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virusebis roli axalSobilebSisistemuri infeqciis ganviTarebasa da
gamosavalSi
marika koWlamazaSvili MD, MPH
Tbilisis saxelmwifo samedicino universiteti,
saerTaSoriso jandacvis skola
MAmarti 1 , 2010
Tbilisi, saqarTvelo
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 2
neonataluri da perinataluri sikvdiloba
Cvil bavSvTa sikvdiloba kvlav rCeba sazogadoebrivi janmrTelobis
erT-erT mniSvnelovan problemad. es maCvenebeli farTod gamoiyeneba
qveyanaSi da qveynebs Soris mosaxleobis janmrTelobis da keTildReobis
Sesadareblad. aTaswleulis ganviTarebis miznebidan meoTxe mizani swored
bavSvTa sikvdilobis Semcirebaa, romlis amocanasac warmoadgens 1990-2015
w.w. periodSi xuT wlamde asakis bavSvTa sikvdilobis ori mesamediT
Semcireba [1].
jandacvis msoflio organizaciis (janmo) monacemebis Tanaxmad
yovelwliurad 13 milioni bavSvi ibadeba, romelTagan 4 milioni
axalSobili iRupeba dabadebidan 4 kviris ganmavlobaSi (neonataluri
periodi- 28 dRe). neonataluri sikvdilobis 75% modis pirvel kviraze, xolo
25%-45% pirvel ocdaoTx saaTze. mkvdradSobadoba ki Seadgens 3,3 milions.
janmos SefasebiT, ganviTarebad qveynebze neonataluri sikvdilobis 98% da
mkvdradSobadobis 97% modis. amavdroulad am qveynebSi Sobadobisa da
sikvdilobis monacemebi yovelTvis ar aris registrirebuli [2].
msoflioSi 5 wlamde asakis baSvTa sikdilobis ZiriTadi mizezebia
Tandayolili dazianebebi, pnevmonia, malaria, wiTela, diarea, aiv/Sidsi,
neonataluri sikvdiloba da ucnobi etiologiis sikvdiloba. amaTgan 36%
modis neonatalur sikvdilobaze, romlis ZiriTadi mizezebia :
dRenakloba (27%), asfiqsia (23%), Tandayolili daavadebebi (7%),
araidentificirebuli (7%) da infeqciuri daaavadebebi (36%). ganviTarebad
qveynebSi neonataluri infeqciebi warmoadgens 1.6 milioni bavSvis
sikvdilobis mizezs, maT Soris wamyvani adgili sefsiss ukavia (26%) [3].
Sesavali
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 3
ukanaskneli aTi wlis ganmavlobaSi saqarTveloSi ganviTarebulma
movlenebma bavSvTa avadobaze mniSvnelovani gavlena iqonia. Cvil bavSvTa
sikvdilianobis maCvenebeli qveyanaSi Zalian maRalia da Seadgens 19.7
SemTxvevas yovel 1000 cocxalSobilze [4,5] . 2008 w. 0-5 wlamde asakis bavSvTa
sikvdilianobis maCveneblebSi (16.0) , 0-1 wlamde bavSvTa sikvdilobas (14.3)
mnivnelovani adgili uWiravs. Cvil bavSvTa gardacvalebis maRal maCvenebels
ki ganapirobebs neonataluri da gansakuTrebiT adreuli neonataluri
sikvdiloba (sikvdilianobis maCvenebeli – 9.2) [6].
saqarTvelos daavadebaTa kontrolis da samedicino statistikis
erovnuli centris monacemebiT 2003-2008 ww. 0 - 1 wlamde asakis bavSvTa
sikvdilianoba 1000 cocxalSobilze 18.5-dan 14.3-mde Semcirda. aseve Semcirda
adreuli neonataluri sikvdilianobis (12,3-dan 9.2-mde) da mkvdradSobadobis
(16.0-dan 12.6-mde) maCveneblebi 1000 cocxalSobilze. 0-1 wlamde asakis bavSvTa
sikvdilobis 92.4% perinatalur periodSi warmoqmnili calkeuli
mdgomareobebiTaa ganpirobebuli, 5.5% - Tandayolili anomaliebiT.
perinataluri sikvdilianobis maCvenebeli 1000 dabadebulze 2003 - 2008 ww.
Semcirda 28.1-dan 21.7-mde [4].
saqarTvelos daavadebaTa kontrolis centris monacemTa Tanaxmad,
axalSobilTa avadobisa da sikvdilobis maCvenebelTa Soris hemoragiuli
sindromis Semdeg neonataluri sefsisi da perinataluri infeqciebi yvelaze
maRali fataluri gamosavliT xasiaTdeba (83.3% da 52.2%). [cxrili #1 ]
saqarTveloSi axalSobilTa sikvdilobis erT-erT umniSvnelovanes
mizezs warmoadgens infeqciebi. SemTxvevaTa did nawilSi gamomwvevi mizezi
daudgeneli rCeba. generalizebuli infeqciis mqone bavSvebSi, romelTac aqvT
mravlobiTi araspecifiuri simptomebi, rogoricaa: hiper- an hipoTermia,
siyviTle, koagulopaTiasTan asocirebuli sisxldena, sunTqvis ukmarisoba,
hepatomegalia, splenomegalia, ismeba “axalSobilTa sefsisis” diagnozi
gamomwvevi faqtoris gansazRvris gareSe da iniSneba mkurnaloba farTo
speqtris antibiotikebiT. miuxedavad aseTi “empiriuli” mkurnalobisa, aseT
axalSobilTa sikvdilobis maCvenebeli Zalian maRalia, daaxloebiT 65%.
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 4
garda amisa, “axalSobilTa sefsisi” xSirad asocirebulia centraluri
nervuli sistemis infeqciebTan – meningiti da encefaliti, rac prognozs
kidev ufro amZimebs [7].
saqarTveloSi generalizebuli infeqciis mqone axalSobilebSi
etiologiuri agentis dadgena xSirad ar xdeba. ar arsebobs zusti
monacemebi axalSobilTa avadobaSi virusuli infeqciebis rolis Sesaxeb.
amJamad pediatriul pacientebSi virusul infeqciebze kvleva xdeba mxolod
serologiuri meTodiT, rac eqims mxolod SezRudul informacias aZlevs,
ismeba “axalSobilTa sefsisis” diagnozi da iniSneba mkurnaloba farTo
speqtris antibiotikebiT. generalizebuli infeqciebis mqone axalSobilTa
mniSvnelovan nawils aReniSneba virusuli infeqciebi, romelTa garkveuli
procenti gankurnebadi virusuli infeqciebia. prevencias daqvemdebarebuli
da gankurnebadi virusuli infeqciebis adreuli diagnostika mogvcems
saSualebas SevamciroT sikvdiloba am populaciur jgufSi.
Cvens qveyanaSi sefsisismagvar sindromSi virusuli paTogenebis rolis
Sesaxeb monacemebis simwire am kvlevis mniSvnelobas aSkaras xdis.
0-1 wlamde asakis bavSvTa ganviTarebis
etapebi
pediatriaSi gamoyofen bavSvTa zrda-ganviTarebis gansazRvrul etapebs
maTi morfologiuri, fiziologiuri da fsiqologiuri maxasiaTeblebis
mixedviT. adamianuri ontogenezis procesSi mniSvnelovania perinataluri da
postnataluri periodi.
postnataluri periodi iwyeba neonataluri periodiT anu
axalSobilobis periodიT, romelic Tavis mxriv iyofa adreul da gvian
periodad. adreuli neonataluri periodi aris dabadebidan Svidi dRe
(mTlianad 168 saaTi). axalSobilis dabadebis pirvelive dReebSi xSiria
Cirqovan septikuri daavadebebi, piodermia, kuW-nawlavisa da sasunTqi gzebis
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 5
zogierTi mZime baqteriuli da virusuli daavadebebi. Cvil bavSvTa advilad
inficirebis mizezebia organizmis aramyari damcvelobiTi unaris, agreTve
sekretoruli imunoglobulin A-s ar arseboba da M jgufis antisxeulebis
dabali koncentracia. gviani neonataluri periodi moicavs 21 dRes
(axalSobilis dabadebis me-8 dRidan 28 dRis CaTvliT). am periodSi Tavs
iCens sxvadasaxva daavadebebis gamovlinebebi, romelic iwvevs ganviTarebidan
gadaxras da dakavSirebulia perinataluri periodisa da adreuli
neonataluri periodis paTologiebTan. gviani neonataluri periodis dros
bavSvTa organizmis rezistentoba dabalia da swored am periodisTvis
damaxasiaTebelia sefsisis klinikuri gamovlineba. bavSvTa ganviTarebis
ocdamecxre dRidan iwyeba ZuZuTi kvebis postnataluri periodi , romelic
grZeldeba erT wlamde [8].
5 wlamde asakis bavSvTa sikvdilobidan 38% swored neonatalur
sikvdilobaze modis. neonatalur periodSi sikvdilobis dRiuri maCvenebeli
30-jer maRalia postneonatalur periodTan SedarebiT. sikvdiloba
gansakuTrebiT maRalia dabadebidan pirveli 24 saaTis ganmavlobaSi
(neonataluri sikvdilobis 25-45% modis). zogadad, neonataluri sikvdilobis
3/4 dabadebidan pirveli kviris ganmavlobaSi viTardeba.
axalSobilTa sefsisi
axalSobilTa sefsisi kvlav rCeba seriozul problemad, vinaidan igi
potenciurad fataluri mdgomareobaa da misi diagnostireba sakmaod rTulia.
klinikuri gamovlineba bundovania da araspecifikuri, swored amitom ar
arsebobs daavadebis sando da standartizebuli markerebi. mozrdilebisaTvis
miRebuli sefsisis klasifikacia, romelic SedarebiT standartizebulia,
axalSobilebSi ar gamoiyeneba. sefsisis mqone aranamkurnalevi axalSobilis
mdgomareoba SemTxvevaTa umetesobaSi mZimdeba da xSirad letaluri
gamosavliT mTavrdeba. amitom zedmeti sifrTxilis gamo bevri axalSobilis
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 6
mkurnaloba mimdinareobs “sefsisze saeWvo” mdgomareobis diagnoziT, rac
umravles SemTxvevaSi realobas ar Seesabameba. sefsisis gavrceleba da
masTan dakavSirebuli sikvdiloba mniSvnelovnad meryeobs sxvadasxva
qveynebSi da didad aris damokidebuli socialur-ekonomikur faqtorebze. igi
warmoadgens ganviTarebad qveynebSi axalSobilTa sikvdilobis 30-50%-is
mizezs [9;10]. saqarTveloSi daavadebTa kontrolisa da sazogadoebrivi
janmrTelobis erovnuli centris monacemebis Tanaxmad 2008w. axalSobilTa
sefsisis incidentoba 1000 cocxladSobilze Seadgens 1.6 [4].
Tandayolili sefsisis klinikuri gamovlinebebi umravlesad
aRiniSneba sicocxlis pirvel kviras. nayofis inficireba xdeba aRmavali
gziT an samSobiaro gzebSi gavlisas. nayofis inficirebis risk-faqtorebs
miekuTvneba dedis saSarde gzebis infeqcia, dRenakloba, orsulisaTvis
Catarebuli zogierTi invaziuri manipulacia, qorioamnioniti da sxv.
neonataluri sefsisi ZiriTadi maxasiaTeblis mixedviT iyofa or
kategoriad: adreuli sefsisi (romelic vlindeba dabadebidan 72 saaTis
ganmavlobaSi pnevmoniiTa da sasunTqi sistemis distres sindromiT), romlis
gamomwvevebia streptokoki da Esherichia coli da mogvianebiT gamovlenili
sefsisi, romelic viTardeba 72 saaTis Semdeg. warmodgenilia sefticemiiTa
da pnevmoniiT. gamomwvevTa Soris dominirebs Klebsiella, Staphylococcus epidermidis,
Pseudomonas aerugenosa [11;12].
rogorc aRvniSneT, klinikuri gamovlinebis mixedviT sefsisi
xasiaTdeba araspecifikuri mimdinareobiT da moicavs sxvadasxva sistemur
infeqciebs rogoricaa sefticemia, meningiti, pnevmonia, arTriti,
osteomieliti da Sardsasqeso sistemis infeqciebi. infeqciebis zedapiruli
gamovlinebebi, rogoricaa konuqtiviti da stomatiti, yovelTvis ar aris
damaxasiaTebeli neonataluri sefsisisTvis. neonataluri sefsisi saWiroebs
droul diagnostirebas, romelic SeiZleba daisvas mxolod laboratoriuli
gamokvlevebis gaTvaliswinebiT. aucilebel laboratoriul kvlevebs
miekuTvneba sisxlis saerTo analizi, sisxlis kultivireba da C reaqtiuli
cilis gansazRvra. meningitze saeWvo SemTxvevebSi am testebs emateba
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 7
Tavzurgtvinis siTxis gamokvleva. daavadebis maRali letalobis gamo
nebismier saeWvo SemTxvevaSi an dedis seriozuli risk-faqtorebis
arsebobisas am gamokvlevebis Catareba aucilebelia [13].
sisxlis kultivireba iTvleba oqros standartad sefsisis
diagnostirebaSi, romlis nakli mdgomareobs imaSi, rom gamokvlevis Sedegi
dayovnebulia 48-72 saaTi. am xnis ganmavlobaSi bavSvi aucilebelad
saWiroebs intensiur mkurnalobas. zogjer gamokvlevis Sedegis molodinSi
axalSobils utardeba arasaWiro mkurnaloba intravenuri antibiotikebiT.
Tanamedrove neonatologiaSi yuradReba maxvildeba aseve mTel rig
damatebiT markerebze, romelTa kompleqsuri ganxilva diagnozis dasmas
aadvilebs. aseTi markerebia IL6, IL1beta, CD11b, TNFa, prokalcitonini, CD14 da
sxv.
herpes virusebis roli axalSobilTa
avadobaSi
virusul infeqciebs Soris herpesvirusebis ojaxis warmomadgenlebs
mniSvnelovani adgili uWiravs axalSobilTa sistemuri infeqciebis
ganviTarebaSi. zogadad, herpesvirusebis warmomadgenelTa Soris adamianis
avadobisa da sikvdilobis gamowveva SeuZlia rva viruss: martivi herpesis
virusi (I da II tipi), Cutyvavila-zosteris virusi, citomegalovirusi, epStein-
baris virusi, herpes virusebi 6, 7 da 8 [14]. herpesvirusTa yvela saxeoba
morfologiurad identuria. isini warmoadgenen ormagad gadajaWvuli dnm
genomis Semcvel virusebs. virioni Sedgeba ikosaedris (ocgverda) birTvuli
membranisagan , romelsac gars ertymis lipidebis ormagi Sre. membranasa da
lipidur Sres Soris moTavsebulia amorfuli cilebis Sre, romelic
cnobilia safarvelis saxelwodebiT. herpesvirusTa saerTo maxasiaTebelia
is, rom pirveladi inficirebisas virusi warmoSobs latentur infeqcias
maspinZel organizmSi, romlis reaqtivacia SeiZleba moxdes sicocxlis
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 8
nebismier safexurze. reaqtivacia aris xSiri, magram yovelTvis ar iZleva am
daavadebisTvis damaxasiaTebel klinikur suraTs. arsebuli virusebi
SeiZleba iyos mizezi bavSvTa dRenaklobis, nayofis mcire wonis,
ganviTarebis anomaliebis, Tandayolili daavadebebisa da persistentuli
infeqciebisa. [15]
axalSobilTa herpesuli infeqcia xSirad xasiaTdeba mwvave
mimdinareobiT. axalSobilebs aqvT susti ujreduli imuniteti da HSV-1 anN2
rig SemTxvevebSi neonataluri herpesis ganviTarebis mizezi xdeba. kvlevebis
Tanaxmad qveynebis umravlesobaSi genitaluri herpesis ganviTarebis ZiriTadi
mizezi HSV-2-ia da masze modis SemTxvevaTa 85%. swored amitom HSV-2 aris
herpesTa jgufis is warmomadgeneli , romelzec modis 70% neonataluri
herpesebis ganviTarebisa [16;17].
gadacema dedidan bavSvze ZiriTadad xdeba mSobiarobis dros (85%-Si)
dedis genitaluri herpesis SemTxvevaSi. iSviaTad SeiZleba moxdes herpesis
virusis transplacenturi gadacemac, gansakuTrebiT es xdeba dedis
pirveladi infeqciis dros. SesaZlebelia aseve axalSobili dainficirdes
postnatalurad. dedis genitaluri herpesis arsebobis SemTxvevaSi
axalSobilebSi herpes virusis gamovlena xdeba dabadebidan pirveli sami
kviris ganmavlobaSi, gansakuTrebiT mexuTe - meTerTmete dRes. SeZenili
postnataluri herpesi viTardeba HSV-1 virusiT da dakavSirebulia ojaxis
wevrebTan an saavadmofos personalTan urTierTobasTan, romlebic arian
HSV-1-is mtarebelni [16].
mucladyofnisa da dabadebis Semdeg SeZenili axalSobilTa herpesuli
infeqciebi klinikuri gamovlinebebis mixedviT SeiZleba daiyos:
kanis, Tvalis (vezikuluri konuqtiviti) da/an piris Rrus
(stomatiti) forma , romelic xasiaTdeba buStukovani gamonayariT
Sesabamis midamoebSi.
centraluri nervuli sistemis (cns) dazianebiT mimdinare forma.
klinikuri simptomebi moicavs gamonayars, meningits, gulyrebs,
encefalitsa da leTargias.
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 9
diseminirebuli herpesuli daavadeba sxvadasxva organoTa sistemebis
dazianebiT, romlis klinikuri gamovlinebaa gamonayari, centraluri
nervuli sistemis dazianeba, organoTa mravlobiTi dazianebebi
(hepatiti, pnevmonia, qorioretiniti) [18;19].
neonataluri herpesis kanis, Tvalis da piris Rrus forma (kTp)
vlindeba daaxloebiT dabadebidan meaTe-meTerTmete dRes. axalSobilebs,
romlebsac aqvT herpes virusTa am formiT gamovlineba 30%-40%-Si
uviTardebaT nevrologiuri dazianebebi antivirusuli mkurnalobis
Cautareblobis SemTxvevaSi. ufro metic, 75% Cvilebisa, romelsac
aReniSnebaT kTp forma mkurnalobis gareSe uviTardebaT centraluri
nervuli sistemis an diseminirebuli herpesuli daavadebebi [20;21].
neonataluri herpesis inkubaciuri periodia 4-21 dRe. simptomebi
xSirad araspecifiuria da moicavs mxolod cxelebas, sunTqvis ukmarisobas,
cianozs da sxv. xSirad mkurnaloben rogorc baqteriul sefsiss da amitom
antivirusuli mkurnaloba yovndeba.
Cvil bavSvebSi sxva gamovlinebebTan erTad, herpesvirusebs SeuZlia
gamoiwvios sistemuri infeqcia da meningoencefaliti. neonataluri herpesebis
gamovlinebebs Soris centraluri nervuli sistemis damoukidebeli
daavadebebi gvxvdeba herpesiT dainficirebul axalSobilTa 35%-Si.
antivirusuli mkurnalobis gareSe sikvdilobis maCvenebeli Seadgens 50% da
ZiriTadad dakavSirebulia tvinis Reros dazianebasTan. daavadebis klinikuri
Taviseburebebi, iseve rogorc simZime da prognozi, mniSvnelovnad aris
damokidebuli herpesvirusebis tipze da qvetipze. es faqtori miuTiTebs am
virusebis tipirebis mniSvnelobaze [20;14].
neonataluri herpesis yvelaze rTuli mimdinareoba da gamosavali
damaxasiaTebelia diseminirebuli daavadebebisaTvis. diseminirebuli
daavadebebis mqone axalSobilebi arian xSirad cxridan TerTmet dRemde
asakobriv jgufSi. diseminireba xdeba neonataluri herpesis SemTxvevaTa
daaxloebiT 22%-Si da mkurnalobis gareSe sikvdiloba maRalia (Seadgens
daaxloebiT 85%). diseminirebuli daavadebis mqone axalSobilebSi adeqvaturi
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 10
mkurnalobis kursis Catarebis SemTxvevaSi sikvdilobis maCvenebeli
mniSvnelovnad iklebs [22].
enterovirusebi
kidev erTi jgufi virusebisa, romelTac SeuZliaT gamoiwvion
sistemuri infeqciebi Cvil bavSvebSi, aris enterovirusebi. rnm-is Semcveli
erT-jaWviani enterovirusebi, romlebic miekuTvnebian Picornaviridae ojaxs
tradiciulad iyofa sam jgufad: 3 poliovirusi, 29 koqsakvirusi da 31
exovirusi. koqsakvirusebi Tavis mxriv iyofa or jgufad A(23 tipi) da B(6
tipi) [23].
enterovirusebis sxvadasxva stereotipiT gamowveuli neonataluri
infeqciebis klinikuri niSnebi erTmaneTisagan Znelad gasarCevia. Tu ar
CavTvliT poliovirusebs, romelic warmoadgens ganivi mielitis
ganviTarebis mizezs. mwvave neonataluri infeqciebis didi nawili modis
exovirusis 11 serotipsa da koqsakvirus B jgufze.
enterovirusebi kuWis mJavis pH- mimarT gamZlea. inarCunebs
sicocxlisunarianobas oTaxis temperaturaze ramodenime dRis ganmavlobaSi.
enterovirusul daavadebebs ZiriTadad ar axasiaTebs sezonuroba.
enterovirusuli infeqciebis gamovlinebaTa axali SemTxvevebi piks aRwevs
zafxulsa da Semodgomaze.
roCesterSi, niu-iorki, CatarebuliPprospeqtuli epidemiologiuri
kvlevis Tanaxmad, sxvadasxva biologiuri masalis (xorxis da fekaluri
masebis) kultivirebiT axalSobilTa 12.8%-s aRmoaCnda enterovirusi.
miuxedavad aseTi maRali gavrcelebisa 79% infeqciis mimdinareobda
asimptomurad. B jgufis streptokokTan da herpes virusebTan asocirebul
hospitalizaciis maCveneblebTan SedarebiT enterovirusebTan asocirebuli
hospitalizaciis ricxvi gacilebiT maRalia. sxva kvlevebis Tanaxmad,
enterovirusebi aReniSneba 26-dan 50-mde axalSobils 100,000 dabadebulze [24].
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 11
virusebis gadacema xdeba adamianidan adamianze fekalur – oraluri
gziT, romelic SeiZleba gagrZeldes inficirebidan ramodenime kviris
ganmavlobaSi. enterovirusuli daavadebebis paTogenezi mimdinareobs
Semdegnairad: oraluri an respiratoruli epiTeliumidan SeWris Semdeg,
replikacia xdeba limfur ujredebSi, romlis gavrceldeba xdeba sisxlis
saSualebiT da gvaZlevs mravalferovan klinikur suraTs inkubaciuri
periodis(2 dRidan 10 dRemde) Semdeg. virusi aseve gadaecema dedidan
bavSvze. aRwerilia infeqciis nozokomialuri gadacema postnatalurad.
kvlevebis Tanaxmad 11%-dan 22%-mde enterovirusebisa gadadis
transplacenturad, ris dastursac warmoadgens daavadebis gamovlineba
dabadebidan pirveli-ori dRis ganmavlobaSi, aseve amnionur siTxesa da
Wiplaris sisxlSi virusis aRmoCena. enterovirusebi xangrZlivad inarCuneben
sicocxlisunarianobas garemoSi.
enterovirusiT avadobis maRali procenti modis neonataluri asakis
mqone bavSvebze, romlis gamomwvevic umravles SemTxvevaSi koqsakvirus B da
exovirusebis serotipi 11-ia. aseve xSiria dabal socialur-ekonomiur
jgufebSi da dabali sanitaruli pirobebis mqone garemoSi. [25;26].
axalSobilebi, romelTac simptomebi uviTardebaT dabadebidan 7 dRis
ganmavlobaSi, ufro mZime klinikuri gamovlinebebiT xasiaTdebian da
savaraudod inficirebulni arian vertikaluri gziT mSobiarobis dros
dedis fekaluri masebidan an genitaluri sekretidan, zogjer ki
transplacenturadac. vertikalurad gadacemuli enterovirusuli infeqciis
dros letaloba maRalia da Tu ganviTarda RviZlis nekrozic, sikvdilobis
maCvenebeli 80% udris [27].
rig SemTxvevebSi perinataluri exovirusuli infeqciis mqone bavSvebs
sicocxlis me-3-me-5 dRes ewyebaT "sefsisi" progresirebadi fulminanturi
hepatitiT, RviZlis ukmarisobiT da diseminirebuli sisxlZarRvSida
koagulaciiT. enterovirusebi axalSobilTa meningitis yvelaze xSiri mizezia
[28].
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 12
ar arsebobs monacemebi saqarTveloSi sistemuri infeqciebis mqone
axalSobilebSi virusuli infeqciebis gavrcelebis Sesaxeb. sxva qveynebSi
Catarebuli kvlevebi am mimarTulebiT cxadyofs infeqciaTa maRal
gavrcelebas neonataluri asakis populaciur jgufSi. iegeris mier
Catarebulma kvlevam 51 dRenakl axalSobilze, romlebic moTavsebuli iyvnen
axalSobilTa reanimaciaSi, gamoavlina herpesis jgufis erT-erTi virusis -
citomegalovirusis arseboba 16 (31,4%) axalSobilSi, romelTac
aReniSnebodaT sunTqvis gaZneleba, hepatosplenomegalia da atipuri
limfocitozi [29].
kvlevis mizans warmoadgenda dagvedgina virusuli infeqciebisa da sxva
risk-faqtorebis roli septiuri axalSobilebisa da Cvilebis sikvdilobaSi.
kvlevis amocanebs warmoadgens Semdegi:
1) generalizebuli infeqciebis mqone axalSobilebSi herpesis jgufis
virusebis da enterovirusebis gavrcelebis Seswavla
2) axalSobilebis klinikuri statusis daxasiaTeba infeqciis tipis
mixedviT
3) infeqciis gamosavlis asociaciis Seswavla infeqciis tipsa da
klinikur statusTan
kvlevis amocanebi
kvlevis mizani
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 13
kvlevis dizaini da sakvlevi jgufi
kvleva Catarda jvaredin-seqciuri meTodiT.
sakvlev kontigents Seadgenda saqarTveloSi generalizebuli infeqciis
simptomebis mqone 187 axalSobili, romlebic 2005 - 2006 wlebSi
hospitalizebulni iyvnen Tbilisis saxelmwifo samedicino universitetis
pediatriuli klinikis axalSobilTa reanimaciis ganyofilebaSi. kvlevaSi
CarTvamde sakvlevi pirebis dedebi detalurad ecnobodnen kvlevis miznebs
da amocanebs da maTi Tanxmobis SemTxvevaSi xels awerdnen Tanxmobis formas.
kvlevaSi CarTvis kriteriumi iyo:
asaki naklebi 8 kviraze
kvlevaSi CarTvis momentisaTvis ucnobi etiologiis
generalizebuli infeqciis arseboba, romlis klinikur
gamoxatulebad iTvleboda: hepatosplenomegalia, siyviTle,
adenopaTia, pnevmonia, kanisa da lorwovanis paTologiebi (peteqia,
purpura, vezikulebi an makulopapuluri egzanTema), nervuli
sistemis dazianeba (meningoencefaliti, mikrocefalia,
hidrocefalia) da Tvalis dazianebani (keratokoniunqtiviti,
qorioretiniti, retinopaTia)
Tavzurgtvinis siTxeSi virusuli infeqciebisaTvis damaxasiaTebeli
cvlilebebis arseboba.
romelime dadasturebuli baqteriuli infeqciis ar arseboba.
kvleva damtkicebulia reabilitaciis centris eTikuri komisiis mier
(eTikuri komisia registrirebulia aSS jandacvis nacionalur institutebSi).
meTodologia
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 14
monacemTa Segroveba
dasamuSavebeli monacemebi Segrovda kvlevis farglebSi
virusologiuri gamokvlevebis Sedegebisa da avadmyofobis istoriidan
amonawerebis safuZvelze, romelic Tan axlda Tavzurgtvinis siTxis da
sisxlis sakvlev nimuSs. imisaTvis, rom daculi yofiliyo
konfidencialuroba, sakvlevi pirebis identificireba xdeboda mxolod
kodirebulad (erTi da igive kodi eniWeboda sinjaras da istoriidan
amonawers) da pacientebis saxeli da gvari ar ewereboda. Segrovebuli
informacia da pacientTa identificirebis dokumenti inaxeboda qalTa da
bavSvTa dacvis kavSirSi, mTavari mkvlevaris ofisSi da xelmisawvdomi iyo
mxolod misTvis. klinikuri monacemebis Segroveba xdeboda axalSobilTa
avadmyofobis istoriebidan.
es informacia moicavda Semdegs:
axalSobilTa demografiul maxasiaTeblebi: asaki, sqesi,
stacionarSi Semosvlis TariRi, gaweris TariRi, mudmivi
sacxovrebeli adgili.
klinikuri informacia, romelic moicavs axalSobilTa
maxasiaTeblebs: gestaciuri (orsulobis) asaki; wona, apgaris
skalis monacemebi, mSobiarobis tipi, mSobiarobis garTulebebi,
axalSobilTa reanimaciaSi momarTvis TariRi da saidan iyo
gamogzavnili; klinikuri statusi Semosvlis dros (kanis, kanqveSa
cximovani qsovilis, sasunTqi sistemis, gul-sisZarRvTa sistemis,
saWmlis momnelebeli sistemis, nervuli sistemis das Sard-sasqeso
sistemis mdgomareobis mixedviT); generalizebuli infeqciis tipi
(adreuli an gviani sefsisi); daavadebis progresireba, mkurnalobis
sqema, reanimaciaSi mkurnalobis xangrZlivoba, klinikuri
gamosavali.
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 15
laboratoriuli gamokvlevis Sedegebi (sisxlis da SardissaerTo
analizi, bioqimiuri maCveneblebi, Tandayolil infeqciebze
gamokvlevis Sedegebi, liqvoris saerTo analizi, rentgenografiuli
da eleqtrokardiografiuli monacemebi da sxva);
monacemebi mSobelTa Sesaxeb: dedis demografiuli maxasiaTeblebi:
dedis asaki mSobiarobis dros, sacxovrebel adgili (sofeli Tu
qalaqi; ganaTlebis done; bavSvebis raodenoba, aRniSnuli pacienti
meramdene bavSvi iyo. dedis klinikuri informacia: prenataluri
vizitebis arseboba, mSobiarobis anamnezi, mSobiarobis garTulebebi
(sanayofe wylebis adreuli daRvra).
aRniSnuli monacemebi Segrovebul iqna mxolod erTi mkvlevaris mier
da gadamowmda Sesabamisi randomizebuli wesiT monacemebis Segrovebis
sizustis dasadgenad.
sisxlis sinjebi da laboratoriuli
gamokvlevebi
TiToeul axalSobils, romelic xvdeboda axalSobilTa reanimaciaSi,
pirvelive dRes uRebdnen 5 ml venur sisxls da 3 ml Tavzurgtvinis siTxes,
romelic igzavneboda virusologiur laboratoriaSi gamosakvlevad. sinjebis
transportirebisaTvis iyenebdnen civ yuTs (40C). aRebuli masala iyofoda 3
nawilad ELISA, PCR da RT-PCR meTodebiT analizisaTvis. PCR -saTvis
gamoyenebul iqna iseTi praimerebi, romlebic Seesabameboda 5"
aramakodirebel konservirebul regions, romlebic saerToa yvela
enterovirusis genomisaTvis. aseTi midgoma Semowmebulia enterovirusebis 65
serotipisaTvis rogorc referens-sinjebze, ise klinikuri sinjebze
gamoyenebis SemTxvevebSi [39]. Catarebul inqa sinjebis skriningi
enterovirusebis romelime serotipis arsebobaze maTi Semdgomi
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 16
identifikaciis gareSe. amplifikaciis produqtebi Senaxul iqna maTi
Semdgomi kvlevisaTvis.
sisxlis rutinuli analizi bioqimiuri analizis CaTvliT Cautardeba
praqtikulad yvela axalSobils, romelic mkurnalobda axalSobilTa
reanimaciaSi.
monacemebis Seyvana, verifikacia, marTva da statistikuri analizi
ganxorcieldeba statistikuri paketis SPSS me-16 versiis saSualebiT.
univariaciuli analizi Catarda demografiuli da klinikuri
maxasiaTeblebis sixSiris (procentulobis) gamosaTvlelad. aseve
gamoyenebul iqna bivariaciuli analizi, raTa Segvefasebina visurusuli
infeqciis (eqspozicia) prognostuli mniSvneloba letalobisTvis
(gamosavali) , riskTa Tanafardobis (Risk Ratio(RR)) 95 procentiani
sarwmunoebis intervalis gamoyenebiT. χ2 (Chi-square) testi an Fisher`s exact testi
iqna gamoyenebul xarisxobriv faqtorTa Soris arsebuli asociaciis
statistikuri sarwmunoebis dasadgenad, xolo stiudentis t test saSualebiT
gamoTvlil iqna uwyvet cvladebs Soris arsebuli asociaciis statistikuri
sarwmunoeba. multivariaciuli analizi ganxorcielda puasonis regresiuli
analizis meTodiT, romelsac gaaCnia garkveuli upiratesobebi sxva
multivariaciul meTodebTan SedarebiT, rodesac daavadebis prevalentoba
aWarbebs 10%-s.
erTwliani kvlevis pirobebSi Tbilisis saxelmwifo samedicino
universitetis pediatriuli klinikis axalSobilTa reanimaciis
statistikuri analizi
Sedegebi
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 17
ganyofilebaSi gamokvleul iqna 187 ucnobi etiologiis generalizebuli
infeqciiს mqone axalSobili, romelTagan 98 (52.4%) iyo mamrobiTi da 89
(47.6%) iyo mdedrobiTi sqesis. momarTvisas 98 (51.3%) axalSobili
miekuTvneboda adreul neonatalur asaks, xolo 91 (48.7%) gvian neonatalur,
anu 7 dRidan 28-dRemde asaks.
stacionarSi Semosul bavSvTaASoris 140 (74.9%) bavSvi 2500 gramze meti
woniT daibada. daavadebul bavSvTa mxolod erTi meoTxedi, anu 42
axalSobili (25.1%) dabali wonis iyo (2500 gramze naklebi). axalSobilTa
mdgomareobis diagnostirebis TvalsazrisiT gamoyenebul iqna apgaris skala.
monacemTa mixedviT 63 (33.7%) axalSobils miniWebuli hqonda 6-ze naklebi
qula. 124 (66.3%) bavSvi ki 6-ze maRali quliT iyo Sefasebuli. bavSvTa
umravlesoba (65.2%) iyo vaginaluri gziT, xolo 34.8% - sakeisro kveTiT
dabadebuli.
aRniSnuli kvlevis Sedegad ganisazRvra herpesvirusebisa da
enterovirusebis gavrceleba generalizebuli infeqciis mqone bavSvebSi.
kvlevaSi CarTul bavSvebs Soris 66 axalSobils (35.3%) aReniSneboda
enterovirusiT infeqciis SemTxveva, romelTagan 3 (7.3%) gardaicvala. 68
axalSobils (36.4%) daudginda romelime herpesvirusiT infeqcia. 53 (28.3%)
axalSobilSi ki daisva ucnobi etiologiis virusuli infeqciis diagnozi.
sakvlev jgufSi antibiotikebiT mkurnaloba Cautarda 171 (91,4%)
bavSvs. mkurnalobis sqemaSi antivirusuli medikamentebi CarTuli iqna
mxolod 33 SemTxvevaSi (17.6%). (ix. cxrili # 2)
cxrili #3 gvaZlevs informacias 179 axalSobilis dedis
demografiuli da klinikuri monacemebis Sesaxeb. dedaTa umravlesoba (84.5%)
iyo 19 welze ufrosi asakis, 114 (61.0%) cxovrobda qalaqSi da 150 (80.2%)
hqonda umaRlesi ganaTleba. 179 dedidan mxolod 43 (23%) dedisTvis iyo
kvlevaSi CarTuli bavSvi pirveli Svili. mniSvnelovnad maRali (89.3%) iyo im
dedebis procenti, romelTac Catarebuli hqondaT prenataluri vizitebi.
sanayofe wylebis adreuli daRvra aRiniSneboda 25 (13.4%) SemTxvevaSi.
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 18
kvlevis ganmavlobaSi reanimaciul ganyofilebaSi Semosul bavSvTa
Soris gardaicvala 41 (63.4%) axalSobili. maT Soris enterovirusebi
aRmoaCnda 3 (7.3%), herpesvirusebi 16 (36.4%) da gamomwvevi virusi ver dadginda
22 (28.3%) SemTxvevaSi. etiologiuri faqtorebis mixedviT axalSobilTa
letalobis maCveneblebi mniSvnelovnad gansxvavdeba erTmaneTisagan. kerZod,
herpesvirusebis infeqciis jgufSi arsebuli letaloba 1.75-jer aRemateba
enterovirusebis jgufSi letalobas (RR = 0.57, 95% CI 0.33,0.97). magram, aqve
unda aRiniSnos, rom bavSvebSi, romelTa Soris ver moxda etiologiuri
agentis identificireba (53.7%) letalobis maCvenebeli ufro maRalia, vidre
enterovirusebiT da herpesvirusebiT gamowveuli bavSvTa letaloba (RR = 0.11
, 95% CI 0.33,0.97).
gamovlinda sarwmuno asociacia axalSobilTa letalobasa da
hospitalizaciis asaks Soris. kerZod, gardacvlilTa Soris 0-7 dRemde
asakis axalSobilebis ricxvi orjer metia gviani neonataluri asakis
axalSobilebTan SedarebiT (RR =2.04 , 95% CI 1.13,3.69, p=0.013). aseve, mamrobiTi
sqesis sakvlev pirTa letaloba Warbobs mdedrobiTi sqesisas, TumcaRa
axalSobilTa letalobasa da sqess Soris statistikuri sarwmunoeba ar
gamovlinda (RR =1.57, 95% CI0.89,2.78, p = .11 ). pacientTa Soris, romlebic
dabali wonis kategorias miekuTvnebodnen (2500 gramze naklebi) letalobis
maCvenebeli gacilebiT dabali iyo im pacientebTan SedarebiT, romlebic
iwonidnen 2500 gramze mets. Tumca es asociacia ar aris statistikurad
sarwmuno (p =.15). (ix. cxrili #5.) da bolos, gamovlinda sarwmuno asociacia
apgaris qulasa da letalobas Soris. kerZod, axalSobilebSi, romlebic
apgaris skalis mixedviT Sefasebul iyvnen 6-ze naklebi quliT, maRalia
letalobis maCvenebeli im pacientebTan SedarebiT , romlebic 6-ze meti
quliT iyvnen Sefasebuli ( RR =2.07, 95% CI 1.21,3.52 , p = .007) .
dedaTa demografiuli da klinikuri maCveneblebis asociacia
axalSobilTa letalobasTan naCvenebia cxrili # 6. dedaTa demografiuli
da klinikuri maCveneblebidan axalSobilTa letalobasTan statistikurad
sarwmunod asocirebuli cvladebia:
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 19
dedis asaki - 18 welze umcrosi asakis dedebs riski ufro maRali
aqvT (RR =2.0, 95% CI 1.13,3.52, p = 0.02)
sacxovrebeli adgili – bavSvTa letaloba soflad macxovrebeli
dedebSi ufro maRalia, vidre qalaqSi macxovreblebisa (RR =1.81,
95% CI 1.05,3.10, p = 0.02)
prenataluri vizitebi - dedebi, romelTac Catarebuli ar hqondaT
prenataluri vizitebi riski ufro maRalia prenataluri vizitebis
mqone dedebTan SedarebiT (RR =2.02, 95% CI 1.09,3.75, p = 0.039).
axalSobilTa dRenakloba – dRenaklul axalSobilTa letalobis
riski aRemateba droulebisas (RR =2.20, 95% CI 1.17,4.42, p = 0.027).
mSobiarobis tipi – vaginalurad dabadebul bavSvTa letalobis
riski maRalia sakeisro kveTiT dabadebulebTan SedarebiT (RR =2.20,
95% CI 1.08,4.48, p = 0.02).
axalSobilTa letalobis asociacia Semdeg cvladebTan ar iyo
statistikurad sarwmuno:
ganaTleba - saSualo ganaTlebis mqone dedebis riski ufro
maRalia, vidre umaRlesi ganaTlebis mqone dedebisa (RR =0.69 , 95%
CI 0.60,2.18, p = 0.69).
pirveli Svili - dedebi, romelTaTvisac sakvlevi pirebi pirveli
Svilebi arian, riski maRalia (RR =1.23, 95% CI 0.67,2.24, p = 0.51).
sanayofo wylebis naadrevi daRvra – dedebs, romelTac
aReniSneboda adreuli sanayofe wylebis daRvra riski maRalia,
vidre vadamitanil orsulebSi, romlebac mSobiarobis dawyebamde
daRvares sanayofe siTxe ( RR =1.11, 95% CI 0.52,2.37, p = 0.78). (ix.
cxrili #7).
vinaidan, Cveni kvlevis mizans warmoadgens virusuli infeqciebisa da
sxva risk-faqtorebis rolis gansazRvra septiuri bavSvebis sikvdilobaSi,
erT-erTi mniSvnelovani da saintereso faqtoria mkurnalobis reJimi,
rogorc axalSobilTa letalobis potenciuri prediqtori. axalSobilebSi,
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 20
romelTac CautardaT antibiotikoTerapia, letalobis maCvenebeli 1.16-jer
metia im neonataluri asakis bavSvebTan SedarebiT, romlebsac ar miuRiaT
antibiotikebi. aqve unda avRniSnoT, antivurusuli mkurnalobasa da
axalSobilTa letalobas Soris asociacia. im pacientebSi, romlebsac ar
CautardaT antivirusuli mkurnaloba( 85.4%) letalobis maCvenebeli
gacilebiT maRalia im CvilbavSvebTan SedarebiT, romlebsac daeniSnaT
antivirusuli (14.6%) mkurnaloba. miuxedavad aseTi Sedegisa, Tu zogadad
vimsjelebT axalSobilTa letalobasa da antibiotikoTerapiasa da
antivirusuli mkurnalobis rejims Soris asociaciaze , Cveni kvlevis
Tanaxmad statistikurad sarwmunod asociacia ar dadginda ( p = .48 da p = .61)
(ix. cxrili # 8).
multivariaciuli analizis Sedegad dadginda, rom etiologiuri
faqtori (virusis tipi), apgaris skalis maCvenebeli, mSobiarobis tipi
(vaginaluri / sakeisro kveTa) da sacxovrebeli adgili (sofeli / qalaqi)
warmoadgens damoukidebel risk-faqtorebs septiuri bavSvebis sikvdilobaSi.
ganviTarebad qveynebSi bavSvTa sikvdilobis 1.6 milioni SemTxveva
neonatalur infeqciebze modis, romelTagan wamyvani mizezi sefsisia. mwiri
resursebis mqone qveynebSi, maT Soris saqarTveloSi, pediatriul pacientebSi
sefsisis etiologiuri faqtorebi da gamosavlebi kargad ar aris
gansazRvruli.
Cveni kvlevis Tanaxmad septikuri bavSvebis letaloba
ganpirobebulia sxvadasxva risk-faqtorebiT, maT Soris wamvani adgili
virusul agentebs eniWebaT. kerZod, enterovirusebsa da herpesvirusebs.
neonataluri enterovirusebis klinikuri manifestacia
mravalxrivia, romelic iwvevs sxvadasxva xarisxis mwvave daavadebebs.
diskusia
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 21
neonataluri asakis jgufSi, enterovirusebiT gamowveuli daavadebebi
zogjer mTavrdeba fataluri, sefsisis msgavsi gamosavliT. miuxedavad imisa,
rom saqarTvelo ganviTarebadi qveyanaa, Cven QqveyanaSi Catarebuli kvlevis
Sedegebi TiTqmis ar gansxvavdeba ganviTarebul qveynebSi Catarebuli
kvlevebis Sedegebisgan. Cveni kvlevis Sedegad dadginda, rom saqarTveloSi
enterovirusebis roli neonataluri asakis septiuri bavSvebis letalobaSi
arc Tu ise maRalia (RR = 0.19, 95% CI 0.06,0.63, p = 0.0016). Tu SevadarebT sxva
kvlevebs, 1993 -2003ww. amerikaSi Catarebuli enterovirusebis erovnuli
kvlevis Tanaxmad, romelic sazRvravda asociacias enterovirusis serotipsa
da neonataluri infeqciebis gamosavals Soris , dadginda, rom 26,737
gamovlenili SemTxvevidan neonataluri asakis iyo 2544, romelTagan
fatalurad dasrulda 3.3%. neonataluri asakis bavSvebSi enterovirusiT
ganpirobebuli letaloba erT Tveze meti asakis bavSvebTan SedarebiT
xuTjer maRali iyo (11.5% vs. 2.5%; odds ratio [OR] = 5.1; 95% CI 3.3, 7.8). amasve
adasturebs verbun-makiolekis holandiaSi neonatalur intensiur
ganyofilebaSi Catarebuli 12 wliani kvleva, romelic gvaZlevs monacemebs
virusuli infeqciebis klinikuri da epidemiologiuri maxasiaTeblebis
Sesaxeb. kvlevis safuZvelze dadginda, rom 5396 pacients Soris virusuli
infeqcia aRmoaCnda 51.
serologiuri kvleva ar aris sarwmuno testi axalSobilebSi
herpesvirusebis diagnostikisTvis. IgM antisxeulebis warmoqmna xSirad
mogvianebiT xdeba [31]. IgG antisxeulebis gansazRvra mxolod retrospeqtuli
diagnostikisTvis xdeba. axalSobilebSi xSirad IgG antisxeulebis warmoqmna
ar xdeba da titris oTxjeradi matebis dafiqsireba SeuZlebelia [32].
amitom gamomwvevi agentis pirdapiri gansazRvra aseT SemTxvevebSi Zalian
mniSvnelovan diagnostikur Rirebulebas iZens. diagnostikis klasikuri
meTodebi, rogorebicaa eleqtronuli mikroskopia, imunofluorescentuli
mikroskopia da virusis kultivireba SedarebiT ufro damuSavebulia HSV-1,
HSV-2, VZV, CMV virusebisaTvis, maSin rodesac, EBV, HHV-6, HHV-7, HHV-8-is
kvleva aRniSnuli meTodebiT dResdReobiT kvlav uamrav siZnelesTanaa
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 22
dakavSirebuli, gansakuTrebiT klinikur pirobebSi. polimerizaciis jaWvur
reaqciaze (pjr) dafuZnebuli meTodebi ganixileba umniSvnelovanes midgomad
aRniSnuli agentebis laboratoriuli deteqciisaTvis [33]. iseTi virusis
SemTxvevaSic ki, rogoricaa martivi herpesis virusi (HSV), romelic
SedarebiT advilad SeiZleba kultivirdes, mainc pjr diagnostika sadReisod
"oqros standartad" iqca zogierTi daavadebis, maT Soris herpesuli
encefalitis diagnostikisaTvis [34].
imis gamo, rom herpesvirusebis jgufis ramdenime warmomadgenelma
SeiZleba ganapirobos msgavsi simptomebis ganviTareba, aseve daavadebis
CamoyalibebaSi SeiZleba ori an ramdenime herpesvirusi erTdroulad iRebdes
monawileobas, dRis wesrigSi dadga iseTi pjr testebis SemuSaveba, romelTa
saSualebiTac SesaZlebelia moxdes ramdenime herpesvirusis erTdrouli
deteqcia. dReisaTvis aseT meTodebs ganekuTvneba paraleluri pjr,
multipleqs pjr ramdenime praimeriT, aseve konsensus pjr praimerTa iseTi
wyviliT, romlebic Seesabameba konservirebul genomur ubans, saerTos
herpesvirusebis jgufis erTdroulad ramdenime warmomadgenlisaTvis.
meTodebs, romlebic gamiznulia aRniSnuli skrininguli meTodiT
gamovlenili virusis Semdgomi konfirmaciisa da tipirebisaTvis, miekuTvneba
hibridizacia saxeoba-specifikuri zondebis gamoyenebiT, budobrivi pjr
saxeoba-specifikuri praimerebis gamoyenebiT, restriqtuli fermentuli
analizi [35-37]. kvlevaSi gamoyenebul iqna konsensus praimerTa ori wyvili
pjr-saTvis, xolo amplifikaciis produqtebis identifikaciisaTvis
gamoyenebul iqna fermentebi BamHI da BstUI [34]. aseTi midgomis sizuste da
sandooba Semowmebulia yvela 8 herpesvirusis amplifikaciisa da
identifikaciisaTvis da dadasturebulia misi dadebiTi mxareebi,
rogorebicaa siswrafe, simartive da xarj-efeqturoba klinikuri
laboratoriuli diagnostikis pirobebSi [34].
enterovirusebis deteqciisaTvis serologiuri kvleva Cveulebriv ar
aris efeqturi serotipebis simravlis gamo [28]. am mizezis gamo pjr-ze
dafuZnebuli swrafi meTodis gamoyeneba enterovirusebis sxvadasxva
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 23
serotipis erTdrouli diagnostikisaTvis, Zlier mniSvnelovani iyo klinikur
pirobebSi aRniSnuli virusebis aRmoCenisaTvis. sxvadasxva avtoris mier
mowodebulia ramdenime aseTi meTodi [38].
Tu gaviTvaliswinebT herpes virusebis seriozul da fatalur
gamosavlebs, igi warmoadgens sazogadoebrivi jandacvisTvis seriozul
problemas saqarTveloSi da mTels msoflioSi. Cveni kvlevis Sedegad
generalizebuli infeqciis mqone axalSobilTa sikvdilobis 39% (16/41) herpes
virusebiT iyo gamowveuli (p = 0.039). miuxedavad imisa, rom saqarTveloSi ar
arsebobs monacemebi herpesvirusebis incidentobis Sesaxeb 100,000
cocxalSobilze ris gamoc sxva qveynebis monacemebTan pirdapiri Sedareba
SeuZlebelia, Cvens mier miRebuli Sedegebis safuZvelze arapirdapir
SegviZlia vimsjeloT, rom incidentoba mniSvnelovnad unda aRematebodes
ganviTarebuli qveynebis maCveneblebs. did britaneTSi herpesvirusebis
incidentoba Seadgens 2/200,000 cocxalSobilze. amerikis monacemebis Tanaxmad
herpesvirusebis incidentoba Seadgens 20-50/100,000 cocxalSobilze, sadac 75%
neonataluri infeqciebis modis herpesvirus 1-sa da herpesvirus 2-ze.
herpesvirusebis prevalentoba aseve dabalia avstraliaSi (1/10 000),
holandiaSi (1/14 000-20 000), daniaSi (1/22 000) , iaponiaSi (1/14 000-20 000),
SvedeTsa(1/15 000) da norvegiaSi (1/25 000) [46].
literaturuli monacemebis Tanaxmad, herpesis virusebis gadacema
dedidan bavSvze transplacenturi gziT arc Tu ise xSiria. gadacema xdeba im
SemTxvevaSi, roca orsulobis mesame trimestrSi dedebs aqvT genitaluri
herpesi klinikuri gamovlinebis an misi gamovlenis gareSe. am dros
axalSobilis inficireba xdeba dedis samSobiaro traqtTan pirdapiri
kontaqtiT, amis gamo sakeisro kveTiT dabadebul bavSvebze genitaluri
herpesis gadacemis riski minimumamde dadis. SesaZlebelia, rom orsulobis
periodSi usimptomod mimdinare genitaluri herpesis arseboba ar iyos
cnobili dedisTvis, Sesabamisad, fiziologiuri mSobiarobis SemTxvevaSi
dedidan bavSvze gadacemis riski didia. Cveni kvlevis Tanaxmad, letaloba im
bavSvebSi, romlebic fiziologiuri mSobiarobiT iyvnen dabadebulni (80.5%)
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 24
metia im pacientebTan SedarebiT, romlebic sakeisro kveTiT daibadnen (19.5%)
(RR =2.20, 95% CI 1.08,4.48, p =0.02) . arsebobs erT-erTi prospeqtuli kvlevis
Sedegebi, romelSic CarTuli iyo 58 000 qali. am kvlevis farglebSi 202
qalSi genitaliebis sekretidan aRmoCenil iqna herpesvirusi, romelTa Soris
117(58%) qalma imSobiara fiziologiuri mSobiarobiT, xolo 85 (42%) daeniSna
sakeisro kveTa. herpesvirusebis mniSvnelovnad dabali SemTxvevebi
dafiqsirda sakeisro kveTiT gaCenil bavSvebs Soris vaginalurad gaCenil
bavSvebTan SedarebiT ( 1.2%(1/85) vs. 7.7(9/117) OR = 0.14, 95% CI 0.02,1.08; p = .047).
kaliforniis StatSi Catarebuli kvleva gviCvenebs, rom mas Semdeg, rac
genitaluri herpesis mqone qalebSi fiziologiuri mSobiarobis ricxvma imata
(8%-dan 35%-mde), Sesabamisad orjer gaizarda neonataluri herpesvirusebis
ricxvic.
Tumca amasTan dakavSirebiT kvlevebis sruliad gansxvavebuli
Sedegebic arsebobs: neonataluri herpesvirusebis incidentoba ar gazrdila
didi britaneTis erT saavadmyofoSi, sadac sakeisro kveTiT mSobiarobis
ricxvi Semcirda 37%-iT genitaluri herpesis mqone qalebSi, TumcaRa
neonataluri herpesvirusebis ricxvi mainc ar gazrdila. anu, sakeisro kveTis
dadebiTi efeqtis Sesaxeb sakmaod urTierTgamomricxavi monacemebi arsebobs.
Cveni kvlevis Sedegebi miekuTvneba im jgufs, romelic sakeisro kveTis damcav
efeqts adasturebs dedidan bavSvze herpesis virusis gadacemis mxriv.
miuxedavad amisa, sadReisod amerikis daavadebaTa kontrolis centris
rekomendaciiT sakeisro kveTa amcirebs axalSobilebze virusuli infeqciebis
gadacemis risks da Tu sakeisro kveTa samSobiaro wylebis adreul
daRvramde iqna Catarebuli, es TiTqmis gamoricxavs axalSobilze virusis
gadacemis risks.
aqve unda aRiniSnos, rom rogorc Cveni kvlevis Sedegad gamovlinda,
maRalia araidentificirebuli virusuli agentiT gamowveuli sikvdiloba,
rac ufro arTulebs mkurnalobisa da gamosavlis gaumjobesebis process.
rodesac vmsjelobT mSobiarobis tipis asociaciaze axalSobilTa
letalobasTan, yuradReba unda gavamaxviloT samSobiaro wylebis adreul
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 25
daRvraze. sxvadasxva qveyanaSi mSobiarobis marTvis taqtika erTmaneTisgan
gansxvavebulia. sanayofe wylebis adreuli daRvra aris garTuleba, romelic
gvxvdeba orsulobis 3%-Si da aris naadrevi mSobiarobis mizezi, igi aseve
warmoadgens perinataluri sikvdilobisa da neonataluri garTulebebis
mizezs, kerZod neonataluri sefsisis, placentis aSrevebisa da
respiratoruli distres sindromis. samSobiaro wylebis adreuli daRvriT
ganpirobebuli axalSobilTa sikvdiloba damokidebulia gestaciur asakze.
orsulobis 24 kviraze samSobiaro wylebis adreuli daRvris SemTxvevaSi
neonataluri sikvdiloba maRalia. Cvens kvlevaSi ganxilul iyo sanayofe
wylebis adreuli daRvris efeqti axalSobilTa letalobaze. monacemebis
Tanaxmad, gamovlinda, rom axalSobilebis letalobis ricxvi, romlebic
sanayofe wylebis adreuli daRvriT iyo gamowveuli maRalia, vidre
vadamitanil orsulobisas mSobiarobis dawyebamde sanayofe wylebis daRvris
SemTxvevaSi. ar iqna miRebuli sarwmuno mtkicebulebebi neonataluri
sikvdilianobis Sesaxeb (RR =1.11, 95% CI 0.52,2.37, p = 0.78). Tu SevadarebT sxva
qveynis monacemebs, amerikaSi naadrevi mSobiaroba Seadgens 11%, romelTagan
3% sanayofe siTxis adreuli daRvriT aris ganpirobebuli. xolo
axalSobilTa sikvdiloba maRalia ZiriTadad orsulobis 24 kviraze sanayofe
siTxis adreuli daRvris SemTxvevaSi. vinaidan sanayofe siTxis
mSobiarobamdeli daRvra orsulobis adreul etapze warmoadgens dedisa da
axalSobilis inficirebis xSir mizezs, mimoxilvis Tanaxmad, romelSic
Sevida 19 kvleva,sadac CarTuli iyo 6000 qali, dadginda antibiotikebis
gamoyenebis sargeblianoba, romelic amcirebs neonatalur infeqciebs (RR =
0.88, 95% CI 0.81,0.96).
U Cveni kvlevis Tanaxmad dedaTa demografiuli da klinikuri
maCveneblebi , kerZod dedis asaki da sacxovrebeli adgili axalSobilTa
sikvdilobis erT-erTi mniSvnelovani prediqtoria. axalSobilTa sikvdiloba
im dedebSi, romelTa asaki < 18 welze da soflad cxovrobdnen aRemateboda
19 welze ufrosi asakisa da qalaqad macxovrebel dedebis maCveneblebs.
axalSobilTa Soris maRali sikvdiloba soflad macxovreblebSi SeiZleba
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 26
aixsnas sxvadasxva faqtoriT, rogoricaa axalSobilTa intensiuri
samkurnalo ganyofilebebis gaumarTaoba, Tanamedrove samkurnalo meTodebis
ar arseboba da dabali socialur-ekonomikuri pirobebi. dedaTa asakisa da
sacxovrebeli adgilis asociacia neonataluri asakis sikvdilobasTan
naCvenebia mraval kvlevaSi [44,45]. kerZod, 1973-1989ww. stokholmi, SvedeTSi,
Catarebuli kvlevis Tanaxmad, romlebic adgendnen axalSobilTa
sikvdilobaze dedis asakis gavlenas, gviCvena, rom axalSobilTa sikvdilobis
maRali ricxvi Tineijer dedebSi dakavSirebulia dedebis fizikuri da
reproduqciuli ganviTarebis xarisxTan. am kvlevis monacemebiT,
neonataluri sikvdilobis risksa da dedis asakobriv jgufebis Soris
kavSiri aSkaraa : axalSobilTa sikvdiloba 20-24 wlis asakis dedebTan
SedarebiT 13-15 wlis (OR = 2.7) da 16-17 wlis (OR = 1.4) dedebSi gacilebiT
maRalia.
mniSvnelovania aseve Cvens kvlevaSi bavSvTa sikvdilobis SemTxvevebis
kavSiri dRenaklobasTan. daaxloebiT 17.1% gardacvlili bavSvebisa iyvnen
dRenaklebi (RR =2.20, 95% CI 1.17,4.41, p = .027) da 52.1% bavSvebisa, romlebic
Sefasebul iyvnen ≤ 6 quliT apgaris skalis mixedviT, fataluri gamosavliT
dasrulda. sxva kvlevis Tanaxmad, romelic nepalSi Catarda da miznad
isaxavda gaerkvia neonataluri sikvdilobis risk-faqotrebi, aseve dadginda,
rom dRenaklobasa da axalSobilTa letalur gamosavals Soris aris
mniSvenelovani asociacia (OR=4.27, 95% CI 3.06, 5.97;) [47].
rac Seexeba herpesvirusebis dauyovnebliv mkurnalobis dawyebas,
mravali faqtori unda inqes gaTvaliswinebuli. kerZod, herpesvirusebis
gamovlenasa da hospitalicias Soris saSualo dro 4 dRea, romelsac kidev
sxva mravali faqtori aferxebs. situacia kidev ufro rTuldeba dabadebisas
simptomebis ar arsebobis SemTxvevaSi, rodesac axalSobili gadayvanilia
binaze. inficirebuli dedis mier vaginalurad dabadebuli axalSobilebi
gamokvleul unda iyvnen 24-48 saaTis ganmavlobaSi. cnobilia antivirusuli
mkurnalobis adreuli Carevis roli neonataluri herpesvirusebis xelsayrel
gamosavalze. antivirusuli mkurnalobis usafrTxoeba da efeqturoba
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 27
virusuli infeqciebis mkurnalobaSi cnobilia bolo aTwleulis manZilze.
antivirusuli mkurnaloba dawyebuli unda iqnes daavadebis rac SeiZleba
adreul etapze. naklebad savaraudoa daavadebis sasurveli gamosavlis
miRweva, Tu simptomebis gamovlenasa da mkurnalobis dawyebas Soris
intervalebi ar iqna Semcirebuli. Cveni kvlevis Tanaxmad, gardaclilTa
Soris (n = 41) antivirusuli mkurnaloba acikloviriT CautardaT 85.6%.
antivirusuli mkurnalobis Sedegad gardacvlil axalSobilTa ricxvi(14.6%)
gacilebiT dabali iyo antibiotikebiT Catarebuli mkurnalobis Sedegad
gardacvlil bavSvTa ricxvze (90.2%). mixedavad amisa, Cveni kvlevis Tanaxmad
antimikrobuli mkurnalobisa da antivirusuli mkurnalobis asociacia
axalSobilTa letalobasTan TiTqmis erTnairia (RR= 1.6 vs. RR= 122, p= 0.48 vs.
p=0.61).
TumcaRa, sxva kvlevebis Tanaxmad, acikloviri ar unda iqnes
daniSnuli rutinulad standartuli antibiotikebis mkurnalobis msgavsad
neonataluri sefsisis dros.
praqtikaSi acikloviri gamoiyeneba misi usafrTxo profilisa da
moxerxebuli rejimis gamo [41]. bolo periodSi Catarebulia kvlevebi,
romlebmac gamoikvlies acikloviris maRali doziTa da xangrZlivi periodis
ganmavlobaSi herpesvirusebis mkurnalobis reJimi[42]., rogorc acikloviris
supresirebuli Terapiis kursi [43]. axalSobilTa sikvdilobisa da
daavadebianobis Semcirebis gaumjobeseba SesaZlebelia mkurnalobis kursis
gaxangrZlivebiT 10 dRidan 14-21 dRemde, romelic Tavis mxriv dakavSirebulia
daavadebis klinikasTan. axalSobilebis samkurnalod neonataluri herpesis
dadgenili an saeWvo infeqciis SemTxvevaSi gamoyenebul unda iqnes
intravenuri acikloviris maRali doza (60 mg/kg dReSi gayofili sam dozad),
8 saaTSi erTxel 21 dRis ganmavlobaSi diseminirebuli formisa da
centraluri nervuli sistemis dros, xolo kanisa da lorwovanis membranis
darRvevis SemTxvevaSi igive doziT 14 dRe.
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 28
arsebobs rigi naklovanebebisa, romelic aqvs Cven kvlevas da saWiroa
gaTvaliswinebul iqnes Sedegebis gaxilvis dros. pirvel rigSi, ZiriTad
naklovanebas warmoadgens sakvlevi jgufis raodenobis simcire, radgan
dabali statistikuri Zala aZnelebs gamovavlinoT statistikurad sarwmuno
asociciacia jgufebs Soris, romlebic Zalian umniSvnelod gansxvavdebian
erTmaneTisgan. aseve, Cveni kvlevis farglebSi axalSobilebi reanimaciul
ganyofilebaSi gadmogzavnil iyvnen mxolod samSobiaro saxlebidan da
poliklinikebidan. SesaZlebelia bavSvebi, romlebsac mkurnaloba
utardebodaT mxolod sakuTari ojaxis eqimis an poliklinikis pediatris
meTvalyureobis qveS, ver moxvedriliyvnen Cvens kvlevaSi. garda amisa,
idealuri iqneboda dedebis klinikur maxasiTeblebze damatebiTi
monacemebis arseboba, kerZod orsulobis dros dedebis virusologiuri
gamokvlevis Sedegebi. es SeiZleba miCneul iqnes kvlevis naklovanebad, Tumca
umravles SemTxvevaSi dedebs orsulobis dros virusologiuri kvlevebi
Catarebuli saerTod ar hqondaT. da bolos, vinaidan Cveni kvlevis mizans
warmoadgenda dagvedgina virusuli infeqciebisa da sxva risk-faqtorebis
roli septiuri bavSvebis sikvdilobaSi, gaweris Semdeg gadarCenil bavSvTa
saboloo gamosavali mniSvnelovani informacia iqneboda, Tumca es monacemebi
CvenTvis ucnobia.
kvlevis naklovanebebi
daskvna
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 29
Cvens mier Catarebuli kvleva sakmaod mniSvnelovan informacias
gvawvdis generalizebuli infeqciis mqone axalSobilebSi virusuli
paTogenebis rolze. kvlevis Sedegad SeiZleba davaskvnaT, rom septikuri
bavSvebis sikvdilobaSi virusul agentebs sakmaod mniSvnelovani adgili
eniWebaT, kerZod, enterovirusebsa da herpesvirusebs. Cveni kvlevis Sedegad
aseve gamovlinda, rom maRalia araidentificirebuli virusuli agentiT
gamowveuli sikvdiloba, rac arTulebs mkurnalobisa da gamosavlis
gaumjobesebis process. kvlevis Sedegebi gasaTvaliswinebelia am jgufis
pacientTa marTvaSi, rac SesaZlebels gaxdis minimumamde Semcirdes
antibiotikebis xSirad aramiznobrivi gamoyeneba da moxdes mizanmimarTuli
antivirusuli mkurnalobis drouli daniSvna, rac am axalSobilTa
keTilsaimedo prognozis Sanss mniSvnelovnad gazrdis.
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 30
cxrili # 1. neonataluri sikvdiloba saqarTveloSi
daavadebebis mixedviT (2003-2005) (dk&sjec)
maxasiaTeblebi SemTxvevebisraodenoba
avadoba / 1000cocxalSobilze
sikvdilobaadreulneonatalur
fataloba
1 sul 5489 116.7 583 10.6
2qalasSidahemoragia
54 1.1 50 92.6
3neonatalurisefsisi
120 2.6 100 83.3
4perinataluriinfeqciebi
203 4.3 106 52.2
5respiratorulidistres sindromi
522 11.1 146.1 28.0
6sxvarespiratorulidarRvevebi
2797 59.9 452 16.2
7qalasSida tramvamSobiarobis dros
231 4.9 36 15.6
8simaxinjeebi 329 7.0 49 14.9
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 31
cxrili # 2. septiuri bavSvebis demografiuli da klinikuri
maxasiTeblebi.
maxasiaTeblebi bavSvTa
raod.(No.*)
procentebi
1 etiologiuri faqtorebi
enterovirusebi
herpesvirusebi
araidentificirebuli
66
68
53
33.5
36.4
28.3
2 mkurnaloba antibiotikebiT
ki
ara
16
177
8.6
91.4
3 antivirusuli mkurnaloba
Kki
ara
158
33
84.5
17.6
4 sqesi
mdedrobiTi
mamrobiTi
89
98
47.6
52.4
5 asaki hospitalizaciisas
< 7 dRe
≤ 7 dRe
96
91
51.3
48.7
6 wona dabadebisas
≤ 2500
> 2500
47
140
25.1
74.9
7 apgaris skala
≤ 6
> 6
63
124
33.7
66.3
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 32
8 dRenakloba
ki
ara
16
171
8.6
91.4
* Number – bavSvTa saerTo raodenoba
cxrili #3. dedaTa demografiuli da klinikuri monacemebi.
maxasiaTeblebi bavSvTa
raod.(No.*)
procentebi
1 dedis asaki
≤18
> 19
29
158
15.5
84.5
2 sacxovrebeli adgili
sofeli
qalaqi
73
114
39.0
61.0
3 ganaTleba
saSualo
umaRlesi
37
150
19.8
80.2
4 pirveli bavSvi
ki
ara
43
144
23.0
77.0
5 prenataluri vizitebi
ki
ara
167
20
89.3
10.7
6 sanayofe wylebis adreuli daRvra
ki
ara
25
162
13.4
86.6
7 mSobiarobis tipi
vaginaluri
sakeisro kveTa
122
65
65.2
34.8
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 33
* Number – bavSvTa saerTo raodenoba
cxrili #4. sikvdilianobis maCveneblebi etiologiuri
faqtorebis mixedviT.
maxasiaTeblebi gard* gadarC. †
RR‡ 95% CI §Chi-squareTest #
p value**No. % No. %
etiologiuri
faqtorebi
enterovirusebi
herpesvirusebi
araidentificerbuli
3
6
2
3
9.0
3.7
3 43.2
2 35.6
1 21.2
0.19
0.57
0.11
0.06,0.63
0.33,0.97
0.03,0.35
9.92
4.47
24.20
0.0016
0.034
0.0000009
sul 1 100 46 100 23.62 0.000007
* gardacvlilTa raodenoba, Number - saerTo raodenoba, procenti† gadarCenilTa raodenoba‡ Risk ratio - riskTa Tanafardoba§ Confidence Interval - sarwmunoebis intervali
# Chi-square Test - xi-kvadrat testi**or mxriani statistikuri testi, p value < 0.05 aris statistikurad sarwmuno
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 34
naxazi 1. letalobis procentuli maCveneblebi etiologiuri
faqtorebis mixedviT.
ჰერპესვირუსებიარაიდენტიფიცირ
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
0.45
sikvdil
oba %
ენტეროვირუსები
ჰერპესვირუსები
არაიდენტიფიცირ
*
*
* statistikurad sarwmuno
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 35
cxrili #5. axalSobilis demografiuli da klinikuri
maCveneblebis asociacia sikvdilobasTan.
maxasiaTeblebi gard* gadarC. † RR‡ 95% CI § Chi-squareTest #
p value**
No. % No. %
sqesi
mdedrobiTi
mamrobiTi
26
15
63.4
36.6
72
74
9.3
50.7
1.57 0.89,2.78 2.55 0.11
asaki
hospitalizaciisas
≤18
>19
11
30
26
73.2.8
18
128
12.3
87.7
2.0 1.13, 3.52 5.14 0.02
apgaris skala
≤ 6
> 6
21 51.7 42 28.8 2.07 1.21,3.52 7.22 0.007
20 48.8 104 71.2
wona dabadebisas
≤ 2500
> 2500
13 31.7 34 23.3 0.15 0.93,1.65 2.03 0.15
28 68.3 112 76.7
* gardacvlilTa raodenoba, Number - saerTo raodenoba, procenti† gadarCenilTa raodenoba‡ Risk ratio - riskTa Tanafardoba§ Confidence Interval - sarwmunoebis intervali
# Chi-square Test - xi-kvadrat testi**or mxriani statistikuri testi, p value < 0.05 aris statistikurad sarwmuno
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 36
cxrili #6. dedaTa demografiuli da klinikuri
maCveneblebis asociacia axalSobilTa
sikvdilobasTan.
maxasiaTeblebi gard* gadarC. † RR‡ 95% CI § Chi-squareTest #
p value**
No. % No. %
dedis asaki
≤ 18
>19
11
30
26.8
73.2
18
128
12.3
87.7
2.0 1.13,3.52 5.14 0.02
sacxovrebeli
adgili
sofeli
qalaqi
22
19
53.7
46.3
51
95
34.9
65.1
1.81 1.05,3.10 4.72 0.02
ganaTleba
saSualo
umaRlesi
9 22.0 28 19.2 1.14 0.60,2.18 0.16 0.69
32 78.0 118 80.8
pirveli bavSvi
ki
ara
11 26.8 32 21.9 1.23 0.67,2.24 0.44 0.51
30 73.2 114 78.1
prenataluri
vizitebi
ki
ara
8 19.5 12 8.2 2.02 1.09,3.75 4.27 0.039
33 80.5 134 91.8
* gardacvlilTa raodenoba, Number - saerTo raodenoba, procenti† gadarCenilTa raodenoba
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 37
‡ Risk ratio - riskTa Tanafardoba§ Confidence Interval - sarwmunoebis intervali
# Chi-square Test - xi-kvadrat testi**or mxriani statistikuri testi, p value < 0.05 aris statistikurad sarwmuno
cxrili #7. mSobiarobis Taviseburebebis asociacia
axalSobilis sikvdilobasTan. 2005-2006ww.
maxasiaTeblebi gard* gadarC. †
RR‡ 95% CI § Chi-squareTest #
p value**No. % No. %
dRenakloba
ki
ara
7
34
17.1
82.9
9
137
6.2
93.8
2.20 1.17,4.414 4.87 0.027
membranis adreuli
darRvevebi
ki
ara
6 14.6 19 13.0 1.11 0.52,2.37 0.07 0.78
35 85.4 127 87.0
mSobiarobis tipi
vaginaluri
sakeisro kveTa
33 80.5 89 61.0 2.20 1.08,4.48 5.38 0.02
8 19.5 57 29.0
* gardacvlilTa raodenoba, Number - saerTo raodenoba, procenti† gadarCenilTa raodenoba‡ Risk ratio - riskTa Tanafardoba§ Confidence Interval - sarwmunoebis intervali
# Chi-square Test - xi-kvadrat testi**or mxriani statistikuri testi, p value < 0.05 aris statistikurad sarwmuno
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 38
cxrili # 8. mkurnalobis rejimis asociacia
axalSobilTa sikvdilobasTan
maxasiaTeblebi gard* gadarC. †
RR‡ 95% CI §Chi-squareTest #
p value**No. % No. %
mkurnaloba
antiobiotikebiT
ara
ki
4 9.8 12 8.2
37 90.2 13.4 91.8
1.6 0.47,2.83 Fisher's
exact
0.48
antivirusuli
mkurnaloba
ara
ki
35 85.4 12.3 84.2
6 14.6 27 18.5
1.22 0.56,2.66 0.26 0.61
* gardacvlilTa raodenoba, Number - saerTo raodenoba, procenti† gadarCenilTa raodenoba‡ Risk ratio - riskTa Tanafardoba§ Confidence Interval - sarwmunoebis intervali
# Chi-square Test - xi-kvadrat testi**or mxriani statistikuri testi, p value < 0.05 aris statistikurad sarwmuno
marika koWlamazaSvili
virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 39
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