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winasityvaoba

epidemiologia erT-erTi yvelaze ufro mniSvnelovani samedicino


disciplinaa. swored epidemiologia aris safuZveli daavadebaTa mimarT swori
prevenciuli RonisZiebebis SemuSavebisa da sazogadoebrivi jandacvis politikis
gansazRvrisa. amitomac iTvleba epidemiologia sazogadoebrivi jandacvis ZiriTad
disciplinad da mecnierul safuZvlad. amave dros, igi aris mtkicebiTi medicinis
fundamentic. gansakuTrebiT gaizarda epidemiologiis mniSvneloba koronavirusuli
infeqciis pandemiis pirobebSi. naTlad gamoCnda, rom maRal doneze organizebuli
epidemiologiuri samsaxuris da aseve kvalificiuri epidemiologebis gareSe,
praqtikulad SeuZlebelia efeqturad ebrZolo infeqciur daavadebebs,
gansakuTrebiT maSin, rodesac asparezze gamodis axali infeqcia da igi drois
umokles periodSi iRebs pandemiur gavrcelebas.
kvalificiuri epidemiologebis momzadebis pirobaa mSobliur enaze
xarisxiani saxelmZRvanelos arseboba. Cveni avtorobiT, 2010 wels Seiqmna pirveli
qarTuli saxelmZRvanelo epidemiologiaSi, romelic aseve Seicavda
biostatistikis ZiriTad sakiTxebs. ganvlili aTi wlis manZilze garkveul wilad
Seicvala midgomebi mTeli rigi epidemiologiuri sakiTxebisadmi, mniSvnelovnad
gaizarda informacia calkeuli daavadebebis SemTxvevaSi, ramac warmoSva
aucilebloba, rom gadamuSavebuliyo saxelmZRvanelo. amdenad, Cvens mier
mowodebuli iqna epidemiologiis meore, gadamuSavebuli saxelmZRvanelo, rac Cveni
azriT, xels Seuwyobs studentebs epidemiologiis disciplinis ufro maRal
doneze dauflebis saqmeSi.
saxelmZRvanelo gankuTvnilia umaRlesi samedicino saswavleblebisTvis,
sadac iswavleba epidemiologia da biostatistika. misi gamoyeneba aseve SeiZleba
magistraturaSi da doqtoranturaSi swavlebis procesSi.
avtorebi, rogorc yovelTvis, madlobiT miiReben nebismieri saxis saqmian
SeniSvnebs, romlebic aucileblad gaTvaliswinebuli iqneba saxelmZRvanelos
Semdgom gamocemaSi.
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sarCevi
Tavi 1 epidemiologiis sagani ................................................................................................................................ 9
1.1. epidemiologiis ganviTarebis istoria ............................................................................................ 11
Tavi 2 mizezobrioba epidemiologiaSi da medicinaSi ....................................................................................... 18
2.1 mizezobrioba ................................................................................................................................................. 18

2.2 mizez-Sedegobrivi kavSiris damadsturebeli ZiriTadi niSnebi ....................................... 25

2.3 riskis faqtorebi ..................................................................................................................................... 29


Tavi 3 kvlevis epidemiologiuri meTodi .............................................................................................................. 34
3.1. aRweriTi (deskriptuli) epidemiologiuri meTodi ............................................................... 34

3.1.1. epidemiologiaSi gamoyenebuli ZiriTadi statistikuri maCveneblebi ............... 37

3.1.2 sikvdilianobisa da avadobis maCveneblebis standartizacia .................................. 45


3.2. analizuri epidemiologiuri meTodi ............................................................................................ 49

3.2.1. kohortuli kvleva ....................................................................................................................... 50

3.2.2. kvleva SemTxveva-kontroliT .................................................................................................62


3.3. eqsperimentuli epidemiologiuri meTodi ................................................................................... 73

3.3.1. randomizebuli kontrolirebadi kvleva .......................................................................... 73

3.3.2. savele eqsperimentuli kvleva .............................................................................................. 77

3.3.3. kvlevebi Temis doneze ................................................................................................................ 78

3.3.4. mosalodneli Secdomebi epidemiologiuri kvlevebis dros .................................. 78


Tavi 4 biostatistika ....................................................................................................................................................... 84
4.1 biostatistikis nawilebi ......................................................................................................................................... 86
4.2 statistikuri kvlevebi .......................................................................................................................... 88

4.2.1 kvlevis gegmis Sedgena ................................................................................................................89

4.2.2 masalis Segroveba .......................................................................................................................98


4.3 miRebuli Sedegebis damuSaveba .......................................................................................................... 99

4.3.1 monacemTa (cvladTa) tipebi .................................................................................................... 99

4.3.2 gazomvis doneebi anu sazomis Skalebi ............................................................................100

4.3.3 monacemTa klasifikacia da statistikuri meTodis SerCeva ................................ 103

4.3.4 sixSireTa da SedarebiT-sixSireTa ganawileba ............................................................ 105


4.3.5 dajgufebaSi gamoyenebuli terminebi ................................................................................ 106

4.4 cvladTa ganawilebis tipebi ............................................................................................................. 108

4.4.1 centraluri tendencia ............................................................................................................ 109

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4.4.2 dispersiis (ganfenis) parametrebi ...................................................................................... 117
4.5 analizuri biostatistika .................................................................................................................. 124

4.5.1 albaToba ........................................................................................................................................... 124

4.5.2 hipoTezis statistikuri testireba ................................................................................. 125


4.5.3 faqtiur da mosalodnel sixSireTa (pirobiTi) cxrilebi ................................. 129

4.5.4 Tavisuflebis xarisxi ................................................................................................................ 131


4.5.5 saSualos standartuli Secdoma ........................................................................................ 133

4.5.6 sarwmunobis (damajereblobis) intervalis gansazRvra .......................................... 137


4.5.7 statistikuri sarwmunobis (damajereblobis) testebi .......................................... 138

4.5.8 korelacia ........................................................................................................................................ 144

4.5.9 regresia, regresuli analizi .............................................................................................. 147


4.5.10 Sedegebis Sefasebis araparametruli meTodebi .......................................................... 148

4.6 monacemTa prezentacia .......................................................................................................................... 157


Tavi 5 swavleba epidemiur procesze ..................................................................................................................... 173
5.1 infeqciur daavadebaTa mniSvneloba ................................................................................................ 173

5.2 epidemiuri procesis daxasiaTeba .................................................................................................... 176

5.2.1. infeqciis wyaro ........................................................................................................................... 177

5.2.2 infeqciis gadacemis meqanizmi ................................................................................................. 181

5.2.3 mimRebloba da imuniteti ........................................................................................................ 185

5.2.4 epidemiuri procesis faqtorebi .......................................................................................... 187

5.2.5 epidemiuri procesis gamovlena ............................................................................................ 189

5.2.6 infeqciur daavadebaTa epidemiologiuri klasifikacia .......................................... 191

Tavi 6 epidemiologiuri zedamxedveloba ............................................................................................................ 193


6.1 retrospeqtuli epidemiologiuri analizi .............................................................................. 203

6.1.1 avadobis mravalwliani dinamikis analizi ...................................................................... 204

6.1.2 sezonuroba (avadobis wliuri dinamikis analizi) ................................................... 207

6.1.3 avadobis analizi mosaxleobis sxvadasxva asakobriv jgufebSi ........................ 209

6.1.4 avadobis teritoriuli ganawilebis analizi ............................................................... 210

6.2 operatiuli epidemiologiuri analizi ....................................................................................... 210


Tavi 7 epidsawinaaRmdego RonisZiebebi .................................................................................................................. 214
Tavi 8 daavadebaTa profilaqtika ............................................................................................................................ 222
8.1. premorbiduli profilaqtika ........................................................................................................... 222

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8.2. pirveladi profilaqtika ................................................................................................................... 223

8.3 meoradi profilaqtika ......................................................................................................................... 224

8.4 mesameuli profilaqtika .................................................................................................................... 225

8.5 skriningi ...................................................................................................................................................... 226

8.6. infeqciur daavadebaTa imunoprofilaqtika ............................................................................. 227

8.6.1. gegmiani acrebis erovnuli kalendari .............................................................................233

8.6.2. acris ukuCvenebebi ..................................................................................................................... 234


8.6.3. acrebis organizacia ................................................................................................................. 236
8.6.4. acris Semdgomi reaqciebi da garTulebebi ...................................................................238

8.6.5. B hepatitis sawinaaRmdego acra ......................................................................................... 240

8.6.6. tuberkulozis sawinaaRmdego acra .................................................................................. 241


8.6.7. difTeria, yivanaxvela, tetanusis sawinaaRmdego acra ......................................... 242

8.6.8. poliomielitis sawinaaRmdego acra ................................................................................ 243

8.6.9. hib-infeqciis sawinaaRmdego acra ...................................................................................... 244

8.6.10. rotavisuruli infeqciis sawinaaRmdego acra ........................................................... 245

8.6.11 pnevmokokuri infeqciis sawinaaRmdego acra ............................................................... 246

8.6.12 wiTelas sawinaaRmdego acra ............................................................................................... 247


8.6.13 ybayuras sawinaaRmdego acra ............................................................................................... 247

8.6.14 wiTuras sawinaaRmdego acra ............................................................................................... 248


papilomavirusuli infeqciis sawinaaRmdego acra ................................................... 248
8.6.15
Tavi 9 saavadmyofosSiga infeqciebi ....................................................................................................................... 250
Tavi 10 dezinfeqcia ........................................................................................................................................................ 257
10.1. dezifeqcia ................................................................................................................................................ 257

10.2. dezinseqcia .............................................................................................................................................. 263

10.3. deratizacia ............................................................................................................................................ 265


Tavi 11 kerZo infeqciur daavadebaTa epidemiologia .................................................................................... 267
11.1 dizenteria (Sigelozi) ....................................................................................................................... 267

11.2 qolera ........................................................................................................................................................ 272

11.3 botulizmi ................................................................................................................................................ 278

11.4 A hepatiti .................................................................................................................................................. 282

11.5 E hepatiti .................................................................................................................................................. 289

11.6 salmonelozi ............................................................................................................................................ 293

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11.7 gripi ............................................................................................................................................................. 298

11.8 meningokokuri infeqcia ....................................................................................................................... 307

11.9 tuberkulozi ............................................................................................................................................ 311

11.10 koronavirusuli infeqciebi ............................................................................................................ 316

11.11 Savi Wiri ....................................................................................................................................................325

11.12 malaria ....................................................................................................................................................... 331

11.13 aiv–infeqcia .............................................................................................................................................. 338

11.14 parenteruli virusuli hepatitebi ........................................................................................... 344

11.15 cofi....................................................................................................................................................................... 358

11.16 tetanusi ....................................................................................................................................................365


Tavi 12 aragadamdeb daavadebaTa epidemiologia ............................................................................................... 370
12.1 onkologiur daavadebaTa epidemiologia .................................................................................. 370
12.2 gul-sisxlZarRvTa (kardiovaskuluri) sistemis daavadebaTa epidemiologia ...... 388
Tavi 13 klinikuri epidemiologia ........................................................................................................................... 402

13.1. normaluri mdgomareobis gansazRvra ......................................................................................... 403

13.2. diagnostikuri kvlevebi ................................................................................................................... 405

13.3. diagnostikuri testebis mgrZnobeloba da specifikuroba ............................................ 407

13.4 diagnostikuri testebis prognozuli Rirebuleba ............................................................. 410

13.5 ramdenime diagnostikuri testis gamoyeneba ............................................................................ 412

13.6 prognozi .....................................................................................................................................................414

13.7 mkurnaloba ................................................................................................................................................ 418

13.8 randomizebuli kontrolirebadi klinikuri kvlevebi ...................................................... 419

13.9 profilaqtika klinikur praqtikaSi ........................................................................................... 425

epidemiologiis da biostatistikis ZiriTadi terminebis ganmarteba .................................................. 426

gamoyenebuli literatura ............................................................................................................................................ 441

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Semoklebebi

aiv - adamianis imunideficitis virusi.


bcJ - (BCG)kalmet-gerenis bacila - tuberkulozis sawinaaRmdego vaqcina.
dksjec – daavadebaTa kontrolisa da sazogadoebrivi janmrTelobis
erovnuli centri.
dyatp - DTaP/P difteria-yivanaxvela (araujreduli) - tetanusi-
poliomielitis sawinaaRmdego vaqcina.
ipv - (IPV)- poliomielitis inaqtivirebuli vaqcina.
opv - (OPV) - poliomielitis oraluri vaqcina.
pjr - polimerizaciis jaWvuri reaqcia.
sjc - sazogadoebrivi jandacvis centri.
td - (Td) - tetanusi-difteriis sawinaaRmdego vaqcina.
wwy - (MMR) - wiTela-wiTura-ybayuras sawinaaRmdego vaqcina.
janmo - janmrTelobis dacvis msoflio organizacia.
HAV - A hepatitis virusi.
HBV - B hepatitis virusi.
HBcAg - B hepatitis virusis birTvis antigeni.
HBe Ag - B hepatitis virusis “e” antigeni.
HBsAg - B hepatitis virusis zedapiruli antigeni.
HCV - C hepatitis virusi.
HDV - D hepatitis virusi.
HEV - E hepatitis virusi.
Hib - vaqcina - b tipis hemofilus influencas (Haemophilus influenzae)
sawinaaRmdego vaqcina.
IgM - M klasis imunoglobulini.
IgG - G klasis imunoglobulini.

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Tavi 1 epidemiologiis sagani

epidemiologia erT-erTi uZvelesi da amasTan swrafad ganviTarebadi disciplinaa,


romlis codnis saWiroebac yvela profilis eqimis winaSe dgas. nebismieri sagnis da maT Soris,
epidemiologiis Seswavlac misi ganmartebidan da Seswavlis obieqtis gansazRvridan iwyeba.
adreul saukuneebSi epidemiologiis Seswavlis sagani iyo mosaxleobaSi masobrivad
gavrcelebuli daavadebebi. radgan im periodSi, rogorc wesi, masobrivi gavrcelebiT
infeqciuri daavadebebi xasiaTdeboda, realurad epidemiologia swored infeqciur daavadebaTa
gavrcelebas Seiswavlida. me-19 saukunis meore naxevarSi infeqciuri daavadebebis gamomwvevi
mikroorganizmebis aRmoCenis Semdeg, epidemiologia mTlianad gadavida infeqciuri daavadebebis
Seswavlaze. im periodis dasawyisSi miiCneoda, rom epidemiologiis Seswavlis obieqti iyo
epidemiebi _ adamianebSi infeqciuri daavadebebis masobrivi gavrcelebis SemTxvevebi. 1936 wels,
rusi epidemiologis v. baSeninis mier gamocemul saxelmZRvaneloSi "zogadi epidemiologiis
kursi" ewera: "epidemiologia aris mecniereba epidemiebis Sesaxeb. igi swavlobs epidemiis
aRmocenebis mizezebs, misi ganviTarebis kanonebs, Caqrobis pirobebs da SeimuSavebs brZolis
RonisZiebebs epidemiuri daavadebebis mimarT." SemdgomSi es Sexeduleba swrafad Seicvala da
epidemiologiis Seswavlis obieqtad miiCneoda adamianebSi infeqciuri daavadebis gavrcelebis
nebismieri SemTxveva, ganurCevlad misi raodenobrivi maCveneblebisa. epidemiologiis Seswavlis
obieqtis aseT transformaciaSi didi wvlili miuZRvis sabWoTa epidemiologiis erT-erT
fuZemdebels l. gromaSevskis.
me-20 saukunis meore naxevarSi infeqciuri daavadebebis winaaRmdeg efeqturi brZolis
fonze, sagrZnoblad gaizarda adamianis paTologiaSi qronikul daavadebaTa, gansakuTrebiT gul-
sisxlZarRvTa sistemis da onkologiur daavadebaTa mniSvneloba da aqedan gamomdinare
epidemiologiis Seswavlis obieqti, iseve rogorc misi formirebis pirvel periodSi, isev gaxda
ara marto infeqciuri, aramed adamianTa populaciaSi nebismieri daavadebis (mdgomareobis)
gavrceleba da maT mier gamowveuli avadoba. amJamad, calsaxad SeiZleba iTqvas, rom
epidemiologia swavlobs adamianebSi nebismieri paTologiuri mdgomareobis aRmocenebisa da
gavrcelebis process.
rac Seexeba epidemiologiis sagnis ganmartebas. cnobili epidemiologis lastis (Last)
ganmartebiT "epidemiologia aris mecniereba adamianis janmrTelobasTan dakavSirebuli
mdgomareobebis an gansazRvrul populaciebSi movlenebis gavrcelebis da maTi determinantebis
Sesaxeb, agreTve kvlevis am monacemebis gamoyenebis Sesaxeb janmrTelobis problemebis
kontrolis mizniT". anu, sxvanairad rom vTqvaT, epidemiologia aris swavleba janmrTelobasTan

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dakavSirebuli mdgomareobebisa da movlenebis gavrcelebis da maTi gamomwvevi mizezebis Sesaxeb,
agreTve misi gamoyenebisa janmrTelobis problemebis kontrolisaTvis.
Cveni azriT, epidemiologiis ufro misaRebi ganmartebaa Semdegi: "epidemiologia aris
mecniereba adamianTa populaciaSi daavadebaTa gavrcelebis, misi gamomwvevi mizezebis da am
daavadebaTa profilaqtikis Sesaxeb".
amrigad, epidemiologia swavlobs mosaxleobis janmrTelobasTan dakavSirebul yvela
movlenas, rogorc infeqciur, ise arainfeqciur daavadebaTa sakiTxebs. arc ise didi xnis win
epidemiologiuri kvlevis meTodebis gamoyeneba daiwyes agreTve travmebis, dedaTa da bavSvTa
janmrTelobis, garemos higienis problemebis SeswavlisTvisac. jansaRi cxovrebis wesTan
dakavSirebuli qcevebic epidemiologiis Seswavlis obieqti gaxda. me-20 saukunis bolos da 21-
e saukuneSi epidemiologiis wiaRSi Caisaxa da ganviTarda axali mimarTulebebi. magaliTad
ekologiuri epidemiologia (enviromental epidemiology), romelic swavlobs mizez-Sedegobriv
kavSirs mosaxleobis janmrTelobis da garemo pirobebis araxelsayrel faqtorebs Soris, aseve
mosaxleobaSi ekologiuri faqtorebiT gamowveuli masobrivi daavadebebis gavrcelebas da maT
profilaqtikas. Tumca, xazgasmiT unda aRiniSnos, rom igi, iseve rogorc iseTi mimarTulebebi
rogoricaa farmakologiuri epidemiologia da genetikuri epidemiologia, aris epidemiologiis
nawili da ara calke mecniereba.
rodesac vexebiT epidemiologiis sagans, aucileblad unda ganvixiloT sazogadoebrivi
jandacvis da epidemiologiis kavSiri. sazogadoebrivi jandacva aris mecniereba daavadebaTa
prevenciis, sicocxlis gaxangrZlivebis, janmrTelobis ganmtkicebis da Sromisunarianobis
amaRlebis Sesaxeb. misi mizania sazogadoebaSi iseTi pirobebis Seqmna, rac uzrunvelyofs
adamianTa janmrTelobas. am miznis realizacia SeuZlebelia epidemiologiis gareSe. Tu ar
viciT ra daavadebebia gavrcelebuli sazogadoebaSi, ra aris amis mizezi da xelSemwyobi
faqtorebi, ra profilaqtikuri RonisZiebebi unda gavataroT maT aRsakveTad, SeuZlebelia
sazogadoebis janmrTelobis mdgomareobis gaumjobesebaze fiqric ki. amitomac iTvleba
epidemiologia sazogadoebrivi jandacvis ZiriTad disciplinad da mecnierul safuZvlad.
swored epidemiologiuri informacia gamoiyeneba sazogadoebrivi jandacvis mier mosaxleobis
janmrTelobis dacvis da ganmtkicebis swori politikis SesamuSaveblad.
amasTan, rogorc erTi, ise meore populaciuri disciplinebia. Tu klinikuri medicina
Seiswavlis daavadebaTa diagnostikis da mkurnalobis sakiTxebs, da orientacias calkeul
individebze akeTebs, sazogadoebrivi jandacva da epidemiologia emsaxureba mTlianad
populaciis janmrTelobis dacvis saqmes da orientacias mTel mosaxleobaze axdens. maTi
swavlebis ZiriTadi samiznea adamianTa populacia. magaliTad, romelime raionSi salmonelozis

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afeTqebis dros, rogorc klinicisti, ise epidemiologi, dainteresebulni arian diagnozis
droul dadgenaSi, magram SemdegSi maT sxvadasxva funqcia akisriaT. klinicistis mTeli
saqmianoba koncentrirebulia avadmyofTa mkurnalobisa da movlis sakiTxebze. maSin, rodesac
epidemiologis funqciaa gamoavlinos is faqtorebi, romlebmac gamoiwvies populaciaSi
daavadebis aRmoceneba da gavrceleba maTze zemoqmedebis mizniT, rom ar dauSvas sxva pirebSic
daavadebis gavrceleba da aRkveTos momavalSi daavadebis ganmeorebis SesaZlebloba.
aqve unda moviyvanoT epidemiologiis ZiriTadi amocanebi :
1. daavadebaTa samedicino da socialur-ekonomikuri mniSvnelobis da adamianis
paTologiaSi maTi adgilisa da rolis gansazRvra.
2. daavadebaTa droSi (wlis manZilze, wlebis mixedviT), teritoriaze da mosaxleobis
sxvadasxva jgufSi (asakobrivi, profesiuli, socialuri, eTnikuri, sqesobrivi) ganawilebis
kanonzomierebaTa Seswavla.
3. populaciaSi daavadebis aRmocenebis mizezebis da im riskis faqtorebis gamovlena,
romlebic zrdian daavadebis ganviTarebis albaTobas.
4. mosaxleobaSi im subpopulaciis gamovlena, romelTac aqvT daavadebis ganviTarebis
maRali riski.
5. populaciaze moqmed riskis faqtorebze zemoqmedeba.
6. ZiriTadi profilaqtikuri RonisZiebebis SemuSaveba da maTi mimarTulebebis
gansazRvra.
7. daavadebaTa mimdinareobisa da gamosavalis Seswavla:
❖ mkurnalobis axali meTodebis Sefaseba.
❖ profilaqtikuri RonisZiebebis Sefaseba.
8. jandacvis politikis da ZiriTadi gadawyvetilebebisaTvis bazisis Seqmna:
❖ samedicino momsaxurebis gaumjobeseba.
❖ kvlevebis da sakontrolo RonisZiebebis prioritetuloba.

1.1. epidemiologiis ganviTarebis istoria

epidemiologia ZiriTadad Cvens welTaRricxvamde 4 saukuniT adre Caisaxa saberZneTSi.


Tumca informaciebi mTeli rigi daavadebebis gavrcelebasa da maT profilaqtikaze bibliaSic
moipoveba. termini epidemiologia berZnuli warmoSobisaa: Epi –Si;ze; demos – xalxi; logos –
swavleba. e.i. epidemiologia pirdapiri mniSvnelobiT niSnavs swavlebas epidemiebis Sesaxeb, anu
iseTi daavadebebis Seswavlas, romlebic mosaxleobaSi farTod aris gavrcelebuli. adreul
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saukuneebSive epidemiologiis yuradRebis centrSi iyo ara calkeuli pirebis avadoba, aramed
mosaxleobis an misi jgufebis avadoba. zustad SeniSnavda rusi epidemiologi v. beliakovi, rom
epidemia SeiZleba iTargmnos rogorc “mosaxleobis avadoba”, xolo epidemiologia rogorc
mecniereba “mosaxleobis avadobis Sesaxeb”. adreul saukuneebSi mosaxleobaSi ZiriTadad
infeqciuri daavadebebi (Savi Wiri, yvavili, keTri da sxv.) iyo gavrcelebuli, amitomac
upiratesi yuradReba maTi gamomwvevi mizezebis Seswavlas eqceoda.
sxvadasxva epidemiebis aRweris Sedegad SeniSnes, rom mTeli rigi daavadebebis epidemiebis
warmoSoba da gavrceleba ar iyo dakavSirebuli adrindel epidemiebTan da isini viTardeboda
garkveul teritoriebze garkveul dros. medicinis mamam, hipokratem (460-377 Cv.wT.aR-mde)
gaaanaliza ra monacemebi sxvadasxva dros da adgilas epidemiebis gavrcelebis Sesaxeb, SemoiRo
mcneba “adgilis da drois epidemiuri konstituciis Sesaxeb”. misi da misi mimdevrebis
SexedulebiT, kosmiuri Zalebis gavleniT sxvadasxva adgilebSi garkveul dros iqmneboda mavne
nivTierebebi, romelTa moxvedra adamianis organizmSi iwvevda daavadebas. Tavis naSromSi
«qarebis Sesaxeb» hipokrate werda, rom haerSi da niadagSi, gansakuTrebiT Waobian niadagSi,
adamianisaTvis mavne nivTierebebis, e.w. miazmebis dagrovebisas, maTi SesunTqva iwvevda adamianebis
masobriv daavadebas. daavadebaTa warmoSobis am Teorias miazmuri ewoda. me-19 saukunis meore
naxevramde es Teoria ZalaSi iyo. bunebrivia, rom miazmebis warmoSobas realurad ver xsnidnen
verc hipokrate da verc momdevno periodis mkvlevarebi.
im periodSi garda terminisa “epidemia”, “gamoiyeneboda agreTve” “endemia” (endemuri
avadoba), “egzotia”, “sporadia” (sporaduli avadoba), “pandemia” (pandemuri avadoba).
Cvens eramde meoTxe saukuneSive moRvaweobda didi moazrovne fukididi, romelic
miiCnevda, rom daavadebaTa masobriv gavrcelebas bevrad uwyobda xels mosaxleobis didi
simWidrove qalaqebSi da maT sacxovrebel qoxebSi. man aRwera saberZneTSi Savi Wiris epidemia
da miuTiTebda, rom es daavadeba adamianze gadadioda avadmyofTan kontaqtisas. is agreTve
aRniSnavda, rom am daavadebis erTxel gadatana adamians ganmeorebiTi daavadebisagan icavda.
daaxloebiT amave periodSi safuZveli Caeyara meore Teorias, romlis Tanaxmadac,
epidemiebis ganviTarebis mizezi iyo adamianebSi daavadebis gamomwvevi cocxali agentebis
moxvedra. es Teoria ekuTvnis Cv. wT. aRricxvamde aseve me-4 saukuneSi moRvawe udides
filosofoss aristoteles. am Teorias SemdgomSi mimdevrebi Zvel romSic gamouCndnen. mark
terencius varoni (116-27 weli Cv. wT. aRricxvamde) am agentebs "Contagium vivum"-s uwodebda.
aqedan warmodga Teoriis dasaxelebac _ kontagiozuri. am Teoriis mimdevrebi emyarebodnen
iseTi daavadebiT Sepyrobil avadmyofebze dakvirvebas, romelTa drosac avadmyofi adamiani
kontaqtSi myofi pirebisaTvis infeqciis wyaros warmoadgenda (Savi Wiri, yvavili da sxva).

12
aRorZinebis epoqaSi es Teoria ganaviTara italielma eqimma jiralomo frakastorom (1478-1553
ww.), romelmac SemoiRo termini "infeqcia". man gamoaqveyna wigni saTauriT "Siphilides Libris III"
(aqedan modis daavadebis saxeli sifilisi), sadac Camoayaliba Sexeduleba kontaqtirebulTaTvis
avadmyofis gadamdeblobis Sesaxeb. am Teoriebis Sesabamisad daavadebebi or jgufad daiyo: 1.
miazmuri, 2. kontagiozuri. miazmuri Teoriis ganviTarebaSi ki didi roli miuZRvis inglisSi
medicinis mamad wodebul saidenhems (XVII saukune).
Tanamedrove gadasaxedidan gasagebia, rom kontagiozuri daavadebebis qveS ZiriTadad
igulisxmeboda anTroponozuli daavadebebi gadacemis aerogenuli da kontaqturi meqanizmebiT,
xolo miazmuri daavadebebi dros _ ZiriTadad zoonozebi, romelTa drosac ar xdeba infeqciis
gadacema avadmyofidan janmrTel adamianze.
miuxedavad imisa, rom adreul saukuneebSi, rogorc mTlianad medicina, ise epidemiologia
sustad iyo ganviTarebuli, bevr qveyanaSi tardeboda mniSvnelovani profilaqtikuri
RonisZiebebi. magaliTad, Zvel romSi sistematurad xdeboda quCebis dasufTaveba da nagvis
gatana, aseve kontroli sakvebi produqtebis xarisxze. ewyoboda sakanalizacio koleqtorebi.
mogvianebiT aq didi wyalsadenic gaiyvanes.
me-17 saukuneSi ingliselma jon grauntma gamoaqveyna sikvdilianobis mizezebis analizi.
is iyo pirveli, vinc Seiswavla Sobadoba, sikvdilianoba da avadoba iseT faqtorebTan kavSirSi,
rogoricaa sqesi, wlis sxvadasxva dro da sacxovrebeli adgili (qalaqi, sofeli). kvlevis
aseTi meTodi sakmaod didi xnis manZilze daviwyebas mieca da mxolod me-19 saukunis
dasawyisSi did britaneTSi uiliam farim kvlav daiwyo am qveyanaSi sikvdilianobis Sesaxeb
statistikuri masalis Segroveba da analizi. is avadobisa da sikvdilianobis epidemiologiuri
analizis dros did yuradRebas aqcevda iseT sakiTxebs, rogoricaa profesiuli saqmianoba,
socialuri mdgomareoba da sxv. u.fari Tanamedrove demografiuli statistikis mamamTavrad
iTvleba.
me-19 saukunis Sua periodSi epidemiologiis ganviTarebas mniSvnelovani biZgi misca
ingliselma eqimma jon snoum, romelmac SemdgomSi "savele epidemiologiis mamis" saxeli
moipova. miuxedavad imisa, rom man ar icoda qoleris etiologia (am daavadebis gamomwvevi 1883
wels gamoyo r.koxma), epidemiologiuri meTodis gamoyenebiT man Seiswavla londonSi 1848-1849
da 1853-1854 wlebSi qoleris gavrcelebis Taviseburebani. qalaqSi daavadebis teritoriuli
gavrcelebis Seswavlis Sedegad man gamoyo ori raioni. A raionSi daavadeba intensiurad iyo
gavrcelebuli da marto 1853 wels am raionSi qoleriT 2458 adamiani gardaicvala, maSin
rodesac B raionSi qolera bevrad naklebi intensiurobiT gvxvdeboda da wlis manZilze am
daavadebiT mxolod 37 adamiani gardaicvala. am raionebis wyalmomaragebis sistemis SeswavliT

13
man daadgina, rom A raioni wyliT maragdeboda mdinare temzis im nawilidan, romelic
binZurdeboda qalaqis sakanalizacio qselidan Camdinare wylebiT, xolo B raionis mosaxleobas
wyali miewodeboda temzis zeda nawilidan, romelic jer kidev ar iyo dabinZurebuli
sakanalizacio Camdinare wylebiT. am gamokvlevis safuZvelze j.snoum daaskvna, rom qolera
vrceldeboda wyliT, romlis dabinZureba xdeboda daavadebuli adamianebis fekaluri masebiT.
mis mier gatarebuli RonisZiebebis Sedegad londonSi aRkveTil iqna am mrisxane infeqciis
gavrceleba.
me-19 saukunis oTxmociani wlebidan moyolebuli msoflioSi daiwyo mikrobiologiuri
aRmoCenebis era. pasteris, koxis, meCnikovis, erlixis, ivanovskis gamokvlevebma daadastura
mosazreba, rom umravlesi epidemiuri daavadebebi iyo infeqciuri bunebis, ramac mniSvnelovani
biZgi misca mTlianad epidemiologiis da gansakuTrebiT infeqciur daavadebaTa epidemiologiis
swraf ganviTarebas. 1917 wlis oqtomberSi ruseTSi bolSevikebis mier ganxorcielebulma
saxelmwifo gadatrialebam da samoqalaqo omis gaCaRebam, xeli Seuwyo am qveyanaSi daavadebebis,
gansakuTrebiT infeqciuri daavadebebis gavrcelebas. sabWoTa kavSiris Seqmnis Semdeg (romlis
SemadgenlobaSic 1921 wels samxedro gziT Seyvanil iqna saqarTveloc) metad mwvaved dadga
epidemiebis winaaRmdeg brZolis sakiTxi. ruseTis imperiaSi da Semdgom sabWoTa kavSirSi,
zogierTi infeqciuri daavadeba ise gavrcelda, rom kiTxvis niSnis qveS dadga TviT
saxelmwifos arsebobis sakiTxic. lenini werda, rom qveyanaSi gaimarjvebs an socializmi an
tili (partaxtiani da SebrunebiTi tifebis gadamtani). aseTma situaciam xeli Seuwyo sabWoTa
kavSirSi epidemiologiis swraf ganviTarebas. 1920 wels odesaSi d. zabolotnis iniciativiT
Camoyalibda msoflioSi epidemiologiis pirveli kaTedra, xolo 1927 wels, mis mier gamoica
pirveli rusuli saxelmZRvanelo "epidemiologiis safuZvlebi". swored d. zabolotnisa da misi
Tanamoazreebis gavleniT epidemiologia sabWoTa kavSirSi, Semdgom ki socialistur qveynebSi,
Semoifargla mxolod infeqciur daavadebaTa problematikiT.
sabWoTa kavSirSi epidemiologiis erT-erTi mamamTavari iyo l.gromaSevski, romelmac
SeimuSava infeqciur daavadebaTa epidemiologiuri klasifikacia, daadgina kanoni gamomwvevis
specifikur lokalizacias da gadacemis meqanizms Soris Sesabamisobis Sesaxeb, mogvawoda Teoria
gadacemis meqanizmis Sesaxeb da a.S. SemdgomSi sabWoTa epidemiologiis ganviTareba
dakavSirebuli iyo baSeninisa da iolkinis saxelebTan. sxvaTa Soris, baSenini iyo pirveli didi
sabWoTa epidemiologi, romelic miuTiTebda epidemiologiis mier arainfeqciur daavadebaTa
Seswavlis aucileblobaze.
meore msoflio omis Semdeg mTel msoflioSi daiwyo epidemiologiis ganviTarebis axali
era, rasac gansakuTrebiT Seuwyo xeli ingliseli mecnierebis dolisa (Doll) da hilis (Hill)

14
mier Catarebulma epidemiologiurma gamokvlevebma. maT mier dadgenil iqna pirdapiri kavSiri
Tambaqos mowevasa da filtvis kibos ganviTarebas Soris. aseve metad mniSvnelovani iyo amave
periodSi amerikis SeerTebuli StatebSi qalaq framingemSi dawyebuli epidemiologiuri
gamokvleva, romelic miznad isaxavda gul-sisxlZarRvTa sistemis daavadebebis ganviTarebis
xelSemwyobi faqtorebis dadgenas.
sxvadasxva paTologiis da daavadebis SeswavlaSi epidemiologiuri kvlevis meTodebis
gamoyenebis mniSvnelobaze miuTiTebs avstralieli ofTalmologis n. gregis Sromac. 1941 wels
man yuradReba miaqcia sidneiSi da avstraliis sxva qalaqebSi bavSvebSi Tandayolili katarqtis
did sixSires. Segrovili masalis safuZvelze man gamoTqva mosazreba, rom arsebobs mizez-
Sedegobrivi kavSiri Tandayolil kataraqtasa da dedis mier orsulobis pirvel periodSi
wiTuras gadatanas Soris. am hipoTezis dasadastureblad ar gamodgeboda arc laboratoriuli
da arc paTologanatomiuri kvlevebi. Sedegi SeeZlo moeca mxolod epidemiologiuri meTodis
gamoyenebas. man Seiswavla Tandayolili kataraqtiT daavadebuli bavSvebis da am daavadebis ar
mqone bavSvTa mSoblebSi wiTuraTi avadoba orsulobis pirvel naxevarSi, ris safuZvelzec igi
mivida im daskvnamde, rom Tandayolili kataraqtis ganviTarebas xels uwyobda dedis mier
orsulobis pirvel naxevarSi wiTuras gadatana.
saqarTveloSi epidemiologiuri skolis Camoyalibeba dakavSirebulia profesor
konstantine kacitaZis saxelTan. 1938 wels misi iniciativiT Tbilisis samedicino institutSi
Camoyalibda saqarTveloSi epidemiologiis pirveli kaTedra, romelsac igi 1976 wlamde
TiTqmis ucvlelad xelmZRvanelobda. mxolod meore msoflio omis dros, mokle periodSi,
rodesac TbilisSi moRvaweobda l. gromaSevski, k. kacitaZem mas dauTmo epidemiologiis
kaTedris gamgis Tanamdeboba. mis saxelTan aris dakavSirebuli saqarTveloSi iseTi daavadebebis
winaaRmdeg brZola, rogoricaa partaxtiani da SebrunebiTi tifi, muclis tifi, difTeria da
sxv. gansakuTrebiT unda aRiniSnos prof. k.kacitaZis Rvawli saqarTveloSi difTeriis
sawinaaRmdego gegmiani acrebis danergvaSi. amasTan, igi iyo ara marto didi Teoretikosi, aramed
praqtikosic da mravali wlis ganmavlobaSi saTaveSi edga saqarTvelos janmrTelobis dacvis
saministros sanitariul-epidemiologiur sammarTvelos.
prof. k. kacitaZis saqmis Rirseuli gamgrZelebeli iyo prof. levan sayvareliZe,
romelic epidemiologiis kaTedras xelmZRvanelobda 1976-1989 wlebSi. igi iyo samedicino
saqmis Zalian didi organizatori ara marto saqarTvelos, aramed sabWoTa kavSiris masStabiT.
1962-1970 wlebSi prof. l. sayvareliZe iyo saqarTvelos janmrTelobis dacvis ministri. igi
moRvaweobda moskovSic da iyo sabWoTa kavSiris janmrTelobis dacvis saministros sanitarul-
epidemiologiuri sammarTvelos ufrosis moadgile. swored misi iniciativiT moskovSi gaixsna

15
centraluri epidemiologiis samecniero-kvleviTi instituti, romelic dResac ruseTis
upirvelesi epidemiologiuri centria. l. sayvareliZis uSualo xelmZRvanelobiT saqarTvelos
Savi Wiris sawinaaRmdego sadguris bazaze Seiqmna mZlavri virusologiuri laboratoria, sadac
daiwyo axali virusuli infeqciebis intensiuri Seswavla. mas aseve Cafiqrebuli hqonda am
bazaze gansakuTrebiT saSiSi infeqciebis sawinaaRmdego institutis Seqmna, romelic erT-erTi
saukeTeso iqneboda sabWoTa kavSiris masStabiT. prof. l. sayvareliZem am mimarTulebiT bevri
ram gaakeTa, Tumca, samwuxarod mas ar dascalda Tavisi Canafiqris bolomde miyvana. sadReisod
mis saxels atarebs daavadebaTa kontrolisa da sazogadoebrivi janmrTelobis erovnuli
centri, romelic xelmZRvanelobs sazogadoebrivi jandacvis, maT Soris epidemiologiur
samsaxurs qveyanaSi. am dawesebulebis SeqmnaSi udidesi roli swored l. sayvareliZem Seasrula.
mravali aTeuli wlis manZilze saqarTveloSi epidemiologiuri samsaxuri sanitariul
samsaxurTan erTad efeqturad funqciobda, razec miuTiTebs qveyanaSi yvavilis, Savi Wiris,
partaxtiani tifis, malariis da sxva umZimesi daavadebebis swrafi likvidacia.
epidemiologiis swraf ganviTarebasTan erTad gaizarda misi swavlebis gaZlierebis
saWiroebac. jer kidev 1967 wels, epidemiologTa saerTaSoriso sazogadoebam janmos evropis
regionul biurosTan erTad Caatara simpoziumi, romelic mieZRvna medicinaSi da sazogadoebriv
jandacvaSi epidemiologiis swavlebis sakiTxebs. aRiniSna, rom mTel msoflioSi, janmrTelobis
dacvis centralur, regionul da raionul xelmZRvanel organoebSi aRiniSneba epidemiologebis
da epidemiologiuri orientaciis xelmZRvanelebis didi saWiroeba, raTa uzrunvelyofil iqnes
daavadebaTa profilaqtikaSi epidemiologiuri codnis efeqturi gamoyeneba. 1971 wels gamoica
saerTaSoriso saxelmZRvanelo samedicino sistemaSi epidemiologiis swavlebis Sesaxeb, sadac
ZiriTadi aqcenti gakeTebulia epidemiologiuri meTodebis swavlebaze.
bolo wlebSi epidemiologiis rolis zrda mniSvnelovnad ganpirobebulia im didi
wvliliT, rac samedicino mecnierebaSi am disciplinam Seitana, gansakuTrebiT infeqciur da
profesiul daavadebaTa, agreTve im daavadebaTa SeswavlaSi, romlebic kvebis darRvevis gamo
viTardeba. kvlevis epidemiologiuri meTodis gamoyenebiT damuSavda mTeli rigi daavadebebis
profilaqtika, manam sanam dadginda maTi etiologia – qolera, suravandi, pelagra, beri-beri da
sxv. mTel rig SemTxvevebSi swored epidemiologiuri kvlevebiT gamovlinda zogierTi
paTologiis etiologia. magaliTad, verc klinikuri da verc paTanatomiuri kvlevebiT ver
dadginda bavSvTa Tandayolili simaxinjeebis mizezebi. mxolod epidemiologiurma kvlevebma
aCvena, rom aseTi bavSvebis dedebi orsulobis adreul periodSi avad iyvnen wiTuraTi.
epidemiologiuri SeswavliT dadgenil iqna iseTi mZime daavadebebis arseboba, rogoricaa
aiv-infeqcia/Sidsi. 1981 wels aSS-Si aRweril iqna Pneumocysta carini–iT gamowveuli pnevmoniisa

16
da kapoSis sarkomis mravlobiTi SemTxvevebi, romelic uvlindebodaT axalgazrda da saSualo
asakis homoseqsual mamakacebs, rac am daavadebis epidemiur bunebaze miuTiTebda. momavalSi
epidemiologiis roli samedicino mecnierebis ganviTarebis saqmeSi kidev ufro gaizrdeba.

17
Tavi 2
mizezobrioba epidemiologiaSi da medicinaSi
2.1. mizezobrioba

jer kidev bavSvobaSi TiToeul adamians SeumCnevia, rom mTel rig movlenebs Soris
arsebobs mWidro kavSiri. magaliTad cxel uToze xelis Sexebasa da tkivils, onkanis
saxeluris gadatrialebasa da wylis nakadis wamosvlas Soris da ase Semdeg. aseTi martivi
kavSirebis codna adamians exmareba cxovrebaSi. am dros adamiani xvdeba, rom xelis dawvis
mizezia cxeli uTo, anu igi gamodis mizezis rolSi, xolo xelis dawva mizezis moqmedebis
Sedegia. adamianisaTvis isic gasagebia, rom mizezi win uswrebs Sedegs, Tumca mizezi SeiZleba
maSinac moqmedebdes, rodesac Sedegi viTardeba. isic cxadia, rom Sedegi mizezis gareSe ver
ganviTardeba. Tu bunebaSi aseTi ram xdeba, maSin Sedegs ganviTarebis sxva mizezi aqvs. adamianebi
xSirad uSveben Secdomas, rodesac erTmaneTis momdevno mdgomareobebs Soris, isini mizez-
Sedegobriv kavSirs xedaven. kargad unda gvaxsovdes wesi "raimes Semdeg _ ar niSnavs raimes
Sedegad". aseTi Secdomebi medicinaSic gvxvdeba, rac SeiZleba gaxdes mizezi wamlis moqmedebis
araswori Sefasebisa. amis magaliTia aseTi Sexeduleba "wavisvi cxvirSi malamo da gamiara
katarulma movlenebma". aseTi azri im adamianebsac ki uCndebaT, romlebmac Zalian kargad ician,
rom kataruli movlenebi mkurnalobis gareSec gaivlis. mxolod sworad Catarebuli
eqsperimenti iZleva saSualebas dadgindes, samkurnalo Careva (am SemTxvevaSi malamos
gamoyeneba) iwvevs Tu ara daavadebis mimdinareobis Secvlas (aCqarebs gripis simptomebis
gaqrobas).
arsebobs Sexeduleba, rom ganviTarebul movlenas yovelTvis aqvs Tavisi mizezi. Teoria,
romelic amtkicebs, rom arsebobs mkacri kavSiri mizezsa da Sedegs Soris da Sedegi yovelTvis
Tan mosdevs mizezs, determinizmis saxeliT aris cnobili. aseTi mkacri kavSiri samedicino-
biologiur movlenebSi naklebad gvxvdeba. amitom Tanamedrove epidemiologiaSi gamoiyeneba
mizezobriobis modeli, romelsac komponenturi ewodeba. es Sexeduleba yvelaze kargad
damuSavebuli aqvs cnobil epidemiolog k. rotmans (K.Rothman).
upirveles yovlisa unda ganvsazRvroT, Tu ra aris mizezi. vebsteris cnobil leqsikonSi
is Semdegnairad aris ganmartebuli "mizezi aris is, rac iwvevs efeqts an Sedegs". raime
movlenis ganviTarebis mizezi SeiZleba iyos aucilebeli da sakmarisi. aucilebelia iseTi
piroba, romlis arsebobasac yovelTvis Tan ar sdevs Sesaswavli Sedegi, magram mizezis gareSe
Sedegi ar dgeba (suraTi #1-1). amis magaliTia tuberkulozis ganviTarebisaTvis organizmSi
tuberkulozis mikobaqteriis (M. tuberculosis) arseboba. sakmarisia mizezi, romlis arsebobisas
18
Sedegi yovelTvis viTardeba. Tumca, es Sedegi sxva pirobebSic SeiZleba ganviTardes (suraTi
#1-2). tuberkulozis mikobaqteriis arseboba organizmSi ar aris sakmarisi mizezi am
daavadebis ganviTarebisaTvis. mas aucileblad unda axldes sxva faqtorebic.

suraTi #1
mizezobriobis 4 etapi

B B

A B A B A B
A B

A A B A B C
1 2 3 4

1. A aris aucilebeli mizezi B SedegisaTvis;


2. A aris sakmarisi mizezi B SedegisaTvis;
3. A aris aucilebeli da sakmarisi mizezi B SedegisaTvis;
4. A da C komponenturi mizezebia B SedegisaTvis.

Sedegis ganviTarebisaTvis mizezi erTdroulad SeiZleba iyos rogorc aucilebeli, ise


sakmarisi. es xdeba maSin, rodesac A mizezis arsebobisas Sedegi yovelTvis dgeba, xolo Tu ar
aris A mizezi, B Sedegi ar viTardeba ((suraTi #1-3). medicinaSi aseTi mdgomareoba, rogorc
wesi, gvxvdeba Zlieri garegani zemoqmedebis dros _ fizikuri, qimiuri. magaliTad Zvalze
fizikuri zemoqmedeba da misi motexiloba. magram, sakmarisia SevamciroT fizikuri
zemoqmedebis Zala, rom Zvlis motexiloba aRar ganviTardeba. aq saWiroa dazusteba: TiTqmis
ar viTardeba. iSviaT SemTxvevaSi motexiloba SeiZleba ganviTardes ConCxze moZraobisTvis
saWiro Cveulebrivi datvirTvis drosac. aseTi ram im adamianebSi gvxvdeba, romlebsac
Zvlovani qsovilis simtkice daqveiTebuli aqvT, magaliTad xanSiSesul asakSi Zvlis
mineralizaciis gamo, an zogierTi daavadebis dros. sxva sityvebiT rom vTqvaT, meqanikuri
travmis drosac, Sexeduleba, rom meqanikuri datvirTva aris aucilebeli da sakmarisi mizezi,
aris gamartivebuli Sexeduleba.

biologiaSi da medicinaSi ufro xSirad adgili aqvs komponentur mizezobriobas.


Sesaswavli Sedegis ganviTarebisaTvis TiToeuli mizezi ar aris sakmarisi, magram

19
erTobliobaSi isini iwveven mocemul Sedegs (suraTi #1-4).

Tu B daavadeba A da C faqtorebiT aris gamowveuli da am ori faqtoris arseboba


sakmarisia, maSin C faqtorisaTvis damatebiTi mizezi aris A faqtori. mis gareSe C faqtori
daavadebas ver iwvevs. es ganmarteba mniSvnelovania, radgan igi gvexmareba gavigoT, Tu
faqtorebidan erT-erTis moqmedebam rogor SeiZleba gamoiwvios Sesaswavli daavadebis
sixSiris cvlileba. magaliTad romelime infeqciuri daavadebis sixSire SeiZleba
damokidebuli iyos ara marto infeqciis wyaros raodenobaze, aramed adamianTa kvebis
Taviseburebebzec. anu, daavadebis ganviTarebis sixSire C faqtoris zemoqmedebiT (virusTan
kontaqti) SeiZleba damokidebuli iyos imazec, Tu ra sixSiriT gvxvdeba A faqtori (kvebis
pirobebis darRveva), romelic saWiroa C faqtoris paTogenobis realizaciisTvis.

daavadebis ganviTarebis meqnizmebi ar icvleba imis miuxedavad, Tu rogoria damatebiTi


mizezebis sixSire. magaliTad, droTa viTarebaSi avadobis done SeiZleba Seicvalos, magram ara
imis gamo, rom biologiuri procesebi Seicvala, romlebic am daavadebis ganviTarebis
safuZvelia, aramed imis gamo, rom Seicvala komponenturi mizezebis sixSire, romlebic
saWiroa am procesis realizaciisaTvis. magaliTad bavSvTa sikvdilianoba dabali Semosavlebis
mqone qveynebSi, sadac is ZiriTadad infeqciur daavadebebTan aris dakavSirebuli, SeiZleba
Seicvalos (Semcirdes) bavSvebisaTvis A vitaminis miwodebiT.

adamianebze mizezis moqmedebis Zalis Sefasebis ZiriTadi saSualebaa eqspozirebul


pirebSi (vinc ganicada mizezis zemoqmedeba) daavadebis ganviTarebis sixSire (statistikuri
kavSiri zemoqmedebasa da daavadebas Soris). epidemiologiur kvlevebSi es Sedegi
damokidebulia ara marto Sesaswavl zemoqmedebaze, aramed sxva faqtorebzec. amitom
zemoqmedebis Zalis Sefaseba daavadebis ganviTarebis sixSiriT SeiZleba ar iyos zusti
damatebiTi mizezebis moqmedebis gamo. pirobebs, romlebic amaxinjeben Sesaswavl kavSirs
damabneveli anu CarTuli faqtorebi (confauding factors) ewodeba. komponenturi mizezebis aseTi
urTierTmoqmedebis Sedegia medicinaSi Catarebuli kvlevis Sedegebis analizis sirTule.
cnobilia, rom filtvis kibos iwvevs Tambaqos moweva, naklebi sixSiriT, magram
aramwevelebic xdebian avad am daavadebiT. Tambaqos mowevis garda iseTi faqtori, romelic ase
Zlier aris dakavSirebuli filtvis kibos ganviTarebasTan, ucnobia. jerac Sesaswavlia rogor
moqmedebs Tambaqos moweva da ra mizezebi iwveven filtvis kibos ganviTarebas aramwevelebSi.
epidemiologiur kvlevebSi, SevadarebT ra zemoqmedebis momxden faqtorebs da maTi gavleniT
ganviTarebul Sedegebs, SeiZleba davadginoT calkeuli komponenturi mizezis SefardebiTi
mniSvneloba.

20
Sesaswavli faqtori SeiZleba iyos daavadebis (mdgomareobis) uSualo mizezi, an man
SeiZleba moaxdinos inicireba sxva Sualeduri movlenebis jaWvis, anda CaerTos movlenaTa
jaWvSi, romelic amoqmedebulia sxva faqtorebis mier. magaliTad cxel zedapirTan SexebiT
kani cxeldeba da es iwvevs cilebis denaturacias da kanis sxva komponentebis daSlas. ufro
o
dabali temperaturisas (60-80 C) moqmedebaSi modis rTuli meqnizmebi, romlebic paTologiis
ganviTarebis uSualo mizezebia. filtvis kibos dros Tambaqos moweva SeiZleba ar iyos
"pirveli" mizezi, igi SeiZleba mniSvnelovnad cvlis "bunebrivi" kancerogenezis mimdinareobas.
codnis dagroveba mizezebis da paTogenezis procesebis urTierTmoqmedebis Taobaze, gvaZlevs
met saSualebas CaverioT im movlenebSi, romlebsac Sedegamde (daavadebamde) mivyavarT.

faqtori, romelic aCqarebs daavadebis ganviTarebas, magaliTad A faqtori suraT #2-3-


ze, sulac ar aris meorexarisxovani faqtori. is warmoadgens srulfasovan komponentur
mizezs. mainicirebeli faqtoris zemoqmedebis gareSe daavadeba SeiZleba saerTod ar
ganviTardes. amitom profilaqtikuri RonisZiebebi, romlebic amcireben daavadebis ganviTarebas,
aris iseTive Rirebuli, rogorc is profilaqtikuri RonisZiebebi, romlebic daavadebis
gavrcelebis aRkveTas iwvevn.

suraTi #2
pirdapiri da arapirdapiri mizezobrivi Sedegebi

1. A faqtori SeiZleba iyos daavadebis pirdapiri mizezi;


2. A faqtorma SeiZleba gamoiwvios movlenaTa jgufis ganviTareba (c,d,e) da
ase moqmedebs B daavadebaze;
3. A faqtorma SeiZleba moaxdinos c,d,e faqtorebis modificireba, romlebic mis
21
gareSe arseboben.
medicinaSi Sexeduleba komponentur mizezebze gamoixateba etiologiis gagebaSi, rogorc
organizmis urTierTmoqmedebis procesi garegani faqtorebis kompleqsTan. Tavis mxriv,
organizmis Taviseburebebi garegani zemoqmedebisas aris misi memkvidreobiTi Taviseburebebis da
konkretul pirobebSi ganviTarebis procesis Sedegi. xelsayreli garemo pirobebi xels uwyobs
organizms, rom normalurad ganviTardes, miuxedavad Tandayolili Taviseburebebis, magram
vTqvaT kvebis reJimis Secvlam (garegani zemoqmedeba) SeiZleba Secvalos arsebobis normaluri
mdgomareoba da gamoiwvios paTologia.
rodesac ramdenime mizezobrivi faqtori erTdroulad moqmedebs, saboloo Sedegi
SeiZleba ufro meti an naklebi iyos, vidre es mosalodnelia calkeuli mizezebis moqmedebis
SejamebiT. Tu saboloo Sedegi ufro metia, vidre calkeuli faqtorebis moqmedebis SejamebiT
miviRebT, maSin adgili aqvs sinergizms. Tu naklebia _ antagonizms. anu sinergizmis dros
faqtorebi erTmaneTis moqmedebas aZlierebs, xolo antagonizmis dros - asustebs. am movlenis
nimuSad SeiZleba moviyvanoT v. kanelis magaliTi (suraTi #3).

suraTi #3
daavadebis gamomwvevi sxvadasxva mizezis moqmedeba
(Kannel W.B. Preventive cardiology. Postgrad Med. 1977, 61, 74-85).
(marTkuTxedSi naCvenebia normis zemoT arsebuli sidide)

saidanac Cans, rom rodesac samive riskis faqtori saxeze iyo, daavadebis ganviTarebis
absoluturi riski TiTqmis 3-jer metia, vidre calkeuli faqtorebis moqmedebiT gamowveuli

22
riskebis jami. rodesac erTdroulad moqmedebs ramdenime mizezobrivi faqtori da maT Soris
aris sinergizmi, pacientis janmrTeloba sagrZnoblad SeiZleba SevcvaloT mxolod erTi
mizezis cvlilebiT. zemoT moyvanil magaliTSi, Tu mamakacebi Tambaqos mowevas Tavs daanebeben
da daicaven eqimis daniSnulebas arteriuli wnevis normalizebis mizniT, gul-sisxlZarRvTa
sistemis daavadebebis ganviTarebis riski mkveTrad ecema, sxva faqtorebis cvlilebebis gareSec.
zogjer daavadebis mizezis nacvlad gamoiyeneba termini "etiologiuri faqtori", riTac
xazi esmeba erTaderTi faqtoris arsebobas, romelic aris daavadebis ganviTarebis mizezi.
mizezobriobis aseTi gageba damaxasiaTebeli iyo me-19 da me-20 saukunis pirveli naxevrisaTvis.
amasTan, igulisxmeboda, rom mizezTan erTad SeiZleba yofiliyo meorexarisxovani pirobebi,
romlebic xels uwyobdnen mizezis realizacias. iqmneboda iluzia aseTi wyvilis arsebobis:
"erTi mizezi _ erTi daavadeba". medicinaSi etiologiasTan erTad gamoyofen daavadebis
paTogenezs, anu misi ganviTarebis meqanizms. adreul periodSi etiologia da paTogenezi met-
naklebad damoukideblad ganixileboda. dReisaTvis es dayofa ufro pirobiTia.
mizezobriobis Sesaxeb klasikuri Sexeduleba medicinaSi Camoyalibda me-19 saukunis
bolos baqteriologiuri aRmoCenebis eraSi. am periodSi infeqciuri daavadebebiT Sepyrobili
adamianebidan gamoyofdnen sxvadasxva mikroorganizmebs da TiToeul maTgans ganixilavdnen
rogorc daavadebis SesaZlo mizezs. saWiro iyo kriteriumebis dadgena, romelTa gamoyenebiTac
SesaZlebeli iqneboda paTogenuri agentis (mizezis) gamoyofa sxva mravalricxovani
mikroorganizmebisgan, romlebic gvxvdebian adamianebis da cxovelebis organizmSi. henlem (Henle)
mogvawoda triada, romelic Semdgom gadaamuSava r. koxma. imisaTvis, rom mikroorganizmsa da
daavadebas Soris kavSiri mizez-Sedegobrivad CaTvliliyo, anu mikroorganizmi daavadebis
gamomwvev mizezad yofiliyo aRiarebuli, koxis triadis mixedviT saWiro iyo:
1. mikroorganizmis gamoyofa Sesaswavli daavadebis mqone pirebisagan;
2. mikroorganizmis ar gamoyofa mocemuli daavadebis armqone pirebisagan;
3. avadmyofis organizmidan gamoyofili mikroorganizmis mier, romlis kultivireba
xdeboda laboratoriaSi, eqsperimentSi daavadebis gamowvevis unari.
am triadaSi pirveli elementi aris aucilebeli mizezi (mikroorganizmis arseboba
aucilebelia organizmSi daavadebis gamosawvevad), xolo mesame _ sakmarisi mizezis niSani
(inficireba iwvevs daavadebas). am kriteriumebis gamoyeneba mraval SemTxvevaSi iyo efeqturi.
magaliTad 1876 wels r. koxma am kriteriumebis gamoyenebiT daamtkica, rom jilexis gamomwvevi
aris B.anthracis. zogierTi daavadebisas ki gvxvdeboda sirTuleebic. magaliTad sufTa
kulturis miReba maSin aris SesaZlebeli, rodesac mikroorganizmebis zrdisaTvis aris saWiro
sakvebi niadagi. mTeli rigi daavadebis gamomwvevisaTvis aseTi niadagis Seqmnas didi Sroma

23
dasWirda. es problema sabolood arc dRes aris gadaWrili. kulturis miRebis gamoTiSva am
kriteriumebidan ki SeuZlebelia, radgan mkvlevarisaTvis gamomwvevi mxolod maSin arsebobs,
rodesac SeiZleba misi Seswavla da Senaxva.
Semdegi sirTule mesame postulatis gamoyenebas exeboda. cnobilia, rom adamianis
daavadebebis mniSvnelovani nawili cxovelebs ar emarTebaT da amdenad eqsperimentSi cxovelTa
daavadeba metad garTulebuli iyo. amasTan dadgenili iyo, rom paTogenuri mikroorganizmebi
TviT adamianebSic yovelTvis rodi iwvevdnen daavadebas (imunitetis gamo). radgan me-19
saukunis meore naxevarSi imunitetis fenomeni da misi meqanizmi bolomde ar iyo gaSifruli,
rig SemTxvevaSi gaugebari rCeboda adamianSi daavadebis ar ganviTarebis mizezebi. amis Sedegi
iyo, rom aRniSnul periodSi mravali eqimi da mkvlevari TviTdainficirebas mimarTavda, raTa
daedgina iyo Tu ara konkretuli mikroorganizmi daavadebis gamomwvevi. magaliTad, 1883 wels
r. koxis mier V. Cholerae-s gamoyofis miuxedavad, mas karga xani qoleris gamomwvevad ar
aRiarebdnen, radgan mesame postulatis ganxorcieleba ver xdeboda. rogorc SemdgomSi
dadginda, es gamowveuli iyo cxovelebis SeuvalobiT am daavadebis mimarT. mxolod 10 wlis
mere, rodesac pasteris institutSi, meCnikovis saxelobis laboratoriaSi, erT-erTma
TanamSromelma warmatebiT Caitara TviTdainficirebis cda qoleris vibrioniT, gaqra eWvi am
vibrionis, rogorc qoleris gamomwvevis Taobaze. amitomac iyo, rom SemdgomSi es triada
gamartivda da mxolod pirveli da meore kriteriumebis arsebobis SemTxvevaSic mikroorganizmi
daavadebis gamomwvevad iTvleboda. Tumca me-20 saukunis Sua periodamde eqsperimentSi adamianis
an cxovelis daavadeba paTogenuri mikroorganizmis etiologiur faqtorad aRiarebis saukeTeso
saSualebad iTvleboda. amitomac iyo xSiri adamianTa TviTdainficireba. meore msoflio omis
Semdgom aseTi eqsperimentebi sagrZnoblad SeizRuda.
koxis midgomam xeli Seuwyo medicinaSi mizezobriobis problemis Seswavlas. Tu am
postulatebis miRebamde iTvleboda, rom erTi da igive daavadeba SeiZleba gamowveuli
yofiliyo sxvadasxva mikroorganizmebiT, misi miRebis Semdeg cxadi gaxda, rom daavadebis
ganviTarebis mizezi konkretuli mikroorganizmia. SeiZleba iTqvas, rom koxis midgoma dResac
ZalaSia. is gaxda safuZveli aRmoCenebisa, romelTa saSualebiT dadginda, rom legionerebis
daavadebas iwvevs gramuaryofiTi baqteria, xolo Sidss _ adamianis imunodeficitis virusi.
me-20 saukunis meore naxevarSi medicinaSi seriozul problemad iqca qronikuli
daavadebebi. dRis wesrigSi daisva sakiTxi, rom dadgeniliyo aragadamdeb daavadebaTa
ganviTarebis mizezebi. infeqciuri daavadebebisagan gansxvavebiT, aragadamdeb daavadebebs
multifaqtoruli buneba aqvT. amasTan, erTi da igive faqtori sxvadasxva daavadebis
ganviTarebis mizezad SeiZleba mogvevlinos. magaliTad, Tambaqos moweva xels uwyobs filtvis

24
kibos, filtvis obstruqciuli daavadebebis, wylulovani daavadebis, Sardis buStis kibos,
gulis iSemiuri daavadebis ganviTarebas. Tavis mxriv, magaliTad, gulis iSemiuri daavadebis
ganviTarebis mizezi mowevis garda SeiZleba iyos arteriuli hipertenzia, hiperqolesterinemia
da sxva. qronikul daavadebaTa mizezobriobis problemis gadaWras seriozuli biZgi misca
diskusiam, romelic msoflioSi mimdinareobda Tambaqos mowevasa da filtvis kibos ganviTarebas
Soris kavSirze. Tambaqos mowevis Taobaze politikis gamosamuSaveblad amerikaSi Seiqmna
samedicino komisia, romelmac 1964 wels warmoadgina angariSi "moweva da janmrTeloba".
filtvis kibos da Tambaqos mowevas Soris kavSiris Sesafaseblad komisiam moawoda niSnebis sia,
romelic am kavSiris mizezobriobas adasturebda. 1965 wels epidemiologma o. hilma aseve
mogvawoda im niSanTa nusxa, romelTac Semdgom moixseniebdnen, rogorc "mizezobriobis
kriteriumebs" (cxrili #1).

ცხრილი #1
მიზეზ-შედეგობრივი კავშირის კრიტერიუმები
kriteriumi komentari
droSi Tanmimdevroba mizezi win uswrebs efeqts
kavSiris Zala maRali fardobiTi riski
efeqtis damokidebuleba dozis momatebisas izrdeba avadoba
dozaze
Seqcevadoba moqmedebis Sesustebisas mcirdeba avadoba
simyare sxvadasxva mkvlevaris mier miiReba erTi da igive
efeqti adgilis, drois da pirobebis miuxedavad
biologiuri realoba efeqti eTanxmeba Tanamedrove mecnierul
Sexedulebebs
specifikuroba erTi mizezi iwvevs erT efeqts
analogia mizez-Sedegobrivi kavSiri ukve dadgenilia
analogiuri mdgomareobis an daavadebisaTvis

2.2. mizez-Sedegobrivi kavSiris damadsturebeli ZiriTadi niSnebi

1. eqspoziciis da daavadebis damokidebuleba droSi. eqspozicia SeiZleba iyos


daavadebis (mdgomareobis) mizezi mxolod im SemTxvevaSi, Tu is win uswrebs daavadebas.
debuleba, rom mizezi win uswrebs Sedegs, intuitiurad naTelia da mizezis zogad ganmartebas
asaxavs.
unda aRiniSnos, rom rig SemTxvevaSi movlenaTa Tanmimdevrobis dadgena sakmaod rTulia.
amis sailustraciod SeiZleba Semdegi magaliTis moyvana. dadgenilia, rom simsuqne mTeli rigi
paTologiis dros, gansakuTrebiT gul-sisxlZarRvTa sistemis daavadebebis dros,
sikvdilianobis zrdas uwyobs xels. aqedan gamomdinare, logikuria vifiqroT, rom simsuqnis

25
arsebobisas sxeulis wonis dakleba adamianze profilaqtikur zemoqmedebas moaxdens. magram
ramdenime epidemiologiuri kvlevis Sedegad gamovlinda, rom wonis daklebisas im adamianebSic
ki izrdeboda sikvdilianoba, romlebic manamde ar avadmyofobdnen. es sagangaSo Sedgebi SeiZleba
avxsnaT imiT, rom wonaSi dakleba iyo sasikvdilo daavadebis preklinikuri gamovlena. am
SemTxvevaSi es daavadeba win uswrebs da iwvevs wonaSi daklebas da ara piriqiT (es
SesaZlebloba rom gamoiricxos, unda vicodeT, gaxdoma iyo Tu ara winaswar dagegmili
movlena).
rogorc aRiniSna, mizezi win unda uswrebdes daavadebas (mdgomareobas). rodesac aseTi
Tanmimdevroba darRveulia, es Zalian Zlieri argumentia mtkicebulebisa, rom ar arsebobs or
movlenas Soris mizez-Sedegobrivi kavSiri. isic unda aRiniSnos, rom rodesac moqmedeba win
uswrebs Sedegs, es jer kidev ar niSnavs, rom maT Soris aris mizez-Sedegobrivi kavSiri.
2. eqspozicias da daavadebas Soris kavSiris biologiuri axsna. biologiuri
meqanizmebis codna, romlebic xsnis eqspozicias da Sedegs Soris kavSirs, aZlierebs mosazrebas,
rom es kavSiri aris mizez-Sedegobrivi. Tumca kavSiri maSinac SeiZleba iyos mizez-Sedegobrivi,
rodesac mizezis moqmedebis meqanizms ver vxsniT. SesaZlebelia iseTi variantic, rodesac
biologiuri meqanizmebis axsna sulac ar aris swori, magram arc es mdgomareoba gamoricxavs
mizez-Sedegobriv kavSirs. magaliTad, Tavdapirvelad Sidsis ganviTarebis mizezi
homoseqsualebSi aixsneboda am ukanasknelTa mier amilnitritis gamoyenebiT.
3. aRmoCenili kavSiris simyare. arc erT kvlevas ar SeuZlia mogvces problemis
gadaWris erTaderTi da saboloo mtkicebuleba. sxvadasxva situaciaSi da sxvadasxva
populaciaSi Catarebuli kvlevebi, rodesac erTnair Sedegs iZleva, es zrdis rwmenas imis
Taobaze, rom kavSiri aris mizez-Sedegobrivi. erTnairi Sedegebi bunebrivia erTmaneTs amagreben.
gansxvavebuli Sedegebis miRebisas ki saWiroa maTi axsna. samwuxarod unda aRiniSnos, rom
efeqtis ganviTareba erTi saxis pirobebSi da am efeqtis ar ganviTareba sxva pirobebSi sakmaod
xSirad xdeba. es gasagebia, radgan sxvadasxva kvleva erTnair Sedegs mxolod im SemTxvevaSi iRebs, Tu
kvlevis Catarebisas mizezobriobis yvela detalis gaTvaliswineba xdeba, rac yovelTvis ar xerxdeba.
4. eqspozicias da daavadebas Soris kavSiris alternatiuli axsna. eqspozicias da
daavadebas Soris kavSiris asaxsnelad mowodebuli hipoTezebi Tavis mniSvnelobas
mniSvnelovanwilad kargaven, Tu arsebuli efeqtis asaxsnelad sxva hipoTezebic arsebobs.
magaliTad, im qalebis ufro meti sicocxlis xangrZlivoba, romlebic klimaqterul periodSi
iReben estrogenebs, Tu SeiZleba aixsnas maTi cxovrebis wesis TaviseburebebiT _ qceviT,
ganaTlebiT, an sxva faqtoriT, maSin hipoTeza estrogenebis metabolizmze dadebiTi moqmedebis
Taobaze saeWvo xdeba. es eWvi SeiZleba gaqarwyldes kontrolirebadi eqsperimentiT. aseTi

26
eqsperimenti Catarda mas Semdeg, rac mravali wlis manZilze xdeboda estrogenebis gamoyeneba,
ise, rom misi efeqturoba ar iyo dagenili. eqsperimentma aCvena, rom estrogenebis gamoyenebas
sargeblis nacvlad moaqvs ziani. anu hipoTeza, romelic qalebis sicocxlis sxvadasxva
xangrZlivobas xsnida klimaqterul periodSi estrogenebis gamoyenebiT da misi dadebiTi
gavleniT metabolizmze, ar iyo swori.
5. efeqtis damokidebuleba dozaze. es niSnavs, rom SesaZlo mizezis raodenobrivi
cvlileba Sesabamisad iwvevs Sedegis raodenobriv cvlilebas. aseTi damokidebulebis arseboba
sakmao argumentia mizez-Sedegobrivi kavSiris sasargeblod. amgvari damokidebulebis magaliTad
SeiZleba moviyvanoT ingliseli epidemiologis r. dolis monacemebi, romelic exeba eqim
mamakacebSi dRis manZilze moweuli sigaretebis raodenobas da filtvis kiboTi sikvdilianobas,
rac gamoqveynda 1976 wels (suraTi #4).

suraTi #4

damokidebuleba eqspozicia-efeqti SeiZleba yovelTvis ar iyos sworxazovani. magaliTad


im pirebSi, romlebic alkohols minimalur dozebSi moixmaren, sikvdilianobis maCveneblebi
dabalia, xolo momatebulia im adamianebSi, romlebic an ar svamen alkohols, an iReben mas
didi dozebiT. aseTi damokidebulebis ganviTarebis mizezi ucnobia. SesaZlebelia Sedegs (am
SemTxvevaSi sikvdili) dabali eqspoziciis dros da Sedegs maRali eqspoziciis dros aqvT
ganviTarebis sxvadasxva meqanizmi.
6. eqspoziciis da efeqtis kavSiris Zala. eqspoziciis daavadebasTan kavSiris Zala
izomeba im fardobiT, romelic arsebobs eqspozirebulTa da araeqspozirebulTa Soris
daavadebis ganviTarebis sixSires Soris. Tu Seiswavleba daavadebis SesaZlo mizezi, daavadebis
ganviTarebis Sansi eqspoziciisas izrdeba, xolo Tu es Terapiuli (profilaqtikuri) Carevaa,
maSin mcirdeba.

27
amasTan, susti kavSiri ar gamoricxavs mizez-Sedegobriv damokidebulebas, xolo Zlieri
kavSiri SeiZleba iyos mizezi gardamavali faqtorebis moqmedebisa. yovel SemTxvevaSi
eqspozicias da daavadebas Soris arsebuli kavSiris Zala aris ara biologiuri kavSiri, aramed
Sesaswavli populaciis Taviseburebebis gamovlena. erT populaciaSi kavSiri SeiZleba iyos
Zlieri, meoreSi _ susti, imis mixedviT, Tu rogoria maTSi sxva komponenturi mizezebis
gavrceleba.
7. eqspoziciis Sewyvetis Semdeg efeqtis gaqroba. Tu eqspozicia aris daavadebis
ganviTarebis mizezi, maSin misi moqmedebis Sewyvetam unda gamoiwvios daavadebis axali
SemTxvevis ganviTarebis Semcireba. gasaTvaliswinebelia isic, rom zemoqmedebis Semdeg avadobis
donis cvlileba SeiZleba ramdenime wlis Semdeg moxdes. magaliTad, qalebSi, romlebic
arasasurveli abortis Tavidan asacileblad dieTilstilbestrols xmarobdnen (saTanado
safuZvlis gareSe), mravali wlis Semdeg saSos kibo viTardeboda. eqspoziciis Semcirebis
Semdeg efeqtis Semcirebis an gaqrobis magaliTad isev mogvyavs r. dolis monacemebi, romelic
man gamoaqveyna 1976 wels da exeba Tambaqos mowevis Sewyvetis Semdeg filtvis kiboTi
sikvdilianobis maCveneblebis cvlilebas (suraTi#5).
Tanamedrove pirobebSi iseTi eqsperimentis Catareba, romlis drosac adamianze xdeba
mavne zemoqmedebis eqspozicia, akrZalulia. magram misaRebia potenciurad mavne eqspoziciis
Sewyveta profilaqtikis mizniT. eqsperimentSi aseTi eqspoziciis Sewyvetis Semdeg avadobis
donis daqveiTeba metyvelebs im hipoTezis sasargeblod, romelic mocemuli daavadebis mizezad
am eqspozicias Tvlis. Tumca igi ar aris amomwuravi mtkicebuleba eqspoziciasa da Sedegs
Soris mizez-Sedegobrivi kavSiris arsebobisa. eqsperimentis yvela SedegisaTvis arsebobs erTze
meti axsna, romelic simarTlis msgavsia.
suraTi#5

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cnobili epidemiologi hili mizezobriobis niSnad, agreTve, gamoyofda kavSiris
specifikurobas. misi SexedulebiT WeSmariti mizezobrivi kavSiri es aris eqspoziciis kavSiri
calkeul daavadebasTan da ara ramdenimesTan. am movlenas ufro xSirad adgili aqvs mwvave
infeqciuri daavadebebis dros. me-20 saukunis bolos Tambaqos moxmarebis momxreebi
mizezobriobis am niSans iyenebdnen imisTvis, rom daesabuTebinaT Tambaqos mowevis uvnebloba
mwevelTaTvis, radgan Tambaqos moweva iwvevs mraval arasasurvel Sedegs da ara erT romelime
paTologias. saerTod specifikuri moqmedebis gamovlena Zlieri argumentia mizez-Sedegobrivi
kavSirisa, xolo specifikurobis ar arseboba susti argumentia mis winaaRmdeg.
aniWebda ra did mniSvnelobas arsebuli kavSiris axsnas, hili aseve gamoyofda
analogiebs, rogorc erT-erT niSans, WeSmariti mizez-Sedegobrivi kavSiris arsebobisa.
magaliTad, erTi saxis kibos ganviTarebis radiaciuli genezi, SeiZleba CaiTvalos
gamosxivebasTan meore saxis kibos kavSiris safuZvlad. magram analogiebi yovelTvis SeiZleba
moiZebnos, igi damokidebulia mkvlevaris fantaziis unarze. amdenad analogia susti argumentia
mizez-Sedegobrivi kavSiris dasadastureblad.
mizez-Sedegobrivi kavSiris arcerTi zemoT CamoTvlili niSani ar aris aucilebeli an
sakmarisi. amitom, rodesac gvinda davdginoT, aris Tu ara or movlenas Soris mizez-
Sedegobrivi kavSiri, unda gaviTvaliswinoT yvela is mtkicebuleba, romelic miRebulia
sxvadasxva saxis kvlevebSi. mxolod am mtkicebulebebis safuZvliani analizis Semdeg SeiZleba
gavakeToT daskvna kavSiris xasiaTis Sesaxeb, anu miviRoT debuleba, rom movlenebs Soris aris
mizez-Sedegobrivi kavSiri, anda uarvyoT aseTi kavSiris arseboba.
Sejamebis saxiT SeiZleba vTqvaT, rom mizez-Sedegobrivi kavSiris arsebobaze miuTiTebs:
• movlenaTa swori Tanmimdevroba droSi;
• mizezsa da Sedegs Soris Zlieri kavSiri;
• efeqtis damokidebuleba dozaze;
• SesaZlo mizezis moqmedebis Sewyvetis Semdeg efeqtis Semcireba an mospoba;
• sxvadasxva kvlevebSi Sedegebis Tanxvedra.
garkveuli mniSvneloba aqvs agreTve cnobil faqtebTan analogias da kavSiris
biologiuri meqanizmebis axsnas.

2.3 riskis faqtorebi

mizezobriobis ganxilvisas aucileblad unda SevexoT riskis faqtorebs. upirveles


yovlisa unda ganvsazRvroT, Tu ra aris riski. epidemiologiaSi riski ewodeba garkveuli
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drois ganmavlobaSi movlenis (rogorc wesi, arasasurveli) ganviTarebis albaTobas.
praqtikulad yvela adamians awuxebs kiTxva, Tu ramdenad didia masSi ama Tu im
paTologiis (daavadebis) ganviTarebis riski. amitom, ara marto medicinaSi, aramed zogadad
cxovrebaSi, riski erT-erTi mniSvnelovani cnebaa.
riskis faqtorebi (risk factors) ewodeba organizmis Taviseburebebs, an garegan
zemoqmedebas, romlebic zrdis mdgomareobis (daavadebis) ganviTarebis risks. e. i. riskis
faqtorebi SeiZleba iyos Sinagani, an garegani, romlebic garemoSi gvxvdebian. es ukanasknelni
SeiZleba iyos infeqciuri daavadebebis gamomwvevni, farmakologiuri preparatebi, toqsinebi,
fizikuri da qimiuri movlenebi da a.S. zogierTi riskis faqtori aris socialuri garemos
nawili, magaliTad meuRlis dakargviT gamowveuli emociuri datvirTva, qceviTi moqmedeba da
a.S. isini iwveven rogorc fsiqikur, ise somatur daavadebebs. zogierT maTgans Zalian didi
mniSvneloba eniWeba sxvadasxva paTologiis ganviTarebaSi. magaliTad Tambaqos moweva,
alkoholis Warbi raodenobiT miReba, usafrTxoebis Rvedebis ar gamoyeneba avtomobiliT
gadaadgilebisas, mouwesrigebeli sqesobrivi cxovreba da a. S.
riskis faqtorebi iwveven avadobis matebas, magram SeiZleba iyos iseTi eqspozicia,
romelic piriqiT, avadobis klebas ganapirobebs. magaliTad aspirinis regularuli miReba zrdis
kuW-nawlavis traqtidan sisxldenis ganviTarebis albaTobas, magram amave dros aqveiTebs
miokardiumis infarqtis da swori nawlavis kibos ganviTarebis albaTobas. iseT faqtorebs,
romlebic amcireben daavadebis ganviTarebis albaTobas, zogjer antiriskis faqtorebsac
uwodeben.
riskis faqtorebis zemoqmedeba win uZRvis daavadebis ganviTarebas. zemoqmedeba SeiZleba
iyos erTjeradi, magaliTad mosaxleobis dasxiveba atomur eleqtrosadgurze avariis gamo.
ufro xSirad maTi moqmedeba droSi sakmaod xangrZlivia. es gansakuTrebiT qronikuli
daavadebebis riskis faqtorebis moqmedebisas xdeba (Tambaqos moweva, arteriuli hipertenzia,
mouwesrigebeli sqesobrivi cxovreba).
Tu romelime zemoqmedebis Sedegad daavadeba swrafad viTardeba, maSin Zneli misaxvedri
ar aris, rom es moqmedeba aris riskis faqtori. magaliTad damwvrobis ganviTareba mzis
sxivebis moqmedebiT. Tumca, rogorc aRiniSna, qronikuli daavadebebis dros, romlebic
dReisaTvis avadobis da sikvdilianobis ZiriTadi mizezebia, kavSiris dadgena riskis faqtoris
zemoqmedebasa da daavadebis ganviTarebas Soris arc ise advilia. amitom aris, rom rac ar unda
maRali kvalifikaciis eqimi iyos, mas ar SeuZlia mxolod sakuTari gamocdilebis xarjze
Seafasos riski.
riskis faqtorebis gamovlenas seriozulad uSlis xels mravali daavadebisaTvis

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damaxasiaTebeli xangrZlivi latenturi periodi, anu dro, romelic gaivlis
faqtoris/faqtorebis moqmedebis dawyebidan daavadebis pirveli niSnebis gamovlenamde. aseTi ram
gansakuTrebiT damaxasiaTebelia onkologiuri daavadebebisaTvis. magaliTad farisebri jirkvlis
kibos ganviTarebas xeli SeiZleba Seuwyos jer kidev bavSvobaSi sxivuri Terapiis Catarebam.
rodesac daavadeba viTardeba zemoqmedebidan ramdenime wlis Semdeg, adamians aviwydeba misi
arseboba da amitom kavSiri zemoqmedebasa da daavadebas Soris daudgeneli rCeba.
riskis faqtorebis gamovlenas xeli SeuZlia SeuSalos maTma farTo gavrcelebam.
magaliTad Tambaqos moweva an qolesteriniT da najeri cximebiT mdidari sakvebis miReba
imdenadaa gavrcelebuli sazogadoebaSi, rom mravali wlis ganmavlobaSi isini adamianis
janmrTelobisaTvis saSiSad ar miiCneoda. mxolod specialuri epidemiologiuri kvlevebis
saSualebiT dadginda, rom es faqtorebi xels uwyoben mTeli rigi daavadebebis ganviTarebas.
Tu riskis faqtoris zemoqmedebiT daavadebis ganviTarebis albaToba dabalia, maSin Zalian
didi raodenobis adamianebze unda movaxdinoT dakvirveba, rom gamovavlinoT avadobis sxvaoba im
pirebis Soris, romlebmac ganicades da ar ganicades am faqtoris moqmedeba. es debuleba
maSinac ZalaSia, rodesac rogorc riskis faqtori, ise daavadeba farTod aris gavrcelebuli.
magaliTad dRemde sabolood ar aris dadgenili iwvevs Tu ara sarZeve jirkvlis kiboTi
avadobis zrdas peroraluri kontraceptivebis gamoyeneba. radgan es riski Zalian dabalia da
igi sulac SeiZleba iyos sistemuri an SemTxveviTi Secdomis Sedegi. piriqiT, ar iwvevs eWvs,
rom B hepatitis virusi aris RviZlujredovani kibos riskis faqtori, radgan am virusis
mtarebel pirebSi RviZlis kibo ramdenime aseuljer ufro xSiria, vidre aramtarebel
adamianebSi.
Tu daavadeba farTod aris gavrcelebuli (gulis daavadebebi, onkologiuri daavadebebi,
insulti) da misTvis ukve dadgenilia riskis faqtorebi, Zalian Znelia axali riskis faqtoris
gamovlena. magaliTad mozrdil adamianebSi Zalian xSirad gvxvdeba uecari sikvdili. umetesad
igi dakavSirebulia gulis iSemiur daavadebasTan. Tumca, ar aris gamoricxuli sxva mizezebic,
romlebic ar aris gamovlenili imis gamo, rom umravlesi SemTxvevisaTvis arsebobs Sesabamisi
axsna.
meore mxriv, iSviaTi daavadebebi da uCveulo klinikuri SemTxvevebi mkvlevarTa did
interess iwvevs. magaliTad Tavis droze amerikaSi Sidsi imdenad uCveulo sindromi iyo, rom
misi ramdenime SemTxvevac ki sakmarisi gaxda, rom evaraudaT axali infeqciuri daavadebis
arseboba da CaetarebinaT intensiuri kvleva misi gamomwvevis aRmoCenisaTvis. analogiurad,
eqimebma didi yuradReba miaqcies iSviaTi daavadebis _ saSos kibos ramdenime SemTxvevas. Catarda
safuZvliani kvleva da dadginda, rom avadmyofTa dedebi orsulobis dros iyenebdnen

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dieTilstilbestrols.
unda aRiniSnos, rom mWidro calsaxa kavSiri riskis faqtors da konkretul daavadebas
Soris umetes SemTxvevaSi ar arsebobs. amis magaliTi naCvenebia suraTze #6, sadac mocemulia
damokidebuleba arteriul hipertenzias da gulis ukmarisobas Soris.

suraTi #6

arteriuli hipertenziiT daavadebul zogierT adamians uviTardeba gulis ukmarisoba,


zogierTs ki ara. amas garda gulis ukmarisoba iseT adamianebsac uviTardebaT, romlebsac ar
aReniSnebaT arteriuli hipertenzia, radgan arsebobs sxva mizezobrivi faqtorebic. amasTan
kavSiri waSlilia imis gamoc, rom arteriuli hipertenzia xels uwyobs ara marto gulis
ukmarisobis, armed sxva daavadebebis ganviTarebasac.
amrigad, miuxedavad imisa, rom arteriuli hipertenziis mqone avadmyofebSi gulis
ukmarisobis ganviTarebis sixSire 3-jer ufro metia, vidre am paTologiis armqone adamianebSi,
eqimebi gasuli saukunis 70-ian wlebamde aseTi kavSiris arsebobaSi darwmunebulebi ar iyvnen.
mxolod gulmodgine, mravalwliani kvleviT adamianTa did jgufze, gamovlinda sarwmuno
monacemebi am kavSiris arsebobis Taobaze.
amitomac aris, rom eqims mxolod sakuTar gamocdilebaze dayrdnobiT, ar SeuZlia
daamtkicos kavSiri faqtoris zemoqmedebasa da daavadebas Soris, Tumca aseTi kavSiris
arsebobis Sesaxeb SeiZleba ivaraudos.
riskis faqtorebis codna gvexmareba prognozis sakiTxSi, radgan misi codna gvaZlevs
saSualebas, rom gamovTqvaT varaudi daavadebis ganviTarebis Taobaze. Tumca, unda aRiniSnos,

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rom Zlieri riskis faqtoris moqmedebis SemTxvevaSic ki daavadebis ganviTareba yovelTvis ar
aris mosalodneli. magaliTad dadgenilia, rom Tambaqos intensiur momxmareblebSi filtvis
kibos ganviTarebis riski bevrad ufro maRalia, vidre aramwevelebSi, Tumca yvela mwevels
rodi uviTardeba es paTologia.
xazi unda gaesvas im faqts, rom arsebobs principuli Seusabamoba populaciaSi avadobasa
da individumisaTvis daavadebis ganviTarebis Sanss Soris. im SemTxvevasic ki, rodesac maRalia
Sansi, rom adamians uaxloesi 5 wlis manZilze ganuviTardes insulti an miokardiumis
infarqti, es jer kidev ar niSnavs, rom adamiani aucileblad daavaddeba am nozologiiT, maSin,
rodesac pacients ainteresebs icodes, aucileblad ganuviTardeba mas es daavadeba Tu ara.
Tumca populaciis doneze daavadebis ganviTarebis albaTobis codna exmareba klinicists
gaataros aucilebeli RonisZiebebi arasasurveli gamosavalis Tavidan asacileblad, iseve,
rogorc epidemiologs, rom gaataros aucilebeli RonisZiebebi populaciaSi daavadebis
gavrcelebis Tavidan asacileblad. amis magaliTia snous moqmedeba londonSi qoleris epidemiis
dros. SeniSna ra, rom am daavadebis ganviTarebis risks zrdis adamianebis mier sasmeli wylis
zogierTi wyarodan gamoyeneba, man aRkveTa epidemiis gavrceleba am wyaroebis gadaketviT.

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Tavi 3
kvlevis epidemiologiuri meTodi

yvela samedicino Tu arasamedicino disciplinas gaaCnia Tavisi kvlevis meTodebi.


gamonaklisi ar aris epidemiologiac, romelic mis winaSe mdgomi amocanebis gadasaWrelad
SeiaraRebulia kvlevis epidemiologiuri meTodiT. rom ara igi, epidemiologiis, rogorc
damoukidebeli samedicino disciplinis arseboba kiTxvis niSnis qveS dadgeboda. Tu meoce
saukunis Sua periodamde kvlevis epidemiologiuri meTodi ZiriTadad gamoiyeneboda
profilaqtikur medicinaSi, dReisaTvis misi gamoyenebis sfero sagrZnoblad gafarTovda da
sakmaod intensiurad gamoiyeneba agreTve klinikur medicinaSi.
kvlevis epidemiologiuri meTodi aris meToduri xerxebis erToblioba, romelic
damyarebulia daavadebaTa droSi da sivrceSi gavrcelebis analizze da romlis saSualebiTac
xdeba profilaqtikuri da klinikuri medicinis aqtualuri problemebis gansazRvra, agreTve
daavadebaTa ganviTarebis mizezebis, pirobebis (riskis faqtorebi) da meqanizmebis gamovlena,
raTa dasabuTdes daavadebaTa prevenciisaTvis saWiro profilaqtikuri RonisZiebebi da Sefasdes
maTi efeqturoba.
kvlevis epidemiologiur meTods farTod iyenebs sazogadoebrivi jandacva. misi
saSualebiT xdeba mosaxleobis avadobis struqturis dadgena, ZiriTadi problemebis gamoyofa,
profilaqtikuri RonisZiebebis SemuSaveba da optimizacia, maTi efeqturobis gansazRvra.
klinikur medicinaSi am meTodis saSualebiT fasdeba skriningis, diagnostikisa da mkurnalobis
meTodebis xarisxi.
epidemiologiuri kvlevis 3 ZiriTadi meTodi arsebobs: 1. aRweriTi (deskriptuli), 2.
analizuri, 3. eqsperimentuli.

3.1 aRweriTi (deskriptuli) epidemiologiuri meTodi

aRweriTi epidemiologiuri meTodis saSualebiT xdeba mosaxleobis avadobis struqturis


dadgena da ZiriTadi samedicino problemebis gamoyofa, TiToeuli nozologiuri erTeulis
epidemiologiuri Taviseburebebis gansazRvra (avadobis mravalwliani dinamikis tendencia,
sezonuroba, teritoriuli gavrceleba, asakobrivi struqtura da sxv.). kvlevis pirvel etapze
rogorc wesi, gamoiyeneba aRweriTi meTodi, romlis Sedegad miRebuli monacemebi aris
safuZveli analizuri kvlevebis dagegmvisaTvis.

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aRweriT kvlevebs miekuTvneba:
• SemTxvevis aRwera;
• SemTxvevaTa seriis kvleva;
• erTmomentiani (jvaredini) kvleva;
• ekologiuri kvleva.
klinikur medicinaSi ufro gavrcelebulia SemTxvevis aRwera da SemTxvevaTa seriis
kvleva. xolo epidemiologiaSi _ erTmomentiani kvleva, romlis drosac Seiswavleba daavadebis
gavrceleba populaciaSi drois garkveul momentSi. amdenad, es kvleva gvaZlevs informacias
daavadebulTa saerTo raodenobis Sesaxeb (SeuZlebelia axali SemTxvevebis identificireba),
amitom mas xSirad prevalentobis kvlevasac uwodeben. aseT kvlevebs mTeli rigi upiratesobebi
gaaCniaT:
– mis Catarebas Wirdeba mcire dro;
– ekonomiuria, ar moiTxovs did finansur danaxarjebs;
– pirveli nabijia riskis faqtorebis Ziebis da hipoTezis formulirebis saqmeSi.
erTmomentiani kvlevis Catareba mizanSewonilia sakiTxis winaswari Seswavlis mizniTac.
mis naklovan mxares warmoadgens miRebuli Sedegebis naklebi damajerebloba, radgan rTulia
kvlevisaTvis saWiro reprezentuli jgufis SerCeva da aqedan gamomdinare SeiZleba ver miviRoT
swori informacia daavadebis mizezebis da riskis faqtorebis Sesaxeb.
erTmomentiani kvlevebi Cven gvaZlevs pasuxs Tu vin aris avad, rodis gaxda avad da sad
gaxda avad. am saxis kvlevebi farTod gamoiyeneba klinikur medicinaSic. magaliTad, misi
saSualebiT SeiZleba davadginoT vin, sad da rodis xdeba avad hipertonuli daavadebiT.
ZiriTadi masala aRweriTi kvlevebis dros aris saaRricxvo da saangariSo dokumentebSi
arsebuli monacemebi, aseve SerCeviTi kvlevebisas miRebuli monacemebi. saaRricxvo da saangariSo
formebi, rogorc wesi, advilad xelmisawvdomia da masSi arsebuli masalis miRebac rTuli ar
aris. rac Seexeba SerCeviTi kvlevis Sedegad miRebul masalas, igi ufro zustia, magram
dakavSirebulia finansur danaxarjebTan da moiTxovs garkveul dros. SerCeviTi kvlevebisas
ZiriTadad gamoiyeneba erTmomentiani kvlevebi.
aRweriTi epidemiologiuri kvlevebisas samedicino problemis mniSvnelobis
gansazRvrisaTvis farTod gamoiyeneba statistikuri maCveneblebi. maTgan yvelaze mniSvnelovania
avadobis, anu incidentobis maCvenebeli, gavrcelebis, anu prevalentobis maCvenebeli,
sikvdilianobis maCvenebeli, sikvdilianobis asakobrivi maCveneblebi, letalobis maCvenebeli.
mniSvnelovania agreTve, avadobis tendenciis gansazRvra da ekonomikuri zianis dadgena.

35
ama Tu im nozologiuri erTeulis gavrcelebis mizezebis dasadgenad da daavadebis
epidemiologiuri Taviseburebebis gamosavlenad aucilebelia avadobis Seswavla teritoriis
mixedviT, garkveul socialur da profesiul jgufebSi, droSi (sezonuroba da mravalwliani
dinamika) da asakobriv WrilSi. unda ganisazRvros Tu vin xdeba avad, sad xdeba avad da rodis
xdeba avad. sxvanairad rom vTqvaT, unda dadgindes riskis teritoria, riskis dro da riskis
jgufebi. deskriptuli epidemiologia swored am kiTxvebze iZleva pasuxs – vin? sad? rodis?
rodesac ganisazRvreba, Tu mocemuli nozologiuri erTeuliT vin, sad da rodis xdeba
avad, Semdgom xdeba hipoTezis an hipoTezebis Camoyalibeba riskis faqtoris/faqtorebis Sesaxeb.
e.i. xdeba Zieba mizezis Tu mizezTa, romlebic apirobeben daavadebis arsebul teritoriul,
asakobriv-sqesobrivi, socialur jgufebSi da droSi gavrcelebas.
hipoTezis dadastureba anu riskis faqtorebis gamovlena da Sefaseba xdeba analizuri
epidemiologiuri kvlevis meTodebiT.
rac Seexeba ekologiur anu korelaciur kvlevas, igi epidemiologiuri kvlevis pirvel
safexurs warmoadgens. aseTi kvlevisas analizis obieqtia ara calkeuli adamianebi, aramed
adamianTa jgufebi an populacia, romlebic cxovroben erT dasaxlebul punqtSi (qveyana, qalaqi,
raioni, sofeli). magaliTad, erT-erT qveyanaSi aRmoCenil iqna kavSiri asTmis sawinaaRmdego
preparatebis gayidvis moculobasa da asTmiT gamowveul sikvdilianobas Soris. aseTi kavSirebi
SeiZleba Seswavlil iqnas sxvadasxva qveyanaSi erTdroulad erTnairi populaciebis SedarebiT
an erT qveyanaSi erTi da igive populaciis sxvadasxva periodSi SeswavliT. meore SemTxvevaSi
SeiZleba gamovricxoT socialur-ekonomikuri faqtorebis zemoqmedeba, romlebmac SesaZlebelia,
xeli SeuSalos ekologiur kvlevebs.
ekologiuri kvlevebi Sesasruleblad advilia, amitomac maT xSirad iyeneben, magram
zogjer miRebuli Sedegebis interpretacia gaZnelebulia, radgan Sedegebis yovelmxriv axsna
ver xerxdeba. amis sailustraciod SeiZleba moviyvanoT Semdegi magaliTi. CineTis erT-erT
provinciaSi – xenanSi dadgenil iqna, rom saylapavis kiboTi daRupul pacientebSi maRali iyo
marilis moxmarebis done, e.i. arsebobs asociacia am or faqtors Soris, magram aseT dros
Zalian Znelia gamoiricxos sxva faqtorebis moqmedeba, magaliTad, alkoholis Warbi moxmareba,
ramac aseve SeiZleba gazardos saylapavis kibos ganviTarebis albaToba. amdenad, ekologiuri
kvlevisas, SesaZlebelia gakeTdes araswori daskvna. miuxedavad amisa, ekologiuri kvleva
xSirad aris sawyisi etapi ufro detaluri epidemiologiuri kvlevebisa.

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3.1.1. epidemiologiaSi gamoyenebuli ZiriTadi statistikuri maCveneblebi

epidemiologiuri kvlevebis Catarebis Sedegad miRebuli monacemebis dasamuSaveblad


gamoiyeneba sami ZiriTadi ganzomileba: Tanafardoba, proporcia (procenti) da maCvenebeli.
Tanafardoba aris ori damoukidebeli sididis Sefardeba. igi gamoiTvleba am sidideebis
erTimeoreze SefardebiT _ x / y.
magaliTad, B hepatitis vaqciniT aicra 40 mamakaci da 60 qali. gvainteresebs Tu
rogoria mamakacTa da qalTa Tanafardoba. igi ase gamoiTvleba:
acrili kacebi /acrili qalebi = 40/60 =2/3 anu 3 acril qalze modis 2 acrili
mamakaci.
Tanafardobis dros mricxvelSi da mniSvnelSi arsebul sidideebs Soris, rogorc wesi,
ar aris specifikuri damokidebuleba.
proporcia aris ori ricxvis ganayofi, sadac mricxveli CarTulia mniSvnelSi da
Sefardeba meryeobs 0-dan 1-mde an 0-dan 100%-mde.
magaliTad, wina monacemebis safuZvelze SeiZleba gamovTvaloT vaqcinirebul mamakacTa
proporcia:
mamakacebi / mamakacebi+qalebi= 40/40+60= 40/100= 0,4 anu 40%-s.
e. i. B hepatitis vaqciniT acrilTa Soris mamakacebi Seadgenen 40%-s.
yvelaze ufro xSirad gamoiyeneba maCvenebeli. unda aRiniSnos, rom proporciis
gamoTvlisas miRebuli sidideebi eqstensiur maCveneblebs warmoadgenen.
maCvenebeli (intensiuri maCvenebeli) aris ori ricxvis ganayofi, sadac mricxvelSi
Setanilia movlenaTa raodenoba, romelsac akvirdebian mocemuli drois ganmavlobaSi, xolo
mniSvnelSi aris mosaxleobis is raodenoba, romelTa Sorisac am movlenas hqonda adgili.
amasTan, mniSvneli moicavs drois intervalsac. maCvenebeli gviCvenebs Tu ramdenad swrafad
warmoiSveba movlena droSi.

sadac n = 3-s, 4-s an 5-s.


maCveneblis magaliTebia incidentoba, prevalentoba, sikvdilianoba da sxva. magaliTad
2020 wels B qalaqSi A hepatitis 100 SemTxveva dafiqsirda. am qalaqis mosaxleoba imave
periodSi Seadgenda 60 000-s. gvinda gamovTvaloT maCvenebeli.
100
37
maCvenebeli = × 100 000 = 166.6
60 000/weli
rogorc vxedavT Tanafardoba, proporcia da maCvenebeli, rogorc sixSiris sazomebi,
erTmaneTisagan mniSvnelovnad ar gansxvavdebian.
aqve SeiZleba moviyvanoT Tanafardobis, proporciis da maCveneblis ZiriTadi
maxasiaTeblebi:

cxrili #2
ganzomilebaTa daxasiaTeba

ganzomilebis saxe ganzomilebis xasiaTi


Tanafardoba ori damoukidebeli ricxvis ganayofi
proporcia (procenti) ori dakavSirebuli ricxvis ganayofi.mricxveli
mniSvnelis Semadgeneli nawilia
maCvenebeli ori dakavSirebuli ricxvis ganayofi. mricxveli
mniSvnelis Semadgeneli nawilia. dro
yovelTvis gaTvaliswinebulia mniSvnelSi
rodesac gvinda erTmaneTisagan ganvasxvavoT Tanafardoba, proporcia da maCvenebeli,
amisaTvis, upirveles yovlisa, unda davsvaT kiTxva, CarTulia Tu ara mricxveli mniSvnelSi?
Tu ara, maSin gvaqvs Tanafardoba, Tu diax, maSin ismeba kiTxva - aris Tu ara dro Setanili
mniSvnelSi? Tu ara, maSin gvaqvs proporcia, Tu diax, aseT SemTxvevaSi _ maCvenebeli. es
yvelaferi naCvenebia #1 sqemaze:
sqema #1.

38
daavadebis gavrcelebis da maTi mniSvnelobis dasadgenad, aseve populaciis janmrTelobis
gamokvlevisas absoluturi ricxvebis gamoyenebas naklebi mniSvneloba eniWeba, radgan isini
saSualebas ar iZleva SevadaroT avadobis done sxvadasxva qveyanaSi, regionSi, mxareSi, droSi,
asakobriv, sqesobriv, Tu socialur jgufebSi. magaliTad, 2020 wels A qalaqSi registrirebul
iqna difTeriis 3 SemTxveva, B qalaqSi – 12. am ori ricxvis Sedarebis safuZvelze SeiZleba
gakeTdes daskvna, rom am wels difTeria B qalaqSi ufro iyo gavrcelebuli, vidre A qalaqSi,
rac ar aris swori. imis dasadgenad, Tu sad ufro intensiurad iyo 2020 wels difTeria
gavrcelebuli, saWiroa SefardebiTi maCveneblebis gamoyeneba. saerTodac epidemiologiaSi
analitikuri miznebisaTvis, rogorc wesi, gamoiyeneba SefardebiTi maCveneblebi.
arsebobs Semdegi saxis SefardebiTi maCveneblebi: eqstensiuri maCvenebeli, intensiuri
maCvenebeli, TvalsaCinoebis maCvenebeli da agreTve, standartizebuli koeficientebi.
eqstensiuri maCveneblebi farTod gamoiyeneba maSin, rodesac saWiroa movlenis an sagnis
struqturis Seswavla. am SemTxvevaSi mTeli sidide iyofa calkeul Semadgenel nawilebad da
gamoiangariSeba maTi xvedriTi wili procentebSi mTelTan SedarebiT. amis magaliTi mocemulia
cxril #3-Si.
cxrili #3
A hepatitiT daavadebulTa hospitalizaciis maCveneblebi
daavadebis dawyebidan

hospitalizaci hospitalizebul hospitalizebulTa raodenoba


is Ta %-Si
vadebi raodenoba
I-II dRe 12 6.0 %
III dRe 18 9.0 %
IV- V dRe 42 21.0 %
VI- VII dRe 102 51.0 %
VIII dRe da zeviT 26 13.0 %
sul 200 100.0 %

rogorc cxrilidan Cans, A hepatitiT daavadebulTa mxolod 6.0%-is hospitalizacia


xdeba daavadebis dawyebis pirvel-meore dRes. umravlesobis hospitalizacia warmoebs mxolod
mexuTe-meeqvse dRes – 51.0%. es procentebi eqstensiur maCveneblebs warmoadgens. analogiurad
SesaZloa gamoTvlil iqnes, magaliTad, sikvdilianobis mizezebis eqstensiuri maCveneblebi
Semdegi formulis gamoyenebiT:

intensiuri maCveneblebi gviCveneben movlenis an procesis sixSires (done, gavrceleba)


39
garemoSi. ZiriTadi intensiuri maCveneblebi, romlebic gamoiyeneba daavadebis epidemiologiuri
Taviseburebebis Sesawavlad, aris avadobis maCvenebeli da prevalentobis maCvenebeli
(gavrcelebis maCvenebeli). saqarTvelosa da mTlianad yofili sabWoTa respublikebisagan
gansxvavebiT, dasavleTis qveynebSi avadobis maCveneblis nacvlad iyeneben termins “incidentobis
maCvenebeli”. calsaxad unda aRiniSnos, rom rogorc avadobis maCvenebeli, ise incidentobis
maCvenebeli, identuri terminebia.
eqimebi Zalian xSirad erTmaneTSi ureven terminebs prevalentoba da insidensi, amitom
saWiroa maTi ganmarteba. “prevalence” – aris daavadebis yvela SemTxveva, romelic mosaxleobaSi
aris registrirebuli ganurCevlad maTi ganviTarebis vadebisa. “incidence” ki daavadebis
axladgamovlenili SemTxvevebi drois garkveul monakveTSi. anu insidensi (incidentoba) aris
daavadebis axali SemTxvevebis gamovlena drois mocemul monakveTSi gansazRvrul populaciaSi.
igi asaxavs populaciaSi axali SemTxvevebis gamovlenis gavrelebis sixSires. sxvanairad rom
vTqvaT, igi “daavadebis Zalis” ganmsazRvrelia. prevalentoba ki gviCvenebs daavadebis
gavrcelebis intensiurobas populaciaSi drois mocemuli momentisaTvis.
avadobis maCveneblis gamosaTvlelad drois gansazRvrul monakveTSi, unda vicodeT
daavadebis axali SemTxvevebis raodenoba drois am monakveTSi da mosaxleobis (populaciis)
raodenoba im teritoriaze, romlisTvisac gamoiTvleba es maCvenebeli. avadobis maCveneblis
gamoTvla SeiZleba drois nebismier monakveTSi – 1 kviris, 1 Tvis, 1, 5, 10 wlis da a.S.
periodSi. Tumca umravles SemTxvevaSi mas iTvlian erTwliani periodisTvis. rogorc avadobis,
ise prevalentobis maCveneblis gamoTvlisas gamoiyeneba “adamiani- dro”. wlis manZilze erTi
adamiani aris erTi adamiani – weli, 5 adamiani – 5 adamiani-weli da a.S.
avadobis (incidentobis) maCvenebeli
A
I=  10 n sadac
N

A – daavadebis axali SemTxvevebis raodenobaa drois mocemul monakveTSi


N – populaciis (mosaxleobis) saSualo raodenoba drois mocemul monakveTSi mocemuli
teritoriisaTvis. mosaxleobis raodenobis mniSvnelovani cvlilebebisas, misi saSualo
raodenoba Semdegi formuliT gamoiangariSeba:

N1 + N 2
N=
2

sadac N1 da N2 mosaxleobis raodenobaa saanalizo periodis dasawyisSi da boloSi;

40
n – tolia 3-is, 4-is an 5-is, imis mixedviT, Tu avadobis maCveneblis gamoTvla gvinda
1000, 10 000, an 100 000 mosaxleze.
magaliTad, gvinda ganvsazRvroT, borjomis raionSi 2020 wels wiTelaTi avadobis
maCvenebeli. amisaTvis unda vicodeT, am raionSi 2020 wels registrirebuli wiTelas
SemTxvevebis ricxvi da mosaxleobis saSualo raodenoba am wlisaTvis. vTqvaT, 2020 wels
registrirebul iqna 52 SemTxveva, xolo mosaxleobis saSualo raodenoba iyo ormoci aTas
xuTasi.

52
I= -------------------------------- X 105 = 128.4
40 500 adamiani-weli

ese igi borjomis raionSi 2020 wels wiTelaTi avadobis maCvenebeli udris 128.4
adamian-wels.
avadobis maCveneblis epidemiologiuri interpretaciisas unda aRiniSnos, rom calke
aRebuli es maCvenebeli yvelaze ufro kargad axasiaTebs saanalizo periodSi daavadebis
gavrcelebis saSualo intensivobas.
aqve unda aRiniSnos, rom avadobis maCveneblis gamosaTvlelad mniSvnelSi zogjer
mosaxleobis (populaciis) saSualo raodenobas ki ar uTiTeben, aramed drois mocemul
monakveTSi riskis qveS myof populacias. ras warmoadgens es cneba? populaciis nawils,
romelic mgrZnobiarea mocemuli daavadebisadmi, ewodeba riskis qveS myofi populacia. Cvens
mier zemoT moyvanil magaliTSi borjomis raionis saSualo mosaxleoba da wiTelas riskis qveS
myofi populacia erTi da igive sidideebia. zogjer ki es sidideebi SeiZleba ar daemTxves.
magaliTad, borjomis raionSi saSvilosnos yelis kibos avadobis maCveneblis gamoTvlisas
riskis qveS myofi populacia iqneba raionis mxolod qalTa mosaxleoba.

prevalentobis (gavrcelebis) maCvenebeli damokidebulia avadobis maCvenebelze da


daavadebis mimdinareobis xangrZlivobaze. rac metia daavadebis mimdinareobis dro, miT metia
41
prevalentobis maCvenebeli. magaliTad, wiTela ZiriTadad xanmokle drois ganmavlobaSi (2-3
kvira) mimdinareobs. aseT SemTxvevaSi avadobis da prevalentobis maCvenebeli erTdaigive ricxvs
udris. amas ver vityviT qronikulad mimdinare daavadebebis dros. magaliTad, Saqriani
diabetisas, romlis mimdinareoba wlobiT ganisazRvreba, prevalentobis maCvenebeli bevrad
aRemateba avadobis maCvenebels; amitomac qronikuli daavadebebisas ufro informaciulia
prevalentobis maCvenebeli. Tumca qronikuli daavadebebis gavrcelebis Taviseburebebis Sefasebis
mizniT gamoiyeneba orive – rogorc avadobis, aseve prevalentobis maCveneblebi, xolo mwvave
daavadebebis SemTxvevaSi, mxolod incidentobis maCvenebeli.
qronikuli daavadebebis SemTxvevaSi, maRali prevalentoba SeiZleba iyos Sedegi maRali
incidentobis da daavadebis xangrZlivi mimdinareobisa. magaliTad, insuliniT Saqriani diabetis
mkurnalobisas, izrdeba am daavadebis prevalentoba. Tavis mxriv, dabali prevalentoba SeiZleba
gapirobebuli iyos dabali incidentobiT an daavadebis xanmokle mimdinareobiT (swrafi
gamojanmrTeleba an sikvdili). prevalentobis Semcireba SeiZleba ganapirobos, erTis mxriv,
incidentobis Semcirebam, an mkurnalobis xarisxis gaumjobesebam, iseve, rogorc im faqtorebma,
romlebic daavadebis mimdinareobis avTvisebianobas da swraf sikvdils iwveven.
Semdegi metad mniSvnelovani maCvenebeli aris sikvdilianobis maCvenebeli, romelic metad
informaciulia da amasTan misi gamoTvlisaTvis monacemebi advili Sesagrovebelia. mraval
qveyanaSi arsebobs wesi adamianis gardacvalebis Semdeg gakeTdes Sesabamisi Canawerebi da
Seivsos specialuri gardacvalebis mowmoba, sadac miTiTebulia gardacvalebis mizezi, asaki
sqesi, sacxovrebeli adgili. saqarTveloSic adamianis gardacvalebis Semdeg ivseba es mowmoba,
sadac aRniSnulia CamoTvlili parametrebi. aseTi mowmobebis da Canawerebis arseboba bevrad
aadvilebs sikvdilianobis realuri maCveneblis gamoTvlas. unda aRiniSnos, rom SesaZlebelia
mTeli rigi monacemebi ar iyos zusti, rac gansakuTrebiT sikvdilianobis mizezs exeba. rac
ufro ganviTarebulia qveyanaSi medicina da diagnostikis xarisxi, miT ufro zustad xdeba
sikvdilis mizezis gansazRvra da Sesabamisad ufro zusticaa sikvdilianobis maCvenebeli.
yvelaze ufro xSirad xdeba sikvdilianobis uxeSi (saerTo) maCveneblis, anu, ubralod,
sikvdilianobis maCveneblis gamoTvla.

sikvdilianobis maCvenebeli SeiZleba gamoTvlil iqnes calkeuli nozologiuri


erTeulebisaTvis, aseve qveynis, regionis, raionis, qalaqis, soflisaTvis.
sikvdilianobis maCvenebeli ama Tu im daavadebisas drois manZilze SeiZleba Seicvalos.

42
amis sailustraciod SeiZleba moviyvanoT sikvdilianobis maCveneblebi zogierTi daavadebis
dros amerikis SeerTebul StatebSi meoce saukunis dasawyissa da bolos.
gasuli saukunis dasawyisSi amerikaSi yvelaze maRali sikvdilianobis maCvenebliT 100
aTas mosaxleze gripi da pnevmoniebi xasiaTdeboda – 202.2; tuberkulozi – 184.4; diarea da
enteritebi – 139.9; gul-sisxlZarRvTa sistemis daavadebebi – 137.4; insulti – 108.9; kibo –
64.0. meoce saukunis bolos sikvdilianobis yvelaze maRali maCvenebeli ukve gulsisxlZarRvTa
sistemis daavadebebis dros gvxvdeba – 189.0; Semdeg modis kibo – 161.5; gripis da pnevmoniebis
dros igi mxolod 21.9 iyo. sikvdilianobis maCveneblebis cvlilebebis msgavsi tendencia
msoflios umravles qveyanaSi da maT Soris, saqarTveloSic aRiniSneba. saukunis win
sikvdilianobas yvelaze xSirad infeqciuri daavadebebi iwvevdnen, dReisaTvis - gul-
sisxlZarRvTa sistemis daavadebebi da avTvisebiani warmonaqmnebi.
sxvadasxva populaciis da dasaxlebuli adgilebis sikvdilianobis maCveneblebis
Sedarebisas SeiZleba Sedegebis araswori interpretacia gamomdinare maTi gansxvavebuli
asakobrivi, sqesobrivi, rasobrivi, eTnikuri da socialuri Semadgenlobis gamo. am
parametrebidan gansakuTrebiT didi mniSvneloba eniWeba asakobriv faqtors, radgan Zalian
xSirad daavadeba da sikvdili asakTan aris asocirebuli.
xSir SemTxvevaSi sakmaod informaciulia proporciuli sikvdilianobis maCveneblis
gamoTvla, romelic gviCvenebs ama Tu im daavadebiT gardacvlilTa xvedriT wils
gardacvalebulTa saerTo raodenobaSi. rac metia proporciuli sikvdilianobis maCvenebeli, miT
ufro did zians ayenebs es daavadeba populaciis janmrTelobas da piriqiT.

43
dedaTa sikvdilianobis maCvenebeli Zalian variabiluria sxvadasxva qveyanaSi. evropaSi igi
saSualod 10-is farglebSia, xolo afrikis zogierT qveyanaSi 500-s uaxlovdeba 100 000
cocxladSobilze.
absoluturi da SefardebiTi sidideebis Sedarebisa da ukeT aRqmis mizniT xSirad
iyeneben TvalsaCinoebis maCveneblebs. sixSirisa da ganawilebis maCveneblebisagan gansxvavebiT, mas
gamoiTvlian iseTi sidideebisagan, romlebic erTmaneTTan uSualod ar arian dakavSirebulni.
TvalsaCinoebis maCvenebeli ufro naTel warmodgenas gvaZlevs movlenis cvlilebebis xasiaTze.
am mizniT erT-erT sidides irCeven rogorc Sedarebis safuZvels, anu Tvlian, rom igi udris 1-
s, 10-s, 100-s an 1000-s da a.S. Semdeg ki danarCen sidideebs gadaiangariSeben bazisuri sididis
mixedviT (cxrili #4).

cxrili #4
eqim epidemiologTa raodenoba q. TbilisSi 1970-1990 wlebSi

weli eqimTa raodenoba TvalsaCinoebis matebis tempi nazardis tempi


wlebis mixedviT maCvenebeli
1970 102 100.0 - -
1975 123 120.6 120.6 20.6
1980 134 131.4 108.9 8.9
1985 146 143.1 108.9 8.9
1990 157 153.9 107.5 7.5

rogorc cxrilidan Cans, Tu 1970 wels eqimTa raodenobas miviRebT pirobiTad


100.0-ad, maSin 1975 wels TvalsaCinoebis maCvenebeli Semdegnairad gamoiangariSeba:

44
analogiurad SeiZleba gamoviangariSoT TvalsaCinoebis maCvenebeli Semdeg wlebSic.
TvalsaCinoebis maCveneblebs xSirad iyeneben dinamikuri rigebis analizis dros, radgan igi
saSualebas gvaZlevs TvalsaCino formebSi warmovidginoT Sesaswavli movlenis ZiriTadi
tendencia. mis dasaxasiaTeblad yvelaze metad gamoiyeneba matebisa da nazardis tempi.
matebis (zrdis) tempi gviCvenebs momdevno donis Sefardebas winamdebare donesTan
gamoxatuls procentebSi da miuTiTebs Tu ramdeni procentiT gaizarda (an Semcirda) done.
magaliTad, eqim-epidemiologTa raodenobis maCvenebeli 1990 wels 1985 welTan SedarebiT ase
gamoiTvleba:
153.9
X 100 = 107.5 %
143.1

dinamikur rigSi maCveneblebi SeiZleba Seicvalos sxvadasxva siswrafiT, rac xasiaTdeba


nazardis tempiT. Tu dinamikur rigSi maCvenebeli izrdeba, maSin nazards dadebiTi mniSvneloba
eniWeba , xolo Tu klebulobs – maSin uaryofiTi da iwereba minus niSniT.
nazardis tempi (procentebSi) udris matebis temps gamoklebuli 100.

3.1.2 sikvdilianobisa da avadobis maCveneblebis standartizacia

mosaxleobis sikvdilianobaze Zalian did gavlenas axdens asaki. amitom ori populaciis
sikvdilianobis maCveneblebis Sedarebisas aucilebelia am momentis gaTvaliswineba. magaliTad,
1981 wels floridis StatSi sikvdilianobis maCvenebeli 100 000 kacze udrida 10.9-s,
aliaskaSi 4.4.-s. erTi SexedviT, daskvna Zalian martivia. aliaskaSi sikvdilianobis done
floridasTan SedarebiT 2.5-jer naklebia, rac SeiZleba vifiqroT, rom gapirobebulia aliaskaSi
samedicino momsaxurebis ufro maRali doniT, rac arasworia. radikaluri gansxvavebis mizezia
floridaSi xanSiSesuli asakis pirTa siWarbe aliaskaTan SedarebiT, sadac mosaxleoba umetesad
axalgazrdobiT aris warmodgenili.
analogiuri magaliTis moyvana SeiZleba avadobis maCveneblebis drosac. magaliTad, 1971
wels wiTelaTi avadoba marneulis raionSi 221.2 iyo; xolo borjomis raionSi – 176.4.
arsebuli gansxvavebis mizezebi SeiZleba iyos ramdenime:
1. acrebiT mocvis sxvadasxva done;
2. diagnostikis gansxvavebuli done;
45
3. mosaxleobis sxvadasxva asakobrivi struqtura.
CamoTvlilidan amJamad CvenTvis yvelaze mniSvnelovania mesame faqtori. wiTela bavSvTa
daavadebaa da rac metia raionSi bavSvTa kontingenti, miT metia am infeqciis gavrcelebis
albaToba. am faqtoris gamosaricxavad saWiroa erTis mxriv avadobis maCveneblebis gamoTvla
asakis mixedviT, da meores mxriv avadobis maCveneblebis standartizacia.
avadobisa da sikvdilianobis maCveneblebis standartizaciis aucileblobis kidev erTi
magaliTi naCvenebia cxril #5-Si.
rogorc vxedavT, sikvdilianobis saerTo maCvenebeli, TeTrkanianebisTvis ufro maRalia,
vidre SavkanianebisTvis, maSin rodesac, asakobrivi maCveneblebi piriqiTaa. amis mizezia
SavkanianTa da TeTrkanianTa sxvadasxva asakobrivi struqtura. amitom, rodesac vadarebT, ori
regionis avadobisa da sikvdilianobis maCveneblebs, erTis mxriv aucilebelia, asakobrivi
maCveneblebis gamoTvla da meores mxriv, maCvenebelTa standartizacia.

cxrili #5
1972 wels baltimorSi sikvdilianobis maCvenebli 1000 adamianze
asakisa da rasis mixedviT

45-64 weli
18-44 weli

65 da meti
5-17 weli
1 wlamde

1-4 weli
sul

asaki

TeTrkaniani 15.2 13.5 0.6 0.4 1.5 10.7 59.7


Savkaniani 9.8 22.6 1.0 0.5 3.6 18.8 61.1
standartizacia maTematikuri operaciaa, romlis mizania iseTi faqtorebis moqmedebis
gamoricxva, romelic Seswavlis sagans ar warmoadgens.
standartizaciis Catarebis aucileblobis momentebia:
• gamoricxva iseTi faqtorebis moqmedebisa, romelsac Cven ar vikvlevT.
• rodesac avadobis da sikvdilianobis donis Sedareba gvinda or populaciaSi, magram
arsebuli gansxvavebis gamo, romlebic moqmedeben avadobaze da sikvdilianobaze (asaki, sqesi,
rasa) es ar xerxdeba.
standartizaciis ori saxe arsebobs: pirdapiri da arapirdapiri.
standartizebuli koeficientis anu maCveneblebis gamoTvlis pirdapiri wesis saCveneblad
SeiZleba moviyvanoT magaliTi. mosaxleobis or – A da B populaciaSi Seswavlil iqna
hipertonuli daavadebis gavrcelebis maCvenebeli (cxrili #6).

46
cxrili #6
standartizebuli maCveneblebis gamoTvlis pirdapiri wesi:
I etapi – avadobis asakobrivi maCveneblebis miReba

A populacia B populacia

asakobrivi jgufebi

maCven.
1000 adamian-welze

1000 adamian-welze
avadobis maCven.
gamokvleulTa

gamokvleulTa

daavadebulTa
daavadebulTa
raodenoba

raodenoba

raodenoba

raodenoba
20 wlamde 35 1 avadobis28.6 28 1 35.7
20-29 weli 60 3 50.0 67 4 59.7
30-39 weli 125 5 40.0 85 5 58.8
40-49 weli 230 10 43.5 812 53 65.3
50-59 weli 280 24 85.7 420 29 69.0
60 weli da meti 1920 346 180.2 444 76 171.2
sul 2650 389 146.8 1856 168 90.5

rogorc aRniSnuli cxrilidan Cans, A populaciaSi avadobis maCveneblebi populaciis


avadobis maCveneblebs 1.6-jer aRemateba. ibadeba kiTxva, Tu ramdenad realuria, miRebuli
suraTi da xom ar aris igi gamowveuli populaciaTa sxvadasxva asakobrivi struqturiT. am
kiTxvaze pasuxis gasacemad viTvliT standartizebul maCvenebels, risTvisac, upirveles
yovlisa, virCevT standarts, romelic warmoadgens orive populaciis saSualo asakobriv
struqturas (cxrili #7).
cxrili #7
standartizebuli maCveneblebis gamoTvlis pirdapiri wesi:
II etapi – Sesadarebeli jgufebis standartis miReba

gamokvleulTa raodenoba
asakobrivi
Apopulacia

Bpopulacia
A

asakobrivi jgufebi struqtura,


sul

20 wlamde 35 28 63 14.0
20-29 weli 60 67 127 28.2
30-39 weli 125 85 210 46.6
40-49 weli 230 812 1042 231.2
50-59 weli 280 420 700 155.4
60 da zeviT 1920 444 2364 524.6
sul 2650 1856 4506 1000.0
47
mesame etapi aris ukve standartizebuli koeficientebis gamoTvla (cxrili #8).
standartizebuli maCvenebeli = mocemuli asakis avadobis maCvenebeli x igive asakis standartze
da Sefardebuli 1000-ze. magaliTad, 20 wlamde asakis pirebSi populaciisaTvis
standartizebuli maCvenebeli udris:

28.6 X14.0
= 0.4
1000

cxrili #8
standartizebuli maCveneblebis gamoTvlis pirdapiri wesi:
III etapi – gamoTvlebis damTavreba
avadobis maCven. standartizebuli
asakobrivi jgufebSi asakobrivi maCveneblebi
jgufebi ganawilebis
Apopulacia

Bpopulacia

populacia
populacia
standarti
A

B
20 wlamde 28.6 35.7 14.0 0.4 0.5
20-29 w. 50.0 59.7 28.2 1.4 1.7
30-39 w. 40.0 58.8 46.6 1.9 2.7
40-49 w. 43.5 65.3 231.2 10.1 15.1
50-59 w. 85.7 69.0 155.4 13.3 10.7
60w. da meti 180.2 171.2 524.6 94.5 89.8
sul 146.8 90.5 1000.0 121.6 120.5

bolo 2 svetis ukanaskneli maCvenebeli aris TiToeuli asakis koeficientebis jami.


mocemul SemTxvevaSi es ori sidide praqtikulad erTmaneTs emTxveva, rac miuTiTebs, rom
avadobis maCveneblebis sxvaoba A da B populaciaSi aris Sedegi ara obieqturi mizezebisa, aramed
ganpirobebulia Sesadarebel jgufebSi (amonarCevebSi) gamokvleulTa sxvadasxva asakobrivi
struqturiT.
standartizebuli koeficientebis mniSvnelobis Seufasebloba ar SeiZleba, Tumca
yovelTvis unda gvaxsovdes, rom isini pirobiTi sidideebia da gamoiyeneba mxolod SedarebiTi
analizisaTvis, magram ara Sesaswavli epidemiologiuri movlenis WeSmariti sixSiris
Sesafaseblad.

48
3.2 analizuri epidemiologiuri meTodi

epidemiologiuri kvlevebi or ZiriTad jgufad iyofa: 1. eqsperimentuli da 2. analizuri


(observaciuli). kvlevebi, romlis mimdinareobaSi ereva adamiani, eqsperimentul kvlevebs
uwodeben. riskis faqtoris gavlenis dasadgenad ama Tu im procesebze da maT Soris mizez-
Sedegobrivi kavSiris gamosavlenad yvelaze ufro mizanSewonilia eqsperimentuli meTodis
gamoyeneba. dgeba adamianTa ori identuri jgufi, erT maTganze xdeba zemoqmedeba riskis
faqtoriT da warmoebs dakvirveba orive jgufze. avadobis donis sxvaoba am jgufebs Soris
ganpirobebulia riskis faqtoriT.
umravles SemTxvevaSi aseTi eqsperimentebis saSualebiT riskis faqtorebis moqmedebis
Seswavla mravali mizezis gamo praqtikulad SeuZlebelia. sadReisod aris mravali kiTxva,
romlebzec pasuxis gacema metad mniSvnelovania. magaliTad, ramdenad ufro maRalia gul-
sisxlZarRvTa sistemis daavadebaTa ganviTarebis riski im pirebSi, romlebic dabali fizikuri
aqtivobiT xasiaTdebian, iwvevs Tu ara radiotelefonebis gamoyeneba tvinis simsivneebis
ganviTarebas da a.S. am kiTxvebze pasuxis gasacemad saWiroa eqsperimentebis Catareba, rac
SeuZlebelia. pirvel rigSi, aseTi eqsperimentebi gagrZeldeboda ramdenime aTeuli weli, meorec
araeTikuria adamianTa jgufebze riskis faqtoriT zemoqmedeba an dieta xangrZlivi drois
ganmavlobaSi ganisazRvros gareSe pirebis mier. amitom riskis faqtorebis zegavlenis
Sesaswavlad saWiroa sxva meTodebis gamoyeneba.
epidemiologiur kvlevebs, romlebSic mkvlevari monacemebs agrovebs movlenebis bunebriv
mimdinareobaze dakvirvebis gziT da ar ereva masSi aqtiurad, observaciuli kvlevebi ewodeba.
observaciul kvlevebs miekuTvneba:
1. kohortuli kvlevebi;
2. SemTxveva-kontroliT kvlevebi;
3. jvaredini (erTmomentiani) kvlevebi.
pirveli ori kvleva amave dros analizur kvlevebs miekuTvneba.
Tu deskriptuli epidemiologiuri meTodis saSualebiT dgindeba vin, sad da rodis xdeba
avad, analizuri epidemiologiuri kvlevebi saSualebas gvaZlevs, davadginoT, Tu ratom xdebian
avad. kvlevis pirvel etapze movlenis aRweris Semdeg yalibdeba hipoTeza/hipoTezebi riskis
faqtorebis Sesaxeb. analizuri epidemiologiuri meTodiT xdeba am hipoTezebis dadastureba an
uaryofa.
cal-calke ganvixiloT aRniSnuli tipis kvlevebi.

49
3.2.1. kohortuli kvleva

termini kohorta (cohort) niSnavs adamianTa jgufs, romlebSic isini gaerTianebuli arian
erTi konkretuli epidemiologiuri niSniT da romlebzec xdeba dakvirveba garkveuli drois
manZilze, raTa dadgindes, Tu ra mouvaT maT momavalSi. niSani, romlis mixedviTac SeiZleba
kohortis formireba, metad mravalferovania. es SeiZleba iyos asaki, sqesi, dabadebis weli,
profesia, socialuri mdgomareoba, erovneba da a.S. kvlevebs, romelTa drosac gamoiyeneba
kohorta, ewodeba kohortuli. aseTi kvlevisas rom miviRoT sarwmuno informacia riskis
faqtorebis Sesaxeb, saWiroa ori aucilebeli pirobis Sesruleba.
upirveles yovlisa, kohortaze meTvalyureobis vada unda aRematebodes Sesaswavli
daavadebis bunebrivi mimdinareobis xangrZlivobas, misi latenturi periodis CaTvliT, raTa
riskis faqtors hqondes gamovlenis SesaZlebloba. Tu Cven gvinda davadginoT bavSvTa asakSi
yelis midamoSi dasxiveba iwvevs Tu ara farisebri jirkvlis kibos, maSin xuTwliani
prospeqtuli dakvirveba arasakmarisia, radgan, rogorc wesi, periodi dasxivebidan farisebri
jirkvlis kibos ganviTarebamde (daavadebis latenturi periodi), ufro xangrZlivia.
meore, kohortaSi gaerTianebul yvela pirze meTvalyureoba unda grZeldebodes
dakvirvebis bolomde, radgan kohortidan adamianTa gamokleba da misi mizezi gavlenas axdens
saboloo Sedegebze da informacia, romelsac Cven viRebT arasruli kohortisagan, SeiZleba
damaxinjebuli iyos.
prospeqtuli kvlevis dasawyisSi kohortaSi Segvyavs mxolod iseTi pirebi, romlebsac
ara aqvT Sesaswavli daavadeba, magram momavalSi SesaZloa ganuviTardeT (sur. #7).

suraTi #7.

50
magaliTad, endometriumis kibos ganviTarebis xelSemwyobi riskis faqtorebis
Seswavlisas kohortaSi ar unda SeviyvanoT iseTi qalebi, romlebsac aqvT saSvilosnos
daavadeba.
kohortuli kvlevis dasawyisSive warmoebs riskis faqtorebis eqspoziciis da
eqspoziciis gareSe myofi pirebis gancalkeveba da ori kohortuli jgufis Seqmna da aRniSnul
jgufebze anu kohortebze dakvirveba garkveuli periodis ganmavlobaSi (magaliTad, mwevelebi
da aramwevelebi), raTa dadgenil iqnes, monawileTa Soris vis ganuviTarda CvenTvis saintereso
daavadeba. kohortuli kvlevis principi kargad Cans suraTi #7-dan.
kohortul kvlevebs uwodeben xangrZlivs (longitudinal), radgan dakvirveba xdeba
xangrZlivi droiT, ufro xSirad ki prospeqtuls (prospective) – radganac kohortis formireba
xdeba awmyo droSi da dakvirveba grZeldeba momavalSi. zogjer avadobis (incidence) kvlevasac –
radgan Sefasebis ZiriTadi saSualebaa daavadebis axali SemTxvevebis registracia gansazRvruli
drois manZilze.
kohortuli kvlevis magaliTad SeiZleba movitanoT kvleva, romelmac didi roli iTamaSa
gul-sisxlZarRvTa sistemis daavadebaTa riskis faqtorebis gansazRvraSi.
1949 wels q. framinhemSi, romelic mdebareobs bostonis maxloblad, daiwyo kvleva,
romelic miznad isaxavda im riskis faqtorebis gamovlenas, romlebic xels uwyoben gulis
iSemiuri daavadebis ganviTarebas.
30-59 wlis daaxloebiT 10 000 qalaqis mcxovrebidan reprezentulad SerCeul iqna
5209 mamakaci da qali. maTi gamokvleviT dadginda, rom 5127 adamiani ar iyo gulis iSemiuri
daavadebiT avad. amitom Semdgom kvlevaSi mxolod isini monawileobdnen. am pirebs yovel or
weliwadSi erTxel utardebodaT gamokvlevebi gulis iSemiuri daavadebis gamosavlenad. kvleva
grZeldeboda 30 wlis manZilze da dadgenil iqna, rom gulis iSemiuri daavadebis ganviTareba
dakavSirebulia arteriuli wnevis momatebasTan, qolesterinis maRal donesTan, Tambaqos
mowevasTan, glukozisadmi tolerantobis darRvevasTan da marcxena parkuWis hipertrofiasTan.
gamovlinda mniSvnelovani gansxvaveba gulis iSemiuri daavadebis ganviTarebis riskisa maT Soris,
visac arc erTi aRniSnuli faqtori ar aReniSneboda, gansxvavebiT maTgan, visac yvela faqtori
uvlindeboda.
kohortuli kvlevis klasikuri magaliTia aseve dolis da hilis gamokvlevebi, romlebmac
safuZveli Cauyares epidemiologiur kvlevebs, romelTa saSualebiT dadginda Tambaqos mowevis
mavne roli mravali daavadebis ganviTarebaSi. amis dasturad SeiZleba moviyvanoT mizez-
Sedegobrivi kavSiri britanel eqimebs Soris Tambaqos mowevasa da gulis koronaruli
daavadebiT gamowveul sikvdilianobas Soris (cxrili #9).

51
rogorc vxedavT, 35-44 wlis asakSi gulis koronaruli daavadebebis Sedegad gamowveuli
sikvdilianoba mwevelebSi 6-jer ufro xSiria, vidre aramwevelebSi.

cxrili #9
gulis koronaruli daavadebis mizeziT gamowveuli sikvdilianoba mwevelebsa da
aramwevelebs Soris
asakobrivi sikvdilianobis maCvenebli atributuli fardobiTi
jgufi 1000 kacze riski riski
mwevelebi aramwevelebi
35-44 0.6 0.1 0.5 6.0
45-54 2.4 1.1 1.3 2.2
55-64 7.2 4.9 2.3 1.5
65-74 14.7 10.8 3.9 1.4
75-84 19.2 21.8 -2.6 0.9
sul 4.4 2.6 1.8 1.7

rogorc aRiniSna, upiratesad kohortuli kvlevisas kohortis Camoyalibeba xdeba awmyo


droSi da dakvirveba warmoebs momaval droSi. aseT kvlevebs xSirad paralelur kohortul
kvlevebs uwodeben. arsebobs, agreTve, istoriuli anu retrospeqtuli kohortuli kvlevebic.
am SemTxvevaSi kohortis gamoyofa xdeba saarqivo masalis mixedviT da Sedegebis Seswavla xdeba
awmyo dromde. kohortuli kvlevis am ori tipis arsi mocemulia suraT #8-ze.
suraTi #8.

ufro sasurvelia prospeqtuli kohortuli kvleevbis Catareba, radgan aseT dros


monacemebis Segroveba xdeba konkretuli gamokvlevebis mizniT, rac saSualebas iZleva Tavidan
aviciloT sistemuri Secdomebi, romlebic amaxinjeben saboloo Sedegs. istoriuli kohortuli
kvlevisas ki monacemebis Segroveba xdeba saarqivo masalaze (umetesad avadmyofobis
istoriidan), sadac monacemebi fiqsirebulia mocemuli kvlevis miznis miuxedavad. aseTi
Sedegebi yovelTvis ar pasuxoben mkacri samecniero kvlevis moTxovnebs.
kohortuli kvlevisas, rodesac xdeba eqspozirebulTa (romelTac ganicades riskis
faqtorTa moqmedeba) da araeqspozirebulTa jgufebis formireba, gadamwyveti mniSvneloba
52
eniWeba maT dakompleqtebas iseTi pirebiT, romlebsac erTnairi niSnebi aqvT (asaki, sqesi,
socialuri mdgomareoba, ganaTleba da a.S.) da gansxvavdebian mxolod erTi niSniT –
gamosakvlevi riskis faqtoris zemoqmedebiT. mxolod aseT SemTxvevaSia SesaZlebeli miRebuli
Sedegebis sxvaoba aixsnas Sesaswavli riskis faqtorebis zemoqmedebiT.

kohortuli kvlevebis dadebiTi da uaryofiTi mxareebi

riskis faqtoris moqmedebis Sesaswavlad eqsperimentis Semdeg kvlevis yvelaze karg


meTodad iTvleba kohortuli kvlevebi, radgan is saSualebas gvaZlevs, gamovavlinoT
SesaZlebeli riskis faqtoris zemoqmedeba, ise rom Tavidan aviciloT sistemuri Secdomebi,
romlebic, rogorc wesi, gvxvdebian maSin, rodesac faqtoris moqmedebis Sefaseba xdeba mas
Semdeg, rac Sedegi cnobilia. amasTan, kohortuli kvleva iZleva pasuxs kiTxvaze, romelic
gansakuTrebiT klinicistebs ainteresebT – daavaddebian Tu ara adamianebi, romlebmac ganicades
riskis faqtoris zemoqmedeba.
radgan kohortuli kvlevebi iwyeba janmrTel adamianebze dakvirvebiT, is saSualebas
gvaZlevs gaanalizdes ramdenime efeqti. maSin, rodesac raime mizezis gamo ar xerxdeba
eqsperimentuli kvlevis Catareba, maT Sesacvlelad yvelaze ufro misaRebia kohortuli kvleva,
romelic amave dros gvaZlevs saSualebas ganisazRvros daavadebis sixSire.
aseTi kvlevebis ZiriTadi uaryofiTi mxarea is, rom Tu Sedegi iSviaTia (rac sakmaod
xSiria), jgufSi unda SeviyvanoT Zalian didi raodenobis adamianebi. amasTan, saTanado Sedegebis
misaRebad, adamianebi xangrZlivi drois ganmavlobaSi unda iyvnen dakvirvebis qveS. magaliTad,
Cvens mier nimuSad moyvanili q. framinhemis kvlevisas ramdenime wlis manZilze dakvirvebis qveS
5 000 adamianze meti iyo da pirveli rva wlis manZilze gulis iSemiuri daavadebis sxvadasxva
gamovlineba mxolod gamokvleulTa 5 %-s ganuviTarda.
mniSvnelovani uaryofiTi mxarea isic, rom kohortaSi Semavali adamianebi, rogorc wesi,
cxovroben Tavisuflad da ara mkvlevarTa meTvalyureobis qveS. maTTan kontaqtis
SesanarCuneblad saWiroa didi energia, adamianuri da finansuri resursebi. amitomac
kohortuli kvlevebi Zalian Zviria da zogjer milionobiT dolari jdeba. es momenti
sagrZnoblad zRudavs kohortuli kvlevebis gamoyenebis areals. mas umetesad iyeneben metad
aqtualuri sakiTxebis gadasaWrelad. Cvens qveyanaSi aseTi kvlevebi SezRudul farglebSi
gamoiyeneba.
kohortuli kvlevebis dadebiTi da uaryofiTi mxareebi mocemulia cxrilSi #10.
eqsperimentebisagan gansxvavebiT, observaciuli kvlevebisas da maT Soris, kohortuli

53
kvlevebisas, xSirad gvxvdeba sistemuri Secdomebi. movlenebis Cveulebrivi msvlelobisas
pirebi, romlebic ganicdian riskis faqtoris zemoqmedebas, bevri maCvenebliT gansxvavdebian
Sesadarebeli jgufis pirebisagan, romlebic am faqtoris zemoqmedebas ar ganicdian. Tu am
gansxvavebebs kavSiri aqvT Sesaswavl daavadebasTan, maSin maT SeuZliaT zegavlena moaxdinon im
kavSirebze, romlebic arseboben riskis faqtorsa da daavadebas Soris. amitomac, observaciuli
kvlevebisas metad mniSvnelovania im “xelis SemSleli” faqtorebis mocileba an maTi
nivelireba, romlebic arseboben ZiriTad da sakontrolo jgufebs Soris da gavlenas axdenen
Sedegze. saWiroa aseTi kvlevebi maqsimalurad mivuaxlovoT eqsperimentis pirobebs.
“xelisSemSlel” anu CarTul (damabnevel) faqtorebs uwodeben iseTebs, romlebic
mkvlevarisagan faraven WeSmarit mizez-Sedegobriv kavSirebs. aseTi faqtorebis mocilebis
Semdegi magaliTi SeiZleba moviyvanoT.
cxrili #10
kohortuli kvlevebis dadebiTi da uaryofiTi mxareebi

dadebiTi mxare uaryofiTi mxare


1. miRebuli Sedegebi xasiaTdeba 1. moiTxovs did finansur da
maRali damajereblobiT. adamianur resursebs.
2. pasuxobs klinikur kiTxvaze: 2. mis Catarebas xSirad Wirdeba didi dro.
daavaddebian Tu ara adamianebi, Tu maT 3. kvleva ar gamoiyeneba iSviaTi
ganicades riskis faqtoris zemoqmedeba. daavadebebis SemTxvevaSi.
3. SeiZleba erTdroulad Seswavlil 4. dakvirvebis qveS myofi yvela pirovnebis
iqnes ramdenime gamosavali. monawileoba kvlevis bolomde metad
4. saSualebas gvaZlevs riskis faqtoris rTulia.
moqmedebis Sefasebisas Tavidan aviciloT
sistemuri Secdoma, romelic viTardeba
maSin, rodesac Sedegi ukve cnobilia
(radgan dakvirvebisas ar aris saWiro
raime faqtis gaxseneba).
5. SeiZleba Seswavlili iyos daavadebis
incidentoba
6. gamoiyeneba iSviaTi eqspoziciis
Seswavlis mizniT

ujredul-namgliseburi anemiis (HbAS) dros, zogierTi mkvlevari miuTiTebda zrdisa da


inteleqtis daqveiTebas. amitom Catarda kvlevebi, raTa daedginaT Tu HbAS-is mqone bavSvebs
54
normaluri hemoglobinis (HbAA) mqone bavSvebTan SedarebiT ufro xSirad uvlindebodaT Tu ara
zrdisa da inteleqtis ganviTarebis defeqtebi. formirebul iqna ori jgufi. erTSi Sevidnen
HbAS-is mqone bavSvebi, meoreSi - HbAA-si. sxva maCveneblebis mxriv es orive jgufi iyo
identuri. mxedvelobaSi iqna miRebuli isic, rom bavSvebis zrdaze gavlenas axdens, agreTve,
maTi sqesi, rasa, dabadebis TariRi, sxeulis masa, socialur-ekonomikuri statusi da sxv.
zogierT am faqtors udaod SeiZleba moexdina gavlena kvlevis Sedegebze. amitom mecnierebma
sxva faqtorebis gamoricxva moaxdines Sesabamisi wyvilebis SerCevis meTodiT. TiToeuli
bavSvisaTvis, romelsac hqonda HbAS , SeirCa zustad iseTive bavSvi, romelic misgan ar
gansxvavdeboda sxva parametrebiT, magram hqonda HbAA. gamokvleul iqna 100 axalSobili (50
HbAS-Ti da 50 HbAA-Ti) 3-5 wlis asakamde. araviTari gansxvaveba bavSvTa zrda-ganviTarebaSi ar
yofila gamovlenili. observaciuli kvlevebisas sistemuri Secdomebis Tavidan acilebis
meTodebs Cven kidev davubrundebiT. rogorc vxedavT, sistemuri Secdomebis Tavidan acilebis
mizniT zogjer kohortul kvlevebSic xdeba sakontrolo jgufis SerCeva.

riskis faqtoris Sefaseba

eqims xSirad uwevs Seadaros avadoba or an met jgufSi, romlebic erTmaneTisagan


gansxvavdebian mocemuli faqtoris zemoqmedebis xarisxiT.
arsebobs ramdenime saSualeba, raTa SevafasoT kavSiri riskis faqtoris zemoqmedebas da
avadobas Soris. esenia, damatebiTi anu atributuli riski (riskebis sxvaoba), fardobiTi riski
(riskebis Sefardeba), damatebiTi populaciuri riski da populaciuri riskis damatebiTi wili
(cxrili #11).
cxrili #11
riskis faqtoris Sefaseba

termini kiTxva gansazRvreba

1. damatebiTi anu rogoria avadoba, romelic gapirobebulia AR=Ie-Iē


atributuli riskis faqtorebis zemoqmedebiT
riski (riskebis sxvaoba AR)
2. fardobiTi riski ramdenjer metia avadoba im pirebisa, RR= Ie / Iē
(riskebis Sefardeba RR) romlebmac ganicades riskis faqtorebis
zemoqmedeba, vidre maTi, vinc es zemoqmedeba
ar ganicada
3. damatebiTi populaciuri rogoria avadoba populaciaSi, romelic ARp=ARXP
riski (ARp) dakavSirebulia riskis faqtoris
gavrcelebasTan
4. populaciuri rogoria riskis faqtoris zemoqmedebiT AFp= ARp / Iy
riskis damatebiTi ganpirobebuli daavadebis SemTxvevebis wili
wili (AFp) populaciaSi

55
 Ie - avadoba im pirebSi, romlebmac riskis faqtoris zemoqmedeba ganicades;

Iē - avadoba im pirebSi, romlebmac riskis faqtoris zemoqmedeba ar ganicades; P


P - riskis faqtoris gavrceleba;
Iy - saerTo avadoba populaciaSi.
damatebiTi, anu atributuli riski – es aris sxvaoba riskis faqtoris zemoqmedebis qveS
myofi pirebis avadobisa da im pirTa avadobisa, romlebmac es zemoqmedeba ar ganicades. Tu
davuSvebT, rom sawyisi avadoba sxva mizezebiT aris gapirobebuli, maSin damatebiTi riski es
aris daavadebis ganviTarebis damatebiTi SemTxvevebi, ganpirobebuli riskis faqtoris
zemoqmedebiT. unda aRiniSnos, rom Sedarebis aseTi formisas riskis faqtorebi ganixileba
rogorc daavadebis mizezi da ara ubralod, rogorc markeri. damatebiTi riskis gamoTvlis
wesidan gamomdinare, mas riskTa sxvaobasac uwodeben. atributul risks sxvanairad kidev
absolutur da uSualo risks uwodeben. damatebiTi riski warmodgenas gvaZlevs jandacvis
problemebis masStaburobaze, romlis safuZvelic aris mocemuli faqtori. magaliTad, #12
cxrilidan Cans, rom insultis ganviTarebis damatebiTi riski mwevel qalebSi aramwevelebTan
SedarebiT udris: 49.6-17.7 = 31.9 100 000 adamian/welze, anu Tambaqos moweva mniSvnelovnad
uwyobs xels qalebSi insultis ganviTarebas.

cxrili #12
118 539 qalisgan Semdgar kohortaSi
kavSiri Tambaqos wevasa da insultis ganviTarebas Soris
(Colditzelal., 1988, цит. По В. Белякову и соавт ., 2001)

kvlevaSi monawileTa insultis dakvirvebaSi myofi insultis SemTxvevaTa


kategoria SemTxvevaTa ricxvi adamiani-welis raodenoba 100 aTas
8 wlis manZilze ricxvi adamian-welze
arasodes eweodnen 70 395 594 17.7
Tavi daanebes wevas 65 282 712 27.9
mwevelebi 139 280 140 49.6
sul 274 980 447 30.2
fardobiTi riski saSualebas iZleva gavigoT ramdenjer metia avadoba im pirebSi,
romlebmac riskis faqtoris zemoqmedeba ganicades maTTan SedarebiT, visac es zemoqmedeba ar
ganucdia. fardobiTi riski aris im jgufTa avadobis Sefardeba, romelTac ganicades da ar
ganucdiaT riskis faqtoris zemoqmedeba. fardobiTi riski avadobis absolutur risks ar
gviCvenebs. magaliTad, iSviaTi daavadebis dros fardobiTi riskis maCvenebeli SeiZleba iyos
Zalian maRali, xolo absoluturi riski – dabali. fardobiTi riski gviCvenebs zemoqmedebasa
da daavadebas Soris kavSiris siZlieres. amrigad, es riski aris riskis faqtoris zemoqmedebis
done, romelic mniSvnelovania daavadebis etiologiis Seswavlisas. damatebiTi da fardobiTi
riski asaxavs riskis faqtorebis moqmedebis sxvadasxva aspeqts, gansakuTrebiT, klinikur
56
medicinaSi. amis dasturad SeiZleba moviyvanoT Psaty B.M.-is magaliTi, romelic gviCvenebs
insultis ganviTarebis risks Tambaqos mowevasTan dakavSirebiT (cxrili #13).
cxrili #13
damatebiTi da fardobiTi riskis Sedareba
insultis ganviTarebasa da Tambaqos mowevasa da asaks Soris kavSiris Seswavlisas

asaki avadobis maCvenebeli 1000 fardobiTi riski damatebiTi


pacientze riski
aramwevelebi mwevelebi
45-49 7.4 29.7 4.0 22.3
50-54 17.2 37.0 2.2 19.8
55-59 27.9 64.7 2.3 36.7
60-64 47.4 76.9 1.6 29.5
65-69 80.2 110.4 1.4 30.2

Tu fardobiTi riski asakis matebasTan mcirdeba 4.0-dan 1.4-mde, damatebiTi riski odnav,
magram mainc matulobs imis xarjze, rom xanSiSesul asakSi insultis ganviTarebis Sansi bevrad
izrdeba imis miuxedavad, adamiani eweva Tu ar eweva. amrigad, miuxedavad imisa, rom asakis
matebasTan erTad kavSiri Tambaqos mowevasa da insultis ganviTarebas Soris mcirdeba,
xanSiSesuli mweveli adamianisaTvis izrdeba insultis ganviTarebis riski da igi ufro maRalia,
vidre saSualo asakSi. analogiuri mdgomareobaa Tambaqos mowevasa da koronaruli daavadebebiT
ganpirobebuli sikvdilianobis SemTxvevebs Soris.
radgan damatebiTi riski gviCvenebs daavadebis ganviTarebis damatebiT SesaZleblobas,
klinikur medicinaSi igi ufro informaciulia fardobiT riskTan SedarebiT. samagierod, es
ukanaskneli ukeTesad asaxavs mizezobrivi kavSiris Zalas. magaliTad, roca fardobiTi riski 10-
is da metis tolia, es miuTiTebs rom zemoqmedebasa da Sedegs Soris aris didi kavSiri da igi
ar aris SemTxveviTi.
rig SemTxvevaSi sainteresoa ara marto individualuri riskis maCveneblebi, aramed imis
dadgenac, Tu rogoria riskis faqtoris zemoqmedebiT ganviTarebuli avadobis faqtoris
xvedriTi wili populaciis saerTo avadobaSi. aseTi informacia metad mniSvnelovania
sazogadoebrivi jandacvis organoebisaTvis, radgan igi gvaZlevs saSualebas, ganvsazRvroT, Tu
romeli riskis faqtorebi aris realurad mniSvnelovani da romels ara aqvs didi mniSvneloba
sazogadoebis janmrTelobis saqmeSi. aseTi saxis codna sazogadoebrivi jandacvis organoebs da
maT xelmZRvanelebs exmareba gansazRvron brZolis prioritetuli mimarTulebani, Tu romeli
risk-faqtoris winaaRmdeg gatarebuli RonisZiebebi gazrdian mosaxleobis janmrTelobis dones.
SedarebiT susti risk-faqtoris winaaRmdeg brZolas, romelic populaciaSi farTodaa
gavrcelebuli, ufro meti roli eniWeba, vidre naklebad gavrcelebul Tundac Zlieri riskis
faqtoris winaaRmdeg RonisZiebebis gatarebas. am TvalsazrisiT metad mniSvnelovania damatebiTi
57
populaciuri riskis sididis codna.
damatebiTi populaciuri riskis gamosaTvlelad damatebiTi riskis maCvenebeli mravldeba
populaciaSi riskis gavrcelebis maCvenebelze. es sidide asaxavs populaciaSi damatebiT
avadobas, gamowveuls riskis faqtoriT. garda amisa, SesaZlebelia gamovTvaloT populaciaSi
riskis faqtoriT gamowveuli avadobis wili, anu populaciuri riskis damatebiTi wili. igi
gamoiangariSeba damatebiTi populaciuri riskis maCveneblis SefardebiT populaciaSi saerTo
avadobasTan. qvemoT moyvanil #14 cxrilSi naCvenebia riskis maCveneblebis gamoTvlis wesi.
ufro vrclad SevexoT fardobiTi riskis gamoTvlis SemTxvevebs. epidemiologebs,
gansakuTrebiT infeqciur daavadebaTa epidemiologiaSi momuSaveebs, xSirad uwevT infeqciur
daavadebaTa afeTqebis Seswavla, romlis drosac saWiro xdeba riskis da fardobiTi riskis
gamoTvla. praqtikaSi aseve sakmaod xSirad gvxvdeba SemTxveva, rodesac ramdenime adamiani erTad
isadilebs da Semdgom maTi nawili avad xdeba gastroenteritiT an sxva romelime sakvebismieri
toqsikoinfeqciiT. aseT dros rogorc eqims, ise pacients ainteresebs Tu romeli sakvebi
produqti gaxda dainficirebis mizezi, gansakuTrebiT eqimebs, radgan pasuxi am kiTxvaze saWiroa
mizanmimarTuli epidsawinaaRmdego RonisZiebebis gasatareblad. pasuxis misaRebad daxmarebas
statistikuri meTodebi gviwevs. qvemoTmoyvanili magaliTi, romelic aRebulia r. gisekes
wignidan, naTlad gviCvenebs, Tu fardobiTi riskis gamoTvla rogor gvexmareba afeTqebis
SeswavlaSi.

cxrili #14
riskis maCveneblebis gamoTvla filtvis kibosa da Tambaqos mowevas Soris kavSiris
dadgenisas

mwevelTa Soris filtvis kibos sikvdilianobis maCvenebeli 0.96/1000/weli


aramwevelTa Soris filtvis kibos sikvdilianobis maCvenebeli 0.07/1000/weli
mwevelTa raodenoba populaciaSi 56 %
filtvis kibos sikvdilianobis saerTo maCvenebeli 0.56/1000/weli
riskis maCveneblebi:
damatebiTi riski = 0.96/1000/weli - 0.07/1000/weli = 0.89/1000/weli
fardobiTi riski = 0.96/1000/weli : 0.07/1000/weli = 13.7
damatebiTi populaciuri riski = 0.89/1000/weli X 0.56 = 0.50/1000/weli
populaciuri riskis damatebiTi 0.89
wili=0.50/1000/weli:0.56/1000/weli =

axali wlis dResaswaulze 15 adamianma erTad isadila. 24 saaTis ganmavlobaSi 5 maTgani


avad gaxda gastroenteritiT. sadili ramdenime kerZisagan Sedgeboda. epidemiologiuri kvlevis
dasawyisSive saWiroa davadginoT, Tu romeli sakvebi produqti miiRo TiToeulma maTganma.
detaluri gamokiTxvis Sedegad miRebul iqna suraTi, romelic naCvenebia cxril #15-Si,
58
saidanac Cans, rom 5 daavadebulidan oTxma SeWama yvelis keqsi da yvelis deserti, maSin
rodesac 10 janmrTeli adamianidan yvelis keqsi erTma adamianma SeWama, yvelis deserti ki –
Svidma. gamomdinare am monacemebidan, SeiZleba vivaraudoT, rom afeTqebis mizezi iyo yvelis
keqsi, magram rogor davadasturoT Cveni mosazreba?

cxrili #15
15 adamianis gamokiTxvis Sedegebi,
romelTa Sorisac adgili hqonda gastroenteritis afeTqebas

produqtis dasaxeleba gastroenteritiT janmrTelebi


daavadebuli (5 (10 adamiani)
adamiani)
tkbili Rvezeli 2 8
yvelis keqsi 4 1
Sveicaruli ruleti 3 4
Sokoladis torti 1 2
yvelis deserti 4 7

amisaTvis, upirveles yovlisa, unda SevadginoT momdevno cxrili, saidanac gamoCndeba Tu


ramdeni adamiani gaxda avad ama Tu im produqtis miRebisas (cxrili #16). rogorc vxedavT,
aTi adamianidan, romelTac miiRes tkbili Rvezeli, avad gaxda ori. xuTma SeWama yvelis keqsi,
avad gaxda - 4 da a.S.

cxrili #16
gastroenteritis afeTqebisas TiToeuli sakvebi produqtis miRebiT
daavadebulTa ricxvi

produqtis dasaxeleba TiToeuli sakvebi maTgan avad gaxda


ramdenma
adamianma SeWama
tkbili Rvezeli 10 2
yvelis keqsi 5 4
Sveicaruli yveli 7 3
Sokoladis torti 3 1
yvelis deserti 11 4

am monacemebidan gamomdinare, SeiZleba gamovTvaloT riski TiToeuli produqtisaTvis, Tu


misi miRebis SemTxvevaSi ramdeni adamiani SeiZleba gaxdes avad.
riskis gamosaTvlelad viyenebT Semdeg formulas:

adamianTa raodenoba, romlebmac SeWames


mocemuli sakvebi da avad gaxdnen
riski =
adamianTa saerTo raodenoba, romlebmac
SeWames aRniSnuli sakvebi
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tkbili RvezelisaTvis riski = 2/10=0.2; yvelis keqsisaTvis 4/5=0.8-s; Sveicaruli
ruletisaTvis 3/7-s anu 0.43-s; Sokoladis tortisaTvis 0.33-s da yvelis desertisaTvis 0.36-
s. miRebuli Sedegebi miuTiTeben, rom ufro didi albaTobaa, rom adamianTa dainficireba moxda
yvelis keqsiT.
Semdgom unda gamovTvaloT daavadebis riski im adamianebisaTvis, romlebsac mocemuli
produqti ar miuRiaT. viciT, rom TiTqmis naxevari gaxda avad im adamianebidan, romlebmac
SeWames Sveicaruli ruleti. magram ra daskvna unda gavakeToT im SemTxvevaSi, Tu im
adamianebidan, romlebmac es ruleti ar SeWames, igive raodenobis adamiani gaxda avad?
sadilobis dros adamianebi bunebrivia, Wamdnen sxvadasxva sakvebs sxvadasxva SefardebiT. Tu
romelime sakvebi iyo absoluturad usafrTxo da ar iyo daavadebis mizezi, maSin Cven moveliT,
rom ganurCevlad imisa, adamianma SeWama Tu ara es sakvebi, daavadebis riski aris erTnairi.
es debuleba epidemiologiaSi aris metad mniSvnelovani. Tu romelime faqtori ar aris
dakavSirebuli daavadebasTan, maSin misi zemoqmedebis qveS myof adamianTa jgufSi daavadeba
iseTive sixSiriT viTardeba, rogorc im adamianebSi, romlebic am faqtoris zemoqmedebas ar
ganicdian. SevadginoT cxrili, sadac naCvenebi iqneba Tu ramdeni adamiani gaxda avad imaT
ricxvidan, romlebmac mocemuli sakvebi ar SeWames. aqve zemoTnaCvenebi formuliT gamovTvaloT
TiToeuli produqtisaTvis daavadebis riski.

cxrili #17
daavadebulTa ricxvi adamianTa saerTo raodenobidan,
romlebmac ar SeWames mocemuli sakvebi

produqtis adamianTa maTgan avad daavadebis riski


dasaxeleba raodenoba, gaxda
romelTac ar
miuRiaT mocemuli
produqti
tkbili Rvezeli 5 3 0.6
yvelis keqsi 10 1 0.1
Sveicaruli yveli 8 2 0.25
Sokoladis torti 12 4 0.33
yvelis deserti 4 1 0.25

imisaTvis, rom SevafasoT daavadebis riski maTTvis, vinc ganicada garkveuli zemoqmedeba
(SeWama sakvebi) da vinc ar ganicada (ar SeWama sakvebi), unda SevafardoT riskebi. amasTan,
mricxvelSi iqneba daavadebis riski maTTvis, vinc ar ganicada es zemoqmedeba. mocemul sidides

60
fardobiTi riski ewodeba da aRiniSneba RR-iT.

fardobiTi riski, dakavSirebuli sxvadasxva sakvebis miRebasTan: sakvebi RR


tkbili Rvezeli 0.33
yvelis keqsi 8.0
Sveicaruli ruleti 1.72
Sokoladis torti 1.0
yvelis deserti 1.44

rodesac fardobiTi riski 1-is mniSvnelobas uaxlovdeba, es niSnavs, rom faqtoris


zemoqmedebis qveS myofi pirebis daavadebis riski daaxloebiT Tanabaria maTi riskis, vinc am
faqtoris zemoqmedebas ar ganicdian da rom konkretuli sakvebi naklebad mosalodnelia iyos
daavadebis mizezi. RR-is maRali mniSvneloba ki piriqiT, miuTiTebs, rom daavadeba SesaZlebelia
dakavSirebuli iyos am sakvebTan. rodesac RR-is mniSvneloba 1-ze naklebia, es niSnavs, rom
sakvebi produqti garkveul wilad damcav funqcias asrulebs, anu vinc es sakvebi ar miiRo,
maTSi daavadebis gavrcelebis albaToba ufro maRalia. is, rom ganxilul magaliTSi yvelaze
maRali fardobiTi riski aRiniSneba yvelis keqsis SemTxvevaSi, maRali albaTobiT gvaZlevs
saSualebas davaskvnaT, rom es sakvebi produqti iyo mizezi gastroenteritis ganviTarebisa. am
monacemebis gacnobisas rCeba erTi kiTxva. ratom gaxda gastroenteritiT avad is piri, vinc ar
SeWama yvelis keqsi? an erTi adamiani, romelmac SeWama aRniSnuli keqsi, ratom ar daavadda?
arsebobs ramdenime SesaZlo pasuxi am kiTxvaze. SesaZloa, pirveli adamiani sxva mizeziT
daavadda, an daaviwyda, rom yvelis keqsi SeWama. epidemiologia ar aris maTematika, anu zusti
mecniereba. meore SemTxvevaSi, adamianma SeiZleba imdenad mcire keqsi SeWama, rom ar miuRia
damainficirebeli doza.
SeiZleba aseve daisvas kiTxva, Tu ratom asrulebs tkbili Rvezeli infeqciisagan damcav
funqcias? pasuxi SeiZleba iyos aseTi: stumarTa didma nawilma gadawyvita aerCia tkbili
Rvezeli da amis gamo uari Tqva Sveicarul keqsze, anu gadarCa dainficirebas.
moyvanili magaliTis Tavisebureba aris is, rom Cven gvqonda SesaZlebloba zustad
dagvedgina, Tu ramdenma adamianma ganicada riskis faqtoris zemoqmedeba da ramdeni gaxda avad.
cxovrebaSi xSirad gvaqvs informacia mxolod dainficirebulTa da daavadebulTa nawilis
Taobaze. aseT SemTxvevaSi sul sxva saxis midgomaa saWiro, rasac SemdgomSi ganvixilavT.

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3.2.2 kvleva SemTxveva-kontroliT

rogorc aRiniSna, kohortul kvlevebs gaaCnia mTeli rigi uaryofiTi momentebi,


romlebisganac rig SemTxvevebSi Tavisufalia kvleva SemTxveva-kontroliT. am tipis kvlevis
principi naCvenebia suraT #9-ze.
populaciidan upirvels yovlisa, unda SeirCes pacientebi Sesaswavli daavadebiT. amasTan,
avadmyofTa amonarCevi unda iyos reprezentuli am paTologiis mqone yvela avadmyofisaTvis.
paralelurad dgeba meore jgufi adamianebisa, romlebsac zustad iseTive monacemebi aqvT,
rogorc pirvel jgufSi gaerTianebulebs, imis gamoklebiT, rom isini ar arian avad Sesaswavli
daavadebiT. es aris sakontrolo jgufi. SemdgomSi orive jgufSi retrospeqtulad Seiswavleba
riskis faqtoris zemoqmedeba. miRebuli Sedegebi saSualebas iZleva gamovTvaloT riskis
faqtoris zemoqmedebiT daavadebis ganviTarebis fardobiTi riski.

suraTi #9.

magaliTad, mkvlevarebs ainteresebdaT, axdenda Tu ara gavlenas Tambaqos moweva filtvis


kibos ganviTarebaze. am kiTxvaze pasuxis gasacemad Catarda kvleva SemTxveva-kontrolis
meTodiT. upirveles yovlisa, SeirCa “SemTxveva” anu filtvis kiboTi daavadebuli pirebi.
SerCeva warmoebda specializebul klinikebSi. meore etapze SerCeul iqna sakontrolo jgufi,
romelSic gaerTiandnen pirvel jgufSi myofi pirebis msgavsi monacemebis mqone adamianebi,
romlebic maTgan erTi niSniT gansxvavdebodnen – filtvis kiboTi ar iyvnen avad. SemdgomSi
62
moxda orive jgufis pirebis gamokiTxva Tambaqos mowevis Taobaze. pirvel jgufSi adamianTa 66
% aRniSnavda Tambaqos mowevas, xolo meore jgufSi 44 %. sxvaoba statistikurad sarwmunoa.
ese igi Tambaqos moweva xels uwyobs filtvis kibos ganviTarebas.
SemTxveva-kontrolis meTodiT kvlevisas gamoiyeneba informacia movlenaze, romelsac
adgili hqonda warsulSi (Tambaqos moweva, samkurnalo preparatebis miReba, sxvadasxva mavne
Cveva da a.S.), rac qmnis sistemuri Secdomis SesaZleblobas. yovelTvis aris SesaZlebloba
warsulis faqtebis ganxilvisa dReisaTvis arsebuli situaciis mixedviT. sistemuri Secdomebis
Tavidan acilebis mizniT xSirad iyeneben pacientebis SerCevis brma meTods, aseve SemTxvevebis
analizis brma meTods da sxv.
rogorc aRiniSna, SemTxveva-kontroliT da kohortuli kvlevebi miekuTvneba
observaciuli kvlevebis jgufs. zogjer eqimebi da studentebi maT erTmaneTSi ureven.
SemTxveva-kontroliT meTodis ZiriTadi ganmasxvavebeli Taviseburebaa is, rom kvlevis
dasawyisisTvis Sesaswavli Sedegi ukve saxezea. xolo kohortuli kvlevisas meTvalyureobis
dawyebisas, gamosakvlev individebs jer ara aqvT Sesaswavli daavadeba. cxril #18-Si naCvenebia
kvlevis am ori meTodis ZiriTadi damaxasiaTebeli niSnebi.
cxrili #18
observaciuli kvlevis meTodebis ZiriTadi niSnebi

kohortuli kvleva SemTxveva-kontroliT erTmomentiani


kvleva kvelva
iwyeba populaciis yovelTvis ar aris iwyeba
gansazRvriT, romelzec gansazRvruli populaciis
moqmedebs riskis populacia, romelic gansazRvriT
faqtori ganicdis riskis
faqtoris zemoqmedebas
SemTxvevebi ar SemTxvevebi mkvlevaris SemTxveva ar SeirCeva,
SeirCeva, aramed mier SeirCeva, arsebuli aramed dgindeba
vlindeba uwyveti avadmyofebis jgufidan mosaxleobis
dakvirvebis procesSi erTmomentiani
gamokvlevisas

sakontrolo jgufi ar mkvlevaris mier SeirCeva sakontrolo jgufSi


SeirCeva, aramed sakontrolo jgufi ise, Sedian is pirebi,
bunebrivad formirdeba rom igi ZiriTadi jgufis romlebsac ar
identuri iyos gamouvlindaT daavadeba
erTmomentiani kvlevisas

zemoqmedeba zemoqmedebis faqtis zemoqmedebis faqtis


ganisazRvreba gaxseneba da Sekreba gaxseneba da Sefaseba
daavadebis xdeba daavadebis xdeba daavadebis
ganviTarebamde ganviTarebis Semdeg ganviTarebis Semdeg.
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rogor unda gamoviTvaloT ama Tu im movlenis ganviTarebis riski aris Tu ara
momatebuli? imis sademonstraciod, Tu rogor gamoiTvleba igi, moviyvanoT aseTi magaliTi. erT
did dawesebulebaSi, sadac 1400-mde adamiani muSaobda, adgili hqonda salmonelozis afeTqebas.
daavadebis diagnozi daesva am dawesebulebis 31 TanamSromels da sasadilos 6 muSaks, anu sul
37 adamians. unda aRiniSnos, rom daavadebis simptomebiT eqimebs mxolod samma adamianma mimarTa,
danarCeni daavadebulebi gamovlindnen saeWvo pirebis ganavalis baqteriologiuri gamokvleviT.
riskis faqtoris zemoqmedebis Sesadareblad janmrTeli TanamSromlebidan SemTxveviTi
SerCeviT SeirCa 58 adamiani, romlebsac Semdgom iseTive kiTxvebiT mimarTes, rogorc 37
daavadebuls. salmonelozis inkubaciuri periodis da daavadebis pirveli klinikuri niSnebis
gamovlenis TariRis gaTvaliswinebiT, gamoiTqva mosazreba, rom dainficirebuli sakvebi
adamianebma miiRes 22 an 23 ianvars. yvela pirovneba pasuxobda Semdeg kiTxvebs:
1. isadila Tu ara sasadiloSi 22 ianvars.
2. isadila Tu ara sasadiloSi 23 ianvars.
3. SeWama Tu ara sadilobis dros salaTa.
4. SeWama Tu ara buterbrodebi.
5. SeWama Tu ara wiwilis xorci.
Segrovebuli monacemebi naCvenebia cxril #19-Si
cxrili #19
37 avadmyofis da 58 janmrTeli adamianis gamokiTxvis Sedegebi salmonelozis afeTqebis dros

sakvebi avadmyofebi janmrTelebi


SeWames ar SeWames ar
uWamiaT uWamiaT
sadili 22 ianvars 6 31 9 48
sadili 23 ianvars 18 19 14 43
salaTa 12 24 5 52
buterbrodebi 16 21 14 44
wiwilis xorci 4 33 4 54

axla Cven unda gamovTvaloT riski (R) da fardobiTi riski (RR), rogorc es
gastroenteritis afeTqebis SemTxvevaSi gavakeTeT, rac am konkretuli magaliTisas
SeuZlebelia, radgan riskis gamosaTvlelad aucileblad unda vicodeT, Tu ramdenma adamianma
SeWama mocemuli produqti (wiladis mniSvnelSi swored es sididea).
zemoT moyvanili magaliTisas es advili dasadgeni iyo. am SemTxvevaSi Cven ar viciT, Tu
ramdenma adamianma isadila sasadiloSi, an ramdenma adamianma SeWama esa Tu is produqti. amasTan
Cven zustad arc daavadebulTa ricxvi viciT, radgan is vinc Tavs Zalian cudad ar grZnobda,
SeiZleba eqims ar mimarTa. radgan ar viciT SemTxvevaTa zusti raodenoba da arc saerTo

64
raodenoba adamianebisa, romlebmac riskis faqtoris zemoqmedeba ganicades, Cven ar SegviZlia
riskis gamoTvla. amrigad, am konkretul SemTxvevaSi gvyavs daavadebulTa da janmrTel pirTa
garkveuli raodenoba. anu, Cven gvaqvs SemTxvevaTa (daavadebulTa) jgufi da sakontrolo
jgufi. aRsaniSnavia, rom rogorc zogadad SemTxveva-kontroliT kvleva, es analizic
retrospeqtulad aris Catarebuli. Cven gvyavda daavadebulTa garkveuli raodenoba, SevarCieT
sakontrolod janmrTeli pirebi da veZebT daavadebis mizezs riskis faqtoris gavrcelebis
SedarebiT ZiriTad da sakontrolo jgufebSi. ZiriTadi principi, romelic am saxis kvlevebSia,
aris Semdegi: Tu romelime faqtoriT gamowveuli dazianeba ufro gavrcelebulia ZiriTad
jgufSi sakontrolo jgufTan SedarebiT, maSin es zemoqmedeba SeiZleba dakavSirebuli iyos
daavadebasTan da SeiZleba iyos misi gamomwvevi mizezi. Tu romelime riskis faqtoris
zemoqmedeba vlindeba mxolod ZiriTad jgufSi da arsad sxvagan, maSin es niSnavs, rom arsebobs
mWidro urTierTkavSiri riskis faqtorsa da daavadebas Soris. sidides, romelsac gamoiTvlian
imis dasadgenad, Tu ramdenad gavrcelebuli iyo zemoqmedeba, ewodeba Sansi (odds) da misi
gamoangariSeba xdeba zemoqmedebis qveS myof pirTa raodenobis SefardebiT im pirTa
raodenobasTan, romlebmac es zemoqmedeba ar ganicades. TiToeuli riskis faqtorisaTvis
(sakvebisaTvis) cal-calke unda gamovTvaloT Sansi.

SemTxvevaTa ricxvi, romlebmac faqtoris zemoqmedeba ganicades


Sansi SemTxvevebisaTvis =
SemTxvevaTa ricxvi, romelTac faqtoris zemoqmedeba ar ganucdiaT

magaliTad, daavadebulebSi salaTa SeWama 12 pirma, xolo 24-s ar uWamia; Sansi am


SemTxvevaSi tolia 12/24=0.5-is.
aseTive wesiT gamoiTvleba Sansi sakontrolo jgufSi.

pirTa raodenoba, romelTac faqtoris zemoqmedeba ganicades


Sansi kontrolisaTvis =
pirTa raodenoba, romelTac faqtoris zemoqmedeba ar ganucdiaT

sakontrolo jgufSi salaTisTvis Sansi tolia 5/52 = 0.096. rogorc vxedavT Sansis
sidide bevrad metia ZiriTad jgufSi sakontrolo jgufTan SedarebiT.
exla SegviZlia gamovTvaloT Sansebis Sefardeba. garkveuli faqtoris zemoqmedebasTan
dakavSirebuli Sansebis Sefardeba (odds ratio, OR) tolia:

Sansi SemTxvevebisaTvis
OR =
Sansi kontrolisaTvis

salaTis SemTxvevaSi OR=0.5/0.096 = 5.21


exla SesaZlebelia ganvixiloT “2 X 2” tipis cxrilebi (mas xSirad uwodeben cxrilebs

65
“ori orze”), romlebic metad mniSvnelovania yvela epidemiologiuri kvlevisas.
“2 X 2” cxrili ase gamoiyureba:

SemTxveva kontroli sul


ganicada zemoqmedeba a b a+b
ar ganicada zemoqmedeba c d c+d
sul a+c b+d

sadac a aris avadmyofi adamianebi, romlebmac ganicades riskis faqtoris zemoqmedeba, b


– janmrTeli (sakontrolo) adamianebis raodenoba, romlebmac aseve ganicades riskis faqtoris
zemoqmedeba, c – avadmyofi adamianebis raodenoba, romlebsac ar ganucdiaT riskis faqtoris
zemoqmedeba da d – janmrTeli (sakontrolo) adamianebis raodenoba, romlebsac ar ganucdiaT
riskis faqtoris zemoqmedeba. a+b aris adamianTa raodenoba, romlebmac ganicades riskis
faqtoris zemoqmedeba, c+d – adamianTa raodenoba, romlebsac ar ganucdiaT riskis faqtoris
zemoqmedeba, a+c aris SemTxvevaTa (daavadebul adamianTa) saerTo raodenoba, xolo b+d
kontrolis saerTo raodenoba. cxrilebs, romlebsac uwodeben “2 X 2” –ze, sinamdvileSi 3X3-
s ufro warmoadgens, magram radgan svetebis da striqonebis jamebi ar Seicaven aranair
damoukidebel informacias, amitomac uwodeben mas zemoTaRniSnul saxels.
unda aRiniSnos, rom maRalkontagiozuri infeqciuri daavadebebisaTvis (magaliTad,
wiTela) SeiZleba arc erTi adamiani ar moxvdes c da b ujrebSi, radgan yvela is adamiani,
romlebmac ganicades riskis faqtoris zemoqmedeba, - daavadda da janmrTeli adamianebi ki yvela
iqneba riskis faqtoris zemoqmedebis gareSe. Cveni magaliTis SemTxvevaSi riskis faqtori
“sadili 22 ianvrisaTvis” cxrili “2 X 2”-ze aseT saxes miiRebs:
avadmyofe janmrTele sul
bi bi
isadiles 22 ianvars 6 9 15
ar usadiliaT 22 31 48 79
ianvars
sul 37 57 94

am cxrilis saSualebiT advilia Sansis da OR-is gamoTvla.


6
Sansi daavadebulTaTvis = = 0.193
31
9
Sansi janmrTelebisaTvis = = 0.188
48
66
0.193
OR = = 1.03
0.188
aq bunebrivad ismeba kiTxva, ratom ar SegviZlia gamovTvaloT riski am cxrilis
saSualebiT (magaliTad, 6/15-ze vinc ganicada faqtoris zemoqmedeba da 31/79-ze vinc ar
ganicada zemoqmedeba)? imitom, rom es kategoriulad dauSvebelia. risks ver gamovTvliT,
radgan Cven ar viciT adamianTa saerTo raodenoba, romlebmac isadiles 22 ianvars da arc
inficirebulTa zusti raodenoba. Cven gvaqvs mxolod SemTxvevaTa arc ise didi jgufi da aseve
sakontrolo jgufi da Cven mxolod am jgufze SeiZleba vimsjeloT. riskebis gamosaTvlelad
aucilebelia sruli da zusti codna, Tu ramdenma ganicada faqtorebis zemoqmedeba da ramdenia
SemTxveva. analogiuri meTodiT riskis faqtori “sadili 23 ianvrisaTvis” cxrili “2 X 2”-ze
ase gamoiyureba:

avadmyofebi janmrTelebi sul


isadiles 23 ianvars 18 14 32
ar usadiliaT 23 19 43 62
ianvars
sul 37 57 94

am SemTxvevaSi daavadebis Sansi maTTvis, vinc isadila sasadiloSi (ganicada riskis


faqtoris zemoqmedeba) da ar usadilia (ar ganucdia riskis faqtoris zemoqmedeba) Seadgens
Sesabamisad 18/19=0.95 da 14/43=0.33. es niSnavs, rom 94 kacs, vinc pasuxobda dasmul
SekiTxvebs, meti Sansi hqondaT, rom daavadebuliyvnen, vidre darCeniliyvnen janmrTelni, Tu maT
isadiles 23 ianvars sasadiloSi.

0.95
OR = = 2.88
0.33
aseTive gziT SeiZleba gamovTvaloT Sansebis Sefardeba (OR) TiToeuli sakvebi
produqtisaTvis. saboloo Sedegebi mocemulia cxril #20-Si.
Tu OR udris 1-s, es niSnavs, rom daavadebis ganviTarebis Sansi Tanabaria orive jgufis
adamianebisaTvis, vinc ganicada da ar ganucdia riskis faqtoris zemoqmedeba. anu Tu OR=1-s,
maSin daavadeba mocemul riskis faqtorTan ar aris dakavSirebuli.
OR-is gamosaTvlelad formula SeiZleba ufro gavamartivoT da mas mivceT aseTi saxe:

67
am magaliTis gacnobisas Cndeba kidev erTi kiTxva. ramdenjer unda aRematebodes OR-is
mniSvneloba 1-s, rom vTqvaT, mocemuli daavadeba aRniSnul riskis faqtorTan aris
dakavSirebuli. mocemuli cxrilidan, sadac OR gamoTvlilia xuTive faqtorisaTvis, SeiZleba
davaskvnaT, rom 22 ianvris sadili inficirebul produqts ar Seicavda. rac Seexeba 23 ianvris
sadils? an salaTas, buterbrodebs an wiwilas?
am kiTxvebze pasuxs iZleva statistikuri meTodi. Cvens mier ganxiluli iyo daavadebis
SemTxvevebi da sakontrolo jgufi SerCeuli 1400 mosamsaxuridan. Cven ver viqnebiT
darwmunebuli, rom absoluturad zusti Sedegebi miviReT, radgan SesaZlebelia, rom yvela
daavadebis SemTxveva ar iqna gamovlenili. aseve SeuZlebelia, rom sakontrolo jgufi iyos 100
%-iT reprezentuli generaluri erTobliobidan. savsebiT SesaZlebelia, rom sakontrolo
jgufSi SemTxveviT moxvda bevri iseTi piri, romlebsac, magaliTad ar uWamiaT X produqti.
Cven rom sxva SemTxvevebi da sxva kontroli agveRo, savsebiT mosalodnelia, rom Sedegebi
yofiliyo sxvanairi. TiToeuli faqtorisaTvis idealuri “WeSmariti “ Sansebis Sefardeba ar
arsebobs. principialurad amis miRweva SesaZlebelia mxolod maSin, Tu yvela usimptomo
formiT daavadebuli gamovlindeboda da Cven yvela janmrTel pirs gamovkiTxavdiT, rac
praqtikulad SeuZlebelia. OR-is zusti mniSvneloba SerCeul jgufebzea damokidebuli.
gamomdinare iqidan, rom didi populaciidan mkvlevars uwevs SearCios sakvlevi jgufi,
qmnis saWiroebas rom gamoyenebul iqnes statistikuri meTodebi. cxrili 2X2-is saSualebiT
Cven SeiZleba gamovTvaloT OR-is sarwmuno mniSvnelobis SesaZlebeli diapazoni, kerZod
sarwmunobis intervali 95%-iani albaTobiT (sarwmunobis intervalis mniSvneloba da misi
gamoTvlis wesi ixile TavSi "bioststistika"), romelic naCvenebia cxril #20-Si.

cxrili #20
daavadebis ganviTarebis Sansebis Sefardeba riskis faqtorebisaTvis, romlebic
moyvanilia mocemul gamokvlevaSi

riskis faqtori OR
sadili 22 ianvars 1.03
sadili 23 ianvars 2.93
salaTa 5.20
buterbrodebi 2.39
wiwila 1.64

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SeiZleba daisvas kiTxva, Tu ratom ar gamoiTvleba sarwmunobis intervali fardobiTi
riskis SemTxvevaSi, magaliTad gastroenteritis afeTqebisas. imitom, rom im SemTxvevaSi Cven
gvqonda sruli informacia adamianTa mTeli jgufis Sesaxeb. riski da fardobiTi riski
gamoTvlil iqna gansazRvruli jgufisaTvis da gansazRvruli produqtebisaTvis. miRebuli
Sedegebi iyo WeSmariti da sxva mniSvneloba maT ar SeiZleba hqonodaT. salmonelozis
afeTqebisas ki Cven ar gvqonda sxva informacia mTeli jgufis Sesaxeb, ganvixilavdiT mxolod
garkveul amonarCevs yvela momsaxure piridan da sarwmunobis intervalis saSualebiT
vcdilobT SevafasoT, Tu ramdenad axdens gavlenas OR-is mniSvnelobaze SemTxvevisa da
kontrolis amonarCevi.
TiTqmis yvela epidemiologiuri kvlevisas Seiswavleba mosaxleobis SezRuduli
raodenoba da vcdilobT, rom miRebuli Sedegebis eqstrapolireba mTeli populaciisaTvis
movaxdinoT. magaliTad, axali antibiotikebis gamocda xdeba pacientTa gansazRvrul jgufze,
Semdeg mas iyeneben msgavsi daavadebebisas adamianTa sxva jgufebSic. mosaxleobaSi wiTelas
imunuri fenis dasadgenad antisxeulebis titrs vswavlobT bavSvTa SezRudul raodenobaze,
xolo Sedegebis eqstrapolireba xdeba am asakis yvela bavSvze. yvela am SemTxvevaSi Cven ar
dagvWirdeboda sarwmunobis intervalis gamoTvla, mxolod Sesaswavli jgufebis zusti aRwera
rom gvdomoda. magram radgan miRebuli Sedegebis gadatana gvinda mosaxleobis farTo jgufebze,
aucilebelia sarwmunobis intervalis gamoTvla.
Cven konkretul SemTxvevaSi, yvela riskis faqtorisaTvis gamoTvlili sarwmunobis
intervali naCvenebia cxril #21-Si.
rogorc cxrilidan Cans, riskis yvela faqtorisaTvis, OR- is sarwmunobis intervali
sakmaod farTo diapazonSi meryeobs. magram OR=1-s, mxolod ori riskis faqtoris sarwmunobis
intervalSi ar gvxvdeba. esenia “sadili 23 ianvars” da “salaTa”. e.i. mxolod am ori
faqtorisaTvis statistikurad sarwmunod OR- is mniSvneloba ar iqneba 1-is toli.

cxrili #21
95%-iani sarwmunobis intervali yvela riskis faqtoris
Sansebis SefardebisaTvis

riskis faqtori OR 95 % sarwmunobis


intervali
sadili 22 ianvars 1.03 0.33-3.18
sadili 23 ianvars 2.93 1.21-7.09
salaTa 5.20 1.65-16.4
buterbrodebi 2.39 0.99-5.80
wiwila 1.64 0.38-7.01

69
SemTxveva-kontroliT kvleva aris metad gavrcelebuli rogorc Teoriul, ise klinikur
medicinaSi. misi dadebiTi mxarea, rom mkvlevars SeuZlia SearCios SemTxveva da moaxdinos
Sedareba daavadebis gavrcelebis donis miuxedavad. aseT dros kohortuli kvleva arc Tu ise
efeqturia. magaliTad, rom miviRoT informacia arasteroiduli anTebis sawinaaRmdego
preparatebis miRebis riskis Sesaxeb 100 pacientze, romlebic arian Tirkmlebis ukmarisobis
terminalur stadiaSi, mogviwevs davakvirdeT kohortas 1 000 000 adamianis SemadgenlobiT 2.5
weli. bunebrivia, aseTi kvlevis Catareba Tavisi sirTulisa da didi danaxarjebis gamo,
ararealuria. maSin rodesac, arc Tu ise rTulia, da ar moiTxovs did danaxarjebs ZiriTadi
jgufisaTvis 100 an meti pacientis moZebna Tirkmlebis ukmarisobiT, sakontrolo jgufis
formireba daavadebis armqone pirebisagan da maTi Sedareba warsulSi arasteroiduli
anTebisawinaaRmdego preparatebis miRebis Taobaze. aseT kvlevaze SeiZleba maqsimum ramdenime Tve
dagvWirdes.
garda amisa, SemTxveva-kontroliT saxis kvlevebis mniSvnelovani upiratesoba imaSic
mdgomareobs, rom CvenTvis saintereso kiTxvaze pasuxis miRebas didi dro ar sWirdeba. bevr
daavadebas aqvs Zalian didi latenturi (inkubaciuri) periodi – dro riskis faqtoris
zemoqmedebidan paTologiuri efeqtebis gamovlenamde. magaliTad, zogierTi qimiuri nivTierebis
kancerogenuli Tviseba vlindeba mxolod maTi zemoqmedebidan 10-20 wlis Semdeg. amitom
mkvlevarebs Zalian did xans mouwevdaT lodini, rom maTTvis saintereso kiTxvaze pasuxi
mieRoT kohortuli kvleviT.
SemTxveva-kontroliT saxis kvlevebi sul ufro mniSvnelovan adgils ikavebs medicinaSi
imis gamo, rom iZleva saSualebas, swrafad da efeqturad gadaiWras mniSvnelovani sakiTxebi.
mudmivad izrdeba am saxis kvlevebis xvedriTi wili samecniero publikaciebSi da
epidemiologiuri mimarTulebis statiebSi. aris mxolod erTi seriozuli problema: am
kvlevebisas xSirad gvxvdeba sistemuri Secdomebi.

sistemuri Secdomebis acileba SemTxveva-kontroliT kvlevebisas

umravles SemTxvevaSi “SemTxveva-kontroliT” kvlevebisas mkvlevari TviTon axdens


sakontrolo jgufis formirebas gansxvavebiT kohortuli kvlevebisagan, sadac bunebrivad xdeba
es procesi. sakontrolo jgufis formirebis xelovnuroba aris uaryofiTi momenti, radgan
SemTxveva-kontroliT kvlevis sarwmunoba damokidebulia ZiriTadi da sakontrolo jgufis
msgavseba-identurobaze.
ZiriTadi da sakontrolo jgufebi msgavsia, Tu sakontrolo jgufi SeiZleba ganvixiloT
70
rogorc ZiriTadi im pirobiT, rom mis monawileebs SeiZleba ganuviTardes Sesaswavli daavadeba,
anu ZiriTadi da sakontrolo jgufis pirebi erTi da igive populaciis warmomadgenlebi unda
iyvnen. msgavsebisaTvis meore aucilebeli momentia, rom rogorc ZiriTadi, ise sakontrolo
jgufis wevrebs erTnairi albaToba unda hqondeT, raTa ganicadon Sesaswavli riskis faqtoris
zemoqmedeba.
ZiriTadi jgufis formireba adre xdeboda klinikaSi an sxva samkurnalo dawesebulebaSi
myofi pacientebisagan. mas Semdeg, rac Seiqmna daavadebaTa registri, magaliTad, avTvisebiani
simsivneebis registri Zalian bevr qveyanaSi da aseve diagnostikuri monacemebis kompiuteruli
bazebi, realuri gaxda, rom populaciis yvela wevrs hqondes Tanabari Sansi moxvdes kvlevis
jgufSi. amasTan, sasurvelia, rom ZiriTad jgufSi Semaval pacientebs gamosakvlevi daavadeba
axali aRmocenebuli hqondeT.
ZiriTadi momenti SemTxveva-kontroliT kvlevebisas aris sakontrolo jgufis formireba.
aris Tu ara SesaZlebloba, rom misi SerCeva moxdes swored? saukeTeso saSualeba rom
sistemuri Secdoma minimumamde iqnes dayvanili, aris sakontrolo da ZiriTadi jgufis
formireba erTidaigive populaciisagan erTdroulad. aseT taqtikas SemTxveva-kontroliT
populaciuri kvleva ewodeba. amis sailustraciod aseTi magaliTis moyvana SeiZleba:
gvainteresebs pirebSi, romlebsac ara aqvT gamoxatuli gul-sisxlZarRvTa daavadeba,
sistematuri fizikuri aqtivoba amcirebs Tu ara gulis gaCerebis risks. am kiTxvaze pasuxis
gasacemad vaSingtonis Statis q. sietlSi da mis mimdebare kingis sagrafoSi Catarda kvleva
SemTxveva-kontroliT. aseTi kvlevis Catarebas bevrad Seuwyo xeli gadaudebeli samedicino
daxmarebis sainformacio sistemis arsebobam. ZiriTad jgufi SeirCa 1250 mcxovrebisagan,
romlebsac drois garkveul monakveTSi gadaitanes gulis gaCereba stacionaris gareT.
pacientebis SerCeva moxda saswrafo samedicino daxmarebis monacemebidan.
sakontrolo jgufis formireba moxda imave teritoriaze, satelefono nomrebis
gamoyenebiT SemTxveviTi wesiT SerCeuli adamianebisagan. rogorc sakontrolo, ise ZiriTadi
jgufis pirebi akmayofilebdnen Semdeg kriteriumebs: 25-75 wlis asaki, gulis klinikurad
gamoxatuli daavadeba, winamdebare daavadebis ararseboba, romelic xels uSlida fizikur
aqtivobas, meuRlis arseboba (maT zustad SeeZloT informaciis miwodeba bunebrivi fizikuri
datvirTvis Sesaxeb). ZiriTadi da sakontrolo jgufi erTmaneTs Seesabameboda asakiT, sqesiT,
ojaxuri mdgomareobiT, sacxovrebeli adgiliT (qalaqi, gareubani). kvlevaSi monawileTa
meuRleebisagan grovdeboda informacia Tavisufali drois gamoyenebis Sesaxeb. orive jgufSi
adamianTa Seyvanis kriteriumebi uzrunvelyofda orive jgufis erTi da igive populaciidan
dakompleqtebas. 163 piris monacemebis Seswavlis safuZvelze, romlebic Sediodnen ZiriTad da

71
sakontrolo jgufebSi, dadasturda wina kvlevis monacemebi. im pirebSi, romlebic Tavisufal
dros aqtiur fizikur datvirTvas iRebdnen, 65-75 %-Si ufro iSviaTad viTardeboda gulis
gaCereba, vidre im adamianebSi, romlebic cxovrebis naklebad moZrav wess iyenebdnen.
meore gza ZiriTadi da sakontrolo jgufis dakompleqtebisa, aris wyvilebis SerCeva. am
meTodis arsi mdgomareobs imaSi, rom ZiriTad jgufSi moxvedril TiToeul pirs Seesabameba
sakontrolo jgufSi erTi an ramdenime analogiuri monacemebis mqone piri. wyvilebis SerCevisas
ZiriTadad iTvaliswineben asaks, sqess da sacxovrebel adgils, radgan es monacemebi xSiradaa
dakavSirebuli daavadebasTan. magram Tu cnobilia sxva mniSvnelovani parametrebi, maSin mxolod
demografiuli monacemebiT ar unda SemovifargloT. es principi sagrZnoblad zrdis meTodis
mgrZnobelobas mizez-Sedegobrivi kavSirebis dasadgenad. magram Tu mkvlevari wyvilebs arCevs im
faqtoris mixedviT, romelic dakavSirebulia Sesaswavl zemoqmedebasTan, maSin izrdeba Sansi,
rom aseT wyvilebs erTnairi anamnezi eqnebaT am zemoqmedebis mimarT. magaliTad, Tu wyvilebs
SevarCevT arTritis simptomis mixedviT, ris gamoc uxSiresad iniSneba arasteroiduli anTebis
sawinaaRmdego preparatebi, maSin izrdeba SesaZleblobebi, rom aseT wyvilebs eqnebaT erTnairi
anamnezi am preparatebis miRebis Taobaze.
kidev erTi gza aris ramdenime sakontrolo jgufis formireba. Tu am SemTxvevaSi viRebT
erTnair Sansebis Tanafardobas, es niSnavs sistemuri Secdomis ararsebobas. xolo Tu Sansebis
Tanafardoba iqneba sxvadasxva, es niSnavs, rom aq aris sistemuri Secdoma da sasurvelia misi
moZebna.
am gzis arsis gasagebad SeiZleba aseTi magaliTis moyvana. SemTxveva-kontroliT kvlevis
gamoyenebiT miznad daisaxes daedginaT, aris Tu ara kavSiri estrogenebis miRebasa da
endometriumis kibos ganviTarebas Soris. ZiriTadi jgufi SearCies erTi sauniversiteto
klinikis farglebSi. Seiqmna agreTve 2 sakontrolo jgufi: erTi – imave klinikis
ginekologiuri avadmyofebisagan, meore – SemTxveviTi SerCeviT, im qalebisgan, romlebic
klinikis momsaxurebis teritoriaze cxovrobdnen.
Tanmxlebi daavadebebi – arteriuli hipertenzia, Saqriani diabeti, da naRvelkenWovani
daavadeba ufro xSirad gvxvdeboda ZiriTad da pirvel sakontrolo jgufSi, rac albaT asaxavs
hospitalizaciis aucileblobis mizezebs. am gansxvavebis miuxedavad orive sakontrolo jgufSi
estrogenebis xangrZlivi miReba aRiniSneboda ufro iSviaTad, vidre ZiriTad jgufSi da orive
SemTxvevaSi Sansebis Tanafardoba TiTqmis erTnairi iyo. aRniSnul sakiTxs (sistemuri
Secdomebis Tavidan acileba) sxva saxis kvlevebisas qvemoTac SevexebiT.
SemTxveva-kontroliT kvleva ar gamoiyeneba eqspoziciis Sesaswavlad, agreTve, zogadad
iTvleba, rom kvleva SemTxveva-kontroliT naklebad damajerebelia kohortul kvlevebTan

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SedarebiT, rac yovelTvis swori ar aris. kargad organizebuli SemTxveva-kontroliT kvlevis
Catarebisas aranakleb damajerebeli Sedegebi SeiZleba miviRoT, vidre kohortuli kvlevisas.
metic, aseT kvlevebs gaaCnia mTeli rigi upiratesobani:
• kargia iSviaTi daavadebebis SeswavlisaTvis;
• swrafad SeiZleba miviRoT pasuxi CvenTvis saintereso sakiTxze. amitomac mas xSirad
iyeneben infeqciur daavadebaTa afeTqebebis Sesaswavlad.
radgan rogorc kohortuli, ise "SemTxveva-kontroliT" kvleva amonarCevze keTdeba,
miRebuli Sedegebis sarmunobisaTvis saWiroa, rom Sedegebi iyos:
• sando (Sinagani damajerebloba). igi gviCvenebs kvlevis Sedegad miRebuli saSualo
sidideebi ramdenad samarTliania kvlevaSi monawile TiToeuli wevrisaTvis;
• ganzogadebadi (garegani damajerebloba). igi gviCvenebs, Tu ramdenad SeiZleba
miRebuli Sedegebis gavrceleba sxva amonarCevebze, anu ramdenad SeiZleba miRebuli Sedegebis
eqstrapolacia mTels populaciaze, saidanac moxda SerCeva;
• ganmeorebadi. Sesaswavli niSnis sxva dros da sxva teritoriebze Seswavlisas
miRebuli unda iqnas analogiuri Sedegebi.

3.3 eqsperimentuli epidemiologiuri meTodi

meTvalyureobisagan gansxvavebiT eqsperimenti gulisxmobs movlenis an misi nawilis


xelovnur Seqmnas, anda procesis bunebriv mimdinareobaSi xelovnur Carevas. Tu meTvalyureobis
Sedegad xdeba riskis faqtorsa da Sedegs Soris kavSiris demonstrireba, eqsperimentis dros
mtkicdeba mizez-Sedegobrivi kavSiri.
eqsperimentuli meTodis dros kvlevis ZiriTadad sami forma arsebobs:
 randomizebuli kontrolirebadi kvleva;
 savele kvlevebi;
 kvlevebi Temis doneze.

3.3.1 randomizebuli kontrolirebadi kvleva

randomizebuli kontrolirebadi kvlevebi eqsperimentuli epidemiologiuri kvlevebia,


romlebic mkurnalobisa da profilaqtikis axali sqemebis Sesafaseblad gamoiyeneba. suraT #10-
ze naCvenebia am kvlevis principi.

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suraTi #10
randomizebuli kontrolirebadi kvlevis sqema

Sesadarebel jgufebSi (ZiriTadi, sakontrolo) adamianTa eqvivalentobis pirobebis


dasacavad pacientebi (gamosakvlevi pirebi) randomizaciis meTodiT, anu SemTxveviTi meTodiT
nawildebian. randmizacia aris procedura, romelic uzrunvelyofs gamosakvlevi pirebis
SemTxveviTi principiT ganawilebas eqsperimentul da sakontrolo jgufSi. kvlevis dasawyisSi
swored randomizacia ganapirobebs jgufebis Tanafardobas. amis Semdgom jgufebs Soris
nebismieri gansxvaveba SemTxveviT xasiaTs atarebs da ar aris gamowveuli mkvlevaris mier
sasurveli Sedegis miRebis mizniT jgufebis araswori dakompleqtebiT. amasTan orive jgufSi
gamosakvlev pirTa raodenoba daaxloebiT erTnairi unda iyos.
randomizebuli kvlevebisas Seswavlis sagani SeiZleba iyos axali samkurnalo Tu

74
profilaqtikuri preparatis moqmedeba, an mkurnalobis axali sqemis gamoyeneba. magaliTad,
miokardiumis infarqtis gadatanis Semdeg, pacientTa adreuli wamoyeneba da Sesabamisad gaweris
vadebi. aseT kvlevaSi CarTuli pirebi unda akmayofilebdnen mocemuli mdgomareobisaTvis
dadgenil kriteriumebs. aseve SesaZlebelia damatebiTi kriteriumebis gamoyeneba, raTa
gamosakvlevi pirebi iyvnen erTgvarovani: aRniSnul kvlevaSi, magaliTad, mxolod iseTi
avadmyofebis CarTva, romelTa daavadeba garTulebis gareSe mimdinareobs.
suraT #11-ze moyvanilia randomizebuli kontrolirebadi kvlevis magaliTi miokardiumis
infarqtiT daavadebulebze, romelic 1988 wels Topol-ma da Tanaavtorebma Caatares.
es gamokvleva gviCvenebs, rom gaurTulebeli miokardiumis infarqtis dros, pacientis
gamowera 3 dRis Semdeg, maTTvis usafrTxoa. ZiriTad jgufSi arsebul pacientebSi, bevrad
naklebia ganmeorebiTi hospitalizaciis SemTxvevebi da Semdgomi garTulebebi im avadmyofebTan
SedarebiT, vinc ufro gvian gamoewernen klinikidan.

suraTi #11

randomizebuli kontrolirebadi kvleva miokardiumis infarqtis gadatanis Semdeg

randomizebuli kontrolirebadi kvlevebi aseve Zalian efeqturi gamodga dabali


Semosavlebis mqone qveynebis mosaxleobaSi mwvave daavadebebis mkurnalobis meTodebis
Sesafaseblad. magaliTad, bangladeSSi 1985 wels qoleris epidemiis dros Catarda gamokvleva

75
mwvave diareiT daavadebul 342 avadmyofSi, romlebsac mkurnalobas utarebdnen peroraluri
rehidrataciiT. erT SemTxvevaSi marilxsnarebi glukozaze iyo damzadebuli, xolo meore
SemTxvevaSi - brinjis fxvnilze. avadmyofebi SemTxveviTi SerCevis meTodiT gayofilni iyvnen or
jgufad da maT Sesabamisad erTi an meore xsnariT utarebdnen mkurnalobas. gamokvlevam aCvena,
rom xsnarebSi oraluri rehidrataciisaTvis glukozis komponentis Secvla brinjis fxvniliT
ufro ukeTes efeqts iZleoda. aseTi gamokvlevebi metad mniSvnelovania, radgan iZleva
saSualebas, ufro efeqturad iqnes gamoyenebuli samedicino samsaxuris resursebi, rac dabali
Semosavlebis mqone qveynebSi sakmaod SezRudulia. glukozis warmoeba did fulad danaxarjebs
moiTxovs, misi deficiti xSiria iseT qveynebSi, sadac diarea farTodaa gavrcelebuli. amdenad,
glukozis Canacvleba brinjis fxvniliT, finansurad metad momgebiania.
amJamad miRebuli praqtikis Tanaxmad mkurnalobis, profilaqtikis da diagnostikis arc
erTi axali meTodis aRiareba ar xdeba randomizebuli kontrolirebadi kvlevis gareSe.
TiToeuli klinikuri gadawyvetileba unda emyarebodes mkacrad dadasturebul mecnierul
faqtebs.
randomizebuli kontrolirebadi kvlevis erT-erTi saxea mkacrad kontrolirebadi
epidemiologiuri eqsperimenti (sammagi brma meTodi). misi meTodika XX saukunis meore
naxevarSi damuSavda vaqcinebis profilaqtikuri efeqturobis dasadgenad da SemdgomSi farTo
gavrceleba miiRo samkurnalo saSualebebis moqmedebis Sesafaseblad. aseTi eqsperimentebis
Catarebisas upirvelesad gamosakvlevi jgufebis formireba xdeba. erT jgufSi Semaval pirebze
zemoqmedeben profilaqtikuri (samkurnalo) preparatiT (ZiriTadi anu sacdeli jgufi), xolo
meore jgufSi SemavalT, romlebic yvela niSniT pirvel jgufSi SemavalTa Sesabamisebi arian, am
preparats ar ukeTeben. isini placebos iReben (sakontrolo jgufi). mkacrad kontrolirebad
epidemiologiur kvlevas sxvanairad kvlevas sammagi brma meTodiT uwodeben, radgan am dros
arc gamosakvlevma pirebma, arc samedicino personalma da arc analizis mwarmoebelma adamianebma
ar ician, Tu konkretul pirs ra preparats ukeTeben. am SemTxvevaSi gamosacdeli preparatis
(vaqcina, wamali) da placebos daSifvra xdeba. deSifrireba warmoebs kvlevis damTavrebisas
avadobis maCveneblebis gansazRvris Semdeg sakvlev da sakontrolo jgufebSi.
randomizebuli kontrolirebadi kvlevebis Catarebisas didi mniSvneloba aqvs mis swor
organizacias, risTvisac upirveles yovlisa, saWiroa kvlevis miznisa da amocanebis gansazRvra.
epidemiologiuri kvlevebi, saerTod, SerCeviTi kvlevebia, amitom misi organizaciisas
mniSvnelovania sworad ganisazRvros generaluri erToblioba da sakvlevi jgufebis moculoba.
generaluri erTobliobis qveS igulisxmeba adamianTa mTeli erToblioba, gaerTianebuli
romelime saerTo niSniT (magaliTad, asaki, sqesi, socialuri jgufi, profesia).

76
rogorc wesi, dakvirveba mTel generalur erTobliobaze SeuZlebelia, rig SemTxvevebSi
ki, arcaa mizanSewonili. amdenad, dakvirveba da eqsperimenti warmoebs generaluri
erTobliobidan miRebul amonarCevze. misi SerCeva generaluri erTobliobidan xdeba mkacrad
gansazRvruli wesebiT da aseT dros amonarCevi aris reprezentuli, e.i. miRebuli Sedegebi
didi sizustiT SeiZleba ganvavrcoT mTel erTobliobaze.
amonarCevis miRebis sxvadasxva wesebi arsebobs: martivi SemTxveviTi, sistemiuri
SemTxveviTi, budobrivi (SemTxveviTi) SerCeva da sxva.
sakvlevi jgufebis moculobis zusti gansazRvra epidemiologiuri kvlevebis
aucilebeli elementia. misi gmoTvlis wesi ganxilulia TavSi "biostatistika" .
Zalian xSirad amonarCevis moculoba materialur-teqnikuri SesaZleblobebiT
ganisazRvreba. amasTan, yovelTvis saWiroa kompromisis moZebna amonarCevis moculobasa da
finansur danaxarjebs Soris. janmom gamoaqveyna saxelmZRvanelo, sadac detalurad aris
mocemuli amonarCevis moculobis gansazRvra jandacvis sistemaSi Casatarebeli kvlevebisaTvis.

3.3.2. savele eqsperimentuli kvleva

savele kvlevebi tardeba ara daavadebul adamianebze, aramed janmrTel adamianebze,


romlebic, rogorc varaudoben, arian daavadebis ganviTarebis safrTxis qveS. amasTan, monacemebis
Segroveba xdeba “savele pirobebSi”, anu mosaxleobaSi, romlebic ar imyofebian janmrTelobis
dacvis dawesebulebebSi. radgan savele kvlevebi moicavs adamianebs, romlebic ar arian avad da
kvlevis mizania daavadebis ganviTarebis aRkveTa, romelTa sixSire SeiZleba Zalian dabali iyos,
maT SesaZlebelia, sakmaod farTo masStabebi miiRon da moiTxovon didi finansebi da
materialur-teqnikuri danaxarjebi. magaliTisaTvis, SeiZleba moviyvanoT solkis mier miRebuli
vaqcinis gamocda poliomielitis profilaqtikis mizniT, romelic erT-erTi yvelaze farTo
masStaburi gamokvleva iyo, rac savele pirobebSi Catarda. eqsperimentma milionze meti bavSvi
moicva.
kidev erTi savele eqsperimentuli kvleva Catarda braziliaSi kanis leiSmaniozis
vaqcinis efeqturobis Sesafaseblad. kvlevis Sedegebi suraT #12-zea mocemuli.
gamokvlevebma aCvena, rom orive jgufSi avadoba iyo erT doneze, e.i. vaqcina iyo
araefeqturi.

77
suraTi #12
kanis leiSmaniozis vaqcinis efeqturobis gansazRvra savele pirobebSi

3.3.3. kvlevebi Temis doneze

am saxis kvlevebi tardeba ara specialurad SerCeul pirebze, aramed mTel Temze
(mosaxleobis did raodenobaze), romlebic gansazRvrul teritoriaze cxovroben. aseTi
kvlevebi mizanSewonilia Catardes iseTi daavadebebis Sesawavlad, romlebic socialuri
faqtorebiT aris gapirobebuli. magaliTad, aseTi kvlevebiT swavloben gul-sisxlZarRvTa
sistemis daavadebebs. xazgasmiT unda aRiniSnos, am tipis kvlevebis naklia is, rom
gamosakvlevi pirebis randomizebuli SerCeva SeuZlebelia. imisaTvis, rom gamovlenili
sxvaobebi mivakuTvnoT Cvens Carevas da ara Temebs Soris arsebul sxvaobebs, saWiroa, sxva
meTodebis gamoyeneba.

3.3.4 mosalodneli Secdomebi epidemiologiuri kvleebis dros

umetesi epidemiologiuri kvlevebis mniSvnelovani mizania daavadebis gavrcelebis


sixSiris zusti raodenobrivi Sefaseba. Tumca aseTi Sefaseba sakmaod rTulia, radgan arsebobs
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mravali faqtori, romlebsac Secdomebamde mivyavarT. amitom, didi yuradReba eTmoba aseTi
Secdomebis minimumamde dayvanas. Secdomebi SeiZleba iyos ori saxis – SemTxveviTi da
sistemuri. SemTxveviTi Secdoma aris gansxvaveba, romelic amonarCevze dakvirvebiT miRebul
Sedegebsa da mTeli populaciisaTvis damaxasiaTebel faqtiur sidides Soris arsebobs da
mxolod SemTxveviTobiT aris gapirobebuli.
SemTxveviTi Secdomebis sami ZiriTadi mizezia:
1. individualuri biologiuri gansxvaveba;
2. SerCevis procesi;
3. arazusti gazomvebi.
SemTxveviTi SerCevis sruli gamoricxva SeuZlebelia, Tundac im mizeziT, rom Cven
SegviZlia gamovikvlioT mxolod amonarCevi populaciidan. aseve SeuZlebelia individualuri
gansxvavebis Tavidan acileba, iseve rogorc arc erTi gazomva ar aris absoluturad zusti.
SemTxveviTi Secdomebis sidide SeiZleba SevamciroT eqspoziciisa da misi efeqtis zusti
raodenobrivi SefasebiT. kvlevis masStabebis gazrda aseve dadebiTad moqmedebs Sedegis
sizusteze.
sistemuri Secdoma epidemiologiuri kvlevebisas im SemTxvevaSi aRmocendeba, rodesac
miRebuli Sedegebi sistematurad gansxvavdeba faqtiuri sidideebisagan.
sistemuri Secdomebis wyaro epidemiologiaSi sakmaod mravalricxovani da
mravalferovania. gamovlenilia 30-ze meti mizezi, romelTagan wamyvania ori:
 Secdomebi SerCevis gamo;
 Secdomebi gazomvis Sedegad.
sistemuri Secdomebi, gapirobebuli amonarCevis SerCeviT im SemTxvevaSi viTardeba,
rodesac sistematuri sxvaobaa gamosakvlevad SerCeul pirebsa da danarCen adamianebs Soris.
xSirad aseT sxvaobas ganapirobebs kvlevis monawileTa “TviTSerCeva”. magaliTad, cnobilia, rom
adamianebi, romlebic Tanaxma arian monawileoba miiRon kvlevebSi, sadac dgindeba Tambaqos
mowevis Sedegebi, sagrZnoblad gansxvavdebian Tambaqos moxmarebis CvevebiT imaTgan, romlebic
gamokvlevaSi monawileobaze uars acxadeben. es ukanasknelni, rogorc wesi, Tavgadakluli
mwevelebi arian.
sistemuri Secdomebi SeiZleba ganapirobos im faqtorma, rom Sesaswavli daavadebis an
faqtoris gamo, adamianma ver miiRos monawileoba kvlevaSi. magaliTad, im sawarmoebis muSebSi,
romlebic formaldehidis zemoqmedebas ganicdian, muSebi, romlebsac uviTardebaT Tvalebis
gaRizianeba, Tavisi surviliT an samedicino konsultaciis Semdeg advilad toveben samsaxurs.
dawesebulebaSi amis Sedegad rCebian muSebi, romlebic naklebad avadoben da amis gamo, rodesac

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tardeba kvleva Tvalis daavadebebze formaldehidis zemoqmedebis Sesaswavlad, amonarCevi ar
iqneba reprezentuli da Sedegebi ki – zusti.
samrewvelo dawesebulebebSi epidemiologiuri kvlevebisas gvxvdeba kidev erTi mizezi,
egreTwodebuli “janmrTeli muSebis efeqtis” fenomeni. kerZod, muSebma TavianTi movaleoba rom
Seasrulon, unda iyvnen sakmaod janmrTelni. adamianebs raime daavadebebiT an daqveiTebuli
SromisunarianobiT samsaxurSi ar miiReben. aqedan gamomdinare, momuSaveTa janmrTelobis
mdgomareobis Sedareba mTel mosaxleobasTan ar iqneba zusti da koreqtuli, radgan momuSave
pirebi ufro janmrTelni arian.
sistemuri Secdomebi xSirad viTardeba calkeuli arazusti gazomvebis Sedegad.
fiziologiuri da bioqimiuri maCveneblebis gamokvleva arasodes ar aris absoluturad zusti.
sxvadasxva laboratoriaSi erTi da igive nimuSis analizisas, Sedegebi SeiZleba iyos
gansxvavebuli. amitomac, epidemiologiuri kvlevebisas, sxvadasxva laboratoriaSi Catarebuli
kvlevis Sedegebis Sedareba gaumarTlebelia. gansakuTrebiT ki maSin, roca ZiriTadi da
sakontrolo jgufebis adamianTa analizi sxvadasxva laboratoriaSi tardeba.
sistemuri Secdomebi SesaZloa aRmocendes retrospeqtuli, magaliTad, SemTxveva-
kontrolis saxis kvlevebisas, rac, SeiZleba, ganpirobebuli iyos miRebuli informaciis
uzustobiT. magaliTad, avadmyofebi kargad ixseneben im faqtoris zemoqmedebas, romlis
Sesaxebac ician, rom igi gavlenas axdens maT daavadebebze (magaliTad, fizikuri datvirTva da
gulis daavadebebi). xolo sxva faqtorebis Sesaxeb informacias naklebad ixseneben, amitomac
kvlevis Sedegebi SeiZleba arazusti iyos.

CarTuli (damabneveli) faqtorebi


Cveulebrivad, adamianis organizmze SesaZlebelia erTdroulad moqmedebdes sxvadasxva
Zalisa da xasiaTis ori (an meti) riskis faqtori. dabneva xdeba im SemTxvevaSi, rodesac ori
faqtoris zemoqmedebis efeqti ar aris gancalkevebuli da amis Sedegad faqtorsa da daavadebas
Soris SesaZlo kavSirze gakeTebuli daskvna simarTles ar Seesabameba. magaliTad, Tambaqos
mowevasa da filtvis kibos Soris asociaciis dadgenisas, Tu mwevelTa da aramwevelTa
qvejgufebSi gaerTianebulTa asaki Zalian gansxvavebulia, asaki iqneba damabneveli faqtori,
radgan filtvis kiboTi avadoba asakis matebasTan erTad izrdeba. anu damabnevel faqtors
TviTon aqvs mizezobrivi kavSiri daavadebasTan (mdgomareobasTan).
faqtorebs, romlebic cvlian Sesaswavli urTierTkavSiris xasiaTs, uwodeben CarTuls
(damabnevels).maT SeiZleba gaaZlieron an Seasuston ZiriTadi faqtoris zemoqmedeba. magaliTad,
cnobilia, rom mwevelebSi filtvis kibos ganviTarebis SesaZlebloba, romlebic amave dros

80
azbestis zemoqmedebas ganicdian, 10-jer ufro maRalia, vidre aramwevelebSi. unda iTqvas, rom
epidemiologiur kvlevebSi yvelaze xSirad damabneveli faqtorebia asaki da socialuri
mdgomareoba. sinamdvileSi damabneveli faqtoris arseboba ar miuTiTeba Secdomis arsebobas
kvlevaSi. es aris fenomeni, romelic unda aRiweros da gaanalizdes. kvlevis Sedegebi maSin
aris arazusti, rodesac damabneveli faqtorebis moqmedeba ar aris gaTvaliswinebuli.
damabneveli faqtorebis moqmedebis Tavidan asacileblad ramdenime meTodi arsebobs, esenia:
 randomizacia;
 restriqcia;
 SerCeva.
analizis stadiaSi, dabneva SeiZleba acilebul iqnes:
 stratifikaciiT;
 statistikuri modelirebiT.
randomizacia eqsperimentul kvlevebSi farTod gamoiyeneba da idealuri meTodia,
romelic uzrunvelyofs Sesadarebel jgufebSi potenciuri damabneveli faqtorebis Tanabar
ganawilebas. Tavidan rom aviciloT am faqtorebis SemTxveviTi araTanabari ganawileba, saWiroa,
amonarCevi iyos sakmaod didi.
restriqciis (mocilebis) meTodi gamoiyeneba imisaTvis, rom gamokvleva Semoifarglos
mxolod im pirebiT, romlebsac gansazRvruli Tvisebebi aqvT (an ganicdian mxolod konkretuli
faqtoris zemoqmedebas), e.i. xdeba sxva faqtorebis zemoqmedebis acileba. magaliTad, rodesac
vswavlobT yavis moxmarebis gavlenas gulis daavadebebis ganviTarebaze, damabneveli faqtori
SeiZleba iyos Tambaqos moweva. restriqciis dros gamokvlevaSi SehyavT mxolod is pirebi,
romlebic ar ewevian. amiT Cven vicilebT damabneveli faqtoris zemoqmedebas.
SerCevis meTodis gamoyenebisas kvlevis monawileebi iseTnairad SeirCeva, rom or
Sesadarebel jgufSi SesaZlebeli iyos potenciuri damabneveli faqtorebis Tanabari ganawileba.
es meTodi gansakuTrebiT xSirad gamoiyeneba SemTxveva-kontrolis saxis kvlevebisas. magaliTad,
rodesac undodaT, SeeswavlaT fizikuri datvirTvis gavlena gulis iSemiuri daavadebebis
ganviTarebaze, TiToeul avadmyofs gulis paTologiiT, SeurCies imave asakis da sqesis
sakontrolo piri. Tumca, es meTodi xSirad did dros da finansur danaxarjebs moiTxovs.
farTo masStabis kvlevebisas CarTuli faqtorebis mocileba xdeba ara dagegmvis, aramed
analizis stadiaSi. am SemTxvevaSi iyeneben stratifikacias, romelic gulisxmobs CarTuli
faqtorebis asociaciis xarisxis raodenobriv Sefasebas mkveTrad gansazRvrul kategoriebSi.
magaliTad, Tu CarTuli faqtori aris asaki, maSin asociaciis Sefaseba SeiZleba moxdes
asakobriv jgufebSi, sadac adamianebi 10-wliani diapazoniT arian gaerTianebulni. Tu CarTuli

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faqtori aris sqesi da eTnikuri warmoSoba, asociacia SeiZleba Sefasdes calkeuli sqesis
pirebSi sxvadasxva eTnikuri jgufebisaTvis.
magaliTis saxiT ganvixiloT v. hemingis (V. Hemming) mier Catarebuli kvleva, romlis
drosac is swavlobda reanimaciis ganyofilebaSi axalSobilTa sikvdilianobaze
saavadmyofosSiga infeqciebis ganviTarebis gavlenas.

cxrili #22a
axalSobilTa sikvdilianobaze saavadmyofosSiga infeqciebis gavlena

gardaicvala gamojanmrTelda

daavadda
saavadmyofosSiga 46 92
infeqciiT RR=2,4(1,80 - 3,26)

ar daavadda
saavadmyofosSiga 104 653
infeqciiT

rogorc am cxrilidan Cans, saavadmyofosSiga infeqciis arseboba mniSvnelovan gavlenas


axdens reanimaciul ganyofilebaSi axalSobilTa sikvdilianobaze. magram igi ar aris erTaderTi
faqtori, romelsac SeuZlia gavlena moaxdinos sikvdilianobaze. nayofis umwifrobas da mis
wonas aseve SeuZlia zemoqmedeba moaxdinos am maCvenebelze, iseve rogorc saavadmyofosSiga
infeqciis ganviTarebis sixSirezec. ar SeiZleba im azris gamoricxva, rom saavadmyofosSiga
infeqcia ar aris is faqtori, romelic zrdis axalSobilTa sikvdilianobas, xolo misi
zegavlenis damadasturebeli monacemebi dakavSirebulia bavSvis wonasTan da saavadmyofosSiga
infeqcia gvevlineba rogorc Tanmxlebi faqtori. imisaTvis, rom zustad davadginoT, axdens Tu
ara saavadmyofosSiga infeqcia sikvdilianobaze gavlenas da rogori xarisxiT, amisTvis unda
mivmarToT stratifikaciul analizs. amisaTvis axalSobilTa populacias vyofT stratebad
sxeulis wonis mixedviT da ise vafasebT saavadmyofosSiga infeqciis zemoqmedebas (cxrili
#22b).
rogorc vxedavT, TiToeul strataSi (wonis miuxedavad) saavadmyofosSiga infeqciiT
daavadeba gavlenas axdens axalSobilTa sikvdilianobaze. Tumca riskis jamuri Sefaseba sxeulis
wonis gaTvaliswinebiT (RR=1,88) naklebi aRmoCnda, vidre riskis "uxeSi" Sefaseba (RR=2,43),
rac niSnavs, rom saavadmyofosSiga infeqciiT daavadebasa da axalSobilTa sxeulis wonas Soris
kavSiris mosazreba logikas ar aris moklebuli. amrigad CarTuli faqtorebis analizisaTvis
stratifikacia aris martivi da saimedo meTodi. misi naklia stratebSi amonarCevis ricxvis

82
Semcireba. amitom, CarTuli faqtoris moqmedebis asacileblad zogjer mimarTaven statistikur
modelirebas. amisaTvis arsebobs mravali statistikuri meTodi.

cxrili #22b
axalSobilTa sikvdilianobaze saavadmyofosSiga infeqciebis gavlena

(stratifikaciuli analizis saSualebiT)

saavadmyofosSiga RR (95%-iani
sxeulis
infeqciiT gardaicva gamojanmrTelda sarwmunobis
wona
daavadeba la intervaliT)
(gramebSi)
1000 gramze daavadda 12 13
1,44 (0,74 - 2,76)
naklebi ar daavadda 10 20
daavadda 12 30
1000-1499 gr. 1,27 (0,70 - 2,31)
ar daavadda 24 83
daavadda 7 11
1500-1999 gr. 3,07 (1,49 - 6,32)
ar daavadda 18 124
2000 grami da daavadda 15 38
2,60 (1,58 - 4,29)
meti ar daavadda 52 426
riskis jamuri Sefaseba sxeulis wonis gaTvaliswinebiT 1.88 (1,40 - 2,54)

mediko-biologiuri kvlevebis Catarebis principi mocemulia helsinkis deklaraciaSi da


sxva publikaciebSi, magaliTad, Ethics and Epidemiology: International guidelines (eTika da
epidemiologia: saerTaSoriso principebi), romelic 1991 wels aris gamocemuli. masSi
miTiTebulia, rom savaldebuloa samedicino eTikis dacva. adamianebma, romelTa janmrTelobas
safrTxe emuqreba, unda Seignon, rom maTze warmoebuli epidemiologiuri kvlevebi sargeblobas
moutans ara marto piradad maT, aramed aTasobiT sxva adamians.
kvlevaSi monawile pirebs aucileblad unda auxsnaT kvlevis miznebi, ris Semdegac isini
yovelgvari Zaldatanebis gareSe iReben gadawvetilebas, miiRon Tu ara kvlevaSi monawileoba.
epidemiologebma pativi unda scen adamianis uflebebs da daicvan maTi konfidencialoba. maT
unda Seatyobinon mosaxleobas, ras da ratom akeTeben isini da kvlevis damTavrebis Semdeg
acnobon miRebuli Sedegebi.

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Tavi 4 biostatistika
statistika aris sagani, romelic farTod gamoiyeneba praqtikulad mecnierebis yvela
dargSi da maT Soris medicinaSi. statistika warmodgeba laTinuri sityvisagan “Status", rac
mdgomareobas niSnavs. misi ramdenime ganmarteba arsebobs. erT-erTi yvelaze ufro gavrcelebuli
ganmartebis Tanaxmad, statistika aris mecnierebis dargi, romelic Seiswavlis masobriv
erTgvarovan movlenebs raodenobriv da Tvisobriv urTierTkavSirSi, avlens movlenaTa
kanonzomierebebs da iZleva maT ganzogadoebas maCveneblebis saxiT. arsebobs statistikis sxva
ganmartebac, romelic ufro teqnikuri xasiaTisaa. am ganmartebis mixedviT, statistika
mecnierebis dargia, romelic axdens monacemebis Segrovebas, klasificirebas, aRweras, analizs,
interpretacias da prezentacias. xazgasmiT unda aRiniSnos, rom statistika swavlobs masobriv
da ara erTeul SemTxvevebs, radgan erTeuli dakvirvebebiT SeuZlebelia Sesaswavli procesis an
movlenis saerTo tipuri (damaxasiaTebeli) Taviseburebebis gamovlena.
cnobili mecnieris j. lastis (John M,Last) ganmartebiT, statistika aris mecniereba
SemTxveviTobis principiT SerCeul monacemTa Segrovebis, Sedegis Sejamebisa da analizis
Sesaxeb. Cveni azriT, es ganmarteba yvelaze ufro srulad gamoxatavs statistikis arss.
statistikis, rogorc mecnierebis aRmocenebas da ganviTarebas mniSvnelovnad Seuwyo
xeli me-17 saukuneSi inglisSi Sesrulebulma Sromam. 1662 wels ingliselma mkvlevarma j.
grauntma (J.Graunt) londonSi gamoaqveyna naSromi saTauriT “bunebrivi da politikuri
dakvirvebebi londonSi sikvdilianobis biuletenebze marTvis, religiis, vaWrobis, ekonomikuri
zrdis, haeris, daavadebebis da sxvadasxva cvlilebebis mixedviT”, sadac gaanalizebul iqna
mosaxleobis sikvdilianobaze iseTi faqtorebis gavlena, rogoric aris asaki, sqesi, wlis
sezonuri periodebi, materialuri mdgomareoba, profesia, sacxovrebeli adgili da a.S.
am dargis Camoyalibeba-ganviTarebaSi didi roli Seasrula astronomma e. haleim,
romelic me-17 saukunis bolos da me-18 saukunis dasawyisSi moRvaweobda. man Seadgina
mecnierulad dasabuTebuli sikvdilianobis cxrilebi. agreTve unda aRiniSnos i. bernulis
Sromebis Sesaxeb, romelmac “did ricxvTa kanoni” mogvawoda. aseve mniSvnelovania p. laplasis
mier albaTobis Teoria Seqmna. aRsaniSnavia me-19 saukunis Sua periodSi u. faris mier
Catarebuli kvlevebic, sadac avtori axdenda britaneTSi sikvdilianobis monacemebis
sistematur Segrovebas da maT analizs. u. farim SeimuSava mravali koncefcia, romelic dResac
gamoiyeneba demografiul statistikasa da daavadebaTa klasifikaciaSi. amdenad igi samarTlianad
iTvleba demografiuli statistikisa da zedamxedvelobis fuZemdeblad. u. farma aseve SeimuSava
mravali epidemiologiuri koncefcia da mogvawoda teqnikuri saSualebebi, romlebic farTod
gamoiyeneba yoveldRiur praqtikaSi.
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statistikis da agreTve epidemiologiis ganviTarebaSi mniSvnelovani roli Seasrula
ingliselma eqimma j. snoum (Dj.Snow), romelmac Seiswavla me-19 saukunis 50-iani wlebis
dasawyisSi londonSi qoleris epidemiis ganviTarebis mizezebi, risTvisac farTod gamoiyena
kvlevis statistikuri meTodi. statistikuri analizis safuZvelze man axsna qalaqSi qoleris
gavrcelebis mizezebi, dasaxa da ganaxorciela RonisZiebebi, romlebmac uzrunvelyo epidemiis
likvidacia. j. snou iTvleba “savele epidemiologiis” fuZemdeblad.
statistikis did rolze medicinaSi mravali mecnieri miuTiTebda. jer kidev me-19
saukuneSi rusi qirurgi pirogovi werda `ama Tu im daavadebis saSiSroebaze an mkurnalobis ama
Tu im meTodiT sargeblobaze msjelobisaTvis iseT mecnierebaSi, rogoricaa qirurgia, ar
arsebobs statistikaze ufro utyuari saSualeba”.
meoce saukuneSi ronald fiSerma (Ronald A. Fisher) mogvawoda ramdenime statistikuri
meTodi sakuTar SromaSi “bunebrivi gadarCevis genetikuri Teoria”. sevol raiTma (Sewall G.
Wright) statistika gamoiyena Tanamedrove populaciur genetikaSi. am da sxva Sromebma
safuZveli Cauyara raodenobrivi modelirebis meTods.
saqarTveloSi statistikis, kerZod, samedicino statistikis ganviTareba ukavSirdeba
profesor i. eliaSvilis saxels, romelmac 1924 wels saqarTvelos jandacvis komisariatis
struqturaSi Camoayaliba statistikis ganyofileba.
statistikis im mimarTulebas, romelic medicinaSi gamoiyeneba biologiuri statistika,
anu, SemoklebiT biostatistika ewodeba. misi sinonimebia samedicino statistika da
sanitariuli statistika. biostatistikis mizania daaxasiaTos interesebis sferoSi arsebuli
mosaxleoba im informaciis safuZvelze, romelic am (samizne) mosaxleobidan SerCeuli
jgufebis Seswavlis safuZvelze miiReba.
rogorc meoce, ise ocdameerTe saukuneSi medicinis nebismier dargSi statistikuri
kvlevis meTodebi farTod gamoiyeneba. swored maTi gamoyenebiT xdeba nebismieri samkurnalo,
diagnostikuri Tu profilaqtikuri RonisZiebebis efeqturobis Sefaseba. aqedan gamomdinare,
nebismieri eqimi, ganurCevlad specialobisa (Terapia, qirurgia, ginekologia, epidemiologia,
higiena, sazogadoebrivi jandacva da sxv.) Tavis praqtikul saqmianobaSi awarmoebs sxvadasxva
saxis statistikur kvlevas an iyenebs statistikuri kvlevis Sedegebs.
calke unda aRiniSnos biostatistikisa da epidemiologiis urTierTkavSiris Sesaxeb.
cnobilia, rom epidemiologia, sazogadod, swavlobs daavadebaTa gavrcelebas mosaxleobaSi da
im riskis faqtorebs, romlebic gavlenas axdenen adamianis janmrTelobaze da xels uwyoben
janmrTelobis gauaresebas an daavadebis aRmoceneba-gavrcelebas. Tumca es ar aris Tanamedrove
epidemiologiis sruli ganmarteba, radgan epidemiologiis mizania, agreTve, miRebuli

85
informaciis gamoyeneba mosaxleobis janmrTelobasTan dakavSirebuli problebis marTvasa da
daavadebaTa prevenciaSi. nebismieri am miznis miRweva SeuZlebelia biostatistikuri kvlevebis
gareSe. meore mxriv, biostatistika farTod iyenebs epidemiologiuri kvlevis meTodebs.
biostatistika farTod gamoiyeneba:
o sazogadoebriv jandacvaSi, nutriciologiaSi da garemos janmrTelobis kvlevaSi;
o medicinis sferoSi klinikuri cdebis dizainsa da analizSi;
o genetikaSi, populaciur da statistikur genetikaSi;
o ekologiaSi, ekologiur prognozirebaSi;
biostatitikur mizezobriobasa da modelirebas gadamwyveti mniSvneloba hqonda
Tanamedrove biologiis fundamenturi Teoriebis SemuSavebaSi.
savsebiT naTelia, rom biostatistika mudmivad gaviTarebadi mecnierebaa. igi mdidrdeba
kvlevis axali meTodebiT. magaliTad, erT-erTi axali mimarTulebaa kvleva meta-analizis
meTodiT, romelic pirvelad ganaxorciela ingliselma maTematikosma karl pirsonma 1904 wels.
termini “meta-analizi” SemoiRo cnobilma amerikelma statistikosma jin glasma 1976 wels. igi
iTvleba Tanamedrove meta-analizis gamoyenebis fuZemdeblad. arCi kokreini iyo randomizebuli
kontrolirebadi kvlevebis mtkice mxardamWeri da Tavisi karieris didi nawili kvlevebSi maT
gamoyenebas miuZRvna. kokreinma xeli Seuwyo sayovelTaod cnobili kokreinis TanamSromlobis
(Cochrane Collaboration) Camoyalibebas 1993 wels. meta-analizi saSualebas iZleva Sejamdes da
ganzogaddes sxvadasxva qveyanaSi da sxvadasxva dros Catarebuli kvlevebi, ris Sedegadac
miiReba didi damajereblobis mqone Sedegi. kokreinis biblioTeka aris monacemTa bazebis nakrebi,
romelic Seicavs sxvadasxva tipis maRalxarisxian damoukidebel mtkicebulebebs jandacvis
sferoSi gadawyvetilebebis misaRebad.
biostatistikis da epidemiologiis ganviTarebam xeli Seuwyo medicinaSi axali
mimarTulebis _ mtkicebulebebze damyarebuli medicinis (Evidence based medicine) Camoyalibebas
da ganviTarebas. es imas niSnavs, rom nebismieri samedicino debuleba Tu praqtikuli samedicino
RonisZieba unda efuZnebodes zust mecnierul Sedegebs. ufro metic, diagnostikis,
mkurnalobisa da pacientTa reabilitaciis meTodebi da eqimebis gadawyvetilebebi am sferoSi
unda emyarebodes kargad dagegmili, organizebuli da Catarebuli statistikuri,
epidemiologiuri da klinikuri kvlevebis Sedegad miRebul informacias.

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4.1 biostatistikis nawilebi

biostatistika pirobiTad iyofa or nawilad:


- aRweriTi biostatistika
- analizuri (inferencialuri, daskvniTi) biostatistika.
aRweriTi biostatistika Seiswavlis monacemTa tipebs da maTi ganawilebis saxeebs, xolo
analizuri biostatistika miRebuli Sedegebis analizis meTodebs.
aRweriTi biostatistika raodenobrivad aRwers informacias da moicavs meTodebs,
romlebic gamoiyeneba informaciuli monacemebis organizebisa da SejamebisaTvis.
aRweriTi biostatistikaSi Sedis grafikebis, diagramebis, cxrilebis ageba da sxvadasxva
aRweriTi ganzomilebebis gamoTvla, rogoricaa saSualo mniSvnelobebi, cvalebadobis sazomebi
da percentilebi (procentilebi). aqedan gamomdinare, aRweriTi biostatistika aRwers
mosaxleobis parametrebs centraluri ganawilebisa da cvalebadobis sazomebisa da grafikuli
teqnikuri saSualebebis gamoyenebiT.
aRweriTi biostatistikis magaliTia daavadebis SemTxvevebis raodenoba wlis ganmavlobaSi
romelime calke aRebul teritoriaze. magaliTad, virusuli hepatitebis da misi calkeuli
nozologiuri erTeulebis SemTxvevebi saqarTveloSi 2018 wels. es da sxva amgvari statistika
Sedgenilia statistikisa da sazogadoebrivi jandacvis samsaxuris specialistebis mier
sxvadasxva saxis samedicino dokumentaciaze dayrdnobiT, avadobis SemTxvevebis informaciuli
monacemebis SegrovebiT da SejamebiT. aqedan gamomdinare, bunebrivia, aRweriTi biostatistika
Seiswavlis monacemTa tipebs da maTi ganawilebis saxeebs.
cnobilia, rom rodesac raime samedicino sakiTxis Seswavla gvsurs, mosaxleobidan
garkveuli niSniT varCevT mcire jgufs. aq mizanSewonilia SemovitanoT generaluri
erTobliobis (populacia) da amonarCevis mcnebebi, raTa ganvmartoT analizuri biostatistika.
individTa an obieqtTa erTobliobas, romelic biostatistikuri kvlevis sagans warmoadgens,
generaluri erToblioba, anu populacia ewodeba.
suraTi #13
populacia da amonarCevi

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generaluri erTobliobis, anu populaciis im nawils, romelic kvlevisaTvis SeirCeva,
amonarCevi ewodeba. am sakiTxs ufro vrclad SevexebiT statistikuri kvlevebis ganxilvisas.
populacia da amonarCevi sqematurad #13 suraTzea naCvenebi.
analizuri biostatistika warmoadgens populaciis amonarCevis analizis safuZvelze
gakeTebul daskvnas da moicavs meTodebs, romlebic gamoiyeneba amonarCevidan miRebuli
informaciis safuZvelze populaciis Sesaxeb daskvnis gasakeTeblad da statistikuri
damajereblobis (sarwmunobis) dasadgenad. saerTod, analizuri biostatistika gansazRvravs
mosaxleobis parametrebs.
ase magaliTad, biostatistikosebi an epidemiologebi aanalizeben erTmomentiani
epidemiologiuri kvlevisas amonarCevis SeswavliT miRebul informacias C hepatitis markeris
(anti-HCV) adamianebSi gavrcelebis Taobaze, raTa gamoitanon daskvna mTel mosaxleobaSi
aRniSnuli markeris gavrcelebis Sesaxeb.
aRweriTi da analizuri biostatistika urTierTkavSirSi unda warmovidginoT.
analizisaTvis Cven gvWirdeba aRweriTi biostatistikis meTodebis gamoyenebis saSualebiT
amonarCevis Seswavlis safuZvelze miRebuli informacia. ufro metic, amonarCevis winaswari
aRweriTi analizi xSirad migvaniSnebs, Tu romeli analizuri biostatistikuri meTodis
gamoyenebaa mizanSewonili.
zemoaRniSnul gansazRvrebebs eyrdnoba statistikuri kvlevebis klasifikacia; kvlevis
miznidan gamomdinare isini an aRweriTia, an analizuri, anu Tu Cven gvinda mxolod informaciis
Segroveba CvenTvis saintereso sakiTxze, maSin kvleva aRweriTi iqneba, xolo, Tu informacia
miRebulia amonarCevidan da kvlevis mizans Seadgens am informaciis gamoyenebiT mTliani
populaciis (mosaxleobis) daxasiaTeba, maSin kvleva analizuri iqneba. amrigad, aRweriTi
biostatistikuri kvlevis sagani SeiZleba iyos rogorc amonarCevi, aseve populacia. am
SemTxvevaSi amosavali wertilia, ra mizans emsaxureba kvleva.
mosaxleobis janmrTelobis sakiTxebTan dakavSirebiT calke ganixilaven demografiul
statistikas, romlis mizania Sobadobis, sikvdilianobis, qorwinebis, ganqorwinebis,
janmrTelobis da janmrTelobis mdgomareobis SecvlasTan an daavadebebTan dakavSirebuli
monacemebis sistematuri, ganuwyveteli Segroveba sxvadasxva administraciul doneze.

4.2 statistikuri kvlevebi

medicinaSi da biologiaSi arsebuli mravali mniSvnelovani problemis Sesaswavlad da


gadasaWrelad gamoiyeneba statistikuri kvlevebi, romelic ramdenime etapisagan Sedgeba:
• kvlevis gegmis Sedgena;
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• masalis Segroveba;
• miRebuli masalis analizi;
• daskvnebis gakeTeba, Sedegebis prezentacia da gavrceleba.

4.2.1 kvlevis gegmis Sedgena

nebismieri statistikuri kvlevis pirveli da mniSvnelovani etapia kvlevis gegmis


Sedgena, romlis drosac unda ganisazRvros ramdenime mniSvnelovani sakiTxi (cxrili #23).

cxrili #23
kvlevis gegmis Sedgenis elementebi

gegmis Semadgeneli elementebi elementebis daxasiaTeba


vis an ras exeba kvleva da ra problemis gadaWra
kvlevis mizani
gvinda?
ra amocanebis Sesruleba aris saWiro kvlevis
kvlevis amocanebi
miznis gansaxorcieleblad?
kvlevis tipi ra saxis kvleva unda Catardes?
Sesaswavli obieqtis daxasiaTeba (mag.Tu
Sesaswavli obieqti an sakiTxi
populaciaa, maSin struqtura (asaki, sqesi,
profesia da a.S.).
ra moculobis kvleva unda Catardes
kvlevis moculoba
sarwmuno Sedegebis misaRebad?
romeli meTodiT unda SeirCes gamosakvlevi
masalis SerCevis meTodi
kontingenti?
kvlevis ganxorcielebis dro drois ra monakveTSi unda Sesruldes kvleva?
kvlevis Casatareblad saWiro
ra Tanxebi da ra kadrebi sWirdeba kvlevis
finansuri da adamianuri resursebi
Catarebas?
statistikuri analizis ra meTodebi unda iqnas
monacemTa damuSavebis meTodebi gamoyenebuli (magaliTad parametruli, Tu
araparametruli)?

kvlevis mizani. vidre kvlevis mizans CamovayalibebT, unda ganvsazRvroT ramdenad


problemuria da mniSvnelovani Cven mier SerCeuli sakiTxis Seswavla medicinisa Tu
sazogadoebrivi jandacvisaTvis. anu unda dadgindes problemis aqtualoba. amisaTvis, pirvel
rigSi, aucilebelia am sakiTxis irgvliv arsebuli literaturis da mocemuli sakiTxis
Taobaze qveyanaSi arsebuli realuri mdgomareobis moZieba da dadgena. gaTvaliswinebul unda
iqnes agreTve, Tu ra saxis kvlevebia Catarebuli CvenTvis saintereso sakiTxis Sesaswavlad
Cven qveyanaSi Tu sazRvargareT da ra Sedegebia miRebuli. aseve, gaTvaliswinebul unda iqnes,
aris Tu ara finansuri resursebi da teqnologiebi dasaxuli miznis Sesasruleblad da gvaqvs
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Tu ara saTanado kvalifikacia da profesionalizmi mocemuli saqmis Sesasruleblad.
mas Semdeg, rac ganxiluli iqneba zemoT aRniSnuli sakiTxebi, naTlad da mkafiod unda
CamovayaliboT kvlevis mizani.
kvlevis amocanebi. dasaxuli miznis Sesasruleblad aucilebelia dadgindes, Tu ra
amocanebis gadaWra aris saWiro kvlevis miznis misaRwevad. magaliTad, kvlevis miznad davisaxeT
SeviswavloT saqarTveloSi B hepatitis gavrceleba. am miznis realizaciisaTvis aucilebelia
Semdegi amocanebis Sesruleba: a) B hepatitiT avadobis dinamikis Seswavla, b) daavadebulTa
asakobrivi, sqesobrivi da a.S. struqturis dadgena, g) daavadebis teritoriuli gavrcelebis
Seswavla regionul da raionul WrilSi, d) riskis faqtorebis gamovlena, romlebic xels
uwyoben am daavadebis gavrcelebas da a.S. amdenad, rogorc wesi, kvlevis mizanis dasaxvis
Semdeg aucileblad unda ganisazRvros is amocanebi, romlebic dagvexmareba miznis miRwevaSi.
kvlevis meTodebi kvlevis mizanidan gamomdinare unda SeirCes is meTodi/meTodebi,
romelTa gamoyenebac mizanSewonilia miznis misaRwevad. Tu gvainteresebs ganvsazRvroT Tambaqos
moxmarebis roli filtvis kibos ganviTarebaSi, SeiZleba gamoviyenoT ramdenime meTodi.
magaliTad, rogorc kohortuli, ise SemTxveva-kontroliT kvleva. rogorc erT, ise meore
meTods aqvs rogorc dadebiTi, ise uaryofiTi mxareebi. rodesac virCevT kvlevis meTods,
aucileblad unda gaviTvaliswinoT mTeli rigi momentebi: kerZod, ramdenad mizanSewonilia
SerCeuli meTodis gamoyeneba kvlevis miznis misaRwevad da rogori iqneba miRebuli Sedegebis
sarwmunobis xarisxi, Cven xelT arsebuli materialuri resursebi, Sesrulebis vadebi da a.S.
kvlevebi SemTxveva-kontroliT SeiZleba ganvaxorcieloT drois SedarebiT mokle monakveTSi da
amisaTvis arcTu ise didi finansuri resursebi dagvWirdeba. samagierod, kohortuli kvlevis
Sedegebi ufro sarwmuno iqneba, Tumca mis Catarebas meti dro, adamianuri da finansuri
resursebi dasWirdeba. amrigad, mkvlevarma realuri mdgomareobidan da pirobebidan gamomdinare
unda gansazRvros miznis misaRwevad kvlevis romeli meTodis gamoyenebas unda mianiWos
upiratesoba.
kvlevis obieqti. misi SerCeva statistikuri kvlevebis erT-erTi yvelaze ufro
mniSvnelovani komponentia. zustad unda ganisazRvros Tu vin an ra unda gamovikvlioT.
magaliTad, Cveni kvlevis mizans Seadgens saqarTvelos janmrTel populaciaSi HBs-antigenis (B
hepatitis ZiriTadi markeri) gavrcelebis donis dadgena. am SemTxvevaSi aucileblad ismeba
kiTxva, Tu vin unda iqnes gamokvleuli zusti da sarwmuno Sedegebis misaRebad. SeiZleba
dagvebados azri, rom miznis Sesasruleblad SesaZlebelia samedicino personalis gamokvleva,
radgan laboratoriuli kvlevisaTvis sisxlis aReba ufro advilia maTgan, vidre mosaxleobis
sxva jgufebidan. magram am SemTxvevaSi gasaTvaliswinebelia, rom samedicino personali B

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hepatitis dros mniSvnelovan riskis jgufs warmoadgens da maTSi HBs-antigenis mtareblobis
done bevrad ufro maRalia, vidre Cveulebriv populaciaSi, amitom samedicino personalSi
Catarebuli kvlevis Sedegebis ganzogadeba qveynis mTel populaciaze araswori iqneba. miRebuli
Sedegebi ar iqneba sarwmuno da, bunebrivia, ver asaxavs antigenis gavrcelebis realur dones
qveynis janmrTel populaciaSi.
miznis misaRwevad aseve SeiZleba dagvebados sxva azric, rom gamovikvlioT kadris
donorebi. am SemTxvevaSic miRebuli Sedegebi ar iqneba realuri suraTis maCvenebeli, radgan
kadris donorebs sistematurad ikvleven HBs-antigenis mtareblobaze da dadebiT SemTxvevaSi
xdeba maTi ganTesva. aqedan gamomdinare kadris donorebSi antigenmtareblobis maCvenebeli
bevrad naklebi iqneba, vidre qveynis mTel populaciaSi.
am magaliTebidan gamomdinare daskvna calsaxaa, zusti da sarwmuno Sedegebis misaRebad
aucilebelia kvlevis obieqtis sworad SerCeva.
kvlevis moculoba. kvlevis obieqtis SerCevis Semdeg mkvlevaris winaSe kidev erTi mwvave
kiTxva ismeba, ra moculobis kvleva unda ganxorcieldes, anu dasaxuli problemis Sesaswavlad
ra raodenobis gamokvleva unda Catardes. Tu saWiroze naklebi raodenobis pirs gamovikvlevT,
maSin Sedegebi ar iqneba sarwmuno, xolo didi moculobis samuSaos Sesruleba SeiZleba
miuRebeli iyos Zalian didi finansuri danaxarjebis gamo. amitom, gamosakvlevi pirebis
raodenoba zustad unda ganisazRvros. ar SeiZleba, rom igi iyos Zalian mcire an Zalian didi.
vTqvaT, miznad davisaxeT davadginoT Tbilisis mozrdili mosaxleobis saSualo simaRle,
risTvisac unda SeviswavloT mTeli statistikuri erToblioba, anu generaluri erToblioba.
Tbilisis mozrdili mosaxleobis generaluri erToblioba daaxloebiT 800 aTasi pirisagan
Sedgeba. adamianTa aseTi raodenobis gamokvleva ararealuria. amitom unda gamovikvlioT
mxolod mosaxleobis garkveuli nawili da movaxdinoT miRebuli Sedegebis ganzogadeba mTeli
generaluri erTobliobisaTvis. magram aucileblad gamokvleul unda iqnes adamianTa is
raodenoba, romelic sarwmuno Sedegebis miRebis saSualebas mogvcems. saerTod, raime mizniT
generaluri erTobliobis, anu mTeli mosaxleobis (populaciis) gamokvleva miuRebelia uamravi
mizezis gamo:
• rogorc aRiniSna, umetes SemTxvevaSi generaluri erTobliobis gamokvleva
fizikurad SeuZlebelia;
• generaluri erTobliobis mcire nawilis Sesaswavlad naklebi dro aris saWiro;
• aseve, generaluri erTobliobis garkveuli nawilis gamosakvlevad ufro naklebi
finansebi, samedicino aparatura da samedicino personali aris saWiro.
amonarCevi, rogorc wesi, garkveul moTxovnebs unda akmayofilebdes:

91
• mas unda hqondes generaluri erTobliobisaTvis damaxasiaTebeli yvela ZiriTadi
niSani, anu is unda iyos reprezentuli;
• amonarCevi sakmarisi raodenobis unda iyos, raTa sarwmuno Sedegebi miviRoT.
cnobilia, rom albaTobis Teoriis da did ricxvTa kanonis mixedviT, rac metia dakvirvebaTa
ricxvi, miT ufro sarwmunoa miRebuli Sedegebi da uaxlovdeba generaluri erTobliobis
gamokvlevis monacemebs.
aqve unda aRiniSnos, rom zogierT SemTxvevaSi SesaZlebelia mTeli generaluri
erTobliobis gamokvleva, magaliTad Tu vikvlevT revmatizmis gavrcelebas kosmonavtebSi,
gamomdinare maTi raodenobidan, sruliad realuria yvela kosmonavtis gamokvleva. 1963 wels
sabWoTa kavSirSi ganxorcielda cimbiris CrdiloeT nawilSi mcxovrebi xalxis _ nivaxebis
janmrTelobis mdgomareobis Seswavla. radgan am xalxis ricxvi mxilod 3740 iyo, gamokvleul
iqna yvela maTgani. aseTi magaliTebi mxolod gamonaklisia da rogorc aRiniSna, Cveulebriv,
vikvlevT generaluri erTobliobis mxolod garkveul nawils, anu amonarCevs.
amonarCevis moculobis gamosaTvleli formula ixileT standartuli Secdomis
ganxilvisas.
masalis SerCevis meTodi. kvlevis Sedegad miRebuli Sedegebis sarwmunoba bevrad aris
damokidebuli imaze, Tu ramdenad sworad iqna SerCeuli generaluri erTobliobis amonarCevi.
amonarCevis SerCeva SeiZleba moxdes:
• SemTxveviTi SerCeviT;
• araSemTxveviTi SerCeviT.
SemTxveviTi SerCeva SerCevis iseTi saxea, rodesac generaluri erTobliobis yvela wevrs
aqvs Tanabari SesaZlebloba moxvdes SerCeulTa Soris. am dros ikvleven dakvirvebis erTeulTa
garkveul jgufs, romelic nebismieri niSnis mixedviT SeirCeva (magaliTad: gvaris, anbanis,
dabadebis wlis da a. S.). SemTxveviTi SerCevis ramdenime saxe arsebobs.
Zalian xSirad gamoiyeneba martivi SemTxveviTi SerCeva, romelic imis saSualebas iZleva,
rom generaluri erTobliobis yvela elements qondes kvlevaSi moxvedris Tanabari albaToba.
amisaTvis pirvel rigSi gadainomreba monacemTa rigSi arsebuli yvela obieqti. Semdeg
specialuri, e.w. SemTxveviT ricxvTa cxrilebis gamoyenebiT ganisazRvreba sawyisi wertili da
am wertilidan moyolebuli SeirCeva gamosakvlevi obieqti. magaliTad, generaluri erToblioba
Sedgeba 1000 obieqtisagan. kvlevisaTvis unda SeirCes mxolod 100 maTgani, romelic saSualebas
mogvcems miviRoT sarwmuno Sedegebi. aTasive obieqti dainomreba, vTqvaT, gvaris anbanis mixedviT
1-dan 1000-mde. Semdeg SemTxveviT ricxvTa cxrilebis gamoyenebiT SeirCeva sawyisi wertili.
vTqvaT SeirCa ricxvi 77. am ricxvidan moyolebuli siaSi arsebuli 100 piri moxvdeba

92
amonarCevSi. sawyisi wertilis SerCeva aseve SeiZleba SemTxveviTi ricxvebis generaciis
kompiuteruli programis gamoyenebiT.
aseve xSirad gamoiyeneba sistemuri SemTxveviTi SerCeva, romlis drosac gamosakvlevi
obieqtebi SeirCeva generalur erTobliobaSi arsebul obieqtTa raodenobis gayofiT amonarCevis
sasurvel zomaze. magaliTad generaluri erToblioba warmodgenilia 2000 pnevmoniiT
daavadebuli pacientis avadmyofobis istoriiT. unda SeviswavloT am erTobliobis 10% anu 200
avadmyofobis istoria. es niSnavs, rom amonarCevSi moxvdeba yoveli me-10 istoria. am meTodis
gamoyenebis SemTxvevaSi aseve aucilebelia, rom SeirCes sawyisi wertili SemTxveviTi cxrilebis
gamoyenebiT da am wertilidan yoveli me-10 obieqti, anu istoria eqvemdebareba Seswavlas.
SerCevis es meTodi gamoiyeneba maSin, rodesac gamosakvlevi struqturisaTvis ar aris
damaxasiaTebeli cikluri (perioduli) gameorebebi. magaliTad, mas ar iyeneben romelime
daavadebis sezonuri meryeobis analizis dros.
jgufuri SemTxveviTi SerCevis dros gamosakvlev jgufSi romelime niSnis mixedviT
iqmneba ori an meti qvejgufi da xdeba maTi gamokvleva. magaliTad, gvinda SeviswavloT Tu
ramdenad aris gavrcelebuli Tambaqos moxmareba studentebSi. am mizniT studentTa jgufSi
Seiqmneba 2 qvejgufi sqesis mixedviT (biWebi, gogonebi) da amis Semdeg SemTxveviTi SerCevis
wesiT orive jgufidan SeirCeva gamosakvlevi kontigenti. aseTi SerCeva saSualebas gvaZlevs
Tambaqos moxmarebis gavrceleba SeviswavloT cal-calke, rogorc vaJebSi, ise gogonebSi.
yvelaze ufro gavrcelebuli niSani, ris mixedviTac jgufebi iqmneba, asakia.
budobrivi SemTxveviTi SerCevisas mTliani erTobliobidan SeirCeva ara calkeuli
obieqtebi, aramed jgufebi. amisaTvis generaluri erToblioba iyofa daaxloebiT erTgvarovan
jgufebad (budeebad). aqedan Sesaswavli jgufi SeirCeva SemTxveviTi SerCevis wesiT da moxdeba
am jgufis yvela wevris gamokvleva. magaliTad, vswavlobT samcxe-javaxeTis regionis
mosaxleobaSi daavadebaTa gavrcelebis dones SemTxveviTi SerCevis wesiT. SevarCevT erT
romelime tipur raions, magaliTad borjomis raions da am raionSi Catarebuli kvlevis
Sedegad miRebuli daskvnebis ganzogadeba moxdeba mTel regionze.
SerCevis erT-erTi gavrcelebuli meTodia klasteruli SerCeva. igi gulisxmobs
amonarCevis SerCevis ramdenime tipis erTdroul gamoyenebas. es meTodi maSin gamoiyeneba,
rodesac Sesaswavli populacia Zalian gafantulia da saWiro ar aris yvela subieqtis
aRricxva da SerCeva. klasteri aris SemTxveviTi SerCevis wesiT SerCeul gamosakvlev obieqtTa
erToblioba. klasteruli SerCevis pirvel etapze dgindeba klasterebis raodenoba, aseve is,
Tu ra asakis, sqesis Tu sxva epidemiologiuri monacemebis mqone pirebi unda SeirCnen. unda
ganisazRvros agreTve klasterSi gamosakvlev obieqtTa raodenoba. klasteruli SerCevisas

93
aucileblad unda vicodeT gamosakvlevi regionis mosaxleobis saerTo raodenoba, iseve rogorc
masSi Semavali qalaqebisa da soflebis mosaxleobis ricxvi.
aseve aucilebelia dadgindes amonarCevis intervali.

kvlevis dasawyisSi unda ganisazRvros aseve SemTxveviTi ricxvi, romelic toli an


naklebi iqneba amonarCevis intervalze, magram igi unda Seicavdes imdenive cifrs, ramdensac
amonarCevis intervali. pirveli klasteri moTavsebuli iqneba siiT pirvel im dasaxlebul
punqtSi, sadac mosaxleobis raodenoba tolia an metia SemTxveviT ricxvze. me-2, me-3, me-4 da
a.S. klasterebis gansazRvrisaTvis viyenebT formulas:
SemTxveviTi ricxvi + amonarCevis intervali.
Tu magaliTad, amonarCevis intervali aris 7493 da SemTxveviTi ricxvi 5734, #1
klasteri iqneba siiT im pirvel dasaxlebul punqtSi, romlis mosaxleoba tolia, an metia
5734-ze, #2 klasteri iqneba siiT im pirvel dasaxlebul punqtSi, romlis mosaxleoba 5734 +
7493 = 13227-ia tolia an metia da a.S.
Semdgom TiToeul klasterSi unda SeirCes ojaxi, romlidanac viwyebT klasteris
kvlevas. SerCeva xdeba SemTxveviTi SerCevis wesiT.
klasteruli SerCevisas erTmaneTs ver SevadarebT calkeul klasterSi miRebuli
monacemebis Sedegebs. magaliTad, vikvlevT kaxeTis regionSi difTeriis acrebiT mocvis
mdgomareobas. cal-calke ver SevadarebT acrebiT mocvis mdgomareobas kaxeTis qalaqebSi da
soflebSi. am mizniT klasteruli SerCeva cal-calke unda Catardes qalaqad da soflad.
amasTan, konkretuli kvlevis dros zustad unda ganisazRvros gamosakvlev pirTa asaki.
medicinasa da biologiaSi zogjer aseve iyeneben araSemTxveviTi SerCevis meTods. Tumca
xazgasmiT unda aRiniSnos, rom is bevrad ufro iSviaTad gamoiyeneba, vidre SemTxveviTi SerCevis
meTodebi, radgan SerCevis es meTodi xSirad subieqtur momentTan aris dakavSirebuli.
araSemTxveviTi SerCevis ramdenime saxe arsebobs:
Tanmimdevruli SerCevis dros vikvlevT yvela im pirs, romelic CvenTvis xelmisawvdomia
da Seesabameba garkveul kriteriumebs. am dros SerCeuli kontingenti, rogorc wesi, naklebad
reprezentulia da miRebuli Sedegebi realurisgan SeiZleba mniSvnelovnad gansxvavdebodes.
miznobrivi SerCevisas xdeba garkveuli mizniT SerCeuli kontingentis gamokvleva, anu
kvlevaSi monawileoben CvenTvis misaRebi obieqtebi. rogorc wina, ise es meTodic subieqturia.
unda aRiniSnos, rom araSemTxveviT SerCevas zogjer upiratesobas vaniWebT SemTxveviTi SerCevis
meTodebTan SedarebiT, radgan igi ufro iolad gansaxorcielebelia.

94
kvlevis ganxorcielebis dro. nebismieri statistikuri kvlevis dagegmvis procesSi
aucileblad unda ganisazRvros dro, romlis ganmavlobaSic Catardeba samuSao. drois
xangrZlivoba damokidebulia kvlevis mraval komponentze. magaliTad kvlevis mizanze, kvlevis
meTodze, Cven xelT arsebul finansur da adamianur resursebze da a.S. im SemTxvevaSi, rodesac
dagegmili samuSaos Sesruleba ver xerxdeba gamiznuli droisaTvis, maSin saWiroa muSaobis
moculobis koreqtireba, anda, Tu es SesaZlebelia, kvlevis vadis gaxangrZliveba.
kvlevis Casatareblad saWiro finansuri da adamianuri resursebi. dagegmvis es elementi
erT-erTi yvelaze mniSvnelovani komponentia, radgan saTanado finansuri uzrunvelyofis gareSe
SeuZlebelia raime saxis kvlevis Catareba. sawyis etapzeve unda ganisazRvros, gvaqvs Tu ara
saWiro finansuri resursebi CvenTvis sasurveli samuSaos Sesasruleblad im moculobiT,
romelic uzrunvelyofs sarwmuno Sedegebis miRebas. Tu ara gvaqvs saWiro Tanxebi, maSin an
unda SevadginoT ufro naklebi danaxarjebis proeqti, anda SevecadoT, rom movZebnoT
dafinansebis damatebiTi wyaro.
amasTan, Tavidanve unda iqnes dadgenili, Tu ra ZalebiT (adamianuri resursebiT) vapirebT
samuSaos Sesrulebas da aris Tu ara es Zalebi sakmarisi kvlevis miznis Sesasruleblad;
rogoria kvlevaSi monawile pirebis profesionalizmi, aqvT Tu ara specialuri ganaTleba,
gamocdileba da unar-Cvevebi samuSaos Sesasruleblad. Tu personali pirvelad iRebs
monawileobas mocemuli tipis kvlevaSi, maT winaswar SeiZleba CautaroT saTanado treiningi an
instruqtaJi.
monacemTa damuSavebis meTodebi. samuSaos dagegmvis periodSive isazRvreba, Tu ra
meTodebiT SeiZleba davamuSaoT miRebuli Sedegebi. rodesac analizisaTvis virCevT ama Tu im
statistikur meTods, zustad unda vicodeT, Tu ra saxis monacemebs SevagrovebT da ra aris
Cveni kvlevis mizani.
magaliTad, Tu monacemebs miviRebT amonarCevis normaluri ganawilebidan, maSin
analizisaTvis parametruli meTodebi unda iqnes gamoyenebuli. am SemTxvevaSi yvelaze xSirad
gamoiyeneba t-testiT dispersuli analizi. Tu ganawileba ar aris normaluri, maSin gamoiyeneba
araparametruli analizis meTodebi. mas agreTve viyenebT maSinac, roca monacemTa rigSi
zogierTi mniSvneloba mkveTrad gansxvavdeba danarCenisagan, im SemTxvevaSic ki Tu mTlianad
ganawileba normaluria. aseve maSin, roca monacemebi aris ranguli xasiaTis (magaliTad roca
vikvlevT axalSobilTa janmrTelobas).
aqve SeiZleba mokle cxrilis saxiT moviyvanoT statistikuri testebis SerCevis
pirobebi. zogierT maTgans Cven detalurad ganvixilavT analizur biostatistikaSi
(cxrili#24).

95
cxrili #24
statistikuri testis sworad SerCeva
(Semoklebuli)

damouki
debeli damokidebuli damoukidebuli
damokidebuli
cvladeb cvladebis cvlad(eb)is
cvlad(eb)is sazomi test(eb)i
is raodenoba tipi
tipi
raodeno
ba
1 2 3 4 5 6
1 0 uwyveti erTi amonarCevis
saSualo
(1 populacia) normaluri t-testi
uwyveti ar gamoiyeneba erTi amonarCevis
mediana
ara- (arcerTi) mediana
normaluri
kategoriuli Tanafardobebi
xi-kvadrati
binomialuri
testi
normaluri 2 damoukidebeli
saSualo amonarCevis
t-testi
1
aranormaluri Mann Whitney,
(2 - ori
mediana vilkoqsonis
damoukidebeli
rangis jamuri
populacia)
2 kategoria testi
kategoriuli

xi-kvadratis,
proporciebi
fiSeris zusti
testi
normaluri
Sewyvilebuli
saSualo
t-testi
0
(1 populacia aranormaluri
orjer ar vilkoqsonis rangis
mediana
gazomili) an gamoiyeneba/ testi
1 kategoriuli
(2 - ormagad maknemaris,
moniSnuli kategoriuli xi-kvadratis testi
populacia) proporciebi

96
1 2 3 4 5 6
normaluri saSualo calmxrivi ANOVA
1 kruskal volisis
(3 an meti aranormaluri kategoriuli mediana
testi
populacia)
kategoriuli proporiebi xi-kvadratis
testi
faqtorialuri
normaluri saSualo
ANOVA
2 an meti (mag., aranormaluri mediana fridmanis testi
ormxrivi kategoriuli
log-wrfivi,
ANOVA)
kategoriuli proporciebi logariTmuli
regresia
0 ar
(1 populacia gamoiyeneba saSualo ganmeorebiTi
normaluri
3 an metjer (mniSvnelobebi) gazomvebi ANOVA
gazomili)
korelacia,
normaluri martivi
uwyveti wrfivi
regresia
araparametruli
1 aranormaluri
korelacia
logariTmuli
uwyveti
regresia
kategoriuli
diskriminaciuli
uwyveti
analizi
mravlobiTi wrfivi
normaluri
regresia
aranormaluri kategoriuli an uwyveti
logariTmuli
kategoriuli
regresia
kovariaciuli
2 an meti analizi zogadi
normaluri
wrfivi modelebi
Sereuli -kategoriuli da (regresia)
ara- uwyveti
normaluri
logariTmuli
kategoriuli
regresia

97
4.2.2. masalis Segroveba

kvlevis gegmis SemuSavebis Semdeg iwyeba meore etapi, romelic gulisxmobs masalis
Segrovebas. saWiro monacemebi SeiZleba movipovoT sxvadasxva samedicino dokumentaciis
meSveobiT. kerZod, saaRricxvo da saangariSo formebis saSualebiT, romlebic advilad
xelmisawvdomia da maTSi arsebuli masalis miRebac rTuli ar aris. magaliTad, romelime
infeqciuri daavadebis gavrcelebis Sesaswavlad SeiZleba gamoviyenoT sazogadoebrivi jandacvis
centrebSi da samkurnalo profilaqtikur dawesebulebebSi arsebuli gadamdeb daavadebaTa
aRricxvis standartuli Jurnalebi (Jurnali #60/B da Jurnali #60/A), romlebic
registraciis oficialur formebs warmoadgens da romlebic aseve SeiZleba gamoyenebul iqnes
epidafeTqebebis kvlevisaTvis. es Jurnalebi Sesabamis dawesebulebebSi inaxeba wlebis manZilze.
amave mizniT SeiZleba gamoviyenoT rogorc erTeuli, ise jgufuri SemTxvevebis epidkvlevis
baraTebi, municipalitetebis da regionebis wliuri angariSebi da a.S. acrebiT mosaxleobis
mocvis Sesaswavlad SeiZleba gamoyenebul iqnes profilaqtikuri acrebis ruka (f.#063),
acrebis individualuri baraTi (f.#026), Catarebuli profilaqtikuri acrebis Sesaxeb angariSi
da a.S. sxvadasxva daavadebaTa klinikuri Taviseburebebis analizisaTvis SeiZleba gamoyenebul
iqnes avadmyofobis istoria, bavSvis ganviTarebis istoria, ambulatoriuli avadmyofis
samedicino baraTi (f.#025/s) da sxva.
mniSvnelovani informaciis miReba SeiZleba aseve sxvadasxva jgufis daavadebaTa Sesaxeb
registrebis saSualebiT, romlebic bolo periodSi sakmaod aqtiurad iqmneba.
informaciis misaRebad erT-erT yvelaze gavrcelebuli formaa gamokiTxvis meTodi,
romelic SeiZleba Catardes rogorc zepiri gamokiTxvis saSualebiT, ise specialurad
Sedgenili anketebis gamoyenebiT. es ukanaskneli gulisxmobs yvela gamosakvlevi piris mier
anketis individualur Sevsebas. misi gamoyeneba mizanSewonilia maSin, rodesac saWiroa
obieqturi informaciis miReba piradi cxovrebis sxvadasxva aspeqtze da ufro xSirad anonimuri
wesiT tardeba. zusti cnobebis misaRebad anketaSi kiTxvebi mkafiod da gasagebad unda iyos
formulirebuli. umjobesia kiTxva iseTnairad iyos dasmuli, rom is mxolod dadebiT an
uaryofiT pasuxs moiTxovdes.
masalis Segrovebis mniSvnelovani wyaros sxvadasxva saxis kvlevebi warmoadgenen,
romlebic, rogorc aRiniSna, 3 saxisaa: 1. aRweriTi, 2. analizuri, 3. eqsperimentuli.

98
4.3. miRebuli Sedegebis damuSaveba

aRweriTi biostatistika
4.3.1. monacemTa (cvladTa) tipebi

kvlevis Sedegad miRebul sxvadasxva monacems cvladi ewodeba. statistikaSi cvladi


aris erT-erTi yvelaze ufro mniSvnelovani cneba.
cvladi aris sidide, romelic ganicdis cvlilebas. anu nebismieri is niSani an movlena,
romelsac SeiZleba qondes gansxvavebuli mniSvnelobebi, warmoadgens cvlads. cvladebi iyofa
or ZiriTad jgufad: xarisxobriv anu kategoriul (e.i. cvladebi warmoadgenen kategoriebs) da
raodenobriv cvladebad (ix. sur. 14).

suraTi #14

xarisxobrivi cvladebi Tavis mxriv iyofa nominalur da ordinalur cvladebad.


nominaluri cvladebis ganlageba SeuZlebelia Tanmimdevrulad bunebrivi ganlagebiT. maT
miekuTvneba, magaliTad, eTnikuri da aRmsareblobiTi jgufebi. nominalur cvladebSi calke aris
gamoyofili dixotomuri cvladi. dixotomuri ewodeba iseT xarisxobriv cvlads, romelsac
SesaZloa hqondes mxolod ori mniSvneloba (diax – ara, cocxali – mkvdari).
Tanmimdevruli, anu ordinaluri cvladi SeiZleba ganawilebuli iyos bunebrivi
TanmimdevrobiT an iyos ranJirebuli. mag.: mciredan didisken an kargidan cudisken. Tumca

99
intervalis zoma am kategoriebs Soris ar SeiZleba iyos raodenobrivi. mag.: qvemo kidurebis
SeSupebis donis Sefaseba +-dan ++++-mde; gulis Suilis gradacia 1-dan 6-mde (Znelad mosasmeni
Suilebidan stetoskopis gareSe SesaZlo mosmenamde).
raodenobrivi cvladebi gviCveneben raodenobas da gamoisaxebian ricxvebiT. isini or
jgufad iyofian: diskretul da uwyvet cvladebad. diskretuli cvladebi yovelTvis mTeli
ricxvebiT gamoisaxeba. maT miekuTvneba daTvlis monacemebi. mag. orsulTa raodenoba, cocxlad
dabadebulTa raodenoba, hospitalizebulTa raodenoba. uwyvetia cvladi, romlisTvisac
SesaZlebelia moiZebnos Sualeduri mniSvneloba nebismier or mniSvnelobas Soris. uwyveti
cvladis magaliTia simaRle (mag.: simaRle SeiZleba iyos 2.1 metri an 2.13435456 metri, es
damokidebulia gamoyenebuli sazomis xarisxze).
garda zemoaRniSnulisa, cvladebi SeiZleba daiyos damoukidebel da damokidebul
cvladebad.
- damoukidebelia cvladi, romelsac irCevs mkvlevari an eqsperimentatori da cvlis
kvlevis miznis Sesabamisad. mag., sisxlis arteriuli wnevis dawevis mizniT medikamentis an
placebos micemis SemTxvevaSi rogorc medikamenti, aseve placebo damoukidebel cvlads
warmoadgens.
- damokidebulia cvladi, romelis asaxavs damoukidebeli cvaldis cvlilebis Sedegs.
mag., sisxlis arteriuli wnevis gazomvis maCvenebelebi medikamentis an placebos miRebis
SemTxvevaSi damokidebul cvladebs warmoadgenen.

4.3.2. gazomvis doneebi anu sazomi Skalebi

Cveulebriv, monacemebi sxvadasxva zomiTa da formiT aris warmodgenili. Zalze


mniSvnelovania vicodeT amis Sesaxeb Tavidanve, raTa monacemebis Sesabamisi analizi vawarmooT.
Cven gvixdeba klinikuri mdgomareobebis an cnebebis gamoxatva gasageb ganzomilebebSi, an
fizikuri xelsawyos erTeulebSi, anda kategoriebSi, Tundac iseTSi, rogoricaa daavadebis
stadiebi. gazomvis TiToeuli done xasiaTdeba sizustis xarisxiTa da sazomi xelsawyos
specifikurobiT.
gazomvis doneebi, anu sazomi Skala cnebebia, romlebic gamomdinareobs Skalis tipebis
Teoriidan. es Teoria Camoayaliba amerikelma fsiqologma stenli smit stivensma (Stanley Smith
Stevens) 1946 wels samecniero naSromSi saxelwodebiT ”gazomvis Skalebis Teoriis
sakiTxisaTvis”. am statiaSi stivensi acxadebs, rom yvela saxis gazomva, rac ki Catarebula
mecnierebaSi, ganxorcielda oTxi sxvadasxva tipis Skalis gamoyenebiT. stivensma am Skalebs
100
uwoda ”nominaluri”, ”ordinaruli”, ” intervaluri” da ”TanafardobiTi”.
am oTx ZiriTad Skalas farTod iyeneben statistikosebi monacemTa gasazomad. amJamad
zogierTi kompiuteruli paketic iyenebs sazomi Skalebs, raTa SearCios, Tu ra saxis analizi
awarmoos. mxolod konkretuli operaciebi SeiZleba Catardes mocemuli konkretuli sazomis
Skalis gamoyenebiT. cxril #25-Si mocemulia, Tu ra saxis operaciebi SeiZleba Catardes
TiToeul sazom Skalaze. ganvixiloT TiToeuli Skala.
nominaluri (klasifikatoruli, kategoriuli) Skala is Skalaa, sadac mocemulia
saxelebi, saxelwodebebi, iarliyebi da a.S., raTa ganvasxvaoT erTi ganzomileba meorisagan
garkveuli Tvisebis, maxasiTeblis an niSnis mixedviT. am SkalaSi ganzomileba (cvladi) ar
iZleva araviTar warmodgenas movlenis sididis Sesaxeb. mag., daavadebis gamosavali SeiZleba
iyos gamojanmrTeleba an sikvdili; pirveladi jandacvis samsaxuri garkveul teritoriaze
SesaZloa arsebobdes an ararsebobdes; fsiqiatriuli pacientebis klasificireba SesaZloa
vawarmooT Semdegnairad: nevrotikebi, maniakalur depresiulebi, Sizofrenikebi. nominalur
SkalaSi Cven SegviZlia mxolod SevamowmoT nominaluri Skalis monacemi romelime konkretuli
mniSvnelobis tolia Tu ara, anda davTvaloT, Tu ramdenjer gvxvdeba TiToeuli mniSvneloba.
mag., sqesi aris nominaluri Skalis cvladi. Cven SegviZlia gvainteresebdes pacientis sqesi
mdedrobiTia Tu mamrobiTi, anda daviTvaloT mamakacTa raodenoba amonarCevSi (ganyofilebaSi).
ordinarul Skalas, anu ranJirebis (rangebis) Skalas gaaCnia nominaluri Skalis Tvisebebi,
magram am ukanasknelisgan gansxvavebiT, mkafiod mowesrigebuli damokidebulebaa ganzomilebebs
Soris. mag., pacientTa socialuri statusi SeiZleba gaizomos da pacienti miekuTvnos dabal,
saSualo an maRal fenas; avadmyofis mdgomareoba SeiZleba Sefasdes rogorc kritikuli, mZime,
saSualo simZimis an msubuqi. amrigad, Cven SegviZlia warmovadginoT ordinaruli monacemebi
rangebis saxiT, magram ver SevZlebT raodenobrivad ganvsazRvroT gansxvavebebi or ordinarul
mniSvnelobas Soris. unda gvaxsovdes, rom am SemTxvevaSi rangebs ki ar vadarebT, aramed
mniSvnelobebs, cvladebs da aqedan gamomdinare, bunebrivia, gansxvavebebs ver gamovxatavT
raodenobrivad. amas kargad xsnis daavadebis simZimis formebis magaliTi.
intervaluri Skala xasiaTdeba gazomvis raodenobrivi erTeuliT, amdenad gansxvaveba
nebismier or ganzomilebas Soris aSkaraa, radgan cnobilia intervali am or ganzomilebas
Soris. intervalur SkalaSi gazomvis erTeuli da nulovani wertili (aTvlis sawyisi
wertili) arbitrulia da winaswar aris pirobiTad SeTanxmebuli. mag,. adamianis sxeulis
temperatura SeiZleba gamoixatos gradusebiT (oC) raodenobriv erTeulebSi, anu ricxvebSi.
temperaturaSi sxvaobac SeiZleba gaizomos raodenobrivad, magram unda gvaxsovdes, rom
intervalur SkalaSi Cven ar gagvaCnia namdvili, WeSmariti nuli (0). mag., temperaturis

101
gasazom Skalaze danayofebs (intervalur monacemebs) – 25oC, 20oC da 5oC garkveuli fizikuri
0
mniSvnelobebi gaaCniaT, magram ramdenadac 0oC arbitrulia, azri ar eqneba imis Tqmas, rom 20 C

temperaturis pirobebSi orjer ufro metad Tbila, vidre 10oC dros.


miuxedavad imisa, rom gazomili kategoriebisadmi qulebis miniWebis saSualebiT
ordinaruli Skala SeiZleba trasformirebul iqnas fsevdo-intervalur Skalad, amiT
ordinaruli Skala ver gaxdeba intervaluri da is mainc SeinarCunebs ordinaruli Skalis
Tvisebebs.
TanafardobiTi Skala. uamravi gazomvebi fizikis, fsiqologiisa da medicinis dargebSi
TanafardobiTi Skalis gamoyenebiT warmoebs. TanafardobiT Skalas gaaCnia intervaluri Skalis
yvela maxasiaTebeli da agreTve WeSmariti, anu absoluturi nuli. ase rom, or cvlads Soris
Tanafardobas azrobrivi mniSvneloba aqvs da is SedarebiTi sazomia. Tanamedrove statistika ase
ganmartavs TanafardobiT Skalas:
TanafardobiTi Skala aris sazomi Skala, romelSic Skalis gaswvriv arsebuli manZilebi
(monakveTebi) erTi da igive mniSvnelobisaa Skalis nebismier adgilas da sadac ”0” aRniSnavs im
sagnis (Tvisebis) ararsebobas, romelic am SkaliT izomeba.
fizikuri ganzomilebebi, rogoricaa simaRle, wona, sigrZe TanafardobiTi Skalis tipuri
cvladebia. TanafardobiTi Skalis gamoyenebis SemTxvevaSi ukve azri aqvs imis Tqmas, rom 10
metri 5 metrze orjer grZelia, radgan am SkalaSi aris namdvili, WeSmariti nuli.
TanfardobiTi Skalis ricxvebis nakrebis saSualos misaRebad saWiroa TiToeuli ricxvis
logariTmis gamoTvla. centraluri tendencia SeiZleba gaizomos TanfardobiTi SkaliT
ariTmetikuli an geometriuli saSualoebis gamoyenebiT, xolo Semdgom, analogiurad SeiZleba
gamoyenebul iqnes standartuli gadaxrisa da variaciis koeficientis gansazRvrisaTvis.
TanafardobiT Skalas iyeneben klinikur da bioqimiur laboratoriebSi biosubstratebSi
zogierTi indikatoris gasazomad. es Skala gvexmareba sxvaobebis sidideTa ara marto
gansazRvraSi, aramed sxaobaTa Tanafardobis povnaSi. Cven SegviZlia am Skalis gamoyenebiT
gavigoT sxvaoba ori bavSvis wonas Soris da gamoviTvaloT wonebis Tanafardoba.
ganxiluli oTxi Skalidan TanafardobiTi Skala yvelaze mZlavri da saukeTeso gazomvis
instrumentia. is iyenebs WeSmarit nuls da moicavs danarCeni sami Skalis yvela Tvisebas.
TanafardobiTi Skala Zalze sasargebloa aramarto statistikur da epidemiologiur, aramed
yvela saxis kvlevaSi.
amrigad, erTi mxriv, gazomvis doneebis codna gvexmareba rogor ”wavikiTxoT” monacemebi,
anu rogori interpartacia gavukeToT maT maTive cvladebis safuZvelze. rodesac Cven viciT,
rom sazomi nominaluria, ukve naTelia, rom ricxobrivi mniSvnelobebi mxolod kodebia
102
saxelebis an saxelwodebebis sanacvlod. meore mxriv, gazomvis donis codna gvexmareba swori
gadawyvetilebis miRebaSi Sesabamisi statistikuri analizis gamoyenebis Taobaze. Tu sazomi
nominaluria, Cven viciT, rom monacemTa mniSvnelobebis verc saSualos gamovTvliT da,
bunebrivia, verc sxva testebs (mag., t-tests) gamoviyenebT.
monacemTa ganawilebis saxeebis, maTi parametrebisa da statistikuri testebis Seswavlis
Semdeg gasagebi iqneba gazomvis Skalebis Sesabamis cvladebze gamoyenebuli statistikuri
gamoTvlebi da testebi, romlebic qvemoT moyvanil cxrilSia mocemuli.

cxrili #25
gazomvis tipebi da Sesabamisi statistikuri gamoTvlebi da testebi

sazomi Skalis Sesabamisi statistikuri gamoTvlebi da testebi


tipi

nominaluri moda, xi-kvadrati


ordinaluri mediana, percentili
intervaluri saSualo, standartuli gadaxra, korelacia, regresia, variaciuli
analizi
TanafardobiTi yvela saxis statistikuri gamoTvla da testi da damatebiT,
Semdegi: saSualo, geometriuli, variaciis koeficienti,
logariTmebi

4.3.3. monacemTa klasifikacia da statistikuri meTodis SerCeva

zogierTi aRweriTi da analizuri manipulaciebi (operaciebi), rasac praqtikaSi vxvdebiT,


gankuTvnilia mxolod garkveul tipis monacemebisaTvis. amitom, unda SegveZlos monacemebis
swori klasificireba, anu imis gansazRvra, Tu romel tips miekuTvneba esa Tu is cvladi.
miuxedavad imisa, rom Cven mier ganxilulis garda statisikosebi monacemTa sxva
klasifikaciebsac iyeneben, monacemTa is tipebi, romlebic ganvixileT savsebiT sakmarisia
ZiriTadi manipulaciebis Casatareblad. amasTan, zogierT SemTxvevaSi monacemebis klasificireba
Zalze rTulia da TviT statistikosebs Soris iwvevs uTanxmoebas. umravles SemTxvevaSi
monacemebis klasificireba advilia, rac, Tavis mxriv, monacemTa analizisaTvis saWiro
statistikuri testis sworad SerCevas ganpirobebs.
monacemTa organizeba (mowesrigeba). Segrovili monacemebi, SesaZloa, Zalze didi iyos.
mag., monacemebi romelime stacionaris sxvadasxva an Tundac erT konkretul ganyofilebaSi
hospitalizebul pacientTa Sesaxeb SesaZloa, moicavdes pacientTa sqess, asaks,
hospitalizaciis TariRs, pirvelad diagnozs, daavadebis dawyebis TariRs, eqimTan mimarTvis

103
TariRs da a.S.. bunebrivia, amgvari informacia ramdenime gverds daikavebs da rTuli iqneba
rogorc aRsaqmelad, aseve analizis Casatareblad. monacemebis organizeba-mowesrigebiT Cven
SegviZlia vrceli monacemebi ufro kompaqturi gavxadoT da gavaadviloT maTi aRqma da analizi.
monacemebis organizebis erT-erTi saSualebaa monacemTa dajgufeba. rogorc es termini
gviCvenebs, monacemebi jgufdeba garkveuli mizniT (monacemTa Seswavlis sakiTxidan gamomdinare),
an ukve arsebuli erTgvari standartuli niSnis mixedviT (mag., asakobrivi dajgufebisas
asakobrivi standartuli dajgufebis gamoyeneba). dajgufeba monacemebis organizebis yvelaze
gavrcelebuli meTodia. unda gvaxsovdes, rom dajgufeba exeba rogorc raodenobriv, aseve
xarisxobriv monacemebs.
raodenobriv monacemTa dajgufeba. cxril #26-Si mocemulia diareis SemTxvevebi
sxvadasxva asakSi.

cxrili #26

diareis SemTxvevebi pacientTa asakis mixedviT

70 64 99 55 64 89 87 65
62 38 67 70 60 69 78 39
pacientTa
75 56 71 51 99 68 95 86
asaki
57 53 47 50 55 81 80 98
51 36 63 66 85 79 83 70

bunebrivia, am cxrilidan naTeli warmodgena ver Segveqmneba daavadebis asakobrivi


ganawilebis Sesaxeb. monacemebis kategoriebad an klasebad dajgufebiT Cven SegviZlia igive
monacemebi advilad gasagebi gavxadoT. dajgufebis pirveli safexuri moiTxovs gadawyvetilebis
miRebas dajgufebis klasis Sesaxeb. erT-erTi gzaa monacemebis warmodgena 10-wliani
intervaliT. ramdenadac yvelaze patara asaki 36 welia, pirveli klasSi gaerTiandeba 30 wlis
da meti asakis avadmyofebi. imisaTvis, rom Tavi avaridoT intervalebis gadafarvas, gamoviyenoT
simbolo ” < ”. maSin pirveli klasi ase Caiwereba: 30<40, Tumca SegveZlo sxvagvaradac
gamogvesaxa, mag., 30-39w. da gasagebi iqneboda, rom 40 wlis asaki ar iqneboda am klasSi. es
klasebad dajgufebis alternatiuli meTodia. 10-wliani intervalis gamoyenebiT Cven miviRebT 7
klass.
erTi SexedviTac naTelia, rom cxrili #26a–dan Cven ukve SegviZlia garkveuli
informaciis miReba. mag., is, rom daavadebis yvelaze meti SemTxveva 60-dan 70 wlamde asakSi
gvxvdeba. am magaliTSi gamoviyeneT monacemebis klasebad dajgufebis zogadi principi. zogierTi
aseTi principi saxelmZRvanelo wesad aris miRebuli.

104
cxrili #26a.
diareis SemTxvevebi asakis mixedviT (dajgufebuli)

asakobrivi SemTxvevebis
jgufebi raodenoba
(sixSireebi)
30<40 3
40<50 1
50<60 8
60<70 10
70<80 7
80<90 7
90<100 4

dReisaTvis monacemebis dajgufebis sami ZiriTadi saxelmZRvanelo wesi (gaidlaini)


arsebobs, esenia:
1. klasebis raodenoba ise mcire unda iyos, rom SevZloT safuZvliani daskvnis gakeTeba,
magram sakmarisad didi imisaTvis, rom SevZloT monacemebis Sesabamisi maxasiaTeblebis warmoCena;
ganxilul magaliTSi Cven 7 klasi gamoviyeneT. cnobilia, rom zogadad klasebis
raodenoba 5 - dan 20-mde meryeobs.
2. TiToeuli dakvirvebis monacemi mxolod erT romelime klass unda miekuTvnebodes.
ganxilul magaliTSi klasebis intervalebis gadafarva ar xdeba, amitom TiToeuli dakvirvebis
monacemi Sesabamis klasSia Setanili.
3. TiToeul klass unda gaaCndes erTi da igive zoma, ramdenadac es SesaZlebelia.
ganxilul magaliTSi klasebis zoma erTnairia, yvela klasi moicavs 10 asaks. erTi da igive
zomis klasebis SerCeva monacemebis grafikul warmodgenaSic gvexmareba. zogjer klasebis zomis
SerCeva kvlevis an mkvlevaris interesebis Sesabamisad warmoebs. mag., Tu Cven gvaqvs daavadebis
SemTxvevebi bavSvebsa da mozrdilebSi, bunebrivia, klasebad dayofis zemoaRwerili zogadi
principi (10 wliani intervalebiT) mizanSewonili ar iqneba.

4.3.4. sixSireTa da SedarebiT-sixSireTa ganawileba

dakvirvebaTa raodenoba (ricxvi), romelic romelime konkretul klasSi xvdeba, am


konkretuli klasis sixSires warmoadgens. mag., 50<60 klasis sixSirea 8, radgan am klasSi
dakvirvebis, anu daavadebis 8 SemTxveva gvxvdeba.
gamosaxvis saSualebas, romelic yvela klassa da maT sixSireebs asaxavs, sixSireTa
ganawileba (da ara sixSireTa ganawilebis cxrili) ewodeba.
sixSireTa garda, xSirad gvainteresebs klasis procenti. klasis procentis

105
gamosaTvlelad jer klasis sixSires vyofT dakvirvebaTa ricxvze, xolo Semdeg ganayofs
vamravlebT 100%-ze. Cven magaliTSi 50<60 klasis procenti iqneba 8/40 = 0.20 anu 20%.
klasis procents, romelic warmodgenilia decimilebSi, SedarebiTi sixSire ewodeba, xolo
gamosaxvis saSualebas, romelic yvela klassa da maT SedarebiT sixSireebs asaxavs, SedarebiT
sixSireTa ganawileba ewodeba. unda gvaxsovdes, rom SedarebiT-sixSireTa jami 1-is (100%-is)
tolia. qvemoT moyvanili cxrili warmoadgens SedarebiT-sixSireTa ganawilebas.

cxrili #26b
SedarebiT-sixSireTa ganawileba

asakobrivi jgufebi SedarebiTi sixSireebi

30<40 0.075
40<50 0.025
50<60 0.200
60<70 0.250
70<80 0.175
80<90 0.175
90<100 0.100
1.000

rodesac vadarebT monacemTa or nakrebs, upiratesoba SedarebiT sixSireTa ganawilebas


eniWeba. es imiT aixsneba, rom SedarebiTi sixSireebi yovelTvis xvdeba 0-sa da 1-s Soris da
erTgvar standarts warmoadgens SedarebisaTvis. monacemTa or nakrebs, romelTac erTanairi
sixSireTa ganawilebebi aqvT, erTnairi SedarebiT sixSireTa ganawilebebi gaaCniaT. monacemTa or
nakrebs erTnairi SedarebiT sixSireTa ganawilebebi gaaCnia mxolod im SemTxvevaSi, roca
am or nakrebs erTanairi sixSireTa ganawilebebi aqvs. es, Tavis mxriv, maSin xdeba, roca
monacemTa orive nakrebSi dakvirvebaTa erTi da igive ricxvia.

4.3.5. dajgufebaSi gamoyenebuli terminebi

garda ukve ganxiluli terminebisa (klasi, sixSire, SedarebiTi sixSire) dajgufebisas


sxva terminebic gamoiyeneba. ganvixiloT isini zemoaRweril magaliTze. yvelaze dabali asaki,
romelic magaliTad 50<60 klasSi moxvdeba 50 welia, mas dabali gamyofi wertili (cut off
point) ewodeba. dabali gamyofi wertili 60<70 klasisaTvis 60 welia, amave dros es ricxvi

maRal gamyof wertils warmoadgens wina (50<60) klasisTvis. 60<70 klasisaTvis ki maRali
106
gamyofi wertili iqneba 70 weli, romelic dabali gamyofi wertilia Semdegi klasisTvis da
a.S.
klasis Sua ricxvs Sua wertili ewodeba. igi warmoadgens dabali da maRali gamyofi
wertilebis saSualos. 50<60 klasisaTvis Sua wertili iqneba (50+60)/2=55. Sua wertili
iZleva erT ricxvs da amdenad, mosaxerxebelia klasis dasaxasiaTeblad. swored amitom mas
xSirad iyeneben klasis grafikulad gamosaxatavad da agreTve aRweriTi sazomebis
gamosaTvlelad.
Semdegi maxasiaTebelia klasis zoma (siRrme), romelic miiReba maRali gamyofi
wertilisa da dabali gamyofi wertilis sxvaobiT.
cxrils, romelic warmogvidgens monacemTa nakrebis klasebs, sixSireebs, SedarebiT
sixSireebsa da Sua wertilebs, dajgufebul monacemTa cxrili ewodeba.
zemoT ganxiluli magaliTis monacemebi SegviZlia warmovadginoT dajgufebul monacemTa
cxrilis saxiT.

cxrili #26g
dajgufebul monacemTa cxrili

asakobrivi SemTxvevebis SedarebiTi Sua wertili


jgufebi raodenoba sixSireebi
(sixSireebi)
30<40 3 0.075 35
40<50 1 0.025 45
50<60 8 0.200 55
60<70 10 0.250 65
70<80 7 0.175 75
80<90 7 0.175 85
90<100 4 0.100 95
1.000

monacemTa klasebad warmodgenis alternatiuli meTodis gamoyenebisas


gamyofi wertilebis nacvlad xmaroben terminebs: qveda zRvarsa da zeda zRvars. ase mag.,
klasis 50-59 zeda zRvaria 59, xolo qveda – 50. Sua wertilis nacvlad ki gamoiyeneba
niSnuli (mark), romelic qveda da zeda zRvrebis saSualos wamoadgens. Cvens konkretul
SemTxvevaSi is tolia (50+59)/2=54.5.
xarisxobriv monacemTa dajgufeba. cxril #27-Si mocemulia diareis SemTxvevebi
daavadebis simZimis mixedviT (msubuqi-ms, saSualo-sS, mZime-mZ).

107
cxrili #27

diareis SemTxvevebi simZimis formebis mixedviT

daavadebis ms sS sS mZ sS
simZimis formebi sS mZ ms mZ mZ
sS mZ mZ mZ sS
ms ms ms ms ms

diareis SemTxvevebis xarisxobrivi monacemebi Cven SegviZlia davajgufoT daavadebis


simZimis formebis mixedviT da warmovadginoT cxrilis saxiT, sadac SegviZlia SevitanoT
monacemTa sixSireebi an sixSireebi da SedarebiTi sixSireebi.
rogorc raodenobrivi cvladebis dajgufebaSi aRvniSneT, xarisxobriv monacemTa
TiToeuli kategoriis sixSireebis gayofiT daavadebis SemTxvevebis saerTo raodenobaze,
miviRebT SedarebiT sixSireebs.
cxrili #27a

diareis SemTxvevebis ganawileba simZimis formebis


sixSireebisa da SedarebiTi sixSireebis mixedviT

simZimis forma sixSire SedarebiTi sixSire

msumbuqi 13 0.325
saSualo 18 0.450
mZime 9 0.225
sul 40 1.000
cxrilidan vigebT, rom diareiT daavadebuli 40 pacientidan 13-s aReniSneboda daavadebis
msumbuqi forma, 18-s - saSualo da 9-s – mZime, anu daavadebulTa 32.5%-s hqonda diareis
msumbuqi forma, 45.0%-s _ saSualo da 22.5%-s – mZime.

4.4. cvladTa ganawilebis tipebi

monacemebis ganawilebis ori tipi arsebobs: centraluri, anu normaluri ganawileba da


dispersia, anu ganfena. normalur ganawilebas hausis ganawilebasac uwodeben karl jonaTan
hausis sapativcemulod, romelmac aRwera aRniSnuli saxis ganawileba. normaluri ganawilebis
dasaxasiaTeblad gamoiyeneba centraluri da sxva mdebareobis parametrebi. jer ganvixiloT
normaluri ganawileba da misi parametrebi.

108
4.4.1. centraluri tendencia

(centraluri mdebareobis da mdebareobis sxva parametrebi)


termini “centraluri tendencia” asaxavs monacemTa SuaSi mdebare mniSvnelobas,
savaraudod, monacemTa tipur mniSvnelobas. aqedan gamomdinare, centraluri tendenciis sazomebi
(parametrebi) ganawilebis Sua, anu centraluri mdebareobis sazomebia.
sxvadasxva saxis kvlevis Sedegad miRebuli monacemebis ukeT aRsaqmelad da
dasamuSaveblad rekomendebulia cvladis sxvadasxva mniSvnelobebis ganlageba rigis saxiT, rasac
variaciuli rigi anu monacemTa rigi ewodeba.
monacemTa rigis raodenobrivi daxasiaTebisaTvis gamoiyeneba centraluri mdebareobis
parametrebi, romelsac miekuTvneba:
• saSualo ariTmetikuli;
• saSualo geometriuli;
• moda;
• mediana.
es parametrebi gviCveneben Tu sad mdebareobs tipuri mniSvnelobebi monacemTa nakrebSi.
unda aRiniSnos, rom monacemTa ganawileba SesaZloa gamoisaxos grafikulad.
Zalian xSirad aRiniSneba monacemTa simetriuli dajgufeba centraluri poziciis
garSemo, rac damaxasiaTebelia normaluri ganawilebisTvis. aseTi ganawilebis grafikis agebisas
miiReba zaris formis msgavsi mrudi, romelsac normaluri ganawilebis mrudi ewodeba (suraTi
#15).

suraTi #15
normaluri ganawilebis mrudi

Tumca isic unda aRiniSnos, rom realobaSi (epidzedamxedvelobis an epidemiologiuri


kvlevis Sedegad miRebuli) monacemebi grafikuli gamosaxvisas iSviaTad SeiZleba savsebiT
imeorebdes zaris formas, amitom medicinasa da biologiaSi uwyveti monacemebis SemTxvevaSi
109
maTi ganzomilebebi miaxloebulia normaluri ganawilebis parametrebTan.
normaluri ganawilebis parametrebi gviCveneben, Tu sad mdebareobs monacemebis centri,
anda monacemTa nakrebis yvelaze tipuri warmomadgeneli. normalur ganawilebas efuZneba
mravali testi, romelic gamoiyeneba monacemTa analizisaTvis.
rig SemTxvevebSi saqme gvaqvs e. w. gadanacvlebul ganawilebasTan. ganawilebas ewodeba
gadanacvlebuli, roca ganawilebis mrudis erTi bolo meoreze grZelia.
zogjer monacemTa iseT ganawilebas viRebT, romelTa centraluri pozicia
gadanacvlebulia centridan marjvniv an marcxniv. monacemTa ganawilebas, romlis centraluri
pozicia mdebareobs marcxniv, xolo ”kudi” – marjvniv, ewodeba ”dadebiTad gadanacvlebuli” an
”gadanacvlebuli marjvniv”. suraTi #16B-ze ganawileba ”dadebiTad gadanacvlebulia”.
ganawileba, romlis centraluri pozicia mdebareobs marjvniv, xolo ”kudi” – marcxniv,
”uaryofiTad gadanacvlebuli” an ”gadanacvlebuli marcxniv” ewodeba. suraTi #16A-ze
ganawileba ”uaryofiTad gadanacvlebulia”.

suraTi 16
marcxniv da marjvniv gadanacvlebuli ganawilebis mrudebi

saSualo ariTmetikuli yvelaze xSirad gamoyenebuli saSualo sididea, romelic


centraluri mdebareobis umniSvnelovanesi maxasiaTebelia. misi gamoTvlisaTvis monacemTa
nakrebSi arsebuli yvela mniSvnelobis jami iyofa monacemTa raodenobaze, rac formulis saxiT
ase gamoisaxeba:
XsaS =

sadac: XsaS _ saSualo ariTmetikulia,


∑ - jamis niSania,
Xi – monacemTa mniSvnelobebia,
n – monacemTa raodenobaa.
110
magaliTad, A hepatitis afeTqebis dros gamovlinda 7 avadmyofi, romelTa inkubaciuri
periodi, Sesabamisad, iyo – 26, 29, 30, 24, 29, 31, 20 dRe. unda gamovTvaloT saSualo
inkubaciuri periodi. zogadad monacemebi SeiZleba iyos daujgufebeli da dajgufebuli.
daujgufebelia monacemebi, roca isini warmodgenilia calkeuli sidideebis saxiT. Cvens mier
moyvanili monacemebic aris daujgufebeli. dajgufebulia monacemebi, roca isini warmodgenilia
jgufebis saxiT erTnairi monacemebis sixSiris mixedviT. saSualo ariTmetikulis
gamosaTvlelad upirveles yovlisa monacemebi unda davajgufoT yvelaze dabali mniSvnelobidan
yvelaze maRali mniSvnelobisaken (anda piriqiT): 20, 24, 26, 29, 29, 30, 31 dRe.
∑Xi = 20 + 24 + 26 + 29 + 29 + 30 + 31 = 189
n = 7
XsaS = 189 /7 = 27 dRes.
anu aRniSnuli afeTqebis dros A hepatitis saSualo inkubaciuri periodi Seadgenda 27
dRes. saSualo ariTmetikuls aqvs ramdenime mniSvnelovani Tviseba. upirveles yovlisa, is
monacemTa nakrebis ”simZimis, anu ariTmetikuli centria”. es niSnavs, rom monacemTa rigSi
TiToeuli mniSvnelobis da saSualo ariTmetikulis sxvaobebis jami aris 0-is toli. es kargad
Cans Cven magaliTzec:

saSualo ariTmetikulis am Tvisebas centrirebis Tviseba ewodeba. es imas niSnavs, rom


monacemTa nakrebi iqneba wonasworobaSi, Tu sayrden wertils movaTavsebT saSualo
ariTmetikulze. wonasworoba dairRveva, Tu sayrdeni wertili sxva adgilas gadainacvlebs.
saSualo ariTmetikulis meore Tavisebureba aris is, rom mis mniSvnelobaze did gavlenas
axdens monacemTa ukiduresi mniSvnelobebi. Tu Cvens magaliTSi 31 dRiani inkubaciuri periodis
magivrad gveqneboda 73 dRe, maSin saSualo ariTmetikuli toli iqneba:

20 + 24 + 26 + 29 + 29 + 30 + 73
XsaS= = 33 dRe
7
33 dRec am monacemebis ”simZimis centria”, magram igi ufro naklebi sizustiT axasiaTebs
monacemebs. erTi eqstremaluri sididis gamo, saSualo ariTmetikuli aRemateba yvela sxva
monacems. am Taviseburebis gamo, saSualo ariTmetikulis gamoTvlas monacemTa asimetriuli
111
ganawilebis dros, didi mniSvneloba ar eniWeba.
maSasadame, saSualo ariTmetikulis gamoyenebas azri aqvs Tu:
• centraluri ganawilebaa,
• ganawileba aris simetriuli,
• ukiduresi mniSvnelobebi mcirea, an ar aris.
mediana. igi centraluri ganawilebis popularuli parametria. mediana zrdis an klebis
tendenciiT dalagebul, mowesrigebul monacemebs or Tanabar nawilad yofs, romelTagan erTi
Sedgeba iseTi monacemebisagan, romlebic aRematebian medianas mniSvnelobas, xolo meore naxevris
monacemTa mniSvnelobebi naklebia medianaze. monacemTa rigis dasaxasiaTeblad mediana
gansakuTrebiT xSirad gamoiyeneba maSin, rodesac ganawileba asimetrulia. xazgasmiT unda
aRiniSnos, rom mediana damokidebuli ar aris ganawilebis eqstremalur mniSvnelobebze. mediana
aRiniSneba M-iT an Md-Ti.
medianas gamoTvla damokidebulia imaze, Tu ramdeni wevria monacemTa rigSi. medianas
gamosaTvleli formulaa:

sadac n – monacemTa raodenobaa. Cveni magaliTis SemTxvevaSi

M=

anu mediana meoTxe mniSvnelobis tolia, e.i. roca monacemTa raodenoba kentia, mediana
monacemTa rigis SuaSia.
Tu monacemTa rigSi aris luwi raodenoba, maSin mediana aris ori Sua mniSvnelobis
saSualo ariTmetikuli. vTqvaT dadgenili gvaqvs A hepatitis inkubaciuri periodi 8 avadmyofis
mimarT:
20, 24, 26, 27, 29, 29, 30, 31 dRe.
am SemTxvevaSi

M=

anu mediana moTavsebulia me-4 da me-5 mniSvnelobebis SuaSi. Sesabamisad mediana udris 27
+ 29 / 2 = 28 dRes.
calsaxad unda iTqvas, rom medianas sidide damokidebulia dakvirvebaTa ricxvze. Tumca
mis gamosaTvlelad viyenebT monacemTa rigis Sua erTi an ori monacemis mniSvnelobas. saSualo
ariTmetikulis daxasiaTebisas aRvniSneT, rom igi damokidebulia eqstremalur mniSvnelobebze.
magaliTad, rodesac gvqonda monacemTa ori rigi, sadac mxolod erTi mniSvneloba iyo
112
gansxvavebuli, saSualo ariTmetikuli sakmaod Seicvala:
20, 24, 26, 29, 29, 30, 31 dRe
20, 24, 26, 29, 29, 30, 73 dRe
pirvel SemTxvevaSi XsaS = 27 dRes. xolo meore SemTxvevaSi XsaS = 33 dRes. maSin
rodesac mediana orive magaliTis dros erTi da igive sididea, me-4 monacemi, anu 29 dRe. e.i.
medianaze gavlenas ar axdens monacemTa ukiduresi mniSvnelobebi, amitom is ar gamoiyeneba
damatebiTi statistikuri manipulaciebis Casatareblad, Tumca igi karg aRweriT ganzomilebas
warmoadgens didi gadaxrebis mqone ganawilebebSi. magaliTad saSualo Semosavali, bunebrivia,
naklebad informaciulia, vidre mediana Semosavali. analogiurad, mravalprofilian stacionarSi
saSualo sidide swor warmodgenas ver Segviqmnis pacientTa dayovnebis Sesaxeb, aseT
SemTxvevaSi mediana kargi aRweriTi ganzomilebaa.
moda. moda monacemTa rigSi aris is sidide, romelic yvelaze ufro xSirad gvxvdeba.
magaliTad, A hepatitis inkubaciuri periodis Seswavlis SemTxvevaSi:
20, 24, 26, 29, 29, 30, 31 dRe – moda tolia 29 dRis, radgan es sidide orjer
gvxvdeba, danarCeni sidideebi ki mxolod erTxel.
Tu monacemTa rigSi TiToeuli cvladis sixSire Tanabaria, anu gvxvdeba erTxel, maSin
monacemTa aseT nakrebs moda ar gaaCnia. xolo Tu monacemTa rigSi ori cvladi gvxvdeba
yvelaze ufro xSirad, maSin aseT monacemTa nakrebs eqneba ori moda. amis magaliTi moyvanilia
qvemoT:
9, 9, 13, 15, 17, 17. aq aris ori moda – 9 da 17.
Tu monacemTa rigSi gvxvdeba erTi moda, maSin aseT ganawilebas unimodaluri ganawileba
ewodeba (suraTi #17), xolo, Tu monacemTa nakrebSi ori cvladi gvxvdeba yvelaze ufro
xSirad, aseT monacemTa nakrebs bimodaluri ganawileba ewodeba (suraTi #18).

suraTi #17

113
suraTi #18

nominalur (kategoriul) monacemebTan dakavSirebiT moda SeiZleba Zalze kargi


maxasiaTebeli aRmoCndes. ase mag. Tu gvainteresebs gripis epidemiisas romel preparats aZlevs
upiratesobas mosaxleoba, saafTiaqo qselidan gayiduli preparetebis moda medikamenti pasuxs
gascems am kiTxvas. amasTan moda, garkveulwilad, am konkretuli medikamentis efeqturobis
Sesafasebladac SeiZleba gamoviyenoT. garda amisa, moda SeiZleba gamoyenebul iqnes ordinaruli
monacemebis SemTxvevaSic. simetriul ganawilebaSi saSualo, mediana da moda Tanabari da
identuri mniSvnelobisaa. rac Seexeba gadacvlebul ganawilebebs, dadebiTad gadanacvlebul
ganawilebaSi saSualo ufro didia vidre mediana, xolo uaryofiTad gadanacvlebul
ganawilebaSi saSualo naklebia vidre mediana. aqve isic unda aRiniSnos, rom es SesaZloa ar
exebodes bimodalur ganawilebas. qvemoT mocemuli sqema da suraTi #19 ukeT warmoaCens
saSualos, medianasa da modas pozicias da maT Soris damokidebulebas gadanacvlebul
ganawilebebis SemTxvevaSi.

sqema#2
saSualos, medianasa da modas pozicia da maT Soris damokidebuleba
gadanacvlebuli ganawilebebis SemTxvevaSi

dadebiTad gadanacvlebuli: saSualo > mediana > moda


uaryofiTad gadanavlebuli: saSualo < mediana < moda

114
suraTi #19
saSualos, medianasa da modis pozicia normaluri da gadanacvlebuli ganawilebaSi

saSualo geometriuli. im SemTxvevaSi, rodesac monacemTa rigSi cvlileba xdeba


geometriuli progresiiT, magaliTad avadobis dinamikaSi matebis tempi, serologiur reaqciebSi
antisxeulebis saSualo titri da sxva, maSin gamarTlebulia saSualo geometriulis gamoTvla.
Xgeom. = n√ X1 x X2 x .................................... Xn,
sadac X1 , X2 da a. S. – calkeuli cvladebia, anu variantebi,
n – fesvi variantis xarisxidan.
amrigad, uwyveti raodenobrivi cvladebis monacemTa rigis zogadi daxasiaTebisaTvis
gamoiyeneba saSualo sidideebi. maTgan yvelaze ufro xSirad gamoiyeneba saSualo ariTmetikuli,
anu, ubralod, saSualo. Tu monacemebi normalurad aris ganawilebuli, maSin yvelaze
informaciulia saSualo ariTmetikuli. igi monacemTa rigis ”simZimis centria”.
meore mniSvnelovani parametria mediana, romelzec eqstremaluri mniSvnelobebi ar
moqmedeben. misi gamoyeneba gansakuTrebiT saWiroa, maSin rodesac monacemTa rigi asimetriulia
da gvxvdeba eqstremaluri mniSvnelobebi.
moda aris mniSvneloba, romelic yvelaze ufro xSirad gvxvdeba. Tu monacemTa rigs,
rogorc wesi, aqvs erTi saSualo ariTmetikuli da mediana, moda SeiZleba qondes erTi,
arcerTi, an ramdenime. moda mniSvnelovania maSin, rodesac gvainteresebs, Tu romeli
mniSvneloba aris yvelaze popularuli.
115
rac Seexeba saSualo geometriuls, mas xSirad iyeneben laboratoriuli monacemebis
damuSavebisas.
monacemTa mdebareobis aRweris sxva parametrebs miekuTvneba kvartili da percentili.
kvartili (meoTxedi) mniSvnelobaa, romelic ganawilebas yofs 4 Tanabar nawilad. igi
gamoiTvleba medianas da ara saSualo ariTmetikulis safuZvelze. monacemTa 25 % pirveli
kvartilis Q1 qveviTaa, monacemTa 25 % Q1-sa da Q2–s (mediana) Soris aris, monacemTa 25 %
Q2–s (mediana) da Q3-s Soris, xolo monacemTa 25 % Q3-is zeviT (suraTi #20). raodenobrivi
cvladebis daxarisxebuli maCveneblebi mocemulia #28 cxrilSi
cxrili #28
raodenobrivi cvladis daxarisxebuli maCveneblebi
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
27 27 28 28 28 29 30 30 31 32 32 33 34 35 36 37 38 38 39 39

suraTi #20
kvartilTa mdebareoba monacemTa nakrebSi

kvartilebis gamoTvlis umartivesi gzaa medianas gamoTvla, romelic amave dros Q2–ia.
cxril #28-Si mocemulia 20 dakvirveba. Cven ukve viciT, rom me-2 kvartili igive medianaa da
Sesabamisad am SemTxvevaSi Q2=32.
116
pirveli kvartilis mosaZebnad saWiroa: (n+1)/4, magram miRebuli cifri unda
damrgvaldes uaxloes mTel ricxvamde:

dakvirvebis pirveli kvartili (Q1) = (20+1) / 4 = 21 /4 =5.25 5, e.i. me-5 dakvirveba, anu Q1
= 28.
me-2 kvartili (Q2) tolia medianis _ (Q2 = 10.5), e.i. me-10 da me-11 mniSvnelobebis
saSualo ariTmetikulis, anu 32-is.
me-3 kvartili udris 3(n+1) /4. Q3 = 3(20+1)/4 = 15.75, e.i. daaxloebiT me-16 dakvirvebas,
anu 37-s.
percentili anu procentili cvladis is mniSvnelobaa, romelic ganawilebis rigs yofs
100 Tanabar nawilad. magaliTad, Tu monacemTa 45% 45-e percentilis qvemoTaa, maSin monacemTa
55% 45-e percentilis zeviT iqneba.
percentili ZiriTadad monacemTa zogadi daxasiaTebisTvis gamoiyeneba, maSinac ki roca
ucnobia monacemTa ganawilebis saxe.

4.4.2. dispersiis (ganfenis) parametrebi

monacemTa variaciuli rigis mniSvnelovani maxasiaTebelia dispersiuli ganawilebis


parametrebi, romlebic gviCveneben, Tu rogor meryeoben cvladebis mniSvnelobebi ganawilebis
erTobliobaSi. gansxvavebiT centraluri mdebareobis parametrebisgan, dispersiis parametrebi
gviCveneben, ramdenad vrclad arian monacemebi ganfenilni centridan. amdenad es parametrebi
dispersiis ufro srulyofil suraTs iZlevian. maT miekuTvneba:
• diapazoni,
• kvartilebs Soris intervali,
• varianta (dispersia),
• standartuli gadaxra,
• variaciis koeficienti
diapazoni gamoxatavs sxvaobas yvelaze did da yvelaze mcire mniSvnelobebs Soris.
amdenad, diapazonze gavlenas axdens ukiduresi mniSvnelobebi. diapazoni ganawilebis yvelaze
martivi ganzomilebaa.
diapazoni SeiZleba gamoisaxos ornairad:
1) sididis saxiT: ganawilebis rigSi minimalur da maqsimalur mniSvnelobebs Soris
sxvaoba. Cvens mier zemoT moyvanil magaliTSi A hepatitis inkubaciuri periodis Sesaxeb
diapazonis gamosaTvlelad 31 dRes (yvelaze didi inkubaciuri periodi) unda gamovakloT 20

117
dRe (minimaluri inkubaciuri periodi), miviRebT 11 dRes. anu inkubaciuri periodis diapazoni
udris 11 dRes.
2) intervalis saxiT: anu minimaluri da maqsimaluri mniSvnelobebis gamosaxva
diapazonis saxiT. e. i. wina magaliTis SemTxvevaSi diapazoni ase daiwereba _ 31-20 (20-31).
kvartilebs Soris intervali moicavs ganawilebis centralur nawils da gamoiTvleba rogorc
sxvaoba mesame da pirveli kvartilebis mniSvnelobebs Soris. am diapazonSi devs monacemTa
nakrebis daaxloebiT naxevari, mis gareT TiToeul mxares moTavsebulia dakvirvebaTa meoTxedi
(suraTi #20).
rogor gamoiTvleba kvartilebs Soris intervali?
kvartilebs Soris intervalis gamosaTvlelad, jer saWiroa pirveli da mesame
kvartilis povna. iseve rogorc medianas gamoTvlisas, amjeradac vawesrigebT monacemebs
(valagebT umciresidan udidesisken) da vadgenT kvartilebis pozicias. poziciis Sesabamisi
sidide warmoadgens saZiebeli kvartilis mniSvnelobas, xolo im SemTxvevaSi, roca kvartili
xvdeba or dakvirvebiT sidides Soris, misi mniSvneloba am dakvirvebaTa mniSvnelobebs Sorisaa
moqceuli.
kvartilTa Soris intervalis (Q3 _ Q1) gamoTvlis etapebi:
1. dakvirvebaTa monacemebis dalageba zrdis mixedviT;
2. pirveli da mesame kvartilebis poziciis dadgena Semdegi formulis mixedviT:
pirveli kvartilis pozicia (Q1) = (n+1) / 4
mesame kvartilis pozicia (Q3) = 3 x (n+1) / 4 = 3x Q1
3. pirveli da mesame kvartilis mniSvnelobebis gansazRvra;
4. kvartilTa Soris intervali Q3 da Q1 mniSvnelobaTa sxvaobis tolia. kvartilTa
Soris intervalis gamoTvlis etapebi ganvixiloT kerZo magaliTze: vTqvaT, mocemulia Semdegi
monacemebis nakrebi:
13, 7, 9, 15, 11, 5, 8, 4.
1. davalagoT monacemebi zrdis mixedviT:
4, 5, 7, 8, 9, 11, 13, 15
2. vipovoT pirveli da mesame kvartilebis pozicia. sul mocemulia 8 dakvirveba, amitom
n=8.
pirveli kvartilis pozicia (Q1) = (n+1) / 4 = (8+1)/4 = 2.25
mesame kvartilis pozicia (Q3) = 3 x (n+1) / 4 = 3x Q1 = 6.75
ase rom, Q1 mdebareobs me-2 da me-3 dakvirvebaTa Soris manZilis erT meoTxedze, xolo
Q3 me-6 da me-7 dakvirvebaTa Soris sxvaobis sam meoTxedze.
118
3. ganvsazRvroT pirveli da mesame kvartilebis mniSvnelobebi.
Q1 –is mniSvneloba: Q1 –is pozicia iyo 2 1/4 ; amitom Q1 –is mniSvneloba tolia meore
dakvirvebas damatebuli mesame da meore dakvirvebebs Soris arsebuli sxvaobis 1/4. Cvens
monacemTa rigSi mesame dakvirvebaa 7, meore dakvirvebaa 5.
Q1=5+(1/4)(7-5) = 5+2/4 = 5.5
Q3 –is mniSvneloba: Q3 –is pozicia iyo 6 3/4 ; amitom Q3 –is mniSvneloba tolia meeqvse
dakvirvebis mniSvnelobas damatebuli me-7 da me-6 dakvirvebaTa mniSvnelobebs Soris arsebuli
sxvaobis 3/4: Cvens monacemTa rigSi me-7 dakvirvebaa 13, me-6 dakvirvebaa 11.
Q3= 11+ (3/4)(13-11) = 11+6/4 = 12.5
4. gamovTvaloT kvartilTa Soris intervali formuliT: Q3 - Q1
Q3 - Q1 = 12.5 – 5.5 = 7.
da bolos, ra mniSvneloba aqvs kvartilebs Soris intervalis gamoTvlas? rogorc zemoT
aRvniSneT, pirvel da mesame kvartils Soris mdebareobs monacemTa nakrebis daaxloebiT 50 %.
kvartilTa Soris intervali gviCvenebs, Tu rogoria monacemTa meryeoba.
standartuli gadaxra.
varianta da standartuli gadaxra dispersiis is parametrebia, romlebic yvelaze xSirad
gamoiyeneba saSualo ariTmetikulTan erTad. Tumca varianta iSviaTad gamoiyeneba rogorc calke
aRebuli parametri. igi standartuli gadaxris gamoTvlis safexuria.
variantas aRniSnaven S asoTi, xolo standartul gadaxras SD asoTi. TiToeuli
dakvirvebis mniSvnelobas gamoklebuli saSualo aris is koncefcia (anu saSualo
ariTmetikulis centrirebis Tviseba), romelsac standartuli gadaxris gamoTvla efuZneba.
Tumca am SemTxvevaSi TiToeuli mniSvnelobisa da da saSualos sxvaobebi kvadratSi agvyavs,
raTa moviSoroT uaryofiTi ricxvebi da nulovani jami. sxvaobebis kvadratSi ayvaniT SegviZlia
SevafasoT saSualos irgvliv arsebul sidideTa gaSla.

variantasa da standartuli gadaxris gamosaTvleli formulebi

( )
varianta gamoiTvleba formuliT:


2
X −X
S2 = i saS
n −1
standartuli gadaxra gamoiTvleba formuliT:

 (X i − X saS )
2

SD =
n −1
119
sadac, XsaS. – saSualo ariTmetikulia,
Xi - calkeuli sididea,
n – dakvirvebaTa raodenobaa,

S – variantaa, xolo
SD – standartuli gadaxra.

rogorc vxedavT, standartuli gadaxra variantas kvadratuli fesvia.


exla detalurad ganvixiloT variantasa da standartuli gadaxris gamoTvlis etapebi:
1. gamovTvaloT monacemTa rigis saSualo ariTmetikuli - XsaS.
2. TiToeuli dakvirvebis mniSvnelobas gamovakloT saSualo ariTmetikuli: Xi –XsaS.

3. sxvaoba aviyvanoT kvadratSi: (Xi –XsaS.)2

4. kvadratSi ayvanili sxvaobebi SevajamoT: ∑(Xi –XsaS. )2


5. kvadratSi ayvanili sxvaobebis jami gavyoT (n-1) -ze

6. variantadan amoviRoT kvadratuli fesvi: SD = S


ganvixiloT standartuli gadaxris gamoTvlis magaliTi:
stacionarSi moTavsebuli A hepatitis mqone 5 pacientis inkubaciuri
periodebia 27, 31, 15, 30 da 22 dRe (cxrili #29).
cxrili #29
stacionarSi moTavsebuli A hepatitis mqone pacientTa inkubaciuri periodebi

Xi XsaS. Xi –XsaS. (Xi –XsaS.)2

15 25 -10 100
22 25 -3 9
27 25 2 4
30 25 5 25
31 25 6 36
sul 174
S= 174 / n-1 = 174/4 = 43.5
SD = S= 6.6 dRe.
standartuli gadaxris gamoTvla Cveulebriv xdeba maSin, roca monacemebi metnaklebad
”normaluradaa ganawilebuli”, anu monacemebi Seesabamebian tipur, zaris formis mruds.
magaliTad, adamianebis simaRles Tu ganvixilavT romelime populaciaSi (an jgufSi, Tundac
romelime klasSi), zogierTi iqneba dabali, zogierTi – maRali, Tumca umravlesoba iqneba
saSualo simaRlis. aseve, mosaxleobis garkveuli nawili msuqania, garkveuli nawili _
gamxdari, magram umravlesobas gaaCnia saSualo wona da wonis sidideebis grafikulad
120
gamosaxvisas saSualo wonis mniSvneloba xvdeba zaris formis mrudis SuaSi.
normalurad ganawilebuli monacemebis SemTxvevaSi centraluri mdebareobis
rekomendebuli parametri saSualo ariTmetikulia, xolo dispersiuli ganawilebis
rekomendirebuli parametri - standartuli gadaxra. amrigad, savsebiT normaluri ganawilebis
SemTxvevaSi zaris formis mrudi SeiZleba srulad daxasiaTdes mxolod saSualo
ariTmetikulisa da standartuli gadaxris gamoyenebiT. standartul gadaxras aqvs garkveuli
statistikuri Tvisebebi, romelTac farTod viyenebT epidemiologiaSi. standartuli gadaxra
monacemTa rigis dispersias gviCvenebs. rac ufro erTgvarovania monacemebi, miT ufro mcire
iqneba standartuli gadaxra da piriqiT, Tu monacemebi erTmaneTisagan mniSvnelovnad
gansxvavdebian, maSin standartuli gadaxris mniSvneloba izrdeba.
albaTobis Teoriis Tanaxmad, iseTi movlenebis SemTxvevebisas, romlebic normalur
ganawilebas eqvemdebarebian, saSualo ariTmetikuls, standartul gadaxras da monacemTa
mniSvnelobebs Soris arsebobs mkacri urTierTdamokidebuleba. kerZod am tipis ganawilebisas:
±1SD –is farglebSi monacemTa 68,3%-ia moTavsebuli,
±2SD –is farglebSi - 95,5%,
±3SD –is farglebSi – 99,7%-ia moTavsebuli, (suraTi #21).

suraTi #21

normaluri ganawilebis mrudi

121
variantebis ganawileba empiriul monacemTa rigSi yovelTvis nawilobriv gansxvavdeba
Teoriulisgan, Tumca es gansxvaveba umniSvneloa da swored es iZleva saSualebas e.w. sami SD-s
principi farTod gamoviyenoT praqtikaSi. normaluri ganawilebisas, Tu viciT saSualo
ariTmetikulis da standartuli gadaxris mniSvnelobebi, am wesis gamoyenebiT SeiZleba
warmodgena SeviqmnaT cvladi mniSvnelobebis SesaZlo meryeobis farglebis Sesaxeb. garda amisa,
am wesis gamoyenebiT SeiZleba vimsjeloT Tu ramdenad tipuria Cveni kvlevis Sedegad miRebuli
monacemebi. Tu kvlevis Sedegad miRebuli monacemebis 95% moTavsebulia XsaS±2SD–is
farglebSi, maSin Cveni monacemTa rigisaTvis saSualo aris tipuri maxasiaTebeli da aqedan
gamomdinare dakvirvebaTa ricxvis gazrda ar aris saWiro. amis sademonstraciod SeiZleba
moviyvanoT aseTi magaliTi. Seswavlil iqna 10 wlis biWebis simaRle. miRebuli Sedegebi
naCvenebia #30 cxrilSi.

cxrili #30
10 wlis biWebis simaRlis gazomvis Sedegebi

simaRle bavSvTa Xi× p Xi - X saS (Xi - X saS)2 (Xi - X saS)2 × p


(sm-Si) raodenoba
Xi (p)
155 1 155 +2 4 4
154 4 616 +1 1 4
153 6 918 0 0 0
152 4 608 -1 1 4
151 1 151 -2 4 4
2448 16

2448
X saS = = 153 sm
16

16 16
SD = = = 1,066 = 1,05 sm
16 − 1 15

Teoriis Tanaxmad, X saS±2SD –is farglebSi (151sm-dan 155sm-mde) unda iyos monacemTa
95%. am SemTxvevaSi Teqvsmetive bavSvis simaRle araTu 95%, aramed 100%-is farglebSia, es ki
imaze metyvelebs, rom saSualo ariTmetikuli 153 sm monacemTa rigisaTvis aris tipuri.
Sesabamisad monacemTa es rigi Seesabameba monacemTa Teoriuli ganawilebis rigs.
standartuli gadaxra SeiZleba gamoyenebul iqnes normasa da normidan gadaxras Soris
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zRvaris dasadgenad, aseve daavadebis endemuri SemTxvevebis raodenobis dasadgenad, agreTve
raime iSviaTi bunebis an mdgomareobis gamosavlenad (saSualodan±3 standartuli gadaxris
farglebSi). standartuli gadaxra saSualo ariTmetikulTan erTad xSirad gamoiyeneba
epidzedamxedvelobis monacemebis analizis dros.
Tumca unda aRiniSnos, rom yovelTvis ar xerxdeba standartuli gadaxris saSualebiT
araerTgvarovani monacemebis rigis Sedareba, Tundac im martivi mizezis gamo, rom monacemebi

SeiZleba sxvadasxva sazom erTeulebSi iyos mocemuli (magaliTad leikocitebis raodenoba 1mm3-
Si da arteriuli wneva vercxliswylis svetis mililitrebSi). aseT SemTxvevaSi monacemTa
variabelurobis Sesafaseblad gamoiyeneba variaciis koeficienti, romelic miiReba standartuli
gadaxris gayofiT saSualo ariTmetikulze. igi gamoiTvleba formuliT:
SD
Cv =  100% , sadac
X
saS
CV – variaciis koeficientia
SD – standartuli gadaxra
X saS – saSualo ariTmetikuli
variaciis koeficienti gviCvenebs Tu standartuli gadaxra saSualo ariTmetikulis
ramdeni procentia. miRebulia, rom Tu CV 20%-ze metia, maSin monacemebis mniSvnelobebi Zalian
gafantulia, Tu 10%-mdea -gafantuloba aris mcire, xolo 10%-20% is dros – saSualo.
variaciis koeficientis mniSvnelobis Sesafaseblad ganvixiloT #31 cxrilSi mocemuli
Sedegebi:

cxrili #31
10 wlis bavSvebis anTropologiuri monacemebis Sedareba

statistikuri simaRle gulmkerdis masa filtvebis sasicocxlo


kriteriumebi (sm) garSemoweriloba (kg) tevadoba (sm3)
(sm)
XsaS 142 66 40 2300
SD ±8,5 ±4 ±6 ±460
CV 6 6 15 20

CV –s Sedarebis gziT Cans, rom yvelaze myari niSani simaRle da gulmkerdis


garSemowerilobaa, yvelaze naklebad myari ki – filtvebis sasicocxlo tevadoba da sxeulis
wona.

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4.5. analizuri biostatistika

4.5.1. albaToba

miRebuli Sedegebis damajereblobis donis dasadgenad da aRweriTi epidemiologiis


safuZvelze SemuSavebuli hipoTezebis Sesamowmeblad (testirebisaTvis) analizuri
biostatistika farTod iyenebs albaTobas.
movlenis albaToba aris varaudi imis Sesaxeb, rom romelime konkretul movlenas
adgili eqneba realobaSi. romelime movlenis albaToba warmoadgens wilads an proporcias,
romelic gviCvenebs am movlenis yvela SesaZlo arsebobas dausruleblad Catarebuli
SemTxveviTi cdebis TiToeul seriaSi. amitom albaToba ar SeiZleba iyos 1-ze meti an 0-ze
naklebi (anu 100%-ze meti da 0%-ze naklebi).
romelime movlenis albaToba gamoixateba Semdegi formuliT:

P(A) – A movlenis albaTobaa, A – ricxvia, romelic asaxavs Tu ramdenjer hqonda


adgili am movlenas, N – movlenis saerTo raodenobaa, sadac A movlenas hqonda adgili.
ganvixiloT magaliTi: samedicino universitetis studentma 100 pacientidan venepunqcia
warmatebiT Cautara 80 pacients. Tu miviRebT, rom pacientebi SemTxveviTobis principiT iyvnen
SerCeulni, maSin albaToba imisa, rom Semdegi venepunqcia pirvelive cdaze iqneba warmatebuli,
tolia:
80 / 100 = 0,8-is, anu 80%-is.
albaTobis gamoTvlis ori wesia miRebuli. gamoTvlis wesebi SeirCeva movlenaTa
raodenobis mixedviT. pirveli aris mimatebis wesi. igi gamoiyeneba maSin, rodesac vixilavT sul
mcire ori urTierTgamomricxavi movlenidan erTi movlenis arsebobis albaTobas. ori
urTierTgamomricxavi movlenidan mxolod erTi movlenis albaToba gamoiTvleba am ori
movlenidan TiToeuli movlenis albaTobebis mimatebiT. anu, P (A an B) = P(A) + P(B), sadac P (A
an B) – aRniSnavs A an B movlenis moxdenis albaTobas.
albaTobis gamoTvlis meori wesi aris gamravlebis wesi. igi gamoiyeneba maSin, roca
gvainteresebs ori damoukidebeli movlenis erTdroulad arsebobis albaToba. ori
damoukidebeli movlenis erTdroulad arsebobis albaToba gamoiTvleba TiToeuli
damoukidebeli movlenis albaTobaTa erTmaneTze gamravlebiT. anu, P (A da B) = P(A) X P(B). sadac
P (A da B) – aRniSnavs A da B movlenebis erTdroulad arsebobis albaTobas.
ganvixiloT albaTobis orive wesis gamoyenebis magaliTebi. mimatebis wesis magaliTi:
samedicino universitetis I kursis studentTa 12,5%-s samedicino koleji aqvs damTavrebuli,
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xolo 5%-s erTwliani mosamzadebeli kursebi. rogoria albaToba imisa, rom samedicino
universitetis I kursis studenti kolejidan an mosamzadebeli kursebidan aris miRebuli? am
SemTxvevaSi or urTierTgamomricxav movlenasTan gvaqvs saqme. studenti an kolejis damTavrebis
Semdeg moxvdeba universitetSi an mosamzadebeli kursebis gavlis Semdeg. amdenad unda
gamoviyenoT albaTobis gamoTvlis mimatebis wesi: P (A an B) = 12,5%+5% = 17,5%. amrigad
albaToba imisa, rom samedicino universitetis I kursis studenti miRebulia an kolejidan, an
mosamzadebeli kursebidan, 17,5% -ia.
ganvixiloT gamravlebis wesis gamoyenebis magaliTi: samedicino universitetis studentTa
12,5%-s damTavrebuli aqvs koleji. studentTa saerTo raodenobis 65,5% aris mdedrobiTi
sqesis. rogoria albaToba imisa, rom samedicino universitetis mdedrobiTi sqesis students
koleji eqneba damTavrebuli? am SemTxvevaSi warmovidginoT, rom sqesi da kolejis damTavreba
damoukideblad SerCeuli faqtorebia. orives erTdroulad arsebobis albaToba gamoiTvleba
gamravlebis wesiT:
P (A da B) = 12,5%/100 X 65,5%/100=818,75%/100=8.19%.
anu samedicino universitetis mdedrobiTi sqesis studentTa 8,19%-s aqvs koleji
damTavrebuli.
mosaxleobaSi albaTobrivi mniSvnelobebi iseTi saxiTaa ganawilebuli, rom maTi
saSualebiT moxerxdes mosaxleobis monacemebis analizi. is albaTobrivi mniSvnelobebi,
romelTa ganawileba SeuZlebelia, anu ar eqvemdebareba ganawilebis principebs, muSavdeba
araparametruli meTodebis gamoyenebiT. sazogadad, miRebulia albaTobrivi ganawilebis Semdegi
saxeebi:
- normaluri ganawileba;
- binomialuri ganawileba;
- t ganawileba;

- X2 (xi-kvadrati) ganawileba.
-

4.5.2. hipoTezis statistikuri testireba

statistikur da epidemiologiur kvlevebSi erT-erTi yvelaze mniSvnelovani sakiTxia


hipoTezis testireba. hipoTezis testireba saSualebas gvaZlevs movaxdinoT mosaxleobis
amonarCevis kvlevis safuZvelze miRebuli Sedegebis ganzogadeba mTel mosaxleobaze (generalur
erTobliobaze). hipoTezis testireba adasturebs an uaryofs amonarCevis SeswavliT miRebuli
Sedegebis safuZvelze gakeTebul daskvnas.
pirvel rigSi, vupasuxoT SekiTxvas – ra aris hipoTeza?
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hipoTeza aris raime movlenis asaxsnelad wamoyenebuli mecnieruli varaudi, romlis
ueWveloba jer ar aris cdiT damtkicebuli. hipoTeza gvexmareba imis garkvevaSi, Tu vin an ra
unda gamovikvlioT, ra kiTxvebi unda davsvaT da ra saxis da ra raodenobis nimuSebi aviRoT.
hipoTezis Camoyalibeba aseve aucilebelia infeqciur daavadebTa afeTqebebis kvlevisaTvis. aseT
dros, zogjer erTi ki ara, ramodenime hipoTezac ki iqmneba.
mecnierebi akvirdebodnen, rom Tambaqos mwevelebSi xSiri iyo filtvis kiboTi daavadebis
SemTxvevebi, amitom gadawyvites kvlevis Catareba da gamoTqves hipoTeza, rom Tambaqos moweva
filtvis kibos ganviTarebis riskis faqtors warmoadgenda. Tu adgili eqneba salomonelozis
afeTqebas, maSin unda Camoyalibdes hipoTeza infeqciis wyaros Sesaxeb, raTa gamokvlevam
gamoiRos Sedegi da droulad moxdes afeTqebis likvidacia.
kvlevis dawyebisas aucilebelia ori hipoTezis Camoyalibeba: erTia – nulovani, xolo
meore – alternatiuli.
maT Soris gansxvavebis dadgenis mizniT davubrundeT Tambaqos mowevasa da filtvis kibos
Soris arsebuli kavSiris magaliTs. jer CamovayaliboT nulovani hipoTeza, romelic uaryofs
gansxvavebis arsebobas Sesadarebel jgufebs Soris kibos SemTxvevebis sixSiris mxriv. Cven
konkretul SemTxvevaSi nulovani hipoTeza (Ho) Semdegnairad Camoyalibdeba: ar arsebobs raime
damokidebuleba (kavSiri) Tambaqos mowevasa da filtvis kibos ganviTarebis risks Soris.
Tambaqos mwevelebSi da aramwevelebSi filtvis kiboTi avadobis maCveneblebs Soris
gamovlenili sxvaoba ar aris WeSmariti da sxvaoba SemTveviTobiTaa ganpirobebuli. amis Semdeg
vayalibebT alternatiul hipoTezas (H1), romelic nulovani hipoTezis sapirispiroa da
amtkicebs, rom arsebobs mniSvnelovani sxvaoba Tambaqos mwevelebsa da aramwevelebs Soris
filtvis kibos ganviTarebis riskis mxriv. anu alternatiuli hipoTeza gveubneba, rom nulovani
hipoTeza arasworia da or jgufSi filtvis kiboTi avadobis maCveneblebs Soris gamovlenili
sxvaoba aris WeSmariti da SemTxveviTobiT ar aris ganpirobebuli. Tu amonarCevis SeswavliT
miRebuli Sedegebis safuZvelze SesaZlebelia nulovani hipoTezis uaryofa, maSin misaRebia misi
sapirispiro – alternatiuli hipoTeza, anu Tu kvlevis Sedegebi statistikurad
damajerebelia, maSin nulovani hipoTeza mcdaria, xolo alternatiuli – swori.
sazogadod, hipoTezis testirebis 5 etaps gamoyofen:
1. testirebisaTvis gamiznuli hipoTezis Camoyalibeba; am mizniT Sesaswavli sakiTxis
Camoyalibeba xdeba ori urTierTgamomricxavi hipoTezis saxiT – nulovani da alternatiuli.
2. amonarCevis SerCeva da monacemebis Segroveba, romlis Sedegadac, saZiebeli
mosaxleobidan SerCeul amonarCevze dakvirvebis monacemebi gamoiyeneba saZiebeli mosaxleobis
parametrebis (mosaxleobis saSualos) gamosaTvlelad.

126
3. statistikuri testebis gamoyeneba Sesabamisi gamoTvlebis Casatareblad; es safexuri
moicavs Sesabamisi statistikuri testebis gamoyenebas mosaxleobis da amonarCevis maxasiaTebel
saSualo mniSvnelobebs Soris gansxvavebis gamosaTvlelad (standartuli gadaxra), an maT
Sesadareblad.
4. kvlevis Sedegad miRebuli Sedegebis Sefaseba nulovan hipoTezasTan mimarTebaSi;
xdeba statistikuri testebis gamoyenebiT miRebuli mniSvnelobebis Sedareba Sesabamis
sixSireTa ganawilebebTan, raTa ganisazRvros kvlevis Sedegebis SemTxveviTobis albaToba. es
imas niSnavs, rom:
• unda ganvsazRvroT damajereblobis done, raTa mis safuZvelze ganvsazRvroT
nulovani hipoTezis uaryofa-miRebis sakiTxi;
• damajereblobis donis mixedviT CamovayaliboT gadawyvetilebis miRebis wesi, Tu ra
pirobebSi SeiZleba miRebul an uaryofil iqnas nulovani hipoTeza.
5. daskvnis gamotana. nulovani hipoTeza miRebuli an uaryofilia gadawyvetilebis
miRebis wesis gamoyenebis safuZvelze. daskvna orgvari SeiZleba iyos:
1. nulovani hipoTeza uaryofilia (mcdaria) alternatiuli hipoTezis sasargeblod.
aseT dros amboben, rom kvlevis Sedegebi statistikurad damajerebelia (e.i. mosalodneli ar
aris, rom kvlevis Sedegebi SemTxveviTobiT iyos ganpirobebuli) winaswar, kvlevis win, Cven
mier SerCeuli damajereblobis doneze.
an,
2. nulovani hipoTeza ar aris uaryofili (is sworia). miRebuli Sedegebi
statistikurad aradamajerebelia, rac metyvelebs nulovani hipoTezis sasargeblod.
xSirad kvlevis Catarebis dros sxvadasxva mizezis gamo vxvdebiT hipoTezebTan
dakavSirebul SecdomaTa sxvadasxva tips. cxrili 2X2-is gamoyenebiT ganvixiloT SecdomaTa
tipebi. gvaqvs nulovani hipoTeza, romelic SeiZleba iyos swori an araswori, anu WeSmariti an
mcdari. misi miRebiT an uaryofiT viRebT Sesabamis gadawyvetilebebs. cxrili 2X2 dagvexmareba
naTlad gaverkvioT nulovani hipoTezis WeSmaritebasa Tu mcdarobaSi, agreTve araswori
daskvnis gakeTebidan gamomdinare Secdomebis arssa da maT mniSvnelobaSi.
davubrundeT isev zemoTmoyvanil magaliTs. roca kvlevis Sedegebis mixedviT nulovani
hipoTeza sworia, es niSnavs, rom filtvis kibos ganviTarebaze Tambaqos moweva ar axdens
gavlenas. meore mxriv, Tu nulovani hipoTeza sworia, magram Cven mas uarvyofT imis gamo, rom
kvlevis Sedegebi SecdomiT, raRac mizeziT, statistikurad damajerebeli aRmoCnda, maSin

vuSvebT Secdomas, romelsac I tipis Secdoma, anu (alfa) Secdoma ewodeba. e. i. I tipis
Secdoma aris nulovani hipoTezis uaryofa maSin, rodesac is sworia. rodesac nulovani
127
hipoTeza ar aris swori da kvlevis Sedegebi statistikurad damajerebelia alternatiuli
hipoTezis sasargeblod, Cven sworad viqceviT, rom uarvyofT nulovan hipoTezas da vaRiarebT
alternatiuli hipoTezis marTebulobas (siswores).
cxrili #32
SecdomaTa tipebi hipoTezis testirebis dros

sinamdvileSi nulovani hipoTeza:


WeSmaritia mcdaria
kvlevis Sedegebidan
II tipis Secdoma
gamomdinare Cven mier Ho misaRebia +
anu Secdoma
SemuSavebuli nulovani
I tipis Secdoma
hipoTeza Ho uarsayofia +
anu Secdoma

im SemTxvevaSi, rodesac nulovani hipoTeza mcdaria, xolo Cveni kvlevis Sedegebi


statistikurad aradamajerebelia, aseT SemTxvevaSi Tu Cven vRebulobT nulovan hipoTezas da
uarvyofT alternatiul hipoTezas, vakeTebT araswor daskvnas. aseT SemTxvevaSi vuSvebT II

tipis Secdomas, romelsac (beta) Secdomas uwodeben. anu II tipis Secdoma aris nulovani
hipoTezis miReba maSin, roca igi arasworia.
nulovani da alternatiuli hipoTezebi gamoisaxeba Semdegi gantolebebis saxiT:
Ho=P1 – Po = 0, anu P1 = P0
HA= P1 – Po ≠ 0, anu P1 ≠ P0
nulovani hipoTezis uaryofa/aRiareba damokidebulia damajereblobis doneze.
damajereblobis done (p albaToba, p mniSvneloba) nebismieri saxis kvlevaSi mniSvnelovania
sarwmunobis (damajereblobis) donis gansazRvra. igi xdeba p albaTobiT, romelic gviCvenebs
sarwmunobis yvelaze dabal dones, romelzec SesaZlebelia nulovani hipoTezis uaryofa.
mkvlevarTa absoluturi umravlesoba nulovani hipoTezis uarsayofad p-s im mniSvnelobas
iyenebs, romelic naklebia 0,05-ze (anu 5%-ze naklebs). albaTobis mocemuli mniSvneloba (0,05)
aris arbitruli da igi sayovelTaod miRebulia biologiur da samedicino kvlevebSi, Tumca
isic unda aRvniSnoT, rom mkvlevarebs TviTon SeuZliaT arbitrulad gansazRvron maTi kvlevis
damajereblobis done (p≤0.01, p≤0.05, p≤0.001).
maSin, roca p tolia an metia 0,05-ze (p > 0,05), nulovani hipoTezis uaryofa
SeuZlebelia. unda miviRoT nulovani hipoTeza da uarvyoT alternatiuli hipoTeza. amrigad, p-
s mniSvnelobis mixedviT xdeba nulovani hipoTezis miReba, an uaryofa.
Tu p naklebia 0,05-ze (p ≤ 0,05), maSin nulovani hipoTeza arasworia da unda miviRoT
128
alternatiuli hipoTeza. am dros naklebad mosalodnelia I tipis Secdomis daSveba. misi
albaToba 100-dan 5 an ufro naklebia.
statistikuri testireba albaTobrivi mniSvnelobebis gamoyenebiT afasebs mxolod
nulovan hipoTezebs da ara mocemul alternatiul hipoTezebs (maT siswores).
p albaTobis mniSvneloba araviTar informacias ar iZleva imis Sesaxeb, Tu ramdenad aris
cvladebi erTmaneTTan dakavSirebuli an erTmaneTTisgan gansxvavebuli. paradoqsulia, Tumca
samedicino praqtikaSi statistikurad damajerebeli gansxvaveba SesaZloa ar iyos klinikurad
mniSvnelovani da, piriqiT, klinikurad mniSvnelovani gansxvavebebi, SesaZloa ar iyos
statistikurad damajerebeli.
p albaTobis mniSvnelobebi dakavSirebulia amonarCevis zomasTan. Tu kvleva didi
raodenobis amonarCevze tardeba (didi kvleva), maSin uniSvnelo gansxvavebebi SesaZloa
dakavSirebuli iyos mniSvnelovan albaTobis doneebTan da, piriqiT, Tu kvleva mcire raodenobis
amonarCevze tardeba (patara kvleva), maSin mZlavr kavSirebs SesaZloa umniSvnelo albaTobis
doneebi aRmoaCndeT.

4.5.3. faqtiur da mosalodnel sixSireTa (pirobiTi) cxrilebi

faqtiur da mosalodnel sixSireTa (pirobiTi) cxrili (SemdgomSi, pirobiTi cxrili)


asaxavs monacemebis jvaredin klasifikacias ori maxasiaTeblis mixedviT, romelTagan TiToeuli
SeiZleba daiyos or an met diskretul da urTierTgamomricxav kategoriebad. erTi kategoria
(cvladi) warmodgenili iqneba horizontalurad (rigis saxiT), xolo meore – vertikalurad
(svetis saxiT). aseT SemTxvevaSi maxasiaTeblebs Soris damokidebulebis gasarkvevad testebis
gamoyeneba advilia.
cxrils, romelSic erT-erTi an orive maxasiTeblisaTvis ori an meti kategoriaa
warmodgenili, r x c cxrili ewodeba. aseT cxrilSi r horizontaluri rigebis raodenobas
asaxavs, xolo c – vertikalur svetebs.
faqtiur da mosalodnel sixSireTa (pirobiT) cxrils, romlis maxasiTeblebi
(ricxobrivi mniSvnelobebi) mxolod or kategoriad iyofa, 2 x 2 –ze, anu oTxjeradi cxrili
ewodeba.
pirobiTi cxrili gviCvenebs, Tu ramdeni obieqti an piria ori kategoriuli cvladis
TiToeul kombinaciaSi.
zogjer pirobiT cxrils sixSireTa ormxriv cxrilsac uwodeben, radgan cxrilSi ori
sxadasxva saxis cvladia mocemuli. mag. asaki da daavadebulTa raodenoba an sqesi da asaki, an
ganaTlebis done da Tambaqos dRiuri moxmarebis done da a.S. ufro gasagebi rom iyos,

129
moviyvanoT sixSireTa erTmxrivi da ormxrivi cxrilebis magaliTebi (cxrilebi #33, 34):

cxrili #33
sixSireTa erTmxrivi cxrili binomialuri SemTxveviTi cvladisaTvis

pasuxi kiTxvaze
diax ara
raodenoba 102 10

rogorc ukve viciT, es cxrili aseve warmoadgens dixotomur cvladTa cxrils. Cven,
SesaZloa, gvqondes multinomialuri SemTxveviTi cvladebi, bunebrivia, aseT SemTxvevaSic
sixSireTa cxrili erTmxrivi iqneba. Tumca mas gansxvavebuli Tavisuflebis xarisxi (ix. 4.5.4
Tavi) eqneba svetebis raodenobidan gamomdinare.

cxrili#34
sixSireTa erTmxrivi cxrili multinomialuri SemTxveviTi cvladisaTvis
pasuxi kiTxvaze
diax ara ar vici miWirs pasuxi
raodenoba 102 2 3 5

pirobiTi cxrili kategoriuli cvladebis warmodgenisa da maT Soris damokidebulebis


(kavSiris) garkvevis martivi meTodia. sazogadod, pirobiTi cxrili xelsayrelia; xi-
kvadratis da sxva testebis (mag., fiSeris zusti testi, stiudentis t- testi, sazogadod,
parametruli da araparametruli testebi) Casatareblad.
pirobiTi cxrilis struqtura warmodgenilia 35 cxrilSi, sadac TiToeuli ujris
mniSvneloba Semdegi laTinuri asoebiTaa gamosaxuli: a, b, c, d. kidura mniSvnelobebi
warmoadgenen Sesabamisi rigebis an svetebis jamur mniSvnelobebs (a+b, a+c, b+d, c+d), xolo
saerTo jami, romelic tolia a+b+c+d warmodgenilia raodenobis amsaxveli aso N –iT.

cxrili# 35
pirobiTi cxrilis struqtura
maxasaTebeli A
maxasaTebeli B kategoria A- kategoria A- jami
1 2
kategoria-1 a b a+b
kategoria-2 c d c+d
jami a+c b+ d N
130
zemoT moyvanili cxrili pirobiTi cxrilis zogadi struqturaa, Tumca is CvenTvis
krgad cnobil, tipur 2X2 cxrils warmoadgens. swored amitom pirobiTi cxrilis yvelaze
martivi nimuSia oTxjeradi, anu 2X2 cxrili.

4.5.4. Tavisuflebis xarisxi

Tavisuflebis xarisxi aris monacemTa seriaSi an ganawilebaSi arsebuli cvladebis


raodenoba, romelTac SeiZleba Tavisuflad mieces ricxobrivi mniSvneloba, roca kategoriaTa
jamuri mniSvnelobebi cnobilia. pirobiT cxrilSi Tavisuflebis xarisxi warmoadgens ujraTa
raodenobas, romelTa ricxobrivi mniSvnelobebi Tavisuflad SeiZleba ganisazRvros monacemTa
nakrebisa da kidura mniSvnelobebis codnis SemTxvevaSi. Tavisuflebis xarisxi aRiniSneba
Sesabamisi inglisuri terminis pirveli asoebiT - df.
iseT albaTobriv ganawilebebSi, rogoricaa t ganawileba da xi-kvadrati ganawileba,
albaTobrivi mniSvnelobebi cvalebadobs amonarCevis Tavisuflebis xarisxis Sesabamisad. Tu
ganawileba SeiZleba warmodgenil iqnas erTi svetis (c) an erTi mwkrivs (r) saxiT, maSin
Tavisuflebis xarisxis ricxvi ganisazRvreba Semdegi formulebiT:
df = c – 1, roca r=1 da
df = r – 1, roca c=1
roca pirobiTi cxrili Seicavs or mwkrivsa da or svets, Tavisuflebis xarisxis
formula aseT saxes Rebulobs:
df = (r–1)(c–1)
ganvixiloT Semdegi martivi magaliTi, raTa naTeli warmodgena Segveqmnas Tavisuflebis
xarisxze. mocemulia oTxjeradi cxrili, sadac Setanilia 50 moswavlis Tvalis feri da sqesi
(cxrili #36a).
cxrili #36a
50 moswavlis Tvalis feri da sqesi

maxasiaTebeli
maxasiaTebeli sqesi
kategoria A- kategoria jami
1 A-2
mamrobiTi mdedrobiTi
kategoria B-1 a+b
a b
Tvalis feri - cisferi 15
kategoria -2 c+d
c d
Tvalis feri - Taflisferi 35
jami a+c b+ d N
20 30 50

131
garda cxrilSi Setanili informaciisa, cnobilia isic, rom 5 vaJs cisferi Tvalebi aqvs.
cxrili ukve aseT saxes miiRebs:

cxrili #36b
50 moswavlis Tvalis feri da sqesi

maxasiaTebeli A - sqesi
maxasiaTebeli B kategoria -1 kategoria-2
jami
mamrobiTi mdedrobiTi
kategoria B-1 a+b
a b
Tvalis feri - cisferi 15
kategoria B-2 c+d
c d
Tvalis feri - Taflisferi 35
jami
a+c b+ d N
20 30 50

cxrilis danarCeni ujrebis mniSvnelobebi ukve advilad gamoiTvleba.


iqidan gamomdinare, rom saWiroa mxolod erTi ujris ricxobrivi mniSvnelobis
gansazRvra, raTa gavigoT cxrilis danarCeni ujrebis ricxobrovi mniSvnelobebi, cxrilis
Tavisuflebis xarisxi gamodis 1. analogiuri pasuxi SegviZlia miviRoT Tavisuflebis xarisxis
formulis gamoviyenebiT:
df = (2 – 1)( 2 – 1) = 1
Tavisuflebis xarisxi farTod gamoiyeneba skrininguli testebis validobis Seswavlis
dros. ganvixiloT magaliTi mxolod cxrilis Sedgenisa da Tavisuflebis xarisxis
gamosaTvlelad.
A infeqciiT inficirebis xarisxis gansazRvrisaTvis SemTxveviTobis principiT SeirCa 814
piri. A infeqciis markeris gamosavlenad gamoyenebuli iqna imunofermentuli analizis meTodi.
kvlevis Catarebis Sedegad aRmoCnda, rom serologiurad dadebiTi iyo 321 piri, xolo
uaryofiTi - 493 piri. A infeqciisaTvis damaxasiaTebeli simptomebi aReniSneboda 303-s,
simptomebi ar aReniSneboda 511-s. simptomebis mqone pirTagan 130 serologiurad dadebiTi iyo.
gamosarkvevia gamoyenebuli testis validoba (mgrZnobeloba, specifikuroba da a.S.
damajereblobis intervalis gamoTvliT).
pirveli etapi: SevadginoT pirobiTi cxrili da SevitanoT kvlevis CvenTvis ukve
cnobili Sedegebi.

132
cxrili#37a
virusiT inficirebis xarisxis Sefaseba

maxasiaTebeli B maxasiaTebeli A - simptomebi


serologiuri testis
kategoria - 1 kategoria - 2 jami
Sedegi
dadebiTi uaryofiTi
kategoria B-1 a+b
a 130 b
dadebiTi 321
kategoria B-2 c+d
c d
uaryofiTi 493
jami b+ d N
a+c 303
511 814
meore etapi: davadginoT pirobiTi cxrilis Tavisuflebis xarisxi. radgan cxrilSi ori
mwkrivi da ori svetia, misi Tavisuflebis xarisxi 1-is tolia.
mesame etapi: gamoviTvaloT b, c da d ujrebis mniSvnelobebi. 2X2 –ze cxrilis ucnobi
ujrebis mniSvnelobebi advili gamosaTvlelia cxrilis Tavisuflebis xarisxis gansazRvris
Semdeg. sabolood, cxrili aseT saxes miiRebs.
cxrili #37b
infeqciiT inficirebis xarisxis Sefaseba

maxasiaTebeli
maxasiaTebeli B Asimptomebi
serologiuri testis Sedegi kategoria-1 kategoria-2 jami
dadebiTi uaryofiTi
kategoria B-1 b a+b
a 130
dadebiTi 191 321
kategoria B-2 d c+d
c 173
uaryofiTi 320 493
a+c b+ d N
jami
303 511 814
amis Semdeg ki gamoiTvleba skrininguli testis validoba.

4.5.5. saSualos standartuli Secdoma

saSualos standartuli Secdoma mniSvnelovani statistikuri sididea, romelic saWiroa


kvlevis Sedegebis sarwmunobis intervalis gamosaTvlelad. epidemiologiaSi da saerTod,
medicinaSi generaluri erTobliobis gamokvleva praqtikulad SeuZlebelia, amitom, rogorc
wesi, ikvleven generaluri erTobliobis garkveul nawils – amonarCevs da miRebuli Sedegebi
gadaaqvT mTel generalur erTobliobaze. aqedan gamomdinare gardauvalia saSualos
standartuli Secdomis arsebobac, radgan, rac ar unda swored iqnes SerCeuli amonarCevi,
miRebuli Sedegebi umniSvnelod mainc iqneba gansxvavebuli im Sedegebisagan, romelic miiReboda
133
mTeli erTobliobis gamokvlevis SemTxvevaSi.
amdenad, saSualos standartuli Secdomas praqtikulad Tavidan ver avicilebT. aris
mxolod erTi gza – gamokvleuli unda iyos mTeli erToblioba, rac, rogorc wesi, mravali
momentis gamo SeuZlebelia. amasTan, saSualos standartuli Secdoma ar unda avurioT
meTodologiur, gazomviT, SemTxveviT da sxva saxis SecdomebSi.
saSualos standartuli Secdoma gviCvenebs, Tu amonarCevis kvlevis Sedegad miRebuli
saSualo ariTmetikuli ramdenad gansxvavdeba im saSualo ariTmetikulisagan, romelsac
miviRebT mTeli generaluri erToblioba rom gamogvekvlia. es aris Secdomis erTaderTi saxe,
romelsac iTvaliswinebs statistikuri kvlevebi da misi Tavidan acileba, rogorc ukve
aRvniSneT, SeuZlebelia. standartuli Secdoma SeiZleba iyos Zalian mcire sidide. amis miRweva
SesaZlebelia Tu kvlevaSi amonarCevi sakmarisi raodenobisaa. rogorc saSualos standartuli
Secdomis gamoTvlis formula gviCvenebs, rac ufro didia dakvirvebaTa ricxvi, miT naklebia
standartuli Secdomis mniSvneloba. samagierod, rac ufro meryeobs Sesaswavli cvladis
mniSvnelobebi da metia standartuli gadaxra, Sesabamisad izrdeba standartuli Secdomis
sididec.
saSualos standartul Secdomasa da dakvirvebaTa ricxvs Soris arsebuli
ukuproporciuli damokidebuleba gamoiyeneba epidemiologiuri kvlevebis dros gamosakvlev
pirTa saWiro raodenobis dasadgenad.
saSualos standartuli gadaxris meSveobiT xdeba saSualos standartuli Secdomis
(saSualo Secdoma, reprezentulobis Secdoma) gamoTvla xdeba Semdegi formuliT:

sadac
SEM- saSualos standartuli Secdomaa;
SD – standartuli gadaxra;
n- dakvirvebaTa raodenoba.
Tu n ≤ 30, maSin formula aseT saxes miiRebs:

fardobiTi sidideebis dros standartuli Secdoma Semdegi formuliT gamoiTvleba:

134
sadac
p – fardobiTi maCvenebelia procentebSi;
q – 100-p;
n – dakvirvebaTa raodenoba.
moviyvanoT standartuli Secdomis gamoTvlis magaliTebi: magaliTi 1.
A hepatitis virusis sawinaaRmdego antisxeulebis arsebobaze (anti-HAV) 150 adamianis
gamokvlevis Sedegad 107 maTgans gamouvlinda antisxeulebi. anu
107 X 100
p% = = 71,3%
150
q = 100% − 71,3% = 28,7%
SEM=?

anu SEM = ±3,7


magaliTi 2.
hiperTireoziT daavadebuli 49 avadmyofs ganesazRvreba pepsinis done.
n=49
XsaS=1,0 g%
SD=0,35 g%
SEM=M?

rogorc wesi, kvlevis Catarebis Semdeg miRebul saSualo ariTmetikulTan erTad,


naCvenebi unda iyos saSualos standartuli Secdomac, rac saSualebas gvaZlevs ganvsazRvroT
sarwmunobis intervali da kvlevis Sedegebis damajerebloba.
xazgasmiT unda aRiniSnos, rom erTmaneTSi ar unda avurioT standartuli gadaxra da
standartuli Secdoma. rogorc aRvniSneT, standartuli gadaxra aris konkretuli monacemebis
nakrebis mravalferovnebis (cvalebadobis) sazomi, maSin rodesac amonarCevis standartuli
Secdoma gviCvenebs Tu mocemuli amonarCevis saSualo ramdenad gansxvavdeba generaluri
erTobliobis saSualosagan.
rogorc aRvniSneT, standartuli Secdomis sidide damokidebulia amonarCevis
raodenobaze, rac gamoyenebulia amonarCevis zomis gansazRvrisaTvis.
amonarCevis moculobis gamosaTvlelad viyenebT formulas:

135
n _ amonarCevis raodenobaa (moculoba),
t _ sarwmunobis kriteriumi (rodesac p (sarwmunobis xarisxi) = 95%-s, t = 2-s),
SD _ standartuli gadaxra,
∆ _ amonarCevis maqsimaluri Secdoma, igi udris t x SEM-s, sadac SEM – saSualo, anu
standartuli Secdomaa.
fardobiTi sidideebisaTvis formula aseT saxes iRebs:

n _ amonarCevis raodenobaa,
t _ sarwmunobis kriteriumi (rodesac p (sarwmunobis xarisxi) = 95%-s, t = 2-s),
p - movlenis gavrcelebis maCvenebeli, rodesac p aris procentebSi, maSin q=100- p,
p -s sidides, rogorc wesi, viRebT an literaturuli monacemebidan, anda winaswar
Catarebuli sacdeli (piloturi) kvlevis meSveobiT. maSin, rodesac p -s mniSvnelobis
gansazRvras raime mizezis gamo ver vaxerxebT, vTvliT, rom p=q-s da udris 50%-s, ris
Sedegad viRebT pxq-s maqsimalur mniSvnelobas.
∆ _ amonarCevis maqsimaluri Secdoma - t x SEM.
magaliTad, miokardiumis infarqtis gadatanis Semdeg gvainteresebs, Tu ra sixSiriT
viTardeba recidivebi. amisTvis aseT pacientTa saWiro raodenobas unda davakvirdeT 3 weli.
kvlevaSi monawile pirTa ricxvis gansazRvrisaTvis viyenebT formulas:

Tu ar gvaqvs literaturuli monacemebi, maSin vTvliT, rom p udris 50%-s,


q = 100 – 50 = 50,
t= 2,
∆ = ± 10% (miaxloebiT).

anu, mocemuli kvlevis Casatareblad 3 wlis manZilze unda davakvirdeT 100 adamians,
romelTac miokardiumis infarqti aqvs gadatanili.
meore magaliTi:
10 adamianze atropinis cdis CatarebiT dadginda, rom pulsi matulobda 90-mde da SD
udrida 10-s. saWiroa reprezentatuli amonarCevis raodenobis gansazRvra ise, rom amonarCevis
maqsimaluri Secdoma (∆) 4%-s ar aRematebodes, xolo t udrides 2-s, raTa sarwmunobis xarisxi
136
95% iyos.
viyenebT formulas:

e. i. sarwmuno Sedegebis misaRebad gamokvleul unda iqnes 25 adamiani, radgan 10


gamokvleva ukve Catarebulia, kidev unda Catardes 15 gamokvleva.

4.5.6 sarwmunobis (damajereblobis) intervalis gansazRvra

saSualos sarwmunobis intervalis dasadgenad saWiroa ori ukiduresi mniSvnelobis _


minimaluri da maqsimaluri SesaZlo sidideebis gansazRvra. intervals, romelSic SesaZlebelia
iyos generaluri erTobliobis, anu mTeli populaciis saSualo, sarwmunobis intervali
ewodeba. igi gamoiTvleba formuliT:
CI=XsaS±tXSEM
sadac
CI – sarwmunobis intervalia,
XsaS. _ saSualo sididea,
SEM - standartuli Secdoma,
t – sarwmunobis koeficienti.
sarwmunobis koeficientis mniSvnelobis zrdasTan erTad izrdeba albaTobis xarisxi, rom
mTeli populaciis saSualo sididis mniSvneloba moTavsebulia sarwmunobis intervalSi.
Uumravles samedicino-biologiuri kvlevebisas iTvleba, rom sarwmunobis koeficienti (t) unda
udrides 2,0-s an 2,5-s. Tu t=1,0-s, maSin albaToba Seadgens 68,3 %-s. Tu t=2,0-s, maSin
albaToba izrdeba 95,5%-mde. rodesac t=2,5-s, maSin albaToba 98,7%-s Seadgens, xolo roca
t=3,0-s, maSin albaToba 99,7%-s aRwevs. medicinaSic da biologiaSic 95%-iani sarwmunoba
iTvleba statistikurad damajereblad. am SemTxvevaSi t=1,96-s.
rodesac t=1,96-s da p (sarwmunobis xarisxi) ki 95%-s, es niSnavs, rom populaciidan 100
amonarCevis gamokvlevisas mxolod 5 SemTxvevaSi saSualo iqneba populaciis saSualodan ±1,96X
SEM-is intervalis gareT, xolo 95 SemTxvevaSi saSualo iqneba miTiTebul intervalSi. anu
mxolod 5 SemTxvevaSi sxvaoba iqneba SemTxveviTi xasiaTis. aqve SeiZleba moviyvanoT cxrili
#38, romelic gviCvenebs Tu ras udris varaudis albaTobis xarisxi – p sarwmunobis
koeficientis sxvadasxva mniSvnelobis dros.

137
cxrili #38
albaTobis cxrili normaluri ganawilebis dros
(Semoklebuli varianti)

t p t p t p
0,1 0,0797 1,1 0,7287 2,1 0,9643
0,2 0,1585 1,2 0,7699 2,2 0,9722
0,3 0,2358 1,3 0,8064 2,3 0,9786
0,4 0,3108 1,4 0,8385 2,4 0,9836
0,5 0,3829 1,5 0,8664 2,5 0,9876
0,6 0,4515 1,6 0,8904 2,6 0,9907
0,7 0,5161 1,7 0,9109 2,7 0,9931
0,8 0,5763 1,8 0,9281 2,8 0,9949
0,9 0,6319 1,9 0,9426 2,9 0,9963
1,0 0,6827 2,0 0,9545 3,0 0,9973

damokidebuleba p mniSvnelobasa da sarwmunobis (damajereblobis) intervals


Soris
rogorc ukve ganvixileT, p mniSvnelobebis mixedviT xdeba nulovani hipoTezis miReba an
uaryofa. ganvixiloT, ra damokidebulebaa p mniSvnelobebsa da damajereblobis intervals
Soris. gavixsenoT, rom
Tu p<, maSin, Cven unda uarvyoT nulovani hipoTeza, xolo
Tu p>, maSin, Cven unda miviRoT nulovani hipoTeza.
Tu p<, maSin damajereblobis intervali (1 -  ) x 100% ar Rebulobs nulovan
mniSvnelobas, radgan igi ar moicavs 1.

4.5.7. statistikuri sarwmunobis (damajereblobis) testebi

statistikuri sarwmunobis testebidan Cven ukve ganvixileT sarwmunobis intervali da p


mniSvneloba. amjerad ganvixiloT damatebiT ori testi, romlebic yvelaze xSirad gvxvdeba
samedicino literaturaSi, esenia: t testi da z testi. xolo, rac Seexeba aseve xSirad
gamoyenebul χ2 (xi kvadrati) tests, igi ganxiluli iqneba Sedegebis Sefasebis araparametruli
meTodebis TavSi.

138
t testi
rodesac vsazRvravT sarwmunobis intervals, pirvel rigSi unda davadginoT, Tu
albaTobis ra xarisxiT iqneba warmodgenili es intervali. swored mis mixedviT isazRvreba
sarwmunobis koeficienti. amrigad, sarwmunobis koeficientis mniSvneloba isazRvreba winaswar,
kvlevis dagegmvis dros. sarwmunobis intervalis gamoTvlis demonstrirebisaTvis gamoviyenoT
wina TavSi moyvanili magaliTebi.
magaliTi 1. ganvsazRvroT sarwmunobis intervali sisxlSi anti-HAV-is indikaciis dros
im pirobiT, rom albaTobis (sarwmunobis) xarisxi p = 95,0%-s da Sesabamisad t=1,96, anu gvaqvs
Semdegi piroba:
n = 150
XsaS = 71,3% SEM = ±3,7% p = 95,0%
t = 1,96
sarwmunobis intervali CI=XsaS. ± t x SEM = 71,3% ± 1,96 x 3,7%= 71,3% ± 7,3%,
anu intervalis zeda da qveda sazRvari iqneba 71,3%-s + 7,3% = 78,6% da 71,3%-s –
7,3% = 64,0%. amrigad 95%-iani albaTobis xarisxiT SeiZleba vTqvaT, rom generalur
erTobliobaSi (populaciaSi) anti-HAV uvlindeba adamianTa aranakleb 64%-s da araumetes
78,6%-s.
magaliTi 2. ganvsazRvroT hiperTireoziT daavadebul pirebSi pepsinis saSualo donis
sarwmunobis intervali Tu albaTobis xarisxi p = 95,0%-s da Sesabamisad t=1,96, anu gvaqvs
Semdegi piroba :
n = 49
XsaS = 1,0g% SEM = + 0,05g% p = 95,0%
t = 1,96
sarwmunobis intervali CI =XsaS. ± t x SEM = 1,0g%±1,96 x 0,05g%= 1g% ± 0,098 g%, anu
intervalis zeda da qveda sazRvrebi Sesabamisad iqneba 1 g%+ 0,098 g% = 1,098g% da 1g% -
0,098g% = 0,902g%-s. amrigad 95%-iani albaTobis xarisxiT SeiZleba vTqvaT, rom
hiperTireoziT daavadebul avadmyofTa populaciaSi pepsinis done meryeobs 0,902g%-dan
1,098g%-mde.
rogorc vxedavT, mocemuli albaTobis xarisxis dros t aris mudmivi sidide da
sarwmunobis intervali damokidebulia saSualos standartul Secdomaze. rac ufro mcirea igi,
Sesabamisad, ufro mWidroa sarwmunobis intervali, xolo Tu saSualos standartuli Secdoma
aris didi, maSin intervalis sazRvrebic izrdeba da Sedegebic uaresdeba. aRsaniSnavia isic, rom
sarwmunobis xarisxis zrdasTan erTad izrdeba sarwmunobis intervalic. Tavis mxriv,

139
sarwmunobis koeficientis t-s (stiudentis) mniSvneloba damokidebulia rogorc sarwmunobis
xarisxze (p), aseve amonarCevis raodenobaze, rac naCvenebia cxrilSi #39.

cxrili #39
sarwmunobis kriteriumis t-s (stiudenti) mniSvnelobebi (Semoklebuli varianti)
n p

0,05=5% 0,01=1% 0,001=0,1%


1 12,70 63,66 637,59
2 4,30 9,92 31,60
3 3,18 5,84 12,94
4 2,78 4,60 8,61
5 2,57 4,03 6,86
6 2,42 3,71 5,96
7 2,36 3,50 5,31
8 2,31 3,36 5,04
9 2,26 3,25 4,78
10 2,23 3,17 4,59
11 2,20 3,17 4,44
12 2,18 3,06 4,32
13 2,16 3,01 4,22
14 2,14 2,98 4,14
15 2,13 2,95 4,07
16 2,12 2,92 4,02
17 2,11 2,90 3,96
18 2,10 2,88 3,92
19 2,09 2,86 3,88
20 2,09 2,84 3,85
21 2,08 2,83 3,82
22 2,07 2,82 3,79
23 2,07 2,81 3,77
24 2,06 2,80 3,75
25 2,06 2,78 3,73
26 2,06 2,78 3,71
27 2,05 2,77 3,69
28 2,05 2,76 3,67
29 2,04 2,76 3,66
30 2,04 2,75 3,64
1,96 2,58 3,29

mcire raodenobis dakvirvebebis dros, am cxrilis me-2, me-3 da me-4 grafaSi moyvanili
ricxvebi gviCveneben Tu Sesadarebeli sidideebi ramdenjer unda aRematebodes saSualos
standartul Secdomas, rom sxvaoba miCneul iqnes sarwmunod.
rogorc vxedavT, rac ufro mcirea dakvirvebaTa ricxvi, miT metia t-s mniSvneloba.
amitom, rodesac amonarCevi aris mcire raodenobis, Sedegebis sarwmunobis dadgenis mizniT
140
gamoiyeneba mocemuli cxrili.
epidemiologiur kvlevebSi xSirad gviwevs dadgena, Tu ramdenad sarwmunoa or saSualo
sidides Soris gansxvaveba, raTa davadginoT rogori iyo Catarebuli samkurnalo Tu
profilaqtikuri RonisZiebebis efeqturoba. amisaTvis gamoiyeneba t koeficienti. misi
saSualebiT SeiZleba davadginoT sxvaobis sarwmunoba rogorc saSualo, ise fardobiTi
sidideebis dros.
saSualo sidideebisaTvis sxvaobis sarwmunobis dasadgeni formulaa:

xolo fardobiTi sidideebisaTvis

sadac XsaS.1, XsaS.2, P1, P2 aris kvlevis Sedegad miRebuli parametrebi,

SEM1 da SEM2 maTi Sesabamisi saSualo Secdomebi.


sxvaoba aris sarwmuno, Tu t ≥ 2, rac niSnavs, rom albaTobis xarisxi aris 95% da meti.
Tu t ‹ 2, maSin Cven ar SegviZlia vTqvaT, rom maCveneblebs Soris sxvaoba aris statistikurad
arsebiTi da sarwmuno. aseT SemTxvevaSi saWiroa dakvirvebis gagrZeleba. Tu sxvaoba ucvleli
rCeba, maSin SegviZlia vTqvaT, rom Sesadarebel generalur erTobliobebs Soris ar aRmoCnda
gansxvaveba Sesadarebeli niSnis mixedviT.
magaliTi. Cven gamovikvlieT anti-HAV-is gavrcelebis sixSire Tbilisis da axalqalaqis
20 wlis da zeda asakis janmrTel populaciaSi (ix. cxrili #40). gvainteresebs am or
teritoriaze miRebuli sxvaoba aris Tu ara sarwmuno.
cxrili #40
anti-HAV-is gavrcelebis sixSire Tbilisis da axalqalaqis janmrTel mozrdil
mosaxleobaSi
kontingenti n P SEM t p
Tbilisi 150 71,3% 3,7 3,13 ›99,7%
axalqalaqi 150 54,0% 4,1

ze

141
anu miRebuli sxvaoba aris sarwmuno.

kritikuli Tanafardoba, anu Z(z) mniSvneloba

vidre ganvixilavdeT, Tu ras warmoadgens kritikuli Tanafardoba, anu Z mniSvneloba da


z testi, gavixsenoT normaluri ganawilebis mrudi, romelic warmogvidgens monacemebis
ganlagebas saSualosTan mimarTebaSi. viciT, rom saSualo sidide aris mrudis centralur
nawilSi, gvaxsovs isic, Tu rogor gamoviTvaloT standartuli gadaxra sarwmunobis
intervalis dasadgenad. magram zogjer gvainteresebs ramdeni standartuli gadaxris
farglebSia esa Tu is monacemi (konkretuli mniSvneloba). ganvixiloT SemTxveva: mag. Tu
cnobilia, rom SemTxveviTobis principiT SerCeuli 1000 mamakacis saSualo wona 85 kg-ia,
standartuli gadaxra ki – 10kg Seadgens, CvenTvis advili gamosaTvlelia wonis meryeobis
farglebi, romelic damaxasiaTebeli iqneba mosaxleobis mamrobiTi nawilisaTvis im SemTxvevaSi,
Tu gvecodineba ganawilebis saxe. Tu sakvlev mosaxleobaSi mamakacTa wonis monacemebi
normalur ganawilebas eqvemdebareba, maSin normaluri mrudis sqemis gamoyenebiT, mamakacTa 68%
(anu 680 mamakacis) saSualo wona iqneba saSualodan +1 standartuli gadaxris farglebSi, anu
85kg. + 1 X 10 , anu 75kg-dan 95kg-mde.
analogiurad, 950 mamakacis wona iqneba 65 – 105 –is farglebSi, xolo 997 mamakacis
wona iqneba sami standartuli gadaxris farglebSi, anu 55 kg-dan 115 kg-mde.
igive magaliTi sxvagvarad warmovadginoT: davuSvaT gvainteresebs 90 kg wona ramdeni
standartuli gadaxriT iqneba saSualodan daSorebuli, anu sad mdebareobs es sidide abscisTa
RerZze da ra nawils moicavs wonis es konkretuli monacemi normaluri ganawilebis mrudis
qveS (es kiTxva asec SegviZlia davsvaT: populaciis ra nawili xasiaTdeba 90 kg woniT).
swored am kiTxvaze sapasuxod gvWirdeba kritikuli mniSvnelobis, anu Z-is gamoTvala, romelic
gamoiTvleba Semdegi formuliT:

sadac x – saZiebeli jgufis amonarCevis saSualoa, µ _ mosaxleobis (parametri) saSualo,


SD – mosaxleobis (parametri) standartuli gadaxra. ar unda dagvaviwydes, rom Z-is
gamoTvalis dros aucilebelia mosaxleobis parametris (saSualo mniSvnelobis) codna. Z-is
mniSvnelobis gamosaTvlelad gamoiyeneba kritikuli Tanafardobis mniSvnelobaTa cxrili, anu Z-
is mniSvnelobaTa cxrili. ganvixiloT kritikuli Tanafardobis gamoTvlis magaliTi.
epidemiologiisa da biostatistikis gamocdaze gasuli 900 studentis saSualo
142
Sefasebam Seadgina 82 qula. standartuli gadaxra tolia 5 qulis. gvainteresebs ramdeni
studentis Sefaseba iqneba 75-85 qulis farglebSi. am amocanis amosaxsnelad saWiroa sami
etapi. pirvel etapze sagamocdo qulebi unda gadaviyvanoT Z-is mniSvnelobebSi zemoT moyvanili
mniSvnelobebis gamoyenebiT. 75 qulis Sesabamisi Z75-is mniSvneloba iqneba:

85 qulis Sesabamisi Z85-is mniSvneloba iqneba :

meore etapze unda ganvsazRvroT, Tu ra nawili Seesabameba Z75-is da Z85-is mniSvnelobebs.


amisaTvis Z-is mniSvnelobaTa cxrilSi vnaxulobT Z-is -1,4-is da 0,6-is Sesabamis mniSvnelobebs,
romlebic udris 0,4192 da 0,2257. exla Cven gvainteresebs are, romelic Seesabameba 75-dan 85
qulas, amisaTvis saWiroa Z-is TiToeuli mniSvnelobis Sesatyvisi areebis Sejameba : 0,4192 +
0,2257=0,6449.
mesame etapze vadgenT studentTa ra raodenobas eqneboda 75-dan 85-qulamde Sefaseba,
risTvisac 900-s (studentTa saerTo raodenoba) vamravlebT saerTo aris moculobaze : 900 X
0,6449 = 580,41. exla Cven SegviZlia pasuxi gavceT amocanis kiTxvas. sagamocdo Sefaseba 75-da
85 qulamde eqneboda 580 students.
roca Z mniSvneloba izrdeba, nulovani hipoTezis aRiarebis albaToba mcirdeba da
piriqiT. imis gasarkvevad, ama Tu im mosaxleobis ra nawili (an mosaxleobis nebismieri wevri)
kritikuli Tanafardobis ra farglebSi Tavsdeba an ra farglebis gareT imyofeba, gamoiyeneba
kritikuli Tanafardobis mniSvnelobaTa cxrili. cxrilis Semoklebuli varianti mocemulia
saxelmZRvanelos boloSi.

z testi
t testis msgavsad z testic statistikuri damajereblobis testia, romlis drosac
xdeba amonarCevis saSualo sididis Sedareba normasTan (mosaxleobis parametrTan), an ori
sxvadasxva amonarCevis saSualo sididis Sedareba erTmaneTTan (didi zomis amonarCevis _ n>30-
is SemTxvevaSi).
z testis gamoTvla igive safexurebs moicavs, rasac t testi da SeiZleba gamoyenebuli
iqnes saSualos standartuli Secdomis sarwmunod gamoTvlis mizniT igive standartuli
gadaxris pirobebSi, roca amonarCevi didi zomisaa (n > 100). aqedan gamomdinare advili
misaxvedria, rom aris iseTi situaciebi, rodesac t testi SeiZleba gamoyenebul iqnes, xolo z

143
testi – ara. xazgasmiT unda aRiniSnos, rom ar arsebobs iseTi situaciebi, rodesac z testi
SeiZleba gamoyenebul iqnes, xolo t testi – ara. amis gamo am ori testidan t testi ufro
mniSvnelovania da ufro farTod gamoiyeneba.
unda gvaxsovdes, rom RerZi albaTobas ki ar asaxavs, aramed albaTobis simWidroves.
normaluri ganawilebis dros TiToeuli konkretuli mniSvneloba gamoTvlilia numerologiuri
meTodebis gamoyenebiT, swored amitom Cven mivmarTavT xolme cxrilebs, romlebSic mocemulia
gamoTvlili mniSvnelobebi. imisaTvis rom cxrilebi gamoviyenoT, pirvel rigSi, saWiroa
gamoviTvaloT z mniSvneloba. unda aRvniSnoT, rom samedicino literaturaSi z mniSvneloba
sxvadasxva saxelwodebiT gvxvdeba: z qula, normaluri gadaxra, standartuli qula, kritikuli
Tanafardoba, Tumca amaTgan yvelaze xSirad gamoiyeneba ori; z mniSvneloba da kritikuli
Tanafardoba.

4.5.8. korelacia

korelacia laTinuri sityvaa da niSnavs movlenaTa Soris urTierTkavSirs.


epidemiologiuri kvlevebis dros Zalian xSirad saWiroa Sesaswavl movlenebs Soris kavSiris
xasiaTis da Zalis dadgena, anu imis gansazRvra, erTi niSnis sididis cvlileba iwvevs Tu ara
cvlilebas meore niSnis mniSvnelobaSi. mag. gvainteresebs Tu ra kavSiri da damokidebuleba
arsebobs garemos temperaturasa da dizenteriiT avadobas Soris, an koRoebis gamravlebasa da
malariiT avadobas Soris da a.S.
unda aRiniSnos, rom Sesaswavl cvlad niSnebs Soris korelaciis dadgena ar niSnavs, rom
maT Soris aucileblad aris mizez-Sedegobrivi kavSiri. amisaTvis saWiroa Sesaswavl movlenaTa
Rrma xarisxobrivi analizi. rodesac laparakia, rom filtvis kibosa da moweul sigaretis
raodenobas Soris arsebobs korelacia, es ar niSnavs, rom Tambaqos moweva iwvevs filtvis
kibos. igive, warmatebiT SeiZleba iTqvas piriqiTac, rom filtvis kibo ganapirobebs Tambaqos
mowevas. korelacia mxolod miuTiTebs, rom arsebobs or movlenas Soris kavSiri. magaliTad
adamianis simaRle da wona korelaciaSia erTmaneTTan. didi wona dakavSirebulia did
simaRlesTan, ese igi maT Soris arsebobs dadebiTi korelacia.
Sesaswavl or movlenas Soris kavSiris dasadgenad yvelaze ufro gavrcelebuli aris
korelaciis meTodi. is SeiZleba gamoisaxos cxrilis, grafikis da korelaciis koeficientis
meSveobiT. rogorc wesi, iyeneben korelaciis koeficientis gamoTvlas. medicinaSi korelaciis
koeficientis gamoTvlas sakmaod xSirad mimarTaven. magaliTad, eqimi pediatri mas iyenebs
bavSvebis da mozardebis fizikuri ganviTarebis Sesafaseblad. Sromis higienaSi da profesiul
paTologiaSi samuSao pirobebsa da momuSaveTa janmrTelobas Soris kavSiris dasadgenad. es
koeficienti saSualebas gvaZlevs aseve ganvsazRvroT damokidebuleba gamosakvlevi kontingentis
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asaks, Sromis pirobebs, samrewvelo mavneobasa da avadobas Soris.
korelaciis koeficienti (pirsonis koeficienti) zomavs or cvlads Soris kavSiris
siZlieres. misi gamoyeneba mizanSewonilia, rodesac Sedareba xdeba xarisxobrivad erTgvarovani
erTobliobebis sxvadasxva niSnebs Soris. magaliTad, ar SeiZleba SevadaroT im adamianTa
jgufebis simaRle da masa, romlebic sxvadasxva sqesis da asakis pirebisagan Sedgeba.
korelaciis koeficienti erTi ricxvis saSualebiT gviCvenebs or Sesaswavl movlenas Soris
kavSiris Zalas da mimarTulebas. kavSiri SeiZleba iyos pirdapiri (dadebiTi) da SebrunebiTi
(uaryofiTi) (ix. cxrili #41)
cxrili #41
korelaciis koeficientis Sefasebis sqema

korelaciis korelaciis koeficientis sidide


Sefaseba pirdapiri(dadebiTi)korelacia SebrunebiTi (uaryofiTi)
korelacia
susti (dabali) 0-dan +0,3-mde 0-dan -0,3-mde
saSualo +0,31-dan +0,69-mde -0,31-dan -0,69-mde
Zlieri (maRali) +0,7-dan +1,0-mde -0,7-dan -1,0-mde

pirdapiri korelaciis dros erTi cvladis mniSvnelobis zrdisas, meore cvladis


mniSvnelobac izrdeba. aseT SemTxvevaSi koeficienti 0-dan +1-mde meryeobs. rac metia
korelaciis koeficienti, miT ufro mWidro kavSiria Sesadarebel sidideebs Soris. magaliTad,
sxvadasxva infeqciuri daavadebebisas temperaturis matebasTan erTad izrdeba pulsis sixSirec.
bavSvis simaRleSi zrdasTan erTad izrdeba misi wonac da a. S. rodesac korelaciis
koeficienti 0-dan -1-mde meryeobs, maSin or cvlads Soris aris uaryofiTi damokidebuleba, anu
erTi mniSvnelobis zrdisas meore sidide mcirdeba. magaliTad, rac ufro farTod aris
mosaxleoba moculi profilaqtikuri acrebiT, miT ufro naklebia maTSi Sesabamisi infeqciebiT
gamowveuli avadoba, rac ufro maRalia garemos temperatura, miT ufro naklebia bronqitebis
ricxvi da a. S.
rodesac korelaciis koeficienti 0-is tolia, es kavSiris ararsebobas uCvenebs. amis
magaliTia adamianis kanis feri da inteleqtis done. unda aRiniSnos, rom korelaciis
koeficientis maqsimaluri mniSvnelobebic ki (+1, _1) ar niSnavs rom or cvlads Soris
arsebobs mizezobrivi kavSiri.
korelaciuri kavSiri SeiZleba iyos sworxazovani (wrfivi) da mrudexazovani.
sworxazovani korelaciis dros erTi niSnis sididis Tanabarzomier cvlilebas meore niSnis
sididis aseve Tanabarzomieri cvlileba moyveba. amis magaliTia maqsimalur da minimalur

145
arteriul wnevebs Soris damokidebuleba.
korelaciis koeficientis gamoTvlis ramdenime meTodi arsebobs. Tu cvladebs Soris
aris sworxazovani korelacia da dakvirvebaTa ricxvi didi ar aris, maSin iyeneben Semdeg
formulas:

r=
 ( Xi − XsaS) (Yi − YsaS)
 ( Xi − XsaS)  (Yi − YsaS)
2 2

sadac r – korelaciis koeficientia,


X da Y - cvladis mniSvnelobebi, romelTa Sorisac dgindeba korelacia.
magaliTad gvinda gamovTvaloT aris Tu ara korelacia sxeulis temperaturasa da
pulsis sixSires Soris (ix. cxrili #42).
cxrili #42
damokidebuleba sxeulis temperaturasa da pulsis sixSires Soris
sxeulis pulsis Xi –XsaS Yi –YsaS (Xi–XsaS)(Yi–YsaS) (Xi–X saS )2 (Yi–Y saS)2
temperatura sixSire
X wuTSi
Y
36 60 -2 -20 40 4 400
36 70 -2 -10 20 4 100
38 80 0 0 0 0 0
40 90 +2 +10 20 4 100
40 100 +2 +20 40 4 400
sul 0 0 120 16 1000

120 120
r = = = +0,952
16 X 1000 126
anu sxeulis temperaturasa da pulsis sixSires Soris aris pirdapiri Zlieri kavSiri.
imaSi dasarwmuneblad, rom amonarCevze kvlevebis Sedegad miRebuli korelaciis
koeficienti Seesabameba mTel populaciaSi arsebul kavSirs da mis Zalas, saWiroa am
koeficientis standartuli Secdomisa da t koeficientis gamoTvla.

1− r2
SEM r = , sadac SEMr aris korelaciuri koeficientis standartuli Secdoma.
n−2
r
t=
SEM r

t-s Sefaseba xdeba t kriteriumis cxrilis mixedviT (ix. cxrili #39)


sadac t n / = n-2 -is dros (n – wyvili variantebis raodenoba) Seesabameba kavSiris
arsebobis albaTobas (p). Cven SemTxvevaSi

146
ese igi korelaciis koeficienti romelic udris 0,952, aris sarwmuno 95%-ze meti
albaTobiT (p<0,05), radgan n/ = 5-2=3-is dros, Cvens mier miRebuli t-s mniSvneloba (5,3) metia
t cxriluri=3,2-ze (p=0,05) da naklebia t cxriluri=5,8-ze (p=0,01). amrigad SeiZleba
vamtkicoT, rom generalur erTobliobaSi sxeulis temperaturasa da pulsis sixSires Soris
aris pirdapiri Zlieri kavSiri.

4.5.9. regresia, regresuli analizi

rogorc aRiniSna, korelaciis koeficienti gviCvenebs ori Sesaswavl movlenas Soris


arsebuli urTierTkavSiris mxolod mimarTulebasa da Zalas. magram ar iZleva saSualebas
vimsjeloT, Tu raodenobrivad rogor cvlis erTi movlenis cvlileba meore movlenas. am
kiTxvaze pasuxis gasacemad iyeneben regresiis meTods.
saerTod, regresia aris funqcia, romelic saSualebas iZleva erTi Sesaswavli niSnis
(movlenis) sididiT ganisazRvros meore niSnis (movlenis) saSualo sidide. regresuli analizi
maTematikuri modelirebaa, romelic gviCvenebs Tu ra gavlenas axdens erTi an meti
damoukidebeli cvladi damokidebul cvladze. regresuli analizi saSualebas gvaZlevs
ganvsazRvroT damoukidebeli cvladis erTi erTeuliT cvlileba rogor Secvlis
raodenobrivad damokidebuli cvladis mniSvnelobas. iseve rogorc korelaciuri analizi,
regresuli analizic ar gamoiyeneba mizez-Sedegobrivi kavSiris dasadgenad.
regresuli analizis sami saxe arsebobs:
1. wrfivi (sworxazovani) regresia;
2. mravlobiTi regresia;
3. arawrfivi regresia, romlis gamoyenebac sakmaod rTul maTematikur operaciebs
moiTxovs.
regresuli analizisas gamoiyeneba regresiis koeficientis gansazRvra,
igi gamoiTvleba formuliT:
SD y
R = r , sadac R aris regresiis koeficienti, r- am sakvlevi movlenebis
SDx

korelaciis koeficienti, SD x da SD y - TiToeuli movlenis dakvirvebaTa mwkrivebis

147
standartuli gadaxris mniSvnelobebi.
magaliTad saWiroa ganvsazRvroT simaRlis mixedviT 9 wlis gogonebis wona. wona
avRniSnoT Y-iT, xolo simaRle – X-iT. cnobilia, rom simaRlis standartuli gadaxra
SDX= ± 5,8 sm, xolo wonis SDy= ± 4,2 kg, simaRlisa da masis korelaciis koeficienti r=+0,6.
regresiis koeficienti tolia:
4.2
R = +0,6  = 0,43 kg/sm-ze
5,8
am gamoTvlis safuZvelze SeiZleba davaskvnaT Semdegi: 9 wlis gogonebisaTvis simaRleSi
1 sm-is momatebisas, maTi saSualo wona izrdeba 0,43kg-iT.
regresiis koeficientis saSualebiT specialuri gazomvebis gareSe SeiZleba ganvsazRvroT
erTi niSnis sidide meore niSnis sididis mixedviT. am mizniT gamoiyeneba wrfivi regresiis
gantoleba:
y = Xy + R (X - Xx) sadac
Y y _ gamosakvlevi niSnis sididea,
X _ cnobili niSnis sidide,
R _ regresiis koeficienti,
Xy da Xx _ niSnebis saSualo mniSvnelobebi.
magaliTad, ramdeni iqneba 9 wlis gogonebis saSualo wona, Tu simaRle 132 sm-ia?
am asakis gogonebisaTvis saSualo wona Xy = 30,5kg-s, xolo saSualo simaRle Xx = 135,5 sm-s.
CavsvaT formulaSi cnobili sidideebi:
y = 30,5 + 0,43 (132 – 135,5) = 30,5 + 0,43 x (- 3,5) = 30,5 – 1,5 =29 kg.-s

4.5.10 Sedegebis Sefasebis araparametruli meTodebi

monacemTa normaluri ganawilebis garda, gvxvdeba sxva saxis ganawilebac.


epidemiologiur kvlevebSi xSirad saqme gvaqvs puasonis ganawilebasTan. Tu normaluri
ganawilebis dros monacemebi aris uwyveti da SeuZliaT miiRon nebismieri ricxviTi
mniSvneloba, puasonis ganawilebisas gvxvdeba diskretuli sidideebi, romlebmac SeiZleba miiRon
mxolod nulovani an mTeli dadebiTi mniSvnelobebi.
amasTan puasonis ganawileba imiTac xasiaTdeba, rom monacemTa umetesoba grafikis saxiT
warmodgenisas xSirad mrudis Sua nawils ki ar Seesabameba, rogorc es normaluri ganawilebis
dros xdeba, aramed sawyis variantebs. magaliTad, SeiZleba moviyvanoT erT-erTi samrewvelo
saamqros muSaTa daavadebebis ganawileba mTeli wlis manZilze, rac naCvenebia #43 cxrilSi da
grafikulad gamosaxulia #22 suraTze.

148
cxrili #43
samrewvelo cexSi muSaTa ganawileba mTeli wlis manZilze daavadebTa ricxvis
mixedviT
daavadebaTa ricxvi V muSaTa raodenoba p a ap a 2p
0 55 0 0 0
1 43 +1 43 43
2 31 +2 62 124
3 8 +3 24 72
4 5 +4 20 80
5 3 +5 15 75
sul 145 394

suraTi #22

is meTodebi, romlebic zemoT iqna aRwerili da romelTa saSualebiTac xdeba miRebul


monacemTa rigebs Soris gansxvavebis sarwmunobis Sefaseba, parametrul meTodebs miekuTvneba.
TuU ganawileba ar aris normaluri, maSin parametruli meTodebis gamoyenebam SeiZleba mcdar
Sedegebamde migviyvanos. aseT SemTxvevaSi umjobesia araparametruli meTodebis gamoyeneba,
romelTa dadebiTi mxareebia gamoyenebis simartive da maRali mgrZnobeloba. araparametrul
testebs iyeneben maSinac, rodesac amonarCevis zoma aris mcire.
ZiriTadi araparametruli kriteriumebi, romlebic gamoiyeneba epidemiologiur kvlevebSi,
aris Tanxmobis kriteriumi X2, vilkinsonis da uaitis kriteriumebi da aseve spirmenis rangebis
korelaciis koeficienti.
Sesabamisobis (Tanxmobis) kriteriumi X2: es kriteriumi mizanSewonilia gamoyenebul iqnas
sixSireebis fardobiTi maCveneblebis ganawilebis Sesadareblad, aseve maT Soris sxvaobis
sarwmunobis dasadgenad. X2-is gamoyeneba ar SeiZleba Tu ar gvaqvs dakvirvebaTa absoluturi
raodenoba da aseve iseTi monacemebisas, romlebic miiReba sigrZis, drois da masis gazomviT.
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pirsonis koeficientis gamosaTvlelad viyenebT formulas:

 2 =  (p − p )

p

sadac  2 - pirsonis koeficientia,


p - faqtobrivi monacemebi,
p - mosalodneli monacemebi.
magaliTad, mwvave respiratoruli daavadebebiT avadobis sezonuri matebis periodSi
gamocdil iqna dibazolis profilaqtikuri moqmedeba, romelic cnobilia, rom zrdis
organizmis araspecifikur rezistentobas. amisaTvis N dasaxlebul punqtSi dakompleqtda ori
jgufi: pirvel jgufSi Sevida 6815 adamiani, romlebic iRebdnen dibazols, xolo meore jgufSi
gaerTianda 11 668 adamiani, romlebsac placebo eZleoda. Sedegebi mocemulia #44 cxrilSi.
cxrili #44
mwvave respiraciuli daavadebiT avadoba im pirebSi, romlebic iRebdnen dibazols da
placebos
preparati daavadebulTa ricxvi (%) janmrTel pirTa ricxvi sul
dibazoli 56 (0,82%) 6 759 6 815
placebo 272 (2,33%) 11 396 11 668
sul 328 (1,78%) 18 155 18 483

Teoriulad vuSvebT, rom dibazols ar gaaCnia profilaqtikuri moqmedena, anu viRebT e.w.
`nulovan hipoTezas~. am SemTxvevaSi avadobis done orive jgufSi iqneba erTnairi da Seesabameba
mTeli gamosakvlevi kontingentis avadobis dones:
328  100
= 1,78%,
18483
anu orive jgufSi avadmyofTa raodenoba 1,78%-is toli iqneba. im pirTa Soris,
romlebic dibazols iRebdnen, es sidide ase gamoiTvleba :
6815  1,78
= 121,
100
e.i. am jgufSi avad unda gamxdariyo 121 piri da janmrTeli unda yofiliyo 6 815-
121=6 694 piri. xolo im pirTa Soris, romlebic placebos iRebdnen avad gaxdeboda
11668  1,78
= 207 piri,
100
janmrTeli ki darCeboda 11 668-207 = 11 461 adamiani.
avadmyofTa da janmrTelTa faqtiuri da mosalodneli raodenoba (im SemTxvevaSi, Tu

150
CavTvliT, rom dibazols ar gaaCnia profilaqtikuri moqmedeba) mocemulia #45 cxrilSi.
cxrili #45
avadmyofTa da janmrTel pirTa faqtiuri da savaraudo monacemebi
maCvenebeli miiRes dibazoli miiRes placebo sul
faqtiuri 56 6759 272 11 396 328 18 155
mosalodneli 121 6694 207 11 461 328 18 155

im SemTxvevaSi, Tu p = p , anu mosalodneli ricxvi faqtiuri ricxvis tolia, X2


nulis toli iqneba da hipoTeza dibazolis profilaqtikuri efeqtis ar arsebobis Sesaxeb
dadasturdeboda. meores mxriv, rac meti iqneba p - p sxvaoba, miT meti iqneba X2-is
mniSvneloba. gamovTvaloT am koeficientis mniSvneloba Cvens SemTxvevaSi :

2 =
(56 − 121)2 + (6759 − 6694)2 + (272 − 207)2 + (11396 + 11461)2 =
121 6694 207 11461
4225 4225 4225 4225
= + + + = 34,9 + 0,63 + 20,4 + 0,37 = 56,3
121 6694 207 11461
imisTvis, rom davadginoT p - p sxvaobis arsi da SemTxveviToba, saWiroa am

koeficientis Sefaseba specialuri, X2-is ganawilebis Sesaxeb cxrilis saSualebiT (cxrili


#46).
Tavisuflebis xarisxis ricxvi ganisazRvreba formuliT:
n = (s − 1)(r − 1), sadac s aris cxril #44-Si (sadac pirveli monacemebia dibazolis da
placebosi) grafebis ricxvi (grafis `sul~ gamoklebiT),
r – igive cxrilSi svetebis raodenoba (mxolod sveti `jami~-is garda).
Sesabamisi monacemebis Casmis Semdeg miviRebT, rom n =(2-1)(2-1)=1
#46 cxrilSi vnaxulobT, rom n =1 mniSvnelobis gaswvriv arsebuli ricxvebi bevrad
naklebia, vidre sidide X2 =56,2, maT Soris bolo grafaSi arsebul ricxvzec - 6,6-zec,
Sesabamisad p<0,01, anu imis albaToba, rom aRniSnul or qvejgufSi avadobis maCveneblebs Soris
miRebuli sxvaoba aris SemTxveviTi, ukiduresad mcirea.
es imaze metyvelebs, rom im jgufSi, sadac dibazols iRebdnen, avadobis dabali done ar
aris SemTxveviTi. amitom am movlenis kavSiri dibazolis profilaqtikur moqmedebasTan eWvs ar
iwvevs.

151
cxrili #46
X2 -is ganawilebis cxrili (Semoklebuli varianti)
Tavisuflebis xarisxis ricxvi n 0,10=10% 0,05=5% 0,01=1%
1 2,7 3,8 6,6
2 4,6 6,0 9,2
3 6,3 7,8 11,3
4 7,8 9,5 13,3
5 9,2 11,1 15,1
6 10,6 12,6 16,8
7 12,0 14,1 18,5
8 13,4 15,5 20,1
9 14,7 16,9 21,7
10 16,0 18,3 23,2
11 17,3 19,7 24,7
12 18,5 21,0 26,2
13 19,8 22,4 27,7
14 21,1 23,7 29,1
15 22,3 25,0 30,6
16 23,5 26,3 32,0
17 24,8 27,6 33,4
18 26,0 28,9 34,8
19 27,2 30,1 36,2
20 28,4 31,4 37,6
21 29,6 32,7 38,9
22 30,8 33,9 40,3
23 32,0 35,2 41,6
24 33,2 36,4 43,0
25 34,4 37,7 44,3
26 35,5 38,9 45,6
27 36,7 40,1 47,0
28 37,9 41,3 48,3
29 39,1 42,6 49,6
30 40,3 43,8 50,9

Sesabamisobis kriteriumis X2 gamoyeneba aseve SesaZlebelia erTdroulad orze meti


empiriuli ganawilebis Sesadareblad.
epidemiologiuri kvlevebis Catarebis dros xSirad gviwevs davadginoT ori Sesadarebeli
amonarCevis dakvirvebis Sedegad miRebul monacemebs Soris sxvaoba aris TuU ara sarwmuno.
rogorc wesi, am mizniT Semowmdeba, erTis mxriv, e.w. nulovani hipoTeza, romlis Tanaxmadac
sarwmuno gansxvaveba miRebul monacemebs Soris ar arsebobs da meore mxriv, sawinaaRmdego
hipoTeza – amonarCevebs Soris mniSvnelovani sxvaoba arsebobs.
152
hipoTezis Semowmeba xdeba sxvadasxva kriteriumebis gamoyenebiT, rogorc parametruli
(ZiriTadad t stiudentis meSveobiT), ise araparametruliT. am ukanasknels miekuTvneba
vilkoksonis kriteriumi, romelic saSualebas gvaZlevs ganvsazRvroT gansxvaveba or
dakavSirebul amonarCevs Soris, dawyvilebuli variantebis sxvaobis Sefasebis safuZvelze.
vilkoksonis kriteriumis gamoyenebisas Tu Seqmnili dawyvilebuli variantebis raodenoba
meryeobs 6-dan 25-mde, maSin Sefaseba xdeba kritikuli mniSvnelobebis cxrilis gamoyenebiT. Tu
variantTa raodenoba 25-ze metia, maSin xdeba specialuri formulis gamoyeneba. am kriteriumis
gamoyenebisas saWiroa Semdegi operaciebis Catareba:
• dadgindes sxvaoba dakvirvebis Sedegad miRebul dawyvilebul variantTa Soris;
• dadgindes am sxvaobaTa rangi dadebiTi Tu uaryofiTi niSnis gauTvaliswineblad (Tu
sxvaoba 0-is tolia, aseT wyvilebs amoagdeben Semdgomi damuSavebidan).
• moxdes im sxvaobaTa rangis dajameba, romlebsac erTnairi niSani (dadebiTi an
uaryofiTi) aqvT.
 
• umciresi jami ( T  ) Sedardes kritikul mniSvnelobebTan ( T05 da T01 ), romelic

naCvenebia #47 cxrilSi.



TuU T  -s miRebuli mniSvneloba metia an toli T05 –ze, maSin viRebT nulovan hipoTezas

da sxvaoba iTvleba arasarwmunod. Tu T  naklebia T05 -is mniSvnelobaze, maSin sxvaoba iTvleba

sarwmunod P<0,05 albaTobiT. xolo Tu T  naklebia T01 -ze, sxvaoba sarwmunod iTvleba P<0,01

albaTobiT.
cxrili #47
vilkoksonis kriteriumis ( T  ) kritikuli mniSvnelobebi
dakavSirebuli erTobliobebisaTvis
sxvaobis done sxvaobis done sxvaobis done
n n n
0,05 0,01 0,05 0,01 0,05 0,01
6 1 - 13 18 11 20 53 39
7 3 - 14 22 14 21 60 44
8 5 1 15 26 17 22 67 50
9 7 3 16 31 21 23 74 56
10 9 4 17 36 24 24 82 62
11 12 6 18 41 29 25 90 69
12 15 8 19 47 33

moviyvanoT vilkoksonis kriteriumis gamoTvlis konkretuli magaliTi. #48 cxrilSi


naCvenebia sisxlis SratSi saerTo cilis donis gamokvlevis Sedegebi im pirebSi, romelTac
153
aReniSnebodaT benzantroniT intoqsikacia karboxolinis Seyvanamde da misi Seyvanis Semdeg.
cxrili #48
benzantronis intoqsikaciis mqone pirebSi karboxolinis Seyvanamde da misi Seyvanis Semdeg
sisxlis SratSi saerTo cilis donis sxvaobis Sefaseba vilkoksonis kriteriumiT
saerTo cilis mniSvnelobaTa mniSvnelobaTa sxvaobaTa
Semcveloba g%-Si sxvaoba sxvaobis rangi uaryofiTi
preparatis preparatis g%-Si mniSvnelobebis
Seyvanamde Seyvanis rangi
Semdeg
15,34 5,46 +0,12 2,3
5,98
2 5,46 -0,52 8 8
35,38 5,80 +0,42 7
5,84
4 6,44 +0,60 10
6,60
5 6,80 +0,20 5
6,80
6 6,94 +0,14 4
6,26
7 7,54 +1,28 12
6,74
8 6,62 -0,12 2,3 2,3
6,42
9 6,78 +0,36 6
5,66
0 6,2 +0,54 9
6,56
1 7,80 +1,24 11
2
5,58 5,60 +0,02 1
Z=2
N=12 + T  =67,5 - T  =10,5
rogorc cxrilidan Cans, Tormetidan aT SemTxvevaSi sxvaobaTa algebruli niSani aris
dadebiTi, xolo or SemTxvevaSi – uaryofiTi (Z = 2). dadebiTi da uaryofiTi rangebis jamma
Seadgina 67,5 da 10,5. amrigad T  (rangebis jamis naklebi mniSvneloba) udris 10,5-s. #47

cxrilSi vnaxulobT, rom T  –s kritikuli mniSvneloba roca n=12-s udris, T05 = 15 da
 
T01 = 8 . radgan T  < T05 –ze, vaskvniT, rom Sesadarebel monacemebs Soris sxvaoba aris

sarwmuno 5%-ze naklebi Secdomis albaTobiT.


spirmenis ranguli korelaciis koeficienti. Sesaswavli niSnebis or raodenobriv rigs
Soris kavSiris dasadgenad yvelaze ufro gavrcelebuli meTodi aris ranguli korelaciis
koeficienti. mis gamosaTvlelad saWiroa Semdegi manipulaciebis Catareba:
• miRebuli monacemebis dalageba zrdis (klebis) mixedviT;
• monacemTa ranJireba;
• orive niSnis rigebSi damoukidebeli wyvilebis rangebis sxvaobis dadgena;
• TiToeuli sxvaobis kvadratSi ayvana da maTi jamis gansazRvra.

154
ranguli korelaciis koeficienti ganisazRvreba formuliT:

sadac p - ranguli korelaciis koeficientia,


∑ d2 - rangebis sxvaobis kvadratebis jami,
n - Sesadarebeli wyvilebis raodenoba.
am koeficientis gamosaTvlelad SeiZleba moviyvanoT magaliTi kavSirisa A hepatitis
endemur regionSi axalwveulTa yofnis xangrZlivobasa da maTi am daavadebiT avadobis
maCveneblebs Soris.
spirmenis koeficientis sidide moTavsebulia 0 -dan ± 1-is farglebSi. amasTan kavSiri
izrdeba erTTan miaxloebisas. koeficientis niSani (+ an -) miuTiTebs, Tu rogori xasiaTis aris
kavSiri - dadebiTi Tu uaryofiTi. moyvanil magaliTSi p = 0,33 niSnavs, rom arsebobs saSualo
siZlieris dadebiTi kavSiri A hepatitiT avadobis dones da axalwveulebis endemur regionSi
yofnis xangrZlivobas Soris.

cxrili #49
axalwveulTa A hepatitiT avadobis kavSiri
endemur regionSi maTi yofnis xangrZlivobasTan
axalwveulTa endemur rangi A hepatitiT rangi
regionSi yofnis d= Rx - Ry d2
(Rx) avadoba (y) (Ry)
xangrZlivoba dReebSi (x)
2 1 371,5 4 -3 9
4 2 359,5 3 -1 1
5 3 381,5 5 -2 4
7 4 352,5 2 2 4
10 5 469,0 9 -4 16
14 6 388,3 8 -2 4
15 7 337,4 1 6 36
20 8 383,6 7 1 1
24 9 599,7 12 -3 9
30 10 500,0 11 -1 1
60 11 382,3 6 5 25
90 12 661,4 13 -1 1
100 13 491,4 10 3 9

d2= 120
155
gamoTvlili koeficientis damajerebloba gamoiTvleba p-s kritikuli mniSvnelobiT, rac
cxril #50-Sia naCvenebi. Cvens mier miRebuli ranguli korelaciis koeficienti p< p0,5-ze,
amitom igi statistikurad sarwmunod ar CaiTvleba, radgan Secdomis daSvebis albaToba 5%-ze
metia.
cxrili #50
spirmenis ranguli korelaciis koeficientis kritikuli mniSvneloba

156
4.6. monacemTa prezentacia

monacemebis damuSavebis procesSi didi mniSvneloba aqvs maT warmoCenas TvalsaCino saxiT,
radgan es procesi aadvilebs rogorc miRebuli Sedegebis aRqmas, ise monacemTa damuSavebas.
monacemTa prezentaciisTvis gamoiyeneba cxrili, grafiki da diagrama.

cxrili
cxrili aris monacemTa warmodgena rigebisa da svetebis saxiT. cxrilebi, romlebic
gamoyenebulia monacemTa demonstraciisaTvis, rac SeiZleba martivi da advilad aRqmadi unda
iyos. amisaTvis cxrils unda hqondes mokle da gasagebi saTauri. cxrilis TiToeuli sveti da
aseve rigic unda dasaTaurdes mokled, magram gasagebad. aucileblad unda iyos aRniSnuli
sazomi erTeulebi Tu aseTi gamoyenebuli gvaqvs cxrilSi (mag. mg/l, mm, sm da a.S). Tu cxrilSi
gamoiyeneba Semoklebebi, cxrilis bolos aucileblad unda iyos iyos isini axsnili. rigebisa
da svetebis bolos unda arsebobdes jamis maCvenebeli grafa.
cxrili SeiZleba iyos erTcvladiani an mravalcvladiani (orcvladiani, samcvladiani,
cxrili 2X2 da standartuli cxrilebi).
erTcvladiani da mravalcvladiani cxrilebis pirvel svetSi aTavseben iseT kategoriul
cvladebs, rogoricaa magaliTad sqesi an asaki. sxva svetebSi ki aRniSnaven im ricxvs an
movlenas, romelic Sedis TiToeul kategoriaSi. cxrilebis Sedgenisas unda gaviTvaliswinoT
isic, rom samze meti cvladis erT cxrilSi moTavseba Znelad aRsaqmelia, amitom sami cvladi -
es aris cvladebis is maqsimaluri raodenoba, romelic rekomendebulia cxrilis Sesaqmnelad.
qvemoT moyvanilia erTi da orcvladiani cxrilebis magaliTebi.

cxrili #51

endemuri Ciyvis SemTxvevebi saqarTveloSi 2013 wels

asaki SemTxvevaTa
raodenoba
1-5w 586
6-11 w 1589
12-15 w 13194
16-49 w 13194
50 w. da zeviT 1589
sul 30152

157
cxrili #52

endemuri Ciyvis SemTxvevebis ganawileba sqesis mixedviT


saqarTveloSi 2013 wels

asaki SemTxvevaTa raodenoba


qali mamakaci sul
1-5 w 286 300 586
6-11 w 802 787 1589
12-15 w 7016 6178 13194
16-49 w 10314 2880 13194
50w da zeviT 1338 251 1589
sul 19756 10396 30152

orive cxrilSi mocemulia 2013 wels saqarTveloSi gamovlenili endemuri Ciyvis


SemTxvevaTa raodenoba. pirvel cxrilSi warmodgenilia SemTxvevaTa ganawileba asakis mixedviT,
anu gvaqvs erTi cvladi – endemuri Ciyvis SemTxvevebi. meore cxrilSi ki es SemTxvevebi
dayofilia sqesis mixedviT, anu gvaqvs ori dixotomuri cvladi – qali/mamakaci.

cxrili 2X2
rogorc zemoT iyo aRniSnuli epidemiologiuri kvlevebSi farTod gamoiyeneba cxrili
2X2. igi saWiroa kohortuli da SemTxveva-kontroliT kvlevebisas iseTi maCveneblebis
warmosadgenad, romlebic gamoiyeneba statistikuri kavSiris maCvenebelTa gamoTvlisas (riskebis
Tanafardoba, Sansebis Tanafardoba). aseTi formis cxrilebSi ori mocemuli cvladidan
TiToeulma SeiZleba mxolod ori mniSvneloba miiRos - an dadebiTi, an uaryofiTi. aseTi
formatis cxrili warmodgenilia qvemoT.

cxrili #53
cxrili 2X2
gamosavali aris gamosavali ar aris sul
faqtoris zemoqmedeba iyo a b a+b
faqtoris zemoqmedeba ar iyo c d c+d
sul a+c b+d a+b+c+d

cxril #54-Si moyvanil magaliTSi zemoqmedeba vaqcinaciaa, gamosavali ki daavadeba an


janmrTelad darCena, anu SegviZlia SevadaroT ori jgufi.
cxrili 2X2 farTod gamoiyeneba skrininguli testebis validobis Sesafaseblad.
158
cxrili #54
B hepatitiT daavadebis SemTxvevebi vaqcinirebul da aravaqcinirebul pirebSi

daavadda janmrTeli darCa sul


vaqcinirebuli 20 980 1000
aravaqcinirebuli 120 880 1000
sul 140 1860 2000

standartuli cxrilebi

zogjer SesaZlebelia arsebobdes standartuli cxrilebi, anu cxrilebis maketebi,


romlebic gviCvenebs, Tu rogori monacemebi unda Segrovdes. es Seuvsebeli cxrilebia,
romlebic advili gamosayenebelia didi masStabis kvlevebis dros.
grafikebi da diagramebi
cxrili monacemebis kargi amsaxveli saSualebaa, magram misi saSualebiT daavadebis
maxasiaTeblebis an sxva maCveneblebis gamosaxva zogjer rTulia TvalsaCinoebis mxriv. aseT
SemTxvevebSi gamoiyeneba grafikebi da diagramebi.
grafiki es aris monacemTa vizualizaciis saSualeba koordinatTa sistemis gamoyenebiT.
is saSualebas iZleva dadgindes monacemTa ganawilebaSi arsebuli kanonzomierebebi, tendenciebi
da gadaxrebi. grafikis daxmarebiT SesaZlebelia kvlevis Sedegebis efeqturad aRqma da
hipoTezebis SemuSaveba. grafikis aRqma da misi saSualebiT warmodgenil monacemTa damaxsovreba
ufro advilia, vidre cxrilebis monacemebis.
grafiks, ise rogorc cxrils, aucileblad unda hqondes mokle, magram gasagebi saTauri.
grafiki igeba koordinatTa sistemis gamoyenebiT, sistemis abscisaze, anu 0X RerZze daitaneba
damoukidebeli cvladebi. es SeiZleba iyos drois monakveTi, asakobrivi jgufebi. ordinataze –
0Y RerZze, daitaneba damokidebuli cvladebi. es SeiZleba iyos iseTi maCveneblebi, rogoricaa:
incidentoba, prevalentoba, SemTxvevebis absoluturi raodenoba da sxva.
koordinatTa sistemaze naCvenebi nebismieri sidide unda iyos ganmartebuli. mag: Tu
RerZze gvaqvs %-is maCvenebeli. mis marcxena zeda mxares unda iyos % -is niSani.
grafiki SeiZleba iyos ariTmetikuli an naxevradlogariTmuli.
naxevradlogariTmuli grafikis ageba xdeba naxevradlogariTmul Skalaze. 0X RerZze
ariTmetikuli Skala gamoiyeneba, xolo 0Y RerZze _ logariTmuli. am tipis grafiki
gamoiyeneba maSin, rodesac ordinataze warmosadgeni maCveneblebi Zalian did diapazonSi
meryeoben da ariTmetikul Skalaze maTi gamosaxva SeuZlebelia.
159
ariTmetikuli grafikebi asaxaven monacemTa ganawilebis kanonzomierebas an tendencias,
romelic droSi izomeba.
ariTmetikuli grafikis agebis dros daculi unda iyos Semdegi pirobebi:
• 0Y RerZi 0X RerZze mokle unda iyos ise, rom maTi Tanafardoba udrides 3:5.
• 0Y RerZis aTvla aucileblad unda daiwyos nulidan.
• RerZebze danayofebi RerZis nebismier adgilas erTi da imave sidides unda asaxavdes.
• unda ganisazRvros mniSvnelobaTa diapazoni, romelic grafikze unda gamoisaxos.
• unda ganisazRvros RerZebze warmosadgeni yvelaze maRali mniSvneloba da unda
damrgvaldes igi uaxloes mTel ricxvamde.
• intervalis zoma ise unda SeirCes, rom saSualeba mogvces monacemebi srulad da
gasagebad warmovadginoT.
ariTmetikuli grafikis ramdenime saxe arsebobs:
1. xazovani grafiki;
2. CarTuli grafiki;
3. histograma;
4. Rerosa da foTlis;
5. wertilovani diagrama.

cxrili #55
Cutyvavilas SemTxvevebi q.TbilisSi 2011-2019 ww.

wlebi SemTxvevebis raodenoba


2011 600
2012 460
2013 380
2014 530
2015 485
2016 320
2017 590
2018 800
2019 510

160
suraTi #23

rogorc cxrilSi #55, aseve grafikze (suraTi #23) warmodgenilia erTi da igive
monacemebi, Tumca, rogorc vxedavT, monacemebis grafikuli asaxva ufro TvalsaCinod gviCvenebs
Cutyvavilas SemTxvevebis raodenobis tendencias q. TbilisSi. amdenad, analizisaTvis monacemebis
warmodgena umjobesia grafikis saxiT.
grafikebze SesaZlebelia ramodenime cvladis warmodgena, magaliTad or da samcvladiani
cxrilebis monacemebisa (cxrili #56 da suraTi #24).
cxrili #56
Cutyvavilas SemTxvevebis raodenoba Tbilissa da baTumSi 2011-2019 wlebSi

wlebi SemTxvevebis raodenoba


Tbilisi baTumi
2011 600 400
2012 460 290
2013 380 160
2014 530 170
2015 485 200
2016 320 80
2017 590 50
2018 800 30
2019 510 150

161
suraTi #24

warmodgenil grafikze mocemulia aris ori cvladi, kerZod Cutvavilas SemTxvevebi,


rogorc TbilisSi, ise baTumSi, magram am SemTxvevaSi cudad aRiqmeba bolo oTxi wli
monacemebi. amitom saWiroa CarTuli grafikis Seqmna. CarTuli grafiki aris grafikis cudad
aRqmadi nawilis gadidebuli varianti. am monacemebis CarTuli grafiki Semdeg saxes miiRebs:

suraTi #25

162
xazovani grafiki gviCvenebs movlenis, daavadebis an janmrTelobasTan dakavSirebuli
mdgomareobis ganawilebas droSi garkveul adgilas garkveul mosaxleobaSi. xazovani grafiki
epidemiuri mrudis saxelwodebiTac aris cnobili, Tumca is mxolod daavadebis epidemiur
gavrcelebas ar asaxavs.
histogramac aseve sixSireTa ganawilebas asaxavs droSi. es aris uwyveti raodenobrivi
cvladebis an variaciuli rigis ganawilebis diagrama. Cveulebriv, histogramebi gamoiyeneba
garkveuli drois garkveul periodSi Setyobinebuli SemTxvevebis raodenobis saCveneblad da
yvelaze xSirad dgeba daavadebis dawyebis TariRis mixedviT.
histogramaze drois intervalebi, rogorc damoukidebeli cvladebi, ganlagdeba 0X
RerZze, xolo SemTxvevebis raodenoba - 0Y RerZze.
drois intervalis SerCeva xdeba daavadebis mixedviT. im daavadebebis afeTqebebis
histogramaze gamosaxvisas, romelTac mcire inkubaciuri periodi aqvT, drois intervali
SeiZleba gamoisaxos dReebiT an saaTebiT. magaliTad salmonelozis afeTqebis dros drois
intervalebi saaTebiT ganisazRvreba, radgan misi inkubaciuri periodi ramdenime saaTidan 3
dRemde meryeobs da aseTi mcire intervalebi saSualebas gvaZlevs SevafasoT afeTqebis xasiaTi.
histogramis Semadgeneli TiToeuli svetis farTi proporciul damokidebulebaSia am
intervalis farglebSi arsebul dakvirvebaTa raodenobasTan. histogramis Semadgeneli svetebi
SeiZleba daiyos kvadratebad; TiToeuli sveti imden kvadrats Seicavs, ramdeni SemTxvevac
gvqonda Sesabamisi drois intervalis farglebSi. histogramaze svetebi erTmaneTs esazRvrebian.
histogramaze SesaZlebelia sxvadasxva cvladis Cveneba, risTvisac saWiroa Sesabamisi
kubis daStrixva an feris Secvla, romelic aucileblad ganmartebuli unda iyos specialuri
aRniSvniT. am aRniSvnas “pirobiTi niSnebi” ewodeba.

histograma #1

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magaliTad #1 histogramaze asaxulia A hepatitis SemTxvevebi sam sxvadasxva raionSi
2003 wlis agvistodan 2004 wlis maisis Tvis CaTvliT.
ruxi kvadratiT aRniSnulia SemTxvevebi im raionSi, sadac aRniSnuli kvleva Catarda.
StrixiT – mezobel raionSi gamovlenili, SaviT – moSorebul raionSi dafiqsirebuli
SemTxvevebi, xolo TeTriT aRniSnulia is SemTxvevebi, romelTa adgilic ucnobia.
sxvadasxvaaRniSvna naCvenebia pirobiT niSnebSi.
0X RerZze dro mocemulia ordRiani intervalebiT, xolo 0Y RerZze – SemTxvevaTa
raodenoba.
samedicino literaturaSi xazovani grafiki da histograma Zalze xSirad gamoiyeneba
monacemTa sixSireebis ganawilebis sailustraciod.

Rerosa da foTlis grafiki

Rerosa da foTlis grafiks, romelic aseve sixSireTa ganawilebas asaxavs, sami


komponenti gaaCnia: Rero, foToli da simbolo. ganvixiloT Rerosa da foTlis grafikis ageba
Semdeg magaliTze: 26 axalgazrda gogonasa da vaJis sixlis SratSi maRali simkvrivis
lipoproteinis done aRmoCnda: 31, 41, 44, 46, 47, 48, 48, 49, 52, 53, 54, 57, 58, 58, 60, 60, 62,
63, 64, 67, 69, 70, 77, 81 da 90 mg/dl. imisaTvis, rom es monacemebi gamovxatoT grafikulad,
unda vicodeT, rom Rero warmoadgens ricxvebis vertikalur svets, romelic marcxniv
mdebareobs da warmoadgens mniSvnelobebs Tanabarzomier intervalebSi. (Cvens SemTxvevaSi, 10-
erTeuliani intervali iqneba, romelic daiwyeba an yvelaze mcire, an yvelaze didi
mniSvnelobidan).

9
8
7
6
5
4
3

foToli ricxvebis nakrebia, romelic uSualod Tavsdeba Reros marjvniv da zogjer


misgan vertikaluri xaziTaa gamoyofili. foTlis TiToeuli es ricxvi dakvirvebis (monacemTa
nakrebis) erT-erTi wevria. monacemTa nakrebis wevrebi foTolSi gadatanisas erTmaneTis mimarT
garkveul Tanmimdevrobas gviCvenebs. gadavitanoT Reroze foTlebi.

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9 0
8 1
7 0 7
6 0 0 2 3 4 7 9
5 2 3 4 7 8 8
4 1 4 6 7 7 8 8 9
3 1

Rerosa da foTlis grafikis TavSi mocemulia monacemTa bolo mniSvneloba – 90 mg/dl.,


Semdegi ricxvi monacemTa nakrebis boloswina mniSvnelobaa da a.S. simbolo#, romelic foTlis
marjvniv mdebareobs, gviCvenebs, Tu ramdeni dakvirveba xvdeba mocemul diapazonSi.

gadavitanoT simbolo # foTlis marjvniv.

Rerosa da foTlis grafikze erTi SexedviTac SegviZlia vTqvaT, rom monacemTa nakrebis
yvelaze didi mniSvneloba aris 90 mg/dl, yvelaze mcire – 31 mg/dl. 40-50 diapazonSi 8
dakvirvebis (gazomvis) monacemia, romlebic warmodgenilia Semdegi mniSvnelobebiT
Tanmimdevrulad: 41, 44, 46, 47, 47, 48, 48 49. Tu grafiks ganvixilavT mxolod foTlebis
ganlagebis mxriv, advili misaxvedri iqneba, rom monacemebi normaluradaa ganawilebuli.

diagrama

diagramebi gamoiyeneba statistikuri informaciis gadmosacemad. misi agebisas gamoiyeneba


koordinatTa sistemis mxolod erTi xazi. maT yvelaze xSirad xmaroben xarisxobrivi
cvladebis Sesadareblad (mag. rasa, sqesi, daavadeba da sxv.).
diagramebi iyofa RerZul (svetebian), radialur, seqtorul da wertilovan diagramebad.
RerZuli diagrama SeiZleba iyos martivi, dajgufebuli da SemadgenlobiTi. martivi RerZuli
diagrama gamosaxavs erTcvladiani cxrilis monacemebs. cvladis kategoria an yoveli
mniSvneloba warmodgenilia svetebiT, romlis sigrZec dakvirvebis qveS myof pirTa an movlenaTa
raodenobis proporciulia. martivi RerZuli diagrama SeiZleba iyos rogorc vertikaluri, ise
horizontaluri.
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vertikaluri RerZuli diagrama histogramisagan imiT gansxvavdeba, rom igi aRniSnavs ara
raodenobriv, aramed xarisxobriv cvladebs.
diagramis agebis wesebi grafikis agebis wesis msgavsia.
#26 suraTze naCvenebia horizontaluri RerZuli diagramis magaliTi, sadac mocemulia
saqarTvelos sapatimroebSi aiv infeqciiT inficirebul patimarTa raodenobis ganawileba riskis
qcevebis mixedviT. misi analizisas SeiZleba davaskvnaT, rom saqarTvelos sapatimroebSi aiv-
infeqciiT daavadebul patimarTa Soris yvelaze meti narkotikebis momxmareblebi arian.

suraTi #26

SemadgenlobiT RerZul diagramaSi meore cvladi pirveli cvladis RerZis Semadgeneli


nawilia. misi interpretacia SeiZleba rTuli iyos, radgan erT xazze mxolod erTi – qveda
komponenti iwyeba, xolo yvela danarCeni - sxvadasxva donezea, ris gamoc diagramis
interpretaciisaTvis damatebiT maTematikuri gamoTvlebia saWiro.
#27 suraTze mocemulia dizenteriis SemTxvevebi 2015-2019 wlebSi erT-erT regionSi.
2015 wels dizenteriis SemTxvevebis saerTo raodenoba iyo 560, aqedan 70 gamowveuli iyo –
Sh.flexneri-iT, 2019 wels ki 505 SemTxvevidan 395 iyo dakavSirebuli Sh.flexneri -Tan. aseTive
tipis diagramebi SeiZleba avagoT, Tu RerZze davitanT procentul maCveneblebs.
aseT diagramebs procentul diagramebsac uwodeben. aucileblad unda aRiniSnos, rom
aseTi tipis diagramebi ar gamodgeba ZiriTadi maCveneblebisa da sxva cvladebis Sesadareblad.

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suraTi #27

kombinirebuli (dajgufebuli) RerZuli diagramebi gamoiyeneba ramodenime cvladis


aRsaniSnavad, rodesac dixotomuri cvladebis gamosaxvaa saWiro.
kombinirebuli RerZuli diagramis agebisas garda grafikebis da diagramebis agebis saerTo wesisa,
daculi unda iqnas Semdegi damatebiTi wesebi:
• jgufis SigniT arsebuli RerZebi Cveulebriv erTmaneTs esazRvrebian, xolo jgufebs
Soris isini gamoyofilia sivrciT.
• erTnairi cvladis gamomxatavi RerZebi sxvadasxvanairad unda iyos Seferili an
daStrixuli. TiToeuli maTgani pirobiT niSnebSi unda iyos ganmartebuli.
• umjobesia erT jgufSi ar iyos oTxze meti cvladi, radgan Tu diagramaze Zalian
bevri cvladia, igi Zneli aRsaqmneli xdeba.
#28 suraTze mocemulia saqarTvelos sam regionis – duSeTis, mcxeTisa da Tbilisis
moswavleebis asaki alkoholuri sasmelis pirveli moxmarebis momentSi. am grafikis interptretacia ase
SeiZleba movaxdinoT: samive regionSi yvelaze met mozards alkoholuri sasmeli pirvelad 9 wlis
asakSi miuRia.

167
suraTi #28
vaJebis asaki alkoholuri sasmelis pirvelad moxmarebisas duSeTSi, mcxeTasa da

TbilisSi Catarebuli kvlevis mixedviT

wriuli, anu seqtoruli diagrama aris martivi, advilad aRqmadi. masze seqtorebis zoma
asaxavs misi Semadgeneli TiToeuli cvladis wils. seqtoruli diagrama, upiratesad,
kategoriuli cvladebis warmosadgenad gamoiyeneba.
seqtoruli diagramebis asagebad daculi unda iqnas Semdegi wesebi:
• misi Seqmna unda daiwyos wris zeda, ukiduresi wertilidan (12 saaTi proeqciaSi).
seqtorebis ganlageba unda moxdes saaTis isris mimarTulebiT didi monacemidan mciresken.
• saWiroa sxvadasxva seqtoris sxvadasxvagvari aRniSvna (feri, Strixi) maTi ukeT aRqmis
mizniT, xolo pirobiT niSnebSi aRniSnuli unda iyos TiToeuli maTganis mniSvneloba.
• TiToeuli seqtoris SigniT, an mis axlos unda mieTiTos TiToeuli nawilis
procentuli wili.
• diagramaze miTiTebuli unda iyos 100% mniSvneloba.

168
suraTi #29

calke gamoyofen venis diagramas, romelic gviCvenebs amonarCevis an mosaxleobis or an


met maxasiTebels Soris Tanxvedris an gansxvavebis xarisxs. diagrama warmodgenilia Tanabari
zomis wreebis saxiT, Tumca, isini, SesaZloa, warmoadgendnen maxasiaTeblebis SedarebiT zomebs.
am saxis diagramam saxelwodeba miiRi misi avtoris jon venis (John Venn) sapativcemulod.
sazogadod, venis diagrama gamoiyeneba raime movlenis maxasiaTeblebSi msgavsebebisa da
gansxvavebebis Semowmebisa da vizualuri warmodgenis mizniT. amitom mas farTod mimarTaven
maTematikaSi, xelovnebasa da literaturaSi. medicinaSi venis diagramis gamoyeneba
mizanSewonilia aqtiuri da pasiuri zedamxedvelobis monacemebis warmosadgenad, daavadebaTa
naadrevi diagnostikis meTodebis efeqturobis Sesadareblad da sxv.

suraTi #30
kiboTi gardacvalebis SemTxvevebis raodenoba monacemTa ori sxvadasxva
wyaros informaciiT

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suraT #30-ze venis diagramis gamoyenebiT warmodgenilia kiboTi gardacvalebis
SemTxvevebis raodenoba monacemTa ori sxvadasxva wyaros informaciis safuZvelze.
wertilovani diagrama asaxavs or raodenobriv (uwyvet) cvlads Soris arsebul
urTierTkavSirs. aseTi diagramis agebisas 0X RerZze erTi cvladia warmodgenili, xolo OY –
meore cvladi.
imisaTvis, rom wertilovani diagrama avagoT, saWiroa TiToeul dakvirvebis pirze an
jgufze gvqondes orive cvladis mniSvnelobebi. Semdeg wertilebi gadaitaneba iq, sadac es ori
mniSvneloba kveTs erTmaneTs. rogorc wesi aRniSvnas akeTeben wertilebiT, Tumca SesaZlebelia
sxva simboloebis gamoyenebac.

suraTi #31

wertilovani diagramebis interpretaciisas yuradRebas aqceven wertilebis ganlagebis


konfiguracias. wertilTa mciredi gafantuloba niSnavs korelaciis maRal dones, xolo meti
gafantuloba korelaciis dabal doneze miuTiTebs.
#31 suraTze mocemulia wertilovani diagrama, sadac naCvenebia muSaTa sisxlSi X
liTonis done, am liTonis Semcvel nivTierebasTan muSaobis xangrZlivobis (wlebSi)
gaTvaliswinebiT. mocemuli diagramis interpretaciiT SeiZleba davaskvnaT, rom rac metia X
nivTierebasTan muSaobis xangrZlivoba, miT metia muSaTa sisxlSi X nivTierebaSi arsebuli
liTonis Semcveloba.

170
administraciuli anu geografiuli rukebi.
administraciuli, an teritoriis geografiuli ruqebi xSirad gamoiyeneba daavadebaTa
gavrcelebis saCveneblad. ruqaze sxvadasxva feriT asaxaven regionebs, sadac avadobis
gansxvavebuli doneebia (suraTi 32).

suraTi #32
A hepatitis gavrceleba msoflioSi

es msoflioSi A hepatitis gavrcelebis rukaa, sadac naTlad Cans, Tu rogor


araTanabradaa gavrcelebuli es daavadeba msoflioSi.

wertilovani ruka

wertilovani ruka igeba adgilis naxazze daavadebis SemTxvevebis wertilebiT aRniSvniT.


wertilovani ruka gamoiyeneba didi afeTqebis gamokvlevisas. am dros igi gvexmareba afeTqebis
wyarosa da afeTqebis gavrcelebis arealis dadgenaSi, magram rogorc adgilis ruka, igi ar
gviCvenebs risks, im SemTxvevaSic ki, Tu romelime adgilas wertilebis raodenoba xSiria. Tu
es adgili mWidrodaa dasaxlebuli, am daavadebiT dainficirebis riski, SeiZleba, ar iyos
maRali.

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snous mier q. londonSi qoleris epidemiis epidgamokvlevisas Sedgenili wertilovani
ruka (sur #33) wertilovani rukis pirveli da amave dros klasikuri magaliTia.

suraTi #33

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Tavi 5
swavleba epidemiur procesze
5.1. infeqciur daavadebaTa mniSvneloba

epidemiologiis erT-erT ZiriTad mimarTulebas infeqciur daavadebaTa epidemiologia


warmoadgens. misi Seswavlis obieqtia infeqciuri sneulebebi. infeqciur daavadebaTa
epidemiologia Seiswavlis adamianTa sazogadoebaSi infeqciur daavadebaTa aRmocenebis,
gavrcelebis da Sewyvetis process da saxavs profilaqtikur RonisZiebebs maT mimarT.
am disciplinis didi mniSvneloba ganpirobebulia infeqciur daavadebaTa farTo
gavrcelebiT da im seriozuli zianiT, romelsac isini ayeneben adamianTa janmrTelobas da
qveynis ekonomikas. miuxedavad arnaxuli warmatebebisa, romelsac kacobriobam miaRwia am
daavadebaTa winaaRmdeg brZolis saqmeSi, ocdaameerTe saukunis dasawyisSic isini
mniSvnelovan problemas warmoadgenen, rac mTeli rigi mizezebiT aris ganpirobebuli.
upirveles yovlisa infeqciuri daavadebebi kvlav rCeba yvelaze ufro gavrcelebul
daavadebaTa jgufad. janmos oficialuri monacemebiT, msoflioSi yovelwliurad infeqciuri
daavadebebiT avaddeba 2 miliardi adamiani. Tu gaviTvaliswinebT, rom umravles qveyanaSi
dResac infeqciur daavadebaTa gamovlenis da aRricxvis saqme Sors aris idealurisagan,
SeiZleba vivaraudoT, rom aRniSnuli ricxvi realurad bevrad metia.
amave dros Zalian maRalia infeqciuri daavadebebiT gamowveuli sikvdilianoba. 2016
wels msoflioSi yvela daavadebiT daaxloebiT 57 milioni adamiani gardaicvala. maTgan
TiTqmis 17 milioni swored infeqciur daavadebebze modioda. amasTan, sxvadasxva
Semosavlebis mqone qveynebSi, infeqciuri daavadebebiT gamowveuli sikvdilianobis
maCveneblebi mkveTrad gansxvavdeba. maRali Semosavlebis mqone qveynebSi sikvdilianobis
mxolod 7% modis infeqciur daavadebebze, maSin, rodesac dabali Semosavlebis mqone
qveynebSi es ricxvi TiTqmis 50%-s aRwevs. am qveynebSi naadrevi sikvdilianobis ZiriTadi
mizezi swored infeqciuri daavadebebia. SemTxveviTi ar aris, rom 1996 wels janmos
generaluri direqtori nakajima werda: `infeqciuri daavadebebis problemaSi globaluri
krizisi dadga, romlisganac daculi ar arian arc Raribebi da arc mdidrebi, arc erT
qveyanas da aravis SeuZlia maTi ignorireba~.
ramdenime infeqciuri daavadebis globaluri likvidaciis miuxedavad, am daavadebaTa
ricxvi TandaTan matulobs. marto bolo 30-40 wlis manZilze ramdenime aTeuli axali
infeqcia gamovlinda. esenia B, C, D, E, G hepatitebi, aiv-infeqcia, legionelozi, laimis
daavadeba, mTeli rigi hemoragiuli cxelebebi, koronavirusuli infeqciebi da a.S. isini

173
seriozul safrTxes uqmnian mosaxleobis janmrTelobas. magaliTad B hepatitis sxvadasxva
markeri uvlindeba 2 miliardamde adamians. amJamad msoflioSi aiv-infeqciiT daavadebulTa
da dainficirebulTa ricxvma TiTqmis 40 milions miaRwia, xolo gardacvlil adamianTa
raodenobam – 32 milions. seriozul SeSfoTebas iwvevs mTeli rigi virusuli hemoragiuli
cxelebebis gavrceleba, romlebic maRali letalobiT xasiaTdebian. magaliTad 2014-2015
wlebSi dasavleT afrikis qveynebSi, upirveles yovelisa liberiaSi, gvineaSi, siera-leoneSi
ifeTqa ebolas cxelebam, romlis drosac daavadda 28 aTasze meti da gardaicvala 11
aTasze meti adamiani. letalobis maCvenebelma ki daaxloebiT 40% Seadgina.
calke unda aRiniSnos koronavirusuli infeqciebis Sesaxeb. 2003 wels mTeli
msoflio didi SeSfoTebiT adevnebda Tvals axali infeqciuri daavadebis – mZime mwvave
respiraciuli sindromis, anu atipuri pnevmoniis (SARS) gavrcelebas. igi pirvelad
vietnamis dedaqalaq hanoiSi gamovlinda da Semdgom amerikisa da evropis qveynebSic
gavrcelda. miuxedavad imisa, rom SemTxvevaTa raodenobam daaxloebiT 8400 Seadgina, xolo
letalobam 10%, man seriozuli ziani miayena sazogadoebas. 2012 wels saudis arabeTSi
gamovlinda kidev erTi koronavirusuli infeqcia – axlo aRmosavleTis respiraciuli
daavadeba (MERS). 2020 wlis pirvel ianvramde am infeqciiT daavadda daaxloebiT 2500
adamiani, letaloba ki 27-35%-Si meryeobda. 2019 wlis dekembridan gavrceleba daiwyo
kidev erTma koronavirusulma infeqciam – COVID-19-iT gamowveulma infeqciam. 2020 wlis 11
marts man ukve pandemiur gavrcelebas miaRwia. 2020 wlis pirveli seqtembrisTvis am
infeqciiT mTels msoflioSi daavadda 25.6 milionze meti da gardaicvala 855 aTasze meti
adamiani. yoveldRiurad aseul aTasobiT adamiani avaddeba am axali infeqciiT. didi
aJiotaJi iyo msoflioSi frinvelis gripis gavrcelebis gamoc, romelic frinvelebis
infeqciuri daavadebaa da maTgan adamianebic avaddebian. mas ZiriTadad H5N1 virusi iwvevs.
daavadebis SemTxvevebi dafiqsirda saqarTvelos mezobel qveynebSi, gansakuTrebiT
intensiurad ki TurqeTSi. am daavadebam Zalian didi ekonomikuri ziani miayena mTel
msoflios. amJamad msoflioSi bevri iseTi daavadebaa gavrcelebuli da kvlav seriozul
problemad iqca, romlebic TiTqmis likvidirebulad iTvleboda. 1989-2004 wlebSi 24
qveyanaSi daaxloebiT 40 aTasi adamiani gaxda avad Savi WiriT, letalobam ki 7.1% Seadgina.
amJamadac daavadeba vlindeba mTel rig qveynebSi. Teoriulad am daavadebis gavrceleba
SesaZlebelia saqarTveloSic. msoflioSi yovelwliurad malariis daaxloebiT 120-280
milioni SemTxveva registrirdeba, romelTagan 365-755 aTasi letalobiT mTavrdeba. amasTan,
malariogenul zonebSi 2 miliardi adamiani cxovrobs.
meoce saukunis meore naxevarSi mniSvnelovani warmatebebi iqna miRweuli

174
tuberkulozis winaaRmdeg brZolis saqmeSi, Tumca 90-iani wlebis dasawyisidan es infeqcia
msoflioSi kvlav farTod gavrcelda. 2017 wels daavadda 10 milioni da gardaicvala 1.6
milioni adamiani.
calke unda aRiniSnos qoleris Sesaxeb. 2017 wels janmoSi 34 qveynidan Sevida
Setyobineba qoleris 1 227 391 SemTxvevis Sesaxeb. 5 654 adamiani ki gardaicvala.
metad sayuradReboa is momentic, rom mTeli rigi daavadebebis SemTxvevaSi bolo
wlebSi dadasturda maTi infeqciuri etiologia. amis yvelaze kargi magaliTia kuWis
wylulovani daavadeba. me-20 saukunis 80-ian wlebSi dadginda, rom mis ganviTarebaSi
mniSvnelovan rols asrulebs fakultatur-anaerobuli mikroorganizmi Helicobacter pylori.
ruseTis samedicino mecnierebaTa akademiis yofili prezidentis v. pokrovskis azriT
infeqciur daavadebebze mTeli daavadebebis TiTqmis 60-70% modis. yvela aRniSnuli faqti
calsaxad metyvelebs Tu ra mniSvnelovani problemebis winaSe dgas dReisaTvis infeqciur
daavadebaTa epidemiologia, romlis ZiriTadi mizania ar dauSvas adamianTa sazogadoebaSi
infeqciur daavadebaTa gavrceleba, xolo maTi aRmocenebisas droulad gaataros
epidsawinaaRmdego RonisZiebebi maTi drouli likvidaciisaTvis.
miuxedavad imisa, rom infeqciuri da aragadamdebi (arainfeqciuri) daavadebebis
epidemiologias aqvs bevri saerTo, upirveles yovlisa kvlevis meTodebi, maT Soris
arsebobs mniSvnelovani gansxvavebebic, rac gamomdinareobs infeqciuri da somaturi
daavadebebis radikaluri gansxvavebisagan.
upirveles yovlisa, infeqciuri daavadebebis absoluturi umravlesobisaTvis
damaxasiaTebelia mkacrad determinirebuli etiologiuri faqtori – paTogenuri
mikroorganizmebi. magaliTad A hepatits iwvevs mxolod A hepatitis virusi, baqteriul
dizenterias - Sigelebi. aragadamdebi daavadebebisas aseTi specifikuroba ar aRiniSneba.
ufro metic, erTi da igive etiologiur faqtors SeuZlia gamoiwvios sxvadasxva daavadeba.
Tambaqos moweva xels uwyobs rogorc gul-sisxlZarRvTa sistemis daavadebaTa ganviTarebas,
aseve avTvisebiani simsivneebis aRmocenebas.
infeqciuri daavadebis aRniSnuli Tavisebureba ganapirobebs meore ganmasxvavebeli
momentis arsebobas. kerZod, daavadebis SemTxveva aris amave dros riskis faqtori, anu
infeqciuri daavadebiT Sepyrobili piri TviTon aris infeqciis wyaro sxva adamianebisaTvis.
Tu droulad ar gatarda epidsawinaaRmdego RonisZiebebi infeqciuri daavadebis
aRmocenebisas, man SeiZleba drois mokle periodSi farTo gavrceleba miiRos da
mniSvnelovani ziani miayenos sazogadoebas. Savi Wiris pirveli pandemiis dros msoflioSi
daaxloebiT 100 milioni adamiani daiRupa. aseTi ziani kacobriobisaTvis ar miuyenebia arc

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erT oms, stiqiur ubedurebebs, socialur Tu bunebriv kataklizmebs.
mesame ganmasxvavebeli niSani aris infeqciuri daavadebis gadatanis Semdeg imunitetis
gamomuSaveba. magaliTad wiTelas gadatanis Semdeg adamiani avad ar gaxdeba ganmeorebiT im
SemTxvevaSic ki, Tu mas mWidro kontaqti aqvs wiTelaTi daavadebulTan. es Tavisebureba
farTod gamoiyeneba infeqciur daavadebaTa profilaqtikaSi.
aRniSnuli Taviseburebebidan gamomdinare infeqciur daavadebaTa epidemiologiaSi
ZiriTadi yuradReba profilaqtikuri da epidsawinaaRmdego RonisZiebebis SemuSavebas eTmoba,
xolo aragadamdeb daavadebaTa epidemiologiaSi – riskis faqtorebs.

5.2. epidemiuri procesis daxasiaTeba

infeqciur daavadebaTa epidemiologiis Seswavlis obieqts warmoadgens epidemiuri


procesi, romlis ramdenime ganmarteba arsebobs. erT-erTi pirveli da gavrcelebuli
ganmarteba mogvawoda cnobilma epidemiologma l. gromaSevskim, romlis Tanaxmadac
epidemiuri procesi aris ganuwyveteli jaWvi erTmaneTTan dakavSirebuli da erTmaneTidan
gamomdinare infeqciuri mdgomareobebisa, dawyebuli usimptomo mtareblobidan damTavrebuli
daavadebis manifesturi formebiT. aseve sakmaod gavrcelebulia meore ganmartebac, romlis
Tanaxmadac epidemiuri procesi aris adamianTa koleqtivSi infeqciur daavadebaTa
gavrcelebis procesi. es ganmartebebi srulad asaxaven epidemiuri procesis arss im
infeqciuri daavadebebis dros, romelTa infeqciis wyaros adamiani warmoadgens.

epidemiuri procesi rTuli socialur-biologiuri movlenaa, romelic sami


erTmaneTTan mWidrod dakavSirebuli elementebisagan, anu rgolisgan Sedgeba (sqema #3).
1. infeqciis wyaro,
2. gadacemis meqanizmi,
3. mimRebi organizmi.
erTi romelime rgolis gamoTiSva epidemiuri procesidan iwvevs mis likvidacias.
aqedan gasagebi xdeba, Tu raoden mWidroa maT Soris kavSiri. davaxasiaToT TiToeuli
rgoli cal-calke.

sqema #3
epidemiuri procesis Semadgeneli rgolebi

infeqciis gadacemis mimRebi

wyaro meqanizmi organizmi

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5.2.1. infeqciis wyaro

infeqciis wyaro ewodeba im obieqts, sadac bunebriv pirobebSi xdeba infeqciuri


agentis cxovelmyofeloba, gamravleba da garemoSi gamoyofa. gansakuTrebuli mniSvneloba
eniWeba im obieqts, romlis gareSec gamomwvevs, rogorc biologiur saxeobas, arseboba ar
SeuZlia. mas specifikuri an ZiriTadi maspinZeli ewodeba. xangrZlivi drois ganmavlobaSi
iTvleboda, rom infeqciis wyaros warmoadgenda mxolod adamiani da cxoveli. im infeqciur
daavadebebs, romelTa drosac infeqciis wyaros warmoadgens adamiani, anTroponozuli
infeqciebi ewodeba (muclis tifi, A hepatiti, difTeria, wiTela, poliomieliti da sxva).
infeqciuri daavadebebis TiTqmis ori mesamedi anTroponozebs warmoadgens. daaxloebiT
mesamedi infeqciuri daavadebebis dros ki infeqciis wyaroa cxovelebi. aseT daavadebebs
zoonozebi ewodeba.
meoce saukunis bolos aRiarebuli iqna, rom zogierTi infeqciuri daavadebebisas
infeqciis wyaros (rezervuars) SeiZleba warmoadgendes garemos elementebi (niadagi, wyali),
sadac bunebriv pirobebSi xdeba infeqciuri agentis cxovelmyofeloba da gamravleba. aseT
daavadebebs sapronozebi ewodeba. am jgufis tipuri warmomadgenlia legionelozi. misi
gamomwvevis - legionelebis cxovelmyofelobisaTvis bunebrivi garemoa Tbili wyalsacavebi.
maTi kolonizacia aseve SeiZleba moxdes wylis rezervuarSi, kondicionerebis kondesantSi
da a. S. amave jgufSi Sedis listeriozi, psevdomoniazi, melioidozi da sxva.
anTroponozuli daavadebebisas infeqciis wyaros warmoadgens daavadebuli adamiani an
baqteriamtarebeli. ZiriTad infeqciis wyaros daavadebuli adamianebi warmoadgenen, rac
ramdenime mizeziT aris ganpirobebuli:
1. mTeli rigi daavadebebisas avadmyofi erTaderT infeqciis wyaros warmoadgens, radgan maT
mtarebloba ar axasiaTebT. aseT daavadebebs miekuTvneba wiTela, A hepatiti, partaxtiani
tifi da sxva.
2. daavadebuli adamiani mtarebelTan SedarebiT bevrad ufro didi raodenobiT gamoyofs
garemoSi infeqciur agents.
3. daavadebuli adamianebisagan gamoyofili mikroorganizmebi ufro virulenturia, vidre
mtareblisagan gamoyofili.
4. daavadebis mimdinareobaSi xSirad aRiniSneba iseTi klinikuri niSnebi, romlebic xels
uwyoben gamomwvevis garemoSi gamoyofas. magaliTad, gripis dros kataruli movlenebi,
dizenteriis da salmonelozis dros _ faRaraTi da a. S.
amasTan, TviTon daavadebuli adamianis, rogorc infeqciis wyaros roli infeqciuri
procesis sxvadasxva etpze ar aris erTnairi. cnobilia, rom infeqciur daavadebebs
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ZiriTadad cikluri mimdinareoba axasiaTebT da oTxi periodis gamoyofa SeiZleba maTi
ganviTarebis dros. esenia: inkubaciuri, prodromuli, klinikuri niSnebis maqsimalurad
ganviTarebis da rekonvalescenciis anu gamojanmrTelebis periodi. inkubaciuri periodi
ewodeba im dros, romelic gaivlis infeqciuri agentis adamianis organizmSi SeWridan,
pirveli klinikuri niSnebis gamovlinebamde. TiToeul daavadebas axasiaTebs minimaluri,
saSualo da maqsimaluri inkubaciuri periodebi. daavadebuli adamiani inkubaciuri periodis
ganmavlobaSi gadamdebi ar aris, radgan am dros gamomwvevi qsovilebis siRrmeSia da is
garemoSi ar gamoiyofa. aris gamonaklisebic: ramdenime infeqciuri daavadeba gadamdebia
inkubaciuri periodis meore naxevarSi. upirveles yovlisa, es aris A da B hepatitebi. xolo
zogierTi daavadebebisas gadamdebloba iwyeba inkubaciuri periodis bolos - wiTela,
yivanaxvela. aseTi infeqciebis winaaRmdeg brZola sakmaod rTulia, radgan epidsawinaaRmdego
RonisZiebebi mimarTuli infeqciis wyaros mimarT araefeqturia.
infeqciur daavadebaTa absoluturi umravlesobis dros daavadebis da gadamdeblobis
dawyeba erTmaneTs emTxveva. miuxedavad imisa, rom prodromul periodSi gamomwvevis gamoyofa
daavadebuli adamianis organizmidan garemoSi ar aris intensiuri, es periodi
epidemiologiuri TvalsazrisiT mainc yvelaze saSiSia, rac ori umTavresi mizeziTaa
ganpirobebuli. jer erTi, am dros avadmyofis mdgomareoba ar aris mZime da amitom is
umetes SemTxvevaSi agrZelebs Tavis Cveul saqmianobas da aqvs bevri kontaqti, rac infeqciis
gavrcelebas uwyobs xels. mniSvneloba aqvs im momentsac, rom prodromul periodSi Zalian
Wirs zusti diagnozis gansazRvra da amdenad, specifikuri epidsawinaaRmdego RonisZiebebi ar
tardeba.
klinikuri niSnebis maqsimalurad ganviTareba emTxveva daavadebulis mier gamomwvevis
maqsimalur gamoyofas garemoSi. miuxedavad amisa, am dros avadmyofis epidemiologiuri
mniSvneloba sagrZnoblad klebulobs, radgan umetes SemTxvevaSi igi woliT reJimSi
imyofeba, rac infeqciis gavrcelebis albaTobas Zalian amcirebs. amasTan, am periodSi ukve
dasmulia daavadebis diagnozi da xorcieldeba Sesabamisi epidsawinaaRmdego RonisZiebebi, rac
aseve amcirebs infeqciis gavrcelebas.
rekonvalescenciis periodSi avadmyofis gadamdebloba sagrZnoblad qveiTdeba, xolo
zogierTi daavadebisas (wiTela, Cutyvavila) gamomwvevis gamoyofa saerTod ar xdeba, ris
gamoc am periodSi avadmyofis epidemiologiuri mniSvneloba didi ar aris. Tumca zogierTi
infeqciisas (muclis tifi, Sigelozi, difTeria) gadamdebloba jer kidev mniSvnelovania.
avadmyofis, rogorc infeqciis wyaros Sefasebisas, aucileblad gaTvaliswinebul unda
iqnas klinikuri mimdinareobis simZime. epidemiologiuri TvalsazrisiT Zalian saSiSia ioli

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(msubuqi) formiT daavadebulebi, radgan isini xSirad agrZeleben koleqtivSi da
sazogadoebrivi TavSeyris adgilebSi yofnas da intensiurad avrceleben daavadebas. maSin,
rodesac mZime formebisas avadmyofi mijaWvulia sawols da infeqciis gavrcelebac
praqtikulad ar xdeba. infeqciis gavrcelebaSi mniSvnelovan rols TamaSoben agreTve
atipuri formebiT daavadebulebi. magaliTad, A hepatitis klinikur mimdinareobaSi tipur
siyviTlian formebs, sixSiriT 5-10-jer aRemateba atipuri, usiyviTlo formebiT mimdinare
daavadeba, romelTa absoluturi umravlesoba gamovlinebis gareSe rCeba da isini
praqtikulad Seuferxeblad avrceleben infeqcias.
didi mniSvneloba aqvs agreTve, daavadebis mimdinareobis xangrZlivobasac. zogierTi
daavadebisas aRiniSneba qronikuli formebi (B hepatiti, C hepatiti), ris gamoc adamiani
xangrZlivi drois ganmavlobaSi warmoadgens infeqciis wyaros.
avadmyofi adamianis, rogorc infeqciis wyaros Sefasebisas, aucileblad unda
gaviTvaliswinoT misi profesia da samuSao adgili. adamianebi, romlebic muSaoben kvebis
mrewvelobasa da wyalmomaragebis sistemaSi, bavSvTa dawesebulebebSi, sazogadoebrivi
TavSeyris adgilebSi, ra Tqma unda, ufro farTod avrceleben infeqcias. didi mniSvneloba
aqvs agreTve, uSualod avadmyofis mier piradi higienis wesebis dacvas, rasac
gansakuTrebuli roli eniWeba nawlavTa infeqciebis dros.
infeqciuri daavadebis gavrcelebaSi mniSvnelovan rols TamaSoben infeqciis
gamomwvevis mtarebeli adamianebi. infeqciuri procesis ori ukiduresi forma arsebobs, erTis
mxriv manifesturi, xolo meores mxriv usimptomo. am ukanasknelis dros adamiani aris
praqtikulad janmrTeli, magram mis organizmSi imyofeba infeqciuri daavadebis gamomwvevi,
romelic periodulad garemoSi gamoiyofa. arsebobs ori saxis mtarebloba: janmrTeli da
rekonvalescenturi.
zogierTi infeqciuri daavadebebis gadatanis Semdeg adamianis organizmSi rCeba
daavadebis gamomwvevi. magaliTad, muclis tifis gadatanisas adamianTa 3-5%-Si, xangrZlivi
drois manZilze organizmSi aris muclis tifis mikrobebi. daaxloebiT aseTive sixSiriT B
hepatitis gadatanis Semdeg viTardeba virusmtarebloba. mtareblobis xangrZlivobis mixedviT
arCeven mwvave da qronikul mtareblobas. Tu mtarebloba grZeldeba 3 Tvemde, maSin saqme
gvaqvs mwvave mtareblobasTan, xolo rodesac mtareblobis procesi grZeldeba 3 Tveze met
xans, adgili aqvs qronikul mtareblobas. iseTi infeqciuri daavadebebis dros, rodesac
aRiniSneba qronikuli mtarebloba, infeqciis ZiriTad wyaros swored isini warmoadgenen.
rac Seexeba janmrTel anu tranzitul mtareblobas, is ramdenime dRis manZilze
grZeldeba da viTardeba maSin, rodesac infeqciuri daavadebis gamomwvevi xvdeba imunur

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organizmSi da sadac misi cxovelmyofelobisa da gamravlebisaTvis araxelsayreli pirobebia.
aseTi saxis mtarebloba axasiaTebs difTerias, meningokokur infeqcias, qoleras da a.S.
infeqciis mtarebeli adamianis mniSvnelovani roli daavadebis gavrcelebaSi ori
momentiTaa ganpirobebuli. mtarebelTa didi umravlesoba gamovlenis gareSe rCeba, ris gamoc
isini infeqcias farTod avrceleben. amasTan, mtarebloba sakmaod xangrZlivi procesia da
qronikuli mtarebloba, rogorc aRiniSna, SeiZleba mTeli cxovreba gagrZeldes.
iseve rogorc avadmyofi adamianis SemTxvevaSi, mtareblobis drosac didi mniSvneloba
aqvs adamianis profesias, samuSao adgils da imas, Tu ramdenad icavs igi piradi higienis
wesebs.
rogorc aRiniSna, zoonozuri daavadebebisas infeqciis wyaros warmoadgens
daavadebuli an mtarebeli cxoveli. maTgan adamianebi SeiZleba dainficirdnen uSualo
kontaqtisas, mwerebis saSualebiT (tkipa, rwyili, moskiti, koRo), cxoveluri produqtebis
sakvebad gamoyenebisas da cxovelebis gamonayofebiT dabinZurebuli wylisa da sakvebis
miRebisas, aseve maTgan miRebuli nedleulis (tyaveuli) damuSavebisas. zoonozuri
daavadebebis gavrcelebaSi wamyvani roli eniWeba Sinaur cxovelebs da frinvelebs (Zroxa,
cxvari, Txa, Rori, ZaRli da sxva), Tumca mTeli rigi daavadebebis gavrcelebaSi
mniSvnelovan rols gareuli cxovelebic asruleben. am daavadebaTa umravlesoba bunebriv-
kerovan infeqciebs warmoadgens. zoonozuri infeqciebs gavrcelebaSi aqtiurad monawileoben
mRrRnelebic.
im SemTxvevaSi, rodesac zoonozuri daavadeba Sinaur cxovelebSi (frinvelebSi)
viTardeba laparakoben anTropurgul keraze. mas miekuTvneba agreTve kerebi, romlebic
formirdeba sinantropul cxovelebSi, anu ara Sinaur, aramed im cxovelebSi da frinvelebSi,
romlebic adamianis saxlSi an mis maxloblad cxovroben (saxlis Tagvi, virTagva, mtredi da
sxva). epizootiis (infeqciuri daavadebis intensiuri gavrceleba cxovelebSi) arseboba
gareul cxovelebSi miuTiTebs bunebrivi keris Camoyalibebaze. aseT infeqciebs bunebriv
kerovani infeqciebi ewodeba. aseTma daavadebebma SeiZleba anTropurguli kerebis formireba
gamoiwvios (magaliTad cofi).
zoonozuri daavadebebis gamomwvevebiT dainficirebuli da daavadebuli adamiani,
rogorc wesi, warmoadgens `biologiur Cixs~. e. i. is ar xdeba infeqciis wyaro da araviTar
rols ar asrulebs am mikroorganizmebis, rogorc damoukidebeli saxeobebis SenarCunebis
saqmeSi, rasac adgili aqvs anTroponozebis dros. zoonozuri daavadebebisas avadmyofi
adamianis aragadamdebloba aixsneba im gadacemis meqanizmebis ar arsebobiT, romelic
cxovelebSi gvxvdeba, agreTve, adamianTa arcTu maRali mimReblobiT aseTi infeqciebis mimarT.

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Tumca arsebobs gamonaklisebi, rodesac daavadebuli adamiani xdeba infeqciis wyaro da
Semdgom igi intensiurad avrcelebs daavadebas. magaliTad Savi Wiris dros, roca adamians
filtvismieri forma uviTardeba, igi xdeba am daavadebis infeqciis wyaro da misgan
aerogenuli meqanizmiT inficirdebian sxvebic. Savi Wiris epidemiebi da pandemiebi
ganpirobebuli iyo swored im momentiT, rom daavadebuli adamiani TviTon xdeba infeqciis
wyaro. Tumca xazgasmiT unda aRiniSnos, rom gamomwvevis aseTi gadacema droebiTia da mas ar
SeuZlia uzrunvelyos gamomwvevis, rogorc biologiuri saxeobis SenarCuneba.
epidemiuri procesisi formireba zoonozuri daavadebebis dros naCvenebia sqema #4-ze.

sqema #4
epidemiuri procesisi formireba zoonozuri daavadebebis dros

5.2.2. infeqciis gadacemis meqanizmi

epidemiuri procesis meore da aucilebel rgols gadacemis meqanizmi warmoadgens.


infeqciuri daavadebis gamomwvevis (parazitis) saxeobis SenarCunebisaTvis aucilebelia
gadacemis meqanizmis arseboba, radgan adamianis sicocxle droSi SezRudulia da mis
sikvdilTan erTad daiRupebian masSi arsebuli mikroorganizmebic. amdenad, swored gadacemis
meqanizmis saSualebiT xdeba gamomwvevisaTvis biologiuri maspinZelis Secvla da axal mimReb
organizmSi moxvedra. moZRvreba gadacemis meqanizmis Sesaxeb mowodebulia l. gromaSevskis mier.
infeqciuri daavadebis gamomwvevis gadacemis meqanizmi evoluciurad Camoyalibebuli
kanonzomieri saSualebaa gamomwvevis gadanacvlebisa infeqciis wyarodan mimReb organizmamde. anu
es aris saSualeba, romliTac gamomwvevi icvlis individualur maspinZels, rac safuZvlad
udevs parazitis, rogorc biologiuri kategoriis arsebobas.
gadacemis meqanizmi aris mravaletapiani procesi da Sedgeba sami urTierTdakavSirebuli
fazisagan (sqema #5).

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sqema #5

yvela infeqciuri daavadebis gamomwvevisaTvis damaxasiaTebelia gadacemis ZiriTadi


meqanizmis arseboba, romelic ganpirobebulia adamianis organizmSi misi ZiriTadi lokalizaciiT
da romelic uzrunvelyofs gamomwvevis, rogorc saxeobis SenarCunebas. infeqciuri agentis
specifikuri lokalizacia dainficirebuli adamianis organizmSi aris parazitis evoluciur-
istoriuli adaptaciis Sedegi, romelic gansazRvravs gamomwvevis adamianis organizmidan
gamoyofis da SeWris gzebs.
gamomwvevis adamianis nawlavebSi lokalizaciisas, misi gamoyofa organizmidan xdeba
fekaluri an pirnaRebi masebiT da adamianis organizmSi SeiWreba oraluri gziT. amitomac
gadacemis es meqanizmi fekalur-oraluri meqanizmis saxelwodebiT aris cnobili. am dros
infeqciis gadacemis ZiriTadi faqtorebi aris wyali da sakvebi produqtebi. swored maTi
saSualebiT xvdeba mimRebi adamianis organizmSi gamomwvevi. bavSvebSi infeqciuri agenti piris
RruSi aseve SeiZleba moxvdes WuWyiani xelebiT, rodesac bavSvi exeba dabinZurebul saTamaSoebs
an sayofacxovrebo sagnebs. amrigad, fekalur-oraluri meqanizmi realizdeba wylis, sakvebi
produqtebis da sayofacxovrebo sagnebis saSualebiT. garemos im abiotur elementebs, romelTa
saSualebiT infeqciuri daavadebis gamomwvevi xvdeba mimReb organizmSi infeqciis gadacemis
faqtorebi ewodeba. xolo faqtorTa erTobliobas, romelic uzrunvelyofs infeqciuri agentis
infeqciis wyarodan mimReb organizmamde gadanacvlebas, ewodeba infeqciis gadacemis gzebi.
fekalur-oraluri gadacemis meqanizmisas gadacemis sami gza arsebobs:
1. wylismieri,
2. sakvebismieri,
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3. sayofacxovrebo-kontaqtis gza.
fekalur-oraluri gadacemis meqanizmiT vrceldeba nawlavTa infeqciebi. zogierTi
maTganis gadacemaSi wamyvan rols wylismieri gadacemis gza asrulebs (muclis tifi, E
hepatiti), rigi infeqciebisas ki sakvebismieri gza (salmonelozi, Sigela zoneTi gamowveuli
dizenteria). zogierTi daavadeba ki samive gziT intensiurad vrceldeba (A hepatiti).
rodesac infeqciuri daavadebis gamomwvevi lokalizdeba sasunTq gzebSi, igi garemoSi
gamoiyofa amosunTqul haerTan erTad (maT Soris xvelebis da ceminebis dros) da imyofeba
masSi aerozolis saxiT. nebismieri aerozolis simyare, maT Soris baqteriulis, ramdenime
faqtoriTaa ganpirobebuli: Sewonili nawilakebis zomiT, formiT, eleqtruli muxtis sididiT,
koncentraciiT. nawilakis zomis mixedviT aerozoli iyofa:
maRaldispersiuli (nawilakTa zomebia 0,5 - 5,0 mk-mde), saSualo dispersiuli (5,0-dan
25,0 mk-mde), wvrildispersiuli (25,0-100 mk-mde), wvrilwveTovani (100,0-dan 250,0 mk-mde) da
msxvilwveTovani (250,0-400,0mk). aerozolis msxvili wveTebi ileqeba niadagze an iatakze,
xolo wvrili wveTebi haerSi Sewonil mdgomareobaSi SeiZleba xangrZlivi drois ganmavlobaSi
darCes da gadaadgildes kidec masSi da gavrceldes oTaxis, derefnis, sarTulis farglebSi.
rodesac adamiani SeisunTqavs aseT inficirebul haers, mis organizmSi xvdeba gamomwvevi,
romelic Semdgom lokalizdeba sasunTq gzebSi. unda aRiniSnos, rom gamomwvevi yvelaze didi
raodenobiT koncentrirebulia infeqciis wyaros irgvliv 1-2 metris radiusSi. gadacemis aseT
gzas ewodeba haer-wveTovani.
rogorc iTqva, gamomwvevis nawili haerTan erTad xvdeba mimRebi adamianis organizmSi,
nawili ki simZimis Zalis gavleniT ileqeba niadagze an iatakze, sadac xdeba maTi gamoSroba da
mtvrad qceva. im daavadebaTa gamomwvevebi, romlebic gamoSrobas kargad uZleben, Semdeg SeiZleba
gavrceldnen haer-mtvrovani gziT (difTeria, tuberkulozi). gadacemis haer-wveTovani da haer-
mtvrovani gzebis erToblioba qmnis aerogenuli gadacemis meqanizms. am meqanizmiT vrceldeba
gripi, difTeria, wiTela, wiTura, yivanaxvela da sxva infeqciebi.
im daavadebebis dros, romelTa gamomwvevi lokalizebulia sisxlSi, romelic
cirkulirebs Caketil sistemaSi, infeqciis gadacemisaTvis aucilebelia sisxlismwoveli mweris
arseboba, romelic erTi adamianidan meoreSi gadaitans gamomwvevs. infeqciis gadacemas
sisxlismwoveli mwerebis saSualebiT transmisiuli gadacemis meqanizmi ewodeba. am meqanizmiT
vrceldeba malaria (koRo anofelesi), Savi Wiri (rwyili), partaxtiani tifi (tili),
tkipismieri encefaliti (tkipa) da sxva infeqciebi.
cocxali gadamtanebis umravlesoba specifikuria garkveuli infeqciebisaTvis da swored
maTi saSualebiT xdeba gamomwvevTa garemoSi cirkulacia. ufro metic, zogierTi gadamtanis

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organizmSi gamomwvevi gadis ganviTarebis biologiur cikls (magaliTad, malariis plazmodiumi
- koRo anofelesis organizmSi, rac sporogoniis saxeliTaa cnobili).
rodesac infeqciuri daavadebis gamomwvevi lokalizebulia safar qsovilze (kani,
lorwovani garsi), maSin dainficireba xdeba uSualo kontaqtis Sedegad kontaqturi meqanizmis
saSualebiT. gamomwvevis gadacema aseve SeiZleba moxdes sayofacxovrebo sagnebis saSualebiT
(arapirdapiri kontaqtis gza). kontaqturi meqanizmiT vrceldeba kanis da veneriuli
daavadebebi, Wrilobis infeqciebi (tetanusi, airovani gangrena da sxva.) da daavadebebi,
romlebic cxovelis mier dakbenasTanaa dakavSirebuli (cofi, sodoku).
CamoTvlili oTxive gadacemis meqanizmis dros infeqciis gadacema `horizontalurad~
xdeba. aris mexuTe gadacemis meqanizmi - vertikaluri, rodesac infeqcia dedidan nayofs
gadaecema transplacenturi gziT. aseTi meqanizmiT vrceldeba sifilisi, aiv-infeqcia, B
hepatiti, wiTura, toqsoplazmozi da sxv. zogierTi maTganis SemTxvevaSi nayofis dainficireba
xdeba maSin, rodesac igi sanayofe gzebs gaivlis. aseve SesaZlebelia axalSobilis dainficireba
ZuZuTi kvebis dros.
bolo wlebSi, aRniSnul xuT gadacemis meqanizms daemata kidev erTi, xelovnuri
gadacemis meqanizmi - parenteruli. am dros infeqciis gadacema erTi adamianidan meoreze xdeba
samedicino manipulaciebis an hemotransfuziebis Sedegad, rodesac gamoiyeneba arasaTanadod
gasterilebuli samedicino instrumentebi an inficirebuli sisxli. am meqanizmis realizacia
mTlianad damokidebulia samedicino personalis saqmianobaze.
amrigad, adamianidan adamianze infeqciuri daavadebebis gadacema xdeba 6 gadacemis
meqanizmis saSualebiT:
1. aerogenuli,
2. fekalur-oraluri,
3. transmisiuli,
4. kontaqturi,
5. vertikaluri,
6. parenteruli.
infeqciur daavadebaTa umravlesobisaTvis damaxasiaTebelia erTi gadacemis meqanizmis
arseboba. zogierTi infeqciuri daavadeba SeiZleba gavrceldes ori gadacemis meqanizmiT
(poliomieliti, wiTura), ramdenime infeqciisaTvis gadacemis sami meqanizmis arseboba aris
damaxasiaTebeli. magaliTad, B da C hepatitebi, aiv-infeqcia vrceldeba kontaqturi,
parenteruli da vertikaluri meqanizmebiT. zogierTi infeqciuri daavadebis dros ki infeqcia
SeiZleba gavrceldes oTxi gadacemis meqanizmis meSveobiT. aseTebia - citomegalovirusuli

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infeqcia (aerogenuli, kontaqturi, vertikaluri, parenteruli), Savi Wiri (transmisiuli,
aerogenuli, kontaqturi, alimenturi) da sxva.

5.2.3. mimRebloba da imuniteti

epidemiuri procesis mesame rgols mimRebi organizmi warmoadgens. mimReblobis qveS


igulisxmeba adamianis organizmis unari, masSi infeqciuri daavadebis gamomwvevis SeWras
upasuxos infeqciuri procesis ganviTarebiT. mimRebloba organizmis saxeobrivi Tvisebaa da igi
memkvidreobiT gadaecema. infeqciuri daavadebebis mimarT mimReblobis xarisxi damokidebulia
organizmis specifikur da araspecifikur dacvis faqtorebze da mis individualur
rezistentobaze. mniSvneloba aqvs agreTve adamianis fizikur mdgomareobas, asaks, sqess.
organizmis mimRebloba mniSvnelovanwilad ganpirobebulia mikroorganizmebis
TaviseburebebiTac. mikroorganizmebis unars gamoiwvios infeqciuri daavadeba adamianis
organizmSi, paTogenoba ewodeba. misi sazomia virulentoba. rac ufro virulenturi Stamebi
xvdebian adamianis organizmSi, miT metia daavadebis ganviTarebis albaToba. gamomwvevis
paTogenoba infeqciuri agentis evoluciurad ganpirobebuli saxeobrivi niSania. didi
mniSvneloba aqvs agreTve adamianis organizmSi moxvedrili infeqciuri agentis dozas, SeWris
gzas da a. S., rac naCvenebia cxrilebSi #57 da #58.
cxrili #57

muclis tifis ganviTarebis albaToba damainficirebeli dozis mixedviT


(Hornick R.R.-is da TanaavtorTa monacemebi)

mikrobTa moxaliseTa daavadebulTa


damainficirebeli raodenoba ricxvi
doza absoluturi (%)
109 42 40 (95)
108 9 8 (89)
107 32 16 (50)
105 116 32 (28)
103 14 0 (0)

185
cxrili #58
muclis tifis ganviTarebis albaToba Stamebis virulentobis mixedviT
(Hornick R.R.-is da TanaavtorTa monacemebi)

gamomwvevis virulentoba moxaliseTa daavadebulTa


ricxvi absoluturi
raodenoba
(%)
Stamebi Vi - antigeniT 47 43 (91,5)
Stamebi Vi antigenis gareSe 39 26 (66,7)

organizmis mimRebloba raodenobrivad gamoisaxeba kontagiozuri indeqsis saSualebiT,


romelic gviCvenebs inficirebul adamianebSi daavadebis ganviTarebis albaTobas. igi ufro
xSirad procentebSi gamoixateba. magaliTad, wiTelas dros kontagiozuri indeqsi 100%-is
tolia, rac niSnavs, rom wiTelas virusiT dainficirebuli yvela adamiani, romelTac ar
gaaCniaT imuniteti am daavadebis mimarT, xdeba avad.
adamianis infeqciur daavadebaTagan dacvis saqmeSi Zalian did rols asrulebs imuniteti
anu organizmis Seuvaloba. jer kidev Cven welTaRricxvamde mexuTe saukuneSi cnobili mecnieri
fukididi werda: `vinc gadaitana daavadeba, mas safrTxe aRar emuqreba, radgan orjer aravin
avaddeba~. organizmis es mdgomareoba dReisaTvis cnobilia SeZenili postinfeqciuri imunitetis
saxeliT. SeZenili imuniteti organizmma SeiZleba gamoimuSavos aseve masSi vaqcinebis Seyvanis
sapasuxod. aseT imunitets xelovnuri aqtiuri imuniteti ewodeba. infeqciur daavadebaTa
profilaqtikis erT-erTi ZiriTadi mimarTulebaa mosaxleobis koleqtiuri imunitetis Seqmna
vaqcinebis saSualebiT.
epidemiologiaSi xSirad gamoiyeneba terminebi: koleqtiuri imuniteti, mosaxleobis
imunologiuri struqtura. koleqtiuri imuniteti es aris koleqtivis unari win aRudges
infeqciuri agentis damazianebel moqmedebas. magaliTad, yvavilis, rogorc infeqciuri daavadebis
likvidacia swored koleqtiuri imunitetis SeqmniT iyo ganpirobebuli.
mosaxleobis imunologiuri struqtura ki aris mosaxleobaSi mocemuli infeqciis mimarT
mimRebi da imunuri pirebis Sefardeba. es struqtura ganisazRvreba imunologiuri,
serologiuri da alergiuli reaqciebis meSveobiT.

186
5.2.4. epidemiuri procesis faqtorebi

rogorc aRiniSna, epidemiuri procesi rTuli socialur-biologiuri movlenaa. misi


ganviTarebisaTvis aucilebelia biologiuri, socialuri da bunebrivi faqtorebis arseboba.
amaTgan biologiuri faqtori aris ZiriTadi faqtori, romlis gareSec ar arsebobs epidemiuri
procesi. xolo socialuri da bunebrivi faqtorebi aZliereben an asusteben epidemiuri
procesis intensivobas.
biologiuri faqtorebis, rogorc epidemiuri procesis ganviTarebis ZiriTad da Sinagan
mizezze, pirvelad aqcenti gaakeTa didma rusma epidemiologma v. beliakovma. misi azriT,
epidemiuri procesis arsi aris gamomwvevi-parazitis da mepatronis organizmis urTierTqmedeba
ara organizmis, aramed populaciur doneze. aqedan gamomdinare epidemiuri procesis ganmarteba
am mecnieris mier aris Semdegnairi: epidemiuri procesi aris gamomwvevi parazitis da adamianTa
organizmis urTierTmoqmedebis procesi populaciur doneze, romelic gamovlindeba
gansazRvrul socialuri da bunebriv pirobebSi erTeuli da mravlobiTi daavadebebiT da aseve
infeqciis usimptomo formebiT.
v. beliakovis Tanaxmad epidemiuri procesis safuZveli aris parazituli sistema -
parazitis populacia specifikur maspinZlis populaciasTan erTad, romelTa Sorisac adgili
aqvs urTierTqmedebas. mas axasiaTebs TviTregulaciis procesi. 70-iani wlebis bolos da 80-
iani wlebis dasawyisSi v. beliakovma Camoayaliba Teoria parazituli sistemis TviTregulaciis
Sesaxeb, romelic nawilia im TviTregulaciisa, romelsac adgili aqvs mTels organul
samyaroSi. am Teoriis Tanaxmad, v. beliakovma gamoyo oTxi debuleba, romlebic asaxavs
epidemiuri procesis Sinagan regulacias:
• parazitisa da maspinZlis populaciis genotipuri da fenotipuri heterogenoba erTmaneTTan
urTierTmoqmedebisas.
• urTierTmomqmedi populaciebis biologiuri Tvisebebis urTierTganmapirobebeli
cvalebadoba.
• parazitis populaciebis fazuri TviTgardaqmna, rac ganapirobebs epidemiuri procesis
araTanabar ganviTarebas.
• socialuri da bunebrivi faqtorebis maregulirebeli roli epidemiuri procesis fazuri
cvlilebebisas.
parazituli sistemis TviTregulaciis TeoriaSi aqcenti keTdeba parazitis populaciis
cvalebadobaze (TviTgardaqmnaze) arsebobis cvlad pirobebSi.
am Teoriis Sisabamisad v. beliakovma epidemiuri procesis swavlebaSi
sami urTierTdakavSirebuli nawili gamoyo:
187
epidemiuri procesis faqtorebi: biologiuri, socialuri, bunebrivi (anu epidemiuri
procesis ganviTarebis mizezebi da pirobebi).
epidemiuri procesis ganviTarebis meqanizmi (rogor viTardeba procesi).
epidemiuri procesis gamovlena (rogor vlindeba procesi).
rogorc vxedavT v. beliakovic aRiarebs, rom miuxedavad biologiuri faqtoris
dominantobisa epidemiur procesSi, misi ganviTarebisaTvis aucilebelia socialuri da bunebrivi
faqtorebic.
epidemiuri procesis ganviTarebaSi socialuri faqtoris mniSvnelovan rolze xazgasmiT
miuTiTebda l. gromaSevski. igi aRniSnavda, rom epidemiuri procesis mimdinareobaSi
raodenobrivi da xarisxobrivi cvlilebebi labiluri socialur-ekonomikuri da bunebrivi
faqtorebiT ganisazRvreba.
socialuri faqtoris qveS igulisxmeba adamianTa cxovrebis pirobebis erToblioba:
sacxovrebeli pirobebi, materialuri keTildReoba, dasaxlebuli adgilebis keTilmowyoba,
kvebis xasiaTi, zogadi da sanitariuli kultura, Sromis pirobebi, mosaxleobis migraciuli
procesebi, demografiuli momentebi, janmrTelobis dacvis sistema, momsaxurebis done da kidev
mravali sxva. isini gavlenas axdenen epidemiuri procesis yvela rgolze. adamianis, rogorc
infeqciis wyaros aqtiuroba bevrad aris ganpirobebuli misi profesiiT, samuSao adgiliT, sxva
adamianebTan urTierTobis xasiaTiT. infeqciis gadacemis meqanizmze kidev ufro did zegavlenas
axdens socialuri faqtorebi. igive SeiZleba iTqvas rogorc calkeul pirTa, ise mTeli
sazogadoebis mimReblobaze.
socialuri faqtorebi zegavlenas axdens agreTve mikroorganizmTa Tvisebebzec.
magaliTad, migraciuli procesebis gaZlierebisas, erTis mxriv, xdeba adamianTa da
sazogadoebrivi fenebis Sereva da gamomwvevTa Setana axal teritoriebze, meores mxriv, izrdeba
mikrorganizmTa virulentoba imis xarjze, rom xdeba maTi cirkulacia sxvadasxva mimReb
adamianTa organizmSi. migraciuli procesebis Sedegad, xSirad mTel rig teritoriebze xdeba
iseTi daavadebebis gavrceleba, romelic manamde am adgilebSi ar aRiricxeboda (qolera, muclis
tifi, grigoriev-Sigas mikrobebiT gamowveuli dizenteria da sxva). epidemiuri procesis
intensivobaze gavlenas axdens agreTve sxvadasxva saxis stiqiuri ubedurebebi (wyaldidoba,
miwisZvrebi, vulkanis amofrqveva da sxva), radgan xdeba komunalur-sayofacxovrebo pirobebis
mkveTri gauareseba, ziandeba wyalmomaragebisa da sakanalizacio sistemebi, rac iwvevs fekalur-
oraluri meqanizmis gaaqtiurebas da nawlavTa infeqciis avadobis donis matebas.
calsaxad SeiZleba iTqvas, rom rac ufro ganviTarebulia qveynis ekonomika da
damakmayofilebelia mosaxleobis socialuri mdgomareoba, miT naklebia infeqciuri daavadebebiT

188
gamowveuli avadobis done da piriqiT. ase iyo adreul da Sua saukuneebSi, me-19 da me-20
saukuneebSi. ase aris dReisaTvis da aseve iqneba momavalSi. mosaxleobis socialur-ekonomikuri
mdgomareobis gaumjobeseba aris infeqciur daavadebaTa profilaqtikis erT-erTi yvelaze
efeqturi saSualeba.
epidemiuri procesis ganviTarebaze seriozul gavlenas axdens bunebrivi faqtorebic,
gamomdinare iqidan, rom adamianebi gansazRvrul bunebriv-klimatur pirobebSi cxovroben da
adamianTa organizmi mudmiv urTierTmoqmedebaSia mis irgvliv arsebul garemo pirobebTan.
ufro TvalsaCino rom iyos bunebrivi faqtorebis roli epidemiur procesze, ramdenime
magaliTi SeiZleba moviyvanoT. imisaTvis, rom malariis plazmodiumis ganviTarebis cikli koRos
organizmSi warimarTos, aucilebelia, rom garemos temperatura garkveul farglebSi iyos.
maSin, roca temperatura 16oC-ze naklebia, koRos organizmSi aRar mimdinareobs es procesi.
gamomdinare aqedan, malaria mxolod garkveul bunebriv pirobebSia gavrcelebuli. igive
SeiZleba iTqvas denges cxelebazec, romlis gadamtani aseve koRoa. mis organizmSi virusis
cxovelmyofelobisTvis saWiroa, rom garemos temperatura 22oC-ze naklebi ar iyos. amdenad es
daavadebac mxolod garkveul teritoriebze gvxvdeba.
uZvelesi droidan iyo SemCneuli, rom zogierT teritoriaze mudmivad gvxvdeboda
garkveuli infeqciebi, xolo sxva teritoriebze ara. 1938 wels rusma mecnierma e. pavlovskim
Camoayaliba moZRvreba infeqciur daavadebaTa bunebrivi kerovnebis Sesaxeb. am Teoriis Tanaxmad
mTeli rigi zoonozuri bunebis infeqciuri daavadebebi gavrcelebulia da gvxvdeba garkveul
geografiul landSaftSi mobinadre zogierT Tbilsisxlian gareul cxovelebSi. aseT
daavadebebs bunebriv-kerovani infeqciebi ewodeba, radgan maTi gavrcelebis arealia bunebrivi
kera, sadac bunebriv-kerovani infeqciis gamomwvevis cirkulaciisaTvis xelsayreli bunebrivi
pirobebia Seqmnili.
5.2.5. epidemiuri procesis gamovlena

epidemiuri procesis intensivobis ramdenime done arsebobs. pirveli aris sporaduli


done. am dros daavadebis erTeuli SemTxvevebi gvxvdeba, romlebic erTmaneTTan naklebad arian
dakavSirebulni. avadobis sporaduli done, rogorc wesi, win uZRvis epidemiuri procesis
mkveTr Senelebas da likvidacias. Semdegi aris endemuri done. igi aRniSnavs avadobis iseT
maCveneblebs, romlebic mocemuli daavadebisaTvis aris damaxasiaTebeli konkretul
teritoriaze da iq arsebuli bunebrivi da socialuri faqtorebis arsebobiT aris
ganpirobebuli. sxvadasxva daavadebisaTvis igi sxvadasxva sididea. magaliTad saqarTveloSi
baqteriuli dizenteriiT avadoba 21-e saukunis dasawyisSi, 7.0-10.0-is farglebSi meryeobda 100
000 mosaxleze, rac epidemiuri procesis intensivobis meore done iyo. A hepatitisaTvis igive
189
sidide daaxloebiT 60.0-80.0-is farglebSi meryeobda. baqteriuli dizenteriiT avadobis
analogiuri maCveneblebi rom dafiqsirdes, igi CaiTvleba gavrcelebis epidemiur doned. anu
erTi da igive teritoriaze, avadobis erTnairi maCveneblebi sxvadasxva daavadebisaTvis
epidemiuri procesis sxvadasxva intensivobaze SeiZleba miuTiTebdes. mocemuli teritoriisaTvis
avadobis damaxasiaTebel saSualo maCvenebels avadobis ordinarul maCvenebels uwodeben. igi
gamoiTvleba bolo 5-8 wlis monacemebis safuZvelze. mis gamosaTvlelad am monacemebis
safuZvelze unda gamovTvaloT saSualo ariTmetikuli da davumatoT ormagi standartuli
Secdoma.
amrigad, avadobis ordinaruli maCvenebli = XsaS. ± 2SEM.
Semdegi aris epidemiuri done. am SemTxvevaSi avadobis maCveneblebi aRemateba avadobis
ordinarul maCvenebls. aseT dros infeqciuri daavadeba intensiurad aris gavrcelebuli mTels
regionSi Tu qveyanaSi. aqve unda ganvasxvavoT erTmaneTisagan epidemia da epidafeTqeba. afeTqeba
aris avadobis mateba ordinarul maCveneblze zeviT SezRudul koleqtivSi (skola, skolamdeli
bavSvTa dawesebuleba), am koleqtivis gareT daavadebis gavrcelebis gareSe. xolo epidemia aris
avadobis mateba ordinarul maCveneblze zeviT mosaxleobis did populaciaSi (qalaqi, raioni,
olqi da a. S.).
movlenas, rodesac infeqciuri daavadebis gavrceleba sayovelTao xasiaTs iRebs da
moicavs ara erT qveyanas, aramed qveyanaTa jgufs da SeiZleba mTel msoflios moedos, pandemia
ewodeba.
infeqciuri daavadebebis pandemiuri gavrceleba xSiri ar aris. Tumca, rodesac igi
gvxvdeba, maSin mosaxleobas seriozul ziani adgeba. Savi Wiris pirveli pandemiis dros,
planetis mosaxleobis 20% daiRupa. gripis erT-erTi pandemiis dros, romelic msoflioSi
1918-1920 wlebSi mimdinareobda, gardaicvala 20 milionze meti adamiani.
daavadebis pandemiuri gavrceleba gvxvdeba iseTi infeqciuri daavadebebisas, romelTac
axasiaTebs gadacemis mravlobiTi meqanizmi an advilad realizebadi erTi gadacemis meqanizmi
(aerogenuli, fekalur-oraluri). Tumca, amave dros, pandemiis ganviTarebisaTvis aucilebelia
mTeli rigi socialuri faqtorebis Tanxvedrac.
aqve unda SevexoT or termins, romelic epidemiologiaSi farTodaa gavrcelebuli. esenia
endemuri da ekzotikuri daavadebebi. endemuri infeqcia (avadobis endemuri done da endemuri
daavadebebi sxvadasxva mcnebebia) ewodeba iseT daavadebas, romlis gavrcelebisa da
arsebobisaTvis mocemul teritoriaze aris xelsayreli bunebrivi da socialuri pirobebi. e. i.
endemuri daavadebebi damaxasiaTebelia mocemuli teritoriisaTvis.
ekzotikuri infeqciebi ki iseT daavadebebs ewodeba, romlebic ar gvxvdebian mocemul

190
teritoriaze, radgan maTi arsebobisaTvis ar aris xelsayreli bunebrivi da socialuri
faqtorebi. Tumca es daavadebebi SeiZleba Setanil iqnes aseT teritoriebze garedan xanmokle
drois manZilze.

5.2.6. infeqciur daavadebaTa epidemiologiuri klasifikacia

infeqciuri daavadebebi daavadebaTa saerTaSoriso statistikuri klasifikaciis me-10


gadaxedvaSi, romelic janmos 43-e ansambleam 1992 wels miiRo, ZiriTadad pirvel klasSi
"zogierTi infeqciuri da parazituli daavadebebi" aris gaerTianebuli, Tumca bevri infeqciuri
daavadeba sxva klasebSic aris gabneuli. am klasifikaciis gamoyeneba infeqciur daavadebaTa
epidemiologiuri Taviseburebebis Sesaswavlad da profilaqtikuri RonisZiebebis SesamuSaveblad
naklebad gamodgeba. amdenad, infeqciur daavadebaTa klasifikacia aqtualuri sakiTxia.
am daavadebaTa klasifikaciis SemuSavebis mcdeloba saTaves mecxramete saukuneSi iRebs.
im periodSi daavadebebi pirobiTad sam jgufad iyofoda: 1. kontagiozuri – romlebic avadmyofi
adamianidan gadaecemoda janmrTel adamians uSualo Sexebisas, an dabinZurebuli sagnebis
saSualebiT. 2. miazmuri – infeqcia gadaecemoda mxolod haeris saSualebiT. 3. kontagiozur-
miazmuri (Sereuli jgufi). samedicino mikrobiologiis ganviTarebis Semdeg, infeqciuri
daavadebebi iyofodnen etiologiuri principis mixedviT. magram mikrobiologiuri klasifikaciis
gamoyeneba SeuZlebelia epidemiologiis miznebisaTvis. erTi da igive jgufSi absoluturad
gansxvavebuli epidemiologiis mqone daavadebebi iyo gaerTianebuli. magaliTad, cofi da wiTela.
yvelaze ufro misaRebi iyo klasifikacia, romelic 1941 wels moawoda sabWoTa
epidemiologma l. gromaSevskim da romelsac man safuZvlad daudo adamianis organizmSi
infeqciuri agentis specifikuri lokalizacia ZiriTad gadacemis meqanizmTan erTad. gamoyofil
iqna 4 didi jgufi: 1. nawlavTa infeqciebi, 2. sasunTqi gzebis infeqciebi, 3. sisxlis
infeqciebi, 4. safari qsovilis infeqciebi. TiToeul jgufSi iyo qvejgufebic.
miuxedavad imisa, rom l. gromaSevskis mier mowodebuli infeqciur daavadebaTa
epidemiologiuri klasifikacia mravali parametriT iyo Zalian kargi, mas mainc hqonda
seriozuli naklovanebebic. 1952 wels meore sabWoTa epidemiologma i. iolkinma klasifikaciis
TiToeul jgufSi cal-calke gamoyo anTroponozebis da zoonozebis qvejgufebi, rac udaod
wingadadgmuli nabiji iyo. epidemiologiuri klasifikacia aucileblad unda iTvaliswinebdes
ekologiur princips, kerZod Tu vin aris infeqciuri daavadebis gamomwvevis rezervuari –
adamianebi, cxovelebi, garemos elementebi. amdenad, dReisaTvis infeqciuri daavadebebi 3 jgufad
iyofa: anTroponozebi, zoonozebi, sapronozebi.
meore ekologiuri niSani, romlis mixedviTac SesaZlebelia infeqciuri daavadebebis
191
dajgufeba aris l.gromaSevskis mier mowodebuli principi – gamomwvevis ZiriTadi
(specifikuri) lokalizacia specifikuri maspinZlis organizmSi mis Sesabamis gadacemis
meqanizmTan erTad. am niSnis mixedviT infeqciebi 4 jgufad iyofa: 1. nawlavTa infeqciebi
gadacemis fekalur-oraluri meqanizmiT, 2. sasunTqi gzebis infeqciebi aerogenuli gadacemis
meqanizmiT, 3. sisxlis infeqciebi gadacemis transmisiuli meqanizmiT, 4. safari qsovilis
infeqciebi gadacemis kontaqturi meqanizmiT. Semdegi kriteriumi aris etiologiuri niSani,
romlis mixedviTac infeqciebi iyofa 5 ZiriTad jgufad: virusuli, baqteriuli, protozouli,
mikozebi, helminTozebi. baqteriul infeqciebSi pirobiTad gaerTianebulni arian qlamidiuri da
riketsiuli etiologiis daavadebebic. amrigad, infeqciuri daavadebebis epidemiologiuri
klasifikaciisaTvis 3 ZiriTadi niSani arsebobs:
• infeqciis rezervuari,
• gamomwvevis specifikuri (ZiriTadi) lokalizacia maspinZlis organizmSi gadacemis
meqanizmTan erTad,
• etiologia.
samive am niSnis mixedviT 1994 wels rusma mecnierma b. Cerkaskim mogvawoda infeqciur
daavadebaTa klasifikacia, romelic Cvenis azriT yvelaze misaRebia am etapze.

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Tavi 6 epidemiologiuri zedamxedveloba
epidemiologiuri zedamxedveloba warmoadgens sainformacio sistemas, romelic awvdis
jandacvis organoebs cnobebs, romlis safuZvelzec unda SemuSavdes RonisZiebebi mosaxleobaSi
daavadebaTa profilaqtikis da avadobis donis Sesamcireblad. sazogadoebrivi jandacvis
samsaxurebisaTvis epidemiologiuri zedamxedveloba warmoadgens instruments, romlis
saSualebiTac isini meTvalyureobas uweven mosaxleobis janmrTelobis mdgomareobas. igi aseve
warmoadgens safuZvels, raTa daisaxos sazogadoebrivi jandacvis saqmianobis prioritetuli
mimarTulebebi da principebi da SemuSavdes profilaqtikuri da epidsawinaaRmdego RonisZiebebis
racionaluri gegma.
epidemiologiuri zedamxedvelobis ZiriTadi debulebebi (mosaxleobis janmrTelobis
mdgomareobis Sesaxeb informaciis sistemuri Segroveba, analizi, interpretacia da gavrceleba)
exeba rogorc gadamdeb, ise aragadamdeb daavadebebs.
infeqciur daavadebaTa epidemiologiuri zedamxedveloba aris garkveul teritoriaze
daavadebis epidemiur procesze uwyveti kompleqsuri meTvalyureoba (dakvirveba)
profilaqtikuri da epidsawinaaRmdego RonisZiebebis racionalizaciis da efeqturobis
asamaRleblad.
epidzedamxedvelobis mizania Seiswavlos daavadebaTa gavrcelebis Taviseburebebi da
mogvces Sefaseba mosaxleobis sxvadasxva jgufSi daavadebis/daavadebaTa aRmocenebisa da
gavrcelebis albaTobaze, maTi efeqturi kontrolisa da profilaqtikisaTvis.
epidemiologiuri zedamxedvelobis amocanebia:
 infeqciuri daavadebebis socialur-ekonomikuri mniSvnelobis gansazRvra;
 gavrcelebis maStabebis da xasiaTis Sefaseba;
 avadobis dinamikis tendenciis da misi tempebis gansazRvra;
 im teritoriebis gamovlena, sadac epidemiologiuri situacia ar aris keTilsaimedo;
 mosaxleobis im kontigentis gamovlena, romelTa daavadebis riski maRalia
gamomdinare maTi samuSao da sayofacxovrebo pirobebisagan;
 im mizezebis da pirobebis gamovlena, romlebic ganapirobeben konkretuli daavadebis
epidemiuri procesis xasiaTs;
 adeqvaturi profilaqtikuri da epidsawinaaRmdego RonisZiebebis SemuSaveba, maTi
realizaciis etapebis dagegmva;
 ganxorcielebuli profilaqtikuri da epidsawinaaRmdego RonisZiebebis masStabebis,
xarisxis da efeqturobis kontroli maTi racionaluri koreqtirebis mizniT;
 epidemiologiuri situaciis prognozi.
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epidemiologiuri zedamxedvelobis sistema SeiZleba warmovidginoT rogorc Semdegi
RonisZiebebis erToblioba, romlebic aseTi TanmimdevrobiT xorcieldeba:
 dakvirveba adgilze, informaciis Segroveba da registracia;
 informaciis gadacema vertikalurad, rogorc qvemdgomi organoebis mier zemdgomi
organoebisaTvis, aseve piriqiT;
 informaciis gacvla horizontalurad, anu dainteresebul uwyebebsa da organizaciebs
Soris;
 epidemiologiuri situaciis Sefaseba, e.i. epidemiologiuri diagnozis dasma;
 mmarTvelobiTi gadawvetilebebis SemuSaveba da gasatarebeli RonisZiebebis
koreqtireba;
 epidemiologiuri situaciis prognozireba.
mTlianobaSi SeiZleba iTqvas, rom nebismieri daavadebebisas epidemiologiuri
zedamxedvelobis sistema Semdegi algoriTmiT funqciobs: informaciis Segroveba – informaciis
gadacema da gacvla – epidemiologiuri analizi (retrospeqtuli da operatiuli)
– prognozireba – mmarTvelobiTi gadawvetilebebis miReba (daavadebis winaaRmdeg
brZolis strategia da taqtika) – gatarebuli profilaqtikuri da epidsawinaaRmdego
RonisZiebebis Sefaseba da saWiroebis SemTxvevaSi maTi koreqcia.
epidemiologiuri zedamxedvelobis ganxorcielebis dros upirvelesi sakiTxi, romelic
droul mowesrigebas saWiroebs, aris daavadebaTa sruli da drouli registracia da aRricxva .
amis gareSe SeuZlebelia mosaxleobis janmrTelobis Sesaxeb realuri informaciis mopoveba.
Tavis mxriv registraciisa da aRricxvis mowesrigebisaTvis aucilebelia avadmyofTa sruli
gamovlena, rac damokidebulia:
a) klinicistTa kvalifikaciaze. eqim klinicistebs unda hqondeT Sesabamisi codna da
unari, rom gamoavlinon ara marto daavadebis tipuri, aramed msubuqi, atipuri da waSlili
formebic, radgan mTeli rigi daavadebebis mimdinareobaSi swored aseTi formebi Warbobs.
amasTan cnobilia, rom Tanamedrove pirobebSi, biologiuri da socialuri faqtorebis
zegavleniT, seriozulad icvleba daavadebaTa klinikuri mimdinareoba, rac bunebrivia arTulebs
swori diagnozis dasmas da avadmyofTa srul gamovlenas. amdenad, klinicistTa kvalifikaciis
zrda aucilebelia avadmyofTa srulad gamosavlenad. daavadebis diagnozis gansazRvrisas metad
mniSvnelovania mkurnali eqimis mier diagnostikis Tanamedrove meTodebis gamoyeneba da rac
mTavaria, aucilebelia infeqciuri daavadebebis dros, epidemiologiuri monacemebis drouli
mopoveba da maTi srulad gamoyeneba, radgan es monacemebi sagrZnoblad aiolebs swori
diagnozis dasmas.

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b) sazogadoebis samedicino ganaTlebaze. Tu avadmyofma adamianma ar mimarTa
samedicino dawesebulebas, bunebrivia, rom daavadeba rCeba gamovlenis gareSe. Tanamedrove
situaciaSi, rodesac gaiolebulia sxvadasxva saxis informaciis, maT Soris samedicino
informaciis mopoveba, daavadebis msubuqi mimdinareobis dros pacienti arCevs TviTmkurnalobas,
rasac Sedegad SeiZleba moyves sazogadoebaSi infeqciuri daavadebis swrafi da intensiuri
gavrceleba. amitom, aucilebelia, rom gaizardos mosaxleobis TviTSegneba da maT yvela
SemTxvevaSi droulad mimarTon samedicino dawesebulebebs. amisaTvis saWiroa, agreTve, am
dawesebulebebis da gansakuTrebiT mkurnali eqimis avtoritetis amaRleba da rac mTavaria,
samedicino momsaxurebis xelmisawvdomoba. orive am mimarTulebiT qveyanaSi seriozuli
sirTuleebia, rac bunebrivia xels uSlis daavadebaTa srul da droul gamovlenas da
aRricxvas.
rodesac grovdeba informacia sxvadasxva daavadebis epidemiologiuri situaciis Taobaze,
unda gaviTvaliswinoT, rom yvela daavadebisaTvis aris saerTo sakiTxebi, iseTebi, rogoricaa
informacia avadobis donis, struqturis da dinamikis Taobaze, magram aris agreTve specifikuri
sakiTxebic. magaliTad, im infeqciebis dros, romlebic imarTebian imunoprofilaqtikis
saSualebiT, saWiroa agreTve monacemebi mosaxleobis imunuri statusis Sesaxeb da riskis
jgufebSi imunitetis daWimulobis Sesaxeb. difTeriis dros mniSvnelovania agreTve informacia
mosaxleobaSi gamomwvevis cirkulaciis Taobaze (baqteriologiuri kontroli, rac moicavs
monacemebs gamomwvevis cirkulaciis masStabebze da mis biologiur Taviseburebebze). wiTelas
dros ki aseTi informacia sulac ar aris saWiro. nawlavTa infeqciebisas epidemiologiuri
zedamxedveloba emyareba garemos sanitariul-higienur kontrols, kvebis obieqtebze
sanitariul-epidemiologiuri reJimis dacvas da a.S. zoonozebis dros saWiroa
epizootologiuri da epidemiologiuri zedamxedveloba, romelic xorcieldeba sanitariuli da
veterinaruli samsaxurebis mier.
infeqciuri daavadebis diagnozis dasmis SemTxvevaSi eqimi valdebulia saswrafod saqmis
kursSi Caayenos sazogadoebrivi jandacvis samsaxuri. saqarTveloSi momqmedi kanonmdeblobis
Tanaxmad, es unda moxdes saswrafo Setyobinebis saSualebiT. mas agzavnis samedicino saqmianobis
yvela subieqti, ganurCevlad daqvemdebarebisa da sakuTrebis formisa, maT Soris laboratoriebi
da kerZo praqtikis mqone eqimebi. Setyobineba unda gaigzavnos, agreTve, infeqciur daavadebaze
eWvis mitanisas da laboratoriuli analizis dadebiTi Sedegis miRebisas.
Setyobinebas daqvemdebarebuli yvela infeqciuri daavadeba or jgufad iyofa:
1. saswrafo Setyobinebas daqvemdebarebuli daavadebebi;
2. yovelTviur Setyobinebas daqvemdebarebuli daavadebebi.

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saswrafo Setyobineba unda gaigzavnos imave samuSao dRes, an daavadebis gamovlenidan
araugvianes 24 saaTis ganmavlobaSi Sesabamisi raionis sazogadoebrivi jandacvis centrSi.
informaciis Setyobineba SeiZleba moxdes nebismieri xelT arsebuli saSualebebiT _ telefoni,
faqsi, el. fosta, saswrafo Setyobinebis baraTi. Tumca Setyobineba ZiriTadad xdeba saswrafo
Setyobinebis baraTiT _ f. #58/1. masSi Semdegi monacemebi fiqsirdeba:
1. avadmyofis gvari, saxeli, mamis saxeli.
2. sqesi, asaki (15 wlamde asakis bavSvebisaTvis dabadebis TariRic).
3. misamarTi (zustad).
4. samuSao adgili/saswavlo dawesebuleba, bavSvTa dawesebulebis dasaxeleba da
misamarTi.
5. diagnozi.
6. daavadebis dawyebis, samedicino dawesebulebaSi pirveli vizitis TariRi.
7. pacientis yofnis adgili (saavadmyofo, saxli).
baraTSi aseve fiqsirdeba, Tu vin gamoavlina SemTxveva da vin agzavnis saswrafo
Setyobinebis baraTs.
saswrafo Setyobinebis gagzavna aucilebelia Semdeg daavadebebze: difTeria, yivanaxvela,
tetanusi, mwvave dune dambla/mwvave poliomieliti, wiTela, wiTura, ybayura, meningokokuri
infeqcia, gripis msgavsi daavadebebis hospitalizaciis SemTxvevebi, A, B, C, D, E hepatitebi,
muclis tifi, salmonelozi, Sigelozi, qolera, Savi Wiri, tularemia, jilexi, brucelozi,
leptospirozi, SebrunebiTi tifi, partaxtiani tifi, cofi, malaria, triqinelozi da sxva.
SedarebisTvis unda aRiniSnos, rom amerikis SeerTebul StatebSic savaldebulo
aRricxvas ZiriTadad es daavadebebi eqvemdebareba. Tumca Statebis mixedviT mniSvnelovnad
meryeobs aRricxvas daqvemdebarebuli daavadebebis raodenoba. magaliTad, zogierT StatSi
aRiricxeba mxolod 35 daavadeba da mdgomareoba, maSin, rodesac rig StatebSi maTi ricxvi
130-s aRwevs. umravles StatSi, aseve savaldebuloa nebismieri daavadebis afeTqebis
registracia. saerTod am qveyanaSi ZiriTadad aRiricxeba mwvave infeqciuri daavadebebi, zogierT
StatSi ki rigi qronikuli da aragadamdebi daavadebebic (azbestozi, aborti, Tandayolili
defeqtebi, mwvave revmatuli Seteva, tyviiT da pesticidebiT mowamvla, silikozi da sxva).
saerTaSoriso konvenciebs daqvemdebarebuli, gansakuTrebiT saSiSi an masTan
gaTanabrebuli infeqciebisas Setyobineba sazogadoebrivi jandacvis centrSi dauyovnebliv unda
gaegzavnos. es daavadebebia:
1. Savi Wiri,
2. qolera,

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3. yviTeli cxeleba,
4. hemoragiuli virusuli cxelebebi (yirim-kongos hemoragiuli cxeleba, hemoragiuli
cxeleba Tirkmlis sindromiT, lasas, ebolas, marburgis daavadebebi),
5. tularemia,
6. jilexi,
7. cofi,
8. mZime mwvave respiraciuli sindromi,
9. yvavili,
10. tkipismieri encefaliti,
11. gripi, gamowveuli axali Stamis virusiT,
12. hidrofobia (cofi adamianebSi).
saswrafo Setyobinebas aseve eqvemdebareba nebismieri infeqciuri daavadebis (mwvave
respiraciuli infeqciebis da gripis garda) jgufuri SemTxveva. jgufurad iTvleba sami da
meti SemTxveva, romelTa Soris arsebobs epidemiologiuri kavSiri.
diagnozis Secvlis SemTxvevaSi, saswrafo Setyobinebis baraTi unda Seivsos da
gaigzavnos xelmeored. masSi Caiwereba axali diagnozi, miTiTebiT `Seicvala~ (miuxedavad imisa,
Secvlili diagnozi eqvemdebareba Tu ara saswrafo Setyobinebas, mag. somaturi daavadeba).
Tu sazogadoebrivi jandacvis centrSi miRebulia saswrafo Setyobinebis baraTi iseTi
pirovnebis Sesaxeb, romelic daavadda, an inkubaciur periodSi imyofeboda sxva teritoriaze
(sxva raionSi), epidemiur keraSi zomebis misaRebad, Setyobinebis mimRebma centrma informacia
araugvianes 24 saaTisa unda gaugzavnos Sesabamisi raionis sazogadoebrivi jandacvis centrs.
infeqciur daavadebaTa yvela SemTxveva, romelic klinikurad diagnostirebulia, an
laboratoriulad dadasturebulia, unda daregistrirdes samkurnalo-profilaqtikuri
dawesebulebis infeqciur daavadebaTa aRricvis JurnalSi _ f.#60/A. es Jurnali adgilze
inaxeba da iyeneben yovelTviuri da yovelwliuri angariSis momzadebisas. sazogadoebrivi
jandacvis centrSi SemTxvevebi registrirdeba JurnalSi _ f.#60/B-Si.
epidemiologiuri zedamxedvelobis erT-erTi mniSvnelovani amocanaa qveynis mTel
teritoriaze daavadebaTa registraciis da aRricxvis unifikacia da daavadebis
diagnostikisaTvis swori kriteriumebis SemuSaveba. am mizniT infeqciur daavadebaTa SemTxvevebi
klasificirdeba or kategoriad: klinikur (savaraudo) da dadasturebul SemTxvevebad.
savaldebulo Setyobinebas eqvemdebareba rogorc erTi, ise meore SemTxveva.
savaraudoa SemTxveva, romlis klinikuri simptomebi Seesabameba Setyobinebas
daqvemdebarebuli daavadebis aRwerilobas. aseTi gansazRvreba exmareba eqims, daadginos aris Tu

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ara mis mier gamovlenili SemTxveva Setyobinebas daqvemdebarebuli daavadeba.
dadasturebulia SemTxveva - rodesac igi dasturdeba specifikuri laboratoriuli
gamokvlevebiT da/an sxva laboratoriulad dadasturebul SemTxvevasTan epidkavSiris dadgenis
safuZvelze. epidemiologiuri kavSiri ganisazRvreba rogorc axlo kontaqti (konkretuli
daavadebis gadacemis meqanizmisa da gadamdeblobis vadebis gaTvaliswinebiT).
magaliTisTvis SeiZleba moviyvanoT A hepatiti. am daavadebis klinikuri (savaraudo)
SemTxvevaa, rodesac aRiniSneba siyviTle, muqi Sardi, umadoba, sisuste, moTenTiloba,
mtkivneuloba marjvena ferdqveSa areSi. kliniko-bioqimiuri analizisas SardSi urobilinogenis
momateba da sisxlis SratSi alaninaminotransferazas zeda zRvaris 2,5-jer momateba. xolo
dadasturebulia SemTxveva, Tu erT-erTi qvemoT mimTiTebuli niSani gvaqvs:
• A hepatitis virusis sawinaaRmdego M klasis antisxeulebze (IgM- anti -HAV) pasuxi
aris dadebiTi.
• vlindeba epidkavSiri zemoT aRwerili klinikuri niSnebis mqone pirsa da AA
hepatitis dadasturebul SemTxvevas Soris.
infeqciur daavadebaTa swori aRricxvisaTvis, aucilebelia TiToeuli daavadebis
SemTxvevis unificirebuli gansazRvra. amasTan, SemTxvevis gansazRvreba fundamenturia da
saWiroebs epidzedamxedvelobis sistemis miznebis da lojistikis gaTvaliswinebas.
epidzedamxedvelobaSi gamoyenebulma SemTxvevis gansazRvrebam unda daabalansos mgZnobelobis,
specifikurobis da ganxorcielebadobis (laboratoriuli testirebisadmi xelmisawvdomoba)
TvalsazrisiT arsebuli moTxovnebi. epidzedamxedvelobaSi gamoyenebuli SemTxvevis gansazRvreba
unda iyos martivi da konkretuli. SemTxvevis gansazRvreba standartul kriteriumTa
erTobliobaa, romelic specifikuri daavadebis, sindromis an janmrTelobis problemis
gamovlenis (klasificirebis) saSualebas iZleva. SemTxvevis gansazRvrebis gamoyeneba
uzrunvelyofs, rom daavadebaTa identifikacia moxdes standartulad, miuxedavad imisa, Tu sad
gamovlindeba igi da romeli eqimi dasvams diagnozs. SemTxvevis gansazRvreba SesaZloa iyos
mgrZnobiare an specifikuri: mgrZnobeloba unaria, sworad gamoavlinos daavadebuli pirebi. igi
fasdeba WeSmaritad daavadebulTa Soris dadebiTi diagnozis mqone SemTxevaTa xvedriTi wiliT.
SemTxvevis gansazRvrebis specifikuroba unaria sworad gamoavlinos janmrTeli (daavadebis
armqone) pirebi. specifikuroba daavadebis WeSmaritad ar mqone pirTa Soris uaryofiTi
Sedegebis mqone pirTa xvedriTi wilia.
epidzedamxedvelobis ramdenime saxe arsebobs. esenia: 1. populaciaze dafuZnebuli; 2.
sayrdeni bazebiT;
populaciaze dafuZnebuli epidzedamxedvelobis sistema moicavs Setyobinebas

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daqvemdebarebuli daavadebebis minitoringis/registris sitemas, romelic saWiroebs samedicino
momsaxurebis sferoSi momuSave eqimebs, raTa specifikuri daavadebis gamovlenis Sesaxeb
Seatyobinon sazoagdoebrivi jandacvis centrebs. populaciaze dafuZnebuli sxva sistemebi
efuZneba kvlevebs, romlebic tardeba reprezentul amonarCevze; am kvlevebs miekuTvneba
magaliTad aSS-is samedicino statistikis erovnuli centris mier Catarebuli kvlevebi,
romlebic tardeba poliklinikebSi, hospitlebSi, da populaciaSi. am kvlevebis Sedegad
miRebuli monacemebi SesaZloa gamoyenebuli iyos nacionalur doneze sxvadasxva daavadebebze
epidzedamxedvelobis mizniT. Tumca, populaciuri kvlevebis naklovanebas warmoadgens is, rom
is xSirad ver gvawvdis informacias specifikur geografiul dasaxlebaSi daavadebaTa
gavrcelebis Sesaxeb. populaciuri epidzedamxedvelobis upiratesobebia:
• reprezentulia;
• dafuZnebulia arsebul sazogadoebrivi jandacvis sistemaze;
• gazrdilia iSviaTi daavadebebis gamovlenis albaToba
rac Seexeba naklovanebebs, es aris misi siZvire.
epidzedamxedveloba sayrdeni bazebiT: epidzedamxedveloba, romelic dafuZnebulia
arCeul populaciur jgufebze da asaxavs am jgufebis maxasiaTeblebs; gamoiyeneba im
SemTxvevaSi, roca SemTxvevaTa srulyofili daTvla ar aris aucilebeli da calkeul
Setyobinebul SemTxvevas sazogadoebrivi jandacvis mxridan reagireba ar moyveba. misi
maxasiaTeblebia:
• monawileoben arCeuli eqimebi an dawesebulebebi;
• xdeba winaswar gansazRvruli daavadebis Setyobineba;
• SesaZlebelia maRali xarisxis monacemebis Segroveba;
• აr aris reprezentuli.
rogorc populaciuri, aseve sayrdeni bazebiT epidzedamxedveloba, SesaZloa, iyos
aqtiuri an pasiuri. pasiuri epidzedamxedveloba - inicirebulia pirveladi jandacvis
samedicino personalis mier. misi upiratesobebia:
• martivia;
• advilad Sesasrulebelia;
• asaxavs daaavdebaTa tendenciebs;
xolo misi naklovanebebia:
• Setyobinebis mowodebis araregularoba;
• SesaZloa ar iyos reprezentuli (warmomadgenlobiTi);
• SesaZloa ar iyos drouli;
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• SesaZloa ver moaxdinos afeTqebis aRmoCena.
aqtiuri epidzedamxedveloba-inicirebulia sazogadoebrivi jandacvis sistemis mier da
gulisxmobs daavadebaTa gamovlenas kardakar Semovlis gziT; is gamoiyeneba pasiuri
epidzedamxedvelobis validaciis mizniT. did finansur resursebs moiTxovs, aqedan gamomdinare
SesaZloa gamoyenebuli iyos drois xanmokle periodSi gansakuTrebiT saSiSi infeqciebis
adreuli gamovlenis mizniT, pasiuri epidzedamxedvelobis validobis Sesafaseblad an
specifikur kvlevebTan erTad. epidzedamxedvelobis am tipis upiratesobaa:
• uzrunvelyofs ufro srulyofil Setyobinebas;
xolo naklovanebebia:
• ar aris reprezentuli;
• moiTxovs met finansur da adamianur resursebs.
daavadebaTa gavrcelebaze kontrolis dawesebis mizniT da maT mimarT profilaqtikuri
RonisZiebebis gasatareblad sazogadoebrivi jandacvis centrSi saswrafo Setyobinebis miRebis
Semdeg epidemiologi valdebulia Caataros keris epidemiologiuri gamokvleva, romlis mizania:
▪ imis dadgena, Tu ramdenad sworad Catarda mkurnali eqimis mier keraSi pirveladi
epidsawinaaRmdego RonisZiebebi;
▪ infeqciis wyaros, gadacemis gzebis da faqtorebis dadgena;
▪ keris sazRvrebis gansazRvra;
▪ garemos im obieqtebis gansazRvra, romlebic gauvnebelyofas eqvemdebareba;
▪ gamovlena im pirebisa, romlebic dainficirebis safrTxis qveS arian, maTze
samedicino meTvalyureobis da sxva saWiro RonisZiebebis organizacia;
▪ RonisZiebebis SemuSaveba keris likvidaciisaTvis.
keraSi misvlisas epidemiologma unda daadginos sworad moxda Tu ara mkurnali eqimis
mier avadmyofis izolacia. mTeli rigi infeqciuri daavadebebisas izolacia aucileblad unda
moxdes infeqciur saavadmyofoSi an ganyofilebaSi, anu hospitalizacia yvela SemTxvevaSi
savaldebuloa. aseTi daavadebebi (qolera, difTeria, muclis tifi da sxva) did
epidemiologiur saSiSroebas qmnian garSemo myofTaTvis, anda maTi srulfasovani mkurnaloba
binaze SeuZlebelia. Tu iseT daavadebasTan gvaqvs saqme, romlis drosac izolacia SesaZlebelia
binaze (wiTela, qunTruSa, yivanaxvela, dizenteria da sxv.), unda dadgindes, ramdenad
damakmayofilebelia sanitariul-higienuri pirobebi da aris Tu ara minimumamde dayvanili
infeqciuri daavadebis gavrcelebis albaToba.
avadmyofis izolaciis Semdeg epidemiologi mkurnal eqimTan erTad organizacias ukeTebs
dezinfeqciis Catarebas, risTvisac unda ganisazRvros keris sazRvrebi da is obieqtebi,

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romlebic damuSavebas eqvemdebarebian, aseve dezinfeqciis saxe.
epidemiuri kera ewodeba im adgils, sadac imyofeba (imyofeboda) infeqciis wyaro im
teritoriiTurT, romlis farglebSic mas SeuZlia gaavrcelos es infeqcia janmrTel pirebSi.
keris sazRvrebi ganpirobebulia gamomwvevis gadacemis meqanizmis TaviseburebebiT. rodesac
laparakia epidemiur keraze, ZiriTadad igulisxmeba ojaxuri kera. gamomdinare daavadebis an
misi gamomwvevis Taviseburebebidan, keraSi SeiZleba Catardes mimdinare da daskvniTi
dezinfeqcia an saerTod ar Catardes is.
mimdinare dezinfeqcia tardeba maSin, rodesac avadmyofi imyofeba binaze. mis Catarebas
gansakuTrebiT didi mniSvneloba aqvs nawlavTa infeqciebis dros. misi mizania, rom infeqciuri
daavadebis gamomwvevi daavadebuli adamianis organizmidan gamoyofisTanave ganadgurdes.
avadmyofis yvela eqskrementi (ganavali, Sardi, pirnaRebi masa, naxveli da sxv.) eqvemdebareba
damuSavebas. keraSi mas atarebs avadmyofis ojaxis wevri, romelsac amisaTvis saTanadod
amzadeben Sesabamisi instruqciis Catarebis saSualebiT.
avadmyofis hospitalizaciis SemTxvevaSi, epidemiologma unda miaqcios yuradReba, rom
droulad Catardes daskvniTi dezinfeqcia (Tu iseTi infeqciaa, romlis drosac savaldebuloa
misi Catareba). misi mizania paTogenuri mikroorganizmebis sruli ganadgureba, romlebic keraSi
sxvadasxva sagnebze darCa. rogorc wesi, daskvniTi dezinfeqcia tardeba sadezinfeqcio sadguris
TanamSromlebis mier, keridan infeqciis wyaros mocilebidan araugvianes 12 saaTisa.
konkretulad epidemiologiuri gamokvleva Semdegi etapebisagan Sedgeba: 1. avadmyofis da
misi garemomcveli pirebisagan epidemiologiuri anamnezis Segroveba, 2. keris sanitariuli
Seswavla, 3. masalis aReba laboratoriuli gamokvlevebisaTvis, 4. samedicino dokumentaciis
Seswavla, 5. miRebuli Sedegebis Sefaseba da keris likvidaciis gzebis dasaxva.
keris gamokvleva, rogorc wesi, iwyeba avadmyofis, ojaxis wevrebis, naTesavebis,
mezoblebis gamokiTxviT da epidemiologiuri anamnezis SegrovebiT. misi mizania im pirobebis
gamovlena, romlebmac xeli Seuwyves infeqciis aRmocenebas, savaraudo infeqciis wyaros
gamovlineba, dainficirebis gzebis dadgena. gamokiTxvis sqema tipuria, Tumca misi calkeuli
detalebi damokidebulia sakvlevi daavadebis epidemiologiur Taviseburebebze. magaliTad,
nawlavTa infeqciebis keris Seswavlisas epidemiologma didi yuradReba unda miaqcios
daavadebis gavrcelebaSi garemos iseT faqtorebis rolis dadgenas, rogoricaa wyali, sakvebi
produqtebi, buzebi. iseTi daavadebis dros, romelTac axasiaTebT mtarebloba, gansakuTrebiT
qronikuli, saWiroa maqsimaluri Zalisxmeva avadmyofis irgvliv aseTi pirebis gamosavlenad.
keris epidemiologiuri gamokvlevis Sedegebi, maT Soris gamokiTxvis Sedegad miRebuli
monacemebic, eqimis mier Setanil unda iqnes keris epidemiologiuri gamokvlevis ruqaSi (f.

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#171), Tumca sruliad miuRebelia gamokiTxvis paralelurad am formebis Sevseba. es procesi
mxolod gamokiTxis damTavrebis Semdeg unda moxdes. xSirad epidemiologs avadmyofis
gamokiTxvasTan erTad uwevs gasaubreba mkurnal eqimTan, romelmac gamoavlina avadmyofi da im
eqimebTan, sadac pacienti hospitalizebulia. amas garda igi ecnoba avadmyofobis istorias.
avadmyofis da misi garemomcveli pirebis gamokiTxvis Semdeg, epidemiologi keris
sanitariuli mdgomareobis Seswavlas axdens. upirveles yovlisa yuradReba eqceva
wyalmomaragebis xasiaTs, tualetis tips (saerTo, individualuri), kvebis xasiaTs da pirobebs,
sacxovrebel saxls, sveli wertilebis mdgomareobas, nagvis da buzebis arsebobas da a.S. es
monacemebic fiqsirdeba keris epidgamokvlevis ruqaSi. bunebrivia am sakiTxebis garkvevas
gadamwyveti mniSvneloba aqvs nawlavTa infeqciebisas.
epidemiologiuri anamnezis Segrovebis da keris sanitariuli daTvalierebis Semdgom,
epidemiologs ukve gaaCnia garkveuli hipoTezebi infeqciis SesaZlo wyaroze da gadacemis
faqtorebis Taobaze, rasac aucileblad dadastureba sWirdeba, rac laboratoriuli
gamokvlevebiT xorcieldeba. magaliTad, Tu muclis tifiT daavadebuli adamianis garemocvaSi
gamovlinda qronikuli mtarebeli, saWiroa misi ganavlis gamokvleva da gamoyofili
gamomwvevebis fagotipireba. erTi da igive fagotipis arsebobisas SegviZlia vamtkicoT, rom am
or SemTxvevas Soris arsebobs mizez - Sedegobrivi kavSiri. Tu A hepatitis keraSi dadgenil
iqna, rom am SemTxvevamde sami kviris win ojaxis erT-erTi wevri avad iyo mwvave respiraciuli
daavadebis diagnoziT, SeiZleba vivaraudoT, rom igi sinamdvileSi avad iyo A hepatitis
usiyviTlo formiT da warmoadgens infeqciis wyaros. am mosazrebis dasadastureblad an
uarsayofad saWiroa misi gamokvleva serologiurad da RviZlis fermentebze. mxolod dadebiTi
pasuxis miRebisas SeiZleba CaiTvalos igi infeqciis wyarod.
igive SeiZleba iTqvas gadacemis faqtorebis Taobaze. Tu vfiqrobT, rom infeqciis
gadacema moxda wylis saSualebiT, saWiroa misi laboratoriuli, gansakuTrebiT
baqteriologiuri gamokvleva. kvebis produqtebze eWvis mitanisas, aseve savaldebuloa maTi
laboratoriuli gamokvleva. nawlavTa infeqciis sayofacxovrebo – kontaqtis gziT
gavrcelebaze varaudis SemTxvevaSi, misi dadastureba SesaZloa sacxovrebel binaSi
Camonarecxebis aRebiT da nawlavis Cxiris arsebobaze gamokvleviT.
samedicino dokumentaciis Seswavla (infeqciur daavadebaTa registraciis Jurnali,
samisamarTo formebi, avadmyofobis istoria, bavSvis ganviTarebis istoria, profilaqtikuri
acrebis ruqa da a.S.) exmareba epidemiologs daazustos mTeli rigi monacemebi, magaliTad
daavadebul pirTa acriTi anamnezi, inkubaciur periodSi samedicino manipulaciebis Catareba,
keraSi adre daavadebul pirTa Sesaxeb informacia da sxva. gansakuTrebuli mniSvneloba

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samedicino dokumentaciis Seswavlas eniWeba im infeqciebis dros, romelTa gavrcelebaSi did
rols TamaSobs hemotransfuziebi da sxvadasxva saxis samkurnalo – diagnostikuri
manipulaciebi. magaliTad aiv – infeqcia, B, C, D, hepatitebi. am daavadebaTa dros infeqciis
wyaros da gadacemis faqtorebis gamovlena samedicino dokumentaciis Seswavlis gareSe metad
rTulia.
miRebuli Sedegebis Semdeg dgeba yvelaze mniSvnelovani etapi. saWiroa monacemebis
analizi, daskvnis gakeTeba da im epidsawinaaRmdego RonisZiebebis dasaxva, romelTa
saSualebiTac SesaZlebelia infeqciis SesaZlo gavrcelebis aRkveTa.
garda CamoTvlili RonisZiebebisa, saWiroa infeqciis wyaros irgvliv kontaqtirebul
pirTa sruli gamovlena da maTze samedicino meTvalyureobis daweseba daavadebis maqsimaluri
inkubaciuri periodis manZilze. am RonisZiebebis mizania kontaqtirebulTa Soris daavadebuli
adamianis drouli gamovlineba infeqciis Semdgomi gavrcelebis Tavidan asacileblad. samedicino
personalis mier sistematurad xdeba kontaqtirebul pirTa Termometrizacia, safari qsovilis
daTvaliereba da a. S. saWiroebis SemTxvevaSi tardeba klinikuri da laboratoriuli
gamokvlevebic.
Tu maqsimaluri inkubaciuri periodis manZilze kontaqtirebulTa Soris mocemuli
daavadebiT avad aravin gaxda, maSin epidemiuri kera daxurulad iTvleba.
epidemiologiuri zedamxedvelobis erT-erTi mniSvnelovani etapia retrospeqtuli da
operatiuli epidemiologiuri analizis Catareba.

6.1. retrospeqtuli epidemiologiuri analizi

retrospeqtuli epidemiologiuri analizi es aris avadobis donis, struqturis,


dinamikis, asakobrivi da teritoriuli ganawilebis analizi, romelic uzrunvelyofs
mizanmimarTuli epidsawinaaRmdego RonisZiebebis SemuSavebas. misi etapebia: 1. daavadebis
mniSvnelobis gansazRvra, 2. avadobis mravalwliani dinamikis Seswavla, 3. avadobis wliuri
dinamikis Seswavla, 4. avadobis asakobrivi ganawilebis analizi, 5. avadobis teritoriuli
ganawilebis analizi. gamomdinare dasaxuli amocanebidan, SesaZloa daavadebis Taviseburebebis
Seswavla sxva parametrebis mixedviTac. magaliTad, daavadebis ganawileba calkeul
koleqtivebSi, avadobis mravalwliani da wliuri dinamikis analizi mosaxleobis calkeul
socialur da asakobriv jgufebSi da a.S. retrospeqtuli epidemiologiuri analizis mizania
Sesaswavli daavadebis riskis teritoriis, riskis periodis, riskis jgufebis gamovlena da
hipoTezebis/hipoTezis formulireba riskis faqtorebis Sesaxeb, romlebic apirobadeben
daavadebis konkretul ganawilebas mosaxleobis sxvadasxva jgufebSi da teritoriebze.
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daavadebis mniSvnelobis gansazRvra mosaxleobis janmrTelobis dacvis sferoSi ramdenime
parametris mixedviT xdeba. upirveles yovlisa, es aris avadobis done, rac ufro maRalia igi,
miT ufro aqtualuria daavadeba sazogadoebisaTvis. metad mniSvnelovani parametria letalobis
maCvenebeli. SeiZleba avadobis done ar iyos maRali, magram Tu letaloba maRalia, maSin aseTi
daavadeba seriozul problemas warmoadgens mosaxleobisaTvis (magaliTad, cofi, botulizmi,
tetanusi da a.S.). mniSvnelovani parametrebia aseve is ekonomikuri da socialuri ziani,
romelsac daavadeba adamianTa populacias ayenebs, anu daavadebis mniSvnelobis gansazRvra xdeba
kompleqsurad, mTeli rigi niSnebis mixedviT. cnobilia, rom dReisaTvis msoflioSi erTerTi
yvelaze mniSvnelovan infeqciur daavadebad aiv-infeqcia iTvleba. es gapirobebulia misi farTo
gavrcelebiT, mZime mimdinareobiT, sikvdilianobis maRali maCveneblebiT da rac mTavaria, im
didi ekonomikuri zianiT, romelsac igi im qveynebs ayenebs, sadac daavadeba intensiuradaa
gavrcelebuli. rac ufro mniSvnelovania daavadeba aRniSnuli parametrebis mixedviT, miT ufro
did yuradRebas moiTxovs misi profilaqtika sazogadoebisagan da upirvelesad samedicino
samsaxurebisagan. analogiuri situaciaa msoflioSi koronavirusuli infeqciis pandemiis gamo.

6.1.1. avadobis mravalwliani dinamikis analizi

Sesawavl teritoriaze konkretuli daavadebis mravalwliani dinamikis analizisaTvis


sasurvelia gaanalizdes minimum 10-15 wlis monacemebi, risTvisac unda vicodeT TiToeul wels
dafiqsirebuli avadobis maCvenebeli. masalis TvalsaCinoebisa da analizis gasaadvileblad
sasurvelia avadobis dinamikis grafikuli gamosaxva, rogorc es suraT #34-zea naCvenebi.
suraTi #34
A hepatitiT avadobis dinamika TbilisSi 1954-1970 wlebSi

avadobis mravalwliani dinamikis analizi moicavs Semdeg etapebs:


• mravalwliani dinamikis grafikuli gamosaxva da misi vizualuri analizi,

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• avadobis tendenciis gansazRvra,
• avadobis mravalwliani dinamikis cvlilebebis Sefaseba.
avadobis mravalwliani dinamikis grafikuli gamosaxulebis vizualuri analizi
saSualebas gvaZlevs raodenobrivad SevafasoT epidemiuri procesis mimarTuleba-tendencia.
epidemiuri procesis intensivobis cvlilebebis mimarTulebas wlebis manZilze epidemiuri
tendencia ewodeba. misi 3 varianti arsebobs:
• stabilizacia,
• mateba,
• daqveiTeba (kleba).
specialistis amocana, romelic avadobis dinamikas swavlobs, upirveles yovlisa aris
epidemiuri tendenciis mimarTulebis gansazRvra, rasac didi praqtikuli mniSvneloba aqvs,
radgan Tu avadobas aqvs matebis tendencia, es niSnavs, rom is profilaqtikuri RonisZiebebi,
romlebic daavadebis winaaRmdeg tardeba, araefeqturia da igi gadasinjvas da koreqtirebas
saWiroebs. Tu avadobis tendencias stabilizaciis xasiaTi aqvs, maSin es miuTiTebs, rom
profilaqtikur RonisZiebebs aqvT garkveuli efeqti, magram RonisZiebaTa am kompleqsiT
SeuZlebelia avadobis klebis miRweva. Tu epidemiur tendencias klebis xasiaTi aqvs, es niSnavs,
rom daavadebis mimarT ganxorcielebuli profilaqtikuri RonisZiebebi efeqturia. magram aq
erTi aucilebeli pirobacaa gasaTvaliswinebeli, saWiroa daavadebis gamovlena da registracia
saTanado doneze iyos. suraT #35-ze naTlad Cans, rom A hepatitiT avadobas TbilisSi 1991-
2004 wlebSi axasiaTebs mkveTrad gamoxatuli klebis tendencia. magram es aris Sedegi ara
imisa, rom aRniSnul periodSi daavadebis mimarT ganxorcielda efeqturi profilaqtikuri
RonisZiebebi da aman gamoiwvia avadobis kleba, aramed am wlebSi, iseve rogorc mTlianad
qveyanaSi, aseve q.TbilisSi mniSvnelovnad gauaresda A hepatitis (agreTve sxva infeqciuri
daavadebebis) gamovlenis da aRricxvis mdgomareoba, ramac gamoiwvia kidec misi avadobis klebis
tendencia.
davubrundeT isev suraT #34-s. aq mocemuli avadobis grafikuli gamosaxulebis
analizisas, daskvnis gakeTeba Zalian advilia. saqarTveloSi A hepatitiT avadobas 1953-1970
wlebSi axasiaTebda kargad gamoxatuli matebis tendencia.
Zalian xSirad avadobis amsaxveli mrudi iseTia, rom tendenciis Sesaxeb daskvnis gakeTeba
mxolod vizualurad sakmaod rTulia. aseT SemTxvevaSi mimarTaven statistikur meTodebs,
romelTagan yvelaze martivia gaTanabrebis meTodi mcocavi saSualos mixedviT.

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suraTi #35
A hepatitiT avadobis dinamika TbilisSi 1990-2004 wlebSi

magaliTad, saqarTvelos erT-erT regionSi dafiqsirda dizenteriis Semdegi raodenobis


SemTxvevebi : 1990 wels – 405 SemTxveva, 1991 wels – 455, 1992 wels - 395, 1993 wels –
380, 1994 wels – 250, 1995 wels – 240, 1996 wels – 250. aseTi monacemebisas daskvnis
gakeTeba tendenciis Taobaze rTulia.
viyenebT zemoTaRniSnul meTods, romlis arsia mezobeli 3 wlis saSualo maCveneblis
gamoTvla im mizniT, rom im maCveneblis nivelireba moxdes, romelic gamowveulia, vTqvaT,
daavadebis afeTqebiT, an sxva raime SemTxveviTi, arakanonzomieri procesiT (cxrili #59).

cxrili #59

wlebi daavadebulTa ricxvi SemTxvevaTa raodenoba gaTanabrebis


Semdeg
1990 405 _
1991 455 (405+455+395) :3=418
1992 395 (455+395+380) :3=410
1993 380 (395+380+250) :3=341
1994 250 (380+250+240) :3=290
1995 240 (250+240+250) :3=247
1996 250
გათანაბრებული რიგი ავადობის კლების ცალსახა ტენდენციას გვიჩვენებს. დღეისათვის
ავადობის ტენდენციის განსაზღვრისათვის იყენებენ უფრო თანამედროვე მეთოდებს. ასეთია
მაგალითად ნ. ვალვაჩევის მიერ მოწოდებული მეთოდი. ამ მიზნით იყენებენ ფორმულას:
Y1=A0+A1X1, სადაც

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Y1 – ორდინატზე წერტილების მნიშვნელობაა. A0 და A1 Y1-ის განსაზღვრისათვის
საჭირო პარამეტრები. X – ინტერვალის მაჩვენებელია.
A0 და A1-ის მნიშვნელობები გამოითვლება ფორმულით:

sadac n – dinamiur rigSi wevrTa raodenobis maCvenebelia.


am meTodiT gamoTvlili avadobis epidemiuri tendencia naCvenebia suraT #34-ze.
epidemiuri tendenciis gansazRrisas didi mniSvneloba aqvs imas, Tu ra siCqariT xdeba
avadobis kleba/mateba, risTvisac iyeneben saSualo wliuri matebis/klebis temps. misi gamoTvla
xdeba formuliT:

sadac T – saSualo wliuri matebis/klebis tempia,


V1 – sakvlevi periodis pirvel wels dafiqsirebuli avadobis maCvenebeli,
Vn – sakvlevi periodis bolo wels dafiqsirebuli avadobis maCvenebeli,
n – sakvlev periodSi wlebis raodenoba.
avadobis dinamikis Seswavlisas yuradReba unda mivaqcioT axasiaTebs Tu ara avadobas
cikluroba, rac avadobis donis periodul matebas da klebas gulisxmobs. avadobis cikluroba
yvelaze kargad sasunTqi gzebis infeqciebis dros aris gamoxatuli. magaliTad, acrebamde
wiTelas dros avadobis periodul matebebs Soris intervali2-3 weli iyo, yivanaxvelas dros
3-4 weli. cikluroba sxva jgufis infeqciebisTvisac aris damaxasiaTebeli, razec Tundac
suraTi #34 metyvelebs, saidanac naTlad Cans, rom A hepatitiT avadobis perioduli mateba
aRiniSneba 3-5 wlis intervaliT (1955, 1958, 1961, 1966, 1970 wlebi). iTvleba, rom
cikluroba gamoxatulia maSin, rodesac daavadebis sawinaaRmdego profilaqtikuri RonisZiebebi
an araefeqturia, an naklebad efeqturi. cikluroba regulirdeba populaciaSi imunuri fenis
odenobiT. maqsimaluri avadobisas populaciaSi imunur pirTa raodenobac maqsimaluria, rac
iwvevs avadobis donis daqveiTebas, manam sanam sazogadoebaSi Sobadobis, migraciis Tu sxva
mizezebis gamo ar dagrovdeba araimunur pirTa didi raodenoba, rac Tavis mxriv apirobadebs
avadobis donis matebas. aseTi cikli mudmivad meordeba manam, sanam daavadebis sawinaaRmdego
efeqturi profilaqtikuri saSualeba ar SemuSavdeba da ganxorcieldeba.

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6.1.2. sezonuroba (avadobis wliuri dinamikis analizi)

TiTqmis yvela infeqciuri daavadebisaTvis damaxasiaTebelia wlis manZilze daavadebis


araTanabari ganawileba, romelime periodSi avadobis mniSvnelovani matebiT, rac sezonurobis
saxiT aris cnobili. magaliTad, dizenteriis SemTxvevebis maqsimaluri raodenoba gvxvdeba wlis
Tbil periodSi, wiTelasi – zamTris dasasruls da gazafxulis dawyebisas da a.S. sezonurobis
Seswavlisas vadgenT sezonuri matebis dawyebis periods, maqsimaluri avadobis periods,
sezonurobis indeqss da sezonurobis koeficients. sezonurobis TvalsaCinod gamosaxvisaTvis
viyenebT mis grafikul gamosaxvas. sezonurobis intensivobis dasadgenad SesaZlebelia TiToeul
TveSi gamovTvaloT avadobis maCvenebeli, Tumca ufro xSirad TiToeul TveSi dafiqsirebul
SemTxvevaTa raodenobas gamoxataven procentebSi wlis manZilze dafiqsirebul mTel SemTxvevaTa
raodenobasTan, romelic 100%-ad iTvleba. saanalizod yvelaze ufro miRebulia sezonurobis
tipuri mrudis Sedgena saSualo mravalwliani monacemebis safuZvelze. suraT #36-ze naCvenebia
A hepatitis sezonuroba TbilisSi 1983-1998 wlebis monacemebis mixedviT.
suraTi #36

rogorc suraTi #36-dan Cans, avadobis minimaluri done saSualo mravalwliani


monacemebis mixedviT aRiniSneba ivnis-ivlisSi, am Tveebze mTeli SemTxvevebis 4.1 - 4.2 %
modioda. sezonuri mateba daiwyo agvistos TveSi, gansakuTrebiT gaZlierda seqtemberSi da
maqsimums anu piks miaRwia oqtombris TveSi.
sezonurobis indeqsis da koeficientis gamosaTvlelad saWiroa vicodeT avadobis
sezonuri matebis Tveebi. aseTad is Tveebi iTvleba, rodesac avadoba saSualo doneze (8.3 %)
maRali iyo, anu I, II, IX, X, XI, XII Tveebi.

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anu A hepatitis sezonuri matebis TveebSi daavadebis 2-jer meti SemTxveva iyo, vidre danarCen
TveebSi.

6.1.3. avadobis analizi mosaxleobis sxvadasxva asakobriv jgufSi

mosaxleobis sxvadasxva asakobrivi jgufi infeqciuri daavadebis mimarT sxvadasxva


mimReblobiT xasiaTdeba, rac maTSi gansxvavebuli avadobis doniT gamoixateba. daavadebis
epidTaviseburebebis Sesawavlad didi mniSvneloba aqvs imis garkvevas, Tu saanalizo daavadebiT
romeli asakobrivi jgufebi xdebian ufro xSirad avad. asakobrivi struqturis dasaxasiaTeblad
iyeneben rogorc eqstensiur, ise intensiur maCveneblebs. masalis TvalsaCinoebisaTvis iyeneben
mis grafikul gamosaxvas svetovani diagramebis saxiT (suraTi #37), sadac naCvenebia TiToel
asakobriv jgufSi dafiqsirebuli daavadebis SemTxvevebi gamosaxuli procentebSi mTel
SemTxvevebTan SedarebiT (eqstensiuri maCveneblebi).
suraTi #37

rogorc vxedavT, C hepatitiT ZiriTadad avad xdebian 15-49 wlis asakis pirebi. maTze
modis mTeli SemTxvevebis 86.6 %, gansakuTrebiT maRalia 20-29 wlis axalgazrdebis xvedriTi
wili avadobaSi – 38.8 %. daavadebulTa aseTi asakobrivi struqtura C hepatitis dros
ganpirobebulia infeqciis gadacemis gzebiT.
C hepatitisagan gansxvavebiT mravali infeqciuri daavadeba ZiriTadad bavSvTa asakSi
gvxvdeba da maT xSirad bavSvTa infeqciebs uwodeben. aseTebia wiTela, Cutyvavila, qunTruSa,
yivanaxvela da sxva, rac erTis mxriv ganpirobebulia am daavadebebisaTvis damaxasiaTebeli
aerogenuli gadacemis meqanizmiT da meores mxriv, sakmaod myari postinfeqciuri imunitetis
arsebobiT.

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nebismieri infeqciiT daavadebulTa asakobrivi struqturis codna gvexmareba ukeTesad
gavigoT am daavadebis epidemiuri procesis Taviseburebebi.
6.1.4. avadobis teritoriuli ganawilebis analizi

avadobis teritoriuli ganawilebis analizi tardeba riskis teritoriebis gamovlenis


mizniT, risTvisac Zalian xSirad iyeneben ruqebs. epidemiologiuri ruqebis safuZveli SeiZleba
iyos qalaqis (raionis, soflis, regionis) sqema. mTeli teritoria iyofa nawilebad (raionebad,
an mikroraionebad). Semdgom ruqaze xdeba daavadebis SemTxvevebis gadatana ZiriTadad
sacxovrebeli adgilis mixedviT, SesaZlebelia aseve monacemebis gadatana samuSao an
saswavleblis adgilis mixedviT. aseT ruqebs kartogramebi ewodeba. maTi saSualebiT ufro
advilia erTis mxriv, daavadebis teritoriuli ganawilebis analizi da meores mxriv, im
faqtorebis gamovlena, romlebic apirobadeben daavadebis araTanabar gavrcelebas sxvadasxva
adgilebSi.
Tu Cven SeviswavliT saqarTveloSi A hepatitis teritoriul gavrcelebas me-20
saukuneSi, vnaxavT, rom es daavadeba ufro intensiurad iyo gavrcelebuli qveynis im raionebSi,
romlebic sakurorto zonebs miekuTvnebian. wlis Tbil periodSi didi raodenobis mosaxleobis
Tavmoyra dasasvenebel adgilebSi, sadac sanitariuli mdgomareoba Sors aris idealurisagan,
xels uwyobda A hepatitis farTo gavrcelebas.
kidev erTi nawlavTa infeqciis – muclis tifis teritoriuli gavrcelebis analizisas
saqarTveloSi, naTeli xdeba, rom igi ZiriTadad im teritoriebze gvxvdeboda, sadac
mosaxleobis wyalmomaragebis sakiTxebi mougvarebeli iyo.
retrospeqtuli epidemiologiuri analizis safuZvelze vlindeba is teritoriebi, sadac
daavadeba farTod aris gavrcelebuli, mosaxleobis is asakobrivi da socialuri jgufebi,
romlebic yvelaze xSirad avaddebian da wlis is periodi, rodesac mniSvnelovnad matulobs
avadoba. aseTi informaciis codnis safuZvelze epidemiologs eZleva SesaZlebloba,
konkretulad gansazRvros Tu rodis, sad da vis unda Cautardes ama Tu im daavadebis dros
profilaqtikuri RonisZiebebi.

6.2. operatiuli epidemiologiuri analizi

retrospeqtuli epidemiologiuri analizis logikuri gagrZelebaa operatiuli


epidemiologiuri analizi, romlis mizania gamoavlinos is cvlilebebi, romlebic aRiniSneba
epidemiuri procesis mimdinareobaSi. amasTan, miRebuli informacia ori mimarTulebiT muSavdeba:
1. informaciis analizi, romelic moicavs irib niSnebs, romelTa mixedviTac SeiZleba
ganisazRvros epidemiuri procesis ganviTarebis SesaZlo tendencia; 2. informaciis analizi,
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romlebic moicaven niSnebs, romlebic uSualod asaxaven epidemiuri procesis ganviTarebis
mdgomareobas da tendencias.
iribi niSnis mixedviT informaciis Sefaseba saSualebas iZleva miRebul iqnas mimdinare
mmarTvelobiTi gadawyvetileba. rogorc wesi, am informaciis moculoba SezRudulia, amitom
aucileblad warmoebs informaciis operatiuli analizi, romelic uSualod asaxavs epidemiuri
procesis mdgomareobas. es analizi moicavs Semdeg mimarTulebebs:
• laboratoriuli gamokvlevebis Sedegebis Sefaseba da analizi;
• uwyveti meTvalyureoba avadobis doneze da dinamikis Sefaseba;
• kerebis epidemiologiuri gamokvleva;
• jgufuri SemTxvevebis epidemiologiuri gamokvleva.
retrospeqtuli da operatiuli analizis safuZvelze ismeba epidemiologiuri diagnozi,
rac safuZvelia adeqvaturi profilaqtikuri RonisZiebebis gatarebisa.
epidemiologiuri situaciis Sefasebisas didi mniSvneloba aqvs im niSnebis codnas,
romlebic faqtiurad warmoadgenen epidemiologiuri situaciis gauaresebis markerebs. maT
mauwyebel niSnebs uwodeben. sasunTqi gzebis infeqciebis dros epidemiologiuri situaciis
gauaresebis mauwyebel niSnebs miekuTvneba koleqtivSi infeqciis wyaros gamoCena da
mosaxleobis araimunuri fenis zrda, aseve cirkulaciaSi myofi infeqciuri agentis peizaJis
cvlileba. magaliTad, meningokokuri infeqciis dros avadobis SesaZlo zrdis mauwyebelia
mozardebSi da mozrdilebSi A da C serologiuri jgufis meningokokebis xvedriTi wilis zrda,
xolo mcire asakis bavSvebSi ki B jgufis meningokokebis gamovlenis zrda. gripis dros
virusebis antigenuri struqturis cvlileba aseve prognostikuli niSania, romelsac SeiZleba
mohyves avadobis zrda. difTeriis mikrobis toqsigenobis zrda miuTiTebs am infeqciis avadobis
SesaZlo zrdaze. rac Seexeba nawlavTa infeqciebs, arasasurvel prognozul niSnebs miekuTvneba
sasmeli wylis da sakvebi produqtebis baqteriologiuri maCveneblebis gauareseba da
mocirkulire gamomwvevebis Tvisebebis cvlileba.
epidemiologiuri situaciis gauareseba SeiZleba gamoiwvios sxvadasxva socialurma da
bunebrivma faqtorebma, romelTa saSualebiTac Zlierdeba sazogadoebaSi infeqciur daavadebaTa
gamomwvevis cirkulacia da gadacemis meqanizmis gaaqtiureba. aseT faqtorebs epidemiologiuri
situaciis gauaresebis winapirobebs uwodeben. magaliTad, nawlavTa infeqciebis dros
epidprocesis gaaqtivebis winapirobebs warmoadgens is socialuri faqtorebi, romlebic xels
uwyoben gamomwvevTa gadacemis ZiriTadi gzebis (wylismieri, sakvebismieri) gaaqtiurebas.
sasunTqi infeqciebis dros aseTi winapiroba SeiZleba iyos koleqtivebis Semadgenlobebis
ganaxleba, rac xels uwyobs koleqtivSi infeqciis Setanas da araimunuri fenis zrdas. amdenad,

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epidemiologiuri situaciis gauaresebis winapirobebis da mauwyebeli niSnebis codna samedicino
samsaxurebs exmareba droulad dagegmos da gaataros profilaqtikuri RonisZiebebi.
amrigad, epidemiologiuri zedamxedvelobis kompleqsur-miznobrivi programebis
diagnostikuri qvesistema gulisxmobs Semdegs: meTvalyureoba epidemiuri procesis
gamovlinebaze, gamomwvevis gadacemis gzebis da faqtorebis Sefaseba da wamyvani gzis gamoyofa,
mizezebis da pirobebis dadgena, romlebic apirobadeben epidemiuri procesis gaaqtiurebas. anu
warmoebs retrospeqtuli da operatiuli epidemiologiuri analizi da ismeba epidemiologiuri
diagnozi.
aRniSnuli prognozebis mesame ganyofilebas mmarTvelobiTi qvesistema warmoadgens, rasac
qveyanaSi ZiriTadad axorcielebs sazogadoebrivi jandacvis samsaxurebi. maTi saqmianobis
mniSvnelovani mimarTuleba aris organizaciuli, meToduri da sakonsultacio muSaoba. aseve
kontroli profilaqtikuri da epidsawinaaRmdego RonisZiebebis gatarebis xarisxze.
calke unda aRiniSnos epidemiologiuri zedamxedvelobis organizacia zoonozuri da
sapronozuli infeqciebis dros. rogorc cnobilia, zoonozebis dros, infeqciis wyaros
warmoadgenen cxovelebi, amdenad, janmrTeli da daavadebuli adamianebis gancalkeveba Sedegs ar
iZleva. epidemiuri kera viTardeba epizooturi kerebis arsebobis fonze. zoonozuri
infeqciebisas epidemiuri kera xasiaTdeba calkeuli daavadebebis arsebobiT, romlebic
erTmaneTTan adamianuri faqtorebiT ar arian dakavSirebulni. rogorc ki wydeba adamianTa
kavSiri epizootur kerasTan, wydeba daavadebis gavrcelebac adamianTa sazogadoebaSi.
zoonozuri infeqciebis dros xorcieldeba epizooturi epidemiologiuri
zedamxedveloba, romlis ZiriTadi principebia:
• zedamxedvelobis organizaciaSi kompleqsuri midgoma (mediko-veterinaruli);
• TiToeuli nozologiuri erTeulis, rogorc epizootologiuri, ise epidemiologiuri
Taviseburebebis gaTvaliswineba;
• epizootologiuri da epidemiologiuri informaciis aqtiuri, sistematuri da
dinamiuri Segroveba da analizi;
• samedicino, veterinarul da sxva dainteresebul samsaxurebs Soris informaciis
mudmivi da operatiuli gacvla.
yvela dainteresebuli samsaxurebis da uwyebebis mier kompleqsuri mmarTvelobiTi
gadawyvetilebis miReba.
Tu anTroponozuli infeqciebis dros epidemiologiur zedamxedvelobas axorcielebs
samedicino samsaxuri, zoonozebis SemTxvevaSi, zedamxedveloba mimdinareobs samedicino da
veterinaruli samsaxurebis mier erToblivad.

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sapronozebis dros ki, iseve rogorc anTroponozebisas, epidemiologiuri zedamxedveloba
samedicino samsaxurebis mier warmoebs. am dros aucilebelia ara marto avadobis analizi,
aramed garemos im obieqtebze meTvalyureobac, romlebmac adamianebis sameurneo saqmianobis gamo
moipoves gansakuTrebuli epidemiologiuri mniSvneloba.
amrigad, infeqciur daavadebaTa sxvadasxva jgufebis dros, epidemiologiuri
zedamxedveloba garkveuli TaviseburebebiT xasiaTdeba, romlebic gaTvaliswinebul unda iqnas
daavadebaTa mimarT profilaqtikuri da epidsawinaaRmdego RonisZiebebis SemuSavebisas.

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Tavi 7 epidsawinaaRmdego RonisZiebebi
rogorc cnobilia, klinikur epidemiologiaSi mniSvnelovani adgili ukavia swavlebas
samkurnalo saSualebebze. aseve profilaqtikur medicinaSi gamorCeuli roli eniWeba swavlebas
profilaqtikur RonisZiebebze. infeqciuri daavadebebis profilaqtikisaTvis mimarTul
RonisZiebebs epidsawinaaRmdego RonisZiebebi ewodeba. sxvanairad rom vTqvaT, epidsawinaaRmdego
RonisZiebebi es aris mecnierebis ganviTarebis Tanamedrove etapze dasabuTebuli rekomendaciebis
erToblioba, romelTa saSualebiTac xdeba mTlianad mosaxleobaSi da mis calkeul jgufebSi
infeqciur daavadebaTa gavrcelebis aRkveTa, Semcireba da calkeuli infeqciuri daavadebebis
likvidacia.
epidsawinaaRmdego RonisZiebebis Semadgenloba da xasiaTi samedicino mecnierebis
ganviTarebasTan erTad icvleba. magaliTad, meoce saukunemde ar xdeboda sanitariul-higienuri
da epidsawinaaRmdego RonisZiebebis diferenciacia. dReisaTvis isini calkea gamoyofili, xolo
is sanitariul-higienuri RonisZiebebi, romlebic mimarTulia infeqciur daavadebaTa
profilaqtikisaken, Sedian epidsawinaaRmdego RonisZiebaTa sistemaSi.
epidsawinaaRmdego RonisZiebebis gatareba xdeba rogorc mTel mosaxleobaSi, an mis
calkeul jgufebSi, ise garkveul obieqtebzec. dReisaTvis yvela is obieqti, sadac xdeba
epidemiologiuri kontroli, iyofa 2 jgufad: epidemiologiurad mniSvnelovani obieqtebi da
danarCeni. Tavis mxriv did qalaqebSi epidemiologiurad mniSvnelovani obieqtebi nawlavTa
infeqciebisaTvis aseve or jgufad iyofa. pirvel jgufSi is obieqtebi Sedis, romlebic wyliT
da sakvebi produqtebiT amarageben mTel qalaqs, an mis calkeul raionebs. maT miekuTvneba rZis
qarxnebi, xorckombinatebi, mefrinveleobis fabrikebi, macivrebi, ludisa da ualkoholo
sasmelebis mwarmoebeli dawesebulebebi da sxv. sanitariuli pirobebis darRvevam am obieqtebze
SeiZleba gamoiwvios mTel qalaqSi, an mis calkeul raionebSi daavadebaTa farTo gavrceleba.
epidemiologiurad mniSvnelovani obieqtebis meore jgufSi is dawesebulebebi Sedian, sadac
sanitariuli pirobebis darRvevam SeiZleba gamoiwvios daavadebaTa gavrceleba mosaxleobis
calkeul jgufebSi da qalaqis calkeul teritoriebze. aseTebia, sasadiloebi, sasursaTo
maRaziebi, sadac realizdeba daufasoebeli rZis produqtebi, bavSvTa saxlebi, sxvadasxva
stacionarebi, samSobiaro saxlebi da sxv.
epidsawinaaRmdego RonisZiebebi Tavis mxriv pirobiTad or jgufad iyofa:
profilaqtikuri da sakuTriv epidsawinaaRmdego. epidsawinaaRmdego RonisZiebebi aris
mecnierulad dasabuTebuli RonisZiebebis erToblioba, romlebic gamoiyeneba infeqciuri
daavadebebis winaaRmdeg brZolis saqmeSi maTi aRmocenebisa da gavrcelebisas. xolo
profilaqtikuri RonisZiebebi ariis RonisZiebaTa sistema, romelic tardeba manam, sanam
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aRmocendeba infeqciuri daavadeba, raTa ar dauSvas misi ganviTareba. profilaqtikuri
RonisZiebebi tardeba mudmivad, ganurCevlad imisa, aris Tu ara infeqciuri daavadeba. xolo
epidsawinaaRmdego RonisZiebebi tardeba mosaxleobaSi infeqciuri daavadebis aRmocenebisas.
profilaqtikur RonisZiebebs miekuTvneba gegmiani acrebi, sistematuri sanitariuli kontroli
mosaxleobis wyalmomaragebaze, sanitariuli da baqteriologiuri kontroli kvebis
produqtebze da mis xarisxze, sanitariuli da epidemiologiuri kontroli sazogadoebrivi
kvebis obieqtebze, bavSvTa dawesebulebebze, gegmiani specifikuri dezinfeqcia, deratizacia,
dezinseqcia, sazRvrebis sanitariuli dacva sazRvargareTidan infeqciur daavadebaTa Semotanis
aRsakveTad da a.S.
epidemiuri procesis aRmocenebisa da ganviTarebisaTvis, rogorc aRniSnuli iyo,
aucilebelia epidemiologiuri triadis arseboba: infeqciis wyaro, gadacemis meqanizmi, mimRebi
organizmi. amaTgan erT-erTi rgolis mocilebas mosdevs epidemiuri procesis Sewyveta. amitomac
epidsawinaaRmdego RonisZiebebi im SemTxvevaSi iqneba efeqturi, Tu isini mimarTulia infeqciis
wyaros gasauvnebelad, gadacemis meqanizmis gasawyvetad da mosaxleobis specifikuri
rezistentobis asamaRleblad. Sesabamisad epidsawinaaRmdego RonisZiebebi dayofilia sam jgufad
(cxrili #60): 1. infeqciis wyaros gasauvnebelad mimarTuli, 2. gadacemis meqanizmis
gasawyvetad mimarTuli da 3. mosaxleobisaTvis specifikuri rezistentobis (imunitetis)
asamaRlebeli.

cxrili #60
epidsawinaaRmdego RonisZiebebis dajgufeba maTi moqmedebis mimarTulebis mixedviT
epidemiuri procesis rgolebi epidsawinaaRmdego RonisZiebebi
infeqciis wyaro klinikur-diagnostikuri, samkurnalo, saizolacio,
sareJimo-SemzRudveli (gaZlierebuli samedicino
meTvalyureoba, observacia, karantini).
sanitariul-veterinaruli da deratizacia.

gadacemis meqanizmi sanitariul-higienuri, dezinfeqcia da dezinseqcia.

mimRebi organizmi imunoprofilaqtika, eqspres profilaqtika.

klinikuri diagnostika. infeqciuri daavadebebis drouli klinikuri daignostika ara


marto samkurnalo, aramed epidsawinaaRmdego RonisZiebebsac miekuTvneba. umravlesi infeqciuri
daavadebebisas, adamianis gadamdebloba iwyeba daavadebis dawyebisTanave. amdenad, rac ufro
droulad daismeba diagnozi, miT ufro swrafad xdeba avadmyofis izolacia da sxva
epidsawinaaRmdego RonisZiebebis gatareba da Sesabamisad infeqciis wyaros mier infeqciis
gadacemis SesaZlebloba sxva pirebze maqsimalurad izRudeba. gamomdinare aqedan, daavadebaTa
215
diagnostikis dros metad didi mniSvneloba eniWeba laboratoriuli meTodebis gamoyenebasac,
amasTan iseTi sadiagnostiko testebis gamoyenebas, romlebic saSualebas iZlevian diagnozi
ganisazRvros daavadebis adreul stadiaSi xanmokle droSi.
infeqciur daavadebaTa diagnostikas seriozulad arTulebs maTi klinikuri
polimorfizmi, prodromul periodSi bevri saerTo klinikuri niSnebis arseboba da a.S. aseT
pirobebSi seriozul rols TamaSobs eqimis gamocdileba da misi unari, SearCios kvlevis
saWiro meTodebi. mTeli rigi daavadebebisas, magaliTad, wiTelas, Cutyvavilas, epidemiuri
parotitis, qunTruSas da zogierTi sxva infeqciis dros diagnozi ZiriTadad klinikuri
niSnebiT ismeba. amave dros Zalian didi mniSvneloba aqvs epidemiologiuri monacemebis
gaTvaliswinebasac.
rogorc aRiniSna, epidsawinaaRmdego RonisZiebebis efeqturoba mniSvnelovanwilad
gapirobebulia imiT, Tu ramdenad srulad da droulad iqneba samkurnalo qselis mier
daavadebuli adamianebis gamovlena. avadmyofTa gamovlenis aqtiuri da pasiuri meTodi arsebobs.
pasiuri gamovlenisas samedicino samsaxurisadmi mimarTvis iniciativa avadmyofs an mis
axloblebs ekuTvniT, xolo aqtiuri gamovlena xdeba samedicino personalis mier
profilaqtikuri gasinjvebisas, sakardakaro Semovlisas, aseve sanitariuli aqtivis informaciis
safuZvelze.
mkurnaloba. infeqciuri avadmyofis drouli etiotropuli mkurnaloba xels uwyobs maTi
organizmis adreul ganTavisuflebas daavadebaTa gamomwvevisagan, ris gamoc adamianebi ufro
xanmokle drois manZilze arian infeqciis wyaro. drouli da swori mkurnaloba aseve xels
uSlis qronikuli formebis ganviTarebas, romelTa drosac adamianTa gadamdebloba bevrad ufro
xangrZlivia, vidre mwvave formebisas. gamomdinare aqedan, mkurnalobac epidsawinaaRmdego
RonisZiebebs miekuTvneba.
izolacia. somaturi daavadebebisagan gansxvavebiT, maSin, rodesac ismeba infeqciuri
daavadebis diagnozi, aucilebelia avadmyofis, romelic infeqciis wyaros warmoadgens, saswrafo
izolacia. misi mizania ar dauSvas infeqciis Semdgomi gavrceleba. es RonisZieba savaldebuloa
yvela anTroponozuli daavadebisaTvis. izolacia iwyeba infeqciis wyaros gamovlinebisTanave da
mTavrdeba maSin, rodesac avadmyofi Tavisufldeba gamomwvevisagan. mTeli rigi daavadebebisas
avadmyofTa gamowera stacionaridan kontroldeba rekonvalescentTa baqteriologiuri
gamokvlevebiT (nawlavTa infeqciebi). rodesac naavadmyofar pirTa laboratoriuli gamokvleva
garTulebulia (virusuli infeqciebi), rekonvalescentTa izolacia wydeba Sesabamis brZanebebSi
miTiTebul vadebSi.
infeqciur avadmyofTa izolaciis ZiriTadad ori forma arsebobs. avadmyofTa moTavseba

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stacionarSi (hospitalizacia) da izolacia binaze. garda amisa, bavSvTa dawesebulebebSi,
arainfeqciur stacionarebSi da sxvagan SeiZleba arsebobdes izolatori, sadac droebiT
aTavseben infeqciur daavadebaze saeWvo pirebs.
mTeli rigi infeqciuri daavadebebisas, izolacia aucileblad unda moxdes infeqciur
saavadmyofoSi, anu hospitalizacia yvela SemTxvevaSi savaldebuloa (muclis tifi, qolera,
poliomieliti, B hepatiti da sxva). sxva daavadebebisas ki – wiTela, Cutyvavila, qunTruSa,
Sigelozi da sxv. hospitalizacia xdeba klinikuri (daavadebis mZime formiT mimdinareoba) da
epidemiologiuri CvenebebiT. am Cvenebebs miekuTvneba: a. avadmyofis araxelsayrel pirobebSi
cxovreba (saerTo sacxovrebeli, normaluri komunaluri pirobebis ararseboba), b. rodesac
ojaxSi cxovroben epidemiologiurad mniSvnelovan obieqtebze (kvebis da wyalmomaragebis
sistema) momuSave pirebi, g. rodesac avadmyofi TviTon muSaobs epidemiologiurad mniSvnelovan
obieqtze. aseT SemTxvevebSi avadmyofis hospitalizaciis sakiTxi mkurnali eqimis da
epidemiologis SeTanxmebis safuZvelze xdeba.
avadmyofis binaze datovebisas, saWiroa misi maqsimaluri izolacia sxva pirebisagan,
amitom avadmyofs calke oTaxSi aTavseben da gamouyofen calke WurWels.
hospitalizaciis dros, avadmyofis gadayvana saavadmyofoSi aucileblad unda
ganxorcieldes samedicino samsaxuris transportiT, raTa Semdgom moxdes misi specialuri
damuSaveba.
sareJimo-SemzRudveli RonisZiebebi. am jgufSi pirobiTad sami saxis RonisZiebebs
gamoyofen. esenia gaZlierebuli samedicino meTvalyureoba, observacia da karantini.
gaZlierebuli samedicino meTvalyureoba. am sistemis RonisZiebaTa mizania mosaxleobaSi
infeqciur avadmyofTa sruli da aqtiuri gamovlena maTi Semdgomi izolaciiT da
hospitalizaciiT. avadmyofTa aqtiuri gamovlena xorcieldeba samedicino personalis mier
mosaxleobis gamokiTxviT, laboratoriuli da klinikuri gasinjviT (anamnezis Segroveba,
Termometria, laboratoriuli analizebi, saWiroebisas klinikuri gamokvleva) maTi
sacxovrebeli da samuSao adgilebis mixedviT. gaZlierebuli samedicino meTvalyureobis
SemoReba xdeba epidemiis saSiSroebis an misi ganviTarebis SemTxvevaSi.
observacia. termini “observacia” pirdapiri mniSvnelobiT meTvalyureobas niSnavs
(observatio-vakvirdebi). Tumca praqtikaSi gaZlierebuli samedicino meTvalyureobis garda
observacia gulisxmobs mosaxleobis gadaadgilebis SezRudvasac. gansakuTrebiT xSirad
observacias mimarTaven samxedro nawilSi rodesac pirad SemadgenlobaSi kontagiozuri
infeqciuri daavadebebis gavrcelebis saSiSroebaa.
observaciis reJimis SemoRebisas maqsimalurad izRudeba mivlinebebi da sxva adgilebidan

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adamianTa Sesvla observaciis teritoriaze. karantinis dros observacia gulisxmobs im
janmrTel pirebze gaZlierebul samedicino meTvalyureobas, romlebsac karantinis zonis
datoveba uwevT.
karantini. sityva “karantini” pirdapiri mniSvnelobiT 40 dRes aRniSnavs (quarantena–
ormoci). igi SemoRebul iqna Sua saukuneebSi, rodesac gemebi, romlebzedac hqondaT eWvi, rom
Savi WiriT daavadebulebi imyofebodnen, an modioda iseTi adgilebidan, sadac Savi Wiris
SemTxvevebi iyo, reidze aCerebdnen 40 dRes. dReisaTvis misi ganmarteba aris Semdegnairi:
karantini aris mosaxleobis epidsawinaaRmdego uzrunvelyofis sistemaSi sareJimo-SemzRudveli,
sanitariul-higienuri da samkurnalo-profilaqtikuri RonisZiebebis erToblioba, romlebic
mimarTulia garkveuli teritoriis dacvisaken masSi infeqciuri daavadebis gamomwvevis
Setanisagan da aseve am daavadebis epidemiuri keris farglebs gareT gavrcelebis SesazRudad.
karantins mimarTaven gansakuTrebiT saSiSi infeqciebis an sxva kontagiozuri infeqciuri
daavadebebis masobrivi gavrcelebisas.
TiToeul konkretul SemTxvevaSi karantinis pirobebSi gasatarebel epidsawinaaRmdego
RonisZiebaTa nusxa damokidebulia konkretul epidemiologiur situaciaze da im daavadebis
Taviseburebebze, ris gamoc karantinis reJimia SemoRebuli. karantinis pirobebis Sesasruleblad
samedicino samsaxuri valdebulia Seqmnas specialistTa jgufebi, romlebic uzrunvelyofen
saizolacio-samkurnalo, sadezinfeqcio RonisZiebebis da laboratoriuli gamokvlevebis
Catarebas, aseve acrebis da eqspres-profilaqtikis ganxorcielebas.
samoqalaqo uwyebaSi naklebad saSiSi infeqciebis dros karantinis SemoReba
dawesebulebaSi gulisxmobs zogierTi SemzRudveli RonisZiebebis gatarebas, magaliTad
adamianTa gancalkeveba, romlebic iyvnen avadmyofTan kontaqtSi, organizebul bavSvTa
dawesebulebaSi axali bavSvebis miRebis akrZalva, iseve rogorc maTi jgufidan jgufSi
gadayvana, avadmyofTan kontaqtSi myofi pirebis ardaSveba bavSvTa koleqtivSi, kvebis obieqtebze
da a.S.
veterinarul-sanitariuli RonisZiebebi. am jgufis RonisZiebebis gatarebis mizania ar
dauSvas mosaxleobaSi zoonozuri daavadebebis gavrceleba, rac miiRweva: 1. Sinaur cxovelebSi
zoonozuri daavadebebis gavrcelebis aRkveTiT da epizootologiuri procesis keTlsaimedobis
dacviT, rasac axorcielebs veterinaruli samsaxuri da 2. sanitariuli kontroli cxoveluri
warmoSobis nedleulze da kvebis produqtebze, raTa gamoiricxos mosaxleobaSi dainficirebuli
produqtebis moxvedra da maTi gamoyeneba. am mimarTulebiT kontrols axorcielebs rogorc
veterinaruli, ise sanitariuli samsaxuri.
RonisZiebebis xasiaTi, romlebic mimarTulia infeqciis gadacemis meqanizmis gasawyvetad

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damokidebulia daavadebis epidemiologiur Taviseburebebze da gamomwvevis gamZleobaze garemo
pirobebSi. yvelaze efeqturia zogadi sanitariuli RonisZiebebi, romlebic tardeba ganurCevlad
imisa, aris Tu ara infeqciuri daavadeba. esenia: sanitariuli kontroli wyalmomaragebaze da
sakveb produqtebze, dasaxlebuli adgilebidan usufTaobis drouli gatana, brZola buzebis
winaaRmdeg da a.S. saerTo sanitariuli RonisZiebebis gatareba wamyvan rols asrulebs nawlavTa
infeqciebis profilaqtikaSi. am infeqciebis gavrcelebis aRsakveTad seriozul rols asrulebs
agreTve dezinfeqcia, dezinseqcia.
RonisZiebebs, romlebic gamoiyeneba mosaxleobis rezistentobis asamaRleblad, miekuTvneba
rogorc zogadi gamajansaRebeli RonisZiebebi, romelTa saSualebiTac xdeba organizmis
araspecifikuri rezistentobis amaRleba, aseve profilaqtikuri acrebi, romelTa meoxebiTac
xdeba infeqciuri daavadebebis mimarT specifikuri imunitetis Seqmna.
im epidsawinaaRmdego RonisZiebebis daxasiaTeba, romlebic aq ar aris ganxiluli, moxdeba
Semdeg TavebSi.
infeqciuri daavadebebis winaaRmdeg sabrZolvelad epidsawinaaRmdego
RonisZiebis/RonisZiebebis SerCeva, damokidebulia daavadebis epidemiologiur Taviseburebebze.
zogadi xasiaTis RonisZiebebis garda, yvelaze efeqturi iqneba im RonisZiebaTa gamoyeneba,
romlebic epidemiuri procesis yvelaze sust da misawvdom rgolis mimarT iqneba mimarTuli.
magaliTad, rogorc aRiniSna, nawlavTa infeqciebis profilaqtikis ZiriTad safuZvels
sanitariul-higienuri xasiaTis RonisZiebebi warmoadgens, romlebic mimarTulia gadacemis
meqanizmis gawyvetisaken. amave dros RonisZiebaTa es jgufi naklebad efeqturia sasunTqi gzebis
infeqciebis dros, radgan maTi gamoyenebiT SeuZlebelia iseTi aqtiuri gadacemis meqanizmis
gawyveta, rogoricaa aerogenuli meqanizmi. sasunTqi gzebis infeqciebis avadobis done
imunologiuri faqtorebiT regulirdeba. aqedan gamomdinare, am jgufis infeqciebisas, wamyvan
rols maT profilaqtikaSi TamaSobs gegmiani acrebi, romelTa saSualebiTac xdeba koleqtiuri
imunitetis Seqmna.
epidsawinaaRmdego muSaobis dadebiTi Sedegi damokidebulia gamoyenebuli RonisZiebebis
xarisxze, maTi drouli da sruli moculobiT Sesrulebaze. epidemiologiaSi erT-erTi
mniSvnelovani cnebaa epidsawinaaRmdego RonisZiebaTa efeqturoba. es aris maTi SesaZlebloba,
Secvalon infeqciuri daavadebebiT gamowveuli avadobis done, struqtura da dinamika, aseve
Tavidan iqnas acilebuli an Semcirebuli avadobiT gamowveuli mosaxleobis janmrTelobis
ziani.
epidsawinaaRmdego RonisZiebaTa efeqturoba sam aspeqtSi ganixileba: epidemiologiuri,
socialuri, ekonomikuri. epidemiologiuri efeqturoba ganisazRvreba mTel mosaxleobaSi an mis

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calkeul jgufebSi avadobis donis cvlilebiT da gamoixateba efeqturobis indeqsiT.
efeqturobis indeqsi gviCvenebs, Tu ramdenjer Semcirda avadoba im pirebSi, romlebmac
miiRes profilaqtikuri preparati (an Seasrules rekomendacia) im pirebTan SedarebiT,
romlebsac es preparati (rekomendacia) ar miuRiaT. is ganisazRvreba formuliT:

sadac K – efeqturobis indeqsia, a – avadoba im pirebSi, romlebmac miiRes


profilaqtikuri preparati (rekomendacia), b – avadoba im pirebSi, romlebsac es preparati
(rekomendacia) ar miuRiaT.
magaliTad, kohortuli gamokvlevis Sedegad dadgenil iqna, rom 50-69 wlis asakis
pirebSi, romlebic Tambaqos ewevian, filtvis kiboTi avadobam 127.2 Seadgina, xolo
aramwevelebSi – 12.8. efeqturobis indeqsi Tambaqos mowevisagan Tavis Sekavebisas tolia 127.2 /
12.8 = 10. unda aRiniSnos rom, RonisZiebebis efeqturobis indeqsi, romelic mTlianad xsnis
riskis faqtoris moqmedebas, udris fardobiTi riskis maCvenebels.
xSirad iyeneben aseve dacvis maCvenebelsac, igi gamoiangariSeba formuliT:

sadac E – dacvis maCvenebelia, a – im pirTa avadoba, romlebmac miiRes preparati


(rekomendacia), b – im pirTa avadoba, romelTac ar miiRes preparati (rekomendacia). dacvis
maCveneblebis saSualebiT SeiZleba ganisazRvros, Tu adamianTa ramdeni procentia daculi,
romlebmac miiRes preparati (rekomendacia).
unda iTqvas, rom dacvis maCvenebeli da efeqturobis indeqsi urTierTdamokidebulia:

epidsawinaaRmdego RonisZiebebis socialuri efeqturoba ganisazRvreba daavadebis


socialuri mniSvnelobis Semcirebis jeradobiT epidsawinaaRmdego RonisZiebebis gamoyenebis
Sedegad. igi gviCvenebs agreTve sikvdilianobis da invalidobis Semcirebis donesac. ekonomikuri
efeqturoba mWidrodaa dakavSirebuli socialurTan. igi gamoixateba im ekonomikuri efeqtiT,
romelic miiRweva RonisZiebis gatarebisas mosaxleobis Sromisunarianobis SenarCunebiT da im
Tanxebis dazogviT, romelic saWiro iqneboda RonisZiebebis argatarebisas daavadebul pirTa
mkurnalobisaTvis. epidsawinaaRmdego RonisZiebebis epidemiologiuri, socialuri da
ekonomikuri efeqturoba erTmaneTTan mWidrodaa dakavSirebuli.
infeqciebs, romelTa mimarT SemuSavebulia mecnierulad dasabuTebuli epidsawinaaRmdego
RonisZiebebi da praqtikulad naCvenebia maTi efeqturoba, marTvadi infeqciebi ewodeba. am
jgufis infeqciebSi ori qvejgufi gamoiyofa: 1. infeqciebi, romelTa marTva
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imunoprofilaqtikiT xdeba da 2. infeqciebi, romelTa marTva sanitariul-higienuri
RonisZiebebiT xdeba. zoonozuri daavadebebis profilaqtika, romelTa drosac infeqciis wyaroa
Sinauri cxovelebi, sanitariul-higienuri RonisZiebebiTa da acrebiT xorcieldeba, xolo
bunebriv-kerovani infeqciebis – sareJimo-SemzRudveli RonisZiebebiT da imunoprofilaqtikiT.
infeqciebs, romelTa marTva imunoprofilaqtikiT xdeba, miekuTvneba anTroponozebi
gadacemis aerogenuri meqanizmiT. xolo infeqciebs, romelTa marTva xorcieldeba sanitariul-
higienuri RonisZiebebiT, miekuTvneba anTroponozebi fekalur-oraluri gadacemis meqanizmiT.

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Tavi 8
daavadebaTa profilaqtika
daavadebaTa mkurnalobaSi Tanamedrove medicinis SezRuduli saSualebebi da samedicino
daxmarebis Rirebulebis swrafi zrda ganapirobebs sazogadoebis sul ufro met yuradRebas
profilaqtikisadmi, miuxadavad imisa, rom klinicistebi dResac bevrad met dros uTmoben
daavadebaTa diagnostikas da mkurnalobas, vidre maT Tavidan acilebas. udavoa, rom momavalSi
daavadebaTa profilaqtikis roli kidev ufro gaizrdeba.
imis mixedviT, Tu ra etapze xorcieldeba RonisZiebebi, profilaqtikis oTxi done
arsebobs:
❖ premorbiduli;
❖ pirveladi;
❖ meoradi;
❖ mesameuli.
maTi Catarebis dro da samizne kontingenti naCvenebia cxrilSi #61.

cxrili # 61
profilaqtikis doneebi
profilaqtikis daavadebis stadia samizne kontingenti
done
premorbiduli daavadebis ganviTarebamde mTeli mosaxleoba da SerCeuli jgufebi

pirveladi daavadebis ganviTarebamde mTeli mosaxleoba, SerCeuli jgufebi


da calkeuli janmrTeli adamianebi
meoradi daavadebis adreuli stadia avadmyofebi
mesameuli daavadebis ganviTarebis stadia avadmyofebi

8.1. p r e m o r b i d u l i p r o f i l a q t i k a

profilaqtikis es done yvelaze gvian iqna gamoyofili, maSin rodesac dagrovda


mniSvnelovani monacemebi gul–sisxlZarRvTa sistemis daavadebaTa epidemiologiis Sesaxeb.
cnobilia, rom gulis iSemiuri daavadeba farTo gavrcelebas iRebs maSin, rodesac arsebobs
misi ZiriTadi sawyisi mizezi, kerZod kvebis racionSi cxoveluri cximebis siWarbe. iseT
qveynebSi (CineTi, iaponia), sadac es faqtori naklebad gvxvdeba, sxva riskis faqtorebis
arsebobis miuxedavad, iseTebis, rogoricaa Tambaqos moweva da arteriuli hipertenzia, gulis
iSemiuri daavadeba naklebad aris gavrcelebuli da igi iSviaTad aris sikvdilis mizezi. Tumca
am qveynebSi Tambaqos mowevis gavrcelebis gamo, xSiria filtvis kibo da insulti, romelic
asocirebulia arteriul hipertenziasTan.
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premorbiduli profilaqtikis mizania sazogadoebaSi socialur-ekonomikuri da kulturuli
Taviseburebebidan gamomdinare, qcevis iseTi Taviseburebebis danergvis Tavidan acileba,
romlebic cnobilia, rogorc daavadebis ganviTarebis riskis xelSemwyobi faqtorebi. mraval
dabali Semosavlebis mqone qveyanaSi, rogorc avadobaSi, ise gansakuTrebiT sikvdilianobaSi
Semcirda infeqciuri da parazituli daavadebebis wili. amis sapirispirod izrdeba
arainfeqciuri paTologiis roli, gansakuTrebiT travmebis, simsivneebis, gulis iSemiuri
daavadebis. isini TandaTan iqcnen sazogadoebrivi jandacvis mniSvnelovan problemad. mTel rig
dabali Semosavlebis mqone qveynebSi gulis iSemiuri daavadeba sul ufro farTod vrceldeba
qalaqis im mosaxleobaSi, romelTac aqvT saSualo da maRali Semosavali da cxovrebis iseT
wess ewevian, romlebic daavadebis ganviTarebis maRal risks moicavs. amdenad am qveynebSic, iseve
rogorc maRali Semosavlebis mqone qveynebSi gul–sisxlZarRvTa sistemis daavadebis
premorbiduli profilaqtika sul ufro met yuradRebas moiTxovs.
premorbiduli profilaqtika saWiroa atmosferuli haeris globaluri dabinZurebis
gamoc, rasac Tan sdevs mJave wvimebi, ozonis fenis dazianeba, smogis ganviTareba, romlebic
Tavis mxriv negatiur zemoqmedebas axdens mosaxleobis janmrTelobaze. samwuxarod
premorbiduli profilaqtikis roli yvela qveyanaSi saTanadod ar aris gaazrebuli. magaliTad
miuxedavad imisa, rom amerikisa da evropis bevr qveyanaSi sigaretis moxmareba TandaTan
mcirdeba, msoflios mraval qveyanaSi, da maT Soris saqarTveloSi, sigaretiT vaWroba kidev
ufro izrdeba, rac am regionebSi seriozul zians ayenebs mosaxleobis janmrTelobas.
premorbiduli profilaqtikis gatarebaSi aqtiuri monawileoba unda miiRos mosaxleobam
da rac mTavaria qveynis mTavrobebma da sainformacio saSualebebma. mxolod samedicino
samsaxurebis ZalisxmeviT mdgomareobis gamosworeba ararealuria.

8.2. pirveladi profilaqtika

pirveladi profilaqtikis mizania ar dauSvas daavadebis aRmoceneba misi gamomwvevi


mizezis mocilebiT anda riskis faqtorebis kontroliT. aseTi profilaqtikis kargi magaliTia
infeqciur daavadebaTa aRkveTa imunizaciis saSualebiT. 1958 wels mTels msoflioSi daiwyo
naturaluri yvavilis sawinaaRmdego acrebi globaluri masStabiT, ris Sedegadac am mrisxane
daavadebis bolo SemTxveva 1977 wels gamovlinda, xolo 1980 wels janmom mTel msoflios
auwya naturaluri yvavilis sayovelTao likividaciis Sesaxeb. aseve imunizaciis wyalobiT
praqtikulad miRweulia poliomielitis likvidacia. 1994 wels amerikis kontinenti
gamocxadda am infeqciisgan Tavisufal teritoriad, xolo 2002 wels kopenhagenSi aRiarebuli
iqna, rom evropaSi aRar gvxvdeba am daavadebis adgilobrivi SemTxvevebi.
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pirvelad profilaqtikas didi mniSvneloba eniWeba iseTi mniSvnelovani daavadebis
winaaRmdeg brZolis saqmeSi, rogoricaa aiv–infeqcia. sqesobrivi cxovrebis mowesrigeba da
sqesobrivi kavSirisas prezervativebis gamoyeneba sagrZnoblad zRudavs am daavadebis
gavrcelebis masStabebs. aseTi profilaqtikis magaliTia agreTve donorTa sisxlis testireba
HBs–antigenis, anti-HCV–s da aiv–infeqciis antisxeulebis arsebobaze, riTac xdeba
hemotransfuziebis saSualebiT B da C hepatitebis da aiv – infeqciis gadacemis aRkveTa.
pirveladi profilaqtikis ori mimarTuleba arsebobs gamomdinare Catarebis obieqtidan:
populaciuri da indivindualuri, romlebic xSirad erTmaneTs avsebs. populaciuri pirveladi
profilaqtika mTeli mosaxleobis anda misi umravlesi nawilis mimarT tardeba, xolo
individualuri xorcieldeba romelime epidemiologiuri niSnis (sqesi, asaki, profesia)
mixedviT gamoyofil riskis jgufSi. aseTi profilaqtikis magaliTebia acrebis Catareba da
imunoglobulinoprofilaqtika epidCvenebiT, aseve samrewvelo obieqtebze gamajansaRebeli
RonisZiebebis gatareba.
populaciuri profilaqtikis upiratesobaa is, rom igi ar saWiroebs riskis jgufebis
identifikacias, xolo naklia is, rom calkeul pirebs nakleb sargeblobas aZlevs. amis
magaliTia usafrTxoebis Rvedebis gamoyeneba transportis marTvisas. umravlesi adamianebi
amerikasa da evropaSi sargebloben aseTi RvedebiT mTeli sicocxlis manZilze. mTlianad
usafrTxoebis Rvedebis gamoyeneba sasargebloa sazogadoebisTvis, magram calkeuli adamianebis
TvalsazrisiT misi sargebloba arcTu ise maRalia. es movlena cnobilia `prevenciuli
paradoqsis saxiT~.
individualuri pirveladi profilaqtika sakmaod efeqturia riskis jgufebis
pirebisaTvis, magram misi naklia is, rom aseTi jgufebis gamosavlineblad saWiroa skriningis
Catareba, rac xSirad teqnikur sirTuleebTan da damatebiT xarjebTan aris dakavSirebuli.

8.3. meoradi profilaqtika

meoradi profilaqtikis mizania daavadebis gamovlena misi ganviTarebis adreul stadiaSi,


rodesac igi usimptomod mimdinareobs, an klinikuri suraTi sustadaa gamoxatuli, raTa
drouli mkurnalobis meoxebiT SeaCeron misi ganviTareba. avadmyofTa gamovlineba xdeba
skrininguli testebis saSualebiT (mamografia, eleqtrokardiografia, nacxis gamokvleva
papanikolaus wesiT da sxva). meoradi profilaqtika saSualebas gvaZlevs Tavidan aviciloT
arasasurveli gamosavali, magaliTad sikvdili, invalidizacia, qronizacia.
meoradi profilaqtikis efeqturobas ganapirobebs sxvadasxva faqtorebi:
a. ramdenad aris SesaZlebeli daavadebis adreul stadiaSi, maSin rodesac klinikuri
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suraTi sustadaa gamoxatuli, misi diagnostireba. e. i. arsebobs Tu ara diagnostikuri
testebi, romelTa saSualebiTac SeiZleba daavadebis diagnozis dasma sawyis periodSi.
b. ramdenad mgrZnobiare, specifikuri da advili gamosayenebelia diagnostikuri testebi.
g. aris Tu ara daavadebis adreul stadiaSi mkurnalobis usafrTxo, efeqturi da
xelmisawvdomi meTodebi.
mTeli rigi daavadebebisas metad efeqturi gamodga meoradi profilaqtika. amis magaliTia
papanikolaus nacxis gamoyeneba saSvilosnos kibos profilaqtikis mizniT. am meTodis meoxebiT
moxerxda daavadebis mZime formebis mkveTri Semcireba. misi gamoyeneba iwyeba qalis mier
sqesobrivi cxovrebis dawyebidan. Tu qali gamokvlevas itarebs 10 weliwadSi erTxel, maSin
saSvilosnos kibos invaziuri formebis ganviTareba 61,4%-iT mcirdeba. xuT wliani intervaliT
gamokvlevebisas – 83,6%-iT, sam wliani intervalisas – 90,8%-Si, xolo Tu gamokvlevebi 2
weliwadSi erTxel Catardeba, maSin invaziuri formebis ganviTarebis albaToba 92,5% - iT
mcirdeba.
meoradi profilaqtikis magaliTia axalSobilTa gamokvleva fenilketonuriaze. am
gamokvlevis Catareba rekomendebulia samSobiaro saxlSi da Semdeg dabadebidan me – 3 kviras.
am paTologiis gamovlenis SemTxvevaSi, Tu bavSvis sakvebSi SevzRudavT fenilalaninis
Semcvelobas 4 - 8 wlis ganmavlobaSi (sasurvelia mTeli cxovrebis manZilze), maSin aseT
bavSvTa 95% normaluri inteleqtiT viTardeba. winaaRmdeg SemTxvevaSi bavSvebi gonebrivad
CamorCenilebi iqnebian. metabolizmis es darRveva 100 000 axalSobilze 2–4 SemTxvevis
sixSiriT gvxvdeba. skriningi fenilketonuriaze sakmaod did ekonomikur efeqtsac iZleva.
farTod gavrcelebul RonisZiebad iTvleba aseve saSualo da xanSiSesul asakSi sisxli
wnevis sistematuri gasinjva hipertoniis gamosavlenad da mis Semdgom samkurnalod. aseve kanis
sinjebi da gulmkerdis rentgenologiuri gamokvlevebi tuberkulozis gamosavlenad da
samkurnalod.
8.4. mesameuli profilaqtika

maSin, rodesac daavadeba gamovlenilia, tardeba mesameuli profilaqtikis RonisZiebebi,


raTa Tavidan aviciloT mdgomareobis damZimeba da garTulebebis ganviTareba. mesameuli
profilaqtika Terapiuli da reabilitaciuri medicinis mniSvnelovani aspeqtia, rac saSualebas
iZleva Tavidan iqnas acilebuli fizikuri ukmarisoba da Sromisuunaroba, minimumamde iqnas
dayvanili tanjva, romelic gamowveulia janmrTelobis dakargviT da ganukurnebeli
mdgomareobisadmi adaptaciis miRweva. xSirad Zalian Znelia zRvaris gavleba mesameul
profilaqtikasa da mkurnalobas Soris, radgan magaliTad qronikuli daavadebebis
mkurnalobisas erT–erTi mTavari amocanaa recidivebis Tavidan acileba. mesameuli profilaqtika
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gansakuTrebiT mniSvnelovania iseTi daavadebebisas, rogoricaa poliomieliti, insulti,
sxvadasxva saxis travmebi, sibrmave da sxva paTologiebi. am mdomareobebisas daavadebaTa
reabilitacia saSualebas iZleva, rom pacientma monawileoba miiRos sazogadoebriv cxovrebaSi.
mesameul profilaqtikas xSirad iyeneben mZimed mimdinare daavadebebisas, romlebic,
rogorc wesi, letalobiT mTavrdeba. aseT dros profilaqtikis mizania ara sikvdilis Tavidan
acileba, aramed sicocxlis gaxangrZliveba. magaliTad Tanamedrove etapze ar arsebobs gverdiTi
amiotrofuli sklerozis mkurnaloba, romelic, rogorc wesi, sasunTqi da saylapavi kunTebis
damblis gamo sikvdiliT mTavrdeba. magram gulmodgine samedicino movlisas, romelic
gastrostomiasac gulisxmobs, raTa Tavidan iqnas acilebuli gauwyloeba da SimSili, sakmaod
xangrZlivdeba sicocxle.

8.5. s k r i n i n g i

skriningi aris aradiagnostirebuli daavadebis, defeqtis an riskis faqtoris


identifikacia gamokiTxviT (Tambaqos moweva), fizikaluri gamokvlevebiT (prostatis palpacia),
laboratoriuli testebiT (SardSi fenilalaninis gansazRvra) an sxva procedurebiT (mag.
sigmoskopia). skriningis saSualebiT SeiZleba adamianTa im jgufidan, romlebic TiTqos
praqtikulad janmrTelni arian, gamovyoT kontingenti, romelTac sxvadasxva daavadeba aqvT. mas
viyenebT pirveladi profilaqtikisas, xolo meoradi profilaqtikis Catareba mis gareSe
SeuZlebelia. savaldebuloa skriningis Catarebis Semdeg gamovlenil avadmyofTa gamokvlevebi
da mkurnaloba.
skriningis ramdenime saxe arsebobs:
❖ masobrivi skriningi – xdeba mTeli mosaxleobis gamokvleva;
❖ mravalprofiliani skriningi – gamoiyeneba erTdroulad sxvadasxva skrininguli
testebi;
❖ mizanmimarTuli skriningi – tardeba adamianTa garkveul jgufSi, romlebic
specifikuri faqtoris zemoqmedebis qveS arian. magaliTad sawarmoebSi muSaTa gamokvleva,
gansakuTrebiT ki iseT sawarmoebSi sadac gamoiyeneba tyvia, azbesti da sxva mavne nivTierebebi.
saZiebeli anu `oportunistuli~ skriningi warmoebs pacientebSi, romlebmac mimarTes
eqimebs sxvadasxva problemebis gamo.
skriningis Catarebisas aucilebelia garkveuli kriteriumebis gaTvaliswineba, rac
mocemulia cxrilSi #62.

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cxrili #62
kriteriumebi, romlebic unda iqnes gaTvaliswinebuli, rodesac vapirebT CavataroT

skriningi:

daavadeba mZime daavadebis farTo gavrceleba preklinikur


stadiaSi, xangrZlivi periodis arseboba daavadebis
pirveli niSnebis gamovlenasa da klinikuri suraTis srul
gamovlenas Soris.
diagnostikuri testi specifikuri, mgrZnobiare da iafi, usafrTxo da misaRebi,
saimedo.
diagnostika da mkurnaloba SesaZloa efeqturi da usafrTxo mkurnaloba.

skriningis Catarebisas unda vicodeT Tu ra samedicino problemebs an daavadebas


vikvlevT. magaliTad rutinuli gamokvlevebisas xSirad niSnaven Sardis saerTo analizs. magram
am analiziT SeiZleba sxvadasxva paTologiis gamovlena - Saqriani diabetis, Sardis gamomyofi
gzis usimptomo infeqciis, kenWovani daavadebis da sxva. amitom sanam am gamokvlevas davniSnavT,
unda gadavwyvitoT, aqvs Tu ara azri mis gakeTebas da Tu aqvs, romeli daavadebis gamosavlenad
vatarebT skrinings.
rogorc cxrilidan Cans skriningis Catareba rekomendebulia iseTi daavadebisaTvis,
romelic gavrcelebulia mosaxleobaSi. magaliTad sarZeve jirkvlis kibo sakmaod
gavrcelebuli paTologiaa saSualo da xanSiSesuli asakis pirebSi, amdenad skrininguli
gamokvlevis Catareba am periodSi sakmaod mniSvnelovani RonisZiebaa. maSin rodesac 20 wlis
qalebSi aRniSnuli daavadebis maCvenebeli erTis tolia 100 000 qalze, amitomac am asakobriv
jgufSi gamokvlevis Catareba ar aris gamarTlebuli.
skriningis obieqti unda iyos iseTi daavadeba, romlis naadrevi diagnostika saSualebas
iZleva Tavidan aviciloT mZime paTologiis ganviTareba. amis magaliTia metabolizmis iseTi
Tandayolili paTologia, rogoricaa fenilketonuria, aseve kibos zogierTi formebi,
magaliTad, saSvilosnos yelis kibo.

8.6. infeqciur daavadebaTa imunoprofilaqtika

infeqciur daavadebaTa winaaRmdeg brZolis saqmeSi mniSvnelovan rols asrulebs


imunoprofilaqtika. es RonisZiebaTa sistemaa, romelic mimarTulia infeqcur daavadebaTa
aRmocenebisa da gavrcelebis SesazRudad, agreTve maTi likvidaciisaken profilaqtikuri
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acrebis Catarebis gziT. profilaqtikuri acrebi aris adamianis organizmSi imunuri
preparatebis Seyvanis gziT infeqciuri daavadebebis mimarT specifikuri imunitetis Seqmna.
mTeli rigi infeqciuri daavadebebisas, romelTa infeqciis wyaroze da gadacemis
meqanizmze zemoqmedeba Sedegs ar iZleva, imunoprofilaqtika erTaderTi profilaqtikuri
saSualebaa, romlis meoxebiTac SesaZlebelia daavadebis gavrcelebis aRkveTa. upirveles
yovlisa, es aris infeqciuri daavadebebi gadacemis aerogenuli meqanizmiT. mravali wlis
gamocdilebam aCvena, rom gegmiani imunizaciiT SesaZlebelia infeqciuri daavadebis epidemiur
procesze efeqturi zemoqmedeba. 1958 wels, janmos mier miRebul iqna globaluri programa
msoflioSi naturaluri yvavilis likvidaciisaTvis imunoprofilaqtikis saSualebiT. es
programa warmatebiT iqna realizebuli da 1980 wels, janmos XXXIII ansambleaze,
oficialurad gamoacxades, rom msoflioSi likvidirebulia es erT-erTi yvelaze ufro
gavrcelebuli da mZime infeqciuri daavadeba, romelmac saukuneebis manZilze aseulobiT
milioni adamianis sicocxle Seiwira. unda aRiniSnos, rom yvavilis likvidacia msoflios
daaxloebiT 313 milioni dolari daujda, maSin, rodesac am daavadebas SeeZlo yovelwliurad
msofliosTvis 1-2 miliardi dolaris zianis miyeneba.
yvavilis likvidaciis programis swrafad da efeqturad Sesrulebam, janmos safuZveli
misca, 1974 wels mieRo imunizaciis gafarToebuli programa. igi miznad isaxavda msoflios
yvela qveyanaSi 6 infeqciuri daavadebis mimarT (tuberkulozi, difTeria, tetanusi, yivanaxvela,
poliomieliti, wiTela) aqtiuri imunizaciis Catarebas da amis Sedegad maTi gavrcelebis
aRkveTas. es daavadebebi SemTxveviT ar iqna SerCeuli, isini seriozul zians ayenebdnen
mosaxleobis janmrTelobas. magaliTad, aRniSnul periodSi wiTela Sedioda im daavadebaTa
aTeulSi, romlebic yvelaze xSirad iwvevdnen bavSvTa sikvdilianobas. yovelwliurad
daaxloebiT 2.5 mln. bavSvi iRupeboda am infeqciiT. amasTan, acrebis SemoRebamde, 3 wlis
asakamde praqtikulad yvela bavSvi, wiTelaTi avaddeboda. axalSobilTa tetanusiT, romelic
metad seriozul problemas warmoadgens dabali da saSualo Semosavlebis mqone qveynebisaTvis,
yovelwliurad 1 mln. bavSvi iRupeboda. aranakleb zians ayenebda bavSvebs yivanaxvela. wlis
manZilze am daavadebiT gamowveuli letaluri gamosavali 0.5-1.0 mln. SemTxvevaSi aRiniSneboda.
mTlianad ki zemoTaRniSnuli 6 infeqciuri daavadebiT yovelwliurad dabali da saSualo
Semosavlebis qveynebSi dabadebuli 90 mln. bavSvidan 5 mln. iRupeboda. swored am mdgomareobam
aiZula janmos mesveurebi da samedicino samyaro, mieRoT imunizaciis gafarToebuli programa,
romlis realizacia ZiriTadad 1977 wlidan daiwyo. am programis mixedviT 1990 wlisaTvis
msoflios yvela qveyanaSi unda Seqmniliyo aucilebeli pirobebi yvela bavSvis imunizaciisaTvis.
dReisaTvis msoflioSi acrebi moicavs bavSvTa mosaxleobis 80%-s - yovelwliurad icreba

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daaxloebiT 130 mln. bavSvi. amJamad umravles qveyanebSi zemoTaRniSnuli eqvsi daavadebis garda
imunizacia tardeba B hepatitis, wiTuras, epidemiuri parotitis da hib-infeqciis mimarTac.
dReisaTvis vaqcinebis saSualebiT warmatebiT ebrZvian 40-ze met infeqcias. uaxloes xanSi
praqtikaSi dainergeba axali vaqcinebi, romelTa saSualebiTac milionobiT sicocxlis gadarCena
moxerxdeba.
yvela preparati, romelic gamoiyeneba imunoprofilaqtikisaTvis, iyofa 3 jgufad: a)
preparatebi, romlebic aqtiuri imunitetis Sesaqmnelad gamoiyeneba, b)preparatebi, romlebic
uzrunvelyofen pasiuri imunitetis Seqmnas, da g) eqspres-profilaqtikisaTvis gamoyenebuli
preparatebi.
aqtiuri imunitetis Sesaqmnelad iyeneben vaqcinebs.
vaqcinebi ewodeba biologiur preparatebs, romlebic gamoiyeneba aqtiuri imunitetis
Sesaqmnelad. ZiriTadad, arsebobs Semdegi ZiriTadi jgufis vaqcinebi: cocxali, daxocili,
qimiuri, anatoqsinebi, rekombinantuli, veqtoruli da rnm - vaqcinebi.
cocxali vaqcinebi Seicaven mikrobebisa da virusebis atenuirebul (dasustebul) Stamebs,
romlebsac Cveulebrivi Stamebisagan gansxvavebiT daqveiTebuli virulentoba aqvT, xolo
imunogenoba - srulad SenarCunebuli, anu SeswevT unari, adamianis organizmSi Seyvanisas
gamoimuSaon xelovnuri aqtiuri imuniteti. cocxali vaqcinebis gamoyenebisas, umravles
SemTxvevaSi gamomuSavdeba sakmaod myari imuniteti, amitomac vaqcinaciis kursi metwilad erTi
acrisagan Sedgeba. revaqcinaciis saWiroebisas intervali vaqcinaciidan revaqcinaciamde sakmaod
xangrZlivia. cocxal vaqcinebs miekuTvneba naturaluri yvavilis, tularemiis, yviTeli
cxelebis, cofis, tuberkulozis, poliomielitis, wiTelas, epidemiuri parotitis, wiTuras,
rotavirusuli infeqciis, Savi Wiris, tkipismieri encefalitis, brucelozis, qu cxelebis da
sxva daavadebaTa vaqcinebi. unda aRiniSnos, rom yvavilis, tularemiis da yviTeli cxelebis
vaqcinebi etalonur vaqcinebad iTvleba maRali imunogenobis gamo. samwuxarod, iSviaTad
vaqcinalurma Stamebma SeiZleba gamoiwvios daavadebisaTvis damaxasiaTebeli klinikuri suraTis
ganviTareba, rac SeiZleba gaxdes mizezi cocxali vaqcinis nacvlad sxva saxis vaqcinis
gamoyenebisa. magaliTad, aseTi situacia aris poliomielitis SemTxvevaSi, rodesac cocxali
vaqcinis nacvlad dRes daxocili vaqcinis gamoyeneba xdeba, Tumca igi efeqturobiT
Camouvardeba cocxal vaqcinas.
daxocili (inaqtivirebuli) vaqcinebi warmoadgenen gacxelebiT an qimiuri nivTierebebiT
(formalini, spirti, acetoni) daxocil (inaqtivirebul) mikrobebs da virusebs, romelTac
antigenuri Tvisebebi SenarCunebuli aqvT. rogorc wesi, cocxal vaqcinebTan SedarebiT
daxocili vaqcinebi naklebad imunogenuria, rac organizmSi maTi mravaljeradi Seyvanis

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aucileblobas ganapirobebs. daxocil vaqcinebs miekuTvneba muclis tifis, qoleris,
yivanaxvelas, leptospirozis vaqcinebi. amasTan, radgan aseT vaqcinebSi didi raodenobiT aris
mikrobuli sxeulebi (virusuli korpuskulebi), zogjer acris Semdeg SeiZleba ganviTardes
Zlieri mtkivneuloba da qronikul daavadebaTa gamwvaveba. amitom, aseTi vaqcinebis gamoyenebisas
acris ukuCvenebebis ricxvi izrdeba. amasTan, daWimuli imunitetis Sesaqmnelad vaqcinaciis
kursi ramdenime acrisagan Sedgeba. revaqcinaciebic xSirad tardeba, rac zrdis acris
Rirebulebas da iwvevs organizaciul siZneleebs. xSirad irRveva acrebis kalendaric
obieqturi mizezebis gamo. amis miuxedavad, inaqtivirebul vaqcinebs mniSvnelovani adgili
ukaviaT specifikuri profilaqtikis sistemaSi, radgan aseTi vaqcinebis gamoyenebisas
gamoricxulia gamomwvevze specifikuri reaqciis ganviTareba.
qimiuri vaqcinebi daxocili vaqcinebis saxesxvaobaa, maTSi mTeli mikrobuli da virusuli
ujredebis nacvlad imunogenur funqcias asrulebs qimiuri meTodebiT maTgan gamocalkevebuli
xsnadi antigenebi. qimiuri vaqcinebi gamoiyeneba muclis tifis, paratifebis dros. amJamad
yvelaze farTod qimiuri vaqcinebidan gamoiyeneba yivanaxvelas sawinaaRmdego araujreduli
vaqcina. qimiur vaqcinebs miekuTvneba aseve koniugirebuli vaqcinebi. aseTebia: hib infeqciis,
meningokokuri infeqciis da pnevmokokuri infeqciis sawinaaRmdego vaqcinebi. am vaqcinebSi
polisaqaridebi (romlebsac susti imunogenuri Tvisebebi gaaCniaT) qimiurad dakavSirebulia
(koniugirebulia) specialur cilebTan (ufro xSirad difTeriis da tetanusis toqsoidebTan),
rac iwvevs Zlier imunur pasuxs adamianis organizmSi.
rekombinantuli vaqcinebi: bolo wlebSi farTod gamoiyeneba genuri inJineriis
saSualebiT miRebuli rekombinantuli vaqcinebi. magaliTad, B hepatitis sawinaaRmdego vaqcina.
aseTi vaqcinebis damzadebisas, usafrTxo mikrobis (nawlavis Cxiri, safuari soko) genomSi
SeyavT infeqciuri daavadebis gamomwvevi geni, romelic pasuxs agebs im antigenis gamomuSavebaze,
romlis moqmedebis sapasuxod organizmSi iqmneba humoruli imuniteti. magaliTad, B hepatitis
HBs-antigenis geni. es meTodi saSualebas iZleva miviRoT CvenTvis saintereso antigeni didi
raodenobiT.
anatoqsini miiReba egzotoqsinze garkveuli drois manZilze formalinis da maRali
temperaturis zemoqmedebiT, ris Sedegadac igi kargavs toqsigenobas, magram imunogenuri
Tvisebebi SenarCunebuli aqvs. anatoqsinebi sakmaod imunogenuri vaqcinebia, magram isinic
organizmSi myari imunitetis gamosamuSaveblad mravaljerad unda iqnas Seyvanili. samedicino
praqtikaSi ZiriTadad gamoiyeneba difTeriis, tetanusis, botulizmis, aerovani gangrenis,
stafilokokuri anatoqsinebi.
veqtoruli vaqcinebis safuZvelia veqtori, anu iseTi virusi, romliTac adamiani xSirad

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inficirdeba. ZiriTadad es aris adamianis adenovirusi. mas acileben im genebs, romlebic mis
virulentobas ganapirobebs. aseT viruss SeuZlia SeaRwios adamianis ujredebSi, magram ar aqvs
masSi replikaciis unari, anu ver ayenebs veranair zians verc ujredebs da verc mTlianad
organizms. is ubralod asrulebs gadamtanis (transportirebis) funqcias. mis genomSi xdeba
CarTva im genis, romlis mitanac gvainteresebs adamianis ujredebSi. ukanasknel periodSi mas
iyeneben koronavirusuli infeqciis vaqcinebis dasamzadeblad. kerZod adenovirusSi xdeba SARS-
CoV-2-is im genis Setana, romelic axdens am virusis S cilis kodirebas. veqtors
(adenoviruss) es geni miaqvs ujredSi da iq xdeba am cilis sinTezi, romlis sapasuxod
organizmi gamoimuSavebs antisxeulebs. amave dros unda aRiniSnos, rom ori-sami kviris Semdeg
organizmSi ukve aRar aris adenovirusi. dReisaTvis yvelaze popularuli am tipis vaqcinaa
Astrazeneca-s vaqcina, romelSic veqtorad gamoyenebulia Simpanzes adenovirusi.
bolo periodSi gamoiyeneba aseve rnm-vaqcinebi. aseT vaqcinebSi moqmedi sawyisia paTogenis
rnm, romelic cilis kodirebas axdens. masTan erTad vaqcinaSi aris lipiduri garsi, romelic
virusis rnm-s icavs da xels uwyobs mis SeWras maspinZeli organizmis ujredebSi. rodesac
vaqcinuri rnm ujredSi moxvdeba, misi zemoqmedebiT ujredi iwyebs rnm-iT kodirebuli cilis
sinTezs. es cila moqmedebs rogorc antigeni da organizmSi gamomuSavdeba Sesabamisi
antisxeulebi. am principiT mzaddeba dRes vaqcinebi koronavirusuli infeqciis mimarT.
rodesac laparakia vaqcinebze, aucilebelia ori terminis – adiuvantis da konservantis
ganmarteba.
adiuvanti aris nivTiereba an nivTierebaTa kompleqsi, romelic Sedis vaqcinis
SemadgenlobaSi da misi saSualebiT xdeba vaqcinis imunogenuri Tvisebebis gaZliereba.
adiuvantis moqmedebis meqanizmi aris Semdegi: vaqcinuri Stamebi adsorbirebulia adiuvantze da
is adamianis organizmSi rCeba didi xnis manZilze, rac aseve xangrZlivi drois ganmavlobaSi
iwvevs vaqcinis zemoqmedebas organizmze, kerZod mis imunur sistemaze, rac apirobebs ufro
Zlieri imunitetis gamomuSavebas. farTod gamoyenebuli adiuvantia – aluminis hidroJangi
AL(OH3). dReisaTvis iyeneben sxva adiuvantebsac.
konservanti aris nivTiereba, romelsac Zalian mcire dozebiT umateben vaqcinas, raTa ar
moxdes masSi im baqteriebis da sokoebis zrda, romlebic SeiZleba mravaldoziani vaqcinis
flakonSi moxvdnen, misi mravaljeradi gamoyenebis dros. yvelaze farTod gamoyenebuli
konservantia Tiomersali, romelic aris vercxliswylis Semcveli, romelic sakmaod toqsikuri
nivTierebaa. es aris erT-erTi ZiriTadi argumenti vaqcinebis winaaRmdeg mebrZoli adamianebisa,
rom vaqcinebi Seicaven nivTierebas, romelic xasiaTdeba Zlieri toqsikurobiT, miuxedavad imisa,
rom Tiomersalis koncentracia vaqcinebSi 0.1%-s ar aRemateba. mravali eqsperimentiT dadginda,

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rom es doza aranair uaryofiT zegavlenas ar axdens vaqcinirebuli adamianebis organizmze.
unda aRiniSnos, rom mTeli rigi vaqcinebi saerTod ar Seicavs Tiomersals. aseTebia wiTelas,
wiTuras, ybayuras, poliomielitis oraluri vaqcinebi da sxva. xSirad vaqcinebi mzaddeba
asocirebuli an kombinirebuli saxiT, anu preparati erTdroulad Seicavs ramdenime
antigens. kombinirebuli vaqcinebia – difTeria-yivanaxvela (araujreduli)-tetanusi-
poliomielitis tetravaqcina, tetanusi-difTeriis divaqcina, wiTela-wiTura-ybayuras
trivaqcina. ukanasknel periodSi kombinirebul vaqcinaTa ricxvs miemata axali preparatebi.
esenia: a) dyat + hepb + hib (DPT-HepB-Hib) _ difTeria, yivanaxvela (araujreduli),
tetanusis, B hepatitis da hib infeqciis sawinaaRmdego vaqcina, romelic aris xuTkomponentiani
preparati. b) dyat + hepb + hib + ipv (DPT-HepB-Hib-IPV) _ difTeria, yivanaxvela
(araujreduli), tetanusis, B hepatitis, hib infeqciis da poliomielitis sawinaaRmdego vaqcina,
romelic aris eqvskomponentiani preparati (heqsa vaqcina). mravalricxovani gamokvlevebiT
dadasturebulia, rom ramdenime vaqcinis erTdrouli Seyvana adamianis organizmSi ar iwvevs
romelime antigenis mimarT imunuri pasuxis dasustebas, rac saSualebas iZleva damzaddes
kombinirebuli vaqcinebi. maTi gamoyenebisas mcirdeba ineqciebis ricxvi, asacrel pirTa
vizitebis raodenoba amcrel kabinetSi, martivdeba acraTa kalendari, mcirdeba vaqcinaciaze
saxelmwifos mier daxarjuli Tanxebi vaqcinaciaTa transportirebis, Senaxvis da acris
Tanxebis Semcirebis xarjze.
adamianis organizmSi vaqcinebis Seyvanis gzebia – peroraluri, kanSi, kanqveS, kunTebSi,
intranazaluri. kanze keTdeba yvavilis, tularemiis, brucelozis da sxva vaqcinebi, kanSi –
tuberkulozis vaqcina, kanqveS – daxocili vaqcinebi da zogierTi cocxali vaqcina, kunTebSi -
difTeriis da tetanusis vaqcinebi. peroralurad – poliomielitis cocxali vaqcina. iseT
SemTxvevebSi, rodesac drois mokle periodSi saWiroa didi raodenobis adamianTa acra, iyeneben
vaqcinebis intranazaluri da peroraluri Seyvanis gzebs.
imunoprofilaqtikisaTvis gamoiyeneba serTificirebuli vaqcinebi, romelTa xarisxze
pasuxismgebelia misi damamzadebeli firma. vaqcinebi unda akmayofilebdnen janmos moTxovnebs.
Sratebi. xelovnuri pasiuri imunitetis Sesaqmnelad gamoiyeneba sisxlis Srati. mas
amzadeben an hiperimunuri cxovelebisagan (heterologiuri Sratebi) an imunuri adamianebisagan
(homologiuri Sratebi). am ukanasknels amzadeben donorTa an placenturi sisxlisagan. Sratebi
Seicaven damcvel antisxeulebs – gama-globulinebs, romelTa saSualebiT adamianis organizmSi
iqmneba pasiuri imuniteti, romlis xangrZlivoba 3-4 kviramde meryeobs. samedicino praqtikaSi
iyeneben antitetanur, antibotulinur (A, B , C da E tipebis Semcveli), antigangrenozul,
antidifTeriul Sratebs, agreTve wiTelas, antirabiul, jilexis sawinaaRmdego gama-

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globulinebs. amJamad heterologiuri, naklebad gasufTavebuli Sratebis nacvlad, sul ufro
farTod iyeneben gasufTavebul homologiur imunoglobulinebs. Sratebi da imunoglobulinebi
gamoiyeneba rogorc profilaqtikis, ise samkurnalo mizniT.
infeqciur daavadebaTa eqspres-profilaqtikis mizniT (dainficirebul organizmSi
aferxeben gamomwvevTa ganviTarebas da gamravlebas) iyeneben zogierT vaqcinas (cofis
sawinaaRmdego), baqteriofags da interferons.
interferoni dabalmolekuluri masis mqone cilaa, romelsac antivirusuli moqmedeba
gaaCnia. mas gamoimuSavebs organizmSi sxvadasxva biologiuri agentebis SeWris sapasuxod
makrofagebi, limfocitebi, Zvlis tvinis ujredebi, Timusi. interferoni axdens virusebis
reproduqciis inhibirebas organizmis ujredebSi. amJamad interferons iReben genuri inJineriis
meTodiTac. am gziTaa miRebuli reaferoni, alfa- da gama-interferoni, romelTac iyeneben B da
C hepatitebis samkurnalod, aseve onkologiaSic. saerTod, interferoni gamoiyeneba rogorc
samkurnalo, aseve profilaqtikis mizniT.
fagi baqteriis virusia, romelic maT liziss iwvevs. isini organizmSi rCebian ramdenime
dRes. maT iyeneben zogierTi infeqciuri daavadebis profilaqtikis da mkurnalobis mizniT.
samedicino praqtikaSi farTod iyeneben muclis tifis, qoleris, dizenteriis, salmonelozis,
stafilokokur fagebs.
samedicino wreebi sistematur muSaobas awarmoeben biologiuri preparatebis da
gansakuTrebiT, vaqcinebis xarisxis gasaumjobeseblad da axali vaqcinebis dasamzadeblad.
ocdameerTe saukuneSi aqcenti keTdeba kombinirebuli (asocirebuli) vaqcinebis damzadebaze,
romelTa gamoyenebiT SesaZlebeli iqneba imunitetis Seqmna erTdroulad ramdenime infeqciuri
daavadebis mimarT. amasTan, upiratesoba mieniWeba enteraluri Seyvanis gzas, xolo
parenteraluri gzis dros acris jeradoba iqneba erTi an maqsimum ori. sagrZnoblad
Semcirdeba vaqcinebis reaqtogenoba, rac mas ufro misaRebs gaxdis sazogadoebis farTo
fenebisTvis. amasTan, sagrZnoblad gaizrdeba im daavadebaTa ricxvi, romelTa profilaqtika
ganxorcieldeba vaqcinebiT. aseT daavadebaTa ricxvSi, upirveles yovlisa, Seva meningokokuri
infeqcia, diareuli daavadebebi da sxv. gamoyenebis farTo prespeqtiva eqneba C hepatitis, aiv-
infeqciis, helikobaqteriozis sawinaaRmdego vaqcinebs maTi damzadebis SemTxvevaSi.

8.6.1. gegmiani acrebis erovnuli kalendari

profilaqtikuri acrebi or jgufad iyofa: gegmiani da epidCvenebiT. epidemiologiuri


CvenebiT acrebi tardeba im SemTxvevaSi, rodesac adgili aqvs infeqciuri daavadebis
gavrcelebis saSiSroebas, anda adgili aqvs daavadebis epidafeTqebas. am saxis acrebi tardeba
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agreTve garkveuli profesiis pirebSi, romlebic advilad SeiZleba dainficirdnen romelime
infeqciiT. magaliTad, Savi Wiris, brucelozis, tularemiis laboratoriaSi muSaobis dawyebis
win personali aucileblad unda aicras Sesabamisi vaqciniT.
gegmiani acrebi utardebaT bavSvebs da mozardebs gansazRvrul asakSi konkretuli sqemiT,
rasac acrebis erovnuli kalendari ewodeba. yvela qveyanaSi moqmedebs aseTi kalendari,
romelic, SesaZloa, erTmaneTisagan gansxvavebuli iyos. janmos rekomendaciebis gaTvaliswinebiT
janmrTelobis dacvis saministro amtkicebs qveyanaSi moqmedi acrebis erovnul kalendars.
saqarTveloSi acrebis erovnuli kalendaris bolo varianti damtkicebulia 2019 wlis 16
seqtembers saqarTvelos okupirebuli teritoriebidan devnilTa, Sromis, janmrTelobisa da
socialuri dacvis ministris brZaneba #01-60/n-iT. am kalendris mixedviT saqarTveloSi
tardeba gegmiani acrebi Semdegi infeqciuri daavadebis mimarT, esenia: B hepatiti, tuberkulozi,
difTeria, tetanusi, yivanaxvela, poliomieliti, hib-infeqcia, rotavirusuli infeqcia,
pnevmokokuri infeqcia, wiTela, wiTura, epidemiuri parotiti, papilomavirusuli infeqcia. am
brZanebaSi 2020 wlis 20 maiss, brZaneba #01-51/n-iT Setanilia garkveuli cvlilebebi.
maqsimaluri daWimulobis imunitetis gamosamuSaveblad aucilebelia acrebis Catareba im
asakSi da im sqemis mixedviT, romelic kalendarSia mocemuli. acrebis sqemis darRvevisas ara
marto ufro susti imuniteti muSavdeba, aramed seriozulad matulobs postvaqcinuri
reaqciebic. magaliTad, difTeria-yivanaxvela-tetanusis vaqcinaciis kursis damTavreba 4 Tvis
asakisaTvis mniSvnelovnad amcirebs garTulebebis risks, 10 Tvis asakSi vaqcinaciis kursis
damTavrebasTan SedarebiT.
rogorc aRiniSna, saqarTveloSi moqmedi acrebis erovnuli kalendari nawilobriv
gansxvavdeba sxva qveynebSi moqmedi kalendarisagan. magaliTad, bevr maRali Semosavlebis mqone
qveyanaSi ar tardeba tuberkulozis sawinaaRmdego acra. magram bevr dabali da saSualo
Semosavlebis qveyanaSi, sadac mosaxleobis umravlesobas mZime socialur-ekonomikur pirobebSi
uwevs cxovreba, am vaqcinis gamoyenebas didi praqtikuli mniSvneloba aqvs. aseve, amerikis
SeerTebul StatebSi gegmiani acrebi tardeba A hepatitze da Cutyvavilaze.

8.6.2. acris ukuCvenebebi

imunizaciis Sedegebi damokidebulia erTis mxriv, vaqcinis imunogenobaze da meores mxriv,


acrebiT mocvis doneze. meoce saukunis bolos ruseTSi, ukrainaSi, saqarTveloSi da sxva
qveynebSi difTeriis afeTqeba gamowveuli iyo imiT, rom difTeriis acrebiT mocvis done am
qveynebSi 30-40 %-s ar aRemateboda. avadobis donis mniSvnelovani SemcirebisaTvis unda aicras
asacreli kontigentis minimum 90%.
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amdenad, Zalian didi mniSvneloba aqvs acris ukuCvenebebis zust dacvas, raTa cru
ukuCvenebebis gamo ar gaizardos araimunur pirTa raodenoba, rac SeiZleba daavadebis
epidafeTqebis mizezi gaxdes. pediatriuli da samkurnalo qseli mTel rig SemTxvevebSi
arasworad gansazRvravs ukuCvenebebs, ris gamoc qveyanaSi SeiZleba sagrZnoblad moimatos
aucrelTa raodenobam.
acrebis ukuCvenebebi mimarTulia acris Semdgom periodSi arasasurveli garTulebebis
Tavidan asacileblad. calsaxad unda iTqvas, rom bevri ar aris im daavadebaTa ricxvi, romelTa
arseboba acris Catarebas uSlis xels.
ukuCveneba yvela vaqcinis SemTxvevaSi aris: mZime alergiuli reaqcia an garTuleba igive
vaqcinis wina dozaze – anafilaqsia, Soki, kolafsi, encefalopaTia an encefaliti, krunCxva
temperaturuli fonis gareSe. yvela cocxali vaqcinis SemTxvevaSi ukuCvenebaa –
kortikosteroidebis maRali dozebiT mkurnaloba, maalkilirebadi da antimetaboluri
preparatebiT an sxivuri TerapiiT mkurnaloba 2 kviraze xangrZlivi drois ganmavlobaSi,
leikozi da limfoma, orsuloba, simsivnuri daavadebebi, anafilaqsiuri reaqcia kvercxis
cilaze (Tu Sedis vaqcinis SemadgenlobaSi).
aris ukuCvenebebi, romlebic mxolod calkeuli vaqcinebis dros gvxvdeba: tuberkulozis
vaqcinis dros es aris aiv-infeqcia/Sidsi; difTeria-yivanaxvela (araujreduli)-tetanusi-
poliomielitis vaqcinisas – acridan 7 dRis ganmavlobaSi ganviTarebuli encefalopaTia, mZime
alergiuli reaqcia vaqcinis wina dozaze, an vaqcinis komponentze; oraluri poliovaqcinis –
aiv infeqcia/Sidsis klinikuri niSnebi (acra inaqtivirebuli vaqciniT tardeba), trivaqcinis -
wiTela- wiTura- ybayuras SemTxvevaSi – mZime imunodeficitebi, aragankurnebuli aqtiuri
tuberkulozi, anamnezSi anafilaqsiuri reaqciebi kvercxis cilaze; B hepatitis vaqcinis _ mZime
alergiuli reaqcia wina dozaze, an vaqcinis komponentze (mag. safuarze); rotavirusuli
infeqciis vaqcinis dros – mZime kombinirebuli imunodeficitis mdgomareoba, nawlavis
invaginacia anamnezSi; pnevmokokuri infeqciis vaqcinis dros – mZime alergiuli reaqcia vaqcinis
wina dozaze an vaqcinis komponentze; heqsavaqcinis SemTxvevaSi - acridan Svidi dRis
ganmavlobaSi ganviTarebuli ucnobi etiologiis encefalopaTia, progresirebadi nervuli
daavadebebi, arakontrolirebadi epilefsia, progresirebadi encefalopaTia da a.S.
vaqcinacia droebiT gadavaddeba Tu pacients aReniSneba zomieri an mZime mwvave
daavadebebi temperaturiT an mis gareSe.
jandacvis msoflios organizaciis rekomendaciebis mixedviT “1 Tveze meti” da mudmivi
ukuCvenebis diagnozis mqone bavSvebi 1 wlamde asakis bavSvebis raodenobis 2%-s ar unda
aRematebodes.

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aqve unda aRiniSnos e.w. cru ukuCvenebebi, anu iseTi paTologiebi Tu mdgomareobebi,
romlebic ar warmoadgenen vaqcinaciis ukuCvenebebs, magram maTi arsebobis rig SemTxvevaSi
mkurnali eqimebi acrebis Catarebas Tavs arideben. esenia: perinataluri encefalopaTia,
stabiluri nevrologiuri mdgomareoba, anemia, qronikuli tonzilitebi, otiti, alergia, asTma,
egzema, diaTezi, ganviTarebis mankebi, fermentopaTia, disbaqteriozi, hipotrofia, diarea
(intoqsikaciis gareSe), infeqciur daavadebasTan kontaqti axlo warsulSi, dRenakluloba da/an
mcire woniT dabadeba (>2000 gr), axalSobilTa hemolizuri daavadeba, ojaxSi acris Semdgomi
garTuleba, alergia naTesavebSi, epilefsia, romelic mkurnalobas emorCileba, orsuli deda,
bunebrivi an xelovnuri kveba, mcired an zomierad gamoxatuli adgilobrivi reaqcia vaqcinis
wina dozis Seyvanisas, mwvave daavadebis rekonvalescenciis faza da sxva.

8.6.3. acrebis organizacia

acrebis organizaciis erT-erTi mniSvnelovani aspeqtia samoqmedo teritoriaze bavSvTa


kontigentis sruli aRricxva, rasac awarmoeben eqimebi eqTnebTan erTad. amisTvis gamoiyeneba
dabadebis, gardacvalebis da samedicino dawesebulebaSi mimarTvianobis monacemebi. miRebuli
Sedegebi SeaqvT bavSvTa aRricxvis JurnalSi. TiToeul bavSvs eniWeba saregistracio nomeri,
romelic aseve fiqsirdeba bavSvis ganviTarebis istoriaSi da profilaqtikuri acrebis ruqaSi.
acrebi tardeba samedicino dawesebulebaSi da mas awarmoebs saTanado licenziis mqone
samedicino personali. amcreli kabineti ori oTaxisagan unda Sedgebodes: 1. saregistracio, 2.
acrebis Casatarebeli. saregistracio oTaxSi inaxeba saregistracio formebi da Jurnalebi,
romelTa Soris aRsaniSnavia profilaqtikuri acrebis ruqa – f. 063. misi Senaxvis yvelaze
misaRebi da gavrcelebuli formaa kartoTekuli sistema, rac mniSvnelovnad aadvilebs
asacreli kontingentis droul da srul dadgenas. organizebul bavSvebze calke kartoTeka
unda gamoiyos.
asacrel oTaxSi aucileblad unda iyos:
 macivari, romelic mxolod vaqcinebis Sesanaxad gamoiyeneba. masze moTavsebuli unda
iyos temperaturis yoveldRiuri (dReSi 2-jer) aRricxvis forma _ 1,7;
 magida instrumentebisa da asacreli preparatebisaTvis;
 karada instrumentebisa da medikamentebisaTvis;
 samedicino taxti, sadac pacients da/an mis Tanmxleb pirs eqneba dayovnebis
saSualeba;
 biqsebi steriluri masaliT;
 civi yuTi, yinulis elementebi, Termometri, Termoindikatorebi, erTjeradi
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Spricebi;
 usafrTxo yuTi gamoyenebuli Spricebisa da nemsebis Sesagroveblad;
 pirveladi samedicino daxmarebis da antiSokuri Terapiis afTiaqi, romelSic unda
iyos antihistaminuri preparatebi (suprastini, dimedroli, pipolfeni), kortikosteroiduli
preparatebi (adrenalini, prednizoloni, hidrokortizoni), sagule saSualebebi (korglikoni,
kofeini, strofantini), glukozis xsnari, fiziologiuri xsnari. niSaduris spirti, saTburi,
laxti;
aucilebelia agreTve gamdinare wylis arseboba.
acris win aucilebelia preparatis Semowmeba, kerZod, misi markireba, mTlianoba, aseve
Termoindikatoris Cveneba, vargisianobis vada.
ar SeiZleba gamoyenebul iqnes vaqcinebi da isini eqvemdebarebian Camowera/ganadgurebas:
 Seusabamo fizikuri mdgomareobisas;
 flakonis mTlianobis darRvevisas, aseve rodesac masze SeiniSneba bzarebi da/an
siTxis gamoJonvis niSnebi;
 flakonze gaugebari markirebis an misi ararsebobisas;
 gasuliania vargisianobis vada;
 darRveulia gamxsnelis flakonis mTlianoba da/an gamxsneli gayinulia;
 vaqcinas ar axlavs imave mwarmoeblis mier mowodebuli konkretuli gamxsneli;
 flakonis saxuravis mTlianoba dairRva arasteriluri nemsiT.
flakonis gaxsna da gamxsnelebis damateba unda warmoebdes aseptikis wesebis sruli
dacviT. asacreli adgili muSavdeba 70 %-iani spirtiT, Tu amis Taobaze sxva miTiTeba ar aris.
acrebi rogorc wesi, unda Catardes erTjeradi instrumentebiT.
acrebis Catarebis Taobaze mSoblebi winaswar unda iyvnen informirebulebi da maT unda
CautardeT saganmanaTleblo saubrebi. acris win aucilebelia asacreli piris samedicino
gamokvleva. mas unda gaezomos temperatura da gairkves, xom ara aqvs acrisadmi romelime
ukuCveneba. yvela acra keTdeba calke SpriciT. acris Catarebis Semdgom savaldebuloa rom
bavSvi imyofebodes samedicino meTvalyureobis qveS 30 wuTis ganmavlobaSi.
acris efeqturoba mniSvnelovnad aris damokidebuli Seyvanili vaqcinis dozaze, amitomac
preparatis zustad is raodenoba unda SeviyvanoT organizmSi, romelic miTiTebulia Tanmxleb
instruqciaSi. mcire dozebiT acrilebs ara marto ar umuSavdebaT imuniteti, aramed man
SeiZleba xeli Seuwyos organizmis alergizacias, xolo gazrdili dozebiT acram SeiZleba
gamoiwvios organizmis refraqteroba anda acris Semdgomi mZime garTulebebi da reaqciebi.
Catarebuli acra registrirdeba profilaqtikuri acrebis ruqaSi – forma # 063-Si, aseve
237
imunizaciis marTvis eleqtronul modulSi. am formis safuZvelze ivseba profilaqtikuri
acrebis baraTi – forma #01, romelic gankuTvnilia TiToeuli pirisTvis xelze gasacemad. da
nebismieri tipis dawesebulebaSi warsadgenad moTxovnis Sesabamisad.
kidev erTi momenti, romelsac acrebis organizaciaSi didi yuradReba eTmoba, aris
vaqcinebis transportireba da Senaxva Sesabamis temperatul reJimSi, rac civi jaWvis
saxeliTaa cnobili. am reJimis darRveva iwvevs vaqcinis biologiuri aqtivobis daqveiTebas da
reaqtogenobis zrdas. aseTi preparatebiT acril pirebs ar gamoumuSavdebaT Sesabamisi
imuniteti. amitomac civi jaWvis gareSe SeuZlebelia vaqcinoprofilaqtikis efeqturobis
uzrunvelyofa.
civi jaWvis pirobebis dasacavad aucilebelia:
 specialurad momzadebuli kadrebis arseboba.
 Sesabamisi samacivro danadgarebis sistemis uzrunvelyofa.
 civi jaWvis yvela etapze temperaturuli reJimis monitoringis uzrunvelyofa
Sesabamisi Termoindikatorebis meoxebiT.
yvela vaqcina unda inaxebodes macivarSi. sxvadasxva vaqcinas gansxvavebul temperaturul
reJimSi sWirdeba Senaxva. magaliTad, ar SeiZleba adsorbirebuli vaqcinebis gayinva, radgan am
dros xdeba antigenTa desorbcia da mkveTrad qveiTdeba vaqcinebis imunogenoba da paralelurad
izrdeba reaqtogenoba. cocxali vaqcinebis umravlesoba kargad Zlebs gayinul mdgomareobaSi,
amitomac, maT, rogorc wesi, uaryofiT temperaturaze inaxaven. Tumca, unda aRiniSnos,
rom maTi gamxsnelebis gayinva dauSvebelia.

8.6.4. acris Semdgomi reaqciebi da garTulebebi

miuxedavad imisa, rom Tanamedrove vaqcinebi Tavisi winamorbedebisagan gansxvavebiT


naklebad reaqtogenulia, acris Catarebis Semdeg acrilTa garkveul raodenobas SeiZleba
ganuviTardes acris Semdgomi reaqciebi, romlebic or jgufad iyofa: adgilobrivi da zogadi.
zogad reaqciebs miekuTvneba temperaturis momateba, saerTo sisuste, Tavis tkivili, Zilis
darRveva, tkivili saxsrebSi da muclis areSi, gulis reva, Rebineba da a.S.
adgilobriv reaqciebs miekuTvneba is cvlilebebi, romlebic vaqcinis Seyvanis adgilze
viTardeba. vaqcinis parenteruli Seyvanisas adgilobrivi reaqciebi vlindeba mtkivneulobiT
ineqciis adgilze, hiperemiis, infiltratis, SeSupebis ganviTarebiT da aseve regionuli
limfadenitis CamoyalibebiT. zogierTi cocxali vaqcinis gamoyenebisas, ineqciis adgilze
viTardeba specifikuri elementebi: magaliTad, tuberkulozis an tularemiis acrebisas. am
elementebis ganviTareba miuTiTebs postvaqcinuri imunitetis gamomuSavebaze.
238
intranazaluri da oraluri imunizaciisas adgilobrivi reaqciebi vlindeba kataraluri
movlenebiT da koniunqtivitiT. adgilobrivi reaqciebi maqsimalur ganviTarebas aRwevs acridan
24 saaTSi da grZeldeba 2-7 dRis manZilze; amis Semdeg qreba mkurnalobis gareSec. unda
aRiniSnos, rom temperaturis mcire momateba da mtkivneuloba ineqciis adgilze – niSnavs
organizmSi imunuri pasuxis gamomuSavebis procesis normalur mimdinareobas.
zogadi da adgilobrivi reaqciebi, romlebic gapirobebulia preparatis toqsikuri
moqmedebiT, ufro gamoxatulia pirveli acris Semdgom, xolo alergiuli reaqciebi ufro
xSiria ganmeorebiTi acrebis dros.
reaqtogenobis dasaSvebi done miTiTebulia vaqcinebis Tanmxleb instruqciebSi. im
SemTxvevaSi, Tu reaqciebi dasaSveb doneze ufro xSiria, maSin dgeba sakiTxi aRniSnuli seriis
vaqcinebis Semdgomi gamoyenebis Taobaze. sakiTxi wydeba erovnul doneze.
iSviaT SemTxvevaSi imunizaciis Semdgom aRiniSneba iseTi paTologiuri procesebi,
romlebic, rogorc wesi, ar aris damaxasiaTebeli postvaqcinuri procesisaTvis da romlebic
iwveven organizmis mZime funqciur dazianebas, zogjer sicocxlisTvis saSiS movlenebsac ki.
msgavsi procesebi postvaqcinuri garTulebebis, anu acris Semdgomo garTulebebis saxeliT aris
cnobili.
arsebobs misi Semdegi saxeebi:
 mZime adgilobrivi reaqciebi: abscesi ineqciis adgilze, hiperemia da SeSupeba 7-8
sm-ze meti diametris, limfadeniti.
 zogadi mZime reaqciebi da garTulebebi:
– nervuli sistemis mxriv: mwvave dambla, encefalopaTia, encefaliti, serozuli
meningiti, febriluri da afebriluri krunCxvebi, gien-baris sindromi.
– sxva saxis garTulebebi: alergiuli reaqciebi, hipermgrZnobelobis mwvave
reaqciebi, anafilaqsiuri Soki, Sratismieri daavadeba (imunoglobulinebis da/an anatoqsinebis
gamoyenebisas), osteiti/osteomieliti, acridan 5 dReSi ganviTarebuli sefsisi, toqsikuri
o
Sokis sindromi, kolapsi, arTralgia, cxeleba 40 C da meti droiT (3 saaTze meti), tirili da
yvirili (3 saaTze xangrZlivi).
postvaqcinuri garTulebebis mizezi SeiZleba iyos sami faqtori:
1. garTulebebi, romlebic vaqcinaciis Catarebis wesebis darRvevasTanaa dakavSirebuli.
magaliTad, aseptikis wesebis darRvevisas viTardeba abscesi. adsorbirebuli vaqcinebis kanqveS
Seyvanam SeiZleba gamoiwvios aseptikuri infiltratebi. steriluri abscesi viTardeba bcJ-
vaqcinis kanqveS Seyvanisas. aqve unda aRiniSnos dozis momateba, sqemis Secvla da sxv.
2. garTulebebi, romlebic vaqcinebis xarisxTanaa dakavSirebuli (narCeni toqsikuroba,

239
kontaminacia). maTi Tavidan acilebis mizniT saWiroa mkacri kontroli vaqcinebis damzadebis,
transportirebis da Senaxvis pirobebze.
3. garTulebebi, romlebic dakavSirebulia acrili piris individualur reaqciasTan. am
dros ufro xSirad alergiuli reaqciebi da nevrologiuri dazianebebi gvxvdeba.
unda aRiniSnos, rom mTel rig SemTxvevebSi vaqcinaciis Semdgom periodSi ganviTarebuli
paTologiuri procesebi aranairad araa dakavSirebuli acrasTan, ubralod, misi gamovlena
droSi SemTxveviT emTxveva acras da maT Soris mizez-Sedegobrivi kavSiri ar arsebobs.
aravaqcinirebul bavSvTa “marTvadi” infeqciebiT daavadebis albaToba mravaljer metia
vidre mZime postvaqcinuri garTulebis ganviTarebis SesaZlebloba.
postvaqcinuri garTulebis gamovlenis SemTxvevaSi saWiroa saswrafo Setyobinebis
gagzavna Sesabamisi raionis sazogadoebrivi jandacvis samsaxurSi, romelic Tavis mxriv
atyobinebs samxareo samsaxurs da daavadebaTa kontrolis da sazogadoebrivi janmrTelobis
erovnul centrs. gamomwvevi mizezebis dasadgenad da Semdgomi saswrafo RonisZiebebis
gasatareblad Setyobinebis miRebidan dauyovnebliv unda daiwyos SemTxvevis gamokvleva,
romelsac atarebs mocemuli raionis epidemiologi SemTxvevis gamomvlen medicinis muSakTan
erTad. yvela msgavs SemTxvevaSi unda Catardes ganmartebiTi muSaoba dazaralebuli bavSvebis
mSoblebTan, sxva samedicino muSakebTan, mosaxleobisa da masmediis warmomadgenlebTan, rac
sazogadoebaSi imunizaciasTan dakavSirebul dadebiTi Sexedulebis SenarCunebas emsaxureba.
Catarebuli kvlevis Sedegebi Setanil unda iqnes postvaqcinuri garTulebis SemTxvevis
epidkvlevis formaSi # IV-04/1.

8.6.5. B hepatitis sawinaaRmdego acra

B hepatitis vaqcina rekombinantuli vaqcinaa da miRebulia genuri inJineriis gziT - B


hepatitis virusis genis suberTeulis CarTviT safuaris sokoSi. safuaris kultivirebis
dasrulebis Semdeg, misgan gamoyofen HBsAg-s, romelsac wmenden safuaris sokosagan. es vaqcina
Seicavs HBV-s zedapiruli antigenis (HBsAg) cilas, adsorbirebuls aluminis hidroJangze da
konservant – Tiomersals.
acra keTdeba samSobiaro saxlSi, bavSvis dabadebis pirvelive dRes, kerZod pirvel 12
saaTSi B hepatitis monovaqciniT. samSobiaroSi aucreli bavSvebis vaqcinacia tardeba
kombinirebuli _ eqvskomponentiani heqsavaqciniT (dyat-hepB-hib-ipv). Tu deda aris HBsAg
dadebiTi, mizanSewonilia vaqcinasTan erTad gakeTdes B hepatitis sawinaaRmdego
imunoglobulini. misi doza ganisazRvreba TandarTuli instruqciiT. tuberkulozis da B
hepatitis vaqcina, iseve rogorc imunoglobulini, SesaZlebelia erTdroulad gakeTdes
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sxvadasxva SpriciT sxvadasxva adgilze.
B hepatitis monovaqcina gamodis Txevadi saxiT da asacreli doza 0.5 ml-ia. vaqcina
keTdeba barZayis kunTis Sua mesamedis wina lateralur areSi. mozrdil pirebSi vaqcinis Seyvana
xdeba mxris Sua mesamedis gare zedapirze, aseve kunTSi. ar SeiZleba vaqcinis Seyvana dundulos
areSi, kanSi an kanqveS vaqcinaciis dabali efeqturobis gamo. Semdegi acrebi warmoebs ori, sami,
oTxi Tvis asakSi, heqsavaqciniT. amrigad, vaqcinaciis kursi 4 acrisagan Sedgeba. revaqcinacia
saWiro ar aris. Tu asacreli piris asaki 20 weli da metia, maSin asacreli doza 1,0 ml-ia.
Tumca, sasurvelia acris adgilis da dozis dazusteba Tanmxleb instruqciaSi.

vaqcinis Senaxvis optimaluri pirobebia +2 - +8 C -ze. dauSvebelia vaqcinis gayinva.


gegmiani acrebis garda sasurvelia samedicino personalis acrac. rogorc dagrovili
gamocdileba gviCvenebs B hepatitis sawinaaRmdego acrebis wyalobiT avadobis done 10-12-jer
mcirdeba. analogiurad mcirdeba agreTve HBsAg-is mtareblobis donec.

8.6.6. tuberkulozis sawinaaRmdego acra

rogorc B hepatitis, ise tuberkulozis sawinaaRmdego acrebi tardeba samSobiaro


saxlSi bavSvis dabadebidan 0-5 dRes. asacrelad gamoiyeneba BCG (bcJ _ bacila kalmet-gerenis)
vaqcina, romelic 1921 wels miRebul iqna frangi mecnierebis Calmette-is da Guerin-is mier
xaris tipis mikobaqteriebis mravalwliani zrdiT kartofilian niadagze, romelsac naRveli da
glicerini hqonda damatebuli. 1948 wlidan yofil sabWoTa kavSirSi da maT Soris
saqarTveloSi, tuberkulozis sawinaaRmdego acrebi savaldebulo gaxda qalaqis samSobiaroSi
dabadebulTaTvis, xolo 1954 wlidan – yvela axalSobilisTvis. amJamad BCG vaqcina mraval
qveyanaSi gegmiani saxiT gamoiyeneba. im qveynebSi ki, sadac avadobis done dabalia, acrebi
tardeba riskis jgufebSi.
bcJ-vaqcina cocxali, liofilizebuli preparatia, romelic gamoSvebulia 10 an 20-
doziani flakonis saxiT. vaqcinas aucileblad Tan axlavs individualuri gamxsneli. vaqcinis
gakeTebis win igi ixsneba gamxsnelSi. asacreli doza 0.05 ml-ia. acra warmoebs kanSi marcxena
mxris zeda mesamedSi. samSobiaroSi aucreli bavSvi unda aicras pirvelive SesaZleblobisTanave.
Tumca 12 Tveze ufrosi asakis bavSvebisaTvis vaqcinacia ar aris rekomendebuli, radgan
klebulobs misi damcvelobiTi efeqti.
acrebis erovnuli kalendaris mixedviT, tuberkulozis sawinaaRmdego acra erTjeradia
da amJamad revaqcinaciebi ar warmoebs. xazgasmiT unda aRiniSnos, rom acris Catarebis win
mantus sinjis dayeneba ar aris saWiro. Tu raime mizezis gamo samSobiaro saxlSi ar Catarda
imunizacia, maSin bavSvis acras poliklinika an klinika awarmoebs.
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tuberkulozis vaqcina unda inaxebodes +2 - +8 C -ze. misi gayinva dasaSvebia, magram ar
aris rekomendebuli, radgan vaqcinis aqtivoba xSiri gayinva-galRobiT sakmaod qveiTdeba.
dauSvebelia gamxsnelis gayinva. bcJ-s gaxsnili flakoni asacrelad vargisia 6 sT-is
ganmavlobaSi. vaqcina da gamxsneli Serevisas unda iyos erTnairi temperaturis.
tuberkulozis sawinaaRmdego acrebiT SesaZlebelia avadobis donis garkveuli Semcireba,
Tumca marTvadi infeqciebisagan gansxvavebiT, tuberkuloziT avadobis donis radikaluri
SemcirebisaTvis imunizaciis garda saWiroa sxva RonisZiebebis gatarebac, upirveles yovlisa,
avadmyofTa drouli gamovlena da maTi efeqturi mkurnaloba.

8.6.7. difTeria, yivanaxvela, tetanusis sawinaaRmdego acra

difTeria, yivanaxvelas da tetanusis sawinaaRmdego acrebisaTvis mowodebulia ramdenime


vaqcina:
◆ heqsavaqcina - dyat+hepB+hib+ipv (DTaP+HepB+Hib+IPV), – difTeria-yivanaxvela
(araujreduli)- tetanusi - Bhepatiti - b tipis Haemophilus influensa - poliomielitis
(inaqtivirebuli) sawinaaRmdego vaqcina;
◆ tetravaqcina - dyatp (DTaP/P) - difTeria-yivanaxvela (araujreduli)- tetanusi -
poliomielitis (inaqtivirebuli) sawinaaRmdego vaqcina;
◆ td (Td ) – tetanusi, difTerias vaqcina.
am vaqcinebSi difTeria da tetanusi warmoadgenen anatoqsinebs, xolo yivanaxvelas da hib
infeqciis sawinaaRmdegod gamoiyeneba qimiuri vaqcinebi. IPV _ aris poliomielitis sawinaaRmdego
inaqtivirebuli vaqcina, B hepatitis mimarT ki gamoiyeneba rekombinantuli vaqcina. adreul
wlebSi yivanaxvelas mimarT gamoiyeneboda inaqtivirebuli vaqcina, romelic xasiaTdeboda
maRali reaqtogenobiT. amitom bolo wlebSi mis nacvlad gamoiyeneba yivanaxvelas araujreduli
qimiuri vaqcina, romelsac bevrad naklebi reaqtogenoba aqvs.
acrebi iwyeba 2 Tvis asakSi da imunizaciisaTvis umjobesia xuT an eqvskomponentiani
vaqcinis gamoyeneba. maTi ar qonis SemTxvevaSi ki acra xdeba dyatp – vaqciniT. heqsavaqcinis
gamoyeneba rekomendebulia 24 Tvemde asakis bavSvebSi. asacreli dozaa 0.5 ml. vaqcina keTdeba
barZayis kunTis Sua mesamedis anterolateralur areSi. 1 wlis zeda asakSi ineqcia SeiZleba
gakeTdes mxris Sua mesamedis gareTa zedapirze. dauSvebelia vaqcinis Seyvana dundulos areSi,
kanSi an kanqveS. vaqcinaciis kursi sami acrisagan Sedgeba. meore acra tardeba sami Tvis asakSi,
xolo mesame acra – oTxi Tvis asakSi. TiToeul acras Soris aucilebelia minimaluri
oTxkviriani intervalis dacva. Tu intervali raime mizezis gamo gaizarda, vaqcinacia grZeldeba
Cveulebrivi sqemiT _ bavSvs acra utardeba pirvelive SesaZleblobisTanave da damatebiTi acris
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Catareba ar aris saWiro.
18 Tvis asakSi tardeba pirveli revaqcinacia dyatp vaqciniT. dagvianebiT damTavrebuli
vaqcinaciis SemTxvevaSi, revaqcinacia tardeba me-3 acridan 6-12 Tvis Semdeg dyatp vaqciniT.
erTi asacreli dozaa 0.5 ml. vaqcina keTdeba barZayis kunTis Sua mesamedis anterolateralur
areSi. revaqcinacia aseve xdeba 5 wlis asakSi amave vaqciniT. doza da Seyvanis adgili ar
icvleba., xolo 14 wlis asakSi revaqcinaciisTvis gamoiyeneba td vaqcina, romelic keTdeba
deltisebur kunTSi. 14 wlis zeviT, 10 weliwadSi erTxel xdeba revaqcinaciebi isev td-
vaqciniT 55 wlis asakamde.

yvela dasaxelebuli vaqcinebis gayinva akrZalulia. isini unda inaxebodes +2 - +8 C -


ze. vaqcinis gaxsnili flakoni vaqcinaciisaTvis vargisia 1 Tvis ganmavlobaSi, Tu daculia civi
jaWvi moTxovnebi.
bolo wlebSi gansakuTrebuli yuradReba eqceva revaqcinaciebis Catarebas mozrdil
asakSi, radgan rogorc gasuli saukunis bolos saqarTveloSi ganviTarebulma difTeriis
epidemiis Seswavlam gviCvena, daavadebulTa TiTqmis naxevars swored mozrdili pirebi
Seadgendnen. yivanaxvelas, tetanusis da gansakuTrebiT difTeriis mimarT Catarebuli imunizacia
mxolod maSin iqneba maRalefeqturi, rodesac aicreba acrebs daqvemdebarebuli kontigentis 95
% mainc.
difTeriis da tetanusis vaqcinebi maRali efeqturobiT xasiaTdebian. maTi gamoyenebiT
dasavleT evropisa da CrdiloeT amerikis qveynebSi am daavadebebiT gamowveuli avadoba 0-s
uaxlovdeba.

8.6.8. poliomielitis sawinaaRmdego acra

1952-1955 wlebSi amerikuli mecnieris solkis mier damzadda da praqtikaSi dainerga


poliomielitis inaqtivirebuli vaqcina, romelic virusis I, II da III tipebs Seicavda. 1958
wels aseve amerikeli mecnieris sebinis mier miRebul iqna poliomielitis atenuirebuli
vaqcina (opv), romelic aseve virusis samive tips Seicavda.
amJamad saqarTveloSi gamoiyeneba ipv (IPV)–poliomielitis inaqtivirebuli vaqcina,
romelic Sedis heqsavaqcinis da tetravaqcinis SemadgenlobaSi. adre prioriteti opv-vaqcinas
eniWeboda. igi damzadebuli iyo poliomielitis virulentobadaqveiTebuli samive tipis
cocxali virusisagan. opv vaqcina Txevadia. acra warmoebda oralurad (piris RruSi
CawveTebiT), 1 doza iyo 2 wveTi.
poliomielitis sawinaaRmdego acrebi tardeba 2, 3 da 4 Tvis asakSi heqsavaqciniT. xolo
revaqcinaciebi 18 Tvis da 5 wlis asakSi - tetravaqciniT.
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poliomielitis vaqcina metad efeqturi vaqcinaa. amitomac 1988 wels janmom miiRo
gadawyvetileba msoflioSi poliomielitis likvidaciis Taobaze. es programa warmatebiT
xorcieldeba. 1988 wels msoflioSi poliomielitis 350 aTasi SemTxveva aRiricxa, 2014 wels
ki mxolod – 359. 1994 wels poliomieliti likvidirebuli iqna amerikis regionSi, 2000
wels - wynari okeanis regionis dasavleT nawilSi (maT Soris CineTSi da avstraliaSi), 2002
wels evropis regionSi, 2014 wels samxreT aRmosavleT aziaSi. amJamad daavadeba
likvidirebulia afrikis kontinentzec. dReisaTvis daavadeba gamowveuli poliomielitis
veluri virusiT gvxvdeba mxolod pakistanSi da avRaneTSi. amis miuxedavad, poliomielitis
sawinaaRmdego gegmian acrebs agrZelebs yvela qveyana, gamomdinare safrTxidan, rom pakistanidan
da avRaneTidan infeqcia SeiZleba Setanili iqnas sxva qveynebSi. magaliTad 2011 wels CineTSi
iyo poliomielitis afeTqeba, rac gamowveuli iyo infeqciis pakistanidan SetaniT.
rogorc aRiniSna, poliomielitis virusi sami tipisgan Sedgeba. 2015 wels janmom
gamoacxada, rom msoflioSi poliomielitis meore tipi aris mospobili. 2019 wlis 24
dekembers ki janmos informaciiT aseve likvidirebulia virusis mesame tipic. ase rom uaxloes
wlebSi mosalodnelia poliomielitis likvidacia mTels msoflioSi.

8.6.9 hib -infeqciis sawinaaRmdego acra

hib -infeqciis gamomwvevi aris b tipis Haemophilus influenzae-s mikrobi, romelic aris
mcire zomis kokobaqteria Pasteurellaceae ojaxidan. cnobilia misi 6 serotipi: a, b, c, d, e, f. igi
aris adamianis zeda sasunTqi gzebis lorwovanis mikrofloris Cveulebrivi warmomadgeneli.
epidemiologiuri situaciis mixedviT misi mtarebloba mosaxleobaSi meryeobs 5-8%-Si.
inficirebulTa mcire nawilSi viTardeba daavadebis klinikuri forma, romelic polimorfizmiT
xasiaTdeba. ufro xSiria zemo da qvemo sasunTqi gzebis dazianebis niSnebi. infeqcia vrceldeba
aerogenuli meqanizmiT. daavadebas ufro xSirad iwvevs b serotipi. rig SemTxvevaSi viTardeba
mZime formebi. magaliTad, yovel wels msoflioSi 3 milioni mZime forma gvxvdeba, romelTagan
janmos monacemebiT daaxloebiT 380 aTasi letalobiT mTavrdeba. gadarCenil pacientTa 15-35%
rCeba invalidi (siyrue, gonebrivi ganviTarebis CamorCena). sikvdilis ZiriTadi mizezia meningiti
da pnevmonia. rogorc wesi iRupebian 5 wlamde asakis bavSvebi. maRali riskis periodia 4-18 Tve.
pirvel TveebSi daavadeba Zalian iSviaTia, radgan axalSobils dedisagan gadaecema antisxeulebi.
aseve iSviaTia daavadeba 5 wlis zeviTac, radgan zeda asakSi bavSvebi gamoimuSaveben imunitets.
me-20 saukunis 90-iani wlebidan msoflioSi gamoiyeneba am daavadebis sawinaaRmdego
vaqcina. xolo 1998 wlidan janmo uwevs rekomendacias yvela qveyanas, rom es vaqcina CarTon
erovnuli acrebis kalendarSi. amJamad gegmiani saxiT vaqcina gamoiyeneba mraval qveyanaSi _
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gansakuTrebiT maRali Semosavlebis mqone qveynebSi.
hib -infeqciis sawinaaRmdego vaqcina gamoiyeneba rogorc mono, ise kombinirebuli saxiT.
mTeli rigi mizezebis gamo umjobesia misi gamoyeneba kombinirebuli saxiT. igi miekuTvneba
qimiuri vaqcinebis ricxvs. aris sakmaod efeqturi da dabalreaqtogenuri. Tumca unda
aRiniSnos, rom amave dros aris sakmaod ZviradRirebulic. acrebi iwyeba 2 Tvis asakSi da
tardeba heqsavaqcinis saSualebiT.

8.6.10. rotavisuruli infeqciis sawinaaRmdego acra

rotavirusuli infeqciis gamomwvevia rotavirusi, romelic Sedis Reoviridae-s ojaxSi da


Seicavs rnm-s. daavadeba farTod aris gavrcelebuli msoflioSi. yovelwliurad 25 milionamde
SemTxveva vlindeba, romelTagan 600-900 aTasi letalurad mTavrdeba. letalobis maCvenebeli
2.4-3.6%-s Seadgens. gansakuTrebiT maRalia letaloba 5 wlamde asakis bavSvebSi. yovelwliurad
am daavadebiT am asakobriv jgufSi 45- aTasze meti bavSvi kvdeba.
iseve rogorc sxva nawlavTa infeqciebi, rotavirusuli infeqciac fekalur-oraluri
meqanizmiT vrceldeba. gadacemis wamyvani gza, gansakuTrebiT mcire asakis bavSvebSi, aris
sayofacxovrebo-kontaqtis gza. amitomac am daavadebas „WuWyiani“ xelebis daavadebasac
uwodeben. fiqroben, rom daavadeba SeiZleba aerogenuli meqanizmiTac gavrceldes.
daavadebis prevenciaSi, sanitariul-higienur RonisZiebebTan erTad, mniSvnelovania acrebi.
2009 wlis ivnisSi janmom yvela qveyanas mouwoda, rom rotavirusuli infeqciis sawinaaRmdego
acrebi Seitanon acrebis erovnul kalendarSi. 2013 wlidan saqarTveloSi daiwyo am infeqciis
mimarT gegmiani acrebi.
rotavirusuli vaqcina miekuTvneba cocxali vaqcinebis tips. vaqcina Seicavs rotavirusis
atenuirebul Stamebs. acra iwyeba 2 Tvis asakidan. doza 1.5 ml-ia, romelic SeyavT
peroralurad (piris RruSi CawveTebiT). meora acra ki keTdeba erT Tviani intervaliT sami
Tvis asakSi.
vaqcinaciis ukuCvenebebia: mZime alergiuli reaqcia vaqcinis wina dozaze, anamnezSi
nawlavTa invaginacia da mZime kombinirebuli imunideficitis mdgomareoba.
acris Sedegad gamomuSavebuli xelovnuri aqtiuri imuniteti 3-4 weli grZeldeba, rac
sakmarisia, raTa bavSvebi davicvaT am daavadebisagan im asakSi, sadac daavadeba gansakuTrebiT
mZimed mimdinareobs da xSiria letaluri gamosavali.
acris Semdgom SeiZleba ganviTardes garkveuli reaqciebi. 10 acrili bavSvidan erTs
aReniSneba Txieri ganavali, xolo 100 acrili bavSvidan erTs tkivili muclis areSi,
meteorizmi, gamonayari. SesaZlebelia nawlavis invaginaciac, rac ufro xSirad maSin viTardeba,
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roca acra mozrdil asakSi xdeba. amitom pirveli acra unda Catardes 12 kviris asakamde,
xolo meore araugvianes 16 kvirisa.

8.6.11. pnevmokokuri infeqciis sawinaaRmdego acra

pnevmokokuri infeqcia erT-erTi yvelaze ufro mZime daavadebaa. igi gansakuTrebiT mZimed
mimdinareobs mcire asakis bavSvebSi da 65 wlis da zeda asakis pirebSi. yovelwliurad am
daavadebiT daaxloebiT 1.5 milioni adamiani kvdeba. mas iwvevs pnevmokoki Streptococcus
pneumoniae. unda aRiniSnos, rom pnevmoniebis TiTqmis 70% am mikroorganizmiT aris
gamowveuli. igi aseve iwvevs meningits, otits, sinusits da a.S. S.pneumoniae-s 91 serotipia
cnobili, Tumca daavadebis ganviTarebaSi ZiriTad rols 2 aTeuli serotipi TamaSobs.
daavadebis prevenciaSi wamyvani adgili vaqcinas ukavia, romelic gasuli saukunis 80-ian
wlebSi iqna mowodebuli. vaqcinaSi moqmedi sawyisi aris pnevmokokis polisaqaridebi, romlebic
susti imunogenuri TvisebebiT xasiaTdebian. amitom iyeneben koniugirebul vaqcinebs, romlebic
maRali imunogenobiT xasiaTdebian. arsebobs 10,13 da 23 valentiani vaqcinebi.
saqarTveloSi pnevmokokuri infeqciis sawinaaRmdego acrebi 2014 wlidan dainerga.
acrebis erovnuli kalendris mixedviT vaqcinacia 3 kursisgan Sedgeba da tardeba 2,4 da 12
Tvis asakSi. pirvel da meore acras Soris intervali unda iyos aranakleb 8 kvira, xolo
meore da mesame acras Soris aranakleb 6 Tve. vaqcinis doza aris 0.5 ml da igi keTdeba
kunTebSi barZayis anterolateralur zedapirze, Sua mesamedSi.
gegmiani acrebis garda, rekomendebulia, rom pnevmokokuri vaqciniT aseve aicran riskis
jgufebi, kerZod:
• 65 wlis da zeda asakis pirebi;
• filtvebis qronikuli daavadebis mqoneni;
• gul-sisxlZarRvTa qronikuli daavadebiT daavadebulni;
• Saqriani diabetiT da RviZlis ciroziT daavadebulni;
• yvela imunokompromentirebuli avadmyofi.
acris Semdeg SeiZleba ganviTardes rogorc adgilobrivi, ise zogadi reaqcia. zogadi
reaqciebis ganviTareba sakmaod iSviaTia da daaxloebiT 2%-Si gvxvdeba. am dros ZiriTadad
gamoxatulia temperaturuli reaqcia, rac Seexeba adgilobriv reaqciebs, igi daaxloebiT 5 %-
Si viTardeba da gamoixateba acris adgilis gamkvrivebaSi, gawiTlebaSi da mtkivneulobaSi.

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8.6.12. wiTelas sawinaaRmdego acra

wiTelas winaaRmdeg brZolis saqmeSi mniSvnelovani etapi iyo 1954 wels amerikeli
mecnieris endersis mier wiTelas atenuirebuli Stamis – Edmonston-is mowodeba, romelic
wiTelas vaqcinis damzadebis safuZveli gaxda. 50-iani wlebis bolos sabWoTa kavSirSi rusi
mecnieris smorodincevis mier damzadebul iqna wiTelas vaqcina Л-16, romliTac 1967 wels
mTel sabWoTa kavSirSi da maT Soris, saqarTveloSic daiwyo wiTelas sawinaaRmdego acrebi.
wiTelas vaqcina cocxali vaqcinaa, romelic mSral mdgomareobaSia gamoSvebuli. mas Tan axlavs
individualuri gamxsneli. doza 0.5 ml-ia. acra keTdeba 12 Tvis asakSi mxris Sua mesamedis
gare zedapirze Rrmad kanqveS.
5 wlis asakSi warmoebs wiTelas sawinaaRmdego revaqcinacia. am SemTxvevaSic doza da
Seyvanis adgili ucvlelia.
wiTelas vaqcina Zalian Termolabiluri vaqcinaa. amdenad, mis Senaxvas “civi jaWvis”
pirobebSi Zalian didi yuradReba unda mieqces. erovnul centralur sawyobSi igi inaxeba 1

weli -15 C - -25 C temperaturaze. amcrel kabinetSi vaqcina unda inaxebodes +2 - +8 C


temperaturaze ara umetes 1 Tvisa. gaxsnili flakoni vargisia gaxsnidan 6 saaTis ganmavlobaSi.
gamxsnelis gayinva dauSvebelia. vaqcina da gamxsneli Serevisas erTnairi temperaturis unda
iyos.
wiTelas vaqcina maRalefeqturi vaqcinebis jgufs miekuTvneba. janmos gaTvlebiT uaxloes
momavalSi, sayovelTao acrebis saSualebiT, msoflioSi moxdeba wiTelas sruli likvidacia.
wiTelas mimarT acrebi monovaqcinis nacvlad amJamd tardeba trivaqciniT – wiTelas,
wiTuras da ybayuras vaqciniT, romelic mTel msoflioSi didi popularobiT sargeblobs.

8.6.13. ybayuras sawinaaRmdego acra

ybayuras winaaRmdeg acrebisaTvis gamoiyeneba cocxali vaqcina, romelic gamoSvebulia


mSrali (liofilizebuli) saxiT. yofil sabWoTa kavSirSi da maT Soris, saqarTveloSic es
acrebi daiwyo 1981 wlidan. vaqcinas Tan axlavs specialuri gamxsneli. vaqcina ZiriTadad
gamodis 10 an 20 doziani flakonebis saxiT.
vaqcinacia iwyeba 12 Tvis asakSi, erTi asacreli dozaa 0.5 ml. igi SeyavT mxris Sua
mesamedis gare zedapirze kanqveS. revaqcinacia swarmoebs igive sqemiT 5 wlis asakSi.

ybayuras vaqcina unda inaxebodes +2 - +8 C temperaturaze. gayinva dasaSvebia. gaxsnili


flakoni asacrelad vargisia gaxsnidan 6 saaTis ganmavlobaSi.
ybayuras monovaqcinis garda asacrelad iyeneben agreTve trivaqcinas – wiTela-wiTura-
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ybayuras vaqcinas. amJamad ybayuras sawinaaRmdego acrebi, rogorc wesi, tardeba trivaqcinis
saSualebiT – wiTelas, wiTuras da ybayuras vaqciniT.

8.6.14. wiTuras sawinaaRmdego acra

wiTura anTroponozuli mwvave virusuli infeqciaa, romelic acrebis SemoRebamde


sayovelTaod iyo gavrcelebuli. daavadeba vrceldeba rogorc aerogenuli meqnizmiT, aseve
vertikalurad (transplacenturad). wiTuras virusi xasiaTdeba teratogenuli moqmedebiT, ris
gamoc es daavadeba mniSvnelovan samedicino problemad iTvleba.
wiTura miekuTvneba im daavadebaTa ricxvs, romelTa likvidacias janmo uaxloes
momavalSi gegmavs aqtiuri imunizaciis meSveobiT. gaiTvaliswina ra wiTuras, gansakuTrebiT
Tandayolili wiTuras sindromis didi mniSvneloba janmrTelobis dacvis saqmeSi, janmos
evropis regionulma 48-e sesiam, 1998 wels wiTura Seitana im infeqciaTa jgufSi, romelTa
winaaRmdeg brZolac xorcieldeba programiT "janmrTeloba yvelasaTvis 21-e saukuneSi".
saqarTveloSi wiTuras sawinaaRmdego acrebi praqtikulad xorcieldeba 2003 wlidan.
imunizaciisTvis gamoiyeneba wiTela-wiTura-ybayuras trivaqcina, romlis gamoyenebis sqema
miTiTebulia wina qveTavSi.

8.6.15. papilomavirusuli infeqciis sawinaaRmdego acra

papilomavirusul infeqcias iwvevs papilomavirusebi (Human Papilomavirus, HPV),


romlebic papilomavirusebis ojaxSi Sedian. amJamad am virusebis 170-ze meti tipia cnobili.
papilomavirusuli infeqcia yvelaze gavrcelebuli sqesobrivi gziT gadamdebi daavadebaa mraval
qveyanaSi, maT Soris aSS-Si, ruseTSi da sxvagan.
msoflioSi sqesobrivad aqtiuri mosaxleobis TiTqmis 80-90% inficirebulia am
virusiT, rac daaxloebiT 600 milion adamians anu planetis mosaxleobis 12%-ze mets
Seadgens. SemTxvevaTa daaxloebiT 90%-Si inficirebul adamians aranairi klinikuri niSnebi ar
aReniSneba, isini ubralod virusmtareblebi arian da bunebrivia avrceleben am daavadebas.
papilomavirusebis 40-ze met tips SeuZlia, rogorc qalebSi, ise mamakacebSi
anogenitaluri traqtis daavadebebis gamomwvevia, maT Soris iseTi onkologiuri daavadebebis,
rogoricaa saSvilosnos yelis kibo, swori nawlavis kibo, saSos kibo, asos kibo da a.S Tumca
maT Soris yvelaze gavrcelebulia saSvilosnos yelis kibo. msoflioSi yovelwliurad am
daavadebis daaxloebiT 570 aTasi axali SemTxveva vlindeba da daaxloebiT 300 aTasi qali
kvdeba. saqarTveloSi saSvilosnos yelis kibo qalebSi yvelaze gavrcelebuli kibos xuTeulSi
Sedis. maRali onkogenuri TvisebebiT gamoirCeva 16, 18, 30, 33, 39, 40, 42, 43, 52, 55, 57, 59,
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61, 62, 67, 70 tipebi.
unda aRiniSnos, rom papilomavirusebi garemoSi sakmaod gamZleni arian. amasTan, isini
sakmaod rezistentulni arian antiseptikebisadmi, rac xSirad xdeba mizezi ginekologebis
dainficirebis.
papilomavirusuli infeqciis prevenciis efeqturi saSualebaa vaqcina, romelic pirvelad
mowodebul iqna 2006 wels amerikis SeerTebul StatebSi. es aris vaqcina Gardasil. igi Seicavs
papilomavirusebis 4 tips - 6, 11, 16, 18 tipebs. aris aseve vaqcina Cervarix, romelic 16 da 18
tipebs Seicavs. metad mniSvnelovania, rom orive es vaqcina Seicavs papilomavirusebis 16 da 18
tipebs, romlebic saSvilosnos yelis kibos SemTxvevaTa 70%-Si aris etiologiuri faqtori.
bolo dros mowodebulia vaqcina Gardasil-9, romelic aRniSnuli 4 tipis garda, aseve Seicavs
31, 33, 45, 52, 58 tipebsac.
acrebi rekomendebulia 9-25 wlis gogonebisa da qalebisaTvis, romlebic ar arian am
virusiT inficirebulni. aseve SesaZlebelia 26-45 wlis qalebic acrac. janmo rekomendacias
uwevs aseve mamrobiTi sqesis pirebis acrasac.
saqarTveloSi 2019 wlis dekembridan savaldebuloa gaxda 10, 11, 12 wlis gogonebis
acra. vaqcinaciis kursi Sedgeba 2 acrisagan, romelTa Soris intervali ar unda iyos 6 Tveze
naklebi. acra acril pirebSi mravali wlis manZilze tovebs myar imunitets.

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Tavi 9 saavadmyofosSiga infeqciebi
saavadmyofosSiga infeqciebi (s.S.i.) Tanamedrove janmrTelobis dacvis erT-erTi
seriozuli problemaa msoflios yvela qveyanaSi. maT mier miyenebuli socialur-ekonomikuri
ziani Zalian didia. rogorc mravalricxovani gamokvlevebi gviCveneben s.S.i. hospitalizaciis
Semdgom ganviTarebuli garTulebebis yvelaze ufro xSir mizezs warmoadgens. janmos
monacemebiT (14 qveynis 55 saavadmyofos monacemTa SeswavliT) pacentTa daaxloebiT 8,7%-s
aReniSneba saavadmyofosSiga infeqciebi. yvelaze dabalia maCvenebeli amerikis SeerTebul
StatebSi – 4-5%. Tumca iq yovelwliurad 1.7 milioni SemTxveva registrirdeba da
saavadmyofosSiga infeqciebiT gamowveuli letaloba me-4 adgilzea da Camouvardeba mxolod
gul-sisxlZarRvTa sistemis, onkologiuri daavadebebiT da insultiT gamowveul
sikvdilianobas. aRmosavleT aziaSi da xmelTaSua zRvis aRmosavleTiT mdebare qveynebSi s.S.i.-iT
avadoba 7-8%-s aRwevs. yvelaze ufro metad ziandeba wlamde asakis bavSvebi da xanSiSesuli
pirebi. ruseTSi da dsT-s sivrceSi, hospitalizebul avadmyofTa 6-7%-s uvlindeba s.S.i., rac
yovelwliurad 2-2,5 milion SemTxvevas Seadgens. saqarTveloSi saavadmyofosSiga infeqciebis
SemTxvevebi arc ise xSiria, rac maTi ar gamovleniT aixsneba. Tumca Tu gaviTvaliswinebT im
sanitariul-epidemiologiur da ekonomikur pirobebs, romlebic Cveni qveynis samkurnalo-
profilaqtikur dawesebulebebSi aris, advili misaxvedria, rom maTi odenoba bevrad metia,
vidre es amerikisa da evropis qveynebSi fiqsirdeba.
bolo wlebSi praqtikulad yvela qveyanaSi saavadmyofosSiga infeqciebs axasiaTebT zrdis
tendencia, rac ramdenime faqtoriT aris ganpirobebuli:
1. invaziuri (damazianebeli da SeRwevadi) samkurnalo-diagnostikuri manipulaciebis
mkveTri zrda.
2. imunodepresantebis da antibiotikebis farTod, xSirad ukontrolod gamoyeneba da
aqedan gamomdinare saavadmyofoebSi mikroorganizmTa antibiotikorezistentuli Stamebis
cirkulacia.
3. hospitalizebul pacientTa struqturis garkveuli cvlilebebi (xanSiSesul pirTa,
dasustebuli bavSvebis da iseTi pacientebis xvedriTi wilis zrda, romlebic daavadebulni
arian xangrZlivad mimdinare, adre ukurnebeli daavadebebiT).
saavadmyofosSiga infeqcia ewodeba mikrobuli warmoSobis nebismier klinikur
gamovlinebas, romelic viTardeba avadmyofis hospitalizaciis, an samkurnalo dawesebulebaSi
mkurnalobis mizniT vizitisas, an saavadmyofodan gaweris Semdeg. infeqcia iTvleba
saavadmyofosSiga infeqciad, Tu is pirvelad vlindeba hospitalizaciidan 48 saaTis Semdeg da
amasTan adgili ar qonia am infeqciis klinikur gamovlinebas hospitalizaciis momentSi
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inkubaciuri periodis gamoricxviT. amJamad janmos iniciativiT s.S.i.-s aseve miekuTvneba
samedicino personalis daavadebebic, romlebic maT daemarTaT TavianTi profesiuli
saqmianobisas.
samedicino personali mTeli rigi infeqciuri daavadebebis mimarT riskis jgufs
warmoadgens. esenia B da C hepatitebi, aiv-infeqcia da a.S. gansakuTrebiT xSirad SeiZleba
dainficirdnen am daavadebebiT is samedicino personali, romlebsac mWidro kontaqti aqvT
sisxlTan (reanimaciuli, qirurgiuli, ginekologiuri, hemodializis ganyofilebebi, agreTve
sisxli gadasxmis sadgurSi momuSaveni). saSualo samedicino personalidan riskis jgufebs
warmoadgenen saproceduro kabinetis eqTnebi, agreTve personali, romlebic gamoyenebuli
samedicino instrumentebis dezinfeqciaze da winasasterilizacio damuSavebaze muSaoben.
zogierTi avtoris monacemebiT Cirqovani qirurgiis ganyofilebaSi momuSave samedicino
personalis 60-65% yovelwliurad avaddeba Cirqovan-anTebiTi infeqciebis sxvadasxva formiT.
xolo samSobiaro saxlebSi es cifri 15%-s Seadgens.
rogorc aRiniSna saavadmyofosSiga infeqciebi seriozul socialur da ekonomikur zians
ayeneben sazogadoebas, rac dakavSirebulia pacientTa stacionarSi yofnis gaxangrZlivebasTan,
maT damatebiT laboratoriul gamokvlevebTan, mkurnalobasTan. amerikelebis monacemebiT,
yovelwliurad es xarjebi 5-10 miliard dolars Seadgens. garda amisa, didi ziani adgeba TviT
pacientTa janmrTelobas, izrdeba invalidobis da letalobis albaToba. janmos monacemebiT im
avadmyofebSi, romlebsac s.S.i.-c aReniSnebaT, letaloba 10-jer ufro maRalia, maTTan
SedarebiT, visac es infeqciebi ara aqvT.
saavadmyofosSiga infeqciebis etiologiuri struqtura sakmaod mravalferovania, maT
Soris gvxvdeba baqteriebi, virusebi, umartivesebi, sokoebi. Tumca SemTxvevaTa TiTqmis 90%
baqteriebze modis. pirobiTad gamomwvevebi or did jgufad SeiZleba gavyoT:
1. adamianis obligaturi paTogenuri mikroorganizmebi;
2. adamianis pirobiT paTogenuri mikroorganizmebi.
pirvel jgufSi Sedis `tradiciuli~ (klasikuri) infeqciebis, magaliTad sasunTqi gzebis
infeqciebis gamomwvevebi (wiTela, wiTura, difTeria, qunTruSa, ybayura), nawlavTa infeqciebis
gamomwvevebi, (salmonelozi, Sigelozi, A hepatiti), safari qsovilis infeqciebis gamomwvevebi (B
da C hepatitebi), da a. S. am daavadebebis TandarTva sagrZnoblad amZimebs ZiriTadi daavadebebis
mimdinareobas, gansakuTrebiT bavSvTa saavadmyofoebSi da samSobiaro saxlebSi. am jgufis
daavadebebze mTlianobaSi modis mTeli hospitaluri infeqciebis daaxloebiT 15-20%.
meore jgufSi, romlebzec modis mTeli SemTxvevebis 80-85%, Sedis daavadebebi,
romelTac pirobiT paTogenuri mikroorganizmebi iwveven. es jgufi warmodgenilia sxvadasxva

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etiologiis da klinikuri mimdinareobis mqone infeqciuri daavadebebiT, romlebic mizez-
Sedegobriv kavSirSia samkurnalo-diagnostikur procedurebTan. am daavadebaTa struqturaSi
mniSvnelovani adgili ukaviaT Cirqovan-anTebiT (Cirqovan-septiur) daavadebebs, romlebic
xasiaTdebian lokaluri anTebiTi procesebiT, romelic SeiZleba daCirqdes, da romelTac aqvT
midrekileba generalizaciisadmi da sefsisis ganviTarebisadmi. gamomwvevebidan dominirebs
stafilokokebi, streptokokebi, gramuaryofiTi baqteriebi (nawlavis Cxiri, klebsiela,
proteusi, seraciebi da sxva.).
saavadmyofosSiga infeqciebi SeiZleba gamoiwvios fsevdomonadebma, legionelebma,
rotavirusebma, citomegalovirusebma da sxvebma. Zalian gaizarda kandidas gvaris sokoebis
roli am daavadebebis ganviTarebaSi, iseve rogorc kriptokokebis da nokardiebis.
etiologiuri struqtura droSi SeiZleba sagrZnoblad Seicvalos. magaliTad, bolo
wlebSi izrdeba gramuaryofiTi baqteriebis da mcirdeba gramdadebiTi baqteriebis roli
hospitalur paTologiaSi. amJamad evropaSi yovelwliurad s.S.i.-T kvdeba daaxloebiT 25 aTasi
adamiani. 2/3 SemTxvevaSi es daavadebebi gamowveulia gramuaryofiTi mikroorganizmebiT.
sxvadasxva mikroorganizmis roli paTologiis ganviTarebaSi damokidebulia mTel rig
faqtorebze: stacionaris profilze, paTologiuri procesis lokalizaciaze, laboratoriuli
gamokvlevebis xasiaTze da doneze da sxvaze. magaliTad Sardsadeni sistemis paTologiebi
ZiriTadad ganpirobebulia gramuaryofiTi mikroorganizmebiT, qveda sasunTqi gzebis
paTologiebi - pnevmokokebiT, ginekologiur ganyofilebebSi sWarbobs gramdadebiTi mikroflora
(stafilokokebi, streptokokebi), fsiqiatriulSi-nawlavTa infeqciebi (Sigelozi, A hepatiti,
muclis tifi), gastroenterologiurSi - helikobaqteriozi, qirurgiul ganyofilebebSi-
gramuaryofiTi mikroflora da stafilokokebi da a.S.
xSir SemTxvevaSi adgili aqvs jvaredin dainficirebas, gansakuTrebiT Cirqovani qirurgiis
ganyofilebaSi. Tu magaliTad erT palataSi imyofebian avadmyofebi stafilokokuri da
lurjCirqmbadi infeqciiT, xdeba mikroorganizmTa gacvla. muclis Rrus qirurgiis
ganyofilebaSi, muclis Rrus infeqciebis TiTqmis naxevar SemTxvevaSi adgili aqvs
polimikrobul inficirebas.
xasgasmiT unda aRiniSnos, rom s.S.i., rogorc wesi, gamowveulia mikroorganizmTa
hospitaluri StamebiT, romlebic xasiaTdebian:
a) samkurnalo wamlebisadmi maRali gamZleobiT;
b) maRali virulentobiT;
g) didi rezistentobiT garemos araxelsayreli faqtorebis mimarT. magaliTad
gamoSrobisadmi, ultraiisferi sxivebisadmi da sadezinfeqcio preparatebisadmi. zogierTi

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sadezinfeqcio nivTierebebis xsnarSi mikroorganizmebi araTu ar iRupebian, aramed SeiZleba
gamravldnen kidec. mTeli rigi gamomwvevebi, magaliTad klebsielebi, fsevdomonadebi, legionelebi
SesaZloa gamravldnen kidec tenian garemoSi-kondicioneris wylis sistemaSi, inhalatorebSi,
saabazano mowyobilobebSi, Txevad samkurnalo wamlebSi, pirsabani niJarebis zedapirze da a.S.
sainteresoa Tu rogoria sxvadasxva paTologiis xvedriTi wili hospitalur infeqciebSi.
amerikelTa monacemebiT maT qveyanaSi s.S.i.-s 29% modis qirurgiuli Wrilobebis infeqciebze.
yvelaze meti 45%-Sardsasqeso traqtis infeqciebze, 19%-pnevmoniebze. letalobis yvelaze did
safrTxes swored pnevmoniebi qmnian, romlebic xSirad viTardeba reanimaciul, intensiuri
Terapiis, qirurgiul ganyofilebebSi. danarCeni infeqciebis xvedriTi wili didi ar aris da 6-
7%-s Seadgens. amasTan unda aRiniSnos, rom hospitaluri infeqciebis mkurnalobasa da
profilaqtikaze daxarjuli Tanxebis 42%-s STanTqaven Wrilobis infeqciebi. pnevmoniebs meore
adgili ukaviaT-39%.
saavadmyofosSiga infeqciebis dros infeqciis wyarod gvevlinebian:
1. pacientebi,
2. samedicino personali,
3. mnaxvelebi.
maT Soris SeiZleba iyvnen msubuqi, atipuri da qronikuli formiT daavadebulebi da
aseve baqteriamtareblebic.
Zalian mravalferovania hospitaluri infeqciebis gadacemis gzebi da meqanizmebi. wamyvani
adgili aerogenul meqanizms ukavia. misi saSualebiT vrceldeba streptokokuri da
stafilokokuri infeqciebi, sasunTqi gzebis infeqciebi (gripi, wiTela, wiTura da sxva.).
fekalur-oraluri gadacemis meqanizmiT vrceldeba nawlavTa infeqciebi (A hepatiti,
Sigelozi, muclis tifi). gamomwvevis gadacema SeiZleba moxdes rogorc sayofacxovrebo
kontaqtis, ise alimenturi gziT. sayofacxovrebo kontaqtiT vrceldeba gramuaryofiTi
baqteriebi. gadacemis faqtorebi SeiZleba iyos kontaminirebuli instrumentebi, sasunTqi
aparatura, TeTreuli. sayofacxovrebo kontaqtis gziT vrceldeba stafilokokuri infeqciac,
gansakuTrebulad maSin, roca igi epidermuli stafilokokebiT aris gamowveuli.
sakvebi produqtebiT SeiZleba gavrceldes salmonelozi, iseve rogorc sxva nawlavTa
infeqciebi da aseve stafilokokuri infeqciac.
hospitaluri infeqciebis gavrcelebaSi didi adgili ukavia gadacemis parenterul
meqanizms, romelic realizdeba rogorc hemotransfuziebis, ise sxvadasxva saxis samedicino
manipulaciebis CatarebiT, rodesac irRveva safari qsovilebis (kani, lorwovani garsi)
mTlianoba. am gzis gaaqtiurebas mniSvnelovnad uwyos xels invaziuri Carevebis zrda. janmos

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monacemebiT TiTqmis 30% samkurnalo-diagnostikuri manipulaciebisa dausabuTeblad tardeba.
saavadmyofosSiga infeqciebis profilaqtika moiTxovs kompleqsur midgomas. upirveles
yovlisa aucilebelia epidemiologiuri zedamxedvelobis organizacia, romelic saWiroa
epidemiologiuri situaciis obieqturi SefasebisaTvis, prognozirebisaTvis da mecnierulad
dasabuTebuli epidsawinaaRmdego da profilaqtikuri RonisZiebebis SesamuSaveblad.
epidemiologiuri zedamxedveloba moicavs daavadebaTa aRricxvas da registracias, etiologiuri
struqturis gaSifvras, paTogenuri da pirobiT paTogenuri mikroorganizmebis cirkulaciis
dadgenas. aqve Sedis kontroli samedicino personalis janmrTelobaze (avadobaze,
mtareblobaze), sanitariul-higienuri da epidsawinaaRmdego reJimis dacvaze. amerikaSi, evropaSi
da aziaSi, iseve rogorc saqarTveloSi, saavadmyofosSiga infeqciebis mimarT profilaqtikuri
da epidsawinaaRmdego RonisZiebebis gatareba infeqciis kontrolis saxeliT aris cnobili.
infeqciis kontrols axorcielebs sxvadasxva profilis eqimebi: mkurnali eqimebi,
epidemiologebi, agreTve saSualo samedicino personali. upirveles yovlisa saWiroa adreuli
da aqtiuri gamovlineba daavadebulebis, maTi sruli aRricxva da registracia. xdeba avadobis
analizi, misi etiologiis, paTologiuri procesis lokalizaciis, gamosavalis mixedviT.
metad mniSvnelovania samkurnalo-profilaqtikur dawesebulebebSi mikrobiologiuri
monitoringis ganxorcieleba, radgan saavadmyofosSiga infeqciebis zrdis erT-erTi ZiriTadi
mizezia hospitaluri Stamebis formireba. stacionarSi hospitaluri Stamebis cirkulaciis
faqtis drouli dadgena metad mniSvnelovania, radgan igi miuTiTebs epidemiologiuri
situaciis gauaresebas da moiTxovs Sesabamisi RonisZiebebis swraf gatarebas. imis
gaTvaliswinebiT, rom maT Soris bevria antibiotikorezistentuli Stamebi, saWiro xdeba
TiToeul samkurnalo dawesebulebaSi qimioprofilaqtikis da qimioTerapiis strategiis da
taqtikis SemuSaveba, riTac Sesabamisad momzadebuli specialistebi unda dakavdnen. aseTi
midgoma miT ufro saWiroa, radgan amJamad arsebobs uzarmazari raodenobis samkurnalo
saSualebebi da isini Zalian farTod gamoiyenebian klinikur medicinaSi.
im RonisZiebebidan, romlebic mimarTulia infeqciis wyaros mimarT, SeiZleba gamovyoT:
daavadebulTa da mtarebelTa drouli gamovlena da maTi Semdgomi izolacia stacionarSi
Semosvlisa da hospitalizaciis periodSi. Zalian didi mniSvneloba aqvs s.S.i.-is yvela
SemTxvevis registracias da epidemiologiuri kvlevis Catarebas dainficirebis mizezebis da
pirobebis dasadgenad da Sesabamisi profilaqtikuri da epidsawinaaRmdego RonisZiebebis
gasatareblad.
im RonisZiebebs, romelTa saSualebiTac xdeba gadacemis meqanizmis gawyveta, miekuTvneba:
sanitariul-higienuri da sadezinfeqcio, agreTve arqiteqturul-dagegmviTi RonisZiebebi.

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arqiteqturul-dagegmviTi RonisZiebebis ZiriTadi mizania ar dauSvas saavadmyofoSi avadmyofTa
`Cirqovani~ da `sufTa~ nakadebis erTmaneTSi Sereva. amisaTvis saWiroa saTavsoebis saWiro
raodenoba da maTi swori ganlageba. `Cirqovani~ qirurgiuli ganyofileba Senobis zeda
sarTulze unda ganlagdes, raTa dabinZurebuli haeri ar gavrceldes sxva ganyofilebebSi.
saavadmyofos ventilacia ise unda iyos dagegmili, rom `WuWyiani~ zonebidan haeri ar
gavrceldes `sufTa~ ganyofilebebSi. ganyofilebaTa da saTavsoTa erTobliobas, romelTac erTi
sanitariul-higienuri reJimi aqvT, ventilaciis sistema calke emsaxureba.
didi mniSvneloba eniWeba Semdeg sanitariul-higienur RonisZiebebs: samedicino
personalis mier piradi higienis wesebis dacvas, samedicino instrumentebis sterilizacias.
umjobesia erTjeradi sistemebis gamoyeneba, aseve erTjeradi TeTreulis gamoyeneba. rogorc
gamoirkva infeqciaTa 40%, romelic pirobiT-paTogenuri mikrofloriTaa ganpirobebuli,
dakavSirebulia maT arsebobasTan samedicino personalis xelebTan. es gansakuTrebiT
enterokokebs exebaT. amitomac samedicino personalma pacientisaTvis manipulaciis Catarebis
win da Semdeg aucileblad unda daibanos xeli. xelebis dabanva maSinacaa saWiro, rodesac
personals qirurgiuli xelTaTmanebi acvia misi gaxdis Semdeg, radgan igi SeiZleba iyos
dazianebuli da am gziT infeqcia SesaZlebelia moxvdes kanze.
saavadmyofoebSi unda Catardes Semdegi RonisZiebebic:
• pacientis TeTreuli ar unda daibertyos haerSi da ar unda davagdoT iatakze,
• samkurnalo ganyofilebebidan rogorc myari, ise Txevadi narCenebi Sesabamisi wesiT
unda gavitanoT,
• savaldebuloa Senobis sistematuri ganiaveba,
• iatakis da sagnebis zedapiris dalageba aucileblad unda moxdes sveli wesiT.
s.S.i.-is profilaqtikisaTvis Zalian didi mniSvneloba aqvs operaciis dros pacientTa
dainficirebis Tavidan acilebas. amitom SedarebiT vrclad SevexoT operaciis momzadebis wess.
avadmyofis momzadeba saoperaciod:
• Tu operacia gegmiuria, yvela baqteriuli infeqcia, garda iseTisa, romelic TviT
operaciis mizezs warmoadgens, operaciis win unda iyos namkurnalevi;
• Tu operacia gegmiuria, hospitalizaciis periodi operaciamde unda iyos
minimaluri;
• Tu operacia ar aris urgentuli, xolo avadmyofi wonaSi daklebulia, man unda
miiRos gaZlierebuli enteruli da parenteruli kveba;
• Tu operacia gegmiuria, operaciis winadRes avadmyofs kargad abanaveben
antimikrobuli sapnis gamoyenebiT;

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• Tu saoperacio areSi ar aris xSiri Tmebi, rasac SeuZlia operaciis msvlelobas
xeli SeuSalos, Tmebis gaparsva ar aris saWiro;
• saoperacio adgili kargad unda moibanos da damuSavdes antimikrobuli saSualebiT
centridan periferiis mimarTulebiT. es are unda moicavdes mTlianad Wrilobis xazs. amasTan
unda iyos sakmaod farTo, rac gamoricxavs operaciis msvlelobisas daumuSavebel kanTan
Sexebas;
• didi operaciis SemTxvevaSi, avadmyofs gadaafareben sterilur zewars ise, rom
avadmyofis arc erTi nawili ar darCes daufaravi, garda saoperacio adgilis da im adgilebisa,
romlebic moiTxoven anesTezias;
• yvelas vinc Sedis saoperacioSi, operaciis msvlelobisas unda ekeTos niRabi,
romelic mas daufaravs mTlianad pirsa da cxvirs. aseve unda exuros CaCi ise, rom srulad
daifaros Tmebi. yvelas unda ecvas baxilebi;
• is, vinc SexebaSi iqneba saoperacio aresTan, instumentebTan, operaciul ganakveTTan,
unda daibanos xelebi da winamxari antimikrobuli saSualebebiT yoveli operaciisa da
procedurebis win. damuSavebuli xelebis steriluri xelsaxociT gamSralebis Semdeg brigadis
wevrebi icvamen sterilur xelTaTmanebs. maTi CxvletiT dazianebis SemTxvevaSi operaciis
msvlelobisas xelTaTmani swrafad unda Seicvalos, rogorc ki amis SesaZlebloba iqneba
usafrTxoebis gaTvaliswinebiT. Ria Zvlebze da implantaciis mizniT orTopediuli operaciis
dros icvaven or-or sterilur xelTaTmans.
specialurad unda momzaddes saoperacio oTaxi:
saoperacios saventilacio sistema unda uzrunvelyofdes erTi saaTis ganmavlobaSi
haeris 20-jerad cvlas. yvela Sesasvleli sahaero xvreli ganlagebuli unda iyos rac
SeiZleba maRla iatakidan da moSorebuli gamwovi xvrelebisagan.
yvela kari unda iyos daketili, garda iseTisa, romlidanac xdeba mowyobilobebis
Semotana, personalis an avadmyofis gadaadgileba. saoperacioSi Sesvlis nebarTvis mqone
personalis ricxvi dayvanil unda iqnas minimumamde, gansakuTrebiT operaciis dawyebis Semdeg.
saoperacio aucileblad unda lagdebodes operaciebs Soris.

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Tavi 10 dezinfeqca
10.1. dezinfeqcia

dezinfeqcia anu gauvnebelyofa (des – uaryofa, infection – infeqcia) garemos


obieqtebidan paTogenuri mikroorganizmebis mocilebas an ganadgurebs niSnavs.
dezinfeqciis mizania garemos obieqtebze, romlebic infeqciis gadacemis faqtorad
gvevlineba, mxolod paTogenuri da pirobiT-paTogenuri mikroorganizmebis ganadgureba. amiT igi
gansxvavdeba sterilizaciisagan, romlis drosac xdeba yvela mikroorganizmis da sporebis
ganadgureba.
dezinfeqciis ori saxe arsebobs: kerovani da profilaqtikuri. kerovani dezinfeqcia
tardeba epidemiur keraSi – binaze, saerTo sacxovrebelSi, bavSvTa da samkurnalo-
profilaqtikur dawesebulebebSi da a.S. gamomdinare iqidan, imyofeba Tu ara infeqciis wyaro
keraSi, mas yofen mimdinare da saboloo dezinfeqciad. mimdinare dezinfeqcia tardeba maSin,
rodesac infeqciis wyaro imyofeba keraSi da misi mizania infeqciuri agentis ganadgureba
moxdes misi avadmyofi an mtarebeli adamianis organizmidan gamoyofisTanave. am dros avadmyofis
yvela gamonayofi – eqskrementebi, pirnaRebi masa, naxveli da sxva muSavdeba. mimdinare
dezinfeqcia tardeba manam, sanam avadmyofi an mtarebeli aris infeqciis wyaro. mas atarebs
avadmyofis irgvliv myofi pirebi, umetes SemTxvevaSi ojaxis wevrebi, aseve hospitalizaciis
SemTxvevaSi – samedicino personali, romelTac saTanado instruqcia aqvT Catarebuli.
gansakuTrebuli mniSvneloba mimdinare dezinfeqcias nawlavTa infeqciebis dros eniWeba,
radgan gamomwvevi periodulad SardTan da ganavalTan erTad gamoiyofa da maTi gakontroleba
da gauvnebelyofa rTuli ar aris. am jgufis infeqciebisas dezinfeqcias eqvemdebareba
avadmyofis mier gamoyenebuli sagnebi da aseve TeTreuli, radgan isic SeiZleba iyos
dainficirebuli. infeqciur saavadmyofoebSi da ganyofilebebSi mimdinare dezinfeqcia
epidsawinaaRmdego reJimis dacvis umniSvnelovanesi elementia.
sasunTqi gzebis infeqciebis dros, rodesac infeqcia aerogenuli meqanizmiT vrceldeba,
mimdinare dezinfeqciis Catareba naklebad efeqturia. am dros mimdinare dezinfeqciis mTavari
mizania Seamciros haeris dabinZureba paTogenuri mikroorganizmebiT, rac miiRweva Senobis
ganiavebiT (ganiavebidan 15 wuTis Semdeg haerSi mikroorganizmebis ricxvi mkveTrad mcirdeba,
xolo 30 wuTis Semdeg saerTod aRar aris, radgan drois am monakveTSi SenobaSi haeri icvleba
garedan SemosuliT, romelic ar Seicavs paTogenur mikroorganizmebs) da ultraiisferi
dasxivebiT, sagnebis zedapiris sveli wesiT dalagebiT. daskvniTi dezinfeqcia tardeba
avadmyofis hospitalizaciis, gamojanmrTelebis an sikvdilis SemTxvevaSi. am dros damuSavebas
eqvemdebareba Senoba, eqskrementebi, pirnaRebi masa, paTogenuri gamonayofebi, tansacmeli,
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TeTreuli, sayofacxovrebo sagnebi, agreTve obieqtebi, romlebic SesaZlebelia kontaminirebuli
aris infeqciis gamomwveviT.
daskvniTi dezinfeqciis ZiriTadi amocanaa im paTogenuri mikroorganizmebis ganadgureba,
romlebic darCa keraSi infeqciis wyaros mocilebis Semdeg garemos sxvadasxva obieqtebze. mas,
rogorc wesi, atareben sadezinfeqcio samsaxuris TanamSromlebi, keridan infeqciis wyaros
mocilebidan 3-12 saaTis farglebSi. gansakuTrebuli mniSvneloba daskvniT dezifeqcias eniWeba
im infeqciebis dros, romelTa gamomwvevebi garemoSi gamZleni arian.
kerovani dezinfeqciis Catarebis Sesaxeb gadawyvetileba, iseve rogorc misi moculobis
da vadebis, aseve sadezinfeqcio saSualebebis da im obieqtebis CamonaTvali, romlebic
eqvemdebareba damuSavebas, damokidebulia daavadebis saxeze, keris sanitariul mdgomareobaze da
misi reglamentireba xdeba normatiuli dokumentebiT. arsebobs infeqciur daavadebaTa
CamonaTvali, romelTa drosac daskvniTi dezinfeqciis Catareba aris aucilebeli, esenia: Savi
Wiri, qolera, SebrunebiTi tifi, epidemiuri partaxtiani tifi, qu cxeleba, muclis tifi da
paratifebi, tuberkulozi, keTri, orniTozi, difTeria da a.S. safari qsovilebis mTeli rigi
infeqciebisas gamomwvevi aris Zalian rezistentuli sxvadasxva saxis qimiuri da fizikuri
faqtorebis zemoqmedebisadmi da maT SeuZliaT sporebis warmoqmna (jilexis, tetanusis da sxv.).
maT gasauvneblad saWiroa iseTi sadezinfeqcio saSualebebis gamoyeneba, romlebic ara marto
baqteriociduli, aramed sporociduli moqmedebiTac xasiaTdebian.
profilaqtikuri dezinfeqcia tardeba infeqciuri daavadebis aRmocenebamde, anda maSin,
rodesac infeqciis wyaro ar aris aRmoCenili, magram gamoricxuli ar aris gamomwvevis
dagroveba garemos elementebze. mas mudmivad atareben wyalmomaragebis, kanalizaciis,
sazogadoebrivi kvebis obieqtebze, agreTve sawarmoebSi, sadac xdeba sakvebi produqtebis,
cxoveluri produqtebis da nedleulis damzadeba, gadamuSaveba da realizacia. profilaqtikuri
dezinfeqcia tardeba agreTve adamianTa masobrivi TavSeyris adgilebSi (sadgurebi, kino-
Teatrebi, sazogadoebrivi transporti, abanoebi, sazogadoebrivi tualetebi, sacurao auzebi da
a.S.), sadac janmrTel mosaxleobaSi aseve SeiZleba iyos infeqciis wyaro. igi moicavs agreTve
Senobebis ganiavebas da sveli wesiT dalagebas, xelebis dabanas, wyalsadenis wylis daqlorvas,
rZis pasterizacias da a.S.
samkurnalo-profilaqtikur dawesebulebebSi pacientebSi da samedicino personalSi
saavadmyofosSiga infeqciebis gavrcelebis Tavidan acilebis mizniT, aseve atareben sadezinfeqcio
RonisZiebebs. kerZod, tardeba mizanmimarTuli profilaqtikuri, mimdinare da daskvniTi
dezinfeqcia. aseT dros aucilebelia dawesebulebis specifikis codna, aseve im obieqtebis,
romlebic yvelaze ufro masiurad binZurdebian paTogenuri da pirobiT-paTogenuri

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mikroorganizmebiT.
dezinfeqciis Casatareblad iyeneben meqanikur, qimiur da fizikur meTodebs, agreTve maT
kombinacias.
meqanikur meTods miekuTvneba garemos obieqtebidan paTogenuri da pirobiT-paTogenuri
mikroorganizmebis mocileba maTi gabertyviT, sveli wesiT gawmendiT, ganiavebiT, mtversasrutiT
damuSavebiT, ventilaciiT da a.S. aseTi wesiT gauvnebelyofis SemTxvevaSi sagnebi
epidemiologiuri TvalsazrisiT naklebad saSiSni an usafrTxoni xdebian.
ufro efeqturia dezinfeqciis fizikuri meTodi, rac gulisxmobs eleqtroenergiis,
sxivuri energiis, ultrabgeris, dabali temperaturis (gayinva), maRali temperaturis (aduReba),
mSrali da notio cxeli haeris, wylis orTqlis gamoyenebas. dezinfeqcia SeiZleba Catardes
sagnebis dawvis saSualebiT. mas iyeneben iafasiani sagnebis, infeqciuri daavadebiT gardacvlil
adamianTa gvamebis, cxovelTa leSis gasanadgureblad. mikrobiologiur praqtikaSi farTod
iyeneben instrumentebis da laboratoriuli WurWlis gamowvas.

sakmaod farTod gamoiyeneba cxeli wyali (60-100 C), romelsac sarecxi saSualebebi aqvs
damatebuli. umetesi mikroorganizmebi vegetaciur formaSi 30 wuTSi iRupeba wyalSi, romlis

temperatura 60-70 C-mdea. 15-45 wuTis ganmavlobaSi 100 C-ze aduRebiT xdeba gauvnebelyofa
TeTreulis, WurWlis, instrumentebis, avadmyofis movlis sagnebis, saTamaSoebis da a.S. wylis
duRilis antimikrobuli moqmedeba Zlierdeba, Tu wyals emateba 2 %-iani natriumis
hidrokarbonati (soda) an saponi.
radioaqtiuri gamosxivebiT nadgurdeba yvela mikroorganizmi, rogorc vegetaciuri, ise
sporovani formebi. mas farTod iyeneben sterilizaciisaTvis, gansakuTrebiT im dawesebulebebSi,
romlebic sterilur produqcias da erTjerad sterilur samedicino instrumentebs uSveben.
damuSavebulia rekomendaciebi radioaqtiuri gamosxivebiT Camdinare wylebis da cxoveluri
warmoSobis nedleulis dezinfeqciisa.
mzis sxivebi mikroorganizmebis umravlesobaze momakvdineblad moqmedeben gamoSrobis da
ultraiisferi gamosxivebis meoxebiT, Tumca misi moqmedeba zedapirulia, amitom mas praqtikaSi
meorexarisxovani roli eniWeba.
ultraiisferi sxivebiT dezinfeqciisaTvis iyeneben specialur baqteriocidul naTuras.
misi saSualebiT xdeba haeris gauvnebelyofa samkurnalo-profilaqtikur dawesebulebebSi,
bavSvTa dawesebulebebSi, baqteriologiur da virusologiur laboratoriebSi, kvebis
mrewvelobis obieqtebze, vaqcinebisa da Sratebis sawarmoo boqsebSi.
mSrali cxeli haeri (mSrali sicxe) gamoirCeva baqteriociduli, virulociduri,

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inseqticiduri da sporociduli moqmedebiT. mas (160-180 C) iyeneben sahaero sterilizatorebSi
da sxva aparatebSi, sadac xdeba laboratoriuli WurWlis, instrumentebis, agreTve metalis,
SuSis da silikonuri rezinis nawarmis gauvnebelyofa. mas iyeneben agreTve kamerebSi, sadac
xdeba tansacmlis, leibebis, TeTreulisa da sxva sagnebis dezinfeqcia. cxeli haeri Tavisi
efeqturobiT Camouvardeba orTqls, radgan igi zedapirulad moqmedebs. paTogenur
mikroorganizmebze fizikuri zemoqmedeba xorcieldeba aseve specialur kamerebSi, sadac
gamoiyeneba orTqli, paraformalini da orTql-haerovani meTodi. orTqlis kamerebSi dezinfeqcia

wylis orTqliT xdeba 104-111 C da 118-120 C -ze. wylis orTqli kargad aRwevs dasamuSavebeli
sagnebis siRrmeSi da uzrunvelyofs maT saimedo damuSavebas. temperaturis gazrdisas
dezinfeqciis dro mcirdeba.
orTql-formalinis kamerebs iyeneben tyaveulis, bewveulis da sxva iseTi nivTebis
dezinfeqciisaTvis, romlebic maRal temperaturaze fuWdebian. aseT kamerebSi temperatura 42-

45 C an 80-90 C –ia. mis deficits formaldehidis orTqli avsebs, e.i. qimiuri nivTiereba
moqmedebs rogorc sadezinfeqcio faqtori. dasamuSavebeli nivTebis siRrmeSi formaldehidis
orTqlis Rrmad SeWris mizniT (igi zedapirulad moqmedebs), nivTebs kameraSi specialur
Camosakideblebze kideben. orTql - haerovani meTodis dros moqmedi agenti teniani cxeli
haeria. orTqlis da cxeli haeris kombinacia xasiaTdeba bevrad ufro didi baqteriociduli
moqmedebiT, vidre mSrali, cxeli haeri.
dezinfeqciisaTvis yvelaze xSirad qimiuri meTodi gamoiyeneba. qimiuri nivTierebebi,
romlebsac iyeneben dezinfeqciisaTvis, dezinfeqtantebi ewodeba. isini garkveul moTxovnebs
unda akmayofilebdnen. esenia: wyalSi kargi xsnadoba, mikroorganizmTa swrafi ganadgurebis
unari, aqtiuroba organuli nivTierebebis arsebobisas, cxovelebisa da adamianebis mimarT
atoqsikuroba an naklebi toqsikuroba, isini aseve ar unda azianebdnen dasamuSavebel sagnebs, ar
unda kargavdnen Tavis baqteriociduli moqmedebis unars rogorc mSral adgilas Senaxvisas, ise
xsnarebSi arsebobisas, ar unda iyvnen ZviradRirebulni da maTi transportireba advilad unda
xdebodes. praqtikaSi yvelaze xSirad qloris Semcveli dezinfeqtantebi gamoiyeneba.
qloris Semcveli dezinfeqtantebi. iyeneben qloris gazs da qlorian wyals, romlebic
aqtiur qlors 7%-mde Seicaven. maTi saSualebiT xdeba sasmeli da Camdinare wylis
gauvnebelyofa.
qloriani kiri Seicavs 28-35% aqtiur qlors (aqtiuri ewodeba qlors, romelic wylis
xsnarebSi monawileobs qimiur reaqciebSi). es qlori qlorian kirSi aramyari naerTis –
kalciumis hipoqloridis SemadgenlobaSia. dezinfeqciisaTvis gamoiyeneba qloriani kiri,

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romelic aqtiur qlors 16%-ze naklebs ar Seicavs.
qloriani kiri gamoSvebulia TeTri fxvnilis saxiT. Senaxvisas igi kargavs aqtiurobas,
amasTan, SeiZleba TviTaaldes. amitom preparati aucileblad unda inaxebodes kargad Tavdaxurul
WurWelSi, mSral da mzisgan dacul SenobaSi. qlorian kirs gaaCnia baqteriociduli, sporociduli,
fungiciduri moqmedeba. iyeneben inventaris, saTamaSoebis, sakvebis narCenebis, niadagis, Txevadi
gamonayofebis, gaformebuli ganavalis dasamuSaveblad. qloriani kiris 0.2 – 1 %-iani xsnarebi
gamoiyeneba nawlavTa da sasunTqi gzebis infeqciebis, 3-5-10 %-iani - tuberkulozis keris
dezinfeqciisaTvis. unda aRiniSnos, rom qlorian kirs aqvs usiamovno suni, aRizianebs sasunTqi
gzebis da Tvalis lorwovan garsebs, dasamuSavebeli sagnebis zedapirs auferulebs da iwvevs
liTonTa korozias. amdenad, misi wyalxsnarebis gamoyeneba ar aris daSvebuli qsovilebis,
metalisagan damzadebuli sagnebis da SeRebili nawarmis dasamuSaveblad. aseve ar iyeneben iseT
SenobebSi, romlebic cudad niavdeba. aseT SemTxvevebSi iyeneben qloramins, Tu ara gvaqvs igi,
maSin dasaSvebia, qloriani kiris xsnariT iatakis, kedlebis da sayofacxovrebo sagnebis damuSaveba
sacxovrebel adgilebSi da saavadmyofoebSi, oRond wlis Tbil periodSi da misi gamoyenebis
Semdeg Senoba kargad unda ganiavdes da masSi adamianebi daiSvebian dezifeqciis damTavrebidan
arauadres 3 saaTisa. qloramini Seicavs 26% aqtiur qlors. amasTan, karg pirobebSi Senaxvisas
(mSral, bnel adgilas) myarad inarCunebs mas. qloraminis wyalxsnarebi xasiaTdebian
baqteriociduli, virulociduri da fungiciduri moqmedebiTac. wyalxsnarebi bevrad ufro
gamZlea, vidre qloriani kiris xsnarebi. isini damzadebidan 10-15 dRis manZilze SeiZleba iqnen
gamoyenebulni. marTalia, qloraminis sadezinfeqcio efeqti naklebia, vidre qloriani kiris,
magram is ar iwvevs qsovilebis gauferulebas, metalebis korozias. ara aqvs usiamovno suni.
sacxovrebeli adgilebis damuSavebis Semdeg, ganiavebiT qloraminis suni swrafad qreba.
qloramini araaqtivirebuli 0.2 – 5 %-iani xsnarebis saxiT gamoiyeneba. misi saSualebiT
warmoebs TeTreulis, WurWlis, naxvelis, samedicino daniSnulebis nawarmis, Senobebis, avejis,
avadmyofis movlis sagnebis, xelebis damuSaveba. 0.2 – 3 %-iani xsnarebiT xdeba nawlavTa da
sasunTqi gzebis infeqciebis kerebSi dezinfeqcia. 1-3 %-iani xsnarebiT – virusuli hepatitebis,
5 %-iani xsnarebiT – tuberkulozis keraSi.
natriumis hipoqloridi Seicavs aqtiur qlors 0.5 – 0.9 %-mde. gamoiyeneba xsnarebis
saxiT TeTreulis, saTamaSoebis, WurWlis, sanitariul-teqnikuri mowyobilobebis, avadmyofis
movlis sagnebis sadezinfeqciod, aseve nawlavTa da sasunTqi gzebis infeqciebis da jilexis
keraSi zogierTi obieqtebis dasamuSaveblad.
damJangveli dezinfeqtantebi. wyalbadis zeJangi (H2O2) Sedis damJangvelTa jgufSi.
mrewveloba uSvebs 29-30%-iani wyliani xsnaris saxiT, perhidrolis saxelwodebiT da

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warmoadgens ufero da usuno siTxes. wyalbadis zeJangi 1-6 %-iani xsnarebis saxiT gamoiyeneba,
romelsac 0.5 % sarecxi saSualebebi (arieli, taidi da sxv.) emateba. mas iyeneben rogorc
mimdinare, ise daskvniTi dezinfeqciis mizniT TeTreulis, WurWlis, saTamaSoebis, binis,
saojaxo nivTebis, samedicino daniSnulebis nawarmis dasamuSaveblad. xasiaTdeba
baqteriociduli, virulociduri da sporociduli efeqtiT. mas iyeneben agreTve nawlavTa,
wveTovani da zoonozuri infeqciebis kerebSic, aseve samedicino instrumentebis
winasasterilizacio damuSavebisaTvis. igi ar afuWebs dasamuSavebel sagnebs da ar Jangavs
metalebs. xazgasasmelia is faqtic, rom wyalbadis zeJangis 6 %-mde koncentraciis xsnarebi
naklebad toqsikuria adamianebisaTvis.
fenolis Semcveli dezinfeqtantebi. am jgufidan aRsaniSnavia lizoli, romelic aris
metad efeqturi sadezinfeqcio saSualeba. mrewveloba uSvebs ori saxis (“a” da “b” markis)
lizols. igi aris moruxo-moyavisfro gamWvirvale siTxe da aqvs fenolis mkveTri suni. kargad
ixsneba wyalSi, gansakuTrebiT – gamTbarSi.
lizols iyeneben ZiriTadad 2 %-iani xsnarebis saxiT binebis, saojaxo nivTebis,
TeTreulisa da gamonayofebis dasamuSaveblad. gansakuTrebiT aRsaniSnavia, rom igi gamoiyeneba
Savi Wiris da sxva saSiSi infeqciebis kerebSi sxvadasxva obieqtebis dasamuSaveblad. lizolis
xsnaris efeqturoba misi SeTbobisas sakmaod izrdeba. mas aqvs baqteriociduli moqmedebis
unari. iyeneben dezinfeqciisaTvis. lizoli toqsikuria adamianebisaTvis.
aldehidebi. am jgufis preparatebidan yvelaze xSirad formalini gamoiyeneba, romelic
aris formaldehidis 40%-iani wyalxsnari. iyeneben tansacmlis, TeTreulis, fexsacmlis
dasamuSaveblad. paraformalinis kamerebSi iyeneben 0.5 – 5 % -ian xsnarebs.
spirtebi. dezinfeqciisaTvis gamoiyeneba 70%-iani eTilis spirti. misi saSualebiT xdeba
saoperacio velis, personalis xelebis, infeqciebisas kanis damuSaveba.
amJamad saqarTveloSi iyeneben mTel rig axal sadezinfeqcio saSualebebs. esenia:
aerodezin – 2000. mas axasiaTebs baqteriociduli, virulociduri da fungiciduri Tvisebebi
(maT Soris B da C hepatitebis da aiv-infeqciis gamomwvevebisadmi). gamoiyeneba mimdinare,
daskvniTi da profilaqtikuri dezinfeqciisaTvis. gansakuTrebiT xSirad mas iyeneben baqteriuli
etiologiis wveTovani (tuberkulozis garda) da nawlavTa infeqciebis, agreTve virusuli
etiologiis nawlavTa infeqciebis kerebSi Znelad misawvdomi sagnebis zedapiris da aparatebis
dasamuSaveblad.
vibacidi aris 10 %-iani koncentrati da gamoSvebulia momwvano, gamWvirvale xsnaris
saxiT. axasiaTebs baqteriociduli, virulociduli (B hepatitis da aiv-infeqciis virusebis
CaTvliT) moqmedeba. iyeneben instrumentebis, inventaris, avadmyofis gamonayofebis

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dasamuSaveblad saavadmyofoebSi, sazogadoebrivi TavSeyris adgilebSi.
mikrocidi gamoiyeneba samkurnalo-profilaqtikur dawesebulebebSi mimdinare, daskvniTi
da profilaqtikuri dezinfeqciisaTvis, sagnebisa da inventaris zedapiris dasamuSaveblad
baqteriuli (garda tuberkulozis) virusuli da sokovani dabinZurebebis SemTxvevaSi.

10.2. dezinseqcia

dezinseqcia (des-uaryofa, insecta-mweri) niSnavs mwerebis ganadgurebas, romlebic


infeqciuri daavadebebis gadamtanebi arian da aseve im mwerebis ganadgurebasac, romlebic xels
uSlian adamianebs SromaSi da dasvenebaSi.
dezinseqcia iseve rogorc dezinfeqcia or jgufad iyofa: kerovani da profilaqtikuri
dezinseqcia.
kerovani dezinseqcia savaldebuloa transmisiuli gziT gadamdebi infeqciuri daavadebebis
da munis kerebSi, aseve nawlavTa infeqciebis kerebSi Tu iq arian buzebi. profilaqtikuri
dezinseqcia tardeba im mizniT, rom xeli SeuSalon mwerebis, tkipebis, buzebis gamoCekas da
aseve maT dasaxlebas sacxovrebel da sameurneo SenobebSi.
mwerebis winaaRmdeg brZolas ZiriTadad sadezinfeqcio samsaxuris da sazogadoebrivi
jandacvis centrebis Sesabamisi ganyofilebebi awarmoeben. sadezinseqcio RonisZiebebis xasiaTi
damokidebulia infeqciis gadacemis meqanizmze da gadamtanTa biologiur Taviseburebebze.
magaliTad, nawlavTa infeqciebis dros sadezinseqcio RonisZiebebi mimarTulia buzebis
raodenobis Semcirebisaken, romlebic gamomwvevTa meqanikuri gadamtanebi arian. sasunTqi gzebis
infeqciebisas dezinseqcia saerTod ar tardeba. rac Seexeba sisxlis infeqciebs, mas
epidsawinaaRmdego RonisZiebaTa sistemaSi erT-erTi wamyvani adgili ukavia.
mwerebis gasanadgureblad iyeneben meqanikur, fizikur, qimiur, biologiur da
kombinirebul meTodebs. meqanikuri meTodisas iyeneben sxvadasxva saxis badeebs, romelTac
amagreben fanjrebze da karebebze da riTac xels uSlian mwerebis adamianTa sacxovrebel
adgilebSi SeRwevas. es meTodi gulisxmobs agreTve mwerebis ganadgurebas sxvadasxva meqanikuri
saSualebebiT.
fizikuri meTodebidan yvelaze farTod gamoiyeneba cxeli mSrali haeriT momuSave
kamerebi. tansacmelis da TeTreulis tansacmelis da Tavis tilebisagan, aseve munis tkipebisagan
2
gasaTavisuflebad kamerebis muSaobis Semdeg reJims iyeneben: sadezinseqcio kameris 1 m -ze 30 kg

dasamuSavebeli masalis moTavsebisas temperatura 57-59 C-s aRwevs da eqspoziciis


2
xangrZlivoba 30 wuTia. 1 m -ze– 60 kg masalis moTavsebisas, temperatura ahyavT 80-85 C -ze

263
2
da eqspozicia 5 wuTia. tyavis da bewveulis tansacmlis, aseve fexsacmlis damuSavebisas 1 m -ze

aTavseben 24 kg masalas, temperatura 49-51 C -ia, xolo eqspozicia 90 wuTi.


2
orTqlis sadezinfeqcio kamerebSi 1 m -ze aTavseben 10-12 dasamuSavebel kompleqts (50

kg) da masze zemoqmedeben 100 C -ze 5 wuTis manZilze.


qimiur nivTierebebs, romlebic gamoiyeneba dezinseqciis Casatareblad, inseqticidebi
ewodeba. tkipebze momqmed inseqticidebs akricidebi ewodeba. mwerebis matlebis gasanadgureblad
gamoyenebul inseqticidebs – lavricidebi, xolo mwerebis da tkipebis kvercxebis
gasanadgureblad gamoyenebul inseqticidebs – ovocidebi. dezinseqciis miznebidan da
amocanebidan gamomdinare inseqticidebi SeiZleba gamoyenebul iqnen dustis, fxvnilis, emulsiis,
suspenziis, sapnis, mazis, xsnaris, aerozolis, specialuri fanqrebis, laqis, saRebavis saxiT.
inseqticidebi Semadgenlobis mixedviT iyofa qlorSemcvel, fosfororganul, karbonatebad,
piretroidebad da sxva jgufebad.
qlororganul inseqticidebs miekuTvneba dilori. mas iyeneben tarakanebis, baRlinjoebis,
tilebis, rwyilebis, koRoebis gasanadgureblad.
fosfororganuli inseqticidebia diqlofosi, karbofosi da sxv. diqlofosi ZiriTadad
gamoSvebulia aerozoluri balonebis saxiT. mas iyeneben buzebis, rwyilebis, tarakanebis,
koRoebis, tkipebis mosaspobad. igi xasiaTdeba didi inseqticiduri da ovociduri aqtivobiT.
mcenareuli inseqticidebi. piretriumi. moruxo-momwvano fxvnilia, romelsac kavkasiuri
gvirilasagan amzadeben. masSi arsebuli nivTierebebi toqsikur zemoqmedebas axdenen mraval
mwerze (buzi, koRo, tarakana, baRlinjo, rwyili da sxv.). misi dadebiTi mxarea is, rom
adamianebisaTvis ar aris toqsikuri, maSin rodesac Zlier toqsikuria mwerebisaTvis. flicidi.
es aris piretriumis xsnari gasufTavebul navTSi. mas amzadeben qarxnuli wesiT.
piretroidebi. es aris sinTezuri gziT miRebuli preparatebi da piretris analogebs
warmoadgenen. am jgufSi Sedis neopini, romelic wyalSi ar ixsneba, samagierod kargad ixsneba
rTul eTerebSi da aromatul naxSirwylebSi. misgan amzadeben dusts.
amJamad saqarTveloSi gamoyenebuli inseqticidebis raodenoba sakmaod mravalferovania.
magaliTad, rovikurti, romelic warmoadgens 25 %-ian emulgirebul koncentrats. mas gaaCnia
inseqticiduri moqmedebis farTo speqtri, gamoiyeneba tarakanebis, buzebis, baRlinjoebis,
rwyilebisa da koRoebis gasanadgureblad.
ddvf – baci yviTeli feris siTxea. igi farTo speqtris inseqticidia. moqmedebs
qlorofosisadmi mdgrad buzebzec. Tumca maRaltoqsikuria adamianebisa da cxovelebis mimarTac.
sadezinseqcio saSualebebs pirobiTad miekuTvneba repelentebi. qimiur nivTierebebs, romlebic

264
afrTxoben mwerebs, repelentebi ewodebaT. sisxlismwoveli mwerebisagan Tavis dacvis mizniT
repelentebs isvamen kanis Ria nawilebze, magram ise, rom ar xdeba kanSi maTi Sezelva. maTi
gamoyeneba dasaSvebia dReSi 2-3-jer. repelentebis ricxvic sakmaod didia. maT miekuTvneba
dieTiltoluamidi, rebemidi-90, reftamidi da a.S. uvnebeli da usafrTxo repelentia mixakis
zeTi.
inseqticidebis Sesafaseblad gamoiyeneba garkveuli epidemiologiuri kriteriumebi.
magaliTad, gamZleoba garemoSi, moqmedebis mravalferovneba – sxvadasxva saxis mwerebze, maTi
ganviTarebis sxvadasxva stadiaze, maRali toqsikuroba mwerebisaTvis da naklebi
adamianebisaTvis da a.S. rac Seexeba repelentebs, maTi Sefasebis mTavari kriteriumia mwerebis
kbenisagan dacvis xangrZlivoba.
Catarebuli sadezinseqcio muSaobis Sefaseba xdeba mwerebis simWidroviT obieqtebze an
teritoriaze, maTi damuSavebis Semdeg.

10.3. deratizacia

deratizacia (rattus-virTagva) aris RonisZiebaTa kompleqsi, romelic mimarTulia


mRrRnelebis winaaRmdeg sabrZolvelad, romlebic infeqciuri (parazituli) daavadebebis
gamomwvevebis mtareblebi arian da amasTan, sazogadoebas did ekonomikur zians ayeneben.
mRrRnelebis winaaRmdeg brZolis saSualebebi or jgufad iyofa: gamafrTxilebeli
(profilaqtikuri) da gamanadgurebeli.
profilaqtikuri RonisZiebebi gulisxmobs iseTi pirobebis Seqmnas, romlebic xels
SeuSlis mRrRnelebs sacxovrebel saxlebSi da sameurneo dawesebulebebSi SeRwevas, iq
cxovrebas da gamravlebas, aseve gamoiwveven mRrRnelebis raodenobis Semcirebas Ria adgilebSi.
arCeven aseve saqalaqo (sasoflo) da savele deratizacias. saqalaqo deratizaciis ZiriTadi
RonisZiebebi mimarTulia sinantropuli da naxevradsinantropuli mRrRnelebis winaaRmdeg.
yvelaze efeqturia sayovelTao, sistemuri deratizacia, romelic gulisxmobs gamafrTxilebeli
da gamanadgurebeli RonisZiebebis kompleqsur Catarebas mTeli wlis manZilze dasaxlebuli
adgilis mTel teritoriaze da yvela obieqtze.
savele deratizaciis ZiriTadi RonisZiebebi mimarTulia veluri (gareuli) mRrRnelebis
mimarT, ZiriTadad bunebriv-kerovani infeqciebis gamomwvevTa mtarebeli mRrRnelebisaken. am
dros deratizaciasTan erTad tardeba dezinseqciac, raTa paralelurad ganadgurdes bunebriv-
kerovani infeqciebis gadamtanebic.
deratizaciis Catareba aucilebelia iseTi mZime daavadebebis dros rogoricaa Savi Wiri
(iseve rogorc daskvniTi dezinfeqcia), tularemia, leptospirozi, iersiniozi, xolo
265
epidemiologiuri Cvenebisas salmonelozis drosac.
gamanadgurebeli deratizaciis Casatareblad iyeneben meqanikur, qimiur da biologiur
meTodebs. meqanikuri meTodi gulisxmobs mRrRnelebis daWeras specialuri xelsawyoebiT
(saTaguri, xafangi) da SeiZleba gamoyenebul iqnas rogorc SenobebSi, ise Ria adgilebSi. igi
usafrTxo meTodia rogorc adamianebisaTvis, ise sasoflo-sameurneo cxovelebisaTvis.
biologiuro meTodi gulisxmobs paTogenuri mikroorganizmebis gamoyenebas, romlebiTac
amuSaveben mRrRnelebis misatyuebels. biologiur meTods miekuTvneba genetikuri meTodic,
romelic emyareba bunebriv populaciaSi winaswar sterilizebuli mamri mRrRnelebis gaSvebas.
biologiur meTods miekuTvneba agreTve `mfarveloba” im cxovelebisa da frinvelebisa,
romlebic mRrRnelebis ganadgurebas awarmoeben.
qimiuri meTodi damyarebulia mRrRnelebis mosawamlad qimiuri nivTierebebis gamoyenebaze,
romelTac raticidebi (rodenticidebi) ewodeba. maTi gamoyenebisas aucilebelia piradi da
sazogadoebrivi usafrTxoebis dacva, gansakuTrebiT ki bavSvTa, samkurnalo dawesebulebebSi da
kvebis obieqtebze.
raticidebi unda akmayofilebdnen garkveul moTxovnebs. mRrRnelebis letalobas mcire
dozebSi unda iwvevdnen, toqsikuri efeqti swrafad unda dgebodes, garemoSi da misatyuebelSi
toqsikurobas didxans unda inarCunebdes da a.S. deratizaciis efeqtis Sesafaseblad
gamokvleul unda iqnas mRrRnelebis raodenoba teritoriaze deratizaciamde da deratizaciis
Semdgom.

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Tavi 11 kerZo infeqciur daavadebaTa epidemiologia
11.1. dizenteria (Sigelozi)

mwvave anTroponozuli infeqciuri daavadebaa, romelsac axasiaTebs gadacemis fekalur-


oraluri meqanizmi, msxvili nawlavis upiratesi dazianeba da organizmis intoqsikacia. daavadeba
uZvelesi droidanaa cnobili. mas jer kidev hipokratem miaqcia yuradReba da daavadebas
dizenteria (dys-moSla, enteros-nawlavi) uwoda. am infeqciis SedarebiT srulyofili aRwera Cv.
w. aR. I saukuneSi mogvawoda areTeim, xolo XVI-XIX saukuneebSi mis Sesaxeb cnobebi mraval
istoriul wyaroSia moxseniebuli. saqarTveloSi dizenteria Sua saukuneebidanvea cnobili,
xolo 1865 (samurzayano), 1873 (quTaisis mazra) da 1897 (kaxeTi) wlebSi aRwerilia misi
epidemiebic.
etiologia. daavadebas iwvevs Shigella–s gvaris baqteriebi (ris gamoc XX saukuneSi am
daavadebas Sigelozi uwodes), romlebic Enterobacteriaceae-s ojaxs miekuTvneba da moicavs xuT
aTeulze met serologiur variants, romlebic saerTaSoriso klasifikaciiT 4 jgufad iyofa:
S. dysenteriae, S. flexneri, S. boydi, S. sonnei. TiToeul maTgani, S. sonnei-s garda, Seicavs ramdenime
serovars. magaliTad, S. dysenteriae-s SemadgenlobaSi Sedis 12 serovari, maT Sorisaa grigoriev-
Siga, Stucer-Smitci da larj-saqsi. S. flexneri aerTianebs 8 serovars, maT Soris niukaslis
serovars. xolo S. boydi aerTianebs 18 serovars.
Sigelebi gramuaryofiTi, umoZrao baqteriebia, ar warmoqmnian sporas da kafsulas,
daSlisas aTavisufleben endotoqsins, warmoqmnian enterotoqsins da citotoqsins, xolo
grigoriev-Sigas Sigelebi – Zliermomqmed neirotoqsins.
Sigelozis gamomwvevi, romelic pirvelad gamoyofil iqna a. grigorievis mier 1891 wels,
gardacvlil avadmyofTa msxvili nawlavidan aRebuli masalidan, 1898 w. detalurad Seiswavla
iaponelma mkvlevarma Sigam. Sigelebis sxva saxeobebi gamoyofili da Seswavlil iqna me-20
saukuneSi. saqarTveloSi Sigelozebis (dizenteriis) epidemiologia Seswavlilia profesor l.
sayvareliZis mier. bolo ramdenime aTeuli wlis ganmavlobaSi Sigelozebis etiologiur
struqturaSi mniSvnelovani cvlilebebi moxda. kerZod klinikurad sakmaod mZimed mimdinare
grigoriev-Sigas Sigelozi, romlis gamomwvevic garemoSi gamoZleobiT ar gamoirCeoda,
Tanmimdevrulad Seicvala SedarebiT ufro msubuqad da xSirad atipurad mimdinare fleqsneris
da zones SigeloziT, romelTa gamomwvevebi garemoSi ufro metad gamZlea. aRsaniSnavia isic,
rom klinikuri mimdinareobis mravalferovnebis gamo, am ukanasknelTa mier ganpirobebuli
daavadebis SemTxvevebis srulad gamovlena gacilebiT Znelia.
garemoSi Sigelas mikrobebi arc ise mdgradni arian. samagierod Tanamedrove Stamebi,
gansakuTrebiT S. sonnei, Zalian gamZlea antibiotikebisadmi. sadezinfeqcio xsnarebi Cveulebriv
267
koncentraciaSi damRupvelad moqmedeben Sigelebze.
infeqciis wyaro. dizenteriis dros infeqciis wyaroa mwvave da qronikuli formiT
daavadebulebi da baqteriamtareblebi (tranzituli da rekonvalescenturi mtareblebi).
avadmyofi gadamdebi xdeba daavadebis dawyebisTanave da gadamdebloba grZeldeba
rekonvalescenciis periodSic, vidre organizmidan gamoiyofa gamomwvevi. ufro xSirad
daavadebas avrceleben mwvave dizenteriiT daavadebulebi, xolo qronikuli dizenteriiT
avadmyofebi gansakuTrebiT saSiSni arian Semodgomasa da zamTris periodSi.
SeiZleba iTqvas, rom xangrZlivi baqteriamtarebloba am daavadebis dros ar aRiniSneba.
mosaxleobis sxvadasxva jgufebSi gamovlinebuli e.w. `baqteriamtareblebis~ umetesoba
dizenteriis sxvadasxva formiT daavadebuli piria.
Tanamedrove pirobebSi dizenteriis infeqciis ZiriTad wyaros warmoadgenen am daavadebis
msubuqi da gaxangrZlivebuli formiT daavadebulebi, romelTa gamovlenac TiTqmis ar xdeba.
rogorc zemoT aRiniSna, dizenteriis etiologiur struqturaSi adgili aqvs garkveul
cvlilebebs, rasac Tan sdevs klinikuri da epidemiologiuri xasiaTis mniSvnelovani
cvlilebebi, rac daavadebis klinikur mimdinareobaSi gamoixata msubuqi da waSlili formebis
simravliT. amis gamo, xSir SemTxvevaSi, aseTi avadmyofebi ar mimarTaven samedicino dawesebulebebs
da baqteriologiuri gamokvlevis gareSe itareben TviTmkurnalobas. araetiotropuli
mkurnaloba ki xels uwyobs daavadebis gaxangrZlivebuli formebis Camoyalibebas, rac
mniSvnelovanwilad zrdis potenciuri infeqciis wyaros raodenobas.
gadacemis meqanizmi. dizenteria, rogorc nawlavTa tipuri infeqcia, vrceldeba fekalur-
oraluri meqanizmiT, romelic aerTianebs sakvebismier, wylismier da sayofacxovrebo-kontaqtiT
gadacemis gzebs. Sigelebis mimarT dadasturebulia gadacemis samive gzis arsebiTi mniSvneloba.
yvelaze ufro xSir faqtorebs, romlebic Sigelebis gadacemaSi iReben monawileobas,
miekuTvneba: 1. sakvebi produqtebi, gansakuTrebiT rZe da misi nawarmi, bostneuli da xili; 2.
wyali 3. sayofacxovrebo moxmarebis sxvadasxva sagani (pirvel rigSi WurWeli, saTamaSoebi), 4.
buzebi.
cnobilia gadacemis gzebis etiologiuri amorCeviTobis, anu Sesatyvisobis Teoria,
romlis Tanaxmadac zones Sigelebi upiratesad sakvebismieri gziT, fleqsneris Sigelebi
wylismieri gziT, xolo grigoriev-Sigas mikrobebi sayofacxovrebo kontaqtis gziT vrceldeba.
iTvleba, rom Tanamedrove pirobebSi zones Sigelozis mimarT e.w. `rZisa~ da `rZis
produqtebis faqtors~ upiratesi mniSvneloba eniWeba, rac ar SeiZleba iTqvas wylis faqtorze
fleqsneris Sigelozis dros, romelic erTnairi intensivobiT SeiZleba gavrceldes, rogorc
wylis, aseve sakvebis meSveobiT.

268
rogorc fleqsneris, ise zones Sigelozis gavrcelebis erT-erT xSir gzad
sayofacxovrebo-kontaqtiT gadacemis gzasac miiCneven, gansakuTrebiT ojaxur kerebSi da bavSvTa
skolamdel koleqtivebSi.
gasaTvaliswinebelia, rom infeqciis gadacemis calkeuli gzis xvedriTi wili
damokidebulia mraval pirobaze, maT Soris mosaxleobis sanitariul mdgomareobaze, kulturis
doneze, kvebis Taviseburebebze. amasTan, gadacemis gzebis mniSvneloba SeiZleba Seicvalos
mosaxleobis yofa-cxovrebis pirobebis SecvlasTan erTad.
epidemiologiuri Taviseburebebi. dizenterias kvlav mniSvnelovani adgili ukavia
nawlavTa mwvave infeqciebs Soris. es daavadeba mTel msoflioSi farTodaa gavrcelebuli da
warmoadgens seriozul problemas dabali Semosavlebis mqone qveynebisaTvis. is gvxvdeba yvela
kontinentze da yvela geografiul zonaSi.
msoflioSi Sigelozis SemTxvevebis registracia arasrulia, rasac ganapirobebs erTi
mxriv zogierT qveyanaSi mxolod baqteriologiurad dadasturebuli SemTxvevebis aRricxva,
xolo meores mxriv, dabali da saSualo Semosavlebis qveynebSi samedicino momsaxurebis da
Sesabamisad diagnostikis dabali done. saqarTveloSi dizenteriiT avadobis maCveneblebi sakmaod
dabalia, magaliTad 2014 wels igi Seadgenda 18.8-s 100 000 mosaxleze, 2015 wels-31.4-s. Cveni
azriT aRniSnuli monacemebi odnavadac ver asaxavs saqarTveloSi dizenteriis gavrcelebis
realur suraTs.
dizenteriis, iseve rogorc nawlavTa sxva mwvave infeqciebis teritoriuli gavrceleba
bevradaa ganpirobebuli socialuri faqtorebiT. saqarTvelos yvela regionSi fleqsneris
Sigelebi, zones SigelebTan erTad dizenteriis ZiriTad gamomwvevs warmoadgenen. avadobis
SedarebiT maRali maCveneblebi aRiricxeba samrewvelo da sakurorto qalaqebSi da im raionebSi,
sadac maRalia Sobadobis da bavSvTa xvedriTi wilis maCveneblebi. aRniSnul raionebSi
migraciul procesebTan da sanitariuli keTilmowyobis donesTan erTad garkveuli mniSvneloba
aqvs mosaxleobis simWidrovesac.
dizenteriis epidemiologiur Taviseburebebs ZiriTadad gansazRvravs am daavadebis
polietiologiuri xasiaTi, klinikuri gamovlinebis polimorfizmi, gadacemis mravalfaqtoruli
meqanizmi, gamomwvevTa gamZleoba garemoSi, postinfeqciuri imunitetis saxe, tipospecifikuroba
da sayovelTao mimRebloba.
avadobis SedarebiT maRali maCveneblebi aRiniSneba bavSvebSi. gansxvavebulia avadobis
maCveneblebi skolamdeli asakis organizebul da araorganizebul bavSvebSi. avadoba Warbobs
organizebulTa Soris.
umcrosi asakis bavSvebSi daavadebis ufro metad gavrcelebis mizezi, garda maTi maRali

269
mimReblobisa, unda iyos isic, rom am asakis bavSvebSi daavadeba mozrdilebTan SedarebiT ufro
tipuri da SedarebiT mZime klinikuri mimdinareobiT xasiaTdeba, rac xels uwyobs avadmyofTa
srul gamovlenas. dizenteriiT bavSvTa maRali avadobis mniSvnelovan faqtorad unda CaiTvalos
agreTve maTi mudmivi urTierToba ufrosebTan, romelTa epidemiologiuri mniSvneloba, rogorc
SesaZlebeli infeqciis wyarosi, sakmaod didia.
dizenterias axasiaTebs mkveTrad gamoxatuli zafxul-Semodgomis sezonuroba.
saqarTveloSi dizenteriiT avadobis maqsimumi aRiniSneba agvisto-seqtemberSi. aRsaniSnavia isic,
rom im faqtorTa intensivoba, romlebic gansazRvraven avadobis sezonur cvalebadobas,
araerTgvarovania. Cveni qveynis calkeul teritoriaze dizenteriis sezonurobis Taviseburebani
erTi mxriv aixsneba gansxvavebuli bunebrivi, upiratesad klimaturi pirobebiT, xolo, meore
mxriv, calkeul TveebSi mosaxleobis migraciis araTanabari intensivobiT.
im faqtorebs, romelTa aqtivobazec damokidebulia Sigelozebis sezonuri
Taviseburebebi, miekuTvneba: mimRebi kontingentis raodenobis da infeqciis wyaros raodenobis
mateba, Tbili periodis dadgomasTan dakavSirebiT adamianis cxovrebis da kvebis reJimis Secvla,
garemoSi gamomwvevTa gamZleobis da sicocxlisunarianobis gazrda, buzebis raodenobis
momateba. es faqtorebi maqsimalurad aqtiurdeba agvisto-seqtemberSi, xolo SemdgomSi
temperaturis TandaTan klebasTan erTad maTi aqtivoba mcirdeba. sanacvlod matulobs
epidemiur keraTa ricxvi da am kerebSi infeqciis wyaros SesaZlo raodenoba. swored am
periodSi TamaSobs gansakuTrebul rols gadacemis sayofacxovrebo-kontaqtis gza.
gadatanili daavadebis Semdeg iqmneba Seuvaloba ramdenime wlis ganmavlobaSi.
gamojanmrTelebis Semdeg, pirvel TveebSi, SesaZlebelia recidivebi. aRiniSneba agreTve
daavadebis ganmeorebiTi SemTxvevebi.
klinika da laboratoriuli diagnostika. inkubaciuri periodi 1-7 dRea. daavadeba iwyeba
mwvaved. gamoxatulia Semdegi klinikuri niSnebi: saerTo sisuste, Tavis tkivili, Zlieri,
SeteviTi xasiaTis tkivili muclis areSi, temperaturis momateba, zogjer gulisreva da
Rebineba. daavadebis dasawyisSi ganavali Txieria, ramdenime saaTis Semdeg masSi Cndeba lorwo,
Semdeg sisxli da Cirqi. TandaTanobiT muclis tkivili Zlierdeba da lokalizdeba muclis
marcxena naxevarSi. avadmyofs awuxebs daukmayofileblobis grZnoba, WinTvebi da tenezmebi.
defekaciis sixSire dRe-RameSi meryeobs 5-dan 50-mde. daavadeba grZeldeba 3-dan 9 dRemde.
daavadebis mimdinareobaSi arCeven msubuq, saSualo da mZime formebs. daavadeba aseve
SeiZleba mimdinareobdes rogorc mwvave, ise qronikuli formiT.
laboratoriuli diagnostikis yvelaze utyuar meTods warmoadgens baqteriologiuri
gamokvleva – ganavlidan Sigelebis gamoyofa. baqteriologiuri gamokvlevis Sedegi

270
damokidebulia masalis aRebis vadebze, masalis raodenobaze da xasiaTze, Catarebul
medikamentozur mkurnalobaze, sakvebi niadagis xarisxze da gamokvlevis jeradobaze.
baqteriologiuri gamokvlevis Sedegi maRalia Tu gamokvleva tardeba daavadebis pirvel
dReebSi, antibiotikebis da sulfanilamidebis gamoyenebamde, agreTve Tu masala grovdeba
uSualod avadmyofis sawolTan da iTeseba erTdroulad ramdenime sakveb niadagze. gamosakvlev
masalas warmoadgens: ganavali, pirnaRebi masebi da kuWis amonarecxi. imis gamo, rom
baqtriologiuri gamokvlevis srulfasovani Sedegebi miiRweva mxolod mravaljeradi
gamokvlevis SemTxvevaSi, aucilebeli xdeba kvlevis damatebiTi meTodebis gamoyeneba, mag.
serologiuri gamokvlevebi specifikuri antisxeulebis aRmoCenisaTvis. am mizniT gamoiyeneba
arapirdapiri hemaglutinaciis reaqcia.
profilaqtika da epidsawinaaRmdego RonisZiebebi. dizenteriis da nawlavTa sxva
infeqciebis warmoSoba-ganviTarebaSi gansakuTrebul rols asrulebs epidemiologiurad
mniSvnelovani obieqtebis sanitariul-higienuri mdgomareoba. amitom saWiroa specialistTa
yuradReba gamaxvildes riskis konkretul obieqtebze, rogoricaa sazogadoebrivi kvebis da
sasursaTo saqonliT movaWre dawesebulebebi, rZis gadamamuSavebeli da ualkoholo sasmelebis
damamzadebeli sawarmoebi, centralizebuli wyalmomaragebis sistemebi, bavSvTa skolamdeli da
saskolo dawesebulebebi.
garemos sanitariuli mdgomareobis gasaumjobesebel RoniZiebaTa moculobis gazrda
iwvevs Sesabamisad avadobis klebas. amasTan, SigelozebiT avadobis donis mkveTri meryeoba da
cvalebadoba, romelic aRiniSneba sanitariul-higienuri mdgomareobis zogadi gaumjobesebisagan
damoukideblad, SeiZleba ganpirobebuli iyos gamomwvevebis biologiuri Taviseburebebis
ganmsazRvreli faqtorebiT. amitom epidemiologiuri zedamxedvelobis sistemis srulyofisaTvis
saWiroa dinamiuri meTvalyureoba gamomwvevTa biologiur Tvisebebze, risTvisac aucilebelia
baqteriologiuri samsaxuris muSaobis gaumjobeseba.
avadmyofis hospitalizaciis an misi binaze datovebis sakiTxi wydeba eqimis mier
pirveladi diagnozis dadgenisas. aRniSnuli sakiTxi aucileblad unda SeTanxmdes
epidemiologTan.
binaze avadmyofis datovebis SemTxvevaSi mas eniSneba mkurnaloba, xolo ojaxSi unda
Catardes axsna-ganmartebiTi muSaoba misi movlisa da dezinfeqciis wesebis Sesaxeb. mkurnaloba
binaze mimdinareobs infeqcionistis konsultaciiT daavadebis mwvave gamovlinebis Caqrobamde
(faRaraTis Sewyveta, sicxis normalizacia da a.S.). samkurnalod binaze datovebuli bavSvebi
gamojanmrTelebamde imyofebian pediatris meTvalyureobis qveS. nawlavTa mwvave daavadebebis
aRmoCenisas epidemiologiur gamokvlevas epidemiologi mxolod daavadebis jgufur SemTxvevaSi

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atarebs. epidemiologiuri gamokvlevis mizania: daavadebis warmoSobisa da gavrcelebis
xelSemwyobi pirobebis gamovlena, keris sazRvrebis dadgena, misi likvidaciisaTvis
epidemiologiurad dasabuTebuli RonisZiebebis Catareba.
daavadebulTan kontaqtSi myofi pirebi eqvemdebarebian SviddRian samedicino dakvirvebas
keraSi ganmeorebiTi daavadebis gamosavlenad. am mizniT axorcieleben daavadebulTan
urTierTobaSi myofTa gasinjvasa da maTze samedicino dakvirvebas (sicxis gazomva, ganavlis
gasinjva, nawlavebis palpacia).
avadmyofis binaze datovebisas daavadebis mTel manZilze tardeba mimdinare dezinfeqcia.
igi tardeba ojaxis wevrebis mier, samedicino muSakebis xelmZRvanelobiT.

11.2. qolera

baqteriuli etiologiis mwvave infeqciuri daavadebaa gadacemis fekalur-oraluri


meqanizmiT, romelic Sedis saerTaSoriso kontrols daqvemdebarebul gansakuTrebiT saSiS
infeqciebis jgufSi.
es daavadeba uZvelesi droidan aris cnobili. mecxramete saukunemde daavadeba
lokalizebuli iyo indostanis naxevarkunZulze, mdinareebis gangis da brahmaputris auzebSi
(dRevandeli indoeTi, pakistani, bangladeSi). sxva regionebSi vrceldeboda Zalian iSviaTad.
situacia radikalurad Seicvala mecxramete saukunis dasawyisSi. savaWro urTierTobebis
gaZlierebis da satransporto mimosvlis gaadvilebis Sedegad qolera masobrivad gavrcelda
sxva adgilebSic. 1817 – 1925 wlebSi am daavadebis 6 pandemia dafiqsirda. 1926-1960 wlebSi
Catarebuli sanitariul-sakarantino RonisZiebebis meSveobiT qoleriT avadoba mniSvnelovnad
Semcirda da realurad dadga sakiTxi misi sakarantino infeqciebis jgufidan amoRebis Taobaze.
1961 wels situacia mkveTrad Seicvala. daiwyo me-7 pandemia.
qoleris gamomwvevi pirvelad gamoyo da Seiswavla 1883-1884 wlebSi genialurma
germanelma mikrobiologma r. koxma. daavadebis kidev erTi gamomwvevi – el-toris vibrioni
1905 wels gamoyo gotSlixma el-toris sakarantino punqtSi.
etiologia. daavadebas iwvevs qoleris vibrioni, romelic miekuTvneba Vibrio - s gvars da
qoleris 01 serologiur jgufs. misi ori biovari aris cnobili – klasikuri (V. cholerae
asiaticae) da el-toris (V. cholerae eltor). pirveli 6 pandemiis gamomwvevi klasikuri qoleris
vibrioni iyo, xolo meSvide pandemiis – el-toris vibrioni. orive biovari 3 serovarisagan
Sedgeba. esenia: Ogava, Inaba da Higoshima.
me-20 saukunis 90-iani wlebis dasawyisSi msoflioSi (ZiriTadad samxreT-aRmosavleT
aziaSi) adgili hqonda diareuli daavadebebis afeTqebas, gamowveuls qoleris vibrioniT,
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romelic ara 01, aramed 0139 serojgufs miekuTvneba (serovari bengali), radgan es vibrionebi
ar aglutinirdebian 01 SratebiT. amJamad es daavadeba ZiriTadad sporaduli formebis saxiT
vrceldeba da mxolod aziis farglebSi gvxvdeba.
qoleris vibrionebi gramuaryofiTi, mZimis formis, moZravi, aerobuli Cxirebia, romlebic
Zalian kargad izrdebian martiv sakveb niadagebze, magaliTad 1%-ian peptonian bulionze.
qoleris vibrionebi gamoyofen rogorc endotoqsins, ise cilovani bunebis egzotoqsins
(enterotoqsini, qolerogeni). swored es ukanaskneli TamaSobs wamyvan rols daavadebis
ganviTarebaSi. amas garda vibrioni Seicavs somatur O – antigens, romelic rogorc aRiniSna 3
serovarisagan Sedgeba, da wamwamovan H – antigens.
bunebaSi sakmaod gavrcelebulia agreTve vibrionebi, romlebic ar aglutinirdebian
qoleris 01 SratiT da iwveven qoleris magvar diareul daavadebebs, maT araaglutinirebadi
vibrionebi ewodeba. isini Tavisi morfologiuri da bioqimiuri TvisebebiT Zalian emsgavsebian
qoleris vibrionebs.
garemo pirobebSi qoleris vibrionebi sakmaod gamZleni arian. es gansakuTrebiT el-toris
vibrionebze iTqmis. kargad itanen dabal temperaturas da gayinvas. aduRebiT iRupebian erT
wuTSi. wyalsatevebSi, rodesac aRiniSneba maRali temperatura, iseve rogorc mTeli rigi
hidrobiontebis organizmSi, vibrionebi ara marto inarCuneben cxovelmyofelobas, aramed
mravldebian. amdenad SeiZleba iTqvas, rom qolera sapronozebsac miekuTvneba. mJave reaqcia,
gansakuTrebiT maSin, rodesac pH<5,5-ze, damRupvelad moqmedebs qoleris vibrionebze, iseve,
rogorc qloris Semcveli sadezinfeqcio nivTierebebi. marilmJava 1:10 000-ze ganzavebulic ki,
swrafad iwvevs vibrionebis inaqtivacias.
infeqciis wyaro. infeqciis ZiriTadi wyaro qoleris dros aris daavadebuli adamiani,
gansakuTrebiT msubuqi da waSlili formebiT daavadebulebi. yvelaze metad saSiSia avadmyofi
daavadebis pirvel dReebSi, rodesac fekaluri da pirnaRebi masebiT garemoSi gamoiyofa aseuli
miliardi vibrioni. rekonvalescenciis periodSi gadamdebloba mkveTrad klebulobs da me-3
kvirisaTvis vibrionebis gamoyofa wydeba.
mniSvnelovan infeqciis wyaros warmoadgenen vibriomtareblebi. qoleris dros aRiniSneba
rogorc `janmrTeli~, ise rekonvalescenturi mtarebloba. gansakuTrebiT xSiria da xangrZlivi
mtarebloba el-toris vibrionebiT gamowveuli qoleris dros.
rogorc aRiniSna qoleris dros gamomwvevis rezervuari SeiZleba iyos wyali.
gadacemis meqanizmi aris fekalur-oraluri. sxva nawlavTa infeqciebisagan gansxvavebiT
qolera advilad vrceldeba, rac aixsneba garemoSi avadmyofis mier Zalian didi raodenobiT
vibrionebis gamoyofiT. magaliTad daavadebis pirvel dReebSi avadmyofi dRe-RameSi 20

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litramde Txier ganavals gamoyofs, romlis TiToeuli mililitri ramdenime aTeul milion
vibrions Seicavs. aseTi didi raodenobiT gamomwvevis gamoyofis mxriv qoleras praqtikulad
analogi ara aqvs. aqve unda aRiniSnos, rom qoleris dros muclis tifisagan gansxvavebiT ar
aRiniSneba baqteriemia, amitom vibrioni iSviaTad gamoiyofa SardiT, is, rogorc wesi, aris
fekaliebSi da pirnaReb masaSi.
gadacemis wamyvani faqtori daavadebis dros aris wyali. inficireba xdeba wylis
sasmelad gamoyenebis an banaobisas. kuWis wvenis mJave reaqcia qoleris vibrionisaTvis gauvali
barieri ar aris. vibrionebis wvril nawlavebSi gadasvlas, sadac xelsayreli pirobebia maTi
cxovelmyofelobisa da gamravlebisaTvis, ramdenime faqtori uwyobs xels. upirveles yovlisa
es aris kuWis wvenis mJavianobis daqveiTeba sxvadasxva daavadebis gamo. barieris gadalaxvaSi
vibrionebs exmareba organizmSi maTi moxvedra wylis did raodenobasTan (gansakuTrebiT civ)
erTad, romelic aneitralebs kuWis wvens, xolo civi wyali amasTan amcirebs kuWis wvenis
sekrecias. vibrionebi sakvebis did nawilebTan erTadac SeiZleba moxvdnen wvril nawlavebSi,
radgan kuWSi yofnis dros SesaZlebelia ar moeswros maTi fizikur-qimiuri damuSaveba.
sakvebi produqtebis da sayofacxovrebo-kontaqtis gziT aseve SesaZlebelia daavadebis
gavrceleba, Tumca maTi roli wylis faqtorTan SedarebiT didi ar aris.
epidemiologiuri Tavseburebebi. qolera mimdinareobis simZimiT, maRali letalobiT,
unariT drois mokle monakveTSi moicvas uzarmazari teritoriebi mosaxleobis sagrZnobi
nawiliT, miekuTvneba yvelaze mniSvnelovan infeqciaTa jgufs.
rogorc aRiniSna, Tu pirveli eqvsi pandemiis gamomwvevi iyo V. cholerae, meSvide pandemiis
mizezia el-toris vibrioni. saqarTvelos pirvelis garda yvela pandemia Seexo. magaliTad meore
pandemia 1828 wels daiwyo indoeTSi, gavrcelda iranSi da aqedan amierkavkasiaSic SemoiWra.
gavrcelebis analogiuri gza aRiniSna mesame pandemiis drosac (1844-1864ww). meoTxe pandemiisas
(1865-1875ww) saqarTveloSi infeqcia ZiriTadad maSindeli osmaleTidan gavrcelda. mexuTe
pandemia (1883-1896ww) Cvens qveyanas, iseve rogorc mTlianad ruseTis imperias, naklebad Seexo.
rac Seexeba meeqvse pandemias (1900-1926ww), igi qveyanaSi sxvadasxva gziT gavrcelda.
me-7 pandemia, romelic indoneziidan daiwyo, 1965 wels yofil sabWoTa kavSirSic
SeiWra. gansakuTrebiT farTod gavrcelda daavadeba 1970 wels, rodesac qoleris SemTxvevebi
dafiqsirda odesaSi, astraxanSi, qerCSi da sxvagan. amave wels am daavadebis afeTqebas adgili
hqonda baTumSic, sadac epidafeTqebis droul likvidaciaSi didi wvlili Seitanes iseTma
cnobilma mecnierebma da jandacvis organizatorebma, rogorebic iyvnen l. sayvareliZe da v.
boWoriSvili.
amJamadac qolera sakmaod farTodaa gavrcelebuli. 1961-2001 wlebSi am infeqciiT

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daavadda 4 725 539 adamiani, gardaicvala 203 780 (letalobam Seadgina 4,8%). SemTxvevebi
dafiqsirda 163 qveyanaSi. epidemiuri procesi ufro intensiuri gaxda 1990 wlidan. 1990-2001
wlebSi qoleris 2 539 630 SemTxveva dafiqsirda, ramac meSvide pandemiis dros gamovlenili
yvela SemTxvevis 59,2% Seadgina. am periodSi daavadebis SemTxvevebi dafiqsirda saqarTvelos
mosazRvre teritoriebze. magaliTad 1994 wels daRestanSi saudis arabeTidan dabrunebul
momlocvelebSi daiwyo qoleris afeTqeba, romelmac 1 600 adamiani moicva. amave wels
ukrainaSi daavadda daaxloebiT 1 000 adamiani. am qveyanaSi daavadebis sporaduli SemTxvevebi
da vibriomtarebloba 1996-2003 wlebSic vlindeboda. amJamad yovelwliurad msoflioSi
qoleris 1.3-4 milionamde SemTxveva viTardeba, romelTagan 21-143 aTasi letalobiT mTavrdeba.
2017 wels janmoSi 34 qveynidan Sevida 1 227 391 SemTxvevis Sesaxeb Setyobineba, romelTagan 5
654 letalobiT damTavrda. gansxvaveba aRniSnul ricxvebs Soris gamowveulia imiT, rom
qoleris bevri SemTxveva ar vlindeba da Sesabamisad ar registrirdeba. 2018-2019 wlebSi
qoleris gavrceleba msoflioSi mniSvnelovnad Semcirda. magaliTad 2018 wels daavadebis
mxolod naxevar milionamde SemTxveva gamovlinda da 2 990 adamiani gardaicvala.
1992 wlis dekemberSi indoeTSi daiwyo qoleris afeTqeba, romelic 1993 wlis martamde
gagrZelda da daavadda 100 aTasze meti adamiani, xolo 1 473 gardaicvala. mniSvnelovani iyo
is, rom daavadebuli adamianebidan gamoyves qoleris vibrionebi ara 01-serologiuri jgufidan,
aramed 0139 Stamebi, romlebic ar aglutinirdebian qoleris 01 - diagnostikuri SratiT. es
Stamebi Seswavlil iqna indoeTis qoleris nacionalur institutSi da isini
identificirebulni iqnen rogorc qoleris vibrionebi 0139 – serologiuri jgufidan, anu
qolera bengali (Stamis pirveli aRmoCenis adgilis aRsaniSnavad).
qoleris SemTxvevebi gvxvdeba wlis Tbil periodSi. endemur kerebSi ZiriTadad bavSvebi
xdebian avad, xolo im dros, rodesac daavadebis SemTxvevebs adgili aqvs iseT teritoriebze,
sadac qolera adre ar vlindeboda, ZiriTadad avaddebian mozrdili pirebi 20-50 wlis asakSi.
daavadeba ZiriTadad azianebs dabali sanitariuli kulturis mqone pirebs. jer kidev 1892
wels cnobili qarTveli sazogado moRvawe i. gogebaSvili gazeT iveriaSi werda: `sadac qolera
gaCenila, sul musri gauvlia Rormucela da loTi adamianebisaTvis~.
klinika da laboratoriuli diagnostika. inkubaciuri periodi 12 saaTi-5 dRes Seadgens.
iSviaTad SeiZleba 6 dRemde gagrZeldes. moxvdeba ra qoleris vibrionebi wvril nawlavebSi,
isini gamoyofen 3 toqsikur substancias: endotoqsins, egzotoqsins (qolerogeni) da
SeRwevadobis faqtors, romlebic ganapirobeben daavadebis ganviTarebas.
daavadeba ufro xSirad usimptomod an msubuqi formiT mimdinareobs da advilad
emorCileba mkurnalobas oraluri rehidrataciuli xsnarebiT. mZime formebi, rogorc wesi,

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iwyeba mwvaved, ufro xSirad Ramis saaTebSi an gamTeniisas. faRaraTi viTardeba uecrad da
yvela momdevno defekaciisas ganavali TandaTan Txierdeba da male igi iRebs wylis
konsistencias da emsgavseba brinjis naxarSs. amasTan erTad aRiniSneba Zlieri saerTo sisuste,
simSrale pirSi, wyurvilis grZnoba, madis daqveiTeba. qoleris ioli formebis dros, daavadeba
SeiZleba am etapze Sewydes da SemTxveva gamojanmrTelebiT damTavrdes. xolo procesis
progresirebisas matulobs defekaciis sixSire, mas Tan erTvis Rebineba, rac ufro auaresebs
avadmyofis mdgomareobas. mas sawolidan adgomac ki uWirs. diareis da Rebinebis gamo adamiani
didi raodenobiT kargavs siTxes da eleqtrolitebs da viTardeba eqsikozi, rasac Tan erTvis
krunCxvebi.
specifikuri mkurnalobis Cautareblobis SemTxvevaSi procesi ufro mZimdeba. Zlieri
dehidrataciis gamo viTardeba Soki, e.w. qoleris algidi. Semdgom viTrdeba koma da sikvdili
hipoqsiis Sedegad. amis Tavidan asacileblad saWiroa drouli intravenuri gadasxmebi da
antibiotikebiT mkurnaloba.
xazgasmiT unda aRiniSnos, rom Tanamedrove pirobebSi qoleris efeqturi mkurnalobis
Sedegad letalobis maCvenebeli saSualod 2-5%-ia. amas xels isic uwyobs, rom dReisaTvis,
rogorc wesi, gvxvdeba el-toris vibrioniT gamowveuli daavadeba, romlis dros mZime formebis
sixSire 10-12%-s ar aRemateba.
qoleris diagnozi ismeba klinikuri da epidemiologiuri monacemebis safuZvelze. Tumca
wamyvania laboratoriuli diagnostika, kerZod qoleris vibrionis amoTesva ganavlidan an
pirnaRebi masidan. masala baqteriologiuri gamokvlevisaTvis aRebul unda iqnas antibiotikebiT
mkurnalobis dawyebamde da rac SeiZleba swrafad unda gadaigzavnos laboratoriaSi. srul
baqteriologiur gamokvlevas sWirdeba 36-48 saaTi. iyeneben agreTve eqspres-diagnostikis
meTodebs: a. luminescentur-serologiuri, b. vibrionebis imobilizaciis da mikroaglutinaciis
meTodi specifikuri O – SratiT da misi Semdgomi mikroskopireba bnel areSi. analizis pasuxi
0,5-2 saaTSi SeiZleba miviRoT. eqspres diagnostikis meTodiT dadebiTi pasuxis miRebis
SemTxvevaSic savaldebuloa baqteriologiuri analizis srulad Catareba.
profilaqtika da epidsawinaaRmdego RonisZiebebi. qoleris profilaqtika gulisxmobs
mosaxleobis sanitariuli mdgomareobis gaumjobesebas, xarisxiani sasmeli wyliT da sakvebi
produqtebiT momaragebas, Camdinare wylebis gauvnebelyofas, dasaxlebuli adgilebis
dasufTavebas da sayofacxovrebo narCenebis droul gatanas.
garda amisa aucilebelia qveynis teritoriis sanitariuli dacva, raTa ucxoeTidan ar
iqnas Semotanili da gavrcelebuli daavadeba. amisaTvis sistematurad xdeba im informaciis
analizi, romelsac janmo ugzavnis yvela qveyanas msoflioSi qoleris gavrcelebis da

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epidemiologiuri situaciis Taobaze. amasTan xdeba sanitariuli kontroli ucxoeTis
qveynebidan Semosul adamianebze aeroportebSi, rkinigzis sadgurebSi, portebSi, sazRvarze,
gansakuTrebiT im qveynebidan Semosulebze, sadac qoleris mxriv arakeTilsaimedo
epidemiologiuri situaciaa. saeWvo pirebi eqvemdebarebian baqteriologiur gamokvlevas. maTze
wesdeba 5-dRiani samedicino meTvalyureoba.
sistematurad kontroldeba Ria wyalsatevebis wyali qoleris vibrionebis arsebobaze.
misi gamoyofis SemTxvevaSi ikrZaleba wylis yovelgvari mizniT moxmareba. es SezRudva ixsneba
baqteriologiuri gamokvlevis samjeradi uaryofiTi pasuxis Semdeg.
rac Seexeba qoleris sawinaaRmdego acrebs, mas damxmare roli aqvs da tardeba, rogorc
wesi, epidemiologiuri maCveneblebis mixedviT. amJamad aris ramdenime oraluri vaqcina,
romliTac adamiani orjer unda aicras. imuniteti grZeldeba 2 weli. 2013-2018 wlebSi janmom
im qveynebs, sadac qoleraa gavrcelebuli, vaqcinis 60 milioni doza miawoda.
qoleris saeWvo an dadasturebuli SemTxvevis gamovlenisas sjc-Si Setyobineba igzavneba
dauyovnebliv. Tavis mxriv raionuli sjc atyobinebs amis Taobaze regionul sjc-s, xolo es
ukanaskneli daavadebaTa kontrolis da sazogadoebrivi janmrTelobis erovnul centrs.
diagnozis dadasturebisas informacia igzavneba janmos centralur ofisSi JenevaSi.
avadmyofi adamiani an vibriomtarebeli eqvemdebareba savaldebulo hospitalizacias.
saavadmyofodan maT weren klinikuri gamojanmrTelebis, antibiotikebiT mkurnalobis kursis
CaTavebis da ganavlis 3-jeradi (yoveldRiuri) baqteriologiuri gamokvlevis uaryofiTi
pasuxis miRebis Semdeg. amasTan pirvel baqteriologiur gamokvlevas atareben mkurnalobis
damTavrebidan 24-36 saaTis Semdeg.
keraSi tardeba daskvniTi dezinfeqcia. savaldebuloa sagnebis kameruli dezinfeqcia.
pirebi, romlebic mWidro kontaqtSi iyvnen avadmyofTan an mtarebelTan da aReniSnebaT kuW-
nawlavis traqtis disfunqcia an qronikuli daavadebebi, eqvemdebarebian provizorul
hospitalizacias. maT weren 5 dRiani samedicino meTvalyureobis, antibiotikebiT eqspres
profilaqtikis kursis CamTavrebis da 3-jeradi baqteriologiuri gamokvlevis uaryofiTi
pasuxis miRebis Semdeg.
eqspres profilaqtika mWidro kontaqtSi myof pirebze tardeba tetracikliniT 4 dRis
ganmavlobaSi, dReSi 3-jer 300 000 s.e. odenobiT. yvela kontaqtirebul pirze wesdeba 5
dRiani samedicino meTvalyureoba. qoleris kera iTvleba likvidirebulad ukanaskneli
avadmyofis an vibriomtareblebis hospitalizaciidan da daskvniTi dezinfeqciis Catarebidan 10
dRis Semdeg.
epidemiur keraSi karantinis SemoReba aris ukiduresi RonisZieba da igi wesdeba

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gansakuTrebuli epidsawinaaRmdego komisiis gadawyvetilebiT. is moicavs: keraSi adamianTa
Sesvla-gamosvlis SezRudvas. Tu aucilebelia pirovnebis/pirovnebebis keridan gasvla, maTze
wesdeba 5 dRiani observacia. keraSi Zlierdeba kontroli wyalsatevebis sanitariul
mdgomareobaze, sasmeli wylis xarisxze, narCenebis droul gatanaze. aqtiurad xdeba saeWvo
avadmyofebis gamovlena, risTvisac SeiZleba gamoiyenon kardakar Semovla.
qoleraze epidzedamxedvelobis sistema gulisxmobs:
• rogorc qveyanaSi, ise msoflioSi qoleriT avadobaze sistematuri informaciis
miRebas.
• sistematur kontrols nawlavTa mwvave infeqciebiT avadobaze.

• Ria wyalsatevebis sistematur gamokvlevas vibriofloraze.

• qveynis teritoriis sanitariul dacvas. qoleris mxriv arakeTilsaimedo


teritoriebidan Semosulebze samedicino kontrolis dawesebas.
2017 wels miRebul iqna qolerasTan brZolis globaluri strategia, romelic
iTvaliswinebs msoflioSi am daavadebiT sikvdilianobis 90%-iT Semcirebas.

11.3. botulizmi

mwvave toqsiko-infeqciuri daavadebaa, romelsac sakmaod mZime mimdinareoba axasiaTebs.


pirvelad igi 1815 wels aRwera germanelma eqimma kernerma. radgan daavadeba dakavSirebuli iyo
Zexvis miRebasTan mas uwodes botulizmi (laT. botulus - Zexvi). daavadebis gamomwvevi 1896
wels van ermengenma gamoyo loris narCenebidan, botulizmiT gardacvlilis gvamis elenTidan da
msxvili nawlavebidan.
etiologia. daavadebas iwvevs Clostridium botulinum, romelic Sedis klostridiebis gvarSi
da Bacilaceae-s ojaxSi. igi aris msxvili, moZravi, gramdadebiTi Cxiri da mkacri anaerobi.
izrdeba mxolod haeris Jangbadis ararsebobis dros.
botulizmis Cxiri garemos araxelsayrel pirobebSi warmoSobs sporebs, romlebic

uaRresad gamZleni arian. magaliTad 100° C temperaturas uZleben 2-3 saaTs. SedarebiT

swrafad iRupebian (30 wuTSi) 120° C -ze avtoklavirebis dros. garemo pirobebSi, magaliTad
niadagSi, sporebi cxovelmyofelobas wlobiT inarCuneben.
botulizmis gamomwvevi anaerobul pirobebSi, rodesac sporebidan warmoiqmnebian
vegetaciuri formebi, gamoimuSavebs egzotoqsins, romelic uZlieresi biologiuri sawamlavia (1
mg toqsini Seicavs 20 milionze met sasikvdilo dozas TagvebisaTvis). sporebisagan

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gansxvavebiT vegetaciuri formebi naklebgamZleni arian da duRiliT 5 wuTSi iRupebian. aseve
toqsini swrafad iSleba aduRebiT.
antigenuri Taviseburebebis da toqsinis gamomuSavebis mixedviT arCeven botulizmis
gamomwvevis 7 serologiur tips: A, B, C, D, E, F da G. yvelaze ufro meti epidemiologiuri
mniSvneloba aqvs A, B, E tipebs, ufro iSviaTia F tipiT gamowveuli daavadeba. isini kargad
uZleben pepsinis da tripsinis moqmedebas, aseve sufris marilis maRal koncentracias (18 %-
mde). ar iSlebian im produqtebSic, romlebic sxvadasxva saneleblebs Seicaven. sakvebSi
botulotoqsinis arseboba xSirad ar cvlis maT organoleptikur Tvisebebs.
sxvadasxva serologiuri tipi sxvadasxva klinikur-epidemiologiuri TaviseburebebiT
xasiaTdeba. B tipiT gamowveuli botulizmi ufro xSirad dakavSirebulia xorcis produqtebis
miRebasTan (Zexvi, lori, xorcis konservebi). daavadeba xasiaTdeba gaxangrZlivebuli
inkubaciuri periodiT, dabali letalobiT da kerovnebiT. klinikur mimdinareobaSi Warbobs
msubuqi da saSualo simZimis formebi. letaluri gamosavali gvxvdeba daavadebis me-5 dRes da
gvian.
E tipis botulizmi dakavSirebulia TevzeulTan. aRiniSneba maRali letaloba (30% da
meti), mokle inkubaciuri periodi, klinikur mimdinareobaSi Warbobs mZime formebi letaluri
gamosavaliT. letaloba ufro xSirad daavadebis pirvel-meore dRes gvxvdeba. aRniSnuli etyoba
dakavSirebulia Tevzis konservebSi toqsinis didi raodenobiT dagrovebasTan.
A tipis botulizmi dakavSirebulia mcenareuli produqtebis konservebTan (soko,
badrijani, danduri da sxva). igi iZleva yvelaze maRal letalobas.
infeqciis wyaro. botulizmis gamomwvevi farTodaa bunebaSi gavrcelebuli. igi binadrobs
wvrilfexa da msxvilfexa rqosani saqonlis, Roris, Tevzebis, moluskebis, frinvelebis da
virTagvebis nawlavebSi. gvxvdeba agreTve adamianis nawlavebSi, magram avadmyofi adamiani
epidemiologiur saSiSroebas ar warmoadgens. dainficirebuli organizmidan klostridiebi
fekalur masebTan erTad gamoiyofa garemoSi xangrZlivi drois ganmavlobaSi, SesaZlebelia
mTeli cxovrebis manZilze. adamianis kuW-nawlavis traqti ar aris optimaluri garemo
botulizmis gamomwvevis gamravlebisa da toqsinis warmoSobisaTvis. daavadebis mizezia mxolod
egzogenurad sakveb produqtebSi gamomuSavebuli toqsini.
botulizmis gamomwvevi niadagSi xelsayreli pirobebis arsebobisas mravldeba. amitom
niadagi warmoadgens infeqciis rezervuars. am TvalsazrisiT botulizmi zoosapronozia.
gadacemis meqanizmi. daavadeba vrceldeba fekalur-oraluri meqanizmiT. gadacemis
faqtoria rogorc cxoveluri, ise mcenareuli warmoSobis sakvebi produqtebi, romlebic
kontaminirebulni arian klostridiebiT. rodesac botulizmis sporebiT dabinZurebuli sakvebi

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produqtebi moxvdebian anaerobul pirobebSi (konservirebisas, Zexveulis, SaSxis damzadebisas
da sxva), spora gardaiqmneba vegetaciur formad, intensiurad mravldeba da paralelurad
gamoyofs egzotoqsins. Semdeg aseTi produqtebis adamianis organizmSi moxvedrisas, viTardeba
daavadeba. unda aRiniSnos, rom dainficirebuli produqti icvlis fers, iZens usiamovno (mZaRe)
suns, konservebi airis dagrovebis gamo amoiburceba (bombaJi). miuxedavad amisa, inficireba arc
ise iSviaTia.
dReisaTvis saqarTveloSi botulizmi ZiriTadad viTardeba saxlSi damzadebuli konservis
miRebis SemTxvevaSi. magaliTad, 2011 wels botulizmis 12 SemTxvevidan 11 daukavSirda ojaxSi
damzadebul bostneulis konservebs, 2012 wels ki 20 SemTxvevidan - 16 SemTxveva. bunebrivia,
rom saxlis pirobebSi Znelia iseTi reJimis dacva, romelic gamoricxavs konservebSi sporebis
moxvedras. gansakuTrebiT xSiria mcenareuli produqtebis da bostneulis konservebiT (kitris,
pomidvriani bostneulis salaTis, badrijnis, sokos, wiwakis, danduris, lobios) gamowveuli
botulizmis SemTxvevebi. xazgasmiT unda iTqvas, rom adamianis dainficireba xdeba mxolod
iseTi produqtis miRebisas, romelSic anaerobul pirobebSi moxda gamomwvevis gamravleba da
toqsinis dagroveba.
unda aRiniSnos, rom botulizmi SeiZleba ganviTardes maSinac, roca misi sporebi
moxvdeba WrilobaSi. mas Wrilobis botulizms uwodeben. aseT SemTxvevaSi daavadeba kontaqturi
meqanizmiT vrceldeba.
aqve unda SevexoT Cvil bavSvTa botulizms, romlis laboratoriulad dadasturebuli
SemTxveva aRweres 1931 wels kaliforniaSi. misi gamomwvevi mizezia Cvil bavSvTa nawlavebSi
sakvebis gziT moxvedrili botulizmis sporebi. cnobilia, rom mozrdili adamianebis
organizmSic xvdeba sakvebis gziT klostridiebi, magram maTSi botulizmi ar viTardeba, radgan
nawlavTa normaluri mikroflora damTrgunvelad moqmedebs botulizmis gamomwvevis sporebidan
vegetaciuri formis ganviTarebasa da gamravlebaze, rasac Cvil bavSvTa SemTxvevaSi adgili ara
aqvs, radgan axalSobilis nawlavTa mikroflora sxvadasxva mizezis gamo xSirad irRveva, rac
qmnis botulizmis ganviTarebisaTvis xelSemwyob pirobebs. xSiria Cvil bavSvTa botulizmis
ganviTareba TafliT kvebis dros. daavadeba ZiriTadad 6 Tvemde asakis bavSvebSi vlindeba.
botulizmi aseve SeiZleba ganviTardes toqsinis SesunTqviT, rac SeiZleba moxdes magaliTad
bioterorizmis dros.
epidemiologiuri Taviseburebebi. botulizmi gvxvdeba yvelgan sporaduli SemTxvevebis an
ojaxuri afeTqebebis saxiT. saqarTveloSi botulizmis yvelaze meti SemTxveva (80-ze meti)
1999 wels gamovlinda, risi ZiriTadi mizezi iyo gorSi saTaliT adamianTa didi jgufis
daavadeba. 2007 wels aRiricxa daavadebis 17 SemTxveva, 2008 wels – 43, 2009 wels – 12, 2011

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wels - 12, 2012 wels - 20, 2013 wels -23, 2018 wels – 14, 2019 wels ki 11 SemTxveva.
rogorc wesi, daavadebis ganviTarebis mizezia saxlSi damzadebuli konservebi, rasac
mosaxleoba araerTi gafrTxilebis miuxedavad farTod moixmars, gamomdinare ekonomikuri
mdgomareobidan. botulizmis gadatanis Semdeg imuniteti an ar muSavdeba, an Zalian sustia.
aRwerilia SemTxvevebi, rodesac adamiani orjer gaxda avad am daavadebiT.
botulizmis gavrceleba sxvadasxva teritoriaze sxvadasxva sakveb produqtTanaa
dakavSirebuli. magaliTad ruseTSi - saxlSi damzadebuli sokos konservebTan da damarilebul
TevzTan, evropaSi – ZexveulTan, amerikaSi – konservebTan, saqarTveloSi, rogorc aRiniSna,
saxlSi damzadebul mcenareuli produqtebis konservebTan. amasTan daavadeba msoflioSi sakmaod
farTod aris gavrcelebuli. magaliTad ruseTSi 1995 wels botulizmis 645 SemTxveva
gamovlinda.
klinika da laboratoriuli diagnostika. botulizmis inkubaciuri periodi 6 saaTidan 10
dRemde meryeobs. ufro xSiria 12-36 saaTiani inkubaciuri periodi. dadgenilia, rom rac ufro
moklea am periodis xangrZlivoba, miT ufro mZimed mimdinareobs daavadeba. rogorc wesi,
daavadeba iwyeba mwvaved. gamoxatulia 3 ZiriTadi sindromi: zogadintoqsikaciuri (sisuste,
Tavis tkivili), gastrointestinuri (gulisreva, Rebineba, tkivili epigastralur areSi) da
paralizuri (piris simSrale, Sekruloba, meteorizmi). dasawyisSive ipyrobs yuradRebas
ofTalmoplegiuri simptomebi: sagnebis gaoreba, nistagmi, midriazi da ptozi. TiTqmis masTan
erTad gamovlindeba ylapvisa da metyvelebis moSla. daavadebis me-3-5 dRes avadmyofi iRupeba
sunTqvis da gulis gaCerebiT. Tu mkurnaloba ar tardeba, letaloba 20-70% - s Soris
meryeobs.
Cvil bavSvTa botulizmis klinikac aris analogiuri. aRsaniSnavia agreTve is, rom bavSvi
tiris CaxleCili xmiT, ver wovs da ver iWers Tavs.
daavadebis laboratoriuli diagnostikisaTvis ikvleven saeWvo sakvebi produqtebis
narCenebs, pirnaReb masas, kuWis amonarecxs, avadmyofis sisxls, ganavals, Sards. toqsinis
aRmosaCenad da misi identifikaciisaTvis atareben biologiur cdas TeTr Tagvebze. gamoyofili
kulturis identificirebisaTvis swavloben mis mikrobiologiur da kulturalur Tvisebebs.
profilaqtika da epidsawinaaRmdego RonisZiebebi. daavadebis profilaqtikaSi wamyvania
sanitariuli da teqnologiuri reJimis dacva sakvebi produqtebis konservirebisas. xorcis da
Tevzis konservireba SeiZleba mxolod maSin, rodesac is aris axali. xilisa da bostneulis
konservirebisas saWiroa maTi guldasmiT garecxva da niadagis nawilis sruli mocileba. aseve
aucilebelia sterilizaciis wesebis zustad dacva.
didi mniSvneloba eniWeba mosaxleobaSi san-ganmanaTlebel muSaobas botulizmis

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gavrcelebis gzebis da misi profilaqtikis Taobaze. axalSobilTa botulizmis Tavidan
asacileblad rekomendebulia maTTvis Taflis micemis akrZalva. daavadebis gamovlenisas
aucilebelia avadmyofis hospitalizacia (rac klinikuri CvenebiT xdeba). mas rac SeiZleba
swrafad unda gaukeTdes antibotulinuri polivalenturi Srati. amasTan igi aucileblad unda
Seicavdes A, B da E tipebis mimarT antitoqsinebs. radgan antitoqsini moqmedebs cirkulaciaSi
myof toqsinze, amitom Srati unda gakeTdes manam, sanam moxdeba toqsinis fiqsacia qsovilebSi.
saeWvo produqti, romelic infeqciis gadacemis faqtori gaxda, laboratoriuli
gamokvlevisaTvis nimuSis aRebis Semdeg eqvemdebareba ganadgurebas. TeTreuls, romelic
avadmyofis gamonayofebiT aris dabinZurebuli, aTavseben 1%-iani qloraminis xsnarSi 4 saaTi, an
3%-iani qloraminis xsnarSi – 30 wuTi. WurWels saWmlis narCenebiT aTavseben 1%-iani
qloraminis xsnarSi 1 sT, xolo saWmlis narCenebis gareSe – 0,05%-iani qloraminis xsnarSi 30
wuTi.
im kontaqtirebul pirebs, romlebmac miiRes saeWvo produqti, aseve ukeTdebaT
polivalenturi antibotulinuri Srati da maTze wesdeba 10 dRiani samedicino meTvalyureoba.
sjc-is epidemiologis mier keris epidgamokvlevis dros ZiriTadi yuradReba unda mieqces
infeqciis gavrcelebaze saeWvo produqtis gamovlenas da mis ganadgurebas. am mizniT pacients
ekiTxebian bolo 7 dRis ganmavlobaSi miiRo Tu ara sakvebad romelime saeWvo produqti
(Sebolili Zexvi, Tevzi, saxlSi damzadebuli bostneulis konservebi: badrijani, stafilo,
tomati, kitri, danduri, lobio, wiwaka), sad miiRo (saxlSi, sazogadoebrivi kvebis
obieqtebSi), iyida Tu saxlSi damzada da a.S.

11.4. A hepatiti

virusuli hepatitebis jgufSi ramdenime damoukidebeli nozologiuri erTeuli Sedis,

romelTagan B, C da D hepatitebi safari qsovilis infeqciebs miekuTvneba, xolo A hepatiti E

hepatitTan erTad Sedis nawlavTa infeqciebis jgufSi. A hepatiti msoflioSi erT-erTi yvelaze
farTod gavrcelebuli infeqciuri daavadebaa, romelic seriozul problemas warmoadgens
dabali Semosavlebis mqone qveynebisaTvis, sadac mTeli virusuli hepatitebis TiTqmis 60-70%-s

igi Seadgens. saqarTveloSic A hepatiti farTod iyo gavrcelebuli da swored mas ekava
dominirebuli adgili virusuli hepatitebiT avadobaSi. amJamad es situacia radikaluradaa
Secvlili. magaliTad, 2018 wels qveyanaSi am daavadebis mxolod 48 SemTxveva gamovlinda.
etiologia. miuxedavad imisa, rom A hepatiti ZvelTaganve iyo cnobili, misi gamomwvevi

mxolod 1973 wels Feinstone-is da Tanaavtorebis mier iqna gamoyofili. rogorc Semdgomma

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gamokvlevebma aCvena, A hepatitis gamomwvevi (HAV) aris mcire zomis (27-32 nm), rnm-is

Semcveli virusi, romelic Sedis –Picornaviridae-is ojaxSi da miekuTvneba enterovirusebis

gvars. virusis SemadgenlobaSia mxolod erTi antigeni - HAAg; romlis sapasuxod organizmSi

gamomuSavdeba antisxeulebi – anti-HAV-i. daavadebis dasawyisSi sisxlis SratSi M klasis


antisxeulebi vlindeba, rac infeqciuri procesis mwvave xasiaTze miuTiTebs, xolo mogvianebiT
ukve G klasis antisxeulebi cirkulireben sisxlSi, rac daavadebis gadatanaze da proteqtuli
imunitetis arsebobaze metyvelebs.

HAV-i uaRresad gamZlea garemoSi. kargad uZlebs maRali temperaturis, mJavebis,


tuteebis, sadezinfeqcio nivTierebebis, eTeris zemoqmedebas. dabal temperaturaze
cxovelmyofelobas inarCunebs ramdenime Tvidan ramdenime wlamde, oTaxis temperaturaze ki
ramdenime kviras. wyalSi - 3-10 Tves. duRiliT virusi 5 wuTSi inaqtivirdeba. mniSvnelovania
agreTve virusis didi gamZleoba qloris moqmedebisadmi. yvelaferi es ganapirobebs virusis
xangrZliv arsebobas sakveb produqtebSi, Camdinare wyalSi da sayofacxovrebo sagnebze, rac
xels uwyobs adamianTa xSir dainficirebas da daavadebis gavrcelebas.

A hepatitis virusi maRali paTogenobiTac gamoirCeva. Teoriulad adamianis organizmSi


ramdenime virusis moxvedraa sakmarisi daavadebis ganviTarebisaTvis.
infeqciis wyaro. A hepatiti tipuri anTroponozia. erTaderTi infeqciis wyaro aris
daavadebuli adamiani. virusmtarebloba praqtikulad ar gvxvdeba. daavadebuli adamianis
fekaluri masebiT virusis gamoyofas adgili aqvs ukve inkubaciuri periodis meore naxevarSi da
maqsimums aRwevs prodromul periodSi. siyviTlis ganviTarebis Semdeg virusis eqskrecia
mkveTrad qveiTdeba da praqtikulad wydeba 3 kviris Semdeg. magaliTad siyviTlis ganviTarebidan
erTi kviris manZilze radioimunuri meTodiT gamokvlevisas HAAg uvlindeba avadmyofTa 50%-s,
meore kviras-20%-s, xolo mesame kviras - mxolod 5%-s. avadmyofi adamiani yvelaze did
epidemiologiur saSiSroebas qmnis prodromul periodSi, manam, sanam ganviTardeba siyviTle,
rac erTi mxriv garemoSi virusebis maqsimaluri gamoyofiT aixsneba, xolo meore mxriv, am
periodSi diagnozis gansazRvris sirTuliT.
daavadebis mimdinareobaSi siyviTlian formebTan erTad gvxvdeba usiyviTlo, subklinikuri
da inaparantuli formebi, romlebic TavianTi sixSiriT bevrad aRematebian mas, gansakuTrebiT
bavSvTa asakSi. sxvadasxva avtorTa monacemebiT bavSvTa koleqtivebSi 1 siyviTlian formaze
saSualod aTamde atipuri forma modis. rogorc praqtika gviCvenebs usiyviTlo formebis
gamovlena, maT Soris saqarTveloSic, praqtikulad ar xdeba. amis gamo, infeqciis gavrcelebaSi
siyviTlian formebTan SedarebiT ufro meti roli usiyviTlo formebs eniWeba, miTumetes, rom

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virusis eqskrecia rogorc siyviTliani, ise usiyviTlo formebis dros erTi da igive vadebSi
gvxvdeba.
gadacemis meqanizmi. warmoadgens ra nawlavTa infeqcias, A hepatiti ZiriTadad vrceldeba
fekalur-oraluri meqanizmiT, romlis realizacia xdeba wyliT, sakvebi produqtebiT da
sayofacxovrebo sagnebiT. gansxvavebiT muclis tifis, qoleris, dizenteriis da sxva
daavadebebisagan, A hepatiti intensiurad vrceldeba rogorc wylis, ise sakvebismieri da
sayofacxovrebo kontaqtis gziT. ama Tu im gadacemis gzis roli mniSvnelovanwilad
ganpirobebulia konkretuli teritoriis sanitariuli mdgomareobiT da mosaxleobis
sanitariuli kulturis doniT. yofili sabWoTa kavSiris umetes teritoriaze daavadeba
ZiriTadad sayofacxovrebo kontaqtis gziT vrceldeba, rac gansakuTrebiT bavSvTa koleqtivebze
iTqmis (bagebi, baRebi, skolebi, internatebi), risi mizezi upirveles yovlisa am
dawesebulebebSi aradamakmayofilebeli sanitariuli mdgomareoba da bavSvebis umravlesobis mier
higienuri wesebis ugulvebelyofaa.
sayofacxovrebo kontaqtis gziT daavadeba intensiurad SeiZleba gavrceldes agreTve
mozrdilTa organizebul dawesebulebebSi. magaliTad samxedro nawilebSi da aseve ojaxur
kerebSi, sadac aradamakmayofilebelia sanitariuli mdgomareoba.
dabinZurebuli wyliT A hepatiti ufro xSirad dabali Semosavlebis mqone qveynebSi
vrceldeba. rac Seexeba maRali Semosavlebis mqone qveynebs, aq rogorc mwvave, ise qronikuli
wylismieri epidemiebi iSviaTobas warmoadgens.
wylis epidemiebi ZiriTadad dakavSirebulia wyalmomaragebis wyaroebad gamoyenebuli
wyalsatevebis fekalur dabinZurebasTan, anda wyalmomaragebis qselSi sxvadasxva saxis
dazianebis Sedegad sasmel wyalSi Camdinare wylis SereviT.
rac Seexeba sakveb produqtebs, maTi dainficireba ufro xSirad xdeba kvebis obieqtebSi
momuSave subklinikuri da inaparantuli formebiT daavadebuli pirebisagan. seriozul safrTxes
warmoadgens bostneuli, romelic morwyulia wyliT, romelSic adamianis fekaluri masebia
Sereuli. rig SemTxvevaSi sakvebi produqtebiT gamowveulma epidemiam SeiZleba Zalian did
masStabebs miaRwios, rogorc amas adgili hqonda 1988 wels CineTis qalaq SanxaiSi, sadac
xamanwkebis miRebis Sedegad avad gaxda 300 aTasze meti adamiani.
Zalian iSviaTad A hepatiti SeiZleba gavrceldes parenteruli meqanizmiT, radgan
daavadebis mwvave periodSi adgili aqvs virusemias. aris monacemebi, rom daavadeba aseve
vrceldeba homoseqsualuri kontaqtiT.
epidemiologiuri Taviseburebebi. A hepatiti msoflioSi farTod, magram araTanabrad aris
gavrcelebuli. avadobis maRali maCveneblebi aRiniSneba dabali Semosavlebis mqone qveynebSi,

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sadac sanitariuli mdgomareoba arasaxarbieloa. am teritoriebze avadobis maCvenebeli asi aTas
mosaxleze aRwevs 400,0-500,0-s. aseTi situacia iyo magaliTad Sua aziis qveynebSi. iq avadobis
maCveneblebi 4-6-jer ufro maRali iyo, vidre sxva yofil sabWoTa respublikebSi. avadobis
maRali maCveneblebi aRiniSneba agreTve afrikis, laTinuri amerikis da aziis mraval qveyanaSi.
sakmaod maRalia avadobis maCveneblebi aRmosavleT da samxreT evropis qveynebSic.
A hepatiti naklebadaa gavrcelebuli centralur da CrdiloeT evropaSi, amerikaSi,
kanadaSi, avstraliaSi da sxva qveynebSi. rodesac am qveynis moqalaqeni miemgzavrebian
samogzaurod ganviTarebad qveynebSi, mkveTrad izrdeba maTi daavadebis safrTxe. magaliTad,
rodesac germaniis moqalaqe turistul mogzaurobaSi miemgzavreba evropis farglebs gareT,
mniSvnelovnad izrdeba misi A hepatitiT daavadebis albaToba.
bolo wlebSi saqarTveloSi A hepatitiT avadobis done mniSvnelovnad Semcirda, rac,
Cveni azriT, dakavSirebulia daavadebis arasrul gamovlinebasTan da registraciasTan. radgan
qveyanaSi ar gatarebula iseTi saxis profilaqtikuri RonisZiebebi, romlebic gamoiwvevda
avadobis maCveneblebis Semcirebas.
konkretul teritoriaze daavadebis gavrcelebis intensivoba gansazRvravs agreTve
daavadebulTa asakobriv struqturas. im qveynebSi, sadac A hepatitiT avadobis maRali da
saSualo maCveneblebi gvxvdeba, daavadeba ZiriTadad bavSvTa infeqcias warmoadgens. 1-14 wlis
bavSvebze modis mTeli registrirebuli SemTxvevebis TiTqmis 60-70%. amasTan bavSvTa xvedriTi
wili mniSvnelovnad izrdeba daavadebis perioduli matebis dros. SeiZleba iTqvas, rom swored
bavSvTa kontigenti apirobebs daavadebisaTvis damaxasiaTebel periodulobas. saqarTveloSi
bavSvTa kontigentze modis SemTxvevaTa 55-65%.
im qveynebSi, sadac A hepatiti sustadaa gavrcelebuli, sakmaod maRalia mozardi da
axalgazrda asakis pirTa xvedriTi wili saerTo avadobaSi. am tendencias adasturebs
mosaxleobis imunostruqturis Seswavla. im qveynebSi, sadac A hepatiti farTod aris
gavrcelebuli, ukve 5-10 wlis bavSvTa TiTqmis 90%-s sisxlSi uvlindebaT G an totaluri
antisxeulebi. maSin, rodesac CrdiloeT evropaSi 10 wlis asakis bavSvTa mxolod 6-10%-s aqvT
antisxeulebi da seropozitiur pirTa raodenoba 50%-s 30-40 wlisaTvis aRwevs.
saqarTveloSi seropozitiurTa raodenoba matebas ukve adreul bavSvTa asakidan iwyebs
da maqsimums 40-49 wlisaTvis aRwevs, rodesac gamokvleulTa TiTqmis 70% seropozitiuria.
xanSiSesul asakSi, seropozitiur pirTa raodenoba qveiTdeba.
unda aRiniSnos, rom seropozitiurTa raodenoba droTa ganmavlobaSi mudmivi sidide ar
aris da igi SeiZleba Seicvalos qveyanaSi epidemiologiuri situaciis cvlilebebis
paralelurad.

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iseve rogorc infeqciur daavadebaTa absoluturi umravlesobisaTvis, A hepatitisaTvis
damaxasiaTebelia avadobis sezonuri meryeoba. daavadebis minimaluri SemTxvevebi ivnis-ivlisSia.
agvistos Tvidan adgili aqvs SemTxvevaTa raodenobis zrdas, rac gansakuTrebiT intensiur
xasiaTs iRebs seqtemberSi. am TveSi daavadebis 2-jer meti SemTxveva vlindeba, vidre agvistoSi.
avadobis maqsimaluri maCveneblebia oqtomber-dekembris TveebSi, SemdgomSi iwyeba avadobis kleba.
saqarTveloSi sezonuri indeqsi daaxloebiT 3,0-is tolia. rogorc vxedavT A hepatitis dros,
gansxvavebiT nawlavTa sxva infeqciebisagan, aRiniSneba Semodgoma-zamTris sezonuroba, rac
upirveles yovlisa daavadebisaTvis damaxasiaTebeli inkubaciuri periodis xangrZlivobiT unda
aixsnas. didi mniSvneloba aqvs agreTve seqtembris dasawyisSi bavSvTa dawesebulebebis (skolebi,
bagebi, internatebi) formirebas.
saerTod A hepatitis SemTxvevebi ZiriTadad bavSvTa dawesebulebebSi gvxvdeba. am mxriv
gansakuTrebiT did saSiSroebas warmoadgens is dawesebulebebi, sadac bavSvTa didi simWidrovea
da darRveulia sanitariul-higienuri normebi. saqarTveloSi, iseve rogorc umravles qveyanaSi,
A hepatitiT yvelaze xSirad avaddebian skolamdeli asakis organizebuli bavSvebi, Semdeg
moswavleebi da bolos skolamdeli asakis araorganizebuli bavSvebi.
klinika da laboratoriuli diagnostika. iseve rogorc sxva virusuli hepatitebis
dros, A hepatitis drosac aRiniSneba rogorc daavadebis manifesturi formebi – siyviTliani
Tu usiyviTlo, aseve subklinikuri da inaparantuli formebi.
inkubaciuri periodi Seadgens 7-50 dRes, saSualod ki 20-30 dRes, amitomac xSirad es
infeqcia mokle inkubaciuri periodis mqone virusul hepatitad moixsenieba. siyviTliani
formebis mimdinareobaSi arCeven prodromul, klinikuri niSnebis maqsimaluri ganviTarebis da
rekonvalescenciis periods. prodromul periodSi, romlis xangrZlivoba 5-7 dRea, aRiniSneba
temperaturis momateba 38,5-39°C-mde, gripismagvari (saerTo sisuste, damtvreuloba, Tavis
tkivili kunTebSi da sxva) da dispefsiuri sindromebi (gulisreva, Rebineba, nawlavTa
disfunqcia da a.S.). asTeniur-vegetatiuri sindromis dros upiratesad gamoxatulia sisuste,
adinamia, uZiloba, Tavis tkivili. prodromuli periodis bolos avadmyofebs aReniSnebaT Sardis
gamuqeba da aqolia.
siyviTliani periodis dadgomisas qveiTdeba intoqsikaciis niSnebi da umjobesdeba
avadmyofis TviTgrZnoba. 2-3 dRis manZilze Zlierdeba siyviTlis intensivoba, Semdeg ki xdeba
misi Semcireba. am periodis xangrZlivoba aris saSualod 7-10 dRe, rasac mohyveba aRdgeniTi
periodi, romlis drosac swrafad xdeba klinikuri niSnebis ukuganviTareba. daavadebis
mimdinareobisas Warbobs msubuqi formebi. mZime mimdinareoba ki SemTxvevaTa 0,5%-Si gvxvdeba,
rac gansakuTrebiT mozrdil da xanSiSesul asakSi aRiniSneba. janmos informaciiT, 2016 wels

286
am daavadebiT daaxloebiT 7.1 aTasi adamiani gardaicvala, rac virusuli hepatitebiT
gardacvlilTa 0.5%-s Seadgens.
siyviTlian formebTan SedarebiT bevrad ufro xSiria usiyviTlo formebi. am dros
arsebuli simptomokompleqsi Zalian hgavs siyviTliani formebis prodromuli periodis
simptomebs. am hepatitis mimdinareobaSi sakmaod xSiria subklinikuri formebic, romelic 10-14
dRis ganmavlobaSi mimdinareobs da aRiniSneba alaninaminotransferazis donis momateba. A
hepatiti yvelaze ufro xSirad inaparantuli formiT gvxvdeba, romlis gamovlenac specifikuri
antisxeulebis indikaciiT warmoebs.
A hepatitis specifikuri diagnostika xdeba sisxlSi M klasis anti - HAV-is indikaciiT,
romelic pirveli klinikuri niSnebis gamovlenamde 3-5 dRiT adre Cndeba sisxlSi da
cirkulirebs daaxloebiT ramdenime Tvis manZilze. es antisxeulebi sinTezirdeba A hepatitis
yvela klinikuri formis dros daaxloebiT erTnair titrSi. maTi ararseboba gamoricxavs A
hepatitis diagnozs.
daavadebis meore kviridan iwyeba G klasis antisxeulebis sinTezi (anti- HAVIgG) da
sisxlSi misi titri maqsimums aRwevs daavadebis me-5-6 Tves da isini cirkulireben TiTqmis
mTeli sicocxlis manZilze. maTi arseboba sisxlSi miuTiTebs daavadebis gadatanaze.
A hepatitis sadiagnostikod garkveuli mniSvneloba eniWeba polimerizaciis jaWvuri
reaqciiT virusis rnm-is gamovlenas.
profilaqtika da epidsawinaaRmdego RonisZiebebi. nebismieri infeqciiT gamowveuli
avadobis Sesamcireblad saWiroa aqtiuri zemoqmedeba infeqciis wyaros gasaneitraleblad,
gadacemis meqanizmis gasawyvetad da mosaxleobis koleqtiuri imunitetis asamaRleblad. A
hepatitis dros, RonisZiebaTa sistema, mimarTuli infeqciis wyaros gasaneitraleblad nakleb
efeqturia, rac gamowveulia erTi mxriv, daavadebuli adamianis gadamdeblobiT inkubaciuri
periodis bolos da siyviTlis gamovlinebamde da meore mxriv, usiyviTlo, subklinikuri da
inaparantuli formebis didi sixSiriT, romlebic praqtikulad ar vlindeba.
bevrad ufro efeqturia gadacemis meqanizmze zemoqmedeba sanitariul-higienuri xasiaTis
RonisZiebebis gatarebiT, raTa Semcirdes fekalur-oraluri gadacemis meqanizmis realizaciis
SesaZlebloba. upirvelesi mniSvneloba eniWeba mosaxleobis uzrunvelyofas xarisxiani sasmeli
wyliT da sakvebi produqtebiT, dasaxlebuli punqtebis keTilmowyobas da usufTaobis droul
gatanas, buzebis winaaRmdeg brZolas da a.S. am RonisZiebebis did efeqturobas adasturebs
dasavleT evropis da CrdiloeT amerikis magaliTi, sadac kargi sanitariul-higienuri
mdgomareoba aris safuZveli A hepatitiT avadobis dabali maCveneblebisa.
radgan dabali Semosavlebis mqone qveynebisaTvis sanitariuli mdgomareobis radikaluri

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gaumjobeseba seriozul siZneleebTanaa dakavSirebuli da amasTan mosaxleobis migraciis
Tanamedrove tempebisas arc maRali Semosavlebis mqone qveynebis mosaxleoba aris daculi A
hepatitis virusiT dainficirebisagan, amJamad didi yuradReba eqceva mosaxleobis aqtiur da
pasiur imunizacias.
pasiuri imunizaciisaTvis gamoiyeneba normaluri imunoglobulini, romelsac donorTa
sisxlisgan amzadeben. am preparatis efeqturoba ZiriTadad damokidebulia masSi anti - HAV–is
titrze. gansakuTrebiT efeqturia igi rodesac antisxeulebis titri 1:10 000-is farglebSia.
amis misaRwevad, rogorc wesi, TiToeuli seria mzaddeba minimum 1000 adamianis sisxlis
Sratisagan. samwuxarod yvela seria ar aris standartuli, rac amcirebs pasiuri imunizaciis
efeqturobas.
imunoglobulini SeiZleba gamoyenebul iqnas rogorc profilaqtikuri mizniT, ise
epidCvenebiT. profilaqtikis mizniT mas ukeTeben A hepatitis sezonuri matebis dawyebis win
seqtembris pirvel dekadaSi, 4-10 wlis organizebul bavSvebs da moswavleebs. am RonisZiebas
farTod iyenebdnen sabWoTa kavSiris evropul nawilSi. saqarTveloSi aRniSnuli kampania
arasodes Catarebula. imunoglobulini SeiZleba gaukeTdes profilaqtikis mizniT agreTve im
pirebs, romlebic miemgzavrebian A hepatitis hiperendemur teritoriebze, rasac farTod iyeneben
evropis qveynebSi. epidCvenebiT imunoglobulins ukeTeben janmrTel 14 wlamde asakis bavSvebs
da fexmZime qalebs, romlebsac kontaqti aqvT A hepatitiT daavadebulTan da ar aqvT
gadatanili es infeqcia. Tu preparati kontaqtis pirvel 10 dRes aris gakeTebuli, maSin misi
efeqturoba 85-90%-s aRwevs da misi moqmedeba daaxloebiT 4-5 Tves grZeldeba, Tumca
zogierTi monacemiT es periodi 9 Tvemdec ki SeiZleba gaizardos. A hepatitis gadatanis
SemTxvevaSi imunoglobulinis gakeTeba ar aris saWiro. imunoglobulinis doza 10 wlamde
bavSvTaTvis 0,75 ml-ia, 14 wlamde - 1,5 ml, xolo orsulTaTvis - 3,0 ml. igi kunTebSi
keTdeba. sazRvargareT ufro xSirad imunoglobulins akeTeben adamianis wonis mixedviT. am
SemTxvevaSi misi dozaa 0,02ml/kg-ze.
A hepatitis winaaRmdeg radikaluri xasiaTis warmatebis miRweva SesaZlebelia mxolod
aqtiuri imunizaciis safuZvelze. 80-iani wlebis meore naxevarSi mowodebul iqna rogorc
atenuirebuli, ise inaqtivirebuli vaqcinebi. atenuirebuli vaqcinebis gamoyenebam CineTSi aCvena
misi sakmao efeqturoba, Tumca amJamad ufro metad inaqtivirebul vaqcinebs aniWeben
upiratesobas misi SedarebiTi usafrTxoebis gamo. vaqcinaciis kursi mozrdilebSi 2 acrisgan
Sedgeba, xolo bavSvebSi 3 acrisgan. serokonversias TiTqmis 100%-Si aqvs adgili. amasTan
antisxeulebi ufro maRal titrSi muSavdeba, vidre pasiuri imunizaciis dros, magram ufro
nakleb titrSi, vidre daavadebis gadatanisas aris, gansakuTrebiT adreuli rekonvalescenciis

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periodSi. dRes arsebuli vaqcinebi sakmaod dabali reaqtogenobiT gamoirCeva.
unda aRiniSnos, rom A hepatitis sawinaaRmdego aqtiuri imunizacia intensiurad tardeba
amerikis SeerTebul StatebSi, espaneTSi, italiaSi, israelSi da sxvagan. ruseTSi mas iyeneben
epidemiologiuri CvenebiT. 2018 wlis monacemebiT 30-ze meti qveyana iyenebs A hepatitis
sawinaaRmdego aqtiur imunizacias gegmiani saxiT.
A hepatitiT daavadebulis hospitalizacia xdeba klinikuri da epidemiologiuri CvenebiT
maSin, rodesac daavadeba mimdinareobs mZimed, an, Tu keraSi aradamakmayofilebeli sanitariuli
mdgomareobaa. A hepatitis 3 an meti klinikuri (savaraudo) SemTxveva, romelic mocemul
teritoriaze daavadebisTvis damaxasiaTebeli inkubaciuri periodis Sesabamisi intervaliT
ganviTarda, saWiroebs sazogadoebrivi jandacvis centris epidemiologis mier gamokvlevis
Catarebas Setyobinebis miRebidan 2 samuSao dRis ganmavlobaSi, infeqciis wyaros da gadacemis
faqtorebis dasadgenad. infeqciis wyaroze saeWvo pirovneba eqvemdebareba Rrma klinikur-
bioqimiur da serologiur gamokvlevas.
kontaqtirebul pirebze wesdeba samedicino meTvalyureoba 35 dRis manZilze. 14 wlamde
asakis bavSvebs da fexmZime qalebs SeiZleba epidCvenebiT gaukeTdeT imunoglobulini, romlis
dozebic zemoT aris miTiTebuli.

11.5. E hepatiti

anTroponozuli virusuli infeqciuri daavadebaa, romelic janmos monacemebiT sxva


mwvave virusuli hepatitebTan SedarebiT yvelaze ufro xSirad gvxvdeba tropikuli da
subtropikuli sartylis hiperendemuri regionebis mozrdil mosaxleobaSi.
gasuli saukunis 70-iani wlebis Sua periodSi dadginda, rom arsebobs A da B
hepatitebisagan gansxvavebuli mesame - arc A da arc B hepatiti, romelic Tavis mxriv or
daavadebas moicavda da romelTagan erT-erTi fekalur-oraluri meqanizmiT vrceldeboda. 80-
iani wlebis pirvel naxevarSi sabolood dadginda fekalur-oraluri meqanizmis mqone arc A da
arc B hepatitis arseboba da mas E hepatiti ewoda. am daavadebis SeswavlaSi didi wvlili
Seitana rusma mecnierma m. balaianma, romelmac 1983 wels saeWvo avadmyofis fekaliebis
eqstraqtis filtratiT TviTdainficirebis magaliTze daadastura am infeqciis calke
nozologiur erTeulad arseboba. rogorc retrospeqtuli gamokvlevebi adasturebs, E hepatiti
gvxvdeboda me-19 saukunis meore da me-20 saukunis pirvel naxevarSic. 1955-1956 wlebSi
indoeTis dedaqalaq deliSi momxdari hepatitis afeTqeba, romlis drosac daavadda 30 aTasi
adamiani da romelic miewereboda A hepatits, dadginda rom iyo E hepatitis afeTqeba. amJamad
yovelwliurad E hepatitis daaxloebiT 3.3 milioni SemTxveva viTardeba.
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etiologia. E hepatitis virusi (HEV) aris rnm-s Semcveli 32-35 nm-is zomis virusi. igi
Orthohepavirus-is gvars miekuTvneba.
E hepatitis virusi oTxi serologiuri tipiT aris warmodgenili - genotipi 1,2,3 da 4.
1 da 2 genotipi mxolod adamianebSi cirkulirebs, xolo 3 da 4 genotipebi - zogierT
cxovelSi (Rori, iremi), Tumca maTSi ar iwvevs daavadebas da iSviaTad maTgan SeiZleba gadaeces
adamians. igi garemoSi A hepatitis virusTan SedarebiT naklebad gamZlea. Tumca kargad uZlebs
dabal temperaturas. swrafad iRupeba qloris Semcveli sadezinfeqcio saSualebebis
zemoqmedebiT.
infeqciis wyaro. msgavsad sxva virusuli hepatitebisa, E hepatitic anTroponozuli
daavadebaa. infeqciis wyaros warmoadgens daavadebuli adamiani. rogorc varaudoben igi
gadamdebi xdeba inkubaciuri periodis gavlis Semdeg. daavadebis klinikur mimdinareobaSi
siyviTlian formebTan erTad gvxvdeba usiyviTlo da subklinikuri formebi, romelTa raodenoba
epidafeTqebebis dros 5-jer ufro metia, vidre siyviTliT mimdinare formebis. amdenad
infeqciis gavrcelebaSi wamyvan rols swored usiyviTlo formebi TamaSoben.
E hepatits ar axasiaTebs virusmtarebloba. aseve ar viTardeba qronikuli formebi.
amdenad mwvave formiT daavadebuli adamiani infeqciis erTaderT wyaros warmoadgens. unda
aRiniSnos, rom SemTxvevaTa 10-15%-Si daavadeba gaxangrZlivebulad (45-100 dRe) mimdinareobs.
varaudoben, rom epidafeTqebebs Soris virusis cirkulacia swored aseTi avadmyofebis xarjzea
SenarCunebuli.
gadacemis meqanizmi. E hepatits gadacemis fekalur-oraluri meqanizmi axasiaTebs. virusis
gavrcelebis ZiriTadi gzaa wylismieri. aseTi epidemiebi Zalian xSiria centralur da samxreT
aziaSi, CrdiloeT da dasavleT afrikaSi, centralur amerikaSi. misi ganviTarebisaTvis
xelSemwyobi faqtorebia mosaxleobis didi simWidrove da wyalmomaragebis saqmeSi arsebuli
seriozuli xarvezebi. am daavadebis yvelaze didi wylismieri afeTqeba dafiqsirda samxreT
CineTSi 1986 wels, rodesac daaxloebiT 6 kviris manZilze 120 aTasi adamiani gaxda avad.
gansakuTrebiT xSiria wylismieri epidemiebi Semodgomaze, rodesac adgili aqvs did
wvimebs, ris Sedegadac wyalmomaragebis wyaroebi intensiurad binZurdeba Camdinare wylebiT.
did rols TamaSobs amave periodSi wylis daqlorvis saqmis Sesustebac.
daavadebis gavrceleba SesaZlebelia dainficirebuli sakvebi produqtebiT. Tumca am gzis
intensiuroba didi ar aris. kidev ufro iSviaTia HEV-is gavrceleba sayofacxovrebo-kontaqtis
gziT, risi mizezic aris avadmyofis fekalur masebSi virusis dabali koncentracia. infeqcia
SeiZleba gavrceldes cxoveluri produqtebis miRebisas, romlebic Termulad kargad ar aris
damuSavebuli. es gansakuTrebiT xSirad xdeba Roris RviZlis gamoyenebisas. am SemTxvevaSi

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daavadeba me-3 genotipiT aris gamowveuli. varaudoben, rom daavadeba SeiZleba gadaeces
hemotransfuziiT da vertikaluri meqanizmiTac.
epidemiologiuri Taviseburebebi. E hepatiti msoflioSi araTanabrad aris gavrcelebuli.
maRali avadobis maCveneblebiT gamoirCeva iseTi qveynebi, rogoricaa indoeTi, birma, nepali,
alJiri, TurqmeneTi, yirgizeTi, tajikeTi, uzbekeTi da sxva, ZiriTadad aziisa da afrikis
qveynebi. am saxelmwifoebSi adgili aqvs daavadebis wylimier afeTqebebs, romelTa drosac
daavadebulTa ricxvi 15-20 aTas adamians aRwevs. yirgizeTisa da tajikeTis zogierT
teritoriaze E hepatitis matebis periodSi misi xvedriTi wili virusuli hepatitebiT
avadobaSi 70-80%-s Seadgens. amasTan am daavadebis dros kargad aris gamoxatuli wylismieri
epidemiebis erT-erTi ZiriTadi niSani – drois mokle periodSi daavadebulTa Zalian didi
raodenoba.
saqarTveloSi E hepatiti 1996 wlidan aRiricxeba, rogorc wesi, erTeuli SemTxvevebis
saxiT. gamonakliss warmoadgens 1996-1997 wlebSi axmetis raionSi gamovlenili A da E
hepatitebis wylismieri afeTqeba. E hepatitis diagnozi daesva 6 pacients, xolo ors
erTdroulad - A da E hepatitebis diagnozi.
Cveni azriT es daavadeba saqarTveloSi 1996 wlamdec arsebobda, rasac adasturebs meoce
saukunis 60-iani wlebis dasawyisSi bolnisis da marneulis raionebSi gamovlenili virusuli
hepatitebis afeTqebebi, romlebic mTeli rigi epidemiologiuri niSnebiT Zalian hgavs E hepatits.
kerZod daavadebulebSi axalgazrda asakis avadmyofTa didi xvedriTi wili da letalobis
SemTxvevebi fexmZime qalebSi.
Cveni monacemebiT saqarTveloSi praqtikulad janmrTeli mosaxleobis 6,5%-s uvlindeba
sisxlSi E hepatitis virusis sawinaaRmdego antisxeulebi – anti – HEV.
yvelaze ufro xSirad E hepatitiT 15-29 wlis asakis pirebi avaddebian. maRali avadobis
mqone regionebSi am asakis gamokvleul pirTa TiTqmis 96%-s sisxlSi uvlindeba anti –
HEVIgG. daavadebulTa aseTi asakobrivi struqtura ganpirobebulia infeqciis ZiriTadad wylis
gziT gavrcelebiT.
endemur teritoriebze adgili aqvs avadobis periodul matebas, rac ZiriTadad 7-8 wlis
intervaliT xdeba. wlis manZilze avadobis SemTxvevebi yvelaze xSiria zafxul-Semodgomis
periodSi.
radgan E hepatiti iSviaTad vrceldeba sayofacxovrebo kontaqtis gziT, amitomac misTvis
dabali kerobrioba aris damaxasiaTebeli. rogorc wesi, ojaxur kerebSi erTi avadmyofi
vlindeba.
iTvleba, rom mosaxleobis mimRebloba am daavadebisadmi sakmaod maRalia. daavadebis

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gadatanis Semdeg yalibdeba postinfeqciuri imuniteti, romelic A hepatitisagan gansxvavebiT ar
grZeldeba mTeli cxovreba, rasac adasturebs naavadmyofari adamianebis sisxlSi anti - HEVIgG
–is cirkulacia mxolod ramdenime wlis ganmavlobaSi.
aqve mokled SeiZleba CamovayaliboT is epidemiologiuri niSnebi, riTac E hepatiti
gansxvdeba A hepatitisagan.
• E hepatitis gavrcelebaSi wamyvan rols TamaSobs wylis faqtori.
• E hepatitiT ZiriTadad avaddebian aqtiuri asakis (15-29) pirebi, A hepatitis dros ki
bavSvebi da mozardebi.
• E hepatitis ojaxuri kerebis dros Zalian dabalia kerobrioba.
• E hepatitisaTvis damaxasiaTebelia avadobis feTqebadi xasiaTi.
• endemur teritoriebze avadobis mateba aRiniSneba 7-8 weliwadSi.
• orsul qalebSi maRalia letaloba.
• avadobis donis mateba xdeba zafxulis TveebSi.
klinika da laboratoriuli diagnostika. daavadebis inkubaciuri periodi 2-10 kviras
Soris meryeobs da ufro xSirad 5-6 kviras Seadgens. e.i. cota ufro mets vidre es A
hepatitis dros aris. rogorc sxva virusuli hepatitebis dros, daavadeba mimdinareobs
rogorc siyviTliani, ise usiyviTlo formebiT. klinikuri suraTi Zalian hgavs A hepatitis
klinikas,
Tumca aris gansxvavebebic. daavadeba iwyeba TandaTanobiT. prodromul periodSi Warbobs
dispepsiuri sindromi. mkveTrad aris gamoxatuli saerTo sisuste, madis daqveiTeba, xSirad
viTardeba gulisreva da Rebineba. A hepatitisagan gansxvavebiT avadmyofTa nawils aReniSneba
diarea da poliarTralgia. siyviTlis ganviTarebis Semdeg avadmyofTa TviTgrZnoba ar
umjobesdeba. es periodi 1-2 kvira grZeldeba. daavadeba ufro xSirad msubuqi formiT
mimdinareobs, rac rogorc usiyviTlo, ise siyviTlian formebsac exeba. mZime formebi ZiriTadad
fexmZime qalebSi gvxvdeba. Tumca ar aris gamoricxuli daavadebis fulminanturi formiT
mimdinareoba araorsul qalebSi da aseve mamakacebSi.
rogorc wesi, E hepatiti ufro xSirad gamojanmrTelebiT mTavrdeba, rasac ver vityviT
mis mimdinareobaze orsul qalebSi. maTSi letalobam SeiZleba 20%-sac miaRwios. gansakuTrebiT
mZimed da maRali letalobiT mimdinareobs daavadeba, rodesac dainficireba xdeba orsulobis
mesame trimestrSi. janmos informaciiT 2015 wels am daavadebiT daaxloebiT 44-57 aTasi
adamiani gardaicvala.
daavadebis diagnozi ismeba klinikuri, epidemiologiuri da laboratoriuli monacemebis
safuZvelze. laboratoriuli gamokvlevebidan yvelaze mniSvnelovania daavadebulTa sisxlSi
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anti - HEVIgM-is aRmoCena imunofermentuli analizis meTodiT, romelic sisxlSi daavadebis
dawyebis me-10-12 dRes Cndeba da cirkulirebs daaxloebiT 1-3 Tvis manZilze. Semdeg adgili
aqvs serokonversias da rekonvalescentis sisxlSi vlindeba anti - HEVIgG, romelic miuTiTebs
daavadebis gadatanaze. iyeneben polimerizaciis jaWvur reaqcias virusis rnm-is aRmosaCenad.
profilaqtika da epidsawinaaRmdego RoniZiebebi. E hepatitis profilaqtikis principebi
analogiuria A hepatitis profilaqtikisa. wamyvani roli eniWeba wyalmomaragebis wyaroebis
dacvas fekaluri masebiT da Camdinare wyliT dabinZurebisagan. didi yuradReba eqceva aseve
mosaxleobaSi sanitariuli ganaTlebis Setanas da adamianebis mier piradi higienis wesebis
dacvas.
CineTSi damzadda E hepatitis sawinaaRmdego licenzirebuli rekombinantuli vaqcina,
romelsac sxva qveynebSi ar iyeneben.

11.6. salmonelozi

baqteriologiuri etiologiis zoonozuri infeqciaa, gadacemis fekalur-oraluri


meqanizmiT. mTels msoflioSi diareuli daavadebebis erT-erTi ZiriTadi etiologiuri faqtoria
salmonela. igi diareuli daavadebebis 4 ZiriTad mizezTa Sorisaa.
daavadebis SeswavlaSi mniSvnelovani roli Seasrula gertnerma, romelmac 1888 wels
gardacvlili adamianidan da mis mier moxmarebuli Zroxis xorcidan gamoyo identuri
mikroorganizmebi da daadgina, rom sakvebi produqtebiT gamowveuli daavadebebi
baqteriologiuri etiologiis iyo. am jgufis mikrobebs salmonelebi 1898 wels linerma
uwoda, rac 1934 wels gaziarebul iqna saerTaSoriso nomenklaturuli komisiis mier.
etiologia. daavadebis gamomwvevi salmonelebi miekuTvnebian enterobaqteriebis ojaxs da
salmonelebis gvars, romelic 2 500-ze met serovars moicavs. isini O somaturi antigenis
mixedviT 46 serojgufad iyofa. salmonelebi gramuaryofiTi, moZravi, fakultaturi anaerobi
mikrobebia. isini Seicaven O – somatur (Termostabilur) antigens, H – antigens da
virulentobis Vi-antigens. serovarebis didi umravlesoba paTogenuria rogorc adamianisaTvis,
ise cxovelebisaTvis da frinvelebisaTvis. 1992 wlis klasifikaciis mixedviT salmonelebis
ori saxea gamoyofili _ S. enterica da S.bongori, romlebic 7 qvesaxed iyofa. salmonelozis
ZiriTadi gamomwvevebi pirvel da meore qvesaxeSi Sedian. adamianis paTologiaSi Semdeg
biovarebs aqvs wamyvani roli – S. typhimurium, S. enteritidis, S. panama, S. infantis, S. newport, S.
derbi, S. anatum, S. london da sxva. amasTan pirvel or biovarze modis daavadebaTa SemTxvevebis
didi umravlesoba.
salmonelebi gamZleni arian garemo pirobebSi. wyalSi inarCuneben cxovelmyofelobas 5
293
Tve, xorcSi – 6 Tve, xolo gayinul xorcSi – 13 Tve, karaqSi – 50-120 dRe, kvercxSi – 12-13
Tve. frinvelis xorcSi da fekaliebSi –80 dRidan 4 wlamde. zogierT sakveb produqtebSi (rZe,
xorci) mravldebian kidec sakmaod intensiurad, ise rom sakvebis organolepturi Tvisebebi ar
icvleba. salmonelebi kargad uZleben dabal temperaturas, Tumca maRal temperaturaze (100°C)
swrafad iRupebian. unda aRiniSnos, rom inficirebul kvercxSi da mis gulSi arsebobisas
duRiliT mxolod 4 wuTis mere inaqtivirdebian.
infeqciis wyaros da rezervuars warmoadgenen sasoflo-sameurneo da gareuli
cxovelebi, frinvelebi, romlebSic daavadeba usimptomo mtareblobidan mZime formebamde
varirebs. adamianebisaTvis gansakuTrebiT saSiSia mtarebeli cxovelebi. rogorc wesi, janmrTel
cxovelebSi salmonelebi daavadebas ver iwveven. organizmis dasustebis SemTxvevaSi isini
wvrili nawlavebidan SeiWrebian qsovilebSi da organoebSi da viTardeba daavadeba.
baqteriamtarebeli da daavadebuli cxovelebi salmonelebs gamoyofen ganavalTan, SardTan,
rZesTan erTad. salmonelebis mtareblebi SeiZleba iyvnen agreTve katebi da ZaRlebi (10%),
aseve sinantropuli mRrRnelebi (40%-mde). salmonelebi farTod aris gavrcelebuli gareul
frinvelebSic (mtredebi, beRurebi, Toliebi).
salmonelozis dros infeqciis wyaros warmoadgens adamianic, gansakuTrebiT
saavadmyofoebSi, sadac avadmyofi da mtarebeli adamianebi did saSiSroebas qmnian wlamde asakis
bavSvebisaTvis, romlebic gansakuTrebiT mimRebni arian am infeqciisadmi. avadmyofi adamianis
gadamdebloba ramdenime dRidan 3 kviramde grZeldeba. rekonvalescenturi mtarebloba SeiZleba
1 welze met xans gagrZeldes.
yofil sabWoTa kavSirSi cnobili rusi mecnieris kilesos mier salmonelozis
afeTqebebis dros Seswavlili iyo infeqciis wyaros Sesaxeb monacemebi. msxvilfexa rqosani
saqoneli infeqciis wyaro iyo 37,7%-Si, Rorebi – 19,8%_Si, cxvrebi – 7,2%-Si, Sinauri
frinvelebi – 7,2%-Si. dainficirebulTa 61,3% aRniSnavda, rom miiRo iZulebiT dakluli
cxovelis xorci.
gadacemis meqanizmi aris fekalur-oraluri. adamianis inficireba ZiriTadad xdeba
sakvebismieri gziT. gadacemis faqtorebi aris sxvadasxva sakvebi produqti, gansakuTrebiT
xorci da misgan damzadebuli produqtebi. yvelaze saSiSia xorci, romelic cxovelis
sicocxleSia dainficirebuli. aseve saSiSia sasaklaoebze xorcis dainficireba cxovelis
dakvlisas. igi SeiZleba agreTve dainficirdes misi transportirebis da realizaciis dros.
naxevarfabrikatebidan yvelaze saSiSia farSi. infeqcia SeiZleba gavrceldes aseve rZisa da misi
produqtebiT, kvercxiT da misgan damzadebuli sakvebiT da a.S. kilesos monacemebiT
salmonelozis afeTqebisas SemTxvevaTa 81,2%-Si gadacemis faqtori iyo xorci da misgan

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damzadebuli sadilebi. 2,2%-Si – Zexveuli, 7,2%-Si frinvelis xorci, 2,2%-Si rZe, 1,8%-Si
kvercxi, 4,3%-Si – Tevzis produqtebi. amJamad salmonelozis gavrcelebaSi wamyvan rols
qaTmis xorci da kvercxi TamaSobs.
wylis saSualebiT umetesad SeiZleba dainficirdnen cxovelebi. rac Seexeba am gziT
adamianebis dasnebovnebas, mas didi roli ara aqvs, radgan am faqtoris saSualebiT adamianis
organizmSi damainficirebeli dozis moxvedra sakmaod rTulia, Tumca ar aris gamoricxuli.
1965 wels kaliforniaSi salmonelozis didi epidemia ganviTarda, romlis mizezi iyo sasmeli
wylis dabinZureba salmonelebiT.
salmonelozi SesaZlebelia gavrceldes sayofacxovrebo-kontaqtis gziT, gansakuTrebiT
pediatriuli da geriatriuli profilis saavadmyofoebSi da samSobiaroebSi, magram am gzis
roli didi ar aris.
rogorc bolo wlebSi dadginda, SesaZlebelia infeqciis gadacema haer-mtvrovani gziT,
rasac SeiZleba adgili hqondes bavSvTa dawesebulebebSi da saavadmyofoebSi.
epidemiologiuri Taviseburebebi. salmonelozi mTel msoflioSi farTod aris
gavrcelebuli. janmos monacemebiT, yovelwlurad, salmonelozuri gastroenteritis
daaxloebiT 95 milioni SemTxveva registrirdeba, 45 aTasi ki letalobiT mTavrdeba. amasTan
umravles qveynebSi mas axasiaTebs matebis tendencia, rac ramdenime mizeziT unda aixsnas: 1.
diagnostikis gaumjobesebiT, 2. sazogadoebrivi kvebis qselis (restornebi, kafeebi, sasadiloebi
da sxv.) intensiuri gafarToebiT, 3. mecxoveleobis da mefrinveleobis dargebis swrafi
ganviTarebiT da cxovelebis sakvebad arc Tu iSviaTad salmonelebiT dabinZurebuli cxoveluri
sakvebis farTod gamoyenebiT, 4. qveynebs Soris savaWro kavSirebis gaZlierebiT da sakvebi
produqtebis realizaciis zrdiT. bolo wlebSi sagrZnobia salmonelozis etiologiuri
struqturis Secvlac. kerZod TandaTan mcirdeba S.typhimurium-is roli da paralelurad
izrdeba S.enteritidis xvedriTi wili avadobaSi, romelic umTavresad vrceldeba frinvelebis
xorciT da kvercxiT da maTgan momzadebuli sakvebiT. bevr qveyanaSi infeqcia upiratesad
swored aseTi gziT vrceldeba. amasTan gamomwvevis Setanisas msxvil mefrinveleobis
fabrikebSi, igi swrafad da
intensiurad vrceldeba, rasac xels uwyobs misi transovarialuri gadacema frinvelebSi.
salmonelozis kidev erTi Tavisebureba gamoikveTa bolo periodSi. kerZod anTroponozuli
xasiaTi. sul ufro izrdeba samkurnalo-profilaqtikur dawesebulebebSi infeqciis gavrceleba
sayofacxovrebo-kontaqtis gziT, sadac wamyvania antibiotikorezistentuli Stamebi da sadac
infeqciis wyaroa adamiani (pacientebi, momvlelebi, dedebi). unda aRiniSnos, rom salmonelebis
`hospitaluri~ Stamebi gamoirCevian maRali virulentobiT da mravalmxrivi gamZleobiT

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antibiotikebisadmi da dezinfeqtantebisadmi. swored maRali virulentoba da pacientTa
premorbiduli foni qmnis SesaZlebels infeqcia gavrceldes sayofacxovrebo – kontaqtis gziT,
romlis drosac adamianis organizmSi arc Tu didi raodenobis salmonelebi xvdeba.
gansakuTrebiT xSiria salmonelozis afeTqeba samSobiaro saxlebSi da pediatriuli profilis
klinikebSi, rasac Tan axlavs wlamde asakis bavSvebis maRali avadobis done da letalobis
aseve maRali maCvenebeli. amasTan xSirad aseT kerebs qronikuli xasiaTi aqvT.
gansxvavebiT mravali qveynisagan, saqarTveloSi oficialuri monacemebiT, dReisaTvis
salmoneloziT avadoba sakmaod dabal donezea. qveyanaSi yovelwliurad oficialurad 150-200
SemTxveva registrirdeba.
saqarTveloSi avadobis dabali donis miuxedavad, sakmaod xSiria am daavadebebis
afeTqebebi. magaliTad 2002 wels adigenis raionis sofel fxeroSi adgili hqonda
salmonelozis did afeTqebas, romlis drosac gamovlinda 177 daavadebuli. yvela isini erTi
qorwilis stumrebi iyvnen. gadacemis faqtorad miCneul iqna daavadebuli Zroxis xorcisagan
damzadebuli kerZebi. aRsaniSnavia, rom baqteriologiuri gamokvleva 54 avadmyofs Cautarda. 37
SemTxvevaSi gamoiyo S. enteritidis. igi agreTve saeWvo produqtidanac amoiTesa. am afeTqebis gamo
2002 wels saqarTveloSi salmoneloziT avadobis yvelaze maRali done dafiqsirda bolo
wlebSi – 12,8 100 aTas mosaxleze.
amave wels abaSis r-nis s. tyvirSi daavadda 118 adamiani. gadacemis faqtori iyo qaTmis
xorci. rogorc avadmyofebidan, ise saeWvo produqtidan amoiTesa S. isangi. didi afeTqeba
gamovlinda daba TianeTSic. Zroxis xorcisagan damzadebuli xinklis miRebiT, 60 adamiani gaxda
avad. aqac etiologiuri faqtori S. enteritidis iyo.
amJamad salmoneloziT ufro xSirad avaddebian mozrdili pirebi. Tumca avadobis done
yvelaze maRalia wlamde asakis bavSvebSi. mimRebloba am infeqciisadmi yvela asakSi sakmaod
maRalia. daavadebis gadatanis Semdeg gamomuSavebuli imuniteti aris susti, xanmokle da
tipospecifikuri.
daavadebas axasiaTebs kargad gamoxatuli sezonuroba. salmonelozis SemTxvevebi
matulobs zafxul-Semodgomaze.
klinika da laboratoriuli diagnostika. inkubaciuri periodi 6-72 saaTia. ufro xSirad
ki 12-36 saaTia. es daavadeba umetesad msubuqi formiT mimdinareobs, Tumca zogjer igi mZimed
mimdinareobs da SeiZleba letalobiT dasruldes. mimdinareobis simZime bevrad aris
damokidebuli organizmis mdgomareobaze da gamomwvevis serotipze. dadgenilia, rom daavadebis
ganviTarebisaTvis adamianis organizmSi unda moxvdes rogorc salmonelebis toqsini
(endotoqsini), ise cocxali gamomwvevic. daavadeba ZiriTadad mimdinareobs gastrointestinuri

296
formiT, iSviaTad – generalizebuli saxiT. Tavis mxriv gastrointestinuri formis sami
varianti aris: gastrituli, gastroenterituli da gastroenterokolituri, romelTaganac
yvelaze xSiria gastroenterituli forma.
gastroenterituli variantisaTvis damaxasiaTebelia mokle inkubaciuri periodi da
daavadeba iwyeba SemcivnebiT da temperaturis momatebiT 38-39°C-mde. aRiniSneba gulisreva,
romelic swrafad RebinebaSi gadadis, tkivili muclis areSi, rasac maleve erTvis faRaraTi
uxvi, myrali sunis, momwvano an muqi yavisferi, Txieri, siTxis Semcveli ganavliT. zogjer
masSi sisxlisa da lorwos minarevebi aRiniSneba. defekacias Tan ar axlavs tenezmebi. cxelebis
xangrZlivoba 3-4 dRes ar aRemateba, diareuli sindromi 7-10 dRe SeiZleba gagrZeldes.
gastroenterokolituri formisaTvis damaxasiaTebelia msxvili nawlavis dazianebis
simptomebi da is mwvave dizenteriis msgavsi klinikiT mimdinareobs. rac Seexeba gastritul
formas, igi Zalian iSviaTia.
daavadebis diagnostikaSi klinikasTan erTad wamyvania laboratoriuli meTodi, kerZod
baqteriologiuri gamokvleva da serologiuri meTodi. baqteriologiuri meTodisas
gamosakvlevad iyeneben pirnaReb masas, ganavals, sisxls, Sards, naRvels da Tesaven myar sakveb
niadagian petris finjanze. serologiuri meTodebidan iyeneben aglutinaciis da arapirdapiri
hemaglutinaciis reaqciebs. bolo wlebSi praqtikaSi dainerga aseve imunofermentuli analizis
meTodi.
profilaqtika da epidsawinaaRmdego RonisZiebebi. salmonelozis profilaqtikaSi mTavaria
misi gavrcelebis donis Semcireba cxovelebSi da salmonelebiT sakvebi produqtebis
dainficirebis aRkveTa, rac miiRweva veterinarul-sanitariuli da sanitariul-
epidsawinaaRmdego RonisZiebebis gatarebiT. unda damyardes veterinaruli kontroli cxovelTa
sakvebze da mis ingredientebze, unda Catardes dezinfeqcia da deratizacia iseT obieqtebze,
rogoricaa xorcis gadamamuSavebeli sawarmoebi, sakvebi produqtebis da nedleulis sawyobebi,
macivrebi. unda moxdes cxovelTa vaqcinacia.
veterinarul-sanitariuli kontroli unda damyardes cxovelTa sasaklaoebze,
xorckombinatebSi, mefrinveleobis fermebSi, rZis qarxnebSi, sadac didi yuradReba unda mieqces
sanitariul-higienuri normebis dacvas, kerZod nedleulisa da damzadebuli produqtebis cal-
calke Senaxva-momzadebas. sanitariulma samsaxurma ar unda dauSvas sakvebi produqtebis
dainficireba maTi damuSavebis, transportirebis da realizaciis dros.
didi yuradReba unda mieqces sanitariuli da epidsaawinaaRmdego reJimis dacvas
samkurnalo-profilaqtikur dawesebulebebSi. antibiotikebisadmi rezistentuli Stamebis
formirebis Tavidan asacileblad dauSvebelia maTi araracionaluri daniSvna da gamoyeneba.

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daavadebis an saeWvo SemTxvevis gamovlenisas aucilebelia saswrafo Setyobineba raionis
sjc-Si, ara ugvianes 24 saaTisa. salmonelozis 3 klinikuri an dadasturebuli SemTxveva,
romelic konkretul teritoriaze 2 kviris ganmavlobaSi ganviTarda, saWiroebs sjc-is
epidemiologis mier gamokvlevis Catarebas. unda gvaxsovdes, rom daavadeba ufro xSirad
afeTqebebis saxiT gvxvdeba. sporaduli SemTxvevebic xSirad gamouvlinebel epidafeTqebas
warmoadgens. dRevandeli qalaqis pirobebSi, sadac mosaxleobis intensiur Sida migracias aqvs
adgili da Zalian farToa sazogadoebrivi kvebis obieqtebis qseli, arc ise iolia afeTqebis
gamovlena.
avadmyofis hospitalizacia xdeba klinikuri CvenebiT. rekonvalescenti kvebis obieqtze an
bavSvTa koleqtivSi daiSveba klinikuri gamojanmrTelebisa da ganavlis 24 saaTis intervaliT
orjeradi baqteriologiuri gamokvlevis uaryofiTi pasuxis miRebis Semdeg (igi tardeba
antibiotikebiT mkurnalobis damTavrebidan 2 dRis Semdeg).
kontaqtSi myof pirebze wesdeba 7 dRiani samedicino meTvalyureoba. gadacemis
faqtorebis dasadgenad baqteriologiuri gamokvleva unda Cautardes yvela saeWvo produqts.
aseTi produqtis gamosavlenad avadmyofs an afeTqebisas avadmyofebs detalurad
ekiTxebian Tu ra sakvebi produqti miiRo da sad, bolo 3 dRis ganmavlobaSi.
epidemiologiuri zedamxedveloba unda ganaxorcielos rogorc sanitariulma da
epidemiologiurma, ise veterinarulma samsaxurebma. yuradReba unda gamaxvildes Semdeg
aspeqtebze:
• cxovelebSi da adamianebSi salmonelozis avadobis doneze da mis tendenciaze;
• salmonelebis etiologiuri struqturis mikrobiologiur monitoringze;
• kontrolze kvebis produqtebis Semotanaze, damzadebaze, transportirebaze,
realizaciaze;
• saavadmyofosSiga infeqciebis kontrolze, infeqciis wyaros gamovlenis, gadacemis
faqtorebis dadgenis da epidsawinaaRmdego RonisZiebebis srulad gatarebis mizniT.

11.7. gripi

virusuli anTroponozuli, sasunTqi gzebis mwvave infeqciuri daavadebaa, romlisTvisac


gadacemis aerogenuli meqanizmia damaxasiaTebeli da SeuZlia drois mokle periodSi globalur
gavrcelebas miaRwios.
daavadebis pirveli detaluri da sarwmuno aRwera 1403 wels frang eqim e. paskes
ekuTvnis. am dros evropaSi gripis epidemia mZvinvarebda. pirveli pandemia 1580 wels aRiricxa.

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me-18 da me-19 saukuneebSi daavadebis oTx-oTxi pandemia ganviTarda. gansakuTrebiT aRsaniSnavia
1918-1920 wlebSi ganviTarebuli pandemia, romelic espanuri gripis, anu `ispankis~ saxeliT
aris cnobili. rogorc varaudoben am dros daaxloebiT 20 milioni adamiani daiRupa. Tumca
zogierTi mecnieris azriT gardacvlilTa raodenoba 50 milions aRemateboda da 100 milionsac
ki aRwevda. Semdegi pandemiebi 1957 da 1968 wlebSi aRiniSna. 21-e saukuneSi, kerZod 2009-2010
wlebSi, daavadebis kidev erTi pandemia ganviTarda msoflioSi.
2009 wlis martis bolos da aprilis dasawyisSi meqsikaSi dafiqsirda gripis afeTqeba,
romelic Semdeg gavrcelda amerikis SeerTebul StatebSi, sadac dadgenil iqna, rom daavadeba
gamowveuli iyo gripis A virusis H1N1 qvetipis axali StamiT, romelic adre mosaxleobaSi
arasodes cirkulirebda. rogorc Semdgom gamoirkva es Stami aris adamianis, Roris da
frinvelis gripis virusebis genebis unikaluri narevi.
meqsikaSi gripis afeTqebam maleve miipyro mkvlevarTa yuradReba, radgan dadginda, rom
virusi advilad vrceldeboda adamianidan adamianze da mas drois mokle periodSi SeeZlo mieRo
pandemiuri gavrceleba. marTlac, am daavadebam, rogorc aRiniSna, swrafad gadainacvla amerikaSi
da Semdeg moedo msoflios umravles qveyanas.
2009 wlis 11 ivniss janmom oficialurad gamoacxada gripis axali pandemiis dawyeba,
romelic gamowveuli iyo H1N1 qvetipis axali StamiT. am momentisaTvis daavadeba ukve
gamovlenili iyo msoflios 74 qveyanaSi. zafxulis periodis dadgomis miuxedavad gripis
intensiuri gavrceleba msoflioSi gagrZelda da 27 agvistosaTvis msoflios 140 qveyanaSi
daavadebis 255 776 SemTxveva gamovlinda, romelTagan 2 627 letalobiT damTavrda. 2009 wlis
Semodgomaze da 2010 wlis zamTarSi daavadeba kidev ufro intensiurad gavrcelda da
pandemiaSi CaerTo TiTqmis yvela qveyana, maT Soris saqarTveloc. 2010 wlis 1 ianvrisTvis
SemTxvevebi ukve 208 qveyanaSi dafiqsirda, xolo gardacvlilTa ricxvma 12 000 gadaaWarba.
2010 wlis 1 ivnisisaTvis am ricxvma 17 000 miaRwia. 2010 wlis 25 martisaTvis daavadeba
msoflios 230 qveyanaSi iyo gavrcelebuli.
pandemia 2010 wlis agvistoSi damTavrda. sul pandemiis dros gardaicvala 18 449
adamiani.
daavadebis saxelwodeba warmodgeba franguli sityvidan `gripper~, rac SeboWvas,
Tavdasxmas niSnavs. mTel rig qveynebSi infeqcias influenca (laTinuri sityva influence-SeWra)
ewodeboda.
etiologia. gripis gamomwvevi 4 tipad iyofa: A, B, C da D. Tumca es ukanaskneli aavadebs
ZiriTadad msxvilfexa rqosan saqonels. adamianebSi igi ar iwvevs daavadebas. A tipis virusi
pirvelad gamoyves 1933 wels ingliselma mecnierebma smitma, endriusma da leidloum. 1940

299
wels aRmoCenil iqna B, xolo 1951 wels – C virusi. gripis virusi miekuTvneba
orTomiqsovirusebis ojaxs da Seicavs rnm-s. mis SemadgenlobaSi Sedis ori zedapiruli
antigeni: hemaglutinini – H da neiraminidaza – N, romelTa cvlileba axali qvetipebis
warmoqmnas iwvevs.
gripis virusisaTvis, gansakuTrebiT A tipisaTvis, damaxasiaTebelia didi antigenuri
cvalebadoba, rac gamoixateba hemaglutininis an neiraminidazas sruli (Sifti) an nawilobrivi
(dreifi) SecvliT da axali qvetipebis SeqmniT. 1980 wlidan janmos winadadebiT gripis A
virusis axali klasifikacia iqna SemoRebuli, rac efuZneba hemaglutininis da neiraminidazis
aRniSvnas. amJamad hemaglutininis 18 da neiraminidazas 11 qvetipi aris cnobili.
epidemiologiurad mniSvneloba aqvs hemaglutininis 3 qvetips (H1,H2,H3) da neiraminidazas or
qvetips (N1,N2). unda aRiniSnos, rom C tipis viruss neiraminidaza ar aqvs.
antigenuri cvlileba da axali qvetipebis warmoqmna iwvevs gripis epidemiur da
pandemiur gavrcelebas. 1918 wels pandemia gamowveuli iyo H1N1 qvetipis virusiT, romelic
aRdgenil da Seswavlil iqna laboratoriaSi 2003 wels. 1957 wels ganviTarebuli aziuri
gripis formula iyo H2N2, romelic pirvelad 1947 wels gamovlinda, xolo 1968 wels
pandemiis gamomwvevi virusis – H3N2. amJamad miRebuli wesiT virusis formula unda
iTvaliswinebdes misi gamoyofis adgils, registraciis nomers, aRmoCenis wels, H da N
antigenebis Taviseburebebs. magaliTad 1968 wels gamoyofili virusis formulaa A (honkongi) 1
(68) H3N2. amJamad msoflioSi cirkulirebs A virusis H1N1 da H3N2 qvetipebi.
garemoSi gripis virusi sxvadasxva fizikuri da qimiuri faqtorebis zemoqmedebiT
swrafad inaqtivirdeba. cudad uZlebs maRal temperaturas. 60-65°C-ze iRupeba 5 wuTSi. aseve
swrafad inaqtivirdeba sadezinfeqcio xsnarebis da ultraiisferi sxivebis zemoqmedebiT.
samagierod gamZlea dabali temperaturisadmi - 20°C - -70°C-ze SeiZleba cxovelmyofeloba
ramdenime weli SeinarCunos. kargad mravldeba qaTmis embrionze.
B tipis virusis ramdenime antigenuri varianti arsebobs, magram maTi ricxvi bevrad ufro
naklebia A virusTan SedarebiT. saerTod misi virulentoba da roli epidemiur procesSi bevrad
Camouvardeba A virusis rols.
infeqciis wyaro. gripi anTroponozuli daavadebaa, miuxedavad imisa, rom ukve sakmao
xania arsebobs monacemebi, rom gripiT avaddebian frinvelebic da ZuZumwovrebic. aRwerilia
epizootiis mravali SemTxveva rogorc gareul, ise Sinaur frinvelebSi. gripiT avaddebian
Sinauri cxovelebic. gansakuTrebiT Rorebi, cxenebi, Zroxebi, ZaRlebi, katebi. fiqroben, rom
adamianis da cxovelebis gripis virusebis urTierTqmedebiT adamianis gripis virusebSi adgili
aqvs maT antigenur dreifs da Sifts da axali qvetipebis da Stamebis warmoqmnas. am mosazrebas

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amyarebs amJamad frinvelis gripis gavrceleba adamianebSi.
gripis infeqciis wyaroa rogorc klinikurad manifestirebuli, ise waSlili formebiT
daavadebuli adamiani. gadamdebloba iwyeba daavadebis dawyebisTanave da avadmyofi gansakuTrebiT
saSiSia pirveli sami dRis manZilze. virusis gamoyofa grZeldeba 5-6 dRe. me-7 dRidan igi aRar
gamoiyofa. daavadebis garTulebis SemTxvevaSi gadamdeblobis periodi SeiZleba gaizardos. unda
aRiniSnos, rom daavadebulTa umravlesoba ar mimarTavs samedicino dawesebulebas. amasTan bevri
maTgani agrZelebs Tavis Cveul saqmianobas, rac xels uwyobs daavadebis farTo gavrcelebas.
gadacemis meqanizmi. gripis gadacemis meqanizmi aerogenulia da virusi haer-wveTovani
gziT vrceldeba. sasunTqi gzebis dazianebuli epiTeliumidan virusi nerwyvis, lorwos da
naxvelis wveTebTan erTad sunTqvis, laparakis, xvelebis, tirilis da daceminebis dros xvdeba
haerSi, sadac misi gamZleoba damokidebulia sinaTlis, tenianobis, temperaturis zemoqmedebaze,
aerozolis dispersiis xarisxze. mravalricxovani monacemebi miuTiTeben, rom sacxovrebeli
binebis haerSi gripis virusi cxovelmyofelobas da dainficirebis unars inarCunebs daaxloebiT
2-9 saaTis manZilze. haeris fardobiTi tenianobis Semcirebisas es dro 1 sT-mde klebulobs.
garkveuli drois ganmavlobaSi gripis virusi aseve inarCunebs cxovelmyofelobas
sayofacxovrebo sagnebze. amitomac Teoriulad dasaSvebia adamianis dainficireba iseTi nivTebis
saSualebiT, rogoricaa WurWeli, saTamaSoebi, pirsaxoci da sxva.
saerTod aRiarebulia, rom adamianis dasainficireblad saWiroa daavadebulTan mWidro da
uSualo kontaqti. rac metia adamianTa simWidrove oTaxSi, samsaxurSi, bavSvTa dawesebulebebSi,
miT ufro advilad da intensiurad vrceldeba gripi.
epidemiologiuri Taviseburebebi. rogorc aRiniSna grips axasiaTebs epidemiuri da
pandemiuri gavrceleba, rac Semdegi faqtorebiT aris ganpirobebuli:
• mokle inkubaciuri periodiT;
• aerogenuli gadacemis meqanizmiT;
• adamianTa maRali mimReblobiT;
• daavadebis msubuqi formebis did ricxviT;
• TiToeuli epidemiis da pandemiis dros gamomwvevis axali antigenuri variantis
cirkulaciiT, romlis mimarTac mosaxleobas ar gaaCnia imuniteti;
• postinfeqciuri imunitetis tiposfecifikurobiT.
gripi mniSvnelovani socialuri problemaa, radgan Zalian maRalia am infeqciiT
gamowveuli avadoba. A virusiT gamowveuli epidemiis dros didi qalaqebis mTeli mosaxleobis
3-11% xdeba avad, B-virusiT gamowveuli gripisas – 4-8%. gansakuTrebiT maRalia bavSvTa
avadoba. epidemiebisas saSualod bavSvTa 20% xdeba avad. am maCvenebelma zogjer 30-40%-sac

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SeiZleba miaRwios. rig SemTxvevaSi gripiT avadobam SeiZleba gadaaWarbos yvela sxva infeqciur
daavadebiT gamowveul avadobas. magaliTad 1918-1920 wlebSi gripiT daaxloebiT 0,5 miliardi
adamiani gaxda avad da daiRupa daaxloebiT 50 milionze meti. unda aRiniSnos, rom es
ZiriTadad ganpirobebuli iyo pirveli msoflio omis SedegebiT. cxovrebis pirobebis
gauaresebam da SimSilma xeli Seuwyo mosaxleobis zogadi imunitetis daqveiTebas da daavadebis
mZimed mimdinareobas.
gripis 1957 wels ganviTarebuli pandemiis dros mTels msoflioSi daaxloebiT 1
miliardi adamiani daavadda, Tumca letaloba ar iyo maRali.
gripis gadatanis dros viTardeba tipospecifikuri imuniteti, rac rogorc aRiniSna,
erT-erTi mizezia am daavadebis swrafi gavrcelebisa. iTvleba, rom A virusiT gamowveuli
gripis gadatanis Semdeg imuniteti 1-1,5 weli grZeldeba, xolo B virusis dros - 3-4 weli.
Tumca mTeli rigi dakvirvebebi mowmobs, rom A virusis zogierTi Stamis mimarT imuniteti
ufro xangrZlivi drois manZilze rCeba.
gripisaTvis damaxasiaTebelia zamTar-gazafxulis sezonuroba, rasac ZiriTadad
apirobadebs wlis am periodSi mosaxleobis didi simWidrove daxurul SenobebSi. zafxulSi
daavadebis minimaluri SemTxvevebia. Semodgomaze iwyeba avadobis zrda da piki wlis civ
periodze modis. janmos rekomendaciiT evropis regionSi Semavali qveynebisTvis (maT Soris
saqarTvelosTvis) gripis sezonad miCneulia mimdinare wlis me-40 kviridan momdevno wlis me-
20 kviris CaTvliT periodi.
klinika. daavadebis inkubaciuri periodi aris xanmokle da meryeobs ramdenime saaTidan 3
dRemde. moxvdeba ra adamianis organizmSi SesunTqul haerTan erTad, virusi SeiWreba sasunTqi
gzebis lorwovani garsis epiTelur ujredebSi, sadac xdeba misi reproduqcia. amasTan es
procesi swrafad mimdinareobs, rac ganapirobebs inkubaciuri periodis xanmokleobas.
dazianebuli ujredebidan virusi xvdeba sisxlSi da viTardeba virusemia. daavadeba iwyeba
mwvaved: temperaturis momatebiT 39-40°C-mde, SemcivnebiT, Tavis tkiviliT, saerTo sisustiT,
tanSi texviT, kunTebis da saxsrebis tkiviliT da a.S. temperaturuli reaqcia grZeldeba 2-5
dRe da ecema lizisiT.
gripis dros erT-erTi wamyvania kataruli sindromi, romelic daaxloebiT 7-10 dRe
grZeldeba, yvelaze didxans rCeba xvela. seriozuli cvlilebebi viTardeba gul-sisxlZarRvTa
sistemaSi. gripis prognozi msubuqi da saSualo simZimis formebis dros keTilsaimedoa, xolo
mZime formisas seriozuli. yvelaze xSiri garTulebaa pnevmonia, romelic umetesad strepto-
stafilokokuri etiologiisaa. es garTuleba yvelaze xSirad `maRali riskis~ pacientebs
emarTebaT – xanSiSesuli asakis pirebs, aseve gulisa da filtvebis qronikuli daavadebebis

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mqoneT. gripi aseve mZimed mimdinareobs bavSvebSi.
janmos monacemebiT yovelwliurad msoflioSi gripis mZime formiT avaddeba 3-5 milioni
adamiani, romelTagan 290-650 aTasi adamiani kvdeba.
profilaqtika da epidsawinaaRmdego RonisZiebebi. gripis profilaqtika xorcieldeba
saerTaSoriso da nacionalur doneze. saerTaSoriso doneze daavadebis profilaqtikas
axorcielebs janmo gripis saerTaSoriso centrebis saSualebiT. maTi ZiriTadi funqciaa gripis
virusis im axali Stamebis drouli aRmoCena, romelTac epidemiuri gavrcelebis potencia aqvT.
nacionalur doneze epidemiologiuri zedamxedvelobis mizania epidsituaciis operatiuli
analizi da Sesabamisi RonisZiebebis gatareba.
gripis specifikuri profilaqtikisaTvis iyeneben rogorc cocxal, ise inaqtivirebul
vaqcinebs. gamoSvebulia aseve vaqcinebi bavSvebisaTvis. acrebs, rogorc wesi, iyeneben
epidCvenebiT, maSin, rodesac am daavadebis epidemiuri gavrcelebis saSiSroebaa. gamomdinare im
faqtoridan, rom gripis dros postinfeqciuri imuniteti tipospecifikuria, aucilebelia
acrebis im vaqciniT Catareba, romelic damzadebulia mocemuli epidemiis gamomwvevi
Stamebisagan. janmo rekomendacias uwevs, rom gripis sawinaaRmdego acra Caitaros mosaxleobis
Semdegma jgufebma:
• orsulma qalebma;
• 65 wlis da zeda asakis pirebma;
• qronikuli daavadebis mqone pirebma;
• jandacvis muSakebma.
gripis efeqturi profilaqtikisaTvis metad mniSvnelovania droulad ganisazRvros
avadobis epidemiuri matebis dawyeba. miRebuli tradiciis Tanaxmad epidemiuri matebis dawyebis
periodad iTvleba dRe, rodesac gripiT da mwvave respiraciuli daavadebiT avadoba 20%-ze
metiT gadaaWarbebs wina kviris Sesabamisi dRis avadobis maCvenebels. amasTan mniSvnelovania
avadobis donis kontroli calkeul asakobriv jgufebSi.
specifikuri profilaqtikisaTvis aseve iyeneben gripis sawinaaRmdego imunoglobulins,
romelsac winaswar gripis vaqciniT acril donorTa sisxlisagan amzadeben. misi gamoyeneba
gansakuTrebiT rekomendebulia mcire asakis bavSvebSi.
karg Sedegebs iZleva gripis profilaqtika iseTi antivirusuli preparatiT, rogoricaa
remantadini. keraSi misi efeqturobis indeqsi 3,0-10,3 farglebSi meryeobs.
daavadebis SemTxvevaSi saWiroa avadmyofis izolacia binaze. hospitalizacia warmoebs
klinikuri da epidemiologiuri (rodesac avadmyofi vlindeba saerTo sacxovrebelSi, yazarmaSi
da a. S.) CvenebebiT. gripis epidemiis dros Tavidan unda aviciloT avadmyofis misvla eqimTan

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poliklinikaSi an sxva samedicino dawesebulebaSi. epidemiis dros aseve unda SeizRudos
mosaxleobis erTmaneTSi kontaqti. am mizniT ikrZaleba masobrivi sadResaswaulo RonisZiebebi,
moswavleebs da studentebs eZlevaT an ugrZeldebaT ardadegebi, ar aris sasurveli kino-
Teatrebis funqcioba da a. S. kontaqtirebuli pirebisaTvis rekomendebulia remantadini miReba
100 mg. dReSi, 10 dRis manZilze. bavSvTa dawesebulebebSi karg Sedegs iZleva
dibazoloprofilaqtika – 1 abi dReSi, 7 dRis manZilze. avadmyofis irgvliv myofma pirebma
unda ataron 3-feniani samedicino niRabi. SenobaSi sadac imyofeba avadmyofi, rekomendebulia
ultraiisferi dasxiveba da sveli wesiT dalageba 0,2-0,3%-iani qloraminis xsnariT. TeTreuli
da WurWeli unda gamoixarSos.

frinvelis gripi

virusuli etiologiis zoonozuri infeqciuri daavadebaa, romelic msoflioSi


intensiurad gavrcelda 2005 wlidan.
es infeqcia pirvelad aRweril iqna 1997 wels honkongSi, rodesac daavadda 18 adamiani
da maTgan 6 gardaicvala. epidemiologiuri kvleviT dadginda, rom adamianebi dainficirdnen
Sinaur frinvelebTan kontaqtis Sedegad. infeqciis Semdgomi gavrcelebis aRsakveTad 3 dRis
manZilze honkongSi gaanadgures Sinauri frinvelebis mTeli populacia (1,5 milionze meti
frinveli). am RonisZiebam efeqti gamoiRo da epizootiis ganviTarebas adgili ar qonia.
etiologia. daavadebas iwvevs frinvelis gripis A virusi, romelic iseve rogorc
adamianis gripis virusi Seicavs or antigens – hemaglutinins da neiraminidazas. infeqciis
ZiriTadi gamomwvevia H5N1 qvetipi. daavadeba SeiZleba gamiwvios H9N2 da H7N9 qvetipebmac,
Tumca maTi epidemiologiuri mniSvneloba bevrad naklebia. saerTod frinvelis grips, virusis
mravali qvetipi iwvevs, romelTagan upirvelesi mniSvneloba rogorc aRiniSna H5N1 –s aqvs.
infeqciis wyaro. infeqciis wyaros ZiriTadad warmoadgens Sinauri frinveli. es daavadeba
maTSi didi xania gavrcelebuli, Tumca igi adamianebs ar gadaecemoda. situacia Seicvala 1997
wlidan. frinvelebis mimRebloba am virusisadmi sakmaod maRalia. maTSi daavadeba mZimed
mimdinareobs da maRalia letalobis maCvenebeli, romelmac zogjer SesaZlebelia 100%-s
miaRwios. am bolo dros literaturaSi gavrcelda informacia, rom H5N1 virusiT
dainficirebuli frinvelebis nawilSi daavadeba Zalian msubuqad mimdinareobs da ar iwvevs
letalobas. am movlenam SeiZleba xeli Seuwyos infeqciis kidev ufro intensiur gavrcelebas
adamianebSi.
epizootur procesSi frinvelebidan yvelaze meti mniSvneloba eniWeba gadamfren
frinvelebs, kerZod gareul ixvs da bats, gansakuTrebiT ixvs, romelTac SeuZliaT infeqcia ara
marto erTi qveynidan meoreSi, aramed erTi kontinentidan meoreSic gaavrcelon.
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aseve gamoirkva, rom frinvelebis garda, virusi vefxvebsa da katebSic vrceldeba da
maTSi daavadeba mZimed mimdinareobs. adre iTvleboda, rom es cxovelebi am infeqciisadmi
Seuvalni iyvnen. virusis gavrceleba cxovelebSi metyvelebs imaze, rom daavadebis rezervuari
sul ufro izrdeba, rac udavod Seuwyobs xels mis farTo gavrcelebas adamianebSic.
rac Seexeba daavadebul adamians, is amJamad infeqciis wyaros ar warmoadgens. magram
mecnierTa azriT, garkveul pirobebSi, Tuki adamianebi erTdroulad sezonuri da frinvelis
gripiT gaxdebian avad, ori virusis urTierTqmedebiT SesaZlebelia iseTi Stamis formireba,
romelic uSualod adamianidan adamians gadaecema. amasTan, rac ufro xSirad moxdeba
erTdroulad ori virusiT dainficireba, miT metia axali Stamis aRmocenebis albaToba.
gadacemis meqanizmi. ufro xSirad adamiani virusiT inficirebul, cocxal frinvelTan
uSualo kontaqtis Sedegad avaddeba. aseve metad saSiSia daavadebuli frinvelis dakvla,
gaputva, xorcis daWra da sakvebad momzadeba. aqve xazi unda gaesvas im faqts, rom Cveulebrivi
wesiT sakvebis momzadebisas (70°C-ze maRal temperaturaze) xdeba virusis gauvnebelyofa.
daavadebis gamomwvevi virusi imyofeba frinvelis eqskrementebSic, romlis gamoSrobisas mis
nawilakebTan erTad virusi SeiZleba moxvdes haerSi da aqedan janmrTeli adamianis sasunTq
gzebSi. sakmaod saSiSia mkvdar frinvelTan xelTaTmanebis gareSe kontaqtic.
adamianis dainficireba SeiZleba aseve moxdes dabinZurebuli sagnebiT, avtotransportiT,
galiebiT, tansacmliT, Termulad daumuSavebeli sakvebiT. TviTon frinvelebSi daavadeba
virusiT dabinZurebuli haeris SesunTqviT gadaecema.
epidemiologiuri Taviseburebebi. rogorc iTqva, daavadeba pirvelad honkongSi
gamovlinda. SemdgomSi daavadebis gavrcelebas adgili hqonda 2003 wlidan da SemTxvevebi
daregistrirda aziis ramdenime qveyanaSi. infeqcia yvelaze intesiurad swored am kontinentzea
gavrcelebuli. 2005 wels daavadebis gavrcelebis areali mniSvnelovnad gaizarda. frinvelis
gripis SemTxvevebi dafiqsirda ruseTSi, ukrainaSi, yazaxeTSi, TurqeTSi, azerbaijanSi da
sxvagan. varaudoben, rom am qveynebSi daavadeba Setanil iqna gadamfreni frinvelebis mier.
saqarTvelosTvis yvelaze saSiSi iyo infeqciis gavrceleba TurqeTSi, romelic pirveli qveyana
iyo samxreT-aRmosavleTi aziis farglebs gareT, sadac adamianebi frinvelis gripiT daavaddnen.
amasTan aq pirvelad erTdroulad dafiqsirda frinvelebSi daavadebis mravali SemTxveva. erTi
kviris ganmavlobaSi TurqeTSi H5N1 tipis virusiT 15 adamiani dainficirda.
janmos monacemebiT 2003 wlis Tebervlidan 2008 wlis Tebervlamde msoflioSi
laboratoriulad dadasturebuli 361 SemTxveva dafiqsirda. aqedan 227 gardaicvala.
gardacvalebis bolo SemTxveva 2014 wels kanadaSi dafiqsirda. mTlianobaSi adamianebSi
frinvelis gripis 861 SenTxveva gamovlinda da maTgan 455 adamiani gardaicvala. saqarTveloSi,

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kerZod aWaraSi, sofel adliaSi am infeqciiT frinvelis (ixvi) daavadebis erTi SemTxveva iqna
gamovlenili 2006 wels.
klinikuri suraTi da laboratoriuli diagnostika. adamianebSi frinvelis gripis
inkubaciuri periodi 2-4 dRea. damaxasiaTebelia Cveulebrivi gripis simptomebi - cxeleba,
kunTebSi texvis SegrZneba, xvela da sxva. gamoxatulia agreTve yelis tkivili. am niSnebs
SeiZleba daerTos koniunqtiviti da pnevmonia. daavadebis mZime mimdinareobisas ramdenime dReSi
viTardeba sunTqvis ukmarisoba, ris Sedegadac pacienti iRupeba. letaloba 50% da metia.
SedarebisaTvis avRniSnavT, rom atipuri pnevmoniis (SARS) dros, romelmac 2002 wlis
noemberSi iCina Tavi, letalobis maCvenebeli 9.6% iyo.
frinvelTa dacemis maCvenebelma SeiZleba 100%-s miaRwios. daavadebul frinvels
aReniSneba niskartidan lorwos dena, galurjeba, Tvalebi daxuWuli da kudi CamoSvebuli aqvs.
aRiniSneba momwvano Seferilobis Txieri ganavali. Tumca es niSnebi frinvelTa sxva daavadebebis
drosac gvxvdeba.
diagnozis gansazRvra mxolod klinikuri niSnebis saSualebiT praqtikulad SeuZlebelia.
aucileblad unda gaviTvaliswinoT epidemiologiuri monacemebic, kerZod inkubaciur periodSi
kontaqti cocxal an mkvdar Sinaur da/an gareul frinvelTan.
frinvelis gripze saeWvo SemTxvevebisas aucilebelia diagnozis laboratoriuli
dadastureba, risTvisac iyeneben polimerizaciis jaWvur reaqcias virusis genomis gamosavlenad.
diagnozi ismeba agreTve imunofluorescenciis meTodiT H5 antigenze antisxeulebis aRmoCeniT.
aseve wyvilad aRebul SratebSi aRniSnuli antisxeulebis titris oTxjeradi zrdiT.
SesaZlebelia agreTve diagnozis dasma virusis dadebiTi kulturiTac.
daavadebis mkurnalobisaTvis iyeneben antivirusul preparatebs, romelTagan aRsaniSnavia
tamiflu (ozeltamiviri), romelic moqmedebs ra virusis neiraminidazaze, xels uSlis
ujredidan virusis gamoyofas, ris gamoc mcirdeba organizmSi virusis koncentracia da amis
Sedegad daavadebis mimdinareobis simZime. rac Seexeba amantadins da remantadins, romlebic
efeqturia adamianis gripis samkurnalod, frinvelis gripis dros Sedegs ar iZleva.
profilaqtika. upirveles yovlisa saWiroa Sinauri frinvelebis dacva daavadebisagan.
amisaTvis minimumamde unda iqnas dayvanili Sinauri da gareuli frinvelebis kontaqti. zogierT
qveyanaSi (magaliTad ruseTSi) iyeneben Sinauri frinvelebis vaqcinaciasac.
Tu Sinaur frinvelebSi gamovlinda daavadebis SemTxveva, savaldebuloa inficirebuli da
kontaqtSi myofi yvela frinvelis ganadgureba. honkongis magaliTi metyvelebs, rom am
RonisZiebebiT Tavidan avicilebT infeqciis Semdgom gavrcelebas.
adamiani unda ecados, rom sxeulis daucveli nawilebi ar dabinZurdes frinvelis

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sisxliT, lorwoTi da sxva gamonayofiT. saeWvo frinvelebTan kontaqtisas saWiroa niRabis da
rezinis xelTaTmanebis gamoyeneba. nanadirevis damuSavebisas yovlad dauSvebelia Tambaqos
moweva, sakvebis da sasmelis miReba. saeWvo Sinauri frinvelebis ganadgurebaSi monawile pirebi
daculi unda iyvnen dainficirebisagan saTanado tansacmliT (erTiani kombinizoni an
grZelsaxeloebiani qirurgiuli xalaTi, wyalgaumtari winsafari, rezinis xelTaTmanebi, rezinis
Ceqmebi, damcavi saTvale, niRabi). riskis jgufebi unda aicran gripis sawinaaRmdego vaqciniT,
raTa Tavidan iqnas acilebuli adamianis da frinvelis gripiT erTdrouli dainficireba.
mTel qveyanaSi da gansakuTrebiT im regionebSi, sadac frinvelis gripis ganviTarebis
meti albaTobaa, saWiroa mosaxleobis sanitariuli ganaTleba da maTi informireba daavadebis
gavrcelebis gzebis da profilaqtikis Sesaxeb.
daavadebis Tavidan asacileblad unda vicodeT, rom frinvelis xorcis momzadeba saWiroa
aranakleb 70°C-ze. ar aris sasurveli Toxlo kvercxis Wama. jobs kvercxi kargad moixarSos.
qaTmis xorci da kvercxi macivarSi sxva produqtebisagan gancalkevebiT unda inaxebodes.
saeWvo SemTxvevis aRmoCenisas saWiroa adgilobriv veterinarul da sazogadoebrivi
jandacvis samsaxurebTan dakavSireba.

11.8. meningokokuri infeqcia

baqteriologiuri etiologiis, anTroponozuli infeqciuri daavadebaa gadacemis


aerogenuli meqanizmiT.
daavadeba uZvelesi droidanaa cnobili. misi aRwera gvxvdeba rogorc antikuri, ise Sua
saukuneebis eqimTa naSromebSi. damoukidebeli nozologiuri erTeulis saxiT igi aRweril iqna
1805 wels, SveicariaSi epidemiis dros. adre daavadeba epidemiuri cerebrospinuri meningitis
saxeliT iyo cnobili. mis SeswavlaSi didi roli iTamaSa veqselbaumis mier 1887 wels
daavadebis gamomwvevis aRmoCenam. 1965 wels, janmrTelobis dacvis saerTaSoriso organizaciis
me-19 msoflio ansambleaze, daavadebas meningokokuri infeqcia ewoda. saqarTveloSi mis
SeswavlaSi didi wvlili miuZRvis cnobil qarTvel infeqcionists, prof. e. bocvaZes.
etiologia. daavadebis gamomwvevia meningokoki – Neisseria meningitidis, romelic
miekuTvneba Neisseriaceae – s ojaxs da Neisseria-s gvars. am gvarSi Sedis paTogenuri
mikroorganizmebis ori warmomadgeneli: N. meningitidis da N. gonnorrhoeae. morfologiurad
meningokokebi gramuaryofiTi momrgvalo formis diplokokebia, romelTa diametri 0,6-0,8 mkm-ia.
antigenuri struqturis mixedviT ganarCeven 12 serologiur jgufs (A, B, C, D, Y, X, W135
da sxva), magram maTgan wamyvani mniSvneloba aqvs A, B da C serotipebs, romlebic meningokokuri
infeqciis generalizebuli formebis 90%-ze mets iwveven. amasTan daavadebis epidemiur
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gavrcelebas upiratesad A serotipi ganapirobebs da mas `epidemiur~ Stams uwodeben. B da C
serotipebi umetesad daavadebis sporadul SemTxvevebs iwveven. Tumca bolo wlebSi gamoirkva,
rom B serotipis meningokokebic sakmaod xSirad iwveven daavadebis epidemiebs da epidafeTqebebs.
bolo wlebSi rig qveynebSi, Y da W 135 serotipiT gamowveuli SemTxvevebis raodenoba izrdeba.
amJamad saqarTveloSi ZiriTadad B da C serotipebi cirkulirebs.
meningokokebi garemoSi nakleb gamZlea. swrafad iRupebian gamoSrobisas, ultraiisferi
sxivebis zemoqmedebiT, 22°C –ze dabali temperaturisas. maTze aseve damRupvelad moqmedebs
maRali temperatura. 55°C–ze meningokokebi 5 wuTSi iRupebian, 100°C –ze ki momentalurad. 2-3
wuTSi inaqtivirdebian qloraminis 0,01%-iani xsnaris, 1%-iani fenolis da 0,1%-iani wyalbadis
zeJangis xsnarebis zemoqmedebiT.
gamomwvevis agresiis ZiriTad faqtors warmoadgens lipopolisaqariduli kompleqsi
(endotoqsini). igi moqmedebs sisxlZarRvTa endoTeliumze da iwvevs masiur sisxlCaqcevebs.
sxvadasxva faqtoris zemoqmedebiT xSirad warmoiSoba meningokokebis L-formebi, romlebic
daavadebis qvemwvave mimdinareobas ganapirobeben.
infeqciis wyaro. meningokokuri infeqcia anTroponozuli daavadebaa. infeqciis wyaroa
daavadebuli da mtarebeli adamiani. daavadebis ZiriTadi klinikuri formebia nazofaringiti,
meningiti da meningokokcemia. maTgan infeqciis gavrcelebaSi wamyvan rols nazofaringitiT
daavadebulebi TamaSoben, rasac ramdenime faqtori ganapirobebs:
• nazofaringiti meningokokuri infeqciis yvelaze ufro gavrcelebuli klinikuri formaa.
• kataruli sindromi ganapirobebs gamomwvevis masiur gamoyofas da gavrcelebas.
• msubuqi mimdinareobis gamo, avadmyofebi ganagrZoben aqtiur cxovrebas, rac aseve xels
uwyobs infeqciis intensiur gavrcelebas.
meningitiT da meningokokcemiiT daavadebulTa epidemiologiuri mniSvneloba
nazofaringitiT daavadebulebTan SedarebiT bevrad ufro naklebia, Tumca unda aRiniSnos is,
rom isini ufro virulentur Stamebs gamoyofen.
rac Seexeba mtareblebs. meningokokuri infeqciis dros ZiriTadad gvxvdeba janmrTeli
mtarebloba. maTi ricxvi sakmaod cvalebadobs epidemiologiuri situaciidan gamomdinare.
sporaduli avadobis dros mosaxleobis 1-3% meningokokebis mtarebelia, epidemiur keraSi –
20-30%. mtareblobis xangrZlivoba 1-3 kviras Seadgens, saSualod 11 dRes. ufro xangrZlivi
mtarebloba aRiniSneba maSin, rodesac adamians cxvir-xaxaSi qronikuli anTebiTi procesi
aReniSneba. did qalaqebSi generalizebuli formiT daavadebul erT adamianze modis 40-50 aTasi
mtarebeli. aqedan gamomdinare, gasagebia maTi didi roli daavadebis gavrcelebaSi. miTumetes,
rom mtarebelTa 5% aris infeqciis qronikuli mtarebeli. isini 6 Tveze met xans, zogjer ki

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ramdenime wlis manZilzec, gamoyofen meningikokebs.
gadacemis meqanizmi. meningokokuri infeqcia aerogenuli meqanizmiT, kerZod haer-
wveTovani gadacemis gziT vrceldeba. sasunTqi gzebis sxva daavadebebisagan gansxvavebiT,
adamianis dainficireba xdeba mxolod infeqciis wyarosTan daxurul sivrceSi xangrZlivi da
mWidro (0,5 – 1,0m-is farglebSi) kontaqtis SemTxvevaSi. es ganpirobebulia meningokokebis
garemoSi susti gamZleobiT, amitom meningokokuri infeqciis epidemia sakmad nela viTardeba.
epidemiologiuri Taviseburebebi. meningokokuri infeqcia ubikvitaruli gavrcelebiT
xasiaTdeba. gansakuTrebiT maRalia avadobis maCveneblebi im qveynebSi, sadac Sobadobis maRali
done aRiniSneba (magaliTad afrikis qveynebSi). am teritoriebze infeqcias xSirad epidemiuri
gavrcelebis xasiaTi aqvs. umetes qveynebSi avadobis done 0,01-0,02-ia 100 aTas mosaxleze.
epidemiebis dros ki es ricxvi 8-12-s aRwevs. miuxedavad avadobis dabali maCveneblebisa,
daavadeba seriozul samedicino problemas warmoadgens maRali letalobis gamo (10-20%).
saqarTveloSic periodulad adgili aqvs daavadebis afeTqebas. Tu am infeqciisas avadobis
maCvenebeli 100 aTas mosaxleze 2-ze naklebia, maSin iTvleba, rom daavadebas sporaduli
gavrcelebis done aqvs, xolo ufro maRali avadobis maCveneblebisas – epidemiuri.
saqarTveloSi bolo wlebSi avadobis yvelaze maRali done 1997 wels aRiniSna. SemdgomSi
avadobis maCveneblebi TandaTan mcirdeba. 1997-2009 wlebis monacemebiT qveyanaSi avadoba
1,19±0,02-is toli iyo 100 000 mosaxleze. momdevno wlebSi avadobis done daaxloebiT
aRniSnul doneze rCeba.
meningokokur infeqcias axasiaTebs kargad gamoxatuli cikluri perioduloba. 10-12 wlis
intervaliT adgili aqvs avadobis donis mniSvnelovan matebas. es perioduloba gansakuTrebiT
kargad aris gamoxatuli afrikis qveynebSi. xolo civi da zomieri klimatis mqone qveynebSi
perioduloba nakleb TvalsaCinoa, gansakuTrebiT me-20 saukunis meore naxevridan. am
teritoriebze daavadebas axasiaTebs kargad gamoxatuli sezonuroba. SemTxvevebis mateba iwyeba
noember-dekemberSi da maqsimums aRwevs mart-maisSi.
am infeqciiT upiratesad avaddebian bavSvebi. 5 wlamde asakis bavSvebi avadmyofTa TiTqmis
70%-s Seadgenen. epidemiuri afeTqebis dros avadobaSi erTvebian mozrdili asakis pirebic,
gansakuTrebiT skolebis, skola-internatebis, sabavSvo saxlebis TanamSromlebi, aseve saerTo
sacxovrebelSi mcxovrebni da jariskacebi.
meningokokur infeqcias dabali kerobrioba axasiaTebs. SemTxvevaTa TiTqmis 95%
erTSemTxveviani kerebiT aris warmodgenili. es ganpirobebulia daavadebis neli gavrcelebiT.
adamianTa mimRebloba am infeqciisadmi sakmaod maRalia. dainficirebis gamosavali damokidebulia
rogorc gamomwvevis virulentobaze, ise makroorganizmis rezistentobaze.

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daavadebis gadatanis Semdeg muSavdeba myari imuniteti.
klinika da laboratoriuli diagnostika. daavadebis inkubaciuri periodi 1-10 dRes
Seadgens. arCeven meningokokuri infeqciis lokalur da generalizebul formebs. lokalur
formas miekuTvneba nazofaringiti. generalizebul formebs – meningokokcemia, meningiti da
Sereuli (meningiti+meningokokcemia) forma.
nazofaringitis dros inkubaciuri periodi saSualod 2-3 dRea. avadmyofi aRniSnavs
temperaturis momatebas (subfebriluri), Tavis tkivils, katarul movlenebs: mSral xvelas,
yelSi fxaWnas, mSral `surdos~, iSviaTad cxviridan lorwoian-Cirqovan gamonadens. daavadeba 3-
5 dRe grZeldeba da gamojanmrTelebiT mTavrdeba.
generalizebuli formebidan aRsaniSnavia meningokokcemia (meningokokuri sefsisi),
romelsac uxSiresad win uZRvis nazofaringiti. Tumca zogjer daavadeba iwyeba moulodnelad,
sruli janmrTelobis fonze. aRiniSneba Zlieri Semcivneba da maRali temperatura 39-40°C,
Tavis tkivili, Rebineba, uZiloba, umadoba, gaZlierebuli wyurvili. daavadebis dawyebidan 5-10
saaTis ganmavlobaSi viTardeba egzanTema, romelic saSualebas iZleva, rom eqimma dasvas swori
diagnozi. gamonayari kanidan amoweulia, zogan wertilovani peteqiebis, zogan 2-15 sm-is
diametris sisxlCaqcevebis saxiT. mZime meningokokcemiis dros avadmyofs ewyeba sisxldena
sxvadasxva organoebidan. meningokokcemia ufro xSirad meningitTan erTad gvxvdeba.
meningokokur meningitsac xSirad win nazofaringiti uZRvis. daavadeba uecrad iwyeba.
xSirad avadmyofi daavadebis dawyebis saaTsac miuTiTebs. temperatura swrafad aRwevs
39-40°C-s. gamoxatulia Tavis autaneli tkivili da Rebineba. es sami klinikuri niSani e.w.
meningitur triadas qmnis. swrafad viTardeba meningialuri sindromi: kefis kunTebis rigidoba,
kerningis, bruZinskis da sxva simptomebi. mZime formebis dros avadmyofs tvinis SeSupebis gamo
ewyeba motoruli agzneba, bodva, halucinaciebi, zogjer tonuri da klonuri krunCxvebi.
meningitiT daavadebuli swori drouli mkurnalobisas 2 kviraSi gamojanmrTeldeba. mZime
formebis dros letaloba sakmaod maRalia.
meningokokuri nazofaringitis diagnozi ismeba baqteriologiurad-cxvir-xaxidan aRebul
nacxSi meningokokebis aRmoCeniT. generalizebuli formebis dros ikvleven sisxls da zurgis
tvinis siTxes. iyeneben rogorc baqterioskopiul, ise baqteriologiur meTods. uaryofiTi
Sedegi ar gamoricxavs meningokokur etiologias.
laboratoriuli diagnostikisaTvis iyeneben agreTve arapirdapiri hemaglutinaciis da
imunofermentuli analizis meTodebs.
profilaqtika da epidsawinaaRmdego RonisZiebebi. meningokokuri infeqciis
profilaqtikaSi didi yuradReba eqceva sanitariul-epidsawinaaRmdego reJimis dacvas bavSvTa

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skolamdel dawesebulebebSi, skolebSi, saerTo sacxovreblebSi da a.S. daavadebis sezonuri
matebisas rekomendebulia kulturuli da sportuli RonisZiebebis SezRudva, raTa Tavidan
aviciloT mosaxleobis, gansakuTrebiT bavSvebis didi raodenobiT Tavmoyra.
specifikuri profilaqtikisaTvis iyeneben vaqcinas. misi gamoyeneba saqarTveloSi gegmiani
saxiT ar xdeba. Tumca msoflios rig qveynebSi, gansakuTrebiT evropis zogierT qveyanaSi, mas
iyeneben gegmiani saxiT. acrebisTvis ZiriTadad gamoiyeneba poli-(Seicavs A,C,Y,W135 serojgufis
meningokokebis polisaqaridebs) da divaqcinas (Seicavs A da C serojgufebis meningokokebis
polisaqaridebs). amJamad msoflioSi ZiriTadad iyeneben koniugirebul vaqcinebs (specifikur
polisaqaridebs, dakavSirebuls koniugatTan). aseve trivaqcinas (Seicavs A, C da W 135
serotipebs.). koniugirebuli vaqcinebi polisaqaridul vaqcinebTan SedarebiT bevrad ufro
Zlier da myar imunitets iZleva. amJamad damzadebulia vaqcina B serojgufis mimarTac. vaqcinis
gakeTebidan me-5 dRes igi ukve icavs imunizebul pirs daavadebisagan, xolo 2 kviris Semdeg
imuniteti maqsimalur dones aRwevs. vaqcinaciis Catareba rekomendebulia bavSvTa koleqtivebSi,
sadac daavadebis 2 da meti SemTxveva dafiqsirda. imunitetis saSualo xangrZlivoba 5 wels
Seadgens. koniugirebuli vaqcinebis SemTxvevaSi - 10 wels.
meningokokuri infeqciis SemTxvevis gamovlenisas informacia unda ecnobos sjc-s,
romelic atarebs keris epidemiologiur gamokvlevas. generalizebuli formisas aucilebelia
avadmyofis hospitalizacia. baqteriologiurad dadasturebuli nazofaringitis dros
hospitalizacia warmoebs epidemiologiuri CvenebiT. binaze izolacia daiSveba, Tu iq ar
cxovrobs skolamdeli asakis bavSvi, an mozrdili piri, romelic muSaobs bavSvTa skolamdel
dawesebulebaSi.
yvela kontaqtirebuli piri eqvemdebareba 10 dRian samedicino meTvalyureobas.
gansakuTrebuli yuradReba eqceva im pirebs, romlebsac cxvir-xaxaSi qronikuli anTebiTi
procesebi aReniSnebaT. daavadebulTan kontaqtSi myofi ojaxis wevrebi da aseve im bavSvTa
koleqtivis wevrebi, sadac daavadebis SemTxveva gamovlinda eqvemdebarebian antibiotikebiT
profilaqtikas.
keraSi ar tardeba daskvniTi dezinfeqcia. mimarTaven yoveldRiur sveli wesiT dalagebas,
Senobis xSir ganiavebas.

11.9. tuberkulozi

tuberkulozi aris talRiseburi mimdinareobis mqone qronikuli infeqciuri daavadeba,


romlisTvisac damaxasiaTebelia paTologiuri procesi sxvadasxva organoebSi, gansakuTrebiT
filtvebSi, aseve klinikuri simptomebis polimorfizmi, intoqsikacia da organizmis
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alergizacia.
tuberkulozi erT-erTi yvelaze mniSvnelovani infeqciuri daavadebaa. igi Sedis im
daavadebaTa aTeulSi, romlebic msoflioSi yvelaze xSirad iwveven adamianTa sikvdils. 2017
wels msoflioSi am infeqciiT daavadda 10 milioni adamiani da gardaicvala 1.6 milioni (maT
Soris 0.3 milioni aiv-infeqciiT iyo daavadebuli). am wels 230 aTasi bavSvi gardaicvala
tuberkuloziT.
etiologia. adamianis tuberkulozis gamomwvevi miekuTvneba paTogenuri mikobaqteriebis
sxvadasxva saxes, romelTa Soris wamyvani mniSvneloba eniWeba M. tuberculosis (adamianis tipi),
M. bovis (xaris tipi), M. africanus (gardamavali tipi). adamianebSi tuberkulozis ZiriTad
gamomwvevs warmoadgens adamianis tipis mikobaqteria (koxis Cxiri), romelzec modis
registrirebul SemTxvevaTa 92%, xolo xarisa da gardamavali tipis gamomwvevebi adamianebSi
daavadebas iwveven Sesabamisad 3-5% SemTxvevaSi. iSviaTad adamianTa daavadeba SeiZleba
gamowveuli iyos frinvelis tipis mikobaqteriebiT (M.avium).
tuberkulozis mikobaqteriebi warmoadgenen wvril, swor an umniSvnelod moxril
Cxirebs. isini xasiaTdebian didi polimorfizmiT; warmoqmnian sporas da kafsulas. koxis Cxiri
Zalian paTogenuria zRvis goWisaTvis da sustad paTogenuria baWiisaTvis; nela izrdeba
specialur sakveb niadagebze da aqvT mJavagamZle Tviseba.
didi epidemiologiuri mniSvneloba eniWeba koxis Cxirebis mdgradobas garemos
obieqtebze. notio naxvelSi mikrobi 75°C-ze gaxurebas 30 wuTi uZlebs, xolo 100°C-ze 5
wuTi. gamomSral naxvelSi 100°C-ze gaxurebisas iRupeba 15 wuTSi, xolo oTaxis temperaturaze
sicocxlis unarianobas inarCunebs 2-10 Tve. rZeSi koxis Cxiri Zlebs xangrZlivi drois
ganmavlobaSi, xolo karaqSi da yvelSi 8 dRidan 10 Tvemde. gayinul xorcSi – 2 wlamde.
mikrobebze damRupvelad moqmedebs mzis da ultraiisferi sxivebi. dezinfeqcisTvis yvelaze
xSirad gamoiyeneba qloris Semcveli preparatebi, romelTac kargi baqteriociduli moqmedeba
axasiaTebT.
infeqciis wyaro. adamianebSi tuberkulozis ZiriTad wyaros warmoadgens filtvis
formiT daavadebuli adamiani, romelic mikobaqteriebs gamoyofs sasunTqi gzebidan. avadmyof
cxovelebs (msxvilfexa rqosani saqoneli, Rorebi da sxva), frinvelebs, agreTve avadmyof
adamianebs, romlebic gamomwvevs gamoyofen SardiT da ganavliT aqvT meorexarisxovani
epidemiologiuri mniSvneloba.
tuberkulozis Ria formiT daavadebuli adamianis gadamdeblobis periodi ganisazRvreba
mikobaqteriebis garemoSi gamoyofis xangrZlivobiT, rac SeiZleba gagrZeldes Tveebi da wlebi.
mikobaqteriebis gamoyofis intensivoba izrdeba klinikuri gamwvavebis (ufro xSirad

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gazafxulze da Semodgomaze) periodSi. cxovelis gadamdebloba matulobs laqtaciis dros.
tuberkulozis filtvgareSe formiT daavadebul adamianebs (Tirkmlis da Sardis
gamomyofi gzebis, Zval-saxsrebis, periferiuli limfuri kvanZebis da sxva organoebis
tuberkulozi), romlebic gamoyofen mikobaqteriebs, rogorc aRiniSna meorexarisxovani
mniSvneloba aqvT.
gadacemis meqanizmi. didi epidemiologiuri mniSvneloba eniWeba gadacemis aerogenul
meqanizms, romelic realizdeba haer-wveTovani da haer-mtvrovani gzebis saSualebiT.
tuberkuloziT dainficireba SeiZleba avadmyofTan pirdapiri kontaqtis arsebobisas, rodesac
mikobaqteriebi garemoSi gamoiyofa xvelis, daceminebis, laparakis, yvirilis dros. gamomwvevis
gadacema am SemTxvevaSi xdeba haer-wveTovani gziT. dainficireba SesaZlebelia avadmyofTan
pirdapiri kontaqtis gareSec – dabinZurebuli sayofacxovrebi sagnebiT, TeTreuliT,
gamomSrali naxvelis Semcveli mtvris nawilakebiT. cxovelebidan da frinvelebidan infeqciis
gadacemas adgili aqvs ZiriTadad sakvebis saSualebiT. am SemTxvevaSi gadacemis faqtorebia rZe
da rZis produqtebi, xorci, kvercxi. gamomwvevis gadacemis saSiSroeba matulobs avadmyofis
mier piradi higienis wesebis darRvevis, dezinfeqciis Cautareblobis, an misi uxarisxod
Catarebis SemTxvevaSi.
epidemiologiuri Taviseburebebi. tuberkulozi warmoadgens ubikvitarul daavadebas. igi
aris mniSvnelovani socialuri problema. tuberkulozis farTod gavrcelebas xels uwyobs
cxovrebis cudi socialur-ekonomikuri pirobebi, mosaxleobis didi simWidrove, sanitariuli
kulturis dabali done, kvalificiuri samedicino daxmarebis xelmiuwvdomloba. me-19 saukunis
meore naxevarSi da me-20 saukunis dasawyisSi, tuberkulozi dabali Semosavlebis mqone
qveynebSi invalidobisa da sikvdilianobis erT-erTi wamyvani mizezi iyo. gasuli saukunis 70-ian
wlebSi msoflioSi da gansakuTrebiT sabWoTa kavSirSi adgili hqonda tuberkuloziT avadobis
mniSvnelovan Semcirebas, rac 90-iani wlebidan Seicvala tuberkuloziT avadobis matebiT TviT
maRali Semosavlebis mqone qveynebSic ki.
mosaxleobis tuberkuloziT avadobis Sefaseba xdeba 4 ZiriTadi maCvenebliT: 1.
inficirebis maCvenebeli (daavadebulTa procenti gamokvleuli mosaxleobidan), 2. sakuTriv
avadobis maCvenebeli (mocemul wels axladgamovlenili avadmyofebis raodenoba 100 000
mosaxleze); 3. prevalentobis maCvenebeli (wlis dasawyisSi aRricxvaze ayvanili aqtiuri
tuberkuloziT daavadebulebi 100 000 mosaxleze), 4. sikvdilianobis maCvenebeli (mocemul
wels tuberkuloziT gardacvlilTa raodenoba 100 000 mosaxleze).
2018 wels saqarTeloSi yvela formis tuberkulozis 2586 SemTxveva aRiricxa da
maCvenebelma 100 000 mosaxleze 69.4 Seadgina. maTgan SemTxvevebis 78.6% filtvis

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tuberkulozze modioda. zogadad, bolo wlebSi saqarTveloSi SeiniSneba tuberkulozis
gavrcelebis maCveneblebis klebis tendencia.
tuberkulozisadmi mgrZnobeloba sayovelTaoa. daavadebulebs Soris sWarboben 2 wlamde
asakis bavSvebi da xandazmulebi (60 weli da zemoT). daavadebas naklebad axasiaTebs
sezonuroba, magram recidivebs da gamwvavebebs ufro xSirad adgili aqvs adre gazafxulze.
daavadebulTa Soris mamakacebis xvedriTi wili ufro metia qalebTan SedarebiT. zoonozuri
tuberkulozi ZiriTadad gvxvdeba soflis mcxovreblebs Soris da mas xSirad profesiuli
xasiaTi aqvs. arajansaRi da arasrulfasovani kvebis mqone pirebi, diabetiT da filtvebis
qronikuli formiT daavadebulebi, alkoholikebi, narkomanebi ufro advilad avaddebian
tuberkuloziT. postinfeqciuri imuniteti aramdgradi da xanmoklea – xSirad adgili aqvs
super – da reinfeqcias.
klinika da laboratoriuli diagnostika. tuberkulozis inkubaciuri periodi 3-12
kviras Seadgens. tuberkuloziT avadobaSi wamyvani mniSvneloba eniWeba sasunTqi gzebis
tuberkulozs, romelzec modis yvela gamovlenili SemTxvevis 90%. pirveladi tuberkulozuri
kompleqsisas warmoiqmneba bronqo-lobuluri pnevmoniis specifikuri kera, romlis drosac
xdeba tuberkulozis mikobaqteriebis gamoyofa. es procesi gansakuTrebiT intensiuria kavernis
warmoqmnisas, xolo SedarebiT zomieri – bronqoadenitis dros. miliaruli tuberkulozis
dros mikobaqteriebi naxvelSi Cndebian kavernis da fibrinozul-kavernozuli formebis dros.
filtvis cirozis Camoyalibebisas mikobaqteriebis gamoyofis intensivoba TandaTan klebulobs.
mikobaqteriebis gamoyofas adgili aqvs agreTve bronqebis, traqeis, xorxis tuberkulozis da
siliko-tuberkulozis dros.
filtvgareSe tuberkulozis dros mikobaqteriebi gamoiyofa nawlavebis, Sard-sasqeso
organoebis, Tvalis, piris Rrus lorwovanis, sarZeve jirkvlis, kanis dazianebis SemTxvevaSi,
agreTve tuberkulozuri etiologiis civi abscesis ganviTarebisas. Zval-saxsrebis
tuberkulozis dros mikobaqteriebi garemoSi ar gamoiyofa. filtvis tuberkulozis ZiriTadi
klinikuri simptomebia cxeleba, xvela, sisxliani naxveli, qoSini da a.S.
mkurnaloba kompleqsuria, rac gulisxmobs antibiotikebiT mkurnalobas, qimioTerapias,
paTogenezur da simptomur Terapias, qirurgiul Carevas, sanatoriul-kurortul mkurnalobas.
janmos monacemebiT 2000-2017 wlebSi, drouli diagnostikis da mkurnalobis wyalobiT, 54
milioni adamianis sicocxle iqna SenarCunebuli. aRsaniSnavia, rom amJamad saqarTveloSi
xelmisawvdomia axali antituberkulozuri preparatebi - delamanidi da bedaqilini.
laboratoriuli diagnostika efuZneba sxvadasxva masalis (naxvelis, Cirqis, Sardis,
plevris da zurgis tvinis siTxis, bronqebidan da kuWidan amonarecxi wylis da sxva)

314
gamokvlevas. gamoiyeneba cil-nilsenis wesiT SeRebili nacxis pirdapiri baqterioskopia an
luminescenturi mikroskopiis meTodi. baqteriologiuri gamokvlevis mizniT masala iTeseba
levenStein-iensenis niadagze. tuberkulozis mikobaqteriebis zrdas sWirdeba 2-4 kvira. sakveb
niadagze masalis daTesvis paralelurad idgmeba biologiuri sinji zRvis goWebze, romlebsac
ineqciidan 10-12 kviris Semdeg uviTardebaT specifikuri infiltrati, xolo 2-4 Tvis Semdeg
xdeba generalizebuli tuberkulozis Camoyalibeba. mikobaqteriebis gamoyofis SemTxvevaSi
dgindeba misi tipi da antibiotikebisadmi mgrZnobeloba. arsebiTi mniSvneloba eniWeba alergiul
sinjis dadgmas tuberkuliniT (mantus sinji), romelic warmoadgens Txier, antigenuri bunebis
preparats, romelic miiReba M. tuberculosis da M. bovis kulturaluri xsnaridan. mantus kanSida
sinjis Casatareblad wina mxris SigniTa zedapiris kanSi SeyavT tuberkulini 0,1 ml-is
raodenobiT. Sedegs afaseben 48-72 saaTis Semdeg. 0-1 mm diametris papula fasdeba uaryofiT
reaqciad, 2-4 mm. – saeWvod, xolo 5 mm-ze meti diametris – dadebiT reaqciad.
profilaqtika da epidsawinaaRmdego RonisZiebebi. profilaqtikuri RonisZiebebi iyofa
zogad da specialur samedicino RonisZiebebad. zogadi RonisZiebebi gulisxmobs sacxovrebeli
da Sromis pirobebis gaumjobesebas, dasaxlebuli adgilebis keTilmowyobas da sxva. specialuri
samedicino RonisZiebebi tardeba samkurnalo-profilaqtikuri da sazogadoebrivi janmrTelobis
dawesebulebebis da specializebuli tubsawinaaRmdego dawesebulebebis mier. Casatarebel
RonisZiebebSi Sedis tuberkulozis sawyisi formiT daavadebul pirTa naadrevi gamovlena da
mkurnaloba. daavadebulebis gamovlinebis mizniT aucilebelia: mosaxleobis uzrunvelyofa
kvalificiuri samedicino daxmarebiT, sxvadasxva specialistebis (ftiziatri, Terapevti,
pediatri da sxva) muSaobis mWidro kavSiri, mosaxleobaSi sanitariul-ganmanaTlebeli muSaobis
Catareba, bavSvebis, mozardebis da mozrdilebis gamokvleva rentgenoskopiis da rentgenografiis
saSualebiT. gamokvlevas pirvel rigSi eqvemdebarebin isini, vinc xSirad avadmyofoben gripiT,
pnevmoniiT, zemo sasunTqi gzebis katariT, bronqitiT, agreTve daudgeneli etiologiis
daavadebis mqone pirebi. bavSvebSi da mozrdilebSi tuberkuloziT daavadebulebis gamovlenis
mizniT gamoiyeneba mantus alergiuli sinji.
muSaobis dawyebis win tuberkulozze gamokvleva sasurvelia CautardeT sazogadoebrivi
kvebis obieqtebis, samkurnalo-profilaqtikuri dawesebulebebis, sanatoriumebis, dasasvenebeli
saxlebis da momsaxurebis sferos muSakebs.
tuberkulozis profilaqtikaSi didi mniSvneloba aqvs sanitariul-epidemiologiuri
reJimis dacvas sawarmoebSi, skolamdel bavSvTa dawesebulebebSi, skolebSi, savaWro qselSi,
sazogadoebrivi kvebis da momsaxurebis sferos obieqtebSi.
tuberkulozis winaaRmdeg brZolaSi ZiriTadia mosaxleobis gegmiani specifikuri

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imunizacia tuberkulozis sawinaaRmdego cocxali (BCG) vaqciniT. profilaqtikuri acrebis
erovnuli kalendris mixedviT amJamad saqarTveloSi tuberkulozis sawinaaRmdego acra
erTjeradia. acra tardeba samSobiaro saxlSi bavSvis dabadebidan pirveli xuTi dRis
ganmavlobaSi. preparati SeyavT marcxena mxris zeda mesamedis kanSi 0,05 ml-is raodenobiT.
tuberkulozis aqtiuri formiT daavadebuli avadmyofebi eqvemdebarebian hospitalizacias
specializebul stacionarSi, mkurnalobis Semdgomi gagrZelebiT specializebul sanatoriumSi.
gatarebuli prevenciuli RonisZiebebis wyalobiT, msoflioSi yovelwliurad daavadebis
SemTxvevebi 1.6-2.0%-iT mcirdeba. am mxriv yvelaze warmatebulia evropis regioni, sadac 2015-
2018 wlebis periodSi avadobis maCvenebeli 15%-iT Semcirda, xolo gardacvlil adamianTa
ricxvi -24%-iT.
sjc-Si Setobineba xdeba forma #58/5-is saSualebiT. avadmyofis hospitalizaciis, an
misi gardacvalebis SemTxvevaSi keraSi tardeba daskvniTi dezinfeqcia, xolo binaze datovebisas
mimdinare dezinfeqcia. aucilebelia TeTreulis da piradi nivTebis dezinfeqcia sadezinfeqcio
kamerebSi.
tuberkuloziT daavadebulTan kontaqtirebul pirebze tardeba samedicino meTvalyureoba
tubsawinaaRmdego dispanseris da epidsamsaxuris mier. kontaqtirebulebs utardebaT vaqcinacia
an qimioprofilaqtika.
naavadmyofar pirebze dispanseruli meTvalyureobas atarebs tubsawinaaRmdego dispanseri.

11.10. koronavirusuli infeqciebi

am daavadebebis gamomwvevia koronavirusebis ojaxSi Semavali virusebi. maTi ricxvi


daaxloebiT 40-mdea. maTgan 7 daavadebas adamianebSi iwvevs. pirvelad virusi 1965 wels iqna
gamoyofili. didi xnis manZilze adamianebSi daavadebis gamomwvevi 4 koronavirusi iyo. isini
iwveven mwvave respiraciul daavadebas da yovelwliurad maTze am jgufis infeqciebis
daaxloebiT 10-12%-ze modis. aRniSnuli 4 virusiT gamowveuli koronavirusuli infeqcia
xasiaTdeba msubuqi mimdinareobiT.
situacia Seicvala maSin, rodesac am virusebis 3 axali tipi iqna gamoyofili da
romlebic sakmaod mZime daavadebas iwveven.

mZime mwvave respiraciuli sindromi (atipuri pnevmonia, SARS)


daavadebis pirveli SemTxveva 2002 wlis noemberSi dafiqsirda samxreT CineTSi.
guangdongis provinciaSi aRweril iqna atipuri pnevmoniis SemTxvevebi, romlebic mZimed
mimdinareobda da xSirad letalobiT mTavrdeboda. daavadebis gamomwvevi iyo axali
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koronavirusi SARS-CoV (Severe acute respiratory syndrome coronavirus). CineTis xelisufleba
informacias am axali daavadebis Sesaxeb blokavda, ris Sedegadac infeqcia 2 TveSi gavrcelda
honkongSi da vietnamSi, xolo 2003 wlis Tebervlidan sxva qveynebSic. aqedan gamomdinare, 2003
wlis 12 marts janmom msoflios acnoba, rom saWiro iyo globaluri sakarantino RonisZiebebi,
raTa SeeCerebinaT infeqciis farTo gavrceleba. 2003 wlis ivnisSi taivanSi dafiqsirda am
daavadebis bolo SemTxveva. mas Semdeg msoflioSi SARS-CoV-iT gamowveuli infeqciis SemTxveva
ar yofila gamovlenili da aRricxuli.
daavadebis gamomwvevia rnm-is Semcveli virusi. fiqroben, rom adamianebSi igi gavrcelda
himalaiSi mcxovrebi civetebidan, Tumca ZiriTadi rezervuari aris Ramura. unda aRiniSnos, rom
CineTSi adamianebi Ramurebs sakvebad iyeneben.
infeqciis wyaroa daavadebuli adamiani, romelic infeqcias avrcelebs daavadebis dawyebis
pirvelive dRidan. ucnobia aris Tu ara adamiani gadamdebi inkubaciur periodSi, iseve rogorc
klinikuri niSnebis alagebis Semdeg. infeqciis gadacemia xdeba aerogenuli meqanizmiT, kerZod
haer-wveTovani da haer-mtvrovani gzebiT. SesaZlebelia ainficireba aseve sayofacxovrebo
sagnebiT, radgan virusi maTze cxovelmyofelobas inarCunebs ramdenime saaTi. infeqcia
mTlianobaSi gavrcelda 29 qveyanaSi, ZiriTadad aziaSi, Tumca igi kanadaSic gamovlinda. sul
daavadebis 8 098 SemTxveva aRiricxa, romelTagan 774 adamiani gardaicvala da letalobis
maCvenebelma daaxloebiT 9.6% Seadgina.
daavadebis inkubaciuri periodi 2-10 dRe, saSualod 7 dRea. ZiriTadi klinikuri
niSnebia: cxeleba (38◦C da meti), Tavis tkivili, mialgia, mSrali xvela, saerTo sisuste. unda
aRiniSnos, rom daavadebas axasiaTebs surdo da cemineba. mZime SemTxvevebSi viTardeba virusuli
pnevmonia, romelic letaluri gamosavalis ZiriTadi mizezia. sainteresoa, rom daavadeba
bavSvebSi upiratesad msubuqad mimdinareobda. umetesad ki avaddebodnen axalgazrda da saSualo
asakis mamakacebi. 50w. da zeda asakis pirebSi ki daavadeba ZiriTadad mZimed mimdinareobda da am
asakobriv jgufSi letaloba 50%-s aRwevda.
daavadebulTa samkurnalod ZiriTadad gamoiyeneboda kortikosteroidebi da
antivirusuli preparati ribavirini.
daavadebis profilaqtika emyareboda a)xelebis higienas; b) socialur distancirebas;
g)samedicino niRbebis gamoyenebas da samedicino dawesebulebebSi infeqciis kontrolis mkacrad
dacvas. 2002-2003 wlebSi daavadebis gavrcelebis SeCereba ZiriTadad sakarantino RonisZiebebiT
moxerxda. am mxriv Tavi gansakuTrebiT vietnamma gamoiCina.

317
axlo aRmosavleTis respiraciuli sindromi
(MERS-Middle East Respiratory Syndrom)

daavadebas iwvevs koronavirusi MERS-CoV, romelic aris rnm-is Semcveli virusi.


daavadebis pirveli SemTxvevebi dafiqsirda 2012 wlis Semodgomaze saudis arabeTSi. 2013 wlis
ivnisamde am daavadebis 50-ze meti SemTxveva gamovlinda, romelTagan TiTqmis naxevari
letaluri gamosavaliT damTavrda.
2015 wlis gazafxulisTvis msoflios 23 qveyanaSi dafiqsirda daavadeba. maT Soris
germaniaSi, italiaSi, safrangeTSi da sxv. 2015 wlis 1 ivnisisTvis gamovlinda 1 154 SemTxveva,
romelTagan 431 letalobiT damTavrda.
sul 2020 wlisTvis msoflioSi am infeqciis 2506 SemTxveva aRiricxa 27 qveyanaSi da
gardaicvala 912 adamiani. SemTxvevebis didi nawili saudis arabeTSi dafiqsirda. am qveynis
Semdeg yvelaze meti SemTxveva 2015 wels samxreT koreaSi ganviTarda, sadac 182 adamiani
dainficirda, romelTagan 33 gardaicvala. unda aRiniSnos, rom letalobis maCvenebeli am
daavadebis dros 27-40%-s Soris meryeobs. igi maRali iyo saudis arabeTSi da SedarebiT
dabali - samxreT koreaSi.
mecnierebi varaudoben, rom infeqciis rezervuaria Ramurebi, romelTagan virusi gadavida
erTkuzian aqlemebSi da maTgan ki adamianebSi. infeqciis wyaroa daavadebuli adamiani, iseve,
rogorc daavadebuli aqlemi. amasTan, infqcias avrcelebs rogorc klinikuri niSnebis mqone
adamiani, ise usimptomo formiT daavadebuli, Tumca es sakiTxi bolomde ar aris Seswavlili.
adamianidan adamianze infeqciis gadacemisTvis saWiroa mWidro kontaqti. amitom infeqcia
ZiriTadad vrceldeba ojaxebSi da samedicino dawesebulebebSi.
adamiani aseve inficirdeba daavadebul aqlemTan kontaqtis Sedegad. dainficireba xdeba
aqlemis xorciT da rZiTac, Tu isini Termulad ar aris kargad damuSavebuli. virusi aris
aseve sisxlSi da SardSi. cxovelidan adamianze infeqciis gadacema xdeba kontaqturi meqanizmiT
da sakvebi produqtebis saSualebiT.
daavadebis inkubaciuri periodia 2-14 dRe. igi iwyeba maRali temperaturiT, Tavis
tkiviliT, TavbrusxveviT, sisustiT, mialgiiT, xvelebiT. sikvdilis mizezia sunTqvis
ukmarisoba.
mimRebloba aris maRali. daavadebis gadatanis Semdeg imuniteti aris xanmokle.
SesaZlebelia ganmeorebiTi daavadebac.
daavadebis mkurnaloba atarebs simptomur xasiaTs. igi gansakuTrebiT mZimed mimdinareobs
xanSiSesul adamianebSi da im pirebSi, romelTac mZime Tanmxlebi daavadebebi aReniSnebaT

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(Saqriani diabeti, gul-sisxlZarRvTa daavadebebi, Tikrmlis ukmarisoba da sxv.).
prevenciuli RonisZiebebi iseTive xasiaTisaa, rogorc mZime, mwvave respiraciuli
sindromis dros. amasTan, saWiroa sifrTxile cxovelebTan da upirveles yovlisa aqlemTan
kontaqtis dros.

axali koronavirusuli infeqcia (COVID-19)

2019 wlis 30 dekembers, Cinelma eqimma li venlianma CatSi gaavrcela informacia, rom
qalaq uxanSi iwyeba SARS-is axali talRa. igi muSaobda am qalaqis centralur saavadmyofoSi
gadaudebeli samedicino daxmarebis ganyofilebaSi, sadac Svidi pacienti iwva pnevmoniis
diagnoziT. es iyo pirveli informacia, romelic msoflioSi gavrcelda axali koronavirusuli
infeqciis Sesaxeb. sami dRis Semdeg, eqimi li policiam daakava „Worebis“ gavrcelebis gamo.
Tumca igi maleve iqna ganTavisuflebuli da daubrunda Tavis Cveul saqmianobas. samwuxarod igi
dainficirda am axali virusiT da 2020 wlis 7 Tebervals gardaicvala 34 wlis asakSi,
datova ra orsuli coli da Svili. 2019 wlis 31 dekembers qalaq uxanis jandacvis komisiam
Setyobineba gaagzavna pekinSi axali infeqciuri daavadebis gavrcelebis Sesaxeb. amrigad pirveli
informacia am axali daavadebis Taobaze msoflioSi 2019 wlis dekembris bolos gavrcelda,
Tumca bevri mkvlevari varaudobs, rom infeqcia CineTSi minimum 1-2 TviT adrec gvxvdeboda.
CineTidan infeqcia swrafad gavrcelda mezobel qveynebSi. magaliTad 2020 wlis 11 ianvars es
daavadeba dafiqsirda iaponiaSi, samxreT koreaSi da tailandSi. ianvar-TebervalSi daavadeba
aTeulobiT qveyanaSi gavrcelda, ris gamoc 11 marts jandacvis msoflio organizaciam axali
koronavirusuli infeqciis pandemia gamoacxada msoflioSi. 2021 wlis 1 ivlisisaTvis
msoflioSi am daavadebis 182 milionze meti SemTxvevaa gamovlenili. 3.95 milionze met
SemTxvevaSi dafiqsirda letaluri gamosavali.
etiologia. axali koronavirusuli infeqciis gamomwvevia SARS-CoV-2, romelic rnm-is
Semcveli virusia. misi rezervuaria Ramurebi. virusma mutaciebis Sedegad gadalaxa saxeobrivi
barieri da dRes rogorc aRvniSneT msoflioSi farTod aris gavrcelebuli. fiqroben, rom
adamianebze es virusi gavrcelda pangolinebis meSveobiT. virusi xasiaTdeba maRali mutagenobiT.
drois mokle monakveTSi gaCnda ramdenime axali Stami. 2020 wlis 20-21 seqtembers inglisSi
gamoyves SARS-CoV-2-is axali Stami, romelsac britanuli Stami ewoda (B.1.1.7). man swrafad
daikava wamyvani adgili aramarto britaneTSi, aramed msoflios mraval qveyanaSi, radgan igi
bevrad ufro swrafad vrceldeba, vidre koronavirusis Tavdapirveli Stami (uxanis Stami).
saqarTveloSi, erT periodSi, swored britanuli Stami gaxda wamyvani etiologiuri faqtori.
2020 wlis dekemberSi samxreT afrikaSi aseve gamoyofili iqna virusis kidev erTi axali
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Stami (B.1.351), romelsac samxreT afrikuli Stami ewoda da romelmac drois mokle
monakveTSi dominanturi adgili daikava samxreT afrikis rig teritoriebze. igi, iseve rogorc
britanuli Stami, bevrad ufro aqtiurad vrceldeba adamianTa populaciaSi, gansakuTrebiT
axalgazrda asakis pirebSi. 2021 wlis 18 maisis monacemebiT, igi msoflios 96 qveyanaSia
gamoyofili.
2021 wlis ianvarSi braziliaSi mecnierebma gamoaqveynes informacia daavadebuli
adamianebidan axali Stamis (P.1.) gamoyofis Taobaze, romelsac braziliuri Stami ewoda. janmos
informaciiT, 2021 wlis 18 maisisaTvis braziliuri Stami msoflios 58 qveyanaSia gamovlenili.
aseve janmos informaciiT, 2020 wlis 5 oqtombers, indoeTis qalaq nagpurSi,
gamoyofili iqna virusis Stami, romelic dReisTvis cnobil Stamebs Soris yvelaze ufro
swrafad vrceldeba da axasiaTebs maRali virulentoba. drois mcire monakveTSi igi
intensiurad gavrcelda bevr qveyanaSi, xolo 2021 wlis gazafxulze indoeTSi yoveldRiurad
am StamiT asiaTasobiT adamiani xdeboda avad. induri Stami (B.1.617.2), gavrcelda aseve
saqarTveloSi. unda aRiniSnos, rom arsebobs induri Stamis meore varianti - B.1.617.1-kappa.
amrigad, 2021 wlis zafxulisaTvis SARS-CoV-2-is Semdegi Stamebia msoflioSi
gavrcelebuli (janmom qveynebis diskreditaciis Tavidan asacileblad, axal Stamebs berZnuli
anbanis asoebis mixedviT mianiWa saxelebi):
• alfa (britanuli);
• beta (samxreT afrikuli);
• gamma (braziliuri);
• delta (induri);
amas garda, samxreT amerikis qveynebSi, aseve cirkulirebs axali, liambda Stami.
virusze kargad moqmedebs spirti, romlis koncentracia ar unda iyos 65% -ze naklebi,
aseve sxva sadezinfeqcio saSualebebi. virusi garemoSi swrafad iRupeba mzis ultraiisferi
sxivebis zemoqmedebiT, Tumca didxans inarCunebs cxovelmyofelobas dabal temperaturaze. amave
dros, garemos zogierT obieqtze, inarCunebs cxovelmyofelobas ramdenime saaTidan sam dRemde.
infeqciis wyaro. infeqciis wyaro aris daavadebuli adamiani. daavadebis gavrcelebaSi
ZiriTad rols msubuqi formiT daavadebuli adamianebi TamaSoben, romelTa xvedriTi wili
daaxloebiT 80%-ia. SemTxvevaTa 15 %-Si infeqcia mZimed mimdinareobs, xolo 5 %-Si daavadeba
iZleva mZime garTulebebs da arc Tu iSviaTia letaluri gamosavalic. mZime formebis roli
infeqciis gavrcelebaSi SedarebiT naklebia.
gadacemis meqanizmi. daava