis

dabali

doniT, sacxovrebeli

adgilis

mavne

ekologiuri

faqtorebiT, postvaqcinuri

reaqciebiT

da-ZmebSi,

neonataluri

sikvdilianobiT

dedis anamnezSi, medikamentebis

mimarT

alergiiT,

probandis

mxriv

fardobiTi

Sanss

zrdis dRenakluloba, antenataluri

hipotrofia,

xSiri

avadoba, Tandayolili

infeqciebi, xelovnuri

kveba, wonaSi

da

fizikur

ganviTarebaSi

CamorCena, avadoba vaqcinaciamde

4 kviris

ganmavlobaSi.

38

daskvnebi

4.Seqmnilia postvaqcinuri revmatiuli

da

respiraciuli

garTulebis

prognozirebis sistema. postvaqcinuri

garTulebis

prediqtorebs warmoadgenen

dedismieri

faqtorebi

da

pacientis anamnezi, avadoba

acramde

da

acris

kalendris

darRveva

39

daskvnebi

5. postvaqcinuri

revmatiuli garTulebebisas

aRiniSneboda

imunitetis

rogorc

ujreduli, ise

humoruli rgolis

aqtivacia. adgili

aqvs

imunologiuri

indeqsebis

(B/T, IgM/B, IgG/B, IgA/B, IgG+IgA+IgM). saSualo

mniSvnelobebis

sarwmuno

momatebas kontrolTan

SedarebiT, maSin

rodesac

postvaqcinuri

respiraciuli garTulebebisas

ZiriTadad

adgili

hqonda

imunosupresias,

40

daskvnebi

6. 6. postvaqcinuripostvaqcinuri


dada respiraciulirespiraciuli


drosdros

bavSvebSibavSvebSi

aRiniSnebodaaRiniSneboda hematologiurihematologiuri

rezistentobisrezistentobis; ;

limfociturlimfocitur--eozinofilurieozinofiluri; ;

limfociturlimfocitur--monociturimonocituri; ;

limfociturilimfocituri; ; imunoreaqtiulobisimunoreaqtiulobis; ;

birTvisbirTvis

wanacvlebiswanacvlebis; ; neitrofilurneitrofilur-- monociturimonocituri, , leikocitebisleikocitebis

wanacvlebiswanacvlebis

indeqsebisindeqsebis

saSualosaSualo mniSvnelobebismniSvnelobebis

sarwmunosarwmuno

momatebamomateba

kontrolTankontrolTan

SedarebiTSedarebiT..

41

praqtikuli rekomendaciebipraqtikuli rekomendaciebi::

postvaqcinuri reaqciebisa da postvaqcinuri reaqciebisa da

garTulebebis prevenciisaTvis garTulebebis prevenciisaTvis

rekomendebuliarekomendebulia

pacientis inicialuri maxasiaTeblebis pacientis inicialuri maxasiaTeblebis

Seswavla da riskis marTvadi faqtorebis Seswavla da riskis marTvadi faqtorebis

Tavidan acileba.Tavidan acileba.

aucilebelia imunizaciis Cvenebisa da aucilebelia imunizaciis Cvenebisa da

ukuCvenebis sworad gansazRvra da ukuCvenebis sworad gansazRvra da

vaqcinaciis Catarebamde damZimebuli vaqcinaciis Catarebamde damZimebuli

anamnezis mqone bavSvebisaTvis saWiroebis anamnezis mqone bavSvebisaTvis saWiroebis

SemTxvevaSi medikamenturi mkurnalobis SemTxvevaSi medikamenturi mkurnalobis

CatarebaCatareba

42

Ppraqtikuli rekomendaciebi

postvaqcinuri reaqciebisa da

garTulebebis dros gansakuTrebuli

yuradReba unda mieqces

organizmis reaqtiulobis cvlilebas,

risTvisac saWiroa avadmyofis

imunologiuri statusis Sefaseba da

hematologiuri indeqsebis Seswavla.

43

gmadlobTgmadlobT yuradRebisTvisyuradRebisTvis

postvaqcinaluri gartulebebis da reaqciebis prognozireba ... › dlibrary › collect › 0002 ›...

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