豬苓湯對於實驗誘發大鼠腎臟草酸鈣結石的預防作用; Prophylaxis of Calcium Oxalate Stones by Zhulingtang on Experimentally induced Nephrolithiasis in Rats

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(1)ύ୯ᙴᛰεᏢύ୯ᙴᏢࣴ‫܌ز‬ᅺγፕЎ ጓဦǺGICMS-333. ࡰ Ꮴ ௲ ௤Ǻഋ‫ؙ‬ӓ. ௲௤. ፕЎᚒҞ. ፜ऴ෯ჹ‫ܭ‬ჴᡍᇨวεႵ๝᠌૛ለ่້ҡ ‫ޑ‬ႣٛբҔ Prophylaxis of Calcium Oxalate Stones by Zhulingtang on Experimentally induced Nephrolithiasis in Rats. ࣴ‫ز‬ғǺዐϺ଼. ύ๮҇୯ΐΜΎԃΎД.

(2) Ҟ. ᒵ. ಃ΋ക ߻‫ق‬ ಃ΋࿯ ‫ֿݜ‬ၰ่ҡ‫ࢬޑ‬ՉੰᏢ..……………………………………1 ಃΒ࿯ ‫ֿݜ‬ၰ่ҡ‫ޑ‬ᖏ‫ރੱ׉‬..……………………………………2 ಃΟ࿯ ర᛾..…………………………………………………………3 ಃѤ࿯ ࣴ‫୏ز‬ᐒ....……………………..……………………………6. ಃΒക Ў᝘௖૸ ಃ΋࿯ ‫ֿݜ‬ၰ่ҡ‫׎ޑ‬ԋচӢ..……………………………………8 ಃΒ࿯ ‫ֿݜ‬ၰ่ҡ‫ߦޑ‬຾‫ڋ׭ک‬Ӣη……………………………10 ಃΟ࿯ ‫ֿݜ‬ၰ่ҡ‫ޑ‬ᅿᜪϷಔԋԋϩ……………………………11 ಃѤ࿯ ‫ֿݜ‬ၰ่ҡ‫ޑ‬Ћೌ‫ݯ‬ᕍ‫ک‬ϣࣽ‫ݯ‬ᕍ………………………12 ಃϖ࿯ ૛ᛰ‫ݯ‬ᕍϷႣٛ‫ֿݜ‬ၰ่ҡ‫ޑ‬Ў᝘ӣ៝…………………14 ಃϤ࿯ ፜ऴ෯‫ޑ‬ᐕўྍࢬ…………………………………………16 ಃΎ࿯ Ў᝘௖૸λ่………………………………………………18. ಃΟക ‫׷‬਑ᆶБ‫ݤ‬ ಃ΋࿯ ཷॊ…………………………………………………………20 ಃΒ࿯ ሺᏔ೛ഢ……………………………………………………20 ಃΟ࿯ ჴᡍ၂Ꮚ……………………………………………………20 IV.

(3) ಃѤ࿯ ᇙഢ፜ऴ෯๧‫ڗ‬న‫ޑ‬ჴᡍБ‫……………………………ݤ‬20 ಃϖ࿯ ୏‫ނ‬ჴᡍ‫؁ޑ‬ᡯ……………………………………………22 ಃϤ࿯ ֿన‫ک‬Ոమ‫ޑ‬ϩ‫…………………………………………݋‬23 ಃΎ࿯ ຑ՗๝᠌่඲؈ᑈ‫ޑ‬ᝄख़ࡋ………………………………24 ಃΖ࿯ ၗ਑ϩ‫……………………………………………………݋‬27. ಃѤക ่݀…………………………………………………………28. ಃϖക ૸ፕ ಃ΋࿯ ፜ऴ෯ჹ‫ܭ‬εႵ૛ለ่້ҡኳࠠ‫ڋ׭ޑ‬բҔ……………36 ಃΒ࿯ǵჴᡍ‫ޑ‬ज़‫ڋ‬..………………………………………………38 ಃΟ࿯ ่ፕ…………………………………………………………39. ୖԵЎ᝘..……………………………………………………………40. मЎᄔा..……………………………………………………………47. ᖴᜏ..…………………………………………………………………48. V.

(4) კ Ҟ ᒵ კ3.1…………………………………………………………………21 კ3.2…………………………………………………………………22 კ3.3…………………………………………………………………23 კ3.4…………………………………………………………………24 კ3.5…………………………………………………………………25 კ3.6…………………………………………………………………25 კ3.7…………………………………………………………………26 კ4.1…………………………………………………………………29 კ4.2…………………………………………………………………29 კ4.3…………………………………………………………………30 კ5.1…………………………………………………………………37. VI.

(5) ߄ Ҟ ᒵ ߄4.1……………………………………………………………………31 ߄4.2……………………………………………………………………32 ߄4.3……………………………………………………………………33 ߄4.4……………………………………………………………………34 ߄4.5……………………………………………………………………35. VII.

(6) ፜ऴ෯ჹ‫ܭ‬ჴᡍᇨวεႵ๝᠌૛ለ่້ҡ‫ޑ‬ႣٛբҔ ࣴ ‫ ز‬ғǺዐϺ଼ ࡰᏤ௲௤Ǻഋ‫ؙ‬ӓ ύ୯ᙴᛰεᏢύ୯ᙴᏢࣴ‫܌ز‬. ΋ঁ໺಍ύᙴᛰ‫ޑ‬БᏊ፜ऴ෯ǴӧҔΌΒᎇᗯᎦᇨวεႵ๝᠌૛ ለ่້ҡ‫ޑ‬ჴᡍύ೏Ҕٰຑ՗‫่ל‬ҡ‫ޑ‬ቹៜǶӅԖΟΜϖଫ໢‫܄‬ Sprague-Dawley εႵᒿᐒϩࣁѤಔǺ҅தǵӼኃᏊǵեᏊໆ፜ऴ෯‫ک‬ ଯᏊໆ፜ऴ෯ಔǶ‫ک‬ӼኃᏊಔ࣬КǴ೭‫ٿ‬ಔ፜ऴ෯ᗯ१‫ޑ‬ಔձǴӧ඲ ᡏ؈ᑈ‫ޑ‬ᝄख़ࡋ΢ܴ֡ᡉ෧ϿǶ‫ک‬εႵ‫ޑ‬ჹྣಔКၨǴӧեᏊໆ፜ऴ ෯‫ک‬ӼኃᏊಔว౜Ոమᕗᡉ๱फ़եǶεႵӼኃᏊಔύว౜‫ޑډ‬аᡏख़ ቚуၨࣁ጗ᄌٰ߄౜‫ޑ‬ғߏᒨ጗Ƕ‫ॺך‬ள‫่ޑډ‬ፕࢂǴ፜ऴ෯ёа෧ ե૛ለ่້඲‫ޑ‬ᝄख़ࡋ‫ک‬ᗉխᡏख़ቚуၨࣁ጗ᄌ‫ޑ‬ਏ݀ǶӢԜǴ໺಍ ύᙴБᏊ፜ऴ෯ёૈࢂ΋ᅿԖਏႣٛ๝᠌่ҡ‫ޑ‬ᛰ‫ނ‬ǶᗨฅǴ‫ॺך‬ჹ ፜ऴ෯‫่ڋ׭‬඲‫ޑ‬ᐒ‫ڋ‬ϝόమཱǴ௢ෳ‫ځ‬ύεϩηёૈΨԖୖᆶǶӢ ԜǴ҂ٰ‫׆‬ఈёа΋Бय़຾Չᖏ‫׉‬ჴᡍǴ᛾ჴ፜ऴ෯ᔈҔӧΓᡏ΢΋ ኬԖႣٛ๝᠌่ҡ‫ޑ‬բҔǹќ΋Бय़‫ॺך‬ёа຾Չೈқ፦ᡏᏢ‫ࣴޑ‬ ‫ز‬Ǵаයૈჹ่ҡ‫ੰޑ‬౛ғ౛ᐒ‫ڋ‬Ԗ‫׳‬೸ᄇ‫ޑ‬ᕕှǶ. ᜢᗖຒǺ૛ለ້ǵΌΒᎇǵ໺಍ύᙴᛰǵ፜ऴ෯ 1.

(7) ಃ΋കǵ߻‫ق‬ ಃ΋࿯ǵ‫ֿݜ‬ၰ่ҡ‫ࢬޑ‬ՉੰᏢ ‫ֿݜ‬ၰ่ҡӧ᏾ঁΓᜪᐕўς࿶ԋࣁ΋ঁத‫ޑـ‬ୢᚒǴѬ֚ᘋΓᜪ ς࿶Ԗߏᇻ‫ޑ‬ᐕўǴӢࣁԵђᏢৎමӧΎίԃ߻(4800 B.C.)‫ޑ‬ђষϷЕ ΏҲ‫ي‬΢ว౜๝᠌่ҡᆶᆮા่ҡǶ‫ډޔ‬౜ӧѬ‫ޑ‬౰Չ౗΋‫ޔ‬Ԗ೴ᅌቚ у‫ޑ‬ᖿ༈Ǵ٠ؒԖӢࣁᙴᏢ‫ޑ‬຾‫؁‬ԶԖ‫܌‬෧Ͽ1Ƕ ‫ֿݜ‬ၰ่ҡࢂ΋ᅿӭӢη‫ޑ‬੯ੰǴѬ‫ޑ‬౰Չ౗(prevalence)‫ک‬วғ౗ (incidence)཮ᒿ๱‫܄‬ձǵԃសǵᅿ௼ǵ໯१ಞᄍǵ਻ং‫୔ک‬ୱᕉნԶԖ ‫܌‬ৡ౦Ƕӧ٥ࢪǴಖ‫ي‬วғ౗(lifetime incidence)ࣁ2-5%ǹӧኻࢪ‫ک‬чऍ ࣁ8-15%ǹӧ؅ਜ਼Ӧߓ܎դࣁ20%Ƕӧऍ୯‫ֿݜޑ‬ၰ่ҡ‫ޑ‬౰Չ౗ёа ว౜Ԗ୔ୱ‫ޑ܄‬ৡ౦ǴՏ‫ࠄܿܭ‬Б‫ޑ‬Ԁ౰Չ౗ࣁനଯǶќѦǴ‫܄ت‬ၨζ ‫܄‬৒ܰᑡ஻ǹқᅿΓၨ໵Γ৒ܰᑡ஻‫ֿݜ‬ၰ่ҡǹԖ‫ֿݜ‬ၰ่ҡৎ௼ў ‫ޣ‬Ǵ஻ੰᐒ౗Ψၨ΋૓Γଯǹ࿶ᔮཇว৖‫ޑ‬୯ৎǴ‫ځ‬Γ҇ᑡ஻౗ཇଯ2Ƕ ӳว‫ܭ‬ΟΜྃԿϖΜྃϐ໔‫ޑ‬ԃសቫǴহ‫ۑ‬วғ౗ၨଯǶԜѦǴғࢲࠠ ᄊᆶᙍ཰ΨԖቹៜ,΋૓ؒԖ፾ࡋၮ୏ǵ֤ᒤϦਫ‫ޣ‬ၨܰள‫ډ‬ԜੰǶ ‫ֿݜ‬ၰ่ҡࢂ΋ঁத‫ޑـ‬੯ੰǶӧШࣚӚ୯‫ک‬ӚӦ୔ύǴԖ೚ӭࢂ ឦ‫ܭ‬ଯวғ౗‫ޑ‬Ӧ୔ǴхࡴԖӦύੇ‫ڬ‬ᜐ‫ޑ‬୯ৎǵЃ୷ථ‫ڶ‬ǵӑࡋǵम ୯ǵύኻǵчኻǵᐞεճ٥฻ 3ǶӧѠ᡼Ǵ߾ 9.6%‫ޑ‬౰Չ౗Ǵӧ‫ࣁ܄ت‬ 14.5%Ǵӧζ‫ ࣁ߾܄‬4.3%ǹӧऍ୯΋ԃԖ΋ԭ࿤Γԛᑡ஻‫ֿݜ‬ၰ่ҡ‫ޑ‬ ੯ੰǴऊԖ 8%Կ 15% ‫ޑ‬౰Չ౗ 4Ƕӵ݀ؒԖᑈཱུ‫ޑ‬Ⴃٛ‫ݯک‬ᕍǴ‫ځ‬ಃ ΋ԃ‫ޑ‬ൺว౗ࣁ 14%Ǵϖԃ‫ޑ‬ൺว౗ࣁ 35%ǴΜԃ‫ޑ‬ൺว౗ࣁ 52% 5Ǵ ΒΜϖԃ‫ޑ‬ൺว౗߾ࣁ 98% 6Ƕ Ԗࣴ‫ࡰز‬рύǴ΢‫ֿݜ‬ၰ่ҡ‫ੰޑ‬ΓǴ‫ت‬ζ‫ޑ‬К‫ࣁٯ‬2.32:1Ƕ‫܄ت‬ ӧ30Կ39ྃ‫ک‬60Կ69 ྃ೭‫ঁٿ‬໘ࢤਔයǴၨ৒ܰᑡ஻΢‫ֿݜ‬ၰ่ҡǶ ζ‫߾܄‬ӧ50Կ59ྃၨ৒ܰᑡ஻΢‫ֿݜ‬ၰ่ҡǶќѦӧ20ྃаΠ‫܈‬70ྃа ΢‫ੰޑ‬஻ѝԖ՞Ͽ೽ϩǶа่ҡԋϩٰϩ‫݋‬Ǵӧ‫܄ت‬Бय़Ǵ૛ለ້ᆶᕗ ለ້షӝࠠ՞66%Ǵ‫ځ‬ԛࢂ૛ለ่້ҡ՞22%Ǵӆ‫ࢂޣ‬ᕗԪҡ՞5%Ǵᕗ ለ਽ᗔ՞3%Ǵֿለ՞3%Ƕӧζ‫܄‬Бय़Ǵ૛ለ້ᆶᕗለ້షӝࠠ՞58%Ǵ 1.

(8) ‫ځ‬ԛࢂᕗԪҡ՞13%Ǵӆ‫ࢂޣ‬૛ለ້՞12%Ǵᕗለ਽ᗔ՞11%Ǵֿለ՞4 %Ƕӆа‫܄‬ձٰ଺КၨǴӧζ‫܄‬Бय़Ǵ߾৒ܰᑡ஻གࢉ‫่܄‬ҡ (хࡴᕗ Ԫҡᆶᕗለ਽ᗔ่ҡ)Ǵ‫ت‬ζК‫ࣁٯ‬1:1.4Ƕӧ‫܄ت‬Бय़Ǵ৒ܰᑡ஻૛ለ້ ่ҡǵ૛ለ້ᆶᕗለ້షӝ่ࠠҡ‫ֿک‬ለ่ҡǴ‫ت‬ζ‫ޑ‬К‫ٯ‬ϩձࣁ 4.2:1Ǵ2.6:1‫ک‬1.5:17ǶӧѠ᡼ࠄ೽Ӧ୔ۚ҇ύǴаљᐒǵ઻຤ᡏΚ‫ޑ‬മ πǵѦ୍঩ǵ୘ΓǵϦ୍঩ᆶ֤ᒤϦਫϐᙍ঩ၨܰᑡ஻‫ֿݜ‬ၰ่ҡ8Ƕ җ‫ֿݜܭ‬ၰ่ҡԖଯวғ౗‫ک‬ଯൺว౗ǴࣁΑ‫ݯ‬ᕍԜ੯ੰǴ೚ӭ୯ ৎ೿ሡा޸຤εໆ‫ޑ‬ᙴᕍ຤ҔǴჹ‫ܭ‬࿶ᔮౢғ΋‫ޑۓ‬ቹៜǶӧऍ୯Ǵ‫؂‬ ԃሡा޸຤18.3ሹऍϡٰ‫ݯ‬ᕍ‫ֿݜ‬ၰ่ҡ9Ƕӧम୯Ǵ‫؂‬ԃሡा޸຤11.13 ሹमᙸ10Ƕӧቺ୯Ǵ‫؂‬ԃሡा޸຤5.4ሹኻϡ11ǶӢԜࣁΑ࿯࣪ᚳε‫ޑ‬ᙴ ᕍ຤ҔǴ‫ॺך‬ሡा໒วԖਏ‫ޑ‬Ⴃ่ٛҡᛰ‫ނ‬Ƕ ಃΒ࿯ǵ‫ֿݜ‬ၰ่ҡ‫ޑ‬ᖏ‫ރੱ׉‬ ‫ֿݜ‬ၰ่ҡࢂ‫سֿݜ‬಍੯ੰύத‫ޑـ‬੯ੰϐ΋ǴѬࢂࡰӧ‫سֿݜ‬಍ ϣԖ่ҡ‫ޑ‬ӸӧǴхࡴ๝᠌ǵᒡֿᆅǵᆮાǵֿၰ฻Տ࿼Ƕ೭٤่ҡࢂ җֿనύᜤ‫ܭ‬ྋှ‫ނޑ‬፦่඲؈ᐘԶԋ‫ޑ‬Ǵӵ૛ለ້ǵᕗለ້ǵᕗለሓ ᗔǵֿለ฻Ƕ ӵ่݀ҡߔ༞ӧֿၡ‫س‬಍ϣǴ൩཮ЇଆੰΓԖ࡚‫܄‬๝็ภ(renal colic)‫ރੱޑ‬Ǵੵภ‫ޑ‬ᝄख़ำࡋ‫ੵک‬ภ‫ޑ‬೽ՏǴ٩่ҡ‫ޑ‬ελǵ่ҡߔ༞ ‫ޑ‬೽Տǵߔ༞‫ޑ‬ำࡋǵঁΓৡ౦Ԗ‫܌‬όӕǴനத‫ޑـ‬Տ࿼Ԗ๝‫ޒ‬ᒡֿᆅ Ҭௗೀǵᒡֿᆅᐉຫဉମ୏ેೀ‫ک‬ᒡֿᆅᆮાҬௗೀǶऩ่ҡߔ༞ӧ๝ ࿈ೀǴ߾ੵภ೽Տ཮ӧဈુ೽‫܈‬ङ೽‫ޑ‬ӦБǴག᝺ࢂ΋ᅿు೽‫໌ޑ‬ภ(dull pain)ǹऩ่ҡߔ༞ӧ๝‫ޒ‬ᒡֿᆅҬௗೀ‫܈‬΢ᆄᒡֿᆅǴ็ภ཮วғӧԻ ମૉ෎Ҭ‫(ف‬costovertebral angle)ೀǴ็ภத཮‫ܫ‬৔Կဈુ೽‫܈‬ӕୁဎ ೽ǴࣗԿӛΠဎ೽‫ۯ‬՜ǴЇଆғ෗Ꮤ‫ੵޑ‬ภǴ‫཮܄ت‬Ԗ࿐ΤੵภǴζ‫܄‬ ߾ԖѦ഍ੵภ‫ރੱޑ‬ǹऩ่ҡߔ༞ӧᒡֿᆅύࢤೀǴନΑ΢ॊ‫ੵޑ‬ภኳ ԄǴΠဎ೽‫ੵޑ‬ภ཮КၨܴᡉǹऩࢂᒡֿᆅΠࢤ೏୹༞Ǵҭ཮р౜΢ॊ ‫ੵޑ‬ภኳԄǴՠภӧ৭ମ΢‫ޑ‬ӦБ‫ک‬ғ෗Ꮤ߾཮КၨܴᡉǴ྽่ҡΠफ़ ԿᆮાਔǴ٠ӝ‫ٳ‬Ԗֿ࡚ǵᓎֿǵλߡ‫؟‬዗ག‫ރੱޑ‬Ƕੵภε೿ࣁତว 2.

(9) ‫ޑ܄‬ǴՠΨёև౜ࣁ࡭ុ‫ੵޑ‬ภǶԖ٤ੰΓӧԺ౳ёว౜Ոֿ‫܈‬ૡՅ ֿǴε೽ϩੰΓӧᡉ༾᜔Πёว౜Ոֿ‫ޑ‬౜ຝǶќѦੰΓՔᒿԖᖍՅᇇ қǵ⧋ЈǵჍӗǵߵհԠǵဎ೽ό፾ǵဎᘞǴଽԶ཮Ԗวᐨ‫ޑ‬౜ຝǴࣗ Կӧᝄख़‫ޑ‬གࢉੰ‫ٯ‬ύǴ཮р౜௳Ո‫܄‬Ҷլੱ‫߄ޑރ‬౜Ƕ ๝᠌่ҡԖёૈߏਔ໔ӸӧᡏϣǴԶੰΓؒԖ߄౜рੱ‫ރੱࢂ܈ރ‬ ᇸ༾ǴЀ‫ࢂځ‬ᡏᑈε‫่ޑ‬ҡǶ‫܌‬а΢ॊ‫ރੱޑ‬Ǵᖏ‫׉‬΢ѝ཮วғ‫ܭ‬εऊ ΋ъ‫ੰޑ‬ΓύǴќѦ‫ޑ‬΋ъ‫ੰޑ‬Γੱ‫ރ‬٠όࢂࡐܴᡉǶ‫ֿݜ‬ၰ่ҡᔈ၀ ջԐว౜ջԐ‫ݯ‬ᕍǴӢࣁ่ҡ཮໾্๝᠌‫ޑ‬фૈǴౢғߔ༞‫܄‬๝ੰᡂǴ Ꮴठ๝᠌ᑈНǴԶЪ৒ܰวғགࢉǴࣗԿว৖‫ډ‬๝૰ᆃǴനࡕሡा೸‫݋‬ ‫ݯޑ‬ᕍǶ ՠࢂǴε೽ϩ‫ޑ‬ᒡֿᆅ่ҡ཮Ծฅᒿֿన௨рǴࢂό໪ाϟΕೀ౛ ‫ޑ‬Ƕ4~5 mm ‫่ޑ‬ҡԖ 40%~50%‫ޑ‬ᐒ౗ёаԾฅ௨рǶऩε‫ ܭ‬6 mm а ΢‫่ޑ‬ҡԾฅ௨р‫ޑ‬ᐒ౗ѝԖ 5%ǶՏӧΠࢤᒡֿᆅ‫่ޑ‬ҡǴԖ 50%‫ޑ‬ ᐒ౗ёаԾฅ௨рǴӧύࢤ‫ک‬΢ࢤᒡֿᆅ‫่ޑ‬ҡǴ߾ӚԖ 25%‫ ک‬10% ‫ޑ‬ ௨рᐒ౗ 12ǶќѦǴӧ Campbell´s Urology ύග‫ډ‬Ǵ่ҡ٩ελ‫ځ‬ԾՉ ௨р౗Ǵϩձࣁλ‫ ܭ‬4 mm ࣁ 80%Ǵ4 Կ 6 mm ࣁ 59%Ǵε‫ ܭ‬6 mm ࢂ 21%Ƕ٩Տ࿼߾ϩձࢂ߈ᆄ 22%Ǵύࢤ 46%Ϸᇻᆄࢂ 71%ǶவЎ᝘΢ٰ ࣮Ǻ่ҡλ‫ ܭ‬5 mm ਔǴ߈ᆄ‫ޑ‬ԾՉ௨р౗வ 71%‫ ډ‬98%ǴԶᇻᆄ߾ࢂ 29%Կ 98%13 Ƕ ಃΟ࿯ ర᛾ 13 ύ୯ᙴᏢύ‫܌‬ᒏ‫ޑ‬Ȩర᛾ȩ࣬྽‫ܭ‬ՋᙴᏢύ‫ֿݜޑ‬ၰགࢉǵ‫ֿݜ‬ၰ ่ҡǵ‫ֿݜ‬ၰဍዦǵ٢ᕧֿ฻ጄᛑǶᐕжᙴৎჹ‫ܭ‬ర᛾‫ޑ‬ፕॊǵϩᜪа Ϸ‫ݯ‬ᕍǴதԖόӕ‫ـ‬ှǴՠΨᙦ൤ֹ᏾Αύᙴჹ‫ܭ‬ర᛾‫ޑ‬౛ፕᡏ‫ݯکس‬ ᕍБ‫ݤ‬Ƕ೭٤‫ޕ‬᛽ࢂ‫ॺך‬ᖏ‫׉‬य़ჹర᛾ਔǴ࣬྽ख़ा‫୷ޑ‬ᘵǴΨૈჹ‫ܭ‬ ࣽᏢࣴ‫ޑز‬πբ஥ٰವε‫௴ޑ‬วǶ‫܌‬аӧ໒‫ֿݜۈ‬ၰ่ҡ‫߻زࣴޑ‬ǴѸ ໪Ӄᇡ᛽ర᛾‫ޑ‬ᐕўྍࢬǶ (1)ᅇжа߻Ǻ 3.

(10) రϐӜᆀǴ२Ӄ‫ܭـ‬Ƞϣ࿶ȡ Ǵ ȠનୢǸϤϡ҅इεፕȡᆀࣁȨర✪ȩǶ ջȠߎ჆ाౣǸϖ᠌॥ൣᑈᆫੰȡ‫ޑ‬Ȩరઝȩ Ǵ‫ځ‬ӕਔ૶ၩǺ Ȩ‫ੰځ‬ύ዗ ๞,……λߡ໳‫ه‬Ǵࣗ߾రȩ ǶԜѦǴ Ƞϣ࿶ȡύۘԖరǵర▞฻ӜᆀǶࡕ ᅇ஭ҸඳӧȠߎ჆ाౣȡύ೛Ԗర᛾஑ጇǴȠ੃෰λߡόճరੰે᛾٠ ‫ݯ‬ಃΜΟȡᒏǺȨరϐࣁੰǴλߡӵๅ‫ރ‬Ǵλဎ۰࡚ǴภЇᙏύǶȩЎ ύග‫ډ‬λߡྔр‫ރ‬ӵๅԯ‫ޣ‬ǴՔᒿλဎੵภǴջϞϐ‫܌‬ᒏҡరΨǶᇥܴ ర᛾ࢂаλߡό౏Ǵֿၰ‫ڈ‬ภࣁЬੱǴΨჹҁੰ‫߄ރੱޑ‬౜‫ੰک‬ӢੰՏ ԖΑ຾΋‫ޑ؁‬ᇡ᛽ 14Ƕ ᅇжӜᙴ๮ՒӧȠύᙒ࿶ǸፕፏరϷλߡόճȡύፕॊǺȨፏరᆶ λߡόճ‫ޣ‬Ǵࣣҗϖ᠌ό೯ǴϤ๜ό‫ک‬ǴΟขฤᔴǴᔼፁ઻ѨǴठଆථ ‫خ‬ǶȩҗԜ๮Ւᇡࣁర᛾ࢂឦ‫ܭ‬΋ᅿੰᐒፄᚇ‫ޑ‬ӄ‫ੰ܄ي‬᛾ǴΞගрర ᛾Ԗϩհǵ዗ǵ਻ǵമǵᆯǵࣳǵ຀ǵჴΖᅿǴࣁВࡕర᛾ᖏ‫׉‬ϩᜪϐ ᚉ‫׎‬Ƕч᚟࠴Ⴖ‫ڶ‬ӧȠ໣ᡍБȡύஒర᛾ᘜયࣁҡǵ਻ǵᆯǵമǵ዗‫ޑ‬ ϖరϐᇥ,ԋࣁࡕШᙴৎჹర᛾ϩᜪ‫ޑ‬౛ፕ٩ᏵǴ‫ځ‬ύ዗ర‫ک‬മరջ࣬՟ ‫࡚ܭ‬ᄌ‫܄‬๝‫ޒ‬๝‫ݹ‬Ƕ (2)໙ঞਔයǺ ໙жணϡБჹర᛾‫ޑ‬วੰᐒᇙբΑᆒ៘‫ࡴཷޑ‬ǴдӧȠፏੰྍং ፕǸరੰፏߠȡஒర᛾ϩࣁҡǵമǵ਻ǵՈǵᆯǵൣǵ዗ΎᅿǴԶаȨፏ రȩ಍ϐǶΞᇥǺ Ȩፏర‫ޣ‬Ǵҗ๝຀Զᆮા዗ࡺΨǶȩ Ȩ๝຀߾λߡኧǴ ᆮા዗߾НΠᔴǶኧԶЪᔴǴ߾రᛅό࠹ǴࡺᒏϐరǶȩܴዴගрర᛾ ‫ੰޑ‬Տӧ๝ᆶᆮાǴੰᐒа๝຀ࣁҁǴᆮા዗ࣁ኱ǴԋࣁࡕШᙴৎ‫܌‬൧ ஖ǴࡰᏤ๱ᖏ‫׉‬ບ‫ݯ‬ర᛾‫ޑ‬Ьा౛ፕ 15Ƕ ќѦǴணϡБ‫܌‬๱Ƞፏੰྍংፕȡ‫ځ‬ύҭ௖૸Ӛᅿర᛾‫ੰޑ‬ӢੰᐒǶ ፕॊᇥ‫ډ‬ǺȨ዗ర‫ޣ‬ǴΟขԖ዗Ǵ਻ཛ‫ܭ‬๝ǴࢬΕ‫ܭ‬झԶԋరΨȩǹȨമ ర‫ޣ‬Ǵᒏമ໾๝਻Զғ዗ԋరΨȩȨҡర‫ޣ‬Ǵ๝ЬНǴН่߾ϯࣁҡǴ ࡺ๝࠼ࣳҡǴ๝຀ࣁ዗‫܌‬४ȩȨᆯర‫ޣ‬Ǵ……Ԝ๝຀όૈ‫ޥܭڋ‬నȩԜ ѦǴΨᇥܴర᛾཮Ԗൺว‫ޑ‬௃‫ݩ‬ӸӧǴӵȨஎੰరǴϞள዗Զว‫ޣ‬ȩǶ ೭ᅿࡽ‫ݙ‬ཀర᛾‫ޑ‬Ӆ‫܄‬ǴΞமፓర᛾‫ੰޑ܄ঁޑ‬ᐒϩ‫݋‬Б‫ݤ‬Ǵࣁᖏ‫ݯ׉‬ ᕍόӕర᛾ග‫ٮ‬Α౛ፕ٩ᏵǶ 4.

(11) ঞǸ৊ࡘᙳ‫܌‬๱Ƞഢ࡚ίߎाБȡගрȨϖరȩϐӜǴঞǸЦᘧ‫܌‬ ๱ȠѦѠઝाȡΞ‫ڀ‬ᡏࡰܴϖర‫ޑ‬ϣ৒Ǻ Ȩ໣ᡍፕϖర‫ޣ‬Ǻҡరǵ਻రǵ ᆯరǵമరǵ዗రΨǶȩ౜жᖏ‫׉‬ϝ‫ݮ‬ҔϖరϐӜǴࡪᖏ‫׉‬ჴሞٰᖱǴ ዗ర‫਻ک‬రឦനத‫ـ‬Ƕ (3)ߎϡਔයǺ ֺϡਔжᕴ่р΋٤ԖჴҔሽॶ‫ޑ‬ర᛾‫ޑ‬ᖏ‫׉‬ບᕍ࿶ᡍǶߎжቅ‫ݞ‬ ໔२Ӄගрགࢉᔸ዗ࢥٕࢂҁੰ‫ޑ‬ЬाठੰӢનǴਥᏵȠનୢҎᐒচੰ ԄǸϤ਻ࣁੰǸ዗ᜪȡύϓǺȨ዗ࣗ࠼‫ܭ‬๝೽Ǵυ‫ىܭ‬ല഍ϐ࿶৥ϾǴ ᢠ่ཱུࣗԶ਻Ոόૈ࠹೯Ǵ߾࿅࿄Զઓค‫܌‬ҔǶȩᇡࣁర᛾‫ੰޑ‬ᐒࢂ‫ک‬ ዗ٕ࠼‫ܭ‬๝‫܌‬Їଆ‫਻ޑ‬Ոᢠ่ԖᜢǴ೭΋ፕᗺࣁర᛾ϐ΢Չགࢉ‫ޑ‬ᇡ᛽ ໒ബΑӃ‫ݞ‬Ƕ ϡǸԙϏྛନ‫᠍܍‬๝຀Զᆮાғ዗ϐᇥѦǴϏྛۘமፓЈϷλဉੰ ᡂᆶర᛾‫ޑ‬ᜢ߯ǴдᇥǺ ȨεΥλဉԖ਻߾λߡ๞ǴλဉԖՈ߾λߡᔴǴ λဉԖ዗߾λߡภǶȩ຾Զගр‫ݯ‬ᕍচ߾Ǻ Ȩ୺Ꮚϐ‫ݤ‬Ǵ٠ҔࢬՉᅉ਻Ǵ ౧ճλߡǴమှٕ዗Ƕ‫ܭځ‬ፓѳЈОǴΞΟ‫ޣ‬ϐᆜሦోǴЈమ߾λߡճǴ Јѳ߾ՈόӰՉȩ٠ࡰрΑర᛾ᆶᙯझǴ⻬ഈǴᒪྔаϷՈరᆶֿՈ‫ޑ‬ ᠙ձाᗺǶ ԙϏྛӧȠϏྛЈ‫ݤ‬ǸరȡύᇥǺȨፏర‫܌‬วǴࣣ๝຀Զᆮાғ዗ ΨǶНОόҬǴЈ๝਻ᢠǴၱ٬഍໚١ՂǴమᐜ࣬υǴᆽӧΠขǴࡺᆮ ા္࡚ǴᆯǵՈǵࣳǵҡаλߡၰрోǶ‫ࢂܭ‬ԖటрόрǴరᛅόᘐϐ ‫ރ‬Ǵࣗ‫ޣ‬౾༞‫ځ‬໔Ǵ߾зΓ඀๊‫خ‬Ƕȩ೭ࢂ‫᠍܍‬ΑணϡБፏరࢂӢ๝຀ Զᆮા዗‫܌‬ठੰ‫ޑ‬ᢀ‫ۺ‬Ǵ٠மፓЈ๝όҬҭࢂख़ाੰᐒϐ΋Ƕ (4)ܴమਔයǺ ܴжᕴ่р಄ӝᖏ‫ޑ׉‬ᒣ᛾ࡼ‫ݯ‬চ߾ǴԶమжςᇡ᛽‫ډ‬Ӛᜪర᛾ϐ ໔ёаϕ࣬ᙯϯ‫܈‬ӕਔӸӧǶ ܴǸЦޭ୸ӧȠ᛾‫ྗݯ‬ᛣǸరȡύගрర᛾ᔈᒿੰҁόӕԶ౦‫ݯځ‬ ‫ޑ‬Ь஭Ƕ‫ځ‬౛җԖΒǴ΋ࣁȨరੰѸҗ዗ࣗғᔸǴᔸғ߾Нన෶ǴᏉ่ Զࣁరȩ ǹΒࣁȨϖ᠌Ϥ๜ǴΜΒ࿶ેǴ਻ࣣ࣬೯౽ȩ ǴࡺȨ߃ଆϐ዗ٕ 5.

(12) ό΋Ǵ‫ځ‬Ӣࣣள໺‫ܭ‬ᆮાԶԋరǶऩόӃ‫܌ځݯ‬ଆϐҁǴЗவ҃ࢬझύ ϐ዗ࡼ‫ݯ‬Ǵ҂ࣁ๓ΨǶȩ ܴǸ஭ඳۢᇡࣁర᛾ᆶ዗ࢥᑈ᝶ԖᜢǴ٠‫ੰע‬ำ‫ߏޑ‬อբࣁᒣ᛾‫ޑ‬ ϣ৒ǴӧȠඳۢӄਜǸరᐜȡගрǺ Ȩరϐ߃ੰǴ߾คόҗЯ዗ቃǴค ৒ᒣ‫خ‬ǶՠԖΦܺൣథԶόཇ‫ޣ‬ǴΞԖరΦόЗϷภᔴࣣѐǴԶᆯనό ςǴరӵқᐜ‫ޣ‬ǴԜோύ਻ΠഐϷ‫ߐڮ‬ό‫ڰ‬ϐ᛾ΨǶࡺѸаેа᛾ǴԶ ჸ‫ࣁځ‬ൣࣁ዗ࣁ຀ǴபЯ‫ݯ‬όठᇤǶȩΞගрΑȨΥ዗‫ەޣ‬మǴᔴ‫ەޣ‬ ճǴΠഐ‫ەޣ‬ϲගǴ຀‫ံەޣ‬Ǵ໚਻ό‫ޣڰ‬Ǵ‫ߐڮံྕە‬ȩ‫ޑ‬ᒣ᛾ࡼ‫ݯ‬ চ߾Ƕ మǸЀӧ੄‫܌‬๱Ƞߎ჆ᖀǸፏరȡΨᇡࣁፏర‫୔ޑ‬ձ٠ߚ๊ჹǴ۳ ۳ᆶੰำߏอԖᜢǴȨ߃߾዗రǵՈరǴΦ߾ྞዖНనǴ࿨ᐜӵᆯӵࣳ ӵҡΨȩ Ƕ‫ݤݯ‬চ߾΢ᇡࣁȨණ዗ճλߡǴѝૈ‫ݯ‬዗రǵՈరԶςǶ‫ځ‬ ᆯࣳҡరǴѸ໪໒ॕՉ਻ǴઇՈ෷഍БёǶȩ೭٤࣮‫ݤ‬ᗨᆶᖏ‫׉‬ჴሞό ֹӄ֍ӝǴՠдςᇡ᛽‫ډ‬Ӛᅿర᛾ϐ໔ёаϕ࣬ᙯϯ‫܈‬ӕਔӸӧǴ੝ձ ࢂдமፓȨ໒ॕՉ਻ǴઇՈ෷഍ȩа‫ݯ‬ᕍҡర‫ݯޑ‬ᕍচ߾Ǵჹᖏ‫׉‬Ԗࡐ ӳ‫ࡰޑ‬ᏤཀကǶ ӧరੱύԖ΋೽ϩ௶ॊ‫ډ‬Ȩҡరȩ‫ک‬Ȩࣳరȩᆶ่ҡੰԖࡐଯ‫ޑ‬ᜢ ᖄ‫܄‬Ǵ‫ރੱځ‬Ψ‫่ک‬ҡ‫็ޑ‬ภ࣬՟ǴӢԜԾύ୯ђж‫ޑ‬ᙴᏢύ൩ᡉҢр ่ҡ೭ঁ੯ੰࡐԐ൩֚ᘋ๱ΓᜪǶ໺಍ύ୯ᙴᏢჹ‫ܭ‬ర᛾‫ޑ‬ᇡ᛽Ǵᒿ๱ ਔж‫ޑ‬όᘐ߻຾Ǵᇡ᛽Ψӧόᘐ‫ޑ‬ుΕǴคፕࢂவੰӜ‫ޑ‬ගрǴੱ‫ޑރ‬ ඔॊǴϩᜪǴੰᐒੰ౛‫ޑ‬ϩ‫݋‬Ǵᗋࢂ‫ݯډ‬ᕍε‫ޑݤ‬ዴҥǴԿܴమਔж, ς೴ᅌ‫׎‬ԋΑவੰӢ‫ډ‬᛾‫ݯ‬౛‫ݤ‬Кၨӄय़‫ޑ‬ᒣ᛾ፕ‫ݯ‬ᡏ‫س‬Ǵ٠ᑈಕΑ೚ ӭՉϐԖਏ‫ޑ‬БᏊ 16Ƕдॺᇡ᛽๝຀‫ک‬዗ٕǵ዗ࢥ‫ک‬ᔸ዗ӧర᛾ठੰύ ‫ޑ‬բҔǴගрΑర᛾‫ޑ‬วғᆶЈ‫ک‬λဉаϷ਻ՈੰᡂԖᜢǴӧ‫ݯ‬ᕍ΢ዴ ҥΑᒣ᛾ፕ‫؃ੰݯکݯ‬ҁ‫ޑ‬চ߾ǴவԶ‫׎‬ԋΑჹర᛾வੰӢ‫ډ‬᛾‫ݯ‬Кၨ ӄय़‫ޑ‬ᇡ᛽ 14-17 Ƕ ಃѤ࿯ ࣴ‫୏ز‬ᐒ ‫ֿݜ‬ၰ่ҡࢂ‫سֿݜ‬಍੯ੰύനத‫ޑـ‬੯ੰϐ΋Ƕᖏ‫׉‬΢ǴੰΓ཮ 6.

(13) а࡚‫܄‬๝็ภǵՈֿǵֿ࡚ǵֿᓎǵλߡ‫؟‬዗གǴՔᒿᖍՅᇇқǵ⧋Јǵ ჍӗǵߵԠǵဎᘞǵဎ೽ό፾ǴଽԶԖวᐨ฻᛾‫߄ٰރ‬౜Ƕӵ݀όᑈཱུ ‫ݯ‬ᕍǴԖ٤ੰΓ཮วғߔ༞‫܄‬๝ੰᡂǴࣗԿว৖‫ډ‬๝૰ᆃǴനࡕሡा೸ ‫ݯ݋‬ᕍǶӧѠ᡼Ǵ‫ֿݜ‬ၰ่ҡԖଯၲ9.6%‫ޑ‬౰Չ౗ǴԶЪ΋‫ޔ‬Ԗ೴ᅌቚ у‫ޑ‬ᖿ༈Ǵӵ݀ؒԖᑈཱུ‫ޑ‬Ⴃٛ‫ݯک‬ᕍǴ‫ځ‬ൺว౗ࡐଯǶࣁΑ‫ݯ‬ᕍԜ੯ ੰǴ೚ӭ୯ৎ೿ሡा޸຤εໆ‫ޑ‬ᙴᕍ຤ҔǴӢԜࣁΑ࿯࣪ᚳε‫ޑ‬ᙴᕍ຤ ҔǴ໒วԖਏ‫ޑ‬Ⴃٛᛰ‫ނ‬Ǵჹ‫ֿݜܭ‬ၰ่ҡ‫ޑ‬Ⴃٛჴӧࢂ΋ঁࡐख़ा‫ޑ‬ ଼ந᝼ᚒǶ ‫ֿݜ‬ၰ่ҡΨࢂঁђԴ‫ޑ‬੯ੰǴӧ໺಍ύ୯ᙴᏢύǴѬࢂឦ‫ܭ‬ర᛾ ύȨҡరȩǵȨࣳరȩ‫ޑ‬ጄᛑǶᐕжаٰǴჹ‫ܭ‬ర᛾‫ޑ‬ϩᜪǵੱ‫ރ‬ǵੰ ӢੰᐒǵບᘐаϷ‫ݯ‬ᕍǴว৖рֹഢᙦ൤‫ޑ‬ϣ৒Ǵ‫ځ‬ύԖ೚ӭԖਏ‫ޑ‬Б ᏊԾᐕжаٰ΋‫ޔ‬٬Ҕ๱Ǵ೭٤‫ޕ‬᛽Ϸ࿶ᡍ‫ޑ‬໺‫܍‬ჴӧࢂ΋ঁख़ा‫ޑ‬ፐ ᚒǴёаග‫ॺךٮ‬ӧᖏ‫׉‬΢‫ݯ‬ᕍ‫ֿݜ‬ၰ่ҡ‫ک‬Ⴃٛൺว‫ࡰޑ‬Ꮴচ߾ǶӢ ԜǴ‫ॺך‬གྷाவ‫ݯ‬ᕍర᛾‫ޑ‬໺಍ύ૛ᛰύ‫פ‬р΋٤Ԗਏ‫ޑ‬Ⴃٛᛰ‫ނ‬Ǵё аճҔ౜жࣽᏢ‫ޑ‬Б‫ݤ‬ϷሺᏔࣴ‫ٰز‬᛾ჴ‫ځ‬ᕍਏǴаයᘉ৖‫ځ‬Ҕ೼Ǵ࿯ ࣪ᚳε‫ޑ‬ᙴᕍ຤Ҕ຾Զ೷ᅽӭ‫ੰޑ‬஻Ƕ. 7.

(14) ಃΒകǵЎ᝘௖૸ ಃ΋࿯ǵ‫ֿݜ‬ၰ่ҡ‫׎ޑ‬ԋচӢ 13 ‫ֿݜ‬ၰ่ҡ‫׎ޑ‬ԋচӢх֖Ο೽ϩǴಃ΋೽ϩࢂᅿ௼‫ک‬ᕉნӢનǴ ಃΒ೽ϩࢂғ౛ғϯӢનǴಃΟ೽ϩࢂ໯१ӢનǶ ಃ΋೽ϩǺᅿ௼‫ک‬ᕉნӢન 1.ᅿ௼ӢનǺ ໵ΓၨқᅿΓό৒ܰᑡ஻‫ֿݜ‬ၰ่ҡǶӧࠄߚǴ15%‫ޑ‬қΓ௼ဂ ᑡ஻‫ֿݜ‬ၰ่ҡǴฅԶѝԖ1%‫ޑ‬໵Γ௼ဂᑡ஻‫ֿݜ‬ၰ่ҡǹӧऍ୯‫ޑ‬ ໵Γ௼ဂӕኬᏱԖၨե‫ޑ‬౰Չ౗Ƕ‫ځ‬Ѭ౰Չ౗ၨե‫ޑ‬ᅿ௼ᗋԖངථ୷ ነΓǵऍࢪচՐ҇ǵаՅӈΓǴՠࢂᅿ௼ϐ໔ԖӵԜεৡ౦‫ޑ‬ዴჴচ Ӣϝฅۘ҂ܴᕕǶ 2.਻ংӢનǺ ֿనໆ෧Ͽࢂ೷ԋ‫ֿݜ‬ၰ่ҡ‫ޑ‬ख़ाচӢϐ΋Ǵ‫ݹ‬዗‫਻ޑ‬ং཮٬ ளֿనໆ෧ϿǴԶቚуֿύ૛ለ້‫ޑ‬ᐚࡋǶӢԜύܿ‫ޑ‬؅ਜ਼Ӧߓ܎ǵ ऍ୯ܿࠄ೽(хࡴՕᛥٚၲԀǵൈ‫ݯ‬٥ԀǵࠄǵчьᛥٰયԀ)೭٤‫ݹ‬ ዗୔ୱ‫ޑ‬౰Չ౗೿ၨଯǶ 3.ᙍ཰ӢનǺ வ٣ࢌ٤ᙍ཰‫ޑ‬ΓǴЀ‫ࢂځ‬πբሡाߏਔ໔֤๱‫ޑ‬ΓǴᑡ஻‫ֿݜ‬ ၰ่ҡ‫ޑ‬ᐒ཮ၨଯǴ‫ٯ‬ӵљᐒǵૐ‫ޜ‬঩Ƕќ΋Бय़ёૈࢂӢࣁНϩឪ ‫ڗ‬ό‫ى‬ǴᏤठֿనᐚᕭ‫܌‬ठ18Ƕ ಃΒ೽ϩǺғ౛ғϯӢન 1.ֿనύ‫້ޑ‬ᚆηǺ а߻೚ӭࣴ‫ࡰز‬рǴଯֿ້೏ᇡࣁࢂ೷ԋ૛ለ่້ҡ‫ޑ‬ख़ाӒᓀ 8.

(15) ӢηǶՠࢂǴҞ߻ว౜‫׎‬ԋֿనύ૛ለ້‫ޑ‬ຬႫ‫ک‬౜ຝύǴ૛ለਥᚆ η‫ޑ‬Ⴋ‫ૈک‬Κࢂ້ᚆη‫ޑ‬15७ǶӢԜǴҞ߻ᇡࣁǴֿనύ‫ޑ‬૛ለਥᚆ ηωࢂ૛ለ่້ҡ‫׎‬ԋ‫ޑ‬،‫ۓ‬Ӣη19Ƕ 2.ֿనύ‫ޑ‬૛ለਥᚆηǺ Robertsonᇡࣁֿనύ‫ޑ‬૛ለਥᚆηࢂ૛ለ่້ҡ‫׎‬ԋ‫ޑ‬നख़ा ‫ޑ‬،‫ۓ‬Ӣη20ǶԖѤঁচӢ཮ቚуֿనύ‫ޑ‬૛ለਥᚆηϩ‫ݜ‬Ǵಃ΋ࢂ ໯१ύ֖Ԗၸӭ૛ለǹಃΒࢂဉၰ֎ԏၸӭ૛ለǹಃΟࢂϣғ‫ޑ܄‬૛ ለӝԋၸӭǹಃѤࢂ੃ϯၰύલϿ૛ለफ़ှಒ๵(oxalate-degrading bacteria) ੝ձࢂOxalobacter formigenes೭ଫಒ๵18Ƕ 3.ֿనύ‫ֿޑ‬ለǺ ֿనύֿለϩ‫ݜ‬ၸӭࢂ૛ለ่້඲‫׎‬ԋ‫ޑ‬ӒᓀӢηǶஒ߈Οϩϐ ΋૛ለ่້ҡ‫ੰޑ‬ΓԖֿనύֿለϩ‫ݜ‬ၸӭ‫ޑ‬౜ຝ20Ƕֿለϩ‫ݜ‬ၸӭ ‫ޑ‬চӢԖឪ‫ڗ‬ၸӭ‫ޑ‬ೈқ፦‫ک‬ϣғ‫ֿޑ܄‬ለౢғၸӭǶ‫܌‬аǴᖏ‫׉‬ ΢ǴӧԖଯֿለֿੱ‫ޑ‬૛ለ້๝่ҡੰΓ‫ي‬΢Ǵ٬Ҕallopurinolёаफ़ ե๝่ҡ‫ޑ‬ൺว౗21Ƕ 4.ֿనύ‫ޑ‬ᘗᘔለᡶǺ ᘗᘔለᡶёа‫ڋ׭‬૛ለ້‫ک‬ᕗለ້‫ޑ‬ԋਡǵғߏ‫ک‬ᆫ໣Ƕ೚ӭࣴ ‫ࡰز‬р่ҡੰΓӕਔԖեᘗᘔለֿੱ(19 to 63%)Ƕ‫܌‬аǴᖏ‫׉‬΢ࡌ᝼ Ԗեᘗᘔለֿੱ‫่ޑ‬ҡੰΓ‫ي‬΢Ǵёа٬Ҕᡵϯᕍ‫ܺ(ݤ‬Ҕᡵ‫܄‬ᛰᡵϯ ֿన)फ़ե่ҡ‫ޑ‬ൺว౗ 18Ƕ 5.ֿన‫ޑ‬pHॶǺ ᡵ‫ֿޑ܄‬నёफ़ե૛ለ่້඲‫׎‬ԋ‫ޑ‬ӒᓀǴฅԶ཮ቚуᕗለ่້ ඲‫׎‬ԋ‫ޑ‬ӒᓀǴᕗለ่້ҡεӭวғӧpHε‫ܭ‬6ǶԜѦǴֿనӧpHλ ‫ܭ‬5.5཮ߦ຾ֿለ่ҡ‫׎ޑ‬ԋǶ ಃΟ೽ϩǺ໯१Ӣન 1.໯१ύ‫ޑ‬૛ለᡶǺ १‫ނ‬ύ‫ޑ‬૛ለᡶ֖ໆӭჲ཮ቹៜֿనύ‫ޑ‬૛ለᡶᐚࡋǶӢԜǴᑡ ஻૛ለ่້ҡ‫ੰޑ‬Γᔈ෧Ͽ൤֖૛ለᡶ‫ޑ‬१‫ނ‬ǴႽࢂ๪๼ǵౡ๼‫ޑ‬ 9.

(16) ਥǵ޸ғǵѯլΚǵ಻ើ޷ǵ૛ಸǵλഝǵഝᎽǵૡယ฻฻18Ƕ 2.໯१ύ‫້ޑ‬Ǻ ࡌ᝼ᑡ஻૛ለ่້ҡ‫ੰޑ‬Γ෧Ͽ້‫ޑ‬ឪ‫ڗ‬ໆς࿶ࢂՉϐԖԃ‫ޑ‬ Б‫ݤ‬ǶՠࢂǴ߈ԃٰ‫زࣴޑ‬ᡉҢ೭ࢂό፾྽‫ޑ‬Б‫ݤ‬ǴࣗԿԖወӧ‫ޑ‬Ӓ ᓀ‫܄‬22ǶCurhan‫زࣴޑ‬ύǴଯ້‫ޑ‬໯१ёаफ़եள‫ډ‬๝่ҡ‫ޑ‬ᐒ౗Ǵ ࣬ჹ‫ޑ‬Ǵե້‫ޑ‬໯१ϸԶϲଯΑள‫ډ‬๝่ҡ‫ޑ‬ᐒ౗22Ƕ೭ࢂӢࣁե້ ໯१٬ள້ӧဉၰύ‫ک‬૛ለᡶ่ӝ‫ޑ‬ໆᡂϿǴӢԜ‫׳‬ӭ‫ޑ‬૛ለᡶ཮೏ ဉၰ֎ԏǴӆϩ‫ݜ‬ԿֿనύǴቚуֿύ૛ለ້ၸႫ‫ک‬ᐚࡋǶ‫܌‬аǴ Wahlࡌ᝼ᑡ஻૛ለ่້ҡ‫ੰޑ‬Γ‫؂‬Ϻሡឪ‫ڗ‬800‫ډ‬1200 mg ‫້ޑ‬23Ƕ 3.‫ځ‬дǺ ໯१ύ֖Ԗၨӭ‫܄ނ୏ޑ‬ೈқ፦ǵ१ᡶǵᗐᜪ‫ک‬િެаϷၨϿ‫ޑ‬ ᠼᆢ፦཮ቚуள‫ֿݜډ‬ၰ่ҡ‫ޑ‬ᐒ౗ǶฅԶၨӭ‫ޑ‬෌‫܄ނ‬ೈқ፦ǵᠼ ᆢ፦аϷၨϿ‫ޑ‬१ᡶǵᗐᜪ‫ک‬િެ཮फ़եள‫ֿݜډ‬ၰ่ҡ‫ޑ‬ᐒ౗ǶԜ ѦǴ‫୼ى‬Нϩ‫ޑ‬ឪ‫ڗ‬Ψёаफ़ե‫ֿݜ‬ၰ่ҡ‫ޑ‬ᑡ஻ᐒ౗Ǵࡌ᝼ऍ‫؂‬Ϻ Нϩឪ‫ڗ‬ໆࣁ2.5Կ3 LǴᆢ࡭௨ֿໆ‫؂‬Ϻࣁ2 L12, 18Ƕ ಃΒ࿯ǵ‫ֿݜ‬ၰ่ҡ‫ߦޑ‬຾‫ڋ׭ک‬Ӣη13 ೷ԋֿనύ‫ޑ‬ᡶᜪ่඲‫׎‬ԋࢂҗ‫ֿܭ‬న‫ޑ‬ԋϩ౦தЇଆǴ΋Бय़ࢂ ߦ຾ӢηᐚࡋϼଯǴќ΋Бय़ࢂ‫ڋ׭‬ӢηᐚࡋϼեǴ‫ࣣޣٿࢂ܈‬Ԗ24Ƕ ֿనύ‫ޑ‬ᡶᜪᚆη‫ޑ‬ᐚࡋѸ໪ाၲ‫ډ‬Ⴋ‫ރک‬ᄊǴֿనύω཮໒‫ۈ‬р౜่ ඲ਡЈǴ຾Զғߏ‫܈‬ᆫ໣ԋࣁၨε‫ޑ‬඲ᡏǴߕ๱ӧԏ໣ᆅ΢Ҝ‫׎‬ԋ่ҡǶ ӧΓᜪֿనύӸӧ๱ࢌ٤‫ނ‬፦ёаႣٛᡶᜪ่඲‫׎ޑ‬ԋǴ೭٬ளֿ నᕴࢂೀӧຬႫ‫ރک‬ᄊ(metastable status)ΠԶؒԖ่඲‫׎ޑ‬ԋǴӢԜ೭ ٤‫ނ‬፦ӧ௓‫่ڋ‬ҡ‫׎ޑ‬ԋ‫ڀ‬Ԗख़ा‫ڋ׭ޑ‬բҔ25Ƕ‫܌‬аǴࣴ‫ߦز‬຾Ӣη ‫ڋ׭ک‬ӢηӧႣ่ٛҡ‫׎‬ԋ΢‫ޑ‬фૈǴࢂॶளుΕ௖૸‫ޑ‬ǴᏇఈஒٰё аၮҔ‫ܭ‬ᖏ‫ݯ׉‬ᕍ‫܈‬Ⴃ่ٛҡ‫ޑ‬ൺวǶЎ᝘ύ‫܌‬ൔ֋‫ֿݜޑ‬ၰ่ҡߦ຾ ӢηԖ້ǵ໊ǵ૛ለᡶᜪǵֿለǵાữለǵTamm-Horsfall proteinǵեֿ నpHॶǵեֿࢬໆǵಒ๵ౢ‫ނ‬ǹคᐒ‫ڋ׭ޑ‬ӢηԖᗔǵpyrophosphateǵ ᘗᘔለᡶǹԖᐒ‫ڋ׭ޑ‬ӢηԖNephrocalcinǵTamm-Horsfall proteinǵ 10.

(17) Urinary prothrombin fragment 1ǵinter-alfa-inhibitorǵGlycosaminoglycansǵ ଯֿࢬໆ2Ƕ ಃΟ࿯ǵ‫ֿݜ‬ၰ่ҡ‫ޑ‬ᅿᜪϷಔԋԋϩ13 ‫ֿݜ‬ၰ่ҡ‫ޑ‬ᅿᜪࢂ٩ྣ‫่֖܌‬඲‫ނ‬፦ٰ଺ϩᜪǴаΠࣁӚᅿ่ҡ ‫ޑ‬ϩᜪǵಔԋԋϩϷ‫܌‬՞ԭϩК26Ǻ 1. ่້֖ҡ(Calcium stone)Ǻ79%Ƕ (1)૛ለ่້ҡ(Calcium oxalate stone)Ǻ59%Ƕ (2)ᕗለ่້ҡ(Calcium phosphate stone)Ǻ9%Ƕ (3)૛ለ້‫ک‬ᕗለ້షӝ่ࠠҡǺ11%Ƕ 2. ֿለ่ҡ(Uric acid stone)Ǻ10%Ƕ 3. གࢉ‫่܄‬ҡ(Struvite stone)Ǻҗᕗለ਽ᗔ(magnesium ammonium phosphate)ಔԋǺ9%Ƕ 4. ાữለ่ҡ(Cystine stone)‫ځک‬д่ҡǺ2%Ƕ ่້֖ҡࢂനத‫ֿݜޑـ‬ၰ่ҡᜪࠠǴεӭኧ‫ޑ‬চӢࢂόܴ‫ޑ‬Ǵѝ Ԗ 15% ‫ੰޑ‬Γёаว౜੝ਸ‫ੰޑ‬ӢǴႽࢂচว‫܄‬ୋҘ‫ރ‬ဏϗ຾ǵ๝λ ᆅለύࢥǵᒪ໺‫ֿ܄‬૛ለၸӭੱ฻฻ǶֿለԖόྋ‫ܭ‬Н‫܄ޑ‬፦Ǵӧለ‫܄‬ ֿనύၨ৒ܰ؇ᐘǹҞ߻ֿለ่ҡ‫ޑ‬วғ౗Ԗ೴ᅌϲଯ‫ޑ‬ᖿ༈ǴЬा‫ک‬ ໯१‫ׯޑ‬ᡂԖᜢǴӧচว‫܄‬ภ॥‫ੰޑ‬ΓύԖ 20% а΢‫ុک‬ว‫܄‬ภ॥‫ޑ‬ ੰΓύԖ 40% а΢཮วғֿለ่ҡǶགࢉ‫่܄‬ҡ‫ֿݜک‬ၰགࢉԖᜢǴ ‫ੰځ‬চ๵ࣁֿનሇનౢғಒ๵(urease-producing organism)Ǵёа٬ளֿ નϩှࣁ਽Ǵ٬ֿనለᡵࡋ΢ϲǴԖճ‫ܭ‬ᕗለᡶ่ҡ‫׎ޑ‬ԋǴᖏ‫׉‬΢ന த‫ޑـ‬གࢉ‫่܄‬ҡࣁജ‫่ރف‬ҡǶાữለ่ҡੱࢂ΋ঁԾᡏᗦ‫܄‬ᒪ໺‫ޑ‬ ӃϺ‫܄‬жᖴ੯ੰ 27Ƕ. 11.

(18) ಃѤ࿯ǵ‫ֿݜ‬ၰ่ҡ‫ޑ‬Ћೌ‫ݯ‬ᕍ‫ک‬ϣࣽ‫ݯ‬ᕍ ΋૓٬Ҕ‫ޑ‬Ћೌ‫ݯ‬ᕍԖаΠѤᅿ 28Ǻ 1. ᡏѦ᎜‫ݢ‬࿗ҡ‫ݤ‬Ǻ ࢂճҔ X Ӏ‫܈‬ຬॣ‫ۓݢ‬ՏǴӆճҔႝᔐ‫܈ݢ‬ႝᅶ‫ٰݢ‬ᔐ࿗่ҡǴ Ԝᅿ‫ݯ‬ᕍБ‫ݤ‬ёаߐບЋೌБԄჴՉǴόሡाഞᎈǶ΋૓ੰΓ࿶ߐບ ଺ֹ‫ܜ‬ՈǵЈႝკǵX ӀᔠࢗǴӵ݀ᔠࢗኧᏵ҅தߡёࡼՉϐǶ΋૓ ٰᇥǴԜᅿ‫ݯ‬ᕍБԄа๝่ҡ‫܈‬΢ᒡֿᆅ่ҡࣁЬǴՠ่ҡό‫ە‬ϼ εǴԶЪԖ΋٤ӒᓀӢηѸ໪ೌ߻‫ݙ‬ཀǴ‫ٯ‬ӵǺଯՈᓸ‫ޑ‬௓‫ڋ‬ǵ‫ط‬๠ ᐒૈᆶ‫ط‬๠ဍεǵᏉՈᐒૈӳᚯǵ๝᠌ว‫ݹ‬௓‫ރڋ‬ᄊǵߔ༞ᝄख़ᆶցǴ ೿ሡा΋‫ٳ‬ԵቾమཱǴωૈ෧Ͽࡕᒪੱ‫ޑ‬วғǶၨத‫ޑـ‬ӝ‫ੱٳ‬൩ࢂ ๝Ոဍǵ่ҡՏ౽೷ԋ๝᠌ߔ༞Нဍǵว‫ݹ‬Ǵ‫ځ‬ԋф౗ऊ 7 Կ 8 ԋǶ 2. ϣຎ᜔࿗ҡ‫ݤ‬Ǻ Ԝᅿ‫ݯ‬ᕍБԄനࣁӭኬϯǶϣຎ᜔ё୔ϩࣁ೬ԄϷฯԄ᜔ǴԶ࿗ ҡ‫ݤ‬ёϩࣁНႝᔐ‫ݤ‬ǵ਻୏࿗ҡ‫ݤ‬ǵຬॣ‫ݢ‬࿗ҡ‫ݤ‬ǵ‫܈‬ႜ৔࿗ҡ‫ݤ‬Ǵ ΋૓Ѡ᡼ᙴࣚεӭ௦ҔฯԄϣຎ᜔у΢Нႝᔐ‫୏਻܈‬Ԅ࿗ҡ‫ݤ‬ǶԜᅿ БԄёှ، 8 Կ 9 ԋ΢ύΠᒡֿᆅ่ҡǴՠჹಔᙃ‫ޑ‬໾্‫܄‬ၨεǴӢ ԜӼӄ‫܄‬൩ᆶᙴৣ‫ޑ‬࿶ᡍᆶ‫ೌמ‬Ԗ๊ε‫ޑ‬Ӣ݀ᜢ߯ǶջߡӵԜǴϝฅ Ԗ೚ӭ௃‫ݩ‬ǴᙴৣόඪߵฅҔԜБ‫ٰݤ‬ೀ౛΋٤ၨፄᚇ‫่ޑ‬ҡǶԖ᠘ ‫ܭ‬ԜǴ౜ӧԖ೬Ԅ᜔Ϸ⑯٥ሐႜ৔࿗ҡᐒǴၮҔ‫ֿ่ݜܭ‬ҡᆶ‫ֿݜ‬೬ ಔᙃ‫ݯޑ‬ᕍǶႜ৔ჹ‫ܭ‬ҺՖ΋ᅿ่ҡࣣёᔐ࿗ǴԶЪ࿗ҡᗭಈࢂ‫܌‬Ԗ ่ҡ‫ݯ‬ᕍБԄ္നಒλǴӢԜǴ่ҡ௨ନ౗നӳǵ໾্‫܄‬ΨനϿǶќ ѦǴႜ৔Ψё‫ݯ‬ᕍᒡֿᆅ೬ಔᙃੰᡂǴӵᒡֿᆅ੟ઞ‫܈‬৲ԺǴୃୃ೚ ӭ่ҡ཮ӝ‫ٳ‬Ԗ೭٤೬ಔᙃੰᡂǴѸ໪ӕਔှ،Ƕ೚ӭଯՏᆶፄᚇ‫܄‬ ่ҡǴऩҔႜ৔࿗ҡӆᇶа೬Ԅϣຎ᜔ǴӵԜ๝‫ޒ‬ᆶ೽ϩ๝࿈่ҡǴ ೿ёаҔ଍Չ‫ޑ܄‬БԄуаೀ౛Ǵ٬ੰΓխ‫ܭ‬໒ΘϐधǶ 3. ࿶Ҝऀ๝ᄒҡೌǺ Ԝᅿ‫ݯ‬ᕍБ‫ࢂݤ‬җੰΓୁङ೽කΕᏤᆅԿ๝‫ޒ‬Ǵӆ࿶ၸ΋ೱՍ‫ޑ‬ Ꮴᆅᘉ஭Ǵ‫ޔ‬Կ๝᠌᜔ё຾Ε๝᠌ϣǴӆճҔຬॣ‫ݢ‬࿗ҡᐒуа࿗ ҡǶ໾α΋૓εཷ 1 Կ 1.5 cm ‫ޔ‬৩ǴՠࢂᡏѦёૈ཮ङॄ΋చ๝᠌ 12.

(19) ЇࢬᆅǴԿ‫ܭ‬ਔ໔‫ߏޑ‬อǴ߾ຎ่ҡೀ౛‫ݩރޑ‬Զ‫ۓ‬Ǵ۳۳ೌࡕ‫ॺך‬ ཮ჹූ੮‫่ޑ‬ҡҔᡏѦ᎜‫ݢ‬࿗ҡ‫ٰݤ‬уаೀ౛Ǵ೭঺ಔӝᕍ‫ݤ‬ᆀࣁ ȨΟܴ‫ݯ‬ᕍ‫ݤ‬ȩǶ 4. ໒๝‫ڗ‬ҡೌǺ ԜΏࢂࡕ΋ၰБԄǴ྽߻य़൳ᅿБԄค‫ݤ‬ೀ౛‫่ޑ‬ҡǴനࡕѝӳ ࿶ԜБ‫ݯݤ‬ᕍǴՠԜᅿБ‫ݤ‬ჹ๝᠌‫ޑ‬໾্‫܄‬ΨനεǶ Ծவ 1980 ԃ Chaussy ว߄ӄШࣚ२‫ٯ‬ௗ‫ڙ‬ᡏѦ᎜‫ݢ‬࿗ҡೌ (Extracorporeal Shock-Wave LithotripsyǴESWL)‫ٯੰޑ‬ϐࡕ 29ǴᡏѦ᎜‫ݢ‬ ࿗ҡೌς࿶ԋࣁ‫ݯ‬ᕍ‫ֿݜ‬ၰ่ҡ‫ޑ‬ಃ΋२ᒧБԄǴҞ߻ԭϩϐΐΜа΢ ‫ֿݜޑ‬ၰ่ҡ೿ёаᡏѦ᎜‫ݢ‬࿗ҡೌٰ‫ݯ‬ᕍǶऩ๝่ҡε‫ ܭ‬2.5 cm аϷ ᒡֿᆅ่ҡε‫ ܭ‬1.0 cm а΢ਔǴ߾ό፾ӝճҔᡏѦ᎜‫ݢ‬࿗ҡೌٰ‫ݯ‬ᕍǴ Ѹ໪௦‫ځڗ‬д‫ޑ‬Б‫ٰݤ‬ଛӝ‫ݯ‬ᕍǶќѦჹ‫ܭ‬ჹѫ஁ǵЈ‫ط‬๝фૈόӄ ‫ޣ‬ǴᏉՈᐒ‫ڋ‬ምᛖ‫ޣ‬Ǵᒡֿᆅ่ҡ೷ԋᝄख़ߔ༞‫ک‬๝Нဍ‫ޣ‬όૈҔ 12, 27, 30. Ƕ ӧϣࣽᛰ‫ݯނ‬ᕍБय़Ǵֿለ่ҡёаαܺ potassium citrateǵ. allopurinol ٰྋှ่ҡǹགࢉ‫่܄‬ҡёаαܺ acetohydroxamic acid ٰྋ ှ่ҡǹાữለ่ҡёаαܺ potassium citrateǵD-penicillamineǵ Į-Mercaptopropionylglycine ٰྋှ่ҡǹ૛ለ่້ҡ٠ؒԖԖਏαܺᛰ ‫ނ‬ёаྋှ่ҡǶ ӧႣٛൺวБय़ǴѸ໪Ӄ࿶җȨжᖴ‫܄‬ຑ՗ȩ‫פ‬рੰӢǴ೭٤ຑ՗ хࡴ่ҡϩ‫݋‬ǵՈనғϯϩ‫݋‬ǵΒΜѤλਔֿనෳ‫ۓ‬Ǵ࿶җ೭٤ຑ՗ё аᘜયрӚᅿੰӢǴӆਥᏵ೭٤ੰӢ๏ϒଯᒧ᏷‫ޑ܄‬ᛰ‫ݯނ‬ᕍǴၲ‫ډ‬Ԗ ਏႣ่ٛҡൺวϐҞ‫ޑ‬Ǵ‫ٯ‬ӵ 27Ǻ 1.֎ԏ‫܄‬ଯֿ້ੱǺSodium cellulose phosphate, ThiazideǶ 2.๝‫܄‬ଯֿ້ੱǺthiazideǶ 3.চว‫܄‬ୋҘ‫ރ‬ဏϗ຾ǺЋೌϪନୋҘ‫ރ‬ဏǶ 4.ଯֿለ่້ҡੱǺallopurinol, potassium citrateǶ 5.ဉ‫܄‬ଯ૛ለੱǺMg, vitamin B6Ƕ. 13.

(20) 6.ֿለ่ҡǺallopurinol, potassium citrateǶ 7.གࢉ‫่܄‬ҡǺantibiotics, acetohydroxamic acid(AHA)Ƕ 8.๝λᆅለՈੱǺpotassium citrateǶ 9.եᘗᘔለ่້ҡੱǺpotassium citrateǶ. ᕴϐǴ่ҡ‫ޑ‬Ћೌ‫ݯ‬ᕍς࿶‫ډ‬ၲӼӄǵБߡǵୋբҔλ‫ޑ‬΋ঁӦ‫؁‬Ǵ ೭‫܈‬೚٬ளੰΓ‫ک‬ᙴৣϸԶ۹ౣΑႣٛ‫ޑ‬ख़ा‫܄‬Ǵаठ‫ܭ‬ൺว౗ۚଯό ΠǴ೭ჹ‫ܭ‬஻‫଼ޑޣ‬நࢂ΋ε࠶ુǴΨεໆ઻຤ᙴᕍၗྍǶӧϣࣽᛰ‫ނ‬ ‫ݯ‬ᕍБय़Ǵࢌ٤ᜪࠠ‫่ޑ‬ҡς࿶ԖԖਏ‫ݯޑ‬ᕍ‫ک‬Ⴃٛ‫܄‬ᛰ‫ނ‬Ǵ‫ٯ‬ӵǺֿ ለ่ҡǵགࢉ‫่܄‬ҡ‫ک‬ાữለ่ҡǶՠࢂനத‫ޑـ‬૛ለ่້ҡନΑ citrate ᜪ‫ޑ‬ᛰ‫ނ‬ёճҔٰႣٛൺวϐѦǴӧҞ߻٠ؒԖዴϪԖਏ‫ޑ‬ᛰ‫ނ‬ ٰ‫ݯ‬ᕍ‫ک‬Ⴃٛ‫ֿݜ‬ၰ่ҡǴ೭٤ᛰ‫ނ‬ϝฅ໪ा‫׳‬ӭߏය‫ޑ‬ᖏ‫׉‬၂ᡍٰ᛾ ܴ‫ځ‬ᕍਏǶӢԜǴว৖Ԗਏ‫ݯޑ‬ᕍ‫܈܄‬Ⴃٛ‫ޑ܄‬ϣࣽᛰ‫ࢂނ‬΋ঁॶளࣴ ‫ޑز‬᝼ᚒ 13Ƕ ಃϖ࿯ǵ૛ᛰ‫ݯ‬ᕍϷႣٛ‫ֿݜ‬ၰ่ҡ‫ޑ‬Ў᝘ӣ៝ ᗨฅᡏѦ᎜‫ݢ‬࿗ҡೌ‫ځࢂ܈‬дЋೌБ‫ݤ‬ёҔٰှ،ε೽ϩ‫่ޑ‬ҡ ୢᚒǴՠϝӸӧ೷ԋ࡚‫܄‬๝ཞ໾31ǵफ़ե๝фૈǵቚу่ҡൺว౗฻॥ ᓀ31, 32Ƕӧᛰ‫ݯނ‬ᕍБय़Ǵ೚ӭᖏ‫׉‬၂ᡍς߄ܴ‫ځ‬ёՉ‫܄‬Ǵcitrate ࢂ‫ځ‬ ύၨཥЪԖ‫׆‬ఈ‫ޑ‬ᛰ‫ނ‬Ǵՠࢂϝฅ໪ा‫׳‬ӭߏය‫ޑ‬ᖏ‫׉‬၂ᡍٰ᛾ܴ‫ځ‬ᕍ ਏǶԜѦǴ೭٤ᛰ‫ޑނ‬٬ҔϝฅӸӧ๱೚ӭ‫ޑ‬ୋբҔ33Ǵ‫ٯ‬ӵǺThiazide ཮Їଆੲ॰ǵ༐ᅵ‫܄ک‬фૈምᛖ฻ǹSodium cellulose phosphate ཮Їଆ Ⴭӗ‫ک‬ဎᘞǹAllopurinol ཮ЇଆҜጥआ੶ǵ⧋ЈǵჍӗ‫ک‬ဎᘞ฻ǹ Potassium citrate ཮Їଆगภǵगဉ਻๞ǵ⧋Ј‫ک‬Ⴭӗ฻13Ƕ ӢࣁۘคԖਏԶЪୋբҔե‫ޑ‬ϣࣽᛰ‫ނ‬ǴёҔٰႣٛ‫ݯ܈‬ᕍ‫ֿݜ‬ၰ ่ҡǶ߈ԃٰШࣚӚ୯ᅰΚӧ೭΋Бय़଺ࣴ‫ز‬ว৖Ǵ‫ځ‬ύԖ΋೽ϩ۳Ӧ Б‫ޑ܄‬෌‫܄ނ‬ᛰ‫ٰނ‬ว৖‫ޑ‬ᖿ༈Ǵ೭٤෌‫܄ނ‬ᛰ‫ނ‬೿Ԗ೏٬Ҕٰ‫ݯ‬ᕍ‫ݜ‬ ֿၰ่ҡ‫ߏޑ‬ΦᐕўǴ‫׆‬ఈ೸ၸࣽᏢ‫୼ૈزࣴޑ‬᛾ܴ‫ځ‬ዴϪᕍਏǴаϷ 14.

(21) Ԗճཥᛰ໒วǶҞ߻ςԖ೚ӭЎ᝘ว߄рٰǴᡉҢ೭٤෌‫ނ‬ᛰԖವε‫ޑ‬ ወΚӧ‫ݯ‬ᕍ‫ک‬Ⴃٛ‫ֿݜ‬ၰ่ҡ΢Ǵ‫ٯ‬ӵ೚ӭύ૛ᛰς࿶೏Ҕ‫ݯܭ‬ᕍ๝่ ҡǶᖐ‫ٰٯ‬ᇥǴύ୯‫ޑ‬໺಍ύᛰǴᐛᘞ(Takusha)Ǵς࿶೏ว߄εႵ‫ي‬΢ ࿶җፓ࿯ମᐏೈқ(osteopontinǴOPN)‫߄ޑ‬౜ǴԖႣٛ૛ለ่ҡ‫ޑ‬բҔ 34. ǶᐛᘞΨԖਏӦ‫ڋ׭‬૛ለ້඲ᡏ‫ޑ‬ቚߏ‫ک‬ᆫ໣35Ƕ ໺಍ύ୯ᙴᏢ‫ޑ‬БᏊ—ϖऴණ(WulingsanǴGorei-san)ǴёԖਏӦ‫׭‬. ‫ڋ‬җ‫ٮ‬ᔈᗯᎦଯᕗ໯१‫ޑ‬εႵ‫܌‬Їว‫ޑ‬๝້፦؈ᑈੱ36ǶYoshimura฻Ꮲ ‫ޣ‬ᡣΜϖӜ଼ந‫ܺ܄ت‬Ҕ፜ऴ෯ȐChorei-toȑ‫܈‬ϖऴණȐGorei-sanȑೱ ុΟϺǴԏ໣ܺҔ߻ࡕΒΜѤλਔ‫ֿޑ‬నǴෳໆֿనჹ‫ܭ‬૛ለ่້඲‫ޑ‬ ‫ڋ׭‬բҔǹΨϩ‫ځ݋‬ύ‫ޑ‬ᡂໆǴԖ້ᚆηǵᕗᚆηǵᗔᚆηǵֿለǵ૛ ለǵᘗᘔለǶ่݀ᡉҢܺҔ፜ऴ෯߻ࡕǴֿనύ‫ޑ‬ᡂໆؒԖܴᡉ‫ׯ‬ᡂǴ Ъֿనჹ‫ܭ‬૛ለ่້඲Ψค‫ڋ׭‬բҔǶܺҔϖऴණ߻ࡕǴֿనύ‫ޑ‬ᗔᚆ ηܴᡉቚуǴЪֿనჹ‫ܭ‬૛ለ่້඲ҭᡉҢܴᡉ‫ڋ׭‬բҔ37Ƕ‫ॺך‬а۳ ‫زࣴޑ‬ளр‫่ޑ‬ፕᇡࣁǴคፕࢂӧᡏѦ38‫ނ୏ک‬ჴᡍ39ǴϖऴණԖႣٛ૛ ለ่້ҡ‫׎‬ԋ‫ޑ‬ਏ݀Ƕ Atmani‫ک‬Khan‫ޑ‬ൔ֋ࡰрǴ΋ᅿч೽ߚࢪ‫ޑ‬෌‫—ނ‬Лᇲѭ٥૛ (Herniaria hirsute)‫ޑ‬๧‫ނڗ‬ǴࢂӦύੇ‫ޑ‬໺಍ᛰҔ෌‫ނ‬Ǵӧነࢶঢ (Morocco)ቶ‫ݱ‬٬Ҕٰ‫ݯ‬ᕍ่ҡ੯ੰǴӧᡏѦёа‫ڋ׭‬૛ለ่້඲ғߏ‫ޑ‬ ቹៜ‫ک‬ᆫ໣40 Ƕ Freitas฻ΓΨԖൔ֋ࡰрǴӧЃՋࢂ΋ᅿ҇໔த٬Ҕٰ‫ݯ‬ᕍ‫ֿݜ‬ၰ ่ҡ‫ޑ‬૛ᛰ—੿੧૛(Phyllanthus niruri)‫ޑ‬๧‫ڋ׭ૈނڗ‬඲ᡏғߏǴдॺ ௢ෳ೭ঁբҔᐒᙯԖёૈੋϷဟ๻ữᆫᑗ(glycosaminoglycans)ӝ‫่ډٳ‬ ҡύ41Ƕ Joshi฻ΓΨว߄Α⣤㈻૛(Tribulus terrestris Linn)‫۟ک‬қ๼ (Bergenia ligulata)೭Βᅿ૛ᛰǴӧӑࡋදၹ೏٬Ҕٰ‫ݯ‬ᕍ‫ֿݜ‬ၰ่ҡǴ ёаᡉ๱Ӧ‫ൂڋ׭‬Н૛ለ่້඲ᡏғߏ‫ޑ‬ᡏѦჴᡍǴ‫ځ‬ύBergenia ligulata‫ڋ׭ޑ‬բҔΞၨTribulus terrestrisࣁ٫42ǶTrianthema monogyna ‫ک‬Macrotyloma uniflorum೭Βᅿё१Ҕ‫ޑ‬෌‫ނ‬Ǵғߏӧӑࡋ‫ܿޑ‬ч೽Ƕ Dasa฻Γ‫ޑ‬ჴᡍᡉҢр‫ޑޣٿ‬๧‫ڗ‬నёа෧λ૛ለ่້඲‫ޑ‬ελ‫ک‬Ԗ ྋှ૛ለ่້඲‫ૈޑ‬Κ43Ƕ 15.

(22) ӧ᛿ࡘᔺ฻Ꮲ‫ޣ‬ჹΒߎ௨ҡ෯‫زࣴޑ‬ύǴճҔεႵᆮાऀጕ‫ޑ‬БԄ ᇨวᆮા่ҡǶᡉҢᡏѦჴᡍύΒߎ௨ҡ෯Ԗྋှᆮા่ҡ‫ޑ‬ਏ݀Ǵӧ ለ‫܄‬చҹΠྋှբҔၨܴᡉǶӧճҔεႵᆮાऀጕ‫ޑ‬БԄᇨวᆮા่ҡ ‫ޑ‬ჴᡍύǴΒߎ௨ҡ෯ჹ‫ܭ‬ᆮા่ҡ‫׎ޑ‬ԋև౜‫ڋ׭‬բҔǹԜѦჹ‫ܭ‬ε Ⴕᆮાϣ‫ޑ‬শҡǴΒߎ௨ҡ෯‫ڀ‬ྋှբҔ44Ƕ ӧ‫ֿݜ‬ၰ่ҡ‫ݯ‬ᕍ‫ޑ‬ᖏ‫׉‬ჴᡍБय़Ǵεഌ‫ޑ‬Ꮲ‫ޣ‬Ԗ೚ӭൔᏤ 45Ǻਪ ҖֵМ฻ჹ 1369 ‫ൂٯ‬પ‫ֿݜ܄‬ၰ่ҡੱ஻‫ޣ‬Ǵ௖૸Α፜ऴ෯ӝҔ‫⚓ؿ‬ Ғ૛෯‫ޑ‬௨ҡਏ݀Ǵ่݀௨ҡ౗ࣁ 75%ǶӢԶᇡࣁᆶ౜ਔ٬Ҕ‫ޑ‬Ջ‫ݤ‬௨ ҡߦ຾ᏊᆶᙼภᏊ࣬КǴ፜ऴ෯‫ޑ‬ਏ݀డόᇽՅǴЪୋբҔλǶӓҖᅿ ԽМа፜ऴ෯٠Ҕႝཱུ݈೯ႝᕍ‫(ݤ‬ᙁᆀ፜ႝ‫ )ݤ‬ᇨᏤ่ҡԾ୏௨рǴё ගଯε่ҡ‫ޑ‬௨р౗(42% ) ǴᏵԜᇡࣁ፜ႝ‫ॶࢂݤ‬ள၂Ҕ‫ޑ‬΋ᅿБ‫ݤ‬Ƕ ႍЕܴМൂપ٬Ҕ፜ऴ෯‫ݯ‬ᕍ‫ֿݜ‬ၰ่ҡ 23 ‫ٯ‬ǴԖਏ౗ 39.11% Ǵคୋ բҔǴ‫ځ‬ύ 78.13% Й໪੝ձЗภǶΞჹ‫ޔ‬৩ 10 mm аΠ‫ޑ‬ᒡֿᆅ่ҡ Ҕ፜ऴ෯‫ݯ‬ᕍǴ٠຾Չᕍਏϩ‫݋‬Ǵ่݀΢ᒡֿᆅ่ҡ‫ ޑ‬4 ‫ڬ‬௨ҡ౗ࣁ 40%ǴΠᒡֿᆅ่ҡ‫ ޑ‬4 ‫ڬ‬௨ҡ౗ࣁ 59.19%Ǵᕴ௨ҡ౗ࣁ 50%Ǵӭኧ߄ ౜ࣁคੱ‫ޑރ‬Ծฅ௨ҡǶҖࡏҔу‫ښ‬፜ऴ෯ٛ‫ֿݯ‬ၡ่ҡൺวᕍਏᢀჸ Ϸϩ‫ځ݋‬ᖏ‫׉‬ӢનǴԏਢ 375 ‫ٯ‬஻‫ޣ‬,‫ځ‬ύ 103 ‫ٯ‬Ջᙴ௨ҡ‫ݯ‬ᕍࡕೱុܺ Ҕу‫ښ‬፜ऴ෯ 3 ঁДǴ‫ځ‬Ꭹ 272 ‫ٯ‬ѝ௦ҔՋᙴதೕೀ౛ǴКၨ‫ٿ‬ಔ‫ޑ‬ൺ ว౗Ǵ٠ჹёૈቹៜൺว౗‫ ޑ‬12 ໨ᖏ‫׉‬Ӣન຾Չ Logistic ӣᘜϩ‫݋‬Ƕ่ ݀:፜ऴ෯‫ݯ‬ᕍಔ‫ޑ‬ൺว౗(10.68%)ᡉ๱ե‫ܭ‬Ջᙴதೕೀ౛ಔ(20.59%) (p=0.1025)Ǵቹៜ‫ځ‬ᕍਏ‫ޑ‬ӢનԖ่ҡ‫ޑ‬ᜪࠠǴ่ҡ‫ੰޑ‬ำ‫ک‬Ԗคགࢉ ‫ٳ‬วੱǶᇳቺࢊ฻ΓҔ፜ऴ෯‫ݯ‬ᕍ‫ֿݜ‬ၰ่ҡ 58 ‫ٯ‬Ǵᕍਏ኱ྗ‫ݯޑ‬ᘰ ࣁੱ‫੃ރ‬Ѩ,่ҡ௨р,࿶ຬॣ‫ݢ‬᛾ჴ่ҡ੃ѨǴӳᙯࣁੱ‫ׯރ‬๓Ǵຬॣ ‫ݢ‬᛾ჴ่ҡΠ౽ 3 cm а΢Ǵᡏᑈᕭλ‫܈‬ኧҞ෧ϿǶ‫ݯ‬ᕍ่݀ࣁǴ58 ‫ٯ‬ ஻‫ޣ‬ύ‫ݯ‬ᘰ 20 ‫ٯ‬Ǵӳᙯ 22 ‫ٯ‬Ǵคਏ 16 ‫ٯ‬ǴᕴԖਏ౗ࣁ 72.4%Ƕ ಃϤ࿯ǵ፜ऴ෯‫ޑ‬ᐕўྍࢬ ፜ऴ෯рԾȠ໾ൣፕȡǴࢂ஭Ҹඳଞჹ഍຀Н዗ϕ่‫ੰޑ‬ᐒԶ೛Ǵ ‫ڀ‬Ԗమ዗ճНբҔǴࣁࡕШ໒ബ෷഍ճН‫ޑݤݯ‬Ӄ‫ݞ‬Ƕ၀Б೏ࡕШᙴৎ 16.

(23) ቶ‫ݱ‬Ҕ‫ܭ‬ᖏ‫׉‬Ӛࣽ੯ੰ‫ݯޑ‬ᕍǴ֡Ԗ౛གྷ‫ޑ‬ਏ݀Ƕ ፜ऴ෯२‫ـ‬Ƞ໾ൣፕȡ໚ܴੰጇǴಃ223చГ:Ȩ໚ܴੰǴ ……ऩે ੌǴว዗Ǵ෰ట໯НǴλߡόճ‫ޣ‬Ǵ፜ऴ෯ЬϐǶȩ 224చΞГ: Ȩ໚ܴੰǴԠрӭԶ෰‫ޣ‬Ǵόёᆶ፜ऴ෯ǴаԠӭगύ ᔿǴ፜ऴ෯ൺճ‫ځ‬λߡΨȩǶ Ͽ഍ੰ319చΞග‫ډ‬: ȨϿ഍ੰǴΠճϤΎВǴࠏԶჍ෰ǴЈྠόள ઀Ǵ፜ऴ෯ЬϐǶȩ46 ӧȠߎ჆ाౣȡȨ᠌๜࿶๎Ӄࡕੰે᛾ಃ΋ȩ‫ޑ‬ಃ17చ‫ک‬Ȩ੃෰λ ߡόճరੰે᛾٠‫ݯ‬ಃΜΟȩ‫ޑ‬ಃ13చϩձࡰрȨϻፏੰӧᠢǴట‫װ‬ϐǴ ྽ᒿ‫܌ځ‬ளԶ‫װ‬ϐǴӵ෰‫ޣ‬Ǵᆶ፜ऴ෯ǴէࣣүԜȩȨેੌว዗, ෰ట ໯НǴλߡόճǴ፜ऴ෯ЬϐǶȩ ፜ऴ෯җ፜ऴǵἐऴǵᐛᘞǵྖҡǵߓጤϖᛰಔԋǶБύа፜ऴࣁ ։Ǵࡺ߷аБӜǶ፜ऴǵἐऴǵᐛᘞࣣ఩ᅖճᔸϐࠔǴ፜ऴᏤ዗ΠՉԶ ό໾഍ǴԶἐऴΞૈ଼๠஖βǴҬ೯Ј๝ǹᐛᘞҒយ‫܄‬ൣǴࡽ೴ᆮાǵ ΟขϐНǴΞᘞ‫ط‬ǵ๝Β࿶ϐОǴࢂᖏ‫׉‬΢ճНమ዗‫ݤ‬ύதҔϐᛰǶҭ ૈՉНԶ΢Ǵ٬഍ࢭ΢෷ǴճНϐύ, Ξံ഍ό‫ى‬ǹἐऴǵᐛᘞӧҁБ ύҔࣁԽᛰǶྖҡճᘻ೯రǴᏤ዗ᘞ዗Ǵᆶ഍໚Ҭ೯ϐύԶ‫ڀ‬ᘞ዗ϐૈǹ ߓጤࣁՈԺԖ௃ϐࠔǴ‫ࠆښ‬ԶҒǴࡽ෷੿഍ǴΞૈᔮЈОаΠҬ‫ܭ‬๝Ƕ ϖᛰଛҴǴૈճНԶό໾഍Ǵ෷഍ԶόᠰٕǴӅࠩНճǵ഍ൺǵ዗మϐ ਏ 47Ƕ ፜ऴ෯᛾‫ޑ‬ᖏ‫߄׉‬౜চЎԖǺว዗Ǵ෰ట໯НǴλߡόճ,ǴࠏԶჍ ෰ǴЈྠόள઀฻ǶࡕШᙴৎᖏ‫׉‬ၮҔ၀БਔЬाаൎᙅ೭٤ੱ‫ރ‬৖໒ ‫ޑ‬Ƕഋܴ48 ǵ‫ك‬ᝄ‫ޱ‬49ǵ஭మऴ50ϩձჹђϞύѦԖᜢ፜ऴ෯᛾‫ݯ‬ᕍԖ ਏ‫ޑ‬ᙴਢ຾Չ಍ीϩ‫݋‬ǴΟ‫ޑޣ‬಍ी่݀εӕλ౦Ǵᆶ໾ൣፕচЎК ၨǴλߡόճǵα෰ǵЈྠѨ઀ǵว዗ࣣᆶϐ࣬ӕǶ೭္ሡाࡰр‫ࢂޑ‬ λߡόճጄൎၨቶǴѬхࡴΑֿᓎǴֿ࡚ǴֿภǴλߡό࿣аϷֿࡕᎩ ᛅόᅰ฻ǶဈለภǴࡰ‫ࢂޑ‬ဈ೽ለཱό፾Ǵ‫ឺޣ܈‬ᆟੵภǴࣗ‫ޣ‬όૈᙯ ୁǶဈࣁ๝ϐ۬Ǵ೭္ဈለภό໻ࡰрΑ੯ੰ‫ޑ‬೽ՏǴԶЪ໔ௗᇥܴΑ ፜ऴ෯᛾‫ੰޑ‬ᐒᆶ๝᠌‫ޑ‬фૈஏϪ࣬ᜢǶ ౜ж‫ݯ‬ᕍጄൎ‫زࣴޑ‬ѝाᒣ᛾ࣁ഍຀Н዗ϕ่ǴၮҔ፜ऴ෯ჹӭᅿ 17.

(24) ࡚ᄌ‫܄‬੯ੰ֡ёаၲ‫ݯډ‬ᕍਏ݀51Ƕ‫ٯ‬ӵǺ࡚ᄌ‫ֿݜ܄‬ၰགࢉǵ๝λౚ ๝‫ݹ‬ǵ๝ੰੱংဂ‫ک‬੝ว‫ੌ܄‬ဍǵ‫ֿݜ‬ၰ่ҡǵ๝ᑈНǵ٢ᕧֿǵα౳ ଳᔿੱংဂᆶᄌ‫܄‬ᔸ੶ǵࢬՉ‫܄‬рՈ዗Ҷլය‫طک‬ฯϯрՈǵ࡚‫܄‬዗ ੰǺӵλ‫ٽ‬ဉ‫ݹ‬ǵ๝‫ޒ‬๝‫ݹ‬ǵႋᆄᖥ௽ᡏࡕᒪੱǵख़ੱགߵ฻Ƕ җԜё‫ޕ‬Ǵ፜ऴ෯ӧђж࿶‫ڂ‬ύԖ٬Ҕλߡόճ‫૶ޑ‬ၩǴ౜жҭத ٬Ҕӧ‫سֿݜ‬಍གࢉǵ่ҡ‫ޑ‬ୢᚒ΢Ǵ‫ޑ‬ዴԖ‫ځ‬фਏǶ ಃΎ࿯ǵЎ᝘௖૸λ่ ‫ֿݜ‬ၰ่ҡ‫׎ޑ‬ԋࢂঁፄᚇ‫ޑ‬ၸำǶ२ӃǴֿనѸ໪ाၲ‫ډ‬ᡶᜪ‫ޑ‬ ຬႫ‫ک‬ᐚࡋǴௗΠٰ่඲ਡЈ‫׎‬ԋǴ඲ᡏ‫ޑ‬ғߏ‫ک‬ᆫ໣࣬ុวғǴ‫׎‬ԋ ඲ᡏѸ໪ૈ୼ଶ੮ӧ๝λᆅύό೏ֿనؑ‫و‬ǴωԖᐒ཮‫׎‬ԋ่ҡ 52Ƕҭ ‫ډڙ‬೚ӭӢન‫ޑ‬ቹៜǴፏӵᅿ௼ǵᕉნǵғ౛ғϯǵ໯१฻ӢનǶќѦ ӧֿనύӸӧ๱ᡶᜪ่඲‫׎‬ԋ‫ߦޑ‬຾Ӣη‫ڋ׭ک‬ӢηǴ่ҡ‫ޑ‬ғԋ΋Б य़ࢂߦ຾ӢηᐚࡋϼଯǴќ΋Бय़ࢂ‫ڋ׭‬ӢηᐚࡋϼեǴ‫ࣣޣٿࢂ܈‬Ԗ ‫܌‬ᏤठǶ ᗨฅᡏѦ᎜‫ݢ‬࿗ҡೌ‫ځࢂ܈‬дЋೌБ‫ݤ‬ёҔٰှ،ε೽ϩ‫่ޑ‬ҡ ୢᚒǴՠϝӸӧ೚ӭ॥ᓀǴ‫ٯ‬ӵ࡚‫܄‬๝ཞ໾ǵफ़ե๝фૈǵቚу่ҡൺ ว౗฻Ƕӧᛰ‫ݯނ‬ᕍБय़Ǵ೚ӭᖏ‫׉‬၂ᡍς߄ܴ‫ځ‬ёՉ‫܄‬Ǵՠࢂჹ‫ܭ‬ᖏ ‫׉‬നத‫ޑـ‬૛ለ่້ҡǴନΑ citrate ϐѦ٩ฅؒԖᛰ‫ނ‬ёճҔӧ‫ݯ‬ᕍ‫܈‬ Ⴃٛ΢ǴԶЪ೭٤ᛰ‫ݯނ‬ᕍϝฅԖ೚ӭ‫ޑ‬ୋբҔӸӧǶ ӢࣁۘคԖਏԶЪୋբҔե‫ޑ‬ϣࣽᛰ‫ނ‬ǴёҔٰႣٛ‫ݯ܈‬ᕍ‫ֿݜ‬ၰ ่ҡǶ߈ԃٰШࣚӚ୯ᅰΚӧ೭΋Бय़଺ࣴ‫ز‬ว৖Ǵ‫ځ‬ύԖ΋೽ϩ۳Ӧ Б‫ޑ܄‬෌‫܄ނ‬ᛰ‫ޑٰނ‬ᖿ༈Ǵ೭٤෌‫܄ނ‬ᛰ‫ނ‬೿Ԗ೏٬Ҕٰ‫ݯ‬ᕍ‫ֿݜ‬ၰ ่ҡ‫ߏޑ‬ΦᐕўǴ‫׆‬ఈ೸ၸࣽᏢ‫୼ૈزࣴޑ‬᛾ܴ‫ځ‬ዴϪᕍਏǴаϷԖճ ཥᛰ໒วǶӢԜǴว৖ԖਏЪୋբҔϿ‫ޑ‬ϣࣽᛰ‫ݯނ‬ᕍࢂ΋ঁॶளࣴ‫ز‬ ‫ޑ‬᝼ᚒǶϐ߻ӧΒߎ௨ҡ෯‫زࣴޑ‬ύǴᡉҢᡏѦ‫ނ୏ک‬ჴᡍύΒߎ௨ҡ ෯೿Ԗ‫کڋ׭‬ྋှᆮા่ҡ‫ޑ‬ਏ݀ǴচҁԵቾբࣁংᒧ‫ޑ‬ᛰ‫ނ‬Ƕόၸҗ ‫ܭ‬Βߎ௨ҡ෯ࢂҗЕ೯ǵФጣǵ‫ݼ‬Ғ૛ǵً߻ηǵߎᒲ૛ǵੇߎ؅ǵྖ ҡǵᘲഝ‫܌‬ಔԋǴ‫ځ‬ύ‫ޑ‬Е೯Ԗ٤ࠔᅿԖ֖ଭେႍለ‫ޑ‬ᅪቾǴ‫܌‬аኩਔ 18.

(25) όԵቾǶ ፜ऴ෯ӧύ୯ς࿶Ԗ‫ٿ‬ίԃ‫ޑ‬٬ҔᐕўǴ‫ݯ‬ᕍጄൎቶ‫ݱ‬ǴЬाфૈ ࣁճНᅖᔸǴђж࿶‫ڂ‬ύԖ٬Ҕӧర᛾‫܈‬λߡόճ‫૶ޑ‬ၩ17Ǵ౜жҭத ٬Ҕӧ‫سֿݜ‬಍གࢉǵ่ҡ‫ޑ‬ୢᚒ΢Ǵ౜жЎ᝘ύΨԖ೚ӭჹ፜ऴ෯‫܈‬ ‫ځ‬ύൂ‫ښ‬ᛰ‫زࣴޑ‬Ƕ‫܌‬аǴ፜ऴ෯ӧӚБय़‫ޑ‬ᕍਏϷբҔࢂॶளుΕ௖ ૸‫ޑ‬Ǵҁࣴ‫ز‬๱ख़‫ܭ‬፜ऴ෯ჹ‫ܭ‬૛ለ่້඲‫ڋ׭ޑ‬բҔǴᏇఈஒٰёа ၮҔ‫ܭ‬ᖏ‫ݯ׉‬ᕍ‫܈‬Ⴃ่ٛҡ‫ޑ‬ൺวǶ. 19.

(26) ಃΟകǵ‫׷‬਑ᆶБ‫ݤ‬ ಃ΋࿯ǵཷॊ Ьाࢂ௖૸፜ऴ෯ჹ‫ܭ‬εႵ๝᠌૛ለ่້඲؈ᑈ‫ڋ׭ޑ‬բҔǶ ಃΒ࿯ǵሺᏔ೛ഢ аΠࣁҁࣴ‫܌ز‬٬ҔϐሺᏔ೛ഢ‫ک‬ჴᡍ୏‫ނ‬аϷ‫ځ‬ቷ୘Ӝᆀᆶౢ ӦӵΠǺ 1.Sprague-Dawley rat (୯ࣽ཮ǴѠ᡼) 2. Drying oven (DENG YNG DO45, Japan) 3.Autoclave (Tomin TM-328, Taiwan) 4.ᚆЈᐒ (HERMLE Z200A, Germany) ಃΟ࿯ǵჴᡍ၂Ꮚ аΠࣁҁࣴ‫܌ز‬٬Ҕϐჴᡍ၂Ꮚ‫ځک‬ቷ୘ӜᆀᆶౢӦӵΠǺ 1. 0.75%ΌΒᎇǺEthylene glycol (Sigma (E9129),USA) 2.፜ऴ෯ǺZhulingtang (ࣽၲᇙᛰިҽԖज़ϦљǴѠ᡼Ѡύ) ಃѤ࿯ǵᇙഢ፜ऴ෯๧‫ڗ‬న‫ޑ‬ჴᡍБ‫ݤ‬ ᛰ‫ྍٰނ‬Ǻ ፜ऴ෯ࢂ٬Ҕࣽၲ(Koda)ᇙᛰިҽԖज़Ϧљ‫܌‬ග‫ࣽޑٮ‬Ꮲύᛰણ ҃ᇙᏊǶ፜ऴ෯‫ޑ‬ಔԋࣁ Polyporus umbellatus (Pers) Fries (፜ऴ), Poria cocos (Schw.) ǴWolf (ἐऴ) ǴAlismatis rhizoma (ᐛᘞ) Ǵtalcum (ྖҡ) ‫ ک‬Colla Corii Asini (ߓጤ)ϖᅿᛰ‫ނ‬Ǵ‫ځ‬ख़ໆК‫ ࣁٯ‬2:2:2:2:1Ǵ‫ځ‬ύ፟ ‫׎‬Ꮚࣁᐘણ(starch)Ƕ‫ॺך‬ஒჴᡍҔ‫ޑ‬፜ऴ෯ણ҃Ҭҗ଄ი‫ݤ‬Γᙴᛰπ ཰‫ೌמ‬ว৖ύЈ)Medical and Pharmaceutical Industry Technology and Development CenterǴTaiwan)ᔠᡍǹHPLC fingerprint კҢ‫ܭ‬კ 3.1Ǵ ᡉ ҢԖΟঁЬा‫֎ޑ‬ԏӾঢ়ӧ 52.210Ǵ57.988 ‫ ک‬65.865 ϩដ. ፜ऴ෯ણ 20.

(27) ҃‫ޑ‬ख़ߎឦԋϩӵΠǺᙿ(Cd) 0.180±0.011µg/g ‫ک‬ႉ(Pb) 0.693±0.021µg/gǶ ፜ऴ෯๧‫ڗ‬న‫ޑ‬ᇙഢࢬำǺ Ӄગ‫ ڗ‬100 g‫ޑ‬፜ऴ෯ણ҃Ǵஒ‫ॹځ‬Ε1000 ml࣒ዟ౟ύǴуΕ500 ml ‫ޑ‬d.d. waterǴӆ‫࣒ע‬ዟ౟‫ܫ‬ӧautoclaveύǴྕࡋ೛‫ࣁۓ‬121 qCΠǴу዗ 15ϩដǶฅࡕ‫ڗ‬р࣒ዟ౟Ǵ౟ύౢ‫ނ‬և౜݀এ‫ރ‬ǴԜਔӆуΕd.d. water ‫ޔ‬Կ750 mlǴஒ‫ځ‬འਗషӝ֡ϬǴฅࡕ‫ܫ‬࿼4 qCӇጃύᓉ࿼ΎϺǶΎϺ ࡕǴஒ‫݋‬р‫ޑ‬΢మᛰనॹрǴа1,500 rpm ᚆЈ10ϩដǴӆஒᚆЈࡕ΢ మᛰనᓯӸ‫ܭ‬4 qCΠഢҔǶ ગ‫ڗ‬፜ऴ෯๧‫ڗ‬న‫ޑ‬ଳख़Ǻ ‫ڗ‬р1 mlᇙഢֹԋ‫ޑ‬፜ऴ෯๧‫ڗ‬నǴးΕ2 mlλᆅύǴ‫ܫ‬࿼ӧ60 qC ੗ጃύଳᔿ΋ϺǴϐࡕ‫ڗ‬рગख़Ǵीᆉр1 mlύ֖፜ऴ෯‫ޑ‬ଳख़Ƕჴᡍ ख़ፄ‫ٿ‬ԛǴ‫ڗ‬ѳ֡ॶǶ ᇙഢӕ΋ᐚࡋ‫ޑ‬፜ऴ෯๧‫ڗ‬నǺ ӧ୏‫ނ‬ჴᡍύǴஒᛰనᇙഢԋ΋ᅿᐚࡋǺ65 mg/mlǶ. კ 3.1 ‫ޑࠠڂ‬፜ऴ෯Ҙᎇ๧‫ڗ‬న‫ޑ‬ଯᓸన࣬ቫ‫ݤ݋‬Ȑhigh pressure liguid chromatographyǴHPLCȑՅறቫ‫݋‬᛼ኧᏵǶΒཱུᆅତӈᔠෳᏔ (Diode array detector)‫ۓ‬ӧё֎ԏ๋Ѧጕ 203 nm. 21.

(28) ಃϖ࿯ǵ୏‫ނ‬ჴᡍ‫؁ޑ‬ᡯ ୏‫ނ‬ჴᡍϩԋѤλಔٰ຾ՉǴ‫؂‬ಔႩᎦΟຼǴ‫܌‬Ԗಔձ೿ауΕ 0.75% ΌΒᎇ(ethylene glycolǴEG)‫ޑ‬१ҔН‫҅ک‬த‫ޑ‬Ⴉ਑ٰᗯᎦǶ‫܌‬Ԗ ಔձ٬Ҕ 8 ଫ໢‫ ܄‬Sprague-Dawley ࠔ‫ޑس‬εқႵ(ନಃ΋λಔ٬Ҕ 11 ଫ Ѧ)Ǵᡏख़εऊࣁ 320 gǶаᒿᐒϩಔ‫ޑ‬БԄϩԋѤঁλಔǴႩᎦѤຼǶ ಃ΋λಔ(Group 1)ࣁჹྣಔǴନΑႩ਑ᗯᎦǴؒԖҺՖ‫ޑ‬ύᛰ‫ݯ‬ᕍǶ ಃΒλಔ(Group 2)ࣁჹྣಔǴନΑа 0.75%ΌΒᎇуΕ१ҔНύᗯ ᎦѦǴ‫؂‬ϺҔगᆅឲ१ᐘણ(starch)4.5 ml ΋ԛǴؒԖҺՖ‫ޑ‬ύᛰ‫ݯ‬ᕍǶ ಃΟλಔ(Group 3)ࣁࣁ፜ऴ෯եᏊໆ‫ݯ‬ᕍಔǴନΑа 0.75%ΌΒᎇ уΕ१ҔНύᗯᎦѦǴ‫؂‬ϺҔगᆅឲ१፜ऴ෯๧‫ڗ‬న(ᐚࡋ 65 mg/ml)1.5 ml ΋ԛ(კ 3.2)Ƕ ಃѤλಔ(Group 4)ࣁ፜ऴ෯ଯᏊໆ‫ݯ‬ᕍಔǴନΑа 0.75%ΌΒᎇу Ε१ҔНύᗯᎦѦǴ‫؂‬ϺҔगᆅឲ१፜ऴ෯๧‫ڗ‬న(ᐚࡋ 65 mg/ml)4.5 ml ΋ԛǶ(Group 3ǵGroup 4 ‫ޑ‬ѳ֡ᏊໆӚձࣁ 305 mg/kgǵ915 mg/kgǶ). კ 3.2 Ҕगᆅឲ१፜ऴ෯๧‫ڗ‬న‫ޑ‬௃‫׎‬. 22.

(29) ႩᎦය໔ಖЗࡕǴ‫܌‬ԖεқႵҔΌ⾸ഞᎈࡕǴа‫ޜ‬ଞ‫ڗܜ‬Ј᠌Ոన ठԝǴฅࡕှও‫ڗ‬р‫ୁٿ‬๝᠌Ƕᚈ๝аᅽଭ݅(formalin)‫ࡕۓڰ‬Ǵӆаҡ ៃ(paraffin)хশǴҔeosin solutionࢉՅᇙԋϪТǶႵ๝ϪТаӀᏢᡉ༾ ᜔‫ୃک‬Ӏᡉ༾᜔ϩձᢀჸǶ ಃϤ࿯ǵֿన‫ک‬Ոమ‫ޑ‬ϩ‫݋‬ ‫ॺך‬٬Ҕжᖴ᠈ԏ໣ΒΜѤλਔֿనኬҁ‫ٿ‬ԛǴӧჴᡍ໒‫کۈ‬ჴᡍ ่‫ޑ״‬ਔং(კ3.3‫ک‬კ3.4)ǶՈమኬҁӕኬԏ໣‫ٿ‬ԛǶ୷ྗᗺ‫ޑ‬Ոమኬҁ வ‫׀‬Ѓԏ໣Զჴᡍ่‫״‬ਔࢂҔଞᓐவЈ᠌‫ڗܜ‬Ƕֿన‫ک‬Ոమύ‫่ޑ‬ҡ੯ ੰӒᓀӢηǴ᝽ӵ້Ǵෞᚆᄊ້ǵᕗǴ‫ک‬pHॶǴҔHitachi-7150‫ک‬ Roche-Omnic analyzerٰෳໆǶ. კ3.3 ჴᡍ໒‫ۈ‬ਔǴҔжᖴ᠈ԏ໣ΒΜѤλਔֿనኬҁ‫ޑ‬௃‫׎‬. 23.

(30) კ3.4 ჴᡍ่‫߻״‬ǴҔжᖴ᠈ԏ໣ΒΜѤλਔֿనኬҁ‫ޑ‬௃‫׎‬ ಃΎ࿯ǵຑ՗๝᠌่඲؈ᑈ‫ޑ‬ᝄख़ࡋ ຑ՗ਔǴ‫؂‬ଫεႵᒧ‫ڗ‬΋ᜐ‫ޑ‬Ⴕ๝ϪТǴӧᡉ༾᜔ΠǴ‫ॺך‬ҔѤచ ጕஒ‫ঁ؂‬๝᠌ჄϩԋΖঁ࣬฻ελ‫୔ޑ‬ୱ(კ3.5)Ǵӆ٬Ҕ΋ᆵኧՏྣ࣬ ᐒஒΖঁ࣬฻ελ‫୔ޑ‬ୱӧ40७‫ޑ‬ຎഁΠ‫ྣܡ‬Ǵ‫ॺך‬ӆ೛ी΋ঁႝတᇶ շ‫ޑ‬კႽीϩБ‫(ݤ‬ImageScoring)ǴҔٰᔅշीϩ‫ޑ‬πբ(კ3.6)Ƕӵӕ Nelde‫܌‬ॊ53ǴӧୃӀᡉ༾᜔100७ΠᢀჸႵ๝ϪТǴ‫܌‬ว౜‫ޑ‬૛ለ่້ ඲؈ᑈаъ‫ۓ‬ໆ‫ޑ‬БԄϩԋѤᅿ฻ભ)ɡ, +, ++, +++)(კ3.7)Ǵϩձࢂவ “ؒԖ่඲؈ᑈ”‫“ډ‬εໆ‫่ޑ‬඲؈ᑈ”ǶѤᅿ฻ભӆϩձ๏ϒϩኧ(0, 1, 2, 3)ٰ߄ҢǴ೭ϩኧᆀࣁȨ่඲؈ᑈࡰኧȩ(crystal deposition index)Ƕ΋Ӆ Ԗ328ঁკႽЎҹ೏Ӹ‫ܫ‬ӧ΋ঁᔞਢύǴ‫୔ঁ؂‬ୱа40७‫ޑ‬ຎഁ๏ϒ΋ ঁ่඲؈ᑈࡰኧǴӆஒΖঁϩኧ‫ڗ‬ѳ֡ॶǶаᚈ‫ޑޓ‬БԄǴϩձҗϤঁ ӕ٣ᐱҥղ᠐Ǵӆ‫ڗ‬ѳ֡ॶа፾྽‫ޑ‬಍ीБ‫ݤ‬ϩ‫݋‬Ǵӵ݀Ԗৡຯϼε‫ޑ‬ ঁਢǴ߾ख़ཥ૸ፕǴа‫ڗ‬ளӅ᛽Ƕ. 24.

(31) კ3.5 ‫ঁ؂‬εႵ๝᠌‫ޑ‬Ҡ‫ރ‬ᘐय़೏Ѥঁ຀ᔕጕϩࣁΖঁ୔ୱǶ. კ 3.6 “ImageScoring”Ǵႝတᇶշ‫ྣזޑ‬ቹႽ‫س‬಍Ƕ 25.

(32) A.. B.. C.. კ 3.7 ҔୃӀᡉ༾᜔ᢀჸ(100X)Ǵаъ‫ۓ‬ໆ‫ޑ‬БԄϩભ૛ለ่້඲؈ ᑈǺAǺmild; BǺmoderate; CǺmassiveǹScale bar=0.1 mm13 (კ‫ڗ‬Ծ‫ ܭ‬ഋ‫҅ػ‬Ǻϖऴණჹ‫ܭ‬ᡏѦ૛ለ่້ҡኳࠠ‫ک‬εႵ૛ለ่້ҡኳࠠ‫ڋ׭ޑ‬բҔ ᅺγፕЎǴύ୯ᙴᛰεᏢύ୯ᙴᏢࣴ‫܌ز‬ǴѠύ 2007ǹpp. 58). 26.

(33) ಃΖ࿯ǵၗ਑ϩ‫݋‬ ӧ୏‫ނ‬ჴᡍύǴεႵख़ໆаϷֿన‫ک‬Ոమ‫ޑ‬ኧॶаmean r standard deviation ٰ߄ҢǴஒၗ਑аone-way ANOVAϩ‫݋‬Ƕ่඲؈ᑈࡰኧ߾а non-parametric Kruskal-Wallis test ଺ಔ໔КၨǴฅࡕӆаWilcoxon rank sum test(Mann-Whitney test)଺ଛჹ‫ޑ‬КၨǴऩp <0.05ж߄Ԗᡉ๱ཀကǶ ҁჴᡍ‫ޑ‬಍ीаthe Statistical Package for the Social Science (SPSS® for Windows, release 15.0, SPSS Inc., Chicago, Illinois)ٰ຾Չीᆉ54Ƕ. 27.

(34) ಃѤകǵ่݀ ӧ୷ྗғϯኧᏵ΢ǴᡉҢѤಔ٠คᡉ๱‫ޑ‬ৡ౦(߄ 4.1)ǶεႵӼኃᏊ ಔ(ΌΒᎇуᐘણ)ӧᡏख़ቚу΢ᡉҢрғߏᒨ጗Ǵѳ֡ࣁ 160.63 ± 23.06 gmǴ‫ک‬εႵ҅தಔ‫ޑ‬ѳ֡ᡏख़ 179.63 ± 13.41 gm ࣬КǴᡏख़ቚуၨࣁ጗ ᄌ( p < 0.001 )(߄ 4.2)Ƕ ӧֿᕗ‫ޑ‬ኧᏵ΢ǴεႵӼኃᏊಔКεႵ҅தಔᡉҢрᡉ๱ၨե‫ޑ‬ኧ ॶ( p = 0.045 )ǶӧՈమᕗ‫ޑ‬ኧᏵ΢ǴεႵӼኃᏊಔ‫ک‬፜ऴ෯եᏊໆಔ೭ ‫ٿ‬ಔᆶεႵ҅தಔКၨǴᡉҢрܴᡉၨե‫ޑ‬ኧॶ(ϩձࣁ p = 0.005 ‫ ک‬p = 0.03)(߄ 4.3) Ƕ όၸǴӧֿύ‫ ޑ‬pH ॶǵֿύෞᚆ້ǵՈమύ‫ ޑ‬pH ॶǵෞᚆ້‫ک‬ Ոమ້΢Ǵ೭Ѥঁဂಔϐ໔٠ؒԖᡉ๱ৡ౦Ƕӧჴᡍ߻ࡕ‫ֿޑ‬ໆᡂϯ ΢Ǵ೭Ѥಔ໔٠คᡉ๱‫ޑ‬ৡ౦( p = 0.199Ǵone way ANOVA )Ƕӧ၁ಒ‫ޑ‬ ኧॶ΢ٰ࣮Ǵჴᡍ߻ࡕ‫ֿޑ‬ໆᡂϯϩձࢂࢂ 8.75 ± 15.627 ml(ಃ 1 ಔ)Ǵ 16.13 ± 8.576 ml(ಃ 2 ಔ)Ǵ11.50 ± 9.181 ml(ಃ 3 ಔ)‫ ک‬5.25 ± 2.315 ml(ಃ 4 ಔ)Ƕ ಔᙃᏢ΢ᡉҢǴ҅தჹྣಔεႵؒԖ๝᠌‫້ޑ‬ϯǴ࣬ϸ‫ޑ‬ǴӧҔΌ Βᎇᗯ१‫ޑ‬εႵ΢(ಃ 2,3,4 ಔ)ӧ๝᠌‫ޑ‬Ҝ፦‫ک‬ᡎ፦ёаว౜่඲؇ ᑈǶҗୃӀᡉ༾᜔ᢀჸΠǴ඲ᡏ৖ҢΑᚈӛ‫ש‬৔(bi-refringent)‫ޑ‬ѦᢀǴ ԶЪคፕࢂӧ๝᠌‫ޑ‬Ҝ፦‫ࢂ܈‬ᡎ፦೿Ԗ೚ӭ‫่ޑ‬඲೏ว౜ (კ 4.1)Ƕ ӕਔǴ‫ॺך‬Ψ‫ݙ‬ཀ‫ډ‬ว‫ޑ܄ݹ‬ᡂϯǴхࡴλᆅϣ೽‫ޑ‬඲ᡏǴԏ໣λ ᆅ‫่ޑ‬඲ਵηǴ๝λᆅ΢Ҝ‫ޑ‬ಒझཞ໾Ǵ໔፦ว‫ݹ‬ϸᔈ‫ک‬඲ᡏ೏Ѯಒझ տᏘ(კ 4.2 ‫ ک‬4.3)Ƕ. 28.

(35) კ 4.1 ӧ๝᠌‫ޑ‬Ҝ፦‫ک‬ᡎ፦֡кᅈ೚ӭ‫ޑ‬૛ለ่້඲. კ 4.2 Ԗว‫ޑ܄ݹ‬ᡂϯǴхࡴλᆅϣ೽‫ޑ‬඲ᡏǴԏ໣λᆅ‫่ޑ‬඲ਵ η‫ک‬๝λᆅ΢Ҝ‫ޑ‬ಒझཞ໾ 29.

(36) კ 4.3 ନΑᆅϣ೽่඲ਵη‫ک‬΢Ҝ‫ޑ‬ಒझཞ໾Ǵᗋёа࣮‫ډ‬໔፦ว ‫ݹ‬ϸᔈ‫ک‬඲ᡏ೏ѮಒझտᏘ. ӧϩ‫่݋‬඲؈ᑈࡰኧࡕǴ‫ঁٿ‬፜ऴ෯ᗯ१ಔ֡ᡉ๱ե‫ܭ‬ӼኃᏊಔǶ ಃ 3 ಔ‫ޑ‬ϩኧவ 1.40 Πफ़Կ 0.41ǴԶಃ 4 ಔ‫ޑ‬ϩኧவ 1.4 0 Πफ़Կ 0.40 (а Mann - Whitney U ᔠᡍǴp = 0.025 ‫ ک‬p = 0.047 )(߄ 4.4)Ƕ ᏾ᡏԶ‫ق‬Ǵ ፜ऴ෯՟Яӧ፜ऴ෯ᗯᎦ‫ޑ‬εႵ΢ǴԋфӦ‫ڋ׭‬Α૛ ለ่້඲؈ᑈӧ๝᠌(Kruskal-Wallis testǴp = 0.041 )Ƕӧ่ҡ‫׎‬ԋ‫ޑ‬วғ ౗΢Ǵаಔϣวғ่ҡ‫׎‬ԋ‫ޑ‬εႵঁኧନаಔϣεႵ‫ޑ‬ᕴኧٰीᆉǴӧ եᏊໆಔவ 90.9ʘΠफ़Կ 75.0ʘǴӧଯᏊໆಔҗ 90.9ʘΠफ़Կ 87.5ʘ(߄ 4.5)Ƕа࣬ჹ‫ޑ‬॥ᓀ(relative risk)ٰ࣮ǴᆶӼኃᏊಔ࣬КǴಃ 3 ಔவ 1 Π फ़Կ 0.82Ǵಃ 4 ಔ٠வ 1 Πफ़‫ ډ‬0.96Ƕ. 30.

(37) ߄ 4.1 εႵ‫ྗ୷ޑ‬ғϯॶ Group 1. Group 2. Normal. EG + Starch. Baseline Data. Group 3. Group 4. EG + ZLT. EG + ZLT. (low dose). (high dose). Urine 22.16 ± 0.84. 22.64 ± 0.40. 20.48 ± 5.36. 22.45 ± 0.92. 0.79 ± 0.39. 1.05 ± 0.40. 0.34 ± 0.22. 0.40 ± 0.31. 6.48 ± 0.53. 6.50 ± 0.24. 6.33 ± 0.50. 6.22 ± 0.24. 6.92 ± 1.41. 6.88 ± 1.14. 5.62 ± 1.09. 7.05 ± 1.50. 21.96 ± 2.08. 21.43 ± 2.03. 20.19 ± 0.46. 22.42 ± 4.65. Phosphorus(mg/dl) Urine free Calcium (mmol/L) Urine pH Serum Calcium(mg/dl) Serum Phosphorus(mg/dl). Values are expressed as Mean ± S.D. One-way ANOVA. Ѥಔ໔εႵ‫ྗ୷ޑ‬ғϯॶؒԖᡉ๱ৡ౦. 31.

(38) ߄4.2 ፜ऴ෯ӧεႵᡏख़‫ک‬๝᠌ख़ໆ΢‫ޑ‬բҔ. Body weight gained (g). Group 1. Group 2. Group 3. Group 4. normal. EG + Starch. EG + ZLT. EG + ZLT. (low dose). (high dose). 130.63 ± 23.06 b*. 167.50 ± 21.21. 161.75 ±16.918. 1.83 ± 0.34. 1.83 ± 0.33. 1.65 ± 0.26. 1.69 ± 0.11. 1.91 ± 0.50. 1.74 ± 0.21. 1.65 ± 0.26. 1.75 ± 0.21. 179.63 ± 13.41. Kidney weight, left (g) Kidney weight, right (g). Values are expressed as Mean ± SD, and analyzed by one-way ANOVA and multiple comparision test (Turkey HSD). b Denotes the comparison of four groups. * p <0.05. 32.

(39) ߄ 4.3 ፜ऴ෯ӧεႵֿన‫ک‬Ոమғϯॶ΢‫ޑ‬բҔ Group 1. Group 2. normal. EG + Starch. Urine Phosphorus. Group 3. Group 4. EG + ZLT. EG + ZLT. (low dose). (high dose). 20.98 ± 1.12. 19.52 ± 0.68 a*. 20.16 ± 0.62. 20.70 ± 0.51. 0.35 ± 0.21. 0.19 ± 0.06. 0.27 ± 0.06. 0.30 ± 0.08. 6.92 ± 0.45. 6.74 ± 0.32. 6.55 ± 0.50. 6.49 ± 0.16. 11.24 ± 0.26. 10.69 ± 0.59. 10.75 ± 0.63. 10.97 ± 0.68. 12.54 ± 1.25. 9.45 ± 2.26 a*. 8.76 ± 1.63 a*. 10.18 ± 2.84. 1.09 ± 0.07. 1.10 ± 0.06. 1.09 ± 0.17. 1.15 ± 0.04. 7.11 ± 0.16. 7.13 ± 0.09. 7.12 ± 0.10. 7.06 ± 0.08. (mg/dl) Urine free Calcium (mmol/L) Urine pH Serum Calcium (mg/dl) Serum Phosphorus (mg/dl) Serum free Calcium (mmol/L) Serum pH. Values are expressed as Mean ± SD, and analyzed by one-way ANOVA and multiple comparision test (Turkey HSD). a Values are significantly different compared to normal group *p <0.05.. 33.

(40) ߄ 4.4 ่඲؈ᑈࡰኧ‫ޑ‬ϩ‫݋‬ P value Number Group. Treatment. Mean of scores. Mann-Whitney. of rats U test Group 2. 11. Group 3. 8. EG + Starch. 1.40 ± 1.20. EG + ZLT. 0.41 ± 0.60 a*. 0.025 a*. 0.40 ± 0.51 a*. 0.047 a*. (low dose) EG + ZLT Group 4. 8 (high dose). Values are expressed as Mean ± SD. Kruskal-Wallis test for three groups p=0.041. a Values are significantly different compared to placebo group (group 2) by Mann-Whitney U test.* p < 0.05. 34.

(41) ߄ 4.5 εႵ๝᠌ύ่඲‫׎‬ԋ‫ޑ‬วғ౗. Group. Number. Number. Incidence. Rat. of. of rats. rate of. Relative. number. urolithic. without. crystal. risk. rats. stone. formation. 8. 0. 8. 0%. 11. 10. 1. 90.9 %. 1. 8. 6. 2. 75.0 %. 0.82. 8. 7. 1. 87.5 %. 0.96. Treatment. d. d. water, 1. Normal normal chow EG water, 2. Placebo. starch gavages EG water,. 3. Low low dose ZLT dose gavages EG water, 4. High high dose dose ZLT gavages. The relative risk is compared to the placebo group, respectively.. 35.

(42) ಃϖകǵ૸ፕ ಃ΋࿯ǵ፜ऴ෯ჹ‫ܭ‬εႵ૛ለ่້ҡኳࠠ‫ڋ׭ޑ‬բҔ ‫่݀زࣴޑॺך‬ᡉҢǴӧΌΒᎇᗯᎦεႵ‫ޑ‬ኳࠠύǴ፜ऴ෯ёаԖ ਏӦफ़ե๝᠌૛ለ่້඲‫ޑ‬ᝄख़ࡋǶӧ፜ऴ෯ᗯᎦ‫ޑ‬εႵ(ಃ 3 ‫ ک‬4 ಔ) ΢Ǵёа࣮‫่ډ‬඲؈ᑈࡰኧफ़եǴԶЪ่඲‫׎‬ԋ‫ޑ‬วғ౗ҭΠफ़Ƕӧ೭ ঁၸำύǴճֿਏ݀ёૈؒԖੋϷ྽ύǴӢࣁჴᡍ߻ࡕֿໆ٠ؒԖᡉ๱ ‫ޑ‬ቚуǶคፕࢂӧֿన‫܈‬Ոమύᕗ‫ޑ‬ᐚࡋǴӼኃᏊ‫ک‬եᏊໆ፜ऴ෯ಔ֡ ե‫҅ܭ‬தჹྣಔ࣬(߄ 4.3)Ƕёૈёа௢ෳǴӧ೭ঁ่඲‫ޑ‬ၸำύᕗࢂ೏ ٬Ҕ‫ޑ‬ǴӢԜӧ೭٤ဂಔՈమ‫ޑ‬ᐚࡋࢂफ़ե‫ޑ‬ǶόၸǴҞ߻٠ؒԖё᎞ ‫ޑ‬᛾Ᏽёаբр೭΋่ፕǶ ᔠ᎙‫܌‬ԖᇨᏤ่ҡ‫׎‬ԋ‫ނ୏ޑ‬ኳࠠǴ๏ϒεႵΌΒᎇ(ethylene glycolǴEG)ࢂӧᡏϣᇨᏤ૛ለ້๝᠌่ҡ 55-59 നத‫کـ‬നԖਏ‫ޑ‬Б‫ݤ‬Ƕ а‫ځ‬дჴᡍБ‫ݤ‬ᇨᏤ่ҡ‫׎‬ԋǴΨࢂԖᔅշ‫ޑ‬Ǵхࡴӧ໯Н‫܈‬१‫ނ‬уΕ ♏୷-L-ಢ਽ለ(hydroxy-L-prolineǴHLP)Ǵ෌Εкᅈ૛ለ‫ޑ‬ᅖ೸଎գᔅ੅ (osmotic mini-pumps)ǴϪନ଑ဉу΢ᗯ१૛ለǴ࿶ဎ๚‫ݙ‬৔૛ለ‫୷♏܈‬ -L-ಢ਽ለ 60ǶฅԶǴᏃᆅԖжᖴ‫܄‬ለύࢥ‫ޑ‬ୋբҔǴӵΌΒᎇᗯᎦεႵ ኳࠠϝฅࢂ΋ঁԋфှ࿶தӧ٬Ҕ‫ޑ‬Б‫ݤ‬Ƕ ‫ځ‬ύ♏୷-L-ಢ਽ለ(HLP)ຫٰຫ೏ख़ຎǴӢࣁѬ‫ک‬ΌΒᎇ΋ኬёа жᖴԋ૛ለ(კ 5.1)ǴՠࠅϿΑ೚ӭࢥ‫܄‬ၨம‫ޑ‬жᖴౢ‫کނ‬жᖴ‫܄‬ለύࢥ ‫ޑ‬ୋբҔǶNeil ฻Ꮲ‫ޣ‬Ҕ 10%‫ ډ‬20%‫୷♏ޑ‬-L-ಢ਽ለ(HLP)ᗯᎦ໢‫ޑ܄‬ Yorkshire-Durox ፜ΒΜϺǴ่݀ԋфӦ೷ԋଯ૛ለֿǴ૛ለ້‫่ޑ‬඲ ֿǴӕਔӧ๝٢ँΨ‫׎‬ԋ૛ለ້Ǵ೭೯த೏ຎࣁ๝᠌่ҡ‫߻ޑ‬០‫ނ‬Ƕ‫܌‬ аǴ♏୷-L-ಢ਽ለ(HLP)΋ኬёаၲ‫کډ‬ΌΒᎇᇨᏤ่ҡ‫׎‬ԋ‫่݀ޑ‬Ǵ ӢԜ‫زࣴॺך‬ი໗ӧϐࡕ‫زࣴޑޑ‬ς࿶௦Ҕ♏୷-L-ಢ਽ለ(HLP)բࣁᇨ Ꮴ่ҡ‫׎‬ԋ‫ޑ‬၂ᏊǶ. 36.

(43) კ 5.1 ΌΒᎇȐEthylene glycolȑ‫୷♏ک‬-L-ಢ਽ለ(HLP)ӧΓᡏ‫ނ୏ک‬ύ жᖴӝԋ૛ለ‫ޑ‬೼৩ 55 Ȑკ‫ڗ‬Ծ‫ ܭ‬Halabe et al. Clinica Chimica Acta. 2003;330:136.ȑ. ᆶӼኃᏊಔ࣬КǴեᏊໆ፜ऴ෯‫ݯ‬ᕍಔӧ่඲‫׎ޑ‬ԋ‫࣬ޑ‬ჹ॥ᓀ (relative risk)΢ࢂԖᡉ๱फ़ե‫ޑ‬Ƕ‫ځ‬д‫ޣزࣴޑ‬ΨԖว߄ᜪ՟‫่݀ޑ‬Ǵ ᖐ‫ٰٯ‬ᇥǴWang ฻Γว߄ӧ glyoxylic acid ᇨᏤ่ҡ‫ޑ‬εႵኳࠠύǴ๏ ϒဎ๚ϣ‫ݙ‬৔፜ऴ෯ёૈӛΠፓ௓(down-regulate) ମᐏೈқ(osteopotin) mRNA ‫߄ޑ‬౜‫ک‬෧Ͽ๝᠌่ҡ‫ޑ‬ᝄख़‫ ܄‬61ǶKoide ฻Γว౜ǴեᏊໆ፜ ऴ෯ԖႣ่ٛҡ‫ޑ‬ਏ݀ 62ǶӕਔǴ‫ځ‬дࣴ‫ޣز‬Ψள‫࣬ډ‬ӕ‫่ޑ‬ፕǴ൩ࢂ ፜ऴ෯‫ځޑ‬ύ΋໨ԋϩ—ᐛᘞǴԖ‫่ڋ׭‬ҡ‫׎‬ԋ‫ޑ‬ਏ݀ 62-64ǶYasui ฻Γ 37.

(44) ว߄ǴӧҔᐛᘞ‫ݯ‬ᕍ‫ޑ‬εႵ΢ǴёаԖਏӦႣٛ૛ለ่້ҡ‫׎ޑ‬ԋ‫ک‬෧ Ͽ OPN ‫߄ޑ‬౜ 34Ƕᒘ੿฻Ꮲ‫ޣ‬Ҕ๝่ҡεႵኳٰ࣮ࠠ፜ऴ෯‫ک‬ᐛᘞჹମ ᐏೈқ(osteopotin) mRNA ‫߄ޑ‬ၲǴ่݀‫ޣٿ‬և౜࣬ӕ‫ڋ׭ޑ‬բҔ 65Ƕ Suzuki ฻ΓҔΑ΋ঁ‫ڋ׭‬૛ለ້඲ᡏ‫׎‬ԋբҔ‫ޑ‬ᡏѦ‫س‬಍ࣴ‫ز‬Ǵдॺள р‫่ޑ‬ፕᇡࣁᐛᘞёаԖਏӦ‫ڋ׭‬඲ᡏ‫׎‬ԋǴғߏ‫ک‬ᆫ໣‫؂ޑ‬΋ঁ‫؁‬ᡯ 35. ǶXhou ฻ΓҗᐛᘞύϩᚆрΟঁϯӝ‫ނ‬Ǵ᠘‫ ࣁۓ‬alisol F 24-acetate,. alisol A 24-acetate ‫ ک‬alisomoxide64ǶYin ฻Γว߄Ǵӧᐛᘞ‫ݯ‬ᕍ‫ ޑ‬Wistar εႵ΢ว౜Ǵᐛᘞёа‫ڋ׭‬ᡏѦ૛ለ่້඲ᡏ‫ޑ‬ғߏ‫ک‬ᆫ໣Ǵᗋёаफ़ ե๝᠌‫້֖ޑ‬ໆ 34Ƕ ന߈ჹ่ҡ‫ޑ‬ᐒ‫زࣴڋ‬Бय़ೈқ፦ᡏᏢ(proteomics)Ψ‫ת‬ᄽΑख़ा ‫فޑ‬ՅǴΨഌុว౜Α೚ӭೈқ፦ᆶϐԖᜢǴ‫ٯ‬ӵёаफ़ե่඲‫ޑ‬ԋਡ ԋߏᆫ໣‫ ޑ‬Tamm-Horsfall protein (THP)66Ǵମᐏೈқ(osteopontin)67Ǵ bikunin68 ‫ ک‬Urinary prothrombin fragment 1 (UPTF1)69 Ѥᅿೈқ፦Ƕ ૛ ለ້‫ک‬ᕗለ້ёа‫ߚک‬ᚆη่ᄬᗖ่‫ډ‬๝᠌߄Ҝಒझ‫߄ޑ‬य़Ǵхࡴ phosphatidylserineǴosteopontin Ǵnucleolin-related protein (NRP) Ǵ hyaluronanǴannexin II 70 ೭ϖᅿೈқ፦Ƕவ೭٤ൔ֋‫่݀زࣴޑॺךک‬Ǵ ‫ॺך‬ёаଷ೛፜ऴ෯ёૈࢂ΋ᅿԖਏٛЗ૛ለ້‫ֿݜ‬ၰ่ҡ‫ޑ‬ᛰ૛Ƕᗨ ฅҞ߻ค‫ݤ‬᛾ܴǴόၸ‫ॺך‬ᇡࣁᐛᘞёૈࢂ‫ځ‬ԖਏԋϩǴૈ೷ԋ෧Ͽ඲ ᡏ؈ᑈǴ፜ऴ෯‫่ל‬ҡ‫ޑ‬ᐒ‫ڋ‬ёૈੋϷεϩη‫ނڋ׭ޑ‬፦ᆶ૛ለ‫ޑ‬жᖴ ೼৩Ǵ‫ॺך‬ᔈ၀຾Չ‫׳‬ӭ‫ٰزࣴޑ‬ዂమ೭΋ᗺǶ ӧ೭໨ࣴ‫ز‬ύǴ‫ॺך‬ว౜ӼኃᏊಔӧჴᡍ่‫״‬ਔǴวғΑаᡏख़ቚ уၨࣁ጗ᄌբࣁ߄౜‫ޑ‬ғߏᒨ጗Ƕ‫ࢂޑ܁ڻ‬Ǵ೭ᅿ౜ຝ٠҂วғӧ፜ऴ ෯ᗯᎦ‫ޑ‬εႵ(group 3 ‫ ک‬4)ǴӢԜ‫ॺך‬ᇡࣁ๏ϒ፜ऴ෯՟Яࢂ΋ঁߥៈ ӢનǶ ಃΒ࿯ǵჴᡍ‫ޑ‬ज़‫ڋ‬ ᜢ‫ܭ‬ҁჴᡍ‫ޑ‬ज़‫ڋ‬ǴԖѤঁБय़Ǻಃ΋ঁࢂ୏‫ނ‬ჴᡍኳࠠ‫ޑ‬ज़‫ڋ‬Ǵ ‫ॺך‬٬ҔΑΌΒᎇ(ethylene glycolǴEG)ٰᇨᏤ૛ለ่້ҡǴฅԶӵӕ߻ य़ග‫ځډ‬ჴԖ೚ӭᇨᏤ่ҡ‫ޑ‬Б‫ݤ‬Ǵՠࢂ೭٤БԄ‫܌‬ᇨᏤ‫่ޑ‬ҡ‫ک‬Γᡏ 38.

(45) ‫׎܌‬ԋ‫่ޑ‬ҡᗋࢂԖ‫܌‬όӕ‫ޑ‬Ǵ‫܌‬аஒٰᔈҔ‫ډ‬Γᡏਔᗋࢂ཮Ԗ‫܌‬ৡ౦ ‫ޑ‬ǶಃΒঁࢂ୏‫ނ‬ჴᡍঁኧ‫ޑ‬ज़‫ڋ‬Ǵҁჴᡍаҙፎ୯ࣽ཮ीฝ‫ޑ‬БԄٰ ຾Չ୏‫ނ‬ჴᡍǴ‫܌‬а୯ࣽ཮๏ϒ‫ॺך‬ӕ΋‫ۓڰץ‬ኧໆ‫ޑ‬εႵǴӢԜԵቾ εႵ‫سࠔޑ‬ǵԋߏᕉნ฻࠼ᢀచҹόёૈ΋ठǴ‫ࢂܭ‬ค‫ݤ‬ӆቚуჴᡍঁ ኧǶಃΟঁࢂᛰቷᛰ‫ޑྍٰނ‬ज़‫ڋ‬Ǵջߡ‫ॺך‬ςග‫ٮ‬፜ऴ෯Ҙᎇ๧‫ڗ‬న ‫ޑ‬ଯᓸన࣬ቫ‫(ݤ݋‬HPLC)Յறቫ‫݋‬᛼ኧᏵǴՠࢂϐࡕᛰቷ‫ޑ‬ᛰ‫ྍٰނ‬ǵ ᇙᛰၸำǵᗯ१‫܌‬Ҕ፜ऴ෯‫ޑ‬ᇙഢၸำ‫ॺךک‬٬Ҕ‫ޑ‬፜ऴ෯ᗋࢂԖёૈ Ԗ٤༾‫ޑ‬όӕǶಃѤঁࢂȨ่඲؈ᑈࡰኧȩ(crystal deposition index)ຑϩ БԄ‫ޑ‬ज़‫ڋ‬Ǵ౥ഖъ‫ۓ‬ໆ‫ޑ‬БԄϝฅӸӧ๱ΓࣁЬᢀ‫ޑ‬ৡ౦Ǵ่ҡ‫ޑ‬ϩ թ‫ک‬ຎഁ‫ޑ‬ᒧ᏷೿཮ቹៜຑϩǴӢԜຑϩБԄҭࢂҁჴᡍ‫ޑ‬ज़‫ڋ‬Ƕ ಃΟ࿯ǵ่ፕ ᕴԶ‫ق‬ϐǴ፜ऴ෯ёа෧ե૛ለ่້඲‫ޑ‬ᝄख़ࡋ‫ک‬ᗉխᡏख़ቚуၨ ࣁ጗ᄌ‫ޑ‬ਏ݀ǶӢԜǴ໺಍ύᙴБᏊ፜ऴ෯ёૈࢂ΋ᅿԖਏႣٛ๝᠌่ ҡ‫ޑ‬ᛰ‫ނ‬ǶᗨฅǴ‫ॺך‬ჹ፜ऴ෯‫่ڋ׭‬඲‫ޑ‬ᐒ‫ڋ‬ϝόమཱǴ௢ෳ‫ځ‬ύε ϩηёૈΨԖୖᆶǶӢԜǴ҂ٰ‫׆‬ఈёа΋Бय़຾Չᖏ‫׉‬ჴᡍǴ᛾ჴ፜ ऴ෯ᔈҔӧΓᡏ΢΋ኬԖႣٛ๝᠌่ҡ‫ޑ‬բҔǴ຾ԶᔅՐੰ஻ှ،‫ي‬Ј ΢‫ޑ‬ภधǴ౥ഖ೭ࢂ‫ࣁي‬ᙴৣ‫ޑ‬ϺᙍǴΨࢂ‫ॺך‬നಖ‫ޑ‬Ҟ‫ޑ‬Ƕќ΋Бय़ ‫ॺך‬ёа຾Չೈқ፦ᡏᏢ(proteomics)‫زࣴޑ‬ǴхࡴΒᆢႝ‫ (ݚ‬twodimensional sodium dodecyl sulfate-polyacrylamide gel electrophoresis, 2D-PAGE)Ǵ୷፦ᇶշႜ৔ಥߕෞᚆ०Չਔ໔፦᛼ሺȐmatrix-assisted laser desorption ionization-time of flight, MALDI-TOFȑǴೈқ፦ᙯӑϷխࣝࢉ Յ‫܈ݤ‬ሇનխࣝࢉՅǴυᘋ‫܄‬ਡᗐਡለ (RNA Interference; RNAi)……฻ ฻Ǵаයૈჹ่ҡ‫ੰޑ‬౛ғ౛ᐒ‫ڋ‬Ԗ‫׳‬೸ᄇ‫ޑ‬ᕕှǶ !. 39.

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(47) Preminger GM, ed. Urolithiasis. University of Cape Town, Cape Town; 2000. 12.. Marshall L DM. Urinary stone disease. In: Smith´s general urology. United States of America: Eds Emil AT and Jack WM, McGraw-Hill Co., Inc.; 2000;pp.291-320.. 13.. ഋ‫҅ػ‬Ǻϖऴණჹ‫ܭ‬ᡏѦ૛ለ่້ҡኳࠠ‫ک‬εႵ૛ለ่້ҡኳࠠ ‫ڋ׭ޑ‬բҔ ᅺγፕЎǴύ୯ᙴᛰεᏢύ୯ᙴᏢࣴ‫܌ز‬ǴѠύ 2006ǹpp. 58.. 14.. ৊଻, ‫ڬ‬ෂ, ଯ‫ڷ‬. ჹύᙴђЎ᝘૶ၩర᛾‫ޑ‬ᐕў‫ݮ‬ॠଓྉ. ύᙴ ᛰᏢт. 2006;24:14.. 15.. ‫௵׵‬, Цᓉ. ర᛾ྉྍ. ଧՋύᙴᏢଣᏢൔ. 2006;29:12.. 16.. ర᛾‫ޑ‬ᐕўྍࢬ http://www.zgxl.net/SLJK/ybjb/miniao/linzheng.htm.. 17.. ൂਜ଼ǵഋη๮. ђϞӜᙴᖏຓߎ᠙Ǹరຓ⻬ഈ‫ڔ‬. ч٧: ύ୯ύ ᙴᛰр‫ ;ޗހ‬1999.. 18.. Lewandowski S, Rodgers AL. Idiopathic calcium oxalate urolithiasis: risk factors and conservative treatment. Clinica Chimica Acta. 2004;345:17-34.. 19.. Robertson WG, Peacock M. The cause of idiopathic calcium stone disease: hypercalciuria or hyperoxaluria? Nephron. 1980;26:105-110.. 20.. Coe FL. Hyperuricosuric calcium oxalate nephrolithiasis. Kidney International. 1978;13:418-426.. 21.. Ettinger B. Allopurinol for treatment of uric acid and calcium calculi. In: Pharmacological Treatment of Endocrinopathies. 1991:16-36.. 22.. Curhan GC, Willett WC, Rimm EB, Stampfer MJ. A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. New England Journal of Medicine. 1993;328:833-838.. 23.. Wahl C, Hess B. [Kidney calculi--is nutrition a trigger or treatment?]. Therapeutische Umschau. 2000;57:138-145. 41.