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°“√»÷°…“æ‘…¢Õß„∫Ω√—ËßToxicity Study of Psidium guajava Linn. Leaves.

‡Õ¡¡π— Õ—µµ«‘™≠å * , ª√“≥’ ™«≈‘µ∏”√ß * , æ—™ √—°…“¡—Ëπ * ·≈– ª√“≥’ ®—π∑‡æÁ™√ **

* °Õß«‘®—¬·≈–æ—≤π“ ¡ÿπ‰æ√

** °Õß欓∏‘«‘∑¬“§≈‘π‘°

°√¡«‘∑¬“»“ µ√å°“√·æ∑¬å

∫∑§—¥¬àÕ

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®—°√µ“¬√âÕ¬≈– 50 (LD50

) æ∫«à“ ¡“°°«à“ 20.0 °./°°. °“√»÷°…“æ‘…‡√◊ÈÕ√—ß„™âÀπŸ¢“« 128 µ—«∑—Èß Õ߇æ»

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·≈– 20.0 °./°°./«—π (‡∑’¬∫‡∑à“°—∫ 1, 10 ·≈– 100 ‡∑à“ ¢Õߢπ“¥∑’Ë„™â√—°…“§π‰¢â∑âÕ߇ ’¬) µ“¡≈”¥—∫

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‡ÕÁπ‰´¡å ALP, SGPT ·≈–´’√—Ë¡ BUN ‡æ‘Ë¡¢÷ÈπÕ¬à“ß¡’π—¬ ”§—≠ (P<0.05) √–¥—∫´’√—Ë¡‚´‡¥’¬¡ ·≈–

Cholesterol ≈¥≈ßÕ¬à“ß¡’π—¬ ”§—≠ (P<0.05) ´÷Ëß∫àß™’È∂÷ߧ«“¡‡ªìπæ‘…µàÕµ—∫ „πÀπŸ‡æ»‡¡’¬æ∫«à“√–¥—∫

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´’√—Ë¡‚°≈∫Ÿ≈‘π≈¥≈ßÕ¬à“ß¡’π—¬ ”§—≠ (P<0.05) „πÀπŸ‡æ»ºŸâ°≈ÿà¡∑¥≈Õß∑ÿ°°≈ÿà¡¡’πÈ”Àπ—°µ—∫·≈–¡â“¡‡æ‘Ë¡

¢÷ÈπÕ¬à“ß¡’π—¬ ”§—≠ (P<0.05) º≈°“√µ√«®Õ«—¬«–¿“¬„π∑“ß®ÿ≈欓∏‘«‘∑¬“¢ÕßÀπŸ‡æ»ºŸâæ∫«à“¡’°“√

‡ª≈’ˬπ·ª≈ß·∫∫‰¢¡—π¢Õßµ—∫·≈–°√«¬‰µ‚ªÉßæÕß æ∫‰¥â∑—Èß„πÀπŸ°≈ÿࡧ«∫§ÿ¡·≈–ÀπŸ°≈ÿà¡∑¥≈Õß „πÀπŸ

‡æ»‡¡’¬°≈ÿà¡∑¥≈Õßæ∫°“√‡ª≈’ˬπ·ª≈ߢÕ߉µ 2 ≈—°…≥–§◊Õ °“√µ°µ–°Õπ¢Õ߇°≈◊Õ·§≈‡´’¬¡„π∑àÕ‰µ

·≈–°√«¬‰µÕ—°‡ ∫‡√◊ÈÕ√—ß ®“°º≈°“√»÷°…“™’È·π–„Àâ‡ÀÁπ«à“§«√„™â„∫Ω√—Ëß„πª√‘¡“≥·≈–‡«≈“∑’Ë°”Àπ¥ ‡æ◊ËÕ

‡ªìπ°“√„™â„∫Ω√—Ë߇ªì𬓠¡ÿπ‰æ√√—°…“‚√§∑âÕ߇ ’¬‰¥âÕ¬à“ߪ≈Õ¥¿—¬

«“√ “√°√¡«‘∑¬“»“ µ√å°“√·æ∑¬å. 2538; 37(4) : 289-305.

178

ABSTRACT

Guava leaf is traditionally used as an antidiarrheal drug. Since toxicological data havenot been reported, acute toxicity study in mice and chronic toxicity study in rats were per-formed. In acute toxicity study, LD

50 of water extract of guava leaves given orally in mice

was more than 20.0 g/kg.For chronic toxicity study, 128 rats of both sexes were divided into four groups. The

control group received distilled water orally and the three treatment groups received theextract of guava leaves at the dose of 0.2, 2.0 and 20.0 g/kg/day (equivalent to 1, 10 and 100times of usual therapeutic dose for the treatment of diarrhea) for 6 months. Body weight gainsof male rats in all guava-treated groups were significantly lower than that of the control groupwhile there was no difference in food consumption among all groups. Behavior and symptomwere normal. There were significant increase (P<0.05) in WBC, ALP, SGPT levels and serumlevel of BUN in male rats whereas serum sodium and cholesterol levels were reduced (P<0.05)indicating signs of hepatotoxicity. In guava-treated female rats, however, serum sodium,potassium and albumin levels were significantly increased (P<0.05) whereas platelets andserum globulin levels were significantly decreased. In male rats, liver weights and spleenweights of the treated groups were increased significantly (P<0.05). Histopathologicaldeterminations showed mild degree of fatty change and hydronephrosis in both control andtreated groups of male rats but nephrocalcinosis and chronic pyelonephritis were observed insome guava-treated female rats.

The results of this toxicity study suggested that for the safe use of guava leaves as anantidiarrheal drug, the recommended dose and duration of treatment should not be exceeded.

Key words : Psidium guajava Linn., Toxicity.

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Ω√—Ëß (Psidium guajava Linn.) À√◊Õ ¡–

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Salmonella typhi, Sal. enteritidis, Shigella

dysenteriae, Shig. flexneri ·≈– Escherichia

coli(3) ·≈–¬—ßæ∫«à“¡’ƒ∑∏‘Ï≈¥°“√∫’∫µ—«¢Õß

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psidiolic acid, guajavolic acid,(7) β -sitosterol,(8) quercetin, guajaverin, leucocyanidine,

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(Platelets) ‚¥¬π—∫®“° counting chamber §à“

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Method(17) ‚¥¬„™â‡§√◊ËÕß Automated Sodium/

Potassium Analyzer √ÿàπ NOVA1 (¢Õß

NOVABIOMEDICAL, USA) ‡Õπ‰´¡å 3 ™π‘¥

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transaminase (SGPT) ‚¥¬«‘∏’¢Õß Henry ·≈–

§≥–(19) , Total cholesterol ‚¥¬«‘∏’ Enzymatic

reaction, BUN ‚¥¬«‘∏’ Diacetylmonoxime,

Creatinine ‚¥¬«‘∏’ Jaffe,s reaction, ‚ª√µ’π√«¡

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√—߉¢à ¡¥≈Ÿ° ·≈–Õ—≥±– ‚¥¬æ‘®“√≥“®“° µ”·Àπàß

√Ÿª√à“ß ¢π“¥ ’ ≈—°…≥–º‘« ≈—°…≥–Àπ⓵—¥·≈–

Õߧåª√–°Õ∫ (Texture) ¢ÕßÕ«—¬«– ™—ËßπÈ”Àπ—°

Õ«—¬«–µà“ßÊ ·≈–‡°Á∫Õ«—¬«–„π 10% Phosphate

buffer formalin 𔉪ºà“π¢∫«π°“√‡µ√’¬¡ ‰≈¥å

‡π◊ÈÕ‡¬◊ËÕ∑“ß®ÿ≈°“¬«‘¿“§»“ µ√å ‡æ◊ËÕµ√«®∑“ß®ÿ≈

欓∏‘«‘∑¬“‚¥¬æ¬“∏‘·æ∑¬åºŸâ‡™’ˬ«™“≠

°“√«‘‡§√“–Àå¢âÕ¡Ÿ≈„™â ∂‘µ‘‡™‘ßæ√√≥π“ °“√

∑¥ Õ∫ ¡¡µ‘∞“π„™â one-way ANOVA ·≈–

‡ª√’¬∫‡∑’¬∫§à“‡©≈’ˬ ‚¥¬«‘∏’ Duncan ,s New Mul-

tiple Range Test ∑’Ë p<0.05

º≈

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°«à“ 20 °./°°.

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º≈µàÕ°“√‡®√‘≠‡µ‘∫‚µ·≈–°“√°‘πÕ“À“√

¢ÕßÀπŸ¢“« (¿“æ∑’Ë 1, 2 ·≈–µ“√“ß∑’Ë 1) ‡¡◊ËÕÀπŸ

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Àπ—°µ—«∑’ˇæ‘Ë¡¢÷Èπ (body weight gain) ¢ÕßÀπŸ

¢“«‡æ»ºŸâ°≈ÿࡉ¥â√—∫¬“ 2.0 ·∫– 20.0 °./°°./«—π

≈¥≈ß·µ°µà“ß®“°°≈ÿࡧ«∫§ÿ¡Õ¬à“ß¡’π—¬ ”§—≠

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Body weight gain (g) Food consumption (g/rat/day)

Mean + SD %Difference Mean + SD %Difference

0 16 M 464.2 + 73.9 20.6 + 1.00.2 16 M 463.9 + 63.8 -0.1 20.6 + 1.0 0.02.0 16 M 411.0 + 33.6 -11.5* 19.3 + 1.2 -6.320.0 10 M 393.2 + 44.9 -16.3* 18.5 + 1.8 -10.20 15 F 181.5 + 36.8 13.4 + 1.3

0.2 14 F 170.8 + 29.2 -5.9 13.2 + 1.2 -1.52.0 13 F 160.7 + 21.7 -11.5 13.0 + 1.4 -3.020.0 13 F 167.5 + 30.5 -7.8 13.3 + 1.1 -0.7

M = Male, F = Female

* significantly different from control (P<0.05)

µ“√“ß∑’Ë 2 º≈∑“ß‚≈À‘µ«‘∑¬“¢ÕßÀπŸ¢“«∑’ˉ¥â√—∫ “√ °—¥„∫Ω√—Ëßπ“π 6 ‡¥◊Õπ

Dose of

P. guajava n/sex

(g/kg/day)

0 16 M 49.2 + 1.8 33.9 + 5.1 21.4 + 2.60.2 16 M 48.6 + 2.2 37.9 + 8.4 22.1 + 3.52.0 16 M 48.7 + 1.8 36.8 + 4.8 22.3 + 2.020.0 10 M 49.1 + 1.4 43.0 + 9.4* 22.3 + 3.20 15 F 44.7 + 2.4 28.5 + 6.9 25.2 + 2.9

0.2 14 F 45.1 + 1.3 31.4 + 7.5 22.1 + 3.1*2.0 13 F 44.6 + 2.1 31.5 + 6.3 19.6 + 2.4*20.0 13 F 45.6 + 1.1 31.9 + 5.6 20.8 + 2.1*

The results are expressed as Mean + SD

* significantly different from control (P<0.05)

Dose of

P. guajava

(g/kg/day)

n/sex

from control from control

Hematocrit White blood cells Platelet

% X 102 cells/mm

3 X 10

4 cells/mm

3

182

µ“√“ß∑’Ë 3 º≈∑“ß™’«‡§¡’¢ÕßÀπŸ¢“«‡æ»ºŸâ∑’ˉ¥â√—∫ “√ °—¥„∫Ω√—Ëßπ“π 6 ‡¥◊Õπ

Dose of P. guajava (g/kg/day)

Parameters 0 0.2 2.0 20.0

n=16 n=16 n=16 n=10

Sodium (mmol/l) 151.5 + 1.5 150.3 + 1.3* 150.2 + 1.5* 150.2 + 1.1*Potassium (mmol/l) 5.3 + 0.8 5.6 + 0.6 5.2 + 0.7 5.8 + 0.6ALP (U/l) 38.7 + 11.3 98.6 + 29.6* 97.2 + 18.6* 96.7 + 29.3*SGOT (U/l) 102.7 + 16.1 102.7 + 21.9 104.7 + 22.4 111.6 + 23.7SGPT (U/l) 16.0 + 6.1 22.2 + 7.0* 22.4 + 8.2* 23.0 + 5.0*Cholesterol (mg%) 98.2 + 30.6 95.7 + 20.2 88.2 + 10.8 73.1 + 16.1*BUN (mg%) 19.2 + 2.8 21.6 + 2.0* 23.9 + 2.0* 21.1 + 2.2*Creatinine (mg%) 1.3 + 0.2 1.1 + 0.2* 1.3 + 0.2 1.2 + 0.1Total Protein (g%) 6.8 + 0.3 6.6 + 0.3* 6.7 + 0.1 6.8 + 0.3Albumin (g%) 3.0 + 0.1 3.0 + 0.1 3.1 + 0.1* 3.0 + 0.1Globulin (g%) 3.8 + 0.3 3.6 + 0.3* 3.5 + 0.1* 3.8 + 0.2

µ“√“ß∑’Ë 4 º≈∑“ß™’«‡§¡’¢ÕßÀπŸ¢“«‡æ»‡¡’¬∑’ˉ¥â√—∫ “√ °—¥„∫Ω√—Ëßπ“π 6 ‡¥◊Õπ

Dose of P. guajava (g/kg/day)

Parameters 0 0.2 2.0 20.0

n=15 n=14 n=13 n=13

Sodium (mmol/l) 149.9 + 1.1 150.5 + 1.1 150.0 + 1.3 151.8 + 1.1*Potassium (mmol/l) 4.3 + 0.5 4.2 + 0.4 4.2 + 0.7 4.8 + 0.2*ALP (U/l) 59.6 + 31.5 76.1 + 30.0 61.8 + 29.5 55.7 + 15.0SGOT (U/l) 102.3 + 26.6 91.8 + 16.3 111.8 + 33.0 101.1 + 31.4SGPT (U/l) 19.3 + 10.2 15.5 + 4.3 25.2 + 6.1* 21.1 + 4.7Cholesterol (mg%) 96.4 + 16.6 102.1 + 21.1 99.5 + 23.5 95.1 + 25.7BUN (mg%) 21.4 + 3.0 22.8 + 1.6 24.4 + 3.8* 22.2 + 2.6Creatinine (mg%) 1.3 + 0.1 1.0 + 0.2* 1.1 + 0.2* 1.4 + 0.2Total Protein (g%) 7.4 + 0.2 7.0 + 0.4* 7.0 + 0.4* 7.2 + 0.7Albumin (g%) 3.3 + 0.2 3.7 + 0.2* 3.7 + 0.3* 3.8 + 0.3*Globulin (g%) 4.1 + 0.2 3.3 + 0.3* 3.2 + 0.3* 3.4 + 0.4*

The results are expressed as Mean + SD

* significantly different from control (P<0.05)

The results are expressed as Mean + SD* significantly different from control (P<0.05)

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πÈ”Àπ—°‰µ∑—Èß Õߢâ“ß ·≈–°√–‡æ“–Õ“À“√„πÀπŸ

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(fatty change) À—«„®æ∫«à“°≈â“¡‡π◊ÈÕÀ—«„®Õ—°‡ ∫

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‡°≈◊Õ·§≈‡ ’¬¡„π∑àÕ‰µ (nephrocalcinosis), °√«¬‰µ

‚ªÉßæÕß (hydronephrosis) ·≈–°√«¬‰µÕ—°‡ ∫

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°≈ÿࡧ«∫§ÿ¡·≈–°≈ÿà¡∑¥≈Õß

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¥Ÿ¥´÷¡·≈–∑”„À⇰‘¥æ‘…µàÕµ—∫‰¥â(24) Õ“°“√æ‘…∑’Ë

‡°‘¥µàÕµ—∫¡’§«“¡ —¡æ—π∏å°—∫πÈ”Àπ—°¢Õßµ—∫∑’ˇæ‘Ë¡¢÷Èπ

„πÀπŸ°≈ÿà¡∑¥≈Õ߇滺Ÿâ∑ÿ°°≈ÿà¡ πÕ°®“°π’È√–¥—∫

Cholesterol „πÀπŸ‡æ»ºŸâ°≈ÿà¡∑¥≈Õß∑’Ë¢π“¥¬“ 20.0

°./°°. ∑’Ë≈¥≈ß®“°°≈ÿࡧ«∫§ÿ¡ Õ“®¡’ “‡Àµÿ®“°

°“√≈¥°“√ √â“ß Cholesterol ∑’˵—∫‡π◊ËÕß®“°

‡´≈≈åµ—∫∂Ÿ°∑”≈“¬(23) ®“°º≈°“√∑¥≈Õߥ—ß°≈à“«

¢â“ßµâπ πà“®–‡ªìπ¢âÕ¡Ÿ≈∫àß™’È«à“°“√∑”ß“π¢Õßµ—∫

ÀπŸ‡æ»ºŸâ°≈ÿà¡∑¥≈Õß¡’·π«‚π⡇ ◊ËÕ¡ ¡√√∂¿“æ≈ß

¡’√“¬ß“π«à“ “√·∑ππ‘π à«π∑’Ë≈–≈“¬πÈ”‰¥â ´÷Ë߇ªìπ

à«πª√–°Õ∫„π„∫¢Õßæ◊™ ¡ÿπ‰æ√™π‘¥Àπ÷ËߢÕß

Õ‘π‚¥π’‡´’¬¡’æ‘…µàÕµ—∫ ‰µ ·≈–°√–‡æ“–Õ—°‡ ∫√à«¡

¥â«¬„π·æ–(25) ‡ªìπ∑’Ëπà“ —߇°µ®“°º≈°“√∑¥≈Õß

„πÀπŸ‡æ»‡¡’¬°≈ÿà¡∑¥≈Õß∑ÿ°°≈ÿà¡ ‰¡àæ∫¢âÕ∫àß™’È

À√◊Õ·π«‚πâ¡«à“µ—∫∑”ß“πº‘¥ª°µ‘ ∑—Èß∑’ˉ¥â√—∫¬“

¢π“¥∑’ˇ∑à“°—π·≈– ¿“æ·«¥≈âÕ¡‡¥’¬«°—π∑ÿ°Õ¬à“ß

ŒÕ√å‚¡π‡æ»Õ“®®–¡’º≈µàÕ°“√ÕÕ°ƒ∑∏‘Ï¢Õß “√

∑”„Àâ “√∫“ß™π‘¥Õ“®· ¥ßæ‘…µàՇ滙“¬·≈–

À≠‘߉¡à‡∑à“°—𠇙àπ alcohol ®–æ∫Õÿ∫—µ‘°“√

· ¥ß§«“¡‡ªìπæ‘…µàÕµ—∫ „π‡æ»™“¬¡“°°«à“‡æ»

À≠‘ß(26) √–¥—∫´’√—Ë¡Õ—≈∫Ÿ¡‘π ∑’ˇæ‘Ë¡¢÷Èπ®“°°≈ÿà¡

§«∫§ÿ¡·≈–√–¥—∫´’√—Ë¡‚°≈∫Ÿ≈‘π∑’Ë≈¥≈ß®“°°≈ÿà¡

§«∫§ÿ¡„πÀπŸ‡æ»‡¡’¬∑ÿ°¢π“¥¬“‡ªìπ°“√‡æ‘Ë¡¢÷Èπ

·≈–≈¥≈ß„πª√‘¡“≥∑’Ë ‡≈Á°πâÕ¬‰¡àπà“®–¡’º≈µàÕ

√–∫∫ √’√–À√◊Õ™’«‡§¡’¢Õß√à“ß°“¬ —µ«å∑¥≈Õß

®“°º≈°“√∑¥≈Õßæ∫«à“πÈ”Àπ—°Õ«—¬«–

—¡æ—∑∏åµà“ßÊ „πÀπŸ‡æ»ºŸâ°≈ÿà¡∑¥≈Õß ‰¥â·°à ¡Õß

µ—∫ ¡â“¡ ‰µ∑—Èß Õߢâ“ß ·≈–°√–‡æ“–Õ“À“√ ¡’πÈ”

Àπ—°‡æ‘Ë¡¢÷Èπ®“°°≈ÿࡧ«∫§ÿ¡ Õ“®®–‡π◊ËÕß¡“®“°

πÈ”Àπ—°µ—«¢ÕßÀπŸ∑’Ë≈¥≈ß∑”„Àâº≈°“√‡ª√’¬∫‡∑’¬∫

πÈ”Àπ—°Õ«—¬«–µàÕπÈ”Àπ—°µ—«ÀπŸ 100 °√—¡ ‡æ‘Ë¡

‡ªìπ —¥ à«π°—π¥â«¬ πÈ”Àπ—°µ—∫·≈–¡â“¡∑’ˇæ‘Ë¡Õ¬à“ß

‡¥àπ™—¥„πÀπŸ‡æ»ºŸâ°≈ÿà¡∑¥≈Õß∑ÿ°°≈ÿà¡πà“®–∫àß™’È

∂÷ß·π«‚πâ¡°“√∑”ß“π¢Õßµ—∫∑’Ë≈¥ª√– ‘∑∏‘¿“æ≈ß

“‡Àµÿ¥—ß°≈à“«¡“·≈â«¢â“ßµâπ

º≈°“√µ√«®∑“ß®ÿ≈欓∏‘«‘∑¬“¢Õß

Õ«—¬«–¿“¬„πæ∫欓∏‘ ¿“æµà“ßÊ ¥—ßµàÕ‰ªπ’È µ—∫

‡°‘¥°“√‡ª≈’ˬπ·ª≈ß·∫∫‰¢¡—π (fatty change) „π

ÀπŸ‡æ»ºŸâ°≈ÿà¡∑¥≈Õß·≈–°≈ÿࡧ«∫§ÿ¡ „π‡æ»‡¡’¬

æ∫°“√‡ª≈’ˬπ·ª≈ßπ’È ”À√—∫°≈ÿࡉ¥â√—∫¬“ 0.2 °./°°.

·≈–°≈ÿࡧ«∫§ÿ¡ ≈—°…≥– fatty change ∑’˵√«®

æ∫§√—Èßπ’Èæ∫‡ªìπ‡æ’¬ßÀ¬àÕ¡‡≈Á° (focal) ‰¡à

°√–®“¬∑—Ë« lobules ¢Õßµ—∫ ®—¥«à“‡ªìπ mild

degree ´÷Ë߉¡à√ÿπ·√ß®π∂÷ߢ—Èπ∑’Ë®–∫àß™’È«à“¬“‡ªìπæ‘…

µàÕµ—∫ ‡π◊ËÕß®“°º≈∑“ß™’«‡§¡’∫àß™’È·π«‚πâ¡°“√

∑” ß “ π ¢ Õ ß µ— ∫ À πŸ ‡ æ » ºŸâ ° ≈ÿà ¡ ∑ ¥ ≈ Õ ß ≈ ¥

ª√– ‘∑∏‘¿“æ≈ß „π¢≥–∑’˺≈°“√µ√«®∑“ß欓∏‘

«‘∑¬“¢Õßµ—∫‰¡àæ∫§«“¡º‘¥ª°µ‘¢Õ߇´≈≈凥àπ™—¥

188

Õ“®‡æ√“–‡´≈≈åµ—∫ “¡“√∂´àÕ¡·´¡À√◊ÕøóôπøŸ„À¡à‰¥â

(regenerate) (27) °≈â“¡‡π◊ÈÕÀ—«„®Õ—°‡ ∫‡ªìπÀ¬àÕ¡

(Focal myocarditis) æ∫„πÀπŸ‡æ»ºŸâ∑—Èß°≈ÿà¡

§«∫§ÿ¡·≈–°≈ÿà¡∑¥≈Õß ·≈–欓∏‘ ¿“æπ’È à«π„À≠à

¡’ “‡Àµÿ®“°°“√µ‘¥‡™◊ÈÕ(28) °“√µ°µ–°Õπ¢Õ߇°≈◊Õ

·§≈‡ ’¬¡„π∑àÕ‰µ (nephrocalcinosis) æ∫„πÀπŸ

‡æ»‡¡’¬°≈ÿà¡∑¥≈Õß∑ÿ°°≈ÿà¡ “‡Àµÿ§◊Õ¡’ª√‘¡“≥

·§≈‡ ’¬¡„π‡≈◊Õ¥ Ÿß Õ“®‡π◊ËÕß¡“®“°¿“«–‰µ«“¬‡√◊ÈÕ√—ß

‚¥¬®–æ∫µ–°Õπ·§≈‡ ’¬¡„π collecting duct ·≈–

Henle,s loop √«¡∑—Èßµ“¡À≈Õ¥‡≈◊Õ¥ΩÕ¬¢Õ߉µ

à«πÕ◊ËπÊ(29) °√«¬‰µ‚ªÉßæÕß (hydronephrosis)

∑’Ëæ∫„πÀπŸ‡æ»ºŸâ∑ÿ°°≈ÿࡇªìπ欓∏‘ ¿“æ∑’Ë¡’‚Õ°“

‡°‘¥¢÷Èπ‡Õßµ“¡∏√√¡™“µ‘„πÀπŸ¢“«æ—π∏ÿå«‘ µ“√å µ—Èß·µà

0-61 ‡ªÕ√凴Áπµå(30) “‡Àµÿ∑’Ë·∑â®√‘߬—߉¡à∑√“∫

°√«¬‰µÕ—°‡ ∫‡√◊ÈÕ√—ß (chronic pyelonephritis) æ∫

„πÀπŸ‡æ»‡¡’¬°≈ÿà¡∑¥≈Õß∑ÿ°°≈ÿà¡ ¡—°‡°‘¥‰¥âßà“¬„π

°√≥’∑“߇¥‘πªí “«–∂Ÿ°Õÿ¥°—Èπ(29) º≈°“√µ√«®

∑“ß®ÿ≈欓∏‘«‘∑¬“∑’Ëæ∫§√—Èßπ’È ∫àß™’È«à“ÀπŸ‡æ»‡¡’¬

°≈ÿà¡∑¥≈Õß¡’·π«‚π⡉µ≈¥ª√– ‘∑∏‘¿“æ≈ß ∂÷ß

·¡â«à“º≈∑“ß™’«‡§¡’®–‰¡à™’È™—¥«à“‰µ∑”ß“πº‘¥ª°µ‘

°Áµ“¡ ·µàº≈∑“ß™’«‡§¡’∑’Ë√–¥—∫ Ÿß°«à“ª°µ‘¢Õß

Creatinine ·≈–BUN ®–æ∫„πºŸâªÉ«¬‚√§‰µ

∑ÿ°™π‘¥∑’Ë√âÕ¬≈– 50 ¢ÕßÀπ૬‰µ (nephron) ∂Ÿ°

∑”≈“¬(23)

‡π◊ËÕß®“°º≈°“√∑¥≈Õߥ—ß°≈à“«¡“·≈â«

¢â“ßµâπ· ¥ß„Àâ‡ÀÁπ«à“ “√ °—¥¢Õß„∫Ω√—ËßÕ“®‡ªìπ

Õ—πµ√“¬µàÕºŸâ∫√‘‚¿§‰¥â ‡æ√“–©–π—Èπ„π°“√„™â “√

°—¥„∫Ω√—Ë߇æ◊ËÕ°“√√—°…“‚√§∑âÕ߇ ’¬ §«√„™â„π

ª√‘¡“≥·≈–√–¬–‡«≈“∑’Ë°”Àπ¥ ‰¡à„™â„πª√‘¡“≥∑’Ë

¡“°‡°‘π‰ª·≈–µ‘¥µàÕ°—ππ“π‡°‘π‰ª°Á®–‡ªìπ°“√

„™â„∫Ω√—Ë߇ªì𬓠¡ÿπ‰æ√√—°…“‚√§∑âÕ߇ ’¬‰¥âÕ¬à“ß

ª≈Õ¥¿—¬

√ÿª

®“°°“√»÷°…“æ‘…‡©’¬∫æ≈—π¢Õß “√ °—¥

„∫Ω√—Ëß„πÀπŸ∂’∫®—°√ æ∫«à“‰¡àª√“°ØÕ“°“√æ‘…„¥Ê

„πÀπŸ∂’∫®—°√∑’ˉ¥â√—∫ “√ °—¥„∫Ω√—Ëß∑“ߪ“°¢π“¥

20.0 °./°°. ·≈–®“°°“√»÷°…“æ‘…‡√◊ÈÕ√—ߢÕß “√

°—¥„∫Ω√—Ëß‚¥¬«‘∏’ªÑÕ𬓷°àÀπŸ¢“«„π¢π“¥ 0.2, 2.0

·≈– 20.0 °./°°./«—π À√◊Õ‡∑’¬∫‡∑à“°—∫ 1, 10 À√◊Õ

100 ‡∑à“¢Õߢπ“¥∑’Ë„™â√—°…“§π‰¢â∑âÕ߇ ’¬µ‘¥µàÕ

°—ππ“π 6 ‡¥◊Õπ · ¥ß„Àâ‡ÀÁπ«à“ “√ °—¥„∫Ω√—Ëß¡’

·π«‚πâ¡∑”„ÀâπÈ”Àπ—°µ—«≈¥≈ß„πÀπŸ‡æ»ºŸâ∑’ˉ¥â√—∫¬“

2.0 ·≈– 20.0 °./°°. ·≈– à«πª√–°Õ∫¢Õ߇≈◊Õ¥

‡ª≈’ˬπ·ª≈߉ª®“°°≈ÿࡧ«∫§ÿ¡ §◊Õ¡’®”π«π‡¡Á¥

‡≈◊Õ¥¢“«‡æ‘Ë¡¢÷Èπ„πÀπŸ‡æ»ºŸâ∑’ˉ¥â√—∫¬“ 20.0 °./°°.

·≈–¡’®”π«π‡°≈Á¥‡≈◊Õ¥≈¥≈ß„πÀπŸ‡æ»‡¡’¬∑ÿ°

¢π“¥¬“ §à“¢Õß‚´‡¥’¬¡Õ‘ÕÕπ·≈– cholesterol ≈¥

≈ß ¢≥–∑’Ë§à“‡ÕÁπ‰´¡å ALP, SGPT ·≈– BUN ‡æ‘Ë¡

¢÷Èπ„πÀπŸ‡æ»ºŸâ∑ÿ°¢π“¥¬“ „πÀπŸ‡æ»‡¡’¬æ∫«à“

‚´‡¥’¬¡·≈–‚ª·µ ‡´’¬¡Õ‘ÕÕπ‡æ‘Ë¡¢÷Èπ∑’Ë¢π“¥¬“

20.0 °./°°. ·≈–§à“Õ—≈∫Ÿ¡‘π‡æ‘Ë¡¢÷Èπ„π¢≥–∑’Ë‚°≈∫Ÿ≈‘π

≈¥≈ß∑ÿ°¢π“¥¬“ πÕ°®“°π’Ȭ—ßæ∫«à“πÈ”Àπ—°µ—∫

·≈–¡â“¡∑’ˇæ‘Ë¡¢÷ÈπÕ¬à“߇¥àπ™—¥„πÀπŸ‡æ»ºŸâ∑’ˉ¥â√—∫¬“

·¡â«à“°“√»÷°…“π’ȉ¥â∑”°“√»÷°…“„π —µ«å∑¥≈Õß°Áµ“¡

¢âÕ¡Ÿ≈∑’ˉ¥â™’È·π–„Àâ‡ÀÁπ«à“ “√ °—¥„∫Ω√—Ë߇ªìπ¬“

¡ÿπ‰æ√∑’Ë„™â√—°…“Õ“°“√∑âÕ߇ ’¬‰¥â„π√–¬–‡«≈“ —ÈπÊ

·µà°“√√—∫ª√–∑“π “√ °—¥„∫Ω√—Ë߇ªìπ‡«≈“π“πµàÕ

‡π◊ËÕßÕ“®¡’º≈°√–∑∫µàÕ°“√∑”ß“π¢Õßµ—∫·≈–‰µ

“√ °—¥„∫Ω√—Ëß„™â‡ªìπ¬“√—°…“Õ“°“√∑âÕ߇ ’¬ ´÷Ëß„™â

‡©æ“–™à«ß√–¬–‡«≈“ —ÈπÊ ¥—ßπ—Èπ∂â“„™â¬“π’ȵàÕ‡π◊ËÕß

°—ππ“πÊ §«√¡’°“√µ√«®‡≈◊Õ¥∑“ß‚≈À‘µ«‘∑¬“ ·≈–

™’«‡§¡’ ·≈–µ√«®ªí “«– ‡æ◊ËÕÀ“§«“¡º‘¥ª°µ‘∑’Ë

Õ“®‡°‘¥¢÷Èπ√–À«à“ß°“√„™â¬“

189

°“√»

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ºŸâ«‘®—¬¢Õ¢Õ∫§ÿ≥ 𓬥√ÿ≥ ‡æÁ™√æ≈“¬

ºŸâÕ”π«¬°“√°Õß«‘®—¬·≈–æ—≤π“ ¡ÿπ‰æ√ ∑’Ë„Àâ°“√

π—∫ πÿπ·≈– à߇ √‘¡ß“π«‘®—¬§√—Èßπ’È π“ß®“√’¬å

∫—π ‘∑∏‘Ï ΩÉ“¬æƒ°…»“ µ√å „π°“√®—¥À“·≈–µ√«®

Õ∫ ¡ÿπ‰æ√∑’Ë„™â„π°“√«‘®—¬ π“ß “«∑«’º≈ ‡¥™“

µ‘«ß»å ≥ Õ¬ÿ∏¬“ ΩÉ“¬æƒ°…‡§¡’ „π°“√µ√«® Õ∫

“√ ”§—≠¢Õß ¡ÿπ‰æ√ 𓬠¡π÷° ‡®…Æ“¿—∑√°ÿ≈

¿“§«‘™“欓∏‘«‘∑¬“ §≥–·æ∑¬»“ µ√å«™‘√欓∫“≈

¡À“«‘∑¬“≈—¬»√’π§√‘π∑√«‘‚√≤ ∑’Ë „À⧫“¡

Õπÿ‡§√“–Àåµ√«® Õ∫ ‰≈¥å‡π◊ÈÕ‡¬◊ËÕ —µ«å∑¥≈Õß ·≈–

π“ß “«Õ—≠™≈’ ®Ÿ±–æÿ∑∏‘ ∑’Ë„À⧔·π–π”·≈–

µ√«®·°â‰¢°“√‡¢’¬π√“¬ß“π°“√«‘®—¬§√—Èßπ’È

‡Õ° “√Õâ“ßÕ‘ß

1. ”π—°ß“π§≥–°√√¡°“√ “∏“√≥ ÿ¢¡Ÿ≈∞“π

°√–∑√«ß “∏“√≥ ÿ¢. ¡ÿπ‰æ√„πß“π “∏“√≥ ÿ¢

¡Ÿ≈∞“π ”À√—∫∫ÿ§≈“°√ “∏“√≥ ÿ¢. Àπâ“ 98.

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