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noitcrafnI laidracoyM
dasraF zrobiraFSPCB/D mrahP
05 esaesiD traeH yranoroC %11 stcefeD traeH latinegnoC % stcefeD traeH latinegnoC %
11 /reveF citamuehR % /reveF citamuehR % traeH citamuehR traeH citamuehR
esaesiD esaesiD
44 eruliaF traeH evitsegnoC % eruliaF traeH evitsegnoC %
22 sisorelcsorehtA % sisorelcsorehtA %
44 erusserP doolB hgiH % erusserP doolB hgiH %
2222 rehtO % rehtO %
:esaesiD traeH yranoroC# eht llitS ,secnavdA etipseD
1 relliK
sesaesiD ralucsavoidraC morF shtaeD fo nwodkaerB egatnecreP :setatS detinU
1002 ataD laniF ,ytilatroM
6161 ekortS % ekortS %
noitaicossA traeH naciremA 8991 etadpU lacitsitatS :stcaF ekortS dna traeH
semordnyS yranoroC etucA
etucA emordnyS yranoroC
noitavelE TS oN noitavelE TS
anignA elbatsnU noitcrafnI laidracoyMIM Q noN IM evaw Q
IM noitavelE TS noN
E dlawnuarB la te . loidraC lloC mA J 0002 ; 63 : 079 – 2601 .
semordnyS yranoroC etucA fo murtcepS
elbatS elbatSanignA anignA
elbatsnU elbatsnUanignA anignA
noN noN -- Q QIM evaw IM evaw
evaw Q evaw QIMIM
noitavelE TS noitavelE TSIMIM
TS noN TS noNSCA noitavelE SCA noitavelE
GCE GCE -- TS TS
KCKC -- BM BM
ninoporT ninoporT
PRC PRC
GCE GCE -- TS TS
.PC nonnaC .PC nonnaC 9991 9991.emordnys yranoroc etuca=SCA
.anigna elbatsnu=AU .LD ttahB loidraC evisavnI J . 3002 ; 51 :3B-9 .B
erutpuR euqalP etucA)IMETS/IMETSN/AU(
elpitluM fo ecneserPseuqalP yranoroC
evitcaerrepyH tnetsisrePsteletalP
ralucsaVnoitammalfnI
lacinilC
lacinilcbuS
eht fo piT ehT :SCA citobmorhtorehtA”grebecI“
non=IMETSN - TS - .noitcrafni laidracoym noitavele tnemgesTS=IMETS - .noitcrafni laidracoym noitavele tnemges
٢
noitcrafni laidracoyM
• a ot eud netfo tsoM euqalp yranoroc derutpur teletalp retal dna doolb ni noitpurretni na ot gnidael sisobmorht/noitagergga
.ylppus negyxo dna wolf• lacidem evissergga rof deen tnegru gniriuqer noitidnoc lacitirC
.tnemeganam• anignA elbatsnU – etuca fo murtceps lacinilc eht fo trap oslA
emordnys yranoroc
ytisrevinU notgnihsaW ta retneC ekortS tenretnI eht fo ysetruoc egamI ytisrevinU notgnihsaW ta retneC ekortS tenretnI eht fo ysetruoc egamI -- gro.retnecekorts.www gro.retnecekorts.www
submorhT submorhT
htaed neddus & noitcrafnI laidracoyM• ni .S.U eht ni )IM( noitcrafnI laidracoyM fo ecnelaverp ehT 2002 saw 7.
6 noillim 1
• sa ynam sa ni deifitnedi era sIM 05 - 57 smitciv tserra caidrac neddus fo % 2,3,4
• nihtiW
6 ,IM dezingocer a fo sraey 7 dna nem fo % 6 ecneirepxe lliw nemow fo %htaed neddus 1
• etar htaed neddus a evah IM roirp a htiw slaudividnI 4-
6 lareneg eht fo taht semitnoitalupop 1
1
1 scitsitatS ekortS dna esaesiD traeH .noitaicossA traeH naciremA scitsitatS ekortS dna esaesiD traeH .noitaicossA traeH naciremA ——
3002
3002 ;noitaicossA traeH naciremA :.xeT ,sallaD .etadpU ;noitaicossA traeH naciremA :.xeT ,sallaD .etadpU 2002 2002 ..
2
2 .enicideM ralucsavoidraC fo koobtxeT A ,esaesiD traeH .JR grebreyM .enicideM ralucsavoidraC fo koobtxeT A ,esaesiD traeH .JR grebreyM 66 .de ht .de ht ;oC srednuaS BW :aihpledalihP ;oC srednuaS BW :aihpledalihP 7991 7991 retpahc: retpahc: 4242 . .
3
3 .AMAJ .G idrabmoL .AMAJ .G idrabmoL 4991 4991 ;; 172 172 :: 876 876 -- 386 386 .. 4
4 TJ reggiB TJ reggiB .noitalucriC . .noitalucriC . 4891 4891 ;; 9696 :: 052 052 -- 852 852 ..
rebmemer ot semiT
• 01 setunim lave DE rof emit• 03 setunim eldeen ot rood• 09 setunim noollab ot rood•
3 )tesno motpmys( sruoh ICP .sv citylonirbiF
ypareht• 21 )tesno motpmys( sruoh rof timil emiT
atad yb detroppus sa seipareht noitaziralucsaver
YGOLOISYHPOHTAP
•sisobmorht & erutpur )euqalp( amorehtAdipil ,elbatsnu na fo erutpur - suotamorehta hcir
teletalp gnitavitca ;yretra laidracipe ni euqalp yranoroc dna noitamrof tolc nirbif ,noisehda
sisobmorht
•msapSesuba gurd & sserts lanitome ot yradnoceS
٣
deriapmIsisylonirbiF
erutpuR euqalP rof srotcaF ksiR
negonirbiF
enietsycomoH
setebaiDsutilleM
loretselohC
gnikomS paC paCeugitaF eugitaF
eroC suotamorehtA eroC suotamorehtA)ycnetsisnoc/ezis( )ycnetsisnoc/ezis(
/ssenkcihT paC /ssenkcihT paCycnetsisnoC ycnetsisnoC
paC paCnoitammalfnI noitammalfnI
.la te V retsuF .la te V retsuF .deM J lgnE N .deM J lgnE N 2991 2991 ;; 623 623 :: 013 013 –– 813 813 .. .la te E klaF .la te E klaF noitalucriC noitalucriC . . 5991 5991 :: 2929 :: 756 756 –– 176 176 ..
euqalPerutpuR
srotcaF cimetsyS srotcaF cimetsySsrotcaF lacoL srotcaF lacoL
noitamroF submorhT ni steletalP fo eloR SCA ni
citorelcsorehtA citorelcsorehtAlesseV lesseV
euqalP euqalPerutpuR erutpuR
,noisehdA teletalP ,noisehdA teletalP dna ,noitavitcA dna ,noitavitcA
noitagerggA noitagerggA
submorhT submorhTnoitamroF noitamroF
citobmorhT citobmorhTnoisulccO noisulccO
IMIMekortS ekortS
ralucsaV ralucsaVhtaeD htaeD
dipiL dipiLeroC eroC
IA refahcS IA refahcS deM J mA . deM J mA . .. 6991 6991 ;; 101 101 :: 991 991 –– 902 902 ..
fo erusopxE fo erusopxE lailehtodnebus lailehtodnebusteletalp rehto dna negalloc teletalp rehto dna negalloc --
gnirehda gnirehda sdnagil sdnagil
AUAUIMETSN IMETSN
maoF maoF slleC slleC
yttaF yttaF kaertS kaertS
etaidemretnI etaidemretnI noiseL noiseL amorehtA amorehtA suorbiF suorbiF
euqalP euqalPdetacilpmoC detacilpmoC
/noiseL /noiseLerutpuR erutpuR
tsriF morFedaceD
drihT morFedaceD
htruoF morFedaceD
noitcnufsyD lailehtodnE
enilemiT sisorelcsorehtA enilemiT sisorelcsorehtA
.JC enipeP morf detpadA .loidraC J mA 8991 ; 28 lppus( 401 .)
ssecorP YROTAMMALFNI= sisorelcsorehtAytilibatsnI euqalP htiw setalerroC noitammalfnI
• detavele SCA ni taht stseggus ecnedivEsrekram yrotammalfni — PRC ,ralucitrap ni — tciderp
stneve ralucsavoidrac fo ksir erutuf eht• ,sserts raehs lairetra ranimal sa hcus srotcaF
suoitcefni dna ,slacidar eerf ,LDL dezidixoorp fo esaeler eht reggirt nac smsinagro -
LI ,ge( senikotyc yrotammalfni -1 FNT , -α LI , -6)• srekram yrotammalfni etuca fo snoitartnecnoC
elpitlum fo ecneserp eht htiw etalerrocsnoisel xelpmoc yllacihpargoigna
traeH .P saznavA 4002 ; 09 : 748 - 258
۴
MJEN MJEN 11// 4141 // 9999 esaesiD yrotammalfnI nA :sisorelcsorehtA : esaesiD yrotammalfnI nA :sisorelcsorehtA :
ygoloisyhpohtaP IM & noitammalfnI ygoloisyhpohtaP IM & noitammalfnI ygoloisyhpohtaP IM & noitammalfnI ygoloisyhpohtaP IM & noitammalfnI
ymotana yranoroC
• 4 ecafrus no nur seiretrA ”yramirP“traeh eht fo
• ynam evah seiretra esehT fo strap lla hcaer nac taht ”sehcnarb“
elcsum traeh eht•)ML( niaM tfeL
–DAL–xCL
•)DAL( gnidnecsed roiretna tfeL–slanogaiD–slatpeS
•( xelfmucric tfeL xCL )–)MO( lanigram esutbO–?ADP tfeL
•)ACR( yretra yranoroc thgiR–ADP–VLP
noitazilacoL IMA
V :roiretnA V :roiretnA 33 V , V , 44 :latpeS :latpeS VV11 V , V , 22 :roirefnI :roirefnI FVA ,III ,II FVA ,III ,II
:laretaL :laretaL V ,LVA ,I V ,LVA ,I 55 V , V , 66
I
II
III
RVa
LVa
FVa
V1
V2
V3
V4
V5
V6
esaesiD traeH rof srotcaF ksiR rojaM
elbaifidoM elbaifidoM elbaifidomnoN elbaifidomnoN srekraM ksiR gnigremE srekraM ksiR gnigremE
erusserp doolb hgiH erusserp doolb hgiH yrotsih ylimaF yrotsih ylimaF enietsycomoHslevel loretselohc lamronbA slevel loretselohc lamronbA egA egA slevel )a( nietorpopil detavelE
setebaiD redneG redneG srotcaf gnittolCgnikoms etteragiC gnikoms etteragiC )PRC( noitammalfni fo srekraM
ytisebO ytisebOytivitcani lacisyhP ytivitcani lacisyhP
.noitalucriC .la te ,MS ydnurG 8991 .noitalucriC .MS ydnurG ;
9991 .deM J lgnE N .E dlawnuarB 7991 .loidraC lloC mA J .la te ,MS ydnurG ; 9991
ytisebo fo snoitatsefinam lacinilC
nilusnI nilusnIecnatsiser ecnatsiser
yticixotoculG yticixotoculG
yticixotopiL yticixotopiL
↓↓ nitcenopidA nitcenopidA
↑↑ nitpeL nitpeL
siso
relc
sore
htA
.NP namssieW ,PA nywleS fo ysetruoC .NP namssieW ,PA nywleS fo ysetruoC 6002 6002 ..
epyT epyT
2
2 dna setebaid dna setebaidsredrosid cimecylg sredrosid cimecylg
↑↑ sAFF sAFF
aimedipilsyD aimedipilsyD
•• LDH woL LDH woL
•• LDL esned ,llamS LDL esned ,llamS
•• aimedirecylgirtrepyH aimedirecylgirtrepyH
noisnetrepyH noisnetrepyH
/noitcnufsyd lailehtodnE /noitcnufsyd lailehtodnE )PRCsh( noitammalfni )PRCsh( noitammalfni
sisylobmorht deriapmI sisylobmorht deriapmI↑↑ IAP IAP --11
۵
lufesu erom a reffo yam ecnerefmucric tsiaw fo tnemerusaeM lufesu erom a reffo yam ecnerefmucric tsiaw fo tnemerusaeMtsiaw naht ytisopida larecsiv fo rekram etagorrus tsiaw naht ytisopida larecsiv fo rekram etagorrus -- oitar pih oitar pih
ytisopida larecsiv rof )s(rekram lamitpO
rpseD rpseD éé .la te PJ s .la te PJ s .JMB .JMB 1002 1002 ;; 223 223 :: 617 617 -- 027 027 ..
ecnerefmucric tsiaw gnirusaeM
.vog.hin.iblhn.www .IBLHN .vog.hin.iblhn.www .IBLHN
tserc cailI tserc cailI
teiD emordnyS cilobateM
– sgnidnif lacisyhp lamronba fo puorG msilobatem s’ydob eht ot detaler – ylesolc
ecnatsiser nilusni ot deknil• taf ydob evissecxE – lanimodba yllaicepse•sedirecylgirt detavelE•erusserp doolb detavelE•esoculg gnitsaf detavelE•level loretselohc LDH woL
۶
emoC ot sgnihT fo epahS ehT
,noitartsullI revoC tsimonocE ehT ceD , 31 , 2002
noitcrafnI laidracoyM noitcrafnI laidracoyM noitatneserp lacinilC noitatneserp lacinilC noitcrafnI laidracoyM noitcrafnI laidracoyM noitatneserp lacinilC noitatneserp lacinilC
IM etucA fo sisongaiDyrotsiH yrotsiH
•• tsehc evisserppo ,esnetni :smotpmys cissalC tsehc evisserppo ,esnetni :smotpmys cissalCmra tfel ot gnitaidar erusserp mra tfel ot gnitaidar erusserp
•• :smotpmys rehtO :smotpmys rehtO gninrub ,ssenivaeh tsehc gninrub ,ssenivaeh tsehc smra ,kcab ,redluohs ,kcen ,waj ot noitaidar smra ,kcab ,redluohs ,kcen ,waj ot noitaidar gnitimov ,aesuan gnitimov ,aesuan siserohpaid siserohpaid aenpsyd aenpsyd ssendedaehthgil ssendedaehthgil
•• eltbus ro dlim eb yam smotpmyS eltbus ro dlim eb yam smotpmyS
:dradnatS dloG niap tsehc
• ytilauQ - ro ;”yvaeh" dna "gnitacoffus" ",ekilerusserp" ",ekilpirg" ",gnizeeuqs" dna ,gnibbats ro prahs reven tsomla si anignA ".niap" ton tub "trofmocsid" a
.noitaripser ro noitisop htiw egnahc ton seod yllausu
• noitaruD - trofmocsid gniteelF .noitarud ni setunim yllacipyt si edosipe lanignaanigna ylerar si sruoh rof gnitsal ehca llud a ro
• noitacoL - ro ,muirtsagipe ,waj ,kcen eht ot noitaidar tub ,lanretsbus yllausu ro ,muirtsagipe eht woleb ,elbidnam eht evoba niaP .nommocnu ton si smra
.lanigna ylerar si llaw tsehc laretal tfel eht revo aera llams a ot dezilacol
• noitacovorP - dna sserts lanoitome ro noitrexe yb detatipicerp yllareneg si anigna yllausu ,anigna seveiler osla nirecylgortin laugnilbuS .tser yb deveiler ylnommoc
nihtiw
03 .setunim lareves ot sdnoces
IM etucA fo sisongaiDnoitanimaxE lacisyhP noitanimaxE lacisyhP
•• aidracydarb ro aidracyhcaT aidracydarb ro aidracyhcaT
•• selotsysartxE selotsysartxE
•• SS33 S ro S ro 44 rumrum noitatigruger lartim , rumrum noitatigruger lartim ,
•• selar gnuL selar gnuL
•• noisnetopyh ro noisnetrepyH noisnetopyh ro noisnetrepyH
•• ssertsid ,rollaP ssertsid ,rollaP
٧
smotpmyS kcattA traeH ni secnereffiD redneG
sexes htob ni lacipyT• ro ,gnizeeuqs ,erusserp ,niaP
tsehc eht ni niap gnibbats• ,kcen ot gnitaidar niaP
waj ro ,mra ,kcab ,redluohs• ni egnahc ,traeh gnidnuoP
mhtyhr•gnihtaerb ytluciffiD• ,gnitimov ,aesuan ,nrubtraeH
niap lanimodba•niks ymmalc ro staews dloC•ssenizziD
nemow ni lacipyT• tsehc tuohtiw( smotpmys redliM
)niap
• ,ssenkaew fo tesno nedduS ,eugitaf ,htaerb fo ssentrohs fo gnileef llarevo ro ,sehca ydob
)niap tsehc tuohtiw( ssenlli
• dlim ro gnileef lausunU ,tsehc ,kcab eht ni trofmocsid tsehc tuohtiw( waj ro ,kcen ,mra
)niap
AHA :ecruoS
noitcrafnI laidracoyM - ssorG
srekraM caidraC srekraM caidraC noitavelE semyznE
-- PORT
٨
retfA srekramoiB suoiraV fo esaeleR fo gnimiTnoitcrafnI laidracoyM etucA
loidraC lloC mA J .la te .L .J ,nosrednA 7002 ; 05 e: 1-e 751 srekraM yranoroC
00 11 22 33 44 55 66 77 88
ninoport caidraC ninoport caidraC -- noisufreper on noisufreper on
IMETS fo tesnO retfA syaD IMETS fo tesnO retfA syaD
LR
U eht fo selpitluM
LR
U eht fo selpitluM
timil ecnerefer reppU timil ecnerefer reppU11
22
55
0101
0202
0505
= LRU = LRU 9999 fo elit% ht fo elit% htpuorG lortnoC ecnerefeR puorG lortnoC ecnerefeR
001 001
ninoport caidraC ninoport caidraC -- noisufreper noisufreperBMKC BMKC -- noisufreper on noisufreper on
BMKC BMKC -- noisufreper noisufreper
IMETS ni srekramoiB caidraC
loidraC lloC mA J .la te treplA loidraC lloC mA J .la te treplA 0002 0002 ;; 6363 :: 959 959 .. mehC nilC .la te uW mehC nilC .la te uW 9991 9991 ;; 5454 :: 4011 4011 ..
ygetartS rekramitluM:SCA ni srekramoiB fo erutuF
sh - hgih = PRC - C ytivitisnes - DC ;nietorp evitcaer 04 DC = L
04 dnagil niarb = PNB ; citeruirtan ;editpepN = TN - AbH ;lanimret 1c A nibolgomeh = 1c ; lCrC = eninitaerc .ecnaraelc
,AD worroM morf noissimrep htiw detpadA dlawnuarB .E noitalucriC . 3002 ; 801 : 052 - 252 ..
etycoyM etycoyM sisorceN sisorceN
noitammalfnI
detareleccA detareleccAsisorelcsorehtA sisorelcsorehtA
ralucsaV ralucsaVegamaD egamaD
cimanydomeHssertS
SCA ni eliforP rekramoiB SCA ni eliforP rekramoiB
shsh -- DC ,PRC DC ,PRC 0404 LL TN ,PNB TN ,PNB -- PNBorp PNBorp
AbH AbH 11ccesoculg doolB esoculg doolB
lCrC lCrCairunimublaorciM airunimublaorciM
ninoporT ninoporT
5151
2 tnemtaerT IM fo sesahP
criC .P ybbiL 1002 ; 401 : 563 ,
etucA etucA gnoL - mretetucA etucA gnoL - mret<( 42 )srh )egrahcsiD(
1. ASA 2. lergodipolC 3. HWML/nirapeH 4. srotibihni aIII/bII PG 5. ateB - srekcolb 6. setartiN 7. bal htaC
1. ASA 2. lergodipolC 3. ateB - srekcolb 4. srotibihnI ECA 5. snitatS 6. elytsefiL + rotcaf ksiR Δ s’
٩
YGRENYS
HWML
ECNESSE ECNESSE
4991 4991 5991 5991 6991 6991 7991 7991 8991 8991 9991 9991 0002 0002 2002 2002 3002 3002 4002 4002 5002 5002 6002 60021002 1002
ERUC ERUC
lergodipolC
ksir gnideelB ksir gnideelB
ksir cimehcsI ksir cimehcsI
aIII/bII PGsrekcolb
MSIRP - SULP
TIUSRUP
YTIUCAIMIT SCITCAT IMIT SCITCAT -- 8181
evisavni ylraE
ICP ICP ~ ~ 55 stnets % stnets % ~~ 5858 stnets % stnets % gurD gurD -- stnets gnitule stnets gnitule
RASI - TCAER 2
tnemeganaM SCA ni senotseliM
SISAO -5
[ [ xunirapadnoF xunirapadnoF ]]
itnA itnA -- xR nibmorhT xR nibmorhT
itnA itnA -- xR teletalP xR teletalP
ygetartS tnemtaerT ygetartS tnemtaerT
nirapeH nirapeH
niripsA niripsA
evitavresnoC evitavresnoC
SUTCI
nidurilaviB
ECALPER 2
DM ,naikuonaM nevetS fo ysetruoc eht htiw dna morf detpadA DM ,naikuonaM nevetS fo ysetruoc eht htiw dna morf detpadA DM ,naikuonaM nevetS fo ysetruoc eht htiw dna morf detpadA DM ,naikuonaM nevetS fo ysetruoc eht htiw dna morf detpadA
0991 0991 2991 2991 4991 4991 6991 6991 8991 8991 0002 0002 2002 2002
0991 0991AHA/CCA AHA/CCA IMA IMArannuG .R rannuG .R
4991 4991IBLHN/RPCHA IBLHN/RPCHA
AU AUdlawnuarB .E dlawnuarB .E
6991 6991 9991 9991desiveR desiveR detadpU detadpU
IMA AHA/CCA IMA AHA/CCAnayR .T nayR .T
4002 7002
4002 7002
detadpU desiveR detadpU desiveR IMETS AHA/CCA IMETS AHA/CCA
.E.E namtnA namtnA
4002 7002
4002 7002
detadpU desiveR detadpU desiveR IMETS AHA/CCA IMETS AHA/CCA
.E.E namtnA namtnA
0002 2002
0002 2002 7002 7002
detadpU desiveR detadpU desiveR desiveR desiveRIMETSN/AU AHA/CCA IMETSN/AU AHA/CCA
.E .E dlawnuarB dlawnuarB nosrednA .J nosrednA .J
0002 2002
0002 2002 7002 7002
detadpU desiveR detadpU desiveR desiveR desiveRIMETSN/AU AHA/CCA IMETSN/AU AHA/CCA
.E .E dlawnuarB dlawnuarB nosrednA .J nosrednA .J
4002 4002 7002 7002
SCA rof senilediuG fo noitulovE SCA rof senilediuG fo noitulovE SCA rof senilediuG fo noitulovE SCA rof senilediuG fo noitulovE
I ssalC
ksiR >>> tifeneB
tnemtaerT /erudecorP DLUOHS /demrofrep eb
deretsinimda
aII ssalC
>> tifeneB ksiR htiw seiduts lanoitiddA
dedeen sevitcejbo desucof
ELBANOSAER SI TI ot mrofrep
retsinimda/erudecorptnemtaert
bII ssalC
≥ tifeneB ksiR daorb htiw seiduts lanoitiddA
;dedeen sevitcejbo atad yrtsiger lanoitiddA
lufpleh eb dluow
tnemtaerT/erudecorP DEREDISNOC EB YAM
III ssalC
≥ ksiR tifeneBdedeen seiduts lanoitidda oN
dluohs tnemtaerT/erudecorP TON eb
deretsinimda/demrofrep LUFPLEH TON SI TI ECNIS
LUFMRAH EB YAM DNA
dluohsdednemmocer si
detacidni silaicifeneb /evitceffe/lufesu si
elbanosaer silaicifeneb /evitceffe/lufesu eb nac
ro dednemmocer ylbaborp sidetacidni
deredisnoc eb thgim/yamelbanosaer eb thgim/yam
si ssenevitceffe/ssenlufesu ro niatrecnu/raelcnu/ nwonknu
dehsilbatse llew ton
dednemmocer ton sidetacidni ton si
ton dluohslaicifeneb/evitceffe/lufesu ton si
lufmrah eb yam
snoitadnemmoceR fo noitacifissalC gniylppA snoitadnemmoceR fo noitacifissalC gniylppA ecnedivE fo leveL dna ecnedivE fo leveL dna
A leveL
( elpitluM 3-5 ) ksir noitalupopdetaulave atarts
lareneG fo ycnetsisnoc
dna noitcerid fo edutingam
tceffe
I ssalC
• nemmoceR - taht noitad
ro erudecorp si tnemtaert
evitceffe /lufesu • tneiciffuS
morf ecnedive elpitlum
dezimodnaratem ro slairt -
sesylana
aII ssalC
• nemmoceR - fo rovaf ni noitad
ro tnemtaert gnieb erudecorp
evitceffe /lufesu • gnitcilfnoc emoS
morf ecnedive elpitlum
slairt dezimodnaratem ro -sesylana
bII ssalC
• nemmoceR - s’noitad
/ssenlufesu llew ssel ycaciffe
dehsilbatse • retaerG
gnitcilfnoc morf ecnedive
elpitlum slairt dezimodnar
atem ro - sesylana
III ssalC
• nemmoceR - taht noitad
ro erudecorp ton tnemtaert
evitceffe/lufesu eb yam dna
lufmrah • tneiciffuS
morf ecnedive elpitlum
slairt dezimodnaratem ro - sesylana
snoitadnemmoceR fo noitacifissalC gniylppA snoitadnemmoceR fo noitacifissalC gniylppA ecnedivE fo leveL dna ecnedivE fo leveL dna
B leveL
( detimiL 2-3 ) ksir noitalupopdetaulave atarts
I ssalC
• nemmoceR - taht noitad
ro erudecorp si tnemtaert
evitceffe/lufesu • ecnedive detimiL
elgnis morf lairt dezimodnar
non ro - dezimodnar
seiduts
aII ssalC
• nemmoceR - fo rovaf ni noitad
ro tnemtaert gnieb erudecorp
evitceffe /lufesu • gnitcilfnoc emoS
morf ecnedive elgnis
lairt dezimodnarnon ro -
dezimodnarseiduts
bII ssalC
• nemmoceR - s’noitad
/ssenlufesu llew ssel ycaciffe
dehsilbatse • retaerG
gnitcilfnoc morf ecnedive
dezimodnar elgnisnon ro lairt -
dezimodnarseiduts
III ssalC
• nemmoceR - taht noitad
ro erudecorp ton tnemtaert
evitceffe/lufesu eb yam dna
lufmrah • ecnedive detimiL
elgnis morf lairt dezimodnar
non ro - dezimodnar
seiduts
snoitadnemmoceR fo noitacifissalC gniylppA snoitadnemmoceR fo noitacifissalC gniylppA ecnedivE fo leveL dna ecnedivE fo leveL dna
snoitadnemmoceR fo noitacifissalC gniylppA snoitadnemmoceR fo noitacifissalC gniylppA ecnedivE fo leveL dna ecnedivE fo leveL dna
C leveL
( detimil yreV 1-2 ) ksir noitalupopdetaulave atarts
I ssalC
• nemmoceR - taht noitad
ro erudecorp si tnemtaert
evitceffe /lufesu • trepxe ylnO
esac ,noinipo ro ,seiduts
dradnats - fo - erac
aII ssalC
• nemmoceR - fo rovaf ni noitad
ro tnemtaert gnieb erudecorp
evitceffe/lufesu • gnigrevid ylnO
,noinipo trepxe ro ,seiduts esac
dradnats - fo - erac
bII ssalC
• nemmoceR - s’noitad
/ssenlufesu llew ssel ycaciffe
dehsilbatse • gnigrevid ylnO
,noinipo trepxe ro ,seiduts esac
dradnats - fo - erac
III ssalC
• dnemmoceR - taht noita
ro erudecorp ton tnemtaert
evitceffe/lufesu eb yam dna
lufmrah • trepxe ylnO
esac ,noinipo ro ,seiduts
dradnats - fo - erac
٠١
eraC tneitaP RE
<( tnemssessa laitinI
01 )nim• sngis lativ erusaeM•S erusaeM pO2•ssecca VI niatbO• niatbO 21 - GCE dael• detegrat ,feirb mrofreP
)EP dna yrotsih
• caidrac laitini niatbOslevel rekram
• laitini etaulavE dna etylortcele
seiduts noitalugaoc• weiver ,tseuqeR
x tsehc elbatrop - yar<(
03 nim
erac tneitap RE
• :dia yromem( tnemtaert lareneg laitinI“ ANOM ” stneitap lla steerg
–enihproM , 2-
4 q detaeper gm 5-
01 nim–negyxO ,
4 S fi eunitnoc ;nim/L aO
2 < 09 %
–GTN rof VI yb dewollof ,yarps ro LS ,trofmocsid tnerrucer ro tnetsisrep–niripsA ,
061 ot
523 )wollaws dna wehc( gm
aiseglanA & negyxOI ssalCnegyxO
1 htiw stneitap ot deretsinimda eb dluohs negyxo latnemelppuS .OaS( noitarutased negyxo lairetra 2 naht ssel 09 .)%
B :ecnedivE fo leveL( )aiseglanA
1 ( etaflus enihproM .
2 ot
4 fo stnemercni htiw VI gm 2-
8 VI gm ta detaeper 5- 51 rof eciohc fo ciseglana eht si )slavretni etunim
.IMETS htiw detaicossa niap fo tnemeganam :ecnedivE fo leveL( )C
75 .la te namtnA CCAJ 4002 ; 44 : 976 .
aiseglanA
• yam hguohtla IMETS rof I ssalC sniamer enihproMIMETSN/AU ni stneve esrevda esaercni
• ekil dioipo ecnis detacidni ton lodamarTseitreporp
• ,ytilatrom esaercni snoitacidem DIASN ot noitroporp ni eruliaf traeh dna ,noitcrafnier
XOC fo eerged -
2 ytivitceles–IMETS rof noissimda no eunitnocsiD–tnemeganam fo esahp etuca gnirud etaitini ton oD
85
nirecylgortiN
fo mroFetartiN
egasoD
fo tesnOtceffE
kaeP tceffE
laugnilbuS
4.0 -
2.1 gm
Q5-
01 nim
2 setunim 8-
01 setunim
etsaportiN
2/1 ot 2 sehcni
03 setunim 3-
6 srh
VI
01 gu / nim sdnoces setunim
nirecylgortiN
I ssalC gniogno htiw stneitaP . trofmocsid cimehcsi ( nirecylgortin laugnilbus eviecer dluohs 0.
4 )gm
yreve
5 fo latot a rof setunim
3 tuoba edam eb dluohs tnemssessa na hcihw retfa ,sesod .nirecylgortin suonevartni rof deen eht :ecnedivE fo leveL( )C
2 fo lortnoc ,trofmocsid cimehcsi gniogno fo feiler rof detacidni si nirecylgortin suonevartnI . .noitsegnoc yranomlup fo tnemeganam ro ,noisnetrepyh :ecnedivE fo leveL( )C
III ssalC1 dluohs setartiN . naht ssel erusserp doolb cilotsys htiw stneitap ot deretsinimda eb ton 09
gH mm ot lauqe ro naht retaerg ro 03 naht ssel( aidracydarb ereves ,enilesab woleb gH mm 05 naht erom( aidracyhcat ,)mpb 001 ,)mpb .noitcrafni VR detcepsus ro :ecnedivE fo leveL(
)C2 dluohs setartiN . esaretseidohpsohp a deviecer evah ohw stneitap ot deretsinimda eb ton
tsal eht nihtiw noitcnufsyd elitcere rof rotibihni 42 ( sruoh 84 .)lifaladat rof sruoh fo leveL( :ecnedivE )B
06 .la te namtnA CCAJ 4002 ; 44 : 976 .
١١
?ASA fo esod thgir eht si tahW
AMAJ ,llebpmaC AMAJ ,llebpmaC 7002 7002 AMAJ ,llebpmaC AMAJ ,llebpmaC 7002 7002
detsegguS detsegguS :esod gnidaoL :esod gnidaoL 061 061 --
523
523 gmgm
:esod yliaD :esod yliaD 5757 --
18
18 gmgm
detsegguS detsegguS :esod gnidaoL :esod gnidaoL 061 061 --
523
523 gmgm
:esod yliaD :esod yliaD 5757 --
18
18 gmgm
snoitadnemmoceR niripsA snoitadnemmoceR niripsA
niripsa yletinifedni eunitnoc dna tratS
57 ot
261 ni d/gm detacidniartnoc sselnu stneitap lla
( niripsa ,GBAC gniogrednu stneitap roF
001 ot
523 nihtiw detrats eb dluohs )d/gm
84 ot yregrus retfa sruoh
erusolc tfarg niev suonehpas ecuder
tsoP - ICP - eviecer dluohs stneitap detnets
523 rep gm rof niripsa fo yad
1 ,tnets latem erab rof htnom
3 shtnom
sumiloris rof - dna tnets gnitule
6 lexatilcap rof shtnom -tnets gnitule
III aII aII aII bII bII bII III III IIIIII aII aII aII bII bII bII III III IIIIII aII aII aII bII bII bII III III IIIaII aII aII bII bII bII III III III
III aII aII aII bII bII bII III III IIIIII aII aII aII bII bII bII III III IIIIII aII aII aII bII bII bII III III IIIaII aII aII bII bII bII III III III
III aII aII aII bII bII bII III III IIIIII aII aII aII bII bII bII III III IIIIII aII aII aII bII bII bII III III IIIaII aII aII bII bII bII III III III
niripsA fo ecnatropmI
.DH etihW J mA loidraC 7991 ; 08 :2B- 01 .B .A refahcS J nilC tsevnI 6891 ; 87 : 37 - 97 .
gnoJeD la te ,JM gnisruN eraC lacitirC . nilC mA N fo 9991 ; 11 : 553 - 173 . .la te ,M resoM J csavoidraC locamrahP 3002 ; 14 : 685 - 295 .
.MR hguorobracS ,RD spillihP J mA loidraC 7991 ; 08 (4 :)A 11 B- 02 .B
• bII PG - ot ibmorht gnitsixe ni negonirbif ecalpsid srotibihni aIIIssorc teletalp rehtruf tneverp dna submorht etagerggasid - dna gniknil
sisobmorht
• bII PG - noitavitca teletalp tneverp srotibihni aIIIbII PG gnikcolb yb - edistuo( aII - )gnilangis ni
hgiH - FAP setalumits nirapeh esodsteletalp setavitca hcihw
yparehT niripsA rof senilediuG AHA/CCA
• fo esod a ni nevig eb dluohs niripsA 57 - 523 yad/gm a si ereht sselnu SCA htiw stneitap lla ot dluohs lergodipolc ,esac hcihw ni( noitacidniartnoc
)nevig eb
< emit ,BBBL wen ro noitavele TS 21 rh
secruoser lacol no desab ygetarts noisufrepeR– <( scitylobmorhT
03 )nim
• APT
51 + sulob gm 0.
57 revo gK/gm
03 + nim 0.
5 revo gK/gm 06 nim
ro• KS 1.
5 revo UI noillim
1 h
– ,ICP( noitnevretni yranoroc suoenatucrep yramirP ytsalpoigna ± ( )tnets
09 ±
03 )nim
–pukcab yregrus cicarohtoidraC
ycnetaP yranoroC eveihcA
•yparehT noisufrepeR laitinI
– erotser ot deyolpme ygetarts laitini eht sa denifeD yretra yranoroc dedulcco eht ot wolf doolb
•
3 :snoitpO rojaM
• noisufrepeR lacigolocamrahP• ICP• noisufrepeR lacigruS etucA•ICP detatilicaF
CCAJ .la te namtnA 4002 ; 44 : 086 .
٢١
IMA ot hcaorppA ni egnahC
IM etucA
eruliaf cityL htiw htaC rof refsnarT
cityL
IM etucA
”detatilicaF“HWML/cityL
stneitap lla yltnegreme refsnarT
0991 - 2002 3002 - 5002
sisylonirbiFnegonimsalP
nimsalP
nirbiF nirbiF negonirbif , negonirbif ,
noitavitcA noitavitcAt :cisnirtxE t :cisnirtxE -- esanikoru ,AP esanikoru ,AP
nierkillak ,aIIX rotcaf :cisnirtnI nierkillak ,aIIX rotcaf :cisnirtnI
esanikotperts :suonegoxE esanikotperts :suonegoxE
nirbiF nirbiF negonirbif , negonirbif ,stcudorp noitadarged stcudorp noitadarged
sisylonirbiF
nimsalP
AP-t
GP
GP
LP
AP-t
nimsalP
AP-t
GP
AP-tGP
LPsPDF
negonimsalP
nirbiF
sPDF
negonimsalP
nirbiF nirbiF
07
gurD
ycneiciffE tolC rof
sisyL
nirbiF
yticificepS
laitnetoP
yticinegitnA
egarevA
esoD
gnisoD
tsoC esanikotpertS hgiH laminiM seY
5.1 UM
1 VI rh noisufni
woL
esalpertsinA hgiH laminiM seY
03 U 2–
5 VI nim noisufni
etaredoM
esalpetlA hgiH taredoM e oN
001 gm
51 VI gm
sulob , 05
revo gm 03
nim , 53 gm
revo 06 nim a
hgiH
esalpeteR hgiH etaredoM oN
01 + 01 U
01 VI stinu
sulob , 2 dn
sulob 03 retal nim
hgiH
esalpetceneT hgiH hgiH oN 03 -
05 gm no desab(
)thgiew b
revo suloB5-
01 sces hgiH
decuder .a
gnihgiew stneitap rof sesod < 56 gk . stneitap roF b < 06 gk : 03 gm , 06 -
96 gk : 54 gm , 07 -
97
gk : 04 gm , 08 -
98 gk : 54 gm , >
09 gk : 05 gm
nosirapmoC citylonirbiF
IMIT 0noisulccO
IMIT 1noitarteneP
IMIT 2wolF wolS
IMIT 3wolF lamroN
elacS IMIT stnegA citylonirbiF devorppA fo nosirapmoC
esanikotpertSesalpertsinAesalpetlAesalpeteR
esoD1.
5 UM 03 gm 001 gm01 x U 2 ni 03 - 06 nim ni
5 nim ni 09 nim revo 03 nim
noitartsinimda suloBONseY oN seYcinegitnAseYoN seYoNsnoitcaer cigrellAoN seY seYoN)noisnetopyh yltsom(negonirbif cimetsySdekraMdliM dekraMetaredoMnoitelped
09 - etar ycnetap nim~ 05 %~ 56 ~ % 57 ~ % 57 %IMIT -
3 wolf 23 % 34 % 45 %06 %
etar ytilatroM7.3%01 .5 % 7.2 % 7.5%)SU( esod/ tsoC$ 492 $ 6112$ 6912$ 6912
٣١
scitylobmorhT :etar noisufreper stciderp ega tolC
•tolc hserf ni evitceffe yreV• ot pU 52 < deretsinimda fi troba ylluf yam % 1 rh
tesno motpmys• retfA 021 setar noisufreper ni llaf citamard setunim• IMIT no tnedneped tifeneb ytilatroM
3 !!wolf
tropsnart ni ypareht citylonirbiF
• yllacitnames si tub skrow ti taht stroppus ecnedivE .tluciffid
• dna sisongaid no eb dluohs sucof detsegguS ot emit taht os DE gniviecer htiw noitacinummoc.decuder si latipsoh ta noitnevretni
tifeneB :yparehT citylobmorhT
• 03 mret trohs ni noitcuder ksir evitaler %( ytilatrom 7- 01 )%
•> stsisrep tifeneB 01 sraey
• ot pu ,tifeneb etipseD 1/
3 stneitap IMETS foypareht noisufreper on eviecer
•noitacilpmoc gnideelb fo raeF
snoitatimiL :yparehT citylobmorhT
•02 ycnetap lessev erotser ot liaf %
•04 - 05 IMIT erotser ot liaf %
3 wolf
•01 - 51 er % - etar noisulcco
•0.5-1 egahrromeh lainarcartni fo etar %
dna snoitacidniartnoC :yparehT citylonirbiF AHA/CCA morF IMETS ni esU citylonirbiF rof snoituaC
4002 etadpU enilediuG *
snoitacidniartnoC etulosbA • egahrromeh lainarcartni roirp ynA • )MVA ,ge( noisel ralucsav larberec larutcurts nwonK • )citatsatem ro yramirp( msalpoen lainarcartni tnangilam nwonK • nihtiw ekorts cimehcsI
3 nihtiw ekorts cimehcsi etuca TPECXE shtnom
3 sruoh
• noitcessid citroa detcepsuS • )sesnem gnidulcxe( sisehtaid gnideelb ro gnideelb evitcA • nihtiw amuart laicaf ro amuart daeh desolc tnacifingiS
3 shtnom
yretrA
)GBAC & ACTP( stnemtaerT evisavnI
yretrA yranoroC yregruS ssapyB
)GBAC(
yretrA yranoroC yregruS ssapyB
)GBAC(
ro/dna tnetSytsalpoignA noollaB
ro/dna tnetSytsalpoignA noollaB