Παιδιατρική | Τόμος 65 • Τεύχος 4 • Ιούλιος - Αύγουστος...

ISSN 0377-2551

∞ƒ£ƒO ™À¡∆∞•∏™¶¿ıËÌ· Î·È Ì¿ıËÌ· ·fi Ù· ÎÚÔ‡ÛÌ·Ù· Û˘Ó‰ÚfiÌÔ˘ Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜ ∂. µ·Ï¿ÛÛË-∞‰¿Ì

∞¡∞™∫O¶∏™∂π™Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ Ì˘ÂÏÔ¸ÂÚÏ·ÛÙÈÎÒÓÛ˘Ó‰ÚfiÌˆÓ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· ™. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘-∞Ó‰ÚÔ˘Ï·Î¿ÎË

¡ÂÎÚˆÙÈÎ‹ ÂÓÙÂÚÔÎÔÏ›ÙÈ‰·: ¡ÂfiÙÂÚÂ˜ ·fi„ÂÈ˜ ∫. Ã·Ù˙Ë˚ˆ·ÓÓ›‰Ë˜

Eƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™¶ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰· ÛÙËÓ ·È‰ÈÎ‹ËÏÈÎ›·. ¶·Ú·ÙËÚ‹ÛÂÈ˜ ÂÚÈfi‰Ô˘ 30 ÂÙÒÓ π. ∫·‚·ÏÈÒÙË˜, ∞. ¡¿ÓÔ˘, ™. ¶ÂÙÚ›‰Ô˘

ªËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰·: ·Ú·ÙËÚ‹ÛÂÈ˜ ÛÂ 1070 ·ÛıÂÓÂ›˜ ™. ¶ÂÙÚ›‰Ô˘, ∂. ∑Â˘Á·Ú›‰Ô˘, ∞. ∂˘ı˘Ì›Ô˘, ∞. ¡¿ÓÔ˘, π. ∫·‚·ÏÈÒÙË˜

ÕÙ˘Â˜ ÂÎ‰ËÏÒÛÂÈ˜ ÙË˜ ÏÔÈÌÒ‰Ô˘˜ ÌÔÓÔ˘Ú‹ÓˆÛË˜ ÛÙ· ‚Ú¤ÊË Î·È Ù· ÌÈÎÚ¿ Ó‹È· ∞. ™ÈÒÌÔ˘, ª. ∆˙Ô‡ÊË, ∂. °·Ï·Ó¿ÎË˜, ∂. ∫ÚËÙÈÎÔ‡,∞. ∫ˆÛÙÔ‡Ï·, ∞. ™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘, ∑. ¶··‰ÔÔ‡ÏÔ˘-∫Ô˘ÏÔ˘Ì‹

∂›Â‰· Ï·ÛÌ·ÏÔÁfiÓˆÓ ÛÂ ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ π. §·Ì·‰·Ú›‰Ë˜, ª. £ÂÔ‰ˆÚ¿ÎË, ª. ªˆÚ·˝ÙÔ˘, ¡. ¡ÈÎÔÏ·˝‰Ô˘, π. ™·Ô˘¿ÎÈÙ, Ã. ∫·Ú‹˜, ∂. ªÈ¯ÂÏ·Î¿ÎË

∂›Â‰· ÏÈÈ‰›ˆÓ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ ÛÂ ·È‰È-Îfi ÏËı˘ÛÌfi ÙË˜ ‰˘ÙÈÎ‹˜ £ÂÛÛ·ÏÔÓ›ÎË˜ ∂. ¶··‰ÔÔ‡ÏÔ˘-∞Ï·Ù¿ÎË, ∫. ¶··‰ÔÔ‡ÏÔ˘-§ÂÁÌ¤ÏÔ˘, µ. ∫Ô˘ÏÔ˘Ú›‰·

EDITORIAL Lessons obtained following the outbreak ofcongenital rubella E. Valassi-Adam

REVIEW ARTICLESCharacteristics of myeloproliferativesyndromes (MPS) during childhood S. Polychronopoulou-Androulakaki

Necrotizing enterocolitis: New concepts C. Hatziioannidis

ORIGINAL ARTICLESPneumococcal meningitis in childhood: a 30-year study J. Kavaliotis, A. Nanou, S. Petridou

Meningococcal meningitis: a descriptive study of 1070 cases S. Petridou, E. Zevgaridou, A. Eythymiou, A. Nanou, J. Kavaliotis

Atypical manifestations of infectiousmononucleosis in children and toddlers E. Siomou, M. Tzoufi, E. Galanakis, E. Kritikou, A. Kostoula, A. Siamopoulou-Mavridou, Z. Papadopoulou-Couloumbis

Plasmalogen levels in full-term neonates I. Labadaridis, M. Theodoraki, M. Moraitou, N. Nikolaidou, J. Saouakit, C. Karis, H. Michelakakis

Lipid and lipoprotein levels in childrenresiding in west Thessaloniki area E. Papadopoulou-Alataki, K. Papadopoulou-Legmpelou, V. Koulourida

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∏ Û˘Ó¤¯ÂÈ· ÙˆÓ ÂÚÈÂ¯ÔÌ¤ÓˆÓ ÛÙËÓ ÚÒÙËÂÛˆÙÂÚÈÎ‹ ÛÂÏ›‰·

COVER july-aug02 14-05-03 13:27 ™ÂÏ›‰·1

E¡¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™∂È‰ËÌ›· Û˘Ó‰ÚfiÌÔ˘ Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜(™™∂) ÙÔ ¤ÙÔ˜ 1999 ∞. ∞Ó‰Ú¤Ô˘, µ. ¶ÂÚÈÛÙ¤ÚË, ∞. ª·Ï¿ÛÎ·

∞ÈÌÔÚÚ·ÁÈÎ¤˜ ÎÂÓÒÛÂÈ˜ ·fi ÙËÓ ÚÒÙË ËÌ¤Ú·˙ˆ‹˜ ÛÂ ÓÂÔÁÓfi ÌÂ ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜∂. Ã·Ù˙Ë‰¿ÎË, ∞. ª·ÓÔ˘Ú¿, ∂. ∫ÔÚ·Î¿ÎË, ∂. °·Ï·Ó¿ÎË˜, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘

∞ÏËı‹˜ Û˘ÓÔÛÙÂˆÙÈÎ‹ Ô›ÛıÈ· Ï·ÁÈÔÎÂÊ·Ï›· ÛÂ ‚Ú¤ÊÔ˜ ∞. ∞Ó‰Ú¤Ô˘, °. µ·ÛÈÏÂ›Ô˘, µ. ¶··‚·ÛÈÏÂ›Ô˘, ∞. ∞Ó·ÛÙ·Û›Ô˘, ∞. ™ÙÚ·ÙÔ˘‰¿ÎË˜

¡fiÛÔ˜ Niemann Pick C: ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜ Î·È ·Ó·ÛÎfiËÛË ÙË˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ ¢. π. ∑·ÊÂÈÚ›Ô˘, ¶. ∆ÚÈ·ÓÙ·Ê‡ÏÏÔ˘, ¡. °ÔÌ¿ÎË˜, ∂. µ·ÚÁÈ¿ÌË, Ã. ∆Û¿ÓÙ·ÏË, ∂. ªÈ¯ÂÏ·Î¿ÎË, M. Vanier

∂¶π∫∞πƒ∞ £∂ª∞∆∞∞·ÁÔÚÂ‡ÛÂÈ˜ ÛÙ· ·È‰È¿ Ù· ÔÔ›· ¿Û¯Ô˘Ó·fi ÂÈÏË„›· ∞. ™Î·Ú‰Ô‡ÙÛÔ˘

Bƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞¢È·ÙÚÔÊ‹ Î·Ù¿ ÙËÓ ÂÁÎ˘ÌÔÛ‡ÓË Î·È ‚¿ÚÔ˜ ÓÂÔÁÓÔ‡ ∂. ¶ÂÙÚ›‰Ô˘, Õ. ™Î·ÏÎ›‰Ô˘, ª. ™ÙÔ˚Î›‰Ô˘, ¡. ¢ÂÛ‡ÚË˜, ¢. ∆ÚÈ¯fiÔ˘ÏÔ˜

CASE REPORTS Sizable epidemic of congenital rubellasyndrome in 1999 A. Andreou, V. Peristeri, A. Balaska

Cow’s milk allergy presenting with bloody stools on the first day of life E. Hatzidaki, A. Manoura, E. Korakaki, E. Galanakis, C. Giannakopoulou

A case of true synostotic posteriorplagiocephaly A. Andreou, G. Vasileiou, V. Papavasileiou, A. Anastasiou, A. Stratoudakis

¡iemann-Pick type C disease: a case report and review of the literature D. I. Zafeiriou, P. Triantafyllou, N. Gombakis, E. Vargiami, C. Tsantali, E. Michelakaki, M. Vanier

CURRENT ISSUES Restrictions for children with epilepsy A. Skardoutsou

AWARD-WINNING ARTICLENutrition during pregnancy in relation to birthweight E. Petridou, A. Skalkidou, M. Stoikidou, N. Dessypris, D. Trichopoulos

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™˘ÓÂ¯›˙ÔÓÙ·È Continued



july-aug02TELIKO 14-05-03 13:31 ™ÂÏ›‰·1

∂¶π™∆O§∏ ¶ƒO™ ∆∏ ™À¡∆∞•∏∏. ¢. ¢ÂÏÏ·ÁÚ·ÌÌ¿ÙÈÎ·˜

BÈ‚ÏÈÔ·Úo˘Û›·ÛË

¶∂ƒπ§∏æ∂π™ ∞ƒ£ƒø¡ ∞¶O ∆∏ µπµ§πO°ƒ∞ºπ∞∏ Û˘ÌÏËÚˆÌ·ÙÈÎ‹ ¯ÔÚ‹ÁËÛË ·ÚÁÈÓ›ÓË˜ ÚÔÊ˘Ï¿ÛÛÂÈ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÓÂÎÚˆÙÈÎ‹˜ÂÓÙÂÚÔÎÔÏ›ÙÈ‰·˜ ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ Amin HJ, Zamora SA, McMillan DD, Fick GH, ButznerJD, Parsons HG et al ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈÎ¿: ºˆÙfiÔ˘ÏÔ˜ ™‡ÚÔ˜

∫˘ÎÏÔÊÔÚÔ‡ÛÂ˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ¯˘ÌÔÎÈÓÒÓ ÛÂ·›Ì· ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ ÛÂ ÓÂÔÁÓ¿ Î·È ÂÓ‹ÏÈÎÂ˜ Sullivan SE, Staba SL, Gersting JA, Hutson AD,Theriaque D, Christensen RD et al ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈÎ¿: ºˆÙfiÔ˘ÏÔ˜ ™‡ÚÔ˜

ÃÔÚ‹ÁËÛË ·ÁÁÂÈÔÈÂÛ›ÓË˜ ÛÂ ·È‰È¿ ÌÂ Î·Ù·ÏËÍ›·: ¶ÂÚÈÁÚ·Ê‹ 5 ÂÚÈÙÒÛÂˆÓ Î·È ·Ó·ÛÎfiËÛË ÙË˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ Liedel JL, Meadow W, Nachman J, Koogler T,Kaharna MD∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈÎ¿: Ã·Ù˙‹˜ ∞Ó·ÛÙ¿ÛÈÔ˜

∂ÈÛÚfiÊËÛË: ŒÓ·˜ ·Ú¿ÁÔÓÙ·˜ ÛÂ Ù·¯¤ˆ˜ ÂÈ‰ÂÈÓÔ‡ÌÂÓË ‚ÚÔÁ¯ÈÔÏ›ÙÈ‰· ÛÂ ÚÒËÓ ˘ÁÈ‹ ‚Ú¤ÊË;Hernandez E, Khoshoo V, Thoppil D, Edell D, Ross G∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈÎ¿: ∆ÛÈÏÈÁÈ¿ÓÓË˜ £ÂÔÊ¿ÓË˜

¶ÚÔÛÂ¯‹ ™˘Ó¤‰ÚÈ·

™˘ÓÙÔÌÔÁÚ·Ê›Â˜

LETTER TO THE EDITORH. D. Dellagrammatikas

Book Review

LITERATURE ABSTRACTS Arginine supplementation prevents necrotizing enterocolitis in the premature infant Amin HJ, Zamora SA, McMillan DD, Fick GH,Butzner JD, Parsons HG et al Greek translation: S. Fotopoulos

Circulating concentrations of chemokines incord blood, neonates, and adults Sullivan SE, Staba SL, Gersting JA, Hutson AD,Theriaque D, Christensen RD et al Greek translation: S. Fotopoulos

Use of vasopressin in refractory hypotension inchildren with vasodilatory shock: Five casesand a review of the literature Liedel JL, Meadow W, Nachman J, Koogler T,Kaharna MDGreek translation: Hatzis Anastasios

Aspiration: A factor in rapidly deteriorating bronchiolitis in previously healthy infants? Hernandez E, Khoshoo V, Thoppil D, Edell D, Ross GGreek translation: Tsiligiannis Th.

Scheduled Medical Meetings

Abbreviations

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¢ÈÌËÓÈ·›· ¤Î‰ÔÛËE›ÛËÌÔ ¶ÂÚÈÔ‰ÈÎfi ÙË˜ EÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ EÙ·ÈÚÂ›·˜

EÎ‰fiÙË˜K. °ÚÈ‚¤·˜

I‰ÈÔÎÙ‹ÙË˜©EÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ EÙ·ÈÚÂ›·MÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 92Aı‹Ó·È 115 28TËÏ.: 010-7771 140 / 010-7771 663, Fax: 010-7758 354

EÈÛÙËÌÔÓÈÎ‹ ™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹¶ÚfiÂ‰ÚÔ˜ : ∫. ª·Ï·Î¿¢ÈÂ˘ı˘ÓÙ‹˜ : ∑. ¶··‰ÔÔ‡ÏÔ˘-∫Ô˘ÏÔ˘Ì‹M¤ÏË : ∂. ∞ÁÁÂÏ¿ÎË-°ÂˆÚÁ¿ÎË

: º. Aı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘: ª. ∞ÓıÚ·ÎfiÔ˘ÏÔ˜: °. µ·ÚÏ¿ÌË˜: ¶. ∫·ÊÚ›ÙÛ·: ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜: £. ∆ÛÈÏÈÁÈ¿ÓÓË˜: ∫. ∆ÛÔ˘Ì¿Î·˜: ™. ºˆÙfiÔ˘ÏÔ˜: A. Ã·Ù˙‹˜

ºÈÏÔÏÔÁÈÎ‹ EÈÌ¤ÏÂÈ·∂ÈÌ¤ÏÂÈ· ÂÏÏËÓÈÎÒÓ ÎÂÈÌ¤ÓˆÓI. K·Ú·‚Ú¿ÓÔ˘

∂ÈÌ¤ÏÂÈ· ·ÁÁÏÈÎÒÓ ÎÂÈÌ¤ÓˆÓ∑. ¶··‰ÔÔ‡ÏÔ˘-∫Ô˘ÏÔ˘Ì‹

∞ÏÏËÏÔÁÚ·Ê›·∂ÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›·ªÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 92∞ı‹Ó·È 115 28∆ËÏ: 010-7771 140 / 010-7771 663, Fax: 010-7758 354

Bimonthly PublicationThe Official Journal of the Hellenic Paediatric Society

PublisherK. Griveas

Owner©Hellenic Paediatric SocietyMichalakopoulou 92Athens 115 28Tel.: 010-7771 140 / 010-7771 663, Fax: 010-7758 354

Scientific Editorial BoardPresident : K. MalakaEditor : Z. Papadopoulou-CouloumbisMembers : E. Agelaki-Georgaki

: F. Athanassiadou-Piperopoulou: M. Anthrakopoulos: G. Varlamis: P. Kafritsa: A. Konstadopoulos: Th. Tsiligiannis: K. Tsoumakas: S. Fotopoulos: ∞. Hatzis

Manuscript Editing

Greek EditingI. Karavranou

English EditingZ. Papadopoulou-Couloumbis

Correspondence Hellenic Paediatric Society Michalakopoulou 92Athens 115 28Tel: 010-7771 140 / 010-7771 663, Fax: 010-7758 354

™˘ÓÙÔÓÈÛÙ‹˜ ∂Î‰fiÛÂˆ˜E¶I™THMONIKE™ EK¢O™EI™ E.¶.E.¶. ∆Û·Ï‰¿ÚË 3, 151 22 M·ÚÔ‡ÛÈTËÏ.: 010-61 41 360-5 Fax: 010-61 41 366

EÙ‹ÛÈ· ™˘Ó‰ÚÔÌ‹ 29,35EÈ‰ÈÎÂ˘fiÌÂÓÔÈ, ºÔÈÙËÙ¤˜: 14,67

Publishing CoordinatorSCIENTIFIC PUBLICATIONS LtdP. Tsaldari 3, Marousi 151 22Tel.: 010-61 41 360-5 Fax: 010-61 41 366

Annual SubscriptionAll foreign countries: US $ 30


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πSSN 0377-2551i


A. °ÂÓÈÎ¤˜ ¶ÏËÚÔÊÔÚ›Â˜∆Ô ÂÚÈÔ‰ÈÎfi “¶∞π¢π∞∆ƒπ∫H” Â›Ó·È Ë Â›ÛËÌË ÂÈÛÙË-

ÌÔÓÈÎ‹ ¤Î‰ÔÛË Î·È È‰ÈÔÎÙËÛ›· ÙË˜ EÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈ-Î‹˜ EÙ·ÈÚÂ›·˜. Œ¯ÂÈ ˆ˜ ‚·ÛÈÎÔ‡˜ ÛÙfi¯Ô˘˜ ÙËÓ ·ÔÙ‡-ˆÛË ÙÔ˘ ·È‰È·ÙÚÈÎÔ‡ ¤ÚÁÔ˘ ÛÙËÓ ∂ÏÏ¿‰· Î·È ÙË Û˘ÓÂ-¯‹ È·ÙÚÈÎ‹ ÂÓËÌ¤ÚˆÛË Î·È ÂÈÌfiÚÊˆÛË ÙˆÓ EÏÏ‹ÓˆÓ¶·È‰È¿ÙÚˆÓ. °È· ÙÔ ÛÎÔfi ·˘Ùfi ‰¤¯ÂÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛËÔÈÎÈÏ›· ¿ÚıÚˆÓ Î·È Û˘ÁÎÂÎÚÈÌ¤Ó·: ¿ÚıÚ· Û‡ÓÙ·ÍË˜ (ÌÂ-Ù¿ ·fi ÚfiÛÎÏËÛË ÙË˜ EÈÛÙËÌÔÓÈÎ‹˜ ™˘ÓÙ·ÎÙÈÎ‹˜ EÈ-ÙÚÔ‹˜), ·Ó·ÛÎÔ‹ÛÂÈ˜, Â›Î·ÈÚ· ı¤Ì·Ù·, ÂÍÂÏ›ÍÂÈ˜ ÛÙËÓπ·ÙÚÈÎ‹ ∂ÈÛÙ‹ÌË, ÚˆÙfiÙ˘Â˜ ÂÚÂ˘ÓËÙÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÌÂ·È‰È·ÙÚÈÎfi ‹ È·ÙÚÔÎÔÈÓˆÓÈÎfi ÂÚÈÂ¯fiÌÂÓÔ, ÁÂÓÈÎ¿ ı¤Ì·-Ù· Ô˘ ·ÊÔÚÔ‡Ó ÙÔÓ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi Î·È ÙËÓ ÔÚÁ¿ÓˆÛËÙË˜ È·ÙÚÈÎ‹˜ ÂÎ·›‰Â˘ÛË˜ Î·È ˘ÁÂ›·˜, ‚Ú·‚Â˘Ì¤ÓÂ˜ ÂÚ-Á·Û›Â˜, ÂÈÏÂÁÌ¤ÓÂ˜ Û˘˙ËÙ‹ÛÂÈ˜ ÛÙÚÔÁÁ˘ÏÒÓ ÙÚ·Â˙ÒÓ,ÂÓ‰È·Ê¤ÚÔ˘ÛÂ˜ ÎÏÈÓÈÎ¤˜ Î·È ·ÂÈÎÔÓÈÛÙÈÎ¤˜ ÂÚÈÙÒÛÂÈ˜,‚Ú·¯Â›Â˜ ‰ËÌÔÛÈÂ‡ÛÂÈ˜, ‚È‚ÏÈÔÎÚÈÛ›Â˜, ÂÈÛÙÔÏ¤˜ ÚÔ˜ÙË Û‡ÓÙ·ÍË, ÂÚÈÏ‹„ÂÈ˜ ÙË˜ ÂÏÏËÓÈÎ‹˜ Î·È Í¤ÓË˜ ‚È‚ÏÈÔ-ÁÚ·Ê›·˜, ·Ó·ÎÔÈÓÒÛÂÈ˜ ÚÔÛÂ¯ÒÓ Û˘ÌÔÛ›ˆÓ Î·È Û˘ÓÂ-‰Ú›ˆÓ ÛÂ ı¤Ì·Ù· Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ¶·È‰È·ÙÚÈÎ‹ Î·È ·Ó·ÊÔ-Ú¤˜ Ó¤ˆÓ ÂÎ‰fiÛÂˆÓ, ÂÏÏËÓÈÎÒÓ Î·È Í¤ÓˆÓ, ·È‰È·ÙÚÈÎÔ‡ÂÓ‰È·Ê¤ÚÔÓÙÔ˜.

H EÈÛÙËÌÔÓÈÎ‹ ™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹ ‰È·ÙËÚÂ› ÙÔ‰ÈÎ·›ˆÌ· Ó· ‰ËÌÔÛÈÂ‡ÂÈ ¿ÚıÚ· ÌÂ È‰È·›ÙÂÚÔ ÂÈÛÙËÌÔÓÈ-Îfi ÂÓ‰È·Ê¤ÚÔÓ ¯ˆÚ›˜ Ó· ÙËÚÂ›Ù·È Ë ÛÂÈÚ¿ ˘Ô‚ÔÏ‹˜ Î·ÈÓ· ·ÔÊ·Û›˙ÂÈ ÁÈ· ÙË ‰ËÌÔÛ›Â˘ÛË ÂÚÁ·ÛÈÒÓ Ô˘ ¤¯Ô˘Ó‚Ú·‚Â˘ıÂ› ÛÙ· Ï·›ÛÈ· ÙÔ˘ ÂÙ‹ÛÈÔ˘ ¶·È‰È·ÙÚÈÎÔ‡ ™˘ÓÂ-‰Ú›Ô˘, ÙËÓ ÔÏÈÎ‹ ‹ ÌÂÚÈÎ‹ ‰ËÌÔÛ›Â˘ÛË ÛÙÚÔÁÁ˘ÏÒÓ ÙÚ·-Â˙ÒÓ È‰È·›ÙÂÚÔ˘ ÂÓ‰È·Ê¤ÚÔÓÙÔ˜, Î·È ÙËÓ ÔÏÈÎ‹ ‹ ÌÂÚÈÎ‹‰ËÌÔÛ›Â˘ÛË ÂÈÛÙÔÏÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÂ ‰ËÌÔÛÈÂ˘-Ì¤Ó· ÂÈÛÙËÌÔÓÈÎ¿ ¿ÚıÚ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

µ. ÀÔ‚ÔÏ‹ Î·È ¢ËÌÔÛ›Â˘ÛË ÙˆÓ ∂ÚÁ·ÛÈÒÓOÈ ÂÚÁ·Û›Â˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÚÔ˜ ÎÚ›ÛË ÁÈ· ‰Ë-

ÌÔÛ›Â˘ÛË ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶∞π¢π∞∆ƒπ∫H” ·ÔÛÙ¤ÏÏÔÓÙ·ÈÂÈ˜ ÙÚÈÏÔ‡Ó ÛÙË ‰ÈÂ‡ı˘ÓÛË:

EÈÛÙËÌÔÓÈÎ‹ ™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹EÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ EÙ·ÈÚÂ›·MÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 92115 28 Aı‹Ó·

ŸÏÂ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ÂÈ-ÛÙÔÏ‹, Ë ÔÔ›· ı· Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘Á-ÁÚ·ÊÂ›˜ ÛÙËÓ ÔÔ›· ı· ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈÂ˘ıÂ› ‹ ˘Ô‚ÏËıÂ› ÁÈ· ÎÚ›-ÛË ÛÂ ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi Î·È fiÙÈ ÔÈ Û˘ÁÁÚ·ÊÂ›˜ ÂÁÎÚ›ÓÔ˘Ó ÙË‰ËÌÔÛ›Â˘Û‹ ÙË˜ ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶∞π¢π∞∆ƒπ∫H”. ∂ÈÏ¤ÔÓ,ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂÈ‰ÔÙ‹ÛÂÈ˜ - ¯ÔÚËÁ›Â˜ ‹¿ÏÏÂ˜ ËÁ¤˜ ˘ÔÛÙ‹ÚÈÍË˜. ŸÏÂ˜ ÔÈ ÎÏÈÓÈÎ¤˜ ¤ÚÂ˘ÓÂ˜ Ú¤-ÂÈ Ó· Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ÁÚ·Ù‹ ‰‹ÏˆÛË ÙˆÓ Û˘ÁÁÚ·Ê¤-ˆÓ fiÙÈ ¤ÁÈÓ·Ó ÌÂÙ¿ ·fi ÏËÚÔÊÔÚËÌ¤ÓË Û˘Ó·›ÓÂÛË ÙˆÓÌÂÙÂ¯fiÓÙˆÓ ‹ ÙˆÓ ÓÔÌ›ÌˆÓ ÂÎÚÔÛÒˆÓ ÙÔ˘˜ Û‡ÌÊˆÓ·ÌÂ ÙÈ˜ ‰È·ÎËÚ‡ÍÂÈ˜ ÙÔ˘ EÏÛ›ÓÎÈ Î·È ÙÔ˘ TfiÎÈÔ.

ŸÏÂ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤ÓÂ˜ ÂÚÁ·Û›Â˜ ıÂˆÚÔ‡ÓÙ·È È‰ÈÔ-ÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶∞π¢π∞∆ƒπ∫H” Î·È Ë ÔÏÈÎ‹ ‹ ÌÂ-

ÚÈÎ‹ ·Ó·‰ËÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi¤ÁÁÚ·ÊË Û˘ÁÎ·Ù¿ıÂÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

∏ ¶∞π¢π∞∆ƒπ∫∏ ÚÔÙÂ›ÓÂÈ Ó· ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÔÈ“∫ÔÈÓ¤˜ ¶ÚÔ‰È·ÁÚ·Ê¤˜ ÁÈ· ÃÂÈÚfiÁÚ·Ê· Ô˘ ˘Ô‚¿Ï-ÏÔÓÙ·È ÛÂ µÔ˚·ÙÚÈÎ¿ ¶ÂÚÈÔ‰ÈÎ¿” (UniformRequirements for Manuscripts Submitted to BiomedicalJournals) Ô˘ ‰ËÌÔÛÈÂ‡ÙËÎ·Ó ÛÙÔ JAMA 1997;277:927-934, http://jama.ama-assn.org/info/auinst_req.html.

OÈ ·fi„ÂÈ˜ Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ÙˆÓ Û˘ÁÁÚ·Ê¤-ˆÓ Ô˘ ‰È·Ù˘ÒÓÔÓÙ·È ÛÙÈ˜ ‰ËÌÔÛÈÂ˘Ì¤ÓÂ˜ ÂÚÁ·Û›Â˜‰ÂÓ ·ÓÙÈÎ·ÙÔÙÚ›˙Ô˘Ó ··Ú·›ÙËÙ· ·˘Ù¤˜ ÙÔ˘ ÂÚÈÔ‰È-ÎÔ‡. H Î·Ù·¯ÒÚËÛË ‰È·ÊËÌ›ÛÂˆÓ ÛÙÔ ÂÚÈÔ‰ÈÎfi ‰ÂÓ˘Ô‰ËÏÒÓÂÈ ÔˆÛ‰‹ÔÙÂ ¤ÁÎÚÈÛË ÙˆÓ ÂÚÈÂ¯ÔÌ¤ÓˆÓÙÔ˘˜ ·fi ÙËÓ EÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ EÙ·ÈÚÂ›·, ÙËÓ EÈ-ÛÙËÌÔÓÈÎ‹ ™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹ ‹ ·fi ÙÔÓ EÎ‰fiÙË ÙÔ˘ÂÚÈÔ‰ÈÎÔ‡.

EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔÛ‡ÌÊˆÓ· ÌÂ ÙÈ˜ ˘Ô‰Â›ÍÂÈ˜ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·-ÎÙ˘ÏÔÁÚ·ÊËÌ¤ÓÔ ÎÂ›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÂÙ·È ÛÙËÓEÈÛÙËÌÔÓÈÎ‹ ™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹ Û˘ÓÔ‰Â˘fiÌÂÓÔ ·fi‰ÈÛÎ¤Ù· Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÚÁ·Û›· ÛÂ ÚfiÁÚ·Ì-Ì· Word.doc ‹ MacWrite Î·È ÙÔ˘˜ ›Ó·ÎÂ˜, ·Ó Â›Ó·È ‰˘-Ó·ÙfiÓ, ÛÂ ÚfiÁÚ·ÌÌ· Excel Î·ıÒ˜ Î·È ÂÈÛÙÔÏ‹ fiÔ˘ Ó··Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈÎ¿ ÔÈ ÙÚÔÔÔÈ‹ÛÂÈ˜ ‹ ÔÈ ·ÓÙÈÚÚ‹-ÛÂÈ˜ ÛÙÈ˜ ÚÔÙ¿ÛÂÈ˜ ÙˆÓ ÎÚÈÙÒÓ. H Î·ı˘ÛÙ¤ÚËÛË ÙË˜Â·Ó˘Ô‚ÔÏ‹˜ ÙÔ˘ ÙÚÔÔÔÈËÌ¤ÓÔ˘ ÎÂÈÌ¤ÓÔ˘ ¤Ú·ÓÙˆÓ 30 ËÌÂÚÒÓ Û˘ÓÂ¿ÁÂÙ·È Ó¤· ˘Ô‚ÔÏ‹.

°È· Ó· ÂÈÙÂ˘¯ıÂ› Ë ¤ÁÎ·ÈÚË ‰ËÌÔÛ›Â˘ÛË ÙË˜ ÂÚÁ·-Û›·˜ Â›Ó·È ··Ú·›ÙËÙÔ Ó· ÂÈÛÙÚ¤ÊÂÙ·È ÙÔ ‰ÈÔÚıˆÌ¤ÓÔÙ˘ÔÁÚ·ÊÈÎfi ‰ÔÎ›ÌÈÔ ·fi ÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜ Ì¤Û· ÛÂ‰‡Ô (2) ËÌ¤ÚÂ˜.

T· ¤ÍÔ‰· ÙˆÓ ÊÈÏÌ˜ Î·È ÙˆÓ ·Ó·Ù‡ˆÓ ‚·Ú‡ÓÔ˘ÓÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜ Î·È Ú¤ÂÈ Ó· ÏËÚÒÓÔÓÙ·È ÌÂ ÙËÓ·ÔÛÙÔÏ‹ ÙÔ˘ ÚÒÙÔ˘ ‰ÔÎÈÌ›Ô˘ Î·ÙÂ˘ıÂ›·Ó ÛÙÔÓ Ù˘Ô-ÁÚ¿ÊÔ.

T· ÎÂ›ÌÂÓ· ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ÂÓ Á›ÓÔÓÙ·È ·Ô‰Â-ÎÙ¤˜ ÁÈ· ‰ËÌÔÛ›Â˘ÛË ‰ÂÓ ÂÈÛÙÚ¤ÊÔÓÙ·È. MÔÚÂ› Ó· ÂÈ-ÛÙÚ·ÊÔ‡Ó, ÂÊfiÛÔÓ ˙ËÙËıÂ›, Ù· Û¯‹Ì·Ù· Î·È ÔÈ ÊˆÙÔ-ÁÚ·Ê›Â˜ Ô˘ Ù· Û˘ÓÔ‰Â‡Ô˘Ó.

°. ™‡ÓÙ·ÍË ÙˆÓ ∂ÚÁ·ÛÈÒÓTÔ Û‡ÓÔÏÔ ÙË˜ ÂÚÁ·Û›·˜ (Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ

ÙˆÓ ÈÓ¿ÎˆÓ Î·È ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÈÎfiÓˆÓ) Ú¤ÂÈ Ó· Â›-Ó·È ‰·ÎÙ˘ÏÔÁÚ·ÊËÌ¤ÓÔ ÛÙË ÌÈ· fi„Ë ÏÂ˘ÎÔ‡ ¯·ÚÙÈÔ‡ÌÂÁ¤ıÔ˘˜ A4 (22x28 cm) ÌÂ ‰ÈÏfi ‰È¿ÛÙËÌ· ÌÂÙ·Í‡ÙˆÓ ÁÚ·ÌÌÒÓ Î·È Ê·Ú‰È¿ ÂÚÈıÒÚÈ· (2,5 cm) ÛÙÈ˜ ‰‡ÔÏÂ˘Ú¤˜.

TÔ ÎÂ›ÌÂÓÔ Ú¤ÂÈ Ó· ¤¯ÂÈ ÙËÓ ·ÎfiÏÔ˘ıË ‰È¿Ù·ÍË:ÛÂÏ›‰· Ù›ÙÏÔ˘, ‚Ú·¯‡˜ Ù›ÙÏÔ˜, ÂÚ›ÏË„Ë ÛÙ· ÂÏÏËÓÈÎ¿Î·È Ù· ·ÁÁÏÈÎ¿, ÎÂ›ÌÂÓÔ, Â˘¯·ÚÈÛÙ›Â˜ Î·ıÒ˜ Î·È ·Ó·-ÊÔÚ¿ ÛÂ ÂÈ‰ÔÙ‹ÛÂÈ˜-¯ÔÚËÁ›Â˜ ‹ ¿ÏÏÂ˜ ËÁ¤˜ ˘ÔÛÙ‹-ÚÈÍË˜, ‚È‚ÏÈÔÁÚ·Ê›·, ›Ó·ÎÂ˜, ÂÈÎfiÓÂ˜, Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ,Î·Ù¿ÏÔÁÔ˜ Û˘ÓÙÌ‹ÛÂˆÓ. K¿ıÂ ¤Ó· ·fi Ù· ·Ú·¿ÓˆÛÙÔÈ¯Â›· Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ ÛÂ ¯ˆÚÈÛÙfi Ê‡ÏÏÔ Î·È ÔÈ ÛÂ-Ï›‰Â˜ Ó· ·ÚÈıÌÔ‡ÓÙ·È ‰È·‰Ô¯ÈÎ¿ ·Ú¯›˙ÔÓÙ·˜ ÌÂ ÙË ÛÂÏ›-‰· Ù›ÙÏÔ˘.

O‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ ™˘ÁÁÚ·ÊÂ›˜

v


H ¤ÎÙ·ÛË ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÁÈ· ÙÈ˜ ·Ó·ÛÎÔ‹ÛÂÈ˜ ÛÂ15-25, ÁÈ· ÙÈ˜ ÂÚÂ˘ÓËÙÈÎ¤˜ ÂÚÁ·Û›Â˜ ÛÂ 12-15 ÛÂÏ›‰Â˜,ÁÈ· Ù· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙÈ˜ ÂÓ‰È·Ê¤ÚÔ˘ÛÂ˜ ÂÚÈÙÒÛÂÈ˜ ÛÂ 3-5 ‰·ÎÙ˘ÏÔÁÚ·ÊËÌ¤ÓÂ˜ ÛÂÏ›‰Â˜, ÂÓÒÁÈ· ÙÈ˜ ‚Ú·¯Â›Â˜ ‰ËÌÔÛÈÂ‡ÛÂÈ˜ ÛÂ 1000 Ï¤ÍÂÈ˜ Î·È ÁÈ·ÙÈ˜ ÂÈÛÙÔÏ¤˜ ÛÂ 250-300 Ï¤ÍÂÈ˜.

™ÂÏ›‰· Ù›ÙÏÔ˘¶Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ:- ÙÔÓ Ù›ÙÏÔ (<14 Ï¤ÍÂÈ˜) Î·ıÒ˜ Î·È ÙÔÓ ‚Ú·¯‡ Ù›ÙÏÔ

(<5 Ï¤ÍÂÈ˜) ÙÔ˘ ¿ÚıÚÔ˘. ¢ÂÓ ÂÈÙÚ¤ÔÓÙ·È Û˘ÓÙÌ‹ÛÂÈ˜, - ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁÚ·Ê¤· ÛÙËÓ

ÔÓÔÌ·ÛÙÈÎ‹, - ÙÔ ÂÈÛÙËÌÔÓÈÎfi Î¤ÓÙÚÔ (›‰Ú˘Ì·, ÎÏÈÓÈÎ‹, ÂÚÁ·-

ÛÙ‹ÚÈÔ) ·fi fiÔ˘ ÚÔ¤Ú¯ÂÙ·È Ë ÂÚÁ·Û›·. ™Â ÂÚ›Ùˆ-ÛË ¤ÏÏÂÈ„Ë˜ Û˘ÓÂÚÁ·Û›·˜ ÌÂ Û˘ÁÎÂÎÚÈÌ¤Ó· Î¤ÓÙÚ·,Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È Ë È‰ÈfiÙËÙ· ÙÔ˘/ÙˆÓ Û˘ÁÁÚ·Ê¤-ˆÓ (.¯. È‰ÈÒÙË˜ ·È‰›·ÙÚÔ˜) Î·È Ô ÙfiÔ˜ ‰È·ÌÔÓ‹˜ÙÔ˘/ÙˆÓ,

- ÙËÓ Ï‹ÚË ‰ÈÂ‡ı˘ÓÛË Î·È ÙÔ ÙËÏ¤ÊˆÓÔ ÙÔ˘ Û˘Á-ÁÚ·Ê¤· ÌÂ ÙÔÓ ÔÔ›Ô Á›ÓÂÙ·È Ë ·ÏÏËÏÔÁÚ·Ê›·.

¶ÂÚÈÏ‹„ÂÈ˜H ÂÚ›ÏË„Ë Ú¤ÂÈ Ó· ·Ó·ÎÂÊ·Ï·ÈÒÓÂÈ ÙÔ˘˜ ÛÙfi-

¯Ô˘˜ ÙË˜ ÂÚÁ·Û›·˜, ÙË ÌÂıÔ‰ÔÏÔÁ›·, Ù· Î˘ÚÈfiÙÂÚ··ÔÙÂÏ¤ÛÌ·Ù· Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜. ¢ÂÓÚ¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙÈ˜ 250 Ï¤ÍÂÈ˜.

™ÙËÓ ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈÎ¿ Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÔ-ÓÙ·È ÛÙËÓ ·Ú¯‹ ÙÔ˘ ÎÂÈÌ¤ÓÔ˘ Ô Ù›ÙÏÔ˜ ÙË˜ ÂÚÁ·Û›·˜ Î·ÈÙ· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁÚ·Ê¤ˆÓ ÛÙ· ·ÁÁÏÈÎ¿. TÔ ÂÚÈÂ¯fi-ÌÂÓÔ ÙÔ˘ ·ÁÁÏÈÎÔ‡ ÎÂÈÌ¤ÓÔ˘ ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê¤ÚÂÈ·fi ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÂÏÏËÓÈÎfi.

T· ¿ÚıÚ· Û‡ÓÙ·ÍË˜ Î·È ÔÈ ·ÂÈÎÔÓÈÛÙÈÎ¤˜ ÂÚÈÙÒ-ÛÂÈ˜ ¤¯Ô˘Ó ÌfiÓÔ ·ÁÁÏÈÎ‹ ÂÚ›ÏË„Ë.

K¿Ùˆ ·fi ÙËÓ ÂÏÏËÓÈÎ‹ Î·È ÙËÓ ·ÁÁÏÈÎ‹ ÂÚ›ÏË„ËÛËÌÂÈÒÓÔÓÙ·È ÙÚÂÈ˜ ¤ˆ˜ ¤ÓÙÂ Ï¤ÍÂÈ˜ ÎÏÂÈ‰È¿ Ô˘ ı·¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ· ÙÔ ıÂÌ·ÙÈÎfi Â˘ÚÂÙ‹ÚÈÔ.

KÂ›ÌÂÓÔOÈ ÂÚÂ˘ÓËÙÈÎ¤˜ ÂÚÁ·Û›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ÂÈÛ·Áˆ-

Á‹, ÌÂıfi‰Ô˘˜, ·ÔÙÂÏ¤ÛÌ·Ù· Î·È Û˘˙‹ÙËÛË. H ∂ÈÛ·Áˆ-Á‹ ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· ‰Â‰ÔÌ¤Ó· ÙË˜ ¤ÚÂ˘Ó·˜ÛÙÔ Û˘ÁÎÂÎÚÈÌ¤ÓÔ ı¤Ì· ÌÂ ÙÈ˜ Î˘ÚÈfiÙÂÚÂ˜ ‚È‚ÏÈÔÁÚ·ÊÈ-Î¤˜ ·Ú·ÔÌ¤˜ Î·È ÙÔ ÛÎÔfi ÙË˜ ÂÚÁ·Û›·˜. H ÂÚÈ-ÁÚ·Ê‹ ÙˆÓ ªÂıfi‰ˆÓ Ú¤ÂÈ Ó· Â›Ó·È ·ÎÚÈ‚‹˜ Î·È ·ÚÎÂ-Ù¿ ÏÂÙÔÌÂÚ‹˜ ÒÛÙÂ Ó· ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó··Ú·ÁˆÁ‹ÙÔ˘˜ ·fi ¿ÏÏÔ˘˜ ÂÚÂ˘ÓËÙ¤˜. T· ∞ÔÙÂÏ¤ÛÌ·Ù· Ú¤ÂÈÓ· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÌÂ Û·Ê‹ÓÂÈ· Î·È Ó· Û˘ÓÔ‰Â‡ÔÓÙ·È·fi ÙËÓ ··Ú·›ÙËÙË ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË. H ™˘˙‹ÙËÛËÚ¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚÔÎ‡-ÙÔ˘Ó ·fi ÙËÓ ÂÚÁ·Û›·, ÙË ÛËÌ·Û›· Ô˘ ÌÔÚÂ› Ó·¤¯Ô˘Ó Î·È ÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ ÌÂ ·Ú·ÙËÚ‹ÛÂÈ˜¿ÏÏˆÓ ÂÚÂ˘ÓËÙÒÓ.

OÈ ÂÓ‰È·Ê¤ÚÔ˘ÛÂ˜ ÂÚÈÙÒÛÂÈ˜ ÂÚÈÏ·Ì‚¿ÓÔ˘ÓÛ‡ÓÙÔÌË ÂÈÛ·ÁˆÁ‹, ÂÚÈÁÚ·Ê‹ ÙË˜ ÂÚ›ÙˆÛË˜ Î·È‚Ú·¯Â›· Û˘˙‹ÙËÛË. OÈ ·ÂÈÎÔÓÈÛÙÈÎ¤˜ ÂÚÈÙÒÛÂÈ˜ Â-ÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÚÈÁÚ·Ê‹ ÙË˜ ÂÚ›ÙˆÛË˜ Î·È

‚Ú·¯Â›· Û˘˙‹ÙËÛË ÌÂ ¤ÌÊ·ÛË ÛÙË ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆ-ÛË. T· ˘fiÏÔÈ· ı¤Ì·Ù· ¤¯Ô˘Ó ÂÏÂ‡ıÂÚË ‰ÔÌ‹ Î·Ù¿ÙËÓ ÎÚ›ÛË ÙˆÓ Û˘ÁÁÚ·Ê¤ˆÓ ÙÔ˘˜.

∂˘¯·ÚÈÛÙ›Â˜ ‹ ·Ó·ÁÓˆÚ›ÛÂÈ˜ (·Ó·ÊÔÚ¿ ÛÂ ÂÈ‰ÔÙ‹-ÛÂÈ˜ - ¯ÔÚËÁ›Â˜ ‹ ¿ÏÏÂ˜ ËÁ¤˜ ˘ÔÛÙ‹ÚÈÍË˜) ı· Ú¤ÂÈÓ· ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÎÂÈÌ¤ÓÔ˘ Î·È ÚÈÓ ·fi ÙÈ˜‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ú·ÔÌ¤˜.

TÈÌ¤˜ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓOÈ ÙÈÌ¤˜ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Ú¤ÂÈ Ó·

ÂÎÊÚ¿˙ÔÓÙ·È ÛÙÔ ¢ÈÂıÓ¤˜ ™‡ÛÙËÌ· MÔÓ¿‰ˆÓ (SI Units)Î·È ÛÙÔ MÂÙÚÈÎfi (Conventional-™˘Ì‚·ÙÈÎfi) ™‡ÛÙËÌ· Ì¤-Û· ÛÂ ·Ú¤ÓıÂÛË. ¶›Ó·ÎÂ˜ ÌÂÙ·ÙÚÔ‹˜ ÂÚÈÏ·Ì‚¿ÓÔ-ÓÙ·È ÛÙÔ JAMA 1986;255:2329-2339.

™˘ÓÙÔÌÔÁÚ·Ê›Â˜OÈ Û˘ÓÙÔÌÔÁÚ·Ê›Â˜ Ô˘ ¤¯Ô˘Ó ÂÈ‚ÏËıÂ› ‰ÈÂıÓÒ˜

‰ËÌÔÛÈÂ‡ÔÓÙ·È ÛÂ Î¿ıÂ ÙÂ‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂ-ÙÔÈ Î·È Ì·ÎÚÔÛÎÂÏÂ›˜ fiÚÔÈ Ô˘ Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È Û˘-¯Ó¿ ÛÙÔ ÎÂ›ÌÂÓÔ ÌÔÚÔ‡Ó Ó· ·ÓÙÈÎ·ı›ÛÙ·ÓÙ·È ·fi Û˘-ÓÙÔÌÔÁÚ·Ê›Â˜ Ô˘ ÂÂÍËÁÔ‡ÓÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜ÛÂ ÂÈ‰ÈÎfi Î·Ù¿ÏÔÁÔ Ô ÔÔ›Ô˜ ˘Ô‚¿ÏÏÂÙ·È Ì·˙› ÌÂ ÙËÓÂÚÁ·Û›·. OÈ Û˘ÓÙÔÌÔÁÚ·Ê›Â˜ ·Ó·Ê¤ÚÔÓÙ·È ÛÂ ·Ú¤ÓıÂ-ÛË ÌfiÓÔ ÛÙÈ˜ ÂÚÈÏ‹„ÂÈ˜.

BÈ‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ú·ÔÌ¤˜™ÙÔ ÙÌ‹Ì· ÙË˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ Î·Ù·¯ˆÚÔ‡ÓÙ·È fiÏÂ˜

ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ú·ÔÌ¤˜ ÌÂ ÙË ÛÂÈÚ¿ Ô˘ ·Ó·Ê¤-ÚÔÓÙ·È ÛÙÔ ÎÂ›ÌÂÓÔ. ™ÙÔ ÎÂ›ÌÂÓÔ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·-Ú·ÔÌ¤˜ ·Ó·Ê¤ÚÔÓÙ·È ÌÂ ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ ÛÂ ·-Ú¤ÓıÂÛË. OÈ ‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ú·ÔÌ¤˜ ‰ÂÓ Ú¤ÂÈ Ó·˘ÂÚ‚·›ÓÔ˘Ó ÙÈ˜ 70 ÛÙÈ˜ ·Ó·ÛÎÔ‹ÛÂÈ˜, ÙÈ˜ 30 ÛÙÈ˜ ÂÚÂ˘-ÓËÙÈÎ¤˜ ÂÚÁ·Û›Â˜, ÙÈ˜ 12 ÛÙ· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙÈ˜ ÂÓ-‰È·Ê¤ÚÔ˘ÛÂ˜ ÂÚÈÙÒÛÂÈ˜, ÙÈ˜ 5 ÛÙÈ˜ ‚Ú·¯Â›Â˜ ‰ËÌÔÛÈ-Â‡ÛÂÈ˜.

H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂ-Ù·È Û‡ÌÊˆÓ· ÌÂ ÙÈ˜ ÚÔ‰È·ÁÚ·Ê¤˜ ÙË˜ InternationalCommittee of Medical Journal Editors / UniformRequirements for Manuscripts Submitted to BiomedicalJournals (JAMA 1997;277:927-934), http://jama.ama-assn.org/info/auinst_req.html. OÈ Û˘ÓÙÌ‹ÛÂÈ˜ ÙˆÓ Ù›ÙÏˆÓÙˆÓ ÂÚÈÔ‰ÈÎÒÓ Á›ÓÔÓÙ·È ÌÂ ‚¿ÛË ÙÔ Cumulated IndexMedicus (List of Journals Indexed in Index Medicus,http://www.nlm.nih.gov).

¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ

I. ¶ÂÚÈÔ‰ÈÎ¿AÓ ÔÈ Û˘ÁÁÚ·ÊÂ›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ,

·Ó Â›Ó·È ÂÙ¿ ‹ ÂÚÈÛÛfiÙÂÚÔÈ ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÚÒÙÔÈ¤ÍÈ Î·È ÚÔÛÙ›ıÂÙ·È “et al” ‹ “Î·È Û˘Ó”.

T·ÎÙÈÎ‹ ¤Î‰ÔÛË ÂÚÈÔ‰ÈÎÔ‡:∞ÏÂÍ›Ô˘ ¢, ª¿Ú· Ã, °È·ÓÓ·ÎÔÔ‡ÏÔ˘ Ã. ∂Ì‚fiÏÈ·,

·ÚfiÓ Î·È Ì¤ÏÏÔÓ: Â›‰Ú·ÛË ÛÙËÓ ÂÈ‰ËÌÈÔÏÔÁ›· ÙˆÓÏÔÈÌˆ‰ÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÙËÓ ·È‰È·ÙÚÈÎ‹ Ú¿ÍË. ¶·È-‰È·ÙÚÈÎ‹ 1996;59:272-279.

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ÃˆÚ›˜ Û˘ÁÁÚ·Ê¤·:National Institutes of Health Consensus

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¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘:∫Ô˘Ú›‰Ë˜ Ã, ∫Ô˘Ú›‰Ë˜ °. ¶·¯˘Û·ÚÎ›· Î·È ˘ÂÚÏÈ-

È‰·ÈÌ›· ÛÂ ·È‰È¿ ‚ÔÚÂÈÔ‰˘ÙÈÎ‹˜ ∫‡ÚÔ˘ [¶ÂÚ›ÏË„Ë].36Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1998 5-7 πÔ˘Ó›-Ô˘; ¶¿ÊÔ˜, ∫‡ÚÔ˜;1998. ÛÂÏ. 172.

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¢È‰·ÎÙÔÚÈÎ‹ ‰È·ÙÚÈ‚‹:¡ÙÔ˘ÓÙÔ˘Ï¿ÎË˜ π. ∏ ¯ÂÈÚÔ˘ÚÁÈÎ‹ ıÂÚ·Â›· ÙÔ˘

Û˘ÁÁÂÓÔ‡˜ ÂÍ·ÚıÚ‹Ì·ÙÔ˜ ÙÔ˘ ÈÛ¯›Ô˘ ÛÂ ·È‰È¿ Î¿ÙˆÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ [‰È‰·ÎÙÔÚÈÎ‹ ‰È·ÙÚÈ‚‹]. ∞ı‹Ó·: ¶·ÓÂÈ-ÛÙ‹ÌÈÔ ∞ıËÓÒÓ; 1979.

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¶›Ó·ÎÂ˜ Î·È EÈÎfiÓÂ˜AÔÛÙ¤ÏÏÔÓÙ·È ÂÈ˜ ÙÚÈÏÔ‡Ó (¤Ó· ÚˆÙfiÙ˘Ô+‰‡Ô

ÊˆÙÔ·ÓÙ›ÁÚ·Ê·). ¶Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï¿ÙÔ˜ ›ÛÔ ÌÂ ÙÔ Ï¿-ÙÔ˜ ÙÔ˘ ÌÔÓfiÛÙËÏÔ˘ (8 cm) ‹ ÌÂ ÙÔ Ï¿ÙÔ˜ fiÏË˜ ÙË˜ ÛÂ-Ï›‰·˜ (16,8 cm). TÔ Ì¤ÁÈÛÙÔ Ì‹ÎÔ˜ ÙÔ˘˜, Ì·˙› ÌÂ ÙÔ˘˜ Ù›ÙÏÔ˘˜, ‰ÂÓ Ú¤ÂÈ Ó· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·fi 22 cm.

OÈ ›Ó·ÎÂ˜ ·ÚÈıÌÔ‡ÓÙ·È ÌÂ ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ ÌÂÙË ÛÂÈÚ¿ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ ÎÂ›ÌÂÓÔ. ¶ÂÚÈÏ·Ì‚¿ÓÔ˘Ó‚Ú·¯‡ Ù›ÙÏÔ Î·È ÂÂÍ‹ÁËÛË ÙˆÓ Û˘ÓÙÌ‹ÛÂˆÓ ÛÙÔ Î¿ÙˆÌ¤ÚÔ˜. ™ÙÔ˘˜ ›Ó·ÎÂ˜ Ú¤ÂÈ Ó· ·ÔÊÂ‡ÁÔÓÙ·È ÔÈ Î¿ıÂ-ÙÂ˜ ÁÚ·ÌÌ¤˜.

ŸÏÔ ÙÔ ·ÂÈÎÔÓÈÛÙÈÎfi ˘ÏÈÎfi (Û¯‹Ì·Ù·, ‰È·ÁÚ¿ÌÌ·-Ù·, ÊˆÙÔÁÚ·Ê›Â˜, ÎÏ.) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÂÈÎfiÓÂ˜. £·Ú¤ÂÈ Ó· Â›Ó·È ¿ÚÈÛÙË˜ ÔÈfiÙËÙ·˜ ÌÂ ÌÔÚÊ‹ ÊˆÙÔÁÚ·-ÊÈÒÓ ‹ Î·È ÚˆÙÔÙ‡ˆÓ. ™ÙÔ ›Ûˆ Ì¤ÚÔ˜ ÙˆÓ ÂÈÎfiÓˆÓÚ¤ÂÈ Ó· ÛËÌÂÈÒÓÂÙ·È ÌÂ ÌÔÏ‡‚È Ô ·ÚÈıÌfi˜ ÙË˜ ÂÈÎfiÓ·˜Î·È ÙÔ fiÓÔÌ· ÙÔ˘ ÚÒÙÔ˘ Û˘ÁÁÚ·Ê¤·, Î·ıÒ˜ Î·È ¤Ó· ‚¤-ÏÔ˜ ÙÔ ÔÔ›Ô Ó· ‰Â›¯ÓÂÈ ÙÔ ¿Óˆ Ì¤ÚÔ˜ ÙË˜ ÂÈÎfiÓ·˜. ™ÙÈ˜ÊˆÙÔÁÚ·Ê›Â˜ ·ÛıÂÓÒÓ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·ÁÓˆÚ›˙ÂÙ·È ËÙ·˘ÙfiÙËÙ¿ ÙÔ˘˜. OÈ ·ÛıÂÓÂ›˜ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·ÈÔÓÔÌ·ÛÙÈÎ¿.

¶ÚÈÓ ·ÔÛÙÂ›ÏÂÙÂ ÙËÓ ÂÚÁ·Û›· Û·˜ ‚Â‚·ÈˆıÂ›ÙÂ fiÙÈ Â-ÚÈÏ·Ì‚¿ÓÂÈ:- ÂÈÛÙÔÏ‹ ˘Ô‚ÔÏ‹˜- ‰‹ÏˆÛË ÌË ÚÔÁÂÓ¤ÛÙÂÚË˜ ‰ËÌÔÛ›Â˘ÛË˜ ÙË˜ ÂÚÁ·Û›·˜- 3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈÌ¤ÓÔ˘ ÙË˜ ÂÚÁ·Û›·˜- ÛÂÏ›‰· Ù›ÙÏÔ˘ (¯ˆÚÈÛÙ‹ ÛÂÏ›‰·): ÂÚÈÏ·Ì‚¿ÓÂÈ

- Ù›ÙÏÔ Î·È ‚Ú·¯‡ Ù›ÙÏÔ ÂÚÁ·Û›·˜- fiÓÔÌ· Î·È ÂÒÓ˘ÌÔ Û˘ÁÁÚ·Ê¤ˆÓ (ÔÏÔÁÚ¿Êˆ˜),

ÂÈÛÙËÌÔÓÈÎfi/¿ Î¤ÓÙÚÔ/· fiÔ˘ ¤ÁÈÓÂ Ë ÂÚÁ·Û›· - fiÓÔÌ·, ‰ÈÂ‡ı˘ÓÛË Î·È ÙËÏ¤ÊˆÓÔ Û˘ÁÁÚ·Ê¤· ÁÈ· ·Ï-

ÏËÏÔÁÚ·Ê›·- ÂÚ›ÏË„Ë ÂÏÏËÓÈÎ‹-·ÁÁÏÈÎ‹, Ï¤ÍÂÈ˜ ÎÏÂÈ‰È¿ (‰ÈÏfi

‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·)- Î·Ù¿ÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹

ÛÂÏ›‰·)- ÎÂ›ÌÂÓÔ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·)- Â˘¯·ÚÈÛÙ›Â˜ ‹ ·Ó·ÁÓˆÚ›ÛÂÈ˜ (·Ó·ÊÔÚ¿ ÛÂ ÂÈ‰ÔÙ‹ÛÂÈ˜-

¯ÔÚËÁ›Â˜ ‹ ¿ÏÏÂ˜ ËÁ¤˜ ˘ÔÛÙ‹ÚÈÍË˜)- ‚È‚ÏÈÔÁÚ·Ê›· (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·)- ›Ó·ÎÂ˜ (Ô Î·ı¤Ó·˜ ÛÂ ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂÈ˜ ÙÚÈÏÔ‡Ó- ÂÈÎfiÓÂ˜, ÌÂ ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ Ì¤ÚÔ˜ Ó· ‰Â›¯ÓÂÈ ÚÔ˜ Ù·

Â¿Óˆ, ·ÚÈıÌËÌ¤ÓÂ˜, ÂÈ˜ ÙÚÈÏÔ‡Ó- Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ ÛÂ ¯ˆÚÈÛÙ‹

ÛÂÏ›‰·) ÂÈ˜ ÙÚÈÏÔ‡Ó.

vii


¶·È‰È·ÙÚÈÎ‹ 2002;65:219-221 Paediatriki 2002;65:219-221

219

™ÙË ÛÂÏ›‰· 273 ·˘ÙÔ‡ ÙÔ˘ ÙÂ‡¯Ô˘˜ ‰ËÌÔÛÈÂ‡Â-Ù·È ¿ÚıÚÔ ÌÂ ÙÔÓ ÔÏ‡ ÂÒ‰˘ÓÔ Ù›ÙÏÔ “∂È‰ËÌ›·Û˘Ó‰ÚfiÌÔ˘ Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜ (™™∂) ÙÔ ¤ÙÔ˜1999” ÙˆÓ ∞. ∞Ó‰Ú¤Ô˘, µ. ¶ÂÚÈÛÙ¤ÚË, ∞. ª·Ï¿-ÛÎ·, fiÔ˘ ÂÚÈÁÚ¿ÊÔÓÙ·È ¤ÓÙÂ ÂÚÈÙÒÛÂÈ˜ Ô˘ÓÔÛ‹ÏÂ˘Û·Ó ÔÈ ›‰ÈÔÈ ÔÈ Û˘ÁÁÚ·ÊÂ›˜ Î·È ·Ó·Ê¤ÚÔ-ÓÙ·È ¿ÏÏÂ˜ Ù¤ÛÛÂÚÈ˜ Ô˘ ·Ó·ÎÔÈÓÒıËÎ·Ó ·fi ¿ÏÏËÔÌ¿‰· ÌÂÙ¿ ÙËÓ ›‰È· ÂÈ‰ËÌ›· (1). ∂ÎÊÚ¿˙ÂÙ·È ÔÊfi‚Ô˜ fiÙÈ ·˘Ù¤˜ ÔÈ ÂÚÈÙÒÛÂÈ˜ ·ÔÙÂÏÔ‡Ó ÌfiÓÔÙËÓ ÎÔÚ˘Ê‹ ÙÔ˘ ·Áfi‚Ô˘ÓÔ˘. ∫¿ıÂ ÊÚ¿ÛË ÙË˜ Ô-Ï‡ ÂÌÂÚÈÛÙ·ÙˆÌ¤ÓË˜ Û˘˙‹ÙËÛË˜ ÂÎÊÚ¿˙ÂÈ, ÓÔÌ›-˙ˆ, Ù· Û˘Ó·ÈÛı‹Ì·Ù· fiÏˆÓ ÙˆÓ ·È‰È¿ÙÚˆÓ, Û˘Ó·È-Ûı‹Ì·Ù· ·ÔÁÔ‹ÙÂ˘ÛË˜, Û˘ÏÏÔÁÈÎ‹˜ ÂÓÔ¯‹˜, ÚÔ-‚ÏËÌ·ÙÈÛÌÔ‡ Î·È ·ÓËÛ˘¯›·˜ ÁÈ· ÙÔ Ì¤ÏÏÔÓ.

∆Ô ÈÛÙÔÚÈÎfi ÙÔ ÂÈ‰ËÌÈÔÏÔÁÈÎÔ‡ Ê·ÈÓÔÌ¤ÓÔ˘ÙË˜ Â·ÓÂÌÊ¿ÓÈÛË˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÙË˜ Û˘ÁÁÂ-ÓÔ‡˜ ÂÚ˘ıÚ¿˜ Â›Ó·È ÁÓˆÛÙfi (2-4): ∆Ô “¿ıËÌ·” ÙË˜

∂ÏÏ¿‰·˜ ÂÈÛËÌ¿ÓıËÎÂ ÌÂÙ¿ ÙËÓ ÂÈ‰ËÌ›· ÙÔ˘1993, ·ÔÙ¤ÏÂÛÂ “ÚˆÙÈ¿” ‰ÈÂıÓÒ˜ Î·È ÚÔÎ¿ÏÂÛÂÛÔ‚·ÚÔ‡˜ ÚÔ‚ÏËÌ·ÙÈÛÌÔ‡˜ ÛÙÔ˘˜ ÂÈ‰ËÌÈÔÏfi-ÁÔ˘˜. ªÂÙ¿ ·fi Â›ÎÔÛÈ ¯ÚfiÓÈ· ·Û˘ÓÙfiÓÈÛÙÔ˘, ·ÙÂ-ÏÔ‡˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÙËÓ ÂÚ˘ıÚ¿ ÂÈÙ‡¯·ÌÂ Ó·¤¯Ô˘ÌÂ ÏËı˘ÛÌfi Â›ÓÔÛÔ, ÛÂ ÔÛÔÛÙfi ÌÂÁ·Ï‡ÙÂ-ÚÔ ·fi fi,ÙÈ ÚÈÓ ·fi ÙËÓ Î˘ÎÏÔÊÔÚ›· ÙÔ˘ ÂÌ‚ÔÏ›Ô˘(·fi 12% ÙË ‰ÂÎ·ÂÙ›· ÙÔ˘ ’70 ÛÂ 36% ÙÔ 1990-91)Î·È Ó· ÌÂÙ·ÙÂıÂ› Ë ËÏÈÎ›· ÓfiÛËÛË˜, ÌÂ ·ÔÙ¤ÏÂÛÌ·Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó 25 ÂÚÈÙÒÛÂÈ˜ Û˘Ó‰ÚfiÌÔ˘ Û˘Á-ÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜. ∏ Û˘¯ÓfiÙËÙ· 24,6/100.000 ‹Ù·ÓÚˆÙÔÊ·Ó‹˜. ™˘¯ÓfiÙËÙÂ˜ 11,1 Î·È 5 ·Ó¿ 100.000,fiÙ·Ó ‰È·ÈÛÙÒıËÎ·Ó ÛÙË ªÂÁ¿ÏË µÚÂÙ·Ó›· Î·È ÛÙÈ˜∏¶∞, ÚÔÎ¿ÏÂÛ·Ó ¤ÓÙÔÓÂ˜ ˘ÁÂÈÔÓÔÌÈÎ¤˜ ÎÈÓËÙÔÔÈ-‹ÛÂÈ˜. ∫·È ÛÙËÓ ∂ÏÏ¿‰·, ÙÔ ‰˘Û¿ÚÂÛÙÔ ÂÈ‰ËÌÈÔ-ÏÔÁÈÎfi Ê·ÈÓfiÌÂÓÔ Û˘ÓÙ¿Ú·ÍÂ, ÚÔ‚ÏËÌ¿ÙÈÛÂ Î·È ÎÈ-ÓËÙÔÔ›ËÛÂ ÙÔÓ ·È‰È·ÙÚÈÎfi ÎfiÛÌÔ. ∞fi ÙÔ 1993

¶¿ıËÌ· Î·È Ì¿ıËÌ· ·fi Ù· ÎÚÔ‡ÛÌ·Ù· Û˘Ó‰ÚfiÌÔ˘ Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜ ∂. µ·Ï¿ÛÛË - ∞‰¿Ì

Lessons obtained following the outbreak of congenital rubella E. Valassi - Adam

∞ƒ£ƒO ™À¡∆∞•∏™ EDITORIAL

�¶ÂÚ›ÏË„Ë: ∏ ·Ó·ÛÎfiËÛË ÙˆÓ ÂÓÂÚÁÂÈÒÓ Ô˘·ÎÔÏÔ‡ıËÛ·Ó ÙËÓ ÚˆÙÔÊ·Ó‹ ·‡ÍËÛË ÙË˜ Û˘¯Ófi-ÙËÙ·˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜ ÛÂ25,6/100.000 Î·Ù¿ ÙËÓ ÂÈ‰ËÌ›· ÙÔ˘ 1993, ‰Â›¯ÓÂÈfiÙÈ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ıÂˆÚËıÔ‡Ó Â·ÚÎÂ›˜. ¶ÚÔÙÂ›-ÓÂÙ·È ÛÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜, ·ÍÈÔÔÈÒÓÙ·˜ ÙËÓ Â·Ê‹ÙÔ˘˜ ÌÂ ÙÔ˘˜ ÁÔÓÂ›˜, Ó· ÙÔ˘˜ ÂÓËÌÂÚÒÛÔ˘Ó ÁÈ· Ù···Ú·›ÙËÙ· Ì¤ÙÚ· Ô˘ Ú¤ÂÈ Ó· ÂÊ·ÚÌfiÛÔ˘Ó ÛÂ·ÙÔÌÈÎfi Â›Â‰Ô. ¶ÚÔÙÂ›ÓÂÙ·È, Â›ÛË˜, Ó· ·ÍÈÔÔÈË-ıÂ› Ë ‰˘Û¿ÚÂÛÙË ÂÌÂÈÚ›· ·fi ÙÔÓ ·Û˘ÓÙfiÓÈÛÙÔ Î·ÈÌÂÚÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ Î·Ù¿ÙË˜ ÂÚ˘ıÚ¿˜, ÒÛÙÂ Ó· ÌËÓ Â·Ó·ÏËÊıÂ› ÌÂ ¿ÏÏ··Ó¿ÏÔÁ· ÂÌ‚fiÏÈ·. ∂ÎÊÚ¿˙ÂÙ·È Ë ÂÏ›‰· ÔÈ ·È‰›·-ÙÚÔÈ Ó· ··ÈÙÔ‡Ó ÙË ‰È·ÌfiÚÊˆÛË Î·È ÙËÓ ÎÔÈÓÔÔ›-ËÛË ÙÔ˘ ∂ıÓÈÎÔ‡ ¶ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÂÌ‚ÔÏÈ·ÛÌÒÓ, ÌÂÙÔ ÔÔ›Ô ı· Û˘ÌÌÔÚÊÒÓÔÓÙ·È.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÂÌ‚ÔÏÈ·ÛÌÔ›, ÚfiÏË„Ë, ·ÁˆÁ‹˘ÁÂ›·˜, Û‡Ó‰ÚÔÌÔ Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜.

�Abstract: An unprecedented increase ofcongenital rubella cases amounting to 25.6/100000was observed during the 1993 outbreak in Greece.The preventive measures that were implementedcannot be considered adequate. It is suggestedthat pediatricians should take advantage of theircontacts with parents and inform them personally ofthe necessary precautions needed for theprevention of the disease. It is also stressed that thesad phenomenon of the increase in congenitalrubella cases was due to partial and uncoordinatedimmunization of the population. This mistakeshould not be repeated when new vaccines areintroduced. Pediatricians should demand for therestructure and implementation of nationalimmunization policies to which they should allsubsequently conform.

Key words: immunizations, prevention, healtheducation, congenital rubella syndrome.


¤¯Ô˘Ó ‰ËÌÔÛÈÂ˘ÙÂ› 19 Û¯ÂÙÈÎ¿ ¿ÚıÚ· ÛÂ 7 ÂÈÛÙË-ÌÔÓÈÎ¿ ÂÚÈÔ‰ÈÎ¿, Î·È fi¯È ÌfiÓÔ ·È‰È·ÙÚÈÎ¿, ¤¯Ô˘ÓÁ›ÓÂÈ 18 ·Ó·ÎÔÈÓÒÛÂÈ˜ ÛÂ 7 Û˘Ó¤‰ÚÈ· (5), ¤¯Ô˘ÓÂÎ‰ÔıÂ› ‚È‚Ï›· (6,7), ˘Ô‚Ï‹ıËÎ·Ó ÂÎı¤ÛÂÈ˜ ÛÙÔ·ÚÌfi‰ÈÔ ÀÔ˘ÚÁÂ›Ô (8), ÂÛÙ¿ÏËÛ·Ó ÂÁÎ‡ÎÏÈÔÈ (9),ÚÔÎÏ‹ıËÎ·Ó Û˘˙ËÙ‹ÛÂÈ˜ ÂÈ‰ËÌÈÔÏfiÁˆÓ ÛÙÈ˜ÛÙ‹ÏÂ˜ ÙÔ˘ British Medical Journal (2-4,10), ÏÂÈ-ÙÔ‡ÚÁËÛ·Ó ÛÂ Â›Â‰Ô ÀÔ˘ÚÁÂ›Ô˘ ÂÈÙÚÔ¤˜ ÂÌ-‚ÔÏÈ·ÛÌÒÓ ÌÂ ÙÔ˘˜ Ï¤ÔÓ ·ÚÌfi‰ÈÔ˘˜ ÂÈÛÙ‹ÌÔ-ÓÂ˜, ÂÎÚÔÛÒÔ˘˜ ÙË˜ ¶·È‰È·ÙÚÈÎ‹˜ ∂Ù·ÈÚÂ›·˜Î·È Î·ıËÁËÙ¤˜ ÙË˜ ·È‰È·ÙÚÈÎ‹˜. ∫ÈÓËÙÔÔÈËı‹Î·-ÌÂ fiÏÔÈ ÔÈ ·È‰›·ÙÚÔÈ, ·fi ÙË ı¤ÛË Ô˘ ‚Ú›ÛÎÂÙ·ÈÔ Î·ı¤Ó·˜. ∂›Ì·ÛÙÂ, fiÌˆ˜, ·ÔÙÂÏÂÛÌ·ÙÈÎÔ›; OıÏÈ‚ÂÚfi˜ ·ÔÏÔÁÈÛÌfi˜ ·Ú·Ì¤ÓÂÈ 9 ÙÂÎÌËÚÈˆÌ¤-ÓÂ˜ ÂÚÈÙÒÛÂÈ˜ ™™∂ ÛÙËÓ ÂÈ‰ËÌ›· ÙÔ˘ 1999,Ô˘ ‹Ù·Ó ÌÈÎÚfiÙÂÚË ·fi ÂÎÂ›ÓË ÙÔ˘ 1993 (2480ÎÚÔ‡ÛÌ·Ù· ¤Ó·ÓÙÈ 10.000) (11). ™Â ·˘Ù‹ ÙËÓ ÂÈ-‰ËÌ›· Ì¿ÏÈÛÙ· ¤ÁÈÓÂ Î·È “ÂÍ·ÁˆÁ‹” ÛÙËÓ ∞ÁÁÏ›·ÌÂ ŒÏÏËÓÂ˜ ÊÔÈÙËÙ¤˜ (1).

∆È ‰ÂÓ Î¿Ó·ÌÂ ÛˆÛÙ¿; ∆È ·ÌÂÏ‹Û·ÌÂ; ¶Ô‡ ¯ˆÏ·›-ÓÂÈ ÙÔ Û‡ÛÙËÌ¿ Ì·˜; ∆È ÌÔÚÔ‡ÌÂ Ó· ‰ÈÔÚıÒÛÔ˘ÌÂ;

O ∞Ó‰Ú¤Ô˘ Î·È ÔÈ Û˘ÓÂÚÁ¿ÙÂ˜ ÙÔ˘ ·Ó·Ê¤ÚÔ˘ÓÌÂ Û·Ê‹ÓÂÈ· Ù· ·‰‡Ó·Ù· ÛËÌÂ›· ÙÔ˘ ı¤Ì·ÙÔ˜:¤ÁÎ˘Â˜ ÌÂ ÎËÏÈ‰Ô‚Ï·ÙÈ‰Ò‰Â˜ ÂÍ¿ÓıËÌ· Ô˘ ‰ÂÓ¤‚·ÏÂ ÛÂ ˘Ô„›· ÙÔÓ Ì·ÈÂ˘Ù‹Ú· ‹ ›Ûˆ˜ Î·È Ó· ÌËÓ·Ó·Ê¤ÚıËÎÂ ÛÙÔ Ì·ÈÂ˘Ù‹Ú·, ÛÂ Ì›· ÂÚ›ÙˆÛË¤ÁÈÓÂ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ·ÓÙÈÛˆÌ¿ÙˆÓ, ·ÏÏ¿ Ë Î‡ËÛËÛ˘ÓÂ¯›ÛÙËÎÂ, ÛÂ ¿ÏÏË ÂÚ›ÙˆÛË Ô ÁÈ·ÙÚfi˜ ÂÌÈ-ÛÙÂ‡ÙËÎÂ ÙË ‰È¿ÁÓˆÛË ÓfiÛËÛË˜ Ô˘ ‹Ù·Ó ÁÚ·Ì-Ì¤ÓË ÛÙÔ ‚È‚ÏÈ¿ÚÈÔ ˘ÁÂ›·˜, Î·ÌÈ¿ ¤ÁÎ˘Ô˜ ‰ÂÓ Â›¯ÂÂÌ‚ÔÏÈ·ÛÙÂ› (1).

OÈ ÛÙÚ·ÙËÁÈÎ¤˜ Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·È ÁÈ· ÙËÓ ·ÓÙÈ-ÌÂÙÒÈÛË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ Â›Ó·È ÁÓˆÛÙ¤˜, ¤¯Ô˘ÓÂÚÈÁÚ·ÊÂ› Â·ÓÂÈÏËÌÌ¤Ó· ÎÈ Â›Ó·È ÈÎÚfi Ó· ·Ó·-ÁÎ¿˙ÂÙ·È Ó· ÁÚ¿ÊÂÈ Î·ÓÂ›˜ Ù· ›‰È· Î·È Ù· ›‰È·(1,5,7,8,11). ∆È ÂÚÈÛÛfiÙÂÚÔ ÌÔÚÔ‡ÌÂ Ó· Î¿ÓÔ˘-ÌÂ ·’ fiÛ· ‹‰Ë ¤ÁÈÓ·Ó;

∏ ÂÌ‚ÔÏÈ·ÛÙÈÎ‹ Î¿Ï˘„Ë ÙˆÓ ÓË›ˆÓ Ê·›ÓÂÙ·ÈfiÙÈ ¤Êı·ÛÂ È· ÛÂ ÔÛÔÛÙfi >90% (12). ∞˘Ùfi,·ÛÊ·ÏÒ˜, Â›Ó·È Â›ÙÂ˘ÁÌ· ÙˆÓ ·È‰È¿ÙÚˆÓ, Ô˘fiÌˆ˜ ‰ÂÓ Ú¤ÂÈ Ó· Ì·˜ ÂÊËÛ˘¯¿˙ÂÈ. ∞Ó ‰ÂÓ ÏË-ÊıÔ‡Ó ÂÈÏ¤ÔÓ Ì¤ÙÚ·, ÁÈ· ·ÚÎÂÙ¿ ¯ÚfiÓÈ· ı·˘¿Ú¯ÂÈ ÌÂÁ¿ÏÔ ÔÛÔÛÙfi Â›ÓÔÛˆÓ ÓÂ·ÚÒÓ ÂÓË-Ï›ÎˆÓ Î·È ‰ÂÓ ı· ¤¯ÂÈ ÂÍ·ÛÊ·ÏÈÛÙÂ› ÙÔ›¯Ô˜ ·ÓÔ-Û›·˜ ÛÙËÓ ÎÔÈÓfiÙËÙ·. ¢ËÏ·‰‹, ÔÈ ÂÈ‰ËÌ›Â˜ ÂÚ˘-ıÚ¿˜ ı· Û˘ÓÂ¯›˙ÔÓÙ·È (8).

∏ ·ÓÔÛ›· ÙˆÓ ÓÂ·ÚÒÓ ÂÓËÏ›ÎˆÓ Ú¤ÂÈ Ó· ÂÍ·-ÛÊ·ÏÈÛÙÂ› ÌÂ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙÔ˘˜. ∏ ÂÁÎ‡ÎÏÈÔ˜ÙÔ˘ ÀÔ˘ÚÁÂ›Ô˘ ÀÁÂ›·˜ Î·È ¶ÚfiÓÔÈ·˜ ÙÔ˘ 1999Û˘ÓÈÛÙ¿ ÙÔÓ “¤ÏÂÁ¯Ô ÙˆÓ ‚È‚ÏÈ·Ú›ˆÓ ˘ÁÂ›·˜ fiÏˆÓÙˆÓ Ì·ıËÙÒÓ Á˘ÌÓ·Û›ˆÓ Î·È Ï˘ÎÂ›ˆÓ ÙË˜ ¯ÒÚ·˜Î·È ÙËÓ ·ÓÔÛÔÔ›ËÛ‹ ÙÔ˘˜ ÌÂ ÙË ‰Â‡ÙÂÚË ‰fiÛËÂÌ‚ÔÏ›Ô˘ ÂÚ˘ıÚ¿˜”. ™˘ÓÈÛÙ¿, Â›ÛË˜, ÙÔÓ “ÂÌ‚Ô-ÏÈ·ÛÌfi ÙˆÓ ·ÓÂÌ‚ÔÏ›·ÛÙˆÓ ıËÏ¤ˆÓ 12 ÂÙÒÓ Î·È

¿Óˆ”, Î·ıÒ˜ Î·È “...ÙËÓ ¤ÁÎ·ÈÚË ÎÈÓËÙÔÔ›ËÛË ÁÈ·ÂÓËÌ¤ÚˆÛË ÙˆÓ Â˘·ıÒÓ ÔÌ¿‰ˆÓ” (9). ™ÙÈ˜ Û˘-ÛÙ¿ÛÂÈ˜, fiÌˆ˜, ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ú·ÎÙÈÎ¤˜Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘˜.

ªÂ Ï‹ÚË Â›ÁÓˆÛË ÙˆÓ ‰˘Ó·ÙÔÙ‹ÙˆÓ Î·È ÙˆÓÚÔÔÙÈÎÒÓ ÙÔ˘ ˘ÁÂÈÔÓÔÌÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, Ë˘ÔÁÚ¿ÊÔ˘Û· ÙÔÏÌ¿ Ó· ÚÔÙÂ›ÓÂÈ ÛÙÔ˘˜ Û˘Ó·-‰¤ÏÊÔ˘˜ ÈÔ ¤ÌÚ·ÎÙË ÎÈÓËÙÔÔ›ËÛË ¤Ú· ·fi‰ËÌÔÛÈÂ‡ÛÂÈ˜ Î·È ÂÈÛËÁ‹ÛÂÈ˜ ÂÚ› ÙÔ˘ Ú·ÎÙ¤Ô˘.∆Ô ÚÒÙÔ ÂÊÈÎÙfi Î·È ·Ó¤ÍÔ‰Ô Ì¤ÙÚÔ Â›Ó·È Ë ÂÓË-Ì¤ÚˆÛË ÙˆÓ ÂÓËÏ›ÎˆÓ. OÈ ·È‰›·ÙÚÔÈ ÌÔÚÔ‡Ó Ó··ÍÈÔÔÈ‹ÛÔ˘Ó ÙËÓ Â·Ê‹ ÙÔ˘˜ ÌÂ ÙÔ˘˜ ÁÔÓÂ›˜ Î·ÈÙÔ Î‡ÚÔ˜ Ô˘ ·Ó·ÌÊÈÛ‚‹ÙËÙ· ‰È·ı¤ÙÔ˘Ó ÁÈ· Ó·ÂÂÎÙÂ›ÓÔ˘Ó ÛÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜ Î·È ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ÙËÓ ÂÈÙ˘¯›· Ô˘ Â›¯·Ó ÛÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙÔ˘ ÓË-È·ÎÔ‡ ÏËı˘ÛÌÔ‡: ™Â Î¿ıÂ ÂÌ‚ÔÏÈ·ÛÌfi ÓË›Ô˘ÁÈ· ÂÚ˘ıÚ¿, Î·ıÒ˜ Î·È ÛÂ Î¿ıÂ ¤ÏÂÁ¯Ô ‚È‚ÏÈ·Ú›Ô˘˘ÁÂ›·˜ ·È‰ÈÔ‡ Ó· ÂÓËÌÂÚÒÓÔ˘Ó ÙÈ˜ ÌËÙ¤ÚÂ˜ fiÙÈ:·) ÙÔ ÈÛÙÔÚÈÎfi ÓfiÛËÛË˜ ·fi ÂÚ˘ıÚ¿ ‰ÂÓ ÙÂÎÌË-ÚÈÒÓÂÈ ·ÓÔÛ›·, ‚) Ú¤ÂÈ ÔÈ ›‰ÈÂ˜ Ó· ¤¯Ô˘Ó Î¿ÓÂÈ‰‡Ô ‰fiÛÂÈ˜ ÂÌ‚ÔÏ›Ô˘ ‹ Ó· ¤¯Ô˘Ó ÔÚÔÏÔÁÈÎ‹ ·fi-‰ÂÈÍË ·ÓÔÛ›·˜ ‹ Ó· ÂÌ‚ÔÏÈ·ÛÙÔ‡Ó ÙÒÚ·, ÚÈÓ ·fiÙËÓ ÂfiÌÂÓË Â›ÛÎÂ„Ë ÛÙÔ È·ÙÚÂ›Ô, ¿Û¯ÂÙ· ·fiÙÔ ·Ó ÚÔÁÚ·ÌÌ·Ù›˙Ô˘Ó Ó· Î¿ÓÔ˘Ó ¿ÏÏÔ ·È‰›, Á)Ú¤ÂÈ Ó· ¤¯Ô˘Ó Î¿ÓÂÈ ‰‡Ô ‰fiÛÂÈ˜ ÂÌ‚ÔÏ›Ô˘ ÂÚ˘-ıÚ¿˜ fiÏÔÈ ÔÈ ¤ÊË‚ÔÈ ÙË˜ ¯ÒÚ·˜ Î·È ‰) ÙÔ ÎfiÛÙÔ˜ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Î·Ï‡ÙÂÙ·È ·fi fiÏ· Ù· ·ÛÊ·ÏÈÛÙÈ-Î¿ Ù·ÌÂ›·.

∞˜ ·Ó·ÚÙ‹ÛÔ˘ÌÂ Ì›· ·Ó·ÎÔ›ÓˆÛË ÛÙÔ È·ÙÚÂ›ÔÌ·˜ Ô˘ Ó· ı˘Ì›˙ÂÈ fiÙÈ Ú¤ÂÈ Ó· Î¿ÓÔ˘Ó ÂÌ‚fiÏÈÔÂÚ˘ıÚ¿˜ fiÏ· Ù· ¿ÙÔÌ· ËÏÈÎ›·˜ ¿Óˆ ÙˆÓ 12 ÂÙÒÓ,·ÎfiÌË ÎÈ ·Ó ¤¯Ô˘Ó ÂÌ‚ÔÏÈ·ÛÙÂ› ÛÂ ‚ÚÂÊÈÎ‹ ËÏÈÎ›·,·ÎfiÌË ÎÈ ·Ó ¤¯ÂÈ Î·Ù·ÁÚ·ÊÂ› ÛÙÔ µÈ‚ÏÈ¿ÚÈÔ ÀÁÂ›-·˜ ÙÔ˘ ·È‰ÈÔ‡ Ë ÎÏÈÓÈÎ‹ ‰È¿ÁÓˆÛË ÂÚ˘ıÚ¿˜.

∏ ÂÓËÌ¤ÚˆÛË Î·È Â˘·ÈÛıËÙÔÔ›ËÛË ÙÔ˘ ÏË-ı˘ÛÌÔ‡ Ê·›ÓÂÙ·È fiÙÈ ·ÔÙÂÏÂ› ÔÏ‡ ÛËÌ·ÓÙÈÎfi ·-Ú¿ÁÔÓÙ· ÛÙËÓ ÂÈÙ˘¯›· ÚÔÁÚ·ÌÌ¿ÙˆÓ ·ÓÔÛÔÔ›-ËÛË˜ (4).

OÈ ÂÈ‰ËÌÈÔÏfiÁÔÈ Ô˘ ÂÓËÌÂÚÒıËÎ·Ó ÁÈ· ÙËÓ“ÂÏÏËÓÈÎ‹ ÂÌÂÈÚ›·” ·fi ÙÔÓ ·ÙÂÏ‹ ÂÌ‚ÔÏÈ·ÛÌfiÙÔ˘ ÏËı˘ÛÌÔ‡ ÁÈ· ÙËÓ ÂÚ˘ıÚ¿ ·ÓËÛ‡¯ËÛ·Ó ÁÈ·ÙÔ ÙÈ ÌÔÚÂ› Ó· Û˘Ì‚Â› Î·È ÛÙÔ˘˜ ‰ÈÎÔ‡˜ ÙÔ˘˜ ÏË-ı˘ÛÌÔ‡˜, ·Ó ÌÂÈˆıÂ› Ë ÂÌ‚ÔÏÈ·ÛÙÈÎ‹ Î¿Ï˘„Ë ÁÈ·‰È¿ÊÔÚ· ÓÔÛ‹Ì·Ù·, ·fi ÙËÓ ·˘Í·ÓfiÌÂÓË Ù¿ÛË¿ÚÓËÛË˜ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ·fi ÙÔ ÎÔÈÓfi (3,4). ∂›-Ó·È Ì›· Ù¿ÛË Ô˘ Â˘Ù˘¯Ò˜ ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ·Îfi-ÌË ÛÙË ¯ÒÚ· Ì·˜.

°È· ÂÌ¿˜, ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ Ì¿ıËÌ· Ô˘ Ú¤-ÂÈ Ó· ¿ÚÔ˘ÌÂ ·fi ÙÔ “¿ıËÌ·” ÙÔ˘ ·Û˘ÓÙfiÓÈ-ÛÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÙËÓ ÂÚ˘ıÚ¿ Â›Ó·È fiÙÈ ÙÔ ÂÈ-‰ËÌÈÔÏÔÁÈÎfi Ê·ÈÓfiÌÂÓÔ ÌÔÚÂ› Ó· Â·Ó·ÏËÊıÂ›ÌÂ ¿ÏÏ· ÓÔÛ‹Ì·Ù· Î·È ¿ÏÏÔ˘˜ Ó¤Ô˘˜ ÂÌ‚ÔÏÈ·-ÛÌÔ‡˜. ∏ ÂÌÊ¿ÓÈÛË ÎÚÔ˘ÛÌ¿ÙˆÓ Û˘Ó‰ÚfiÌÔ˘ Û˘Á-ÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜ ÂÈ‚Â‚·›ˆÛÂ ÙËÓ ÔÚıfiÙËÙ· ÙË˜


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ÁÓˆÛÙ‹˜ Ô‰ËÁ›·˜ ÙˆÓ ÂÈ‰ËÌÈÔÏfiÁˆÓ: ªËÓ ÂÈÛ¿ÁÂ-ÙÂ ÛÙÔ ÚfiÁÚ·ÌÌ¿ Û·˜ Ó¤· ÂÌ‚fiÏÈ·, ·Ó ‰ÂÓ ÂÍ·-ÛÊ·Ï›ÛÂÙÂ ÙË ‰˘Ó·ÙfiÙËÙ· ÙË˜ ÂÏ¿¯ÈÛÙË˜ ··Ú·›-ÙËÙË˜ Î¿Ï˘„Ë˜ ÙÔ˘ ÏËı˘ÛÌÔ‡ ÌÂ ·˘Ù¿ (7). ∞Ó, ÁÈ··Ú¿‰ÂÈÁÌ·, ÂÈÛ·¯ıÂ› ÙÔ ÂÌ‚fiÏÈÔ ÙË˜ ·ÓÂÌÂ˘ÏÔ-ÁÈ¿˜ ¯ˆÚ›˜ Ó· ÂÚÈÏËÊıÂ› ÛÙÔ ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ·∂Ì‚ÔÏÈ·ÛÌÒÓ, ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ Ó· ÂÌ‚ÔÏÈ·ÛÙÔ‡ÓÎ¿ÔÈ· ˘ÁÈ‹ ·È‰È¿ ÛÙÔÓ È‰ÈˆÙÈÎfi ÙÔÌ¤· (ÌÂ ÙË ÁÓˆ-ÛÙ‹ ›ÂÛË ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· fiÛÔ ÂÚÈÛÛfiÙÂÚ· ÂÌ‚fi-ÏÈ· Á›ÓÂÙ·È). ∆fiÙÂ, Â›Ó·È ‚¤‚·ÈÔ fiÙÈ ı· Â·Ó·ÏËÊıÂ›ÙÔ ¿ıËÌ· ÙË˜ ÂÚ˘ıÚ¿˜: ı· ÌÂÈˆıÔ‡Ó ÔÈ ÂÈ‰ËÌ›Â˜·ÓÂÌÂ˘ÏÔÁÈ¿˜ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· (fiˆ˜ ¤ÁÈÓÂ Î·ÈÌÂ ÙËÓ ÂÚ˘ıÚ¿), ı· ·˘ÍËıÂ› ÙÔ ÔÛÔÛÙfi ÙˆÓ Â›ÓÔ-ÛˆÓ ÂÓËÏ›ÎˆÓ Ô˘ Û‹ÌÂÚ· ˘ÔÏÔÁ›˙ÂÙ·È ÛÂ <10%(fiˆ˜ ¤ÁÈÓÂ Î·È ÌÂ ÙËÓ ÂÚ˘ıÚ¿), ı· ÌÂÙ·ÙÂıÂ› ËËÏÈÎ›· ÓfiÛËÛË˜ ÚÔ˜ Ù· ¿Óˆ (fiˆ˜ ¤ÁÈÓÂ Î·È ÌÂÙËÓ ÂÚ˘ıÚ¿) Î·È Ë ·ÓÂÌÂ˘ÏÔÁÈ¿, Ô˘ ˆ˜ ÓfiÛËÌ·ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜ Â›Ó·È ‹ÈÔ ÌÂ ÂÈÏÔÎ¤˜ Û¿-ÓÈÂ˜ Î·È Î·Ï‹˜ ÚfiÁÓˆÛË˜, ı· ÌÂÙ·ÙÚ·Â› ÛÂ Ófi-ÛËÌ· ÙˆÓ ÂÓËÏ›ÎˆÓ ÌÂ ıÓËÙfiÙËÙ· Î·È ÔÏÏ¤˜ ÛÔ-‚·Ú¤˜ ÂÈÏÔÎ¤˜.

∆Ô Ì¿ıËÌ· Ô˘ Ú¤ÂÈ Ó· ¿ÚÔ˘ÌÂ ·fi ÙÔ ¿-ıËÌ· ÙË˜ ÂÚ˘ıÚ¿˜ Û˘ÓÔ„›˙ÂÙ·È ÛÙ· ÂÍ‹˜: ·) ÔÙ¤È· ·ÙÔÌÈÎ¤˜ ·ÔÊ¿ÛÂÈ˜ ÁÈ· ÙËÓ ÂÈÛ·ÁˆÁ‹ Ó¤ˆÓ ÂÌ-‚ÔÏ›ˆÓ ÛÙÔ Û¯‹Ì· ÙˆÓ ·È‰ÈÒÓ Ô˘ ÊÚÔÓÙ›˙Ô˘ÌÂ,‚) ··›ÙËÛË Ó· ‰È·ÌÔÚÊÒÓÂÙ·È Î·È Ó· ÎÔÈÓÔÔÈÂ›Ù·ÈÂıÓÈÎ‹ ÛÙÚ·ÙËÁÈÎ‹ Î·È Ó· Û˘ÌÌÔÚÊÒÓÔÓÙ·È fiÏÔÈ ÛÂ·˘Ù‹, Á) ÙÔ ‰È˜ ÂÍ·Ì·ÚÙÂ›Ó ÌÂ ·Ó¿ÏÔÁÂ˜ ·Ûı¤ÓÂÈÂ˜,.¯. ·ÓÂÌÂ˘ÏÔÁÈ¿, ‰ÂÓ ı· Ì·˜ Î·ÎÔ¯·Ú·ÎÙËÚ›ÛÂÈ·ÏÒ˜ ˆ˜ ÌË ÛÔÊÔ‡˜, ·ÏÏ¿ ÎÈÓ‰˘ÓÂ‡Ô˘ÌÂ Ó· Á›-ÓÔ˘ÌÂ ˘fiÏÔÁÔÈ ı·Ó¿ÙˆÓ Î·È ÂÈÏÔÎÒÓ ÛÂ ÓÂ·-ÚÔ‡˜ ·ÓÂÌ‚ÔÏ›·ÛÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜ Ô˘ ¯ˆÚ›˜ ÙÔÓ·ÙÂÏ‹ ÂÌ‚ÔÏÈ·ÛÌfi ÙÔ˘ ÏËı˘ÛÌÔ‡ ı· Â›¯·Ó ·Ô-ÎÙ‹ÛÂÈ Ê˘ÛÈÎ‹ ·ÓÔÛ›· ·fi ÙËÓ ·È‰ÈÎ‹ ÙÔ˘˜ ËÏÈÎ›·Î·È ‰) ÛÙÔ˘˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡˜ ‰ÂÓ ·ÚÎÂ› ÙÔ “ˆÊÂÏ¤-ÂÈÓ” ÙÔ˘˜ ÂÏ¿ÙÂ˜ Ì·˜, ÂÈ‚¿ÏÏÂÙ·È Û˘Á¯ÚfiÓˆ˜ ÙÔ“ÌË ‚Ï¿ÙÂÈÓ” fiÛÔ˘˜ ‰ÂÓ ¤¯Ô˘Ó ÙÔ ÚÔÓfiÌÈÔ Ó· Â›-Ó·È ÂÏ¿ÙÂ˜ Ì·˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. ∞Ó‰Ú¤Ô˘ ∞, ¶ÂÚÈÛÙ¤ÚË µ. ª·Ï¿ÛÎ·˜ ∞. ∂È‰ËÌ›· Û˘Ó-

‰ÚfiÌÔ˘ Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜ (™™∂) ÙÔ ¤ÙÔ˜ 1999. ¶·È‰È·-ÙÚÈÎ‹ 2002;65:273-277.

2. Panagiotopoulos T, Antoniadou I, Valassi-Adam E. Increasein congenital rubella after immunization in Greece:retrospective survey and systematic review. BMJ1999;319:1462-1467.

3. Berger A. How does herd immunity work? BMJ1999;319:1467.

4. King S. Vaccination policies: individual rights vs communityhealth. BMJ 1999;319:1448-1449.

5. πƒπ™, µ¿ÛË ∂ÏÏËÓÈÎ‹˜ µÈ‚ÏÈÔÁÚ·Ê›·˜ ÁÈ· ÙËÓ ÀÁÂ›· ÙÔ˘¶·È‰ÈÔ‡. www.ich.gr.

6. µ·Ï¿ÛÛË-∞‰¿Ì ∂. ¶ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ÂÊ·ÚÌÔÁ‹ ÂÌ‚ÔÏÈ·-ÛÌÒÓ ÛÙËÓ ∂ÏÏ¿‰·. ™ÙÔ: ∂Ì‚fiÏÈ·, ∫·ÙÙ¿ÌË˜ Ã, ÂÈÌ. ™˘-ÌfiÛÈ·. 21Ô ∂Ù‹ÛÈÔ ¶·ÓÂÏÏ‹ÓÈÔ π·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ. ∞ı‹Ó·:π·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›· ∞ıËÓÒÓ; 1995. ÛÂÏ. 28-36.

7. ¶·Ó·ÁÈˆÙfiÔ˘ÏÔ˜ ∆. ∆Ô Ê·ÈÓfiÌÂÓÔ ÙË˜ Û˘ÏÏÔÁÈÎ‹˜ ·ÓÔ-Û›·˜ Î·È Ë Ú·ÎÙÈÎ‹ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡. ™ÙÔ: µ·Ï¿ÛÛË-∞‰¿Ì∂, ¶·Ó·ÁÈˆÙfiÔ˘ÏÔ˜ ∆, ÂÈÌ. ∂Ì‚ÔÏÈ·ÛÌÔ›. ∞Ú¯¤˜ Î·È ‰È-Ï‹ÌÌ·Ù· ÛÙËÓ ÎÏÈÓÈÎ‹ Ú¿ÍË. ∫ÏÈÓÈÎ¿ ÊÚÔÓÙÈÛÙ‹ÚÈ·. ∞ı‹-Ó·: π·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›· ∞ıËÓÒÓ; 2000. ÛÂÏ. 70-83.

8. ¶·Ó·ÁÈˆÙfiÔ˘ÏÔ˜ ∆, ∞ÓÙˆÓÈ¿‰Ô˘ π, µ·Ï¿ÛÛË-∞‰¿Ì ∂.ŒÎıÂÛË πÀ¶. ªÂÁ¿ÏË ÂÈ‰ËÌ›· Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜ ÙÔ1993 ÛÙËÓ ∂ÏÏ¿‰·: ∂Â›ÁÔÓ Úfi‚ÏËÌ· ‰ËÌfiÛÈ·˜ ˘ÁÂ›·˜.¢ÂÎ 1995, ∞ı‹Ó·.

9. ∂ÁÎ‡ÎÏÈÔ˜ ÙÔ˘ ÀÔ˘ÚÁÂ›Ô˘ ÀÁÂ›·˜ Î·È ¶ÚfiÓÔÈ·˜: ∞ÓÔÛÔ-Ô›ËÛË Î·Ù¿ ÙË˜ πÏ·Ú¿˜-∂Ú˘ıÚ¿˜-¶·ÚˆÙ›ÙÈ‰·˜ ∞.¶.µ1/ÔÈÎ 2138, 29-4-1999.

10. Giannakos G, Pirounaki M, Hadjichristodoulou C. Incidenceof congenital rubella in Greece has decreased. BMJ2000;320:1408.

11. µ·Ï¿ÛÛË-∞‰¿Ì ∂. ∂Ú˘ıÚ¿: OÈ ıÏÈ‚ÂÚ¤˜ Û˘Ó¤ÂÈÂ˜ ÙË˜ ·-Ú·Ì¤ÏËÛË˜. ¢∞’ ¶∫¶∞ 1995;42:163-167.

12. µ·Ï¿ÛÛË-∞‰¿Ì ∂. ∞‰ËÌÔÛ›Â˘ÙÂ˜ ÏËÚÔÊÔÚ›Â˜ ·fi ¤ÚÂ˘-Ó· ÙÔ˘ πÀ¶ 2001.


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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 24-05-2002 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 28-05-2002

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂Ï¤ÓË µ·Ï¿ÛÛË-∞‰¿ÌÀ·Î›ÓıˆÓ 29, ∆.∫. 154 52, ¶. æ˘¯ÈÎfi E-mail: [email protected]


Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ Ì˘ÂÏÔ¸ÂÚÏ·ÛÙÈÎÒÓ Û˘Ó‰ÚfiÌˆÓ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· ™. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘ - ∞Ó‰ÚÔ˘Ï·Î¿ÎË

Characteristics of myeloproliferative syndromes (MPS) during childhood S. Polychronopoulou - Androulakaki

∞¡∞™∫O¶∏™∏ REVIEW ARTICLE


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�¶ÂÚ›ÏË„Ë: ∆· Ì˘ÂÏÔ¸ÂÚÏ·ÛÙÈÎ¿ Û‡Ó‰ÚÔÌ·(ªÀ™) ÛÙ· ·È‰È¿ ·ÔÙÂÏÔ‡Ó ÂÓ‰È·Ê¤ÚÔ˘ÛÂ˜ ÎÏÈ-ÓÈÎ¤˜ ÔÓÙfiÙËÙÂ˜, ÔÈ ÔÔ›Â˜ ÏfiÁˆ ÙË˜ Û·ÓÈfiÙËÙ¿˜ÙÔ˘˜ Î·Ù¿ ÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·, ÌfiÏÈ˜ ÚfiÛÊ·Ù·¤¯Ô˘Ó ·Ú¯›ÛÂÈ Ó· ÌÂÏÂÙÒÓÙ·È Ï¤ÔÓ ÂÈÛÙ·Ì¤Ó·.∫·Ù’ ·Ó·ÏÔÁ›· ÌÂ ÙÈ˜ ·ÓÙ›ÛÙÔÈ¯Â˜ ÎÏÈÓÈÎ¤˜ ÔÓÙfiÙË-ÙÂ˜ ÙˆÓ ÂÓËÏ›ÎˆÓ, ÛÙ· ªÀ™ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë¯ÚfiÓÈ· Ì˘ÂÏÔÁÂÓ‹˜ ÏÂ˘¯·ÈÌ›· Ù‡Ô˘ ÂÓËÏ›ÎÔ˘, Ë·ÏËı‹˜ ÔÏ˘Î˘ÙÙ·Ú·ÈÌ›·, Ë È‰ÈÔ·ı‹˜ ıÚÔÌ‚Ô-Î˘ÙÙ·Ú·ÈÌ›·, Ë È‰ÈÔ·ı‹˜ Ì˘ÂÏÔ˝ÓˆÛË, ÂÓÒ È‰È·›-ÙÂÚË ÔÓÙfiÙËÙ· Ì˘ÂÏÔ¸ÂÚÏ·ÛÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘Ô˘ ··ÓÙ¿Ù·È ·ÔÎÏÂÈÛÙÈÎ¿ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›··ÔÙÂÏÂ› Ë ÓÂ·ÓÈÎÔ‡ Ù‡Ô˘ Ì˘ÂÏÔÌÔÓÔÎ˘ÙÙ·ÚÈÎ‹ÏÂ˘¯·ÈÌ›·. ¶·Ú¿ ÙÔ fiÙÈ ÔÈ ·ÓˆÙ¤Úˆ ÔÓÙfiÙËÙÂ˜ Â-ÚÈÎÏÂ›ÔÓÙ·È ÛÙËÓ ›‰È· ÔÌ¿‰· ÙˆÓ ªÀ™, ÂÎ¿ÛÙË ÂÍ·˘ÙÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ È‰È·ÈÙÂÚfiÙËÙÂ˜ ÛÙËÓ ÎÏÈÓÈÎ‹ÚÔ‚ÔÏ‹, ÙËÓ ÂÚÁ·ÛÙËÚÈ·Î‹ ÂÈÎfiÓ· Î·È Ù· ˘ÔÎÂ›-ÌÂÓ· ‚ÈÔÏÔÁÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿. ∫ÔÈÓ¿ ÛÙÔÈ¯Â›·Ô˘, ˆ˜ Â› ÙÔ ÏÂ›ÛÙÔÓ, ÙÈ˜ Û˘Ó‰¤Ô˘Ó ·ÔÙÂÏÔ‡Ó:·) Ô ÎÏˆÓÈÎÔ‡ Ù‡Ô˘ ÔÏÏ·Ï·ÛÈ·ÛÌfi˜ ÂÓfi˜ ·ÓÒ-Ì·ÏÔ˘ ·Ú¯¤ÁÔÓÔ˘ ·ÈÌÔÔÈËÙÈÎÔ‡ Î˘ÙÙ¿ÚÔ˘, ‚) ËÛ˘ÌÌÂÙÔ¯‹ fiÏˆÓ ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ÛÂÈÚÒÓ ÙÔ˘ Ì˘Â-ÏÔ‡ ÙˆÓ ÔÛÙÒÓ (ªO) ÛÙËÓ ·ıÔÏÔÁÈÎ‹ ‰È·‰ÈÎ·-Û›·, ·Ú¿ ÙÔ fiÙÈ ÛÙÔ ·›Ì· ‰˘Ó·ÙfiÓ Ó· ÂÎ‰ËÏÒÓÔ-ÓÙ·È ÌÂ È‰È·›ÙÂÚ· ÂÚÁ·ÛÙËÚÈ·Î¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿,Á) Ë ÔÈÎ›ÏÔ˘ ‚·ıÌÔ‡ ÚÔ‹ ÙÔ˘˜ ÁÈ· ÂÍ¤ÏÈÍË ÛÂÔÍÂ›· ÏÂ˘¯·ÈÌ›· Î·È ‰) ÔÈ Û˘¯Ó¿, ·Ú¯ÈÎ¿, ·ÏÏËÏÔÂ-ÈÎ·Ï˘ÙfiÌÂÓÂ˜ ÎÏÈÓÈÎ¤˜ Î·È ÂÚÁ·ÛÙËÚÈ·Î¤˜ ÂÈÎfi-ÓÂ˜, ÔÈ ÔÔ›Â˜ ÛÙËÓ ÔÚÂ›· ¿ÏÏÔÙÂ Û˘ÁÎÏ›ÓÔ˘Ó Î·È¿ÏÏÔÙÂ ·ÔÎÏ›ÓÔ˘Ó ˘¤Ú ‰È·ÊÔÚÂÙÈÎÒÓ ‰È·Ù·Ú·-¯ÒÓ. OÈ ˘ÔÎÂ›ÌÂÓÔÈ ·ıÔÁÂÓÂÙÈÎÔ› ÌË¯·ÓÈÛÌÔ› Â›-Ó·È ÂÓ ÔÏÏÔ›˜ ¿ÁÓˆÛÙÔÈ, ÙÔ˘Ï¿¯ÈÛÙÔÓ ÛÙ· ·È‰È¿,·ÏÏ¿ Ê·›ÓÂÙ·È fiÙÈ ·ÔÙÂÏÔ‡Ó ·ÓÙ·Ó·ÎÏ¿ÛÂÈ˜ ÙˆÓÁÂÓÂÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Ô˘ ¤¯Ô˘Ó ÂÈÛ˘Ì‚Â› ÛÙÔÓ·ıÔÏÔÁÈÎfi ·ÈÌÔÔÈËÙÈÎfi ÎÏÒÓÔ.

�Abstract: The myeloproliferative syndromes(MPS) in children represent interesting clinico-haematological entities which, due to their rarityduring childhood, have been studied thoroughlyonly recently. In comparison to their equivalentadult haematological types, chronic myeloidleukemia (Philadelphia positive-adult type),polycythemia vera, essential thrombocythemia andidiopathic myelofilibrosis are included in childhoodMPS, while juvenile myelomonocytic leukaemia(JMML) occurs almost exclusively in children. Inspite of the fact that all the above entities aregrouped within the same type of diseases in thatthey all show myeloproliferative characteristics,nevertheless each one of them has a distinctclinical and/or haematological presentation, whiledifferences in the underlying pathophysiology haverecently been identified. Common pathogeneticlinks that are similar among this group of diseasesinclude: a) abnormal clonal growth of a geneticallydefective hemopoietic stem cell clone which resultsin a multilineage clonal process, b) existence oflineage heterogeneity among particular diseases,because of hierarchically different levels of clonalgeneration, c) the existence of a pathologically andclinically distinct disease variety, due to differentsets of genetic lesions responsible for them and d)the various tendency, because of the inherentgenetic instability of the transformed cell, to clonalevolution and indigenous disease transformation toacute leukemia. Nevertheless, the underlyingpathogenetic mechanisms still remain unknown atleast among children, reflecting a wide spectrum ofdifferent genetic alterations of the abnormallydisturbed haemopoietic clone.

∂ÈÌÂÏ‹ÙÚÈ· ∞’ ∆Ì‹Ì·ÙÔ˜ ¶·È‰È·ÙÚÈÎ‹˜ ∞ÈÌ·ÙÔÏÔÁ›·˜-OÁÎÔÏÔÁ›·˜ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

Registrar, 1st Division of theDepartment of Pediatric Hematology/Oncology“Aghia Sophia” Children’s Hospital, Athens



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Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ Ì˘ÂÏÔ¸ÂÚÏ·ÛÙÈÎÒÓ Û˘Ó-‰ÚfiÌˆÓ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·

∆· Ì˘ÂÏÔ¸ÂÚÏ·ÛÙÈÎ¿ Û‡Ó‰ÚÔÌ· (ªÀ™) ÛÙ··È‰È¿ Û˘ÓÈÛÙÔ‡Ó Û¿ÓÈÂ˜, ·ÏÏ¿ ÂÍ·ÈÚÂÙÈÎ¿ ÂÓ‰È·-Ê¤ÚÔ˘ÛÂ˜ ÎÏÈÓÈÎ¤˜ ÔÓÙfiÙËÙÂ˜, ÏfiÁˆ ‰Â ÙË˜ Û·-ÓÈfiÙËÙ¿˜ ÙÔ˘˜ ÌfiÏÈ˜ ÚfiÛÊ·Ù· ¤¯Ô˘Ó ·Ú¯›ÛÂÈ Ó·ÌÂÏÂÙÒÓÙ·È Ï¤ÔÓ ÂÈÛÙ·Ì¤Ó· ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·(1,2). ∞ÓÙ›ıÂÙ·, ÛÙÔ ¯ÒÚÔ ÙË˜ ·ÈÌ·ÙÔÏÔÁ›·˜ ÙˆÓÂÓËÏ›ÎˆÓ, Ù· ªÀ™ Â›Ó·È ÁÓˆÛÙ¿ ·fi ÙÔ 1951 fiÙ·ÓÚˆÙÔÂÚÈÁÚ¿ÊËÎ·Ó ·fi ÙÔÓ Dameshek, Ô ÔÔ›Ô˜˘fi ÙÔ ÁÂÓÈÎfi ·˘Ùfi fiÚÔ Â›¯Â Û˘ÌÂÚÈÏ¿‚ÂÈ ÙËÓ ·ÏË-ı‹ ÔÏ˘Î˘ÙÙ·Ú·ÈÌ›· (∞¶), ÙË Ì˘ÂÏÔ˝ÓˆÛË ‹ Ì˘ÂÏÔ-ÂÈ‰‹ ÌÂÙ·Ï·Û›· (ªª), ÙËÓ È‰ÈÔ·ı‹ ıÚÔÌ‚ÔÎ˘ÙÙ·-Ú·ÈÌ›· (π£) Î·È ÙË ¯ÚfiÓÈ· Ì˘ÂÏÔÁÂÓ‹ ÏÂ˘¯·ÈÌ›·(Ãª§) (3).

∆· ªÀ™ Û˘ÁÎ·Ù·Ï¤ÁÔÓÙ·È ÛÙÈ˜ ÚÔÏÂ˘¯·ÈÌÈÎ¤˜Î·Ù·ÛÙ¿ÛÂÈ˜, ÂÌÊ·Ó›˙ÔÓÙ·˜ ·˘ÍËÌ¤ÓË Ù¿ÛË ÂÍ¤ÏÈ-ÍË˜ ÛÂ Ï¤ÔÓ ÂÈıÂÙÈÎ¿ ÎÏˆÓÈÎÔ‡ Ù‡Ô˘ ÓÔÛ‹Ì·Ù·(4). OÈ ·Ú¿ÁÔÓÙÂ˜, ÔÈ ÔÔ›ÔÈ ÌÂ ÙËÓ ‰Ú¿ÛË ÙÔ˘˜‰ËÌÈÔ˘ÚÁÔ‡Ó ‹ ÂÈÏ¤ÁÔ˘Ó ˘¤Ú ÂÓfi˜ ·ıÔÏÔÁÈÎÔ‡Î˘ÙÙ·ÚÈÎÔ‡ ÎÏÒÓÔ˘ Ô˘ ÛÙË Û˘Ó¤¯ÂÈ· ·Ó·Ù‡ÛÛÂ-Ù·È ˘¤ÚÌÂÙÚ·, Â›Ó·È ÂÓ ÔÏÏÔ›˜ ¿ÁÓˆÛÙÔÈ. ÕÁÓˆ-ÛÙÔ ·ÎfiÌË ·Ú·Ì¤ÓÂÈ ÙÈ Ô‰ËÁÂ› ÛÙËÓ ÙÂÏÈÎ‹ ÂÈ-ÎÚ¿ÙËÛË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÎÏÈÓÈÎÒÓ Î·È ÂÚÁ·ÛÙËÚÈ·-ÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ ÌÂÙ·Í‡ ÙˆÓ ‰È·ÊfiÚˆÓ Ì˘ÂÏÔ¸-ÂÚÏ·ÛÙÈÎÒÓ Û˘Ó‰ÚfiÌˆÓ. ¶Èı·ÓfiÙ·Ù·, fiÌˆ˜,·ÔÙÂÏÔ‡Ó ·ÓÙ·Ó·ÎÏ¿ÛÂÈ˜ ÙˆÓ ÁÂÓÂÙÈÎÒÓ ‰È·Ù·-Ú·¯ÒÓ ÙÔ˘ DNA Ô˘ ¤¯Ô˘Ó ÂÈÛ˘Ì‚Â› ÛÙ· ÛˆÌ·ÙÈ-Î¿ Î‡ÙÙ·Ú· ÙÔ˘ ·ıÔÏÔÁÈÎÔ‡ ·ÈÌÔÔÈËÙÈÎÔ‡ ÎÏÒ-ÓÔ˘ (2-4).

™Ù· ÁÂÓÈÎ¿ Î·È ÎÔÈÓ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ ªÀ™ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë ·‡ÍËÛË, ÌÂÌÔÓˆÌ¤Ó· ‹ ÛÂ Û˘Ó-‰˘·ÛÌfi, ÙˆÓ ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ, ÙˆÓ ·ÈÌÔÂÙ·-Ï›ˆÓ Î·È ÙˆÓ ÂÚ˘ıÚÔÎ˘ÙÙ¿ÚˆÓ, ÂÓÒ ÛÂ fiÏÂ˜ Û¯Â-‰fiÓ ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ‰È·ÈÛÙÒÓÂÙ·È ÎÏÈÓÈÎ¿ ÛÏËÓÔ-ÌÂÁ·Ï›· (3). ∞Ó Î·È Ë ÎÏÈÓÈÎ‹ ÂÌÊ¿ÓÈÛË Î·È Ë ·ıÔ-Á¤ÓÂÈ¿ ÙÔ˘˜ ‰È·Ê¤ÚÂÈ ·fi ÙËÓ ÔÌ¿‰· ÙˆÓ Ì˘ÂÏÔ‰˘-ÛÏ·ÛÙÈÎÒÓ Û˘Ó‰ÚfiÌˆÓ (ª¢™), Û˘¯Ó¿ Ë ‰È·ÊÔÚÈÎ‹‰È¿ÁÓˆÛË ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô ·˘ÙÒÓ ÔÓÙÔÙ‹ÙˆÓ Â›Ó·È‰˘Û¯ÂÚ‹˜ (5).

™ÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·, Ù· ªÀ™ ÂÎÚÔÛˆÔ‡ÓÙ·ÈÎ·Ù¿ Î‡ÚÈÔ ÏfiÁÔ ·fi ÙËÓ Ãª§ ÂÓËÏ›ÎÔ˘ Ù‡Ô˘, ÙËÓÂ·ÓÈÎÔ‡ Ù‡Ô˘ Ì˘ÂÏÔÌÔÓÔÎ˘ÙÙ·ÚÈÎ‹ ÏÂ˘¯·ÈÌ›·(JMML), ÙËÓ ·ÏËı‹ ÔÏ˘Î˘ÙÙ·Ú·ÈÌ›·, ÙËÓ È‰ÈÔ·ı‹ıÚÔÌ‚ÔÎ˘ÙÙ¿ÚˆÛË, ÂÓÒ ÔÈ ÏÔÈ¤˜ ÌÔÚÊ¤˜ ªÀ™ Â›-Ó·È ÂÍ·ÈÚÂÙÈÎ¿ Û¿ÓÈÂ˜ (1,2,5). ™·Ó ÚÔ‰È·ıÂÛÈÎÔ›·Ú¿ÁÔÓÙÂ˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ ªÀ™ ÛÙ· ·È‰È¿ıÂˆÚÔ‡ÓÙ·È Ù· Û‡Ó‰ÚÔÌ· Down, Kostmann,

Noonan Î·È Schwachmann, Ë ·Ó·ÈÌ›· Fanconi, ÔÌˆÛ·˚ÎÈÛÌfi˜ ÙË˜ ÙÚÈÛˆÌ›·˜ 8, Ë ÓÂ˘ÚÔ˚ÓˆÌ¿ÙˆÛËÙ‡Ô˘ 1, ÔÈ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈÂ˜, Ù˘¯fiÓ ÚÔËÁËıÂ›-Û· ¯ËÌÂÈÔıÂÚ·Â›· Î.Ï. (1,2,5).

ÃÚfiÓÈ· Ì˘ÂÏÔÁÂÓ‹˜ ÏÂ˘¯·ÈÌ›· Ù‡Ô˘ ÂÓËÏ›ÎÔ˘(Ãª§)

∞ÔÙÂÏÂ› ÙÔ 2-5% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙË˜ ·È‰ÈÎ‹˜ÏÂ˘¯·ÈÌ›·˜ Î·È Ë ÂÙ‹ÛÈ· Â›ÙˆÛË ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜Â›Ó·È ÌÈÎÚfiÙÂÚË ·fi 1/105 ¿ÙÔÌ· ËÏÈÎ›·˜ ÌÈÎÚfiÙÂ-ÚË˜ ÙˆÓ 20 ÂÙÒÓ. ∏ ·ÈÙÈÔÏÔÁ›· ÙË˜ ÓfiÛÔ˘ ÁÂÓÈÎ¿·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË, ·Ó Î·È ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙÂ› ÌÂ ÙËÓÈÔÓ›˙Ô˘Û· ·ÎÙÈÓÔ‚ÔÏ›· ÏfiÁˆ ·‡ÍËÛË˜ ÙˆÓ ÂÚÈÛÙ·-ÙÈÎÒÓ ¤ˆ˜ Î·È 7 ÊÔÚ¤˜ ·fi ÙÔ ·Ó·ÌÂÓfiÌÂÓÔ ÛÙ· ÌÈ-ÎÚ¿ ·È‰È¿, ÌÂÙ¿ ·fi ÙËÓ ˘ÚËÓÈÎ‹ ¤ÎÚËÍË ÛÙË ÃÈ-ÚÔÛ›Ì· Î·È ÙÔ ¡·ÁÎ·Û¿ÎÈ (1,2).

Ã·Ú·ÎÙËÚÈÛÙÈÎfi Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎfi Â‡ÚËÌ· ÙË˜ÓfiÛÔ˘ ·ÔÙÂÏÂ› Ë ÌÂÙ¿ıÂÛË t (9;22), ÁÓˆÛÙ‹ Î·È ˆ˜¯ÚˆÌfiÛˆÌ· ºÈÏ·‰¤ÏÊÂÈ·˜, Ë ÔÔ›· ÌÂ ÙÈ˜ ÎÏ·ÛÈ-Î¤˜ Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎ¤˜ ÌÂıfi‰Ô˘˜ ·ÓÈ¯ÓÂ‡ÂÙ·È ÛÙÔ90%, ÂÓÒ ÌÂ ÌÔÚÈ·ÎÔ‡˜ ·ÓÈ¯ÓÂ˘Ù¤˜ ÛÙÔ 100% ÙˆÓ·Û¯fiÓÙˆÓ. ∏ ÏÂÙÔÌÂÚ‹˜ ·Ó¿Ï˘ÛË ÙˆÓ ÛËÌÂ›ˆÓıÚ·‡ÛË˜ ÙˆÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ ÛÙÈ˜ ı¤ÛÂÈ˜ 9q34 Î·È22q11 ¤‰ˆÛÂ ÙËÓ Â˘Î·ÈÚ›· Î·È ÙË ‰˘Ó·ÙfiÙËÙ· Î·-Ù·ÓfiËÛË˜ ÛËÌ·ÓÙÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ ÙË˜ ·ıÔÁ¤ÓÂÈ·˜ÙË˜ Ãª§ (5).

∂›Ó·È ÁÓˆÛÙfi Û‹ÌÂÚ· fiÙÈ ÛÙÔ ¯ÚˆÌfiÛˆÌ· 9 Î·ÈÛÙËÓ ÂÚÈÔ¯‹ 9q34 Â‰Ú¿˙ÂÙ·È ÙÔ ÚˆÙÔ-ÔÁÎÔÁÔÓ›-‰ÈÔ abl, ÙÔ ÔÔ›Ô Îˆ‰ÈÎÔÔÈÂ› ÚˆÙÂ˝ÓË Ô˘ ¤¯ÂÈ‰Ú¿ÛË ÎÈÓ¿ÛË˜ ÙË˜ Ù˘ÚÔÛ›ÓË˜ Î·È Ô ÏÂÈÙÔ˘ÚÁÈÎfi˜ÙË˜ ÚfiÏÔ˜ ·ÊÔÚ¿ ÛÙËÓ ÂÓ‰ÔÎ˘ÙÙ¿ÚÈ· ÌÂÙ·ÁˆÁ‹Û‹Ì·ÙÔ˜, Û˘ÌÌÂÙ¤¯ÔÓÙ·˜ ÛËÌ·ÓÙÈÎ¿ ÛÙÔÓ ÔÏÏ·-Ï·ÛÈ·ÛÌfi Î·È ÙË ‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ Ì˘ÂÏÈÎÒÓÎ˘ÙÙ¿ÚˆÓ (2). ªÂ ÙË ÌÂÙ¿ıÂÛË Î·È Û‡ÓÙËÍË ÙˆÓ Â-ÚÈÔ¯ÒÓ bcr/abl Û¯ËÌ·Ù›˙ÂÙ·È ·ıÔÏÔÁÈÎ‹ ÚˆÙÂ˝ÓËÌÂÁ¤ıÔ˘˜ 210 kd, Ë ÔÔ›· ÂÌÊ·Ó›˙ÂÈ ¯·Ú·ÎÙËÚÈÛÙÈ-Î¿ ÂÓÂÚÁÔÔÈËÌ¤ÓË˜ ÎÈÓ¿ÛË˜ ÙË˜ Ù˘ÚÔÛ›ÓË˜. ∏ Î‡-ÚÈ· ‰Ú¿ÛË ÙË˜ p210 Â›Ó·È Ë ÊˆÛÊÔÚ˘Ï›ˆÛË ÛÂÈÚ¿˜Î˘ÙÙ·ÚÈÎÒÓ ÚˆÙÂ˚ÓÒÓ, ·Ó¿ÌÂÛ· ÛÙÈ˜ ÔÔ›Â˜ Û˘-ÁÎ·Ù·Ï¤ÁÔÓÙ·È Î·È ÌfiÚÈ· ˘Â‡ı˘Ó· ÁÈ· ÙÔÓ ÔÏÏ·-Ï·ÛÈ·ÛÌfi Î·È ‰È·ÊÔÚÔÔ›ËÛË ÙÔ˘ Î˘ÙÙ¿ÚÔ˘. ∆Â-ÏÈÎfi ·ÔÙ¤ÏÂÛÌ· fiÏË˜ ·˘Ù‹˜ ÙË˜ ‰È·‰ÈÎ·Û›·˜ Â›Ó·ÈË ÌÂÙ·ÁˆÁ‹ ÚÔ˜ ÙÔÓ ˘Ú‹Ó· ÙÔ˘ Î˘ÙÙ¿ÚÔ˘ Û˘ÓÂ-¯Ô‡˜ Û‹Ì·ÙÔ˜, Ô˘ Ô‰ËÁÂ› ÛÂ ÌË ÂÏÂÁ¯fiÌÂÓÔ ÔÏ-Ï·Ï·ÛÈ·ÛÌfi Î·È ÂÎÙÚÔ‹ ÙÔ˘ ÛÂ Î·ÎfiËıÂ˜ (2).∞Ó¿ÏÔÁË ÌÂÙ¿ıÂÛË ¤¯ÂÈ ·Ú·ÙËÚËıÂ› Î·È ÛÙÈ˜ ÔÍÂ›-Â˜ ÏÂÌÊÔ‚Ï·ÛÙÈÎ¤˜ ÏÂ˘¯·ÈÌ›Â˜ (O§§), ·ÏÏ¿ ÛÙËÓÚÔÎÂÈÌ¤ÓË ÂÚ›ÙˆÛË ÚfiÎÂÈÙ·È ÁÈ· ‰È·ÊÔÚÂÙÈÎ‹

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ¯ÚfiÓÈ· Ì˘ÂÏÔÁÂÓ‹˜ ÏÂ˘¯·ÈÌ›· Ù‡-Ô˘ ÂÓËÏ›ÎÔ˘, ·ÏËı‹˜ ÔÏ˘Î˘ÙÙ·Ú·ÈÌ›·, È‰ÈÔ·ı‹˜ıÚÔÌ‚ÔÎ˘ÙÙ·Ú·ÈÌ›·, È‰ÈÔ·ı‹˜ Ì˘ÂÏÔ˝ÓˆÛË, ÓÂ·ÓÈ-ÎÔ‡ Ù‡Ô˘ Ì˘ÂÏÔÌÔÓÔÎ˘ÙÙ·ÚÈÎ‹ ÏÂ˘¯·ÈÌ›·, Ì˘ÂÏÔ¸-ÂÚÏ·ÛÙÈÎ¿ Û‡Ó‰ÚÔÌ·, ·È‰ÈÎ‹ ËÏÈÎ›·.

Key words: chronic myeloid leukemia, poly-cythemia vera, essential thrombocythemia, idio-pathic myelofibrosis, juvenile myelomonocyticleukemia, myeloproliferative syndromes, child-hood.



224

ÚˆÙÂ˝ÓË, ÙÔ Ì¤ÁÂıÔ˜ ÙË˜ ÔÔ›·˜ ·Ó¤Ú¯ÂÙ·È ÛÙ·185 kd. ∏ p185 ÚÔ¤Ú¯ÂÙ·È Î·È ·˘Ù‹ ·fi ÙË Û‡-ÓÙËÍË ÙˆÓ 2 ·Ó·ÊÂÚı¤ÓÙˆÓ ÁÔÓÈ‰›ˆÓ bcr-abl, Ù·ÔÔ›· fiÌˆ˜ ¤¯Ô˘Ó ˘ÔÛÙÂ› ıÚ·‡ÛË ÛÂ ‰È·ÊÔÚÂÙÈÎ¿ÛËÌÂ›· Î·È Î·Ù’ Â¤ÎÙ·ÛË Î·È Ë ÏÂÈÙÔ˘ÚÁÈÎ‹ ÙË˜‰Ú¿ÛË ÂÓ¤¯ÂÈ ‰È·ÊÔÚ¤˜ ÛÂ Û¯¤ÛË ÌÂ ÙËÓ p210 (2,4).

∫ÏÈÓÈÎ‹ ÚÔ‚ÔÏ‹ ∏ Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ÂÍ·ÚÙ¿Ù·È ¿ÌÂÛ· ·fi ÙËÓ

·ıÔÁ¤ÓÂÈ· ÙË˜ ÓfiÛÔ˘ Ô˘ Ô‰ËÁÂ› ÛÂ ˘¤ÚÌÂÙÚË·‡ÍËÛË ÙˆÓ ·ÒÚˆÓ Î·È ˆÚ›ÌˆÓ ÎÔÎÎÈÔÎ˘ÙÙ¿ÚˆÓ,Î·ıÒ˜ Î·È ÛÙË Û˘Ó˘¿Ú¯Ô˘Û· ÂÎÛÂÛËÌ·ÛÌ¤ÓËÛÏËÓÔÌÂÁ·Ï›·. ∞Ó·ÈÌ›·, ˘ÚÂÙfi˜, È‰ÚÒÙÂ˜, ·Ò-ÏÂÈ· ‚¿ÚÔ˘˜, ‰˘ÛÂÙÈÎ¿ ÂÓÔ¯Ï‹Ì·Ù·, Î·ÎÔ˘¯›·,ÎÔÈÏÈ·Î¿ ¿ÏÁË, ·ÈÌÔÚÚ·ÁÈÎ‹ ‰È¿ıÂÛË, ÔÛÙÈÎ¿ ¿ÏÁË ‹·ÚıÚ·ÏÁ›Â˜, ·ÔÙÂÏÔ‡Ó Ù· Û˘¯ÓfiÙÂÚ· ÂÌÊ·ÓÈ˙fiÌÂ-Ó· Û˘ÌÙÒÌ·Ù·. §fiÁˆ ÙÔ˘ ·˘ÍËÌ¤ÓÔ˘ ·ÚÈıÌÔ‡ ÙˆÓÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ Û˘¯ÓfiÙÂÚ· ÛÙ· ·È‰È¿ ÂÌÊ·-Ó›˙ÂÙ·È ÏÂ˘ÎfiÛÙ·ÛË, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÌÊ¿ÓÈÛË·ÛÙ¿ıÂÈ·˜, Û·ÛÌÒÓ Î·È ÚÈ·ÈÛÌÔ‡. ∞fi ÙËÓ ·ÓÙÈ-ÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË ‰È·ÈÛÙÒÓÂÙ·È ÛÏËÓÔÌÂÁ·Ï›·, ËÔÔ›· Û˘¯Ó¿ Â›Ó·È ÂÎÛÂÛËÌ·ÛÌ¤ÓË, ¯ˆÚ›˜ Ó· Û˘ÓÔ-‰Â‡ÂÙ·È ·fi ‰ÈfiÁÎˆÛË ‹·ÙÔ˜ ‹ ÏÂÌÊ·‰¤ÓˆÓ, ÂÓÒÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ÛËÌÂ›· ÏÂ˘ÎfiÛÙ·ÛË˜, ÂÈÏ¤ÔÓ,·ÓÂ˘Ú›ÛÎÔÓÙ·È Ô›‰ËÌ· ÔÙÈÎÒÓ ıËÏÒÓ, ·ÚÂÁÎÂÊ·-ÏÈ‰ÈÎ‹ ÛËÌÂÈÔÏÔÁ›· Î·È ‰ÂÚÌ·ÙÈÎ¿ Ô˙›‰È· ÔÊÂÈÏfiÌÂ-Ó· ÛÂ ÂÍˆÌ˘ÂÏÈÎ‹ ·ÈÌÔÔ›ËÛË (1,2).

O ·ÚÈıÌfi˜ ÙˆÓ ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ Û˘¯Ó¿˘ÂÚ‚·›ÓÂÈ Ù· 105/ÎÎ¯, ÂÓÒ Û·ÓÈfiÙÂÚ· ·Ó¤Ú¯ÂÙ·ÈÎ·È ¿Óˆ ÙˆÓ 106/ÎÎ¯, ÙÔ ‰Â Â›¯ÚÈÛÌ· ÙÔ˘ ÂÚÈÊÂ-ÚÈÎÔ‡ ·›Ì·ÙÔ˜ ÂÚÈÏ·Ì‚¿ÓÂÈ Î‡ÙÙ·Ú· ÙË˜ Ì˘ÂÏÈ-Î‹˜ ÛÂÈÚ¿˜ ÛÂ fiÏÂ˜ ÙÈ˜ ‚·ıÌ›‰Â˜ ˆÚ›Ì·ÓÛË˜. ™ÙÔÌ˘ÂÏfi ÙˆÓ ÔÛÙÒÓ (ªO) ‰È·ÈÛÙÒÓÂÙ·È ˘ÂÚÔ¯‹ÙË˜ ÏÂ˘Î‹˜ ÛÂÈÚ¿˜, ·‡ÍËÛË ÙˆÓ ÌÔÓÔ‡ÚËÓˆÓ,·ÓÂ‡ÚÂÛË ‰˘ÛÏ·ÛÙÈÎÒÓ ‚·ÛÂfiÊÈÏˆÓ Î·È ËˆÛÈÓfi-ÊÈÏˆÓ Î·È ÛÙË ¯ÚfiÓÈ· Ê¿ÛË ÙË˜ ÓfiÛÔ˘ Ù· ‚Ï·ÛÙÈ-Î¿ Î‡ÙÙ·Ú· Â›Ó·È Î¿Ùˆ ÙÔ˘ 5%. ™ÙËÓ ÔÛÙÂÔÌ˘ÂÏÈ-Î‹ ‚ÈÔ„›· (Oµ) ·ÓÂ˘Ú›ÛÎÂÙ·È ›ÓˆÛË, Ë ‰Ú·ÛÙËÚÈfi-ÙËÙ· ÙË˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜ ÙˆÓ ÏÂ˘ÎÒÓ ·È-ÌÔÛÊ·ÈÚ›ˆÓ (LAP score) Â›Ó·È ÂÏ·ÙÙˆÌ¤ÓË, ÂÓÒ·˘ÍËÌ¤ÓË ·ÓÂ˘Ú›ÛÎÂÙ·È Ë ÚˆÙÂ˝ÓË Ô˘ ‰ÂÛÌÂ‡ÂÈÙË ‚ÈÙ·Ì›ÓË µ12. ∞·Ú·›ÙËÙÔ ÛÙÔÈ¯Â›Ô ÁÈ· ÙË ‰È¿-ÁÓˆÛË ÙË˜ ÓfiÛÔ˘ ·ÔÙÂÏÂ› Ë ·ÓÂ‡ÚÂÛË ÙË˜ ÌÂÙ¿-ıÂÛË˜ t(9;22), Ë ÔÔ›· Û˘¯Ó¿ ·ÓÈ¯ÓÂ‡ÂÙ·È Î·È ÛÂÂÚÈfi‰Ô˘˜ ‡ÊÂÛË˜ ÙË˜ Ãª§ (2).

∏ ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÙË˜ Ãª§ Ù‡Ô˘ ÂÓËÏ›-ÎÔ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÓÔÛ‹Ì·Ù· fiˆ˜ Ë ÓÂ·ÓÈÎÔ‡ Ù‡-Ô˘ Ì˘ÂÏÔÌÔÓÔÎ˘ÙÙ·ÚÈÎ‹ ÏÂ˘¯·ÈÌ›· (juvenilemyelomonocytic leukaemia-JMML) (¶›Ó·Î·˜ 1), ËÔÍÂ›· Ì˘ÂÏÔÁÂÓ‹˜ ÏÂ˘¯·ÈÌ›· (Oª§) (Â› ‚Ï·ÛÙÈ-Î‹˜ ÎÚ›ÛÂˆ˜) Î·È ÔÈ ‰È·ÊfiÚÔ˘ ·ÈÙÈÔÏÔÁ›·˜ ÏÂ˘¯·È-ÌÔÂÈ‰Â›˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜ fiˆ˜ Â› ÛÔ‚·ÚÒÓ ÏÔÈÌÒÍÂ-ˆÓ, Û˘ÁÁÂÓÒÓ Î·Ú‰È·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ Î.¿. ™ÙË‚Ï·ÛÙÈÎ‹ ÎÚ›ÛË ÙË˜, Ë Ãª§ ÂÓ›ÔÙÂ ‰ËÌÈÔ˘ÚÁÂ›

Úfi‚ÏËÌ· ‰È·ÊÔÚÈÎ‹˜ ‰È¿ÁÓˆÛË˜ ·fi ÙË de novoÔÍÂ›· ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ ÏÂ˘¯·ÈÌ›· (O§§), ÙÔ ÔÔ›ÔÂÈÏ‡ÂÙ·È ·fi ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ ÌÂÁ¤ıÔ˘˜ÙË˜ ÚˆÙÂ˝ÓË˜ Ô˘ ·Ú¿ÁÂÙ·È ·fi ÙË Û‡ÓÙËÍË ÙˆÓÁÔÓÈ‰›ˆÓ bcr/abl. ∏ ‚Ï·ÛÙÈÎ‹ ÎÚ›ÛË ÛÙ· ·È‰È¿ ÌÂÃª§ Û˘Ó‹ıˆ˜ ÂÌÊ·Ó›˙ÂÙ·È ÂÓÙfi˜ 3 ¯ÚfiÓˆÓ ·fi ÙËÓ·Ú¯ÈÎ‹ ‰È¿ÁÓˆÛË, ÛÙ· 2/3 ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·ÊÔ-Ú¿ ÙË Ì˘ÂÏÈÎ‹ Î·È ÛÙÔ 1/3 ÙË ÏÂÌÊÈÎ‹ ÛÂÈÚ¿. ™ÙËÓÙÂÏÂ˘Ù·›· ÂÚ›ÙˆÛË, ÙÔ ÏÂ˘¯·ÈÌÈÎfi Î‡ÙÙ·ÚÔ Â›Ó·Èµ-Î˘ÙÙ·ÚÈÎ‹˜ ÚÔ¤ÏÂ˘ÛË˜ Î·È ÛÙ· Î‡ÙÙ·Ú· ÙÔ˘ªO Î·Ù¿ Î·ÓfiÓ· ÂÌÊ·Ó›˙ÔÓÙ·È ÂÈÚfiÛıÂÙÂ˜ Î˘Ù-Ù·ÚÔÁÂÓÂÙÈÎ¤˜ ‚Ï¿‚Â˜ (2).

∏ ÓfiÛÔ˜ Û˘Ó‹ıˆ˜ ÂÌÊ·Ó›˙ÂÙ·È ÛÙËÓ ¯ÚÔÓ›·ÙË˜ Ê¿ÛË, Ë ÔÔ›· ‰È·ÚÎÂ› ÂÚ›Ô˘ Ì¤¯ÚÈ 3 ¤ÙË. ∏ÂÈÙ·¯˘ÓfiÌÂÓË Ê¿ÛË ÙË˜ Ãª§ ¯·Ú·ÎÙËÚ›˙ÂÙ·È·fi ·ÓıÂÎÙÈÎfiÙËÙ· ÙˆÓ ÏÂ˘¯·ÈÌÈÎÒÓ Î˘ÙÙ¿ÚˆÓÛÙ· ‹‰Ë ¯ÔÚËÁÔ‡ÌÂÓ· ¯ËÌÂÈÔıÂÚ·Â˘ÙÈÎ¿ ÛÎÂ˘¿-ÛÌ·Ù·, ·‡ÍËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ÛÏËÓfi˜, ·Ó·È-Ì›· Î·È ·ÒÏÂÈ· ‚¿ÚÔ˘˜. ∫·Ù¿ Î·ÓfiÓ· ·ÎÔÏÔ˘ıÂ›Ë ‚Ï·ÛÙÈÎ‹ ÎÚ›ÛË Ô˘ ÌÔÚÂ› Ó· ÚÔ¤Ú¯ÂÙ·È,fiˆ˜ ‹‰Ë ·Ó·Ê¤ÚıËÎÂ, ·fi Î‡ÙÙ·ÚÔ ÙË˜ Ì˘ÂÏÈ-Î‹˜ ‹ ÙË˜ ÏÂÌÊÈÎ‹˜ ÛÂÈÚ¿˜ (1,2).

∏ ıÂÚ·Â›· ÙË˜ ÓfiÛÔ˘ ÛÙË ¯ÚfiÓÈ· Ê¿ÛË ·-Ï·ÈfiÙÂÚ· ÛÙËÚÈ˙fiÙ·Ó ÛÂ ¯ÔÚ‹ÁËÛË ˘‰ÚÔÍ˘Ô˘Ú›·˜Î·È ‚Ô˘ÛÔ˘ÏÊ¿ÓË˜. ∆· ÙÂÏÂ˘Ù·›·, fiÌˆ˜, ¯ÚfiÓÈ·˘¿Ú¯ÂÈ Ë Ù¿ÛË ¯ÔÚ‹ÁËÛË˜ ÈÓÙÂÚÊÂÚfiÓË˜-· ÌÂ ‹¯ˆÚ›˜ ¯ËÌÂÈÔıÂÚ·Â›· Ô˘ Î˘Ú›ˆ˜ ÂÚÈÏ·Ì‚¿ÓÂÈÙËÓ ·Ú·Û˘Ù›ÓË. ¶¿ÓÙˆ˜, ˆ˜ ıÂÚ·Â›· ÂÎÏÔÁ‹˜ ÁÈ·ÙÔ˘˜ ·È‰È·ÙÚÈÎÔ‡˜ ·ÛıÂÓÂ›˜ ıÂˆÚÂ›Ù·È Ë ‰ÈÂÓ¤Ú-ÁÂÈ· ÂÙÂÚfiÏÔÁË˜ ÌÂÙ·ÌfiÛ¯Â˘ÛË˜ Ì˘ÂÏÔ‡ ÙˆÓÔÛÙÒÓ ·fi Û˘Ì‚·Ùfi Û˘ÁÁÂÓ‹ ‹ ÌË Û˘ÁÁÂÓ‹ ‰fiÙË,ÌÂ Èı·ÓfiÙËÙ· Ì·ÎÚ¿˜ ÂÈ‚›ˆÛË˜ ÙˆÓ ·ÛıÂÓÒÓ ÛÂÔÛÔÛÙfi ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ 80% (1,2).

ª˘ÂÏÔÌÔÓÔÎ˘ÙÙ·ÚÈÎ‹ ÏÂ˘¯·ÈÌ›· ÓÂ·ÓÈÎÔ‡ Ù‡Ô˘(Juvenile myelomonocytic leukaemia - JMML)

∏ JMML ·Ó‹ÎÂÈ ÛÙ· ÎÏˆÓÈÎÔ‡ Ù‡Ô˘ ·ÈÌ·ÙÔÏÔ-ÁÈÎ¿ ÓÔÛ‹Ì·Ù· Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·ÚÔ˘Û›·ÂÌ‚Ú˘˚ÎÔ‡ Ù‡Ô˘ ·ÈÌÔÔ›ËÛË˜. ¶·Ú¿ ÙÔ fiÙÈ, ·fiÔÚÈÛÌ¤ÓÔ˘˜ ÂÚÂ˘ÓËÙ¤˜ Û˘˙ËÙÂ›Ù·È Î·È ‰ÈÂÚÂ˘Ó¿Ù·ÈÛÙÔ Ï·›ÛÈÔ ÙˆÓ ª¢™ ÙˆÓ ·È‰ÈÒÓ, ÔÈ ÂÚÈÛÛfiÙÂ-ÚÔÈ ÈÛÙÂ‡Ô˘Ó fiÙÈ ÂÈÎÚ·ÙÂ› Ë Ì˘ÂÏÔ¸ÂÚÏ·ÛÙÈÎ‹Ê‡ÛË ÙË˜ ÓfiÛÔ˘ Î·È ÔÊÂ›ÏÂÈ Ó· ıÂˆÚÂ›Ù·È ˆ˜ ªÀ™‹ Ó· Î·Ù·¯ˆÚÂ›Ù·È ˆ˜ ÂÓ‰È¿ÌÂÛË, ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô·ÓˆÙ¤Úˆ, ÎÏÈÓÈÎ‹ ÔÓÙfiÙËÙ· (bridging disorder) (5).

™˘Ó‹ıˆ˜, Ë ÓfiÛÔ˜ ÚÔÛ‚¿ÏÏÂÈ ·ÁfiÚÈ· (·Ó·ÏÔ-Á›· ·ÁÔÚÈÒÓ ÚÔ˜ ÎÔÚ›ÙÛÈ· ÂÚ›Ô˘ 3:1) ËÏÈÎ›·˜0-4 ÂÙÒÓ (‰È¿ÌÂÛË ËÏÈÎ›· 1,8 ¤ÙË) Î·È ÚÔ‚¿ÏÏÂÈÌÂ ˘ÚÂÙfi, ÂÌÌ¤ÓÔ˘ÛÂ˜ ÏÔÈÌÒÍÂÈ˜, ·ÈÌÔÚÚ·ÁÈÎ¤˜ÂÎ‰ËÏÒÛÂÈ˜ Î·È ÛÙ·ÛÈÌfiÙËÙ· ·Ó¿Ù˘ÍË˜, ÂÓÒÛ·ÓÈfiÙÂÚ· ÚÔÛÙ›ıÂÓÙ·È ÛÙËÓ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ‚‹-¯·˜ Î·È Ù·¯‡ÓÔÈ·. ∞ÓÙÈÎÂÈÌÂÓÈÎ¿ ‰È·ÈÛÙÒÓÂÙ·ÈÂÎÛÂÛËÌ·ÛÌ¤ÓË Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·, ÁÂÓÈÎÂ˘Ì¤-ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·, Í·ÓıÒÌ·Ù· ‰¤ÚÌ·ÙÔ˜,



225

¯·Ú·ÎÙËÚÈÛÙÈÎfi ÂÍ¿ÓıËÌ· ÚÔÛÒÔ˘ ‹ Î·È ÂÎ˙Â-Ì·ÙÔÂÈ‰‹ ‰ÂÚÌ·ÙÈÎ¿ ÛÙÔÈ¯Â›· (1).

™ÙË ÁÂÓÈÎ‹ ÂÍ¤Ù·ÛË ·›Ì·ÙÔ˜ ‰È·ÈÛÙÒÓÂÙ·È ÌÂ-ÙÚ›Ô˘ ‚·ıÌÔ‡ ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÛË, Ô˘ ‰ÂÓ ÍÂÂÚÓ¿fiÌˆ˜ Ù· 105/ÎÎ¯ Î·È Û˘ÓÔ‰Â‡ÂÙ·È ·fi ·ÚÔ˘Û›·‰˘ÛÏ·ÛÙÈÎÒÓ ÎÔÎÎÈÔÎ˘ÙÙ¿ÚˆÓ, ÌÈÎÚfi ·ÚÈıÌfi‚Ï·ÛÙÒÓ, ·˘ÍËÌ¤ÓÔ ·ÚÈıÌfi ÌÔÓÔÎ˘ÙÙ¿ÚˆÓ, ·-ÚÔ˘Û›· ÂÌ‡ÚËÓˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ, ‹È··Ó·ÈÌ›· Î·È ıÚÔÌ‚ÔÂÓ›·. ∆· Â›Â‰· ÙË˜ HbF Â›-Ó·È Û˘Ó‹ıˆ˜ ˘„ËÏ¿, ·ÓÂÚ¯fiÌÂÓ· Î·Ù¿ Î·ÓfiÓ·¿Óˆ ÙÔ˘ 10%, ÂÓ›ÔÙÂ ÍÂÂÚÓÔ‡Ó Î·È ÙÔ 70%, Û‡ÓË-ıÂ˜ ‰Â Â‡ÚËÌ· ·ÔÙÂÏÂ› Î·È Ë ˘ÂÚÁ·ÌÌ·ÛÊ·ÈÚÈ-Ó·ÈÌ›· (2).

O Ì˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ (ªO) Â›Ó·È ˘ÂÚÎ˘ÙÙ·ÚÈ-Îfi˜, ÂÌÊ·Ó›˙ÂÈ ˘ÂÚÏ·Û›· ÙË˜ Ì˘ÂÏÈÎ‹˜ ÛÂÈÚ¿˜ÌÂ Ù·˘Ùfi¯ÚÔÓË ÌÂ›ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÌÂÁ·Î·-Ú˘ÔÎ˘ÙÙ¿ÚˆÓ. O Î·Ú˘fiÙ˘Ô˜ ÙˆÓ Ì˘ÂÏÈÎÒÓ Î˘ÙÙ¿-ÚˆÓ ÛÙÔ 40-67% ÙˆÓ ·ÛıÂÓÒÓ Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi˜,ÛÙÔ 25-35% ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÔÓÔÛˆÌ›· 7 Î·È ÌfiÓÔ ÙÔ10-25% ÙˆÓ ·ÛıÂÓÒÓ ÂÌÊ·Ó›˙ÂÈ ¿ÏÏÔ˘ Ù‡Ô˘ ¯Úˆ-ÌÔÛˆÌ·ÙÈÎ¤˜ ‚Ï¿‚Â˜. ∂Í ÔÚÈÛÌÔ‡, Ë ÓfiÛÔ˜ ‰ÂÓÛ˘Ó‰˘¿˙ÂÙ·È ÌÂ ÌÂÙ¿ıÂÛË t (9;22) (2). ¶ÚfiÛÊ·Ù·,ÌÂÙ¿ ·fi ‰ÈÂıÓ‹ Û˘ÌÊˆÓ›· Ô˘ ÂÂÙÂ‡¯ıË ÌÂÙ·Í‡ÙÔ˘ International JMML Working Group Î·È ÙÔ˘European Working Group on MDS in Childhood(EWOG - MDS), ¤¯Ô˘Ó ıÂÛÈÛÙÂ› ÌÂ›˙ÔÓ· Î·È ÂÏ¿Û-ÛÔÓ· ‰È·ÁÓˆÛÙÈÎ¿ ÎÏÈÓÈÎ¿ Î·È ÂÚÁ·ÛÙËÚÈ·Î¿ ÎÚÈÙ‹-ÚÈ· ÙË˜ ÓfiÛÔ˘, Ì¤¯ÚÈ˜ fiÙÔ˘ Î·ıÔÚÈÛÙÔ‡Ó Ï‹Úˆ˜ÔÈ ‚Ï¿‚Â˜ ÔÈ ÔÔ›Â˜ ÛÂ ÌÔÚÈ·Îfi Â›Â‰Ô ·ÓÈ¯ÓÂ˘fi-ÌÂÓÂ˜ ı· ÙËÓ Ù·˘ÙÔÔÈÔ‡Ó ‰È·ÁÓˆÛÙÈÎ¿. ø˜ ÂÎ ÙÔ‡-ÙÔ˘, Û‹ÌÂÚ· Ë ‰È¿ÁÓˆÛË ÙË˜ JMML Ú¤ÂÈ Ó· ÛÙË-Ú›˙ÂÙ·È ÛÂ Û˘ÁÎÂÎÚÈÌ¤Ó· ‰È·ÁÓˆÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ· (6-8), fiˆ˜ ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2.

∏ Û˘Ó‡·ÚÍË ÙË˜ JMML ÂÈ‰ÈÎfiÙÂÚ· ÌÂ ÌÔÓÔÛˆ-Ì›· 7, ·Ï·ÈfiÙÂÚ· Â›¯Â ¯·Ú·ÎÙËÚÈÛÙÂ› Û·Ó “Û‡Ó‰ÚÔ-ÌÔ ‚ÚÂÊÈÎ‹˜ ÌÔÓÔÛˆÌ›·˜ 7”. ™‹ÌÂÚ·, Ë ‰È¿ÎÚÈÛËÙË˜ ÔÓÙfiÙËÙ·˜ ·˘Ù‹˜ ‰ÂÓ ·Ó·ÁÓˆÚ›˙ÂÙ·È ÂÊfiÛÔÓ Ù·

ÎÏÈÓÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ Î·È Ë ÂÈ‚›ˆÛË ÙˆÓ ·ÛıÂÓÒÓÌÂ JMML Î·È ÌÔÓÔÛˆÌ›· 7 ‰ÂÓ ‰È·Ê¤ÚÔ˘Ó ·fi ÂÎÂ›-Ó· ÙˆÓ ·ÛıÂÓÒÓ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi Î·Ú˘fiÙ˘Ô ‹ ÌÂ¿ÏÏÂ˜ Î·Ú˘ÔÙ˘ÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ (9).

∏ ·ıÔÁ¤ÓÂÈ· ÙË˜ JMML ¤¯ÂÈ ÛËÌ·ÓÙÈÎ¿ ‰ÈÂ-ÚÂ˘ÓËıÂ› Ì¤Ûˆ ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ Î·ÏÏÈÂÚÁÂÈÒÓ ÙˆÓÌ˘ÂÏÈÎÒÓ Î˘ÙÙ¿ÚˆÓ. Ã·Ú·ÎÙËÚÈÛÙÈÎfi ÙË˜ Â‡ÚËÌ·,ÙÔ ÔÔ›Ô Û‹ÌÂÚ· ıÂˆÚÂ›Ù·È “ÂÎ ÙˆÓ ˆÓ Ô˘Î ¿ÓÂ˘”ÛÙÔÈ¯Â›Ô ÙË˜ ‰È¿ÁÓˆÛË˜ ÙË˜ ÓfiÛÔ˘, ·ÔÙÂÏÂ› Ë·ÓÂ‡ÚÂÛË ·˘ÙfiÌ·ÙË˜ ·Ó¿Ù˘ÍË˜ ·ÔÈÎÈÒÓ ÙË˜ÎÔÎÎÈÒ‰Ô˘˜ - ÌÔÓÔÎ˘ÙÙ·ÚÈÎ‹˜ ÛÂÈÚ¿˜ (CFU-GM)¯ˆÚ›˜ ÙËÓ ÂÍˆÁÂÓ‹ ÚÔÛı‹ÎË ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔ-ÓÙ· ÙˆÓ ÎÔÎÎÈÔÎ˘ÙÙ¿ÚˆÓ/ÌÔÓÔ‡ÚËÓˆÓ (Granulo-cyte-monocyte colony stimulating factor - GM-CSF) ÛÂ Î˘ÙÙ·ÚÈÎ¤˜ Î·ÏÏÈ¤ÚÁÂÈÂ˜ Ì˘ÂÏÈÎÒÓ Î˘ÙÙ¿-ÚˆÓ (2). ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ù· Ê˘ÛÈÔÏÔÁÈÎ¿ Î‡ÙÙ·Ú·ÙÔ˘ ªO ··ÈÙÔ‡Ó ÂÍˆÁÂÓ‹ ÚÔÛı‹ÎË ·˘ÍËÙÈÎÒÓ·ÈÌÔÔÈËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÁÈ· Ó· ·Ó·Ù˘¯ıÔ‡Ó invitro Î·È Ó· Û¯ËÌ·Ù›ÛÔ˘Ó ·ÔÈÎ›Â˜, ÁÂÁÔÓfi˜ Ô˘·Ó·ÈÚÂ›Ù·È ÛÙËÓ JMML, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÎÔÎÎÈÒ-‰Ë-ÌÔÓÔÎ˘ÙÙ·ÚÈÎ‹ ÛÂÈÚ¿ Î·È Û·ÊÒ˜ ˘Ô‰ÂÈÎÓ‡ÂÈÙÔÓ Ì˘ÂÏÔ¸ÂÚÏ·ÛÙÈÎfi ÙË˜ ¯·Ú·ÎÙ‹Ú·. ∞Í›˙ÂÈ Ó·ÛËÌÂÈˆıÂ› ÂÈÚfiÛıÂÙ· fiÙÈ Ë ·˘ÙfiÌ·ÙË ·Ó¿Ù˘ÍËÙË˜ Ì˘ÂÏÔÌÔÓÔÎ˘ÙÙ·ÚÈÎ‹˜ ÛÂÈÚ¿˜ ÛÙË JMML invitro ·Ó·ÛÙ¤ÏÏÂÙ·È ÌÂÙ¿ ·fi: ·) ·Ê·›ÚÂÛË ÙˆÓ ÌÔ-ÓÔÎ˘ÙÙ¿ÚˆÓ ·fi ÙÔÓ ªO Î·È ‚) ÚÔÛı‹ÎË ÛÙÈ˜Î˘ÙÙ·ÚÈÎ¤˜ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ·ÓÙÈÛˆÌ¿ÙˆÓ Ô˘ ÛÙÚ¤-ÊÔÓÙ·È Î·Ù¿ ÙÔ˘ GM-CSF Î·È ÙÔ˘ ·Ú¿ÁÔÓÙ· Ó¤-ÎÚˆÛË˜ ÙÔ˘ fiÁÎÔ˘ · (Tumor necrosis factor · -TNF·). ∞fi Ù· ·ÓˆÙ¤Úˆ ÂÈÚ·Ì·ÙÈÎ¿ ‰Â‰ÔÌ¤Ó·ÚÔÎ‡ÙÂÈ fiÙÈ Ù· ÚÔÁÔÓÈÎ¿ Î‡ÙÙ·Ú· ÙË˜ ÎÔÎÎÈÒ-‰Ô˘˜-ÌÔÓÔÎ˘ÙÙ·ÚÈÎ‹˜ ÛÂÈÚ¿˜ ÂÌÊ·Ó›˙Ô˘Ó ·˘ÍËÌ¤-ÓË Â˘·ÈÛıËÛ›· ÛÙÔÓ GM-CSF, ¯ˆÚ›˜ Ó· ‰È·ÈÛÙÒ-ÓÂÙ·È ÛÙÔÓ ÔÚfi ·ıÔÏÔÁÈÎ‹ ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓÙÔ˘ Û˘ÁÎÂÎÚÈÌ¤ÓÔ˘ ·Ú¿ÁÔÓÙ·. ∏ fiÏË ÓfiÛÔ˜ ıÂˆ-ÚÂ›Ù·È ˆ˜ Ë ÎÏÈÓÈÎ‹ Î·È ÂÚÁ·ÛÙËÚÈ·Î‹ ·ÓÙ·Ó¿ÎÏ·-ÛË, ÙË˜ ·ıÔÏÔÁÈÎ‹˜ ·ÚÔ˘Û›·˜ ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi,

¶›Ó·Î·˜ 1. ∫ÏÈÓÈÎ¿ Î·È ÂÚÁ·ÛÙËÚÈ·Î¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ‰È·ÊÔÚÈÎ‹˜ ‰È¿ÁÓˆÛË˜ ÌÂÙ·Í‡ ÙË˜ Ãª§ Ù‡Ô˘ ÂÓËÏ›ÎÔ˘ Î·È ÙË˜ JMML

Ã·Ú·ÎÙËÚÈÛÙÈÎfi JMML Ãª§

ñ ∏ÏÈÎ›· <4 ÂÙÒÓ >4 ÂÙÒÓñ ∞ÁfiÚÈ·:∫ÔÚ›ÙÛÈ· 3:1 1,8:1ñ §Â˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· ¿Óˆ ÙˆÓ 10x105/L ∞Û‡ÓËıÂ˜ ™‡ÓËıÂ˜ñ ∞ÈÌÔÛÊ·ÈÚ›ÓË <12 gr/dL ™‡ÓËıÂ˜ ¶ÔÈÎ›ÏÏÂÈñ ∞ÈÌÔÂÙ¿ÏÈ· ™˘Ó‹ıˆ˜ ÂÏ·ÙÙˆÌ¤Ó· ™˘Ó‹ıˆ˜ ·˘ÍËÌ¤Ó·ñ ªÔÓÔÎ˘ÙÙ¿ÚˆÛË ™‡ÓËıÂ˜ ∞Û‡ÓËıÂ˜ñ ¶ÚÔÓÔÚÌÔ‚Ï¿ÛÙÂ˜ ¡·È ∞Û‡ÓËıÂ˜ñ ∞˘ÍËÌ¤Ó· Â›Â‰· HbF ™‡ÓËıÂ˜ Ÿ¯Èñ §ÂÌÊ·‰ÂÓÔ¿ıÂÈ· ¡·È Ÿ¯Èñ ¢ÂÚÌ·ÙÈÎfi ÂÍ¿ÓıËÌ· ¡·È Ÿ¯Èñ µ·ÎÙËÚÈ·Î¤˜ ÏÔÈÌÒÍÂÈ˜ ™‡ÓËıÂ˜ ∞Û‡ÓËıÂ˜ñ ∞ÈÌÔÚÚ·Á›· ¡·È ∞Û‡ÓËıÂ˜ñ ªÂÈˆÌ¤ÓË ·ÏÎ·ÏÈÎ‹ ÊˆÛÊ·Ù¿ÛË (∞º) ÏÂ˘ÎÒÓ ¶ÔÈÎ›ÏÏÂÈ ™‡ÓËıÂ˜ñ ÃÚˆÌfiÛˆÌ· Ph ‹ ÌÂÙ¿ıÂÛË bcr/abl Ÿ¯È >90-95%ñ ¢È¿ÌÂÛË ÂÈ‚›ˆÛË 1-2 ¤ÙË 4-5 ¤ÙËñ µÏ·ÛÙÈÎ‹ ÎÚ›ÛË ∞Û˘Ó‹ıË˜ ™˘Ó‹ıË˜


‰ÈÂÁÂÚÌ¤ÓˆÓ ÌÔÓÔÎ˘ÙÙ¿ÚˆÓ (10). ∂Ó‰È·Ê¤ÚÔÓ Â‡-ÚËÌ·, Â›ÛË˜, ·ÔÙÂÏÂ› Ë ‰È·›ÛÙˆÛË fiÙÈ ÙÔ cis-ÚÂÙÈÓÔ˚Îfi ÔÍ‡ ÌÂÈÒÓÂÈ ÙË ‰Ú¿ÛË ÙÔ˘ GM-CSF ÛÙ·ÚÔÁÔÓÈÎ¿ Î‡ÙÙ·Ú· ÙË˜ JMML, ÁÂÁÔÓfi˜ Ô˘ ÌÔ-ÚÂ› Ó· ¤¯ÂÈ ‰È·ÁÓˆÛÙÈÎ‹, ·ÏÏ¿ Î·È ıÂÚ·Â˘ÙÈÎ‹·Í›· (1,2,5).

∏ Û˘Û¯¤ÙÈÛË ÙË˜ JMML ÌÂ ÙË ÓÂ˘ÚÔ˚ÓˆÌ¿ÙˆÛËÙ‡Ô˘ π (NF1) ¤¯ÂÈ ·ÔÙÂÏ¤ÛÂÈ ¤Ó· ÂÈÏ¤ÔÓ Â‰›Ô¤ÚÂ˘Ó·˜ ÙË˜ ·ıÔÁ¤ÓÂÈ·˜ ÙË˜ ÓfiÛÔ˘, ‰Â‰ÔÌ¤ÓË˜ÙË˜ ·˘ÍËÌ¤ÓË˜ Â›ÙˆÛË˜ ÙË˜ JMML ÛÂ ·ÛıÂÓÂ›˜ÌÂ NF1. ªÂ ÎÏÈÓÈÎ¿ ÎÚÈÙ‹ÚÈ·, 14% ÙˆÓ JMML·ÛıÂÓÒÓ ÂÌÊ·Ó›˙ÂÈ NF1, ÂÓÒ 7% ÂÌÊ·Ó›˙ÂÈ ¿ÏÏÂ˜Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ ÂÎÙfi˜ ·fi NF1 (11). Ã·Ú·-ÎÙËÚÈÛÙÈÎ¿ ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ë Â›ÙˆÛË ÙË˜ JMMLÛÂ ·È‰È¿ ÌÂ NF1 Â›Ó·È 350 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË ÛÂÛ¯¤ÛË ÌÂ ÙËÓ Â›ÙˆÛË Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ·È‰È¿¯ˆÚ›˜ NF1 (11).

∆Ô ÁÔÓ›‰ÈÔ NF1 ¤¯ÂÈ ‚ÚÂıÂ› fiÙÈ Îˆ‰ÈÎÔÔÈÂ›ÚˆÙÂ˝ÓË (neurofibromin) Ô˘ ÂÌÏ¤ÎÂÙ·È ÛÙËÓ ÂÓ-‰ÔÎ˘ÙÙ¿ÚÈ· ÌÂÙ·ÁˆÁ‹ Û‹Ì·ÙÔ˜ Ì¤Ûˆ ÙË˜ Ô‰Ô‡ÙÔ˘ ras. Àfi Ê˘ÛÈÔÏÔÁÈÎ¤˜ Û˘Óı‹ÎÂ˜, ÙÔ ÁÔÓ›‰ÈÔNF1 ‰Ú· ·Ó·ÛÙ·ÏÙÈÎ¿ ÛÙËÓ Ô‰fi ÌÂÙ·‚›‚·ÛË˜ Û‹-Ì·ÙÔ˜ ÙÔ˘ ras, ÂÓ¤¯ÔÓÙ·˜ È‰ÈfiÙËÙÂ˜ ÔÁÎÔÎ·Ù·-ÛÙ·ÏÙÈÎÔ‡ ÁÔÓÈ‰›Ô˘ ÛÂ ÚÒÈÌË Ê¿ÛË ÙË˜ Ì˘ÂÏÔ-Ô›ËÛË˜. ªÂ ÙËÓ ·Ô˘Û›· ‹ ÙË ÏÂÈÙÔ˘ÚÁÈÎ‹ ·‰Ú·-ÓÔÔ›ËÛË ÙÔ˘ NF1 ÁÔÓÈ‰›Ô˘ Î·È ÙËÓ ¿ÚÛË ÙË˜ ·Ó·-ÛÙ·ÏÙÈÎ‹˜ ÙÔ˘ ‰Ú¿ÛË˜ Â› ÙË˜ ras Ô‰Ô‡, ÚÔÎ‡-ÙÂÈ ÌË ÂÏÂÁ¯fiÌÂÓÔ˜ ÔÏÏ·Ï·ÛÈ·ÛÌfi˜ ÙˆÓ Ì˘ÂÏÈ-ÎÒÓ Î˘ÙÙ¿ÚˆÓ, ÌÂ ıÂˆÚËÙÈÎ‹ Î·Ù¿ÏËÍË ÙËÓ ÂÌÊ¿ÓÈ-ÛË ÙË˜ JMML (2,6,7,12,13). ™ËÌÂÈ·Î¤˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜ÙÔ˘ ras ¤¯Ô˘Ó Â›ÛË˜ ÂÓÔ¯ÔÔÈËıÂ› fiÙÈ ÂÓ¤¯ÔÓÙ·ÈÛÙËÓ ·ıÔÁ¤ÓÂÈ· ÙË˜ JMML ÏfiÁˆ ÂÓÂÚÁÔÔ›ËÛË˜ÙË˜ ·ÓˆÙ¤Úˆ Ô‰Ô‡ ÌÂÙ·‚›‚·ÛË˜ ÙÔ˘ Û‹Ì·ÙÔ˜ (6).

∏ ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÙË˜ ÓfiÛÔ˘ ÂÚÈÏ·Ì‚¿-ÓÂÈ ÔÈÎ›ÏÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜ ·Ó¿ÏÔÁË˜ ÎÏÈÓÈÎÔÂÚÁ·-ÛÙËÚÈ·Î‹˜ ÚÔ‚ÔÏ‹˜, fiˆ˜ Û˘ÁÁÂÓÂ›˜ ÏÔÈÌÒÍÂÈ˜Î·È Û˘Ó‰˘·ÛÌ¤ÓÂ˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈÂ˜. π‰È·›ÙÂÚËÚÔÛÔ¯‹ ··ÈÙÂ›Ù·È ÛÙË ‰È·ÊÔÚÔ‰È¿ÁÓˆÛË ÙË˜ÓfiÛÔ˘ ·fi ÙË ÏÔ›ÌˆÍË ÌÂ ÙÔÓ Èfi Epstein-Barr(EBV) (1,2,9).

¶ÔÈÎÈÏ›· ıÂÚ·Â˘ÙÈÎÒÓ Û¯ËÌ¿ÙˆÓ ¤¯ÂÈ ‰ÔÎÈÌ·-ÛÙÂ› ÛÙËÓ ÚÔÛ¿ıÂÈ· Â›ÙÂ˘ÍË˜ Ï‹ÚÔ˘˜ ‹ ÙÔ˘-Ï¿¯ÈÛÙÔÓ ÌÂÚÈÎ‹˜ ‡ÊÂÛË˜ ÙË˜ JMML (14-17). Ã·-Ú·ÎÙËÚÈÛÙÈÎ¿ ·Ó·Ê¤ÚÔÓÙ·È Ù· Î¿ÙˆıÈ:

·) ∂ÓÙ·ÙÈÎ‹ ¯ËÌÂÈÔıÂÚ·Â›· (Ãª£) Ù‡Ô˘ÔÍÂ›·˜ Ì˘ÂÏÔÁÂÓÔ‡˜ ÏÂ˘¯·ÈÌ›·˜ Û·Ó›ˆ˜ ÂÈÛ¿ÁÂÈÙÔ˘˜ ·ÛıÂÓÂ›˜ ÛÂ ‡ÊÂÛË Î·È ·Ó ÙÔ‡ÙÔ ÂÈÙÂ˘¯ıÂ›,‰È·ÚÎÂ› ÌÈÎÚfi ÌfiÓÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·. ∆Ô ÁÂÁÔÓfi˜ÙË˜ ·˘ÍËÌ¤ÓË˜ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÙfiÙËÙ·˜ Ù¤-ÙÔÈˆÓ ıÂÚ·Â˘ÙÈÎÒÓ Û¯ËÌ¿ÙˆÓ ¤¯ÂÈ Ô‰ËÁ‹ÛÂÈ ÛÙËÓÂÁÎ·Ù¿ÏÂÈ„‹ ÙÔ˘˜ Î·È ÛÙË ¯ÚËÛÈÌÔÔ›ËÛ‹ ÙÔ˘˜ Ìfi-ÓÔ ÂÓ Â›‰ÂÈ ÚÔ·Ú·ÛÎÂ˘·ÛÙÈÎÒÓ Û¯ËÌ¿ÙˆÓ ÚÔÌÂÙ·ÌfiÛ¯Â˘ÛË˜ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ (ªªO).

‚) ◊È· Ãª£ ÌÂ ¯·ÌËÏ¤˜ ‰fiÛÂÈ˜ 6-ÌÂÚÎ·ÙÔ-Ô˘Ú›ÓË˜ Î·È ·Ú·Û˘Ù›ÓË˜ ¤¯ÂÈ ‰ÔÎÈÌ·ÛÙÂ›, ¯ˆÚ›˜fiÌˆ˜ ·ÈÛÈfi‰ÔÍ· ÌËÓ‡Ì·Ù·.

Á) ¶·ÚfiÙÈ ¤¯ÂÈ ‚ÚÂıÂ› fiÙÈ Ë ÈÓÙÂÚÊÂÚfiÓË-· ¤¯ÂÈ·Ó·ÛÙ·ÏÙÈÎ‹ ‰Ú¿ÛË ÛÙËÓ ·˘ÙfiÌ·ÙË ·Ó¿Ù˘ÍË ÙˆÓCFU-GM ·ÔÈÎÈÒÓ ÛÂ in vitro Î˘ÙÙ·ÚÈÎ¤˜ Î·ÏÏÈ¤Ú-ÁÂÈÂ˜, ÛÂ ıÂÚ·Â˘ÙÈÎ‹ ‚¿ÛË ‰ÂÓ ¤¯ÂÈ ÚÔÛÊ¤ÚÂÈıÂÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù·.

‰) ∞Ó¿ÏÔÁË ÌÂ ÙËÓ ÈÓÙÂÚÊÂÚfiÓË-· ‰Ú¿ÛË, ÛÂ invitro ÌÂÏ¤ÙÂ˜, ¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ Î·È ÙÔ 13 cis-ÚÂÙÈ-ÓÔ˚Îfi ÔÍ‡ Î·È ÛÂ ıÂÚ·Â˘ÙÈÎfi Â›Â‰Ô ˘fiÛ¯ÂÙ·ÈÎ·Ï‡ÙÂÚË ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·, Î·ıfiÛÔÓ ÙÔ 40-50% ÙˆÓ ·ÛıÂÓÒÓ ·ÓÙ·ÔÎÚ›ÓÂÙ·È ¯ˆÚ›˜ È‰È·›ÙÂÚËÙÔÍÈÎfiÙËÙ· ÛÂ ‰fiÛÂÈ˜ ÂÚ› Ù· 200 mg/m2 ∂™.

Â) ∂˘ÓÔ˚ÎÔ› ÚÔÁÓˆÛÙÈÎÔ› ‰Â›ÎÙÂ˜ ÁÈ· ÙÔ˘˜·ÛıÂÓÂ›˜ Ô˘ ÚfiÎÂÈÙ·È Ó· ˘Ô‚ÏËıÔ‡Ó ÛÂ ¯ËÌÂÈ-ÔıÂÚ·Â›· ‹ ¿ÏÏÂ˜ ıÂÚ·Â˘ÙÈÎ¤˜ ÚÔÛ¿ıÂÈÂ˜ÏËÓ ªªO ıÂˆÚÔ‡ÓÙ·È: Ë ÙÈÌ‹ ·ÈÌÔÂÙ·Ï›ˆÓ ¿ÓˆÙˆÓ 33x109/L, ËÏÈÎ›· Î¿Ùˆ ÙˆÓ 2 ÂÙÒÓ Î·È Â›Â‰·HbF Î·ÙÒÙÂÚ· ÙÔ˘ 15%.

ÛÙ) ∏ ÌÂÙ·ÌfiÛ¯Â˘ÛË ÚÔÁÔÓÈÎÒÓ ·ÈÌÔÔÈËÙÈ-ÎÒÓ Î˘ÙÙ¿ÚˆÓ Â›Ó·È Û‹ÌÂÚ· Ë ÌÔÓ·‰ÈÎ‹ ıÂÚ·Â›·Ô˘ ¤¯ÂÈ ÂÈÙ‡¯ÂÈ, ÛÂ ¤Ó· ÔÛÔÛÙfi ·ÛıÂÓÒÓ Î˘-Ì·ÈÓfiÌÂÓÔ ·Ó¿ ÌÂÏ¤ÙË ·fi 20-30%, 5ÂÙ‹ Û˘ÓÔÏÈÎ‹ÂÈ‚›ˆÛË. ø˜ ËÁ¤˜ ÌÔÛ¯Â˘Ì¿ÙˆÓ ¤¯Ô˘Ó Ì¤¯ÚÈÛ‹ÌÂÚ· ¯ÚËÛÈÌÔÔÈËıÂ› Û˘ÁÁÂÓÂ›˜ Î·È ÌË Û˘ÁÁÂÓÂ›˜Ï‹Úˆ˜ Û˘Ì‚·ÙÔ› ‹ Î·È ÌÂ ÌÂÚÈÎ‹ Û˘Ì‚·ÙfiÙËÙ·


226

¶›Ó·Î·˜ 2. ªÂ›˙ÔÓ· Î·È ÂÏ¿ÛÛÔÓ· ‰È·ÁÓˆÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ· ÙË˜ JMML

∂Ó‰ÂÈÎÙÈÎ¿ ÎÏÈÓÈÎ¿ ∂Ï¿ÛÛÔÓ· ÂÚÁ·ÛÙËÚÈ·Î¿ ¶ÂÚ·ÈÙ¤Úˆ ‰È·ÁÓˆÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ·¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ· (Ó· ÏËÚÔ‡ÓÙ·È Î·È Ù· 3) ˘Ô‰ÂÈÎÓ‡ÔÓÙ· Û·Ê‹ ‰È¿ÁÓˆÛË

(··ÈÙÔ‡ÓÙ·È ÙÔ˘Ï¿¯ÈÛÙÔÓ 2)

ñ ∏·ÙÔÛÏËÓÔÌÂÁ·Ï›· ñ µÏ¿ÛÙÂ˜ ªO <20% ñ ∞˘ÍËÌ¤Ó· Â›Â‰· HbF ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ËÏÈÎ›·ñ §ÂÌÊ·‰ÂÓÔ¿ıÂÈ· ñ ∞ÚÓËÙÈÎfi ¯ÚˆÌfiÛˆÌ· ñ ¶·ÚÔ˘Û›· ÛÙÔ ¶∞ ¿ˆÚˆÓ ÌÔÚÊÒÓ ÙË˜

ºÈÏ·‰¤ÏÊÂÈ· ‹ ·Ó›¯ÓÂ˘ÛË Ì˘ÂÏÈÎ‹˜ ÛÂÈÚ¿˜ÌÂÙ¿ıÂÛË˜ bcr-abl

ñ ø¯ÚfiÙËÙ· ñ ªÔÓÔÎ‡ÙÙ·Ú· ÛÙÔ ÂÚÈÊÂÚÈÎfi ñ §Â˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· ¿Óˆ ÙˆÓ ·›Ì· (¶∞) ¿Óˆ ÙˆÓ 1x109/L 10x109/L

ñ ¶˘ÚÂÙfi˜ ñ ¶·ÚÔ˘Û›· ÎÏˆÓÈÎÔ‡ Ù‡Ô˘ ‰È·Ù·Ú·¯‹˜ ÂÚÈÏ·Ì‚·ÓÔÌ¤ÓË˜ Î·È ÙË˜ ÌÔÓÔÛˆÌ›·˜ 7

ñ ¢ÂÚÌ·ÙÈÎfi ÂÍ¿ÓıËÌ· ñ ÀÂÚÂ˘·ÈÛıËÛ›· ÛÙÔÓ GM-CSF ÙˆÓ Ì˘ÂÏÈÎÒÓ ÚÔÁÔÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ in vitro


‰fiÙÂ˜, Î·ıÒ˜ Î·È ÔÌÊ¿ÏÈÔ ÌfiÛ¯Â˘Ì·. ∏ Èı·ÓfiÙË-Ù· ˘ÔÙÚÔ‹˜ ÌÂÙ¿ ªªO ·Ó¤Ú¯ÂÙ·È ÂÚ›Ô˘ ÛÙÔ50%. °È· Î·Ï‡ÙÂÚ· ·ÔÙÂÏ¤ÛÌ·Ù· ÛÂ ÂÚ›ÙˆÛË·ÚÔ˘Û›·˜ ÂÎÛÂÛËÌ·ÛÌ¤ÓË˜ ÛÏËÓÔÌÂÁ·Ï›·˜ ¤¯ÂÈÛ˘ÛÙ·ıÂ› ·fi ÔÚÈÛÌ¤ÓÔ˘˜ Ó· ÚÔËÁÂ›Ù·È ÙË˜ ªªOÛÏËÓÂÎÙÔÌ‹, ¯ˆÚ›˜ fiÌˆ˜ ÙÔ‡ÙÔ Ó· Â›Ó·È Â˘Ú‡ÙÂ-Ú· ·Ô‰ÂÎÙfi.

˙) ¢Â‰ÔÌ¤ÓˆÓ ÙˆÓ Ì¤¯ÚÈ Û‹ÌÂÚ· ·Ó·ÊÂÚı¤ÓÙˆÓÌ¿ÏÏÔÓ ·ÔÁÔËÙÂ˘ÙÈÎÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ, Ó¤Â˜ ıÂ-Ú·Â˘ÙÈÎ¤˜ ÚÔÛÂÏ¿ÛÂÈ˜ ÂÈ¯ÂÈÚÔ‡ÓÙ·È ÁÈ· ÙËÓ·ÓÙÈÌÂÙÒÈÛË ÙË˜ JMML ·fi Û˘ÁÎÏ›ÓÔ˘ÛÂ˜ ‰ÈÂ-ıÓÂ›˜ ıÂÚ·Â˘ÙÈÎ¤˜ ÔÌ¿‰Â˜, ÔÈ ÔÔ›Â˜ Î˘Ú›ˆ˜ ·ÊÔ-ÚÔ‡Ó ÛÙË ¯ÔÚ‹ÁËÛË: i) ·ÓÙ·ÁˆÓÈÛÙÈÎÒÓ ÙÔ˘ GM-CSF ·Ó·ÏfiÁˆÓ, ii) Ó¤ˆÓ ·Ú·ÁÒÁˆÓ ÙÔ˘ ÚÂÙÈÓÔ˚-ÎÔ‡ ÔÍ¤Ô˜, iii) ‰ÈÊıÂÚÈÙÈÎ‹˜ ÙÔÍ›ÓË˜ Û˘Ó‰˘·ÛÌ¤ÓË˜ÁÂÓÂÙÈÎ¿ ÌÂ GM-CSF Î·È iv) ·Ó·ÛÙÔÏ¤ˆÓ ÙË˜ ÙÚ·Ó-ÛÊÂÚ¿ÛË˜ ÙË˜ farnesyl-protein.

∞ÏËı‹˜ ÔÏ˘Î˘ÙÙ·Ú·ÈÌ›· (∞¶) ∞ÔÙÂÏÂ› ÂÍ·ÈÚÂÙÈÎ¿ Û¿ÓÈ· ÎÏˆÓÈÎÔ‡ Ù‡Ô˘ ·È-

Ì·ÙÔÏÔÁÈÎ‹ ‰È·Ù·Ú·¯‹ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜. ∏‚Ï¿‚Ë ÙË˜ ∞¶ ÂÓÙÔ›˙ÂÙ·È ÛÙÔ ·Ú¯¤ÁÔÓÔ ÔÏ˘‰‡-Ó·ÌÔ Î‡ÙÙ·ÚÔ (SC) Î·È Ë ÓfiÛÔ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È·fi ·‡ÍËÛË ÙË˜ ÂÚ˘ıÚÔÎ˘ÙÙ·ÚÈÎ‹˜ Ì¿˙·˜ Î·È ÙË˜ÚÔ‰È¿ıÂÛË˜ ÁÈ· ıÚÔÌ‚ˆÙÈÎ¿ ÂÂÈÛfi‰È· (3,4).

∞ÈÙÈÔ·ıÔÁÂÓÂÙÈÎ¿, Ë ∞¶ ‰ÂÓ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙÂ›ÌÂ Û˘ÁÎÂÎÚÈÌ¤ÓË Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎ‹ ‚Ï¿‚Ë. ™ÙÈ˜ Î˘Ù-Ù·ÚÈÎ¤˜ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ‰È·ÈÛÙÒÓÂÙ·È ·˘ÙfiÌ·ÙË·Ó¿Ù˘ÍË Î·Ù’ ÂÍÔ¯‹Ó ÙˆÓ BFU-E ·ÔÈÎÈÒÓ, ¯ˆÚ›˜ÙËÓ ÂÍˆÁÂÓ‹ ÚÔÛı‹ÎË ÂÚ˘ıÚÔÔÈËÙ›ÓË˜ (∂¶O).∆Ô‡ÙÔ ‰ËÏÒÓÂÈ ÙËÓ ·ÓÂÍ¿ÚÙËÙË Ê‡ÛË ÙË˜ ÓfiÛÔ˘·fi Ù· Â›Â‰· ÙË˜ ∂¶O in vivo, Ù· ÔÔ›· ¿ÏÏˆÛÙÂ·ÓÈ¯ÓÂ‡ÔÓÙ·È ÛÙÔÓ ÔÚfi ÙˆÓ ·ÛıÂÓÒÓ ÂÓÙfi˜ ÙˆÓ Ê˘-ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ (18,19). ∂ÚÂ˘ÓËÙÈÎ¤˜ ÚÔÛ¿-ıÂÈÂ˜ ‰ÂÓ ¤¯Ô˘Ó Ì¤¯ÚÈ ÛÙÈÁÌ‹˜ ‰È·ÏÂ˘Î¿ÓÂÈ Ï‹-Úˆ˜ ÙËÓ ·ıÔÁ¤ÓÂÈ· ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜, ·fi ÔÚÈÛÌ¤-ÓÂ˜ fiÌˆ˜ ÌÂÏ¤ÙÂ˜ (3,4,20-23) ¤¯Ô˘Ó ÚÔÎ‡„ÂÈ ÛË-Ì·ÓÙÈÎ¿ Û˘ÌÂÚ¿ÛÌ·Ù·, ÂÎ ÙˆÓ ÔÔ›ˆÓ ÂÈÁÚ·Ì-Ì·ÙÈÎ¿ ÛËÌÂÈÒÓÔÓÙ·È: ·) Ë ‰ÔÌÈÎ‹ Î·È ÏÂÈÙÔ˘ÚÁÈÎ‹·ÎÂÚ·ÈfiÙËÙ· ÙÔ˘ ˘Ô‰Ô¯¤· ÙË˜ ∂¶O, ‚) Ë ·˘ÍËÌ¤-ÓË ¤ÎÊÚ·ÛË ÙˆÓ ÚˆÙÂ˚ÓÒÓ Bcl-x Î·È ÂÈ‰ÈÎfiÙÂÚ·ÙË˜ Bcl-xL, ÔÈ ÔÔ›Â˜ ‰ÚÔ˘Ó ·Ó·ÛÙ¤ÏÏÔÓÙ·˜ ÙËÓ·fiÙˆÛË Î·È Û˘ÌÌÂÙ¤¯ÔÓÙ·˜ ıÂˆÚËÙÈÎ¿ ÛÙËÓ ÙÂ-ÏÈÎ‹ ·‡ÍËÛË ÙË˜ ÂÚ˘ıÚÔÎ˘ÙÙ·ÚÈÎ‹˜ Ì¿˙·˜. ∞ÓÙ›ıÂ-Ù·, ·Ú·ÙËÚÂ›Ù·È ÂÎÛÂÛËÌ·ÛÌ¤ÓË ÌÂ›ˆÛË ÙˆÓ ÂÈ-¤‰ˆÓ ÙÔ˘ ˘Ô‰Ô¯¤· ÙË˜ ıÚÔÌ‚ÔÔÈËÙ›ÓË˜ Î·È ÙË˜ÌÂÙ·ÁˆÁ‹˜ ÙÔ˘ ÂÓ‰ÔÎ˘ÙÙ¿ÚÈÔ˘ Û‹Ì·ÙÔ˜, ÛÙË ÌÂ-Á·Î·Ú˘ÔÎ˘ÙÙ·ÚÈÎ‹ ÛÂÈÚ¿, Á) Ë in vitro ·˘ÍËÌ¤ÓËÂ˘·ÈÛıËÛ›· ÙË˜ ÂÚ˘ıÚ¿˜ ÛÂÈÚ¿˜ ÛÙËÓ ∂¶O, ÙÔÓ·˘ÍËÙÈÎfi ·Ú¿ÁÔÓÙ· ÙË˜ ÈÓÛÔ˘Ï›ÓË˜ (InsulinGrowth Factor 1 - IGF-1) Î·È ÙÔ˘˜ ·˘ÍËÙÈÎÔ‡˜ ·-Ú¿ÁÔÓÙÂ˜ ÙË˜ ÏÂ˘Î‹˜ ÛÂÈÚ¿˜, ÁÂÁÔÓfi˜ Ô˘ Èı·Ó¿ÂÚÌËÓÂ‡ÂÈ Î·È ÙËÓ ·ÚÔ˘Û›· ·˘ÍËÌ¤ÓˆÓ ÏÂ˘ÎÒÓ ·È-ÌÔÛÊ·ÈÚ›ˆÓ ˘fi Û˘Óı‹ÎÂ˜ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÂÈ¤-

‰ˆÓ ÙˆÓ ·ÓˆÙ¤ÚˆÓ ·Ú·ÁfiÓÙˆÓ Î·È ‰) Ë ·˘ÙfiÌ·ÙË·Ó¿Ù˘ÍË, ¯ˆÚ›˜ ÂÍˆÁÂÓ‹ ÚÔÛı‹ÎË ÙˆÓ ·ÓÙ›ÛÙÔÈ-¯ˆÓ ·˘ÍËÙÈÎÒÓ ·ÈÌÔÔÈËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, ÙË˜ÂÚ˘ıÚ¿˜ Î˘Ú›ˆ˜ ‹/Î·È ÙË˜ ÏÂ˘Î‹˜ ÛÂÈÚ¿˜.

∏ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÙË˜ ∞¶ ÔÈÎ›ÏÏÂÈ Î·È Î·Ù’ Ô˘Û›·ÔÊÂ›ÏÂÙ·È ÛÙËÓ ·‡ÍËÛË ÙˆÓ ÙÈÌÒÓ ÙË˜ ·ÈÌÔÛÊ·ÈÚ›-ÓË˜ Î·È ÙÔ˘ ·ÈÌ·ÙÔÎÚ›ÙË, ÂÓÒ ·Ú¿ÏÏËÏ· ·ÓÙ·Ó·-ÎÏ¿ ÙËÓ ·˘ÍËÌ¤ÓË Ù¿ÛË Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ÔÈ ¿Û¯Ô-ÓÙÂ˜ ÁÈ· ıÚÔÌ‚ÒÛÂÈ˜. ∆Ô ·›ÛıËÌ· ˙¿ÏË˜, Ë ÎÂÊ·-Ï·ÏÁ›·, Ë Â‡ÎÔÏË ÎfiˆÛË, Ô ÎÓËÛÌfi˜ Î·È ÔÈ Ó˘¯ÙÂ-ÚÈÓÔ› È‰ÚÒÙÂ˜ Â›Ó·È Ù· Û˘¯ÓfiÙÂÚ· Û˘ÌÙÒÌ·Ù· Ô˘ÂÌÊ·Ó›˙Ô˘Ó Ù· ·È‰È¿ ÌÂ ∞¶. ∆· ıÚÔÌ‚ˆÙÈÎ¿ ÂÂÈ-Ûfi‰È·, Ô˘ ·ÔÙÂÏÔ‡Ó ÙË Û˘¯ÓfiÙÂÚË ÂÎ‰‹ÏˆÛËÙË˜ ÓfiÛÔ˘ ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ ¿Û¯ÔÓÙÂ˜, Â›Ó·È Û¿ÓÈ·ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·. ∞fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË‰È·ÈÛÙÒÓÂÙ·È ÛÂ fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÛÏËÓÔÌÂ-Á·Ï›· (1,2,5,24).

∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, Ë ‰È¿ÁÓˆÛË ÙË˜∞¶ Ù›ıÂÙ·È ÂÊfiÛÔÓ ·ÔÎÏÂÈÛÙÔ‡Ó ¿ÏÏÂ˜ ·ıÔÏÔÁÈ-Î¤˜ Î·Ù·ÛÙ¿ÛÂÈ˜ Û˘Ó‰˘·˙fiÌÂÓÂ˜ ÌÂ ÔÏ˘ÂÚ˘ıÚ·È-Ì›·. °È· ÙË ‰È¿ÁÓˆÛË ÙË˜ ÓfiÛÔ˘, Ë PolycythemiaVera Study Group (PVSG) ¤¯ÂÈ ıÂÛ›ÛÂÈ ÎÚÈÙ‹ÚÈ·‚¿ÛÂÈ ÙˆÓ ÔÔ›ˆÓ Â‰Ú·ÈÒÓÂÙ·È Ë ‰È¿ÁÓˆÛË(3,25,26). ∆Ô‡Ù· ·ÊÔÚÔ‡Ó ÛÙËÓ ·ÓÂ‡ÚÂÛË: ·) Ì¿-˙·˜ ÂÚ˘ıÚÒÓ ÌÂÁ·Ï‡ÙÂÚË˜ ·fi 36 ÁÈ· ÙÔ˘˜ ¿Ó-‰ÚÂ˜ Î·È 32 mL/kg µ™ ÁÈ· ÙÈ˜ Á˘Ó·›ÎÂ˜, ‚) ÎÔÚÂ-ÛÌÔ‡ ·ÚÙËÚÈ·ÎÔ‡ ·›Ì·ÙÔ˜ ¿Óˆ ÙÔ˘ 92% Î·È Á)ÛÏËÓÔÌÂÁ·Ï›·˜ ÛÙËÓ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË.

™Â ÂÚ›ÙˆÛË Î·Ù¿ ÙËÓ ÔÔ›· ‰ÂÓ ··ÓÙÒÓÙ·ÈÎ·È ÔÈ ÙÚÂÈ˜ ÚÔ·Ó·ÊÂÚıÂ›ÛÂ˜ ÚÔ¸Ôı¤ÛÂÈ˜, ÙfiÙÂ··ÈÙÂ›Ù·È Ë ·ÓÂ‡ÚÂÛË ‰‡Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙˆÓ ·Óˆ-Ù¤Úˆ ÎÚÈÙËÚ›ˆÓ, ÌÂ Û‡Á¯ÚÔÓË ·ÚÔ˘Û›·: ·) ÙÈÌ‹˜·ÈÌÔÂÙ·Ï›ˆÓ ¿Óˆ ÙˆÓ 400.000/ÎÎ¯, ‚) ·ÚÈıÌÔ‡ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ¿Óˆ ·fi 12.000/ÎÎ¯, ¯ˆÚ›˜Û˘Ó‡·ÚÍË ˘ÚÂÙÔ‡ ‹ ÛËÌÂ›ˆÓ ÏÔ›ÌˆÍË˜, Á) ·˘ÍË-Ì¤ÓË˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜ ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·È-Ú›ˆÓ (LAP score ¿Óˆ ÙÔ˘ 100) Î·È ‰) ‰ÂÛÌÂ˘ÙÈÎ‹˜ÈÎ·ÓfiÙËÙ·˜ ‚ÈÙ·Ì›ÓË˜ µ12 ÌÂÁ·Ï‡ÙÂÚË˜ ·fi 2.200.

™ÙË ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÙË˜ ∞¶ ÂÓÙ¿ÛÛÔÓÙ·ÈÓÔÛ‹Ì·Ù· Ô˘ Û˘Ó‰¤ÔÓÙ·È ÌÂ ÂÌÊ¿ÓÈÛË ‰Â˘ÙÂÚÔ-·ıÔ‡˜ ÔÏ˘ÂÚ˘ıÚ·ÈÌ›·˜, Â›ÙÂ ÏfiÁˆ ÈÛÙÈÎ‹˜ ˘Ô-Í›·˜ Â›ÙÂ ÏfiÁˆ ÏÂÈÙÔ˘ÚÁÈÎ‹˜ ‰È·Ù·Ú·¯‹˜ ÙÔ˘ ˘Ô-‰Ô¯¤· ÙË˜ ∂¶O (3,22,27).

™ËÌ·ÓÙÈÎ‹ ·Ú¿ÌÂÙÚÔ ·ÔÙÂÏÂ› Ë ‰È·ÊÔÚÈÎ‹‰È¿ÁÓˆÛË ÙˆÓ ÚˆÙÔ·ıÒÓ ·fi ÙÈ˜ ‰Â˘ÙÂÚÔ·-ıÂ›˜ ÔÏ˘ÂÚ˘ıÚ·ÈÌ›Â˜, ÙÈ˜ ÚÔÎ·ÏÔ‡ÌÂÓÂ˜ ·fi˘ÊÈÛÙ¿ÌÂÓË ÈÛÙÈÎ‹ ˘ÔÍ›· (.¯. ·ÚÔ˘Û›· ·ÈÌÔ-ÛÊ·ÈÚÈÓÒÓ ÌÂ ˘„ËÏÔ‡ ‚·ıÌÔ‡ Û˘ÁÁ¤ÓÂÈ· ÌÂ ÙÔ O2,¤ÏÏÂÈ„Ë ÙÔ˘ 2,3 DPG) Î·È ÙË Û˘Ó·ÎfiÏÔ˘ıË ·‡ÍËÛËÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ ∂¶O. ™Â ÔÚÈÛÌ¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜‰È·ÈÛÙÒÓÂÙ·È ˘¤ÚÌÂÙÚË ·Ú·ÁˆÁ‹ ∂¶O Ì¤Ûˆ·‰ÈÂ˘ÎÚ›ÓÈÛÙˆÓ Ì¤¯ÚÈ Û‹ÌÂÚ· ·ÈÙÈÔ·ıÔÁÂÓÂÙÈÎÒÓÌË¯·ÓÈÛÌÒÓ. ø˜ ¤Ó·˜ Ù¤ÙÔÈÔ˜ ÌË¯·ÓÈÛÌfi˜ ·Ó·Ê¤-ÚÂÙ·È Ë ·‰˘Ó·Ì›· ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ó· ·ÓÙÈÏËÊıÔ‡Ó


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ÙËÓ Â¿ÚÎÂÈ· O2 Ô˘ ÙÔ˘˜ ÚÔÛÊ¤ÚÂÙ·È Ì¤Ûˆ ÙË˜·ÈÌ·ÙÈÎ‹˜ Ô‰Ô‡, ÌÂ Â·ÎfiÏÔ˘ıË ÙËÓ ·Ï›Ó‰ÚÔÌË ÌÂ-Ù·‚›‚·ÛË ÂÓÈÛ¯˘ÙÈÎÔ‡ Û‹Ì·ÙÔ˜ ÁÈ· ÂÚ·ÈÙ¤Úˆ ·‡ÍË-ÛË ÙË˜ ·Ú·ÁˆÁ‹˜ ÙË˜ ∂¶O (1,2).

∏ ÚˆÙÔ·ı‹˜ ÔÈÎÔÁÂÓ‹˜ Î·È Ë Û˘ÁÁÂÓ‹˜ Ô-Ï˘ÂÚ˘ıÚ·ÈÌ›· (primary familial and congenitalpolycythaemia - PFCP) ·ÔÙÂÏÔ‡Ó ˘ÔÔÌ¿‰Â˜ÙˆÓ ÔÈÎÔÁÂÓÒÓ ÔÏ˘Î˘ÙÙ·Ú·ÈÌÈÒÓ Ô˘ ··ÓÙÒ-ÓÙ·È ÛÙË ÓÂ·Ú‹ ‹ ÂÊË‚ÈÎ‹/·È‰ÈÎ‹ ËÏÈÎ›·. OÈ Â-ÚÈÛÛfiÙÂÚÂ˜ ÂÍ ·˘ÙÒÓ Â›Ó·È Â›ÎÙËÙÂ˜, ·ÏÏ¿ ˘¿Ú-¯Ô˘Ó Î·È ÎÏËÚÔÓÔÌÔ‡ÌÂÓÂ˜ ÌÔÚÊ¤˜ ÙË˜ ÓfiÛÔ˘.™ÙÈ˜ ÎÏËÚÔÓÔÌÔ‡ÌÂÓÂ˜ PFCP, Ë ÓfiÛÔ˜ Î·Ù¿ Î·Ófi-Ó· ÌÂÙ·‚È‚¿˙ÂÙ·È ÌÂ ÙÔÓ ÛˆÌ·ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ·¯·Ú·ÎÙ‹Ú·, Û·ÓÈfiÙÂÚ· ÌÂ ÙÔÓ ˘ÔÏÂÈfiÌÂÓÔ Ûˆ-Ì·ÙÈÎfi, ·ÏÏ¿ ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› Î·È ÛÔÚ·‰ÈÎ¤˜ÌÔÚÊ¤˜ (1,27).

£ÂˆÚËÙÈÎ¿ ·Ó·Ê¤ÚÔÓÙ·È ·ÚÎÂÙÔ› Èı·ÓÔ› ·-ıÔÁÂÓÂÙÈÎÔ› ÌË¯·ÓÈÛÌÔ› Î·È ·›ÙÈ· ˘Â‡ı˘Ó· ÁÈ· ÙËÓÂÌÊ¿ÓÈÛË ÙË˜ PFCP. ™Ù· ·›ÙÈ· ·˘Ù¿ ÂÚÈÏ·Ì‚¿ÓÔ-ÓÙ·È Ë ·˘ÍËÌ¤ÓË Â˘·ÈÛıËÛ›· ÙˆÓ ÓÂÊÚÈÎÒÓ ·ÈÛıË-ÙËÚ›ˆÓ ÌË¯·ÓÈÛÌÒÓ ÛÙ· Â›Â‰· ÙÔ˘ O2, Ô ÌÂÁ¿-ÏÔ˜ ·ÚÈıÌfi˜ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ÙË˜ ∂¶O Ô˘ ÂÌÊ·-Ó›˙Ô˘Ó Ù· ÚÔÁÔÓÈÎ¿ Î‡ÙÙ·Ú· ÙË˜ ÂÚ˘ıÚ¿˜ ÛÂÈÚ¿˜Î·È, Ù¤ÏÔ˜, Ë ̆ „ËÏ‹ Û˘ÁÁ¤ÓÂÈ· ÌÂÙ·Í‡ ÙË˜ ∂¶O Î·ÈÙÔ˘ ˘Ô‰Ô¯¤· ÙË˜ (3).

O ˘Ô‰Ô¯¤·˜ ÙË˜ ∂¶O Â›Ó·È ÁÓˆÛÙfi fiÙÈ ·Ô-ÙÂÏÂ›Ù·È ·fi 3 ÙÌ‹Ì·Ù·, ÙÔ ÂÍˆÎ˘ÙÙ¿ÚÈÔ, ÙÔ ‰È·-ÌÂÌ‚Ú·ÓÈÎfi Î·È ÙÔ Î˘ÙÙ·ÚÔÏ·ÛÌ·ÙÈÎfi. ™ÙÔ Ï·›-ÛÈÔ ÙË˜ ÂÚÂ˘ÓËÙÈÎ‹˜ ÚÔÛ¤ÁÁÈÛË˜ ÙË˜ PFCP¤¯Ô˘Ó ÂÓÙÔÈÛÙÂ› 7 ‰È·ÊÔÚÂÙÈÎ¤˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÙÔ˘ÁÔÓÈ‰›Ô˘ Ô˘ Îˆ‰ÈÎÔÔÈÂ› ÙÔÓ ˘Ô‰Ô¯¤· ÙË˜ ∂¶OÛÂ ¿Û¯ÔÓÙÂ˜. ŸÏÂ˜ ÔÈ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ¤¯ÂÈ ‚ÚÂıÂ› fiÙÈÂ‰Ú¿˙ÔÓÙ·È ÛÙÔ ÂÍfiÓÈÔ 8, ÛÂ ÂÚÈÔ¯‹ Ô˘ Îˆ‰ÈÎÔ-ÔÈÂ› ·ÚÓËÙÈÎ‹ Ú˘ıÌÈÛÙÈÎ‹ ‰Ú¿ÛË ÙÔ˘ ˘Ô‰Ô¯¤·,ÌÂ ·ÔÙ¤ÏÂÛÌ· Ì¤Ûˆ ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ·˘ÙÒÓ Ó··›ÚÂÙ·È Î·È Ë ·ÓˆÙ¤Úˆ ·Ó·ÊÂÚıÂ›Û· ‰˘Ó·ÙfiÙËÙ··ÚÓËÙÈÎ‹˜ Ú‡ıÌÈÛË˜ ÙË˜ ÂÚ˘ıÚÔÔ›ËÛË˜ (3,22).

ø˜ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÁÓˆÚ›ÛÌ·Ù· ÙË˜ PFCP ıÂ-ˆÚÔ‡ÓÙ·È: ·) Ë ·‡ÍËÛË ÙË˜ ÂÚ˘ıÚÔÎ˘ÙÙ·ÚÈÎ‹˜ Ì¿-˙·˜, ¯ˆÚ›˜ fiÌˆ˜ ‰È·¯ÚÔÓÈÎ¤˜ ‰È·Î˘Ì¿ÓÛÂÈ˜, ‚) Ë·Ô˘Û›· ¿ÏÏˆÓ ·ÈÙ›ˆÓ Ô˘ ÚÔÎ·ÏÔ‡Ó ‰Â˘ÙÂÚÔ-·ı‹ ÔÏ˘ÂÚ˘ıÚ·ÈÌ›·, Á) Ë ·Ô˘Û›· ÎÏÈÓÈÎÔÂÚÁ·-ÛÙËÚÈ·ÎÒÓ ÂÓ‰Â›ÍÂˆÓ Ô˘ Ó· Û˘ÓËÁÔÚÔ‡Ó ˘¤Ú∞¶, ÂÚÈÏ·Ì‚·ÓÔÌ¤ÓË˜ Î·È ÙË˜ ·ÒÙÂÚË˜ Èı·Ófi-ÙËÙ·˜ ÂÍ¤ÏÈÍË˜ ÛÂ ÔÍÂ›· ÏÂ˘¯·ÈÌ›· Î·È ‰) Ë Â›‰ÂÈ-ÍË ·fi Ù· ÚÔÁÔÓÈÎ¿ Î‡ÙÙ·Ú· ÙË˜ ÂÚ˘ıÚ¿˜ ÛÂÈ-Ú¿˜ ·˘ÍËÌ¤ÓË˜ Â˘·ÈÛıËÛ›·˜ ÛÙËÓ ∂¶O ÛÂ Â›Â-‰· Ê˘ÛÈÔÏÔÁÈÎ¿ ‹ Î·È ¯·ÌËÏfiÙÂÚ· ÙˆÓ Ê˘ÛÈÔÏÔÁÈ-ÎÒÓ in vitro ÛÂ Î˘ÙÙ·ÚÈÎ¤˜ Î·ÏÏÈ¤ÚÁÂÈÂ˜, ¯ˆÚ›˜fiÌˆ˜ Ó· ‰È·ÈÛÙÒÓÂÙ·È Î·È ·˘ÙfiÌ·ÙË ·Ó¿Ù˘ÍËBFU-E ·ÔÈÎÈÒÓ, ÁÂÁÔÓfi˜ Ô˘ ·ÓÙ›ıÂÙ· ¯·Ú·ÎÙË-Ú›˙ÂÈ ÙËÓ ∞¶.

£ÂÚ·Â˘ÙÈÎ¿, ˆ˜ ·Ú¯ÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ∞¶˘‹ÚÍ·Ó ÔÈ ·Ê·ÈÌ¿ÍÂÈ˜. ªÂ ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯Úfi-

ÓÔ˘, fiÌˆ˜, ‰È·ÈÛÙÒıËÎÂ fiÙÈ ÌÂ ÙÈ˜ ·Ê·ÈÌ¿ÍÂÈ˜·˘Í·ÓfiÙ·Ó Ë Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜ Ì˘ÂÏÔ˝ÓˆÛË˜Î·È ·ÎÔÏÔ‡ıˆ˜ ÂÁÎ·Ù·ÏÂ›ÊıËÎÂ Û·Ó ıÂÚ·Â˘ÙÈÎ‹Ì¤ıÔ‰Ô˜, È‰È·›ÙÂÚ· ÛÙ· ÓÂ·Ú¿ ¿ÙÔÌ· (28). ∞ÓÙ›ıÂ-Ù·, ıÂˆÚÂ›Ù·È fiÙÈ ÔÈ ·Ê·ÈÌ¿ÍÂÈ˜ ÌÔÚÂ› Ó· ·ÔÙÂ-ÏÔ‡Ó ıÂÚ·Â›· ÂÎÏÔÁ‹˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ·ÌÈÁ‹ Ô-Ï˘ÂÚ˘ıÚ·ÈÌ›·, ÔÈ ÔÔ›ÔÈ ‰ÂÓ ÂÌÊ·Ó›˙Ô˘Ó ÚÔÔÙÈ-Î¿ ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ Ì˘ÂÏÔ˝ÓˆÛË˜ (29). O Ú·‰ÈÂ-ÓÂÚÁfi˜ ÊÒÛÊÔÚÔ˜ (32ƒ) ·Ó‹ÎÂÈ ÛÙÔ˘˜ ÔÏ‡ ·Ô-ÙÂÏÂÛÌ·ÙÈÎÔ‡˜ Î·È Î·Ï¿ ·ÓÂÎÙÔ‡˜ ıÂÚ·Â˘ÙÈÎÔ‡˜·Ú¿ÁÔÓÙÂ˜, ÚÔÛÊ¤ÚÔÓÙ·˜ Ì·ÎÚ¿ ÂÈ‚›ˆÛË ÌÂÎ·Ï‹ ÔÈfiÙËÙ· ˙ˆ‹˜. ∏ ¯Ú‹ÛË ÙÔ˘ ÂÁÎ˘ÌÔÓÂ› ÎÈÓ-‰‡ÓÔ˘˜ ÂÌÊ¿ÓÈÛË˜ ÔÍÂ›·˜ ÏÂ˘¯·ÈÌ›·˜ Î·È ‰ÂÓ Û˘-ÓÈÛÙ¿Ù·È ÛÂ ÓÂ·Ú‹˜ ËÏÈÎ›·˜ ·ÛıÂÓÂ›˜, ÙˆÓ ÔÔ›ˆÓÙÔ ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›ˆÛË˜ Â›Ó·È Ì·ÎÚfi (29). ∏˘‰ÚÔÍ˘Ô˘Ú›· Â›Ó·È ÈÛ¯˘Úfi˜ ÌË ·ÏÎ˘ÏÈÔ‡ÓÙ·˜ Ì˘Â-ÏÔÎ·Ù·ÛÙ·ÏÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ ·Ó·ÛÙ¤ÏÏÂÈÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ì¤Ûˆ ÌÂ›ˆ-ÛË˜ ÙË˜ Û‡ÓıÂÛË˜ ÙÔ˘ DNA. ™Ù· ÏÂÔÓÂÎÙ‹Ì·Ù·ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Û˘ÁÎ·Ù·Ï¤ÁÔÓÙ·È Ë Â‡ÎÔÏË Ï‹„Ë·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Î·È Ë Î·Ï‹ ·ÓÔ¯‹, Ô˘ ÙÔ Î·ıÈ-ÛÙÔ‡Ó È‰È·›ÙÂÚ· ¯Ú‹ÛÈÌÔ ÛÂ Ì·ÎÚÔ¯ÚfiÓÈ· ·ÁˆÁ‹.∏ ˘‰ÚÔÍ˘Ô˘Ú›· ÌÂÈÒÓÂÈ Ù· Â›Â‰· ÙÔ˘ ·ÈÌ·ÙÔ-ÎÚ›ÙË, ÙÔÓ ·ÚÈıÌfi ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ·Ó·ÎÔ˘-Ê›˙ÂÈ ·fi ÙÔ ·›ÛıËÌ· ÎÓËÛÌÔ‡ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ∞¶. ∏ ·ÒÙÂÚË ÏÂ˘¯·ÈÌÔÁfiÓÔ˜ ‰Ú¿ÛË ÙË˜, ·Ó Î·È˘·ÚÎÙ‹, ıÂˆÚÂ›Ù·È Û¯ÂÙÈÎ¿ ¯·ÌËÏ‹ ÂÓÒ Ê·›ÓÂÙ·ÈÌ¿ÏÏÔÓ fiÙÈ ÌÂÈÒÓÂÈ ÎÏÈÓÈÎ¿ Ù· ıÚÔÌ‚ˆÙÈÎ¿ ÂÂÈÛfi-‰È·, Ù· ÔÔ›· ·ÔÙÂÏÔ‡Ó Î·È ÌÂ›˙ÔÓ· ·Ú¿ÁÔÓÙ·ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜. °È· ÙÔ ÏfiÁÔ ·˘Ùfi·ÔÙÂÏÂ› Û‹ÌÂÚ· ıÂÚ·Â›· ÂÎÏÔÁ‹˜ ÛÙÔ˘˜ ·ÛıÂ-ÓÂ›˜ ÌÂ ∞¶ (30).

π‰ÈÔ·ı‹˜ ıÚÔÌ‚ÔÎ˘ÙÙ·Ú·ÈÌ›· (Essentialthrombocythaemia - ET)

H ET Â›Ó·È ÂÍ·ÈÚÂÙÈÎ¿ Û¿ÓÈ· ÓÔÛÔÏÔÁÈÎ‹ ÔÓÙfi-ÙËÙ· ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· Î·È Ì¤¯ÚÈ Û‹ÌÂÚ· ¤¯Ô˘ÓÂÚÈÁÚ·ÊÂ› ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ÂÚ› ÙÈ˜ 20 ÂÚÈ-ÙÒÛÂÈ˜ (31,32). ™·Ó ·ÈÌ·ÙÔÏÔÁÈÎfi ÓfiÛËÌ· Û˘-ÁÎ·Ù·Ï¤ÁÂÙ·È ÛÙÈ˜ ÎÏˆÓÈÎÔ‡ Ù‡Ô˘ ‰È·Ù·Ú·¯¤˜ÙÔ˘ ·Ú¯¤ÁÔÓÔ˘ ·ÈÌÔÔÈËÙÈÎÔ‡ Î˘ÙÙ¿ÚÔ˘, ·ÚfiÙÈ˘¿Ú¯Ô˘Ó ÔÚÈÛÌ¤ÓÂ˜ ÌÂÏ¤ÙÂ˜ Ô˘ Û˘ÓËÁÔÚÔ‡Ó,ÛÂ Î¿ÔÈÂ˜ ÂÚÈÙÒÛÂÈ˜, ˘¤Ú ÔÏ˘ÎÏˆÓÈÎÔ‡ ÓÔ-Û‹Ì·ÙÔ˜. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· ÙË˜ Ófi-ÛÔ˘, ‰ÂÓ ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ› Û˘Û¯¤ÙÈÛ‹ ÙË˜ ÌÂ Û˘-ÁÎÂÎÚÈÌ¤ÓÔ ÁÔÓ›‰ÈÔ, ÂÓÒ ÔÈ ¯ÚˆÌÔÛˆÌ·ÙÈÎ¤˜ ‚Ï¿-‚Â˜ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ˘˜ ¿Û¯ÔÓÙÂ˜ Â›Ó·ÈÂÍ·ÈÚÂÙÈÎ¿ Û¿ÓÈÂ˜ (3).

∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÙÔ ÂÚÂ˘ÓËÙÈÎfi ÂÓ‰È·Ê¤-ÚÔÓ ¤¯ÂÈ ÛÙÚ·ÊÂ› ÛÙËÓ ·ÏÏËÏÂ›‰Ú·ÛË ÙË˜ ıÚÔÌ-‚ÔÔÈËÙ›ÓË˜ (∆ƒO) ÌÂ ÙÔÓ Î˘ÙÙ·ÚÈÎfi ÙË˜ ˘Ô‰Ô-¯¤· (c-Mpl) Î·È ÙËÓ ÂÓ‰ÔÎ˘ÙÙ¿ÚÈ· ÌÂÙ·ÁˆÁ‹ Û‹-Ì·ÙÔ˜. ∞˘Ùfi Ô˘ ¤¯ÂÈ ‰È·ÈÛÙˆıÂ› Â›Ó·È fiÙÈ Ù· Â›-Â‰· ÙË˜ ∆ƒO, Î·Ù¿ Î‡ÚÈÔ ÏfiÁÔ, Ú˘ıÌ›˙ÔÓÙ·È ·fi


228


ÙÔ ‚·ıÌfi Û‡Ó‰ÂÛ‹˜ ÙË˜ ÌÂ ÙÔÓ c-Mpl. º·›ÓÂÙ·È ‰ÂfiÙÈ ˘„ËÏ¿ Â›Â‰· ÙË˜ ∆ƒO ‰˘Ó·ÙfiÓ Ó· ÚÔÎ‡-ÙÔ˘Ó ÏfiÁˆ ÂÓ‰ÔÁÂÓÔ‡˜ ÌÂÙ·ÁÚ·ÊÈÎÔ‡ ÂÏÏÂ›ÌÌ·-ÙÔ˜ ÙÔ˘ c-Mpl, ÌÂ ·ÔÙ¤ÏÂÛÌ· Ë Î¿ı·ÚÛË ÙË˜ ∆ƒOÓ· Â›Ó·È ÌÂÈˆÌ¤ÓË Î·È ¿Ú· Ù· Â›Â‰¿ ÙË˜ ÛÙÔÓÔÚfi Î·ıÒ˜ Î·È Ë ÏÂÈÙÔ˘ÚÁÈÎ‹ ÙË˜ ‰Ú·ÛÙËÚÈfiÙËÙ·ÛÙÔ˘˜ ¿Û¯ÔÓÙÂ˜ Ó· Â›Ó·È ·˘ÍËÌ¤Ó· (4).

∆· ÎÚÈÙ‹ÚÈ· Ô˘ ¤¯ÂÈ ıÂÛ›ÛÂÈ Ë PVSG ÁÈ· ÙË‰È¿ÁÓˆÛË ÙË˜ ÓfiÛÔ˘ ÛÂ ÂÓ‹ÏÈÎÂ˜ Î·È ·È‰È·ÙÚÈ-ÎÔ‡˜ ·ÛıÂÓÂ›˜ Â›Ó·È Ù· ÂÍ‹˜ (3): ·) ÙÈÌ‹ ·ÈÌÔÂÙ·-Ï›ˆÓ ¿Óˆ ÙˆÓ 600x109/L ÛÂ 2 ÌÂÙÚ‹ÛÂÈ˜ ÌÂ ‰È·ÊÔ-Ú¿ ÂÓfi˜ ÌËÓfi˜, ‚) ·ÔÎÏÂÈÛÌfi˜ ¿ÏÏˆÓ Î·Ù·ÛÙ¿ÛÂ-ˆÓ Ô˘ ÚÔÎ·ÏÔ‡Ó ıÚÔÌ‚ÔÎ˘ÙÙ¿ÚˆÛË, Á) ÙÈÌ‹ ·È-Ì·ÙÔÎÚ›ÙË Î¿Ùˆ ÙÔ˘ 40% ‹ Ê˘ÛÈÔÏÔÁÈÎ‹ Ì¿˙· ÂÚ˘-ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ, ·Ó¿ÏÔÁ· ÌÂ ÙÔ Ê‡ÏÔ ÙˆÓ·ÛıÂÓÒÓ, ‰) Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÙÈÌ¤˜ MCV, ÊÂÚÚÈÙ›ÓË˜ÔÚÔ‡ ‹ ÛÈ‰‹ÚÔ˘ ÛÙÔ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ (ªO), Â)·Ô˘Û›· ›ÓˆÛË˜ ÙÔ˘ ªO ‹ ›ÓˆÛË ÙÔ˘ ªO ÛÂ ÌÈ-ÎÚfiÙÂÚÔ ÙÔ˘ 1/3 ÙÔ˘ ˘ÏÈÎÔ‡ ÙË˜ ÔÛÙÂÔÌ˘ÂÏÈÎ‹˜‚ÈÔ„›·˜, ¯ˆÚ›˜ ·˘Ù‹ Ó· Û˘ÓÔ‰Â‡ÂÙ·È ·fi ÛÏËÓÔ-ÌÂÁ·Ï›· ‹ ÏÂ˘ÎÔÂÚ˘ıÚÔ‚Ï·ÛÙÈÎ‹ ·ÓÙ›‰Ú·ÛË Î·ÈÛÙ) ·Ô˘Û›· ¯ÚˆÌÔÛÒÌ·ÙÔ˜ ºÈÏ·‰¤ÏÊÂÈ·˜ ‹ ¿Ï-ÏË˜ ÌÂÙ¿ıÂÛË˜ ÙˆÓ ÂÚÈÔ¯ÒÓ bcr/abl.

∏ Û˘¯ÓfiÙËÙ· ÙË˜ ÓfiÛÔ˘ Â›Ó·È ·Ó¿ÏÔÁË ÌÂ ·˘Ù‹ÙË˜ ∞¶, Ë ‰È¿ÌÂÛË ËÏÈÎ›· ‰È¿ÁÓˆÛË˜ Ù· 65 ¤ÙË,ÂÓÒ ÌfiÓÔ ÙÔ 10-25% ÙˆÓ ·Û¯fiÓÙˆÓ ‰È·ÁÈÁÓÒÛÎÂ-Ù·È ÛÂ ËÏÈÎ›· ÌÈÎÚfiÙÂÚË ÙˆÓ 40 ÂÙÒÓ Î·È, Î·Ù¿ Û˘-Ó¤ÂÈ·, ÂÌÊ·Ó›˙ÂÙ·È ÂÍ·ÈÚÂÙÈÎ¿ Û¿ÓÈ· ÛÙËÓ ·È‰È-Î‹ ËÏÈÎ›· (1,2,5,31,33,34).

∏ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÙË˜ ÓfiÛÔ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ·È-ÌÔÚÚ·Á›Â˜, ıÚÔÌ‚ÒÛÂÈ˜, ÌÈÎÚÔ·ÁÁÂÈ·Î¿ ¤ÌÊÚ·-ÎÙ· ÌÂ ÏÂÈÙÔ˘ÚÁÈÎ¿ Û˘ÌÙÒÌ·Ù·, fiˆ˜ ·Ú·ÈÛıË-Û›·, ÎÂÊ·Ï·ÏÁ›·, ·ÈÛıËÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜, Î·Ù·-ÛÙ¿ÛÂÈ˜ ÔÈ ÔÔ›Â˜ Ô‰ËÁÔ‡Ó ÌÂÚÈÎ¤˜ ÊÔÚ¤˜ ÛÂ ÛÔ-‚·Ú‹ ÓÔÛËÚfiÙËÙ· (35). ™Ô‚·Ú¿ ıÚÔÌ‚ˆÙÈÎ¿ ÂÂÈ-Ûfi‰È· ÂÌÊ·Ó›˙ÂÈ ÙÔ 20-30% ÙˆÓ ·Û¯fiÓÙˆÓ, ÌÂ Î‡-ÚÈÔ˘˜ ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ÙË ÌÂÁ¿ÏË ËÏÈ-Î›·, ÙË Ì·ÎÚfi¯ÚÔÓË ÓfiÛÔ Î·È ÙÔ ıÂÙÈÎfi ÈÛÙÔÚÈÎfiÁÈ· ıÚÔÌ‚ÒÛÂÈ˜. ™¿ÓÈ· Û˘Ó˘¿Ú¯ÂÈ ÛÏËÓÔÌÂÁ·-Ï›· Î·È ·Í›˙ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ ÛÙÔ 30% ÙˆÓ ·ÛıÂ-ÓÒÓ Ë ‰È¿ÁÓˆÛË Ù›ıÂÙ·È Ù˘¯·›· (2).

£ÂÚ·Â˘ÙÈÎ¿ ¤¯ÂÈ ÂÈ¯ÂÈÚËıÂ› Ë ¯ÔÚ‹ÁËÛË Ú·-‰ÈÂÓÂÚÁÔ‡ 32ƒ, ‚Ô˘ÛÔ˘ÏÊ¿ÓË˜, ˘‰ÚÔÍ˘Ô˘Ú›·˜ Î·ÈÈÓÙÂÚÊÂÚfiÓË˜-· (28,36). ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÁÈ·ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ∂∆ ¤¯ÂÈ ‰ÔÎÈÌ·ÛÙÂ› Ë ·Ó·-ÁÎÚÂÏ›‰Ë Ô˘ ‰Ú· Î˘Ú›ˆ˜ Û·Ó ·ÓÙÈ-cAMP ÊˆÛÊÔ-‰ÈÂÛÙÂÚ¿ÛË, ¤¯ÂÈ ÔÏ‡ Î·Ï‹ ‚ÈÔ‰È·ıÂÛÈÌfiÙËÙ· Î·È‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚÂ¿˙ÂÈ ÙÈ˜ ¿ÏÏÂ˜ Ì˘ÂÏÈÎ¤˜ ÛÂÈ-Ú¤˜ (37-39). ∏ ÂÊ·ÚÌÔÁ‹ ÙË˜ ¤¯ÂÈ ÍÂÎÈÓ‹ÛÂÈ ·fi Ù·Ì¤Û· ÙË˜ ‰ÂÎ·ÂÙ›·˜ ÙÔ˘ ’80 Î·È ÂÌÊ·Ó›˙ÂÈ ÂÓı·Ú-Ú˘ÓÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù·, ÌÂ ·ÓÙ·fiÎÚÈÛË Ô˘ Î˘-Ì·›ÓÂÙ·È ÛÙÔ 90% ÙˆÓ ·ÛıÂÓÒÓ. ™ÙÈ˜ ·ÚÂÓ¤ÚÁÂÈÂ˜ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Û˘ÁÎ·Ù·Ï¤ÁÔÓÙ·È Ë ‰ÔÛÔÂÍ·ÚÙÒ-ÌÂÓË Î·È ·Ó·ÛÙÚ¤„ÈÌË ÌÂ›ˆÛË ÙË˜ ·ÓÙ›ÛÙ·ÛË˜ ÙˆÓ

·ÁÁÂ›ˆÓ Î·È ÙË˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜, Ë ·‡ÍËÛË ÙÔ˘Î·Ú‰È·ÎÔ‡ Ú˘ıÌÔ‡ Î·È ÙË˜ Û˘ÛÙ·ÏÙÈÎfiÙËÙ·˜ ÙˆÓÎÔÈÏÈÒÓ, Ë Î·Ù·ÎÚ¿ÙËÛË ˘ÁÚÒÓ, ÙÔ ·›ÛıËÌ· ˙¿ÏË˜,ÔÈ ‰È·ÚÚÔ˚Î¤˜ ÎÂÓÒÛÂÈ˜, ÙÔ ‰ÂÚÌ·ÙÈÎfi ÂÍ¿ÓıËÌ·,‹È· ·Ó·ÈÌ›· Î.¿. ¶Ú¤ÂÈ, ¿ÓÙˆ˜, Ó· ÛËÌÂÈˆıÂ› fiÙÈÔÈ ·ÚÂÓ¤ÚÁÂÈÂ˜ ÙË˜ ·Ó·ÁÎÚÂÏ›‰Ë˜ Û˘ÓÔÏÈÎ¿ ÎÚ›-ÓÔÓÙ·È ˆ˜ ÂÏ¿ÛÛÔÓÂ˜ Î·È Û‹ÌÂÚ· ·ÔÙÂÏÂ› ÙË ıÂ-Ú·Â›· ÂÎÏÔÁ‹˜ Î˘Ú›ˆ˜ ÁÈ· Ù· ÓÂ·Ú¿ ¿ÙÔÌ·, ·ÊÂ-Ófi˜ ÏfiÁˆ ÙË˜ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿˜ ÙË˜, Î˘Ú›ˆ˜fiÌˆ˜ ÏfiÁˆ ÙË˜ ÌË ÏÂ˘¯·ÈÌÔÁfiÓÔ˘ ·ÒÙÂÚË˜ ‰Ú¿-ÛË˜ ÙË˜ (40).

π‰ÈÔ·ı‹˜ Ì˘ÂÏÔ˝ÓˆÛË ∏ ÓfiÛÔ˜ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· Â›Ó·È ÂÍ·ÈÚÂÙÈÎ¿

Û¿ÓÈ· Î·È ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› ÛÔÚ·‰ÈÎ¤˜ ÂÚÈ-ÙÒÛÂÈ˜, ÔÚÈÛÌ¤ÓÂ˜ ÙˆÓ ÔÔ›ˆÓ ¤¯Ô˘Ó ÔÈÎÔÁÂÓ‹Â›ÙˆÛË (1,2,5). Ã·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÚÔÔ‰Â˘ÙÈ-Î‹ ›ÓˆÛË ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, ÛÏËÓÔÌÂÁ·Ï›·Î·È ÂÍˆÌ˘ÂÏÈÎ‹ ·ÈÌÔÔ›ËÛË. ™ÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì·‰È·ÈÛÙÒÓÂÙ·È Ë ·ÚÔ˘Û›· ÔÈÎÈÏÔÎ˘ÙÙ¿ÚˆÛË˜,Û˘ÓÔ‰Â˘fiÌÂÓË˜ ·fi ‰·ÎÚ˘ÔÎ‡ÙÙ·Ú· Î·È ÏÂ˘ÎÔÂ-Ú˘ıÚÔ‚Ï¿ÛÙˆÛË. ™˘¯Ó¿ Û˘Ó˘¿Ú¯ÂÈ ‹ÈÔ˘ ‚·ı-ÌÔ‡ ·Ó·ÈÌ›·, ÂÓÒ Ù· ·ÈÌÔÂÙ¿ÏÈ· Î·È Ù· ÏÂ˘Î¿ ·È-ÌÔÛÊ·›ÚÈ· ÌÔÚÂ› Ó· Â›Ó·È ÛÂ Ê˘ÛÈÔÏÔÁÈÎ¿, ¯·ÌË-Ï¿ ‹ Î·È ˘„ËÏ¿ Â›Â‰·. ∏ ÔÚÂ›· ÙË˜ ÓfiÛÔ˘ ÌÔ-ÚÂ› Ó· ÂÌÊ·Ó›ÛÂÈ ‡ÊÂÛË ·˘ÙfiÌ·ÙË ‹ ÌÂÙ¿ ·fi ¯Ô-Ú‹ÁËÛË ÛÙÂÚÔÂÈ‰ÒÓ Î·È Û·ÓÈfiÙÂÚ· Ó· ÂÎÙÚ·Â›ÛÂ ¿ÏÏÔ Î·ÎfiËıÂ˜ ·ÈÌ·ÙÔÏÔÁÈÎfi ÓfiÛËÌ·. ¢Â‰ÔÌ¤-ÓË˜ ÙË˜ Û·ÓÈfiÙËÙ·˜ ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜, ‰ÂÓ ˘¿Ú-¯Ô˘Ó Û·ÊÂ›˜ ıÂÚ·Â˘ÙÈÎ¤˜ Ô‰ËÁ›Â˜ ÁÈ· ÙÔ˘˜ ·È-‰È·ÙÚÈÎÔ‡˜ ·ÛıÂÓÂ›˜ (2).

∂›ÏÔÁÔ˜ ∆· Ì˘ÂÏÔ¸ÂÚÏ·ÛÙÈÎ¿ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ Ù·

Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎ¿ Û‡Ó‰ÚÔÌ· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈ-Î›·˜, ¤¯Ô˘Ó ·ÔÙÂÏ¤ÛÂÈ Â‰›Ô ÂÓÙ·ÙÈÎ‹˜ ÂÈÛÙËÌÔ-ÓÈÎ‹˜ ¤ÚÂ˘Ó·˜ ÙËÓ ÙÂÏÂ˘Ù·›· ÂÓÙ·ÂÙ›·. §fiÁˆ,fiÌˆ˜, ÙË˜ Û·ÓÈfiÙËÙ¿˜ ÙÔ˘˜ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·,¤¯ÂÈ Á›ÓÂÈ ·fiÏ˘Ù· ·ÓÙÈÏËÙfi ·fi fiÏÔ˘˜ ÙÔ˘˜ÂÚÂ˘ÓËÙ¤˜ Î·È ÛÙÈ˜ ‰‡Ô ÏÂ˘Ú¤˜ ÙÔ˘ ∞ÙÏ·ÓÙÈÎÔ‡,fiÙÈ ÌfiÓÔ Ì¤Ûˆ ÂÓÔÔÈËÌ¤ÓˆÓ ÚÔÔÙÈÎÒÓ ÌÂÏÂ-ÙÒÓ, ÌÂ ÎÔÈÓ¿ ‰È·ÁÓˆÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ· ı· Â¤ÏıÂÈÚfiÔ‰Ô˜ ÙfiÛÔ ÛÂ Â›Â‰Ô ‰ÈÂÚÂ‡ÓËÛË˜ ÙË˜ ·ıÔ-Á¤ÓÂÈ·˜, fiÛÔ Î·È ÛÂ Â›Â‰Ô Î·Ù·ÓfiËÛË˜ Î·È Î·Ù·-ÁÚ·Ê‹˜ ÙˆÓ È‰È·ÈÙÂÚÔÙ‹ÙˆÓ ÙÔ˘˜ ÛÙ· ·È‰È¿. ∂›Ó·È‰Â ·Ó·ÌÂÓfiÌÂÓÔ fiÙÈ Ë ÚfiÔ‰Ô˜ ·˘Ù‹ ı· ˆı‹ÛÂÈÎ·È ÛÂ ıÂÚ·Â˘ÙÈÎ¤˜ Ï¤ÔÓ ·ÔÙÂÏÂÛÌ·ÙÈÎ¤˜ Ï‡-ÛÂÈ˜ Î·È ÛÙ· ·È‰È¿.

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¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘-∞Ó‰ÚÔ˘Ï·Î¿ÎËπˆ¿ÓÓÔ˘ °ÂÓÓ·‰›Ô˘ 14∞, ∆.∫. 115 21, ∞ı‹Ó· E-mail: [email protected]

™ÎÔfi˜: ™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ó· ÚÔÛ‰ÈÔÚÈÛÙÂ› ·Ó ËÛ˘ÌÏËÚˆÌ·ÙÈÎ‹ ¯ÔÚ‹ÁËÛË L-·ÚÁÈÓ›ÓË˜ ÂÏ·ÙÙÒÓÂÈ ÙË Û˘-¯ÓfiÙËÙ· fiÏˆÓ ÙˆÓ ÛÙ·‰›ˆÓ ÙË˜ ÓÂÎÚˆÙÈÎ‹˜ ÂÓÙÂÚÔÎÔÏ›ÙÈ‰·˜(¡∂∫) ÛÂ ÚfiˆÚ· ÓÂÔÁÓ¿ ÌÂ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ <1250 g Î·ÈËÏÈÎ›·˜ Î‡ËÛË˜ <32 Â‚‰ÔÌ¿‰ˆÓ. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ™ÙË ÌÂÏ¤ÙË, Ô˘ ‹Ù·Ó Ù˘¯·ÈÔÔÈËÌ¤ÓË,‰ÈÏ‹ Ù˘ÊÏ‹, ÂÏÂÁ¯fiÌÂÓË, ÂÚÈÂÏ‹ÊıËÛ·Ó ÚÔ‰ÚÔÌÈÎ¿ 152ÚfiˆÚ· ÓÂÔÁÓ¿. ∂‚‰ÔÌ‹ÓÙ· ¤ÓÙÂ (ÔÌ¿‰· ∞) ‹Ú·Ó L-·ÚÁÈ-Ó›ÓË (1,5 mmol/kg/ËÌ¤Ú·) Î·È Ù· ˘fiÏÔÈ· 77, ÔÌ¿‰· ÂÏ¤Á-¯Ô˘, ‹Ú·Ó placebo (ÔÌ¿‰· µ), ÌÂ ÙËÓ ÂÓÙÂÚÈÎ‹ ‹ Î·È ·ÚÂ-ÓÙÂÚÈÎ‹ ‰È·ÙÚÔÊ‹ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÚÒÙˆÓ 28 ËÌÂÚÒÓÙË˜ ˙ˆ‹˜ ÙÔ˘˜. ∏ ‰È·ÙÚÔÊÈÎ‹ ÚfiÛÏË„Ë Î·È ÔÈ Û˘ÁÎÂÓÙÚÒ-ÛÂÈ˜ ·ÌÌˆÓ›·˜, ·ÚÁÈÓ›ÓË˜ Î·È ·ÌÈÓÔÍ¤ˆÓ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ ÌÂ-ÙÚ‹ıËÎ·Ó ÛÂ fiÏ· Ù· ÓÂÔÁÓ¿ ÙËÓ 3Ë, ÙË 14Ë Î·È ÙËÓ 28Ë ËÌ¤-Ú·, Î·ıÒ˜ Â›ÛË˜ Î·È Î·Ù¿ ÙË ‰È¿ÁÓˆÛË ÙË˜ ¡∂∫. ∞ÔÙÂÏ¤ÛÌ·Ù·: ¡∂∫ ·ÚÔ˘Û›·Û·Ó 5 ÓÂÔÁÓ¿ ÙË˜ ÔÌ¿‰·˜ ∞,Û˘ÁÎÚÈÓfiÌÂÓ· ÌÂ 21 ÓÂÔÁÓ¿ ÙË˜ ÔÌ¿‰·˜ µ (p<0,001). ∏ÚÔÛÏ·Ì‚·ÓfiÌÂÓË ·ÚÁÈÓ›ÓË Î·È ÔÈ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÙË˜ ÛÙÔÏ¿ÛÌ· ‹Ù·Ó ›‰ÈÂ˜ Î·È ÛÙÈ˜ ‰‡Ô ÔÌ¿‰Â˜ ÙˆÓ ÓÂÔÁÓÒÓ Î·Ù¿ÙËÓ ¤Ó·ÚÍË ÙË˜ ÌÂÏ¤ÙË˜ (fiˆ˜ ·Ó·ÌÂÓfiÙ·Ó) Î·È ·˘ÍËÌ¤ÓÂ˜ÙË 14Ë Î·È 28Ë ËÌ¤Ú· ÛÙ· ÓÂÔÁÓ¿ ÙË˜ ÔÌ¿‰·˜ ∞. OÈ Û˘ÁÎÂ-ÓÙÚÒÛÂÈ˜ ÙË˜ ·ÚÁÈÓ›ÓË˜ ÛÙÔ Ï¿ÛÌ· ‹Ù·Ó ¯·ÌËÏ¤˜, Î·Ù¿ ÙË‰È¿ÁÓˆÛË ÙË˜ ¡∂∫ Î·È ÛÙÈ˜ ‰‡Ô ÔÌ¿‰Â˜ ÙˆÓ ÓÂÔÁÓÒÓ. ¢ÂÓ

˘‹Ú¯·Ó ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÛÙ· ÌËÙÚÈÎ¿ Î·È ÓÂÔÁÓÈÎ¿‰ËÌÔÁÚ·ÊÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿, ÛÙË ‰È·ÙÚÔÊÈÎ‹ ÚfiÛÏË„Ë,ÛÙËÓ ·ÌÌˆÓ›· ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ Î·È ÛÙÈ˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÙˆÓÔÏÈÎÒÓ Î·È ÙˆÓ ··Ú·›ÙËÙˆÓ ·ÌÈÓÔÍ¤ˆÓ, ÌÂÙ·Í‡ ÙˆÓ ‰‡ÔÔÌ¿‰ˆÓ ÙˆÓ ÌÂÏÂÙËı¤ÓÙˆÓ ÓÂÔÁÓÒÓ. ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ Û˘ÌÏËÚˆÌ·ÙÈÎ‹ ¯ÔÚ‹ÁËÛË ·ÚÁÈÓ›ÓË˜(1,5 mmol/kg/ËÌ¤Ú·) ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ ÂÏ·ÙÙÒÓÂÈ ÙÔ Ô-ÛÔÛÙfi fiÏˆÓ ÙˆÓ ÛÙ·‰›ˆÓ ¡∂∫.

∏ Û˘ÌÏËÚˆÌ·ÙÈÎ‹ ¯ÔÚ‹ÁËÛË ·ÚÁÈÓ›ÓË˜ ÚÔÊ˘Ï¿ÛÛÂÈ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÓÂÎÚˆÙÈÎ‹˜ ÂÓÙÂÚÔ-ÎÔÏ›ÙÈ‰·˜ ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿1

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›·

1Amin HJ, Zamora SA, McMillan DD, Fick GH,Butzner JD, Parsons HG et al Arginine supplementation prevents necrotizingenterocolitis in the premature infant J Pediatr 2002;140:425-431

ºˆÙfiÔ˘ÏÔ˜ ™‡ÚÔ˜ ¶·È‰›·ÙÚÔ˜-¡ÂÔÁÓÔÏfiÁÔ˜ ¢È‰¿ÎÙˆÚ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ∞Ó·ÏËÚˆÙ‹˜ ¢ÈÂ˘ı˘ÓÙ‹˜ µ’ ª∂¡ ¡ÔÛÔÎÔÌÂ›Ô˘ ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·”



232

¡ÂÎÚˆÙÈÎ‹ ÂÓÙÂÚÔÎÔÏ›ÙÈ‰·: ¡ÂfiÙÂÚÂ˜ ·fi„ÂÈ˜ ∫. Ã·Ù˙Ë˚ˆ·ÓÓ›‰Ë˜

Necrotizing enterocolitis: New conceptsC. Hatziioannidis

∞¡∞™∫O¶∏™∏ REVIEW ARTICLE

�¶ÂÚ›ÏË„Ë: ∏ ÓÂÎÚˆÙÈÎ‹ ÂÓÙÂÚÔÎÔÏ›ÙÈ‰· Â›Ó·ÈÊÏÂÁÌÔÓÒ‰Ë˜ ÓfiÛÔ˜, Ô˘ ¤¯ÂÈ ‚·ÚÈ¿ ÎÏÈÓÈÎ‹ ÂÈÎfi-Ó·, ÛÔ‚·Ú¤˜ ÂÈÏÔÎ¤˜ Î·È ÌÂÁ¿ÏË ıÓËÙfiÙËÙ·.¶ÚÔÛ‚¿ÏÏÂÈ ÙÔ ·ÓÒÚÈÌÔ ¤ÓÙÂÚÔ, ÁÈ’ ·˘Ùfi Â›Ó·È Û˘-¯Ó‹ ÛÙ· ÚfiˆÚ· Î·È È‰È·›ÙÂÚ· ÛÙ· ÔÏ‡ ÌÈÎÚ¿ ÓÂ-ÔÁÓ¿ (ÙÔ 90% ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ·ÊÔÚ¿ ÚfiˆÚ·).∏ ·ÈÙÈÔÏÔÁ›· ÙË˜ Â›Ó·È Ì¤¯ÚÈ Û‹ÌÂÚ· ¿ÁÓˆÛÙË. ∏·ıÔÁ¤ÓÂÈ¿ ÙË˜, ·Ú¿ ÙÈ˜ ÂÓÙ·ÙÈÎ¤˜ ¤ÚÂ˘ÓÂ˜, ‰ÂÓ¤¯ÂÈ ÍÂÎ·ı·ÚÈÛÙÂ› Ï‹Úˆ˜. ∏ Û‡Á¯ÚÔÓË ıÂˆÚ›·˘ÔÛÙËÚ›˙ÂÈ fiÙÈ Ë ·ıÔÁ¤ÓÂÈ· ÙË˜ ÓfiÛÔ˘ Â›Ó·È Ô-Ï˘·Ú·ÁÔÓÙÈÎ‹. OÚÈÛÌ¤ÓÔÈ ·Ú¿ÁÔÓÙÂ˜ ˘„ËÏÔ‡ÎÈÓ‰‡ÓÔ˘ ÂÓÂÚÁÔÔÈÔ‡Ó ÚÔÊÏÂÁÌÔÓÒ‰ÂÈ˜ ÌÂÛÔ-Ï·‚ËÙ¤˜, ÌÂ ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· ÙË Ó¤ÎÚˆÛË ÙÔ˘ÂÓÙ¤ÚÔ˘. OÈ Î˘ÚÈfiÙÂÚÔÈ ÚÔÊÏÂÁÌÔÓÒ‰ÂÈ˜ ÌÂÛÔ-Ï·‚ËÙ¤˜ Â›Ó·È ÔÈ Î˘ÙÔÎ›ÓÂ˜, Ô ·Ú¿ÁÔÓÙ·˜ ÂÓÂÚÁÔ-Ô›ËÛË˜ ·ÈÌÔÂÙ·Ï›ˆÓ, ÙÔ ÌÔÓÔÍÂ›‰ÈÔ ÙÔ˘ ·˙ÒÙÔ˘Î.Ï. ¶ÔÏÏÔ› ÂÚÂ˘ÓËÙ¤˜ ÚÔÛ¿ıËÛ·Ó Ó· ‚ÚÔ˘ÓÂÈ‰ÈÎÔ‡˜ ‰Â›ÎÙÂ˜ ÁÈ· ÙËÓ ÚÒÈÌË ‰È¿ÁÓˆÛË ÙË˜ Ófi-ÛÔ˘, ÌÂÙ·Í‡ ÙˆÓ ÔÔ›ˆÓ Â›Ó·È Î·È ÙÔ ªRI. ∏ ıÂÚ·-Â›· ÙË˜ ÓfiÛÔ˘ ·ÔÛÎÔÂ› ÛÙË ‰ÈfiÚıˆÛË fiÏˆÓÙˆÓ ‰È·Ù·Ú·¯ÒÓ Ô˘ ÚÔÎ‡ÙÔ˘Ó, ÙËÓ ÂÓÙ·ÙÈÎ‹˘ÔÛÙ‹ÚÈÍË ÙÔ˘ ÓÂÔÁÓÔ‡ Î·È ÙË ¯ÔÚ‹ÁËÛË ·ÓÙÈ-‚›ˆÛË˜. ∏ ¯ÂÈÚÔ˘ÚÁÈÎ‹ ıÂÚ·Â›· ÂÊ·ÚÌfi˙ÂÙ·ÈfiÙ·Ó ˘¿Ú¯Ô˘Ó ÂÓ‰Â›ÍÂÈ˜ Ó¤ÎÚˆÛË˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘.∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ë ÂÚÈÙÔÓ·˚Î‹ ·ÚÔ¯¤ÙÂ˘ÛËÂÊ·ÚÌfi˙ÂÙ·È ÌÂ ÂÈÙ˘¯›· ÛÂ ÌÈÎÚ¿ ÚfiˆÚ·, Î·-ıÒ˜ Î·È ÛÂ ÂÈÏÂÁÌ¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜. ∏ Î·Ï‡ÙÂÚËÎ·Ù·ÓfiËÛË ÙË˜ ·ıÔÁ¤ÓÂÈ·˜ ÙË˜ ¡∂∫ Û˘Ó¤‚·ÏÂÛÙËÓ ·Ó¿Ù˘ÍË ÚÔÏËÙÈÎÒÓ ÛÙÚ·ÙËÁÈÎÒÓ. ™Â ÎÏÈ-ÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ¤¯ÂÈ ‚ÚÂıÂ› ÂÏ¿ÙÙˆÛË ÙË˜ Û˘¯ÓfiÙË-Ù·˜ ÙË˜ ÓfiÛÔ˘ ÌÂ ÙÔ ÌËÙÚÈÎfi ıËÏ·ÛÌfi, Û˘ÌÏ‹-ÚˆÌ· ÌÂ IgA Î·È ÙËÓ ÚÔÊ˘Ï·ÎÙÈÎ‹ ¯ÔÚ‹ÁËÛË·ÓÙÈ‚ÈÔÙÈÎÒÓ, ÊˆÛÊÔÏÈ›‰È· ·˘ÁÔ‡ Î·È ÂÚ˘ıÚÔ-ÔÈËÙ›ÓË.

�Abstract: Necrotizing enterocolitis (NEC) is aninflammatory condition with severe clinicalpresentation, many complications and highmortality. N∂C affects the immature intestine andconsequently it affects primarily the prematureinfants and, in 90% of the cases, the very low birthweight infants. The aetiology is unknown and thepathogenesis remains unclear despite extensiveresearch during the last decades. According torecent studies the pathophysiology ismultifactorial. Various high-risk factors activateproinflammatory mediators resulting in intestinalnecrosis. The most important of these mediatorsinclude the cytokines, the platelet-activating factor(PAF) and nitric oxide (NO). For many yearsinvestigators have attempted to identify specifictests for the early diagnosis of the disease, MRIbeing one of those. Treatment consists ofmanagement of all the co-existing disorders,intensive care management and treatment withantibiotics. Surgical intervention is required whenthere is evidence of intestinal necrosis. Peritonealdrainage has been successfully used recently inVLBW infants and in selected cases. Betterunderstanding of the pathogenesis of NEC hasallowed the development of preventive strategies.Clinical trials have reported reduction of diseaseincidence by using breast milk feeding, IgAsupplementation, enteral antibiotic prophylaxis,egg phospholipid supplementation and erythro-poietin.

µ’ ¡ÂÔÁÓÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹ ∞¶£, ¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞,£ÂÛÛ·ÏÔÓ›ÎË

2nd Neonatal Department of Aristotelion University ofThessaloniki, AHEPA Hospital, Thessaloniki


∂ÈÛ·ÁˆÁ‹∏ ÓÂÎÚˆÙÈÎ‹ ÂÓÙÂÚÔÎÔÏ›ÙÈ‰· (¡∂∫) Â›Ó·È ÊÏÂÁÌÔ-

ÓÒ‰Ë˜ ÓfiÛÔ˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘, Ô˘ ¤¯ÂÈ ‚·ÚÈ¿ ÎÏÈÓÈÎ‹ ÂÈ-ÎfiÓ·, ÛÔ‚·Ú¤˜ ÂÈÏÔÎ¤˜ Î·È ÌÂÁ¿ÏË ıÓËÙfiÙËÙ·.

™˘¯ÓfiÙËÙ· ∏ ¡∂∫ ÚÔÛ‚¿ÏÏÂÈ Î˘Ú›ˆ˜ ÙÔ ·ÓÒÚÈÌÔ ¤ÓÙÂÚÔ,

ÁÈ’ ·˘Ùfi Â›Ó·È Û˘¯Ó‹ ÛÙ· ÚfiˆÚ·, Û·ÓÈfiÙÂÚË ÛÙ·ÙÂÏÂÈfiÌËÓ· Î·È ÔÏ‡ Û¿ÓÈ· ÛÙË ‚ÚÂÊÈÎ‹ Î·È ÛÙË ÌÂ-Á·Ï‡ÙÂÚË ËÏÈÎ›·. ∏ Û˘¯ÓfiÙËÙ¿ ÙË˜ ÛÙÔ ÁÂÓÈÎfi ÏË-ı˘ÛÌfi Â›Ó·È 1-2,4 ÂÚÈÙÒÛÂÈ˜ ÛÙ· 1000 ˙ÒÓÙ· ÓÂÔ-ÁÓ¿. ¶ÚÔÛ‚¿ÏÏÂÈ ÙÔ 1-5% ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÂÈÛ¿ÁÔ-ÓÙ·È ÛÙÈ˜ ªÔÓ¿‰Â˜ ∂ÓÙ·ÙÈÎ‹˜ ¡ÔÛËÏÂ›·˜ ¡ÂÔÁÓÒÓ(ª∂¡¡). ∞fi ÙÔ ÔÛÔÛÙfi ·˘Ùfi, ÙÔ 7-13% ·ÊÔÚ¿ ÛÂÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ Î·È ÙÔ ˘fiÏÔÈÔ ÛÙ· ÚfiˆÚ·.¶ÚfiˆÚ· ÓÂÔÁÓ¿ <34 Â‚‰ÔÌ¿‰Â˜ Î‡ËÛË˜ Ô˘ ÓÔÛË-ÏÂ‡ÔÓÙ·È ÛÂ ª∂¡¡, ÚÔÛ‚¿ÏÏÔÓÙ·È ÛÂ ÔÛÔÛÙfi 3,9-22,4% ÌÂ Ì¤ÛË Û˘¯ÓfiÙËÙ· 10% (1,2). ∆· ÙÂÏÂ˘Ù·›·¯ÚfiÓÈ·, Ë Û˘¯ÓfiÙËÙ· ·˘Ù‹ ¤¯ÂÈ ÂÏ·ÙÙˆıÂ› ·ÚÎÂÙ¿ ÛÂÔÚÈÛÌ¤ÓÂ˜ ¯ÒÚÂ˜, fiˆ˜ Ë ∞˘ÛÙÚ·Ï›· Î·È Ë π·ˆÓ›·.ŒÙÛÈ, ÛÙËÓ ∞˘ÛÙÚ·Ï›· Ù· ÙÂÏÂ˘Ù·›· ÙÚ›· ¯ÚfiÓÈ· ÛÂÚfiˆÚ· <32 Â‚‰ÔÌ¿‰Â˜ Î‡ËÛË˜, ÙÔ ÔÛÔÛÙfi ·˘Ùfi¤¯ÂÈ ÂÏ·ÙÙˆıÂ› ·fi 8% ÛÂ 3% (3).

∞ÈÙÈÔÏÔÁ›· ∏ ·ÈÙÈÔÏÔÁ›· ÙË˜ ¡∂∫ ·Ú·Ì¤ÓÂÈ ‚·ÛÈÎ¿ ¿ÁÓˆ-

ÛÙË Î·È ·Û·Ê‹˜. ∏ ÌfiÓË ÂÈ‚Â‚·ÈˆÌ¤ÓË ÛÙ·ıÂÚ‹Û˘Û¯¤ÙÈÛË ÌÂ ÙË ¡∂∫ Â›Ó·È Ë ÚÔˆÚfiÙËÙ·, ÛÂ Û˘Ó-‰˘·ÛÌfi ÌÂ ÙËÓ ÚÒÈÌË ¤Ó·ÚÍË ÙË˜ ÂÓÙÂÚÈÎ‹˜ Û›ÙÈ-ÛË˜. ∞Ó Î·È ·Ú¯ÈÎ¿ Ë ¡∂∫ Â›¯Â ·Ô‰ÔıÂ› ÛÂ ÔÈÎÈÏ›··Ú·ÁfiÓÙˆÓ Ô˘ ÚÔÎ·ÏÔ‡Ó ÂÚÈÁÂÓÓËÙÈÎfi stress,ÚÔÛÂÎÙÈÎ¤˜ ÂÈ‰ËÌÈÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ‰ÂÓ ¤¯Ô˘Ó‰Â›ÍÂÈ Û˘Û¯¤ÙÈÛË ÌÂ ÂÌ‚Ú˘˚Î‹ ‰˘Û¯¤ÚÂÈ·, ÚÒÈÌËÚ‹ÍË ÌÂÌ‚Ú·ÓÒÓ, ¯·ÌËÏfi Apgar score, ·Ó·ÓÂ˘ÛÙÈ-Î‹ ‰˘Û¯¤ÚÂÈ· Î·È ¿ÓÔÈ·. O Î˘ÚÈfiÙÂÚÔ˜ ·Ú¿ÁÔ-ÓÙ·˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Â›Ó·È Ë ÚÔˆÚfiÙËÙ·.

∂ÍˆÙÂÚÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ Ô˘ ÌÔÚÂ› Ó· ÂËÚÂ-¿ÛÔ˘Ó ÙËÓ ÂÌÊ¿ÓÈÛË ÙË˜ ¡∂∫ Â›Ó·È Ô ¯ÚfiÓÔ˜ ¤Ó·Ú-ÍË˜ Û›ÙÈÛË˜, Ë Ù·¯‡ÙËÙ· ¯ÔÚ‹ÁËÛË˜ Á¿Ï·ÎÙÔ˜, ÔÙ‡Ô˜ ÙÔ˘ Á¿Ï·ÎÙÔ˜ (ÌËÙÚÈÎfi Á¿Ï·, ¤Ó·ÓÙÈ ÙÚÔÔ-ÔÈËÌ¤ÓÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰·˜) Î·È Ë ·Ó¿Ù˘ÍË ÌÈ-ÎÚÔ‚›ˆÓ. ∆¤ÏÔ˜, Ë ÂÓÙÂÚÈÎ‹ ÈÛ¯·ÈÌ›· ¤¯ÂÈ ÂÓÔ¯Ô-ÔÈËıÂ› ÛÙËÓ ·ÈÙÈÔÏÔÁ›· ÙË˜ ¡∂∫ (4,5).

¶·ıÔÁ¤ÓÂÈ· ∏ ·ıÔÁ¤ÓÂÈ· ÙË˜ ¡∂∫, ·Ú¿ ÙÈ˜ ÂÓÙ·ÙÈÎ¤˜

¤ÚÂ˘ÓÂ˜ ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ÙÚÈ¿ÓÙ· ÂÙÒÓ, ‰ÂÓ ¤¯ÂÈ ‰È-Â˘ÎÚÈÓÈÛÙÂ› Ï‹Úˆ˜. ∏ Û‡Á¯ÚÔÓË ıÂˆÚ›· ˘ÔÛÙË-Ú›˙ÂÈ fiÙÈ Ë ·ıÔÁ¤ÓÂÈ· ÙË˜ ÓfiÛÔ˘ Â›Ó·È ÔÏ˘·Ú·-ÁÔÓÙÈÎ‹. ¶·Ú¿ÁÔÓÙÂ˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, fiˆ˜ Ë

ÚÔˆÚfiÙËÙ·, Ô ·ÔÈÎÈÛÌfi˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ ÌÂ ÌÈÎÚfi-‚È·, Ë Û›ÙÈÛË ÌÂ ÌË ÌËÙÚÈÎfi Á¿Ï· Î·È Ë ÂÓÙÂÚÈÎ‹ÈÛ¯·ÈÌ›·-˘ÔÍ›· Û˘Ì‚¿ÏÏÔ˘Ó ÛÙÔ ÙÂÏÈÎfi ·ÔÙ¤ÏÂ-ÛÌ·, Ô˘ Â›Ó·È Ë ÂÓÙÂÚÈÎ‹ Ó¤ÎÚˆÛË (6).

O ÚfiÏÔ˜ ÙË˜ ÂÓÙÂÚÈÎ‹˜ ÈÛ¯·ÈÌ›·˜ ÛÙË ¡∂∫ ¤¯ÂÈÌÂÏÂÙËıÂ› ÛÂ ÌÔÓÙ¤Ï· ÂÈÚ·Ì·Ùfi˙ˆˆÓ Î·È ÛÂ ÂÈ-‰ËÌÈÔÏÔÁÈÎ¤˜ ·Ó·Ï‡ÛÂÈ˜ ÛÂ ÚfiˆÚ· ÓÂÔÁÓ¿. ™ÂÂÈÚ·Ì·Ùfi˙ˆ·, Ï‹ÚË˜ ÈÛ¯·ÈÌ›· ÙÔ˘ ÂÓÙ¤ÚÔ˘‡ÛÙÂÚ· ·fi ·ÔÏ›ÓˆÛË ÙË˜ ÌÂÛÂÓÙÂÚ›Ô˘ ·ÚÙË-Ú›·˜, ÚÔÎ·ÏÂ› ÂÏ·ÊÚ¤˜ ÈÛÙÔÏÔÁÈÎ¤˜ ·ÏÏÔÈÒÛÂÈ˜,·ÏÏ¿ ‡ÛÙÂÚ· ·fi ÙËÓ Â·Ó·ÈÌ¿ÙˆÛË ÚÔÎ·ÏÂ›Ù·ÈÛÔ‚·Ú‹ ÂÓÙÂÚÈÎ‹ Ó¤ÎÚˆÛË (7).

∏ ÚÒÈÌË ¤Ó·ÚÍË Û›ÙÈÛË˜ Â›Ó·È ¤Ó·˜ ÛËÌ·ÓÙÈ-Îfi˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· ÙË ¡∂∫ Î·È ¤¯ÂÈ ‚ÚÂıÂ› ÛÂ ÌÂ-Ï¤ÙÂ˜ fiÙÈ ÙÔ ÌËÙÚÈÎfi Á¿Ï· ÂÏ·ÙÙÒÓÂÈ ÙË Û˘¯ÓfiÙËÙ·ÙË˜ ¡∂∫ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÔ ÙÚÔÔÔÈËÌ¤ÓÔ Á¿Ï··ÁÂÏ¿‰·˜ (8).

∏ ·ÓˆÚÈÌfiÙËÙ· ÙÔ˘ ÂÓÙ¤ÚÔ˘ ‰Ú· Î·Ù·ÛÙ·ÏÙÈÎ¿ÛÙËÓ ÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È ÛÙË ‰Ú·ÛÙÈÎfi-ÙËÙ· ÙË˜ Ï·ÎÙ¿ÛË˜, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÂÚ›ÛÛÂÈ·¿ÂÙË˜ Ï·ÎÙfi˙Ë˜ ÛÙÔ ¤ÓÙÂÚÔ Ô˘ Â˘ÓÔÂ› ÙËÓ ·Ó¿-Ù˘ÍË ÙˆÓ ÌÈÎÚÔ‚›ˆÓ. ∏ Ï·ÎÙfi˙Ë ‰È·Û¿Ù·È ·fi Ù·ÌÈÎÚfi‚È· ÛÂ ‚Ú·¯Â›·˜ ·Ï‡ÛÔ˘ ÏÈ·Ú¿ ÔÍ¤·, ∏2 Î·ÈCO2. ∏ ˘ÂÚÛ›ÙÈÛË ·˘Í¿ÓÂÈ ÙË ‰˘Û·ÔÚÚfiÊËÛËÙË˜ Ï·ÎÙfi˙Ë˜, ÙË˜ ÚˆÙÂ˝ÓË˜ Î·È ÙÔ˘ Ï›Ô˘˜,Ú¿ÁÌ· Ô˘ ÂÈ‰ÂÈÓÒÓÂÈ ÙËÓ ÈÛ¯·ÈÌÈÎ‹ ÂÓÙÂÚÈÎ‹‚Ï¿‚Ë Î·È ÚÔÎ·ÏÂ› ‰È¿Ù·ÛË ·fi ·¤ÚÈ·, Ù· ÔÔ›· Â›-ÛË˜ ÂÏ·ÙÙÒÓÔ˘Ó ÙËÓ ·ÈÌ¿ÙˆÛË ÙÔ˘ ‚ÏÂÓÔÁfiÓÓÔ˘ (3).

OÈ ÂÈ‚·Ú˘ÓÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ Ô˘ ·Ó·Ê¤Ú·ÌÂ,ÛÙÔ ¤‰·ÊÔ˜ ÂÓfi˜ ·ÓÒÚÈÌÔ˘ ÂÓÙ¤ÚÔ˘, ÂÓÂÚÁÔÔÈ-Ô‡Ó ÚÔÊÏÂÁÌÔÓÒ‰ÂÈ˜ ÌÂÛÔÏ·‚ËÙ¤˜, ÌÂ ·ÔÙ¤ÏÂ-ÛÌ· ÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ÙË˜ ¡∂∫, Ô˘ Â›Ó·È Ë Ó¤-ÎÚˆÛË ÙÔ˘ ÂÓÙ¤ÚÔ˘. OÈ Î˘ÚÈfiÙÂÚÔÈ ·fi ÙÔ˘˜ ÚÔ-ÊÏÂÁÌÔÓÒ‰ÂÈ˜ ÌÂÛÔÏ·‚ËÙ¤˜ Â›Ó·È ÔÈ Î˘ÙÔÎ›ÓÂ˜[ÈÓÙÂÚÏÂ˘Î›ÓË-1 (πL-1) Î·È ÈÓÙÂÚÏÂ˘Î›ÓË-6 (πL-6), Á-ÈÓÙÂÚÊÂÚfiÓË Î·È Ô ·Ú¿ÁÔÓÙ·˜ Ó¤ÎÚˆÛË˜ fiÁÎÔ˘(∆¡F)], Ô ·Ú¿ÁÔÓÙ·˜ ÂÓÂÚÁÔÔ›ËÛË˜ ·ÈÌÔÂÙ·-Ï›ˆÓ (PAF), ÙÔ ÌÔÓÔÍÂ›‰ÈÔ ÙÔ˘ ·˙ÒÙÔ˘ (¡O) Î·È ËÂÓ‰ÔıËÏ›ÓË. ¶ÂÈÚ·Ì·ÙÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ·˘ÍËÌ¤Ó· Â›Â‰· ·˘ÙÒÓ ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÛÙÔ ·›-Ì· Î·È ÙÔ ÂÓÙÂÚÈÎfi ÙÔ›¯ˆÌ· ÓÂÔÁÓÒÓ ÌÂ ¡∂∫ Î·ÈÂÈÚ·Ì·Ùfi˙ˆˆÓ ÌÂ ÂÓÙÂÚÈÎ‹ ‚Ï¿‚Ë. ∂ÈÏ¤ÔÓ,ÔÏÏÔ› ·fi ·˘ÙÔ‡˜ ÙÔ˘˜ ·Ú¿ÁÔÓÙÂ˜, ‡ÛÙÂÚ· ·fiÂÓ‰ÔÊÏ¤‚È· ¯ÔÚ‹ÁËÛË ÛÂ ÂÈÚ·Ì·Ùfi˙ˆ·, ¤¯Ô˘ÓÚÔÎ·Ï¤ÛÂÈ ÂÓÙÂÚÈÎ‹ Ó¤ÎÚˆÛË. º¿ÚÌ·Î· ‹ ·ÓÙ·-ÁˆÓÈÛÙ¤˜ Ô˘ ÂÌÔ‰›˙Ô˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ‹ ÙË ‰Ú¿-ÛË ·˘ÙÒÓ ÙˆÓ ·Ú·ÁfiÓÙˆÓ, ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙËÓ¤Ó·ÚÍË ÙË˜ ¡∂∫. OÈ ÌÂÛÔÏ·‚ËÙ¤˜ ·˘ÙÔ›, ÌÂ ÙË ÛÂÈ-Ú¿ ÙÔ˘˜, ÚÔÎ·ÏÔ‡Ó ‰È·Ù·Ú·¯‹ ÛÙÔ Î˘ÙÙ·ÚÈÎfi Â›-Â‰Ô ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÙÔÈ¯ÒÌ·ÙÔ˜ Ô˘ Ô‰ËÁÂ› ÛÂ


233

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÓÂÎÚˆÙÈÎ‹ ÂÓÙÂÚÔÎÔÏ›ÙÈ‰·, ÚÔ-ÊÏÂÁÌÔÓÒ‰ÂÈ˜ ·Ú¿ÁÔÓÙÂ˜, Ó¤ÎÚˆÛË ÂÓÙ¤ÚÔ˘.

Key words: necrotizing enterocolitis, proinflam-matory factors, intestinal necrosis.


‰È¿Û·ÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÊÚ·ÁÌÔ‡, ÊÏÂÁÌÔÓ‹ Î·ÈÂ›ÛÔ‰Ô ·ıÔÁfiÓˆÓ ÌÈÎÚÔ‚›ˆÓ ÛÙÔ ÂÓÙÂÚÈÎfi ÙÔ›-¯ˆÌ·, ÌÂ ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· ÙË Ó¤ÎÚˆÛË ÙÔ˘ÂÓÙ¤ÚÔ˘ (™¯‹Ì· 1) (6,9).

∏ ÌÈÎÚÔ‚È·Î‹ ‰È‹ıËÛË Â›Ó·È ·Ó·ÌÊ›‚ÔÏ· ‰Â˘-ÙÂÚÔ·ı‹˜ ·Ú¿ÁÔÓÙ·˜ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· ÙË˜¡∂∫, ·ÏÏ¿ Â›Ó·È ¿ÁÓˆÛÙÔ Â¿Ó Ù· ÌÈÎÚfi‚È· Â›Ó·È·fi ÙÔ˘˜ ·Ú¯ÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ Ô˘ ÂÓÂÚÁÔÔÈ-Ô‡Ó ÙËÓ ¤Ó·ÚÍË ÙË˜ ÓfiÛÔ˘. OÈ ÂÈ‰ËÌÈÎ¤˜ ÌÔÚÊ¤˜ÙË˜ ¡∂∫ Ô˘ Û˘Ó·ÓÙÒÓÙ·È ÛÙÈ˜ ª∂¡¡ ˘Ôı¤ÙÔ˘Ó¤Ó·Ó ¿ÌÂÛÔ ÚfiÏÔ ÙˆÓ ÌÈÎÚÔ‚›ˆÓ ÛÙËÓ ·ıÔÁ¤ÓÂÈ·ÙË˜ ÓfiÛÔ˘ (3,9).

∆Ô ÚfiˆÚÔ ÓÂÔÁÓfi ÂÎÙ›ıÂÙ·È ÛÂ ÔÏÏÔ‡˜ ·-Ú¿ÁÔÓÙÂ˜ Ô˘ ÚÔÎ·ÏÔ‡Ó ÂÚÈÁÂÓÓËÙÈÎfi stress,fiˆ˜ ˘fiÙ·ÛË, ˘ÔıÂÚÌ›·, ˘ÔÍ›·, Û›ÙÈÛË Î·È·Ó·ÈÌ›·. ŸÏ· ·˘Ù¿ ·›˙Ô˘Ó ÚfiÏÔ ÛÙËÓ ·ıÔÁ¤ÓÂÈ·ÙË˜ ÈÛ¯·ÈÌÈÎ‹˜ ‚Ï¿‚Ë˜ ÛÙÔ ÓÂÔÁÓÈÎfi ¤ÓÙÂÚÔ. ∆Ô¤ÓÙÂÚÔ ÙÔ˘ ÓÂÔÁÓÔ‡ ¤¯ÂÈ ÔÏ‡ ÂÏ·ÙÙˆÌ¤ÓË ÈÎ·Ófi-ÙËÙ· ÛÙË Ú‡ıÌÈÛË ÙË˜ ÚÔ‹˜ ÙÔ˘ ·›Ì·ÙÔ˜ Î·È ÙË˜ÔÍ˘ÁfiÓˆÛË˜. OÈ ÂÏÂ‡ıÂÚÂ˜ Ú›˙Â˜ ÙÔ˘ O2 ÂÓÔ¯Ô-ÔÈÔ‡ÓÙ·È Û·Ó ÌÂÛÔÏ·‚ËÙ¤˜ ÛÙË ‚Ï¿‚Ë ÙÔ˘ ‚ÏÂÓ-ÓÔÁfiÓÔ˘ ÛÙË ¡∂∫. ∞ÎfiÌË, Î¿ÔÈÔ ÚfiÏÔ ÛÙËÓ ·-ıÔÁ¤ÓÂÈ· ÙË˜ ¡∂∫ Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó ÔÍÂÈ‰ˆÙÈÎ¤˜Ô˘Û›Â˜ Î·È ÚˆÙÂ¿ÛÂ˜, Ô˘ ·Ú¿ÁÔÓÙ·È ·fi Ô˘-‰ÂÙÂÚfiÊÈÏ· ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘, Î·ıÒ˜Î·È ÙÔÈÎ¿ ·Ú·ÁfiÌÂÓÂ˜ ÚÔÛÙ·ÁÏ·Ó‰›ÓÂ˜ Î·ÈÏÂ˘ÎÔÙÚÈ¤ÓÂ˜ (10,11).

¶·Ú¿ÁÔÓÙÂ˜ Ô˘ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ·ıÔÁ¤ÓÂÈ·ÙË˜ ¡∂∫

O ·Ú¿ÁÔÓÙ·˜ ÂÓÂÚÁÔÔ›ËÛË˜ ·ÈÌÔÂÙ·Ï›ˆÓ(PAF) Â›Ó·È ¤Ó·˜ ÊˆÛÊÔÏÈÈ‰ÈÎfi˜ ·Ú¿ÁÔÓÙ·˜Ô˘ Ê·›ÓÂÙ·È fiÙÈ ·›˙ÂÈ ¤Ó· ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ

·ıÔÊ˘ÛÈÔÏÔÁ›· ÙË˜ ¡∂∫. ™˘ÓÙ›ıÂÙ·È ÌÂÙ¿ ÙËÓÂÓÂÚÁÔÔ›ËÛË ÙË˜ ÊˆÛÊÔÏÈ¿ÛË˜ ∞2ππ (PLA2) Î·È‰È·Û¿Ù·È ·fi ÙÔ ¤Ó˙˘ÌÔ PAF-·ÎÂÙ˘Ï˘‰ÚÔÏ¿ÛË(PAF-AH). O PAF ·ÛÎÂ› ÙË ‰Ú¿ÛË ÙÔ˘ Ì¤Ûˆ ÙË˜ÂÓÂÚÁÔÔ›ËÛË˜ ÙÔ˘ ˘Ô‰Ô¯¤· G-ÚˆÙÂ˝ÓË-˙Â‡-ÁÔ˜ PAF, Ô˘ Â›Ó·È ·ÚÒÓ ÛÙ· ÂÚÈÛÛfiÙÂÚ· Î‡Ù-Ù·Ú·, ·ÏÏ¿ Î˘Ú›ˆ˜ ÛÙÔ ÂÓÙÂÚÈÎfi ÂÈı‹ÏÈÔ (12).

∂Ó‰ÔÊÏ¤‚È· ¯ÔÚ‹ÁËÛË ÙÔ˘ PAF ÛÂ ÂÓ‹ÏÈÎ·ÎÔ˘Ó¤ÏÈ· ÚÔÎ·ÏÂ› ÈÛ¯·ÈÌÈÎ‹ ÂÓÙÂÚÈÎ‹ Ó¤ÎÚˆÛË,fiÌÔÈ· ÌÂ ÙË ÓfiÛÔ ÙË˜ ÓÂÔÁÓÈÎ‹˜ ¡∂∫. ªÂÏ¤ÙÂ˜ ÛÂÓÂÔÁÓ¿ ÌÂ ¡∂∫ ¤¯Ô˘Ó ‰Â›ÍÂÈ ·˘ÍËÌ¤Ó· Â›Â‰·ÙÔ˘ PAF ÛÙÔ Ï¿ÛÌ· Î·È ÛÙ· ÎfiÚ·Ó·. ∏ ·ÛÊ˘Í›·ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙË Û›ÙÈÛË ÌÂ ÙÚÔÔÔÈËÌ¤ÓÔ Á¿-Ï· ·ÁÂÏ¿‰·˜ ·˘Í¿ÓÔ˘Ó Ù· ÂÓÙÂÚÈÎ¿ PLA2-IImRNAÎ·È ÙË ‰Ú·ÛÙÈÎfiÙËÙ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ Î·È PAF-˘Ô‰Ô-¯¤· mRNA ÛÂ ÓÂÔÁÓ¿ ˙ÒˆÓ. ∂ÈÏ¤ÔÓ, ıÂÚ·Â›·ÌÂ ·ÓÙ·ÁˆÓÈÛÙ¤˜ ÙÔ˘ PAF-˘Ô‰Ô¯¤· ÂÏ·ÙÙÒÓÂÈÙË Û˘¯ÓfiÙËÙ· ÙË˜ ÂÓÙÂÚÈÎ‹˜ ‚Ï¿‚Ë˜ Î·È ÙË˜ ıÓË-ÙfiÙËÙ·˜. ∂›ÛË˜, ÂÈÚ·Ì·Ùfi˙ˆ· ÛÙ· ÔÔ›· ¯ÔÚË-Á‹ıËÎÂ ÙÔ ¤Ó˙˘ÌÔ PAF-AH Â›¯·Ó Ì›· ÛËÌ·ÓÙÈÎ‹ÂÏ¿ÙÙˆÛË ÛÙË Û˘¯ÓfiÙËÙ· ÙË˜ ¡∂∫. ∏ ‰Ú·ÛÙÈÎfi-ÙËÙ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ Â›Ó·È ÂÏ·ÙÙˆÌ¤ÓË ÛÙ· ÓÂÔÁÓ¿, ÂÓÒÂ›Ó·È ˘·ÚÎÙ‹ ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· Î·È fi¯È ÛÙÔ ÙÚÔÔ-ÔÈËÌ¤ÓÔ Á¿Ï· ·ÁÂÏ¿‰·˜. ∏ ÚÔÛı‹ÎË ÙÔ˘ Û˘ÛÙ·-ÙÈÎÔ‡ ·˘ÙÔ‡ ÛÙÔ Á¿Ï· ÊfiÚÌÔ˘Ï·˜ ÙˆÓ ÚfiˆÚˆÓ ÓÂ-ÔÁÓÒÓ ‰ÈÎ·ÈÔÏÔÁÂ› ÂÈÚfiÛıÂÙË ¤ÚÂ˘Ó· (13-15).

¶ÂÈÚ·Ì·ÙÈÎ¿ ‰Â‰ÔÌ¤Ó· ‰ËÏÒÓÔ˘Ó fiÙÈ ÔÈ ·Ú¿ÁÔ-ÓÙÂ˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙË ¡∂∫ ‰ÈÂÁÂ›ÚÔ˘Ó ÙËÓ ·-Ú·ÁˆÁ‹ ÙÔ˘ PAF, Ô˘ ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÌ-Ê¿ÓÈÛË ÂÓÙÂÚÈÎ‹˜ Ó¤ÎÚˆÛË˜ (16). ¶ÔÏÏ¤˜ ÌÂÏ¤ÙÂ˜¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ô PAF ‰ÈÂÁÂ›ÚÂÈ ÙËÓ ·Ú·ÁˆÁ‹ ‰È·-ÊfiÚˆÓ ‰Â˘ÙÂÚÂ˘fiÓÙˆÓ ÌÂÛÔÏ·‚ËÙÒÓ, fiˆ˜ TNF, IL-1, NO, Ú›˙Â˜ ÔÍ˘ÁfiÓÔ˘, ıÚÔÌ‚ÔÍ¿ÓÂ˜ Î·È ÏÂ˘ÎÔÙÚÈ¤-ÓÂ˜, Ô˘ ÌÂ ÙË ÛÂÈÚ¿ ÙÔ˘˜ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ·Ó¿-Ù˘ÍË ÙË˜ ÂÓÙÂÚÈÎ‹˜ Ó¤ÎÚˆÛË˜ (9).

À¿Ú¯ÂÈ Ë ˘fiıÂÛË fiÙÈ Ô PAF Î·È ¿ÏÏÔÈ ÌÂÛÔ-Ï·‚ËÙ¤˜ ÂÓÂÚÁÔÔÈÔ‡Ó ÙËÓ ·fiÙˆÛË ÙˆÓ Î˘ÙÙ¿-ÚˆÓ ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÂÈıËÏ›Ô˘, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙËÓ·ÒÏÂÈ· ÙË˜ ÈÛ¯˘Ú‹˜ Û˘Ó‰ÂÙÈÎ‹˜ ·ÎÂÚ·ÈfiÙËÙ·˜ÙÔ˘ ÂÈıËÏ›Ô˘, ÙËÓ ·‡ÍËÛË ÙË˜ ‰È·ÂÚ·ÙfiÙËÙ·˜ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ Î·È ÙËÓ Â›ÛÔ‰Ô ÌÈÎÚÔ‚›ˆÓ ÛÙÔÂÓÙÂÚÈÎfi ÙÔ›¯ˆÌ· (9).

∏ Î˘ÎÏÔÔÍ˘ÁÂÓ¿ÛË-2 (COX-2) Î·È Ô ˘ÚËÓÈÎfi˜·Ú¿ÁˆÓ-∫µ (NF-KB) ¤¯ÂÈ ‚ÚÂıÂ› ÛÂ ÂÈÚ·Ì·ÙÈÎ¤˜ÌÂÏ¤ÙÂ˜ fiÙÈ Ú¤ÂÈ Ó· ·›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔÛÙËÓ ·ıÔÁ¤ÓÂÈ· ÙË˜ ¡∂∫. ∏ Î˘ÎÏÔÔÍ˘ÁÂÓ¿ÛË(COX), ÁÈ· ÙËÓ ÔÔ›· ¤¯Ô˘Ó ·Ó·ÁÓˆÚÈÛÙÂ› ‰‡Ô Ù‡-ÔÈ, Ë COX-1 Î·È Ë COX-2, Î·Ù·Ï‡ÂÈ ÙÔÓ ÌÂÙ·‚ÔÏÈ-ÛÌfi ÙÔ˘ ·Ú·¯È‰ÔÓÈÎÔ‡ ÔÍ¤Ô˜ ÛÂ ÚÔÛÙ·ÁÏ·Ó‰›-ÓÂ˜, ÏÂ˘ÎÔÙÚÈ¤ÓÂ˜ Î·È ıÚÔÌ‚ÔÍ¿ÓÂ˜. ∏ ‰Ú·ÛÙÈÎfi-ÙËÙ¿ ÙË˜ ·˘Í¿ÓÂÙ·È ·fi ÚÔÊÏÂÁÌÔÓÒ‰ÂÈ˜ Î˘ÙÔ-Î›ÓÂ˜, fiˆ˜ IL-1, IL-6 Î·È TNF Î·È ¤¯ÂÈ ‚ÚÂıÂ› fiÙÈ·˘Í¿ÓÂÈ ÛÂ ÊÏÂÁÌÔÓÒ‰ÂÈ˜ Î·Ù·ÛÙ¿ÛÂÈ˜ ÙÔ˘ Á·-ÛÙÚÂÓÙÂÚÈÎÔ‡ ÛˆÏ‹Ó·. ∂›ÛË˜, Ô NF-KB Â›Ó·È Ì›·


234

™¯‹Ì· 1. ¶·ıÔÁ¤ÓÂÈ· ¡∂∫.

ñ ∞ÛÊ˘Í›·ñ ÀfiÙ·ÛËñ ¶ÔÏ˘ÂÚ˘ı·ÈÌ›· ñ OÍ¤ˆÛËñ ¶ÚÔˆÚfiÙËÙ·

∞ÒÏÂÈ· ÂÈıËÏÈ·ÎÔ‡ ÂÓÙÂÚÈÎÔ‡ ÊÚ·ÁÌÔ‡

ºÏÂÁÌÔÓ‹ ‚ÏÂÓÓÔÁfiÓÔ˘

πÛ¯·ÈÌ›·

TNF, PAF, IL-6

¡∂∫

+

ñ ∞ÓÔÛÔÏÔÁÈÎ‹ ·ÓˆÚÈÌfiÙËÙ· ñ ¶ÚÔÛÎfiÏÏËÛË Î·È ‰›Ô‰Ô˜

·ıÔÁfiÓˆÓ ÌÈÎÚÔ‚›ˆÓ ñ •¤ÓÔ Á¿Ï·


ÛËÌ·ÓÙÈÎ‹ ÚˆÙÂ˝ÓË Ô˘ Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ÂÓÂÚÁÔ-Ô›ËÛË ÔÏÏÒÓ ÊÏÂÁÌÔÓˆ‰ÒÓ ÌÂÛÔÏ·‚ËÙÒÓ Î·ÈÎ˘ÙÔÎÈÓÒÓ (17).

∏ ÈÓ‰ÔÌÂı·Î›ÓË, ¤Ó·˜ ÌË ÂÈ‰ÈÎfi˜ ·Ó·ÛÙÔÏ¤·˜ÙË˜ COX-1 Î·È COX-2, ÚÔÎ·ÏÂ› ·ÁÁÂÈÔÛ˘ÛÙÔÏ‹ Î·È¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËıÂ› ·ÔÙÂÏÂÛÌ·ÙÈÎ¿ ÛÂ ÓÂÔÁÓ¿ ÁÈ·ÙÔ ÎÏÂ›ÛÈÌÔ ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ fiÚÔ˘. ∞Ù˘¯Ò˜, fiÌˆ˜,Û˘ÓÔ‰Â‡ÂÙ·È ·fi Ì›· ·˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ· ¡∂∫ Ïfi-Áˆ ÂÏ·ÙÙˆÌ¤ÓË˜ ·ÈÌ¿ÙˆÛË˜ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘, Ô˘Ô‰ËÁÂ› ÛÂ ÈÛ¯·ÈÌ›· ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ Î·È Â·ÎfiÏÔ˘-ıË ‰È‹ıËÛË ·fi ÌÈÎÚfi‚È· (18,19).

∆Ô ¡O Î·È Ë ÂÈÛ·ÁˆÁÈÎ‹ Û˘ÓıÂÙ¿ÛË ÙÔ˘ ¡O(π¡O™) ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËıÂ› ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÙË˜¡∂∫. OÈ Ford Î·È Û˘Ó ‚Ú‹Î·Ó fiÙÈ ÙÔ ¡O ·Ú¿ÁÂÙ·È ÛÂÌÂÁ¿ÏÂ˜ ÔÛfiÙËÙÂ˜ ·fi Ù· ÂÓÙÂÚÔÎ‡ÙÙ·Ú· ·ÛıÂÓÒÓÌÂ ¡∂∫. ∞Ó·ÛÙÔÏÂ›˜ ÙÔ˘ ¡O ¤¯ÂÈ ‚ÚÂıÂ› fiÙÈ ·Ó·-ÛÙ¤ÏÏÔ˘Ó ‹ Î·Ù·ÚÁÔ‡Ó ÙÈ˜ ˘ÔÙ·ÛÈÎ¤˜ ÂÈÙÒÛÂÈ˜ÙÔ˘ TNF. ∞ÎfiÌË, ÂÓ‰ÔÊÏ¤‚È· ¯ÔÚ‹ÁËÛË ÓÈÙÚÔÁÏ˘ÎÂ-Ú›ÓË˜, ÂÓfi˜ ÂÓÈÛ¯˘Ù‹ ÙÔ˘ ¡O, ÂÏ·ÙÙÒÓÂÈ ÙËÓ ÂÓÙÂÚÈÎ‹‚Ï¿‚Ë ÛÂ ÎÔ˘Ó¤ÏÈ· Ô˘ ¿Û¯Ô˘Ó ·fi ¡∂∫ (20,21).

∏ ÈÓ‰ÔÌÂı·Î›ÓË, Ë ‚ÈÙ·Ì›ÓË ∂, Ë Î·ÊÂ˝ÓË, Ë ıÂ-ÔÊ˘ÏÏ›ÓË, Ë ¯Ú‹ÛË ÎÔÎ·˝ÓË˜ ·fi ÙË ÌËÙ¤Ú· Î·È ¿Ï-Ï· ÂÈ‰ÈÎ¿ Ê·ÚÌ·ÎÔÏÔÁÈÎ¿ ÚÔ˚fiÓÙ· ¤¯Ô˘Ó ÂÓÔ¯Ô-ÔÈËıÂ› ÁÈ· ÙËÓ ¤Ó·ÚÍË ÙË˜ ¡∂∫ (22).

∂›ÛË˜, ÔÈ ÈÓÙÂÚÏÂ˘Î›ÓÂ˜ ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙÂ› ÌÂÙËÓ ·ıÔÁ¤ÓÂÈ· ÙË˜ ¡∂∫. ∏ πL-4 ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙÂ› ÌÂÙËÓ ·Ó·ÛÙÔÏ‹ ÙË˜ ¤Ó·ÚÍË˜ ¤ÎÊÚ·ÛË˜ ÙÔ˘ ¡O Î·ÈÙËÓ ÂÏ¿ÙÙˆÛË ÙË˜ Û‡ÓıÂÛË˜ ÙÔ˘ ¡O (23). ∏ πL-6¤¯ÂÈ Û˘Û¯ÂÙÈÛÙÂ› ÌÂ ÙË ¡∂∫ ÌÂ ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÙÚfi-Ô˘˜. OÈ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÙË˜ πL-6 ÛÙÔ ·›Ì· ÙÔ˘ ÔÌ-Ê¿ÏÈÔ˘ ÏÒÚÔ˘ Â›Ó·È ·˘ÍËÌ¤ÓÂ˜ ÛÂ ÓÂÔÁÓ¿ Ô˘ ÂÌ-Ê¿ÓÈÛ·Ó ·ÚÁfiÙÂÚ· ÛÔ‚·Ú¤˜ ÂÈÏÔÎ¤˜, fiˆ˜ Û‹-„Ë, ÓÂ˘ÌÔÓ›·, ¡∂∫ Î·È ÂÓ‰ÔÎÔÈÏÈ·Î‹ ÂÁÎÂÊ·ÏÈÎ‹·ÈÌÔÚÚ·Á›·. ™Â ÓÂÔÁÓ¿ ÌÂ ¡∂∫ ÔÈ Û˘ÁÎÂÓÙÚÒÛÂÈ˜‚Ú¤ıËÎ·Ó ·˘ÍËÌ¤ÓÂ˜ ÌfiÓÔ ÛÂ ÂÚÈÙÒÛÂÈ˜ ÚÔ¯ˆ-ÚËÌ¤ÓË˜ ÓfiÛÔ˘, Ô˘ Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ÂÓÙÂÚÈÎ‹Ó¤ÎÚˆÛË Î·È ÂÈ‰ÈÎfiÙÂÚ· fiÙ·Ó ˘¿Ú¯ÂÈ ÌÈÎÚÔ‚È·ÈÌ›·(24,25). ∏ πL-8 ¤¯ÂÈ ‚ÚÂıÂ› ÛËÌ·ÓÙÈÎ¿ ·˘ÍËÌ¤ÓË ÛÂÓÂÔÁÓ¿ ÌÂ ¡∂∫ ÙÚ›ÙÔ˘ ÛÙ·‰›Ô˘ (26). ∏ πL-1 ¤¯ÂÈ‚ÚÂıÂ› ·˘ÍËÌ¤ÓË ÛÙÔ ÂÚÈÙÔÓ·˚Îfi ˘ÁÚfi ÓÂÔÁÓÒÓ ÌÂ¡∂∫ Ô˘ ¯ÂÈÚÔ˘ÚÁ‹ıËÎ·Ó. ∂›ÛË˜, ÔÈ Û˘ÁÎÂÓÙÚÒ-ÛÂÈ˜ ÛÙÔÓ ÔÚfi πL-1 Î·È πL-1 receptor antagonist (IL-1ra) Â›Ó·È ·˘ÍËÌ¤ÓÂ˜ ÛÂ ÛÔ‚·Ú¤˜ ÂÚÈÙÒÛÂÈ˜¡∂∫, Ô˘ ÛËÌ·›ÓÂÈ Î¿ÔÈ· Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ¡∂∫Î·È ·˘Ù‹˜ ÙË˜ ÚÔÊÏÂÁÌÔÓÒ‰Ô˘˜ Î˘ÙÔÎ›ÓË˜(26,27). ∏ πL-2 ·˘Í¿ÓÂÈ ÙË ‰›Ô‰Ô ÌÈÎÚÔ‚›ˆÓ ·fi ÙÔÓÂÓÙÂÚÈÎfi ÛˆÏ‹Ó· ÛÙÔ˘˜ ÌÂÛÂÓÙ¤ÚÈÔ˘˜ ÏÂÌÊ·‰¤ÓÂ˜.∂ÎÙfi˜ ·fi ÙÔÓ Èı·Ófi ÚfiÏÔ ÙË˜ ÛÙËÓ ÚfiÎÏËÛËÙË˜ ÂÓÙÂÚÈÎ‹˜ ‚Ï¿‚Ë˜, Ë πL-2 ·›˙ÂÈ Î¿ÔÈÔ ÚfiÏÔÛÙËÓ ›·ÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÙÔÈ¯ÒÌ·ÙÔ˜ (28,29).

∫ÏÈÓÈÎ‹ ÂÈÎfiÓ·∏ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÙË˜ ¡∂∫ ÂÚÈÏ·Ì‚¿ÓÂÈ ÁÂÓÈÎ¿

Û˘ÌÙÒÌ·Ù· Î·È Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ÂÙÈÎfi. ∆·

ÁÂÓÈÎ¿ Û˘ÌÙÒÌ·Ù· Â›Ó·È ‰ÈÂÁÂÚÛÈÌfiÙËÙ·, ˘ÓË-Ï›·, ¿ÓÔÈ· Î·È ıÂÚÌÔÚÚ˘ıÌÈÛÙÈÎ‹ ·ÛÙ¿ıÂÈ·. ∆·Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ÂÙÈÎfi Â›Ó·È ‰È·Ù·Ú·¯¤˜ Û›ÙÈ-ÛË˜ ÌÂ ˘fiÏÂÈÌÌ· Á¿Ï·ÙÔ˜, ¤ÌÂÙÔÈ, ÌÂÙÂˆÚÈÛÌfi˜Î·È ·ÈÌÔÚÚ·ÁÈÎ¤˜ ÎÂÓÒÛÂÈ˜. ∆· Û˘ÌÙÒÌ·Ù· ·˘Ù¿‰ÂÓ Â›Ó·È ÂÈ‰ÈÎ¿ Î·È ·ÔÙÂÏÔ‡Ó ÌfiÓÔ Ì›· ¤Ó‰ÂÈÍËÂÈÎÂ›ÌÂÓË˜ Û‹„Ë˜. ªÂÁ¿ÏË ·ÈÌÔÚÚ·Á›· ·fi ÙÔ¤ÓÙÂÚÔ Û˘Ì‚·›ÓÂÈ ÛÂ 25-63% ÙˆÓ ÂÚÈÙÒÛÂˆÓ,ÂÓÒ ÌË ÂÌÊ·Ó‹˜ ·ÈÌÔÚÚ·Á›· ˘¿Ú¯ÂÈ ÛÙÔ 22-59%(20,29,30).

À¿Ú¯Ô˘Ó ÔÚÈÛÌ¤ÓÂ˜ ÌÈÎÚ¤˜ ‰È·ÊÔÚ¤˜ ÛÙËÓÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÙË˜ ¡∂∫ ·Ó¿ÌÂÛ· ÛÙ· ÔÏ‡ ¯·ÌË-ÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ ÓÂÔÁÓ¿ (¶Ãµ°¡) Î·È Ù· ¿Ï-Ï· ÓÂÔÁÓ¿. ∂›Ó·È ÛËÌ·ÓÙÈÎfi Ó· ı˘ÌfiÌ·ÛÙÂ fiÙÈ Ù·ÎÏÈÓÈÎ¿ Â˘Ú‹Ì·Ù· ÛÙ· ¶Ãµ°¡ Â›Ó·È ‰‡ÛÎÔÏÔ Ó··Ó·ÁÓˆÚÈÛÙÔ‡Ó, ÏfiÁˆ ÙÔ˘ ÌÈÎÚÔ‡ ÙÔ˘˜ ‚¿ÚÔ˘˜,ÙË˜ Û˘Ó˘¿Ú¯Ô˘Û·˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‰˘Û¯¤ÚÂÈ·˜,ÙÔ˘ ÌË¯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡, ÙˆÓ ÔÏÏÒÓ ËÏÂÎÙÚÔ-‰›ˆÓ ·fi Ù· monitors Î·È ÙˆÓ ÂÓ‰ÔÊÏ¤‚ÈˆÓ ÁÚ·Ì-ÌÒÓ. ∆· ¶Ãµ°¡ ¤¯Ô˘Ó ˘„ËÏfiÙÂÚÔ ·ÈÌ·ÙÔÎÚ›ÙË,¯·ÌËÏfiÙÂÚ· ·ÈÌÔÂÙ¿ÏÈ· Î·È ÌÂÁ·Ï‡ÙÂÚË ÔÍ¤ˆÛË·fi Ù· ¿ÏÏ· ÓÂÔÁÓ¿ (20,31).

O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÙË˜ ¡∂∫ ÌÔÚÂ› Ó·Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi˜ ‹ Ó· ˘¿Ú¯ÂÈ Ô˘‰ÂÙÂÚÔÂÓ›·,ıÚÔÌ‚ÔÂÓ›·, ÔÍ¤ˆÛË Î·È ËÏÂÎÙÚÔÏ˘ÙÈÎ¤˜ ‰È·Ù·-Ú·¯¤˜. À¿Ú¯ÂÈ ‰È·ÊÔÚ¿ ÛÙ· ÌÈÎÚfi‚È· Ô˘ ·ÔÌÔ-ÓÒÓÔÓÙ·È ÛÙÔ ·›Ì· Î·È ÙÔ ÂÚÈÙÔÓ·˚Îfi ˘ÁÚfi ÙˆÓ¶Ãµ°¡ ÌÂ ¡∂∫ ·fi Ù· ˘fiÏÔÈ· ÓÂÔÁÓ¿. ™Ù·¶Ãµ°¡ ·ÓÂ˘Ú›ÛÎÂÙ·È ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ ÙÔ ÎÔÏÔ‚·-ÎÙËÚ›‰ÈÔ ·fi Ù· ¿ÏÏ· ÚfiˆÚ· (23% ¤Ó·ÓÙÈ 54%).™Â ·˘Ù¿ Û˘Ó‹ıˆ˜ ·ÔÌÔÓÒÓÂÙ·È Ì›· ÔÈÎÈÏ›· ÌÈ-ÎÚÔ‚›ˆÓ, fiˆ˜ Clostridium SP, Pseudomonas SP,Klebsiella SP, Staphylococcus coagulase ·ÚÓËÙÈ-Îfi˜ Î·È ÂÓÙÂÚfiÎÔÎÎÔ˜ (32).

O ·ÎÙÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÎÔÈÏ›·˜ ‰Â›¯ÓÂÈ ‰È·ÙÂ-Ù·Ì¤ÓÂ˜ ÂÓÙÂÚÈÎ¤˜ ¤ÏÈÎÂ˜, ·¤Ú· ÛÙÔ ÂÓÙÂÚÈÎfi ÙÔ›-¯ˆÌ· ‹ ÛÙËÓ ˘Ï·›· ÊÏ¤‚·. ™¿ÓÈ· ÛÙ· ¶Ãµ°¡·Ó·ÁÓˆÚ›˙ÂÙ·È ·¤Ú·˜ ÛÙÔ ˘Ï·›Ô Û‡ÛÙËÌ·, ÏfiÁˆÙÔ˘ ÌÈÎÚÔ‡ ÌÂÁ¤ıÔ˘˜ ÙË˜ ÎÔÈÏ›·˜ ÙÔ˘˜ (31).

O ‚·ıÌfi˜ Î·È Ë ‚·Ú‡ÙËÙ· ÙË˜ ÂÓÙÂÚÈÎ‹˜ ‚Ï¿‚Ë˜ÔÈÎ›ÏÏÂÈ ÛÂ ÌÂÁ¿ÏÔ ‚·ıÌfi Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ·fiÙÔÈÎ‹ ¤ÏÎˆÛË ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ Î·È Ó¤ÎÚˆÛË ÙÔ˘ÂÛˆÙÂÚÈÎÔ‡ ÂÓÙÂÚÈÎÔ‡ ÙÔÈ¯ÒÌ·ÙÔ˜ Ì¤¯ÚÈ Ï‹ÚË Ó¤-ÎÚˆÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÙÔÈ¯ÒÌ·ÙÔ˜, ‰È¿ÙÚËÛË, ÂÚÈ-ÙÔÓ›ÙÈ‰· Î·È Û‹„Ë. OÈ ÂÚÈÔ¯¤˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Ô˘ÚÔÛ‚¿ÏÏÔÓÙ·È Û˘Ó‹ıˆ˜ Â›Ó·È Ô ÙÂÏÈÎfi˜ ÂÈÏÂfi˜ Î·ÈÙÔ ÂÁÁ‡˜ ÎfiÏÔÓ, fiÌˆ˜ fiÏÂ˜ ÔÈ ÂÚÈÔ¯¤˜ ÙÔ˘ ÂÓÙ¤-ÚÔ˘ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔÛ‚ÏËıÔ‡Ó. ∆Ô Â˘Ú‡ Ê¿-ÛÌ· ÙË˜ ÂÓÙÂÚÈÎ‹˜ ‚Ï¿‚Ë˜ ÂÍËÁÂ› ÙËÓ ÔÈÎÈÏ›· ÙˆÓÎÏÈÓÈÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ. ŒÙÛÈ, ·Ó¿ÏÔÁ· ÌÂ Ù· ÎÏÈÓÈÎ¿Â˘Ú‹Ì·Ù· Î·È Ù· Â˘Ú‹Ì·Ù· ·fi ÙÔ ¤ÓÙÂÚÔ ‰È·ÎÚ›-ÓÔÓÙ·È ÙÚ›· ÛÙ¿‰È· (¶›Ó·Î·˜ 1) (33).

∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯Ô˘Ó ·Ó·Ù˘¯ıÂ› ‰È¿ÊÔ-ÚÂ˜ Ì¤ıÔ‰ÔÈ ÁÈ· ÙËÓ ¤ÁÎ·ÈÚË ·Ó·ÁÓÒÚÈÛË ÙË˜


235


¡∂∫. OÈ Ì¤ıÔ‰ÔÈ ·˘Ù¤˜ Â›Ó·È Ë ÙÔÓÔÌÂÙÚ›· ÙÔ˘ÂÙÈÎÔ‡, Ë Ì¤ÙÚËÛË ÙÔ˘ D-Á·Ï·ÎÙÈÎÔ‡ ÛÙ· Ô‡-Ú· Î·È ÙÔ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜. ∫·Ì›·,fiÌˆ˜, ·fi ·˘Ù¤˜ ÙÈ˜ ÌÂıfi‰Ô˘˜ ‰ÂÓ Â›Ó·È ÂÈ‰ÈÎ‹Î·È ¤¯Ô˘Ó ÂÚÈÔÚÈÛÌ¤ÓË ÎÏÈÓÈÎ‹ ÛËÌ·Û›·. ∆ÂÏÂ˘-Ù·›·, ÙÔ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ ¯ÚËÛÈÌÔÔÈÂ›-Ù·È fiÏÔ Î·È ÂÚÈÛÛfiÙÂÚÔ ÁÈ· ÙËÓ ÂÍ·ÎÚ›‚ˆÛË ÙË˜·ÚÔ˘Û›·˜ Î·È ÂÓÙÔÈÛÌÔ‡ ·ÛÎÈÙÈÎÔ‡ ˘ÁÚÔ‡,Ô˘ ‰ÈÂ˘ÎÔÏ‡ÓÂÈ ÙËÓ ·Ú·Î¤ÓÙËÛË ÎÔÈÏ›·˜. ∞Îfi-ÌË, ÔÈ ˘¤ÚË¯ÔÈ ÛÙÔ Ì¤ÏÏÔÓ ı· ·›ÍÔ˘Ó Î¿ÔÈÔÚfiÏÔ ÛÙÔÓ Î·ıÔÚÈÛÌfi ÙË˜ ·ÚÔ˘Û›·˜ ÙË˜ ÂÓÙÂ-ÚÈÎ‹˜ ÈÛ¯·ÈÌ›·˜ ÌÂ ÙËÓ ÂÍ¤Ù·ÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ÙÔÈ¯ÒÌ·ÙÔ˜, ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ Î·È ÙˆÓ ÌÂÛÂÓÙ¤-ÚÈˆÓ ·ÁÁÂ›ˆÓ (34).

¶ÚÒÈÌË ‰È¿ÁÓˆÛË °È· ÔÏÏ¿ ¯ÚfiÓÈ· ÂÚÂ˘ÓËÙ¤˜ ¤¯Ô˘Ó ÚÔÛ·ı‹-

ÛÂÈ Ó· ·Ó·ÁÓˆÚ›ÛÔ˘Ó ÂÈ‰ÈÎÔ‡˜ ‰Â›ÎÙÂ˜ Ô˘ ı· Â¤-ÙÚÂ·Ó ÙËÓ ÚÒÈÌË ‰È¿ÁÓˆÛË Î·È ıÂÚ·Â›· ÙË˜¡∂∫. ™‹ÌÂÚ·, ·ÚfiÙÈ ˘¿Ú¯ÂÈ ÛËÌ·ÓÙÈÎfi ÂÓ‰È·Ê¤-ÚÔÓ ÛÙË Ì¤ÙÚËÛË ÔÈÎ›ÏˆÓ ¯ËÌÈÎÒÓ ÌÂÛÔÏ·‚ËÙÒÓÁÈ· ÙËÓ ÚfiÁÓˆÛË ÙË˜ ÓfiÛÔ˘, ‰ÂÓ ˘¿Ú¯ÂÈ ÔÌÔ-ÊˆÓ›· ÁÈ· ÙË ¯ÚËÛÈÌÔÔ›ËÛË Î¿ÔÈ·˜ ·Ú·‰ÂÎÙ‹˜ÌÂıfi‰Ô˘. ª›· ÚfiÛÊ·ÙË ÌÂÏ¤ÙË Ì¤ÙÚËÛÂ ÙË ‰Â-ÛÌÂ˘Ì¤ÓË ÌÂ ÏÈ·Ú¿ ÔÍ¤· ÂÓÙÂÚÈÎ‹ ÚˆÙÂ˝ÓË, Ô˘

Â›Ó·È ‰Â›ÎÙË˜ ÂÈıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ·ÂÏÂ˘-ıÂÚÒÓÂÙ·È ÛÙË Û˘ÛÙËÌ·ÙÈÎ‹ Î˘ÎÏÔÊÔÚ›·. ª›· ¿Ï-ÏË ÚfiÛÊ·ÙË ÌÂÏ¤ÙË ¯ÚËÛÈÌÔÔ›ËÛÂ ÙË Ì·ÁÓËÙÈÎ‹ÙÔÌÔÁÚ·Ê›· (ªRI) ÁÈ· ÙËÓ ·Ó·›Ì·ÎÙË ‰È¿ÁÓˆÛËÙË˜ ÂÓÙÂÚÈÎ‹˜ Ó¤ÎÚˆÛË˜ ÛÂ ÚfiˆÚ· ÓÂÔÁÓ¿ ÌÂ˘Ô„›· ¡∂∫. ¶ÚfiˆÚ· ÓÂÔÁÓ¿ ÌÂ ¡∂∫ Ô˘ ¯ÂÈ-ÚÔ˘ÚÁ‹ıËÎ·Ó Î·È Â›¯·Ó Ó¤ÎÚˆÛË ÙÔ˘ ÂÓÙ¤ÚÔ˘ Â›-¯·Ó ·ÚÔ˘ÛÈ¿ÛÂÈ ÛÙÔ ªRI ÂÈÎfiÓ· Ê˘Û·Ï›‰ˆÓ ÛÙÔ¤ÓÙÂÚÔ. ∞Ó Î·È Ë Ì¤ıÔ‰Ô˜ ·˘Ù‹ ¤¯ÂÈ ÂÚÈÔÚÈÛÌ¤ÓË¯ÚËÛÈÌfiÙËÙ· ÛÙÔ Û‡Á¯ÚÔÓÔ ÓÂÔÁÓÈÎfi ÂÚÈ‚¿ÏÏÔÓ,ÌÂÏÏÔÓÙÈÎ¤˜ ÌÂÏ¤ÙÂ˜ Ô˘ ı· ÂÚÂ˘ÓÔ‡Ó ÏÂÈÙÔ˘ÚÁÈ-Î¤˜ ÂÈÎfiÓÂ˜ ÙÔ˘ MRI, ÌÔÚÂ› Ó· ‚ÔËı‹ÛÔ˘Ó ÛÙËÓÚfiÁÓˆÛË ÙË˜ ÂÍ¤ÏÈÍË˜ ÙË˜ ÂÓÙÂÚÈÎ‹˜ ‚Ï¿‚Ë˜ ÛÂÏËı˘ÛÌfi ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (35-37).

£ÂÚ·Â›· ™Â ˘Ô„›· ¡∂∫, ı· Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ ¤ÁÎ·ÈÚË

Î·È ÂÈıÂÙÈÎ‹ ıÂÚ·Â›·. ∏ ıÂÚ·Â›· ÂÚÈÏ·Ì‚¿ÓÂÈÂÓ‰ÔÊÏ¤‚È· ¯ÔÚ‹ÁËÛË ˘ÁÚÒÓ, ·ÔÛ˘ÌÊfiÚËÛËÙÔ˘ ÂÓÙ¤ÚÔ˘ ÌÂ ÚÈÓÔÁ·ÛÙÚÈÎfi Î·ıÂÙ‹Ú·, ‰ÈfiÚıˆ-ÛË ·Ó·ÈÌ›·˜ Î·È ıÚÔÌ‚ÔÂÓ›·˜ Î·È ÂÌÂÈÚÈÎ‹ ¯Ô-Ú‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Î·Ù¿ ÙË˜ ÂÓÙÂÚÈÎ‹˜ ¯ÏˆÚ›-‰·˜. ™˘Ó‹ıˆ˜, Ô Û˘Ó‰˘·ÛÌfi˜ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÂÚÈ-Ï·Ì‚¿ÓÂÈ ·ÌÈÎÈÏÏ›ÓË ‹ ‚·ÓÎÔÌ˘Î›ÓË Î·È ÁÂÓÙ·Ì˘-Î›ÓË ‹ ÎÂÊÔÙ·Í›ÌË.


236

¶›Ó·Î·˜ 1. ∆ÚÔÔÔÈËÌ¤Ó· ÎÚÈÙ‹ÚÈ· ÛÙ·‰ÈÔÔ›ËÛË˜ ÙË˜ ¡∂∫ Î·Ù¿ Bell

™Ù¿‰ÈÔ ∆·ÍÈÓfiÌËÛË ™˘ÛÙËÌ·ÙÈÎ¿ ÛËÌÂ›· ™ËÌÂ›· ·fi ÙÔ ¤ÓÙÂÚÔ ∞ÎÙÈÓÔÏÔÁÈÎ¿ ÛËÌÂ›·

π∞ ñ ⁄ÔÙË ¡∂∫ ñ £ÂÚÌÔÚÚ˘ıÌÈÛÙÈÎ‹ ñ ∞˘ÍËÌ¤ÓÔ Á·ÛÙÚÈÎfi ñ º˘ÛÈÔÏÔÁÈÎ¿ ‹ ÂÓÙÂÚÈÎ‹ ·ÛÙ¿ıÂÈ·, ¿ÓÔÈ·, ˘fiÏÂÈÌÌ·, ‰È¿Ù·ÛË ‰È¿Ù·ÛË, ‹ÈÔ˜ ÂÈÏÂfi˜‚Ú·‰˘Î·Ú‰›·, Ï‹ı·ÚÁÔ˜ Ì¤ÛË˜ ÎÔÈÏ›·˜,

¤ÌÂÙÔÈ, ıÂÙÈÎfi ÙÂÛÙ ∏‚ ÛÙ· ÎfiÚ·Ó·

πµ ñ ⁄ÔÙË ¡∂∫ ñ ÿ‰È·, fiˆ˜ π∞ ñ ∞ÓÔÈÎÙfi ÎfiÎÎÈÓÔ ·›Ì· ñ ÿ‰È·, fiˆ˜ π∞·fi ÙÔÓ ÚˆÎÙfi

ππ∞ ñ ∞Ô‰Â‰ÂÈÁÌ¤ÓË ñ ÿ‰È·, fiˆ˜ π∞ ñ ÿ‰È·, fiˆ˜ πµ. ñ ¢È¿Ù·ÛË ÂÓÙ¤ÚÔ˘, ¡∂∫, ‡ÔÙË ∂ÈÏ¤ÔÓ, ·Ô˘Û›· ÂÈÏÂfi˜, ÂÓÙÂÚÈÎ‹ ÓfiÛÔ˜ ÂÓÙÂÚÈÎÒÓ ‹¯ˆÓ ÌÂ ‹ ÓÂ˘Ì¿ÙˆÛË

¯ˆÚ›˜ ÎÔÈÏÈ·Î‹ Â˘·ÈÛıËÛ›·

ππµ ñ ∞Ô‰Â‰ÂÈÁÌ¤ÓË ñ ÿ‰È·, fiˆ˜ π∞. ∂ÈÏ¤ÔÓ, ñ ÿ‰È·, fiˆ˜ ππ∞. ∂ÈÏ¤ÔÓ, ñ ÿ‰È·, fiˆ˜ ππ∞. ∂ÈÏ¤ÔÓ, ¡∂∫, Ì¤ÙÚÈ· ‹È· ÌÂÙ·‚ÔÏÈÎ‹ ÔÍ¤ˆÛË ·Ô˘Û›· ÂÓÙÂÚÈÎÒÓ ‹¯ˆÓ. Â›ÛËÌÔ˜ ·ÛÎ›ÙË˜ ÓfiÛÔ˜ Î·È ‹È· ıÚÔÌ‚ÔÂÓ›· ∂›ÛËÌÔ˜ ÌÂÙÂˆÚÈÛÌfi˜ ÌÂ

‹ ¯ˆÚ›˜ ÎÔÈÏÈ·Î‹ Î˘ÙÙ·Ú›ÙÈ‰· ‹ Ì¿˙· ÛÙÔ ‰ÂÍÈfi Î¿Ùˆ ÙÂÙ·ÚÙËÌfiÚÈÔÙË˜ ÎÔÈÏ›·˜

πππ∞ ñ ¶ÚÔ¯ˆÚËÌ¤ÓË ñ ÿ‰È·, fiˆ˜ ππµ. ∂ÈÏ¤ÔÓ, ñ ÿ‰È·, fiˆ˜ ππµ. ∂ÈÏ¤ÔÓ, ñ ÿ‰È·, fiˆ˜ ππ∞. ∂ÈÏ¤ÔÓ, ¡∂∫, ÛÔ‚·Ú‹ ˘fiÙ·ÛË, ‚Ú·‰˘Î·Ú‰›·, ÛËÌÂ›· ÁÂÓÈÎÂ˘Ì¤ÓË˜ Â›ÛËÌÔ˜ ·ÛÎ›ÙË˜ÓfiÛËÛË, ÚÔÛ‚ÔÏ‹ ÛÔ‚·Ú‹ ¿ÓÔÈ·, ÂÚÈÙÔÓ›ÙÈ‰·˜, ¤ÓÙÔÓË ÂÓÙ¤ÚÔ˘ Û˘Ó‰˘·ÛÌfi˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ Â˘·ÈÛıËÛ›·, ÌÂÙÂˆÚÈÛÌfi˜

Î·È ÌÂÙ·‚ÔÏÈÎ‹˜ ÔÍ¤ˆÛË˜, ÎÔÈÏ›·˜‰È¿¯˘ÙË ÂÓ‰·ÁÁÂÈ·Î‹ ‹ÍË Î·È Ô˘‰ÂÙÂÚÔÂÓ›·

πππµ ñ ¶ÚÔ¯ˆÚËÌ¤ÓË ñ ÿ‰È·, fiˆ˜ πππ∞ ñ ÿ‰È·, fiˆ˜ πππ∞ ñ ÿ‰È·, fiˆ˜ πππ∞. ∂ÈÏ¤ÔÓ, ¡∂∫, ÛÔ‚·Ú‹ ÓÂ˘ÌÔÂÚÈÙfiÓ·ÈÔ ÓfiÛËÛË, ‰È¿ÙÚËÛË ÂÓÙ¤ÚÔ˘


∏ ÚfiÛıÂÙË ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÁÈ· ·Ó·Â-Úfi‚È· ÌÈÎÚfi‚È· (ÎÏÈÓ‰·Ì˘Î›ÓË ‹ ÌÂÙÚÔÓÈ‰·˙fiÏË)‰ÂÓ ÂÓ‰Â›ÎÓ˘Ù·È ÁÈ· ‡ÔÙÂ˜ ÂÚÈÙÒÛÂÈ˜, ·Ú¿ÌfiÓÔÓ ÂÊfiÛÔÓ ¤¯ÂÈ Û˘Ì‚Â› ‰È¿ÙÚËÛË ‹ ÂÚÈÙÔÓ›ÙÈ-‰·. ∆· ·ÓÙÈ‚ÈÔÙÈÎ¿, ‚¤‚·È·, ÙÚÔÔÔÈÔ‡ÓÙ·È ·Ó¿ÏÔ-Á· ÌÂ ÙÈ˜ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ÙˆÓ ÎÔÚ¿ÓˆÓ, ÙÔ˘ ·›Ì·ÙÔ˜Î·È ÙÔ˘ ∂¡À. ÃÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÁÈ· 3 ËÌ¤ÚÂ˜Â›Ó·È ·ÚÎÂÙ‹, ÂÊfiÛÔÓ ˘¿Ú¯ÂÈ ÎÏÈÓÈÎ‹ ‚ÂÏÙ›ˆÛË Î·ÈÙ· ÂÚÁ·ÛÙËÚÈ·Î¿ Â›Ó·È ·ÚÓËÙÈÎ¿. ¡ÂÔÁÓ¿ ÌÂ ·Ô-‰Â‰ÂÈÁÌ¤ÓË ¡∂∫ ¯ÚÂÈ¿˙ÔÓÙ·È ıÂÚ·Â›· ÙÔ˘Ï¿¯È-ÛÙÔÓ ÁÈ· 8-10 ËÌ¤ÚÂ˜.

¡ÂÔÁÓ¿ ÌÂ ¡∂∫ ÙÚ›ÙÔ˘ ÛÙ·‰›Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·ÈÂÓÙ·ÙÈÎ‹ ÓÔÛËÏÂ›·, Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÌË¯·ÓÈÎ‹˘ÔÛÙ‹ÚÈÍË ·Ó·ÓÔ‹˜, Û˘ÓÂ¯‹ ·Ú·ÎÔÏÔ‡ıËÛË˙ˆÙÈÎÒÓ ÛËÌÂ›ˆÓ ÌÂ monitors, ·ÎÙÈÓÔÏÔÁÈÎfi ¤ÏÂÁ¯ÔÎÔÈÏ›·˜ Î¿ıÂ 6-8 ÒÚÂ˜, ‰ÈfiÚıˆÛË ÔÍ¤ˆÛË˜ Î·ÈËÏÂÎÙÚÔÏ˘ÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, ¯ÔÚ‹ÁËÛË ÎÔÏÏÔÂÈ-‰ÒÓ, ·Ú·ÁÒÁˆÓ ·›Ì·ÙÔ˜, fiˆ˜ ÊÚ¤ÛÎÔ˘ Î·ÙÂ-„˘ÁÌ¤ÓÔ˘ Ï¿ÛÌ·ÙÔ˜ Î·È ·ÈÌÔÂÙ·Ï›ˆÓ. °È· ÙË‚ÂÏÙ›ˆÛË ÙË˜ ·ÈÌ¿ÙˆÛË˜ ÙˆÓ ÔÚÁ¿ÓˆÓ Î·È ÙËÓ ÂÓ›-Û¯˘ÛË ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘ Â›Ó·È ··Ú·›ÙËÙ· ÈÓfiÙÚÔ··ÁÁÂÈÔÛ˘ÛÙ·ÏÙÈÎ¿, fiˆ˜ ÓÙÔ·Ì›ÓË Î·È ÓÙÔ‚Ô˘Ù·-Ì›ÓË ÌÂ ·Ú¯ÈÎ‹ ‰fiÛË 5 Ìg/kg/min ¤ˆ˜ 20Ìg/kg/min. ∆· ÓÂÔÁÓ¿ ·˘Ù¿ ¯ÚÂÈ¿˙ÔÓÙ·È ıÂÚ·Â›·ÁÈ· 14-21 ËÌ¤ÚÂ˜ (10,20,33).

∂ÊfiÛÔÓ Ë ÓfiÛÔ˜ ÂÍÂÏ›ÛÛÂÙ·È ·Ú¿ ÙËÓ ¤ÓÙÔÓËÛ˘ÓÙËÚËÙÈÎ‹ ·ÁˆÁ‹, ÙfiÙÂ Ë ¯ÂÈÚÔ˘ÚÁÈÎ‹ Â¤Ì‚·ÛËÂ›Ó·È ·Ó·ÁÎ·›·. OÈ ÂÓ‰Â›ÍÂÈ˜ ÁÈ· ¯ÂÈÚÔ˘ÚÁÈÎ‹ Â¤Ì-‚·ÛË ‰È·Ê¤ÚÔ˘Ó ÌÂÙ·Í‡ ÙˆÓ ‰È·ÊfiÚˆÓ Î¤ÓÙÚˆÓ.°ÂÓÈÎ¿, Ë ÂÌÊ¿ÓÈÛË ÚÔÔ‰Â˘ÙÈÎ‹˜ ÂÈ‰Â›ÓˆÛË˜ ÌÂ·˘Í·ÓfiÌÂÓË ÌÂÙ·‚ÔÏÈÎ‹ ÔÍ¤ˆÛË, ıÚÔÌ‚ÔÂÓ›·,ÚÔÔ‰Â˘ÙÈÎfi shock ·fi ·ÒÏÂÈÂ˜ ÙÚ›ÙÔ˘ ¯ÒÚÔ˘Î·È ·‡ÍËÛË ÙÔ˘ ÌÂÙÂˆÚÈÛÌÔ‡ ÙË˜ ÎÔÈÏ›·˜, ·ÔÙÂ-ÏÂ› ¤Ó‰ÂÈÍË Ì·˙ÈÎ‹˜ ÂÓÙÂÚÈÎ‹˜ Ó¤ÎÚˆÛË˜. ∏ ·ÎÙÈÓÔ-ÏÔÁÈÎ‹ ÂÈÎfiÓ· ÌÂ ‰È·ÙÂÙ·Ì¤ÓÂ˜ ÂÓÙÂÚÈÎ¤˜ ¤ÏÈÎÂ˜Û˘ÓÔ‰Â˘fiÌÂÓÂ˜ ÌÂ ÂÓÙÂÚÈÎ‹ ‰È¿Ù·ÛË Â›Ó·È Û˘¯Ó¿¤Ó‰ÂÈÍË ÂÓÙÂÚÈÎ‹˜ Ó¤ÎÚˆÛË˜ Î·È ÚÔ¿ÁÁÂÏÔ˜ ‰È¿-ÙÚËÛË˜. ∂Ó‰Â›ÍÂÈ˜ ÁÈ· ¿ÌÂÛË ¯ÂÈÚÔ˘ÚÁÈÎ‹ Â¤Ì‚·-ÛË Â›Ó·È ÙÔ ÓÂ˘ÌÔÂÚÈÙfiÓ·ÈÔ Î·È ÂÚ˘ıÚfiÙËÙ· ‹ Ô›-‰ËÌ· ÙÔ˘ ÎÔÈÏÈ·ÎÔ‡ ÙÔÈ¯ÒÌ·ÙÔ˜. OÈ ‚·ÛÈÎ¤˜ ¯ÂÈ-ÚÔ˘ÚÁÈÎ¤˜ ·Ú¯¤˜ ÙË˜ ÂÓÙÂÚÈÎ‹˜ ·ÔÛ˘Ì›ÂÛË˜ Â›-Ó·È Ë ÂÎÙÔÌ‹ ÙÔ˘ ÓÂÎÚˆı¤ÓÙÔ˜ ÂÓÙÂÚÈÎÔ‡ ÙÌ‹Ì·-ÙÔ˜ Î·È Ë ·ÚÔ¯¤ÙÂ˘ÛË ÙË˜ ÚÔ‹˜ ÙˆÓ ÎÔÚ¿ÓˆÓ. ∏·Ê·›ÚÂÛË ÙÔ˘ ÚÔÛ‚Â‚ÏËÌ¤ÓÔ˘ ÂÓÙÂÚÈÎÔ‡ ÙÌ‹Ì·-ÙÔ˜ ÌÂ ·Ú¯ÈÎ‹ ·Ó·ÛÙfiÌˆÛË Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È·ÛÊ·Ï‹˜ ÛÂ ÛÙ·ıÂÚÔÔÈËÌ¤Ó· ÓÂÔÁÓ¿, ÛÙ· ÔÔ›·ÙÔ ÂÓ·ÔÌÂ›Ó·Ó ¤ÓÙÂÚÔ Ê·›ÓÂÙ·È ˘ÁÈ¤˜ Î·È ‰ÂÓ ¤¯ÂÈÛ˘Ì‚Â› ÌÂÁ¿ÏË ÂÚÈÙÔÓ·˚Î‹ ÚÔÛ‚ÔÏ‹. ªÂÙ¿ ·fiÌ›· ÈÎ·ÓÔÔÈËÙÈÎ‹ ÂÚ›Ô‰Ô ıÂÚ·Â›·˜ ÌÔÚÂ› Ó· Á›-ÓÂÈ ÂÈÏÂÎÙÈÎ¿ Â·Ó·ÛÙfiÌˆÛË ÛÂ ¤Ó· ‰Â‡ÙÂÚÔ ÛÙ¿-‰ÈÔ (10,20,33,38-40).

∏ ¯ÚËÛÈÌÔÔ›ËÛË ÂÚÈÙÔÓ·˚Î‹˜ ·ÚÔ¯¤ÙÂ˘ÛË˜ÌÂ ÙÔÈÎ‹ ·Ó·ÈÛıËÛ›· ÛÂ ÂÈÏÂÁÌ¤Ó· ÓÂÔÁÓ¿ ÌÂ ÛÔ-‚·Ú‹ ¡∂∫ ¤¯ÂÈ Û˘ÛÙ·ıÂ› ·fi ÙÔ˘˜ Janik Î·È Û˘Ó.

∞˘Ù‹ Ë Ì¤ıÔ‰Ô˜ ÂÈÙÚ¤ÂÈ ÛÙ·ıÂÚÔÔ›ËÛË Î·È ·Ú-ÁfiÙÂÚ·, Â¿Ó ¯ÚÂÈ·ÛÙÂ›, ¯ÂÈÚÔ˘ÚÁÈÎ‹ Â¤Ì‚·ÛË. ∏Ì¤ıÔ‰Ô˜ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È Â˘ÂÚÁÂÙÈÎ‹ ÌfiÓÔ ÛÂ ÓÂ-ÔÁÓ¿ ÌÈÎÚfiÙÂÚ· ·fi 1000 g, ÛÂ ÚÔÛÂÎÙÈÎ¿ ÂÈ-ÏÂÁÌ¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜ Î·È ‰ÂÓ ÌÔÚÂ› Ó· ÂÊ·ÚÌfi-˙ÂÙ·È ÁÂÓÈÎ¿ (41-43).

¶ÚfiÏË„Ë ∏ Î·Ï‡ÙÂÚË Î·Ù·ÓfiËÛË ÙË˜ ·ıÔÁ¤ÓÂÈ·˜ ÙË˜

¡∂∫ ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó¿Ù˘ÍË ÚÔÏËÙÈÎÒÓ Î·È ıÂ-Ú·Â˘ÙÈÎÒÓ ÛÙÚ·ÙËÁÈÎÒÓ. £ÂˆÚËÙÈÎ¿, Ë ÚfiÏË„ËÙË˜ ¡∂∫ ı· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÂÚÈÔÚÈÛÌfiÙˆÓ ÂÈÎ›Ó‰˘ÓˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ Û˘Ì‚¿ÏÏÔ˘ÓÛÙËÓ ÂÓÙÂÚÈÎ‹ ÈÛ¯·ÈÌ›· ÙÔ˘ ·ÓÒÚÈÌÔ˘ ÂÓÙ¤ÚÔ˘,¯ÚËÛÈÌÔÔ›ËÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜ Ô˘ ÂÚÈ¤-¯ÂÈ ÔÏÏ¿ Û˘ÛÙ·ÙÈÎ¿ Ô˘ ÚÔÛÙ·ÙÂ‡Ô˘Ó ÙÔ ¤ÓÙÂÚÔÎ·È, Ù¤ÏÔ˜, ¯ÚËÛÈÌÔÔ›ËÛË ¿ÏÏˆÓ Ô˘ÛÈÒÓ Ô˘ ‚ÂÏ-ÙÈÒÓÔ˘Ó ÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È ·Ó·-ÛÙ¤ÏÏÔ˘Ó ÙÔ˘˜ ·ıÔÁÂÓÂÙÈÎÔ‡˜ ÌË¯·ÓÈÛÌÔ‡˜ Ô˘Ô‰ËÁÔ‡Ó ÛÙË ¡∂∫ (3).

O ‚ÏÂÓÓÔÁfiÓÔ˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Û¯ËÌ·Ù›˙ÂÈ ÙÔÓÚÒÙÔ ÊÚ·ÁÌfi ÛÙ· ·ÓÙÈÁfiÓ· Ô˘ ÚÔÛ‚¿ÏÏÔ˘Ó ÙÔÂÈı‹ÏÈfi ÙÔ˘. O ÊÚ·ÁÌfi˜ ·˘Ùfi˜ Û˘Ó›ÛÙ·Ù·È ·fi‰È¿ÊÔÚÔ˘˜ ·Ú¿ÁÔÓÙÂ˜, fiˆ˜ ÙÔ Á·ÛÙÚÈÎfi pH,Á·ÛÙÚÈÎ¿ Î·È ·ÁÎÚÂ·ÙÈÎ¿ ¤Ó˙˘Ì·, ÂÈÊ¿ÓÂÈ· ‚ÏÂÓ-ÓÔÁfiÓÔ˘ ÏÔ‡ÛÈ· ÛÂ ÁÏ˘ÎÔÚˆÙÂ˝ÓÂ˜ Î·È ·ÓÔÛÔ-ÛÊ·ÈÚ›ÓÂ˜ (16,44).

∏ Ê˘ÛÈÔÏÔÁÈÎ‹ ÌÈÎÚÔ‚È·Î‹ ¯ÏˆÚ›‰· ÙÔ˘ ÂÓÙ¤-ÚÔ˘ ÛÙÔ ÓÂÔÁÓfi, ˆ˜ ÁÓˆÛÙfiÓ, ·ÔÙÂÏÂ›Ù·È ·fi Á·-Ï·ÎÙÔ‚¿ÎÈÏÔ˘˜ (·Ó·ÂÚfi‚È· ÌÈÎÚfi‚È·, fiˆ˜bacteroides Î·È Bifidobacterium), Î˘Ú›ˆ˜ ÛÙ· ıË-Ï¿˙ÔÓÙ· ÓÂÔÁÓ¿ Î·È ÙÔ ÌË ·ıÔÁfiÓÔ ÎÔÏÔ‚·ÎÙËÚ›-‰ÈÔ Î·È ÂÓÙÂÚfiÎÔÎÎÔ˘˜. To ¤ÓÙÂÚÔ, fiÌˆ˜, ÙˆÓ ÓÂÔ-ÁÓÒÓ Ô˘ ÓÔÛËÏÂ‡ÔÓÙ·È ÛÂ ÂÓÙ·ÙÈÎ¤˜ ÌÔÓ¿‰Â˜·ÔÈÎ›˙ÂÙ·È ·fi ÌÂÁ¿ÏÔ ·ÚÈıÌfi ·ıÔÁfiÓˆÓ ÌÈÎÚÔ-‚›ˆÓ, Ô˘ ÌÂÙ¿ ÙË ‰È¿Û·ÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓ-ÓÔÁfiÓÔ˘ ‰È·ÂÚÓÔ‡Ó ÙÔÓ ÂÓÙÂÚÈÎfi ‚ÏÂÓÓÔÁfiÓÔ Î·ÈÂÈÛ¤Ú¯ÔÓÙ·È ÛÙÔ ÂÓÙÂÚÈÎfi ÙÔ›¯ˆÌ·. ∆· ÌÈÎÚfi‚È··˘Ù¿ Â›Ó·È clostridium difficile, E. Coli, Klebsiellapneumoniae, staphylococcus aureus Î·Èepidermidis. ¶ÚfiÛÊ·ÙÂ˜ ÌÂÏ¤ÙÂ˜ Û˘ÌÂÚ·›ÓÔ˘ÓfiÙÈ Ù· ¶Ãµ°¡ ˘ÔÏÂ›ÔÓÙ·È ÛÙÔÓ ·ÔÈÎÈÛÌfi ÙÔ˘ÂÓÙ¤ÚÔ˘ ·fi ·Ó·ÂÚfi‚È· ÌÈÎÚfi‚È· Î·È Ë ÌË ‡·ÚÍË·˘ÙÒÓ ÙˆÓ ÌÈÎÚÔ‚›ˆÓ ÂÈÙÚ¤ÂÈ ÙËÓ ˘ÂÚ-·Ó¿Ù˘-ÍË ÂÚÈÛÛfiÙÂÚÔ ·ıÔÁfiÓˆÓ ÌÈÎÚÔ‚›ˆÓ, Ô˘ Ô‰Ë-ÁÔ‡Ó ÛÙËÓ ¤Ó·ÚÍË ÙË˜ ¡∂∫ (9,45).

°È· ÙËÓ ÚfiÏË„Ë ÙË˜ ¡∂∫ ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈË-ıÂ› ÛÂ ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ Ô˘Û›Â˜ Î·È Ê¿ÚÌ·Î·, ÛÙËÓÚÔÛ¿ıÂÈ· Ó· ÂÏ·ÙÙÒÛÔ˘Ó ÙË ‚·Ú‡ÙËÙ¿ ÙË˜ Î·ÈÓ· ‚ÂÏÙÈÒÛÔ˘Ó ÙËÓ ¤Î‚·Û‹ ÙË˜. ∆¤ÙÔÈÂ˜ Ô˘Û›Â˜ Î·ÈÊ¿ÚÌ·Î· Â›Ó·È ÙÔ ÌËÙÚÈÎfi Á¿Ï·, ÙÔ Û˘ÌÏ‹ÚˆÌ·IgA, Ë ÚÔÊ˘Ï·ÎÙÈÎ‹ ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ, Î˘-Ú›ˆ˜ ‚·ÓÎÔÌ˘Î›ÓË˜, Ë ¯ÔÚ‹ÁËÛË ‰ÂÍ·ÌÂı·˙fiÓË˜,ÊˆÛÊÔÏÈÈ‰›ˆÓ ·˘ÁÔ‡ Û·Ó Û˘ÌÏ‹ÚˆÌ· ÛÙÔ

237



Á¿Ï·, ÂÚ˘ıÚÔÔÈËÙ›ÓË˜ Î·È Ù¤ÏÔ˜ Ù· ÚÔ‚ÈÔÙÈÎ¿(46-50).

∆Ô ÌËÙÚÈÎfi Á¿Ï· ÂÚÈ¤¯ÂÈ ÔÈÎÈÏ›· ·Ú·ÁfiÓÙˆÓÔ˘ ¤¯ÂÈ ‚ÚÂıÂ› fiÙÈ ¤¯Ô˘Ó ·ÓÙÈÊÏÂÁÌÔÓÒ‰ÂÈ˜ È‰Èfi-ÙËÙÂ˜ Î·È ÌÔÚÔ‡Ó Ó· ÚÔÛÙ·ÙÂ‡ÛÔ˘Ó ÙÔ ¤ÓÙÂÚÔ·fi ÙÈ˜ ÙÔÍ›ÓÂ˜. ∆¤ÙÔÈÔÈ ·Ú¿ÁÔÓÙÂ˜ Â›Ó·È Î˘ÙÙ·-ÚÔÚÔÛÙ·ÙÂ˘ÙÈÎÔ›, fiˆ˜ PGE2, PGF2, EGF Î·È Ï·-ÎÙÔÊÂÚÚ›ÓË, ˆÚÈÌ·ÓÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜, fiˆ˜ ÛÙÂ-ÚÔÂÈ‰‹ Î·È ı˘ÚÔÚÌfiÓÂ˜, ¤Ó˙˘Ì·, fiˆ˜ PAF-acetylhydrolase, Ï˘ÛÔ˙‡ÌÂ˜, ÂÎÎÚÈÙÈÎ‹ IgA Î·È·ÓÙÈÔÍÂÈ‰ˆÙÈÎ¤˜ Ô˘Û›Â˜, fiˆ˜ ·-ÙÔÎÔÊÂÚfiÏË,·ÛÎÔÚ‚ÈÎfi, ‚-Î·ÚÔÙ›ÓË Î·È Ô˘ÚÈÎfi ÔÍ‡. ™Â Ì›· ÂÚ-Á·Û›· ‚Ú¤ıËÎÂ fiÙÈ ÛÂ ÓÂÔÁÓ¿ Ô˘ ÛÈÙ›˙ÔÓÙ·Ó ·Ô-ÎÏÂÈÛÙÈÎ¿ ÌÂ Í¤ÓÔ Á¿Ï· Ë ¡∂∫ ‹Ù·Ó 6-10 ÊÔÚ¤˜ÈÔ Û˘¯Ó‹ ·’ fi,ÙÈ ÛÂ ·˘Ù¿ Ô˘ ÛÈÙ›˙ÔÓÙ·Ó ÌÂ ÌË-ÙÚÈÎfi Á¿Ï· Î·È 3 ÊÔÚ¤˜ ÛÂ Û¯¤ÛË ÌÂ ÂÎÂ›Ó· Ô˘ÛÈÙ›˙ÔÓÙ·Ó ÌÂ ÌÈÎÙfi (ÌËÙÚÈÎfi Î·È Í¤ÓÔ) (16,51).

∏ ÂÚ˘ıÚÔÔÈËÙ›ÓË Ô˘ ‚Ú›ÛÎÂÙ·È ÛÙÔ ÌËÙÚÈÎfiÁ¿Ï· ¤¯ÂÈ Î¿ÔÈÔ ÚfiÏÔ ÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ Á·-ÛÙÚÂÓÙÂÚÈÎÔ‡ ÛˆÏ‹Ó·. ∂ÔÌ¤Óˆ˜, Ë ÂÚ˘ıÚÔÔÈË-Ù›ÓË Ú¤ÂÈ Ó· ¤¯ÂÈ ÚÔÛÙ·ÙÂ˘ÙÈÎfi ÚfiÏÔ ÛÙËÓ ÂÎ-‰‹ÏˆÛË ÙË˜ ¡∂∫. ™Â Ì›· ·Ó·‰ÚÔÌÈÎ‹ ÌÂÏ¤ÙË ÙˆÓLedbetter DJ Î·È Û˘Ó ‚Ú¤ıËÎÂ fiÙÈ ÚfiˆÚ· ‚¿ÚÔ˘˜500-1200 g, ÛÙ· ÔÔ›· ¯ÔÚËÁ‹ıËÎÂ ÂÚ˘ıÚÔÔÈËÙ›-ÓË, ·ÚÔ˘Û›·Û·Ó ¡∂∫ ÛÂ ÌÈÎÚfiÙÂÚË Û˘¯ÓfiÙËÙ·(52). ∂›ÛË˜, Ô GM-CSF ¤¯ÂÈ ‚ÚÂıÂ› fiÙÈ ÂÏ·ÙÙÒÓÂÈÛËÌ·ÓÙÈÎ¿ ÙË ıÓËÙfiÙËÙ· ·fi Ô˘‰ÂÙÂÚÔÂÓÈÎ‹ ÛË-„·ÈÌ›·, Ô˘ Û˘ÓÔ‰Â‡ÂÙ·È ÌÂ ¡∂∫ (53).

Œ¯ÂÈ ‚ÚÂıÂ› fiÙÈ Ë ¯ÔÚ‹ÁËÛË Á¿Ï·ÎÙÔ˜ ÂÌÏÔ˘-ÙÈÛÌ¤ÓÔ˘ ÌÂ ÊˆÛÊÔÏÈ›‰È· ·˘ÁÔ‡ ÛÂ ÚfiˆÚ·Û˘Ì‚¿ÏÏÂÈ ÛÂ ÂÏ¿ÙÙˆÛË Î·Ù¿ 6 ÊÔÚ¤˜ ÙË˜ Û˘¯Ófi-ÙËÙ·˜ ÙË˜ ¡∂∫. ∞˘Ù¿ Ù· ÊˆÛÊÔÏÈ›‰È· Â›Ó·È Û˘-ÛÙ·ÙÈÎ¿ ÙˆÓ ÌÂÌ‚Ú·ÓÒÓ ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ Î·È ÙÔ˘ÂÓÙÂÚÈÎÔ‡ ·Ú¿ÁÔÓÙ· Î·È Ù· Û˘ÛÙ·ÙÈÎ¿ ÙÔ˘˜ ·Ú·-¯È‰ÔÓÈÎfi Î·È ¯ÔÏ›ÓË ¤¯Ô˘Ó ÈÎ·ÓÔÔÈËÙÈÎ¤˜ ÚÔÛÙ·-ÙÂ˘ÙÈÎ¤˜ È‰ÈfiÙËÙÂ˜ (49,54).

∏ PAF-acetylhydrolase ¤¯ÂÈ ‚ÚÂıÂ› ÛÙÔ ÌËÙÚÈÎfiÁ¿Ï· Î·È ÙÔ ¤Ó˙˘ÌÔ ·˘Ùfi Ú¤ÂÈ Ó· ÚÔÛÙ·ÙÂ‡ÂÈ·fi ÙË ¡∂∫ (55).

ŒÓ· ÛÎÂ‡·ÛÌ· ·fi ÙÔ ÛÙfiÌ· ÙË˜ IgA Î·È Ë ÔÍÈ-ÓÔÔ›ËÛË ÙË˜ ÂÓÙÂÚÈÎ‹˜ ÙÚÔÊ‹˜ ¤¯ÂÈ ‚ÚÂıÂ› fiÙÈÂÏ·ÙÙÒÓÔ˘Ó ÙË Û˘¯ÓfiÙËÙ· ÙË˜ ¡∂∫ (46).

∆· ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹, Ô˘ ¤¯ÂÈ ‚ÚÂıÂ› fiÙÈ ·˘-Í¿ÓÔ˘Ó ÙËÓ ÂÓÙÂÚÈÎ‹ ÎÈÓËÙÈÎfiÙËÙ· Î·È ÂÏ·ÙÙÒÓÔ˘ÓÙËÓ ÂÓÙÂÚÈÎ‹ ‰È·ÂÚ·ÙfiÙËÙ· Î·È ÌÂÙ·Î›ÓËÛË ÙˆÓÌÈÎÚÔ‚›ˆÓ, fiÙ·Ó ¯ÔÚËÁÔ‡ÓÙ·È ÚÔÁÂÓÓËÙÈÎ¿, ÂÏ·Ù-ÙÒÓÔ˘Ó ÛËÌ·ÓÙÈÎ¿ ÙÔÓ Î›Ó‰˘ÓÔ ÙË˜ ¡∂∫. ∏ Û‡Á-¯ÚÔÓË ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Ì·˙› ÌÂ ÎÔÚÙÈÎÔÛÙÂ-ÚÔÂÈ‰‹ ÛÂ ÚÒÈÌË Ú‹ÍË ı˘Ï·Î›Ô˘ ÂÏ·ÙÙÒÓÂÈ Ù·ÂÂÈÛfi‰È· ¡∂∫ (47).

∆Ô ¡O, fiˆ˜ ·Ó·Ê¤ÚıËÎÂ, Â›Ó·È ÛËÌ·ÓÙÈÎfi˜Ú˘ıÌÈÛÙ‹˜ ÙÔ˘ ·ÁÁÂÈ·ÎÔ‡ ÙfiÓÔ˘ ÙË˜ ·Ó·Ù˘ÛÛfi-ÌÂÓË˜ Î˘ÎÏÔÊÔÚ›·˜ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ÛˆÏ‹Ó·.∂Ó‰ÔıËÏÈ·Î‹ ·Ú·ÁˆÁ‹ ÙÔ˘ ¡O ÛÂ Î·ÓÔÓÈÎ¤˜ Ô-

ÛfiÙËÙÂ˜ ‰È·ÙËÚÂ› ÂÏ·ÙÙˆÌ¤ÓË ÙËÓ ·ÁÁÂÈ·Î‹ ·ÓÙ›-ÛÙ·ÛË ÛÙÔ ÓÂÔÁÓÈÎfi Á·ÛÙÚÂÓÙÂÚÈÎfi ÛˆÏ‹Ó·. ∞˘Ù‹Ë ·Ú·ÁˆÁ‹ ÙÔ˘ ¡O ÚÔÛÙ·ÙÂ‡ÂÈ ÙÔÓ ÂÓÙÂÚÈÎfi‚ÏÂÓÓÔÁfiÓÔ ·fi ˘ÔÍÈÎ¤˜-ÈÛ¯·ÈÌÈÎ¤˜ ‚Ï¿‚Â˜ Î·ÈÚÒÈÌÔ ÂÓ‰ÔÙÔÍÈÎfi shock. ∞ÓÙ›ıÂÙ·, fiÌˆ˜, ÌÂÁ¿-ÏË ·Ú·ÁˆÁ‹ ÙÔ˘ ¡O ·fi ÌÂÁ¿ÏË ‰Ú·ÛÙÈÎfiÙËÙ·ÙË˜ Û˘ÓıÂÙ¿ÛË˜ ÙÔ˘ ¡O (INOS), Ô˘ ·Ú·ÙËÚÂ›-Ù·È ÛÂ ÚÔ¯ˆÚËÌ¤Ó· ÛÙ¿‰È· ÊÏÂÁÌÔÓ‹˜, ÌÔÚÂ›Ó· ÚÔÎ·Ï¤ÛÂÈ ÙÔÍÈÎ¿ Â›Â‰· ¡O. °È’ ·˘Ùfi ¤¯ÂÈ˘ÔÙÂıÂ› fiÙÈ ÂÈ‰ÈÎÔ› ·Ó·ÛÙÔÏÂ›˜ ÙË˜ π¡O™ ÌÔÚÂ›Ó· ÂÏ·ÙÙÒÛÔ˘Ó ÙË ‚·Ú‡ÙËÙ· ÙË˜ ÂÓÙÂÚÈÎ‹˜ ‚Ï¿-‚Ë˜ ÛÙË ¡∂∫ (3,55).

∆· ÚÔ‚ÈÔÙÈÎ¿ ·ÔÙÂÏÔ‡ÓÙ·È ·fi ·Ó·ÂÚfi‚È·ÌÈÎÚfi‚È· Ô˘ ·ÔÙÂÏÔ‡Ó Ì¤ÚÔ˜ ÙË˜ Ê˘ÛÈÔÏÔÁÈÎ‹˜¯ÏˆÚ›‰·˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È ÂÚÈ¤¯Ô˘Ó Î˘Ú›ˆ˜bifidobacterium infantis (bifido) Î·È Lactobacillusacidophilus. OÈ ÂÈ‰ÈÎÔ› ÌË¯·ÓÈÛÌÔ› ÙˆÓ ÚÔ‚ÈÔÙÈ-ÎÒÓ ÛÙËÓ ÚÔÛÙ·Û›· ·fi ÙË ¡∂∫ ‰ÂÓ ¤¯Ô˘Ó ÍÂÎ·-ı·ÚÈÛÙÂ› Ï‹Úˆ˜. ∆· ÚÔ‚ÈÔÙÈÎ¿ ÌÔÚÔ‡Ó Ó· ÌÂ-Ù·‚¿ÏÔ˘Ó ÙÔ˘˜ ÌË¯·ÓÈÛÌÔ‡˜ ÙË˜ ÂÓÙÂÚÈÎ‹˜ ÊÏÂÁ-ÌÔÓ‹˜, fiˆ˜ ÙÔÓ ·ÔÈÎÈÛÌfi ·fi ·ıÔÁfiÓ· ÌÈÎÚfi-‚È·, ÙËÓ ·Ú·ÁˆÁ‹ ÊÏÂÁÌÔÓˆ‰ÒÓ ÌÂÛÔÏ·‚ËÙÈÎÒÓÛ˘ÛÙ·ÙÈÎÒÓ, ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ ·ÓÔÛÔÏÔÁÈÎÔ‡ÌË¯·ÓÈÛÌÔ‡ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È ÙËÓ ÂÓ›Û¯˘ÛË ÙÔ˘ÂÓÙÂÚÈÎÔ‡ ÊÚ·ÁÌÔ‡. O ÂÈ‰ÈÎfi˜ Â˘ÂÚÁÂÙÈÎfi˜ ÚfiÏÔ˜·˘ÙÒÓ ÙˆÓ ÌÈÎÚÔ‚›ˆÓ Û˘Ó›ÛÙ·Ù·È ÛÙËÓ ·Ó·ÛÙÔÏ‹·Ó¿Ù˘ÍË˜ ·ÂÚfi‚ÈˆÓ ·ıÔÁfiÓˆÓ ÌÈÎÚÔ‚›ˆÓ Î·ÈÚÔÛÎfiÏÏËÛË˜ ·˘ÙÒÓ ÛÙÔÓ ÂÓÙÂÚÈÎfi ‚ÏÂÓÓÔÁfiÓÔ.∞˘Ùfi ÂÈÙ˘Á¯¿ÓÂÙ·È ÌÂ ÙËÓ ·Ú·ÁˆÁ‹ ÙÔÍÈÎÒÓ Ô˘-ÛÈÒÓ, fiˆ˜ ÌÂı·ÓfiÏË˜, ·ÎÂÙfiÓË˜ Î·È ÔÍ¤ˆÓ, fiˆ˜ÔÍÂ˚ÎÔ‡ Î·È Á·Ï·ÎÙÈÎÔ‡, Ô˘ Ô‰ËÁÔ‡Ó ÛÙËÓ ÂÏ¿Ù-ÙˆÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ pH (35,45,50,56).

∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¤˜ ÌÂÏ¤-ÙÂ˜ ÛÂ ÂÈÚ·Ì·Ùfi˙ˆ· Ô˘ ‰Â›¯ÓÔ˘Ó ÙÔÓ Â˘ÂÚÁÂÙÈ-Îfi ÚfiÏÔ ÙˆÓ ÚÔ‚ÈÔÙÈÎÒÓ ÛÙË ¡∂∫. ™ÙÈ˜ ÌÂÏ¤ÙÂ˜·˘Ù¤˜ ‚Ú¤ıËÎÂ fiÙÈ Ù· ÚÔ‚ÈÔÙÈÎ¿ ÂÏ·ÙÙÒÓÔ˘Ó ÙËÓÂÓ‰ÔÙÔÍÈÓ·ÈÌ›·, ÙË ‰È·ÂÚ·ÙfiÙËÙ· ÙÔ˘ ‚ÏÂÓÓÔÁfi-ÓÔ˘ Î·È ·˘Í¿ÓÔ˘Ó ÙË ÊˆÛÊÔÏÈ¿ÛË ∞2 ππ Ô˘ Û˘Ì-‚¿ÏÏÂÈ ÛÙË Û‡ÓıÂÛË ÙÔ˘ PAF. ∆· ÚÔ‚ÈÔÙÈÎ¿¤¯Ô˘Ó ¯ÔÚËÁËıÂ› ÚÔÏËÙÈÎ¿ Î·È ÛÂ ÓÂÔÁÓ¿, ·ÏÏ¿ÔÈ ˘¿Ú¯Ô˘ÛÂ˜ ÙÂÎÌËÚÈˆÌ¤ÓÂ˜ ÂÚÁ·Û›Â˜ Â›Ó·È Ï›-ÁÂ˜. OÈ ÂÚÁ·Û›Â˜ ·˘Ù¤˜, ·ÚfiÙÈ Â›Ó·È Ï›ÁÂ˜, ‰Â›-¯ÓÔ˘Ó fiÙÈ Ù· ÚÔ‚ÈÔÙÈÎ¿ ÂÏ·ÙÙÒÓÔ˘Ó ÙË Û˘¯ÓfiÙË-Ù· ÙË˜ ¡∂∫, Î·ıÒ˜ Î·È ÙË ıÓËÙfiÙËÙ· ·fi ·˘Ù‹Ó(35,57).

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Pneumococcal meningitis in childhood: a 30-year studyJ. Kavaliotis, A. Nanou, S. Petridou

∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹, ¡ÔÛÔÎÔÌÂ›Ô ∂È‰ÈÎÒÓ ¶·ı‹ÛÂˆÓ, £ÂÛÛ·ÏÔÓ›ÎË

Department of Paediatrics,Infectious Diseases Hospital, Thessaloniki

�¶ÂÚ›ÏË„Ë: O Streptococcus pneumoniae (PN)Â›Ó·È ÌÂ›˙ÔÓ ·›ÙÈÔ ÌÈÎÚÔ‚È·Î‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ÛÙ··È‰È¿ ÚÔÎ·ÏÒÓÙ·˜ ‰˘ÓËÙÈÎ¿ ı·Ó·ÙËÊfiÚÔ ÏÔ›Ìˆ-ÍË ÌÂ ˘„ËÏfi ÔÛÔÛÙfi ÓÂ˘ÚÔÏÔÁÈÎÒÓ ˘ÔÏÂÈÌÌ¿-ÙˆÓ. ™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ·˘Ù‹˜ ‹Ù·Ó Ë ÂÎÙ›ÌËÛËÙˆÓ ÎÏÈÓÈÎÔ-ÂÈ‰ËÌÈÔÏÔÁÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙË˜ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎ‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈ-Î›·. ªÂÏÂÙ‹ıËÎ·Ó 116 ÂÚÈÙÒÛÂÈ˜ ÓÂ˘ÌÔÓÈÔÎÔÎ-ÎÈÎ‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ Ô˘ ÓÔÛËÏÂ‡ÙËÎ·Ó ÛÙËÓ ÎÏÈÓÈÎ‹ÙË ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô 1970-1999 (30 ¤ÙË). ∏ ËÏÈÎ›·ÙˆÓ ·ÛıÂÓÒÓ Î˘Ì·ÈÓfiÙ·Ó ·fi ÙÔÓ 1 Ì‹Ó· ¤ˆ˜ Ù·14 ¤ÙË (‰È¿ÌÂÛË ËÏÈÎ›· 12 Ì‹ÓÂ˜). ¶·Ú·ÙËÚ‹ıËÎÂ˘ÂÚÔ¯‹ ÙˆÓ ·ÁÔÚÈÒÓ (80/116, 69%). ™Â 45/116·È‰È¿ ‰È·ÈÛÙÒıËÎÂ Ë ‡·ÚÍË Î¿ÔÈ·˜ ˘ÔÎÂ›ÌÂ-ÓË˜ Î·Ù¿ÛÙ·ÛË˜. ™Â 21 ÂÚÈÙÒÛÂÈ˜ Û˘Ó˘‹Ú¯Â˘ÔÎÂ›ÌÂÓÔ ÓfiÛËÌ· (ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈÎ‹ Î¿ÎˆÛË,ÛÏËÓÂÎÙÔÌ‹, Û˘ÁÁÂÓ‹˜ Î·Ú‰ÈÔ¿ıÂÈ·, ÓÂÊÚÈÎ‹·ÓÂ¿ÚÎÂÈ·, ÂÈÏË„›·), ÂÓÒ ÛÂ 24 ·ÛıÂÓÂ›˜ ·Ú·-ÙËÚ‹ıËÎÂ ÔÍÂ›· ÏÔ›ÌˆÍË Ï›ÁÔ ÚÈÓ ÙËÓ ¤Ó·ÚÍË ÙË˜ÌËÓÈÁÁ›ÙÈ‰·˜. ∂ÈÏÔÎ¤˜ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÂ ÌÂÁ¿-ÏÔ ·ÚÈıÌfi ·ÛıÂÓÒÓ: Û·ÛÌÔ›, Î˘Ú›ˆ˜ ÙÔÓÈÎÔÎÏÔÓÈ-ÎÔ›, ÛÂ 40 ·ÛıÂÓÂ›˜ (35%), ‰È·Ù·Ú·¯¤˜ Û˘ÓÂ›‰ËÛË˜ÛÂ 61 (53%), ÓÂ˘ÚÔÏÔÁÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ ÛÂ 25(22%) Î·È ·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÛÂ 14(12%). ¢¤Î· ÙÚÂÈ˜ ·ÛıÂÓÂ›˜ ·Â‚›ˆÛ·Ó (11,2%).ÀÔÏÂÈÌÌ·ÙÈÎ¤˜ ‚Ï¿‚Â˜, fiˆ˜ ÎÒÊˆÛË, ÂÈÏË„›·,ÎÈÓËÙÈÎ¤˜ Î·È ÓÂ˘ÚÔÏÔÁÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ Î·È ‰È·ÓÔË-ÙÈÎ‹ Î·ı˘ÛÙ¤ÚËÛË, ·Ú·ÙËÚ‹ıËÎ·Ó ÛÂ 32 ·ÛıÂ-ÓÂ›˜ (31%) Î·Ù¿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜ ·fi ÙËÓ ÎÏÈÓÈÎ‹.™‡ÁÎÚÈÛË ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·Â‚›ˆÛ·Ó ÌÂ Ì›·ÔÌ¿‰· ·È‰ÈÒÓ ·Ó¿ÏÔÁË˜ ËÏÈÎ›·˜ Î·È Ê‡ÏÔ˘ Ô˘ıÂÚ·Â‡ÙËÎ·Ó, ¤‰ÂÈÍÂ fiÙÈ Ë ıÓËÙfiÙËÙ· ‹Ù·Ó ˘„Ë-ÏfiÙÂÚË ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÂÈÏÔÎ¤˜, ‰È·Ù·Ú·¯¤˜Û˘ÓÂ›‰ËÛË˜, ·Ó·ÓÂ˘ÛÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜, ˘„ËÏfiÏÂ‡ÎˆÌ· ÛÙÔ ∂¡À Î·È ¯·ÌËÏfi Û¿Î¯·ÚÔ ÛÙÔ ∂¡À.

�Abstract: Streptococcus pneumoniae is a majorbacterial meningitis pathogen in children. It stillremains a significant cause of lethal meningitis.The aim of this study was to evaluate the clinicaland epidemiological characteristics of children withpneumococcal meningitis. The study groupconsisted of 116 patients with pneumococcalmeningitis who were admitted to our departmentduring a period of 30 years (1970-1999). Patients’age ranged from 1 month to 14 years (median: 12months). There was a male preponderance (69%).In 45/116 (39%) patients an underlying conditionwas found. Twenty one had an underlying disease(head injury, splenectomy, renal disease, epilepsy,congenital heart disease) and twenty four had apreceding acute infection shortly before menin-gitis. Complications occurred in a large percent-age of patients: seizures, mainly generalized tonic-clonic, in 40 patients (35%); consciousness disor-ders in 61 (53%); neurological dysfunction in 25(22%); systemic manifestations in 5 (4%) andrespiratory dysfunction in 14 (12%). 18% of thepatients (21/116) presented with seizures duringthe first 3 days of the disease. Thirteen patientsdied (11.2%). Sequelae, including hearing loss,epilepsy, motor defects, neurological deficits andmental retardation, were present on discharge in32 patients (31%). Comparison of the patients whodied with a group of children matched for age andsex that recovered, showed that lethal outcomewas observed more frequently in patients withcomplications, consciousness disorders, respi-ratory disturbances, high CSF protein and low CSF glucose. Despite early diagnosis andappro-priate therapy, pneumococcal meningitis is



242

∂ÈÛ·ÁˆÁ‹O Streptococcus pneumoniae ·ÔÙÂÏÂ› Ì›·

·fi ÙÈ˜ Î‡ÚÈÂ˜ ·ÈÙ›Â˜ ÛÔ‚·ÚÒÓ ÏÔÈÌÒÍÂˆÓ ÙË˜·È‰ÈÎ‹˜ ËÏÈÎ›·˜ ‰ÈÂıÓÒ˜ Î·È ÌÂ›˙ÔÓ ·›ÙÈÔ ÙË˜ ÌÈ-ÎÚÔ‚È·Î‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ÌÂ ˘„ËÏfi ÔÛÔÛÙfi ıÓË-ÙfiÙËÙ·˜ Î·È ÓÂ˘ÚÔÏÔÁÈÎÒÓ ˘ÔÏÂÈÌÌ¿ÙˆÓ. O Â-ÚÈÔÚÈÛÌfi˜ Ì¿ÏÈÛÙ· ÙÔ˘ Haemophilus influenzaetype b (Hib) ˆ˜ ·ÈÙ›Ô˘ ÙË˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ·‡ÍËÛÂÎ·Ù¿ ÔÏ‡ ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ S. pneumoniae ÛÙË‚·ÚÈ¿ ·˘Ù‹ ÏÔ›ÌˆÍË ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜ (1). ∏·ÓÙÔ¯‹, Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÙˆÓ ÛÙÂÏÂ¯ÒÓ ÙÔ˘ÓÂ˘ÌÔÓÈÔÎfiÎÎÔ˘ ÛÙ· ·ÓÙÈ‚ÈÔÙÈÎ¿ ·ÔÙÂÏÂ›, Â›-ÛË˜, ¤Ó· ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ· Ô˘ ·ÊÔÚ¿ Î·È ÛÙËıÂÚ·Â›· ÙË˜ ÌÈÎÚÔ‚È·Î‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ (2). ŒÙÛÈ,Ë ÁÓÒÛË ÙË˜ ÂÈ‰ËÌÈÔÏÔÁ›·˜ ÙË˜ ÓÂ˘ÌÔÓÈÔÎÔÎÎÈ-Î‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ Â›Ó·È ¿ÓÙ· ¯Ú‹ÛÈÌË.

™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ·˘Ù‹˜ ‹Ù·Ó Ë ÂÎÙ›ÌËÛËÙˆÓ ÂÈ‰ËÌÈÔÏÔÁÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ, ÙˆÓ ÎÏÈÓÈ-ÎÒÓ ÛÙÔÈ¯Â›ˆÓ Î·È ÙˆÓ ÚÔÁÓˆÛÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓÙË˜ ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎ‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ÛÂ ·È‰È¿ ÙË˜µ. ∂ÏÏ¿‰Ô˜ ÌÂ ‚¿ÛË Ù· ÛÙÔÈ¯Â›· ÙË˜ ÎÏÈÓÈÎ‹˜ Ì·˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∏ ÌÂÏ¤ÙË ·ÊÔÚ¿ ÙË µ. ∂ÏÏ¿‰· ÌÂ ÏËı˘ÛÌfi ÂÚ›Ô˘

3.000.000 (1/3 ÂÚ›Ô˘ ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ÏËı˘ÛÌÔ‡ ÙË˜ ¯Ò-Ú·˜). ∆Ô ¡ÔÛÔÎÔÌÂ›Ô ∂È‰ÈÎÒÓ ¶·ı‹ÛÂˆÓ Â›Ó·È ÙÔ Î‡ÚÈÔ Î¤-ÓÙÚÔ ·Ó·ÊÔÚ¿˜ ÁÈ· ÌÈÎÚÔ‚È·Î‹ ÌËÓÈÁÁ›ÙÈ‰· ÛÙË µ. ∂ÏÏ¿‰·.∂Ï¿¯ÈÛÙ· ÂÚÈÛÙ·ÙÈÎ¿ ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎ‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ Ô˘ÓÔÛËÏÂ‡ıËÎ·Ó, Ù· ÙÂÏÂ˘Ù·›· Î˘Ú›ˆ˜ ¯ÚfiÓÈ·, ÛÂ ¿ÏÏ· ÓÔÛÔ-ÎÔÌÂ›· ÙË˜ £ÂÛÛ·ÏÔÓ›ÎË˜ ÈÛÙÂ‡Ô˘ÌÂ fiÙÈ ‰ÂÓ ·ÏÏÔÈÒÓÔ˘ÓÙË Û˘ÓÔÏÈÎ‹ ÂÈÎfiÓ· ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜.

∆Ô ˘ÏÈÎfi ÙË˜ ÌÂÏ¤ÙË˜ ·ÔÙ¤ÏÂÛ·Ó ·È‰È¿ ÌÂ ÂÚÁ·ÛÙË-ÚÈ·Î¿ ÙÂÎÌËÚÈˆÌ¤ÓË ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰· Ô˘ ÓÔ-ÛËÏÂ‡ıËÎ·Ó ÛÙËÓ ÎÏÈÓÈÎ‹ ÙËÓ ÂÚ›Ô‰Ô 1970-1999. ∞Ó·ÛÎÔ-‹ıËÎ·Ó ÔÈ Ê¿ÎÂÏÔÈ ÓÔÛËÏÂ›·˜ ÙˆÓ ·ÛıÂÓÒÓ Î·È ÂÍ‹¯ıËÛ·ÓÛÙÔÈ¯Â›· Ô˘ ·ÊÔÚÔ‡Û·Ó ‰ËÌÔÁÚ·ÊÈÎ¿, ÎÏÈÓÈÎ¿ Î·È ÂÚÁ·-ÛÙËÚÈ·Î¿ ‰Â‰ÔÌ¤Ó·, ÌÂ ‚¿ÛË ÂÈ‰ÈÎfi Î·È Û˘ÁÎÂÎÚÈÌ¤ÓÔ ‰ÂÏ-Ù›Ô Î·Ù·ÁÚ·Ê‹˜ ÛÙÔÈ¯Â›ˆÓ.

∫ÚÈÙ‹ÚÈ· ÂÈÛ·ÁˆÁ‹˜ ÛÙË ÌÂÏ¤ÙË ‹Ù·Ó: ·) ÛËÌÂ›· Î·È Û˘-ÌÙÒÌ·Ù· ÌËÓÈÁÁ›ÙÈ‰·˜, ‚) ÂÚÁ·ÛÙËÚÈ·Î¤˜ ÂÓ‰Â›ÍÂÈ˜ ·fi ÙÔ∂¡À Û˘Ì‚·Ù¤˜ ÌÂ ÌÈÎÚÔ‚È·Î‹ ÌËÓÈÁÁ›ÙÈ‰· (ÏÂ˘ÎÔÎ‡ÙÙ·Ú·>20/mm3, Ô˘‰ÂÙÂÚÔÊÈÏ›·, ·˘ÍËÌ¤ÓË ÚˆÙÂ˝ÓË, ÂÏ·ÙÙˆÌ¤-ÓË ÁÏ˘Îfi˙Ë) Î·È Á) ·ÔÌfiÓˆÛË ÙÔ˘ S. pneumoniae ·fi Î·Ï-ÏÈ¤ÚÁÂÈ· ∂¡À ‹/Î·È ·›Ì·ÙÔ˜ ‹ Î·È ·Ó›¯ÓÂ˘Û‹ ÙÔ˘ ÌÂ ÙÔslidex test.

∏ ·ÈÌÔÎ·ÏÏÈ¤ÚÁÂÈ· ‹Ù·Ó ıÂÙÈÎ‹ ÛÙÔ 10,3% ÙˆÓ ÂÚÈ-ÙÒÛÂˆÓ, ÂÓÒ Ô ÓÂ˘ÌÔÓÈfiÎÔÎÎÔ˜ ·ÔÌÔÓÒıËÎÂ ·fi ÙËÓÎ·ÏÏÈ¤ÚÁÂÈ· ∂¡À ÛÙÔ 90% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (¶›Ó·Î·˜ 1).

∫·Ó¤Ó· ·È‰› ‰ÂÓ Â›¯Â Ï¿‚ÂÈ ÔÔÈÔ‰‹ÔÙÂ ·ÓÙÈÓÂ˘ÌÔ-ÓÈÔÎÔÎÎÈÎfi ÂÌ‚fiÏÈÔ ÚÈÓ ÓÔÛ‹ÛÂÈ.

°È· ÙËÓ ÂÎÙ›ÌËÛË ‰È·ÊfiÚˆÓ ÛÙÔÈ¯Â›ˆÓ, fiÔ˘ Î·È ·Ó¯ÚÂÈ¿ÛÙËÎÂ ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÔÈ Ì¤-ıÔ‰ÔÈ x-ÙÂÙÚ¿ÁˆÓÔ Î·È t-students test.

∞ÔÙÂÏ¤ÛÌ·Ù·∏ÏÈÎ›· Î·È Ê‡ÏÔ: ∆ËÓ ÂÚ›Ô‰Ô 1/1/1970-

31/12/1999 ÓÔÛËÏÂ‡ıËÎ·Ó ÛÙËÓ ∫ÏÈÓÈÎ‹ 116 ÂÚÈ-ÙÒÛÂÈ˜ ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎ‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜. ∏ ‰È¿-ÌÂÛË ËÏÈÎ›· ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó 12 Ì‹ÓÂ˜ (Â‡ÚÔ˜:1 Ì‹Ó·˜ ¤ˆ˜ 14 ¯ÚfiÓÈ·). OÈ 80 ‹Ù·Ó ·ÁfiÚÈ· (69%).∏ ËÏÈÎÈ·Î‹ Î·Ù·ÓÔÌ‹ ¤‰ÂÈÍÂ ÌÂÁ·Ï‡ÙÂÚË Û˘¯Ófi-ÙËÙ· ÙË˜ ÓfiÛÔ˘ ÛÂ ËÏÈÎ›Â˜ <2 ¯ÚfiÓˆÓ (∂ÈÎfiÓ· 1).

∂Ù‹ÛÈ· Î·È ÂÔ¯È·Î‹ Î·Ù·ÓÔÌ‹: ∏ ÂÙ‹ÛÈ· Î·Ù·-ÓÔÌ‹ ÙË˜ ÓfiÛÔ˘ ¤‰ÂÈÍÂ Ì›· ÂÚ›Ô˘ ÛÙ·ıÂÚ‹ Ô-ÚÂ›·, ÂÓÒ ˘‹ÚÍ·Ó Î¿ÔÈÂ˜ ÂÚ›Ô‰ÔÈ ÌÂ ·˘ÍËÌ¤ÓÔ·ÚÈıÌfi ÎÚÔ˘ÛÌ¿ÙˆÓ (∂ÈÎfiÓ· 2). ∏ Ù˘ÈÎ‹ ÂÔ¯È·-Î‹ Î·Ù·ÓÔÌ‹ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÓÂ˘ÌÔÓÈÔÎÔÎÎÈ-Î‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ·Ú·ÙËÚ‹ıËÎÂ Î·È ÛÙÔ ˘ÏÈÎfiÌ·˜. ∆Ô 72% (84/116) ÙˆÓ ÂÈÛ·ÁˆÁÒÓ ¤ÁÈÓÂ ·fiÙÔÓ OÎÙÒ‚ÚÈÔ ¤ˆ˜ Î·È ÙÔÓ ∞Ú›ÏÈÔ (∂ÈÎfiÓ· 3).

∂›ÙˆÛË ÙË˜ ÓfiÛÔ˘: ∏ Ì¤ÛË ÂÙ‹ÛÈ· Â›ÙˆÛËÙË˜ ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎ‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ÛÙË £ÂÛÛ·-ÏÔÓ›ÎË ÂÎÙÈÌ‹ıËÎÂ ÛÙÔ 0,48/100.000 ÏËı˘ÛÌÔ‡(¶›Ó·Î·˜ 2).

ÀÔÎÂ›ÌÂÓÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜: ™Â 45 ·fi ÙÔ˘˜ 116·ÛıÂÓÂ›˜ (39%) ‰È·ÈÛÙÒıËÎÂ Ë ‡·ÚÍË ˘ÔÎÂ›-ÌÂÓˆÓ ‹ Û˘Ó˘·Ú¯Ô˘ÛÒÓ Î·Ù·ÛÙ¿ÛÂˆÓ Ô˘ ÌÔ-ÚÂ› Ó· Û˘Ó¤‚·Ï·Ó ÛÙËÓ ÂÌÊ¿ÓÈÛË ÙË˜ ÌËÓÈÁÁ›ÙÈ‰·˜.∂›ÎÔÛÈ ¤Ó·˜ (18%) ·ÛıÂÓÂ›˜ Â›¯·Ó ˘ÔÎÂ›ÌÂÓÔÓfiÛËÌ·: ÎÚ·ÓÈ·Î‹ Î¿ÎˆÛË (8, 38%), ¯ÚfiÓÈ· Ì¤ÛË

¶·Ú¿ ÙË ‰˘Ó·ÙfiÙËÙ· ¤ÁÎ·ÈÚË˜ ‰È¿ÁÓˆÛË˜ Î·È Î·-Ù¿ÏÏËÏË˜ ıÂÚ·Â˘ÙÈÎ‹˜ ·ÁˆÁ‹˜, Ë ÓÂ˘ÌÔÓÈÔÎÔ-ÎÈÎÎ‹ ÌËÓÈÁÁ›ÙÈ‰· ÂÍ·ÎÔÏÔ˘ıÂ› Ó· Û¯ÂÙ›˙ÂÙ·È ÌÂÎ·Î‹ ÚfiÁÓˆÛË, ˘ÔÏÂÈÌÌ·ÙÈÎ¤˜ ‚Ï¿‚Â˜ Î·È ˘„Ë-Ïfi ÔÛÔÛÙfi ıÓËÙfiÙËÙ·˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÓÂ˘ÌÔÓÈfiÎÔÎÎÔ˜, ÌËÓÈÁÁ›ÙÈ‰·, ÌÈ-ÎÚÔ‚È·Î¤˜ ÏÔÈÌÒÍÂÈ˜, ·È‰È¿.

still associated with a poor prognosis, serioussequelae and a high mortality rate.

Key words: pneumococcus, meningitis, bacterialinfections, children.

¶›Ó·Î·˜ 1. £¤ÛË ·ÔÌfiÓˆÛË˜ S. pneumoniae ÛÂ 116·ÛıÂÓÂ›˜ ÌÂ ÌËÓÈÁÁ›ÙÈ‰·

∞ÚÈıÌfi˜ ∫·ÏÏÈ¤ÚÁÂÈ· ∫·ÏÏÈ¤ÚÁÂÈ· Slidex·ÛıÂÓÒÓ ∂¡À ·›Ì·ÙÔ˜ test

6 + + +6 + + -

43 + - +21 - - +40 + - -



243

ˆÙ›ÙÈ‰· (6, 28%), ÛÏËÓÂÎÙÔÌ‹ (3, 14%), Û˘ÁÁÂÓ‹Î·Ú‰ÈÔ¿ıÂÈ· (2, 9%), ÓÂÊÚÔ¿ıÂÈ· (1, 5%), ÂÈ-ÏË„›· (1, 5%).

∂›ÎÔÛÈ Ù¤ÛÛÂÚÈ˜ ·ÛıÂÓÂ›˜ (21%) ·ÚÔ˘Û›·Û·ÓÎ¿ÔÈ· ÔÍÂ›· ÏÔ›ÌˆÍË ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡, Ï›ÁÔÚÈÓ ÙËÓ ÂÎ‰‹ÏˆÛË ÙË˜ ÌËÓÈÁÁ›ÙÈ‰·˜. ¢¤Î· ·fiÙÔ˘˜ ·ÛıÂÓÂ›˜ (42%) Â›¯·Ó ÔÍÂ›· Ì¤ÛË ˆÙ›ÙÈ‰·, ËÔÔ›· ‰È·ÁÓÒÛıËÎÂ ÚÈÓ ‹ Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘·ÛıÂÓÔ‡˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Î·È ÙË ‰È¿ÁÓˆÛË ÙË˜ÌËÓÈÁÁ›ÙÈ‰·˜. ŒÍÈ ·fi ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜ Â›¯·ÓÏ¿‚ÂÈ ·ÓÙÈ‚›ˆÛË ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹. ŒÓ·˜ ·Â‚›ˆ-ÛÂ, ¤Ó·˜ ‰È·ÎÔÌ›ÛÙËÎÂ ÛÂ ÌÔÓ¿‰· ÂÓÙ·ÙÈÎ‹˜ ÓÔÛË-ÏÂ›·˜ Î·È ¤Ó·˜ ÛÂ ˆÙÔÚÈÓÔÏ·Ú˘ÁÁÔÏÔÁÈÎ‹ ÎÏÈÓÈÎ‹(ÌÂÙ¿ ÙË ıÂÚ·Â›· ÙË˜ ÌËÓÈÁÁ›ÙÈ‰·˜ Î·È ÁÈ· ¯ÂÈ-ÚÔ˘ÚÁÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ‰˘ÛÏ·Û›·˜ ÙË˜ Ì·ÛÙÔÂÈ-‰Ô‡˜ ·fiÊ˘ÛË˜). ™Â 14/24 ·ÛıÂÓÂ›˜ (58%) Â›¯ÂÚÔËÁËıÂ› ÙË˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ÏÔ›ÌˆÍË ÙÔ˘ ·Ó·ÓÂ˘-ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÛÂ 7 ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ·ÊÔ-

ÚÔ‡ÛÂ ÙÔ Î·ÙÒÙÂÚÔ ·Ó·ÓÂ˘ÛÙÈÎfi. ∞ÁˆÁ‹ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹: OÈ 36/116 ·ÛıÂÓÂ›˜

(31%) Â›¯·Ó Ï¿‚ÂÈ ·ÓÙÈ‚›ˆÛË ·ÚÂÓÙÂÚÈÎÒ˜ ÙÔ ÚÔË-ÁÔ‡ÌÂÓÔ 24ˆÚÔ ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹. ∏ ·ÁˆÁ‹ ·ÊÔ-ÚÔ‡ÛÂ ·ÌÈÎÈÏÏ›ÓË (22, 61%) ‹ ÎÂÊÙÚÈ·ÍfiÓË (12,33%) ‹ ÁÂÓÙ·Ì˘Î›ÓË (2, 5,5%). OÈ ·ÛıÂÓÂ›˜ Â›¯·Ó ‰È·-ÎÔÌÈÛÙÂ› ·fi ¿ÏÏ· ÓÔÛËÏÂ˘ÙÈÎ¿ È‰Ú‡Ì·Ù· ‹ Î¤ÓÙÚ·˘ÁÂ›·˜. ∆ÚÂÈ˜ ·fi ÙÔ˘˜ ·ÛıÂÓÂ›˜ ·˘ÙÔ‡˜ ·Â‚›ˆÛ·Ó.

∫ÏÈÓÈÎ¿ Â˘Ú‹Ì·Ù· Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹: ∏ ÎÏÈÓÈÎ‹Î·Ù¿ÛÙ·ÛË Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ¯·Ú·ÎÙËÚ›ÛÙËÎÂˆ˜ ÛÔ‚·Ú‹ (33, 28%), Ì¤ÙÚÈ· (57, 49%) ‹ Î·Ï‹(26, 22%). ∆· Û˘¯ÓfiÙÂÚ· Â˘Ú‹Ì·Ù· Î·Ù¿ ÙËÓ ÂÈÛ·-ÁˆÁ‹ ‹Ù·Ó: ˘ÚÂÙfi˜ (95, 82%), ¤ÌÂÙÔÈ (77, 66%),ÎÂÊ·Ï·ÏÁ›· (29, 25%) Î·È Û·ÛÌÔ› (21, 18%). ∏Ì¤ÛË ıÂÚÌÔÎÚ·Û›· Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ‹Ù·Ó38,2ÔC ± 1,08 (Â‡ÚÔ˜: 36-40,5ÔC).

¶ÔÚÂ›· ÓfiÛÔ˘: ∏ ‰È¿ÚÎÂÈ· ÓÔÛËÏÂ›·˜ Î˘Ì¿ÓıË-ÎÂ ·fi 1 ¤ˆ˜ 15 ËÌ¤ÚÂ˜ ÛÙÔ 55% Î·È 16 ¤ˆ˜ 23

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20

15

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0-6 7-12 2 3 4 5 6 7 8 9 10 11 12 13 14ª‹ÓÂ˜ ŒÙË

∂ÈÎfiÓ· 1. ∏ÏÈÎÈ·Î‹ Î·Ù·ÓÔÌ‹ ÛÂ 116 ·ÛıÂÓÂ›˜ ÌÂ ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰· (1970-1999).

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∂ÈÎfiÓ· 2. ∂Ù‹ÛÈ· Î·Ù·ÓÔÌ‹ ÛÂ 116 ·ÛıÂÓÂ›˜ ÌÂ ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰· (1970-1999).


ËÌ¤ÚÂ˜ ÛÙÔ 27% ÙˆÓ ÂÚÈÙÒÛÂˆÓ. ∏ Ì¤ÛË ‰È¿Ú-ÎÂÈ· ˘ÚÂÙÔ‡ Î·Ù¿ ÙË ÓÔÛËÏÂ›· ‹Ù·Ó 7 ËÌ¤ÚÂ˜. ∂›-ÎÔÛÈ ÙÚÂÈ˜ ·ÛıÂÓÂ›˜ (20%) ·ÚÔ˘Û›·Û·Ó ·Ú·ÙÂÈ-ÓfiÌÂÓÔ ˘ÚÂÙfi.

∂ÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù·: ∆· ·ÔÙÂÏ¤ÛÌ·Ù·ÂÏ¤Á¯Ô˘ ·›Ì·ÙÔ˜ Î·È ∂¡À Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ Ê·›ÓÔ-ÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3. ¢Â‡ÙÂÚË ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤-ÓÙËÛË ¤ÁÈÓÂ ÛÂ 102 ·ÛıÂÓÂ›˜ ÌÂÙ¿ ÙÔ ¤Ú·˜ ÙË˜ıÂÚ·Â›·˜. O Ì¤ÛÔ˜ ·ÚÈıÌfi˜ ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÓ ÛÙÔ∂¡À ‹Ù·Ó 25,6 ± 4,5/mm3, Ë Ì¤ÛË ÙÈÌ‹ ÚˆÙÂ˝ÓË˜55,9 ± 60,2 mg% Î·È Ë Ì¤ÛË ÙÈÌ‹ ÁÏ˘Îfi˙Ë˜ 53,8 ±68,8 mg%.

∂ÈÏÔÎ¤˜: ∂ÈÏÔÎ¤˜ Î·È ÓÂ˘ÚÔÏÔÁÈÎ¤˜ ÂÎ‰Ë-ÏÒÛÂÈ˜ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÂ ÌÂÁ¿ÏÔ ·ÚÈıÌfi ·ÛıÂ-ÓÒÓ (89/116, 77%) (¶›Ó·Î·˜ 4). ŒÍÈ ·ÛıÂÓÂ›˜ ·-ÚÔ˘Û›·Û·Ó ‰È·Ù·Ú·¯¤˜ Û˘ÓÂ›‰ËÛË˜ ÌÂ ‰È¿ÚÎÂÈ··fi 1 ¤ˆ˜ 7 ËÌ¤ÚÂ˜. ™·ÛÌÔ‡˜ ÂÎ‰‹ÏˆÛÂ ÙÔ 34%ÙˆÓ ·ÛıÂÓÒÓ. OÈ Û·ÛÌÔ› ‹Ù·Ó Î˘Ú›ˆ˜ ÁÂÓÈÎÂ˘Ì¤-ÓÔÈ ÙÔÓÈÎÔÎÏÔÓÈÎÔ›, ÔÏÈÁfiÏÂÙË˜ ‰È¿ÚÎÂÈ·˜. ™Â 9·ÛıÂÓÂ›˜ (22%) Ë ‰È¿ÚÎÂÈ· ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚË ·fi30 min. ŒÓ·˜ ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·ÛÂ Î·Ù¿ ÙË ‰È¿Ú-ÎÂÈ· ÙË˜ ıÂÚ·Â›·˜ ·ÚÔ‰ÈÎ‹ ¯ÔÏÔÏÈı›·ÛË.

∞ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜: ∞ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›·¤ÁÈÓÂ ÛÂ 12 ·ÛıÂÓÂ›˜ Î·È ‹Ù·Ó ·ıÔÏÔÁÈÎ‹ ÛÙÔ˘˜11. ™Â 31 ·ÛıÂÓÂ›˜ ¯ÚÂÈ¿ÛÙËÎÂ Ó· Á›ÓÂÈ ËÏÂÎÙÚÔÂ-ÁÎÂÊ·ÏÔÁÚ¿ÊËÌ·. ™ÙÔ˘˜ 18 ÙÔ ∏∂° ‹Ù·Ó ·ıÔ-ÏÔÁÈÎfi.

£ÂÚ·Â›·: OÈ ·ÛıÂÓÂ›˜ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÌÂ·ÓÙÈ‚ÈÔÙÈÎ¿ Î·È Û˘ÌÙˆÌ·ÙÈÎ‹ ·ÁˆÁ‹, Û‡ÌÊˆÓ·ÌÂ Ù· ÈÛ¯‡ÔÓÙ· ÚˆÙfiÎÔÏÏ· ÙË˜ ÎÏÈÓÈÎ‹˜ Ì·˜. ∫·-Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ 30 ¯ÚfiÓˆÓ ˘‹ÚÍ·Ó 3 ıÂÚ·-Â˘ÙÈÎ¿ Û¯‹Ì·Ù·: ·ÌÈÎÈÏÏ›ÓË ‹ ÂÓÈÎÈÏÏ›ÓË, ·ÌÈ-ÎÈÏÏ›ÓË Î·È ¯ÏˆÚ·ÌÊÂÓÈÎfiÏË Î·È, ÙÂÏÈÎ¿, ÎÂÊÙÚÈ·-ÍfiÓË. ∏ ÎÂÊ·ÏÔÛÔÚ›ÓË ·ÓÙÈÎ·Ù¤ÛÙËÛÂ ÙÔ ÚÔË-ÁÔ‡ÌÂÓÔ ıÂÚ·Â˘ÙÈÎfi Û¯‹Ì· Î·Ù¿ Ù· Ù¤ÏË ÙË˜ ‰Â-Î·ÂÙ›·˜ ÙÔ˘ ’80. ŸÏ· Ù· ·ÔÌÔÓˆı¤ÓÙ· ÛÙÂÏ¤¯Ë‹Ù·Ó Â˘·›ÛıËÙ· ÛÙ· ·ÓÙÈ‚ÈÔÙÈÎ¿ Ô˘ ¯ÚËÛÈÌÔÔÈ-‹ıËÎ·Ó ÁÈ· ÙË ıÂÚ·Â›· ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ·ÛıÂÓÒÓ.

ÀÔÙÚÔ¤˜ ÌËÓÈÁÁ›ÙÈ‰·˜: ∂ÓÓ¤· ·fi ÙÔ˘˜ 116·ÛıÂÓÂ›˜ (8%) Â›¯·Ó ÓÔÛ‹ÛÂÈ Î·È ·Ï·ÈfiÙÂÚ· ·fiÌÈÎÚÔ‚È·Î‹ ÌËÓÈÁÁ›ÙÈ‰·, Ì›· ÊÔÚ¿ ÔÈ 8 Î·È ‰‡Ô ÊÔ-Ú¤˜ Ô ¤Ó·˜. ™Ù· Ù¤ÛÛÂÚ· ·fi Ù· ‰¤Î· ·˘Ù¿ ÂÂÈ-Ûfi‰È· Â›¯Â ·ÔÌÔÓˆıÂ› ÓÂ˘ÌÔÓÈfiÎÔÎÎÔ˜, ÂÓÒÛÙ· ˘fiÏÔÈ· Ë ÌÈÎÚÔ‚È·Î‹ ÌËÓÈÁÁ›ÙÈ‰· ‹Ù·Ó¿ÁÓˆÛÙË˜ ·ÈÙÈÔÏÔÁ›·˜. ÀÔÎÂ›ÌÂÓÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜Â›¯·Ó ÔÈ 8 ·fi ÙÔ˘˜ 9 ·ÛıÂÓÂ›˜ (89%): ÛÏËÓÂÎÙÔ-Ì‹ (1), ¯ÚfiÓÈ· Ì¤ÛË ˆÙ›ÙÈ‰· Î·È ‰˘ÛÏ·Û›· Ì¤ÛÔ˘ˆÙfi˜ (1), Î¿Ù·ÁÌ· ÎÚ·Ó›Ô˘ (4), ÂÈÏË„›· (1) Î·ÈÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈÎ‹ Î¿ÎˆÛË ÌÂ ÂÁÎÂÊ·ÏÈÎ‹ ‰È¿ÛÂÈ-ÛË (1). ∫·Ó¤Ó·˜ ·fi ÙÔ˘˜ 9 ·ÛıÂÓÂ›˜ ‰ÂÓ ·ÚÔ˘-Û›·ÛÂ Û·ÛÌÔ‡˜ Î·Ù¿ ÙË ÓÔÛËÏÂ›·, ‰‡Ô ·ÚÔ˘-Û›·Û·Ó ÎÒÌ· Î·È ‰‡Ô Û˘ÁÎÏ›ÓÔÓÙ· ÛÙÚ·‚ÈÛÌfi Î·ÈËÌÈ·ÓÔ„›·. ŸÏÔÈ ÔÈ ·ÛıÂÓÂ›˜ ıÂÚ·Â‡ıËÎ·Ó. ∫·Ù¿ÙËÓ ¤ÍÔ‰Ô ·fi ÙËÓ ∫ÏÈÓÈÎ‹, ÓÂ˘ÚÔÏÔÁÈÎ¿ ˘ÔÏÂ›Ì-Ì·Ù· ·ÚÔ˘Û›·˙·Ó 3 ·ÛıÂÓÂ›˜ (33%): ÚÈÓÈÎ‹ ËÌÈ·-ÓÔ„›·, ÎÒÊˆÛË Î·È ‚·ÚËÎÔ˝·.

ŒÎ‚·ÛË: ∫·Ù¿ ÙË Û˘ÓÔÏÈÎ‹ ¯ÚÔÓÈÎ‹ ‰È¿ÚÎÂÈ·ÙË˜ ÌÂÏ¤ÙË˜ ·Â‚›ˆÛ·Ó 13 ·ÛıÂÓÂ›˜ (11,2%) (¶›-Ó·Î·˜ 5). ∏ Ì¤ÛË ËÏÈÎ›· ·˘ÙÒÓ ‹Ù·Ó 30,5 Ì‹ÓÂ˜(30 ËÌ¤ÚÂ˜ ¤ˆ˜ 9 ¯ÚfiÓÈ·). OÈ ı¿Ó·ÙÔÈ Û˘Ó¤‚ËÛ·ÓÓˆÚ›˜ Î·Ù¿ ÙËÓ ÔÚÂ›· ÙË˜ ÓfiÛÔ˘, Ï›ÁÂ˜ ËÌ¤ÚÂ˜


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0

%

π·Ó. ºÂ‚. ª¿ÚÙ. ∞Ú. ª¿ÈÔ˜ πÔ‡Ó. πÔ‡Ï. ∞‡Á. ™ÂÙ. OÎÙ. ¡Ô¤Ì. ¢ÂÎ.

ª‹ÓÂ˜

∂ÈÎfiÓ· 3. ∂Ô¯È·Î‹ Î·Ù·ÓÔÌ‹ ÛÂ 116 ·ÛıÂÓÂ›˜ ÌÂ ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰· (1970-1999).

¶›Ó·Î·˜ 2. ª¤ÛË ÂÙ‹ÛÈ· Û˘¯ÓfiÙËÙ· ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎ‹˜ ÌË-ÓÈÁÁ›ÙÈ‰·˜ ÛÙË £ÂÛÛ·ÏÔÓ›ÎË (1970-1999)

ŒÙË ¶ÏËı˘ÛÌfi˜ ∞ÚÈıÌfi˜ ™˘¯ÓfiÙËÙ·(Ì¤ÛÔ˜) ·ÛıÂÓÒÓ

1970-1979 871.580 22 0,251980-1989 946.864 10 0,11990-1999 1.005.431 14 0,13



245

ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô.∆ËÓ ÚÒÙË ‰ÂÎ·ÂÙ›· ÙË˜ ÌÂÏ¤ÙË˜ ˘‹ÚÍ·Ó 8 ı¿Ó·-ÙÔÈ ÛÂ 51 ·ÛıÂÓÂ›˜ (16%), ÙË ‰Â‡ÙÂÚË ‰ÂÎ·ÂÙ›· 4ı¿Ó·ÙÔÈ ÛÂ 31 ·ÛıÂÓÂ›˜ (13%) Î·È ÙËÓ ÙÂÏÂ˘Ù·›·‰ÂÎ·ÂÙ›· 1 ı¿Ó·ÙÔ˜ ÛÂ 34 ·ÛıÂÓÂ›˜ (3%). ÀÔÏÂÈÌ-Ì·ÙÈÎ¤˜ ‚Ï¿‚Â˜ Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô ·ÚÔ˘Û›·Û·Ó 32·fi ÙÔ˘˜ 103 ÂÈ˙‹Û·ÓÙÂ˜ ·ÛıÂÓÂ›˜ (31%). ™˘¯Ófi-ÙÂÚ· ‹Ù·Ó Ù· ÓÂ˘ÚÔÏÔÁÈÎ¿ ˘ÔÏÂ›ÌÌ·Ù·.

™‡ÁÎÚÈÛË ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·Â‚›ˆÛ·Ó ÌÂ ÔÌ¿-‰· ·ÛıÂÓÒÓ Ô˘ ÂÈ‚›ˆÛ·Ó (·Ó¿ÏÔÁË˜ ËÏÈÎ›·˜ Î·ÈÊ‡ÏÔ˘) (¶›Ó·Î·˜ 6) ¤‰ÂÈÍÂ fiÙÈ Ë ÚÒÙË ÔÌ¿‰· Â›¯ÂÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÌÂ ÙË ‰Â‡ÙÂÚË (p<0,01) ÛÙÈ˜ÂÍ‹˜ ·Ú·Ì¤ÙÚÔ˘˜: ·ÚÔ˘Û›· ÂÈÏÔÎÒÓ, ‰È·Ù·-Ú·¯¤˜ Û˘ÓÂ›‰ËÛË˜, ·Ó·ÓÂ˘ÛÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜,˘„ËÏfi ÏÂ‡ÎˆÌ· Î·È ¯·ÌËÏfi Û¿Î¯·ÚÔ ÛÙÔ ∂¡À. OÈ9/13 ·ÛıÂÓÂ›˜ Ô˘ ·Â‚›ˆÛ·Ó (69%) ÂÈÛ‹¯ıËÛ·ÓÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÛÙÔ ÚÒÙÔ (6) ‹ ÛÙÔ ‰Â‡ÙÂÚÔ24ˆÚÔ ÙË˜ ÓfiÛÔ˘.

™˘ÌÂÚ¿ÛÌ·Ù·O S. Pneumoniae Â›Ó·È Ë Î‡ÚÈ· ·ÈÙ›· ÛÔÚ·‰È-

ÎÒÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ÌÈÎÚÔ‚È·Î‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ÛÂ

¶›Ó·Î·˜ 4. ∂ÈÏÔÎ¤˜ ÛÂ 116 ·ÛıÂÓÂ›˜ ÌÂ ÓÂ˘ÌÔÓÈÔÎÔÎÎÈ-Î‹ ÌËÓÈÁÁ›ÙÈ‰· (1970-1999)

∂ÈÏÔÎ¤˜ ™‡ÓÔÏÔ ∞ÚÈıÌfi˜ %·ÛıÂÓÒÓ

ñ ¢È·Ù·Ú·¯¤˜ Û˘ÓÂ›‰ËÛË˜ 61 53∫ÒÌ· 20™˘Á¯˘ÙÈÎ‹ Î·Ù¿ÛÙ·ÛË 12ÀÓËÏ›· 29

ñ ™·ÛÌÔ› 40 34°ÂÓÈÎÂ˘Ì¤ÓÔÈ ÙÔÓÈÎÔÎÏÔÓÈÎÔ› 31∂ÛÙÈ·ÎÔ› 9

ñ ¡Â˘ÚÔÏÔÁÈÎ¤˜ 25 21¶·Ú¿Ï˘ÛË ÎÚ·ÓÈ·ÎÒÓ Ó. 12ÀÔÛÎÏËÚ›‰È· Û˘ÏÏÔÁ‹ 7∏ÌÈ¿ÚÂÛË 4À‰ÚÔÎ¤Ê·ÏÔ˜ 2

ñ ∞Ó·ÓÂ˘ÛÙÈÎ¤˜ 14 12∞Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ· 2∞Ó·ÓÔ‹ Cheyne-Stokes 4ÕÓÔÈ· 8

ñ ™˘ÛÙËÌ·ÙÈÎ¤˜ 5 4Shock 2¢∂¶ 3

¶›Ó·Î·˜ 5. £ÓËÙfiÙËÙ· Î·È ˘ÔÏÂÈÌÌ·ÙÈÎ¤˜ ‚Ï¿‚Â˜ Î·Ù¿ ÙËÓ¤ÍÔ‰Ô ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô ÛÂ 116 ·ÛıÂÓÂ›˜ ÌÂ ÓÂ˘ÌÔÓÈÔ-ÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰· (1970-1999)

∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ %

∞ÛıÂÓÂ›˜ 116£¿Ó·ÙÔÈ 13 11,2∂È˙ÒÓÙÂ˜ 103ÀÔÏÂ›ÌÌ·Ù· Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô 32 31

- ¡Â˘ÚÔÏÔÁÈÎ¿ ˘ÔÏÂ›ÌÌ·Ù·: Î˘Ú›ˆ˜ ·Ú¿Ï˘ÛË ÎÚ·ÓÈ·ÎÒÓ ÓÂ‡ÚˆÓÎ·È ˘ÔÛÎÏËÚ›‰È· Û˘ÏÏÔÁ‹ 15 47

- ¢È·Ù·Ú·¯¤˜ ·ÎÔ‹˜ 6 19- ∂ÈÏË„›· 2 6- ∫ÈÓËÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ 2 6- ¢È·ÓÔËÙÈÎ‹ Î·ı˘ÛÙ¤ÚËÛË 3 9

¶›Ó·Î·˜ 3. ∂ÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù· (·›Ì· Î·È ∂¡À) Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, ÛÂ 116 ·ÛıÂÓÂ›˜ ÌÂ ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰·(1970-1999)

% ª¤ÛË ÙÈÌ‹ ± ™∞ ∂‡ÚÔ˜

Hb (g/dl) 10 ± 1,74 5,55-14,4<10 45>10 55

§Â˘ÎÔÎ‡ÙÙ·Ú· (/Ìl) 12370 ± 5917 1000-40000<10000 34>10000 66

∆∫∂ (mm/h) 81,7 ± 33,8 5-156<20 520-50 1350-100 50>100 42

∫‡ÙÙ·Ú· ∂¡À (/mm3) 1650 ± 2772,4 5-25000<500 38501-1000 131001-2000 13>2000 36

°Ï˘Îfi˙Ë ∂¡À (mg%) 32 ± 20,5 0-108<20 2821-40 43>40 27

¶ÚˆÙÂ˝ÓË ∂¡À (mg%) 230 ± 155,2 24-879<100 18101-200 31>200 51



246

‚Ú¤ÊË Î·È ·È‰È¿, ÂÈ‰ÈÎ¿ ÛÂ ¯ÒÚÂ˜ fiÔ˘ ÙÔ ÂÌ‚fi-ÏÈÔ Î·Ù¿ ÙÔ˘ ∏. influenzae type b ¤¯ÂÈ ÂÈÛ·¯ıÂ› ÛÙÔÂıÓÈÎfi ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÔ‡ Î·È, Û˘ÓÂÒ˜,¤¯ÂÈ Ô‰ËÁ‹ÛÂÈ ÛÙËÓ Ô˘ÛÈ·ÛÙÈÎ‹ ÂÍ¿ÏÂÈ„‹ ÙÔ˘ ˆ˜·ÈÙ›Ô˘ ÙË˜ ÌÈÎÚÔ‚È·Î‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜. ∏ ÓfiÛÔ˜ ·-Ú·ÙËÚÂ›Ù·È ÛÂ fiÏÂ˜ ÙÈ˜ ËÏÈÎÈ·Î¤˜ ÔÌ¿‰Â˜ Î·È ¤¯ÂÈ˘„ËÏ¿ ÔÛÔÛÙ¿ ıÓËÙfiÙËÙ·˜ Ô˘ Î˘Ì·›ÓÔÓÙ·È ·fi10% ¤ˆ˜ 60% ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ËÏÈÎ›·, ÙË ÁÂˆÁÚ·-ÊÈÎ‹ ÂÚÈÔ¯‹ ‹ Ù˘¯fiÓ ˘ÔÎÂ›ÌÂÓË ÓfiÛÔ. OÈ ˘Ô-ÏÂÈÌÌ·ÙÈÎ¤˜ ‚Ï¿‚Â˜ ÌÂÙ·Í‡ ÙˆÓ ÂÈ˙ÒÓÙˆÓ Â›Ó·È,Â›ÛË˜, Û˘¯Ó¤˜ Î·È ÚÔÛÂÁÁ›˙Ô˘Ó ÙÔ 50% ÙˆÓ·ÛıÂÓÒÓ (4-8).

™ÙË ÌÂÏ¤ÙË Ì·˜, ÙÔ ÔÛÔÛÙfi ıÓËÙfiÙËÙ·˜ ‹Ù·Ó11,2%. ∆Ô ÔÛÔÛÙfi ·˘Ùfi ÔÈÎ›ÏÏÂÈ ÛÂ ‰È¿ÊÔÚÂ˜¯ÒÚÂ˜. ∆· ‰ÈÎ¿ Ì·˜ Â˘Ú‹Ì·Ù· Â›Ó·È Î¿Ô˘ ÛÙÔ Ì¤-ÛÔÓ (7-21% ÛÂ ÔÚÈÛÌ¤ÓÂ˜ ‰˘ÙÈÎ¤˜ ¯ÒÚÂ˜) (3,5-7,9,10). ∞Ó, ‚¤‚·È·, ÌÂÏÂÙ‹ÛÔ˘ÌÂ ÙË ıÓËÙfiÙËÙ··Ó¿ ‰ÂÎ·ÂÙ›·, ‰È·ÈÛÙÒÓÔ˘ÌÂ fiÙÈ ˘¿Ú¯ÂÈ ‚·ıÌÈ-·›· ÂÏ¿ÙÙˆÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ıÓËÙfiÙËÙ·˜ ·fi ÙËÓÚÒÙË ¤ˆ˜ ÙËÓ ÙÚ›ÙË ‰ÂÎ·ÂÙ›·. ∞˘Ùfi ÌÔÚÂ› Ó··Ô‰ÔıÂ› ÛÙËÓ ·˘ÍËÌ¤ÓË ˘Ô„›· ÙˆÓ ÁÈ·ÙÚÒÓ ÁÈ·ÙË ÌËÓÈÁÁ›ÙÈ‰· Î·È ¿Ú· ÛÙËÓ Ù·¯‡ÙÂÚË ‰È¿ÁÓˆÛË

Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ıÂÚ·Â›·. ™ÙË ÌÂ›ˆÛË·˘Ù‹ Ú¤ÂÈ Ó· ¤·ÈÍÂ ÚfiÏÔ Î·È Ë ·Ó¿Ù˘ÍË ÌÔ-Ó¿‰ˆÓ ÂÓÙ·ÙÈÎ‹˜ ÓÔÛËÏÂ›·˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·.∏ ıÓËÙfiÙËÙ· (6%) ÛÂ Û¯ÂÙÈÎ‹ ÌÂÏ¤ÙË ÛÙËÓ ÂÚÈÔ-¯‹ ÙˆÓ ∞ıËÓÒÓ (11), ÙËÓ ÂÚ›Ô‰Ô 1995-1999, ‹Ù·Ó·Ó¿ÏÔÁË ÙË˜ ıÓËÙfiÙËÙ·˜ Ô˘ ÂÌ›ÙÂÈ ÛÙËÓ ÙÂ-ÏÂ˘Ù·›· ‰ÂÎ·ÂÙ›· ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜. ¶Ú¤ÂÈ Ó· ÛË-ÌÂÈˆıÂ› fiÙÈ Î·Ó¤Ó· ÛÙ¤ÏÂ¯Ô˜ S. pneumoniae ‰ÂÓ‹Ù·Ó ·ÓıÂÎÙÈÎfi ÛÙ· ·ÓÙÈ‚ÈÔÙÈÎ¿ Ô˘ ¯ÔÚËÁ‹ıËÎ·ÓÛÙÔ˘˜ ·ÛıÂÓÂ›˜ Ì·˜.

OÈ ·ÛıÂÓÂ›˜ Ô˘ Î·Ù¤ÏËÍ·Ó Â›¯·Ó ‚Ú·¯‡ÙÂÚÔÈÛÙÔÚÈÎfi ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹, ÂÚÈÛÛfiÙÂÚÂ˜ ÂÈ-ÏÔÎ¤˜, Û˘¯ÓfiÙÂÚÂ˜ ‰È·Ù·Ú·¯¤˜ Û˘ÓÂ›‰ËÛË˜ Î·È¯·ÌËÏfiÙÂÚÂ˜ ÙÈÌ¤˜ Hb ÛÂ Û¯¤ÛË ÌÂ ÙÔ˘˜ ÂÈ˙‹Û·-ÓÙÂ˜ ·ÛıÂÓÂ›˜. ∏ ÌÈÎÚ‹ ËÏÈÎ›· ·ÔÙÂÏÔ‡ÛÂ, Â›ÛË˜,·Ú¿ÁÔÓÙ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. ∆Ô 60% ÙˆÓ ·ÛıÂÓÒÓ‹Ù·Ó <24 ÌËÓÒÓ. ªÂÏ¤ÙÂ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ ·Ó Ô ·ÛıÂ-Ó‹˜ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ÙÔ˘ ÎÚÈÙÈÎÔ‡ ÔÚ›Ô˘ ÙˆÓ 12ÌËÓÒÓ, Ë ÚfiÁÓˆÛË Â›Ó·È ÔÏ‡ Î·Ï‡ÙÂÚË (12).

À„ËÏfi ‹Ù·Ó Î·È ÙÔ ÔÛÔÛÙfi ÙˆÓ ˘ÔÏÂÈÌÌ·ÙÈ-ÎÒÓ ‚Ï·‚ÒÓ (31%). ∞˘Ùfi Â›Ó·È Û‡ÌÊˆÓÔ Î·È ÌÂ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜ (4,6,9) Î·È ‚Ú›ÛÎÂÙ·È ÎÔÓÙ¿ ÛÙÔ

¶›Ó·Î·˜ 6. ™‡ÁÎÚÈÛË ÔÚÈÛÌ¤ÓˆÓ ‰Â‰ÔÌ¤ÓˆÓ ·ÛıÂÓÒÓ Ô˘ ·Â‚›ˆÛ·Ó Î·È ·ÛıÂÓÒÓ Ô˘ Â¤˙ËÛ·Ó ÌÂÙ¿ ·fi ÓÂ˘ÌÔÓÈÔÎÔÎÎÈ-Î‹ ÌËÓÈÁÁ›ÙÈ‰· (1970-1999)

¢Â‰ÔÌ¤Ó· ∞Ô‚ÈÒÛ·ÓÙÂ˜ ∂È˙‹Û·ÓÙÂ˜ ™Ù·ÙÈÛÙÈÎ‹(n=13) (n=30) ‰È·ÊÔÚ¿ (p)

n ª¤ÛË ÙÈÌ‹ n ª¤ÛË ÙÈÌ‹

º‡ÏÔ (·ÁfiÚÈ) 8 20∏ÏÈÎ›· (Ì‹ÓÂ˜) 30,5 26

≤12 ÌËÓÒÓ 9 (69%) 17 (56,6%)¶ÚÔ‰È·ıÂÛÈÎ‹ Î·Ù¿ÛÙ·ÛË 3 4∫Ú·ÓÈÔÂÁÎÂÊ·ÏÈÎ‹ Î¿ÎˆÛË 0 2ª·ÎÚ‡ ÈÛÙÔÚÈÎfi ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ (>48 h) 4 10µÚ·¯‡ ÈÛÙÔÚÈÎfi ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ (<48 h) 9 12∞ÓÙÈ‚›ˆÛË ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ 4 8¢È·Ù·Ú·¯¤˜ Û˘ÓÂ›‰ËÛË˜ 11 10 <0,01

∫ÒÌ· 7 2™·ÛÌÔ› 4 9∞Ó·ÓÂ˘ÛÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ 9 1 <0,01∂ÈÏÔÎ¤˜ 8 2 <0,01∏Ì¤Ú· ÓfiÛÔ˘ Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ 3 2,5¢È¿ÚÎÂÈ· ˘ÚÂÙÔ‡ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ (ÒÚÂ˜) 60 50¶˘ÚÂÙfi˜ Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ (ÔC) 38,4 38,3

≥38,5ÔC 7 (53,8%) 15 (50%)¢È¿ÚÎÂÈ· ˘ÚÂÙÔ‡ Î·Ù¿ ÙË ÓÔÛËÏÂ›· (ÒÚÂ˜) 3 7∫‡ÙÙ·Ú· ∂¡À (/mm3) 999 1289

≤100 2 (15,4%) 5 (16,6%)101-500 5 (38,4%) 7 (23,3%)

¶ÚˆÙÂ˝ÓË ∂¡À (mg%) 391,5 217 <0,01°Ï˘Îfi˙Ë ∂¡À (mg%) 18,3 35 <0,01§Â˘ÎÔÎ‡ÙÙ·Ú· ·›Ì·ÙÔ˜ (Ìg/dl) 11700 11800

≤5000 1 (7,7%) 3 (10%)5001-10000 4 (30,7%) 7 (23,3%)

∆∫∂ (mm/h) 111 80,3≤20 0 0≥50 8 (61,5%) 24 (80%)

Hb ≤10 gr/dl 8 (61,5%) 8,3 16 (53,3%) 10,2



247

ÔÛÔÛÙfi ÚÔËÁÔ‡ÌÂÓË˜ ÌÂÏ¤ÙË˜ Ì·˜ Ô˘ ·ÊÔ-ÚÔ‡ÛÂ Ì·ÎÚÔ¯ÚfiÓÈ· ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·ÛıÂ-ÓÒÓ (13). OÈ ‰È·Ù·Ú·¯¤˜ ·ÎÔ‹˜ ·Ú·Ì¤ÓÔ˘Ó ÙÔÛËÌ·ÓÙÈÎfiÙÂÚÔ ˘fiÏÂÈÌÌ· ÙË˜ ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎ‹˜ÌËÓÈÁÁ›ÙÈ‰·˜ (14,15). ∏ ÎÒÊˆÛË ‹Ù·Ó ÌfiÓÈÌË ÛÂfiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ì·˜ ÌÂ ÙËÓ ÂÈÏÔÎ‹ ·˘Ù‹(19%). ™‡ÌÊˆÓ· ÌÂ ÚfiÛÊ·ÙË ÌÂÏ¤ÙË (16), ÌfiÓÔÙÔ 2,4% ·fi 124 ·È‰È¿ ÌÂ ÌÈÎÚÔ‚È·Î‹ ÌËÓÈÁÁ›ÙÈ‰··fi N. meningitidis Î·È S. pneumoniae Â›¯Â ÌfiÓÈÌËÎÒÊˆÛË. OÈ Û˘ÁÁÚ·ÊÂ›˜ ÈÛÙÂ‡Ô˘Ó fiÙÈ ˘¿Ú¯ÂÈÌ›· “Â·ÏÏ¿ÛÛÔ˘Û· ‹ Î˘Ì·ÈÓfiÌÂÓË” ·ÒÏÂÈ··ÎÔ‹˜ ÛÙËÓ ÔÍÂ›· ÌÈÎÚÔ‚È·Î‹ ÌËÓÈÁÁ›ÙÈ‰·.

™ËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ·ÛıÂÓÒÓ Ì·˜ Â›¯Â Î¿ÔÈ·˘ÔÎÂ›ÌÂÓË Î·Ù¿ÛÙ·ÛË ‹ ÓfiÛÔ (10,14,17). ∆Ô Î¿-Ù·ÁÌ· ÎÚ·Ó›Ô˘ ·Ú·Ì¤ÓÂÈ ÌÂ›˙ˆÓ ÚÔÁÓˆÛÙÈÎfi˜·Ú¿ÁÔÓÙ·˜ ÁÈ· ÔÍÂ›· ‹ ˘ÔÙÚÔÈ¿˙Ô˘Û· ÓÂ˘ÌÔ-ÓÈÔÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰· (13). ∂›Ó·È ÂÓ‰È·Ê¤ÚÔÓ fiÙÈÎ·Ó¤Ó·˜ ·fi ÙÔ˘˜ 9 ·ÛıÂÓÂ›˜ Ì·˜ ÌÂ ˘ÔÙÚÔÈ¿-˙Ô˘Û· ÌËÓÈÁÁ›ÙÈ‰· ‰ÂÓ Â›¯Â Î·Î‹ ¤Î‚·ÛË. ™ÙÔ˘˜·ÛıÂÓÂ›˜ ·˘ÙÔ‡˜, ÙÔ ÔÛÔÛÙfi ˘ÔÎÂ›ÌÂÓË˜ ÓfiÛÔ˘‹Ù·Ó ˘„ËÏfiÙÂÚÔ ·fi ·˘Ùfi ÙˆÓ ¿ÏÏˆÓ ·ÛıÂÓÒÓ(88% ¤Ó·ÓÙÈ 12%).

∆· ˘„ËÏ¿ ÔÛÔÛÙ¿ ıÓËÙfiÙËÙ·˜ Î·È ˘ÔÏÂÈÌ-Ì¿ÙˆÓ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ÚÔÊ‡Ï·ÍË ·fi ÙËÓ ÓÂ˘-ÌÔÓÈÔÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰· Â›Ó·È ÛËÌ·ÓÙÈÎ‹. ∂›Ó·ÈÔÏ‡ Èı·Ófi Ó· ‰ÔıÂ› Ï‡ÛË ÛÙÔ Úfi‚ÏËÌ· ÌÂ Ù·Ó¤· Û˘˙Â˘ÁÌ¤Ó· ÂÌ‚fiÏÈ· Ô˘ ÌÂÏÂÙÒÓÙ·È ‹ Ô˘¤¯Ô˘Ó Î˘ÎÏÔÊÔÚ‹ÛÂÈ.

¶·Ú¿ ÙË ‰˘Ó·ÙfiÙËÙ· ¤ÁÎ·ÈÚË˜ ‰È¿ÁÓˆÛË˜ Î·ÈÎ·Ù¿ÏÏËÏË˜ ıÂÚ·Â›·˜, Ë ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎ‹ ÌË-ÓÈÁÁ›ÙÈ‰· ·Ú·Ì¤ÓÂÈ Ì›· ÛÔ‚·Ú‹ ÏÔ›ÌˆÍË ÌÂ ˘„Ë-Ïfi ÔÛÔÛÙfi ıÓËÙfiÙËÙ·˜.

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Infectious Diseases. 5th ed - CD ROM. N York: ChurchillLivingstone; 2000.

2. Henriques Normark B, Novak R, Ortqvist A, Kallenius G,Tuomanen E, Normark S. Clinical isolates ofStreptococcus pneumoniae that exhibit tolerance ofvancomycin. Clin Infect Dis 2001;32:552-558.

3. Stanek RJ, Mufson MA. A 20-year epidemiological studyof pneumococcal meningitis. Clin Infect Dis 1999;28:1265-1272.

4. Mencia Bartolome S, Casado Flores J, Marin Barba C,Gonzalez-Vicent M, Ruiz Lopez MJ. Pneumococcalmeningitis in children. Review of 28 cases. An Esp Pediatr2000;53:94-99.

5. Venetz I, Schopfer K, Muhlemann K. Paediatric, invasivepneumococcal disease in Switzerland, 1985-1994. Swiss

Pneumococcal Study Group. Int J Epidemiol 1998;27:1101-1104.

6. Kornelisse RF, Westerbeek CM, Spoor AB, van der HeijdeB, Spanjaard L, Neijens HJ et al. Pneumococcal meningitisin children: prognostic indicators and outcome. Clin InfectDis 1995;21:1390-1397.

7. Kirkpatrick B, Reeves DS, MacGowan AP. A review of theclinical presentation, laboratory features, antimicrobialtherapy and outcome of 77 episodes of pneumococcalmeningitis occurring in children and adults. J Infect1994;29:171-182.

8. Hoen B, Viel JF, Gerard A, Dureux JB, Canton P. Mortalityin pneumococcal meningitis: a multivariate analysis ofprognostic factors. Eur J Med 1993;2:28-32.

9. Arditi M, Mason EO Jr, Bradley JS, Tan TQ, Barson WJ,Schutze GE et al. Three-year multicenter surveillance ofpneumococcal meningitis in children: clinical character-istics, and outcome related to penicillin susceptibility anddexamethasone use. Pediatrics 1998;102:1087-1097.

10. Laurichesse H, Romaszko JP, Nguyen LT, Souweine B,Poirier V, Guolon D et al. Clinical characteristics andoutcome of patients with invasive pneumococcal disease,Puy-de-Dome, France, 1994-1998. Eur J Clin MicrobiolInfect Dis 2001;20:299-308.

11. Syriopoulou V, Daikos GL, Soulis K, Michos A, AlexandrouH, Pavlopoulou I et al. Epidemiology of invasive childhoodpneumococcal infections in Greece. Acta Paediatr2000;89(Suppl):30-34.

12. Laxer RM, Marks MI. Pneumococcal meningitis in children.Am J Dis Child 1977;131:850-853.

13. Pikis A, Kavaliotis J, Tsikoulas J, Andrianopoulos P,Venzon D, Manios S. Long-term sequelae of pneumo-coccal meningitis in children. Clin Pediatr 1996; 35:72-80.

14. Buckingham SC, McCullers JA, Lujan-Zilbermann J,Knapp KM, Orman KL, English BK. Pneumococcalmeningitis in children: relationship of antibiotic resistanceto clinical characteristics and outcome. Pediatr Infect Dis J2001;20:837-843.

15. Bedford H, de Louvois J, Halket S, Peckham C, Hurley R,Harvey D. Meningitis in infancy in England and Wales:follow up at age 5 years. BMJ 2001;323:533-535.

16. Richardson MP, Reid A, Tarlow MJ, Rudd PT. Hearing lossduring bacterial meningitis. Arch Dis Child 1997;76:134-138.

17. Alonso Palacio J, Madrigal Diez V, Garcia Fuentes M.Pneumococcal meningitis in the infantile population ofCantabria. An Esp Pediatr 1992;36:441-445.


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ªËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰·: ·Ú·ÙËÚ‹ÛÂÈ˜ ÛÂ 1070 ·ÛıÂÓÂ›˜ ™. ¶ÂÙÚ›‰Ô˘, ∂. ∑Â˘Á·Ú›‰Ô˘, ∞. ∂˘ı˘Ì›Ô˘, ∞. ¡¿ÓÔ˘, π. ∫·‚·ÏÈÒÙË˜

Meningococcal meningitis: a descriptive study of 1070 casesS. Petridou, E. Zevgaridou, A. Eythymiou, A. Nanou, J. Kavaliotis


�¶ÂÚ›ÏË„Ë: O ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˜ ·ÔÙÂÏÂ› ÙÔÛËÌ·ÓÙÈÎfiÙÂÚÔ ·›ÙÈÔ ÌÈÎÚÔ‚È·Î‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ·-ÁÎÔÛÌ›ˆ˜. ¶·Ú¿ ÙËÓ Î·Ù¿ÏÏËÏË ·ÓÙÈÌÈÎÚÔ‚È·Î‹ıÂÚ·Â›· Î·È ÙËÓ ÂÏ¿ÙÙˆÛË ÙË˜ Û˘¯ÓfiÙËÙ¿˜ ÙÔ˘,ÌÔÚÂ› Ó· ÚÔÎ·Ï¤ÛÂÈ ÂÈ‰ËÌ›Â˜ ÌÂ ÛÔ‚·Ú¤˜ Û˘-Ó¤ÂÈÂ˜. ™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ·˘Ù‹˜ Â›Ó·È Ë ·Ó¿Ï˘-ÛË ÙˆÓ ÎÏÈÓÈÎÔ-ÂÈ‰ËÌÈÔÏÔÁÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓÙË˜ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ Ù· ÙÂÏÂ˘-Ù·›· 30 ¯ÚfiÓÈ·. ∫·Ù¿ ÙË ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô1970-1999, ÓÔÛËÏÂ‡ÙËÎ·Ó ÛÙËÓ ∫ÏÈÓÈÎ‹ Û˘ÓÔÏÈÎ¿ 1070·ÛıÂÓÂ›˜ ÌÂ ÌËÓÈÁÁ›ÙÈ‰· ·fi ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ. ∏ÔÌ¿‰· ·˘Ù‹ ÂÚÈÏ·Ì‚¿ÓÂÈ 357 ÂÚÈÙÒÛÂÈ˜ Ô˘¯·Ú·ÎÙËÚ›ÛÙËÎ·Ó ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ¤˜ ÌÂ ‚¿ÛËÎÏÈÓÈÎ¿ ÎÚÈÙ‹ÚÈ· (·˘ÛÙËÚ¿ Ù˘ÈÎfi ·ÈÌÔÚÚ·ÁÈÎfiÂÍ¿ÓıËÌ· ÌÂ ÓÂÎÚÒÛÂÈ˜), Î·ıÒ˜ Î·È ÂÚÁ·ÛÙËÚÈ·-Î¿ Â˘Ú‹Ì·Ù· ·fi ÙÔ ∂¡À Û˘Ì‚·Ù¿ ÌÂ ÌËÓÈÁÁ›ÙÈ‰·.∏ ÌÂÏ¤ÙË ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÂÈ ·È‰È¿ ÌÂ ÌËÓÈÁÁÈÙÈ‰Ô-ÎÔÎÎ·ÈÌ›· Î·È ÌfiÓÔÓ. ∏ Ì¤ÛË ËÏÈÎ›· ÙˆÓ ·ÛıÂÓÒÓ‹Ù·Ó 3,6±3,2 ¤ÙË (30 ËÌÂÚÒÓ ¤ˆ˜ 14 ÂÙÒÓ). ∆Ô57% (608/1070) ‹Ù·Ó ·ÁfiÚÈ·. ∏ ÂÙ‹ÛÈ· Î·Ù·ÓÔÌ‹¤‰ÂÈÍÂ ÛËÌ·ÓÙÈÎ‹ ÂÏ¿ÙÙˆÛË ÙË˜ Â›ÙˆÛË˜ ÌÂÙ¿ÙÔ 1980. ∆ËÓ ÂÚ›Ô‰Ô 1996-1999 ·Ú·ÙËÚ‹ıËÎÂÂÈ‰ËÌ›· ÙË˜ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÓfiÛÔ˘ ÌÂ Û¯ÂÙÈ-Î¿ ÌÈÎÚfi ·ÚÈıÌfi ·ÛıÂÓÒÓ. ∏ ÎÏÈÓÈÎ‹ ÔÚÂ›· ÙË˜ÓfiÛÔ˘ ‹Ù·Ó ÁÂÓÈÎ¿ Î·Ï‹. ∆Ô 10% ÙˆÓ ·ÛıÂÓÒÓ ·-ÚÔ˘Û›·ÛÂ Û·ÛÌÔ‡˜, Î˘Ú›ˆ˜ ÁÂÓÈÎÂ˘Ì¤ÓÔ˘˜ Î·ÈÎ˘Ú›ˆ˜ ÙÈ˜ ‰‡Ô ÚÒÙÂ˜ ËÌ¤ÚÂ˜ ÙË˜ ÓfiÛÔ˘. ¢È·Ù·-Ú·¯¤˜ Û˘ÓÂ›‰ËÛË˜ ÛËÌÂÈÒıËÎ·Ó ÛÙÔ 50% ÙˆÓ ·È-‰ÈÒÓ, ÂÓÒ Î·Ù·ÏËÍ›· ÛÙÔ 6% ÙˆÓ ·ÛıÂÓÒÓ. ∆Ô9% ÙˆÓ ·ÛıÂÓÒÓ ·ÚÔ˘Û›·ÛÂ ÂÈÏÔÎ¤˜ (97/1070,Î˘Ú›ˆ˜ ·ÚıÚ›ÙÈ‰·). ¡Â˘ÚÔÏÔÁÈÎ¿ ˘ÔÏÂ›ÌÌ·Ù··Ú·ÙËÚ‹ıËÎ·Ó ÛÂ 26/1058 (3%) ·È‰È¿. ∏ ıÓËÙfi-ÙËÙ· ‹Ù·Ó 1,1% (12/1070 ·ÛıÂÓÂ›˜). ∏ Û‡ÁÎÚÈÛËÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·Â‚›ˆÛ·Ó ÌÂ ÔÌ¿‰· ·ÚfiÌÔÈ·˜

�Abstract: Neisseria meningitidis (NM) is themost important cause of bacterial meningitis (BM)worldwide. The aim of this study was to determinethe clinico-epidemiological characteristics of NMmeningitis in the last 30 years. During the period1970-1999, a total of 1070 cases of BM due to NMwere hospitalized in our Department (studygroup). This group included 357 cases withoutbacteriological confirmation of NM, but withlaboratory findings compatible with BM and clinicalfeatures strictly typical for meningococcal infection(characteristic hemorrhagic rash with necrosis). Itdid not include cases with meningococcemiaalone. There was a male preponderance(608/1070, 57%). The median age of the childrenwas 3.6±3.25 years (30 days to 14 years). Theannual distribution revealed a significant decreasein the incidence of NM meningitis after the year1980. During 1996-1999 an outbreak ofmeningococcal disease occurred, but with arelatively small number of patients. The clinicalcourse was good in the majority of cases. About10% of the patients presented with seizures,usually generalized, occuring mainly during thefirst two days of the disease. Consciousnessdisorders occurred in 50%, shock in 6% andcomplications in 9% (mainly arthritis) of thepatients. Neurological sequelae were observed in26/1058 (3%) children. The mortality rate was 1.1%(12/1070). Comparison of the patients who died,with a group of patients of similar sex and age thatwere cured, showed that the first group had ashorter pre-admission history, a higher rate ofconsciousness alterations and diffuse hemorrhagic

¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¡ÔÛÔÎÔÌÂ›Ô˘ ∂È‰ÈÎÒÓ ¶·ı‹ÛÂˆÓ,£ÂÛÛ·ÏÔÓ›ÎË

Department of Paediatrics,Infectious Diseases Hospital, Thessaloniki



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∂ÈÛ·ÁˆÁ‹∏ N. meningitidis Â›Ó·È Ë Î‡ÚÈ· ·ÈÙ›· ÌËÓÈÁÁ›ÙÈ-

‰·˜ ·ÁÎÔÛÌ›ˆ˜. ∏ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÓfiÛÔ˜·ÔÙÂÏÂ› Úfi‚ÏËÌ· ÁÈ· ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ¯ÒÚÂ˜,ÂÓÒ ÂÎ‰ËÏÒÓÔÓÙ·È ·ÎfiÌË ÌÂÁ¿ÏÂ˜ ÂÈ‰ËÌ›Â˜ ÛÂÔÏÏ¤˜ ÂÚÈÔ¯¤˜ ÙÔ˘ ÎfiÛÌÔ˘, fiˆ˜ ÛÙËÓ ∂˘ÚÒË(ƒˆÛ›·, ™Î·Ó‰ÈÓ·‚›· Î.Ï.), ÛÙËÓ ∞ÊÚÈÎ‹ (·ÎfiÌËÎ·È ÂÎÙfi˜ “˙ÒÓË˜ ÌËÓÈÁÁ›ÙÈ‰·˜”), ÛÙÔÓ ∫·Ó·‰¿,ÛÙËÓ ∞˘ÛÙÚ·Ï›· (1-3). ∏ ÁÓÒÛË ÙË˜ ÂÈ‰ËÌÈÔÏÔ-Á›·˜ ÙË˜ ÓfiÛÔ˘ Â›Ó·È ¿ÓÙ· ¯Ú‹ÛÈÌË, ÂÈ‰ÈÎ¿ ÙÒÚ·Ô˘ Î˘ÎÏÔÊÔÚÔ‡Ó ‹ ı· Î˘ÎÏÔÊÔÚ‹ÛÔ˘Ó Î·È Ó¤·Û˘˙Â˘ÁÌ¤Ó· ÂÌ‚fiÏÈ· ÁÈ· ÔÚÈÛÌ¤ÓÂ˜ ÔÚÔ-ÔÌ¿‰Â˜ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘.

™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ô Î·ıÔÚÈÛÌfi˜ ÙˆÓÎÏÈÓÈÎÔÂÈ‰ËÌÈÔÏÔÁÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙË˜ ÌË-ÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ÛÙ· ÙÂÏÂ˘Ù·›· 30¯ÚfiÓÈ·, ÌÂ ‚¿ÛË Ù· ÛÙÔÈ¯Â›· ÙË˜ ∫ÏÈÓÈÎ‹˜ Ì·˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∞ÛıÂÓÂ›˜: ∏ ÔÌ¿‰· ÌÂÏ¤ÙË˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ·È‰È¿ ÌÂ ÌË-

ÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰· (n=1070) Ô˘ ÓÔÛËÏÂ‡ıËÎ·ÓÛÙËÓ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ÙÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘ ∂È‰ÈÎÒÓ ¶·ı‹-ÛÂˆÓ £ÂÛÛ·ÏÔÓ›ÎË˜ ÙËÓ ÂÚ›Ô‰Ô 1970-1999 (30 ¯ÚfiÓÈ·).

™˘ÏÏÔÁ‹ ÛÙÔÈ¯Â›ˆÓ: ∏ ÌÂÏ¤ÙË Â›Ó·È ·Ó·‰ÚÔÌÈÎ‹. ªÂ ‚¿-ÛË ÂÈ‰ÈÎfi ‰ÂÏÙ›Ô Û˘ÏÏÔÁ‹˜ ÛÙÔÈ¯Â›ˆÓ ·Ó·ÛÎÔ‹ıËÎ·Ó ÔÈÊ¿ÎÂÏÏÔÈ ÓÔÛËÏÂ›·˜ ÙˆÓ ·ÛıÂÓÒÓ Î·È Û˘ÁÎÂÓÙÚÒıËÎ·ÓÛÙÔÈ¯Â›· ÁÈ· ‰È¿ÊÔÚÂ˜ ·Ú·Ì¤ÙÚÔ˘˜: ‰ËÌÔÁÚ·ÊÈÎ¿ ‰Â‰Ô-Ì¤Ó·, ÚÔ‰È·ıÂÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜, ÈÛÙÔÚÈÎfi ÌËÓÈÁÁ›ÙÈ‰·˜,ÎÏÈÓÈÎ‹ Û˘ÌÙˆÌ·ÙÔÏÔÁ›·, ÂÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù·, ·ÓÙÈ-‚ÈÔıÂÚ·Â›· Î·È ÂÍ¤ÏÈÍË ÙË˜ ÓfiÛÔ˘.

OÚÈÛÌÔ›: °È· ÙÈ˜ ·Ó¿ÁÎÂ˜ ÙË˜ ÌÂÏ¤ÙË˜ ¯ÚËÛÈÌÔÔÈ‹ıË-Î·Ó ÔÈ ·Ú·Î¿Ùˆ ÔÚÈÛÌÔ› ÁÈ· Ù· ·ÓÙ›ÛÙÔÈ¯· ‰Â‰ÔÌ¤Ó·: ·)¶ÚÔ‰È·ıÂÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÁÈ· ÌËÓÈÁÁ›ÙÈ‰·: ·ÚÔ˘Û›· Î·-ÎÔ‹ıÂÈ·˜, ·ÚÔ˘Û›· ·ÔÊÚ·ÎÙÈÎ‹˜ ÓÂ˘ÌÔÓÔ¿ıÂÈ·˜, ÈÛÙÔ-ÚÈÎfi ÚÔËÁËıÂ›Û·˜ ÌÈÎÚÔ‚È·Î‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜, Î·ÎÒÛÂÈ˜ÎÚ·Ó›Ô˘-ÂÁÎÂÊ¿ÏÔ˘, ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·, ÛÏËÓÂÎÙÔÌ‹, Û˘Á-ÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜, ‚) £ÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÁÈ· ÌË-ÓÈÁÁ›ÙÈ‰·: ·ÚÔ˘Û›· ÂÚ›ÙˆÛË˜ ÌÈÎÚÔ‚È·Î‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜

ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·, ÙÔ˘Ï¿¯ÈÛÙÔÓ 4 Â‚‰ÔÌ¿‰Â˜ Î·È Ï¤ÔÓ ÚÈÓÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ·ÛıÂÓÔ‡˜-‰Â›ÎÙË ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô, Á) ¢Â˘-ÙÂÚÔ·ı¤˜ ÎÚÔ‡ÛÌ·: ·˘Ùfi Ô˘ Û˘Ì‚·›ÓÂÈ ÛÂ ¿ÙÔÌ· ÙÔ˘ÛÙÂÓÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ 24 ÒÚÂ˜Î·È Ï¤ÔÓ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ÓfiÛÔ˘ ÛÙÔÓ ·ÛıÂÓ‹-‰Â›ÎÙË,‰) ∂ÈÏÔÎ¤˜: ·ÚÔ˘Û›· Û˘ÌÙˆÌ¿ÙˆÓ Î·È ÛËÌÂ›ˆÓ Ô˘ ‰ÂÓÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙ· Û˘Ó‹ıË ÎÏÈÓÈÎ¿ ÛÙÔÈ¯Â›· ÙË˜ ÌËÓÈÁÁ›ÙÈ-‰·˜ (ÎÒÌ·, Û·ÛÌÔ› ÌÂÙ¿ 3 ËÌ¤ÚÂ˜ ıÂÚ·Â›·˜, Û‡Ó‰ÚÔÌÔ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‰˘Û¯¤ÚÂÈ·˜, ·ÚıÚ›ÙÈ‰·, ÂÚÈÎ·Ú‰›ÙÈ‰·, ˘Ô-ÛÎÏËÚ›‰È· Û˘ÏÏÔÁ‹), Â) ÀÔÏÂ›ÌÌ·Ù·: ÔÔÈÔ‰‹ÔÙÂ ·ıÔ-ÏÔÁÈÎfi Â‡ÚËÌ· Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô ÙÔ˘ ·ÛıÂÓÔ‡˜ ·fi ÙÔ ÓÔÛÔ-ÎÔÌÂ›Ô (‰È·Ù·Ú·¯¤˜ ·ÎÔ‹˜, ·Ú¿Ï˘ÛË ÎÚ·ÓÈ·ÎÒÓ ÓÂ‡ÚˆÓ,‰È·Ù·Ú·¯¤˜ fiÚ·ÛË˜, ˘‰ÚÔÎ¤Ê·ÏÔ˜, ‰È·ÓÔËÙÈÎ‹ Î·ı˘ÛÙ¤ÚË-ÛË, ÎÈÓËÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜, Ô˘Ï¤˜ ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ ÓÂÎÚÒÛÂ-ˆÓ), ÛÙ) Ã·ÌËÏ‹ Û˘ÛÙÔÏÈÎ‹ ›ÂÛË: ÔÚ›ÛÙËÎÂ ÌÂ ‚¿ÛË ÙËÓ ËÏÈ-Î›· ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È Ù· ÂÍ‹˜ fiÚÈ· ÁÈ· ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ËÏÈ-ÎÈ·Î‹ ÔÌ¿‰· (¤ˆ˜ 1 ÌËÓfi˜ <70 mmHg, 1 ÌËÓfi˜-5 ÂÙÒÓ <80mmHg, 5 ÂÙÒÓ Î·È ÌÂÁ·Ï‡ÙÂÚ· <90 mmHg). ∆· fiÚÈ· ·˘Ù¿·ÓÙÈÚÔÛˆÂ‡Ô˘Ó Û˘ÛÙÔÏÈÎ‹ ›ÂÛË ÙÔ˘Ï¿¯ÈÛÙÔÓ 1 ™∞ (ÛÙ·-ıÂÚ‹ ·fiÎÏÈÛË) Î¿Ùˆ ·fi ÙËÓ Î·ÙÒÙÂÚË Ê˘ÛÈÔÏÔÁÈÎ‹ ÙÈÌ‹Î·È ˙) ¶ÏÂÈÔÎ˘ÙÙ¿ÚˆÛË: Î‡ÙÙ·Ú· ∂¡À ≥20/mm3.

∫ÚÈÙ‹ÚÈ· ÂÈÛ·ÁˆÁ‹˜ ÛÙË ÌÂÏ¤ÙË: ∫ÚÈÙ‹ÚÈ· ÂÈÛ·ÁˆÁ‹˜ÛÙË ÌÂÏ¤ÙË ‹Ù·Ó: i) ÛËÌÂ›· Î·È Û˘ÌÙÒÌ·Ù· ÌËÓÈÁÁ›ÙÈ‰·˜, ii)ÂÚÁ·ÛÙËÚÈ·Î¤˜ ÂÓ‰Â›ÍÂÈ˜ ·fi ÙÔ ∂¡À Û˘Ì‚·Ù¤˜ ÌÂ ÌÈÎÚÔ-‚È·Î‹ ÌËÓÈÁÁ›ÙÈ‰· (ÏÂÈÔÎ˘ÙÙ¿ÚˆÛË, Ô˘‰ÂÙÂÚÔÊÈÏ›·, ˘„ËÏfiÏÂ‡ÎˆÌ·, ¯·ÌËÏfi Û¿Î¯·ÚÔ), iii) ·ÔÌfiÓˆÛË ÙË˜ N.meningitidis ·fi Î·ÏÏÈ¤ÚÁÂÈ· ∂¡À ‹/Î·È ·›Ì·ÙÔ˜ ‹ Î·È ·Ó›-¯ÓÂ˘ÛË ÙË˜ ÌÂ ÙÔ slidex test Î·È iv) ÂÚÈÙÒÛÂÈ˜ ¯ˆÚ›˜ ·Ô-ÌfiÓˆÛË ÙË˜ N. meningitidis, ·ÏÏ¿ ÌÂ ÎÏÈÓÈÎ¿ Î·È ÂÚÁ·ÛÙË-ÚÈ·Î¿ (ÏÂ˘ÎÔÎ‡ÙÙ·Ú· ∂¡À >20/mm3, Ô˘‰ÂÙÂÚÔÊÈÏ›·, ·˘ÍË-Ì¤ÓË ÚˆÙÂ˝ÓË, ÂÏ·ÙÙˆÌ¤ÓË ÁÏ˘Îfi˙Ë) Â˘Ú‹Ì·Ù· ·ÔÏ‡Ùˆ˜Û˘Ì‚·Ù¿ ÌÂ ÌÈÎÚÔ‚È·Î‹ ÌËÓÈÁÁ›ÙÈ‰· Î·È ·ÈÌÔÚÚ·ÁÈÎfi ÂÍ¿Ó-ıËÌ· ·˘ÛÙËÚ¿ Î·È ·fiÏ˘Ù· Ù˘ÈÎfi ÙË˜ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ÏÔ›ÌˆÍË˜. ∆Ô 59,4% ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ Â›¯Â Ï¿‚ÂÈ ·ÓÙÈ-‚›ˆÛË πV ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Î·È Ê˘ÛÈÎ¿ÚÈÓ ÙË Ï‹„Ë Î·ÏÏÈÂÚÁÂÈÒÓ ·›Ì·ÙÔ˜ Î·È ∂¡À. OÈ ·ÛıÂÓÂ›˜·˘ÙÔ› ·ÔÊ·Û›ÛÙËÎÂ Ó· Û˘ÌÂÚÈÏËÊıÔ‡Ó ÛÙË ÌÂÏ¤ÙË, ‰ÈfiÙÈÈÛÙÂ‡Ô˘ÌÂ fiÙÈ Ô ·ÔÎÏÂÈÛÌfi˜ ÙÔ˘˜ ı· Â›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ·

ËÏÈÎ›·˜ Î·È Ê‡ÏÔ˘ Ô˘ È¿ıËÎ·Ó ¤‰ÂÈÍÂ fiÙÈ Ë ÚÒÙËÔÌ¿‰· Â›¯Â ‚Ú·¯‡ÙÂÚË ‰È¿ÚÎÂÈ· ÙË˜ ÓfiÛÔ˘ ÚÈÓÙËÓ ÂÈÛ·ÁˆÁ‹, ·˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ· ‰È·Ù·Ú·¯ÒÓÛ˘ÓÂ›‰ËÛË˜ Î·È ‰È¿¯˘ÙÔ ·ÈÌÔÚÚ·ÁÈÎfi ÂÍ¿ÓıËÌ·. ∏Û˘¯ÓfiÙÂÚË ÔÚÔ-ÔÌ¿‰· ÛÙË ÌÂÏ¤ÙË Ì·˜ ‹Ù·Ó Ë µ.™ÙËÓ ÂÈ‰ËÌ›·, fiÌˆ˜, ÙÔ˘ 1996-1999 Î˘ÚÈ¿Ú¯ËÛÂË ÔÚÔ-ÔÌ¿‰· C. ™˘ÌÂÚ·ÛÌ·ÙÈÎ¿: 1) Ë Â›ÙˆÛËÙË˜ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ Ê·›ÓÂÙ·È fiÙÈ¤¯ÂÈ ÂÏ·ÙÙˆıÂ› ÛÙËÓ ÂÚÈÔ¯‹ Ì·˜ ÌÂ ÂÍ·›ÚÂÛË Î¿-ÔÈÂ˜ ÂÚÈfi‰Ô˘˜ ÂÈ‰ËÌÈÒÓ Î·È 2) Ë ÓfiÛÔ˜ ·ÚÔ˘-ÛÈ¿˙ÂÈ ‹È· ÎÏÈÓÈÎ‹ ÔÚÂ›· ÌÂ ÌÈÎÚfi ÔÛÔÛÙfi ˘Ô-ÏÂÈÌÌ¿ÙˆÓ Î·È ¯·ÌËÏ‹ ıÓËÙfiÙËÙ·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÌËÓÈÁÁ›ÙÈ‰·, ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˜,ÏÔÈÌÒÍÂÈ˜, ·È‰È¿.

rash. The most frequent serogroup of NM in ourstudy was type B. However, serogroup Cpredominated in the 1996-1999 outbreak. As aconclusion: 1) the incidence of NM meningitisseems to have declined in our area with theexception of a few periods of disease outbreaks, 2)the disease has a mild clinical course, with fewneurological sequelae and a low rate of mortality.

Key words: meningitis, meningococcus, infe-ctious diseases, children.


ÛÙÚ¤‚ÏˆÛË ÙË˜ ÂÈÎfiÓ·˜ ÙË˜ ÓfiÛÔ˘. ∞ÔÎÏÂÈÛÌfi˜ ·ÛıÂÓÒÓ: ¢ÂÓ Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÛÙË ÌÂ-

Ï¤ÙË ·ÛıÂÓÂ›˜ ÌÂ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎ·ÈÌ›· ÌfiÓÔ Î·È fi¯È ÌËÓÈÁ-Á›ÙÈ‰·. ø˜ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎ·ÈÌ›· ıÂˆÚ‹Û·ÌÂ ÙËÓ Î·Ù¿ÛÙ·ÛËÌÂ Ù· ÂÍ‹˜ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿: ˘ÚÂÙfi˜ >38ÔC, ÂÙ¤¯ÂÈÂ˜ ‹ÔÚÊ˘ÚÈÎfi ÂÍ¿ÓıËÌ· ‹ ÎÂÚ·˘ÓÔ‚fiÏÔ˜ ÌÔÚÊ‹ ÛË„·ÈÌ›·˜ ÌÂ˘ÚÂÙfi, ÂÙ¤¯ÂÈÂ˜ ‹ ÔÚÊ‡Ú· Ù·¯¤ˆ˜ ÂÍ·ÏÔ‡ÌÂÓÂ˜, ·ÈÌÔ-‰˘Ó·ÌÈÎ‹ ·ÛÙ¿ıÂÈ· Î·È ·ÔÌfiÓˆÛË ÙË˜ N. meningitidis.

∫·Ó¤Ó· ·È‰› ‰ÂÓ Â›¯Â Ï¿‚ÂÈ ÔÔÈÔ‰‹ÔÙÂ ·ÓÙÈÌËÓÈÁÁÈÙÈ-‰ÔÎÔÎÎÈÎfi ÂÌ‚fiÏÈÔ ÚÈÓ ÓÔÛ‹ÛÂÈ.

∞ÔÙÂÏ¤ÛÌ·Ù· °ÂÓÈÎ¿ ÛÙÔÈ¯Â›·: ∫·Ù¿ ÙËÓ ÂÚ›Ô‰Ô 1970-1999

ÓÔÛËÏÂ‡ıËÎ·Ó ÛÙËÓ KÏÈÓÈÎ‹ 1070 ·ÛıÂÓÂ›˜ (608·ÁfiÚÈ·) ÌÂ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰·. ∏ ËÏÈ-Î›· ÙˆÓ ·ÛıÂÓÒÓ Î˘Ì·ÈÓfiÙ·Ó ·fi 30 ËÌ¤ÚÂ˜ ¤ˆ˜14 ¯ÚfiÓÈ· (‰È¿ÌÂÛË 30 Ì‹ÓÂ˜). ∏ Û˘¯ÓfiÙËÙ· ÙË˜

ÓfiÛÔ˘ ‹Ù·Ó ˘„ËÏfiÙÂÚË ÛÙ· ·È‰È¿ <2 ÂÙÒÓ(499/1070, 47%) Î·È ÌÂÈˆÓfiÙ·Ó ¤ÓÙÔÓ· ÌÂÙ¿ Ù· 2¯ÚfiÓÈ· ÙË˜ ˙ˆ‹˜ (∂ÈÎfiÓ· 1).

∂È‰ËÌÈÔÏÔÁÈÎ¿ ‰Â‰ÔÌ¤Ó·: ∏ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈ-Î‹ ÓfiÛÔ˜ ¤¯ÂÈ ·ÁÎfiÛÌÈ· Î·Ù·ÓÔÌ‹ Î·È ÂÌÊ·Ó›˙Â-Ù·È Â›ÙÂ ÌÂ ÂÓ‰ËÌÈÎ‹, Â›ÙÂ ÌÂ ÂÈ‰ËÌÈÎ‹ ÌÔÚÊ‹.™ÙËÓ ÂÚ›Ô‰Ô ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜ ·Ú·ÙËÚ‹ıËÎÂÊı›ÓÔ˘Û· ÔÚÂ›· ÙË˜ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÌËÓÈÁÁ›-ÙÈ‰·˜, ÂÓÒ ÛÂ ÔÚÈÛÌ¤ÓÂ˜ ¯ÚÔÓÈÎ¤˜ ÂÚÈfi‰Ô˘˜˘‹ÚÍÂ ·˘ÍËÌ¤ÓÔ˜ ·ÚÈıÌfi˜ ÎÚÔ˘ÛÌ¿ÙˆÓ (∂ÈÎfiÓ·2). ∆ÂÏÂ˘Ù·›· ÂÈ‰ËÌÈÎ‹ ¤Í·ÚÛË ‹Ù·Ó ÙË˜ ÂÚÈfi-‰Ô˘ 1996-1999. ∏ Ì¤ÛË ÂÙ‹ÛÈ· Û˘¯ÓfiÙËÙ· ÙË˜ ÌË-ÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ÛÙËÓ fiÏË ÙË˜£ÂÛÛ·ÏÔÓ›ÎË˜ ‹Ù·Ó 1,2 ÂÚÈÙÒÛÂÈ˜ ·Ó¿ 100.000ÏËı˘ÛÌfi, ÌÂ ‰È·Î‡Ì·ÓÛË 0,3-2,8 (¶›Ó·Î·˜ 1). ∏ÂÔ¯È·Î‹ Î·Ù·ÓÔÌ‹ ¤‰ÂÈÍÂ ·˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ·,Î˘Ú›ˆ˜ ÙÔ˘˜ ¯ÂÈÌÂÚÈÓÔ‡˜ Î·È Â·ÚÈÓÔ‡˜ Ì‹ÓÂ˜


250

∂ÈÎfiÓ· 1. ∏ÏÈÎÈ·Î‹ Î·Ù·ÓÔÌ‹ ÂÚÈÙÒÛÂˆÓ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜.

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∂ÈÎfiÓ· 2. ∂Ù‹ÛÈ· Î·Ù·ÓÔÌ‹ ÂÚÈÙÒÛÂˆÓ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ (1970-1999).

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(∂ÈÎfiÓ· 3). ∏ Û˘¯ÓfiÙÂÚË ÔÚÔ-ÔÌ¿‰· Ô˘ ·Ú·ÙË-Ú‹ıËÎÂ ÛÙÔ ˘ÏÈÎfi ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜ ‹Ù·Ó Ë B.øÛÙfiÛÔ, ÛÙËÓ ÂÈ‰ËÌ›· ÙÔ˘ 1996-1999 ÂÈÎÚ¿ÙËÛÂË ÔÚÔ-ÔÌ¿‰· C (∂ÈÎfiÓ· 4).

¢Â˘ÙÂÚÔ·ıÂ›˜ ÂÚÈÙÒÛÂÈ˜ - ¶ÚÔ‰È·ıÂÙÈÎÔ›·Ú¿ÁÔÓÙÂ˜ - πÛÙÔÚÈÎfi ÌËÓÈÁÁ›ÙÈ‰·˜: ∏ ÌËÓÈÁÁÈÙÈ‰Ô-ÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰· Â›Ó·È Ì›· ÌÂÙ·‰ÔÙÈÎ‹ ÓfiÛÔ˜Ô˘ ‰È·ÛÂ›ÚÂÙ·È ÙfiÛÔ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· fiÛÔ Î·ÈÛÙËÓ ÎÔÈÓfiÙËÙ·. ¢Â˘ÙÂÚÔ·ıÂ›˜ ÂÚÈÙÒÛÂÈ˜ ÌË-ÓÈÁÁ›ÙÈ‰·˜ ÛÙËÓ ›‰È· ÔÈÎÔÁ¤ÓÂÈ· ·Ú·ÙËÚ‹ıËÎ·Ó ÛÂ7 ·ÛıÂÓÂ›˜-‰Â›ÎÙÂ˜ (0,65%), ÂÓÒ ‰Â˘ÙÂÚÔ·ıÂ›˜ÂÚÈÙÒÛÂÈ˜ ÛÂ ‚ÚÂÊÔÓËÈ·ÎÔ‡˜ ÛÙ·ıÌÔ‡˜ ‹ Û¯Ô-ÏÂ›Ô ÛËÌÂÈÒıËÎ·Ó ÛÂ 3 ·ÛıÂÓÂ›˜-‰Â›ÎÙÂ˜ (0,3%). ∏‡·ÚÍË ÚÔ‰È·ıÂÙÈÎÒÓ Î·Ù·ÛÙ¿ÛÂˆÓ ‹ ˘ÔÎÂ›ÌÂ-ÓˆÓ ÓfiÛˆÓ ‹Ù·Ó Û¿ÓÈ· Î·È ‰È·ÈÛÙÒıËÎÂ ÛÂ 17·ÛıÂÓÂ›˜ (Î·ÎÔ‹ıÂÈ· 1, ÚÔËÁÔ‡ÌÂÓÔ ÂÂÈÛfi‰ÈÔÌËÓÈÁÁ›ÙÈ‰·˜ 7, ¯ÚfiÓÈ· ·ÔÊÚ·ÎÙÈÎ‹ ÓÂ˘ÌÔÓÔ¿-ıÂÈ· 1, Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ 2, ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈÎ¤˜Î·ÎÒÛÂÈ˜ 4, ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ· 1 Î·È ÛÏËÓÂÎÙÔÌ‹ 1).£ÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÁÈ· ÌÈÎÚÔ‚È·Î‹ ÌËÓÈÁÁ›-ÙÈ‰· ˘‹ÚÍÂ ÛÂ 10 ·fi ÙÔ˘˜ 1070 ·ÛıÂÓÂ›˜ (0,93%).

¢Â‰ÔÌ¤Ó· ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹: ¶˘ÚÂÙfi ÚÈÓ ÙËÓÂÈÛ·ÁˆÁ‹ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Â›¯·Ó 1068/1070(99,8%) ·È‰È¿. ∏ Ì¤ÛË ‰È¿ÚÎÂÈ· ˘ÚÂÙÔ‡ ‹Ù·Ó 37ÒÚÂ˜. ∞ÓÙÈ‚›ˆÛË (IV ‹ IM) Â›¯·Ó Ï¿‚ÂÈ 345/1070(32%) ·ÛıÂÓÂ›˜: ·ÌÈÎÈÏÏ›ÓË 241, ÎÂÊ·ÏÔÛÔÚ›ÓË

84 Î·È ·ÌÈÓÔÁÏ˘ÎÔÛ›‰Ë 11. ™Â 9 ÂÚÈÙÒÛÂÈ˜ ‰ÂÓ·Ó·ÊÂÚfiÙ·Ó ÙÔ Â›‰Ô˜ ÙÔ˘ ·ÓÙÈ‚ÈÔÙÈÎÔ‡ Ô˘ Â›¯Â¯ÔÚËÁËıÂ›.

¢Â‰ÔÌ¤Ó· Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹: OÈ ·ÛıÂÓÂ›˜ ÂÈ-Û‹¯ıËÛ·Ó ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Â›ÙÂ Ì¤Ûˆ ÙÔ˘ ·È‰È¿-ÙÚÔ˘ ÙÔ˘˜, Â›ÙÂ Ì¤Ûˆ ¿ÏÏÔ˘ ÓÔÛÔÎÔÌÂ›Ô˘ ‹ Î¤-ÓÙÚÔ˘ ˘ÁÂ›·˜. ∆Ô 90% (963/1070) ÙˆÓ ·È‰ÈÒÓ ÂÈ-Û‹¯ıËÎÂ ÂÓÙfi˜ 3 ËÌÂÚÒÓ ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ Ófi-ÛÔ˘. ∏ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ‹Ù·Ó Î·Ï‹ ÛÂ 220/1070(21%), Ì¤ÙÚÈ· ÛÂ 661/1070 (62%) Î·È ÛÔ‚·Ú‹ ÛÂ189/1070 (18%) ·ÛıÂÓÂ›˜. ∆· Î‡ÚÈ· Û˘ÌÙÒÌ·Ù·Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ¶˘-ÚÂÙfi Â›¯·Ó ÌfiÓÔ ÔÈ 664/1070 ·ÛıÂÓÂ›˜. ¢È·Ù·Ú·-¯¤˜ Û˘ÓÂÈ‰‹ÛÂˆ˜ ÔÈ 537/1070, ÂÓÒ ÛÂ ÎÒÌ· Î·Ù¿ÙËÓ ÂÈÛ·ÁˆÁ‹ ‹Ù·Ó ÌfiÓÔ 41/1070 (4%) ·ÛıÂÓÂ›˜.ÀfiÙ·ÛË ‰È·ÈÛÙÒıËÎÂ ÛÂ 97/1070 ·ÛıÂÓÂ›˜, Î˘-Ú›ˆ˜ ÌÈÎÚfiÙÂÚÔ˘˜ ÙˆÓ 5 ÂÙÒÓ (72/97).

∆· ÂÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù· ·fi ÙÔ ∂¡À Î·Ù¿ÙËÓ ÂÈÛ·ÁˆÁ‹ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3. O Ì¤ÛÔ˜·ÚÈıÌfi˜ ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÓ ‹Ù·Ó 2263. À„ËÏ¤˜ ÙÈÌ¤˜ÏÂ˘ÎÒÌ·ÙÔ˜ Î·È ¯·ÌËÏ¤˜ ÙÈÌ¤˜ ÁÏ˘Îfi˙Ë˜ ‚Ú¤ıËÎ·ÓÛÙÔ 66% Î·È ÛÙÔ 64% ÙˆÓ ·ÛıÂÓÒÓ ·ÓÙÈÛÙÔ›¯ˆ˜.

∆· ÂÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù· ·fi ÙÈ˜ ·Ó·Ï‡ÛÂÈ˜·›Ì·ÙÔ˜ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 4. §Â˘ÎÔÎ˘ÙÙ¿Úˆ-ÛË ·Ú·ÙËÚ‹ıËÎÂ ÛÙÔ 69% ÙˆÓ ·ÛıÂÓÒÓ. Ã·ÌËÏ‹ÙÈÌ‹ ·ÈÌÔÛÊ·ÈÚ›ÓË˜ ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· ‰È·È-ÛÙÒıËÎÂ ÛÙÔ 39% ÙˆÓ ·ÛıÂÓÒÓ. ∏ ∆∫∂ ‹Ù·Ó >50mm/1Ë ÒÚ· ÛÙÔ 66% Î·È >100 mm/1Ë ÒÚ· ÛÙÔ17% ÙˆÓ ·ÛıÂÓÒÓ.

∫ÏÈÓÈÎ‹ ÔÚÂ›·: ∏ Ì¤ÛË ‰È¿ÚÎÂÈ· ÓÔÛËÏÂ›·˜ ‹Ù·Ó13 ËÌ¤ÚÂ˜. ¡ÔÛËÏÂ›· ¿Óˆ ·fi 4 Â‚‰ÔÌ¿‰Â˜ ¯ÚÂÈ¿-ÛÙËÎÂ ÙÔ 5% ÙˆÓ ·ÛıÂÓÒÓ. ∏ Ì¤ÛË ‰È¿ÚÎÂÈ· ˘ÚÂ-ÙÔ‡ ‹Ù·Ó 3 ËÌ¤ÚÂ˜ (Â‡ÚÔ˜ 0-30 ËÌ¤ÚÂ˜). ™Â 71 ·ÛıÂ-ÓÂ›˜ Ô ˘ÚÂÙfi˜ ‰È‹ÚÎÂÛÂ ¿Óˆ ·fi 10 ËÌ¤ÚÂ˜.™ÙÔ˘˜ ·ÛıÂÓÂ›˜ ·˘ÙÔ‡˜ ·Ú·ÙËÚ‹ıËÎÂ ·˘ÍËÌ¤ÓË

∂ÈÎfiÓ· 3. ∂Ô¯È·Î‹ Î·Ù·ÓÔÌ‹ ÂÚÈÙÒÛÂˆÓ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜.

I·Ó. ºÂ‚. M¿Ú. AÚ. M¿ÈÔ˜ IÔ‡Ó. IÔ‡Ï. A‡Á. ™ÂÙ. OÎÙ. NÔ¤Ì. ¢ÂÎ.

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¶›Ó·Î·˜ 1. ª¤ÛË ÂÙ‹ÛÈ· Û˘¯ÓfiÙËÙ· ÙË˜ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈ-Î‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ÛÙË £ÂÛÛ·ÏÔÓ›ÎË

¶ÂÚ›Ô‰Ô˜ ¶ÏËı˘ÛÌfi˜ ∞ÚÈıÌfi˜ ™˘¯ÓfiÙËÙ·(Ì¤ÛË ÙÈÌ‹) ·ÛıÂÓÒÓ

1970-1979 871.580 243 2,81980-1989 946.864 46 0,51990-1999 1.005.431 31 0,3



252

Û˘¯ÓfiÙËÙ· ÂÈÏÔÎÒÓ: ‰È·Ù·Ú·¯¤˜ Û˘ÓÂ›‰ËÛË˜(42/71), ·ÚıÚ›ÙÈ‰· (14/71), ÂÚÈÎ·Ú‰›ÙÈ‰· (2/71),Û·ÛÌÔ› (2/71), ˘ÔÛÎÏËÚ›‰È· Û˘ÏÏÔÁ‹ (3/71).

∞ÈÌÔÚÚ·ÁÈÎfi ÂÍ¿ÓıËÌ· ·ÚÔ˘Û›·Û·Ó 818 ·fiÙÔ˘˜ 1070 ·ÛıÂÓÂ›˜ (76%). ™ÙÔ˘˜ 86 ·fi ·˘ÙÔ‡˜(8%) ˘‹Ú¯·Ó Î·È ÓÂÎÚÒÛÂÈ˜. ∆Ô ÂÍ¿ÓıËÌ· ‹Ù·Ó‰È¿Û·ÚÙÔ (484/818, 59%), ·Ú·Èfi (298/818, 36%)‹ ÂÓÙÔÈÛÌ¤ÓÔ ÛÙ· Î¿Ùˆ ¿ÎÚ· (36/818, 4%). ™Â123/1070 ·ÛıÂÓÂ›˜ (11%) ·Ú·ÙËÚ‹ıËÎÂ ÎËÏÈ‰Ô-‚Ï·ÙÈ‰Ò‰Â˜ ÂÍ¿ÓıËÌ· ÙËÓ ÚÒÙË ËÌ¤Ú· ÙË˜ Ófi-ÛÔ˘: ÙÔ 86% ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ·ÈÌÔÚÚ·ÁÈÎfi ÂÍ¿ÓıË-Ì· Î·È ÙÔ 14% ÛÂ ·ÛıÂÓÂ›˜ ¯ˆÚ›˜ ¿ÏÏÔ˘ Ù‡Ô˘

ÂÍ¿ÓıËÌ·. ™Â 29 ¿ÏÏÔ˘˜ ·ÛıÂÓÂ›˜ ·Ú·ÙËÚ‹ıËÎÂÎËÏÈ‰Ô‚Ï·ÙÈ‰Ò‰Â˜ ÂÍ¿ÓıËÌ· Î·Ù¿ ÙËÓ ÔÚÂ›· ÙË˜ÓfiÛÔ˘ Î·È ÛÂ 11 Ê˘Û·ÏÏÈ‰Ò‰Â˜ ÂÍ¿ÓıËÌ·. ∂È¯Â›-ÏÈÔ ¤ÚËÙ· ÂÌÊ¿ÓÈÛ·Ó 106/1070 (10%) ·ÛıÂÓÂ›˜.

∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÓÔÛËÏÂ›·˜, ¤Ó·˜ ·ÚÈıÌfi˜·ÛıÂÓÒÓ ·ÚÔ˘Û›·ÛÂ ‰È¿ÊÔÚ· ÓÂ˘ÚÔÏÔÁÈÎ¿ Û˘-ÌÙÒÌ·Ù·: Û·ÛÌÔ› (26), ¿ÚÂÛË ÎÚ·ÓÈ·ÎÒÓ ÓÂ‡-ÚˆÓ (9), ÛÙÚ·‚ÈÛÌfi˜ (7), ·ÚÂÁÎÂÊ·ÏÈ‰ÈÎ‹ ·Ù·Í›·(6), ÎÈÓËÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ (6), Û‡Ó‰ÚÔÌÔ ·Ó·ÓÂ˘ÛÙÈ-Î‹˜ ‰˘Û¯¤ÚÂÈ·˜ (4), ‰ÈÏˆ›· (2), Ó˘ÛÙ·ÁÌfi˜ (1).

∂ÈÏÔÎ¤˜ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÂ 97/1070 (9%)·ÛıÂÓÂ›˜: ·ÚıÚ›ÙÈ‰·, ÌÔÓÔ- ‹ ÔÏ˘- (82), ˘ÔÛÎÏË-Ú›‰È· Û˘ÏÏÔÁ‹ (6), ÔÛÙÂÔÌ˘ÂÏ›ÙÈ‰· (3), ÂÚÈÎ·Ú‰›-ÙÈ‰· (2), ˘Ô‰fiÚÈ· Ô˙›‰È· (4). ¢‡Ô ·ÛıÂÓÂ›˜ ·Ó¤-Ù˘Í·Ó Ï‹ÚË Û˘Ó‰ÚÔÌ‹ ∫awasaki, ÓˆÚ›˜ Î·Ù¿ ÙËÓÔÚÂ›· ÙË˜ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜.

ŒÎ‚·ÛË: ∏ ıÓËÙfiÙËÙ· ÛÙÔ ˘ÏÈÎfi Ì·˜ ‹Ù·Ó 1,1%(12/1070 ·ÛıÂÓÂ›˜). ŸÏÔÈ ÔÈ ı¿Ó·ÙÔÈ Û˘Ó¤‚ËÛ·ÓÙËÓ ÂÚ›Ô‰Ô 1970-1982. ŒÎÙÔÙÂ, ‰ÂÓ ·Ú·ÙËÚ‹ıË-ÎÂ ı¿Ó·ÙÔ˜ ·fi ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰·.

ÀÔÏÂ›ÌÌ·Ù· ·ÚÔ˘Û›·Û·Ó ÔÈ 26 ·fi ÙÔ˘˜1058 ÂÈ˙‹Û·ÓÙÂ˜ (2,4%). O Ù‡Ô˜ ÙˆÓ ˘ÔÏÂÈÌ-Ì¿ÙˆÓ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 5. ™˘¯ÓfiÙÂÚÔ ˘fi-ÏÂÈÌÌ· ‹Ù·Ó Ë ·Ú¿Ï˘ÛË ÎÚ·ÓÈ·ÎÔ‡ ÓÂ‡ÚÔ˘(17/1058) Î·È Ë ‰È·Ù·Ú·¯‹ ÙË˜ ·ÎÔ‹˜ (9/1058).

™˘˙‹ÙËÛË∏ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÏÔ›ÌˆÍË ·Ú·Ì¤ÓÂÈ Ì›·

·ÂÈÏËÙÈÎ‹ ÓfiÛÔ˜ ÁÈ· ÙË ˙ˆ‹ Î·È ·ÔÙÂÏÂ› ·ÎfiÌË

∂ÈÎfiÓ· 4. ∫·Ù·ÓÔÌ‹ ÔÚÔ-ÔÌ¿‰ˆÓ ÛÂ ÂÚÈÙÒÛÂÈ˜ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÏÔ›ÌˆÍË˜.

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™˘ÌÙÒÌ·Ù· ∞ÚÈıÌfi˜ %

¶˘ÚÂÙfi˜ 664 6238-39ÔC 518 4839,1-40,5ÔC 142 13>40,6ÔC 4 0,4

∂Í¿ÓıËÌ· 818 76ŒÌÂÙÔÈ 870 81¢È·Ù·Ú·¯¤˜ Û˘ÓÂ›‰ËÛË˜ 537 50∂˘ÂÚÂıÈÛÙfiÙËÙ· 118 11∫ÒÌ· 41 4ÀÓËÏ›· 378 35∞Ó·ÓÂ˘ÛÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ 51 5∫ÂÊ·Ï·ÏÁ›· 495 46ÀfiÙ·ÛË 97 9Shock 64 6™·ÛÌÔ› 84 8



253

·ÁÎfiÛÌÈÔ Úfi‚ÏËÌ· (4). øÛÙfiÛÔ, Ú¤ÂÈ Ó· ÙÔÓÈ-ÛÙÂ› fiÙÈ Î‡ÚÈÔ˜ Êfi‚Ô˜ Â›Ó·È Ë ÎÂÚ·˘ÓÔ‚fiÏÔ˜ ÌÔÚ-Ê‹ ÙË˜ ÓfiÛÔ˘, Ë ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÛË„·ÈÌ›·, ÌÂıÓËÙfiÙËÙ· Ô˘ ˘ÂÚ‚·›ÓÂÈ ÙÔ >10% (4-8). ∞ÓÙ›ıÂ-Ù·, Ë ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰· ¤¯ÂÈ ÌÈÎÚfi Ô-ÛÔÛÙfi ıÓËÙfiÙËÙ·˜, fiˆ˜ ÚÔÎ‡ÙÂÈ ÙfiÛÔ ·fi ‰È¿-ÊÔÚÂ˜ (7,9-11) fiÛÔ Î·È ·fi ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË.∏ ÛËÌ·ÓÙÈÎfiÙÂÚË ·Ú¿ÌÂÙÚÔ˜ ÁÈ· ÙË ÓfiÛÔ Â›Ó·È Ë¤ÁÎ·ÈÚË ·Ó·ÁÓÒÚÈÛ‹ ÙË˜ ·fi ÙÔÓ È·ÙÚfi, Î¿ÙÈ Ô˘ÔÏÏ¤˜ ÊÔÚ¤˜ ÌÔÚÂ› Ó· Â›Ó·È Ì›· ‰‡ÛÎÔÏË ‰ÈÂÚ-Á·Û›·. ŸÏÔÈ ÔÈ ÁÈ·ÙÚÔ› Ú¤ÂÈ Ó· ¤¯Ô˘Ó ˘„ËÏfi ‰Â›-ÎÙË ˘fiÓÔÈ·˜ ÁÈ· ÙË ÓfiÛÔ, ‰ÈfiÙÈ Ë ·Ú¯ÈÎ‹ ‰È¿ÁÓˆ-ÛË ‚·Û›˙ÂÙ·È ÌfiÓÔ ÛÂ ÎÏÈÓÈÎ¿ ÎÚÈÙ‹ÚÈ·. ∆Ô ÂÍ¿ÓıË-Ì·, Ô˘ ·ÔÙÂÏÂ› ¤Ó· ·fi Ù· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙË˜ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÏÔ›ÌˆÍË˜, ·Ô˘ÛÈ¿˙ÂÈ ÔÏÏ¤˜ÊÔÚ¤˜, ÂÓÒ, ·Ó ˘¿Ú¯ÂÈ, ÌÔÚÂ› Ó· Â›Ó·È ÎËÏÈ‰Ô-‚Ï·ÙÈ‰Ò‰Â˜ ÛÙ· ·Ú¯ÈÎ¿ ÛÙ¿‰È· ÙË˜ ÓfiÛÔ˘ (12-14).∆Ô 23% ÙˆÓ ·ÛıÂÓÒÓ Ì·˜ ‰ÂÓ Â›¯Â ÂÍ¿ÓıËÌ· Î·È ÙÔ11% Â›¯Â ÌfiÓÔ ÎËÏÈ‰Ô‚Ï·ÙÈ‰Ò‰Â˜ ÂÍ¿ÓıËÌ·.

∏ ·Ó·˙‹ÙËÛË Î·È ÌË ‰È·›ÛÙˆÛË ÙË˜ ÎÏ·ÛÈÎ‹˜Û˘ÌÙˆÌ·ÙÔÏÔÁ›·˜ ÙË˜ ÌËÓÈÁÁ›ÙÈ‰·˜ (˘ÚÂÙfi˜, ÎÂ-

Ê·Ï·ÏÁ›·, ¤ÌÂÙÔÈ, ÌËÓÈÁÁÈÛÌfi˜, ‰È·Ù·Ú·¯¤˜ Û˘ÓÂ›-‰ËÛË˜, ÂÙ¤¯ÂÈÂ˜) ‰ÂÓ ı· Ú¤ÂÈ Ó· ÂÊËÛ˘¯¿˙ÂÈÙÔÓ È·ÙÚfi, ‰ÈfiÙÈ ÔÏÏ¤˜ ÊÔÚ¤˜ Ë ÎÏ·ÛÈÎ‹ ·˘Ù‹ Û˘-ÌÙˆÌ·ÙÔÏÔÁ›· ÂÏÏÂ›ÂÈ ‹ Â›Ó·È ÌÂÚÈÎÒ˜ ¤Î‰ËÏË.¢È·Ù·Ú·¯¤˜ Û˘ÓÂ›‰ËÛË˜ Î·È ÎÂÊ·Ï·ÏÁ›· Â›¯Â ÙÔ50% ÙˆÓ ·ÛıÂÓÒÓ Ì·˜. ∂Ì¤ÙÔ˘˜ ÂÌÊ¿ÓÈÛÂ ÙÔ 81%,ÂÓÒ ˘ÚÂÙfi Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ Â›¯Â ÌfiÓÔ ÙÔ 62%ÙˆÓ ·ÛıÂÓÒÓ. πÛÙÔÚÈÎfi, fiÌˆ˜, ˘ÚÂÙÔ‡ ·Ó¤ÊÂÚÂÙÔ 99% ÙˆÓ ·ÛıÂÓÒÓ. ∏ ‰È·ÊÔÚ¿ ·˘Ù‹ ÙÔ˘ ÔÛÔ-ÛÙÔ‡ ÙÔ˘ ˘ÚÂÙÔ‡ ÚÈÓ Î·È Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, ·Ô-‰›‰ÂÙ·È ÛÙË Ï‹„Ë ·ÓÙÈ˘ÚÂÙÈÎÒÓ, Î˘Ú›ˆ˜ ÛÙ· ÓÔÛÔ-ÎÔÌÂ›· ‹ ÛÙ· Î¤ÓÙÚ· ˘ÁÂ›·˜ ·fi fiÔ˘ ÂÛÙ¿ÏËÛ·ÓÙ· ·È‰È¿. ∏ Ï‹„Ë ·ÓÙÈ‚ÈÔÙÈÎÒÓ (Ô˘ ‰È¤Ú¯ÔÓÙ·È ÙÔ∂¡À) ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÂÚÈÔÚÈ˙fiÙ·Ó ÛÂ 1 ‹ 2 ‰fi-ÛÂÈ˜ ·ÌÈÎÈÏÏ›ÓË˜ ‹ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÂ 1 ‰fiÛËÎÂÊÙÚÈ·ÍfiÓË˜. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÛÙË ÌËÓÈÁÁ›ÙÈ‰· ˘-ÚÂÙfi ÌÔÚÂ› Ó· ÌËÓ ÂÎ‰ËÏÒÛÔ˘Ó Ù· ÓÂÔÁÓ¿ Î·È ‚Ú¤-ÊË ‹ ÔÈ ‚·ÚÈ¿ ¿Û¯ÔÓÙÂ˜ (1).

∏ ÏÔ›ÌˆÍË ·fi N. meningitidis Â›Ó·È Ì›· ÏÔÈÌÒ-‰Ë˜ ÓfiÛÔ˜ Ô˘ ÌÂÙ·‰›‰ÂÙ·È ·fi ¿ÙÔÌÔ ÛÂ ¿ÙÔÌÔÌÂ ÙËÓ ·Ó·ÓÂ˘ÛÙÈÎ‹ Ô‰fi Î·È ¤¯ÂÈ ÙËÓ Ù¿ÛË Ó·

¶›Ó·Î·˜ 3. ∂˘Ú‹Ì·Ù· ·fi ÙÔ ∂¡À ÛÂ 1070 ·È‰È¿ ÌÂ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰·

ª¤ÛË ÙÈÌ‹ ± ™∞ ¢È·Î‡Ì·ÓÛË ∞ÚÈıÌfi˜ %

ñ §Â˘ÎÔÎ‡ÙÙ·Ú· (/mm3) 2263 ± 2253 20-27.000 10650-500 191 18501-1000 73 71001-2000 149 14>2000 652 62

ñ °Ï˘Îfi˙Ë (mg/dl) 36 ± 23 0-150 10360-20 290 2821-40 371 36>40 375 36

ñ §Â‡ÎˆÌ· (mg/dl) 184 ± 140 10-980 1006<100 346 34101-200 282 28>200 378 38

¶›Ó·Î·˜ 4. ∂ÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù· ÛÂ 1070 ·È‰È¿ ÌÂ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰·

ª¤ÛË ÙÈÌ‹ ± ™∞ ¢È·Î‡Ì·ÓÛË ∞ÚÈıÌfi˜ %

ñ Hb (g/dl) 10,6 ± 1,7 4,5-16,3 1030<10 402 39>10 628 61

ñ §Â˘ÎÔÎ‡ÙÙ·Ú· (/mm3) 14281 ± 6783 1600-51700 1053<10.000 322 30>10.000 731 69

ñ ∆∫∂ (mm/1Ë ÒÚ·) 67 ± 33,8 3-141 986<20 93 920-50 246 2551-100 477 48>100 170 17

ñ ÃÚ. ÚÔıÚÔÌ‚›ÓË˜ 13 ± 0,5 12-70 256<20 238 93>20 18 7

ñ πÓˆ‰ÔÁfiÓÔ (mg/dl) 431 ± 137 6-866 215<300 103 48>300 112 52



254

‰È·ÛÂ›ÚÂÙ·È ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· Î·È ÛÙËÓ ÎÔÈÓfiÙËÙ·.O Î›Ó‰˘ÓÔ˜ ÂÓ‰Ô-ÔÈÎÔÁÂÓÂÈ·Î‹˜ ÌÂÙ¿‰ÔÛË˜ ·Ó·-Ê¤ÚÂÙ·È ÛÂ ÔÛÔÛÙfi 4-5% (8). O Û¯ÂÙÈÎfi˜ Î›Ó‰˘-ÓÔ˜ ÁÈ· ÙÔ˘˜ ‚ÚÂÊÔÓËÈ·ÎÔ‡˜ ÛÙ·ıÌÔ‡˜ Â›Ó·È ÌÈ-ÎÚfiÙÂÚÔ˜, ·ÏÏ¿ fi¯È ·ÌÂÏËÙ¤Ô˜ (8,15). ™ÙÔ ˘ÏÈÎfi ÙË˜ÌÂÏ¤ÙË˜ Ì·˜ ‰Â‡ÙÂÚÔ ÎÚÔ‡ÛÌ· ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ·-Ú·ÙËÚ‹ıËÎÂ ÛÂ ÔÛÔÛÙfi 0,65%, ÂÓÒ ‰Â‡ÙÂÚÔ ÎÚÔ‡-ÛÌ· ÛÂ ‚ÚÂÊÔÓËÈ·Îfi ÛÙ·ıÌfi ÛÂ ÔÛÔÛÙfi 0,3%.

∂Ó‰È·Ê¤ÚÔ˘Û· Â›Ó·È Ë ·Ú·ÙËÚÔ‡ÌÂÓË ÛÙ·ıÂ-Ú‹ ÌÂ›ˆÛË ÙË˜ ÓfiÛÔ˘ ÛÙËÓ ÂÚÈÔ¯‹ Ì·˜. ∆· ÙÂ-ÏÂ˘Ù·›· ¯ÚfiÓÈ· ÙË˜ ÌÂÏ¤ÙË˜ (1996-1999) ·Ú·ÙË-Ú‹ıËÎÂ ÂÈ‰ËÌ›· ÙË˜ ÓfiÛÔ˘, ÙfiÛÔ ÛÙËÓ ÂÚÈÔ¯‹Ì·˜ fiÛÔ Î·È ÛÙË ÏÔÈ‹ ¯ÒÚ· (16). OÈ ÂÚÈÙÒÛÂÈ˜‹Ù·Ó Û¯Â‰fiÓ ‰ÈÏ¿ÛÈÂ˜ ÙˆÓ ÚÔËÁÔ‡ÌÂÓˆÓ ÂÙÒÓ,¯ˆÚ›˜ fiÌˆ˜ Ó· Êı¿ÛÔ˘Ó ÙÔÓ ·ÚÈıÌfi ·ÛıÂÓÒÓ ÙˆÓÚÒÙˆÓ 10 ÂÙÒÓ ÙË˜ ÌÂÏ¤ÙË˜. ∫‡ÚÈ· ÔÚÔ-ÔÌ¿‰·Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÈ‰ËÌ›·˜ ‹Ù·Ó Ë C. ∫·Ù¿ ÙË¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô, fiÌˆ˜, ÙË˜ ÌÂÏ¤ÙË˜, Î‡ÚÈ· ÔÚÔ-ÔÌ¿‰· Û˘ÓÔÏÈÎ¿ ‹Ù·Ó Ë µ (16). ∞‡ÍËÛË ÙË˜ ÔÚÔ-ÔÌ¿‰·˜ C ÙËÓ ÂÚ›Ô‰Ô 1996-1999 ·Ú·ÙËÚ‹ıËÎÂÎ·È ÛÂ ¿ÏÏÂ˜ ¯ÒÚÂ˜ ÙË˜ ∂˘ÚÒË˜ Î·È ÙË˜ ∞ÌÂÚÈ-Î‹˜ (11,17,18).

∆Ô Û‡Ó‰ÚÔÌÔ Kawasaki Ô˘ ·Ú·ÙËÚ‹ıËÎÂ Î·-Ù¿ ÙË ‰È·‰ÚÔÌ‹ ÙË˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ÛÂ 2 ·ÛıÂÓÂ›˜,·ÔÙÂÏÂ› ˆ˜ ÁÓˆÛÙfiÓ Ì›· ÔÏ˘Û˘ÛÙËÌ·ÙÈÎ‹ Û˘Ó-‰ÚÔÌ‹ Ô˘ ÚÔÛ‚¿ÏÏÂÈ Ù· ·ÁÁÂ›·. ∏ ·ÈÙÈÔÏÔÁ›·ÙË˜ Â›Ó·È ¿ÁÓˆÛÙË, ·Ó Î·È ¤¯ÂÈ Û˘Ó‰ÂıÂ› ÌÂ ÔÏ-ÏÔ‡˜ ÏÔÈÌÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙÂ˜. º˘ÛÈÎ¿, ‰ÂÓ ÌÔ-ÚÔ‡ÌÂ Ó· Û˘ÌÂÚ¿ÓÔ˘ÌÂ ·Ó Ë ÂÎ‰‹ÏˆÛË ÙË˜ Ófi-ÛÔ˘ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ Ì·˜ ‹Ù·Ó ÂÈÏÔÎ‹ ÙË˜ ÌËÓÈÁ-ÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ‹ Ì›· Û˘Ì·ÚÔÌ·Ú-ÙÔ‡Û· ÓfiÛÔ˜.

∏ ıÓËÙfiÙËÙ· ·fi ÙË ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÌËÓÈÁ-Á›ÙÈ‰· ‹Ù·Ó ÌÈÎÚ‹ Î·È ÂÚÈÔÚ›ÛÙËÎÂ Ì¤¯ÚÈ ÙÔ 1982.™‡ÁÎÚÈÛË ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·Â‚›ˆÛ·Ó ÌÂ ÔÌ¿‰··ÛıÂÓÒÓ ›‰ÈÔ˘ Ê‡ÏÔ˘, ËÏÈÎ›·˜ Î·È ‚·Ú‡ÙËÙ·˜ Ófi-ÛÔ˘ Ô˘ Â¤˙ËÛ·Ó, ¤‰ÂÈÍÂ fiÙÈ ÔÈ ·Ô‚ÈÒÛ·ÓÙÂ˜·ÛıÂÓÂ›˜ Â›¯·Ó ‚Ú·¯‡ÙÂÚÔ ÈÛÙÔÚÈÎfi ÚÈÓ ÙËÓ ÂÈÛ·-ÁˆÁ‹ ÙÔ˘˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô, ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi‰È·Ù·Ú·¯ÒÓ Û˘ÓÂ›‰ËÛË˜ Î·È ˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi‰È¿¯˘ÙÔ˘ ·ÈÌÔÚÚ·ÁÈÎÔ‡ ÂÍ·Óı‹Ì·ÙÔ˜ (¶›Ó·Î·˜ 6).∏ Ì¤ÛË ËÏÈÎ›· ÙˆÓ ı·ÓfiÓÙˆÓ ‹Ù·Ó 36 Ì‹ÓÂ˜. OÈ Â-ÚÈÛÛfiÙÂÚÔÈ ·fi ·˘ÙÔ‡˜ ÂÈÛ‹¯ıËÛ·Ó ÛÙÔ ÓÔÛÔÎÔ-ÌÂ›Ô ÙÔ ÚÒÙÔ 24ˆÚÔ ÙË˜ ÓfiÛÔ˘ Î·È ÙÔ 75% ·Â-‚›ˆÛÂ ÙËÓ ÚÒÙË ËÌ¤Ú· ÂÈÛ·ÁˆÁ‹˜. ™Ù·ÙÈÛÙÈÎ‹·Ó¿Ï˘ÛË ‰ÂÓ ¤ÁÈÓÂ, ‰ÈfiÙÈ Ô ·ÚÈıÌfi˜ ÙˆÓ ı·ÓfiÓÙˆÓ

ıÂˆÚ‹ıËÎÂ ÌÈÎÚfi˜ ÁÈ· ÂÍ·ÁˆÁ‹ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ. ™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ë ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›-

ÙÈ‰· Ê·›ÓÂÙ·È fiÙÈ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙˆÙÈÎ‹ Ù¿ÛË ÛÙËÓÂÚÈÔ¯‹ Ì·˜, ¤¯ÂÈ ‹È· ÎÏÈÓÈÎ‹ ÔÚÂ›·, ÌÈÎÚfi Ô-ÛÔÛÙfi ıÓËÙfiÙËÙ·˜ (Ë ÌËÓÈÁÁ›ÙÈ‰·, fi¯È Ë ÌËÓÈÁÁÈÙÈ-‰ÔÎÔÎÎ·ÈÌ›·) Î·È ¯·ÌËÏfi, Â›ÛË˜, ÔÛÔÛÙfi ˘Ô-ÏÂÈÌÌ¿ÙˆÓ.

µÈ‚ÏÈÔÁÚ·Ê›·1. Apicella MA. N. meningitidis. In: Mandell, Douglas and

Bennett’s, eds. Principle and practice of infectiousdiseases. 5th ed (electronic). London: Churchill; 2000.

2. Feigin RD, Pearlman E. Bacterial meningitis beyond theneonatal period. In: Feigin RD, Cherry FD, eds. Textbookof Pediatric Infectious Diseases. 4th ed. London: WBSaunders Co; 1998. p. 400-429.

3. Booy R, Kroll JS. Bacterial meningitis and meningococcalinfection. Curr Opin Pediatr 1998;10:13-18.

4. American Academy of Pediatrics. Meningococcal diseaseprevention and central strategies for practice basedphysicians. Pediatrics 1996;97:404-412.

5. Rosenstein NE, Perkins BA, Stephens DS, Popovic T,Hughes JM. Meningococcal disease. N Engl J Med2001;344:1378-1388.

6. Malley R, Inkelis SH, Coelho P, Huskins WC, KuppermanN. Cerebrospinal fluid pleocytosis and prognosis ininvasive meningococcal disease in children. Pediatr InfectDis J 1998;17:855-859.

7. Van Deuren M, Brandtzaeg P, van der Meer J. Update onmeningococcal disease with emphasis on pathogenesisand clinical management. Clin Microbiol Rev2000;13:144-166.

8. Salzman MB, Rubin LG. Meningococcemia. Infect DisEmerg 1996;10:709-725.

9. Juncal AR, Molino ML, Rodriguez I, Cid A, Guillan B, PardoF. Clinical and epidemiologic study of meningococcalmeningitis in the health region of Santiago de Compostela.Enferm Infect Microbiol Clin 1997;15:510-514.

10. Erickson L, De Wals P. Complications and sequelae ofmeningococcal disease in Quebec, Canada, 1990-1994.Clin Infect Dis 1998;26:1159-1164.

11. Leake JAD, Perkins BA. Meningococcal disease:challenges in prevention and management. Infect Med

¶›Ó·Î·˜ 6. ∫ÏÈÓÈÎ¿ Î·È ÂÚÁ·ÛÙËÚÈ·Î¿ ‰Â‰ÔÌ¤Ó· ÛÂ 12 ·È-‰È¿ ÌÂ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰· Ô˘ ·Â‚›ˆÛ·Ó

∞ÚÈıÌfi˜ %

∏ÏÈÎ›· <48 ÌËÓÒÓ 10 83µÚ·¯‡ ÈÛÙÔÚÈÎfi ÚÔ ÂÈÛ·ÁˆÁ‹˜ 9 75µ·ÚÈ¿ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ 12 100Shock 9 75∫ÒÌ· 10 83¢∂¶ 2 17™·ÛÌÔ› 6 50£¿Ó·ÙÔ˜ ÙÔ 1Ô 24ˆÚÔ 9 75°Ï˘Îfi˙Ë ∂¡À <40 mg/dl 10 83∆∫∂ <20 mm 1Ë ÒÚ· 7 58

¢∂¶: ‰È¿¯˘ÙË ÂÓ‰·ÁÁÂÈ·Î‹ ‹ÍË

¶›Ó·Î·˜ 5. ÀÔÏÂ›ÌÌ·Ù· Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙÔ ÓÔÛÔÎÔ-ÌÂ›Ô ÛÂ 1058 ·È‰È¿ ÌÂ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰·

∞ÚÈıÌfi˜ %

¶·Ú¿Ï˘ÛË ÎÚ·ÓÈ·ÎÒÓ ÓÂ‡ÚˆÓ 17 1,6¢È·Ù·Ú·¯¤˜ ·ÎÔ‹˜ 9 0,8O˘Ï¤˜ ‰ÂÚÌ·ÙÈÎÒÓ ÓÂÎÚÒÛÂˆÓ 2 0,2À‰ÚÔÎ¤Ê·ÏÔ˜ 1 0,1



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2000;17:364-377. 12. Welsby PD, Crolledge CL. Meningococcal meningitis. A

diagnosis not to be missed. BMJ 1990;300:1150-1151. 13. Palmer SR, Corson J, Hall R, Payne S, Ludlow J, Deere B

et al. Meningococcal disease in Wales: clinical features,outcome and public health management. J Infect1992;25:321-328.

14. Riordan F, Thomson AP, Sills JA, Hirt CA. Who spots thespots? Diagnosis and treatment of early meningococcaldisease in children. BMJ 1996;313:1255-1256.

15. De Wols P, Hertoge L, Borlee-Grimee I. Meningococcaldisease in Belgium. Secondary attack rate amonghousehold day care nursery and pre-elementary schoolcontacts. J Infect 1981;3(Suppl 1):53-58.

16. Kremastinou J, Tzanakaki G, Kansouzidou A, Pagalis A,Danielides V, Kouppari G et al. Recent emergence ofserogroup C meningococcal disease in Greece. FEMSImmunol Med Microbiol 1999;23:49-51.

17. Rosenstein NE, Perkins BA, Stephens DS, Lefkowitz L,Cartter ML, Danila R et al. The changing epidemiology ofmeningococcal disease in the United States, 1992-1996. JInfect Dis 1999;180:1894-1901.

18. Ferreiros CM, Gomez JA, Criado M. Prevention ofmeningococcal disease: present and future. Rev MedMicrobiol 1998;9:29-37.


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: π. ∫·‚·ÏÈÒÙË˜ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¡ÔÛÔÎÔÌÂ›Ô˘ ∂È‰ÈÎÒÓ ¶·ı‹ÛÂˆÓ °Ú. §·ÌÚ¿ÎË 13, ∆.∫. 546 38, £ÂÛÛ·ÏÔÓ›ÎË

∂ÈÛ·ÁˆÁ‹: OÈ ¯˘ÌÔÎ›ÓÂ˜ Â›Ó·È ÛËÌ·ÓÙÈÎ¤˜ ÁÈ· ÙËÓ ÎÈÓËÙÈÎfiÙË-Ù· ÙˆÓ ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÓ. Œ¯ÂÈ ‚ÚÂıÂ› fiÙÈ Ë ¯ËÌÂÈÔÙ·Í›· Â›Ó·È·ÓÂ·ÚÎ‹˜ ÛÙ· ÓÂÔÁÓ¿ Î·È È‰È·›ÙÂÚ· ÛÙ· ÚfiˆÚ·. ∏ ·ÓÂ-¿ÚÎÂÈ· ·˘Ù‹ Èı·Ó¿ Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ·˘ÍËÌ¤ÓË Â˘·ÈÛıËÛ›·Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù· ÓÂÔÁÓ¿ ÛÙË Û‹„Ë. ¢ÂÓ ¤¯ÂÈ ‰ËÌÔÛÈÂ˘-ıÂ› ÔÈÂ˜ Â›Ó·È ÔÈ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÙˆÓ ¯˘ÌÔÎÈÓÒÓ ÛÙ· ÓÂÔÁÓ¿,Ô‡ÙÂ Â›Ó·È ÁÓˆÛÙfi Â¿Ó ÔÈ ̄ ·ÌËÏ¤˜ ·˘Ù¤˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ Û˘Ì-‚¿ÏÏÔ˘Ó ÛÙËÓ ·ÓÂ·ÚÎ‹ ¯ËÌÂÈÔÙ·Í›· Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù·ÓÂÔÁ¤ÓÓËÙ·. ™ÎÔfi˜: ¢È·Ù˘ÒÛ·ÌÂ ÙËÓ ˘fiıÂÛË fiÙÈ ÔÈ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ÙˆÓ ¯˘ÌÔÎÈÓÒÓ ÙÔ˘ ÔÚÔ‡: 1) ı· Ú¤ÂÈ Ó· Â›Ó·È ¯·ÌËÏfiÙÂÚÂ˜ÛÙ· ÚfiˆÚ· Û˘ÁÎÚÈÓfiÌÂÓÂ˜ ÌÂ ÂÎÂ›ÓÂ˜ ÙˆÓ ÙÂÏÂÈfiÌËÓˆÓ Î·È2) ı· Ú¤ÂÈ, Â›ÛË˜, Ó· Â›Ó·È ¯·ÌËÏfiÙÂÚÂ˜ ÙfiÛÔ ÛÙ· Úfiˆ-Ú· fiÛÔ Î·È ÛÙ· ÙÂÏÂÈfiÌËÓ·, ·fi ÙÈ˜ ·ÓÙ›ÛÙÔÈ¯Â˜ Û˘ÁÎÂÓÙÚÒ-ÛÂÈ˜ ÙˆÓ ÂÓËÏ›ÎˆÓ. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ¢Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ÂÏ‹ÊıËÛ·Ó ·fi Úfi-ˆÚ· Î·È ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÓ ·fiÏ˘ÙÔ·ÚÈıÌfi ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ Î·È ËˆÛÈÓÔÊ›ÏˆÓ ÙÔ˘ ÂÚÈ-ÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜. ∂›ÛË˜, ÂÏ‹ÊıË ‰Â›ÁÌ· ·›Ì·ÙÔ˜ ÔÌÊ¿ÏÈÔ˘ÏÒÚÔ˘ ÚfiˆÚˆÓ Î·È ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔÁÓÒÓ ·fi ÂÁÎ˘ÌÔÓÔ‡-ÛÂ˜ Ô˘ ‰ÂÓ Â›¯·Ó ÎÏÈÓÈÎ¤˜ ÂÓ‰Â›ÍÂÈ˜ ¯ÔÚÈÔ·ÌÓÈÔÓ›ÙÈ‰·˜, Î·-ıÒ˜ Â›ÛË˜ Î·È ·fi ˘ÁÈÂ›˜ ÂıÂÏÔÓÙ¤˜ ÂÓ‹ÏÈÎÂ˜. ∏ ÙÂ¯ÓÈÎ‹ELISA ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÁÈ· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ Û˘ÁÎÂ-ÓÙÚÒÛÂˆÓ ÛÙÔÓ ÔÚfi ÙˆÓ ¯˘ÌÔÎÈÓÒÓ: ∂¡∞-78 (epithelialneutrophil activating peptide-78), ÙÔ˘ GRO-· (growth-relatedoncogene-·), ÙË˜ eotaxin ÙÔ˘ RANTES (regulated upon

activation, normal T cell expressed and secreted) Î·È ÙÔ˘ªπƒ-1· (macrophage inflammatory protein 1·). ∞ÔÙÂÏ¤ÛÌ·Ù·: ∆· Â›Â‰· ÙˆÓ ¯˘ÌÔÎÈÓÒÓ ÛÙÔÓ ÔÚfi ÙˆÓÚÔÒÚˆÓ ‹Ù·Ó Â›ÙÂ ›‰È· ‹ Î·È ˘„ËÏfiÙÂÚ· ·fi ÂÎÂ›Ó· Ô˘‚Ú¤ıËÎ·Ó ÛÙ· ÙÂÏÂÈfiÌËÓ· Î·È ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜. ™˘ÌÂÚ¿ÛÌ·Ù·: ¶ÈÛÙÂ‡Ô˘ÌÂ fiÙÈ Ë ¯ËÌÂÈÔÙ·ÎÙÈÎ‹ ·ÓÂ¿Ú-ÎÂÈ· Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ ‰ÂÓ Û¯ÂÙ›˙ÂÙ·ÈÌÂ ÙÈ˜ ÂÏ·ÙÙˆÌ¤ÓÂ˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÛÙÔÓ ÔÚfi ÔÔÈ·Û‰‹ÔÙÂ·fi ÙÈ˜ ÂÈ‰ÈÎ¤˜ ¯˘ÌÔÎ›ÓÂ˜ Ô˘ ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó.

∫˘ÎÏÔÊÔÚÔ‡ÛÂ˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ¯˘ÌÔÎÈÓÒÓ ÛÂ ·›Ì· ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ ÛÂ ÓÂÔÁÓ¿ Î·È ÂÓ‹ÏÈÎÂ˜1


1Sullivan SE, Staba SL, Gersting JA, Hutson AD, TheriaqueD, Christensen RD et al Circulating concentrations of chemokines in cord blood,neonates, and adults Pediatr Res 2002;51:653-657

ºˆÙfiÔ˘ÏÔ˜ ™‡ÚÔ˜ ¶·È‰›·ÙÚÔ˜-¡ÂÔÁÓÔÏfiÁÔ˜ ¢È‰¿ÎÙˆÚ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ∞Ó·ÏËÚˆÙ‹˜ ¢ÈÂ˘ı˘ÓÙ‹˜ µ’ ª∂¡ ¡ÔÛÔÎÔÌÂ›Ô˘ ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·”



256

ÕÙ˘Â˜ ÂÎ‰ËÏÒÛÂÈ˜ ÙË˜ ÏÔÈÌÒ‰Ô˘˜ ÌÔÓÔ˘Ú‹ÓˆÛË˜ ÛÙ· ‚Ú¤ÊË Î·È Ù· ÌÈÎÚ¿ Ó‹È· ∞. ™ÈÒÌÔ˘1, ª. ∆˙Ô‡ÊË1, ∂. °·Ï·Ó¿ÎË˜1, ∂. ∫ÚËÙÈÎÔ‡1, ∞. ∫ˆÛÙÔ‡Ï·2, ∞. ™È·ÌÔÔ‡ÏÔ˘ - ª·˘Ú›‰Ô˘1, ∑. ¶··‰ÔÔ‡ÏÔ˘ - ∫Ô˘ÏÔ˘Ì‹1

Atypical manifestations of infectious mononucleosis in children and toddlers E. Siomou1, M. Tzoufi1, E. Galanakis1, E. Kritikou1, A. Kostoula2, A. Siamopoulou - Mavridou1, Z. Papadopoulou - Couloumbis1


1 ∆ÔÌ¤·˜ ÀÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, ¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô πˆ·ÓÓ›ÓˆÓ

2 ªÈÎÚÔ‚ÈÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ, ¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô πˆ·ÓÓ›ÓˆÓ

1 Department of Child Health,University Hospital of Ioannina, Ioannina

2 Laboratory of Microbiology,University Hospital of Ioannina, Ioannina

�¶ÂÚ›ÏË„Ë: H ÏÔÈÌÒ‰Ë˜ ÌÔÓÔ˘Ú‹ÓˆÛË (§M)·fi ÙÔÓ Èfi Epstein-Barr (EBV) Ê·›ÓÂÙ·È fiÙÈ Â›Ó·ÈÂÚÈÛÛfiÙÂÚÔ Û˘¯Ó‹ ÛÙË ÌÈÎÚ‹ ·È‰ÈÎ‹ ËÏÈÎ›·, ·’fiÛÔ ıÂˆÚÔ‡ÓÙ·Ó ÛÙÔ ·ÚÂÏıfiÓ. ™Â ·ÓÙ›ıÂÛË ÌÂÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ Î·È Ù· ÌÂÁ·Ï‡ÙÂÚË˜ ËÏÈÎ›·˜ ·È‰È¿,Ë ÏÔ›ÌˆÍË ÛÙË ‚ÚÂÊÈÎ‹ Î·È ÚÒÈÌË ÓËÈ·Î‹ ËÏÈÎ›·¯·Ú·ÎÙËÚ›˙ÂÙ·È Û˘Ó‹ıˆ˜ ·fi ‹È· Û˘ÌÙˆÌ·ÙÔ-ÏÔÁ›·. øÛÙfiÛÔ, ÛÂ ÔÚÈÛÌ¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜ ÔÈ ÂÎ-‰ËÏÒÛÂÈ˜ ÙË˜ ÌÔÚÂ› Ó· Â›Ó·È È‰È·›ÙÂÚ· ¿Ù˘Â˜ ·Ï-Ï¿ Î·È ·ÓËÛ˘¯ËÙÈÎ¤˜. ¶·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· ÎÏÈÓÈÎ¿Î·È ÂÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù· ÙË˜ ÏÔ›ÌˆÍË˜ ·fiÙÔÓ EBV ÛÂ Ù¤ÛÛÂÚ· ·È‰È¿, ËÏÈÎ›·˜ ÌÈÎÚfiÙÂÚË˜ÙˆÓ 2 ÂÙÒÓ, Ô˘ ÓÔÛËÏÂ‡ÙËÎ·Ó ÛÙËÓ ¶·ÓÂÈÛÙË-ÌÈ·Î‹ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ πˆ·ÓÓ›ÓˆÓ, ÌÂ È‰È·›ÙÂÚ·¿Ù˘Â˜ ÂÎ‰ËÏÒÛÂÈ˜ ÙË˜ ÓfiÛÔ˘. H ÚÒÙË ÂÚ›Ùˆ-ÛË ÂÌÊ·Ó›ÛÙËÎÂ ÌÂ ·Ú·ÙÂÈÓfiÌÂÓÔ ÂÌ‡ÚÂÙÔ,Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·, ıÚÔÌ‚ÔÂÓ›· Î·È ·Ú¿Ù·ÛËÙÔ˘ ¯ÚfiÓÔ˘ ÂÓÂÚÁÔÔÈËÌ¤ÓË˜ ÌÂÚÈÎ‹˜ ıÚÔÌ‚Ô-Ï·ÛÙ›ÓË˜ (APTT) ÂÍ·ÈÙ›·˜ ÙË˜ ‡·ÚÍË˜ ıÂÙÈÎÔ‡·ÓÙÈËÎÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙÔ˘ Ï‡ÎÔ˘. H ‰Â‡ÙÂÚË·ÚÔ˘ÛÈ¿ÛÙËÎÂ ÌÂ ˘ÂÚ˘ÚÂÍ›·, Ë·ÙÔÛÏËÓÔÌÂ-Á·Ï›·, Ë·ÙÈÎ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·, ›ÎÙÂÚÔ, ÏÂ˘ÎÔÂ-Ó›·, ıÚÔÌ‚ÔÂÓ›·, ·Ó·ÈÌ›·, ÌÂÁ¿ÏË ·‡ÍËÛË LDHÎ·È ÊÂÚÚÈÙ›ÓË˜, Â˘Ú‹Ì·Ù· ÂÓ‰ÂÈÎÙÈÎ¿ ‡·ÚÍË˜ ·È-ÌÔÊ·ÁÔÎ˘ÙÙ·ÚÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘. ™ÙËÓ ÙÚ›ÙË ÂÚ›-ÙˆÛË ÛËÌÂÈÒıËÎÂ ¤ÓÙÔÓË ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÛË, ÂÓÒÛÙËÓ Ù¤Ù·ÚÙË, ¤Ú·Ó ÙË˜ ÂÎÛÂÛËÌ·ÛÌ¤ÓË˜ ÏÂ˘ÎÔ-Î˘ÙÙ¿ÚˆÛË˜, Û˘Ó˘‹Ú¯Â Â›ÌÔÓË ‚Ï·ÙÈ‰Ò‰Ë˜·ÎÚÔ‰ÂÚÌ·Ù›ÙÈ‰· (ˆ˜ Â› Û˘Ó‰ÚfiÌÔ˘ Gianotti-Crosti). ™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ê·›ÓÂÙ·È fiÙÈ Ë §M ÛÙ·‚Ú¤ÊË Î·È Ù· ÌÈÎÚ¿ Ó‹È· ÌÔÚÂ› Ó· ÂÎ‰ËÏˆıÂ› ÌÂ¿Ù˘· Î·È ÛÔ‚·Ú¿ Û˘ÌÙÒÌ·Ù·, ·ÏÏ¿ Î·È ÌÂ È‰È-·›ÙÂÚ· ·ÈÌ·ÙÔÏÔÁÈÎ¿ ÂÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù· Î·È

�Abstract: Epstein-Barr virus infectious mono-nucleosis appears to occur more frequently duringearly childhood than it was considered in the past.In contrast to the adults and older children, theinfection in infants and toddlers is usuallycharacterized by mild symptoms. However, insome cases, the clinical manifestations may berather atypical and severe. We present the clinicaland laboratory findings of EBV infection in fourchildren younger than 2 years of age, who wereadmitted to the Department of Pediatrics of theUniversity Hospital of Ioannina, with very unusualmanifestations. The first case presented withpersistent pyrexia, hepatosplenomegaly, thrombo-cytopenia and prolonged activated partialthromboplastin time (APTT) due to the presence oflupus anticoagulant. The second presented withhyperpyrexia, hepatosplenomegaly, liver dysfun-ction, jaundice, leukocytopenia, thrombocyto-penia, anemia and significant elevation of LDH andferritin levels, findings compatible withhemophagocytic syndrome. In the third case therewas marked leukocytosis, while in the fourth,besides the presence of leucocytosis, there wasalso persistent papular acrodermatitis (resemblingthe Gianotti-Crosti syndrome). In conclusion, itseems that infectious mononucleosis in infants andtoddlers may be manifested with atypical andsevere symptoms as well as specific hematologicallaboratory findings and should, therefore, beincluded in the differential diagnosis ofhematologic abnormalities in infancy and earlychildhood.



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¤ÙÛÈ Ú¤ÂÈ Ó· Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙË ‰È·ÊÔÚÈÎ‹‰È¿ÁÓˆÛË ÙˆÓ ·ÈÌ·ÙÔÏÔÁÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ÛÙË‚ÚÂÊÈÎ‹ Î·È ÚÒÈÌË ÓËÈ·Î‹ ËÏÈÎ›·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÏÔÈÌÒ‰Ë˜ ÌÔÓÔ˘Ú‹ÓˆÛË, Èfi˜Epstein-Barr, ·ÈÌÔÊ·ÁÔÎ˘ÙÙ·ÚÈÎfi Û‡Ó‰ÚÔÌÔ,APTT, ·ÓÙÈËÎÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙÔ˘ Ï‡ÎÔ˘.

Key words: infectious mononucleosis, Epstein-Barr virus, hemophagocytic syndrome, APTT,lupus anticoagulant.

™˘ÓÙÔÌÔÁÚ·Ê›Â˜ §M §ÔÈÌÒ‰Ë˜ ÌÔÓÔ˘Ú‹ÓˆÛË EBV πfi˜ Epstein-Barr VCA ·ÓÙÈÛÒÌ·Ù· ∞ÓÙÈÎ·„È‰ÈÎ¿ ·ÓÙÈÛÒÌ·Ù·

∂ÈÛ·ÁˆÁ‹H ÏÔÈÌÒ‰Ë˜ ÌÔÓÔ˘Ú‹ÓˆÛË (§M) ·ÔÙÂÏÂ› ÙÔ

ÈÔ ÁÓˆÛÙfi ÎÏÈÓÈÎfi Û‡Ó‰ÚÔÌÔ ÏÔ›ÌˆÍË˜ ·fi ÙÔÓ ÈfiEpstein-Barr (EBV), Ô ÔÔ›Ô˜ Â˘ı‡ÓÂÙ·È ÂÚ›Ô˘ÁÈ· ÙÔ 90% ÙˆÓ ÂÚÈÙÒÛÂˆÓ §M (1). ∂ÌÊ·Ó›˙ÂÙ·ÈÎ˘Ú›ˆ˜ ÛÂ ÓÂ·ÚÔ‡˜ ÂÓ‹ÏÈÎÂ˜, ·ÏÏ¿ Û˘¯Ó¿ ÓÔÛÔ‡ÓÎ·È ·È‰È¿ Î·È Ì¿ÏÈÛÙ· ÂÚÈÛÛfiÙÂÚÔ Û˘¯Ó¿ ÛÂ Û¯¤-ÛË ÌÂ fi,ÙÈ ÈÛÙÂ˘fiÙ·Ó ·Ï·ÈfiÙÂÚ·. ™ÙË ‚ÚÂÊÈÎ‹ Î·ÈÙËÓ ÚÒÈÌË ÓËÈ·Î‹ ËÏÈÎ›· Ë ÓfiÛÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·ÈÛ¯ÂÙÈÎ¿ Û¿ÓÈ· Î·È ÌÔÚÂ› Ó· ‰È·Ê‡ÁÂÈ Ë ‰È¿ÁÓˆÛ‹ÙË˜, ÙfiÛÔ ÏfiÁˆ ÙˆÓ ¿Ù˘ˆÓ ÎÏÈÓÈÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ,fiÛÔ Î·È ÏfiÁˆ ÙË˜ Û¿ÓÈ·˜ ·ÓÂ‡ÚÂÛË˜ ıÂÙÈÎÒÓ ÂÙÂ-ÚfiÊÈÏˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ (Monotest) (1,2). ∆· ÙÂÏÂ˘-Ù·›· ¯ÚfiÓÈ·, fiÌˆ˜, ÔÈ ‰È·ÁÓˆÛÙÈÎ¤˜ ‰˘Ó·ÙfiÙËÙÂ˜¤¯Ô˘Ó ‚ÂÏÙÈˆıÂ› ÛËÌ·ÓÙÈÎ¿, Â‰ÈÎ¿ ˆ˜ ÚÔ˜ ÙËÓ ·Ó›-¯ÓÂ˘ÛË ÙˆÓ ÂÈ‰ÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙÔ˘ ÈÔ‡, Û˘-ÓËı¤ÛÙÂÚ· ÙˆÓ ·ÓÙÈÎ·„È‰ÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ (IgM,IgG Virus-Capsid Antigen: VCA), ·ÏÏ¿ Î·È ÙˆÓ ·ÓÙÈ-ÛˆÌ¿ÙˆÓ Î·Ù¿ ÙÔ˘ ÚÒÈÌÔ˘ ·ÓÙÈÁfiÓÔ˘ (EarlyAntigen) Î·È ÙˆÓ ·ÓÙÈÁfiÓˆÓ ÙÔ˘ ˘Ú‹Ó· (NuclearAntigen) (2).

H §M Û˘Ó‹ıˆ˜ ÂÌÊ·Ó›˙ÂÙ·È ˆ˜ ÁÂÓÈÎÂ˘Ì¤ÓË ·˘-ÙÔÂÚÈÔÚÈ˙fiÌÂÓË ÓfiÛÔ˜ ÌÂ ˘ÚÂÙfi, Ê·Ú˘ÁÁ›ÙÈ‰·,ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· Î·È Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·. ™Â·È‰È¿, fiÌˆ˜, ÌÈÎÚfiÙÂÚ· ÙˆÓ 4 ÂÙÒÓ, Ë ÏÔ›ÌˆÍËÛ·Ó›ˆ˜ ÂÎ‰ËÏÒÓÂÙ·È ÌÂ Ù· ıÂˆÚÔ‡ÌÂÓ· ˆ˜ ÎÏ·-ÛÈÎ¿ Û˘ÌÙÒÌ·Ù· Î·È Û˘Ó‹ıˆ˜ Â›Ó·È ·Û˘ÌÙˆÌ·ÙÈ-Î‹ ‹ ÂÌÊ·Ó›˙ÂÙ·È ÌÂ Û˘ÌÙÒÌ·Ù· ¿ÏÏˆÓ ÎÔÈÓÒÓÏÔÈÌÒÍÂˆÓ (ÚÈÓ›ÙÈ‰·, ‚‹¯·˜) (1). øÛÙfiÛÔ, Â›Ó·È ‰˘-Ó·ÙfiÓ ÛÂ ¤Ó· Û¯ÂÙÈÎ¿ ÌÈÎÚfi ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓÓ· ÂÌÊ·ÓÈÛÙÔ‡Ó ÛÔ‚·Ú¤˜ ÂÈÏÔÎ¤˜ ·fi ‰È¿ÊÔÚ·Û˘ÛÙ‹Ì·Ù· Î·Ù¿ ÙËÓ ÔÚÂ›· ÙË˜ ÓfiÛÔ˘. ¶ÔÏÏ¤˜·fi ÙÈ˜ ÂÈÏÔÎ¤˜ ·˘Ù¤˜ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÙË˜·ÓÔÛÔÏÔÁÈÎ‹˜ ‰È¤ÁÂÚÛË˜ Î·È ÔÏ˘ÎÏˆÓÈÎ‹˜ ÂÓÂÚ-ÁÔÔ›ËÛË˜ ÛÙ· Ï·›ÛÈ· ÙË˜ ÏÔ›ÌˆÍË˜ ·fi ÙÔÓ EBV(1,3-6).

™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Â›Ó·È Ë ÂÚÈ-ÁÚ·Ê‹ ÙÂÛÛ¿ÚˆÓ ÂÚÈÙÒÛÂˆÓ ÚˆÙÔ·ıÔ‡˜ ÏÔ›-ÌˆÍË˜ ·fi ÙÔÓ EBV, ÌÂ È‰È·›ÙÂÚ· ÎÏÈÓÈÎ¿ Î·È ÂÚÁ·-ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù·.

ÀÏÈÎfi Î·È Ì¤ıÔ‰Ô˜ ™ÙË ÌÂÏ¤ÙË Û˘ÌÂÚÈÏ‹ÊıËÛ·Ó Ù¤ÛÛÂÚ· ·È‰È¿ ËÏÈÎ›·˜

ÌÈÎÚfiÙÂÚË˜ ÙˆÓ 2 ÂÙÒÓ ÌÂ ÏÔ›ÌˆÍË ·fi ÙÔÓ EBV, Ù· ÔÔ›·ÓÔÛËÏÂ‡ÙËÎ·Ó ÛÙËÓ ¶·ÓÂÈÛÙËÌÈ·Î‹ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ πˆ-·ÓÓ›ÓˆÓ, ÌÂ È‰È·›ÙÂÚ· ¿Ù˘· ÎÏÈÓÈÎ¿ Î·È ÂÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹-Ì·Ù·. H ‰È¿ÁÓˆÛË ‚·Û›ÛÙËÎÂ ÛÙ· ÎÏÈÓÈÎ¿ Î·È ÔÚÔÏÔÁÈÎ¿ ÎÚÈ-Ù‹ÚÈ· ÙË˜ ÔÍÂ›·˜ ÏÔ›ÌˆÍË˜: ·ÓÂ‡ÚÂÛË IgM VCA ·ÓÙÈÛˆÌ¿-ÙˆÓ Î·È/‹ ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË ÙË˜ ÙÈÌ‹˜ ÙˆÓ IgG, ÛÙËÓ ÔÚÂ›·ÙË˜ ÓfiÛÔ˘. ™Â ÔÚÈÛÌ¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜ ·ÓÈ¯ÓÂ‡ıËÎ·Ó Â›ÛË˜Î·È Ù· ·ÓÙÈÛÒÌ·Ù· Î·Ù¿ ÙÔ˘ ÚÒÈÌÔ˘ ·ÓÙÈÁfiÓÔ˘ Î·È ÙˆÓ·ÓÙÈÁfiÓˆÓ ÙÔ˘ ˘Ú‹Ó·. °È· ÙËÓ ·Ó›¯ÓÂ˘ÛË ÙˆÓ IgG Î·È IgM-VCA ·ÓÙÈÛˆÌ¿ÙˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ·ÓÔÛÔÂÓ˙˘ÌÈÎ‹ Ì¤ıÔ-‰Ô˜ (ELISA) ÌÂ ¤ÙÔÈÌ· ·ÓÙÈ‰Ú·ÛÙ‹ÚÈ· ÙÔ˘ Ô›ÎÔ˘ MeridianDiagnostics, Inc. H Â˘·ÈÛıËÛ›· ÙË˜ ÌÂıfi‰Ô˘, Û˘ÁÎÚÈÓfiÌÂÓËÌÂ ÙË Ì¤ıÔ‰Ô ÙÔ˘ ¤ÌÌÂÛÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ (Indirectfluorescent Antibody: IFA), ‹Ù·Ó ·ÓÙ›ÛÙÔÈ¯· 100% Î·È 99,4%,ÌÂ fiÚÈ· ·ÍÈÔÈÛÙ›·˜ 95,3-100%, Û‡ÌÊˆÓ· ÌÂ ÙËÓ ·Ú·ÛÎÂ˘-·ÛÙÈÎ‹ ÂÙ·ÈÚÂ›·. °È· ÙËÓ ·Ó›¯ÓÂ˘ÛË ÙˆÓ IgM-VCA ·ÓÙÈÛˆÌ¿-ÙˆÓ Î·È ÚÔ˜ ·ÔÊ˘Á‹Ó „Â˘‰Ò˜ ıÂÙÈÎÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ,ÚÔËÁ‹ıËÎÂ ÚÔÛÚfiÊËÛË ÙÔ˘ ÚÂ˘Ì·ÙÔÂÈ‰Ô‡˜ ·Ú¿ÁÔÓÙ·ÛÙÔÓ ÔÚfi ÌÂ ÙË ¯Ú‹ÛË ÂÈ‰ÈÎÔ‡ sorbent. °È· ÙËÓ ·Ó›¯ÓÂ˘ÛËÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙÔ˘ ÚÒÈÌÔ˘ ·ÓÙÈÁfiÓÔ˘ ¯ÚËÛÈÌÔÔÈ-‹ıËÎÂ Ë Ì¤ıÔ‰Ô˜ ÙÔ˘ ¤ÌÌÂÛÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ (EBV-EAIFA test, Meridian Diagnostics, Inc.). °È· ÙËÓ ·Ó›¯ÓÂ˘ÛË ÙˆÓ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙˆÓ ·ÓÙÈÁfiÓˆÓ ÙÔ˘ ˘Ú‹Ó· ¯ÚËÛÈÌÔÔÈ‹-ıËÎÂ ÙÔ EBV-NA test, ÙÔ ÔÔ›Ô ·ÓÙÈÚÔÛˆÂ‡ÂÈ Â˘·›ÛıËÙËÌ¤ıÔ‰Ô ¤ÌÌÂÛÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ ÌÂ ·ÓÙÈÛ˘ÌÏ‹ÚˆÌ·(ACIF, Meridian Diagnostics, Inc.), ÌÂ ÂÈ‰ÈÎfiÙËÙ· Î·È Â˘·È-ÛıËÛ›· 98,6% Î·È 100% ·ÓÙ›ÛÙÔÈ¯·. H ·ÓÂ‡ÚÂÛË ÙÔ˘ ·ÓÙÈË-ÎÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙÔ˘ Ï‡ÎÔ˘, Û‡ÌÊˆÓ· ÌÂ Ù· ÎÚÈÙ‹ÚÈ· ÙË˜¢ÈÂıÓÔ‡˜ ∂Ù·ÈÚÂ›·˜ £ÚfiÌ‚ˆÛË˜ Î·È ∞ÈÌfiÛÙ·ÛË˜, ÛÙËÚ›¯ıË-ÎÂ ÛÙËÓ ·Ú¿Ù·ÛË ÙÔ˘ APTT, ÛÙÔ ıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÙˆÓÌÂÏÂÙÒÓ ·Ó¿ÌÂÈÍË˜ 1:1 Ê˘ÛÈÔÏÔÁÈÎÔ‡ Ï¿ÛÌ·ÙÔ˜ Î·È Ï¿-ÛÌ·ÙÔ˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È ÛÙËÓ ÂÈ‚Â‚·›ˆÛË ÙË˜ ‡·ÚÍË˜ÂÓfi˜ ÊˆÛÊÔÏÈÔÂÈ‰ÔÂÍ·ÚÙÒÌÂÓÔ˘ ·ÓÙÈËÎÙÈÎÔ‡ (DadeBehring) (7).

¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛÂˆÓ¶ÂÚ›ÙˆÛË ÚÒÙËÕÚÚÂÓ ·ÛıÂÓ‹˜ ËÏÈÎ›·˜ 19 ÌËÓÒÓ, ÌÂ ÈÛÙÔÚÈÎfi

˘ÂÚ˘ÚÂÍ›·˜ Î·È ÛÏËÓÔÌÂÁ·Ï›·˜ ·fi 10ËÌ¤ÚÔ˘.∏ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË ¤‰ÂÈÍÂ £ 38,5ÔC, Â›¯ÚÈ-ÛÌ· ·Ì˘Á‰·ÏÒÓ, Ë·ÙÔÌÂÁ·Ï›· (2 cm), ÛÏËÓÔÌÂ-Á·Ï›· (3 cm).

∂ÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù·: ÏÂ˘Î¿ 8.700/mm3



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(ÏÂÌÊÔÎ‡ÙÙ·Ú· 23%), Ht 29%, AM¶ 115.000/mm3,TKE 45 mm/1Ë ÒÚ·, CRP 48 mg/L, APTT 60/31sec, INR 0,9, ÈÓˆ‰ÔÁfiÓÔ 309 mg/dl, ¯ÚfiÓÔÈ ‹ÍË˜:Kº, ÂÙÂÚfiÊÈÏ· ·ÓÙÈÛÒÌ·Ù· (-).

µÈÔ„›· Ì˘ÂÏÔ‡: ‹È· ‰˘ÛÏ·Û›· ÂÚ˘ıÚ‹˜ ÛÂÈ-Ú¿˜, ÌÈÎÚ‹ ·‡ÍËÛË ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ.

OÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜: EBV IgM-VCA (-), IgG(+) (1,958/0,900 Î·È ÌÂÙ¿ 10 ËÌ¤ÚÂ˜ 2,849/0,900),·ÓÙÈÛÒÌ·Ù· Î·Ù¿ ÙÔ˘ ÚÒÈÌÔ˘ ·ÓÙÈÁfiÓÔ˘ (+), Î·-Ù¿ ·ÓÙÈÁfiÓˆÓ ÙÔ˘ ˘Ú‹Ó· (-), ·ÓÙÈ·ÈÌÔÂÙ·ÏÈ·Î¿ (-), ¿ÌÂÛË-¤ÌÌÂÛË Coombs (-), ·ÓÙÈÎ·Ú‰ÈÔÏÈÈÓÈÎ¿ (-), ANA (-), ·ÓÙÈËÎÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Ï‡ÎÔ˘ (+).

™ËÌÂÈÒıËÎÂ ‡ÊÂÛË ÂÌ˘Ú¤ÙÔ˘ ÙËÓ 23Ë ËÌ¤Ú·,˘Ô¯ÒÚËÛË Ë·ÙÔÌÂÁ·Ï›·˜-ÛÏËÓÔÌÂÁ·Ï›·˜ Î·ÈıÚÔÌ‚ÔÂÓ›·˜ ÙËÓ 30Ë ËÌ¤Ú·. ªÂÙ¿ 11 Ì‹ÓÂ˜:AM¶ 248.000/mm3, APTT 35/32 sec, ·ÓÙÈËÎÙÈÎfi˜·Ú¿ÁÔÓÙ·˜ Ï‡ÎÔ˘ (-).

¶ÂÚ›ÙˆÛË ‰Â‡ÙÂÚË£‹Ï˘ 22 ÌËÓÒÓ, ÌÂ ÈÛÙÔÚÈÎfi ˘ÂÚ˘ÚÂÍ›·˜

·fi 4ËÌ¤ÚÔ˘, ÈÎÙÂÚÈÎ‹ ¯ÚÔÈ¿ ‰¤ÚÌ·ÙÔ˜ Î·È ÛÎÔ-ÙÂÈÓfi¯ÚÔ· Ô‡Ú· ·fi 24ÒÚÔ˘. ∏ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤-Ù·ÛË ¤‰ÂÈÍÂ £ 39,5ÔC, Ë·ÙÔÌÂÁ·Ï›· (3 cm), ÛÏË-ÓÔÌÂÁ·Ï›· (3 cm).

∂ÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù·: ÏÂ˘Î¿ 2.550/mm3

(Ô˘‰ÂÙÂÚfiÊÈÏ· 688/mm3, ÏÂÌÊÔÎ‡ÙÙ·Ú· 64%),TKE 30 mm/1Ë ÒÚ·, CRP 14 mg/L, Ht 30%, ¢EK1,0%, AM¶ 50.000/mm3, APTT 37/31 sec, INR 1,ÈÓˆ‰ÔÁfiÓÔ 110 mg/dl, TBL 7 mg/dl, DBL 4,8mg/dl), AST 314 U/L, ALT 287 U/L, ÁGT 110 mg/dl,LDH 6.800 U/L, ¯ÔÏËÛÙÂÚfiÏË 177 mg/dl, ÙÚÈÁÏ˘ÎÂ-Ú›‰È· 364 mg/dl, ÊÂÚÚÈÙ›ÓË 16.273 ng/ml, ÂÙÂÚfiÊÈ-Ï· ·ÓÙÈÛÒÌ·Ù· (-).

µÈÔ„›· Ì˘ÂÏÔ‡: ·ÓÂ·ÚÎ‹˜ Ï‹„Ë ÈÛÙÔ‡.OÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜: EBV IgM-VCA (+)

(0,941/0,618), IgG (+) (0,669/0,452 Î·È ÌÂÙ¿ 15ËÌ¤ÚÂ˜: 2,354/0,452).

™ËÌÂÈÒıËÎÂ ‡ÊÂÛË ÂÌ˘Ú¤ÙÔ˘ ÙËÓ 7Ë ËÌ¤Ú·,˘Ô¯ÒÚËÛË Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·˜ Î·È ÏÂÌÊ·‰ÂÓÔ-¿ıÂÈ·˜ ÙËÓ 21Ë Î·È 28Ë ËÌ¤Ú· ·ÓÙ›ÛÙÔÈ¯· Î·È·ÔÎ·Ù¿ÛÙ·ÛË ÂÚÁ·ÛÙËÚÈ·ÎÒÓ Â˘ÚËÌ¿ÙˆÓ ÙËÓ30Ë ËÌ¤Ú·.

¶ÂÚ›ÙˆÛË ÙÚ›ÙË£‹Ï˘ 20 ÌËÓÒÓ, ÌÂ ÈÛÙÔÚÈÎfi ÂÌ˘Ú¤ÙÔ˘ Î·È

ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·˜ ·fi 4ËÌ¤ÚÔ˘. ∂ÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜: ÏÂ˘Î¿ 27.750/mm3

(ÏÂÌÊÔÎ‡ÙÙ·Ú· 83%, ¿Ù˘· 15%), AM¶297.000/mm3, Ht 43%, TKE 28 mm/1Ë ÒÚ·, CRP 14mg/L, ÂÙÂÚfiÊÈÏ· ·ÓÙÈÛÒÌ·Ù· (-).

OÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜: IgM-VCA (+) (1,417/0,253), IgG (+) (0,523/0,378).

¶ÂÚ›ÙˆÛË Ù¤Ù·ÚÙË£‹Ï˘ 12 ÌËÓÒÓ ÌÂ ÈÛÙÔÚÈÎfi ÂÌ˘Ú¤ÙÔ˘, ÏÂÌ-

Ê·‰ÂÓÔ¿ıÂÈ·˜, Ë·ÙÔÌÂÁ·Ï›·˜, ‚Ï·ÙÈ‰Ò‰Ô˘˜·ÎÚÔ‰ÂÚÌ·Ù›ÙÈ‰·˜ ·fi 3ËÌ¤ÚÔ˘.

∂ÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜: ÏÂ˘Î¿ 37.070/mm3

(ÏÂÌÊÔÎ‡ÙÙ·Ú· 60%, ¿Ù˘· 20%), AM¶ 246.000/mm3, Ht 32%, TKE 30 mm/1Ë ÒÚ·, CRP 18 mg/L,ÂÙÂÚfiÊÈÏ· ·ÓÙÈÛÒÌ·Ù· (-).

OÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜: IgM-VCA (+) (0,635/0,449), IgG (+) (1,560/0,768).

™˘˙‹ÙËÛË H §M ·ÔÙÂÏÂ› ÎÔÈÓfi ÓfiÛËÌ· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈ-

Î›·˜. øÛÙfiÛÔ, ÛÙ· ‚Ú¤ÊË Î·È ÛÙ· ÌÈÎÚ¿ Ó‹È· (ÌÈ-ÎÚfiÙÂÚ· ÙˆÓ 2 ÂÙÒÓ) ‰ÂÓ Â›Ó·È È‰È·›ÙÂÚ· Û˘¯Ó‹ Î·È‰È·‰Ú¿ÌÂÈ ˘ÔÎÏÈÓÈÎ¿, ÂÓÒ Ë ÎÏ·ÛÈÎ‹ ÂÈÎfiÓ·,fiˆ˜ ·˘Ù‹ ÂÌÊ·Ó›˙ÂÙ·È ÛÙÔ˘˜ ÓÂ·ÚÔ‡˜ ÂÓ‹ÏÈÎÂ˜,·Ú·ÙËÚÂ›Ù·È Î˘Ú›ˆ˜ ÛÂ ÌÂÁ·Ï‡ÙÂÚË˜ ËÏÈÎ›·˜·È‰È¿ (1).

H ‰È¿ÁÓˆÛË ÙË˜ ÓfiÛÔ˘ ÛÙËÚ›˙ÂÙ·È ÛÂ ÎÏÈÓÈÎ¿Î·È ÂÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù·, fiˆ˜ Ë ·ÓÂ‡ÚÂÛËÙˆÓ ÂÙÂÚfiÊÈÏˆÓ Î·È ÙˆÓ ÂÈ‰ÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·-Ù¿ ÙÔ˘ ÈÔ‡, Û˘ÓËı¤ÛÙÂÚ· ÙˆÓ IgM Î·È IgG VCA·ÓÙÈÛˆÌ¿ÙˆÓ. ∫·È ÛÙ· 4 Ó‹È·, Ù· ÂÙÂÚfiÊÈÏ· ·ÓÙÈ-ÛÒÌ·Ù· ‹Ù·Ó ·ÚÓËÙÈÎ¿, Èı·ÓfiÓ ÏfiÁˆ ÙË˜ ÌÈÎÚ‹˜ÙÔ˘˜ ËÏÈÎ›·˜, Î·ıÒ˜ Â›Ó·È ÁÓˆÛÙfi fiÙÈ ·ÓÂ˘Ú›ÛÎÔ-ÓÙ·È ıÂÙÈÎ¿ ÌfiÓÔ ÛÙÔ 5% ÙˆÓ ·È‰ÈÒÓ ËÏÈÎ›·˜ ÌÈ-ÎÚfiÙÂÚË˜ ÙˆÓ 2 ÂÙÒÓ (2).

™ÙÔÓ ÚÒÙÔ ·ÛıÂÓ‹, Ù· IgM-VCA ·ÓÙÈÛÒÌ·Ù·‹Ù·Ó ·ÚÓËÙÈÎ¿, ÂÓÒ Ë ÙÈÌ‹ ÙˆÓ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ·˘Í‹ıËÎÂ ÌÂÙ¿ ·fi 10 ËÌ¤ÚÂ˜. H ·Ô˘Û›· ÙˆÓIgM ·ÓÙÈÛˆÌ¿ÙˆÓ ‰ÂÓ ·Ó·ÈÚÔ‡ÛÂ ÙËÓ ÔÚÔÏÔÁÈÎ‹‰È¿ÁÓˆÛË ÙË˜ ÔÍÂ›·˜ ÏÔ›ÌˆÍË˜, Î·ıÒ˜ ¤¯ÂÈ ‚ÚÂıÂ›fiÙÈ ÛÂ ÔÛÔÛÙfi 17% ÙˆÓ ·È‰ÈÒÓ ËÏÈÎ›·˜ ÌÈÎÚfiÙÂ-ÚË˜ ÙˆÓ 4 ÂÙÒÓ ‰ÂÓ ·ÓÈ¯ÓÂ‡ÔÓÙ·È IgM ·ÓÙÈÛÒÌ·Ù·Î·Ù¿ ÙËÓ ÔÍÂ›· Ê¿ÛË ÙË˜ ÓfiÛÔ˘ (0-3 Â‚‰ÔÌ¿‰Â˜)(2). H ‰È¿ÁÓˆÛË ÙË˜ ÚˆÙÔ·ıÔ‡˜ ÏÔ›ÌˆÍË˜ ÛÙÔÓ·ÛıÂÓ‹ ·˘Ùfi ÛÙËÚ›¯ıËÎÂ ÛÙËÓ ·‡ÍËÛË ÙË˜ ÙÈÌ‹˜ÙˆÓ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ, ÛÙËÓ ·ÓÂ‡ÚÂÛË ·ÓÙÈÛˆÌ¿-ÙˆÓ Î·Ù¿ ÙÔ˘ ÚÒÈÌÔ˘ ·ÓÙÈÁfiÓÔ˘ Î·È ÛÙËÓ ·Ô˘-Û›· ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙˆÓ ·ÓÙÈÁfiÓˆÓ ÙÔ˘ ˘Ú‹Ó·(2). ™ÙÔÓ ›‰ÈÔ ·ÛıÂÓ‹ ·Ú·ÙËÚ‹ıËÎÂ Â›ÛË˜ ·-ÚÔ‰ÈÎ‹ ·Ú¿Ù·ÛË ÙÔ˘ APTT, ıÂÙÈÎfi˜ ·ÓÙÈËÎÙÈÎfi˜·Ú¿ÁÔÓÙ·˜ ÙÔ˘ Ï‡ÎÔ˘ Î·È ÂÈÌ¤ÓÔ˘Û· ıÚÔÌ‚Ô-ÂÓ›·. O ·ÓÙÈËÎÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙÔ˘ Ï‡ÎÔ˘ Î·ÈÙ· ·ÓÙÈÛÒÌ·Ù· Î·Ù¿ Î·Ú‰ÈÔÏÈ›ÓË˜ ·ÔÙÂÏÔ‡Ó Ì›·ÂÙÂÚÔÁÂÓ‹ ÔÌ¿‰· ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ, Ù· ÏÂÁfiÌÂÓ··ÓÙÈÊˆÛÊÔÏÈÈ‰ÈÎ¿ ·ÓÙÈÛÒÌ·Ù·, Ù· ÔÔ›· ÛÙÚ¤-ÊÔÓÙ·È Î·Ù¿ ÙˆÓ Û˘Ó‰Â‰ÂÌ¤ÓˆÓ ÌÂ Ù· ÊˆÛÊÔÏÈ-ÔÂÈ‰‹ ÚˆÙÂ˚ÓÒÓ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜. ∫ÏÈÓÈÎ¿, ·Ó Î·È¤¯Ô˘Ó Û˘Û¯ÂÙÈÛıÂ› ÌÂ ÙËÓ ÚfiÎÏËÛË ıÚÔÌ‚ˆÙÈÎÒÓÂÂÈÛÔ‰›ˆÓ, in vitro ÚÔÎ·ÏÔ‡Ó ·Ú¿Ù·ÛË ÙÔ˘APTT (3). ™Ù· ·È‰È¿ Ê·›ÓÂÙ·È Ó· ˘¿Ú¯Ô˘Ó ‰‡ÔÙ‡ÔÈ ·ÓÙÈËÎÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙÔ˘ Ï‡ÎÔ˘. O ÚÒ-ÙÔ˜ Â›Ó·È Î·ÏÔ‹ıË˜ Î·È ·ÚÔ‰ÈÎfi˜ (Èı·Ó¿ ÌÂÙ·-ÏÔÈÌÒ‰Ë˜) Î·È Î·Ù¿ Î·ÓfiÓ· ‰ÂÓ ÚÔÎ·ÏÂ› Û˘ÌÙÒ-Ì·Ù· (4), fiˆ˜ Î·È ÛÙÔ ‰ÈÎfi Ì·˜ ·ÛıÂÓ‹ fiÔ˘ Î·-Ì›· ÂÈÏÔÎ‹ ‰ÂÓ ÛËÌÂÈÒıËÎÂ Î·Ù¿ ÙËÓ ÂÚ›Ô‰Ô



259

ÙË˜ ·ÚÔ˘Û›·˜ ÙÔ˘. øÛÙfiÛÔ, Û·ÓÈfiÙÂÚ·, Ë ·ÚÔ-‰ÈÎ‹ ·ÚÔ˘Û›· ·ÓÙÈËÎÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙÔ˘ Ï‡-ÎÔ˘ ÛÂ ·È‰È¿ ¯ˆÚ›˜ ˘ÔÎÂ›ÌÂÓÔ ÓfiÛËÌ· ¤¯ÂÈ Û˘-Û¯ÂÙÈÛÙÂ› ÌÂ ÙËÓ ÂÌÊ¿ÓÈÛË Î·È ·ÈÌÔÚÚ·ÁÈÎÒÓ ÂÂÈ-ÛÔ‰›ˆÓ (5). O ‰Â‡ÙÂÚÔ˜ Ù‡Ô˜ Â›Ó·È Ô ÏÂÁfiÌÂÓÔ˜“·˘ÙÔ¿ÓÔÛÔ˜”, Ô ÔÔ›Ô˜ ÂÌÊ·Ó›˙ÂÙ·È Û˘Ó‹ıˆ˜ÛÙËÓ ÂÊË‚Â›·, ÂÈÌ¤ÓÂÈ Î·È Û˘Ó‰˘¿˙ÂÙ·È ÌÂ ÙËÓ ÂÌ-Ê¿ÓÈÛË ıÚÔÌ‚ÔÂÌ‚ÔÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ (4). ™ÙÔ˘˜ÂÓ‹ÏÈÎÂ˜ ¯ˆÚ›˜ ˘ÔÎÂ›ÌÂÓÔ ÓfiÛËÌ·, Ë ·ÓÂ‡ÚÂÛËÙÔ˘ ·ÓÙÈËÎÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙÔ˘ Ï‡ÎÔ˘ ¤¯ÂÈ Û˘Ó-‰˘·ÛÙÂ› ÌÂ ÏÔ›ÌˆÍË ·fi ÙÔÓ EBV (6), ÂÓÒ ÛÙ· ·È-‰È¿ ÌÂ ÏÔ›ÌˆÍË ·fi ¿ÏÏÔ˘˜ ÈÔ‡˜ fiˆ˜ CMV, ·‰Â-ÓÔ˚Ô‡˜ (8), ·ÓÂÌÂ˘ÏÔÁÈ¿˜-¤ÚËÙ· ˙ˆÛÙ‹Ú· (9).™‡ÌÊˆÓ· ÌÂ ÙË ÁÓˆÛÙ‹ ÛÂ ÂÌ¿˜ ‚È‚ÏÈÔÁÚ·Ê›·, ‰ÂÓ¤¯ÂÈ Á›ÓÂÈ ·ÓÙ›ÛÙÔÈ¯Ë ÂÚÈÁÚ·Ê‹ ÛÂ ‚Â‚·ÈˆÌ¤ÓËÏÔ›ÌˆÍË ·fi ÙÔÓ EBV ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·.

™ÙË ‰Â‡ÙÂÚË ·ÛıÂÓ‹ ‹Ù·Ó ÂÓÙ˘ˆÛÈ·Î‹ Ë ‚·-ÚÈ¿ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ·, Ë ÌÂÁ¿ÏË ·‡ÍËÛË ÙË˜ LDH Î·ÈÊÂÚÚÈÙ›ÓË˜, Î·ıÒ˜ Î·È Ë ÂÏ¿ÙÙˆÛË ÙˆÓ ÏÂ˘ÎÒÓ ·È-ÌÔÛÊ·ÈÚ›ˆÓ, ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ÙÔ˘ ÈÓˆ‰ÔÁfiÓÔ˘. HÂÚÁ·ÛÙËÚÈ·Î‹ ·˘Ù‹ ÂÈÎfiÓ·, ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙÔÓ›ÎÙÂÚÔ Î·È ÙËÓ ¤ÓÙÔÓË Ë·ÙÈÎ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ô˘ÂÌÊ¿ÓÈ˙Â ÙÔ ·È‰›, Ô‰ËÁÔ‡ÛÂ ÛÙËÓ Èı·Ó‹ ‰È¿ÁÓˆ-ÛË ÙÔ˘ ·ÈÌÔÊ·ÁÔÎ˘ÙÙ·ÚÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, Û¯ÂÙÈ˙fi-ÌÂÓÔ˘ ÌÂ ÙËÓ ÔÍÂ›· ÏÔ›ÌˆÍË ·fi ÙÔÓ EBV (10). OEBV ·ÔÙÂÏÂ› ÙÔ Û˘ÓËı¤ÛÙÂÚÔ ÏÔÈÌÒ‰Â˜ ·›ÙÈÔ ÙÔ˘·ÈÌÔÊ·ÁÔÎ˘ÙÙ·ÚÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ (74%), ÂÓÒ ÂÓÔ-¯ÔÔÈÔ‡ÓÙ·È Î·È ¿ÏÏÔÈ ÈÔ›, fiˆ˜ Ô ÂÚËÙÔ˚fi˜ 6,CMV, ·‰ÂÓÔ˚Ô›, ·Ú‚Ô˚fi˜, Èfi˜ ·ÓÂÌÂ˘ÏÔÁÈ¿˜-¤ÚË-Ù· ˙ˆÛÙ‹Ú·, Î·ıÒ˜ Î·È ÙÔ˘ ·ÏÔ‡ ¤ÚËÙ·, ÙÔ˘ ˘-ÚÂÙÔ‡ Q Î·È ÙË˜ ÈÏ·Ú¿˜ (11). ∆· ÎÏÈÓÈÎ¿ Â˘Ú‹Ì·Ù·¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ·Ú·ÙÂÈÓfiÌÂÓÔ ÂÌ‡ÚÂÙÔ,·ÓÎ˘ÙÙ·ÚÔÂÓ›·, Ë·ÙÈÎ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·, Ë·ÙÔ-ÛÏËÓÔÌÂÁ·Ï›·, ‰È·Ù·Ú·¯¤˜ ÙË˜ ËÎÙÈÎfiÙËÙ·˜,›ÎÙÂÚÔ, ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· Î·È Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ KN™.∂ÚÁ·ÛÙËÚÈ·Î¿ ‰È·ÈÛÙÒÓÔÓÙ·È ˘ÂÚÙÚ·ÓÛ·ÌÈÓ·-Û·ÈÌ›·, ·‡ÍËÛË ÙË˜ ÊÂÚÚÈÙ›ÓË˜, ÙË˜ LDH, ÙˆÓ ÙÚÈ-ÁÏ˘ÎÂÚÈ‰›ˆÓ Î·È ÂÏ¿ÙÙˆÛË ÙÔ˘ ÈÓˆ‰ÔÁfiÓÔ˘. H ‰È¿-ÁÓˆÛË ÂÈ‚Â‚·ÈÒÓÂÙ·È ÌÂ ÙËÓ ·ÓÂ‡ÚÂÛË ÛÙË ‚ÈÔ-„›· ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÏÂÌ-ÊÔ˚ÛÙÈÔÎ˘ÙÙ¿ÚˆÓ ÌÂ ·ÈÌÔÊ·ÁÔÎ‡ÙÙ·Ú· (10). ∞fiÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ÙÔ˘ ·ÈÌÔÊ·ÁÔÎ˘ÙÙ·ÚÈÎÔ‡ Û˘Ó‰Úfi-ÌÔ˘ Ô˘ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÏÔ›ÌˆÍË, ‰˘ÛÌÂÓ¤ÛÙÂÚËÚfiÁÓˆÛË ÂÌÊ·Ó›˙Ô˘Ó Î˘Ú›ˆ˜ Ù· ÌÈÎÚ¿ Ó‹È· (ı·-Ó·ÙËÊfiÚÔ ÛÂ ÔÛÔÛÙfi 60% ÛÂ ·È‰È¿ ÌÈÎÚfiÙÂÚ·ÙˆÓ 3 ÂÙÒÓ Î·È 69% ÛÂ ÌÈÎÚfiÙÂÚ· ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜)(11) Î·È ÂÎÂ›Ó· ÌÂ ˘Ô˚Óˆ‰ÔÁÔÓ·ÈÌ›· Î·È ˘ÂÚÙÚÈ-ÁÏ˘ÎÂÚÈ‰·ÈÌ›· (12,13). ™ÙËÓ ÂÚ›ÙˆÛË ÙË˜ ÌÈÎÚ‹˜·ÛıÂÓÔ‡˜, ·Ó Î·È Ù· ÎÏÈÓÈÎ¿ Î·È ÂÚÁ·ÛÙËÚÈ·Î¿ ‰Â-‰ÔÌ¤Ó· ‹Ù·Ó Û˘Ì‚·Ù¿ ÌÂ ÙËÓ ‡·ÚÍË ·ÈÌÔÊ·ÁÔ-Î˘ÙÙ·ÚÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, Ë ‰È¿ÁÓˆÛË ‰ÂÓ ÂÈ‚Â‚·È-ÒıËÎÂ ÁÈ·Ù› ·¤Ù˘¯Â ÙÂ¯ÓÈÎ¿ Ë ‚ÈÔ„›· Ì˘ÂÏÔ‡ ÙˆÓÔÛÙÒÓ. ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ ·ÈÌÔÊ·ÁÔÎ˘ÙÙ·ÚÈ-Îfi Û‡Ó‰ÚÔÌÔ Û¯ÂÙÈ˙fiÌÂÓÔ ÌÂ ÔÍÂ›· ÏÔ›ÌˆÍË ·fi

ÙÔÓ EBV ÂÌÊ·Ó›˙ÂÈ ÙË ‰˘ÛÌÂÓ¤ÛÙÂÚË ÚfiÁÓˆÛË·fi Ù· ˘fiÏÔÈ· ÏÔÈÌÒ‰Ë ·›ÙÈ·, Î·ıÒ˜ ·Ó·Ê¤ÚÂ-Ù·È ı·Ó·ÙËÊfiÚ· ¤Î‚·ÛË ÛÙÔ 73% (11), Ë ÔÚÂ›·ÙË˜ ·ÛıÂÓÔ‡˜ Ì·˜, ·Ú¿ ÙË ÌÈÎÚ‹ ÙË˜ ËÏÈÎ›·, ‹Ù·ÓÂÍ·ÈÚÂÙÈÎ¿ Î·Ï‹. ¶·ÚÔ˘Û›·ÛÂ ÎÏÈÓÈÎ‹ Î·È ÂÚÁ·-ÛÙËÚÈ·Î‹ ‚ÂÏÙ›ˆÛË ÌÂÙ¿ ÙËÓ ¿ÚÔ‰Ô 10 ËÌÂÚÒÓÎ·È Ï‹ÚË ·ÔÎ·Ù¿ÛÙ·ÛË ÌÂÙ¿ ¤Ó· Ì‹Ó·.

™ÙËÓ ÙÚ›ÙË Î·È Ù¤Ù·ÚÙË ·ÛıÂÓ‹ ÛËÌÂÈÒÓÂÙ·È È‰È-·›ÙÂÚ· Ë ¤ÓÙÔÓË ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÛË, ¯ˆÚ›˜ fiÌˆ˜ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË ÙË˜ TKE Î·È CRP, Â‡ÚËÌ· Û˘Ì-‚·Ùfi ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· Î·È ¿ÏÏË˜ ÌÂÏ¤ÙË˜ Ô˘Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÛÙËÓ ÎÏÈÓÈÎ‹ Ì·˜, fiÔ˘ ¤ÁÈÓÂ·Ó·‰ÚÔÌÈÎ‹ ÂÎÙ›ÌËÛË ÛÂ fiÏÂ˜ ÙÈ˜ §M Ì›·˜ 7ÂÙ›·˜(14). ™ÙË ÌÂÏ¤ÙË ÙˆÓ Sumaya Î·È Û˘Ó (1) ·Ó·Ê¤-ÚÂÙ·È fiÙÈ Ô Ì¤ÛÔ˜ fiÚÔ˜ ÙˆÓ ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÓ ÛÙ··È‰È¿ ËÏÈÎ›·˜ ÌÈÎÚfiÙÂÚË˜ ÙˆÓ 4 ÂÙÒÓ ‹Ù·Ó14.775±5.155/mm3 (MO±SD), ÂÓÒ ÛÙ· ÌÂÁ·Ï‡ÙÂ-Ú· ‹Ù·Ó 11.150±3.586/mm3. øÛÙfiÛÔ, ÛÙËÓ ÙÚ›ÙËÎ·È Ù¤Ù·ÚÙË ·ÛıÂÓ‹, Ô ·ÚÈıÌfi˜ ÙˆÓ ÏÂ˘ÎÔÎ˘ÙÙ¿-ÚˆÓ ‹Ù·Ó Î·Ù¿ ÔÏ‡ ˘„ËÏfiÙÂÚÔ˜ ·fi ÙÔÓ ·Ó·ÊÂ-ÚfiÌÂÓÔ ÛÙËÓ ·Ú·¿Óˆ ÌÂÏ¤ÙË ÁÈ· ·È‰È¿ ·ÓÙ›-ÛÙÔÈ¯Ë˜ ËÏÈÎ›·˜. π‰È·›ÙÂÚÔ Â‡ÚËÌ· ÛÙËÓ Ù¤Ù·ÚÙË·ÛıÂÓ‹ ‹Ù·Ó Ë ÂÌÊ¿ÓÈÛË Â›ÌÔÓË˜ ‚Ï·ÙÈ‰Ò‰Ô˘˜·ÎÚÔ‰ÂÚÌ·Ù›ÙÈ‰·˜ (Û‡Ó‰ÚÔÌÔ Gianotti-Crosti). HÂÌÊ¿ÓÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·˘ÙÔ‡ Â›¯Â ·Ô‰ÔıÂ›ÛÙÔ ·ÚÂÏıfiÓ ·ÔÎÏÂÈÛÙÈÎ¿ ÛÙÔÓ Èfi ÙË˜ Ë·Ù›ÙÈ-‰·˜ B, ÛÙË Û˘Ó¤¯ÂÈ· fiÌˆ˜ ÂÓÔ¯ÔÔÈ‹ıËÎ·Ó Î·È ¿Ï-ÏÔÈ ÈÔ› fiˆ˜ ÔÈ EBV, CMV, RSV, ÂÓÙÂÚÔ˚Ô›, ·ÏÏ¿Î·È Ô ‚-·ÈÌÔÏ˘ÙÈÎfi˜ ÛÙÚÂÙfiÎÔÎÎÔ˜ ÙË˜ ÔÌ¿‰·˜ A(15). ∫ÏÈÓÈÎ¿ ÙÔ ÂÍ¿ÓıËÌ· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓÂÌÊ¿ÓÈÛË ÂÚ˘ıÚˆÒÓ ‚Ï·Ù›‰ˆÓ ÌÂ Û˘ÌÌÂÙÚÈÎ‹ÂÓÙfiÈÛË ÛÙ· ¿ÎÚ·, ÙÔ˘˜ ÁÏÔ˘ÙÔ‡˜ Î·È ÏÈÁfiÙÂÚÔÛÙÔÓ ÎÔÚÌfi. H ¤Îı˘ÛË ÙÔ˘ ÂÍ·Óı‹Ì·ÙÔ˜ ÂÈÌ¤ÓÂÈÛ˘Ó‹ıˆ˜ ÁÈ· 3-4 Â‚‰ÔÌ¿‰Â˜, fiˆ˜ Î·È ÛÙËÓ ÂÚ›-ÙˆÛË ÙË˜ ‰ÈÎ‹˜ Ì·˜ ·ÛıÂÓÔ‡˜ (15).

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ë ÚˆÙÔ·ı‹˜ ÏÔ›ÌˆÍË ·fiÙÔÓ EBV ÛÙ· ‚Ú¤ÊË Î·È Ù· ÌÈÎÚ¿ Ó‹È· ÌÔÚÂ› Ó·ÂÌÊ·Ó›˙ÂÈ ‹È· ‹ ÂÓ‰Â¯ÔÌ¤Óˆ˜ È‰È·›ÙÂÚ· ·ÓËÛ˘¯Ë-ÙÈÎ¿ ÎÏÈÓÈÎ¿ Î·È ÂÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù· Î·È Ú¤-ÂÈ Ó· Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙË ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆ-ÛË ÙˆÓ ·ÈÌ·ÙÔÏÔÁÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ÛÙË ‚ÚÂÊÈÎ‹Î·È ÚÒÈÌË ÓËÈ·Î‹ ËÏÈÎ›·.

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‰ÔÌ‹ ÙÔ˘˜ ÁÏ˘ÎÂÚÔÊˆÛÊÔÏÈ›‰È·. ™˘ÁÎÂÎÚÈÌ¤Ó·,ÛÙË ı¤ÛË sn-1 ÂÚÈ¤¯Ô˘Ó Ì›· 1,2 ·ÎfiÚÂÛÙË ·ÏÎÔfi-ÏË Ì·ÎÚ¿˜ ·Ï˘Û›‰·˜ ·ÓıÚ¿ÎˆÓ Ô˘ ÚÔÛ‰¤ÓÂÙ·ÈÛÙË ÁÏ˘ÎÂÚfiÏË ÌÂ ¤Ó· ‚ÈÓ˘Ï-·ÈıÂÚÈÎfi ‰ÂÛÌfi. ∞ÓÙ›-

ıÂÙ·, Ù· ˘fiÏÔÈ· ÁÏ˘ÎÂÚÔÊˆÛÊÔÏÈ›‰È· ÛÙËÓ›‰È· ı¤ÛË ¤¯Ô˘Ó ¤Ó· ÏÈ·Úfi ÔÍ‡ Ô˘ ÚÔÛ‰¤ÓÂÙ·ÈÛÙË ÁÏ˘ÎÂÚfiÏË ÌÂ ÂÛÙÂÚÈÎfi ‰ÂÛÌfi. ∞ÔÙÂÏÔ‡Ó ÙÔ5-20% ÙˆÓ ÊˆÛÊÔÏÈÈ‰›ˆÓ ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ÌÂÌ‚Ú·ÓÒÓ ÙÔ˘ ·ÓıÚÒÔ˘. ∞ÓÂ˘Ú›ÛÎÔÓÙ·È ÛÂ È‰È-·›ÙÂÚ· ÌÂÁ¿ÏÂ˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÛÙËÓ Î·Ú‰È¿, ÛÙÔ


261

∂›Â‰· Ï·ÛÌ·ÏÔÁfiÓˆÓ ÛÂ ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ π. §·Ì·‰·Ú›‰Ë˜1, ª. £ÂÔ‰ˆÚ¿ÎË1, ª. ªˆÚ·˝ÙÔ˘2, ¡. ¡ÈÎÔÏ·˝‰Ô˘1, π. ™·Ô˘¿ÎÈÙ1, Ã. ∫·Ú‹˜1, ∂. ªÈ¯ÂÏ·Î¿ÎË2

Plasmalogen levels in full-term neonates I. Labadaridis1, M. Theodoraki1, M. Moraitou2, N. Nikolaidou1, J. Saouakit1, C. Karis1, H. Michelakakis2


�¶ÂÚ›ÏË„Ë: ∆· Ï·ÛÌ·ÏÔÁfiÓ· Â›Ó·È ÌÔÓ·‰ÈÎ¿ ˆ˜ÚÔ˜ ÙË ‰ÔÌ‹ ÙÔ˘˜ ÊˆÛÊÔÏÈ›‰È·. ∞ÓÂ˘Ú›ÛÎÔÓÙ·ÈÛÙ· ÂÚÈÛÛfiÙÂÚ· Î‡ÙÙ·Ú· Î·È ÈÛÙÔ‡˜, ·ÔÙÂÏÔ‡Ó‰Â ÙÔ 80-90% ÙˆÓ ÊˆÛÊÔÏÈÈ‰›ˆÓ ÙË˜ Ì˘ÂÏ›ÓË˜.∆· ‰‡Ô ÚÒÙ· ÛÙ¿‰È· ÙË˜ Û‡ÓıÂÛ‹˜ ÙÔ˘˜ ÂÓÙÔ›-˙ÔÓÙ·È Î·Ù’ ·ÔÎÏÂÈÛÙÈÎfiÙËÙ· ÛÙ· ˘ÂÚÔÍ˘ÛÒÌ·-Ù·. ∏ ‚ÈÔÏÔÁÈÎ‹ ÛËÌ·Û›· ÙˆÓ ÌÔÚ›ˆÓ ·˘ÙÒÓ Î·Ù·-‰ÂÈÎÓ‡ÂÙ·È ·fi ÙËÓ ‡·ÚÍË ÎÏËÚÔÓÔÌÈÎÒÓ ÓÔÛË-Ì¿ÙˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙË ÌÂÈˆÌ¤ÓË Û‡ÓıÂÛ‹ÙÔ˘˜. ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ÌÂÙÚ‹ıËÎ·Ó Ù· Â›Â-‰· Ï·ÛÌ·ÏÔÁfiÓˆÓ ÛÙÈ˜ ÌÂÌ‚Ú¿ÓÂ˜ ÂÚ˘ıÚÔÎ˘Ù-Ù¿ÚˆÓ ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔÁÓÒÓ ËÏÈÎ›·˜ 1-4 ËÌÂÚÒÓ.™‡ÌÊˆÓ· ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù¿ Ì·˜, Ù· Â›Â‰·Ï·ÛÌ·ÏÔÁfiÓˆÓ ÙˆÓ ÓÂÔÁÓÒÓ ‹Ù·Ó ¯·ÌËÏfiÙÂÚ··fi ·˘Ù¿ ÙˆÓ ÌÂÁ·Ï‡ÙÂÚˆÓ ·È‰ÈÒÓ ËÏÈÎ›·˜ 6 ÌË-ÓÒÓ-8 ÂÙÒÓ. ∏ ‰È·ÊÔÚ¿ ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹(p<0,001). ∆· ¯·ÌËÏ¿ Â›Â‰· Ï·ÛÌ·ÏÔÁfiÓˆÓÛÙ· ÓÂÔÁÓ¿ ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔÓÙ·È ˘’ fi„ËÛÙËÓ ÂÚÁ·ÛÙËÚÈ·Î‹ ‰ÈÂÚÂ‡ÓËÛË ÙˆÓ ˘ÂÚÔÍ˘Ûˆ-ÌÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ. ∂ÈÏ¤ÔÓ, ‰Â‰ÔÌ¤ÓÔ˘ fiÙÈ Ù·Ï·ÛÌ·ÏÔÁfiÓ· ıÂˆÚÔ‡ÓÙ·È ÂÓ‰ÔÁÂÓÂ›˜ ·ÓÙÈÔÍÂÈ-‰ˆÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜, Ù· ÌÂÈˆÌ¤Ó· Â›Â‰¿ ÙÔ˘˜ÛÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›· ÌÔÚÂ› Ó· ·ÔÙÂÏÔ‡Ó ÚÔ‰È·-ıÂÛÈÎfi ·Ú¿ÁÔÓÙ· ÔÍÂÈ‰ˆÙÈÎ‹˜ ‚Ï¿‚Ë˜ ÛÙË Û˘-ÁÎÂÎÚÈÌ¤ÓË ËÏÈÎÈ·Î‹ ÔÌ¿‰·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: Ï·ÛÌ·ÏÔÁfiÓ·, ÓÂÔÁÓ¿, ÔÍÂÈ‰ˆÙÈ-Îfi stress.

�Abstract: Plasmalogens are structurally uniquephospholipids. They are found in most cells andtissues and they are particularly abundant in brainwhere they constitute 80-90% of the myelinphospholipids. Peroxisomes are essential for theirbiosynthesis since the first two enzymes of therelevant pathway are exclusively located onperoxisomal membranes. The biologicalimportance of plasmalogens is highlighted by theexistence of inherited metabolic disordersassociated with their diminished synthesis. In thepresent study the levels of red blood cellplasmalogens were measured in neonates 1-4days old. According to our results the above levelswere lower in neonates compared to older children6 months-8 years old. The difference wasstatistically significant (p<0.001). The low levels ofplasmalogens in neonates should be taken intoaccount when investigating for peroxisomaldisorders. Furthermore, since it is believed thatplasmalogens act as endogenous antioxidants,their low levels in early life may be a predisposingfactor for oxidative damage in neonates.

Key words: plasmalogens, neonates, oxidativestress.

1 ª∂¡ ¡ÂÔÁÓÒÓ & ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶°¡ ¡›Î·È·˜, ¶ÂÈÚ·È¿˜ 2 ¢/ÓÛË ∂Ó˙˘ÌÔÏÔÁ›·˜ Î·È ∫˘ÙÙ·ÚÈÎ‹˜ §ÂÈÙÔ˘ÚÁ›·˜,

πÓÛÙÈÙÔ‡ÙÔ ÀÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, ∞ı‹Ó·

1 Neonatal ICU & Pediatric Clinic of theGeneral Hospital of Nikea, Piraeus

2 Center of Enzymology & Cellular Function,Institute of Child Health, Athens



262

ÓÂ˘ÚÈÎfi Û‡ÛÙËÌ·, ÛÙ· Ô˘‰ÂÙÂÚfiÊÈÏ· Î·È Ù· Ì·ÎÚÔ-Ê¿Á·. π‰È·›ÙÂÚ· ÛÙË Ì˘ÂÏ›ÓË, ÙÔ 80-90% ÙˆÓ ·Èı·-ÓÔÏ·ÌÈÓÔ-ÊˆÛÊÔÏÈÈ‰›ˆÓ Â›Ó·È Ï·ÛÌ·ÏÔÁfiÓ· (1,2).

∞·Ú·›ÙËÙË ÁÈ· ÙË Û‡ÓıÂÛ‹ ÙÔ˘˜ Â›Ó·È Ë ‡·Ú-ÍË ÏÂÈÙÔ˘ÚÁÈÎÒÓ ˘ÂÚÔÍ˘ÛˆÌ¿ÙˆÓ (3).

∏ ‡·ÚÍË ÎÏËÚÔÓÔÌÈÎÒÓ ÌÂÙ·‚ÔÏÈÎÒÓ ÓÔÛËÌ¿-ÙˆÓ Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÙËÓ ÂÏÏÈ‹ Û‡ÓıÂÛËÏ·ÛÌ·ÏÔÁfiÓˆÓ ·Ó·‰ÂÈÎÓ‡ÂÈ ÙË ‚ÈÔÏÔÁÈÎ‹ ÛËÌ·-Û›· ÙˆÓ ÌÔÚ›ˆÓ ·˘ÙÒÓ (1,2,4). ™ÂÈÚ¿ ·fi ÂÚÂ˘ÓË-ÙÈÎ¿ ‰Â‰ÔÌ¤Ó· ‰Â›¯ÓÔ˘Ó ˆ˜ Ù· Ï·ÛÌ·ÏÔÁfiÓ·‰ÂÓ Â›Ó·È ÌfiÓÔ ‰ÔÌÈÎ¿ Û˘ÛÙ·ÙÈÎ¿ ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓÌÂÌ‚Ú·ÓÒÓ, ·ÏÏ¿ ¤¯Ô˘Ó ÎÈ ¿ÏÏÂ˜ ÛËÌ·ÓÙÈÎ¤˜ ÏÂÈ-ÙÔ˘ÚÁ›Â˜. ™Â ·˘Ù¤˜ Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë ·Ôı‹-ÎÂ˘ÛË ·Ú·¯È‰ÔÓÈÎÔ‡ ÔÍ¤Ô˜, Ë Û˘ÌÌÂÙÔ¯‹ ÙÔ˘˜ ÛÙËÛ‡ÓÙËÍË ÌÂÌ‚Ú·ÓÒÓ, ÛÙË ÌÂÙ·ÊÔÚ¿ ÈfiÓÙˆÓ Î·ÈÛÙËÓ ÂÎÚÔ‹ ¯ÔÏËÛÙÂÚfiÏË˜. ∂ÈÏ¤ÔÓ, Ù· Ï·ÛÌ·-ÏÔÁfiÓ· Ê·›ÓÂÙ·È fiÙÈ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ·ÓÙÈÔÍÂÈ-‰ˆÙÈÎ‹ ¿Ì˘Ó· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ¤Ó·ÓÙÈ ‰Ú·ÛÙÈÎÒÓÌÔÚÊÒÓ ÙÔ˘ ÔÍ˘ÁfiÓÔ˘ (oxygen reactive species,ROS) (5-9).

∆Ô ÔÍÂÈ‰ˆÙÈÎfi stress ·ÔÙÂÏÂ› ÛÔ‚·Úfi ÂÈ‚·-Ú˘ÓÙÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· Ù· ÓÂÔÁÓ¿ Î·È ıÂˆÚÂ›Ù·ÈfiÙÈ Û˘ÌÌÂÙ¤¯ÂÈ ÌÂÙ·Í‡ ¿ÏÏˆÓ ÛÙËÓ ·Ó¿Ù˘ÍË ·Ì-ÊÈ‚ÏËÛÙÚÔÂÈ‰Ô¿ıÂÈ·˜ ÙË˜ ÚÔˆÚfiÙËÙ·˜, ÏÂ˘ÎÔ-Ì·Ï·Î›·˜, ‚ÚÔÁ¯ÔÓÂ˘ÌÔÓÈÎ‹˜ ‰˘ÛÏ·Û›·˜ Î·È ÓÂ-ÎÚˆÙÈÎ‹˜ ÂÓÙÂÚÔÎÔÏ›ÙÈ‰·˜ (10).

™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ÌÂÙÚ‹ıËÎ·Ó Ù· Â›Â‰·ÙˆÓ Ï·ÛÌ·ÏÔÁfiÓˆÓ ÛÙ· ÂÚ˘ıÚÔÎ‡ÙÙ·Ú· Ê˘ÛÈÔ-ÏÔÁÈÎÒÓ ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔÁÓÒÓ. ∆· ·ÔÙÂÏ¤ÛÌ·Ù·Û˘ÁÎÚ›ıËÎ·Ó ÌÂ ÙÈ˜ ·ÓÙ›ÛÙÔÈ¯Â˜ ÙÈÌ¤˜ ·È‰ÈÒÓ ËÏÈ-Î›·˜ 6 ÌËÓÒÓ-8 ÂÙÒÓ.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈªÂÏÂÙ‹ıËÎ·Ó 25 ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ ËÏÈÎ›·˜ 1-4 ËÌÂÚÒÓ

Î·È 15 ·È‰È¿ ËÏÈÎ›·˜ 6 ÌËÓÒÓ-8 ÂÙÒÓ. °È· ÙÈ˜ ÌÂÙÚ‹ÛÂÈ˜ ¯ÚË-ÛÈÌÔÔÈ‹ıËÎ·Ó Ù· ÂÚ˘ıÚÔÎ‡ÙÙ·Ú· ·fi ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜Ô˘ Ï‹ÊıËÎ·Ó ÁÈ· ··Ú·›ÙËÙÂ˜ ÂÚÁ·ÛÙËÚÈ·Î¤˜ ÂÍÂÙ¿ÛÂÈ˜.

∆· Â›Â‰· Ï·ÛÌ·ÏÔÁfiÓˆÓ ÌÂÙÚ‹ıËÎ·Ó ÛÂ ÂÎ¯‡ÏÈÛÌ·ÏÈÈ‰›ˆÓ ÙË˜ ÌÂÌ‚Ú¿ÓË˜ ÙˆÓ ÂÚ˘ıÚÔÎ˘ÙÙ¿ÚˆÓ ÌÂ ·¤ÚÈ·¯ÚˆÌ·ÙÔÁÚ·Ê›·. O ·ÎfiÚÂÛÙÔ˜ ·ÈıÂÚÈÎfi˜ ‰ÂÛÌfi˜ ÙˆÓ Ï·-ÛÌ·ÏÔÁfiÓˆÓ ÌÂÙÂÙÚ¿Ë ÛÙË ‰ÈÌÂı˘Ï·ÎÂÙ¿ÏË ÙË˜ ·ÓÙ›ÛÙÔÈ-

¯Ë˜ ·Ï‰Â˛‰Ë˜. ∏ Â› ÙÔÈ˜ ÂÎ·Ùfi Û¯ÂÙÈÎ‹ Û˘ÁÎ¤ÓÙÚˆÛË ÙˆÓÏ·ÛÌ·ÏÔÁfiÓˆÓ ˘ÔÏÔÁ›ÛÙËÎÂ ˆ˜ ÙÔ ËÏ›ÎÔ ÙË˜ C18:0 ‰ÈÌÂ-ı˘Ï·ÎÂÙ¿ÏË˜ ÚÔ˜ ÙÔ ÌÂı˘ÏÛÙÂ·ÚÈÎfi (C18:0 DMA / C18:0) Î·ÈÙË˜ C16:0 ‰ÈÌÂı˘Ï·ÎÂÙ¿ÏË˜ ÚÔ˜ ÙÔ ÌÂı˘Ï·ÏÌÈÙÈÎfi (C16:0

DMA / C16:0) (11). H ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¤ÁÈÓÂ ÌÂ ÙË

‰ÔÎÈÌ·Û›· t-test.

∞ÔÙÂÏ¤ÛÌ·Ù· - ™˘˙‹ÙËÛË ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜ Ê·›ÓÔÓÙ·È ÛÙÔÓ

¶›Ó·Î· 1. ™‡ÌÊˆÓ· ÌÂ ÙÈ˜ ÌÂÙÚ‹ÛÂÈ˜ Ì·˜ Ù· ÓÂÔ-ÁÓ¿ ¤¯Ô˘Ó ¯·ÌËÏfiÙÂÚ· Â›Â‰· Ï·ÛÌ·ÏÔÁfiÓˆÓ·’ fi,ÙÈ Ù· ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚË˜ ËÏÈÎ›·˜. ∏ ‰È·ÊÔ-Ú¿ ·˘Ù‹ Â›Ó·È ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹, fiˆ˜ ·ÔÎ¿-Ï˘„Â Ë ‰ÔÎÈÌ·Û›· t-test.

∞Í›˙ÂÈ Ó· ÛËÌÂÈˆıÂ› ˆ˜ Ù· Â›Â‰· ÙˆÓ Ï·-ÛÌ·ÏÔÁfiÓˆÓ ÛÂ ·ÛıÂÓ‹ ÌÂ ‰È·Ù·Ú·¯‹ ÙË˜ ‚ÈÔÁ¤-ÓÂÛË˜ ÙˆÓ ˘ÂÚÔÍ˘ÛˆÌ¿ÙˆÓ Î·È ·Ô‰Â‰ÂÈÁÌ¤ÓËÌÂ›ˆÛË ÙË˜ Û‡ÓıÂÛ‹˜ ÙÔ˘˜, Ô˘ ‰È·ÁÓÒÛıËÎÂ ÛÙÔÂÚÁ·ÛÙ‹ÚÈfi Ì·˜, ‹Ù·Ó ÛÙ· Î·ÙÒÙÂÚ· Â›Â‰· ·˘-ÙÒÓ Ô˘ ÌÂÙÚ‹ıËÎ·Ó ÛÂ ÓÂÔÁÓ¿ (¶›Ó·Î·˜ 1).

∏ ·ÚÔ‡Û· ÂÚÁ·Û›· ·ÔÙÂÏÂ› ÙËÓ ÚÒÙË ‰Ë-ÌÔÛÈÂ˘Ì¤ÓË ÌÂÏ¤ÙË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ Ï·ÛÌ·ÏÔ-ÁfiÓˆÓ ÛÙ· ÂÚ˘ıÚÔÎ‡ÙÙ·Ú· ÓÂÔÁÓÒÓ. ∏ Ì¤ÙÚËÛËÙˆÓ Ï·ÛÌ·ÏÔÁfiÓˆÓ Â›Ó·È Ì›· ·fi ÙÈ˜ ·Ú·Ì¤-ÙÚÔ˘˜ Ô˘ ÂÎÙÈÌÒÓÙ·È ÛÙË ‰È¿ÁÓˆÛË ÙˆÓ ˘ÂÚÔ-Í˘ÛˆÌÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ (4). ∆· Â˘Ú‹Ì·Ù¿ Ì·˜ Â›-Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈÎ¿ ˆ˜ ÚÔ˜ ·˘Ù‹ ÙËÓ Î·ÙÂ‡-ı˘ÓÛË Î·È ‰Â›¯ÓÔ˘Ó ÙËÓ ·Ó¿ÁÎË ¯ÚËÛÈÌÔÔ›ËÛË˜‰È·ÊÔÚÂÙÈÎÒÓ ÙÈÌÒÓ ·Ó·ÊÔÚ¿˜ ÁÈ· Ù· Ï·ÛÌ·ÏÔ-ÁfiÓ· ÛÙË ‰ÈÂÚÂ‡ÓËÛË ÓÂÔÁÓÒÓ ‡ÔÙˆÓ ÁÈ· ˘Â-ÚÔÍ˘ÛˆÌÈ·Î¿ ÓÔÛ‹Ì·Ù·.

O ÚfiÏÔ˜ ÙˆÓ Ï·ÛÌ·ÏÔÁfiÓˆÓ, 75 ¯ÚfiÓÈ· ÌÂÙ¿ÙËÓ ·Ó·Î¿Ï˘„‹ ÙÔ˘˜, ·Ú·Ì¤ÓÂÈ ˘fi ÂÍ¤Ù·ÛË. ™ÂÈ-Ú¿ ÌÂÏÂÙÒÓ ‰Â›¯ÓÂÈ ˆ˜ ÂÓ¤¯ÔÓÙ·È ÛÂ ÔÏÏ¤˜ Î·ÈÛËÌ·ÓÙÈÎ¤˜ ‚ÈÔÏÔÁÈÎ¤˜ ÏÂÈÙÔ˘ÚÁ›Â˜. ∆· Ï·ÛÌ·ÏÔ-ÁfiÓ· ÂÚÈ¤¯Ô˘Ó ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ ÔÍ¤· ÛÙËı¤ÛË sn-2. £ÂˆÚÔ‡ÓÙ·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈÎ‹ ‰ÂÍ·-ÌÂÓ‹ ·Ú·¯È‰ÔÓÈÎÔ‡ ÔÍ¤Ô˜, ÙÔ ÔÔ›Ô ·ÂÏÂ˘ıÂÚÒ-ÓÂÙ·È ÌÂ ÙË ‰Ú¿ÛË ÙË˜ ÂÈ‰ÈÎ‹˜ ÊˆÛÊÔÏÈ¿ÛË˜ ∞2ÁÈ· Ó· ÌÂÙ·‚ÔÏÈÛÙÂ› ÛÂ ÚÔÛÙ·ÁÏ·‰›ÓÂ˜ Î·È ¿ÏÏÂ˜

¶›Ó·Î·˜ 1. ∂›Â‰· Ï·ÛÌ·ÏÔÁfiÓˆÓ ÛÂ ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿, ·È‰È¿ Î·È ‰‡Ô ·ÛıÂÓÂ›˜ ÌÂ ‰È·Ù·Ú·¯‹ ÙË˜ ‚ÈÔÁ¤ÓÂÛË˜ ÙˆÓ ˘Â-ÚÔÍ˘ÛˆÌ¿ÙˆÓ

∆ÂÏÂÈfiÌËÓ· ¶·È‰È¿ AÛıÂÓÂ›˜ ÌÂ ‰È·Ù·Ú·¯‹ ÓÂÔÁÓ¿ (n=25) (n=15) ‚ÈÔÁ¤ÓÂÛË˜ ÙˆÓ ˘ÂÚÔÍ˘ÛˆÌ¿ÙˆÓ

C16:0DMA/C16:0(%) ∂‡ÚÔ˜: 6,6-9,4* 9,4-12,4ª.∆.: 7,7 10,9 6,6 1,0SD: 0,76 0,84

C18:0DMA/C18:0 (%) E‡ÚÔ˜: 13,5-21,5* 18,0-24,0 13,9 1,2ª.∆.: 16,8 21,9SD: 1,9 1,0

ª.∆.: Ì¤ÛË ÙÈÌ‹*p<0,001



263

‚ÈÔÏÔÁÈÎ¿ ‰Ú·ÛÙÈÎ¤˜ Ô˘Û›Â˜ (12). ∂ÈÏ¤ÔÓ, ¤¯ÂÈ ÚÔÙ·ıÂ› ˆ˜ Ù· Ï·ÛÌ·ÏÔÁfi-

Ó· ‚ÂÏÙÈÛÙÔÔÈÔ‡Ó ÙË ÏÂÈÙÔ˘ÚÁ›· ˘Ô‰Ô¯¤ˆÓ, ÂÓ-˙‡ÌˆÓ Î·È ·ÓÙÏÈÒÓ ÈfiÓÙˆÓ, Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÂ ‰È·‰È-Î·Û›Â˜ Û‡ÓÙËÍË˜ Î˘ÙÙ·ÚÈÎÒÓ ÌÂÌ‚Ú·ÓÒÓ Î·È ÛÙËÓÂÎÚÔ‹ ¯ÔÏËÛÙÂÚfiÏË˜ Ì¤Ûˆ ÙË˜ HDL (6-8).

∂Í·ÈÚÂÙÈÎ‹˜ ÛËÌ·Û›·˜ Ê·›ÓÂÙ·È ˆ˜ Â›Ó·È Ô Úfi-ÏÔ˜ ÙÔ˘˜ ˆ˜ ÂÓ‰ÔÁÂÓÒÓ ·ÓÙÈÔÍÂÈ‰ˆÙÈÎÒÓ ·Ú·Áfi-ÓÙˆÓ. ∏ ·ÓÙÈÔÍÂÈ‰ˆÙÈÎ‹ ‰Ú¿ÛË ÙˆÓ Ï·ÛÌ·ÏÔÁfi-ÓˆÓ ÈÛÙÂ‡ÂÙ·È ˆ˜ ÔÊÂ›ÏÂÙ·È ÛÙÔ ‚ÈÓ˘Ï-·ÈıÂÚÈÎfi‰ÂÛÌfi ÛÙË ı¤ÛË sn-1, ·ÏÏ¿ Î·È ÛÙËÓ ·ÚÔ˘Û›· Ô-Ï˘·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ ÛÙË ı¤ÛË sn-2 (12).Œ¯ÂÈ ‚ÚÂıÂ› ˆ˜ Ë ˘ÔÍ›·/ÈÛ¯·ÈÌ›· Ô‰ËÁÂ› ÛÂ ÌÂ›-ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ Ï·ÛÌ·ÏÔÁfiÓˆÓ, È‰È·›ÙÂÚ·ÂÎÂ›ÓˆÓ Ô˘ ÂÚÈ¤¯Ô˘Ó ·Ú·¯È‰ÔÓÈÎfi ÔÍ‡ (13), ÂÓÒRAW Î‡ÙÙ·Ú· ÌÂ ¤ÏÏÂÈÌÌ· Ï·ÛÌ·ÏÔÁfiÓˆÓ, ·ÏÏ¿Î·È Î‡ÙÙ·Ú· ·ÛıÂÓÒÓ ÌÂ Û‡Ó‰ÚÔÌÔ Zellweger, ÂÌ-Ê·Ó›˙Ô˘Ó ·˘ÍËÌ¤ÓË Â˘·ÈÛıËÛ›· ÛÙÔ ÔÍÂÈ‰ˆÙÈÎfistress (9,14).

In vitro ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ ˆ˜ Ë ·ÚÔ˘Û›·Ï·ÛÌ·ÏÔÁfiÓˆÓ ÚÔÛÙ·ÙÂ‡ÂÈ Ù· ÔÏ˘·ÎfiÚÂÛÙ·ÏÈ·Ú¿ ÔÍ¤· Î·È ÙÈ˜ ÏÈÔÚˆÙÂ˝ÓÂ˜ ¯·ÌËÏ‹˜ ˘-ÎÓfiÙËÙ·˜ (LDL) ·fi ÙËÓ ÔÍÂ›‰ˆÛË ÌÂ Û‡Á¯ÚÔÓËÎ·Ù·Ó¿ÏˆÛË ÙÔ˘ ‚ÈÓ˘Ï-·ÈıÂÚÈÎÔ‡ ‰ÂÛÌÔ‡ (15). ∏‰Ú¿ÛË ÙÔ˘˜ Â›Ó·È Û˘Ó·ÁˆÓÈÛÙÈÎ‹ Î·È ÚÔÛıÂÙÈÎ‹ÙË˜ ‰Ú¿ÛË˜ ÙË˜ ·-ÙÔÎÔÊÂÚfiÏË˜. Œ¯ÂÈ ‰Â ÚÔÙ·-ıÂ› ˆ˜ Ô ÚfiÏÔ˜ ÙˆÓ Ï·ÛÌ·ÏÔÁfiÓˆÓ ÛÙËÓ ÚÔ-ÛÙ·Û›· ¤Ó·ÓÙÈ ÙˆÓ ‰Ú·ÛÙÈÎÒÓ ÌÔÚÊÒÓ ÔÍ˘ÁfiÓÔ˘Â›Ó·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙfiÛÔ ÛËÌ·ÓÙÈÎfi˜, fiÛÔ Î·È ÙË˜ ·-ÙÔÎÔÊÂÚfiÏË˜ (16).

∆Ô ÔÍÂÈ‰ˆÙÈÎfi stress ·›˙ÂÈ ÂÍ·ÈÚÂÙÈÎ¿ ÛËÌ·ÓÙÈ-Îfi ÚfiÏÔ ÛÙËÓ ·ıÔÏÔÁ›· ÙÔ˘ ÓÂÔÁÓÔ‡. OÈ ‰Ú·ÛÙÈ-Î¤˜ ÌÔÚÊ¤˜ ÔÍ˘ÁfiÓÔ˘ ÂÓ¤¯ÔÓÙ·È ÛÙËÓ ˘ÔÍÈÎ‹/ÈÛ¯·ÈÌÈÎ‹ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·, ÙË ‚ÚÔÁ¯ÔÓÂ˘ÌÔÓÈÎ‹‰˘ÛÏ·Û›·, ÙËÓ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô¿ıÂÈ· ÙË˜ ÚÔ-ˆÚfiÙËÙ·˜, ÙË ÓÂÎÚˆÙÈÎ‹ ÂÓÙÂÚÔÎÔÏ›ÙÈ‰· Î.¿. (17).

∏ ·ÓÙÈÔÍÂÈ‰ˆÙÈÎ‹ ¿Ì˘Ó· ·ÔÙÂÏÂ›Ù·È ·fi ÂÍˆ-Î·È ÂÓ‰ÔÎ˘ÙÙ·ÚÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ Ô˘ ‰ÚÔ˘Ó Û˘-ÓÂÚÁ·ÙÈÎ¿ ÁÈ· Ó· ‰È·ÙËÚËıÂ› Ë ‚¤ÏÙÈÛÙË ÔÍÂÈ‰Ô·-Ó·ÁˆÁÈÎ‹ ÈÛÔÚÚÔ›· (9,17). ∆· Ï·ÛÌ·ÏÔÁfiÓ·,Û‡ÌÊˆÓ· ÌÂ Ù· Ì¤¯ÚÈ ÙÒÚ· ÂÚÂ˘ÓËÙÈÎ¿ ‰Â‰ÔÌ¤Ó·,Â›Ó·È ¤Ó·˜ ·fi ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÓÙÈÔÍÂÈ‰ˆÙÈÎÔ‡˜ ·-Ú¿ÁÔÓÙÂ˜. ∞Í›˙ÂÈ Ó· ÛËÌÂÈˆıÂ› ˆ˜ ÚfiˆÚ· ÓÂÔ-ÁÓ¿ ÌÂ ˘„ËÏ¤˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ Ï·ÛÌ·ÏÔÁfiÓˆÓÎ·È ÔÏ˘·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ ÛÂ ÙÚ·¯ÂÈ·Î¤˜ÂÎÎÚ›ÛÂÈ˜, Û¿ÓÈ· ·Ó·Ù‡ÛÛÔ˘Ó ‚ÚÔÁ¯ÔÓÂ˘ÌÔÓÈ-Î‹ ‰˘ÛÏ·Û›· (18).

∆Ô fiÛÔ Â˘¿ÏˆÙÔ˜ Â›Ó·È ¤Ó·˜ ÔÚÁ·ÓÈÛÌfi˜ ÛÙÔÔÍÂÈ‰ˆÙÈÎfi stress ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ·ÓÙÈÔÍÂÈ‰ˆÙÈ-Î‹ ÙÔ˘ ¿Ì˘Ó·, ·fi ÙÔ ÊÔÚÙ›Ô ÙÔ˘ ÔÍÂÈ‰ˆÙÈÎÔ‡stress, ·ÏÏ¿ Î·È ÙË ¯ËÌÈÎ‹ Û‡ÛÙ·ÛË ÙˆÓ ‰È·ÊfiÚˆÓÔÚÁ¿ÓˆÓ ÙÔ˘ ÙË Û˘ÁÎÂÎÚÈÌ¤ÓË ¯ÚÔÓÈÎ‹ ÛÙÈÁÌ‹(19). ∆· ¯·ÌËÏfiÙÂÚ· Â›Â‰· Ï·ÛÌ·ÏÔÁfiÓˆÓÔ˘ ‚Ú¤ıËÎ·Ó ÛÙË ÌÂÏ¤ÙË Ì·˜ ıÂˆÚÔ‡ÌÂ fiÙÈ ·Ô-

ÙÂÏÔ‡Ó ·Ú¿ÁÔÓÙ· ·˘ÍËÌ¤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ Î·È Î·ıÈ-ÛÙÔ‡Ó Ù· ÓÂÔÁÓ¿ ÈÔ Â˘¿ÏˆÙ· ÛÂ ÂÓ‰Â¯fiÌÂÓÔ ÔÍÂÈ-‰ˆÙÈÎfi stress.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Gould SJ, Raymond GV, Valle D. The peroxisome

biogenesis disorders. In: Scriver CR, Beaudet AL, SlyWS, Valle D, eds. Childs B, Kinzler KW, Vogelstein Bassoc. eds. The metabolic and molecular bases ofinherited diseases. 8th ed. New York: McGraw-Hill; 2001.p. 3181-3218.

2. Wanders RJA, Barth PG, Heymans HAS. Singleperoxisomal enzyme deficiencies. In: Scriver CR, BeaudetAL, Sly WS, Valle D, eds. Childs B, Kinzler KW, VogelsteinB assoc. eds. The metabolic and molecular bases ofinherited diseases. 8th ed. New York: McGraw-Hill; 2001.p. 3219-3256.

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4. ªÈ¯ÂÏ·Î¿ÎË ∂. ÀÂÚÔÍÂÈ‰ÈÔÛÒÌ·Ù·: µÈÔÁ¤ÓÂÛË, ¢ÔÌ‹,§ÂÈÙÔ˘ÚÁ›· Î·È ÀÂÚÔÍÂÈ‰ÈÔÛˆÌÈ·Î¿ ¡ÔÛ‹Ì·Ù·. °ÂÓÂÙÈÎ‹ÙÔ˘ ∞ÓıÚÒÔ˘ 1999;1:21-37.

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6. Glaser PE, Gross RW. Plasmenylethanolamine facilitatesrapid membrane fusion: a stopped-flow kinetic investigationcorrelating the propensity of a major plasma membraneconstituent to adopt an HII phase with its ability to promotemembrane fusion. Biochemistry 1994;33:5805-5812.

7. Duhm J, Engelman B, Schonthier UM, Streich S.Accelerated maximal velocity of the red blood cell Na+/K+

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8. Mandel H, Sharf R, Berant M, Wanders RJA, Vreken P,Aviram M. Plasmalogen phospholipids are involved inHDL-mediated cholesterol efflux: Insights frominvestigations with plasmalogen deficient cells. BiochemBiophys Res Commun 1998;250:369-373.

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10. °Î›Î· ∞, ª¿Ó‰˘Ï· ∂, ∞Ó·ÁÓˆÛÙ¿ÎË˜ ¢. ¡fiÛÔ˜ ÙˆÓ ÂÏÂ˘-ı¤ÚˆÓ ÚÈ˙ÒÓ ÔÍ˘ÁfiÓÔ˘ ÛÙË ÓÂÔÁÓÔÏÔÁ›·. ¢ÂÏÙ ∞’ ¶·È‰È·-ÙÚ ∫ÏÈÓ ¶·ÓÂ ∞ıËÓÒÓ 2000;47:139-147.

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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 18-01-2002HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 20-03-2002

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂Ï¤ÓË ªÈ¯ÂÏ·Î¿ÎË πÓÛÙÈÙÔ‡ÙÔ ÀÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” ∆.∫. 115 27, ∞ı‹Ó·E-mail: [email protected]

™ÎÔfi˜: ™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ó· ÂÎÙÈÌËıÂ› Ë ·ÚÔ˘Û›·ÂÓ‰Â›ÍÂˆÓ ÂÈÛÚfiÊËÛË˜ ÛÂ ÚÒËÓ ˘ÁÈ‹ ‚Ú¤ÊË ÌÂ ‚ÚÔÁ¯ÈÔÏ›ÙÈ-‰· ·fi Èfi ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Û˘ÁÎ˘Ù›Ô˘, Ù· ÔÔ›· ÂÌÊ¿ÓÈÛ·Ó Ù·-¯Â›· ÂÈ‰Â›ÓˆÛË ÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ÙÔ˘˜ ÏÂÈÙÔ˘ÚÁ›·˜. ÀÏÈÎfi Î·È Ì¤ıÔ‰Ô˜: O ‰Â›ÎÙË˜ ÙˆÓ ÏÈÔÂÈ‰ÒÓ Ì·ÎÚÔÊ¿ÁˆÓÂÎÙÈÌ‹ıËÎÂ ÛÂ ¤ÍÈ ÚÒËÓ ˘ÁÈ‹ ‚Ú¤ÊË ÌÂ ‚ÚÔÁ¯ÈÔÏ›ÙÈ‰· ·fi·Ó·ÓÂ˘ÛÙÈÎfi Û˘ÁÎ˘ÙÈ·Îfi Èfi Î·È ¯ˆÚ›˜ ÚÔËÁÔ‡ÌÂÓÔ ÈÛÙÔÚÈ-Îfi ÂÈÛÚfiÊËÛË˜, Ù· ÔÔ›· ·ÚÔ˘Û›·Û·Ó ÌÈ· ÔÏ‡ Ù·¯Â›· ÂÈ-‰Â›ÓˆÛË ÙË˜ Î·Ù¿ÛÙ·Û‹˜ ÙÔ˘˜, Ë ÔÔ›· ¯ÚÂÈ¿ÛÙËÎÂ ÌË¯·ÓÈÎfi·ÂÚÈÛÌfi. ∞ÔÙÂÏ¤ÛÌ·Ù·: ∆· ¤ÓÙÂ ·fi Ù· ¤ÍÈ ·È‰È¿ Â›¯·Ó ‰Â›ÎÙË ÏÈÔ-ÂÈ‰ÒÓ Ì·ÎÚÔÊ¿ÁˆÓ ¿Óˆ ·fi 100, Â›Â‰Ô Ô˘ Â›Ó·È ÔÏ‡ÂÓ‰ÂÈÎÙÈÎfi ÁÈ· ÂÈÛÚfiÊËÛË. ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ÂÈÛÚfiÊËÛË Â›Ó·È Èı·Ófi Ó· ·›˙ÂÈ ¤Ó· Úfi-

ÏÔ, fiÙ·Ó ÂÈÛ˘Ì‚·›ÓÂÈ Ù·¯Â›· ÂÈ‰Â›ÓˆÛË ÛÂ ·È‰È¿ ÌÂ ‚ÚÔÁ-¯ÈÔÏ›ÙÈ‰· ·fi ·Ó·ÓÂ˘ÛÙÈÎfi Û˘ÁÎ˘ÙÈ·Îfi Èfi.

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1Hernandez E, Khoshoo V, Thoppil D, Edell D,Ross G Aspiration: A factor in rapidly deterioratingbronchiolitis in previously healthy infants? Pediatr Pulmonol 2002;33:30-31

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Lipid and lipoprotein levels in children residing in west Thessaloniki area E. Papadopoulou - Alataki, K. Papadopoulou - Legmpelou, V. Koulourida


�¶ÂÚ›ÏË„Ë: ∏ ˘ÂÚÏÈÈ‰·ÈÌ›· Â›Ó·È ·fi ÙÔ˘˜ÛËÌ·ÓÙÈÎfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ·Ó¿Ù˘ÍË ·ıËÚˆÌ¿ÙˆÛË˜ Î·È Î·Ú‰È·ÁÁÂÈ·Î‹˜ÓfiÛÔ˘. ™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë ‰ÈÂÚÂ‡ÓËÛËÙÔ˘ ÏÈÈ‰ÔÁÚ¿ÌÌ·ÙÔ˜ ·È‰ÈÒÓ ÙˆÓ ‰˘ÙÈÎÒÓ Û˘ÓÔÈ-ÎÈÒÓ ÙË˜ £ÂÛÛ·ÏÔÓ›ÎË˜ Ì·˙› ÌÂ ÛÙÔÈ¯Â›· ·fi ÙÔÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Î·È ÙËÓ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË,ÒÛÙÂ Ó· ÂÍ·¯ıÔ‡Ó Û˘ÌÂÚ¿ÛÌ·Ù· ˆ˜ ÚÔ˜ ÙËÓ¤ÎÙ·ÛË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ ÛÙÔÓ ·È‰ÈÎfi ÏËı˘-ÛÌfi ÙË˜ ÂÚÈÔ¯‹˜ ·˘Ù‹˜. ∆Ô ˘ÏÈÎfi ÙË˜ ÌÂÏ¤ÙË˜·ÔÙ¤ÏÂÛ·Ó 171 ·È‰È¿ ËÏÈÎ›·˜ 3-16 ÂÙÒÓ, Ô˘ÚÔÛ‹Ïı·Ó ÛÙ· Ù·ÎÙÈÎ¿ ÂÍˆÙÂÚÈÎ¿ È·ÙÚÂ›·. ™ÂÎ¿ıÂ ·È‰› ¤ÁÈÓÂ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË, Î·Ù·ÁÚ·Ê‹ ÙÔ˘ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡, ˘ÔÏÔÁÈÛÌfi˜ ÙÔ˘ ¢Â›-ÎÙË ª¿˙·˜ ™ÒÌ·ÙÔ˜ (¢ª™) Î·È ÌÂÙÚ‹ıËÎ·Ó Ë ÔÏÈ-Î‹ ¯ÔÏËÛÙÂÚfiÏË (TC), Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· (TG),HDL- Î·È LDL-¯ÔÏËÛÙÂÚfiÏË, Ë ·ÔÏÈÔÚˆÙÂ˝ÓË∞-π (ApoA-π), Ë ·ÔÏÈÔÚˆÙÂ˝ÓË µ (ApoB) Î·È ËÏÈÔÚˆÙÂ˝ÓË (·) [Lp(a)] ÛÂ ÚˆÈÓfi ‰Â›ÁÌ· ÔÚÔ‡ÌÂÙ¿ 12ˆÚË ÓËÛÙÂ›·. ¢È·ÈÛÙÒıËÎ·Ó 1-5 ÌË ·Ô-‰ÂÎÙÔ› ÁÈ· ÙËÓ ËÏÈÎ›· ÙÔ˘˜ ÏÈÈ‰·ÈÌÈÎÔ› ‰Â›ÎÙÂ˜ ÛÂ31,5% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·È‰ÈÒÓ Î·È ÂÈ‰ÈÎfiÙÂÚ·:·) ÛÂ 57,1% ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ÌÂ ıÂÙÈÎfiÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, ‚) ÛÂ 52% ÙˆÓ ·È‰ÈÒÓ ÌÂÊ˘ÛÈÔÏÔÁÈÎfi µ™ Î·È ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈ-Îfi, Á) ÛÂ 31,6% ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ÌÂ ·Ú-ÓËÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Î·È ‰) ÛÂ 18,9% ÙˆÓ·È‰ÈÒÓ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi µ™ Î·È ·ÚÓËÙÈÎfi ÔÈÎÔÁÂ-ÓÂÈ·Îfi ÈÛÙÔÚÈÎfi. ∞fi ÙË Û‡ÁÎÚÈÛË ÌÂÙ·Í‡ ÙˆÓ·È‰ÈÒÓ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi µ™ ‚Ú¤ıËÎÂ fiÙÈ ·˘Ù¿Ô˘ Â›¯·Ó ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Â›¯·ÓÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¿ ·˘ÍËÌ¤ÓÂ˜ ÙÈÌ¤˜ TC Î·ÈLDL-C ÛÂ Û¯¤ÛË ÌÂ ·˘Ù¿ Ô˘ Â›¯·Ó ·ÚÓËÙÈÎfi ÔÈ-ÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi. O ¢ª™ ‚Ú¤ıËÎÂ fiÙÈ ¤¯ÂÈÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌfiÓÔ ÌÂÙ· Â›Â‰· ÙˆÓ TG. ŸÛÔÓ ·ÊÔÚ¿ ÛÙ· ·È‰È¿

�Abstract: Hyperlipidemia is one of the main riskfactors for the development of atherosclerosis andcardiovascular disease. The objective of this studywas to examine the lipid profile in children living inwest Thessaloniki areas and to assess the role ofobesity and positive family history in an attempt toevaluate the extent of the problem in this area. Westudied 171 children aged 3-16 years, who wereexamined on an outpatient basis. A completephysical examination was performed and the familyhistory was carefully recorded. Body Mass Index(BMI) was calculated for every child and serumlevels of total cholesterol (TC), triglycerides (TG),HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C),apolipoprotein A-I (ApoA-π), apolipoprotein B(ApoB) and lipoprotein (a) [Lp(a)] were obtainedfollowing an overnight fasting. Non acceptablelevels of 1-5 lipimic indices according to age wereobserved in 31.5% of all the children studied andparticularly: a) in 57.1% of obese children withpositive family history b) in 52% of the children withpositive family history and normal body weight c) in31.6% of obese children without positive history andd) in 18.9% of the children without predisposingfactors. Family history was found to be associatedwith TC and LDL-C (p<0.001), while BMI was foundto be positively correlated with TG (p<0.001).73.7% of children with a history of parentalhypercholesterolemia presented with hyper-lipidemia, mainly TC and LDL-C. Lipid disorders inchildren residing in west Thessaloniki area are veryfrequent, even among those who have a negativefamily history and normal Body Mass Index. It issuggested that lipid profile screening should beperformed in all children for the early detection andprompt management of dyslipidemia in childhood.

¶·È‰È·ÙÚÈÎfi ∆Ì‹Ì·, °¶ ¡ÔÛÔÎÔÌÂ›Ô “¶··ÁÂˆÚÁ›Ô˘”, £ÂÛÛ·ÏÔÓ›ÎË

Pediatric Division, General Peripheral Hospital“Papageorgiou”, Thessaloniki


™˘ÓÙÔÌÔÁÚ·Ê›Â˜ TC OÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏËTG ∆ÚÈÁÏ˘ÎÂÚ›‰È·LDL-C ÃÔÏËÛÙÂÚfiÏË ÏÈÔÚˆÙÂ˚ÓÒÓ ¯·ÌËÏ‹˜

˘ÎÓfiÙËÙ·˜HDL-C ÃÔÏËÛÙÂÚfiÏË ÏÈÔÚˆÙÂ˚ÓÒÓ ˘„ËÏ‹˜

˘ÎÓfiÙËÙ·˜ApoA-π ∞ÔÏÈÔÚˆÙÂ˝ÓË ∞-πApoB ∞ÔÏÈÔÚˆÙÂ˝ÓË µLp(a) §ÈÔÚˆÙÂ˝ÓË (·)¢ª™ ¢Â›ÎÙË˜ Ì¿˙·˜ ÛÒÌ·ÙÔ˜∂£ ∂Î·ÙÔÛÙÈ·›· ı¤ÛË§O §È·Ú¿ ÔÍ¤·NS ™Ù·ÙÈÛÙÈÎ¿ ÌË ÛËÌ·ÓÙÈÎfiµ™ µ¿ÚÔ˜ ÛÒÌ·ÙÔ˜

∂ÈÛ·ÁˆÁ‹ ∏ ·‡ÍËÛË ÙˆÓ ÏÈÈ‰›ˆÓ ÙÔ˘ ÔÚÔ‡ ÛÙËÓ ·È‰ÈÎ‹

ËÏÈÎ›· Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ÚÒÈÌË ¤Ó·ÚÍË ÙË˜ ·ıËÚˆ-Ì¿ÙˆÛË˜ Î·È ÙËÓ ÂÌÊ¿ÓÈÛË ÙË˜ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘(™¡) ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ (1). ¶·Ú¿ÁÔÓÙÂ˜ Ô˘ ÚÔ-‰È·ı¤ÙÔ˘Ó, Â›ÛË˜, ÛÙËÓ ÂÌÊ¿ÓÈÛË ·ıËÚˆÌ¿Ùˆ-ÛË˜ Â›Ó·È ÙÔ Î¿ÓÈÛÌ·, Ë ˘¤ÚÙ·ÛË, Ë ·¯˘Û·ÚÎ›·Î·È Ô Û·Î¯·ÚÒ‰Ë˜ ‰È·‚‹ÙË˜ (2-5).

Œ¯ÂÈ ‰È·ÈÛÙˆıÂ› fiÙÈ ÛÂ ÔÈÎÔÁ¤ÓÂÈÂ˜ Ô˘ ·-ÚÔ˘ÛÈ¿˙Ô˘Ó ˘„ËÏ‹ Û˘¯ÓfiÙËÙ· ™¡, ˘¿Ú¯ÂÈ Â›ÛË˜ÛÂ ˘„ËÏ‹ Û˘¯ÓfiÙËÙ· ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· (2,6).OÈ ÏÈÔÚˆÙÂ˝ÓÂ˜ Ê·›ÓÂÙ·È fiÙÈ ·›˙Ô˘Ó ÛÔ˘‰·›ÔÚfiÏÔ ÛÙËÓ ÂÍ¤ÏÈÍË ÙË˜ ·ıËÚˆÌ·ÙÈÎ‹˜ ‰È·‰ÈÎ·Û›·˜.OÈ ·˘ÍËÌ¤ÓÂ˜ ÙÈÌ¤˜ ÙˆÓ LDL-ÏÈÔÚˆÙÂ˚ÓÒÓ Ô˘Â›Ó·È ‚·ÛÈÎÔ› ÊÔÚÂ›˜ ÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜ ÛÙÔ ·›Ì·Î·È ÔÈ ÂÏ·ÙÙˆÌ¤ÓÂ˜ ÙÈÌ¤˜ ÙˆÓ HDL-ÏÈÔÚˆÙÂ˚ÓÒÓ·˘Í¿ÓÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛË˜ ÛÙÂÊ·ÓÈ·›·˜ Ófi-ÛÔ˘ (6). OÈ LDL ÌÂÙ·Ê¤ÚÔ˘Ó ÙË ¯ÔÏËÛÙÂÚfiÏË Î·ÈÙËÓ ÂÈÛ¿ÁÔ˘Ó ÛÙÔ˘˜ ÂÚÈÊÂÚÈÎÔ‡˜ ÈÛÙÔ‡˜ ‰È·Ì¤-ÛÔ˘ ÙˆÓ ApoB100 Ô˘ ÂÈ‰ÚÔ‡Ó ÛÙÔ˘˜ ·ÓÙ›ÛÙÔÈ-¯Ô˘˜ ˘Ô‰Ô¯Â›˜. ªÂÙ·ÏÏ·Á‹ ÙÔ˘ ÁÔÓÈ‰›Ô˘ ÙˆÓ˘Ô‰Ô¯¤ˆÓ ÙË˜ LDL Ô‰ËÁÂ› ÛÂ ÏËÌÌÂÏ‹ ‹ ÌËÚfiÛÏË„Ë ÙˆÓ ÌÔÚ›ˆÓ LDL, ÌÂ Û˘Ó¤ÂÈ· ÙËÓ ·‡-

ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘˜ Î·È ÙËÓ ÔÍÂÈ‰ˆÙÈÎ‹ ÙÔ˘˜ÙÚÔÔÔ›ËÛË (7). ∞ÎfiÌË, Ô Ú˘ıÌfi˜ ÚfiÛÏË„Ë˜ÙË˜ LDL ·fi ÙÔ˘˜ ÈÛÙÔ‡˜ ÂÍ·ÚÙ¿Ù·È Î˘Ú›ˆ˜ ·fiÙËÓ ÂÓ‰ÔÎ˘ÙÙ¿ÚÈ· ¯ÔÏËÛÙÂÚfiÏË Ô˘ Ú˘ıÌ›˙ÂÈ ÙË‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ LDL ˘Ô‰Ô¯¤ˆÓ. ∏ ÚfiÛÏË„ËÎÂÎÔÚÂÛÌ¤ÓˆÓ ÏÈÒÓ Î·Ù·ÛÙ¤ÏÏÂÈ ·˘Ù‹ ÙË ‰Ú·-ÛÙËÚÈfiÙËÙ· Î·È, Û˘ÓÂÒ˜, ÙËÓ ·fiÛ˘ÚÛË ÙË˜ ¯Ô-ÏËÛÙÂÚfiÏË˜ (8).

OÈ ÈÔ ÚfiÛÊ·ÙÂ˜ ÌÂÏ¤ÙÂ˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÛÙËÌÂÏ¤ÙË ÙÔ˘ ÏÈÈ‰ÔÁÚ¿ÌÌ·ÙÔ˜ ÙË Ì¤ÙÚËÛË ÙˆÓ ·Ô-ÏÈÔÚˆÙÂ˚ÓÒÓ ∞-π Î·È µ, Î·ıÒ˜ Â›ÛË˜ ÙË˜ ÏÈÔ-ÚˆÙÂ˝ÓË˜ (·) [Lp(a)]. ∏ ·ÔÏÈÔÚˆÙÂ˝ÓË µ Ô˘Â›Ó·È Ô ÌÂÙ·ÊÔÚ¤·˜ ÙË˜ LDL ¯ÔÏËÛÙÂÚfiÏË˜ Î·È Ë·ÔÏÈÔÚˆÙÂ˝ÓË ∞-π, Ô ÌÂÙ·ÊÔÚ¤·˜ ÙË˜ HDL ¯Ô-ÏËÛÙÂÚfiÏË˜, ıÂˆÚÔ‡ÓÙ·È ÈÔ ÂÍÂÈ‰ÈÎÂ˘Ì¤ÓÔÈ ‰Â›-ÎÙÂ˜ ÁÈ· ÙËÓ ÚfiÏË„Ë ÙË˜ ™¡. ∞Ó Î·È Ë ÏÂÈÙÔ˘ÚÁ›·ÙË˜ ÏÈÔÚˆÙÂ˝ÓË˜ (·) ‰ÂÓ Â›Ó·È Ï‹Úˆ˜ ÂÍ·ÎÚÈ-‚ˆÌ¤ÓË, Ê·›ÓÂÙ·È fiÙÈ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓ Î·Ú‰È·Î‹ÚÔÛ‚ÔÏ‹, ÙË ÛÙ¤ÓˆÛË ÙˆÓ ·ÚÙËÚÈÒÓ Î·È ÙËÓ Â·-Ó·ÛÙ¤ÓˆÛË ÙˆÓ ·ÁÁÂ›ˆÓ ÌÂÙ¿ ·fi ÂÁ¯Â›ÚËÛË by-pass Î·È ·Ó·ÁÓˆÚ›˙ÂÙ·È Û·Ó ¤Ó·˜ ·ÓÂÍ¿ÚÙËÙÔ˜·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ™¡ (9,10). ∞˘ÍËÌ¤Ó·Â›Â‰· ÙË˜ Lp(a) ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËıÂ› ÁÈ· ÙËÓ ÂÌ-Ê¿ÓÈÛË ÙË˜ ·ıËÚˆÌ¿ÙˆÛË˜ Î·È ÂÁÎÂÊ·ÏÈÎÒÓÂÂÈÛÔ‰›ˆÓ (11-13).

∆· ·ÓˆÙ¤Úˆ ‰Â‰ÔÌ¤Ó· Ô‰ËÁÔ‡Ó ÛÙÔ Û˘Ì¤Ú·-ÛÌ· fiÙÈ Ë ·Ó›¯ÓÂ˘ÛË ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÙˆÓ ÏÈÈ‰›ˆÓÎ·È Ë ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ ÌÔÚÂ› Ó· ÂÈ‚Ú·‰‡ÓÂÈÙËÓ ÂÍ¤ÏÈÍË ÙË˜ ·ıËÚˆÌ¿ÙˆÛË˜. ∏ ÚfiÏË„Ë Ô˘ÚÔÙÂ›ÓÂÙ·È ·fi ÙËÓ ∂ÈÙÚÔ‹ ¢È·ÙÚÔÊ‹˜ ÙË˜∞ÌÂÚÈÎ·ÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ ∞Î·‰ËÌ›·˜ (∞∞P) Û˘ÓÈ-ÛÙ¿ Ó· Á›ÓÂÙ·È ÂÈÏÂÎÙÈÎ¿ ÚÔÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ÙˆÓ ÏÈÈ‰›ˆÓ ÛÂ ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚ· ÙˆÓ 2 ÂÙÒÓ,fiÙ·Ó ˘¿Ú¯ÂÈ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÚÒÈÌË˜ ÂÎ-‰‹ÏˆÛË˜ Î·Ú‰È·ÁÁÂÈ·Î‹˜ ÓfiÛÔ˘ (¤ÌÊÚ·ÁÌ· ‹ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ ÛÂ Û˘ÁÁÂÓ‹ 1Ô˘ ‹ 2Ô˘ ‚·ı-ÌÔ‡ ÛÂ ËÏÈÎ›· <55 ÂÙÒÓ) ‹/Î·È ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·È-Ì›·˜ ÛÂ ¤Ó·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÔÓ¤· (ÔÏÈÎ‹ ¯ÔÏËÛÙÂ-ÚfiÏË >240 mg/dl) (14,15).


266

ÁÔÓ¤ˆÓ Ô˘ ¿Û¯Ô˘Ó ·fi ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·,‰È·ÈÛÙÒıËÎÂ ˘ÂÚÏÈÈ‰·ÈÌ›· ÛÂ ÔÛÔÛÙfi 73,7%,ÌÂ Î‡ÚÈ· ·‡ÍËÛË ÙˆÓ TC Î·È LDL-C. OÈ ‰È·Ù·Ú·-¯¤˜ ÙˆÓ ÏÈÈ‰›ˆÓ ÛÙ· ·È‰È¿ ÙË˜ ‰˘ÙÈÎ‹˜ £ÂÛÛ·-ÏÔÓ›ÎË˜ Â›Ó·È ÔÏ‡ Û˘¯Ó¤˜, ·ÎfiÌË Î·È ÌÂÙ·Í‡ ·˘-ÙÒÓ ÌÂ ÂÏÂ‡ıÂÚÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Î·È Ê˘-ÛÈÔÏÔÁÈÎfi ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜. ∫Ú›ÓÂÙ·È ÛÎfiÈÌÔ ÔÚÔÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÏÈÈ‰›ˆÓ Ó· ¤¯ÂÈ Â˘Ú‡-ÙÂÚË ÂÊ·ÚÌÔÁ‹ ÛÙ· ·È‰È¿, ÌÂ ÛÙfi¯Ô ÙËÓ ÚÒÈÌË·Ó›¯ÓÂ˘ÛË Î·È ¤ÁÎ·ÈÚË ·Ú¤Ì‚·ÛË Î·Ù¿ ÙË˜ ·ıË-ÚˆÌ¿ÙˆÛË˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÏÈ›‰È·, ÏÈÔÚˆÙÂ˝ÓÂ˜, ÔÈÎÔÁÂ-ÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, ·¯˘Û·ÚÎ›·.

Key words: lipids, lipoproteins, family history,obesity.



267

¢È¿ÊÔÚÂ˜ ÌÂÏ¤ÙÂ˜, fiÌˆ˜, ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë·Ó›¯ÓÂ˘ÛË ÙË˜ ÚÒÈÌË˜ ÂÎ‰‹ÏˆÛË˜ ™¡ ‰ÂÓ ÌÔÚÂ›Ó· ‚·ÛÈÛÙÂ› ÌfiÓÔ ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÙË˜˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜, ‰ÈfiÙÈ ¤ÙÛÈ ‰ÂÓ ·ÓÈ¯ÓÂ‡ÂÙ·È¤Ó·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ·È‰ÈÒÓ ÌÂ ·˘ÍËÌ¤ÓÂ˜ ÙÈ-Ì¤˜ ¯ÔÏËÛÙÂÚfiÏË˜ (16-20). °È’ ·˘Ùfi, ÙÔ NCEP(National Cholesterol Education Program forChildren and Adolescents) ‰ËÌÔÛ›Â˘ÛÂ Ô‰ËÁ›Â˜ ÁÈ·ÙËÓ ·Ó›¯ÓÂ˘ÛË ·È‰ÈÒÓ ÌÂ ˘„ËÏfi Î›Ó‰˘ÓÔ Ó· ·Ó·-Ù‡ÍÔ˘Ó ™¡. ™‡ÌÊˆÓ· ÌÂ ·˘Ù¤˜, ÂÎÙfi˜ ·fi ÙÈ˜ÚÔ·Ó·ÊÂÚıÂ›ÛÂ˜ ÂÓ‰Â›ÍÂÈ˜, ÂÏ¤Á¯ÔÓÙ·È ÁÈ· Èı·Ó‹˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ·È‰È¿ ÛÙ· ÔÔ›· ‰ÂÓ ÌÔÚÂ›Ó· ·ÓÈ¯ÓÂ˘ıÂ› ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‹ ˘¿Ú¯Ô˘ÓÂÈÚfiÛıÂÙ· ¿ÏÏÔÈ ·Ú¿ÁÔÓÙÂ˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ÁÈ· ™¡, fiˆ˜ ·¯˘Û·ÚÎ›·, Î¿ÓÈÛÌ·, ·˘ÍËÌ¤ÓËÚfiÛÏË„Ë ÏÈ·ÚÒÓ Î·È ¯ÔÏËÛÙÂÚfiÏË˜, ÈÛÙÔÚÈÎfiÛ·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË ‹ ˘¤ÚÙ·ÛË˜ (21).

™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë ‰ÈÂÚÂ‡-ÓËÛË ÙÔ˘ ÏÈÈ‰ÔÁÚ¿ÌÌ·ÙÔ˜ ·È‰ÈÒÓ ÙˆÓ ‰˘ÙÈÎÒÓÛ˘ÓÔÈÎÈÒÓ ÙË˜ £ÂÛÛ·ÏÔÓ›ÎË˜ Ì·˙› ÌÂ ÛÙÔÈ¯Â›· ·fiÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Î·È ÙËÓ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË,ÒÛÙÂ Ó· ÂÍ·¯ıÔ‡Ó Û˘ÌÂÚ¿ÛÌ·Ù· ˆ˜ ÚÔ˜ ÙËÓ¤ÎÙ·ÛË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfiÙË˜ ÂÚÈÔ¯‹˜ ·˘Ù‹˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ªÂÏÂÙ‹ıËÎ·Ó 171 ·È‰È¿ (84 ·ÁfiÚÈ·, 87 ÎÔÚ›ÙÛÈ·) ·fi

Ù· 800 Ó¤· ·È‰È¿ Ô˘ ÚÔÛ‹Ïı·Ó ÛÙ· ∆·ÎÙÈÎ¿ ∂ÍˆÙÂÚÈÎ¿π·ÙÚÂ›· ÙÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘ Î·Ù¿ ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·fiÙÔÓ π·ÓÔ˘¿ÚÈÔ Ì¤¯ÚÈ ÙÔ ¢ÂÎ¤Ì‚ÚÈÔ 2001, ÁÈ· ÔÈÎ›ÏÂ˜ ·È-Ù›Â˜. ∏ ËÏÈÎ›· ÙÔ˘˜ Î˘Ì·›ÓÔÓÙ·Ó ·fi 3 ¤ˆ˜ 16 ¤ÙË (Ì¤ÛËËÏÈÎ›· 9,3 ± 3,5 ¤ÙË). ∞fi ÙË ÌÂÏ¤ÙË ·ÔÎÏÂ›ÛÙËÎ·Ó ·È-‰È¿ Ô˘ Â›¯·Ó ÚfiÛÊ·ÙÔ ÂÌ‡ÚÂÙÔ ‹ ¤·ÈÚÓ·Ó Ê¿ÚÌ·Î·,Î·ıÒ˜ Â›ÛË˜ ·È‰È¿ ÌÂ ÓÔÛ‹Ì·Ù· ÙÔ˘ ‹·ÙÔ˜, ÙˆÓ ÓÂ-ÊÚÒÓ ‹ ÙÔ˘ ı˘ÚÂÔÂÈ‰‹. O ÛÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ÂÍËÁ‹ıË-ÎÂ ÛÙÔ˘˜ ÁÔÓÂ›˜ Î·È Ù· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Î·È ‹Ù·Ó fiÏÔÈÛ‡ÌÊˆÓÔÈ.

™Â fiÏ· Ù· ·È‰È¿ ¤ÁÈÓÂ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË, Î·Ù·ÁÚ·Ê‹ ÙÔ˘ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡, Ì¤ÙÚËÛË ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ·Ú·Ì¤ÙÚˆÓ (‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜, Ì‹ÎÔ˜ ÛÒÌ·ÙÔ˜ Î·È ‰Â›ÎÙË˜Ì¿˙·˜ ÛÒÌ·ÙÔ˜), Ì¤ÙÚËÛË ÙË˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ Î·È Ï‹„ËËÏÂÎÙÚÔÎ·Ú‰ÈÔÁÚ·Ê‹Ì·ÙÔ˜.

∆Ô ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ıÂˆÚ‹ıËÎÂ ıÂÙÈÎfi fiÙ·Ó ˘‹Ú-¯Â ¤ÌÊÚ·ÁÌ· ‹ ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ ÛÙÔ˘˜ Û˘ÁÁÂÓÂ›˜ÚÒÙÔ˘ ‹ ‰Â‡ÙÂÚÔ˘ ‚·ıÌÔ‡ ÛÂ ËÏÈÎ›· <55 ÂÙÒÓ ‹ ·‡ÍËÛËÙË˜ ÔÏÈÎ‹˜ ¯ÔÏËÛÙÂÚfiÏË˜ >240 mg/dl (14,15). O ‰Â›ÎÙË˜Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) ˘ÔÏÔÁ›ÛÙËÎÂ ·fi ÙÔ ËÏ›ÎÔ ÙÔ˘ ‚¿-ÚÔ˘˜ ÛÒÌ·ÙÔ˜ (µ™) ÛÂ kg ‰È¿ ÙÔ˘ ‡„Ô˘˜ ÛÂ m ÛÙÔ ÙÂÙÚ¿-ÁˆÓÔ (BMI=kg/m2). ¶·¯‡Û·ÚÎ· ıÂˆÚ‹ıËÎ·Ó Ù· ·È‰È¿ Î·ÈÔÈ ¤ÊË‚ÔÈ ÌÂ ¢ª™ >95Ë ÂÎ·ÙÔÛÙÈ·›· ı¤ÛË ÁÈ· ÙËÓ ËÏÈÎ›· Î·ÈÙÔ Ê‡ÏÔ ÙÔ˘˜, Û‡ÌÊˆÓ· ÌÂ ÂÈ‰ÈÎ¿ ÓÔÚÌÔÁÚ¿ÌÌ·Ù· (22).

∆· ·È‰È¿ ÙË˜ ÌÂÏ¤ÙË˜ Ù·ÍÈÓÔÌ‹ıËÎ·Ó ÛÂ 4 ÔÌ¿‰Â˜, ·Ó¿-ÏÔÁ· ÌÂ ÙÔ ¢ª™ Î·È ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, ˆ˜ ÂÍ‹˜: ËÔÌ¿‰· ∞ ÂÚÈÂÏ¿Ì‚·ÓÂ 19 ·È‰È¿ Ô˘ ‹Ù·Ó ·¯‡Û·ÚÎ· ÌÂ

·ÚÓËÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, Ë ÔÌ¿‰· µ ÂÚÈÂÏ¿Ì‚·ÓÂ 7·È‰È¿ Ô˘ ‹Ù·Ó ·¯‡Û·ÚÎ· ÌÂ ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈ-Îfi, Ë ÔÌ¿‰· ° ÂÚÈÂÏ¿Ì‚·ÓÂ 50 ·È‰È¿ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi µ™Î·È ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Î·È Ë ÔÌ¿‰· ¢ ÂÚÈÂÏ¿Ì-‚·ÓÂ 95 ·È‰È¿ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi µ™ Î·È ·ÚÓËÙÈÎfi ÔÈÎÔÁÂÓÂÈ·-Îfi ÈÛÙÔÚÈÎfi.

™Â ÚˆÈÓfi ‰Â›ÁÌ· ·›Ì·ÙÔ˜ ÌÂÙ¿ 12ˆÚË ÓËÛÙÂ›· ÚÔÛ-‰ÈÔÚ›ÛÙËÎ·Ó: ÔÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË (TC), ÙÚÈÁÏ˘ÎÂÚ›‰È· (TG),HDL ¯ÔÏËÛÙÂÚfiÏË (HDL-C), LDL ¯ÔÏËÛÙÂÚfiÏË (LDL-C),·ÔÏÈÔÚˆÙÂ˝ÓË ∞-π (ApoA-π), ·ÔÏÈÔÚˆÙÂ˝ÓË µ (ApoB),ÏÈÔÚˆÙÂ˝ÓË (·) [Lp(a)] Î·È ·ıËÚˆÌ·ÙÈÎfi˜ ‰Â›ÎÙË˜. OÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜, ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ Î·ÈÙË˜ HDL-¯ÔÏËÛÙÂÚfiÏË˜ ¤ÁÈÓÂ ÌÂ ÂÓ˙˘Ì·ÙÈÎ‹ ¯ÚˆÌ·ÙÔÌÂÙÚÈ-Î‹ Ì¤ıÔ‰Ô, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙÔÓ ·˘ÙfiÌ·ÙÔ ‚ÈÔ¯ËÌÈÎfi ·Ó·-Ï˘Ù‹ Olympus Au 560 Î·È Olympus Au 400 ÙË˜ ÂÙ·ÈÚÂ›·˜Medicon. H ÙÈÌ‹ ÙË˜ LDL-¯ÔÏËÛÙÂÚfiÏË˜ ˘ÔÏÔÁ›ÛÙËÎÂ ÌÂ‚¿ÛË ÙÔÓ Ù‡Ô Friedewald: (¯ÔÏËÛÙÂÚfiÏË-ÙÚÈÁÏ˘ÎÂÚ›‰È·/5)-HDL Î·È ÙÔ˘ ·ıËÚˆÌ·ÙÈÎÔ‡ ‰Â›ÎÙË ÌÂ ‚¿ÛË ÙÔ ËÏ›ÎÔ ¯ÔÏË-ÛÙÂÚfiÏË/HDL-C. OÈ ApoA-π, ApoB Î·È Lp(a) ÚÔÛ‰ÈÔÚ›ÛÙË-Î·Ó ÌÂ ·ÓÔÛÔÓÂÊÂÏÔÌÂÙÚ›·, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙÔ ÓÂÊÂÏfiÌÂ-ÙÚÔ Beckman Array 360 System. ŸÏÔÈ ÔÈ ÚÔÛ‰ÈÔÚÈÛÌÔ› ¤ÁÈ-Ó·Ó Ì¤Û· ÛÂ ‰‡Ô ¤ˆ˜ ÂÙ¿ ËÌ¤ÚÂ˜ ·fi ÙËÓ ·ÈÌÔÏË„›· Î·È ÔÈÔÚÔ› ÙÔ˘ ·›Ì·ÙÔ˜ Ê˘Ï¿¯ıËÎ·Ó ÛÂ Î·Ù¿„˘ÍË ÛÙÔ˘˜ -20ÔC¤ˆ˜ -50ÔC.

∏ ·ÍÈÔÏfiÁËÛË ÙˆÓ ÙÈÌÒÓ ÙˆÓ ÏÈÈ‰›ˆÓ Î·È ÏÈÔÚˆÙÂ˚-ÓÒÓ ¤ÁÈÓÂ Û‡ÌÊˆÓ· ÌÂ ÚÔËÁÔ‡ÌÂÓÂ˜ ÂÏÏËÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ÙˆÓ ∫·‚·˙·Ú¿ÎË Î·È Û˘Ó (1998), ∆ÛfiÏ· Î·È Û˘Ó (1999) Î·ÈShulpis Î·È Û˘Ó (1998) ÛÂ ÌÂÁ¿ÏÔ˘˜ ·È‰È·ÙÚÈÎÔ‡˜ ÏËı˘-ÛÌÔ‡˜ (23-25). OÈ Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÙÈÌ¤˜ ÌÂ ÙÈ˜ ÂÎ·ÙÔÛÙÈ·›Â˜ı¤ÛÂÈ˜ (∂£) ·Ó¿ ËÏÈÎ›· Î·È Ê‡ÏÔ ·ÔÙ¤ÏÂÛ·Ó ÛËÌÂ›Ô ·Ó·-ÊÔÚ¿˜ ÁÈ· ÙËÓ ·Ó›¯ÓÂ˘ÛË ·ıÔÏÔÁÈÎÒÓ ÙÈÌÒÓ ÛÙ· ·È‰È¿ ÙË˜ÌÂÏ¤ÙË˜ Ì·˜. ø˜ fiÚÈÔ ·Ô‰ÂÎÙÒÓ ÙÈÌÒÓ ıÂˆÚ‹ıËÎÂ Ë 75Ë∂£ ÁÈ· ÙËÓ TC, TG, LDL-C Î·È ApoB Î·È Ë 25Ë ∂£ ÁÈ· ÙËÓHDL-C Î·È ApoA-π, Û‡ÌÊˆÓ· ÌÂ ÙË ÌÂÏ¤ÙË ÙˆÓ ∫·‚·˙·Ú¿ÎËÎ·È Û˘Ó (1998).

¶·ıÔÏÔÁÈÎ¤˜ ÙÈÌ¤˜ ÁÈ· ÙË ÏÈÔÚˆÙÂ˝ÓË (·) ıÂˆÚ‹ıËÎ·ÓÙÈÌ¤˜ ˘„ËÏfiÙÂÚÂ˜ ·fi ·˘Ù¤˜ Ô˘ ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙËÓ 95Ë ∂£ÁÈ· ÙËÓ ËÏÈÎ›· Î·È ÙÔ Ê‡ÏÔ Î·È ÔˆÛ‰‹ÔÙÂ ÙÈÌ‹ ÌÂÁ·Ï‡ÙÂ-ÚË ·fi 30 mg/dl (9,10). ø˜ ‰˘ÛÏÈÈ‰·ÈÌ›· ıÂˆÚ‹ıËÎÂ Ë‡·ÚÍË ÌË ·Ô‰ÂÎÙ‹˜ ÙÈÌ‹˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÈ· ¤Ó·Ó ·fi ÙÔ˘˜ÏÈÈ‰·ÈÌÈÎÔ‡˜ ‰Â›ÎÙÂ˜ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó.

™Ù·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË∏ ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ¤ÁÈÓÂ ÌÂ ÙË ‚Ô‹ıÂÈ· ËÏÂÎÙÚÔÓÈ-

ÎÔ‡ ˘ÔÏÔÁÈÛÙ‹ (∏/À) Î·È ÌÂ ÙÔ ÛÙ·ÙÈÛÙÈÎfi ÚfiÁÚ·ÌÌ·SPSS 10.0. ∏ ‰È·‰ÈÎ·Û›· ÙË˜ ÛÙ·ÙÈÛÙÈÎ‹˜ ·Ó¿Ï˘ÛË˜ ÂÚÈÂ-Ï¿Ì‚·ÓÂ ˘ÔÏÔÁÈÛÌfi ÁÈ· Î¿ıÂ ÌÂÙ·‚ÏËÙ‹ ÙË˜ Ì¤ÛË˜ ÙÈÌ‹˜(mean) Î·È ÙË˜ Ù˘ÈÎ‹˜ ·fiÎÏÈÛË˜ (SD).

∏ Û‡ÁÎÚÈÛË ÙˆÓ ÏÈÈ‰›ˆÓ Î·È ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ·-Ú·Ì¤ÙÚˆÓ ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ ¤ÁÈÓÂ ÌÂ t-test. ∏ Û˘Û¯¤ÙÈ-ÛË ÙˆÓ ·Ú·Ì¤ÙÚˆÓ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·ÛıÂÓÒÓ ¤ÁÈÓÂ ÌÂ ÙËÛÙ·ÙÈÛÙÈÎ‹ Ì¤ıÔ‰Ô Pearson, ÂÓÒ ÁÈ· ÙË Û‡ÁÎÚÈÛË ÙˆÓ ·-Ú·Ì¤ÙÚˆÓ ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÌË ·-Ú·ÌÂÙÚÈÎ‹ Ì¤ıÔ‰Ô˜ Mann Whitney. ø˜ fiÚÈÔ ÛÙ·ÙÈÛÙÈÎ‹˜ ÛË-Ì·ÓÙÈÎfiÙËÙ·˜ ıÂˆÚ‹ıËÎÂ Ë ÙÈÌ‹ p<0,05.


∞ÔÙÂÏ¤ÛÌ·Ù·∞fi ÙË Û‡ÁÎÚÈÛË ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ·Ú·-

Ì¤ÙÚˆÓ Î·È ÙˆÓ ÙÈÌÒÓ ÙˆÓ ÏÈÈ‰›ˆÓ ÌÂÙ·Í‡ ÙˆÓ‰‡Ô Ê‡ÏˆÓ ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈ-Î‹ ‰È·ÊÔÚ¿ (¶›Ó·Î·˜ 1), ÁÈ’ ·˘Ùfi fiÏÔÈ ÔÈ ÂÚ·ÈÙ¤-Úˆ ˘ÔÏÔÁÈÛÌÔ› ¤ÁÈÓ·Ó ÌÂÙ¿ ·fi ÔÌ·‰ÔÔ›ËÛËÙˆÓ ‰‡Ô Ê‡ÏˆÓ.

Ÿˆ˜ Ê·›ÓÂÙ·È Î·È ÛÙÔÓ ¶›Ó·Î· 2, ÙÔ 15,2%ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó ·¯‡Û·ÚÎ· (ÂÎ ÙˆÓ ÔÔ›ˆÓ ÙÔ11,1% Â›¯Â ·ÚÓËÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Î·È ÙÔ4,1% Â›¯Â ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi), ÂÓÒ ÙÔ29,2% ÙˆÓ ·È‰ÈÒÓ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi µ™ Â›¯Â ıÂÙÈÎfiÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Î·È ÙÔ 55,6% Â›¯Â ·ÚÓËÙÈÎfiÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi. ∞fi Ù· 171 ·È‰È¿ ÙË˜ ÌÂ-Ï¤ÙË˜ Ù· 54 (31,5%) Â›¯·Ó 1-5 ÌË ·Ô‰ÂÎÙÔ‡˜ ÁÈ·ÙËÓ ËÏÈÎ›· ÙÔ˘˜ ÏÈÈ‰·ÈÌÈÎÔ‡˜ ‰Â›ÎÙÂ˜. ∆Ô ÌÂÁ·Ï‡-ÙÂÚÔ ÔÛÔÛÙfi ÌË ·Ô‰ÂÎÙÒÓ ÙÈÌÒÓ Â›¯·Ó Ù· ·È-‰È¿ ÌÂ ·¯˘Û·ÚÎ›· Î·È ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔ-ÚÈÎfi (57,1%), ·ÎÔÏÔ˘ıÔ‡Û·Ó Ù· ·È‰È¿ ÌÂ Ê˘ÛÈÔ-ÏÔÁÈÎfi µ™ Î·È ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi (52%),Ë ÔÌ¿‰· ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ÌÂ ·ÚÓËÙÈÎfi ÔÈ-ÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi (31,6%) Î·È Ù¤ÏÔ˜ Ë ÔÌ¿‰·ÙˆÓ ·È‰ÈÒÓ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi µ™ Î·È ·ÚÓËÙÈÎfi ÔÈ-ÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi (18,9%).

∏ Ì¤ÛË ÙÈÌ‹ ÙˆÓ ÏÈÈ‰›ˆÓ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓÙÔ˘ ÔÚÔ‡ ÛÂ Î¿ıÂ ÔÌ¿‰· Ê·›ÓÂÙ·È ·Ó·Ï˘ÙÈÎ¿ ÛÙÔÓ¶›Ó·Î· 3. ∞fi ÙË ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ÙˆÓ ·ÓˆÙ¤-Úˆ ÙÈÌÒÓ ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ ‰È·ÈÛÙÒıËÎÂ fiÙÈ Ù··È‰È¿ ÙË˜ ÔÌ¿‰·˜ ∞ (·¯‡Û·ÚÎ· ÌÂ ·ÚÓËÙÈÎfi ÔÈ-

ÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi) ¤¯Ô˘Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¿·˘ÍËÌ¤Ó· Â›Â‰· TG ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙËÓ ÔÌ¿‰·¢ (Ê˘ÛÈÔÏÔÁÈÎÔ‡ µ™ Î·È ÌÂ ·ÚÓËÙÈÎfi ÔÈÎÔÁÂÓÂÈ·ÎfiÈÛÙÔÚÈÎfi) (p<0,004) Î·È ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¿ ·˘-ÍËÌ¤ÓË Lp(a) ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙËÓ ÔÌ¿‰· µ (·¯‡-Û·ÚÎ· ÌÂ ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi) (p<0,02).

∆· ·È‰È¿ ÙË˜ ÔÌ¿‰·˜ µ (·¯‡Û·ÚÎ· ÌÂ ıÂÙÈÎfiÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi) ¤¯Ô˘Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈ-Î¿ ÂÏ·ÙÙˆÌ¤ÓË ApoA-I (p<0,04) Î·È ÛÙ·ÙÈÛÙÈÎ¿ÛËÌ·ÓÙÈÎ¿ ·˘ÍËÌ¤ÓË Lp(a) (p<0,005) ÛÂ Û‡ÁÎÚÈÛËÌÂ ÙËÓ ÔÌ¿‰· ° (Ê˘ÛÈÔÏÔÁÈÎÔ‡ µ™ ÌÂ ıÂÙÈÎfi ÔÈÎÔ-ÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi) Î·È ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙËÓ ÔÌ¿‰·¢ (Ê˘ÛÈÔÏÔÁÈÎÔ‡ µ™ ÌÂ ·ÚÓËÙÈÎfi ÔÈÎÔÁÂÓÂÈ·ÎfiÈÛÙÔÚÈÎfi) (p<0,04).

∆· ·È‰È¿ ÙË˜ ÔÌ¿‰·˜ ° (Ê˘ÛÈÔÏÔÁÈÎÔ‡ µ™ ÌÂıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi) ¤¯Ô˘Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛË-Ì·ÓÙÈÎ¿ ·˘ÍËÌ¤ÓÂ˜ ÙÈÌ¤˜ TC Î·È LDL-C ÛÂ Û‡ÁÎÚÈÛËÌÂ ÙËÓ ÔÌ¿‰· ¢ (Ê˘ÛÈÔÏÔÁÈÎÔ‡ µ™ ÌÂ ·ÚÓËÙÈÎfi ÔÈ-ÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi) (p<0,004) (¶›Ó·Î·˜ 4).

∏ ‰ÔÎÈÌ·Û›· Pearson ¤‰ÂÈÍÂ fiÙÈ ˘¿Ú¯ÂÈ ıÂÙÈÎ‹Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙÔ˘ ¢ª™ Î·È ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ-‰›ˆÓ (r=0,28, p<0,001) Î·È ÌÂÙ·Í‡ ÙË˜ ¯ÔÏËÛÙÂ-ÚfiÏË˜ Î·È ÙË˜ LDL-C (r=0,80, p<0,001), HDL-C(r=-0,37, p<0,001), ApoB (r=0,62, p<0,001),Lp(a) (r=0,29, p<0,001) Î·È ·ıËÚˆÌ·ÙÈÎÔ‡ ‰Â›ÎÙË(r=0,38, p<0,001). ∆· ÙÚÈÁÏ˘ÎÂÚ›‰È· ¤¯Ô˘Ó ·ÚÓË-ÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ ÙËÓ HDL-C (r=-0,25, p<0,001)Î·È ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ ÙËÓ ApoB (r=0,22,p<0,01). ∏ Lp(a) ¤¯ÂÈ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ıÂÙÈÎ‹Û˘Û¯¤ÙÈÛË ÌÂ ÙËÓ TC (r=0,29, p<0,001), LDL-C(r=0,27, p<0,001) Î·È ApoB (r=0,32, p<0,001). O·ıËÚˆÌ·ÙÈÎfi˜ ‰Â›ÎÙË˜ ¤¯ÂÈ ÛËÌ·ÓÙÈÎ‹ Û˘Û¯¤ÙÈÛËÌÂ fiÏÂ˜ ÙÈ˜ ·Ú·Ì¤ÙÚÔ˘˜, ÂÎÙfi˜ ·fi ÙËÓ Lp(a).

∞fi Ù· 50 ·È‰È¿ ÌÂ ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔ-ÚÈÎfi, Ù· 19 ·Ó‹ÎÔ˘Ó ÛÂ 9 ÔÈÎÔÁ¤ÓÂÈÂ˜ fiÔ˘ Ô ¤Ó·˜·fi ÙÔ˘˜ ‰‡Ô ÁÔÓÂ›˜ ¤¯ÂÈ ÁÓˆÛÙ‹ ˘ÂÚ¯ÔÏËÛÙÂ-ÚÔÏ·ÈÌ›· (TC>240 mg/dl), ÁÈ· ÙËÓ ÔÔ›· ˘Ô‚¿Ï-ÏÂÙ·È ÛÂ ‰È·ÈÙËÙÈÎ‹ ‹/Î·È Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÁˆÁ‹.∞ÍÈÔÛËÌÂ›ˆÙÔ Â›Ó·È ·ÎfiÌË ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Î·Ó¤Ó·


268

¶›Ó·Î·˜ 1. ™ˆÌ·ÙÔÌÂÙÚÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ Î·È ÏÈ›‰È· ·›Ì·ÙÔ˜ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ Î·È Î·Ù¿ Ê‡ÏÔ

¶·Ú¿ÌÂÙÚÔ˜ ™‡ÓÔÏÔ ·È‰ÈÒÓ (n=171) ∞ÁfiÚÈ· (n=84) ∫ÔÚ›ÙÛÈ· (n=87) p

ª¤ÛË ÙÈÌ‹ (±SD)

∏ÏÈÎ›· (¤ÙË) 9,3±3,5 9,4±3,4 9,2±3,5 NSµ¿ÚÔ˜ ÛÒÌ·ÙÔ˜ (cm) 38,2±17,7 38,5±18,3 37,9±17,2 NSª‹ÎÔ˜ ÛÒÌ·ÙÔ˜ (cm) 137,9±19,7 137,6±20,2 138,6±19,2 NS¢ª™ (kg/m2) 18,9±4,3 19±4,1 18,6±4,3 NSOÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË (mg/dl) 172±29,1 170±29,7 173,5±29 NS∆ÚÈÁÏ˘ÎÂÚ›‰È· (mg/dl) 75,4±37,1 75,1±36,6 76,4±42,2 NSLDL-C (mg/dl) 101,6±26,3 105,8±30,1 102,3±26,2 NSHDL-C (mg/dl) 55±13,4 54,4±15 56,3±11,6 NSApoA-I (mg/dl) 134,5±27,3 132,1±25,7 137±28,9 NSApoB (mg/dl) 77,6±20,8 76,2±19,7 78,3±21,9 NSLp(a) (mg/dl) 21,4±19 19,6±19,8 23,9±25,9 NS

¶›Ó·Î·˜ 2. ∫·Ù·ÓÔÌ‹ ÙˆÓ ·È‰ÈÒÓ ÛÂ 4 ÔÌ¿‰Â˜ Û‡ÌÊˆÓ·ÌÂ ÙÔ ¢ª™ Î·È ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi

OÌ¿‰Â˜ ªË ·Ô‰ÂÎÙÔ› ÏÈÈ‰·ÈÌÈÎÔ› ‰Â›ÎÙÂ˜

n % n %

∞ 19 11,1 6/19 31,6µ 7 4,1 4/7 57,1° 50 29,2 26/50 52¢ 95 55,6 18/95 18,9™‡ÓÔÏÔ 171 54 31,5


·fi Ù· 19 ·È‰È¿ ‰ÂÓ ‹Ù·Ó ·¯‡Û·ÚÎÔ. ™Â 4/9 ÔÈ-ÎÔÁ¤ÓÂÈÂ˜ ·Ú·ÙËÚ‹ıËÎ·Ó ‰˘ÛÏÈÈ‰·ÈÌÈÎ¤˜ ‰È·Ù·-Ú·¯¤˜ ÛÂ fiÏ· Ù· ·‰¤ÏÊÈ·-Ì¤ÏË. ªË ·Ô‰ÂÎÙÔ› ÏÈ-È‰·ÈÌÈÎÔ› ‰Â›ÎÙÂ˜ ‚Ú¤ıËÎ·Ó ÛÂ 14/19 ·È‰È¿(73,7%). ŸÏÂ˜ ÔÈ ÂÚÈÙÒÛÂÈ˜ ·ÊÔÚÔ‡Û·Ó ·˘ÍË-Ì¤ÓË TC, Ë ÔÔ›· Û˘ÓÔ‰Â˘fiÙ·Ó Î·È ·fi ¿ÏÏÔ˘˜·ıÔÏÔÁÈÎÔ‡˜ ‰Â›ÎÙÂ˜, fiˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·-Î· 5. ¢È·Ù·Ú·¯¤˜ ÙË˜ LDL-C ‚Ú¤ıËÎ·Ó ÛÂ 13/14·È‰È¿, 6 ·fi Ù· ÔÔ›· Â›¯·Ó ÔÚÈ·Î¤˜ ÙÈÌ¤˜ (110-129 mg/dl), ÂÓÒ Ù· ˘fiÏÔÈ· 7 Â›¯·Ó ·ıÔÏÔÁÈÎ¤˜ÙÈÌ¤˜ (>130 mg/dl) (¶›Ó·Î·˜ 5). À„ËÏfiÙÂÚÂ˜ Ì¤-ÛÂ˜ ÙÈÌ¤˜ TC, LDL-C Î·È Lp(a) Â›¯·Ó Ù· ·È‰È¿ ÌÂÙËÓ “ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·” Û˘ÁÎÚÈÓfiÌÂ-Ó· ÌÂ ·˘Ù¿ ¯ˆÚ›˜ ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜(Ê˘ÛÈÔÏÔÁÈÎfi µ™ Î·È ·ÚÓËÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔ-ÚÈÎfi), fiˆ˜ Ê·›ÓÂÙ·È ÛÙÔ ™¯‹Ì· 1.

™˘˙‹ÙËÛË ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È ÔÈ Û˘-

ÁÎÂÓÙÚÒÛÂÈ˜ ÙˆÓ TC, TG, LDL-C, HDL-C, ApoA-π,ApoB Î·È Lp(a) ÛÂ ·È‰È¿ ÙˆÓ ‰˘ÙÈÎÒÓ Û˘ÓÔÈÎÈÒÓÙË˜ £ÂÛÛ·ÏÔÓ›ÎË˜ ÌÂÙ¿ ·fi ·ÔÎÏÂÈÛÌfi ÙˆÓ Û˘-ÓËı¤ÛÙÂÚˆÓ ·ÈÙ›ˆÓ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ‰˘ÛÏÈÈ‰·È-Ì›·˜ Î·È Á›ÓÂÙ·È Û˘Û¯ÂÙÈÛÌfi˜ ÌÂ ÙÔ ÔÈÎÔÁÂÓÂÈ·ÎfiÈÛÙÔÚÈÎfi Î·È ÙÔ ¢ª™.

¢È·ÈÛÙÒÓÂÙ·È fiÙÈ ÙÔ Ê‡ÏÔ ‰ÂÓ ¤¯ÂÈ È‰È·›ÙÂÚËÛËÌ·Û›· ÁÈ· Ù· Â›Â‰· ÙˆÓ ÏÈÈ‰›ˆÓ ÙÔ˘ ÔÚÔ‡,ÁÈ·Ù› fiˆ˜ ÚÔ¤Î˘„Â ·fi ÙË ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛËÔÈ ‰È·ÊÔÚ¤˜ Û˘ÁÎÂÓÙÚÒÛÂˆÓ ÙˆÓ ÏÈÈ‰›ˆÓ ·Ó¿ÌÂ-Û· ÛÂ ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· ‰ÂÓ ‹Ù·Ó ÛËÌ·ÓÙÈÎ¤˜.

∆Ô ‰Â‰ÔÌ¤ÓÔ ·˘Ùfi Û˘ÌÊˆÓÂ› ÌÂ ÙÈ˜ ÌÂÏ¤ÙÂ˜ ÙˆÓ∫·‚·˙·Ú¿ÎË Î·È Û˘Ó (1998), ∆ÛfiÏ· Î·È Û˘Ó (1999)Î·È ™¿‚‚· Î·È Û˘Ó (2000) (23,24,26).

∂ÏÂ‡ıÂÚÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Â›¯·Ó 114/171·È‰È¿ ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜ (66,6%) ÛÂ Û‡ÁÎÚÈÛË ÌÂ52,2% ÙˆÓ Diller Î·È Û˘Ó (1995) Î·È 69,5% ÙˆÓ ∆Ûfi-Ï· Î·È Û˘Ó (1999) (27,24).

∏ Û˘¯ÓfiÙËÙ· ÙË˜ ·¯˘Û·ÚÎ›·˜ ÛÙÔ Û˘ÓÔÏÈÎfi‰Â›ÁÌ· ÙˆÓ ·È‰ÈÒÓ Ì·˜ ·Ó¤Ú¯ÂÙ·È ÛÂ 15,2% (‰ÂÓ˘‹Ú¯Â ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÌÂÙ·Í‡ÙˆÓ ‰‡Ô Ê‡ÏˆÓ (p=0,72) (¶›Ó·Î·˜ 1). ¶ÚfiÛÊ·ÙËÌÂÏ¤ÙË ·fi ÙË µ. ∂ÏÏ¿‰· ÛÂ 8000 ·È‰È¿-ÂÊ‹‚Ô˘˜‰È·›ÛÙˆÛÂ Û˘¯ÓfiÙËÙ· ·¯˘Û·ÚÎ›·˜ 12,5%, ¤¯Ô-ÓÙ·˜ fiˆ˜ Î·È ÂÌÂ›˜ ˆ˜ ÎÚÈÙ‹ÚÈÔ ¢ª™ >95Ë ∂£(28). ¢˘ÛÏÈÈ‰·ÈÌ›· ‰È·ÈÛÙÒıËÎÂ ÛÙÔ 38,4% ÙˆÓ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜, ÂÓÒ ÛÂ·ÓÙ›ÛÙÔÈ¯Ë ÌÂÏ¤ÙË ÙˆÓ ∆ÛfiÏ· Î·È Û˘Ó (1999) ‹Ù·Ó¯·ÌËÏfiÙÂÚË (21,6-29,8%) (24).

™ÙËÓ ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ ÌÂ ÙÔ ıÂÙÈÎfi ÔÈÎÔÁÂ-ÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, Ë ‰˘ÛÏÈÈ‰·ÈÌ›· Êı¿ÓÂÈ ÛÙÔ 52%,ÂÓÒ ÛÂ ÚÔËÁÔ‡ÌÂÓË ÂÏÏËÓÈÎ‹ ÌÂÏ¤ÙË Â›Ó·È ÌfiÏÈ˜30,7-34,8% (24). ¶·Ï·ÈfiÙÂÚË ÌÂÏ¤ÙË ÙˆÓ °ÚËÁÔ-Ú¤· Î·È Û˘Ó (1990) ÛÂ ·È‰È¿ ÂÌÊÚ·ÁÌ·ÙÈÒÓ ÁÔÓ¤-ˆÓ ¤‰ÂÈÍÂ ‰˘ÛÏÈÈ‰·ÈÌ›· ÛÂ ÔÛÔÛÙfi 63,8% (29).

¢È·ÈÛÙÒıËÎÂ fiÙÈ Ô ¢ª™ ·ÚÔ˘ÛÈ¿˙ÂÈ ÛÙ·ÙÈÛÙÈ-ÎÒ˜ ÛËÌ·ÓÙÈÎ‹ Û¯¤ÛË ÌÂ Ù· TG. ∆· ·È‰È¿ ÌÂ ·˘-ÍËÌ¤ÓÔ ¢ª™ Î·È ıÂÙÈÎfi ÈÛÙÔÚÈÎfi ¤¯Ô˘Ó ÛÙ·ÙÈÛÙÈÎ¿ÛËÌ·ÓÙÈÎ¿ ÂÏ·ÙÙˆÌ¤ÓË ApoA-π ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÈ˜¿ÏÏÂ˜ ÔÌ¿‰Â˜. ∆· Â˘Ú‹Ì·Ù¿ Ì·˜ Û˘ÌÊˆÓÔ‡Ó ÌÂÚÔËÁÔ‡ÌÂÓÂ˜ ÌÂÏ¤ÙÂ˜ ÙˆÓ ∆ÛfiÏ· Î·È Û˘Ó (1999),fiÔ˘ ·Ú·ÙËÚ‹ıËÎÂ ÛËÌ·ÓÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÙÔ˘ ¢ª™ÌÂ Ù· TG Î·È ApoA-π Î·È ÙˆÓ ™¿‚‚· Î·È Û˘Ó (2000),fiÔ˘ ‚Ú¤ıËÎÂ ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÙÔ˘ ¢ª™ ÌÂ ÙËÓLDL-C Î·È Ù· TG Î·È ·ÚÓËÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ ÙËÓHDL-C. ™ÙË ÌÂÏ¤ÙË ÙˆÓ ™Ô‡ÏË Î·È Û˘Ó (1991) ÛÂ 42·¯‡Û·ÚÎ· ·È‰È¿ ÚÔÂÊË‚ÈÎ‹˜ ËÏÈÎ›·˜ ‰È·ÈÛÙÒ-ıËÎÂ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË ÙË˜ LDL-C Î·ÈÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ÂÏ¿ÙÙˆÛË ÙË˜ ∏DL-C ÛÂ Û‡-ÁÎÚÈÛË ÌÂ ÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘ (30).

∂›ÛË˜, ‰È·ÈÛÙÒıËÎÂ fiÙÈ Ù· ·È‰È¿ ÌÂ Ê˘ÛÈÔ-ÏÔÁÈÎfi µ™ Î·È ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi


269

¶›Ó·Î·˜ 3. ª¤ÛË ÙÈÌ‹ Î·È ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË ÙˆÓ ÏÈÈ‰›ˆÓ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ ·Ó¿ ÔÌ¿‰· ÌÂÏ¤ÙË˜

OÌ¿‰· TC TG LDL-C HDL-C ApoA-I ApoB Lp(a) TC/HDL-C

A 167,79 92,53 94,95 54,05 128,59 75,659 25,573 3,31535,07 35,58 33,89 20,26 29,68 23,362 26,062 1,002

B 170,43 88,86 81,88 48,29 114,51 69,657 7,59 3,74730,53 43,82 30,15 14,45 21,87 11,164 3,584 1,125

° 184,04 80,28 110,68 57,52 136,05 82,968 29,415 3,26831,97 45,23 26,38 12,55 26,10 25,384 29,979 0,578

¢ 166,55 68,38 97,10 55,15 136,43 75,220 16,913 3,11524,43 30,52 23,39 12,08 27,51 17,261 16,683 0,724

™‡ÓÔÏÔ 171,96 75,38 100,49 55,44 134,48 77,487 21,360 3,20829,14 37,16 27,17 13,44 27,29 20,863 23,183 0,746

¶›Ó·Î·˜ 4. ™‡ÁÎÚÈÛË ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ ÙˆÓ ÏÈÈ‰›ˆÓ Ô˘Â›¯·Ó ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ

OÌ¿‰Â˜ p

TC ° - ¢ <0,004TG ∞ - ¢ <0,004LDL-C ° - ¢ <0,004ApoA-I µ - ° <0,04

µ - ¢ <0,04Lp(a) ∞ - µ <0,02

µ - ° <0,005µ - ¢ <0,04


·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË ÙˆÓÂÈ¤‰ˆÓ ÙˆÓ TC Î·È LDL-C, ÛÂ Û‡ÁÎÚÈÛË ÌÂ Ù· ·È-‰È¿ ¯ˆÚ›˜ ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜. ∆· Â˘Ú‹Ì·-Ù¿ Ì·˜ Û˘ÌÊˆÓÔ‡Ó ÌÂ ÙË ÌÂÏ¤ÙË ÙˆÓ ∆ÛfiÏ· Î·È Û˘Ó(1999), ÛÙËÓ ÔÔ›· ‰È·ÈÛÙÒıËÎÂ fiÙÈ ÙÔ ıÂÙÈÎfi ÔÈ-ÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Â›¯Â ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹Û¯¤ÛË ÌfiÓÔ ÌÂ ÙËÓ TC Î·È ÙËÓ LDL-C, Î·ıÒ˜ Î·È ÌÂÙË ÌÂÏ¤ÙË ÙˆÓ ™¿‚‚· Î·È Û˘Ó (2000), ÛÙËÓ ÔÔ›· ËÔÏ˘·Ú·ÁÔÓÙÈÎ‹ ·Ó¿Ï˘ÛË Ô˘ ¤ÁÈÓÂ ÁÈ· ÙËÓ Â›-‰Ú·ÛË ‰È·ÊfiÚˆÓ ·Ú·Ì¤ÙÚˆÓ ÛÙ· ÏÈ›‰È· ¤‰ÂÈÍÂıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÙÔ˘ ıÂÙÈÎÔ‡ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔ-ÚÈÎÔ‡ ÌÂ Ù· Â›Â‰· ÙË˜ TC, TG Î·È LDL-C.

™ÙËÓ ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ ¯ˆÚ›˜ ÂÈ‚·Ú˘ÓÙÈ-ÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ‰È·ÈÛÙÒıËÎ·Ó ‰È·Ù·Ú·¯¤˜ ÙˆÓÏÈÈ‰›ˆÓ ÛÂ ÔÛÔÛÙfi 18,9%, ÂÓÒ ÛÙË ÌÂÏ¤ÙË ÙˆÓ∆ÛfiÏ· Î·È Û˘Ó (1999) ÙÔ ÔÛÔÛÙfi ·˘Ùfi ‹Ù·Ó ÌÂ-Á·Ï‡ÙÂÚÔ ÙÔ˘ 20% (24).

™Ù· 19 ·fi Ù· 50 ·È‰È¿ ÌÂ ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·-Îfi ÈÛÙÔÚÈÎfi (38%) ‰È·ÈÛÙÒıËÎÂ ˘ÂÚ¯ÔÏËÛÙÂÚÔ-Ï·ÈÌ›· ÛÂ ¤Ó·Ó ·fi ÙÔ˘˜ ‰‡Ô ÁÔÓÂ›˜, ¤Ó·ÓÙÈ 42,2%ÛÙË ÌÂÏ¤ÙË ÙˆÓ ∆ÛfiÏ· Î·È Û˘Ó (1999) (24). ∏ ÏÂÈ-Ô„ËÊ›· ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ (73,7%) Â›¯Â ·˘ÍËÌ¤ÓËTC, ÂÓÒ Û˘Ó˘‹Ú¯Â ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË ÙË˜ LDL-CÛÙÔ 36,8% Î·È ÙË˜ Lp(a) ÛÙÔ 31,5%. ™‡ÌÊˆÓ· ÌÂ


270

¶›Ó·Î·˜ 5. ∆ÈÌ¤˜ ÏÈÈ‰›ˆÓ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ ÙˆÓ ·È‰ÈÒÓ ÌÂ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ÛÂ ¤Ó·Ó ·fi ÙÔ˘˜ ÁÔÓÂ›˜

n º‡ÏÔ OÈÎÔÁ¤ÓÂÈ· ∏ÏÈÎ›· (¤ÙË) ∞ÁˆÁ‹ TC* TG* LDL* HDL* ApoA-I* ApoB* Lp(a)*

1 ∫ 1Ë 11 ¢›·ÈÙ· 221 73 148 58 164 10,3 102 ∞ 1Ë 12 194 55 131 52 155 80 103 ∫ 2Ë 5 ¢›·ÈÙ· 225 62 143 70 155 110 164 ∞ 2Ë 3 192 91 120 54 165 99 105 ∞ 2Ë 11 190 49 100 80 164 72,3 126 ∞ 3Ë 8 ¢›·ÈÙ· 238 131 144 68 156 162 807 ∫ 3Ë 11 215 147 128 58 156 140 808 ∫ 4Ë 11 ¢›·ÈÙ· 241 66 168 60 105 91 2,489 ∫ 4Ë 10 207 163 114 60 124 78,4 210 ∞ 5Ë 9,5 ¢›·ÈÙ· 241 96 166 56 115 111 23,511 ∫ 5Ë 8 ¢›·ÈÙ· 220 67 156 51 115 97,5 712 ∞ 6Ë 12,5 ¢›·ÈÙ· 229 101 156 53 140 113 8513 ∞ 6Ë 8,5 153 79 96 41 100 71 18,214 ∫ 7Ë 13 215 95 98 67 132 67 7415 ∫ 7Ë 11 200 68 123 60 128 82 25416 ∞ 7Ë 4 216 53 125 80 185 43,6 89,917 ∫ 8Ë 10 221 54 122 88 144 73,6 6,518 ∞ 8Ë 8 194 48 118 66 121 71,9 8,519 ∫ 9Ë 10 215 46 110 96 172 69,1 9,5

*mg/dl

250

200

150

100

50

0TC TG LDL-C HDL-C ApoA1 ApoB Lp(a)

mg

/dl

™¯‹Ì· 1. ™¯ËÌ·ÙÈÎ‹ ·ÂÈÎfiÓÈÛË ÙˆÓ ÏÈÈ‰›ˆÓ (Ì¤ÛÂ˜ ÙÈÌ¤˜) ÙˆÓ ·È‰ÈÒÓ ÌÂ “ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·” Î·È ·˘ÙÒÓ ¯ˆ-Ú›˜ ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜.

ÔÈÎÔÁÂÓ‹˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·¯ˆÚ›˜ ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜


271


ÙÔ˘˜ Diller Î·È Û˘Ó (1995) ÛÙÔ 40% ÙˆÓ ·È‰ÈÒÓÔ˘ ˘Ô‚¿ÏÏÔÓÙ·È ÛÂ ¤ÏÂÁ¯Ô ÏfiÁˆ ÁÔÓÂ˚Î‹˜˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜, ‰È·ÈÛÙÒÓÂÙ·È ·‡ÍËÛËÙË˜ LDL-C Î·È Î·Ù¿ ÙÔ˘˜ Hennermann Î·È Û˘Ó(1998) ÛÙÔ 39,4% ‰È·ÈÛÙÒÓÂÙ·È ·‡ÍËÛË ÙË˜ Lp(a)(27,31).

∏ ÔÈÎÔÁÂÓ‹˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ÂÚÈÁÚ¿ÊÂ-Ù·È Â›ÙÂ ˆ˜ ÔÌfi˙˘ÁË (Û˘¯ÓfiÙËÙ· 1/1.000.000), Ô˘¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘ÂÚ‚ÔÏÈÎ‹ ·‡ÍËÛË ÙË˜ TC(>600 mg%), Â›ÙÂ ˆ˜ ÂÙÂÚfi˙˘ÁË ÌÔÚÊ‹ (Û˘¯ÓfiÙË-Ù· 1/500), fiÔ˘ ·Ú·ÙËÚÂ›Ù·È ·‡ÍËÛË ÙˆÓ ÂÈ¤-‰ˆÓ ÙˆÓ TC>300 mg% Î·È LDL>200 mg%.

∆· ÂÚÈÛÛfiÙÂÚ·, fiÌˆ˜, ·È‰È¿ Î·È ¤ÊË‚ÔÈ ÌÂÂ›Â‰· LDL ÌÂÙÚ›ˆ˜ ·˘ÍËÌ¤Ó· ‰ÂÓ ÓÔÛÔ‡Ó ·fiÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·. ∏ ˘ÂÚÏÈÈ‰·ÈÌ›··Ô‰›‰ÂÙ·È ÛÂ ÔÏ˘ÁÔÓÈ‰È·Î‹ ÎÏËÚÔÓÔÌÈÎ‹ ‰È·Ù·-Ú·¯‹ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ Î·Î¤˜ ‰È·ÙÚÔÊÈÎ¤˜ Û˘Ó‹-ıÂÈÂ˜ Î·È ¿ÏÏÔ˘˜ ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜,.¯. ·¯˘Û·ÚÎ›· Î·È ÂÏ·ÙÙˆÌ¤ÓË Ê˘ÛÈÎ‹ ‰Ú·ÛÙË-ÚÈfiÙËÙ·. ∏ Û˘Ó‹ıˆ˜ Ì¤ÙÚÈ· ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓÙË˜ LDL ‰›ÓÂÈ ÙË ı¤ÛË ÙË˜ ÛÂ Ì›· Î·Ù¿ÛÙ·ÛË ·ÍÈÔ-ÛËÌÂ›ˆÙË˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ Î·Ù¿ ÙËÓ ÂÓ‹ÏÈ-ÎË ˙ˆ‹ (8).

∏ Ì¤ÙÚËÛË ÙË˜ LDL Â›Ó·È Î·Ï‡ÙÂÚÔ˜ ÚÔÁÓˆ-ÛÙÈÎfi˜ ‰Â›ÎÙË˜ ·fi ÙÈ˜ ÙÈÌ¤˜ ÙË˜ TC, ÂÓÒ Ë ˘ÔÏÈ-È‰·ÈÌÈÎ‹ ‰›·ÈÙ· ·ÔÙÂÏÂ› ÙÔÓ ·ÎÚÔÁˆÓÈ·›Ô Ï›ıÔÎ·Ù¿ ÙË˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈ-Î›·. °È· ÙÔ ÏfiÁÔ ·˘Ùfi, ÛÙ· ·È‰È¿ ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜ÌÂ ÙËÓ “ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·” Ô˘ Â›-¯·Ó ·ıÔÏÔÁÈÎ¿ ·˘ÍËÌ¤ÓÂ˜ ÙÈÌ¤˜ TC Î·È LDL (¶›-Ó·Î·˜ 5), Á›ÓÂÙ·È ‰È·ÈÙËÙÈÎ‹ ·Ú¤Ì‚·ÛË ÛÙ·‰›Ô˘ π(ÔÏÈÎfi Ï›Ô˜ 30%, ÎÂÎÔÚÂÛÌ¤Ó· §O<10%, ÔÏ˘·-ÎfiÚÂÛÙ· §O<10%, ÌÔÓÔ·ÎfiÚÂÛÙ· §O<15% ÙˆÓÔÏÈÎÒÓ ıÂÚÌ›‰ˆÓ, ¯ÔÏËÛÙÂÚfiÏË <300 mg%, ˘‰·-Ù¿ÓıÚ·ÎÂ˜ 55%, ÚˆÙÂ˝ÓÂ˜ 15-20% ËÌÂÚËÛ›ˆ˜)Î·È Ù·ÎÙÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛË.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ ÌÂ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÏÈÈ‰›ˆÓ ÛÙÈ˜ ‰˘ÙÈÎ¤˜ Û˘ÓÔÈÎ›Â˜ÙË˜ £ÂÛÛ·ÏÔÓ›ÎË˜ ‚Ú¤ıËÎÂ ·˘ÍËÌ¤ÓÔ (31,5%). ∆Ô18,9% ÙˆÓ ·È‰ÈÒÓ ÌÂ ·ıÔÏÔÁÈÎfi ÏÈÈ‰fiÁÚ·ÌÌ·‰ÂÓ Â›¯Â ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜. ∫Ú›ÓÂÙ·È,ÏÔÈfiÓ, ÛÎfiÈÌÔ Ô ¤ÏÂÁ¯Ô˜ ÙˆÓ ÏÈÈ‰›ˆÓ Î·È ÙˆÓ ÏÈ-ÔÚˆÙÂ˚ÓÒÓ Ó· ¤¯ÂÈ Â˘Ú‡ÙÂÚË ÂÊ·ÚÌÔÁ‹ ÛÙ··È‰È¿, ÌÂ ·ÒÙÂÚÔ ÛÙfi¯Ô ÙËÓ ÙÚÔÔÔ›ËÛË ÙÔ˘‚·ıÌÔ‡ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜ ÂÎ‰‹ÏˆÛË˜ ÛÙÂÊ·ÓÈ·›·˜ÓfiÛÔ˘ Î·Ù¿ ÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Lauer RM, Lee J, Clarke WR. Factors affecting the

relationship between childhood and adult cholesterollevels: the Muscatine Study. Pediatrics 1988;82:309-318.

2. PDAY Research Group. Relationship of the atherosclerosisin young men to serum lipoprotein cholesterol

concentrations and smoking: a preliminary report from thePathobiological Determinants of Atherosclerosis Group.JAMA 1990;265:3018-3024.

3. Newman WP III, Freedman DS, Voors AW, Gard PD,Srinivasan SR, Cresanta JL et al. Relation of serumlipoprotein levels and systolic blood pressure to earlyatherosclerosis. The Bogalusa Heart Study. N Engl J Med1986;314:138-144.

4. Burns TL, Moll PP, Lauer RM. Increased familiarcardiovascular mortality in obese schoolchildren: theMuscatine Ponderosity Family Study. Pediatrics1992;89:262-268.

5. Sarlud H, Laakso M, Voutilainen E, Penttila I, Pyorala K.Familial aggregation of non-insulin dependent diabetesand coronary heart disease are accompanied by differenteffects on serum lipids, lipoproteins and apolipoproteins.Atherosclerosis 1991;86:17-29.

6. ∆ÛfiÏ·˜ °, ∫·‚·˙·Ú¿ÎË˜ ∂. §ÈÔÚˆÙÂ˝ÓÂ˜ Î·È ·ıËÚˆÌ¿-ÙˆÛË ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·. π. ªÂÙ·‚ÔÏÈÛÌfi˜ ÙˆÓ ÏÈÔÚˆ-ÙÂ˚ÓÒÓ Î·È ·ıÔÁ¤ÓÂÈ· ÙË˜ ·ıËÚˆÌ¿ÙˆÛË˜. ¶·È‰È·ÙÚÈÎ‹1992;55:65-77.

7. Ã›ÙÔÁÏÔ˘-ª·Î¤‰Ô˘ ∞. ¶ÚÔÏËÙÈÎfi˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ-¯Ô˜ ÛÂ ·È‰È¿ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·Ó¿Ù˘ÍË ÛÙÂÊ·ÓÈ·›-·˜ ÓfiÛÔ˘. ¶Ú·ÎÙÈÎ¿ 12Ë˜ ∂ÈÛÙËÌÔÓÈÎ‹˜ ∏ÌÂÚ›‰·˜ µ’¶∞π¢. ∫§. £ÂÛÛ·ÏÔÓ›ÎË; 2001. ÛÂÏ. 90-98.

8. ¢·Ì·Ó¿ÎË-O˘Ú·ÓÔ‡ ¢, ∫·Ú¿Î·˜ Ã. ¢˘ÛÏÈÈ‰·ÈÌ›Â˜ ÛÙËÓ·È‰ÈÎ‹ ËÏÈÎ›·. π·ÙÚÈÎfi˜ ∆‡Ô˜ 2001;238:8-9.

9. ™Ô‡ÏË ∫∂, ∫·Ú›Î·˜ °∞, °·‚Ú›ÏË ™. ∂›Â‰· ÏÈÔÚˆ-ÙÂ˝ÓË˜ (·) ÛÂ 3298 ∂ÏÏËÓfiÔ˘Ï·, ËÏÈÎ›·˜ 6-14 ÂÙÒÓ. ¶·È-‰È·ÙÚÈÎ‹ 2001;64:55-58.

10. °ÚËÁÔÚÈ¿‰Ë˜ °. ∏ Û˘Ì‚ÔÏ‹ ÙË˜ Ì¤ÙÚËÛË˜ ÙˆÓ ÚˆÙÂ˚ÓÒÓÛÙË ‰È¿ÁÓˆÛË Î·È ·Ú·ÎÔÏÔ‡ıËÛË ÓÔÛËÌ¿ÙˆÓ. ∂Î‰. πª∫˘ÚÈ·Î›‰Ë˜; 1996. ÛÂÏ. 42-45.

11. Dahlen GH, Guyton JR, Attar M, Farmer JA, Kautz JA,Gotto AM Jr. Association of levels of lipoprotein Lp(a),plasma lipids and other lipoproteins with coronary arterydisease documented by angiography. Circulation1986;74:758-765.

12. Murai A, Miyahara I, Fujimoto N, Matsuda M, KameyamaM. Lp(a) lipoprotein as a risk factor for coronary heartdisease and cerebral infarction. Atherosclerosis1986;59:199-206.

13. §·˙·Ú›‰Ô˘ ™, µ·ÚÏ¿ÌË˜ °. ∞ÓÙÈÌÂÙÒÈÛË ·È‰ÈÒÓ ÌÂ˘ÂÚÏÈÈ‰·ÈÌ›·. ¶·È‰È·ÙÚ ÃÚÔÓÈÎ¿ 1994;21,3:215-220.

14. Finberg L, Bell EF, Dweck HS, Hatch TF, Holmes FC,Kretchmer N et al. Indications for cholesterol testing inchildren. Committee on Nutrition. Pediatrics 1989;83:141.

15. American Academy of Pediatrics Committee on Nutrition.Cholesterol in Childhood. Pediatrics 1998;101:141-147.

16. Dennison BA, Kikuchi DA, Srinivasan SR, Webber LS,Berenson GS. Serum total cholesterol screening for thedetection of elevated low-density lipoprotein in childrenand adolescents: the Bogalusa Heart Study. Pediatrics1990;85:472-479.

17. Meyerson DA, Santanello NC. Pediatric lipid screeningbased upon criteria of high-risk family history fails toidentify two-thirds of higher-risk children. Circulation


1988;78(Suppl II):383. 18. Griffin TC, Christoffel KK, Binns HJ, McGuire PA. Family

history evaluation as a predictive screen for childhoodhypercholesterolemia. Pediatric Practice Research Group.Pediatrics 1989;84:365-373.

19. Davidson DM, Van Camp J, Iftner CA, Landry SM, BradleyBJ, Wong ND. Family history fails to detect the majority ofchildren with high capillary blood total cholesterol. J SchHealth 1991;61:75-80.

20. Steiner NJ, Neinstein LS, Pennbridge J. Hyper-cholesterolemia in adolescents: effectiveness of screeningstrategies based on selected risk factors. Pediatrics1991;88:269-275.

21. National Cholesterol Education Program. Report of theExpert Panel on Blood Cholesterol Levels in Children andAdolescents. (National Institutes of Health publication No91-2732) Bethesda, Maryland: National Heart, Lung andBlood Institute; September 1991. p. 1-119.

22. ∫·Ù˙fi˜ °. ¶·È‰ÈÎ‹ ·¯˘Û·ÚÎ›·. ™‡Á¯ÚÔÓÂ˜ ·fi„ÂÈ˜. ¡¤·¶·È‰È·ÙÚ ÃÚÔÓ 2001;1:13-20.

23. ∫·‚·˙·Ú¿ÎË˜ ∂, ∆ÛfiÏ·˜ °, ™ÎÔ‡ÚÔ˘-Ã·Ù˙Ë·ÚÁ˘ÚÔ‡ ¢,ºÔ˘ÛÙÔ‡ÎÔ˘ ª, ¢‹ÌÔ˘ ™, ¢ÂÏËÁÈ¿ÓÓË µ. ∫·Ù·ÓÔÌ‹ ÔÏÈ-Î‹˜ ¯ÔÏËÛÙÂÚfiÏË˜, ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ·ÔÏÈÔÚˆÙÂ˚-ÓÒÓ ÛÂ ‚Ú¤ÊË Î·È ·È‰È¿. ¶·È‰È·ÙÚÈÎ‹ 1998;61:148-160.

24. ∆ÛfiÏ·˜ °, ¢Ú·Î¿ÙÔ˜ ∞, ∆ÛÔ˘Î¿ÙÔ˘ £, ºˆÙÂÈÓÔ‡ ∞, ¶·Ó·-ÁÔ‡ÏÈ· ª, ∫·‚·˙·Ú¿ÎË˜ ∂. ¶ÚÔÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÙËÓ·Ó›¯ÓÂ˘ÛË ÙË˜ ˘ÂÚÏÈÈ‰·ÈÌ›·˜ ÛÙ· ·È‰È¿. ¶·È‰È·ÙÚÈÎ‹1999;62:295-304.

25. Schulpis K, Karikas GA. Serum cholesterol and triglyceridedistribution in 7767 school-aged Greek children. Pediatrics1998;101:861-864.

26. ™¿‚‚·˜ ™Ã, ∆ÔÚÓ·Ú›ÙË˜ ª, ∂ÈÊ·Ó›Ô˘-™¿‚‚·˜ ª, ∫Ô˘Ú›-‰Ë˜ °, Ã·Ù˙ËÁÂˆÚÁ›Ô˘ Ã, ™È·ÌÔ‡ÓÎË ª. ∂›Â‰· ÏÈÈ‰›ˆÓ

Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ ÛÂ ÂÊ‹‚Ô˘˜ ÛÙËÓ ∫‡ÚÔ. ™‡ÁÎÚÈÛË ÌÂÂÏÏËÓÈÎ¿ ‰Â‰ÔÌ¤Ó·. ¶·È‰È·ÙÚ µ ∂ÏÏ¿‰ 2000;12:195-204.

27. Diller PM, Huster GA, Leach AD, Laskarzewski PM,Sprecher DL. Definition and application of thediscretionary screening indicators according to theNational Cholesterol Education Program for Children andAdolescents. J Pediatr 1995;126:345-352.

28. ¶··¯Ú‹ÛÙÔ˘ ∞, ∞˚‚¿˙Ë˜ µ, ªËÙÛ¤·˜ ¶, ºÈ‰¿ÓË ™, ¶·˘-Ï¿ÙÔ˜ ™, ªÔ˘ÚÏ‹ ∂. ∂ÎÙ›ÌËÛË ÙË˜ ·¯˘Û·ÚÎ›·˜ ·fi ÙÔ‚¿ÚÔ˜ Î·È ÙËÓ Ù˘¯‹ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ÙÔ˘ ÙÚÈÎ¤Ê·ÏÔ˘ ÛÂ·È‰È¿ 6-18 ¯ÚfiÓˆÓ. ¶·È‰È·ÙÚ ÃÚÔÓ 1998;23:181-189.

29. °ÚËÁÔÚ¤·˜ Ã, ¡Ù·Ú›ÏË˜ ∂, ∆¿ÛË-¶··ı¤Ô˘ ¢, ∞˘ÁÔ˘ÛÙ›-‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘ ¶, ∫·Ú·Ì¤ÚË˜ ™, ª·Ï·Î¿-∑·ÊÂÈÚ›Ô˘∫. ∂›Â‰· Î·È ‰È·Ù·Ú·¯¤˜ ÏÈÈ‰›ˆÓ-ÏÈÔÚˆÙÂ˚ÓÒÓ ÔÚÔ‡ÛÂ ·È‰È¿ ÂÌÊÚ·ÁÌ·ÙÈÒÓ ÁÔÓ¤ˆÓ. ¶·È‰È·ÙÚÈÎ‹ 1990;53:152-161.

30. ™Ô‡ÏË ∫∂, ª·ÓÙ˙·ÁÚÈÒÙË-ªÂ˚Ì·Ú›‰Ë ª, µÚÂÙÙfi˜ ∫. ∂›-Â‰· ¯ÔÏËÛÙÂÚfiÏË˜, ÎÏ·ÛÌ¿ÙˆÓ ¯ÔÏËÛÙÂÚfiÏË˜ Î·È ÙÚÈ-ÁÏ˘ÎÂÚÈ‰›ˆÓ ÛÂ Û¯¤ÛË ÌÂ ÙÔ˘˜ ·ÓıÚˆÔÌÂÙÚÈÎÔ‡˜ ‰Â›-ÎÙÂ˜ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ÚÔÂÊË‚ÈÎ‹˜ ËÏÈÎ›·˜. ¶·È‰È·-ÙÚÈÎ‹ 1991;54:129-136.

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¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂˘ÊËÌ›· ¶··‰ÔÔ‡ÏÔ˘-∞Ï·Ù¿ÎË ∞ÓÙÈÛı¤ÓÔ˘˜ 28, ∆.∫. 542 50, £ÂÛÛ·ÏÔÓ›ÎË E-mail: [email protected]


∂ÈÛ·ÁˆÁ‹OÈ ÂÈ‰ËÌ›Â˜ ÂÚ˘ıÚ¿˜ ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· Û˘Ì-

‚·›ÓÔ˘Ó ÛÙËÓ ∂ÏÏ¿‰· ÌÂ ÙË ¯·Ú·ÎÙËÚÈÛÙÈÎ‹ Û˘¯Ófi-ÙËÙ· ÙˆÓ 6-9 ÂÙÒÓ, ÛËÌÂ›Ô ÂÓ‰ÂÈÎÙÈÎfi ÙˆÓ ¯·ÌËÏÒÓÂÈ¤‰ˆÓ ·ÓÔÛ›·˜ ÙÔ˘ ÏËı˘ÛÌÔ‡, ·Ú¿ ÙËÓ ¤Ó·Ú-ÍË ˘Ô¯ÚÂˆÙÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÛÙÔÓ ·È‰ÈÎfi ÏË-ı˘ÛÌfi ·fi ÙÔ 1989. ∆È˜ ÂÈ‰ËÌ›Â˜ ·˘Ù¤˜ ·ÎÔÏÔ˘ıÂ›Ë ÂÈ‰ËÌÈÎ‹ ÂÌÊ¿ÓÈÛË ÎÚÔ˘ÛÌ¿ÙˆÓ ™™∂ Ô˘ ÚÔ-Î·ÏÂ› ÛÔ‚·Ú¤˜ ÌfiÓÈÌÂ˜ ‚Ï¿‚Â˜ ÌÂ ÚÒÈÌË Î·È fi„È-ÌË ÂÌÊ¿ÓÈÛË ·fi ÔÏÏ¿ fiÚÁ·Ó· (1).

™ÙËÓ ÂÈ‰ËÌ›· ÂÚ˘ıÚ¿˜ ÙÔ˘ 1993 Â›¯·ÌÂ ÓÔÛË-ÏÂ‡ÛÂÈ ‰‡Ô ÓÂÔÁÓ¿ ÌÂ ™™∂ (2), ÂÓÒ Â›¯·Ó ·Ó·ÊÂÚ-ıÂ›/‰ËÌÔÛÈÂ˘ıÂ› Î·È ¿ÏÏ· 23 ÂÚÈÛÙ·ÙÈÎ¿, Î˘Ú›ˆ˜·fi ÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÓÔÌÔ‡ ∞ÙÙÈÎ‹˜ (3). ∏ ÂÚÈ-

ÁÚ·Ê‹ ÙfiÛˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ™™∂ ‹Ù·Ó ÚˆÙÔÊ·Ó‹˜ÁÈ· Ù· ÂÏÏËÓÈÎ¿ Î·È ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·ÊÈÎ¿ ‰Â‰ÔÌ¤-Ó· Î·È ·ÔÙ¤ÏÂÛÂ ·ÓÙÈÎÂ›ÌÂÓÔ ÂÈÛÙËÌÔÓÈÎ‹˜ ·ÓÙÈ-·Ú¿ıÂÛË˜ ÌÂÙ·Í‡ ∂ÏÏ‹ÓˆÓ “ÂÈ‰ÈÎÒÓ” Î·È ÂÎÚÔ-ÛÒˆÓ “ÊÔÚ¤ˆÓ”, Ì¤Û· ·fi ÙÈ˜ ÛÂÏ›‰Â˜ Í¤ÓÔ˘ È·-ÙÚÈÎÔ‡ ÂÚÈÔ‰ÈÎÔ‡ (4,5). ™˘ÁÎÂÎÚÈÌ¤Ó·, ˘ÔÛÙËÚ›-¯ıËÎÂ fiÙÈ ˘‹Ú¯Â Ú·ÁÌ·ÙÈÎ‹ ‰È·¯ÚÔÓÈÎ‹ ·‡ÍËÛËÎÚÔ˘ÛÌ¿ÙˆÓ ™™∂, Ô˘ ·Ô‰fiıËÎÂ ÛÙÔÓ ˘Ô¯ÚÂˆ-ÙÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi ÌfiÓÔ ÙˆÓ ·È‰ÈÒÓ, ÌÂ ·ÔÙ¤ÏÂ-ÛÌ· ÙË ÌÂÙ·ÙfiÈÛË ÙË˜ Â˘·›ÛıËÙË˜ ÛÙËÓ ÂÚ˘ıÚ¿ËÏÈÎ›·˜ ÛÙ· ¿ÙÔÌ· ÙË˜ ·Ó··Ú·ÁˆÁÈÎ‹˜ ËÏÈÎ›·˜(5). ∆· ÛÙ·ÙÈÛÙÈÎ¿ ‰Â‰ÔÌ¤Ó· ÛÙ· ÔÔ›· ÛÙËÚ›¯ıËÎÂË ¿Ô„Ë ·˘Ù‹, ·ÓÙÈÎÚÔ‡ÛÙËÎ·Ó Û·Ó ·ÓÂ·ÚÎ‹ Î·È·Ó·ÍÈfiÈÛÙ· ·fi ¿ÏÏÔ˘˜, Ô˘ ˘ÔÛÙ‹ÚÈÍ·Ó fiÙÈ


273

∂È‰ËÌ›· Û˘Ó‰ÚfiÌÔ˘ Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜ (™™∂) ÙÔ ¤ÙÔ˜ 1999 ∞. ∞Ó‰Ú¤Ô˘, µ. ¶ÂÚÈÛÙ¤ÚË, ∞. ª·Ï¿ÛÎ·

Sizable epidemic of congenital rubella syndrome in 1999 A. Andreou, V. Peristeri, A. Balaska

∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT

�¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ¤ÓÙÂÂÚÈÛÙ·ÙÈÎÒÓ ™™∂, Ô˘ ÓÔÛËÏÂ‡ıËÎ·Ó ÛÙÔ ÙÌ‹Ì·Ì·˜ ÌÂÙ¿ ÙËÓ Â˘ÌÂÁ¤ıË ÂÈ‰ËÌ›· ÂÚ˘ıÚ¿˜ ÙÔ˘1999. OÈ ÈÔ Û˘¯Ó¤˜ ‚Ï¿‚Â˜ ‹Ù·Ó Ë ·ÌÊÔÙÂÚfi-ÏÂ˘ÚË ÎÒÊˆÛË, Ô ·ÌÊÔÙÂÚfiÏÂ˘ÚÔ˜ Î·Ù·ÚÚ¿-ÎÙË˜, ÙÔ ÌÈÎÚfi ‚¿ÚÔ˜ ÁÈ· ÙËÓ ËÏÈÎ›· Î‡ËÛË˜ Î·È ÔÈÂÁÎÂÊ·ÏÈÎ¤˜ Â·Û‚ÂÛÙÒÛÂÈ˜. OÈ Â˘ÌÂÁ¤ıÂÈ˜ ÂÈ‰Ë-Ì›Â˜ ÂÚ˘ıÚ¿˜ Î·È ™™∂ ÌÔÚÔ‡Ó Ó· ÚÔÏËÊıÔ‡Ó ÌÂÙÔÓ Ù·˘Ùfi¯ÚÔÓÔ ÂÌ‚ÔÏÈ·ÛÌfi fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ Î·ÈfiÏˆÓ ÙˆÓ ÌË ÂÁÎ‡ˆÓ, ÌË ¿ÓÔÛˆÓ Á˘Ó·ÈÎÒÓ ·Ó··-Ú·ÁˆÁÈÎ‹˜ ËÏÈÎ›·˜, Ô˘ ‰ÂÓ ¤¯Ô˘Ó ·ÓÔÛ›· Î·Ù¿ÙË˜ ÂÚ˘ıÚ¿˜. ∂ÍÂÙ¿˙ÔÓÙ·È ÂÎÙÂÓÒ˜, Ë ·‡ÍËÛË ÙˆÓ·Ó·ÊÂÚı¤ÓÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ™™∂ ÛÙÈ˜ ‰‡Ô ÙÂÏÂ˘-Ù·›Â˜ ÂÈ‰ËÌ›Â˜ ÂÚ˘ıÚ¿˜ Î·È Ù· Ì¤ÙÚ· Ô˘ Ú¤ÂÈÓ· ÏËÊıÔ‡Ó ÁÈ· ÙÔÓ ÂÚÈÔÚÈÛÌfi ÙÔ˘˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: Û‡Ó‰ÚÔÌÔ Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜,ÂÈ‰ËÌ›· ÂÚ˘ıÚ¿˜, ÚfiÏË„Ë Û˘ÁÁÂÓÔ‡˜ Û˘Ó‰Úfi-ÌÔ˘ ÂÚ˘ıÚ¿˜.

�Abstract: The clinical presentation of congenitalrubella syndrome (CRS) is described in 5 infantsadmitted to our department following the 1999sizable rubella outbreak. The most frequent CRS-related defects observed were bilateral deafness,bilateral catarracts, small weight for gestational ageand cerebral calcifications. Sizable rubella andCRS outbreaks could be prevented by immunizingall children as well as all non-pregnant women ofchild-bearing age who lack rubella immunity. Theincrease of reported CRS cases during the last tworubella outbreaks and the appropriate preventingactions that should be implemented are extensivelydiscussed.

Key words: congenital rubella syndrome, rubellaepidemic, prevention of congenital rubellasyndrome.

¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ∂™À,πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔÓ›ÎË˜

Division of Neonatology, Ippokration General Hospital, Thessaloniki


ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ˘¿Ú¯ÂÈ ‰È·¯ÚÔÓÈÎ‹ ÌÂ›ˆÛËÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ (4). ∆ËÓ ¿Ô„Ë ·˘Ù‹ ÛÙ‹ÚÈÍ·ÓÎ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ, Ì¤¯ÚÈ ÂÎÂ›ÓË ÙË ÛÙÈÁÌ‹, Â›¯·Ó·Ó·ÊÂÚıÂ› ÌfiÓÔ 4 ÎÚÔ‡ÛÌ·Ù· ™™∂ ÛÙËÓ ÂÈ‰ËÌ›·ÂÚ˘ıÚ¿˜ ÙÔ˘ 1999 (4,6). ™ÙËÓ ›‰È· ÂÈ‰ËÌ›· (1999)ÓÔÛËÏÂ‡Û·ÌÂ 5 ÓÂÔÁÓ¿ ÌÂ ™™∂, Ù· ÔÔ›· Î·È ÂÚÈ-ÁÚ¿ÊÔ˘ÌÂ.

™ÎÔfi˜ ÙË˜ ·Ó·ÊÔÚ¿˜ ·˘Ù‹˜ Â›Ó·È Ó· ÙÔÓ›ÛÔ˘-ÌÂ Í·Ó¿ ÙË ÛÔ‚·ÚfiÙËÙ· ÙË˜ ¿ıËÛË˜ ·˘Ù‹˜ Î·ÈÙËÓ ·Ó¿ÁÎË Ï‹„Ë˜ ÈÔ ‰Ú·ÛÙÈÎÒÓ Ì¤ÙÚˆÓ, ÁÈ· ÙËÌÂ›ˆÛË, Î·Ù’ ·Ú¯¿˜, ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ™™∂.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜¶ÂÚ›ÙˆÛË ÚÒÙË ¡ÂÔÁÓfi ı‹Ï˘, ÁÂÓÓ‹ıËÎÂ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂ-

Ùfi ÌÂÙ¿ ·fi ‰È¿ÚÎÂÈ· Î‡ËÛË˜ (¢∫) 34 Â‚‰ÔÌ¿‰ˆÓ,·fi ÌËÙ¤Ú· ‰Â˘ÙÂÚfiÙÔÎË, ËÏÈÎ›·˜ 30 ÂÙÒÓ. ∏ ‚·ı-ÌÔÏÔÁ›· ∞pgar ‹Ù·Ó ÛÙÔ 1Ô min 8 Î·È ÛÙÔ 5Ô min9. ¢È·ÎÔÌ›ÛÙËÎÂ ÛÙÔ ÙÌ‹Ì· Ì·˜, ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÁ¤ÓÓËÛË, ÁÈ·Ù› ‹Ù·Ó ÌÈÎÚfi ÁÈ· ÙË ‰È¿ÚÎÂÈ· Î‡ËÛË˜.∏ ÌËÙ¤Ú· ·Ó·Ê¤ÚÂÈ ÂÍ¿ÓıËÌ· ÎËÏÈ‰Ô‚Ï·ÙÈ‰Ò‰Â˜ÛÙÔÓ ÎÔÚÌfi Î·È Ù· ¿ÎÚ· Î·È ˘Ú¤ÙÈÔ ÛÙÔ 1Ô ÙÚ›-ÌËÓÔ ÙË˜ Î‡ËÛË˜. ∏ fiÏË Î·Ù¿ÛÙ·ÛË ·ÓÙÈÌÂÙˆ›-ÛÙËÎÂ Û·Ó ·ÏÏÂÚÁÈÎfi ÂÍ¿ÓıËÌ· ·fi ÙÔÓ ıÂÚ¿Ô-ÓÙ· ÁÈ·ÙÚfi, ¯ˆÚ›˜ Î·Ó¤Ó· ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô.∆Ô ˘ÂÚË¯ÔÁÚ¿ÊËÌ· (À/Ã) ÙÔ˘ ÂÌ‚Ú‡Ô˘ ¤‰ÂÈÍÂÂÓ‰ÔÌ‹ÙÚÈ· Î·ı˘ÛÙ¤ÚËÛË ·Ó¿Ù˘ÍË˜. ∆Ô ‚¿ÚÔ˜Á¤ÓÓËÛË˜ (µ°) ‹Ù·Ó 1340 g (<10Ë ÂÎ. ı¤ÛË), ÙÔÌ‹ÎÔ˜ ÛÒÌ·ÙÔ˜ (ª™) 41 cm (10Ë<p<25Ë ÂÎ. ı¤-ÛË) Î·È Ë ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ (¶∫) 29 cm (10Ë ÂÎ.ı¤ÛË). ∏ Ê˘ÛÈÎ‹ ÂÍ¤Ù·ÛË Î·Ù¿ Û˘ÛÙ‹Ì·Ù· ‹Ù·ÓÊ˘ÛÈÔÏÔÁÈÎ‹. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ:Ht 48%, ÏÂ˘Î¿ 6700 mm3, ( 59%, Ï 36%), ·ÈÌÔÂ-Ù¿ÏÈ· 63.000 mm3. ∆Ô À/Ã Î·Ú‰È¿˜ ‹Ù·Ó Ê˘ÛÈÔÏÔ-ÁÈÎfi, fiˆ˜ Î·È Ô Ï‹ÚË˜ ÔÊı·ÏÌÔÏÔÁÈÎfi˜ ¤ÏÂÁ-¯Ô˜. ∏ ·ÎÙÈÓÔÁÚ·Ê›· (·/·) Ì·ÎÚÒÓ ÔÛÙÒÓ ¤‰ÂÈÍÂ‰È·˘Á·ÛÙÈÎ¤˜ Ù·ÈÓ›Â˜ ÛÙÈ˜ ÌÂÙ·Ê‡ÛÂÈ˜ ÙˆÓ Ì·ÎÚÒÓÔÛÙÒÓ, Â‡ÚËÌ· Û˘Ì‚·Ùfi ÌÂ ™™∂. ∆· ·ÎÔ˘ÛÙÈÎ¿ÚÔÎÏËÙ¿ ‰˘Ó·ÌÈÎ¿ (∞¶¢) ÛÙÔ ·ÚÈÛÙÂÚfi ·˘Ù›‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿, ÂÓÒ ÛÙÔ ‰ÂÍ› ¤‰ÂÈÍ·Ó Ì¤ÙÚÈÔ˘‚·ıÌÔ‡ ‚·ÚËÎÔ˝·. ∆Ô À/Ã ÂÁÎÂÊ¿ÏÔ˘ ‹Ù·Ó Ê˘ÛÈÔ-ÏÔÁÈÎfi. O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÂÚ˘ıÚ¿ ¤‰ÂÈÍÂıÂÙÈÎ¿ IgM ·ÓÙÈÛÒÌ·Ù· (ELIZA) ÁÈ· ÙÔ ÓÂÔÁÓfi Î·È·ÚÓËÙÈÎ¿ ÁÈ· ÙË ÌËÙ¤Ú·. OÈ Ù›ÙÏÔÈ ÙˆÓ ÂÈ‰ÈÎÒÓ πgG·ÓÙÈÛˆÌ¿ÙˆÓ ÙÔ˘ ÓÂÔÁÓÔ‡ ‹Ù·Ó 244 IU/ml Î·È ÙË˜ÌËÙ¤Ú·˜ 612 IU/ml. ™ÙËÓ ËÏÈÎ›· ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜, Ë„˘¯ÔÎÈÓËÙÈÎ‹ ·Ó¿Ù˘ÍË ÙÔ˘ ‚Ú¤ÊÔ˘˜ ‹Ù·Ó Ê˘ÛÈÔÏÔ-ÁÈÎ‹ Î·È ÙÔ Úfi‚ÏËÌ· ÙË˜ ·ÎÔ‹˜ ·Ú¤ÌÂÓÂ ÙÔ ›‰ÈÔ.

¶ÂÚ›ÙˆÛË ‰Â‡ÙÂÚË¡ÂÔÁÓfi ı‹Ï˘, ÁÂÓÓ‹ıËÎÂ ÌÂ Î·ÈÛ·ÚÈÎ‹ ÙÔÌ‹

ÏfiÁˆ ·ÏÏÔ›ˆÛË˜ ·ÏÌÒÓ, ÌÂÙ¿ ·fi ¢∫ 36 Â‚‰Ô-Ì¿‰ˆÓ, ·fi ÌËÙ¤Ú· ÚˆÙfiÙÔÎË, ËÏÈÎ›·˜ 24 ÂÙÒÓ.∏ ‚·ıÌÔÏÔÁ›· Apgar ‹Ù·Ó ÛÙÔ 1Ô min 2 Î·È ÛÙÔ 5Ô

min 6. ¢È·ÎÔÌ›ÛÙËÎÂ ÛÙÔ ÙÌ‹Ì· Ì·˜, ·Ì¤Ûˆ˜ ÌÂÙ¿ÙË Á¤ÓÓËÛË, ÁÈ· ÂÚÈÁÂÓÓËÙÈÎ‹ ·ÛÊ˘Í›· Î·È ·Ó·-ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ·. ∆Ô ÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi‹Ù·Ó ÂÏÂ‡ıÂÚÔ. ∫·Ù¿ ÙËÓ Î‡ËÛË ‰ÂÓ ¤ÁÈÓÂ ÔÚÔÏÔ-ÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÛÙË ÌËÙ¤Ú· ÁÈ· Û˘ÁÁÂÓÂ›˜ ÏÔÈÌÒ-ÍÂÈ˜. ∆· ÛˆÌ·ÙÔÌÂÙÚÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙÔ˘ ÓÂÔ-ÁÓÔ‡ ‹Ù·Ó: µ° 2040 g (10Ë<p<25Ë ÂÎ. ı¤ÛË), ¶∫31,5 cm (25Ë ÂÎ. ı¤ÛË), ª™ 45 cm (25Ë ÂÎ. ı¤ÛË).∏ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ¤‰ÂÈÍÂ Ë·-ÙÔÛÏËÓÔÌÂÁ·Ï›·, ÂÏ·ÙÙˆÌ¤ÓÔ Ì˘˚Îfi ÙfiÓÔ Î·È Óˆ-ıÚ¿ ·Ú¯¤ÁÔÓ· ·ÓÙ·Ó·ÎÏ·ÛÙÈÎ¿. O ÂÚÁ·ÛÙËÚÈ·Îfi˜¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ: ∏t 37%, ÏÂ˘Î¿ 8.600 mm3 ( 45%,Ï 50%), ·ÈÌÔÂÙ¿ÏÈ· 55.000 mm3. ™ÙÔ Ù¤ÏÔ˜ ÙË˜ÚÒÙË˜ Â‚‰ÔÌ¿‰·˜ ˙ˆ‹˜ ÙÔ ÓÂÔÁÓfi ·ÚÔ˘Û›·ÛÂ¿ÌÂÛË ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·, Ô˘ ·Ú‹ÏıÂ ÌÂÙ¿·fi ÌÂÚÈÎ¤˜ ËÌ¤ÚÂ˜. ∏ Ï‹ÚË˜ ÔÊı·ÏÌÔÏÔÁÈÎ‹ÂÍ¤Ù·ÛË ¤‰ÂÈÍÂ ˘ÚËÓÈÎfi Î·Ù·ÚÚ¿ÎÙË ¿ÌÊˆ. ∆·∞¶¢ ¤‰ÂÈÍ·Ó ‚·ÚËÎÔ˝· ÛÙ· fiÚÈ· ÙË˜ ÎÒÊˆÛË˜ ¿Ì-Êˆ. ™ÙËÓ ·/· Ì·ÎÚÒÓ ÔÛÙÒÓ ˘‹Ú¯·Ó ‰È·˘Á·ÛÙÈ-Î¤˜ Ù·ÈÓ›Â˜ ÛÙÈ˜ ÌÂÙ·Ê‡ÛÂÈ˜ ÙˆÓ Ì·ÎÚÒÓ ÔÛÙÒÓ,Â‡ÚËÌ· Û˘Ì‚·Ùfi ÌÂ ™™∂. ∞fi ÙËÓ ·ÍÔÓÈÎ‹ ÙÔÌÔ-ÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ‰È·ÈÛÙÒıËÎ·Ó 2 ÛÙÈÎÙ¤˜ Â·-Û‚ÂÛÙÒÛÂÈ˜ ÛÙ· fiÚÈ· Ê·È¿˜ ÏÂ˘Î‹˜ Ô˘Û›·˜, ‚ÚÂÁ-Ì·ÙÈÎ¿ ¿ÌÊˆ. ∆Ô À/Ã Î·Ú‰È¿˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi.O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÂÈ‰ÈÎ¿ ÁÈ· ÂÚ˘ıÚ¿ IgM·ÓÙÈÛÒÌ·Ù· (∂LISA) ‹Ù·Ó ıÂÙÈÎfi˜ ÛÙÔ ÓÂÔÁÓfi Î·ÈÛÙË ÌËÙ¤Ú·. O Ù›ÙÏÔ˜ ÙˆÓ ÂÈ‰ÈÎÒÓ ÁÈ· ÂÚ˘ıÚ¿ IgG·ÓÙÈÛˆÌ¿ÙˆÓ ÙÔ˘ ÓÂÔÁÓÔ‡ ‹Ù·Ó 226 IU/ml Î·È ÙË˜ÌËÙ¤Ú·˜ 400 IU/ml.

∆o ‚Ú¤ÊÔ˜ ¯ÂÈÚÔ˘ÚÁ‹ıËÎÂ ÁÈ· ·Ê·›ÚÂÛË ÙÔ˘Î·Ù·ÚÚ¿ÎÙË ¿ÌÊˆ ÛÂ ËÏÈÎ›· 15 ËÌÂÚÒÓ. ™Â ËÏÈÎ›·6 ÌËÓÒÓ ÙÔÔıÂÙ‹ıËÎ·Ó ·ÌÊÔÙÂÚfiÏÂ˘Ú· ÎÔ-¯ÏÈ·Î¿ ÂÌÊ˘ÙÂ‡Ì·Ù·. ∏ ·Ú·ÎÔÏÔ‡ıËÛË ÛÙ· ÂÍˆ-ÙÂÚÈÎ¿ È·ÙÚÂ›· ÙË˜ ÎÏÈÓÈÎ‹˜ Ì¤¯ÚÈ ÙÔÓ ÚÒÙÔ ¯Úfi-ÓÔ ˙ˆ‹˜ ¤‰ÂÈÍÂ ‚·ÚÈ¿ „˘¯ÔÎÈÓËÙÈÎ‹ Î·ı˘ÛÙ¤ÚËÛËÎ·È ÁÂÓÈÎÂ˘Ì¤ÓË ˘ÔÙÔÓ›·.

¶ÂÚ›ÙˆÛË ÙÚ›ÙË¡ÂÔÁÓfi ¿ÚÚÂÓ, ÁÂÓÓ‹ıËÎÂ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔ-

ÎÂÙfi ÌÂÙ¿ ·fi ¢∫ 39 Â‚‰ÔÌ¿‰ˆÓ ·fi ÌËÙ¤Ú·ÚˆÙfiÙÔÎË, ËÏÈÎ›·˜ 16 ÂÙÒÓ. ∏ ÌËÙ¤Ú· ÂÌÊ¿ÓÈÛÂÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÚÒÙÔ˘ ÙÚÈÌ‹ÓÔ˘ ÙË˜ Î‡ËÛË˜ ˘-Ú¤ÙÈÔ Î·È ÎËÏÈ‰Ô‚Ï·ÙÈ‰Ò‰Â˜ ÂÍ¿ÓıËÌ· ÛÂ fiÏÔ ÙÔÛÒÌ· ÙË˜, Ô˘ ·Ô‰fiıËÎ·Ó ÛÂ ÈÔÁÂÓ‹ ÏÔ›ÌˆÍË.™ÙÔ ‚È‚ÏÈ¿ÚÈÔ ˘ÁÂ›·˜ ÙË˜ ÌËÙ¤Ú·˜ ·Ó·ÁÚ·ÊfiÙ·ÓfiÙÈ Â›¯Â ÓÔÛ‹ÛÂÈ ·fi ÂÚ˘ıÚ¿ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·.∆Ô À/Ã ÂÌ‚Ú‡Ô˘ ¤‰ÂÈÍÂ Î·ı˘ÛÙ¤ÚËÛË ÙË˜ ·Ó¿Ù˘-ÍË˜. ∏ ‚·ıÌÔÏÔÁ›· Apgar ‹Ù·Ó ÛÙÔ 10Ô min 9 Î·ÈÛÙÔ 5Ô min 10. ∆Ô ÓÂÔÁÓfi ‰È·ÎÔÌ›ÛÙËÎÂ ÛÙÔ ÙÌ‹-Ì· Ì·˜ ÛÂ ËÏÈÎ›· 1 ËÌ¤Ú·˜, ÏfiÁˆ ·ÌÊÔÙÂÚfiÏÂ˘-ÚÔ˘ Î·Ù·ÚÚ¿ÎÙË. ∆· ÛˆÌ·ÙÔÌÂÙÚÈÎ¿ ¯·Ú·ÎÙËÚÈ-ÛÙÈÎ¿ ‹Ù·Ó: µ° 1850 g (<10Ë ÂÎ. ı¤ÛË), ¶∫ 31,5cm (<10Ë ÂÎ. ı¤ÛË), ª™ 45 cm (<10Ë ÂÎ. ı¤ÛË).∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, Ë ÂÍ¤Ù·ÛË Î·Ù¿ Û˘ÛÙ‹Ì·Ù·


274



275

¤‰ÂÈÍÂ Û˘ÛÙÔÏÈÎfi Ê‡ÛËÌ· 1/6 ÛÙÔ ÚÔÎ¿Ú‰ÈÔ Î·È‹È· ˘ÂÚÙÔÓ›·. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ:∏t 48%, ÏÂ˘Î¿ 12.300 mm3 ( 42%, Ï 56%), ·ÈÌÔ-ÂÙ¿ÏÈ· 230.000 mm3. ∆Ô À/Ã Î·Ú‰È¿˜ ¤‰ÂÈÍÂ ·-Ú·ÌÔÓ‹ ·ÓÔÈÎÙÔ‡ ·ÚÙËÚÈ·ÎÔ‡ fiÚÔ˘ Î·È ‰˘ÛÏ·-ÛÙÈÎ‹ ÓÂ˘ÌÔÓÈÎ‹ ‚·Ï‚›‰·. ∆· ∞¶¢ Î·Ù¤ÁÚ·„·Ó·ÌÊÔÙÂÚfiÏÂ˘ÚË ÓÂ˘ÚÔ·ÈÛıËÙËÚÈ·Î‹ ‚·ÚËÎÔ˝·ÛÙ· fiÚÈ· ÙË˜ ÎÒÊˆÛË˜. ∏ ·/· Ì·ÎÚÒÓ ÔÛÙÒÓ ·ÂÈ-ÎfiÓÈ˙Â ÌË ÂÈ‰ÈÎ¤˜ ·ÏÏÔÈÒÛÂÈ˜ ÛÙÈ˜ ÌÂÙ·Ê‡ÛÂÈ˜. OÔÊı·ÏÌÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ·ÔÎ¿Ï˘„Â ·ÌÊÔÙÂÚfi-ÏÂ˘ÚÔ ˘ÚËÓÈÎfi Î·Ù·ÚÚ¿ÎÙË. ™ÙËÓ ·ÍÔÓÈÎ‹ ÙÔÌÔ-ÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ˘‹Ú¯·Ó ÂÓ‰ÔÎÚ·ÓÈ·Î¤˜ Â·-Û‚ÂÛÙÒÛÂÈ˜ ÛÙÔ ÌÂÛÔÏfi‚ÈÔ Î·È ÂÓ‰Ô·ÚÂÁ¯˘Ì·ÙÈ-Î¿ ¿ÌÊˆ Î·È ‰È¿Ù·ÛË ÙÔ˘ ÎÔÈÏÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜.O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ ÙËÓ ‡·ÚÍË ÂÈ‰ÈÎÒÓÁÈ· ÂÚ˘ıÚ¿ πgM ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔ ÓÂÔÁÓfi Î·È ÛÙËÏÂ¯ˆ›‰· ÌËÙ¤Ú·. OÈ Ù›ÙÏÔÈ ÙˆÓ ÂÈ‰ÈÎÒÓ ÁÈ· ÂÚ˘ıÚ¿IgG ·ÓÙÈÛˆÌ¿ÙˆÓ ‹Ù·Ó >400 IU/ml Î·È ÛÙÔ ÓÂÔÁÓfiÎ·È ÛÙË ÌËÙ¤Ú·.

™Â ËÏÈÎ›· 7 ËÌÂÚÒÓ ˙ˆ‹˜ ¤ÁÈÓÂ ¯ÂÈÚÔ˘ÚÁÈÎ‹·Ê·›ÚÂÛË ÙÔ˘ Î·Ù·ÚÚ¿ÎÙË ¿ÌÊˆ. ™Â ËÏÈÎ›· 7 ÌË-ÓÒÓ ÙÔÔıÂÙ‹ıËÎ·Ó ·ÌÊÔÙÂÚfiÏÂ˘Ú· ÎÔ¯ÏÈ·Î¿ÂÌÊ˘ÙÂ‡Ì·Ù·. ∏ ·Ú·ÎÔÏÔ‡ıËÛË ÛÙ· ÂÍˆÙÂÚÈÎ¿È·ÙÚÂ›· Ì¤¯ÚÈ ÙËÓ ËÏÈÎ›· ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ ¤‰ÂÈÍÂ ÁÂ-ÓÈÎÂ˘Ì¤ÓË ˘ÂÚÙÔÓ›· Î·È ‚·ÚÈ¿ „˘¯ÔÎÈÓËÙÈÎ‹ Î·ı˘-ÛÙ¤ÚËÛË.

¶ÂÚ›ÙˆÛË Ù¤Ù·ÚÙË Î·È ¤ÌÙË¶ÚfiÎÂÈÙ·È ÁÈ· ‰›‰˘Ì· ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó

ÌÂ Î·ÈÛ·ÚÈÎ‹ ÙÔÌ‹ ÏfiÁˆ ÚÔˆÚfiÙËÙ·˜ Î·È ÈÛ¯È·-Î‹˜ ÚÔ‚ÔÏ‹˜ ÙÔ˘ ÚÒÙÔ˘ ‰È‰‡ÌÔ˘, ÌÂÙ¿ ·fi ¢∫33 Â‚‰ÔÌ¿‰ˆÓ ·fi ÌËÙ¤Ú· ÚˆÙfiÙÔÎË, ËÏÈÎ›·˜ 26ÂÙÒÓ. ∏ Î‡ËÛË ‹Ù·Ó ‰È¯ÔÚÈ·Î‹, ‰È·ÌÓÈ·Î‹. ™ÙÔ 2ÔÌ‹Ó· ÙË˜ Î‡ËÛË˜ Ë ÌËÙ¤Ú· ÂÌÊ¿ÓÈÛÂ ˘Ú¤ÙÈÔ, ÎË-ÏÈ‰Ô‚Ï·ÙÈÙÒ‰Â˜ ÂÍ¿ÓıËÌ· ÛÂ fiÏÔ ÙÔ ÛÒÌ· Î·È ‰Èfi-ÁÎˆÛË ÔÈÛıÔˆÙÈ·›ˆÓ ÏÂÌÊ·‰¤ÓˆÓ. ∆¤ıËÎÂ ÎÏÈÓÈ-Î¿ Ë ‰È¿ÁÓˆÛË ÂÚ˘ıÚ¿˜ Î·È ¤ÁÈÓÂ ÔÚÔÏÔÁÈÎfi˜¤ÏÂÁ¯Ô˜ ÌfiÓÔ ÌÂ IgG ·ÓÙÈÛÒÌ·Ù· ÛÙÔÓ 4Ô Î·È 5ÔÌ‹Ó· ÙË˜ Î‡ËÛË˜, Ô˘ ¤‰ÂÈÍÂ ÙÈÌ¤˜ 240 IU/ml Î·È214 IU/ml, ·ÓÙ›ÛÙÔÈ¯·. ∏ ÌËÙ¤Ú· ‰ÂÓ ‰¤¯ÙËÎÂ ‰È·-ÎÔ‹ ÙË˜ Î‡ËÛË˜. ∆· ÓÂÔÁÓ¿ ÂÈÛ‹¯ıËÛ·Ó ÛÙÔ ÙÌ‹-Ì· ÏfiÁˆ ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ Î·È ÙË˜ ÚÔˆÚfiÙËÙ·˜.

∆Ô ÚÒÙÔ ‰›‰˘ÌÔ ‹Ù·Ó ·ÁfiÚÈ Î·È Â›¯Â ‚·ıÌÔÏÔ-Á›· ∞pgar ÛÙÔ 1Ô min 6 Î·È ÛÙÔ 5Ô min 9. ∆· Ûˆ-Ì·ÙÔÌÂÙÚÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ‹Ù·Ó: µ™ 1630 g(25Ë<p<50Ë), ¶∫ 29 cm (10Ë<p<50Ë), ª™ 42 cm(25Ë ÂÎ. ı¤ÛË). ∏ ÂÍ¤Ù·ÛË Î·Ù¿ Û˘ÛÙ‹Ì·Ù· Î·Ù¿ÙËÓ ÂÈÛ·ÁˆÁ‹ ¤‰ÂÈÍÂ ‹ÈÔ Û˘ÛÙÔÏÈÎfi Ê‡ÛËÌ· ÛÙÔÚÔÎ¿Ú‰ÈÔ. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó: ∏t52%, ÏÂ˘Î¿ 13.600 mm3 ( 41%, Ï 50%), ·ÈÌÔÂÙ¿-ÏÈ· 170.000 mm3. ∆Ô À/Ã Î·Ú‰È¿˜ ¤‰ÂÈÍÂ ·Ú·ÌÔÓ‹·ÓÔÈÎÙÔ‡ ·ÚÙËÚÈ·ÎÔ‡ fiÚÔ˘. ∏ ÔÊı·ÏÌÔÏÔÁÈÎ‹ÂÍ¤Ù·ÛË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ‹. ∏ ·/· Ì·ÎÚÒÓ ÔÛÙÒÓÂ›¯Â ·Û·ÊÂ›˜ ·Ú·ÈˆÙÈÎ¤˜ ÂÛÙ›Â˜ Î·È ÂÏ·ÊÚ¿ ·Óˆ-

Ì·Ï›· ·Ú˘Ê‹˜ ÛÙÈ˜ ¿Óˆ ÌÂÙ·Ê‡ÛÂÈ˜ ÙˆÓ ÌËÚÈ·›-ˆÓ ÔÛÙÒÓ. ∆Ô À/Ã ÂÁÎÂÊ¿ÏÔ˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi.∆· ∞¶¢ ¤‰ÂÈÍ·Ó ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡ ·ÌÊÔÙÂÚfiÏÂ˘-ÚË ÓÂ˘ÚÔ·ÈÛıËÙËÚÈ·Î‹ ‚·ÚËÎÔ˝· ÛÙ· fiÚÈ· ÙË˜ ÎÒ-ÊˆÛË˜. O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó ıÂÙÈÎfi˜ ÁÈ· ÂÈ-‰ÈÎ¿ ÁÈ· ÂÚ˘ıÚ¿ IgM ·ÓÙÈÛÒÌ·Ù·. OÈ Ù›ÙÏÔÈ ÁÈ· Ù·ÂÈ‰ÈÎ¿ ÁÈ· ÂÚ˘ıÚ¿ πgG ·ÓÙÈÛÒÌ·Ù· ‹Ù·Ó 296 IU/ml.

™Â ËÏÈÎ›· 3 ÌËÓÒÓ ¤ÁÈÓÂ ¯ÂÈÚÔ˘ÚÁÈÎ‹ Û‡ÁÎÏÈÛËÙÔ˘ ·ÓÔÈÎÙÔ‡ ·ÚÙËÚÈ·ÎÔ‡ fiÚÔ˘. ™Â ËÏÈÎ›· 8 ÌË-ÓÒÓ ÙÔÔıÂÙ‹ıËÎ·Ó ÎÔ¯ÏÈ·Î¿ ÂÌÊ˘ÙÂ‡Ì·Ù· ¿ÌÊˆ.™ÙËÓ ËÏÈÎ›· ÙÔ˘ 1 ¤ÙÔ˘˜ ·ÚÔ˘Û›·˙Â ÌÈÎÚÔÎÂÊ·-Ï›·, ÂÓÒ Ë „˘¯ÔÎÈÓËÙÈÎ‹ ÙÔ˘ ·Ó¿Ù˘ÍË ‹Ù·Ó Ê˘ÛÈÔ-ÏÔÁÈÎ‹.

∆Ô ‰Â‡ÙÂÚÔ ‰›‰˘ÌÔ ‹Ù·Ó ı‹Ï˘ Î·È Â›¯Â ‚·ıÌÔ-ÏÔÁ›· Apgar ÛÙÔ 1Ô min 8 Î·È ÛÙÔ 5Ô min 10. ∆·ÛˆÌ·ÙÔÌÂÙÚÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ‹Ù·Ó: µ° 1555 g(10Ë<p<25Ë), ¶∫ 28,5 cm (10Ë<p<25Ë), ª™ 40,5cm (10Ë<p<25Ë). ∏ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË, ·Ì¤Ûˆ˜ ÌÂ-Ù¿ ÙË Á¤ÓÓËÛË, ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ‹. O ÂÚÁ·ÛÙËÚÈ·-Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ: ∏t 50%, ÏÂ˘Î¿ 12.800 mm3 (52%, Ï 45%), ·ÈÌÔÂÙ¿ÏÈ· 210.000 mm3. ∆Ô À/ÃÎ·Ú‰È¿˜ ¤‰ÂÈÍÂ ·ÓÔÈ¯Ùfi ·ÚÙËÚÈ·Îfi fiÚÔ Ô˘¤ÎÏÂÈÛÂ ·˘ÙfiÌ·Ù· ÛÂ Ï›ÁÂ˜ ËÌ¤ÚÂ˜. ∏ ·/· Ì·ÎÚÒÓÔÛÙÒÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ‹, fiˆ˜ Î·È Ë ÔÊı·ÏÌÔÏÔ-ÁÈÎ‹ ÂÍ¤Ù·ÛË. ∆· ∞¶¢ ¤‰ÂÈÍ·Ó ÓÂ˘ÚÔ·ÈÛıËÙËÚÈ·Î‹‚·ÚËÎÔ˝· ÌÂÁ¿ÏÔ˘ ‚·ıÌÔ‡, ÛÙ· fiÚÈ· ÙË˜ ÎÒÊˆ-ÛË˜ ¿ÌÊˆ. ∆Ô À/Ã ÂÁÎÂÊ¿ÏÔ˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi. OÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ ÙËÓ ‡·ÚÍË ÂÈ‰ÈÎÒÓ Igª·ÓÙÈÛˆÌ¿ÙˆÓ ÁÈ· ÂÚ˘ıÚ¿. ∆· Â›Â‰· ÙˆÓ ÂÈ‰ÈÎÒÓÁÈ· ÂÚ˘ıÚ¿ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ ‹Ù·Ó 204 IU/ml.

™Â ËÏÈÎ›· 8 ÌËÓÒÓ ÙÔÔıÂÙ‹ıËÎ·Ó ÎÔ¯ÏÈ·Î¿ ÂÌ-Ê˘ÙÂ‡Ì·Ù· ¿ÌÊˆ. ™ÙËÓ ËÏÈÎ›· ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ Â›¯ÂÊ˘ÛÈÔÏÔÁÈÎ‹ ÛˆÌ·ÙÈÎ‹ Î·È „˘¯ÔÎÈÓËÙÈÎ‹ ·Ó¿Ù˘ÍË.

™˘˙‹ÙËÛË∏ ‰È¿ÁÓˆÛË ÙÔ˘ ™™∂ ÙÂÎÌËÚÈÒıËÎÂ Î·È ÛÙ· ¤-

ÓÙÂ ÂÚÈÛÙ·ÙÈÎ¿ Ì·˜ ÌÂ ÙËÓ ·ÓÂ‡ÚÂÛË ÂÈ‰ÈÎÒÓ ÁÈ·ÂÚ˘ıÚ¿ IgM ·ÓÙÈÛˆÌ¿ÙˆÓ. ŸÏ· Ù· ÓÂÔÁÓ¿ Â›¯·ÓÛÔ‚·Ú¤˜ ·ÈÛıËÙËÚÈ·Î¤˜ ‚Ï¿‚Â˜, fiˆ˜ ·ÌÊÔÙÂÚfi-ÏÂ˘ÚË ÎÒÊˆÛË (4), ÂÙÂÚfiÏÂ˘ÚË ÛÔ‚·Ú‹ ‚·ÚË-ÎÔ˝· (1) Î·È ·ÌÊÔÙÂÚfiÏÂ˘ÚÔ Î·Ù·ÚÚ¿ÎÙË (2). ¢‡ÔÓÂÔÁÓ¿ Â›¯·Ó ÛÔ‚·Ú‹ „˘¯ÔÎÈÓËÙÈÎ‹ Î·ı˘ÛÙ¤ÚËÛËÛÙËÓ ËÏÈÎ›· ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜.

∫·Ì›· ÌËÙ¤Ú· ‰ÂÓ Â›¯Â ÂÌ‚ÔÏÈ·ÛÙÂ› Î·Ù¿ ÙË˜ÂÚ˘ıÚ¿˜. ¶·ÚfiÙÈ Â›¯Â ÚÔËÁËıÂ› ÂÈ‰ËÌ›· ÂÚ˘-ıÚ¿˜, ‰ÂÓ Ù¤ıËÎÂ Ë ˘Ô„›· ÓfiÛËÛË˜ ·fi ÂÚ˘ıÚ¿ÛÂ ‰‡Ô ·fi ÙÈ˜ ÙÚÂÈ˜ ¤ÁÎ˘Â˜ Ô˘ Â›¯·Ó ·ÚÔ˘ÛÈ¿-ÛÂÈ ÎËÏÈ‰Ô‚Ï·ÙÈ‰Ò‰Â˜ ÂÍ¿ÓıËÌ·. OÚÔÏÔÁÈÎfi˜¤ÏÂÁ¯Ô˜ ¤ÁÈÓÂ ÛÂ Ì›· ÌfiÓÔ ¤ÁÎ˘Ô ÌÂ ÎËÏÈ‰Ô‚Ï·ÙÈ-‰Ò‰Â˜ ÂÍ¿ÓıËÌ· ‡ÔÙÔ ÁÈ· ÂÚ˘ıÚ¿, ·ÏÏ¿ ‹Ù·Ó·ÙÂÏ‹˜ Î·È ÌË ‰È·ÁÓˆÛÙÈÎfi˜ (ÌfiÓÔ πgG ·ÓÙÈÛÒÌ·-Ù·). ª›· ¤ÁÎ˘Ô˜, ÚÔÂÚ¯fiÌÂÓË ·fi ·Ó·ÙÔÏÈÎ¤˜ ¯ÒÚÂ˜, Â›¯Â ÁÚ·ÌÌ¤ÓÔ ÛÙÔ ‚È‚ÏÈ¿ÚÈÔ ˘ÁÂ›·˜ fiÙÈ


ÓfiÛËÛÂ ·fi ÂÚ˘ıÚ¿ ÛÙË ·È‰ÈÎ‹ ËÏÈÎ›·. O Ì·ÈÂ˘-Ù‹Ú·˜ ÙË˜ ıÂÒÚËÛÂ ÂÚÈÙÙ‹ ÙË ‰ÈÂÚÂ‡ÓËÛË/ÂÈ‚Â-‚·›ˆÛË ÙË˜ ·ÓÔÛÔÏÔÁÈÎ‹˜ ÙË˜ Î·Ù¿ÛÙ·ÛË˜ ÌÂÔÚÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô, fiÙ·Ó ·˘Ù‹ ·ÚÔ˘Û›·ÛÂ ÎËÏÈ-‰Ô‚Ï·ÙÈ‰Ò‰Â˜ ÂÍ¿ÓıËÌ·. ∆Ô ÓÂÔÁÓfi Ô˘ ÁÂÓÓ‹ıË-ÎÂ Â›¯Â ÛÔ‚·Ú¤˜ Î·È ¯·Ú·ÎÙËÚÈÛÙÈÎ¤˜ ‚Ï¿‚Â˜ ™™∂·fi ÙËÓ ÚÒÙË ËÌ¤Ú· ÙË˜ ˙ˆ‹˜ (ÏÈÔ‚·Ú¤˜, Î·-Ù·ÚÚ¿ÎÙË˜ ¿ÌÊˆ), ¯ˆÚ›˜ Ó· ÚÔÎ·Ï¤ÛÂÈ ˘Ô„›·ÁÈ· ÙÔ ™™∂ ÛÙÔÓ ·È‰›·ÙÚÔ Ô˘ ÙÔ ÂÍ¤Ù·ÛÂ, ÚÈÓÙÔ ‰È·ÎÔÌ›ÛÂÈ ÛÙÔ ÙÌ‹Ì· Ì·˜.

∆· ·Ú·¿Óˆ ‰Â›¯ÓÔ˘Ó ‰˘ÛÎÔÏ›Â˜, Ï¿ıË Î·È·Ú·ÏÂ›„ÂÈ˜, Ô˘ ÛÂ Î·ÈÚfi ÂÈ‰ËÌ›·˜ ÌÔÚÔ‡Ó Ó··ÔÊÂ‡ÁÔÓÙ·È ‹ Ó· ÂÏ·¯ÈÛÙÔÔÈÔ‡ÓÙ·È. °ÂÓÈÎ¿, Ë·‰˘Ó·Ì›· ‰È¿ÁÓˆÛË˜ ÙË˜ ÂÚ˘ıÚ¿˜ Î·È ÙÔ˘ ™™∂,fiÙ·Ó ˘¿Ú¯Ô˘Ó ÛÔÚ·‰ÈÎ¿ ÎÚÔ‡ÛÌ·Ù·, ı· ÌÔ-ÚÔ‡ÛÂ Ó· ‰ÈÎ·ÈÔÏÔÁËıÂ› ÏfiÁˆ Û·ÓÈfiÙËÙ·˜. ™ÂÎ·ÈÚfi, fiÌˆ˜, ÂÈ‰ËÌ›·˜, ÔÈ “˘ÁÂÈÔÓÔÌÈÎ¤˜ ·Ú¯¤˜”¤¯Ô˘Ó ·ÚÎÂÙfi ¯ÚfiÓÔ ÁÈ· Ï‹„Ë Ì¤ÙÚˆÓ Î·È ÂÓËÌ¤-ÚˆÛË fiÏˆÓ fiÛˆÓ ÊÚÔÓÙ›˙Ô˘Ó ¤ÁÎ˘Â˜, Á˘Ó·›ÎÂ˜·Ó··Ú·ÁˆÁÈÎ‹˜ ËÏÈÎ›·˜ Î·È ‚Ú¤ÊË. ∞’ fiÛÔ ÁÓˆ-Ú›˙Ô˘ÌÂ, Ù¤ÙÔÈ· ÂÓËÌ¤ÚˆÛË ‰ÂÓ ˘‹ÚÍÂ ÛÂ Î·Ó¤Ó·ÊÔÚ¤· ˘ÁÂ›·˜.

∆· 5 ·ÚfiÓÙ· ÎÚÔ‡ÛÌ·Ù·, Ì·˙› ÌÂ ¿ÏÏ· 4 Ô˘·Ó·ÎÔÈÓÒıËÎ·Ó ·fi ¿ÏÏË ÎÏÈÓÈÎ‹ (6), Â›Ó·È Ë ÎÔ-Ú˘Ê‹ ÙÔ˘ ·Áfi‚Ô˘ÓÔ˘, Â¿Ó ˘ÔÏÔÁ›ÛÔ˘ÌÂ: ·) ÙËÓÂÏÏÈ‹ ÔÚÁ¿ÓˆÛË Î·Ù·ÁÚ·Ê‹˜ ÎÚÔ˘ÛÌ¿ÙˆÓ ™™∂,‚) ÙËÓ, ÁÈ· ·ÓÙÈÎÂÈÌÂÓÈÎÔ‡˜ ÏfiÁÔ˘˜, ·‰˘Ó·Ì›· ÂÎ-·›‰Â˘ÛË˜/ÂÓËÌ¤ÚˆÛË˜ ÙˆÓ ÁÈ·ÙÚÒÓ ¿Óˆ ÛÙÔı¤Ì· ·˘Ùfi, Á) ÙËÓ ·ÓÂÏÏ·‰ÈÎ‹ ¤ÏÏÂÈ„Ë ÂÚÁ·ÛÙË-Ú›ˆÓ ÌÂ ‰˘Ó·ÙfiÙËÙ· Î·ÏÏÈ¤ÚÁÂÈ·˜ ÙÔ˘ ÈÔ‡, ÂÍ¤Ù·-ÛË˜ ¯Ú‹ÛÈÌË˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙˆÓ ‡ÔÙˆÓ ÂÚÈ-ÛÙ·ÙÈÎÒÓ Ô˘ ¤¯Ô˘Ó ·ÚÓËÙÈÎ¿ IgM Î·È ‰) fiÙÈ ¤Ó·ÌÂÁ¿ÏÔ ÔÛÔÛÙfi Û˘ÁÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ ·fi ÂÚ˘-ıÚ¿ Â›Ó·È ·Û˘ÌÙˆÌ·ÙÈÎfi Î·Ù¿ ÙË Á¤ÓÓËÛË Î·ÈÌÔÚÂ› Ó· ÂÌÊ·Ó›ÛÂÈ ‚Ï¿‚Â˜ ·ÚÎÂÙ¿ ·ÚÁfiÙÂÚ·.Œ¯Ô˘Ó ÂÚ¿ÛÂÈ ‰‡Ô ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ÂÈ‰ËÌ›· ÙË˜ÂÚ˘ıÚ¿˜ Î·È ·ÎfiÌ· ‰ÂÓ ¤¯Ô˘ÌÂ Î¿ÔÈ· Â›ÛËÌËÂÓËÌ¤ÚˆÛË ÁÈ· ÙÔÓ ·ÚÈıÌfi ÙˆÓ ‰ËÏˆÌ¤ÓˆÓ ÎÚÔ˘-ÛÌ¿ÙˆÓ ™™∂.

∏ ÚÔÛÙ·Û›· ÙÔ˘ ÂÌ‚Ú‡Ô˘ Î·Ù¿ ÙË˜ ÂÚ˘ıÚ¿˜Á›ÓÂÙ·È Î˘Ú›ˆ˜ ÌÂ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙÔ˘ ÁÂÓÈÎÔ‡ÏËı˘ÛÌÔ‡. °È· ÙÔ ÛÎÔfi ·˘Ùfi ¤¯Ô˘Ó ÚÔÙ·ıÂ›‰‡Ô ‚·ÛÈÎ¤˜ ÛÙÚ·ÙËÁÈÎ¤˜: ·) Ë ÁÂÓÈÎÂ˘Ì¤ÓË ·ÓÔ-ÛÔÔ›ËÛË ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· (¤ÌÌÂÛË ÚÔÊ‡Ï·-ÍË) Î·È ‚) Ô ÂÎÏÂÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÙˆÓ Á˘Ó·ÈÎÒÓ·Ó··Ú·ÁˆÁÈÎ‹˜ ËÏÈÎ›·˜ (¿ÌÂÛË ÚÔÊ‡Ï·ÍË) (7).∏ ÔÏ˘ÂÙ‹˜ ÂÌÂÈÚ›· ¤¯ÂÈ ‰Â›ÍÂÈ fiÙÈ Â›Ó·È ·Ó·ÁÎ·›·Ë ÔÏÔÎÏ‹ÚˆÛË Î·È ÙˆÓ ‰‡Ô ÛÙÚ·ÙËÁÈÎÒÓ ÁÈ· ÙËÓÂ›ÙÂ˘ÍË ÙÔ˘ Ì¤ÁÈÛÙÔ˘ ÂÏ¤Á¯Ô˘ ÛÙÔ ‚Ú·¯‡ÙÂÚÔ‰˘Ó·Ùfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· (8). ∞fi ÌfiÓÂ˜ ÙÔ˘˜ Î·ÈÔÈ ‰‡Ô ÛÙÚ·ÙËÁÈÎ¤˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÚÎÂÙ¿ ÌÂÈÔÓÂ-ÎÙ‹Ì·Ù· Î·È ¯ÚÂÈ¿˙ÔÓÙ·È ÔÏÏ¿ ¯ÚfiÓÈ· ÁÈ· Ó·¤¯Ô˘Ó ÛËÌ·ÓÙÈÎ‹ Â›‰Ú·ÛË (7,8).

ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ÓÔÛÔÔ›ËÛË ÛÙËÓ ·È‰ÈÎ‹ËÏÈÎ›·, ÔÈ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ fiÙ·Ó ¤Ó·˜ ÈÎ·-ÓÔÔÈËÙÈÎfi˜ ·ÚÈıÌfi˜ ·È‰ÈÒÓ Ì›·˜ ÎÔÈÓfiÙËÙ·˜·ÓÔÛÔÔÈËıÂ› Î·Ù¿ Ì›·˜ ÓfiÛÔ˘ ÁÈ· ÙËÓ ÔÔ›·˘¿Ú¯ÂÈ ÂÌ‚fiÏÈÔ, ÙfiÙÂ ÂÍ·ÛÊ·Ï›˙ÂÙ·È ÚÔÛÙ·Û›·Î·Ù¿ ÙË˜ ÓfiÛÔ˘ ·˘Ù‹˜ ÁÈ· Î¿ıÂ ¿ÙÔÌÔ ÙË˜ ÎÔÈÓfi-ÙËÙ·˜ (9). °È· ÙÈ˜ ÓfiÛÔ˘˜ ÌÂ ÌÂÁ¿ÏË ÌÂÙ·‰ÔÙÈÎfi-ÙËÙ·, fiˆ˜ Ë ÂÚ˘ıÚ¿ Î·È Ë ÈÏ·Ú¿, Ú¤ÂÈ Ó· ·ÓÔ-ÛÔÔÈËıÂ› ˘„ËÏfi ÔÛÔÛÙfi ·È‰ÈÒÓ (>90%) ÁÈ· Ó·˘¿Ú¯ÂÈ ÚÔÛÙ·Û›· ÁÈ· ÙÔÓ Î·ı¤Ó· (9).

™ÙËÓ ∂ÏÏ¿‰·, Ô ˘Ô¯ÚÂˆÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜Î·Ù¿ ÙË˜ ÂÚ˘ıÚ¿˜ ¿Ú¯ÈÛÂ ÙÔ 1989 ·fi ÙËÓ ·È‰È-Î‹ ËÏÈÎ›· Î·È ÙÔ ÔÛÔÛÙfi ÂÌ‚ÔÏÈ·ÛÌÔ‡, Ì¤¯ÚÈ Û‹-ÌÂÚ·, ıÂˆÚÂ›Ù·È fiÙÈ Â›Ó·È ÌÈÎÚfiÙÂÚÔ ·fi ÙÔ ÔÛÔ-ÛÙfi Ô˘ ÚÔÛÙ·ÙÂ‡ÂÈ ·fi ÙËÓ ÂÈ‰ËÌÈÎ‹ ¤ÎÚËÍËÙË˜ ÓfiÛÔ˘ (3). ∆Ô Úfi‚ÏËÌ· ÂÚÈÏ¤ÎÂÙ·È ·Ó ·Ó·-ÏÔÁÈÛÙÔ‡ÌÂ ÙË Ì·˙ÈÎ‹ ÂÈÛ‚ÔÏ‹ ÌÂÙ·Ó·ÛÙÒÓ ·fi¯ÒÚÂ˜ Ô˘ ‰ÂÓ Á›ÓÔÓÙ·È ÂÌ‚ÔÏÈ·ÛÌÔ›, Î·ıÒ˜ Î·ÈÙËÓ ·ıÚfi· Ù·ÍÈ‰ÈˆÙÈÎ‹ Î›ÓËÛË ÌÂÙ·Í‡ ¯ˆÚÒÓ ÌÂ‰È·ÊÔÚÂÙÈÎ¤˜ ÔÏÈÙÈÎ¤˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡. ŒÙÛÈ, Î·Ù¿ÙËÓ ÂÈ‰ËÌ›· ÂÚ˘ıÚ¿˜ ÙÔ˘ 1999, ÊÔÈÙËÙ¤˜ ·fi ÙËÓ∂ÏÏ¿‰· ÌÂÙ¤ÊÂÚ·Ó ÙË ÓfiÛÔ ÛÙËÓ ∞ÁÁÏ›·, ÌÂ ·Ô-Ù¤ÏÂÛÌ· Ó· ˘¿ÚÍÔ˘Ó ÌÈÎÚÔ-ÂÈ‰ËÌ›Â˜ ÂÚ˘ıÚ¿˜ÛÂ 4 ·ÓÂÈÛÙ‹ÌÈ·, fiÔ˘ ÊÔÈÙÔ‡Û·Ó, Î·ıÒ˜ Î·È¤Ó· ÎÚÔ‡ÛÌ· ™™∂ (10).

∏ ÛÙÚ·ÙËÁÈÎ‹ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈ-Î›·˜, Ô˘ ÂÊ·ÚÌfiÛÙËÎÂ ÛÙËÓ ∂ÏÏ¿‰·, Â›¯Â Û·ÓÂ·ÎfiÏÔ˘ıÔ Ó· ÌÂÙ·ÙÔÈÛÙÂ› Ë ËÏÈÎ›· ÓfiÛËÛË˜¤Ó·ÓÙÈ ÙË˜ ÂÚ˘ıÚ¿˜ ÛÙËÓ ÂÓ‹ÏÈÎË Î·È ·Ó··Ú·Áˆ-ÁÈÎ‹ ËÏÈÎ›· (3). ŒÙÛÈ, ÌÔÚÂ› Ó· ÂÍËÁËıÂ› Î·Ù¿ ¤Ó·Ì¤ÚÔ˜ Ë ·˘ÍËÌ¤ÓË ·Ó·ÊÔÚ¿ ÎÚÔ˘ÛÌ¿ÙˆÓ ™™∂ÛÙÈ˜ ÙÂÏÂ˘Ù·›Â˜ ÂÈ‰ËÌ›Â˜ ÂÚ˘ıÚ¿˜ (3). ™ÙËÓ ·˘-ÍËÌ¤ÓË ·Ó·ÊÔÚ¿ ÎÚÔ˘ÛÌ¿ÙˆÓ ™™∂ Û˘Ó¤‚·Ï·Ó Î·È¿ÏÏÔÈ ·Ú¿ÁÔÓÙÂ˜, fiˆ˜ Ë ‰˘Ó·ÙfiÙËÙ· ÂÚÁ·ÛÙË-ÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ (ÂÈ‰ÈÎ¿ IgM ·ÓÙÈÛÒÌ·Ù·), Ë Î·-Ï‡ÙÂÚË ÂÎ·›‰Â˘ÛË ÙˆÓ ·È‰È¿ÙÚˆÓ Î·È Î˘Ú›ˆ˜ Ë·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÓÂÔÁÓÔÏfiÁˆÓ, ÌÂ ÙË ‰Ë-ÌÈÔ˘ÚÁ›· ÓÂÔÁÓÔÏÔÁÈÎÒÓ ÙÌËÌ¿ÙˆÓ Ô˘ ¿Ú¯ÈÛÂ·fi Ù· Ì¤Û· ÙË˜ ‰ÂÎ·ÂÙ›·˜ ÙÔ˘ 1980. ¢ÂÓ Â›Ó·È Ù˘-¯·›Ô ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ‰ÂÓ ·Ó·Ê¤ÚıËÎ·Ó ÛÙËÓ ÙÂ-ÏÂ˘Ù·›· ÂÈ‰ËÌ›· ÎÚÔ‡ÛÌ·Ù· ™™∂, ‚Â‚·ÈˆÌ¤Ó· ‹Èı·Ó¿, ÛÂ ËÏÈÎ›Â˜ ÌÂÁ·Ï‡ÙÂÚÂ˜ ÙË˜ ÓÂÔÁÓÈÎ‹˜,ÂÓÒ ÛÙËÓ ÂÈ‰ËÌ›· ÙÔ˘ 1993 Ë Û˘ÓÙÚÈÙÈÎ‹ ÏÂÈÔ-„ËÊ›· ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ·ÊÔÚÔ‡ÛÂ ÛÙË ÓÂÔÁÓÈÎ‹Î·È ¿ÌÂÛË ÌÂÙ·ÓÂÔÁÓÈÎ‹ ËÏÈÎ›·.

ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ Á˘Ó·ÈÎÒÓ·Ó··Ú·ÁˆÁÈÎ‹˜ ËÏÈÎ›·˜ ÁÈ· ÚÔÛÙ·Û›· ·fi ÙËÓÂÚ˘ıÚ¿, ¤¯Ô˘Ó ÚÔÙ·ıÂ› ÙÚÂÈ˜ ÛÙÚ·ÙËÁÈÎ¤˜ (7): ·)ÚÔÁ·ÌÈ·›Ô˜ ¤ÏÂÁ¯Ô˜ Î·È ÂÌ‚ÔÏÈ·ÛÌfi˜ ÙˆÓ Â˘·›ÛıËÙˆÓ Á˘Ó·ÈÎÒÓ, ‚) ÚÔÁÂÓÓËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜Î·È ÂÌ‚ÔÏÈ·ÛÌfi˜ ÙˆÓ Â˘·›ÛıËÙˆÓ Á˘Ó·ÈÎÒÓ ·Ì¤-Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓ· ‹ ÙËÓ ·Ô‚ÔÏ‹. ∏ ÛÙÚ·ÙËÁÈÎ‹·˘Ù‹ ·ÔÛÎÔÂ› ÛÙËÓ ÚÔÛÙ·Û›· ÙˆÓ ÂfiÌÂÓˆÓ


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Î˘‹ÛÂˆÓ. ™ÙÈ˜ ∏¶∞ ÙÔ 38% ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ™∂ÙË˜ ÙÂÏÂ˘Ù·›·˜ ‰ÂÎ·ÂÙ›·˜ Û˘Ó¤‚Ë ÛÂ ‰Â˘ÙÂÚfiÙÔ-ÎÂ˜ ¤ÁÎ˘Â˜ Ô˘ ‰ÂÓ Â›¯·Ó ·ÓÔÛ›· Î·Ù¿ ÙË˜ ÂÚ˘-ıÚ¿˜ (8) Î·È Á) ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÛÂ Ï‡-ÎÂÈ·, ·ÓÂÈÛÙ‹ÌÈ·, ÓÔÛÔÎÔÌÂ›· Î·È, ÁÂÓÈÎ¿, ¯Ò-ÚÔ˘˜ ÂÚÁ·Û›·˜. ÀÔÏÔÁ›ÛÙËÎÂ fiÙÈ Ë ÚÒÙË ÛÙÚ·-ÙËÁÈÎ‹ ı· ÌÔÚÔ‡ÛÂ Ó· ÌÂÈÒÛÂÈ Î·Ù¿ 45% Î·È Ë‰Â‡ÙÂÚË Î·Ù¿ 56% Ù· ÎÚÔ‡ÛÌ·Ù· ™™∂ Ô˘ Î·Ù·-ÁÚ¿ÊËÎ·Ó ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂÎ·ÂÙ›· ÛÙÈ˜ ∏¶∞ (7). ∏ÙÚ›ÙË ÛÙÚ·ÙËÁÈÎ‹ ‰ÂÓ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎ‹, fiÙ·ÓÙ· ÎÚÔ‡ÛÌ·Ù· ÂÚ˘ıÚ¿˜ Û˘Ì‚·›ÓÔ˘Ó ÛÂ ÌË ÂÚÁ·-˙fiÌÂÓÂ˜ Á˘Ó·›ÎÂ˜.

¶ÂÚÈÔÚÈÛÌfi˜ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ™™∂ ÌÔÚÂ› Ó·ÂÈÙÂ˘¯ıÂ› ·ÎfiÌ· Î·È ÛÙÔ Í¤Û·ÛÌ· ÂÈ‰ËÌ›·˜ÂÚ˘ıÚ¿˜, ·Ó ·ÎÔÏÔ˘ıËıÂ› Ì›· ÁÚ‹ÁÔÚË Î·È ÂÈıÂ-ÙÈÎ‹ ÛÙÚ·ÙËÁÈÎ‹ ÌÂ ·ÔÌfiÓˆÛË ÙˆÓ ‡ÔÙˆÓ Â-ÚÈÛÙ·ÙÈÎÒÓ ‹ ÂÎÙÂı¤ÓÙˆÓ ·ÙfiÌˆÓ, ÚÔÛÙ·Û›· ÙˆÓÂÁÎ‡ˆÓ, ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ Â˘·›ÛıËÙˆÓ ·ÙfiÌˆÓ(ÂÍ·›ÚÂÛË ÔÈ ¤ÁÎ˘Â˜) Î·È ÂÈ‚Â‚·›ˆÛË ÙË˜ ·ÓÔÛÔ-ÏÔÁÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜ ÙˆÓ ÂÎÙÂı¤ÓÙˆÓ ÂÁÎ‡ˆÓ (8).™ÙËÓ ∂ÏÏ¿‰·, Ë ÛÙÚ·ÙËÁÈÎ‹ ·˘Ù‹ ÌÔÚÂ› Ó· ·Ô-‰ÂÈ¯ıÂ› ÔÏ‡ ¯Ú‹ÛÈÌË, ‰ÈfiÙÈ Î·Ù¿ Î·ÓfiÓ· ÔÈ ÂÈ‰Ë-Ì›Â˜ ÂÚ˘ıÚ¿˜ ·Ú¯›˙Ô˘Ó ·fi ÙÔ ÛÙÚ·Ùfi Î·È ÌÂÙ¿ÂÂÎÙÂ›ÓÔÓÙ·È ÛÙÈ˜ ÎÔÈÓfiÙËÙÂ˜ (4). ∞˘Ùfi ‰›ÓÂÈ Ô-Ï‡ÙÈÌÔ ¯ÚfiÓÔ ÛÙÈ˜ ˘ÁÂÈÔÓÔÌÈÎ¤˜ ·Ú¯¤˜ ÁÈ· ÂÓËÌ¤Úˆ-ÛË Î·È Ï‹„Ë Î·Ù¿ÏÏËÏˆÓ Ì¤ÙÚˆÓ, fiˆ˜ ·˘Ù¿ Ô˘ÚÔ·Ó·Ê¤ÚıËÎ·Ó. ∂ÈÏ¤ÔÓ, Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ ÙˆÓ ÌË¿ÓÔÛˆÓ ÓÂÔÛ˘ÏÏ¤ÎÙˆÓ ÌÔÚÂ› Ó· ÂÍ·ÏÂ›„ÂÈ Ì›· Ë-Á‹ ÂÈ‰ËÌÈÒÓ, fiˆ˜ ¤ÁÈÓÂ Î·È ÛÂ ¿ÏÏ· ÎÚ¿ÙË (11).

∏ ·Ó¿ÁÎË ÁÈ· Â›ÙÂ˘ÍË Î·È ‰È·Ù‹ÚËÛË ˘„ËÏÔ‡ÂÈ¤‰Ô˘ ·ÓÔÛ›·˜, Û˘ÓÂ¯Ô‡˜ Â·ÁÚ‡ÓËÛË˜ Î·È¿ÌÂÛË˜ ÂÊ·ÚÌÔÁ‹˜ Ì¤ÙÚˆÓ ÂÏ¤Á¯Ô˘ Â›Ó·È ÎÚ›ÛÈ-ÌË˜ ÛËÌ·Û›·˜ ÁÈ· Ó· ÂÍ·Ê·ÓÈÛÙÂ› ÙÔ ™™∂ (12) ‹ ÁÈ·Ó· ÛÙ·Ì·Ù‹ÛÂÈ Ë ÌÂÁ·ÏÔ-ÂÈ‰ËÌÈÎ‹ ÂÌÊ¿ÓÈÛËÎÚÔ˘ÛÌ¿ÙˆÓ ÂÚ˘ıÚ¿˜ Î·È ™™∂ ÛÙËÓ ∂ÏÏ¿‰·. ∏ÔÚÈÛÙÈÎ‹ ÂÍ¿ÏÂÈ„Ë ÙÔ˘ ™™∂ Ê·›ÓÂÙ·È ‰‡ÛÎÔÏÔ˜ Î·ÈÌ·ÎÚÈÓfi˜ ÛÙfi¯Ô˜ ÁÈ· Ù· ÂÏÏËÓÈÎ¿ ‰Â‰ÔÌ¤Ó·, ·Ó·Ó·ÏÔÁÈÛÙÂ› Î·ÓÂ›˜ ÙÈ˜ ˘¿Ú¯Ô˘ÛÂ˜ ‰ÔÌ¤˜ Î·È ÙËÛ˘ÓÂ¯‹ Â›ÛÔ‰Ô ÌÂÙ·Ó·ÛÙÒÓ ·fi ¯ÒÚÂ˜ Ô˘ ‰ÂÓ Á›-ÓÔÓÙ·È ÂÌ‚ÔÏÈ·ÛÌÔ›. ∆Ô Úfi‚Ï‹Ì· ·ÓÔÛÔÔ›ËÛË˜ÙˆÓ ÌÂÙ·Ó·ÛÙÒÓ ··Û¯ÔÏÂ› Û‹ÌÂÚ· ÙÈ˜ ÚÔËÁÌ¤-ÓÂ˜ ¯ÒÚÂ˜ Ô˘ ¤¯Ô˘Ó Ï‡ÛÂÈ ÙÔ Úfi‚ÏËÌ· ÙÔ˘ ™™∂ÛÙÔÓ ÂÓ‰ÔÁÂÓ‹ ÏËı˘ÛÌfi (7,12).

°È· Ù· ÂÏÏËÓÈÎ¿ ‰Â‰ÔÌ¤Ó·, ÌÂÙ·Í‡ ÙˆÓ ¿ÏÏˆÓ,ÈÛÙÂ‡Ô˘ÌÂ fiÙÈ ÛÙÈ˜ ‰È¿ÊÔÚÂ˜ “·ÚÌfi‰ÈÂ˜ ˘ÁÂÈÔÓÔ-ÌÈÎ¤˜ ÂÈÙÚÔ¤˜” ÁÈ· ÙÈ˜ Û˘ÁÁÂÓÂ›˜ ÏÔÈÌÒÍÂÈ˜ Ô˘˘¿Ú¯Ô˘Ó Ú¤ÂÈ Ó· Û˘ÌÌÂÙ¤¯Ô˘Ó ÌÂ Î‡ÚÈÔ ÚfiÏÔÎ·È ÂÎÂ›ÓÔÈ ÔÈ ÁÈ·ÙÚÔ›, ÔÈ ÔÔ›ÔÈ ÚÒÙÔÈ ‰È·ÁÈÁÓÒ-ÛÎÔ˘Ó ÙÈ˜ ·ı‹ÛÂÈ˜ ·˘Ù¤˜, fiˆ˜ ÔÈ Ì·ÈÂ˘Ù‹ÚÂ˜ Î·ÈÔÈ ÓÂÔÁÓÔÏfiÁÔÈ.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Freij BJ, South MA, Sever JL. Maternal rubella and the

congenital rubella syndrome. Clin Perinatol 1988;15:247-257.

2. ™È·Ì›ÛË ¶, ∆·Ì·ÎÔ‡‰Ë˜ ¶, ¶··‚·ÛÈÏÂ›Ô˘ µ, °ÎÚÈÌ›˙Ë˜°, ª·ÓÙ·ÏÂÓ¿ÎË˜ ™, ∞Ó‰Ú¤Ô˘ ∞. ™˘ÁÁÂÓ‹˜ ÂÚ˘ıÚ¿ (·Ó·-ÊÔÚ¿ ‰‡Ô ÂÚÈÙÒÛÂˆÓ). ∂ÏÏËÓÈÎ‹ ª·ÈÂ˘ÙÈÎ‹ Î·È °˘Ó·È-ÎÔÏÔÁ›· 1995;7:246-248.

3. ¶·Ó·ÁÈˆÙfiÔ˘ÏÔ˜ ∆, ∞ÓÙˆÓÈ¿‰Ô˘ π, µ·Ï¿ÛÛË-∞‰¿Ì ∂. ∂È-‰ËÌ›· Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜ ÙÔ 1993 ÛÙËÓ ∂ÏÏ¿‰·. ∫·Ù·-ÁÚ·Ê‹ 25 ÂÈ‚Â‚·ÈˆÌ¤ÓˆÓ ÂÚÈÙÒÛÂˆÓ. ¶·È‰È·ÙÚÈÎ‹1997;60:582-591.

4. Giannakos G, Pirounaki M, Hadjichristodoulou C.Incidence of congenital rubella in Greece has decreased[letter]. BMJ 2000;320:1408.

5. Panagiotopoulos ∆, Antoniadou π, Valassi-Adam ∂.Incidence of congenital rubella in Greece [letter]. BMJ2000;321:1287.

6. ªËÏ›ÁÎÔ˜ B, ∂ÏÂ˘ıÂÚ¿ÎË˜ N, ª›¯Ô˜ A, ¶··‰fiÔ˘ÏÔ˜ °,£·ÓfiÔ˘ÏÔ˜ µ, OÚÊ·ÓÔ‡ ∂ Î·È Û˘Ó. ™˘ÁÁÂÓ‹˜ ÂÚ˘ıÚ¿ -¶ÚfiÎÏËÛË ÁÈ· Â·ÁÚ‡ÓËÛË ·È‰È¿ÙÚÔ˘. 38Ô ¶·ÓÂÏÏ‹ÓÈÔ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ. 2000, 16-18 πÔ˘Ó›Ô˘; ∫ˆ˜; 2000.ÛÂÏ. 218.

7. Schluter WW, Reef SE, Redd SC, Dykewicz CA. Changingepidemiology of congenital rubella syndrome in the UnitedStates. J Infect Dis 1998;178:636-641.

8. Cooper LZ, Alford CA. Rubella. In: Remington J, Klein J,editors. Infections disease of the fetus and newborn infant.5th ed. Philadelphia: WB Saunders Co; 2001. p. 371.

9. Berger A. How does herd immunity work? [Editorial]. BMJ1999;319:1467.

10. Tookey P, Molyneaux P, Helms P. UK case of congenitalrubella can be linked to Greek cases [letter]. BMJ2000;321:766.

11. Preblud SR, Serdula MK, Frank JA Jr, Brandling-BennettAD, Hinman AR. Rubella vaccination in the United States:a ten-year review. Epidemiol Rev 1980;2:171-194.

12. Reef SE, Plotkin S, Cordero JF, Katz M, Cooper L,Schwartz B et al. Preparing for elimination of congenitalrubella syndrome (CRS): summary of a workshop onCRS elimination in the United States. Clin Infect Dis2000;31:85-95.


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¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞. ∞Ó‰Ú¤Ô˘ ÃÂÈÌˆÓ›‰Ô˘ 15, ∆.∫. 551 33, ∫·Ï·Ì·ÚÈ¿E-mail: [email protected]


∂ÈÛ·ÁˆÁ‹O fiÚÔ˜ ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ·Ó·Ê¤-

ÚÂÙ·È ÛÙÈ˜ ·ÓÂÈı‡ÌËÙÂ˜ ÂÎ‰ËÏÒÛÂÈ˜ Ô˘ ÚÔÎ·-ÏÔ‡ÓÙ·È ÌÂ ÙË ÌÂÛÔÏ¿‚ËÛË ·ÓÔÛÔÏÔÁÈÎÒÓ ÌË¯·ÓÈ-ÛÌÒÓ ¤Ó·ÓÙÈ ÙˆÓ ÚˆÙÂ˚ÓÒÓ ÙÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿-‰·˜. ∏ Û˘¯ÓfiÙËÙ· ÙË˜ ·ÏÏÂÚÁ›·˜ ÛÙÔ Á¿Ï· ·ÁÂ-Ï¿‰·˜ ÛÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›· Â›Ó·È 2-3% (1,2). ∞Ó¿ÏÔ-Á· ÌÂ ÙÔÓ ˘ÔÎÂ›ÌÂÓÔ ·ÓÔÛÔÏÔÁÈÎfi ÌË¯·ÓÈÛÌfi Ù·-ÍÈÓÔÌÂ›Ù·È: ·) ÛÂ ·ÓÔÛÔÏÔÁÈÎ‹ ·ÓÙ›‰Ú·ÛË Ô˘

ÚÔÎ·ÏÂ›Ù·È ÌÂ ÙË ÌÂÛÔÏ¿‚ËÛË IgE Î·È ÚÔ‚¿ÏÏÂÈÎÏÈÓÈÎ¿ ÌÂ ·ÁÁÂÈÔÔ›‰ËÌ·, Û˘ÚÈÁÌfi, ÚÈÓ›ÙÈ‰·, ÂÌ¤-ÙÔ˘˜, ¤Î˙ÂÌ· ‹ ·Ó·Ê˘Ï·Í›· Î·È ‚) ÛÂ ·ÓÔÛÔÏÔÁÈÎ‹·ÓÙ›‰Ú·ÛË ¯ˆÚ›˜ ÙË ÌÂÛÔÏ¿‚ËÛË IgE Ô˘ ÌÔÚÂ›Ó· ÂÌÊ·ÓÈÛÙÂ› ÌÂ ÙË ÌÔÚÊ‹ ÓÂ˘ÌÔÓÈÎ‹˜ ·ÈÌÔÛÈ-‰‹ÚˆÛË˜, ‰˘Û·ÔÚÚfiÊËÛË˜, ÎÔÏ›ÙÈ‰·˜, ÔÈÛÔÊ·-Á›ÙÈ‰·˜ ‹ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈÎ‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜.∂ÓÙÔ‡ÙÔÈ˜, Â›Ó·È ‰‡ÛÎÔÏÔ Ó· Î·ıÔÚÈÛÙÂ› ÛÂ ÔÈÔ‚·ıÌfi Û˘ÌÌÂÙ¤¯ÂÈ Ô Î·ı¤Ó·˜ ·fi ÙÔ˘˜ ·Ú·¿Óˆ


278

�¶ÂÚ›ÏË„Ë: O fiÚÔ˜ ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿-‰·˜ ·Ó·Ê¤ÚÂÙ·È ÛÙÈ˜ ·ÓÂÈı‡ÌËÙÂ˜ ÂÎ‰ËÏÒÛÂÈ˜Ô˘ ÚÔÎ·ÏÔ‡ÓÙ·È ÌÂ ÙË ÌÂÛÔÏ¿‚ËÛË ·ÓÔÛÔÏÔÁÈ-ÎÒÓ ÌË¯·ÓÈÛÌÒÓ ¤Ó·ÓÙÈ ÙˆÓ ÚˆÙÂ˚ÓÒÓ ÙÔ˘ Á¿Ï·-ÎÙÔ˜ ·ÁÂÏ¿‰·˜. ∏ ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜Â›Ó·È ÓfiÛÔ˜ ÙË˜ ‚ÚÂÊÈÎ‹˜ Î˘Ú›ˆ˜ ËÏÈÎ›·˜. ™Â Û¿-ÓÈÂ˜ ÂÚÈÙÒÛÂÈ˜ Ë ÎÏÈÓÈÎ‹ Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ÂÌ-Ê·Ó›˙ÂÙ·È ÙÔÓ ÚÒÙÔ Ì‹Ó· ÙË˜ ˙ˆ‹˜ ‹ ÌÂÙ¿ ÙÔÓ‰ˆ‰¤Î·ÙÔ Ì‹Ó·. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ˘¿Ú¯Ô˘Ó ÂÏ¿-¯ÈÛÙÂ˜ ·Ó·ÊÔÚ¤˜ ÂÚÈÙÒÛÂˆÓ ·ÏÏÂÚÁ›·˜ ÛÙÔ Á¿-Ï· ·ÁÂÏ¿‰·˜, Ô˘ ÂÌÊ·Ó›ÛÙËÎ·Ó ÙËÓ ÚÒÙË Â‚‰Ô-Ì¿‰· ÙË˜ ˙ˆ‹˜. ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ·ÏÏÂÚ-Á›·˜ ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ Ô˘ ÂÌÊ·Ó›ÛÙËÎÂ ·fiÙËÓ ÚÒÙË ËÌ¤Ú· ÙË˜ ˙ˆ‹˜ ÌÂ ·ÈÌÔÚÚ·ÁÈÎ¤˜ ÎÂ-ÓÒÛÂÈ˜ ÛÂ ÙÂÏÂÈfiÌËÓÔ ÓÂÔÁÓfi. ∞fi ÙËÓ ˘¿Ú¯Ô˘-Û· ‚È‚ÏÈÔÁÚ·Ê›· ÚÔÎ‡ÙÂÈ fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· ÙËÓÚÒÙË ÂÚ›ÙˆÛË ·ÏÏÂÚÁ›·˜ ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ÌÂ ÙË ÌÂÛÔÏ¿‚ËÛË ÔÏÈÎ‹˜ ·ÓÔÛÔÛÊ·ÈÚ›ÓË˜ E Ô˘ÂÚÈÁÚ¿ÊÂÙ·È ÛÂ ÙÂÏÂÈfiÌËÓÔ ÓÂÔÁÓfi, ÌÂ ÂÌÊ¿ÓÈÛË·ÈÌÔÚÚ·ÁÈÎÒÓ ÎÂÓÒÛÂˆÓ Ï›ÁÂ˜ ÌfiÓÔ ÒÚÂ˜ ÌÂÙ¿ ÙË¯ÔÚ‹ÁËÛË ÂÍ·ÓıÚˆÔÔÈËÌ¤ÓÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂ-Ï¿‰·˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ·ÈÌÔÚÚ·ÁÈÎ¤˜ ÎÂÓÒÛÂÈ˜, ·ÏÏÂÚÁ›·ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜, ÓÂÔÁÓfi.

�Abstract: Cow’s milk allergy is an immunesystem reaction to milk protein. It is a disease ofearly infancy. The onset of clinical presentationrarely occurs before the first month of life and afterthe age of twelve months. There have been only afew cases of cow’s milk allergy described on thefirst week of life. We report a case of cow’s milkallergy, that presented with bloody stools startingon the twentieth hour of life, in a full term otherwisehealthy neonate. To the best of our knowledge,our case is the first case of immunoglobulin Emediated reaction to cow’s milk protein in a fullterm neonate, that presented with bloody stools afew hours after commencing formula feeding andbefore the end of the first twenty-four hours of life.

Key words: bloody stools, cow’s milk allergy,neonate.

∞ÈÌÔÚÚ·ÁÈÎ¤˜ ÎÂÓÒÛÂÈ˜ ·fi ÙËÓ ÚÒÙË ËÌ¤Ú· ˙ˆ‹˜ ÛÂ ÓÂÔÁÓfi ÌÂ ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ∂. Ã·Ù˙Ë‰¿ÎË1, ∞. ª·ÓÔ˘Ú¿1, ∂. ∫ÔÚ·Î¿ÎË1, ∂. °·Ï·Ó¿ÎË˜2, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘1

Cow’s milk allergy presenting with bloody stools on the first day of life E. Hatzidaki1, A. Manoura1, E. Korakaki1, E. Galanakis2, C. Giannakopoulou1


1 ¡ÂÔÁÓÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜ 2 ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜

1 Department of Neonatology of University of Crete 2 Pediatric Clinic of University of Crete


·ÓÔÛÔÏÔÁÈÎÔ‡˜ ÌË¯·ÓÈÛÌÔ‡˜ ÛÙËÓ ÚfiÎÏËÛË ÙË˜ÈÛÙÈÎ‹˜ ‚Ï¿‚Ë˜. OÈ ·ÈÌÔÚÚ·ÁÈÎ¤˜ ÎÂÓÒÛÂÈ˜ Û·Ó ÎÏÈ-ÓÈÎ‹ ÂÎ‰‹ÏˆÛË ÙË˜ ·ÏÏÂÚÁ›·˜ ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜‰ÂÓ ıÂˆÚÂ›Ù·È fiÙÈ ÚÔÎ·ÏÔ‡ÓÙ·È ·fi ·ÓÔÛÔÏÔÁÈÎ‹·ÓÙ›‰Ú·ÛË ÌÂ ÙË ÌÂÛÔÏ¿‚ËÛË IgE (3).

∏ ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ Â›Ó·È Ì›· ÓfiÛÔ˜ÙË˜ ‚ÚÂÊÈÎ‹˜ ËÏÈÎ›·˜ Î·È Ë ÏÂÈÔ„ËÊ›· ÙˆÓ ‚ÚÂ-ÊÒÓ ÂÌÊ·Ó›˙ÂÈ ÙËÓ ÎÏÈÓÈÎ‹ Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ÙÔ˘˜ÚÒÙÔ˘˜ Ì‹ÓÂ˜ ÙË˜ ˙ˆ‹˜. ™Â Û¿ÓÈÂ˜ ÂÚÈÙÒ-ÛÂÈ˜, Ë Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ÂÌÊ·Ó›˙ÂÙ·È ÙÔÓ ÚÒÙÔÌ‹Ó· ÙË˜ ˙ˆ‹˜ ‹ ÌÂÙ¿ ÙÔÓ ‰ˆ‰¤Î·ÙÔ Ì‹Ó· (3,4).™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ˘¿Ú¯Ô˘Ó ÂÏ¿¯ÈÛÙÂ˜ ·Ó·ÊÔÚ¤˜ÂÚÈÙÒÛÂˆÓ ·ÏÏÂÚÁ›·˜ ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ Ô˘ÂÌÊ·Ó›ÛÙËÎ·Ó ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· ÙË˜ ˙ˆ‹˜ (5-8).

¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ·ÏÏÂÚÁ›·˜ ÛÙÔ Á¿Ï··ÁÂÏ¿‰·˜ Ô˘ ÂÌÊ·Ó›ÛÙËÎÂ ·fi ÙËÓ ÚÒÙË ËÌ¤Ú·ÙË˜ ˙ˆ‹˜ ÌÂ ·ÈÌÔÚÚ·ÁÈÎ¤˜ ÎÂÓÒÛÂÈ˜ ÛÂ ÙÂÏÂÈfiÌËÓÔÓÂÔÁÓfi. ∞fi ÙËÓ ˘¿Ú¯Ô˘Û· ‚È‚ÏÈÔÁÚ·Ê›· ÚÔÎ‡-ÙÂÈ fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· ÙËÓ ÚÒÙË ÂÚ›ÙˆÛË ·Ï-ÏÂÚÁ›·˜ ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ÌÂ ÙË ÌÂÛÔÏ¿‚ËÛËIgE Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ÛÂ ÙÂÏÂÈfiÌËÓÔ ÓÂÔÁÓfi, ÌÂÂÌÊ¿ÓÈÛË ·ÈÌÔÚÚ·ÁÈÎÒÓ ÎÂÓÒÛÂˆÓ Ï›ÁÂ˜ ÌfiÓÔÒÚÂ˜ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÂÍ·ÓıÚˆÔÔÈËÌ¤ÓÔ˘ Á¿-Ï·ÎÙÔ˜ ·ÁÂÏ¿‰·˜.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜¶ÚfiÎÂÈÙ·È ÁÈ· ÓÂÔÁÓfi ¿ÚÚÂÓ Ô˘ ÂÌÊ¿ÓÈÛÂ ·È-

ÌÔÚÚ·ÁÈÎ¤˜ ÎÂÓÒÛÂÈ˜ ·fi ÙËÓ 20‹ ÒÚ· ÙË˜ ˙ˆ‹˜ÙÔ˘. ∆Ô ÓÂÔÁÓfi ÁÂÓÓ‹ıËÎÂ ÙÂÏÂÈfiÌËÓÔ, Ë Î‡ËÛË·Ó·Ê¤ÚıËÎÂ ¯ˆÚ›˜ È‰È·›ÙÂÚ· ÚÔ‚Ï‹Ì·Ù· Î·È Ô ÙÔ-ÎÂÙfi˜ ¤ÁÈÓÂ ÌÂ ÚÔÁÚ·ÌÌ·ÙÈÛÌ¤ÓË Î·ÈÛ·ÚÈÎ‹ ÙÔÌ‹ÏfiÁˆ ‰˘Û·Ó·ÏÔÁ›·˜. ∆Ô ÓÂÔÁÓfi ‰ÂÓ ¯ÚÂÈ¿ÛÙËÎÂ·Ó¿ÓË„Ë Î·È ÛÈÙ›ÛÙËÎÂ ÌÂ ÂÍ·ÓıÚˆÔÔÈËÌ¤ÓÔ Á¿-Ï· ·ÁÂÏ¿‰·˜ ·fi ÙËÓ 3Ë ÒÚ· ÙË˜ ˙ˆ‹˜ ÙÔ˘. ∂›Ó·ÈÙÔ ‰Â‡ÙÂÚÔ ·È‰› Ê·ÈÓÔÙ˘ÈÎ¿ ˘ÁÈÒÓ ÁÔÓ¤ˆÓ. ∆Ô ÔÈ-ÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂÏÂ‡ıÂÚÔ. ∞fi ÙËÓ ·ÓÙÈ-ÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ·ıÔÏÔÁÈÎ¿Â˘Ú‹Ì·Ù·. OÈ ÎÂÓÒÛÂÈ˜ ‹Ù·Ó ˘‰·ÚÔ‡˜ Û‡ÛÙ·ÛË˜,ÌÂ ¿ÊıÔÓË ÔÛfiÙËÙ· ·›Ì·ÙÔ˜. ∞fi ÙÔÓ ·Ú¯ÈÎfi ÂÚ-Á·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ‰È·ÈÛÙÒıËÎÂ: Hct 38,8%, Hb13,8 g/dL, ·ÈÌÔÂÙ¿ÏÈ· 309000/mm3, ÏÂ˘Î¿4500/mm3, (ÌÂ 38% ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· Ô˘‰ÂÙÂÚfi-ÊÈÏ·, 33% ÏÂÌÊÔÎ‡ÙÙ·Ú·, 10% ÌÔÓÔÎ‡ÙÙ·Ú· Î·È19% ËˆÛÈÓfiÊÈÏ·), Ë C-·ÓÙÈ‰ÚÒÛ· ÚˆÙÂ˝ÓË ‹Ù·Ó0,4 mg/dL. O ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÚÔ˘Ù›Ó·˜ Î·È Ô¤ÏÂÁ¯Ô˜ ËÎÙÈÎfiÙËÙ·˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∞fiÙÔÓ ·ÎÙÈÓÔÏÔÁÈÎfi Î·È ÙÔÓ ˘ÂÚË¯ÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯ÔÙË˜ ÎÔÈÏÈ¿˜ ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ·ıÔÏÔÁÈÎ¿ Â˘Ú‹-Ì·Ù·. ∏ Û›ÙÈÛË ÙÔ˘ ÓÂÔÁÓÔ‡ ‰È·ÎfiËÎÂ Î·È ¯ÔÚË-Á‹ıËÎÂ ·ÚÂÓÙÂÚÈÎ‹ ‰È·ÙÚÔÊ‹. ªÂ ÙËÓ ˘Ô„›· ÏÔ›-ÌˆÍË˜, ÙÔ ÓÂÔÁÓfi Î·Ï‡ÊıËÎÂ ÌÂ ·ÓÙÈ‚ÈÔÙÈÎ‹ ·Áˆ-Á‹, Ë ÔÔ›· ‰È·ÎfiËÎÂ ·ÊÔ‡ ·fi ÙÈ˜ Î·ÏÏÈ¤ÚÁÂÈÂ˜·›Ì·ÙÔ˜, Ô‡ÚˆÓ, ÎÔÚ¿ÓˆÓ Î·È ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô˘

˘ÁÚÔ‡ ‰ÂÓ ·ÔÌÔÓÒıËÎÂ ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi˜. ∆Ô ÓÂ-ÔÁÓfi Û˘Ó¤¯È˙Â Ó· ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÈÌÔÚÚ·ÁÈÎ¤˜ ÎÂÓÒ-ÛÂÈ˜ Î·È ÙËÓ Ù¤Ù·ÚÙË ËÌ¤Ú· ˙ˆ‹˜ ‰ÈÂÓÂÚÁ‹ıËÎÂ ÎÔ-ÏÔÓÔÛÎfiËÛË. O ‚ÏÂÓÓÔÁfiÓÔ˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ ‹Ù·ÓÂ‡ıÚ˘ÙÔ˜, ÔÈ‰ËÌ·ÙÒ‰Ë˜, ÌÂ ÚfiÛÊ·Ù· ÛÙÔÈ¯Â›··ÈÌÔÚÚ·Á›·˜. ∞fi ÙÈ˜ ‚ÈÔ„›Â˜ Ô˘ ÂÏ‹ÊıËÛ·Ó ‰È·-ÈÛÙÒıËÎÂ Ë ·ÚÔ˘Û›· ‰ÈËı‹ÛÂˆÓ, Î˘Ú›ˆ˜ ·fiËˆÛÈÓfiÊÈÏ· Î·È Û¿ÓÈ· ·fi Ô˘‰ÂÙÂÚfiÊÈÏ·. ∆Ô ÓÂ-ÔÁÓfi Û˘Ó¤¯È˙Â Ó· ·Ô‚¿ÏÂÈ ÎfiÚ·Ó· ÌÂ ÚÔÔ‰Â˘-ÙÈÎ¿ ÌÂÈÔ‡ÌÂÓË ÔÛfiÙËÙ· ·›Ì·ÙÔ˜ Ì¤¯ÚÈ ÙËÓ ¤ÎÙËËÌ¤Ú· ÙË˜ ˙ˆ‹˜ ÙÔ˘. ∆ËÓ ›‰È· ËÌ¤Ú· ¤ÁÈÓÂ ÚÔ-Û¿ıÂÈ· Â·Ó·Û›ÙÈÛË˜ ÌÂ ÂÍ·ÓıÚˆÔÔÈËÌ¤ÓÔ Á¿-Ï· ·ÁÂÏ¿‰·˜. §›ÁÂ˜ ÒÚÂ˜ ·ÚÁfiÙÂÚ·, ÙÔ ÓÂÔÁÓfi ·-ÚÔ˘Û›·ÛÂ ÎÂÓÒÛÂÈ˜ ÌÂ ¿ÊıÔÓË ÔÛfiÙËÙ· ·›Ì·ÙÔ˜Î·È Ë Û›ÙÈÛË ‰È·ÎfiËÎÂ. ∏ ÔÏÈÎ‹ IgE ÙËÓ ¤ÎÙË ËÌ¤-Ú· ˙ˆ‹˜ ‹Ù·Ó 60,2 IU/mL, ÂÓÒ Ë ÂÈ‰ÈÎ‹ ÛÙËÓ Úˆ-ÙÂ˝ÓË ÙÔ˘ Á¿Ï·ÎÙÔ˜ IgE ‹Ù·Ó 3,8 Au/ml, Ù¿ÍË 3. ∏·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ıÂˆÚ‹ıËÎÂ ˆ˜ ËÏ¤ÔÓ Èı·Ó‹ ‰È¿ÁÓˆÛË. ÃÔÚËÁ‹ıËÎÂ ÂÓÙÂÚÈÎ‹ Û›-ÙÈÛË ÌÂ Á¿Ï· ·fi ÂÏÂ‡ıÂÚ· ·ÌÈÓÔÍ¤· ·fi ÙËÓ¤‚‰ÔÌË ËÌ¤Ú· ˙ˆ‹˜, Ë ÔÔ›· ¤ÁÈÓÂ Î·Ï¿ ·ÓÂÎÙ‹·fi ÙÔ ÓÂÔÁÓfi. OÈ ÎÂÓÒÛÂÈ˜ ÙÔ˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ-Î¤˜ ÛÂ Û‡ÛÙ·ÛË Î·È ÛÂ Û˘¯ÓfiÙËÙ·, ÂÓÒ Ë ÚfiÛÏË-„Ë ‚¿ÚÔ˘˜ ‹Ù·Ó ÈÎ·ÓÔÔÈËÙÈÎ‹, ÙfiÛÔ Î·Ù¿ ÙËÓ ¤ÍÔ-‰fi ÙÔ˘ ·fi ÙËÓ ÎÏÈÓÈÎ‹ Ì·˜, fiÛÔ Î·È ÛÙËÓ ËÏÈÎ›·ÙˆÓ 3 ÌËÓÒÓ Ô˘ Â·ÓÂÎÙÈÌ‹ıËÎÂ ÛÙÔ ÂÍˆÙÂÚÈÎfiÌ·˜ È·ÙÚÂ›Ô.

™˘˙‹ÙËÛËO ‚ÏÂÓÓÔÁfiÓÔ˜ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Û˘ÛÙ‹Ì·-

ÙÔ˜ ÂÎÙ›ıÂÙ·È Î·ıËÌÂÚÈÓ¿ ÛÂ ÔÏÏ¿ ÙÚÔÊÈÎ¿ ·ÓÙÈ-ÁfiÓ·, ‰ÂÓ ÂÈÙÚ¤ÂÈ fiÌˆ˜ ÙËÓ ·ÔÚÚfiÊËÛË ·ÓÔ-ÛÔÏÔÁÈÎ¿ ·Ó·ÁÓˆÚ›ÛÈÌˆÓ ÌÔÚ›ˆÓ. ∞˘Ùfi ÔÊÂ›ÏÂÙ·ÈÛÙÈ˜ È‰ÈfiÙËÙÂ˜ Ô˘ ÙÔ˘ ÂÈÙÚ¤Ô˘Ó Ó· ÏÂÈÙÔ˘ÚÁÂ›ˆ˜ “ÊÚ·ÁÌfi˜”. ∫·Ù¿ ÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô, ÂÍ·ÈÙ›·˜ÙË˜ ·ÓˆÚÈÌfiÙËÙ·˜, ·ÓÔÛÔÏÔÁÈÎ¿ ·Ó·ÁÓˆÚ›ÛÈÌ·ÌfiÚÈ· ÌÔÚÂ› ‰˘ÓËÙÈÎ¿ Ó· ·ÔÚÚÔÊËıÔ‡Ó, Ó· Â-Ú¿ÛÔ˘Ó ÛÙËÓ Î˘ÎÏÔÊÔÚ›· Î·È Ó· ÚÔÎ·Ï¤ÛÔ˘Ó·ÓÔÛÔÏÔÁÈÎ‹ ·ÓÙ›‰Ú·ÛË (1). ™ÙÔ ÓÂÔÁÓfi Ô˘ ÂÚÈ-ÁÚ¿ÊÔ˘ÌÂ Ë Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ÂÌÊ·Ó›ÛÙËÎÂ ÔÏ‡ÓˆÚ›˜, Ï›ÁÂ˜ ÌfiÓÔ ÒÚÂ˜ ÌÂÙ¿ ÙÔ ÚÒÙÔ ÁÂ‡Ì· ÌÂÂÍ·ÓıÚˆÔÔÈËÌ¤ÓÔ Á¿Ï· ·ÁÂÏ¿‰·˜, ÁÂÁÔÓfi˜ Ô˘Ì·˜ Î¿ÓÂÈ Ó· ÈÛÙÂ‡Ô˘ÌÂ fiÙÈ Ë Â˘·ÈÛıËÙÔÔ›ËÛË¤ÁÈÓÂ ÛÙËÓ ÂÓ‰ÔÌ‹ÙÚÈ· ˙ˆ‹. ∂Ó‰ÔÌ‹ÙÚÈ· Â˘·ÈÛıË-ÙÔÔ›ËÛË ¤¯ÂÈ ·Ó·ÊÂÚıÂ› ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Â›ÙÂÌÂÙ¿ ·fi ‰È·Ï·ÎÔ˘ÓÙÈ·Î‹ ÌÂÙ·ÊÔÚ¿ ·ÓÙÈÁfiÓˆÓ,Â›ÙÂ ÌÂÙ¿ ·fi ·ÚÔ˘Û›· ·ÓÙÈÁÔÓÈÎÒÓ ÛÙÔÈ¯Â›ˆÓ ÛÙÔ·ÌÓÈ·Îfi ˘ÁÚfi (6,7,9). O ·ÎÚÈ‚‹˜, fiÌˆ˜, ÌË¯·ÓÈ-ÛÌfi˜ ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi˜. ∏ ÂÍˆÌ‹ÙÚÈ· Â·Ê‹ ÌÂ ÙÈ˜ÚˆÙÂ˝ÓÂ˜ ÙÔ˘ ·ÁÂÏ·‰ÈÓÔ‡ Á¿Ï·ÎÙÔ˜ Â¿ÁÂÈ ÙËÓÎÏÈÓÈÎ‹ ¤ÎÊÚ·ÛË ÙË˜ ·ÏÏÂÚÁ›·˜ ÛÂ ¤Ó· Â˘·ÈÛıËÙÔ-ÔÈËÌ¤ÓÔ ¿ÙÔÌÔ. °ÂÓÈÎ¿, Ë ·ÈÌÔÚÚ·Á›· ·fi ÙÔ Î·-ÙÒÙÂÚÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ· ıÂˆÚÂ›Ù·È fiÙÈ


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Û¯ÂÙ›˙ÂÙ·È ÌÂ ·ÓÔÛÔÏÔÁÈÎ‹ ·ÓÙ›‰Ú·ÛË ¯ˆÚ›˜ ÙËÌÂÛÔÏ¿‚ËÛË IgE (3). OÈ ·˘ÍËÌ¤ÓÂ˜, fiÌˆ˜, ÙÈÌ¤˜ÙË˜ IgE, ÙfiÛÔ ÙË˜ ÔÏÈÎ‹˜ fiÛÔ Î·È ÙË˜ ÂÈ‰ÈÎ‹˜, ÛÙÈ˜ÚˆÙÂ˝ÓÂ˜ ÙÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰·˜ Ô˘ ‰È·ÈÛÙÒ-ıËÎ·Ó ÛÙÔ ÓÂÔÁÓfi Ì·˜, Ì·˜ Î¿ÓÂÈ Ó· ÈÛÙÂ‡Ô˘ÌÂfiÙÈ ·ÓÔÛÔÏÔÁÈÎfi˜ ÌË¯·ÓÈÛÌfi˜ ÌÂ ÙË ÌÂÛÔÏ¿‚ËÛËIgE Â˘ı‡ÓÂÙ·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ÛÂ Î¿ÔÈÔ ‚·ıÌfi ÁÈ·ÙËÓ ÚfiÎÏËÛË ÙË˜ ÈÛÙÈÎ‹˜ ‚Ï¿‚Ë˜. ∆Ô 50-70% ÙˆÓ‚ÚÂÊÒÓ ÌÂ ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ÂÌÊ·Ó›-˙ÂÈ Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ‰¤ÚÌ·, ÙÔ 50-60% ÂÌÊ·-Ó›˙ÂÈ Û˘ÌÙÒÌ·Ù· ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙË-Ì·, ÂÓÒ 20-30% ÂÌÊ·Ó›˙ÂÈ Û˘ÌÙÒÌ·Ù· ·fi ÙÔ·Ó·ÓÂ˘ÛÙÈÎfi Û‡ÛÙËÌ·. ¶ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ 70%ÙˆÓ ‚ÚÂÊÒÓ ÂÌÊ·Ó›˙ÂÈ ÔÏÏ·Ï‹ ÎÏÈÓÈÎ‹ Û˘ÌÙˆ-Ì·ÙÔÏÔÁ›· ·fi ‰‡Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰È·ÊÔÚÂÙÈÎ¿ ÔÚ-Á·ÓÈÎ¿ Û˘ÛÙ‹Ì·Ù· (3,4).

∏ ·ÚÔ˘Û›· ·›Ì·ÙÔ˜ ÛÙ· ÎfiÚ·Ó· ‰ÂÓ Â›Ó·È·Û‡ÓËıÂ˜ ÁÂÁÔÓfi˜ ÛÙ· ¿ÚÚˆÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ÌÂ ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ Ô˘ ÓÔÛËÏÂ‡ÔÓÙ·ÈÛÙÈ˜ ªÔÓ¿‰Â˜ ∂ÓÙ·ÙÈÎ‹˜ ¡ÔÛËÏÂ›·˜ ¡ÂÔÁÓÒÓ, ÛÂ·ÓÙ›ıÂÛË ÌÂ Ù· ÙÂÏÂÈfiÌËÓ· ˘ÁÈ‹ ÓÂÔÁÓ¿. ∆Ô ÓÂÔ-ÁÓfi Ô˘ ÂÚÈÁÚ¿ÊÔ˘ÌÂ Â›Ó·È ¤Ó· ˘ÁÈ¤˜ ÙÂÏÂÈfiÌËÓÔÓÂÔÁÓfi Ô˘ ÙËÓ 20‹ ÒÚ· ÙË˜ ˙ˆ‹˜ ÙÔ˘ ·ÚÔ˘Û›·-ÛÂ ·ÈÌÔÚÚ·ÁÈÎ¤˜ ÎÂÓÒÛÂÈ˜, ¯ˆÚ›˜ Î·Ó¤Ó· ¿ÏÏÔÛ‡ÌÙˆÌ·, ÂÓÒ ‚ÚÈÛÎfiÙ·Ó ÛÂ ÔÏ‡ Î·Ï‹ ÁÂÓÈÎ‹Î·Ù¿ÛÙ·ÛË. ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ‰È·ÊÔÚÔ‰È·ÁÓˆÛÙÈ-Î‹ Ì·˜ ÚÔÛ¤ÁÁÈÛË: Ë Î·Ù¿ÔÛË ·›Ì·ÙÔ˜ ÙË˜ ÌË-Ù¤Ú·˜ Î·Ù¿ ÙÔÓ ÙÔÎÂÙfi ‹ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ıËÏ·-ÛÌÔ‡ ÛÂ ÂÚ›ÙˆÛË ‡·ÚÍË˜ Ú·Á¿‰ˆÓ ÛÙÈ˜ ıËÏ¤˜ÙˆÓ Ì·ÛÙÒÓ ÙË˜, Ë ·ÚÔ˘Û›· Ú·Á¿‰·˜ ÙÔ˘ ‰·ÎÙ˘-Ï›Ô˘ ‹ Ô ÙÚ·˘Ì·ÙÈÛÌfi˜ ÙÔ˘ ÔÚıÔ‡ ·fi ÙËÓ Î·Î‹Î·È ‚›·ÈË ÙÔÔı¤ÙËÛË ıÂÚÌÔÌ¤ÙÚÔ˘ ·ÔÎÏÂ›ÛÙË-Î·Ó ¿ÌÂÛ· ÙfiÛÔ ·fi ÙË ¯ÚÔÈ¿ ÙÔ˘ ·›Ì·ÙÔ˜, fiÛÔÎ·È ·fi ÙËÓ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË Î·È ÙÈ˜ ÏËÚÔÊÔÚ›Â˜Ô˘ ‹Ú·ÌÂ ·fi ÙÔ˘˜ ÁÔÓÂ›˜ ÙÔ˘. ¢È·Ù·Ú·¯¤˜ Ë-ÎÙÈÎfiÙËÙ·˜ ·ÔÎÏÂ›ÛÙËÎ·Ó ·fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi¤ÏÂÁ¯Ô. ÕÏÏÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜ Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È ÌÂ·ÈÌÔÚÚ·ÁÈÎ¤˜ ÎÂÓÒÛÂÈ˜, fiˆ˜ Û˘ÛÙÚÔÊ‹ ÂÓÙ¤-ÚÔ˘, ÂÓÙÂÚÈÎ‹ ·fiÊÚ·ÍË, ÔÏ‡Ô‰Â˜, ÓÂÎÚˆÙÈÎ‹ÂÓÙÂÚÔÎÔÏ›ÙÈ‰·, ÓfiÛÔ˜ Hirschprung’s, ÂÁÎÔÏÂ·-ÛÌfi˜ ‹ ·ÈÌÔÚÚ·Á›· ·fi ÙÔ ·ÓÒÙÂÚÔ Á·ÛÙÚÂÓÙÂÚÈ-Îfi Û‡ÛÙËÌ· ‰ÂÓ ıÂˆÚ‹ıËÎ·Ó ÔÏ‡ Èı·Ó¤˜ Û·Ó·ÈÙ›Â˜, Ï·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„ÈÓ Ù· Â˘Ú‹Ì·Ù· ·fiÙËÓ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË, Ù· ÂÚÁ·ÛÙËÚÈ·Î¿ Â˘-Ú‹Ì·Ù· Î·È Ù· Â˘Ú‹Ì·Ù· ·fi ÙËÓ ÎÔÏÔÓÔÛÎfiËÛËÛÂ ¤Ó· ÙÂÏÂÈfiÌËÓÔ ÓÂÔÁÓfi ÛÂ ÔÏ‡ Î·Ï‹ ÁÂÓÈÎ‹Î·Ù¿ÛÙ·ÛË (10,11). ªÂ ‚¿ÛË Ù· ÂÚÁ·ÛÙËÚÈ·Î¿ Â˘-Ú‹Ì·Ù·, Ù· Â˘Ú‹Ì·Ù· ·fi ÙËÓ ÎÔÏÔÓÔÛÎfiËÛË,Ù· ÈÛÙÔ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· ·fi ÙË ‚ÈÔ„›· ÙÔ˘ÔÚıÔÛÈÁÌÔÂÈ‰Ô‡˜ Î·È ÙËÓ Â·ÓÂÌÊ¿ÓÈÛË ÙˆÓ ·È-ÌÔÚÚ·ÁÈÎÒÓ ÎÂÓÒÛÂˆÓ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ Â·Ó·Û›-ÙÈÛË ÌÂ ÂÍ·ÓıÚˆÔÔÈËÌ¤ÓÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ÛÂ¤Ó· Î·Ù¿ Ù· ¿ÏÏ· ˘ÁÈ¤˜ ÙÂÏÂÈfiÌËÓÔ ÓÂÔÁÓfi, Ë ·Ï-

ÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ Ì‹ÎÂ Ï¤ÔÓ ÈÛ¯˘Ú¿ÛÙË ‰È·ÊÔÚÔ‰È·ÁÓˆÛÙÈÎ‹ Ì·˜ ÛÎ¤„Ë. ªÂ ‚¿ÛË Ù·ÎÚÈÙ‹ÚÈ· Ô˘ ÚfiÙÂÈÓ·Ó ÔÈ Savilathi, Bahna Î·ÈGandhi, Ù· ÔÔ›· ÚÔÛ·ÚÌfiÛÙËÎ·Ó ·fi ÙËÓ ∂˘-Úˆ·˚Î‹ ∂Ù·ÈÚÂ›· ¶·È‰È·ÙÚÈÎ‹˜ °·ÛÙÚÂÓÙÂÚÔÏÔ-Á›·˜ Î·È ÙËÓ ∂˘Úˆ·˚Î‹ ∞Î·‰ËÌ›· ∞ÏÏÂÚÁ›·˜ Î·È∫ÏÈÓÈÎ‹˜ ∞ÓÔÛÔÏÔÁ›·˜, Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ˘Ô-¯ÒÚËÛË ÙË˜ Û˘ÌÙˆÌ·ÙÔÏÔÁ›·˜ ÌÂÙ¿ ·fi ·ÔÌ¿-ÎÚ˘ÓÛË ÙÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰·˜ ·fi ÙË ‰È·ÙÚÔÊ‹ÙÔ˘ ‚Ú¤ÊÔ˘˜, Â·ÓÂÌÊ¿ÓÈÛË ÙË˜ Û˘ÌÙˆÌ·ÙÔÏÔ-Á›·˜ ÌÂÙ¿ ÙËÓ ÚÔÛı‹ÎË ÙÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰·˜ÛÙÔ ‰È·ÈÙÔÏfiÁÈÔ ÙÔ˘ ‚Ú¤ÊÔ˘˜, ˘Ô¯ÒÚËÛË ÙË˜Û˘ÌÙˆÌ·ÙÔÏÔÁ›·˜ ÌÂÙ¿ ·fi ÂÎ Ó¤Ô˘ ·ÔÌ¿-ÎÚ˘ÓÛË ÙÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰·˜ ·fi ÙË ‰È·ÙÚÔ-Ê‹, ·ÔÎÏÂÈÛÌfi ÙË˜ ‰˘Û·ÓÂÍ›·˜ ÛÙÔ Á¿Ï· ·ÁÂ-Ï¿‰·˜ Î·È ÙˆÓ ÏÔÈÌÒÍÂˆÓ (12), Ë ·ÏÏÂÚÁ›· ÛÙÔÁ¿Ï· ·ÁÂÏ¿‰·˜ ıÂˆÚ‹ıËÎÂ ˆ˜ Ë Ï¤ÔÓ Èı·Ó‹‰È¿ÁÓˆÛË.

£ÂÚ·Â˘ÙÈÎ¿ Û˘ÓÈÛÙ¿Ù·È Ë Ï‹ÚË˜ ·ÔÊ˘Á‹ÙÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰·˜ Î·È ÙˆÓ ÚÔ˚fiÓÙˆÓ ÙÔ˘·fi ÙË ‰È·ÙÚÔÊ‹ ·˘ÙÒÓ ÙˆÓ ‚ÚÂÊÒÓ. ∆Ô ÌËÙÚÈÎfiÁ¿Ï· ·ÔÙÂÏÂ› ·Ó·ÌÊÈÛ‚‹ÙËÙ· ÙËÓ È‰·ÓÈÎfiÙÂÚËÙÚÔÊ‹ ÁÈ· ÙË Û›ÙÈÛË ÙˆÓ ‚ÚÂÊÒÓ ·˘ÙÒÓ. ™ÙÈ˜ Û¿-ÓÈÂ˜ ÂÚÈÙÒÛÂÈ˜ ‚ÚÂÊÒÓ Ô˘ ·ÚÔ˘Û›·Û·Ó ·Ï-ÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ÂÓÒ ‰È·ÙÚ¤ÊÔÓÙ·Ó·ÔÎÏÂÈÛÙÈÎ¿ ÌÂ ÌËÙÚÈÎfi ıËÏ·ÛÌfi, ÚÔÙÂ›ÓÂÙ·È Ë·ÔÊ˘Á‹ ÙÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰·˜ Î·È ÙˆÓ ÚÔ˚fi-ÓÙˆÓ ÙÔ˘ ·fi ÙË ‰›·ÈÙ· ÙË˜ ÌËÙ¤Ú·˜. À¿Ú¯Ô˘ÓÛÙÔ ÂÌfiÚÈÔ ‰È¿ÊÔÚ· Á¿Ï·Ù· Ô˘ ‰È·Ê¤ÚÔ˘Ó ˆ˜ÚÔ˜ ÙÔ Â›‰Ô˜ ÙË˜ ÚˆÙÂ˝ÓË˜ Î·È ÙÔ ‚·ıÌfi ˘‰Úfi-Ï˘ÛË˜. ªÂÚÈÎ¿ ‚Ú¤ÊË Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÌËÓ ·ÓÂ-¯ÙÔ‡Ó Á¿Ï·Ù· ÌÂ ˘‰ÚÔÏ˘Ì¤ÓË ÏÂ˘ÎˆÌ·Ù›ÓË ‹˘‰ÚÔÏ˘Ì¤ÓË Î·˙Â˝ÓË, ÔfiÙÂ Î·È Û˘ÓÈÛÙ¿Ù·È Ë ¯Ô-Ú‹ÁËÛË Á¿Ï·ÎÙÔ˜ ÌÂ ÂÏÂ‡ıÂÚ· ·ÌÈÓÔÍ¤· (13). ™ÙÔÓÂÔÁÓfi Ì·˜, Ï·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„ÈÓ ÙË ÌÂÁ¿ÏË Ô-ÛfiÙËÙ· ·›Ì·ÙÔ˜ Ô˘ ˘‹Ú¯Â ÛÙ· ÎfiÚ·Ó·, ÙÔ ÁÂ-ÁÔÓfi˜ fiÙÈ Ë ·ÚÔ˘Û›· ÙÔ˘ ·›Ì·ÙÔ˜ ·ÊÂÓfi˜ ÌÂÓÂ¤ÌÂÓÂ Î·È ·ÊÂÙ¤ÚÔ˘ Â·ÓÂÌÊ·Ó›ÛÙËÎÂ ÛÂ ÛËÌ·-ÓÙÈÎ‹ ÔÛfiÙËÙ· ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ Â·Ó·¯ÔÚ‹ÁËÛËÙÔ˘ ÂÍ·ÓıÚˆÔÔÈËÌ¤ÓÔ˘ Á¿Ï·ÎÙÔ˜ Î·È ÙÔ fiÙÈ ËÛ˘ÌÙˆÌ·ÙÔÏÔÁ›· ÂÌÊ·Ó›ÛÙËÎÂ ÔÏ‡ ÓˆÚ›˜, ·fiÙËÓ ÚÒÙË ËÌ¤Ú· ÙË˜ ˙ˆ‹˜, ·ÔÊ·Û›Û·ÌÂ Ó· ¯Ô-ÚËÁ‹ÛÔ˘ÌÂ Á¿Ï· ÌÂ ·ÌÈÓÔÍ¤·.

∏ ÎÏÈÓÈÎ‹ ÔÚÂ›· ÙË˜ ·ÏÏÂÚÁ›·˜ ÛÙÔ Á¿Ï· ·ÁÂ-Ï¿‰·˜ ÔÈÎ›ÏÏÂÈ. ™Â ÌÂÚÈÎ¿ ·È‰È¿ Â›Ó·È ·ÚÔ‰ÈÎ‹Î·È ˘Ô¯ˆÚÂ› ¯ˆÚ›˜ Ó· ‰ËÌÈÔ˘ÚÁÂ› È‰È·›ÙÂÚ· ÚÔ-‚Ï‹Ì·Ù·, ÂÓÒ ÛÂ Î¿ÔÈ· ¿ÏÏ· ÌÔÚÂ› Ó· Â›Ó·È ÛÔ-‚·ÚfiÙÂÚË ‹ Ó· ·ÂÈÏÂ› ·ÎfiÌ· Î·È ÙË ˙ˆ‹ ÙÔ˘˜. ∏‡·ÚÍË ÁÂÓÂÙÈÎ‹˜ ÚÔ‰È¿ıÂÛË˜ Â›Ó·È Î·ıÔÚÈÛÙÈ-Î‹˜ ÛËÌ·Û›·˜ ÁÈ· ÙËÓ ÂÈÌÔÓ‹ ‹ fi¯È ÙË˜ Û˘ÌÙˆ-Ì·ÙÔÏÔÁ›·˜. ™ÙÔ 45-55% ÙˆÓ ‚ÚÂÊÒÓ Ë Û˘ÌÙˆ-Ì·ÙÔÏÔÁ›· ¤¯ÂÈ ˘Ô¯ˆÚ‹ÛÂÈ ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ÙË˜˙ˆ‹˜, ÛÙÔ 60-75% ÙÔÓ ‰Â‡ÙÂÚÔ, ÛÙÔ 85-90% ÙÔÓ


ÙÚ›ÙÔ Î·È ÛÙÔ 92% ÙÔÓ ¤ÌÙÔ ÌÂ ‰¤Î·ÙÔ ¯ÚfiÓÔÙË˜ ˙ˆ‹˜ (3,4).

¶ÂÚÈÁÚ¿ÊÔ˘ÌÂ ÙËÓ ÂÚ›ÙˆÛË ˘ÁÈÔ‡˜ ÙÂÏÂÈfi-ÌËÓÔ˘ ÓÂÔÁÓÔ‡ ÌÂ ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜Ô˘ ·ÚÔ˘Û›·ÛÂ ·ÈÌÔÚÚ·ÁÈÎ¤˜ ÎÂÓÒÛÂÈ˜ ·fi ÙËÓÚÒÙË ËÌ¤Ú· ÙË˜ ˙ˆ‹˜ ÙÔ˘. ∏ ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï··ÁÂÏ¿‰·˜ Â›Ó·È ÂÍ·ÈÚÂÙÈÎ¿ Û¿ÓÈ· ÛÂ ·˘Ù‹ ÙËÓ ËÏÈ-Î›·. ∏ ·‡ÍËÛË ÙË˜ ÔÏÈÎ‹˜ IgE Î·È ÙË˜ ÂÈ‰ÈÎ‹˜ ÛÙËÓÚˆÙÂ˝ÓË ÙÔ˘ Á¿Ï·ÎÙÔ˜ IgE Ì¿˜ Î¿ÓÔ˘Ó Ó· ÈÛÙÂ‡-Ô˘ÌÂ fiÙÈ ·ÓÔÛÔÏÔÁÈÎ‹ ·ÓÙ›‰Ú·ÛË Ô˘ ÚÔÎ·ÏÂ›Ù·ÈÌÂ ÙË ÌÂÛÔÏ¿‚ËÛË IgE ÌÔÚÂ›, ÙÔ˘Ï¿¯ÈÛÙÔÓ ÂÓ Ì¤-ÚÂÈ, Ó· Û˘ÌÌÂÙ¤¯ÂÈ ÛÙÔÓ ·ÓÔÛÔÏÔÁÈÎfi ÌË¯·ÓÈÛÌfiÚfiÎÏËÛË˜ ÙË˜ ÈÛÙÈÎ‹˜ ‚Ï¿‚Ë˜. ∏ ÂÌÊ¿ÓÈÛË ÙË˜Û˘ÌÙˆÌ·ÙÔÏÔÁ›·˜ ·fi ÙËÓ ÚÒÙË ÎÈfiÏ·˜ ËÌ¤Ú·ÙË˜ ˙ˆ‹˜ ÛÙÔ ÓÂÔÁÓfi Ì·˜ ı¤ÙÂÈ ÈÛ¯˘Ú¿ ÙËÓ Èı·-ÓfiÙËÙ· ÙË˜ ÂÓ‰ÔÌ‹ÙÚÈ·˜ Â˘·ÈÛıËÙÔÔ›ËÛË˜.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ë ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿-‰·˜ ÂÌÊ·Ó›˙ÂÙ·È Û¿ÓÈ· ÛÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô. ∏·ÚÔ˘Û›· ·›Ì·ÙÔ˜ ÛÙ· ÎfiÚ·Ó· ÛÂ ¤Ó· Î·Ù¿ Ù·¿ÏÏ· ˘ÁÈ¤˜ ÙÂÏÂÈfiÌËÓÔ ÓÂÔÁÓfi ·ÎfiÌ· Î·È ÙËÓ ÚÒ-ÙË ËÌ¤Ú· ÙË˜ ˙ˆ‹˜ ÌÔÚÂ› Ó· ÔÊÂ›ÏÂÙ·È ÛÂ ·ÏÏÂÚ-Á›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜. ∏ Â˘·ÈÛıËÙÔÔ›ËÛË ÙÔ˘ÎÏÈÓÈÎÔ‡ ıÂˆÚÂ›Ù·È ÌÂ›˙ÔÓÔ˜ ÛËÌ·Û›·˜ ÁÈ· ÙË Î·Ù¿ÙÔ ‰˘Ó·ÙfiÓ Û˘ÓÙÔÌfiÙÂÚË ‰È·ÁÓˆÛÙÈÎ‹ ÚÔÛ¤ÁÁÈÛËÎ·È ·ÔÊ˘Á‹ ¿ÛÎÔˆÓ Î·È Â›ÔÓˆÓ ÁÈ· ÙÔ ÓÂÔÁÓfi‰È·ÁÓˆÛÙÈÎÒÓ ·ÚÂÌ‚¿ÛÂˆÓ.

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8. ∫ÔÏÈÔ¿ÓÔ˘ ∞, ª¿Ó‰˘Ï· ∂, ∞Ó·ÁÓˆÛÙ¿ÎË˜ ¢. ∏ ·ÏÏÂÚÁ›·ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ÛÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›·. ¢ÂÏÙ›Ô ∞’ ¶·È‰È·-ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 1995;42:19-24.

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¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ÃÚÈÛÙ›Ó· °È·ÓÓ·ÎÔÔ‡ÏÔ˘ ∞ÙÏ·ÓÙ›‰Ô˜ 37, ∆.∫. 713 05, ∏Ú¿ÎÏÂÈÔ ∫Ú‹ÙË˜


™˘ÓÙÔÌÔÁÚ·Ê›Â˜O¶ O›ÛıÈ· Ï·ÁÈÔÎÂÊ·Ï›· ∞™§ƒ ∞ÏËı‹˜ Û˘ÓÔÛÙ¤ˆÛË ÙË˜ Ï·Ì‚‰ÔÂÈ‰Ô‡˜ Ú·Ê‹˜ ¶O¶ ¶·Ú·ÌÔÚÊˆÙÈÎ‹ Ô›ÛıÈ· Ï·ÁÈÔÎÂÊ·Ï›· ∞™O¶ ∞ÏËı‹˜ Û˘ÓÔÛÙÂˆÙÈÎ‹ Ô›ÛıÈ· Ï·ÁÈÔÎÂÊ·Ï›· ∞∆∫ ∞ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÎÚ·Ó›Ô˘

∂ÈÛ·ÁˆÁ‹ ¶Ï·ÁÈÔÎÂÊ·Ï›· Â›Ó·È ¤Ó·˜ fiÚÔ˜ Ô˘ ‰ËÏÒÓÂÈ

ÂÙÂÚfiÏÂ˘ÚË (·Û‡ÌÌÂÙÚË) ÂÈ¤‰ˆÛË ÙÔ˘ ÎÚ·Ó›-Ô˘. ™ÙËÓ O¶, Ë ÂÈ¤‰ˆÛË ·ÊÔÚ¿ ÙÔ ÈÓÈ·Îfi ÔÛÙfi.∆· ÈÔ Û˘¯Ó¿, ÌË Û˘Ó‰ÚÔÌÈÎ¿, ·›ÙÈ· O¶ ÔÊÂ›ÏÔ-ÓÙ·È ÛÂ ·Ú·ÌfiÚÊˆÛË ÙÔ˘ ÎÂÊ·ÏÈÔ‡ ·fi ‰˘Ó¿-ÌÂÈ˜ Ô˘ ÂÈ‰ÚÔ‡Ó ÙfiÛÔ ÂÓ‰ÔÌ‹ÙÚÈ· (‰È‰˘Ì›·,ÚÔˆÚfiÙËÙ·, Ú·È‚fiÎÚ·ÓÔ, Î·ı‹ÏˆÛË ÙÔ˘ Ï·È-ÌÔ‡), fiÛÔ Î·È ÂÍˆÌ‹ÙÚÈ·, ·fi ÙË Û˘ÓÂ¯‹ ‡ÙÈ· ı¤-ÛË ÙÔ˘ ÎÂÊ·ÏÈÔ‡. ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ·˘Ù¤˜, Ë Ú·Ê‹Â›Ó·È ¿ÓÙÔÙÂ ·ÓÔÈÎÙ‹. §ÈÁfiÙÂÚÔ Û˘¯Ó¿, Ë O¶ÔÊÂ›ÏÂÙ·È ÛÂ ÂÙÂÚfiÏÂ˘ÚË ·ÏËı‹ Û˘ÓÔÛÙ¤ˆÛË

ÙË˜ Ï·Ì‚‰ÔÂÈ‰Ô‡˜ Ú·Ê‹˜ (∞™§ƒ) ÌÂ ·Ó·ÙÔÌÈÎ‹Û‡ÁÎÏÂÈÛ‹ ÙË˜. ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ Ô›ÛıÈˆÓ Ï·-ÁÈÔÎÂÊ·ÏÈÒÓ, Ë ·Ú·ÌÔÚÊˆÙÈÎ‹ Ô›ÛıÈ· Ï·ÁÈÔ-ÎÂÊ·Ï›· (¶O¶) ·ÔÙÂÏÂ› ÙÔ 97%-99% ÙˆÓ ÂÚÈ-ÙÒÛÂˆÓ Î·È Ë ·ÏËı‹˜ Û˘ÓÔÛÙÂˆÙÈÎ‹ Ô›ÛıÈ·Ï·ÁÈÔÎÂÊ·Ï›· (∞™O¶) ÙÔ ˘fiÏÔÈÔ 1%-3% (1,2).∏ ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÌÂÙ·Í‡ ∞™O¶ Î·È ¶O¶ Â›-Ó·È ÎÚ›ÛÈÌË˜ ÛËÌ·Û›·˜, ÁÈ·Ù› Ë ıÂÚ·Â›· ÙË˜ ∞™O¶Â›Ó·È Û¯Â‰fiÓ ¿ÓÙÔÙÂ ¯ÂÈÚÔ˘ÚÁÈÎ‹, ÂÓÒ Ë ıÂÚ·Â›·ÙË˜ ¶O¶ Â›Ó·È Î·Ù¿ Î·ÓfiÓ· Û˘ÓÙËÚËÙÈÎ‹ (1-3).

∏ Û¯¤ÛË ÌÂÙ·Í‡ ¶O¶ Î·È ∞™O¶ ¤ÁÈÓÂ ÂÎ Ó¤Ô˘·ÓÙÈÎÂ›ÌÂÓÔ ÂÓ‰È·Ê¤ÚÔÓÙÔ˜ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·-Ê›· Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÂÍ·ÈÙ›·˜ ÙË˜ ·‡ÍËÛË˜ÙÔ˘ ·ÚÈıÌÔ‡ ·Ú·ÔÌÒÓ ÂÚÈÙÒÛÂˆÓ O¶(1,2,4-6), Ô˘ ·Ô‰fiıËÎÂ ÛÙË Û‡ÛÙ·ÛË ÙË˜ ∞ÌÂÚÈ-Î·ÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ ∂Ù·ÈÚÂ›·˜, ÙÔ 1992, Ó· ÎÔÈ-ÌÔ‡ÓÙ·È Ù· ‚Ú¤ÊË ‡ÙÈ·, ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÂÏ·ÙÙˆ-ıÂ› Ô Î›Ó‰˘ÓÔ˜ ÙÔ˘ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ (7).

¶ÚÈÓ Ï›Á· ¯ÚfiÓÈ·, ÔÏÏ¤˜ ÂÚÈÙÒÛÂÈ˜ ¶O¶


282

�¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È ‚Ú¤ÊÔ˜ ÌÂ ‰ÂÍÈ¿·ÏËı‹ Û˘ÓÔÛÙÂˆÙÈÎ‹ Ô›ÛıÈ· Ï·ÁÈÔÎÂÊ·Ï›·. ∏‰È¿ÁÓˆÛË Ù¤ıËÎÂ ÌÂ ‚¿ÛË ÎÏÈÓÈÎ¿ ÎÚÈÙ‹ÚÈ·, fiˆ˜·˘Ù¿ ÂÚÈÁÚ¿ÊËÎ·Ó ÚfiÛÊ·Ù· Î·È ÂÈ‚Â‚·ÈÒıË-ÎÂ ÌÂ ÙÚÈÛ‰È¿ÛÙ·ÙË ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÎÚ·Ó›Ô˘.™˘˙ËÙÔ‡ÓÙ·È Ù· ÓÂfiÙÂÚ· ‰Â‰ÔÌ¤Ó· ÁÈ· ÙËÓ ·‡ÍË-ÛË ÙË˜ Û˘¯ÓfiÙËÙ·˜ ÙË˜ Ô›ÛıÈ·˜ Ï·ÁÈÔÎÂÊ·Ï›·˜(O¶), Ù· ·›ÙÈ¿ ÙË˜, ÙË ‰È¿ÁÓˆÛ‹ ÙË˜, ÙË ‰È·ÊÔÚÔ-‰È¿ÁÓˆÛË ÌÂÙ·Í‡ ·ÏËıÔ‡˜ Û˘ÓÔÛÙÂˆÙÈÎ‹˜ O¶Î·È ·Ú·ÌÔÚÊˆÙÈÎ‹˜ O¶ Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛË.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ·ÏËı‹˜ Û˘ÓÔÛÙÂˆÙÈÎ‹ Ô›ÛıÈ·Ï·ÁÈÔÎÂÊ·Ï›·, Ô›ÛıÈ· Ï·ÁÈÔÎÂÊ·Ï›·, ·Ú·-ÌÔÚÊˆÙÈÎ‹ Ï·ÁÈÔÎÂÊ·Ï›·.

�Abstract: A case of true synostotic posteriorplagiocephaly on the right side is reported. Thediagnosis was based on clinical criteria, as theywere described recently, and confirmed by 3-Daxial tomography of the skull. The new dataconcerning the increased incidence of posteriorplagiocephaly is discussed, as well as the causes,diagnosis, differential diagnosis and management.

Key words: true synostotic posterior plagio-cephaly, posterior plagiocephaly, deformationalplagiocephaly.

∞ÏËı‹˜ Û˘ÓÔÛÙÂˆÙÈÎ‹ Ô›ÛıÈ· Ï·ÁÈÔÎÂÊ·Ï›· ÛÂ ‚Ú¤ÊÔ˜ ∞. ∞Ó‰Ú¤Ô˘1, °. µ·ÛÈÏÂ›Ô˘1, µ. ¶··‚·ÛÈÏÂ›Ô˘1, ∞. ∞Ó·ÛÙ·Û›Ô˘2, ∞. ™ÙÚ·ÙÔ˘‰¿ÎË˜3

A case of true synostotic posterior plagiocephaly A. Andreou1, G. Vasileiou1, V. Papavasileiou1, A. Anastasiou2, A. Stratoudakis3


1 ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ∂™À πÔÎÚ¿ÙÂÈÔ˘ °¶¡ £ÂÛÛ·ÏÔÓ›ÎË˜2 ∞ÎÙÈÓÔÏÔÁÈÎfi ∆Ì‹Ì· πÔÎÚ¿ÙÂÈÔ˘ °¶¡ £ÂÛÛ·ÏÔÓ›ÎË˜ 3 ¶Ï·ÛÙÈÎfi˜ ÃÂÈÚÔ˘ÚÁfi˜, π‰ÈˆÙÈÎfi˜ È·ÙÚfi˜

1 Neonatal Department, NHS Ippokratio Hospital of Thessaloniki2 Radiology Department, Ippokratio Hospital of Thessaloniki3 Plastic Surgeon, private practice


ÂÎÏ·Ì‚¿ÓÔÓÙ·Ó Û·Ó ∞™O¶, ÂÓÒ ·Ô‰ÂÈÎÓ˘fiÙ·Ó Î·-Ù¿ ÙËÓ ÂÁ¯Â›ÚËÛË Î·È ÙËÓ ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË fiÙÈ ËÚ·Ê‹ ‰ÂÓ ‹Ù·Ó ·Ó·ÙÔÌÈÎ¿ Û˘ÁÎÂÎÏÂÈÛÌ¤ÓË. ∆Ô1996, Ô Huang ÂÚÈ¤ÁÚ·„Â ÌÂ ÏÂÙÔÌ¤ÚÂÈÂ˜ Ù·ÎÏÈÓÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙË˜ ÎÚ·ÓÈ·Î‹˜ ·Ú·ÌfiÚ-ÊˆÛË˜, Ô˘ ÚÔ¤Ú¯ÂÙ·È ÙfiÛÔ ·fi ÙËÓ ∞™O¶ fiÛÔÎ·È ·fi ÙËÓ ¶O¶ Î·È Û˘Ì¤Ú·ÓÂ fiÙÈ ÌÂ ‚¿ÛË ·˘Ù¿ÌÔÚÂ› Ó· Á›ÓÂÈ ‰È·ÊÔÚÔ‰È¿ÁÓˆÛË ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô·ı‹ÛÂˆÓ (2).

¶ÂÚÈÁÚ¿ÊÔ˘ÌÂ ¤Ó· ÂÚÈÛÙ·ÙÈÎfi ∞™O¶ ÁÈ· ÙËÛ·ÓÈfiÙËÙ¿ ÙÔ˘ Î·È ÁÈ· Ó· ·Ó·Ê¤ÚÔ˘ÌÂ ÙÈ˜ Ó¤Â˜ÂÍÂÏ›ÍÂÈ˜ ÛÙÔ Úfi‚ÏËÌ· ÙË˜ O¶.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜∫ÔÚ›ÙÛÈ ËÏÈÎ›·˜ 6 ÌËÓÒÓ ÚÔÛÎÔÌ›ÛÙËÎÂ ÛÙ·

ÂÍˆÙÂÚÈÎ¿ È·ÙÚÂ›· ÙÔ˘ ÙÌ‹Ì·ÙÔ˜ ÁÈ· ¤ÏÂÁ¯Ô ·Û˘Ì-ÌÂÙÚ›·˜ ÎÚ·Ó›Ô˘. ∆Ô ÔÈÎÔÁÂÓÂÈ·Îfi, Ì·ÈÂ˘ÙÈÎfi Î·ÈÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂÏÂ‡ıÂÚ·. ∏ Ê˘ÛÈÎ‹ÂÍ¤Ù·ÛË ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ-Î‹. ∆Ô ‚Ú¤ÊÔ˜ ‰ÂÓ ÎÔÈÌfiÙ·Ó ·ÔÎÏÂÈÛÙÈÎ¿ ÛÂ ‡ÙÈ·ı¤ÛË. ™Â ËÏÈÎ›· 2 ÌËÓÒÓ ·Ú·ÙËÚ‹ıËÎÂ ÁÈ· ÚÒÙËÊÔÚ¿ ·Û˘ÌÌÂÙÚ›· ÙÔ˘ ÎÚ·Ó›Ô˘ ÌÂ ÂÈ¤‰ˆÛË ÙË˜ÈÓÈ·Î‹˜ ÂÚÈÔ¯‹˜ ‰ÂÍÈ¿. §fiÁˆ ÙË˜ ÚÔÔ‰Â˘ÙÈÎ‹˜ÂÈ‰Â›ÓˆÛË˜, ¤ÁÈÓÂ ÛÂ ËÏÈÎ›· 4 ÌËÓÒÓ ·Ï‹ ·ÎÙÈÓÔ-ÁÚ·Ê›· Î·È ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÎÚ·Ó›Ô˘ (∞∆∫)Ô˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿. ∏ ·Ú·ÌfiÚÊˆÛË ÙÔ˘ ÎÚ·-Ó›Ô˘ Î·È ÙÔ˘ ÚÔÛÒÔ˘ ‹Ù·Ó ·ÚÎÂÙ¿ ÂÌÊ·Ó‹˜, ÛÂ‚·ıÌfi Ô˘ ÔÈ ÁÔÓÂ›˜ ÓÙÚ¤ÔÓÙ·Ó Ó· Î˘ÎÏÔÊÔÚ‹-ÛÔ˘Ó ÌÂ ÙÔ ·È‰› ÙÔ˘˜ ÂÎÙfi˜ ÛÈÙÈÔ‡.

∏ Ê˘ÛÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ˘ ÎÚ·Ó›Ô˘ Î·È ÙÔ˘ ÚÔÛÒ-Ô˘ ¤‰ÂÈÍÂ ÂÎÛÂÛËÌ·ÛÌ¤ÓË O¶ ‰ÂÍÈ¿, ÌÂ ¤ÓÙÔÓ·„ËÏ·ÊËÙ‹ ÔÛÙÈÎ‹ ·ÎÚÔÏÔÊ›· Î·Ù¿ Ì‹ÎÔ˜ ÙË˜ ‰Â-ÍÈ¿˜ Ï·Ì‚‰ÔÂÈ‰Ô‡˜ Ú·Ê‹˜. ™‡ÛÙÔÈ¯· ÚÔ˜ ÙËÓÏ·ÁÈÔÎÂÊ·Ï›· „ËÏ·ÊfiÙ·Ó ÔÛÙÈÎ‹ ‰ÈfiÁÎˆÛË ÛÙËÓÈÓÈÔÌ·ÛÙÔÂÈ‰‹ ÂÚÈÔ¯‹, ‰È·ÛÙ¿ÛÂˆÓ 4x5 cm (∂ÈÎfi-Ó· 1·). ∞ÓÙ›ÛÙÔÈ¯· ÚÔ˜ ÙË ‚Ï¿‚Ë ˘‹Ú¯Â ÛÙÚÔÁ-Á˘Ï‹ ÚÔ¤ÙÂÈ· ÙË˜ ‚ÚÂÁÌ·ÙÈÎ‹˜ ÂÚÈÔ¯‹˜ ÚÔ˜Ù· ¤Íˆ Î·È ¿Óˆ (∂ÈÎfiÓ· 1·). ∆Ô ÎÚ·Ó›Ô fiˆ˜ Ê·È-ÓfiÙ·Ó ·fi ¿Óˆ Â›¯Â Û¯‹Ì· ÙÚ·Â˙›Ô˘ (∂ÈÎfiÓ· 2‚),ÂÓÒ fiˆ˜ Ê·ÈÓfiÙ·Ó ·fi ›Ûˆ Â›¯Â Û¯‹Ì· ·Ú·Ï-ÏËÏÔÁÚ¿ÌÌÔ˘ (∂ÈÎfiÓ· 1·). ∆Ô ÎÂÊ¿ÏÈ Â›¯Â ÂÌÊ·Ó‹ÎÏ›ÛË ÚÔ˜ Ù· ‰ÂÍÈ¿ (∂ÈÎfiÓ· 3), ÌÂ ·ÓÙÈÛÙ·ıÌÈÛÙÈÎ‹·Ú·ÌfiÚÊˆÛË ÙË˜ ·˘¯ÂÓÈÎ‹˜ ÌÔ›Ú·˜ ÙË˜ ÛÔÓ‰˘-ÏÈÎ‹˜ ÛÙ‹ÏË˜. ∆Ô ÚfiÛˆÔ ‹Ù·Ó ÂÏ·ÊÚ¿ ·Û‡ÌÌÂ-ÙÚÔ ÌÂ ÌÈÎÚfiÙÂÚÔ ¿ÓÔÈÁÌ· ÔÊı·ÏÌÔ‡ Û‡ÛÙÔÈ¯·,‡„Ô˜ Û‡ÛÙÔÈ¯Ô˘ ÔÊÚ‡Ô˜ ¯·ÌËÏfiÙÂÚÔ ·fi ÙÔ ·ÓÙ›-ÛÙÔÈ¯Ô, ÂÏ·ÊÚ¿ ÎÏ›ÛË ÙË˜ ÚÈÓfi˜ ÚÔ˜ ÙËÓ ·ÓÙ›-ÛÙÔÈ¯Ë ÏÂ˘Ú¿ Î·È ÔÏ‡ ‹È· ÛÙÚÔÁÁ˘Ï‹ ÚÔ‚ÔÏ‹ÙÔ˘ ÌÂÙˆÈ·›Ô˘ ·ÓÙ›ÛÙÔÈ¯·. ∆Ô ·˘Ù› ‹Ù·Ó ÌÂÙ·ÙÔÈ-ÛÌ¤ÓÔ ÚÔ˜ Ù· Î¿Ùˆ Î·È ÂÌÚfi˜ (∂ÈÎfiÓ· 4). ∆· ÎÏÈ-ÓÈÎ¿ Â˘Ú‹Ì·Ù· ¤ıÂÛ·Ó ÙË ‰È¿ÁÓˆÛË O¶ ·fi ·ÏËı‹Û˘ÓÔÛÙ¤ˆÛË ÙË˜ ‰ÂÍÈ¿˜ Ï·Ì‚‰ÔÂÈ‰Ô‡˜ Ú·Ê‹˜. ∏ÙÚÈÛ‰È¿ÛÙ·ÙË ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÎÚ·Ó›Ô˘ ¤‰ÂÈÍÂ

ÔÛÙÈÎ‹ ·ÎÚÔÏÔÊ›· ÛÙË ı¤ÛË ÙË˜ ‰ÂÍÈ¿˜ Ï·Ì‚‰ÔÂÈ-‰Ô‡˜ Ú·Ê‹˜ Î·È ÂÍ¿ÏÂÈ„Ë ÙË˜ Ú·Ê‹˜, ÛËÌÂ›· Ô˘Û˘ÓËÁÔÚÔ‡Û·Ó ÁÈ· ∞™O¶ (∂ÈÎfiÓ· 5).

∏ ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ¤ÁÈÓÂ ·fi ÙËÓ O¶, Ô˘ÔÊÂ›ÏÂÙ·È ÛÙË Û˘ÓÂ¯‹ ‡ÙÈ· ı¤ÛË ÙË˜ ÎÂÊ·Ï‹˜. ∆·


283

∂ÈÎfiÓ· 1. ™¯ËÌ·ÙÈÎ‹ ·Ú¿ÛÙ·ÛË ÙÔ˘ Û¯‹Ì·ÙÔ˜ ÙÔ˘ ÎÂÊ·ÏÈ-Ô‡ ÛÂ ‰ÂÍÈ¿ O¶. O›ÛıÈ· ı¤·. ·) ∞™O¶. º·›ÓÂÙ·È ÙÔ ·Ú·Ï-ÏËÏfiÁÚ·ÌÌÔ Û¯‹Ì· ÙÔ˘ ÎÂÊ·ÏÈÔ‡, Ë ÂÍ¿ÏÂÈ„Ë ÙË˜ ‰ÂÍÈ¿˜Ï·Ì‚‰ÔÂÈ‰Ô‡˜ Ú·Ê‹˜, Ë ‰ÈfiÁÎˆÛË ÛÙËÓ ÈÓÈÔÌ·ÛÙÔÂÈ‰‹ Â-ÚÈÔ¯‹ (‰ÂÍÈfi Î¿Ùˆ, ·ÓÔÈÎÙfi ‚¤ÏÔ˜), Ë ÚÔ¤ÙÂÈ· ÛÙË ‚ÚÂÁÌ·-ÙÈÎ‹ ÂÚÈÔ¯‹ ·ÓÙ›ÛÙÔÈ¯· ÚÔ˜ ÙË ‚Ï¿‚Ë (·ÚÈÛÙÂÚfi ¿Óˆ, ·ÓÔÈ-ÎÙfi ‚¤ÏÔ˜), Ë ÎÏ›ÛË ÙË˜ ÎÂÊ·Ï‹˜ Û‡ÛÙÔÈ¯· ÚÔ˜ ÙË ‚Ï¿‚Ë(ÎÏÂÈÛÙfi ‚¤ÏÔ˜) Î·È ÌÂÙ·ÙfiÈÛË ÙÔ˘ Û‡ÛÙÔÈ¯Ô˘ ·˘ÙÈÔ‡ ÚÔ˜Ù· Î¿Ùˆ. ‚) ¶O¶. º·›ÓÂÙ·È ÙÔ ÛÙÚÔÁÁ˘Ïfi Û¯‹Ì· ÙÔ˘ ÎÂÊ·ÏÈ-Ô‡ Î·È Ë ·ÚÔ˘Û›· ÙË˜ Ï·Ì‚‰ÔÂÈ‰Ô‡˜ Ú·Ê‹˜.

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∂ÈÎfiÓ· 2. ™¯ËÌ·ÙÈÎ‹ ·Ú¿ÛÙ·ÛË ÙÔ˘ Û¯‹Ì·ÙÔ˜ ÙÔ˘ ÎÂÊ·ÏÈ-Ô‡ ÛÂ ‰ÂÍÈ¿ O¶. £¤· ·fi Â¿Óˆ. ·) ¶O¶. º·›ÓÂÙ·È ÙÔ ·-Ú·ÏÏËÏfiÁÚ·ÌÌÔ Û¯‹Ì· ÙÔ˘ ÎÂÊ·ÏÈÔ‡, Ë ÚÔ¤ÙÂÈ· ÙÔ˘ Û‡-ÛÙÔÈ¯Ô˘ ÌÂÙÒÔ˘, Ë ÚÔ˜ Ù· ÂÌÚfi˜ ÌÂÙ·ÙfiÈÛË ÙÔ˘ Û‡-ÛÙÔÈ¯Ô˘ ·˘ÙÈÔ‡. ‚) ∞™O¶. º·›ÓÂÙ·È ÙÔ ÙÚ·Â˙ÔÂÈ‰¤˜ Û¯‹Ì·ÙÔ˘ ÎÂÊ·ÏÈÔ‡, Ë Û‡ÛÙÔÈ¯Ë ÈÓÈÔÌ·ÛÙÈÎ‹ ‰ÈfiÁÎˆÛË (‰ÂÍÈfi Î¿Ùˆ‚¤ÏÔ˜), Ë ·ÓÙ›ÛÙÔÈ¯Ë ÚÔ¤ÙÂÈ· ÙÔ˘ ‚ÚÂÁÌ·ÙÈÎÔ‡ ÔÛÙÔ‡, Ë·ÓÙ›ÛÙÔÈ¯Ë ÚÔ¤ÙÂÈ· ÙÔ˘ ÌÂÙˆÈ·›Ô˘ ÔÛÙÔ‡ Î·È Ë ÚÔ˜ Ù·›Ûˆ ·ÚÂÎÙfiÈÛË ÙÔ˘ Û‡ÛÙÔÈ¯Ô˘ ·˘ÙÈÔ‡.

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Î˘ÚÈfiÙÂÚ· ‰È·ÊÔÚÔ‰È·ÁÓˆÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ· ÂÚÈ-ÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1 Î·È Ê·›ÓÔÓÙ·È ÛÙÈ˜ ∂ÈÎfi-ÓÂ˜ 1 Î·È 2.

∏ Ï·ÁÈÔÎÂÊ·Ï›· ‰ÈÔÚıÒıËÎÂ ¯ÂÈÚÔ˘ÚÁÈÎ¿ ÛÂËÏÈÎ›· 7 ÌËÓÒÓ. ∆ÚÂÈ˜ Ì‹ÓÂ˜ ÌÂÙ¿ ÙËÓ ÂÁ¯Â›ÚËÛË˘‹Ú¯Â Û·Ê‹˜ ‚ÂÏÙ›ˆÛË ÙË˜ ·Ú·ÌfiÚÊˆÛË˜ ÙÔ˘ÎÚ·Ó›Ô˘ Î·È ÙÔ˘ ÚÔÛÒÔ˘ Î·È ¤Ó· ¯ÚfiÓÔ ·ÚÁfiÙÂ-Ú· Ë ·Ú·ÌfiÚÊˆÛË ÙÔ˘ ÎÚ·Ó›Ô˘ ‹Ù·Ó ‰‡ÛÎÔÏ··ÓÙÈÏËÙ‹ ·fi ÙÔ˘˜ ÌË ÁÓˆÚ›˙ÔÓÙÂ˜. ªfiÓÔ Ë ‰Èfi-ÁÎˆÛË ÛÙËÓ ÈÓÈÔÌ·ÛÙÔÂÈ‰‹ ÂÚÈÔ¯‹ ·Ú¤ÌÂÓÂ, ·-Ú¿ ÙË ‚ÂÏÙ›ˆÛË, Â‡ÎÔÏ· ·ÓÙÈÏËÙ‹, fiÙ·Ó ‰ÂÓ Î·-Ï˘ÙfiÙ·Ó ·fi Ù· Ì·ÏÏÈ¿ ÙÔ˘ ÎÂÊ·ÏÈÔ‡.

™˘˙‹ÙËÛË °È· ·ÚÎÂÙ¿ ¯ÚfiÓÈ·, Ë ‰È¿ÎÚÈÛË ÌÂÙ·Í‡ ¶O¶ Î·È

∞™O¶ ‚·ÛÈ˙fiÙ·Ó fi¯È ÛÙÈ˜ ‰È·ÊÔÚ¤˜ ÙÔ˘ Û¯‹Ì·ÙÔ˜ÙÔ˘ ÎÂÊ·ÏÈÔ‡, ·ÏÏ¿ ÂÚÈÛÛfiÙÂÚÔ ÛÙÔ ÛÙÔÈ¯Â›Ô ÙË˜ÚÔfi‰Ô˘ ÙË˜ ·Ú·ÌfiÚÊˆÛË˜ Î·Ù¿ ÙË ‰È·¯ÚÔÓÈÎ‹ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË. OÈ ·ÛıÂÓÂ›˜ ÌÂ ·Ú·ÌÔÚÊˆÙÈÎ‹Ï·ÁÈÔÎÂÊ·Ï›· ·fi ÂÓ‰ÔÌ‹ÙÚÈ· Û˘Ì›ÂÛË ıÂˆ-ÚÔ‡ÓÙ·Ó fiÙÈ ‚ÂÏÙÈÒÓÔÓÙ·È ÌÂÙ¿ ÙË Á¤ÓÓËÛË. ŸÛÔÈ·ÛıÂÓÂ›˜ ÌÂ O¶ ‰ÂÓ ‚ÂÏÙÈÒÓÔÓÙ·Ó ÌÂÙ¿ ÙË Á¤ÓÓË-ÛË, ıÂˆÚÔ‡ÓÙ·Ó fiÙÈ Â›¯·Ó Û˘ÁÎÂÎÏÂÈÛÌ¤ÓË Ï·Ì-‚‰ÔÂÈ‰‹ Ú·Ê‹ Î·È ıÂÚ·Â‡ÔÓÙ·Ó ¯ÂÈÚÔ˘ÚÁÈÎ¿.ŸÌˆ˜, ÛÙÔ ¯ÂÈÚÔ˘ÚÁÂ›Ô ÁÈÓfiÙ·Ó ·ÓÙÈÏËÙfi fiÙÈ ÔÈÚ·Ê¤˜ ‰ÂÓ Â›¯·Ó ÎÏÂ›ÛÂÈ ÚfiˆÚ· Î·È ÔÈ ÂÚÈÙÒ-ÛÂÈ˜ ·˘Ù¤˜ ÔÓÔÌ¿˙ÔÓÙ·Ó “ÏÂÈÙÔ˘ÚÁÈÎ‹ Û˘ÓÔÛÙ¤ˆ-ÛË ÙË˜ Ï·Ì‚‰ÔÂÈ‰Ô‡˜”. ™‡ÓÙÔÌ·, ¤ÁÈÓÂ ·ÓÙÈÏËÙfifiÙÈ ÔÈ ·Ú·ÌÔÚÊÒÛÂÈ˜ ·˘Ù¤˜ ÔÊÂ›ÏÔÓÙ·È ÛÙË ı¤ÛËÙÔ˘ ÎÂÊ·ÏÈÔ‡ Î·È ·Ó·Ù‡ÛÛÔÓÙ·È fiÙ·Ó ÙÔ ‚Ú¤ÊÔ˜Û·Ù·Ï¿ ·Ú·ÙÂÙ·Ì¤ÓÔ ¯ÚfiÓÔ ‡ÙÈ· ÛÙËÓ ÎÔ‡ÓÈ·ÙÔ˘ ‹ ÙË ı¤ÛË ÙÔ˘ ·˘ÙÔÎÈÓ‹ÙÔ˘. ∏ Û˘ÓÂ¯‹˜ ‡ÙÈ·ı¤ÛË ÌÔÚÂ› Ó· ÚÔÎ·Ï¤ÛÂÈ O¶ ÛÂ ¤Ó· Ê˘ÛÈÔÏÔ-ÁÈÎfi Î·Ù¿ ÙË Á¤ÓÓËÛË ÎÂÊ¿ÏÈ ‹ Ó· ÂÈ‰ÂÈÓÒÛÂÈ Ì›·‹È· ·Ú·ÌfiÚÊˆÛË ÙÔ˘ ÎÂÊ·ÏÈÔ‡ Ô˘ Û˘Ó¤‚Ë ÂÓ-‰ÔÌ‹ÙÚÈ· ·fi ÂÚÈÔÚÈÛÙÈÎ¤˜ ‰˘Ó¿ÌÂÈ˜.

ªÂÙ¿ ÙÔ 1992 ˘‹ÚÍÂ ÌÂÁ¿ÏË ·‡ÍËÛË ÙˆÓ O¶,Ô˘ ·Ô‰fiıËÎÂ ÛÙË Û‡ÛÙ·ÛË ÙË˜ ∞ÌÂÚÈÎ·ÓÈÎ‹˜∞Î·‰ËÌ›·˜ ¶·È‰È·ÙÚÈÎ‹˜ Ó· ÙÔÔıÂÙÔ‡ÓÙ·È Ù·‚Ú¤ÊË ‡ÙÈ· ÁÈ· ÙËÓ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ·fiÙÔ Û‡Ó‰ÚÔÌÔ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ (7).

™Â ¤Ó· ÎÚ·ÓÈÔÚÔÛˆÈÎfi Î¤ÓÙÚÔ ÙˆÓ ∏¶∞,ÂÓÒ ÙÔ 1992 ÌfiÓÔ 30% ÙˆÓ Ï·ÁÈÔÎÂÊ·ÏÈÒÓ ÔÊÂÈ-ÏfiÙ·Ó ÛÂ Ô›ÛıÈÂ˜ Ï·ÁÈÔÎÂÊ·Ï›Â˜ Î·È 70% ÛÂÚfiÛıÈÂ˜, ÙÔ 1998 ÙÔ 95% ÙˆÓ Ï·ÁÈÔÎÂÊ·ÏÈÒÓÔÊÂÈÏfiÙ·Ó ÛÂ Ô›ÛıÈÂ˜ Ï·ÁÈÔÎÂÊ·Ï›Â˜ Î·È ÌfiÓÔ5% ÛÂ ÚfiÛıÈÂ˜ (1).

∞˘Ù‹ Ë Ì·˙ÈÎ‹ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÓÂÔ-ÁÓÒÓ ÌÂ ¶O¶ ·ÚÂ›¯Â Ì›· ‚¿ÛË ‰Â‰ÔÌ¤ÓˆÓ ÁÈ·

∂ÈÎfiÓ· 3. O›ÛıÈ· ÊˆÙÔÁÚ¿ÊÈÛË ÙÔ˘ ÎÂÊ·ÏÈÔ‡. º·›ÓÂÙ·È ËÎÏ›ÛË ÙÔ˘ ÎÂÊ·ÏÈÔ‡ Û‡ÛÙÔÈ¯· ÚÔ˜ ÙË ‚Ï¿‚Ë.

∂ÈÎfiÓ· 4. ºˆÙÔÁÚ·Ê›· ÚÔÛÒÔ˘. º·›ÓÂÙ·È Ë Û‡ÛÙÔÈ¯Ë ÎÏ›-ÛË ÙÔ˘ ÎÂÊ·ÏÈÔ‡, Ë ¯·ÌËÏfiÙÂÚË ı¤ÛË ÙÔ˘ Û‡ÛÙÔÈ¯Ô˘ ÊÚ˘-‰ÈÔ‡, Ë ÚÔ˜ Ù· Î¿Ùˆ ·ÚÂÎÙfiÈÛË ÙÔ˘ Û‡ÛÙÔÈ¯Ô˘ ·˘ÙÈÔ‡Î·È Ë ÚÔ¤ÙÂÈ· ÙÔ˘ ·ÓÙ›ÛÙÔÈ¯Ô˘ ˙˘ÁˆÌ·ÙÈÎÔ‡.

∂ÈÎfiÓ· 5. ∆ÚÈÛ‰È¿ÛÙ·ÙË ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÎÚ·Ó›Ô˘. º·›-ÓÂÙ·È Ë Ï‹ÚË˜ ÂÍ¿ÏÂÈ„Ë ÙË˜ ‰ÂÍÈ¿˜ Ï·Ì‚‰ÔÂÈ‰Ô‡˜ Ú·Ê‹˜Î·È Ë ·ÓÙÈÎ·Ù¿ÛÙ·Û‹ ÙË˜ ·fi ÔÛÙÈÎ‹ ·ÎÚÔÏÔÊ›·, Î·È Ë ÔÛÙÈ-Î‹ ‰ÈfiÁÎˆÛË ÛÙËÓ ÈÓÈÔÌ·ÛÙÔÂÈ‰‹ ÂÚÈÔ¯‹.


ÌÂÏ¤ÙË, Ë ÔÔ›· ‰ÂÓ ˘‹Ú¯Â Ù· ÚÔËÁÔ‡ÌÂÓ· ¯Úfi-ÓÈ·. ∞˘Ùfi Â¤ÙÚÂ„Â ÙÔ 1996 ÛÙÔÓ Huang Î·È Û˘Ó Ó·ÌÔÚ¤ÛÂÈ Ó· ·ÓÙÈ‰È·ÛÙÂ›ÏÂÈ ÙËÓ ¶O¶ ·fi ÙËÓ∞™O¶, ÛÂ Ì›· ÚÔÁÚ·ÌÌ·ÙÈÛÌ¤ÓË ÌÂÏ¤ÙË 102 ÂÚÈ-ÛÙ·ÙÈÎÒÓ O¶, fiÔ˘ Î·Ù·ÁÚ¿ÊËÎ·Ó ÌÂ ÏÂÙÔÌ¤-ÚÂÈ·, ·fi ÂÈ‰ÈÎÔ‡˜, Ù· ÎÏÈÓÈÎ¿, ·ÂÈÎÔÓÈÛÙÈÎ¿, ‰ÈÂÁ-¯ÂÈÚËÙÈÎ¿ Î·È ÈÛÙÔÏÔÁÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ (¶›Ó·Î·˜1). µÚ¤ıËÎÂ fiÙÈ Ë ÎÚ·ÓÈ·Î‹ ·Ú·ÌfiÚÊˆÛË ÏfiÁˆ∞™O¶ ¤¯ÂÈ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ Ô˘ Â›Ó·È ‰È·ÊÔÚÂÙÈÎ¿‹ ÙÂÏÂ›ˆ˜ ·ÓÙ›ıÂÙ· ·fi ·˘Ù¿ ÙË˜ ¶O¶ (¶›Ó·Î·˜ 1,∂ÈÎfiÓ· 1 Î·È 2). O Mulliken (1), ÙÔ 1999, ÂÈ‚Â‚·›-ˆÛÂ Ù· Â˘Ú‹Ì·Ù· ÙÔ˘ Huang ÌÂ ÔÚÈÛÌ¤ÓÂ˜ ÂÏ·-ÊÚ¤˜ ÙÚÔÔÔÈ‹ÛÂÈ˜/‰ÈÂ˘ÎÚÈÓ›ÛÂÈ˜. ŒÓ· ÛËÌÂ›ÔÔ˘ ÙÚÔÔÔ›ËÛÂ ‹Ù·Ó Ë ÌÂÙ·ÙfiÈÛË ÙÔ˘ Û‡ÛÙÔÈ-¯Ô˘ ÚÔ˜ ÙË ‚Ï¿‚Ë ·˘ÙÈÔ‡ ÛÙËÓ ∞™O¶, Ô˘ ÂÎÙfi˜·fi ÚÔ˜ Ù· ›Ûˆ Î·È Î¿Ùˆ Ô˘ ÂÚÈ¤ÁÚ·„Â ÔHuang, ÌÔÚÂ› Ó· Â›Ó·È ÚÔ˜ Ù· ÂÌÚfi˜ ‹ ¯ˆÚ›˜ÌÂÙ·ÙfiÈÛË.

OÈ ‰È·ÊÔÚ¤˜ ÛÙËÓ ·Ú·ÌfiÚÊˆÛË ÙÔ˘ ÎÚ·Ó›Ô˘ÌÂÙ·Í‡ ¶O¶ Î·È ∞™O¶ ÔÊÂ›ÏÔÓÙ·È ÛÙÔ ‰È·ÊÔÚÂÙÈ-Îfi ÌË¯·ÓÈÛÌfi ÚfiÎÏËÛË˜. ™ÙËÓ ¶O¶ Ë ·Ú·ÌfiÚ-ÊˆÛË ÔÊÂ›ÏÂÙ·È ÛÂ ‰Â˘ÙÂÚÔ·ıÂ›˜, ÌË Ê˘ÛÈÔÏÔÁÈ-Î¤˜ ÂÍˆÙÂÚÈÎ¤˜ ‰˘Ó¿ÌÂÈ˜, Ô˘ ‰ÚÔ˘Ó Â¿Óˆ ÛÂ ÂÓ-‰ÔÁÂÓÒ˜ Ê˘ÛÈÔÏÔÁÈÎfi Î·È ·Ó·Ù˘ÛÛfiÌÂÓÔ ÎÚ·Ó›Ô.™ÙËÓ ∞™O¶ ˘¿Ú¯ÂÈ ÚˆÙ·Ú¯ÈÎ¿ ÌË Ê˘ÛÈÔÏÔÁÈÎ‹·Ó¿Ù˘ÍË ÙË˜ Ú·Ê‹˜ (Û‡ÁÎÏÂÈÛË), Ô˘ ·ÔÙÚ¤ÂÈÙËÓ ÂÁÎ¿ÚÛÈ· ÚÔ˜ ·˘Ù‹Ó ÌÂÏÏÔÓÙÈÎ‹ Â¤ÎÙ·ÛËÙÔ˘ ÎÚ·Ó›Ô˘. ™˘Á¯ÚfiÓˆ˜, Ô ·˘Í·ÓfiÌÂÓÔ˜ ÂÁÎ¤Ê·-ÏÔ˜ ·ÛÎÂ› ÂÛˆÙÂÚÈÎ‹ ›ÂÛË ÚÔ˜ ÙÈ˜ ·ÓÔÈÎÙ¤˜ Ú·-Ê¤˜ Î·È Ì·˙› ÌÂ ÙÔÓ ÚÔËÁÔ‡ÌÂÓÔ ÌË¯·ÓÈÛÌfi ÙË˜·ÔÙÚÔ‹˜ ÙË˜ Â¤ÎÙ·ÛË˜ ·Ú·ÌÔÚÊÒÓÔ˘Ó ÙÔıfiÏÔ ÙÔ˘ ÎÚ·Ó›Ô˘ ÛÂ ·ÓÒÌ·ÏÔ Û¯‹Ì·. ∏ ·Û˘ÌÌÂ-ÙÚ›· ÙÔ˘ ÚÔÛÒÔ˘ Â›Ó·È Û˘Ó‹ıˆ˜ ‹È· Î·È ÛÙËÓ∞™O¶ ÔÊÂ›ÏÂÙ·È ÛÙËÓ ÎÏ›ÛË ÙË˜ ‚¿ÛË˜ ÙÔ˘ ÎÂÊ·-ÏÈÔ‡ ÚÔ˜ ÙË ÌÂÚÈ¿ ÙË˜ ‚Ï¿‚Ë˜, ÂÓÒ ÛÙËÓ ¶O¶ÔÊÂ›ÏÂÙ·È ÛÙËÓ ¤ÓÙÔÓË ‰ÈfiÁÎˆÛË ÙÔ˘ Û‡ÛÙÔÈ¯Ô˘ÌÂÙˆÈ·›Ô˘ Î·È ˙˘ÁˆÌ·ÙÈÎÔ‡ ÔÛÙÔ‡.

O ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙË˜ O¶ ÌÂ ÙËÓ ·Ï‹·ÎÙÈÓÔÁÚ·Ê›· ÎÚ·Ó›Ô˘ Â›Ó·È ·ÚÎÂÙ¤˜ ÊÔÚ¤˜ ÌË ‰È·-ÁÓˆÛÙÈÎfi˜. ∏ ∞∆∫ Â›Ó·È ·ÍÈfiÈÛÙË, ·ÏÏ¿ fi¯È ÛÂ

fiÏÂ˜ ÙÈ˜ ÂÚÈÙÒÛÂÈ˜. ∆fiÛÔ Ë ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›·ÎÚ·Ó›Ô˘, fiÛÔ Î·È Ë ∞∆∫ ‹Ù·Ó ÌË ‰È·ÁÓˆÛÙÈÎ¤˜ ÛÙÔÂÚÈÛÙ·ÙÈÎfi Ì·˜. ¶ÈÔ ·ÍÈfiÈÛÙË Â›Ó·È Ë ÚfiÛÊ·Ù·¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓË ÙÂ¯ÓÈÎ‹ ÙË˜ ÙÚÈÛ‰È¿ÛÙ·ÙË˜∞∆∫, Ô˘ ıÂˆÚÂ›Ù·È Ë Î·Ï‡ÙÂÚË Ì¤ıÔ‰Ô˜ ·ÓÂ‡ÚÂ-ÛË˜ ‡·ÚÍË˜ ‹ ·Ô˘Û›·˜ ∞™§ƒ (1). ∆· ·ÂÈÎÔÓÈ-ÛÙÈÎ¿ Â˘Ú‹Ì·Ù· ÔÛÙÈÎ‹˜ ·ÎÚÔÏÔÊ›·˜ ÛÙË ı¤ÛË ÙË˜Ï·Ì‚‰ÔÂÈ‰Ô‡˜ Î·È Ë Ï‹ÚË˜ ÂÍ¿ÏÂÈ„Ë ÙË˜ Ú·Ê‹˜,fiˆ˜ Ê¿ÓËÎÂ Î·È ÛÙÔ ÂÚÈÛÙ·ÙÈÎfi Ì·˜ (∂ÈÎfiÓ· 5),Â›Ó·È ÂÓ‰ÂÈÎÙÈÎ¿ ÁÈ· ∞™O¶ (1,2). ∞ÏÏ¿ Î·È Ë ÙÚÈÛ-‰È¿ÛÙ·ÙË ∞∆∫ ·ÚÔ˘ÛÈ¿˙ÂÈ, ˘fi ÔÚÈÛÌ¤ÓÂ˜ ÚÔ¸-Ôı¤ÛÂÈ˜, ÙÂ¯ÓÈÎ¤˜ ‰˘ÛÎÔÏ›Â˜ Ô˘ ÌÔÚÂ› Ó· ‰Ò-ÛÔ˘Ó ··ÙËÏ‹ ÂÈÎfiÓ· Û˘ÓÔÛÙ¤ˆÛË˜ (1). ™˘ÌÂÚ·-ÛÌ·ÙÈÎ¿, Ë Ê˘ÛÈÎ‹ ÂÍ¤Ù·ÛË ·fi ÌfiÓË ÙË˜ ‹ ÛÂ Û˘Ó-‰˘·ÛÌfi ÌÂ ÙÚÈÛ‰È¿ÛÙ·ÙË ∞∆∫ ÌÔÚÂ› Ó· ‰È·ÊÔÚÔ-‰È·ÁÓÒÛÂÈ ÌÂ ·ÎÚ›‚ÂÈ· ÙËÓ ∞™O¶ ·fi ÙËÓ ¶O¶. ªÂ‚¿ÛË Ù· ÎÚÈÙ‹ÚÈ· ·˘Ù¿, ÙÔ ÔÛÔÛÙfi ÙË˜ ∞™O¶ ÌÂ-Ù·Í‡ fiÏˆÓ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÌÂÌÔÓˆÌ¤ÓË˜ Û˘ÓÔ-ÛÙ¤ˆÛË˜ Â›Ó·È 1,3%-3% (1) Î·È fi¯È 15%-20%, fiˆ˜·Ó¤ÊÂÚ·Ó ÚÔËÁÔ‡ÌÂÓ· ·ÚÎÂÙÔ› ÂÚÂ˘ÓËÙ¤˜ (8-10).∂›Ó·È ÚÔÊ·Ó¤˜ fiÙÈ Ë ‰È¿ÁÓˆÛ‹ ÙÔ˘˜ ‹Ù·Ó Ï·Óı·-ÛÌ¤ÓË, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ‚ÚÂÊÒÓÓ· ˘ÔÛÙÂ› ¯ˆÚ›˜ ÏfiÁÔ ÌÂ›˙ÔÓ· ÂÓ‰ÔÎÚ·ÓÈ·Î‹ ¯ÂÈ-ÚÔ˘ÚÁÈÎ‹ Â¤Ì‚·ÛË.

∏ ¤ÁÎ·ÈÚË Î·È ÛˆÛÙ‹ ‰È·ÊÔÚÔ‰È¿ÁÓˆÛË ÌÂÙ·Í‡∞™O¶ Î·È ¶O¶ Â›Ó·È ÎÚÈÙÈÎ‹˜ ÛËÌ·Û›·˜ ÁÈ· ÙËÓ Î·-Ù¿ÏÏËÏË ıÂÚ·Â›·. ∏ ıÂÚ·Â›· ÙË˜ ∞™O¶ Á›ÓÂÙ·ÈÎ·Ù¿ Î·ÓfiÓ· ¯ÂÈÚÔ˘ÚÁÈÎ¿ Î·È Â›Ó·È ·ÏÔ‡ÛÙÂÚË Î·ÈÌÂ ¿ÚÈÛÙ· ·ÔÙÂÏ¤ÛÌ·Ù· fiÙ·Ó Á›ÓÂÈ ÙÔ˘˜ ÚÒÙÔ˘˜6 Ì‹ÓÂ˜ ˙ˆ‹˜. ªÂÙ·Í‡ 6-12 ÌËÓÒÓ Ë ÂÁ¯Â›ÚËÛË Â›-Ó·È ÈÔ ÔÏ‡ÏÔÎË Î·È Ë ÚfiÁÓˆÛË ·ÚÎÂÙ¿ Î·Ï‹,ÂÓÒ ÌÂÙ¿ ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ˙ˆ‹˜ Ë ÚfiÁÓˆÛË Â›Ó·ÈÂÈÊ˘Ï·ÎÙÈÎ‹ ÁÈ·Ù› ¤¯Ô˘Ó ‹‰Ë ÂÁÎ·Ù·ÛÙ·ıÂ› ÌfiÓÈ-ÌÂ˜ ·Ú·ÌÔÚÊÒÛÂÈ˜. §›ÁÂ˜ ÂÚÈÙÒÛÂÈ˜ ∞™O¶,Ô˘ ‰ÂÓ Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ÛÔ‚·Ú‹ ·Ú·ÌfiÚÊˆ-ÛË, ÌÔÚÔ‡Ó Ó· ·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó Û˘ÓÙËÚËÙÈÎ¿.

™ÙËÓ ¶O¶ Ë ·ÓÙÈÌÂÙÒÈÛË Â›Ó·È Î˘Ú›ˆ˜ Û˘ÓÙË-ÚËÙÈÎ‹ Î·È Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ ÙÈ˜ ÚÒÙÂ˜ Â‚‰ÔÌ¿-‰Â˜ ˙ˆ‹˜. ™Ù· Û˘ÓÙËÚËÙÈÎ¿ Ì¤ÙÚ· ÂÚÈÏ·Ì‚¿ÓÔ-ÓÙ·È Ë Û˘¯Ó‹ ·ÏÏ·Á‹ ı¤ÛÂˆ˜ ÙÔ˘ ÎÂÊ·ÏÈÔ‡, Ë


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¶›Ó·Î·˜ 1. ∫ÏÈÓÈÎ‹ ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË Ô›ÛıÈ·˜ Ï·ÁÈÔÎÂÊ·Ï›·˜

∂˘Ú‹Ì·Ù· ¶·Ú·ÌÔÚÊˆÙÈÎ‹ O¶ ™˘ÓÔÛÙÂˆÙÈÎ‹ O¶

∂ÙÂÚfiÏÂ˘ÚË Ô›ÛıÈ· ‰ÈfiÁÎˆÛË πÓÈ·Îfi ÔÛÙÔ‡Ó µÚÂÁÌ·ÙÈÎfi ÔÛÙÔ‡ÓªÂÙˆÈ·›· ‰ÈfiÁÎˆÛË OÌfiÏÂ˘Ú· ∂ÙÂÚfiÏÂ˘Ú·OÌfiÏÂ˘ÚË ‰ÈfiÁÎˆÛË ÈÓÈÔÌ·ÛÙÔÂÈ‰Ô‡˜ ∞Ô‡Û· ¶·ÚÔ‡Û·µ¿ÛË ÎÚ·Ó›Ô˘ Î·È ÚfiÛˆÔ ÃˆÚ›˜ ÎÏ›ÛË ∫Ï›ÛË ÚÔ˜ Ù· Î¿Ùˆ ÔÌfiÏÂ˘Ú·OÛÙÈÎ‹ ·ÎÚÔÏÔÊ›· ∞Ô‡Û· ¶·ÚÔ‡Û·™¯‹Ì· ÎÂÊ·ÏÈÔ‡: ı¤· ·fi ¿Óˆ ¶·Ú·ÏÏËÏfiÁÚ·ÌÌÔ ∆Ú·¤˙ÈÔ™¯‹Ì· ÎÂÊ·ÏÈÔ‡: ı¤· ·fi ›Ûˆ º˘ÛÈÔÏÔÁÈÎfi ¶·Ú·ÏÏËÏfiÁÚ·ÌÌÔ∫·Ù¿ÛÙ·ÛË Ï·Ì‚ÔÂÈ‰Ô‡˜ Ú·Ê‹˜ ∞ÓÔÈÎÙ‹ ∫ÏÂÈÛÙ‹¶·ÚÂÎÙfiÈÛË ÔÌfiÏÂ˘ÚÔ˘ ·˘ÙÈÔ‡ ¶ÚfiÛıÈ· ¶ÔÈÎ›ÏË¶·ÚÂÎÙfiÈÛË ÔÌfiÏÂ˘ÚÔ˘ ÊÚ˘‰ÈÔ‡ ∫·Ì›· ¶ÚÔ˜ Ù· Î¿Ùˆ∫Ï›ÛË Ì‡ÙË˜ Ÿ¯È ∂ÙÂÚfiÏÂ˘Ú·¶ÚÔ¤ÙÂÈ· ˙˘ÁˆÌ·ÙÈÎÔ‡ OÌfiÏÂ˘Ú· ∂ÙÂÚfiÏÂ˘Ú·


ÙÔÔı¤ÙËÛË ·ÊÚˆ‰ÒÓ ÛÊËÓÒÓ Î·È Ë ÚËÓ‹˜ ÙÔ-Ôı¤ÙËÛË fiÙ·Ó ÙÔ ‚Ú¤ÊÔ˜ ÂÚ¿ÛÂÈ ÙËÓ ËÏÈÎ›· ÙˆÓ6 ÌËÓÒÓ (1). ªÂÁ¿ÏË ÚfiÔ‰Ô ÛÙË Û˘ÓÙËÚËÙÈÎ‹ ıÂ-Ú·Â›· ¤ÊÂÚÂ Ë ¯Ú‹ÛË ÂÈ‰ÈÎÒÓ ÎÚ·ÓÒÓ Ô˘ ‰ÚÔ˘ÓÂ›ÙÂ ÌÂ ·ıËÙÈÎfi ‹ ‰˘Ó·ÌÈÎfi ÙÚfiÔ (1,11). ∏ ıÂ-Ú·Â›· ÌÂ ÎÚ¿ÓÔ˜ Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ ÚÈÓ ·fi ÙÔÓ6Ô Ì‹Ó· ˙ˆ‹˜ Î·È Û˘Ó‹ıˆ˜ ‰È·ÚÎÂ› 4-5 Ì‹ÓÂ˜ (11).ªÂÙ¿ ÙÔÓ 1Ô ¯ÚfiÓÔ ˙ˆ‹˜ Â›Ó·È ÂÏ¿¯ÈÛÙ· ·ÔÙÂÏÂ-ÛÌ·ÙÈÎ‹ (1,11). §›ÁÔÈ ·ÛıÂÓÂ›˜ ÌÂ ¶O¶ ¤¯Ô˘ÓÂÍ·Ú¯‹˜ ÛÔ‚·Ú‹, ÚÔ˚Ô‡Û· ·Ú·ÌfiÚÊˆÛË Ô˘‰ÂÓ ··ÓÙ¿ ÛÙ· Û˘ÓÙËÚËÙÈÎ¿ Ì¤ÙÚ·. ∆· ·›ÙÈ· ÛÙÈ˜ÂÚÈÙÒÛÂÈ˜ ·˘Ù¤˜, Û‡ÌÊˆÓ· ÌÂ Ì›· ÌÂÏ¤ÙË, ÌÔ-ÚÂ› Ó· Â›Ó·È ÁÂÓÂÙÈÎ¿ (3). ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ·˘Ù¤˜Î·È ÛÂ ÂÎÂ›ÓÂ˜ Ô˘ ‰È·ÁÓÒÛıËÎ·Ó ·ÚÁÔÔÚËÌ¤Ó···ÈÙÂ›Ù·È ¯ÂÈÚÔ˘ÚÁÈÎ‹ ‰ÈfiÚıˆÛË (2,3).

∞fi fiÛÔ ÁÓˆÚ›˙Ô˘ÌÂ, ÙÔ Úfi‚ÏËÌ· ÙË˜ O¶‰ÂÓ ¤¯ÂÈ ··Û¯ÔÏ‹ÛÂÈ È‰È·›ÙÂÚ· ÙËÓ ÂÏÏËÓÈÎ‹ ‚È-‚ÏÈÔÁÚ·Ê›·, Ô‡ÙÂ ÙËÓ ÂÓËÌ¤ÚˆÛË/ÂÎ·›‰Â˘ÛË ÙˆÓ·È‰È¿ÙÚˆÓ. ∏ Û‡ÛÙ·ÛË Î·È ·fi ÙÔ˘˜ ŒÏÏËÓÂ˜·È‰È¿ÙÚÔ˘˜ Ó· ÎÔÈÌÔ‡ÓÙ·È Ù· ‚Ú¤ÊË ‡ÙÈ·, ¿Ú¯È-ÛÂ Ù· ÙÂÏÂ˘Ù·›· Ï›Á· ¯ÚfiÓÈ· Î·È ·Ó·Ì¤ÓÂÙ·È Ó· ·˘-Í‹ÛÂÈ Ù· ÂÚÈÛÙ·ÙÈÎ¿ O¶. ∏ ÂÓËÌ¤ÚˆÛË/ ÂÎ·›-‰Â˘ÛË ÙˆÓ ·È‰È¿ÙÚˆÓ ÛÙÈ˜ ÂÎ‰ËÏÒÛÂÈ˜ ÙË˜ ÂÙÂÚfi-ÏÂ˘ÚË˜ ∞™§ƒ Â›Ó·È ·Ó·ÁÎ·›·, ‰ÈfiÙÈ ÁÂÓÈÎ¿ ı· ÂÈ-ÙÚ¤„ÂÈ ·ÎÚÈ‚¤ÛÙÂÚË ‰È¿ÁÓˆÛË Î·È Î·Ù·ÏÏËÏfiÙÂÚËıÂÚ·Â›· ÙË˜ O¶ Î·È ÂÈ‰ÈÎ¿ ı· ·ÔÙÚ¤„ÂÈ ÌË ·Ó·-ÁÎ·›· ¯ÂÈÚÔ˘ÚÁÈÎ‹ Â¤Ì‚·ÛË ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ¶O¶.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Mulliken JB, Vander Woude DL, Hansen M, LaBrie RA,

Scott RM. Analysis of posterior plagiocephaly:deformational versus synostotic. Plast Reconstr Surg1999;103:371-380.

2. Huang MH, Gruss JS, Clarren SK, Mouradian WE,Cunningham ML, Roberts TS et al. The differentialdiagnosis of posterior plagiocephaly: the true lambdoidsynostosis versus positional molding. Plast Reconstr Surg1996;98:765-774.

3. Lin KY, Nolen AA, Gampper TJ, Jane JA, Opperman LA,Ogle RC. Elevated levels of transforming growth factorsbeta 2 and beta 3 in lambdoid sutures from children withpersistent plagiocephaly. Cleft Palate Cran J 1997;34:331-337.

4. Argenta LC, David LR, Wilson JA, Bell WO. An increase ininfant cranial deformity with supine sleeping position. JCraniofac Surg 1996;7:5-11.

5. Turk AE, McCarthy JG, Thorne CH, Wisoff JH. The “backto sleep campaign” and deformational plagiocephaly: isthere cause for concern? J Craniofac Surg 1996;7:12-18.

6. Gonzalez de Dios J, Moya M, Jimenez L, Alcala-SantaellaR, Carratala F. Increase in the incidence of occipitalplagiocephaly. Rev Neurol 1998;27:782-784.

7. American Academy of Pediatrics Task Force on infantpositioning and SIDS: Positioning and SIDS. Pediatrics1992;89:1120-1126.

8. McComb JG. Treatment of fuctional lambdoid synostosis.Neurosurg Clin N Am 1991;2:665-672.

9. Muakkassa KF, Hoffman HJ, Hinton DR, Hendrick EB,Humphreys RP, Ash J. Lambdoid synostosis. Part 2:Review of cases managed at The Hospital for SickChildren, 1972-1982. J Neurosurg 1984;61:340-347.

10. Jimenez DF, Barone CM, Argamaso RV, Goodrich JT,Shprintzen RJ. Asterion region synostosis. Cleft PalateCran J 1994;31:136-141.

11. Eppley BL. Helmet versus nonhelmet treatment innonsynostotic positional posterior plagiocephaly. J CranSurg 2001;12:97.


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287

¡fiÛÔ˜ Niemann Pick C: ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜ Î·È ·Ó·ÛÎfiËÛË ÙË˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ ¢. π. ∑·ÊÂÈÚ›Ô˘1, ¶. ∆ÚÈ·ÓÙ·Ê‡ÏÏÔ˘1, ¡. °ÔÌ¿ÎË˜1, ∂. µ·ÚÁÈ¿ÌË1, Ã. ∆Û¿ÓÙ·ÏË1, ∂. ªÈ¯ÂÏ·Î¿ÎË2, M. Vanier3

Niemann-Pick type C disease: a case report and review of the literature D. I. Zafeiriou1, P. Triantafyllou1, N. Gombakis1, E. Vargiami1, C. Tsantali1, E. Michelakaki2, M. Vanier3


1 A’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∞¶£ 2 πÓÛÙÈÙÔ‡ÙÔ ÀÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, ∞ı‹Ó· 3 Laboratoire Fondation Gillet-Marcel Merieux, Centre

Hospitalier Lyon-Sud, France

1 1st Pediatric Clinic of Aristotelion University, Thessaloniki2 Institute of Child Health, Athens3 Laboratoire Fondation Gillet-Marcel Merieux, Centre

Hospitalier Lyon-Sud, France

�¶ÂÚ›ÏË„Ë: ∏ ÓfiÛÔ˜ Niemann-Pick Ù‡Ô˘ C (¡P-C) ÎÏËÚÔÓÔÌÂ›Ù·È ÌÂ ÙÔÓ ·˘ÙÔÛˆÌ·ÙÈÎfi ˘ÔÏÂÈfi-ÌÂÓÔ ¯·Ú·ÎÙ‹Ú· Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·ÓÂ¿Ú-ÎÂÈ· ÙË˜ ÚˆÙÂ˝ÓË˜ NP-C1 ‹ ∏∂1 Ô˘ Ô‰ËÁÂ› ÛÂ‰È·Ù·Ú·¯‹ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜.∏ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· Û˘¯Ó¿ ÂÚÈÏ·Ì‚¿ÓÂÈ ÚÒÈÌË Ë·-ÙÔÛÏËÓÔÌÂÁ·Ï›·, ·Ù·Í›·, ‰˘ÛÙÔÓ›·, Î·Ù·ÏËÍ›·,‰˘Û·ÚıÚ›· Î·È ¿ÓÔÈ·. ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË·ÁÔÚÈÔ‡ ËÏÈÎ›·˜ 3,5 ÂÙÒÓ, ÙÔ ÔÔ›Ô ÂÈÛ‹¯ıË ÛÙËÓ∫ÏÈÓÈÎ‹ ÁÈ· ¤ÏÂÁ¯Ô „˘¯ÔÎÈÓËÙÈÎ‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜ÌÂ ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ Î·È ÔÌÈÏ›·˜, Î·ıÒ˜Î·È ·ÛÙ¿ıÂÈ· ‚¿‰ÈÛË˜ ÌÂ Û˘¯Ó¤˜ ÙÒÛÂÈ˜. ∫·Ù¿ ÙËÓÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË ‰È·ÈÛÙÒıËÎ·Ó Ë·ÙÔÛÏËÓÔÌÂÁ·-Ï›·, ·Ù·Í›·, ‰˘Û·ÚıÚ›· Î·È ‰˘ÛÎÔÏ›· ÛÙËÓ Î›ÓËÛËÙˆÓ ÔÊı·ÏÌÒÓ ÚÔ˜ Ù· ¿Óˆ ÛÙÔÓ Î¿ıÂÙÔ ¿ÍÔÓ·.O ÓÂ˘ÚÔÊ˘ÛÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ Ù·¯˘Ù‹ÙˆÓ·ÁˆÁÈÌfiÙËÙ·˜ ÓÂ‡ÚˆÓ ¤‰ˆÛÂ Â˘Ú‹Ì·Ù· Û˘Ì‚·Ù¿ÌÂ ‹È· ·ÔÌ˘ÂÏÈÓˆÙÈÎ‹ ÂÚÈÊÂÚÈÎ‹ ÓÂ˘ÚÔ¿ıÂÈ·.∏ ÂÍ¤Ù·ÛË ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ¤‰ÂÈÍÂ ·ÚÔ˘Û›·¿ÊıÔÓˆÓ ÈÛÙÈÔÎ˘ÙÙ¿ÚˆÓ ÌÂ ·ÊÚÒ‰Â˜ Î˘ÙÙ·ÚfiÏ·-ÛÌ·, ÂÓÒ ÛÂ Î·ÏÏÈ¤ÚÁÂÈ· ÈÓÔ‚Ï·ÛÙÒÓ ‰¤ÚÌ·ÙÔ˜‰È·ÈÛÙÒıËÎ·Ó ·˘ÍËÌ¤Ó· Â›Â‰· ÌË ÂÛÙÂÚÔÔÈË-Ì¤ÓË˜ ¯ÔÏËÛÙÂÚfiÏË˜ (ÌÂÙ¿ ·fi ÈÛÙÔ¯ËÌÈÎ‹ ¯ÚÒÛËÌÂ ÊÈÏÈ›ÓË) Î·È ¯·ÌËÏ¿ Â›Â‰· Û‡ÓıÂÛË˜ ÂÛÙ¤-ÚˆÓ ¯ÔÏËÛÙÂÚfiÏË˜, Â˘Ú‹Ì·Ù· Û˘Ì‚·Ù¿ ÌÂ ÓfiÛÔNP-C. ªÂ ·ÊÔÚÌ‹ ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ Á›ÓÂÙ·È Ì›··Ó·ÛÎfiËÛË ÙË˜ ˘¿Ú¯Ô˘Û·˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ Ô˘·ÊÔÚ¿ ÛÙË ÓfiÛÔ NP-C, Î·ıÒ˜ Î·È Ì›· ·ÚÔ˘Û›·ÛËÙˆÓ ÂÚÂ˘ÓËÙÈÎÒÓ ıÂÚ·Â˘ÙÈÎÒÓ ‰˘Ó·ÙÔÙ‹ÙˆÓ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÓfiÛÔ˜ Niemann-Pick C, Ë·ÙÔ-ÛÏËÓÔÌÂÁ·Ï›·, Î¿ıÂÙË ¿ÚÂÛË ‚Ï¤ÌÌ·ÙÔ˜, ÏÈ›-‰ˆÛË, ÂÚÈÊÂÚÈÎ‹ ÓÂ˘ÚÔ¿ıÂÈ·, „˘¯ÔÎÈÓËÙÈÎ‹ ·-ÏÈÓ‰ÚfiÌËÛË, ÌÂÙ·‚ÔÏÈÛÌfi˜ ¯ÔÏËÛÙÂÚfiÏË˜.

�Abstract: Niemann-Pick type C (NP-C) diseaseis an autosomal-recessive inherited neuroviscerallipid storage disorder. It is due either to proteinNPC1 or to HE1 deficiency, which leads todisturbance of cholesterol metabolism and ischaracterized by early hepatosplenomegaly andprogressive ataxia, dystonia, cataplexy, dysarthriaand dementia. We describe a 3.5 year-old Greekpatient with NP-C disease, who presented withregression both in cognitive and motor domains.Almost 10 months before admission, the childdeveloped progressive speech and behaviouralchanges, as well as gait disturbances with frequentfalls. The examination demonstratedhepatosplenomegaly, ataxia and vertical gazepalsy. Nerve conduction velocities revealed milddemyelinating peripheral neuropathy. Bonemarrow examination demonstrated the presence offoam cells, while cholesterol esterification studiesshowed massive accumulation of unesterifiedcholesterol and very low intracellular esterificationof exogenous lipoprotein-derived cholesterol,results indicative of NP-C disease. The currentliterature as well as the therapeutic modalitiesregarding NP-C are extensively reviewed.

Key words: Niemann-Pick type C, hepatospl-enomegaly, vertical gaze palsy, lipidosis,peripheral neuropathy, psychomotor regression,cholesterol metabolism.


∂ÈÛ·ÁˆÁ‹∏ ÓfiÛÔ˜ Niemann-Pick (NP) ·ÊÔÚ¿ Ì›· ÂÙÂÚÔ-

ÁÂÓ‹ ÔÌ¿‰· Ï˘ÛÔÛˆÌÈ·ÎÒÓ ·ıÚÔÈÛÙÈÎÒÓ ‰È·Ù·Ú·-¯ÒÓ ÙˆÓ ÏÈÈ‰›ˆÓ, Ô˘ ÌÂ ‚¿ÛË Î˘ÙÙ·ÚÔ‚ÈÔ¯ËÌÈÎ¿‰Â‰ÔÌ¤Ó· ˘Ô‰È·ÈÚÂ›Ù·È ÛÂ ‰‡Ô Î·ÙËÁÔÚ›Â˜: ËÚÒÙË ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¤ÏÏÂÈ„Ë ÙÔ˘ ÂÓ˙‡ÌÔ˘ÛÊÈÁÁÔÌ˘ÂÏÈÓ¿ÛË ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙË Û˘ÛÛÒÚÂ˘ÛËÛÊÈÁÁÔÌ˘ÂÏ›ÓË˜ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ˘˜ Ù‡Ô˘˜ ∞Î·È µ, ÂÓÒ Ë ‰Â‡ÙÂÚË ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·ÓÂ-¿ÚÎÂÈ· ÙË˜ ÚˆÙÂ˝ÓË˜ NP-C1 ‹ ∏∂1 Ô˘ Ô‰ËÁÂ›ÛÂ ‰È·Ù·Ú·¯‹ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙË˜ ¯ÔÏËÛÙÂÚfi-ÏË˜ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ˘˜ Ù‡Ô˘˜ C Î·È D. ∏ Ófi-ÛÔ˜ ÎÏËÚÔÓÔÌÂ›Ù·È ÌÂ ÙÔÓ ·˘ÙÔÛˆÌ·ÙÈÎfi ˘ÔÏÂÈ-fiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·. ∏ ·ÚÔ˘Û›· ·ÊÚˆ‰ÒÓ Î˘ÙÙ¿-ÚˆÓ ÛÙÔ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ Î·È ¿ÏÏÔ˘˜ ÈÛÙÔ‡˜, Î·-ıÒ˜ Î·È Ë ÔÈÎ›ÏÔ˘ ‚·ıÌÔ‡ ÔÚÁ·ÓÔÌÂÁ·Ï›·, ·Ô-ÙÂÏÔ‡Ó ÎÔÈÓ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ fiÏˆÓ ÙˆÓ ÌÔÚÊÒÓ,ÂÓÒ ÛÔ‚·Ú‹ ÓÂ˘ÚÔÏÔÁÈÎ‹ Û˘ÌÌÂÙÔ¯‹ ·ÊÔÚ¿ ÙÔ˘˜Ù‡Ô˘˜ A Î·È C, Î·È fi¯È ÙÔÓ Ù‡Ô µ ÙË˜ ÓfiÛÔ˘(1,2).

O Ù‡Ô˜ C ÙË˜ ÓfiÛÔ˘ Niemann Pick (NP-C)·ÔÙÂÏÂ› Û¿ÓÈ· ‰È·Ù·Ú·¯‹ ÌÂ Û˘¯ÓfiÙËÙ· 1 ÛÙÈ˜10.000 ÁÂÓÓ‹ÛÂÈ˜ ˙ÒÓÙˆÓ ÓÂÔÁÓÒÓ Î·È ÎÏËÚÔÓÔ-ÌÂ›Ù·È ÌÂ ÙÔÓ ·˘ÙÔÛˆÌ·ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·-ÎÙ‹Ú· (3). ∏ ÁÂÓÂÙÈÎ‹ Î·È ÎÏÈÓÈÎ‹ ÂÙÂÚÔÁ¤ÓÂÈ· ÙË˜ÓfiÛÔ˘ ‰›ÓÂÈ ¤Ó· Â˘Ú‡ Ê¿ÛÌ· Ê·ÈÓÔÙ‡ˆÓ Ô˘ ‰È·-Ê¤ÚÔ˘Ó ˆ˜ ÚÔ˜ ÙËÓ ËÏÈÎ›· ¤Ó·ÚÍË˜ ÙˆÓ Û˘ÌÙˆ-Ì¿ÙˆÓ, ÙÔ ‚·ıÌfi Û˘ÌÌÂÙÔ¯‹˜ ÔÚÁ·ÓÔÌÂÁ·Ï›·˜Î·È ÙÔ ‚·ıÌfi ÓÂ˘ÚÔÏÔÁÈÎ‹˜ ÂÎÊ‡ÏÈÛË˜ Î·È ‰˘ÛÏÂÈ-ÙÔ˘ÚÁ›·˜. ™˘Ó‹ıˆ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Ë·ÙÔ-ÛÏËÓÈÎfi Û‡Ó‰ÚÔÌÔ Î·È ÂÍÂÏÈÎÙÈÎ‹ ÓÂ˘ÚÔÏÔÁÈÎ‹ÂÎÊ‡ÏÈÛË, Ù· ÔÔ›· ÛÂ ÌÔÚÈ·Îfi Â›Â‰Ô ÔÊÂ›ÏÔ-ÓÙ·È ÛÂ ‰È·Ù·Ú·¯‹ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙË˜ ¯ÔÏË-ÛÙÂÚfiÏË˜, ÌÂ ¿ıÚÔÈÛË ÙË˜ ÌË ÂÛÙÂÚÔÔÈËÌ¤ÓË˜ÌÔÚÊ‹˜ ÙË˜ ÛÙ· Ï˘ÛÔÛˆÌ¿ÙÈ· ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘∫¡™ Î·È ¿ÏÏˆÓ ÈÛÙÒÓ, ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÌÂÙ·ÏÏ¿ÍÂ-ˆÓ ÛÙÔ ÁÔÓ›‰ÈÔ NP-C1 (ÁÈ· ÙÔ 95% ÙˆÓ ·ÛıÂÓÒÓ)‹ ÛÙÔ ÁÔÓ›‰ÈÔ NP-C2 (ÁÈ· ÙÔ ˘fiÏÔÈÔ 5% ÙˆÓ·ÛıÂÓÒÓ) (4-7).

¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÂÓfi˜ ·ÁÔÚÈÔ‡ 3,5ÂÙÒÓ ÌÂ ÓfiÛÔ NP-C1 Ô˘ ‰È·ÁÓÒÛıËÎÂ ÛÙ· Ï·›-ÛÈ· ÂÏ¤Á¯Ô˘ „˘¯ÔÎÈÓËÙÈÎ‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜, ÌÂÙËÓ ·ÚÔ˘Û›· Ë·ÙÔÛÏËÓÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ ÁÓˆ-ÛÙÔ‡ ·fi ÙËÓ ËÏÈÎ›· ÙˆÓ 3 ÌËÓÒÓ.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜ ∞ÁfiÚÈ ËÏÈÎ›·˜ 3,5 ÂÙÒÓ ÂÈÛ¿ÁÂÙ·È ÛÙËÓ ∫ÏÈÓÈÎ‹

ÁÈ· ¤ÏÂÁ¯Ô „˘¯ÔÎÈÓËÙÈÎ‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜. ∂›Ó·ÈÙÔ ‰Â‡ÙÂÚÔ ·È‰› 6ÌÂÏÔ‡˜ ÔÈÎÔÁ¤ÓÂÈ·˜, Ê·ÈÓÔÙ˘È-Î¿ ˘ÁÈÒÓ ÁÔÓ¤ˆÓ, Ô˘ ÁÂÓÓ‹ıËÎÂ ÌÂÙ¿ ·fi ÙÂÏÂÈ-fiÌËÓË Î‡ËÛË ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi. ∆· ÛˆÌ·ÙÔ-ÌÂÙÚÈÎ¿ ÛÙÔÈ¯Â›· Î·Ù¿ ÙË Á¤ÓÓËÛË ‹Ù·Ó ÂÓÙfi˜ ÙˆÓÊ˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ Î·È Ë ÂÚÈÁÂÓÓËÙÈÎ‹ ÂÚ›Ô-

‰Ô˜ ·Ó·Ê¤ÚÂÙ·È ÔÌ·Ï‹. ∞fi ÙÔ ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfiÙÔ˘ ·È‰ÈÔ‡ ·Ó·Ê¤ÚÂÙ·È ÓÔÛËÏÂ›· ÛÂ ËÏÈÎ›· 3 ÌË-ÓÒÓ ÁÈ· ¤ÏÂÁ¯Ô Ë·ÙÔÛÏËÓÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, ¯ˆ-Ú›˜ ˆÛÙfiÛÔ Ó· ‰È·ÈÛÙˆıÂ› Û˘ÁÎÂÎÚÈÌ¤ÓË ‰È·Ù·-Ú·¯‹ ·fi ÙÔÓ ÎÏÈÓÈÎfi Î·È ·Ú·ÎÏÈÓÈÎfi ¤ÏÂÁ¯Ô. ¢¤-Î· Ì‹ÓÂ˜ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ·Ó·Ê¤ÚÂÙ·È ·ÏÏ·Á‹Û˘ÌÂÚÈÊÔÚ¿˜ ÌÂ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ı˘ÌÈÎÔ‡, ÂÌÊ¿-ÓÈÛË ÂÈıÂÙÈÎfiÙËÙ·˜ Î·È ·ÓÙÈÎÔÈÓˆÓÈÎ‹˜ Û˘ÌÂÚÈ-ÊÔÚ¿˜, ·ÏÈÓ‰ÚfiÌËÛË ÔÌÈÏ›·˜, ‰È·Ù·Ú·¯¤˜ ÎÈÓËÙÈ-ÎfiÙËÙ·˜ ÌÂ ·ÛÙ¿ıÂÈ· ‚¿‰ÈÛË˜ Î·È Û˘¯Ó¤˜ ÙÒ-ÛÂÈ˜, Î·ıÒ˜ Î·È ‰Â˘ÙÂÚÔ·ı‹˜ ·ÒÏÂÈ· ÂÏ¤Á¯Ô˘ÙˆÓ ÛÊÈÁÎÙ‹ÚˆÓ.

∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÙËÓ ∫ÏÈÓÈÎ‹, ÙÔ ·È‰› ÂÈ-ÛÎÔÈÎ¿ ·ÚÔ˘Û›·˙Â ÂÎ¯˘ÌÒÛÂÈ˜ ÛÙÔ ÛÏ·¯ÓÈÎfiÎÚ·Ó›Ô ÏfiÁˆ ÙˆÓ Û˘¯ÓÒÓ ÙÒÛÂˆÓ, ÂÓÒ Î·Ù¿ ÙËÓ„ËÏ¿ÊËÛË ÙË˜ ÎÔÈÏ›·˜ ‰È·ÈÛÙÒıËÎÂ Ë·ÙÔÛÏË-ÓÔÌÂÁ·Ï›· (·ÚÈÛÙÂÚfi˜ ÏÔ‚fi˜ „ËÏ·ÊËÙfi˜ 2-3 cmÎ·È ÛÏ‹Ó·˜ „ËÏ·ÊËÙfi˜ 2-3 cm Î¿ÙˆıÂÓ ÙÔ˘ ·ÚÈ-ÛÙÂÚÔ‡ ÏÂ˘ÚÈÎÔ‡ ÙfiÍÔ˘). ∞fi ÙË ÓÂ˘ÚÔÏÔÁÈÎ‹ÂÍ¤Ù·ÛË ‰È·ÈÛÙÒıËÎÂ ·Ù·Í›· Î·È ‰˘ÛÎÔÏ›· ÛÙËÓÎ›ÓËÛË ÙˆÓ ÔÊı·ÏÌÒÓ ÚÔ˜ Ù· ¿Óˆ ÛÙÔÓ Î¿ıÂÙÔ¿ÍÔÓ· (Î¿ıÂÙË ¿ÚÂÛË ‚Ï¤ÌÌ·ÙÔ˜).

O ·ÈÌ·ÙÔÏÔÁÈÎfi˜ Î·È ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·ÓÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ, ÌÂ ÂÍ·›ÚÂÛË ÌÈ-ÎÚ‹ ·‡ÍËÛË ÙË˜ SGOT (134 IU/dl). O ˘ÂÚË¯Ô-ÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÎÔÈÏ›·˜ ÂÈ‚Â‚·›ˆÛÂ ÙËÓ ·-ÚÔ˘Û›· Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·˜, ÂÓÒ Ë Ì·ÁÓËÙÈÎ‹ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘, Ù· ÛÙÂÏÂ¯È·›· ·ÎÔ˘ÛÙÈÎ¿,Ù· ÔÙÈÎ¿ Î·È Ù· ÛˆÌ·ÙÔ·ÈÛıËÙÈÎ¿ ÚÔÎÏËÙ¿ ‰˘-Ó·ÌÈÎ¿ ‹Ù·Ó ¯ˆÚ›˜ ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·. OÈ Ù·-¯‡ÙËÙÂ˜ ·ÁˆÁÈÌfiÙËÙ·˜ ÙˆÓ ÂÚÈÊÂÚÈÎÒÓ ÓÂ‡ÚˆÓ¤‰ÂÈÍ·Ó Â˘Ú‹Ì·Ù· ÂÓ‰ÂÈÎÙÈÎ¿ ‹È·˜ ·ÔÌ˘ÂÏÈÓˆÙÈ-Î‹˜ ÔÏ˘ÓÂ˘ÚÔ¿ıÂÈ·˜. OÈ ÎÈÓËÙÈÎ¤˜ Ù·¯‡ÙËÙÂ˜·ÁˆÁÈÌfiÙËÙ·˜ ÙÔ˘ ÂÚÔÓÈ·›Ô˘ Î·È ÎÓËÌÈ·›Ô˘ ÓÂ‡-ÚÔ˘ ‹Ù·Ó 33,2 Î·È 32,0 m/sec ·ÓÙ›ÛÙÔÈ¯· ÌÂ Î·ÙÒ-ÙÂÚÂ˜ Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÙÈÌ¤˜ 46,7 Î·È 38,2 m/sec·ÓÙ›ÛÙÔÈ¯· Î·È Ê˘ÛÈÔÏÔÁÈÎ¿ Û‡ÓıÂÙ· Ì˘˚Î¿ ‰˘Ó·-ÌÈÎ¿, ÂÓÒ ÔÈ ·ÈÛıËÙÈÎ¤˜ Ù·¯‡ÙËÙÂ˜ ·ÁˆÁÈÌfiÙËÙ·˜ÙÔ˘ Ì¤ÛÔ˘ Î·È Á·ÛÙÚÔÎÓËÌÈ·›Ô˘ ÓÂ‡ÚÔ˘ ‹Ù·Ó 35,3Î·È 40,0 m/sec ·ÓÙ›ÛÙÔÈ¯· ÌÂ Î·ÙÒÙÂÚÂ˜ Ê˘ÛÈÔÏÔ-ÁÈÎ¤˜ ÙÈÌ¤˜ 42,8 Î·È 46,7 m/sec ·ÓÙ›ÛÙÔÈ¯· Î·È Ê˘-ÛÈÔÏÔÁÈÎ¿ Û‡ÓıÂÙ· ·ÈÛıËÙÈÎ¿ ‰˘Ó·ÌÈÎ¿. ∏ ÔÚÁ·-ÓÔÌÂÁ·Ï›· ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙË ÓÂ˘ÚÔÏÔÁÈÎ‹ ‰˘-ÛÏÂÈÙÔ˘ÚÁ›· ¤ıÂÛ·Ó ÙËÓ ˘fiÓÔÈ· Èı·ÓÔ‡ ÌÂÙ·‚Ô-ÏÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜, ÁÈ· ÙË ‰ÈÂÚÂ‡ÓËÛË ÙÔ˘ ÔÔ›Ô˘·ÎÔÏÔ‡ıËÛÂ ÂÍ¤Ù·ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ (ªÈÎÚÔ-‚ÈÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜)Ô˘ ¤‰ÂÈÍÂ ‰Â›ÁÌ· Î˘ÙÙ·ÚÔ‚ÚÈı¤˜ ÌÂ ·ÚÔ˘Û›·¿ÊıÔÓˆÓ ÈÛÙÈÔÎ˘ÙÙ¿ÚˆÓ ÌÂ ·ÊÚÒ‰Â˜ Î˘ÙÙ·Úfi-Ï·ÛÌ·, ÂÓ‰ÂÈÎÙÈÎ¿ ÙË˜ ÓfiÛÔ˘ NP (∂ÈÎfiÓ· 1).

°È· ÙËÓ ÂÈ‚Â‚·›ˆÛË ÙË˜ ‰È¿ÁÓˆÛË˜ Î·È ÙÔÓÎ·ıÔÚÈÛÌfi ÙÔ˘ Ù‡Ô˘ ÙË˜ ÓfiÛÔ˘ ÂÏ‹ÊıË ‚ÈÔ„›·‰¤ÚÌ·ÙÔ˜ ÁÈ· Î·ÏÏÈ¤ÚÁÂÈ· ÈÓÔ‚Ï·ÛÙÒÓ, fiÔ˘


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‰È·ÈÛÙÒıËÎ·Ó ·˘ÍËÌ¤Ó· Â›Â‰· ÌË ÂÛÙÂÚÔÔÈË-Ì¤ÓË˜ ¯ÔÏËÛÙÂÚfiÏË˜ (ÌÂÙ¿ ·fi ÈÛÙÔ¯ËÌÈÎ‹ ¯ÚÒÛËÌÂ ÊÈÏÈ›ÓË) Î·È ¯·ÌËÏ¿ Â›Â‰· ÂÓ‰ÔÎ˘ÙÙ·ÚÈÎ‹˜Û‡ÓıÂÛË˜ ÂÛÙ¤ÚˆÓ ¯ÔÏËÛÙÂÚfiÏË˜ (·ÛıÂÓ‹˜ 70pmol/mg ÚˆÙÂ˝ÓË˜ ÌÂÙ¿ ·fi 4,5 ÒÚÂ˜, Ì¿ÚÙ˘ÚÂ˜2950±1200 pmol/mg ÚˆÙÂ˝ÓË˜), Â˘Ú‹Ì·Ù· Û˘Ì-‚·Ù¿ ÌÂ ÓfiÛÔ NP-C. ¶ÂÚ·ÈÙ¤Úˆ ÌÂÏ¤ÙÂ˜ Ù·˘ÙÔÔ›-ËÛË˜ (complementation studies) Î·Ù¤Ù·Í·Ó ÙÔÓ·ÛıÂÓ‹ ÛÙËÓ ÔÌ¿‰· NP-C1. ¶·Ú¿ Ù·‡Ù·, ÁÔÓÈ‰È·-Î‹ ÌÂÏ¤ÙË ÁÈ· ÙËÓ ÎÔÈÓ‹ ÌÂÙ¿ÏÏ·ÍË NP-C1, Ë ÔÔ›··ÓÂ˘Ú›ÛÎÂÙ·È ÛÙÔ 95% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (4-7),·¤‚Ë ·ÚÓËÙÈÎ‹.

™˘˙‹ÙËÛË ¶·Ú¿ ÙËÓ ÎÏÈÓÈÎ‹ ÂÙÂÚÔÁ¤ÓÂÈ· ÙË˜ ÓfiÛÔ˘ NP-C

Ô˘ ·ÊÔÚ¿ ÙfiÛÔ ÛÙËÓ ËÏÈÎ›· ÂÌÊ¿ÓÈÛË˜ ÙˆÓ Û˘-ÌÙˆÌ¿ÙˆÓ fiÛÔ Î·È ÛÙÔ ‚·ıÌfi ÔÚÁ·ÓÔÌÂÁ·Ï›·˜Î·È ÓÂ˘ÚÔÏÔÁÈÎ‹˜ Û˘ÌÌÂÙÔ¯‹˜, ÂÚÈÁÚ¿ÊÔÓÙ·ÈÙÚÂÈ˜ ÎÔÈÓÔ› Ê·ÈÓfiÙ˘ÔÈ (1,2,4): ·) ÚÒÈÌË ¤Ó·ÚÍËÛÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›· ÌÂ Ù·¯Â›· ÂÍ¤ÏÈÍË Ô˘ Û¯ÂÙ›˙Â-Ù·È ÌÂ Ë·ÙÈÎ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Î·È „˘¯ÔÎÈÓËÙÈÎ‹ Î·-ı˘ÛÙ¤ÚËÛË, ‚) ¤Ó·ÚÍË ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· (Û˘Ó‹-

ıˆ˜ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓ ÎÔÈÓ‹ ÌÂÙ¿ÏÏ·ÍË NP-C1)Ô˘ ÂÎ‰ËÏÒÓÂÙ·È ÌÂ Ì·ıËÛÈ·Î¤˜ ‰˘ÛÎÔÏ›Â˜ ‹ „˘-¯ÔÎÈÓËÙÈÎ‹ ·ÏÈÓ‰ÚfiÌËÛË Î·È Á) Î·ı˘ÛÙÂÚËÌ¤ÓË¤Ó·ÚÍË ÙË˜ ÓfiÛÔ˘ ÛÙËÓ ÂÊË‚ÈÎ‹ ‹ ÂÓ‹ÏÈÎË ˙ˆ‹.

µÈ‚ÏÈÔÁÚ·ÊÈÎ¿ ·Ó·Ê¤ÚÂÙ·È ˆ˜ Ë ÓfiÛÔ˜ ÌÔ-ÚÂ› Ó· ÂÎ‰ËÏˆıÂ› ÛÂ ÔÔÈ·‰‹ÔÙÂ ËÏÈÎ›·, ·fi ÙËÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô Ì¤¯ÚÈ ÙËÓ 4Ë ‹ 5Ë ‰ÂÎ·ÂÙ›· ÙË˜˙ˆ‹˜, Û˘¯ÓfiÙÂÚ· fiÌˆ˜ ÛÙÔ 2Ô-3Ô ¯ÚfiÓÔ ÙË˜ ˙ˆ‹˜(1,2). ∏ ÔÚÁ·ÓÔÌÂÁ·Ï›· ÌÂ ÙË ÌÔÚÊ‹ ÙË˜ ÛÏËÓÔ-‹/Î·È Ë·ÙÔÌÂÁ·Ï›·˜ ÌÔÚÂ› Ó· ÚÔËÁÂ›Ù·È ‹ Ó·¤ÂÙ·È ÙˆÓ ÓÂ˘ÚÔÏÔÁÈÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ. OÈ ImrieÎ·È Wraith ¤¯Ô˘Ó ·Ó·ÎÔÈÓÒÛÂÈ Ù¤ÛÛÂÚÈ˜ ÂÚÈÙÒ-ÛÂÈ˜ ·È‰ÈÒÓ ÌÂ NP-C Ô˘ ÁÈ· ÔÏÏ¿ ¯ÚfiÓÈ· ÙÔ ÌÔ-Ó·‰ÈÎfi ÎÏÈÓÈÎfi ÛËÌÂ›Ô ÙË˜ ÓfiÛÔ˘ ‹Ù·Ó Ë ÛÏËÓÔ-ÌÂÁ·Ï›· (4).

ŒÓ· Â˘Ú‡ Ê¿ÛÌ· Ê·ÈÓÔÙ‡ˆÓ ·ÊÔÚ¿ ÛÙÈ˜ ÓÂ˘-ÚÔÏÔÁÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÙË˜ ÓfiÛÔ˘ (1,2,4,6). ™Â ÌÂ-ÚÈÎÔ‡˜ ·ÛıÂÓÂ›˜ ÂÚÈÁÚ¿ÊÂÙ·È Ê˘ÛÈÔÏÔÁÈÎ‹ ·Ó¿-Ù˘ÍË Î·Ù¿ ÙË ‚ÚÂÊÈÎ‹ Î·È ÚÒÙË ÓËÈ·Î‹ ËÏÈÎ›·,ÌÂ ÙËÓ ÂÌÊ¿ÓÈÛË ·ÚÁfiÙÂÚ· Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔ-ÏÈÒÓ ‹ „˘¯ÔÎÈÓËÙÈÎ‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜, ÂÓÒ ÛÂ ¿Ï-ÏÔ˘˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ˘ÔÙÔÓ›· Î·È „˘¯ÔÎÈÓËÙÈÎ‹


289

∂ÈÎfiÓ· 1. ∆˘ÈÎ¿ ÈÛÙÈÔÎ‡ÙÙ·Ú· ÌÂ ·ÊÚÒ‰Â˜ Î˘ÙÙ·ÚfiÏ·ÛÌ· ÂÓ‰ÂÈÎÙÈÎ¿ ÙË˜ ÓfiÛÔ˘ Niemann-Pick C.



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Î·ı˘ÛÙ¤ÚËÛË ·fi ÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›·. ∏ ÎÏÈÓÈÎ‹ ÂÈ-ÎfiÓ· Û˘¯Ó¿ ÂÚÈÏ·Ì‚¿ÓÂÈ ·Ù·Í›·, ‰˘ÛÙÔÓ›·, Î·Ù·-ÏËÍ›· (ÌÂ ÙËÓ ÂÈÎfiÓ· ÙË˜ ·ÈÊÓ›‰È·˜ ·ÒÏÂÈ·˜ ÙÔ˘Ì˘˚ÎÔ‡ ÙfiÓÔ˘ Ô˘ Ô‰ËÁÂ› ÛÂ ÙÒÛÂÈ˜), ‰˘Û·ÚıÚ›·Î·È ¿ÓÔÈ·. §ÈÁfiÙÂÚÔ Û˘¯Ó¿ ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÌÊ¿-ÓÈÛË ÙÚfiÌÔ˘ ‹ Î·È Û·ÛÌÒÓ (Ô˘ ‰ÂÓ ÂÏ¤Á¯ÔÓÙ·ÈÂ‡ÎÔÏ·). ŒÓ· ÂÈ‰ÈÎfi Â‡ÚËÌ· Ô˘ ÂÚÈÁÚ¿ÊÂÙ·ÈÛÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ NP-C Â›Ó·È Ë‰˘ÛÎÔÏ›· Î›ÓËÛË˜ ÙˆÓ ÔÊı·ÏÌÈÎÒÓ ‚ÔÏ‚ÒÓ ÛÙÔÎ¿ıÂÙÔ Â›Â‰Ô (Î¿ıÂÙË ·Ú¿Ï˘ÛË ‚Ï¤ÌÌ·ÙÔ˜ ‹Î¿ıÂÙË ˘ÂÚ˘ÚËÓÈÎ‹ ÔÊı·ÏÌÔÏËÁ›·) (1,2,4,7).øÛÙfiÛÔ, ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› Î·È ÌÔÚÊ¤˜ ÙË˜ ÓfiÛÔ˘¯ˆÚ›˜ ÓÂ˘ÚÔÏÔÁÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ (2,4,6,8).

∞Ó·Ê¤ÚÂÙ·È ˆ˜ Ë NP-C ÌÔÚÂ› Ó· ·ÔÙÂÏ¤ÛÂÈ·›ÙÈÔ ÂÌ‚Ú˘˚ÎÔ‡ ‡‰Úˆ· ‹ Ó· ÂÌÊ·ÓÈÛÙÂ› ˆ˜ ÔÍÂ›·ÓÂÔÁÓÈÎ‹ Ë·Ù›ÙÈ‰· (1,6) Î·È ·ÎfiÌË ÌÂ ÙË ÌÔÚÊ‹‰È¿ÌÂÛË˜ ÓÂ˘ÌÔÓ›·˜ Ô˘ Ô‰ËÁÂ› ÛÂ ÛÔ‚·Ú‹ ·Ó·-ÓÂ˘ÛÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ· Î·È ·ÊÔÚ¿ Û˘¯ÓfiÙÂÚ· ÛÙÈ˜ÂÚÈÙÒÛÂÈ˜ ÌÂÙ¿ÏÏ·ÍË˜ ÛÙÔ ÁÔÓ›‰ÈÔ NP-C2 (1,9).OÈ ·ÛıÂÓÂ›˜ ÌÂ ÚÒÈÌË ¤Ó·ÚÍË ÌÔÚÂ› Ó· Î·Ù·Ï‹-ÍÔ˘Ó ÚÈÓ ÙË Û¯ÔÏÈÎ‹ ËÏÈÎ›·, ÂÓÒ ·Ó Ë ÚÒÙË ÂÎ-‰‹ÏˆÛË ÙË˜ ÓfiÛÔ˘ ·ÊÔÚ¿ ÛÙË Û¯ÔÏÈÎ‹ ËÏÈÎ›·,ÌÔÚÂ› Ó· ÂÈ˙‹ÛÔ˘Ó Ì¤¯ÚÈ ÙË 2Ë ‰ÂÎ·ÂÙ›· ÙË˜ ˙ˆ-‹˜ ÙÔ˘˜ (4). O ·ÛıÂÓ‹˜ Ì·˜ ·ÚÔ˘Û›·ÛÂ Ë·ÙÔ-ÛÏËÓÈÎfi Û‡Ó‰ÚÔÌÔ ·fi ÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›·, ˆÛÙfi-ÛÔ Ë ˘Ô„›· Î·È ‰È¿ÁÓˆÛË ÙË˜ ÓfiÛÔ˘ Ù¤ıËÎÂ ÛÂËÏÈÎ›· 3,5 ÂÙÒÓ, fiÙ·Ó ÛÙËÓ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÚÔÛÙ¤-ıËÎ·Ó Î·È Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ∫¡™.

¶ÚfiÎÂÈÙ·È ÁÈ· ÙË ‰Â‡ÙÂÚË ÂÚÈÁÚ·Ê‹ ÂÚ›Ùˆ-ÛË˜ ÓfiÛÔ˘ NP-C ÛÙËÓ ÂÏÏËÓÈÎ‹ ‚È‚ÏÈÔÁÚ·Ê›·. HÚÒÙË ·ÊÔÚÔ‡ÛÂ ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ 7 ÌËÓÒÓÔ˘ ÚÔ¤‚·ÏÂ ÌÂ ÂÈÎfiÓ· ·ÔÊÚ·ÎÙÈÎÔ‡ ÈÎÙ¤ÚÔ˘Î·È Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›· Î·È ÙÔ ÔÔ›Ô ‰ÂÓ Â›¯ÂÓÂ˘ÚÔÏÔÁÈÎ‹ Û˘ÌÌÂÙÔ¯‹ ¤ˆ˜ ÙËÓ ËÏÈÎ›· ÙË˜ ÙÂ-ÏÂ˘Ù·›·˜ ÂÍ¤Ù·ÛË˜ (3 ÂÙÒÓ) (10). ¶·Ú¿ Ù·‡Ù·, ¤ÍÈÂÈÏ¤ÔÓ ·‰ËÌÔÛ›Â˘ÙÂ˜ ÂÚÈÙÒÛÂÈ˜ ÙË˜ ÓfiÛÔ˘(∂. ªÈ¯ÂÏ·Î¿ÎË, πÓÛÙÈÙÔ‡ÙÔ ÀÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡,ÚÔÛˆÈÎ‹ ÂÈÎÔÈÓˆÓ›·) ·˘Í¿ÓÔ˘Ó ÙÔÓ ·ÚÈıÌfiÙˆÓ ÂÚÈÙÒÛÂˆÓ ÙË˜ ÓfiÛÔ˘ ÛÙÔÓ ∂ÏÏ·‰ÈÎfi ¯ÒÚÔÛÂ ÔÎÙÒ.

∏ ÂÚÈÊÂÚÈÎ‹ ÔÏ˘ÓÂ˘ÚÔ¿ıÂÈ· ·ÔÌ˘ÂÏÈÓˆ-ÙÈÎÔ‡ Ù‡Ô˘ ‹Ù·Ó ¤Ó· ÂÈÏ¤ÔÓ Â‡ÚËÌ· Û˘ÌÌÂÙÔ-¯‹˜ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Ô˘Èı·ÓfiÙ·Ù· Ó· Û˘ÓÂÈÛÊ¤ÚÂÈ Î·Ù¿ ¤Ó· ÔÛÔÛÙfiÛÙË ÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÈÎfiÓ· ÙÔ˘ ·ÛıÂÓÔ‡˜ Ì·˜. ∞ÛÙ¿-ıÂÈ· ‚¿‰ÈÛË˜, Û˘¯Ó¤˜ ÙÒÛÂÈ˜, ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂÏËÌÌÂÏ‹ ÔÊı·ÏÌÔÎÈÓËÙÈÎ‹ Û˘Ó¤ÚÁÂÈ· (Û˘ÓÂÂ›·ÙË˜ ¿ÚÂÛË˜ ÙÔ˘ Î¿ıÂÙÔ˘ ‚Ï¤ÌÌ·ÙÔ˜), ·ÏÏ¿ Î·ÈÈ‰ÈfiÌÔÚÊÂ˜ ÎÚ›ÛÂÈ˜ “Î·Ù·ÏËÍ›·˜” Â›ÛË˜ ÂÚÈ-ÁÚ¿ÊÔÓÙ·È ÛÂ ·ÛıÂÓÂ›˜ ÌÂ NP-C. ∂È‰ÈÎfiÙÂÚ· fiÛÔÓ·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙËÙ· ÙË˜ ÂÚÈÊÂÚÈÎ‹˜ ÓÂ˘ÚÔ¿-ıÂÈ·˜ ÛÙË NP-C, ÌfiÓÔ 3 ‰ËÌÔÛÈÂ˘Ì¤ÓÂ˜ ÂÚÈÙÒ-ÛÂÈ˜ ˘¿Ú¯Ô˘Ó ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· (11-13).

º·›ÓÂÙ·È fiÌˆ˜ fiÙÈ Â›Ó·È Û˘¯ÓfiÙÂÚË ·’ fi,ÙÈ ÂÚÈ-ÁÚ¿ÊÂÙ·È (ª. Vanier, ÚÔÛˆÈÎ‹ ÂÈÎÔÈÓˆÓ›·). ¶¿-ÓÙˆ˜, Ë Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘-ÛÙ‹Ì·ÙÔ˜ Â›Ó·È ‰Â‰ÔÌ¤ÓË ÛÙÔ ÂÈÚ·Ì·ÙÈÎfi ÌÔÓÙ¤-ÏÔ ÙË˜ ÓfiÛÔ˘ (BALB/c ÔÓÙ›ÎÈ·) Î·È Ì¿ÏÈÛÙ· ·Ó·-ÛÙÚ¤ÊÂÙ·È ÌÂ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ÂÌ‚Ú˘˚ÎÒÓ Ë·ÙÈ-ÎÒÓ Î˘ÙÙ¿ÚˆÓ, Ù· ÔÔ›· ‰ÈÔÚıÒÓÔ˘Ó ÙËÓ ÂÓ·fiıÂ-ÛË ÙˆÓ ÏÈÈ‰›ˆÓ ÛÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ÈÛÙÔ‡˜ (14).

∏ Ù·˘ÙÔÔ›ËÛË ÙÔ˘ ÁÔÓÈ‰›Ô˘ NP-C1 ·fi ÙÔÓCastea Î·È Û˘Ó ÙÔ 1997 (15) ¤‰ˆÛÂ Ó¤· ÒıËÛËÛÙËÓ ¤ÚÂ˘Ó· Û¯ÂÙÈÎ¿ ÌÂ ÙË ÓfiÛÔ NP-C. ∆Ô ÁÔÓ›‰ÈÔNP-C1 ¤¯ÂÈ ¯·ÚÙÔÁÚ·ÊËıÂ› ÛÙÔ ¯ÚˆÌfiÛˆÌ·18q11-12 Î·È Îˆ‰ÈÎÔÔÈÂ› Ì›· ÁÏ˘ÎÔÚˆÙÂ˝ÓË ÌÂÌÔÚÈ·Îfi ‚¿ÚÔ˜ 142 KDa ·ÔÙÂÏÔ‡ÌÂÓË ·fi 1278·ÌÈÓÔÍ¤· (1,5,16,17). OÈ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ NP-C1ÁÔÓ›‰ÈÔ Â˘ı‡ÓÔÓÙ·È ÁÈ· ÙÔ 95% ÙˆÓ ÂÚÈÙÒÛÂˆÓNP-C (4,18). °È· ÙÔ ˘fiÏÔÈÔ 5% Ê·›ÓÂÙ·È ˆ˜ Â˘-ı‡ÓÂÙ·È ¤Ó· ‰Â‡ÙÂÚÔ ÁÔÓ›‰ÈÔ, ÙÔ NP-C2. ∆Ô ÁÔÓ›-‰ÈÔ ·˘Ùfi Îˆ‰ÈÎÔÔÈÂ› ÙËÓ ÚˆÙÂ˝ÓË ∏∂1 Î·È ¤¯ÂÈ¯·ÚÙÔÁÚ·ÊËıÂ› ÛÙÔ ¯ÚˆÌfiÛˆÌ· 14q24.3 (3). OÈÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ NP-C1 ‹ NP-C2 ÁÔÓ›‰ÈÔ Ê·›ÓÂÙ·ÈfiÙÈ ÂËÚÂ¿˙Ô˘Ó ÙËÓ ›‰È· Ô‰fi ÂÓ‰ÔÎ˘ÙÙ¿ÚÈÔ˘ ÌÂÙ·-‚ÔÏÈÛÌÔ‡ ÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜, ·Ó·ÛÙ¤ÏÏÔÓÙ·˜ È-ı·ÓfiÓ ÙË ÌÂÙ·ÊÔÚ¿ ÙË˜ ÌË ÂÛÙÂÚÔÔÈËÌ¤ÓË˜ ÙË˜ÌÔÚÊ‹˜ ÛÙÔ ÂÓ‰ÔÏ·ÛÌ·ÙÈÎfi ‰›ÎÙ˘Ô, ÌÂ Û˘Ó¤ÂÈ·ÙËÓ ¿ıÚÔÈÛ‹ ÙË˜ ÛÙ· Ï˘ÛÔÛˆÌ¿ÙÈ· ‹/Î·È fi„ÈÌ· ÂÓ-‰ÔÛˆÌ¿ÙÈ·. ∂ÓÒ Â›Ó·È ÁÓˆÛÙ‹ Ë ‰ÈÂÚÁ·Û›· ÌÂÙ·-ÊÔÚ¿˜ ÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜ ·fi ÙÔ Ï¿ÛÌ· ÛÙÔÂÛˆÙÂÚÈÎfi ÙˆÓ Î˘ÙÙ¿ÚˆÓ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÛÙ·Ï˘ÛÔÛˆÌ¿ÙÈ· ‹/Î·È fi„ÈÌ· ÂÓ‰ÔÛˆÌ¿ÙÈ·, ‰ÂÓ ¤¯ÂÈ·ÎfiÌË ÂÍ·ÎÚÈ‚ˆıÂ› Ô ÙÚfiÔ˜ ÌÂÙ·ÊÔÚ¿˜ ÙË˜ ·fiÙ· Ï˘ÛÔÛˆÌ¿ÙÈ· ÛÙÔ ÂÓ‰ÔÏ·ÛÌ·ÙÈÎfi ‰›ÎÙ˘Ô. OÈÂÚÂ˘ÓËÙ¤˜ ˘Ôı¤ÙÔ˘Ó ˆ˜ Ë ÚˆÙÂ˝ÓË NP-C1,Ô˘ ÂÓÙÔ›˙ÂÙ·È ÛÙË ÌÂÌ‚Ú¿ÓË ÙˆÓ Ï˘ÛÔÛˆÌ·-Ù›ˆÓ, ·ÔÙÂÏÂ› ÚˆÙÂ˝ÓË-ÌÂÙ·ÊÔÚ¤· ÙË˜ ¯ÔÏËÛÙÂ-ÚfiÏË˜ ·fi ·˘Ù¿, Î·ıÒ˜ ÔÈ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÙË˜ Ô˘·ÊÔÚÔ‡Ó ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ NP-C1 Û¯ÂÙ›˙ÔÓÙ·È ÌÂ¿ıÚÔÈÛË ÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜ ÛÙ· Ï˘ÛÔÛˆÌ¿ÙÈ·.øÛÙfiÛÔ, ÛÂ ÚfiÛÊ·ÙË ÌÂÏ¤ÙË, ÔÈ J. Davies Î·ÈÛ˘Ó (19) ¤‰ÂÈÍ·Ó ˆ˜ Ë ÚˆÙÂ˝ÓË NP-C1 Ê·›ÓÂÙ·ÈÓ· ÏÂÈÙÔ˘ÚÁÂ› ˆ˜ ‰È·ÌÂÌ‚Ú·ÓÈÎ‹ ·ÓÙÏ›· Ô˘ ÌÂÙ·-Ê¤ÚÂÈ ·fi ÙÔ Û‡ÛÙËÌ· Ï˘ÛÔÛˆÌ·Ù›ˆÓ/ÂÓ‰ÔÛˆÌ·-Ù›ˆÓ ÏÈÔÊÈÏÈÎ¿ ÌfiÚÈ· (fiˆ˜ ÏÈ·Ú¿ ÔÍ¤·), fi¯ÈfiÌˆ˜ Î·È ¯ÔÏËÛÙÂÚfiÏË Î·È ›Ûˆ˜ ÚfiÎÂÈÙ·È ÁÈ· Â˘-Î·Ú˘ˆÙÈÎfi Ì¤ÏÔ˜ Ì›·˜ ÔÈÎÔÁ¤ÓÂÈ·˜ RND(resistance-nodulatin-division) ÚÔÎ·Ú˘ˆÙÈÎÒÓÂÚÌÂ·ÛÒÓ. ∏ ‰Ú¿ÛË ÙË˜ ˆ˜ ÂÚÌÂ¿ÛË˜ Ê·›ÓÂÙ·ÈÓ· Â›Ó·È ÛËÌ·ÓÙÈÎ‹ ÛÙË ‰È·Ù‹ÚËÛË ÙË˜ ÂÓ‰ÔÎ˘ÙÙ¿-ÚÈ·˜ ÔÌÔÈfiÛÙ·ÛË˜ ÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜. ¶·Ú·Ì¤ÓÂÈ,ˆÛÙfiÛÔ, ·‰ÈÂ˘ÎÚ›ÓÈÛÙÔ Ò˜ ÌÈ· ‰È·Ù·Ú·¯‹ ÛÙËÌÂÙ·ÊÔÚ¿ ÙˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ ÌÔÚÂ› Ó· Ô‰ËÁ‹-ÛÂÈ ÛÂ ¿ıÚÔÈÛË ¯ÔÏËÛÙÂÚfiÏË˜, fiˆ˜ Û˘Ì‚·›ÓÂÈÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ NP-C (1,3-5,16-19).


∏ ∏∂1 Â›Ó·È Ì›· Ï˘ÛÔÛˆÌÈ·Î‹ ÚˆÙÂ˝ÓË ÌÂ ‰˘-Ó·ÙfiÙËÙ· ‰¤ÛÌÂ˘ÛË˜ ÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜. ¶·Ú·Ì¤-ÓÂÈ ·Û·Ê¤˜ Ò˜ ·ÎÚÈ‚Ò˜ Ë ∏∂1 Û˘ÓÂÈÛÊ¤ÚÂÈ ÛÙËÌÂÙ·ÊÔÚ¿ ÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜ ·fi Ù· Ï˘ÛÔÛˆÌ¿-ÙÈ·, Î·ıÒ˜ Î·È Ò˜ Û˘Û¯ÂÙ›˙ÂÙ·È Ô ÚfiÏÔ˜ ÙË˜ ÌÂ ÙË‰Ú¿ÛË ÙË˜ NP-C1 (3,18-20).

£· Ú¤ÂÈ Ó· ˘Ô„È·ÛÙÔ‡ÌÂ ÙË ÓfiÛÔ NP-C, ·-Ú¿ ÙÔ Â˘Ú‡ Ê¿ÛÌ· ÎÏÈÓÈÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ, ÛÂ Î¿ıÂ‚Ú¤ÊÔ˜ ‹ ·È‰› ÌÂ ·ÁÓÒÛÙÔ˘ ·ÈÙÈÔÏÔÁ›·˜ ÔÚÁ·ÓÔ-ÌÂÁ·Ï›· ‹/Î·È ÓÂ˘ÚÔÏÔÁÈÎ‹ Û˘Ó‰ÚÔÌ‹ ÌÂ ÙË ÌÔÚÊ‹„˘¯ÔÎÈÓËÙÈÎ‹˜ Î·ı˘ÛÙ¤ÚËÛË˜ ‹ ·ÏÈÓ‰ÚfiÌËÛË˜Î·È ·ÚÁfiÙÂÚ· ·Ù·Í›·˜, ‰˘Û·ÚıÚ›·˜ Î·È Î¿ıÂÙË˜ÔÊı·ÏÌÔÏËÁ›·˜. O ·Ú¯ÈÎfi˜ ‰È·ÁÓˆÛÙÈÎfi˜ ¤ÏÂÁ-¯Ô˜ ·ÊÔÚ¿ ÛÙËÓ ·Ó·˙‹ÙËÛË ·ÊÚˆ‰ÒÓ Î˘ÙÙ¿ÚˆÓÛÙÔ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ, ÂÓÒ Ë ÙÂÎÌËÚ›ˆÛË ÙË˜ ‰È¿-ÁÓˆÛË˜ ı· Á›ÓÂÈ ÌÂ ÙËÓ ·ÓÂ‡ÚÂÛË ·˘ÍËÌ¤ÓˆÓ ÂÈ-¤‰ˆÓ ÌË ÂÛÙÂÚÔÔÈËÌ¤ÓË˜ ¯ÔÏËÛÙÂÚfiÏË˜ ÛÂÎ·ÏÏÈ¤ÚÁÂÈ· ÈÓÔ‚Ï·ÛÙÒÓ ·fi ‚ÈÔ„›· ‰¤ÚÌ·ÙÔ˜ Î·È¯·ÌËÏÒÓ ÂÈ¤‰ˆÓ ÂÛÙ¤ÚˆÓ ¯ÔÏËÛÙÂÚfiÏË˜, Î·-ıÒ˜ Î·È ÁÔÓÈ‰È·Î‹ ÌÂÏ¤ÙË ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ Ô˘Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙË ÓfiÛÔ (1,2,4).

¶ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË ÙË˜ ÓfiÛÔ˘ NP-C Â›Ó·È‰˘Ó·Ù‹ ÌÂ ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ ÂÈ¤‰Ô˘ ÌËÂÛÙÂÚÔÔÈËÌ¤ÓË˜ ¯ÔÏËÛÙÂÚfiÏË˜ ÛÂ Î·ÏÏÈ¤ÚÁÂÈÂ˜Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ·ÌÓÈ·ÎÔ‡ ˘ÁÚÔ‡. ∂ÈÏ¤ÔÓ, Â›Ó·È ‰˘-Ó·Ù‹ Ë ·Ó›¯ÓÂ˘ÛË ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÙÔ ÁÔÓ›‰ÈÔ NP-C1ÛÂ Î·ÏÏÈ¤ÚÁÂÈÂ˜ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ·ÌÓÈ·ÎÔ‡ ˘ÁÚÔ‡ ÌÂÌÔÚÈ·Î¤˜ Î·È ‚ÈÔ¯ËÌÈÎ¤˜ ÌÂıfi‰Ô˘˜ (21,22).

¢ÂÓ ˘¿Ú¯Ô˘Ó È‰È·›ÙÂÚÂ˜ ‰˘Ó·ÙfiÙËÙÂ˜ ıÂÚ·-Â˘ÙÈÎ‹˜ ·Ú¤Ì‚·ÛË˜ ÛÙ· ·È‰È¿ ÌÂ NP-C. ∏ Û‡-ÛÙ·ÛË ÁÈ· ‰È·ÙÚÔÊ‹ ÌÂ ¯·ÌËÏ¿ ÏÈ·Ú¿, Î·ıÒ˜ Î·ÈË Ï‹„Ë Ê·ÚÌ·ÎÂ˘ÙÈÎÒÓ ÛÎÂ˘·ÛÌ¿ÙˆÓ ÁÈ· ÙÔÓ¤ÏÂÁ¯Ô ÙˆÓ ÂÈ¤‰ˆÓ ¯ÔÏËÛÙÂÚfiÏË˜, Èı·ÓfiÓ Ó·ÂÚÈÔÚ›˙ÂÈ ÙËÓ ¿ıÚÔÈÛË ÏÈÈ‰›ˆÓ ÛÙÔ ‹·Ú, ˆÛÙfi-ÛÔ ‰ÂÓ ¤¯Ô˘Ó Î·ÌÈ¿ Â›‰Ú·ÛË ÛÙËÓ ÂÍ¤ÏÈÍË ÙˆÓÛ˘ÌÙˆÌ¿ÙˆÓ ·fi ÙÔ ∫¡™ (1,23). ¶ÚfiÛÊ·ÙÂ˜ ÌÂ-Ï¤ÙÂ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ ˆ˜ ÛÙË ÓfiÛÔ NP-C, ¤Ú· ·fiÙË Ï˘ÛÔÛˆÌÈ·Î‹ ¿ıÚÔÈÛË ¯ÔÏËÛÙÂÚfiÏË˜, ·Ú·ÙË-ÚÂ›Ù·È Î·È ·ÓÂ¿ÚÎÂÈ· ÙˆÓ ÂÚÔÍ˘ÛˆÌ·Ù›ˆÓ. ™ÂÂÈÚ·Ì·Ùfi˙ˆ· ¤¯Ô˘Ó ‹‰Ë ‰ÔÎÈÌ·ÛÙÂ› ·Ú¿ÁÔÓÙÂ˜Ô˘ ‰ÚÔ˘Ó ‰ÈÂÁÂÚÙÈÎ¿ ÛÙ· ÂÚÔÍ˘ÛˆÌ¿ÙÈ·, fiˆ˜Ë ÎÏÔÊÈÌÚ¿ÙË Î·È ÙÔ ÂÚÊÏÔ˘ÚÔÎÙ·ÓÈÎfi ÔÍ‡,ÚÔÎ·ÏÒÓÙ·˜ ‚ÂÏÙ›ˆÛË ÙË˜ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ ÙˆÓÂÚÔÍ˘ÛˆÌ·Ù›ˆÓ, ·ÏÏ¿ Î·È ÂÚÈÔÚÈÛÌfi ÙË˜ Ï˘ÛÔ-ÛˆÌÈ·Î‹˜ ¿ıÚÔÈÛË˜ ¯ÔÏËÛÙÂÚfiÏË˜ ÛÙÔ ‹·Ú, ÁÂ-ÁÔÓfi˜ È‰È·›ÙÂÚ· ÂÓı·ÚÚ˘ÓÙÈÎfi ÁÈ· Èı·Ó‹ ÂÊ·ÚÌÔ-Á‹ ÙË˜ ÌÂıfi‰Ô˘ Î·È ÛÂ ·ÓıÚÒÔ˘˜ (24). ªÂÏ¤ÙÂ˜Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ ÂÓ˙˘ÌÈÎ‹ ˘ÔÎ·Ù¿ÛÙ·ÛË ÌÂ ÌÂ-Ù·ÌfiÛ¯Â˘ÛË ‚ÔÂ›Ô˘ Ì˘ÂÏÔ‡ Â›Ó·È ‹‰Ë ÛÂ ÂÍ¤ÏÈÍË,ÂÓÒ Ë ÚfiÛÊ·ÙË ¯·ÚÙÔÁÚ¿ÊËÛË ÙˆÓ ˘Â‡ı˘ÓˆÓÁÔÓÈ‰›ˆÓ ‰ËÌÈÔ˘ÚÁÂ› ÂÏ›‰Â˜ ÁÈ· ÙË ‰˘Ó·ÙfiÙËÙ·ÁÔÓÈ‰È·Î‹˜ ıÂÚ·Â›·˜ ÛÙÔ Ì¤ÏÏÔÓ (1,25,26). ∂È-Ï¤ÔÓ, Û¯Â‰È¿˙ÂÙ·È Ë ÎÏÈÓÈÎ‹ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ Ê·ÚÌ¿-

ÎÔ˘ OGT 918 (N-bytyldeoxyno- jirimycin) ÛÂ ·ÛıÂÓÂ›˜ÌÂ NP-C (27). ∆Ô OGT 918 Ô˘ ·ÔÙÂÏÂ› ·Ó·ÛÙÔÏ¤·ÙË˜ Û‡ÓıÂÛË˜ Á·ÁÁÏÈÔÛÈ‰›ˆÓ, ¤¯ÂÈ ‹‰Ë ‰ÔÎÈÌ·ÛÙÂ› ÛÂ·ÛıÂÓÂ›˜ ÌÂ ¿ÏÏ· Ï˘ÛÔÛˆÌÈ·Î¿ ·ıÚÔÈÛÙÈÎ¿ ÓÔÛ‹Ì·-Ù·, fiˆ˜ ÓfiÛÔ ÙÔ˘ Gaucher Î·È ÓfiÛÔ ÙÔ˘ Fabry, ÌÂÂÓı·ÚÚ˘ÓÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù·. ªÂÙ¿ ·fi ÂÈÚ·Ì·ÙÈ-Î¤˜ ÌÂÏ¤ÙÂ˜ ÛÂ ÔÓÙÈÎÔ‡˜ ÌÂ NP-C, Ê·›ÓÂÙ·È Ó· Î·-ı˘ÛÙÂÚÂ› ÙËÓ ÂÌÊ¿ÓÈÛË ÓÂ˘ÚÔÏÔÁÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓÎ·È Ó· Ô‰ËÁÂ› ÛÂ Ì·ÎÚfiÙÂÚË ÂÈ‚›ˆÛË, ¯ˆÚ›˜ ˆÛÙfi-ÛÔ Ó· ÚÔÛÊ¤ÚÂÈ ·ÈÙÈÔÏÔÁÈÎ‹ ıÂÚ·Â›· ÛÙË ÓfiÛÔ(28-33).

µÈ‚ÏÈÔÁÚ·Ê›· 1. Kolodny EH. Niemann-Pick disease. Curr Opin Hematol

2000;7:48-52. 2. ¡atowicz MR, Stoler JM, Prence EM, Liscum L. Marked

heterogeneity in Niemann-Pick disease, type C. Clinicaland ultrastructural findings. Clin Pediatr (Phila)1995;34:190-197.

3. Naureckiene S, Sleat DE, Lackland H, Fensom A, Vanier MT,Wattiaux R et al. Identification of HE1 as the second gene ofNiemann-Pick C disease. Science 2000;290:2298-2301.

4. Imrie J, Wraith JE. Isolated splenomegaly as thepresenting feature of Niemann-Pick disease type C. ArchDis Child 2001;84:427-429.

5. Cruz JC, Sugii S, Yu C, Chang TY. Role of Niemann-Picktype C1 protein in intracellular trafficking of low densitylipoprotein-derived cholesterol. J Biol Chem2000;275:4013-4021.

6. Millat G, Marcais C, Rafi MA, Yamamoto T, Morris JA,Pentchev PG et al. Niemann-Pick C1 disease: the I1061Tsubstitution is a frequent mutant allele in patients ofWestern European descent and correlates with a classicjuvenile phenotype. Am J Hum Genet 1999;65:1321-1329.

7. Lengyel D, Weissert M, Schmid L, Gottlob I. Eyemovement abnormalities as a sign for the diagnosis inNiemann-Pick disease type C. Klin Monatsbl Augenheilkd1999;214:50-52.

8. Fensom AH, Grant AR, Steinberg SJ, Ward CP, Lake BD,Logan EC et al. An adult with a non-neuronopathic form ofNiemann-Pick C disease. J Inherit Metab Dis 1999;22:84-86.

9. Schofer O, Mischo B, Puschel W, Harzer K, Vanier MT.Early-lethal pulmonary form of Niemann-Pick type Cdisease belonging to a second, rare geneticcomplementation group. Eur J Pediatr 1998;157:45-49.

10. ª·ÓˆÏ¿ÎË ¡, ÃÚËÛÙÔÌ¿ÓÔ˘ ∂, ¢ÚÔÁÎ¿ÚË ∂, ª¿ÓÈ· ¢,§·ÁÎÒÓ· ∂. ¡fiÛÔ˜ Niemann-Pick Ù‡Ô˘ C. ¶·È‰È·ÙÚÈÎ‹1998;61:78-83.

11. Marks HG, Spencer D, Sweet BA, Argoff CE. Peripheralnervous system involvement in new variant of Niemann-Pick disease type C [abstract]. Ann Neurol 1990;28:435.

12. Hahn AF, Gilbert JJ, Kwarciak C, Gillett J, Bolton CF, RuparCA et al. Nerve biopsy findings in Niemann-Pick type II(NP-C). Acta Neuropathol 1994;87:149-154.

13. Alvelious G, Hjalmarson O, Griffiths WJ, Bjorkhem I, SjovallJ. Identification of unusual 7-oxygenated bile acid sulfatesin a patient with Niemann-Pick disease, type C. J Lipid Res


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2001;42:1571-1577. 14. Veyron P, Mutin M, Touraine JL. Transplantation of fetal

liver cells corrects accumulation of lipids in tissues andprevents fatal neuropathy in cholesterol-storage diseaseBALB/c mice. Transplantation 1996;62:1039-1045.

15. Castea ED, Morris JA, Coleman KG, Loftus SK, Zhang D,Cummings C et al. Niemann-Pick C1 disease gene:homology to mediators of cholesterol homeostasis.Science 1997;277:228-231.

16. Ioannou YA. The structure and function of the Niemann-Pick C1 protein. Mol Genet Metab 2000;71:175-181.

17. Watari H, Blanchette-Mackie EJ, Dwyer NK, Glick JM,Patel S, Neufeld EB et al. Niemann-Pick C1 protein:obligatory roles for N-terminal domains and lysosomaltargeting in cholesterol mobilization. Proc Natl Acad SciUSA 1999;96:805-810.

18. Marx J. Disease genes clarify cholesterol trafficking.Science 2000;290:2227-2229.

19. Davies JP, Chen FW, Ioannou YA. Transmembranemolecular pump activity of Niemann-Pick C1 protein.Science 2000;290:2295-2297.

20. Naureckiene S, Sleat DE, Lackland H, Fensom A, Vanier MT,Wattiaux R et al. Identification of HE1 as the second gene ofNiemann-Pick C disease. Science 2000;290:2298-2301.

21. Vanier MT, Rodriguez-Lafrasse C, Rousson R, Mandon G,Boue J, Choiset A et al. Prenatal diagnosis of Niemann-Pick type C disease: current strategy from an experience of37 pregnancies at risk. Am J Hum Genet 1992;51:111-122.

22. Tsukamoto H, Yamamoto T, Nishigaki T, Sakai N, NandaE, Ninomiva H et al. SSCP analysis by RT-PCR for theprenatal diagnosis of Niemann-Pick disease type C.Prenat Diagn 2001;21:55-57.

23. Erickson RP, Garver WS, Camargo F, Hossain GS,Heidenreich RA. Pharmacological and geneticmodifications of somatic cholesterol do not substantiallyalter the course of CNS disease in Niemann-Pick C mice.J Inherit Metab Dis 2000;23:54-62.

24. Schedin S, Pentchev P, Dallner G. Reduced cholesterolaccumulation and improved deficient peroxisomalfunctions in a murine model of Niemann-Pick type C

disease upon treatment with peroxisomal proliferators.Biochem Pharmacol 1998;56:1195-1199.

25. Hsu YS, Hwu WL, Huang SF, Lu MY, Chen RL, Lin DT etal. Niemann-Pick disease type C (a cellular cholesterollipidosis) treated by bone marrow transplantation. BoneMarrow Transplant 1999;24:103-107.

26. Erlich S, Miranda SR, Visser JW, Dagan A, Gatt S,Schuchman EH. Fluorescence-based selection of gene-corrected hematopoietic stem and progenitor cells fromacid sphingomyelinase-deficient mice: implications forNiemann-Pick disease gene therapy and the developmentof improved stem cell gene transfer procedures. Blood1999;93:80-86.

27. http://www.npdf.org/treatmt.htm28. Barranger JA. Risks of Gaucher’s treatment. Lancet

2000;356:1353-1354. 29. Kranda M. Treatment of Gaucher’s disease with OGT 918.

Lancet 2000;356:677. 30. Mistry PK. Treatment of Gaucher’s disease with OGT 918.

Lancet 2000;356:676-677. 31. Mellor HR, Adam A, Platt FM, Dwek RA, Butter TD, Cox T

et al. Novel oral treatment of Gaucher’s disease with N-butyldeoxynojirimycin (OGT 918) to decrease substratebiosynthesis. Lancet 2000;355:1481-1485.

32. Abe A, Gregory S, Lee L, Killen PD, Brady RO, Kulkarni Aet al. Reduction of globotriaosylceramide in Fabry diseasemice by substrate deprivation. J Clin Invest2000;105:1563-1571.

33. Abe A, Arend LJ, Lee L, Lingwood C, Brady RO, ShaymanJA. Glycosphingolipid depletion in Fabry diseaselymphoblasts with potent inhibitors of glucosylceramidesynthase. Kidney Int 2000;57:446-454.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 18-01-2002 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 16-04-2002

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: Dr ¢ËÌ‹ÙÚÈÔ˜ π. ∑·ÊÂÈÚ›Ô˘ ¶·È‰›·ÙÚÔ˜-¶·È‰ÔÓÂ˘ÚÔÏfiÁÔ˜ ∂ÁÓ·Ù›·˜ 106, ∆.∫. 546 22, £ÂÛÛ·ÏÔÓ›ÎË E-mail: [email protected]


∂ÈÛ·ÁˆÁ‹OÈ ÁÔÓÂ›˜ ÙˆÓ ·È‰ÈÒÓ Ù· ÔÔ›· ¿Û¯Ô˘Ó ·fi

ÂÈÏË„›· ·ÓËÛ˘¯Ô‡Ó È‰È·›ÙÂÚ· Ì‹ˆ˜ ÙÔ ·È‰›ÙÔ˘˜ ÙÚ·˘Ì·ÙÈÛÙÂ› ÛÔ‚·Ú¿ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÂÓfi˜ÂÂÈÛÔ‰›Ô˘ ·ÒÏÂÈ·˜ ÙË˜ Û˘ÓÂ›‰ËÛË˜.

™˘¯Ó¿ ÂÈ‚¿ÏÏÔ˘Ó ÂÚÈÔÚÈÛÌÔ‡˜ ÛÙÈ˜ ‰Ú·ÛÙË-ÚÈfiÙËÙÂ˜ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜, ÔÈ ÔÔ›Â˜ ÌÔÚÂ› Ó·Ô‰ËÁ‹ÛÔ˘Ó ÛÂ ÌÂÙ·‚ÔÏ‹ ÛÙËÓ ÔÈfiÙËÙ· ÙË˜ ˙ˆ‹˜,·ÏÏ¿ Î·È ÛÂ ‰È·Ù·Ú·¯¤˜ ÛÙË Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘.Ÿˆ˜ Ê·›ÓÂÙ·È fiÌˆ˜ ·fi ÙËÓ ·Ó·ÛÎfiËÛË ÙË˜Û¯ÂÙÈÎ‹˜ ‚È‚ÏÈÔÁÚ·Ê›·˜, Ô Î›Ó‰˘ÓÔ˜ ÛˆÌ·ÙÈÎ‹˜‚Ï¿‚Ë˜ ÛÙ· ·È‰È¿ ÌÂ ÂÈÏË„›· Â›Ó·È ÂÏ¿¯ÈÛÙ· ·˘-ÍËÌ¤ÓÔ˜ Î·È Û¯Â‰fiÓ ÂÚÈÔÚ›˙ÂÙ·È ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ÂÎÂ›ÓÂ˜ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÔÏ‡ Û˘¯Ó¤˜ ‹ ·ÓıÂÎÙÈ-

Î¤˜ ÛÙ· Ê¿ÚÌ·Î· ÎÚ›ÛÂÈ˜ (1-5). ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ÔÈÛËÌ·ÓÙÈÎÔ› Î›Ó‰˘ÓÔÈ Ô˘ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó Ù· ¿ÙÔÌ·ÌÂ ÂÈÏË„›·, ·È‰È¿ Î·È ÂÓ‹ÏÈÎÂ˜, Î·ıÒ˜ Î·È Ô‰Ë-Á›Â˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ ÌÂ ‚¿ÛË ÌÈ· ‰ËÌÔ-Û›Â˘ÛË ÂÌÂÈÚÔÁÓˆÌfiÓˆÓ ÙË˜ ¢ÈÂıÓÔ‡˜ ŒÓˆÛË˜ÁÈ· ÙËÓ ∫·Ù·ÔÏ¤ÌËÛË ÙË˜ ∂ÈÏË„›·˜ (7).

∂È‰ÈÎ¤˜ ‚Ï¿‚Â˜¶ÓÈÁÌfi˜: O ÓÈÁÌfi˜, ÏfiÁˆ ÙË˜ Î·Ù·‚‡ıÈÛË˜ ÙÔ˘

ÎÂÊ·ÏÈÔ‡ ÛÙÔ ÓÂÚfi, Â›Ó·È ÙÔ Û˘¯ÓfiÙÂÚÔ ı·Ó·ÙËÊfi-ÚÔ ·Ù‡¯ËÌ·. ∏ Û˘¯ÓfiÙËÙ· ÙÔ˘ ÓÈÁÌÔ‡ ÛÙ· ¿ÙÔÌ·ÌÂ ÂÈÏË„›· Â›Ó·È 4-7 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË ·fi ÂÎÂ›-ÓË ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi (3,4).

£¿Ó·ÙÔ˜ ˆ˜ Û˘Ó¤ÂÈ· ÓÈÁÌÔ‡ ¤¯ÂÈ ÂÚÈÁÚ·ÊÂ›


293

∞·ÁÔÚÂ‡ÛÂÈ˜ ÛÙ· ·È‰È¿ Ù· ÔÔ›· ¿Û¯Ô˘Ó ·fi ÂÈÏË„›· ∞. ™Î·Ú‰Ô‡ÙÛÔ˘

Restrictions for children with epilepsy A. Skardoutsou

E¶π∫∞πƒ∞ £∂ª∞∆∞ CURRENT ISSUES

µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

2nd Pediatric Clinic of University of Athens Children’s Hospital “P. & A. Kyriakou”, Athens

�¶ÂÚ›ÏË„Ë: ∏ Î·Ï‡ÙÂÚË Î·Ù·ÓfiËÛË ÙË˜ ÂÈÏË-„›·˜ ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂÎ·ÂÙ›· Î·È Ë ¯ÚËÛÈÌÔÔ›ËÛËÔÏÏÒÓ Ó¤ˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ¤¯Ô˘Ó·ÏÏ¿ÍÂÈ ÙËÓ ·ÓÙ›ÏË„‹ Ì·˜ ÁÈ· ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ Ê˘-ÛÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÙÔÓ ÔÔ›Ô ·ÓÙÈÌÂÙˆ›˙Ô˘Ó Ù· ¿ÙÔ-Ì· ÌÂ ÂÈÏË„›·. ™‹ÌÂÚ· ıÂˆÚÂ›Ù·È fiÙÈ Ù· ¿ÙÔÌ··˘Ù¿ ı· Ú¤ÂÈ Ó· ÂÓı·ÚÚ‡ÓÔÓÙ·È Ó· ˙Ô˘Ó fiÛÔ ÙÔ‰˘Ó·ÙfiÓ Ê˘ÛÈÔÏÔÁÈÎ‹ ˙ˆ‹ Î·È Ó· Û˘ÌÌÂÙ¤¯Ô˘ÓÛÙÈ˜ ‰Ú·ÛÙËÚÈfiÙËÙÂ˜ ÔÈ ÔÔ›Â˜ ‰ÂÓ Û˘ÓÂ¿ÁÔÓÙ·ÈÛÔ‚·Úfi Î›Ó‰˘ÓÔ ÛˆÌ·ÙÈÎ‹˜ ‚Ï¿‚Ë˜. ∂ÓÙÔ‡ÙÔÈ˜,ÔÚÈÛÌ¤ÓÂ˜ ÚÔÊ˘Ï¿ÍÂÈ˜ ÎÚ›ÓÔÓÙ·È ÛÎfiÈÌÂ˜. ¶ÂÚÈ-ÁÚ¿ÊÔÓÙ·È ÔÈ ÛËÌ·ÓÙÈÎÔ› Î›Ó‰˘ÓÔÈ ÔÈ ÔÔ›ÔÈ ·ÂÈ-ÏÔ‡Ó Ù· ¿ÙÔÌ· ÌÂ ÂÈÏË„›·, Î·ıÒ˜ Î·È Ô‰ËÁ›Â˜ ÁÈ·ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ ‚¿ÛÂÈ ÌÈ·˜ ‰ËÌÔÛ›Â˘ÛË˜ÂÌÂÈÚÔÁÓˆÌfiÓˆÓ ÙË˜ ¢ÈÂıÓÔ‡˜ ŒÓˆÛË˜ ÁÈ· ÙËÓ∫·Ù·ÔÏ¤ÌËÛË ÙË˜ ∂ÈÏË„›·˜ (InternationalLeague Against Epilepsy) (7).

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÂÈÏË„›·, ·È‰È¿, ÙÚ·˘Ì·ÙÈÛÌÔ›,··ÁÔÚÂ‡ÛÂÈ˜, Û˘ÛÙ¿ÛÂÈ˜.

�Abstract: Children with epilepsy should beencouraged to live as normal life as possible.However many children with seizure disordersmust take special precautions because of seizurerelated injuries. The specific injuries from a seizureand a set of guidelines based on a report of theInternational League against Epilepsy (7) ispresented.

Key words: epilepsy, children, injuries, restrictions,recommendations.



294

ÛÂ ÂÈÏËÙÈÎÔ‡˜ ÂÓ‹ÏÈÎÂ˜ Ì¤ÛË˜ ËÏÈÎ›·˜ 20-30ÂÙÒÓ, ÂÓÒ Â›Ó·È Û¿ÓÈÔ˜ ÛÙ· ÌÈÎÚfiÙÂÚ· ·È‰È¿ Ù·ÔÔ›· Â›¯·Ó Î·Ï‹ ÂÈÙ‹ÚËÛË Î·Ù¿ ÙÔ ‰È¿ÛÙËÌ·ÙË˜ Â·Ê‹˜ ÙÔ˘˜ ÌÂ ÙÔ ÓÂÚfi (3-5). ™Â fiÛ· ·È‰È¿¤ÁÈÓÂ ¤ÁÎ·ÈÚË Î·È ÛˆÛÙ‹ ·Ó¿ÓË„Ë ‰ÂÓ ·Ú¤ÌÂÈÓ·ÓÓÂ˘ÚÔÏÔÁÈÎ¿ Î·Ù¿ÏÔÈ·. ™Ù· ·È‰È¿ ËÏÈÎ›·˜ Î¿ÙˆÙˆÓ 5 ÂÙÒÓ, Ë Û˘¯ÓfiÙËÙ· ÓÈÁÌÔ‡ ‰ÂÓ ‰È·Ê¤ÚÂÈ·fi ÂÎÂ›ÓË ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi, ›Ûˆ˜ ÏfiÁˆ ÙË˜Î·Ï‡ÙÂÚË˜ ÂÈÙ‹ÚËÛË˜ ÛÙËÓ ËÏÈÎ›· ·˘Ù‹ (4). ∆··È‰È¿ ÌÂ ÂÈ‰ÈÎ¤˜ ·Ó¿ÁÎÂ˜ Î·È ÂÎÂ›Ó· ÌÂ ÊÙˆ¯fi¤ÏÂÁ¯Ô ÙˆÓ ÎÚ›ÛÂˆÓ ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔÎ·Ù·‚‡ıÈÛË˜ Î·È ¯ÚÂÈ¿˙ÔÓÙ·È È‰È·›ÙÂÚË ÚÔÛÔ¯‹Î·È Û˘ÓÂ¯‹ Â›‚ÏÂ„Ë.

¶ÓÈÁÌfi˜ ¤¯ÂÈ ÂÚÈÁÚ·ÊÂ› ÛÙË ı¿Ï·ÛÛ·, ÛÙËÌ·ÓÈ¤Ú· ÙÔ˘ ÛÈÙÈÔ‡, ÛÙËÓ ÈÛ›Ó· ÎÔÏ‡Ì‚ËÛË˜,·ÎfiÌË Î·È ÛÙËÓ ÈÛ›Ó· ˘‰ÚÔıÂÚ·Â›·˜. ¶ÈÔ ÂÈÎ›Ó-‰˘ÓÔ˜ ¯ÒÚÔ˜ Â›Ó·È ÙÔ Ì¿ÓÈÔ ÙÔ˘ ÛÈÙÈÔ‡, ÂÊ’fiÛÔÓ ÂÚÈÛÛfiÙÂÚ· ·fi Ù· ÌÈÛ¿ ¿ÙÔÌ· Ô˘ Â›¯·Ó·Ù‡¯ËÌ· ÂÎÂ› ·Â‚›ˆÛ·Ó. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÌÈ·˜ÂÈÏËÙÈÎ‹˜ ÎÚ›ÛË˜, ÙÔ ¿ÙÔÌÔ ÂÍ·Ê·Ó›˙ÂÙ·È ÁÚ‹-ÁÔÚ· Î¿Ùˆ ·fi ÙËÓ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ÓÂÚÔ‡, Û˘Ó‹-ıˆ˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÙÔÓÈÎ‹˜ Ê¿ÛË˜ ÙÔ˘ ÁÂ-ÓÈÎÂ˘Ì¤ÓÔ˘ ÙÔÓÈÎÔÎÏÔÓÈÎÔ‡ Û·ÛÌÔ‡. ∏ ‰È¿ÛˆÛËÂ›Ó·È Â˘ÎÔÏfiÙÂÚË ÛÙÔ Î·ı·Úfi Î·È Û¯ÂÙÈÎ¿ ÚË¯fiÓÂÚfi ÙË˜ ÈÛ›Ó·˜, ÛÂ Û¯¤ÛË ÌÂ ÙÔ ıÔÏfi ÓÂÚfi ÙÔ˘ÔÙ·ÌÔ‡ Î·È ÙË˜ Ï›ÌÓË˜.

∆Ú·‡Ì· ÙÔ˘ ÎÂÊ·ÏÈÔ‡: ∂›Ó·È Ô Û˘¯ÓfiÙÂÚÔ˜ Ù‡-Ô˜ ·Ù˘¯‹Ì·ÙÔ˜ Ô˘ ÌÔÚÂ› Ó· Û˘Ì‚Â› ÛÙ· ¿ÙÔÌ·ÌÂ ÂÈÏË„›·, Û¿ÓÈ· fiÌˆ˜ ÛÙ· ·È‰È¿ ÙÔ ÙÚ·‡Ì·Â›Ó·È ÙfiÛÔ ÛÔ‚·Úfi ÒÛÙÂ Ó· ÚÔÎ·Ï¤ÛÂÈ ÂÈÏÔ-Î¤˜, fiˆ˜ Â›Ó·È ÙÔ Î¿Ù·ÁÌ· ÙÔ˘ ÎÚ·Ó›Ô˘ Î·È Ë˘ÔÛÎÏËÚ›‰È· Û˘ÏÏÔÁ‹. ∆¤ÙÔÈÂ˜ ÂÈÏÔÎ¤˜ ¤¯Ô˘ÓÂÚÈÁÚ·ÊÂ› ÛÂ ÂÓ‹ÏÈÎÂ˜ ÌÂ ·ÓıÂÎÙÈÎ‹ ÛÙ· Ê¿ÚÌ·-Î· ÂÈÏË„›·, ÔÈ ÔÔ›ÔÈ ‰È¤ÌÂÓ·Ó ÛÂ È‰Ú‡Ì·Ù· (1).

∂ÁÎ·‡Ì·Ù·: ™Â ÂÓ‹ÏÈÎÂ˜ ÌÂ ÂÈÏË„›· ¤¯Ô˘Ó ÂÚÈ-ÁÚ·ÊÂ› ÂÁÎ·‡Ì·Ù·, Ù· ÔÔ›· Û˘Ó‹ıˆ˜ Û˘Ì‚·›ÓÔ˘ÓÛÙÔ Û›ÙÈ ·fi ÙÔ ˙ÂÛÙfi ÓÂÚfi ÛÙËÓ ÎÔ˘˙›Ó· Î·È ÙÔÌ¿ÓÈÔ, ÙÔ ËÏÂÎÙÚÈÎfi Û›‰ÂÚÔ, ÙÈ˜ ËÏÂÎÙÚÈÎ¤˜ Û˘-ÛÎÂ˘¤˜ Î·È ÙË ÊˆÙÈ¿ ÙÔ˘ Ù˙·ÎÈÔ‡ (6). ∆· ÛÔ‚·ÚfiÙÂ-Ú· Â›Ó·È ÂÎÂ›Ó· ÛÙÔ Ì¿ÓÈÔ. ∆· ÂÁÎ·‡Ì·Ù· ·˘Ù¿ ÌÔ-ÚÔ‡Ó ÛÂ ÌÂÁ¿ÏÔ ‚·ıÌfi Ó· ÚÔÏËÊıÔ‡Ó ÛÙ· ·È‰È¿.

∞Ó·ÁÎ·ÈfiÙËÙ· ÙˆÓ ÂÚÈÔÚÈÛÌÒÓªÂ ÛÎÔfi Ó· ÂÎÙÈÌËıÂ› Ë ·Ó·ÁÎ·ÈfiÙËÙ· ÁÈ· Â-

ÚÈÔÚÈÛÌÔ‡˜ ÛÙÈ˜ ‰Ú·ÛÙËÚÈfiÙËÙÂ˜ ÙˆÓ ·ÙfiÌˆÓ Ô˘¿Û¯Ô˘Ó ·fi ÂÈÏË„›·, Û˘ÁÎÚÔÙ‹ıËÎÂ Ì›· ÂÈ-ÙÚÔ‹ ÂÌÂÈÚÔÁÓˆÌfiÓˆÓ ˘fi ÙËÓ ·ÈÁ›‰· ÙË˜ ¢ÈÂ-ıÓÔ‡˜ ŒÓˆÛË˜ Î·Ù¿ ÙË˜ ∂ÈÏË„›·˜. ∆Ô ÁÂÓÈÎfi Û˘-Ì¤Ú·ÛÌ· Ô˘ ‰È·Ù˘ÒıËÎÂ ‹Ù·Ó fiÙÈ ·Ó Î·È ‰ÂÓÂ›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÊ·ÚÌÔÛÙÔ‡Ó Î·ÓfiÓÂ˜ ÎÔÈÓÔ› ÁÈ·fiÏ· Ù· ·È‰È¿, ÔÚÈÛÌ¤ÓÂ˜ ··ÁÔÚÂ‡ÛÂÈ˜ Û·Ó ·Ú¯‹ÎÚ›ÓÔÓÙ·È ÛÎfiÈÌÂ˜ (7). OÈ ··ÁÔÚÂ‡ÛÂÈ˜, fiˆ˜·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙÔ ·ÚfiÓ ÎÂ›ÌÂÓÔ, ÚÔ¤Ú¯ÔÓÙ·È

Î·Ù¿ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ ÙÔ˘˜ ·fi ÙÈ˜ ·ÔÊ¿-ÛÂÈ˜ ÙË˜ ·ÓˆÙ¤Úˆ ÂÈÙÚÔ‹˜ ÂÌÂÈÚÔÁÓˆÌfiÓˆÓ,fiˆ˜ ·ÎÚÈ‚Ò˜ ¤¯Ô˘Ó ‰ËÌÔÛÈÂ˘ıÂ› ÛÙÔÓ ÂÈÛÙËÌÔ-ÓÈÎfi Ù‡Ô (7). ∏ ·fiÊ·ÛË ÁÈ· ÙÔ Â›‰Ô˜ ÙË˜ ··-ÁfiÚÂ˘ÛË˜ Ú¤ÂÈ Ó· ·ÔÚÚ¤ÂÈ ·fi ÙËÓ ÎÔÈÓ‹ ÏÔ-ÁÈÎ‹, ÒÛÙÂ Ó· ÌËÓ ‰È·Ù·Ú¿ÛÛÂÙ·È Ë ÈÛÔÚÚÔ›· ÌÂ-Ù·Í‡ ÙË˜ ·Ó¿ÁÎË˜ ÙÔ˘ ·È‰ÈÔ‡ ÁÈ· Ê˘ÛÈÎ‹ ÚÔ-ÛÙ·Û›· ·ÊÂÓfi˜ Î·È Û˘ÓÂ¯È˙fiÌÂÓË ÁÓÒÛË Î·È ·˘ÙÔ-ÂÎÙ›ÌËÛË ·ÊÂÙ¤ÚÔ˘. O ÚfiÏÔ˜ ÙÔ˘ ÁÈ·ÙÚÔ‡ ÛÙÈ˜ÂÚÈÙÒÛÂÈ˜ ·˘Ù¤˜ Â›Ó·È Ó· ‰ÈÂ˘ÎÔÏ‡ÓÂÈ ÙËÓ ÂÊÂ˘-ÚÂÙÈÎfiÙËÙ· ÙˆÓ ÁÔÓ¤ˆÓ Ó· ÚÔÛ·ÚÌfiÛÔ˘Ó ÙÈ˜Û¯ÂÙÈÎ¤˜ ··ÁÔÚÂ‡ÛÂÈ˜ ÛÙÔÓ ÙÚfiÔ ˙ˆ‹˜ Î·È ÙËÓÚÔÛˆÈÎfiÙËÙ· ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜.

OÈ ÂÚÈÔÚÈÛÌÔ› ÂÍ˘ËÚÂÙÔ‡Ó ÙÚÂÈ˜ Î‡ÚÈÔ˘˜ Ïfi-ÁÔ˘˜. O ÚÒÙÔ˜ Â›Ó·È Ó· ÂÚÈÔÚÈÛÙÂ› Ô Î›Ó‰˘ÓÔ˜ÛˆÌ·ÙÈÎ‹˜ ‚Ï¿‚Ë˜, fiˆ˜ Â›Ó·È Ë ÙÒÛË, ÙÔ¤ÁÎ·˘Ì·, ÔÈ ıÏ¿ÛÂÈ˜, Ë ÂÎ‰ÔÚ¿, ÙÔ Î¿Ù·ÁÌ· ÙˆÓÔÛÙÒÓ Î·È ÙˆÓ ‰ÔÓÙÈÒÓ Î·È ÙÔ ÂÍ¿ÚıÚËÌ· ÙÔ˘ ÈÛ¯›-Ô˘. O ‰Â‡ÙÂÚÔ˜ ÏfiÁÔ˜ Â›Ó·È Ó· ÂÚÈÔÚÈÛÙÂ› Ë ¤Î-ıÂÛË ÙÔ˘ ·È‰ÈÔ‡ ÛÂ ·Ú¿ÁÔÓÙÂ˜ Ô˘ ÌÔÚÂ› ÛÂÔÚÈÛÌ¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜ Ó· ÂÈÛÂ‡ÛÔ˘Ó ÙËÓ ÂÌ-Ê¿ÓÈÛË Û·ÛÌÒÓ, fiˆ˜ Â›Ó·È Ù· ‰È·ÏÂ›ÔÓÙ· Êˆ-ÙÂÈÓ¿ ÂÚÂı›ÛÌ·Ù·, Ë ÛÙ¤ÚËÛË ÙÔ˘ ‡ÓÔ˘ Î·È Ë ·Ï-ÎÔfiÏË. ŒÓ·˜ ÙÚ›ÙÔ˜ ÏfiÁÔ˜ Â›Ó·È, ÁÈ· ÔÚÈÛÌ¤ÓÂ˜ÂÚÈÙÒÛÂÈ˜, Ë ÚfiÏË„Ë ÙÔ˘ Û˘Ó·ÈÛıËÌ·ÙÈÎÔ‡ÙÚ·‡Ì·ÙÔ˜.

OÈ ÂÚÈÔÚÈÛÌÔ› ÈÛ¯‡Ô˘Ó ÁÈ· Û˘ÁÎÂÎÚÈÌ¤ÓÔ ¯ÚÔ-ÓÈÎfi ‰È¿ÛÙËÌ·, ÛÙÈ˜ ·ÎfiÏÔ˘ıÂ˜ ÂÚÈÙÒÛÂÈ˜: ·)ÁÈ· ‰È¿ÛÙËÌ· 2-3 ÌËÓÒÓ ÌÂÙ¿ ·fi ¤Ó· ÚÒÙÔ ÂÈ-ÏËÙÈÎfi ÂÂÈÛfi‰ÈÔ ÁÈ· ÙÔ ÔÔ›Ô ‰ÂÓ ¤¯ÂÈ ‰ÔıÂ›Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÁˆÁ‹, ‚) ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·ÁˆÁ‹˜ Î·È Ì¤¯ÚÈ˜ fiÙÔ˘ ÂÎÙÈÌËıÂ›fiÙÈ ‰ÂÓ Â›Ó·È ÔÏ‡ Èı·Ófi Ó· ·ÎÔÏÔ˘ı‹ÛÔ˘Ó Î·È¿ÏÏ· ÂÂÈÛfi‰È· Î·È Á) ÁÈ· Ï›ÁÔ˘˜ Ì‹ÓÂ˜ ÌÂÙ¿ ÙË‰È·ÎÔ‹ ÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ.

OÈ ÂÚÈÔÚÈÛÌÔ› ÌÔÚÂ› Ó· ‰È·ÙËÚËıÔ‡Ó ÁÈ··ÚÔÛ‰ÈfiÚÈÛÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÛÙ· ·È‰È¿ ÌÂÂ›ÌÔÓÔ˘˜ Û·ÛÌÔ‡˜, ÔÈ ÔÔ›ÔÈ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔ-ÓÙ·È ÛÙË ıÂÚ·Â›·. ªÂÚÈÎ¿ ·fi ·˘Ù¿ ¿Û¯Ô˘Ó·fi ÂÍÂÏÈÎÙÈÎ¿ ÂÈÏËÙÈÎ¿ Û‡Ó‰ÚÔÌ·. ™Â ·Ó¿ÏÔ-ÁÂ˜ ÂÚÈÙÒÛÂÈ˜, ÔÈ ··ÁÔÚÂ‡ÛÂÈ˜ ÌÔÚÂ› Ó· ÙÚÔ-ÔÔÈËıÔ‡Ó ÌÂ ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘.

¶·Ú¿ÁÔÓÙÂ˜ ÔÈ ÔÔ›ÔÈ ÂËÚÂ¿˙Ô˘Ó ÙËÓ ·fiÊ·ÛËÁÈ· ÙÔ˘˜ ÂÚÈÔÚÈÛÌÔ‡˜

∏ÏÈÎ›· ÙÔ˘ ·È‰ÈÔ‡: OÈ ÂÈÙÚÂfiÌÂÓÂ˜ ‰Ú·ÛÙË-ÚÈfiÙËÙÂ˜ ı· Ú¤ÂÈ Ó· Â›Ó·È ·Ó¿ÏÔÁÂ˜ ÌÂ ÙËÓ ËÏÈ-Î›· ÙÔ˘ ·È‰ÈÔ‡ Î·È Ó· Ù·ÈÚÈ¿˙Ô˘Ó ÌÂ ÙÔ ¯·Ú·ÎÙ‹-Ú· Î·È ÙËÓ ÈÎ·ÓfiÙËÙ¿ ÙÔ˘ Ó· Î·Ù·ÓÔÂ›. °È· Ù· ·È-‰È¿ Î¿Ùˆ ÙˆÓ 8 ÂÙÒÓ, ÔÈ ÂÚÈÔÚÈÛÌÔ› ¤¯Ô˘Ó ÙÔÓ ¯·-Ú·ÎÙ‹Ú· ÙˆÓ Î·ÓfiÓˆÓ. ∆· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Û˘-Ó‹ıˆ˜ Î·Ù·ÓÔÔ‡Ó ÙË ÛËÌ·Û›· Î·È ÙËÓ ·Ó·ÁÎ·ÈfiÙË-Ù· ÙˆÓ ÂÚÈÔÚÈÛÌÒÓ Î·È ı· Ú¤ÂÈ Ó· ÂÈ‰ÈÒÎÂÙ·È


Ë Û˘Ó·›ÓÂÛ‹ ÙÔ˘˜, ·ÊÔ‡ ÚÒÙ· ÙÔ˘˜ ÂÍËÁËıÂ› fiÙÈı· ÈÛ¯‡ÛÔ˘Ó ÁÈ· ÂÚÈÔÚÈÛÌ¤ÓÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·.

∆‡Ô˜ ÙˆÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ: ŸÙ·Ó ÔÈ ÎÚ›-ÛÂÈ˜ Û˘Ì‚·›ÓÔ˘Ó ÌfiÓÔ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘‹ ‰ÂÓ ÚÔÎ·ÏÔ‡Ó ·ÒÏÂÈ· ÙË˜ Û˘ÓÂ›‰ËÛË˜, ‰ÂÓ¯ÚÂÈ¿˙ÂÙ·È ÌÂÙ·‚ÔÏ‹ ÛÙÔÓ ÙÚfiÔ ÙË˜ ˙ˆ‹˜ ÙÔ˘·È‰ÈÔ‡. ∞ÓÙ›ıÂÙ·, ÔÈ ÎÚ›ÛÂÈ˜ Ô˘ ÚÔÎ·ÏÔ‡Ó ‚·-ıÈ¿ ·ÒÏÂÈ· ÙË˜ Û˘ÓÂ›‰ËÛË˜, ‚¿˙Ô˘Ó ÙÔ ·È‰› ÛÂÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Èı·ÓfiÙËÙ·ÚfiÎÏËÛË˜ Ê˘ÛÈÎ‹˜ ‚Ï¿‚Ë˜. ªÂÚÈÎ¿ ·È‰È¿ ·-ÚÔ˘ÛÈ¿˙Ô˘Ó ·Ú·ÙÂÙ·Ì¤ÓË ÌÂÙÂÎÚÈÙÈÎ‹ Ê¿ÛË˘ÓËÏ›·˜ Î·È Î·Ù¿ ÙÔ ‰È¿ÛÙËÌ· ·˘Ùfi ¯ÚÂÈ¿˙ÔÓÙ·È·Ú·ÎÔÏÔ‡ıËÛË.

™˘¯ÓfiÙËÙ· ÙˆÓ ÎÚ›ÛÂˆÓ: ŸÙ·Ó ÔÈ ÂÈÏËÙÈÎ¤˜ÎÚ›ÛÂÈ˜ Â›Ó·È ·Ú·È¤˜, ÌÔÚÂ› Ó· ÌËÓ ¯ÚÂÈ¿˙ÂÙ·È Î·-Ó¤Ó·˜ ÂÚÈÔÚÈÛÌfi˜. ∂¿Ó ¤¯ÂÈ ÂÚ¿ÛÂÈ ¯ÚÔÓÈÎfi ‰È¿-ÛÙËÌ· ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ ¯ˆÚ›˜ ÂÂÈÛfi-‰ÈÔ Û·ÛÌÒÓ, Â›Ó·È ÏÔÁÈÎfi ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ÂÚÈÔ-ÚÈÛÌÔ› ÛÙ·‰È·Î¿ Ó· ‰È·ÎfiÙÔÓÙ·È. ∞ÓÙ›ıÂÙ·, ÛÙ··È‰È¿ ÌÂ ÔÏ‡ Û˘¯Ó¤˜ ÎÚ›ÛÂÈ˜, fiˆ˜ Â›Ó·È Û˘Ó‹-ıˆ˜ ÔÈ ·Ê·ÈÚ¤ÛÂÈ˜, ÔÈ Ì˘ÔÎÏÔÓÈÎÔ›, ÔÈ ·ÙÔÓÈÎÔ› ‹ ÔÈÙÔÓÈÎÔ› Û·ÛÌÔ›, fiˆ˜ Î·È ÛÙËÓ ÂÚ›ÙˆÛË Úˆ-ÙÔ‰È·ÁÓˆÛıÂ›Û·˜ ÂÈÏË„›·˜, ÔÈ ÂÚÈÔÚÈÛÌÔ› Ú¤-ÂÈ Ó· Û˘ÓÂ¯›˙ÔÓÙ·È Ì¤¯ÚÈ˜ fiÙÔ˘ ÂÈÙÂ˘¯ıÂ› ÈÎ·ÓÔ-ÔÈËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÎÚ›ÛÂˆÓ.

ÃÚfiÓÔ˜ Î·È ÙfiÔ˜ Ô˘ Û˘Ì‚·›ÓÔ˘Ó ÔÈ ÂÈÏËÙÈ-Î¤˜ ÎÚ›ÛÂÈ˜: ™Â ÔÚÈÛÌ¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜, ÔÈ ÎÚ›ÛÂÈ˜ÂÈÛÂ‡‰ÔÓÙ·È ·fi Ù· ‰È·ÏÂ›ÔÓÙ· ÊˆÙÂÈÓ¿ ÂÚÂı›-ÛÌ·Ù·, Ù· ÔÔ›· ÂÎ¤ÌÂÈ Ë ÔıfiÓË ÙË˜ ÙËÏÂfiÚ·-ÛË˜, ÙÔ˘ ‚›ÓÙÂÔ Î·È Ë ÓÙÈÛÎÔÙ¤Î. OÈ Û˘Óı‹ÎÂ˜ ·˘-Ù¤˜ Ú¤ÂÈ Ó· ·ÔÊÂ‡ÁÔÓÙ·È ‹ Ó· ÌÂÈÒÓÂÙ·È Ë Â›-‰Ú·Û‹ ÙÔ˘˜ ÌÂ ÙÔ Ó· ·ÔÊÂ‡ÁÂÈ ÙÔ Â˘·›ÛıËÙÔ ¿ÙÔ-ÌÔ Ó· ÎÔÈÙ¿˙ÂÈ ÙË ÊˆÙÂÈÓ‹ ËÁ‹ ‹ Ó· ÎÏÂ›ÓÂÈ ÙÔ ¤Ó·ÙÔ˘ Ì¿ÙÈ fiÙ·Ó ·ÈÛı¿ÓÂÙ·È Î¿ÔÈ· ‰˘ÛÊÔÚ›·.

™˘ÌÌfiÚÊˆÛË: ∏ ˘Â˘ı˘ÓfiÙËÙ· ÙÔ˘ ·È‰ÈÔ‡ Ó··›ÚÓÂÈ Ù· ·ÓÙÈÂÈÏËÙÈÎ¿ Ê¿ÚÌ·Î· ÛÂ Î·ÓÔÓÈÎ¿‰È·ÛÙ‹Ì·Ù· Â›Ó·È ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ÂËÚÂ¿˙ÂÈ ÙËÓ ·Ó¿ÁÎË ÁÈ· ÂÚÈÔÚÈÛÌÔ‡˜, È‰È·›ÙÂÚ·Î·Ù¿ ÙËÓ ÂÊË‚ÈÎ‹ ËÏÈÎ›·, fiˆ˜ Î·È Ë ÔÈÎÔÓÔÌÈÎ‹ Â˘-¯¤ÚÂÈ· ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜ Ó· ·ÁÔÚ¿˙ÂÈ Û˘ÛÙËÌ·ÙÈÎ¿Ù· Ê¿ÚÌ·Î·, ·Ó Î·È Ù· ·ÓÙÈÂÈÏËÙÈÎ¿ Ê¿ÚÌ·Î· Û‹-ÌÂÚ· ¯ÔÚËÁÔ‡ÓÙ·È ¯ˆÚ›˜ ÔÈÎÔÓÔÌÈÎ‹ Û˘ÌÌÂÙÔ¯‹.

™˘ÓÓÔÛËÚfiÙËÙ·: ∏ Û˘Ó‡·ÚÍË ÙË˜ ÂÈÏË„›·˜ÌÂ ¿ÏÏÔ ¯ÚfiÓÈÔ ÓfiÛËÌ· Â›Ó·È ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁÔ-ÓÙ·˜ Ô˘ ÂËÚÂ¿˙ÂÈ (·˘Í¿ÓÂÈ) ÙËÓ ·Ó¿ÁÎË ÁÈ· Â-ÚÈÔÚÈÛÌÔ‡˜.

¢˘ÓËÙÈÎ¤˜ ··ÁÔÚÂ‡ÛÂÈ˜ OÈ ·ÎfiÏÔ˘ıÂ˜ ··ÁÔÚÂ‡ÛÂÈ˜ ÎÚ›ÓÔÓÙ·È ÛÎfiÈ-

ÌÂ˜ ÁÈ· Ù· ·È‰È¿ ÌÂ ÂÈÏË„›·, fiÔ˘ Ô Î›Ó‰˘ÓÔ˜ Î·-Ù¿ ÙË ‰È¿ÚÎÂÈ· ÌÈ·˜ ÎÚ›ÛË˜ ÂÎÙÈÌ¿Ù·È fiÙÈ Â›Ó·È ÛÔ-‚·ÚfiÙÂÚÔ˜ ·fi ÙÈ˜ ÂÈÙÒÛÂÈ˜ ÙË˜ ··ÁfiÚÂ˘ÛË˜.

™ÙÔ Û›ÙÈ: ∆· ·È‰È¿ ‰ÂÓ Ú¤ÂÈ ÔÙ¤ Ó· Ì¤ÓÔ˘ÓÌfiÓ· ÙÔ˘˜ ÛÙÔ Ì¿ÓÈÔ. ∆· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Ú¤-ÂÈ Ó· ÂÓı·ÚÚ‡ÓÔÓÙ·È Ó· ¯ÚËÛÈÌÔÔÈÔ‡Ó ÙÔ ÓÙÔ˘˜Î·È Ó· ·›ÚÓÔ˘Ó ÔÚÈÛÌ¤ÓÂ˜ ÚÔÊ˘Ï¿ÍÂÈ˜ (¶›Ó·Î·˜1). ∞ÒÏÂÈ· ÙË˜ Û˘ÓÂ›‰ËÛË˜ ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÂÈÛÂ ÙÒÛË ÛÙÔ Ì¿ÓÈÔ Î·È ÓÈÁÌfi. ∫ÏÈÓÔÛÎÂ¿ÛÌ·-Ù· Ù· ÔÔ›· ÌÔÚÂ› Ó· ÚÔÎ·Ï¤ÛÔ˘Ó ·ÛÊ˘Í›·,fiˆ˜ Â›Ó·È Ù· Ê·Ú‰È¿ Î·Ï‡ÌÌ·Ù· ÙˆÓ Ì·ÍÈÏ·ÚÈÒÓÎ·È ÙÔ˘ ·ÏÒÌ·ÙÔ˜, Ù· ÔÏ‡ ÌÂÁ¿Ï· Î·È Ì·Ï·Î¿Ì·ÍÈÏ¿ÚÈ· Î·È Ù· ËÏÂÎÙÚÈÎ¿ ·ÏÒÌ·Ù·, Ú¤ÂÈ Ó··ÔÊÂ‡ÁÔÓÙ·È, È‰È·›ÙÂÚ· ÛÙ· ‚Ú¤ÊË Î·È Ù· ÔÏ‡ÌÈÎÚ¿ ·È‰È¿. ∂›ÛË˜, Ú¤ÂÈ Ó· ·ÔÊÂ‡ÁÔÓÙ·È ÔÈ·ÓÔÈ¯ÙÔ› ÊÔ‡ÚÓÔÈ, Ù· ·ÓÔÈ¯Ù¿ Ù˙¿ÎÈ· Î·È ÔÈ ÛÎ¿ÏÂ˜¯ˆÚ›˜ ÚÔÛÙ·ÙÂ˘ÙÈÎfi ÎÈÁÎÏ›‰ˆÌ· ·ÛÊ·ÏÂ›·˜.

ÕÏÏÔÈ ÎË‰ÂÌfiÓÂ˜ ÂÎÙfi˜ ·fi ÙÔ˘˜ ÁÔÓÂ›˜: ∏ ÌÂ-˚ÌÈÛ›ÙÂÚ, ÙÔ ÚÔÛˆÈÎfi ÙÔ˘ ·È‰ÈÎÔ‡ ÛÙ·ıÌÔ‡ Î·È


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¶›Ó·Î·˜ 1. ™˘ÛÙ¿ÛÂÈ˜ ÁÈ· ÙËÓ ÚÔÛÙ·Û›· ÙˆÓ ·È‰ÈÒÓ Ô˘ ¿Û¯Ô˘Ó ·fi ÂÈÏË„›·, Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ·Ú·ÌÔÓ‹˜ ÙÔ˘˜ ÛÙÔÓÂÚfi (Kemp Î·È Sibert)

∫ÔÏ‡ÌÈñ ¡· ÎÔÏ˘Ì¿ Ì·˙› ÌÂ Î¿ÔÈÔ Ê›ÏÔ ÙÔ˘ ‹ ÂÓ‹ÏÈÎ· Ô˘ Í¤ÚÂÈ Î·Ïfi ÎÔÏ‡ÌÈ ñ ∫·Ï‹ ÂÈÙ‹ÚËÛË ÛÙËÓ ÈÛ›Ó·. O ÂÈÙËÚËÙ‹˜ Ó· ¤¯ÂÈ ÂÎ·È‰Â˘ÙÂ› ÛÙËÓ Î·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈÎ‹ ·Ó¿ÓË„Ë Î·È Ó· ÁÓˆÚ›˙ÂÈ ÏÂÙÔ-

Ì¤ÚÂÈÂ˜ ÁÈ· ÙËÓ ÂÈÏË„›· ÙÔ˘ ·È‰ÈÔ‡ ñ ¡· ·ÔÊÂ‡ÁÂÙ·È ÙÔ ÎÔÏ‡ÌÈ ÛÙ· ÔÙ¿ÌÈ· Î·È ÙÈ˜ Ï›ÌÓÂ˜

§Ô˘ÙÚfi Î·ı·ÚÈfiÙËÙ·˜ ñ ¡· ÏÔ‡˙ÂÙ·È ÌÂ ÙÔ ÙËÏ¤ÊˆÓÔ ÙÔ˘ ÓÙÔ˘˜ ÛÙÔ ¯¤ÚÈ Î·È Ó· ÌËÓ ˘¿Ú¯ÂÈ ‰È·¯ˆÚÈÛÙÈÎfi ·fi Á˘·Ï› ÛÙË Ì·ÓÈ¤Ú·, ÒÛÙÂ Ó· ÚÔ-

ÏËÊıÂ› ÙÚ·˘Ì·ÙÈÛÌfi˜ ÙÔ˘ ÎÂÊ·ÏÈÔ‡ ñ ∆Ô ÌÈÎÚfi ·È‰› Ó· ‚Ú›ÛÎÂÙ·È ˘fi Û˘ÓÂ¯‹ Â›‚ÏÂ„Ë ñ ∏ fiÚÙ· ÙÔ˘ Ì¿ÓÈÔ˘ Ó· ÌËÓ ÎÏÂÈ‰ÒÓÂÈ

¶·È‰È¿ ÌÂ ÊÙˆ¯fi ¤ÏÂÁ¯Ô ÙˆÓ ÎÚ›ÛÂˆÓ ñ ™˘ÓÂ¯‹˜ Â›‚ÏÂ„Ë ·fi ÂÓ‹ÏÈÎ· ÛÂ fiÏË ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÎÔÏ‡Ì‚ËÛË˜ ‹ ÙÔ˘ ÏÔ˘ÙÚÔ‡ ñ ∆Ô ÏÔ˘ÙÚfi Î·ı·ÚÈfiÙËÙ·˜ Ó· Á›ÓÂÙ·È ÌÂ ÙÔ ·È‰› Î·ıÈÛÌ¤ÓÔ ÛÂ Î·ÚÂÎÏ¿ÎÈ, ÌÂ ÙË ‚·Ï‚›‰· ÙË˜ ·Ô¯¤ÙÂ˘ÛË˜ ·ÓÔÈ¯Ù‹ Î·È ÙÔ ÙË-

Ï¤ÊˆÓÔ ÙÔ˘ ÓÙÔ˘˜ ÛÙÔ ¯¤ÚÈ ñ ™ÙÔ Ì¿ÓÈÔ Ó· ˘¿Ú¯ÂÈ ıÂÚÌÔÛÙ·ÙÈÎ‹ Ì·Ù·Ú›· Î·È, Â¿Ó Â›Ó·È ‰˘Ó·ÙfiÓ, ÂÈ‰ÈÎfi ÂÍ¿ÚÙËÌ· ÛÙÔ ÓÙÔ˘˜ ÙÔ ÔÔ›Ô ‰È·ÎfiÙÂÈ ÙË

ÚÔ‹ ÙÔ˘ ˙ÂÛÙÔ‡ ÓÂÚÔ‡ fiÙ·Ó ·˘Ùfi ÍÂÂÚ¿ÛÂÈ ÙËÓ ÚÔÎ·ıÔÚÈÛÌ¤ÓË ıÂÚÌÔÎÚ·Û›· ñ ∏ ÌËÙ¤Ú· Ô˘ ¿Û¯ÂÈ ·fi ÂÈÏË„›· Ó· Û˘ÓÔ‰Â‡ÂÙ·È ·fi ¿ÏÏÔ ¿ÙÔÌÔ fiÙ·Ó Î¿ÓÂÈ Ì¿ÓÈÔ ÙÔ ‚Ú¤ÊÔ˜ ‹ ÙÔ Ó‹ÈÔ ·È‰› ÙË˜.



296

ÙÔ˘ Û¯ÔÏÂ›Ô˘, fiˆ˜ Î·È Î¿ıÂ ¿ÙÔÌÔ ÙÔ ÔÔ›Ô ÊÚÔ-ÓÙ›˙ÂÈ ÙÔ ·È‰› Ú¤ÂÈ Ó· ÂÓËÌÂÚˆıÔ‡Ó fiÙÈ ÙÔ ·È-‰› ÂÓ‰¤¯ÂÙ·È Ó· ·ÚÔ˘ÛÈ¿ÛÂÈ ÎÚ›ÛÂÈ˜ ÂÈÏË„›·˜.∂È‚¿ÏÏÂÙ·È ÔÈ ÎË‰ÂÌfiÓÂ˜ Ó· ·ÔÎÙ‹ÛÔ˘Ó ÙÈ˜ ‚·-ÛÈÎ¤˜ ÁÓÒÛÂÈ˜ Û¯ÂÙÈÎ¿ ÌÂ ÙË ÓfiÛÔ, ÙÈ˜ ÚÔÊ˘Ï¿-ÍÂÈ˜ Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÌÈ·˜ ÎÚ›ÛË˜. OÈ ÎË‰ÂÌfi-ÓÂ˜ Û˘¯Ó¿ ÊÔ‚Ô‡ÓÙ·È fiÙÈ ‰ÂÓ ı· Â›Ó·È ÛÂ ı¤ÛË Ó··Ó·ÁÓˆÚ›ÛÔ˘Ó Ì›· ÎÚ›ÛË ‹ Ó· ‰ÒÛÔ˘Ó ÛˆÛÙ¿ ÙÈ˜ÚÒÙÂ˜ ‚Ô‹ıÂÈÂ˜ Â¿Ó ¯ÚÂÈ·ÛÙÂ›. OÈ ÁÔÓÂ›˜ ı· Ú¤-ÂÈ Ó· ‰ÒÛÔ˘Ó ÏÂÙÔÌÂÚ‹ ÂÚÈÁÚ·Ê‹ ÙË˜ ÎÚ›ÛË˜Î·È ÏËÚÔÊÔÚ›Â˜ ÁÈ· ÙÈ˜ ÚÒÙÂ˜ ‚Ô‹ıÂÈÂ˜, Î·ıÒ˜Î·È ÔÈÔÓ ı· Î·Ï¤ÛÔ˘Ó fiÙ·Ó Û˘Ì‚Â› Ì›· ÎÚ›ÛË. OÈÎË‰ÂÌfiÓÂ˜ Ú¤ÂÈ Ó· ·ÓÙÈ‰Ú¿ÛÔ˘Ó ÌÂ „˘¯Ú·ÈÌ›·,ÒÛÙÂ Ó· ÌËÓ ÙÚÔÌÔÎÚ·ÙËıÂ› ÙÔ ·È‰› Î·È ÔÈ ¿ÏÏÔÈ·ÚÂ˘ÚÈÛÎfiÌÂÓÔÈ. ªÂÙ¿ ÙÔ ÂÂÈÛfi‰ÈÔ ÔÏÏ¿ ·È-‰È¿ Â›Ó·È Û˘¯Ó¿ Û˘Á¯˘ÙÈÎ¿ Î·È ÙÚÔÌ·ÁÌ¤Ó· Î·È¯ÚÂÈ¿˙ÔÓÙ·È Î·ıËÛ‡¯·ÛË.

∂¿Ó ˘¿Ú¯ÂÈ ÁÈ·ÙÚfi˜ ‹ ·‰ÂÏÊ‹ ÓÔÛÔÎfiÌÔ˜ÛÙÔ Û¯ÔÏÂ›Ô, Ú¤ÂÈ Ó· ÂÓËÌÂÚÒÓÂÙ·È ·fi ÙÔ˘˜ÁÔÓÂ›˜ Û¯ÂÙÈÎ¿ ÌÂ ÙÈ˜ ÚÔÊ˘Ï¿ÍÂÈ˜ Î·È ÙÔ˘˜ Â-ÚÈÔÚÈÛÌÔ‡˜ Ô˘ Â›Ó·È ··Ú·›ÙËÙÔÈ. ∆Ô ·È‰› ÂÈ-ÙÚ¤ÂÙ·È Ó· Û˘ÌÌÂÙ¤¯ÂÈ ÛÙË Á˘ÌÓ·ÛÙÈÎ‹ Î·È ÛÙÈ˜·ıÏËÙÈÎ¤˜ ‰Ú·ÛÙËÚÈfiÙËÙÂ˜ Ô˘ Á›ÓÔÓÙ·È ÛÙÔ Û¯Ô-ÏÂ›Ô. ∏ Ù·ÎÙÈÎ‹ Ê˘ÛÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È ÔÈ Î·-ÓÔÓÈÎ¤˜ Û˘Óı‹ÎÂ˜ ÌÂÏ¤ÙË˜ ‰ÂÓ ÂÈÛÂ‡‰Ô˘Ó ÙÈ˜ÂÈÏËÙÈÎ¤˜ ÎÚ›ÛÂÈ˜. ªÂÚÈÎ¿ ·È‰È¿ ÔÏ‡ Û¿ÓÈ·¤¯Ô˘Ó ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ Ó· ÂÎ‰ËÏÒÛÔ˘Ó statusepilepticus. ∂¿Ó Ô ÎË‰ÂÌfiÓ·˜ ÙÔ˘˜ ÛÂ ·˘Ù¤˜ ÙÈ˜ÂÚÈÙÒÛÂÈ˜ ¤¯ÂÈ ÂÎ·È‰Â˘ÙÂ› Ó· ¯ÔÚËÁ‹ÛÂÈ ·ÓÙÈÂ-ÈÏËÙÈÎ¿ Ù·¯Â›·˜ ‰Ú¿ÛË˜ fiˆ˜ Â›Ó·È Ë ‰È·˙Â¿-ÌË ·fi ÙÔ ÔÚıfi, ÔÈ ··ÁÔÚÂ‡ÛÂÈ˜ ÛÂ ·˘Ù¤˜ ÙÈ˜ Â-ÚÈÙÒÛÂÈ˜ ÌÔÚÂ› Ó· Á›ÓÔ˘Ó ÏÈÁfiÙÂÚÔ ·˘ÛÙËÚ¤˜.

∂¿Ó ÙÔ ·È‰› ÛÂ Î¿ıÂ ÎÚ›ÛË ¯¿ÓÂÈ Ô‡Ú·, Î·ÏfiÂ›Ó·È Ó· ‰È·ı¤ÙÂÈ ÌÈ· ·ÏÏ·ÍÈ¿ Ë ÔÔ›· Ó· ·Ú·Ì¤-ÓÂÈ ÛÙÔ Û¯ÔÏÂ›Ô ÙÔ˘. °ÂÓÈÎ¿, ÔÈ Û˘ÌÌ·ıËÙ¤˜ ı·Ú¤ÂÈ Ó· ÂÓËÌÂÚÒÓÔÓÙ·È fiÙÈ ÙÔ ·È‰› ¿Û¯ÂÈ ·fiÂÈÏË„›·, ÂÈ‰ÈÎ¿ fiÙ·Ó ÔÈ ÎÚ›ÛÂÈ˜ Â›Ó·È ÁÂÓÈÎÂ˘Ì¤-ÓÂ˜ ‹ Á›ÓÔÓÙ·È Â‡ÎÔÏ· ·ÓÙÈÏËÙ¤˜. ÃÚÂÈ¿˙ÂÙ·È Ô-Ï‡˜ ¯ÚfiÓÔ˜ ÁÈ· Ó· ÂÈÛıÂ› ‹ Ó· ·ÔÊ·Û›ÛÂÈ Ë ÔÈ-ÎÔÁ¤ÓÂÈ· fiÙÈ Ú¤ÂÈ Ó· ·ÔÎ·Ï˘ÊıÂ› ÙÔ È·ÙÚÈÎfiÚfi‚ÏËÌ· ÙÔ˘ ·È‰ÈÔ‡, fiÌˆ˜ ı· Ú¤ÂÈ Ó· ÂÓ-ı·ÚÚ‡ÓÂÙ·È Û¯ÂÙÈÎ¿ ÌÂ ·˘Ùfi ÙÔ ı¤Ì·.

∞ıÏ‹Ì·Ù· Î·È „˘¯·ÁˆÁÈÎ¤˜ ‰Ú·ÛÙËÚÈfiÙËÙÂ˜ ∫ÔÏ‡ÌÈ, Î·Ófi, ÎˆËÏ·Û›·, ÈÛÙÈÔÏÔ˝· ∆Ô ÎÔÏ‡ÌÈ ÛÙË ı¿Ï·ÛÛ· Î·È ÙËÓ ÈÛ›Ó· ‰ÂÓ

··ÁÔÚÂ‡ÂÙ·È, ˘fi ÙËÓ ÚÔ¸fiıÂÛË fiÙÈ ÙÔ ·È‰›‚Ú›ÛÎÂÙ·È Î¿Ùˆ ·fi ÙËÓ ¿ÁÚ˘ÓË ·Ú·ÎÔÏÔ‡ıË-ÛË ÂÓfi˜ ÂÓ‹ÏÈÎ·, Ô ÔÔ›Ô˜ Ó· Í¤ÚÂÈ Î·Ïfi ÎÔÏ‡ÌÈÎ·È Î·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈÎ‹ ·Ó¿ÓË„Ë. °È· Ù· ¿ÏÏ··ıÏ‹Ì·Ù· ı· Ú¤ÂÈ Ó· ÏËÊıÔ‡Ó ˘’ fi„ÈÓ Ë ËÏÈÎ›·ÙÔ˘ ·È‰ÈÔ‡, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÎÚ›ÛÂˆÓ Î·È ÙÔ fi-ÛÔ Î·Ï‹ ı· Â›Ó·È Ë Â›‚ÏÂ„‹ ÙÔ˘ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·

ÙË˜ ·Ú·ÌÔÓ‹˜ ÙÔ˘ ÛÙÔ ÓÂÚfi. ∏ ·¿ÓÙËÛË ÂÍ·ÙÔ-ÌÈÎÂ‡ÂÙ·È ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ÂÚ›ÙˆÛË. ∫·Ïfi Â›Ó·ÈÓ· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙ· ·ıÏ‹Ì·Ù· ·˘Ù¿ ÂÈ‰ÈÎfi Ûˆ-Û›‚ÈÔ ÎÔÚÌÔ‡. ∆Ô ÎÔÏ‡ÌÈ ÛÙ· ÔÙ¿ÌÈ· Î·È ÙÈ˜ Ï›-ÌÓÂ˜ ··ÁÔÚÂ‡ÂÙ·È.

OÚÂÈ‚·Û›· ÌÂ Û¯ÔÈÓ›, ·Ó·ÚÚ›¯ËÛË ÛÂ ‰¤ÓÙÚ· ‹·fiÙÔÌÔ˘˜ ‚Ú¿¯Ô˘˜

O Î›Ó‰˘ÓÔ˜ Ô˘ Û˘ÓÔ‰Â‡ÂÈ Ù· ·ıÏ‹Ì·Ù· Ô˘Á›ÓÔÓÙ·È ÛÂ ÌÂÁ¿ÏÔ ‡„Ô˜ Â›Ó·È ÛËÌ·ÓÙÈÎfi˜ Î·È ÁÈ’·˘Ùfi ı· Ú¤ÂÈ Ó· ··ÁÔÚÂ‡ÔÓÙ·È fiˆ˜ ÂÈ‚¿Ï-ÏÂÈ Ë ÎÔÈÓ‹ ÏÔÁÈÎ‹, fi¯È ÌfiÓÔ ÛÙ· ·È‰È¿ ÌÂ ÂÈÏË-„›· ·ÏÏ¿ Î·È ÛÂ Î¿ıÂ ¿ÏÏÔ ·È‰›.

¶Ô‰‹Ï·ÙÔ, ·ÙÈÓ¿˙, ·Ù›ÓÈ ÌÂ ÙÈÌfiÓÈ ‹ ·Ù›ÓÈ ÌÂÚfi‰Â˜ (skateboard)

ŸÏ· Ù· ·È‰È¿ ı· Ú¤ÂÈ Ó· ·ÔÊÂ‡ÁÔ˘Ó ÙÔ Ô-‰‹Ï·ÙÔ ÛÂ ÔÏ˘Û‡¯Ó·ÛÙÔ˘˜ ‰ÚfiÌÔ˘˜ Î·È È‰È·›ÙÂÚ·ÂÎÂ›Ó· Ô˘ ¿Û¯Ô˘Ó ·fi ÂÈÏË„›·. ∫¿ıÂ ·È‰› Ô˘Û˘ÌÌÂÙ¤¯ÂÈ ÛÂ ·˘Ù¤˜ ÙÈ˜ ‰Ú·ÛÙËÚÈfiÙËÙÂ˜ ı· Ú¤ÂÈÓ· ÊÔÚ¿ÂÈ ÚÔÛÙ·ÙÂ˘ÙÈÎfi ÎÚ¿ÓÔ˜ Î·È ÂÈÁÔÓ¿ÙÈ·ÚÔÛÙ·ÙÂ˘ÙÈÎ¿ Î·Ï‡ÌÌ·Ù·, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓÚÔ‰È¿ıÂÛ‹ ÙÔ˘ Ó· Î¿ÓÂÈ Û·ÛÌÔ‡˜. ∂¿Ó ÔÈ ÂÈÏË-ÙÈÎ¤˜ ÎÚ›ÛÂÈ˜ ‰ÂÓ ÂÏ¤Á¯ÔÓÙ·È ÌÂ Ù· Ê¿ÚÌ·Î· Î·È Ë‰È¿ÁÓˆÛË Â›Ó·È ÔÏ‡ ÚfiÛÊ·ÙË, ÙÔ Ô‰‹Ï·ÙÔ, ÙÔ·ÙÈÓ¿˙ Î·È ÙÔ ·Ù›ÓÈ ÌÂ ÙÈÌfiÓÈ ‹ ÌÂ Úfi‰Â˜ ı· Ú¤-ÂÈ Ó· ··ÁÔÚÂ‡ÔÓÙ·È, ÙÔ˘Ï¿¯ÈÛÙÔÓ ÛÙËÓ ·Ú¯‹.

™ÎÈ ÛÂ ÌÂÁ¿ÏÂ˜ ·ÔÛÙ¿ÛÂÈ˜, ÙÚ¤ÍÈÌÔ ÛÂ ÌÂÁ¿-ÏÂ˜ ·ÔÛÙ¿ÛÂÈ˜ Î·È ¿ÏÏ· ·ıÏ‹Ì·Ù· ·ÓÙÔ¯‹˜

O Î¿Ì·ÙÔ˜ Ô˘ ÚÔÎ·ÏÔ‡Ó Ù· ·ıÏ‹Ì·Ù· ·˘Ù¿‰ÂÓ ·˘Í¿ÓÂÈ ÙËÓ Èı·ÓfiÙËÙ· Ó· ÂÎ‰ËÏˆıÂ› ÂÈÏË-ÙÈÎ‹ ÎÚ›ÛË. ∂Ó‰ÂÈÎÙÈÎfi ‰È¿ÛÙËÌ· ÁÈ· ÙÔ Â¿Ó ı·ÚÔÎÏËıÂ› ÎÚ›ÛË ‹ fi¯È Â›Ó·È Ë ÂÚ›Ô‰Ô˜ ÙË˜ ÚÔ-fiÓËÛË˜ ÛÙÔ Û˘ÁÎÂÎÚÈÌ¤ÓÔ ¿ıÏËÌ·.

¶Ô‰fiÛÊ·ÈÚÔ, Ì¿ÛÎÂÙ, ‚fiÏÂ¸, Ù¤ÓÓÈ˜, Ú¿-ÁÎÌ˘, ¯fiÎÂ¸ (·ıÏ‹Ì·Ù· Â·Ê‹˜)

ªÈÎÚÔÙÚ·˘Ì·ÙÈÛÌÔ› ÙÔ˘ ÎÂÊ·ÏÈÔ‡ Î·Ù¿ ÙË‰È¿ÚÎÂÈ· ·˘ÙÒÓ ÙˆÓ ·ıÏËÌ¿ÙˆÓ Â›Ó·È ·›ı·ÓÔ Ó·ÂÈÛÂ‡ÛÔ˘Ó Ì›· ÂÈÏËÙÈÎ‹ ÎÚ›ÛË.

∫·Ù·‰‡ÛÂÈ˜ ÛÙÔ ‚˘ıfi Î·È ÂÏÂ‡ıÂÚÂ˜ ÙÒÛÂÈ˜ÛÙÔÓ ·¤Ú· ÌÂ ·ÏÂÍ›ÙˆÙÔ (sky diving)

OÈ Î·Ù·‰‡ÛÂÈ˜ ÛÙÔ ‚˘ıfi Î·È ÔÈ ÂÏÂ‡ıÂÚÂ˜ ÙÒ-ÛÂÈ˜ ÛÙÔÓ ·¤Ú· Â›Ó·È ·fi ÙÈ˜ Ï›ÁÂ˜ ‰Ú·ÛÙËÚÈfiÙË-ÙÂ˜ ÔÈ ÔÔ›Â˜ Ú¤ÂÈ Ó· ··ÁÔÚÂ‡ÔÓÙ·È.

∫·Ù·ÛÎ‹ÓˆÛË Î·È ‰È·Ó˘ÎÙ¤ÚÂ˘ÛË ÛÙÔ Û›ÙÈÂÓfi˜ Ê›ÏÔ˘

∏ Û˘ÌÌÂÙÔ¯‹ ÛÂ Î·Ù·ÛÎ‹ÓˆÛË ‹ Ë ‰È·Ó˘ÎÙ¤-ÚÂ˘ÛË ÛÙÔ Û›ÙÈ Ê›ÏˆÓ ‹ Û˘ÁÁÂÓÒÓ ÂÈÙÚ¤ÔÓÙ·È,˘fi ÙËÓ ÚÔ¸fiıÂÛË fiÙÈ fiˆ˜ ·ÎÚÈ‚Ò˜ Û˘Ì‚·›ÓÂÈÎ·È ÌÂ ÙÔ Û¯ÔÏÂ›Ô Î·È Ù· ·ıÏ‹Ì·Ù· „˘¯·ÁˆÁ›·˜,Î¿ÔÈÔ ˘Â‡ı˘ÓÔ ¿ÙÔÌÔ ı· Â›Ó·È ÂÓËÌÂÚˆÌ¤ÓÔÁÈ· ÙÔÓ Ù‡Ô ÙˆÓ ÎÚ›ÛÂˆÓ Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ ·È-‰› Î·È ı· Í¤ÚÂÈ Ò˜ Ú¤ÂÈ Ó· ‰ÒÛÂÈ ÙÈ˜ ÚÒÙÂ˜‚Ô‹ıÂÈÂ˜ Î·È Ó· ÂÈ‰ÔÔÈ‹ÛÂÈ ÙÔ˘˜ ÁÔÓÂ›˜ Â¿Ó ·-Ú·ÛÙÂ› ·Ó¿ÁÎË.


∆·Í›‰È· ÌÂ ÙÔ ·ÂÚÔÏ¿ÓÔ ‹ ÛÂ ÂÚÈÔ¯¤˜ ¯·ÌË-Ï‹˜ ·ÚÔ¯‹˜ È·ÙÚÈÎÒÓ ˘ËÚÂÛÈÒÓ

∆· Ù·Í›‰È· ÌÂ ‰È¿ÊÔÚ· Ì¤Û· ‰ÂÓ ··ÁÔÚÂ‡Ô-ÓÙ·È ÛÙ· ·È‰È¿ ÌÂ ÂÈÏË„›·, ·ÚÎÂ› Ó· Â›Ó·È ‰˘Ó·-ÙfiÓ Ó· ‰ÔıÔ‡Ó ÔÈ ÚÒÙÂ˜ ‚Ô‹ıÂÈÂ˜ fiÙ·Ó ¯ÚÂÈ·ÛÙÂ›.OÈ ÁÔÓÂ›˜ ı· Ú¤ÂÈ Ó· Û¯Â‰È¿ÛÔ˘Ó Î·È Ó· ÚÔ-‚Ï¤„Ô˘Ó ÙÈ ÌÔÚÂ› Ó· ¯ÚÂÈ·ÛÙÂ› Î·È Ò˜ ı· ·ÓÙÈ-‰Ú¿ÛÔ˘Ó ÛÙËÓ ÂÚ›ÙˆÛË ÌÈ·˜ ÎÚ›ÛË˜ Î·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙÔ˘ Ù·ÍÈ‰ÈÔ‡ Î·È ı· Ú¤ÂÈ Ó· ‰È·ı¤ÙÔ˘Ó·ÓÙÈÂÈÏËÙÈÎ¿ Ù·¯Â›·˜ ‰Ú¿ÛÂˆ˜ ÛÂ ÎÏ‡ÛÌ·Ù· ‹Î·È ·ÌÔ‡ÏÂ˜ ÁÈ· Ó· Ù· ¯ÔÚËÁ‹ÛÔ˘Ó ·fi ÙÔ ÔÚıfi.

™Â ÌÂÚÈÎ¤˜ ÂÚÈÙÒÛÂÈ˜ ÌÔÚÂ› ÙÔ Ù·Í›‰È Ó··Ó·‚ÏËıÂ› ÁÈ· Ï›ÁÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· (·È‰› ÌÂÚfiÛÊ·ÙÔ Ì˘ÔÎÏÔÓÈÎfi status epilepticus ‹ fiÙ·Ó·Ó·Ì¤ÓÂÙ·È Î·Ï‡ÙÂÚË Ú‡ıÌÈÛË ÙˆÓ ÎÚ›ÛÂˆÓ).

O‰‹ÁËÛË ·˘ÙÔÎÈÓ‹ÙÔ˘ ‹ ¿ÏÏÔ˘ Î˘ÎÏÔÊÔÚÈ·ÎÔ‡Ì¤ÛÔ˘

OÈ ÓfiÌÔÈ Ô˘ ·ÊÔÚÔ‡Ó ÙÔ˘˜ ÂÚÈÔÚÈÛÌÔ‡˜ ÙË˜Ô‰‹ÁËÛË˜ ÔÈÎ›ÏÏÔ˘Ó ·fi ¯ÒÚ· ÛÂ ¯ÒÚ·. ™Â ÌÂÚÈ-Î¤˜ ¯ÒÚÂ˜ ‰ÂÓ ÈÛ¯‡Ô˘Ó ÂÚÈÔÚÈÛÌÔ›, ˘fi ÙËÓ ÚÔ-¸fiıÂÛË fiÙÈ Ô ıÂÚ¿ˆÓ È·ÙÚfi˜ ‰›ÓÂÈ ÙËÓ ¤ÁÎÚÈÛ‹ÙÔ˘ ÁÈ’ ·˘Ùfi. ™Â ¿ÏÏÂ˜ ¯ÒÚÂ˜ ÈÛ¯‡ÂÈ fiÙÈ Ô ·ÛıÂÓ‹˜ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÂÈ, ˘fi ÙËÓ ÚÔ¸fiıÂÛË fiÙÈ ·-Ú·Ì¤ÓÂÈ ÂÏÂ‡ıÂÚÔ˜ ÎÚ›ÛÂˆÓ ÁÈ· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ··fi 3 Ì‹ÓÂ˜ ¤ˆ˜ Î·È ¤Ó· ¯ÚfiÓÔ (8).

ŸÛ· ¿ÙÔÌ· Ô‰ËÁÔ‡Ó ÂÓÒ Û˘ÓÂ¯›˙Ô˘Ó Ó· ¤¯Ô˘ÓÂÈÏËÙÈÎ¤˜ ÎÚ›ÛÂÈ˜, ı· Ú¤ÂÈ Ó· ÂÓËÌÂÚÒÓÔÓÙ·ÈÁÚ·ÙÒ˜ ÁÈ· ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ ÙÔ˘˜ ÔÔ›Ô˘˜ Û˘ÓÂ-¿ÁÂÙ·È Ë Ô‰‹ÁËÛË. OÈ ¿Û¯ÔÓÙÂ˜ Ô˘ ‰ÂÓ Û˘Ì-ÌÔÚÊÒÓÔÓÙ·È ÌÂ ÙÈ˜ ˘Ô‰Â›ÍÂÈ˜ ÙÔ˘ ÁÈ·ÙÚÔ‡ Ó··›ÚÓÔ˘Ó Ù· Ê¿ÚÌ·Î¿ ÙÔ˘˜ Ù·ÎÙÈÎ¿, ‰ÂÓ ı· Ú¤ÂÈÓ· Ô‰ËÁÔ‡Ó ÂÓÒ Ú¤ÂÈ Ó· ÚÔÂÈ‰ÔÔÈÔ‡ÓÙ·È fiÙÈÛÙËÓ ·ÓÙ›ıÂÙË ÂÚ›ÙˆÛË Â¿Ó Û˘Ì‚Â› Î¿ÔÈÔ ·Ù‡-¯ËÌ· ÁÈ· ÙÔ ÔÔ›Ô ı· Â›Ó·È ˘·›ÙÈÔÈ, Ë ·ÛÊ·ÏÈÛÙÈÎ‹ÂÙ·ÈÚÂ›· ‰ÂÓ ı· ÙÔ˘˜ Î·Ï‡„ÂÈ.

∞Ó Î·È ÔÈ ÓÔÌÔıÂÛ›Â˜ ‰È·Ê¤ÚÔ˘Ó ÛÙÈ˜ ‰È¿ÊÔÚÂ˜¯ÒÚÂ˜, fiÙ·Ó ¤Ó· ¿ÙÔÌÔ ·ÚÔ˘ÛÈ¿˙ÂÈ ÎÚ›ÛÂÈ˜ Î·Ù¿ÙË ‰È¿ÚÎÂÈ· ·ÏÏ·Á‹˜ ÛÙ· ÂÈÏËÙÈÎ¿ Ê¿ÚÌ·Î· ËÔÔ›· Á›ÓÂÙ·È Î¿Ùˆ ·fi ÙËÓ Î·ıÔ‰‹ÁËÛË ÁÈ·ÙÚÔ‡,‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È Ó· ÛÙ·Ì·Ù‹ÛÂÈ ÙËÓ Ô‰‹ÁËÛË ÂÊ’fiÛÔÓ ·Ó·Ì¤ÓÂÙ·È fiÙÈ Ë Â·Ó·¯ÔÚ‹ÁËÛË ÙˆÓ ÚÔË-ÁÔ‡ÌÂÓˆÓ Ê·ÚÌ¿ÎˆÓ ı· Â·Ó·Ê¤ÚÂÈ ÙÔÓ ¤ÏÂÁ¯ÔÙˆÓ ÎÚ›ÛÂˆÓ. ∏ ‰È·ÎÔ‹ ÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·Ú-

Ì¿ÎˆÓ ı¤ÙÂÈ ¤Ó· ‰›ÏËÌÌ· ÁÈ· ·ÌÊfiÙÂÚÔ˘˜ ÁÈ·ÙÚfiÎ·È ·ÛıÂÓ‹. ™Â ·ÛıÂÓÂ›˜ ÌÂ Ï‹ÚË ¤ÏÂÁ¯Ô ÚÈÓ·fi ÙË ‰È·ÎÔ‹, Ë Èı·ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ÌÂÙ¿ ÙË‰È·ÎÔ‹ Â›Ó·È ÌÈÎÚ‹ Î·È ÙÔ Èı·ÓfiÙÂÚÔ ‰È¿ÛÙËÌ·ÁÈ’ ·˘Ùfi ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ Â›Ó·È ÔÈ ÚÒÙÔÈ 3-6 Ì‹ÓÂ˜ÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙˆÓ Ê·ÚÌ¿ÎˆÓ. OÈ ¿Û¯ÔÓÙÂ˜, ÁÂ-ÓÈÎ¿, ‰ÂÓ Ú¤ÂÈ Ó· Ô‰ËÁÔ‡Ó ÛÂ ·˘Ùfi ÙÔ ‰È¿ÛÙËÌ·.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ù· ·È‰È¿ Ù· ÔÔ›· ¿Û¯Ô˘Ó·fi ÂÈÏË„›· ı· Ú¤ÂÈ Ó· ÂÓı·ÚÚ‡ÓÔÓÙ·È Ó· Û˘Ì-ÌÂÙ¤¯Ô˘Ó ÛÂ fiÏÂ˜ ÙÈ˜ ‰Ú·ÛÙËÚÈfiÙËÙÂ˜, ÔÈ ÔÔ›Â˜ ‰ÂÓÛ˘ÓÂ¿ÁÔÓÙ·È ÛÔ‚·Úfi Î›Ó‰˘ÓÔ Ê˘ÛÈÎ‹˜ ‚Ï¿‚Ë˜.

°È· Ó· ÂÏ·¯ÈÛÙÔÔÈËıÔ‡Ó ÔÈ ÂÚÈÔÚÈÛÌÔ› ÛÙ·¿ÙÔÌ· ÌÂ ÂÈÏË„›· ı· Ú¤ÂÈ Ó· ·˘ÍËıÂ› Ë ÂÎ·›-‰Â˘ÛË ÙfiÛÔ ÙˆÓ ÁÔÓ¤ˆÓ fiÛÔ Î·È ÙË˜ ÎÔÈÓˆÓ›·˜. ∆Ôı¤Ì· ÙË˜ Î·Ù·ÏÏËÏfiÙËÙ·˜ ÙˆÓ ÂÚÈÔÚÈÛÌÒÓ, ÙË˜‰È¿ÚÎÂÈ¿˜ ÙÔ˘˜ fiˆ˜ Î·È ÙˆÓ ÂÈÙÒÛÂˆÓ ·fi ÙËÓÂÊ·ÚÌÔÁ‹ ÙÔ˘˜ ·Ú·Ì¤ÓÂÈ ·ÓÔÈ¯Ùfi ÁÈ· ÂÚ·ÈÙ¤ÚˆÂÈÛÙËÌÔÓÈÎ‹ ¤ÚÂ˘Ó·.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Spitz MC. Injuries and death as a consequence of seizures

in people with epilepsy. Epilepsia 1998;39:904-907. 2. Ziegler A, Reinberg O, Deonna T. Épilepsie et accidents:

quel risque chez l’ enfant? Arch Pediatr 1994;1:801-805. 3. Kemp AM, Sibert JR. Epilepsy in children and the risk of

drowning. Arch Dis Child 1993;68:684-685. 4. Diekima DS, Quan L, Holt VL. Epilepsy as a risk factor for

submersion injury in children. Pediatrics 1993;91:612-616. 5. Pearn J, Bart R, Yamaoka R. Drowning risks to epileptic

children: a study from Hawaii. Br Med J 1978;2:1284-1285. 6. Josty IC, Narayanan V, Dickson WA. Burns in patients with

epilepsy: Changes in epidemiology and implications forburn treatment and prevention. Epilepsia 2000;41:453-456.

7. Commission of Pediatrics of the ILAE. Restrictions forchildren with epilepsy. Epilepsia 1997;38:1054-1056.

8. Krumholz A. Driving and epilepsy: a historical perspective andreview of current regulations. Epilepsia 1994;35:668-674.


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¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™Î·Ú‰Ô‡ÙÛÔ˘ ∞ÁÁÂÏÈÎ‹ ªÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 54, ∆.∫. 115 28, ∞ı‹Ó·



298

¢È·ÙÚÔÊ‹ Î·Ù¿ ÙËÓ ÂÁÎ˘ÌÔÛ‡ÓË Î·È ‚¿ÚÔ˜ ÓÂÔÁÓÔ‡ ∂. ¶ÂÙÚ›‰Ô˘1,2, Õ. ™Î·ÏÎ›‰Ô˘1, ª. ™ÙÔ˚Î›‰Ô˘3, ¡. ¢ÂÛ‡ÚË˜1, ¢. ∆ÚÈ¯fiÔ˘ÏÔ˜1,2

Nutrition during pregnancy in relation to birthweight E. Petridou1,2, A. Skalkidou1, M. Stoikidou3, N. Dessypris1, D. Trichopoulos1,2

µƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞ AWARD-WINNING ARTICLE

1 ∂ÚÁ·ÛÙ‹ÚÈÔ ÀÁÈÂÈÓ‹˜ Î·È ∂È‰ËÌÈÔÏÔÁ›·˜, π·ÙÚÈÎ‹ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

2 ∆Ì‹Ì· ∂È‰ËÌÈÔÏÔÁ›·˜, ™¯ÔÏ‹ ¢ËÌfiÛÈ·˜ ÀÁÂ›·˜, ¶·ÓÂÈÛÙ‹ÌÈÔ ∏arvard

3 ∆Ì‹Ì· ∂ÈÛÎÂÙÚÈÒÓ ÀÁÂ›·˜, ™¯ÔÏ‹ ∂ÈÛÙËÌÒÓ ÀÁÂ›·˜, ∞ı‹Ó·

µÚ·‚Â›Ô “£Ú¤„Ë Î·È ¢È·ÙÚÔÊ‹”36Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, 1998

1 Department of Hygiene and Epidemiology,University of Athens Medical School

2 Department of Epidemiology,∏arvard School of Public Health

3 Department of Health Visiting, School of Health Sciencesand Welfare, Athens Polytechnic

Award on “Diet and Nutrition”36th Panhellenic Meeting, 1998

�¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ Â›Ó·È Ë ‰ÈÂÚÂ‡-ÓËÛË ÙË˜ Û¯¤ÛË˜ ÌÂÙ·Í‡, ·ÊÂÓfi˜ ÙË˜ ÚfiÛÏË„Ë˜‰È·ÙÚÔÊÈÎÒÓ ÛÙÔÈ¯Â›ˆÓ ‰È·ÊfiÚˆÓ ‰È·ÙÚÔÊÈÎÒÓÔÌ¿‰ˆÓ Î·Ù¿ ÙËÓ ÂÁÎ˘ÌÔÛ‡ÓË Î·È ·ÊÂÙ¤ÚÔ˘ ÙÔ˘‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ ˘ÁÈÒÓ, ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔÁÓÒÓ. ∏ÌÂÏ¤ÙË Û˘ÌÂÚÈ¤Ï·‚Â ÙÚÈ·ÎfiÛÈÂ˜ ÂÍ‹ÓÙ· ÔÎÙÒ Á˘-Ó·›ÎÂ˜, ÔÈ ÔÔ›Â˜ Á¤ÓÓËÛ·Ó ÛÂ Û˘ÁÎÂÎÚÈÌ¤ÓÂ˜ ËÌÂ-ÚÔÌËÓ›Â˜ ÌÈ·˜ ÂÚÈfi‰Ô˘ ÔÎÙÒ ÌËÓÒÓ, ÛÂ ¤ÍÈ ÌÂÁ¿-ÏÂ˜ ª·ÈÂ˘ÙÈÎ¤˜ ∫ÏÈÓÈÎ¤˜ ‰‡Ô ÌÂÁ¿ÏˆÓ ÂÏÏËÓÈÎÒÓfiÏÂˆÓ. ŒÁÈÓÂ ÚÔÛˆÈÎ‹ Û˘Ó¤ÓÙÂ˘ÍË ÌÂ Î¿ıÂÏÂ¯ˆ˝‰·, Ô˘ ‚·Û›ÛÙËÎÂ ÛÂ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔÂÏÂÁÌ¤ÓË˜ ·ÍÈÔÈÛÙ›·˜. ∂ÎÙfi˜ ·fi ÙÈ˜ ËÌÈÔÛÔÙÈ-Î¤˜ ·Ú·Ì¤ÙÚÔ˘˜ ‰È·ÙÚÔÊ‹˜, ÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔÛ˘ÌÂÚÈÏ¿Ì‚·ÓÂ ÂÚˆÙ‹ÛÂÈ˜ Û¯ÂÙÈÎ¿ ÌÂ ÎÔÈÓˆÓÈÎÔ-‰ËÌÔÁÚ·ÊÈÎ¤˜ ÌÂÙ·‚ÏËÙ¤˜, Î·ıÒ˜ Î·È ÌÂÙ·‚ÏË-Ù¤˜ Ô˘ ·ÊÔÚÔ‡Û·Ó ·Ó··Ú·ÁˆÁÈÎ¤˜ ·Ú·Ì¤-ÙÚÔ˘˜ Î·È ÙÔÓ ÙÚfiÔ ˙ˆ‹˜. ∆· ÛÙÔÈ¯Â›· ·Ó·Ï‡ıË-Î·Ó ÌÂ ÔÏ˘·Ú·ÁÔÓÙÈÎ‹ ÌÂıÔ‰ÔÏÔÁ›·. ŒÁÈÓÂ¤ÏÂÁ¯Ô˜ ÙˆÓ ‰È·ÙÚÔÊÈÎÒÓ ÌÂÙ·‚ÏËÙÒÓ ˆ˜ ÚÔ˜ÙË ıÂÚÌÈ‰ÈÎ‹ ÚfiÛÏË„Ë, Î·ıÒ˜ Î·È ÙÔ˘˜ ÌË ‰È·-ÙÚÔÊÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙÔ ‚¿-ÚÔ˜ Á¤ÓÓËÛË˜. ∞fi ÙÈ˜ ÔÌ¿‰Â˜ ÙÚÔÊ›ÌˆÓ, ÙÔ ÎÚ¤-·˜ Î·È Ù· ·Ú¿ÁˆÁ¿ ÙÔ˘, Î·ıÒ˜ Î·È ÙÔ „¿ÚÈ Î·È Ù·¿ÏÏ· ı·Ï·ÛÛÈÓ¿ ‚Ú¤ıËÎ·Ó Ó· Û˘Û¯ÂÙ›˙ÔÓÙ·È ÌÂ·˘ÍËÌ¤ÓÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ (ÙÈÌ‹ ÎÚÈÙËÚ›Ô˘ p ‰‡Ô‰ÈÂ˘ı‡ÓÛÂˆÓ 0,08 Î·È 0,16 ·ÓÙ›ÛÙÔÈ¯·). ∞fi Ù·‰È·ÙÚÔÊÈÎ¿ ÛÙÔÈ¯Â›· ÌÂ ıÂÚÌÈ‰ÈÎ‹ ·fi‰ÔÛË, Ù·ÌÔÓÔ·ÎfiÚÂÛÙ· Ï›Ë Û˘Û¯ÂÙ›˙ÔÓÙ·È ıÂÙÈÎ¿ ÌÂ ÙÔ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ Î·È ·ÚÎÂÙ¿ ·fi ·˘Ù¿ ÛÂ ‚·ıÌfi ÛÙ·-ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎfi, ÛÂ ÔÏÏ¿ ·fi Ù· ÌÔÓÙ¤Ï·

�Abstract: The aim of the study was toinvestigate the relation between consumption ofvarious food groups and intake of energy-generating macronutrients on one hand, andbirthweight on the other, among apparentlyhealthy, term singletons. Three hundred sixty eightwomen out of 400, who delivered in six MaternityClinics in two Greek cities during a specifiedperiod, completed an interviewer-administered,validated, semiquantitative food frequencyquestionnaire. Study participants also providedinformation on sociodemographic, reproductiveand lifestyle variables. Data were analyzed throughmultiple regression modeling. Nutritional variableswere energy-adjusted, and non nutritionalcorrelates of birthweight were accounted for. Theanalysis revealed most of the established nonnutritional associations of birthweight - anindication of study validity. Among food groups,meat and meat products and fish and sea foodwere suggestively associated with increasedbirthweight (two tailed p-values 0.08 and 0.16respectively). Among energy-generating nutrients,monounsaturated fat was positively associatedwith birthweight and significantly so in several ofthe models. Our findings are considered as beingcompatible with the hypotheses that links fish andmeat intake to fetal growth, and are indicative of apositive association between intake of mono-unsaturated fat and birthweight.


∂ÈÛ·ÁˆÁ‹¶ÔÏÏ¤˜ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó ÂÍÂÙ¿ÛÂÈ ÙË Û¯¤ÛË ÌË

‰È·ÙÚÔÊÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÌÂ ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜Î·È ¤¯Ô˘Ó ‚ÚÂÈ fiÙÈ ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ ÙÔ˘ ÚÒÙÔ˘·È‰ÈÔ‡ Â›Ó·È ¯·ÌËÏfiÙÂÚÔ ·fi ÂÎÂ›ÓÔ ÙˆÓ ÂfiÌÂ-ÓˆÓ ÙfiÎˆÓ (1,2). ∂›ÛË˜, Á˘Ó·›ÎÂ˜ ÌÈÎÚ‹˜ ‹ ÔÏ‡ÌÂÁ¿ÏË˜ ËÏÈÎ›·˜ Î‡ËÛË˜ (1,3), ¯·ÌËÏÔ‡ ÎÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈÎÔ‡ ÂÈ¤‰Ô˘ (1,4,5) Î·È ÌÈÎÚ‹˜ ÛˆÌ·ÙÈ-Î‹˜ ‰È¿Ï·ÛË˜ (6-11), Û˘Ó‹ıˆ˜ ÁÂÓÓÔ‡Ó ÓÂÔÁÓ¿ ÌÂÌÈÎÚfiÙÂÚÔ ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜. H ·ÈÌÔÚÚ·Á›· Î·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙË˜ ÂÁÎ˘ÌÔÛ‡ÓË˜, È‰È·›ÙÂÚ· Î·Ù¿ ÙÔ ÙÚ›-ÙÔ ÙÚ›ÌËÓÔ (12-14), Ë ˘¤ÚÙ·ÛË (15), Ë ÙÔÍÈÓ·ÈÌ›·Î·Ù¿ ÙËÓ Î‡ËÛË (16), Î·ıÒ˜ Î·È ÙÔ ÈÛÙÔÚÈÎfi ·Ô-‚ÔÏÒÓ (17,18), ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙÂ› ÌÂ ÌÈÎÚfi ‚¿ÚÔ˜Á¤ÓÓËÛË˜ ÙÔ˘ ÓÂÔÁÓÔ‡. ∂›ÛË˜, ˘¿Ú¯Ô˘Ó ÂÚÈÔ-ÚÈÛÌ¤ÓÂ˜ ÂÓ‰Â›ÍÂÈ˜ Ô˘ Û˘ÓËÁÔÚÔ‡Ó fiÙÈ ˘¿Ú¯ÂÈıÂÙÈÎ‹ Û¯¤ÛË ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ ÂÎÙÚÒÛÂˆÓ ÌÂ ÙÔ ÌÈ-

ÎÚfi ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ ÙÔ˘ ÓÂÔÁÓÔ‡ (17). ∏ ·‡ÍËÛËÙÔ˘ ‚¿ÚÔ˘˜ ÙË˜ ÌËÙ¤Ú·˜ Î·Ù¿ ÙËÓ ÂÁÎ˘ÌÔÛ‡ÓË(19,20), Ô˘ ÂÓ Ì¤ÚÂÈ ·ÓÙ·Ó·ÎÏ¿ ÙËÓ ˘„ËÏfiÙÂÚËıÂÚÌÈ‰ÈÎ‹ ÚfiÛÏË„Ë ÙË˜ ÂÁÎ‡Ô˘, Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂÌÂÁ·Ï‡ÙÂÚÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ ÓÂÔÁÓÔ‡, ÂÓÒ ÙÔ Î¿-ÓÈÛÌ· Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÁÎ˘ÌÔÛ‡ÓË˜(3,10,21,22) Î·È Ë Î·Ù·Ó¿ÏˆÛË Î·Ê¤ (23,26) Û˘-Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÌÈÎÚfiÙÂÚÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜. ∏ ÌÂ-Á¿ÏË Î·Ù·Ó¿ÏˆÛË ÔÈÓÔÓÂ‡Ì·ÙÔ˜ Î·Ù¿ ÙËÓ ÂÁÎ˘-ÌÔÛ‡ÓË ¤¯ÂÈ ÙÔÍÈÎ‹ Â›‰Ú·ÛË ÛÙÔ ¤Ì‚Ú˘Ô, ÂÓÒ·ÓÙ›ıÂÙ·, Ë Ï‹„Ë ÌÈÎÚ‹˜ ÔÛfiÙËÙ·˜ ·ÏÎÔÔÏÔ‡¯ˆÓÔÙÒÓ Ê·›ÓÂÙ·È Ó· ÌË Û¯ÂÙ›˙ÂÙ·È ‹ ÂÓ‰¤¯ÂÙ·È ·Îfi-Ì· Î·È Ó· Û¯ÂÙ›˙ÂÙ·È ıÂÙÈÎ¿ ÌÂ ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜(1,27,28).

∂ÓÒ ¤¯ÂÈ ÙÂÎÌËÚÈˆıÂ› Ë Û¯¤ÛË ÌÂÙ·Í‡ ˘ÔÛÈÙÈ-ÛÌÔ‡ ÙË˜ ÌËÙ¤Ú·˜ Î·È ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜(1,20,29), Ï›ÁÂ˜ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó ·Û¯ÔÏËıÂ› ÌÂ ÙË


299

Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÛÙËÓ ·Ó¿Ï˘ÛË. ∆· ·ÔÙÂ-Ï¤ÛÌ·Ù· ·˘Ù¿ ıÂˆÚÔ‡ÓÙ·È Û˘Ì‚·Ù¿ ÌÂ ÙËÓ ˘fiıÂ-ÛË fiÙÈ Ë ÚfiÛÏË„Ë ÎÚ¤·ÙÔ˜ Î·È „·ÚÈÔ‡ Û¯ÂÙ›˙ÂÙ·ÈıÂÙÈÎ¿ ÌÂ ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ÓÂÔÁÓÔ‡ Î·È ˘Ô‰ËÏÒÓÔ˘ÓÙËÓ ‡·ÚÍË ·ÓÙ›ÛÙÔÈ¯Ë˜ Û¯¤ÛË˜ ÙˆÓ ÌÔÓÔ·ÎfiÚÂ-ÛÙˆÓ ÏÈÒÓ ÌÂ ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ·‡ÍËÛË ÓÂÔÁÓÔ‡, ‚¿ÚÔ˜ Á¤ÓÓËÛË˜,ÌÔÓÔ·ÎfiÚÂÛÙ· ÏÈ›‰È·, „¿ÚÈ Î·È ÎÚ¤·˜, ˆÌ¤Á· 3-ÏÈ·Ú¿ ÔÍ¤·.

Key words: fetal growth, birthweight, monounsa-turated fat, fish and meat, omega-3 fatty acids.

¶›Ó·Î·˜ 1. ∆·ÍÈÓfiÌËÛË ÛÂ ÔÌ¿‰Â˜ ÙˆÓ ‰È·ÊfiÚˆÓ ÂÈ‰ÒÓ ÙÚÔÊ›ÌˆÓ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÙË˜ Û˘¯ÓfiÙË-Ù·˜ Ï‹„Ë˜ ÙÚÔÊÒÓ

OÌ¿‰Â˜ ÙÚÔÊ›ÌˆÓ ∂›‰Ô˜ ÙÚÔÊ›ÌˆÓ

¢ËÌËÙÚÈ·Î¿ Î·È ·Ì˘ÏÒ‰Ë ÕÛÚÔ „ˆÌ›, Ì·‡ÚÔ „ˆÌ›, ·Ú·‰ÔÛÈ·Îfi „ˆÌ›, Ú‡˙È, Ì·Î·ÚfiÓÈ·, ÔÈÎ›Ï· ‰ËÌËÙÚÈ·Î¿ ÁÈ· ÚˆÈÓfi, ÙÚ·¯·Ó¿˜, Ù˘ÚfiÈÙ· (1/2), ÎÚÂ·ÙfiÈÙ· (1/2), Ï·¯·ÓfiÈÙ· (1/2), ›ÙÛ· (1/2), ·ÛÙ›ÙÛÈÔ (1/2), ·Ù¿ÙÂ˜

°Ï˘Î¿ Î·È ÎÔÌfiÛÙÂ˜ ∑¿¯·ÚË, ÌÈÛÎfiÙ·, ÛÔÎÔÏ¿Ù·, ÁÎÔÊÚ¤ÙÂ˜, Ì·ÎÏ·‚¿˜, Î·ÓÙ·˝ÊÈ Î·È ¿ÏÏ· ÂÏÏËÓÈÎ¿ ÁÏ˘-Î¿, ÁÏ˘Î¿ ÎÔ˘Ù·ÏÈÔ‡, ˙ÂÏ¤, ÊÚÔ˘˚ÙÔÁÏ·Û¤, ÁÏ˘Î¿ ÌÂ ÎÚ¤ÌÂ˜, ÙËÁ·Ó›ÙÂ˜, Î·Ú·Ì¤ÏÂ˜, Ì¤-ÏÈ, ÎÔÌfiÛÙ· (1/2)

ŸÛÚÈ·, ÍËÚÔ› Î·ÚÔ› Î·È ÛfiÚÔÈ •ËÚ¿ Ê·ÛfiÏÈ·, ÚÂ‚›ıÈ·, Ê·Î¤˜, Ê¿‚·, Ê·ÛfiÏÈ· Á›Á·ÓÙÂ˜, ÍËÚÔ› Î·ÚÔ› §·¯·ÓÈÎ¿ ºÚ¤ÛÎÈÂ˜ ÙÔÌ¿ÙÂ˜, Ì·ÁÂÈÚÂÌ¤ÓÂ˜ ÙÔÌ¿ÙÂ˜, ·ÁÁÔ‡ÚÈ·, ÈÂÚÈ¤˜, ÊÚ¤ÛÎÔ Ï¿¯·ÓÔ, Ì·ÁÂÈ-

ÚÂÌ¤ÓÔ Ï¿¯·ÓÔ, Ì·ÚÔ‡ÏÈ, ÊÚ¤ÛÎÔ Î·ÚfiÙÔ, Ì·ÁÂÈÚÂÌ¤Ó· Î·ÚfiÙ·, ÎÚÂÌÌ‡‰È·, ÊÚ¤ÛÎ·Ê·ÛÔÏ¿ÎÈ·, ÌÂÏÈÙ˙¿ÓÂ˜, Û·Ó¿ÎÈ, Ú¿Û·, Ì¿ÌÈÂ˜, ·ÁÚÈÔÚ·‰›ÎÈ·, ·ÁÎÈÓ¿ÚÂ˜, ÊÚ¤ÛÎ·Ê·Ú‰È¿ Ê·ÛfiÏÈ·, ·Ú·Î¿˜, ÎÔ˘ÓÔ˘›‰È, ÌÚfiÎÔÏ·, ÎÔÎÎÈÓÔÁÔ‡ÏÈ·, Ì·ÓÈÙ¿ÚÈ·, Ï·¯·ÓfiÈ-Ù·, ÌÔ˘Û·Î¿˜

ºÚÔ‡Ù· ∫·ÚÔ‡˙È, ÂfiÓÈ, Ì·ÓÙ·Ú›ÓÈ·, ÔÚÙÔÎ¿ÏÈ·, Ì‹Ï·, ÚÔ‰¿ÎÈÓ·, ·¯Ï¿‰È·, ÛÙ·Ê‡ÏÈ·, ‚ÂÚ›-ÎÔÎ·, ÎÂÚ¿ÛÈ·, ÊÚ¿Ô˘ÏÂ˜, Ì·Ó¿ÓÂ˜, Û‡Î·, ·Ó·Ó¿˜, ÁÎÚ¤È-ÊÚÔ˘Ù, ÊÚ¤ÛÎÔ˜ ¯˘Ìfi˜ÊÚÔ‡ÙˆÓ, ·ÔÍËÚ·Ì¤Ó· ÊÚÔ‡Ù·, ÎÔÌfiÛÙ· (1/2)

∫Ú¤·˜ Î·È ·Ú¿ÁˆÁ· ÃÔÈÚÈÓfi, ÌÔÛ¯¿ÚÈ, ·ÚÓ›, Î·ÙÛ›ÎÈ, ÎÔÙfiÔ˘ÏÔ, Á·ÏÔÔ‡Ï·, Î·ÓÈÛÙfi ¯ÔÈÚÈÓfi, ÏÔ˘Î¿ÓÈÎ·,Û˘ÎÒÙÈ Î·È ¿ÏÏÂ˜ ÂÓÙÚ¿‰Â˜, ·˘Á¿, ÎÚÂ·ÙfiÈÙ· (1/2), ÌÔ˘Û·Î¿˜ (1/2), ·ÛÙ›ÙÛÈÔ (1/2)

æ¿ÚÈ· Î·È ı·Ï·ÛÛÈÓ¿ æ¿ÚÈ· Î·È ÔÛÙÚ·ÎÔÂÈ‰‹ °¿Ï· Î·È Á·Ï·ÎÙÔÎÔÌÈÎ¿ ∆˘Ú› Ê¤Ù·, Î·Û¤ÚÈ, ¿ÏÏ· Ù˘ÚÈ¿, Ï‹ÚÂ˜ Á¿Ï·, ·Ô‚Ô˘Ù˘ÚˆÌ¤ÓÔ Á¿Ï·, ÁÈ·Ô‡ÚÙÈ Ï‹ÚˆÓ

ÏÈ·ÚÒÓ Î·È ÌÂÈˆÌ¤ÓˆÓ ÏÈ·ÚÒÓ, Ô˘Ù›ÁÎ· ÌÂ Á¿Ï·, Ô˘Ù›ÁÎ· ÌÂ Á¿Ï· Î·È Ú‡˙È, ·Áˆ-Ùfi, Ù˘ÚfiÈÙ· Î·È ›ÙÛ· (1/2)

§¿‰È Î·È Ï›Ë µÔ‡Ù˘ÚÔ ÛÙÔ „ˆÌ›, Ì·ÁÂÈÚÈÎfi ‚Ô‡Ù˘ÚÔ, Ì·ÚÁ·Ú›ÓË ÛÂ „ˆÌ›, Ì·ÁÂÈÚÈÎ‹ Ì·ÚÁ·Ú›ÓË, ÛÔ-Ú¤Ï·ÈÔ, ÂÏ·ÈfiÏ·‰Ô, ÂÏÈ¤˜

∆Ô (1/2) ÛËÌÂÈÒÓÂÙ·È ÁÈ· Ù· Ì·ÁÂÈÚÂÌ¤Ó· ÁÂ‡Ì·Ù· Ô˘ ÌÔÈÚ¿ÛÙËÎ·Ó ÛÂ ‰‡Ô ÔÌ¿‰Â˜ ÙÚÔÊ›ÌˆÓ



300

Û¯¤ÛË ·Ó¿ÌÂÛ· ÛÙÈ˜ ‰È·ÙÚÔÊÈÎ¤˜ Û˘Ó‹ıÂÈÂ˜ ÙË˜ÌËÙ¤Ú·˜ Î·È ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ ÙÔ˘ ÓÂÔÁÓÔ‡ ÛÂ¯ÒÚÂ˜ fiÔ˘ ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ˘ÔÛÈÙÈÛÌfi˜ (9,29-35). Œ¯ÂÈ ÚÔÙ·ıÂ› fiÙÈ Ë Î·Ù·Ó¿ÏˆÛË „·ÚÈÔ‡ Î·È·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ Ì·ÎÚ¿˜ ·Ï‡ÛÔ˘ (ˆÌ¤-Á· 3-ÏÈ·Ú¿ ÔÍ¤· ÙˆÓ „·ÚÈÒÓ) ÂÓ‰¤¯ÂÙ·È Ó· Â›Ó·ÈÛËÌ·ÓÙÈÎ‹ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÂÌ‚Ú‡Ô˘ (36-38), ·Ó Î·È Ë Î˘Ú›·Ú¯Ë ¿Ô„Ë Â›Ó·È fiÙÈ Ë ÔÈÔÙÈ-Î‹ Û‡ÛÙ·ÛË ÙË˜ ‰È·ÙÚÔÊ‹˜ ÛÙÈ˜ ·Ó·Ù˘ÁÌ¤ÓÂ˜¯ÒÚÂ˜ ‰ÂÓ Û¯ÂÙ›˙ÂÙ·È ÛËÌ·ÓÙÈÎ¿ ÌÂ ÙÔ ‚¿ÚÔ˜Á¤ÓÓËÛË˜ (31).

™ÙËÓ ∂ÏÏ¿‰·, ÙÔ ÌÈÎÚfi ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ Â›Ó·ÈÛ¿ÓÈÔ (39). ™ÙÔ Ï·›ÛÈÔ ÂÓfi˜ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Ô˘Â›¯Â ˆ˜ ÛÙfi¯Ô ÙË ‰ÈÂÚÂ‡ÓËÛË ÙË˜ ÂÈ‰ËÌÈÔÏÔÁ›·˜ÂÚÈÁÂÓÓËÙÈÎÒÓ Û˘ÓıËÎÒÓ (40,41), ÂÚÂ˘Ó‹ıËÎÂ ËÛ¯¤ÛË ÌÂÙ·Í‡ ÙË˜ Î·Ù·Ó¿ÏˆÛË˜ ‰È·ÙÚÔÊÈÎÒÓÔÌ¿‰ˆÓ Î·È ÚfiÛÏË„Ë˜ ÙÚÔÊ›ÌˆÓ ˘„ËÏ‹˜ ıÂÚÌÈ-‰ÈÎ‹˜ ÂÓ¤ÚÁÂÈ·˜ ·ÊÂÓfi˜ Î·È ÙÔ˘ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜·ÊÂÙ¤ÚÔ˘, ÌÂÙ¿ ·fi ¤ÏÂÁ¯Ô ÁÈ· ÙÂÎÌËÚÈˆÌ¤ÓÔ˘˜Î·È Èı·ÓÔ‡˜ ÌË ‰È·ÙÚÔÊÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ Ô˘Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ™ÙË ÌÂÏ¤ÙË Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó 400 Á˘Ó·›ÎÂ˜ Ô˘ Á¤ÓÓË-

Û·Ó ¤Ó· ÙÂÏÂÈfiÌËÓÔ Î·È Ê·ÈÓÔÌÂÓÈÎ¿ ˘ÁÈ¤˜ ÓÂÔÁÓfi, ÛÂ ¤ÍÈ Ì·È-Â˘Ù‹ÚÈ· ÙË˜ ∞ı‹Ó·˜ Î·È ÙË˜ §¿ÚÈÛ·˜ ·fi ÙÔ ª¿ÚÙÈÔ Ì¤¯ÚÈÙÔÓ OÎÙÒ‚ÚÈÔ ÙÔ˘ 1995. OÈ Á˘Ó·›ÎÂ˜ ·˘Ù¤˜ ‰ÂÓ ¤·Û¯·Ó ·fiÛ·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Î·È Á¤ÓÓËÛ·Ó ÛÂ Ì›· ·fi ÙÈ˜ Û˘ÁÎÂÎÚÈ-Ì¤ÓÂ˜ ËÌ¤ÚÂ˜ Ô˘ Ù· ¿ÙÔÌ· Ô˘ ¤·ÈÚÓ·Ó Û˘Ó¤ÓÙÂ˘ÍË ÂÈ-ÛÎ¤ÊıËÎ·Ó Ù· Û˘ÓÂÚÁ·˙fiÌÂÓ· Ì·ÈÂ˘Ù‹ÚÈ·. ∞fi ÙÔ Û‡ÓÔÏÔÙˆÓ Á˘Ó·ÈÎÒÓ, ÌfiÓÔ ÔÈ 32 ‰ÂÓ ‹Ù·Ó ÛÂ ı¤ÛË Ó· Û˘ÓÂÚÁ·ÛÙÔ‡Ó‹ ‰ÂÓ ı¤ÏËÛ·Ó Ó· Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙË ÌÂÏ¤ÙË. ªÂÙ¿ ·fi Û˘-ÁÎ·Ù¿ıÂÛË ÙˆÓ ÏÂ¯ˆ˝‰ˆÓ, ‰‡Ô ÂÈ‰ÈÎ¿ ÂÎ·È‰Â˘Ì¤ÓÂ˜ ÂÈÛÎ¤-ÙÚÈÂ˜ ˘ÁÂ›·˜ ¤Î·Ó·Ó ÂÎÙÂÙ·Ì¤ÓË Û˘Ó¤ÓÙÂ˘ÍË ÌÂ ‚¿ÛË ÚÔ-Îˆ‰ÈÎÔÔÈËÌ¤ÓÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ, ÙÔ ÔÔ›Ô ÂÚÈÂÏ¿Ì‚·ÓÂÎÔÈÓˆÓÈÎÔ‰ËÌÔÁÚ·ÊÈÎ¤˜ Î·È ‚ÈÔ˚·ÙÚÈÎ¤˜ ÌÂÙ·‚ÏËÙ¤˜, Î·ıÒ˜Î·È ÂÚˆÙ‹ÛÂÈ˜ Û¯ÂÙÈÎ¤˜ ÌÂ ÙÔÓ ÙÚfiÔ ˙ˆ‹˜. ∂ÈÏ¤ÔÓ, Û˘-ÌÏËÚÒıËÎÂ Î·È ¤Ó· ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ‰È·ÙÚÔÊ‹˜ ÌÂ ËÌÈÔ-ÛÔÙÈÎ¤˜ ÌÂÙ·‚ÏËÙ¤˜ Ô˘ Î¿Ï˘Ù·Ó ÂÚˆÙ‹ÛÂÈ˜ ÁÈ· ÙËÓ Î·Ù·-Ó¿ÏˆÛË 190 ÙÚÔÊ›ÌˆÓ Î·È ÔÙÒÓ (42).

ªÂÙ¿ ·fi ÙÈ˜ ·Ï¤˜ ‰È·ÍÔÓÈÎ¤˜ ÈÓ·ÎÔÔÈ‹ÛÂÈ˜ ÙˆÓÛÙÔÈ¯Â›ˆÓ, ¤ÁÈÓÂ ÔÏ˘·Ú·ÁÔÓÙÈÎ‹ ·Ó¿Ï˘ÛË ÌÂ ÂÍ·ÚÙËÌ¤ÓË

¶›Ó·Î·˜ 2. ∫·Ù·ÓÔÌ‹ ÙˆÓ 368 ÌËÙ¤ÚˆÓ ÌÔÓ‹ÚˆÓ Î˘‹ÛÂˆÓ·Ó¿ÏÔÁ· ÌÂ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙË˜ Î‡ËÛË˜ Î·È ÙÔ˘ ÙÔÎÂÙÔ‡

ªÂÙ·‚ÏËÙ‹ N %

ñ ∏ÏÈÎ›· ÌËÙ¤Ú·˜ (¤ÙË)≤19 14 3,820-24 83 22,625-29 156 42,430-34 94 25,535-39 18 4,9≥40 3 0,8

ñ ∂Î·›‰Â˘ÛË ÌËÙ¤Ú·˜ (¤ÙË) ≤11 54 14,712 154 41,813-15 88 23,9≥16 72 19,6

ñ ⁄„Ô˜ ÌËÙ¤Ú·˜ (cm) ≤159 40 10,9160-164 141 38,3165-169 121 32,9170-174 55 14,9≥175 11 3,0

ñ πÛÙÔÚÈÎfi ·Ô‚ÔÏÒÓ ¡·È 42 11,4Ÿ¯È 326 88,6

ñ πÛÙÔÚÈÎÒÓ ÂÎÙÚÒÛÂˆÓ ¡·È 58 15,8Ÿ¯È 310 84,2

ñ ∞ÈÌÔÚÚ·Á›· ¡·È 70 19,0Ÿ¯È 298 81,0

ñ ŒÌÂÙÔ˜ ¡·È 81 22,0Ÿ¯È 287 78,0

ñ ∫¿ÓÈÛÌ· (ÙÛÈÁ¿Ú·/ËÌ¤Ú·) 0 248 67,41-5 67 18,26-10 43 11,7≥11 10 2,7

ñ OÈÓÔÓÂ˘Ì·ÙÒ‰Ë ÔÙ¿ ¶ÔÙ¤ 239 64,9∂˘Î·ÈÚÈ·Î¿ 129 35,1

ñ ∫·Ê¤˜ (ÊÏ˘Ù˙¿ÓÈ·/ËÌ¤Ú·) 0 123 33,4<1 60 16,31 118 32,1>1 67 18,2

ñ ™ÎÂ˘¿ÛÌ·Ù· Ê˘ÏÏÈÎÔ‡ ÔÍ¤ˆ˜ ¡·È 127 34,5Ÿ¯È 241 65,5

ñ ªËÙÚÈÎ‹ ÚfiÛÏË„Ë ‚¿ÚÔ˘˜ (kg) ≤7 21 5,78-9 30 8,110-11 67 18,212-13 86 23,414-15 70 19,016-17 43 11,718-19 19 5,2≥20 32 8,7

ñ ∆ÔÎÂÙfi˜º˘ÛÈÔÏÔÁÈÎfi˜ 247 67,1∫·ÈÛ·ÚÈÎ‹ ÙÔÌ‹ 121 32,9

ñ ™ÂÈÚ¿ Á¤ÓÓËÛË˜ 1 207 56,2≥2 161 43,8

ñ º‡ÏÔ∞ÁfiÚÈ 173 47,0∫ÔÚ›ÙÛÈ 195 53,0

ñ µ¿ÚÔ˜ Á¤ÓÓËÛË˜ (g)≤2500 17 4,62501-3000 56 15,23001-3500 158 42,93501-4000 111 30,2>4001 26 7,1


ÌÂÙ·‚ÏËÙ‹ ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ ÛÂ ÁÚ·ÌÌ¿ÚÈ·. ™Â fiÏ· Ù· ‚·-ÛÈÎ¿ ÌÔÓÙ¤Ï· Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÔÈ ÌÂÙ·‚ÏËÙ¤˜ Ô˘ ·ÊÔ-ÚÔ‡Û·Ó ÙËÓ ÂÁÎ˘ÌÔÛ‡ÓË Î·È ÙÔÓ ÙÔÎÂÙfi, ÌÂ ÙÔÓ ÙÚfiÔ Ô˘·Ó·Ê¤ÚÂÙ·È ÛÙËÓ ·Ú¿ÁÚ·ÊÔ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÙË˜ ÌÂ-Ï¤ÙË˜. OÈ ‰È·ÙÚÔÊÈÎ¤˜ ÌÂÙ·‚ÏËÙ¤˜ ·ÍÈÔÏÔÁ‹ıËÎ·Ó ÌÂ ‚¿ÛË

ÙÈ˜ ÔÌ¿‰Â˜ ÙÚÔÊ›ÌˆÓ Ô˘ ÚÔÙ¿ıËÎ·Ó ·fi ÙÔ˘˜ DavidsonÎ·È Passmore (43), ÌÂ ÙË ‰È·ÊÔÚ¿ fiÙÈ ÛÙË ÌÂÏ¤ÙË ·˘Ù‹ ‰Ë-ÌÈÔ˘ÚÁ‹ıËÎÂ Ì›· ÂÈÏ¤ÔÓ Î·ÙËÁÔÚ›· ÁÈ· Ù· „¿ÚÈ· Î·È Ù·ı·Ï·ÛÛÈÓ¿, ÂÓÒ Ù· ‰ËÌËÙÚÈ·Î¿ Î·È ¿ÏÏ· ·Ì˘ÏÒ‰Ë ˘ÔÏÔÁ›-ÛÙËÎ·Ó ÛÂ Ì›· Î·ÙËÁÔÚ›· (¶›Ó·Î·˜ 1). ∂ÈÏ¤ÔÓ, ·ÍÈÔÏfiÁË-ÛË ÙˆÓ ‰È·ÙÚÔÊÈÎÒÓ ÌÂÙ·‚ÏËÙÒÓ ¤ÁÈÓÂ ·Ó¿ÏÔÁ· ÌÂ ÙË ıÂÚ-ÌÈ‰ÈÎ‹ ·Í›· ÙˆÓ ÂÈÌ¤ÚÔ˘˜ ÙÚÔÊ›ÌˆÓ.

∞ıÚÔ›ÛÙËÎ·Ó ÔÈ Û˘¯ÓfiÙËÙÂ˜ Î·Ù·Ó¿ÏˆÛË˜ ÙÚÔÊ›ÌˆÓÙË˜ ›‰È·˜ ÔÌ¿‰·˜ (44) Î·È ÁÈ· fiÛÂ˜ ÙÚÔÊ¤˜ Î·Ù·Ó·ÏÒÓÔÓÙ·ÈÌfiÓÔ ÔÚÈÛÌ¤ÓÂ˜ ÂÔ¯¤˜ ÙÔ˘ ¯ÚfiÓÔ˘, ¤ÁÈÓÂ ÚÔÙ‡ˆÛË ·Ó¿-ÏÔÁ· ÌÂ ÙËÓ ÂÔ¯ÈÎfiÙËÙ· ÙË˜ Î·Ù·Ó¿ÏˆÛ‹˜ ÙÔ˘˜ Î·Ù¿ ÙËÓÂÚ›Ô‰Ô ÙË˜ ÂÁÎ˘ÌÔÛ‡ÓË˜. O ˘ÔÏÔÁÈÛÌfi˜ ÙˆÓ ıÂÚÌ›‰ˆÓÔ˘ ÚÔÛÊ¤ÚÂÈ Ë ÚfiÛÏË„Ë ‰È·ÊfiÚˆÓ Ù‡ˆÓ ÙÚÔÊ›ÌˆÓ Î·ÈÛÙË Û˘Ó¤¯ÂÈ· ÙË˜ ÔÏÈÎ‹˜ ıÂÚÌÈ‰ÈÎ‹˜ ÚfiÛÏË„Ë˜ ÙÚÔÊ›ÌˆÓÚ·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÌÂ ‚¿ÛË ÙÔ ¿ıÚÔÈÛÌ· ÙˆÓ ÁÈÓÔÌ¤ÓˆÓÙË˜ ıÂÚÌÈ‰ÈÎ‹˜ ·Í›·˜ ÙÔ˘ Û˘ÁÎÂÎÚÈÌ¤ÓÔ˘ ÙÚÔÊ›ÌÔ˘ Â› ÙËÓÔÛfiÙËÙ· Î·È ÙË Û˘¯ÓfiÙËÙ· Î·Ù·Ó¿ÏˆÛË˜. ∏ ÂÓ¤ÚÁÂÈ· Î·ÈÙÔ ‰È·ÙÚÔÊÈÎfi ÂÚÈÂ¯fiÌÂÓÔ Î¿ıÂ ÙÚÔÊ›ÌÔ˘ ˘ÔÏÔÁ›ÛÙËÎÂÌÂ ‚¿ÛË ›Ó·ÎÂ˜ Ô˘ ·Ó·Ï‡Ô˘Ó ÙË Û‡ÛÙ·ÛË ÙˆÓ ÂÏÏËÓÈÎÒÓÊ·ÁËÙÒÓ (45). ÀÔÏÔÁ›ÛÙËÎ·Ó Ù· ·ÎfiÏÔ˘ı· ‰È·ÙÚÔÊÈÎ¿ÛÙÔÈ¯Â›· ÛÂ ÁÚ·ÌÌ¿ÚÈ· Î·Ù·Ó¿ÏˆÛË˜ ·Ó¿ ËÌ¤Ú·: ÎÔÚÂÛÌ¤-Ó·, ÌÔÓÔ·ÎfiÚÂÛÙ· Î·È ÔÏ˘·ÎfiÚÂÛÙ· Ï›Ë, Î·ıÒ˜ Î·È ˘‰·-Ù¿ÓıÚ·ÎÂ˜ Î·È ÚˆÙÂ˝ÓÂ˜. ∏ ıÂÚÌÈ‰ÈÎ‹ ÚfiÛÏË„Ë ÌÂÙÚ‹ıË-ÎÂ ÛÂ Kcal ·Ó¿ ËÌ¤Ú·.

∏ ÔÏÈÎ‹ ıÂÚÌÈ‰ÈÎ‹ ÚfiÛÏË„Ë Û¯ÂÙ›˙ÂÙ·È ıÂÙÈÎ¿ ÌÂ ÙËÓÎ·Ù·Ó¿ÏˆÛË ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ÔÌ¿‰ˆÓ ÙÚÔÊ›ÌˆÓ (¶›Ó·-Î·˜ 1) Î·È ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ‰È·ÙÚÔÊÈÎÒÓ ÛÙÔÈ¯Â›ˆÓ ıÂÚÌÈ-‰ÈÎ‹˜ ·Í›·˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ·Ú·¿Óˆ. ™˘ÓÂÒ˜, ÚÔÎÂÈ-Ì¤ÓÔ˘ Ó· ÂÏÂÁ¯ıÔ‡Ó ÔÈ Èı·Ó¤˜ Û˘Á¯˘ÙÈÎ¤˜ ÂÈ‰Ú¿ÛÂÈ˜ ÌÂ‚¿ÛË ÙÈ˜ ·ÔÎÏ›ÛÂÈ˜ ÙË˜ Ì¤ÛË˜ ÙÈÌ‹˜ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fiÌÔÓÔ·Ú·ÁÔÓÙÈÎ¤˜ ÂÍ·ÚÙ‹ÛÂÈ˜ ÙˆÓ Ú·ÁÌ·ÙÈÎÒÓ ÙÈÌÒÓ ÙˆÓ‰È·ÙÚÔÊÈÎÒÓ ÌÂÙ·‚ÏËÙÒÓ ·fi ÙËÓ ÔÏÈÎ‹ ıÂÚÌÈ‰ÈÎ‹ ÚfiÛÏË-„Ë, ¤ÁÈÓÂ ÚÔÙ‡ˆÛË ÁÈ· ÙË ıÂÚÌÈ‰ÈÎ‹ ÚfiÛÏË„Ë ÁÈ· fiÏÂ˜ÙÈ˜ ‰È·ÙÚÔÊÈÎ¤˜ ·Ú·Ì¤ÙÚÔ˘˜ (46).

∞ÔÙÂÏ¤ÛÌ·Ù· ™ÙÔÓ ¶›Ó·Î· 2 Ê·›ÓÂÙ·È Ë Î·Ù·ÓÔÌ‹ ÙˆÓ Á˘Ó·È-

ÎÒÓ Ô˘ Û˘ÌÌÂÙÂ›¯·Ó ÛÙË ÌÂÏ¤ÙË ÌÂ ‚¿ÛË ¯·Ú·-ÎÙËÚÈÛÙÈÎ¿ ÙË˜ ÂÁÎ˘ÌÔÛ‡ÓË˜ Î·È ÙÔ˘ ÙÔÎÂÙÔ‡, ÂÓÒÔ ¶›Ó·Î·˜ 3 ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÈ˜ ·ÓÙ›ÛÙÔÈ¯Â˜ Î·Ù·ÓÔ-Ì¤˜ Û˘¯ÓÔÙ‹ÙˆÓ ÌÂ ‚¿ÛË ÙËÓ Î·Ù·Ó¿ÏˆÛË ÙˆÓ‰È·ÊfiÚˆÓ ÔÌ¿‰ˆÓ ÙÚÔÊ›ÌˆÓ. OÈ ›Ó·ÎÂ˜ ·˘ÙÔ›¤¯Ô˘Ó ÂÚÈÁÚ·ÊÈÎ‹ ·Í›·.

™ÙÔÓ ¶›Ó·Î· 4 Ê·›ÓÔÓÙ·È ÔÈ ·ÌÔÈ‚·›ˆ˜ ÚÔÙ˘-ˆÌ¤ÓÔÈ Û˘ÓÙÂÏÂÛÙ¤˜ Û˘Û¯ÂÙ›ÛÂˆ˜ Ô˘ ÚÔ¤Î˘-„·Ó ·fi ÙËÓ ÔÏ˘·Ú·ÁÔÓÙÈÎ‹ ·Ó¿Ï˘ÛË Î·È ÂÚÈ-ÁÚ¿ÊÔ˘Ó ÙË ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ Ô˘Û˘ÓÂ¿ÁÂÙ·È Ë ÔÈÔÙÈÎ‹ ‹ ÔÛÔÙÈÎ‹ ÌÂÙ·‚ÔÏ‹ ÙˆÓÚÔ‰È·ıÂÛÈÎÒÓ ·Ú·ÁfiÓÙˆÓ. ∆· ¿ÚÚÂÓ· ÓÂÔÁÓ¿‹Ù·Ó ÛÂ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎfi ‚·ıÌfi ‚·Ú‡ÙÂÚ··fi Ù· ı‹ÏÂ· Î·Ù¿ 114 g. ∆· ÚˆÙfiÙÔÎ· ÓÂÔÁÓ¿Î·È ·˘Ù¿ ÙˆÓ ÔÔ›ˆÓ ÔÈ ÌËÙ¤ÚÂ˜ ‹Ù·Ó Â›ÙÂ ÔÏ‡ Ó¤-Â˜, Â›ÙÂ Û¯ÂÙÈÎ¿ ËÏÈÎÈˆÌ¤ÓÂ˜, Â›¯·Ó ÌÈÎÚfiÙÂÚÔ


301

¶›Ó·Î·˜ 3. ∫·Ù·ÓÔÌ‹ ÙˆÓ 368 ÌËÙ¤ÚˆÓ ÌÔÓ‹ÚˆÓ Î˘‹ÛÂˆÓ·Ó¿ÏÔÁ· ÌÂ ÙË ‰È·ÙÚÔÊÈÎ‹ ÚfiÛÏË„Ë

ªÂÙ·‚ÏËÙ‹ N %

ñ OÏÈÎ‹ ıÂÚÌÈ‰ÈÎ‹ ÚfiÛÏË„Ë (kcal) ≤1999 80 21,72000-2299 73 19,92300-2599 69 18,72600-2999 71 19,3≥3000 75 20,4

ñ ¢ËÌËÙÚÈ·Î¿ Î·È ¿ÏÏ· ·Ì˘ÏÒ‰Ë ≤2 ·Ó¿ ËÌ¤Ú· 69 18,83 123 33,44 106 28,8>4 70 19,0

ñ °Ï˘Î¿ Î·È ÎÔÌfiÛÙÂ˜ <1 ·Ó¿ ËÌ¤Ú· 156 42,41-2 95 25,83-4 84 22,8>4 33 9,0

ñ ŸÛÚÈ·, ÍËÚÔ› Î·ÚÔ› Î·È ÛfiÚÔÈ ≤1 ·Ó¿ Ì‹Ó· 75 20,42-3 106 28,84-5 101 27,4≥6 86 23,4

ñ §·¯·ÓÈÎ¿ ≤2 ·Ó¿ ËÌ¤Ú· 43 11,73 101 27,44 129 35,1≥5 95 25,8

ñ ºÚÔ‡Ù· ≤2 ·Ó¿ ËÌ¤Ú· 57 15,53 108 29,34 99 26,95 63 17,2≥6 41 11,1

ñ °¿Ï· Î·È Á·Ï·ÎÙÔÎÔÌÈÎ¿ ≤3 ·Ó¿ ËÌ¤Ú· 85 23,14 90 24,55 80 21,76 48 13,0≥7 65 17,7

ñ ¶ÚfiÛıÂÙ· Ï›Ë Î·È ¤Ï·È· ≤2 ·Ó¿ ËÌ¤Ú· 113 30,73 147 40,0≥4 108 29,3

ñ ∫Ú¤·˜ Î·È ·Ú¿ÁˆÁ· ≤3 ÊÔÚ¤˜/Â‚‰ÔÌ¿‰· 83 22,64-5 117 31,76-7 90 24,5>7 78 21,2

ñ æ¿ÚÈ· Î·È ı·Ï·ÛÛÈÓ¿ ≤1 ÊÔÚ¤˜/Ì‹Ó· 78 21,22-3 87 23,64-5 115 31,3≥6 88 23,9



302

‚¿ÚÔ˜ Á¤ÓÓËÛË˜, ·Ó Î·È ÔÈ ‰È·ÊÔÚ¤˜ Ô˘ ÚÔ¤Î˘-„·Ó ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜. ¡ÂÔÁÓ¿ ÌË-Ù¤ÚˆÓ ÌÂ Ì¤ÛË ÂÎ·›‰Â˘ÛË (·ÔÏ˘Ù‹ÚÈÔ §˘ÎÂ›Ô˘)Â›¯·Ó ÌÂÁ·Ï‡ÙÂÚÔ ‚¿ÚÔ˜ ·fi Ù· ÓÂÔÁÓ¿ ÌËÙ¤ÚˆÓÌÂ ˘„ËÏfiÙÂÚË ‹ ¯·ÌËÏfiÙÂÚË ÌfiÚÊˆÛË, ·Ó Î·È ÔÈ‰È·ÊÔÚ¤˜ ‹Ù·Ó ¿ÏÈ ÌË ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜. ∆Ô‚¿ÚÔ˜ Á¤ÓÓËÛË˜ ÙˆÓ ÓÂÔÁÓÒÓ ÌËÙ¤ÚˆÓ ÌÂ ˘„ËÏfi·Ó¿ÛÙËÌ· ‹Ù·Ó Ï›ÁÔ ÌÂÁ·Ï‡ÙÂÚÔ, ÂÓÒ ÙÔ ÈÛÙÔÚÈÎfi·Ô‚ÔÏÒÓ Î·È ·ÈÌÔÚÚ·Á›·˜ Î·Ù¿ ÙËÓ ÂÁÎ˘ÌÔÛ‡ÓËÛ¯ÂÙ›ÛÙËÎÂ ÌÂ Ï›ÁÔ ÌÈÎÚfiÙÂÚÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ ÓÂ-ÔÁÓÔ‡. ∆Ô ÈÛÙÔÚÈÎfi ÂÎÙÚÒÛÂˆÓ ‰ÂÓ ‚Ú¤ıËÎÂ Ó·Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙÔ ‚¿ÚÔ˜ ÓÂÔÁÓÔ‡ ÂfiÌÂÓË˜ ÂÁÎ˘-ÌÔÛ‡ÓË˜.

∆Ô Î¿ÓÈÛÌ· Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÁÎ˘ÌÔÛ‡-ÓË˜ ·ÚÔ˘Û›·ÛÂ ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ ·ÚÓËÙÈÎ‹ Û˘-Û¯¤ÙÈÛË ÌÂ ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜, ÂÓÒ Ë Î·Ù·Ó¿Ïˆ-ÛË Î·Ê¤ ·ÚÔ˘Û›·ÛÂ ·ÚÓËÙÈÎ‹, ·ÏÏ¿ ÌË ÛÙ·ÙÈÛÙÈ-Î¿ ÛËÌ·ÓÙÈÎ‹ Û˘Û¯¤ÙÈÛË. ∂Í¿ÏÏÔ˘, Ë Ì¤ÙÚÈ· Î·Ù·-Ó¿ÏˆÛË ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ (Î·ÌÈ¿ ·fi ÙÈ˜ Á˘Ó·›-ÎÂ˜ Ô˘ Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÛÙË ÌÂÏ¤ÙË ‰ÂÓ ·Ó¤-ÊÂÚÂ Î·Ù·Ó¿ÏˆÛË ÂÚÈÛÛfiÙÂÚˆÓ ·fi 7 ÔÙ‹ÚÈ··ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ ÙËÓ Â‚‰ÔÌ¿‰·) ·ÚÔ˘Û›·ÛÂıÂÙÈÎ‹ Î·È ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ ÙÔ

‚¿ÚÔ˜ Á¤ÓÓËÛË˜. ∂ÓÒ Ë ·‡ÍËÛË ‚¿ÚÔ˘˜ ÙË˜ ÌËÙ¤-Ú·˜ Î·Ù¿ ÙËÓ ÂÁÎ˘ÌÔÛ‡ÓË ‚Ú¤ıËÎÂ fiÙÈ ·ÔÙÂÏÂ›ÛËÌ·ÓÙÈÎfi ÚÔÁÓˆÛÙÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ÙÔ ‚¿ÚÔ˜Á¤ÓÓËÛË˜, Ë ÔÏÈÎ‹ ıÂÚÌÈ‰ÈÎ‹ ÚfiÛÏË„Ë, ÁÈ· ‰Â‰Ô-Ì¤ÓË ·‡ÍËÛË ‚¿ÚÔ˘˜ ÙË˜ ÌËÙ¤Ú·˜, ‰ÂÓ ‚Ú¤ıËÎÂÓ· Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜. ∆· ÓÂÔÁÓ¿ÙˆÓ ÌËÙ¤ÚˆÓ Ô˘ Ï¿Ì‚·Ó·Ó ÛÎÂ˘¿ÛÌ·Ù· Ê˘ÏÏÈ-ÎÔ‡ ÔÍ¤Ô˜ Î·Ù¿ ÙËÓ ÂÁÎ˘ÌÔÛ‡ÓË ‹Ù·Ó ‚·Ú‡ÙÂÚ·.OÈ ¶›Ó·ÎÂ˜ 2 Î·È 4 ÂÚÈ¤¯Ô˘Ó ÙÈ˜ ÌÂÙ·‚ÏËÙ¤˜ ÁÈ·ÙÈ˜ ÔÔ›Â˜ ˘¿Ú¯ÂÈ ÂÎ ÙˆÓ ÚÔÙ¤ÚˆÓ ˘fiıÂÛË fiÙÈÛ¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜. ÕÏÏÂ˜ ÌÂÙ·-‚ÏËÙ¤˜, fiˆ˜ .¯. Ô ÙfiÔ˜ ÌfiÓÈÌË˜ Î·ÙÔÈÎ›·˜ ÙË˜ÌËÙ¤Ú·˜ Î·È Ë Ï‹„Ë ‚ÈÙ·ÌÈÓÒÓ Î·Ù¿ ÙËÓ ÂÁÎ˘ÌÔ-Û‡ÓË, ÁÈ· ÙÈ˜ ÔÔ›Â˜ Ô‡ÙÂ ·Ó·ÌÂÓfiÙ·Ó, ·ÏÏ¿ Ô‡ÙÂÎ·È ‚Ú¤ıËÎÂ Û˘Û¯¤ÙÈÛË ÌÂ ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜, ‰ÂÓ¤¯Ô˘Ó Û˘ÌÂÚÈÏËÊıÂ› ÛÙÔ˘˜ ›Ó·ÎÂ˜.

OÈ ÌÂÙ·‚ÏËÙ¤˜ ÙÔ˘ ¶›Ó·Î· 4 ·ÔÙÂÏÔ‡Ó ÙÔ ‚·-ÛÈÎfi ÌÔÓÙ¤ÏÔ, ÛÙÔ ÔÔ›Ô ÚÔÛÙ¤ıËÎ·Ó ÂÓ·ÏÏ·ÎÙÈ-Î¿ ÔÈ ÔÌ¿‰Â˜ ÙÚÔÊ›ÌˆÓ ÌÂ ÙË ÛÂÈÚ¿ Ô˘ Ê·›ÓÔÓÙ·ÈÛÙÔÓ ¶›Ó·Î· 3. ∆· ·ÔÙÂÏ¤ÛÌ·Ù· Û˘ÓÔ„›˙ÔÓÙ·ÈÛÙÔÓ ¶›Ó·Î· 5. ∫·Ì›· ·fi ÙÈ˜ ÔÌ¿‰Â˜ ÙÚÔÊ›ÌˆÓ‰ÂÓ Û˘Û¯ÂÙ›ÛÙËÎÂ ÛÂ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎfi ‚·ıÌfiÌÂ ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜, ·ÓÂÍ¿ÚÙËÙ· ·Ó Ë ÂÎÙ›ÌËÛË

¶›Ó·Î·˜ 4. ªÂÚÈÎÔ› Û˘ÓÙÂÏÂÛÙ¤˜ ÂÍ·ÚÙ‹ÛÂˆ˜ ba, ÛÙ·ıÂÚ¿ ÛÊ¿ÏÌ·Ù· (SE) Î·È ÙÈÌ¤˜ ÎÚÈÙËÚ›Ô˘ P ÁÈ· Úfi‚ÏÂ„Ë ÙÔ˘ ‚¿ÚÔ˘˜Á¤ÓÓËÛË˜ ÛÂ ÁÚ·ÌÌ¿ÚÈ· ·fi ‚·ÛÈÎ¤˜ ÌÂÙ·‚ÏËÙ¤˜ ÙË˜ Î˘‹ÛÂˆ˜ Î·È ÙÔ˘ ÙÔÎÂÙÔ‡: ·ÔÙÂÏ¤ÛÌ·Ù· ÔÏ˘·Ú·ÁÔÓÙÈÎ‹˜ ·Ó¿-Ï˘ÛË˜

ªÂÙ·‚ÏËÙ¤˜ ∫·ÙËÁÔÚ›· ‹ ÌÔÓ¿‰· b SE (b) ∆ÈÌ¤˜ ÎÚÈÙËÚ›Ô˘ -P

ñ º‡ÏÔ ∞ÁfiÚÈ 114 47 0,02∫ÔÚ›ÙÛÈ OÌ¿‰· ·Ó·ÊÔÚ¿˜

ñ ™ÂÈÚ¿ Á¤ÓÓËÛË˜ 1 -94 52 0,07≥2 OÌ¿‰· ·Ó·ÊÔÚ¿˜

ñ ∏ÏÈÎ›· ÌËÙ¤Ú·˜ ≤24 ¯ÚfiÓÈ· -35 59 0,5425-34 OÌ¿‰· ·Ó·ÊÔÚ¿˜≥35 -75 82 0,36

ñ ∂Î·›‰Â˘ÛË ÌËÙ¤Ú·˜ ≤11 ¯ÚfiÓÈ· -138 73 0,0612 OÌ¿‰· ·Ó·ÊÔÚ¿˜

≥13 -84 53 0,11ñ ⁄„Ô˜ ÌËÙ¤Ú·˜ 5 cm 34 24 0,15ñ πÛÙÔÚÈÎfi ·Ô‚ÔÏÒÓ ¡·È -105 74 0,15

Ÿ¯È OÌ¿‰· ·Ó·ÊÔÚ¿˜ñ πÛÙÔÚÈÎfi ÂÎÙÚÒÛÂˆÓ ¡·È -21 66 0,75

Ÿ¯È OÌ¿‰· ·Ó·ÊÔÚ¿˜ñ ∞ÈÌÔÚÚ·Á›· ¡·È -84 60 0,16

Ÿ¯È OÌ¿‰· ·Ó·ÊÔÚ¿˜ñ ∫¿ÓÈÛÌ· Î·Ù¿ ÙËÓ ÂÁÎ˘ÌÔÛ‡ÓË 5 ÙÛÈÁ¿Ú· -87 31 <10-2

ñ ∫·Ê¤˜ 1 ÊÏ˘Ù˙¿ÓÈ/ËÌ¤Ú· -19 23 0,41ñ OÈÓÔÓÂ˘Ì·ÙÒ‰Ë ÔÙ¿ Ÿ¯È OÌ¿‰· ·Ó·ÊÔÚ¿˜

¡·È 163 50 <10-2

ñ ªËÙÚÈÎ‹ ÚfiÛÏË„Ë ‚¿ÚÔ˘˜ 2 kg 77 13 10-4

ñ OÏÈÎ‹ ıÂÚÌÈ‰ÈÎ‹ ÚfiÛÏË„Ë 300 Kcal -4 17 0,81ñ ™ÎÂ˘¿ÛÌ·Ù· Ê˘ÏÏÈÎÔ‡ ÔÍ¤ˆ˜ Ÿ¯È OÌ¿‰· ·Ó·ÊÔÚ¿˜

¡·È 108 50 0,03

a ªÂÙ¿ ·fi ·ÌÔÈ‚·›Ô ¤ÏÂÁ¯Ô ÁÈ· fiÏÂ˜ ÙÈ˜ ÌÂÙ·‚ÏËÙ¤˜ ÙÔ˘ ÔÏ˘·Ú·ÁÔÓÙÈÎÔ‡ ÌÔÓÙ¤ÏÔ˘, Ô Û˘ÓÙÂÏÂÛÙ‹˜ ÌÂÚÈÎ‹˜ ÂÍ·ÚÙ‹ÛÂˆ˜ b ‰ËÏÒÓÂÈ ÙË Ì¤ÛË ÙÈÌ‹ ÌÂÙ·‚ÏËÙ‹˜, ‰ËÏ·‰‹ ÙÔ˘ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ ÛÂ g ÁÈ· ÌÂÙ·‚ÔÏ‹ ÙË˜ ·ÓÂÍ¿ÚÙËÙË˜ ÌÂÙ·‚ÏËÙ‹˜ (.¯.Ê‡ÏÔ˘, ÛÂÈÚ¿˜ Á¤ÓÓËÛË˜) Î·Ù¿ Ì›· ÌÔÓ¿‰·


¤ÁÈÓÂ ÂÓ·ÏÏ·ÎÙÈÎ¿ ÁÈ· Î¿ıÂ ÔÌ¿‰· (ÌÔÓÙ¤Ï· 1-9) ‹Ù·˘Ùfi¯ÚÔÓ· (ÌÔÓÙ¤ÏÔ 10). ªfiÓÔ ÙÔ ÎÚ¤·˜ Î·È Ù··Ú¿ÁˆÁ¿ ÙÔ˘, Î·ıÒ˜ Î·È ÙÔ „¿ÚÈ Î·È Ù· ı·Ï·ÛÛÈ-Ó¿ ·ÚÔ˘Û›·Û·Ó ÔÚÈ·Î‹ ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ ÙÔ‚¿ÚÔ˜ Á¤ÓÓËÛË˜. ∞Ó Î·È Â›Ó·È ÏÈÁfiÙÂÚÔ ÛÙ·ÙÈÛÙÈÎ¿ÛËÌ·ÓÙÈÎ‹, Ë Û¯¤ÛË ·Ó¿ÌÂÛ· ÛÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜Î·È ÙËÓ ÚfiÛÏË„Ë „·ÚÈÒÓ Î·È ı·Ï·ÛÛÈÓÒÓ Â›Ó·È›Ûˆ˜ ÂÚÈÛÛfiÙÂÚÔ ·ÍÈÔÛËÌÂ›ˆÙË, ÁÈ·Ù› Û¯ÂÙ›˙ÂÙ·ÈÌÂ ·‡ÍËÛË ‚¿ÚÔ˘˜ ÙÔ˘ ÓÂÔÁÓÔ‡ ÙË˜ Ù¿ÍÂˆ˜ ÙˆÓ66 g, ÛÂ Û¯¤ÛË ÌÂ Ù· 18 g ·‡ÍËÛË˜ Ô˘ Û˘ÓÂ¿-ÁÂÙ·È Ë Ï‹„Ë Ì›·˜ ÌÔÓ¿‰·˜ ÎÚ¤·ÙÔ˜ Î·È ·Ú·ÁÒ-ÁˆÓ ÙÔ˘.

™ÙÔÓ ¶›Ó·Î· 6 Ê·›ÓÔÓÙ·È ÔÈ Ì¤ÛÂ˜ ÙÈÌ¤˜ Î·È ÔÈ·ÓÙ›ÛÙÔÈ¯Â˜ ÛÙ·ıÂÚ¤˜ ·ÔÎÏ›ÛÂÈ˜ ÙË˜ ÚfiÛÏË„Ë˜ÛÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÁÎ˘ÌÔÛ‡ÓË˜ ‰È·ÙÚÔÊÈÎÒÓ Ì·-

ÎÚÔÛÙÔÈ¯Â›ˆÓ Ô˘ ÚÔÛÊ¤ÚÔ˘Ó ÂÓ¤ÚÁÂÈ·, ÌÂÙ¿·fi ¤ÏÂÁ¯Ô ÙË˜ ıÂÚÌÈ‰ÈÎ‹˜ ÚfiÛÏË„Ë˜. OÈ ÚÔÙ˘-ˆÌ¤ÓÂ˜ ÁÈ· ıÂÚÌÈ‰ÈÎ‹ ÚfiÛÏË„Ë ÛÙ·ıÂÚ¤˜ ·Ô-ÎÏ›ÛÂÈ˜ Ô˘ ·ÔÙ˘ÒÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 7, ¯ÚËÛÈ-ÌÔÔÈ‹ıËÎ·Ó ˆ˜ ÌÔÓ¿‰Â˜ ÁÈ· ÙÔÓ ˘ÔÏÔÁÈÛÌfi ÙˆÓÌÂÚÈÎÒÓ Û˘ÓÙÂÏÂÛÙÒÓ ÂÍ¿ÚÙËÛË˜ Ô˘ ÚÔ¤Î˘„·Ó·fi ÙËÓ ÔÏ˘·Ú·ÁÔÓÙÈÎ‹ ·Ó¿Ï˘ÛË. ∆· ÛÙÔÈ¯Â›·ÙÔ˘ ¶›Ó·Î· 7 ‰Â›¯ÓÔ˘Ó fiÙÈ ÛÙÈ˜ ÔÌ¿‰Â˜ Ì·ÎÚÔÛÙÔÈ-¯Â›ˆÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó, ÌfiÓÔ Ù· ÌÔÓÔ·ÎfiÚÂÛÙ·Ï›Ë Ê·›ÓÂÙ·È fiÙÈ Û¯ÂÙ›˙ÔÓÙ·È ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¿ÌÂ ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜. ™˘ÁÎÂÎÚÈÌ¤Ó·, ÛÙÔ ¤ÎÙÔÌÔÓÙ¤ÏÔ, Ê·›ÓÂÙ·È fiÙÈ Ì›· ·‡ÍËÛË ÙË˜ Ù¿ÍÂˆ˜ ÙˆÓ8 g (›ÛË ÌÂ Ì›· ÂÓÂÚÁÂÈ·Î¿ ÚÔÙ˘ˆÌ¤ÓË ÛÙ·ıÂÚ¿·fiÎÏÈÛË) ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÚfiÛÏË„Ë ÌÔÓÔ·Îfi-ÚÂÛÙˆÓ ÏÈÒÓ, Û˘ÓÂ¿ÁÂÙ·È ·‡ÍËÛË ÙÔ˘ ‚¿ÚÔ˘˜ÓÂÔÁÓÔ‡ Î·Ù¿ 49 g.

™˘˙‹ÙËÛË Ÿˆ˜ Û˘Ì‚·›ÓÂÈ ÛÂ Î¿ıÂ ÂÈ‰ËÌÈÔÏÔÁÈÎ‹ ÌÂÏ¤-

ÙË, ÚÈÓ ÂÈ¯ÂÈÚ‹ÛÂÈ Î·ÓÂ›˜ Ó· ÂÚÌËÓÂ‡ÛÂÈ Ù· ·Ô-ÙÂÏ¤ÛÌ·Ù· ÛÙÔ Ï·›ÛÈÔ ÙˆÓ ‚ÈÔ˚·ÙÚÈÎÒÓ ‰Â‰ÔÌ¤-ÓˆÓ, Â›Ó·È ·Ó·ÁÎ·›Ô Ó· ÂÍÂÙ·ÛÙÔ‡Ó Ù¤ÛÛÂÚ· ˙ËÙ‹-Ì·Ù· (47): ·) ·Ó ˘¿Ú¯Ô˘Ó Û˘ÛÙËÌ·ÙÈÎ¿ ÛÊ¿ÏÌ·Ù·ÂÈÏÔÁ‹˜, ‚) ·Ó ˘¿Ú¯Ô˘Ó Û˘ÛÙËÌ·ÙÈÎ¿ ÛÊ¿ÏÌ·Ù·ÏËÚÔÊfiÚËÛË˜, Á) ·Ó ˘¿Ú¯Ô˘Ó Û˘Á¯˘ÙÈÎ¤˜ ÂÈ-‰Ú¿ÛÂÈ˜ Î·È ‰) ÔÈ· Â›Ó·È Ë ÈÛ¯‡˜ ÙË˜ ÌÂÏ¤ÙË˜.


303

¶›Ó·Î·˜ 5. ªÂÚÈÎÔ› Û˘ÓÙÂÏÂÛÙ¤˜ ÂÍ·ÚÙ‹ÛÂˆ˜ ba, ÛÙ·ıÂÚ¿ ÛÊ¿ÏÌ·Ù· (SE) Î·È ÙÈÌ¤˜ ÎÚÈÙËÚ›Ô˘ P ÁÈ· Úfi‚ÏÂ„Ë ÙÔ˘ ‚¿ÚÔ˘˜Á¤ÓÓËÛË˜ ÛÂ ÔÌ¿‰Â˜ ·fi ‰È·ÙÚÔÊÈÎ¤˜ ÌÂÙ·‚ÏËÙ¤˜: ·ÔÙÂÏ¤ÛÌ·Ù· ÔÏ˘·Ú·ÁÔÓÙÈÎ‹˜ ·Ó¿Ï˘ÛË˜

ªÂÙ·‚ÏËÙ¤˜ ªÔÓ¿‰· b SE (b) ∆ÈÌ¤˜ ÎÚÈÙËÚ›Ô˘ -P

1 ¢ËÌËÙÚÈ·Î¿ Î·È ·Ì˘ÏÒ‰Ë 1 ·Ó¿ ËÌ¤Ú· 31 37 0,402 °Ï˘Î¿ Î·È ÎÔÌfiÛÙÂ˜ 1 ·Ó¿ ËÌ¤Ú· 4 33 0,903 ŸÛÚÈ·, ÍËÚÔ› Î·ÚÔ› Î·È ÛfiÚÔÈ 1 ·Ó¿ Â‚‰ÔÌ¿‰· -46 60 0,444 §·¯·ÓÈÎ¿ 1 ·Ó¿ ËÌ¤Ú· 5 26 0,845 ºÚÔ‡Ù· 1 ·Ó¿ ËÌ¤Ú· -8 23 0,726 ∫Ú¤·˜ Î·È ·Ú¿ÁˆÁ· 1 ·Ó¿ Â‚‰ÔÌ¿‰· 19 10 0,077 æ¿ÚÈ· Î·È ı·Ï·ÛÛÈÓ¿ 1 ·Ó¿ Â‚‰ÔÌ¿‰· 55 45 0,228 °¿Ï· Î·È Á·Ï·ÎÙÔÎÔÌÈÎ¿ 1 ·Ó¿ ËÌ¤Ú· -3 22 0,899 §¿‰È Î·È Ï›Ë 1 ·Ó¿ ËÌ¤Ú· 27 30 0,36

10 ∆·˘Ùfi¯ÚÔÓÔ ÌÔÓÙ¤ÏÔb

¢ËÌËÙÚÈ·Î¿ Î·È ·Ì˘ÏÒ‰Ë 1 ·Ó¿ ËÌ¤Ú· 18 38 0,63°Ï˘Î¿ Î·È ÎÔÌfiÛÙÂ˜ 1 ·Ó¿ ËÌ¤Ú· -2 32 0,96ŸÛÚÈ·, ÍËÚÔ› Î·ÚÔ› Î·È ÛfiÚÔÈ 1 ·Ó¿ Â‚‰ÔÌ¿‰· -86 61 0,16§·¯·ÓÈÎ¿ 1 ·Ó¿ ËÌ¤Ú· -8 27 0,76ºÚÔ‡Ù· 1 ·Ó¿ ËÌ¤Ú· -11 23 0,62∫Ú¤·˜ Î·È ·Ú¿ÁˆÁ· 1 ·Ó¿ Â‚‰ÔÌ¿‰· 18 10 0,08æ¿ÚÈ· Î·È ı·Ï·ÛÛÈÓ¿ 1 ·Ó¿ Â‚‰ÔÌ¿‰· 66 47 0,16°¿Ï· Î·È Á·Ï·ÎÙÔÎÔÌÈÎ¿ 1 ·Ó¿ ËÌ¤Ú· -5 18 0,79§¿‰È Î·È Ï›Ë 1 ·Ó¿ ËÌ¤Ú· 12 30 0,69

a ‚Ï¤Â ˘ÔÛËÌÂ›ˆÛË ÛÙÔÓ ¶›Ó·Î· 4 b ªÂÙ¿ ·fi ¤ÏÂÁ¯Ô ÁÈ· ÙÈ˜ ÌÂÙ·‚ÏËÙ¤˜ ÙÔ˘ ‚·ÛÈÎÔ‡ ÌÔÓÙ¤ÏÔ˘ Ô˘ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 4

∏ ÔÏÈÎ‹ ıÂÚÌÈ‰ÈÎ‹ ÂÓ¤ÚÁÂÈ· ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙÔ ÌÔÓÙ¤ÏÔ 10. OÈ ‰È·ÙÚÔÊÈÎ¤˜ ÌÂÙ·‚ÏËÙ¤˜ ÙÔ˘ Â¿Óˆ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ¶›-Ó·Î· ¤¯Ô˘Ó ÂÈÛ·¯ıÂ› ÂÓ·ÏÏ·ÎÙÈÎ¿ Î·È Ì›· Î¿ıÂ ÊÔÚ¿ ÛÙ· ÌÔÓÙ¤Ï· 1-9. OÈ ‰È·ÙÚÔÊÈÎ¤˜ ÌÂÙ·‚ÏËÙ¤˜ ÛÙÔ Î¿Ùˆ ÙÌ‹Ì· ÙÔ˘ ¶›-Ó·Î· ¤¯Ô˘Ó ÂÈÛ·¯ıÂ› Ù·˘Ùfi¯ÚÔÓ· ÁÈ· ·ÌÔÈ‚·›Ô ¤ÏÂÁ¯Ô ÙˆÓ Û˘Á¯˘ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ

¶›Ó·Î·˜ 6. ª¤ÛÂ˜ ÙÈÌ¤˜ Î·È ÛÙ·ıÂÚ¤˜ ·ÔÎÏ›ÛÂÈ˜ (SD) ÁÈ·ÂÓÂÚÁÂÈ·Î¿ ÚÔÙ˘ˆÌ¤Ó· ‰È·ÙÚÔÊÈÎ¿ ÛÙÔÈ¯Â›·* ÛÙÈ˜ 368ÌËÙ¤ÚÂ˜

ªÂÙ·‚ÏËÙ‹ ªÔÓ¿‰· ª¤ÛË ÙÈÌ‹ SD

£ÂÚÌ›‰Â˜ Kcal 2550 -∫ÔÚÂÛÌ¤Ó· Ï›Ë g 35 7ªÔÓÔ·ÎfiÚÂÛÙ· Ï›Ë g 57 8¶ÔÏ˘·ÎfiÚÂÛÙ· Ï›Ë g 14 4À‰·Ù¿ÓıÚ·ÎÂ˜ g 261 42¶ÚˆÙÂ˝ÓÂ˜ g 87 11

* BÈ‚ÏÈÔÁÚ·Ê›· 46



304

∂ÌÊ·Ó‹ Û˘ÛÙËÌ·ÙÈÎ¿ ÛÊ¿ÏÌ·Ù· ÂÈÏÔÁ‹˜ ‰ÂÓÚ¤ÂÈ Ó· ˘¿Ú¯Ô˘Ó, ÂÂÈ‰‹ Ë ÂÈÏÔÁ‹ ÙˆÓ ËÌÂ-ÚÒÓ Î·Ù¿ ÙÈ˜ ÔÔ›Â˜ ¤ÁÈÓ·Ó ÔÈ Û˘ÓÂÓÙÂ‡ÍÂÈ˜ ÛÙ·Ì·ÈÂ˘Ù‹ÚÈ· ¤ÁÈÓÂ Ù˘¯·›·, ¯ˆÚ›˜ ÔÈ ËÌÂÚÔÌËÓ›Â˜Û˘ÏÏÔÁ‹˜ ‰Â‰ÔÌ¤ÓˆÓ Ó· ¤¯Ô˘Ó Û¯¤ÛË ÌÂ Î·ÌÈ¿·fi ÙÈ˜ ÌÂÙ·‚ÏËÙ¤˜ ÙË˜ ÌÂÏ¤ÙË˜. ∂›ÛË˜, ‰ÂÓ Ê·›-ÓÂÙ·È Ó· ˘¿Ú¯Ô˘Ó Û˘ÛÙËÌ·ÙÈÎ¿ ÛÊ¿ÏÌ·Ù· ÏË-ÚÔÊfiÚËÛË˜, ÂÂÈ‰‹ ÔÈ Û˘ÓÂÓÙÂ‡ÍÂÈ˜ ÌÂ ÙÈ˜ ÏÂ-¯ˆ˝‰Â˜ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÚÈÓ ·fi ÙËÓ ·Ó·˙‹-ÙËÛË ÙÔ˘ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ ÙÔ˘ Û˘ÁÎÂÎÚÈÌ¤ÓÔ˘ÓÂÔÁÓÔ‡ ÛÙÔ ·Ú¯Â›Ô ÙË˜ ª·ÈÂ˘ÙÈÎ‹˜ ∫ÏÈÓÈÎ‹˜.∂Í¿ÏÏÔ˘, ÌÂ ÙËÓ ÔÏ˘·Ú·ÁÔÓÙÈÎ‹ ·Ó¿Ï˘ÛË, ·Ô-ÊÂ‡ÁÔÓÙ·È Î·Ù¿ ÙÔ ‰˘Ó·ÙfiÓ ÔÈ ÂÓ‰Â¯fiÌÂÓÂ˜ Û˘Á-¯˘ÙÈÎ¤˜ ÂÈ‰Ú¿ÛÂÈ˜ ·fi ÙÔ˘˜ ÌË ‰È·ÙÚÔÊÈÎÔ‡˜ÚÔÛ‰ÈÔÚÈÛÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ÙÔ˘ ‚¿ÚÔ˘˜ Á¤Ó-ÓËÛË˜, Î·ıÒ˜ Â›ÛË˜ Î·È ÔÈ ·ÌÔÈ‚·›Â˜ Û˘Á¯˘ÙÈÎ¤˜ÂÈ‰Ú¿ÛÂÈ˜ ·Ó¿ÌÂÛ· ÛÙÔ˘˜ ‰È·ÙÚÔÊÈÎÔ‡˜ ·Ú¿-ÁÔÓÙÂ˜. ∏ ·ÍÈÔÈÛÙ›· ÙË˜ ÌÂÏ¤ÙË˜ ÂÓÈÛ¯‡ÂÙ·È Â›-ÛË˜ ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ·Ó¤‰ÂÈÍÂ fiÏÂ˜ ÙÈ˜ Î·ıÈÂ-ÚˆÌ¤ÓÂ˜ Û˘Û¯ÂÙ›ÛÂÈ˜ ·Ó¿ÌÂÛ· ÛÂ ÌË ‰È·ÙÚÔÊÈ-ÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ Î·È ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜.

∫·Ù¿ ÙÔ Û¯Â‰È·ÛÌfi ÙË˜ ¤ÚÂ˘Ó·˜, Ô ˘ÔÏÔÁÈ-ÛÌfi˜ ÙË˜ ÈÛ¯‡Ô˜ ¤ÁÈÓÂ ÌÂ Ù¤ÙÔÈÔ ÙÚfiÔ ÒÛÙÂ Ó··Ó·‰ÂÈ¯ıÂ› Ë Î·ıÈÂÚˆÌ¤ÓË ·ÚÓËÙÈÎ‹ Û¯¤ÛË ·Ó¿ÌÂ-Û· ÛÙÔ Î¿ÓÈÛÌ· ÙË˜ ÂÁÎ‡Ô˘ Î·È ÙÔ ‚¿ÚÔ˜ Á¤ÓÓË-

ÛË˜. ŸÛÔÓ ·ÊÔÚ¿ ÛÙÈ˜ ‰È·ÙÚÔÊÈÎ¤˜ ·Ú·Ì¤-ÙÚÔ˘˜, Ë ÌfiÓË ‰fiÎÈÌË ·ÈÙÈÔÏÔÁÈÎ‹ ˘fiıÂÛË ·ÊÔ-ÚÔ‡ÛÂ ÙË Û¯¤ÛË ÌÂÙ·Í‡ ÙˆÓ ˆÌ¤Á· 3-ÏÈ·ÚÒÓÔÍ¤ˆÓ Î·È ÙÔ˘ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜. ŸÌˆ˜, ÁÈ· ÙËÓ·ÍÈÔÏfiÁËÛË ÙË˜ ·Ú·¿Óˆ ˘fiıÂÛË˜ ˘‹Ú¯·ÓÂÁÁÂÓÂ›˜ ÂÚÈÔÚÈÛÌÔ›, ·ÊÔ‡ Ù· ‰Â‰ÔÌ¤Ó· ÁÈ· Ù·Û˘ÛÙ·ÙÈÎ¿ ÙˆÓ ÂÏÏËÓÈÎÒÓ Ê·ÁËÙÒÓ ‰ÂÓ ÂÌÂÚÈ¤-¯Ô˘Ó ÏËÚÔÊÔÚ›Â˜ Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ÂÚÈÂÎÙÈÎfiÙËÙ·ÛÂ ·ÎfiÚÂÛÙ· ÏÈ·Ú¿ ÔÍ¤· Ì·ÎÚ¿˜ ·Ï‡ÛÔ˘. ªÂÏÂ-Ù‹ıËÎ·Ó Û˘ÓÔÏÈÎ¿ 400 ÏÂ¯ˆ˝‰Â˜, ÁÈ·Ù› Ô ·ÚÈıÌfi˜·˘Ùfi˜ ıÂˆÚ‹ıËÎÂ ·ÚÎÂÙ¿ ÌÂÁ¿ÏÔ˜ ÁÈ· ÙËÓ ·Ó¿-‰ÂÈÍË ÛËÌ·ÓÙÈÎÒÓ Û˘Û¯ÂÙ›ÛÂˆÓ Ú·ÎÙÈÎ‹˜ ÛËÌ·-Û›·˜. ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜fi¯È ÌfiÓÔ ‰ÂÓ ¤Ú¯ÔÓÙ·È ÛÂ ·ÓÙ›ıÂÛË, ·ÏÏ¿ ÌÔÚÂ›Ó· ıÂˆÚËıÂ› fiÙÈ Â›Ó·È Û˘Ì‚·Ù¿ ÌÂ ÙËÓ ˘fiıÂÛË fiÙÈË ·˘ÍËÌ¤ÓË ÚfiÛÏË„Ë „·ÚÈÔ‡ Î·È ı·Ï·ÛÛÈÓÒÓÂ˘Ô‰ÒÓÂÈ ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÂÌ‚Ú‡Ô˘. ∂Í¿ÏÏÔ˘,Ù· ·ÔÙÂÏ¤ÛÌ·Ù· Û˘ÌÊˆÓÔ‡Ó ÌÂ ÚÔËÁÔ‡ÌÂÓÂ˜ÌÂÏ¤ÙÂ˜ (31,33,48) Ô˘ ÙÔÓ›˙Ô˘Ó fiÙÈ Ë ÚfiÛÏË„ËÎÚ¤·ÙÔ˜, ÙÚÔÊ‹˜ ÏÔ‡ÛÈ·˜ ÛÂ ÚˆÙÂ˝ÓÂ˜, ÌÔÚÂ›Ó· ·ÚÔ˘ÛÈ¿˙ÂÈ ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ ÙÔ ‚¿ÚÔ˜Á¤ÓÓËÛË˜. ¶·Ú’ fiÏ· ·˘Ù¿, Î·Ì›· ·fi ÙÈ˜ ·Ú·¿-Óˆ Û˘Û¯ÂÙ›ÛÂÈ˜ ‰ÂÓ ÂÌÊ·Ó›˙ÂÙ·È ·ÚÎÂÙ¿ ÛËÌ·ÓÙÈ-Î‹ ÁÈ· ¯¿Ú·ÍË Ó¤·˜ ÔÏÈÙÈÎ‹˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙË‰È·ÙÚÔÊ‹ ÙˆÓ ÂÁÎ‡ˆÓ Á˘Ó·ÈÎÒÓ.

¶›Ó·Î·˜ 7. ªÂÚÈÎÔ› Û˘ÓÙÂÏÂÛÙ¤˜ ÂÍ·ÚÙ‹ÛÂˆ˜ b, ÛÙ·ıÂÚ¿ ÛÊ¿ÏÌ·Ù· (SE) Î·È ÙÈÌ¤˜ ÎÚÈÙËÚ›Ô˘ P ÁÈ· Úfi‚ÏÂ„Ë ÙÔ˘ ‚¿ÚÔ˘˜Á¤ÓÓËÛË˜ ÛÂ ÁÚ·ÌÌ¿ÚÈ· ·fi ‰È·ÙÚÔÊÈÎ¿ ÛÙÔÈ¯Â›· ÁÈ· ÙÈ˜ 368 ÔÌ¿‰Â˜: ·ÔÙÂÏ¤ÛÌ·Ù· ÔÏ˘·Ú·ÁÔÓÙÈÎ‹˜ ·Ó¿Ï˘ÛË˜

ªÔÓÙ¤ÏÔ ¢È·ÙÚÔÊÈÎfi ÛÙÔÈ¯Â›Ô (g) b SE (b) ∆ÈÌ‹ ÎÚÈÙËÚ›Ô˘ -P

1 ∫ÔÚÂÛÌ¤Ó· Ï›Ë 31 23,7 0,192 ªÔÓÔ·ÎfiÚÂÛÙ· Ï›Ë 54 22,9 0,023 ¶ÔÏ˘·ÎfiÚÂÛÙ· Ï›Ë 41 24,3 0,094 À‰·Ù¿ÓıÚ·ÎÂ˜ -22 26,7 0,415 ¶ÚˆÙÂ˝ÓÂ˜ 17 22,8 0,46

∆·˘ÙÔ¯ÚÔÓÈÎ¿ ÌÔÓÙ¤Ï· ÂÓ·ÏÏ·ÎÙÈÎÒÓ ‰È·ÙÚÔÊÈÎÒÓ ÛÙÔÈ¯Â›ˆÓ

6 ªÔÓÔ·ÎfiÚÂÛÙ· Ï›Ë 49 24,0 0,04¶ÔÏ˘·ÎfiÚÂÛÙ· Ï›Ë 29 25,3 0,24

¶ÚˆÙÂ˝ÓÂ˜ 26 22,9 0,247 À‰·Ù¿ÓıÚ·ÎÂ˜ 3 28,3 0,91

ªÔÓÔ·ÎfiÚÂÛÙ· Ï›Ë 48 26,3 0,06¶ÔÏ˘·ÎfiÚÂÛÙ· Ï›Ë 29 25,4 0,24

¶ÚˆÙÂ˝ÓÂ˜ 25 25,9 0,33

™‡ÓÔÏÔ ‰È·ÙÚÔÊÈÎÒÓ ÛÙÔÈ¯Â›ˆÓ, ÂÍ·ÈÚÔ˘Ì¤ÓË˜ ÙË˜ ÔÏÈÎ‹˜ ıÂÚÌÈ‰ÈÎ‹˜ ÚfiÛÏË„Ë˜

8 À‰·Ù¿ÓıÚ·ÎÂ˜ 4 29,0 0,88ªÔÓÔ·ÎfiÚÂÛÙ· Ï›Ë 47 26,9 0,07¶ÔÏ˘·ÎfiÚÂÛÙ· Ï›Ë 29 25,6 0,25

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™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÌÂÏ¤-ÙË˜ ˘Ô‰ËÏÒÓÔ˘Ó fiÙÈ Ë ÚfiÛÏË„Ë „·ÚÈÔ‡ Î·È ÌÔ-ÓÔ·ÎfiÚÂÛÙˆÓ ÏÈÈ‰›ˆÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ıÂÙÈÎ‹ Û˘Û¯¤-ÙÈÛË ÌÂ ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜, ·ÏÏ¿ Î·Ì›· ·fi ÙÈ˜Û˘Û¯ÂÙ›ÛÂÈ˜ ·˘Ù¤˜ ‰ÂÓ Â›Ó·È ·ÚÎÂÙ¿ ÛËÌ·ÓÙÈÎ‹ÒÛÙÂ Ó· ÛËÌ·ÙÔ‰ÔÙÂ› ·ÏÏ·Á‹ ÛÙË ‰È·ÙÚÔÊÈÎ‹ Ô-ÏÈÙÈÎ‹ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÁÎ˘ÌÔÛ‡ÓË˜. ™˘ÓÂ-Ò˜, Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜ ¯ÚÂÈ¿˙ÂÙ·È Ó·ÂÈ‚Â‚·ÈˆıÔ‡Ó ·fi ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜ ÛÂ ‰È·ÊÔÚÂÙÈ-Î¤˜ ÏËı˘ÛÌÈ·Î¤˜ ÔÌ¿‰Â˜.

∂˘¯·ÚÈÛÙ›Â˜£ÂÚÌ¤˜ Â˘¯·ÚÈÛÙ›Â˜ ÛÙÈ˜ ∂ÈÛÎ¤ÙÚÈÂ˜ ÀÁÂ›·˜ Î˘Ú›Â˜

ª¤Ú· ∂Ï¤ÓË Î·È ¢È·Ì·ÓÙÔÔ‡ÏÔ˘ ∆¤ÓÈ· ÁÈ· ÙË Û˘ÁÎ¤ÓÙÚˆÛËÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ, Î·ıÒ˜ Î·È ÛÙÈ˜ ÌËÙ¤ÚÂ˜ Ô˘ Û˘ÌÌÂÙÂ›¯·ÓÛÙË ÌÂÏ¤ÙË.

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∂¶π™∆O§∏ ¶ƒO™ ∆∏ ™À¡∆∞•∏ LETTER TO THE EDITOR

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ŒÓ· ·fi Ù· ı¤Ì·Ù· Ô˘ ·ÚÔ˘ÛÈ¿ÛÙËÎ·Ó ÚfiÛÊ·Ù· ·Ó·ÊÂÚfiÙ·Ó ÛÙË ÛËÌ·Û›· ÙÔ˘ ÎÏ¿Ì·ÙÔ˜ ÙÔ˘ ÓÂ-ÔÁÓÔ‡ Î·È, ÌÂÙ·Í‡ ¿ÏÏˆÓ, ÛÙÔ ÎÏ¿Ì· ÙÔ˘ ÓÂÔÁÓÔ‡ ˆ˜ Ì¤ÛÔ˘ ÂÎ‰‹ÏˆÛË˜ Â›Ó·˜. ™˘ÁÎÂÎÚÈÌ¤Ó·, ˘‹ÚÍÂ ËÂÈÌ¤ÚÔ˘˜ ÂÈÎÂÊ·Ï›‰·: “∫¿ıÂ fiÙÂ ÎÏ·›ÂÈ ÙÔ ÌˆÚfi ÂÂÈ‰‹ ÂÈÓ¿ÂÈ” Î·È ÛÙË Û˘Ó¤¯ÂÈ· (ÛÂ Û¯¤ÛË ÌÂ ÙË Û›-ÙÈÛË): “∆È Û˘ÛÙ‹ÓÔ˘ÌÂ”. ∂ÎÂ› ·Ó·Ê¤ÚÔÓÙ·È Ù· ·ÎfiÏÔ˘ı·, Ù· ÔÔ›· ÌÂÙ·Ê¤Úˆ ·˘ÙÔÏÂÍÂ›: “∆¿ÈÛÌ· Î¿ıÂ‰˘fiÌÈÛÈ-Ù¤ÛÛÂÚÈ˜ ÒÚÂ˜. ∞Ó Í˘Ó‹ÛÂÈ ÓˆÚ›ÙÂÚ· ÙÔ˘ ‰›ÓÔ˘ÌÂ 20-30 g ÚfiÊËÌ·, ÁÈ· Ó· ËÛ˘¯¿ÛÂÈ, ÒÛÔ˘ Ó·¤¯Ô˘Ó ÂÚ¿ÛÂÈ ‰˘fiÌÈÛÈ ÒÚÂ˜ ·fi ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ÚÔËÁÔ‡ÌÂÓÔ˘ ÁÂ‡Ì·ÙÔ˜ Î·È Â¿Ó ‰ÂÓ ¤¯ÂÈ Í˘Ó‹ÛÂÈ ÛÙÈ˜Ù¤ÛÛÂÚÈ˜ ÒÚÂ˜, ÙÔ Í˘Ó¿ÌÂ Ó· Ê¿ÂÈ, ÂÎÙfi˜ ·fi ÙË Ó‡ÎÙ·, ÔfiÙÂ ı¤ÏÔ˘ÌÂ Ó· ·ÔÎÙ‹ÛÂÈ ÙË Û˘Ó‹ıÂÈ· Ó·ÎÔÈÌ¿Ù·È ÂÚÈÛÛfiÙÂÚÂ˜ ÒÚÂ˜. ¢¤Î· ÏÂÙ¿ ÛÙÔ ÚÒÙÔ ÛÙ‹ıÔ˜, fiÛÔ ı¤ÏÂÈ ·fi ÙÔ ‰Â‡ÙÂÚÔ ÛÙ‹ıÔ˜ Î·È ·ÓÙ›-ÛÙÚÔÊ· ÙËÓ ÂfiÌÂÓË ÊÔÚ¿”. ™ÙË Û˘Ó¤¯ÂÈ·, ·Ú·Ù›ıÂÓÙ·È ¿ÏÏ· ˙ËÙ‹Ì·Ù·.

£¤Ïˆ ÏÔÈfiÓ Ó· Û¯ÔÏÈ¿Ûˆ Ù· ·ÓˆÙ¤Úˆ Û¯ÂÙÈÎ¿ ÌÂ ÙÔ ÚÔÙÂÈÓfiÌÂÓÔ ·˘ÛÙËÚfi “ˆÚ¿ÚÈÔ ıËÏ·ÛÌÔ‡”Î.Ï. Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÈÔ ¿Óˆ.

∏ Û›ÙÈÛË ÙÔ˘ ÙÂÏÂÈfiÌËÓÔ˘ ÓÂÔÁÓÔ‡ Î·Ù’ Â›ÎÏËÛË (feeding on demand) ·fi ÙÔ ÛÙ‹ıÔ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È·fi ÌÂÁ¿ÏË Û˘¯ÓfiÙËÙ· (8 Ì¤¯ÚÈ ÂÚÈÛÛfiÙÂÚ· ·fi 12 ÁÂ‡Ì·Ù· ÙÔ 24ˆÚÔ) Î·È ·fi ÌË Î·ÓÔÓÈÎfiÙËÙ·. ¢Ë-Ï·‰‹, ·Ú·ÙËÚÔ‡ÓÙ·È ÌÈÎÚfiÙÂÚ· ‹ ÌÂÁ·Ï‡ÙÂÚ· ‰È·ÛÙ‹Ì·Ù· ÌÂÙ·Í‡ ıËÏ·ÛÌÒÓ ÌÂ Ù¿ÛË Û˘ÁÎ¤ÓÙÚˆÛ‹˜ÙÔ˘˜ ÙËÓ ËÌ¤Ú· ‹ ÙË Ó‡¯Ù·, ·Ó¿ÏÔÁ· ÌÂ ÙÔ Î¿ıÂ ÓÂÔÁÓfi. °È· Ù· ÈÔ ¿Óˆ, Ë ÌËÙ¤Ú· fi¯È ÌfiÓÔ ı· Ú¤ÂÈÓ· Â›Ó·È ÂÓËÌÂÚˆÌ¤ÓË, ·ÏÏ¿ ı· Ú¤ÂÈ Ó· Ù‡¯Ô˘Ó ÛÂ‚·ÛÌÔ‡ Î·È ÂÈÏ¤ÔÓ Ó· ÌËÓ ˘¿ÚÍÂÈ ÚÔÛ¿ıÂÈ· “ÙÈ-ı¿ÛÂ˘ÛË˜” ÙÔ˘ ÓÂÔÁÓÔ‡ ÛÂ Û˘ÁÎÂÎÚÈÌ¤ÓÔ ÚÔÎ·ıÔÚÈÛÌ¤ÓÔ ÌÔÓÙ¤ÏÔ. ∏ ‰È¿ÚÎÂÈ· ÙÔ˘ ıËÏ·ÛÌÔ‡ ·fi ÙÔÛÙ‹ıÔ˜, Â›ÛË˜ Î·ıÔÚ›˙ÂÙ·È ·fi ÙÔ ÓÂÔÁÓfi. ∆Ô ÓÂÔÁÓfi ı· Ú¤ÂÈ Ó· ÌÂ›ÓÂÈ ÛÙÔ ÛÙ‹ıÔ˜ Ì¤¯ÚÈ Ó· ÙÂÏÂÈÒ-ÛÂÈ. ŸÙ·Ó ÙÂÏÂÈÒÛÂÈ, ‹ ı· ·Ê‹ÛÂÈ ÙÔ ÛÙ‹ıÔ˜ ‹ ı· ÎÔÈÌËıÂ› Î·È ‰ÂÓ ı· ı¤ÏÂÈ Ó· ıËÏ¿ÛÂÈ ¿ÏÏÔ ÌÂÙ¿ ·fi‹È· ÚÔÛ¿ıÂÈ· ·Ê‡ÓÈÛ‹˜ ÙÔ˘. ∞Ó¿ÏÔÁ· ÌÂ ÙÔ ÔÛfi ÙÔ˘ Á¿Ï·ÎÙÔ˜ ÙÔ ÔÔ›Ô ÙÔ ÓÂÔÁÓfi ¤¯ÂÈ ÚÔÛÏ¿‚ÂÈ,ÙÔ ÌÂÛÔ‰È¿ÛÙËÌ· Ì¤¯ÚÈ ÙÔÓ ÂfiÌÂÓÔ ıËÏ·ÛÌfi ı· Â›Ó·È ÌÈÎÚfiÙÂÚÔ ‹ ÌÂÁ·Ï‡ÙÂÚÔ. ŒÓ· È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈ-Îfi ˙‹ÙËÌ· Â›Ó·È Ë ÙÂ¯ÓÈÎ‹ ÙÔ˘ ıËÏ·ÛÌÔ‡, fiˆ˜ Â›Ó·È ÙÔ Î·Ù¿ÏÏËÏÔ “Á¿ÓÙ˙ˆÌ·” ÙÔ˘ ÓÂÔÁÓÔ‡ ÛÙÔ ÛÙ‹ıÔ˜.ªÂ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ·ÔÊÂ‡ÁÔÓÙ·È ÔÏÏ¿ ÚÔ‚Ï‹Ì·Ù·, fiˆ˜ ÔÈ Ú·Á¿‰Â˜ ÙˆÓ ıËÏÒÓ, Ë ÂÒ‰˘ÓË ‰È¿Ù·-ÛË ÙˆÓ Ì·ÛÙÒÓ (ÙÔ “¤ÙÚˆÌ¿” ÙÔ˘˜), Ë ¯·ÌËÏ‹ ·Ú·ÁˆÁ‹ Á¿Ï·ÎÙÔ˜ Î·È Ë ÌË ÈÎ·ÓÔÔ›ËÛË ÙÔ˘ ÓÂÔÁÓÔ‡.∂ÔÌ¤Óˆ˜, Ë Ú·ÎÙÈÎ‹ ‰È‰·ÛÎ·Ï›· ÙÔ˘ ıËÏ·ÛÌÔ‡ ¤¯ÂÈ È‰È·›ÙÂÚË ÛËÌ·Û›·. ∆Ô ÓÂÔÁÓfi ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È ·Ú¿ÌfiÓÔÓ ÙÔ Á¿Ï· ÙË˜ ÌËÙ¤Ú·˜ ÙÔ˘. ∆›ÔÙÂ ¿ÏÏÔ. ∆· ÔÔÈ·‰‹ÔÙÂ ÚÔÊ‹Ì·Ù·, Û˘ÌÏËÚÒÌ·Ù· Î.Ï. ¤¯Ô˘Ó·ÚÓËÙÈÎ‹ Â›‰Ú·ÛË ÛÙËÓ ÂÈÙ˘¯›· ÙÔ˘ ıËÏ·ÛÌÔ‡. ∞ÓÙ› Ó· ·Ô˙ËÙÔ‡ÌÂ ˆÚ¿ÚÈ·, ÔÛfiÙËÙÂ˜ Î·È ‚¿ÚË, ÔÈ“Â·ÁÁÂÏÌ·Ù›Â˜ ÙË˜ ˘ÁÂ›·˜” Î·È ÔÈ ÌËÙ¤ÚÂ˜ ı· Ú¤ÂÈ Ó· Ì¿ıÔ˘Ó Ó· ‚·Û›˙ÔÓÙ·È ÛÂ Û˘ÌÂÚÈÊÔÚ¤˜ Î·È Ûˆ-Ì·ÙÈÎ¿ ÎÚÈÙ‹ÚÈ·, Ô˘ Â›ÙÂ ¯·Ú·ÎÙËÚ›˙Ô˘Ó ÙËÓ ÂÈÙ˘¯›· ÙÔ˘ ıËÏ·ÛÌÔ‡ ‹ ·ÔÙÂÏÔ‡Ó ÚÔÂÈ‰ÔÔÈËÙÈÎ¿ ÛË-ÌÂ›· ÚÔ‚ÏËÌ¿ÙˆÓ ÙÔ˘.

°È· Ù· ·ÓˆÙ¤Úˆ ˘¿Ú¯ÂÈ ÏÔ‡ÛÈ· ‚È‚ÏÈÔÁÚ·Ê›· ÛÂ È·ÙÚÈÎ¿ ÂÚÈÔ‰ÈÎ¿, È·ÙÚÈÎ¿ ‚È‚Ï›·, ·ÏÏ¿ Î·È ÛÙÈ˜Ô‰ËÁ›Â˜ ÙË˜ ¶·ÁÎfiÛÌÈ·˜ OÚÁ¿ÓˆÛË˜ ÀÁÂ›·˜.

À¿Ú¯Ô˘Ó Î·È ¿ÏÏ· ˙ËÙ‹Ì·Ù· Á‡Úˆ ·fi ÙÔ ıËÏ·ÛÌfi Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ·Ó·Ù˘¯ıÔ‡Ó, ·ÏÏ¿ Ë Úfi-ıÂÛ‹ ÌÔ˘ ‹Ù·Ó Ó· ÂÈÛËÌ¿Óˆ fiÙÈ ÂÓÒ ÔÈ ÊÔÈÙËÙ¤˜ ÙË˜ È·ÙÚÈÎ‹˜, ÔÈ ÂÈ‰ÈÎÂ˘fiÌÂÓÔÈ È·ÙÚÔ› ÛÙËÓ ¶·È‰È·ÙÚÈÎ‹Î·È, Ù¤ÏÔ˜, ÔÈ ¶·È‰›·ÙÚÔÈ Â›Ó·È, ÛÙÔ ıÂˆÚËÙÈÎfi Â›Â‰Ô, ÔÏ‡ Î·ÏÔ› ÁÓÒÛÙÂ˜ ÙˆÓ ÏÂÔÓÂÎÙËÌ¿ÙˆÓ ÙÔ˘ ıË-Ï·ÛÌÔ‡, ÙˆÓ ‰È·ÊÔÚÒÓ ÌÂÙ·Í‡ Á·Ï¿ÙˆÓ ÙË˜ ÚÒÙË˜ ‚ÚÂÊÈÎ‹˜ ËÏÈÎ›·˜ Î·È ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÙÔ˜ Î·È ¿Ï-Ï· Û˘Ó·Ê‹, Û˘¯Ó¿ ˘ÛÙÂÚÔ‡Ó ·ÂÏÈÛÙÈÎ¿ ÛÙËÓ Ú·ÎÙÈÎ‹ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ıËÏ·ÛÌÔ‡. O ÏfiÁÔ˜; ∞ÏÔ‡ÛÙ·-Ù·, Ë fiÏË ÂÎ·›‰Â˘ÛË ÛÙËÓ ¶·È‰È·ÙÚÈÎ‹ ¤¯ÂÈ ÓÔÛÔÎÔÌÂÈ·Îfi ¯·Ú·ÎÙ‹Ú·, ÍÂ¯ÓÒÓÙ·˜ fiÙÈ Ë ¶·È‰È·ÙÚÈÎ‹ ‹ Î·-Ï‡ÙÂÚ· Ë ÀÁÂ›· ÙÔ˘ ¶·È‰ÈÔ‡ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÏËıÒÚ· ˙ËÙËÌ¿ÙˆÓ/ÚÔ‚ÏËÌ¿ÙˆÓ ÛÙÔ ÂÍˆÓÔÛÔÎÔÌÂÈ-·Îfi Â›Â‰Ô.

∏. ¢. ¢ÂÏÏ·ÁÚ·ÌÌ¿ÙÈÎ·˜∞Ó·ÏËÚˆÙ‹˜ ∫·ıËÁËÙ‹˜ ¶·È‰È·ÙÚÈÎ‹˜-¡ÂÔÁÓÔÏÔÁ›·˜


¶·È‰È·ÙÚÈÎ‹ 2002;65:308 Paediatriki 2002;65:308

308

C. P. Panayiotopoulos: “Panayiotopoulos syndrome. A common and benign childhood epileptic syndrome” J. Libbey, London 2002, ÛÂÏ›‰Â˜ 174. ISBN: 0 86196 619 8

µÈ‚ÏÈÔ·ÚÔ˘Û›·ÛË

∂›Ó·È ÙÈÌ‹ ÁÈ· Ì¤Ó· Ë ·ÚÔ˘Û›·ÛË ÙÔ˘ ÙÂÏÂ˘Ù·›Ô˘ ‚È‚Ï›Ô˘ ÙÔ˘ Û˘Ó·‰¤ÏÊÔ˘ ∆fiÌË ¶·Ó·ÁÈˆÙfiÔ˘ÏÔ˘Ô˘ ÂÎ‰fiıËÎÂ ÙÔÓ ∞Ú›ÏÈÔ 2002. O Û˘ÁÁÚ·Ê¤·˜, ˘ÊËÁËÙ‹˜ ÛÂ ·Ï·ÈfiÙÂÚÂ˜ ÂÔ¯¤˜ ÙË˜ ¡Â˘ÚÔÏÔÁÈÎ‹˜∫ÏÈÓÈÎ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ˘‹ÚÍÂ ‰¿ÛÎ·ÏÔ˜ ÁÈ· ÔÏÏÔ‡˜ ŒÏÏËÓÂ˜ È·ÙÚÔ‡˜. °È· Û‡ÓÙÔÌÔ ‰È¿-ÛÙËÌ· ‰ÈÂÙ¤ÏÂÛÂ Î·È ¢ÈÂ˘ı˘ÓÙ‹˜ ÙË˜ ¡Â˘ÚÔÏÔÁÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·”. ∆·ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Â›Ó·È ¢ÈÂ˘ı˘ÓÙ‹˜ ÙÔ˘ ∆Ì‹Ì·ÙÔ˜ ∫ÏÈÓÈÎ‹˜ ¡Â˘ÚÔÊ˘ÛÈÔÏÔÁ›·˜ Î·È ∂ÈÏË„›·˜ ÙÔ˘ St.Thomas’ Hospital ÛÙÔ §ÔÓ‰›ÓÔ Î·È ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛÙÂ› ‰ÈÂıÓÒ˜ Û·Ó ¤Ó·˜ ·fi ÙÔ˘˜ Ï¤ÔÓ ‰È·ÎÂÎÚÈÌ¤ÓÔ˘˜ÂÈÏËÙÔÏfiÁÔ˘˜.

∆Ô ÂÈÏËÙÈÎfi Û‡Ó‰ÚÔÌÔ, ÛÙÔ ÔÔ›Ô ·Ó·Ê¤ÚÂÙ·È ÙÔ ‚È‚Ï›Ô, ·Ó·ÁÓˆÚ›ÛÙËÎÂ ÚfiÛÊ·Ù· ·fi ÙËÓInternational League Against Epilepsy (ILAE) Û·Ó ·˘ÙfiÓÔÌÔ Û‡Ó‰ÚÔÌÔ ÌÂ ÙÔ fiÓÔÌ· Û‡Ó‰ÚÔÌÔ ¶·Ó·ÁÈˆ-ÙfiÔ˘ÏÔ˘ (Panayiotopoulos syndrome). ÃˆÚ›˜ ·ÌÊÈ‚ÔÏ›·, Î·ÏÔ› ÎÏÈÓÈÎÔ› ‹ ÂÚÂ˘ÓËÙ¤˜ È·ÙÚÔ› ˘¿Ú¯Ô˘Ó·ÚÎÂÙÔ›. ∏ ÈÎ·ÓfiÙËÙ·, fiÌˆ˜, Î·ıÔÚÈÛÌÔ‡ Ó¤Ô˘ Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È ÔÏ‡ ‰‡ÛÎÔÏË ˘fiıÂÛË. ∏ ‰ÈÂıÓ‹˜ ·Ó·-ÁÓÒÚÈÛË ÙÔ˘ ÂÈÏËÙÈÎÔ‡ ·˘ÙÔ‡ Û˘Ó‰ÚfiÌÔ˘ ÌÂ ÙÔ fiÓÔÌ· “¶·Ó·ÁÈˆÙfiÔ˘ÏÔ˜”, ·ÛÊ·ÏÒ˜ ·ÔÙÂÏÂ› ÛÔ‚·-Úfi Â›ÙÂ˘ÁÌ· Î·È ÌÂÁ¿ÏË ÙÈÌ‹ ÁÈ· ÙÔÓ ›‰ÈÔ, ·ÏÏ¿ Î·È ÁÈ· ÙËÓ ∂ÏÏ¿‰·.

∆Ô Û‡Ó‰ÚÔÌÔ ¶·Ó·ÁÈˆÙfiÔ˘ÏÔ˘ ÂÓ‰È·Ê¤ÚÂÈ È‰È·›ÙÂÚ· ÙÔÓ ¶·È‰›·ÙÚÔ. ª·˙› ÌÂ ÙËÓ Î·ÏÔ‹ıË ÂÛÙÈ·Î‹ÂÈÏË„›· ÌÂ ÎÂÓÙÚÔÎÚÔÙ·ÊÈÎ¤˜ ·È¯Ì¤˜ (benign epilepsy with centrotemporal spikes - BECTS) ·ÔÙÂÏÔ‡ÓÙÈ˜ Û˘¯ÓfiÙÂÚÂ˜ ÌÔÚÊ¤˜ ÂÈÏË„›·˜ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·. ∆Ô Û‡Ó‰ÚÔÌÔ ¶·Ó·ÁÈˆÙfiÔ˘ÏÔ˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È·fi ÎÚ›ÛÂÈ˜ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È Û˘Ó‹ıˆ˜ ÚÈÓ ·fi Ù· 6 ¯ÚfiÓÈ· Î·È ·ÊÔÚÔ‡Ó ÂÍ›ÛÔ˘ ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ·.OÈ ÎÚ›ÛÂÈ˜ ÙÔ˘˜ Â›Ó·È Û¿ÓÈÂ˜ Î·È Û˘Ì‚·›ÓÔ˘Ó Î˘Ú›ˆ˜ ÙË Ó‡¯Ù·. ™ÙËÓ Ù˘ÈÎ‹ ÙÔ˘˜ ÌÔÚÊ‹, ÔÈ ÎÚ›ÛÂÈ˜ ¯·-Ú·ÎÙËÚ›˙ÔÓÙ·È ·Ú¯ÈÎ¿ ·fi ÂÎ‰ËÏÒÛÂÈ˜ ·fi ÙÔ ·˘ÙfiÓÔÌÔ Û‡ÛÙËÌ·, ÂÓÒ Ô ·ÛıÂÓ‹˜ ‰È·ÙËÚÂ› ÙÈ˜ ·ÈÛı‹ÛÂÈ˜ÙÔ˘ Î·È Â›Ó·È ÛÂ ı¤ÛË Ó· ÔÌÈÏ‹ÛÂÈ. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ˆ¯ÚfiÙËÙ· ‹ ÂÚ˘ıÚfiÙËÙ·, Ì˘‰Ú›·ÛË ‹ Ì‡ÛË, ˘ÂÚ¤Î-ÎÚÈÛË ÛÈ¤ÏÔ˘, ÂÌÂÙfi˜, ‚‹¯·˜, ·ÒÏÂÈ· ÂÏ¤Á¯Ô˘ ÙˆÓ ÛÊÈÎÙ‹ÚˆÓ. O ÂÌÂÙfi˜ Â›Ó·È Û˘Ó‹ıË˜, Î·ıÒ˜ ·ÊÔÚ¿ÙÔ 70% ÙˆÓ ·ÛıÂÓÒÓ. ∞ÎÔÏÔ˘ıÂ› ·ÒÏÂÈ· ·ÈÛı‹ÛÂˆÓ, ÛÙÚÔÊ‹ ÙÔ˘ ‚Ï¤ÌÌ·ÙÔ˜ ÚÔ˜ Ù· Ï¿ÁÈ· Î·È ÂÌÊ·-Ó›˙ÔÓÙ·È Û·ÛÌÔ› ÂÛÙÈ·ÎÔ› ‹ Î·È ÁÂÓÈÎÂ˘Ì¤ÓÔÈ. ™Â ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ·ÛıÂÓÒÓ ÔÈ ÎÚ›ÛÂÈ˜ ‰È·ÚÎÔ‡Ó Â-ÚÈÛÛfiÙÂÚÔ ·fi 30 ÏÂÙ¿ (ÂÛÙÈ·Î‹ ÂÈÏËÙÈÎ‹ Î·Ù¿ÛÙ·ÛË). ™Â Î¿ÔÈÂ˜ ÂÚÈÙÒÛÂÈ˜ ÔÈ ÂÎ‰ËÏÒÛÂÈ˜ ·fi ÙÔ·˘ÙfiÓÔÌÔ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔÎ·Ï¤ÛÔ˘Ó Û‡Á¯˘ÛË ÛÙÔÓ È·ÙÚfi Î·È Ó· ıÂˆÚËıÔ‡Ó Û·Ó ÂÎ‰ËÏÒÛÂÈ˜ ÂÁÎÂ-Ê·Ï›ÙÈ‰·˜ ‹ ËÌÈÎÚ·Ó›·˜. ∆Ô ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ÂÌÊ·Ó›˙ÂÈ ¯·Ú·ÎÙËÚÈÛÙÈÎ¤˜ ÂÎÊÔÚÙ›ÛÂÈ˜ ·È¯ÌË-ÚÒÓ Î˘Ì¿ÙˆÓ Ô˘ Û˘Ó‹ıˆ˜ ÂÈÎÚ·ÙÔ‡Ó ÈÓÈ·Î¿. ∏ ÚfiÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È ¿ÚÈÛÙË, Î·ıÒ˜ Ù· ÂÂÈ-Ûfi‰È· ÛÙ·Ì·ÙÔ‡Ó Ì¤Û· ÛÂ ¤Ó· ÌÂ ‰‡Ô ¯ÚfiÓÈ·. O Î›Ó‰˘ÓÔ˜ ·Ó¿Ù˘ÍË˜ ÂÈÏË„›·˜ ÛÙÔ Ì¤ÏÏÔÓ Â›Ó·È ·Úfi-ÌÔÈÔ˜ ÌÂ ÙÔÓ ÎÔÈÓfi ÏËı˘ÛÌfi.

™ÙÔ ‚È‚Ï›Ô ·Ó·Ï‡ÔÓÙ·È ÌÂ ÏÂÙÔÌ¤ÚÂÈ· Ù· ÎÏÈÓÈÎ¿ Î·È ÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙÔ˘ Û˘Ó‰Úfi-ÌÔ˘ Î·È ÂÚÈÁÚ¿ÊÔÓÙ·È 60 ÂÚÈÙÒÛÂÈ˜ ·ÛıÂÓÒÓ. ¶ÈÛÙÂ‡ˆ fiÙÈ ÙÔ ‚È‚Ï›Ô ·ÔÙÂÏÂ› ÔÏ‡ÙÈÌÔ ‚Ô‹ıËÌ·, fi¯ÈÌfiÓÔ ÁÈ· ÙÔ˘˜ ÓÂ˘ÚÔÏfiÁÔ˘˜ Î·È ·È‰ÔÓÂ˘ÚÔÏfiÁÔ˘˜, ·ÏÏ¿ Î·È ÁÈ· ÙÔÓ ÁÂÓÈÎfi ·È‰›·ÙÚÔ.

™ˆÙ‹ÚË˜ °. °ÈÔ˘ÚÔ‡ÎÔ˜ ¶·È‰ÔÓÂ˘ÚÔÏfiÁÔ˜ ÀÊËÁËÙ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ


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24-28 ∞˘ÁÔ‡ÛÙÔ˘ 2002 29th World Congress of the Seoul, Korea (South)International Society of Hematology ¶ÏËÚÔÊÔÚ›Â˜: Hwa-Jung LeeTel.: 82-2-3476-7700Fax: 82-2-3476-8800E-mail: [email protected]

4-7 ™ÂÙÂÌ‚Ú›Ô˘ 2002 Annual Congress of the European Utrecht, Netherlands Society for Pediatric Research (ESPR) Tel.: 31-343-443888Fax: 31-343-442043E-mail: [email protected]

14-15 ™ÂÙÂÌ‚Ú›Ô˘ 2002 2Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ∞ı‹Ó· ÀÔÂÈ‰ÈÎÔÙ‹ÙˆÓ ÙË˜ ¶·È‰È·ÙÚÈÎ‹˜ ¶ÏËÚÔÊÔÚ›Â˜: C&C International A.E. Conventions & Congresses∆ËÏ.: 010 - 68 89 100 Fax: 010 - 68 44 777 E-mail: [email protected]

18-21 ™ÂÙÂÌ‚Ú›Ô˘ 2002 International Society of Porto, Portugal Pediatric Oncology (SIOP) “Brain tumours and new modalities of therapy”Congress Secretariat: Tel.: +31 (0) 20 5040 208 Fax: +31 (0) 20 5040 225 E-mail: [email protected]

19-21 ™ÂÙÂÌ‚Ú›Ô˘ 2002 27 UMEMPS Congress Alicante, Spain Congress Secretariat: Viajes Pacifico, S.L. c/ Maria Cubi, 4 entlo Tel.: +34 93 238 8777 Fax: +34 93 238 7488 E-mail: [email protected]

20-25 ™ÂÙÂÌ‚Ú›Ô˘ 2002 9th International Child Neurology Beijing, ChinaCongress and the 7th Asian and Oceanian Congress of Child Neurology ¶ÏËÚÔÊÔÚ›Â˜: Dr. Yu-Wu Jiang, Xin-Hua Bao E-mail: [email protected] Website: http://www.ciccst.org.cn/icnc2002

¶PO™EXH ™YNE¢PIA


27-29 ™ÂÙÂÌ‚Ú›Ô˘ 2002 6Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ÌÂ ¢ÈÂıÓ‹ £ÂÛÛ·ÏÔÓ›ÎË ™˘ÌÌÂÙÔ¯‹ ÙË˜ ∂ÏÏËÓÈÎ‹˜ ∂Ù·ÈÚÂ›·˜ ÁÈ· ÙË ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ Ï¿Î·˜

28 ™ÂÙÂÌ‚Ú›Ô˘ 2002 ∏ÌÂÚ›‰· Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎÒÓ Û˘Ó‰ÚfiÌˆÓ ¡·‡ÏÈÔ ∂ÏÏËÓÈÎ‹˜ ∞ÈÌ·ÙÔÏÔÁÈÎ‹˜ ∂Ù·ÈÚÂ›·˜ ¶ÏËÚÔÊÔÚ›Â˜: ∂æπ§O¡ ∆ËÏ.: 010 - 72 54 360-2Fax: 010 - 72 54 363E-mail: [email protected]

10-12 OÎÙˆ‚Ú›Ô˘ 2002 2Ô ¶·ÓËÂÈÚˆÙÈÎfi π·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ πˆ¿ÓÓÈÓ·•ÂÓÔ‰Ô¯Â›Ô “Du Lac”

12-13 OÎÙˆ‚Ú›Ô˘ 2002 ∂ÊË‚ÈÎ‹ π·ÙÚÈÎ‹ 2002 ∞ı‹Ó· ¶ÏËÚÔÊÔÚ›Â˜: ∫¤ÓÙÚÔ ¢ËÌÔÛ›ˆÓ ™¯¤ÛÂˆÓ, ∂Ï¤ÓË Ã·Ï˘‚›‰Ô˘ ∆ËÏ.: 010 - 77 11 673 & 77 56 336Fax: 010 - 77 11 289

19 OÎÙˆ‚Ú›Ô˘ 2002 16Ô ™ÂÌÈÓ¿ÚÈÔ ∂Â›ÁÔ˘Û·˜ Î·È ∞ı‹Ó· ∂ÓÙ·ÙÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ “∞Ù˘¯‹Ì·Ù·-∫·ÎÒÛÂÈ˜ Î·È ∂ÓÙ·ÙÈÎ‹ £ÂÚ·Â›·”¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”¶ÏËÚÔÊÔÚ›Â˜: °ÂˆÚÁ›· ™È‰¤ÚË ∆ËÏ.: 010 - 77 98 033

19-23 OÎÙˆ‚Ú›Ô˘ 2002 American Academy of Pediatrics Boston, MA2002 Annual Meeting ¶ÏËÚÔÊÔÚ›Â˜: Congress SecretariatTel.: 847-228-5005Fax: 847-228-5059

22-27 OÎÙˆ‚Ú›Ô˘ 2002 49th Annual Meeting of the American San Francisco, CAAcademy of Child and Adolescent Psychiatry Tel.: 202-966-7300Fax: 202-966-2891E-mail: [email protected]

28-29 OÎÙˆ‚Ú›Ô˘ 2002 3rd European Conference on London, England Pediatric Asthma ¶ÏËÚÔÊÔÚ›Â˜: Conference Secretariat Castle House Medical Conferences Tel.: 44-0-1892-539-606Fax: 44-0-1892-517-773E-mail: [email protected]

xii

¶PO™EXH ™YNE¢PIA


xv

™˘ÓÙÔÌÔÁÚ·Ê›Â˜AIDS

AMP, ADP, ATP

ATPasecalCSF ‹ ENYCNS ‹ ∫¡™cmCoAcmÑcm2

cAMPÆCCRPDNAECG ‹ ∏∫°EEG ‹ ∏∂°ELISA

ESR ‹ ∆∫∂EDTAgHctHbHLA

IgICU ‹ ª∂£IUi.m. ‹ ∂.ª.i.p. ‹ ∂.¶.i.v. ‹ ∂.º.LlogmolªW ‹ MBMCHMCVmRNAmminnNNS ‹ ª™Ôsm%PCRpHPCO2PO2p

EÏÏËÓÈÎÔ› fiÚÔÈÛ‡Ó‰ÚÔÌÔ Â›ÎÙËÙË˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜

ÌÔÓÔ-, ‰È-, ÙÚÈÊˆÛÊÔÚÈÎ‹ ·‰ÂÓÔÛ›ÓË

ÙÚÈÊˆÛÊ·Ù¿ÛË ÙË˜ ·‰ÂÓÔÛ›ÓË˜ıÂÚÌ›‰·ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfiÎÂÓÙÚÈÎfi ÓÂ˘ÚÈÎfi Û‡ÛÙËÌ·ÂÎ·ÙÔÛÙfiÛ˘Ó¤Ó˙˘ÌÔ ∞Î˘‚ÈÎfi ÂÎ·ÙÔÛÙfi ÙÂÙÚ·ÁˆÓÈÎfi ÂÎ·ÙÔÛÙfiÎ˘ÎÏÈÎfi AMP‚·ıÌfi˜ KÂÏÛ›Ô˘C-·ÓÙÈ‰ÚÒÛ· ÚˆÙÂ˝ÓË‰ÂÔÍ˘ÚÈ‚Ô˙ÔÓÔ˘ÎÏÂ˚ÓÈÎfi ÔÍ‡ËÏÂÎÙÚÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ·ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ·¤Ó˙˘ÌÔ-Û˘Ó‰¤ÙË˜ ·ÓÔÛÔÚÔÛÚfiÊËÛË˜ÚÔÛ‰ÈÔÚÈÛÌfi˜Ù·¯‡ÙËÙ· Î·ıÈ˙‹ÛÂˆ˜ ÂÚ˘ıÚÒÓÂı˘ÏÂÓÔ‰È·ÌÈÓÔÙÂÙÚ·ÔÍÂ˚Îfi ÔÍ‡ÁÚ·ÌÌ¿ÚÈo·ÈÌ·ÙÔÎÚ›ÙË˜·ÈÌÔÛÊ·ÈÚ›ÓË·ÓÙÈÁfiÓÔ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜

·ÓÔÛÔÛÊ·ÈÚ›ÓËÌÔÓ¿‰· ÂÓÙ·ÙÈÎ‹˜ ıÂÚ·Â›·˜‰ÈÂıÓ‹˜ ÌÔÓ¿‰·ÂÓ‰ÔÌ˘˚Î¿ÂÓ‰ÔÂÚÈÙÔÓ·˚Î¿ÂÓ‰ÔÊÏ¤‚È·Ï›ÙÚÔ(·)ÏÔÁ¿ÚÈıÌÔ˜ÁÚ·ÌÌÔÌfiÚÈÔÌÔÚÈ·Îfi ‚¿ÚÔ˜Ì¤ÛË ·ÈÌÔÛÊ·ÈÚ›ÓË ÂÚ˘ıÚÒÓÌ¤ÛÔ˜ fiÁÎÔ˜ ÂÚ˘ıÚÒÓ ·ÁÁÂÏÈÔÊfiÚÔ˜ RNAÌ¤ÙÚÔÏÂÙfi·ÚÈıÌfi˜ ÓÂ˘ÙÒÓÈÔÌË ÛËÌ·ÓÙÈÎfiÔÛÌÒÏÈÔÂ› ÙÔÈ˜ ÂÎ·Ùfi·Ï˘ÛÈ‰ˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿ÛË˜Û˘ÁÎ¤ÓÙÚˆÛË ÈfiÓÙˆÓ ˘‰ÚÔÁfiÓÔ˘ÌÂÚÈÎ‹ Ù¿ÛË CO2ÌÂÚÈÎ‹ Ù¿ÛË ÔÍ˘ÁfiÓÔ˘Èı·ÓfiÙËÙ·

AÁÁÏÈÎÔ› fiÚÔÈacquired immunodeficiencysyndromeadenosine 5mono-, di-,triphosphateadenosine triphosphatasecaloriecerebrospinal fluidcentral nervous systemcentimetercoenzyme Acubic centimetersquare centimetercyclic AMPdegree(s) CelsiusC-reactive proteindeoxyribonucleic acidelectrocardiogramelectroencephalogramenzyme-linked immunoabsorbentassayerythrocyte sedimentation rateethylenediaminetetracetategramhaematocrithaemoglobin(human) histocompatibilityleucocyte antigenimmunoglobulinintensive care unitinternational Unitintramuscularintraperitonealintravenousliterlogarithmmolemolecular weightmean corpuscular haemoglobinmean corpuscular volumemessenger RNAmeterminutenumber newtonnot significantosmolepercent polymerase chain reactionpotentia hydrogeniicarbon dioxide pressureoxygen pressureprobability

™YNTOMO°PAºIE™ ABBREVIATIONS


xvi

EÏÏËÓÈÎÔ› fiÚÔÈ™˘ÓÙÔÌÔÁÚ·Ê›Â˜

p.o.RIARNARDSsecs.c. ‹ À.¢.SDSEU

™˘Ó‰˘·˙fiÌÂÓ· ÚÔı¤Ì·Ù·

tera- (1012)giga- (109)mega-(106)kilo- (103)hecto(102)deca (101)deci (10-1)centi- (10-2)milli(10-3)micro (10-6)nano (10-9)pico (10-12) femto (10-15)atto (10-18)

·fi ÙÔ ÛÙfiÌ·Ú·‰ÈÔ·ÓÔÛÔ·ÔÚÚÔÊËÙÈÎ‹ ‰ÔÎÈÌ·Û›·ÚÈ‚ÔÓÔ˘ÎÏÂ˚ÓÈÎfi ÔÍ‡Û‡Ó‰ÚÔÌÔ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‰˘Û¯¤ÚÈ·˜‰Â˘ÙÂÚfiÏÂÙÔ˘Ô‰fiÚÈ·ÛÙ·ıÂÚ‹ ·fiÎÏÈÛËÛÙ·ıÂÚfi ÛÊ¿ÏÌ·ÌÔÓ¿‰·

Combining prefixes

TGMkhdadcmÌnpfa

by mouthradioimmunoassayribonucleic acidrespiratory distress syndromesecondsubcutaneousstandard deviationstandard errorunit

AÁÁÏÈÎÔ› fiÚÔÈ


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